%0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e66751 %T COVID-19 Perceptions Among Communities Living on Ground Crossings of Somali Region of Ethiopia: Community Cross-Sectional Survey Study %A Farah,Alinoor Mohamed %A Abdulahi,Abdifatah %A Hussein,Abdulahi %A Hussein,Ahmed Abdikadir %A Osman,Abdi %A Mohamud,Mohamed %A Mowlid,Hasan %A Hailu,Girum %A Alwan,Fathia %A Bizuneh,Ermiyas Abebe %A Ibrahim,Ahmed Mohammed %A Abdulahi,Elyas %K COVID-19 %K perceptions %K border-crossings %K SARS-CoV-2 %K coronavirus %K respiratory %K infectious %K pandemic %K Somali %K Ethiopia %K Africa %K community-based %K World Health Organization %K WHO %K cross-sectional study %K multistage sampling technique %K transmission %K cross-border %K community engagement %D 2025 %7 24.4.2025 %9 %J JMIR Form Res %G English %X Background: The COVID-19 pandemic has profoundly affected the movement of people across borders in Eastern and Southern Africa. The implementation of border closures and restrictive measures has disrupted the region’s economic and social dynamics. In areas where national authorities lack full control over official and unofficial land crossings, enforcing public health protocols to mitigate health risks may prove challenging. Objective: This study aimed to assess perceived factors that influence the spread and control of COVID-19 among Somali communities living on and near ground crossings in Tog Wajaale, Somali region, Ethiopia. Methods: A community-based cross-sectional study was conducted using a multistage sampling technique. Beliefs and perceptions of the virus’s spread and control were partially adapted from the World Health Organization (WHO) resources, exploring four main perception themes: (1) perceived facilitators for the spread of the virus, (2) perceived inhibitors, (3) risk labeling, and (4) sociodemographic variables. A sample size of 634 was determined using the single proportion formula. Standardized mean scores (0‐100) and SDs categorized perception themes, with mean differences by sociodemographic variables analyzed using ANOVA and t tests. Statistical significance was established with a 95% CI and a P value below .05. The data were analyzed using STATA version 14.1. Results: Factors influencing COVID-19 spread and control include behavioral nonadherence and enabling environments. A total of 81.9% (439/536) did not comply with social distancing, and 92.2% (493/536) faced constraints preventing them from staying home and enabling environments. Misconceptions were prevalent, including beliefs about hot weather (358/536, 66.8%), traditional medicine (36/536, 6.7%), and religiosity (425/536, 79.3%). False assurances also contributed, such as feeling safe due to geographic distance from hot spots (76/536, 14.2%) and perceiving the virus as low-risk or exaggerated (162/536, 30.2%). Only 25.2% (135/536) followed standard precautions and 29.9% (160/536) were vaccinated. Employment, region, income, sex, education, and information sources significantly influenced behavioral nonadherence, myth prevalence, and false assurances. Conclusions: The findings highlight the need for substantial risk communication and community engagement. Only 46.6% (250/536) of individuals adhered to precautionary measures, there was a high perception of nonadherence, and essential COVID-19 resources were lacking. Additionally, numerous misconceptions and false reassurances were noted. Understanding cross-border community behavior is crucial for developing effective, contextually appropriate strategies to mitigate COVID-19 risk in these regions. %R 10.2196/66751 %U https://formative.jmir.org/2025/1/e66751 %U https://doi.org/10.2196/66751 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e58567 %T Patient-Related Metadata Reported in Sequencing Studies of SARS-CoV-2: Protocol for a Scoping Review and Bibliometric Analysis %A O'Connor,Karen %A Weissenbacher,Davy %A Elyaderani,Amir %A Lautenbach,Ebbing %A Scotch,Matthew %A Gonzalez-Hernandez,Graciela %+ Department of Computational Biomedicine, Cedars-Sinai Medical Center, 700 N. San Vicente Blvd, Pacific Design Center Suite G549F, Los Angeles, CA, 90069, United States, 1 310 423 3521, graciela.gonzalezhernandez@cshs.org %K SARS-CoV-2 %K COVID-19 %K genomic epidemiology %K GISAID %K GenBank %K sequence records %K patient-related metadata %K scoping review %K protocol %D 2025 %7 22.4.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: There has been an unprecedented effort to sequence the SARS-CoV-2 virus and examine its molecular evolution. This has been facilitated by the availability of publicly accessible databases, such as the GISAID (Global Initiative on Sharing All Influenza Data) and GenBank, which collectively hold millions of SARS-CoV-2 sequence records. Genomic epidemiology, however, seeks to go beyond phylogenetic (the study of evolutionary relationships among biological entities) analysis by linking genetic information to patient characteristics and disease outcomes, enabling a comprehensive understanding of transmission dynamics and disease impact. While these repositories include fields reflecting patient-related metadata for a given sequence, the inclusion of these demographic and clinical details is scarce. The current understanding of patient-related metadata in published sequencing studies and its quality remains unexplored. Objective: Our review aims to quantitatively assess the extent and quality of patient-reported metadata in papers reporting original whole genome sequencing of the SARS-CoV-2 virus and analyze publication patterns using bibliometric analysis. Finally, we will evaluate the efficacy and reliability of a machine learning classifier in accurately identifying relevant papers for inclusion in the scoping review. Methods: The National Institutes of Health’s LitCovid collection will be used for the automated classification of papers reporting having deposited SARS-CoV-2 sequences in public repositories, while an independent search will be conducted in MEDLINE and PubMed Central for validation. Data extraction will be conducted using Covidence (Veritas Health Innovation Ltd). The extracted data will be synthesized and summarized to quantify the availability of patient metadata in the published literature of SARS-CoV-2 sequencing studies. For the bibliometric analysis, relevant data points, such as author affiliations, citation metrics, author keywords, and Medical Subject Headings terms will be extracted. Results: This study is expected to be completed in early 2025. Our classification model has been developed and we have classified publications in LitCovid published through February 2023. As of September 2024, papers through August 2024 are being prepared for processing. Screening is underway for validated papers from the classifier. Direct literature searches and screening of the results began in October 2024. We will summarize and narratively describe our findings using tables, graphs, and charts where applicable. Conclusions: This scoping review will report findings on the extent and types of patient-related metadata reported in genomic viral sequencing studies of SARS-CoV-2, identify gaps in the reporting of patient metadata, and make recommendations for improving the quality and consistency of reporting in this area. The bibliometric analysis will uncover trends and patterns in the reporting of patient-related metadata, including differences in reporting based on study types or geographic regions. The insights gained from this study may help improve the quality and consistency of reporting patient metadata, enhancing the utility of sequence metadata and facilitating future research on infectious diseases. Trial Registration: OSF Registries osf.io/wrh95; https://doi.org/10.17605/OSF.IO/WRH95 International Registered Report Identifier (IRRID): DERR1-10.2196/58567 %M 40262134 %R 10.2196/58567 %U https://www.researchprotocols.org/2025/1/e58567 %U https://doi.org/10.2196/58567 %U http://www.ncbi.nlm.nih.gov/pubmed/40262134 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 11 %N %P e56877 %T Assessing COVID-19 Mortality in Serbia’s Capital: Model-Based Analysis of Excess Deaths %A Cvijanovic,Dane %A Grubor,Nikola %A Rajovic,Nina %A Vucevic,Mira %A Miltenovic,Svetlana %A Laban,Marija %A Mostic,Tatjana %A Tasic,Radica %A Matejic,Bojana %A Milic,Natasa %K COVID-19 %K COVID-19 impact %K SARS-Cov-2 %K coronavirus %K respiratory %K infectious disease %K pulmonary %K pandemic %K excess mortality %K death rate %K death toll %K centralized health care %K urban %K Serbia %K dense population %K public health %K surveillance %D 2025 %7 17.4.2025 %9 %J JMIR Public Health Surveill %G English %X Background: Concerns have been raised about discrepancies in COVID-19 mortality data, particularly between preliminary and final datasets of vital statistics in Serbia. In the original preliminary dataset, released daily during the ongoing pandemic, there was an underestimation of deaths in contrast to those reported in the subsequently released yearly dataset of vital statistics. Objective: This study aimed to assess the accuracy of the final mortality dataset and justify its use in further analyses. In addition, we quantified the relative impact of COVID-19 on the death rate in the Serbian capital’s population. In the process, we aimed to explore whether any evidence of cause-of-death misattribution existed in the final published datasets. Methods: Data were sourced from the electronic databases of the Statistical Office of the Republic of Serbia. The dataset included yearly recorded deaths and the causes of death of all citizens currently living in the territory of Belgrade, the capital of the Republic of Serbia, from 2015 to 2021. Standardization and modeling techniques were utilized to quantify the direct impact of COVID-19 and to estimate excess deaths. To account for year-to-year trends, we used a mixed-effects hierarchical Poisson generalized linear regression model to predict mortality for 2020 and 2021. The model was fitted to the mortality data observed from 2015 to 2019 and used to generate mortality predictions for 2020 and 2021. Actual death rates were then compared to the obtained predictions and used to generate excess mortality estimates. Results: The total number of excess deaths, calculated from model estimates, was 3175 deaths (99% CI 1715-4094) for 2020 and 8321 deaths (99% CI 6975-9197) for 2021. The ratio of estimated excess deaths to reported COVID-19 deaths was 1.07. The estimated increase in mortality during 2020 and 2021 was 12.93% (99% CI 15.74%-17.33%) and 39.32% (99% CI 35.91%-39.32%) from the expected values, respectively. Those aged 0‐19 years experienced an average decrease in mortality of 22.43% and 23.71% during 2020 and 2021, respectively. For those aged up to 39 years, there was a slight increase in mortality (4.72%) during 2020. However, in 2021, even those aged 20‐39 years had an estimated increase in mortality of 32.95%. For people aged 60‐79 years, there was an estimated increase in mortality of 16.95% and 38.50% in 2020 and 2021, respectively. For those aged >80 years, the increase was estimated at 11.50% and 34.14% in 2020 and 2021, respectively. The model-predicted deaths matched the non-COVID-19 deaths recorded in the territory of Belgrade. This concordance between the predicted and recorded non-COVID-19 deaths provides evidence that the cause-of-death misattribution did not occur in the territory of Belgrade. Conclusions: The finalized mortality dataset for Belgrade can be safely used in COVID-19 impact analysis. Belgrade experienced a significant increase in mortality during 2020 and 2021, with most of the excess mortality attributable to SARS-CoV-2. Concerns about increased mortality from causes other than COVID-19 in Belgrade seem misplaced as their impact appears negligible. %R 10.2196/56877 %U https://publichealth.jmir.org/2025/1/e56877 %U https://doi.org/10.2196/56877 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e53339 %T Application of an Innovative Methodology to Build Infrastructure for Digital Transformation of Health Systems: Developmental Program Evaluation %A Buchan,M Claire %A Katapally,Tarun Reddy %A Bhawra,Jasmin %+ CHANGE Research Lab, School of Occupational and Public Health, Toronto Metropolitan University, 350 Victoria Street, Toronto, ON, M5B2K3, Canada, 1 416 979 5000 ext 553466, jasmin.bhawra@torontomu.ca %K digital health platform %K citizen science %K evaluation %K health systems %K digital health %K app %K innovative %K digital transformation %K public health %K crises %K communicable disease %K coronavirus %K chronic diseases %K decision-making %K assessment %K thematic analysis %K self-report survey %K risk %K artificial intelligence %K AI %D 2025 %7 17.4.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: The current public health crises we face, including communicable disease pandemics such as COVID-19, require cohesive societal efforts to address decision-making gaps in our health systems. Digital health platforms that leverage big data ethically from citizens can transform health systems by enabling real-time data collection, communication, and rapid responses. However, the lack of standardized and evidence-based methods to develop and implement digital health platforms currently limits their application. Objective: This study aims to apply mixed evaluation methods to assess the development of a rapid response COVID-19 digital health platform before public launch by engaging with the development and research team, which consists of interdisciplinary researchers (ie, key stakeholders). Methods: Using a developmental evaluation approach, this study conducted (1) a qualitative survey assessing digital health platform objectives, modifications, and challenges administered to 5 key members of the software development team and (2) a role-play pilot with 7 key stakeholders who simulated 8 real-world users, followed by a self-report survey, to evaluate the utility of the digital health platform for each of its objectives. Survey data were analyzed using an inductive thematic analysis approach. Postpilot test survey data were aggregated and synthesized by participant role. Results: The digital health platform met original objectives and was expanded to accommodate the evolving needs of potential users and COVID-19 pandemic regulations. Key challenges noted by the development team included navigating changing government policies and supporting the data sovereignty of platform users. Strong team cohesion and problem-solving were essential in the overall success of program development. During the pilot test, participants reported positive experiences interacting with the platform and found its features relatively easy to use. Users in the community member role felt that the platform accurately reflected their risk of contracting COVID-19, but reported some challenges interacting with the interface. Those in the decision maker role found the data visualizations helpful for understanding complex information. Both participant groups highlighted the utility of a tutorial for future users. Conclusions: Evaluation of the digital health platform development process informed our decisions to integrate the research team more cohesively with the development team, a practice that is currently uncommon given the use of external technology vendors in health research. In the short term, the developmental evaluation resulted in shorter sprints, and the role-play exercise enabled improvements to the log-in process and user interface ahead of public deployment. In the long term, this exercise informed the decision to include a data scientist as part of both teams going forward to liaise with researchers throughout the development process. More interdisciplinarity was also integrated into the research process by providing health system training to computer programmers, a key factor in human-centered artificial intelligence development. %M 40245398 %R 10.2196/53339 %U https://formative.jmir.org/2025/1/e53339 %U https://doi.org/10.2196/53339 %U http://www.ncbi.nlm.nih.gov/pubmed/40245398 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e67646 %T Search Volume of Insomnia and Suicide as Digital Footprints of Global Mental Health During the COVID-19 Pandemic: 3-Year Infodemiology Study %A Lin,Sheng-Hsuan %A Su,Kuan-Pin %A Tsou,Hsiao-Hui %A Hsia,Pei-Hsuan %A Lin,Yu-Hsuan %+ Institute of Population Health Sciences, National Health Research Institutes, 35 Keyan Road Zhunan, Miaoli County, 35053, Taiwan, 886 37 206 166 ext 36383, yuhsuanlin@nhri.edu.tw %K mediation analysis %K internet searches %K stay-at-home measures %K insomnia %K suicide %K COVID-19 %D 2025 %7 17.4.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: The global COVID-19 pandemic’s mental health impact was primarily studied in the initial year of lockdowns but remained underexplored in subsequent years despite evolving conditions. This study aimed to address this gap by investigating how COVID-19–related factors, including nationwide COVID-19 deaths and incidence rates, influenced mental health indicators over time. Objective: This study aimed to examine the interplay among national COVID-19 pandemic deaths, incidence rates, stay-at-home behaviors, and mental health indicators across different income-level countries. Specifically, we assessed the mediating role of stay-at-home behaviors in the relationship between the COVID-19 pandemic deaths and mental health indicators. Methods: We analyzed data from 45 countries spanning March 2020 to October 2022. COVID-19–related factors included national COVID-19 pandemic deaths and incidence rates, obtained from publicly available datasets. Stay-at-home behaviors were assessed using Google Location History data, which captured residence-based cell phone activity as a proxy for mobility patterns. Mental health indicators were evaluated through Google Trends data, measuring changes in search volumes for “insomnia” and “suicide.” The interplay among these variables was assessed using mediation analysis to quantify the proportion mediated by stay-at-home behaviors in the association between COVID-19 deaths and mental health indicators. Results: In high-income countries, during the first pandemic year (March 2020 to February 2021), a higher monthly COVID-19 death count was associated with increased searches for “insomnia,” with a total effect estimate of 2.1×10-4 (95% CI 4.3×10-5 to 3.9×10-4; P=.01). Stay-at-home behaviors mediated 31.9% of this effect (95% CI 9.8% to 127.5%, P=.02). This association weakened and became nonsignificant in the second and third years (P=.25 and P=.54, respectively). For middle-income countries, a different pattern emerged regarding “suicide” searches. Higher COVID-19 death counts were linked to a decline in “suicide” searches in the first (estimate: –3.5×10-4, 95% CI –6.1×10-4 to –9.8×10-5; P=.006) and second years (P=.01). Mediation analysis indicated that this effect was not significantly explained by stay-at-home behaviors, suggesting the influence of other societal factors. In high-income countries, no significant association between COVID-19 deaths and “suicide” searches was observed in the first year (P=.86). However, a positive association emerged in the second year, approaching statistical significance (estimate: 2.2×10-4, 95% CI –9.5×10-7 to 4.2×10-4; P=.05), and became significant in the third year (estimate: 5.0×10-4, 95% CI 5.0×10-5 to 1.0×10-3; P=.03,), independent of stay-at-home behaviors. Conclusions: Our findings highlight how the mental health impact of the pandemic varied across income groups and evolved over time. The mediating effect of stay-at-home behaviors was significant in the early phases but diminished in later stages, particularly in high-income countries. Meanwhile, middle-income countries exhibited unique patterns that suggest alternative protective factors. These insights can inform tailored mental health interventions and policy strategies in future public health crises. %M 40245400 %R 10.2196/67646 %U https://www.jmir.org/2025/1/e67646 %U https://doi.org/10.2196/67646 %U http://www.ncbi.nlm.nih.gov/pubmed/40245400 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e68199 %T Changes in Physical Activity, Heart Rate, and Sleep Measured by Activity Trackers During the COVID-19 Pandemic Across 34 Countries: Retrospective Analysis %A Wyatt,Bastien %A Forstmann,Nicolas %A Badier,Nolwenn %A Hamy,Anne-Sophie %A De Larochelambert,Quentin %A Antero,Juliana %A Danino,Arthur %A Vercamer,Vincent %A De Villele,Paul %A Vittrant,Benjamin %A Lanz,Thomas %A Reyal,Fabien %A Toussaint,Jean-François %A Delrieu,Lidia %+ , Institute for Research in bioMedicine and Epidemiology of Sport, Université Paris Cité, 11 Avenue du Tremblay, Paris, 75012, France, 33 141744307, lidia.delrieu@insep.fr %K Covid-19 %K pandemic %K physical activity %K step %K activity tracker %K public health %K Withings %K heart rate %K wearable sensors %K sleep duration %K sleep quality %K pre-pandemic %K public health %K sedentary behavior %D 2025 %7 4.4.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic disrupted behavior within populations, affecting physical activity (PA), heart rate (HR), and sleep characteristics in particular. Activity trackers provide unique insights into these changes, enabling large-scale, real-time monitoring. Objective: This study aims to analyze the associations between the features of the COVID-19 pandemic worldwide and PA, HR, and sleep parameters, using data collected from activity trackers over a 3-year period. Methods: We performed a retrospective analysis using anonymized data collected from the 208,818 users of Withings Steel HR activity trackers, spanning 34 countries, over a 3-year period from January 2019 to March 2022. Key metrics analyzed included daily step counts, average heart rate, and sleep duration. The statistical methods used included descriptive analyses, time-trend analysis, and mixed models to evaluate the impact of restriction measures, controlling for potential confounders such as sex, age, and seasonal variations. Results: We detected a significant decrease in PA, with a 12.3% reduction in daily step count (from 5802 to 5082 steps/d) over the 3 years. The proportion of sedentary individuals increased from 38% (n=14,177) in 2019 to 52% (n=19,510) in 2020 and remained elevated at 51% (n=18,972) in 2022, while the proportion of active individuals dropped from 8% (n=2857) to 6% (n=2352) in 2020 before returning to 8% (n=2877) in 2022. In 2022, the global population had not returned to prepandemic PA levels, with a noticeable persistence of inactivity. During lockdowns, HR decreased by 1.5%, which was associated with lower activity levels. Sleep duration increased during restrictions, particularly in the countries with the most severe lockdowns (eg, an increase of 15 min in countries with stringent measures compared to 5 min in less restricted regions). Conclusions: The sustained decrease in PA and its physiological consequences highlight the need for public health strategies to mitigate the long-term effects of the measures taken during the pandemic. Despite the gradual lifting of restrictions, PA levels have not fully recovered, with lasting implications for global health. If similar circumstances arise in the future, priority should be given to measures for effectively increasing PA to counter the increase in sedentary behavior, mitigate health risks, and prevent the rise of chronic diseases. %M 40184182 %R 10.2196/68199 %U https://www.jmir.org/2025/1/e68199 %U https://doi.org/10.2196/68199 %U http://www.ncbi.nlm.nih.gov/pubmed/40184182 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e60472 %T Patient Factors Associated With the Use of Online Portal Health Information in the Postpandemic Era: Cross-Sectional Analysis of a National Survey %A Maini,Ishana %A Gilotra,Kevin %A Sadigh,Gelareh %+ , Department of Radiological Sciences, University of California Irvine, 101 The City Dr S, Orange, CA, 92868, United States, 1 (714) 456 3610, gsadigh@uci.edu %K patient portal %K utilization %K health disparity %K post-pandemic %K health information %K prevalence %K portal use %K survey %K health care provider %K Americans %K US %D 2025 %7 3.4.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Patients’ electronic access to their health information can improve long-term health outcomes. Few studies have evaluated barriers that may limit access to portal health information before the COVID-19 pandemic such as preference for in-person visits, lack of perceived need to use a patient portal system, and lack of comfort or experience with computers. With the increased use of telehealth during the pandemic, patients’ comfort with portal applications and digital health literacy has improved. Objective: The purpose of this study was to assess the prevalence of portal use and factors associated with patients’ portal access after the COVID-19 pandemic. Methods: This study used data from the 2022 National Cancer Institute’s Health Information National Trends Survey (HINTS 6). Adult patients (aged ≥18 years) who responded to the survey question about patient portal access were included. A multivariate logistic regression analysis was performed to determine characteristics associated with portal access. Results: A total number of 5958 patients were included (weighted n=245,721,106), with a mean age of 48.2 (20.1) years and were mostly female (119,538,392/236,138,857, 50.6%) and white (167,163,482/227,232,636, 73.6%). Overall, 61.3% (150,722,178/245,721,106) of all respondents reported accessing portals over the last 12 months and 43.7% (82,620,907/188,860,031) used multiple portals. Most participants (135,011,661/150,104,795, 89.9%) reported using portals to access test results, followed by viewing clinical notes (104,541,142/149,867,276, 69.8%) downloading personal health information (47,801,548/150,017,130, 31.9%). The likelihood of portal use significantly increased by 24.9% points (95% CI 19.4-30.5) when patients were offered access to portals by health care providers or insurers compared with those not offered access or did not know if they were offered access. The likelihood of portal use also increased by 19.5% points (95% CI 15.1-23.9) among patients with a health care provider encouraging them to access portals, compared to patients who did not receive encouragement to do so. Having a college education versus education below college level and living in metropolitan areas versus nonmetropolitan regions increased the probability of portal use by 6.9% points (95% CI 3.1-10.8) and 6.9% points (95% CI 1.3-12.6), respectively. Of note, males (compared with females) and those of Hispanic background (compared with non-Hispanic individuals) were less likely to be offered portal access by 10.8% points (95% CI 6.3-15.2) and 6.9% points (95% CI 1.7-12.1), respectively. Conclusions: This study demonstrates that most Americans use patient portals, though certain patient populations such as those with less than college degree education or living in nonmetropolitan areas continue to face greater difficulty accessing them. Interventions targeted at equality in offering access to patient portals and encouraging patients to use them could advance equitable and widespread access to patient portals. %M 40179386 %R 10.2196/60472 %U https://www.jmir.org/2025/1/e60472 %U https://doi.org/10.2196/60472 %U http://www.ncbi.nlm.nih.gov/pubmed/40179386 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e54650 %T Infoveillance of COVID-19 Infections in Dentistry Using Platform X: Descriptive Study %A Al-Mansoori,Alghalia %A Al Hayk,Ola %A Qassmi,Sharifa %A Aziz,Sarah M %A Haouari,Fatima %A Chivese,Tawanda %A Tamimi,Faleh %A Daud,Alaa %+ College of Dental Medicine, QU Health, Qatar University, Al Tarfa St, Doha, 2713, Qatar, 974 77193993, adaud@qu.edu.qa %K COVID-19 %K dentistry %K infection %K patient %K infoveillance %K platform X %K Twitter %D 2025 %7 3.4.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: The effect of the COVID-19 pandemic on the well-being of dental professionals and patients has been difficult to track and quantify. X (formerly known as Twitter) proved to be a useful infoveillance tool for tracing the impact of the COVID-19 pandemic worldwide. Objective: This study aims to investigate the use of X to track COVID-19 infections and deaths associated with dental practices. Methods: English Tweets reporting infections or deaths associated with the dental practice were collected from January 1, 2020, to March 31, 2021. Tweets were searched manually using the X Pro search engine (previously known as TweetDeck [X Corp], Twitter Inc, and TweetDeck Ltd) and automatically using a tweet crawler on the X Academic Research application programming interface. Queries included keywords on infection or death of dental staff and patients caused by COVID-19. Tweets registering events on infection or death of dentists, dental staff, and patients as part of their conversation were included. Results: A total of 5641 eligible tweets were retrieved. Of which 1583 (28.1%) were deemed relevant after applying the inclusion and exclusion criteria. Of the relevant tweets, 311 (19.6%) described infections at dental practices, where 1168 (86.9%) infection cases were reported among dentists, 134 (9.9%) dental staff, and 41 (3.1%) patients. The majority of reported infections occurred in the United States, India, and Canada, affecting individuals aged 20-51 years. Among the 600 documented deaths, 253 (42.2%) were dentists, 22 (3.7%) were dental staff, and 7 (1.2%) were patients. The countries with the highest number of deaths were the United States, Pakistan, and India, with an affected age range of 23-83 years. Conclusions: The data suggest that analyses of X information in populations of affected areas may provide useful information regarding the impact of a pandemic on the dental profession and demonstrate a correlation with suspected and confirmed infection or death cases. Platform X shows potential as an early predictor for disease spread. However, further research is required to confirm its validity. %M 40179381 %R 10.2196/54650 %U https://www.jmir.org/2025/1/e54650 %U https://doi.org/10.2196/54650 %U http://www.ncbi.nlm.nih.gov/pubmed/40179381 %0 Journal Article %@ 2817-1705 %I JMIR Publications %V 4 %N %P e67363 %T Generative Large Language Model—Powered Conversational AI App for Personalized Risk Assessment: Case Study in COVID-19 %A Roshani,Mohammad Amin %A Zhou,Xiangyu %A Qiang,Yao %A Suresh,Srinivasan %A Hicks,Steven %A Sethuraman,Usha %A Zhu,Dongxiao %+ Department of Computer Science, Wayne State University, 5057 Woodward Ave, Suite 14101.3, Detroit, MI, 48202, United States, 1 3135773104, dzhu@wayne.edu %K personalized risk assessment %K large language model %K conversational AI %K artificial intelligence %K COVID-19 %D 2025 %7 27.3.2025 %9 Original Paper %J JMIR AI %G English %X Background: Large language models (LLMs) have demonstrated powerful capabilities in natural language tasks and are increasingly being integrated into health care for tasks like disease risk assessment. Traditional machine learning methods rely on structured data and coding, limiting their flexibility in dynamic clinical environments. This study presents a novel approach to disease risk assessment using generative LLMs through conversational artificial intelligence (AI), eliminating the need for programming. Objective: This study evaluates the use of pretrained generative LLMs, including LLaMA2-7b and Flan-T5-xl, for COVID-19 severity prediction with the goal of enabling a real-time, no-code, risk assessment solution through chatbot-based, question-answering interactions. To contextualize their performance, we compare LLMs with traditional machine learning classifiers, such as logistic regression, extreme gradient boosting (XGBoost), and random forest, which rely on tabular data. Methods: We fine-tuned LLMs using few-shot natural language examples from a dataset of 393 pediatric patients, developing a mobile app that integrates these models to provide real-time, no-code, COVID-19 severity risk assessment through clinician-patient interaction. The LLMs were compared with traditional classifiers across different experimental settings, using the area under the curve (AUC) as the primary evaluation metric. Feature importance derived from LLM attention layers was also analyzed to enhance interpretability. Results: Generative LLMs demonstrated strong performance in low-data settings. In zero-shot scenarios, the T0-3b-T model achieved an AUC of 0.75, while other LLMs, such as T0pp(8bit)-T and Flan-T5-xl-T, reached 0.67 and 0.69, respectively. At 2-shot settings, logistic regression and random forest achieved an AUC of 0.57, while Flan-T5-xl-T and T0-3b-T obtained 0.69 and 0.65, respectively. By 32-shot settings, Flan-T5-xl-T reached 0.70, similar to logistic regression (0.69) and random forest (0.68), while XGBoost improved to 0.65. These results illustrate the differences in how generative LLMs and traditional models handle the increasing data availability. LLMs perform well in low-data scenarios, whereas traditional models rely more on structured tabular data and labeled training examples. Furthermore, the mobile app provides real-time, COVID-19 severity assessments and personalized insights through attention-based feature importance, adding value to the clinical interpretation of the results. Conclusions: Generative LLMs provide a robust alternative to traditional classifiers, particularly in scenarios with limited labeled data. Their ability to handle unstructured inputs and deliver personalized, real-time assessments without coding makes them highly adaptable to clinical settings. This study underscores the potential of LLM-powered conversational artificial intelligence (AI) in health care and encourages further exploration of its use for real-time, disease risk assessment and decision-making support. %M 40146990 %R 10.2196/67363 %U https://ai.jmir.org/2025/1/e67363 %U https://doi.org/10.2196/67363 %U http://www.ncbi.nlm.nih.gov/pubmed/40146990 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e69506 %T Physiological Sensors Equipped in Wearable Devices for Management of Long COVID Persisting Symptoms: Scoping Review %A Kukreti,Shikha %A Lu,Meng-Ting %A Yeh,Chun-Yin %A Ko,Nai-Ying %+ Department of Nursing, College of Medicine, National Cheng Kung University, No.1, Dasyue Rd, East District, Tainan City, 701, Taiwan, 886 062353535, konaiying@gmail.com %K wearable devices %K long COVID %K physiological sensors %K review %K COVID %K COVID-19 %D 2025 %7 26.3.2025 %9 Review %J J Med Internet Res %G English %X Background: Wearable technology has evolved in managing COVID-19, offering early monitoring of key physiological parameters. However, the role of wearables in tracking and managing long COVID is less understood and requires further exploration of their potential. Objective: This review assessed the application and effectiveness of wearable devices in managing long COVID symptoms, focusing on commonly used sensors and their potential for improving long-term patient care. Methods: A literature search was conducted across databases including PubMed, Embase, Web of Science, and Cochrane Central, adhering to PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) reporting guidelines. The search was updated regularly throughout 2024. Abstract and full-text screening and selection were facilitated using Rayyan software developed by Qatar Computing Research Institute. Quality appraisal was conducted using the Joanna Briggs Institute (JBI) critical appraisal tool to ensure the methodological rigor of the included studies. Data were extracted on study characteristics, wearable devices, sensors used, and monitored physiological parameters, and the results were synthesized in a narrative format. Results: A total of 1186 articles were identified, and after duplicate removal and screening, 15 studies were initially included, with 11 studies meeting the criteria for final data synthesis. The included studies varied in design, ranging from observational to interventional trials, and involved sample sizes from 3 to 17,667 participants across different countries. In total, 10 different wearable devices were used to monitor long COVID symptoms, capturing key metrics such as heart rate variability, body temperature, sleep, and physical activity. Smartwatches were the most used wearable devices and fitness trackers with electrocardiography and photoplethysmography sensors were used to monitor heart rate, oxygen saturation, and respiratory rate. Of the 10 devices, 4 were Food and Drug Administration–approved, emphasizing the reliability and validation of the physiological data collected. Studies were primarily conducted in the United States and Europe, reflecting significant regional research interest in wearable technology for long COVID management. Conclusions: This review highlights the potential of wearable technology in providing continuous and personalized monitoring for long COVID patients. Although wearables show promise in tracking persistent symptoms, further research is needed to improve usability, validate long-term efficacy, and enhance patient engagement. %M 40137051 %R 10.2196/69506 %U https://www.jmir.org/2025/1/e69506 %U https://doi.org/10.2196/69506 %U http://www.ncbi.nlm.nih.gov/pubmed/40137051 %0 Journal Article %@ 1947-2579 %I JMIR Publications %V 17 %N %P e66598 %T Reporting of Fairness Metrics in Clinical Risk Prediction Models Used for Precision Health: Scoping Review %A Rountree,Lillian %A Lin,Yi-Ting %A Liu,Chuyu %A Salvatore,Maxwell %A Admon,Andrew %A Nallamothu,Brahmajee %A Singh,Karandeep %A Basu,Anirban %A Bu,Fan %A Mukherjee,Bhramar %+ Department of Biostatistics, Yale School of Public Health, Yale University, 60 College St, New Haven, CT, 06510, United States, 1 2037378644, bhramar.mukherjee@yale.edu %K bias %K cardiovascular disease %K COVID-19 %K risk stratification %K sensitive features %K clinical risk prediction %K equity %D 2025 %7 19.3.2025 %9 Review %J Online J Public Health Inform %G English %X Background: Clinical risk prediction models integrated into digitized health care informatics systems hold promise for personalized primary prevention and care, a core goal of precision health. Fairness metrics are important tools for evaluating potential disparities across sensitive features, such as sex and race or ethnicity, in the field of prediction modeling. However, fairness metric usage in clinical risk prediction models remains infrequent, sporadic, and rarely empirically evaluated. Objective: We seek to assess the uptake of fairness metrics in clinical risk prediction modeling through an empirical evaluation of popular prediction models for 2 diseases, 1 chronic and 1 infectious disease. Methods: We conducted a scoping literature review in November 2023 of recent high-impact publications on clinical risk prediction models for cardiovascular disease (CVD) and COVID-19 using Google Scholar. Results: Our review resulted in a shortlist of 23 CVD-focused articles and 22 COVID-19 pandemic–focused articles. No articles evaluated fairness metrics. Of the CVD-focused articles, 26% used a sex-stratified model, and of those with race or ethnicity data, 92% had study populations that were more than 50% from 1 race or ethnicity. Of the COVID-19 models, 9% used a sex-stratified model, and of those that included race or ethnicity data, 50% had study populations that were more than 50% from 1 race or ethnicity. No articles for either disease stratified their models by race or ethnicity. Conclusions: Our review shows that the use of fairness metrics for evaluating differences across sensitive features is rare, despite their ability to identify inequality and flag potential gaps in prevention and care. We also find that training data remain largely racially and ethnically homogeneous, demonstrating an urgent need for diversifying study cohorts and data collection. We propose an implementation framework to initiate change, calling for better connections between theory and practice when it comes to the adoption of fairness metrics for clinical risk prediction. We hypothesize that this integration will lead to a more equitable prediction world. %M 39962044 %R 10.2196/66598 %U https://ojphi.jmir.org/2025/1/e66598 %U https://doi.org/10.2196/66598 %U http://www.ncbi.nlm.nih.gov/pubmed/39962044 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 5 %N %P e66524 %T Experiences of Public Health Professionals Regarding Crisis Communication During the COVID-19 Pandemic: Systematic Review of Qualitative Studies %A Okuhara,Tsuyoshi %A Terada,Marina %A Okada,Hiroko %A Yokota,Rie %A Kiuchi,Takahiro %+ Department of Health Communication, The University of Tokyo, 7 Chome-3-1 Hongo, Tokyo, 113-8654, Japan, 81 3 5800 6549, okuhara-ctr@umin.ac.jp %K COVID-19 %K health communication %K infodemic %K misinformation %K social media %K SARS-CoV-2 %K pandemic %K infectious %K digital age %K systematic review %K internet %K public health %K government %K health professional %K crisis communication %K qualitative %K disinformation %K eHealth %K digital health %K medical informatics %D 2025 %7 14.3.2025 %9 Review %J JMIR Infodemiology %G English %X Background: The COVID-19 pandemic emerged in the digital age and has been called the first “data-driven pandemic” in human history. The global response demonstrated that many countries had failed to effectively prepare for such an event. Learning through experience in a crisis is one way to improve the crisis management process. As the world has returned to normal after the pandemic, questions about crisis management have been raised in several countries and require careful consideration. Objective: This review aimed to collect and organize public health professionals’ experiences in crisis communication to the public during the COVID-19 pandemic. Methods: We searched PubMed, MEDLINE, CINAHL, Web of Science, Academic Search Complete, PsycINFO, PsycARTICLES, and Communication Abstracts in February 2024 to locate English-language articles that qualitatively investigated the difficulties and needs experienced by health professionals in their communication activities during the COVID-19 pandemic. Results: This review included 17 studies. Our analysis identified 7 themes and 20 subthemes. The 7 themes were difficulties in pandemic communication, difficulties caused by the “infodemic,” difficulties in partnerships within or outside of public health, difficulties in community engagement, difficulties in effective communication, burnout among communicators, and the need to train communication specialists and establish a permanent organization specializing in communication. Conclusions: This review identified the gaps between existing crisis communication guidelines and real-world crisis communication in the digital environment and clarified the difficulties and needs that arose from these gaps. Crisis communication strategies and guidelines should be updated with reference to the themes revealed in this review to effectively respond to subsequent public health crises. Trial Registration: PROSPERO CRD42024528975; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=528975 International Registered Report Identifier (IRRID): RR2-10.2196/58040 %M 40085849 %R 10.2196/66524 %U https://infodemiology.jmir.org/2025/1/e66524 %U https://doi.org/10.2196/66524 %U http://www.ncbi.nlm.nih.gov/pubmed/40085849 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e59217 %T Opportunities and Challenges in Using Electronic Health Record Systems to Study Postacute Sequelae of SARS-CoV-2 Infection: Insights From the NIH RECOVER Initiative %A Mandel,Hannah L %A Shah,Shruti N %A Bailey,L Charles %A Carton,Thomas %A Chen,Yu %A Esquenazi-Karonika,Shari %A Haendel,Melissa %A Hornig,Mady %A Kaushal,Rainu %A Oliveira,Carlos R %A Perlowski,Alice A %A Pfaff,Emily %A Rao,Suchitra %A Razzaghi,Hanieh %A Seibert,Elle %A Thomas,Gelise L %A Weiner,Mark G %A Thorpe,Lorna E %A Divers,Jasmin %A , %+ Department of Population Health, New York University Grossman School of Medicine, 180 Madison Avenue, New York, NY, 10016, United States, 1 732 314 1595, Hannah.Mandel@nyulangone.org %K COVID-19 %K SARS-CoV-2 %K Long COVID, post-acute COVID-19 syndrome %K electronic health records %K machine learning %K public health surveillance %K post-infection syndrome %K medical informatics %K electronic medical record %K electronic health record network %K electronic health record data %K clinical research network %K clinical data research network %K common data model %K digital health %K infection %K respiratory %K infectious %K epidemiological %K pandemic %D 2025 %7 5.3.2025 %9 Viewpoint %J J Med Internet Res %G English %X The benefits and challenges of electronic health records (EHRs) as data sources for clinical and epidemiologic research have been well described. However, several factors are important to consider when using EHR data to study novel, emerging, and multifaceted conditions such as postacute sequelae of SARS-CoV-2 infection or long COVID. In this article, we present opportunities and challenges of using EHR data to improve our understanding of long COVID, based on lessons learned from the National Institutes of Health (NIH)–funded RECOVER (REsearching COVID to Enhance Recovery) Initiative, and suggest steps to maximize the usefulness of EHR data when performing long COVID research. %M 40053748 %R 10.2196/59217 %U https://www.jmir.org/2025/1/e59217 %U https://doi.org/10.2196/59217 %U http://www.ncbi.nlm.nih.gov/pubmed/40053748 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e54543 %T Exploring Psychological Trends in Populations With Chronic Obstructive Pulmonary Disease During COVID-19 and Beyond: Large-Scale Longitudinal Twitter Mining Study %A Zhang,Chunyan %A Wang,Ting %A Dong,Caixia %A Dai,Duwei %A Zhou,Linyun %A Li,Zongfang %A Xu,Songhua %+ School of Electrical Engineering, Xi'an Jiaotong University, No. 28, Xianning West Road, Xi'an, 710049, China, 86 13289346632, wang.ting@xjtu.edu.cn %K COVID-19 %K chronic obstructive pulmonary disease (COPD) %K psychological trends %K Twitter %K data mining %K deep learning %D 2025 %7 5.3.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Chronic obstructive pulmonary disease (COPD) ranks among the leading causes of global mortality, and COVID-19 has intensified its challenges. Beyond the evident physical effects, the long-term psychological effects of COVID-19 are not fully understood. Objective: This study aims to unveil the long-term psychological trends and patterns in populations with COPD throughout the COVID-19 pandemic and beyond via large-scale Twitter mining. Methods: A 2-stage deep learning framework was designed in this study. The first stage involved a data retrieval procedure to identify COPD and non-COPD users and to collect their daily tweets. In the second stage, a data mining procedure leveraged various deep learning algorithms to extract demographic characteristics, hashtags, topics, and sentiments from the collected tweets. Based on these data, multiple analytical methods, namely, odds ratio (OR), difference-in-difference, and emotion pattern methods, were used to examine the psychological effects. Results: A cohort of 15,347 COPD users was identified from the data that we collected in the Twitter database, comprising over 2.5 billion tweets, spanning from January 2020 to June 2023. The attentiveness toward COPD was significantly affected by gender, age, and occupation; it was lower in females (OR 0.91, 95% CI 0.87-0.94; P<.001) than in males, higher in adults aged 40 years and older (OR 7.23, 95% CI 6.95-7.52; P<.001) than in those younger than 40 years, and higher in individuals with lower socioeconomic status (OR 1.66, 95% CI 1.60-1.72; P<.001) than in those with higher socioeconomic status. Across the study duration, COPD users showed decreasing concerns for COVID-19 and increasing health-related concerns. After the middle phase of COVID-19 (July 2021), a distinct decrease in sentiments among COPD users contrasted sharply with the upward trend among non-COPD users. Notably, in the post-COVID era (June 2023), COPD users showed reduced levels of joy and trust and increased levels of fear compared to their levels of joy and trust in the middle phase of COVID-19. Moreover, males, older adults, and individuals with lower socioeconomic status showed heightened fear compared to their counterparts. Conclusions: Our data analysis results suggest that populations with COPD experienced heightened mental stress in the post-COVID era. This underscores the importance of developing tailored interventions and support systems that account for diverse population characteristics. %M 40053739 %R 10.2196/54543 %U https://www.jmir.org/2025/1/e54543 %U https://doi.org/10.2196/54543 %U http://www.ncbi.nlm.nih.gov/pubmed/40053739 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e64667 %T The Impact of Stay-At-Home Mandates on Uncertainty and Sentiments: Quasi-Experimental Study %A Biliotti,Carolina %A Fraccaroli,Nicolò %A Puliga,Michelangelo %A Bargagli-Stoffi,Falco J %A Riccaboni,Massimo %+ W R Rhodes Center for International Economics and Finance, Brown University, 111 Thayer Street, Box 1970, Providence, RI, United States, 1 401 863 2809, nicolo_fraccaroli@brown.edu %K lockdown policy %K sentiment analysis %K uncertainty %K social media %K quasi-experiment %D 2025 %7 4.3.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: As the spread of the SARS-CoV-2 virus coincided with lockdown measures, it is challenging to distinguish public reactions to lockdowns from responses to COVID-19 itself. Beyond the direct impact on health, lockdowns may have worsened public sentiment toward politics and the economy or even heightened dissatisfaction with health care, imposing a significant cost on both the public and policy makers. Objective: This study aims to analyze the causal effect of COVID-19 lockdown policies on various dimensions of sentiment and uncertainty, using the Italian lockdown of February 2020 as a quasi-experiment. At the time of implementation, communities inside and just outside the lockdown area were equally exposed to COVID-19, enabling a quasi-random distribution of the lockdown. Additionally, both areas had similar socioeconomic and demographic characteristics before the lockdown, suggesting that the delineation of the strict lockdown zone approximates a randomized experiment. This approach allows us to isolate the causal effects of the lockdown on public emotions, distinguishing the impact of the policy itself from changes driven by the virus’s spread. Methods: We used Twitter data (N=24,261), natural language models, and a difference-in-differences approach to compare changes in sentiment and uncertainty inside (n=1567) and outside (n=22,694) the lockdown areas before and after the lockdown began. By fine-tuning the AlBERTo (Italian BERT optimized) pretrained model, we analyzed emotions expressed in tweets from 1124 unique users. Additionally, we applied dictionary-based methods to categorize tweets into 4 dimensions—economy, health, politics, and lockdown policy—to assess the corresponding emotional reactions. This approach enabled us to measure the direct impact of local policies on public sentiment using geo-referenced social media and can be easily adapted for other policy impact analyses. Results: Our analysis shows that the lockdown had no significant effect on economic uncertainty (b=0.005, SE 0.007, t125=0.70; P=.48) or negative economic sentiment (b=–0.011, SE 0.0089, t125=–1.32; P=.19). However, it increased uncertainty about health (b=0.036, SE 0.0065, t125=5.55; P<.001) and lockdown policy (b=0.026, SE 0.006, t125=4.47; P<.001), as well as negative sentiment toward politics (b=0.025, SE 0.011, t125=2.33; P=.02), indicating that lockdowns have broad externalities beyond health. Our key findings are confirmed through a series of robustness checks. Conclusions: Our findings reveal that lockdowns have broad externalities extending beyond health. By heightening health concerns and negative political sentiment, policy makers have struggled to secure explicit public support for government measures, which may discourage future leaders from implementing timely stay-at-home policies. These results highlight the need for authorities to leverage such insights to enhance future policies and communication strategies, reducing uncertainty and mitigating social panic. %M 40053818 %R 10.2196/64667 %U https://www.jmir.org/2025/1/e64667 %U https://doi.org/10.2196/64667 %U http://www.ncbi.nlm.nih.gov/pubmed/40053818 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 12 %N %P e58582 %T The Utilization of Electronic Consultations (eConsults) to Address Emerging Questions Related to Long COVID-19 in Ontario, Canada: Mixed Methods Analysis %A Singh,Jatinderpreet %A Quon,Michael %A Goulet,Danica %A Keely,Erin %A Liddy,Clare %K COVID-19 %K long COVID %K eConsult %K consultation %K Canada %K mixed methods analysis %K diagnosis %K primary care %K electronic consultation %K COVID specialist %K specialist %K patient %K assessment %K COVID-19 vaccination %K vaccination %K symptom %K medical education %K web-based consultation %K teleconsultation %K web-based consultations %D 2025 %7 28.2.2025 %9 %J JMIR Hum Factors %G English %X Background: Long COVID is an often debilitating condition affecting millions of people. Its diverse clinical presentations make effective diagnosis and management at the primary care level difficult, while specialist services for long COVID face extensive wait times. An electronic consultation (eConsult) program in Ontario developed a long COVID specialist group to allow primary care providers (PCPs) prompt access to specialist advice for patients with long COVID. Objective: This study aims to assess patterns of service use, response times, impact, and clinical content of eConsult cases submitted to an eConsult long COVID specialist group in Ontario. Methods: This study is a mixed methods analysis of eConsults submitted by PCPs to the long COVID specialist group of 2 eConsult services (Champlain eConsult BASE and Ontario eConsult) between June 1, 2021, and July 31, 2022. Data sources included the use data collected automatically by the services, responses to a mandatory closeout survey, and the content of PCP questions and specialist responses (Champlain eConsult BASE service only). Clinical questions or responses were analyzed using 2 validated taxonomies. Descriptive statistics were used for survey responses and use data. Results: A total of 40 PCPs submitted 47 eConsults through Champlain eConsult BASE and 197 PCPs submitted 228 cases through Ontario eConsult. The median specialist response time was 0.6 (IQR 0.19-2.36; mean 1.7, SD 2.29) days. The 5 most common symptoms of long COVID were fatigue (14/47, 30%), dyspnea (7/47, 15%), cough (6/47, 13%), altered sense of smell (ie, anosmia and parosmia; 6/47, 13%), and cognitive changes (6/47, 13%). The five main question categories asked by PCPs were: (1) management of chronic symptoms of COVID-19, (2) need for additional work-up or follow-up testing, (3) community resources to support or manage patients with long COVID, (4) diagnostic clarification, and (5) guidance regarding COVID-19 vaccination. Conclusions: The long COVID groups provided rapid access to a multispecialty service that facilitated the avoidance of unnecessary face-to-face referrals. An assessment of eConsults highlighted 5 common question types, providing insight into potential gaps in knowledge among PCPs that could help guide medical education and policy. %R 10.2196/58582 %U https://humanfactors.jmir.org/2025/1/e58582 %U https://doi.org/10.2196/58582 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e63879 %T Usage Trends and Data Sharing Practices of Healthcare Wearable Devices Among US Adults: Cross-Sectional Study %A Chandrasekaran,Ranganathan %A Sadiq T,Muhammed %A Moustakas,Evangelos %+ Department of Information & Decision Sciences / Department of Biomedical and Health Information Sciences, University of Illinois at Chicago, 2428 Univ Hall, 601 S Morgan St, Chicago, IL, 60607, United States, 1 3129962676, ranga@uic.edu %K healthcare wearable devices %K data-sharing behavior %K willingness to share wearable data %K activity trackers %K wearable use %K post-pandemic %K wearables %K healthcare delivery %K disease detection %K patient engagement %K digital literacy %K adults %K United States %K survey %K cross-sectional survey %K data sharing %D 2025 %7 21.2.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Health care wearable devices can transform health care delivery by enabling real-time, continuous monitoring that facilitates early disease detection, personalized treatments, and improved patient engagement. The COVID-19 pandemic has heightened awareness of the importance of health technology, accelerating interest in wearables as tools for monitoring health and managing chronic conditions. As we navigate the postpandemic era, understanding the adoption and data-sharing behaviors associated with wearable devices has become increasingly critical. Despite their potential, challenges and low adoption rates persist, with significant gaps in understanding the impact of sociodemographic factors, health conditions, and digital literacy on the use and data-sharing behaviors of these devices. Objective: This study aimed to explore the usage and data-sharing practices (willingness to share wearable data and actual data-sharing behavior) of wearable devices among US adults specifically during the later phases of the COVID-19 pandemic. Methods: Using cross-sectional data from the National Cancer Institute’s Health Information National Trends Survey 6, conducted from March to November 2022, this study uses responses from 5591 US adults to examine wearable use, willingness to share wearable data with providers, family, and friends, and the wearable data-sharing behavior. Results: The results indicate an increase in wearable device adoption to 36.36% (2033/5591) in 2022, up from 28%-30% in 2019. We also find a significant discrepancy between the willingness to share data, with 78.4% (1584/2020) of users open to sharing with health care providers, and the actual sharing behavior, where only 26.5% (535/ 2020) have done so. Higher odds of using wearables were associated with female gender (odds ratio [OR] 1.49, 95% CI 1.17-1.90, P<.01) and higher income levels (OR 2.65, 95% CI 1.42-4.93, P<.01 for incomes between US $50,000 and US $75,000, and OR 3.2, 95% CI 1.71-5.97, P<.01 for incomes above US $75,000). However, the likelihood of usage and data sharing declines significantly with age. Compared with African American respondents, Hispanic respondents were more willing to share wearable data with providers (OR 1.92, 95% CI 1.02-3.62, P<.05), though the odds of their actual sharing of wearable data with providers was relatively less (OR 0.44, 95% CI 0.20-0.97, P<.05). Frequency of provider visits (OR 1.23, 95% CI 1.08-1.39, P<.01), and total medical conditions (OR 1.35, 95% CI 1.05-1.73, P<.01) were significant predictors of data-sharing behavior. The study also identified weight, frequency of provider visits, technological self-efficacy and frequent physical activity as predictors for higher wearable use. Conclusions: Insights from this study are crucial for health care providers and policy makers aiming to leverage wearable technology to enhance health outcomes. Addressing the disparities and barriers identified can lead to more effective integration of these technologies in health care systems, thereby maximizing the potential of digital health tools to improve public health outcomes. %M 39982763 %R 10.2196/63879 %U https://www.jmir.org/2025/1/e63879 %U https://doi.org/10.2196/63879 %U http://www.ncbi.nlm.nih.gov/pubmed/39982763 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e63190 %T Leveraging Large Language Models for Infectious Disease Surveillance—Using a Web Service for Monitoring COVID-19 Patterns From Self-Reporting Tweets: Content Analysis %A Xie,Jiacheng %A Zhang,Ziyang %A Zeng,Shuai %A Hilliard,Joel %A An,Guanghui %A Tang,Xiaoting %A Jiang,Lei %A Yu,Yang %A Wan,Xiufeng %A Xu,Dong %+ Department of Electrical Engineering and Computer Science, University of Missouri, 227 Naka Hall, Columbia, MO, 65211, United States, 1 5738822299, xudong@missouri.edu %K COVID-19 %K self-reporting data %K large language model %K Twitter %K social media analysis %K natural language processing %K machine learning %D 2025 %7 20.2.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: The emergence of new SARS-CoV-2 variants, the resulting reinfections, and post–COVID-19 condition continue to impact many people’s lives. Tracking websites like the one at Johns Hopkins University no longer report the daily confirmed cases, posing challenges to accurately determine the true extent of infections. Many COVID-19 cases with mild symptoms are self-assessed at home and reported on social media, which provides an opportunity to monitor and understand the progression and evolving trends of the disease. Objective: We aim to build a publicly available database of COVID-19–related tweets and extracted information about symptoms and recovery cycles from self-reported tweets. We have presented the results of our analysis of infection, reinfection, recovery, and long-term effects of COVID-19 on a visualization website that refreshes data on a weekly basis. Methods: We used Twitter (subsequently rebranded as X) to collect COVID-19–related data, from which 9 native English-speaking annotators annotated a training dataset of COVID-19–positive self-reporters. We then used large language models to identify positive self-reporters from other unannotated tweets. We used the Hibert transform to calculate the lead of the prediction curve ahead of the reported curve. Finally, we presented our findings on symptoms, recovery, reinfections, and long-term effects of COVID-19 on the Covlab website. Results: We collected 7.3 million tweets related to COVID-19 between January 1, 2020, and April 1, 2024, including 262,278 self-reported cases. The predicted number of infection cases by our model is 7.63 days ahead of the official report. In addition to common symptoms, we identified some symptoms that were not included in the list from the US Centers for Disease Control and Prevention, such as lethargy and hallucinations. Repeat infections were commonly occurring, with rates of second and third infections at 7.49% (19,644/262,278) and 1.37% (3593/262,278), respectively, whereas 0.45% (1180/262,278) also reported that they had been infected >5 times. We identified 723 individuals who shared detailed recovery experiences through tweets, indicating a substantially reduction in recovery time over the years. Specifically, the average recovery period decreased from around 30 days in 2020 to approximately 12 days in 2023. In addition, geographic information collected from confirmed individuals indicates that the temporal patterns of confirmed cases in states such as California and Texas closely mirror the overall trajectory observed across the United States. Conclusions: Although with some biases and limitations, self-reported tweet data serves as a valuable complement to clinical data, especially in the postpandemic era dominated by mild cases. Our web-based analytic platform can play a significant role in continuously tracking COVID-19, finding new uncommon symptoms, detecting and monitoring the manifestation of long-term effects, and providing necessary insights to the public and decision-makers. %M 39977859 %R 10.2196/63190 %U https://www.jmir.org/2025/1/e63190 %U https://doi.org/10.2196/63190 %U http://www.ncbi.nlm.nih.gov/pubmed/39977859 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 11 %N %P e63996 %T A Call for Action: Lessons Learned From a Pilot to Share a Complex, Linked COVID-19 Cohort Dataset for Open Science %A Amid,Clara %A van Roode,Martine Y %A Rinck,Gabriele %A van Beek,Janko %A de Vries,Rory D %A van Nierop,Gijsbert P %A van Gorp,Eric C M %A Tobian,Frank %A Oude Munnink,Bas B %A Sikkema,Reina S %A Jaenisch,Thomas %A Cochrane,Guy %A Koopmans,Marion P G %K data sharing %K data management %K open science %K COVID-19 %K emerging infectious disease %K global health %D 2025 %7 11.2.2025 %9 %J JMIR Public Health Surveill %G English %X The COVID-19 pandemic proved how sharing of genomic sequences in a timely manner, as well as early detection and surveillance of variants and characterization of their clinical impacts, helped to inform public health responses. However, the area of (re)emerging infectious diseases and our global connectivity require interdisciplinary collaborations to happen at local, national and international levels and connecting data to understand the linkages between all factors involved. Here, we describe experiences and lessons learned from a COVID-19 pilot study aimed at developing a model for storage and sharing linked laboratory data and clinical-epidemiological data using European open science infrastructure. We provide insights into the barriers and complexities of internationally sharing linked, complex cohort datasets from opportunistic studies for connected data analyses. An analytical timeline of events, describing key actions and delays in the execution of the pilot, and a critical path, defining steps in the process of internationally sharing a linked cohort dataset are included. The pilot showed how building on existing infrastructure that had previously been developed within the European Nucleotide Archive at the European Molecular Biology Laboratory-European Bioinformatics Institute for pathogen genomics data sharing, allowed the rapid development of connected “data hubs.” These data hubs were required to link human clinical-epidemiological data under controlled access with open high dimensional laboratory data, under FAIR (Findable, Accessible, Interoperable, Reusable) principles. Based on our own experiences, we call for action and make recommendations to support and to improve data sharing for outbreak preparedness and response. %R 10.2196/63996 %U https://publichealth.jmir.org/2025/1/e63996 %U https://doi.org/10.2196/63996 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e57847 %T Health IT Implementation and the Impact of the COVID-19 Pandemic on Clinician-IT Dynamics: Qualitative Study %A Bamgboje-Ayodele,Adeola %A Boscolo,Adrian %A Burger,Mitchell %A Hutchings,Owen %A Shaw,Miranda %A Shaw,Tim %A Tariq,Amina %A Naicker,Sundresan %A McPhail,Steven %A Baysari,Melissa %+ Biomedical Informatics and Digital Health, School of Medical Sciences, Faculty of Medicine and Health, University of Sydney, RC Mills Building, Camperdown, 2006, Australia, 61 02 9351 9644, adeola.ba@sydney.edu.au %K health IT %K implementation %K COVID-19 pandemic %K process evaluation %K sociotechnical factors %K virtual hospital %K COVID-19 %D 2025 %7 11.2.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic necessitated the rapid development and implementation of health ITs to support health care delivery. Health IT implementation is difficult at the best of times, due to complex sociotechnical challenges that vary across contexts and settings; however, it is currently unclear how the pandemic impacted health IT implementation processes. The aim of this study was to explore the impact of the pandemic on health IT implementation processes, including pre- and postimplementation phases, and identify the sociotechnical factors that shaped health IT implementation during an unprecedented circumstance. Objective: This study aimed to explore the impact of the pandemic on HIT implementation processes, including pre- and postimplementation phases, and identify the socio-technical factors that shaped health IT implementation during an unprecedented circumstance. Methods: Participants were from one of two teams: (1) health care staff members (doctors, nurses, nurse unit managers, and support staff members) from a virtual hospital in Australia; and (2) IT professionals within the broader health care organization assigned to the hospital. Participants took part in an interview or focus group from July to November 2022. Participants were asked to describe the process used for rapid health IT design and implementation during the COVID-19 pandemic. Qualitative data were analyzed thematically. Results: A total of 15 participants took part in the study. Both internal and external team structures, and the communication pathways that underpinned these, were reported to influence the health IT lifecycle, which in turn impacted outcomes, particularly when perceived normal ways of working were challenged during the pandemic. Across the pre-post lifecycle, preimplementation processes were viewed to be most impacted by the COVID-19 pandemic. Participants reported that their roles and responsibilities changed during health IT implementations in the pandemic, impacting co-design processes and highlighting the need for health IT implementation processes to cater for new work and the redistribution of existing work. Conclusions: Our study uncovered the negative impact of the COVID-19 pandemic on team structures, communication pathways, and health IT preimplementation processes (project management and co-design). While health care organizations are keen to transition beyond the ways of working during the pandemic, it is imperative to learn from the health IT implementation successes and failures that occurred in the pandemic via process evaluations. Our evaluation offers learnings for research (an adapted interdisciplinary team communication framework), practice (the need for health care organizations to review their communication structures, IT staff skills, and proposed processes), and education (the need for better education and training of IT professionals working in clinical settings on health concepts) on health IT implementations as the world transitions to the “new norm.” %M 39933168 %R 10.2196/57847 %U https://www.jmir.org/2025/1/e57847 %U https://doi.org/10.2196/57847 %U http://www.ncbi.nlm.nih.gov/pubmed/39933168 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e67012 %T Effectiveness of Continuous Glucose Monitoring on Short-Term, In-Hospital Mortality Among Frail and Critically Ill Patients With COVID-19: Randomized Controlled Trial %A Shang,Jiawei %A Yuan,Ziming %A Zhang,Zuoyan %A Zhou,Quanhong %A Zou,Yan %A Wang,Wei %+ , Department of Intensive Care Medicine, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 600 Yishan Road, Shanghai, 200233, China, 86 18930173816, drwangwei3037@126.com %K intermittently scanned continuous glucose monitoring %K isCGM %K COVID-19 %K in-ICU mortality %K continuous glucose monitoring %K CGM %K point of care testing %K POCT %K glucose monitoring %K in-hospital mortality %K mortality %K inpatient mortality %K critically ill %K frail %K SARS-CoV-2 %K intensive care unit %K ICU %K exploratory %K prospective %K randomized %K open label %K parallel %K single center %K clinical trial %D 2025 %7 7.2.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: The use of continuous glucose monitoring (CGM) in the hospital setting is growing, with more patients using these devices at home, especially during the COVID-19 pandemic. Frail and critically ill patients with COVID-19 and previously normal glucose tolerance are also associated with variability in their glucose levels during their intensive care unit (ICU) stay. However, very limited evidence supports the use of CGM in ICU settings, especially among frail patients with COVID-19. Objective: We aimed to investigate the effectiveness of CGM on ICU-related outcomes among frail and critically ill patients with confirmed COVID-19. Methods: This was an exploratory, prospective, open-label, parallel, single-center, randomized controlled trial. A total of 124 patients was finally analyzed. The primary outcome was 28-day, in-ICU mortality. The secondary outcome included the length of ICU stay as well as the occurrence of hypoglycemia and severe hypoglycemia events. Results: The mean age was 78.3 (SD 11.5) years. The mean fasting glucose level and hemoglobin A1c level at baseline were 8.12 (SD 1.54) mmol/L and 7.2% (SD 0.8%), respectively. The percentage of participants with diabetes was 30.6% (38/124). The corresponding hazard ratio of the primary outcome in the intermittently scanned CGM (isCGM) group when compared with the point-of-care testing (POCT) group was 0.18 (95% CI 0.04-0.79). The average length of ICU stay was 10.0 (SD 7.57) days in the isCGM group and 14.0 (SD 6.86) days in the POCT group (P=.02). At the end of study period, the mean value of fasting glucose in the isCGM group and the POCT group was 6.07 (SD 0.63) mmol/L and 7.76 (SD 0.62) mmol/L, respectively (P=.01). A total of 207 hypoglycemia events (<3.9 mmol/L) was detected, with 43 in the isCGM group and 164 in the POCT group (P<.001). A total of 81 severe hypoglycemia events (<2.8 mmol/L) was detected, with 16 in the isCGM group and 65 in the POCT group (P<.001). The major adverse event in this study was bleeding in the puncture site, with a total of 6 occurrences in the isCGM group. During the follow-up, none of the participants dropped out because of bleeding in the puncture site. Conclusions: We found a significant clinical benefit from the use of CGM among frail and critically ill patients with COVID-19. These findings support the use of CGM in the ICU and might help with the extension of application in various in-hospital settings. Trial Registration: Chinese Clinical Trial Registry ChiCTR2200059733; https://www.chictr.org.cn/showproj.html?proj=169257 %M 39918851 %R 10.2196/67012 %U https://www.jmir.org/2025/1/e67012 %U https://doi.org/10.2196/67012 %U http://www.ncbi.nlm.nih.gov/pubmed/39918851 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e63910 %T Public Health Messaging on Twitter During the COVID-19 Pandemic: Observational Study %A Rao,Ashwin %A Sabri,Nazanin %A Guo,Siyi %A Raschid,Louiqa %A Lerman,Kristina %+ Information Sciences Institute, University of Southern California, 4676 Admiralty Way STE 1001, Marina del Rey, CA, 90292, United States, 1 2135050363, mohanrao@usc.edu %K public health %K public health messaging %K COVID-19 %K Twitter %K emotions %K moral foundations %K polarization %D 2025 %7 5.2.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Effective communication is crucial during health crises, and social media has become a prominent platform for public health experts (PHEs) to share information and engage with the public. At the same time, social media also provides a platform for pseudoexperts who may spread contrarian views. Despite the importance of social media, key elements of communication, such as the use of moral or emotional language and messaging strategy, particularly during the emergency phase of the COVID-19 pandemic, have not been explored. Objective: This study aimed to analyze how PHEs and pseudoexperts communicated with the public during the emergency phase of the COVID-19 pandemic. We focused on the emotional and moral language used in their messages on various COVID-19 pandemic–related topics. We also analyzed their interactions with political elites and the public’s engagement with PHEs to gain a deeper understanding of their influence on public discourse. Methods: For this observational study, we gathered a dataset of >539,000 original posts or reposts from 489 PHEs and 356 pseudoexperts on Twitter (subsequently rebranded X) from January 2020 to January 2021, along with the replies to the original posts from the PHEs. We identified the key issues that PHEs and pseudoexperts prioritized. We also determined the emotional and moral language in both the original posts and the replies. This allows us to characterize priorities for PHEs and pseudoexperts as well as differences in messaging strategy between these 2 groups. We also evaluated the influence of PHEs’ language and strategy on the public response. Results: Our analyses revealed that PHEs focused more on masking, health care, education, and vaccines, whereas pseudoexperts discussed therapeutics and lockdowns more frequently (P<.001). PHEs typically used positive emotional language across all issues (P<.001), expressing optimism and joy. Pseudoexperts often used negative emotions of pessimism and disgust, while limiting positive emotional language to origins and therapeutics (P<.001). Along the dimensions of moral language, PHEs and pseudoexperts differed on care versus harm and authority versus subversion across different issues. Negative emotional and moral language tends to boost engagement in COVID-19 discussions across all issues. However, the use of positive language by PHEs increases the use of positive language in the public responses. PHEs act as liberal partisans: they express more positive affect in their posts directed at liberals and more negative affect in their posts directed at conservative elites. In contrast, pseudoexperts act as conservative partisans. These results provide nuanced insights into the elements that have polarized the COVID-19 discourse. Conclusions: Understanding the nature of the public response to PHEs’ messages on social media is essential for refining communication strategies during health crises. Our findings underscore the importance of using moral-emotional language strategically to reduce polarization and build trust. %M 39908546 %R 10.2196/63910 %U https://www.jmir.org/2025/1/e63910 %U https://doi.org/10.2196/63910 %U http://www.ncbi.nlm.nih.gov/pubmed/39908546 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e41175 %T Digital Health Intervention (SANGYAN Podcast) to Enhance Knowledge Related to COVID-19 and Other Health Conditions: Protocol for an Implementation and Evaluation Study %A Joshi,Ashish %A Mohan,Surapaneni Krishna %A Pandya,Apurva Kumar %A Grover,Ashoo %A Saggu,Sofia Rani %A Revathi,Saravanavel Kalpana %A Sharma,Shruti %+ , School of Public Health, University of Memphis, Robison Hall 3825 DeSoto Avenue, Memphis, TN, 38152, United States, 1 443 570 6018, ashish1875@gmail.com %K podcast %K human-centered behavior %K pandemic %K coronavirus %K intervention %K digital health %K usefulness %K effectiveness %K usability %D 2025 %7 20.1.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: Podcasts are an unconventional method of disseminating information through audio to the masses. They are an emerging portable technology and a valuable resource that provides unlimited access for promoting health among participants. Podcasts related to health care have been used as a source of medical education, but there is a dearth of studies on the use of podcasts as a source of health information. This study will provide new perspectives by implementing the SANGYAN podcast, which contains information about COVID-19 and other health conditions.  Objective: The study aims to determine the usefulness and effectiveness of the SANGYAN podcast as a digital health intervention to address misinformation related to COVID-19 and other health conditions among individuals in Chennai, Tamil Nadu, India. Methods: An implementation and evaluation study will be conducted with 500 participants from the Panimalar Medical College Hospital & Research Institute (PMCHRI) and Rural Health Training Centre in Chennai. Among individuals aged 18 years and older, those residing in the selected urban and rural settings who visit the outpatient department of the PMCHRI and Rural Health Training Centre will be recruited. For participants who consent to the study, their sociodemographic details will be noted and their health literacy will be assessed using the Rapid Estimate of Adult Literacy in Medicine scale. Once the participants have listened to the podcast, the usability, acceptance, and user satisfaction of the podcast will be assessed. Descriptive analysis will be used for continuous variables, and frequency analysis will be used for categorical variables. Bivariate analysis will be conducted to understand the correlation of sociodemographic features in response to perception, usefulness, acceptance, and user satisfaction of the podcast. All analysis will be performed using SPSS (version 24), and the results will be reported with 95% CIs and P<.05. Results: As of December 2024, the SANGYAN podcast has been launched for voluntary usage in the PMCHRI. Conclusions: The finding from this research project will aid in the development and implementation of data-driven, evidence-based, and human-centered behavior change interventions using podcasts to address public health challenges among populations living in diverse settings. This would also help in enhancing the acceptability of podcasts as a source of health-related information. International Registered Report Identifier (IRRID): DERR1-10.2196/41175 %M 39832172 %R 10.2196/41175 %U https://www.researchprotocols.org/2025/1/e41175 %U https://doi.org/10.2196/41175 %U http://www.ncbi.nlm.nih.gov/pubmed/39832172 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e64940 %T How Authoritative Media and Personal Social Media Influence Policy Compliance Through Trust in Government and Risk Perception: Quantitative Cross-Sectional Survey Study %A Zhang,Hua %A Yang,Cheng %A Deng,Xiuxian %A Luo,Chunyan %+ Guangxi Minzu University, 188 East Daxue Road, Nanning, 530000, China, 86 13538076494, 202221252000175@stu.gxmzu.edu.cn %K paradox of trust %K risk perception %K trust in government %K policy compliance %K pandemic %K authoritative media %K social media %K China %D 2025 %7 20.1.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Previous studies on public compliance with policies during pandemics have primarily explained it from the perspectives of motivation theory, focusing on normative motivation (trust in policy-making institutions) and calculative motivation (fear of contracting the disease). However, the social amplification of a risk framework highlights that the media plays a key role in this process. Objective: This study aims to integrate the motivation theory of compliance behavior and the social amplification of risk framework to uncover the “black boxes” of the mechanisms by which normative motivation and calculative motivation influence public policy compliance behavior through the use of media. Methods: During the COVID-19 pandemic, we conducted a web-based survey of 2309 Chinese citizens from December 4, 2022, to March 21, 2023. We treated the public’s policy compliance behavior during the pandemic as the dependent variable. Media use, specifically the use of authoritative media and “we-media,” that is, personal social media accounts and media platforms operated by individuals, was set as the independent variable. Trust in government, representing normative motivation, and risk perception, representing calculative motivation, were included as mediating variables. A structural equation model was constructed and analyzed using Stata. Results: First, the mediation effect of trust in government indicates that the use of authoritative media can enhance trust in government, which significantly increases individuals’ policy compliance behavior (β coefficient=0.108, 95% CI 0.080-0.135; P<.001). Second, the mediation effect of risk perception shows that the use of we-media heightened individual risk perception, thereby significantly enhancing policy compliance behavior (β coefficient=0.012, 95% CI 0.002-0.021; P=.02). Third, the study revealed the “paradox of trust”: the chain mediation effect in which authoritative media increased trust in government and reduced risk perception, ultimately decreasing policy compliance behavior (β coefficient=–0.005, 95% CI –0.009 to –0.001; P=.008). Conclusions: By combining the motivation theory of compliance behavior with the social amplification of risk framework in risk communication, we found that trust in government, as a normative motivation, operates through authoritative media, while risk perception, as a calculative motivation, promotes compliance behavior through we-media. In addition, in major crises, the public’s use of authoritative media can lead to the paradox of trust: on the one hand, trust in the government increases policy compliance; on the other hand, this trust reduces risk perception, thereby decreasing compliance behavior. Authoritative institutions need to balance providing authoritative information with maintaining the public’s risk perception. %M 39832177 %R 10.2196/64940 %U https://www.jmir.org/2025/1/e64940 %U https://doi.org/10.2196/64940 %U http://www.ncbi.nlm.nih.gov/pubmed/39832177 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e52591 %T Global Use, Adaptation, and Sharing of Massive Open Online Courses for Emergency Health on the OpenWHO Platform: Survey Study %A Johnston,Jamie Sewan %A Skinner,Nadine Ann %A Tokar,Anna %A Arabi,Elham %A Ndiaye,Ngouille Yabsa %A Strehlow,Matthew Charles %A Utunen,Heini %+ Stanford Center for Health Education, Stanford University, 408 Panama Mall, Stanford, CA, 94305, United States, 1 650 647 0501, jamiejs@stanford.edu %K MOOCs %K online learning %K global health education %K digital health %K health worker training %K health emergencies %K outbreak %K COVID-19 %D 2025 %7 10.1.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic demonstrated the global need for accessible content to rapidly train health care workers during health emergencies. The massive open access online course (MOOC) format is a broadly embraced strategy for widespread dissemination of trainings. Yet, barriers associated with technology access, language, and cultural context limit the use of MOOCs, particularly in lower-resource communities. There is tremendous potential for MOOC developers to increase the global scale and contextualization of learning; however, at present, few studies examine the adaptation and sharing of health MOOCs to address these challenges. Objective: The World Health Organization’s Health Emergencies Programme Learning and Capacity Development Unit and the Stanford Center for Health Education collaborated to survey learners from 4 emergency health MOOCs on the OpenWHO platform to examine differences in course use by World Bank country income classification across three dimensions: (1) how health education MOOCs are used and shared, (2) how health workers adapt MOOC content to meet local training and information needs, and (3) how content adaptations help frontline health workers overcome barriers to using MOOCs. Methods: This study draws upon two sources of data: (1) course enrollment data collected from the 4 emergency health MOOCs (N=96,395) and (2) survey data collected from learners who participated in at least 1 of the 4 MOOCs (N=926). Descriptive statistics are used to summarize learner characteristics. Differences in enrollment, sharing, and adaptation by country income classification are examined using Pearson chi-square test. Results: Of the enrollees who indicated their country of residence, half were from lower-middle-income countries (LMICs; 43,168/85,882, 50%) and another 9% (7146/85,882) from low-income countries. The majority of all respondents shared content (819/926, 88%) and used content in official trainings (563/926, 61%). Respondents were more likely to share and use content for trainings in LMICs than in high-income countries (91% vs 81%; P=.001). Learners in LMICs also shared content with more people on average compared with high-income country learners although the difference is not statistically significant (9.48 vs 6.73 people; P=.084). Compared with learners in high-income countries, learners in LMICs were more likely to adapt materials to distribute via offline formats or technologies, such as WhatsApp or text message (31% vs 8%; P<.001); to address cultural, linguistic, or other contextual needs (20% vs 12%; P=.076); and to meet local guidelines (20% vs 9%; P=.010). Learners in LMICs indicated greater accessibility challenges due to technological and linguistic barriers. Conclusions: Learners commonly share content from MOOCs about public health emergencies; this is especially true in low-income countries and LMICs. However, content is often adapted and shared via alternative formats. Our findings identify a critical opportunity to improve MOOC design and dramatically scale the impact of MOOCs to better meet diverse global needs. %M 39792445 %R 10.2196/52591 %U https://www.jmir.org/2025/1/e52591 %U https://doi.org/10.2196/52591 %U http://www.ncbi.nlm.nih.gov/pubmed/39792445 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e67627 %T Trends in Mental Health Outcomes of College Students Amid the Pandemic (Roadmap mHealth App): Longitudinal Observational Study %A Jayaraj,Gautham %A Cao,Xiao %A Horwitz,Adam %A Rozwadowski,Michelle %A Shea,Skyla %A Hanauer,Shira N %A Hanauer,David A %A Tewari,Muneesh %A Shedden,Kerby %A Choi,Sung Won %+ Department of Pediatrics, Medical School, University of Michigan, 1200 E Hospital Dr, Medical Professional Building D4115, Ann Arbor, MI, 48109, United States, 1 734 615 5707, sungchoi@med.umich.edu %K mHealth %K college %K student %K mental health %K positive psychology %K flourishing %K COVID-19 %K wellbeing %K mobile phone %K SARS-CoV-2 %K coronavirus %K pandemic %K COVID %K app %K digital health %K smartphone %K eHealth %K telehealth %K telemedicine %K longitudinal %K higher education %K depression %K anxiety %K loneliness %D 2025 %7 9.1.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: The mental health crisis among college students intensified amid the COVID-19 pandemic, suggesting an urgent need for innovative solutions to support them. Previous efforts to address mental health concerns have been constrained, often due to the underuse or shortage of services. Mobile health (mHealth) technology holds significant potential for providing resilience-building support and enhancing access to mental health care. Objective: This study aimed to examine the trends in mental health and well-being outcomes over 3 years among college students, with an exploratory aim to assess the potential impact of the Roadmap mHealth app on these outcomes. Methods: A fully automated longitudinal observational study was conducted remotely from a large public academic institution in the Midwestern United States, evaluating mental health and well-being outcomes among college students using the Roadmap mHealth app over 3 fall semesters from 2020 to 2022. The study enrolled 2164 college students in Year I, with 1128 and 1033 students returning in Years II and III, respectively. Participants completed various self-reported measures, including the Patient Health Questionnaire-9 for depression, Generalized Anxiety Disorder-7 for anxiety, and additional metrics for coping, flourishing, and loneliness. Results: The findings indicated an evolving trajectory in students’ mental health. In Year I, depression and anxiety levels were higher compared with levels reported between 2014 and 2019, remaining stable into Year II. However, significant decreases were noted by Year III for both depression (Year I mean 7.78, SD 5.65 vs Year III mean 6.21, SD 4.68; t108=–2.90; P=.01) and anxiety (Year I mean 6.61, SD 4.91 vs Year III mean 5.62, SD 4.58; t116=–2.02; P=.046). Problem-focused coping decreased initially from Year I (mean 2.46, SD 0.58) to Year II (mean 2.36, SD 0.60; t1073=–5.87; P<.001), then increased by Year III (mean 2.40, SD 0.63; t706=2.26; P=.02). Emotion-focused (Year I mean 2.33, SD 0.41 vs Year III mean 2.22, SD 0.47; t994=–7.47; P<.001) and avoidant coping (Year I mean 1.76, SD 0.37 vs Year III mean 1.65, SD 0.38; t997=–8.53; P=.02) consistently decreased. Loneliness significantly decreased from Year I (mean 5.79, SD 1.74) to Year III (mean 5.17, SD 1.78; t1013=–10.74; P<.001), accompanied by an increase in flourishing from Year I (mean 63.78, SD 14.76) to Year III (mean 66.98, SD 15.06; t994=7.22; P<.001). Analysis of app usage indicated that the positive piggy bank and gratitude journal were the favored activities. Greater engagement with the app was positively correlated with enhanced flourishing, even after adjusting for demographic and sociobehavioral factors (β=.04, SE .016; t3974=2.17; P=.03). Conclusions: In this study, students’ mental health and well-being improved, with notable reductions in depression, anxiety, and loneliness, associated with an increase in flourishing. The app did not appear to worsen students’ mental health. Based on the usage pattern, it is possible the app enhanced positive psychology-based practices. Future research should explore the efficacy of mHealth interventions through randomized controlled trials to further understand their impact on college students’ mental health outcomes. Trial Registration: ClinicalTrials.gov NCT04766788; https://clinicaltrials.gov/ct2/show/NCT04766788 International Registered Report Identifier (IRRID): RR2-10.2196/29561 %M 39787592 %R 10.2196/67627 %U https://www.jmir.org/2025/1/e67627 %U https://doi.org/10.2196/67627 %U http://www.ncbi.nlm.nih.gov/pubmed/39787592 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 14 %N %P e55636 %T Citizen Worry and Adherence in Response to Government Restrictions in Switzerland During the COVID-19 Pandemic: Repeated Cross-Sectional Online Surveys %A Kraege,Vanessa %A Dumans-Louis,Céline %A Maglieri,Céline %A Bochatay,Séverine %A Durand,Marie-Anne %A Garnier,Antoine %A Selby,Kevin %A von Plessen,Christian %+ Department of Internal Medicine, Le Groupement Hospitalier de l’Ouest Lémanique, Chemin du Monastier 10, 1260 Nyon, Switzerland, 41 765567810, celine.dumanslouis@ghol.ch %K COVID-19 pandemic %K citizens %K worry %K anxiety %K communication %K prevention %K adherence %K restrictions %K Switzerland %K cross sectional %K online survey %K survey %K Swiss %K adults %K questionnaire %K social media %K linear regression %K age %K gender %K health literacy %K education %K women %K young people %D 2025 %7 7.1.2025 %9 Original Paper %J Interact J Med Res %G English %X Background: Good communication between health authorities and citizens is crucial for adherence to preventive measures during a pandemic. Crisis communication often appeals to worries about negative consequences for oneself or others. While worry can motivate protective behavior, it can also be overwhelming and lead to irrational choices or become a mental health problem. Also, the levels and consequences of worry can differ between different groups of citizens. Little is known about the evolution of worries during the pandemic and adherence to measures in distinct groups. Objective: This study aimed to evaluate worries in the Swiss population as well as associations between worry levels and citizens’ adherence to government restrictions during different phases of the COVID-19 pandemic. Methods: We carried out an observational study with 4 cross-sectional online surveys of adults in the Canton of Vaud, Switzerland. Questionnaires were distributed through social media and websites during 4 periods: survey 1: April 17 to May 14, 2020; survey 2: May 15 to June 22, 2020; survey 3: October 30 to December 12, 2020; and survey 4: June 18 to December 30, 2021. On visual analog scales from 0 to 100, participants reported worry, self-adherence to pandemic restrictions, and their perceived adherence to others. We used multivariable linear regression, adjusting for age, gender, health literacy, and education to assess associations between self-reported worry, adherence, and study periods. Results: We collected 7106 responses. After excluding 2377 questionnaires (incomplete, age <18 years, residence outside Vaud), 4729 (66.55%) were analyzed (mean age 47, SD 15.6 years, 63.96% women). Mean worry across the 4 periods was 42/100, significantly higher in women (44.25/100, vs 37.98/100; P<.001) and young people (43.77/100 in those aged 18-39 years, vs 41.69/100; P=.005; in those aged 40-64 years and 39.16/100; P=.002; in those aged >64 years). Worries were higher during survey 1 and survey 3 (52.41/100 and 56.32/100 vs 38.93/100, P<.001; and 35.71/100, P<.001) than during survey 2 and survey 4, respectively. This corresponds to pandemic peaks during which federal restrictions were better followed with self-reported adherence of 84.80/100 and 89.59/100 in survey 1 and survey 3 versus 78.69/100 (P<.001) and 78.64/100 (P<.001) in survey 2 and survey 4. A 2.9-point increase in worry score, adjusted for the pandemic period, gender, age, education, and health literacy, was associated with a 10-point increase in personal adherence score (95% CI 2.5-3.2; P<.001). Conclusions: Worries were higher in women, young people, and during the peak of the COVID-19 pandemic. Higher worry levels were associated with increased self-reported adherence to federal restrictions. Authorities should consider population worry levels and population subgroups in the planning and design of pandemic communication. %M 39773986 %R 10.2196/55636 %U https://www.i-jmr.org/2025/1/e55636 %U https://doi.org/10.2196/55636 %U http://www.ncbi.nlm.nih.gov/pubmed/39773986 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e59230 %T Quantifying the Regional Disproportionality of COVID-19 Spread: Modeling Study %A Sasaki,Kenji %A Ikeda,Yoichi %A Nakano,Takashi %K infectious disease %K COVID-19 %K epidemiology %K public health %K SARS-CoV-2 %K pandemic %K inequality measure %K information theory %K Kullback-Leibler divergence %D 2025 %7 3.1.2025 %9 %J JMIR Form Res %G English %X Background: The COVID-19 pandemic has caused serious health, economic, and social consequences worldwide. Understanding how infectious diseases spread can help mitigate these impacts. The Theil index, a measure of inequality rooted in information theory, is useful for identifying geographic disproportionality in COVID-19 incidence across regions. Objective: This study focused on capturing the degrees of regional disproportionality in incidence rates of infectious diseases over time. Using the Theil index, we aim to assess regional disproportionality in the spread of COVID-19 and detect epicenters where the number of infected individuals was disproportionately concentrated. Methods: To quantify the degree of disproportionality in the incidence rates, we applied the Theil index to the publicly available data of daily confirmed COVID-19 cases in the United States over a 1100-day period. This index measures relative disproportionality by comparing daily regional case distributions with population proportions, thereby identifying regions where infections are disproportionately concentrated. Results: Our analysis revealed a dynamic pattern of regional disproportionality in the confirmed cases by monitoring variations in regional contributions to the Theil index as the pandemic progressed. Over time, the index reflected a transition from localized outbreaks to widespread transmission, with high values corresponding to concentrated cases in some regions. We also found that the peaks in the Theil index often preceded surges in confirmed cases, suggesting its potential utility as an early warning signal. Conclusions: This study demonstrated that the Theil index is one of the effective indices for quantifying regional disproportionality in COVID-19 incidence rates. Although the Theil index alone cannot fully capture all aspects of pandemic dynamics, it serves as a valuable tool when used alongside other indicators such as infection and hospitalization rates. This approach allows policy makers to monitor regional disproportionality efficiently, offering insights for early intervention and targeted resource allocation. %R 10.2196/59230 %U https://formative.jmir.org/2025/1/e59230 %U https://doi.org/10.2196/59230 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e58566 %T Patient Organizations’ Digital Responses to the COVID-19 Pandemic: Scoping Review %A Wallraf,Simon %A Dierks,Marie-Luise %A John,Cosima %A Lander,Jonas %+ Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Carl-Neuberg-Str. 1, Hanover, 30625, Germany, 49 511 532 4038, Wallraf.Simon@mh-hannover.de %K patient organizations %K COVID-19 %K digital adaptation %K digital transformation %K scoping review %D 2024 %7 20.12.2024 %9 Review %J J Med Internet Res %G English %X Background: Patient organizations (POs) play a crucial role in supporting individuals with health conditions. Their activities range from counseling to support groups to advocacy. The COVID-19 pandemic and its related public health measures prompted rapid digital transformation efforts across multiple sectors, including health care. Objective: This study aimed to explore how POs digitally responded to pandemic-related circumstances, focusing on aspects such as the technologies used, positive outcomes, and challenges encountered. Methods: This scoping review followed the methodological guidance of the JBI (Joanna Briggs Institute) Scoping Review Methodology Group and adhered to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) reporting guidelines. A systematic search of PubMed, the Web of Science Core Collection, and the WHO (World Health Organization) COVID-19 database, supplemented by a citation search approach, was conducted. The initial search was performed on November 10, 2022, and updated on November 8, 2023. Publications were eligible if they were published after November 30, 2019, and addressed pandemic-related digitalization efforts of POs, defined as nonprofit organizations with a focus on health-related support. A 2-step screening process was used to identify relevant literature. Data were extracted using a standardized table to capture aspects such as digital adaptation activities (eg, types of technologies implemented, positive outcomes, challenges, and facilitating factors) and coded inductively to identify similarities across included publications, and the findings were synthesized narratively. Results: The search and its subsequent update yielded 2212 records, with 13 articles included in this review. These articles revealed a range of PO services that were digitally adapted during the pandemic, with videoconferencing software emerging as the most commonly used tool (n=9 articles). The digital adaptation of group-based support activities was the most frequently reported transformation (n=9). Other adaptations included the digitalization of counseling services (n=3) and the delivery of information and education (n=3), including educational workshops, weekly webinars, and the dissemination of information through digital newsletters. While the use of digital formats, particularly for POs’ group activities, often increased accessibility by breaking down preexisting barriers (n=5), they also created new barriers for certain groups, such as those lacking digital skills or resources (n=4). Some participants experienced a loss of interpersonal aspects, like a sense of community (n=3). However, further findings suggest that the digital delivery of such group activities preserved essential interpersonal aspects (n=7) and a preference among some participants to continue digital group activities (n=4), suggesting the potential for sustainability of such options post the COVID-19 pandemic. Conclusions: The rapid digitalization efforts of POs demonstrate their adaptability and the potential of digital technologies to improve support services, despite some challenges. Future digitalization strategies should focus, among other things, on promoting digital literacy to ensure the accessibility and inclusiveness of digital services. Trial Registration: OSF Registries, https://osf.io/anvf4 %M 39705075 %R 10.2196/58566 %U https://www.jmir.org/2024/1/e58566 %U https://doi.org/10.2196/58566 %U http://www.ncbi.nlm.nih.gov/pubmed/39705075 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 4 %N %P e53424 %T Application of a Language Model Tool for COVID-19 Vaccine Adverse Event Monitoring Using Web and Social Media Content: Algorithm Development and Validation Study %A Daluwatte,Chathuri %A Khromava,Alena %A Chen,Yuning %A Serradell,Laurence %A Chabanon,Anne-Laure %A Chan-Ou-Teung,Anthony %A Molony,Cliona %A Juhaeri,Juhaeri %+ Epidemiology and Benefit-Risk Department, Sanofi, 1755 Steeles Ave West, Toronto, ON, M2R 3T4, Canada, 1 4166672753, alena.khromava@sanofi.com %K adverse event %K COVID-19 %K detection %K large language model %K mass vaccination %K natural language processing %K pharmacovigilance %K safety %K social media %K vaccine %D 2024 %7 20.12.2024 %9 Original Paper %J JMIR Infodemiology %G English %X Background: Spontaneous pharmacovigilance reporting systems are the main data source for signal detection for vaccines. However, there is a large time lag between the occurrence of an adverse event (AE) and the availability for analysis. With global mass COVID-19 vaccination campaigns, social media, and web content, there is an opportunity for real-time, faster monitoring of AEs potentially related to COVID-19 vaccine use. Our work aims to detect AEs from social media to augment those from spontaneous reporting systems. Objective: This study aims to monitor AEs shared in social media and online support groups using medical context-aware natural language processing language models. Methods: We developed a language model–based web app to analyze social media, patient blogs, and forums (from 190 countries in 61 languages) around COVID-19 vaccine–related keywords. Following machine translation to English, lay language safety terms (ie, AEs) were observed using the PubmedBERT-based named-entity recognition model (precision=0.76 and recall=0.82) and mapped to Medical Dictionary for Regulatory Activities (MedDRA) terms using knowledge graphs (MedDRA terminology is an internationally used set of terms relating to medical conditions, medicines, and medical devices that are developed and registered under the auspices of the International Council for Harmonization of Technical Requirements for Pharmaceuticals for Human Use). Weekly and cumulative aggregated AE counts, proportions, and ratios were displayed via visual analytics, such as word clouds. Results: Most AEs were identified in 2021, with fewer in 2022. AEs observed using the web app were consistent with AEs communicated by health authorities shortly before or within the same period. Conclusions: Monitoring the web and social media provides opportunities to observe AEs that may be related to the use of COVID-19 vaccines. The presented analysis demonstrates the ability to use web content and social media as a data source that could contribute to the early observation of AEs and enhance postmarketing surveillance. It could help to adjust signal detection strategies and communication with external stakeholders, contributing to increased confidence in vaccine safety monitoring. %M 39705077 %R 10.2196/53424 %U https://infodemiology.jmir.org/2024/1/e53424 %U https://doi.org/10.2196/53424 %U http://www.ncbi.nlm.nih.gov/pubmed/39705077 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e52713 %T SARS-CoV-2 Infections in a Triad of Primary School Learners (Grades 1-7), Their Parents, and Teachers in KwaZulu-Natal, South Africa: Protocol for a Cross-Sectional and Nested Case-Cohort Study %A Dassaye,Reshmi %A Chetty,Terusha %A Daniels,Brodie %A Gaffoor,Zakir %A Spooner,Elizabeth %A Ramraj,Trisha %A Mthethwa,Ncengani %A Nsibande,Duduzile Faith %A Pillay,Saresha %A Bhana,Arvin %A Magasana,Vuyolwethu %A Reddy,Tarylee %A Mohlabi,Khanya %A Moore,Penelope Linda %A Burgers,Wendy A %A de Oliveira,Tulio %A Msomi,Nokukhanya %A Goga,Ameena %+ HIV and Other Infectious Diseases Research Unit, South African Medical Research Council, Francie van Zijl Drive, Parowvallei, Cape Town, 7505, South Africa, 27 312604486, Reshmi.Dassaye@mrc.ac.za %K COVID-19 %K SARS-CoV-2 %K learners %K seroprevalence %K long COVID %K transmission dynamics %D 2024 %7 19.12.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: In low- and middle-income countries (LMICs) such as South Africa, there is paucity of data on SARS-CoV-2 infections among children attending school, including seroprevalence and transmission dynamics. Objective: This pilot study aims to assess (1) the prevalence of self-reported or confirmed SARS-CoV-2 prior infections, COVID-19 symptoms (including long COVID), seroprevalence of SARS-CoV-2 antibodies, and general/mental health, (2) longitudinal changes in SARS-CoV-2 seroprevalence, and (3) SARS-CoV-2 acute infections, immune responses, transmission dynamics, and symptomatic versus asymptomatic contacts in a unique cohort of unvaccinated primary school learners, their parents, teachers, and close contacts in semirural primary school settings. Methods: Learners (grades 1-7) from primary schools in KwaZulu-Natal, South Africa, their parents, and teachers will be invited to enroll into the COVID kids school study (CoKiDSS). CoKiDSS comprises 3 parts: a cross-sectional survey (N=640), a follow-up survey (n=300), and a nested case-cohort substudy. Finger-prick blood and saliva samples will be collected for serological and future testing, respectively, in the cross-sectional (451 learners:147 parents:42 teachers) and follow-up (210 learners:70 parents:20 teachers) surveys. The nested case-cohort substudy will include cases from the cross-sectional survey with confirmed current SARS-CoV-2 infection (n=30) and their close contacts (n=up to 10 per infected participant). Finger-prick blood (from all substudy participants), venous blood (from cases), and nasal swabs (from cases and contacts) will be collected for serological testing, immunological testing, and viral genome sequencing, respectively. Questionnaires covering sociodemographic and general and mental health information, prior and current SARS-CoV-2 symptoms and testing information, vaccination status, preventative behavior, and lifestyle will be administered. Statistical methods will include generalized linear mixed models, intracluster correlation, descriptive analysis, and graphical techniques. Results: A total of 645 participants were enrolled into the cross-sectional survey between May and August 2023. A subset of 300 participants were followed up in the follow-up survey in October 2023. Screening of the participants into the nested case-cohort substudy is planned between November 2023 and September 2024. Data cleanup and analysis for the cross-sectional survey is complete, while those for the follow-up survey and nested case substudy will be completed by the third quarter of 2024. The dissemination and publication of results is anticipated for the fourth quarter of 2024. Conclusions: This study provides data from an LMIC setting on the impact of SARS-CoV-2 on school-attending learners, their parents, and teachers 3 years after the SARS-CoV-2 pandemic was declared and 21-24 months after resumption of normal school attendance. In particular, this study will provide data on the prevalence of self-reported or confirmed SARS-CoV-2 prior infection, prior and current symptoms, seroprevalence, changes in seroprevalence, SARS-CoV-2 transmission, SARS-CoV-2 adaptive immune responses, and symptoms of long COVID and mental health among a triad of learners, their parents, and teachers. International Registered Report Identifier (IRRID): DERR1-10.2196/52713 %M 39700491 %R 10.2196/52713 %U https://www.researchprotocols.org/2024/1/e52713 %U https://doi.org/10.2196/52713 %U http://www.ncbi.nlm.nih.gov/pubmed/39700491 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e57608 %T Implementation and User Satisfaction of a Comprehensive Telemedicine Approach for SARS-CoV-2 Self-Sampling: Monocentric, Prospective, Interventional, Open-Label, Controlled, Two-Arm Feasibility Study %A Voit,Florian %A Erber,Johanna %A Egert-Schwender,Silvia %A Hanselmann,Michael %A Laxy,Michael %A Kehl,Victoria %A Hoffmann,Dieter %A Jeske,Samuel D %A Michler,Thomas %A Protzer,Ulrike %A Kohlmayer,Florian %A Schmid,Roland M %A Spinner,Christoph D %A Weidlich,Simon %K telemedicine %K self-sampling %K SARS-CoV-2 %K user satisfaction %K user %K implementation %K acute respiratory syndrome %K respiratory syndrome %K coronavirus %K self-sampling %K monocentric %K prospective %K interventional %K open-label %K two-arm feasibility study %K innovative %K application %K healthcare %K treatment %K mobile phone %K pandemic control %K health care %D 2024 %7 11.12.2024 %9 %J JMIR Form Res %G English %X Background: The universal availability of smartphones has created new opportunities for innovative telemedicine applications in health care. The COVID-19 pandemic has heightened the demand for contactless health care services, making SARS-CoV-2 polymerase chain reaction (PCR) testing a crucial component of pandemic containment. Objective: This feasibility study aimed to examine a comprehensive telemedicine approach for SARS-CoV-2 testing, focusing on the practicality, user satisfaction, and economic implications of self-sampling guided by a telemedicine platform. Methods: The study process involved shipping self-sampling kits, providing instructions for at-home sample collection, processing biomaterials (swabs and capillary blood), communicating test results, and providing interoperable data for clinical routine and research through a medical mobile app. A total of 100 individuals were randomly assigned to either the conventional health care professional (HCP)–performed SARS-CoV-2 testing group (conventional testing group, CG) or the telemedicine-guided SARS-CoV-2 self-sampling approach (telemedicine group, TG). Feasibility of the TG approach, user satisfaction, user-centered outcomes, and economic aspects were assessed and compared between the groups. Results: In the TG group, 47 out of 49 (95%) individuals received a self-sampling kit via mail, and 37out of 49 (76%) individuals successfully returned at least one sample for diagnostics. SARS-CoV-2 PCR tests were conducted in 95% (35/37) of TG cases compared with 88% (44/50) in the CG. Users in the TG reported high satisfaction levels with ease of use (5.2/7), interface satisfaction (5.2/7), and usefulness (4.3/7). A microcosting model indicated a slightly higher cost for the TG approach than the CG approach. The TG demonstrated the potential to facilitate interoperable data transmission by providing anonymized, standardized datasets for extraction using Health Level 7-Fast Healthcare Interoperability Resources. This supports the national COVID-19 Data Exchange Platform and facilitates epidemiological evaluation based on the German COVID Consensus dataset. Conclusion: These preliminary findings suggest that a telemedicine-based approach to SARS-CoV-2 testing is feasible and could be integrated into existing hospital data infrastructures. This model has the potential for broader application in medical care, offering a scalable solution that could improve user satisfaction and treatment quality in the future. Trial Registration: Deutsches Register Klinischer Studien (DRKS) DRKS00027093; https://www.drks.de/search/de/trial/DRKS00027093 %R 10.2196/57608 %U https://formative.jmir.org/2024/1/e57608 %U https://doi.org/10.2196/57608 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 12 %N %P e51219 %T Information Source Characteristics of Personal Data Leakage During the COVID-19 Pandemic in China: Observational Study %A Wang,Zhong %A Hu,Fangru %A Su,Jie %A Lin,Yuyao %K public health emergency %K privacy leakage %K characteristics of information sources %K COVID-19 %K China %K information source %K data privacy %K public health %K leakage %D 2024 %7 10.12.2024 %9 %J JMIR Med Inform %G English %X Background: During the COVID-19 pandemic, in the period of preventing and controlling the spread of the virus, a large amount of personal data was collected in China, and privacy leakage incidents occurred. Objective: We aimed to examine the information source characteristics of personal data leakage during the COVID-19 pandemic in China. Methods: We extracted information source characteristics of 40 personal data leakage cases using open coding and analyzed the data with 1D and 2D matrices. Results: In terms of organizational characteristics, data leakage cases mainly occurred in government agencies below the prefecture level, while few occurred in the medical system or in high-level government organizations. The majority of leakers were regular employees or junior staff members rather than temporary workers or senior managers. Family WeChat groups were the primary route for disclosure; the forwarding of documents was the main method of divulgence, while taking screenshots and pictures made up a comparatively smaller portion. Conclusions: We propose the following suggestions: restricting the authority of nonmedical institutions and low-level government agencies to collect data, strengthening training for low-level employees on privacy protection, and restricting the flow of data on social media through technical measures. %R 10.2196/51219 %U https://medinform.jmir.org/2024/1/e51219 %U https://doi.org/10.2196/51219 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e60963 %T Global and Regional Prevalence of Domestic Violence During the COVID-19 Pandemic and Its Determinants: Protocol for a Systematic Review and Meta-Analysis %A Bidhendi-Yarandi,Razieh %A Biglarian,Akbar %A Nosrati Nejad,Farhad %A Roshanfekr,Payam %A Behboudi-Gandevani,Samira %+ Faculty of Nursing and Health Sciences, Nord University, Postbox 1490, Bodø, 8049, Norway, 47 75517670, samira.behboudi-gandevani@nord.no %K COVID-19 %K domestic violence %K systematic review and meta-analysis %K lockdowns %K pandemic effects %K intimate partner violence %K elder abuse %K child abuse %K vulnerable populations %D 2024 %7 9.12.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Domestic violence is one of the most significant global public health priorities. This social problem could be accelerated by global catastrophes such as the COVID-19 pandemic. The structural changes due to the imposition of health measures, combined with personal and social problems, may worsen the situation. Objective: This study aims to investigate the global and regional prevalence of domestic violence during the COVID-19 pandemic and its determinants. Methods: We will perform a comprehensive review of the literature in PubMed, PsycINFO, Embase, Cochrane COVID-19 Register, and Applied Social Sciences Index and Abstracts, up to July 2024. This review will adhere to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) reporting guidelines. Observational studies will be considered eligible if they have a population-based design, report the number of cases or prevalence of domestic violence during the COVID-19 pandemic, and report potential determinants. Studies in languages other than English, those with unclear data, case reports, conference proceedings, reviews, and letters will be excluded. To assess the methodological quality, a standardized critical appraisal checklist for studies reporting prevalence data will be used. A robust Bayesian approach will be applied using the STATA software package (version 14; STATA Inc) and JASP 0.19.1 (GNU Affero General Public License [GNU AGPL]) software. Results: The search and screening for the systematic literature review are anticipated to be finished in October 2024. Data extraction, quality appraisal, and subsequent data synthesis will begin in November 2024. The review is expected to be completed by April 2025, and the study results will be published in 2025. Conclusions: This systematic review and meta-analysis will address significant gaps in understanding the pandemic’s impact on domestic violence, providing a comprehensive assessment of its prevalence and contributing factors. Despite some limitations, the study incorporates diverse data sources and vulnerable groups to offer a detailed and accurate picture. The findings will inform targeted interventions and policy responses to mitigate the impact of future global crises on domestic violence rates. Trial Registration: PROSPERO CRD42022351634; https://tinyurl.com/yth37jkx International Registered Report Identifier (IRRID): PRR1-10.2196/60963 %M 39652848 %R 10.2196/60963 %U https://www.researchprotocols.org/2024/1/e60963 %U https://doi.org/10.2196/60963 %U http://www.ncbi.nlm.nih.gov/pubmed/39652848 %0 Journal Article %@ 2152-7202 %I JMIR Publications %V 16 %N %P e48194 %T Implementing a Patient Portal for the Remote Follow-Up of Self-Isolating Patients With COVID-19 Infection Through Patient and Stakeholder Engagement (the Opal-COVID Study): Mixed Methods Pilot Study %A Ma,Yuanchao %A Lessard,David %A Vicente,Serge %A Engler,Kim %A Rodriguez Cruz,Adriana %A Laymouna,Moustafa %A , %A Hijal,Tarek %A Del Balso,Lina %A Thériault,Guillaume %A Paisible,Nathalie %A Kronfli,Nadine %A Pomey,Marie-Pascale %A Peiris,Hansi %A Barkati,Sapha %A Brouillette,Marie-Josée %A Klein,Marina %A Cox,Joseph %A de Pokomandy,Alexandra %A Asselah,Jamil %A Bartlett,Susan J %A Lebouché,Bertrand %+ Chronic Viral Illness Service, McGill University Health Centre, D02.4110 – Glen Site, 1001 Decarie Blvd, Montreal, QC, H4A 3J1, Canada, 1 514 843 2090, bertrand.lebouche@mcgill.ca %K SARS-CoV-2 %K coronavirus %K infectious disease %K implementation science %K Canada %K patient portal %K telehealth %K telemedicine %K app %K health information technology %K remote monitoring %K mobile phone %D 2024 %7 4.12.2024 %9 Original Paper %J J Particip Med %G English %X Background: The COVID-19 pandemic was an unprecedent challenge to public health systems, with 95% of cases in Quebec sent home for self-isolation. To ensure continuous care, we implemented an intervention supported by a patient portal (Opal) to remotely monitor at-home patients with COVID-19 via daily self-reports of symptoms, vital signs, and mental health that were reviewed by health care professionals. Objective: We describe the intervention’s implementation, focusing on the (1) process; (2) outcomes, including feasibility, fidelity, acceptability, usability, and perceived response burden; and (3) barriers and facilitators encountered by stakeholders. Methods: The implementation followed a co-design approach operationalized through patient and stakeholder engagement. The intervention included a 14-day follow-up for each patient. In the mixed methods study at the McGill University Health Centre in Montreal, Quebec, participants completed questionnaires on implementation outcomes on days 1, 7, and 14. All scores were examined against predefined success thresholds. Linear mixed models and generalized estimating equations were used to assess changes in scores over time and whether they differed by sex, age, and race. Semistructured interviews were conducted with expert patients, health care professionals, and coordinators for the qualitative analysis and submitted to thematic analysis guided by the Consolidated Framework for Implementation Research. Results: In total, 51 participants were enrolled between December 2020 and March 2021; 49 (96%) were included in the quantitative analysis. Observed recruitment and retention rates (51/52, 98% and 49/51, 96%) met the 75% feasibility success threshold. Over 80% of the participants found it “quite easy/very easy” to complete the daily self-report, with a completion rate (fidelity) of >75% and a nonsignificant decreasing trend over time (from 100%, 49/49 to 82%, 40/49; P=.21). Mean acceptability and usability scores at all time points exceeded the threshold of 4 out of 5. Acceptability scores increased significantly between at least 2 time points (days 1, 7, and 14: mean 4.06, SD 0.57; mean 4.26, SD 0.59; and mean 4.25, SD 0.57; P=.04). Participants aged >50 years reported significantly lower mean ease of use (usability) scores than younger participants (days 1, 7, and 14: mean 4.29, SD 0.91 vs mean 4.67, SD 0.45; mean 4.13, SD 0.89 vs mean 4.77, SD 0.35; and mean 4.24, SD 0.71 vs mean 4.72, SD 0.71; P=.004). In total, 28 stakeholders were interviewed between June and September 2021. Facilitators included a structured implementation process, a focus on stakeholders’ recommendations, the adjustability of the intervention, and the team’s emphasis on safety. However, Opal’s thorough privacy protection measures and limited acute follow-up capacities were identified as barriers, along with implementation delays due to data security–related institutional barriers. Conclusions: The intervention attained targets across all studied implementation outcomes. Qualitative findings highlighted the importance of stakeholder engagement. Telehealth tools have potential for the remote follow-up of acute health conditions. International Registered Report Identifier (IRRID): RR2-10.2196/35760 %M 39631058 %R 10.2196/48194 %U https://jopm.jmir.org/2024/1/e48194 %U https://doi.org/10.2196/48194 %U http://www.ncbi.nlm.nih.gov/pubmed/39631058 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e53320 %T Ever Use of Telehealth in Nebraska by March 2021: Cross-Sectional Analysis %A Smith,Lisa C %A Johnson,George %A Jadhav,Snehal %A Kabayundo,Josiane %A Ahuja,Muskan %A Wang,Hongmei %A Ratnapradipa,Kendra L %+ Department of Epidemiology, University of Nebraska Medical Center, 984395 Nebraska Medical Center, Omaha, NE, 68198-4395, United States, 1 402 552 7238, kendra.ratnapradipa@unmc.edu %K COVID-19 %K digital divide %K health care access %K telehealth %K cross-sectional study %K Nevada %K United States %K adult %K medical care %K geographical area %K disparity %K accessibility %K utilization %K survey %K chi-square test %K regression model %K socioeconomic %K demographic %K health condition %K digital health %D 2024 %7 28.11.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Nationally, COVID-19 spurred the uptake of telehealth to facilitate patients’ access to medical care, especially among individuals living in geographically isolated areas. Despite the potential benefits of telehealth to address health care access barriers and enhance health outcomes, there are still disparities in the accessibility and utilization of telehealth services. Hence, identifying facilitators and barriers to telehealth should be prioritized to ensure that disparities are mitigated rather than exacerbated. Objective: This study aims to identify factors associated with ever use of telehealth in Nebraska, a primarily rural state with a significant portion of its population living in nonmetropolitan areas. Methods: A stratified random sample of Nebraska households (n=5300), with oversampling of census tracts with at least 30% African American, Hispanic, or Native American populations, received a mailed survey (English and Spanish) with web-based response options about social determinants of health and health care access (October 2020-March 2021). Survey weights were used for all calculations. Chi-square tests were used to compare telehealth use (yes or no) by participant sociodemographic, health, and access variables. Robust Poisson regression models were used to compute prevalence odds ratios (POR) with 95% CIs of telehealth use after controlling for socioeconomic, demographic, and health conditions. Results: The overall response rate was 20.8% (1101/5300). About 25.5% of Nebraska adults had ever used telehealth (urban 26.4%, rural 20.8%), despite 97% of respondents reporting internet access (98.3% urban, 90.5% rural). In the chi-square analysis, telehealth use was statistically significantly more common (P<.05) among those who are aged <45 years (32.4%), female (30.7%), and non-Hispanic (25.9%); with at least a bachelor’s degree (32.6%); who had a routine checkup (30.2%) or health care visit other than a routine checkup (34.2%); and with any chronic health conditions (29.6%) but did not differ (P≥.05) by race, marital status, income, insurance, having a primary care provider, or 1-way travel time for medical visits. In univariate models, internet access, age, sex, ethnicity, education, any health care visit in the past year, and no chronic health condition were significant (P<.05). When adjusted, education (POR 1.87, 95% CI 0.33-10.63) and sex (1.38, 0.93-2.04) were not significant, but internet access (5.43, 1.62-18.16), age <45 (5.33, 2.22-12.81) and 45-64 years (9.05, 2.37-34.62), non-Hispanic ethnicity (7.40, 2.39-22.90), any health care visit (2.43, 1.23-4.79), and any chronic condition (1.73, 1.09-2.76) were significantly associated with having ever used telehealth. Conclusions: This study highlights disparities in telehealth use. Despite high coverage, internet access was a significant predictor of telehealth use, highlighting the role of the digital divide in telehealth access and use. Telehealth use was significantly less prevalent among older adults, people without chronic health conditions, and Hispanic individuals. Targeted interventions that address barriers to telehealth use and improve health care access are warranted. %M 39608002 %R 10.2196/53320 %U https://www.jmir.org/2024/1/e53320 %U https://doi.org/10.2196/53320 %U http://www.ncbi.nlm.nih.gov/pubmed/39608002 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e56926 %T SARS-CoV-2 Infection Risk by Vaccine Doses and Prior Infections Over 24 Months: ProHEpiC-19 Longitudinal Study %A Torán-Monserrat,Pere %A Lamonja-Vicente,Noemí %A Costa-Garrido,Anna %A Carrasco-Ribelles,Lucía A %A Quirant,Bibiana %A Boigues,Marc %A Molina,Xaviera %A Chacón,Carla %A Dacosta-Aguayo,Rosalia %A Arméstar,Fernando %A Martínez Cáceres,Eva María %A Prado,Julia G %A Violán,Concepción %A , %K SARS-CoV-2 %K COVID-19 %K health care workers %K cohort %K extended Cox models %K coronavirus %K epidemiology %K epidemiological %K risks %K infectious %K respiratory %K longitudinal %K vaccines %K vaccination %K vaccinated %D 2024 %7 22.11.2024 %9 %J JMIR Public Health Surveill %G English %X Background: As the vaccination campaign against COVID-19 progresses, it becomes crucial to comprehend the lasting effects of vaccination on safeguarding against new infections or reinfections. Objective: This study aimed to assess the risk of new SARS-CoV-2 infections based on the number of vaccine doses, prior infections, and other clinical characteristics. Methods: We defined a cohort of 800 health care workers in a 24-month study (March 2020 to December 2022) in northern Barcelona to determine new infections by SARS-CoV-2. We used extended Cox models, specifically Andersen-Gill (AG) and Prentice-Williams-Peterson, and we examined the risk of new infections. The AG model incorporated variables such as sex, age, job title, number of chronic conditions, vaccine doses, and prior infections. Additionally, 2 Prentice-Williams-Peterson models were adjusted, one for those individuals with no or 1 infection and another for those with 2 or 3 infections, both with the same covariates as the AG model. Results: The 800 participants (n=605, 75.6% women) received 1, 2, 3, and 4 doses of the vaccine. Compared to those who were unvaccinated, the number of vaccine doses significantly reduced (P<.001) the risk of infection by 66%, 81%, 89%, and 99%, respectively. Unit increase in the number of prior infections reduced the risk of infection by 75% (P<.001). When separating individuals by number of previous infections, risk was significantly reduced for those with no or 1 infection by 61% (P=.02), and by 88%, 93%, and 99% (P<.001) with 1, 2, 3, or 4 doses, respectively. In contrast, for those with 2 or 3 previous infections, the reduction was only significant with the fourth dose, at 98% (P<.001). The number of chronic diseases only increased the risk by 28%‐31% (P<.001) for individuals with 0‐1 previous infections. Conclusions: The study suggests that both prior infections and vaccination status significantly contribute to SARS-CoV-2 immunity, supporting vaccine effectiveness in reducing risk of reinfection for up to 24 months after follow-up from the onset of the pandemic. These insights contribute to our understanding of long-term immunity dynamics and inform strategies for mitigating the impact of COVID-19. Trial Registration: ClinicalTrials.gov NCT04885478; http://clinicaltrials.gov/ct2/show/NCT04885478 %R 10.2196/56926 %U https://publichealth.jmir.org/2024/1/e56926 %U https://doi.org/10.2196/56926 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e50235 %T The Challenges and Lessons Learned Building a New UK Infrastructure for Finding and Accessing Population-Wide COVID-19 Data for Research and Public Health Analysis: The CO-CONNECT Project %A Jefferson,Emily %A Milligan,Gordon %A Johnston,Jenny %A Mumtaz,Shahzad %A Cole,Christian %A Best,Joseph %A Giles,Thomas Charles %A Cox,Samuel %A Masood,Erum %A Horban,Scott %A Urwin,Esmond %A Beggs,Jillian %A Chuter,Antony %A Reilly,Gerry %A Morris,Andrew %A Seymour,David %A Hopkins,Susan %A Sheikh,Aziz %A Quinlan,Philip %+ Population Health and Genomics, School of Medicine, University of Dundee, The Health Informatics Centre, Ninewells Hospital and Medical School, Dundee, DD2 1FD, United Kingdom, 44 01382383943, e.r.jefferson@dundee.ac.uk %K COVID-19 %K infrastructure %K trusted research environments %K safe havens %K feasibility analysis %K cohort discovery %K federated analytics %K federated discovery %K lessons learned %K population wide %K data %K public health %K analysis %K CO-CONNECT %K challenges %K data transformation %D 2024 %7 20.11.2024 %9 Viewpoint %J J Med Internet Res %G English %X The COVID-19-Curated and Open Analysis and Research Platform (CO-CONNECT) project worked with 22 organizations across the United Kingdom to build a federated platform, enabling researchers to instantaneously and dynamically query federated datasets to find relevant data for their study. Finding relevant data takes time and effort, reducing the efficiency of research. Although data controllers could understand the value of such a system, there were significant challenges and delays in setting up the platform in response to COVID-19. This paper aims to present the challenges and lessons learned from the CO-CONNECT project to support other similar initiatives in the future. The project encountered many challenges, including the impacts of lockdowns on collaboration, understanding the new architecture, competing demands on people’s time during a pandemic, data governance approvals, different levels of technical capabilities, data transformation to a common data model, access to granular-level laboratory data, and how to engage public and patient representatives meaningfully on a highly technical project. To overcome these challenges, we developed a range of methods to support data partners such as explainer videos; regular, short, “touch base” videoconference calls; drop-in workshops; live demos; and a standardized technical onboarding documentation pack. A 4-stage data governance process emerged. The patient and public representatives were fully integrated team members. Persistence, patience, and understanding were key. We make 8 recommendations to change the landscape for future similar initiatives. The new architecture and processes developed are being built upon for non–COVID-19–related data, providing an infrastructural legacy. %M 39566065 %R 10.2196/50235 %U https://www.jmir.org/2024/1/e50235 %U https://doi.org/10.2196/50235 %U http://www.ncbi.nlm.nih.gov/pubmed/39566065 %0 Journal Article %@ 2562-7600 %I JMIR Publications %V 7 %N %P e44580 %T Remote Patient Monitoring at Home in Patients With COVID-19: Narrative Review %A Cornelis,Justien %A Christiaens,Wendy %A de Meester,Christophe %A Mistiaen,Patriek %+ Belgian Health Care Knowledge Centre, Kruidtuinlaan 55, Brussels, 1000, Belgium, 32 475834741, justien.cornelis@kce.fgov.be %K COVID-19 %K coronavirus disease %K telemonitoring %K remote patient monitoring %K review %K pandemic %K at-home monitoring %K implementation %K health care %K patient care %D 2024 %7 19.11.2024 %9 Review %J JMIR Nursing %G English %X Background: During the pandemic, health care providers implemented remote patient monitoring (RPM) for patients experiencing COVID-19. RPM is an interaction between health care professionals and patients who are in different locations, in which certain patient functioning parameters are assessed and followed up for a certain duration of time. The implementation of RPM in these patients aimed to reduce the strain on hospitals and primary care. Objective: With this literature review, we aim to describe the characteristics of RPM interventions, report on patients with COVID-19 receiving RPM, and provide an overview of outcome variables such as length of stay (LOS), hospital readmission, and mortality. Methods: A combination of different searches in several database types (traditional databases, trial registers, daily [Google] searches, and daily PubMed alerts) was run daily from March 2020 to December 2021. A search update for randomized controlled trials (RCTs) was performed in April 2022. Results: The initial search yielded more than 4448 articles (not including daily searches). After deduplication and assessment for eligibility, 241 articles were retained describing 164 telemonitoring studies from 160 centers. None of the 164 studies covering 248,431 patients reported on the presence of a randomized control group. Studies described a “prehosp” group (96 studies) with patients who had a suspected or confirmed COVID-19 diagnosis and who were not hospitalized but closely monitored at home or a “posthosp” group (32 studies) with patients who were monitored at home after hospitalization for COVID-19. Moreover, 34 studies described both groups, and in 2 studies, the description was unclear. In the prehosp and posthosp groups, there were large variations in the number of emergency department (ED) visits (0%-36% and 0%-16%, respectively) and no convincing evidence that RPM leads to less or more ED visits or hospital readmissions (0%-30% and 0%-22%, respectively). Mortality was generally low, and there was weak to no evidence that RPM is associated with lower mortality. Moreover, there was no evidence that RPM shortens previous LOS. A literature update identified 3 small-scale RCTs, which could not demonstrate statistically significant differences in these outcomes. Most papers claimed savings; however, the scientific base for these claims was doubtful. The overall patient experiences with RPM were positive, as patients felt more reassured, although many patients declined RPM for several reasons (eg, technological embarrassment, digital literacy). Conclusions: Based on these results, there is no convincing evidence that RPM in COVID-19 patients avoids ED visits or hospital readmissions and shortens LOS or reduces mortality. On the other hand, there is no evidence that RPM has adverse outcomes. Further research should focus on developing, implementing, and evaluating an RPM framework. %M 39287362 %R 10.2196/44580 %U https://nursing.jmir.org/2024/1/e44580 %U https://doi.org/10.2196/44580 %U http://www.ncbi.nlm.nih.gov/pubmed/39287362 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e49708 %T Designing and Validating a Survey for National-Level Data During the COVID-19 Pandemic in Sri Lanka: Cross-Sectional Mobile Phone Surveys %A Phadnis,Rachael %A Perera,Udara %A Lea,Veronica %A Davlin,Stacy %A Lee,Juliette %A Siesel,Casey %A Abeygunathilaka,Dhanushka %A Wickramasinghe,S C %+ Centers for Disease Control and Prevention Foundation, 600 Peachtree St NE, #1000, Atlanta, GA, 30308, United States, 1 320 248 7430, rachaelphadnis@gmail.com %K pilot study %K mobile phone survey %K survey methodology %K COVID-19 %K data collection %K national survey %K pandemic %K population-based study %K Sri Lanka %K middle-income countries %K low-income countries %K vaccine acceptability %K vaccine %K COVID-19 vaccination %D 2024 %7 8.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic has generated a demand for timely data, resulting in a surge of mobile phone surveys for tracking the impacts of and responses to the pandemic. Mobile phone surveys have become a preferred mode of data collection across low- and middle-income countries. Objective: This study piloted 2 population-based, cross-sectional mobile phone surveys among Sri Lankan residents in 2020 and 2021 during the COVID-19 pandemic. The surveys aimed to gather data on knowledge, attitudes, and practices, vaccine acceptability, availability, and barriers to COVID-19 testing, and use of a medicine distribution service. Methods: The study used Surveda, an open-source survey tool developed by the NCD (noncommunicable disease) Mobile Phone Survey Data 4 Health Initiative, for data collection and management. The surveys were conducted through interactive voice response using automated, prerecorded messages in Sinhala, Tamil, and English. The sample design involved random sampling of mobile phone numbers, stratified by sex, proportional to the general population. Eligibility criteria varied between surveys, targeting adults aged 35 years and older with any noncommunicable disease for the first survey and all adults for the second survey. The data were adjusted to population estimates, and statistical analysis was conducted using SAS (SAS Institute) and R software (R Core Team). Descriptive statistics, Rao-Scott chi-square tests, and z tests were used to analyze the data. Response rates, cooperation rates, and productivity of the sampling approach were calculated. Results: In the first survey, n=5001, the overall response rate was 7.5%, with a completion rate of 85.6%. In the second survey, n=1250, the overall response rate was 10.9%, with a completion rate of 61.9%. Approximately 3 out of 4 adults reported that they avoided public places (888/1175, 75.6%), more than two-thirds avoided public transportation (808/1173, 68.9%), and 9 out of 10 practiced physical distancing (1046/1167, 89.7%). Approximately 1 out of 10 Sri Lankan persons reported being tested for COVID-19, and the majority of those received a polymerase chain reaction test (112/161, 70%). Significantly more males than females reported being tested for COVID-19 (98/554, 17.8% vs 61/578, 10.6%, respectively; P<.001). Finally, the majority of adult Sri Lankan people reported that they definitely or probably would get the COVID-19 vaccination (781/1190, 65.7%). Conclusions: The surveys revealed that, overall, the adult Sri Lankan population adhered to COVID-19 mitigation strategies. These findings underscore the use of mobile phone surveys in swiftly and easily providing essential data to inform a country’s response during the COVID-19 pandemic, obviating the need for face-to-face data collection. %M 39514850 %R 10.2196/49708 %U https://formative.jmir.org/2024/1/e49708 %U https://doi.org/10.2196/49708 %U http://www.ncbi.nlm.nih.gov/pubmed/39514850 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e64270 %T Digital Contact Tracing Implementation Among Leaders and Health Care Workers in a Pediatric Hospital During the COVID-19 Pandemic: Qualitative Interview Study %A O'Dwyer,Brynn %A Jaana,Mirou %A Hui,Charles %A Chreim,Samia %A Ellis,Jennifer %+ Telfer School of Management, University of Ottawa, 55 Laurier Ave E, Ottawa, ON, K1N 6N5, Canada, 1 6135625731 ext 3400, jaana@telfer.uottawa.ca %K COVID-19 %K surveillance %K technology %K digital contact tracing %K qualitative %K hospitals %K Reach, Effectiveness, Adoption, Implementation, and Maintenance framework %K RE-AIM %D 2024 %7 5.11.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Health systems had to rapidly implement infection control strategies to sustain their workforces during the COVID-19 pandemic. Various outbreak response tools, such as digital contact tracing (DCT), have been developed to monitor exposures and symptoms of health care workers (HCWs). Limited research evidence exists on the experiences with these technologies and the impacts of DCT innovations from the perspective of stakeholders in health care environments. Objective: This study aims to identify the factors influencing the adoption of DCT, highlight variations in perspectives across 3 key stakeholder groups concerning the impact of DCT, and provide benchmarking evidence for future pandemic preparedness. Methods: Guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework, we conducted an exploratory qualitative study to investigate the implementation and impact of DCT at the Children’s Hospital of Eastern Ontario between December 2022 and April 2023. We conducted 21 semistructured interviews with key stakeholders, including health care administrators (6/21, 29%), occupational health and safety specialists (8/21, 38%), and HCWs (7/21, 33%). Stakeholders were asked about the factors influencing engagement with the DCT tool, organizational-level uptake, the implementation process, long-term use and sustainability of DCT, and unintended consequences. Verbatim transcripts were subject to thematic analysis using NVivo (QSR International). Results: The implementation of DCT was viable and well received. End users indicated that their engagement with the DCT tool was facilitated by its perceived ease of use and the ability to gain awareness of probable COVID-19 exposures; however, risk assessment consequences and access concerns were reported as barriers (reach). Participants commonly agreed that the DCT technology had a positive influence on the hospital’s capacity to meet the demands of COVID-19 (effectiveness). Implementors and occupational specialists referred to negative staffing impacts and the loss of nuanced information as unintended consequences (effectiveness). Safety-focused communication strategies and having a DCT tool that was human-centered were crucial factors driving staff adoption of the technology. Conversely, adoption was challenged by the misaligned delivery of the DCT tool with HCWs’ standard practices, alongside the evolving perceived threat of COVID-19. Stakeholders collectively agreed on the viability of DCT and its applicability to infectious disease practices (maintenance). Conclusions: Hospital stakeholders were highly satisfied with DCT technology and it was perceived as feasible, efficient, and having a positive impact on organizational safety. Challenges related to the alignment and delivery of DCT, alongside the evolving perspectives on COVID-19, posed obstacles to continued adoption by HCWs. Our findings contribute to evidence-based practices and present benchmarks that can inform preparedness for future pandemics and infectious disease outbreaks and help other organizations implement similar technologies. %M 39499919 %R 10.2196/64270 %U https://publichealth.jmir.org/2024/1/e64270 %U https://doi.org/10.2196/64270 %U http://www.ncbi.nlm.nih.gov/pubmed/39499919 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e56989 %T Association Between Sociodemographic Factors and Vaccine Acceptance for Influenza and SARS-CoV-2 in South Korea: Nationwide Cross-Sectional Study %A Hong,Seohyun %A Son,Yejun %A Lee,Myeongcheol %A Lee,Jun Hyuk %A Park,Jaeyu %A Lee,Hayeon %A Dragioti,Elena %A Fond,Guillaume %A Boyer,Laurent %A López Sánchez,Guillermo Felipe %A Smith,Lee %A Tully,Mark A %A Rahmati,Masoud %A Choi,Yong Sung %A Lee,Young Joo %A Yeo,Seung Geun %A Woo,Selin %A Yon,Dong Keon %K COVID-19 %K influenza %K South Korea %K vaccination %K vaccinations %K COVID-19 vaccine %K COVID-19 vaccination %K SARS-CoV-2 %K SARS-CoV-2 vaccine %K pandemic %K SARS-CoV-2 vaccination %K vaccine %K vaccine hesitancy %D 2024 %7 1.11.2024 %9 %J JMIR Public Health Surveill %G English %X Background: The imperative arises to study the impact of socioeconomic factors on the acceptance of SARS-CoV-2 and influenza vaccines amid changes in immunization policies during the COVID-19 pandemic. Objective: To enhance targeted public health strategies and improve age-specific policies based on identified risk factors, this study investigated the associations between sociodemographic factors and vaccination behaviors during the COVID-19 pandemic, with emphasis on age-specific vaccine cost policies. Methods: This study analyzed data from the Korean Community Health Survey 2019‐2022 with 507,964 participants to investigate the impact of age-specific policies on vaccination behaviors during the pandemic period. Cohorts aged 19‐64 years and 65 years or older were stratified based on age (years), sociodemographic factors, and health indicators. The cohorts were investigated to assess the influence of relevant risk factors on vaccine acceptance under the pandemic by using weighted odds ratio and ratio of odds ratio (ROR). Results: Among 507,964 participants, the acceptance of the SARS-CoV-2 vaccine (COVID-19 vaccine) was higher among individuals with factors possibly indicating higher socioeconomic status, such as higher education level (age 19‐64 years: ROR 1.34; 95% CI 1.27‐1.40 and age ≥65 years: ROR 1.19; 95% CI 1.01‐1.41) and higher income (age 19‐64 years: ROR 1.67; 95% CI 1.58‐1.76 and age ≥65 years: ROR 1.21; 95% CI 1.06‐1.38) for both age cohorts compared to influenza vaccine acceptance before the pandemic. In the context of influenza vaccination during the pandemic, the older cohort exhibited vaccine hesitancy associated with health care mobility factors such as lower general health status (ROR 0.89; 95% CI 0.81‐0.97). Conclusions: SARS-CoV-2 vaccination strategies should focus on reducing hesitancy among individuals with lower social participation. To improve influenza vaccine acceptance during the pandemic, strategies for the younger cohort should focus on individuals with lower social participation, while efforts for the older cohort should prioritize individuals with limited access to health care services. %R 10.2196/56989 %U https://publichealth.jmir.org/2024/1/e56989 %U https://doi.org/10.2196/56989 %0 Journal Article %@ 2817-1705 %I JMIR Publications %V 3 %N %P e55059 %T Targeting COVID-19 and Human Resources for Health News Information Extraction: Algorithm Development and Validation %A Ravaut,Mathieu %A Zhao,Ruochen %A Phung,Duy %A Qin,Vicky Mengqi %A Milovanovic,Dusan %A Pienkowska,Anita %A Bojic,Iva %A Car,Josip %A Joty,Shafiq %+ Nanyang Technological University, 50 Nanyang Avenue, Singapore, 639798, Singapore, 65 88947729, mathieuj001@e.ntu.edu.sg %K COVID-19 %K SARS-CoV-2 %K summary %K summarize %K news articles %K deep learning %K classification %K summarization %K machine learning %K extract %K extraction %K news %K media %K NLP %K natural language processing %D 2024 %7 30.10.2024 %9 Original Paper %J JMIR AI %G English %X Background: Global pandemics like COVID-19 put a high amount of strain on health care systems and health workers worldwide. These crises generate a vast amount of news information published online across the globe. This extensive corpus of articles has the potential to provide valuable insights into the nature of ongoing events and guide interventions and policies. However, the sheer volume of information is beyond the capacity of human experts to process and analyze effectively. Objective: The aim of this study was to explore how natural language processing (NLP) can be leveraged to build a system that allows for quick analysis of a high volume of news articles. Along with this, the objective was to create a workflow comprising human-computer symbiosis to derive valuable insights to support health workforce strategic policy dialogue, advocacy, and decision-making. Methods: We conducted a review of open-source news coverage from January 2020 to June 2022 on COVID-19 and its impacts on the health workforce from the World Health Organization (WHO) Epidemic Intelligence from Open Sources (EIOS) by synergizing NLP models, including classification and extractive summarization, and human-generated analyses. Our DeepCovid system was trained on 2.8 million news articles in English from more than 3000 internet sources across hundreds of jurisdictions. Results: Rules-based classification with hand-designed rules narrowed the data set to 8508 articles with high relevancy confirmed in the human-led evaluation. DeepCovid’s automated information targeting component reached a very strong binary classification performance of 98.98 for the area under the receiver operating characteristic curve (ROC-AUC) and 47.21 for the area under the precision recall curve (PR-AUC). Its information extraction component attained good performance in automatic extractive summarization with a mean Recall-Oriented Understudy for Gisting Evaluation (ROUGE) score of 47.76. DeepCovid’s final summaries were used by human experts to write reports on the COVID-19 pandemic. Conclusions: It is feasible to synergize high-performing NLP models and human-generated analyses to benefit open-source health workforce intelligence. The DeepCovid approach can contribute to an agile and timely global view, providing complementary information to scientific literature. %M 39475833 %R 10.2196/55059 %U https://ai.jmir.org/2024/1/e55059 %U https://doi.org/10.2196/55059 %U http://www.ncbi.nlm.nih.gov/pubmed/39475833 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e56390 %T An Online Tailored COVID-19 Vaccination Decision Aid for Dutch Citizens: Development, Dissemination, and Use %A Preuhs,Katharina %A Bussink-Voorend,Daphne %A van Keulen,Hilde M %A Wildeman,Ilona %A Hautvast,Jeannine %A Hulscher,Marlies %A van Empelen,Pepijn %+ Netherlands Organization for Applied Scientific Research (TNO), Expertise Group Child Health, PO Box 2215, Leiden, 2301 CE, Netherlands, 31 615597505, katharina.preuhs@tno.nl %K COVID-19 %K COVID-19 vaccination %K informed decision-making %K user-centered design %K low literacy %K eHealth %K tailored decision aid %D 2024 %7 30.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Since December 2019, COVID-19 led to a pandemic causing many hospitalizations and deaths. Vaccinations were developed and introduced to control viral transmission. In the Dutch context, the decision to accept vaccination is not mandatory. An informed decision is based on sufficient and reliable information, in line with one’s attitudes and values, and with consideration of pros and cons. To support people in informed decision-making, we developed an online COVID-19 vaccination decision aid (DA). Objective: This article aims to describe the development, dissemination, and use of the DA. Methods: Building on a previously developed DA, the COVID-19 vaccination DA was developed in 3 phases following a user-centered design approach: (1) definition phase, (2) concept testing, and (3) prototype testing. End users, individuals with low literacy, and experts (with relevant expertise on medical, behavioral, and low literacy aspects) were involved in the iterative development, design, and testing, with their feedback forming the basis for adaptations to the DA. Results: The DA was developed within 14 weeks. The DA consists of 3 modules, namely, Provide Information, Support Decision-Making, and Facilitate Actions Following a Decision. These modules are translated into various information tiles and diverse functionalities such as a knowledge test, a value clarification tool using a decisional balance, and a communication tool. The DA was disseminated for use in May 2021. Users varied greatly regarding age, gender, and location in the Netherlands. Conclusions: This paper elaborates on the development of the COVID-19 vaccination DA in a brief period and its dissemination for use among Dutch adults in the Netherlands. The evaluation of use showed that we were able to reach a large proportion and variety of people throughout the Netherlands. %M 39475719 %R 10.2196/56390 %U https://formative.jmir.org/2024/1/e56390 %U https://doi.org/10.2196/56390 %U http://www.ncbi.nlm.nih.gov/pubmed/39475719 %0 Journal Article %@ 1947-2579 %I JMIR Publications %V 16 %N %P e54578 %T Contact Tracing Different Age Groups During the COVID-19 Pandemic: Retrospective Study From South-West Germany %A Dyer,Christopher Michael %A Negoescu,Alexandra-Teodora %A Borchert,Matthias %A Harter,Christoph %A Kühn,Anne %A Dambach,Peter %A Marx,Michael %+ Rhein-Neckar District and Heidelberg City Public Health Authority, Kurfürsten-Anlage 38 - 40, Heidelberg, 69115, Germany, 49 6201 522 2949, C.Dyer@Rhein-Neckar-Kreis.de %K COVID-19 %K SARS-CoV-2 %K pandemic %K quarantine %K contact tracing %K contact tracing effectiveness %K demographics %K mortality %K case fatality %K public health surveillance %K public health systems %D 2024 %7 29.10.2024 %9 Original Paper %J Online J Public Health Inform %G English %X Background: Contact tracing was implemented in many countries during the COVID-19 pandemic to prevent disease spread, reduce mortality, and avoid overburdening health care systems. In several countries, including Germany, new systems were needed to trace potentially infected individuals. Objective: Using data collected in the Rhine-Neckar and Heidelberg (RNK/HD) districts in southwest Germany (population: 706,974), this study examines the overall effectiveness and efficiency of contact tracing in different age groups and stages of the pandemic. Methods: From January 27, 2020, to April 30, 2022, the RNK/HD Health Authority collected data on COVID-19 infections, quarantines, and deaths. Data on infection, quarantine, and death was grouped by age (young: 0-19 years; adult: 20-65 years; and senior citizens: >65 years) and pandemic phase (infectious wave plus subsequent lull periods) and analyzed for proportion, risk, and relative risk (RR). The overall effectiveness and efficiency of contact tracing were determined by calculating quarantine sensitivity (proportion of the infected population captured in quarantine), positive predictive value (PPV; proportion of the quarantined population that was infected), and the weighted Fβ-score (combined predictive performance). Results: Of 706,974 persons living in RNK/HD during the study period, 192,175 (27.2%) tested positive for SARS-CoV-2, 74,810 (10.4%) were quarantined, and 932 (0.132%) died following infection. Compared with adults, the RR of infection was lower among senior citizens (0.401, 95% CI 0.395-0.407) and while initially lower for young people, was ultimately higher for young people across all 5 phases (first-phase RR 0.502, 95% CI 0.438-0.575; all phases RR 1.35, 95% CI 1.34-1.36). Of 932 COVID-19–associated deaths during the study period, 852 were senior citizens (91.4%), with no deaths reported among young people. Relative to adults, senior citizens had the lowest risk of quarantine (RR 0.436, 95% CI 0.424-0.448), while young people had the highest RR (2.94, 95% CI 2.90-2.98). The predictive performance of contact tracing was highest during the second and third phases of the pandemic (Fβ-score=0.272 and 0.338, respectively). In the second phase of the pandemic, 5810 of 16,814 COVID-19 infections were captured within a total quarantine population of 39,687 (sensitivity 34.6%; PPV 14.6%). In the third phase of the pandemic, 3492 of 8803 infections were captured within a total quarantine population of 16,462 (sensitivity 39.7%; PPV 21.2%). Conclusions: The use of quarantine aligned with increasing risks of COVID-19 infection and death. High levels of quarantine sensitivity before the introduction of the vaccine show how contact tracing systems became increasingly effective at capturing and quarantining the infected population. High levels of PPV and Fβ-scores indicate, moreover, that contact tracing became more efficient at identifying infected individuals. Additional analysis of transmission pathways is needed to evaluate the application of quarantine in relation to infection and death risks within specific age groups. %M 39471373 %R 10.2196/54578 %U https://ojphi.jmir.org/2024/1/e54578 %U https://doi.org/10.2196/54578 %U http://www.ncbi.nlm.nih.gov/pubmed/39471373 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 12 %N %P e54246 %T A New Natural Language Processing–Inspired Methodology (Detection, Initial Characterization, and Semantic Characterization) to Investigate Temporal Shifts (Drifts) in Health Care Data: Quantitative Study %A Paiva,Bruno %A Gonçalves,Marcos André %A da Rocha,Leonardo Chaves Dutra %A Marcolino,Milena Soriano %A Lana,Fernanda Cristina Barbosa %A Souza-Silva,Maira Viana Rego %A Almeida,Jussara M %A Pereira,Polianna Delfino %A de Andrade,Claudio Moisés Valiense %A Gomes,Angélica Gomides dos Reis %A Ferreira,Maria Angélica Pires %A Bartolazzi,Frederico %A Sacioto,Manuela Furtado %A Boscato,Ana Paula %A Guimarães-Júnior,Milton Henriques %A dos Reis,Priscilla Pereira %A Costa,Felício Roberto %A Jorge,Alzira de Oliveira %A Coelho,Laryssa Reis %A Carneiro,Marcelo %A Sales,Thaís Lorenna Souza %A Araújo,Silvia Ferreira %A Silveira,Daniel Vitório %A Ruschel,Karen Brasil %A Santos,Fernanda Caldeira Veloso %A Cenci,Evelin Paola de Almeida %A Menezes,Luanna Silva Monteiro %A Anschau,Fernando %A Bicalho,Maria Aparecida Camargos %A Manenti,Euler Roberto Fernandes %A Finger,Renan Goulart %A Ponce,Daniela %A de Aguiar,Filipe Carrilho %A Marques,Luiza Margoto %A de Castro,Luís César %A Vietta,Giovanna Grünewald %A Godoy,Mariana Frizzo de %A Vilaça,Mariana do Nascimento %A Morais,Vivian Costa %+ Computer Science Department, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil, Street Daniel de Carvalho, 1846, apto 201, Belo Horizonte, 30431310, Brazil, 55 31999710134, angelfire7@gmail.com %K health care %K machine learning %K data drifts %K temporal drifts %D 2024 %7 28.10.2024 %9 Original Paper %J JMIR Med Inform %G English %X Background: Proper analysis and interpretation of health care data can significantly improve patient outcomes by enhancing services and revealing the impacts of new technologies and treatments. Understanding the substantial impact of temporal shifts in these data is crucial. For example, COVID-19 vaccination initially lowered the mean age of at-risk patients and later changed the characteristics of those who died. This highlights the importance of understanding these shifts for assessing factors that affect patient outcomes. Objective: This study aims to propose detection, initial characterization, and semantic characterization (DIS), a new methodology for analyzing changes in health outcomes and variables over time while discovering contextual changes for outcomes in large volumes of data. Methods: The DIS methodology involves 3 steps: detection, initial characterization, and semantic characterization. Detection uses metrics such as Jensen-Shannon divergence to identify significant data drifts. Initial characterization offers a global analysis of changes in data distribution and predictive feature significance over time. Semantic characterization uses natural language processing–inspired techniques to understand the local context of these changes, helping identify factors driving changes in patient outcomes. By integrating the outcomes from these 3 steps, our results can identify specific factors (eg, interventions and modifications in health care practices) that drive changes in patient outcomes. DIS was applied to the Brazilian COVID-19 Registry and the Medical Information Mart for Intensive Care, version IV (MIMIC-IV) data sets. Results: Our approach allowed us to (1) identify drifts effectively, especially using metrics such as the Jensen-Shannon divergence, and (2) uncover reasons for the decline in overall mortality in both the COVID-19 and MIMIC-IV data sets, as well as changes in the cooccurrence between different diseases and this particular outcome. Factors such as vaccination during the COVID-19 pandemic and reduced iatrogenic events and cancer-related deaths in MIMIC-IV were highlighted. The methodology also pinpointed shifts in patient demographics and disease patterns, providing insights into the evolving health care landscape during the study period. Conclusions: We developed a novel methodology combining machine learning and natural language processing techniques to detect, characterize, and understand temporal shifts in health care data. This understanding can enhance predictive algorithms, improve patient outcomes, and optimize health care resource allocation, ultimately improving the effectiveness of machine learning predictive algorithms applied to health care data. Our methodology can be applied to a variety of scenarios beyond those discussed in this paper. %M 39467275 %R 10.2196/54246 %U https://medinform.jmir.org/2024/1/e54246 %U https://doi.org/10.2196/54246 %U http://www.ncbi.nlm.nih.gov/pubmed/39467275 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e55531 %T Internet-Based Social Connections of Black American College Students in Pre–COVID-19 and Peri–COVID-19 Pandemic Periods: Network Analysis %A Lee,Eun %A Kim,Heejun %A Esener,Yildiz %A McCall,Terika %+ Department of Scientific Computing, Pukyong National University, 45, Yongso-ro, Nam-gu, Busan, 48513, Republic of Korea, 82 10 7356 7890, eunlee@pknu.ac.kr %K COVID-19 pandemic %K college students %K Black American %K African American %K social network analysis %K social media %K mental health %K depression %D 2024 %7 28.10.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: A global-scale pandemic, such as the COVID-19 pandemic, greatly impacted communities of color. Moreover, physical distancing recommendations during the height of the COVID-19 pandemic negatively affected people’s sense of social connection, especially among young individuals. More research is needed on the use of social media and communication about depression, with a specific focus on young Black Americans. Objective: This paper aims to examine whether there are any differences in social-networking characteristics before and during the pandemic periods (ie, pre–COVID-19 pandemic vs peri–COVID-19 pandemic) among the students of historically black colleges and universities (HBCUs). For the study, the researchers focus on the students who have posted a depression-related tweet or have retweeted such posts on their timeline and also those who have not made such tweets. This is done to understand the collective patterns of both groups. Methods: This paper analyzed the social networks on Twitter (currently known as X; X Corp) of HBCU students through comparing pre–COVID-19 and peri–COVID-19 pandemic data. The researchers quantified the structural properties, such as reciprocity, homophily, and communities, to test the differences in internet-based socializing patterns between the depression-related and non–depression related groups for the 2 periods. Results: During the COVID-19 pandemic period, the group with depression-related tweets saw an increase in internet-based friendships, with the average number of friends rising from 1194 (SD 528.14) to 1371 (SD 824.61; P<.001). Their mutual relationships strengthened (reciprocity: 0.78-0.8; P=.01), and they showed higher assortativity with other depression-related group members (0.6-0.7; P<.001). In a network with only HBCU students, internet-based and physical affiliation memberships aligned closely during the peri–COVID-19 pandemic period, with membership entropy decreasing from 1.0 to 0.5. While users without depression-related tweets engaged more on the internet with other users who shared physical affiliations, those who posted depression-related tweets maintained consistent entropy levels (modularity: 0.75-0.76). Compared with randomized networks before and during the COVID-19 pandemic (P<.001), the users also exhibited high homophily with other members who posted depression-related tweets. Conclusions: The findings of this study provided insight into the social media activities of HBCU students’ social networks and communication about depression on social media. Future social media interventions focused on the mental health of Black college students may focus on providing resources to students who communicate about depression. Efforts aimed at providing relevant resources and information to internet-based communities that share institutional affiliation may enhance access to social support, particularly for those who may not proactively seek assistance. This approach may contribute to increased social support for individuals within these communities, especially those with a limited social capacity. %M 39467280 %R 10.2196/55531 %U https://www.jmir.org/2024/1/e55531 %U https://doi.org/10.2196/55531 %U http://www.ncbi.nlm.nih.gov/pubmed/39467280 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e58518 %T Chinese Public Attitudes and Opinions on Health Policies During Public Health Emergencies: Sentiment and Topic Analysis %A Liu,Min %A Yuan,Shuo %A Li,Bingyan %A Zhang,Yuxi %A Liu,Jia %A Guan,Cuixia %A Chen,Qingqing %A Ruan,Jiayi %A Xie,Lunfang %+ School of Nursing, Anhui Medical University, No. 81, Meishan Road, Shushan District, Hefei, 230031, China, 86 13856958216, 527548725@qq.com %K public health emergencies %K nucleic acid testing %K governance strategies %K sentiment analysis %K LDA %K social media %K COVID-19 %K opinion analysis %D 2024 %7 28.10.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: By the end of 2021, the new wave of COVID-19 sparked by the Omicron variant spread rapidly due to its highly contagious nature, affecting more than 170 countries worldwide. Nucleic acid testing became the gold standard for diagnosing novel coronavirus infections. As of July 2022, numerous cities and regions in China have implemented regular nucleic acid testing policies, which have had a significant impact on socioeconomics and people’s lives. This policy has garnered widespread attention on social media platforms. Objective: This study took the newly issued regular nucleic acid testing policy during the COVID-19 pandemic as an example to explore the sentiment responses and fluctuations of netizens toward new policies during public health emergencies. It aimed to propose strategies for managing public opinion on the internet and provide recommendations for policy making and public opinion control. Methods: We collected blog posts related to nucleic acid testing on Weibo from April 1, 2022, to July 31, 2022. We used the topic modeling technique latent Dirichlet allocation (LDA) to identify the most common topics posted by users. We used Bidirectional Encoder Representations from Transformers (BERT) to calculate the sentiment score of each post. We used an autoregressive integrated moving average (ARIMA) model to examine the relationship between sentiment scores and changes over time. We compared the differences in sentiment scores across various topics, as well as the changes in sentiment before and after the announcement of the nucleic acid price reduction policy (May 22) and the lifting of the lockdown policy in Shanghai (June 1). Results: We collected a total of 463,566 Weibo posts, with an average of 3799.72 (SD 1296.06) posts published daily. The LDA topic extraction identified 8 topics, with the most numerous being the Shanghai outbreak, nucleic acid testing price, and transportation. The average sentiment score of the posts was 0.64 (SD 0.31), indicating a predominance of positive sentiment. For all topics, posts with positive sentiment consistently outnumbered those with negative sentiment (χ27=24,844.4, P<.001). The sentiment scores of posts related to “nucleic acid testing price” decreased after May 22 compared with before (t120=3.882, P<.001). Similarly, the sentiment scores of posts related to the “Shanghai outbreak” decreased after June 1 compared with before (t120=11.943, P<.001). Conclusions: During public health emergencies, the topics of public concern were diverse. Public sentiment toward the regular nucleic acid testing policy was generally positive, but fluctuations occurred following the announcement of key policies. To understand the primary concerns of the public, the government needs to monitor social media posts by citizens. By promptly sharing information on media platforms and engaging in effective communication, the government can bridge the information gap between the public and government agencies, fostering a positive public opinion environment. %M 39466313 %R 10.2196/58518 %U https://www.jmir.org/2024/1/e58518 %U https://doi.org/10.2196/58518 %U http://www.ncbi.nlm.nih.gov/pubmed/39466313 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e62657 %T Developing National Information Systems to Monitor COVID-19 Vaccination: A Global Observational Study %A Brooks,Donald J %A Kim,Carolyn Inae %A Mboussou,Franck Fortune %A Danovaro-Holliday,M Carolina %K COVID-19 %K COVID-19 vaccine %K immunization information system %K vaccination monitoring %K vaccine %K monitoring and evaluation %D 2024 %7 25.10.2024 %9 %J JMIR Public Health Surveill %G English %X Background: Strong information systems are essential for safe and effective immunization programs. The COVID-19 vaccine rollout presented all immunization information systems (IIS) with challenging demands—requiring in-depth vaccine implementation data at all health system levels in real time. The system development approaches taken by countries were heterogeneous, with some countries opting to adapt existing systems and others implementing new ones. Objective: Using data reported by Member States to the World Health Organization (WHO), we aim to develop a global understanding of (1) the types of IIS used to monitor COVID-19 vaccination implemented in 2021 and (2) the approaches taken by countries to develop these systems. Methods: We conducted a descriptive analysis of data reported through a supplemental questionnaire of the WHO/United Nations Children's Emergency Fund (UNICEF) Joint Reporting Form on Immunization, collecting data for 2021 on (1) the use of and developmental approaches taken for 7 IIS functions (appointments, aggregate reporting, individual-level reporting, reminders, home-based records, safety surveillance, and stock management), and (2) modifications needed for digital health frameworks to permit COVID-19 vaccination monitoring. Results: In total, 188 of 194 WHO Member States responded to the supplemental questionnaire, with 155 reporting on the IIS-related questions. Among those reporting, for each of the 7 IIS functions explored, greater than 85% of responding countries reported that the system was in place for COVID-19 vaccines. Among responding countries, “aggregate reporting system” was the system most frequently reported as being in place (n=116, 98.3%), while “reminder system” was the least (n=77, 89%). Among the countries reporting using a system, whether an existing system was adapted for COVID-19 vaccines or a new one was developed varied by system. Additionally, two-thirds (n=127, 67.6%) of countries reported establishing at least one new system, ranging from 72% (n=42) in high-income countries (HICs) to 62% (n=16) in low-income countries. Concurrently, 55.3% (n=104) of countries reported adapting at least one system already in place for COVID-19 vaccines, with 62% (n=36) of HICs reporting this compared to about 53% for other income groups. Of those reporting developing new systems, for each of the systems explored, more than 85% of countries reported that they intended to keep new systems specific to COVID-19 vaccines. Further, 147 of the 188 (78.2%) Member States responding to the supplemental questionnaire responded to the digital health frameworks question. Lastly, 31% (n=46) of responding countries reported needing to adapt them for COVID-19 vaccination systems. HICs had a higher percentage. Conclusions: Nearly all countries have adapted existing or developed new IIS to monitor COVID-19 vaccination. The approaches varied, notably by income group. Reflection is needed on how to sustain the investments made in IIS during the pandemic. Continued support for IIS is critical, given their essential role in program monitoring and performance. %R 10.2196/62657 %U https://publichealth.jmir.org/2024/1/e62657 %U https://doi.org/10.2196/62657 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e58257 %T Online Media Use and COVID-19 Vaccination in Real-World Personal Networks: Quantitative Study %A Oană,Iulian %A Hâncean,Marian-Gabriel %A Perc,Matjaž %A Lerner,Jürgen %A Mihăilă,Bianca-Elena %A Geantă,Marius %A Molina,José Luis %A Tincă,Isabela %A Espina,Carolina %+ Department of Sociology, University of Bucharest, Panduri 90-92, Bucharest, 050663, Romania, 40 305 97 30 ext 021, iulian.oana@sas.unibuc.ro %K vaccine hesitancy %K online media %K social media %K assortative mixing %K personal network analysis %K social network analysis %K Romania %K vaccination %K health information %K COVID-19 %D 2024 %7 25.10.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Most studies assessing the impact of online media and social media use on COVID-19 vaccine hesitancy predominantly rely on survey data, which often fail to capture the clustering of health opinions and behaviors within real-world networks. In contrast, research using social network analysis aims to uncover the diverse communities and discourse themes related to vaccine support and hesitancy within social media platforms. Despite these advancements, there is a gap in the literature on how a person’s social circle affects vaccine acceptance, wherein an important part of social influence stems from offline interactions. Objective: We aimed to examine how online media consumption influences vaccination decisions within real-world social networks by analyzing unique quantitative network data collected from Romania, an Eastern European state and member of the European Union. Methods: We conducted 83 face-to-face interviews with participants from a living lab in Lerești, a small rural community in Romania, using a personal network analysis framework. This approach involved gathering data on both the respondents and individuals within their social circles (referred to as alters). After excluding cases with missing data, our analysis proceeded with 73% (61/83) of the complete personal networks. To examine the hierarchical structure of alters nested within ego networks, we used a mixed multilevel logistic regression model with random intercepts. The model aimed to predict vaccination status among alters, with the focal independent variable being the respondents’ preferred source of health and prevention information. This variable was categorized into 3 types: traditional media, online media (including social media), and a combination of both, with traditional media as the reference category. Results: In this study, we analyzed 61 personal networks, encompassing between 15 and 25 alters each, totaling 1280 alters with valid data across all variables of interest. Our primary findings indicate that alters within personal networks, whose respondents rely solely on online media for health information, exhibit lower vaccination rates (odds ratio [OR] 0.37, 95% CI 0.15-0.92; P=.03). Conversely, the transition from exclusive traditional media use to a combination of both traditional and online media does not significantly impact vaccination rate odds (OR 0.75, 95% CI 0.32-1.78; P=.52). In addition, our analysis revealed that alters in personal networks of respondents who received the vaccine are more likely to have received the vaccine themselves (OR 3.75, 95% CI 1.79-7.85; P<.001). Conclusions: Real-world networks combine diverse human interactions and attributes along with consequences on health opinions and behaviors. As individuals’ vaccination status is influenced by how their social alters use online media and vaccination behavior, further insights are needed to create tailored communication campaigns and interventions regarding vaccination in areas with low levels of digital health literacy and vaccination rates, as Romania exposes. %M 39454189 %R 10.2196/58257 %U https://www.jmir.org/2024/1/e58257 %U https://doi.org/10.2196/58257 %U http://www.ncbi.nlm.nih.gov/pubmed/39454189 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e60000 %T The Perspectives of Community Pharmacists Toward the Name-Based Rationing System During the COVID-19 Pandemic in Taiwan: Cross-Sectional Survey Study %A Chen,En-ling %A Bai,Chyi-Huey %A Kocis,Paul T %A Hwang,Wenke %+ Department of Public Health Sciences, Penn State College of Medicine, 90 Hope Drive, Suite 2200, Hershey, PA, 17033, United States, 1 717 531 7070, whwang@psu.edu %K name-based rationing system %K NBRS %K community pharmacy %K community pharmacist %K COVID-19 %K SARS-CoV-2 %K KAP %K knowledge, attitude, and practices %K public health %K health emergencies %K government strategy %K mobile phone %D 2024 %7 24.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: In Taiwan’s public health system, community-based pharmacists are key first-line health care providers due to their high accessibility. During the COVID-19 pandemic, the pharmacists played a central role in the distribution of these supplies through the Name-Based Rationing System (NBRS), during an acute shortage of masks and testing kits, that helped reduce the spread of the disease. The NBRS, an innovative government-guided strategy developed after the COVID-19 outbreak, provided equitable and convenient access to masks and COVID-19 test kits. Objective: This study aimed to investigate (1) Taiwanese pharmacists’ knowledge, attitude, and practices (KAPs) of COVID-19, with the intention to assess their preparedness for public health emergencies and their capabilities to implement COVID-19–related policies effectively; (2) their perspectives toward the NBRS; and (3) the association between individual’s KAP and corresponding perspectives toward the NBRS. Methods: A cross-sectional, web-based survey was conducted in 2 major cities in Taiwan, from June 18 to September 11, 2022, during the peak of the COVID-19 pandemic. To gauge community pharmacists’ KAP, a 66-question instrument was developed using guidelines from the Taiwanese Centers for Disease Control, the International Pharmaceutical Federation, and the Taiwanese Pharmacist Association. The instrument’s internal consistency reliability was ascertained using Cronbach α (0.819), and its content validity was verified by field experts. Results: Overall, 343 Taiwanese community pharmacists were recruited in the study. Among them, 88% (303/343) scored high on knowledge domain questions related to SARS-CoV-2; 58% (201/343) and 39% (136/343) held positive and neutral attitudes toward COVID-19–related policies, respectively; and 77% (266/343) practiced infectious disease prevention measures in compliance with official guidelines. The results demonstrated a high level of competency in pharmacists in a public health crisis. It revealed that factors including age, pharmacy characteristics, and the number of customers were associated with their perceptions and willingness to continuously participate in the NBRS. Overall, the community pharmacists showed greater support for the COVID-19–testing NBRS compared with the mask NBRS, because of the more favorable influence on the revenue and workforce of the pharmacies and the well-being of the pharmacists. Responses also highlighted concerns about rapid government policy changes and supply dynamics, underscoring the importance of effective communication and considering supply availability in facilitating a successful NBRS. Conclusions: The strong KAP of the community pharmacists justified the government leveraging their expertise in Taiwan’s COVID-19 response. While community pharmacies have proven to be essential distribution centers through the NBRS, improving community connections, communication with the government, and supply management are recommended to strengthen the system. These potential approaches aim to ensure successful NBRS implementation and better preparedness for future public health emergencies. Overall, pharmacists have demonstrated their integral role in achieving equitable outcomes and their dedication to public health efforts during crises. %M 39447161 %R 10.2196/60000 %U https://formative.jmir.org/2024/1/e60000 %U https://doi.org/10.2196/60000 %U http://www.ncbi.nlm.nih.gov/pubmed/39447161 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e51909 %T Infodemics and Vaccine Confidence: Protocol for Social Listening and Insight Generation to Inform Action %A Kolis,Jessica %A Brookmeyer,Kathryn %A Chuvileva,Yulia %A Voegeli,Christopher %A Juma,Sarina %A Ishizumi,Atsuyoshi %A Renfro,Katy %A Wilhelm,Elisabeth %A Tice,Hannah %A Fogarty,Hannah %A Kocer,Irma %A Helms,Jordan %A Verma,Anisha %+ Global Immunization Division, Global Health Center, Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA, 30333, United States, 1 404 718 3876, ywe5@cdc.gov %K infodemic %K infodemic management %K vaccine confidence %K vaccine demand %K misinformation %K disinformation %K infodemiology %K mixed methods %K thematic analysis %K COVID-19 %D 2024 %7 24.10.2024 %9 Protocol %J JMIR Public Health Surveill %G English %X Background: In the fall of 2020, the COVID-19 infodemic began to affect public confidence in and demand for COVID-19 vaccines in the United States. While polls indicated what consumers felt regarding COVID-19 vaccines, they did not provide an understanding of why they felt that way or the social and informational influences that factored into vaccine confidence and uptake. It was essential for us to better understand how information ecosystems were affecting the confidence in and demand for COVID-19 vaccines in the United States. Objective: The US Centers for Disease Control and Prevention (CDC) established an Insights Unit within the COVID-19 Response’s Vaccine Task Force in January 2021 to assist the agency in acting more swiftly to address the questions, concerns, perceptions, and misinformation that appeared to be affecting uptake of COVID-19 vaccines. We established a novel methodology to rapidly detect and report on trends in vaccine confidence and demand to guide communication efforts and improve programmatic quality in near real time. Methods: We identified and assessed data sources for inclusion through an informal landscape analysis using a snowball method. Selected data sources provided an expansive look at the information ecosystem of the United States regarding COVID-19 vaccines. The CDC’s Vaccinate with Confidence framework and the World Health Organization’s behavioral and social drivers for vaccine decision-making framework were selected as guiding principles for interpreting generated insights and their impact. We used qualitative thematic analysis methods and a consensus-building approach to identify prevailing and emerging themes, assess their potential threat to vaccine confidence, and propose actions to increase confidence and demand. Results: As of August 2022, we have produced and distributed 34 reports to >950 recipients within the CDC and externally. State and local health departments, nonprofit organizations, professional associations, and congressional committees have referenced and used the reports for learning about COVID-19 vaccine confidence and demand, developing communication strategies, and demonstrating how the CDC monitored and responded to misinformation. A survey of the reports’ end users found that nearly 75% (40/53) of respondents found them “very” or “extremely” relevant and 52% (32/61) used the reports to inform communication strategies. In addition, our methodology underwent continuous process improvement to increase the rigor of the research process, the validity of the findings, and the usability of the reports. Conclusions: This methodology can serve as a diagnostic technique for rapidly identifying opportunities for public health interventions and prevention. As the methodology itself is adaptable, it could be leveraged and scaled for use in a variety of public health settings. Furthermore, it could be considered beyond acute public health crises to support adherence to guidance and recommendations and could be considered within routine monitoring and surveillance systems. %M 39447166 %R 10.2196/51909 %U https://publichealth.jmir.org/2024/1/e51909 %U https://doi.org/10.2196/51909 %U http://www.ncbi.nlm.nih.gov/pubmed/39447166 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e53409 %T Updated Surveillance Metrics and History of the COVID-19 Pandemic (2020-2023) in Sub-Saharan Africa: Longitudinal Trend Analysis %A Lundberg,Alexander L %A Soetikno,Alan G %A Wu,Scott A %A Ozer,Egon A %A Welch,Sarah B %A Mason,Maryann %A Murphy,Robert L %A Hawkins,Claudia %A Liu,Yingxuan %A Moss,Charles B %A Havey,Robert J %A Achenbach,Chad J %A Post,Lori A %+ Buehler Center for Health Policy and Economics, Robert J Havey, MD Institute for Global Health, Northwestern University, 420 E. Superior, Chicago, IL, 60611, United States, 1 312 503 1706, lori.post@northwestern.edu %K SARS-CoV-2 %K COVID-19 %K sub-Saharan Africa %K pandemic %K surveillance %K public health %K COVID-19 transmission %K speed %K acceleration %K deceleration %K jerk %K dynamic panel %K generalized method of moments %K Arellano-Bond %D 2024 %7 23.10.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: This study updates the initial COVID-19 pandemic surveillance in sub-Saharan Africa (SSA) from 2020 by providing 2 additional years of data for the region. Objective: First, we aimed to measure whether there was an expansion or contraction in the pandemic in SSA when the World Health Organization (WHO) declared an end to the public health emergency for the COVID-19 pandemic on May 5, 2023. Second, we used dynamic and genomic surveillance methods to describe the history of the pandemic in the region and situate the window of the WHO declaration within the broader history. Third, we aimed to provide historical context for the course of the pandemic in SSA. Methods: In addition to updates of traditional surveillance data and dynamic panel estimates from the original study by Post et al (2021), this study used data on sequenced SARS-CoV-2 variants from the Global Initiative on Sharing All Influenza Data (GISAID) to identify the appearance and duration of variants of concern. We used Nextclade nomenclature to collect clade designations from sequences and used Pangolin nomenclature for lineage designations of SARS-CoV-2. Finally, we conducted a 1-sided t-test to assess whether regional weekly speed was greater than an outbreak threshold of 10. We ran the test iteratively with a rolling 6-month window of data across the sample period. Results: Speed for the region remained well below the outbreak threshold before and after the WHO declaration. Acceleration and jerk were also low and stable. The 7-day persistence coefficient remained somewhat large (1.11) and statistically significant. However, both shift parameters for the weeks around the WHO declaration were negative, meaning the clustering effect of new COVID-19 cases had become recently smaller. From November 2021 onward, Omicron was the predominant variant of concern in sequenced viral samples. The rolling t-test of speed equal to 10 was insignificant for the entire sample period. Conclusions: While COVID-19 continues to circulate in SSA, the region never reached outbreak status, and the weekly transmission rate remained below 1 case per 100,000 population for well over 1 year ahead of the WHO declaration. COVID-19 is endemic in the region and no longer reaches the threshold for its classification as a pandemic. Both standard and enhanced surveillance metrics confirm that the pandemic ended in SSA by the time the WHO made its declaration. %M 39013111 %R 10.2196/53409 %U https://publichealth.jmir.org/2024/1/e53409 %U https://doi.org/10.2196/53409 %U http://www.ncbi.nlm.nih.gov/pubmed/39013111 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e49190 %T Statistical Analysis of Telehealth Use and Pre- and Postpandemic Insurance Coverage in Selected Health Care Specialties in a Large Health Care System in Arkansas: Comparative Cross-Sectional Study %A Cengil,Aysenur Betul %A Eksioglu,Sandra %A Eksioglu,Burak %A Eswaran,Hari %A Hayes,Corey J %A Bogulski,Cari A %+ Industrial Engineering Department, College of Engineering, University of Arkansas, 4183 Bell Engineering Center, Fayetteville, AR, 72701, United States, 1 4795756042, sandra@uark.edu %K appointment scheduling metrics %K insurance coverage %K statistical hypothesis testing %K telehealth %D 2024 %7 18.10.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic triggered policy changes in 2020 that allowed insurance companies to reimburse telehealth services, leading to increased telehealth use, especially in rural and underserved areas. However, with many emergency rules ending in 2022, patients and health care providers face potential challenges in accessing these services. Objective: This study analyzed telehealth use across specialties in Arkansas before and after the pandemic (2017-2022) using data from electronic medical records from the University of Arkansas for Medical Sciences Medical Center. We explored trends in insurance coverage for telehealth visits and developed metrics to compare the performance of telehealth versus in-person visits across various specialties. The results inform insurance coverage decisions for telehealth services. Methods: We used pre- and postpandemic data to determine the impacts of the COVID-19 pandemic and changes in reimbursement policies on telehealth visits. We proposed a framework to calculate 3 appointment metrics: indirect waiting time, direct waiting time, and appointment length. Statistical analysis tools were used to compare the performance of telehealth and in-person visits across the following specialties: obstetrics and gynecology, psychiatry, family medicine, gerontology, internal medicine, neurology, and neurosurgery. We used data from approximately 4 million in-person visits and 300,000 telehealth visits collected from 2017 to 2022. Results: Our analysis revealed a statistically significant increase in telehealth visits across all specialties (P<.001), showing an 89% increase from 51,589 visits in 2019 to 97,461 visits in 2020, followed by a 21% increase to 117,730 visits in 2021. Around 92.57% (134,221/145,001) of telehealth patients from 2020 to 2022 were covered by Medicare, Blue Cross and Blue Shield, commercial and managed care, Medicaid, and Medicare Managed Care. In-person visits covered by Medicare and Medicaid decreased by 15%, from 313,196 in 2019 to 264,696 in 2022. During 2020 to 2022, about 22.84% (33,123/145,001) of total telehealth visits during this period were covered by Medicare and 53.58% (86,317/161,092) were in psychiatry, obstetrics and gynecology, and family medicine. We noticed a statistically significant decrease (P<.001) in the average indirect waiting time for telehealth visits, from 48.4 to 27.7 days, and a statistically significant reduction in appointment length, from 93.2 minutes in 2020 to 39.59 minutes in 2022. The indirect waiting time for psychiatry telehealth visits was almost 50% shorter than that for in-person visits. These findings highlight the potential benefits of telehealth in providing access to health care, particularly for patients needing psychiatric care. Conclusions: Reverting to prepandemic regulations could negatively affect Arkansas, where many live in underserved areas. Our analysis shows that telehealth use remained stable beyond 2020, with psychiatry visits continuing to grow. These findings may guide insurance and policy decisions in Arkansas and other regions facing similar access challenges. %M 39423000 %R 10.2196/49190 %U https://www.jmir.org/2024/1/e49190 %U https://doi.org/10.2196/49190 %U http://www.ncbi.nlm.nih.gov/pubmed/39423000 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e58242 %T Habit and Help—Experiences of Technology Use During the COVID-19 Pandemic: Interview Study Among Older Adults %A Kilaberia,Tina R %A Hu,Yuanyuan %A Bell,Janice F %+ Silver School of Social Work, New York University, 1 Washington Square North, Room 315, New York, NY, 10003, United States, 1 212 998 5938, tk3127@nyu.edu %K pandemic %K older people %K technology habit %K subjective experience %K acceptance of technology %D 2024 %7 18.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic compelled older adults to engage with technology to a greater extent given emergent public health observance and home-sheltering restrictions in the United States. This study examined subjective experiences of technology use among older adults as a result of unforeseen and widespread public health guidance catalyzing their use of technology differently, more often, or in new ways. Objective: This study aimed to explore whether older adults scoring higher on the Unified Theory of Acceptance and Use of Technology questionnaire fared better in aspects of technology use, and reported better subjective experiences, in comparison with those scoring lower. Methods: A qualitative study using prevalence and thematic analyses of data from 18 older adults (mean age 79 years) in 2 groups: 9 scoring higher and 9 scoring lower on the Unified Theory of Acceptance and Use of Technology questionnaire. Results: Older adults were fairly competent technology users across both higher- and lower-scoring groups. The higher-scoring group noted greater use of technology in terms of telehealth and getting groceries and household items. Cognitive difficulty was described only among the lower-scoring group; they used technology less to get groceries and household items and to obtain health information. Qualitative themes depict the role of habit in technology use, enthusiasm about technology buttressed by the protective role of technology, challenges in technology use, and getting help regardless of technology mastery. Conclusions: Whereas the pandemic compelled older adults to alter or increase technology use, it did not change their global outlook on technology use. Older adults’ prepandemic habits of technology use and available help influenced the degree to which they made use of technology during the COVID-19 pandemic. %M 39422990 %R 10.2196/58242 %U https://formative.jmir.org/2024/1/e58242 %U https://doi.org/10.2196/58242 %U http://www.ncbi.nlm.nih.gov/pubmed/39422990 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e49871 %T Spatiotemporal Cluster Detection for COVID-19 Outbreak Surveillance: Descriptive Analysis Study %A Martonik,Rachel %A Oleson,Caitlin %A Marder,Ellyn %+ Deloitte, 1919 North Lynn Street, Arlington, VA, 22209, United States, 1 7032039550, rachel.martonik@gmail.com %K COVID-19 %K cluster detection %K disease outbreaks %K surveillance %K SaTScan %K space-time surveillance %K spatiotemporal %K United States %K outbreak %K outbreaks %K pandemic %K real-time surveillance %K detection %K tool %K tools %K effectiveness %K public health %K intervention %K interventions %K community settings %K outbreak detection %D 2024 %7 16.10.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: During the peak of the winter 2020-2021 surge, the number of weekly reported COVID-19 outbreaks in Washington State was 231; the majority occurred in high-priority settings such as workplaces, community settings, and schools. The Washington State Department of Health used automated address matching to identify clusters at health care facilities. No other systematic, statewide outbreak detection methods were in place. This was a gap given the high volume of cases, which delayed investigations and decreased data completeness, potentially leading to undetected outbreaks. We initiated statewide cluster detection using SaTScan, implementing a space-time permutation model to identify COVID-19 clusters for investigation. Objective: To improve outbreak detection, the Washington State Department of Health initiated a systematic cluster detection model to identify timely and actionable COVID-19 clusters for local health jurisdiction (LHJ) investigation and resource prioritization. This report details the model’s implementation and the assessment of the tool’s effectiveness. Methods: In total, 6 LHJs participated in a pilot to test model parameters including analysis type, geographic aggregation, cluster radius, and data lag. Parameters were determined through heuristic criteria to detect clusters early when they are smaller, making interventions more feasible. This study reviews all clusters detected after statewide implementation from July 17 to December 17, 2021. The clusters were analyzed by LHJ population and disease incidence. Clusters were compared with reported outbreaks. Results: A weekly, LHJ-specific retrospective space-time permutation model identified 2874 new clusters during this period. While the weekly analysis included case data from the prior 3 weeks, 58.25% (n=1674) of all clusters identified were timely—having occurred within 1 week of the analysis and early enough for intervention to prevent further transmission. There were 2874 reported outbreaks during this same period. Of those, 363 (12.63%) matched to at least one SaTScan cluster. The most frequent settings among reported and matched outbreaks were schools and youth programs (n=825, 28.71% and n=108, 29.8%), workplaces (n=617, 21.46% and n=56, 15%), and long-term care facilities (n=541, 18.82% and n=99, 27.3%). Settings with the highest percentage of clusters that matched outbreaks were community settings (16/72, 22%) and congregate housing (44/212, 20.8%). The model identified approximately one-third (119/363, 32.8%) of matched outbreaks before cases were associated with the outbreak event in our surveillance system. Conclusions: Our goal was to routinely and systematically identify timely and actionable COVID-19 clusters statewide. Regardless of population or incidence, the model identified reasonably sized, timely clusters statewide, meeting the objective. Among some high-priority settings subject to public health interventions throughout the pandemic, such as schools and community settings, the model identified clusters that were matched to reported outbreaks. In workplaces, another high-priority setting, results suggest the model might be able to identify outbreaks sooner than existing outbreak detection methods. %M 39412839 %R 10.2196/49871 %U https://publichealth.jmir.org/2024/1/e49871 %U https://doi.org/10.2196/49871 %U http://www.ncbi.nlm.nih.gov/pubmed/39412839 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e63024 %T Exploring the Linkages Among Chronic Illness, Substance Use, and COVID-19 Infection in Adults Aged 50 Years and Older: Retrospective Cross-Sectional Analysis of National Representative Data %A Ruksakulpiwat,Suebsarn %A Niyomyart,Atsadaporn %A Riangkam,Chontira %A Phianhasin,Lalipat %A Benjasirisan,Chitchanok %A Adams,Jon %+ Department of Medical Nursing, Faculty of Nursing, Mahidol University, 2 Wanglang Road, Siriraj, Bangkoknoi, Bangkok, 10700, Thailand, 66 984782692, suebsarn25@gmail.com %K multiple chronic conditions %K medical complexity %K co-occurring conditions %K substance use %K COVID-19 %K SARS-CoV-2 %K older adults %K gerontology %K geriatrics %D 2024 %7 15.10.2024 %9 Original Paper %J JMIR Aging %G English %X Background: The co-occurrence of chronic illnesses and substance use presents complex challenges for health care systems. Understanding the interplay between these factors, compounded by the context of the COVID-19 pandemic, is essential for effective intervention strategies. Objective: This study aims to investigate the relationships among chronic illness, substance use, and COVID-19 infection in adults aged 50 years and older. Methods: Participants were 1196 adults aged 50 years and older. Descriptive statistics were used to describe demographic information. Logistic regressions and multiple regression analyses were used to determine associations between chronic illnesses, substance use, and COVID-19 infection. Mediation analysis was used to determine the effect of chronic illness mediators in the association between COVID-19 concerns and substance use. Results: The mean age was 68 (SD 10.3) years, with 58.6% (701/1196) being women. Adjusted analysis revealed that age and sex (women) significantly predicted a lower level of substance use (P<.05). However, marital status (separated or widowed) and chronic illness significantly predicted a higher level of substance use (P<.05). Furthermore, having dementia, arthritis, and high cholesterol significantly predicted a higher level of concern about the COVID-19 pandemic (P<.05). Logistic regression analysis indicated that individuals with hypertension (odds ratio [OR] 1.91, 95% CI 1.37-2.66; P<.001), lung disease (OR 2.42, 95% CI 1.23-4.75; P=.01), heart condition (OR 1.99, 95% CI 1.28-3.10; P=.002), stroke (OR 2.35, 95% CI 1.07-5.16; P=.03), and arthritis (OR 1.72, 95% CI 1.25-2.37; P=.001) were more likely to have their work affected by the COVID-19 pandemic. The mediation analysis showed a significant effect of COVID-19 concern on substance use through the mediation of chronic illness, with a 95% CI of –0.02 to –0.01 and an indirect effect of –0.01. Conclusions: Our study reveals complex associations among chronic illnesses, substance use, and COVID-19 infection among adults aged 50 years and older. It underscores the impact of demographics and specific chronic conditions on substance use behaviors and COVID-19 concerns. In addition, certain chronic illnesses were linked to heightened vulnerability in employment status during the pandemic. These findings emphasize the need for targeted interventions addressing physical health and substance use in this population during the COVID-19 pandemic. %M 39405517 %R 10.2196/63024 %U https://aging.jmir.org/2024/1/e63024 %U https://doi.org/10.2196/63024 %U http://www.ncbi.nlm.nih.gov/pubmed/39405517 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e63951 %T Effectiveness of a Person-Centered Interdisciplinary Rehabilitation Treatment of Post–COVID-19 Condition: Protocol for a Single-Case Experimental Design Study %A Wiertz,Carolina M H %A van Meulenbroek,Thijs %A Lamper,Cynthia %A Hemmen,Bea %A Sep,Simone %A Huijnen,Ivan %A Goossens,Marielle E J B %A Burgers,Jako %A Verbunt,Jeanine %+ Department of Rehabilitation Medicine, Care and Public Health Research Institute, Maastricht University, PO Box 616, Maastricht, 6200 MD, Netherlands, 31 433882160, cmh.wiertz@maastrichtuniversity.nl %K rehabilitation medicine %K postacute COVID-19 syndrome %K quality of life %K long COVID %K COVID-19 %K multidisciplinary care %K interdisciplinary care %D 2024 %7 11.10.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Patients with post–COVID-19 condition (PCC) experience a wide range of complaints (physical, cognitive, and mental), sometimes with high levels of disability in daily activities. Evidence of effective interdisciplinary rehabilitation treatment is lacking. A person-centered, biopsychosocial, interdisciplinary rehabilitation program, adapted to expert opinions and the patient’s needs, was therefore developed. Objective: This study aims to present a study protocol for a clinical trial to evaluate the effect of a new, person-centered, interdisciplinary rehabilitation treatment for PCC. It is aimed at improving participation in society and health-related quality of life in patients with PCC who perceive a high level of disability in daily activities or participation. Methods: A total of 20 Dutch adults, aged 18 years or older, with high levels of disability in daily activities and participation in society will be included in this replicated and randomized single-case experimental design study, from October 2023 onward. The replicated and randomized single-case experimental design consists of 3 phases. The baseline phase is the observational period, in which no specific treatment will be given. In the intervention phase, patients will receive the new outpatient treatment 3 times a week for 12 weeks, followed by a 12-week follow-up phase. During the intervention phase, the treatment will be personalized according to the patient’s physical, mental, and cognitive symptoms and goals. The treatment team can consist of a rehabilitation physician, physiotherapist, occupational therapist, speech therapist, and psychologist. The primary outcomes of the study are daily diaries, which consist of 8 questions selected from validated questionnaires (Utrecht Scale for Evaluation of Rehabilitation-Participation, EQ-5D-5L, and the Hospital Anxiety and Depression Scale). The other primary outcome measurements are participation in society (Utrecht Scale for Evaluation of Rehabilitation-Participation) and health-related quality of life (EQ-5D-5L). The secondary outcomes are physical tests and validated questionnaires aimed at physical, mental, and cognitive complaints. Effect evaluation based on daily assessments will include visual analysis, calculation of effect sizes (Nonoverlap of All Pairs), randomization tests, and multilevel analysis. In addition, other analyses will be based on ANOVA or a 2-tailed Student t test. Results: Data collection for this study started in October 2023 and is planned to be completed in July 2024. The results will be published in peer-reviewed journals and presented at international conferences. Conclusions: This is the first study investigating the effect of an interdisciplinary rehabilitation treatment with a person-centered, biopsychosocial approach in patients with PCC. Our findings will help to improve the treatment and support of patients with PCC. Trial Registration: German Clinical Trials Register DRKS00032636; https://drks.de/search/en/trial/DRKS00032636 International Registered Report Identifier (IRRID): DERR1-10.2196/63951 %M 39393059 %R 10.2196/63951 %U https://www.researchprotocols.org/2024/1/e63951 %U https://doi.org/10.2196/63951 %U http://www.ncbi.nlm.nih.gov/pubmed/39393059 %0 Journal Article %@ 2563-3570 %I JMIR Publications %V 5 %N %P e58018 %T Comparison of the Neutralization Power of Sotrovimab Against SARS-CoV-2 Variants: Development of a Rapid Computational Method %A Ashoor,Dana %A Marzouq,Maryam %A Fathallah,M-Dahmani %+ Department of Life Sciences, Health Biotechnology Program - King Fahad Chair for Health Biotechnology, College of Graduate Studies, Arabian Gulf University, Road 2904 Building 293, Manama, 329, Bahrain, 973 17239875, danana@agu.edu.bh %K in silico %K anti–SARS-CoV-2 %K neutralizing antibody %K Sotrovimab %K S309 %K variants %K SARS-CoV-2 %K Omicron %K subvariants %K computational method %K monoclonal %K amino acid %K protein %K mutation %D 2024 %7 10.10.2024 %9 Original Paper %J JMIR Bioinform Biotech %G English %X Background: The rapid evolution of SARS-CoV-2 imposed a huge challenge on disease control. Immune evasion caused by genetic variations of the SARS-CoV-2 spike protein’s immunogenic epitopes affects the efficiency of monoclonal antibody–based therapy of COVID-19. Therefore, a rapid method is needed to evaluate the efficacy of the available monoclonal antibodies against the new emerging variants or potential novel variants. Objective: The aim of this study is to develop a rapid computational method to evaluate the neutralization power of anti–SARS-CoV-2 monoclonal antibodies against new SARS-CoV-2 variants and other potential new mutations. Methods: The amino acid sequence of the extracellular domain of the spike proteins of the severe acute respiratory syndrome coronavirus (GenBank accession number YP_009825051.1) and SARS-CoV-2 (GenBank accession number YP_009724390.1) were used to create computational 3D models for the native spike proteins. Specific mutations were introduced to the curated sequence to generate the different variant spike models. The neutralization potential of sotrovimab (S309) against these variants was evaluated based on its molecular interactions and Gibbs free energy in comparison to a reference model after molecular replacement of the reference receptor-binding domain with the variant’s receptor-binding domain. Results: Our results show a loss in the binding affinity of the neutralizing antibody S309 with both SARS-CoV and SARS-CoV-2. The binding affinity of S309 was greater to the Alpha, Beta, Gamma, and Kappa variants than to the original Wuhan strain of SARS-CoV-2. However, S309 showed a substantially decreased binding affinity to the Delta and Omicron variants. Based on the mutational profile of Omicron subvariants, our data describe the effect of the G339H and G339D mutations and their role in escaping antibody neutralization, which is in line with published clinical reports. Conclusions: This method is rapid, applicable, and of interest to adapt the use of therapeutic antibodies to the treatment of emerging variants. It could be applied to antibody-based treatment of other viral infections. %M 39388246 %R 10.2196/58018 %U https://bioinform.jmir.org/2024/1/e58018 %U https://doi.org/10.2196/58018 %U http://www.ncbi.nlm.nih.gov/pubmed/39388246 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 13 %N %P e47370 %T Changes in the Epidemiological Features of Influenza After the COVID-19 Pandemic in China, the United States, and Australia: Updated Surveillance Data for Influenza Activity %A Jiang,Mingyue %A Jia,Mengmeng %A Wang,Qing %A Sun,Yanxia %A Xu,Yunshao %A Dai,Peixi %A Yang,Weizhong %A Feng,Luzhao %+ School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, 31 Beiji Tower, Dongcheng District, Beijing, 100730, China, 86 10 65120716, fengluzhao@cams.cn %K influenza %K seasonal variation %K COVID-19 pandemic %K stringency index %D 2024 %7 9.10.2024 %9 Original Paper %J Interact J Med Res %G English %X Background: There has been a global decrease in seasonal influenza activity since the onset of the COVID-19 pandemic. Objective: We aimed to describe influenza activity during the 2021/2022 season and compare it to the trends from 2012 to 2023. We also explored the influence of social and public health prevention measures during the COVID-19 pandemic on influenza activity. Methods: We obtained influenza data from January 1, 2012, to February 5, 2023, from publicly available platforms for China, the United States, and Australia. Mitigation measures were evaluated per the stringency index, a composite index with 9 measures. A general additive model was used to assess the stringency index and the influenza positivity rate correlation, and the deviance explained was calculated. Results: We used over 200,000 influenza surveillance data. Influenza activity remained low in the United States and Australia during the 2021/2022 season. However, it increased in the United States with a positive rate of 26.2% in the 49th week of 2022. During the 2021/2022 season, influenza activity significantly increased compared with the previous year in southern and northern China, with peak positivity rates of 28.1% and 35.1% in the second week of 2022, respectively. After the COVID-19 pandemic, the dominant influenza virus genotype in China was type B/Victoria, during the 2021/2022 season, and accounted for >98% (24,541/24,908 in the South and 20,543/20,634 in the North) of all cases. Influenza virus type B/Yamagata was not detected in all these areas after the COVID-19 pandemic. Several measures individually significantly influence local influenza activity, except for influenza type B in Australia. When combined with all the measures, the deviance explained values for influenza A and B were 87.4% (P<.05 for measures of close public transport and restrictions on international travel) and 77.6% in southern China and 83.4% (P<.05 for measures of school closing and close public transport) and 81.4% in northern China, respectively. In the United States, the association was relatively stronger, with deviance-explained values of 98.6% for influenza A and 99.1% (P<.05 for measures of restrictions on international travel and public information campaign) for influenza B. There were no discernible effects on influenza B activity in Australia between 2020 and 2022 due to the incredibly low positive rate of influenza B. Additionally, the deviance explained values were 95.8% (P<.05 for measures of restrictions on gathering size and restrictions on international travel) for influenza A and 72.7% for influenza B. Conclusions: Influenza activity has increased gradually since 2021. Mitigation measures for COVID-19 showed correlations with influenza activity, mainly driven by the early stage of the pandemic. During late 2021 and 2022, the influence of mitigation management for COVID-19 seemingly decreased gradually, as the activity of influenza increased compared to the 2020/2021 season. %M 39382955 %R 10.2196/47370 %U https://www.i-jmr.org/2024/1/e47370 %U https://doi.org/10.2196/47370 %U http://www.ncbi.nlm.nih.gov/pubmed/39382955 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 13 %N %P e44492 %T Shift in Demographic Involvement and Clinical Characteristics of COVID-19 From Wild-Type SARS-CoV-2 to the Delta Variant in the Indian Population: In Silico Analysis %A Kumar,Ashutosh %A Asghar,Adil %A Raza,Khursheed %A Narayan,Ravi K %A Jha,Rakesh K %A Satyam,Abhigyan %A Kumar,Gopichand %A Dwivedi,Prakhar %A Sahni,Chetan %A Kumari,Chiman %A Kulandhasamy,Maheswari %A Motwani,Rohini %A Kaur,Gurjot %A Krishna,Hare %A Kumar,Sujeet %A Sesham,Kishore %A Pandey,Sada N %A Parashar,Rakesh %A Kant,Kamla %+ Department of Microbiology, All India Institute of Medical Sciences-Bathinda, Mandi Dabwali Rd, Bathinda, 151001, India, 91 0164 286 ext 8710, drkamlakant@gmail.com %K SARS-CoV-2 %K COVID-19 %K epidemiology %K demographic shift %K severity of illness %K variant %K virus %K pandemic %K population studies %K genomic analysis %D 2024 %7 8.10.2024 %9 Original Paper %J Interact J Med Res %G English %X Background: The Delta variant (B.1.617.2) was considered the most dangerous SARS-CoV-2 strain; however, in-depth studies on its impact based on demographic and clinical characteristics of COVID-19 are scarce. Objective: We aimed to investigate the shift in demographic and clinical characteristics of the COVID-19 pandemic with the emergence of the SARS-CoV-2 Delta variant compared with the wild-type (WT) strain (B.1). Methods: A cross-sectional study of COVID-19 cases in the Indian population caused by the WT strain (B.1) and Delta variant of SARS-CoV-2 was performed. The viral genomic sequence metadata containing demographic, vaccination, and patient status details (N=9500, NDelta=6238, NWT=3262) were statistically analyzed. Results: With the Delta variant, in comparison with the WT strain, a higher proportion of young individuals (<20 years) were infected (0-9 years: Delta: 281/6238, 4.5% vs B.1: 75/3262, 2.3%; 10-19 years: Delta: 562/6238, 9% vs B.1: 229/3262, 7%; P<.001). The proportion of women contracting infection increased (Delta: 2557/6238, 41% vs B.1: 1174/3262, 36%; P<.001). However, it decreased for men (Delta: 3681/6238, 59% vs B.1: 2088/3262, 64%; P<.001). An increased proportion of the young population developed symptomatic illness and were hospitalized (Delta: 27/262, 10.3% vs B.1: 5/130, 3.8%; P=.02). Moreover, an increased proportion of the women (albeit not men) from the young (Delta: 37/262, 14.1% vs B.1: 4/130, 3.1%; P<.001) and adult (Delta: 197/262, 75.2% vs B.1: 72/130, 55.4%; P<.001) groups developed symptomatic illness and were hospitalized. The mean age of men and women who contracted infection (Delta: men=37.9, SD 17.2 years; women=36.6, SD 17.6 years; P<.001; B.1: men=39.6, SD 16.9 years; women=40.1, SD 17.4 years; P<.001) as well as developing symptoms or being hospitalized (Delta: men=39.6, SD 17.4 years; women=35.6, SD 16.9 years, P<.001; B.1: men=47, SD 18 years; women=49.5, SD 20.9 years, P<.001) were considerably lower with the Delta variant than the B.1 strain. The total mortality was about 1.8 times higher with the Delta variant than with the WT strain. With the Delta variant, compared with B.1, mortality decreased for men (Delta: 58/85, 68% vs B.1: 15/20, 75%; P<.001); in contrast, it increased for women (Delta: 27/85, 32% vs B.1: 5/20, 25%; P<.001). The odds of death increased with age, irrespective of sex (odds ratio 3.034, 95% CI 1.7-5.2, P<.001). Frequent postvaccination infections (24/6238) occurred with the Delta variant following complete doses. Conclusions: The increased involvement of young people and women, the lower mean age for illness, higher mortality, and frequent postvaccination infections were significant epidemiological concerns with the Delta variant. %M 39378428 %R 10.2196/44492 %U https://www.i-jmr.org/2024/1/e44492 %U https://doi.org/10.2196/44492 %U http://www.ncbi.nlm.nih.gov/pubmed/39378428 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 7 %N %P e53864 %T Moderators of the Effects of a Digital Parenting Intervention on Child Conduct and Emotional Problems Implemented During the COVID-19 Pandemic: Results From a Secondary Analysis of Data From the Supporting Parents and Kids Through Lockdown Experiences (SPARKLE) Randomized Controlled Trial %A Pokorna,Nikola %A Palmer,Melanie %A Pearson,Oliver %A Beckley-Hoelscher,Nicholas %A Shearer,James %A Kostyrka-Allchorne,Katarzyna %A Robertson,Olly %A Koch,Marta %A Slovak,Petr %A Day,Crispin %A Byford,Sarah %A Waite,Polly %A Creswell,Cathy %A Sonuga-Barke,Edmund J S %A Goldsmith,Kimberley %+ Institute of Psychiatry, Psychology & Neuroscience, King’s College London, 16 De Crespigny Park, London, SE5 8AB, United Kingdom, 44 020 7848 0002, edmund.sonuga-barke@kcl.ac.uk %K parenting %K intervention %K smartphone app %K randomized controlled trial %K COVID-19 pandemic %K moderators %K conduct problems %K emotional problems %D 2024 %7 8.10.2024 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: A smartphone app, Parent Positive, was developed to help parents manage their children’s conduct and emotional problems during the COVID-19 pandemic. A randomized controlled trial, Supporting Parents and Kids Through Lockdown Experiences (SPARKLE), found Parent Positive to be effective in reducing children’s emotional problems. However, app effectiveness may be influenced by a range of child, family, socioeconomic, and pandemic-related factors. Objective: This study examined whether baseline factors related to the child, family, and socioeconomic status, as well as pandemic-related disruption circumstances, moderated Parent Positive’s effects on child conduct and emotional problems at 1- and 2-month follow-up. Methods: This study was a secondary exploratory analysis of SPARKLE data. The data set included 646 children (4-10 years of age) with parents randomized to either Parent Positive (n=320) or follow-up as usual (n=326). Candidate baseline moderators included child age, gender, attention-deficit/hyperactivity disorder symptoms, parental psychological distress, family conflict, household income, employment status, household overcrowding, and pandemic-related disruption risk (ie, homeschooling, lockdown status, and isolation status). Child conduct and emotional problem outcomes measured at 1- (T2) and 2-months (T3) post randomization were analyzed using linear mixed-effects analysis of covariance models adjusting for baseline (T1) measure of outcome and including intervention and intervention by time point interaction terms allowing for different effects at the 2 time points. Moderation of intervention effects by baseline factors was assessed by replacing the intervention by time interaction terms with intervention by time point by baseline moderator interaction terms. Results: Child gender was a significant moderator of the Parent Positive versus follow-up as usual effect on emotional problems (B=0.72, 95% CI 0.12-1.33; P=.02). Specifically, the effect of Parent Positive was close to significant (T2: B=–0.41, 95% CI –0.82 to 0.0004; P=.05) or significant (T3: B=–0.76, 95% CI –1.22 to –0.30; P<.001) in males only when compared with females, and males experienced a significantly larger reduction in emotional problems than females in the Parent Positive arm at the 2-month post randomization time point. None of the other investigated baseline factors moderated effects on emotional problems, and no factors moderated effects on conduct problems. Conclusions: This study highlights Parent Positive’s potential for effectively reducing emotional problems in primary school-aged male children across a wide range of families. However, due to limited variability in the demographic background of the families, cautious interpretation is required, and replications are necessary in diverse samples with longer follow-up times. Trial Registration: ClinicalTrials.gov NCT04786080; https://clinicaltrials.gov/ct2/show/NCT04786080 %M 39378100 %R 10.2196/53864 %U https://pediatrics.jmir.org/2024/1/e53864 %U https://doi.org/10.2196/53864 %U http://www.ncbi.nlm.nih.gov/pubmed/39378100 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e60387 %T United Voices Group-Singing Intervention to Address Loneliness and Social Isolation Among Older People With HIV During the COVID-19 Pandemic: Intervention Adaption Study %A Hill,Miranda %A Greene,Meredith %A Johnson,Julene K %A Tan,Judy Y %+ Cancer Research Center for Health Equity, Division of Population Sciences, Department of Biomedical Sciences, Cedars-Sinai Medical Center, 6500 Wilshire Blvd, Los Angeles, CA, 90048, United States, 1 3104231499, judy.tan@cshs.org %K HIV %K AIDS %K mental health %K loneliness %K older adults %K music-based interventions %K technology %K mobile phone %D 2024 %7 8.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: People living with HIV experience HIV stigma alongside a spectrum of aging-related health conditions that accelerate their vulnerability to the ill effects of loneliness and social isolation. Group-singing interventions are efficacious in improving psychosocial well-being among older people in the general population; however, the social curative effects of group singing have not been explored in relation to HIV stigma. By promoting group identification, bonding, and pride, group singing may reduce loneliness, social isolation, and other negative impacts of HIV stigma among older people living with HIV. Access to group-singing programs may be enhanced by technology. Objective: While group singing has been extensively studied in older adults, group-singing interventions have not been adapted for older people living with HIV to target loneliness and social isolation in the context of HIV stigma. The objective of this study was to describe the systematic development of a group-singing intervention to reduce loneliness and social isolation among older people living with HIV. Methods: In the San Francisco Bay Area between February 2019 and October 2019, we engaged older people living with HIV in a rigorous, 8-stage, community-engaged intervention adaptation process using the Assessment, Decision, Adaptation, Production, Topical Experts, Integration, Training, and Testing (ADAPT-ITT) framework. On the basis of a formative assessment of the needs and preferences of older people living with HIV, we selected an evidence-based group-singing intervention for older adults and systematically adapted the intervention components by administering them to a community advisory council (n=13). Results: The result was United Voices, a 12-week hybrid (web-based and in-person) group-singing intervention for older people living with HIV. United Voices comprises 12 web-based (ie, via Zoom [Zoom Video Communications]) rehearsals, web-based and in-person drop-in helpdesk sessions, and a professionally produced final concert recording. Conclusions: Through an iterative process and in consultation with stakeholders and topic experts, we refined and manualized United Voices and finalized the design of a pilot randomized controlled trial to evaluate the feasibility and acceptability of the intervention protocol and procedures. The findings provide insights into the barriers and facilitators involved in culturally tailoring interventions for older people living with HIV, implementing intervention adaptations within web-based environments, and the promise of developing hybrid music-based interventions for older adults with HIV. %M 39378071 %R 10.2196/60387 %U https://formative.jmir.org/2024/1/e60387 %U https://doi.org/10.2196/60387 %U http://www.ncbi.nlm.nih.gov/pubmed/39378071 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e59274 %T Association Between Ursodeoxycholic Acid and Clinical Outcomes in Patients With COVID-19 Infection: Population-Based Cohort Study %A Lee,Hyunjun %A Kim,Min Gul %A Yeom,Sang Woo %A Noh,Sang Jae %A Jeong,Cho Yun %A Kim,Min Ji %A Kang,Min Gu %A Ko,Ji Hoon %A Park,Su Cheol %A Kweon,Hyeok Tae %A Sim,Sang Il %A Lee,Hyun %A You,Yeon Seok %A Kim,Jong Seung %+ Department of Medical Informatics, Department of Otorhinolaryngology, Jeonbuk National University School of Medicine and Hospital, 20 Geonji-ro, Deokjin-gu, Jeonju-si, Jeonbuk-do, Jeonju, 54907, Republic of Korea, 82 +82 63 250 2792, kjsjdk@gmail.com %K Covid 19 %K COVID-19 %K ursodeoxycholic acid %K population-based cohort study %K SARS-CoV-2 %K Coronavirus %K pandemic %K population-based %K retrospective cohort study %K propensity score %K UDCA %K public health %K common data model %K clinical %K severity %D 2024 %7 7.10.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Several studies have investigated the relationship between ursodeoxycholic acid (UDCA) and COVID-19 infection. However, complex and conflicting results have generated confusion in the application of these results. Objective: We aimed to investigate whether the association between UDCA and COVID-19 infection can also be demonstrated through the analysis of a large-scale cohort. Methods: This retrospective study used local and nationwide cohorts, namely, the Jeonbuk National University Hospital into the Observational Medical Outcomes Partnership common data model cohort (JBUH CDM) and the Korean National Health Insurance Service claim–based database (NHIS). We investigated UDCA intake and its relationship with COVID-19 susceptibility and severity using validated propensity score matching. Results: Regarding COVID-19 susceptibility, the adjusted hazard ratio (aHR) value of the UDCA intake was significantly lowered to 0.71 in the case of the JBUH CDM (95% CI 0.52-0.98) and was significantly lowered to 0.93 (95% CI 0.90-0.96) in the case of the NHIS. Regarding COVID-19 severity, the UDCA intake was found to be significantly lowered to 0.21 (95% CI 0.09-0.46) in the case of JBUH CDM. Furthermore, the aHR value was significantly lowered to 0.77 in the case of NHIS (95% CI 0.62-0.95). Conclusions: Using a large-scale local and nationwide cohort, we confirmed that UDCA intake was significantly associated with reductions in COVID-19 susceptibility and severity. These trends remained consistent regardless of the UDCA dosage. This suggests the potential of UDCA as a preventive and therapeutic agent for COVID-19 infection. %M 39139026 %R 10.2196/59274 %U https://publichealth.jmir.org/2024/1/e59274 %U https://doi.org/10.2196/59274 %U http://www.ncbi.nlm.nih.gov/pubmed/39139026 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e54991 %T Health Care Usage During the COVID-19 Pandemic and the Adoption of Telemedicine: Retrospective Study of Chronic Disease Cohorts %A Bjarnadóttir,Margrét Vilborg %A Anderson,David %A Anderson,Kelley M %A Aljwfi,Omar %A Peluso,Alina %A Ghannoum,Adam %A Balba,Gayle %A Shara,Nawar %+ Decisions, Operations and Information Technology, University of Maryland, College Park, 4353 Van Munching Hall, College Park, MD, 20742, United States, 1 301 405 2061, mbjarnad@umd.edu %K telehealth utilization %K health care utilization %K demographic differences %K cohort study %K telehealth %K COVID-19 %K telehealth adaption %D 2024 %7 3.10.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic accelerated telehealth adoption across disease cohorts of patients. For many patients, routine medical care was no longer an option, and others chose not to visit medical offices in order to minimize COVID-19 exposure. In this study, we take a comprehensive multidisease approach in studying the impact of the COVID-19 pandemic on health care usage and the adoption of telemedicine through the first 12 months of the COVID-19 pandemic. Objective: We studied the impact of the COVID-19 pandemic on in-person health care usage and telehealth adoption across chronic diseases to understand differences in telehealth adoption across disease cohorts and patient demographics (such as the Social Vulnerability Index [SVI]). Methods: We conducted a retrospective cohort study of 6 different disease cohorts (anxiety: n=67,578; depression: n=45,570; diabetes: n=81,885; kidney failure: n=29,284; heart failure: n=21,152; and cancer: n=35,460). We used summary statistics to characterize changes in usage and regression analysis to study how patient characteristics relate to in-person health care and telehealth adoption and usage during the first 12 months of the pandemic. Results: We observed a reduction in in-person health care usage across disease cohorts (ranging from 10% to 24%). For most diseases we study, telehealth appointments offset the reduction in in-person visits. Furthermore, for anxiety and depression, the increase in telehealth usage exceeds the reduction in in-person visits (by up to 5%). We observed that younger patients and men have higher telehealth usage after accounting for other covariates. Patients from higher SVI areas are less likely to use telehealth; however, if they do, they have a higher number of telehealth visits, after accounting for other covariates. Conclusions: The COVID-19 pandemic affected health care usage across diseases, and the role of telehealth in replacing in-person visits varies by disease cohort. Understanding these differences can inform current practices and provides opportunities to further guide modalities of in-person and telehealth visits. Critically, further study is needed to understand barriers to telehealth service usage for patients in higher SVI areas. A better understanding of the role of social determinants of health may lead to more support for patients and help individual health care providers improve access to care for patients with chronic conditions. %M 39361360 %R 10.2196/54991 %U https://www.jmir.org/2024/1/e54991 %U https://doi.org/10.2196/54991 %U http://www.ncbi.nlm.nih.gov/pubmed/39361360 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e54066 %T The Relationship Between Epidemic Perception and Cyberbullying Behaviors of Chinese Adolescents During the COVID-19 Pandemic: Cross-Sectional Study %A Feng,Yonggang %A Xue,Qihui %A Yu,Peng %A Peng,Lanxiang %K COVID-19 %K epidemic perception %K cyberbullying behaviors %K insomnia %K anxiety and depression %D 2024 %7 2.10.2024 %9 %J JMIR Public Health Surveill %G English %X Background: In response to the COVID-19 outbreak, the government initiated measures for social distancing, leading to a gradual transition of adolescents’ social interactions toward web-based platforms. Consequently, web-based behaviors, particularly cyberbullying, have become a prominent concern. Considering that adolescents experience more intense feelings, the widely increased negative emotions and strains perceived from the COVID-19 pandemic may end up engaging in cyberbullying behaviors. In addition, during the COVID-19 pandemic, adolescents experiencing insomnia and negative affect are more prone to diminished self-control, which is associated with cyberbullying behaviors. Objective: This study aims to investigate the relationship between epidemic perception and cyberbullying behaviors, while also examining the serial mediating roles of insomnia and negative affect on the relationship between epidemic perception and cyberbullying behaviors. Methods: This study presents a large-scale web-based survey conducted during the period of concentrated COVID-19 outbreaks, encompassing 20,000 Chinese adolescents. A total of 274 submitted questionnaires were discarded because of high levels of missing data or their answers were clearly fictitious or inconsistent. The final count of valid participants amounted to 19,726 (10,371 boys, age range: 12‐18 years; mean 14.80, SD 1.63 years). The Perceptions of COVID-19 Scale, Negative Affect Scale, Insomnia Scale, and Cyberbullying Behavior Scale were used to assess participants’ responses on the Questionnaire Star platform. Results: The results show that epidemic perception is positively correlated with cyberbullying behaviors (r=0.13; P<.001), insomnia (r=0.19; P<.001), and negative affect (r=0.25; P<.001). Insomnia is positively correlated with negative affect (r=0.44; P<.001) and cyberbullying behaviors (r=0.30; P<.001). Negative affect is positively correlated with cyberbullying behaviors (r=0.25; P<.001). And insomnia and negative affect play independent mediating and serial mediating roles in epidemic perception and cyberbullying behaviors. Conclusions: This study provides additional empirical evidence on the relationship between the perception of COVID-19 pandemic and cyberbullying in adolescents. In addition, the study offers recommendations for implementing interventions targeted at mitigating cyberbullying in adolescents during the COVID-19 pandemic. %R 10.2196/54066 %U https://publichealth.jmir.org/2024/1/e54066 %U https://doi.org/10.2196/54066 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e55697 %T Associations Between Acute COVID-19 Symptom Profiles and Long COVID Prevalence: Population-Based Cross-Sectional Study %A Hirschtick,Jana L %A Slocum,Elizabeth %A Xie,Yanmei %A Power,Laura E %A Elliott,Michael R %A Orellana,Robert C %A Fleischer,Nancy L %K SARS-CoV-2 %K COVID-19 %K post-acute COVID-19 syndrome %K epidemiology %K surveillance %D 2024 %7 1.10.2024 %9 %J JMIR Public Health Surveill %G English %X Background: Growing evidence suggests that severe acute COVID-19 illness increases the risk of long COVID (also known as post–COVID-19 condition). However, few studies have examined associations between acute symptoms and long COVID onset. Objective: This study aimed to examine associations between acute COVID-19 symptom profiles and long COVID prevalence using a population-based sample. Methods: We used a dual mode (phone and web-based) population-based probability survey of adults with polymerase chain reaction–confirmed SARS-CoV-2 between June 2020 and May 2022 in the Michigan Disease Surveillance System to examine (1) how acute COVID-19 symptoms cluster together using latent class analysis, (2) sociodemographic and clinical predictors of symptom clusters using multinomial logistic regression accounting for classification uncertainties, and (3) associations between symptom clusters and long COVID prevalence using modified Poisson regression. Results: In our sample (n=4169), 15.9% (n=693) had long COVID, defined as new or worsening symptoms at least 90 days post SARS-CoV-2 infection. We identified 6 acute COVID-19 symptom clusters resulting from the latent class analysis, with flu-like symptoms (24.7%) and fever (23.6%) being the most prevalent in our sample, followed by nasal congestion (16.4%), multi-symptomatic (14.5%), predominance of fatigue (10.8%), and predominance of shortness of breath (10%) clusters. Long COVID prevalence was highest in the multi-symptomatic (39.7%) and predominance of shortness of breath (22.4%) clusters, followed by the flu-like symptom (15.8%), predominance of fatigue (14.5%), fever (6.4%), and nasal congestion (5.6%) clusters. After adjustment, females (vs males) had greater odds of membership in the multi-symptomatic, flu-like symptom, and predominance of fatigue clusters, while adults who were Hispanic or another race or ethnicity (vs non-Hispanic White) had greater odds of membership in the multi-symptomatic cluster. Compared with the nasal congestion cluster, the multi-symptomatic cluster had the highest prevalence of long COVID (adjusted prevalence ratio [aPR] 6.1, 95% CI 4.3‐8.7), followed by the predominance of shortness of breath (aPR 3.7, 95% CI 2.5‐5.5), flu-like symptom (aPR 2.8, 95% CI 1.9‐4.0), and predominance of fatigue (aPR 2.2, 95% CI 1.5‐3.3) clusters. Conclusions: Researchers and clinicians should consider acute COVID-19 symptom profiles when evaluating subsequent risk of long COVID, including potential mechanistic pathways in a research context, and proactively screen high-risk patients during the provision of clinical care. %R 10.2196/55697 %U https://publichealth.jmir.org/2024/1/e55697 %U https://doi.org/10.2196/55697 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e53767 %T Evaluation and Future Challenges in a Self-Guided Web-Based Intervention With and Without Chat Support for Depression and Anxiety Symptoms During the COVID-19 Pandemic: Randomized Controlled Trial %A Dominguez-Rodriguez,Alejandro %A Sanz-Gomez,Sergio %A González Ramírez,Leivy Patricia %A Herdoiza-Arroyo,Paulina Erika %A Trevino Garcia,Lorena Edith %A de la Rosa-Gómez,Anabel %A González-Cantero,Joel Omar %A Macias-Aguinaga,Valeria %A Arenas Landgrave,Paulina %A Chávez-Valdez,Sarah Margarita %+ School of Medicine and Health Sciences, Tecnologico de Monterrey, Avenue Gral Ramón Corona #2514, Colonia Nuevo México, Zapopan, 45201, Mexico, 52 3336693000, leivy@tec.mx %K self-guided web-based intervention %K chat support %K depression %K anxiety %K COVID-19 %K opinion %K usability %K randomized control trial %D 2024 %7 30.9.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic has had an impact on mental health worldwide. Low- and middle-income countries were largely affected by it. Mexico was one of the most affected countries. Extended periods of lockdowns, isolation, and social distancing, among other factors, highlighted the need to introduce web-based psychological interventions to the Mexican population. In this context, Mental Health COVID-19 emerged as a self-guided web-based intervention (SGWI) aimed at adults to improve mental health during the COVID-19 pandemic. Objective: This study aims to assess the efficacy of 2 modalities of a self-guided intervention (with and without chat support) in reducing depression symptoms, generalized anxiety, community posttraumatic stress, widespread fear, anxiety, sleep quality, physiological and affective coping, and suicide ideation. In addition, it aimed to compare the moderating role of coping strategies, acceptance, and satisfaction in participants’ symptom reduction. We hypothesize that the self-guided, chat-supported modality will show higher efficacy than the modality without chat support in achieving clinical change and better performance as a moderator of depression symptoms, generalized anxiety, community posttraumatic stress, widespread fear, anxiety, sleep quality, physiological and affective coping, and suicide ideation, as well as an increase in participants’ satisfaction and acceptability. Methods: A randomized controlled trial was conducted. Data were collected from May 2020 to June 2022. We performed intrasubject measures at 4 evaluation periods: pretest, posttest, and follow-up measurements at 3 and 6 months. Differences between intervention groups were assessed through the Mann-Whitney U test for continuous variables and the chi-square test for categorical variables. Changes due to intervention were analyzed using Wilcoxon W test. Moderated regression analysis was performed to test the hypothesized moderating role of coping strategies, usability, and opinion about treatment on clinical change. Results: A total of 36 participants completed the intervention; of these, 5 (14%) were part of the SGWI group, and 31 (86%) were on the SGWI plus chat support (SGWI+C) group, which included a chat service with therapists. The perceived high complexity of the system for the SGWI group had a moderating effect associated with a lack of efficacy of the intervention regarding depression, but not when controlled for sociodemographic variables. A perception of lower helpfulness of the intervention was associated with poorer outcomes. Coping strategies did not show moderating effects. Conclusions: Enhancing the utility of web-based interventions for reducing clinical symptoms by incorporating a support chat to boost treatment adherence seemed to improve the perception of the intervention’s usefulness. Web-based interventions face several challenges, such as eliminating complexities in platform use and increasing the users’ perceived utility of the intervention, among other issues identified in the study. Trial Registration: ClinicalTrials.gov NCT04468893; https://clinicaltrials.gov/study/NCT04468893?tab=results International Registered Report Identifier (IRRID): RR2-10.2196/23117 %M 39348893 %R 10.2196/53767 %U https://formative.jmir.org/2024/1/e53767 %U https://doi.org/10.2196/53767 %U http://www.ncbi.nlm.nih.gov/pubmed/39348893 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 4 %N %P e60678 %T Evaluating the Influence of Role-Playing Prompts on ChatGPT’s Misinformation Detection Accuracy: Quantitative Study %A Haupt,Michael Robert %A Yang,Luning %A Purnat,Tina %A Mackey,Tim %+ Global Health Program, Department of Anthropology, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, United States, 1 858 534 4145, tkmackey@ucsd.edu %K large language models %K ChatGPT %K artificial intelligence %K AI %K experiment %K prompt engineering %K role-playing %K social identity %K misinformation detection %K COVID-19 %D 2024 %7 26.9.2024 %9 Original Paper %J JMIR Infodemiology %G English %X Background: During the COVID-19 pandemic, the rapid spread of misinformation on social media created significant public health challenges. Large language models (LLMs), pretrained on extensive textual data, have shown potential in detecting misinformation, but their performance can be influenced by factors such as prompt engineering (ie, modifying LLM requests to assess changes in output). One form of prompt engineering is role-playing, where, upon request, OpenAI’s ChatGPT imitates specific social roles or identities. This research examines how ChatGPT’s accuracy in detecting COVID-19–related misinformation is affected when it is assigned social identities in the request prompt. Understanding how LLMs respond to different identity cues can inform messaging campaigns, ensuring effective use in public health communications. Objective: This study investigates the impact of role-playing prompts on ChatGPT’s accuracy in detecting misinformation. This study also assesses differences in performance when misinformation is explicitly stated versus implied, based on contextual knowledge, and examines the reasoning given by ChatGPT for classification decisions. Methods: Overall, 36 real-world tweets about COVID-19 collected in September 2021 were categorized into misinformation, sentiment (opinions aligned vs unaligned with public health guidelines), corrections, and neutral reporting. ChatGPT was tested with prompts incorporating different combinations of multiple social identities (ie, political beliefs, education levels, locality, religiosity, and personality traits), resulting in 51,840 runs. Two control conditions were used to compare results: prompts with no identities and those including only political identity. Results: The findings reveal that including social identities in prompts reduces average detection accuracy, with a notable drop from 68.1% (SD 41.2%; no identities) to 29.3% (SD 31.6%; all identities included). Prompts with only political identity resulted in the lowest accuracy (19.2%, SD 29.2%). ChatGPT was also able to distinguish between sentiments expressing opinions not aligned with public health guidelines from misinformation making declarative statements. There were no consistent differences in performance between explicit and implicit misinformation requiring contextual knowledge. While the findings show that the inclusion of identities decreased detection accuracy, it remains uncertain whether ChatGPT adopts views aligned with social identities: when assigned a conservative identity, ChatGPT identified misinformation with nearly the same accuracy as it did when assigned a liberal identity. While political identity was mentioned most frequently in ChatGPT’s explanations for its classification decisions, the rationales for classifications were inconsistent across study conditions, and contradictory explanations were provided in some instances. Conclusions: These results indicate that ChatGPT’s ability to classify misinformation is negatively impacted when role-playing social identities, highlighting the complexity of integrating human biases and perspectives in LLMs. This points to the need for human oversight in the use of LLMs for misinformation detection. Further research is needed to understand how LLMs weigh social identities in prompt-based tasks and explore their application in different cultural contexts. %M 39326035 %R 10.2196/60678 %U https://infodemiology.jmir.org/2024/1/e60678 %U https://doi.org/10.2196/60678 %U http://www.ncbi.nlm.nih.gov/pubmed/39326035 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e54421 %T Identifying Potential Factors Associated With Racial Disparities in COVID-19 Outcomes: Retrospective Cohort Study Using Machine Learning on Real-World Data %A Dasa,Osama %A Bai,Chen %A Sajdeya,Ruba %A Kimmel,Stephen E %A Pepine,Carl J %A Gurka J,Matthew J %A Laubenbacher,Reinhard %A Pearson,Thomas A %A Mardini,Mamoun T %+ Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, PO Box 100238, Gainesville, FL, 32610, United States, 1 3527331234, osama.dasa@gmail.com %K health disparities %K racial disparities %K COVID-19 outcomes %K social determinants of health %K area deprivation index %K health outcomes %K machine learning %K real-world data %K COVID-19 %K SARS-CoV-2 %K real-world data %K socioeconomic status %D 2024 %7 26.9.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Racial disparities in COVID-19 incidence and outcomes have been widely reported. Non-Hispanic Black patients endured worse outcomes disproportionately compared with non-Hispanic White patients, but the epidemiological basis for these observations was complex and multifaceted. Objective: This study aimed to elucidate the potential reasons behind the worse outcomes of COVID-19 experienced by non-Hispanic Black patients compared with non-Hispanic White patients and how these variables interact using an explainable machine learning approach. Methods: In this retrospective cohort study, we examined 28,943 laboratory-confirmed COVID-19 cases from the OneFlorida Research Consortium’s data trust of health care recipients in Florida through April 28, 2021. We assessed the prevalence of pre-existing comorbid conditions, geo-socioeconomic factors, and health outcomes in the structured electronic health records of COVID-19 cases. The primary outcome was a composite of hospitalization, intensive care unit admission, and mortality at index admission. We developed and validated a machine learning model using Extreme Gradient Boosting to evaluate predictors of worse outcomes of COVID-19 and rank them by importance. Results: Compared to non-Hispanic White patients, non-Hispanic Blacks patients were younger, more likely to be uninsured, had a higher prevalence of emergency department and inpatient visits, and were in regions with higher area deprivation index rankings and pollutant concentrations. Non-Hispanic Black patients had the highest burden of comorbidities and rates of the primary outcome. Age was a key predictor in all models, ranking highest in non-Hispanic White patients. However, for non-Hispanic Black patients, congestive heart failure was a primary predictor. Other variables, such as food environment measures and air pollution indicators, also ranked high. By consolidating comorbidities into the Elixhauser Comorbidity Index, this became the top predictor, providing a comprehensive risk measure. Conclusions: The study reveals that individual and geo-socioeconomic factors significantly influence the outcomes of COVID-19. It also highlights varying risk profiles among different racial groups. While these findings suggest potential disparities, further causal inference and statistical testing are needed to fully substantiate these observations. Recognizing these relationships is vital for creating effective, tailored interventions that reduce disparities and enhance health outcomes across all racial and socioeconomic groups. %M 39326040 %R 10.2196/54421 %U https://publichealth.jmir.org/2024/1/e54421 %U https://doi.org/10.2196/54421 %U http://www.ncbi.nlm.nih.gov/pubmed/39326040 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e54503 %T Assessment of the Effective Sensitivity of SARS-CoV-2 Sample Pooling Based on a Large-Scale Screening Experience: Retrospective Analysis %A Cabrera Alvargonzalez,Jorge J %A Larrañaga,Ana %A Martinez,Javier %A Pérez Castro,Sonia %A Rey Cao,Sonia %A Daviña Nuñez,Carlos %A Del Campo Pérez,Víctor %A Duran Parrondo,Carmen %A Suarez Luque,Silvia %A González Alonso,Elena %A Silva Tojo,Alfredo José %A Porteiro,Jacobo %A Regueiro,Benito %+ Microbiology Department, Complexo Hospitalario Universitario de Vigo, Servicio Galego de Saude, Estrada de Clara Campoamor, 341, Vigo, 36312, Spain, 34 986811111, jorge.julio.cabrera.alvargonzalez@sergas.es %K pooling %K sensitivity %K SARS-CoV-2 %K PCR %K saliva %K screening %K surveillance %K COVID-19 %K nonsymptomatic %K transmission control %D 2024 %7 24.9.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The development of new large-scale saliva pooling detection strategies can significantly enhance testing capacity and frequency for asymptomatic individuals, which is crucial for containing SARS-CoV-2. Objective: This study aims to implement and scale-up a SARS-CoV-2 screening method using pooled saliva samples to control the virus in critical areas and assess its effectiveness in detecting asymptomatic infections. Methods: Between August 2020 and February 2022, our laboratory received a total of 928,357 samples. Participants collected at least 1 mL of saliva using a self-sampling kit and registered their samples via a smartphone app. All samples were directly processed using AutoMate 2550 for preanalytical steps and then transferred to Microlab STAR, managed with the HAMILTON Pooling software for pooling. The standard pool preset size was 20 samples but was adjusted to 5 when the prevalence exceeded 2% in any group. Real-time polymerase chain reaction (RT-PCR) was conducted using the Allplex SARS-CoV-2 Assay until July 2021, followed by the Allplex SARS-CoV-2 FluA/FluB/RSV assay for the remainder of the study period. Results: Of the 928,357 samples received, 887,926 (95.64%) were fully processed into 56,126 pools. Of these pools, 4863 tested positive, detecting 5720 asymptomatic infections. This allowed for a comprehensive analysis of pooling’s impact on RT-PCR sensitivity and false-negative rate (FNR), including data on positive samples per pool (PPP). We defined Ctref as the minimum cycle threshold (Ct) of each data set from a sample or pool and compared these Ctref results from pooled samples with those of the individual tests (ΔCtP). We then examined their deviation from the expected offset due to dilution [ΔΔCtP = ΔCtP – log2]. In this work, the ΔCtP and ΔΔCtP were 2.23 versus 3.33 and –0.89 versus 0.23, respectively, comparing global results with results for pools with 1 positive sample per pool. Therefore, depending on the number of genes used in the test and the size of the pool, we can evaluate the FNR and effective sensitivity (1 – FNR) of the test configuration. In our scenario, with a maximum of 20 samples per pool and 3 target genes, statistical observations indicated an effective sensitivity exceeding 99%. From an economic perspective, the focus is on pooling efficiency, measured by the effective number of persons that can be tested with 1 test, referred to as persons per test (PPT). In this study, the global PPT was 8.66, reflecting savings of over 20 million euros (US $22 million) based on our reagent prices. Conclusions: Our results demonstrate that, as expected, pooling reduces the sensitivity of RT-PCR. However, with the appropriate pool size and the use of multiple target genes, effective sensitivity can remain above 99%. Saliva pooling may be a valuable tool for screening and surveillance in asymptomatic individuals and can aid in controlling SARS-CoV-2 transmission. Further studies are needed to assess the effectiveness of these strategies for SARS-CoV-2 and their application to other microorganisms or biomarkers detected by PCR. %M 39316785 %R 10.2196/54503 %U https://publichealth.jmir.org/2024/1/e54503 %U https://doi.org/10.2196/54503 %U http://www.ncbi.nlm.nih.gov/pubmed/39316785 %0 Journal Article %@ 1947-2579 %I JMIR Publications %V 16 %N %P e58378 %T Evaluation of Drug and Herbal Medicinal Promotions on Social Media During the COVID-19 Pandemic in Relation to World Health Organization Ethical Criteria and South African Health Products Regulatory Authority Guidelines in South Africa: Cross-Sectional Content Analysis %A Chimukuche,Rujeko Samanthia %A Ndlazi,Julia %A Mtolo,Lucky Thembani %A Bird,Kristien %A Seeley,Janet %+ Social Sciences Core, Africa Health Research Institute, Nelson R Mandela School of Medicine, 3rd Floor, K-RITH Tower Building, 719 Umbilo Road, Durban, 4013, South Africa, 27 31 521 0038, rujeko.chidawanyika@ahri.org %K drug advertising %K internet %K social media %K ethical guidelines %K traditional medicine %K COVID-19 %D 2024 %7 18.9.2024 %9 Original Paper %J Online J Public Health Inform %G English %X Background: Consideration of ethics in the promotion of medications is essential to safeguard the health of consumers, particularly during health crises. The World Health Organization (WHO) and the South African Health Products Regulatory Authority (SAHPRA) have established stringent standards to ensure the integrity of pharmaceutical promotions and safeguard public health, including advertisements on the internet and social media platforms. However, the dynamic nature of online advertising poses challenges for monitoring and enforcing ethical standards. Objective: The study aimed (1) to examine the COVID-19 drug and medicinal promotions across online platforms and social media from 2020 to 2022 in South Africa and (2) to ensure that drug promotions adhere to ethical guidelines outlined by the WHO and SAPHRA. Methods: A cross-sectional content analysis was conducted to assess drug and medicinal advertisements across various internet and social media platforms. A systematic approach was used to identify and analyze promotional content, focusing on adherence to ethical guidelines outlined by WHO and SAPHRA. Data were collected and analyzed to determine the extent of compliance and identify any potential violations or areas for improvement. Results: A total of 14 online drug advertisements were included in this analysis. Our findings show that most of the drugs advertised did not meet the regulations and guidelines provided by WHO and SAHPRA. There were omissions about active ingredients, proprietary names, adverse drug responses, precautions, and overdosage and adverse drug reactions. Traditional medicines were not fully consistent with the approved WHO ethical criteria data sheet. Conclusions: Our analysis highlights the critical importance of ensuring compliance with ethical guidelines in drug promotions on the internet and social media platforms. There is a need for continued vigilance and enforcement efforts to uphold ethical standards and protect the health of the public. Ongoing monitoring and collaboration between national drug regulatory agencies, pharmaceutical companies, and online platforms will be essential for promoting responsible advertising. In addition, safety monitoring and pharmacovigilance systems for herbal medicinal products are yet to be established. %M 39293046 %R 10.2196/58378 %U https://ojphi.jmir.org/2024/1/e58378 %U https://doi.org/10.2196/58378 %U http://www.ncbi.nlm.nih.gov/pubmed/39293046 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e56854 %T Crisis and Emergency Risk Communication and Emotional Appeals in COVID-19 Public Health Messaging: Quantitative Content Analysis %A Ho,Shirley S %A Chuah,Agnes S F %A Ho,Vanessa S %A Rosenthal,Sonny %A Kim,Hye Kyung %A Soh,Shannon S H %+ Wee Kim Wee School of Communication and Information, Nanyang Technological University, WKWSCI Building, 31 Nanyang Link, Singapore, 637718, Singapore, tsyho@ntu.edu.sg %K COVID-19 %K crisis and emergency risk communication %K CERC %K emotional appeal %K content analysis %K public health %K Facebook %K social media %K Singapore %D 2024 %7 17.9.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Although COVID-19 is no longer a global health emergency, it remains pervasive in Singapore, a city-state situated in Southeast Asia, with periodic waves of infection. In addition to disease management, strong communication strategies are critical in the government’s response to the pandemic to keep the public updated and equip them in protecting themselves. Objective: Grounded in the crisis and emergency risk communication (CERC) framework and emotional appeals, this study aimed to analyze public health communication strategies in Singapore during the COVID-19 pandemic. Methods: Quantitative content analysis was conducted on 696 Facebook (Meta Platforms Inc) posts and 83 website articles published by Singapore-based public health institutions between January 2020 and September 2022. Results: The results showed that increasing communication on message themes, such as inquisitive messaging and clarification, can enhance communication strategies. The use of emotional appeals also varies with time and should be carefully used as they are context-specific. Conclusions: Theoretically, this study contributes to advancements in the CERC framework and concepts of emotional appeals by exploring the applications and changes of CERC message types and emotional appeals at different phases. The findings can provide practical guidance for authorities and communication practitioners in developing effective communication strategies. %M 39288399 %R 10.2196/56854 %U https://www.jmir.org/2024/1/e56854 %U https://doi.org/10.2196/56854 %U http://www.ncbi.nlm.nih.gov/pubmed/39288399 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e45530 %T Messenger Use and Video Calls as Correlates of Depressive and Anxiety Symptoms: Results From the Corona Health App Study of German Adults During the COVID-19 Pandemic %A Edler,Johanna-Sophie %A Terhorst,Yannik %A Pryss,Rüdiger %A Baumeister,Harald %A Cohrdes,Caroline %+ Mental Health Research Unit, Department of Epidemiology and Health Monitoring, Robert Koch Institute, PO Box 650261, Berlin, 12101, Germany, 49 30187542692, cohrdesc@rki.de %K passive data %K depression %K anxiety %K predicting mental health %K mobile phone %D 2024 %7 16.9.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Specialized studies have shown that smartphone-based social interaction data are predictors of depressive and anxiety symptoms. Moreover, at times during the COVID-19 pandemic, social interaction took place primarily remotely. To appropriately test these objective data for their added value for epidemiological research during the pandemic, it is necessary to include established predictors. Objective: Using a comprehensive model, we investigated the extent to which smartphone-based social interaction data contribute to the prediction of depressive and anxiety symptoms, while also taking into account well-established predictors and relevant pandemic-specific factors. Methods: We developed the Corona Health App and obtained participation from 490 Android smartphone users who agreed to allow us to collect smartphone-based social interaction data between July 2020 and February 2021. Using a cross-sectional design, we automatically collected data concerning average app use in terms of the categories video calls and telephony, messenger use, social media use, and SMS text messaging use, as well as pandemic-specific predictors and sociodemographic covariates. We statistically predicted depressive and anxiety symptoms using elastic net regression. To exclude overfitting, we used 10-fold cross-validation. Results: The amount of variance explained (R2) was 0.61 for the prediction of depressive symptoms and 0.57 for the prediction of anxiety symptoms. Of the smartphone-based social interaction data included, only messenger use proved to be a significant negative predictor of depressive and anxiety symptoms. Video calls were negative predictors only for depressive symptoms, and SMS text messaging use was a negative predictor only for anxiety symptoms. Conclusions: The results show the relevance of smartphone-based social interaction data in predicting depressive and anxiety symptoms. However, even taken together in the context of a comprehensive model with well-established predictors, the data only add a small amount of value. %M 39283658 %R 10.2196/45530 %U https://www.jmir.org/2024/1/e45530 %U https://doi.org/10.2196/45530 %U http://www.ncbi.nlm.nih.gov/pubmed/39283658 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e51237 %T Patient Engagement With and Perceptions of the COVIDA Project, a Volunteer-Led Telemonitoring and Teleorientation Service for COVID-19 Community Management: Mixed Methods Study %A Escobar-Agreda,Stefan %A Silva-Valencia,Javier %A Soto-Becerra,Percy %A Reategui-Rivera,C Mahony %A De la Cruz-Torralva,Kelly %A Chahuara-Rojas,Max %A Hernandez-Iriarte,Bruno %A Espinoza-Herrera,Daniel Hector %A Delgado,Carlos Alberto %A Matassini,Silvana %A Vargas-Herrera,Javier %A Rojas-Mezarina,Leonardo %+ Unidad de Telesalud, Facultad de Medicina, Universidad Nacional Mayor de San Marcos, Grau Avenue, 775, Lima, 15001, Peru, 51 619 7000 ext 4650, jvargash@unmsm.edu.pe %K telemonitoring %K volunteers %K engagement %K COVID-19 %K Peru %K telehealth %K perceptions %D 2024 %7 13.9.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: During the pandemic in Peru, the COVIDA (Collaboration Network of Volunteer Brigade Members for the Investigation, Detection, and Primary Management of Community Cases Affected by COVID-19) project proposed an innovative way to provide telemonitoring and teleorientation to COVID-19 patients, led by health care student volunteers. However, it has not been described how this interaction is perceived from the patient’s perspective and which factors increase their engagement with this service. Objective: The aim of this study is to describe the perceptions of patients about COVIDA and identify factors associated with their engagement with this service. Methods: A mixed methods study was conducted to evaluate perceptions of patients that participated in the COVIDA project. This telehealth intervention organized by the National University of San Marcos was implemented in Peru from August to December 2020. The service involved daily phone calls by volunteer students to monitor registered COVID-19 patients until the completion of the 14th day of the illness or if a warning sign was identified. The volunteers also provided teleorientation to address the patients’ needs and concerns. Quantitative analysis was performed to describe the characteristics of the patients and to assess the factors related to their engagement with the service, which was defined by the percentage of participants who completed the follow-up according to their individual schedule. Qualitative analysis through semistructured interviews evaluated the patients’ perceptions of the service regarding the aspects of communication, interaction, and technology. Results: Of the 770 patients enrolled in COVIDA, 422 (55.7%) were female; the median age was 39 (IQR 28-52) years. During the monitoring, 380 patients (49.4%) developed symptoms, and 471 (61.2%) showed warning signs of COVID-19. The overall median for engagement was 93% (IQR 35.7%-100%). Among those patients who did not develop warning signs, engagement was associated with the presence of symptoms (OR 3.04, 95% CI 2.22-4.17), a positive COVID-19 test at the start of follow-up (OR 1.97, 95% CI 1.48-2.61), and the presence of comorbidities (OR 1.83, 95% CI 1.29-2.59). Patients reported that the volunteers provided clear and valuable information and emotional support. Communication via phone calls took place smoothly and without interruptions. Conclusions: COVIDA represents a well-accepted and well-perceived alternative model for student volunteers to provide telemonitoring, teleorientation, and emotional support to patients with COVID-19 in the context of overwhelmed demand for health care services. The deployment of this kind of intervention should be prioritized among patients with symptoms and comorbidities, as they show more engagement with these services. %M 39269741 %R 10.2196/51237 %U https://formative.jmir.org/2024/1/e51237 %U https://doi.org/10.2196/51237 %U http://www.ncbi.nlm.nih.gov/pubmed/39269741 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e53978 %T Bridging Language Barriers in COVID-19 Research: Descriptive Study of AccesoCovid.com’s Reach and User Engagement %A Abascal Miguel,Lucía %A Forster,Maeve %A Gallalee,Sarah %A Carson,Mariam %A Fieldhouse,Jane K %A Keir,Alexandra %A Maya,Sigal %A Rahman,Sabahat %A Reid,Michael J A %A Vasilopoulos,Hariclea %A Lima Sanchez,Dania Nimbe %+ Institute for Global Health Sciences, University of California, San Francisco, 550 16th St, San Francisco, CA, 94158, United States, 1 (415) 476 5190, maeve.forster@ucsf.edu %K COVID-19 research dissemination %K multilingual scientific platform %K language barriers in science %K Spanish scientific communication %K equitable access to research %K global health equity %D 2024 %7 9.9.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic underscored the challenge of swiftly disseminating research findings to a global audience. Language barriers further exacerbated disparities in access to timely scientific information, particularly for non-English speaking communities. The majority of COVID-19 research was published in English, limiting accessibility for Spanish-speaking populations. Objective: This paper aims to assess the reach and effectiveness of AccesoCovid.com, a platform designed to disseminate up-to-date COVID-19 research in both English and Spanish, addressing the language gap in scientific communication. Methods: AccesoCovid.com was developed through a partnership between the University of California, San Francisco (UCSF) and Universidad Nacional Autónoma de México (UNAM). The website’s performance and user engagement were evaluated using Google Analytics over a span of 2 years. Key metrics included user language preference, geographical distribution, and site traffic. The website summarized and translated 1032 articles on various COVID-19 topics, such as “Pharmaceutical Interventions and Vaccines.” Results: From February 2021 to February 2023, the platform attracted 57,000 users. Of the 43,000 unique new visitors, 84.2% (n=36,219) hailed from Spanish-speaking regions. The majority accessed the site organically through search engines, with 88.4% (n=38,000) of users arriving this way, while 5000 (11.6%) users accessed the site directly. Most users (n=30,894, 72.1%) preferred the Spanish version of the site. The website’s most accessed category was “Pharmaceutical Interventions and Vaccines,” followed by “Clinical Presentation and Management” and “Mental Health.” Regarding language distribution, 72.1% (n=30,894) of users primarily used Spanish; 21.4% (n=9215) used English; and 6.7% (n=2891) spoke other languages, including Portuguese, Chinese, and German. Geographically, the website attracted visitors from 179 countries, with the highest visitor counts from Mexico (n=12,342, 28.7%), Spain (n=6405, 14.9%), the United States (n=4416, 10.3%), and Peru (n=3821, 8.9%). Conclusions: AccesoCovid.com successfully bridged a critical language gap in the dissemination of COVID-19 research. Its success underscores the pressing need for multilingual scientific resources. The platform demonstrated significant user engagement and reach, particularly in Spanish-speaking countries. This highlights the potential for similar platforms to ensure equitable access to scientific knowledge across diverse linguistic communities. Future efforts should focus on expanding to other languages and conducting formal evaluations to enhance user satisfaction and impact. %M 39250219 %R 10.2196/53978 %U https://formative.jmir.org/2024/1/e53978 %U https://doi.org/10.2196/53978 %U http://www.ncbi.nlm.nih.gov/pubmed/39250219 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e53580 %T Impact of Long SARS-CoV-2 Omicron Infection on the Health Care Burden: Comparative Case-Control Study Between Omicron and Pre-Omicron Waves %A Valdivieso-Martinez,Bernardo %A Lopez-Sanchez,Victoria %A Sauri,Inma %A Diaz,Javier %A Calderon,Jose Miguel %A Gas-Lopez,Maria Eugenia %A Lidon,Laura %A Philibert,Juliette %A Lopez-Hontangas,Jose Luis %A Navarro,David %A Cuenca,Llanos %A Forner,Maria Jose %A Redon,Josep %+ Hospital Clínico de la Comunidad Valenciana (INCLIVA) Research Institute, University of Valencia, Menendez y Pelayo, 4, Valencia, 46010, Spain, 34 658909676, josep.redon@uv.es %K Omicron %K long COVID %K post–COVID-19 %K diagnostics %K primary care %K specialist %K emergency department %K hospitalization %D 2024 %7 3.9.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Following the initial acute phase of COVID-19, health care resource use has escalated among individuals with SARS-CoV-2 infection. Objective: This study aimed to compare new diagnoses of long COVID and the demand for health services in the general population after the Omicron wave with those observed during the pre-Omicron waves, using similar assessment protocols for both periods and to analyze the influence of vaccination. Methods: This matched retrospective case-control study included patients of both sexes diagnosed with acute SARS-CoV-2 infection using reverse transcription polymerase chain reaction or antigen tests in the hospital microbiology laboratory during the pandemic period regardless of whether the patients were hospitalized. We included patients of all ages from 2 health care departments that cover 604,000 subjects. The population was stratified into 2 groups, youths (<18 years) and adults (≥18 years). Patients were followed-up for 6 months after SARS-CoV-2 infection. Previous vaccination, new diagnoses, and the use of health care resources were recorded. Patients were compared with controls selected using a prospective score matched for age, sex, and the Charlson index. Results: A total of 41,577 patients with a history of prior COVID-19 infection were included, alongside an equivalent number of controls. This cohort encompassed 33,249 (80%) adults aged ≥18 years and 8328 (20%) youths aged <18 years. Our analysis identified 40 new diagnoses during the observation period. The incidence rate per 100 patients over a 6-month period was 27.2 for vaccinated and 25.1 for unvaccinated adults (P=.09), while among youths, the corresponding rates were 25.7 for vaccinated and 36.7 for unvaccinated individuals (P<.001). Overall, the incidence of new diagnoses was notably higher in patients compared to matched controls. Additionally, vaccinated patients exhibited a reduced incidence of new diagnoses, particularly among women (P<.001) and younger patients (P<.001) irrespective of the number of vaccine doses administered and the duration since the last dose. Furthermore, an increase in the use of health care resources was observed in both adult and youth groups, albeit with lower figures noted in vaccinated individuals. In the comparative analysis between the pre-Omicron and Omicron waves, the incidence of new diagnoses was higher in the former; however, distinct patterns of diagnosis were evident. Specifically, depressed mood (P=.03), anosmia (P=.003), hair loss (P<.001), dyspnea (<0.001), chest pain (P=.04), dysmenorrhea (P<.001), myalgia (P=.011), weakness (P<.001), and tachycardia (P=.015) were more common in the pre-Omicron period. Similarly, health care resource use, encompassing primary care, specialist, and emergency services, was more pronounced in the pre-Omicron wave. Conclusions: The rise in new diagnoses following SARS-CoV-2 infection warrants attention due to its potential implications for health systems, which may necessitate the allocation of supplementary resources. The absence of vaccination protection presents a challenge to the health care system. %M 39226091 %R 10.2196/53580 %U https://publichealth.jmir.org/2024/1/e53580 %U https://doi.org/10.2196/53580 %U http://www.ncbi.nlm.nih.gov/pubmed/39226091 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 13 %N %P e40801 %T Telemedicine Research Trends in 2001-2022 and Research Cooperation Between China and Other Countries Before and After the COVID-19 Pandemic: Bibliometric Analysis %A Feng,Hanlin %A Kurata,Karin %A Cao,Jianfei %A Itsuki,Kageyama %A Niwa,Makoto %A Aoyama,Atsushi %A Kodama,Kota %+ Medical Data Science Lab, Hoshi University, 2-4-41 Ebara, Shinagawa-Ku, Tokyo, 142-8501, Japan, 81 337861011, kodama.kota@hoshi.ac.jp %K telemedicine %K telehealth %K coauthorship analysis %K network analysis %K bibliometric analysis %K co-occurrence analysis %D 2024 %7 30.8.2024 %9 Original Paper %J Interact J Med Res %G English %X Background: Advancements in technology have overcome geographical barriers, making telemedicine, which offers remote emergency services, healthcare, and medication guidance, increasingly popular. COVID-19 restrictions amplified its global importance by bridging distances. Objective: This study aimed to analyze Chinese and global literature data, present new global telemedicine research trends, and clarify the development potential, collaborations, and deficiencies in China's telemedicine research. Methods: We conducted bibliometrics and network analyses on relevant documents from the Web of Science database from 2001 to 2022. Data collection was completed on October 30, 2023. Considering COVID-19’s impact, 2020 was used as a baseline, dividing the data into 2 periods: 2001-2019 and 2020-2022. The development potential was determined based on publication trends. An international coauthorship network analysis identified collaboration statuses and potential. Co-occurrence analysis was conducted for China and the world. Results: We identified 25,333 telemedicine-related research papers published between 2001 and 2022, with a substantial increase during the COVID-19 period (2020-2022), particularly in China (1.93-fold increase), moving its global publication rank from tenth to sixth. The United States, the United Kingdom, and Australia contributed 62.96% of the literature, far ahead of China’s 3.90%. Globally, telemedicine research increased significantly post-2020. Between 2001 and 2019, the United States and Australia were central in coauthor networks; post-2020, the United States remained the largest node. Network hubs included the United States, the United Kingdom, Australia, and Canada. Keyword co-occurrence analysis revealed 5 global clusters from 2001 to 2019 (system technology, health care applications, mobile health, mental health, and electronic health) and 2020 to 2022 (COVID-19, children’s mental health, artificial intelligence, digital health, and rehabilitation of middle-aged and older adults). In China, the research trends aligned with global patterns, with rapid growth post-2020. From 2001 to 2019, China cooperated closely with Indonesia, India, Japan, Taiwan, and South Korea. From 2020 to 2022, cooperation expanded to Japan, Singapore, Malaysia, and South Korea, as well as Saudi Arabia, Egypt, South Africa, Ghana, Lebanon, and other African and Middle Eastern countries. Chinese keyword co-occurrence analysis showed focus areas in system technology, health care applications, mobile health, big data analysis, and electronic health (2001-2019) and COVID-19, artificial intelligence, digital health, and mental health (2020-2022). Although psychology research increased, studies on children’s mental health and middle-aged and older adults’ rehabilitation were limited. Conclusions: We identified the latest trends in telemedicine research, demonstrating its significant potential in China and providing directions for future development and collaborations in telemedicine research. %M 39213010 %R 10.2196/40801 %U https://www.i-jmr.org/2024/1/e40801 %U https://doi.org/10.2196/40801 %U http://www.ncbi.nlm.nih.gov/pubmed/39213010 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e57309 %T Contextual Acceptance of COVID-19 Mitigation Mobile Apps in the United States: Mixed Methods Survey Study on Postpandemic Data Privacy %A Feng,Yuanyuan %A Stenger,Brad %A Zhang,Shikun %+ Department of Computer Science, University of Vermont, 85 South Prospect Street, Burlington, VT, 05405, United States, 1 802 656 3475, yuanyuan.feng@uvm.edu %K data privacy %K health privacy %K COVID-19 %K mobile apps %K contextual integrity %K respiratory %K infectious %K pulmonary %K pandemic %K mobile app %K app %K apps %K digital health %K digital technology %K digital intervention %K digital interventions %K smartphone %K smartphones %K mobile phone %D 2024 %7 29.8.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic gave rise to countless user-facing mobile apps to help fight the pandemic (“COVID-19 mitigation apps”). These apps have been at the center of data privacy discussions because they collect, use, and even retain sensitive personal data from their users (eg, medical records and location data). The US government ended its COVID-19 emergency declaration in May 2023, marking a unique time to comprehensively investigate how data privacy impacted people’s acceptance of various COVID-19 mitigation apps deployed throughout the pandemic. Objective: This research aims to provide insights into health data privacy regarding COVID-19 mitigation apps and policy recommendations for future deployment of public health mobile apps through the lens of data privacy. This research explores people’s contextual acceptance of different types of COVID-19 mitigation apps by applying the privacy framework of contextual integrity. Specifically, this research seeks to identify the factors that impact people’s acceptance of data sharing and data retention practices in various social contexts. Methods: A mixed methods web-based survey study was conducted by recruiting a simple US representative sample (N=674) on Prolific in February 2023. The survey includes a total of 60 vignette scenarios representing realistic social contexts that COVID-19 mitigation apps could be used. Each survey respondent answered questions about their acceptance of 10 randomly selected scenarios. Three contextual integrity parameters (attribute, recipient, and transmission principle) and respondents’ basic demographics are controlled as independent variables. Regression analysis was performed to determine the factors impacting people’s acceptance of initial data sharing and data retention practices via these apps. Qualitative data from the survey were analyzed to support the statistical results. Results: Many contextual integrity parameter values, pairwise combinations of contextual integrity parameter values, and some demographic features of respondents have a significant impact on their acceptance of using COVID-19 mitigation apps in various social contexts. Respondents’ acceptance of data retention practices diverged from their acceptance of initial data sharing practices in some scenarios. Conclusions: This study showed that people’s acceptance of using various COVID-19 mitigation apps depends on specific social contexts, including the type of data (attribute), the recipients of the data (recipient), and the purpose of data use (transmission principle). Such acceptance may differ between the initial data sharing and data retention practices, even in the same context. Study findings generated rich implications for future pandemic mitigation apps and the broader public health mobile apps regarding data privacy and deployment considerations. %M 39207832 %R 10.2196/57309 %U https://www.jmir.org/2024/1/e57309 %U https://doi.org/10.2196/57309 %U http://www.ncbi.nlm.nih.gov/pubmed/39207832 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 4 %N %P e51328 %T Descriptions of Scientific Evidence and Uncertainty of Unproven COVID-19 Therapies in US News: Content Analysis Study %A Watson,Sara %A Benning,Tyler J %A Marcon,Alessandro R %A Zhu,Xuan %A Caulfield,Timothy %A Sharp,Richard R %A Master,Zubin %+ Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Medical Center Boulevard, Suite 310, Winston-Salem, NC, 27157, United States, 1 3367164289, zmaster@wakehealth.edu %K COVID-19 %K COVID-19 drug treatment %K information dissemination %K health communication %K uncertainty %K content analysis %K information sources %K therapy %K misinformation %K communication %K scientific evidence %K media analysis %K news report %K COVID-19 therapy %K treatment %K public awareness %K public trepidation %K therapeutic %K therapeutics %K vaccine %K vaccines %K pandemic %K United States %K media analysis %K safety %K efficacy %K evidence %K news %K report %K reports %D 2024 %7 29.8.2024 %9 Original Paper %J JMIR Infodemiology %G English %X Background: Politicization and misinformation or disinformation of unproven COVID-19 therapies have resulted in communication challenges in presenting science to the public, especially in times of heightened public trepidation and uncertainty. Objective: This study aims to examine how scientific evidence and uncertainty were portrayed in US news on 3 unproven COVID-19 therapeutics, prior to the development of proven therapeutics and vaccines. Methods: We conducted a media analysis of unproven COVID-19 therapeutics in early 2020. A total of 479 discussions of unproven COVID-19 therapeutics (hydroxychloroquine, remdesivir, and convalescent plasma) in traditional and online US news reports from January 1, 2020, to July 30, 2020, were systematically analyzed for theme, scientific evidence, evidence details and limitations, safety, efficacy, and sources of authority. Results: The majority of discussions included scientific evidence (n=322, 67%) although only 24% (n=116) of them mentioned publications. “Government” was the most frequently named source of authority for safety and efficacy claims on remdesivir (n=43, 35%) while “expert” claims were mostly mentioned for convalescent plasma (n=22, 38%). Most claims on hydroxychloroquine (n=236, 79%) were offered by a “prominent person,” of which 97% (n=230) were from former US President Trump. Despite the inclusion of scientific evidence, many claims of the safety and efficacy were made by nonexperts. Few news reports expressed scientific uncertainty in discussions of unproven COVID-19 therapeutics as limitations of evidence were infrequently included in the body of news reports (n=125, 26%) and rarely found in headlines (n=2, 2%) or lead paragraphs (n=9, 9%; P<.001). Conclusions: These results highlight that while scientific evidence is discussed relatively frequently in news reports, scientific uncertainty is infrequently reported and rarely found in prominent headlines and lead paragraphs. %M 39207825 %R 10.2196/51328 %U https://infodemiology.jmir.org/2024/1/e51328 %U https://doi.org/10.2196/51328 %U http://www.ncbi.nlm.nih.gov/pubmed/39207825 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e52318 %T Surveillance Metrics and History of the COVID-19 Pandemic in Central Asia: Updated Epidemiological Assessment %A Lundberg,Alexander L %A Ozer,Egon A %A Wu,Scott A %A Soetikno,Alan G %A Welch,Sarah B %A Liu,Yingxuan %A Havey,Robert J %A Murphy,Robert L %A Hawkins,Claudia %A Mason,Maryann %A Achenbach,Chad J %A Post,Lori A %+ Buehler Center for Health Policy and Economics, Robert J. Havey, MD Institute for Global Health, Northwestern University, 420 E. Superior St., Chicago, IL, 60611, United States, 1 312 503 1706, alexander.lundberg@northwestern.edu %K SARS-CoV-2 %K COVID-19 %K Central Asia %K pandemic %K surveillance %K public health %K COVID-19 transmission %K speed %K acceleration %K deceleration %K jerk %K dynamic panel %K generalized method of moments %K GMM %K Arellano-Bond %K 7-day lag %K Armenia %K Azerbaijan %K Cyprus %K Faeroe Islands %K Georgia %K Gibraltar %K Kazakhstan %K Kosovo %K Kyrgyzstan %K Macedonia %K Russia %K Tajikistan Turkey %K Turkmenistan %K Uzbekistan %D 2024 %7 28.8.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: This study updates the COVID-19 pandemic surveillance in Central Asia we conducted during the first year of the pandemic by providing 2 additional years of data for the region. The historical context provided through additional data can inform regional preparedness and early responses to infectious outbreaks of either the SARS-CoV-2 virus or future pathogens in Central Asia. Objective: First, we aim to measure whether there was an expansion or contraction in the pandemic in Central Asia when the World Health Organization (WHO) declared the end of the public health emergency for the COVID-19 pandemic on May 5, 2023. Second, we use dynamic and genomic surveillance methods to describe the history of the pandemic in the region and situate the window of the WHO declaration within the broader history. Third, we aim to provide historical context for the course of the pandemic in Central Asia. Methods: Traditional surveillance metrics, including counts and rates of COVID-19 transmissions and deaths, and enhanced surveillance indicators, including speed, acceleration, jerk, and persistence, were used to measure shifts in the pandemic. To identify the appearance and duration of variants of concern, we used data on sequenced SARS-CoV-2 variants from the Global Initiative on Sharing All Influenza Data (GISAID). We used Nextclade nomenclature to collect clade designations from sequences and Pangolin nomenclature for lineage designations of SARS-CoV-2. Finally, we conducted a 1-sided t test to determine whether regional speed was greater than an outbreak threshold of 10. We ran the test iteratively with 6 months of data across the sample period. Results: Speed for the region had remained below the outbreak threshold for 7 months by the time of the WHO declaration. Acceleration and jerk were also low and stable. Although the 1- and 7-day persistence coefficients remained statistically significant, the coefficients were relatively small in magnitude (0.125 and 0.347, respectively). Furthermore, the shift parameters for either of the 2 most recent weeks around May 5, 2023, were both significant and negative, meaning the clustering effect of new COVID-19 cases became even smaller in the 2 weeks around the WHO declaration. From December 2021 onward, Omicron was the predominant variant of concern in sequenced viral samples. The rolling t test of speed equal to 10 became entirely insignificant for the first time in March 2023. Conclusions: Although COVID-19 continues to circulate in Central Asia, the rate of transmission remained well below the threshold of an outbreak for 7 months ahead of the WHO declaration. COVID-19 appeared to be endemic in the region and no longer reached the threshold of a pandemic. Both standard and enhanced surveillance metrics suggest the pandemic had ended by the time of the WHO declaration. %M 39013115 %R 10.2196/52318 %U https://publichealth.jmir.org/2024/1/e52318 %U https://doi.org/10.2196/52318 %U http://www.ncbi.nlm.nih.gov/pubmed/39013115 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e47465 %T Patient-Reported Experiences of Persistent Post–COVID-19 Conditions After Hospital Discharge During the Second and Third Waves of the Pandemic in Switzerland: Cross-Sectional Questionnaire Study %A Tacchini-Jacquier,Nadine %A Monnay,Sévrine %A Coquoz,Nicolas %A Bonvin,Eric %A Verloo,Henk %+ Department of Nursing, School of Health Sciences, University of Applied Sciences and Arts Western Switzerland (HES-SO), 5, Chemin de l’Agasse, Sion, 1950, Switzerland, 41 78 769 89 90, henk.verloo@hevs.ch %K patient-reported experience measures %K PREMs %K long COVID %K fatigue %K post-traumatic stress disorder %K depression %K anxiety %K SARS-CoV-2 infection %K post-COVID %K COVID-19 %K pandemic %K hospital discharge %K pandemic %D 2024 %7 28.8.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Hospitalized patients infected with SARS-CoV-2 should recover within a few weeks. However, even those with mild versions can experience symptoms lasting 4 weeks or longer. These post–COVID-19 condition (PCC) comprise various new, returning, or ongoing symptoms that can last for months or years and cause disability. Few studies have investigated PCC using self-reports from discharged patients infected with SARS-CoV-2 to complement clinical and biomarker studies. Objective: This study aimed to investigate self-reported, persistent PCC among patients infected with SARS-CoV-2 who were discharged during the second and third waves of the COVID-19 pandemic. Methods: We designed, pretested, and posted an ad hoc paper questionnaire to all eligible inpatients discharged between October 2020 and April 2021. At 4 months post discharge, we collected data on PCC and scores for the Multidimensional Fatigue Inventory (MFI), the Patient Health Questionnaire-4 (PHQ-4), a Brief Memory Screening Scale (Q3PC), and a posttraumatic stress disorder scale (PCL-5). Descriptive, inferential, and multivariate linear regression statistics assessed PCC symptomatology, associations, and differences regarding sociodemographic characteristics and hospital length of stay (LOS). We examined whether our variables of interest significantly predicted MFI scores. Results: Of the 1993 valid questionnaires returned, 245 were from discharged patients with SARS-CoV-2 (median age 71, IQR 62.7-77 years). Only 28.2% (69/245) of respondents were symptom-free after 4 months. Women had significantly more persistent PCC symptoms than men (P≤.001). Patients with a hospital LOS ≥11 days had more PCC symptoms as well (P<.001)—women had more symptoms and longer LOS. No significant differences were found between age groups (18-64, 65-74, and ≥75 years old; P=.50) or between intensive care units and other hospitalization units (P=.09). Patients self-reported significantly higher PHQ-4 scores during their hospitalization than at 4 months later (P<.001). Three-fourth (187/245, 76.4%) of the respondents reported memory loss and concentration disorders (Q3PC). No significant differences in the median MFI score (56, IQR 1-3, range 50-60]) were associated with sociodemographic variables. Patients with a hospital LOS of ≥11 days had a significantly higher median PCL-5 score (P<.001). Multivariate linear regression allowed us to calculate that the combination of PHQ-4, Q3PC, and PCL-5 scores, adjusted for age, sex, and LOS (of either ≥11 days [median 2 symptoms, IQR 1-5] or <11 days), did not significantly predict MFI scores (R2=0.09; F4,7 =1.5; P=.22; adjusted R2=0.06). Conclusions: The majority of inpatients infected with SARS-CoV-2 presented with PCC 4 months after discharge, with complex clinical pictures. Only one-third of them were symptom-free during that time. Based on our findings, MFI scores were not directly related to self-reported depression, anxiety, or posttraumatic scores adjusted for age, sex, or LOS. Further research is needed to explore PCC and fatigue based on self-reported health experiences of discharged inpatients infected with SARS-CoV-2. %M 39197160 %R 10.2196/47465 %U https://publichealth.jmir.org/2024/1/e47465 %U https://doi.org/10.2196/47465 %U http://www.ncbi.nlm.nih.gov/pubmed/39197160 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e47416 %T Geospatial Point-of-Care Testing Strategies for COVID-19 Resilience in Resource-Poor Settings: Rural Cambodia Field Study %A Kost,Gerald Joseph %A Eng,Muyngim %A Zadran,Amanullah %+ Point-of-care Testing Center for Teaching and Research (POCT•CTR), School of Medicine, University of California, Davis, 506 Citadel Drive, Davis, CA, 95616, United States, 1 916 734 2525, geraldkost@gmail.com %K Cambodia %K COVID-19 %K diagnostic portals %K mobile-testing van and clinic %K molecular diagnostics %K point-of-care testing %K POCT %K public health resilience %K rapid antigen test %K RAgT %K SARS-CoV-2 %K Solano and Yolo counties %K California %D 2024 %7 27.8.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Point-of-care testing (POCT) generates intrinsically fast, inherently spatial, and immediately actionable results. Lessons learned in rural Cambodia and California create a framework for planning and mobilizing POCT with telehealth interventions. Timely diagnosis can help communities assess the spread of highly infectious diseases, mitigate outbreaks, and manage risks. Objective: The aims of this study were to identify the need for POCT in Cambodian border provinces during peak COVID-19 outbreaks and to quantify geospatial gaps in access to diagnostics during community lockdowns. Methods: Data sources comprised focus groups, interactive learners, webinar participants, online contacts, academic experts, public health experts, and officials who determined diagnostic needs and priorities in rural Cambodia during peak COVID-19 outbreaks. We analyzed geographic distances and transit times to testing in border provinces and assessed a high-risk province, Banteay Meanchey, where people crossed borders daily leading to disease spread. We strategized access to rapid antigen testing and molecular diagnostics in the aforementioned province and applied mobile-testing experience among the impacted population. Results: COVID-19 outbreaks were difficult to manage in rural and isolated areas where diagnostics were insufficient to meet needs. The median transit time from border provinces (n=17) to testing sites was 73 (range 1-494) minutes, and in the high-risk Banteay Meanchey Province (n=9 districts), this transit time was 90 (range 10-150) minutes. Within border provinces, maximum versus minimum distances and access times for testing differed significantly (P<.001). Pareto plots revealed geospatial gaps in access to testing for people who are not centrally located. At the time of epidemic peaks in Southeast Asia, mathematical analyses showed that only one available rapid antigen test met the World Health Organization requirement of sensitivity >80%. We observed that in rural Solano and Yolo counties, California, vending machines and public libraries dispensing free COVID-19 test kits 24-7 improved public access to diagnostics. Mobile-testing vans equipped with COVID-19 antigen, reverse transcription polymerase chain reaction, and multiplex influenza A/B testing proved useful for differential diagnosis, public awareness, travel certifications, and telehealth treatment. Conclusions: Rural diagnostic portals implemented in California demonstrated a feasible public health strategy for Cambodia. Automated dispensers and mobile POCT can respond to COVID-19 case surges and enhance preparedness. Point-of-need planning can enhance resilience and assure spatial justice. Public health assets should include higher-quality, lower-cost, readily accessible, and user-friendly POCT, such as self-testing for diagnosis, home molecular tests, distributed border detection for surveillance, and mobile diagnostics vans for quick telehealth treatment. High-risk settings will benefit from the synthesis of geospatially optimized POCT, automated 24-7 test access, and timely diagnosis of asymptomatic and symptomatic patients at points of need now, during new outbreaks, and in future pandemics. %M 39190459 %R 10.2196/47416 %U https://publichealth.jmir.org/2024/1/e47416 %U https://doi.org/10.2196/47416 %U http://www.ncbi.nlm.nih.gov/pubmed/39190459 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e45513 %T The Clinical Severity of COVID-19 Variants of Concern: Retrospective Population-Based Analysis %A Harrigan,Sean P %A Velásquez García,Héctor A %A Abdia,Younathan %A Wilton,James %A Prystajecky,Natalie %A Tyson,John %A Fjell,Chris %A Hoang,Linda %A Kwong,Jeffrey C %A Mishra,Sharmistha %A Wang,Linwei %A Sander,Beate %A Janjua,Naveed Z %A Sbihi,Hind %+ BC Centre for Disease Control, 655 W12th Avenue, Vancouver, BC, V5Z4R4, Canada, 1 604 7071400, hind.sbihi@bccdc.ca %K COVID-19 %K SARS-CoV-2 %K severity %K whole genome sequencing %K WGS %K social determinants of health %K SDOHs %K vaccination %K variants of concern %K VOCs %K Alpha %K Gamma %K Delta %K Omicron %D 2024 %7 27.8.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: SARS-CoV-2 variants of concern (VOCs) emerged and rapidly replaced the original strain worldwide. The increased transmissibility of these new variants led to increases in infections, hospitalizations, and mortality. However, there is a scarcity of retrospective investigations examining the severity of all the main VOCs in presence of key public health measures and within various social determinants of health (SDOHs). Objective: This study aims to provide a retrospective assessment of the clinical severity of COVID-19 VOCs in the context of heterogenous SDOHs and vaccination rollout. Methods: We used a population-based retrospective cohort design with data from the British Columbia COVID-19 Cohort, a linked provincial surveillance platform. To assess the relative severity (hospitalizations, intensive care unit [ICU] admissions, and deaths) of Gamma, Delta, and Omicron infections during 2021 relative to Alpha, we used inverse probability treatment weighted Cox proportional hazard modeling. We also conducted a subanalysis among unvaccinated individuals, as assessed severity differed across VOCs and SDOHs. Results: We included 91,964 individuals infected with a SARS-CoV-2 VOC (Alpha: n=20,487, 22.28%; Gamma: n=15,223, 16.55%; Delta: n=49,161, 53.46%; and Omicron: n=7093, 7.71%). Delta was associated with the most severe disease in terms of hospitalization, ICU admissions, and deaths (hospitalization: adjusted hazard ratio [aHR] 2.00, 95% CI 1.92-2.08; ICU: aHR 2.05, 95% CI 1.91-2.20; death: aHR 3.70, 95% CI 3.23-4.25 relative to Alpha), followed generally by Gamma and then Omicron and Alpha. The relative severity by VOC remained similar in the unvaccinated individual subanalysis, although the proportion of individuals infected with Delta and Omicron who were hospitalized was 2 times higher in those unvaccinated than in those fully vaccinated. Regarding SDOHs, the proportion of hospitalized individuals was higher in areas with lower income across all VOCs, whereas among Alpha and Gamma infections, 2 VOCs that cocirculated, differential distributions of hospitalizations were found among racially minoritized groups. Conclusions: Our study provides robust severity estimates for all VOCs during the COVID-19 pandemic in British Columbia, Canada. Relative to Alpha, we found Delta to be the most severe, followed by Gamma and Omicron. This study highlights the importance of targeted testing and sequencing to ensure timely detection and accurate estimation of severity in emerging variants. It further sheds light on the importance of vaccination coverage and SDOHs in the context of pandemic preparedness to support the prioritization of allocation for resource-constrained or minoritized groups. %M 39190434 %R 10.2196/45513 %U https://publichealth.jmir.org/2024/1/e45513 %U https://doi.org/10.2196/45513 %U http://www.ncbi.nlm.nih.gov/pubmed/39190434 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 13 %N %P e48339 %T Parental Patterns of Alcohol Consumption During the COVID-19 Pandemic: Scoping Review %A Ou,Christine %A Corby,Kathryn %A Booth,Kelsey %A Ou,Hui-Hui %+ Canadian Institute for Substance Use Research, School of Nursing, University of Victoria, HSD Building Room 402, 3800 Finnerty Road, Victoria, BC, V8P 5C2, Canada, 1 250 721 7954, christineou@uvic.ca %K parent %K alcohol use %K COVID-19 %K scoping review %K parenting %K alcohol %K addict %K addiction %K substance use %K health behavior %K health behaviors %K scoping %K review methods %K review methodology %K drink %K drinking %K alcoholic %K alcoholism %D 2024 %7 26.8.2024 %9 Review %J Interact J Med Res %G English %X Background: The declaration of the COVID-19 pandemic led to public health restrictions that impacted the lives of people across the globe. Parents were particularly burdened with balancing multiple responsibilities, such as working from home while caring for and educating their children. Alcohol use among parents is an area that warrants further exploration. Objective: This study aimed to investigate patterns of parental alcohol consumption during the COVID-19 pandemic, focusing on relative changes in the frequency and quantity of alcohol use compared to prepandemic use, nonparent adult samples, or both. Methods: A scoping review informed by the methodology of Arksey and O’Malley explored patterns of parental alcohol consumption during the COVID-19 pandemic. Searches were conducted in CINAHL, Ovid MEDLINE, PsycINFO, and Web of Science. Search terms were created using the Joanna Briggs Institute framework of Population, Concept, and Context, with the population being parents and the concept being alcohol consumption during the COVID-19 pandemic. Results: The database search yielded 3568 articles, which were screened for eligibility. Of the 3568 articles, 40 (1.12%) met the inclusion criteria and were included in the scoping review. Findings indicated the following: (1) having children at home was a factor associated with parental patterns of alcohol use; (2) mixed findings regarding gender-related patterns of alcohol consumption; and (3) linkages between parental patterns of alcohol use and mental health symptoms of stress, depression, and anxiety. Conclusions: This scoping review revealed heterogeneous patterns in parental alcohol use across sociocultural contexts during the COVID-19 pandemic. Given the known harms of alcohol use, it is worthwhile for clinicians to assess parental drinking patterns and initiate conversations regarding moderation in alcohol use. %M 39186759 %R 10.2196/48339 %U https://www.i-jmr.org/2024/1/e48339 %U https://doi.org/10.2196/48339 %U http://www.ncbi.nlm.nih.gov/pubmed/39186759 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e63656 %T A Microfinance Intervention With or Without Peer Support to Improve Mental Health Among Transgender and Nonbinary Adults (the Creating Access to Resources and Economic Support Study): Protocol for a Randomized Controlled Trial %A Poteat,Tonia C %A Reisner,Sari L %A Wirtz,Andrea L %A Mayo-Wilson,Larissa Jennings %A Brown,Carter %A Kornbluh,Wiley %A Humphrey,Ash %A Perrin,Nancy %+ Duke University School of Nursing, 307 Trent Drive, Durham, NC, 27710, United States, 1 919 684 9303, tonia.poteat@duke.edu %K clinical trial %K depression %K anxiety %K peer support %K minority stress %K cash transfer %K COVID-19 %D 2024 %7 26.8.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Transgender and nonbinary (TNB) people experience economic and psychosocial inequities that make them more likely to be subject to financial and mental health harms exacerbated by the COVID-19 pandemic. Sustainable, multilevel interventions are needed to address these harms. The onset of the COVID-19 pandemic galvanized many TNB-led organizations to provide emergency financial and peer support for TNB people negatively impacted by the pandemic. However, the efficacy of these interventions has not been evaluated. The Creating Access to Resources and Economic Support (CARES) study seeks to assess the efficacy of feasible, acceptable, and community-derived interventions to reduce economic and psychological harms experienced by transgender people in the wake of the COVID-19 pandemic. Objective: The study aims to (1) compare the efficacy of microgrants with peer mentoring with that of microgrants without peer mentoring in reducing psychological distress, (2) examine mechanisms by which microgrants with or without peer mentoring may impact psychological distress, and (3) explore participants’ intervention experiences and perceived efficacy. Methods: We will enroll 360 TNB adults into an embedded, mixed methods, 3-arm, and 12-month randomized controlled trial. Participants will be randomized 1:1:1 to arm A (enhanced usual care), which will receive a single microgrant plus monthly financial literacy education, arm B (extended microgrants), which will receive enhanced usual care plus monthly microgrants, or arm C (peer mentoring), which will receive extended microgrants combined with peer mentoring. All intervention arms last for 6 months, and participants complete semiannual, web-based surveys at 0, 6, and 12 months as well as brief process measures at 3 and 6 months. A subset of 36 participants, 12 (33%) per arm, will complete longitudinal in-depth interviews at 3 and 9 months. Results: Full recruitment began on January 8, 2024, and, as of July 26, 2024, a total of 138 participants have enrolled. Recruitment is expected to be completed no later than March 31, 2025, and the final study visit will take place in March 2026. Conclusions: This national, web-based study will demonstrate whether an intervention tailored to reduce material hardship and improve peer support among TNB adults will reduce psychological distress. Its equitable, community-academic partnership will ensure the rapid dissemination of study findings. Trial Registration: ClinicalTrials.gov NCT05971160; https://clinicaltrials.gov/study/NCT05971160 International Registered Report Identifier (IRRID): DERR1-10.2196/63656 %M 39186770 %R 10.2196/63656 %U https://www.researchprotocols.org/2024/1/e63656 %U https://doi.org/10.2196/63656 %U http://www.ncbi.nlm.nih.gov/pubmed/39186770 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e38786 %T Prevalence of Health Misinformation on Social Media—Challenges and Mitigation Before, During, and Beyond the COVID-19 Pandemic: Scoping Literature Review %A Kbaier,Dhouha %A Kane,Annemarie %A McJury,Mark %A Kenny,Ian %+ School of Computing and Communications, The Open University, Walton Hall, Milton Keynes, MK7 6AA, United Kingdom, dhouha.kbaier@open.ac.uk %K health misinformation %K online health communities %K vaccine hesitancy %K social media %K health professionals %K public health %K COVID-19 %K intervention %K antivaxxers %D 2024 %7 19.8.2024 %9 Review %J J Med Internet Res %G English %X Background: This scoping review accompanies our research study “The Experience of Health Professionals With Misinformation and Its Impact on Their Job Practice: Qualitative Interview Study.” It surveys online health misinformation and is intended to provide an understanding of the communication context in which health professionals must operate. Objective: Our objective was to illustrate the impact of social media in introducing additional sources of misinformation that impact health practitioners’ ability to communicate effectively with their patients. In addition, we considered how the level of knowledge of practitioners mitigated the effect of misinformation and additional stress factors associated with dealing with outbreaks, such as the COVID-19 pandemic, that affect communication with patients. Methods: This study used a 5-step scoping review methodology following Arksey and O’Malley’s methodology to map relevant literature published in English between January 2012 and March 2024, focusing on health misinformation on social media platforms. We defined health misinformation as a false or misleading health-related claim that is not based on valid evidence or scientific knowledge. Electronic searches were performed on PubMed, Scopus, Web of Science, and Google Scholar. We included studies on the extent and impact of health misinformation in social media, mitigation strategies, and health practitioners’ experiences of confronting health misinformation. Our independent reviewers identified relevant articles for data extraction. Results: Our review synthesized findings from 70 sources on online health misinformation. It revealed a consensus regarding the significant problem of health misinformation disseminated on social network platforms. While users seek trustworthy sources of health information, they often lack adequate health and digital literacies, which is exacerbated by social and economic inequalities. Cultural contexts influence the reception of such misinformation, and health practitioners may be vulnerable, too. The effectiveness of online mitigation strategies like user correction and automatic detection are complicated by malicious actors and politicization. The role of health practitioners in this context is a challenging one. Although they are still best placed to combat health misinformation, this review identified stressors that create barriers to their abilities to do this well. Investment in health information management at local and global levels could enhance their capacity for effective communication with patients. Conclusions: This scoping review underscores the significance of addressing online health misinformation, particularly in the postpandemic era. It highlights the necessity for a collaborative global interdisciplinary effort to ensure equitable access to accurate health information, thereby empowering health practitioners to effectively combat the impact of online health misinformation. Academic research will need to be disseminated into the public domain in a way that is accessible to the public. Without equipping populations with health and digital literacies, the prevalence of online health misinformation will continue to pose a threat to global public health efforts. %M 39159456 %R 10.2196/38786 %U https://www.jmir.org/2024/1/e38786 %U https://doi.org/10.2196/38786 %U http://www.ncbi.nlm.nih.gov/pubmed/39159456 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e53175 %T Comparison of Different Reverse Transcriptase–Polymerase Chain Reaction–Based Methods for Wastewater Surveillance of SARS-CoV-2: Exploratory Study %A Länsivaara,Annika %A Lehto,Kirsi-Maarit %A Hyder,Rafiqul %A Janhonen,Erja Sinikka %A Lipponen,Anssi %A Heikinheimo,Annamari %A Pitkänen,Tarja %A Oikarinen,Sami %A , %+ Faculty of Medicine and Health Technology, Tampere University, Arvo Ylpön katu 34, Tampere, 33520, Finland, 358 503241937, annika.lansivaara@tuni.fi %K wastewater surveillance %K surveillance systems %K SARS-CoV-2 %K COVID-19 %K wastewater %K surveillance %K Finland %K monitoring %K detection %K low-resource settings %K RNA %K spatial %K temporal changes %K reverse transcription droplet digital polymerase chain reaction %K quantitative reverse transcription polymerase chain reaction %K reverse transcription strand invasion based amplification %D 2024 %7 19.8.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Many countries have applied the wastewater surveillance of the COVID-19 pandemic to their national public health monitoring measures. The most used methods for detecting SARS-CoV-2 in wastewater are quantitative reverse transcriptase–polymerase chain reaction (RT-qPCR) and reverse transcriptase–droplet digital polymerase chain reaction (RT-ddPCR). Previous comparison studies have produced conflicting results, thus more research on the subject is required. Objective: This study aims to compare RT-qPCR and RT-ddPCR for detecting SARS-CoV-2 in wastewater. It also aimed to investigate the effect of changes in the analytical pipeline, including the RNA extraction kit, RT-PCR kit, and target gene assay, on the results. Another aim was to find a detection method for low-resource settings. Methods: We compared 2 RT-qPCR kits, TaqMan RT-qPCR and QuantiTect RT-qPCR, and RT-ddPCR based on sensitivity, positivity rates, variability, and correlation of SARS-CoV-2 gene copy numbers in wastewater to the incidence of COVID-19. Furthermore, we compared 2 RNA extraction methods, column- and magnetic-bead–based. In addition, we assessed 2 target gene assays for RT-qPCR, N1 and N2, and 2 target gene assays for ddPCR N1 and E. Reverse transcription strand invasion-based amplification (RT-SIBA) was used to detect SARS-CoV-2 from wastewater qualitatively. Results: Our results indicated that the most sensitive method to detect SARS-CoV-2 in wastewater was RT-ddPCR. It had the highest positivity rate (26/30), and its limit of detection was the lowest (0.06 gene copies/µL). However, we obtained the best correlation between COVID-19 incidence and SARS-CoV-2 gene copy number in wastewater using TaqMan RT-qPCR (correlation coefficient [CC]=0.697, P<.001). We found a significant difference in sensitivity between the TaqMan RT-qPCR kit and the QuantiTect RT-qPCR kit, the first having a significantly lower limit of detection and a higher positivity rate than the latter. Furthermore, the N1 target gene assay was the most sensitive for both RT-qPCR kits, while no significant difference was found between the gene targets using RT-ddPCR. In addition, the use of different RNA extraction kits affected the result when the TaqMan RT-qPCR kit was used. RT-SIBA was able to detect SARS-CoV-2 RNA in wastewater. Conclusions: As our study, as well as most of the previous studies, has shown RT-ddPCR to be more sensitive than RT-qPCR, its use in the wastewater surveillance of SARS-CoV-2 should be considered, especially if the amount of SARS-CoV-2 circulating in the population was low. All the analysis steps must be optimized for wastewater surveillance as our study showed that all the analysis steps including the compatibility of the RNA extraction, the RT-PCR kit, and the target gene assay influence the results. In addition, our study showed that RT-SIBA could be used to detect SARS-CoV-2 in wastewater if a qualitative result is sufficient. %M 39158943 %R 10.2196/53175 %U https://publichealth.jmir.org/2024/1/e53175 %U https://doi.org/10.2196/53175 %U http://www.ncbi.nlm.nih.gov/pubmed/39158943 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e57382 %T Study of Postacute Sequelae of COVID-19 Using Digital Wearables: Protocol for a Prospective Longitudinal Observational Study %A El-Toukhy,Sherine %A Hegeman,Phillip %A Zuckerman,Gabrielle %A Das,Anirban Roy %A Moses,Nia %A Troendle,James %A Powell-Wiley,Tiffany M %+ Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, 11545 Rockville Pike, Rockville, MD, 20852, United States, 1 3015944743, sherine.el-toukhy@nih.gov %K postacute sequelae of COVID-19 %K wearable devices %K physiological parameters %K prospective observational study %K mobile phone %D 2024 %7 16.8.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Postacute sequelae of COVID-19 (PASC) remain understudied in nonhospitalized patients. Digital wearables allow for a continuous collection of physiological parameters such as respiratory rate and oxygen saturation that have been predictive of disease trajectories in hospitalized patients. Objective: This protocol outlines the design and procedures of a prospective, longitudinal, observational study of PASC that aims to identify wearables-collected physiological parameters that are associated with PASC in patients with a positive diagnosis. Methods: This is a single-arm, prospective, observational study of a cohort of 550 patients, aged 18 to 65 years, male or female, who own a smartphone or a tablet that meets predetermined Bluetooth version and operating system requirements, speak English, and provide documentation of a positive COVID-19 test issued by a health care professional within 5 days before enrollment. The primary end point is long COVID-19, defined as ≥1 symptom at 3 weeks beyond the first symptom onset or positive diagnosis, whichever comes first. The secondary end point is chronic COVID-19, defined as ≥1 symptom at 12 weeks beyond the first symptom onset or positive diagnosis. Participants must be willing and able to consent to participate in the study and adhere to study procedures for 6 months. Results: The first patient was enrolled in October 2021. The estimated year for publishing the study results is 2025. Conclusions: This is a fully decentralized study investigating PASC using wearable devices to collect physiological parameters and patient-reported outcomes. The study will shed light on the duration and symptom manifestation of PASC in nonhospitalized patient subgroups and is an exemplar of the use of wearables as population-level monitoring health tools for communicable diseases. Trial Registration: ClinicalTrials.gov NCT04927442; https://clinicaltrials.gov/study/NCT04927442 International Registered Report Identifier (IRRID): DERR1-10.2196/57382 %M 39150750 %R 10.2196/57382 %U https://www.researchprotocols.org/2024/1/e57382 %U https://doi.org/10.2196/57382 %U http://www.ncbi.nlm.nih.gov/pubmed/39150750 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e53322 %T Predicting Long COVID in the National COVID Cohort Collaborative Using Super Learner: Cohort Study %A Butzin-Dozier,Zachary %A Ji,Yunwen %A Li,Haodong %A Coyle,Jeremy %A Shi,Junming %A Phillips,Rachael V %A Mertens,Andrew N %A Pirracchio,Romain %A van der Laan,Mark J %A Patel,Rena C %A Colford,John M %A Hubbard,Alan E %A , %+ Division of Biostatistics, University of California Berkeley School of Public Health, 2121 Berkeley Way, Berkeley, CA, 94720, United States, 1 3024376262, zbutzin@berkeley.edu %K long COVID %K COVID-19 %K machine learning %K respiratory %K infectious %K SARS-CoV-2 %K sequelae %K chronic %K long term %K covariate %K covariates %K risk %K risks %K predict %K prediction %K predictions %K predictive %K Super Learner %K ensemble %K stacking %D 2024 %7 15.8.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Postacute sequelae of COVID-19 (PASC), also known as long COVID, is a broad grouping of a range of long-term symptoms following acute COVID-19. These symptoms can occur across a range of biological systems, leading to challenges in determining risk factors for PASC and the causal etiology of this disorder. An understanding of characteristics that are predictive of future PASC is valuable, as this can inform the identification of high-risk individuals and future preventative efforts. However, current knowledge regarding PASC risk factors is limited. Objective: Using a sample of 55,257 patients (at a ratio of 1 patient with PASC to 4 matched controls) from the National COVID Cohort Collaborative, as part of the National Institutes of Health Long COVID Computational Challenge, we sought to predict individual risk of PASC diagnosis from a curated set of clinically informed covariates. The National COVID Cohort Collaborative includes electronic health records for more than 22 million patients from 84 sites across the United States. Methods: We predicted individual PASC status, given covariate information, using Super Learner (an ensemble machine learning algorithm also known as stacking) to learn the optimal combination of gradient boosting and random forest algorithms to maximize the area under the receiver operator curve. We evaluated variable importance (Shapley values) based on 3 levels: individual features, temporal windows, and clinical domains. We externally validated these findings using a holdout set of randomly selected study sites. Results: We were able to predict individual PASC diagnoses accurately (area under the curve 0.874). The individual features of the length of observation period, number of health care interactions during acute COVID-19, and viral lower respiratory infection were the most predictive of subsequent PASC diagnosis. Temporally, we found that baseline characteristics were the most predictive of future PASC diagnosis, compared with characteristics immediately before, during, or after acute COVID-19. We found that the clinical domains of health care use, demographics or anthropometry, and respiratory factors were the most predictive of PASC diagnosis. Conclusions: The methods outlined here provide an open-source, applied example of using Super Learner to predict PASC status using electronic health record data, which can be replicated across a variety of settings. Across individual predictors and clinical domains, we consistently found that factors related to health care use were the strongest predictors of PASC diagnosis. This indicates that any observational studies using PASC diagnosis as a primary outcome must rigorously account for heterogeneous health care use. Our temporal findings support the hypothesis that clinicians may be able to accurately assess the risk of PASC in patients before acute COVID-19 diagnosis, which could improve early interventions and preventive care. Our findings also highlight the importance of respiratory characteristics in PASC risk assessment. International Registered Report Identifier (IRRID): RR2-10.1101/2023.07.27.23293272 %R 10.2196/53322 %U https://publichealth.jmir.org/2024/1/e53322 %U https://doi.org/10.2196/53322 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e51325 %T Linking Opinions Shared on Social Media About COVID-19 Public Health Measures to Adherence: Repeated Cross-Sectional Surveys of Twitter Use in Canada %A Denis-Robichaud,José %A Rees,Erin E %A Daley,Patrick %A Zarowsky,Christina %A Diouf,Assane %A Nasri,Bouchra R %A de Montigny,Simon %A Carabin,Hélène %+ Faculté de médecine vétérinaire, Université de Montréal, 3190, rue Sicotte, Saint-Hyacinthe, QC, J2S 2M2, Canada, 1 514 343 6111 ext 8569, helene.carabin@umontreal.ca %K adherence to mask wearing %K adherence to vaccination %K social media %K sociodemographic characteristics %K Twitter %K COVID-19 %K survey data %D 2024 %7 13.8.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: The effectiveness of public health measures (PHMs) depends on population adherence. Social media were suggested as a tool to assess adherence, but representativeness and accuracy issues have been raised. Objective: The objectives of this repeated cross-sectional study were to compare self-reported PHM adherence and sociodemographic characteristics between people who used Twitter (subsequently rebranded X) and people who did not use Twitter. Methods: Repeated Canada-wide web-based surveys were conducted every 14 days from September 2020 to March 2022. Weighted proportions were calculated for descriptive variables. Using Bayesian logistic regression models, we investigated associations between Twitter use, as well as opinions in tweets, and self-reported adherence with mask wearing and vaccination. Results: Data from 40,230 respondents were analyzed. As self-reported, Twitter was used by 20.6% (95% CI 20.1%-21.2%) of Canadians, of whom 29.9% (95% CI 28.6%-31.3%) tweeted about COVID-19. The sociodemographic characteristics differed across categories of Twitter use and opinions. Overall, 11% (95% CI 10.6%-11.3%) of Canadians reported poor adherence to mask-wearing, and 10.8% (95% CI 10.4%-11.2%) to vaccination. Twitter users who tweeted about COVID-19 reported poorer adherence to mask wearing than nonusers, which was modified by the age of the respondents and their geographical region (odds ratio [OR] 0.79, 95% Bayesian credibility interval [BCI] 0.18-1.69 to OR 4.83, 95% BCI 3.13-6.86). The odds of poor adherence to vaccination of Twitter users who tweeted about COVID-19 were greater than those of nonusers (OR 1.76, 95% BCI 1.48-2.07). English- and French-speaking Twitter users who tweeted critically of PHMs were more likely (OR 4.07, 95% BCI 3.38-4.80 and OR 7.31, 95% BCI 4.26-11.03, respectively) to report poor adherence to mask wearing than non–Twitter users, and those who tweeted in support were less likely (OR 0.47, 95% BCI 0.31-0.64 and OR 0.96, 95% BCI 0.18-2.33, respectively) to report poor adherence to mask wearing than non–Twitter users. The OR of poor adherence to vaccination for those tweeting critically about PHMs and for those tweeting in support of PHMs were 4.10 (95% BCI 3.40-4.85) and 0.20 (95% BCI 0.10-0.32), respectively, compared to non–Twitter users. Conclusions: Opinions shared on Twitter can be useful to public health authorities, as they are associated with adherence to PHMs. However, the sociodemographics of social media users do not represent the general population, calling for caution when using tweets to assess general population-level behaviors. %M 39137009 %R 10.2196/51325 %U https://www.jmir.org/2024/1/e51325 %U https://doi.org/10.2196/51325 %U http://www.ncbi.nlm.nih.gov/pubmed/39137009 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e48907 %T Identifying Reddit Users at a High Risk of Suicide and Their Linguistic Features During the COVID-19 Pandemic: Growth-Based Trajectory Model %A Yan,Yifei %A Li,Jun %A Liu,Xingyun %A Li,Qing %A Yu,Nancy Xiaonan %+ Department of Social and Behavioural Sciences, City University of Hong Kong, Tat Chee Avenue, Kowloon, HKSAR, P. R. China, Hong Kong, 000, China (Hong Kong), 852 34429436, nancy.yu@cityu.edu.hk %K COVID-19 pandemic %K Reddit %K suicide risk %K trajectory %D 2024 %7 8.8.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Suicide has emerged as a critical public health concern during the COVID-19 pandemic. With social distancing measures in place, social media has become a significant platform for individuals expressing suicidal thoughts and behaviors. However, existing studies on suicide using social media data often overlook the diversity among users and the temporal dynamics of suicide risk. Objective: By examining the variations in post volume trajectories among users on the r/SuicideWatch subreddit during the COVID-19 pandemic, this study aims to investigate the heterogeneous patterns of change in suicide risk to help identify social media users at high risk of suicide. We also characterized their linguistic features before and during the pandemic. Methods: We collected and analyzed post data every 6 months from March 2019 to August 2022 for users on the r/SuicideWatch subreddit (N=6163). A growth-based trajectory model was then used to investigate the trajectories of post volume to identify patterns of change in suicide risk during the pandemic. Trends in linguistic features within posts were also charted and compared, and linguistic markers were identified across the trajectory groups using regression analysis. Results: We identified 2 distinct trajectories of post volume among r/SuicideWatch subreddit users. A small proportion of users (744/6163, 12.07%) was labeled as having a high risk of suicide, showing a sharp and lasting increase in post volume during the pandemic. By contrast, most users (5419/6163, 87.93%) were categorized as being at low risk of suicide, with a consistently low and mild increase in post volume during the pandemic. In terms of the frequency of most linguistic features, both groups showed increases at the initial stage of the pandemic. Subsequently, the rising trend continued in the high-risk group before declining, while the low-risk group showed an immediate decrease. One year after the pandemic outbreak, the 2 groups exhibited differences in their use of words related to the categories of personal pronouns; affective, social, cognitive, and biological processes; drives; relativity; time orientations; and personal concerns. In particular, the high-risk group was discriminant in using words related to anger (odds ratio [OR] 3.23, P<.001), sadness (OR 3.23, P<.001), health (OR 2.56, P=.005), achievement (OR 1.67, P=.049), motion (OR 4.17, P<.001), future focus (OR 2.86, P<.001), and death (OR 4.35, P<.001) during this stage. Conclusions: Based on the 2 identified trajectories of post volume during the pandemic, this study divided users on the r/SuicideWatch subreddit into suicide high- and low-risk groups. Our findings indicated heterogeneous patterns of change in suicide risk in response to the pandemic. The high-risk group also demonstrated distinct linguistic features. We recommend conducting real-time surveillance of suicide risk using social media data during future public health crises to provide timely support to individuals at potentially high risk of suicide. %M 39115925 %R 10.2196/48907 %U https://www.jmir.org/2024/1/e48907 %U https://doi.org/10.2196/48907 %U http://www.ncbi.nlm.nih.gov/pubmed/39115925 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e55759 %T The Double-Edged Sword of Online Learning for Ethnoracial Differences in Adolescent Mental Health During Late Period of the COVID-19 Pandemic in the United States: National Survey %A Campos-Castillo,Celeste %A Tamla Rai,Vijaya %A Laestadius,Linnea I %+ Department of Media and Information, Michigan State University, 404 Wilson Rd, East Lansing, MI, 48823, United States, 1 5174325912, camposca@msu.edu %K mental health %K school modality %K race and ethnicity %K confidants %K sleep %K equity %K remote learning %K virtual learning %K racial justice %K anxiety %K depression %K depressive %K student %K students %K school %K schools %K adolescent %K adolescents %K teen %K teens %K teenager %K teenagers %K race %K racial %K eLearning %K online learning %K education %K equality %K inequality %K inequity %K disparity %K disparities %K teaching %K ethnic %K ethnicities %D 2024 %7 5.8.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Despite several theories suggesting online learning during the COVID-19 pandemic would aggravate ethnoracial disparities in mental health among adolescents, extant findings suggest no ethnoracial differences in mental health or that those from minoritized ethnoracial groups reported better mental health than their White counterparts. Objective: This study aimed to identify why findings from prior studies appear to not support that ethnoracial disparities in mental health were aggravated by testing 2 pathways. In pathway 1 pathway, online learning was associated with reporting fewer confidants, which in turn was associated with poorer mental health. In pathway 2, online learning was associated with reporting better sleep, which in turn was associated with better mental health. Methods: We analyzed survey data from a US sample (N=540) of 13- to 17-year-olds to estimate how school modality was associated with mental health via the 2 pathways. The sample was recruited from the AmeriSpeak Teen Panel during spring of 2021, with an oversample of Black and Latino respondents. Ethnoracial categories were Black, Latino, White, and other. Mental health was measured with the 4-item Patient Health Questionnaire, which assesses self-reported frequency of experiencing symptoms consistent with anxiety and depression. School modality was recorded as either fully online or with some in-person component (fully in-person or hybrid). We recorded self-reports of the number of confidants and quality of sleep. Covariates included additional demographics and access to high-speed internet. We estimated bivariate associations between ethnoracial group membership and both school modality and mental health. To test the pathways, we estimated a path model. Results: Black and Latino respondents were more likely to report being in fully online learning than their White counterparts (P<.001). Respondents in fully online learning reported fewer confidants than those with any in-person learning component (β=–.403; P=.001), and reporting fewer confidants was associated with an increased likelihood of reporting symptoms consistent with anxiety (β=–.121; P=.01) and depression (β=–.197; P<.001). Fully online learning respondents also reported fewer concerns of insufficient sleep than their in-person learning counterparts (β=–.162; P=.006), and reporting fewer concerns was associated with a decreased likelihood of reporting symptoms consistent with anxiety (β=.601; P<.001) and depression (β=.588; P<.001). Because of these countervailing pathways, the total effect of membership in a minoritized ethnoracial group on mental health was nonsignificant. Conclusions: The findings compel more nuanced discussions about the consequences of online learning and theorizing about the pandemic’s impact on minoritized ethnoracial groups. While online learning may be a detriment to social connections, it appears to benefit sleep. Interventions should foster social connections in online learning and improve sleep, such as implementing policies to enable later start times for classes. Future research should incorporate administrative data about school modality, rather than relying on self-reports. %M 39102274 %R 10.2196/55759 %U https://formative.jmir.org/2024/1/e55759 %U https://doi.org/10.2196/55759 %U http://www.ncbi.nlm.nih.gov/pubmed/39102274 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e43022 %T Using a Smartphone-Based Chatbot for Postoperative Care After Intravitreal Injection During the COVID-19 Pandemic: Retrospective Cohort Study %A Wu,Pei-Chang %A Chiang,Wei-Yu %A Lo,Jung %A Lee,Jong-Jer %A Chen,Yung-Jen %A Kuo,Hsi-Kung %A Chiau,Jie-Shin %A Hsu,Shu-Hui %A Chen,Yi-Hao %+ Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123, Da-Pi Road, Niao-Sung District, Kaohsiung, 88301, Taiwan, 886 77317123 ext 2801, kaneyhc@gmail.com %K smartphone chatbot %K postoperative care %K intravitreal injection %K age-related macular degeneration %K self-report, endophthalmitis %K COVID-19 %D 2024 %7 2.8.2024 %9 Short Paper %J JMIR Form Res %G English %X Background: During the COVID-19 pandemic period, it was difficult to carry out regular and scheduled follow-up of patients in the outpatient department, especially during lockdown periods. However, early detection of initial infection or other serious conditions is vital for patients after ocular surgery, such as intravitreal injection (IVI) for age-related macular degeneration (AMD). Objective: We evaluated the use of a smartphone-based postoperative care chatbot system (PCCS) with an instant bidirectional feedback system for patients to self-report postoperative symptoms and signs. Methods: During the COVID-19 level 3 epidemic alert in July 2021 in Taiwan, the PCCS alerted the patients to report and grade 6 ocular symptoms and signs associated with ocular inflammation or retinal detachment. Patients used the PCCS for 7 days post surgery to assess their symptoms and signs each day after receiving an alert. Data were automatically collected using a cloud computer system, including symptom grades and messages sent to medical staff for further medical assistance. A user satisfaction questionnaire was administered to the patients on the seventh day post surgery. Results: In total, 185 patients participated in this study. There were 26 (3.03%) reports of symptom grade deterioration (including increased blurred vision, eye swelling, nausea, and floaters or flashes) from 12 (6.5%) patients. We found no difference in the gender of patients who received an early medical consultation. One case of endophthalmitis was reported, wherein an improvement was observed after prompt administration of IVI antibiotics twice. Overall, 87% (n=185) of patients were satisfied or very satisfied with communicating their symptoms instantly through the app; they were willing to use it again and believed that it could improve the quality of care. Seven of the 185 (3.8%) patients had an earlier medical consultation and 1 (0.5%) had endophthalmitis. Conclusions: The chatbot system, designed for self-reporting postoperative symptoms and providing instant bidirectional feedback on smartphones, could be beneficial for enhancing the quality of care in early medical consultations without gender differences among patients with AMD receiving IVI, and achieved satisfactory responses from patients. %M 38643063 %R 10.2196/43022 %U https://formative.jmir.org/2024/1/e43022 %U https://doi.org/10.2196/43022 %U http://www.ncbi.nlm.nih.gov/pubmed/38643063 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e52257 %T Understanding the Use of Mobility Data in Disasters: Exploratory Qualitative Study of COVID-19 User Feedback %A Chan,Jennifer Lisa %A Tsay,Sarah %A Sambara,Sraavya %A Welch,Sarah B %+ Department of Emergency Medicine, Feinberg School of Medicine, Northwestern University, 211 E. Ontario Street312-694-7000, Chicago, IL, 60611, United States, 1 312 694 7000, jennifer-chan@northwestern.edu %K mobility data %K disasters %K surveillance %K COVID-19 %K qualitative %K user feedback %K policy making %K emergency %K pandemic %K disaster response %K data usage %K situational awareness %K data translation %K big data %D 2024 %7 1.8.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Human mobility data have been used as a potential novel data source to guide policies and response planning during the COVID-19 global pandemic. The COVID-19 Mobility Data Network (CMDN) facilitated the use of human mobility data around the world. Both researchers and policy makers assumed that mobility data would provide insights to help policy makers and response planners. However, evidence that human mobility data were operationally useful and provided added value for public health response planners remains largely unknown. Objective: This exploratory study focuses on advancing the understanding of the use of human mobility data during the early phase of the COVID-19 pandemic. The study explored how researchers and practitioners around the world used these data in response planning and policy making, focusing on processing data and human factors enabling or hindering use of the data. Methods: Our project was based on phenomenology and used an inductive approach to thematic analysis. Transcripts were open-coded to create the codebook that was then applied by 2 team members who blind-coded all transcripts. Consensus coding was used for coding discrepancies. Results: Interviews were conducted with 45 individuals during the early period of the COVID-19 pandemic. Although some teams used mobility data for response planning, few were able to describe their uses in policy making, and there were no standardized ways that teams used mobility data. Mobility data played a larger role in providing situational awareness for government partners, helping to understand where people were moving in relation to the spread of COVID-19 variants and reactions to stay-at-home orders. Interviewees who felt they were more successful using mobility data often cited an individual who was able to answer general questions about mobility data; provide interactive feedback on results; and enable a 2-way communication exchange about data, meaning, value, and potential use. Conclusions: Human mobility data were used as a novel data source in the COVID-19 pandemic by a network of academic researchers and practitioners using privacy-preserving and anonymized mobility data. This study reflects the processes in analyzing and communicating human mobility data, as well as how these data were used in response planning and how the data were intended for use in policy making. The study reveals several valuable use cases. Ultimately, the role of a data translator was crucial in understanding the complexities of this novel data source. With this role, teams were able to adapt workflows, visualizations, and reports to align with end users and decision makers while communicating this information meaningfully to address the goals of responders and policy makers. %M 39088256 %R 10.2196/52257 %U https://humanfactors.jmir.org/2024/1/e52257 %U https://doi.org/10.2196/52257 %U http://www.ncbi.nlm.nih.gov/pubmed/39088256 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e43119 %T Implementation of a Web-Based Chatbot to Guide Hospital Employees in Returning to Work During the COVID-19 Pandemic: Development and Before-and-After Evaluation %A Unlu,Ozan %A Pikcilingis,Aaron %A Letourneau,Jonathan %A Landman,Adam %A Patel,Rajesh %A Shenoy,Erica S %A Hashimoto,Dean %A Kim,Marvel %A Pellecer,Johnny %A Zhang,Haipeng %+ Division of Cardiovascular Medicine, Brigham and Women's Hospital, 70 Francis St, Boston, MA, 02115, United States, 1 857 407 4561, ounlu@bwh.harvard.edu %K chatbot %K return to work %K employee %K health care personnel %K COVID-19 %K conversational agent %K occupational health %K support service %K health care delivery %K agile methodology %K digital intervention %K digital support %K work policy %K hospital staff %D 2024 %7 25.7.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Throughout the COVID-19 pandemic, multiple policies and guidelines were issued and updated for health care personnel (HCP) for COVID-19 testing and returning to work after reporting symptoms, exposures, or infection. The high frequency of changes and complexity of the policies made it difficult for HCP to understand when they needed testing and were eligible to return to work (RTW), which increased calls to Occupational Health Services (OHS), creating a need for other tools to guide HCP. Chatbots have been used as novel tools to facilitate immediate responses to patients’ and employees’ queries about COVID-19, assess symptoms, and guide individuals to appropriate care resources. Objective: This study aims to describe the development of an RTW chatbot and report its impact on demand for OHS support services during the first Omicron variant surge. Methods: This study was conducted at Mass General Brigham, an integrated health care system with over 80,000 employees. The RTW chatbot was developed using an agile design methodology. We mapped the RTW policy into a unified flow diagram that included all required questions and recommendations, then built and tested the chatbot using the Microsoft Azure Healthbot Framework. Using chatbot data and OHS call data from December 10, 2021, to February 17, 2022, we compared OHS resource use before and after the deployment of the RTW chatbot, including the number of calls to the OHS hotline, wait times, call length, and time OHS hotline staff spent on the phone. We also assessed Centers for Disease Control and Prevention data for COVID-19 case trends during the study period. Results: In the 5 weeks post deployment, 5575 users used the RTW chatbot with a mean interaction time of 1 minute and 17 seconds. The highest engagement was on January 25, 2022, with 368 users, which was 2 weeks after the peak of the first Omicron surge in Massachusetts. Among users who completed all the chatbot questions, 461 (71.6%) met the RTW criteria. During the 10 weeks, the median (IQR) number of daily calls that OHS received before and after deployment of the chatbot were 633 (251-934) and 115 (62-167), respectively (U=163; P<.001). The median time from dialing the OHS phone number to hanging up decreased from 28 minutes and 22 seconds (IQR 25:14-31:05) to 6 minutes and 25 seconds (IQR 5:32-7:08) after chatbot deployment (U=169; P<.001). Over the 10 weeks, the median time OHS hotline staff spent on the phone declined from 3 hours and 11 minutes (IQR 2:32-4:15) per day to 47 (IQR 42-54) minutes (U=193; P<.001), saving approximately 16.8 hours per OHS staff member per week. Conclusions: Using the agile methodology, a chatbot can be rapidly designed and deployed for employees to efficiently receive guidance regarding RTW that complies with the complex and shifting RTW policies, which may reduce use of OHS resources. %M 39052994 %R 10.2196/43119 %U https://formative.jmir.org/2024/1/e43119 %U https://doi.org/10.2196/43119 %U http://www.ncbi.nlm.nih.gov/pubmed/39052994 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 13 %N %P e55699 %T Cardiovascular Comorbidities in COVID-19: Comprehensive Analysis of Key Topics %A Markovič,Rene %A Ternar,Luka %A Trstenjak,Tim %A Marhl,Marko %A Grubelnik,Vladimir %+ Faculty of Electrical Engineering and Computer Science, University of Maribor, Koroška cesta 46, Maribor, SI-2000, Slovenia, 386 2 220 73 96, vlado.grubelnik@um.si %K COVID-19 %K cardiovascular diseases %K metabolic disorders %K embolism and thrombosis %K hypertension %K hyperglycemia %K iron metabolism disorders %K MeSH %K embolism %K thrombosis %K heart failure %K nutritional %K vascular disease %K glucose %K effective %D 2024 %7 24.7.2024 %9 Original Paper %J Interact J Med Res %G English %X Background: The interrelation between COVID-19 and various cardiovascular and metabolic disorders has been a critical area of study. There is a growing need to understand how comorbidities such as cardiovascular diseases (CVDs) and metabolic disorders affect the risk and severity of COVID-19. Objective: The objective of this study is to systematically analyze the association between COVID-19 and cardiovascular and metabolic disorders. The focus is on comorbidity, examining the roles of CVDs such as embolism, thrombosis, hypertension, and heart failure, as well as metabolic disorders such as disorders of glucose and iron metabolism. Methods: Our study involved a systematic search in PubMed for literature published from 2000 to 2022. We established 2 databases: one for COVID-19–related articles and another for CVD-related articles, ensuring all were peer-reviewed. In terms of data analysis, statistical methods were applied to compare the frequency and relevance of MeSH (Medical Subject Headings) terms between the 2 databases. This involved analyzing the differences and ratios in the usage of these terms and employing statistical tests to determine their significance in relation to key CVDs within the COVID-19 research context. Results: The study revealed that “Cardiovascular Diseases” and “Nutritional and Metabolic Diseases” were highly relevant as level 1 Medical Subject Headings descriptors in COVID-19 comorbidity research. Detailed analysis at level 2 and level 3 showed “Vascular Disease” and “Heart Disease” as prominent descriptors under CVDs. Significantly, “Glucose Metabolism Disorders” were frequently associated with COVID-19 comorbidities such as embolism, thrombosis, and heart failure. Furthermore, iron deficiency (ID) was notably different in its occurrence between COVID-19 and CVD articles, underlining its significance in the context of COVID-19 comorbidities. Statistical analysis underscored these differences, highlighting the importance of both glucose and iron metabolism disorders in COVID-19 research. Conclusions: This work lays the foundation for future research that utilizes a knowledge-based approach to elucidate the intricate relationships between these conditions, aiming to develop more effective health care strategies and interventions in the face of ongoing pandemic challenges. %M 39046774 %R 10.2196/55699 %U https://www.i-jmr.org/2024/1/e55699 %U https://doi.org/10.2196/55699 %U http://www.ncbi.nlm.nih.gov/pubmed/39046774 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e52353 %T A Multimorbidity Analysis of Hospitalized Patients With COVID-19 in Northwest Italy: Longitudinal Study Using Evolutionary Machine Learning and Health Administrative Data %A Benny,Dayana %A Giacobini,Mario %A Catalano,Alberto %A Costa,Giuseppe %A Gnavi,Roberto %A Ricceri,Fulvio %+ Centre for Biostatistics, Epidemiology, and Public Health, Department of Clinical and Biological Sciences, University of Turin, Regione Gonzole 10, Orbassano, Turin, 10043, Italy, 39 0116705440, dayana.benny@unito.it %K machine learning %K evolutionary algorithm %K multimorbidity %K data analysis %K epidemiology %K feature bins %K COVID-19 %K long COVID %K ICD %K ATC %K polypharmacy %K sparse binary data %K feature engineering %K public health %K severity %K epidemiology %K coronavirus %K SARS-CoV-2 %K risk assessments %K risk assessment %K data %K data mining %K big data %K longitudinal study %K longitudinal analysis %K longitudinal analyses %K health data %K Italy %D 2024 %7 18.7.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Multimorbidity is a significant public health concern, characterized by the coexistence and interaction of multiple preexisting medical conditions. This complex condition has been associated with an increased risk of COVID-19. Individuals with multimorbidity who contract COVID-19 often face a significant reduction in life expectancy. The postpandemic period has also highlighted an increase in frailty, emphasizing the importance of integrating existing multimorbidity details into epidemiological risk assessments. Managing clinical data that include medical histories presents significant challenges, particularly due to the sparsity of data arising from the rarity of multimorbidity conditions. Also, the complex enumeration of combinatorial multimorbidity features introduces challenges associated with combinatorial explosions. Objective: This study aims to assess the severity of COVID-19 in individuals with multiple medical conditions, considering their demographic characteristics such as age and sex. We propose an evolutionary machine learning model designed to handle sparsity, analyzing preexisting multimorbidity profiles of patients hospitalized with COVID-19 based on their medical history. Our objective is to identify the optimal set of multimorbidity feature combinations strongly associated with COVID-19 severity. We also apply the Apriori algorithm to these evolutionarily derived predictive feature combinations to identify those with high support. Methods: We used data from 3 administrative sources in Piedmont, Italy, involving 12,793 individuals aged 45-74 years who tested positive for COVID-19 between February and May 2020. From their 5-year pre–COVID-19 medical histories, we extracted multimorbidity features, including drug prescriptions, disease diagnoses, sex, and age. Focusing on COVID-19 hospitalization, we segmented the data into 4 cohorts based on age and sex. Addressing data imbalance through random resampling, we compared various machine learning algorithms to identify the optimal classification model for our evolutionary approach. Using 5-fold cross-validation, we evaluated each model’s performance. Our evolutionary algorithm, utilizing a deep learning classifier, generated prediction-based fitness scores to pinpoint multimorbidity combinations associated with COVID-19 hospitalization risk. Eventually, the Apriori algorithm was applied to identify frequent combinations with high support. Results: We identified multimorbidity predictors associated with COVID-19 hospitalization, indicating more severe COVID-19 outcomes. Frequently occurring morbidity features in the final evolved combinations were age>53, R03BA (glucocorticoid inhalants), and N03AX (other antiepileptics) in cohort 1; A10BA (biguanide or metformin) and N02BE (anilides) in cohort 2; N02AX (other opioids) and M04AA (preparations inhibiting uric acid production) in cohort 3; and G04CA (Alpha-adrenoreceptor antagonists) in cohort 4. Conclusions: When combined with other multimorbidity features, even less prevalent medical conditions show associations with the outcome. This study provides insights beyond COVID-19, demonstrating how repurposed administrative data can be adapted and contribute to enhanced risk assessment for vulnerable populations. %M 39024001 %R 10.2196/52353 %U https://publichealth.jmir.org/2024/1/e52353 %U https://doi.org/10.2196/52353 %U http://www.ncbi.nlm.nih.gov/pubmed/39024001 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e50751 %T Physician and Practice Characteristics Influencing Telemedicine Uptake Among Frontline Clinicians in the Early COVID-19 Pandemic Response: National Survey Study %A Hamline,Michelle Y %A Xing,Guibo %A Kravitz,Richard L %A Miller,Marykate %A Melnikow,Joy %+ Department of Pediatrics, University of California Davis, 2516 Stockton Blvd, Sacramento, CA, 95817, United States, 1 9167345387, mhamline@ucdavis.edu %K telemedicine %K telehealth %K COVID-19 pandemic %K frontline clinicians %K telemonitoring %K frontliners %K virtual care %K influence %K clinician %K physician %K pre-pandemic %K pandemic %K survey %K health outcome %D 2024 %7 17.7.2024 %9 Original Paper %J JMIR Form Res %G English %X Background:  Telemedicine expanded rapidly during the COVID-19 pandemic, as key policy changes, financial support, and pandemic fears tipped the balance toward internet-based care. Despite this increased support and benefits to patients and clinicians, telemedicine uptake was variable across clinicians and practices. Little is known regarding physician and institutional characteristics underlying this variability. Objective:  This study aimed to evaluate factors influencing telemedicine uptake among frontline physicians in the early pandemic response. Methods:  We surveyed a national stratified sample of frontline clinicians drawn from the American Medical Association Physician Professional Data in June or July 2020. The survey inquired about the first month and most recent month (June 2020) of pandemic telemedicine use; sample data included clinician gender, specialty, census region, and years in practice. Local pandemic conditions were estimated from county-level data on COVID-19 rates at the time of survey response. Data were analyzed in a weighted logistic regression, controlling for county-specific pandemic data, and weighted to account for survey data stratification and nonresponse. Results:  Over the first 3-4 months of the pandemic, the proportion of physicians reporting use of telemedicine in >30% of visits increased from 29.2% (70/239) to 35.7% (85/238). Relative to primary care, odds of substantial telemedicine use (>30%) both during the first month of the pandemic and in June 2020 were increased among infectious disease and critical care physicians and decreased among hospitalists and emergency medicine physicians. At least minimal prepandemic telemedicine use (odds ratio [OR] 11.41, 95% CI 1.34-97.04) and a high 2-week moving average of local COVID-19 cases (OR 10.16, 95% CI 2.07-49.97) were also associated with substantial telemedicine use in June 2020. There were no significant differences according to clinician gender, census region, or years in practice. Conclusions:  Prepandemic telemedicine use, high local COVID-19 case counts, and clinician specialty were associated with higher levels of substantial telemedicine use during the early pandemic response. These results suggest that telemedicine uptake in the face of the pandemic may have been heavily influenced by the level of perceived threat and the resources available for implementation. Such understanding has important implications for reducing burnout and preparation for future public health emergencies. %M 39018095 %R 10.2196/50751 %U https://formative.jmir.org/2024/1/e50751 %U https://doi.org/10.2196/50751 %U http://www.ncbi.nlm.nih.gov/pubmed/39018095 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e57842 %T eHealth Literacy and Web-Based Health Information–Seeking Behaviors on COVID-19 in Japan: Internet-Based Mixed Methods Study %A Mitsutake,Seigo %A Oka,Koichiro %A Okan,Orkan %A Dadaczynski,Kevin %A Ishizaki,Tatsuro %A Nakayama,Takeo %A Takahashi,Yoshimitsu %+ Human Care Research Team, Tokyo Metropolitan Institute for Geriatrics and Gerontology, 35-2 Sakae-cho, Itabahshi-ku, Tokyo, 173-0015, Japan, 81 3 3964 3241, mitsu@tmig.or.jp %K COVID-19 %K infectious %K public health %K SARS-COV-2 %K respiratory %K eHealth %K health communication %K web-based information %K DHLI %K eHEALS %K internet %K mixed methods study %K adult population %K Asia %K Asian %K cross sectional %K survey %K surveys %K questionnaire %K questionnaires %K Japan %K Japanese %K information seeking %K information behavior %K information behavior %K health literacy %K eHealth literacy %K digital health literacy %D 2024 %7 11.7.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: During the COVID-19 pandemic, much misinformation and disinformation emerged and spread rapidly via the internet, posing a severe public health challenge. While the need for eHealth literacy (eHL) has been emphasized, few studies have compared the difficulties involved in seeking and using COVID-19 information between adult internet users with low or high eHL. Objective: This study examines the association between eHL and web-based health information–seeking behaviors among adult Japanese internet users. Moreover, this study qualitatively shed light on the difficulties encountered in seeking and using this information and examined its relationship with eHL. Methods: This cross-sectional internet-based survey (October 2021) collected data from 6000 adult internet users who were equally divided into sample groups by gender, age, and income. We used the Japanese version of the eHL Scale (eHEALS). We also used a Digital Health Literacy Instrument (DHLI) adapted to the COVID-19 pandemic to assess eHL after we translated it to Japanese. Web-based health information–seeking behaviors were assessed by using a 10-item list of web sources and evaluating 10 topics participants searched for regarding COVID-19. Sociodemographic and other factors (eg, health-related behavior) were selected as covariates. Furthermore, we qualitatively explored the difficulties in information seeking and using. The descriptive contents of the responses regarding difficulties in seeking and using COVID-19 information were analyzed using an inductive qualitative content analysis approach. Results: Participants with high eHEALS and DHLI scores on information searching, adding self-generated information, evaluating reliability, determining relevance, and operational skills were more likely to use all web sources of information about COVID-19 than those with low scores. However, there were negative associations between navigation skills and privacy protection scores when using several information sources, such as YouTube (Google LLC), to search for COVID-19 information. While half of the participants reported no difficulty seeking and using COVID-19 information, participants who reported any difficulties, including information discernment, incomprehensible information, information overload, and disinformation, had lower DHLI score. Participants expressed significant concerns regarding “information quality and credibility,” “abundance and shortage of relevant information,” “public trust and skepticism,” and “credibility of COVID-19–related information.” Additionally, they disclosed more specific concerns, including “privacy and security concerns,” “information retrieval challenges,” “anxieties and panic,” and “movement restriction.” Conclusions: Although Japanese internet users with higher eHEALS and total DHLI scores were more actively using various web sources for COVID-19 information, those with high navigation skills and privacy protection used web-based information about COVID-19 cautiously compared with those with lower proficiency. The study also highlighted an increased need for information discernment when using social networking sites in the “Health 2.0” era. The identified categories and themes from the qualitative content analysis, such as “information quality and credibility,” suggest a framework for addressing the myriad challenges anticipated in future infodemics. %M 38990625 %R 10.2196/57842 %U https://www.jmir.org/2024/1/e57842 %U https://doi.org/10.2196/57842 %U http://www.ncbi.nlm.nih.gov/pubmed/38990625 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e49422 %T Retrospecting Digital Media Use, Negative Emotions, and Trust Gaps During the COVID-19 Pandemic in China: Cross-Sectional Web-Based Survey %A Wei,Lu %A Huang,Qing %+ International Communication Institute, College of Media and International Culture, Zhejiang University, 866 Yuhangtang Road, Zijingang Campus, Hangzhou, 310058, China, 86 0571 87075102, qing_huang@zju.edu.cn %K digital media use %K negative emotions %K family members–strangers trust gap %K family members–acquaintances trust gap %K mediation effect %K COVID-19 %D 2024 %7 10.7.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Retrospecting the trust gaps and their dynamics during the pandemic is crucial for understanding the root causes of postpandemic challenges and offers valuable insights into preparing for future public health emergencies. The COVID-19 pandemic eroded people’s trust in strangers and acquaintances, while their trust in family members remained relatively stable. This resulted in 2 trust gaps, namely, the family members–strangers trust gap and the family members–acquaintances trust gap. Widening trust gaps impede social integration and undermine the effective management of public health crises. However, little is known about how digital media use shaped trust gaps during a pandemic. Objective: This study aims to investigate the relationships between digital media use, negative emotions, the family members–strangers trust gap, and the family members–acquaintances trust gap during the COVID-19 pandemic in China. We test the mediating role of negative emotions between digital media use and 2 trust gaps and compare the indirect effect of digital media use on 2 trust gaps through negative emotions. Methods: A cross-sectional web-based survey was conducted in China between January 31, 2020, and February 9, 2020. A total of 1568 adults participated in the survey. Questions related to digital media use, negative emotions, trust in family members, trust in acquaintances, and trust in strangers during the pandemic were asked. Regression analyses were performed to test the associations between the examined variables. We used a 95% bootstrap CI approach to estimate the mediation effects. Results: Digital media use was positively associated with negative emotions (B=0.17, SE 0.03; P<.001), which in turn were positively associated with the family members–strangers trust gap (B=0.15, SE 0.03; P<.001). Likewise, digital media use was positively associated with negative emotions (B=0.17, SE 0.03; P<.001), while negative emotions were positively associated with the family members–acquaintances trust gap (B=0.08, SE 0.03; P=.01). Moreover, the indirect effect of digital media use on the family members–strangers trust gap (B=0.03, SE 0.01; 95% CI 0.01-0.04) was stronger than that on the family members–acquaintances trust gap (B=0.01, SE 0.01; 95% CI 0.003-0.027). Conclusions: The results demonstrate that negative emotions resulting from the frequent use of digital media are a key factor that accounts for the widening trust gaps. Considering the increasing reliance on digital media, the findings indicate that the appropriate use of digital media can prevent the overamplification of negative emotions and curb the enlargement of trust gaps. This may help restore social trust and prepare for future public health crises in the postpandemic era. %M 38986127 %R 10.2196/49422 %U https://www.jmir.org/2024/1/e49422 %U https://doi.org/10.2196/49422 %U http://www.ncbi.nlm.nih.gov/pubmed/38986127 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e45840 %T Pandemic Fatigue and Preferences for COVID-19 Public Health and Social Measures in China: Nationwide Discrete Choice Experiment %A Yang,Meng %A He,Zonglin %A Zhang,Yin %A Liu,Taoran %A Ming,Wai-kit %+ Department of Infectious Diseases and Public Health, City University of Hong Kong, Room 1A-503, 5/F, Block 1, To Yuen Building, 31 To Yuen Street, Hong Kong, China (Hong Kong), 852 34426956, wkming2@cityu.edu.hk %K pandemic fatigue %K preference %K public health and social measures %K discrete choice experiment %K COVID-19 %D 2024 %7 27.6.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Information on the public’s preferences for current public health and social measures (PHSMs) and people’s mental health under PHSMs is insufficient. Objective: This study aimed to quantify the public’s preferences for varied PHSMs and measure the level of pandemic fatigue in the COVID-19 normalization stage in China. Methods: A nationwide cross-sectional study with a discrete choice experiment and psychometric scales was conducted to assess public preferences for and attitudes toward PHSMs, using the quota sampling method. The COVID-19 Pandemic Fatigue Scale (CPFS) was used to screen fatigue levels among respondents. The multinomial logit model, latent class model, and Mann-Whitney test were used for statistical analysis. We also conducted subgroup analysis based on sex, age, monthly income, mental health status, and pandemic fatigue status. Results: A total of 689 respondents across China completed the survey. The discrete choice experiment revealed that respondents attached the greatest importance to the risk of COVID-19 infection within 3 months (45.53%), followed by loss of income within 3 months (30.69%). Vulnerable populations (low-income populations and elderly people) were more sensitive to the risk of infection, while younger respondents were more sensitive to income loss and preferred nonsuspension of social places and transportation. Migrants and those with pandemic fatigue had less acceptance of the mandatory booster vaccination and suspension of transportation. Additionally, a higher pandemic fatigue level was observed in female respondents, younger respondents, migrants, and relatively lower-income respondents (CPFS correlation with age: r=–0.274, P<.001; correlation with monthly income: r=–0.25, P<.001). Mandatory booster COVID-19 vaccination was also not preferred by respondents with a higher level of pandemic fatigue, while universal COVID-19 booster vaccination was preferred by respondents with a lower level of pandemic fatigue. Conclusions: Pandemic fatigue is widely prevalent in respondents across China, and respondents desired the resumption of normal social life while being confronted with the fear of COVID-19 infection in the normalization stage of COVID-19 in China. During future pandemics, the mental burden and adherence of residents should be considered for the proper implementation of PHSMs. %M 38935420 %R 10.2196/45840 %U https://publichealth.jmir.org/2024/1/e45840 %U https://doi.org/10.2196/45840 %U http://www.ncbi.nlm.nih.gov/pubmed/38935420 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e53551 %T Updated Surveillance Metrics and History of the COVID-19 Pandemic (2020-2023) in Europe: Longitudinal Trend Analysis %A Lundberg,Alexander L %A Wu,Scott A %A Soetikno,Alan G %A Hawkins,Claudia %A Murphy,Robert L %A Havey,Robert J %A Ozer,Egon A %A Moss,Charles B %A Welch,Sarah B %A Mason,Maryann %A Liu,Yingxuan %A Post,Lori A %+ Buehler Center for Health Policy and Economics, Robert J. Havey, MD Institute for Global Health, Northwestern University, 420 E. Superior, Chicago, IL, 60611, United States, 1 3125031706, lori.post@northwestern.edu %K Europe %K COVID-19 %K history of the pandemic %K method of the moments %K Arellano-Bond estimators %K Albania %K Andorra %K Austria %K Belarus %K Belgium %K Bosnia and Herzegovina %K Bulgaria %K Croatia %K the Czech Republic %K Denmark %K Estonia %K Finland %K France %K Germany %K Greece %K Greenland %K Hungary %K Iceland %K Ireland %K the Isle of Man %K Italy %K Latvia %K Liechtenstein %K Lithuania %K Luxembourg %K Moldova %K Monaco %K Montenegro %K the Netherlands %K Norway %K Poland %K Portugal %K Romania %K San Marino %K Serbia %K Slovakia %K Slovenia %K Spain %K Sweden %K Switzerland %K Ukraine %K the United Kingdom %K the Vatican City %D 2024 %7 21.6.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: In this study, we built upon our initial research published in 2020 by incorporating an additional 2 years of data for Europe. We assessed whether COVID-19 had shifted from the pandemic to endemic phase in the region when the World Health Organization (WHO) declared the end of the public health emergency of international concern on May 5, 2023. Objective: We first aimed to measure whether there was an expansion or contraction in the pandemic in Europe at the time of the WHO declaration. Second, we used dynamic and genomic surveillance methods to describe the history of the pandemic in the region and situate the window of the WHO declaration within the broader history. Third, we provided the historical context for the course of the pandemic in Europe in terms of policy and disease burden at the country and region levels. Methods: In addition to the updates of traditional surveillance data and dynamic panel estimates from the original study, this study used data on sequenced SARS-CoV-2 variants from the Global Initiative on Sharing All Influenza Data to identify the appearance and duration of variants of concern. We used Nextclade nomenclature to collect clade designations from sequences and Pangolin nomenclature for lineage designations of SARS-CoV-2. Finally, we conducted a 1-tailed t test for whether regional weekly speed was greater than an outbreak threshold of 10. We ran the test iteratively with 6 months of data across the sample period. Results: Speed for the region had remained below the outbreak threshold for 4 months by the time of the WHO declaration. Acceleration and jerk were also low and stable. While the 1-day and 7-day persistence coefficients remained statistically significant, the coefficients were moderate in magnitude (0.404 and 0.547, respectively; P<.001 for both). The shift parameters for the 2 weeks around the WHO declaration were small and insignificant, suggesting little change in the clustering effect of cases on future cases at the time. From December 2021 onward, Omicron was the predominant variant of concern in sequenced viral samples. The rolling t test of speed equal to 10 became insignificant for the first time in April 2023. Conclusions: While COVID-19 continues to circulate in Europe, the rate of transmission remained below the threshold of an outbreak for 4 months ahead of the WHO declaration. The region had previously been in a nearly continuous state of outbreak. The more recent trend suggested that COVID-19 was endemic in the region and no longer reached the threshold of the pandemic definition. However, several countries remained in a state of outbreak, and the conclusion that COVID-19 was no longer a pandemic in Europe at the time is unclear. %M 38568186 %R 10.2196/53551 %U https://publichealth.jmir.org/2024/1/e53551 %U https://doi.org/10.2196/53551 %U http://www.ncbi.nlm.nih.gov/pubmed/38568186 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e48549 %T Testing a Biobehavioral Model of Chronic Stress and Weight Gain in Young Children (Family Stress Study): Protocol and Baseline Demographics for a Prospective Observational Study %A Pare,Shannon M %A Gunn,Elizabeth %A Morrison,Katherine M %A Miller,Alison L %A Duncan,Alison M %A Buchholz,Andrea C %A Ma,David W L %A Tremblay,Paul F %A Vallis,Lori Ann %A Mercer,Nicola J %A Haines,Jess %+ Department of Family Relations and Applied Nutrition, University of Guelph, 50 Stone Road East, Guelph, ON, N1G 2W1, Canada, 1 5198244120 ext 58820, spare@uoguelph.ca %K stress %K child, preschool %K adiposity %K household chaos %K cortisol %K COVID-19 %K behavioral mechanisms %K caregiver-child relationship quality %D 2024 %7 20.6.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Chronic stress is an important risk factor in the development of obesity. While research suggests chronic stress is linked to excess weight gain in children, the biological or behavioral mechanisms are poorly understood. Objective: The objectives of the Family Stress Study are to examine behavioral and biological pathways through which chronic stress exposure (including stress from COVID-19) may be associated with adiposity in young children, and to determine if factors such as child sex, caregiver-child relationship quality, caregiver education, and caregiver self-regulation moderate the association between chronic stress and child adiposity. Methods: The Family Stress Study is a prospective cohort study of families recruited from 2 Canadian sites: the University of Guelph in Guelph, Ontario, and McMaster University in Hamilton, Ontario. Participants will be observed for 2 years and were eligible to participate if they had at least one child (aged 2-6 years) and no plans to move from the area within the next 3 years. Study questionnaires and measures were completed remotely at baseline and will be assessed using the same methods at 1- and 2-year follow-ups. At each time point, caregivers measure and report their child’s height, weight, and waist circumference, collect a hair sample for cortisol analysis, and fit their child with an activity monitor to assess the child’s physical activity and sleep. Caregivers also complete a web-based health and behaviors survey with questions about family demographics, family stress, their own weight-related behaviors, and their child’s mental health, as well as a 1-day dietary assessment for their child. Results: Enrollment for this study was completed in December 2021. The final second-year follow-up was completed in April 2024. This study’s sample includes 359 families (359 children, 359 female caregivers, and 179 male caregivers). The children’s mean (SD) age is 3.9 years (1.2 years) and 51% (n=182) are female. Approximately 74% (n=263) of children and 80% (n=431) of caregivers identify as White. Approximately 34% (n=184) of caregivers have a college diploma or less and nearly 93% (n=499) are married or cohabiting with a partner. Nearly half (n=172, 47%) of the families have an annual household income ≥CAD $100,000 (an average exchange rate of 1 CAD=0.737626 USD applies). Data cleaning and analysis are ongoing as of manuscript publication. Conclusions: Despite public health restrictions from COVID-19, the Family Stress Study was successful in recruiting and using remote data collection to successfully engage families in this study. The results from this study will help identify the direction and relative contributions of the biological and behavioral pathways linking chronic stress and adiposity. These findings will aid in the development of effective interventions designed to modify these pathways and reduce obesity risk in children. Trial Registration: ClinicalTrials.gov NCT05534711; https://clinicaltrials.gov/study/NCT05534711 International Registered Report Identifier (IRRID): DERR1-10.2196/48549 %M 38900565 %R 10.2196/48549 %U https://www.researchprotocols.org/2024/1/e48549 %U https://doi.org/10.2196/48549 %U http://www.ncbi.nlm.nih.gov/pubmed/38900565 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e51498 %T Population Behavior Changes Underlying Phasic Shifts of SARS-CoV-2 Exposure Settings Across 3 Omicron Epidemic Waves in Hong Kong: Prospective Cohort Study %A Chan,Chin Pok %A Lee,Shui Shan %A Kwan,Tsz Ho %A Wong,Samuel Yeung Shan %A Yeoh,Eng-Kiong %A Wong,Ngai Sze %+ JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Rm 204, School of Public Health Building, Prince of Wales Hospital, New Territories, Hong Kong, China, 86 22528862, candy_wong@cuhk.edu.hk %K exposure risk %K contact setting %K social distancing %K epidemic control %K participatory surveillance %K SARS-CoV-2 %K COVID-19 %D 2024 %7 19.6.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Exposure risk was shown to have affected individual susceptibility and the epidemic spread of COVID-19. The dynamics of risk by and across exposure settings alongside the variations following the implementation of social distancing interventions are understudied. Objective: This study aims to examine the population’s trajectory of exposure risk in different settings and its association with SARS-CoV-2 infection across 3 consecutive Omicron epidemic waves in Hong Kong. Methods: From March to June 2022, invitation letters were posted to 41,132 randomly selected residential addresses for the recruitment of households into a prospective population cohort. Through web-based monthly surveys coupled with email reminders, a representative from each enrolled household self-reported incidents of SARS-CoV-2 infections, COVID-19 vaccination uptake, their activity pattern in the workplace, and daily and social settings in the preceding month. As a proxy of their exposure risk, the reported activity trend in each setting was differentiated into trajectories based on latent class growth analyses. The associations of different trajectories of SARS-CoV-2 infection overall and by Omicron wave (wave 1: February-April; wave 2: May-September; wave 3: October-December) in 2022 were evaluated by using Cox proportional hazards models and Kaplan-Meier analysis. Results: In total, 33,501 monthly responses in the observation period of February-December 2022 were collected from 5321 individuals, with 41.7% (2221/5321) being male and a median age of 46 (IQR 34-57) years. Against an expanding COVID-19 vaccination coverage from 81.9% to 95.9% for 2 doses and 20% to 77.7% for 3 doses, the cumulative incidence of SARS-CoV-2 infection escalated from <0.2% to 25.3%, 32.4%, and 43.8% by the end of waves 1, 2, and 3, respectively. Throughout February-December 2022, 52.2% (647/1240) of participants had worked regularly on-site, 28.7% (356/1240) worked remotely, and 19.1% (237/1240) showed an assorted pattern. For daily and social settings, 4 and 5 trajectories were identified, respectively, with 11.5% (142/1240) and 14.6% (181/1240) of the participants gauged to have a high exposure risk. Compared to remote working, working regularly on-site (adjusted hazard ratio [aHR] 1.47, 95% CI 1.19-1.80) and living in a larger household (aHR 1.12, 95% CI 1.06-1.18) were associated with a higher risk of SARS-CoV-2 infection in wave 1. Those from the highest daily exposure risk trajectory (aHR 1.46, 95% CI 1.07-2.00) and the second highest social exposure risk trajectory (aHR 1.52, 95% CI 1.18-1.97) were also at an increased risk of infection in waves 2 and 3, respectively, relative to the lowest risk trajectory. Conclusions: In an infection-naive population, SARS-CoV-2 transmission was predominantly initiated at the workplace, accelerated in the household, and perpetuated in the daily and social environments, as stringent restrictions were scaled down. These patterns highlight the phasic shift of exposure settings, which is important for informing the effective calibration of targeted social distancing measures as an alternative to lockdown. %M 38896447 %R 10.2196/51498 %U https://publichealth.jmir.org/2024/1/e51498 %U https://doi.org/10.2196/51498 %U http://www.ncbi.nlm.nih.gov/pubmed/38896447 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e51292 %T How College Students Used Information From Institutions of Higher Education in the United States During COVID-19: Web-Based Cross-Sectional Survey Study %A Peprah,Emmanuel %A Amesimeku,Etornam %A Angulo,Brian %A Chhetri,Himani %A Fordjuoh,Judy %A Ruan,Christina %A Wang,Cong %A Patena,John %A Vieira,Dorice %A Ryan,Nessa %A Iloegbu,Chukwuemeka %A Gyamfi,Joyce %A Odumegwu,Jonathan %+ Implementing Evidence-Based Interventions Through Engagement (ISEE) Lab, Department of Global and Environmental Health, New York University School of Global Public Health, 708 Broadway, New York, NY, 10012, United States, 1 212 992 6095, ep91@nyu.edu %K COVID-19 %K pandemic %K public health %K preventative %K prevention %K social distancing %K masks %K personal protective equipment %K cross-sectional %K surveys %K higher learning %K higher education %K university students %K information source %K web-based information %K health information %K dissemination %K awareness %K information spread %K young adults %K social media %K university %K postsecondary %K students %K young adult %K college %K concern %K worry %K anxiety %K perceptions %D 2024 %7 17.6.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The start of the COVID-19 pandemic resulted in the implementation of nonpharmaceutical interventions by US institutions of higher education at an unprecedented level. During the backdrop of an emerging pandemic, younger adults (eg, college students) had an overall lower risk for severe outcomes for SARS-CoV-2, making this population a potential source of transmission for age groups with high susceptibility and negative health outcomes. We examine how college students’ level of concern for COVID-19 was influenced by different sources of information, their living status, income level, and other demographic identifiers and its association with prevention behavior change. Objective: We sought to examine the level of concern, defined as the extent to which the participant would take corrective action to mitigate contracting or spreading the virus (to family or friends) by using personal protective equipment such as a face mask, practicing social distancing, and following other public health recommendations, among college students during the COVID-19 pandemic. Methods: A cross-sectional, web-based survey was conducted in 2021 among 185 college students aged 18-41 years, with most living in New York City and the United States (n=134, 72.4%). Out of 185 college students, 94 provided their zip codes, with 51 of those college students indicating they lived in New York City areas. The participants completed the survey via a QR code. Study participants who did not complete the full survey or were not college students in any US college or university were excluded. Analyses were conducted using R (version 4.2.2; R Foundation for Statistical Computing). Results: Of 185 respondents participated in the study, 25 (13.5.%) used emails from their schools, 51 (27.6%) used mainstream media, and 109 (58.9%) used social media and other sources to obtain information about COVID-19. Of the 109 participants who learned about the pandemic from social media, 91 (83.5%) were concerned; however, only 63% (32/51) and 60% (15/25) of the participants who sourced information from mainstream media and their schools’ email, respectively, were concerned. Further, the participants who received information from social media and other sources were about 3 times more likely to be concerned about COVID-19 than participants who received information from the university via email (P=.036; OR=3.07, 95% CI: 1.06-8.83).. Conclusions: College students who received information from social media and other sources were more likely to be concerned about COVID-19 than students who received information from their school via emails. %M 38885019 %R 10.2196/51292 %U https://formative.jmir.org/2024/1/e51292 %U https://doi.org/10.2196/51292 %U http://www.ncbi.nlm.nih.gov/pubmed/38885019 %0 Journal Article %@ 2563-6316 %I %V 5 %N %P e43341 %T Health Care System Overstretch and In-Hospital Mortality of Intubated Patients With COVID-19 in Greece From September 2020 to April 2022: Updated Retrospective Cohort Study %A Lytras,Theodore %K COVID-19 %K pandemic %K health care disparities %K intensive care unit %K right to health %K quality of care %K intubation %K mortality %K health disparity %K health inequality %K surveillance data %K inpatient %K mortality %K COVID-19 patient %K hospitalization %K ICU %K disparity %K inequality %K surveillance %K health care system %K Greece %K region %K Delta %K Omicron %K vaccination %K vaccine %K public health %K patient load %K deterioration %K time %D 2024 %7 10.6.2024 %9 %J JMIRx Med %G English %X Background: Our previous analysis showed how in-hospital mortality of intubated patients with COVID-19 in Greece is adversely affected by patient load and regional disparities. Objective: We aimed to update this analysis to include the large Delta and Omicron waves that affected Greece during 2021-2022, while also considering the effect of vaccination on in-hospital mortality. Methods: Anonymized surveillance data were analyzed from all patients with COVID-19 in Greece intubated between September 1, 2020, and April 4, 2022, and followed up until May 17, 2022. Time-split Poisson regression was used to estimate the hazard of dying as a function of fixed and time-varying covariates: the daily total count of intubated patients with COVID-19 in Greece, age, sex, COVID-19 vaccination status, region of the hospital (Attica, Thessaloniki, or rest of Greece), being in an intensive care unit, and an indicator for the period from September 1, 2021. Results: A total of 14,011 intubated patients with COVID-19 were analyzed, of whom 10,466 (74.7%) died. Mortality was significantly higher with a load of 400-499 intubated patients, with an adjusted hazard ratio (HR) of 1.22 (95% CI 1.09-1.38), rising progressively up to 1.48 (95% CI 1.31-1.69) for a load of ≥800 patients. Hospitalization away from the Attica region was also independently associated with increased mortality (Thessaloniki: HR 1.22, 95% CI 1.13-1.32; rest of Greece: HR 1.64, 95% CI 1.54-1.75), as was hospitalization after September 1, 2021 (HR 1.21, 95% CI 1.09-1.36). COVID-19 vaccination did not affect the mortality of these already severely ill patients, the majority of whom (11,944/14,011, 85.2%) were unvaccinated. Conclusions: Our results confirm that in-hospital mortality of severely ill patients with COVID-19 is adversely affected by high patient load and regional disparities, and point to a further significant deterioration after September 1, 2021, especially away from Attica and Thessaloniki. This highlights the need for urgent strengthening of health care services in Greece, ensuring equitable and high-quality care for all. %R 10.2196/43341 %U https://xmed.jmir.org/2024/1/e43341 %U https://doi.org/10.2196/43341 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e48464 %T Effect of a Structured Multilevel Telehealth Service on Hospital Admissions and Mortality During COVID-19 in a Resource-Limited Region in Brazil: Retrospective Cohort Study %A Oliveira,Clara Rodrigues Alves %A Pires,Magda Carvalho %A Meira,Karina Cardoso %A de Jesus,Jordana Cristina %A Borges,Isabela Nascimento %A Paixão,Maria Cristina %A Mendes,Mayara Santos %A Ribeiro,Leonardo Bonisson %A Marcolino,Milena Soriano %A Alkmim,Maria Beatriz Moreira %A Ribeiro,Antonio Luiz Pinho %+ Department of Internal Medicine, Medical School, Universidade Federal de Minas Gerais, 110 Avenida Professor Alfredo Balena, Room 107, Ala Sul Santa Efigênia, Belo Horizonte, 30130-100, Brazil, 55 3134099669, claralves@gmail.com %K COVID-19 %K telehealth %K health care %K clinical outcomes %K hospital admission %K mortality %K adoption %K effectiveness %K digital health tool %K flu %K teleconsultation %K digital health %K digital literacy %K telemonitoring %D 2024 %7 10.6.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic represented a great stimulus for the adoption of telehealth and many initiatives in this field have emerged worldwide. However, despite this massive growth, data addressing the effectiveness of telehealth with respect to clinical outcomes remain scarce.  Objective: The aim of this study was to evaluate the impact of the adoption of a structured multilevel telehealth service on hospital admissions during the acute illness course and the mortality of adult patients with flu syndrome in the context of the COVID-19 pandemic. Methods: A retrospective cohort study was performed in two Brazilian cities where a public COVID-19 telehealth service (TeleCOVID-MG) was deployed. TeleCOVID-MG was a structured multilevel telehealth service, including (1) first response and risk stratification through a chatbot software or phone call center, (2) teleconsultations with nurses and medical doctors, and (3) a telemonitoring system. For this analysis, we included data of adult patients registered in the Flu Syndrome notification databases who were diagnosed with flu syndrome between June 1, 2020, and May 31, 2021. The exposed group comprised patients with flu syndrome who used TeleCOVID-MG at least once during the illness course and the control group comprised patients who did not use this telehealth service during the respiratory illness course. Sociodemographic characteristics, comorbidities, and clinical outcomes data were extracted from the Brazilian official databases for flu syndrome, Severe Acute Respiratory Syndrome (due to any respiratory virus), and mortality. Models for the clinical outcomes were estimated by logistic regression. Results: The final study population comprised 82,182 adult patients with a valid registry in the Flu Syndrome notification system. When compared to patients who did not use the service (n=67,689, 82.4%), patients supported by TeleCOVID-MG (n=14,493, 17.6%) had a lower chance of hospitalization during the acute respiratory illness course, even after adjusting for sociodemographic characteristics and underlying medical conditions (odds ratio [OR] 0.82, 95% CI 0.71-0.94; P=.005). No difference in mortality was observed between groups (OR 0.99, 95% CI 0.86-1.12; P=.83). Conclusions: A telehealth service applied on a large scale in a limited-resource region to tackle COVID-19 was related to reduced hospitalizations without increasing the mortality rate. Quality health care using inexpensive and readily available telehealth and digital health tools may be delivered in areas with limited resources and should be considered as a potential and valuable health care strategy. The success of a telehealth initiative relies on a partnership between the involved stakeholders to define the roles and responsibilities; set an alignment between the different modalities and levels of health care; and address the usual drawbacks related to the implementation process, such as infrastructure and accessibility issues. %M 38857068 %R 10.2196/48464 %U https://www.jmir.org/2024/1/e48464 %U https://doi.org/10.2196/48464 %U http://www.ncbi.nlm.nih.gov/pubmed/38857068 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e48043 %T A Metric of Societal Burden Based on Virus Succession to Determine Economic Losses and Health Benefits of China’s Lockdown Policies: Model Development and Validation %A Chen,Wenxiu %A Zhang,Bin %A Wang,Chen %A An,Wei %A Guruge,Shashika Kumudumali %A Chui,Ho-kwong %A Yang,Min %+ National Engineering Reaserch Center of Industrial Wastewater Detoxification and Resource Recovery, Research Center for Eco-Environmental Sciences, Chinese Academy of Sciences, 18 Shuangqing Road, Beijing, 100085, China, 86 18001155476, anwei@rcees.ac.cn %K SARS-CoV-2 %K lockdown %K virus succession %K benefit %K loss %K fatality rate %K pandemic %K blanket lockdown %K partial lockdown %D 2024 %7 7.6.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The COVID-19 pandemic had a profound impact on the global health system and economic structure. Although the implementation of lockdown measures achieved notable success in curbing the spread of the pandemic, it concurrently incurred substantial socioeconomic costs. Objective: The objective of this study was to delineate an equilibrium between the economic losses and health benefits of lockdown measures, with the aim of identifying the optimal boundary conditions for implementing these measures at various pandemic phases. Methods: This study used a model to estimate the half-lives of the observed case fatality rates of different strains. It was based on global infection and death data collected by the World Health Organization and strain sequence time series data provided by Nextstrain. The connection between the health benefits and economic losses brought by lockdown measures was established through the calculation of disability-adjusted life years. Taking China’s city lockdowns as an example, this study determined the cost-benefit boundary of various lockdown measures during the evolution of COVID-19. Results: The study reveals a direct proportionality between economic losses due to lockdowns and the observed case fatality rates of virus strains, a relationship that holds true irrespective of population size or per capita economic output. As SARS-CoV-2 strains evolve and population immunity shifts, there has been a notable decrease in the observed case fatality rate over time, exhibiting a half-life of roughly 8 months. This decline in fatality rates may offset the health benefits of maintaining unchanged lockdown measures, given that the resultant economic losses might exceed the health benefits. Conclusions: The initial enforcement of lockdown in Wuhan led to significant health benefits. However, with the decline in the observed case fatality rate of the virus strains, the economic losses increasingly outweighed the health benefits. Consequently, it is essential to consistently refine and enhance lockdown strategies in accordance with the evolving fatality and infection rates of different virus strains, thereby optimizing outcomes in anticipation of future pandemics. %M 38848555 %R 10.2196/48043 %U https://publichealth.jmir.org/2024/1/e48043 %U https://doi.org/10.2196/48043 %U http://www.ncbi.nlm.nih.gov/pubmed/38848555 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e47070 %T COVID-19 Vaccine Effectiveness and Digital Pandemic Surveillance in Germany (eCOV Study): Web Application–Based Prospective Observational Cohort Study %A Lang,Anna-Lena %A Hohmuth,Nils %A Višković,Vukašin %A Konigorski,Stefan %A Scholz,Stefan %A Balzer,Felix %A Remschmidt,Cornelius %A Leistner,Rasmus %+ d4l Data4Life gGmbH, c/o Digital Health Cluster (DHC) im Hasso-Plattner-Institut, Rudolf-Breitscheid-Straße 187, Potsdam, 14482, Germany, 49 015756025551, annalena.lang.26@gmail.com %K COVID-19 %K SARS-CoV-2 %K COVID-19 vaccines %K BNT162b2 %K vaccine effectiveness %K participatory disease surveillance %K web application %K digital public health %K vaccination %K Germany %K effectiveness %K data collection %K disease surveillance %K tool %D 2024 %7 4.6.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic posed significant challenges to global health systems. Efficient public health responses required a rapid and secure collection of health data to improve the understanding of SARS-CoV-2 and examine the vaccine effectiveness (VE) and drug safety of the novel COVID-19 vaccines. Objective: This study (COVID-19 study on vaccinated and unvaccinated subjects over 16 years; eCOV study) aims to (1) evaluate the real-world effectiveness of COVID-19 vaccines through a digital participatory surveillance tool and (2) assess the potential of self-reported data for monitoring key parameters of the COVID-19 pandemic in Germany. Methods: Using a digital study web application, we collected self-reported data between May 1, 2021, and August 1, 2022, to assess VE, test positivity rates, COVID-19 incidence rates, and adverse events after COVID-19 vaccination. Our primary outcome measure was the VE of SARS-CoV-2 vaccines against laboratory-confirmed SARS-CoV-2 infection. The secondary outcome measures included VE against hospitalization and across different SARS-CoV-2 variants, adverse events after vaccination, and symptoms during infection. Logistic regression models adjusted for confounders were used to estimate VE 4 to 48 weeks after the primary vaccination series and after third-dose vaccination. Unvaccinated participants were compared with age- and gender-matched participants who had received 2 doses of BNT162b2 (Pfizer-BioNTech) and those who had received 3 doses of BNT162b2 and were not infected before the last vaccination. To assess the potential of self-reported digital data, the data were compared with official data from public health authorities. Results: We enrolled 10,077 participants (aged ≥16 y) who contributed 44,786 tests and 5530 symptoms. In this young, primarily female, and digital-literate cohort, VE against infections of any severity waned from 91.2% (95% CI 70.4%-97.4%) at week 4 to 37.2% (95% CI 23.5%-48.5%) at week 48 after the second dose of BNT162b2. A third dose of BNT162b2 increased VE to 67.6% (95% CI 50.3%-78.8%) after 4 weeks. The low number of reported hospitalizations limited our ability to calculate VE against hospitalization. Adverse events after vaccination were consistent with previously published research. Seven-day incidences and test positivity rates reflected the course of the pandemic in Germany when compared with official numbers from the national infectious disease surveillance system. Conclusions: Our data indicate that COVID-19 vaccinations are safe and effective, and third-dose vaccinations partially restore protection against SARS-CoV-2 infection. The study showcased the successful use of a digital study web application for COVID-19 surveillance and continuous monitoring of VE in Germany, highlighting its potential to accelerate public health decision-making. Addressing biases in digital data collection is vital to ensure the accuracy and reliability of digital solutions as public health tools. %M 38833299 %R 10.2196/47070 %U https://www.jmir.org/2024/1/e47070 %U https://doi.org/10.2196/47070 %U http://www.ncbi.nlm.nih.gov/pubmed/38833299 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e49562 %T Identifying X (Formerly Twitter) Posts Relevant to Dementia and COVID-19: Machine Learning Approach %A Azizi,Mehrnoosh %A Jamali,Ali Akbar %A Spiteri,Raymond J %+ Department of Computer Science, University of Saskatchewan, S425 Thorvaldson Building, 110 Science Place, Saskatoon, SK, S7N5C9, Canada, 1 306 966 2909, spiteri@cs.usask.ca %K machine learning %K dementia %K Alzheimer disease %K COVID-19 %K X (Twitter) %K natural language processing %D 2024 %7 4.6.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: During the pandemic, patients with dementia were identified as a vulnerable population. X (formerly Twitter) became an important source of information for people seeking updates on COVID-19, and, therefore, identifying posts (formerly tweets) relevant to dementia can be an important support for patients with dementia and their caregivers. However, mining and coding relevant posts can be daunting due to the sheer volume and high percentage of irrelevant posts. Objective: The objective of this study was to automate the identification of posts relevant to dementia and COVID-19 using natural language processing and machine learning (ML) algorithms. Methods: We used a combination of natural language processing and ML algorithms with manually annotated posts to identify posts relevant to dementia and COVID-19. We used 3 data sets containing more than 100,000 posts and assessed the capability of various algorithms in correctly identifying relevant posts. Results: Our results showed that (pretrained) transfer learning algorithms outperformed traditional ML algorithms in identifying posts relevant to dementia and COVID-19. Among the algorithms tested, the transfer learning algorithm A Lite Bidirectional Encoder Representations from Transformers (ALBERT) achieved an accuracy of 82.92% and an area under the curve of 83.53%. ALBERT substantially outperformed the other algorithms tested, further emphasizing the superior performance of transfer learning algorithms in the classification of posts. Conclusions: Transfer learning algorithms such as ALBERT are highly effective in identifying topic-specific posts, even when trained with limited or adjacent data, highlighting their superiority over other ML algorithms and applicability to other studies involving analysis of social media posts. Such an automated approach reduces the workload of manual coding of posts and facilitates their analysis for researchers and policy makers to support patients with dementia and their caregivers and other vulnerable populations. %M 38833288 %R 10.2196/49562 %U https://formative.jmir.org/2024/1/e49562 %U https://doi.org/10.2196/49562 %U http://www.ncbi.nlm.nih.gov/pubmed/38833288 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e52655 %T Searching COVID-19 Clinical Research Using Graph Queries: Algorithm Development and Validation %A Invernici,Francesco %A Bernasconi,Anna %A Ceri,Stefano %+ Department of Electronics, Information, and Bioengineering, Politecnico di Milano, Via Ponzio 34/5, Milan, 20133, Italy, 39 23993494, anna.bernasconi@polimi.it %K big data corpus %K clinical research %K co-occurrence network %K COVID-19 Open Research Dataset %K CORD-19 %K graph search %K Named Entity Recognition %K Neo4j %K text mining %D 2024 %7 30.5.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Since the beginning of the COVID-19 pandemic, >1 million studies have been collected within the COVID-19 Open Research Dataset, a corpus of manuscripts created to accelerate research against the disease. Their related abstracts hold a wealth of information that remains largely unexplored and difficult to search due to its unstructured nature. Keyword-based search is the standard approach, which allows users to retrieve the documents of a corpus that contain (all or some of) the words in a target list. This type of search, however, does not provide visual support to the task and is not suited to expressing complex queries or compensating for missing specifications. Objective: This study aims to consider small graphs of concepts and exploit them for expressing graph searches over existing COVID-19–related literature, leveraging the increasing use of graphs to represent and query scientific knowledge and providing a user-friendly search and exploration experience. Methods: We considered the COVID-19 Open Research Dataset corpus and summarized its content by annotating the publications’ abstracts using terms selected from the Unified Medical Language System and the Ontology of Coronavirus Infectious Disease. Then, we built a co-occurrence network that includes all relevant concepts mentioned in the corpus, establishing connections when their mutual information is relevant. A sophisticated graph query engine was built to allow the identification of the best matches of graph queries on the network. It also supports partial matches and suggests potential query completions using shortest paths. Results: We built a large co-occurrence network, consisting of 128,249 entities and 47,198,965 relationships; the GRAPH-SEARCH interface allows users to explore the network by formulating or adapting graph queries; it produces a bibliography of publications, which are globally ranked; and each publication is further associated with the specific parts of the query that it explains, thereby allowing the user to understand each aspect of the matching. Conclusions: Our approach supports the process of query formulation and evidence search upon a large text corpus; it can be reapplied to any scientific domain where documents corpora and curated ontologies are made available. %M 38814687 %R 10.2196/52655 %U https://www.jmir.org/2024/1/e52655 %U https://doi.org/10.2196/52655 %U http://www.ncbi.nlm.nih.gov/pubmed/38814687 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e44827 %T An Accessible Web-Based Survey to Monitor the Mental Health of People With Mild Intellectual Disability or Low Literacy Skills During the COVID-19 Pandemic: Comparative Data Analysis %A Koks-Leensen,Monique CJ %A Menko,Anouk %A Raaijmakers,Fieke %A Fransen-Kuppens,Gerdine AJ %A Bevelander,Kirsten E %+ Department of Primary and Community Care, Radboud university medical center, Geert Grooteplein 21, Nijmegen, 6525 EZ, Netherlands, 31 243618181, monique.koks-leensen@radboudumc.nl %K monitoring %K mental health %K intellectual disabilities %K low literacy %K COVID-19 %K web-based survey %D 2024 %7 30.5.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The COVID-19 pandemic and related control measures affected the mental health of all populations. Particular subgroups are underrepresented in mainstream surveys because they are hard to reach, and study measurements are not adapted to their skills. These subgroups include people with lower cognitive and literacy skills, such as people with mild intellectual disability (MID), who were considered vulnerable during the COVID-19 pandemic given their low socioeconomic status, small social networks, increased risks of health problems, and difficulties understanding health-related information. Objective: This study examines the impact of the COVID-19 pandemic on mental health among people with MID or low literacy skills compared with those predominantly represented in national surveys. Methods: A repeated cross-sectional study of people with MID or low literacy skills and a general population sample was conducted in the Netherlands. An easy-read web-based survey was co-designed with, and tested among, people with MID or low literacy skills and conducted in 3 rounds within 1 year of the COVID-19 pandemic (T1: November to December 2020, T2: March to April 2021, and T3: September to October 2021). The survey contained questions about demographics and 6 aspects of mental health: feeling happy, feeling energized, feeling stressed, worry, feeling lonely, and sleeping problems. Results: Our adapted survey and recruitment procedure enabled 1059 persons with MID or low literacy skills to participate (T1: n=412, 38.9%; T2: n=351, 33.1%; and T3: n=296, 28%). They were significantly younger, had a lower level of education, and more often than not were born outside the Netherlands compared to the general population sample (P<.001). Approximately half of them (604/1059, 57.03%) received professional care. They displayed poorer mental health scores than the general population sample. The percentages of people with MID or low literacy skills who reported more negative feelings in T1 ranged from 20.6% (85/412) reporting feeling lonely often or almost always to 57.8% (238/412) reporting feeling happy almost never or sometimes. The general population sample’s percentages were 5.4% (160/2930) and 32.2% (941/2918), respectively. Although scores improved over time in both populations, the disproportional effects remained. Conclusions: General COVID-19–related restrictions for the entire Dutch population affected people with MID or low literacy skills more negatively than the general population. Our study underscores the relevance of including these subpopulations in public health research because they are often overlooked in regular health data. An accessible web-based survey particularly targeted at this population enabled us to do so, and we reached a group of respondents significantly different from regular survey participants. This survey’s results provided insights into the health of people with MID or low literacy skills and gained knowledge to be used by care organizations and policy makers to reduce health disparities during a pandemic and in general. %M 38607229 %R 10.2196/44827 %U https://publichealth.jmir.org/2024/1/e44827 %U https://doi.org/10.2196/44827 %U http://www.ncbi.nlm.nih.gov/pubmed/38607229 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e53321 %T Prevalence and Factors Associated With Willingness to Sustain Pandemic-Induced Digital Work in the General Population and Moderating Effects of Screen Hours: Cross-Sectional Study %A Li,Jiaying %A Fong,Daniel Yee Tak %A Ho,Mandy Man %A Choi,Edmond Pui Hang %A Lok,Kris Yuet Wan %A Lee,Jung Jae %A Duan,WenJie %A Wong,Janet Yuen Ha %A Lin,Chia-Chin %+ School of Nursing, The University of Hong Kong, 5/F, Academic Building 3 Sassoon Road, Pokfulam, Hong Kong SAR, 999077, China (Hong Kong), 852 39176645, dytfong@hku.hk %K COVID-19 pandemic %K digital work %K willingness to sustain %K screen time %K general population %D 2024 %7 28.5.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: The pandemic has accelerated digital work transformation, yet little is known about individuals’ willingness to sustain such digital modes and its associated factors. A better understanding of this willingness and its drivers is crucial for guiding the development of future digital work infrastructure, training programs, and strategies to monitor and prevent related health issues. Objective: This study aims to quantify the general population’s willingness to sustain pandemic-induced digital work, identify its associated factors, and examine how screen time moderates these relationships. Methods: A cross-sectional study was conducted targeting Hong Kong residents aged ≥18 years who have increased engagement in digital work since the pandemic. Data were collected through self-reported, web-based surveys. Descriptive statistics determined prevalence rates, while structured multiphase logistic regression identified associated factors and explored the moderating effects of screen hour levels. Results: This unfunded study enrolled 1014 participants from May 2 to June 24, 2022, and completed data analysis within 3 months after data collection. A total of 391 (38.6%; 95% CI 35.6%-41.6%) participants expressed willingness to sustain digital work. Positive factors associated with this willingness included being an employee (odds ratio [OR] 3.12, 95% CI 1.59-6.45; P=.001), being health professionals (OR 3.32, 95% CI 1.49-7.82; P=.004), longer screen hours (OR 1.09, 95% CI 1.03-1.15; P=.002), and higher depression levels (OR 1.20, 95% CI 1.01-1.44; P=.04). Conversely, negatively associated factors included older age (OR 0.87, 95% CI 0.81-0.94; P=.001), extroversion (OR 0.66, 95% CI 0.51-0.86; P=.002), higher eHealth literacy (OR 0.96, 95% CI 0.93-0.98; P<.001), perceived greater susceptibility to COVID-19 (OR 0.84, 95% CI 0.74-0.96; P=.009), residence in a high-severity COVID-19 community (OR 0.73, 95% CI 0.63-0.84; P<.001), having infected individuals in the immediate social circle (OR 0.64, 95% CI 0.46-0.88; P=.006), higher BMI (OR 0.94, 95% CI 0.90-0.99; P=.02), feelings of being out of control (OR 0.96, 95% CI 0.93-0.98; P=.002), and higher fear of COVID-19 (OR 0.96, 95% CI 0.94-0.98; P=.001). In addition, a moderating effect of screen hour level (high: >8 h/d; low: ≤8 h/d) influenced the association among 10 factors related to willingness to sustain pandemic-induced digital work, including age, education level, household size, needs for regular medical care, BMI, frequency of both vigorous and moderate physical activities, perceived COVID-19 severity, immediate social circle COVID-19 presence, and fear of COVID-19 (all P values for interaction <.05). Conclusions: The substantial willingness of the general population to sustain digital work after the pandemic highlights the need for robust telework infrastructure, thorough monitoring of adverse health outcomes, and the potential to expand telehealth services among this group. The identification of factors influencing this willingness and the moderating role of screen hours inform the development of personalized strategies to enhance digital work acceptance where needed. %M 38805704 %R 10.2196/53321 %U https://www.jmir.org/2024/1/e53321 %U https://doi.org/10.2196/53321 %U http://www.ncbi.nlm.nih.gov/pubmed/38805704 %0 Journal Article %@ 2563-6316 %I %V 5 %N %P e52970 %T The Role of Anxiety and Prosocial Behaviors on Adherence Behaviors to Prevent COVID-19 in University Students in the United States: Cross-Sectional Study %A Corbera,Silvia %A Marín-Chollom,Amanda M %K prosocial behavior %K COVID-19 %K anxiety %K COVID-19 prevention %K preventive health behavior %K adherence to prevention %D 2024 %7 27.5.2024 %9 %J JMIRx Med %G English %X Background: In situations of acute stress, individuals may engage in prosocial behaviors or risk-taking self-oriented behaviors. The COVID-19 pandemic created large stress-promoting conditions that impacted individuals’ decisions to adhere to COVID-19 preventative behaviors. Objectives: The study aimed to examine the relationship between anxiety during the pandemic and adherence behaviors to prevent the spread of COVID-19, and the moderating influence of prosocial behaviors. We hypothesized that individuals with high anxiety during COVID-19 would adhere more to preventive COVID-19 behaviors than ones with low anxiety and that this relationship would be stronger in those individuals with higher prosocial behaviors. Methods: A web-based survey was administered through the SONA web-based participant tool of the psychology department of a university in the Northeastern United States. A final sample of 54 undergraduate students completed web-based questionnaires during the second wave of the COVID-19 pandemic, from January to May 2021, which included demographic measures and surveys on prosocial behaviors, anxiety, and COVID-19 preventive behaviors. Moderation analyses were conducted using PROCESS in SPSS. Results: Participants reported high levels of trait and state anxiety symptoms, most of them meeting or exceeding the cutoff criteria to be clinically meaningful (state anxiety: 47/54, 87%; trait anxiety: 38/44, 86%), and over 50% highly adhered to the COVID-19 preventive behaviors of wearing a face mask, using hand sanitizer, handwashing, coughing/sneezing into their elbow or a tissue, self-quarantining, maintaining social distance, avoiding social gatherings, and avoiding nonessential travel. No significant associations were observed between prosocial behavior, anxiety types, and adherence to COVID-19 preventive behaviors. However, when moderation analyses were conducted between anxiety types and adherence to COVID-19 preventive behaviors, results demonstrated a statistically significant interaction of public prosocial behavior with state anxiety (β=−.17, t53=−2.60; P=.01), predicting engagement in COVID-19 preventative behaviors. At high levels of anxiety, low levels of prosocial public behaviors were associated with higher engagement in COVID-19 preventative behaviors. In contrast, high levels of public prosocial behavior were associated with low engagement in COVID-19 preventative behaviors at higher levels of anxiety. Conclusions: These results provide information that can aid in the creation of interventions that could increase adherence to COVID-19 preventative behaviors (Reviewed by the Plan P #PeerRef Community). %R 10.2196/52970 %U https://xmed.jmir.org/2024/1/e52970 %U https://doi.org/10.2196/52970 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e47154 %T Short- and Long-Term Predicted and Witnessed Consequences of Digital Surveillance During the COVID-19 Pandemic: Scoping Review %A Comer,Leigha %A Donelle,Lorie %A Hiebert,Bradley %A Smith,Maxwell J %A Kothari,Anita %A Stranges,Saverio %A Gilliland,Jason %A Long,Jed %A Burkell,Jacquelyn %A Shelley,Jacob J %A Hall,Jodi %A Shelley,James %A Cooke,Tommy %A Ngole Dione,Marionette %A Facca,Danica %+ School of Nursing, University of South Carolina, 1601 Greene Street, Room 617, Columbia, SC, 29208-4001, United States, 1 803 777 6528, LDONELLE@mailbox.sc.edu %K digital surveillance %K COVID-19 %K public health %K scoping review %K pandemic %K digital technologies %D 2024 %7 24.5.2024 %9 Review %J JMIR Public Health Surveill %G English %X Background: The COVID-19 pandemic has prompted the deployment of digital technologies for public health surveillance globally. The rapid development and use of these technologies have curtailed opportunities to fully consider their potential impacts (eg, for human rights, civil liberties, privacy, and marginalization of vulnerable groups). Objective: We conducted a scoping review of peer-reviewed and gray literature to identify the types and applications of digital technologies used for surveillance during the COVID-19 pandemic and the predicted and witnessed consequences of digital surveillance. Methods: Our methodology was informed by the 5-stage methodological framework to guide scoping reviews: identifying the research question; identifying relevant studies; study selection; charting the data; and collating, summarizing, and reporting the findings. We conducted a search of peer-reviewed and gray literature published between December 1, 2019, and December 31, 2020. We focused on the first year of the pandemic to provide a snapshot of the questions, concerns, findings, and discussions emerging from peer-reviewed and gray literature during this pivotal first year of the pandemic. Our review followed the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) reporting guidelines. Results: We reviewed a total of 147 peer-reviewed and 79 gray literature publications. Based on our analysis of these publications, we identified a total of 90 countries and regions where digital technologies were used for public health surveillance during the COVID-19 pandemic. Some of the most frequently used technologies included mobile phone apps, location-tracking technologies, drones, temperature-scanning technologies, and wearable devices. We also found that the literature raised concerns regarding the implications of digital surveillance in relation to data security and privacy, function creep and mission creep, private sector involvement in surveillance, human rights, civil liberties, and impacts on marginalized groups. Finally, we identified recommendations for ethical digital technology design and use, including proportionality, transparency, purpose limitation, protecting privacy and security, and accountability. Conclusions: A wide range of digital technologies was used worldwide to support public health surveillance during the COVID-19 pandemic. The findings of our analysis highlight the importance of considering short- and long-term consequences of digital surveillance not only during the COVID-19 pandemic but also for future public health crises. These findings also demonstrate the ways in which digital surveillance has rendered visible the shifting and blurred boundaries between public health surveillance and other forms of surveillance, particularly given the ubiquitous nature of digital surveillance. International Registered Report Identifier (IRRID): RR2-https://doi.org/10.1136/bmjopen-2021-053962 %M 38788212 %R 10.2196/47154 %U https://publichealth.jmir.org/2024/1/e47154 %U https://doi.org/10.2196/47154 %U http://www.ncbi.nlm.nih.gov/pubmed/38788212 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 7 %N %P e43315 %T Evidence for Changes in Screen Use in the United States During Early Childhood Related to COVID-19 Pandemic Parent Stressors: Repeated Cross-Sectional Study %A Glassman,Jill %A Humphreys,Kathryn L %A Jauregui,Adam %A Milstein,Arnold %A Sanders,Lee %+ Clinical Excellence Research Center (CERC), Stanford University School of Medicine, 453 Quarry Road, Stanford, CA, United States, 1 8314195302, jill.r.glassman@stanford.edu %K child health %K parent-child relationship %K screen time %K technoference %K health equity %D 2024 %7 22.5.2024 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: The COVID-19 pandemic transformed the home lives of many families in the United States, especially those with young children. Understanding the relationship between child and parent screen time and family stressors exacerbated by the pandemic may help inform interventions that aim to support early child development. Objective: We aim to assess the changing relationship between family screen time and factors related to pandemic-induced remote work and childcare or school closures. Methods: In the spring of 2021 we administered a survey, similar to one administered in the spring of 2019, to a national sample of parents of young children (aged 6 to 60 months). Using iterative sampling with propensity scores, we recruited participants whose sociodemographic characteristics matched the 2019 survey. Participants were aged >18 years, proficient in English or Spanish, and residing in the United States. The main outcomes were changes in child screen time (eg, mobile phone, tablet, computer, and television) and parenting technoference, defined as perceived screen-related interference with parent-child interactions. Additional survey items reported pandemic-related job loss, and changes to work hours, work location, caregiving responsibilities, day care or school access, and family health and socioeconomic status. Results: We enrolled 280 parents, from diverse backgrounds. Parents reported pandemic-related changes in child screen time (mean increase of 1.1, SD 0.9 hours), and greater parenting technoference (3.0 to 3.4 devices interfering per day; P=.01). Increased child screen time and parenting technoference were highest for parents experiencing job loss (mean change in child screen time 1.46, SD 1.03; mean parenting technoference score 3.89, SD 2.05), second highest for working parents who did not lose their job (mean change in child screen time 1.02, SD 0.83; mean parenting technoference score 3.37, SD 1.94), and lowest for nonworking parents (mean change in child screen time 0.68, SD 0.66; mean parenting technoference score 2.66, SD 1.70), with differences significant at P<.01. School closure and job loss were most associated with increased child screen time during the pandemic after controlling for other stressors and sociodemographic characteristics (d=0.52, P<.001; d=0.31, P=.01). Increased child screen time and school closure were most associated with increased parenting technoference (d=0.78, P<.001; d=0.30, P=.01). Conclusions: Work and school changes due to the COVID-19 pandemic were associated with increased technology interference in the lives of young children. This study adds to our understanding of the interaction between technology use at home and social factors that are necessary to support early childhood health and development. It also supports possible enhanced recommendations for primary care providers and childcare educators to guide parents in establishing home-based “screen time rules” not only for their children but also for themselves. %M 38446995 %R 10.2196/43315 %U https://pediatrics.jmir.org/2024/1/e43315 %U https://doi.org/10.2196/43315 %U http://www.ncbi.nlm.nih.gov/pubmed/38446995 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e44398 %T Updated Surveillance Metrics and History of the COVID-19 Pandemic (2020-2023) in Latin America and the Caribbean: Longitudinal Trend Analysis %A Post,Lori Ann %A Wu,Scott A %A Soetikno,Alan G %A Ozer,Egon A %A Liu,Yingxuan %A Welch,Sarah B %A Hawkins,Claudia %A Moss,Charles B %A Murphy,Robert L %A Mason,Maryann %A Havey,Robert J %A Lundberg,Alexander L %+ Buehler Center for Health Policy and Economics, Robert J Havey, MD Institute for Global Health, Northwestern University, 420 E Superior, Chicago, IL, 60611, United States, 1 312 503 1706, lori.post@northwestern.edu %K SARS-CoV-2 %K COVID-19 %K Latin America %K Caribbean %K pandemic %K surveillance %K COVID-19 transmission %K speed %K acceleration %K deceleration %K jerk %K dynamic panel %K generalized method of moments %K GMM %K Arellano-Bond %K 7-day lag %K epidemiological %K pandemic %K genomic %K transmission %D 2024 %7 17.5.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: In May 2020, the World Health Organization (WHO) declared Latin America and the Caribbean (LAC) the epicenter of the COVID-19 pandemic, with over 40% of worldwide COVID-19–related deaths at the time. This high disease burden was a result of the unique circumstances in LAC. Objective: This study aimed to (1) measure whether the pandemic was expanding or contracting in LAC when the WHO declared the end of COVID-19 as a public health emergency of international concern on May 5, 2023; (2) use dynamic and genomic surveillance methods to describe the history of the pandemic in the region and situate the window of the WHO declaration within the broader history; and (3) provide, with a focus on prevention policies, a historical context for the course of the pandemic in the region. Methods: In addition to updates of traditional surveillance data and dynamic panel estimates from the original study, we used data on sequenced SARS-CoV-2 variants from the Global Initiative on Sharing All Influenza Data (GISAID) to identify the appearance and duration of variants of concern (VOCs). We used Nextclade nomenclature to collect clade designations from sequences and Pangolin nomenclature for lineage designations of SARS-CoV-2. Additionally, we conducted a 1-sided t test for whether the regional weekly speed (rate of novel COVID-19 transmission) was greater than an outbreak threshold of 10. We ran the test iteratively with 6 months of data across the period from August 2020 to May 2023. Results: The speed of pandemic spread for the region had remained below the outbreak threshold for 6 months by the time of the WHO declaration. Acceleration and jerk were also low and stable. Although the 1- and 7-day persistence coefficients remained statistically significant for the 120-day period ending on the week of May 5, 2023, the coefficients were relatively modest in magnitude (0.457 and 0.491, respectively). Furthermore, the shift parameters for either of the 2 most recent weeks around May 5, 2023, did not indicate any change in this clustering effect of cases on future cases. From December 2021 onward, Omicron was the predominant VOC in sequenced viral samples. The rolling t test of speed=10 became entirely insignificant from January 2023 onward. Conclusions: Although COVID-19 continues to circulate in LAC, surveillance data suggest COVID-19 is endemic in the region and no longer reaches the threshold of the pandemic definition. However, the region experienced a high COVID-19 burden in the early stages of the pandemic, and prevention policies should be an immediate focus in future pandemics. Ahead of vaccination development, these policies can include widespread testing of individuals and an epidemiological task force with a contact-tracing system. %M 38568194 %R 10.2196/44398 %U https://publichealth.jmir.org/2024/1/e44398 %U https://doi.org/10.2196/44398 %U http://www.ncbi.nlm.nih.gov/pubmed/38568194 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e55623 %T Implementation of Inpatient Electronic Consultations During the COVID-19 Crisis and Its Sustainability Beyond the Pandemic: Quality Improvement Study %A Aledia,Anna S %A Dangodara,Amish A %A Amin,Aanya A %A Amin,Alpesh N %+ Department of Medicine & Hospital Medicine, University of California, Irvine, 333 City Boulevard West, Suite 500, Orange, CA, 92868, United States, 1 714 456 3785, anamin@uci.edu %K COVID-19 %K electronic consultation %K eConsult %K e-consult %K inpatient %K consultations %K pandemic %K infectious %K novel coronavirus %K coronavirus %K patients %K patient %K staff %K health care %K health care providers %K tool %K tools %K effectiveness %D 2024 %7 16.5.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Limiting in-person contact was a key strategy for controlling the spread of the highly infectious novel coronavirus (COVID-19). To protect patients and staff from the risk of infection while providing continued access to necessary health care services, we implemented a new electronic consultation (e-consult) service that allowed referring providers to receive subspecialty consultations for patients who are hospitalized and do not require in-person evaluation by the specialist. Objective: We aimed to assess the impact of implementing e-consults in the inpatient setting to reduce avoidable face-to-face referrals during the COVID-19 pandemic. Methods: This quality improvement study evaluated all inpatient e-consults ordered from July 2020 to December 2022 at the University of California Irvine Medical Center. The impact of e-consults was assessed by evaluating use (eg, number of e-consults ordered), e-consult response times, and outcome of the e-consult requests (eg, resolved electronically or converted to the in-person evaluation of patient). Results: There were 1543 inpatient e-consults ordered across 11 participating specialties. A total of 53.5% (n=826) of requests were addressed electronically, without the need for a formal in-person evaluation of the patient. The median time between ordering an e-consult and a specialist documenting recommendations in an e-consult note was 3.7 (IQR 1.3-8.2) hours across all specialties, contrasted with 7.3 (IQR 3.6-22.0) hours when converted to an in-person consult (P<.001). The monthly volume of e-consult requests increased, coinciding with surges of COVID-19 cases in California. After the peaks of the COVID-19 crisis subsided, the use of inpatient e-consults persisted at a rate well above the precrisis levels. Conclusions: An inpatient e-consult service was successfully implemented, resulting in fewer unnecessary face-to-face consultations and significant reductions in the response times for consults requested on patients who are hospitalized and do not require an in-person evaluation. Thus, e-consults provided timely, efficient delivery of inpatient consultation services for appropriate problems while minimizing the risk of direct transmission of the COVID-19 virus between health care providers and patients. The service also demonstrated its value as a tool for effective inpatient care coordination beyond the peaks of the pandemic leading to the sustainability of service and value. %M 38754103 %R 10.2196/55623 %U https://www.jmir.org/2024/1/e55623 %U https://doi.org/10.2196/55623 %U http://www.ncbi.nlm.nih.gov/pubmed/38754103 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e48564 %T Difference in Rumor Dissemination and Debunking Before and After the Relaxation of COVID-19 Prevention and Control Measures in China: Infodemiology Study %A Liu,Xiaoqi %A Hu,Qingyuan %A Wang,Jie %A Wu,Xusheng %A Hu,Dehua %+ Department of Biomedical Informatics, School of Life Sciences, Central South University, 172 Tongzipo Road, Changsha, Hunan, 410013, China, 86 13975869106, hudehua@csu.edu.cn %K new stage %K public health emergency %K information epidemic %K propagation characteristic %K debunking mechanism %K China %D 2024 %7 15.5.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: The information epidemic emerged along with the COVID-19 pandemic. While controlling the spread of COVID-19, the secondary harm of epidemic rumors to social order cannot be ignored. Objective: The objective of this paper was to understand the characteristics of rumor dissemination before and after the pandemic and the corresponding rumor management and debunking mechanisms. This study aimed to provide a theoretical basis and effective methods for relevant departments to establish a sound mechanism for managing network rumors related to public health emergencies such as COVID-19. Methods: This study collected data sets of epidemic rumors before and after the relaxation of the epidemic prevention and control measures, focusing on large-scale network rumors. Starting from 3 dimensions of rumor content construction, rumor propagation, and rumor-refuting response, the epidemic rumors were subdivided into 7 categories, namely, involved subjects, communication content, emotional expression, communication channels, communication forms, rumor-refuting subjects, and verification sources. Based on this framework, content coding and statistical analysis of epidemic rumors were carried out. Results: The study found that the rumor information was primarily directed at a clear target audience. The main themes of rumor dissemination were related to the public’s immediate interests in the COVID-19 field, with significant differences in emotional expression and mostly negative emotions. Rumors mostly spread through social media interactions, community dissemination, and circle dissemination, with text content as the main form, but they lack factual evidence. The preferences of debunking subjects showed differences, and the frequent occurrence of rumors reflected the unsmooth channels of debunking. The χ2 test of data before and after the pandemic showed that the P value was less than .05, indicating that the difference in rumor content before and after the pandemic had statistical significance. Conclusions: This study’s results showed that the themes of rumors during the pandemic are closely related to the immediate interests of the public, and the emotions of the public accelerate the spread of these rumors, which are mostly disseminated through social networks. Therefore, to more effectively prevent and control the spread of rumors during the pandemic and to enhance the capability to respond to public health crises, relevant authorities should strengthen communication with the public, conduct emotional risk assessments, and establish a joint mechanism for debunking rumors. %M 38748460 %R 10.2196/48564 %U https://www.jmir.org/2024/1/e48564 %U https://doi.org/10.2196/48564 %U http://www.ncbi.nlm.nih.gov/pubmed/38748460 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e51910 %T Understanding the Impact of Communicating Uncertainty About COVID-19 in the News: Randomized Between-Subjects Factorial Experiment %A Zhao,Rui %A Lu,Xuerong %A Yang,Jiayi %A Li,Biao %+ School of Journalism, Renmin University of China, 19 Zhong Guancun Street, Beijing, 100081, China, 86 18810386586, libiao@ruc.edu.cn %K information uncertainty %K health communication %K uncertainty management %K COVID-19 %K public health perception %K health information %D 2024 %7 14.5.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Whether and how the uncertainty about a public health crisis should be communicated to the general public have been important and yet unanswered questions arising over the past few years. As the most threatening contemporary public health crisis, the COVID-19 pandemic has renewed interest in these unresolved issues by both academic scholars and public health practitioners. Objective: The aim of this study was to investigate the impact of communicating uncertainty about COVID-19–related threats and solutions on individuals’ risk perceptions and misinformation vulnerability, as well as the sequential impact of these effects on health information processing and preventative behavioral intentions. Methods: A 2×2 (threat uncertainty [presence vs absence]×solution uncertainty [presence vs absence]) full-fractional between-subjects online experiment was conducted with 371 Chinese adults. Focusing on the discussion of whether the asymptomatic cases detected during the COVID-19 pandemic would further lead to an uncontrolled pandemic, news articles were manipulated in terms of whether the infectiousness of asymptomatic cases and the means to control the transmission are presented in terms of their certainty or uncertainty. Participants were randomly assigned to one of the four experimental conditions, being instructed to read one news article. After reading the news article assigned, participants were asked to respond to a series of questions to assess their cognitive and behavioral responses. Results: Individuals were more susceptible to believing false COVID-19–related information when a certain threat and uncertain solution were framed in the news article. Moreover, individuals’ perceptions of crisis severity increased when exposed to news information containing uncertain solutions. Both misinformation vulnerability and perceived severity were positively associated with information processing. Information seeking was positively associated with protective behavioral intention, whereas information avoidance was negatively associated with protective behavioral intention. Conclusions: Our findings imply that uncertainty, depending on its aspect, can be effectively communicated to the public during an emerging public health crisis. These results have theoretical and practical implications for health communicators and journalists. Given its limited influence on individuals’ cognitive and behavioral responses, uncertainty related to a health threat should be disseminated to meet the public’s expectation of information transparency. However, caution is advised when communicating uncertainty related to potential solutions, as this factor exhibited a mixed impact on individual responses during a crisis. %M 38743940 %R 10.2196/51910 %U https://www.jmir.org/2024/1/e51910 %U https://doi.org/10.2196/51910 %U http://www.ncbi.nlm.nih.gov/pubmed/38743940 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e46029 %T Ambulance Services Attendance for Mental Health and Overdose Before and During COVID-19 in Canada and the United Kingdom: Interrupted Time Series Study %A Law,Graham %A Cooper,Rhiannon %A Pirrie,Melissa %A Ferron,Richard %A McLeod,Brent %A Spaight,Robert %A Siriwardena,A Niroshan %A Agarwal,Gina %A , %+ Department of Family Medicine, McMaster University, 100 Main Street West, Hamilton, ON, , Canada, 1 905 525 9140, gina.agarwal@gmail.com %K COVID-19 %K mental health %K overdose %K emergency medical services %K administrative data %K Canada %K the United Kingdom %K ambulance %K sex %K age %K lockdown %K pandemic planning %K emergency service %D 2024 %7 10.5.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The COVID-19 pandemic impacted mental health and health care systems worldwide. Objective: This study examined the COVID-19 pandemic’s impact on ambulance attendances for mental health and overdose, comparing similar regions in the United Kingdom and Canada that implemented different public health measures. Methods: An interrupted time series study of ambulance attendances was conducted for mental health and overdose in the United Kingdom (East Midlands region) and Canada (Hamilton and Niagara regions). Data were obtained from 182,497 ambulance attendance records for the study period of December 29, 2019, to August 1, 2020. Negative binomial regressions modeled the count of attendances per week per 100,000 population in the weeks leading up to the lockdown, the week the lockdown was initiated, and the weeks following the lockdown. Stratified analyses were conducted by sex and age. Results: Ambulance attendances for mental health and overdose had very small week-over-week increases prior to lockdown (United Kingdom: incidence rate ratio [IRR] 1.002, 95% CI 1.002-1.003 for mental health). However, substantial changes were observed at the time of lockdown; while there was a statistically significant drop in the rate of overdose attendances in the study regions of both countries (United Kingdom: IRR 0.573, 95% CI 0.518-0.635 and Canada: IRR 0.743, 95% CI 0.602-0.917), the rate of mental health attendances increased in the UK region only (United Kingdom: IRR 1.125, 95% CI 1.031-1.227 and Canada: IRR 0.922, 95% CI 0.794-1.071). Different trends were observed based on sex and age categories within and between study regions. Conclusions: The observed changes in ambulance attendances for mental health and overdose at the time of lockdown differed between the UK and Canada study regions. These results may inform future pandemic planning and further research on the public health measures that may explain observed regional differences. %M 38728683 %R 10.2196/46029 %U https://publichealth.jmir.org/2024/1/e46029 %U https://doi.org/10.2196/46029 %U http://www.ncbi.nlm.nih.gov/pubmed/38728683 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e40792 %T The Changing Landscape of Respiratory Viruses Contributing to Hospitalizations in Quebec, Canada: Results From an Active Hospital-Based Surveillance Study %A Gilca,Rodica %A Amini,Rachid %A Carazo,Sara %A Doggui,Radhouene %A Frenette,Charles %A Boivin,Guy %A Charest,Hugues %A Dumaresq,Jeannot %+ Direction des risques biologiques, Institut national de santé publique du Québec, 945 Av. Wolfe, Québec, QC, G1V5B3, Canada, 1 4186505115 ext 6278, rodica.gilca@inspq.qc.ca %K respiratory viruses %K SARS-CoV-2 %K COVID-19 %K hospitalizations %K acute respiratory infections %K children %K adults %K coinfections %K prepandemic %K pandemic %D 2024 %7 6.5.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: A comprehensive description of the combined effect of SARS-CoV-2 and respiratory viruses other than SARS-CoV-2 (ORVs) on acute respiratory infection (ARI) hospitalizations is lacking. Objective: This study aimed to compare the viral etiology of ARI hospitalizations before the pandemic (8 prepandemic influenza seasons, 2012-13 to 2019-20) and during 3 pandemic years (periods of increased SARS-CoV-2 and ORV circulation in 2020-21, 2021-22, and 2022-23) from an active hospital-based surveillance network in Quebec, Canada. Methods: We compared the detection of ORVs and SARS-CoV-2 during 3 pandemic years to that in 8 prepandemic influenza seasons among patients hospitalized with ARI who were tested systematically by the same multiplex polymerase chain reaction (PCR) assay during periods of intense respiratory virus (RV) circulation. The proportions of infections between prepandemic and pandemic years were compared by using appropriate statistical tests. Results: During prepandemic influenza seasons, overall RV detection was 92.7% (1384/1493) (respiratory syncytial virus [RSV]: 721/1493, 48.3%; coinfections: 456/1493, 30.5%) in children (<18 years) and 62.8% (2723/4339) (influenza: 1742/4339, 40.1%; coinfections: 264/4339, 6.1%) in adults. Overall RV detection in children was lower during pandemic years but increased from 58.6% (17/29) in 2020-21 (all ORVs; coinfections: 7/29, 24.1%) to 90.3% (308/341) in 2021-22 (ORVs: 278/341, 82%; SARS-CoV-2: 30/341, 8.8%; coinfections: 110/341, 32.3%) and 88.9% (361/406) in 2022-23 (ORVs: 339/406, 84%; SARS-CoV-2: 22/406, 5.4%; coinfections: 128/406, 31.5%). In adults, overall RV detection was also lower during pandemic years but increased from 43.7% (333/762) in 2020-21 (ORVs: 26/762, 3.4%; SARS-CoV-2: 307/762, 40.3%; coinfections: 7/762, 0.9%) to 57.8% (731/1265) in 2021-22 (ORVs: 179/1265, 14.2%; SARS-CoV-2: 552/1265, 43.6%; coinfections: 42/1265, 3.3%) and 50.1% (746/1488) in 2022-23 (ORVs: 409/1488, 27.5%; SARS-CoV-2: 337/1488, 22.6%; coinfections: 36/1488, 2.4%). No influenza or RSV was detected in 2020-21; however, their detection increased in the 2 subsequent years but did not reach prepandemic levels. Compared to the prepandemic period, the peaks of RSV hospitalization shifted in 2021-22 (16 weeks earlier) and 2022-23 (15 weeks earlier). Moreover, the peaks of influenza hospitalization shifted in 2021-22 (17 weeks later) and 2022-23 (4 weeks earlier). Age distribution was different compared to the prepandemic period, especially during the first pandemic year. Conclusions: Significant shifts in viral etiology, seasonality, and age distribution of ARI hospitalizations occurred during the 3 pandemic years. Changes in age distribution observed in our study may reflect modifications in the landscape of circulating RVs and their contribution to ARI hospitalizations. During the pandemic period, SARS-CoV-2 had a low contribution to pediatric ARI hospitalizations, while it was the main contributor to adult ARI hospitalizations during the first 2 seasons and dropped below ORVs during the third pandemic season. Evolving RVs epidemiology underscores the need for increased scrutiny of ARI hospitalization etiology to inform tailored public health recommendations. %M 38709551 %R 10.2196/40792 %U https://publichealth.jmir.org/2024/1/e40792 %U https://doi.org/10.2196/40792 %U http://www.ncbi.nlm.nih.gov/pubmed/38709551 %0 Journal Article %@ 1947-2579 %I JMIR Publications %V 16 %N %P e53445 %T Characterization of Post–COVID-19 Definitions and Clinical Coding Practices: Longitudinal Study %A Maripuri,Monika %A Dey,Andrew %A Honerlaw,Jacqueline %A Hong,Chuan %A Ho,Yuk-Lam %A Tanukonda,Vidisha %A Chen,Alicia W %A Panickan,Vidul Ayakulangara %A Wang,Xuan %A Zhang,Harrison G %A Yang,Doris %A Samayamuthu,Malarkodi Jebathilagam %A Morris,Michele %A Visweswaran,Shyam %A Beaulieu-Jones,Brendin %A Ramoni,Rachel %A Muralidhar,Sumitra %A Gaziano,J Michael %A Liao,Katherine %A Xia,Zongqi %A Brat,Gabriel A %A Cai,Tianxi %A Cho,Kelly %+ Veterans Affairs Boston Healthcare System, 2 Avenue de Lafayette, Boston, MA, 02111, United States, 1 617 390 6976, monika.maripuri@va.gov %K veterans %K long COVID-19 %K postacute sequelae of SARS-CoV-2 %K PASC %K International Classification of Diseases %K U09.9 ICD-10 code %K algorithm validation %K chart review %K electronic health records %K COVID-19 %D 2024 %7 3.5.2024 %9 Original Paper %J Online J Public Health Inform %G English %X Background: Post–COVID-19 condition (colloquially known as “long COVID-19”) characterized as postacute sequelae of SARS-CoV-2 has no universal clinical case definition. Recent efforts have focused on understanding long COVID-19 symptoms, and electronic health record (EHR) data provide a unique resource for understanding this condition. The introduction of the International Classification of Diseases, Tenth Revision (ICD-10) code U09.9 for “Post COVID-19 condition, unspecified” to identify patients with long COVID-19 has provided a method of evaluating this condition in EHRs; however, the accuracy of this code is unclear. Objective: This study aimed to characterize the utility and accuracy of the U09.9 code across 3 health care systems—the Veterans Health Administration, the Beth Israel Deaconess Medical Center, and the University of Pittsburgh Medical Center—against patients identified with long COVID-19 via a chart review by operationalizing the World Health Organization (WHO) and Centers for Disease Control and Prevention (CDC) definitions. Methods: Patients who were COVID-19 positive with either a U07.1 ICD-10 code or positive polymerase chain reaction test within these health care systems were identified for chart review. Among this cohort, we sampled patients based on two approaches: (1) with a U09.9 code and (2) without a U09.9 code but with a new onset long COVID-19–related ICD-10 code, which allows us to assess the sensitivity of the U09.9 code. To operationalize the long COVID-19 definition based on health agency guidelines, symptoms were grouped into a “core” cluster of 11 commonly reported symptoms among patients with long COVID-19 and an extended cluster that captured all other symptoms by disease domain. Patients having ≥2 symptoms persisting for ≥60 days that were new onset after their COVID-19 infection, with ≥1 symptom in the core cluster, were labeled as having long COVID-19 per chart review. The code’s performance was compared across 3 health care systems and across different time periods of the pandemic. Results: Overall, 900 patient charts were reviewed across 3 health care systems. The prevalence of long COVID-19 among the cohort with the U09.9 ICD-10 code based on the operationalized WHO definition was between 23.2% and 62.4% across these health care systems. We also evaluated a less stringent version of the WHO definition and the CDC definition and observed an increase in the prevalence of long COVID-19 at all 3 health care systems. Conclusions: This is one of the first studies to evaluate the U09.9 code against a clinical case definition for long COVID-19, as well as the first to apply this definition to EHR data using a chart review approach on a nationwide cohort across multiple health care systems. This chart review approach can be implemented at other EHR systems to further evaluate the utility and performance of the U09.9 code. %M 38700929 %R 10.2196/53445 %U https://ojphi.jmir.org/2024/1/e53445 %U https://doi.org/10.2196/53445 %U http://www.ncbi.nlm.nih.gov/pubmed/38700929 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e49841 %T Defining the Subtypes of Long COVID and Risk Factors for Prolonged Disease: Population-Based Case-Crossover Study %A Resendez,Skyler %A Brown,Steven H %A Ruiz Ayala,Hugo Sebastian %A Rangan,Prahalad %A Nebeker,Jonathan %A Montella,Diane %A Elkin,Peter L %+ Department of Biomedical Informatics, University at Buffalo, State University of New York, 77 Goodell Street, Suite 540, Buffalo, NY, 14203, United States, 1 5073581341, elkinp@buffalo.edu %K long COVID %K PASC %K postacute sequelae of COVID-19 %K public health %K policy initiatives %K pandemic %K diagnosis %K COVID-19 treatment %K long COVID cause %K health care support %K public safety %K COVID-19 %K Veterans Affairs %K United States %K COVID-19 testing %K clinician %K mobile phone %D 2024 %7 30.4.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: There have been over 772 million confirmed cases of COVID-19 worldwide. A significant portion of these infections will lead to long COVID (post–COVID-19 condition) and its attendant morbidities and costs. Numerous life-altering complications have already been associated with the development of long COVID, including chronic fatigue, brain fog, and dangerous heart rhythms. Objective: We aim to derive an actionable long COVID case definition consisting of significantly increased signs, symptoms, and diagnoses to support pandemic-related clinical, public health, research, and policy initiatives. Methods: This research employs a case-crossover population-based study using International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) data generated at Veterans Affairs medical centers nationwide between January 1, 2020, and August 18, 2022. In total, 367,148 individuals with ICD-10-CM data both before and after a positive COVID-19 test were selected for analysis. We compared ICD-10-CM codes assigned 1 to 7 months following each patient’s positive test with those assigned up to 6 months prior. Further, 350,315 patients had novel codes assigned during this window of time. We defined signs, symptoms, and diagnoses as being associated with long COVID if they had a novel case frequency of ≥1:1000, and they significantly increased in our entire cohort after a positive test. We present odds ratios with CIs for long COVID signs, symptoms, and diagnoses, organized by ICD-10-CM functional groups and medical specialty. We used our definition to assess long COVID risk based on a patient’s demographics, Elixhauser score, vaccination status, and COVID-19 disease severity. Results: We developed a long COVID definition consisting of 323 ICD-10-CM diagnosis codes grouped into 143 ICD-10-CM functional groups that were significantly increased in our 367,148 patient post–COVID-19 population. We defined 17 medical-specialty long COVID subtypes such as cardiology long COVID. Patients who were COVID-19–positive developed signs, symptoms, or diagnoses included in our long COVID definition at a proportion of at least 59.7% (268,320/449,450, based on a denominator of all patients who were COVID-19–positive). The long COVID cohort was 8 years older with more comorbidities (2-year Elixhauser score 7.97 in the patients with long COVID vs 4.21 in the patients with non–long COVID). Patients who had a more severe bout of COVID-19, as judged by their minimum oxygen saturation level, were also more likely to develop long COVID. Conclusions: An actionable, data-driven definition of long COVID can help clinicians screen for and diagnose long COVID, allowing identified patients to be admitted into appropriate monitoring and treatment programs. This long COVID definition can also support public health, research, and policy initiatives. Patients with COVID-19 who are older or have low oxygen saturation levels during their bout of COVID-19, or those who have multiple comorbidities should be preferentially watched for the development of long COVID. %M 38687984 %R 10.2196/49841 %U https://publichealth.jmir.org/2024/1/e49841 %U https://doi.org/10.2196/49841 %U http://www.ncbi.nlm.nih.gov/pubmed/38687984 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e38761 %T Media Discourse Regarding COVID-19 Vaccinations for Children Aged 5 to 11 Years in Australia, Canada, the United Kingdom, and the United States: Comparative Analysis Using the Narrative Policy Framework %A Chadwick,Verity L %A Saich,Freya %A Freeman,Joseph %A Martiniuk,Alexandra %+ Faculty of Medicine and Health, University of Sydney, Edward Ford Building, A27 Fisher Road, Camperdown, 2006, Australia, 61 (02) 9351 2222, alexandra.martiniuk@sydney.edu.au %K COVID-19 %K SARS-CoV-2 %K vaccine %K mRNA %K Pfizer-BioNTech %K pediatric %K children %K media %K news %K web-based %K infodemic %K disinformation %D 2024 %7 29.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Media narratives can shape public opinion and actions, influencing the uptake of pediatric COVID-19 vaccines. The COVID-19 pandemic has occurred at a time where infodemics, misinformation, and disinformation are present, impacting the COVID-19 response. Objective: This study aims to investigate how narratives about pediatric COVID-19 vaccines in the media of 4 English-speaking countries: the United States, Australia, Canada, and the United Kingdom. Methods: The Narrative Policy Framework was used to guide the comparative analyses of the major print and web-based news agencies’ media regarding COVID-19 vaccines for children aged 5 to 11 years. Data were sought using systematic searching on Factiva (Dow Jones) of 4 key phases of pediatric vaccine approval and rollout. Results: A total of 400 articles (n=287, 71.8% in the United States, n=40, 10% in Australia, n=60, 15% in Canada, and n=13, 3% in the United Kingdom) met the search criteria and were included. Using the Narrative Policy Framework, the following were identified in each article: hero, villain, survivor, and plot. The United States was the earliest country to vaccinate children, and other countries’ media often lauded the United States for this. Australian and Canadian media narratives about vaccines for children aged 5 to 11 years were commonly about protecting susceptible people in society, whereas the US and the UK narratives focused more on the vaccine helping children return to school. All 4 countries focused on the vaccines for children aged 5 to 11 years as being key to “ending” the pandemic. Australian and Canadian narratives frequently compared vaccine rollouts across states or provinces and bemoaned local progress in vaccine delivery compared with other countries globally. Canadian and US narratives highlighted the “infodemic” about the COVID-19 pandemic and disinformation regarding child vaccines as impeding uptake. All 4 countries—the United States, Australia, the United Kingdom, and Canada—used war imagery in reporting about COVID-19 vaccines for children. The advent of the Omicron variant demonstrated that populations were fatigued by the COVID-19 pandemic, and the media reporting increasingly blamed the unvaccinated. The UK media narrative was unique in describing vaccinating children as a distraction from adult COVID-19 vaccination efforts. The United States and Canada had narratives expressing anger about potential vaccine passports for children. In Australia, general practitioners were labelled as heroes. Finally, the Canadian narrative suggested altruistic forgoing of COVID-19 vaccine “boosters” as well as pediatric COVID-19 vaccines to benefit those in poorer nations. Conclusions: Public health emergencies require clear; compelling and accurate communication. The stories told during this pandemic are compelling because they contain the classic elements of a narrative; however, they can be reductive and inaccurate. %M 36383344 %R 10.2196/38761 %U https://formative.jmir.org/2024/1/e38761 %U https://doi.org/10.2196/38761 %U http://www.ncbi.nlm.nih.gov/pubmed/36383344 %0 Journal Article %@ 1947-2579 %I JMIR Publications %V 16 %N %P e44931 %T Effect of Long-Distance Domestic Travel Ban Policies in Japan on COVID-19 Outbreak Dynamics During Dominance of the Ancestral Strain: Ex Post Facto Retrospective Observation Study %A Kurita,Junko %A Iwasaki,Yoshitaro %+ Department of Nursing, Faculty of Sports & Health Science, Daitobunka University, 560 Iwadono, Higashimatsuyama-shi, 3558501, Japan, 81 0493 31 1503, kuritaj@ic.daito.ac.jp %K airport users %K COVID-19 %K effective reproduction number %K Go To Travel campaign %K hotel visitors %K mobility %K long-distance travel %K infection control %K lockdown %K travelling %K travel %K pandemic %D 2024 %7 22.4.2024 %9 Original Paper %J Online J Public Health Inform %G English %X Background: In Japan, long-distance domestic travel was banned while the ancestral SARS-CoV-2 strain was dominant under the first declared state of emergency from March 2020 until the end of May 2020. Subsequently, the “Go To Travel” campaign travel subsidy policy was activated, allowing long-distance domestic travel, until the second state of emergency as of January 7, 2021. The effects of this long-distance domestic travel ban on SARS-CoV-2 infectivity have not been adequately evaluated. Objective: We evaluated the effects of the long-distance domestic travel ban in Japan on SARS-CoV-2 infectivity, considering climate conditions, mobility, and countermeasures such as the “Go To Travel” campaign and emergency status. Methods: We calculated the effective reproduction number R(t), representing infectivity, using the epidemic curve in Kagoshima prefecture based on the empirical distribution of the incubation period and procedurally delayed reporting from an earlier study. Kagoshima prefecture, in southern Japan, has several resorts, with an airport commonly used for transportation to Tokyo or Osaka. We regressed R(t) on the number of long-distance domestic travelers (based on the number of airport limousine bus users provided by the operating company), temperature, humidity, mobility, and countermeasures such as state of emergency declarations and the “Go To Travel” campaign in Kagoshima. The study period was June 20, 2020, through February 2021, before variant strains became dominant. A second state of emergency was not declared in Kagoshima prefecture but was declared in major cities such as Tokyo and Osaka. Results: Estimation results indicated a pattern of declining infectivity with reduced long-distance domestic travel volumes as measured by the number of airport limousine bus users. Moreover, infectivity was lower during the “Go To Travel” campaign and the second state of emergency. Regarding mobility, going to restaurants, shopping malls, and amusement venues was associated with increased infectivity. However, going to grocery stores and pharmacies was associated with decreased infectivity. Climate conditions showed no significant association with infectivity patterns. Conclusions: The results of this retrospective analysis suggest that the volume of long-distance domestic travel might reduce SARS-CoV-2 infectivity. Infectivity was lower during the “Go To Travel” campaign period, during which long-distance domestic travel was promoted, compared to that outside this campaign period. These findings suggest that policies banning long-distance domestic travel had little legitimacy or rationale. Long-distance domestic travel with appropriate infection control measures might not increase SARS-CoV-2 infectivity in tourist areas. Even though this analysis was performed much later than the study period, if we had performed this study focusing on the period of April or May 2021, it would likely yield the same results. These findings might be helpful for government decision-making in considering restarting a “Go To Travel” campaign in light of evidence-based policy. %M 38648635 %R 10.2196/44931 %U https://ojphi.jmir.org/2024/1/e44931 %U https://doi.org/10.2196/44931 %U http://www.ncbi.nlm.nih.gov/pubmed/38648635 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e48784 %T Assessing SARS-CoV-2 Testing Adherence in a University Town: Recurrent Event Modeling Analysis %A García,Yury E %A Schmidt,Alec J %A Solis,Leslie %A Daza-Torres,María L %A Montesinos-López,J Cricelio %A Pollock,Brad H %A Nuño,Miriam %+ Department of Public Health Sciences, University of California, 1 Shields Avenue, Davis, CA, 95616, United States, 1 5056999560, mnuno@ucdavis.edu %K Healthy Davis Together %K COVID-19 %K COVID-19 surveillance program %K community surveillance %K HDT: HYT %K Healthy Yolo Together %K SARS-CoV-2 %K severe acute respiratory syndrome coronavirus 2 %K coronavirus %K demographic %K demographics %K testing %K adherence %K compliance %K USA %K United States %K response program %K response programs %K engagement %K participation %K infectious %K trend %K trends %K community based %K surveillance %K public health %K infection control %K PCR %K polymerase chain reaction %K RT-qPCR %K reverse transcription quantitative polymerase chain reaction %K viral %K virus %K viruses %D 2024 %7 17.4.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Healthy Davis Together was a program launched in September 2020 in the city of Davis, California, to mitigate the spread of COVID-19 and facilitate the return to normalcy. The program involved multiple interventions, including free saliva-based asymptomatic testing, targeted communication campaigns, education efforts, and distribution of personal protective equipment, community partnerships, and investments in the local economy. Objective: This study identified demographic characteristics of individuals that underwent testing and assessed adherence to testing over time in a community pandemic-response program launched in a college town in California, United States. Methods: This study outlines overall testing engagement, identifies demographic characteristics of participants, and evaluates testing participation changes over 4 periods of the COVID-19 pandemic, distinguished by the dominant variants Delta and Omicron. Additionally, a recurrent model is employed to explore testing patterns based on the participants’ frequency, timing, and demographic characteristics. Results: A total of 770,165 tests were performed between November 18, 2020, and June 30, 2022, among 89,924 (41.1% of total population) residents of Yolo County, with significant participation from racially or ethnically diverse participants and across age groups. Most positive cases (6351 of total) and highest daily participation (895 per 100,000 population) were during the Omicron period. There were some gender and age-related differences in the pattern of recurrent COVID-19 testing. Men were slightly less likely (hazard ratio [HR] 0.969, 95% CI 0.943-0.996) to be retested and more likely (HR 1.104, 95% CI 1.075-1.134) to stop testing altogether than women. People aged between 20 and 34 years were less likely to be retested (HR 0.861, 95% CI 0.828-0.895) and more likely to stop testing altogether (HR 2.617, 95% CI 2.538-2.699). However, older age groups were less likely to stop testing, especially those aged between 65-74 years and 75-84 years, than those aged between 0 and 19 years. The likelihood of stopping testing was lower (HR 0.93, 95% CI 0.889-0.976) for the Asian group and higher for the Hispanic or Latino (HR 1.185, 95% CI 1.148-1.223) and Black or African American (HR 1.198, 95% CI 1.054-1.350) groups than the White group. Conclusions: The unique features of a pandemic response program that supported community-wide access to free asymptomatic testing provide a unique opportunity to evaluate adherence to testing recommendations and testing trends over time. Identification of individual and group-level factors associated with testing behaviors can provide insights for identifying potential areas of improvement in future testing initiatives. %M 38631033 %R 10.2196/48784 %U https://publichealth.jmir.org/2024/1/e48784 %U https://doi.org/10.2196/48784 %U http://www.ncbi.nlm.nih.gov/pubmed/38631033 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e38170 %T Comparing Contact Tracing Through Bluetooth and GPS Surveillance Data: Simulation-Driven Approach %A Qian,Weicheng %A Cooke,Aranock %A Stanley,Kevin Gordon %A Osgood,Nathaniel David %+ Department of Computer Science, University of Saskatchewan, 110 Science Place, Saskatoon, SK, S7N 5C9, Canada, 1 3069661947, weicheng.qian@usask.ca %K smartphone-based sensing %K proximity contact data %K transmission models %K agent-based simulation %K health informatics %K mobile phone %D 2024 %7 17.4.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Accurate and responsive epidemiological simulations of epidemic outbreaks inform decision-making to mitigate the impact of pandemics. These simulations must be grounded in quantities derived from measurements, among which the parameters associated with contacts between individuals are notoriously difficult to estimate. Digital contact tracing data, such as those provided by Bluetooth beaconing or GPS colocating, can provide more precise measures of contact than traditional methods based on direct observation or self-reporting. Both measurement modalities have shortcomings and are prone to false positives or negatives, as unmeasured environmental influences bias the data. Objective: We aim to compare GPS colocated versus Bluetooth beacon–derived proximity contact data for their impacts on transmission models’ results under community and types of diseases. Methods: We examined the contact patterns derived from 3 data sets collected in 2016, with participants comprising students and staff from the University of Saskatchewan in Canada. Each of these 3 data sets used both Bluetooth beaconing and GPS localization on smartphones running the Ethica Data (Avicenna Research) app to collect sensor data about every 5 minutes over a month. We compared the structure of contact networks inferred from proximity contact data collected with the modalities of GPS colocating and Bluetooth beaconing. We assessed the impact of sensing modalities on the simulation results of transmission models informed by proximate contacts derived from sensing data. Specifically, we compared the incidence number, attack rate, and individual infection risks across simulation results of agent-based susceptible-exposed-infectious-removed transmission models of 4 different contagious diseases. We have demonstrated their differences with violin plots, 2-tailed t tests, and Kullback-Leibler divergence. Results: Both network structure analyses show visually salient differences in proximity contact data collected between GPS colocating and Bluetooth beaconing, regardless of the underlying population. Significant differences were found for the estimated attack rate based on distance threshold, measurement modality, and simulated disease. This finding demonstrates that the sensor modality used to trace contact can have a significant impact on the expected propagation of a disease through a population. The violin plots of attack rate and Kullback-Leibler divergence of individual infection risks demonstrated discernible differences for different sensing modalities, regardless of the underlying population and diseases. The results of the t tests on attack rate between different sensing modalities were mostly significant (P<.001). Conclusions: We show that the contact networks generated from these 2 measurement modalities are different and generate significantly different attack rates across multiple data sets and pathogens. While both modalities offer higher-resolution portraits of contact behavior than is possible with most traditional contact measures, the differential impact of measurement modality on the simulation outcome cannot be ignored and must be addressed in studies only using a single measure of contact in the future. %M 38422493 %R 10.2196/38170 %U https://www.jmir.org/2024/1/e38170 %U https://doi.org/10.2196/38170 %U http://www.ncbi.nlm.nih.gov/pubmed/38422493 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e51449 %T SARS-CoV-2 Infection, Hospitalization, and Associated Factors Among People Living With HIV in Southeastern China From December 2022 to February 2023: Cross-Sectional Survey %A Cheng,Wei %A Xu,Yun %A Jiang,Haibo %A Li,Jun %A Hou,Zhigang %A Meng,Haibin %A Wang,Wei %A Chai,Chengliang %A Jiang,Jianmin %+ Zhejiang Provincial Center for Disease Control and Prevention, 3399 Binsheng Road, Binjiang District, Hangzhou, 310051, China, jmjiang@cdc.zj.cn %K associated factors %K COVID-19 %K hospitalization %K infection %K people living with HIV %K SARS-CoV-2 Omicron variant %D 2024 %7 17.4.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Limited studies have explored the impact of the Omicron variant on SARS-CoV-2 infection, hospitalization, and associated factors among people living with HIV, particularly in China. The adjustment of preventive policies since December 2022 in China presents an opportunity to evaluate the real-world factors influencing SARS-CoV-2 infection and related hospitalization among people living with HIV. Objective: This study aimed to investigate SARS-CoV-2 infection, hospitalization rates, and associated factors among people living with HIV following the adjustment of preventive policies from December 2022 to February 2023 in southeastern China. Methods: A cross-sectional telephone or web-based survey was conducted among people living with HIV in 5 cities in southeastern China from December 2022 to February 2023. Demographic information, SARS-CoV-2 infection and related hospitalization, and HIV-specific characteristics were collected from existing databases and special investigations. Multivariate logistic regression analyses were conducted to determine the associated factors for infection and hospitalization rates of SARS-CoV-2. Additionally, subgroup analyses were conducted for the association between vaccination and infection across different vaccination statuses and time since the last vaccination. Results: Among people living with HIV with a COVID-19 testing history, the SARS-CoV-2 infection rate was 67.13% (95% CI 65.81%-68.13%), whereas the hospitalization rate was 0.71% (95% CI 0.46%-0.97%). Factors such as age, latest CD4 cell count, latest HIV viral load, and transmission route were found to be associated with SARS-CoV-2 infection, while age, cancer, latest CD4 cell count, and latest HIV viral load were associated with SARS-CoV-2 hospitalization. In terms of SARS-CoV-2 vaccination, compared to unvaccinated people living with HIV, there was a lower infection rate among those who had been vaccinated for <3 months in the booster vaccination group (adjusted odds ratio [aOR] 0.72, 95% CI 0.53-0.98; P=.04); and there was also a lower risk of hospitalization among people living with HIV who had received vaccination in the past 6-12 months (aOR 0.33, 95% CI 0.14-0.81; P=.02) and more than 12 months ago (aOR 0.22, 95% CI 0.07-0.72; P=.01). Conclusions: After the ease of prevention and control measures in China, we observed a high SARS-CoV-2 infection rate but a low hospitalization rate. General risk factors, such as higher age and vaccination status, and HIV-related parameters, such as the latest CD4 cell count and HIV viral load, were associated with SARS-CoV-2 infection and hospitalization. A booster vaccination campaign for booster doses should be considered among people living with HIV in confronting possible COVID-19 epidemic emergencies in the near future. %M 38630534 %R 10.2196/51449 %U https://publichealth.jmir.org/2024/1/e51449 %U https://doi.org/10.2196/51449 %U http://www.ncbi.nlm.nih.gov/pubmed/38630534 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e50139 %T Twitter Analysis of Health Care Workers’ Sentiment and Discourse Regarding Post–COVID-19 Condition in Children and Young People: Mixed Methods Study %A Chepo,Macarena %A Martin,Sam %A Déom,Noémie %A Khalid,Ahmad Firas %A Vindrola-Padros,Cecilia %+ Department of Targeted Intervention, University College London, Charles Bell House 43-45, Foley Street, London, W1W 7TY, United Kingdom, 44 (0)20 3108 3232, sam.martin@ucl.ac.uk %K COVID-19 %K postacute sequelae of SARS-CoV-2 %K PASC %K post–COVID-19 condition %K children %K vaccines %K social media %K social network analysis %K Twitter %D 2024 %7 17.4.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic has had a significant global impact, with millions of cases and deaths. Research highlights the persistence of symptoms over time (post–COVID-19 condition), a situation of particular concern in children and young people with symptoms. Social media such as Twitter (subsequently rebranded as X) could provide valuable information on the impact of the post–COVID-19 condition on this demographic. Objective: With a social media analysis of the discourse surrounding the prevalence of post–COVID-19 condition in children and young people, we aimed to explore the perceptions of health care workers (HCWs) concerning post–COVID-19 condition in children and young people in the United Kingdom between January 2021 and January 2022. This will allow us to contribute to the emerging knowledge on post–COVID-19 condition and identify critical areas and future directions for researchers and policy makers. Methods: From a pragmatic paradigm, we used a mixed methods approach. Through discourse, keyword, sentiment, and image analyses, using Pulsar and InfraNodus, we analyzed the discourse about the experience of post–COVID-19 condition in children and young people in the United Kingdom shared on Twitter between January 1, 2021, and January 31, 2022, from a sample of HCWs with Twitter accounts whose biography identifies them as HCWs. Results: We obtained 300,000 tweets, out of which (after filtering for relevant tweets) we performed an in-depth qualitative sample analysis of 2588 tweets. The HCWs were responsive to announcements issued by the authorities regarding the management of the COVID-19 pandemic in the United Kingdom. The most frequent sentiment expressed was negative. The main themes were uncertainty about the future, policies and regulations, managing and addressing the COVID-19 pandemic and post–COVID-19 condition in children and young people, vaccination, using Twitter to share scientific literature and management strategies, and clinical and personal experiences. Conclusions: The perceptions described on Twitter by HCWs concerning the presence of the post–COVID-19 condition in children and young people appear to be a relevant and timely issue and responsive to the declarations and guidelines issued by health authorities over time. We recommend further support and training strategies for health workers and school staff regarding the manifestations and treatment of children and young people with post–COVID-19 condition. %M 38630514 %R 10.2196/50139 %U https://www.jmir.org/2024/1/e50139 %U https://doi.org/10.2196/50139 %U http://www.ncbi.nlm.nih.gov/pubmed/38630514 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e50897 %T Experiences, Lessons, and Challenges With Adapting REDCap for COVID-19 Laboratory Data Management in a Resource-Limited Country: Descriptive Study %A Ndlovu,Kagiso %A Mauco,Kabelo Leonard %A Makhura,Onalenna %A Hu,Robin %A Motlogelwa,Nkwebi Peace %A Masizana,Audrey %A Lo,Emily %A Mphoyakgosi,Thongbotho %A Moyo,Sikhulile %+ Department of Computer Science, University of Botswana, Private Bag UB 0022, Gaborone, 00267, Botswana, 267 71786953, ndlovuk@ub.ac.bw %K REDCap %K DHIS2 %K COVID-19 %K National Health Laboratory %K eHealth %K interoperability %K data management %K Botswana %D 2024 %7 16.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic brought challenges requiring timely health data sharing to inform accurate decision-making at national levels. In Botswana, we adapted and integrated the Research Electronic Data Capture (REDCap) and the District Health Information System version 2 (DHIS2) platforms to support timely collection and reporting of COVID-19 cases. We focused on establishing an effective COVID-19 data flow at the national public health laboratory, being guided by the needs of health care professionals at the National Health Laboratory (NHL). This integration contributed to automated centralized reporting of COVID-19 results at the Ministry of Health (MOH). Objective: This paper reports the experiences, challenges, and lessons learned while designing, adapting, and implementing the REDCap and DHIS2 platforms to support COVID-19 data management at the NHL in Botswana. Methods: A participatory design approach was adopted to guide the design, customization, and implementation of the REDCap platform in support of COVID-19 data management at the NHL. Study participants included 29 NHL and 4 MOH personnel, and the study was conducted from March 2, 2020, to June 30, 2020. Participants’ requirements for an ideal COVID-19 data management system were established. NVivo 11 software supported thematic analysis of the challenges and resolutions identified during this study. These were categorized according to the 4 themes of infrastructure, capacity development, platform constraints, and interoperability. Results: Overall, REDCap supported the majority of perceived technical and nontechnical requirements for an ideal COVID-19 data management system at the NHL. Although some implementation challenges were identified, each had mitigation strategies such as procurement of mobile Internet routers, engagement of senior management to resolve conflicting policies, continuous REDCap training, and the development of a third-party web application to enhance REDCap’s capabilities. Lessons learned informed next steps and further refinement of the REDCap platform. Conclusions: Implementation of REDCap at the NHL to streamline COVID-19 data collection and integration with the DHIS2 platform was feasible despite the urgency of implementation during the pandemic. By implementing the REDCap platform at the NHL, we demonstrated the possibility of achieving a centralized reporting system of COVID-19 cases, hence enabling timely and informed decision-making at a national level. Challenges faced presented lessons learned to inform sustainable implementation of digital health innovations in Botswana and similar resource-limited countries. %M 38625736 %R 10.2196/50897 %U https://formative.jmir.org/2024/1/e50897 %U https://doi.org/10.2196/50897 %U http://www.ncbi.nlm.nih.gov/pubmed/38625736 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e50157 %T Personalized Management of Fatigue in Individuals With Myalgic Encephalomyelitis/Chronic Fatigue Syndrome and Long COVID Using a Smart Digital mHealth Solution: Protocol for a Participatory Design Approach %A Dorronzoro-Zubiete,Enrique %A Castro-Marrero,Jesús %A Ropero,Jorge %A Sevillano-Ramos,José Luis %A Dolores Hernández,María %A Sanmartin Sentañes,Ramon %A Alegre-Martin,Jose %A Launois-Obregón,Patricia %A Martin-Garrido,Isabel %A Luque Budia,Asuncion %A Lacalle-Remigio,Juan R %A Béjar Prado,Luis %A Rivera Romero,Octavio %+ Electronic Technology Department, Universidad de Sevilla, avda. Reina Mercedes s/n,, ETSII Informática, Sevilla, 41012, Spain, 34 954554325, orivera@us.es %K acceptability %K myalgic encephalomyelitis/chronic fatigue syndrome %K long COVID %K mHealth %K fatigue %K physical activity %K lifestyle health %K personalized self-management %K user-centered design %D 2024 %7 12.4.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Fatigue is the most common symptom in myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and long COVID, impacting patients’ quality of life; however, there is currently a lack of evidence-based context-aware tools for fatigue self-management in these populations. Objective: This study aimed to (1) address fatigue in ME/CFS and long COVID through the development of digital mobile health solutions for self-management, (2) predict perceived fatigue severity using real-time data, and (3) assess the feasibility and potential benefits of personalized digital mobile health solutions. Methods: The MyFatigue project adopts a patient-centered approach within the participatory health informatics domain. Patient representatives will be actively involved in decision-making processes. This study combines inductive and deductive research approaches, using qualitative studies to generate new knowledge and quantitative methods to test hypotheses regarding the relationship between factors like physical activity, sleep behaviors, and perceived fatigue in ME/CFS and long COVID. Co-design methods will be used to develop a personalized digital solution for fatigue self-management based on the generated knowledge. Finally, a pilot study will evaluate the feasibility, acceptance, and potential benefits of the digital health solution. Results: The MyFatigue project opened to enrollment in November 2023. Initial results are expected to be published by the end of 2024. Conclusions: This study protocol holds the potential to expand understanding, create personalized self-management approaches, engage stakeholders, and ultimately improve the well-being of individuals with ME/CFS and long COVID. International Registered Report Identifier (IRRID): PRR1-10.2196/50157 %M 38608263 %R 10.2196/50157 %U https://www.researchprotocols.org/2024/1/e50157 %U https://doi.org/10.2196/50157 %U http://www.ncbi.nlm.nih.gov/pubmed/38608263 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e47170 %T Evaluating the Knowledge of and Behavior Toward COVID-19 and the Possibility of Isolating at a City Level: Survey Study %A Verot,Elise %A Chaux,Robin %A Gagnaire,Julie %A Bonjean,Paul %A Gagneux-Brunon,Amandine %A Berthelot,Philippe %A Pelissier,Carole %A Boulamail,Billal %A Chauvin,Franck %A Pozzetto,Bruno %A Botelho-Nevers,Elisabeth %+ CIC EC 1408 INSERM Saint-Etienne, CHU de Saint-Etienne, Bâtiment le Canopée- 2ème étage, Saint-Etienne cedex 2, 42055, France, 33 04 77 12 77 88, elise.verot@univ-st-etienne.fr %K SARS-CoV-2 %K COVID-19 %K health literacy %K knowledge, attitude, and perception/practices (KAP) %K public health %K population %K mass testing %K screening %K pandemic %K sociological trends %K COVID-19 screening %D 2024 %7 11.4.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Mass testing campaigns were proposed in France during the first wave of the COVID-19 pandemic to detect and isolate asymptomatic individuals infected by SARS-CoV-2. During mass testing in Saint-Étienne (February 2021), we performed a survey of the general population. Objective: We evaluated, on the scale of a city’s population, the literacy level about SARS-CoV-2 transmission, barrier gesture respect, and isolation acceptability or possibility in case of SARS-CoV-2 infection. Methods: We used the validated CovQuest-CC questionnaire. Data were analyzed and correlated with volunteer characteristics and their SARS-CoV-2 screening results using multivariate analysis. Results: In total, 4707 participants completed the CovQuest-CC questionnaire. Multivariate analysis revealed that female sex was a determinant of a higher score of knowledge about SARS-CoV-2 transmission (adjusted β coefficient=0.14, 95% CI 0.04-0.23; corrected P=.02). Older ages of 50-59 years (adjusted β coefficient=0.25, 95% CI 0.19-0.31; corrected P<.001) and ≥60 years (adjusted β coefficient=0.25, 95% CI 0.15-0.34; corrected P<.001) were determinants of a higher score on barrier gesture respect compared to ages 20-49 years considered as reference. Female sex was also a determinant of a higher score on barrier gesture respect (adjusted β coefficient=0.10, 95% CI 0.02-4.63; corrected P<.001). The knowledge score was correlated with the score on barrier gesture respect measures (adjusted β coefficient=0.03, 95% CI 0.001-0.004; corrected P=.001). Older ages of 50-59 years (adjusted β coefficient=0.21, 95% CI 0.13-0.29; corrected P<.001) and ≥60 years (adjusted β coefficient=0.25, 95% CI 0.1-0.38; corrected P<.001) were determinants of a higher score on isolation acceptability or possibility compared to the age of 20-49 years considered as reference. Finally, the knowledge score regarding SARS-CoV-2 transmission was significantly associated with a lower risk of RT-PCR (reverse transcriptase–polymerase chain reaction) positivity (adjusted odds ratio 0.80, 95% CI 0.69-0.94; corrected P<.03), implying that a 1-point increase in the knowledge score lowers the risk of positivity by 20% on average. Conclusions: This study identified factors associated with health literacy regarding SARS-CoV-2 infection in asymptomatic individuals in a large French city’s population. We can confirm that in the context of the COVID-19 pandemic, the determinants of better health literacy are not the same as those in other contexts. It seems critical to obtain a more detailed understanding of the determinants of individual citizens’ behavior, as part of a strategy to combat the large-scale spread of the virus. The harsh experience of this pandemic should teach us how to nurture research to structure customized interventions to encourage the adoption of ad hoc behaviors to engage citizens in adapting behaviors more favorable to their health. %M 38602767 %R 10.2196/47170 %U https://publichealth.jmir.org/2024/1/e47170 %U https://doi.org/10.2196/47170 %U http://www.ncbi.nlm.nih.gov/pubmed/38602767 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e54008 %T Longitudinal Monitoring of Clinician-Patient Video Visits During the Peak of the COVID-19 Pandemic: Adoption and Sustained Challenges in an Integrated Health Care Delivery System %A Palakshappa,Jessica A %A Hale,Erica R %A Brown,Joshua D %A Kittel,Carol A %A Dressler,Emily %A Rosenthal,Gary E %A Cutrona,Sarah L %A Foley,Kristie L %A Haines,Emily R %A Houston II,Thomas K %+ Wake Forest University School of Medicine, 1 Medical Center Blvd, Winston Salem, NC, 27157, United States, 1 336 716 8465, jpalaksh@wakehealth.edu %K telehealth %K telemedicine %K e-health %K eHealth %K video visits %K video %K ICT %K information and communication technology %K survey %K surveys %K adoption %K usability %K experience %K experiences %K attitude %K attitudes %K opinion %K perception %K perceptions %K perspective %K perspectives %K COVID-19 %D 2024 %7 8.4.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Numerous prior opinion papers, administrative electronic health record data studies, and cross-sectional surveys of telehealth during the pandemic have been published, but none have combined assessments of video visit success monitoring with longitudinal assessments of perceived challenges to the rapid adoption of video visits during the pandemic. Objective: This study aims to quantify (1) the use of video visits (compared with in-person and telephone visits) over time during the pandemic, (2) video visit successful connection rates, and (3) changes in perceived video visit challenges. Methods: A web-based survey was developed for the dual purpose of monitoring and improving video visit implementation in our health care system during the COVID-19 pandemic. The survey included questions regarding rates of in-person, telephone, and video visits for clinician-patient encounters; the rate of successful connection for video visits; and perceived challenges to video visits (eg, software, hardware, bandwidth, and technology literacy). The survey was distributed via email to physicians, advanced practice professionals, and clinicians in May 2020. The survey was repeated in March 2021. Differences between the 2020 and 2021 responses were adjusted for within-respondent correlation across surveys and tested using generalized estimating equations. Results: A total of 1126 surveys were completed (511 surveys in 2020 and 615 surveys in 2021). In 2020, only 21.7% (73/336) of clinicians reported no difficulty connecting with patients during video visits and 28.6% (93/325) of clinicians reported no difficulty in 2021. The distribution of the percentage of successfully connected video visits (“Over the past two weeks of scheduled visits, what percentage did you successfully connect with patients by video?”) was not significantly different between 2020 and 2021 (P=.74). Challenges in conducting video visits persisted over time. Poor connectivity was the most common challenge reported by clinicians. This response increased over time, with 30.5% (156/511) selecting it as a challenge in 2020 and 37.1% (228/615) in 2021 (P=.01). Patients not having access to their electronic health record portals was also a commonly reported challenge (109/511, 21.3% in 2020 and 137/615, 22.3% in 2021, P=.73). Conclusions: During the pandemic, our health care delivery system rapidly adopted synchronous patient-clinician communication using video visits. As experience with video visits increased, the reported failure rate did not significantly decline, and clinicians continued to report challenges related to general network connectivity and patient access to technology. %M 38587889 %R 10.2196/54008 %U https://www.jmir.org/2024/1/e54008 %U https://doi.org/10.2196/54008 %U http://www.ncbi.nlm.nih.gov/pubmed/38587889 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e53367 %T Moving Biosurveillance Beyond Coded Data Using AI for Symptom Detection From Physician Notes: Retrospective Cohort Study %A McMurry,Andrew J %A Zipursky,Amy R %A Geva,Alon %A Olson,Karen L %A Jones,James R %A Ignatov,Vladimir %A Miller,Timothy A %A Mandl,Kenneth D %+ Computational Health Informatics Program, Boston Children's Hospital, Landmark 5506 Mail Stop BCH3187, 401 Park Drive, Boston, MA, 02215, United States, 1 6173554145, kenneth_mandl@harvard.edu %K natural language processing %K COVID-19 %K artificial intelligence %K AI %K public health, biosurveillance %K surveillance %K respiratory %K infectious %K pulmonary %K SARS-CoV-2 %K symptom %K symptoms %K detect %K detection %K pipeline %K pipelines %K clinical note %K clinical notes %K documentation %K emergency %K urgent %K pediatric %K pediatrics %K paediatric %K paediatrics %K child %K children %K youth %K adolescent %K adolescents %K teen %K teens %K teenager %K teenagers %K diagnose %K diagnosis %K diagnostic %K diagnostics %D 2024 %7 4.4.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Real-time surveillance of emerging infectious diseases necessitates a dynamically evolving, computable case definition, which frequently incorporates symptom-related criteria. For symptom detection, both population health monitoring platforms and research initiatives primarily depend on structured data extracted from electronic health records. Objective: This study sought to validate and test an artificial intelligence (AI)–based natural language processing (NLP) pipeline for detecting COVID-19 symptoms from physician notes in pediatric patients. We specifically study patients presenting to the emergency department (ED) who can be sentinel cases in an outbreak. Methods: Subjects in this retrospective cohort study are patients who are 21 years of age and younger, who presented to a pediatric ED at a large academic children’s hospital between March 1, 2020, and May 31, 2022. The ED notes for all patients were processed with an NLP pipeline tuned to detect the mention of 11 COVID-19 symptoms based on Centers for Disease Control and Prevention (CDC) criteria. For a gold standard, 3 subject matter experts labeled 226 ED notes and had strong agreement (F1-score=0.986; positive predictive value [PPV]=0.972; and sensitivity=1.0). F1-score, PPV, and sensitivity were used to compare the performance of both NLP and the International Classification of Diseases, 10th Revision (ICD-10) coding to the gold standard chart review. As a formative use case, variations in symptom patterns were measured across SARS-CoV-2 variant eras. Results: There were 85,678 ED encounters during the study period, including 4% (n=3420) with patients with COVID-19. NLP was more accurate at identifying encounters with patients that had any of the COVID-19 symptoms (F1-score=0.796) than ICD-10 codes (F1-score =0.451). NLP accuracy was higher for positive symptoms (sensitivity=0.930) than ICD-10 (sensitivity=0.300). However, ICD-10 accuracy was higher for negative symptoms (specificity=0.994) than NLP (specificity=0.917). Congestion or runny nose showed the highest accuracy difference (NLP: F1-score=0.828 and ICD-10: F1-score=0.042). For encounters with patients with COVID-19, prevalence estimates of each NLP symptom differed across variant eras. Patients with COVID-19 were more likely to have each NLP symptom detected than patients without this disease. Effect sizes (odds ratios) varied across pandemic eras. Conclusions: This study establishes the value of AI-based NLP as a highly effective tool for real-time COVID-19 symptom detection in pediatric patients, outperforming traditional ICD-10 methods. It also reveals the evolving nature of symptom prevalence across different virus variants, underscoring the need for dynamic, technology-driven approaches in infectious disease surveillance. %M 38573752 %R 10.2196/53367 %U https://www.jmir.org/2024/1/e53367 %U https://doi.org/10.2196/53367 %U http://www.ncbi.nlm.nih.gov/pubmed/38573752 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e50189 %T Sex Differences in Clustering Unhealthy Lifestyles Among Survivors of COVID-19: Latent Class Analysis %A Le,Lan T H %A Hoang,Thi Ngoc Anh %A Nguyen,Tan T %A Dao,Tien D %A Do,Binh N %A Pham,Khue M %A Vu,Vinh H %A Pham,Linh V %A Nguyen,Lien T H %A Nguyen,Hoang C %A Tran,Tuan V %A Nguyen,Trung H %A Nguyen,Anh T %A Nguyen,Hoan V %A Nguyen,Phuoc B %A Nguyen,Hoai T T %A Pham,Thu T M %A Le,Thuy T %A Nguyen,Thao T P %A Tran,Cuong Q %A Quach,Ha-Linh %A Nguyen,Kien T %A Duong,Tuyen Van %+ School of Nutrition and Health Sciences, Taipei Medical University, No. 250, Wuxing Street, Taipei, 11031, Taiwan, 886 227361661 ext 6545, tvduong@tmu.edu.tw %K sex difference %K cluster %K lifestyle behavior %K COVID-19 recovery %K latent class analysis %K sex %K unhealthy %K lifestyle %K adult %K long COVID-19 %K infected %K survivor %K public health %K intervention %K promote %K well-being %K COVID-19 %K adults %K mobile phone %D 2024 %7 2.4.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The COVID-19 pandemic has underscored the significance of adopting healthy lifestyles to mitigate the risk of severe outcomes and long-term consequences. Objective: This study focuses on assessing the prevalence and clustering of 5 unhealthy lifestyle behaviors among Vietnamese adults after recovering from COVID-19, with a specific emphasis on sex differences. Methods: The cross-sectional data of 5890 survivors of COVID-19 in Vietnam were analyzed from December 2021 to October 2022. To examine the sex differences in 5 unhealthy lifestyle behaviors (smoking, drinking, unhealthy diet, physical inactivity, and sedentary behavior), the percentages were plotted along with their corresponding 95% CI for each behavior. Latent class analysis was used to identify 2 distinct classes of individuals based on the clustering of these behaviors: the “less unhealthy” group and the “more unhealthy” group. We examined the sociodemographic characteristics associated with each identified class and used logistic regression to investigate the factors related to the “more unhealthy” group. Results: The majority of individuals (male participants: 2432/2447, 99.4% and female participants: 3411/3443, 99.1%) exhibited at least 1 unhealthy behavior, with male participants being more susceptible to multiple unhealthy behaviors. The male-to-female ratio for having a single behavior was 1.003, but it escalated to 25 for individuals displaying all 5 behaviors. Male participants demonstrated a higher prevalence of combining alcohol intake with sedentary behavior (949/2447, 38.8%) or an unhealthy diet (861/2447, 35.2%), whereas female participants tended to exhibit physical inactivity combined with sedentary behavior (1305/3443, 37.9%) or an unhealthy diet (1260/3443, 36.6%). Married male participants had increased odds of falling into the “more unhealthy” group compared to their single counterparts (odds ratio [OR] 1.45, 95% CI 1.14-1.85), while female participants exhibited lower odds (OR 0.65, 95% CI 0.51-0.83). Female participants who are underweight showed a higher likelihood of belonging to the “more unhealthy” group (OR 1.11, 95% CI 0.89-1.39), but this was not observed among male participants (OR 0.6, 95% CI 0.41-0.89). In both sexes, older age, dependent employment, high education, and obesity were associated with higher odds of being in the “more unhealthy” group. Conclusions: The study identified notable sex differences in unhealthy lifestyle behaviors among survivors of COVID-19. Male survivors are more likely to engage in unhealthy behaviors compared to female survivors. These findings emphasize the importance of tailored public health interventions targeting sex-specific unhealthy behaviors. Specifically, addressing unhealthy habits is crucial for promoting post–COVID-19 health and well-being. %M 38564248 %R 10.2196/50189 %U https://publichealth.jmir.org/2024/1/e50189 %U https://doi.org/10.2196/50189 %U http://www.ncbi.nlm.nih.gov/pubmed/38564248 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e41559 %T Response of Unvaccinated US Adults to Official Information About the Pause in Use of the Johnson & Johnson–Janssen COVID-19 Vaccine: Cross-Sectional Survey Study %A Mishra,Vishala %A Dexter,Joseph P %+ Data Science Initiative, Harvard University, Science and Engineering Complex 1.312-10, 150 Western Avenue, Allston, MA, 02134, United States, 1 8023381330, jdexter@fas.harvard.edu %K Centers for Disease Control and Prevention %K CDC %K COVID-19 %K health communication %K health information %K health literacy %K public health %K risk perception %K SARS-CoV-2 %K vaccine hesitancy %K web-based surveys %D 2024 %7 1.4.2024 %9 Research Letter %J J Med Internet Res %G English %X Using a rapid response web-based survey, we identified gaps in public understanding of the Centers for Disease Control and Prevention’s messaging about the pause in use of the Johnson & Johnson–Janssen COVID-19 vaccine and estimated changes in vaccine hesitancy using counterfactual questions. %M 38557597 %R 10.2196/41559 %U https://www.jmir.org/2024/1/e41559 %U https://doi.org/10.2196/41559 %U http://www.ncbi.nlm.nih.gov/pubmed/38557597 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 4 %N %P e49699 %T Exploring the Impact of the COVID-19 Pandemic on Twitter in Japan: Qualitative Analysis of Disrupted Plans and Consequences %A Kamba,Masaru %A She,Wan Jou %A Ferawati,Kiki %A Wakamiya,Shoko %A Aramaki,Eiji %+ Division of Information Science, Graduate School of Science and Technology, Nara Institute of Science and Technology, 8916-5 Takayama-cho, Ikoma, 630-0192, Japan, 81 0743 72 5250, aramaki@is.naist.jp %K COVID-19 %K natural language processing %K NLP %K Twitter %K disrupted plans %K concerns %D 2024 %7 1.4.2024 %9 Original Paper %J JMIR Infodemiology %G English %X Background: Despite being a pandemic, the impact of the spread of COVID-19 extends beyond public health, influencing areas such as the economy, education, work style, and social relationships. Research studies that document public opinions and estimate the long-term potential impact after the pandemic can be of value to the field. Objective: This study aims to uncover and track concerns in Japan throughout the COVID-19 pandemic by analyzing Japanese individuals’ self-disclosure of disruptions to their life plans on social media. This approach offers alternative evidence for identifying concerns that may require further attention for individuals living in Japan. Methods: We extracted 300,778 tweets using the query phrase Corona-no-sei (“due to COVID-19,” “because of COVID-19,” or “considering COVID-19”), enabling us to identify the activities and life plans disrupted by the pandemic. The correlation between the number of tweets and COVID-19 cases was analyzed, along with an examination of frequently co-occurring words. Results: The top 20 nouns, verbs, and noun plus verb pairs co-occurring with Corona no-sei were extracted. The top 5 keywords were graduation ceremony, cancel, school, work, and event. The top 5 verbs were disappear, go, rest, can go, and end. Our findings indicate that education emerged as the top concern when the Japanese government announced the first state of emergency. We also observed a sudden surge in anxiety about material shortages such as toilet paper. As the pandemic persisted and more states of emergency were declared, we noticed a shift toward long-term concerns, including careers, social relationships, and education. Conclusions: Our study incorporated machine learning techniques for disease monitoring through the use of tweet data, allowing the identification of underlying concerns (eg, disrupted education and work conditions) throughout the 3 stages of Japanese government emergency announcements. The comparison with COVID-19 case numbers provides valuable insights into the short- and long-term societal impacts, emphasizing the importance of considering citizens’ perspectives in policy-making and supporting those affected by the pandemic, particularly in the context of Japanese government decision-making. %M 38557446 %R 10.2196/49699 %U https://infodemiology.jmir.org/2024/1/e49699 %U https://doi.org/10.2196/49699 %U http://www.ncbi.nlm.nih.gov/pubmed/38557446 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e53343 %T Identification of Predictors for Clinical Deterioration in Patients With COVID-19 via Electronic Nursing Records: Retrospective Observational Study %A Sung,Sumi %A Kim,Youlim %A Kim,Su Hwan %A Jung,Hyesil %+ Department of Nursing, College of Medicine, Inha University, 100 Inha-ro, Michuhol-gu, Incheon, 22212, Republic of Korea, 82 32 860 8206, hsjung@inha.ac.kr %K COVID-19 %K infectious %K respiratory %K SARS-CoV-2 %K nursing records %K SNOMED CT %K random forest %K logistic regression %K EHR %K EHRs %K machine learning %K documentation %K deterioration %K health records %K health record %K patient record %K patient records %K nursing %K standardization %K standard %K standards %K standardized %K standardize %K nomenclature %K term %K terms %K terminologies %K terminology %D 2024 %7 29.3.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Few studies have used standardized nursing records with Systematized Nomenclature of Medicine–Clinical Terms (SNOMED CT) to identify predictors of clinical deterioration. Objective: This study aims to standardize the nursing documentation records of patients with COVID-19 using SNOMED CT and identify predictive factors of clinical deterioration in patients with COVID-19 via standardized nursing records. Methods: In this study, 57,558 nursing statements from 226 patients with COVID-19 were analyzed. Among these, 45,852 statements were from 207 patients in the stable (control) group and 11,706 from 19 patients in the exacerbated (case) group who were transferred to the intensive care unit within 7 days. The data were collected between December 2019 and June 2022. These nursing statements were standardized using the SNOMED CT International Edition released on November 30, 2022. The 260 unique nursing statements that accounted for the top 90% of 57,558 statements were selected as the mapping source and mapped into SNOMED CT concepts based on their meaning by 2 experts with more than 5 years of SNOMED CT mapping experience. To identify the main features of nursing statements associated with the exacerbation of patient condition, random forest algorithms were used, and optimal hyperparameters were selected for nursing problems or outcomes and nursing procedure–related statements. Additionally, logistic regression analysis was conducted to identify features that determine clinical deterioration in patients with COVID-19. Results: All nursing statements were semantically mapped to SNOMED CT concepts for “clinical finding,” “situation with explicit context,” and “procedure” hierarchies. The interrater reliability of the mapping results was 87.7%. The most important features calculated by random forest were “oxygen saturation below reference range,” “dyspnea,” “tachypnea,” and “cough” in “clinical finding,” and “oxygen therapy,” “pulse oximetry monitoring,” “temperature taking,” “notification of physician,” and “education about isolation for infection control” in “procedure.” Among these, “dyspnea” and “inadequate food diet” in “clinical finding” increased clinical deterioration risk (dyspnea: odds ratio [OR] 5.99, 95% CI 2.25-20.29; inadequate food diet: OR 10.0, 95% CI 2.71-40.84), and “oxygen therapy” and “notification of physician” in “procedure” also increased the risk of clinical deterioration in patients with COVID-19 (oxygen therapy: OR 1.89, 95% CI 1.25-3.05; notification of physician: OR 1.72, 95% CI 1.02-2.97). Conclusions: The study used SNOMED CT to express and standardize nursing statements. Further, it revealed the importance of standardized nursing records as predictive variables for clinical deterioration in patients. %M 38414056 %R 10.2196/53343 %U https://www.jmir.org/2024/1/e53343 %U https://doi.org/10.2196/53343 %U http://www.ncbi.nlm.nih.gov/pubmed/38414056 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e45864 %T #ProtectOurElders: Analysis of Tweets About Older Asian Americans and Anti-Asian Sentiments During the COVID-19 Pandemic %A Ng,Reuben %A Indran,Nicole %+ Lee Kuan Yew School of Public Policy, National University of Singapore, 469C Bukit Timah Road, Singapore, 259772, Singapore, 65 66013967, spprng@nus.edu.sg %K AAPI %K anti-Asian hate %K anti-Asian %K Asian Americans and Pacific Islanders %K Asian-American %K content analysis %K coronavirus %K COVID-19 %K discourse %K discriminate %K discrimination %K discriminatory %K Pacific Islander %K racial %K racism %K racist %K SARS-CoV-2 %K social media %K tweet %K Twitter %D 2024 %7 29.3.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: A silver lining to the COVID-19 pandemic is that it cast a spotlight on a long-underserved group. The barrage of attacks against older Asian Americans during the crisis galvanized society into assisting them in various ways. On Twitter, now known as X, support for them coalesced around the hashtag #ProtectOurElders. To date, discourse surrounding older Asian Americans has escaped the attention of gerontologists—a gap we seek to fill. Our study serves as a reflection of the level of support that has been extended to older Asian Americans, even as it provides timely insights that will ultimately advance equity for them. Objective: This study explores the kinds of discourse surrounding older Asian Americans during the COVID-19 crisis, specifically in relation to the surge in anti-Asian sentiments. The following questions guide this study: What types of discourse have emerged in relation to older adults in the Asian American community and the need to support them? How do age and race interact to shape these discourses? What are the implications of these discourses for older Asian Americans? Methods: We retrieved tweets (N=6099) through 2 search queries. For the first query, we collated tweets with the hashtag #ProtectOurElders. For the second query, we collected tweets with an age-based term, for example, “elderly” or “old(er) adults(s)” and either the hashtag #StopAAPIHate or #StopAsianHate. Tweets were posted from January 1, 2020, to August 1, 2023. After applying the exclusion criteria, the final data set contained 994 tweets. Inductive and deductive approaches informed our qualitative content analysis. Results: A total of 4 themes emerged, with 50.1% (498/994) of posts framing older Asian Americans as “vulnerable and in need of protection” (theme 1). Tweets in this theme either singled them out as a group in need of protection because of their vulnerable status or discussed initiatives aimed at safeguarding their well-being. Posts in theme 2 (309/994, 31%) positioned them as “heroic and resilient.” Relevant tweets celebrated older Asian Americans for displaying tremendous strength in the face of attack or described them as individuals not to be trifled with. Tweets in theme 3 (102/994, 10.2%) depicted them as “immigrants who have made selfless contributions and sacrifices.” Posts in this section referenced the immense sacrifices made by older Asian Americans as they migrated to the United States, as well as the systemic barriers they had to overcome. Posts in theme 4 (85/994, 8.5%) venerated older Asian Americans as “worthy of honor.” Conclusions: The COVID-19 crisis had the unintended effect of garnering greater support for older Asian Americans. It is consequential that support be extended to this group not so much by virtue of their perceived vulnerability but more so in view of their boundless contributions and sacrifices. %M 38551624 %R 10.2196/45864 %U https://www.jmir.org/2024/1/e45864 %U https://doi.org/10.2196/45864 %U http://www.ncbi.nlm.nih.gov/pubmed/38551624 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e52587 %T Data Sharing in a Decentralized Public Health System: Lessons From COVID-19 Syndromic Surveillance %A Rigby,Ryan C %A Ferdinand,Alva O %A Kum,Hye-Chung %A Schmit,Cason %+ Population Informatics Lab, Department of Health Policy and Management, Texas A&M University School of Public Health, 212 Adriance Lab Rd, College Station, TX, 77845, United States, 1 9794360277, schmit@tamu.edu %K syndromic surveillance %K federalism %K COVID-19 %K public health %K SARS-CoV-2 %K COVID-19 pandemic %K United States %K decentralized %K data sharing %K digital health %K ethical guidelines %K risk score %K technology %K innovation %K information system %K collaborative framework %K infodemiology %K digital technology %K health information %K health data %K health policy %K surveillance %D 2024 %7 28.3.2024 %9 Viewpoint %J JMIR Public Health Surveill %G English %X The COVID-19 pandemic revealed that data sharing challenges persist across public health information systems. We examine the specific challenges in sharing syndromic surveillance data between state, local, and federal partners. These challenges are complicated by US federalism, which decentralizes public health response and creates friction between different government units. The current policies restrict federal access to state and local syndromic surveillance data without each jurisdiction’s consent. These policies frustrate legitimate federal governmental interests and are contrary to ethical guidelines for public health data sharing. Nevertheless, state and local public health agencies must continue to play a central role as there are important risks in interpreting syndromic surveillance data without understanding local contexts. Policies establishing a collaborative framework will be needed to support data sharing between federal, state, and local partners. A collaborative framework would be enhanced by a governance group with robust state and local involvement and policy guardrails to ensure the use of data is appropriate. These policy and relational challenges must be addressed to actualize a truly national public health information system. %M 38546731 %R 10.2196/52587 %U https://publichealth.jmir.org/2024/1/e52587 %U https://doi.org/10.2196/52587 %U http://www.ncbi.nlm.nih.gov/pubmed/38546731 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e49058 %T Outpatient Video Visits During the COVID-19 Pandemic: Cross-Sectional Survey Study of Patients’ Experiences and Characteristics %A van den Bosch,Stefanie C %A van Dalen,Demi %A Meinders,Marjan %A van Goor,Harry %A Bergé,Stefaan %A Stommel,Martijn %A van Dulmen,Sandra %+ Department of Surgery, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, 6525 GA, Netherlands, 31 243611111, demi.vandalen@radboudumc.nl %K telemedicine %K video visit %K remote consultation %K eHealth %K patient-centered care %K COVID-19 %K mobile phone %D 2024 %7 27.3.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: During the first lockdown of the COVID-19 pandemic, an exponential increase in video consultations replacing in-person outpatient visits was observed in hospitals. Insight into patients’ experiences with this type of consultation is helpful for a broad, sustainable, and patient-centered implementation of video consultation. Objective: This study aims to examine patients’ experiences with video consultation during the COVID-19 pandemic and identify discriminative patient and consultation characteristics to determine when video consultation is most feasible. Methods: A cross-sectional survey study was conducted. Patients aged ≥18 years and scheduled for a video consultation at the outpatient clinic of a Dutch university medical center from August 2020 to December 2020 for all medical specialties were eligible. Patients’ experiences were explored through a study-specific survey using descriptive quantitative statistics. Open-ended questions were qualitatively analyzed and thematically categorized into appreciated aspects and aspects for improvement. Discriminative patient and consultation characteristics were identified using 3 distinctive survey items. Characteristics of patients who scored and those who did not score all 3 items positively were analyzed using binary logistic regression. Results: A total of 1054 patients were included in the analysis. Most patients (964/1054, 91.46%) were satisfied with their video consultation, with a mean overall grade of 8.6 (SD 1.3) of 10. In the qualitative analyses, 70.02% (738/1054) of the patients cited aspects they appreciated and 44.97% (474/1054) mentioned aspects for improvement during their consultation. Patients with better self-rated health reported a positive evaluation significantly more often (P=.001), which also held true for other medical specialties (vs surgical and nonsurgical specialties; P<.001). Conclusions: Video consultation was perceived as highly satisfactory by patients during the COVID-19 pandemic, with the best experience reported by healthy participants and those undergoing their first consultation. Appreciated aspects are mainly at the individual professional level, organizational level, and innovation level itself. The aspects that were mentioned for improvement can be changed for the better. %M 38536236 %R 10.2196/49058 %U https://www.jmir.org/2024/1/e49058 %U https://doi.org/10.2196/49058 %U http://www.ncbi.nlm.nih.gov/pubmed/38536236 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e43554 %T The Impact of Wireless Emergency Alerts on a Floating Population in Seoul, South Korea: Panel Data Analysis %A Yoon,Sungwook %A Lim,Hyungsoo %A Park,Sungho %+ Business School, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, 08826, Republic of Korea, 82 2 880 6949, spark104@snu.ac.kr %K COVID-19 %K empirical identification %K floating population %K social distancing %K wireless emergency alert %D 2024 %7 25.3.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Wireless emergency alerts (WEAs), which deliver disaster information directly to individuals’ mobile phones, have been widely used to provide information related to COVID-19 and to encourage compliance with social distancing guidelines during the COVID-19 pandemic. The floating population refers to the number of people temporarily staying in a specific area, and this demographic data can be a useful indicator to understand the level of social distancing people are complying with during the COVID-19 pandemic. Objective: This study aimed to empirically analyze the impact of WEAs on the floating population where WEAs were transmitted in the early stages of the COVID-19 pandemic. As most WEA messages focus on compliance with the government’s social distancing guidelines, one of the goals of transmitting WEAs during the COVID-19 pandemic is to control the floating population at an appropriate level. Methods: We investigated the empirical impact of WEAs on the floating population across 25 districts in Seoul by estimating a panel regression model at the district-hour level with a series of fixed effects. The main independent variables were the number of instant WEAs, the daily cumulative number of WEAs, the total cumulative number of WEAs, and information extracted from WEAs by natural language processing at the district-hour level. The data set provided a highly informative empirical setting as WEAs were sent by different local governments with various identifiable district-hour–level data. Results: The estimates of the impact of WEAs on the floating population were significantly negative (–0.013, P=.02 to –0.014, P=.01) across all specifications, implying that an additional WEA issuance reduced the floating population by 1.3% (=100(1–e–0.013)) to 1.4% (=100(1–e–0.014)). Although the coefficients of DCN (the daily cumulative number of WEAs) were also negative (–0.0034, P=.34 to –0.0052, P=.15) across all models, they were not significant. The impact of WEAs on the floating population doubled (–0.025, P=.02 to –0.033, P=.005) when the first 82 days of observations were used as subsamples to reduce the possibility of people blocking WEAs. Conclusions: Our results suggest that issuing WEAs and distributing information related to COVID-19 to a specific district was associated with a decrease in the floating population of that district. Furthermore, among the various types of information in the WEAs, location information was the only significant type of information that was related to a decrease in the floating population. This study makes important contributions. First, this study measured the impact of WEAs in a highly informative empirical setting. Second, this study adds to the existing literature on the mechanisms by which WEAs can affect public response. Lastly, this study has important implications for making optimal WEAs and suggests that location information should be included. %M 38526536 %R 10.2196/43554 %U https://publichealth.jmir.org/2024/1/e43554 %U https://doi.org/10.2196/43554 %U http://www.ncbi.nlm.nih.gov/pubmed/38526536 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e50799 %T Use of Sentinel Surveillance Platforms for Monitoring SARS-CoV-2 Activity: Evidence From Analysis of Kenya Influenza Sentinel Surveillance Data %A Owusu,Daniel %A Ndegwa,Linus K %A Ayugi,Jorim %A Kinuthia,Peter %A Kalani,Rosalia %A Okeyo,Mary %A Otieno,Nancy A %A Kikwai,Gilbert %A Juma,Bonventure %A Munyua,Peninah %A Kuria,Francis %A Okunga,Emmanuel %A Moen,Ann C %A Emukule,Gideon O %+ Influenza Division, US Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA, 30333, United States, 1 4044014398, pgv7@cdc.gov %K SARS-CoV-2 %K COVID-19 %K influenza %K sentinel surveillance %K Kenya %K epidemic %K local outbreak %K respiratory infection %K surveillance %K cocirculation %K monitoring %K respiratory pathogen %D 2024 %7 25.3.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Little is known about the cocirculation of influenza and SARS-CoV-2 viruses during the COVID-19 pandemic and the use of respiratory disease sentinel surveillance platforms for monitoring SARS-CoV-2 activity in sub-Saharan Africa. Objective: We aimed to describe influenza and SARS-CoV-2 cocirculation in Kenya and how the SARS-CoV-2 data from influenza sentinel surveillance correlated with that of universal national surveillance. Methods: From April 2020 to March 2022, we enrolled 7349 patients with severe acute respiratory illness or influenza-like illness at 8 sentinel influenza surveillance sites in Kenya and collected demographic, clinical, underlying medical condition, vaccination, and exposure information, as well as respiratory specimens, from them. Respiratory specimens were tested for influenza and SARS-CoV-2 by real-time reverse transcription polymerase chain reaction. The universal national-level SARS-CoV-2 data were also obtained from the Kenya Ministry of Health. The universal national-level SARS-CoV-2 data were collected from all health facilities nationally, border entry points, and contact tracing in Kenya. Epidemic curves and Pearson r were used to describe the correlation between SARS-CoV-2 positivity in data from the 8 influenza sentinel sites in Kenya and that of the universal national SARS-CoV-2 surveillance data. A logistic regression model was used to assess the association between influenza and SARS-CoV-2 coinfection with severe clinical illness. We defined severe clinical illness as any of oxygen saturation <90%, in-hospital death, admission to intensive care unit or high dependence unit, mechanical ventilation, or a report of any danger sign (ie, inability to drink or eat, severe vomiting, grunting, stridor, or unconsciousness in children younger than 5 years) among patients with severe acute respiratory illness. Results: Of the 7349 patients from the influenza sentinel surveillance sites, 76.3% (n=5606) were younger than 5 years. We detected any influenza (A or B) in 8.7% (629/7224), SARS-CoV-2 in 10.7% (768/7199), and coinfection in 0.9% (63/7165) of samples tested. Although the number of samples tested for SARS-CoV-2 from the sentinel surveillance was only 0.2% (60 per week vs 36,000 per week) of the number tested in the universal national surveillance, SARS-CoV-2 positivity in the sentinel surveillance data significantly correlated with that of the universal national surveillance (Pearson r=0.58; P<.001). The adjusted odds ratios (aOR) of clinical severe illness among participants with coinfection were similar to those of patients with influenza only (aOR 0.91, 95% CI 0.47-1.79) and SARS-CoV-2 only (aOR 0.92, 95% CI 0.47-1.82). Conclusions: Influenza substantially cocirculated with SARS-CoV-2 in Kenya. We found a significant correlation of SARS-CoV-2 positivity in the data from 8 influenza sentinel surveillance sites with that of the universal national SARS-CoV-2 surveillance data. Our findings indicate that the influenza sentinel surveillance system can be used as a sustainable platform for monitoring respiratory pathogens of pandemic potential or public health importance. %M 38526537 %R 10.2196/50799 %U https://publichealth.jmir.org/2024/1/e50799 %U https://doi.org/10.2196/50799 %U http://www.ncbi.nlm.nih.gov/pubmed/38526537 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 13 %N %P e43585 %T Influence of Environmental Factors and Genome Diversity on Cumulative COVID-19 Cases in the Highland Region of China: Comparative Correlational Study %A Deji,Zhuoga %A Tong,Yuantao %A Huang,Honglian %A Zhang,Zeyu %A Fang,Meng %A Crabbe,M James C %A Zhang,Xiaoyan %A Wang,Ying %+ Department of Clinical Laboratory Medicine Center, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, 110 Ganhe Rd, Shanghai, 200437, China, 86 021 65161782, nadger_wang@139.com %K COVID-19 %K environmental factors %K altitude %K population density %K virus mutation %D 2024 %7 25.3.2024 %9 Original Paper %J Interact J Med Res %G English %X Background: The novel coronavirus SARS-CoV-2 caused the global COVID-19 pandemic. Emerging reports support lower mortality and reduced case numbers in highland areas; however, comparative studies on the cumulative impact of environmental factors and viral genetic diversity on COVID-19 infection rates have not been performed to date. Objective: The aims of this study were to determine the difference in COVID-19 infection rates between high and low altitudes, and to explore whether the difference in the pandemic trend in the high-altitude region of China compared to that of the lowlands is influenced by environmental factors, population density, and biological mechanisms. Methods: We examined the correlation between population density and COVID-19 cases through linear regression. A zero-shot model was applied to identify possible factors correlated to COVID-19 infection. We further analyzed the correlation of meteorological and air quality factors with infection cases using the Spearman correlation coefficient. Mixed-effects multiple linear regression was applied to evaluate the associations between selected factors and COVID-19 cases adjusting for covariates. Lastly, the relationship between environmental factors and mutation frequency was evaluated using the same correlation techniques mentioned above. Results: Among the 24,826 confirmed COVID-19 cases reported from 40 cities in China from January 23, 2020, to July 7, 2022, 98.4% (n=24,430) were found in the lowlands. Population density was positively correlated with COVID-19 cases in all regions (ρ=0.641, P=.003). In high-altitude areas, the number of COVID-19 cases was negatively associated with temperature, sunlight hours, and UV index (P=.003, P=.001, and P=.009, respectively) and was positively associated with wind speed (ρ=0.388, P<.001), whereas no correlation was found between meteorological factors and COVID-19 cases in the lowlands. After controlling for covariates, the mixed-effects model also showed positive associations of fine particulate matter (PM2.5) and carbon monoxide (CO) with COVID-19 cases (P=.002 and P<.001, respectively). Sequence variant analysis showed lower genetic diversity among nucleotides for each SARS-CoV-2 genome (P<.001) and three open reading frames (P<.001) in high altitudes compared to 300 sequences analyzed from low altitudes. Moreover, the frequencies of 44 nonsynonymous mutations and 32 synonymous mutations were significantly different between the high- and low-altitude groups (P<.001, mutation frequency>0.1). Key nonsynonymous mutations showed positive correlations with altitude, wind speed, and air pressure and showed negative correlations with temperature, UV index, and sunlight hours. Conclusions: By comparison with the lowlands, the number of confirmed COVID-19 cases was substantially lower in high-altitude regions of China, and the population density, temperature, sunlight hours, UV index, wind speed, PM2.5, and CO influenced the cumulative pandemic trend in the highlands. The identified influence of environmental factors on SARS-CoV-2 sequence variants adds knowledge of the impact of altitude on COVID-19 infection, offering novel suggestions for preventive intervention. %M 38526532 %R 10.2196/43585 %U https://www.i-jmr.org/2024/1/e43585 %U https://doi.org/10.2196/43585 %U http://www.ncbi.nlm.nih.gov/pubmed/38526532 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e55517 %T Community Members’ Perceptions of a Resource-Rich Well-Being Website in California During the COVID-19 Pandemic: Qualitative Thematic Analysis %A Heilemann,MarySue V %A Lai,Jianchao %A Cadiz,Madonna P %A Meza,Jocelyn I %A Flores Romero,Daniela %A Wells,Kenneth B %+ School of Nursing, University of California, Los Angeles, 700 Tiverton Avenue, Box 956919, Los Angeles, CA, 90095-6919, United States, 1 310 206 4735, mheilema@sonnet.ucla.edu %K adaptation %K humans %K pandemics %K mental health %K COVID-19 %K health resources %K California %K psychological %K stigma %K digital %K prevention %K public health %K emotions %K website %K qualitative research %D 2024 %7 25.3.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: To address needs for emotional well-being resources for Californians during the COVID-19 pandemic, the Together for Wellness/Juntos por Nuestro Bienestar (T4W/Juntos) website was developed in collaboration with multiple community partners across California, funded by the California Department of Health Care Services Behavioral Health Division federal emergency response. Objective: This qualitative study was designed to explore and describe the perspectives of participants affiliated with California organizations on the T4W/Juntos website, understand their needs for web-based emotional health resources, and inform iterative website development. Methods: After providing informed consent and reviewing the website, telephone interviews were conducted with 29 participants (n=21, 72% in English and n=8, 28% in Spanish) recruited by partnering community agencies (October 2021-February 2022). A 6-phase thematic analysis was conducted, enhanced using grounded theory techniques. The investigators wrote reflexive memos and performed line-by-line coding of 12 transcripts. Comparative analyses led to the identification of 15 overarching codes. The ATLAS.ti Web software (ATLAS.ti Scientific Software Development GmbH) was used to mark all 29 transcripts using these codes. After examining the data grouped by codes, comparative analyses led to the identification of main themes, each with a central organizing concept. Results: Four main themes were identified: (1) having to change my coping due to the pandemic, (2) confronting a context of shifting perceptions of mental health stigma among diverse groups, (3) “Feels like home”—experiencing a sense of inclusivity and belonging in T4W/Juntos, and (4) “It’s a one-stop-shop”—judging T4W/Juntos to be a desirable and useful website. Overall, the T4W/Juntos website communicated support and community to this sample during the pandemic. Participants shared suggestions for website improvement, including adding a back button and a drop-down menu to improve functionality as well as resources tailored to the needs of groups such as older adults; adolescents; the lesbian, gay, bisexual, transgender, and queer community; police officers; and veterans. Conclusions: The qualitative findings from telephone interviews with this sample of community members and service providers in California suggest that, during the COVID-19 pandemic, the T4W/Juntos website was well received as a useful, accessible tool, with some concerns noted such as language sometimes being too “professional” or “clinical.” The look, feel, and content of the website were described as welcoming due to pictures, animations, and videos that showcased resources in a personal, colorful, and inviting way. Furthermore, the content was perceived as lacking the stigma typically attached to mental health, reflecting the commitment of the T4W/Juntos team. Unique features and diverse resources, including multiple languages, made the T4W/Juntos website a valuable resource, potentially informing dissemination. Future efforts to develop mental health websites should consider engaging a diverse sample of potential users to understand how to tailor messages to specific communities and help reduce stigma. %M 38526558 %R 10.2196/55517 %U https://formative.jmir.org/2024/1/e55517 %U https://doi.org/10.2196/55517 %U http://www.ncbi.nlm.nih.gov/pubmed/38526558 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e53593 %T Parents’ User Experience Accessing and Using a Web-Based Map of COVID-19 Recommendations for Health Decision-Making: Qualitative Descriptive Study %A Cyrkot,Samantha %A Hartling,Lisa %A Scott,Shannon D %A Elliott,Sarah A %+ Alberta Research Centre for Health Evidence, Department of Pediatrics, University of Alberta, 4-474 Edmonton Clinical Health Academy, 11405-87 Avenue, Edmonton, AB, T6G1C9, Canada, 1 7804921241, se2@ualberta.ca %K awareness %K COVID-19 %K credibility %K credible %K descriptive %K guidelines %K health evidence %K information behavior %K information needs %K information seeking %K information-seeking behaviour %K interface %K internet %K interview %K knowledge mobilization %K parent %K parenting %K public health %K qualitative %K recommendation %K recommender %K SARS-CoV-2 %K think-aloud activity %K think-aloud %K trust %K trustworthy %K usability %K user experience %K web design %K website %D 2024 %7 20.3.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The eCOVID19 Recommendations Map & Gateway to Contextualization (RecMap) website was developed to identify all COVID-19 guidelines, assess the credibility and trustworthiness of the guidelines, and make recommendations understandable to various stakeholder groups. To date, little has been done to understand and explore parents’ experiences when accessing and using the RecMap website for COVID-19 health decision-making. Objective: To explore (1) where parents look for COVID-19 health information and why, (2) parents’ user experience when accessing and using the RecMap website to make health decisions, and (3) what knowledge mobilization activities are needed to increase parents’ awareness, use, and engagement with the RecMap website. Methods: We conducted a qualitative descriptive study using semistructured interviews and a think-aloud activity with parents of children aged 18 years or younger living in Canada. Participants were asked to provide feedback on the RecMap website and to “think aloud” as they navigated the website to find relevant COVID-19 health recommendations. Demographic information was collected using a web-based questionnaire. A hybrid deductive and inductive thematic approach guided analysis and data synthesis. Results: A total of 21 participants (13/21, 62% mothers) were interviewed and participated in a think-aloud activity. The data were categorized into four sections, representative of key elements that deductively and inductively emerged from the data: (1) parent information seeking behaviors and preferences for COVID-19, (2) RecMap website usability, (3) perceived usefulness of the RecMap website, and (4) knowledge mobilization strategies to increase awareness, use, and engagement of the RecMap website. Parents primarily used the internet to find COVID-19 information and focused on sources that they determined to be credible, trustworthy, simple, and engaging. As the pandemic evolved, participants’ information-seeking behaviors changed, specifically their topics of interest and search frequency. Most parents were not aware of the RecMap website before this study but found satisfaction with its concept and layout and expressed intentions to use and share it with others. Parents experienced some barriers to using the RecMap website and suggested key areas for improvement to facilitate its usability and perceived usefulness. Recommendations included a more user-friendly home page for lay audiences (separate public-facing user interface), improving the search and filter options, quicker navigation, clearer titles, more family-friendly graphics, and improving mobile-friendly access. Several strategies to disseminate the RecMap website were also expressed, including a mix of traditional and nontraditional methods (handouts and social media) in credible and high-traffic locations that parents frequent often. Conclusions: Overall, parents liked the concept of the RecMap website but had some suggestions to improve its usability (language, navigation, and website interface). These findings can be used to improve the RecMap website for parents and offer insight for the development and dissemination of effective web-based health information tools and resources for the general public. %M 38506915 %R 10.2196/53593 %U https://formative.jmir.org/2024/1/e53593 %U https://doi.org/10.2196/53593 %U http://www.ncbi.nlm.nih.gov/pubmed/38506915 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 4 %N %P e51113 %T Government-Nongovernmental Organization (NGO) Collaboration in Macao’s COVID-19 Vaccine Promotion: Social Media Case Study %A Xian,Xuechang %A Neuwirth,Rostam J %A Chang,Angela %+ Department of Communication, University of Macau, Avenida da Universidade, Taipa, Macao SAR, 999078, China, 86 88228991, wychang@um.edu.mo %K COVID-19 %K government %K vaccine %K automated content analysis %K Granger causality test %K network agenda setting %K QAP %K social media %D 2024 %7 19.3.2024 %9 Original Paper %J JMIR Infodemiology %G English %X Background: The COVID-19 pandemic triggered unprecedented global vaccination efforts, with social media being a popular tool for vaccine promotion. Objective: This study probes into Macao’s COVID-19 vaccine communication dynamics, with a focus on the multifaceted impacts of government agendas on social media. Methods: We scrutinized 22,986 vaccine-related Facebook posts from January 2020 to August 2022 in Macao. Using automated content analysis and advanced statistical methods, we unveiled intricate agenda dynamics between government and nongovernment entities. Results: “Vaccine importance” and “COVID-19 risk” were the most prominent topics co-occurring in the overall vaccine communication. The government tended to emphasize “COVID-19 risk” and “vaccine effectiveness,” while regular users prioritized vaccine safety and distribution, indicating a discrepancy in these agendas. Nonetheless, the government has limited impact on regular users in the aspects of vaccine importance, accessibility, affordability, and trust in experts. The agendas of government and nongovernment users intertwined, illustrating complex interactions. Conclusions: This study reveals the influence of government agendas on public discourse, impacting environmental awareness, public health education, and the social dynamics of inclusive communication during health crises. Inclusive strategies, accommodating public concerns, and involving diverse stakeholders are paramount for effective social media communication during health crises. %M 38502184 %R 10.2196/51113 %U https://infodemiology.jmir.org/2024/1/e51113 %U https://doi.org/10.2196/51113 %U http://www.ncbi.nlm.nih.gov/pubmed/38502184 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e47979 %T Predicting COVID-19 Vaccination Uptake Using a Small and Interpretable Set of Judgment and Demographic Variables: Cross-Sectional Cognitive Science Study %A Vike,Nicole L %A Bari,Sumra %A Stefanopoulos,Leandros %A Lalvani,Shamal %A Kim,Byoung Woo %A Maglaveras,Nicos %A Block,Martin %A Breiter,Hans C %A Katsaggelos,Aggelos K %+ Department of Computer Science, University of Cincinnati, 2901 Woodside Drive, Cincinnati, OH, 45219, United States, 1 617 413 0953, breitehs@ucmail.uc.edu %K reward %K aversion %K judgment %K relative preference theory %K cognitive science %K behavioral economics %K machine learning %K balanced random forest %K mediation %K moderation %K mobile phone %K smartphone %D 2024 %7 18.3.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Despite COVID-19 vaccine mandates, many chose to forgo vaccination, raising questions about the psychology underlying how judgment affects these choices. Research shows that reward and aversion judgments are important for vaccination choice; however, no studies have integrated such cognitive science with machine learning to predict COVID-19 vaccine uptake. Objective: This study aims to determine the predictive power of a small but interpretable set of judgment variables using 3 machine learning algorithms to predict COVID-19 vaccine uptake and interpret what profile of judgment variables was important for prediction. Methods: We surveyed 3476 adults across the United States in December 2021. Participants answered demographic, COVID-19 vaccine uptake (ie, whether participants were fully vaccinated), and COVID-19 precaution questions. Participants also completed a picture-rating task using images from the International Affective Picture System. Images were rated on a Likert-type scale to calibrate the degree of liking and disliking. Ratings were computationally modeled using relative preference theory to produce a set of graphs for each participant (minimum R2>0.8). In total, 15 judgment features were extracted from these graphs, 2 being analogous to risk and loss aversion from behavioral economics. These judgment variables, along with demographics, were compared between those who were fully vaccinated and those who were not. In total, 3 machine learning approaches (random forest, balanced random forest [BRF], and logistic regression) were used to test how well judgment, demographic, and COVID-19 precaution variables predicted vaccine uptake. Mediation and moderation were implemented to assess statistical mechanisms underlying successful prediction. Results: Age, income, marital status, employment status, ethnicity, educational level, and sex differed by vaccine uptake (Wilcoxon rank sum and chi-square P<.001). Most judgment variables also differed by vaccine uptake (Wilcoxon rank sum P<.05). A similar area under the receiver operating characteristic curve (AUROC) was achieved by the 3 machine learning frameworks, although random forest and logistic regression produced specificities between 30% and 38% (vs 74.2% for BRF), indicating a lower performance in predicting unvaccinated participants. BRF achieved high precision (87.8%) and AUROC (79%) with moderate to high accuracy (70.8%) and balanced recall (69.6%) and specificity (74.2%). It should be noted that, for BRF, the negative predictive value was <50% despite good specificity. For BRF and random forest, 63% to 75% of the feature importance came from the 15 judgment variables. Furthermore, age, income, and educational level mediated relationships between judgment variables and vaccine uptake. Conclusions: The findings demonstrate the underlying importance of judgment variables for vaccine choice and uptake, suggesting that vaccine education and messaging might target varying judgment profiles to improve uptake. These methods could also be used to aid vaccine rollouts and health care preparedness by providing location-specific details (eg, identifying areas that may experience low vaccination and high hospitalization). %M 38315620 %R 10.2196/47979 %U https://publichealth.jmir.org/2024/1/e47979 %U https://doi.org/10.2196/47979 %U http://www.ncbi.nlm.nih.gov/pubmed/38315620 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e50716 %T Use of Digital COVID-19 Exposure Notifications at a Large Gathering: Survey Analysis of Public Health Conference Attendees %A Drover,Caitlin M %A Elder,Adam S %A Guthrie,Brandon L %A Revere,Debra %A Briggs,Nicole L %A West,Laura M %A Higgins,Amanda %A Lober,William B %A Karras,Bryant T %A Baseman,Janet G %+ Department of Epidemiology, School of Public Health, University of Washington, Hans Rosling Center for Population Health, 3980 15th Avenue NE, Seattle, WA, 98195-1616, United States, 1 5056159180, eldera3@uw.edu %K COVID-19 %K exposure notification %K digital public health tool %K survey analysis %K conference %K online survey %K digital tool %K public health %K contact tracing %D 2024 %7 18.3.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: WA Notify was Washington State’s smartphone-based COVID-19 digital exposure notification (EN) tool, which was used to help limit the spread of COVID-19 between November 30, 2020, and May 11, 2023. Following the 2022 Washington State Public Health Association Annual Conference, attendees who had WA Notify activated began receiving ENs alerting them to a possible COVID-19 exposure during the conference. A survey was emailed to all conference attendees to measure WA Notify adoption, mechanisms through which attendees received ENs, and self-reported engagement in protective behaviors postexposure. Objective: This study aimed to learn more about the experiences of WA Notify adopters and nonadopters who may have been exposed to COVID-19 at a large group gathering. Methods: A web-based survey administered through REDCap (Research Electronic Data Capture; Vanderbilt University) was sent to all attendees of the Washington State Public Health Association conference. Self-reported demographic information and characteristics of respondents were summarized. Regression models were used to estimate relative risks to compare WA Notify adoption and testing behaviors between groups. Results: Of the 464 total registered attendees who were sent the survey, 205 (44%) responses were received; 201 eligible attendees were included in this analysis. Of those, 149 (74%) respondents reported having WA Notify activated on their phones at the time of the conference. Among respondents with WA Notify activated, 54% (n=77) reported learning of their potential exposure from a WA Notify EN. Respondents who reported that they did not have WA Notify activated and learned of their potential exposure via the event-wide email from conference organizers were 39% less likely to test for COVID-19 compared to respondents with WA Notify activated who learned of their potential exposure from the email (relative risk 0.61, 95% CI 0.40-0.93; P=.02), and this gap was even larger when compared to respondents who learned of their exposure from a WA Notify EN. The most commonly cited reason for not having WA Notify activated was privacy concerns (n=17, 35%), followed by not wanting to receive ENs (n=6, 12%) and being unaware of WA Notify (n=5, 10%). Conclusions: Digital EN systems are an important tool to directly and anonymously notify close contacts of potential exposures and provide guidance on the next steps in a timely manner. Given the privacy concerns, there is still a need for increasing transparency surrounding EN technology to increase uptake by the public if this technology were to be used in the future to slow the spread of communicable diseases. %M 38498047 %R 10.2196/50716 %U https://formative.jmir.org/2024/1/e50716 %U https://doi.org/10.2196/50716 %U http://www.ncbi.nlm.nih.gov/pubmed/38498047 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54500 %T Pharmacy Students’ Attitudes Toward Distance Learning After the COVID-19 Pandemic: Cross-Sectional Study From Saudi Arabia %A Alsahali,Saud %A Almutairi,Salman %A Almutairi,Salem %A Almofadhi,Saleh %A Anaam,Mohammed %A Alshammari,Mohammed %A Abdulsalim,Suhaj %A Almogbel,Yasser %+ Department of Pharmacy Practice, College of Pharmacy, Qassim University, Madinah Road, Unaizah, Qassim, Buraydah, 56219, Saudi Arabia, 966 163011503, s.alsahali@qu.edu.sa %K distance learning %K e-learning %K pharmacy education %K team based learning %K educational experience. %D 2024 %7 15.3.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Electronic learning refers to the use of assistive tools in offline and distance learning environments. It allows students to access learning tools and materials anytime and anywhere. However, distance learning courses depend on several factors that affect the quality of learning, which consequently affect students’ preferences in the settings and tools used to deliver educational materials. Objective: This study aimed to evaluate students’ preferences for continuing distance learning after the pandemic and to assess the distance educational environment after the pandemic. It also aimed to identify the factors affecting distance learning and evaluate students’ preferences regarding modes of communication with instructors. Methods: A web-based survey was used to conduct this cross-sectional study. The target participants of this study were students in the doctor of pharmacy program at Unaizah College of Pharmacy, Qassim, Saudi Arabia. All students enrolled from December 2022 to January 2023 received an invitation with a link to the web-based survey. Results: The survey was completed by 141 students (58 female students and 83 male students). The research results showed that most students (102/141, 72.3%) did not wish to continue distance education for laboratory courses, and 60.3% (85/141) did not wish to continue taking distance team-based learning after the pandemic. Additionally, 83.7% (118/141) of the students indicated that distance courses were simple. More than half of the participants (79/141, 56%) stated that having a camera on during class negatively impacted their learning, and only 29.1% (41/141) of the students stated that nonvisual communication with their fellow students impacted their learning. A large proportion of students (83/141, 58.9%) reported impairment of social engagement on campus, 44% (62/141) in-person interactions during classes, and 73.7% (104/141) were relieved that their classes were not disrupted. Conclusions: Similar to all types of education, distance learning is characterized by advantages and disadvantages, as reported by students. Students felt that the course material was intelligible, and the distance course was uncomplicated. Moreover, they expressed relief that their studies were not disrupted. However, they also reported the loss of face-to-face contact during courses as the most significant drawback of distance learning versus face-to-face learning, followed by a lack of social connection on campus. %M 38488833 %R 10.2196/54500 %U https://formative.jmir.org/2024/1/e54500 %U https://doi.org/10.2196/54500 %U http://www.ncbi.nlm.nih.gov/pubmed/38488833 %0 Journal Article %@ 2561-1011 %I JMIR Publications %V 8 %N %P e54823 %T Cardiac Rehabilitation During the COVID-19 Pandemic and the Potential for Digital Technology to Support Physical Activity Maintenance: Qualitative Study %A Park,Linda G %A Chi,Serena %A Pitsenbarger,Susan %A Johnson,Julene K %A Shah,Amit J %A Elnaggar,Abdelaziz %A von Oppenfeld,Julia %A Cho,Evan %A Harzand,Arash %A Whooley,Mary A %+ Department of Community Health Systems, University of California San Francisco, 2 Koret Way, Room 531A, San Francisco, CA, 94143-0610, United States, 1 415 502 6616, linda.park@ucsf.edu %K cardiac rehabilitation %K cardiac rehab %K COVID-19 %K digital health %K digital technology %K physical activity %K physical activity maintenance %K social media %K older adults %K pandemic %K social distancing %K technology %K wearables %K CR %K exercise %K cardiovascular disease %K gerontology %K geriatric %K geriatrics %K hospital %K medical facility %K California %K interview %K thematic analysis %K anxiety %D 2024 %7 14.3.2024 %9 Original Paper %J JMIR Cardio %G English %X Background: Social distancing from the COVID-19 pandemic may have decreased engagement in cardiac rehabilitation (CR) and may have had possible consequences on post-CR exercise maintenance. The increased use of technology as an adaptation may benefit post-CR participants via wearables and social media. Thus, we sought to explore the possible relationships of both the pandemic and technology on post-CR exercise maintenance. Objective: This study aimed to (1) understand CR participation during the COVID-19 pandemic, (2) identify perceived barriers and facilitators to physical activity after CR completion, and (3) assess willingness to use technology and social media to support physical activity needs among older adults with cardiovascular disease. Methods: We recruited participants aged 55 years and older in 3 different CR programs offered at both public and private hospitals in Northern California. We conducted individual interviews on CR experiences, physical activity, and potential for using technology. We used thematic analysis to synthesize the data. Results: In total, 22 participants (n=9, 41% female participants; mean age 73, SD 8 years) completed in-depth interviews. Themes from participants’ feedback included the following: (1) anxiety and frustration about the wait for CR caused by COVID-19 conditions, (2) positive and safe participant experience once in CR during the pandemic, (3) greater attention needed to patients after completion of CR, (4) notable demand for technology during the pandemic and after completion of CR, and (5) social media networking during the CR program considered valuable if training is provided. Conclusions: Individuals who completed CR identified shared concerns about continuing physical activity despite having positive experiences during the CR program. There were significant challenges during the pandemic and heightened concerns for safety and health. The idea of providing support by leveraging digital technology (wearable devices and social media for social support) resonated as a potential solution to help bridge the gap from CR to more independent physical activity. More attention is needed to help individuals experience a tailored and safe transition to home to maintain physical activity among those who complete CR. %M 38483450 %R 10.2196/54823 %U https://cardio.jmir.org/2024/1/e54823 %U https://doi.org/10.2196/54823 %U http://www.ncbi.nlm.nih.gov/pubmed/38483450 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e50278 %T Dental Students’ Satisfaction With Web-Based Learning During the Initial Phase of the COVID-19 Pandemic: Mixed Methods Study %A Lee,Minjung %A An,So Youn %A Ihm,Jungjoon %+ Dental Research Institute, School of Dentistry, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, 08826, Republic of Korea, 82 8802343 ext 2343, ijj127@snu.ac.kr %K web-based learning %K student satisfaction %K transactional distance theory %K health profession education %K COVID-19 %D 2024 %7 8.3.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic has precipitated an accelerated shift in education, moving from traditional learning to web-based learning. This transition introduced a notable transactional distance (TD) between the instructors and learners. Although disease control and staff and students’ safety are the top priorities during a pandemic, the successful delivery of education is equally crucial. However, the ramifications of this swift transition are particularly critical in the context of dental education. Dental education is inherently practice oriented, necessitating hands-on training and manual skills development, which poses unique challenges to distance learning approaches. Objective: This study aims to examine dental students’ web-based learning satisfaction and experience of TD, investigate the predictors of web-based learning satisfaction, and explore the perceptions of students about the advantages and disadvantages of web-based learning. Methods: This study explored the factors associated with web-based learning satisfaction using TD theory during the transition to web-based education. Psychological factors that could influence satisfaction were adapted from the health belief model. We conducted a cross-sectional web-based survey of 345 dental students from 2 institutions in South Korea who were enrolled in the spring semester of 2020. Data were collected between July 8 and September 14, 2020. Qualitative analysis was used to examine responses to open-ended questions concerning perceptions of web-based learning. Results: A multivariate hierarchical linear regression model was used to analyze the effects of student characteristics, TD, and psychological factors (ie, perceived risk of infection and efficacy belief of web-based learning) on web-based learning satisfaction. The average score for web-based learning satisfaction was 3.62 (SD 0.84), just above the midpoint of the possible range (1-5). Self-regulated learning (β=0.08; P=.046), learner-instructor interaction (β=0.08; P=.03), and learner-content interaction (β=0.64; P<.001) were associated with higher levels of satisfaction. Moreover, a significant association was revealed between high efficacy beliefs in web-based learning (β=0.20; P<.001) and satisfaction. Although the learning structure (synchronous vs asynchronous) did not exhibit a significant association with satisfaction, the qualitative analysis results revealed that each structure possesses distinct strengths and weaknesses. The students in synchronous learning (79/345, 22.9%) recognized heightened autonomy in the “learning environment” (19/79, 24%); however, technical issues (28/79, 35%) and reduced concentration (15/79, 19%) were identified as downsides. Conversely, the students in asynchronous settings (266/345, 77.1%) emphasized unlimited access to learning content (74/266, 27.8%) and the flexibility of “learning in preferred time” (69/266, 25.9%). Nevertheless, challenges, such as self-management difficulties (66/266, 24.8%) and limited interactions (55/266, 20.7%), were evident. Conclusions: The findings suggest that efforts to minimize TD, facilitating self-regulated learning and interaction among students and instructors, are critical for achieving web-based learning satisfaction. Moreover, establishing a common understanding among students regarding the necessity and efficacy of web-based learning during epidemics could enhance their satisfaction. %M 38457808 %R 10.2196/50278 %U https://www.jmir.org/2024/1/e50278 %U https://doi.org/10.2196/50278 %U http://www.ncbi.nlm.nih.gov/pubmed/38457808 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e49307 %T Effects of Face Mask Mandates on COVID-19 Transmission in 51 Countries: Retrospective Event Study %A Näher,Anatol-Fiete %A Schulte-Althoff,Matthias %A Kopka,Marvin %A Balzer,Felix %A Pozo-Martin,Francisco %+ Digital Global Public Health, Hasso Plattner Institute, University of Potsdam, Rudolf-Breitscheid-Strasse 187, Campus III, Bldg G2, Potsdam, 14482, Germany, 49 331 5509176, anatolfiete.naeher@hpi.de %K nonpharmacological interventions %K face masks %K infectious diseases %K acute respiratory infections %K COVID-19 %K real-world evidence %D 2024 %7 8.3.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The question of the utility of face masks in preventing acute respiratory infections has received renewed attention during the COVID-19 pandemic. However, given the inconclusive evidence from existing randomized controlled trials, evidence based on real-world data with high external validity is missing. Objective: To add real-world evidence, this study aims to examine whether mask mandates in 51 countries and mask recommendations in 10 countries increased self-reported face mask use and reduced SARS-CoV-2 reproduction numbers and COVID-19 case growth rates. Methods: We applied an event study approach to data pooled from four sources: (1) country-level information on self-reported mask use was obtained from the COVID-19 Trends and Impact Survey, (2) data from the Oxford COVID-19 Government Response Tracker provided information on face mask mandates and recommendations and any other nonpharmacological interventions implemented, (3) mobility indicators from Google’s Community Mobility Reports were also included, and (4) SARS-CoV-2 reproduction numbers and COVID-19 case growth rates were retrieved from the Our World in Data—COVID-19 data set. Results: Mandates increased mask use by 8.81 percentage points (P=.006) on average, and SARS-CoV-2 reproduction numbers declined on average by −0.31 units (P=.008). Although no significant average effect of mask mandates was observed for growth rates of COVID-19 cases (−0.98 percentage points; P=.56), the results indicate incremental effects on days 26 (−1.76 percentage points; P=.04), 27 (−1.89 percentage points; P=.05), 29 (−1.78 percentage points; P=.04), and 30 (−2.14 percentage points; P=.02) after mandate implementation. For self-reported face mask use and reproduction numbers, incremental effects are seen 6 and 13 days after mandate implementation. Both incremental effects persist for >30 days. Furthermore, mask recommendations increased self-reported mask use on average (5.84 percentage points; P<.001). However, there were no effects of recommendations on SARS-CoV-2 reproduction numbers or COVID-19 case growth rates (−0.06 units; P=.70 and −2.45 percentage points; P=.59). Single incremental effects on self-reported mask use were observed on days 11 (3.96 percentage points; P=.04), 13 (3.77 percentage points; P=.04) and 25 to 27 (4.20 percentage points; P=.048 and 5.91 percentage points; P=.01) after recommendation. Recommendations also affected reproduction numbers on days 0 (−0.07 units; P=.03) and 1 (−0.07 units; P=.03) and between days 21 (−0.09 units; P=.04) and 28 (−0.11 units; P=.05) and case growth rates between days 1 and 4 (−1.60 percentage points; P=.03 and −2.19 percentage points; P=.03) and on day 23 (−2.83 percentage points; P=.05) after publication. Conclusions: Contrary to recommendations, mask mandates can be used as an effective measure to reduce SARS-CoV-2 reproduction numbers. However, mandates alone are not sufficient to reduce growth rates of COVID-19 cases. Our study adds external validity to the existing randomized controlled trials on the effectiveness of face masks to reduce the spread of SARS-CoV-2. %M 38457225 %R 10.2196/49307 %U https://publichealth.jmir.org/2024/1/e49307 %U https://doi.org/10.2196/49307 %U http://www.ncbi.nlm.nih.gov/pubmed/38457225 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e48255 %T Durability of the Effectiveness of Heterologous COVID-19 Vaccine Regimens in Thailand: Retrospective Cohort Study Using National Registration Data %A Kumwichar,Ponlagrit %A Poonsiri,Chittawan %A Botwright,Siobhan %A Sirichumroonwit,Natchalaikorn %A Loharjun,Bootsakorn %A Thawillarp,Supharerk %A Cheewaruangroj,Nontawit %A Chokchaisiripakdee,Amorn %A Teerawattananon,Yot %A Chongsuvivatwong,Virasakdi %+ Department of Epidemiology, Faculty of Medicine, Prince of Songkla University, 15 Kanchanavanit Road, Hat Yai, Songkhla, 90110, Thailand, 66 74451165, cvirasak@medicine.psu.ac.th %K COVID-19 %K heterologous vaccine %K vaccine %K vaccine effectiveness %K durability %K time %K waning %K real-world %K public health %K vaccination strategy %K health outcome %K vaccines %K vaccination %K unvaccinated %K big data %K registry %K registries %K health outcomes %K effectiveness %K SARS-CoV-2 %K cohort %K database %K databases %K vaccinated %K Cochran-Mantel-Haenszel %K Mantel-Haenszel %K regression %K risk %K risks %K association %K associations %K odds ratio %K odds ratios %D 2024 %7 5.3.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The durability of heterologous COVID-19 vaccine effectiveness (VE) has been primarily studied in high-income countries, while evaluation of heterologous vaccine policies in low- and middle-income countries remains limited. Objective: We aimed to evaluate the duration during which the VE of heterologous COVID-19 vaccine regimens in mitigating serious outcomes, specifically severe COVID-19 and death following hospitalization with COVID-19, remains over 50%. Methods: We formed a dynamic cohort by linking records of Thai citizens aged ≥18 years from citizen vital, COVID-19 vaccine, and COVID-19 cases registry databases between May 2021 and July 2022. Encrypted citizen identification numbers were used to merge the data between the databases. This study focuses on 8 common heterologous vaccine sequences: CoronaVac/ChAdOx1, ChAdOx1/BNT162b2, CoronaVac/CoronaVac/ChAdOx1, CoronaVac/ChAdOx1/ChAdOx1, CoronaVac/ChAdOx1/BNT162b2, BBIBP-CorV/BBIBP-CorV/BNT162b2, ChAdOx1/ChAdOx1/BNT162b2, and ChAdOx1/ChAdOx1/mRNA-1273. Nonimmunized individuals were considered for comparisons. The cohort was stratified according to the vaccination status, age, sex, province location, month of vaccination, and outcome. Data analysis employed logistic regression to determine the VE, accounting for potential confounders and durability over time, with data observed over a follow-up period of 7 months. Results: This study includes 52,580,841 individuals, with approximately 17,907,215 and 17,190,975 receiving 2- and 3-dose common heterologous vaccines (not mutually exclusive), respectively. The 2-dose heterologous vaccinations offered approximately 50% VE against severe COVID-19 and death following hospitalization with COVID-19 for 2 months; however, the protection significantly declined over time. The 3-dose heterologous vaccinations sustained over 50% VE against both outcomes for at least 8 months, as determined by logistic regression with durability time-interaction modeling. The vaccine sequence consisting of CoronaVac/CoronaVac/ChAdOx1 demonstrated >80% VE against both outcomes, with no evidence of VE waning. The final monthly measured VE of CoronaVac/CoronaVac/ChAdOx1 against severe COVID-19 and death following hospitalization at 7 months after the last dose was 82% (95% CI 80.3%-84%) and 86.3% (95% CI 83.6%-84%), respectively. Conclusions: In Thailand, within a 7-month observation period, the 2-dose regimens could not maintain a 50% VE against severe and fatal COVID-19 for over 2 months, but all of the 3-dose regimens did. The CoronaVac/CoronaVac/ChAdOx1 regimen showed the best protective effect against severe and fatal COVID-19. The estimated durability of 50% VE for at least 8 months across all 3-dose heterologous COVID-19 vaccine regimens supports the adoption of heterologous prime-boost vaccination strategies, with a primary series of inactivated virus vaccine and boosting with either a viral vector or an mRNA vaccine, to prevent similar pandemics in low- and middle-income countries. %M 38441923 %R 10.2196/48255 %U https://publichealth.jmir.org/2024/1/e48255 %U https://doi.org/10.2196/48255 %U http://www.ncbi.nlm.nih.gov/pubmed/38441923 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e49411 %T Machine Learning–Based Approach for Identifying Research Gaps: COVID-19 as a Case Study %A Abd-alrazaq,Alaa %A Nashwan,Abdulqadir J %A Shah,Zubair %A Abujaber,Ahmad %A Alhuwail,Dari %A Schneider,Jens %A AlSaad,Rawan %A Ali,Hazrat %A Alomoush,Waleed %A Ahmed,Arfan %A Aziz,Sarah %+ AI Center for Precision Health, Weill Cornell Medicine-Qatar, A031, Weill Cornell Medicine-Qatar, Education City, Al Luqta St, Doha, 23435, Qatar, 974 55708599, aaa4027@qatar-med.cornell.edu %K research gaps %K research gap %K research topic %K research topics %K scientific literature %K literature review %K machine learning %K COVID-19 %K BERTopic %K topic clustering %K text analysis %K BERT %K NLP %K natural language processing %K review methods %K review methodology %K SARS-CoV-2 %K coronavirus %K COVID %D 2024 %7 5.3.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Research gaps refer to unanswered questions in the existing body of knowledge, either due to a lack of studies or inconclusive results. Research gaps are essential starting points and motivation in scientific research. Traditional methods for identifying research gaps, such as literature reviews and expert opinions, can be time consuming, labor intensive, and prone to bias. They may also fall short when dealing with rapidly evolving or time-sensitive subjects. Thus, innovative scalable approaches are needed to identify research gaps, systematically assess the literature, and prioritize areas for further study in the topic of interest. Objective: In this paper, we propose a machine learning–based approach for identifying research gaps through the analysis of scientific literature. We used the COVID-19 pandemic as a case study. Methods: We conducted an analysis to identify research gaps in COVID-19 literature using the COVID-19 Open Research (CORD-19) data set, which comprises 1,121,433 papers related to the COVID-19 pandemic. Our approach is based on the BERTopic topic modeling technique, which leverages transformers and class-based term frequency-inverse document frequency to create dense clusters allowing for easily interpretable topics. Our BERTopic-based approach involves 3 stages: embedding documents, clustering documents (dimension reduction and clustering), and representing topics (generating candidates and maximizing candidate relevance). Results: After applying the study selection criteria, we included 33,206 abstracts in the analysis of this study. The final list of research gaps identified 21 different areas, which were grouped into 6 principal topics. These topics were: “virus of COVID-19,” “risk factors of COVID-19,” “prevention of COVID-19,” “treatment of COVID-19,” “health care delivery during COVID-19,” “and impact of COVID-19.” The most prominent topic, observed in over half of the analyzed studies, was “the impact of COVID-19.” Conclusions: The proposed machine learning–based approach has the potential to identify research gaps in scientific literature. This study is not intended to replace individual literature research within a selected topic. Instead, it can serve as a guide to formulate precise literature search queries in specific areas associated with research questions that previous publications have earmarked for future exploration. Future research should leverage an up-to-date list of studies that are retrieved from the most common databases in the target area. When feasible, full texts or, at minimum, discussion sections should be analyzed rather than limiting their analysis to abstracts. Furthermore, future studies could evaluate more efficient modeling algorithms, especially those combining topic modeling with statistical uncertainty quantification, such as conformal prediction. %M 38441952 %R 10.2196/49411 %U https://formative.jmir.org/2024/1/e49411 %U https://doi.org/10.2196/49411 %U http://www.ncbi.nlm.nih.gov/pubmed/38441952 %0 Journal Article %@ 2562-0959 %I JMIR Publications %V 7 %N %P e54052 %T A Content Analysis of Indoor Tanning Twitter Chatter During COVID-19 Shutdowns: Cross-Sectional Qualitative Study %A Groshon,Laurie %A Waring,Molly E %A Blashill,Aaron J %A Dean,Kristen %A Bankwalla,Sanaya %A Palmer,Lindsay %A Pagoto,Sherry %+ University of Connecticut, 2006 Hillside Road, Unit 1248, Room 22, Storrs, CT, 06268, United States, 1 4344654162, sherry.pagoto@uconn.edu %K attitude %K attitudes %K content analysis %K dermatology %K opinion %K opinion %K perception %K perceptions %K perspective %K perspectives %K sentiment %K skin %K social media %K social media %K sun %K tan %K tanner %K tanners %K tanning %K tweet %K tweets %K Twitter %D 2024 %7 4.3.2024 %9 Original Paper %J JMIR Dermatol %G English %X Background: Indoor tanning is a preventable risk factor for skin cancer. Statewide shutdowns during the COVID-19 pandemic resulted in temporary closures of tanning businesses. Little is known about how tanners reacted to losing access to tanning businesses. Objective: This study aimed to analyze Twitter (subsequently rebranded as X) chatter about indoor tanning during the statewide pandemic shutdowns. Methods: We collected tweets from March 15 to April 30, 2020, and performed a directed content analysis of a random sample of 20% (1165/5811) of tweets from each week. The 2 coders independently rated themes (κ=0.67-1.0; 94%-100% agreement). Results: About half (589/1165, 50.6%) of tweets were by people unlikely to indoor tan, and most of these mocked tanners or the act of tanning (562/589, 94.9%). A total of 34% (402/1165) of tweets were posted by users likely to indoor tan, and most of these (260/402, 64.7%) mentioned missing tanning beds, often citing appearance- or mood-related reasons or withdrawal. Some tweets by tanners expressed a desire to purchase or use home tanning beds (90/402, 22%), while only 3.9% (16/402) mentioned tanning alternatives (eg, self-tanner). Very few tweets (29/1165, 2.5%) were public health messages about the dangers of indoor tanning. Conclusions: Findings revealed that during statewide shutdowns, half of the tweets about indoor tanning were mocking tanning bed users and the tanned look, while about one-third were indoor tanners reacting to their inability to access tanning beds. Future work is needed to understand emerging trends in tanning post pandemic. %M 38437006 %R 10.2196/54052 %U https://derma.jmir.org/2024/1/e54052 %U https://doi.org/10.2196/54052 %U http://www.ncbi.nlm.nih.gov/pubmed/38437006 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e47846 %T Integration of Patient-Reported Outcome Data Collected Via Web Applications and Mobile Apps Into a Nation-Wide COVID-19 Research Platform Using Fast Healthcare Interoperability Resources: Development Study %A Oehm,Johannes Benedict %A Riepenhausen,Sarah Luise %A Storck,Michael %A Dugas,Martin %A Pryss,Rüdiger %A Varghese,Julian %+ Institute of Medical Informatics, University of Münster, Albert-Schweizer-Campus 1, Gebäude 11, Münster, 48149, Germany, 49 251 83 58247, johannes.oehm@uni-muenster.de %K Fast Healthcare Interoperability Resources %K FHIR %K FHIR Questionnaire %K patient-reported outcome %K mobile health %K mHealth %K research compatibility %K interoperability %K Germany %K harmonized data collection %K findable, accessible, interoperable, and reusable %K FAIR data %K mobile phone %D 2024 %7 27.2.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: The Network University Medicine projects are an important part of the German COVID-19 research infrastructure. They comprise 2 subprojects: COVID-19 Data Exchange (CODEX) and Coordination on Mobile Pandemic Apps Best Practice and Solution Sharing (COMPASS). CODEX provides a centralized and secure data storage platform for research data, whereas in COMPASS, expert panels were gathered to develop a reference app framework for capturing patient-reported outcomes (PROs) that can be used by any researcher. Objective: Our study aims to integrate the data collected with the COMPASS reference app framework into the central CODEX platform, so that they can be used by secondary researchers. Although both projects used the Fast Healthcare Interoperability Resources (FHIR) standard, it was not used in a way that data could be shared directly. Given the short time frame and the parallel developments within the CODEX platform, a pragmatic and robust solution for an interface component was required. Methods: We have developed a means to facilitate and promote the use of the German Corona Consensus (GECCO) data set, a core data set for COVID-19 research in Germany. In this way, we ensured semantic interoperability for the app-collected PRO data with the COMPASS app. We also developed an interface component to sustain syntactic interoperability. Results: The use of different FHIR types by the COMPASS reference app framework (the general-purpose FHIR Questionnaire) and the CODEX platform (eg, Patient, Condition, and Observation) was found to be the most significant obstacle. Therefore, we developed an interface component that realigns the Questionnaire items with the corresponding items in the GECCO data set and provides the correct resources for the CODEX platform. We extended the existing COMPASS questionnaire editor with an import function for GECCO items, which also tags them for the interface component. This ensures syntactic interoperability and eases the reuse of the GECCO data set for researchers. Conclusions: This paper shows how PRO data, which are collected across various studies conducted by different researchers, can be captured in a research-compatible way. This means that the data can be shared with a central research infrastructure and be reused by other researchers to gain more insights about COVID-19 and its sequelae. %M 38411999 %R 10.2196/47846 %U https://www.jmir.org/2024/1/e47846 %U https://doi.org/10.2196/47846 %U http://www.ncbi.nlm.nih.gov/pubmed/38411999 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e44349 %T Optimization of Screening Strategies for COVID-19: Scoping Review %A Liu,Yuanhua %A Yin,Yun %A Ward,Michael P %A Li,Ke %A Chen,Yue %A Duan,Mengwei %A Wong,Paulina P Y %A Hong,Jie %A Huang,Jiaqi %A Shi,Jin %A Zhou,Xuan %A Chen,Xi %A Xu,Jiayao %A Yuan,Rui %A Kong,Lingcai %A Zhang,Zhijie %+ Department of Epidemiology and Health Statistics, School of Public Health, Fudan University, No.130, Dong'An Road, Xuhui District, Shanghai, 200032, China, 86 021 54237410, epistat@gmail.com %K COVID-19 %K screening strategy %K optimization %K polymerase chain reaction test %K antigen test %D 2024 %7 27.2.2024 %9 Review %J JMIR Public Health Surveill %G English %X Background: COVID-19 screening is an effective nonpharmaceutical intervention for identifying infected individuals and interrupting viral transmission. However, questions have been raised regarding its effectiveness in controlling the spread of novel variants and its high socioeconomic costs. Therefore, the optimization of COVID-19 screening strategies has attracted great attention. Objective: This review aims to summarize the evidence and provide a reference basis for the optimization of screening strategies for the prevention and control of COVID-19. Methods: We applied a methodological framework for scoping reviews and the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) checklist. We conducted a scoping review of the present publications on the optimization of COVID-19 screening strategies. We searched the PubMed, Web of Science, and Elsevier ScienceDirect databases for publications up to December 31, 2022. English publications related to screening and testing strategies for COVID-19 were included. A data-charting form, jointly developed by 2 reviewers, was used for data extraction according to the optimization directions of the screening strategies. Results: A total of 2770 unique publications were retrieved from the database search, and 95 abstracts were retained for full-text review. There were 62 studies included in the final review. We summarized the results in 4 major aspects: the screening population (people at various risk conditions such as different regions and occupations; 12/62, 19%), the timing of screening (when the target population is tested before travel or during an outbreak; 12/62, 19%), the frequency of screening (appropriate frequencies for outbreak prevention, outbreak response, or community transmission control; 6/62, 10%), and the screening and detection procedure (the choice of individual or pooled detection and optimization of the pooling approach; 35/62, 56%). Conclusions: This review reveals gaps in the optimization of COVID-19 screening strategies and suggests that a number of factors such as prevalence, screening accuracy, effective allocation of resources, and feasibility of strategies should be carefully considered in the development of future screening strategies. %M 38412011 %R 10.2196/44349 %U https://publichealth.jmir.org/2024/1/e44349 %U https://doi.org/10.2196/44349 %U http://www.ncbi.nlm.nih.gov/pubmed/38412011 %0 Journal Article %@ 2371-4379 %I JMIR Publications %V 9 %N %P e45536 %T COVID-19 Vaccination Reactions and Risk of Breakthrough Infections Among People With Diabetes: Cohort Study Derived From Community Reporters %A Dreyer,Nancy A %A Knuth,Kendall B %A Xie,Yiqiong %A Reynolds,Matthew W %A Mack,Christina D %+ Real World Solutions, IQVIA, 2400 Ellis Road, Durham, NC, 27703, United States, 1 5742767958, christina.mack@iqvia.com %K COVID-19 %K diabetes %K vaccine %K vaccine hesitancy %K registry %K person-generated health data %K patient-reported outcomes %K side effects %K vaccination %K infection %K nondiabetic adult %K clinical data %K fatigue %K headache %K risk %K patient data %K medication %K community health %D 2024 %7 27.2.2024 %9 Original Paper %J JMIR Diabetes %G English %X Background: This exploratory study compares self-reported COVID-19 vaccine side effects and breakthrough infections in people who described themselves as having diabetes with those who did not identify as having diabetes. Objective: The study uses person-reported data to evaluate differences in the perception of COVID-19 vaccine side effects between adults with diabetes and those who did not report having diabetes. Methods: This is a retrospective cohort study conducted using data provided online by adults aged 18 years and older residing in the United States. The participants who voluntarily self-enrolled between March 19, 2021, and July 16, 2022, in the IQVIA COVID-19 Active Research Experience project reported clinical and demographic information, COVID-19 vaccination, whether they had experienced any side effects, test-confirmed infections, and consented to linkage with prescription claims. No distinction was made for this study to differentiate prediabetes or type 1 and type 2 diabetes nor to verify reports of positive COVID-19 tests. Person-reported medication use was validated using pharmacy claims and a subset of the linked data was used for a sensitivity analysis of medication effects. Multivariate logistic regression was used to estimate the adjusted odds ratios of vaccine side effects or breakthrough infections by diabetic status, adjusting for age, gender, education, race, ethnicity (Hispanic or Latino), BMI, smoker, receipt of an influenza vaccine, vaccine manufacturer, and all medical conditions. Evaluations of diabetes medication-specific vaccine side effects are illustrated graphically to support the examination of the magnitude of side effect differences for various medications and combinations of medications used to manage diabetes. Results: People with diabetes (n=724) reported experiencing fewer side effects within 2 weeks of vaccination for COVID-19 than those without diabetes (n=6417; mean 2.7, SD 2.0 vs mean 3.1, SD 2.0). The adjusted risk of having a specific side effect or any side effect was lower among those with diabetes, with significant reductions in fatigue and headache but no differences in breakthrough infections over participants’ maximum follow-up time. Diabetes medication use did not consistently affect the risk of specific side effects, either using self-reported medication use or using only diabetes medications that were confirmed by pharmacy health insurance claims for people who also reported having diabetes. Conclusions: People with diabetes reported fewer vaccine side effects than participants not reporting having diabetes, with a similar risk of breakthrough infection. Trial Registration: ClinicalTrials.gov NCT04368065; https://clinicaltrials.gov/study/NCT04368065 %M 38412008 %R 10.2196/45536 %U https://diabetes.jmir.org/2024/1/e45536 %U https://doi.org/10.2196/45536 %U http://www.ncbi.nlm.nih.gov/pubmed/38412008 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e44062 %T The Use of ICD-9-CM Coding to Identify COVID-19 Diagnoses and Determine Risk Factors for 30-Day Death Rate in Hospitalized Patients in Italy: Retrospective Study %A Giordani,Barbara %A Burgio,Alessandra %A Grippo,Francesco %A Barone,Alessandra %A Eugeni,Erica %A Baglio,Giovanni %+ Research, National Outcomes Evaluation Programme (PNE) and International Relations Unit, Italian National Agency for Regional Healthcare Services, Via Piemonte 60, Rome, 00187, Italy, 39 06 42749713, giordani@agenas.it %K COVID-19 %K ICD-9-CM coding %K hospitalizations %K SARS-CoV-2 %K coronavirus %K risk factor %K Italy %K death rate %K monitoring %K hospital records %K coding %K algorithm %D 2024 %7 23.2.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: In Italy, it has been difficult to accurately quantify hospital admissions of patients with a COVID-19 diagnosis using the Hospital Information System (HIS), mainly due to the heterogeneity of codes used in the hospital discharge records during different waves of the COVID-19 pandemic. Objective: The objective of this study was to define a specific combination of codes to identify the COVID-19 hospitalizations within the HIS and to investigate the risk factors associated with mortality due to COVID-19 among patients admitted to Italian hospitals in 2020. Methods: A retrospective study was conducted using the hospital discharge records, provided by more than 1300 public and private Italian hospitals. Inpatient hospitalizations were detected by implementing an algorithm based on specific International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code combinations. Hospitalizations were analyzed by different clinical presentations associated with COVID-19 diagnoses. In addition, 2 multivariable Cox regression models were performed among patients hospitalized “due to COVID-19” from January 1 to December 31, 2020, to investigate potential risk factors associated with 30-day death and the temporal changes over the course of the pandemic; in particular, the 30-day death rates during the first and the second waves were analyzed across 3 main geographical areas (North, Center, and South and Islands) and by discharge wards (ordinary and intensive care). Results: We identified a total of 325,810 hospitalizations with COVID-19–related diagnosis codes. Among these, 73.4% (n=239,114) were classified as “due to COVID-19,” 14.5% (n=47,416) as “SARS-CoV-2 positive, but not due to COVID-19,” and 12.1% (n=39,280) as “suspected COVID-19” hospitalizations. The cohort of patients hospitalized “due to COVID-19” included 205,048 patients, with a median age of 72 years and a higher prevalence of male patients (n=124,181, 60.6%). The overall 30-day death rate among hospitalized patients due to COVID-19 was 9.9 per 1000 person-days. Mortality was lower for women (hazard ratio [HR]=0.83; P<.001) and for patients coming from high migration pressure countries, especially Northern Africans (HR=0.65; P<.001) and Central and Eastern Europeans (HR=0.66; P<.001), compared to patients coming from Italy and high-income countries. In the southern regions and the Islands, mortality was higher compared to the northern regions (HR=1.17; P<.001), especially during the second wave of COVID-19 among patients with a transfer to intensive care units (HR=2.52; P<.001). Conclusions: To our knowledge, the algorithm is the first attempt to define, at a national level, selection criteria for identifying COVID-19 hospitalizations within the HIS. The implemented algorithm will be used to monitor the pandemic over time, and the patients selected in 2020 will be followed up in the next years to assess the long-term effects of COVID-19. %M 38393763 %R 10.2196/44062 %U https://publichealth.jmir.org/2024/1/e44062 %U https://doi.org/10.2196/44062 %U http://www.ncbi.nlm.nih.gov/pubmed/38393763 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e44406 %T Mobile Apps for COVID-19 Detection and Diagnosis for Future Pandemic Control: Multidimensional Systematic Review %A Gheisari,Mehdi %A Ghaderzadeh,Mustafa %A Li,Huxiong %A Taami,Tania %A Fernández-Campusano,Christian %A Sadeghsalehi,Hamidreza %A Afzaal Abbasi,Aaqif %+ School of Nursing and Health Sciences of Boukan, Urmia University of Medical Sciences, Kurdistan Blv Boukan, Urmia, 5951715161, Iran, 98 9129378390, Mustaf.ghaderzadeh@sbmu.ac.ir %K COVID-19 %K detection %K diagnosis %K internet of things %K cloud computing %K mobile applications %K mobile app %K mobile apps %K artificial intelligence: AI %K mobile phone %K smartphone %D 2024 %7 22.2.2024 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: In the modern world, mobile apps are essential for human advancement, and pandemic control is no exception. The use of mobile apps and technology for the detection and diagnosis of COVID-19 has been the subject of numerous investigations, although no thorough analysis of COVID-19 pandemic prevention has been conducted using mobile apps, creating a gap. Objective: With the intention of helping software companies and clinical researchers, this study provides comprehensive information regarding the different fields in which mobile apps were used to diagnose COVID-19 during the pandemic. Methods: In this systematic review, 535 studies were found after searching 5 major research databases (ScienceDirect, Scopus, PubMed, Web of Science, and IEEE). Of these, only 42 (7.9%) studies concerned with diagnosing and detecting COVID-19 were chosen after applying inclusion and exclusion criteria using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) protocol. Results: Mobile apps were categorized into 6 areas based on the content of these 42 studies: contact tracing, data gathering, data visualization, artificial intelligence (AI)–based diagnosis, rule- and guideline-based diagnosis, and data transformation. Patients with COVID-19 were identified via mobile apps using a variety of clinical, geographic, demographic, radiological, serological, and laboratory data. Most studies concentrated on using AI methods to identify people who might have COVID-19. Additionally, symptoms, cough sounds, and radiological images were used more frequently compared to other data types. Deep learning techniques, such as convolutional neural networks, performed comparatively better in the processing of health care data than other types of AI techniques, which improved the diagnosis of COVID-19. Conclusions: Mobile apps could soon play a significant role as a powerful tool for data collection, epidemic health data analysis, and the early identification of suspected cases. These technologies can work with the internet of things, cloud storage, 5th-generation technology, and cloud computing. Processing pipelines can be moved to mobile device processing cores using new deep learning methods, such as lightweight neural networks. In the event of future pandemics, mobile apps will play a critical role in rapid diagnosis using various image data and clinical symptoms. Consequently, the rapid diagnosis of these diseases can improve the management of their effects and obtain excellent results in treating patients. %M 38231538 %R 10.2196/44406 %U https://mhealth.jmir.org/2024/1/e44406 %U https://doi.org/10.2196/44406 %U http://www.ncbi.nlm.nih.gov/pubmed/38231538 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e48134 %T Newspaper Coverage of Hospitals During a Prolonged Health Crisis: Longitudinal Mixed Methods Study %A van de Baan,Frank %A Gifford,Rachel %A Ruwaard,Dirk %A Fleuren,Bram %A Westra,Daan %+ Department of Health Services Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Duboisdomein 30, Maastricht, 6229GT, Netherlands, 31 043 38 81 553, f.vandebaan@maastrichtuniversity.nl %K health communication %K news coverage %K media %K misinformation %K accuracy %K news %K reporting %K newspaper %K knowledge translation %K COVID-19 %K dissemination %K communication %D 2024 %7 21.2.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: It is important for health organizations to communicate with the public through newspapers during health crises. Although hospitals were a main source of information for the public during the COVID-19 pandemic, little is known about how this information was presented to the public through (web-based) newspaper articles. Objective: This study aims to examine newspaper reporting on the situation in hospitals during the first year of the COVID-19 pandemic in the Netherlands and to assess the degree to which the reporting in newspapers aligned with what occurred in practice. Methods: We used a mixed methods longitudinal design to compare internal data from all hospitals (n=5) located in one of the most heavily affected regions of the Netherlands with the information reported by a newspaper covering the same region. The internal data comprised 763 pages of crisis meeting documents and 635 minutes of video communications. A total of 14,401 newspaper articles were retrieved from the LexisNexis Academic (RELX Group) database, of which 194 (1.3%) articles were included for data analysis. For qualitative analysis, we used content and thematic analyses. For quantitative analysis, we used chi-square tests. Results: The content of the internal data was categorized into 12 themes: COVID-19 capacity; regular care capacity; regional, national, and international collaboration; human resources; well-being; public support; material resources; innovation; policies and protocols; finance; preparedness; and ethics. Compared with the internal documents, the newspaper articles focused significantly more on the themes COVID-19 capacity (P<.001), regular care capacity (P<.001), and public support (P<.001) during the first year of the pandemic, whereas they focused significantly less on the themes material resources (P=.004) and policies and protocols (P<.001). Differences in attention toward themes were mainly observed between the first and second waves of the pandemic and at the end of the third wave. For some themes, the attention in the newspaper articles preceded the attention given to these themes in the internal documents. Reporting was done through various forms, including diary articles written from the perspective of the hospital staff. No indication of the presence of misinformation was found in the newspaper articles. Conclusions: Throughout the first year of the pandemic, newspaper articles provided coverage on the situation of hospitals and experiences of staff. The focus on themes within newspaper articles compared with internal hospital data differed significantly for 5 (42%) of the 12 identified themes. The discrepancies between newspapers and hospitals in their focus on themes could be attributed to their gatekeeping roles. Both parties should be aware of their gatekeeping role and how this may affect information distribution. During health crises, newspapers can be a credible source of information for the public. The information can also be valuable for hospitals themselves, as it allows them to anticipate internal and external developments. %M 38381496 %R 10.2196/48134 %U https://publichealth.jmir.org/2024/1/e48134 %U https://doi.org/10.2196/48134 %U http://www.ncbi.nlm.nih.gov/pubmed/38381496 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e44258 %T Perspectives on the COVID-19 Vaccination Rollout in 17 Countries: Reflexive Thematic and Frequency Analysis Based on the Strengths, Weaknesses, Opportunities, and Threats (SWOT) Framework %A Kopilaš,Vanja %A Nasadiuk,Khrystyna %A Martinelli,Lucia %A Lhotska,Lenka %A Todorovic,Zoran %A Vidmar,Matjaz %A Machado,Helena %A Svalastog,Anna Lydia %A Gajović,Srećko %+ BIMIS-Biomedical Research Center Šalata, University of Zagreb School of Medicine, Šalata 4, Zagreb, 10000, Croatia, 385 1 4566 948, srecko.gajovic@hiim.hr %K SARS-CoV-2 virus %K COVID-19 vaccination %K pandemic %K hesitancy %K safety %K vaccination %K COVID-19 %K tool %K implementation %K vaccine hesitancy %K effectiveness %K sociocultural %K communication %K disinformation %D 2024 %7 19.2.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: As the SARS-CoV-2 virus created a global pandemic and rapidly became an imminent threat to the health and lives of people worldwide, the need for a vaccine and its quick distribution among the population was evident. Due to the urgency, and on the back of international collaboration, vaccines were developed rapidly. However, vaccination rollouts showed different success rates in different countries and some also led to increased vaccine hesitancy. Objective: The aim of this study was to identify the role of information sharing and context sensitivity in various vaccination programs throughout the initial COVID-19 vaccination rollout in different countries. Moreover, we aimed to identify factors in national vaccination programs related to COVID-19 vaccine hesitancy, safety, and effectiveness. Toward this end, multidisciplinary and multinational opinions from members of the Navigating Knowledge Landscape (NKL) network were analyzed. Methods: From May to July 2021, 25 completed questionnaires from 27 NKL network members were collected. These contributors were from 17 different countries. The responses reflected the contributors’ subjective viewpoints on the status and details of the COVID-19 vaccination rollout in their countries. Contributors were asked to identify strengths, weaknesses, opportunities, and threats (ie, SWOT) of the respective vaccination programs. The responses were analyzed using reflexive thematic analysis, followed by frequency analysis of identified themes according to the represented countries. Results: The perspectives of NKL network members showed a link between organizational elements of the vaccination rollout and the accompanying societal response, both of which were related to strengths and weaknesses of the process. External sociocultural variables, improved public communication around vaccination-related issues, ethical controversies, and the spread of disinformation were the dominant themes related to opportunities and challenges. In the SWOT 2×2 matrix, Availability and Barriers emerged as internal categories, whereas Transparent communication and promotion and Societal divide emerged as key external categories. Conclusions: Inventory of themes and categories inspired by elements of the SWOT framework provides an informative multidisciplinary perspective for effective implementation of public health strategies in the battle against COVID-19 or any future pandemics of a similar nature. %M 38373020 %R 10.2196/44258 %U https://humanfactors.jmir.org/2024/1/e44258 %U https://doi.org/10.2196/44258 %U http://www.ncbi.nlm.nih.gov/pubmed/38373020 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e48466 %T Ethnic Disparities in COVID-19 Vaccine Mistrust and Receipt in British Columbia, Canada: Population Survey %A Mahmood,Bushra %A Adu,Prince %A McKee,Geoffrey %A Bharmal,Aamir %A Wilton,James %A Janjua,Naveed Zafar %+ Division of Endocrinology, University of British Columbia, 2775 Laurel St 4116, Vancouver, BC, V5Z 1M9, Canada, 1 7787073711, bushra.mahmood@bccdc.ca %K COVID-19 %K vaccine hesitancy %K mistrust %K trust %K ethnic minorities %K South Asian %K vaccine %K vaccination %K hesitancy %K ethnic %K ethnicity %K minority %K cultural %K racial %K minorities %K SARS-CoV-2 %K coronavirus %K Asia %K Asian %D 2024 %7 16.2.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Racialized populations in the United States, Canada, and the United Kingdom have been disproportionately affected by COVID-19. Higher vaccine hesitancy has been reported among racial and ethnic minorities in some of these countries. In the United Kingdom, for example, higher vaccine hesitancy has been observed among the South Asian population and Black compared with the White population, and this has been attributed to lack of trust in government due to historical and ongoing racism and discrimination. Objective: This study aimed to assess vaccine receipt by ethnicity and its relationship with mistrust among ethnic groups in British Columbia (BC), Canada. Methods: We included adults ≥18 years of age who participated in the BC COVID-19 Population Mixing Patterns Survey (BC-Mix) from March 8, 2021, to August 8, 2022. The survey included questions about vaccine receipt and beliefs based on a behavioral framework. Multivariable logistic regression was used to assess the association between mistrust in vaccines and vaccine receipt among ethnic groups. Results: The analysis included 25,640 adults. Overall, 76.7% (22,010/28,696) of respondents reported having received at least 1 dose of COVID-19 vaccines (Chinese=86.1%, South Asian=79.6%, White=75.5%, and other ethnicity=73.2%). Overall, 13.7% (3513/25,640) of respondents reported mistrust of COVID-19 vaccines (Chinese=7.1%, South Asian=8.2%, White=15.4%, and other ethnicity=15.2%). In the multivariable model (adjusting for age, sex, ethnicity, educational attainment, and household size), mistrust was associated with a 93% reduced odds of vaccine receipt (adjusted odds ratio 0.07, 95% CI 0.06-0.08). In the models stratified by ethnicity, mistrust was associated with 81%, 92%, 94%, and 95% reduced odds of vaccine receipt among South Asian, Chinese, White, and other ethnicities, respectively. Indecision, whether to trust the vaccine or not, was significantly associated with a 70% and 78% reduced odds of vaccine receipt among those who identified as White and of other ethnic groups, respectively. Conclusions: Vaccine receipt among those who identified as South Asian and Chinese in BC was higher than that among the White population. Vaccine mistrust was associated with a lower odds of vaccine receipt in all ethnicities, but it had a lower effect on vaccine receipt among the South Asian and Chinese populations. Future research needs to focus on sources of mistrust to better understand its potential influence on vaccine receipt among visible minorities in Canada. %M 38363596 %R 10.2196/48466 %U https://publichealth.jmir.org/2024/1/e48466 %U https://doi.org/10.2196/48466 %U http://www.ncbi.nlm.nih.gov/pubmed/38363596 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 4 %N %P e44395 %T The Role of Social Media in Knowledge, Perceptions, and Self-Reported Adherence Toward COVID-19 Prevention Guidelines: Cross-Sectional Study %A Garrett,Camryn %A Qiao,Shan %A Li,Xiaoming %+ Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, The University of South Carolina, Discovery Building I, 915 Greene Street, Columbia, SC, 29208, United States, 1 803 777 6844, camrynmg@email.sc.edu %K COVID-19 %K digital media %K social media %K TikTok %K Instagram %K Twitter %K Facebook %K prevention guidelines %D 2024 %7 16.2.2024 %9 Original Paper %J JMIR Infodemiology %G English %X Background: Throughout the COVID-19 pandemic, social media has served as a channel of communication, a venue for entertainment, and a mechanism for information dissemination. Objective: This study aims to assess the associations between social media use patterns; demographics; and knowledge, perceptions, and self-reported adherence toward COVID-19 prevention guidelines, due to growing and evolving social media use. Methods: Quota-sampled data were collected through a web-based survey of US adults through the Qualtrics platform, from March 15, 2022, to March 23, 2022, to assess covariates (eg, demographics, vaccination, and political affiliation), frequency of social media use, social media sources of COVID-19 information, as well as knowledge, perceptions, and self-reported adherence toward COVID-19 prevention guidelines. Three linear regression models were used for data analysis. Results: A total of 1043 participants responded to the survey, with an average age of 45.3 years, among which 49.61% (n=515) of participants were men, 66.79% (n=696) were White, 11.61% (n=121) were Black or African American, 13.15% (n=137) were Hispanic or Latino, 37.71% (n=382) were Democrat, 30.21% (n=306) were Republican, and 25% (n=260) were not vaccinated. After controlling for covariates, users of TikTok (β=–.29, 95% CI –0.58 to –0.004; P=.047) were associated with lower knowledge of COVID-19 guidelines, users of Instagram (β=–.40, 95% CI –0.68 to –0.12; P=.005) and Twitter (β=–.33, 95% CI –0.58 to –0.08; P=.01) were associated with perceiving guidelines as strict, and users of Facebook (β=–.23, 95% CI –0.42 to –0.043; P=.02) and TikTok (β=–.25, 95% CI –0.5 to -0.009; P=.04) were associated with lower adherence to the guidelines (R2 0.06-0.23). Conclusions: These results allude to the complex interactions between online and physical environments. Future interventions should be tailored to subpopulations based on their demographics and social media site use. Efforts to mitigate misinformation and implement digital public health policy must account for the impact of the digital landscape on knowledge, perceptions, and level of adherence toward prevention guidelines for effective pandemic control. %M 38194493 %R 10.2196/44395 %U https://infodemiology.jmir.org/2024/1/e44395 %U https://doi.org/10.2196/44395 %U http://www.ncbi.nlm.nih.gov/pubmed/38194493 %0 Journal Article %@ 2561-1011 %I JMIR Publications %V 8 %N %P e51439 %T Factors That Influence Patient Satisfaction With the Service Quality of Home-Based Teleconsultation During the COVID-19 Pandemic: Cross-Sectional Survey Study %A Meng,Guangxia %A McAiney,Carrie %A McKillop,Ian %A Perlman,Christopher M %A Tsao,Shu-Feng %A Chen,Helen %+ School of Public Health Sciences, University of Walterloo, 200 University Ave W, Waterloo, ON, N2L 3G1, Canada, 1 519 888 4567 ext 42131, helen.chen@uwaterloo.ca %K teleconsultation %K secondary stroke prevention %K telemedicine %K service quality %K patient satisfaction %D 2024 %7 16.2.2024 %9 Original Paper %J JMIR Cardio %G English %X Background: Ontario stroke prevention clinics primarily held in-person visits before the COVID-19 pandemic and then had to shift to a home-based teleconsultation delivery model using telephone or video to provide services during the pandemic. This change may have affected service quality and patient experiences. Objective: This study seeks to understand patient satisfaction with Ontario stroke prevention clinics’ rapid shift to a home-based teleconsultation delivery model used during the COVID-19 pandemic. The research question explores explanatory factors affecting patient satisfaction. Methods: Using a cross-sectional service performance model, we surveyed patients who received telephone or video consultations at 2 Ontario stroke prevention clinics in 2021. This survey included closed- and open-ended questions. We used logistic regression and qualitative content analysis to understand factors affecting patient satisfaction with the quality of home-based teleconsultation services. Results: The overall response rate to the web survey was 37.2% (128/344). The quantitative analysis was based on 110 responses, whereas the qualitative analysis included 97 responses. Logistic regression results revealed that responsiveness (adjusted odds ratio [AOR] 0.034, 95% CI 0.006-0.188; P<.001) and empathy (AOR 0.116, 95% CI 0.017-0.800; P=.03) were significant factors negatively associated with low satisfaction (scores of 1, 2, or 3 out of 5). The only characteristic positively associated with low satisfaction was when survey consent was provided by the substitute decision maker (AOR 6.592, 95% CI 1.452-29.927; P=.02). In the qualitative content analysis, patients with both low and high global satisfaction scores shared the same factors of service dissatisfaction (assurance, reliability, and empathy). The main subcategories associated with dissatisfaction were missing clinical activities, inadequate communication, administrative process issues, and absence of personal connection. Conversely, the high-satisfaction group offered more positive feedback on assurance, reliability, and empathy, as well as on having a competent clinician, appropriate patient selection, and excellent communication and empathy skills. Conclusions: The insights gained from this study can be considered when designing home-based teleconsultation services to enhance patient experiences in stroke prevention care. %M 38363590 %R 10.2196/51439 %U https://cardio.jmir.org/2024/1/e51439 %U https://doi.org/10.2196/51439 %U http://www.ncbi.nlm.nih.gov/pubmed/38363590 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e40491 %T Learning From COVID-19: What Would It Take to Be Better Prepared in the Eastern Mediterranean Region? %A Kufoof,Lara %A Hajjeh,Rana %A Al Nsour,Mohannad %A Saad,Randa %A Bélorgeot,Victoria %A Abubakar,Abdinasir %A Khader,Yousef %A Rawaf,Salman %+ Department of Public Health, Faculty of Medicine, Jordan University of Science and Technology, Alramtha-Amman Street, Irbid, 22110, Jordan, 962 796802040, yskhader@just.edu.jo %K COVID-19 %K integration %K pandemic preparedness %K primary health care %K public health %D 2024 %7 15.2.2024 %9 Viewpoint %J JMIR Public Health Surveill %G English %X The COVID-19 transmission in the Eastern Mediterranean Region (EMR) was influenced by various factors such as conflict, demographics, travel and social restrictions, migrant workers, weak health systems, and mass gatherings. The countries that responded well to COVID-19 had high-level political commitment, multisectoral coordination, and existing infrastructures that could quickly mobilize. However, some EMR countries faced challenges due to political instability and fragile health systems, which hindered their response strategies. The pandemic highlighted the region’s weak health systems and preparedness, fragmented surveillance systems, and lack of trust in information sharing. COVID-19 exposed the disruption of access and delivery of essential health services as a major health system fragility. In 2020, the World Health Organization (WHO) conducted a global pulse survey, which demonstrated that the EMR experienced the highest disruption in health services compared to other WHO regions. However, thanks to prioritization by the WHO and its member states, significant improvement was observed in 2021 during the second round of the WHO’s National Pulse Survey. The pandemic underscored the importance of political leadership, community engagement, and trust and emphasized that investing in health security benefits everyone. Increasing vaccine coverage, building regional capacities, strengthening health systems, and working toward universal health coverage and health security are all priorities in the EMR. Emergency public health plays a key role in preparing for and responding to pandemics and biological threats. Integrating public health into primary care and investing in public health workforce capacity building is essential to reshaping public health and health emergency preparedness. %M 38359418 %R 10.2196/40491 %U https://publichealth.jmir.org/2024/1/e40491 %U https://doi.org/10.2196/40491 %U http://www.ncbi.nlm.nih.gov/pubmed/38359418 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e48430 %T Impact of the COVID-19 Pandemic on People Living With Rare Diseases and Their Families: Results of a National Survey %A Macaluso,Maurizio %A Rothenberg,Marc E %A Ferkol,Thomas %A Kuhnell,Pierce %A Kaminski,Henry J %A Kimberlin,David W %A Benatar,Michael %A Chehade,Mirna %A , %+ Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave - MLC 5041, Cincinnati, OH, 45229, United States, 1 513 636 2710, maurizio.macaluso@cchmc.org %K rare diseases %K rare %K chronic %K COVID-19 infection %K cross-sectional survey %K access to care %K changes in symptoms and use of medications %K psychological impact on self and family %K access %K accessibility %K cross-sectional %K national %K nationwide %K survey %K surveys %K COVID-19 %K SARS-CoV-2 %K coronavirus %K comorbid %K comorbidity %K vulnerable %D 2024 %7 14.2.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: With more than 103 million cases and 1.1 million deaths, the COVID-19 pandemic has had devastating consequences for the health system and the well-being of the entire US population. The Rare Diseases Clinical Research Network funded by the National Institutes of Health was strategically positioned to study the impact of the pandemic on the large, vulnerable population of people living with rare diseases (RDs). Objective: This study was designed to describe the characteristics of COVID-19 in the RD population, determine whether patient subgroups experienced increased occurrence or severity of infection and whether the pandemic changed RD symptoms and treatment, and understand the broader impact on respondents and their families. Methods: US residents who had an RD and were <90 years old completed a web-based survey investigating self-reported COVID-19 infection, pandemic-related changes in RD symptoms and medications, access to care, and psychological impact on self and family. We estimated the incidence of self-reported COVID-19 and compared it with that in the US population; evaluated the frequency of COVID-19 symptoms according to self-reported infection; assessed infection duration, complications and need for hospitalization; assessed the influence of the COVID-19 pandemic on RD symptoms and treatment, and whether the pandemic influenced access to care, special food and nutrition, or demand for professional psychological assistance. Results: Between May 2, 2020, and December 15, 2020, in total, 3413 individuals completed the survey. Most were female (2212/3413, 64.81%), White (3038/3413, 89.01%), and aged ≥25 years (2646/3413, 77.53%). Overall, 80.6% (2751/3413) did not acquire COVID-19, 2.08% (71/3413) acquired it, and 16.58% (566/3413) did not know. Self-reported cases represented an annual incidence rate of 2.2% (95% CI 1.7%-2.8%). COVID-19 cases were more than twice the expected (71 vs 30.3; P<.001). COVID-19 was associated with specific symptoms (loss of taste: odds ratio [OR] 38.9, 95% CI 22.4-67.6, loss of smell: OR 30.6, 95% CI 17.7-53.1) and multiple symptoms (>9 symptoms vs none: OR 82.5, 95% CI 29-234 and 5-9: OR 44.8, 95% CI 18.7-107). Median symptom duration was 16 (IQR 9-30) days. Hospitalization (7/71, 10%) and ventilator support (4/71, 6%) were uncommon. Respondents who acquired COVID-19 reported increased occurrence and severity of RD symptoms and use or dosage of select medications; those who did not acquire COVID-19 reported decreased occurrence and severity of RD symptoms and use of medications; those who did not know had an intermediate pattern. The pandemic made it difficult to access care, receive treatment, get hospitalized, and caused mood changes for respondents and their families. Conclusions: Self-reported COVID-19 was more frequent than expected and was associated with increased prevalence and severity of RD symptoms and greater use of medications. The pandemic negatively affected access to care and caused mood changes in the respondents and family members. Continued surveillance is necessary. %M 38354030 %R 10.2196/48430 %U https://publichealth.jmir.org/2024/1/e48430 %U https://doi.org/10.2196/48430 %U http://www.ncbi.nlm.nih.gov/pubmed/38354030 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e41792 %T The Effect of the COVID-19 Pandemic on Non–COVID-19 Deaths: Population-Wide Retrospective Cohort Study %A Wai,Abraham Ka-chung %A Yip,Tsz Fung %A Wong,Yui Hang %A Chu,Chun Kit %A Lee,Teddy %A Yu,Ken Hung On %A So,Wang Leong %A Wong,Janet Y H %A Wong,Carlos King-ho %A Ho,Joshua W %A Rainer,Timothy %+ School of Biomedical Sciences, The University of Hong Kong, L4-44, Laboratory Block, 21 Sassoon Road, Hong Kong, China (Hong Kong), 852 6518 4979, jwkho@hku.hk %K excess death %K causal inference %K health care avoidance %K emergency department %K COVID-19 %K hospital avoidance behavior %K mortality %K epidemiology %K health care %K hospital care %K death rate %K death %K hospital %K avoidance %K population %K cohort %K death toll %K impact %K excess %K Hong Kong %D 2024 %7 13.2.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Health care avoidance in the COVID-19 pandemic has been widely reported. Yet few studies have investigated the dynamics of hospital avoidance behavior during pandemic waves and inferred its impact on excess non–COVID-19 deaths. Objective: This study aimed to measure the impact of hospital avoidance on excess non–COVID-19 deaths in public hospitals in Hong Kong. Methods: This was a retrospective cohort study involving 11,966,786 patients examined between January 1, 2016, and December 31, 2021, in Hong Kong. All data were linked to service, treatment, and outcomes. To estimate excess mortality, the 2-stage least squares method was used with daily tallies of emergency department (ED) visits and 28-day mortality. Records for older people were categorized by long-term care (LTC) home status, and comorbidities were used to explain the demographic and clinical attributes of excess 28-day mortality. The primary outcome was actual excess death in 2020 and 2021. The 2-stage least squares method was used to estimate the daily excess 28-day mortality by daily reduced visits. Results: Compared with the prepandemic (2016-2019) average, there was a reduction in total ED visits in 2020 of 25.4% (548,116/2,142,609). During the same period, the 28-day mortality of non–COVID-19 ED deaths increased by 7.82% (2689/34,370) compared with 2016-2019. The actual excess deaths in 2020 and 2021 were 3143 and 4013, respectively. The estimated total excess non–COVID-19 28-day deaths among older people in 2020 to 2021 were 1958 (95% CI 1100-2820; no time lag). Deaths on arrival (DOAs) or deaths before arrival (DBAs) increased by 33.6% (1457/4336) in 2020, while non–DOA/DBAs increased only by a moderate 4.97% (1202/24,204). In both types of deaths, the increases were higher during wave periods than in nonwave periods. Moreover, non-LTC patients saw a greater reduction in ED visits than LTC patients across all waves, by more than 10% (non-LTC: 93,896/363,879, 25.8%; LTC: 7,956/67,090, 11.9%). Most of the comorbidity subsets demonstrated an annualized reduction in visits in 2020. Renal diseases and severe liver diseases saw notable increases in deaths. Conclusions: We demonstrated a statistical method to estimate hospital avoidance behavior during a pandemic and quantified the consequent excess 28-day mortality with a focus on older people, who had high frequencies of ED visits and deaths. This study serves as an informed alert and possible investigational guideline for health care professionals for hospital avoidance behavior and its consequences. %M 38349717 %R 10.2196/41792 %U https://publichealth.jmir.org/2024/1/e41792 %U https://doi.org/10.2196/41792 %U http://www.ncbi.nlm.nih.gov/pubmed/38349717 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e47441 %T A Digital Respiratory Ward in Leicester, Leicestershire, and Rutland, England, for Patients With COVID-19: Economic Evaluation of the Impact on Acute Capacity and Wider National Health Service Resource Use %A Swift,Jim %A O'Kelly,Noel %A Barker,Chris %A Woodward,Alex %A Ghosh,Sudip %+ Spirit Health, Spirit House, Saffron Way, Leicester, LE2 6UP, United Kingdom, 44 1162865000, jim.swift@spirit-health.com %K Covid-19 %K telemedicine %K digital technology %K home transition %K length of stay %K cost-effectiveness analysis %K cost %K costs %K economic %K economics %K telehealth %K hospitalization %K hospital %K hospitals %K hospitalizations %K resource %K resources %K hospital stay %K ward %K wards %K virtual care %K remote care %K financial %K finance %K finances %K remote %K respiratory %K SARS-CoV-2 %K pulmonary %K lung %K lungs %K service %K services %K delivery %D 2024 %7 13.2.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic stressed global health care systems’ acute capacity and caused a diversion of resources from elective care to the treatment of acute respiratory disease. In preparing for a second wave of COVID-19 infections, England’s National Health Service (NHS) in Leicester, Leicestershire, and Rutland sought to protect acute capacity in the winter of 2020-2021. Their plans included the introduction of a digital ward where patients were discharged home early and supported remotely by community-based respiratory specialists, who were informed about patient health status by a digital patient monitoring system. Objective: The objective of the digital ward was to maintain acute capacity through safe, early discharge of patients with COVID-19 respiratory disease. The study objective was to establish what impact this digital ward had on overall NHS resource use. Methods: There were no expected differences in patient outcomes. A cost minimization was performed to demonstrate the impact on the NHS resource use from discharging patients into a digital COVID-19 respiratory ward, compared to acute care length of stay (LOS). This evaluation included all 310 patients enrolled in the service from November 2020 (service commencement) to November 2021. Two primary methods, along with sensitivity analyses, were used to help overcome the uncertainty associated with the estimated comparators for the observational data on COVID-19 respiratory acute LOS, compared with the actual LOS of the 279 (90%) patients who were not discharged on oxygen nor were in critical care. Historic comparative LOS and an ordinary least squares model based on local monthly COVID-19 respiratory median LOS were used as comparators. Actual comparator data were sourced for the 31 (10%) patients who were discharged home and into the digital ward for oxygen weaning. Resource use associated with delivering care in the digital ward was sourced from the digital system and respiratory specialists. Results: In the base case, the digital ward delivered estimated health care system savings of 846.5 bed-days and US $504,197 in net financial savings across the 2 key groups of patients—those on oxygen and those not on oxygen at acute discharge (both P<.001). The mean gross and net savings per patient were US $1850 and US $1626 in the base case, respectively, without including any savings associated with a potential reduction in readmissions. The 30-day readmission rate was 2.9%, which was below comparative data. The mean cost of the intervention was US $223.53 per patient, 12.1% of the estimated gross savings. It was not until the costs were increased and the effect reduced simultaneously by 78.4% in the sensitivity analysis that the intervention was no longer cost saving. Conclusions: The digital ward delivered increased capacity and substantial financial savings and did so with a high degree of confidence, at a very low absolute and relative cost. %M 38349716 %R 10.2196/47441 %U https://formative.jmir.org/2024/1/e47441 %U https://doi.org/10.2196/47441 %U http://www.ncbi.nlm.nih.gov/pubmed/38349716 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e51640 %T Limitations of the Cough Sound-Based COVID-19 Diagnosis Artificial Intelligence Model and its Future Direction: Longitudinal Observation Study %A Kim,Jina %A Choi,Yong Sung %A Lee,Young Joo %A Yeo,Seung Geun %A Kim,Kyung Won %A Kim,Min Seo %A Rahmati,Masoud %A Yon,Dong Keon %A Lee,Jinseok %+ Department of Biomedical Engineering, Kyung Hee University, 1732 Deogyeong-daero, Giheung-gu, Seoul, 17104, Republic of Korea, 82 2 6935 2476, gonasago@khu.ac.kr %K COVID-19 variants %K cough sound %K artificial intelligence %K diagnosis %K human lifestyle %K SARS-CoV-2 %K AI model %K cough %K sound-based %K diagnosis %K sounds app %K development %K COVID-19 %K AI %D 2024 %7 6.2.2024 %9 Short Paper %J J Med Internet Res %G English %X Background: The outbreak of SARS-CoV-2 in 2019 has necessitated the rapid and accurate detection of COVID-19 to manage patients effectively and implement public health measures. Artificial intelligence (AI) models analyzing cough sounds have emerged as promising tools for large-scale screening and early identification of potential cases. Objective: This study aimed to investigate the efficacy of using cough sounds as a diagnostic tool for COVID-19, considering the unique acoustic features that differentiate positive and negative cases. We investigated whether an AI model trained on cough sound recordings from specific periods, especially the early stages of the COVID-19 pandemic, were applicable to the ongoing situation with persistent variants. Methods: We used cough sound recordings from 3 data sets (Cambridge, Coswara, and Virufy) representing different stages of the pandemic and variants. Our AI model was trained using the Cambridge data set with subsequent evaluation against all data sets. The performance was analyzed based on the area under the receiver operating curve (AUC) across different data measurement periods and COVID-19 variants. Results: The AI model demonstrated a high AUC when tested with the Cambridge data set, indicative of its initial effectiveness. However, the performance varied significantly with other data sets, particularly in detecting later variants such as Delta and Omicron, with a marked decline in AUC observed for the latter. These results highlight the challenges in maintaining the efficacy of AI models against the backdrop of an evolving virus. Conclusions: While AI models analyzing cough sounds offer a promising noninvasive and rapid screening method for COVID-19, their effectiveness is challenged by the emergence of new virus variants. Ongoing research and adaptations in AI methodologies are crucial to address these limitations. The adaptability of AI models to evolve with the virus underscores their potential as a foundational technology for not only the current pandemic but also future outbreaks, contributing to a more agile and resilient global health infrastructure. %M 38319694 %R 10.2196/51640 %U https://www.jmir.org/2024/1/e51640 %U https://doi.org/10.2196/51640 %U http://www.ncbi.nlm.nih.gov/pubmed/38319694 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e45429 %T Impact of the COVID-19 Pandemic on the Personal Networks and Neurological Outcomes of People With Multiple Sclerosis: Cross-Sectional and Longitudinal Case-Control Study %A Riley,Claire %A Venkatesh,Shruthi %A Dhand,Amar %A Doshi,Nandini %A Kavak,Katelyn %A Levit,Elle %A Perrone,Christopher %A Weinstock-Guttman,Bianca %A Longbrake,Erin %A De Jager,Philip %A Xia,Zongqi %+ University of Pittsburgh, 3501 Fifth Ave, BST3-10.044, Pittsburgh, PA, 15260, United States, 1 412 383 5377, zxia1@post.harvard.edu %K neurology %K neurodegenerative disease %K multiple sclerosis %K personal networks %K COVID-19 %D 2024 %7 6.2.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The coronavirus disease 2019 (COVID-19) pandemic has negatively affected the social fabric. Objective: We evaluated the associations between personal social networks and neurological function in people with multiple sclerosis (pwMS) and controls in the prepandemic and pandemic periods. Methods: During the early pandemic (March-December 2020), 8 cohorts of pwMS and controls completed a questionnaire quantifying the structure and composition of their personal social networks, including the health behaviors of network members. Participants from 3 of the 8 cohorts had additionally completed the questionnaire before the pandemic (2017-2019). We assessed neurological function using 3 interrelated patient-reported outcomes: Patient Determined Disease Steps (PDDS), Multiple Sclerosis Rating Scale-Revised (MSRS-R), and Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function. We identified the network features associated with neurological function using paired 2-tailed t tests and covariate-adjusted regressions. Results: In the cross-sectional analysis of the pandemic data from 1130 pwMS and 1250 controls during the pandemic, having a higher percentage of network members with a perceived negative health influence was associated with worse disability in pwMS (MSRS-R: β=2.181, 95% CI 1.082-3.279; P<.001) and poor physical function in controls (PROMIS Physical Function: β=–5.707, 95% CI –7.405 to –4.010; P<.001). In the longitudinal analysis of 230 pwMS and 136 controls, the networks of all participants contracted, given an increase in constraint (pwMS-prepandemic: mean 52.24, SD 15.81; pwMS-pandemic: mean 56.77, SD 18.91; P=.006. Controls-prepandemic: mean 48.07, SD 13.36; controls-pandemic: mean 53.99, SD 16.31; P=.001) and a decrease in network size (pwMS-prepandemic: mean 8.02, SD 5.70; pwMS-pandemic: mean 6.63, SD 4.16; P=.003. Controls-prepandemic: mean 8.18, SD 4.05; controls-pandemic: mean 6.44, SD 3.92; P<.001), effective size (pwMS-prepandemic: mean 3.30, SD 1.59; pwMS-pandemic: mean 2.90, SD 1.50; P=.007. Controls-prepandemic: mean 3.85, SD 1.56; controls-pandemic: mean 3.40, SD 1.55; P=.01), and maximum degree (pwMS-prepandemic: mean 4.78, SD 1.86; pwMS-pandemic: mean 4.32, SD 1.92; P=.01. Controls-prepandemic: mean 5.38, SD 1.94; controls-pandemic: mean 4.55, SD 2.06; P<.001). These network changes were not associated with worsening function. The percentage of kin in the networks of pwMS increased (mean 46.06%, SD 29.34% to mean 54.36%, SD 30.16%; P=.003) during the pandemic, a change that was not seen in controls. Conclusions: Our findings suggest that high perceived negative health influence in the network was associated with worse function in all participants during the pandemic. The networks of all participants became tighter knit, and the percentage of kin in the networks of pwMS increased during the pandemic. Despite these perturbations in social connections, network changes from the prepandemic to the pandemic period were not associated with worsening function in all participants, suggesting possible resilience. %M 38319703 %R 10.2196/45429 %U https://publichealth.jmir.org/2024/1/e45429 %U https://doi.org/10.2196/45429 %U http://www.ncbi.nlm.nih.gov/pubmed/38319703 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 4 %N %P e37881 %T Verification in the Early Stages of the COVID-19 Pandemic: Sentiment Analysis of Japanese Twitter Users %A Ueda,Ryuichiro %A Han,Feng %A Zhang,Hongjian %A Aoki,Tomohiro %A Ogasawara,Katsuhiko %+ Faculty of Health Sciences, Hokkaido University, N12-W5, Kita-ku, Sapporo, 060-0812, Japan, 81 11 706 3409, oga@hs.hokudai.ac.jp %K COVID-19 %K sentiment analysis %K Twitter %K infodemiology %K NLP %K Natural Language Processing %D 2024 %7 6.2.2024 %9 Original Paper %J JMIR Infodemiology %G English %X Background: The COVID-19 pandemic prompted global behavioral restrictions, impacting public mental health. Sentiment analysis, a tool for assessing individual and public emotions from text data, gained importance amid the pandemic. This study focuses on Japan’s early public health interventions during COVID-19, utilizing sentiment analysis in infodemiology to gauge public sentiment on social media regarding these interventions. Objective: This study aims to investigate shifts in public emotions and sentiments before and after the first state of emergency was declared in Japan. By analyzing both user-generated tweets and retweets, we aim to discern patterns in emotional responses during this critical period. Methods: We conducted a day-by-day analysis of Twitter (now known as X) data using 4,894,009 tweets containing the keywords “corona,” “COVID-19,” and “new pneumonia” from March 23 to April 21, 2020, approximately 2 weeks before and after the first declaration of a state of emergency in Japan. We also processed tweet data into vectors for each word, employing the Fuzzy-C-Means (FCM) method, a type of cluster analysis, for the words in the sentiment dictionary. We set up 7 sentiment clusters (negative: anger, sadness, surprise, disgust; neutral: anxiety; positive: trust and joy) and conducted sentiment analysis of the tweet groups and retweet groups. Results: The analysis revealed a mix of positive and negative sentiments, with “joy” significantly increasing in the retweet group after the state of emergency declaration. Negative emotions, such as “worry” and “disgust,” were prevalent in both tweet and retweet groups. Furthermore, the retweet group had a tendency to share more negative content compared to the tweet group. Conclusions: This study conducted sentiment analysis of Japanese tweets and retweets to explore public sentiments during the early stages of COVID-19 in Japan, spanning 2 weeks before and after the first state of emergency declaration. The analysis revealed a mix of positive (joy) and negative (anxiety, disgust) emotions. Notably, joy increased in the retweet group after the emergency declaration, but this group also tended to share more negative content than the tweet group. This study suggests that the state of emergency heightened positive sentiments due to expectations for infection prevention measures, yet negative information also gained traction. The findings propose the potential for further exploration through network analysis. %M 38127840 %R 10.2196/37881 %U https://infodemiology.jmir.org/2024/1/e37881 %U https://doi.org/10.2196/37881 %U http://www.ncbi.nlm.nih.gov/pubmed/38127840 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e47453 %T Profiles of Cough and Associated Risk Factors in Nonhospitalized Individuals With SARS-CoV-2 Omicron Variant Infection: Cross-Sectional Online Survey in China %A Xu,Tingting %A Chen,Yuehan %A Zhan,Wenzhi %A Chung,Kian Fan %A Qiu,Zhongmin %A Huang,Kewu %A Chen,Ruchong %A Xie,Jiaxing %A Wang,Gang %A Zhang,Min %A Wang,Xuefen %A Yao,Hongmei %A Liao,Xiuqing %A Zhang,Yunhui %A Zhang,Guojun %A Zhang,Wei %A Sun,Dejun %A Zhu,Jia %A Jiang,Shujuan %A Feng,Juntao %A Zhao,Jianping %A Sun,Gengyun %A Huang,Huaqiong %A Zhang,Jianyong %A Wang,Lingwei %A Wu,Feng %A Li,Suyun %A Xu,Pusheng %A Chi,Chunhua %A Chen,Ping %A Jiang,Mei %A He,Wen %A Huang,Lianrong %A Luo,Wei %A Li,Shiyue %A Zhong,Nanshan %A Lai,Kefang %A , %+ State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, 151 Yanjiang Rd, Guangzhou, 510000, China, 86 18826437341, klai@163.com %K COVID-19 %K Omicron variant %K nonhospitalized %K cough %D 2024 %7 5.2.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Cough is a common symptom during and after COVID-19 infection; however, few studies have described the cough profiles of COVID-19. Objective: The aim of this study was to investigate the prevalence, severity, and associated risk factors of severe and persistent cough in individuals with COVID-19 during the latest wave of the Omicron variant in China. Methods: In this nationwide cross-sectional study, we collected information of the characteristics of cough from individuals with infection of the SARS-CoV-2 Omicron variant using an online questionnaire sent between December 31, 2022, and January 11, 2023. Results: There were 11,718 (n=7978, 68.1% female) nonhospitalized responders, with a median age of 37 (IQR 30-47) years who responded at a median of 16 (IQR 12-20) days from infection onset to the time of the survey. Cough was the most common symptom, occurring in 91.7% of participants, followed by fever, fatigue, and nasal congestion (68.8%-87.4%). The median cough visual analog scale (VAS) score was 70 (IQR 50-80) mm. Being female (odds ratio [OR] 1.31, 95% CI 1.20-1.43), having a COVID-19 vaccination history (OR 1.71, 95% CI 1.37-2.12), current smoking (OR 0.48, 95% CI 0.41-0.58), chronic cough (OR 2.04, 95% CI 1.69-2.45), coronary heart disease (OR 1.71, 95% CI 1.17-2.52), asthma (OR 1.22, 95% CI 1.02-1.46), and gastroesophageal reflux disease (GERD) (OR 1.21, 95% CI 1.01-1.45) were independent factors for severe cough (VAS>70, 37.4%). Among all respondents, 35.0% indicated having a productive cough, which was associated with risk factors of being female (OR 1.44, 95% CI 1.31-1.57), having asthma (OR 1.84, 95% CI 1.52-2.22), chronic cough (OR 1.44, 95% CI 1.19-1.74), and GERD (OR 1.22, 95% CI 1.01-1.47). Persistent cough (>3 weeks) occurred in 13.0% of individuals, which was associated with the risk factors of having diabetes (OR 2.24, 95% CI 1.30-3.85), asthma (OR 1.70, 95% CI 1.11-2.62), and chronic cough (OR 1.97, 95% CI 1.32-2.94). Conclusions: Cough is the most common symptom in nonhospitalized individuals with Omicron SARS-CoV-2 variant infection. Being female, having asthma, chronic cough, GERD, coronary heart disease, diabetes, and a COVID-19 vaccination history emerged as independent factors associated with severe cough, productive cough, and persistent cough. %M 38315527 %R 10.2196/47453 %U https://publichealth.jmir.org/2024/1/e47453 %U https://doi.org/10.2196/47453 %U http://www.ncbi.nlm.nih.gov/pubmed/38315527 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e50388 %T Perceptions of the Agency and Responsibility of the NHS COVID-19 App on Twitter: Critical Discourse Analysis %A Heaton,Dan %A Nichele,Elena %A Clos,Jérémie %A Fischer,Joel E %+ School of Computer Science, University of Nottingham, Wollaton Road, Nottingham, NG8 1BB, United Kingdom, 44 115 951 5151, daniel.heaton@nottingham.ac.uk %K COVID-19 %K information system %K automated decisions %K agency metaphor %K corpus linguistics %K decision-making algorithm %K transitivity %D 2024 %7 1.2.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Since September 2020, the National Health Service (NHS) COVID-19 contact-tracing app has been used to mitigate the spread of COVID-19 in the United Kingdom. Since its launch, this app has been a part of the discussion regarding the perceived social agency of decision-making algorithms. On the social media website Twitter, a plethora of views about the app have been found but only analyzed for sentiment and topic trajectories thus far, leaving the perceived social agency of the app underexplored. Objective: We aimed to examine the discussion of social agency in social media public discourse regarding algorithm-operated decisions, particularly when the artificial intelligence agency responsible for specific information systems is not openly disclosed in an example such as the COVID-19 contact-tracing app. To do this, we analyzed the presentation of the NHS COVID-19 App on Twitter, focusing on the portrayal of social agency and the impact of its deployment on society. We also aimed to discover what the presentation of social agents communicates about the perceived responsibility of the app. Methods: Using corpus linguistics and critical discourse analysis, underpinned by social actor representation, we used the link between grammatical and social agency and analyzed a corpus of 118,316 tweets from September 2020 to July 2021 to see whether the app was portrayed as a social actor. Results: We found that active presentations of the app—seen mainly through personalization and agency metaphor—dominated the discourse. The app was presented as a social actor in 96% of the cases considered and grew in proportion to passive presentations over time. These active presentations showed the app to be a social actor in 5 main ways: informing, instructing, providing permission, disrupting, and functioning. We found a small number of occasions on which the app was presented passively through backgrounding and exclusion. Conclusions: Twitter users presented the NHS COVID-19 App as an active social actor with a clear sense of social agency. The study also revealed that Twitter users perceived the app as responsible for their welfare, particularly when it provided instructions or permission, and this perception remained consistent throughout the discourse, particularly during significant events. Overall, this study contributes to understanding how social agency is discussed in social media discourse related to algorithmic-operated decisions This research offers valuable insights into public perceptions of decision-making digital contact-tracing health care technologies and their perceptions on the web, which, even in a postpandemic world, may shed light on how the public might respond to forthcoming interventions. %M 38300688 %R 10.2196/50388 %U https://www.jmir.org/2024/1/e50388 %U https://doi.org/10.2196/50388 %U http://www.ncbi.nlm.nih.gov/pubmed/38300688 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e43943 %T The Effect of a Video-Assisted Health Education Program Followed by Peer Education on the Health Literacy of COVID-19 and Other Infectious Diseases Among School Children: Quasi-Randomized Controlled Trial %A Zhang,Xiaojuan %A Wen,Yingkun Justin %A Han,Ning %A Jiang,Yawen %+ School of Public Health (Shenzhen), Sun Yat-sen University, Room 533, West Wing of Medical Complex #1, Sun Yat-sen University, 66 Gongchang Road, Guangming District Shenzhen, Shenzhen, Guangdong, China, 86 13632974660, jiangyw26@mail.sysu.edu.cn %K infectious diseases %K primary school students %K quasi-randomized controlled trial %K video-assisted health education %K peer education %K item response theory %K IRT %D 2024 %7 29.1.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: To improve the engagement and effectiveness of traditional health programs, it is necessary to explore alternative models of health education including video-assisted lectures and peer education. Objective: This study aimed to evaluate the effects of a combination of video-assisted lectures and peer education on health literacy related to infectious diseases among students. Methods: Third-grade classes from 11 pilot schools in Longgang District of Shenzhen, China, were randomized to the intervention and control groups. In the intervention group, a video-assisted interactive health education program was conducted twice over a time span of 5 months. Each of the 2 sessions included a 40-minute lecture on COVID-19 and other common infectious diseases in schools and a 5-minute science video. In addition, 5 “little health supervisors” at the end of the first session were elected in each class, who were responsible for helping class members to learn health knowledge and develop good hygiene habits. Students answered the same quiz before the first and after the second session. Models based on item response theory (IRT) were constructed to score the students’ knowledge of infectious diseases based on the quiz. Results: In total, 52 classes and 2526 students (intervention group: n=1311; control group: n=1215) were enrolled. Responses of the baseline survey were available for 2177 (86.2%; intervention group: n=1306; control group: n=871) students and those of the postintervention survey were available for 1862 (73.7%; intervention group: n=1187; control group: n=675). There were significant cross-group differences in the rates of correctly answering questions about influenza symptoms, transmission, and preventive measures; chicken pox symptoms; norovirus diarrhea symptoms; mumps symptoms; and COVID-19 symptoms. Average IRT scores of questions related to infectious diseases in the intervention and control groups were, respectively, –0.0375 (SD 0.7784) and 0.0477 (SD 0.7481) before the intervention (P=.01), suggesting better baseline knowledge in the control group. After the intervention, the average scores of the intervention and control groups were 0.0543 (SD 0.7569) and –0.1115 (SD 0.7307), respectively (P<.001), suggesting not only significantly better scores but also greater improvement in the intervention group. Conclusions: After the health education project, the correct answer rate of infectious disease questions in the intervention group was higher than that of the control group, which indicates significant effects of the combination of video-assisted lectures and peer education for the promotion of health literacy. In addition, the intervention effect of the first session persisted for at least 4 months up to the second session. As such, the proposed program was effective in improving the health literacy of school children in relation to infectious diseases and should be considered for massive health promotion campaigns during pandemics. Trial Registration: ISRCTN ISRCTN49297995; https://www.isrctn.com/ISRCTN49297995 %M 38285496 %R 10.2196/43943 %U https://humanfactors.jmir.org/2024/1/e43943 %U https://doi.org/10.2196/43943 %U http://www.ncbi.nlm.nih.gov/pubmed/38285496 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e47048 %T Depression and Anxiety Symptoms Among Cisgender Gay and Bisexual Men During the Onset of the COVID-19 Pandemic: Time Series Analysis of a US National Cohort Study %A Mirzayi,Chloe %A Westmoreland,Drew %A Stief,Matthew %A Grov,Christian %+ CUNY Graduate School of Public Health and Health Policy, 55 W 125 Street, New York, NY, 10027, United States, 1 6463640254, cgrov@sph.cuny.edu %K COVID-19 pandemic %K lesbian, gay, bisexual, transgender, and queer %K LGBTQ %K mental health %K depression %K anxiety %K time series %K gay and bisexual men %K cisgender gay %K pandemic %K gay %D 2024 %7 26.1.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The onset of the COVID-19 pandemic in the United States in March 2020 caused a dramatic change in the way many people lived. Few aspects of daily life were left undisrupted by the pandemic’s onset as well as the accompanying policies to control the spread of the disease. Previous research has found that the pandemic may have significantly impacted the mental health of lesbian, gay, bisexual, transgender, and queer (LGBTQ) individuals—potentially more so than other individuals. However, the pandemic did not affect all areas of the United States at the same time, and there may be regional variation in the impact of the onset of the pandemic on depressive symptoms among LGBTQ individuals. Objective: To assess regional variation of the impact of the pandemic, we conducted a time series analysis stratified by US geographic region to examine symptoms of depression and anxiety among a sample of primarily cisgender gay and bisexual men before and after the onset of the COVID-19 pandemic in the United States. Methods: In total, 5007 participants completed assessments as part of the Together 5000 study, an ongoing prospective cohort study. Depressive and anxiety symptoms were measured using the Patient Health Questionnaire-4. Patient Health Questionnaire-4 scores were graphed as a function of days from March 15, 2020. Locally estimated scatterplot smoothing trend lines were applied. A sieve-bootstrap Mann-Kendall test for monotonic trend was conducted to assess the presence and direction of trends in the scatterplots. We then compared the observed trends to those observed for 1 year prior (2018-2019) to the pandemic onset using data collected from the same sample. Results: Significant positive trends were detected for the Northeast (P=.03) and Midwest (P=.01) regions of the United States in the 2020 assessment, indicating that symptoms of anxiety and depression were increasing in the sample in these regions immediately prior to and during the onset of the pandemic. In contrast, these trends were not present in data from the 2018 to 2019 assessment window. Conclusions: Symptoms of anxiety and depression increased among the study population in the Northeast and Midwest during the beginning months of the COVID-19 pandemic, but similar increase was not observed in the South and West regions. These trends were also not found for any region in the 2018 to 2019 assessment window. This may indicate region-specific trends in anxiety and depression, potentially driven by the burden of the pandemic and policies that varied from region to region. Future studies should consider geographic variation in COVID-19 spread and policies as well as explore potential mechanisms by which this could influence the mental health of LGBTQ individuals. %M 38277213 %R 10.2196/47048 %U https://publichealth.jmir.org/2024/1/e47048 %U https://doi.org/10.2196/47048 %U http://www.ncbi.nlm.nih.gov/pubmed/38277213 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e46538 %T Challenges and Implications for Menopausal Health and Help-Seeking Behaviors in Midlife Women From the United States and China in Light of the COVID-19 Pandemic: Web-Based Panel Surveys %A Lau,Bobo Hi Po %A Tang,Catherine So Kum %A Holroyd,Eleanor %A Wong,William Chi Wai %+ Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 3/F, Ap Lei Chau Clinic, 161 Main Street, Ap Lei Chau, Hong Kong, China (Hong Kong), 852 25185650, wongwcw@hku.hk %K menopause %K help-seeking %K health beliefs %K telehealth %K COVID-19 %K women %K menopausal health %K women's health %K online survey %K health beliefs %K awareness %K digital health %K symptom management %K health education %D 2024 %7 26.1.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The global population of women of menopausal age is quickly increasing. The COVID-19 pandemic has led to an accelerated increase in the use of telehealth services, especially technological solutions targeting women’s health. Understanding the factors behind midlife women’s help-seeking behaviors amidst the pandemic will assist in the development of person-centered holistic telehealth solutions targeting menopausal and postreproductive health. Objective: This study aimed to compare the factors underlying help-seeking for menopausal distress among midlife women in the United States and China. Methods: We conducted 2 web-based panel surveys in the United States using Amazon Mechanical Turk and in China using Credamo between July and October 2022. A total of 1002 American and 860 Chinese women aged between 40 and 65 years took part in the survey. The survey was designed based on the Health Belief Model with questions related to their menopausal knowledge, perceived severity of menopausal symptoms, perceived susceptibility to menopausal distress, perceived benefits of help-seeking, perceived COVID-19– and non–COVID-19–related barriers against help-seeking, self-efficacy, and motivation to seek help. Structural equations models were fitted for the data using full information maximum likelihood to manage missing data. Results: Knowledge was not directly related to help-seeking motivation in both samples. Among the Chinese sample, knowledge was negatively related to perceived severity but positively related to COVID-19–related barriers; in turn, higher perceived severity, benefits, COVID-19–related barriers, and self-efficacy and lower non–COVID-19–related barriers were related to more motivation to seek help. In the US sample, knowledge was negatively related to perceived severity, susceptibility, benefits, barriers (COVID-19– and non–COVID-19–related), and self-efficacy; in turn, higher self-efficacy, COVID-19–related barriers, and benefits were associated with more help-seeking motivation. The factors explained 53% and 45.3% of the variance of help-seeking motivation among the American and Chinese participants, respectively. Conclusions: This study revealed disparate pathways between knowledge, health beliefs, and the motivation for help-seeking among American and Chinese midlife women with respect to menopausal distress. Our findings show that knowledge may not directly influence help-seeking motivation. Instead, perceived benefits and self-efficacy consistently predicted help-seeking motivation. Interestingly, concern over COVID-19 infection was related to higher help-seeking motivation in both samples. Hence, our findings recommend the further development of telehealth services to (1) develop content beyond health education and symptom management that serves to enhance the perceived benefits of addressing women’s multidimensional menopausal health needs, (2) facilitate patient–care provider communication with a focus on self-efficacy and a propensity to engage in help-seeking behaviors, and (3) target women who have greater midlife health concerns in the postpandemic era. %M 38277194 %R 10.2196/46538 %U https://publichealth.jmir.org/2024/1/e46538 %U https://doi.org/10.2196/46538 %U http://www.ncbi.nlm.nih.gov/pubmed/38277194 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e50150 %T A Comparison of ChatGPT and Fine-Tuned Open Pre-Trained Transformers (OPT) Against Widely Used Sentiment Analysis Tools: Sentiment Analysis of COVID-19 Survey Data %A Lossio-Ventura,Juan Antonio %A Weger,Rachel %A Lee,Angela Y %A Guinee,Emily P %A Chung,Joyce %A Atlas,Lauren %A Linos,Eleni %A Pereira,Francisco %+ National Institute of Mental Health, National Institutes of Health, 3D41, 10 Center Dr, Bethesda, MD, 20814, United States, 1 3018272632, juan.lossio@nih.gov %K sentiment analysis %K COVID-19 survey %K large language model %K few-shot learning %K zero-shot learning %K ChatGPT %K COVID-19 %D 2024 %7 25.1.2024 %9 Original Paper %J JMIR Ment Health %G English %X Background: Health care providers and health-related researchers face significant challenges when applying sentiment analysis tools to health-related free-text survey data. Most state-of-the-art applications were developed in domains such as social media, and their performance in the health care context remains relatively unknown. Moreover, existing studies indicate that these tools often lack accuracy and produce inconsistent results. Objective: This study aims to address the lack of comparative analysis on sentiment analysis tools applied to health-related free-text survey data in the context of COVID-19. The objective was to automatically predict sentence sentiment for 2 independent COVID-19 survey data sets from the National Institutes of Health and Stanford University. Methods: Gold standard labels were created for a subset of each data set using a panel of human raters. We compared 8 state-of-the-art sentiment analysis tools on both data sets to evaluate variability and disagreement across tools. In addition, few-shot learning was explored by fine-tuning Open Pre-Trained Transformers (OPT; a large language model [LLM] with publicly available weights) using a small annotated subset and zero-shot learning using ChatGPT (an LLM without available weights). Results: The comparison of sentiment analysis tools revealed high variability and disagreement across the evaluated tools when applied to health-related survey data. OPT and ChatGPT demonstrated superior performance, outperforming all other sentiment analysis tools. Moreover, ChatGPT outperformed OPT, exhibited higher accuracy by 6% and higher F-measure by 4% to 7%. Conclusions: This study demonstrates the effectiveness of LLMs, particularly the few-shot learning and zero-shot learning approaches, in the sentiment analysis of health-related survey data. These results have implications for saving human labor and improving efficiency in sentiment analysis tasks, contributing to advancements in the field of automated sentiment analysis. %M 38271138 %R 10.2196/50150 %U https://mental.jmir.org/2024/1/e50150 %U https://doi.org/10.2196/50150 %U http://www.ncbi.nlm.nih.gov/pubmed/38271138 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e48159 %T Impact of the COVID-19 Pandemic on Health Care Utilization in the Vaccine Safety Datalink: Retrospective Cohort Study %A Qian,Lei %A Sy,Lina S %A Hong,Vennis %A Glenn,Sungching C %A Ryan,Denison S %A Nelson,Jennifer C %A Hambidge,Simon J %A Crane,Bradley %A Zerbo,Ousseny %A DeSilva,Malini B %A Glanz,Jason M %A Donahue,James G %A Liles,Elizabeth %A Duffy,Jonathan %A Xu,Stanley %+ Research and Evaluation, Kaiser Permanente Southern California, 100 S Los Robles, 5th Floor, Pasadena, CA, 91101, United States, 1 626 564 3538, lei.x.qian@kp.org %K COVID-19 pandemic %K health care utilization %K telehealth %K inpatient %K emergency department %K outpatient %K vaccine safety %K electronic health record %K resource allocation %K difference-in-difference %K interrupted time series analysis %D 2024 %7 23.1.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Understanding the long-term impact of the COVID-19 pandemic on health care utilization is important to health care organizations and policy makers for strategic planning, as well as to researchers when designing studies that use observational electronic health record data during the pandemic period. Objective: This study aimed to evaluate the changes in health care utilization across all care settings among a large, diverse, and insured population in the United States during the COVID-19 pandemic. Methods: We conducted a retrospective cohort study within 8 health care organizations participating in the Vaccine Safety Datalink Project using electronic health record data from members of all ages from January 1, 2017, to December 31, 2021. The visit rates per person-year were calculated monthly during the study period for 4 health care settings combined as well as by inpatient, emergency department (ED), outpatient, and telehealth settings, both among all members and members without COVID-19. Difference-in-difference analysis and interrupted time series analysis were performed to assess the changes in visit rates from the prepandemic period (January 2017 to February 2020) to the early pandemic period (April-December 2020) and the later pandemic period (July-December 2021), respectively. An exploratory analysis was also conducted to assess trends through June 2023 at one of the largest sites, Kaiser Permanente Southern California. Results: The study included more than 11 million members from 2017 to 2021. Compared with the prepandemic period, we found reductions in visit rates during the early pandemic period for all in-person care settings. During the later pandemic period, overall use reached 8.36 visits per person-year, exceeding the prepandemic level of 7.49 visits per person-year in 2019 (adjusted percent change 5.1%, 95% CI 0.6%-9.9%); inpatient and ED visits returned to prepandemic levels among all members, although they remained low at 0.095 and 0.241 visits per person-year, indicating a 7.5% and 8% decrease compared to pre-pandemic levels among members without COVID-19, respectively. Telehealth visits, which were approximately 42% of the volume of outpatient visits during the later pandemic period, were increased by 97.5% (95% CI 86.0%-109.7%) from 0.865 visits per person-year in 2019 to 2.35 visits per person-year in the later pandemic period. The trends in Kaiser Permanente Southern California were similar to those of the entire study population. Visit rates from January 2022 to June 2023 were stable and appeared to be a continuation of the use levels observed at the end of 2021. Conclusions: Telehealth services became a mainstay of the health care system during the late COVID-19 pandemic period. Inpatient and ED visits returned to prepandemic levels, although they remained low among members without evidence of COVID-19. Our findings provide valuable information for strategic resource allocation for postpandemic patient care and for designing observational studies involving the pandemic period. %M 38091476 %R 10.2196/48159 %U https://publichealth.jmir.org/2024/1/e48159 %U https://doi.org/10.2196/48159 %U http://www.ncbi.nlm.nih.gov/pubmed/38091476 %0 Journal Article %@ 1947-2579 %I JMIR Publications %V 16 %N %P e50962 %T Patient Characteristics Associated With Phone and Video Visits at a Tele-Urgent Care Center During the Initial COVID-19 Response: Cross-Sectional Study %A Khairat,Saif %A John,Roshan %A Pillai,Malvika %A McDaniel,Philip %A Edson,Barbara %+ Carolina Health Informatics Program, University of North Carolina at Chapel Hill, 428 Carrington Hall, Chapel Hill, NC, 27514, United States, 1 9198435413, Saif@unc.edu %K telehealth %K telemedicine %K tele-urgent care %K virtual urgent care %K nonemergency care %K televisit %K phone visit %K video visit %K urgent care %K health services research %K COVID-19 %K health disparities %K insurance status %K cross-sectional study %D 2024 %7 19.1.2024 %9 Original Paper %J Online J Public Health Inform %G English %X Background: Health systems rapidly adopted telemedicine as an alternative health care delivery modality in response to the COVID-19 pandemic. Demographic factors, such as age and gender, may play a role in patients’ choice of a phone or video visit. However, it is unknown whether there are differences in utilization between phone and video visits. Objective: This study aimed to investigate patients’ characteristics, patient utilization, and service characteristics of a tele-urgent care clinic during the initial response to the pandemic. Methods: We conducted a cross-sectional study of urgent care patients using a statewide, on-demand telemedicine clinic with board-certified physicians during the initial phases of the pandemic. The study data were collected from March 3, 2020, through May 3, 2020. Results: Of 1803 telemedicine visits, 1278 (70.9%) patients were women, 730 (40.5%) were aged 18 to 34 years, and 1423 (78.9%) were uninsured. There were significant differences between telemedicine modalities and gender (P<.001), age (P<.001), insurance status (P<.001), prescriptions given (P<.001), and wait times (P<.001). Phone visits provided significantly more access to rural areas than video visits (P<.001). Conclusions: Our findings suggest that offering patients a combination of phone and video options provided additional flexibility for various patient subgroups, particularly patients living in rural regions with limited internet bandwidth. Differences in utilization were significant based on patient gender, age, and insurance status. We also found differences in prescription administration between phone and video visits that require additional investigation. %M 38241073 %R 10.2196/50962 %U https://ojphi.jmir.org/2024/1/e50962 %U https://doi.org/10.2196/50962 %U http://www.ncbi.nlm.nih.gov/pubmed/38241073 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e42753 %T Assessment of Qatar’s Health Care Community Call Center Efficacy in Addressing COVID-19 Pandemic Health Care Challenges: Cross-Sectional Study %A Waheed,Muhammad Atif %A Al Mannai,Lolwa %A Khudadad,Hanan %A Alenbawi,Jamil %A Mansaray,Mariama Aminata %A Al Abdulla,Samya %+ Primary Healthcare Corporation, Qatar, Al Mina Street, Doha, 40000, Qatar, 974 33015895, dratifwaheed@gmail.com %K COVID-19 %K COVID Response Service %K community call center %K virtual consultations %D 2024 %7 18.1.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The global COVID-19 pandemic caused by SARS-CoV-2 created many unprecedented challenges for health care organizations worldwide, placing a great deal of strain on the health care systems, especially access to health care services. To address these challenges, Qatar established a centralized digital platform as a community call center, initially offering digital consultations via its hotline (number: 16000) and later expanding to include a COVID-19 vaccination hotline (number: 7077) for mass immunization. Objective: This study aims to comprehensively examine the community call center’s operations and their significant role during the COVID-19 pandemic. Methods: Retrospective data were collected from the Health Information and Technology Department of the Primary Health Care Corporation, Qatar, from March 29, 2020, to January 27, 2022. Data analysis for the hotline (number: 16000) focused on telephone and video call volumes, call response rates, abandonment rates, and call classification. In addition, data from the COVID-19 vaccination hotline (number: 7077) were analyzed for call volumes, call response rates, abandonment rates, appointment booking rates, confirmations, rescheduling, and cancellations. Results: The hotline (number: 16000) received a substantial total of 429,212 calls, with 284,849 (66.37%) calls effectively answered. The average number of calls received per day during the study period was 640.61 (SD 470.53), and the average number of calls answered per day was 425.14 (SD 206.64). Notably, of the total 128,468 consultations, video consultations were conducted for 3810 (2.96%). Among the diverse call categories, diabetes mellitus (6284/84,299, 7.45%), prescriptions and medications (4709/84,299, 5.59%), hypertension (3874/84,299, 4.6%), vitamin D-related issues (3770/84,299, 4.47%), upper respiratory tract infections (2690/84,299, 3.19%), and COVID-19–related inquiries (2590/84,299, 3.07%) were most frequently addressed. For the COVID-19 vaccination hotline (number: 7077), an impressive total of 1,512,354 calls were received, with a 58.27% (n=881,305) call response rate. The average number of calls per day during the study period was 3828.74 (SD 2931.94), and the average number of calls answered per day was 2231.15 (SD 1496.02). Appointment booking accounted for 26.37% (265,721/1,007,596), appointment confirmation accounted for 10.24% (103,136/1,007,596), rescheduling accounted for 7.95% (80,124/1,007,596), and cancellations accounted for 1.6% (16,128/1,007,596) of the calls. Conclusions: The findings of this research highlight the crucial significance of the community call center hotline (number: 16000) and the COVID-19 vaccination hotline (number: 7077) in effectively addressing the multifaceted challenges posed by the global COVID-19 pandemic. In Qatar, the community call center emerged as an indispensable and accessible centralized resource, facilitating streamlined digital consultations and vaccination appointments. The impressive call response rate highlights its operational efficiency, adeptly managing a diverse range of health-related issues. This study emphasizes the critical role of community call centers in health care emergency response, signaling their potential as invaluable assets for future preparedness and effective mitigation strategies during similar public health crises. %M 38085918 %R 10.2196/42753 %U https://formative.jmir.org/2024/1/e42753 %U https://doi.org/10.2196/42753 %U http://www.ncbi.nlm.nih.gov/pubmed/38085918 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 12 %N %P e42813 %T Digital Interventions for Stress Among Frontline Health Care Workers: Results From a Pilot Feasibility Cohort Trial %A Espinola,Caroline W %A Nguyen,Binh %A Torres,Andrei %A Sim,Walter %A Rueda,Alice %A Beavers,Lindsay %A Campbell,Douglas M %A Jung,Hyejung %A Lou,Wendy %A Kapralos,Bill %A Peter,Elizabeth %A Dubrowski,Adam %A Krishnan,Sridhar %A Bhat,Venkat %+ Department of Psychiatry, University of Toronto, 250 College Street, 8th floor, Toronto, ON, Canada, 1 416 360 4000 ext 76404, venkat.bhat@utoronto.ca %K virtual reality %K simulation %K mobile app %K stress %K moral distress %K moral injury %K COVID-19 %K mobile phone %D 2024 %7 9.1.2024 %9 Original Paper %J JMIR Serious Games %G English %X Background: The COVID-19 pandemic has challenged the mental health of health care workers, increasing the rates of stress, moral distress (MD), and moral injury (MI). Virtual reality (VR) is a useful tool for studying MD and MI because it can effectively elicit psychophysiological responses, is customizable, and permits the controlled study of participants in real time. Objective: This study aims to investigate the feasibility of using an intervention comprising a VR scenario and an educational video to examine MD among health care workers during the COVID-19 pandemic and to use our mobile app for longitudinal monitoring of stress, MD, and MI after the intervention. Methods: We recruited 15 participants for a compound intervention consisting of a VR scenario followed by an educational video and a repetition of the VR scenario. The scenario portrayed a morally challenging situation related to a shortage of life-saving equipment. Physiological signals and scores of the Moral Injury Outcome Scale (MIOS) and Perceived Stress Scale (PSS) were collected. Participants underwent a debriefing session to provide their impressions of the intervention, and content analysis was performed on the sessions. Participants were also instructed to use a mobile app for 8 weeks after the intervention to monitor stress, MD, and mental health symptoms. We conducted Wilcoxon signed rank tests on the PSS and MIOS scores to investigate whether the VR scenario could induce stress and MD. We also evaluated user experience and the sense of presence after the intervention through semi–open-ended feedback and the Igroup Presence Questionnaire, respectively. Qualitative feedback was summarized and categorized to offer an experiential perspective. Results: All participants completed the intervention. Mean pre- and postintervention scores were respectively 10.4 (SD 9.9) and 13.5 (SD 9.1) for the MIOS and 17.3 (SD 7.5) and 19.1 (SD 8.1) for the PSS. Statistical analyses revealed no significant pre- to postintervention difference in the MIOS and PSS scores (P=.11 and P=.22, respectively), suggesting that the experiment did not acutely induce significant levels of stress or MD. However, content analysis revealed feelings of guilt, shame, and betrayal, which relate to the experience of MD. On the basis of the Igroup Presence Questionnaire results, the VR scenario achieved an above-average degree of overall presence, spatial presence, and involvement, and slightly below-average realism. Of the 15 participants, 8 (53%) did not answer symptom surveys on the mobile app. Conclusions: Our study demonstrated VR to be a feasible method to simulate morally challenging situations and elicit genuine responses associated with MD with high acceptability and tolerability. Future research could better define the efficacy of VR in examining stress, MD, and MI both acutely and in the longer term. An improved participant strategy for mobile data capture is needed for future studies. Trial Registration: ClinicalTrails.gov NCT05001542; https://clinicaltrials.gov/study/NCT05001542 International Registered Report Identifier (IRRID): RR2-10.2196/32240 %M 38194247 %R 10.2196/42813 %U https://games.jmir.org/2024/1/e42813 %U https://doi.org/10.2196/42813 %U http://www.ncbi.nlm.nih.gov/pubmed/38194247 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e47099 %T Development of New Stringency Indices for Nonpharmacological Social Distancing Policies Implemented in Korea During the COVID-19 Pandemic: Random Forest Approach %A Apio,Catherine %A Han,Kyulhee %A Lee,Doeun %A Lee,Bogyeom %A Park,Taesung %+ Department of Statisitcs, Seoul National University, Building 25, Room 310, Gwanak-gu, Seoul, 08826, Republic of Korea, 82 010 5557 8924, tspark@stats.snu.ac.kr %K COVID-19 %K restriction policy %K Stringency Index %K Korea Stringency Index %K social distancing %K physical distancing %K pandemic %K government %K restriction %K effectiveness %K policy %D 2024 %7 8.1.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: In the absence of an effective treatment method or vaccine, the outbreak of the COVID-19 pandemic elicited a wide range of unprecedented restriction policies aimed at mitigating and suppressing the spread of the SARS-CoV-2 virus. These policies and their Stringency Index (SI) of more than 160 countries were systematically recorded in the Oxford COVID-19 Government Response Tracker (OxCGRT) data set. The SI is a summary measure of the overall strictness of these policies. However, the OxCGRT SI may not fully reflect the stringency levels of the restriction policies implemented in Korea. Korea implemented 33 COVID-19 restriction policies targeting 4 areas: public facilities, public events, social gatherings, and religious gatherings. Objective: This study aims to develop new Korea Stringency Indices (KSIs) that reflect the stringency levels of Korea’s restriction policies better and to determine which government-implemented policies were most effective in managing the COVID-19 pandemic in Korea. Methods: The random forest method was used to calculate the new KSIs using feature importance values and determine their effectiveness in managing daily COVID-19 confirmed cases. Five analysis periods were considered, including November 01, 2020, to January 20, 2021 (Period 1), January 20, 2021, to June 27, 2021 (Period 2), November 01, 2020, to June 27, 2021 (Period 3), June 27, 2021, to November 01, 2021 (Period 4), and November 01, 2021, to April 24, 2022 (Period 5). Results: Among the KSIs, public facilities in period 4, public events in period 2, religious gatherings in periods 1 and 3, and social gatherings in period 5 had the highest importance. Among the public facilities, policies associated with operation hour restrictions in cinemas, restaurants, PC rooms, indoor sports facilities, karaoke, coffee shops, night entertainment facilities, and baths or saunas had the highest importance across all analysis periods. Strong positive correlations were observed between daily confirmed cases and public facilities, religious gatherings, and public events in period 1 of the pandemic. From then, weaker and negative correlations were observed in the remaining analysis periods. The comparison with the OxCGRT SI showed that the SI had a relatively lower feature importance and correlation with daily confirmed cases than the proposed KSIs, making KSIs more effective than SI. Conclusions: Restriction policies targeting public facilities were the most effective among the policies analyzed. In addition, different periods call for the enforcement of different policies given their effectiveness varies during the pandemic. %M 38190233 %R 10.2196/47099 %U https://publichealth.jmir.org/2024/1/e47099 %U https://doi.org/10.2196/47099 %U http://www.ncbi.nlm.nih.gov/pubmed/38190233 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e43112 %T General Characteristics and Design Taxonomy of Chatbots for COVID-19: Systematic Review %A Lim,Wendell Adrian %A Custodio,Razel %A Sunga,Monica %A Amoranto,Abegail Jayne %A Sarmiento,Raymond Francis %+ National Telehealth Center, National Institutes of Health, University of the Philippines Manila, 670 Padre Faura Street, Ermita, Manila, 1000, Philippines, 63 9269819254, wolim@up.edu.ph %K COVID-19 %K health chatbot %K conversational agent in health care %K artificial intelligence %K systematic review %K mobile phone %D 2024 %7 5.1.2024 %9 Review %J J Med Internet Res %G English %X Background: A conversational agent powered by artificial intelligence, commonly known as a chatbot, is one of the most recent innovations used to provide information and services during the COVID-19 pandemic. However, the multitude of conversational agents explicitly designed during the COVID-19 pandemic calls for characterization and analysis using rigorous technological frameworks and extensive systematic reviews. Objective: This study aims to describe the general characteristics of COVID-19 chatbots and examine their system designs using a modified adapted design taxonomy framework. Methods: We conducted a systematic review of the general characteristics and design taxonomy of COVID-19 chatbots, with 56 studies included in the final analysis. This review followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines to select papers published between March 2020 and April 2022 from various databases and search engines. Results: Results showed that most studies on COVID-19 chatbot design and development worldwide are implemented in Asia and Europe. Most chatbots are also accessible on websites, internet messaging apps, and Android devices. The COVID-19 chatbots are further classified according to their temporal profiles, appearance, intelligence, interaction, and context for system design trends. From the temporal profile perspective, almost half of the COVID-19 chatbots interact with users for several weeks for >1 time and can remember information from previous user interactions. From the appearance perspective, most COVID-19 chatbots assume the expert role, are task oriented, and have no visual or avatar representation. From the intelligence perspective, almost half of the COVID-19 chatbots are artificially intelligent and can respond to textual inputs and a set of rules. In addition, more than half of these chatbots operate on a structured flow and do not portray any socioemotional behavior. Most chatbots can also process external data and broadcast resources. Regarding their interaction with users, most COVID-19 chatbots are adaptive, can communicate through text, can react to user input, are not gamified, and do not require additional human support. From the context perspective, all COVID-19 chatbots are goal oriented, although most fall under the health care application domain and are designed to provide information to the user. Conclusions: The conceptualization, development, implementation, and use of COVID-19 chatbots emerged to mitigate the effects of a global pandemic in societies worldwide. This study summarized the current system design trends of COVID-19 chatbots based on 5 design perspectives, which may help developers conveniently choose a future-proof chatbot archetype that will meet the needs of the public in the face of growing demand for a better pandemic response. %M 38064638 %R 10.2196/43112 %U https://www.jmir.org/2024/1/e43112 %U https://doi.org/10.2196/43112 %U http://www.ncbi.nlm.nih.gov/pubmed/38064638 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e44619 %T Acceptance and User Experiences of a Wearable Device for the Management of Hospitalized Patients in COVID-19–Designated Wards in Ho Chi Minh City, Vietnam: Action Learning Project %A Luu,An Phuoc %A Nguyen,Truong Thanh %A Cao,Van Thi Cam %A Ha,Trinh Hoang Diem %A Chung,Lien Thi Thu %A Truong,Trung Ngoc %A Nguyen Le Nhu,Tung %A Dao,Khoa Bach %A Nguyen,Hao Van %A Khanh,Phan Nguyen Quoc %A Le,Khanh Thuy Thuy %A Tran,Luu Hoai Bao %A Nhat,Phung Tran Huy %A Tran,Duc Minh %A Lam,Yen Minh %A Thwaites,Catherine Louise %A Mcknight,Jacob %A Vinh Chau,Nguyen Van %A Van Nuil,Jennifer Ilo %A , %+ Oxford University Clinical Research Unit, 764 Vo Van Kiet, Ho Chi Minh City, 70000, Vietnam, 84 362620124, jvannuil@oucru.org %K vital signs %K wearable devices %K action learning %K technology acceptance model %K TAM %K COVID-19 %K user-centered design %K wearables %K remote monitoring %K technology acceptance %K oximeter %D 2024 %7 5.1.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Wearable devices have been used extensively both inside and outside of the hospital setting. During the COVID-19 pandemic, in some contexts, there was an increased need to remotely monitor pulse and saturated oxygen for patients due to the lack of staff and bedside monitors. Objective: A prototype of a remote monitoring system using wearable pulse oximeter devices was implemented at the Hospital for Tropical Diseases in Ho Chi Minh City, Vietnam, from August to December 2021. The aim of this work was to support the ongoing implementation of the remote monitoring system. Methods: We used an action learning approach with rapid pragmatic methods, including informal discussions and observations as well as a feedback survey form designed based on the technology acceptance model to assess the use and acceptability of the system. Based on these results, we facilitated a meeting using user-centered design principles to explore user needs and ideas about its development in more detail. Results: In total, 21 users filled in the feedback form. The mean technology acceptance model scores ranged from 3.5 (for perceived ease of use) to 4.4 (for attitude) with behavioral intention (3.8) and perceived usefulness (4.2) scoring in between. Those working as nurses scored higher on perceived usefulness, attitude, and behavioral intention than did physicians. Based on informal discussions, we realized there was a mismatch between how we (ie, the research team) and the ward teams perceived the use and wider purpose of the technology. Conclusions: Designing and implementing the devices to be more nurse-centric from their introduction could have helped to increase their efficiency and use during the complex pandemic period. %M 38180799 %R 10.2196/44619 %U https://humanfactors.jmir.org/2024/1/e44619 %U https://doi.org/10.2196/44619 %U http://www.ncbi.nlm.nih.gov/pubmed/38180799 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e44249 %T Pediatric and Young Adult Household Transmission of the Initial Waves of SARS-CoV-2 in the United States: Administrative Claims Study %A Chung,Ming Kei %A Hart,Brian %A Santillana,Mauricio %A Patel,Chirag J %+ Department of Biomedical Informatics, Harvard Medical School, Harvard University, 10 Shattuck Street, Room 302, Boston, MA, 02115, United States, 1 617 432 1195, chirag_patel@hms.harvard.edu %K household transmission %K infectivity %K pediatric %K COVID-19 %K children %K claims data %K administrative data %K transmission %K risk factor %K logistic regression %K regression %K multivariable logistics regression %K multiple logistic regression statistics %K cohort %K retrospective cohort %K laboratory %K LOINC %K infant %K toddler %K newborn %D 2024 %7 4.1.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: The correlates responsible for the temporal changes of intrahousehold SARS-CoV-2 transmission in the United States have been understudied mainly due to a lack of available surveillance data. Specifically, early analyses of SARS-CoV-2 household secondary attack rates (SARs) were small in sample size and conducted cross-sectionally at single time points. From these limited data, it has been difficult to assess the role that different risk factors have had on intrahousehold disease transmission in different stages of the ongoing COVID-19 pandemic, particularly in children and youth. Objective: This study aimed to estimate the transmission dynamic and infectivity of SARS-CoV-2 among pediatric and young adult index cases (age 0 to 25 years) in the United States through the initial waves of the pandemic. Methods: Using administrative claims, we analyzed 19 million SARS-CoV-2 test records between January 2020 and February 2021. We identified 36,241 households with pediatric index cases and calculated household SARs utilizing complete case information. Using a retrospective cohort design, we estimated the household SARS-CoV-2 transmission between 4 index age groups (0 to 4 years, 5 to 11 years, 12 to 17 years, and 18 to 25 years) while adjusting for sex, family size, quarter of first SARS-CoV-2 positive record, and residential regions of the index cases. Results: After filtering all household records for greater than one member in a household and missing information, only 36,241 (0.85%) of 4,270,130 households with a pediatric case remained in the analysis. Index cases aged between 0 and 17 years were a minority of the total index cases (n=11,484, 11%). The overall SAR of SARS-CoV-2 was 23.04% (95% CI 21.88-24.19). As a comparison, the SAR for all ages (0 to 65+ years) was 32.4% (95% CI 32.1-32.8), higher than the SAR for the population between 0 and 25 years of age. The highest SAR of 38.3% was observed in April 2020 (95% CI 31.6-45), while the lowest SAR of 15.6% was observed in September 2020 (95% CI 13.9-17.3). It consistently decreased from 32% to 21.1% as the age of index groups increased. In a multiple logistic regression analysis, we found that the youngest pediatric age group (0 to 4 years) had 1.69 times (95% CI 1.42-2.00) the odds of SARS-CoV-2 transmission to any family members when compared with the oldest group (18 to 25 years). Family size was significantly associated with household viral transmission (odds ratio 2.66, 95% CI 2.58-2.74). Conclusions: Using retrospective claims data, the pediatric index transmission of SARS-CoV-2 during the initial waves of the COVID-19 pandemic in the United States was associated with location and family characteristics. Pediatric SAR (0 to 25 years) was less than the SAR for all age other groups. Less than 1% (n=36,241) of all household data were retained in the retrospective study for complete case analysis, perhaps biasing our findings. We have provided measures of baseline household pediatric transmission for tracking and comparing the infectivity of later SARS-CoV-2 variants. %M 37967280 %R 10.2196/44249 %U https://www.jmir.org/2024/1/e44249 %U https://doi.org/10.2196/44249 %U http://www.ncbi.nlm.nih.gov/pubmed/37967280 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 10 %N %P e43705 %T Impact of the COVID-19 Pandemic on Medical Grand Rounds Attendance: Comparison of In-Person and Remote Conferences %A Monahan,Ken %A Gould,Edward %A Rice,Todd %A Wright,Patty %A Vasilevskis,Eduard %A Harrell,Frank %A Drago,Monique %A Mitchell,Sarah %+ Vanderbilt University Medical Center, 1215 21st Avenue, Medical Center East - 5th Floor, Nashville, TN, 37232, United States, 1 6153222318, ken.monahan@vumc.org %K continuing medical education %K COVID-19 %K distance education %K professional development %K virtual learning %D 2024 %7 3.1.2024 %9 Short Paper %J JMIR Med Educ %G English %X Background: Many academic medical centers transitioned from in-person to remote conferences due to the COVID-19 pandemic, but the impact on faculty attendance is unknown. Objective: This study aims to evaluate changes in attendance at medical grand rounds (MGR) following the transition from an in-person to remote format and as a function of the COVID-19 census at Vanderbilt Medical Center. Methods: We obtained the faculty attendee characteristics from Department of Medicine records. Attendance was recorded using a SMS text message–based system. The daily COVID-19 census was recorded independently by hospital administration. The main attendance metric was the proportion of eligible faculty that attended each MGR. Comparisons were made for the entire cohort and for individual faculty. Results: The observation period was from March 2019 to June 2021 and included 101 MGR conferences with more than 600 eligible faculty. Overall attendance was unchanged during the in-person and remote formats (12,536/25,808, 48.6% vs 16,727/32,680, 51.2%; P=.44) and did not change significantly during a surge in the COVID-19 census. Individual faculty members attendance rates varied widely. Absolute differences between formats were less than –20% or greater than 20% for one-third (160/476, 33.6%) of faculty. Pulmonary or critical care faculty attendance increased during the remote format compared to in person (1450/2616, 55.4% vs 1004/2045, 49.1%; P<.001). A cloud-based digital archive of MGR lectures was accessed by <1% of faculty per conference. Conclusions: Overall faculty attendance at MGR did not change following the transition to a remote format, regardless of the COVID-19 census, but individual attendance habits fluctuated in a bidirectional manner. Incentivizing the use of a digital archive may represent an opportunity to increase faculty consumption of MGR. %M 38029287 %R 10.2196/43705 %U https://mededu.jmir.org/2024/1/e43705 %U https://doi.org/10.2196/43705 %U http://www.ncbi.nlm.nih.gov/pubmed/38029287 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e43850 %T Public Interest in Psilocybin and Psychedelic Therapy in the Context of the COVID-19 Pandemic: Google Trends Analysis %A Danias,George %A Appel,Jacob %+ Icahn School of Medicine at Mount Sinai, 1 Gustave L Levy Pl, New York, NY, 10029, United States, 1 7189153386, george.danias@icahn.mssm.edu %K psilocybin %K Google Trends %K COVID-19 %K medical informatics %K depression %K anxiety %K substance use %K social media %K trend analysis %K antidepressant %D 2023 %7 29.12.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Psychedelic substances have demonstrated promise in the treatment of depression, anxiety, and substance use disorders. Significant media coverage has been dedicated to psychedelic medicine, but it is unclear whether the public associates psilocybin with its potential therapeutic benefits. The COVID-19 pandemic led to an increase in depression, anxiety, and substance abuse in the general population. Objective: This study attempts to link increases in interest in these disorders with increases in interest in psilocybin using Google Trends. Methods: Weekly interest-over-time Google Trends data for 4 years, from the week of March 11, 2018, to the week of March 6, 2022, were obtained for the following terms: “psilocybin,” “psychedelic therapy,” “cannabis,” “cocaine,” “antidepressant,” “depression,” “anxiety,” and “addiction.” Important psilocybin-related news and the declaration of the pandemic were noted. Trends data for each of the queried terms were plotted, and multiple regression analysis was performed to determine the slope of the prepandemic and postpandemic data with 95% CIs. Nonparametric Tau-U analysis was performed correcting for baseline trends. Results from this test were used to make inferences about the pre- and postpandemic trends and inferences about the change in overall level of searches between the 2 groups. Results: Tau values for prepandemic data were significant for stable trends, all ranging –0.4 to 0.4. Tau values for postpandemic data showed positive trends for “psilocybin,” “psychedelic therapy,” and “antidepressant.” All other trends remained stable in the range of –0.4 to 0.4. When comparing Tau values for pre- and postpandemic data, overall increases in relative search volume (RSV) were seen for “psilocybin,” “psychedelic therapy,” and “anxiety,” and overall decreases in RSV were seen for “depression,” “addiction,” and “cocaine.” Overall RSVs for “cannabis” and “antidepressant” remained stable as Tau values ranged between –0.4 and 0.4. In the immediate aftermath of the declaration of the pandemic, drop-offs in interest were seen for all terms except for “anxiety” and “cannabis.” After the initial shock of a global pandemic, “psilocybin” and “psychedelic therapy” groups demonstrated increases in interest trends and overall RSV. Conclusions: These data suggest that overall interest in “psilocybin” and “psychedelic therapy” increased at higher rates and to higher levels after than before the declaration of the pandemic. This is consistent with our hypothesis that interest increased for these treatments after the pandemic as incidence of depression, anxiety, and addiction increased. However, there may be other drivers of interest for these topics, since interest in antidepressants—the typical pharmacologic treatments for depression and anxiety—followed the expected pattern of drop-off and accelerated interest back to prepandemic levels. Interest in “psilocybin” and “psychedelic therapy” may have also been partially driven by popular culture hype and novelty, explaining why interest increased at a higher rate post pandemic and continued to grow, surpassing prior interest. %M 38064635 %R 10.2196/43850 %U https://formative.jmir.org/2023/1/e43850 %U https://doi.org/10.2196/43850 %U http://www.ncbi.nlm.nih.gov/pubmed/38064635 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e40216 %T Decreased Seasonal Influenza Rates Detected in a Crowdsourced Influenza-Like Illness Surveillance System During the COVID-19 Pandemic: Prospective Cohort Study %A Gertz,Autumn %A Rader,Benjamin %A Sewalk,Kara %A Varrelman,Tanner J %A Smolinski,Mark %A Brownstein,John S %+ Computational Epidemiology Lab, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, United States, 1 8572185188, info@outbreaksnearme.org %K participatory surveillance %K influenza %K crowdsourced data %K disease surveillance %K surveillance %K COVID-19 %K respiratory %K transmission %K detection %K survey %K sore throat %K fever %K cough %K vaccination %K diagnosis %K precautions %D 2023 %7 28.12.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Seasonal respiratory viruses had lower incidence during their 2019-2020 and 2020-2021 seasons, which overlapped with the COVID-19 pandemic. The widespread implementation of precautionary measures to prevent transmission of SARS-CoV-2 has been seen to also mitigate transmission of seasonal influenza. The COVID-19 pandemic also led to changes in care seeking and access. Participatory surveillance systems have historically captured mild illnesses that are often missed by surveillance systems that rely on encounters with a health care provider for detection. Objective: This study aimed to assess if a crowdsourced syndromic surveillance system capable of detecting mild influenza-like illness (ILI) also captured the globally observed decrease in ILI in the 2019-2020 and 2020-2021 influenza seasons, concurrent with the COVID-19 pandemic. Methods: Flu Near You (FNY) is a web-based participatory syndromic surveillance system that allows participants in the United States to report their health information using a brief weekly survey. Reminder emails are sent to registered FNY participants to report on their symptoms and the symptoms of household members. Guest participants may also report. ILI was defined as fever and sore throat or fever and cough. ILI rates were determined as the number of ILI reports over the total number of reports and assessed for the 2016-2017, 2017-2018, 2018-2019, 2019-2020, and 2020-2021 influenza seasons. Baseline season (2016-2017, 2017-2018, and 2018-2019) rates were compared to the 2019-2020 and 2020-2021 influenza seasons. Self-reported influenza diagnosis and vaccination status were captured and assessed as the total number of reported events over the total number of reports submitted. CIs for all proportions were calculated via a 1-sample test of proportions. Results: ILI was detected in 3.8% (32,239/848,878) of participants in the baseline seasons (2016-2019), 2.58% (7418/287,909) in the 2019-2020 season, and 0.27% (546/201,079) in the 2020-2021 season. Both influenza seasons that overlapped with the COVID-19 pandemic had lower ILI rates than the baseline seasons. ILI decline was observed during the months with widespread implementation of COVID-19 precautions, starting in February 2020. Self-reported influenza diagnoses decreased from early 2020 through the influenza season. Self-reported influenza positivity among ILI cases varied over the observed time period. Self-reported influenza vaccination rates in FNY were high across all observed seasons. Conclusions: A decrease in ILI was detected in the crowdsourced FNY surveillance system during the 2019-2020 and 2020-2021 influenza seasons, mirroring trends observed in other influenza surveillance systems. Specifically, the months within seasons that overlapped with widespread pandemic precautions showed decreases in ILI and confirmed influenza. Concerns persist regarding respiratory pathogens re-emerging with changes to COVID-19 guidelines. Traditional surveillance is subject to changes in health care behaviors. Systems like FNY are uniquely situated to detect disease across disease severity and care seeking, providing key insights during public health emergencies. %M 38153782 %R 10.2196/40216 %U https://publichealth.jmir.org/2023/1/e40216 %U https://doi.org/10.2196/40216 %U http://www.ncbi.nlm.nih.gov/pubmed/38153782 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 10 %N %P e43120 %T Democratizing the Development of Chatbots to Improve Public Health: Feasibility Study of COVID-19 Misinformation %A Powell,Leigh %A Nour,Radwa %A Sleibi,Randa %A Al Suwaidi,Hanan %A Zary,Nabil %+ Institute for Excellence in Health Professions Education, Mohammed Bin Rashid University of Medicine and Health Sciences, Building 14, Dubai Healthcare City, PO Box 505055, Dubai, United Arab Emirates, 971 585960762, nabil.zary@mbru.ac.ae %K COVID-19 %K vaccine hesitancy %K infodemic %K chatbot %K motivational interviewing %K social media %K conversational agent %K misinformation %K online health information %K usability study %K vaccine misinformation %D 2023 %7 28.12.2023 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Chatbots enable users to have humanlike conversations on various topics and can vary widely in complexity and functionality. An area of research priority in chatbots is democratizing chatbots to all, removing barriers to entry, such as financial ones, to help make chatbots a possibility for the wider global population to improve access to information, help reduce the digital divide between nations, and improve areas of public good (eg, health communication). Chatbots in this space may help create the potential for improved health outcomes, potentially alleviating some of the burdens on health care providers and systems to be the sole voices of outreach to public health. Objective: This study explored the feasibility of developing a chatbot using approaches that are accessible in low- and middle-resource settings, such as using technology that is low cost, can be developed by nonprogrammers, and can be deployed over social media platforms to reach the broadest-possible audience without the need for a specialized technical team. Methods: This study is presented in 2 parts. First, we detailed the design and development of a chatbot, VWise, including the resources used and development considerations for the conversational model. Next, we conducted a case study of 33 participants who engaged in a pilot with our chatbot. We explored the following 3 research questions: (1) Is it feasible to develop and implement a chatbot addressing a public health issue with only minimal resources? (2) What is the participants’ experience with using the chatbot? (3) What kinds of measures of engagement are observed from using the chatbot? Results: A high level of engagement with the chatbot was demonstrated by the large number of participants who stayed with the conversation to its natural end (n=17, 52%), requested to see the free online resource, selected to view all information about a given concern, and returned to have a dialogue about a second concern (n=12, 36%). Conclusions: This study explored the feasibility of and the design and development considerations for a chatbot, VWise. Our early findings from this initial pilot suggest that developing a functioning and low-cost chatbot is feasible, even in low-resource environments. Our results show that low-resource environments can enter the health communication chatbot space using readily available human and technical resources. However, despite these early indicators, many limitations exist in this study and further work with a larger sample size and greater diversity of participants is needed. This study represents early work on a chatbot in its virtual infancy. We hope this study will help provide those who feel chatbot access may be out of reach with a useful guide to enter this space, enabling more democratized access to chatbots for all. %M 37290040 %R 10.2196/43120 %U https://humanfactors.jmir.org/2023/1/e43120 %U https://doi.org/10.2196/43120 %U http://www.ncbi.nlm.nih.gov/pubmed/37290040 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e52901 %T Assessing the Impact of Evidence-Based Mental Health Guidance During the COVID-19 Pandemic: Systematic Review and Qualitative Evaluation %A Smith,Katharine A %A Ostinelli,Edoardo G %A Ede,Roger %A Allard,Lisa %A Thomson,Michaela %A Hewitt,Kiran %A Brown,Petra %A Zangani,Caroline %A Jenkins,Matthew %A Hinze,Verena %A Ma,George %A Pothulu,Prajnesh %A Henshall,Catherine %A Malhi,Gin S %A Every-Palmer,Susanna %A Cipriani,Andrea %+ Department of Psychiatry, University of Oxford, Warneford Hospital, Warneford Lane, Headington, Oxford, OX3 7JX, United Kingdom, 44 1865902135, katharine.smith@psych.ox.ac.uk %K evidence synthesis %K guidelines %K mental health %K systematic review %K focus group %K survey %K COVID-19 %K pandemic %K digital health %K eHealth %K mobile phone %D 2023 %7 22.12.2023 %9 Review %J JMIR Ment Health %G English %X Background: During the COVID-19 pandemic, the Oxford Precision Psychiatry Lab (OxPPL) developed open-access web-based summaries of mental health care guidelines (OxPPL guidance) in key areas such as digital approaches and telepsychiatry, suicide and self-harm, domestic violence and abuse, perinatal care, and vaccine hesitancy and prioritization in the context of mental illness, to inform timely clinical decision-making. Objective: This study aimed to evaluate the practice of creating evidence-based health guidelines during health emergencies using the OxPPL guidance as an example. An international network of clinical sites and colleagues (in Australia, New Zealand, and the United Kingdom) including clinicians, researchers, and experts by experience aimed to (1) evaluate the clinical impact of the OxPPL guidance, as an example of an evidence-based summary of guidelines; (2) review the literature for other evidence-based summaries of COVID-19 guidelines regarding mental health care; and (3) produce a framework for response to future global health emergencies. Methods: The impact and clinical utility of the OxPPL guidance were assessed using clinicians’ feedback via an international survey and focus groups. A systematic review (protocol registered on Open Science Framework) identified summaries or syntheses of guidelines for mental health care during and after the COVID-19 pandemic and assessed the accuracy of the methods used in the OxPPL guidance by identifying any resources that the guidance had not included. Results: Overall, 80.2% (146/182) of the clinicians agreed or strongly agreed that the OxPPL guidance answered important clinical questions, 73.1% (133/182) stated that the guidance was relevant to their service, 59.3% (108/182) said that the guidelines had or would have a positive impact on their clinical practice, 42.9% (78/182) that they had shared or would share the guidance, and 80.2% (146/182) stated that the methodology could be used during future health crises. The focus groups found that the combination of evidence-based knowledge, clinical viewpoint, and visibility was crucial for clinical implementation. The systematic review identified 2543 records, of which 2 syntheses of guidelines met all the inclusion criteria, but only 1 (the OxPPL guidance) used evidence-based methodology. The review showed that the OxPPL guidance had included the majority of eligible guidelines, but 6 were identified that had not been included. Conclusions: The study identified an unmet need for web-based, evidence-based mental health care guidance during the COVID-19 pandemic. The OxPPL guidance was evaluated by clinicians as having a real-world clinical impact. Robust evidence-based methodology and expertise in mental health are necessary, but easy accessibility is also needed, and digital technology can materially help. Further health emergencies are inevitable and now is the ideal time to prepare, including addressing the training needs of clinicians, patients, and carers, especially in areas such as telepsychiatry and digital mental health. For future planning, guidance should be widely disseminated on an international platform, with allocated resources to support adaptive updates. %M 38133912 %R 10.2196/52901 %U https://mental.jmir.org/2023/1/e52901 %U https://doi.org/10.2196/52901 %U http://www.ncbi.nlm.nih.gov/pubmed/38133912 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e46370 %T Client and Clinician Experiences and Perspectives of Exercise Physiology Services During the COVID-19 Pandemic: Qualitative Study %A Brown,Riley C C %A Keating,Shelley E %A Owen,Patrick J %A Jansons,Paul S %A McVicar,Jenna %A Askew,Christopher D %A Clanchy,Kelly M %A Maddison,Ralph %A Maiorana,Andrew %A Robinson,Suzanne M %A Mundell,Niamh L %+ Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Highway, Geelong, 3125, Australia, 61 3 9244 3729, niamh.mundell@deakin.edu.au %K telehealth %K coronavirus %K telemedicine %K eHealth %K rehabilitation %K qualitative study %K exercise %K exercise physiology %K clinician %K engagement %K interview %K tool %K implementation %K effectiveness %D 2023 %7 21.12.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic led to changes in the delivery of exercise physiology services. The lived experience of those who continued to provide or receive exercise physiology services during the heightened public health restrictions of the inaugural year of the COVID-19 pandemic has received little attention to date. Acquiring this knowledge will be fundamental in addressing whether telehealth is a viable option for service delivery in exercise care, research, and policy. This is especially pertinent in the wake of the COVID-19 pandemic and subsequent global interest in digital health delivery of health care services. Objective: This study aims to explore the clinician and client experiences and perspectives of exercise physiology services delivered in person or via telehealth during the inaugural year of the COVID-19 pandemic (after January 25, 2020; the date of the first confirmed case in Australia). Methods: Eligible participants for this study were adult (aged 18 years or older; capable of understanding and writing in English) clients who received and clinicians who delivered 1 or more exercise physiology sessions in Australia during the first year of the COVID-19 pandemic (June 2020 to June 2021). The data collection period spanned from January 20, 2021, to September 24, 2021. A total of 18 semistructured individual interviews were conducted with accredited exercise physiologists (n=7) and clients (n=11) who engaged with exercise physiology services during this period. All interviews were digitally recorded and transcribed verbatim. Thematic analysis was conducted with themes and subthemes derived using deductive and inductive approaches. Results: A total of 3 dominant themes, each with 2 subthemes, were identified. The first theme was that telehealth enables access to services but limits the use of some clinical tools. Remote access to services was valued by both clinicians and clients, but the exercise clinical environment could not be replicated over telehealth. This was especially true regarding access to exercise equipment. Second, engagement and the “relational space” are limited by telehealth. Perceived challenges regarding social interactions and a sense of community were a limitation for clients, and difficulties fostering clinician-client report were noted by clinicians. Finally, technological challenges are pervasive in the telehealth delivery of exercise services. Both clinicians and clients noted that systems necessary to facilitate telehealth frequently disrupted delivery, and client-based technical issues were influenced by digital health literacy. Conclusions: Shared client and accredited exercise physiologist experiences highlight key considerations for the ongoing implementation of telehealth to facilitate the uptake and effectiveness of exercise physiology services. These findings imply that the co-design of solutions to client-perceived limitations of telehealth delivery is warranted. %M 38127430 %R 10.2196/46370 %U https://www.jmir.org/2023/1/e46370 %U https://doi.org/10.2196/46370 %U http://www.ncbi.nlm.nih.gov/pubmed/38127430 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e42505 %T A Biobanking System for Diagnostic Images: Architecture Development, COVID-19–Related Use Cases, and Performance Evaluation %A Esposito,Giuseppina %A Allarà,Ciro %A Randon,Marco %A Aiello,Marco %A Salvatore,Marco %A Aceto,Giuseppe %A Pescapè,Antonio %+ Bio Check Up Srl, Via Riviera di Chiaia, 9a, Naples, 80122, Italy, 39 08119322515, gesposito@biocheckup.net %K biobank %K diagnostics %K COVID-19 %K network performance %K eHealth %D 2023 %7 21.12.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Systems capable of automating and enhancing the management of research and clinical data represent a significant contribution of information and communication technologies to health care. A recent advancement is the development of imaging biobanks, which are now enabling the collection and storage of diagnostic images, clinical reports, and demographic data to allow researchers identify associations between lifestyle and genetic factors and imaging-derived phenotypes. Objective: The aim of this study was to design and evaluate the system performance of a network for an operating biobank of diagnostic images, the Bio Check Up Srl (BCU) Imaging Biobank, based on the Extensible Neuroimaging Archive Toolkit open-source platform. Methods: Three usage cases were designed focusing on evaluation of the memory and computing consumption during imaging collections upload and during interactions between two kinds of users (researchers and radiologists) who inspect chest computed tomography scans of a COVID-19 cohort. The experiments considered three network setups: (1) a local area network, (2) virtual private network, and (3) wide area network. The experimental setup recorded the activity of a human user interacting with the biobank system, which was continuously replayed multiple times. Several metrics were extracted from network traffic traces and server logs captured during the activity replay. Results: Regarding the diagnostic data transfer, two types of containers were considered: the Web and the Database containers. The Web appeared to be the more memory-hungry container with a higher computational load (average 2.7 GB of RAM) compared to that of the database. With respect to user access, both users demonstrated the same network performance level, although higher resource consumption was registered for two different actions: DOWNLOAD & LOGOUT (100%) for the researcher and OPEN VIEWER (20%-50%) for the radiologist. Conclusions: This analysis shows that the current setup of BCU Imaging Biobank is well provisioned for satisfying the planned number of concurrent users. More importantly, this study further highlights and quantifies the resource demands of specific user actions, providing a guideline for planning, setting up, and using an image biobanking system. %M 38064636 %R 10.2196/42505 %U https://formative.jmir.org/2023/1/e42505 %U https://doi.org/10.2196/42505 %U http://www.ncbi.nlm.nih.gov/pubmed/38064636 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 12 %N %P e44606 %T Evaluating the Effectiveness of School Closure in COVID-19–Related Syndromes From Community-Based Syndromic Surveillance: Longitudinal Observational Study %A Chung,Ping-Chen %A Chen,Kevin J %A Chang,Hui-Mei %A Chan,Ta-Chien %+ Research Center for Humanities and Social Sciences, Academia Sinica, 128 Academia Road, Section 2, Taipei City, 115, Taiwan, 886 227898160, tachien@sinica.edu.tw %K school closure %K COVID-19 %K syndromic surveillance %K outpatient %K mobility %D 2023 %7 15.12.2023 %9 Original Paper %J Interact J Med Res %G English %X Background: During the COVID-19 pandemic, a school closure policy was adopted to prevent cluster transmission in schools and subsequent household transmission. However, the effectiveness of school closure is not consistent in studies conducted in different countries. Objective: This study aimed to explore the association between school closure and the daily standardized incidence of COVID-19–related syndromes in an outpatient syndromic surveillance system. Methods: We calculated the incidence of COVID-19–related syndromes derived from a community-based syndromic surveillance system between the first week of January and the second or fourth weeks after school closure in 2021 and 2022 in Taipei City, Taiwan. The effect of school closure on the standardized incidence of COVID-19–related syndromes was evaluated by interrupted time series analysis using an autoregressive integrated moving average with a distributed lag function. The exogenous variables were changes in human mobility measured by Google COVID-19 community mobility reports. Furthermore, the models quantified the influence of different age groups and the hierarchy of medical facilities, such as clinics or community hospitals. Results: School closure was only negatively and significantly associated with the overall standardized incidence of COVID-19–related syndromes in 2021 for 2 weeks after the intervention (coefficient −1.24, 95% CI −2.40 to −0.08). However, in different age groups, school closure had a significantly negative association with the standardized incidence among people aged 13-18 years and ≥65 years for 2 weeks after the intervention in clinics in 2021. In community hospitals, school closure was significantly positively associated with the standardized incidence among people aged 19-24 years in 2021. In 2022, 2 weeks after the intervention, school closure had a significantly negative association with the standardized incidence among people aged 0-6, 7-12, and 19-24 years in community hospitals and aged >45 years in clinics. Furthermore, the standardized incidence was positively associated with movement change toward grocery and pharmacy stores in all age groups in 2022. In addition, movement changes toward residences were significantly positively associated with the standardized incidence among all age groups. Conclusions: Overall, school closure effectively suppresses COVID-19–related syndromes in students owing to the reduction of physical contact. In addition, school closure has a spillover effect on elderly people who stay at home. %M 38100192 %R 10.2196/44606 %U https://www.i-jmr.org/2023/1/e44606 %U https://doi.org/10.2196/44606 %U http://www.ncbi.nlm.nih.gov/pubmed/38100192 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e49771 %T Potential and Limitations of ChatGPT 3.5 and 4.0 as a Source of COVID-19 Information: Comprehensive Comparative Analysis of Generative and Authoritative Information %A Wang,Guoyong %A Gao,Kai %A Liu,Qianyang %A Wu,Yuxin %A Zhang,Kaijun %A Zhou,Wei %A Guo,Chunbao %+ Women and Children's Hospital, Chongqing Medical University, No 120 Longshan Road, Longshan Street, Yubei District, Chongqing, 400010, China, 86 023 60354300, guochunbao@foxmail.com %K ChatGPT 3.5 %K ChatGPT 4.0 %K artificial intelligence %K AI %K COVID-19 %K pandemic %K public health %K information retrieval %D 2023 %7 14.12.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic, caused by the SARS-CoV-2 virus, has necessitated reliable and authoritative information for public guidance. The World Health Organization (WHO) has been a primary source of such information, disseminating it through a question and answer format on its official website. Concurrently, ChatGPT 3.5 and 4.0, a deep learning-based natural language generation system, has shown potential in generating diverse text types based on user input. Objective: This study evaluates the accuracy of COVID-19 information generated by ChatGPT 3.5 and 4.0, assessing its potential as a supplementary public information source during the pandemic. Methods: We extracted 487 COVID-19–related questions from the WHO’s official website and used ChatGPT 3.5 and 4.0 to generate corresponding answers. These generated answers were then compared against the official WHO responses for evaluation. Two clinical experts scored the generated answers on a scale of 0-5 across 4 dimensions—accuracy, comprehensiveness, relevance, and clarity—with higher scores indicating better performance in each dimension. The WHO responses served as the reference for this assessment. Additionally, we used the BERT (Bidirectional Encoder Representations from Transformers) model to generate similarity scores (0-1) between the generated and official answers, providing a dual validation mechanism. Results: The mean (SD) scores for ChatGPT 3.5–generated answers were 3.47 (0.725) for accuracy, 3.89 (0.719) for comprehensiveness, 4.09 (0.787) for relevance, and 3.49 (0.809) for clarity. For ChatGPT 4.0, the mean (SD) scores were 4.15 (0.780), 4.47 (0.641), 4.56 (0.600), and 4.09 (0.698), respectively. All differences were statistically significant (P<.001), with ChatGPT 4.0 outperforming ChatGPT 3.5. The BERT model verification showed mean (SD) similarity scores of 0.83 (0.07) for ChatGPT 3.5 and 0.85 (0.07) for ChatGPT 4.0 compared with the official WHO answers. Conclusions: ChatGPT 3.5 and 4.0 can generate accurate and relevant COVID-19 information to a certain extent. However, compared with official WHO responses, gaps and deficiencies exist. Thus, users of ChatGPT 3.5 and 4.0 should also reference other reliable information sources to mitigate potential misinformation risks. Notably, ChatGPT 4.0 outperformed ChatGPT 3.5 across all evaluated dimensions, a finding corroborated by BERT model validation. %M 38096014 %R 10.2196/49771 %U https://www.jmir.org/2023/1/e49771 %U https://doi.org/10.2196/49771 %U http://www.ncbi.nlm.nih.gov/pubmed/38096014 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e43105 %T Effects of User-Reported Risk Factors and Follow-Up Care Activities on Satisfaction With a COVID-19 Chatbot: Cross-Sectional Study %A Singh,Akanksha %A Schooley,Benjamin %A Patel,Nitin %+ IT & Cybersecurity, Department of Electrical and Computer Engineering, Brigham Young University, 240 Engineering Building, Provo, UT, 84602, United States, 1 8014220027, Ben_Schooley@byu.edu %K patient engagement %K chatbot %K population health %K health recommender systems %K conversational recommender systems %K design factors %K COVID-19 %D 2023 %7 14.12.2023 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The COVID-19 pandemic influenced many to consider methods to reduce human contact and ease the burden placed on health care workers. Conversational agents or chatbots are a set of technologies that may aid with these challenges. They may provide useful interactions for users, potentially reducing the health care worker burden while increasing user satisfaction. Research aims to understand these potential impacts of chatbots and conversational recommender systems and their associated design features. Objective: The objective of this study was to evaluate user perceptions of the helpfulness of an artificial intelligence chatbot that was offered free to the public in response to COVID-19. The chatbot engaged patients and provided educational information and the opportunity to report symptoms, understand personal risks, and receive referrals for care. Methods: A cross-sectional study design was used to analyze 82,222 chats collected from patients in South Carolina seeking services from the Prisma Health system. Chi-square tests and multinomial logistic regression analyses were conducted to assess the relationship between reported risk factors and perceived chat helpfulness using chats started between April 24, 2020, and April 21, 2022. Results: A total of 82,222 chat series were started with at least one question or response on record; 53,805 symptom checker questions with at least one COVID-19–related activity series were completed, with 5191 individuals clicking further to receive a virtual video visit and 2215 clicking further to make an appointment with a local physician. Patients who were aged >65 years (P<.001), reported comorbidities (P<.001), had been in contact with a person with COVID-19 in the last 14 days (P<.001), and responded to symptom checker questions that placed them at a higher risk of COVID-19 (P<.001) were 1.8 times more likely to report the chat as helpful than those who reported lower risk factors. Users who engaged with the chatbot to conduct a series of activities were more likely to find the chat helpful (P<.001), including seeking COVID-19 information (3.97-4.07 times), in-person appointments (2.46-1.99 times), telehealth appointments with a nearby provider (2.48-1.9 times), or vaccination (2.9-3.85 times) compared with those who did not perform any of these activities. Conclusions: Chatbots that are designed to target high-risk user groups and provide relevant actionable items may be perceived as a helpful approach to early contact with the health system for assessing communicable disease symptoms and follow-up care options at home before virtual or in-person contact with health care providers. The results identified and validated significant design factors for conversational recommender systems, including triangulating a high-risk target user population and providing relevant actionable items for users to choose from as part of user engagement. %M 38096007 %R 10.2196/43105 %U https://mhealth.jmir.org/2023/1/e43105 %U https://doi.org/10.2196/43105 %U http://www.ncbi.nlm.nih.gov/pubmed/38096007 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e34386 %T Manifestations and Outcomes of Intracerebral Hemorrhage During the COVID-19 Pandemic in China: Multicenter, Longitudinal Cohort Study %A Wan,Yan %A He,Quan Wei %A Chen,Shaoli %A Li,Man %A Xia,Yuanpeng %A Zhang,Lei %A Sun,Zhou %A Chen,Xiaolu %A Wang,David %A Chang,Jiang %A Hu,Bo %+ Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, NO.1277, Jiefang Road, Wuhan, 430022, China, 86 13707114863, hubo@mail.hust.edu.cn %K COVID-19 %K intracerebral hemorrhage %K manifestation %K outcome %K cohort study %D 2023 %7 13.12.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The COVID-19 pandemic has inevitably affected the distribution of medical resources, and epidemic lockdowns have had a significant impact on the nursing and treatment of patients with other acute diseases, including intracerebral hemorrhage (ICH). Objective: This study aimed to investigate how the COVID-19 pandemic affected the manifestations and outcomes of patients with ICH. Methods: Patients with acute ICH before (December 1, 2018-November 30, 2019) and during (December 1, 2019-November 30, 2020) the COVID-19 pandemic at 31 centers in China from the Chinese Cerebral Hemorrhage: Mechanism and Intervention (CHEERY) study were entered into the analysis. Demographic information and clinical manifestations and outcomes were collected and compared between the 2 groups. Results: From December 1, 2018, to November 30, 2020, a total of 3460 patients with ICH from the CHEERY study were enrolled and eventually analyzed. The results showed that during the COVID-19 pandemic, patients with ICH were more likely to be older (P<.001) with a history of ischemic stroke (P=.04), shorter time from onset to admission (P<.001), higher blood pressure (P<.001), higher fasting blood glucose (P=.003), larger hematoma volume (P<.001), and more common deep ICH (P=.01) and intraventricular hemorrhage (P=.02). These patients required more intensive care unit treatment (P<.001) and preferred to go to the hospital directly rather than call an ambulance (P<.001). In addition, the COVID-19 pandemic was associated with an increased risk of pulmonary infection during hospitalization (adjusted risk ratio [RRadjusted] 1.267, 95% CI 1.065-1.509), lower probability of a 3-month good outcome (RRadjusted 0.975, 95% CI 0.956-0.995), and a higher probability of in-hospital (RRadjusted 3.103, 95% CI 2.156-4.465), 1-month (RRadjusted 1.064, 95% CI 1.042-1.087), and 3-month (RRadjusted 1.069, 95% CI 1.045-1.093) mortality. Conclusions: Our study indicated that the cloud of COVID-19 has adversely impacted the presentation and outcomes of ICH. Medical workers may pay more attention to patients with ICH, while the public should pay more attention to hypertension control and ICH prevention. Trial Registration: Chinese Clinical Trial Registry ChiCTR1900020872; https://www.chictr.org.cn/showprojEN.html?proj=33817 %M 38090794 %R 10.2196/34386 %U https://publichealth.jmir.org/2023/1/e34386 %U https://doi.org/10.2196/34386 %U http://www.ncbi.nlm.nih.gov/pubmed/38090794 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e42310 %T Development of a Virtual Human for Supporting Tobacco Cessation During the COVID-19 Pandemic %A Loveys,Kate %A Lloyd,Erica %A Sagar,Mark %A Broadbent,Elizabeth %+ Department of Psychological Medicine, The University of Auckland, Level 3, Building 507, 22-30 Park Avenue, Grafton, Auckland, 1023, New Zealand, 64 93737599 ext 86756, e.broadbent@auckland.ac.nz %K virtual human %K conversational agent %K tobacco cessation %K eHealth %K COVID-19 %K public health %K virtual health worker %K smoking cessation %K artificial intelligence %K AI %K chatbot %K digital health intervention %K web-based health %K mobile phone %D 2023 %7 5.12.2023 %9 Viewpoint %J J Med Internet Res %G English %X People who consume tobacco are at greater risk of developing severe COVID-19. Unfortunately, the COVID-19 pandemic reduced the accessibility of tobacco cessation services as a result of necessary social restrictions. Innovations were urgently needed to support tobacco cessation during the pandemic. Virtual humans are artificially intelligent computer agents with a realistic, humanlike appearance. Virtual humans could be a scalable and engaging way to deliver tobacco cessation information and support. Florence, a virtual human health worker, was developed in collaboration with the World Health Organization to remotely support people toward tobacco cessation during the COVID-19 pandemic. Florence delivers evidence-based information, assists with making quit plans, and directs people to World Health Organization–recommended cessation services in their country. In this viewpoint, we describe the process of developing Florence. The development was influenced by a formative evaluation of data from 115 early users of Florence from 49 countries. In general, Florence was positively perceived; however, changes were requested to aspects of her design and content. In addition, areas for new content were identified (eg, for nonsmoker support persons). Virtual health workers could expand the reach of evidence-based tobacco cessation information and personalized support. However, as they are a new innovation in tobacco cessation, their efficacy, feasibility, and acceptability in this application needs to be evaluated, including in diverse populations. %M 38051571 %R 10.2196/42310 %U https://www.jmir.org/2023/1/e42310 %U https://doi.org/10.2196/42310 %U http://www.ncbi.nlm.nih.gov/pubmed/38051571 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e44257 %T Residential Segregation and County-Level COVID-19 Booster Coverage in the Deep South: Surveillance Report and Ecological Study %A Zeng,Chengbo %A Zhang,Jiajia %A Li,Zhenlong %A Sun,Xiaowen %A Ning,Huan %A Yang,Xueying %A Weissman,Sharon %A Olatosi,Bankole %A Li,Xiaoming %+ Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, 4th Floor, 915 Greene Street, Columbia, SC, 29208, United States, czeng@email.sc.edu %K Deep South %K COVID-19 %K vaccine %K booster %K residential segregation %D 2023 %7 5.12.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: COVID-19 had a greater impact in the Deep South compared with other regions in the United States. While vaccination remains a top priority for all eligible individuals, data regarding the progress of booster coverage in the Deep South and how the coverage varies by county and age are sparse. Despite existing evidence of racial and ethnic disparities in COVID-19 vaccinations at the individual level, there is an urgent need for evidence at the population level. Such information could highlight vulnerable communities and guide future health care policy-making and resource allocation. Objective: We aimed to evaluate county-level COVID-19 booster coverage by age group in the Deep South and explore its association with residential segregation. Methods: An ecological study was conducted at the population level by integrating COVID-19 vaccine surveillance data, residential segregation index, and county-level factors across the 418 counties of 5 Deep South states from December 15, 2021, to October 19, 2022. We analyzed the cumulative percentages of county-level COVID-19 booster uptake by age group (eg, 12 to 17 years, 18 to 64 years, and at least 65 years) by the end of the study period. The longitudinal relationships were examined between residential segregation, the interaction of time and residential segregation, and COVID-19 booster coverage using the Poisson model. Results: As of October 19, 2022, among the 418 counties, the median of booster uptake was 40% (IQR 37.8%-43%). Compared with older adults (ie, at least 65 years; median 63.1%, IQR 59.5%-66.5%), youth (ie, 12 to 17 years; median 14.1%, IQR 11.3%-17.4%) and adults (ie, 18 to 64 years; median 33.4%, IQR 30.5%-36.5%) had lower percentages of booster uptake. There was geospatial heterogeneity in the county-level COVID-19 booster coverage. We found that higher segregated counties had lower percentages of booster coverage. Such relationships attenuated as time increased. The findings were consistent across the age groups. Conclusions: The progress of county-level COVID-19 booster coverage in the Deep South was slow and varied by age group. Residential segregation precluded the county-level COVID-19 booster coverage across age groups. Future efforts regarding vaccination strategies should focus on youth and adults. Health care facilities and resources are needed in racial and ethnic minority communities. %M 38051568 %R 10.2196/44257 %U https://publichealth.jmir.org/2023/1/e44257 %U https://doi.org/10.2196/44257 %U http://www.ncbi.nlm.nih.gov/pubmed/38051568 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e44530 %T The Use of Medical Crowdfunding to Mitigate the Personal Costs of Serious Chronic Illness: Scoping Review %A Killela,Mary %A Biddell,Caitlin %A Keim-Malpass,Jessica %A Schwartz,Todd A %A Soto,Sandra %A Williams,Jessica %A Santacroce,Sheila %+ School of Nursing, University of North Carolina at Chapel Hill, 120 N Medical Dr, Chapel Hill, NC, 27599, United States, 1 919 843 8566, mkillela@email.unc.edu %K COVID-19 %K chronic illness %K costs %K financial %K stress %K appraisal %K coping %K crowdfunding %K social network %K social support %K caregiver %K systematic scoping review %K medical crowdfunding %K social network %K coping behavior %D 2023 %7 4.12.2023 %9 Review %J J Med Internet Res %G English %X Background: Persons diagnosed with serious chronic illnesses and their caretakers experience multiple types of financial costs that strain their income and generate financial distress. Many turn to medical crowdfunding (MCF) to mitigate the harms of these costs on their health and quality of life. Objective: This scoping review aims to summarize the research on MCF for persons diagnosed with serious chronic illness regarding study designs and methods; the responsible conduct of research practices; and study foci as they relate to stress, stress appraisals, and the coping processes. Methods: This review was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. Eligible studies were conducted in countries designated as high income by the World Bank and focused on beneficiaries diagnosed with serious chronic illness. The findings of the included studies were summarized as they related to the key concepts in a conceptual framework derived from an established stress, appraisal, and coping framework and a conceptual model of financial toxicity in pediatric oncology. Results: Overall, 26 studies were eligible for inclusion in the review. The main findings included a lack of integration of qualitative and quantitative approaches and the inconsistent reporting of the responsible conduct of research practices. The included studies focused on financial stressors that contributed to financial burden, such as out-of-pocket payments of medical bills, basic living expenses, medical travel expenses, and lost income owing to illness-related work disruptions. Few studies addressed stress appraisals as threatening or the adequacy of available financial resources. When mentioned, appraisals related to the global financial struggle during the COVID-19 pandemic or the capacity of social network members to donate funds. The consequences of MCF included the receipt of 3 forms of social support (tangible, informational, and emotional), privacy loss, embarrassment, and the propagation of scientifically unsupported information. Studies found that friends and family tended to manage MCF campaigns. Although most of the studies (21/26, 81%) focused on monetary outcomes, a few (5/26, 19%) concentrated on peoples’ experiences with MCF. Conclusions: The identified methodological gaps highlight the need for more robust and reproducible approaches to using the copious data available on public MCF platforms. The integration of quantitative and qualitative methods will allow for nuanced explorations of the MCF experience. A more consistent elaboration of strategies to promote the responsible conduct of research is warranted to minimize risk to populations that are vulnerable and express concerns regarding the loss of privacy. Finally, an examination of the unanticipated consequences of MCF is critical for the development of future interventions to optimize existing supports while providing needed supports, financial and nonfinancial, that are lacking. %M 38048149 %R 10.2196/44530 %U https://www.jmir.org/2023/1/e44530 %U https://doi.org/10.2196/44530 %U http://www.ncbi.nlm.nih.gov/pubmed/38048149 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 3 %N %P e43700 %T Using COVID-19 Vaccine Attitudes Found in Tweets to Predict Vaccine Perceptions in Traditional Surveys: Infodemiology Study %A Sigalo,Nekabari %A Frias-Martinez,Vanessa %+ College of Information Studies, University of Maryland, 4130 Campus Dr, College Park, MD, 20742, United States, 1 301 405 2033, nsigalo@terpmail.umd.edu %K social media %K Twitter %K COVID-19 %K vaccine %K surveys %K SARS-CoV-2 %K vaccinations %K hesitancy %D 2023 %7 30.11.2023 %9 Original Paper %J JMIR Infodemiology %G English %X Background: Traditionally, surveys are conducted to answer questions related to public health but can be costly to execute. However, the information that researchers aim to extract from surveys could potentially be retrieved from social media, which possesses data that are highly accessible and lower in cost to collect. Objective: This study aims to evaluate whether attitudes toward COVID-19 vaccines collected from the Household Pulse Survey (HPS) could be predicted using attitudes extracted from Twitter (subsequently rebranded X). Ultimately, this study aimed to determine whether Twitter can provide us with similar information to that observed in traditional surveys or whether saving money comes at the cost of losing rich data. Methods: COVID-19 vaccine attitudes were extracted from the HPS conducted between January 6 and May 25, 2021. Twitter’s streaming application programming interface was used to collect COVID-19 vaccine tweets during the same period. A sentiment and emotion analysis of tweets was conducted to examine attitudes toward the COVID-19 vaccine on Twitter. Generalized linear models and generalized linear mixed models were used to evaluate the ability of COVID-19 vaccine attitudes on Twitter to predict vaccine attitudes in the HPS. Results: The results revealed that vaccine perceptions expressed on Twitter performed well in predicting vaccine perceptions in the survey. Conclusions: These findings suggest that the information researchers aim to extract from surveys could potentially also be retrieved from a more accessible data source, such as Twitter. Leveraging Twitter data alongside traditional surveys can provide a more comprehensive and nuanced understanding of COVID-19 vaccine perceptions, facilitating evidence-based decision-making and tailored public health strategies. %M 37903294 %R 10.2196/43700 %U https://infodemiology.jmir.org/2023/1/e43700 %U https://doi.org/10.2196/43700 %U http://www.ncbi.nlm.nih.gov/pubmed/37903294 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 6 %N %P e43185 %T Use of a Data Repository to Identify Delirium as a Presenting Symptom of COVID-19 Infection in Hospitalized Adults: Cross-Sectional Cohort Pilot Study %A Solberg,Laurence M %A Duckworth,Laurie J %A Dunn,Elizabeth M %A Dickinson,Theresa %A Magoc,Tanja %A Snigurska,Urszula A %A Ser,Sarah E %A Celso,Brian %A Bailey,Meghan %A Bowen,Courtney %A Radhakrishnan,Nila %A Patel,Chirag R %A Lucero,Robert %A Bjarnadottir,Ragnhildur I %+ Geriatrics Research, Education, and Clinical Center, North Florida/South Georgia Veterans Health System, Veterans Health Administration, 1601 South West Archer Road, GRECC-182, Gainesville, FL, 32608, United States, 1 3525486000 ext 105033, lmsolberg@ufl.edu %K COVID-19 %K delirium %K neurocognitive disorder %K data repository %K adults %K pilot study %K symptom %K electronic health record %K viral infection %K clinical %K patient %K research %K diagnosis %K disorder %K memory %K covid %K memory loss %K old %K old age %D 2023 %7 30.11.2023 %9 Original Paper %J JMIR Aging %G English %X Background: Delirium, an acute confusional state highlighted by inattention, has been reported to occur in 10% to 50% of patients with COVID-19. People hospitalized with COVID-19 have been noted to present with or develop delirium and neurocognitive disorders. Caring for patients with delirium is associated with more burden for nurses, clinicians, and caregivers. Using information in electronic health record data to recognize delirium and possibly COVID-19 could lead to earlier treatment of the underlying viral infection and improve outcomes in clinical and health care systems cost per patient. Clinical data repositories can further support rapid discovery through cohort identification tools, such as the Informatics for Integrating Biology and the Bedside tool. Objective: The specific aim of this research was to investigate delirium in hospitalized older adults as a possible presenting symptom in COVID-19 using a data repository to identify neurocognitive disorders with a novel group of International Classification of Diseases, Tenth Revision (ICD-10) codes. Methods: We analyzed data from 2 catchment areas with different demographics. The first catchment area (7 counties in the North-Central Florida) is predominantly rural while the second (1 county in North Florida) is predominantly urban. The Integrating Biology and the Bedside data repository was queried for patients with COVID-19 admitted to inpatient units via the emergency department (ED) within the health center from April 1, 2020, and April 1, 2022. Patients with COVID-19 were identified by having a positive COVID-19 laboratory test or a diagnosis code of U07.1. We identified neurocognitive disorders as delirium or encephalopathy, using ICD-10 codes. Results: Less than one-third (1437/4828, 29.8%) of patients with COVID-19 were diagnosed with a co-occurring neurocognitive disorder. A neurocognitive disorder was present on admission for 15.8% (762/4828) of all patients with COVID-19 admitted through the ED. Among patients with both COVID-19 and a neurocognitive disorder, 56.9% (817/1437) were aged ≥65 years, a significantly higher proportion than those with no neurocognitive disorder (P<.001). The proportion of patients aged <65 years was significantly higher among patients diagnosed with encephalopathy only than patients diagnosed with delirium only and both delirium and encephalopathy (P<.001). Most (1272/4828, 26.3%) patients with COVID-19 admitted through the ED during our study period were admitted during the Delta variant peak. Conclusions: The data collected demonstrated that an increased number of older patients with neurocognitive disorder present on admission were infected with COVID-19. Knowing that delirium increases the staffing, nursing care needs, hospital resources used, and the length of stay as previously noted, identifying delirium early may benefit hospital administration when planning for newly anticipated COVID-19 surges. A robust and accessible data repository, such as the one used in this study, can provide invaluable support to clinicians and clinical administrators in such resource reallocation and clinical decision-making. %M 37910448 %R 10.2196/43185 %U https://aging.jmir.org/2023/1/e43185 %U https://doi.org/10.2196/43185 %U http://www.ncbi.nlm.nih.gov/pubmed/37910448 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e50367 %T Incivility in COVID-19 Vaccine Mandate Discourse and Moral Foundations: Natural Language Processing Approach %A Tin,Jason %A Stevens,Hannah %A Rasul,Muhammad Ehab %A Taylor,Laramie D %+ Department of Communication, University of California, Davis, 1 Shields Avenue, Davis, CA, 95616, United States, 1 530 752 1011, merasul@ucdavis.edu %K incivility %K vaccine hesitancy %K moral foundations %K COVID-19 %K vaccines %K morality %K social media %K natural language processing %K machine learning %D 2023 %7 29.11.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Vaccine hesitancy poses a substantial threat to efforts to mitigate the harmful effects of the COVID-19 pandemic. To combat vaccine hesitancy, officials in the United States issued vaccine mandates, which were met with strong antivaccine discourse on social media platforms such as Reddit. The politicized and polarized nature of COVID-19 on social media has fueled uncivil discourse related to vaccine mandates, which is known to decrease confidence in COVID-19 vaccines. Objective: This study examines the moral foundations underlying uncivil COVID-19 vaccine discourse. Moral foundations theory poses that individuals make decisions to express approval or disapproval (ie, uncivil discourse) based on innate moral values. We examine whether moral foundations are associated with dimensions of incivility. Further, we explore whether there are any differences in the presence of incivility between the r/coronaviruscirclejerk and r/lockdownskepticism subreddits. Methods: Natural language processing methodologies were leveraged to analyze the moral foundations underlying uncivil discourse in 2 prominent antivaccine subreddits, r/coronaviruscirclejerk and r/lockdownskepticism. All posts and comments from both of the subreddits were collected since their inception in March 2022. This was followed by filtering the data set for key terms associated with the COVID-19 vaccine (eg, “vaccinate” and “Pfizer”) and mandates (eg, “forced” and “mandating”). These key terms were selected based on a review of existing literature and because of their salience in both of the subreddits. A 10% sample of the filtered key terms was used for the final analysis. Results: Findings suggested that moral foundations play a role in the psychological processes underlying uncivil vaccine mandate discourse. Specifically, we found substantial associations between all moral foundations (ie, care and harm, fairness and cheating, loyalty and betrayal, authority and subversion, and sanctity and degradation) and dimensions of incivility (ie, toxicity, insults, profanity, threat, and identity attack) except for the authority foundation. We also found statistically significant differences between r/coronaviruscirclejerk and r/lockdownskepticism for the presence of the dimensions of incivility. Specifically, the mean of identity attack, insult, toxicity, profanity, and threat in the r/lockdownskepticism subreddit was significantly lower than that in the r/coronaviruscirclejerk subreddit (P<.001). Conclusions: This study shows that moral foundations may play a substantial role in the presence of incivility in vaccine discourse. On the basis of the findings of the study, public health practitioners should tailor messaging by addressing the moral values underlying the concerns people may have about vaccines, which could manifest as uncivil discourse. Another way to tailor public health messaging could be to direct it to parts of social media platforms with increased uncivil discourse. By integrating moral foundations, public health messaging may increase compliance and promote civil discourse surrounding COVID-19. %M 38019581 %R 10.2196/50367 %U https://formative.jmir.org/2023/1/e50367 %U https://doi.org/10.2196/50367 %U http://www.ncbi.nlm.nih.gov/pubmed/38019581 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 12 %N %P e43572 %T Nonface-to-Face Visitation to Restrict Patient Visits for Infection Control: Integrative Review %A Jeong,Hyunwoo %A Choi,Yonsu %A Kim,Heejung %+ College of Nursing, Yonsei University, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea, 82 02 2228 3273, hkim80@yuhs.ac %K nonface-to-face visitation %K visit restriction %K infection control %K patient %K family %D 2023 %7 28.11.2023 %9 Review %J Interact J Med Res %G English %X Background: In the COVID-19 pandemic, a visit restriction policy for patients has been implemented in medical institutions worldwide and visits are being made using alternative communication technologies. This shift has also required the use of platforms to prevent negative consequences of these restrictions. Objective: The purpose of this review was to comprehensively explore nonface-to-face visits as an alternative during infection prevention and to synthesize the scientific evidence of their benefits and disadvantages. Methods: A comprehensive search was conducted via the PubMed, Embase, CINAHL, Cochrane, and Web of Science electronic databases; unpublished trials in the clinical trials register ClinicalTrials.gov; and Virginia Henderson International Nursing Library up to September 10, 2021. The search query was developed according to the guidelines of the Peer Review of Electronic Search Strategies and included keywords on the topics of telemedicine and visitation restrictions. The inclusion criteria were a nonface-to-face modality using telemedicine with family in a hospital setting, experimental and observational studies, and articles written in English. The exclusion criteria were inaccessible in full text, not related to patient or family involvement, mainly focused on the study protocol, or only discussing the pros and cons of telemedicine. Results: Overall, patients’ families experienced emotional distress due to restrictions on face-to-face visits. Nonface-to-face virtual visits compensating for these restrictions had a positive effect on reducing the risk of infection to the patient and the family. This further encouraged psychological and physical recovery and decreased psychological distress. However, nonface-to-face virtual technology could not replace the existence of actual families, and technical problems with networks and devices are reported as limitations. Conclusions: Ensuring the availability of technology and educating on the same in alignment with the characteristics of patients and their families, nonface-to-face virtual visits need to show more potential as an effective patient-centered treatment strategy based on more research and advanced practice. %M 38015595 %R 10.2196/43572 %U https://www.i-jmr.org/2023/1/e43572 %U https://doi.org/10.2196/43572 %U http://www.ncbi.nlm.nih.gov/pubmed/38015595 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e43584 %T Predictors of Dropout Among Psychosomatic Rehabilitation Patients During the COVID-19 Pandemic: Secondary Analysis of a Longitudinal Study of Digital Training %A Gao,Lingling %A Keller,Franziska Maria %A Becker,Petra %A Dahmen,Alina %A Lippke,Sonia %+ Health Psychology and Behavioural Medicine, Constructor University Bremen, Campus Ring 1, Bremen, 28759, Germany, 49 4212004730, slippke@constructor.university %K dropout %K web-based study %K digital therapy %K medical rehabilitation %K digital training %K mental disorder %K psychosomatic rehabilitation %K COVID-19 %D 2023 %7 27.11.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: High dropout rates are a common problem reported in web-based studies. Understanding which risk factors interrelate with dropping out from the studies provides the option to prevent dropout by tailoring effective strategies. Objective: This study aims to contribute an understanding of the predictors of web-based study dropout among psychosomatic rehabilitation patients. We investigated whether sociodemographics, voluntary interventions, physical and mental health, digital use for health and rehabilitation, and COVID-19 pandemic–related variables determine study dropout. Methods: Patients (N=2155) recruited from 4 psychosomatic rehabilitation clinics in Germany filled in a web-based questionnaire at T1, which was before their rehabilitation stay. Approximately half of the patients (1082/2155, 50.21%) dropped out at T2, which was after the rehabilitation stay, before and during which 3 voluntary digital trainings were provided to them. According to the number of trainings that the patients participated in, they were categorized into a comparison group or 1 of 3 intervention groups. Chi-square tests were performed to examine the differences between dropout patients and retained patients in terms of sociodemographic variables and to compare the dropout rate differences between the comparison and intervention groups. Logistic regression analyses were used to assess what factors were related to study dropout. Results: The comparison group had the highest dropout rate of 68.4% (173/253) compared with the intervention groups’ dropout rates of 47.98% (749/1561), 50% (96/192), and 42.9% (64/149). Patients with a diagnosis of combined anxiety and depressive disorder had the highest dropout rate of 64% (47/74). Younger patients (those aged <50 y) and patients who were less educated were more likely to drop out of the study. Patients who used health-related apps and the internet less were more likely to drop out of the study. Patients who remained in their jobs and patients who were infected by COVID-19 were more likely to drop out of the study. Conclusions: This study investigated the predictors of dropout in web-based studies. Different factors such as patient sociodemographics, physical and mental health, digital use, COVID-19 pandemic correlates, and study design can correlate with the dropout rate. For web-based studies with a focus on mental health, it is suggested to consider these possible dropout predictors and take appropriate steps to help patients with a high risk of dropping out overcome difficulties in completing the study. %M 37903289 %R 10.2196/43584 %U https://www.jmir.org/2023/1/e43584 %U https://doi.org/10.2196/43584 %U http://www.ncbi.nlm.nih.gov/pubmed/37903289 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e49435 %T Fight Against the Mandatory COVID-19 Immunity Passport on Twitter: Natural Language Processing Study %A Gable,Jessica S M %A Sauvayre,Romy %A Chauvière,Cédric %+ Polytech Clermont, Clermont Auvergne INP, Université Clermont Auvergne, 2 avenue Blaise Pascal, TSA 60 026, Aubiere, 63178, France, 33 781425636, romy.sauvayre@uca.fr %K mandatory vaccination %K public policy %K public health measures %K COVID-19 %K vaccine %K social media analysis %K Twitter %K natural language processing %K deep learning %K social media %K public health %K vaccination %K immunity %K social distancing %K neural network %K effectiveness %D 2023 %7 23.11.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: To contain and curb the spread of COVID-19, the governments of countries around the world have used different strategies (lockdown, mandatory vaccination, immunity passports, voluntary social distancing, etc). Objective: This study aims to examine the reactions produced by the public announcement of a binding political decision presented by the president of the French Republic, Emmanuel Macron, on July 12, 2021, which imposed vaccination on caregivers and an immunity passport on all French people to access restaurants, cinemas, bars, and so forth. Methods: To measure these announcement reactions, 901,908 unique tweets posted on Twitter (Twitter Inc) between July 12 and August 11, 2021, were extracted. A neural network was constructed to examine the arguments of the tweets and to identify the types of arguments used by Twitter users. Results: This study shows that in the debate about mandatory vaccination and immunity passports, mostly “con” arguments (399,803/847,725, 47%; χ26=952.8; P<.001) and “scientific” arguments (317,156/803,583, 39%; χ26=5006.8; P<.001) were used. Conclusions: This study shows that during July and August 2021, social events permeating the public sphere and discussions about mandatory vaccination and immunity passports collided on Twitter. Moreover, a political decision based on scientific arguments led citizens to challenge it using pseudoscientific arguments contesting the effectiveness of vaccination and the validity of these political decisions. %M 37850906 %R 10.2196/49435 %U https://www.jmir.org/2023/1/e49435 %U https://doi.org/10.2196/49435 %U http://www.ncbi.nlm.nih.gov/pubmed/37850906 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 3 %N %P e43891 %T Monitoring SARS-CoV-2 Using Infoveillance, National Reporting Data, and Wastewater in Wales, United Kingdom: Mixed Methods Study %A Cuff,Jordan P %A Dighe,Shrinivas Nivrutti %A Watson,Sophie E %A Badell-Grau,Rafael A %A Weightman,Andrew J %A Jones,Davey L %A Kille,Peter %+ School of Biosciences, Cardiff University, Sir Martin Evans Building, Museum Avenue, Cardiff, CF10 3AX, United Kingdom, 44 29 2087 4974, Kille@cardiff.ac.uk %K COVID-19 %K Google Trends %K infodemiology %K quantitative reverse transcription polymerase chain reaction %K RT-qPCR %K wastewater %K infoveillance %K public health care %K health care statistics %K correlation analysis %K analysis %K public health %K online health %K eHealth %K public interest %D 2023 %7 23.11.2023 %9 Original Paper %J JMIR Infodemiology %G English %X Background: The COVID-19 pandemic necessitated rapid real-time surveillance of epidemiological data to advise governments and the public, but the accuracy of these data depends on myriad auxiliary assumptions, not least accurate reporting of cases by the public. Wastewater monitoring has emerged internationally as an accurate and objective means for assessing disease prevalence with reduced latency and less dependence on public vigilance, reliability, and engagement. How public interest aligns with COVID-19 personal testing data and wastewater monitoring is, however, very poorly characterized. Objective: This study aims to assess the associations between internet search volume data relevant to COVID-19, public health care statistics, and national-scale wastewater monitoring of SARS-CoV-2 across South Wales, United Kingdom, over time to investigate how interest in the pandemic may reflect the prevalence of SARS-CoV-2, as detected by national testing and wastewater monitoring, and how these data could be used to predict case numbers. Methods: Relative search volume data from Google Trends for search terms linked to the COVID-19 pandemic were extracted and compared against government-reported COVID-19 statistics and quantitative reverse transcription polymerase chain reaction (RT-qPCR) SARS-CoV-2 data generated from wastewater in South Wales, United Kingdom, using multivariate linear models, correlation analysis, and predictions from linear models. Results: Wastewater monitoring, most infoveillance terms, and nationally reported cases significantly correlated, but these relationships changed over time. Wastewater surveillance data and some infoveillance search terms generated predictions of case numbers that correlated with reported case numbers, but the accuracy of these predictions was inconsistent and many of the relationships changed over time. Conclusions: Wastewater monitoring presents a valuable means for assessing population-level prevalence of SARS-CoV-2 and could be integrated with other data types such as infoveillance for increasingly accurate inference of virus prevalence. The importance of such monitoring is increasingly clear as a means of objectively assessing the prevalence of SARS-CoV-2 to circumvent the dynamic interest and participation of the public. Increased accessibility of wastewater monitoring data to the public, as is the case for other national data, may enhance public engagement with these forms of monitoring. %M 37903300 %R 10.2196/43891 %U https://infodemiology.jmir.org/2023/1/e43891 %U https://doi.org/10.2196/43891 %U http://www.ncbi.nlm.nih.gov/pubmed/37903300 %0 Journal Article %@ 2371-4379 %I JMIR Publications %V 8 %N %P e42607 %T Glycemic Control, Renal Progression, and Use of Telemedicine Phone Consultations Among Japanese Patients With Type 2 Diabetes Mellitus During the COVID-19 Pandemic: Retrospective Cohort Study %A Sankoda,Akiko %A Nagae,Yugo %A Waki,Kayo %A Sze,Wei Thing %A Oba,Koji %A Mieno,Makiko %A Nangaku,Masaomi %A Yamauchi,Toshimasa %A Ohe,Kazuhiko %+ Department of Planning, Information and Management, The University of Tokyo Hospital, 7 Chome-3-1 Hongo, Bunkyo City, Tokyo, 113-8655, Japan, 81 3 5 80091289, kwaki-tky@m.u-tokyo.ac.jp %K glycemic control %K renal progression %K telemedicine %K phone consultations %K COVID-19 %K diabetes mellitus %K type 2 diabetes %D 2023 %7 21.11.2023 %9 Original Paper %J JMIR Diabetes %G English %X Background: Reduced or delayed medical follow-ups have been reported during the COVID-19 pandemic, which may lead to worsening clinical outcomes for patients with diabetes. The Japanese government granted special permission for medical institutions to use telephone consultations and other remote communication modes during the COVID-19 pandemic. Objective: We aimed to evaluate changes in the frequency of outpatient consultations, glycemic control, and renal function among patients with type 2 diabetes before and during the COVID-19 pandemic. Methods: This is a retrospective single-cohort study conducted in Tokyo, Japan, analyzing results for 3035 patients who visited the hospital regularly. We compared the frequency of outpatient consultations attended (both in person and via telemedicine phone consultation), glycated hemoglobin A1c (HbA1c), and estimated glomerular filtration rate (eGFR) among patients with type 2 diabetes mellitus during the 6 months from April 2020 to September 2020 (ie, during the COVID-19 pandemic) with those during the same period of the previous year, 2019, using Wilcoxon signed rank tests. We conducted a multivariate logistic regression analysis to identify factors related to the changes in glycemic control and eGFR. We also compared the changes in HbA1c and eGFR from 2019 to 2020 among telemedicine users and telemedicine nonusers using difference-in-differences design. Results: The overall median number of outpatient consultations attended decreased significantly from 3 (IQR 2-3) in 2019 to 2 (IQR 2-3) in 2020 (P<.001). Median HbA1c levels deteriorated, though not to a clinically significant degree (6.90%, IQR 6.47%-7.39% vs 6.95%, IQR 6.47%-7.40%; P<.001). The decline in median eGFR was greater during the year 2019-2020 compared to the year 2018-2019 (–0.9 vs –0.5 mL/min/1.73 m2; P=.01). Changes in HbA1c and eGFR did not differ between patients who used telemedicine phone consultations and those who did not. Age and HbA1c level before the pandemic were positive predictors of worsening glycemic control during the COVID-19 pandemic, whereas the number of outpatient consultations attended was identified as a negative predictor of worsening glycemic control during the pandemic. Conclusions: The COVID-19 pandemic resulted in reduced attendance of outpatient consultations among patients with type 2 diabetes, and these patients also experienced deterioration in kidney function. Difference in consultation modality (in person or by phone) did not affect glycemic control and renal progression of the patients. %M 37315193 %R 10.2196/42607 %U https://diabetes.jmir.org/2023/1/e42607 %U https://doi.org/10.2196/42607 %U http://www.ncbi.nlm.nih.gov/pubmed/37315193 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e45875 %T A Web-Based COVID-19 Tool for Testing Residents in Retirement Homes: Development Study %A Davoodi,Mansoor %A Batista,Ana %A Mertel,Adam %A Senapati,Abhishek %A Abdussalam,Wildan %A Vyskocil,Jiri %A Barbieri,Giuseppe %A Fan,Kai %A Schlechte-Welnicz,Weronika %A M Calabrese,Justin %+ Center for Advanced Systems Understanding, Untermarkt 20, Görlitz, 02826, Germany, 49 3581375237, m.davoodi-monfared@hzdr.de %K application %K COVID-19 %K optimized testing %K pandemic %K retirement home %K web application %D 2023 %7 21.11.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Long-term care facilities have been widely affected by the COVID-19 pandemic. Empirical evidence demonstrated that older people are the most impacted and are at higher risk of mortality after being infected. Regularly testing care facility residents is a practical approach to detecting infections proactively. In many cases, the care staff must perform the tests on the residents while also providing essential care, which in turn causes imbalances in their working time. Once an outbreak occurs, suppressing the spread of the virus in retirement homes (RHs) is challenging because the residents are in contact with each other, and isolation measures cannot be widely enforced. Regular testing strategies, on the other hand, have been shown to effectively prevent outbreaks in RHs. However, high-frequency testing may consume substantial staff working time, which results in a trade-off between the time invested in testing and the time spent providing essential care to residents. Objective: We developed a web application (Retirement Home Testing Optimizer) to assist RH managers in identifying effective testing schedules for residents. The outcome of the app, called the “testing strategy,” is based on dividing facility residents into groups and then testing no more than 1 group per day. Methods: We created the web application by incorporating influential factors such as the number of residents and staff, the average rate of contacts, the amount of time spent to test, and constraints on the test interval and size of groups. We developed mixed integer nonlinear programming models for balancing staff workload in long-term care facilities while minimizing the expected detection time of a probable infection inside the facility. Additionally, by leveraging symmetries in the problem, we proposed a fast and efficient local search method to find the optimal solution. Results: Considering the number of residents and staff and other practical constraints of the facilities, the proposed application computes the optimal trade-off testing strategy and suggests the corresponding grouping and testing schedule for residents. The current version of the application is deployed on the server of the Where2Test project and is accessible on their website. The application is open source, and all contents are offered in English and German. We provide comprehensive instructions and guidelines for easy use and understanding of the application’s functionalities. The application was launched in July 2022, and it is currently being tested in RHs in Saxony, Germany. Conclusions: Recommended testing strategies by our application are tailored to each RH and the goals set by the managers. We advise the users of the application that the proposed model and approach focus on the expected scenarios, that is, the expected risk of infection, and they do not guarantee the avoidance of worst-case scenarios. %M 37988136 %R 10.2196/45875 %U https://formative.jmir.org/2023/1/e45875 %U https://doi.org/10.2196/45875 %U http://www.ncbi.nlm.nih.gov/pubmed/37988136 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e42545 %T Selection Bias in Digital Conversations on Depression Before and During COVID-19 %A Lee,Edward %A Agustines,Davin %A Woo,Benjamin K P %+ College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, 4385 Ocean View Blvd, Montrose, CA, 91020, United States, 1 8189260488, edward.lee@westernu.edu %K depression %K COVID-19 %K treatment %K race %K ethnicity %K digital conversations %K health belief model %K artificial intelligence %K AI %K natural language processing %K NLP %D 2023 %7 20.11.2023 %9 Letter to the Editor %J JMIR Form Res %G English %X %M 37983077 %R 10.2196/42545 %U https://formative.jmir.org/2023/1/e42545 %U https://doi.org/10.2196/42545 %U http://www.ncbi.nlm.nih.gov/pubmed/37983077 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e34128 %T Feasibility of Telemedicine in the Management Strategy of Patients With Lymphoma Amid the COVID-19 Pandemic in Spain: Prospective Observational Study %A Cordoba,Raul %A Lopez-Garcia,Alberto %A Morillo,Daniel %A Perez-Saenz,Maria-Angeles %A Askari,Elham %A Prieto,Rosa Elena %A Castillo Bazan,Eva %A Llamas Sillero,Pilar %A Herrero Gonzalez,Antonio %A Short Apellaniz,Jorge %A del Olmo,Marta %A Arcos,Javier %+ Department of Hematology, Clinical and Organizational Innovation Unit (UICO), Fundacion Jimenez Diaz University Hospital, Health Research Institute IIS-FJD, Avenida Reyes Catolicos 2, Madrid, 28040, Spain, 34 915504800 ext 3854, raul.cordoba@fjd.es %K telemedicine %K lymphoma %K COVID-19 %K cancer %K telehealth %K risk factor %K patient portal %K electronic health record %K EHR %D 2023 %7 17.11.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: On March 14, 2020, a state of alarm was declared in Spain due to the spread of SARS-CoV-2. Beyond this date, COVID-19 in the country changed the practice of oncologic care. Objective: Since recurrent hospital visits were a potential risk factor for contagion, the aim of this prospective observational study was to analyze the consequences of the COVID-19 pandemic in the health care of patients with lymphoma. Methods: All data were obtained from the electronic medical record. Variables such as age, sex, reason of the visit, use of the patient portal, changes in management, enrollment in clinical trials, and COVID-19 infection were recorded. Results: In all, 290 patients visited the lymphoma clinic, totaling 437 appointments. The median age was 66 (range 18-94) years, and 157 (54.1%) patients were male. Of them, 214 (73.8%) patients had only 1 visit to the clinic. Only 23 (7.9%) patients did not have access to the patient portal. Amid the COVID-19 pandemic, 78 (26.9%) patients remained in active treatment, 35 (12.1%) experienced delays in their treatments, and 6 (2.1%) experienced treatment discontinuation. During the follow-up, only 7 (2.4%) patients had a COVID-19 infection (6 cases with confirmed polymerase chain reaction test and 1 case with clinical suspicion). Despite the implementation of telemedicine strategies to avoid visits to the hospital, 66 (22.8%) patients had in-person visits at the lymphoma clinic. Patients who attended in-person consultations were younger than those who preferred telemedicine consultations (62 vs 66 years; P=.10) and had less use of the patient portal (17/224, 7.6% vs 6/66, 9%; P=.10), although these differences did not reach statistical significance. Patients who attended in-person visits were more likely to have had only 1 visit to the hospital (29/66, 43.9% vs 185/224, 82.6%; P<.001). Regarding the reason of in-person consultations, more patients were on active treatment in comparison to those using telemedicine resources (37/66, 56.1% vs 42/224, 18.3%; P<.001). Patients with a preference for telemedicine strategies had more surveillance visits (147/224, 65.6% vs 24/66, 36.4%; P<.001). Regarding treatment modifications, more treatment delays (29/224, 12.9% vs 6/66, 9.1%; P=.10) and more definite treatment discontinuations (6/224, 2.7% vs 0/66, 0%; P=.10) were seen in patients using telemedicine resources when compared to patients attending in-person visits, although these differences did not reach statistical significance. Regarding the type of therapy, patients attending in-person visits were more likely to receive an intravenous treatment rather than those using telemedicine (23/66, 62.2% vs 17/224, 40.5%; P<.001). Conclusions: Telemedicine such as patient portals are feasible strategies in the management of patients with lymphoma during the COVID-19 pandemic, with a reduction of in-person visits to the hospital and a very low contagion rate. %M 36645838 %R 10.2196/34128 %U https://formative.jmir.org/2023/1/e34128 %U https://doi.org/10.2196/34128 %U http://www.ncbi.nlm.nih.gov/pubmed/36645838 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e44292 %T Evaluating Web-Based Care for Mental Health and Substance Use Issues for Lesbian, Gay, Bisexual, Transgender, Queer, Questioning, and 2-Spirit Youths in the Context of the COVID-19 Pandemic: Community-Based Participatory Research Study %A Chaiton,Michael %A Thorburn,Rachel %A Chan,Emily %A Copeland,Ilana %A Luphuyong,Chieng %A Feng,Patrick %+ Applied Psychology and Human Development, Ontario Institute for Studies in Education, University of Toronto, 252 Bloor St W, Toronto, ON, M5S 1V6, Canada, 1 519 702 4000, rachel.thorburn@mail.utoronto.ca %K web-based care %K COVID-19 %K LGBTQ2S+ %K youth %K mental health %K substance use %K web-based %K care %K quality of care %K design %K communication %K policy %K model %K cost %K service %D 2023 %7 17.11.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Mental health (MH) and substance use (SU) care supports are often difficult to access for the lesbian, gay, bisexual, transgender, queer, questioning, and 2-spirit (LGBTQ2S+) population. There is little known on how the shift to web-based care has affected and changed the experiences of LGBTQ2S+ youths within the MH care system. Objective: This study sought to examine how web-based care modalities have affected access to care and quality of care for LGBTQ2S+ youths seeking MH and SU services. Methods: Researchers used a web-based co-design method to explore this population’s relationship with MH and SU care supports, focusing on the experiences of 33 LGBTQ2S+ youths and their relationship with MH and SU supports during the COVID-19 pandemic. A participatory design research method was used to gain experiential knowledge of LGBTQ2S+ youths’ lived experience with accessing MH and SU care. Thematic analysis was used to examine the resulting audio-recorded data transcripts and create themes. Results: Themes related to web-based care included accessibility, web-based communication, provision of choice, and provider relationship and interactions. Barriers to care were identified in particular for disabled youths, rural youths, and other participants with marginalized intersecting identities. Unexpected benefits of web-based care were also found and emphasize the idea that this modality is beneficial for some LGBTQ2S+ youths. Conclusions: During the COVID-19 pandemic, a time where MH- and SU-related problems have increased, programs need to reevaluate current measures so that the negative effects of web-based care modalities can be reduced for this population. Implications for practice encourage service providers to be more empathetic and transparent when providing services for LGBTQ2S+ youths. It is suggested that LGBTQ2S+ care should be provided by LGBTQ2S+ folks or organizations or service providers who are trained by LGBTQ2S+ community members. Additionally, hybrid models of care should be established in the future so that LGBTQ2S+ youths have the option to access in-person services, web-based ones, or both as there can be benefits to web-based care once it has been properly developed. Implications for policy also include moving away from a traditional health care team model and developing free and lower-cost services in remote areas. %M 37319010 %R 10.2196/44292 %U https://www.jmir.org/2023/1/e44292 %U https://doi.org/10.2196/44292 %U http://www.ncbi.nlm.nih.gov/pubmed/37319010 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e44250 %T Comparing a Data Entry Tool to Provider Insights Alone for Assessment of COVID-19 Hospitalization Risk: Pilot Matched Cohort Comparison Study %A Yahya,Gezan %A O'Keefe,James B %A Moore,Miranda A %+ Department of Family and Preventive Medicine, School of Medicine, Emory University, 4500 N Shallowford Rd, Suite B, Atlanta, GA, 30338, United States, 1 703 405 3211, miranda.moore@emory.edu %K COVID-19 %K risk assessment %K hospitalization %K outpatient %K telemedicine %K data %K tool %K risk %K assessment %K utilization %K algorithm %K symptoms %K disease %K community %K patient %K decision making tool %K risk algorithm %D 2023 %7 16.11.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: In March 2020, the World Health Organization declared COVID-19 a global pandemic, necessitating an understanding of factors influencing severe disease outcomes. High COVID-19 hospitalization rates underscore the need for robust risk prediction tools to determine estimated risk for future hospitalization for outpatients with COVID-19. We introduced the “COVID-19 Risk Tier Assessment Tool” (CRTAT), designed to enhance clinical decision-making for outpatients. Objective: We investigated whether CRTAT offers more accurate risk tier assignments (RTAs) than medical provider insights alone. Methods: We assessed COVID-19–positive patients enrolled at Emory Healthcare's Virtual Outpatient Management Clinic (VOMC)—a telemedicine monitoring program, from May 27 through August 24, 2020—who were not hospitalized at the time of enrollment. The primary analysis included patients from this program, who were later hospitalized due to COVID-19. We retroactively formed an age-, gender-, and risk factor–matched group of nonhospitalized patients for comparison. Data extracted from clinical notes were entered into CRTAT. We used descriptive statistics to compare RTAs reported by algorithm–trained health care providers and those produced by CRTAT. Results: Our patients were primarily younger than 60 years (67% hospitalized and 71% nonhospitalized). Moderate risk factors were prevalent (hospitalized group: 1 among 11, 52% patients; 2 among 2, 10% patients; and ≥3 among 4, 19% patients; nonhospitalized group: 1 among 11, 52% patients, 2 among 5, 24% patients, and ≥3 among 4, 19% patients). High risk factors were prevalent in approximately 45% (n=19) of the sample (hospitalized group: 11, 52% patients; nonhospitalized: 8, 38% patients). Approximately 83% (n=35) of the sample reported nonspecific symptoms, and the symptoms were generally mild (hospitalized: 12, 57% patients; nonhospitalized: 14, 67% patients). Most patient visits were seen within the first 1-6 days of their illness (n=19, 45%) with symptoms reported as stable over this period (hospitalized: 7, 70% patients; nonhospitalized: 3, 33% patients). Of 42 matched patients (hospitalized: n=21; nonhospitalized: n=21), 26 had identical RTAs and 16 had discrepancies between VOMC providers and CRTAT. Elements that led to different RTAs were as follows: (1) the provider “missed” comorbidity (n=6), (2) the provider noted comorbidity but undercoded risk (n=10), and (3) the provider miscoded symptom severity and course (n=7). Conclusions: CRTAT, a point-of-care data entry tool, more accurately categorized patients into risk tiers (particularly those hospitalized), underscored by its ability to identify critical factors in patient history and clinical status. Clinical decision-making regarding patient management, resource allocation, and treatment plans could be enhanced by using similar risk assessment data entry tools for other disease states, such as influenza and community-acquired pneumonia. The COVID-19 pandemic has accelerated the adoption of telemedicine, enabling remote patient tools such as CRTAT. Future research should explore the long-term impact of outpatient clinical risk assessment tools and their contribution to better patient care. %M 37903299 %R 10.2196/44250 %U https://formative.jmir.org/2023/1/e44250 %U https://doi.org/10.2196/44250 %U http://www.ncbi.nlm.nih.gov/pubmed/37903299 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e47112 %T Wearable Devices to Diagnose and Monitor the Progression of COVID-19 Through Heart Rate Variability Measurement: Systematic Review and Meta-Analysis %A Sanches,Carlos Alberto %A Silva,Graziella Alves %A Librantz,Andre Felipe Henriques %A Sampaio,Luciana Maria Malosa %A Belan,Peterson Adriano %+ Informatics and Knowledge Management Graduate Program, Universidade Nove de Julho, 235/249 - Liberdade, São Paulo, 01525-000, Brazil, 55 3385 9078 ext 9078, carlos.sanches@uni9.edu.br %K heart rate variability %K HRV %K wearable device %K COVID-19 %K SARS-CoV-2 %K wearable %K diagnosis %K mobile phone %D 2023 %7 14.11.2023 %9 Review %J J Med Internet Res %G English %X Background: Recent studies have linked low heart rate variability (HRV) with COVID-19, indicating that this parameter can be a marker of the onset of the disease and its severity and a predictor of mortality in infected people. Given the large number of wearable devices that capture physiological signals of the human body easily and noninvasively, several studies have used this equipment to measure the HRV of individuals and related these measures to COVID-19. Objective: The objective of this study was to assess the utility of HRV measurements obtained from wearable devices as predictive indicators of COVID-19, as well as the onset and worsening of symptoms in affected individuals. Methods: A systematic review was conducted searching the following databases up to the end of January 2023: Embase, PubMed, Web of Science, Scopus, and IEEE Xplore. Studies had to include (1) measures of HRV in patients with COVID-19 and (2) measurements involving the use of wearable devices. We also conducted a meta-analysis of these measures to reduce possible biases and increase the statistical power of the primary research. Results: The main finding was the association between low HRV and the onset and worsening of COVID-19 symptoms. In some cases, it was possible to predict the onset of COVID-19 before a positive clinical test. The meta-analysis of studies reported that a reduction in HRV parameters is associated with COVID-19. Individuals with COVID-19 presented a reduction in the SD of the normal-to-normal interbeat intervals and root mean square of the successive differences compared with healthy individuals. The decrease in the SD of the normal-to-normal interbeat intervals was 3.25 ms (95% CI −5.34 to −1.16 ms), and the decrease in the root mean square of the successive differences was 1.24 ms (95% CI −3.71 to 1.23 ms). Conclusions: Wearable devices that measure changes in HRV, such as smartwatches, rings, and bracelets, provide information that allows for the identification of COVID-19 during the presymptomatic period as well as its worsening through an indirect and noninvasive self-diagnosis. %M 37820372 %R 10.2196/47112 %U https://www.jmir.org/2023/1/e47112 %U https://doi.org/10.2196/47112 %U http://www.ncbi.nlm.nih.gov/pubmed/37820372 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e46589 %T Quantifying Health Policy Uncertainty in China Using Newspapers: Text Mining Study %A Chen,Chen %A Zhu,Junli %+ School of Public Health, Capital Medical University, No. 10, Xitou Road, Youanmen Wai, Beijing, 100069, China, 86 18701515093, smallying@126.com %K China %K health policy %K newspaper %K uncertainty %K severe acute respiratory syndrome %K SARS %K COVID-19 %D 2023 %7 14.11.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: From the severe acute respiratory syndrome (SARS) outbreak in 2003 to the COVID-19 pandemic in 2019, a series of health measures and policies have been introduced from the central to the local level in China. However, no study has constructed an uncertainty index that can reflect the volatility, risk, and policy characteristics of the health environment. Objective: We used text mining analysis on mainstream newspapers to quantify the volume of reports about health policy and the total number of news articles and to construct a series of indexes that could reflect the uncertainty of health policy in China. Methods: Using the Wisenews database, 11 of the most influential newspapers in mainland China were selected to obtain the sample articles. The health policy uncertainty (HPU) index for each month from 2003 to 2022 was constructed by searching articles containing the specified keywords and calculating their frequency. Robustness tests were conducted through correlation analysis. The HPU index was plotted using STATA (version 16.0), and a comparative analysis of the China and US HPU indexes was then performed. Results: We retrieved 6482 sample articles from 7.49 million news articles in 11 newspapers. The China HPU index was constructed, and the robustness test showed a correlation coefficient greater than 0.74, which indicates good robustness. Key health events can cause index fluctuations. At the beginning of COVID-19 (May 2020), the HPU index climbed to 502.0. In December 2022, China’s HPU index reached its highest value of 613.8 after the release of the “New Ten Rules” pandemic prevention and control policy. There were significant differences in HPU index fluctuations between China and the United States during SARS and COVID-19, as well as during the Affordable Care Act period. Conclusions: National health policy is a guide for health development, and uncertainty in health policy can affect not only the implementation of policy by managers but also the health-seeking behavior of the people. Here, we conclude that changes in critical health policies, major national or international events, and infectious diseases with widespread impact can create significant uncertainty in China’s health policies. The uncertainty of health policies in China and the United States is quite different due to different political systems and news environments. What is the same is that COVID-19 has brought great policy volatility to both countries. To the best of our knowledge, our work is the first systematic text mining study of HPU in China. %M 37962937 %R 10.2196/46589 %U https://www.jmir.org/2023/1/e46589 %U https://doi.org/10.2196/46589 %U http://www.ncbi.nlm.nih.gov/pubmed/37962937 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e48107 %T Trial of the Pluslife SARS-CoV-2 Nucleic Acid Rapid Test Kit: Prospective Cohort Study %A Zhu,Dandan %A Huang,Jing %A Hu,Bei %A Cao,Donglin %A Chen,Dingqiang %A Song,Xinqiang %A Chen,Jialing %A Zhou,Hao %A Cen,Aiqun %A Hou,Tieying %+ Hospital Office, Huazhong University of Science and Technology Union Shenzhen Hospital/Shenzhen Nanshan People’s Hospital, 89 Taoyuan Road, Nanshan District, Shenzhen, 518052, China, 86 075526553111, sz_houtieying@yeah.net %K SARS-CoV-2 %K COVID-19 %K RHAM %K RNase hybridization-assisted amplification %K field trial %K diagnosis %K screening %K rapid test %K cohort study %K detection %K recruitment %K infection %K Pluslife %D 2023 %7 14.11.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: In response to the SARS-CoV-2 epidemic, a convenient, rapid, and sensitive diagnostic method for detecting COVID-19 is crucial for patient control and timely treatment. Objective: This study aimed to validate the detection of SARS-CoV-2 with the Pluslife SARS-CoV-2 rapid test kit developed based on a novel thermostatic amplification technique called RNase hybridization-assisted amplification. Methods: From November 25 to December 8, 2022, patients with suspected or confirmed COVID-19, close contacts, and health care workers at high risk of exposure were recruited from 3 hospitals and 1 university. Respiratory specimens were collected for testing with the Pluslife SARS-CoV-2 rapid test kit and compared with reverse transcription-quantitative polymerase chain reaction (RT-qPCR) and a commercial antigen assay kit. Samples from 1447 cases were obtained from 3 “ready-to-test” scenarios in which samples were collected on site and tested immediately, and samples from 503 cases were obtained from a “freeze-thaw test” scenario in which samples were collected, frozen, and thawed for testing. Results: Pluslife SARS-CoV-2 rapid testing of samples from the “ready-to-test” scenario was found to be accurate (overall sensitivity and specificity of 98.3% and 99.3%, respectively) and diagnostically useful (positive and negative likelihood ratios of 145.45 and 0.02, respectively). Pluslife SARS-CoV-2 rapid testing of samples from the “freeze-thaw test” scenario was also found to be accurate (overall sensitivity and specificity of 71.2% and 98.6%, respectively) and diagnostically useful (positive and negative likelihood ratios of 51.01 and 0.67, respectively). Our findings demonstrated that the time efficiency and accuracy of the results in a “ready-to-test” scenario were better. The time required from sample preparation to the seeing the result of the Pluslife SARS-CoV-2 rapid test was 10 to 38 minutes, which was substantially shorter than that of RT-qPCR (at least 90 minutes). In addition, the diagnostic efficacy of the Pluslife SARS-CoV-2 rapid test was better than that of a commercial antigen assay kit. Conclusions: The developed RNase hybridization-assisted amplification assay provided rapid, sensitive, and convenient detection of SARS-CoV-2 infection and may be useful for enhanced detection of COVID-19 in homes, high-risk industries, and hospitals. %M 37962934 %R 10.2196/48107 %U https://publichealth.jmir.org/2023/1/e48107 %U https://doi.org/10.2196/48107 %U http://www.ncbi.nlm.nih.gov/pubmed/37962934 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 6 %N %P e42517 %T Older Adults’ Trust and Distrust in COVID-19 Public Health Information: Qualitative Critical Incident Study %A Shiroma,Kristina %A Zimmerman,Tara %A Xie,Bo %A Fleischmann,Kenneth R %A Rich,Kate %A Lee,Min Kyung %A Verma,Nitin %A Jia,Chenyan %+ School of Information, The University of Texas at Austin, 1616 Guadalupe St, Suite 5.202, Austin, TX, 78701, United States, 1 5124713821, kristinashiroma@utexas.edu %K health information %K information-seeking behavior %K COVID-19 %K qualitative research methods %K communication %K media and networks %K aging %K older adults %K elderly population %K mass media %K public health information %K trust %D 2023 %7 9.11.2023 %9 Original Paper %J JMIR Aging %G English %X Background: The COVID-19 infodemic has imposed a disproportionate burden on older adults who face increased challenges in accessing and assessing public health information, but little is known about factors influencing older adults’ trust in public health information during COVID-19. Objective: This study aims to identify sources that older adults turn to for trusted COVID-19 public health information and factors that influence their trust. In addition, we explore the relationship between public health information sources and trust factors. Methods: Adults aged 65 years or older (N=30; mean age 71.6, SD 5.57; range 65-84 years) were recruited using Prime Panels. Semistructured phone interviews, guided by critical incident technique, were conducted in October and November 2020. Participants were asked about their sources of COVID-19 public health information, the trustworthiness of that information, and factors influencing their trust. Interview data were examined with thematic analysis. Results: Mass media, known individuals, and the internet were the older adults’ main sources for COVID-19 public health information. Although they used social media for entertainment and personal communication, the older adults actively avoided accessing or sharing COVID-19 information on social media. Factors influencing their trust in COVID-19 public health information included confirmation bias, personal research, resigned acceptance, and personal relevance. Conclusions: These findings shed light on older adults’ use of information sources and their criteria for evaluating the trustworthiness of public health information during a pandemic. They have implications for the future development of effective public health communication, policies, and interventions for older adults during health crises. %M 37856774 %R 10.2196/42517 %U https://aging.jmir.org/2023/1/e42517 %U https://doi.org/10.2196/42517 %U http://www.ncbi.nlm.nih.gov/pubmed/37856774 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e44795 %T A Digital Mask-Voiceprint System for Postpandemic Surveillance and Tracing Based on the STRONG Strategy %A Pan,Xiaogao %A Hounye,Alphonse Houssou %A Zhao,Yuqi %A Cao,Cong %A Wang,Jiaoju %A Abidi,Mimi Venunye %A Hou,Muzhou %A Xiong,Li %A Chai,Xiangping %+ Department of Emergency Medicine, Second Xiangya Hospital, Central South University, 139 Renmin Road, Changsha, 410011, China, 86 13687318831, chaixiangping@csu.edu.cn %K COVID-19 %K surveillance %K digital tracing %K mask management %K voiceprint %K Spatiotemporal Reporting Over Network and GPS %K STRONG %K STRONG strategy %K living with the virus %K dynamic clearance %K surveillance %K digital surveillance %K pandemic %K vaccine %K public health %K mental %K social %K communication technology %K communication %K tracing %D 2023 %7 6.11.2023 %9 Viewpoint %J J Med Internet Res %G English %X Lockdowns and border closures due to COVID-19 imposed mental, social, and financial hardships in many societies. Living with the virus and resuming normal life are increasingly being advocated due to decreasing virus severity and widespread vaccine coverage. However, current trends indicate a continued absence of effective contingency plans to stop the next more virulent variant of the pandemic. The COVID-19–related mask waste crisis has also caused serious environmental problems and virus spreads. It is timely and important to consider how to precisely implement surveillance for the dynamic clearance of COVID-19 and how to efficiently manage discarded masks to minimize disease transmission and environmental hazards. In this viewpoint, we sought to address this issue by proposing an appropriate strategy for intelligent surveillance of infected cases and centralized management of mask waste. Such an intelligent strategy against COVID-19, consisting of wearable mask sample collectors (masklect) and voiceprints and based on the STRONG (Spatiotemporal Reporting Over Network and GPS) strategy, could enable the resumption of social activities and economic recovery and ensure a safe public health environment sustainably. %M 37856760 %R 10.2196/44795 %U https://www.jmir.org/2023/1/e44795 %U https://doi.org/10.2196/44795 %U http://www.ncbi.nlm.nih.gov/pubmed/37856760 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 9 %N %P e40264 %T An Inquiry-Based Distance Learning Tool for Medical Students Under Lockdown (“COVID-19 Rounds”): Cross-Sectional Study %A Akhras,Aya %A ElSaban,Mariam %A Tamil Selvan,Varshini %A Alzaabi,Shaika Zain %A Senok,Abiola  %A Zary,Nabil %A Ho,Samuel B %+ College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Building 14, Dubai Healthcare City, Dubai, United Arab Emirates, 971 524165428, samuel.ho@mbru.ac.ae %K medical education %K COVID-19 %K technology-enhanced learning %K distance learning %K student engagement %K 5E instructional model %D 2023 %7 6.11.2023 %9 Original Paper %J JMIR Med Educ %G English %X Background: The COVID-19 pandemic presented significant challenges to both clinical practice and the delivery of medical education. Educators and learners implemented novel techniques, including distance learning and web-based rounds, while trying to stay updated with the surge of information regarding COVID-19 epidemiology, pathogenesis, and treatment. Hence, we designed and implemented a technologically enhanced course called “COVID-19 Rounds” to educate students about the rapidly evolving pandemic. Objective: The objectives of this study are to describe a technologically enhanced course called “COVID-19 Rounds” and evaluate the following: (1) student satisfaction and program usefulness in achieving preset objectives, (2) perceived improvement in literacy regarding the pandemic, and (3) the impact of student engagement by designing infographics and initiating COVID-19–related research projects. Methods: This is a cross-sectional study measuring the impact of the implementation of the web-based “COVID-19 Rounds” course. This program included web-based clinical experiences with physicians on actual rounds in COVID-19 wards in the hospital, weekly updates on evolving data and new research, and engagement in student-led projects. The study population included 47 fourth-year medical students at the Mohamed Bin Rashid University of Medicine and Health Sciences in Dubai, the United Arab Emirates, who attended the course. We designed and administered a 47-item survey to assess student satisfaction, program usefulness, impact on knowledge, and student engagement. Data were collected at the end of program delivery via Microsoft Forms. Results: In total, 38 (81%) out of 47 fourth-year medical students participated in this study. The final course evaluation revealed an overall high satisfaction rate, with a mean rating of 3.9 (SD 0.94) on the 5-point Likert scale. Most students were satisfied with the course format (27/38, 71%), organization (31/38, 82%), and the learning experience (28/38, 74%) that the course offered. The course was particularly appreciated for offering evidence-based talks about aspects of the pandemic (34/38, 90%), providing weekly updates regarding emerging evidence (32/38, 84%), and enhancing understanding of the challenges of the pandemic (34/38, 90%). Satisfaction with distance learning was moderate (23/37, 62%), and a minority of students would have preferred an in-person version of the course (10/37, 27%). Student engagement in the course was high. All students participated in small group presentations of infographics of pandemic-related topics. Perceived advantages included conciseness and visual appeal, and disadvantages included the lack of detail and the time-consuming nature of infographic design, especially for students with no prior design experience. After the course ended, 27 (57%) students began research projects. This resulted in 6 abstracts presented at local meetings and 8 scientific papers published or submitted for publication. Conclusions: This inquiry-based adaptive approach to educating medical students about updates on COVID-19 via web-based learning was successful in achieving objectives and encouraging engagement in research. However, shortcomings of the course related to the lack of in-person teaching and clinical activities were also highlighted. %M 37856734 %R 10.2196/40264 %U https://mededu.jmir.org/2023/1/e40264 %U https://doi.org/10.2196/40264 %U http://www.ncbi.nlm.nih.gov/pubmed/37856734 %0 Journal Article %@ 2561-3278 %I JMIR Publications %V 8 %N %P e50924 %T Severity Classification Using Dynamic Time Warping–Based Voice Biomarkers for Patients With COVID-19: Feasibility Cross-Sectional Study %A Watase,Teruhisa %A Omiya,Yasuhiro %A Tokuno,Shinichi %+ Gradutate School of Health Innovation, Kanagawa University of Human Service, RGB 2A, 3-25-10 Tonomachi, Kawasaki-ku, Kawasaki, Kanagawa, 2100821, Japan, 81 44 589 8100, terrywatase@gmail.com %K voice biomarker %K dynamic time warping %K COVID-19 %K smartphone %K severity classification %K biomarker %K feasibility study %K illness %K monitoring %K respiratory disease %K accuracy %K logistic model %K tool %K model %D 2023 %7 6.11.2023 %9 Original Paper %J JMIR Biomed Eng %G English %X Background: In Japan, individuals with mild COVID-19 illness previously required to be monitored in designated areas and were hospitalized only if their condition worsened to moderate illness or worse. Daily monitoring using a pulse oximeter was a crucial indicator for hospitalization. However, a drastic increase in the number of patients resulted in a shortage of pulse oximeters for monitoring. Therefore, an alternative and cost-effective method for monitoring patients with mild illness was required. Previous studies have shown that voice biomarkers for Parkinson disease or Alzheimer disease are useful for classifying or monitoring symptoms; thus, we tried to adapt voice biomarkers for classifying the severity of COVID-19 using a dynamic time warping (DTW) algorithm where voice wavelets can be treated as 2D features; the differences between wavelet features are calculated as scores. Objective: This feasibility study aimed to test whether DTW-based indices can generate voice biomarkers for a binary classification model using COVID-19 patients’ voices to distinguish moderate illness from mild illness at a significant level. Methods: We conducted a cross-sectional study using voice samples of COVID-19 patients. Three kinds of long vowels were processed into 10-cycle waveforms with standardized power and time axes. The DTW-based indices were generated by all pairs of waveforms and tested with the Mann-Whitney U test (α<.01) and verified with a linear discrimination analysis and confusion matrix to determine which indices were better for binary classification of disease severity. A binary classification model was generated based on a generalized linear model (GLM) using the most promising indices as predictors. The receiver operating characteristic curve/area under the curve (ROC/AUC) validated the model performance, and the confusion matrix calculated the model accuracy. Results: Participants in this study (n=295) were infected with COVID-19 between June 2021 and March 2022, were aged 20 years or older, and recuperated in Kanagawa prefecture. Voice samples (n=110) were selected from the participants’ attribution matrix based on age group, sex, time of infection, and whether they had mild illness (n=61) or moderate illness (n=49). The DTW-based variance indices were found to be significant (P<.001, except for 1 of 6 indices), with a balanced accuracy in the range between 79% and 88.6% for the /a/, /e/, and /u/ vowel sounds. The GLM achieved a high balance accuracy of 86.3% (for /a/), 80.2% (for /e/), and 88% (for /u/) and ROC/AUC of 94.8% (95% CI 90.6%-94.8%) for /a/, 86.5% (95% CI 79.8%-86.5%) for /e/, and 95.6% (95% CI 92.1%-95.6%) for /u/. Conclusions: The proposed model can be a voice biomarker for an alternative and cost-effective method of monitoring the progress of COVID-19 patients in care. %M 37982072 %R 10.2196/50924 %U https://biomedeng.jmir.org/2023/1/e50924 %U https://doi.org/10.2196/50924 %U http://www.ncbi.nlm.nih.gov/pubmed/37982072 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e44299 %T Moral Distress, Mental Health, and Risk and Resilience Factors Among Military Personnel Deployed to Long-Term Care Facilities During the COVID-19 Pandemic: Research Protocol and Participation Metrics %A Nazarov,Anthony %A Fikretoglu,Deniz %A Liu,Aihua %A Born,Jennifer %A Michaud,Kathy %A Hendriks,Tonya %A Bélanger,Stéphanie AH %A Do,Minh T %A Lam,Quan %A Brooks,Brenda %A King,Kristen %A Sudom,Kerry %A Jetly,Rakesh %A Garber,Bryan %A Thompson,Megan %+ MacDonald Franklin Operational Stress Injury Research Centre, Lawson Health Research Institute, 550 Wellington Road, London, ON, N6C 0A7, Canada, 1 6474044924, anthony.nazarov@proton.me %K mental health %K military %K Canadian Armed Forces %K operational organization %K logistics support %K health care %K moral distress %K moral injury %K deployment %K risk factors %K COVID-19 %K quarantine %K readiness %K well-being %K resilience %K long-term care facility %K centre de soins de longue durée %K survey %K older adult %K qualitative interviews %K quantitative %D 2023 %7 6.11.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: The earliest days of the COVID-19 pandemic in Canada were marked by a significant surge in COVID-19 cases and COVID-19–related deaths among residents of long-term care facilities (LTCFs). As part of Canada’s response to the COVID-19 pandemic, Canadian Armed Forces (CAF) personnel were mobilized for an initial emergency domestic deployment to the hardest-hit LTCFs (Operation LASER LTCF) to support the remaining civilian staff in ensuring the continued delivery of care to residents. Akin to what was observed following past CAF international humanitarian missions, there was an expected increased risk of exposure to multiple stressors that may be psychologically traumatic and potentially morally injurious in nature (ie, related to core values, eg, witnessing human suffering). Emerging data from health care workers exposed to the unprecedented medical challenges and dilemmas of the early pandemic stages also indicated that such experiences were associated with increased risk of adverse mental health outcomes. Objective: This study aims to identify and quantify the individual-, group-, and organizational-level risk and resilience factors associated with moral distress, moral injury, and traditional mental health and well-being outcomes of Operation LASER LTCF CAF personnel. This paper aimed to document the methodology, implementation procedures, and participation metrics. Methods: A multimethod research initiative was conducted consisting of 2 primary data collection studies (a quantitative survey and qualitative interviews). The quantitative arm was a complete enumeration survey with web-based, self-report questionnaires administered at 3 time points (3, 6, and 12 mo after deployment). The qualitative arm consisted of individual, web-based interviews with a focus on understanding the nuanced lived experiences of individuals participating in the Operation LASER LTCF deployment. Results: CAF personnel deployed to Operation LASER LTCF (N=2595) were invited to participate in the study. Data collection is now complete. Overall, of the 2595 deployed personnel, 1088 (41.93%), 582 (22.43%), and 497 (19.15%) responded to the survey at time point 1 (3 mo), time point 2 (6 mo), and time point 3 (12 mo) after deployment, respectively. The target sample size for the qualitative interviews was set at approximately 50 considering resourcing and data saturation. Interest in participating in qualitative interviews surpassed expectations, with >200 individuals expressing interest; this allowed for purposive sampling across key characteristics, including gender, rank, Operation LASER LTCF role, and province. In total, 53 interviews were conducted. Conclusions: The data generated through this research have the potential to inform and promote better understanding of the well-being and mental health of Operation LASER LTCF personnel over time; identify general and Operation LASER LTCF–specific risk and protective factors; provide necessary support to the military personnel who served in this mission; and inform preparation and interventions for future missions, especially those more domestic and humanitarian in nature. International Registered Report Identifier (IRRID): DERR1-10.2196/44299 %M 37676877 %R 10.2196/44299 %U https://www.researchprotocols.org/2023/1/e44299 %U https://doi.org/10.2196/44299 %U http://www.ncbi.nlm.nih.gov/pubmed/37676877 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e46874 %T Public Health Surveillance of Behavioral Cancer Risk Factors During the COVID-19 Pandemic: Sentiment and Emotion Analysis of Twitter Data %A Christodoulakis,Nicolette %A Abdelkader,Wael %A Lokker,Cynthia %A Cotterchio,Michelle %A Griffith,Lauren E %A Vanderloo,Leigh M %A Anderson,Laura N %+ Department of Health Research Methods, Evidence, and Impact, McMaster University, CRL-221, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada, 1 9055259140 ext 21725, ln.anderson@mcmaster.ca %K cancer risk factors %K Twitter %K sentiment analysis %K emotion analysis %K social media %K physical inactivity %K poor nutrition %K alcohol %K smoking %D 2023 %7 2.11.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic and its associated public health mitigation strategies have dramatically changed patterns of daily life activities worldwide, resulting in unintentional consequences on behavioral risk factors, including smoking, alcohol consumption, poor nutrition, and physical inactivity. The infodemic of social media data may provide novel opportunities for evaluating changes related to behavioral risk factors during the pandemic. Objective: We explored the feasibility of conducting a sentiment and emotion analysis using Twitter data to evaluate behavioral cancer risk factors (physical inactivity, poor nutrition, alcohol consumption, and smoking) over time during the first year of the COVID-19 pandemic. Methods: Tweets during 2020 relating to the COVID-19 pandemic and the 4 cancer risk factors were extracted from the George Washington University Libraries Dataverse. Tweets were defined and filtered using keywords to create 4 data sets. We trained and tested a machine learning classifier using a prelabeled Twitter data set. This was applied to determine the sentiment (positive, negative, or neutral) of each tweet. A natural language processing package was used to identify the emotions (anger, anticipation, disgust, fear, joy, sadness, surprise, and trust) based on the words contained in the tweets. Sentiments and emotions for each of the risk factors were evaluated over time and analyzed to identify keywords that emerged. Results: The sentiment analysis revealed that 56.69% (51,479/90,813) of the tweets about physical activity were positive, 16.4% (14,893/90,813) were negative, and 26.91% (24,441/90,813) were neutral. Similar patterns were observed for nutrition, where 55.44% (27,939/50,396), 15.78% (7950/50,396), and 28.79% (14,507/50,396) of the tweets were positive, negative, and neutral, respectively. For alcohol, the proportions of positive, negative, and neutral tweets were 46.85% (34,897/74,484), 22.9% (17,056/74,484), and 30.25% (22,531/74,484), respectively, and for smoking, they were 41.2% (11,628/28,220), 24.23% (6839/28,220), and 34.56% (9753/28,220), respectively. The sentiments were relatively stable over time. The emotion analysis suggests that the most common emotion expressed across physical activity and nutrition tweets was trust (69,495/320,741, 21.67% and 42,324/176,564, 23.97%, respectively); for alcohol, it was joy (49,147/273,128, 17.99%); and for smoking, it was fear (23,066/110,256, 20.92%). The emotions expressed remained relatively constant over the observed period. An analysis of the most frequent words tweeted revealed further insights into common themes expressed in relation to some of the risk factors and possible sources of bias. Conclusions: This analysis provided insight into behavioral cancer risk factors as expressed on Twitter during the first year of the COVID-19 pandemic. It was feasible to extract tweets relating to all 4 risk factors, and most tweets had a positive sentiment with varied emotions across the different data sets. Although these results can play a role in promoting public health, a deeper dive via qualitative analysis can be conducted to provide a contextual examination of each tweet. %M 37917123 %R 10.2196/46874 %U https://formative.jmir.org/2023/1/e46874 %U https://doi.org/10.2196/46874 %U http://www.ncbi.nlm.nih.gov/pubmed/37917123 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e48789 %T Topic and Trend Analysis of Weibo Discussions About COVID-19 Medications Before and After China’s Exit from the Zero-COVID Policy: Retrospective Infoveillance Study %A Lan,Duo %A Ren,Wujiong %A Ni,Ke %A Zhu,Yicheng %+ School of Journalism and Communication, Beijing Normal University, 19 Xinjiekou Outer St Haidian District, Beijing, 100875, China, 86 13436952270, yicheng@bnu.edu.cn %K zero-COVID policy %K topic modeling %K Weibo %K COVID-19 medications %K social risk %K personal risk %K social media %K COVID-19 %K China %K pandemic %K self-medication %D 2023 %7 27.10.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: After 3 years of its zero-COVID policy, China lifted its stringent pandemic control measures with the announcement of the 10 new measures on December 7, 2022. Existing estimates suggest 90%-97% of the total population was infected during December. This change created a massive demand for COVID-19 medications and treatments, either modern medicines or traditional Chinese medicine (TCM). Objective: This study aimed to explore (1) how China’s exit from the zero-COVID policy impacted media and the public’s attention to COVID-19 medications; (2) how social COVID-19 medication discussions were related to existing model estimates of daily cases during that period; (3) what the diversified themes and topics were and how they changed and developed from November 1 to December 31, 2022; and (4) which topics about COVID-19 medications were focused on by mainstream and self-media accounts during the exit. The answers to these questions could help us better understand the consequences of exit strategies and explore the utilities of Sina Weibo data for future infoveillance studies. Methods: Using a scrapper for data retrieval and the structural topic modeling (STM) algorithm for analysis, this study built 3 topic models (all data, before a policy change, and after a policy change) of relevant discussions on the Chinese social media platform Weibo. We compared topic distributions against existing estimates of daily cases and between models before and after the change. We also compared proportions of weibos published by mainstream versus self-media accounts over time on different topics. Results: We found that Weibo discussions shifted sharply from concerns of social risks (case tracking, governmental regulations, etc) to those of personal risks (symptoms, purchases, etc) surrounding COVID-19 infection after the exit from the zero-COVID policy. Weibo topics of “symptom sharing” and “purchase and shortage” of modern medicines correlated more strongly with existing susceptible-exposed-infected-recovered (SEIR) model estimates compared to “TCM formulae” and other topics. During the exit, mainstream accounts showed efforts to specifically engage in topics related to worldwide pandemic control policy comparison and regulations about import and reimbursement of medications. Conclusions: The exit from the zero-COVID policy in China was accompanied by a sudden increase in social media discussions about COVID-19 medications, the demand for which substantially increased after the exit. A large proportion of Weibo discussions were emotional and expressed increased risk concerns over medication shortage, unavailability, and delay in delivery. Topic keywords showed that self-medication was sometimes practiced alone or with unprofessional help from others, while mainstream accounts also tried to provide certain medication instructions. Of the 16 topics identified in all 3 STM models, only “symptom sharing” and “purchase and shortage” showed a considerable correlation with SEIR model estimates of daily cases. Future studies could consider topic exploration before conducting predictive infoveillance analysis, even with narrowly defined search criteria with Weibo data. %M 37889532 %R 10.2196/48789 %U https://www.jmir.org/2023/1/e48789 %U https://doi.org/10.2196/48789 %U http://www.ncbi.nlm.nih.gov/pubmed/37889532 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e50199 %T Exploring Political Mistrust in Pandemic Risk Communication: Mixed-Method Study Using Social Media Data Analysis %A Unlu,Ali %A Truong,Sophie %A Tammi,Tuukka %A Lohiniva,Anna-Leena %+ Finnish Institute for Health and Welfare, Mannerheimintie 166, Helsinki, 00271, Finland, 358 295246000, ali.unlu@thl.fi %K political trust %K social media %K text classification %K topic modeling %K COVID-19 %K Finland %K trust %K authority %K public health outcome %K pandemic %K perception %K mistrust %K interaction %K Twitter %K Facebook %K analysis %K computational method %K natural language processing %K misinformation %K communication %K crisis %D 2023 %7 20.10.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: This research extends prior studies by the Finnish Institute for Health and Welfare on pandemic-related risk perception, concentrating on the role of trust in health authorities and its impact on public health outcomes. Objective: The paper aims to investigate variations in trust levels over time and across social media platforms, as well as to further explore 12 subcategories of political mistrust. It seeks to understand the dynamics of political trust, including mistrust accumulation, fluctuations over time, and changes in topic relevance. Additionally, the study aims to compare qualitative research findings with those obtained through computational methods. Methods: Data were gathered from a large-scale data set consisting of 13,629 Twitter and Facebook posts from 2020 to 2023 related to COVID-19. For analysis, a fine-tuned FinBERT model with an 80% accuracy rate was used for predicting political mistrust. The BERTopic model was also used for superior topic modeling performance. Results: Our preliminary analysis identifies 43 mistrust-related topics categorized into 9 major themes. The most salient topics include COVID-19 mortality, coping strategies, polymerase chain reaction testing, and vaccine efficacy. Discourse related to mistrust in authority is associated with perceptions of disease severity, willingness to adopt health measures, and information-seeking behavior. Our findings highlight that the distinct user engagement mechanisms and platform features of Facebook and Twitter contributed to varying patterns of mistrust and susceptibility to misinformation during the pandemic. Conclusions: The study highlights the effectiveness of computational methods like natural language processing in managing large-scale engagement and misinformation. It underscores the critical role of trust in health authorities for effective risk communication and public compliance. The findings also emphasize the necessity for transparent communication from authorities, concluding that a holistic approach to public health communication is integral for managing health crises effectively. %M 37862088 %R 10.2196/50199 %U https://www.jmir.org/2023/1/e50199 %U https://doi.org/10.2196/50199 %U http://www.ncbi.nlm.nih.gov/pubmed/37862088 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e45225 %T Potential Target Discovery and Drug Repurposing for Coronaviruses: Study Involving a Knowledge Graph–Based Approach %A Lou,Pei %A Fang,An %A Zhao,Wanqing %A Yao,Kuanda %A Yang,Yusheng %A Hu,Jiahui %+ Institute of Medical Information, Chinese Academy of Medical Sciences & Peking Union Medical College, No. 3 Yabao Road, Chaoyang District, Beijing, 100020, China, 86 01052328782, hu.jiahui@imicams.ac.cn %K coronavirus %K heterogeneous data integration %K knowledge graph embedding %K drug repurposing %K interpretable prediction %K COVID-19 %D 2023 %7 20.10.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: The global pandemics of severe acute respiratory syndrome, Middle East respiratory syndrome, and COVID-19 have caused unprecedented crises for public health. Coronaviruses are constantly evolving, and it is unknown which new coronavirus will emerge and when the next coronavirus will sweep across the world. Knowledge graphs are expected to help discover the pathogenicity and transmission mechanism of viruses. Objective: The aim of this study was to discover potential targets and candidate drugs to repurpose for coronaviruses through a knowledge graph–based approach. Methods: We propose a computational and evidence-based knowledge discovery approach to identify potential targets and candidate drugs for coronaviruses from biomedical literature and well-known knowledge bases. To organize the semantic triples extracted automatically from biomedical literature, a semantic conversion model was designed. The literature knowledge was associated and integrated with existing drug and gene knowledge through semantic mapping, and the coronavirus knowledge graph (CovKG) was constructed. We adopted both the knowledge graph embedding model and the semantic reasoning mechanism to discover unrecorded mechanisms of drug action as well as potential targets and drug candidates. Furthermore, we have provided evidence-based support with a scoring and backtracking mechanism. Results: The constructed CovKG contains 17,369,620 triples, of which 641,195 were extracted from biomedical literature, covering 13,065 concept unique identifiers, 209 semantic types, and 97 semantic relations of the Unified Medical Language System. Through multi-source knowledge integration, 475 drugs and 262 targets were mapped to existing knowledge, and 41 new drug mechanisms of action were found by semantic reasoning, which were not recorded in the existing knowledge base. Among the knowledge graph embedding models, TransR outperformed others (mean reciprocal rank=0.2510, Hits@10=0.3505). A total of 33 potential targets and 18 drug candidates were identified for coronaviruses. Among them, 7 novel drugs (ie, quinine, nelfinavir, ivermectin, asunaprevir, tylophorine, Artemisia annua extract, and resveratrol) and 3 highly ranked targets (ie, angiotensin converting enzyme 2, transmembrane serine protease 2, and M protein) were further discussed. Conclusions: We showed the effectiveness of a knowledge graph–based approach in potential target discovery and drug repurposing for coronaviruses. Our approach can be extended to other viruses or diseases for biomedical knowledge discovery and relevant applications. %M 37862061 %R 10.2196/45225 %U https://www.jmir.org/2023/1/e45225 %U https://doi.org/10.2196/45225 %U http://www.ncbi.nlm.nih.gov/pubmed/37862061 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e44155 %T Evaluation of Primary Allied Health Care in Patients Recovering From COVID-19 at 6-Month Follow-up: Dutch Nationwide Prospective Cohort Study %A Slotegraaf,Anne I %A Gerards,Marissa H G %A Verburg,Arie C %A de van der Schueren,Marian A E %A Kruizenga,Hinke M %A Graff,Maud J L %A Cup,Edith H C %A Kalf,Johanna G %A Lenssen,Antoine F %A Meijer,Willemijn M %A Kool,Renée A %A de Bie,Rob A %A van der Wees,Philip J %A Hoogeboom,Thomas J %A , %+ IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Centre, Kapittelweg 54, Nijmegen, 6525 EP, Netherlands, 31 243615305, Thomas.hoogeboom@radboudumc.nl %K COVID-19 %K allied health care %K primary care %K care %K patient %K physical %K nutritional %K cognitive %K mental functioning %K support %K recovery %K diet %K exercise %K exercise therapist %K physical therapist %K speech therapist %K language %K descriptive statistics %K regression %K linear mixed model %K statistics %K statistician %K statistical %D 2023 %7 20.10.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Patients recovering from COVID-19 often experience persistent problems in their daily activities related to limitations in physical, nutritional, cognitive, and mental functioning. To date, it is unknown what treatment is needed to support patients in their recovery from COVID-19. Objective: This study aimed to evaluate the primary allied health care of patients recovering from COVID-19 at 6-month follow-up and to explore which baseline characteristics are associated with changes in the scores of outcomes between baseline and 6-month follow-up. Methods: This Dutch nationwide prospective cohort study evaluated the recovery of patients receiving primary allied health care (ie, dietitians, exercise therapists, occupational therapists, physical therapists, and speech and language therapists) after COVID-19. All treatments offered by primary allied health professionals in daily practice were part of usual care. Patient-reported outcome measures on participation, health-related quality of life, fatigue, physical functioning, and psychological well-being were assessed at baseline and at 3- and 6-month follow-up. Linear mixed model analyses were used to evaluate recovery over time, and uni- and multivariable linear regression analyses were used to examine the association between baseline characteristics and recovery. Results: A total of 1451 adult patients recovering from COVID-19 and receiving treatment from 1 or more primary allied health professionals were included. For participation (Utrecht Scale for Evaluation of Rehabilitation—Participation range 0-100), estimated mean differences of at least 2.3 points were observed at all time points. For the health-related quality of life (EuroQol Visual Analog Scale, range 0-100), the mean increase was 12.3 (95% CI 11.1-13.6) points at 6 months. Significant improvements were found for fatigue (Fatigue Severity Scale, range 1-7): the mean decrease was –0.7 (95% CI –0.8 to –0.6) points at 6 months. However, severe fatigue was reported by 742/929 (79.9%) patients after 6 months. For physical functioning (Patient-Reported Outcomes Measurement Information System—Physical Function Short Form 10b, range 13.8-61.3), the mean increase was 5.9 (95% CI 5.9-6.4) points at 6 months. Mean differences of –0.8 (95% CI –1.0 to –0.5) points for anxiety (Hospital Anxiety and Depression Scale range 0-21) and –1.6 (95% CI –1.8 to –1.3) points for depression were found after 6 months. A worse baseline score, hospital admission, and male sex were associated with greater improvement between baseline and 6-month follow-up, whereas age, the BMI, comorbidities, and smoking status were not associated with mean changes in any outcome measures. Conclusions: Patients recovering from COVID-19 who receive primary allied health care make progress in recovery but still experience many limitations in their daily activities after 6 months. Our findings provide reference values to health care providers and health care policy makers regarding what to expect from the recovery of patients who receive health care from 1 or more primary allied health professionals. Trial Registration: ClinicalTrials.gov NCT04735744; https://tinyurl.com/3vf337pn International Registered Report Identifier (IRRID): RR2-10.2340/jrm.v54.2506 %M 37862083 %R 10.2196/44155 %U https://publichealth.jmir.org/2023/1/e44155 %U https://doi.org/10.2196/44155 %U http://www.ncbi.nlm.nih.gov/pubmed/37862083 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e44556 %T Exploring Young Adults’ Views About Aroha, a Chatbot for Stress Associated With the COVID-19 Pandemic: Interview Study Among Students %A Kang,Annie %A Hetrick,Sarah %A Cargo,Tania %A Hopkins,Sarah %A Ludin,Nicola %A Bodmer,Sarah %A Stevenson,Kiani %A Holt-Quick,Chester %A Stasiak,Karolina %+ Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, 22-30 Park Road Avenue, Grafton, Auckland, 1142, New Zealand, 64 99233890, k.stasiak@auckland.ac.nz %K chatbot %K mental health %K COVID-19 %K young adults %K acceptability %K qualitative methods %D 2023 %7 12.10.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: In March 2020, New Zealand was plunged into its first nationwide lockdown to halt the spread of COVID-19. Our team rapidly adapted our existing chatbot platform to create Aroha, a well-being chatbot intended to address the stress experienced by young people aged 13 to 24 years in the early phase of the pandemic. Aroha was made available nationally within 2 weeks of the lockdown and continued to be available throughout 2020. Objective: In this study, we aimed to evaluate the acceptability and relevance of the chatbot format and Aroha’s content in young adults and to identify areas for improvement. Methods: We conducted qualitative in-depth and semistructured interviews with young adults as well as in situ demonstrations of Aroha to elicit immediate feedback. Interviews were recorded, transcribed, and analyzed using thematic analysis assisted by NVivo (version 12; QSR International). Results: A total of 15 young adults (age in years: median 20; mean 20.07, SD 3.17; female students: n=13, 87%; male students: n=2, 13%; all tertiary students) were interviewed in person. Participants spoke of the challenges of living during the lockdown, including social isolation, loss of motivation, and the demands of remote work or study, although some were able to find silver linings. Aroha was well liked for sounding like a “real person” and peer with its friendly local “Kiwi” communication style, rather than an authoritative adult or counselor. The chatbot was praised for including content that went beyond traditional mental health advice. Participants particularly enjoyed the modules on gratitude, being active, anger management, job seeking, and how to deal with alcohol and drugs. Aroha was described as being more accessible than traditional mental health counseling and resources. It was an appealing option for those who did not want to talk to someone in person for fear of the stigma associated with mental health. However, participants disliked the software bugs. They also wanted a more sophisticated conversational interface where they could express themselves and “vent” in free text. There were several suggestions for making Aroha more relevant to a diverse range of users, including developing content on navigating relationships and diverse chatbot avatars. Conclusions: Chatbots are an acceptable format for scaling up the delivery of public mental health and well-being–enhancing strategies. We make the following recommendations for others interested in designing and rolling out mental health chatbots to better support young people: make the chatbot relatable to its target audience by working with them to develop an authentic and relevant communication style; consider including holistic health and lifestyle content beyond traditional “mental health” support; and focus on developing features that make users feel heard, understood, and empowered. %M 37527545 %R 10.2196/44556 %U https://formative.jmir.org/2023/1/e44556 %U https://doi.org/10.2196/44556 %U http://www.ncbi.nlm.nih.gov/pubmed/37527545 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e47272 %T Immune-Boosting Effect of the COVID-19 Vaccine: Real-World Bidirectional Cohort Study %A Liu,Ming %A Zhao,Tianshuo %A Mu,Qiuyue %A Zhang,Ruizhi %A Liu,Chunting %A Xu,Fei %A Liang,Luxiang %A Zhao,Linglu %A Zhao,Suye %A Cai,Xianming %A Wang,Mingting %A Huang,Ninghua %A Feng,Tian %A Lei,Shiguang %A Yang,Guanghong %A Cui,Fuqiang %+ Guizhou Center for Disease Control and Prevention, 73 Bageyan Road, Yunyan District, Guizhou, Guiyang, 550004, China, 86 0851 86828805, ghyang_gzmu@outlook.com %K bidirectional cohort study %K booster administration %K COVID-19 vaccine %K real-world study %K SARS-CoV-2 %K vaccine efficacy %K COVID-19 %D 2023 %7 11.10.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: As the SARS-CoV-2 attenuates and antibodies from the COVID-19 vaccine decline, long-term attention should be paid to the durability of primary booster administration and the preventive effect of the second or multiple booster doses of the COVID-19 vaccine. Objective: This study aimed to explore the durability of primary booster administration and the preventive effect of second or multiple booster doses of the COVID-19 vaccine. Methods: We established a bidirectional cohort in Guizhou Province, China. Eligible participants who had received the primary booster dose were enrolled for blood sample collection and administration of the second booster dose. A retrospective cohort for the time of administration was constructed to evaluate antibody attenuation 6-12 months after the primary booster dose, while a prospective cohort on the vaccine effect of the second booster dose was constructed for 4 months after the second administration. Results: Between September 21, 2022, and January 30, 2023, a total of 327 participants were included in the final statistical analysis plan. The retrospective cohort revealed that approximately 6-12 months after receiving the primary booster, immunoglobulin G (IgG) slowly declined with time, while immunoglobulin A (IgA) remained almost constant. The prospective cohort showed that 28 days after receiving the second booster, the antibody levels were significantly improved. Higher levels of IgG and IgA were associated with better protection against COVID-19 infection for vaccine recipients. Regarding the protection of antibody levels against post–COVID-19 symptoms, the increase of the IgG had a protective effect on brain fog and sleep quality, while IgA had a protective effect on shortness of breath, brain fog, impaired coordination, and physical pain. Conclusions: The IgG and IgA produced by the second booster dose of COVID-19 vaccines can protect against SARS-CoV-2 infection and may alleviate some post–COVID-19 symptoms. Further data and studies on secondary booster administration are required to confirm these conclusions. %M 37819703 %R 10.2196/47272 %U https://publichealth.jmir.org/2023/1/e47272 %U https://doi.org/10.2196/47272 %U http://www.ncbi.nlm.nih.gov/pubmed/37819703 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e42960 %T Building a Chatbot in a Pandemic %A Rambaud,Kimberly %A van Woerden,Simon %A Palumbo,Leonardo %A Salvi,Cristiana %A Smallwood,Catherine %A Rockenschaub,Gerald %A Okoliyski,Michail %A Marinova,Lora %A Fomaidi,Galina %A Djalalova,Malika %A Faruqui,Nabiha %A Melo Bianco,Viviane %A Mosquera,Mario %A Spasov,Ivaylo %A Totskaya,Yekaterina %+ World Health Organization Regional Office for Europe, Marmorvej 51, Copenhagen, Denmark, 45 627164307, kimb.ramb@gmail.com %K COVID-19 %K chatbots %K evidence-based communication channels %K conversational agent %K user-centered %K health promotion %K digital health intervention %K online health information %K digital health tool %K health communication %D 2023 %7 10.10.2023 %9 Viewpoint %J J Med Internet Res %G English %X Easy access to evidence-based information on COVID-19 within an infodemic has been a challenging task. Chatbots have been introduced in times of emergency, when human resources are stretched thin and individuals need a user-centered resource. The World Health Organization Regional Office for Europe and UNICEF (United Nations Children's Fund) Europe and Central Asia came together to build a chatbot, HealthBuddy+, to assist country populations in the region to access accurate COVID-19 information in the local languages, adapted to the country context. Working in close collaboration with thematic technical experts, colleagues and counterparts at the country level allowed the project to be tailored to a diverse range of subtopics. To ensure that HealthBuddy+ was relevant and useful in countries across the region, the 2 regional offices worked closely with their counterparts in country offices, which were essential in partnering with national authorities, engaging communities, promoting the tool, and identifying the most relevant communication channels in which to embed HealthBuddy+. Over the past 2 years, the project has expanded from a web-based chatbot in 7 languages to a multistream, multifunction chatbot available in 16 regional languages, and HealthBuddy+ continues to expand and adjust to meet emerging health emergency needs. %M 37074958 %R 10.2196/42960 %U https://www.jmir.org/2023/1/e42960 %U https://doi.org/10.2196/42960 %U http://www.ncbi.nlm.nih.gov/pubmed/37074958 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e49944 %T A Natural Language Processing Model for COVID-19 Detection Based on Dutch General Practice Electronic Health Records by Using Bidirectional Encoder Representations From Transformers: Development and Validation Study %A Homburg,Maarten %A Meijer,Eline %A Berends,Matthijs %A Kupers,Thijmen %A Olde Hartman,Tim %A Muris,Jean %A de Schepper,Evelien %A Velek,Premysl %A Kuiper,Jeroen %A Berger,Marjolein %A Peters,Lilian %+ Department of Primary- and Long-Term Care, University Medical Center Groningen, Home Post Code FA21, PO Box 196, Groningen, 9700 RB, Netherlands, 31 050 3616161, t.m.homburg@umcg.nl %K natural language processing %K primary care %K COVID-19 %K EHR %K electronic health records %K public health %K multidisciplinary %K NLP %K disease identification %K BERT model %K model development %K prediction %D 2023 %7 4.10.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Natural language processing (NLP) models such as bidirectional encoder representations from transformers (BERT) hold promise in revolutionizing disease identification from electronic health records (EHRs) by potentially enhancing efficiency and accuracy. However, their practical application in practice settings demands a comprehensive and multidisciplinary approach to development and validation. The COVID-19 pandemic highlighted challenges in disease identification due to limited testing availability and challenges in handling unstructured data. In the Netherlands, where general practitioners (GPs) serve as the first point of contact for health care, EHRs generated by these primary care providers contain a wealth of potentially valuable information. Nonetheless, the unstructured nature of free-text entries in EHRs poses challenges in identifying trends, detecting disease outbreaks, or accurately pinpointing COVID-19 cases. Objective: This study aims to develop and validate a BERT model for detecting COVID-19 consultations in general practice EHRs in the Netherlands. Methods: The BERT model was initially pretrained on Dutch language data and fine-tuned using a comprehensive EHR data set comprising confirmed COVID-19 GP consultations and non–COVID-19–related consultations. The data set was partitioned into a training and development set, and the model’s performance was evaluated on an independent test set that served as the primary measure of its effectiveness in COVID-19 detection. To validate the final model, its performance was assessed through 3 approaches. First, external validation was applied on an EHR data set from a different geographic region in the Netherlands. Second, validation was conducted using results of polymerase chain reaction (PCR) test data obtained from municipal health services. Lastly, correlation between predicted outcomes and COVID-19–related hospitalizations in the Netherlands was assessed, encompassing the period around the outbreak of the pandemic in the Netherlands, that is, the period before widespread testing. Results: The model development used 300,359 GP consultations. We developed a highly accurate model for COVID-19 consultations (accuracy 0.97, F1-score 0.90, precision 0.85, recall 0.85, specificity 0.99). External validations showed comparable high performance. Validation on PCR test data showed high recall but low precision and specificity. Validation using hospital data showed significant correlation between COVID-19 predictions of the model and COVID-19–related hospitalizations (F1-score 96.8; P<.001; R2=0.69). Most importantly, the model was able to predict COVID-19 cases weeks before the first confirmed case in the Netherlands. Conclusions: The developed BERT model was able to accurately identify COVID-19 cases among GP consultations even preceding confirmed cases. The validated efficacy of our BERT model highlights the potential of NLP models to identify disease outbreaks early, exemplifying the power of multidisciplinary efforts in harnessing technology for disease identification. Moreover, the implications of this study extend beyond COVID-19 and offer a blueprint for the early recognition of various illnesses, revealing that such models could revolutionize disease surveillance. %M 37792444 %R 10.2196/49944 %U https://www.jmir.org/2023/1/e49944 %U https://doi.org/10.2196/49944 %U http://www.ncbi.nlm.nih.gov/pubmed/37792444 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e49342 %T Longitudinal Evaluation of an Integrated Post–COVID-19/Long COVID Management Program Consisting of Digital Interventions and Personal Support: Randomized Controlled Trial %A Derksen,Christina %A Rinn,Robin %A Gao,Lingling %A Dahmen,Alina %A Cordes,Cay %A Kolb,Carina %A Becker,Petra %A Lippke,Sonia %+ Health Psychology and Behavioural Medicine, Constructor University Bremen, Campus Ring 1, Bremen, 28759, Germany, 49 421 200 4730, cderksen@constructor.university %K postacute COVID-19 syndrome %K PACS %K symptom reduction %K work ability %K social participation %K personal pilots %K digital interventions %K empowerment %K randomized controlled trial %K propensity score matching %K COVID-19 %D 2023 %7 4.10.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: The postacute COVID-19 syndrome (PACS) can be addressed with multidisciplinary approaches, including professional support and digital interventions. Objective: This research aimed to test whether patients who received a health care facilitation program including medical internet support from human personal pilots and digital interventions (intervention group [IG] and active control group [ACG]) would experience fewer symptoms and have higher work ability and social participation than an untreated comparison group (CompG). The second objective was to compare the impact of a diagnostic assessment and digital interventions tailored to patients’ personal capacity (IG) with that of only personal support and digital interventions targeting the main symptoms (ACG). Methods: In total, 1020 patients with PACS were recruited. Using a randomized controlled trial design between the IG and the ACG, as well as propensity score matching to include the CompG, analyses were run with logistic regression and hierarchical-linear models. Results: Symptoms decreased significantly in all groups over time (βT1-T2=0.13, t549=5.67, P<.001; βT2-T4=0.06, t549=2.83, P=.01), with a main effect of the group (β=–.15, t549=–2.65, P=.01) and a more pronounced effect in the IG and ACG compared to the CompG (between groups: βT1-T2=0.14, t549=4.31, P<.001; βT2-T4=0.14, t549=4.57, P<.001). Work ability and social participation were lower in the CompG, but there was no significant interaction effect. There were no group differences between the IG and the ACG. Conclusions: Empowerment through personal pilots and digital interventions reduces symptoms but does not increase work ability and social participation. More longitudinal research is needed to evaluate the effects of a diagnostic assessment. Social support and digital interventions should be incorporated to facilitate health care interventions for PACS. Trial Registration: ClinicalTrials.gov NCT05238415; https://classic.clinicaltrials.gov/ct2/show/NCT05238415. International Registered Report Identifier (IRRID): RR2-10.1186/s12879-022-07584-z %M 37792437 %R 10.2196/49342 %U https://www.jmir.org/2023/1/e49342 %U https://doi.org/10.2196/49342 %U http://www.ncbi.nlm.nih.gov/pubmed/37792437 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e42758 %T Conversational AI and Vaccine Communication: Systematic Review of the Evidence %A Passanante,Aly %A Pertwee,Ed %A Lin,Leesa %A Lee,Kristi Yoonsup %A Wu,Joseph T %A Larson,Heidi J %+ Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, United Kingdom, 44 2076368636, aly.passanante@lshtm.ac.uk %K chatbots %K artificial intelligence %K conversational AI %K vaccine communication %K vaccine hesitancy %K conversational agent %K COVID-19 %K vaccine information %K health information %D 2023 %7 3.10.2023 %9 Review %J J Med Internet Res %G English %X Background: Since the mid-2010s, use of conversational artificial intelligence (AI; chatbots) in health care has expanded significantly, especially in the context of increased burdens on health systems and restrictions on in-person consultations with health care providers during the COVID-19 pandemic. One emerging use for conversational AI is to capture evolving questions and communicate information about vaccines and vaccination. Objective: The objective of this systematic review was to examine documented uses and evidence on the effectiveness of conversational AI for vaccine communication. Methods: This systematic review was conducted following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. PubMed, Web of Science, PsycINFO, MEDLINE, Scopus, CINAHL Complete, Cochrane Library, Embase, Epistemonikos, Global Health, Global Index Medicus, Academic Search Complete, and the University of London library database were searched for papers on the use of conversational AI for vaccine communication. The inclusion criteria were studies that included (1) documented instances of conversational AI being used for the purpose of vaccine communication and (2) evaluation data on the impact and effectiveness of the intervention. Results: After duplicates were removed, the review identified 496 unique records, which were then screened by title and abstract, of which 38 were identified for full-text review. Seven fit the inclusion criteria and were assessed and summarized in the findings of this review. Overall, vaccine chatbots deployed to date have been relatively simple in their design and have mainly been used to provide factual information to users in response to their questions about vaccines. Additionally, chatbots have been used for vaccination scheduling, appointment reminders, debunking misinformation, and, in some cases, for vaccine counseling and persuasion. Available evidence suggests that chatbots can have a positive effect on vaccine attitudes; however, studies were typically exploratory in nature, and some lacked a control group or had very small sample sizes. Conclusions: The review found evidence of potential benefits from conversational AI for vaccine communication. Factors that may contribute to the effectiveness of vaccine chatbots include their ability to provide credible and personalized information in real time, the familiarity and accessibility of the chatbot platform, and the extent to which interactions with the chatbot feel “natural” to users. However, evaluations have focused on the short-term, direct effects of chatbots on their users. The potential longer-term and societal impacts of conversational AI have yet to be analyzed. In addition, existing studies do not adequately address how ethics apply in the field of conversational AI around vaccines. In a context where further digitalization of vaccine communication can be anticipated, additional high-quality research will be required across all these areas. %M 37788057 %R 10.2196/42758 %U https://www.jmir.org/2023/1/e42758 %U https://doi.org/10.2196/42758 %U http://www.ncbi.nlm.nih.gov/pubmed/37788057 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e49804 %T Identifying Inequities in Video and Audio Telehealth Services for Primary Care Encounters During COVID-19: Repeated Cross-Sectional, Observational Study %A Buis,Lorraine R %A Brown,Lindsay K %A Plegue,Melissa A %A Kadri,Reema %A Laurie,Anna R %A Guetterman,Timothy C %A Vydiswaran,V G Vinod %A Li,Jiazhao %A Veinot,Tiffany C %+ Department of Family Medicine, University of Michigan, 1018 Fuller Street, Ann Arbor, MI, 48104, United States, 1 734 998 7120, buisl@umich.edu %K COVID-19 %K telemedicine %K health equity %K clinical encounters %K electronic health records %D 2023 %7 29.9.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic resulted in rapid changes in how patient care was provided, particularly through the expansion of telehealth and audio-only phone-based care. Objective: The goal of this study was to evaluate inequities in video and audio-only care during various time points including the initial wave of the COVID-19 pandemic, later stages of the pandemic, and a historical control. We sought to understand the characteristics of care during this time for a variety of different groups of patients that may experience health care inequities. Methods: We conducted a retrospective analysis of electronic health record (EHR) data from encounters from 34 family medicine and internal medicine primary care clinics in a large, Midwestern health system, using a repeated cross-sectional, observational study design. These data included patient demographic data, as well as encounter, diagnosis, and procedure records. Data were obtained for all in-person and telehealth encounters (including audio-only phone-based care) that occurred during 3 separate time periods: an initial COVID-19 period (T2: March 16, 2020, to May 3, 2020), a later COVID-19 period (T3: May 4, 2020, to September 30, 2020), and a historical control period from the previous year (T1: March 16, 2019, to September 30, 2019). Primary analysis focused on the status of each encounter in terms of whether it was completed as scheduled, it was canceled, or the patient missed the appointment. A secondary analysis was performed to evaluate the likelihood of an encounter being completed based on visit modality (phone, video, in-person). Results: In total, there were 938,040 scheduled encounters during the 3 time periods, with 178,747 unique patients, that were included for analysis. Patients with completed encounters were more likely to be younger than 65 years old (71.8%-74.1%), be female (58.8%-61.8%), be White (75.6%-76.7%), and have no significant comorbidities (63.2%-66.8%) or disabilities (53.2%-61.1%) in all time periods than those who had only canceled or missed encounters. Effects on different subpopulations are discussed herein. Conclusions: Findings from this study demonstrate that primary care utilization across delivery modalities (in person, video, and phone) was not equivalent across all groups before and during the COVID-19 pandemic and different groups were differentially impacted at different points. Understanding how different groups of patients responded to these rapid changes and how health care inequities may have been affected is an important step in better understanding implementation strategies for digital solutions in the future. %M 37773609 %R 10.2196/49804 %U https://www.jmir.org/2023/1/e49804 %U https://doi.org/10.2196/49804 %U http://www.ncbi.nlm.nih.gov/pubmed/37773609 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e45216 %T Evaluating a Peer-Support Mobile App for Mental Health and Substance Use Among Adolescents Over 12 Months During the COVID-19 Pandemic: Randomized Controlled Trial %A Birrell,Louise %A Debenham,Jennifer %A Furneaux-Bate,Ainsley %A Prior,Katrina %A Spallek,Sophia %A Thornton,Louise %A Chapman,Catherine %A Newton,Nicola %+ The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Level 6, Jane Foss Russell Building G02, Sydney, 2006, Australia, 61 2 8627 9003, louise.birrell@sydney.edu.au %K mental health %K substance use %K prevention %K school-based %K peer support %K anxiety %K social support %K psychosocial support systems %K depression %K adolescent %K mobile apps %K eHealth %K mHealth %K mobile phone %K COVID-19 %D 2023 %7 27.9.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Although it is well known that adolescents frequently turn to their friends for support around mental health and substance use problems, there are currently no evidence-based digital programs to support them to do this. Objective: The aim of this study was to evaluate the efficacy of the Mind your Mate program, a digital peer-support program, in improving mental health symptoms, reducing the uptake of substance use, and increasing help seeking. The Mind your Mate program consists of a 40-minute web-based classroom lesson and a companion smartphone mobile app. The active control group received school-based health education as usual. Methods: A cluster randomized controlled trial was conducted with 12 secondary schools and 166 students (mean age 15.3, SD 0.41 years; 72/166, 43.4% female; and 133/166, 80.1% born in Australia). Participants completed self-reported questionnaires assessing symptoms of mental health (depression, anxiety, and psychological distress), substance use (alcohol and other drug use), and help-seeking measures at baseline and at 6-month and 12-month follow-ups. Results: Students who received the Mind your Mate program had greater reductions in depressive symptoms over a 12-month period than controls (b=−1.86, 95% CI −3.73 to 0.02; Cohen d=−0.31). Anxiety symptoms decreased among students in the intervention group; however, these reductions did not meet statistical significance thresholds. No differences were observed in relation to psychological distress or help-seeking. Conclusions: Small to moderate reductions in depression symptoms were observed among students allocated to receive the Mind your Mate intervention. Although the current results are encouraging, there is a need to continue to refine, develop, and evaluate innovative applied approaches for the prevention of mental disorders in real-world settings. Trial Registration: Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12620000753954; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12620000753954 International Registered Report Identifier (IRRID): RR2-10.2196/26796 %M 37756116 %R 10.2196/45216 %U https://www.jmir.org/2023/1/e45216 %U https://doi.org/10.2196/45216 %U http://www.ncbi.nlm.nih.gov/pubmed/37756116 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 3 %N %P e41863 %T Assessment of the Early Detection of Anosmia and Ageusia Symptoms in COVID-19 on Twitter: Retrospective Study %A Faviez,Carole %A Talmatkadi,Manissa %A Foulquié,Pierre %A Mebarki,Adel %A Schück,Stéphane %A Burgun,Anita %A Chen,Xiaoyi %+ Centre de Recherche des Cordeliers, Université Paris Cité, Sorbonne Université, Institut National de la Santé et de la Recherche Médicale (INSERM) UMR 1138, 24 Boulevard du Montparnasse, Paris, 75015, France, 33 142754200, carole.faviez@inserm.fr %K social media %K COVID-19 %K anosmia %K ageusia %K infodemiology %K symptom %K Twitter %K psychological %K tweets %K pandemic %K rapid stage %K epidemic %K information %K knowledge %K online health %K tweets %K misinformation %K education %K online education %K ehealth %K qualitative %D 2023 %7 25.9.2023 %9 Original Paper %J JMIR Infodemiology %G English %X Background: During the unprecedented COVID-19 pandemic, social media has been extensively used to amplify the spread of information and to express personal health-related experiences regarding symptoms, including anosmia and ageusia, 2 symptoms that have been reported later than other symptoms. Objective: Our objective is to investigate to what extent Twitter users reported anosmia and ageusia symptoms in their tweets and if they connected them to COVID-19, to evaluate whether these symptoms could have been identified as COVID-19 symptoms earlier using Twitter rather than the official notice. Methods: We collected French tweets posted between January 1, 2020, and March 31, 2020, containing anosmia- or ageusia-related keywords. Symptoms were detected using fuzzy matching. The analysis consisted of 3 parts. First, we compared the coverage of anosmia and ageusia symptoms in Twitter and in traditional media to determine if the association between COVID-19 and anosmia or ageusia could have been identified earlier through Twitter. Second, we conducted a manual analysis of anosmia- and ageusia-related tweets to obtain quantitative and qualitative insights regarding their nature and to assess when the first associations between COVID-19 and these symptoms were established. We randomly annotated tweets from 2 periods: the early stage and the rapid spread stage of the epidemic. For each tweet, each symptom was annotated regarding 3 modalities: symptom (yes or no), associated with COVID-19 (yes, no, or unknown), and whether it was experienced by someone (yes, no, or unknown). Third, to evaluate if there was a global increase of tweets mentioning anosmia or ageusia in early 2020, corresponding to the beginning of the COVID-19 epidemic, we compared the tweets reporting experienced anosmia or ageusia between the first periods of 2019 and 2020. Results: In total, 832 (respectively 12,544) tweets containing anosmia (respectively ageusia) related keywords were extracted over the analysis period in 2020. The comparison to traditional media showed a strong correlation without any lag, which suggests an important reactivity of Twitter but no earlier detection on Twitter. The annotation of tweets from 2020 showed that tweets correlating anosmia or ageusia with COVID-19 could be found a few days before the official announcement. However, no association could be found during the first stage of the pandemic. Information about the temporality of symptoms and the psychological impact of these symptoms could be found in the tweets. The comparison between early 2020 and early 2019 showed no difference regarding the volumes of tweets. Conclusions: Based on our analysis of French tweets, associations between COVID-19 and anosmia or ageusia by web users could have been found on Twitter just a few days before the official announcement but not during the early stage of the pandemic. Patients share qualitative information on Twitter regarding anosmia or ageusia symptoms that could be of interest for future analyses. %M 37643302 %R 10.2196/41863 %U https://infodemiology.jmir.org/2023/1/e41863 %U https://doi.org/10.2196/41863 %U http://www.ncbi.nlm.nih.gov/pubmed/37643302 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e48398 %T Assessing the Effectiveness of a Massive Open Online Course for Caregivers Amid the COVID-19 Pandemic: Methodological Study %A Lumini,Maria José %A Sousa,Maria Rui %A Salazar,Berta %A Martins,Teresa %+ Nursing School of Porto, Centro de Investigação em Tecnologias e Serviços de Saúde (CINTESIS), Rede de Investigação em Saúde (RISE), Rua Dr. António Bernardino de Almeida, Porto, 4200-072, Portugal, 351 00351225 073 50, lumini@esenf.pt %K caregivers %K education %K COVID-19 %K distance %K effectiveness %K skill %K safe care %K health system %K older people %K family %K social isolation %K massive open online courses %K care challenges %D 2023 %7 25.9.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic has presented significant challenges to health care systems, particularly impacting the older population due to their vulnerability and increased susceptibility to severe complications. Many of the most vulnerable individuals rely on informal caregivers, who play a vital role in enabling them to continue living in their homes. However, social isolation and limited access to health services during the pandemic have made caregiving more difficult. In response, massive open online courses (MOOCs) have emerged as a training and support solution for caregivers. This study focuses on a MOOC developed to assist caregivers during the pandemic, aiming to enhance their knowledge of COVID-19 and prevention measures and promote effective self-care practices. Objective: The study’s aim is to develop and validate a MOOC integrating personal and housing hygiene measures to be adopted in self-care–related activities, surveillance, and monitoring by caregivers of the most vulnerable home-dwelling–dependent people, to provide safe care and prevent SARS-CoV-2 infection. Methods: A methodological study was developed. The content of the MOOC was developed based on scientific evidence and a Delphi study. The course was organized into 9 modules, addressing aspects related to safe self-care assistance and minimizing the risk of contagion. A convenience sample of 33 informal caregivers was recruited through a caregivers’ association to verify the adequacy of the course. Knowledge questionnaires were administered before and after the course to assess the impact on caregivers‘ knowledge. The Family Caregiving Factors Inventory was used to evaluate caregiver resources, knowledge, expectations, and difficulties. Additionally, the technology acceptance model was applied to assess participants’ satisfaction with the MOOC. Results: Prior to attending the MOOC, participants demonstrated an average knowledge level score of mean 14.94 (SD 2.72). After completing the course, this score significantly increased to mean 16.52 (SD 2.28), indicating an improvement in knowledge. Caregivers found the course accessible, valuable, and applicable to their caregiving roles. Feedback regarding the MOOC’s structure, illustrative videos, and language was overwhelmingly positive. Participants perceived the course as a valuable resource for decision-making in care delivery, leading to enhanced self-esteem and confidence. Conclusions: The MOOC has proven to be an effective tool for increasing caregivers’ knowledge and empowering them in their roles. Remarkably, even low-literacy caregivers found the course valuable for its clear and understandable information. The MOOC demonstrated its adaptability to challenges faced during the pandemic, ensuring access to relevant information. This empowering strategy for caregivers has yielded positive outcomes. The MOOC represents a tool to support and empower informal caregivers, enabling them to provide optimal care during difficult times. %M 37747772 %R 10.2196/48398 %U https://formative.jmir.org/2023/1/e48398 %U https://doi.org/10.2196/48398 %U http://www.ncbi.nlm.nih.gov/pubmed/37747772 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e42857 %T Social Media and Selfie-Related Mortality Amid COVID-19: Interrupted Time Series Analysis %A Kang-Auger,Sarit %A Lewin,Antoine %A Ayoub,Aimina %A Bilodeau-Bertrand,Marianne %A Marcoux,Sophie %A Auger,Nathalie %+ Institut national de santé publique du Québec, 190 Cremazie Blvd E, Montreal, QC, H2P 1E2, Canada, 1 514 864 1600, nathalie.auger@inspq.qc.ca %K COVID-19 %K injury %K mortality %K mortality rate %K web-based news %K selfie %K social media %K time series regression %D 2023 %7 25.9.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: COVID-19 had a considerable impact on mortality, but its effect on behaviors associated with social media remains unclear. As travel decreased due to lockdowns during the pandemic, selfie-related mortality may have decreased, as fewer individuals were taking smartphone photographs in risky locations. Objective: In this study, we examined the effect of the COVID-19 pandemic on trends in selfie-related mortality. Methods: We identified fatal selfie-related injuries reported in web-based news reports worldwide between March 2014 and April 2021, including the deaths of individuals attempting a selfie photograph or anyone else present during the incident. The main outcome measure was the total number of selfie-related deaths per month. We used interrupted time series regression to estimate the monthly change in the number of selfie-related deaths over time, comparing the period before the pandemic (March 2014 to February 2020) with the period during the pandemic (March 2020 to April 2021). Results: The study included a total of 332 selfie-related deaths occurring between March 2014 and April 2021, with 18 (5.4%) deaths during the pandemic. Most selfie-related deaths occurred in India (n=153, 46.1%) and involved men (n=221, 66.6%) and young individuals (n=296, 89.2%). During the pandemic, two-thirds of selfie-related deaths were due to falls, whereas a greater proportion of selfie-related deaths before the pandemic were due to drowning. Based on interrupted time series regression, there was an average of 1.3 selfie-related deaths per month during the pandemic, compared with 4.3 deaths per month before the pandemic. The number of selfie-related deaths decreased by 2.6 in the first month of the pandemic alone and continued to decrease thereafter. Conclusions: Our findings indicate that the COVID-19 pandemic led to a marked decrease in selfie-related mortality, suggesting that lockdowns and travel restrictions likely prevented hazardous selfie-taking. The decrease in selfie-related mortality occurred despite a potential increase in social media use during the pandemic. %M 37747765 %R 10.2196/42857 %U https://formative.jmir.org/2023/1/e42857 %U https://doi.org/10.2196/42857 %U http://www.ncbi.nlm.nih.gov/pubmed/37747765 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e45767 %T Using Social Media to Help Understand Patient-Reported Health Outcomes of Post–COVID-19 Condition: Natural Language Processing Approach %A Dolatabadi,Elham %A Moyano,Diana %A Bales,Michael %A Spasojevic,Sofija %A Bhambhoria,Rohan %A Bhatti,Junaid %A Debnath,Shyamolima %A Hoell,Nicholas %A Li,Xin %A Leng,Celine %A Nanda,Sasha %A Saab,Jad %A Sahak,Esmat %A Sie,Fanny %A Uppal,Sara %A Vadlamudi,Nirma Khatri %A Vladimirova,Antoaneta %A Yakimovich,Artur %A Yang,Xiaoxue %A Kocak,Sedef Akinli %A Cheung,Angela M %+ Faculty of Health, School of Health Policy and Management, York University, 4700 Keele Street, North York, Toronto, ON, M3J 1P3, Canada, 1 6477069756, edolatab@yorku.ca %K long COVID %K post–COVID-19 condition %K PCC %K social media %K natural language processing %K transformer models %K bidirectional encoder representations from transformers %K machine learning %K Twitter %K Reddit %K PRO %K patient-reported outcome %K patient-reported symptom %K health outcome %K symptom %K entity extraction %K entity normalization %D 2023 %7 19.9.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: While scientific knowledge of post–COVID-19 condition (PCC) is growing, there remains significant uncertainty in the definition of the disease, its expected clinical course, and its impact on daily functioning. Social media platforms can generate valuable insights into patient-reported health outcomes as the content is produced at high resolution by patients and caregivers, representing experiences that may be unavailable to most clinicians. Objective: In this study, we aimed to determine the validity and effectiveness of advanced natural language processing approaches built to derive insight into PCC-related patient-reported health outcomes from social media platforms Twitter and Reddit. We extracted PCC-related terms, including symptoms and conditions, and measured their occurrence frequency. We compared the outputs with human annotations and clinical outcomes and tracked symptom and condition term occurrences over time and locations to explore the pipeline’s potential as a surveillance tool. Methods: We used bidirectional encoder representations from transformers (BERT) models to extract and normalize PCC symptom and condition terms from English posts on Twitter and Reddit. We compared 2 named entity recognition models and implemented a 2-step normalization task to map extracted terms to unique concepts in standardized terminology. The normalization steps were done using a semantic search approach with BERT biencoders. We evaluated the effectiveness of BERT models in extracting the terms using a human-annotated corpus and a proximity-based score. We also compared the validity and reliability of the extracted and normalized terms to a web-based survey with more than 3000 participants from several countries. Results: UmlsBERT-Clinical had the highest accuracy in predicting entities closest to those extracted by human annotators. Based on our findings, the top 3 most commonly occurring groups of PCC symptom and condition terms were systemic (such as fatigue), neuropsychiatric (such as anxiety and brain fog), and respiratory (such as shortness of breath). In addition, we also found novel symptom and condition terms that had not been categorized in previous studies, such as infection and pain. Regarding the co-occurring symptoms, the pair of fatigue and headaches was among the most co-occurring term pairs across both platforms. Based on the temporal analysis, the neuropsychiatric terms were the most prevalent, followed by the systemic category, on both social media platforms. Our spatial analysis concluded that 42% (10,938/26,247) of the analyzed terms included location information, with the majority coming from the United States, United Kingdom, and Canada. Conclusions: The outcome of our social media–derived pipeline is comparable with the results of peer-reviewed articles relevant to PCC symptoms. Overall, this study provides unique insights into patient-reported health outcomes of PCC and valuable information about the patient’s journey that can help health care providers anticipate future needs. International Registered Report Identifier (IRRID): RR2-10.1101/2022.12.14.22283419 %M 37725432 %R 10.2196/45767 %U https://www.jmir.org/2023/1/e45767 %U https://doi.org/10.2196/45767 %U http://www.ncbi.nlm.nih.gov/pubmed/37725432 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e45322 %T The Skewed Impact of Highly Cited Articles on Journal Impact Factor %A Ide,Kazuki %+ Division of Scientific Information and Public Policy, Center for Infectious Disease Education and Research (CiDER), Osaka University, Techno-Alliance Building C 208, 2-8 Yamadaoka, Suita, Osaka, 565-0871, Japan, 81 06 6879 4168, ide-k@cider.osaka-u.ac.jp %K COVID-19 %K journal impact factor %K JIF %K scientometrics %K bibliometrics %K infometrics %K journal %K assessment %K research %K resources %K medical journal %K literature %K database %K community %K behavior %D 2023 %7 18.9.2023 %9 Letter to the Editor %J J Med Internet Res %G English %X %M 37721788 %R 10.2196/45322 %U https://www.jmir.org/2023/1/e45322 %U https://doi.org/10.2196/45322 %U http://www.ncbi.nlm.nih.gov/pubmed/37721788 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e49061 %T Exploring YouTube’s Recommendation System in the Context of COVID-19 Vaccines: Computational and Comparative Analysis of Video Trajectories %A Ng,Yee Man Margaret %A Hoffmann Pham,Katherine %A Luengo-Oroz,Miguel %+ Department of Journalism & Institute of Communications Research, University of Illinois at Urbana-Champaign, 810 S Wright St, Champaign, IL, 61801, United States, 1 217 300 8186, margaretnym@gmail.com %K algorithmic auditing %K antivaccine sentiment %K crowdsourcing %K recommendation systems %K watch history %K YouTube %D 2023 %7 15.9.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Throughout the COVID-19 pandemic, there has been a concern that social media may contribute to vaccine hesitancy due to the wide availability of antivaccine content on social media platforms. YouTube has stated its commitment to removing content that contains misinformation on vaccination. Nevertheless, such claims are difficult to audit. There is a need for more empirical research to evaluate the actual prevalence of antivaccine sentiment on the internet. Objective: This study examines recommendations made by YouTube’s algorithms in order to investigate whether the platform may facilitate the spread of antivaccine sentiment on the internet. We assess the prevalence of antivaccine sentiment in recommended videos and evaluate how real-world users’ experiences are different from the personalized recommendations obtained by using synthetic data collection methods, which are often used to study YouTube’s recommendation systems. Methods: We trace trajectories from a credible seed video posted by the World Health Organization to antivaccine videos, following only video links suggested by YouTube’s recommendation system. First, we gamify the process by asking real-world participants to intentionally find an antivaccine video with as few clicks as possible. Having collected crowdsourced trajectory data from respondents from (1) the World Health Organization and United Nations system (nWHO/UN=33) and (2) Amazon Mechanical Turk (nAMT=80), we next compare the recommendations seen by these users to recommended videos that are obtained from (3) the YouTube application programming interface’s RelatedToVideoID parameter (nRTV=40) and (4) from clean browsers without any identifying cookies (nCB=40), which serve as reference points. We develop machine learning methods to classify antivaccine content at scale, enabling us to automatically evaluate 27,074 video recommendations made by YouTube. Results: We found no evidence that YouTube promotes antivaccine content; the average share of antivaccine videos remained well below 6% at all steps in users’ recommendation trajectories. However, the watch histories of users significantly affect video recommendations, suggesting that data from the application programming interface or from a clean browser do not offer an accurate picture of the recommendations that real users are seeing. Real users saw slightly more provaccine content as they advanced through their recommendation trajectories, whereas synthetic users were drawn toward irrelevant recommendations as they advanced. Rather than antivaccine content, videos recommended by YouTube are likely to contain health-related content that is not specifically related to vaccination. These videos are usually longer and contain more popular content. Conclusions: Our findings suggest that the common perception that YouTube’s recommendation system acts as a “rabbit hole” may be inaccurate and that YouTube may instead be following a “blockbuster” strategy that attempts to engage users by promoting other content that has been reliably successful across the platform. %M 37713243 %R 10.2196/49061 %U https://www.jmir.org/2023/1/e49061 %U https://doi.org/10.2196/49061 %U http://www.ncbi.nlm.nih.gov/pubmed/37713243 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e44461 %T Capturing Emerging Experiential Knowledge for Vaccination Guidelines Through Natural Language Processing: Proof-of-Concept Study %A Lösch,Lea %A Zuiderent-Jerak,Teun %A Kunneman,Florian %A Syurina,Elena %A Bongers,Marloes %A Stein,Mart L %A Chan,Michelle %A Willems,Willemine %A Timen,Aura %+ Athena Institute, Faculty of Science, Vrije Universiteit Amsterdam, De Boelelaan 1105, Amsterdam, 1081 HV, Netherlands, 31 205987031, lea.loesch@vu.nl %K guidelines as topic %K COVID-19 %K public health %K natural language processing %K NLP %K social media %K stakeholder engagement %K vaccine %K vaccination %K health policy %K coronavirus %K SARS-CoV-2 %D 2023 %7 14.9.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Experience-based knowledge and value considerations of health professionals, citizens, and patients are essential to formulate public health and clinical guidelines that are relevant and applicable to medical practice. Conventional methods for incorporating such knowledge into guideline development often involve a limited number of representatives and are considered to be time-consuming. Including experiential knowledge can be crucial during rapid guidance production in response to a pandemic but it is difficult to accomplish. Objective: This proof-of-concept study explored the potential of artificial intelligence (AI)–based methods to capture experiential knowledge and value considerations from existing data channels to make these insights available for public health guideline development. Methods: We developed and examined AI-based methods in relation to the COVID-19 vaccination guideline development in the Netherlands. We analyzed Dutch messages shared between December 2020 and June 2021 on social media and on 2 databases from the Dutch National Institute for Public Health and the Environment (RIVM), where experiences and questions regarding COVID-19 vaccination are reported. First, natural language processing (NLP) filtering techniques and an initial supervised machine learning model were developed to identify this type of knowledge in a large data set. Subsequently, structural topic modeling was performed to discern thematic patterns related to experiences with COVID-19 vaccination. Results: NLP methods proved to be able to identify and analyze experience-based knowledge and value considerations in large data sets. They provide insights into a variety of experiential knowledge that is difficult to obtain otherwise for rapid guideline development. Some topics addressed by citizens, patients, and professionals can serve as direct feedback to recommendations in the guideline. For example, a topic pointed out that although travel was not considered as a reason warranting prioritization for vaccination in the national vaccination campaign, there was a considerable need for vaccines for indispensable travel, such as cross-border informal caregiving, work or study, or accessing specialized care abroad. Another example is the ambiguity regarding the definition of medical risk groups prioritized for vaccination, with many citizens not meeting the formal priority criteria while being equally at risk. Such experiential knowledge may help the early identification of problems with the guideline’s application and point to frequently occurring exceptions that might initiate a revision of the guideline text. Conclusions: This proof-of-concept study presents NLP methods as viable tools to access and use experience-based knowledge and value considerations, possibly contributing to robust, equitable, and applicable guidelines. They offer a way for guideline developers to gain insights into health professionals, citizens, and patients’ experience-based knowledge, especially when conventional methods are difficult to implement. AI-based methods can thus broaden the evidence and knowledge base available for rapid guideline development and may therefore be considered as an important addition to the toolbox of pandemic preparedness. %M 37610972 %R 10.2196/44461 %U https://www.jmir.org/2023/1/e44461 %U https://doi.org/10.2196/44461 %U http://www.ncbi.nlm.nih.gov/pubmed/37610972 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e41364 %T Potential Determinants Contributing to COVID-19 Vaccine Acceptance and Hesitancy in Taiwan: Rapid Qualitative Mixed Methods Study %A Lin,Li-Yin %A Lin,Chun-Ji %A Kuan,Chen-I %A Chiou,Hung-Yi %+ Institute of Population Health Sciences, National Health Research Institutes, No 35, Keyan Road, Zhunan Town, Miaoli County, 35053, Taiwan, 886 37 206166 ext 36300, hychiou@nhri.edu.tw %K COVID-19 %K vaccine acceptance %K vaccine hesitancy %K google trends %K public health %K vaccination %K health promotion %K thematic analysis %K infoveillance %D 2023 %7 12.9.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Although vaccination has been shown to be one of the most important interventions, COVID-19 vaccine hesitancy remains one of the top 10 global public health challenges worldwide. Objective: The objective of this study is to investigate (1) major determinants of vaccine hesitancy, (2) changes in the determinants of vaccine hesitancy at different time periods, and (3) the potential factors affecting vaccine acceptance. Methods: This study applied a mixed methods approach to explore the potential determinants contributing to vaccine hesitancy among the Taiwanese population. The quantitative design of this study involved using Google Trends search query data. We chose the search term “疫苗“ (vaccine), selected ”台灣” (Taiwan) as the location, and selected the period between December 18, 2020, and July 31, 2021. The rising keywords related to vaccine acceptance and hesitancy were collected. Based on the responses obtained from the qualitative study and the rising keywords obtained in Google Trends, the 3 most popular keywords related to vaccine hesitancy were identified and used as search queries in Google Trends between December 18, 2020, and July 31, 2021, to generate relative search volumes (RSVs). Lastly, autoregressive integrated moving average modeling was used to forecast the RSVs for the 3 keywords between May 29 and July 31, 2021. The estimated RSVs were compared to the observed RSVs in Google Trends within the same time frame. Results: The 4 prevailing factors responsible for COVID-19 vaccine acceptance and hesitancy were doubts about the government and manufacturers, side effects, deaths associated with vaccination, and efficacy of vaccination. During the vaccine observation period, “political role” was the overarching consideration leading to vaccine hesitancy. During the peak of the pandemic, side effects, death, and vaccine protection were the main factors contributing to vaccine hesitancy. The popularity of the 3 frequently searched keywords “side effects,” “vaccine associated deaths,” and “vaccine protection” continued to rise throughout the pandemic outbreak. Lastly, the highest Google search queries related to COVID-19 vaccines emerged as “side effects” prior to vaccination, deaths associated with vaccines during the period when single vaccines were available, and “side effects” and “vaccine protection” during the period when multiple vaccines were available. Conclusions: Investigating the key factors influencing COVID-19 vaccine hesitancy appears to be a fundamental task that needs to be undertaken to ensure effective implementation of COVID-19 vaccination. Google Trends may be used as a complementary infoveillance tool by government agencies for future vaccine policy implementation and communication. %M 37698904 %R 10.2196/41364 %U https://formative.jmir.org/2023/1/e41364 %U https://doi.org/10.2196/41364 %U http://www.ncbi.nlm.nih.gov/pubmed/37698904 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e48638 %T Smartphone-Assisted Medical Care for Vestibular Dysfunction as a Telehealth Strategy for Digital Therapy Beyond COVID-19: Scoping Review %A Noda,Masao %A Kuroda,Tatsuaki %A Nomura,Akihiro %A Ito,Makoto %A Yoshizaki,Tomokazu %A Fushiki,Hiroaki %+ Mejiro University Ear Institute Clinic, 320 Ukiya, Iwatsukiku, Saitama-shi, Saitama, 339-8501, Japan, 81 48 797 3341, fushiki@mejiro.ac.jp %K dizziness %K vertigo %K telemedicine %K smartphone %K digital therapy %K telehealth %K COVID-19 %K information technology %K scoping review %K health device %K remote diagnosis %K medical care %D 2023 %7 11.9.2023 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Dizziness and vertigo can be caused by various factors, such as peripheral vestibular and central disorders. Although consultations with specialists are advisable when necessary, patients with severe vertigo symptoms may have limited mobility, which may interfere with hospital visits. The spread of COVID-19 has further limited the number of hospital visits for patients with dizziness; therefore, a method of medical care that enables more accurate treatment under time and geographical constraints is needed. Telemedicine has become widespread, owing to the popularity of smartphone and tablet devices in recent years, and the use of devices and systems has made it possible to provide efficient medical care. However, no previous scoping review has mapped existing studies on telemedicine for vertigo and dizziness, and no recommendations have been made regarding which devices and systems should be used for specific diseases. Objective: The aim of this review was to map and assess previous studies on the use of information communications technology, smartphones, and apps for treating patients with vertigo and discuss the added value of introducing telemedicine to improve the quality of medical care and create an environment that builds security and trust among patients. Methods: A scoping review was conducted with the methodological framework of Arksey and O’Malley and in accordance with the of the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews) guidelines. The PubMed, MEDLINE, and Cochrane Library databases were searched to retrieve previous reports on smartphone-assisted telemedicine treatment for vertigo published between January 2000 and May 2023. Two authors independently assessed eligibility and extracted data. Results: This review included 20 papers that reported devices or systems for telemedicine for vestibular dysfunction. Among studies that reported the use of a device or app, 2 were related to anamnesis and subjective symptoms, 12 were related to objective examination, 7 were related to remote diagnosis, and 7 were related to treatment and rehabilitation. Conclusions: With the advancement of technology, the use of telemedicine in patients with dizziness may be feasible. In the future, it will be necessary to consider how telemedicine can be used in dizziness treatment and develop an effective treatment system combining in-person medical care and the effective use of devices for the management of severe vertigo and related diseases. The smooth introduction of telemedicine in vertigo treatment is expected to improve the quality of treatment, increase opportunities for patients to receive medical care, and reduce time and travel costs, leading to a sense of security and trust among patients. %M 37695671 %R 10.2196/48638 %U https://mhealth.jmir.org/2023/1/e48638 %U https://doi.org/10.2196/48638 %U http://www.ncbi.nlm.nih.gov/pubmed/37695671 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e42217 %T Telehealth Use During the COVID-19 Pandemic Among Veterans and Nonveterans: Web-Based Survey Study %A Shoemaker,Holly E %A Thorpe,Alistair %A Stevens,Vanessa %A Butler,Jorie M %A Drews,Frank A %A Burpo,Nicole %A Scherer,Laura D %A Fagerlin,Angela %+ Department of Population Health Sciences, Spencer Fox Eccles School of Medicine, University of Utah, 295 Chipeta Way, Williams Building, Salt Lake City, UT, 84108, United States, 1 801 587 2100, angie.fagerlin@hsc.utah.edu %K telehealth %K telemedicine %K veterans %K COVID-19 %K health care %K nationwide web-based survey %K underserved population %K accessible health care %K health inequality %K health care disparity %D 2023 %7 8.9.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: In the first year of the COVID-19 pandemic, studies reported delays in health care usage due to safety concerns. Delays in care may result in increased morbidity and mortality from otherwise treatable conditions. Telehealth provides a safe alternative for patients to receive care when other circumstances make in-person care unavailable or unsafe, but information on patient experiences is limited. Understanding which people are more or less likely to use telehealth and their experiences can help tailor outreach efforts to maximize the impact of telehealth. Objective: This study aims to examine the characteristics of telehealth users and nonusers and their reported experiences among veteran and nonveteran respondents. Methods: A nationwide web-based survey of current behaviors and health care experiences was conducted in December 2020-March 2021. The survey consisted of 3 waves, and the first wave is assessed here. Respondents included US adults participating in Qualtrics web-based panels. Primary outcomes were self-reported telehealth use and number of telehealth visits. The analysis used a 2-part regression model examining the association between telehealth use and the number of visits with respondent characteristics. Results: There were 2085 participants in the first wave, and 898 (43.1%) reported using telehealth since the pandemic began. Most veterans who used telehealth reported much or somewhat preferring an in-person visit (336/474, 70.9%), while slightly less than half of nonveterans (189/424, 44.6%) reported this preference. While there was no significant difference between veteran and nonveteran likelihood of using telehealth (odds ratio [OR] 1.33, 95% CI 0.97-1.82), veterans were likely to have more visits when they did use it (incidence rate ratio [IRR] 1.49, 95% CI 1.07-2.07). Individuals were less likely to use telehealth and reported fewer visits if they were 55 years and older (OR 0.39, 95% CI 0.25-0.62 for ages 55-64 years; IRR 0.43, 95% CI 0.28-0.66) or lived in a small city (OR 0.63, 95% CI 0.43-0.92; IRR 0.71, 95% CI 0.51-0.99). Receiving health care partly or primarily at the Veterans Health Administration (VA) was associated with telehealth use (primarily VA: OR 3.25, 95% CI 2.20-4.81; equal mix: OR 2.18, 95% CI 1.40-3.39) and more telehealth visits (primarily VA: IRR 1.5, 95% CI 1.10-2.04; equal mix: IRR 1.57, 95% CI 1.11-2.24). Conclusions: Telehealth will likely continue to be an important source of health care for patients, especially following situations like the COVID-19 pandemic. Some groups who may benefit from telehealth are still underserved. Telehealth services and outreach should be improved to provide accessible care for all. %M 37527547 %R 10.2196/42217 %U https://formative.jmir.org/2023/1/e42217 %U https://doi.org/10.2196/42217 %U http://www.ncbi.nlm.nih.gov/pubmed/37527547 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e42446 %T Enhancing the Predictive Power of Google Trends Data Through Network Analysis: Infodemiology Study of COVID-19 %A Chu,Amanda MY %A Chong,Andy C Y %A Lai,Nick H T %A Tiwari,Agnes %A So,Mike K P %+ Department of Information Systems, Business Statistics and Operations Management, The Hong Kong University of Science and Technology, Clear Water Bay, Hong Kong, Hong Kong, 852 23587726, immkpso@ust.hk %K internet search volumes %K network analysis %K pandemic risk %K health care analytics %K network connectedness %K infodemiology %K infoveillance %K mobile phone %K COVID-19 %D 2023 %7 7.9.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The COVID-19 outbreak has revealed a high demand for timely surveillance of pandemic developments. Google Trends (GT), which provides freely available search volume data, has been proven to be a reliable forecast and nowcast measure for public health issues. Previous studies have tended to use relative search volumes from GT directly to analyze associations and predict the progression of pandemic. However, GT’s normalization of the search volumes data and data retrieval restrictions affect the data resolution in reflecting the actual search behaviors, thus limiting the potential for using GT data to predict disease outbreaks. Objective: This study aimed to introduce a merged algorithm that helps recover the resolution and accuracy of the search volume data extracted from GT over long observation periods. In addition, this study also aimed to demonstrate the extended application of merged search volumes (MSVs) in combination of network analysis, via tracking the COVID-19 pandemic risk. Methods: We collected relative search volumes from GT and transformed them into MSVs using our proposed merged algorithm. The MSVs of the selected coronavirus-related keywords were compiled using the rolling window method. The correlations between the MSVs were calculated to form a dynamic network. The network statistics, including network density and the global clustering coefficients between the MSVs, were also calculated. Results: Our research findings suggested that although GT restricts the search data retrieval into weekly data points over a long period, our proposed approach could recover the daily search volume over the same investigation period to facilitate subsequent research analyses. In addition, the dynamic time warping diagrams show that the dynamic networks were capable of predicting the COVID-19 pandemic trends, in terms of the number of COVID-19 confirmed cases and severity risk scores. Conclusions: The innovative method for handling GT search data and the application of MSVs and network analysis to broaden the potential for GT data are useful for predicting the pandemic risk. Further investigation of the GT dynamic network can focus on noncommunicable diseases, health-related behaviors, and misinformation on the internet. %M 37676701 %R 10.2196/42446 %U https://publichealth.jmir.org/2023/1/e42446 %U https://doi.org/10.2196/42446 %U http://www.ncbi.nlm.nih.gov/pubmed/37676701 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e45664 %T Unmet Psychosocial Needs of Health Care Professionals in Europe During the COVID-19 Pandemic: Mixed Methods Approach %A Hummel,Svenja %A Michelsen,Ina %A Zafar,Ali %A Moritz,Steffen %A Benoy,Charles %A Lemogne,Cédric %A Almeida,Rosa %A Losada,Raquel %A Ribeiro,Oscar %A Frisardi,Vincenza %A Tarricone,Ilaria %A Ferrari,Silvia %A Dechent,Frieder %A Huber,Christian G %A Weidt,Steffi %A Mayer,Gwendolyn %A Schultz,Jobst-Hendrik %+ Department of General Internal Medicine and Psychosomatics, Heidelberg University Hospital, Im Neuenheimer Feld 410, Heidelberg, Germany, 49 62215634170, svenja.hummel@med.uni-heidelberg.de %K COVID-19 %K mental health %K health care professionals %K health care workers %K pandemic preparedness %K mixed methods %K coping %K stressors %K psychosocial %D 2023 %7 6.9.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The COVID-19 pandemic severely affected everyday life and working conditions for most Europeans, particularly health care professionals (HCPs). Over the past 3 years, various policies have been implemented in various European countries. Studies have reported on the worsening of mental health, work-related stress, and helpful coping strategies. However, having a closer look is still necessary to gain more information on the psychosocial stressors and unmet needs of HCPs as well as nonmedical staff. Objective: This study aimed to obtain quantitative information on job-related stressors of physicians and nurses and the coping strategies of HCPs and nonmedical staff at 2 periods of the COVID-19 pandemic. By further analyzing qualitative comments, we wanted to gain more information on the psychosocial stressors and unmet needs of HCPs as well as nonmedical staff on different levels of experience. Methods: A cross-sectional survey was conducted at 2 time points during the COVID-19 pandemic in several European countries. The first study period (T1) lasted between April 1 and June 20, 2020, and the second study period (T2) lasted between November 25, 2021, and February 28, 2022. On a quantitative level, we used a questionnaire on stressors for physicians and nurses and a questionnaire on coping strategies for HCPs and nonmedical staff. Quantitative data were descriptively analyzed for mean values and differences in stressors and coping strategies. Qualitative data of free-text boxes of HCPs and nonmedical staff were analyzed via thematic analysis to explore the experiences of the individuals. Results: T1 comprised 609 participants, and T2 comprised 1398 participants. Overall, 296 participants made 438 qualitative comments. The uncertainty about when the pandemic would be controlled (T1: mean 2.28, SD 0.85; T2: mean 2.08, SD 0.90) and the fear of infecting the family (T1: mean 2.26, SD 0.98; T2: mean 2.02, SD 1.02) were the most severe stressors identified by physicians and nurses in both periods. Overall, the use of protective measures (T1: mean 2.66, SD 0.60; T2: mean 2.66, SD 0.60) and acquiring information about COVID-19 (T1: mean 2.29, SD 0.82; T2: mean 1.99, SD 0.89) were identified as the most common coping strategies for the entire study population. Using thematic analysis, we identified 8 themes of personal experiences on the micro, meso, and macro levels. Measures, working conditions, feelings and emotions, and social climate were frequently mentioned topics of the participants. In T1, feelings of isolation and uncertainty were prominent. In T2, feelings of exhaustion were expressed and vaccination was frequently discussed. Moreover, unmet psychosocial needs were identified. Conclusions: There is a need for improvement in pandemic preparedness. Targeted vocational education measures and setting up of web-based mental health support could be useful to bridge gaps in psychosocial support needs in future crises. %M 37672320 %R 10.2196/45664 %U https://publichealth.jmir.org/2023/1/e45664 %U https://doi.org/10.2196/45664 %U http://www.ncbi.nlm.nih.gov/pubmed/37672320 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e44540 %T Patient and Clinician Perceptions of the Pulse Oximeter in a Remote Monitoring Setting for COVID-19: Qualitative Study %A Torres-Robles,Andrea %A Allison,Karen %A Poon,Simon K %A Shaw,Miranda %A Hutchings,Owen %A Britton,Warwick J %A Wilson,Andrew %A Baysari,Melissa %+ Menzies Centre for Health Policy and Economics, The University of Sydney, Charles Perkins Centre D17, Sydney, 2006, Australia, 61 2 9036 6357, andrea.torresrobles@sydney.edu.au %K remote monitoring %K patient experience %K user experience %K COVID-19 %K pulse oximetry %K usability %K acceptability %K oximetry %K wearable device %D 2023 %7 5.9.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: As a response to the COVID-19 pandemic, the Sydney Local Health District in New South Wales, Australia, launched the rpavirtual program, the first full-scale virtual hospital in Australia, to remotely monitor and follow up stable patients with COVID-19. As part of the intervention, a pulse oximeter wearable device was delivered to patients to monitor their oxygen saturation levels, a critical indicator of COVID-19 patient deterioration. Understanding users’ perceptions toward the device is fundamental to assessing its usability and acceptability and contributing to the effectiveness of the intervention, but no research to date has explored the user experience of the pulse oximeter for remote monitoring in this setting. Objective: This study aimed to explore the use, performance, and acceptability of the pulse oximeter by clinicians and patients in rpavirtual during COVID-19. Methods: Semistructured interviews and usability testing were conducted. Stable adult patients with COVID-19 (aged ≥18 years) who used the pulse oximeter and were monitored by rpavirtual, and rpavirtual clinicians monitoring these patients were interviewed. Clinicians could be nurses, doctors, or staff who were part of the team that assisted patients with the use of the pulse oximeter. Usability testing was conducted with patients who had the pulse oximeter when they were contacted. Interviews were coded using the Theoretical Framework of Acceptability. Usability testing was conducted using a think-aloud protocol. Data were collected until saturation was reached. Results: Twenty-one patients (average age 51, SD 13 years) and 15 clinicians (average age 41, SD 11 years) completed the interview. Eight patients (average age 51, SD 13 years) completed the usability testing. All participants liked the device and thought it was easy to use. They also had a good understanding of how to use the device and the device’s purpose. Patients’ age and device use–related characteristics (eg, the warmth of hands and hand steadiness) were identified by users as factors negatively impacting the accurate use of the pulse oximeter. Conclusions: Patients and clinicians had very positive perceptions of the pulse oximeter for COVID-19 remote monitoring, indicating high acceptability and usability of the device. However, factors that may impact the accuracy of the device should be considered when delivering interventions using the pulse oximeter for remote monitoring. Targeted instructions about the use of the device may be necessary for specific populations (eg, older people and patients unfamiliar with technology). Further research should focus on the integration of the pulse oximeter data into electronic medical records for real-time and secure patient monitoring. %M 37535831 %R 10.2196/44540 %U https://www.jmir.org/2023/1/e44540 %U https://doi.org/10.2196/44540 %U http://www.ncbi.nlm.nih.gov/pubmed/37535831 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e46701 %T Flexible and Innovative Connectivity Solution to Support National Decentralized Infectious Diseases Point-of-Care Testing Programs in Primary Health Services: Descriptive Evaluation Study %A Saha,Amit %A Andrewartha,Kelly %A Badman,Steven G %A Tangey,Annie %A Smith,Kirsty S %A Sandler,Sergio %A Ramsay,Stuart %A Braund,Wilton %A Manoj-Margison,Stuart %A Matthews,Susan %A Shephard,Mark D S %A Guy,Rebecca %A Causer,Louise %+ Kirby Institute, University of New South Wales, Level 6, Wallace Wurth Building, Sydney, NSW, 2052, Australia, 61 2 9385 9254, asaha@kirby.unsw.edu.au %K infectious disease %K diagnostics %K POC testing %K point-of-care %K connectivity %K digital health %K disease surveillance %K GeneXpert %D 2023 %7 1.9.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Molecular point-of-care (POC) testing for Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), and Trichomonas vaginalis (TV) has been available in regional and remote primary health services in Australia as part of a decentralized POC testing program since 2016 and for SARS-CoV-2 from 2020. As there was no suitable existing connectivity infrastructure to capture and deliver POC test results to a range of end users, a new system needed to be established. Objective: The aim of the study is to design, implement, and optimize a connectivity system to meet clinical management, analytical quality management, and public health surveillance needs. Methods: We used commercially available e-messaging technology coupled with adapted proprietary software to integrate a decentralized molecular POC testing platform (GeneXpert) in primary health services and interface with end-user databases. This connectivity infrastructure was designed to overcome key barriers to the implementation, integration, and monitoring of these large multijurisdictional infectious disease POC testing networks. Test result messages were tailored to meet end-user needs. Using centrally captured deidentified data, we evaluated the time to receipt of test results and completeness of accompanying demographic data. Results: From January 2016 to April 2020, we operationalized the system at 31 health services across 4 jurisdictions and integrated with 5 different patient management systems to support the real-time delivery of 29,356 CT/NG and TV test results to designated recipients (patient management system and local clinical and central program databases). In 2019, 12,105 CT/NG and TV results were delivered, and the median time to receipt of results was 3.2 (IQR 2.2-4.6) hours, inclusive of test runtime. From May 2020 to August 2022, we optimized the system to support rapid scale-up of SARS-CoV-2 testing (105 services; 6 jurisdictions; 71,823 tests) and additional sexually transmissible infection testing (16,232 tests), including the electronic disease-specific notifications to jurisdictional health departments and alerts for connectivity disruption and positive results. In 2022, 19,355 results were delivered with an overall median transmission time of 2.3 (IQR 1.4-3.1) hours, 2.2 (IQR 1.2-2.3) hours for SARS-CoV-2 (n=16,066), 3.0 (IQR 2.0-4.0) hours for CT/NG (n=1843), and 2.6 (IQR 1.5-3.8) hours for TV (n=1446). Demographic data (age, sex, and ethnicity) were completed for 99.5% of test results in 2022. Conclusions: This innovative connectivity system designed to meet end-user needs has proven to be sustainable, flexible, and scalable. It represents the first such system in Australia established independent of traditional pathology providers to support POC testing in geographically dispersed remote primary health services. The system has been optimized to deliver real-time test results and has proven critical for clinical, public health, and quality management. The system has significantly supported equitable access to rapid diagnostics for infectious diseases across Australia, and its design is suitable for onboarding other POC tests and testing platforms in the future. %M 37656506 %R 10.2196/46701 %U https://www.jmir.org/2023/1/e46701 %U https://doi.org/10.2196/46701 %U http://www.ncbi.nlm.nih.gov/pubmed/37656506 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e44114 %T A Data Taxonomy for Adaptive Multifactor Authentication in the Internet of Health Care Things %A Suleski,Tance %A Ahmed,Mohiuddin %+ School of Science, Edith Cowan University, 270 Joondalup Dr, Joondalup WA, Perth, 6027, Australia, 61 13 43 28, tsuleski@our.ecu.edu.au %K health care %K authentication %K contextual data model %K Internet of Health Care Things %K multifactor %K mobile phone %D 2023 %7 29.8.2023 %9 Viewpoint %J J Med Internet Res %G English %X The health care industry has faced various challenges over the past decade as we move toward a digital future where services and data are available on demand. The systems of interconnected devices, users, data, and working environments are referred to as the Internet of Health Care Things (IoHT). IoHT devices have emerged in the past decade as cost-effective solutions with large scalability capabilities to address the constraints on limited resources. These devices cater to the need for remote health care services outside of physical interactions. However, IoHT security is often overlooked because the devices are quickly deployed and configured as solutions to meet the demands of a heavily saturated industry. During the COVID-19 pandemic, studies have shown that cybercriminals are exploiting the health care industry, and data breaches are targeting user credentials through authentication vulnerabilities. Poor password use and management and the lack of multifactor authentication security posture within IoHT cause a loss of millions according to the IBM reports. Therefore, it is important that health care authentication security moves toward adaptive multifactor authentication (AMFA) to replace the traditional approaches to authentication. We identified a lack of taxonomy for data models that particularly focus on IoHT data architecture to improve the feasibility of AMFA. This viewpoint focuses on identifying key cybersecurity challenges in a theoretical framework for a data model that summarizes the main components of IoHT data. The data are to be used in modalities that are suited for health care users in modern IoHT environments and in response to the COVID-19 pandemic. To establish the data taxonomy, a review of recent IoHT papers was conducted to discuss the related work in IoHT data management and use in next-generation authentication systems. Reports, journal articles, conferences, and white papers were reviewed for IoHT authentication data technologies in relation to the problem statement of remote authentication and user management systems. Only publications written in English from the last decade were included (2012-2022) to identify key issues within the current health care practices and their management of IoHT devices. We discuss the components of the IoHT architecture from the perspective of data management and sensitivity to ensure privacy for all users. The data model addresses the security requirements of IoHT users, environments, and devices toward the automation of AMFA in health care. We found that in health care authentication, the significant threats occurring were related to data breaches owing to weak security options and poor user configuration of IoHT devices. The security requirements of IoHT data architecture and identified impactful methods of cybersecurity for health care devices, data, and their respective attacks are discussed. Data taxonomy provides better understanding, solutions, and improvements of user authentication in remote working environments for security features. %M 37490633 %R 10.2196/44114 %U https://www.jmir.org/2023/1/e44114 %U https://doi.org/10.2196/44114 %U http://www.ncbi.nlm.nih.gov/pubmed/37490633 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e44000 %T Effects of Web-Based Mindfulness-Based Interventions on Anxiety, Depression, and Stress Among Frontline Health Care Workers During the COVID-19 Pandemic: Systematic Review and Meta-Analysis %A Yang,Jia-ming %A Ye,Hua %A Long,Yi %A Zhu,Qiang %A Huang,Hui %A Zhong,Yan-biao %A Luo,Yun %A Yang,Lei %A Wang,Mao-yuan %+ Department of Rehabilitation Medicine, First Affiliated Hospital of Gannan Medical University, 128 Jinling Road, Zhanggong District, Ganzhou City, Jiangxi Province, Ganzhou, 341000, China, 86 13767766152, wmy.gmu.kf@gmail.com %K web-based %K mindfulness-based intervention %K COVID-19 %K health care worker %K mental disorder %D 2023 %7 29.8.2023 %9 Review %J J Med Internet Res %G English %X Background: Since 2019, the COVID-19 outbreak has spread around the world, and health care workers, as frontline workers, have faced tremendous psychological stress. Objective: The purpose of this study is to explore whether web-based mindfulness-based interventions continue to have a positive impact on anxiety, depression, and stress among health care workers during the COVID-19 pandemic. Methods: The inclusion criteria were as follows: (1) participants were frontline health care workers during the COVID-19 pandemic; (2) the experimental group was a web-based mindfulness-based intervention; (3) the control group used either general psychological intervention or no intervention; (4) outcome indicators included scales to assess anxiety, depression, and stress; and (5) the study type was a randomized controlled study. Studies that did not meet the above requirements were excluded. We searched 9 databases, including Web of Science, Embase, PubMed, Cochrane Library, Scopus, ScienceDirect, SinoMed, China National Knowledge Infrastructure (CNKI), and Wanfang Database, for randomized controlled studies on the effects of web-based mindfulness-based interventions on common mental disorder symptoms among health care workers from January 1, 2020, to October 20, 2022. The methodological quality of the included studies was assessed using the Physiotherapy Evidence Database scale. The Cochrane risk of bias tool was used to assess the risk of bias. Subgroup analysis was used to look for sources of heterogeneity and to explore whether the results were the same for subgroups under different conditions. Sensitivity analysis was used to verify the stability of the pooled results. Results: A total of 10 randomized controlled studies with 1311 participants were included. The results showed that web-based mindfulness-based interventions were effective in reducing the symptoms of anxiety (standard mean difference [SMD]=–0.63, 95% CI –0.96 to –0.31, P<.001, I2=87%), depression (SMD=–0.52, 95% CI –0.77 to –0.26, P<.001, I2=75%), and stress (SMD=–0.20, 95% CI –0.35 to –0.05, P=.01, I2=58%) among health care workers during the COVID-19 pandemic, but with wide CIs and high heterogeneity. Conclusions: Web-based mindfulness-based interventions may be effective in reducing the symptoms of anxiety, depression, and stress among frontline health care workers during the COVID-19 pandemic. However, this effect is relatively mild and needs to be further explored by better studies in the future. Trial Registration: PROSPERO CRD42022343727; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=343727 %M 37527546 %R 10.2196/44000 %U https://www.jmir.org/2023/1/e44000 %U https://doi.org/10.2196/44000 %U http://www.ncbi.nlm.nih.gov/pubmed/37527546 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e44950 %T Checkpoint Travel Numbers as a Proxy Variable in Population-Based Studies During the COVID-19 Pandemic: Validation Study %A Kreslake,Jennifer M %A Aarvig,Kathleen %A Muller-Tabanera,Hope %A Vallone,Donna M %A Hair,Elizabeth C %+ Schroeder Institute, Truth Initiative, 900 G Street Northwest, Floor 4, Washington, DC, 20001, United States, 1 2024545782, jkreslake@truthinitiative.org %K research methods %K public health %K data quality %K psychosocial factors %K history %K COVID-19 %K social %K behavioral %K validation %K social distancing %K tracking survey %K survey %K pandemic %D 2023 %7 29.8.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The COVID-19 pandemic had wide-ranging systemic impacts, with implications for social and behavioral factors in human health. The pandemic may introduce history bias in population-level research studies of other health topics during the COVID-19 period. Objective: We sought to identify and validate an accessible, flexible measure to serve as a covariate in research spanning the COVID-19 pandemic period. Methods: Transportation Security Administration checkpoint travel numbers were used to calculate a weekly sum of daily passengers and validated against two measures with strong face validity: (1) a self-reported item on social distancing practices drawn from a continuous tracking survey among a national sample of youths and young adults (15-24 years) in the United States (N=45,080, approximately 280 unique respondents each week); and (2) Google’s Community Mobility Reports, which calculate daily values at the national level to represent rates of change in visits and length of stays to public spaces. For the self-reported survey data, an aggregated week-level variable was calculated as the proportion of respondents who did not practice social distancing that week (January 1, 2019, to May 31, 2022). For the community mobility data, a weekly estimate of change was calculated using daily values compared to a 5-week prepandemic baseline period (January 3, 2020, to February 6, 2020). Spearman rank correlation coefficients were calculated for each comparison. Results: Checkpoint travel data ranged from 668,719 travelers in the week of April 8, 2020, to nearly 15.5 million travelers in the week of May 18, 2022. The weekly proportion of survey respondents who did not practice social distancing ranged from 18.1% (n=42; week of April 15, 2020) to 70.9% (n=213; week of May 25, 2022). The measures were strongly correlated from January 2019 to May 2022 (ρ=0.90, P<.001) and March 2020 to May 2022 (ρ=0.87, P<.001). Strong correlations were observed when analyses were restricted to age groups (15-17 years: ρ=0.90; P<.001; 18-20 years: ρ=0.87; P<.001; 21-24 years: ρ=0.88; P<.001), racial or ethnic minorities (ρ=0.86, P<.001), and respondents with lower socioeconomic status (ρ=0.88, P<.001). There were also strong correlations between the weekly change from the baseline period for checkpoint travel data and community mobility data for transit stations (ρ=0.92, P<.001) and retail and recreation (ρ=0.89, P<.001), and moderate significant correlations for grocery and pharmacy (ρ=0.68, P<.001) and parks (ρ=0.62, P<.001). A strong negative correlation was observed for places of residence (ρ=−0.78, P<.001), and a weak but significant positive correlation was found for workplaces (ρ=0.24, P<.001). Conclusions: The Transportation Security Administration’s travel checkpoint data provide a publicly available flexible time-varying metric to control for history bias introduced by the pandemic in research studies spanning the COVID-19 period in the United States. %M 37191643 %R 10.2196/44950 %U https://publichealth.jmir.org/2023/1/e44950 %U https://doi.org/10.2196/44950 %U http://www.ncbi.nlm.nih.gov/pubmed/37191643 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e44657 %T Wastewater Surveillance for SARS-CoV-2 at Long-Term Care Facilities: Mixed Methods Evaluation %A Keck,James W %A Lindner,Jess %A Liversedge,Matthew %A Mijatovic,Blazan %A Olsson,Cullen %A Strike,William %A Noble,Anni %A Adatorwovor,Reuben %A Lacy,Parker %A Smith,Ted %A Berry,Scott M %+ Department of Family & Community Medicine, University of Kentucky, 2195 Harrodsburg Rd, Suite 125, Lexington, KY, 40504, United States, 1 907 729 2924, jameswkeck@gmail.com %K wastewater surveillance %K wastewater-based epidemiology %K evaluation %K long-term care facility %K COVID-19 %K SARS-CoV-2 %D 2023 %7 29.8.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Wastewater surveillance provided early indication of COVID-19 in US municipalities. Residents of long-term care facilities (LTCFs) experienced disproportionate morbidity and mortality early in the COVID-19 pandemic. We implemented LTCF building-level wastewater surveillance for SARS-CoV-2 at 6 facilities in Kentucky to provide early warning of SARS-CoV-2 in populations considered vulnerable. Objective: This study aims to evaluate the performance of wastewater surveillance for SARS-CoV-2 at LTCFs in Kentucky. Methods: We conducted a mixed methods evaluation of wastewater surveillance following Centers for Disease Control and Prevention (CDC) guidelines for evaluating public health surveillance systems. Evaluation steps in the CDC guidelines were engaging stakeholders, describing the surveillance system, focusing the evaluation design, gathering credible evidence, and generating conclusions and recommendations. We purposively recruited stakeholders for semistructured interviews and undertook thematic content analysis of interview data. We integrated wastewater, clinical testing, and process data to characterize or calculate 7 surveillance system performance attributes (simplicity, flexibility, data quality, sensitivity and positive predictive value [PPV], timeliness, representativeness, and stability). Results: We conducted 8 stakeholder interviews. The surveillance system collected wastewater samples (N=811) 2 to 4 times weekly at 6 LTCFs in Kentucky from March 2021 to February 2022. Synthesis of credible evidence indicated variable surveillance performance. Regarding simplicity, surveillance implementation required moderate human resource and technical capacity. Regarding flexibility, the system efficiently adjusted surveillance frequency and demonstrated the ability to detect additional pathogens of interest. Regarding data quality, software identified errors in wastewater sample metadata entry (110/3120, 3.53% of fields), technicians identified polymerase chain reaction data issues (140/7734, 1.81% of reactions), and staff entered all data corrections into a log. Regarding sensitivity and PPV, using routine LTCF SARS-CoV-2 clinical testing results as the gold standard, a wastewater SARS-CoV-2 signal of >0 RNA copies/mL was 30.6% (95% CI 24.4%-36.8%) sensitive and 79.7% (95% CI 76.4%-82.9%) specific for a positive clinical test at the LTCF. The PPV of the wastewater signal was 34.8% (95% CI 27.9%-41.7%) at >0 RNA copies/mL and increased to 75% (95% CI 60%-90%) at >250 copies/mL. Regarding timeliness, stakeholders received surveillance data 24 to 72 hours after sample collection, with delayed reporting because of the lack of weekend laboratory staff. Regarding representativeness, stakeholders identified challenges delineating the population contributing to LTCF wastewater because of visitors, unknown staff toileting habits, and the use of adult briefs by some residents preventing their waste from entering the sewer system. Regarding stability, the reoccurring cost to conduct 1 day of wastewater surveillance at 1 facility was approximately US $144.50, which included transportation, labor, and materials expenses. Conclusions: The LTCF wastewater surveillance system demonstrated mixed performance per CDC criteria. Stakeholders found surveillance feasible and expressed optimism regarding its potential while also recognizing challenges in interpreting and acting on surveillance data. %R 10.2196/44657 %U https://publichealth.jmir.org/2023/1/e44657 %U https://doi.org/10.2196/44657 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 12 %N %P e43492 %T Mobile Health–Supported Active Syndrome Surveillance for COVID-19 Early Case Finding in Addis Ababa, Ethiopia: Comparative Study %A Bisrat,Haileleul %A Manyazewal,Tsegahun %A Fekadu,Abebaw %+ Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, BL_03_420 St., Addis Abeba, 9086, Ethiopia, 251 911940459, haylishb2@gmail.com %K mobile health %K mHealth %K digital health %K COVID-19 %K syndrome assessment %K surveillance %K Ethiopia %K public health %K syndrome surveillance %K self-care %K telemedicine %K telecom, SARS-CoV-2 %D 2023 %7 28.8.2023 %9 Original Paper %J Interact J Med Res %G English %X Background: Since most people in low-income countries do not have access to reliable laboratory services, early diagnosis of life-threatening diseases like COVID-19 remains challenging. Facilitating real-time assessment of the health status in a given population, mobile health (mHealth)–supported syndrome surveillance might help identify disease conditions earlier and save lives cost-effectively. Objective: This study aimed to evaluate the potential use of mHealth-supported active syndrome surveillance for COVID-19 early case finding in Addis Ababa, Ethiopia. Methods: A comparative cross-sectional study was conducted among adults randomly selected from the Ethio telecom list of mobile phone numbers. Participants underwent a comprehensive phone interview for COVID-19 syndromic assessments, and their symptoms were scored and interpreted based on national guidelines. Participants who exhibited COVID-19 syndromes were advised to have COVID-19 diagnostic testing at nearby health care facilities and seek treatment accordingly. Participants were asked about their test results, and these were cross-checked against the actual facility-based data. Estimates of COVID-19 detection by mHealth-supported syndromic assessments and facility-based tests were compared using Cohen Kappa (κ), the receiver operating characteristic curve, sensitivity, and specificity analysis. Results: A total of 2741 adults (n=1476, 53.8% men and n=1265, 46.2% women) were interviewed through the mHealth platform during the period from December 2021 to February 2022. Among them, 1371 (50%) had COVID-19 symptoms at least once and underwent facility-based COVID-19 diagnostic testing as self-reported, with 884 (64.5%) confirmed cases recorded in facility-based registries. The syndrome assessment model had an optimal likelihood cut-off point sensitivity of 46% (95% CI 38.4-54.6) and specificity of 98% (95% CI 96.7-98.9). The area under the receiver operating characteristic curve was 0.87 (95% CI 0.83-0.91). The level of agreement between the mHealth-supported syndrome assessment and the COVID-19 test results was moderate (κ=0.54, 95% CI 0.46-0.60). Conclusions: In this study, the level of agreement between the mHealth-supported syndromic assessment and the actual laboratory-confirmed results for COVID-19 was found to be reasonable, at 89%. The mHealth-supported syndromic assessment of COVID-19 represents a potential alternative method to the standard laboratory-based confirmatory diagnosis, enabling the early detection of COVID-19 cases in hard-to-reach communities, and informing patients about self-care and disease management in a cost-effective manner. These findings can guide future research efforts in developing and integrating digital health into continuous active surveillance of emerging infectious diseases. %M 37556182 %R 10.2196/43492 %U https://www.i-jmr.org/2023/1/e43492 %U https://doi.org/10.2196/43492 %U http://www.ncbi.nlm.nih.gov/pubmed/37556182 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e42669 %T Information Circulation Among Spanish-Speaking and Caribbean Communities Related to COVID-19: Social Media–Based Multidimensional Analysis %A Vargas Meza,Xanat %A Park,Han Woo %+ Department of Media & Communication, YeungNam University, 280 Daehak-Ro, Gyeongsan si, 38541, Republic of Korea, 82 538102270, hanpark@ynu.ac.kr %K COVID-19 %K social media %K Spanish %K multidimensional analysis %K Caribbean %K accessibility %D 2023 %7 23.8.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Scientific studies from North America and Europe tend to predominate the internet and benefit English-speaking users. Meanwhile, the COVID-19 death rate was high at the onset of the pandemic in Spanish-speaking countries, and information about nearby Caribbean countries was rarely highlighted. Given the rise in social media use in these regions, the web-based dissemination of scientific information related to COVID-19 must be thoroughly examined. Objective: This study aimed to provide a multidimensional analysis of peer-reviewed information circulation related to COVID-19 in Spanish-speaking and Caribbean regions. Methods: COVID-19–related, peer-reviewed resources shared by web-based accounts located in Spanish-speaking and Caribbean regions were identified through the Altmetric website, and their information was collected. A multidimensional model was used to examine these resources, considering time, individuality, place, activity, and relations. Time was operationalized as the 6 dates of data collection, individuality as the knowledge area and accessibility level, place as the publication venue and affiliation countries, activity as the Altmetric score and number of mentions in the selected regions, and relations as coauthorship between countries and types of social media users who disseminated COVID-19–related information. Results: The highest information circulation peaks in Spanish-speaking countries were from April 2020 to August 2020 and from December 2020 to April 2021, whereas the highest peaks in Caribbean regions were from December 2019 to April 2020. Regarding Spanish-speaking regions, at the onset of the pandemic, scientific expertise was concentrated on a few peer-reviewed sources written in English. The top scientific journals mentioned were from English-speaking, westernized regions, whereas the top scientific authorships were from China. The most mentioned scientific resources were about breakthrough findings in the medical and health sciences area, written in highly technical language. The top relationships were self-loops in China, whereas international collaborations were between China and the United States. Argentina had high closeness and betweenness, and Spain had high closeness. On the basis of social media data, a combination of media outlets; educational institutions; and expert associations, particularly from Panama, influenced the diffusion of peer-reviewed information. Conclusions: We determined the diffusion patterns of peer-reviewed resources in Spanish-speaking countries and Caribbean territories. This study aimed to advance the management and analysis of web-based public data from non-white people to improve public health communication in their regions. %M 37402284 %R 10.2196/42669 %U https://www.jmir.org/2023/1/e42669 %U https://doi.org/10.2196/42669 %U http://www.ncbi.nlm.nih.gov/pubmed/37402284 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 3 %N %P e43685 %T Content and User Engagement of Health-Related Behavior Tweets Posted by Mass Media Outlets From Spain and the United States Early in the COVID-19 Pandemic: Observational Infodemiology Study %A Alvarez-Mon,Miguel Angel %A Pereira-Sanchez,Victor %A Hooker,Elizabeth R %A Sanchez,Facundo %A Alvarez-Mon,Melchor %A Teo,Alan R %+ Department of Medicine and Medical Specialties, Faculty of Medicine and Health Sciences, University of Alcala, Campus Universitario – C/ 19, Av de Madrid, Km 33,600., Alcala de Henares, 28871, Spain, 34 918854505, maalvarezdemon@icloud.com %K COVID-19 %K health communication %K social media %K Twitter %K health promotion %K public health %K mass media %D 2023 %7 22.8.2023 %9 Original Paper %J JMIR Infodemiology %G English %X Background: During the early pandemic, there was substantial variation in public and government responses to COVID-19 in Europe and the United States. Mass media are a vital source of health information and news, frequently disseminating this information through social media, and may influence public and policy responses to the pandemic. Objective: This study aims to describe the extent to which major media outlets in the United States and Spain tweeted about health-related behaviors (HRBs) relevant to COVID-19, compare the tweeting patterns between media outlets of both countries, and determine user engagement in response to these tweets. Methods: We investigated tweets posted by 30 major media outlets (n=17, 57% from Spain and n=13, 43% from the United States) between December 1, 2019 and May 31, 2020, which included keywords related to HRBs relevant to COVID-19. We classified tweets into 6 categories: mask-wearing, physical distancing, handwashing, quarantine or confinement, disinfecting objects, or multiple HRBs (any combination of the prior HRB categories). Additionally, we assessed the likes and retweets generated by each tweet. Poisson regression analyses compared the average predicted number of likes and retweets between the different HRB categories and between countries. Results: Of 50,415 tweets initially collected, 8552 contained content associated with an HRB relevant to COVID-19. Of these, 600 were randomly chosen for training, and 2351 tweets were randomly selected for manual content analysis. Of the 2351 COVID-19–related tweets included in the content analysis, 62.91% (1479/2351) mentioned at least one HRB. The proportion of COVID-19 tweets mentioning at least one HRB differed significantly between countries (P=.006). Quarantine or confinement was mentioned in nearly half of all the HRB tweets in both countries. In contrast, the least frequently mentioned HRBs were disinfecting objects in Spain 6.9% (56/809) and handwashing in the United States 9.1% (61/670). For tweets from the United States mentioning at least one HRB, disinfecting objects had the highest median likes and retweets, whereas mask-wearing– and handwashing-related tweets achieved the highest median number of likes in Spain. Tweets from Spain that mentioned social distancing or disinfecting objects had a significantly lower predicted count of likes compared with tweets mentioning a different HRB (P=.02 and P=.01, respectively). Tweets from the United States that mentioned quarantine or confinement or disinfecting objects had a significantly lower predicted number of likes compared with tweets mentioning a different HRB (P<.001), whereas mask- and handwashing-related tweets had a significantly greater predicted number of likes (P=.04 and P=.02, respectively). Conclusions: The type of HRB content and engagement with media outlet tweets varied between Spain and the United States early in the pandemic. However, content related to quarantine or confinement and engagement with handwashing was relatively high in both countries. %M 37347948 %R 10.2196/43685 %U https://infodemiology.jmir.org/2023/1/e43685 %U https://doi.org/10.2196/43685 %U http://www.ncbi.nlm.nih.gov/pubmed/37347948 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 3 %N %P e43703 %T Using COVID-19 Vaccine Attitudes on Twitter to Improve Vaccine Uptake Forecast Models in the United States: Infodemiology Study of Tweets %A Sigalo,Nekabari %A Awasthi,Naman %A Abrar,Saad Mohammad %A Frias-Martinez,Vanessa %+ College of Information Studies, University of Maryland, 4130 Campus Dr, College Park, MD, 20742-4345, United States, 1 301 405 2033, nsigalo@terpmail.umd.edu %K social media %K Twitter %K COVID-19 %K vaccine %K surveys %K SARS-CoV-2 %K vaccinations %K hesitancy %K vaccine hesitancy %K forecast model %K vaccine uptake %K health promotion %K infodemiology %K health information %K misinformation %D 2023 %7 21.8.2023 %9 Original Paper %J JMIR Infodemiology %G English %X Background: Since the onset of the COVID-19 pandemic, there has been a global effort to develop vaccines that protect against COVID-19. Individuals who are fully vaccinated are far less likely to contract and therefore transmit the virus to others. Researchers have found that the internet and social media both play a role in shaping personal choices about vaccinations. Objective: This study aims to determine whether supplementing COVID-19 vaccine uptake forecast models with the attitudes found in tweets improves over baseline models that only use historical vaccination data. Methods: Daily COVID-19 vaccination data at the county level was collected for the January 2021 to May 2021 study period. Twitter’s streaming application programming interface was used to collect COVID-19 vaccine tweets during this same period. Several autoregressive integrated moving average models were executed to predict the vaccine uptake rate using only historical data (baseline autoregressive integrated moving average) and individual Twitter-derived features (autoregressive integrated moving average exogenous variable model). Results: In this study, we found that supplementing baseline forecast models with both historical vaccination data and COVID-19 vaccine attitudes found in tweets reduced root mean square error by as much as 83%. Conclusions: Developing a predictive tool for vaccination uptake in the United States will empower public health researchers and decisionmakers to design targeted vaccination campaigns in hopes of achieving the vaccination threshold required for the United States to reach widespread population protection. %M 37390402 %R 10.2196/43703 %U https://infodemiology.jmir.org/2023/1/e43703 %U https://doi.org/10.2196/43703 %U http://www.ncbi.nlm.nih.gov/pubmed/37390402 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 3 %N %P e43011 %T News Coverage of Face Masks in Australia During the Early COVID-19 Pandemic: Topic Modeling Study %A Dasgupta,Pritam %A Amin,Janaki %A Paris,Cecile %A MacIntyre,C Raina %+ Department of Health Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Level 3,, 75 Talavera Rd, Sydney, New South Wales, 2109, Australia, 61 480148227, pritam.dasgupta@students.mq.edu.au %K face masks %K mask %K COVID-19 %K web-based news %K community sentiment %K topic modeling %K latent Dirichlet allocation %D 2023 %7 16.8.2023 %9 Original Paper %J JMIR Infodemiology %G English %X Background: During the COVID-19 pandemic, web-based media coverage of preventative strategies proliferated substantially. News media was constantly informing people about changes in public health policy and practices such as mask-wearing. Hence, exploring news media content on face mask use is useful to analyze dominant topics and their trends. Objective: The aim of the study was to examine news related to face masks as well as to identify related topics and temporal trends in Australian web-based news media during the early COVID-19 pandemic period. Methods: Following data collection from the Google News platform, a trend analysis on the mask-related news titles from Australian news publishers was conducted. Then, a latent Dirichlet allocation topic modeling algorithm was applied along with evaluation matrices (quantitative and qualitative measures). Afterward, topic trends were developed and analyzed in the context of mask use during the pandemic. Results: A total of 2345 face mask–related eligible news titles were collected from January 25, 2020, to January 25, 2021. Mask-related news showed an increasing trend corresponding to increasing COVID-19 cases in Australia. The best-fitted latent Dirichlet allocation model discovered 8 different topics with a coherence score of 0.66 and a perplexity measure of –11.29. The major topics were T1 (mask-related international affairs), T2 (introducing mask mandate in places such as Melbourne and Sydney), and T4 (antimask sentiment). Topic trends revealed that T2 was the most frequent topic in January 2021 (77 news titles), corresponding to the mandatory mask-wearing policy in Sydney. Conclusions: This study demonstrated that Australian news media reflected a wide range of community concerns about face masks, peaking as COVID-19 incidence increased. Harnessing the news media platforms for understanding the media agenda and community concerns may assist in effective health communication during a pandemic response. %M 37379362 %R 10.2196/43011 %U https://infodemiology.jmir.org/2023/1/e43011 %U https://doi.org/10.2196/43011 %U http://www.ncbi.nlm.nih.gov/pubmed/37379362 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e38965 %T Impact of Beliefs About Local Physician Supply and Self-Rated Health on Willingness to See a Nurse Practitioner During the COVID-19 Pandemic: Web-Based Survey and Experiment %A Campos-Castillo,Celeste %+ Department of Media and Information, Michigan State University, 404 Wilson Rd, East Lansing, MI, 48824, United States, 1 517 432 5192, camposca@msu.edu %K primary care shortage %K workforce %K health care seeking %K public opinion %K consumers %K online studies %K COVID-19 %K pandemic %K primary care %K nurse practitioners %K nurse %K healthcare %K resources %K advocacy %D 2023 %7 16.8.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic overburdened primary care clinicians. For nurse practitioners (NPs) to alleviate the burden, the public must be willing to see an NP over a physician. Those with poor health tended to continue seeking care during the pandemic, suggesting that they may be willing to see an NP. Objective: The aim of this study is to evaluate the public’s willingness to see an NP for primary care and how this may be associated with their beliefs about the local supply of physicians and self-rated health. Two studies were conducted: (1) a survey to identify correlations and (2) an experiment to assess how willingness is dependent on information about the local supply of physicians. Methods: The survey and experiment were conducted digitally in April and December 2020, respectively. Participants were US adults recruited from Amazon’s Mechanical Turk platform. The key independent variables were self-rated health, which was a dichotomized 5-point scale (excellent, very good, good vs fair, and poor), and beliefs about local physician supply. The survey measured beliefs about local physician supply, while the experiment manipulated beliefs by altering information the participants read about the local supply of physicians. Willingness to see an NP was assessed in 2 ways. First as an overall preference over a physician and the second as a preference given 2 clinically significant scenarios in which participants imagined they were experiencing either coughing or a headache (presentation order randomized). Multiple regressions and ANOVAs were used to assess how beliefs about the local physician supply and self-rated health were associated with overall willingness to see an NP. Bivariate probits simultaneously estimated willingness to see an NP in the 2 clinically significant scenarios. Results: The survey showed that concerns about physician supply were associated with lower willingness to see an NP among respondents with comparatively better health but a greater willingness among respondents with comparatively worse health. The experiment suggests that only the latter is causal. For the 2 clinically significant scenarios, these patterns appeared for the coughing scenario in the survey and the headache scenario in the experiment. Conclusions: US adults with comparatively worse self-rated health become more willing to see an NP for primary care when they hear information that raises their concerns about the local physician supply. The differences between the survey and experiment results may be useful for interpreting findings from future studies. Findings may aid in managing finite health care resources during public health crises and crafting successful messaging by NP advocacy groups. Efforts to address nursing shortages will also be needed. %M 37347928 %R 10.2196/38965 %U https://formative.jmir.org/2023/1/e38965 %U https://doi.org/10.2196/38965 %U http://www.ncbi.nlm.nih.gov/pubmed/37347928 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e39754 %T Using Bandit Algorithms to Maximize SARS-CoV-2 Case-Finding: Evaluation and Feasibility Study %A Rayo,Michael F %A Faulkner,Daria %A Kline,David %A Thornhill IV,Thomas %A Malloy,Samuel %A Della Vella,Dante %A Morey,Dane A %A Zhang,Net %A Gonsalves,Gregg %+ Public Health Modeling Unit, Department of the Epidemiology of Microbial Diseases, Yale School of Public Health, 350 George Street, 3rd Floor, New Haven, CT, 06511, United States, 1 2036069149, gregg.gonsalves@yale.edu %K active surveillance %K bandit algorithms %K infectious disease %K community health %K reinforcement learning %K COVID-19 %K SARS-CoV-2 %D 2023 %7 15.8.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The Flexible Adaptive Algorithmic Surveillance Testing (FAAST) program represents an innovative approach for improving the detection of new cases of infectious disease; it is deployed here to screen and diagnose SARS-CoV-2. With the advent of treatment for COVID-19, finding individuals infected with SARS-CoV-2 is an urgent clinical and public health priority. While these kinds of Bayesian search algorithms are used widely in other settings (eg, to find downed aircraft, in submarine recovery, and to aid in oil exploration), this is the first time that Bayesian adaptive approaches have been used for active disease surveillance in the field. Objective: This study’s objective was to evaluate a Bayesian search algorithm to target hotspots of SARS-CoV-2 transmission in the community with the goal of detecting the most cases over time across multiple locations in Columbus, Ohio, from August to October 2021. Methods: The algorithm used to direct pop-up SARS-CoV-2 testing for this project is based on Thompson sampling, in which the aim is to maximize the average number of new cases of SARS-CoV-2 diagnosed among a set of testing locations based on sampling from prior probability distributions for each testing site. An academic-governmental partnership between Yale University, The Ohio State University, Wake Forest University, the Ohio Department of Health, the Ohio National Guard, and the Columbus Metropolitan Libraries conducted a study of bandit algorithms to maximize the detection of new cases of SARS-CoV-2 in this Ohio city in 2021. The initiative established pop-up COVID-19 testing sites at 13 Columbus locations, including library branches, recreational and community centers, movie theaters, homeless shelters, family services centers, and community event sites. Our team conducted between 0 and 56 tests at the 16 testing events, with an overall average of 25.3 tests conducted per event and a moving average that increased over time. Small incentives—including gift cards and take-home rapid antigen tests—were offered to those who approached the pop-up sites to encourage their participation. Results: Over time, as expected, the Bayesian search algorithm directed testing efforts to locations with higher yields of new diagnoses. Surprisingly, the use of the algorithm also maximized the identification of cases among minority residents of underserved communities, particularly African Americans, with the pool of participants overrepresenting these people relative to the demographic profile of the local zip code in which testing sites were located. Conclusions: This study demonstrated that a pop-up testing strategy using a bandit algorithm can be feasibly deployed in an urban setting during a pandemic. It is the first real-world use of these kinds of algorithms for disease surveillance and represents a key step in evaluating the effectiveness of their use in maximizing the detection of undiagnosed cases of SARS-CoV-2 and other infections, such as HIV. %M 37581924 %R 10.2196/39754 %U https://publichealth.jmir.org/2023/1/e39754 %U https://doi.org/10.2196/39754 %U http://www.ncbi.nlm.nih.gov/pubmed/37581924 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e43000 %T Frontline Health Care Workers’ Mental Health and Well-Being During the First Year of the COVID-19 Pandemic: Analysis of Interviews and Social Media Data %A Vera San Juan,Norha %A Martin,Sam %A Badley,Anna %A Maio,Laura %A Gronholm,Petra C %A Buck,Caroline %A Flores,Elaine C %A Vanderslott,Samantha %A Syversen,Aron %A Symmons,Sophie Mulcahy %A Uddin,Inayah %A Karia,Amelia %A Iqbal,Syka %A Vindrola-Padros,Cecilia %+ Rapid Research Evaluation and Appraisal Lab (RREAL), Department of Targeted Intervention, University College London, Gower Street, London, WC1E 6BT, United Kingdom, 44 20 7679 2000, n.verasanjuan@ucl.ac.uk %K mental health %K frontline %K health care workers %K COVID-19 %K health services research %K Collaborative and Digital Analysis of Big Qualitative Data in Time Sensitive Contexts %K LISTEN method %D 2023 %7 14.8.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic has shed light on fractures in health care systems worldwide and continues to have a significant impact, particularly in relation to the health care workforce. Frontline staff have been exposed to unprecedented strain, and delivering care during the pandemic has affected their safety, mental health, and well-being. Objective: This study aimed to explore the experiences of health care workers (HCWs) delivering care in the United Kingdom during the COVID-19 pandemic to understand their well-being needs, experiences, and strategies used to maintain well-being (at individual and organizational levels). Methods: We analyzed 94 telephone interviews with HCWs and 2000 tweets about HCWs’ mental health during the first year of the COVID-19 pandemic. Results: The results were grouped under 6 themes: redeployment, clinical work, and sense of duty; well-being support and HCW’s coping strategies; negative mental health effects; organizational support; social network and support; and public and government support. Conclusions: These findings demonstrate the need for open conversations, where staff’s well-being needs and the strategies they adopted can be shared and encouraged, rather than implementing top-down psychological interventions alone. At the macro level, the findings also highlighted the impact on HCW’s well-being of public and government support as well as the need to ensure protection through personal protective equipment, testing, and vaccines for frontline workers. %M 37402283 %R 10.2196/43000 %U https://www.jmir.org/2023/1/e43000 %U https://doi.org/10.2196/43000 %U http://www.ncbi.nlm.nih.gov/pubmed/37402283 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e44760 %T Online Help-Seeking Among Youth Victims of Sexual Violence Before and During COVID-19 (2016-2021): Analysis of Hotline Use Trends %A Goodman,Kimberly L %A Kamke,Kristyn %A Mullin,Tara M %+ Rape, Abuse, and Incest National Network, 1220 L St NW, Suite 505, Washington, DC, 20009, United States, 1 202 587 5347, kimberlyg@rainn.org %K child sexual abuse %K hotlines %K COVID-19 %K help-seeking %K online services %K child abuse %K mental health well-being %K child support %K sexual abuse %K mental health service %K sexual violence %D 2023 %7 11.8.2023 %9 Short Paper %J JMIR Public Health Surveill %G English %X Background: Three years since the onset of COVID-19, pandemic-related trends in child sexual abuse (CSA) remain poorly understood. Common administrative surveillance metrics may have underestimated abuse during the pandemic, given youths’ limited access to mandatory reporters. Research using anonymous service-use data showed increased violence-related online help-seeking but overlooked youth-specific help-seeking for CSA during COVID-19. Understanding pandemic-related trends in CSA can inform abuse detection practices and mental health service provision for youth victims. Objective: The purpose of this study was to harness anonymous help-seeking data from the National Sexual Assault Online Hotline (NSAOH) to glean insights about CSA occurrence in the United States during the COVID-19 pandemic. Methods: We used an archival sample of victims who contacted NSAOH from 2016 to 2021 (n=41,561). We examined differences in the proportion of youth and adult victims contacting NSAOH during the first COVID-19 year (March 2020 to February 2021) compared to the prior year (March 2019 to February 2020; n=11,719). Further, we compared key characteristics of hotline interactions among youth victims during the first COVID-19 year to the prior year (n=5913). Using joinpoint regression analysis, we examined linear trends in the number of monthly sampled youth and adult victims (excluding victims of unknown age) from 2016 to 2021 who discussed any victimization event (n=26,904) and who discussed recent events (ie, events occurring during the pandemic; n=9932). Results: Most youth victims were abused by family members prior to (1013/1677, 60.4%) and after (2658/3661, 72.6%) the onset of COVID-19. The number of youth victims contacting NSAOH spiked in March 2020 and peaked in November 2020 for all youth (slope=28.2, 95% CI 18.7-37.7) and those discussing recent events (slope=17.4, 95% CI 11.1-23.6). We observed a decline in youth victims into spring 2021 for all youth (slope=–56.9, 95% CI –91.4 to –22.3) and those discussing recent events (slope=–33.7, 95% 47.3 to -20.0). The number of adult victims discussing any victimization event increased steadily from January 2018 through May 2021 (slope=3.6; 95% CI 2.9-4.2) and then declined (slope=–13.8, 95% CI –22.8 to –4.7). Trends were stable for adults discussing recent events. Conclusions: This study extends the use of hotline data to understand the implications of the pandemic on CSA. We observed increased youth help-seeking through the NSAOH coinciding with the onset of COVID-19. Trends persisted when limiting analyses to recent victimization events, suggesting increased help-seeking reflected increased CSA during COVID-19. These findings underscore the utility of anonymous online services for youth currently experiencing abuse. Further, the findings support calls for increased youth mental health services and efforts to incorporate online chat into youth-targeted services. %M 37566446 %R 10.2196/44760 %U https://publichealth.jmir.org/2023/1/e44760 %U https://doi.org/10.2196/44760 %U http://www.ncbi.nlm.nih.gov/pubmed/37566446 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e45731 %T Defining Misinformation and Related Terms in Health-Related Literature: Scoping Review %A El Mikati,Ibrahim K %A Hoteit,Reem %A Harb,Tarek %A El Zein,Ola %A Piggott,Thomas %A Melki,Jad %A Mustafa,Reem A %A Akl,Elie A %+ Outcomes and Implementation Research Unit, Department of Internal Medicine, University of Kansas Medical Center, 3901 Rainbow Blvd, MS3002, Kansas City, KS, 66160, United States, 1 913 588 6048, rmustafa@kumc.edu %K misinformation %K disinformation %K infodemic %K fake news %K malinformation %K health %K COVID-19 %K scoping review %K health-related literature %K electronic database %K misleading %K related term %K systematic review %D 2023 %7 9.8.2023 %9 Review %J J Med Internet Res %G English %X Background: Misinformation poses a serious challenge to clinical and policy decision-making in the health field. The COVID-19 pandemic amplified interest in misinformation and related terms and witnessed a proliferation of definitions. Objective: We aim to assess the definitions of misinformation and related terms used in health-related literature. Methods: We conducted a scoping review of systematic reviews by searching Ovid MEDLINE, Embase, Cochrane, and Epistemonikos databases for articles published within the last 5 years up till March 2023. Eligible studies were systematic reviews that stated misinformation or related terms as part of their objectives, conducted a systematic search of at least one database, and reported at least 1 definition for misinformation or related terms. We extracted definitions for the terms misinformation, disinformation, fake news, infodemic, and malinformation. Within each definition, we identified concepts and mapped them across misinformation-related terms. Results: We included 41 eligible systematic reviews, out of which 32 (78%) reviews addressed the topic of public health emergencies (including the COVID-19 pandemic) and contained 75 definitions for misinformation and related terms. The definitions consisted of 20 for misinformation, 19 for disinformation, 10 for fake news, 24 for infodemic, and 2 for malinformation. “False/inaccurate/incorrect” was mentioned in 15 of 20 definitions of misinformation, 13 of 19 definitions of disinformation, 5 of 10 definitions of fake news, 6 of 24 definitions of infodemic, and 0 of 2 definitions of malinformation. Infodemic had 19 of 24 definitions addressing “information overload” and malinformation had 2 of 2 definitions with “accurate” and 1 definition “used in the wrong context.” Out of all the definitions, 56 (75%) were referenced from other sources. Conclusions: While the definitions of misinformation and related terms in the health field had inconstancies and variability, they were largely consistent. Inconstancies related to the intentionality in misinformation definitions (7 definitions mention “unintentional,” while 5 definitions have “intentional”). They also related to the content of infodemic (9 definitions mention “valid and invalid info,” while 6 definitions have “false/inaccurate/incorrect”). The inclusion of concepts such as “intentional” may be difficult to operationalize as it is difficult to ascertain one’s intentions. This scoping review has the strength of using a systematic method for retrieving articles but does not cover all definitions in the extant literature outside the field of health. This scoping review of the health literature identified several definitions for misinformation and related terms, which showed variability and included concepts that are difficult to operationalize. Health practitioners need to exert caution before labeling a piece of information as misinformation or any other related term and only do so after ascertaining accurateness and sometimes intentionality. Additional efforts are needed to allow future consensus around clear and operational definitions. %M 37556184 %R 10.2196/45731 %U https://www.jmir.org/2023/1/e45731 %U https://doi.org/10.2196/45731 %U http://www.ncbi.nlm.nih.gov/pubmed/37556184 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e44981 %T The Impact of Accelerated Digitization on Patient Portal Use by Underprivileged Racial Minority Groups During COVID-19: Longitudinal Study %A Mai,Feng %A Ko,Dong-Gil %A Shan,Zhe %A Zhang,Dawei %+ Department of Information Systems and Analytics, Miami University, 800 E High St, Rm 3035, Oxford, OH, 45056, United States, 1 (513) 529 2135, shanz3@miamioh.edu %K digital divide %K race %K health care %K patient portal %K mobile health %K accelerated digitization %K COVID-19 %K mobile phone %D 2023 %7 9.8.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Prior research on the digital divide has documented substantial racial inequality in using web-based health resources. The recent COVID-19 pandemic led to accelerated mass digitization, raising alarms that underprivileged racial minority groups are left further behind. However, it is unclear to what extent the use of health information and communications technology by underprivileged racial minority groups is affected. Objective: We have considered the COVID-19 disruption as a rare exogenous shock and estimated the impact of the accelerated digitization on the quantity and variety of patient portal use. In this study, we aimed to answer the following 2 key research questions. Did patients alter their use of health information and communications technology owing to COVID-19–induced digital acceleration? Does the effect differ across racial lines? Methods: We used a longitudinal patient portal use data set gathered from a large urban academic medical center to explore the effect of accelerated digitization on the racial digital gap in health care. We limited the sample period of our study to 2 same periods (March 11 to August 30) in 2019 and 2020. Our final sample consisted of 25,612 patients belonging to 1 of the 3 racial groups: Black or African American (n=5157, 20.13%), Hispanic (n=253, 0.99%), and White (n=20,202, 78.88%) patients. We estimated the panel data regression using 3 different models: pooled ordinary least squares (OLS), random effect (RE), and fixed effect (FE). Results: Our study yielded 4 findings. First, we confirmed that the racial digital divide remains a significant issue for telehealth; underprivileged racial minority group patients had lower patient portal use than White patients before the pandemic (Minority: OLS, β=−.158; P<.001; RE, β=−.168; P<.001). Second, we found that the digital gap regarding patient portal use frequency between underprivileged racial minority groups and White patients is shrinking rather than widening after the COVID-19 pandemic started (COVID_Period×Minority: OLS, β=.028; P=.002; RE, β=.037; P<.001; FE, β=.043; P<.001). Third, the shrinking gap is foremost driven by access through mobile (vs desktop) devices (COVID_Period×Minority: web, β=−.020; P=.02; mobile, β=.037; P<.001). Finally, underprivileged racial minority groups expanded their use of a variety of portal functionalities faster than White patients during the pandemic (COVID_Period×Minority [for functionality]: OLS, β=−.004; P<.001; RE, β=−.004; P<.001; FE, β=−.003; P=.001). Conclusions: Using the COVID-19 pandemic as a natural experiment, we offer empirical evidence that accelerated digitization has shrunk the racial digital divide in telehealth, and the trend is mostly driven by mobile devices. These findings provide new insights into the digital behaviors among underprivileged racial minority groups during accelerated digitization. They also offer policy makers an opportunity to identify new strategies to help close the racial digital gap in the postpandemic world. %M 37384810 %R 10.2196/44981 %U https://www.jmir.org/2023/1/e44981 %U https://doi.org/10.2196/44981 %U http://www.ncbi.nlm.nih.gov/pubmed/37384810 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e45069 %T Topics in Antivax and Provax Discourse: Yearlong Synoptic Study of COVID-19 Vaccine Tweets %A Zaidi,Zainab %A Ye,Mengbin %A Samon,Fergus %A Jama,Abdisalan %A Gopalakrishnan,Binduja %A Gu,Chenhao %A Karunasekera,Shanika %A Evans,Jamie %A Kashima,Yoshihisa %+ Melbourne School of Psychological Sciences, University of Melbourne, Parkville, Australia, 61 383444000, zainab.raziazaidi@unimelb.edu.au %K COVID-19 vaccine %K vaccine hesitancy %K antivax %K stance detection %K topic modeling %K misinformation %K disinformation %D 2023 %7 8.8.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Developing an understanding of the public discourse on COVID-19 vaccination on social media is important not only for addressing the ongoing COVID-19 pandemic but also for future pathogen outbreaks. There are various research efforts in this domain, although, a need still exists for a comprehensive topic-wise analysis of tweets in favor of and against COVID-19 vaccines. Objective: This study characterizes the discussion points in favor of and against COVID-19 vaccines posted on Twitter during the first year of the pandemic. The aim of this study was primarily to contrast the views expressed by both camps, their respective activity patterns, and their correlation with vaccine-related events. A further aim was to gauge the genuineness of the concerns expressed in antivax tweets. Methods: We examined a Twitter data set containing 75 million English tweets discussing the COVID-19 vaccination from March 2020 to March 2021. We trained a stance detection algorithm using natural language processing techniques to classify tweets as antivax or provax and examined the main topics of discourse using topic modeling techniques. Results: Provax tweets (37 million) far outnumbered antivax tweets (10 million) and focused mostly on vaccine development, whereas antivax tweets covered a wide range of topics, including opposition to vaccine mandate and concerns about safety. Although some antivax tweets included genuine concerns, there was a large amount of falsehood. Both stances discussed many of the same topics from opposite viewpoints. Memes and jokes were among the most retweeted messages. Most tweets from both stances (9,007,481/10,566,679, 85.24% antivax and 24,463,708/37,044,507, 66.03% provax tweets) came from dual-stance users who posted both provax and antivax tweets during the observation period. Conclusions: This study is a comprehensive account of COVID-19 vaccine discourse in the English language on Twitter from March 2020 to March 2021. The broad range of discussion points covered almost the entire conversation, and their temporal dynamics revealed a significant correlation with COVID-19 vaccine–related events. We did not find any evidence of polarization and prevalence of antivax discourse over Twitter. However, targeted countering of falsehoods is important because only a small fraction of antivax discourse touched on a genuine issue. Future research should examine the role of memes and humor in driving web-based social media activity. %M 37552535 %R 10.2196/45069 %U https://www.jmir.org/2023/1/e45069 %U https://doi.org/10.2196/45069 %U http://www.ncbi.nlm.nih.gov/pubmed/37552535 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e44774 %T Public Opinions About Palliative and End-of-Life Care During the COVID-19 Pandemic: Twitter-Based Content Analysis %A Wang,Yijun %A Chukwusa,Emeka %A Koffman,Jonathan %A Curcin,Vasa %+ Department of Population Health Sciences, King's College London, Addison House, Guy's Campus, Great Maze Pond, London, SE1 1UL, United Kingdom, 44 07746123151, k1924020@kcl.ac.uk %K palliative care %K end-of-life care %K COVID-19 %K Twitter %K public opinions %D 2023 %7 7.8.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Palliative and end-of-life care (PEoLC) played a critical role in relieving distress and providing grief support in response to the heavy toll caused by the COVID-19 pandemic. However, little is known about public opinions concerning PEoLC during the pandemic. Given that social media have the potential to collect real-time public opinions, an analysis of this evidence is vital to guide future policy-making. Objective: This study aimed to use social media data to investigate real-time public opinions regarding PEoLC during the COVID-19 crisis and explore the impact of vaccination programs on public opinions about PEoLC. Methods: This Twitter-based study explored tweets across 3 English-speaking countries: the United States, the United Kingdom, and Canada. From October 2020 to March 2021, a total of 7951 PEoLC-related tweets with geographic tags were retrieved and identified from a large-scale COVID-19 Twitter data set through the Twitter application programming interface. Topic modeling realized through a pointwise mutual information–based co-occurrence network and Louvain modularity was used to examine latent topics across the 3 countries and across 2 time periods (pre- and postvaccination program periods). Results: Commonalities and regional differences among PEoLC topics in the United States, the United Kingdom, and Canada were identified specifically: cancer care and care facilities were of common interest to the public across the 3 countries during the pandemic; the public expressed positive attitudes toward the COVID-19 vaccine and highlighted the protection it affords to PEoLC professionals; and although Twitter users shared their personal experiences about PEoLC in the web-based community during the pandemic, this was more prominent in the United States and Canada. The implementation of the vaccination programs raised the profile of the vaccine discussion; however, this did not influence public opinions about PEoLC. Conclusions: Public opinions on Twitter reflected a need for enhanced PEoLC services during the COVID-19 pandemic. The insignificant impact of the vaccination program on public discussion on social media indicated that public concerns regarding PEoLC continued to persist even after the vaccination efforts. Insights gleaned from public opinions regarding PEoLC could provide some clues for policy makers on how to ensure high-quality PEoLC during public health emergencies. In this post–COVID-19 era, PEoLC professionals may wish to continue to examine social media and learn from web-based public discussion how to ease the long-lasting trauma caused by this crisis and prepare for public health emergencies in the future. Besides, our results showed social media’s potential in acting as an effective tool to reflect public opinions in the context of PEoLC. %M 37368840 %R 10.2196/44774 %U https://formative.jmir.org/2023/1/e44774 %U https://doi.org/10.2196/44774 %U http://www.ncbi.nlm.nih.gov/pubmed/37368840 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e47637 %T Virtual First Emergency Medicine Visits: The Future of Convenient and Efficient Emergency Care %A Sakumoto,Matthew %+ University of California, San Francisco, 533 Parnassus Ave, U127, San Francisco, CA, 94143, United States, 1 4154761000, matthew.sakumoto@ucsf.edu %K telehealth %K virtual care %K emergency medicine %K telemedicine %K emergency department %K acute care facilities %K virtual visit %K COVID-19 %K virtual %K utilization %K medicine %K acute illness %K illness %K injury %K patient %K infection %K care %K physician %D 2023 %7 3.8.2023 %9 Commentary %J J Med Internet Res %G English %X The COVID-19 pandemic has led to increased patient volumes, staff shortages, and limited resources in emergency departments, resulting in the rapid acceleration of telemedicine in emergency medicine. The virtual first (VF) program connects patients with emergency medicine clinicians via synchronous virtual video visits, reducing unnecessary emergency department visits and diverting patients to appropriate care settings. VF video visits can improve patient outcomes by providing early intervention for acute care needs and can enhance patient satisfaction by providing convenient, accessible, and personalized care. However, challenges include the lack of physical examination, clinician telehealth training and competencies, and the requirement for a robust telemedicine infrastructure. Additionally, digital health equity is important to ensure equitable access to care. Despite these challenges, the potential benefits of VF video visits in emergency medicine are substantial, and this study is a strong step in building the evidence base for these advancements. %M 36976827 %R 10.2196/47637 %U https://www.jmir.org/2023/1/e47637 %U https://doi.org/10.2196/47637 %U http://www.ncbi.nlm.nih.gov/pubmed/36976827 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e42840 %T Using Virtual Emergency Medicine Clinicians as a Health System Entry Point (Virtual First): Cross-Sectional Survey Study %A Potter,Jennifer %A Watson Gans,Dana %A Gardner,Alison %A O'Neill,James %A Watkins,Christopher %A Husain,Iltifat %+ Department of Emergency Medicine, Wake Forest University School of Medicine, 1 Medical Center Blvd, Winston-Salem, NC, 27157, United States, 1 9204504469, j.k.potter@wakehealth.edu %K telehealth %K virtual care %K emergency medicine %K telemedicine %K emergency department %K acute care facilities %K virtual visit %K COVID-19 %K virtual %K utilization %K medicine %K acute illness %K illness %K injury %K patient %K efficacy %K infection %K care %K physician %D 2023 %7 3.8.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic accelerated the use and acceptance of telemedicine. Simultaneously, emergency departments (EDs) have experienced increased ED boarding. With this acceptance of telemedicine and the weighty increase in patient boarding, we proposed the innovative Virtual First (VF) program to leverage emergency medicine clinicians’ (EMCs) ability to triage patients. VF seeks to reduce unnecessary ED visits by connecting patients with EMCs prior to seeking in-person care rather than using traditional ED referral systems. Objective: The goal of this study is to investigate how patients’ access to EMCs from home via the establishment of VF changed how patients sought care for acute care needs. Methods: VF is a synchronous virtual video visit at a tertiary care academic hospital. VF was staffed by EMCs and enabled full management of patient complaints or, if necessary, referral to the appropriate level of care. Patients self-selected this service as an alternative to seeking in-person care at a primary care provider, urgent care center, or ED. A postvisit convenience sample survey was collected through a phone SMS text message or email to VF users. This is a cross-sectional survey study. The primary outcome measure is based on responses to the question “How would you have sought care if a VF visit was not available to you?” Secondary outcome measures describe valued aspects and criticisms. Results were analyzed using descriptive statistics. Results: There were 3097 patients seen via VF from July 2021 through May 2022. A total of 176 (5.7%) patients completed the survey. Of these, 87 (49.4%) would have sought care at urgent care centers if VF had not been available. There were 28 (15.9%) patients, 26 (14.8%) patients, and 1 (0.6%) patient that would have sought care at primary care providers, EDs, or other locations, respectively. Interestingly, 34 (19.3%) patients would not have sought care. The most valued aspect of VF was receiving care in the comfort of the home (n=137, 77.8%). For suggested improvements, 58 (33%) patients most commonly included “Nothing” as free text. Conclusions: VF has the potential to restructure how patients seek medical care by connecting EMCs with patients prior to ED arrival. Without the option of VF, 64.2% (113/177) of patients would have sought care at an acute care facility. VF’s innovative employment of EMCs allows for acute care needs to be treated virtually if feasible. If not, EMCs understand the local resources to better direct patients to the appropriate site. This has the potential to substantially decrease patient costs because patients are given the appropriate destination for in-person care, reducing the likelihood of the need for transfer and multiple ED visits. %M 37276547 %R 10.2196/42840 %U https://www.jmir.org/2023/1/e42840 %U https://doi.org/10.2196/42840 %U http://www.ncbi.nlm.nih.gov/pubmed/37276547 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e44822 %T Dynamic Trends and Underlying Factors of COVID-19 Vaccine Booster Hesitancy in Adults: Cross-Sectional Observational Study %A Wu,Jian %A Ma,Mingze %A Li,Quanman %A Guo,Xinghong %A Tarimo,Clifford Silver %A Jia,Shiyu %A Zhou,Xue %A Wang,Meiyun %A Gu,Jianqin %A Miao,Yudong %A Ye,Beizhu %+ Department of Health Management, College of Public Health, Zhengzhou University, No.100, Science Avenue, Gaoxin District, Zhengzhou, Henan, 450001, China, 86 67739815, yebeizhu@zzu.edu.cn %K COVID-19 vaccine %K vaccine hesitancy %K COVID-19 booster vaccination %K influencing factors %K China %D 2023 %7 1.8.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: COVID-19 vaccine hesitancy reduces vaccination rates, which is detrimental to building herd immunity and halting the spread of COVID-19 and its variations. Most researches have simply identified the reasons affecting COVID-19 vaccination reluctance without delving into its dynamics, which makes forecasting future trends difficult. Objective: This study aimed to examine the current COVID-19 vaccine booster hesitancy rate in Chinese adults as well as the dynamics of vaccine hesitancy and its influencing factors. The results of this study will have practical implications for policy responses in mainland China, and effective COVID-19 booster vaccination in specific populations. Methods: The web-based survey was completed by creating questionnaires and using a stratified random sampling method to collect information from adults (≥18 years old) among 2556 households in 4 geographical regions of China. We collected sociodemographic information, health status, awareness of COVID-19 and its vaccine, self-perceptions, trust in medical staff and vaccine developers, and so on. The odds ratios and 95% CI for the statistical associations were estimated using logistic regression models. Results: Overall, 6659 participants (females: n=3540, 53.2%; males: n=3119, 46.8%) responded. In total, 533 (8%; 95% CI 7.4%-8.7%) participants presented a clear hesitancy in receiving the COVID-19 booster vaccination, while 736 (11.1%; 95% CI 10.3%-11.8%) expressed hesitancy in regular booster vaccination. A higher prevalence of vaccine hesitancy in both booster vaccination and regular booster vaccination was observed among participants with a history of allergies, experiencing chronic disease, lower levels of public health prevention measures or susceptibility or benefits or self-efficiency, higher levels of severity or barriers, and lower trust in both medical staff and vaccine developers (P<.05). The females and participants with higher education levels, higher levels of barriers, lower levels of susceptibility, and lower trust in vaccine developers preferred to have attitudinal changes from acceptance to hesitancy, while people with higher education levels, lower self-report health conditions, experiencing chronic disease, history of allergies, and lower trust in medical staff and developers were all positively associated with constant COVID-19 booster hesitancy. Conclusions: The prevalence of COVID-19 vaccine booster hesitancy is not high in mainland China. However, there is a slight increment in hesitancy on regular booster vaccination. Conducting targeted information guidance for people with higher education levels and chronic diseases, as well as improving accessibility to booster vaccination and increasing trust in medical staff and vaccine producers may be highly effective in reducing vaccine hesitancy. %M 37526963 %R 10.2196/44822 %U https://publichealth.jmir.org/2023/1/e44822 %U https://doi.org/10.2196/44822 %U http://www.ncbi.nlm.nih.gov/pubmed/37526963 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e43720 %T The Use of Travel as an Appeal to Motivate Millennial Parents on Facebook to Get Vaccinated Against COVID-19: Message Framing Evaluation %A Arshanapally,Suraj %A Starr,Tiearra %A Elsberry,Lauren Blackmun %A Rinker,Robin %+ National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Mailstop H16-4, Atlanta, GA, 30329, United States, 1 404 498 1007, otv1@cdc.gov %K COVID-19 %K coronavirus %K vaccination %K travel %K parents %K millennial %K appeal %K health communication %K social media %K Facebook %K infectious disease %K message testing %K public health %K messaging %K parenting %K program %D 2023 %7 1.8.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: In summer 2021, the Centers for Disease Control and Prevention recommended that people get fully vaccinated against COVID-19 before fall travel to protect themselves and others from getting and spreading COVID-19 and new variants. Only 61% of parents had reported receiving at least 1 dose of the COVID-19 vaccine, according to a Kaiser Family Foundation study. Millennial parents, ages 25 to 40 years, were a particularly important parent population because they were likely to have children aged 12 years or younger (the age cutoff for COVID-19 vaccine eligibility during this time period) and were still planning to travel. Since Facebook has been identified as a popular platform for millennials and parents, the Centers for Disease Control and Prevention’s Travelers’ Health Branch determined an evaluation of public health messages was needed to identify which message appeals would resonate best with this population on Facebook. Objective: The objective was to evaluate which travel-based public health message appeals aimed at addressing parental concerns and sentiments about COVID-19 vaccination would resonate most with Millennial parents (25 to 40 years old) using Facebook Ads Manager and social media metrics. Methods: Six travel-based public health message appeals on parental concerns and sentiments around COVID-19 were developed and disseminated to millennial parents using Facebook Ads Manager. The messages ran from October 23, 2021, to November 8, 2021. Primary outcomes included the number of people reached and the number of impressions delivered. Secondary outcomes included engagements, clicks, click-through rate, and audience sentiments. A thematic analysis was conducted to analyze comments. The advertisement budget was evaluated by cost-per-mille and cost-per-click metrics. Results: All messages reached a total of 6,619,882 people and garnered 7,748,375 impressions. The Family (n=3,572,140 people reached, 53.96%; 4,515,836 impressions, 58.28%) and Return to normalcy (n=1,639,476 people reached, 24.77%; 1,754,227 impressions, 22.64%) message appeals reached the greatest number of people and garnered the most impressions out of all 6 message appeals. The Family message appeal received 3255 engagements (60.46%), and the Return to normalcy message appeal received 1148 engagements (21.28%). The Family appeal also received the highest number of positive post reactions (n=82, 28.37%). Most of the comments portrayed negative opinions about COVID-19 vaccination (n=46, 68.66%). All 6 message appeals were either on par with or outperformed cost-per-mille benchmarks set by other similar public health campaigns. Conclusions: Health communicators can use travel, specifically the Family and Return to normalcy message appeals, to successfully reach parents in their future COVID-19 vaccination campaigns and potentially inform health communication messaging efforts for other vaccine-preventable infectious disease campaigns. Public health programs can also utilize the lessons learned from this evaluation to communicate important COVID-19 information to their parent populations through travel messaging. %M 37437085 %R 10.2196/43720 %U https://formative.jmir.org/2023/1/e43720 %U https://doi.org/10.2196/43720 %U http://www.ncbi.nlm.nih.gov/pubmed/37437085 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e41959 %T Effects of Prosocial and Hope-Promoting Communication Strategies on COVID-19 Worry and Intentions for Risk-Reducing Behaviors and Vaccination: Experimental Study %A Scharnetzki,Elizabeth %A Waterston,Leo %A Scherer,Aaron M %A Thorpe,Alistair %A Fagerlin,Angela %A Han,Paul K J %+ Center for Interdisciplinary Population and Health Research, MaineHealth Institute for Research, 509 Forest Ave., Suite 200, Portland, ME, 04101, United States, 1 8053409716, elizabeth.scharnetzki@mainehealth.org %K COVID-19 %K communication %K hope %K prosocial %K vaccination %K risk %K behavior %K vaccine %K effect %K communication %K effectiveness %K social %K messages %K public %K web-based %K survey %D 2023 %7 1.8.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic has engendered widespread fear and skepticism about recommended risk-reducing behaviors including vaccination. Health agencies are faced with the need to communicate to the public in ways that both provide reassurance and promote risk-reducing behaviors. Communication strategies that promote prosocial (PS) values and hope are being widely used; however, the existing research on the persuasiveness of these strategies has offered mixed evidence. There is also very little research examining the comparative effectiveness of PS and hope-promoting (HP) strategies. Objective: The aim of this study is to evaluate the comparative effectiveness of PS and HP messages in reassuring the public and motivating COVID-19 risk–reducing behaviors. Methods: A web-based factorial experiment was conducted in which a diverse sample of the US public was randomized to read messages which adapted existing COVID-19 information from a public website produced by a state government public health department to include alternative framing language: PS, HP, or no additional framing (control). Participants then completed surveys measuring COVID-19 worry and intentions for COVID-19 risk–reducing behaviors and vaccination. Results: COVID-19 worry was unexpectedly higher in the HP than in the control and PS conditions. Intentions for COVID-19 risk–reducing behaviors did not differ between groups; however, intentions for COVID-19 vaccination were higher in the HP than in the control condition, and this effect was mediated by COVID-19 worry. Conclusions: It appears that HP communication strategies may be more effective than PS strategies in motivating risk-reducing behaviors in some contexts but with the paradoxical cost of promoting worry. %M 37379364 %R 10.2196/41959 %U https://formative.jmir.org/2023/1/e41959 %U https://doi.org/10.2196/41959 %U http://www.ncbi.nlm.nih.gov/pubmed/37379364 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e40277 %T Expressive Interviewing Agents to Support Health-Related Behavior Change: Randomized Controlled Study of COVID-19 Behaviors %A Stewart,Ian %A Welch,Charles %A An,Lawrence %A Resnicow,Ken %A Pennebaker,James %A Mihalcea,Rada %+ School of Computer Science and Engineering, University of Michigan, 2260 Hayward Street, Ann Arbor, MI, 48109, United States, 1 7347648504, ianbstew@umich.edu %K expressive writing %K motivational interviewing %K dialogue systems %K counseling %K behavior change %K text analysis %K COVID-19 %K mental health %K automated writing %K writing system %K stress %K psychological health %D 2023 %7 1.8.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Expressive writing and motivational interviewing are well-known approaches to help patients cope with stressful life events. Although these methods are often applied by human counselors, it is less well understood if an automated artificial intelligence approach can benefit patients. Providing an automated method would help expose a wider range of people to the possible benefits of motivational interviewing, with lower cost and more adaptability to sudden events like the COVID-19 pandemic. Objective: This study presents an automated writing system and evaluates possible outcomes among participants with respect to behavior related to the COVID-19 pandemic. Methods: We developed a rule-based dialogue system for “Expressive Interviewing” to elicit writing from participants on the subject of how COVID-19 has impacted their lives. The system prompts participants to describe their life experiences and emotions and provides topic-specific prompts in response to participants’ use of topical keywords. In May 2021 and June 2021, we recruited participants (N=151) via Prolific to complete either the Expressive Interviewing task or a control task. We surveyed participants immediately before the intervention, immediately after the intervention, and again 2 weeks after the intervention. We measured participants’ self-reported stress, general mental health, COVID-19–related health behavior, and social behavior. Results: Participants generally wrote long responses during the task (53.3 words per response). In aggregate, task participants experienced a significant decrease in stress in the short term (~23% decrease, P<.001) and a slight difference in social activity compared with the control group (P=.03). No significant differences in short-term or long-term outcomes were detected between participant subgroups (eg, male versus female participants) except for some within-condition differences by ethnicity (eg, higher social activity among African American people participating in Expressive Interviewing vs participants of other ethnicities). For short-term effects, participants showed different outcomes based on their writing. Using more anxiety-related words was correlated with a greater short-term decrease in stress (r=–0.264, P<.001), and using more positive emotion words was correlated with a more meaningful experience (r=0.243, P=.001). As for long-term effects, writing with more lexical diversity was correlated with an increase in social activity (r=0.266, P<.001). Conclusions: Expressive Interviewing participants exhibited short-term, but not long-term, positive changes in mental health, and some linguistic metrics of writing style were correlated with positive change in behavior. Although there were no significant long-term effects observed, the positive short-term effects suggest that the Expressive Interviewing intervention could be used in cases in which a patient lacks access to traditional therapy and needs a short-term solution. Trial Registration: Clincaltrials.gov NCT05949840; https://www.clinicaltrials.gov/study/NCT05949840 %M 37074948 %R 10.2196/40277 %U https://formative.jmir.org/2023/1/e40277 %U https://doi.org/10.2196/40277 %U http://www.ncbi.nlm.nih.gov/pubmed/37074948 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e44079 %T The Effectiveness and Cost-Effectiveness of a Universal Digital Parenting Intervention Designed and Implemented During the COVID-19 Pandemic: Evidence From a Rapid-Implementation Randomized Controlled Trial Within a Cohort %A Palmer,Melanie %A Beckley-Hoelscher,Nicholas %A Shearer,James %A Kostyrka-Allchorne,Katarzyna %A Robertson,Olly %A Koch,Marta %A Pearson,Oliver %A Slovak,Petr %A Day,Crispin %A Byford,Sarah %A Goldsmith,Kimberley %A Waite,Polly %A Creswell,Cathy %A Sonuga-Barke,Edmund J S %+ Institute of Psychiatry, Psychology & Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, United Kingdom, 44 0207 848 0269, edmund.sonuga-barke@kcl.ac.uk %K parenting %K intervention %K digital application %K randomized controlled trial %K COVID-19 pandemic %K mobile phone %D 2023 %7 27.7.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Children’s conduct and emotional problems increased during the COVID-19 pandemic. Objective: We tested whether a smartphone parenting support app, Parent Positive, developed specifically for this purpose, reversed these effects in a cost-effective way. Parent Positive includes 3 zones. Parenting Boosters (zone 1) provided content adapted from standard face-to-face parent training programs to tackle 8 specific challenges identified by parents and parenting experts as particularly relevant for parents during the pandemic. The Parenting Exchange (zone 2) was a parent-to-parent and parent-to-expert communication forum. Parenting Resources (zone 3) provided access to existing high-quality web-based resources on a range of additional topics of value to parents (eg, neurodevelopmental problems, diet, and sleep). Methods: Supporting Parents And Kids Through Lockdown Experiences (SPARKLE), a randomized controlled trial, was embedded in the UK-wide COVID-19: Supporting Parents, Adolescents and Children during Epidemics (Co-SPACE) longitudinal study on families’ mental health during the pandemic. Parents of children aged 4 to 10 years were randomized 1:1 to Parent Positive or follow-up as usual (FAU) between May 19, 2021, and July 26, 2021. Parent Positive provided advice on common parenting challenges and evidence-based web-based resources and facilitated parent-to-parent and expert-to-parent support. Child conduct and emotional problems and family well-being were measured before randomization (T1) and at 1 (T2) and 2 (T3) months after randomization. Service use, costs, and adverse events were measured, along with app use and satisfaction. The primary outcome was T2 parent-reported child conduct problems, which were analyzed using linear mixed regression models. Results: A total of 320 participants were randomized to Parent Positive, and 326 were randomized to FAU. The primary outcome analysis included 79.3% (512/646) of the participants (dropout: 84/320, 26% on Parent Positive and 50/326, 15% on FAU). There were no statistically significant intervention effects on conduct problems at either T2 (standardized effect=−0.01) or T3 (secondary outcome; standardized effect=−0.09) and no moderation by baseline conduct problems. Significant intervention-related reductions in emotional problems were observed at T2 and T3 (secondary outcomes; standardized effect=−0.13 in both cases). Parent Positive, relative to FAU, was associated with more parental worries at T3 (standardized effect=0.14). Few intervention-attributable adverse events were reported. Parent Positive was cost-effective once 4 outliers with extremely high health care costs were excluded. Conclusions: Parent Positive reduced child emotional problems and was cost-effective compared with FAU once outliers were removed. Although small when considered against targeted therapeutic interventions, the size of these effects was in line with trials of nontargeted universal mental health interventions. This highlights the public health potential of Parent Positive if implemented at the community level. Nevertheless, caution is required before making such an interpretation, and the findings need to be replicated in large-scale, whole-community studies. Trial Registration: ClinicalTrials.gov NCT04786080; https://clinicaltrials.gov/ct2/show/NCT04786080 %M 37498669 %R 10.2196/44079 %U https://www.jmir.org/2023/1/e44079 %U https://doi.org/10.2196/44079 %U http://www.ncbi.nlm.nih.gov/pubmed/37498669 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 10 %N %P e43615 %T Technologies in Home-Based Digital Rehabilitation: Scoping Review %A Arntz,Angela %A Weber,Franziska %A Handgraaf,Marietta %A Lällä,Kaisa %A Korniloff,Katariina %A Murtonen,Kari-Pekka %A Chichaeva,Julija %A Kidritsch,Anita %A Heller,Mario %A Sakellari,Evanthia %A Athanasopoulou,Christina %A Lagiou,Areti %A Tzonichaki,Ioanna %A Salinas-Bueno,Iosune %A Martínez-Bueso,Pau %A Velasco-Roldán,Olga %A Schulz,Ralf-Joachim %A Grüneberg,Christian %+ Division of Physiotherapy, Department of Applied Health Sciences, University of Applied Health Sciences Bochum, Gesundheitscampus 6-8, Bochum, 44801, Germany, 49 234 77727 679, angela.arntz@hs-gesundheit.de %K digital rehabilitation %K digital technologies %K home-based rehabilitation %K digital health intervention %K scoping review %K artificial intelligence %K AI %K machine learning %K COVID-19 pandemic %K mobile app %K remote health %K mobile phone %D 2023 %7 27.7.2023 %9 Original Paper %J JMIR Rehabil Assist Technol %G English %X Background: Due to growing pressure on the health care system, a shift in rehabilitation to home settings is essential. However, efficient support for home-based rehabilitation is lacking. The COVID-19 pandemic has further exacerbated these challenges and has affected individuals and health care professionals during rehabilitation. Digital rehabilitation (DR) could support home-based rehabilitation. To develop and implement DR solutions that meet clients’ needs and ease the growing pressure on the health care system, it is necessary to provide an overview of existing, relevant, and future solutions shaping the constantly evolving market of technologies for home-based DR. Objective: In this scoping review, we aimed to identify digital technologies for home-based DR, predict new or emerging DR trends, and report on the influences of the COVID-19 pandemic on DR. Methods: The scoping review followed the framework of Arksey and O’Malley, with improvements made by Levac et al. A literature search was performed in PubMed, Embase, CINAHL, PsycINFO, and the Cochrane Library. The search spanned January 2015 to January 2022. A bibliometric analysis was performed to provide an overview of the included references, and a co-occurrence analysis identified the technologies for home-based DR. A full-text analysis of all included reviews filtered the trends for home-based DR. A gray literature search supplemented the results of the review analysis and revealed the influences of the COVID-19 pandemic on the development of DR. Results: A total of 2437 records were included in the bibliometric analysis and 95 in the full-text analysis, and 40 records were included as a result of the gray literature search. Sensors, robotic devices, gamification, virtual and augmented reality, and digital and mobile apps are already used in home-based DR; however, artificial intelligence and machine learning, exoskeletons, and digital and mobile apps represent new and emerging trends. Advantages and disadvantages were displayed for all technologies. The COVID-19 pandemic has led to an increased use of digital technologies as remote approaches but has not led to the development of new technologies. Conclusions: Multiple tools are available and implemented for home-based DR; however, some technologies face limitations in the application of home-based rehabilitation. However, artificial intelligence and machine learning could be instrumental in redesigning rehabilitation and addressing future challenges of the health care system, and the rehabilitation sector in particular. The results show the need for feasible and effective approaches to implement DR that meet clients’ needs and adhere to framework conditions, regardless of exceptional situations such as the COVID-19 pandemic. %M 37253381 %R 10.2196/43615 %U https://rehab.jmir.org/2023/1/e43615 %U https://doi.org/10.2196/43615 %U http://www.ncbi.nlm.nih.gov/pubmed/37253381 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e38369 %T V-CarE—A Conceptual Design Model for Providing COVID-19 Pandemic Awareness: Proposal for a Virtual Reality Design Approach to Facilitate People With Persistent Postural-Perceptual Dizziness %A Zaidi,Syed Fawad M %A Shafiabady,Niusha %A Afifi,Shereen %A Beilby,Justin %+ Department of Business Information Systems, Torrens University Australia, 17/51 Foveaux St, Surry Hills, Sydney, 2010, Australia, 61 1300 575 803, fawad.zaidi@torrens.edu.au %K COVID-19 %K immersion %K pandemic %K Persistent Postural–Perceptual Dizziness %K PPPD %K virtual reality %D 2023 %7 27.7.2023 %9 Proposal %J JMIR Res Protoc %G English %X Background: Virtual reality (VR) technology has been solidifying its ground since its existence, where engagement and a sense of presence are key. The contemporary field of development has captured the attention of researchers due to its flexibility and compatibility attributes. During the COVID-19 pandemic, several research outputs have shown promising prospects of continuing research in the field of VR design and development—in health sciences including learning and training. Objective: In this paper, we aim to propose a conceptual development model named V-CarE (Virtual Care Experience) that can facilitate the understanding of pandemics when it comes to a crisis, taking precautionary measures where needed, and getting used to certain actions for preventing pandemic spread through habituation. Moreover, this conceptual model is useful to expand the development strategy to incorporate different types of users and technological aid as per need and requirement. Methods: For a detailed understanding of the proposed model, we have developed a novel design strategy to bring awareness to the user about the current COVID-19 pandemic. VR research in health sciences has shown that with appropriate management and development, VR technology can efficiently support people with health issues and special needs, which motivated our attempts to explore the possibility of employing our proposed model to treat Persistent Postural-Perceptual Dizziness (PPPD)—a persistent nonvertiginous dizziness that could last for 3 months or more. The purpose of including patients with PPPD is to get them engaged in the learning experience and to make them comfortable with VR. We believe this confidence and habituation would help them get engaged with VR for treatment (dizziness alleviation) while practicing the preventive measures during the pandemic in an interactive environment without actually facing any pandemic directly. Subsequently, for advanced development using the V-CarE model, we have briefly discussed that even contemporary technology like internet of things (IoT) for handling devices, can be incorporated without disrupting the complete 3D-immersive experience. Results: In our discussion, we have shown that the proposed model represents a significant step toward the accessibility of VR technology by creating a pathway toward awareness of pandemics and, also, an effective care strategy for PPPD people. Moreover, by introducing advanced technology, we will only further enhance the development for wider accessibility of VR technology while keeping the core purpose of the development intact. Conclusions: V-CarE–based developed VR projects are designed with all the core elements of health sciences, technology, and training making it accessible and engaging for the users and improving their lifestyle by safely experiencing the unknown. We suggest that with further design-based research, the proposed V-CarE model has the potential to be a valuable tool connecting different fields to wider communities. %M 37224279 %R 10.2196/38369 %U https://www.researchprotocols.org/2023/1/e38369 %U https://doi.org/10.2196/38369 %U http://www.ncbi.nlm.nih.gov/pubmed/37224279 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e43068 %T A Medical Ethics Framework for Conversational Artificial Intelligence %A Fournier-Tombs,Eleonore %A McHardy,Juliette %+ United Nations University Centre for Policy Research, 767 Third Avenue, Floor 35, New York, NY, 10017, United States, 1 646 905 5225, fourniertombs@unu.edu %K chatbot %K medicine %K ethics %K AI ethics %K AI policy %K conversational agent %K COVID-19 %K risk %K medical ethics %K privacy %K data governance %K artificial intelligence %D 2023 %7 26.7.2023 %9 Viewpoint %J J Med Internet Res %G English %X The launch of OpenAI’s GPT-3 model in June 2020 began a new era for conversational chatbots. While there are chatbots that do not use artificial intelligence (AI), conversational chatbots integrate AI language models that allow for back-and-forth conversation between an AI system and a human user. GPT-3, since upgraded to GPT-4, harnesses a natural language processing technique called sentence embedding and allows for conversations with users that are more nuanced and realistic than before. The launch of this model came in the first few months of the COVID-19 pandemic, where increases in health care needs globally combined with social distancing measures made virtual medicine more relevant than ever. GPT-3 and other conversational models have been used for a wide variety of medical purposes, from providing basic COVID-19–related guidelines to personalized medical advice and even prescriptions. The line between medical professionals and conversational chatbots is somewhat blurred, notably in hard-to-reach communities where the chatbot replaced face-to-face health care. Considering these blurred lines and the circumstances accelerating the adoption of conversational chatbots globally, we analyze the use of these tools from an ethical perspective. Notably, we map out the many types of risks in the use of conversational chatbots in medicine to the principles of medical ethics. In doing so, we propose a framework for better understanding the effects of these chatbots on both patients and the medical field more broadly, with the hope of informing safe and appropriate future developments. %M 37224277 %R 10.2196/43068 %U https://www.jmir.org/2023/1/e43068 %U https://doi.org/10.2196/43068 %U http://www.ncbi.nlm.nih.gov/pubmed/37224277 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e43628 %T Assessing How Risk Communication Surveillance Prompts COVID-19 Vaccine Acceptance Among Internet Users by Applying the Situational Theory of Problem Solving: Cross-Sectional Study %A Jin,Qiang %A Raza,Syed Hassan %A Yousaf,Muhammad %A Zaman,Umer %A Ogadimma,Emenyeonu C %A Shah,Amjad Ali %A Core,Rachel %A Malik,Aqdas %+ Institute of Media and Communication Studies, Bahauddin Zakariya University, Bosan Road, Multan, 60000, Pakistan, 92 3316350594, sherazibzu@gmail.com %K COVID-19 %K vaccine safety %K risk communication %K digital interventions %K health communication %K Situational Theory of Problem Solving %D 2023 %7 26.7.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: The World Health Organization has recently raised concerns regarding the low number of people fully vaccinated against COVID-19. The low ratio of fully vaccinated people and the emergence of renewed infectious variants correspond to worsening public health. Global health managers have highlighted COVID-19 vaccine–related infodemics as a significant risk perception factor hindering mass vaccination campaigns. Objective: Given the ambiguous digital communication environment that has fostered infodemics, resource-limited nations struggle to boost public willingness to encourage people to fully vaccinate. Authorities have launched some risk communication–laden digital interventions in response to infodemics. However, the value of the risk communication strategies used to tackle infodemics needs to be evaluated. The current research using the tenets of the Situational Theory of Problem Solving is novel, as it explores the impending effects of risk communication strategies. The relationship between infodemic-induced risk perception of COVID-19 vaccine safety and risk communication actions to intensify willingness to be fully vaccinated was examined. Methods: This study used a cross-sectional research design vis-à-vis a nationally representative web-based survey. We collected data from 1946 internet users across Pakistan. Participants voluntarily participated in this research after completing the consent form and reading ethical permissions. Responses were received over 3 months, from May 2022 to July 2022. Results: The results delineated that infodemics positively affected risk perception. This realization pushed the public to engage in risky communicative actions through reliance on and searches for accurate information. Therefore, the prospect of managing infodemics through risk information exposure (eg, digital interventions) using the situational context could predict robust willingness to be fully vaccinated against COVID-19. Conclusions: These pioneering results offer strategic considerations for health authorities to effectively manage the descending spiral of optimal protection against COVID-19. This research concludes that the likelihood of managing infodemics using situational context through exposure to relevant information could improve one’s knowledge of forfending and selection, which can lead to robust protection against COVID-19. Hence, more situation-specific information about the underlying problem (ie, the selection of an appropriate vaccine) can be made accessible through several official digital sources to achieve a more active public health response. %M 37315198 %R 10.2196/43628 %U https://formative.jmir.org/2023/1/e43628 %U https://doi.org/10.2196/43628 %U http://www.ncbi.nlm.nih.gov/pubmed/37315198 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e45164 %T A National Health and Wellness SMS Text Message Program for Breast Cancer Survivors During COVID-19 (EMPOWER-SMS COVID-19): Mixed Methods Evaluation Using the RE-AIM Framework %A Singleton,Anna C %A Raeside,Rebecca %A Hyun,Karice K %A Hayes,Molly %A Sherman,Kerry A %A Elder,Elisabeth %A Redfern,Julie %A Partridge,Stephanie R %+ Engagement and Co-Design Research Hub, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Level 6 Block K Westmead Hospital, Sydney, 2753, Australia, 61 2 9351 2222, anna.singleton@sydney.edu.au %K digital health %K telemedicine %K SMS text messaging %K breast cancer %K implementation science %K cancer survivorship %K supportive care %K public health %K COVID-19 %D 2023 %7 25.7.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: COVID-19 lockdowns caused widespread closures of supportive care services for breast cancer survivors in Australia. In a randomized controlled trial, our team’s lifestyle-focused, evidence-based SMS text message support program (EMPOWER-SMS COVID-19) was found to be acceptable and useful for breast cancer survivors, and it was ready for rapid widespread delivery. Objective: This study aims to evaluate the reach (uptake) of an adapted 3-month lifestyle-focused SMS text message program (EMPOWER-SMS COVID-19) and barriers and enablers to implementation using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. Methods: A mixed methods pre-post study was conducted to evaluate the EMPOWER-SMS COVID-19 program. The study evaluated the following aspects: (1) reach/representativeness, which refers to the proportion of participant enrollment (ie, number enrolled/number that visited the study website) and demographics (eg, age, sex, ethnicity, time since completing treatment, Index of Relative Socio-economic Advantage and Disadvantage [IRSAD; quintile 1, which refers to most disadvantaged areas, to quintile 5, which refers to least disadvantaged areas, and remoteness); (2) effectiveness, in which participant engagement and acceptability were evaluated using SMS text message reply data and a feedback survey (5-point Likert scale and free-text responses); (3) adoption, which corresponds to the proportion of organizations or health professionals who agreed to promote the program; (4) implementation fidelity and maintenance, which evaluated SMS text message delivery data, opt-outs, costs, and adaptations. Quantitative data were summarized using means and SDs or frequencies and percentages, while qualitative data were analyzed thematically. Results: With regard to the reach/representativeness of the program, 841/1340 (62.8%) participants enrolled and provided electronic consent. Participants had a mean age of 58.8 (SD 9.8; range 30-87) years. According to the data collected, most participants identified as female (837/840, 99.6%) and White (736/840, 87.6%) and nearly half (418/841, 49.7%) finished treatment ≤18 months ago. Most resided in major cities (574/838, 68.5%) and 30% (251/838) in IRSAD quintile 1 or 2. In terms of effectiveness, 852 replies were received from 511 unique participants (median 1; range 1-26). The most common replies were participants stating how they heard about the program (467/852, 54.8%) or “thank you” (131/852, 15.4%). None of the replies contained urgent safety concerns. Among participants who provided feedback (449/841, 53.4%), most “(strongly) agreed” the SMS text messages were easy to understand (445/448, 99.3%), useful (373/440, 84.8%), helped participants feel supported (388/448, 86.6%), and motivated participants to be physically active (312/445, 70.1%) and eat healthier (313/457, 68.5%). Free-text responses revealed 5 factors influencing engagement: (1) feeling supported and less alone, (2) motivation and reassurance for health self-management, (3) the variety of information, (4) weblinks to information and resources, and (5) the option to save the SMS text messages. Concerning adoption, 50% (18/36) of organizations/health professionals agreed to promote the program. With regard to implementation/maintenance, SMS text messages were delivered as planned (97.43% [41,257/42,344] of SMS text messages were successfully delivered) with minimal opt-outs (62/838, 7.4%) and low cost (Aus $15.40/participant; Aus $1=US $0.67). No adaptations were made during the intervention period. Postintervention adaptations included adding weblinks and participant-selected customizations. Conclusions: EMPOWER-SMS COVID-19 was implemented quickly, had a broad reach, and had high engagement and acceptability among socioeconomically diverse participants. The program had high fidelity, low cost, and required minimal staff oversight, which may facilitate future implementation. However, further research is needed to evaluate barriers and enablers to adoption and implementation for health professionals and strategies for long-term maintenance. %M 37490319 %R 10.2196/45164 %U https://www.jmir.org/2023/1/e45164 %U https://doi.org/10.2196/45164 %U http://www.ncbi.nlm.nih.gov/pubmed/37490319 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 3 %N %P e41582 %T Public Officials’ Engagement on Social Media During the Rollout of the COVID-19 Vaccine: Content Analysis of Tweets %A Marani,Husayn %A Song,Melodie Yunju %A Jamieson,Margaret %A Roerig,Monika %A Allin,Sara %+ Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON, M5T 3M6, Canada, 1 (416) 978 432, husayn.marani@mail.utoronto.ca %K Twitter %K COVID-19 %K vaccines %K sentiment analysis %K public officials %D 2023 %7 20.7.2023 %9 Original Paper %J JMIR Infodemiology %G English %X Background: Social media is an important way for governments to communicate with the public. This is particularly true in times of crisis, such as the COVID-19 pandemic, during which government officials played a strong role in promoting public health measures such as vaccines. Objective: In Canada, provincial COVID-19 vaccine rollout was delivered in 3 phases aligned with federal government COVID-19 vaccine guidance for priority populations. In this study, we examined how Canadian public officials used Twitter to engage with the public about vaccine rollout and how this engagement has shaped public response to vaccines across jurisdictions. Methods: We conducted a content analysis of tweets posted between December 28, 2020, and August 31, 2021. Leveraging the social media artificial intelligence tool Brandwatch Analytics, we constructed a list of public officials in 3 jurisdictions (Ontario, Alberta, and British Columbia) organized across 6 public official types and then conducted an English and French keyword search for tweets about vaccine rollout and delivery that mentioned, retweeted, or replied to the public officials. We identified the top 30 tweets with the highest impressions in each jurisdiction in each of the 3 phases (approximately a 26-day window) of the vaccine rollout. The metrics of engagement (impressions, retweets, likes, and replies) from the top 30 tweets per phase in each jurisdiction were extracted for additional annotation. We specifically annotated sentiment toward public officials’ vaccine responses (ie, positive, negative, and neutral) in each tweet and annotated the type of social media engagement. A thematic analysis of tweets was then conducted to add nuance to extracted data characterizing sentiment and interaction type. Results: Among the 6 categories of public officials, 142 prominent accounts were included from Ontario, Alberta, and British Columbia. In total, 270 tweets were included in the content analysis and 212 tweets were direct tweets by public officials. Public officials mostly used Twitter for information provision (139/212, 65.6%), followed by horizontal engagement (37/212, 17.5%), citizen engagement (24/212, 11.3%), and public service announcements (12/212, 5.7%). Information provision by government bodies (eg, provincial government and public health authorities) or municipal leaders is more prominent than tweets by other public official groups. Neutral sentiment accounted for 51.5% (139/270) of all the tweets, whereas positive sentiment was the second most common sentiment (117/270, 43.3%). In Ontario, 60% (54/90) of the tweets were positive. Negative sentiment (eg, public officials criticizing vaccine rollout) accounted for 12% (11/90) of all the tweets. Conclusions: As governments continue to promote the uptake of the COVID-19 booster doses, findings from this study are useful in informing how governments can best use social media to engage with the public to achieve democratic goals. %M 37315194 %R 10.2196/41582 %U https://infodemiology.jmir.org/2023/1/e41582 %U https://doi.org/10.2196/41582 %U http://www.ncbi.nlm.nih.gov/pubmed/37315194 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e41836 %T Perceptions of Global Health Engagements in Relation to the COVID-19 Pandemic Among Health Care Workers and Administrators in Western Kenya: Protocol for a Multistage Qualitative Study %A Amick,Erick %A Naanyu,Violet %A Bucher,Sherri %A Henry,Beverly W %+ Susan and Richard Kiphart Center for Global Health and Social Development, Crown Family School of Social Work, Policy, and Practice, University of Chicago, 969 E 60th st, Chicago, IL, 60637, United States, 1 773 702 0795, eamick@uchicago.edu %K global health %K global health engagements %K GHEs %K health care workers %K local perspectives %K low- and middle-income countries %K LMICs %D 2023 %7 19.7.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: There has been significant interest in global health in low- and middle-income countries (LMICs) among individuals living in high-income countries (HICs) over the past 30 years. Much of the literature on global health engagements (GHEs) has been presented from the perspective of individuals from high-income countries. Local stakeholders such as health care workers and health care administrators represent critical constituencies for global health activities, yet their perspectives are underrepresented in the literature. The purpose of this study is to examine the experiences of local health care workers and administrators with GHEs in Kenya. We will explore the perceived role GHEs play in preparing the health system to address a public health crisis, as well as their role in pandemic recovery and its aftermath. Objective: The aims of this study are to (1) examine how Kenyan health care workers and administrators interpret experiences with GHEs as having advantaged or hindered them and the local health system to provide care during an acute public health crisis and (2) to explore recommendations to reimagine GHEs in a postpandemic Kenya. Methods: This study will be conducted at a large teaching and referral hospital in western Kenya with a long history of hosting GHEs in support of its tripartite mission of providing care, training, and research. This qualitative study will be conducted in 3 phases. In phase 1, in-depth interviews will be conducted to capture participants’ lived experience in relation to their unique understandings of the pandemic, GHEs, and the local health system. In phase 2, group discussions using nominal group techniques will be conducted to determine potential priority areas to reimagine future GHEs. In phase 3, in-depth interviews will be conducted to explore these priority areas in greater detail to explore recommendations for potential strategies, policies, and other actions that might be used to achieve the priorities determined to be of highest importance. Results: The study activities commenced in late summer 2022, with findings to be published in 2023. It is anticipated that the findings from this study will provide insight into the role GHEs play in a local health system in Kenya and provide critical stakeholder and partner input from persons hitherto ignored in the design, implementation, and management of GHEs. Conclusions: This qualitative study will examine the perspectives of GHEs in relation to the COVID-19 pandemic among Kenyan health care workers and health care administrators in western Kenya using a multistage protocol. Using a combination of in-depth interviews and nominal group techniques, this study aims to shed light on the roles global health activities are perceived to play in preparing health care professionals and the health system to address an acute public health crisis. International Registered Report Identifier (IRRID): PRR1-10.2196/41836 %M 37315197 %R 10.2196/41836 %U https://www.researchprotocols.org/2023/1/e41836 %U https://doi.org/10.2196/41836 %U http://www.ncbi.nlm.nih.gov/pubmed/37315197 %0 Journal Article %@ 2291-9694 %I %V 11 %N %P e45496 %T Interoperable, Domain-Specific Extensions for the German Corona Consensus (GECCO) COVID-19 Research Data Set Using an Interdisciplinary, Consensus-Based Workflow: Data Set Development Study %A Lichtner,Gregor %A Haese,Thomas %A Brose,Sally %A Röhrig,Larissa %A Lysyakova,Liudmila %A Rudolph,Stefanie %A Uebe,Maria %A Sass,Julian %A Bartschke,Alexander %A Hillus,David %A Kurth,Florian %A Sander,Leif Erik %A Eckart,Falk %A Toepfner,Nicole %A Berner,Reinhard %A Frey,Anna %A Dörr,Marcus %A Vehreschild,Jörg Janne %A von Kalle,Christof %A Thun,Sylvia %K interoperability %K research data set %K Fast Healthcare Interoperability Resources %K FHIR %K FAIR principle %K COVID-19 %K interoperable %K SARS-CoV-2 %K pediatric %K immunization %K cardiology %K standard %D 2023 %7 18.7.2023 %9 %J JMIR Med Inform %G English %X Background: The COVID-19 pandemic has spurred large-scale, interinstitutional research efforts. To enable these efforts, researchers must agree on data set definitions that not only cover all elements relevant to the respective medical specialty but also are syntactically and semantically interoperable. Therefore, the German Corona Consensus (GECCO) data set was developed as a harmonized, interoperable collection of the most relevant data elements for COVID-19–related patient research. As the GECCO data set is a compact core data set comprising data across all medical fields, the focused research within particular medical domains demands the definition of extension modules that include data elements that are the most relevant to the research performed in those individual medical specialties. Objective: We aimed to (1) specify a workflow for the development of interoperable data set definitions that involves close collaboration between medical experts and information scientists and (2) apply the workflow to develop data set definitions that include data elements that are the most relevant to COVID-19–related patient research regarding immunization, pediatrics, and cardiology. Methods: We developed a workflow to create data set definitions that were (1) content-wise as relevant as possible to a specific field of study and (2) universally usable across computer systems, institutions, and countries (ie, interoperable). We then gathered medical experts from 3 specialties—infectious diseases (with a focus on immunization), pediatrics, and cardiology—to select data elements that were the most relevant to COVID-19–related patient research in the respective specialty. We mapped the data elements to international standardized vocabularies and created data exchange specifications, using Health Level Seven International (HL7) Fast Healthcare Interoperability Resources (FHIR). All steps were performed in close interdisciplinary collaboration with medical domain experts and medical information specialists. Profiles and vocabulary mappings were syntactically and semantically validated in a 2-stage process. Results: We created GECCO extension modules for the immunization, pediatrics, and cardiology domains according to pandemic-related requests. The data elements included in each module were selected, according to the developed consensus-based workflow, by medical experts from these specialties to ensure that the contents aligned with their research needs. We defined data set specifications for 48 immunization, 150 pediatrics, and 52 cardiology data elements that complement the GECCO core data set. We created and published implementation guides, example implementations, and data set annotations for each extension module. Conclusions: The GECCO extension modules, which contain data elements that are the most relevant to COVID-19–related patient research on infectious diseases (with a focus on immunization), pediatrics, and cardiology, were defined in an interdisciplinary, iterative, consensus-based workflow that may serve as a blueprint for developing further data set definitions. The GECCO extension modules provide standardized and harmonized definitions of specialty-related data sets that can help enable interinstitutional and cross-country COVID-19 research in these specialties. %R 10.2196/45496 %U https://medinform.jmir.org/2023/1/e45496 %U https://doi.org/10.2196/45496 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e45263 %T Safety Signal Generation for Sudden Sensorineural Hearing Loss Following Messenger RNA COVID-19 Vaccination: Postmarketing Surveillance Using the French Pharmacovigilance Spontaneous Reporting Database %A Thai-Van,Hung %A Valnet-Rabier,Marie-Blanche %A Anciaux,Maëva %A Lambert,Aude %A Maurier,Anaïs %A Cottin,Judith %A Pietri,Tessa %A Destère,Alexandre %A Damin-Pernik,Marlène %A Perrouin,Fanny %A Bagheri,Haleh %+ Department of Medical and Clinical Pharmacology, Regional Pharmacovigilance Center of Toulouse, CIC1436, Toulouse University Hospital, 37 Allées Jules Guesde, Toulouse, 31000, France, 33 561145902, haleh.bagheri@univ-tlse3.fr %K mRNA COVID-19 vaccine %K COVID-19 %K messenger RNA %K tozinameran %K elasomeran %K sudden sensorineural hearing loss %K audiogram %K positive rechallenge %K spontaneous reporting %K postmarketing %K surveillance %K pharmacovigilance %D 2023 %7 14.7.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The World Health Organization recently described sudden sensorineural hearing loss (SSNHL) as a possible adverse effect of COVID-19 vaccines. Recent discordant pharmacoepidemiologic studies invite robust clinical investigations of SSNHL after COVID-19 messenger RNA (mRNA) vaccines. This postmarketing surveillance study, overseen by French public health authorities, is the first to clinically document postvaccination SSNHL and examine the role of potential risk factors. Objective: This nationwide study aimed to assess the relationship between SSNHL and exposure to mRNA COVID-19 vaccines and estimate the reporting rate (Rr) of SSNHL after mRNA vaccination per 1 million doses (primary outcome). Methods: We performed a retrospective review of all suspected cases of SSNHL after mRNA COVID-19 vaccination spontaneously reported in France between January 2021 and February 2022 based on a comprehensive medical evaluation, including the evaluation of patient medical history, side and range of hearing loss, and hearing recovery outcomes after a minimum period of 3 months. The quantification of hearing loss and assessment of hearing recovery outcomes were performed according to a grading system modified from the Siegel criteria. A cutoff of 21 days was used for the delay onset of SSNHL. The primary outcome was estimated using the total number of doses of each vaccine administered during the study period in France as the denominator. Results: From 400 extracted cases for tozinameran and elasomeran, 345 (86.3%) spontaneous reports were selected. After reviewing complementary data, 49.6% (171/345) of documented cases of SSNHL were identified. Of these, 83% (142/171) of SSNHL cases occurred after tozinameran vaccination: Rr=1.45/1,000,000 injections; no difference for the rank of injections; complete recovery in 22.5% (32/142) of cases; median delay onset before day 21=4 days (median age 51, IQR 13-83 years); and no effects of sex. A total of 16.9% (29/171) of SSNHL cases occurred after elasomeran vaccination: Rr=1.67/1,000,000 injections; rank effect in favor of the first injection (P=.03); complete recovery in 24% (7/29) of cases; median delay onset before day 21=8 days (median age 47, IQR 33-81 years); and no effects of sex. Autoimmune, cardiovascular, or audiovestibular risk factors were present in approximately 29.8% (51/171) of the cases. SSNHL was more often unilateral than bilateral for both mRNA vaccines (P<.001 for tozinameran; P<.003 for elasomeran). There were 13.5% (23/142) of cases of profound hearing loss, among which 74% (17/23) did not recover a serviceable ear. A positive rechallenge was documented for 8 cases. Conclusions: SSNHL after COVID-19 mRNA vaccines are very rare adverse events that do not call into question the benefits of mRNA vaccines but deserve to be known given the potentially disabling impact of sudden deafness. Therefore, it is essential to properly characterize postinjection SSNHL, especially in the case of a positive rechallenge, to provide appropriate individualized recommendations. %M 37071555 %R 10.2196/45263 %U https://publichealth.jmir.org/2023/1/e45263 %U https://doi.org/10.2196/45263 %U http://www.ncbi.nlm.nih.gov/pubmed/37071555 %0 Journal Article %@ 2563-3570 %I JMIR Publications %V 4 %N %P e43906 %T Mutations of SARS-CoV-2 Structural Proteins in the Alpha, Beta, Gamma, and Delta Variants: Bioinformatics Analysis %A Khetran,Saima Rehman %A Mustafa,Roma %+ Department of Life Sciences, Sardar Bahadur Khan Women's University, Bawrery Road near Kidney Hospital Quetta, Quetta, 87300, Pakistan, aspirantcss2022@gmail.com %K virus evolution %K influenza and other respiratory viruses %K advances in virus research %K COVID-19 %K protein %K mutation %K genomic %K vaccine development %K phylogenetic analysis %K biochemistry %D 2023 %7 14.7.2023 %9 Original Paper %J JMIR Bioinform Biotech %G English %X Background: COVID-19 and Middle East Respiratory Syndrome are two pandemic respiratory diseases caused by coronavirus species. The novel disease COVID-19 caused by SARS-CoV-2 was first reported in Wuhan, Hubei Province, China, in December 2019, and became a pandemic within 2-3 months, affecting social and economic platforms worldwide. Despite the rapid development of vaccines, there have been obstacles to their distribution, including a lack of fundamental resources, poor immunization, and manual vaccine replication. Several variants of the original Wuhan strain have emerged in the last 3 years, which can pose a further challenge for control and vaccine development. Objective: The aim of this study was to comprehensively analyze mutations in SARS-CoV-2 variants of concern (VoCs) using a bioinformatics approach toward identifying novel mutations that may be helpful in developing new vaccines by targeting these sites. Methods: Reference sequences of the SARS-CoV-2 spike (YP_009724390) and nucleocapsid (YP_009724397) proteins were compared to retrieved sequences of isolates of four VoCs from 14 countries for mutational and evolutionary analyses. Multiple sequence alignment was performed and phylogenetic trees were constructed by the neighbor-joining method with 1000 bootstrap replicates using MEGA (version 6). Mutations in amino acid sequences were analyzed using the MultAlin online tool (version 5.4.1). Results: Among the four VoCs, a total of 143 nonsynonymous mutations and 8 deletions were identified in the spike and nucleocapsid proteins. Multiple sequence alignment and amino acid substitution analysis revealed new mutations, including G72W, M2101I, L139F, 209-211 deletion, G212S, P199L, P67S, I292T, and substitutions with unknown amino acid replacement, reported in Egypt (MW533289), the United Kingdom (MT906649), and other regions. The variants B.1.1.7 (Alpha variant) and B.1.617.2 (Delta variant), characterized by higher transmissibility and lethality, harbored the amino acid substitutions D614G, R203K, and G204R with higher prevalence rates in most sequences. Phylogenetic analysis among the novel SARS-CoV-2 variant proteins and some previously reported β-coronavirus proteins indicated that either the evolutionary clade was weakly supported or not supported at all by the β-coronavirus species. Conclusions: This study could contribute toward gaining a better understanding of the basic nature of SARS-CoV-2 and its four major variants. The numerous novel mutations detected could also provide a better understanding of VoCs and help in identifying suitable mutations for vaccine targets. Moreover, these data offer evidence for new types of mutations in VoCs, which will provide insight into the epidemiology of SARS-CoV-2. %M 37485046 %R 10.2196/43906 %U https://bioinform.jmir.org/2023/1/e43906 %U https://doi.org/10.2196/43906 %U http://www.ncbi.nlm.nih.gov/pubmed/37485046 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e46563 %T Implementing and Maintaining a SARS-CoV-2 Exposure Notification Application for Mobile Phones: The Finnish Experience %A Pihlajamäki,Mika %A Wickström,Sara %A Puranen,Kaija %A Helve,Otto %A Yrttiaho,Aleksi %A Siira,Lotta %+ Finnish Institute for Health and Welfare, PO Box 30, Helsinki, 00271, Finland, 358 29 524 8755, lotta.siira@thl.fi %K digital proximity tracing %K DPT %K exposure notification application %K ENA %K COVID-19 %K Finland %K digital health %K mobile health %K mHealth %K contact tracing %K user %K data privacy %K effectiveness %K mobile app %K technology %K public health %D 2023 %7 13.7.2023 %9 Viewpoint %J JMIR Public Health Surveill %G English %X Exposure notification applications (ENAs) or digital proximity tracing apps were used in several countries during the COVID-19 pandemic. In this viewpoint, we share our experience of implementing and running the Finnish ENA (Koronavilkku), one of the national ENAs with the highest proportion of users during the pandemic. With the aim of strengthening public trust and increasing app uptake, there was a strong prioritization of privacy and data security for the end user throughout the ENA development. This, in turn, limited the use of the app as a tool for health care professionals and deeper insight into its potential effectiveness. The ENA was designed to supplement conventional contact tracing, rather than replace it, and to serve as an early warning system and a trigger for action for the user in case of potential exposure. The predefined target of 40% uptake in the population was achieved within 3 months of the ENA launch. We consider easy-to-understand information produced together with communication experts crucial during the changing pandemic situation. This information educated people about the app as one component in mitigating the pandemic. As the pandemic and its mitigation evolved, the ENA also needed adapting and updating. A few months after its launch, Finland joined European interoperability, which allowed the ENA to share information with ENAs of other countries. We added automatic token issuing to the ENA as of mid-2021. If added earlier and more comprehensively, automatization could have more effectively saved resources in health care services and prevented overburdening contact tracing teams, while also notifying potentially exposed individuals quicker and more reliably. In the spring of 2021, the number of active apps started to gradually decline. Quarantine and testing practices for asymptomatic vaccinated individuals following exposure to the virus were eased and home tests became more common, eventually replacing laboratory testing for much of the population. Taken together, this led to decreased token issuance, which weakened the potential public health usefulness of the app. A self-service option for token issuance would likely have prolonged the lifespan of the app. The ENA was discontinued in mid-2022. Regularly conducted surveys would have helped gain timely knowledge on the use and effectiveness of the app for better responding to the changing needs during the pandemic. %M 37440286 %R 10.2196/46563 %U https://publichealth.jmir.org/2023/1/e46563 %U https://doi.org/10.2196/46563 %U http://www.ncbi.nlm.nih.gov/pubmed/37440286 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e44727 %T Understanding Resilience and Mental Well-Being in Southwest Indigenous Nations and the Impact of COVID-19: Protocol for a Multimethods Study %A Baldwin,Julie A %A Alvarado,Angelica %A Jarratt-Snider,Karen %A Hunter,Amanda %A Keene,Chesleigh %A Castagno,Angelina E %A Ali-Joseph,Alisse %A Roddy,Juliette %A Begay Jr,Manley A %A Joseph,Darold H %A Goldtooth,Carol %A Camplain,Carolyn %A Smith,Melinda %A McCue,Kelly %A Begay,Andria B %A Teufel-Shone,Nicolette I %+ Northern Arizona University, NAU P. O. Box 4065, Flagstaff, AZ, 86011, United States, 1 9285236566, Julie.Baldwin@nau.edu %K community-engaged research %K Indigenous %K Native nations %K COVID-19 %K resilience %K well-being %D 2023 %7 13.7.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Despite experiencing many adversities, American Indian and Alaska Native populations have demonstrated tremendous resilience during the COVID-19 pandemic, drawing upon Indigenous determinants of health (IDOH) and Indigenous Nation Building. Objective: Our multidisciplinary team undertook this study to achieve two aims: (1) to determine the role of IDOH in tribal government policy and action that supports Indigenous mental health and well-being and, in turn, resilience during the COVID-19 crisis and (2) to document the impact of IDOH on Indigenous mental health, well-being, and resilience of 4 community groups, specifically first responders, educators, traditional knowledge holders and practitioners, and members of the substance use recovery community, working in or near 3 Native nations in Arizona. Methods: To guide this study, we developed a conceptual framework based on IDOH, Indigenous Nation Building, and concepts of Indigenous mental well-being and resilience. The research process was guided by the Collective benefit, Authority to control, Responsibility, Ethics (CARE) principles for Indigenous Data Governance to honor tribal and data sovereignty. Data were collected through a multimethods research design, including interviews, talking circles, asset mapping, and coding of executive orders. Special attention was placed on the assets and culturally, socially, and geographically distinct features of each Native nation and the communities within them. Our study was unique in that our research team consisted predominantly of Indigenous scholars and community researchers representing at least 8 tribal communities and nations in the United States. The members of the team, regardless of whether they identified themselves as Indigenous or non-Indigenous, have many collective years of experience working with Indigenous Peoples, which ensures that the approach is culturally respectful and appropriate. Results: The number of participants enrolled in this study was 105 adults, with 92 individuals interviewed and 13 individuals engaged in 4 talking circles. Because of time constraints, the team elected to host talking circles with only 1 nation, with participants ranging from 2 to 6 in each group. Currently, we are in the process of conducting a qualitative analysis of the transcribed narratives from interviews, talking circles, and executive orders. These processes and outcomes will be described in future studies. Conclusions: This community-engaged study lays the groundwork for future studies addressing Indigenous mental health, well-being, and resilience. Findings from this study will be shared through presentations and publications with larger Indigenous and non-Indigenous audiences, including local recovery groups, treatment centers, and individuals in recovery; K-12 and higher education educators and administrators; directors of first responder agencies; traditional medicine practitioners; and elected community leaders. The findings will also be used to produce well-being and resilience education materials, in-service training sessions, and future recommendations for stakeholder organizations. International Registered Report Identifier (IRRID): DERR1-10.2196/44727 %M 37205637 %R 10.2196/44727 %U https://www.researchprotocols.org/2023/1/e44727 %U https://doi.org/10.2196/44727 %U http://www.ncbi.nlm.nih.gov/pubmed/37205637 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e46867 %T Investigating COVID-19’s Impact on Mental Health: Trend and Thematic Analysis of Reddit Users’ Discourse %A Zhu,Jianfeng %A Yalamanchi,Neha %A Jin,Ruoming %A Kenne,Deric R %A Phan,NhatHai %+ Department of Computer Science, Kent State University, 800 E Summit St, Kent, OH, 44240, United States, 1 2348639445, jzhu10@kent.edu %K COVID-19 %K Reddit %K r/Depression %K r/Anxiety %K pandemic %K mental health %K trend analysis %K thematic analysis %K natural language processing (NLP) %K Word2Vec %D 2023 %7 12.7.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic has resulted in heightened levels of depression, anxiety, and other mental health issues due to sudden changes in daily life, such as economic stress, social isolation, and educational irregularity. Accurately assessing emotional and behavioral changes in response to the pandemic can be challenging, but it is essential to understand the evolving emotions, themes, and discussions surrounding the impact of COVID-19 on mental health. Objective: This study aims to understand the evolving emotions and themes associated with the impact of COVID-19 on mental health support groups (eg, r/Depression and r/Anxiety) on Reddit (Reddit Inc) during the initial phase and after the peak of the pandemic using natural language processing techniques and statistical methods. Methods: This study used data from the r/Depression and r/Anxiety Reddit communities, which consisted of posts contributed by 351,409 distinct users over a period spanning from 2019 to 2022. Topic modeling and Word2Vec embedding models were used to identify key terms associated with the targeted themes within the data set. A range of trend and thematic analysis techniques, including time-to-event analysis, heat map analysis, factor analysis, regression analysis, and k-means clustering analysis, were used to analyze the data. Results: The time-to-event analysis revealed that the first 28 days following a major event could be considered a critical window for mental health concerns to become more prominent. The theme trend analysis revealed key themes such as economic stress, social stress, suicide, and substance use, with varying trends and impacts in each community. The factor analysis highlighted pandemic-related stress, economic concerns, and social factors as primary themes during the analyzed period. Regression analysis showed that economic stress consistently demonstrated the strongest association with the suicide theme, whereas the substance theme had a notable association in both data sets. Finally, the k-means clustering analysis showed that in r/Depression, the number of posts related to the “depression, anxiety, and medication” cluster decreased after 2020, whereas the “social relationships and friendship” cluster showed a steady decrease. In r/Anxiety, the “general anxiety and feelings of unease” cluster peaked in April 2020 and remained high, whereas the “physical symptoms of anxiety” cluster showed a slight increase. Conclusions: This study sheds light on the impact of COVID-19 on mental health and the related themes discussed in 2 web-based communities during the pandemic. The results offer valuable insights for developing targeted interventions and policies to support individuals and communities in similar crises. %M 37436793 %R 10.2196/46867 %U https://www.jmir.org/2023/1/e46867 %U https://doi.org/10.2196/46867 %U http://www.ncbi.nlm.nih.gov/pubmed/37436793 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e41388 %T Assessment of the Dissemination of COVID-19–Related Articles Across Social Media: Altmetrics Study %A Tornberg,Haley %A Moezinia,Carine %A Wei,Chapman %A Bernstein,Simone A %A Wei,Chaplin %A Al-Beyati,Refka %A Quan,Theodore %A Diemert,David J %+ Department of Medicine, David Geffen School of Medicine at University of California, 10833 Le Conte Ave, Los Angeles, CA, 90095, United States, 1 313 310 2931, Ralbeyat@gmail.com %K Altmetric %K COVID-19 %K citation %K dissemination %K information spread %K impact factor %K information %K social media %K bibliometric %K scientometric %K health professional %K Twitter %K database %K data %K citation %K impact factor %D 2023 %7 12.7.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: The use of social media assists in the distribution of information about COVID-19 to the general public and health professionals. Alternative-level metrics (ie, Altmetrics) is an alternative method to traditional bibliometrics that assess the extent of dissemination of a scientific article on social media platforms. Objective: Our study objective was to characterize and compare traditional bibliometrics (citation count) with newer metrics (Altmetric Attention Score [AAS]) of the top 100 Altmetric-scored articles on COVID-19. Methods: The top 100 articles with the highest AAS were identified using the Altmetric explorer in May 2020. AAS, journal name, and mentions from various social media platforms (Twitter, Facebook, Wikipedia, Reddit, Mendeley, and Dimension) were collected for each article. Citation counts were collected from the Scopus database. Results: The median AAS and citation count were 4922.50 and 24.00, respectively. TheNew England Journal of Medicine published the most articles (18/100, 18%). Twitter was the most frequently used social media platform with 985,429 of 1,022,975 (96.3%) mentions. Positive correlations were observed between AAS and citation count (r2=0.0973; P=.002). Conclusions: Our research characterized the top 100 COVID-19–related articles by AAS in the Altmetric database. Altmetrics could complement traditional citation count when assessing the dissemination of an article regarding COVID-19. International Registered Report Identifier (IRRID): RR2-10.2196/21408 %M 37343075 %R 10.2196/41388 %U https://formative.jmir.org/2023/1/e41388 %U https://doi.org/10.2196/41388 %U http://www.ncbi.nlm.nih.gov/pubmed/37343075 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e41376 %T COVID-19 Conceptual Modeling: Single-Center Cross-Sectional Study %A Abuauf,Mawahib %A Raboe,Enaam Hassan %A Alshareef,Muneera %A Rabie,Nada %A Zailaie,Roaa %A Alharbi,Abdullah %A Felemban,Walaa %A Alnasser,Ibrahim %A Shalaby,Hanin %+ Pediatric Department, King Fahad Armed Forces Hospital, Al Kurnaysh Br Rd, Al Andalus, Jeddah, 23341-7384, Saudi Arabia, 966 505653268, maabuaufmd@hotmail.com %K conceptual model %K conceptual framework %K modeling %K Saudi Arabia %K COVID-19 %K SARS-CoV-2 %K mortality %K morbidity %K CURB-65 %K socioeconomic %K health care %K hospital database %K electronic record %K medical decision-making %K hospital admission %K hospitalization %K cross-sectional %K death %K intensive care %D 2023 %7 11.7.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Conceptual models are abstract representations of the real world. They are used to refine medical and nonmedical health care scopes of service. During the COVID-19 pandemic, numerous analytic predictive models were generated aiming to evaluate the impact of implemented policies on mitigating the spread of the virus. The models also aimed to examine the psychosocial factors that might govern the general population’s adherence to these policies and to identify factors that could affect COVID-19 vaccine uptake and allocation. The outcomes of these analytic models helped set priorities when vaccines were available and predicted readiness to resume non–COVID-19 health care services. Objective: The objective of our research was to implement a descriptive-analytical conceptual model that analyzes the data of all COVID-19–positive cases admitted to our hospital from March 1 to May 31, 2020, the initial wave of the pandemic, the time interval during which local policies and clinical guidelines were constantly updated to mitigate the local effects of COVID-19, minimize mortality, reduce intensive care unit (ICU) admission, and ensure the safety of health care providers. The primary outcome of interest was to identify factors that might affect mortality and ICU admission rates and the impact of the implemented policy on COVID-19 positivity among health care providers. The secondary outcome of interest was to evaluate the sensitivity of the COVID-19 visual score, implemented by the Saudi Arabia Ministry of Health for COVID-19 risk assessment, and CURB-65 (confusion, urea, respiratory rate, blood pressure, and age >65 years) scores in predicting ICU admission or mortality among the study population. Methods: This was a cross-sectional study. The relevant attributes were constructed based on research findings from the first wave of the pandemic and were electronically retrieved from the hospital database. Analysis of the conceptual model was based on the International Society for Pharmacoeconomics and Outcomes Research guidelines and the Society for Medical Decision-Making. Results: A total of 275 individuals tested positive for COVID-19 within the study design interval. The conceptualization model revealed a low-risk population based on the following attributes: a mean age of 42 (SD 19.2) years; 19% (51/275) of the study population being older adults ≥60 years of age; 80% (220/275) having a CURB-65 score <4; 53% (147/275) having no comorbidities; 5% (13/275) having extreme obesity; and 20% (55/275) having a significant hematological abnormality. The overall rate of ICU admission for the study population was 5% (13/275), and the overall mortality rate was 1.5% (4/275). The multivariate correlation analysis revealed that a high-selectivity approach was adopted, resulting in patients with complex medical problems not being sent to MOH isolation facilities. Furthermore, 5% of health care providers tested positive for COVID-19, none of whom were health care providers allocated to the COVID-19 screening areas, indicating the effectiveness of the policy implemented to ensure the safety of health care providers. Conclusions: Based on the conceptual model outcome, the selectivity applied in retaining high-risk populations within the hospital might have contributed to the observed low mortality rate, without increasing the risk to attending health care providers. %M 37256829 %R 10.2196/41376 %U https://formative.jmir.org/2023/1/e41376 %U https://doi.org/10.2196/41376 %U http://www.ncbi.nlm.nih.gov/pubmed/37256829 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e42143 %T The Impact of Priority Settings at the Start of COVID-19 Mass Vaccination on Subsequent Vaccine Uptake in Japan: One-Year Prospective Cohort Study %A Hori,Daisuke %A Takahashi,Tsukasa %A Ozaki,Akihiko %A Tabuchi,Takahiro %+ Institute of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, 305-8575, Japan, 81 29 853 6025, daisuke_hori@md.tsukuba.ac.jp %K cohort studies %K SARS-CoV-2 %K COVID-19 %K Japan %K vaccination %K vaccination hesitancy %K vaccines %D 2023 %7 10.7.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Distributing COVID-19 vaccines to the public was an important task for the governments of each country. Because of various limitations, priority settings for vaccination were determined at the time of mass vaccination. However, trends between vaccine intention and uptake, as well as reasons for getting vaccinated or not getting vaccinated, among these groups were understudied, undermining verification of the legitimacy of priority selection. Objective: This study aims to illustrate a trend from prior COVID-19 vaccine intention, when the vaccine was not available, to the actual uptake within 1 year when all residents had access to the vaccine, to illustrate a change of reason for getting vaccinated or not getting vaccinated and to examine whether priority settings predicted subsequent vaccination uptake. Methods: Prospective cohort, web-based, self-administered surveys were conducted in Japan at 3 time points: February 2021, September to October 2021, and February 2022. In total, 13,555 participants (age: mean 53.1, SD 15.9 years) provided valid responses, with a 52.1% follow-up rate. On the basis of the information obtained in February 2021, we identified 3 types of priority groups: health care workers (n=831), people aged ≥65 years (n=4048), and those aged 18 to 64 years with underlying medical conditions (n=1659). The remaining patients were treated as nonpriority (n=7017). Modified Poisson regression analysis with a robust error estimated the risk ratio for COVID-19 vaccine uptake after adjusting for socioeconomic background, health-seeking behavior, attitude toward vaccines, and COVID-19 infection history. Results: In February 2021, a total of 5182 out of 13,555 (38.23%) respondents expressed their intention to get vaccinated. In February 2022, a total of 1570 out of 13,555 (11.6%) respondents completed the third dose and 10,589 (78.1%) respondents completed the second dose. Prior vaccine intention and subsequent vaccine coverage rates were higher in the priority groups. Protection of themselves and their families from potential infection was the most frequent reason for getting vaccinated, whereas concern about side effects was the most frequent reason for hesitation across the groups. Risk ratios for received, reserved, or intended for vaccination in February 2022 were 1.05 (95% CI 1.03-1.07) for the health care worker group, 1.02 (95% CI 1.005-1.03) for the older adult group, and 1.01 (95% CI 0.999-1.03) for the preexisting conditions group compared with the nonpriority group. Prior vaccine intention and confidence in vaccines were strong predictors of vaccine uptake. Conclusions: The priority settings at the start of the COVID-19 vaccination program had a significant impact on vaccine coverage after 1 year. The priority group for vaccination achieved higher vaccination coverage in February 2022. There was room for improvement among the nonpriority group. The findings of this study are essential for policy makers in Japan and other countries to develop effective vaccination strategies for future pandemics. %M 37235691 %R 10.2196/42143 %U https://publichealth.jmir.org/2023/1/e42143 %U https://doi.org/10.2196/42143 %U http://www.ncbi.nlm.nih.gov/pubmed/37235691 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e44188 %T Facilitators of and Barriers to Accessing Hospital Medical Specialty Telemedicine Consultations During the COVID-19 Pandemic: Systematic Review %A Cunha,Ana Soraia %A Pedro,Ana Rita %A Cordeiro,João V %+ NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Avenida Padre Cruz, Lisbon, 1600-560, Portugal, 351 217 512 100, asr.cunha@ensp.unl.pt %K health services accessibility %K COVID-19 %K hospitals %K barriers %K facilitators %K telemedicine %D 2023 %7 10.7.2023 %9 Review %J J Med Internet Res %G English %X Background: The COVID-19 pandemic accelerated the digital transition in health care, which required a rapid adaptation for stakeholders. Telemedicine has emerged as an ideal tool to ensure continuity of care by allowing remote access to specialized medical services. However, its rapid implementation has exacerbated disparities in health care access, especially for the most susceptible populations. Objective: We aimed to characterize the determinant factors (facilitators and barriers) of access to hospital medical specialty telemedicine consultations during the COVID-19 pandemic and to identify the main opportunities and challenges (technological, ethical, legal, and social) generated by the use of telemedicine in the context of the COVID-19 pandemic. Methods: We conducted a systematic review according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A total of 4 databases (Scopus, Web of Science, PubMed, and Cochrane COVID-19 Study Register) were searched for empirical studies published between January 3, 2020, and December 31, 2021, using established criteria. The protocol of this review was registered and published in PROSPERO (CRD42022302825). A methodological quality assessment was performed, and the results were integrated into a thematic synthesis. The identification of the main opportunities and challenges was done by interpreting and aggregating the thematic synthesis results. Results: Of the 106 studies identified, 9 met the inclusion criteria and the intended quality characteristics. All studies were originally from the United States. The following facilitating factors of telemedicine use were identified: health insurance coverage; prevention of SARS-CoV-2 infection; access to internet services; access to technological devices; better management of work-life balance; and savings in travel costs. We identified the following barriers to telemedicine use: lack of access to internet services; lack of access to technological devices; racial and ethnic disparities; low digital literacy; low income; age; language barriers; health insurance coverage; concerns about data privacy and confidentiality; geographic disparities; and the need for complementary diagnostic tests or the delivery of test results. Conclusions: The facilitating factors and barriers identified in this systematic review present different opportunities and challenges, including those of a technological nature (access to technological devices and internet services and level of digital literacy), a sociocultural and demographic nature (ethnic and racial disparities, geographic disparities, language barriers, and age), a socioeconomic nature (income level and health insurance coverage), and an ethical and legal nature (data privacy and confidentiality). To expand telemedicine access to hospital-based specialty medical consultations and provide high-quality care to all, including the most susceptible communities, the challenges identified must be thoroughly researched and addressed with informed and dedicated responses. %M 37262124 %R 10.2196/44188 %U https://www.jmir.org/2023/1/e44188 %U https://doi.org/10.2196/44188 %U http://www.ncbi.nlm.nih.gov/pubmed/37262124 %0 Journal Article %@ 2817-1705 %I JMIR Publications %V 2 %N %P e42313 %T Application of a Comprehensive Evaluation Framework to COVID-19 Studies: Systematic Review of Translational Aspects of Artificial Intelligence in Health Care %A Casey,Aaron Edward %A Ansari,Saba %A Nakisa,Bahareh %A Kelly,Blair %A Brown,Pieta %A Cooper,Paul %A Muhammad,Imran %A Livingstone,Steven %A Reddy,Sandeep %A Makinen,Ville-Petteri %+ South Australian Health and Medical Research Institute, North Terrace, Adelaide, 5000, Australia, 61 08 8128 4064, aaron.casey@sahmri.com %K artificial intelligence %K health care %K clinical translation %K translational value %K evaluation %K capability %K utility %K adoption %K COVID-19 %K AI application %K health care AI %K model validation %K AI model %K AI tools %D 2023 %7 6.7.2023 %9 Review %J JMIR AI %G English %X Background: Despite immense progress in artificial intelligence (AI) models, there has been limited deployment in health care environments. The gap between potential and actual AI applications is likely due to the lack of translatability between controlled research environments (where these models are developed) and clinical environments for which the AI tools are ultimately intended. Objective: We previously developed the Translational Evaluation of Healthcare AI (TEHAI) framework to assess the translational value of AI models and to support successful transition to health care environments. In this study, we applied the TEHAI framework to the COVID-19 literature in order to assess how well translational topics are covered. Methods: A systematic literature search for COVID-19 AI studies published between December 2019 and December 2020 resulted in 3830 records. A subset of 102 (2.7%) papers that passed the inclusion criteria was sampled for full review. The papers were assessed for translational value and descriptive data collected by 9 reviewers (each study was assessed by 2 reviewers). Evaluation scores and extracted data were compared by a third reviewer for resolution of discrepancies. The review process was conducted on the Covidence software platform. Results: We observed a significant trend for studies to attain high scores for technical capability but low scores for the areas essential for clinical translatability. Specific questions regarding external model validation, safety, nonmaleficence, and service adoption received failed scores in most studies. Conclusions: Using TEHAI, we identified notable gaps in how well translational topics of AI models are covered in the COVID-19 clinical sphere. These gaps in areas crucial for clinical translatability could, and should, be considered already at the model development stage to increase translatability into real COVID-19 health care environments. %M 37457747 %R 10.2196/42313 %U https://ai.jmir.org/2023/1/e42313 %U https://doi.org/10.2196/42313 %U http://www.ncbi.nlm.nih.gov/pubmed/37457747 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e44603 %T Reddit and Google Activity Related to Non-COVID Epidemic Diseases Surged at Start of COVID-19 Pandemic: Retrospective Study %A Cummins,Jack A %A Lipworth,Adam D %+ Lahey Dermatology, 67 S Bedford St, Burlington, MA 01803, Burlington, MA, , United States, 1 781 744 5115, adam.d.lipworth@lahey.org %K COVID-19 %K Reddit %K Google Trends %K chikungunya %K Ebola %K H1N1 %K Middle Eastern respiratory syndrome %K MERS %K severe acute respiratory syndrome %K SARS %K Zika %K infectious disease %K social media %K search data %K search query %K web-based search %K information behavior %K information seeking %K public interest %D 2023 %7 6.7.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Resources such as Google Trends and Reddit provide opportunities to gauge real-time popular interest in public health issues. Despite the potential for these publicly available and free resources to help optimize public health campaigns, use for this purpose has been limited. Objective: The purpose of this study is to determine whether early public awareness of COVID-19 correlated with elevated public interest in other infectious diseases of public health importance. Methods: Google Trends search data and Reddit comment data were analyzed from 2018 through 2020 for the frequency of keywords “chikungunya,” “Ebola,” “H1N1,” “MERS,” “SARS,” and “Zika,” 6 highly publicized epidemic diseases in recent decades. After collecting Google Trends relative popularity scores for each of these 6 terms, unpaired 2-tailed t tests were used to compare the 2020 weekly scores for each term to their average level over the 3-year study period. The number of Reddit comments per month with each of these 6 terms was collected and then adjusted for the total estimated Reddit monthly comment volume to derive a measure of relative use, analogous to the Google Trends popularity score. The relative monthly incidence of comments with each search term was then compared to the corresponding search term’s pre-COVID monthly comment data, again using unpaired 2-tailed t tests. P value cutoffs for statistical significance were determined a priori with a Bonferroni correction. Results: Google Trends and Reddit data both demonstrate large and statistically significant increases in the usage of each evaluated disease term through at least the initial months of the pandemic. Google searches and Reddit comments that included any of the evaluated infectious disease search terms rose significantly in the first months of 2020 above their baseline usage, peaking in March 2020. Google searches for “SARS” and “MERS” remained elevated for the entirety of the 2020 calendar year, as did Reddit comments with the words “Ebola,” “H1N1,” “MERS,” and “SARS” (P<.001, for each weekly or monthly comparison, respectively). Conclusions: Google Trends and Reddit can readily be used to evaluate real-time general interest levels in public health–related topics, providing a tool to better time and direct public health initiatives that require a receptive target audience. The start of the COVID-19 pandemic correlated with increased public interest in other epidemic infectious diseases. We have demonstrated that for 6 distinct infectious causes of epidemics over the last 2 decades, public interest rose substantially and rapidly with the outbreak of COVID-19. Our data suggests that for at least several months after the initial outbreak, the public may have been particularly receptive to dialogue on these topics. Public health officials should consider using Google Trends and social media data to identify patterns of engagement with public health topics in real time and to optimize the timing of public health campaigns. %M 37256832 %R 10.2196/44603 %U https://formative.jmir.org/2023/1/e44603 %U https://doi.org/10.2196/44603 %U http://www.ncbi.nlm.nih.gov/pubmed/37256832 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e42958 %T COVID-19 Vaccine Hesitancy Among Patients Recovered From COVID-19 Infection in Wuhan, China: Cross-Sectional Questionnaire Study %A Huang,Yiman %A Zhang,Ling %A Fu,Jiaqi %A Wu,Yijin %A Wang,Hao %A Xiao,Weijun %A Xin,You %A Dai,Zhenwei %A Si,Mingyu %A Chen,Xu %A Jia,Mengmeng %A Leng,Zhiwei %A Cui,Dan %A Su,Xiaoyou %+ School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, 31 BeiJiGe San Tiao, Dongcheng District, Beijing, 100730, China, 86 65105830, suxiaoyou@hotmail.com %K COVID-19 %K COVID-19 survivors %K vaccine hesitancy %K complacency %K confidence %K convenience %K cross-sectional questionnaire %K health education %K health promotion %K public health %D 2023 %7 3.7.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Although patients recovered from COVID-19 already have immunity gained from natural infection, they are still at risk of reinfection due to the emergence of new variants of COVID-19 and the diminishing of naturally acquired immunity over time. Vaccination is associated with efficacious protection against COVID-19 infection and could boost infection-acquired immunity; however, various COVID-19 survivors have not been vaccinated due to vaccine hesitancy. Objective: The aim of this study was to investigate COVID-19 vaccine hesitancy and related factors among COVID-19 survivors. Methods: A cross-sectional questionnaire survey was conducted among patients who recovered from COVID-19 infection in Wuhan, China, between June 10 and July 25, 2021. The questionnaire included sociodemographic information, items on COVID-19 infection, the COVID-19 vaccine hesitancy scale based on the 3Cs (complacency, convenience, and confidence) model, trust in vaccine manufacturers and health facilities, and reasons for the decision to accept COVID-19 vaccination. Multivariate logistic regression analysis was used to assess the factors influencing COVID-19 vaccine hesitancy. Results: Among the 1422 participants, 538 (37.8%) were not vaccinated against COVID-19. The COVID-19–recovered patients who self-reported having a current unhealthy status expressed more hesitancy about the COVID-19 vaccine than those who perceived themselves to be healthy (odds ratio [OR] 0.45, 95% CI 0.28-0.71). Compared to the asymptomatic patients, patients with mild symptoms were more likely to receive a COVID-19 vaccine (OR 1.67, 95% CI 1.02-2.82). Regarding the 3Cs model, high complacency (P=.005) and low convenience (P=.004) were significant negative factors for COVID-19 vaccination. Trust in vaccine manufacturers and health facilities was a significant positive factor for COVID-19 vaccination (OR 1.14, 95% CI 1.09-1.19). “Self-needs” was the main reason for patients to receive the COVID-19 vaccine, whereas “already have antibodies and do not need vaccination” was the main reason for patients to not receive the COVID-19 vaccine. Conclusions: Among the three major factors of vaccine hesitancy, complacency proved to be the most notable among COVID-19–recovered patients. Therefore, educational campaigns can focus on raising the awareness of risk of infection and the benefits of vaccination to reduce complacency toward vaccination among this population. In particular, for individuals who have recovered from COVID-19, improving factors related to convenience such as transportation, the environment of vaccination, and providing door-to-door service was also deemed necessary to facilitate their vaccination. In addition, addressing the concerns about vaccination of COVID-19–recovered patients could foster trust and promote their uptake of vaccination. %M 37247615 %R 10.2196/42958 %U https://publichealth.jmir.org/2023/1/e42958 %U https://doi.org/10.2196/42958 %U http://www.ncbi.nlm.nih.gov/pubmed/37247615 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e40441 %T Addressing Behavioral Barriers to COVID-19 Testing With Health Literacy–Sensitive eHealth Interventions: Results From 2 National Surveys and 2 Randomized Experiments %A Bonner,Carissa %A Batcup,Carys %A Cvejic,Erin %A Ayre,Julie %A Pickles,Kristen %A Copp,Tessa %A Cornell,Samuel %A Nickel,Brooke %A Dhahir,Mustafa %A McCaffery,Kirsten %+ School of Public Health, Faculty of Medicine and Health, University of Sydney, Edward Ford Building A27, Sydney, 2006, Australia, 61 2 9351 7125, carissa.bonner@sydney.edu.au %K behavior change %K health literacy %K COVID-19 %K testing %K infectious disease %K public health %D 2023 %7 29.6.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Polymerase chain reaction (PCR) testing for COVID-19 was crucial in Australia’s prevention strategy in the first 2 years of the pandemic, including required testing for symptoms, contact with cases, travel, and certain professions. However, several months into the pandemic, half of Australians were still not getting tested for respiratory symptoms, and little was known about the drivers of and barriers to COVID-19 PCR testing as a novel behavior at that time. Objective: We aimed to identify and address COVID-19 testing barriers, and test the effectiveness of multiple eHealth interventions on knowledge for people with varying health literacy levels. Methods: The intervention was developed in 4 phases. Phase 1 was a national survey conducted in June 2020 (n=1369), in which testing barriers were coded using the capability-opportunity-motivation-behavior framework. Phase 2 was a national survey conducted in November 2020 (n=2034) to estimate the prevalence of testing barriers and health literacy disparities. Phase 3 was a randomized experiment testing health literacy–sensitive written information for a wide range of barriers between February and March 2021 (n=1314), in which participants chose their top 3 barriers to testing to view a tailored intervention. Phase 4 was a randomized experiment testing 2 audio-visual interventions addressing common testing barriers for people with lower health literacy in November 2021, targeting young adults as a key group endorsing misinformation (n=1527). Results: In phase 1, barriers were identified in all 3 categories: capability (eg, understanding which symptoms to test for), opportunity (eg, not being able to access a PCR test), and motivation (eg, not believing the symptoms are those of COVID-19). Phase 2 identified knowledge gaps for people with lower versus higher health literacy. Phase 3 found no differences between the intervention (health literacy–sensitive text for top 3 barriers) and control groups. Phase 4 showed that a fact-based animation or a TikTok-style video presenting the same facts in a humorous style increased knowledge about COVID-19 testing compared with government information. However, no differences were found for COVID-19 testing intentions. Conclusions: This study identified a wide range of barriers to a novel testing behavior, PCR testing for COVID-19. These barriers were prevalent even in a health system where COVID-19 testing was free and widely available. We showed that key capability barriers, such as knowledge gaps, can be improved with simple videos targeting people with lower health literacy. Additional behavior change strategies are required to address motivational issues to support testing uptake. Future research will explore health literacy strategies in the current context of self-administered rapid antigen tests. The findings may inform planning for future COVID-19 variant outbreaks and new public health emergencies where novel testing behaviors are required. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12621000876897, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=382318 ; Australian New Zealand Clinical Trials Registry ACTRN12620001355965, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380916&isReview=true %M 37172319 %R 10.2196/40441 %U https://publichealth.jmir.org/2023/1/e40441 %U https://doi.org/10.2196/40441 %U http://www.ncbi.nlm.nih.gov/pubmed/37172319 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 9 %N %P e39831 %T Influence of Social Media on Applicant Perceptions of Anesthesiology Residency Programs During the COVID-19 Pandemic: Quantitative Survey %A Dunn,Tyler %A Patel,Shyam %A Milam,Adam J %A Brinkman,Joseph %A Gorlin,Andrew %A Harbell,Monica W %+ Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 5777 E Mayo Blvd, Phoenix, AZ, 85054, United States, 1 480 342 1800, Harbell.Monica@mayo.edu %K anesthesiology residency %K application %K COVID-19 pandemic %K social media %K impact %K residency %K anesthesia %K anesthesiology %K pandemic %K effectiveness %K restrictions %K barriers %K rotations %K visits %K interviews %K applicants %K perception %K students %K program %D 2023 %7 29.6.2023 %9 Original Paper %J JMIR Med Educ %G English %X Background: Social media may be an effective tool in residency recruitment, given its ability to engage a broad audience; however, there are limited data regarding the influence of social media on applicants’ evaluation of anesthesiology residency programs. Objective: This study evaluates the influence of social media on applicants’ perceptions of anesthesiology residency programs during the COVID-19 pandemic to allow programs to evaluate the importance of a social media presence for residency recruitment. The study also sought to understand if there were differences in the use of social media by applicant demographic characteristics (eg, race, ethnicity, gender, and age). We hypothesized that given the COVID-19 pandemic restrictions on visiting rotations and the interview process, the social media presence of anesthesiology residency programs would have a positive impact on the recruitment process and be an effective form of communication about program characteristics. Methods: All anesthesiology residency applicants who applied to Mayo Clinic Arizona were emailed a survey in October 2020 along with statements regarding the anonymity and optional nature of the survey. The 20-item Qualtrics survey included questions regarding subinternship rotation completion, social media resource use and impact (eg, “residency-based social media accounts positively impacted my opinion of the program”), and applicant demographic characteristics. Descriptive statistics were examined, and perceptions of social media were stratified by gender, race, and ethnicity; a factor analysis was performed, and the resulting scale was regressed on race, ethnicity, age, and gender. Results: The survey was emailed to 1091 individuals who applied to the Mayo Clinic Arizona anesthesiology residency program; there were 640 unique responses recorded (response rate=58.6%). Nearly 65% of applicants reported an inability to complete 2 or more planned subinternships due to COVID-19 restrictions (n=361, 55.9%), with 25% of applicants reporting inability to do any visiting student rotations (n=167). Official program websites (91.5%), Doximity (47.6%), Instagram (38.5%), and Twitter (19.4%) were reported as the most used resources by applicants. The majority of applicants (n=385, 67.3%) agreed that social media was an effective means to inform applicants, and 57.5% (n=328) of them indicated that social media positively impacted their perception of the program. An 8-item scale with good reliability was created, representing the importance of social media (Cronbach α=.838). There was a positive and statistically significant relationship such that male applicants (standardized β=.151; P=.002) and older applicants (β=.159; P<.001) had less trust and reliance in social media for information regarding anesthesiology residency programs. The applicants’ race and ethnicity were not associated with the social media scale (β=–.089; P=.08). Conclusions: Social media was an effective means to inform applicants, and generally positively impacted applicants’ perception of programs. Thus, residency programs should consider investing time and resources toward building a social media presence to improve resident recruitment. %M 37205642 %R 10.2196/39831 %U https://mededu.jmir.org/2023/1/e39831 %U https://doi.org/10.2196/39831 %U http://www.ncbi.nlm.nih.gov/pubmed/37205642 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e41134 %T Interdisciplinary Approach to Identify and Characterize COVID-19 Misinformation on Twitter: Mixed Methods Study %A Isip Tan,Iris Thiele %A Cleofas,Jerome %A Solano,Geoffrey %A Pillejera,Jeanne Genevive %A Catapang,Jasper Kyle %+ English Language and Linguistics, University of Birmingham, The University of Birmingham, Edgbaston, Birmingham, B15 2TT, United Kingdom, 44 0 121 414 3344, jxc1354@student.bham.ac.uk %K COVID-19 %K misinformation %K natural language processing %K Twitter %K biterm topic modeling %D 2023 %7 28.6.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Studying COVID-19 misinformation on Twitter presents methodological challenges. A computational approach can analyze large data sets, but it is limited when interpreting context. A qualitative approach allows for a deeper analysis of content, but it is labor-intensive and feasible only for smaller data sets. Objective: We aimed to identify and characterize tweets containing COVID-19 misinformation. Methods: Tweets geolocated to the Philippines (January 1 to March 21, 2020) containing the words coronavirus, covid, and ncov were mined using the GetOldTweets3 Python library. This primary corpus (N=12,631) was subjected to biterm topic modeling. Key informant interviews were conducted to elicit examples of COVID-19 misinformation and determine keywords. Using NVivo (QSR International) and a combination of word frequency and text search using key informant interview keywords, subcorpus A (n=5881) was constituted and manually coded to identify misinformation. Constant comparative, iterative, and consensual analyses were used to further characterize these tweets. Tweets containing key informant interview keywords were extracted from the primary corpus and processed to constitute subcorpus B (n=4634), of which 506 tweets were manually labeled as misinformation. This training set was subjected to natural language processing to identify tweets with misinformation in the primary corpus. These tweets were further manually coded to confirm labeling. Results: Biterm topic modeling of the primary corpus revealed the following topics: uncertainty, lawmaker’s response, safety measures, testing, loved ones, health standards, panic buying, tragedies other than COVID-19, economy, COVID-19 statistics, precautions, health measures, international issues, adherence to guidelines, and frontliners. These were categorized into 4 major topics: nature of COVID-19, contexts and consequences, people and agents of COVID-19, and COVID-19 prevention and management. Manual coding of subcorpus A identified 398 tweets with misinformation in the following formats: misleading content (n=179), satire and/or parody (n=77), false connection (n=53), conspiracy (n=47), and false context (n=42). The discursive strategies identified were humor (n=109), fear mongering (n=67), anger and disgust (n=59), political commentary (n=59), performing credibility (n=45), overpositivity (n=32), and marketing (n=27). Natural language processing identified 165 tweets with misinformation. However, a manual review showed that 69.7% (115/165) of tweets did not contain misinformation. Conclusions: An interdisciplinary approach was used to identify tweets with COVID-19 misinformation. Natural language processing mislabeled tweets, likely due to tweets written in Filipino or a combination of the Filipino and English languages. Identifying the formats and discursive strategies of tweets with misinformation required iterative, manual, and emergent coding by human coders with experiential and cultural knowledge of Twitter. An interdisciplinary team composed of experts in health, health informatics, social science, and computer science combined computational and qualitative methods to gain a better understanding of COVID-19 misinformation on Twitter. %M 37220196 %R 10.2196/41134 %U https://formative.jmir.org/2023/1/e41134 %U https://doi.org/10.2196/41134 %U http://www.ncbi.nlm.nih.gov/pubmed/37220196 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 3 %N %P e45392 %T Expert Credibility and Sentiment in Infodemiology of Hydroxychloroquine’s Efficacy on Cable News Programs: Empirical Analysis %A Yim,Dobin %A Khuntia,Jiban %A King,Elliot %A Treskon,Matthew %A Galiatsatos,Panagis %+ Health Administration Research Consortium, University of Colorado Denver, 1475 Lawrence St, Denver, CO, 80202, United States, 1 3038548024, jiban.khuntia@ucdenver.edu %K source credibility %K infodemic %K infoveillance %K broadcasting %K cable television %K COVID-19 %D 2023 %7 27.6.2023 %9 Original Paper %J JMIR Infodemiology %G English %X Background: Infodemic exacerbates public health concerns by disseminating unreliable and false scientific facts to a population. During the COVID-19 pandemic, the efficacy of hydroxychloroquine as a therapeutic solution emerged as a challenge to public health communication. Internet and social media spread information about hydroxychloroquine, whereas cable television was a vital source. To exemplify, experts discussed in cable television broadcasts about hydroxychloroquine for treating COVID-19. However, how the experts’ comments influenced airtime allocation on cable television to help in public health communication, either during COVID-10 or at other times, is not understood. Objective: This study aimed to examine how 3 factors, that is, the credibility of experts as doctors (DOCTOREXPERT), the credibility of government representatives (GOVTEXPERT), and the sentiments (SENTIMENT) expressed in discussions and comments, influence the allocation of airtime (AIRTIME) in cable television broadcasts. SENTIMENT pertains to the information credibility conveyed through the tone and language of experts’ comments during cable television broadcasts, in contrast to the individual credibility of the doctor or government representatives because of the degree or affiliations. Methods: We collected transcriptions of relevant hydroxychloroquine-related broadcasts on cable television between March 2020 and October 2020. We coded the experts as DOCTOREXPERT or GOVTEXPERT using publicly available data. To determine the sentiments expressed in the broadcasts, we used a machine learning algorithm to code them as POSITIVE, NEGATIVE, NEUTRAL, or MIXED sentiments. Results: The analysis revealed a counterintuitive association between the expertise of doctors (DOCTOREXPERT) and the allocation of airtime, with doctor experts receiving less airtime (P<.001) than the nonexperts in a base model. A more nuanced interaction model suggested that government experts with a doctorate degree received even less airtime (P=.03) compared with nonexperts. Sentiments expressed during the broadcasts played a significant role in airtime allocation, particularly for their direct effects on airtime allocation, more so for NEGATIVE (P<.001), NEUTRAL (P<.001), and MIXED (P=.03) sentiments. Only government experts expressing POSITIVE sentiments during the broadcast received a more extended airtime (P<.001) than nonexperts. Furthermore, NEGATIVE sentiments in the broadcasts were associated with less airtime both for DOCTOREXPERT (P<.001) and GOVTEXPERT (P<.001). Conclusions: Source credibility plays a crucial role in infodemics by ensuring the accuracy and trustworthiness of the information communicated to audiences. However, cable television media may prioritize likeability over credibility, potentially hindering this goal. Surprisingly, the findings of our study suggest that doctors did not get good airtime on hydroxychloroquine-related discussions on cable television. In contrast, government experts as sources received more airtime on hydroxychloroquine-related discussions. Doctors presenting facts with negative sentiments may not help them gain airtime. Conversely, government experts expressing positive sentiments during broadcasts may have better airtime than nonexperts. These findings have implications on the role of source credibility in public health communications. %M 37204334 %R 10.2196/45392 %U https://infodemiology.jmir.org/2023/1/e45392 %U https://doi.org/10.2196/45392 %U http://www.ncbi.nlm.nih.gov/pubmed/37204334 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 10 %N %P e43250 %T Role of Oral Intake, Mobility, and Activity Measures in Informing Discharge Recommendations for Hospitalized Inmate and Noninmate Patients With COVID-19: Retrospective Analysis %A Briggs,Matthew S %A Kolbus,Erin Shevawn %A Patterson,Kevin Michael %A Harmon-Matthews,Lindsay Elizabeth %A McGrath,Shana %A Quatman-Yates,Catherine C %A Meirelles,Cristiane %A Salsberry,Marka Jean %+ Rehabilitation Services, The Ohio State University Wexner Medical Center, Jameson Crane Sports Medicine Institute, 2835 Fred Taylor Drive, Columbus, OH, 43202, United States, 1 614 293 2385, matt.briggs@osumc.edu %K incarceration %K Functional Oral Intake %K Activity Measure for Postacute Care %K speech language pathology %K physical therapy %K occupational therapy %K COVID-19 %D 2023 %7 27.6.2023 %9 Original Paper %J JMIR Rehabil Assist Technol %G English %X Background: Patients who were incarcerated were disproportionately affected by COVID-19 compared with the general public. Furthermore, the impact of multidisciplinary rehabilitation assessments and interventions on the outcomes of patients admitted to the hospital with COVID-19 is limited. Objective: We aimed to compare the functional outcomes of oral intake, mobility, and activity between inmates and noninmates diagnosed with COVID-19 and examine the relationships among these functional measures and discharge destination. Methods: A retrospective analysis was performed on patients admitted to the hospital for COVID-19 at a large academic medical center. Scores on functional measures including the Functional Oral Intake Scale and Activity Measure for Postacute Care (AM-PAC) were collected and compared between inmates and noninmates. Binary logistic regression models were used to evaluate the odds of whether patients were discharged to the same place they were admitted from and whether patients were being discharged with a total oral diet with no restrictions. Independent variables were considered significant if the 95% CIs of the odds ratios (ORs) did not include 1.0. Results: A total of 83 patients (inmates: n=38; noninmates: n=45) were included in the final analysis. There were no differences between inmates and noninmates in the initial (P=.39) and final Functional Oral Intake Scale scores (P=.35) or in the initial (P=.06 and P=.46), final (P=.43 and P=.79), or change scores (P=.97 and P=.45) on the AM-PAC mobility and activity subscales, respectively. When examining separate regression models using AM-PAC mobility or AM-PAC activity scores as independent variables, greater age upon admission decreased the odds (OR 0.922, 95% CI 0.875-0.972 and OR 0.918, 95% CI 0.871-0.968) of patients being discharged with a total oral diet with no restrictions. The following factors increased the odds of patients being discharged to the same place they were admitted from: being an inmate (OR 5.285, 95% CI 1.334-20.931 and OR 6.083, 95% CI 1.548-23.912), “Other” race (OR 7.596, 95% CI 1.203-47.968 and OR 8.515, 95% CI 1.311-55.291), and female sex (OR 4.671, 95% CI 1.086-20.092 and OR 4.977, 95% CI 1.146-21.615). Conclusions: The results of this study provide an opportunity to learn how functional measures may be used to better understand discharge outcomes in both inmate and noninmate patients admitted to the hospital with COVID-19 during the initial period of the pandemic. %M 37224276 %R 10.2196/43250 %U https://rehab.jmir.org/2023/1/e43250 %U https://doi.org/10.2196/43250 %U http://www.ncbi.nlm.nih.gov/pubmed/37224276 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e46357 %T Vector Autoregression for Forecasting the Number of COVID-19 Cases and Analyzing Behavioral Indicators in the Philippines: Ecologic Time-Trend Study %A Latorre,Angelica Anne Eligado %A Nakamura,Keiko %A Seino,Kaoruko %A Hasegawa,Takanori %+ Department of Global Health Entrepreneurship, Tokyo Medical and Dental University, Yushima 1-5-45, Bunkyo-ku, Tokyo, 113-8510, Japan, 81 3 5803 4048, nakamura.ith@tmd.ac.jp %K COVID-19 %K forecasting %K interest by the general public %K mobility %K surveillance %K vector autoregression %D 2023 %7 27.6.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Traditional surveillance systems rely on routine collection of data. The inherent delay in retrieval and analysis of data leads to reactionary rather than preventive measures. Forecasting and analysis of behavior-related data can supplement the information from traditional surveillance systems. Objective: We assessed the use of behavioral indicators, such as the general public’s interest in the risk of contracting SARS-CoV-2 and changes in their mobility, in building a vector autoregression model for forecasting and analysis of the relationships of these indicators with the number of COVID-19 cases in the National Capital Region. Methods: An etiologic, time-trend, ecologic study design was used to forecast the daily number of cases in 3 periods during the resurgence of COVID-19. We determined the lag length by combining knowledge on the epidemiology of SARS-CoV-2 and information criteria measures. We fitted 2 models to the training data set and computed their out-of-sample forecasts. Model 1 contains changes in mobility and number of cases with a dummy variable for the day of the week, while model 2 also includes the general public’s interest. The forecast accuracy of the models was compared using mean absolute percentage error. Granger causality test was performed to determine whether changes in mobility and public’s interest improved the prediction of cases. We tested the assumptions of the model through the Augmented Dickey-Fuller test, Lagrange multiplier test, and assessment of the moduli of eigenvalues. Results: A vector autoregression (8) model was fitted to the training data as the information criteria measures suggest the appropriateness of 8. Both models generated forecasts with similar trends to the actual number of cases during the forecast period of August 11-18 and September 15-22. However, the difference in the performance of the 2 models became substantial from January 28 to February 4, as the accuracy of model 2 remained within reasonable limits (mean absolute percentage error [MAPE]=21.4%) while model 1 became inaccurate (MAPE=74.2%). The results of the Granger causality test suggest that the relationship of public interest with number of cases changed over time. During the forecast period of August 11-18, only change in mobility (P=.002) improved the forecasting of cases, while public interest was also found to Granger-cause the number of cases during September 15-22 (P=.001) and January 28 to February 4 (P=.003). Conclusions: To the best of our knowledge, this is the first study that forecasted the number of COVID-19 cases and explored the relationship of behavioral indicators with the number of COVID-19 cases in the Philippines. The resemblance of the forecasts from model 2 with the actual data suggests its potential in providing information about future contingencies. Granger causality also implies the importance of examining changes in mobility and public interest for surveillance purposes. %M 37368473 %R 10.2196/46357 %U https://formative.jmir.org/2023/1/e46357 %U https://doi.org/10.2196/46357 %U http://www.ncbi.nlm.nih.gov/pubmed/37368473 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e44549 %T Evaluation of the EsteR Toolkit for COVID-19 Decision Support: Sensitivity Analysis and Usability Study %A Alpers,Rieke %A Kühne,Lisa %A Truong,Hong-Phuc %A Zeeb,Hajo %A Westphal,Max %A Jäckle,Sonja %+ Fraunhofer Institute for Digital Medicine MEVIS, Max-von-Laue-Str. 2, Bremen, 28209, Germany, 49 421 218 ext 59228, rieke.alpers@mevis.fraunhofer.de %K COVID-19 %K public health %K decision support tool %K sensitivity analysis %K web application %K usability study %D 2023 %7 27.6.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: During the COVID-19 pandemic, local health authorities were responsible for managing and reporting current cases in Germany. Since March 2020, employees had to contain the spread of COVID-19 by monitoring and contacting infected persons as well as tracing their contacts. In the EsteR project, we implemented existing and newly developed statistical models as decision support tools to assist in the work of the local health authorities. Objective: The main goal of this study was to validate the EsteR toolkit in two complementary ways: first, investigating the stability of the answers provided by our statistical tools regarding model parameters in the back end and, second, evaluating the usability and applicability of our web application in the front end by test users. Methods: For model stability assessment, a sensitivity analysis was carried out for all 5 developed statistical models. The default parameters of our models as well as the test ranges of the model parameters were based on a previous literature review on COVID-19 properties. The obtained answers resulting from different parameters were compared using dissimilarity metrics and visualized using contour plots. In addition, the parameter ranges of general model stability were identified. For the usability evaluation of the web application, cognitive walk-throughs and focus group interviews were conducted with 6 containment scouts located at 2 different local health authorities. They were first asked to complete small tasks with the tools and then express their general impressions of the web application. Results: The simulation results showed that some statistical models were more sensitive to changes in their parameters than others. For each of the single-person use cases, we determined an area where the respective model could be rated as stable. In contrast, the results of the group use cases highly depended on the user inputs, and thus, no area of parameters with general model stability could be identified. We have also provided a detailed simulation report of the sensitivity analysis. In the user evaluation, the cognitive walk-throughs and focus group interviews revealed that the user interface needed to be simplified and more information was necessary as guidance. In general, the testers rated the web application as helpful, especially for new employees. Conclusions: This evaluation study allowed us to refine the EsteR toolkit. Using the sensitivity analysis, we identified suitable model parameters and analyzed how stable the statistical models were in terms of changes in their parameters. Furthermore, the front end of the web application was improved with the results of the conducted cognitive walk-throughs and focus group interviews regarding its user-friendliness. %M 37368487 %R 10.2196/44549 %U https://formative.jmir.org/2023/1/e44549 %U https://doi.org/10.2196/44549 %U http://www.ncbi.nlm.nih.gov/pubmed/37368487 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e43980 %T Effectiveness and Medicoeconomic Evaluation of Home Monitoring of Patients With Mild COVID-19: Covidom Cohort Study %A Jaulmes,Luc %A Yordanov,Youri %A Descamps,Alexandre %A Durand-Zaleski,Isabelle %A Dinh,Aurélien %A Jourdain,Patrick %A Dechartres,Agnès %+ Centre de pharmaco-épidémiologie de l’APHP, Dépt. de Santé Publique, Hôpital Pitié Salpêtrière, Sorbonne Université, AP-HP, 47-83 boulevard de l'Hôpital, Paris, 75013, France, 33 1 42 16 03 25, lucjaulmes+jmir@pm.me %K COVID-19 %K Covidom %K home monitoring %K telehealth %K tele-surveillance %K primary outcome %K remote monitoring %K digital health intervention %K emergency medical service %K patient care %K digital care %K mobile phone %D 2023 %7 23.6.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Covidom was a telemonitoring solution for home monitoring of patients with mild to moderate COVID-19, deployed in March 2020 in the Greater Paris area in France to alleviate the burden on the health care system. The Covidom solution included a free mobile application with daily monitoring questionnaires and a regional control center to quickly handle patient alerts, including dispatching emergency medical services when necessary. Objective: This study aimed to provide an overall evaluation of the Covidom solution 18 months after its inception in terms of effectiveness, safety, and cost. Methods: Our primary outcome was to measure effectiveness using the number of handled alerts, response escalation, and patient-reported medical contacts outside of Covidom. Then, we analyzed the safety of Covidom by assessing its ability to detect clinical worsening, defined as hospitalization or death, and the number of patients with clinical worsening without any preceding alert. We evaluated the cost of Covidom and compared the cost of hospitalization for Covidom and non-Covidom patients with mild COVID-19 cases seen in the emergency departments of the largest network of hospitals in the Greater Paris area (Assistance Publique-Hôpitaux de Paris). Finally, we reported on user satisfaction. Results: Of the 60,073 patients monitored by Covidom, the regional control center handled 285,496 alerts and dispatched emergency medical services 518 times. Of the 13,204 respondents who responded to either of the follow-up questionnaires, 65.8% (n=8690) reported having sought medical care outside the Covidom solution during their monitoring period. Of the 947 patients who experienced clinical worsening while adhering to daily monitoring, only 35 (3.7%) did not previously trigger alerts (35 were hospitalized, including 1 who died). The average cost of Covidom was €54 (US $1=€0.8614) per patient, and the cost of hospitalization for COVID-19 worsening was significantly lower in Covidom than in non-Covidom patients with mild COVID-19 cases seen in the emergency departments of Assistance Publique-Hôpitaux de Paris. The patients who responded to the satisfaction questionnaire had a median rating of 9 (out of 10) for the likelihood of recommending Covidom. Conclusions: Covidom may have contributed to alleviating the pressure on the health care system in the initial months of the pandemic, although its impact was lower than anticipated, with a substantial number of patients having consulted outside of Covidom. Covidom seems to be safe for home monitoring of patients with mild to moderate COVID-19. %M 37134021 %R 10.2196/43980 %U https://www.jmir.org/2023/1/e43980 %U https://doi.org/10.2196/43980 %U http://www.ncbi.nlm.nih.gov/pubmed/37134021 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e42678 %T COVID-19 Contact Tracing Strategies During the First Wave of the Pandemic: Systematic Review of Published Studies %A Amicosante,Anna Maria Vincenza %A Rosso,Annalisa %A Bernardini,Fabio %A Guglielmi,Elisa %A Eugeni,Erica %A Da Re,Filippo %A Baglio,Giovanni %+ Research and International Relations Unit, Italian National Agency for Regional Healthcare Services, Via Piemonte, 60, Rome, 00187, Italy, 39 06 427491, baglio@agenas.it %K COVID-19 %K SARS-CoV-2 %K contact tracing %K public health %K infectious disease %K disease control %K community engagement %K digital tool %D 2023 %7 23.6.2023 %9 Review %J JMIR Public Health Surveill %G English %X Background: Contact tracing (CT) represented one of the core activities for the prevention and control of COVID-19 in the early phase of the pandemic. Several guidance documents were developed by international public health agencies and national authorities on the organization of COVID-19 CT activities. While most research on CT focused on the use digital tools or relied on modelling techniques to estimate the efficacy of interventions, poor evidence is available on the real-world implementation of CT strategies and on the organizational models adopted during the initial phase of the emergency to set up CT activities. Objective: We aimed to provide a comprehensive picture of the organizational aspects of CT activities during the first wave of the pandemic through the systematic identification and description of CT strategies used in different settings during the period from March to June 2020. Methods: A systematic review of published studies describing organizational models of COVID-19 CT strategies developed in real-world settings was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. PubMed, Embase, and Cochrane Library were searched. Studies not providing a description of the organizational aspects of CT strategies and studies reporting or modelling theoretical strategies or focusing on the description of digital technologies’ properties were excluded. Quality of reporting was assessed by using the Template for Intervention Description and Replication Checklist for Population Health and Policy. We developed a narrative synthesis, using a conceptual framework to map the extracted studies broken down by target population. Results: We retrieved a total of 1638 studies, of which 17 were included in the narrative synthesis; 7 studies targeted the general population and 10 studies described CT activities carried out in specific population subgroups. Our review identified some common elements across studies used to develop CT activities, including decentralization of CT activities, involvement of trained nonpublic health resources (eg, university students or civil servants), use of informatics tools for CT management, interagency collaboration, and community engagement. CT strategies implemented in the workplace envisaged a strong collaboration with occupational health services. Outreach activities were shown to increase CT efficiency in susceptible groups, such as people experiencing homelessness. Data on the effectiveness of CT strategies are scarce, with only few studies reporting on key performance indicators. Conclusions: Despite the lack of systematically collected data on CT effectiveness, our findings can provide some indication for the future planning and development of CT strategies for infectious disease control, mainly in terms of coordination mechanisms and the use of human and technical resources needed for the rapid development of CT activities. Further research on the organizational models of CT strategies during the COVID-19 pandemic would be required to contribute to a more robust evidence-making process. %M 37351939 %R 10.2196/42678 %U https://publichealth.jmir.org/2023/1/e42678 %U https://doi.org/10.2196/42678 %U http://www.ncbi.nlm.nih.gov/pubmed/37351939 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e42775 %T Diagnostic Concordance of Telemedicine as Compared With Face-to-Face Care in Primary Health Care Clinics in Rural India: Randomized Crossover Trial %A Verma,Neha %A Buch,Bimal %A Taralekar,Radha %A Acharya,Soumyadipta %+ Intelehealth, 3400 N Charles Street, Suite 208, Baltimore, MD, 21218, United States, 1 4108707146, nverma39@gmail.com %K telemedicine %K telehealth %K eHealth %K opensource %K digital assistant %K diagnostic concordance %K COVID-19 %K primary care %K rural health %K teleconsultation %K patient care %D 2023 %7 23.6.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: With the COVID-19 pandemic, there was an increase and scaling up of provider-to-provider telemedicine programs that connect frontline health providers such as nurses and community health workers at primary care clinics with remote doctors at tertiary facilities to facilitate consultations for rural patients. Considering this new trend of increasing use of telemedicine, this study was conducted to generate evidence for patients, health providers, and policymakers to compare if provider-to-provider telemedicine-based care is equivalent to in-person care and is safe and acceptable in terms of diagnostic and treatment standards. Objective: This study aims to compare the diagnosis and treatment decisions from teleconsultations to those of in-person care in teleclinics in rural Gujarat. Methods: We conducted a diagnostic concordance study using a randomized crossover study design with 104 patients at 10 telemedicine primary care clinics. Patients reporting to 10 telemedicine primary care clinics were randomly assigned to first receive an in-person doctor consultation (59/104, 56.7%) or to first receive a health worker–assisted telemedicine consultation (45/104, 43.3%). The 2 groups were then switched, with the first group undergoing a telemedicine consultation following the in-person consultation and the second group receiving an in-person consultation after the teleconsultation. The in-person doctor and remote doctor were blinded to the diagnosis and management plan of the other. The diagnosis and treatment plan of in-person doctors was considered the gold standard. Results: We enrolled 104 patients reporting a range of primary health care issues into the study. We observed 74% (77/104) diagnostic concordance and 79.8% (83/104) concordance in the treatment plan between the in-person and remote doctors. No significant association was found between the diagnostic and treatment concordance and the order of the consultation (P=.65 and P=.81, respectively), the frontline health worker–doctor pair (both P=.93), the gender of the patient (both P>.99), or the mode of teleconsultation (synchronous vs asynchronous; P=.32 and P=.29, respectively), as evaluated using Fisher exact tests. A significant association was seen between the diagnostic and treatment concordance and the type of case (P=.004 and P=.03, respectively). The highest diagnostic concordance was seen in the management of hypertension (20/21, 95% concordance; Cohen kappa=0.93) and diabetes (14/15, 93% concordance; Cohen kappa=0.89). The lowest values were seen in cardiology (1/3, 33%) and patients presenting with nonspecific symptoms (3/10, 30%). The use of a digital assistant to facilitate the consultation resulted in increased adherence to evidence-based care protocols. Conclusions: The findings reflect that telemedicine can be a safe and acceptable alternative mode of care especially in remote rural settings when in-person care is not accessible. Telemedicine has advantages. for the potential gains for improved health care–seeking behavior for patients, reduced costs for the patient, and improved health system efficiency by reducing overcrowding at tertiary health facilities. %M 37130015 %R 10.2196/42775 %U https://formative.jmir.org/2023/1/e42775 %U https://doi.org/10.2196/42775 %U http://www.ncbi.nlm.nih.gov/pubmed/37130015 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e44286 %T Convergence in Mobility Data Sets From Apple, Google, and Meta %A Sganzerla Martinez,Gustavo %A Kelvin,David J %+ Department of Microbiology and Immunology, Dalhousie University, 5850 College street, Halifax, NS, B3H4H7, Canada, 1 647 529 3556, david.kelvin@dal.ca %K Google %K Apple %K Meta %K COVID-19 mobility %K COVID-19 %K mobility %K data set %K data %K pattern %K pandemic %K mobile %K operating system %K system %K validation %K tool %K asset %D 2023 %7 22.6.2023 %9 Viewpoint %J JMIR Public Health Surveill %G English %X Background: The higher movement of people was one of the variables that contributed to the spread of the infectious agent SARS-CoV-2 during the COVID-19 pandemic. Governments worldwide responded to the virus by implementing measures that would restrict people’s movements, and consequently, the spread of the disease. During the onset of the pandemic, the technology companies Apple, Google, and Meta used their infrastructure to anonymously gather mobility reports from their users. Objective: This study aims to compare mobility data reports collected by Apple, Google, and Meta (formerly Facebook) during the COVID-19 pandemic and a major winter storm in Texas in 2021. We aim to explore the hypothesis that different people exhibit similar mobility trends during dramatic events and to emphasize the importance of this type of data for public health measures. The study also aims to promote evidence for companies to continue releasing mobility trends data, given that all 3 companies have discontinued these services. Methods: In this study, we collected mobility data spanning from 2020 to 2022 from 3 major tech companies: Apple, Google, and Meta. Our analysis focused on 58 countries that are common to all 3 databases, enabling us to conduct a comprehensive global-scale analysis. By using the winter storm that occurred in Texas in 20201 as a benchmark, we were able to assess the robustness of the mobility data obtained from the 3 companies and ensure the integrity of our findings. Results: Our study revealed convergence in the mobility trends observed across different companies during the onset of significant disasters, such as the first year of the COVID-19 pandemic and the winter storm that impacted Texas in 2021. Specifically, we observed strong positive correlations (r=0.96) in the mobility data collected from different tech companies during the first year of the pandemic. Furthermore, our analysis of mobility data during the 2021 winter storm in Texas showed a similar convergence of trends. Additionally, we found that periods of stay-at-home orders were reflected in the data, with record-low mobility and record-high stay-at-home figures. Conclusions: Our findings provide valuable insights into the ways in which major disruptive events can impact patterns of human mobility; moreover, the convergence of data across distinct methodologies highlights the potential value of leveraging mobility data from multiple sources for informing public health decision-making. Therefore, we conclude that the use of mobility data is an asset for health authorities to consider during natural disasters, as we determined that the data sets from 3 companies yielded convergent mobility patterns. Comparatively, data obtained from a single source would be limited, and therefore, more difficult to interpret, requiring careful analysis. %M 37347516 %R 10.2196/44286 %U https://publichealth.jmir.org/2023/1/e44286 %U https://doi.org/10.2196/44286 %U http://www.ncbi.nlm.nih.gov/pubmed/37347516 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e41479 %T The Adoption of a COVID-19 Contact-Tracing App: Cluster Analysis %A Hengst,Tessi M %A Lechner,Lilian %A van der Laan,Laura Nynke %A Hommersom,Arjen %A Dohmen,Daan %A Hooft,Lotty %A Metting,Esther %A Ebbers,Wolfgang %A Bolman,Catherine A W %+ Department of Psychology, Open University, Valkenburgerweg 177, Heerlen, 6419 AT, Netherlands, 31 0455762, tessi.hengst@ou.nl %K contact-tracing app %K CTA %K CoronaMelder %K intention %K adoption %K cluster analysis %K application %K psychosocial %K data %K risk %K societal %K social norm %K norm %K COVID-19 %K adaptation %K acceptance %K mHealth %K mobile health %D 2023 %7 20.6.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: During the COVID-19 pandemic, there was limited adoption of contact-tracing apps (CTAs). Adoption was particularly low among vulnerable people (eg, people with a low socioeconomic position or of older age), while this part of the population tends to have lesser access to information and communication technology and is more vulnerable to the COVID-19 virus. Objective: This study aims to understand the cause of this lagged adoption of CTAs in order to facilitate adoption and find indications to make public health apps more accessible and reduce health disparities. Methods: Because several psychosocial variables were found to be predictive of CTA adoption, data from the Dutch CTA CoronaMelder (CM) were analyzed using cluster analysis. We examined whether subgroups could be formed based on 6 psychosocial perceptions (ie, trust in the government, beliefs about personal data, social norms, perceived personal and societal benefits, risk perceptions, and self-efficacy) of (non)users concerning CM in order to examine how these clusters differ from each other and what factors are predictive of the intention to use a CTA and the adoption of a CTA. The intention to use and the adoption of CM were examined based on longitudinal data consisting of 2 time frames in October/November 2020 (N=1900) and December 2020 (N=1594). The clusters were described by demographics, intention, and adoption accordingly. Moreover, we examined whether the clusters and the variables that were found to influence the adoption of CTAs, such as health literacy, were predictive of the intention to use and the adoption of the CM app. Results: The final 5-cluster solution based on the data of wave 1 contained significantly different clusters. In wave 1, respondents in the clusters with positive perceptions (ie, beneficial psychosocial variables for adoption of a CTA) about the CM app were older (P<.001), had a higher education level (P<.001), and had higher intention (P<.001) and adoption (P<.001) rates than those in the clusters with negative perceptions. In wave 2, the intention to use and adoption were predicted by the clusters. The intention to use CM in wave 2 was also predicted using the adoption measured in wave 1 (P<.001, β=–2.904). Adoption in wave 2 was predicted by age (P=.022, exp(B)=1.171), the intention to use in wave 1 (P<.001, exp(B)=1.770), and adoption in wave 1 (P<.001, exp(B)=0.043). Conclusions: The 5 clusters, as well as age and previous behavior, were predictive of the intention to use and the adoption of the CM app. Through the distinguishable clusters, insight was gained into the profiles of CM (non)intenders and (non)adopters. Trial Registration: OSF Registries osf.io/cq742; https://osf.io/cq742 %M 37338969 %R 10.2196/41479 %U https://formative.jmir.org/2023/1/e41479 %U https://doi.org/10.2196/41479 %U http://www.ncbi.nlm.nih.gov/pubmed/37338969 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e44951 %T Understanding Mobile Health and Youth Mental Health: Scoping Review %A Ding,Xiaoxu %A Wuerth,Kelli %A Sakakibara,Brodie %A Schmidt,Julia %A Parde,Natalie %A Holsti,Liisa %A Barbic,Skye %+ Faculty of Medicine, Department of Occupational Science and Occupational Therapy, University of British Columbia, T325 - 2211 Wesbrook Mall | Musqueam Territory, Vancouver, BC, V6T 2A1, Canada, 1 236 992 8222, xxd51@student.ubc.ca %K adolescent %K COVID-19 %K engagement %K health outcome %K illness %K implementation %K mental disorder %K mental health %K mHealth intervention %K mHealth tools %K mHealth %K policy %K scoping review %K young adult %K youth %D 2023 %7 16.6.2023 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: A total of 75% of people with mental health disorders have an onset of illness between the ages of 12 and 24 years. Many in this age group report substantial obstacles to receiving quality youth-centered mental health care services. With the rapid development of technology and the recent COVID-19 pandemic, mobile health (mHealth) has presented new opportunities for youth mental health research, practice, and policy. Objective: The research objectives were to (1) synthesize the current evidence supporting mHealth interventions for youths who experience mental health challenges and (2) identify current gaps in the mHealth field related to youth’s access to mental health services and health outcomes. Methods: Guided by the methods of Arksey and O’Malley, we conducted a scoping review of peer-reviewed studies that used mHealth tools to improve youth mental health (January 2016-February 2022). We searched MEDLINE, PubMed, PsycINFO, and Embase databases using the following key terms: (1) mHealth; (2) youth and young adults; and (3) mental health. The current gaps were analyzed using content analysis. Results: The search produced 4270 records, of which 151 met inclusion criteria. Included articles highlight the comprehensive aspects of youth mHealth intervention resource allocation for targeted conditions, mHealth delivery methods, measurement tools, evaluation of mHealth intervention, and youth engagement. The median age for participants in all studies is 17 (IQR 14-21) years. Only 3 (2%) studies involved participants who reported their sex or gender outside of the binary option. Many studies (68/151, 45%) were published after the onset of the COVID-19 outbreak. Study types and designs varied, with 60 (40%) identified as randomized controlled trials. Notably, 143 out of 151 (95%) studies came from developed countries, suggesting an evidence shortfall on the feasibility of implementing mHealth services in lower-resourced settings. Additionally, the results highlight concerns related to inadequate resources devoted to self-harm and substance uses, weak study design, expert engagement, and the variety of outcome measures selected to capture impact or changes over time. There is also a lack of standardized regulations and guidelines for researching mHealth technologies for youths and the use of non–youth-centered approaches to implementing results. Conclusions: This study may be used to inform future work as well as the development of youth-centered mHealth tools that can be implemented and sustained over time for diverse types of youths. Implementation science research that prioritizes youths’ engagement is needed to advance the current understanding of mHealth implementation. Moreover, core outcome sets may support a youth-centered measurement strategy to capture outcomes in a systematic way that prioritizes equity, diversity, inclusion, and robust measurement science. Finally, this study suggests that future practice and policy research are needed to ensure the risk of mHealth is minimized and that this innovative health care service is meeting the emerging needs of youths over time. %M 37220197 %R 10.2196/44951 %U https://mhealth.jmir.org/2023/1/e44951 %U https://doi.org/10.2196/44951 %U http://www.ncbi.nlm.nih.gov/pubmed/37220197 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e35573 %T Health Chatbots in Africa: Scoping Review %A Phiri,Millie %A Munoriyarwa,Allen %+ School of Communication, University of Johannesburg, 5 Kingsway Ave, Auckland Park, Westcliff, 2092, South Africa, 27 721474171, phirimillie@yahoo.co.uk %K chatbots %K health %K Africa %K technology %K artificial intelligence %K chatbot %K health promotion %K health database %K World Health Organization %K WHO %K rural area %K epidemiology %K vulnerable population %K health sector %K Cochrane database %D 2023 %7 14.6.2023 %9 Review %J J Med Internet Res %G English %X Background: This scoping review explores and summarizes the existing literature on the use of chatbots to support and promote health in Africa. Objective: The primary aim was to learn where, and under what circumstances, chatbots have been used effectively for health in Africa; how chatbots have been developed to the best effect; and how they have been evaluated by looking at literature published between 2017 and 2022. A secondary aim was to identify potential lessons and best practices for others chatbots. The review also aimed to highlight directions for future research on the use of chatbots for health in Africa. Methods: Using the 2005 Arksey and O’Malley framework, we used a Boolean search to broadly search literature published between January 2017 and July 2022. Literature between June 2021 and July 2022 was identified using Google Scholar, EBSCO information services—which includes the African HealthLine, PubMed, MEDLINE, PsycInfo, Cochrane, Embase, Scopus, and Web of Science databases—and other internet sources (including gray literature). The inclusion criteria were literature about health chatbots in Africa published in journals, conference papers, opinion, or white papers. Results: In all, 212 records were screened, and 12 articles met the inclusion criteria. Results were analyzed according to the themes they covered. The themes identified included the purpose of the chatbot as either providing an educational or information-sharing service or providing a counselling service. Accessibility as a result of either technical restrictions or language restrictions was also noted. Other themes that were identified included the need for the consideration of trust, privacy and ethics, and evaluation. Conclusions: The findings demonstrate that current data are insufficient to show whether chatbots are effectively supporting health in the region. However, the review does reveal insights into popular chatbots and the need to make them accessible through language considerations, platform choice, and user trust, as well as the importance of robust evaluation frameworks to assess their impact. The review also provides recommendations on the direction of future research. %M 35584083 %R 10.2196/35573 %U https://www.jmir.org/2023/1/e35573 %U https://doi.org/10.2196/35573 %U http://www.ncbi.nlm.nih.gov/pubmed/35584083 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e44970 %T Seesaw Effect Between COVID-19 and Influenza From 2020 to 2023 in World Health Organization Regions: Correlation Analysis %A Wang,Qing %A Jia,Mengmeng %A Jiang,Mingyue %A Liu,Wei %A Yang,Jin %A Dai,Peixi %A Sun,Yanxia %A Qian,Jie %A Yang,Weizhong %A Feng,Luzhao %+ School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, No 9, Dongdan Santiao, Dongcheng District, Beijing, 100730, China, 86 10 65120716, fengluzhao@cams.cn %K COVID-19 %K influenza %K negative correlation %K seesaw effect %K respiratory infectious disease %K epidemiological trends %D 2023 %7 12.6.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Seasonal influenza activity showed a sharp decline in activity at the beginning of the emergence of COVID-19. Whether there is an epidemiological correlation between the dynamic of these 2 respiratory infectious diseases and their future trends needs to be explored. Objective: We aimed to assess the correlation between COVID-19 and influenza activity and estimate later epidemiological trends. Methods: We retrospectively described the dynamics of COVID-19 and influenza in 6 World Health Organization (WHO) regions from January 2020 to March 2023 and used the long short-term memory machine learning model to learn potential patterns in previously observed activity and predict trends for the following 16 weeks. Finally, we used Spearman correlation coefficients to assess the past and future epidemiological correlation between these 2 respiratory infectious diseases. Results: With the emergence of the original strain of SARS-CoV-2 and other variants, influenza activity stayed below 10% for more than 1 year in the 6 WHO regions. Subsequently, it gradually rose as Delta activity dropped, but still peaked below Delta. During the Omicron pandemic and the following period, the activity of each disease increased as the other decreased, alternating in dominance more than once, with each alternation lasting for 3 to 4 months. Correlation analysis showed that COVID-19 and influenza activity presented a predominantly negative correlation, with coefficients above –0.3 in WHO regions, especially during the Omicron pandemic and the following estimated period. The diseases had a transient positive correlation in the European region of the WHO and the Western Pacific region of the WHO when multiple dominant strains created a mixed pandemic. Conclusions: Influenza activity and past seasonal epidemiological patterns were shaken by the COVID-19 pandemic. The activity of these diseases was moderately or greater than moderately inversely correlated, and they suppressed and competed with each other, showing a seesaw effect. In the postpandemic era, this seesaw trend may be more prominent, suggesting the possibility of using one disease as an early warning signal for the other when making future estimates and conducting optimized annual vaccine campaigns. %M 37191650 %R 10.2196/44970 %U https://publichealth.jmir.org/2023/1/e44970 %U https://doi.org/10.2196/44970 %U http://www.ncbi.nlm.nih.gov/pubmed/37191650 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 6 %N %P e40953 %T Video Calls as a Replacement for Family Visits During Lockdowns in Aged Care: Interview Study With Family Members %A Kelly,Ryan M %A Xing,Yushan %A Baker,Steven %A Waycott,Jenny %+ School of Computing and Information Systems, University of Melbourne, 700 Swanston Street, Melbourne, 3010, Australia, 61 383442215, ryan.kelly@unimelb.edu.au %K aged care %K COVID-19 pandemic %K lockdowns %K older adults %K video calls %K videoconferencing %K mobile phone %K COVID-19 %D 2023 %7 12.6.2023 %9 Original Paper %J JMIR Aging %G English %X Background: Lockdowns have been used to prevent the spread of transmissible illnesses such as influenza, norovirus, and COVID-19 in care homes. However, lockdowns deny care home residents supplemental care and the socioemotional enrichment that comes from seeing family members. Video calling has the potential to enable ongoing contact between residents and family members during lockdowns. However, video calls can be considered by some as a poor substitute for in-person visits. It is important to understand family members’ experiences with video calling during lockdowns to ensure the effective use of this technology in the future. Objective: This study aimed to understand how family members use video calls to communicate with relatives living in aged care during lockdowns. We focused on experiences during the COVID-19 pandemic, which involved extensive lockdowns in aged care homes. Methods: We conducted semistructured interviews with 18 adults who had been using video calls with relatives living in aged care during pandemic lockdowns. The interviews focused on how participants had been using video calls, what benefits they gained from video-based interactions, and what challenges they encountered when using the technology. We analyzed the data using the 6-phase reflexive approach to thematic analysis by Braun and Clarke. Results: We developed 4 themes through our analysis. Theme 1 interprets video calling as a medium for the continuation of care during lockdowns. Using video calls, family members were able to provide social enrichment for residents and engaged in health monitoring to uphold residents’ welfare. Theme 2 highlights how video calling extended care by supporting frequent contact, transmitting nonverbal cues that were essential for communication, and negating the need for face masks. Theme 3 interprets organizational issues such as the lack of technology and staff time as impediments to the continuation of familial care through video. Finally, theme 4 highlights the need for 2-way communication, interpreting residents’ unfamiliarity with video calling and their health conditions as further barriers to the continuation of care. Conclusions: This study suggests that, during restrictions arising from the COVID-19 pandemic, video calls became a medium for enabling family members to continue participating in the care of their relatives. The use of video calls to continue care illustrates their value for families during times of mandatory lockdown and supports the use of video to complement face-to-face visits at other times. However, better support is needed for video calling in aged care homes. This study also revealed a need for video calling systems that are designed for the aged care context. %M 37191951 %R 10.2196/40953 %U https://aging.jmir.org/2023/1/e40953 %U https://doi.org/10.2196/40953 %U http://www.ncbi.nlm.nih.gov/pubmed/37191951 %0 Journal Article %@ 2563-3570 %I JMIR Publications %V 4 %N %P e40673 %T Genomic Insights Into the Evolution and Demographic History of the SARS-CoV-2 Omicron Variant: Population Genomics Approach %A Garg,Kritika M %A Lamba,Vinita %A Chattopadhyay,Balaji %+ Trivedi School of Biosciences, Ashoka University, Rajiv Gandhi Education City, Sonipat, 131029, India, 91 8073119246, balaji.chattopadhyay@ashoka.edu.in %K SARS-CoV-2 %K Omicron %K evolutionary network %K population subdivision %K genome evolution %K COVID-19 %K microevolution %D 2023 %7 12.6.2023 %9 Original Paper %J JMIR Bioinform Biotech %G English %X Background: A thorough understanding of the patterns of genetic subdivision in a pathogen can provide crucial information that is necessary to prevent disease spread. For SARS-CoV-2, the availability of millions of genomes makes this task analytically challenging, and traditional methods for understanding genetic subdivision often fail. Objective: The aim of our study was to use population genomics methods to identify the subtle subdivisions and demographic history of the Omicron variant, in addition to those captured by the Pango lineage. Methods: We used a combination of an evolutionary network approach and multivariate statistical protocols to understand the subdivision and spread of the Omicron variant. We identified subdivisions within the BA.1 and BA.2 lineages and further identified the mutations associated with each cluster. We further characterized the overall genomic diversity of the Omicron variant and assessed the selection pressure for each of the genetic clusters identified. Results: We observed concordant results, using two different methods to understand genetic subdivision. The overall pattern of subdivision in the Omicron variant was in broad agreement with the Pango lineage definition. Further, 1 cluster of the BA.1 lineage and 3 clusters of the BA.2 lineage revealed statistically significant signatures of selection or demographic expansion (Tajima’s D<−2), suggesting the role of microevolutionary processes in the spread of the virus. Conclusions: We provide an easy framework for assessing the genetic structure and demographic history of SARS-CoV-2, which can be particularly useful for understanding the local history of the virus. We identified important mutations that are advantageous to some lineages of Omicron and aid in the transmission of the virus. This is crucial information for policy makers, as preventive measures can be designed to mitigate further spread based on a holistic understanding of the variability of the virus and the evolutionary processes aiding its spread. %M 37456139 %R 10.2196/40673 %U https://bioinform.jmir.org/2023/1/e40673 %U https://doi.org/10.2196/40673 %U http://www.ncbi.nlm.nih.gov/pubmed/37456139 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e40635 %T Meeting the Behavioral Health Needs of Health Care Workers During COVID-19 by Leveraging Chatbot Technology: Development and Usability Study %A Jackson-Triche,Maga %A Vetal,Don %A Turner,Eva-Marie %A Dahiya,Priya %A Mangurian,Christina %+ Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, 675 18th Street, San Francisco, CA, 94143, United States, 1 628 206 5925, Christina.Mangurian@ucsf.edu %K chatbot technology %K health care workers %K mental health equity %K COVID-19 %K mental health chatbot %K behavioral health treatment %K mental health screening %K telehealth %K psychoeducation %K employee support %D 2023 %7 8.6.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: During the COVID-19 pandemic, health care systems were faced with the urgent need to implement strategies to address the behavioral health needs of health care workers. A primary concern of any large health care system is developing an easy-to-access, streamlined system of triage and support despite limited behavioral health resources. Objective: This study provides a detailed description of the design and implementation of a chatbot program designed to triage and facilitate access to behavioral health assessment and treatment for the workforce of a large academic medical center. The University of California, San Francisco (UCSF) Faculty, Staff, and Trainee Coping and Resiliency Program (UCSF Cope) aimed to provide timely access to a live telehealth navigator for triage and live telehealth assessment and treatment, curated web-based self-management tools, and nontreatment support groups for those experiencing stress related to their unique roles. Methods: In a public-private partnership, the UCSF Cope team built a chatbot to triage employees based on behavioral health needs. The chatbot is an algorithm-based, automated, and interactive artificial intelligence conversational tool that uses natural language understanding to engage users by presenting a series of questions with simple multiple-choice answers. The goal of each chatbot session was to guide users to services that were appropriate for their needs. Designers developed a chatbot data dashboard to identify and follow trends directly through the chatbot. Regarding other program elements, website user data were collected monthly and participant satisfaction was gathered for each nontreatment support group. Results: The UCSF Cope chatbot was rapidly developed and launched on April 20, 2020. As of May 31, 2022, a total of 10.88% (3785/34,790) of employees accessed the technology. Among those reporting any form of psychological distress, 39.7% (708/1783) of employees requested in-person services, including those who had an existing provider. UCSF employees responded positively to all program elements. As of May 31, 2022, the UCSF Cope website had 615,334 unique users, with 66,585 unique views of webinars and 601,471 unique views of video shorts. All units across UCSF were reached by UCSF Cope staff for special interventions, with >40 units requesting these services. Town halls were particularly well received, with >80% of attendees reporting the experience as helpful. Conclusions: UCSF Cope used chatbot technology to incorporate individualized behavioral health triage, assessment, treatment, and general emotional support for an entire employee base (N=34,790). This level of triage for a population of this size would not have been possible without the use of chatbot technology. The UCSF Cope model has the potential to be scaled, adapted, and implemented across both academically and nonacademically affiliated medical settings. %M 37146178 %R 10.2196/40635 %U https://www.jmir.org/2023/1/e40635 %U https://doi.org/10.2196/40635 %U http://www.ncbi.nlm.nih.gov/pubmed/37146178 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 10 %N %P e42740 %T Design Validation of a Relational Agent by COVID-19 Patients: Mixed Methods Study %A Islam,Ashraful %A Chaudhry,Beenish Moalla %+ School of Computing and Informatics, University of Louisiana at Lafayette, James R Oliver Hall, 301 East Lewis Street, Lafayette, LA, 70503, United States, 1 337 482 1676, beenish.chaudhry@louisiana.edu %K COVID-19 %K relational agent %K mHealth %K design validation %K health care %K chatbot %K digital health intervention %K health care professional %K heuristic %K health promotion %K mental well-being %K design validation survey %K self-isolation %D 2023 %7 8.6.2023 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Relational agents (RAs) have shown effectiveness in various health interventions with and without doctors and hospital facilities. In situations such as a pandemic like the COVID-19 pandemic when health care professionals (HCPs) and facilities are unable to cope with increased demands, RAs may play a major role in ameliorating the situation. However, they have not been well explored in this domain. Objective: This study aimed to design a prototypical RA in collaboration with COVID-19 patients and HCPs and test it with the potential users, for its ability to deliver services during a pandemic. Methods: The RA was designed and developed in collaboration with people with COVID-19 (n=21) and 2 groups of HCPs (n=19 and n=16, respectively) to aid COVID-19 patients at various stages by performing 4 main tasks: testing guidance, support during self-isolation, handling emergency situations, and promoting postrecovery mental well-being. A design validation survey was conducted with 98 individuals to evaluate the usability of the prototype using the System Usability Scale (SUS), and the participants provided feedback on the design. In addition, the RA’s usefulness and acceptability were rated by the participants using Likert scales. Results: In the design validation survey, the prototypical RA received an average SUS score of 58.82. Moreover, 90% (88/98) of participants perceived it to be helpful, and 69% (68/98) of participants accepted it as a viable alternative to HCPs. The prototypical RA received favorable feedback from the participants, and they were inclined to accept it as an alternative to HCPs in non-life-threatening scenarios despite the usability rating falling below the acceptable threshold. Conclusions: Based on participants’ feedback, we recommend further development of the RA with improved automation and emotional support, ability to provide information, tracking, and specific recommendations. %M 36350760 %R 10.2196/42740 %U https://humanfactors.jmir.org/2023/1/e42740 %U https://doi.org/10.2196/42740 %U http://www.ncbi.nlm.nih.gov/pubmed/36350760 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 9 %N %P e39105 %T Impact of COVID-19 on Public Interest in Breast Cancer Screening and Related Symptoms: Google Trends Analysis %A Tan,Si Ying %A Tang,Matilda Swee Sun %A Ong,Chin-Ann Johnny %A Tan,Veronique Kiak Mien %A Shannon,Nicholas Brian %+ Department of Breast Surgery, Division of Surgery and Surgical Oncology, Singapore General Hospital, Academia, 20 College Road, Department of Breast Surgery, Singapore, 169856, Singapore, 65 63266834, tan.si.ying@singhealth.com.sg %K breast cancer screening %K breast cancer symptoms %K COVID-19 %K public interest %K Google Trends %K screening %K breast cancer %K symptoms %K cancer %K trend %K mammography %K monitoring %D 2023 %7 6.6.2023 %9 Original Paper %J JMIR Cancer %G English %X Background: The COVID-19 pandemic has led to a decrease in cancer screening due to the redeployment of health care resources and public avoidance of health care facilities. Breast cancer is the most common cancer diagnosed in female individuals, with improved survival rates from early detection. An avoidance of screening, resulting in late detection, greatly affects survival and increases health care resource burden and costs. Objective: This study aimed to evaluate if a sustained decrease in public interest in screening occurred and to evaluate other search terms, and hence interest, associated with that. Methods: This study used Google Trends to analyze public interest in breast cancer screening and symptoms. We queried search data for 4 keyword terms (“mammogram,” “breast pain,” “breast lump,” and “nipple discharge”) from January 1, 2019, to January 1, 2022. The relative search frequency metric was used to assess interest in these terms, and related queries were retrieved for each keyword to evaluate trends in search patterns. Results: Despite an initial drastic drop in interest in mammography from March to April 2020, this quickly recovered by July 2020. After this period, alongside the recovery of interest in screening, there was a rapid increase in interest for arranging for mammography. Relative search frequencies of perceived breast cancer–related symptoms such as breast lump, nipple discharge, and breast pain remained stable. There was increase public interest in natural and alternative therapy of breast lumps despite the recovery of interest in mammography and breast biopsy. There was a significant correlation between search activity and Breast Cancer Awareness Month in October. Conclusions: Online search interest in breast cancer screening experienced a sharp decline at the beginning of the COVID-19 pandemic, with a subsequent return to baseline interest in arranging for mammography followed this short period of decreased interest. %M 37163461 %R 10.2196/39105 %U https://cancer.jmir.org/2023/1/e39105 %U https://doi.org/10.2196/39105 %U http://www.ncbi.nlm.nih.gov/pubmed/37163461 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e43344 %T The Kinetics of Anti–SARS-CoV-2 Antibodies in Pediatric Patients and the Characterization of Post–COVID-19 Condition at 6 Months After Infection: Protocol for a Longitudinal Observational Study %A Arguni,Eggi %A Chamida,Fatia Murni %A Indrawanti,Ratni %A Rusmawatiningtyas,Desy %A Dewi,Yunika Puspa %A Laksanawati,Ida Safitri %+ Department of Child Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Jalan Farmako, Sekip Utara, Sleman, Yogyakarta, 55281, Indonesia, 62 274 560 300, eggiarguni@ugm.ac.id %K kinetics %K anti–SARS-CoV-2 antibodies %K post–COVID-19 condition %K long COVID %K pediatric patient %K antibodies %K COVID-19 %D 2023 %7 6.6.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Data regarding the kinetics of anti–SARS-CoV-2 antibodies and information about post–COVID-19 condition (colloquially known as “long COVID”) in children are scarce, especially in low-income countries. Even though cases of COVID-19 in children are less prevalent than adults, post–COVID-19 condition cases in children are high and have a burden that may impact their growth and development. There are other features of antibody kinetics in connection with SARS-CoV-2 infection that are yet unknown as of this writing, especially in children following infection. Furthermore, the long-term results, risk factors, and underlying pathophysiology are still uncertain. To better understand post–COVID-19 condition in children, it is necessary to further investigate the impact of clinically significant factors such multisystem inflammatory syndrome and disease severity among hospitalized survivors through their SARS-CoV-2 antibody response. Objective: We aim to analyze anti–receptor-binding domain SARS-CoV-2 immunoglobulin G antibodies over time and characterize the signs and symptoms of post–COVID-19 condition in pediatric patients at the time of diagnosis and at 2 weeks and 1, 3, and 6 months following infection. Methods: This is a longitudinal observational study in Indonesia. Pediatric patients diagnosed with COVID-19 by positive molecular assay using nasopharyngeal swab will be tested for anti–SARS-CoV-2 antibodies using the Roche Elecsys Anti-SARS-CoV-2 S assay at the time of diagnosis and at 2 weeks and 1, 3, and 6 months following infection. Antibody titer data will be reported as means and SDs. The respondents’ signs and symptoms will be observed up to 6 months after the onset of infection, including the vaccination event, reinfection, rehospitalization, and mortality. The clinical features will be reported as frequencies and percentages. Results: Participant enrollment began in February 2022. As of September 30, 2022, a total of 58 patients were enrolled. After data collection, results are expected to be analyzed in August 2023. Conclusions: This study will allow us to know the kinetics of anti–receptor-binding domain SARS-CoV-2 immunoglobulin G antibodies and data regarding post–COVID-19 condition up to 6 months following infection in the Indonesian pediatric population. Furthermore, this study has the potential to serve as a foundation for government decisions about vaccination programs and prevention measures. International Registered Report Identifier (IRRID): DERR1-10.2196/43344 %M 37246961 %R 10.2196/43344 %U https://www.researchprotocols.org/2023/1/e43344 %U https://doi.org/10.2196/43344 %U http://www.ncbi.nlm.nih.gov/pubmed/37246961 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e43113 %T The Development of a Chatbot Technology to Disseminate Post–COVID-19 Information: Descriptive Implementation Study %A Nehme,Mayssam %A Schneider,Franck %A Perrin,Anne %A Sum Yu,Wing %A Schmitt,Simon %A Violot,Guillemette %A Ducrot,Aurelie %A Tissandier,Frederique %A Posfay-Barbe,Klara %A Guessous,Idris %+ Division of Primary Care Medicine, Geneva University Hospitals, Rue Gabrielle Perret-Gentil 4, Geneva, 1205, Switzerland, 41 223729677, mayssam.nehme@hcuge.ch %K COVID-19 %K post–COVID-19 %K long COVID %K PASC %K postacute sequelae of SARS-CoV-2 %K chatbot %K medical technology %K online platform %K information %K communication %K dissemination %K disease management %K conversational agent %K digital surveillance %K pediatric %K children %K caregiver %D 2023 %7 5.6.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Post–COVID-19, or long COVID, has now affected millions of individuals, resulting in fatigue, neurocognitive symptoms, and an impact on daily life. The uncertainty of knowledge around this condition, including its overall prevalence, pathophysiology, and management, along with the growing numbers of affected individuals, has created an essential need for information and disease management. This has become even more critical in a time of abundant online misinformation and potential misleading of patients and health care professionals. Objective: The RAFAEL platform is an ecosystem created to address the information about and management of post–COVID-19, integrating online information, webinars, and chatbot technology to answer a large number of individuals in a time- and resource-limited setting. This paper describes the development and deployment of the RAFAEL platform and chatbot in addressing post–COVID-19 in children and adults. Methods: The RAFAEL study took place in Geneva, Switzerland. The RAFAEL platform and chatbot were made available online, and all users were considered participants of this study. The development phase started in December 2020 and included developing the concept, the backend, and the frontend, as well as beta testing. The specific strategy behind the RAFAEL chatbot balanced an accessible interactive approach with medical safety, aiming to relay correct and verified information for the management of post–COVID-19. Development was followed by deployment with the establishment of partnerships and communication strategies in the French-speaking world. The use of the chatbot and the answers provided were continuously monitored by community moderators and health care professionals, creating a safe fallback for users. Results: To date, the RAFAEL chatbot has had 30,488 interactions, with an 79.6% (6417/8061) matching rate and a 73.2% (n=1795) positive feedback rate out of the 2451 users who provided feedback. Overall, 5807 unique users interacted with the chatbot, with 5.1 interactions per user, on average, and 8061 stories triggered. The use of the RAFAEL chatbot and platform was additionally driven by the monthly thematic webinars as well as communication campaigns, with an average of 250 participants at each webinar. User queries included questions about post–COVID-19 symptoms (n=5612, 69.2%), of which fatigue was the most predominant query (n=1255, 22.4%) in symptoms-related stories. Additional queries included questions about consultations (n=598, 7.4%), treatment (n=527, 6.5%), and general information (n=510, 6.3%). Conclusions: The RAFAEL chatbot is, to the best of our knowledge, the first chatbot developed to address post–COVID-19 in children and adults. Its innovation lies in the use of a scalable tool to disseminate verified information in a time- and resource-limited environment. Additionally, the use of machine learning could help professionals gain knowledge about a new condition, while concomitantly addressing patients’ concerns. Lessons learned from the RAFAEL chatbot will further encourage a participative approach to learning and could potentially be applied to other chronic conditions. %M 37195688 %R 10.2196/43113 %U https://www.jmir.org/2023/1/e43113 %U https://doi.org/10.2196/43113 %U http://www.ncbi.nlm.nih.gov/pubmed/37195688 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e44551 %T A Mobile-Based Preventive Intervention for Young, Arabic-Speaking Asylum Seekers During the COVID-19 Pandemic in Germany: Design and Implementation %A Frick,Ulrich %A Sipar,Dilan %A Bücheler,Leonie %A Haug,Fabian %A Haug,Julian %A Almeqbaali,Khalifa Mohammed %A Pryss,Rüdiger %A Rosner,Rita %A Comtesse,Hannah %+ Catholic University Eichstätt-Ingolstadt, Ostenstraße 26, Eichstätt, 85072, Germany, 49 8421 93 21705, hannah.comtesse@ku.de %K prevention %K COVID-19 %K refugees %K asylum seekers %K adolescents %K feasibility %K behavior planning %K vaccination %K mobile phone %D 2023 %7 5.6.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Most individuals seeking asylum in Germany live in collective housing and are thus exposed to a higher risk of contagion during the COVID-19 pandemic. Objective: In this study, we aimed to test the feasibility and efficacy of a culture-sensitive approach combining mobile app–based interventions and a face-to-face group intervention to improve knowledge about COVID-19 and promote vaccination readiness among collectively accommodated Arabic-speaking adolescents and young adults. Methods: We developed a mobile app that consisted of short video clips to explain the biological basis of COVID-19, demonstrate behavior to prevent transmission, and combat misconceptions and myths about vaccination. The explanations were provided in a YouTube-like interview setting by a native Arabic-speaking physician. Elements of gamification (quizzes and rewards for solving the test items) were also used. Consecutive videos and quizzes were presented over an intervention period of 6 weeks, and the group intervention was scheduled as an add-on for half of the participants in week 6. The manual of the group intervention was designed to provide actual behavioral planning based on the health action process approach. Sociodemographic information, mental health status, knowledge about COVID-19, and available vaccines were assessed using questionnaire-based interviews at baseline and after 6 weeks. Interpreters assisted with the interviews in all cases. Results: Enrollment in the study proved to be very challenging. In addition, owing to tightened contact restrictions, face-to-face group interventions could not be conducted as planned. A total of 88 participants from 8 collective housing institutions were included in the study. A total of 65 participants completed the full-intake interview. Most participants (50/65, 77%) had already been vaccinated at study enrollment. They also claimed to comply with preventive measures to a very high extent (eg, “always wearing masks” was indicated by 43/65, 66% of participants), but practicing behavior that was not considered as effective against COVID-19 transmission was also frequently reported as a preventive measure (eg, mouth rinsing). By contrast, factual knowledge of COVID-19 was limited. Preoccupation with the information materials presented in the app steeply declined after study enrollment (eg, 12/61, 20% of participants watched the videos scheduled for week 3). Of the 61 participants, only 18 (30%) participants could be reached for the follow-up interviews. Their COVID-19 knowledge did not increase after the intervention period (P=.56). Conclusions: The results indicated that vaccine uptake was high and seemed to depend on organizational determinants for the target group. The current mobile app–based intervention demonstrated low feasibility, which might have been related to various obstacles faced during the delivery. Therefore, in the case of future pandemics, transmission prevention in a specific target group should rely more on structural aspects rather than sophisticated psychological interventions. %M 37134019 %R 10.2196/44551 %U https://formative.jmir.org/2023/1/e44551 %U https://doi.org/10.2196/44551 %U http://www.ncbi.nlm.nih.gov/pubmed/37134019 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e38323 %T Ontarians’ Perceptions of Public Health Communications and Misinformation During the COVID-19 Pandemic: Survey Study %A Fahim,Christine %A Cooper,Jeanette %A Theivendrampillai,Suvabna %A Pham,Ba' %A Straus,Sharon %+ Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto, 209 Victoria Street, Toronto, ON, M5B 1T8, Canada, 1 416 360 4000 ext 77300, christine.fahim@unityhealth.to %K misinformation %K information seeking %K COVID-19 %K trust %K dissemination %K health communication %K risk %K communication %K policy maker %K transmission %K health emergency %K age %K gender %K survey %D 2023 %7 2.6.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Clear, accurate, and transparent risk communication is critical to providing policy makers and the public with directions to effectively implement public health strategies during a health emergency. Objective: We aimed to explore the public’s preferred sources of obtaining COVID-19 information, perceptions on the prevalence and drivers of misinformation during the pandemic, and suggestions to optimize health communications during future public health emergencies. Methods: We administered a web-based survey that included Likert scale, multiple choice and open-ended response questions to residents of Ontario, Canada. We aimed to recruit a sample that reflected population diversity with respect to age and gender. Data were collected between June 10, 2020, and December 31, 2020, and were analyzed using descriptive statistics; open-ended data were analyzed using content analysis. Subgroup analyses to explore perceptions by age and gender were conducted using ordinal regression. Results: A total of 1823 individuals participated in the survey (n=990, 54% women; n=703, 39% men; n=982, 54% aged 18-40 years; n=518, 28% aged 41-60 years; and n=215, 12% aged ≥61 years). Participants most commonly obtained COVID-19 information from local television news (n=1118, 61%) followed by social media (n=938, 51%), national or international television news (n=888, 49%), and friends and family (n=835, 46%). Approximately 55% (n=1010) of the participants believed they had encountered COVID-19–related misinformation; 70% (n=1284) of the participants reported high levels of trust in health authority websites and health care providers; 66% (n=1211) reported high levels of trust in health ministers or public health organizations. Sources perceived to be less trustworthy included friends and family, talk radio, social media, as well as blogs and opinion websites. Men were more likely to report encountering misinformation and to trust friends or family (odds ratio [OR] 1.49, 95% CI 1.24-1.79) and blogs or opinion websites (OR 1.24, 95% CI 1.03-1.50), compared to women. Compared to those aged 18-40 years, participants aged ≥41years were more likely to trust all assessed information sources, with the exception of web-based media sources, and less likely to report encountering misinformation. Of those surveyed, 58% (n=1053) had challenges identifying or appraising COVID-19 information. Conclusions: Over half of our participants perceived that they had encountered COVID-19 misinformation, and 58% had challenges identifying or appraising COVID-19 information. Gender and age differences in perceptions of misinformation and trust in information sources were observed. Future research to confirm the validity of these perceptions and to explore information-seeking patterns by population subgroups may provide useful insights on how to optimize health communication during public health emergencies. %M 37159394 %R 10.2196/38323 %U https://formative.jmir.org/2023/1/e38323 %U https://doi.org/10.2196/38323 %U http://www.ncbi.nlm.nih.gov/pubmed/37159394 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e47079 %T Characterizing Symptoms and Identifying Biomarkers of Long COVID in People With and Without HIV: Protocol for a Remotely Conducted Prospective Observational Cohort Study %A Márquez,Nuria Gallego %A Jamal,Armaan %A Johnston,Rowena %A Richter,E India %A Gorbach,Pamina M %A Vannorsdall,Tracy D %A Rubin,Leah H %A Jennings,Cheryl %A Landay,Alan L %A Peluso,Michael J %A Antar,Annukka A R %+ Department of Medicine, Johns Hopkins University School of Medicine, 720 Rutland Avenue, Ross Research Building Room 1064, Baltimore, MD, 21205, United States, 1 (410) 614 9140, aantar1@jhmi.edu %K HIV %K SARS-CoV-2 %K COVID-19 %K long COVID %K post–acute COVID-19 syndrome %K postacute sequelae of SARS-CoV-2 infection %K prospective observational cohort study %K remote study %K remote participation %D 2023 %7 31.5.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Living with HIV is a risk factor for severe acute COVID-19, but it is unknown whether it is a risk factor for long COVID. Objective: This study aims to characterize symptoms, sequelae, and cognition formally and prospectively 12 months following SARS-CoV-2 infection in people living with HIV compared with people without HIV. People with no history of SARS-CoV-2 infection, both with and without HIV, are enrolled as controls. The study also aims to identify blood-based biomarkers or patterns of immune dysregulation associated with long COVID. Methods: This prospective observational cohort study enrolled participants into 1 of the following 4 study arms: people living with HIV who had SARS-CoV-2 infection for the first time <4 weeks before enrollment (HIV+COVID+ arm), people without HIV who had SARS-CoV-2 infection for the first time within 4 weeks of enrollment (HIV−COVID+ arm), people living with HIV who believed they never had SARS-CoV-2 infection (HIV+COVID− arm), and people without HIV who believed they never had SARS-CoV-2 infection (HIV−COVID− arm). At enrollment, participants in the COVID+ arms recalled their symptoms, mental health status, and quality of life in the month before having SARS-CoV-2 infection via a comprehensive survey administered by telephone or on the web. All participants completed the same comprehensive survey 1, 2, 4, 6, and 12 months after post–acute COVID-19 symptom onset or diagnosis, if asymptomatic, (COVID+ arms) or after enrollment (COVID− arms) on the web or by telephone. In total, 11 cognitive assessments were administered by telephone at 1 and 4 months after symptom onset (COVID+ arms) or after enrollment (COVID− arms). A mobile phlebotomist met the participants at a location of their choice for height and weight measurements, orthostatic vital signs, and a blood draw. Participants in the COVID+ arms donated blood 1 and 4 months after COVID-19, and participants in the COVID− arms donated blood once or none. Blood was then shipped overnight to the receiving study laboratory, processed, and stored. Results: This project was funded in early 2021, and recruitment began in June 2021. Data analyses will be completed by summer 2023. As of February 2023, a total of 387 participants were enrolled in this study, with 345 participants having completed enrollment or baseline surveys together with at least one other completed study event. The 345 participants includes 76 (22%) HIV+COVID+, 121 (35.1%) HIV−COVID+, 78 (22.6%) HIV+COVID−, and 70 (20.3%) HIV−COVID− participants. Conclusions: This study will provide longitudinal data to characterize COVID-19 recovery over 12 months in people living with and without HIV. Additionally, this study will determine whether biomarkers or patterns of immune dsyregulation associate with decreased cognitive function or symptoms of long COVID. International Registered Report Identifier (IRRID): DERR1-10.2196/47079 %M 37104709 %R 10.2196/47079 %U https://www.researchprotocols.org/2023/1/e47079 %U https://doi.org/10.2196/47079 %U http://www.ncbi.nlm.nih.gov/pubmed/37104709 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e40650 %T The COVID-19 Pandemic and Daily Steps in the General Population: Meta-analysis of Observational Studies %A Wu,Ziying %A Wang,Yilun %A Zhang,Yuqing %A Bennell,Kim L %A White,Daniel K %A Shen,Liusong %A Ren,Wei %A Wei,Jie %A Zeng,Chao %A Lei,Guanghua %+ Department of Orthopaedics, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, China, 86 073184327326, lei_guanghua@csu.edu.cn %K COVID-19 %K daily steps %K physical activity %K meta-analysis %D 2023 %7 30.5.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The COVID-19 pandemic has the potential to accelerate another pandemic: physical inactivity. Daily steps, a proxy of physical activity, are closely related to health. Recent studies indicate that over 7000 steps per day is the critical physical activity standard for minimizing the risk of all-cause mortality. Moreover, the risk of cardiovascular events has been found to increase by 8% for every 2000 steps per day decrement. Objective: To quantify the impact of the COVID-19 pandemic on daily steps in the general adult population. Methods: This study follows the guidelines of the MOOSE (Meta-analysis Of Observational Studies in Epidemiology) checklist. PubMed, EMBASE, and Web of Science were searched from inception to February 11, 2023. Eligible studies were observational studies reporting monitor-assessed daily steps before and during the confinement period of the COVID-19 pandemic in the general adult population. Two reviewers performed study selection and data extraction independently. The modified Newcastle-Ottawa Scale was used to assess the study quality. A random effects meta-analysis was conducted. The primary outcome of interest was the number of daily steps before (ie, January 2019 to February 2020) and during (ie, after January 2020) the confinement period of COVID-19. Publication bias was assessed with a funnel plot and further evaluated with the Egger test. Sensitivity analyses were performed by excluding studies with low methodological quality or small sample sizes to test the robustness of the findings. Other outcomes included subgroup analyses by geographic location and gender. Results: A total of 20 studies (19,253 participants) were included. The proportion of studies with subjects with optimal daily steps (ie, ≥7000 steps/day) declined from 70% before the pandemic to 25% during the confinement period. The change in daily steps between the 2 periods ranged from –5771 to –683 across studies, and the pooled mean difference was –2012 (95% CI –2805 to –1218). The asymmetry in the funnel plot and Egger test results did not indicate any significant publication bias. Results remained stable in sensitivity analyses, suggesting that the observed differences were robust. Subgroup analyses revealed that the decline in daily steps clearly varied by region worldwide but that there was no apparent difference between men and women. Conclusions: Our findings indicate that daily steps declined substantially during the confinement period of the COVID-19 pandemic. The pandemic further exacerbated the ever-increasing prevalence of low levels of physical activity, emphasizing the necessity of adopting appropriate measures to reverse this trend. Further research is required to monitor the consequence of long-term physical inactivity. Trial Registration: PROSPERO CRD42021291684; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=291684 %M 37252779 %R 10.2196/40650 %U https://publichealth.jmir.org/2023/1/e40650 %U https://doi.org/10.2196/40650 %U http://www.ncbi.nlm.nih.gov/pubmed/37252779 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 12 %N %P e43308 %T The Relationship Between Face Mask Use and Face-Touching Frequency in Public Areas: Naturalistic Study %A Niesen,Sydney %A Ramon,Daniel %A Spencer-Hwang,Rhonda %A Sinclair,Ryan %+ San Diego State University, 5500 Campanile Dr, San Diego, CA, 92182, United States, 1 6195945200, sydney.niesen@gmail.com %K COVID-19 %K mask wearing %K face-touching %K self-inoculation %K public health %K digital surveillance %K webcam video %K prevention %K health risk %K health %K risk %K mask %K surveillance %K transmission %K behavior %D 2023 %7 29.5.2023 %9 Original Paper %J Interact J Med Res %G English %X Background: Throughout the COVID-19 pandemic in the United States, a major public health goal has been reducing the spread of the virus, with particular emphasis on reducing transmission from person to person. Frequent face touching can transmit viral particles from one infected person and subsequently infect others in a public area. This raises an important concern about the use of face masks and their relationship with face-touching behaviors. One concern discussed during the pandemic is that wearing a mask, and different types of masks, could increase face touching because there is a need to remove the mask to smoke, drink, eat, etc. To date, there have been few studies that have assessed this relationship between mask wearing and the frequency of face touching relative to face-touching behaviors. Objective: This study aimed to compare the frequency of face touching in people wearing a mask versus not wearing a mask in high–foot traffic urban outdoor areas. The purpose of this study was to assess if mask wearing was associated with increased face touching. Methods: Public webcam videos from 4 different cities in New York, New Jersey, Louisiana, and Florida were used to collect data. Face touches were recorded as pedestrians passed under the webcam. Adult pedestrians wearing masks were compared to those not wearing masks. Quantitative measures of frequency, duration, site of touch, and oral activities were recorded. Linear regression analysis was used to assess the association between mask use and face touching. Results: Of the 490 observed subjects, 241 (49.2%) were wearing a mask properly and 249 (50.8%) were not. In the unmasked group, 33.7% (84/249) were wearing it improperly, covering the mouth only. Face touching occurred in 11.4% (56/490) of the masked group and 17.6% (88/490) in the unmasked group. Of those who touched their face, 61.1% (88/144) of people were not wearing a mask. The most common site of face touching was the perioral region in both groups. Both the masked and unmasked group had a frequency of face touching for 0.03 touches/s. Oral activities such as eating or smoking increased face touching in the unmasked group. Conclusions: Contrary to expectations, non–mask-wearing subjects touched their face more frequently than those who were wearing a mask. This finding is substantial because wearing a face mask had a negative association with face touching. When wearing a mask, individuals are less likely to be spreading and ingesting viral particles. Therefore, wearing a mask is more effective in preventing the spread of viral particles. %M 37094229 %R 10.2196/43308 %U https://www.i-jmr.org/2023/1/e43308 %U https://doi.org/10.2196/43308 %U http://www.ncbi.nlm.nih.gov/pubmed/37094229 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 3 %N %P e44714 %T Global Misinformation Spillovers in the Vaccination Debate Before and During the COVID-19 Pandemic: Multilingual Twitter Study %A Lenti,Jacopo %A Mejova,Yelena %A Kalimeri,Kyriaki %A Panisson,André %A Paolotti,Daniela %A Tizzani,Michele %A Starnini,Michele %+ Departament de Fisica, Universitat Politecnica de Catalunya, Campus Nord B4, Barcelona, 08034, Spain, 34 934 01 62 00, michele.starnini@upc.edu %K vaccination hesitancy %K vaccine %K misinformation %K Twitter %K social media %K COVID-19 %D 2023 %7 24.5.2023 %9 Original Paper %J JMIR Infodemiology %G English %X Background: Antivaccination views pervade online social media, fueling distrust in scientific expertise and increasing the number of vaccine-hesitant individuals. Although previous studies focused on specific countries, the COVID-19 pandemic has brought the vaccination discourse worldwide, underpinning the need to tackle low-credible information flows on a global scale to design effective countermeasures. Objective: This study aimed to quantify cross-border misinformation flows among users exposed to antivaccination (no-vax) content and the effects of content moderation on vaccine-related misinformation. Methods: We collected 316 million vaccine-related Twitter (Twitter, Inc) messages in 18 languages from October 2019 to March 2021. We geolocated users in 28 different countries and reconstructed a retweet network and cosharing network for each country. We identified communities of users exposed to no-vax content by detecting communities in the retweet network via hierarchical clustering and manual annotation. We collected a list of low-credibility domains and quantified the interactions and misinformation flows among no-vax communities of different countries. Results: The findings showed that during the pandemic, no-vax communities became more central in the country-specific debates and their cross-border connections strengthened, revealing a global Twitter antivaccination network. US users are central in this network, whereas Russian users also became net exporters of misinformation during vaccination rollout. Interestingly, we found that Twitter’s content moderation efforts, in particular the suspension of users following the January 6 US Capitol attack, had a worldwide impact in reducing the spread of misinformation about vaccines. Conclusions: These findings may help public health institutions and social media platforms mitigate the spread of health-related, low-credibility information by revealing vulnerable web-based communities. %M 37223965 %R 10.2196/44714 %U https://infodemiology.jmir.org/2023/1/e44714 %U https://doi.org/10.2196/44714 %U http://www.ncbi.nlm.nih.gov/pubmed/37223965 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e40514 %T Joint Analysis of the Epidemic Evolution and Human Mobility During the First Wave of COVID-19 in Spain: Retrospective Study %A Steinegger,Benjamin %A Granell,Clara %A Rapisardi,Giacomo %A Gómez,Sergio %A Matamalas,Joan %A Soriano-Paños,David %A Gómez-Gardeñes,Jesús %A Arenas,Alex %+ Universitat Rovira i Virgili, Avda Paisos Catalans 26, Tarragona, 43007, Spain, 34 977559687, alexandre.arenas@urv.cat %K epidemics %K NPIs %K nonpharmaceutical intervention %K human behavior %K Spain %K COVID-19 %K mobility data %K epidemic evolution %K public health %K surveillance %K public health intervention %K model-based inference %D 2023 %7 22.5.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The initial wave of the COVID-19 pandemic placed a tremendous strain on health care systems worldwide. To mitigate the spread of the virus, many countries implemented stringent nonpharmaceutical interventions (NPIs), which significantly altered human behavior both before and after their enactment. Despite these efforts, a precise assessment of the impact and efficacy of these NPIs, as well as the extent of human behavioral changes, remained elusive. Objective: In this study, we conducted a retrospective analysis of the initial wave of COVID-19 in Spain to better comprehend the influence of NPIs and their interaction with human behavior. Such investigations are vital for devising future mitigation strategies to combat COVID-19 and enhance epidemic preparedness more broadly. Methods: We used a combination of national and regional retrospective analyses of pandemic incidence alongside large-scale mobility data to assess the impact and timing of government-implemented NPIs in combating COVID-19. Additionally, we compared these findings with a model-based inference of hospitalizations and fatalities. This model-based approach enabled us to construct counterfactual scenarios that gauged the consequences of delayed initiation of epidemic response measures. Results: Our analysis demonstrated that the pre–national lockdown epidemic response, encompassing regional measures and heightened individual awareness, significantly contributed to reducing the disease burden in Spain. The mobility data indicated that people adjusted their behavior in response to the regional epidemiological situation before the nationwide lockdown was implemented. Counterfactual scenarios suggested that without this early epidemic response, there would have been an estimated 45,400 (95% CI 37,400-58,000) fatalities and 182,600 (95% CI 150,400-233,800) hospitalizations compared to the reported figures of 27,800 fatalities and 107,600 hospitalizations, respectively. Conclusions: Our findings underscore the significance of self-implemented prevention measures by the population and regional NPIs before the national lockdown in Spain. The study also emphasizes the necessity for prompt and precise data quantification prior to enacting enforced measures. This highlights the critical interplay between NPIs, epidemic progression, and human behavior. This interdependence presents a challenge in predicting the impact of NPIs before they are implemented. %M 37213190 %R 10.2196/40514 %U https://publichealth.jmir.org/2023/1/e40514 %U https://doi.org/10.2196/40514 %U http://www.ncbi.nlm.nih.gov/pubmed/37213190 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 9 %N %P e44339 %T Factors Associated With Online Patient-Provider Communications Among Cancer Survivors in the United States During COVID-19: Cross-sectional Study %A Kim,Jiyeong %A Linos,Eleni %A Fishman,Debra A %A Dove,Melanie S %A Hoch,Jeffrey S %A Keegan,Theresa H %+ Department of Public Health Sciences, School of Medicine, University of California, Davis, 1 Shield ave, Davis, CA, 95616, United States, 1 5307522793, jykim3@stanford.edu %K online patient-provider communication %K cancer survivor %K COVID-19 %K telehealth %K eHealth activities %K telemedicine %K eHealth %K e-health %K patient provider %K online communication %K patient-physician %K national survey %K sociodemographic %K oncology %K cancer %D 2023 %7 22.5.2023 %9 Original Paper %J JMIR Cancer %G English %X Background: Online patient-provider communication (OPPC) is crucial in enhancing access to health information, self-care, and related health outcomes among cancer survivors. The necessity of OPPC increased during SARS-CoV-2/COVID-19, yet investigations in vulnerable subgroups have been limited. Objective: This study aims to assess the prevalence of OPPC and sociodemographic and clinical characteristics associated with OPPC among cancer survivors and adults without a history of cancer during COVID-19 versus pre–COVID-19. Methods: Nationally representative cross-sectional survey data (Health Information National Trends Survey 5, 2017-2020) were used among cancer survivors (N=1900) and adults without a history of cancer (N=13,292). COVID-19 data included data from February to June 2020. We calculated the prevalence of 3 types of OPPC, defined as using the email/internet, tablet/smartphone, or electronic health record (EHR) for patient-provider communication, in the past 12 months. To investigate the associations of sociodemographic and clinical factors with OPPC, multivariable-adjusted weighted logistic regression was performed to obtain odds ratios (ORs) and 95% CIs. Results: The average prevalence of OPPC increased from pre-COVID to COVID among cancer survivors (39.7% vs 49.7%, email/internet; 32.2% vs 37.9%, tablet/smartphone; 19.0% vs 30.0%, EHR). Cancer survivors (OR 1.32, 95% CI 1.06-1.63) were slightly more likely to use email/internet communications than adults without a history of cancer prior to COVID-19. Among cancer survivors, the email/internet (OR 1.61, 95% CI 1.08-2.40) and EHRs (OR 1.92, 95% CI 1.22-3.02) were more likely to be used during COVID-19 than pre–COVID-19. During COVID-19, subgroups of cancer survivors, including Hispanics (OR 0.26, 95% CI 0.09-0.71 vs non-Hispanic Whites) or those with the lowest income (US $50,000-60 years old) in the family (aOR 0.685, 95% CI 0.510-0.911), had better knowledge about COVID-19 (aOR 0.942, 95% CI 0.916-0.970), and had mental health disorders (aOR 0.795, 95% CI 0.646-0.975) were less likely to report hesitancy to undergo RAT. Conclusions: Hesitancy to undergo SARS-CoV-2 RAT was low among individuals who were not yet infected with SARS-CoV-2. Efforts should be made to improve the awareness and acceptance of RAT among men, younger adults, individuals with a lower education or salary, families without children and elders, and individuals who access COVID-19 information via traditional media. In a reopening world, our study could inform the development of contextualized mass screening strategies in general and the scale-up of RAT in particular, which remains an indispensable option in emergency preparedness. %M 36888911 %R 10.2196/43555 %U https://publichealth.jmir.org/2023/1/e43555 %U https://doi.org/10.2196/43555 %U http://www.ncbi.nlm.nih.gov/pubmed/36888911 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e42966 %T Patient Experiences With Virtual Care During the COVID-19 Pandemic: Phenomenological Focus Group Study %A Curran,Vernon R %A Hollett,Ann %A Peddle,Emily %+ Faculty of Medicine, Memorial University, Prince Philip Drive, St John's, NL, A1B 3V6, Canada, 1 7098643346, vcurran@mun.ca %K virtual care %K focus group %K patients %K patient education %K qualitative study %K patient experience %K health care system %K digital literacy %K rural community %K technology adoption %K COVID-19 %D 2023 %7 1.5.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Virtual care has expanded during the COVID-19 pandemic and enabled greater access and continuity of care for many patients. From a patient-oriented research perspective, understanding the patient experience with virtual care appointments is an important first step in identifying ways to better support patient use and satisfaction. Objective: The purpose of this qualitative study was (1) to explore patients’ experiences and perspectives with the adoption and use of virtual care during COVID-19 in Newfoundland and Labrador, Canada, and (2) identify the education and informational needs of patients to inform future strategies for supporting patient use of virtual care. Methods: Using a phenomenological approach, we conducted a focus group interview with a purposive sample of patient representatives representing a cross-section of the population of the province of Newfoundland and Labrador. Five patient representatives were recruited from the Newfoundland and Labrador Support Patient Advisory Council and participated in the focus group. The focus group was conducted in February 2022 via videoconferencing technology. Using thematic analysis, we identified several recurrent themes that described respondents’ experiences with the use of virtual care during COVID-19, as well as their perceptions of education and informational needs to support more effective patient use of virtual care. Results: Respondents felt that virtual care is a beneficial addition to the health care system, enabling greater convenience and access to health care services. Key barriers and challenges in adopting and using virtual care appear to primarily arise from patients’ lack of knowledge, understanding, and familiarity with respect to virtual care. Cost, technological access, connectivity, and low digital literacy were challenges for some patients, particularly in rural communities and among older patient population. Patient education and support were critical and needed to be inclusive, easy to understand, and include information regarding privacy, security, consent, and the technology itself. The types of patient education experiences regarded as most helpful included peer support and knowledge sharing among patients themselves. Conclusions: Beyond the COVID-19 pandemic, virtual care will have a continuing role in enhancing the continuity of care for patients through more convenient access. The education and informational needs of patients are important considerations in promoting the adoption and use of virtual care. Key education and informational needs and strategies were identified to enable and empower patients with the knowledge, digital literacy skills, and support to effectively use virtual care. %M 37036827 %R 10.2196/42966 %U https://formative.jmir.org/2023/1/e42966 %U https://doi.org/10.2196/42966 %U http://www.ncbi.nlm.nih.gov/pubmed/37036827 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e43498 %T An Exploration of Practitioners’ Experiences of Delivering Digital Social Care Interventions to Children and Families During the COVID-19 Pandemic: Mixed Methods Study %A Hickey,Grainne %A Dunne,Claire %A Maguire,Lauren %A McCarthy,Niamh %+ Barnardos Ireland, Christchurch Sq, Dublin 8, Dublin, D08DT63, Ireland, 353 861438861, grainne.hickey@barnardos.ie %K digital social care %K social care practice %K children and families %K COVID-19 %K mobile phone %D 2023 %7 28.4.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital technology is an increasing feature of social care practice, and its use has accelerated greatly in response to the COVID-19 pandemic. Objective: This study aimed to assess social care practitioners’ experiences of delivering digital interventions to vulnerable children and families during the pandemic. Methods: A mixed methods study combining survey and qualitative research was conducted. In total, 102 social care practitioners working in the Republic of Ireland who delivered a range of digital social care support took part in a web-based survey. This survey captured practitioners’ engagement and experiences of delivering digital social care interventions to children and families as well as training and capacity building needs. Subsequently, 19 focus groups with 106 social care practitioners working with children and families were also conducted. These focus groups were directed by a topic guide and explored in more depth practitioners’ perceptions of digital social care practice, the perceived impact of digital technology on their work with children and families, and the future application of digital social care interventions. Results: The survey findings revealed that 52.9% (54/102) and 45.1% (46/102) of practitioners, respectively, felt “confident” and “comfortable” engaging in digital service delivery. The vast majority of practitioners (93/102, 91.2%) identified maintaining connection during the pandemic as a benefit of digital social care practice; approximately three-quarters of practitioners (74/102, 72.5%) felt that digital social care practice offered service users “increased access and flexibility”; however, a similar proportion of practitioners (70/102, 68.6%) identified inadequate home environments (eg, lack of privacy) during service provision as a barrier to digital social care practice. More than half of the practitioners (54/102, 52.9%) identified poor Wi-Fi or device access as a challenge to child and family engagement with digital social care. In total, 68.6% (70/102) of practitioners felt that they needed further training on the use of digital platforms for service delivery. Thematic analysis of qualitative (focus group) data revealed 3 overarching themes: perceived advantages and disadvantages for service users, practitioners’ challenges in working with children and families through digital technologies, and practitioners’ personal challenges and training needs. Conclusions: These findings shed light on practitioners’ experiences of delivering digital child and family social care services during the COVID-19 pandemic. Both benefits and challenges within the delivery of digital social care support as well as conflicting findings across the experiences of practitioners were identified. The implications of these findings for the development of therapeutic practitioner–service user relationships through digital practice as well as confidentiality and safeguarding are discussed. Training and support needs for the future implementation of digital social care interventions are also outlined. %M 36888555 %R 10.2196/43498 %U https://formative.jmir.org/2023/1/e43498 %U https://doi.org/10.2196/43498 %U http://www.ncbi.nlm.nih.gov/pubmed/36888555 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e46782 %T Investigating the Comparative Effectiveness of Place-Based and Scatter-Site Permanent Supportive Housing for People Experiencing Homelessness During the COVID-19 Pandemic: Protocols for a Mixed Methods, Prospective Longitudinal Study %A Henwood,Benjamin F %A Kuhn,Randall %A Padwa,Howard %A Ijadi-Maghsoodi,Roya %A Corletto,Gisele %A Lawton,Alex %A Chien,Jessie %A Bluthenthal,Ricky %A Cousineau,Michael R %A Chinchilla,Melissa %A Tran Smith,Bikki %A Vickery,Katherine D %A Harris,Taylor %A Patanwala,Maria %A Akabike,Whitney %A Gelberg,Lillian %+ Suzanne Dworak-Peck School of Social Work, University of Southern California, 669 W 34th Street, Los Angeles, CA, 90089, United States, 1 6107316872, bhenwood@usc.edu %K homelessness %K housing first %K permanent supportive housing %K COVID-19 %K homeless %K housing %K health outcome %K patient-centered %K person-centered %K photo-elicitation %D 2023 %7 28.4.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Permanent supportive housing (PSH) is an evidence-based practice to address homelessness that is implemented using 2 distinct approaches. The first approach is place-based PSH (PB-PSH), or single-site housing placement, in which an entire building with on-site services is designated for people experiencing homelessness. The second approach is scatter-site PSH (SS-PSH), which uses apartments rented from a private landlord while providing mobile case management services. Objective: This paper describes the protocols for a mixed methods comparative effectiveness study of 2 distinct approaches to implementing PSH and the patient-centered quality of life, health care use, and health behaviors that reduce COVID-19 risk. Methods: People experiencing homelessness who are placed in either PB-PSH or SS-PSH completed 6 monthly surveys after move-in using smartphones provided by the study team. A subsample of participants completed 3 qualitative interviews at baseline, 3 months, and 6 months that included photo elicitation interviewing. Two stakeholder advisory groups, including one featuring people with lived experience of homelessness, helped guide study decisions and interpretations of findings. Results: Study recruitment was supposed to occur over 6 months starting in January 2021 but was extended due to delays in recruitment. These delays included COVID-19 delays (eg, recruitment sites shut down due to outbreaks and study team members testing positive) and delays that may have been indirectly related to the COVID-19 pandemic, including high staff turnover or recruitment sites having competing priorities. In end-July 2022, in total, 641 people experiencing homelessness had been referred from 26 partnering recruitment sites, and 563 people experiencing homelessness had enrolled in the study and completed a baseline demographic survey. Of the 563 participants in the study, 452 had recently moved into the housing when they enrolled, with 272 placed in PB-PSH and 180 placed in SS-PSH. Another 111 participants were approved but are still waiting for housing placement. To date, 49 participants have been lost to follow-up, and 12% of phones (70 of the initial 563 distributed) were reported lost by participants. Conclusions: Recruitment during the pandemic, while successful, was challenging given that in-person contact was not permitted at times either by program sites or the research institutions during COVID-19 surges and high community transmission, which particularly affected homelessness programs in Los Angeles County. To overcome recruitment challenges, flexible strategies were used, which included extending the recruitment period and the distribution of cell phones with paid data plans. Given current recruitment numbers and retention rates that are over 90%, the study will be able to address a gap in the literature by considering the comparative effectiveness of PB-PSH versus SS-PSH on patient-centered quality of life, health care use, and health behaviors that reduce COVID-19 risk, which can influence future public health approaches to homelessness and infectious diseases. Trial Registration: ClinicalTrials.gov NCT04769349; https://clinicaltrials.gov/ct2/show/NCT04769349 International Registered Report Identifier (IRRID): DERR1-10.2196/46782 %M 37115590 %R 10.2196/46782 %U https://www.researchprotocols.org/2023/1/e46782 %U https://doi.org/10.2196/46782 %U http://www.ncbi.nlm.nih.gov/pubmed/37115590 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e34163 %T Demographic Determinants and Geographical Variability of COVID-19 Vaccine Hesitancy in Underserved Communities: Cross-sectional Study %A Matas,Jennifer L %A Landry,Latrice G %A Lee,LaTasha %A Hansel,Shantoy %A Coudray,Makella S %A Mata-McMurry,Lina V %A Chalasani,Nishanth %A Xu,Liou %A Stair,Taylor %A Edwards,Christina %A Puckrein,Gary %A Meyer,William %A Wiltz,Gary %A Sampson,Marian %A Gregerson,Paul %A Barron,Charles %A Marable,Jeffrey %A Akinboboye,Olakunle %A Il'yasova,Dora %+ National Minority Quality Forum, 1201 15th Street, NW, Suite 340, Washington, DC, 20005, United States, 1 202 223 7560 ext 175, dilyasova@nmqf.org %K COVID-19 vaccine %K vaccine hesitancy %K underrepresented in research %K minority populations %K federally qualified health center (FQHC) %K public health %K COVID-19 %D 2023 %7 27.4.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: COVID-19 hospitalizations and deaths disproportionately affect underserved and minority populations, emphasizing that vaccine hesitancy can be an especially important public health risk factor in these populations. Objective: This study aims to characterize COVID-19 vaccine hesitancy in underserved diverse populations. Methods: The Minority and Rural Coronavirus Insights Study (MRCIS) recruited a convenience sample of adults (age≥18, N=3735) from federally qualified health centers (FQHCs) in California, the Midwest (Illinois/Ohio), Florida, and Louisiana and collected baseline data in November 2020-April 2021. Vaccine hesitancy status was defined as a response of “no” or “undecided” to the question “Would you get a coronavirus vaccine if it was available?” (“yes” categorized as not hesitant). Cross-sectional descriptive analyses and logistic regression models examined vaccine hesitancy prevalence by age, gender, race/ethnicity, and geography. The expected vaccine hesitancy estimates for the general population were calculated for the study counties using published county-level data. Crude associations with demographic characteristics within each region were assessed using the chi-square test. The main effect model included age, gender, race/ethnicity, and geographical region to estimate adjusted odds ratios (ORs) and 95% CIs. Interactions between geography and each demographic characteristic were evaluated in separate models. Results: The strongest vaccine hesitancy variability was by geographic region: California, 27.8% (range 25.0%-30.6%); the Midwest, 31.4% (range 27.3%-35.4%); Louisiana, 59.1% (range 56.1%-62.1%); and Florida, 67.3% (range 64.3%-70.2%). The expected estimates for the general population were lower: 9.7% (California), 15.3% (Midwest), 18.2% (Florida), and 27.0% (Louisiana). The demographic patterns also varied by geography. An inverted U-shaped age pattern was found, with the highest prevalence among ages 25-34 years in Florida (n=88, 80.0%,) and Louisiana (n=54, 79.4%; P<.05). Females were more hesitant than males in the Midwest (n= 110, 36.4% vs n= 48, 23.5%), Florida (n=458, 71.6% vs n=195, 59.3%), and Louisiana (n= 425, 66.5% vs. n=172, 46.5%; P<.05). Racial/ethnic differences were found in California, with the highest prevalence among non-Hispanic Black participants (n=86, 45.5%), and in Florida, with the highest among Hispanic (n=567, 69.3%) participants (P<.05), but not in the Midwest and Louisiana. The main effect model confirmed the U-shaped association with age: strongest association with age 25-34 years (OR 2.29, 95% CI 1.74-3.01). Statistical interactions of gender and race/ethnicity with the region were significant, following the pattern found by the crude analysis. Compared to males in California, the associations with the female gender were strongest in Florida (OR=7.88, 95% CI 5.96-10.41) and Louisiana (OR=6.09, 95% CI 4.55-8.14). Compared to non-Hispanic White participants in California, the strongest associations were found with being Hispanic in Florida (OR=11.18, 95% CI 7.01-17.85) and Black in Louisiana (OR=8.94, 95% CI 5.53-14.47). However, the strongest race/ethnicity variability was observed within California and Florida: the ORs varied 4.6- and 2-fold between racial/ethnic groups in these regions, respectively. Conclusions: These findings highlight the role of local contextual factors in driving vaccine hesitancy and its demographic patterns. %M 36811869 %R 10.2196/34163 %U https://publichealth.jmir.org/2023/1/e34163 %U https://doi.org/10.2196/34163 %U http://www.ncbi.nlm.nih.gov/pubmed/36811869 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 10 %N %P e39697 %T Eliciting Opinions on Health Messaging During the COVID-19 Pandemic: Qualitative Survey Study %A Ruiz,Sienna %A Okere,Uzoma Charles %A Eggers,Michelle %A O'Leary,Catina %A Politi,Mary %A Wan,Fei %A Housten,Ashley J %+ Division of Public Health Sciences, Department of Surgery, Washington University in St. Louis, 660 S Euclid Ave, MSC 8100-0094-02, St. Louis, MO, 63110, United States, 1 (314) 454 7958, ahousten@wustl.edu %K COVID-19 %K health messaging %K rural populations %K urban populations %K communication %K health information %K messaging %K dissemination %K health equity %K prevention %K implementation %D 2023 %7 27.4.2023 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Effective public health messaging has been necessary throughout the COVID-19 pandemic, but stakeholders have struggled to communicate critical information to the public, especially in different types of locations such as urban and rural areas. Objective: This study aimed to identify opportunities to improve COVID-19 messages for community distribution in rural and urban settings and to summarize the findings to inform future messaging. Methods: We purposively sampled by region (urban or rural) and participant type (general public or health care professional) to survey participants about their opinions on 4 COVID-19 health messages. We designed open-ended survey questions and analyzed the data using pragmatic health equity implementation science approaches. Following the qualitative analysis of the survey responses, we designed refined COVID-19 messages incorporating participant feedback and redistributed them via a short survey. Results: In total, 67 participants consented and enrolled: 31 (46%) community participants from the rural Southeast Missouri Bootheel, 27 (40%) community participants from urban St Louis, and 9 (13%) health care professionals from St Louis. Overall, we found no qualitative differences between the responses of our urban and rural samples to the open-ended questions. Participants across groups wanted familiar COVID-19 protocols, personal choice in COVID-19 preventive behaviors, and clear source information. Health care professionals contextualized their suggestions within the specific needs of their patients. All groups suggested practices consistent with health-literate communications. We reached 83% (54/65) of the participants for message redistribution, and most had overwhelmingly positive responses to the refined messages. Conclusions: We suggest convenient methods for community involvement in the creation of health messages by using a brief web-based survey. We identified areas of improvement for future health messaging, such as reaffirming the preventive practices advertised early in a crisis, framing messages such that they allow for personal choice of preventive behavior, highlighting well-known source information, using plain language, and crafting messages that are applicable to the readers’ circumstances. %M 36848256 %R 10.2196/39697 %U https://humanfactors.jmir.org/2023/1/e39697 %U https://doi.org/10.2196/39697 %U http://www.ncbi.nlm.nih.gov/pubmed/36848256 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 6 %N %P e41554 %T Satisfaction With Telehealth Services Compared With Nontelehealth Services Among Pediatric Patients and Their Caregivers: Systematic Review of the Literature %A Kodjebacheva,Gergana Damianova %A Culinski,Taylor %A Kawser,Bushra %A Coffer,Katelynn %+ Department of Public Health and Health Sciences, College of Health Sciences, University of Michigan-Flint, 303 E. Kearsley St., Flint, MI, 48502, United States, 1 (810) 424 5373, gergana@umich.edu %K satisfaction %K pediatrics %K telehealth %K telemedicine %K virtual care %K caregivers %K patients %K children %K COVID-19 %K coronavirus %K SARS-CoV-2 %K technology use %K caregiver %K adolescent %K youth %K satisfaction survey %K health outcome %K review methodology %K systematic review %D 2023 %7 27.4.2023 %9 Review %J JMIR Pediatr Parent %G English %X Background: Telehealth refers to the use of technology to deliver health care remotely. The COVID-19 pandemic has prompted an increase in telehealth services. Objective: This study aimed to review satisfaction with pediatric care in studies that had at least one group of pediatric patients and their caregivers receiving telehealth services during the COVID-19 pandemic and at least one comparison group of those receiving nontelehealth services. Methods: We searched for peer-reviewed studies published in the English language that compared the satisfaction with pediatric care between pediatric patients and their caregivers receiving telehealth services during the COVID-19 pandemic and those receiving nontelehealth services. Owing to stay-at-home orders, studies with comparison groups for nontelehealth services that took place either before or during the pandemic were eligible. We searched the PubMed, Embase, CINAHL, and PsycINFO databases on January 5, 2023. We followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A total of 2 reviewers independently screened the titles and abstracts before reviewing the full text of the remaining articles. The following information was extracted from each eligible study: country, participant characteristics by comparison group, study design, telehealth approach, measurement tools to assess satisfaction, and findings by comparison group. Results: All 14 eligible studies assessed satisfaction among caregivers and pediatric patients participating in video or telephone visits during the COVID-19 pandemic compared with those having in-person appointments either before or during the pandemic. In 5 of the 14 studies, a comparison of nontelehealth services took place before the pandemic, and in the remaining 9 investigations, nontelehealth services took place during the pandemic. A total of 13 studies were observational investigations with different designs, and 1 study was a quasi-experimental intervention with 3 comparison groups for video, in-person, and hybrid visits. In 9 of the 14 studies, satisfaction with telehealth services was higher than during in-person visits. Caregivers were satisfied with video visits for the ease of use and reduced need for transportation. Reasons caregivers were not satisfied with remote care included limited personal interaction with the provider, technological challenges, and a lack of physical examination. Those participating in nontelehealth services expressed that in-person interactions promoted treatment adherence. Only 1 study assessed satisfaction where adolescent patients completed their own surveys; a higher percentage of adolescents using telehealth services reported effective communication with the provider compared with patients using in-person visits. Conclusions: In most studies, telehealth services received more favorable or comparable satisfaction ratings than in-person visits. Needed improvements in telehealth services included strategies to address technological challenges and develop better rapport among the patient, caregiver, and medical provider. Interventions may investigate the influence of telehealth services on access to and quality of care. %M 37000504 %R 10.2196/41554 %U https://pediatrics.jmir.org/2023/1/e41554 %U https://doi.org/10.2196/41554 %U http://www.ncbi.nlm.nih.gov/pubmed/37000504 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e45003 %T Use of Rapid Antigen Tests to End Isolation in a University Setting: Observational Study %A Zigo,Liliana %A Wilkinson,Alyson %A Landry,Megan %A Castel,Amanda D %A Vyas,Amita %A McDonnell,Karen %A Nagaraj,Nitasha Chaudhary %A Goldman,Lynn R %+ Office of the Dean, Milken Institute School of Public Health, The George Washington University, 950 New Hampshire Ave NW, 3rd Fl, Washington, DC, 20037, United States, 1 2029940883, mmlandry@gwu.edu %K COVID-19 %K college %K university %K students %K rapid antigen test %K isolation %K antigen test %K testing %K tool %K utility %K symptoms %K policy %K productivity %K age %K university students %D 2023 %7 27.4.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: COVID-19 isolation recommendations have evolved over the course of the pandemic. Initially, the US Centers for Disease Control and Prevention required 10 days of isolation after a positive test result. In December 2021, this was reduced to a minimum of 5 days with symptom improvement, followed by 5 days of mask wearing. As a result, several institutions of higher education, including the George Washington University, required persons testing positive for COVID-19 to either submit a negative rapid antigen test (RAT) with symptom resolution to leave isolation after 5 days or to maintain a 10-day isolation period in the absence of a negative RAT and the presence of continued symptoms. RATs are tools that can be used both to shorten isolation periods and to ensure that persons testing positive for COVID-19 remain in isolation if infectious. Objective: The purpose of this analysis is to report on the experience of implementing RAT policies, examine the number of days that isolation was reduced via RAT testing, determine the factors that predicted uploading a RAT, and determine RAT positivity percentages to illustrate the utility of using RATs to end isolation. Methods: In this study, 880 individuals in COVID-19 isolation at a university in Washington, DC, uploaded 887 RATs between February 21 and April 14, 2022. Daily positivity percentages were calculated, and multiple logistic regression analyses examined the odds of uploading a RAT by campus residential living status (ie, on or off campus), student or employee designation, age, and days in isolation. Results: A total of 76% (669/880) of individuals in isolation uploaded a RAT during the study period. Overall, 38.6% (342/887) of uploaded RATs were positive. Uploaded RATs were positive 45.6% (118/259) of the time on day 5; 45.4% (55/121) on day 6; 47.1% (99/210) on day 7; and 11.1% (7/63) on day 10 or beyond. Adjusted logistic regression modeling indicated cases living on campus had increased odds of uploading a RAT (odds ratio [OR] 2.54, 95% CI 1.64-3.92), whereas primary student affiliation (OR 0.29, 95% CI 0.12-0.69) and days in isolation (OR 0.45, 95% CI 0.39-0.52) had decreased odds of uploading a RAT. Of the 545 cases with a negative RAT, 477 were cleared prior to day 10 of their isolation due to lack of symptoms and timely submission, resulting in a total of 1547 days of lost productivity saved compared to all being in isolation for 10 days. Conclusions: RATs are beneficial, as they can support a decision to release individuals from isolation when they have recovered and maintain isolation for people who may still be infectious. Future isolation policies should be guided by similar protocols and research to reduce the spread of COVID-19 and minimize lost productivity and disruption to individuals’ lives. %M 37040562 %R 10.2196/45003 %U https://formative.jmir.org/2023/1/e45003 %U https://doi.org/10.2196/45003 %U http://www.ncbi.nlm.nih.gov/pubmed/37040562 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e37139 %T Individual Factors Influencing the Public’s Perceptions About the Importance of COVID-19 Immunity Certificates in the United Kingdom: Cross-sectional Web-based Questionnaire Survey %A Niculaescu,Corina-Elena %A Sassoon,Isabel Karen %A Landa-Avila,Irma Cecilia %A Colak,Ozlem %A Jun,Gyuchan Thomas %A Balatsoukas,Panagiotis %+ School of Design and Creative Arts, Loughborough University, Design School, East Park, Loughborough University, Loughborough, LE11 3TU, United Kingdom, 44 7854801211, P.Balatsoukas@lboro.ac.uk %K immunity passports %K immunity certificates %K vaccine passports %K COVID-19 %K health belief model %K vaccination %K pandemic %K cross-sectional survey %K low income %K vulnerable population %K socioeconomic %K public perception %K public policy %D 2023 %7 27.4.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Understanding how perceptions around immunity certificates are influenced by individual characteristics is important to inform evidence-based policy making and implementation strategies for services around immunity and vaccine certification. Objective: This study aimed to assess what were the main individual factors influencing people’s perception of the importance of using COVID-19 immunity certificates, including health beliefs about COVID-19, vaccination views, sociodemographics, and lifestyle factors. Methods: A cross-sectional web-based survey with a nationally representative sample in the United Kingdom was conducted on August 3, 2021. Responses were collected and analyzed from 534 participants, aged 18 years and older, who were residents of the United Kingdom. The primary outcome measure (dependent variable) was the participants’ perceived importance of using immunity certificates, computed as an index of 6 items. The following individual drivers were used as the independent variables: (1) personal beliefs about COVID-19 (using constructs adapted from the Health Belief Model), (2) personal views on vaccination, (3) willingness to share immunity status with service providers, and (4) variables related to respondents’ lifestyle and sociodemographic characteristics. Results: The perceived importance of immunity certificates was higher among respondents who felt that contracting COVID-19 would have a severe negative impact on their health (β=0.2564; P<.001) and felt safer if vaccinated (β=0.1552; P<.001). The prospect of future economic recovery positively influenced the perceived importance of immunity certificates. Respondents who were employed or self-employed (β=–0.2412; P=.001) or experienced an increase in income after the COVID-19 pandemic (β=–0.1287; P=.002) perceived the use of immunity certificates as less important compared to those who were unemployed or had retired or those who had experienced a reduction in their income during the pandemic. Conclusions: The findings of our survey suggest that more vulnerable members in our society (those unemployed or retired and those who believe that COVID-19 would have a severe impact on their health) and people who experienced a reduction in income during the pandemic perceived the severity of not using immunity certificates in their daily life as higher. %M 36920837 %R 10.2196/37139 %U https://formative.jmir.org/2023/1/e37139 %U https://doi.org/10.2196/37139 %U http://www.ncbi.nlm.nih.gov/pubmed/36920837 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e46123 %T Telemedicine Use by Age in Louisiana Medicaid During COVID-19: Claims-Based Longitudinal Analysis %A Park,Sooyeol %A Walker,Brigham %A Anderson,Andrew %A Shao,Yixue %A Callison,Kevin %+ Department of Health Policy and Management, Tulane University, 1440 Canal Street, New Orleans, LA, 70112, United States, 1 6149891764, kcallison@tulane.edu %K telemedicine %K age %K disparities %K COVID-19 %K availability %K health care services %K infection %K age %K pandemic %K usage %K users %K reliance %K digital literacy %K internet %K trends %D 2023 %7 26.4.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Limited availability of in-person health care services and fear of contracting COVID-19 during the pandemic promoted an increased reliance on telemedicine. However, long-standing inequities in telemedicine due to unequal levels of digital literacy and internet connectivity among different age groups raise concerns about whether the uptake of telemedicine has exacerbated or alleviated those inequities. Objective: The aim of this study is to examine changes in telemedicine and in-person health service use during the COVID-19 pandemic across age groups for Medicaid beneficiaries in the state of Louisiana. Methods: Interrupted time series models were used on Louisiana Medicaid claims data to estimate trends in total, in-person, and telemedicine monthly office visit claims per 1000 Medicaid beneficiaries between January 2018 and December 2020. Changes in care pattern trends and levels were estimated around the infection peaks (April 2020 and July 2020) and for an end-of-year infection leveling off period (December 2020). Four mutually exclusive age categories (0 to 17, 18 to 34, 35 to 49, and 50 to 64 years) were used to compare the differences. Results: Prior to the COVID-19 pandemic, telemedicine services accounted for less than 1% of total office visit claim volume across the age groups. Each age group followed similar patterns of sharp increases in April 2020, downward trends until sharp increases again in July 2020, followed by flat trends thereafter until December 2020. These sharp increases were most pronounced for older patients, with those aged 50 to 64 years seeing increases of 184.09 telemedicine claims per 1000 Medicaid beneficiaries in April 2020 (95% CI 172.19 to 195.99) and 120.81 in July 2020 (95% CI 101.32 to 140.31) compared with those aged 18 to 34 years, seeing increases of 84.47 (95% CI 78.64 to 90.31) and 57.00 (95% CI 48.21 to 65.79), respectively. This resulted in overall changes from baseline to December 2020 levels of 123.65 (95% CI 112.79 to 134.51) for those aged 50 to 64 years compared with 59.07 (95% CI 53.89 to 64.24) for those aged 18 to 34 years. Conclusions: Older Medicaid beneficiaries in Louisiana had higher rates of telemedicine claim volume during the COVID-19 pandemic compared with younger beneficiaries. %M 37099371 %R 10.2196/46123 %U https://www.jmir.org/2023/1/e46123 %U https://doi.org/10.2196/46123 %U http://www.ncbi.nlm.nih.gov/pubmed/37099371 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e44517 %T Participatory Surveillance for COVID-19 Trend Detection in Brazil: Cross-sectional Study %A Wittwer,Salome %A Paolotti,Daniela %A Lichand,Guilherme %A Leal Neto,Onicio %+ Institute for Information Security, Department of Computer Science, ETH Zürich, Universitätstrasse 6, Zurich, 8092, Switzerland, 41 44 632 50 94, onicio.batistalealneto@inf.ethz.ch %K participatory surveillance %K COVID-19 %K digital epidemiology %K coronavirus %K infectious disease %K epidemic %K pandemic %K SARS-CoV-2 %K forecast %K trend %K reporting %K self-report %K surveillance %D 2023 %7 26.4.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The ongoing COVID-19 pandemic has emphasized the necessity of a well-functioning surveillance system to detect and mitigate disease outbreaks. Traditional surveillance (TS) usually relies on health care providers and generally suffers from reporting lags that prevent immediate response plans. Participatory surveillance (PS), an innovative digital approach whereby individuals voluntarily monitor and report on their own health status via web-based surveys, has emerged in the past decade to complement traditional data collection approaches. Objective: This study compared novel PS data on COVID-19 infection rates across 9 Brazilian cities with official TS data to examine the opportunities and challenges of using PS data, and the potential advantages of combining the 2 approaches. Methods: The TS data for Brazil are publicly accessible on GitHub. The PS data were collected through the Brazil Sem Corona platform, a Colab platform. To gather information on an individual’s health status, each participant was asked to fill out a daily questionnaire on symptoms and exposure in the Colab app. Results: We found that high participation rates are key for PS data to adequately mirror TS infection rates. Where participation was high, we documented a significant trend correlation between lagged PS data and TS infection rates, suggesting that PS data could be used for early detection. In our data, forecasting models integrating both approaches increased accuracy up to 3% relative to a 14-day forecast model based exclusively on TS data. Furthermore, we showed that PS data captured a population that significantly differed from a traditional observation. Conclusions: In the traditional system, the new recorded COVID-19 cases per day are aggregated based on positive laboratory-confirmed tests. In contrast, PS data show a significant share of reports categorized as potential COVID-19 cases that are not laboratory confirmed. Quantifying the economic value of PS system implementation remains difficult. However, scarce public funds and persisting constraints to the TS system provide motivation for a PS system, making it an important avenue for future research. The decision to set up a PS system requires careful evaluation of its expected benefits, relative to the costs of setting up platforms and incentivizing engagement to increase both coverage and consistent reporting over time. The ability to compute such economic tradeoffs might be key to have PS become a more integral part of policy toolkits moving forward. These results corroborate previous studies when it comes to the benefits of an integrated and comprehensive surveillance system, and shed light on its limitations and on the need for additional research to improve future implementations of PS platforms. %M 36888908 %R 10.2196/44517 %U https://publichealth.jmir.org/2023/1/e44517 %U https://doi.org/10.2196/44517 %U http://www.ncbi.nlm.nih.gov/pubmed/36888908 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e39588 %T Impact of Human Mobility on COVID-19 Transmission According to Mobility Distance, Location, and Demographic Factors in the Greater Bay Area of China: Population-Based Study %A Xia,Jizhe %A Yin,Kun %A Yue,Yang %A Li,Qingquan %A Wang,Xiling %A Hu,Dongsheng %A Wang,Xiong %A Du,Zhanwei %A Cowling,Ben J %A Chen,Erzhen %A Zhou,Ying %+ Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Ruijin Second Road 197, HuangPu District, Shanghai, 200000, China, 86 64370045 ext 600603, zy12941@rjh.com.cn %K COVID-19 %K mobility restriction %K mobility distance %K demographic factors %K locations %D 2023 %7 26.4.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Mobility restriction was one of the primary measures used to restrain the spread of COVID-19 globally. Governments implemented and relaxed various mobility restriction measures in the absence of evidence for almost 3 years, which caused severe adverse outcomes in terms of health, society, and economy. Objective: This study aimed to quantify the impact of mobility reduction on COVID-19 transmission according to mobility distance, location, and demographic factors in order to identify hotspots of transmission and guide public health policies. Methods: Large volumes of anonymized aggregated mobile phone position data between January 1 and February 24, 2020, were collected for 9 megacities in the Greater Bay Area, China. A generalized linear model (GLM) was established to test the association between mobility volume (number of trips) and COVID-19 transmission. Subgroup analysis was also performed for sex, age, travel location, and travel distance. Statistical interaction terms were included in a variety of models that express different relations between involved variables. Results: The GLM analysis demonstrated a significant association between the COVID-19 growth rate ratio (GR) and mobility volume. A stratification analysis revealed a higher effect of mobility volume on the COVID-19 GR among people aged 50-59 years (GR decrease of 13.17% per 10% reduction in mobility volume; P<.001) than among other age groups (GR decreases of 7.80%, 10.43%, 7.48%, 8.01%, and 10.43% for those aged ≤18, 19-29, 30-39, 40-49, and ≥60 years, respectively; P=.02 for the interaction). The impact of mobility reduction on COVID-19 transmission was higher for transit stations and shopping areas (instantaneous reproduction number [Rt] decreases of 0.67 and 0.53 per 10% reduction in mobility volume, respectively) than for workplaces, schools, recreation areas, and other locations (Rt decreases of 0.30, 0.37, 0.44, and 0.32, respectively; P=.02 for the interaction). The association between mobility volume reduction and COVID-19 transmission was lower with decreasing mobility distance as there was a significant interaction between mobility volume and mobility distance with regard to Rt (P<.001 for the interaction). Specifically, the percentage decreases in Rt per 10% reduction in mobility volume were 11.97% when mobility distance increased by 10% (Spring Festival), 6.74% when mobility distance remained unchanged, and 1.52% when mobility distance declined by 10%. Conclusions: The association between mobility reduction and COVID-19 transmission significantly varied according to mobility distance, location, and age. The substantially higher impact of mobility volume on COVID-19 transmission for longer travel distance, certain age groups, and specific travel locations highlights the potential to optimize the effectiveness of mobility restriction strategies. The results from our study demonstrate the power of having a mobility network using mobile phone data for surveillance that can monitor movement at a detailed level to measure the potential impacts of future pandemics. %M 36848228 %R 10.2196/39588 %U https://publichealth.jmir.org/2023/1/e39588 %U https://doi.org/10.2196/39588 %U http://www.ncbi.nlm.nih.gov/pubmed/36848228 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e41369 %T The Effects of COVID-19 Pandemic Policy on Social Needs Across the State of Kansas and Western Missouri: Paired Survey Response Testing %A Mudaranthakam,Dinesh Pal %A Pepper,Sam %A Fortney,Tanner %A Alsup,Alexander %A Woodward,Jennifer %A Sykes,Kevin %A Calhoun,Elizabeth %+ Department of Biostatistics & Data Science, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS, 66160, United States, 1 9139456922, dmudaranthakam@kumc.edu %K social determinants of health %K COVID-19 %K food assistance program %K public health %K quality of life %K well-being %K health disparity %K health inequity %K health policy %K Kansas %K social work %K socioeconomic %D 2023 %7 25.4.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Studying patients’ social needs is critical to the understanding of health conditions and disparities, and to inform strategies for improving health outcomes. Studies have shown that people of color, low-income families, and those with lower educational attainment experience greater hardships related to social needs. The COVID-19 pandemic represents an event that severely impacted people’s social needs. This pandemic was declared by the World Health Organization on March 11, 2020, and contributed to food and housing insecurity, while highlighting weaknesses in the health care system surrounding access to care. To combat these issues, legislators implemented unique policies and procedures to help alleviate worsening social needs throughout the pandemic, which had not previously been exerted to this degree. We believe that improvements related to COVID-19 legislature and policy have positively impacted people’s social needs in Kansas and Missouri, United States. In particular, Wyandotte County is of interest as it suffers greatly from issues related to social needs that many of these COVID-19–related policies aimed to improve. Objective: The research objective of this study was to evaluate the change in social needs before and after the COVID-19 pandemic declaration based on responses to a survey from The University of Kansas Health System (TUKHS). We further aimed to compare the social needs of respondents from Wyandotte County from those of respondents in other counties in the Kansas City metropolitan area. Methods: Social needs survey data from 2016 to 2022 were collected from a 12-question patient-administered survey distributed by TUKHS during a patient visit. This provided a longitudinal data set with 248,582 observations, which was narrowed down into a paired-response data set for 50,441 individuals who had provided at least one response before and after March 11, 2020. These data were then bucketed by county into Cass (Missouri), Clay (Missouri), Jackson (Missouri), Johnson (Kansas), Leavenworth (Kansas), Platte (Missouri), Wyandotte (Kansas), and Other counties, creating groupings with at least 1000 responses in each category. A pre-post composite score was calculated for each individual by adding their coded responses (yes=1, no=0) across the 12 questions. The Stuart-Maxwell marginal homogeneity test was used to compare the pre and post composite scores across all counties. Additionally, McNemar tests were performed to compare responses before and after March 11, 2020, for each of the 12 questions across all counties. Finally, McNemar tests were performed for questions 1, 7, 8, 9, and 10 for each of the bucketed counties. Significance was assessed at P<.05 for all tests. Results: The Stuart-Maxwell test for marginal homogeneity was significant (P<.001), indicating that respondents were overall less likely to identify an unmet social need after the COVID-19 pandemic. McNemar tests for individual questions indicated that after the COVID-19 pandemic, respondents across all counties were less likely to identify unmet social needs related to food availability (odds ratio [OR]=0.4073, P<.001), home utilities (OR=0.4538, P<.001), housing (OR=0.7143, P<.001), safety among cohabitants (OR=0.6148, P<.001), safety in their residential location (OR=0.6172, P<.001), child care (OR=0.7410, P<0.01), health care access (OR=0.3895, P<.001), medication adherence (OR=0.5449, P<.001), health care adherence (OR=0.6378, P<.001), and health care literacy (0.8729, P=.02), and were also less likely to request help with these unmet needs (OR=0.7368, P<.001) compared with prepandemic responses. Responses from individual counties were consistent with the overall results for the most part. Notably, no individual county demonstrated a significant reduction in social needs relating to a lack of companionship. Conclusions: Post-COVID-19 responses showed improvement across almost all social needs–related questions, indicating that the federal policy response possibly had a positive impact on social needs across the populations of Kansas and western Missouri. Some counties were impacted more than others and positive outcomes were not limited to urban counties. The availability of resources, safety net services, access to health care, and educational opportunities could play a role in this change. Future research should focus on improving survey response rates from rural counties to increase their sample size, and to evaluate other explanatory variables such as food pantry access, educational status, employment opportunities, and access to community resources. Government policies should be an area of focused research as they may affect the social needs and health of the individuals considered in this analysis. %M 36977199 %R 10.2196/41369 %U https://publichealth.jmir.org/2023/1/e41369 %U https://doi.org/10.2196/41369 %U http://www.ncbi.nlm.nih.gov/pubmed/36977199 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e40138 %T Maintaining Adherence to COVID-19 Preventive Practices and Policies Pertaining to Masking and Distancing in the District of Columbia and Other US States: Systematic Observational Study %A Ruiz,Monica S %A McMahon,Mercedes V %A Latif,Hannah %A Vyas,Amita %+ Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, 950 New Hampshire Ave NW, Suite 300, Washington, DC, 20052, United States, 1 202 994 3676, msruiz@gwu.edu %K COVID-19 %K mask adherence %K social distancing %K public health %K health policy %K public health mandates %D 2023 %7 25.4.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Prior to the development of effective vaccines against SARS-CoV-2, masking and social distancing emerged as important strategies for infection control. Locations across the United States required or recommended face coverings where distancing was not possible, but it is unclear to what extent people complied with these policies. Objective: This study provides descriptive information about adherence to public health policies pertaining to mask wearing and social distancing and examines differences in adherence to these policies among different population groups in the District of Columbia and 8 US states. Methods: This study was part of a national systematic observational study using a validated research protocol for recording adherence to correct mask wearing and maintaining social distance (6 feet/1.83 meters) from other individuals. Data were collected from December 2020 to August 2021 by research team members who stationed themselves in outdoor areas with high pedestrian traffic, observed individuals crossing their paths, and collected data on whether individuals’ masks were present (visible or not visible) or worn (correctly, incorrectly, not at all) and whether social distance was maintained if other individuals were present. Observational data were entered electronically into Google Forms and were exported in Excel format for analysis. All data analyses were conducted using SPSS. Information on local COVID-19 protection policies (eg, mask wearing requirements) was obtained by examining city and state health department websites for the locations where data were being collected. Results: At the time these data were collected, most locations in our study required (5937/10,308, 57.6%) or recommended (4207/10,308, 40.8%) masking. Despite this, more than 30% of our sample were unmasked (2889/10136, 28.5%) or masked incorrectly (636/10136, 6.3%). Masking policy was significantly related to correct masking with locations that required or recommended masking (66% correct masking vs 28/164, 17.1% in locations that did not require masking, P<.001). Participants who maintained social distance from others were more likely to be correctly masked than those who were not (P<.001). Adherence to masking policy by location was significant (P<.001); however, this was driven by 100% compliance in Georgia, which did not require masks at any point during the data collection period. When the same analysis was conducted for compliance with mask requirements and recommendations, there was no significant difference by location. Overall adherence to masking policies was 66.9% Conclusions: Despite a clear relationship between mask policies and masking behavior, one-third of our sample was nonadherent to those policies, and approximately 23% of our sample did not have any mask, either on or visible. This may speak to the confusion surrounding “risk” and protective behaviors, as well as pandemic fatigue. These results underscore the importance of clear public health communication, particularly given variations in public health policies across states and localities. %M 36888910 %R 10.2196/40138 %U https://publichealth.jmir.org/2023/1/e40138 %U https://doi.org/10.2196/40138 %U http://www.ncbi.nlm.nih.gov/pubmed/36888910 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e42206 %T Predictors of Cyberchondria During the COVID-19 Pandemic: Cross-sectional Study Using Supervised Machine Learning %A Infanti,Alexandre %A Starcevic,Vladan %A Schimmenti,Adriano %A Khazaal,Yasser %A Karila,Laurent %A Giardina,Alessandro %A Flayelle,Maèva %A Hedayatzadeh Razavi,Seyedeh Boshra %A Baggio,Stéphanie %A Vögele,Claus %A Billieux,Joël %+ Department of Behavioural and Cognitive Sciences, University of Luxembourg, Maison des Sciences Humaines 11, Porte des Sciences, Esch-sur-Alzette, L-4366, Luxembourg, 352 46 66 44 6862, alexandre.infanti@uni.lu %K cyberchondria %K COVID-19 %K online health information %K fear of COVID-19 %K health anxiety %K machine learning %D 2023 %7 25.4.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Cyberchondria is characterized by repeated and compulsive online searches for health information, resulting in increased health anxiety and distress. It has been conceptualized as a multidimensional construct fueled by both anxiety and compulsivity-related factors and described as a “transdiagnostic compulsive behavioral syndrome,” which is associated with health anxiety, problematic internet use, and obsessive-compulsive symptoms. Cyberchondria is not included in the International Classification of Diseases 11th Revision or the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, and its defining features, etiological mechanisms, and assessment continue to be debated. Objective: This study aims to investigate changes in the severity of cyberchondria during the COVID-19 pandemic and identify the predictors of cyberchondria at this time. Methods: Data collection started on May 4, 2020, and ended on June 10, 2020, which corresponds to the first wave of the COVID-19 pandemic in Europe. At the time the study took place, French-speaking countries in Europe (France, Switzerland, Belgium, and Luxembourg) all implemented lockdown or semilockdown measures. The survey consisted of a questionnaire collecting demographic information (sex, age, education level, and country of residence) and information about socioeconomic circumstances during the first lockdown (eg, economic situation, housing, and employment status) and was followed by several instruments assessing various psychological and health-related constructs. Inclusion criteria for the study were being at least 18 years of age and having a good understanding of French. Self-report data were collected from 725 participants aged 18-77 (mean 33.29, SD 12.88) years, with females constituting the majority (416/725, 57.4%). Results: The results showed that the COVID-19 pandemic affected various facets of cyberchondria: cyberchondria-related distress and compulsion increased (distress z=–3.651, P<.001; compulsion z=–5.697, P<.001), whereas the reassurance facet of cyberchondria decreased (z=–6.680, P<.001). In addition, COVID-19–related fears and health anxiety emerged as the strongest predictors of cyberchondria-related distress and interference with functioning during the pandemic. Conclusions: These findings provide evidence of the impact of the COVID-19 pandemic on cyberchondria and identify factors that should be considered in efforts to prevent and manage cyberchondria at times of public health crises. In addition, they are consistent with a theoretical model of cyberchondria during the COVID-19 pandemic proposed in 2020. These findings have implications for the conceptualization and future assessment of cyberchondria. %M 36947575 %R 10.2196/42206 %U https://formative.jmir.org/2023/1/e42206 %U https://doi.org/10.2196/42206 %U http://www.ncbi.nlm.nih.gov/pubmed/36947575 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e38430 %T A Personalized Avatar-Based Web Application to Help People Understand How Social Distancing Can Reduce the Spread of COVID-19: Cross-sectional, Observational, Pre-Post Study %A Etienne,Doriane %A Archambault,Patrick %A Aziaka,Donovan %A Chipenda-Dansokho,Selma %A Dubé,Eve %A Fallon,Catherine S %A Hakim,Hina %A Kindrachuk,Jason %A Krecoum,Dan %A MacDonald,Shannon E %A Ndjaboue,Ruth %A Noubi,Magniol %A Paquette,Jean-Sébastien %A Parent,Elizabeth %A Witteman,Holly O %+ VITAM – Centre de recherche en santé durable, Université Laval, 2480, Chemin de la Canardière, Québec, QC, G1J 2G1, Canada, 1 418 663 5313 ext 12286, doriane.etienne.1@ulaval.ca %K social distancing %K COVID-19 %K SARS-CoV-2 %K pandemic %K personalized risk communication %K public health %K digital health intervention %K web application %K visualization %K personalized avatar %D 2023 %7 25.4.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: To reduce the transmission of SARS-CoV-2 and the associated spread of COVID-19, many jurisdictions around the world imposed mandatory or recommended social or physical distancing. As a result, at the beginning of the pandemic, various communication materials appeared online to promote distancing. Explanations of the science underlying these mandates or recommendations were either highly technical or highly simplified. Objective: This study aimed to understand the effects of a dynamic visualization on distancing. Our overall aim was to help people understand the dynamics of the spread of COVID-19 in their community and the implications of their own behavior for themselves, those around them, the health care system, and society. Methods: Using Scrum, which is an agile framework; JavaScript (Vue.js framework); and code already developed for risk communication in another context of infectious disease transmission, we rapidly developed a new personalized web application. In our application, people make avatars that represent themselves and the people around them. These avatars are integrated into a 3-minute animation illustrating an epidemiological model for COVID-19 transmission, showing the differences in transmission with and without distancing. During the animation, the narration explains the science of how distancing reduces the transmission of COVID-19 in plain language in English or French. The application offers full captions to complement the narration and a descriptive transcript for people using screen readers. We used Google Analytics to collect standard usage statistics. A brief, anonymous, optional survey also collected self-reported distancing behaviors and intentions in the previous and coming weeks, respectively. We launched and disseminated the application on Twitter and Facebook on April 8, 2020, and April 9, 2020. Results: After 26 days, the application received 3588 unique hits from 82 countries. The optional survey at the end of the application collected 182 responses. Among this small subsample of users, survey respondents were nearly (170/177, 96%) already practicing distancing and indicated that they intended to practice distancing in the coming week (172/177, 97.2%). Among the small minority of people (n=7) who indicated that they had not been previously practicing distancing, 2 (29%) reported that they would practice distancing in the week to come. Conclusions: We developed a web application to help people understand the relationship between individual-level behavior and population-level effects in the context of an infectious disease spread. This study also demonstrates how agile development can be used to quickly create personalized risk messages for public health issues like a pandemic. The nonrandomized design of this rapid study prevents us from concluding the application’s effectiveness; however, results thus far suggest that avatar-based visualizations may help people understand their role in infectious disease transmission. %M 36961787 %R 10.2196/38430 %U https://formative.jmir.org/2023/1/e38430 %U https://doi.org/10.2196/38430 %U http://www.ncbi.nlm.nih.gov/pubmed/36961787 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e37237 %T Users’ Reactions to Announced Vaccines Against COVID-19 Before Marketing in France: Analysis of Twitter Posts %A Dupuy-Zini,Alexandre %A Audeh,Bissan %A Gérardin,Christel %A Duclos,Catherine %A Gagneux-Brunon,Amandine %A Bousquet,Cedric %+ Service de santé publique et information médicale, Centre Hospitalier Universitaire de Saint Etienne, Bâtiment CIM42, Hôpital Nord, Saint Etienne, 42055, France, 33 4 77 12 79 74, cedric.bousquet@chu-st-etienne.fr %K COVID-19 Vaccines %K Social Media %K Deep Learning %K France %K Sentiment Analysis %D 2023 %7 24.4.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Within a few months, the COVID-19 pandemic had spread to many countries and had been a real challenge for health systems all around the world. This unprecedented crisis has led to a surge of online discussions about potential cures for the disease. Among them, vaccines have been at the heart of the debates and have faced lack of confidence before marketing in France. Objective: This study aims to identify and investigate the opinions of French Twitter users on the announced vaccines against COVID-19 through sentiment analysis. Methods: This study was conducted in 2 phases. First, we filtered a collection of tweets related to COVID-19 available on Twitter from February 2020 to August 2020 with a set of keywords associated with vaccine mistrust using word embeddings. Second, we performed sentiment analysis using deep learning to identify the characteristics of vaccine mistrust. The model was trained on a hand-labeled subset of 4548 tweets. Results: A set of 69 relevant keywords were identified as the semantic concept of the word “vaccin” (vaccine in French) and focused mainly on conspiracies, pharmaceutical companies, and alternative treatments. Those keywords enabled us to extract nearly 350,000 tweets in French. The sentiment analysis model achieved 0.75 accuracy. The model then predicted 16% of positive tweets, 41% of negative tweets, and 43% of neutral tweets. This allowed us to explore the semantic concepts of positive and negative tweets and to plot the trends of each sentiment. The main negative rhetoric identified from users’ tweets was that vaccines are perceived as having a political purpose and that COVID-19 is a commercial argument for the pharmaceutical companies. Conclusions: Twitter might be a useful tool to investigate the arguments for vaccine mistrust because it unveils political criticism contrasting with the usual concerns on adverse drug reactions. As the opposition rhetoric is more consistent and more widely spread than the positive rhetoric, we believe that this research provides effective tools to help health authorities better characterize the risk of vaccine mistrust. %M 36596215 %R 10.2196/37237 %U https://www.jmir.org/2023/1/e37237 %U https://doi.org/10.2196/37237 %U http://www.ncbi.nlm.nih.gov/pubmed/36596215 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e43411 %T Motivational Profiles and Associations With Physical Activity Before, During, and After the COVID-19 Pandemic: Retrospective Study %A Nuss,Kayla %A Sui,Wuyou %A Rhodes,Ryan %A Liu,Sam %+ Klein Buendel, 1667 Cole Blvd, Suite No 220, Golden, CO, 80401, United States, 1 9705814824, knuss@kleinbuendel.com %K motivational profile %K self-determination theory %K physical activity %K COVID-19 %K health lifestyle %K latent profile analysis %K mental well-being %K health intervention %D 2023 %7 24.4.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: In March 2020, the World Health Organization declared the worldwide COVID-19 outbreak a pandemic, triggering many countries, including Canada, to issue stay-at-home orders to their citizens. Research indicates that these stay-at-home orders are associated with a decline in physical activity (PA), a behavior that can reduce disease risk and improve the quality of life. Many behavioral change theories, such as the self-determination theory (SDT) of motivation, state that PA engagement is mediated by psychological constructs, such as motivation. According to the SDT, motivation exists on a continuum from more controlled (external or coerced) to more autonomous (volitional) regulatory forms. Individuals move along the continuum from more controlled to more autonomous forms through the fulfillment of 3 psychological needs: autonomy, competence, and relatedness. Research indicates that moderate-to-vigorous physical activity (MVPA) is positively associated with the autonomous regulatory form of motivation. Recently, researchers have speculated that a better method to describe motivation than movement along the continuum is to generate motivational profiles, which represent combinations of differing levels of controlled and autonomous regulation existing simultaneously. Objective: We aimed to identify distinct motivational profiles and determine their association with MVPA before, during, and after the COVID-19 pandemic. Methods: Using a cross-sectional, retrospective design, we surveyed 977 Canadian adults. We assessed motivation for PA using the Behavioral Regulations in Exercise Questionnaire-3 (BREQ-3). We assessed PA pre–, during, and post–COVID-19 stay-at-home orders in Canada using the International Physical Activity Questionnaire (IPAQ). We derived motivational profiles using latent profile analysis (LPA). Using motivational profiles as an independent variable, we assessed their effect on PA at all 3 time points with multilevel models that included the participant ID as a random variable. Results: We identified 4 profiles: high controlled and high autonomous (HCHA), low overall motivation (LOM), high autonomous and introjected (HAI), and high amotivation and external (HAE). The HCHA profile had the highest levels of weekly MVPA minutes at all 3 time points, followed by the HAI profile. Conclusions: Our results suggest that a combination of both autonomous and controlled regulatory forms may be more effective in influencing MVPA than the controlled or autonomous forms alone, particularly during times of high stress, such as a worldwide pandemic. Although the odds of another global pandemic are low, these results may also be applied to other times of stress, such as job transitions, relationship changes (eg, change in marital status), or the death of a loved one. We suggest that clinicians and practitioners consider developing PA interventions that seek to increase both controlled and autonomous regulatory forms instead of aiming to reduce controlled forms. %M 36927666 %R 10.2196/43411 %U https://formative.jmir.org/2023/1/e43411 %U https://doi.org/10.2196/43411 %U http://www.ncbi.nlm.nih.gov/pubmed/36927666 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e44720 %T Adapting and Scaling a Digital Health Intervention to Improve Maternal and Child Health Among Ethnic Minority Women in Vietnam Amid the COVID-19 Context: Protocol for the dMOM Project %A McBride,Bronwyn %A O'Neil,John %A Nguyen,Phuong Chi %A Linh,Dang Thuy %A Trinh,Hue Thi %A Vu,Nguyen C %A Nguyen,Liem T %+ Faculty of Health Sciences, Simon Fraser University, 8888 University Dr, Burnaby, BC, V5A 1S6, Canada, 1 6044417162, bronwyn_mcbride@sfu.ca %K mobile health %K digital health %K Vietnam %K maternal health %K maternal, newborn, and child health %K MNCH, health equity, ethnic minority %K maternal and child health %K child health %K ethnography %K coronavirus %K COVID-19 %K perinatal %K antenatal %K woman %K mother %K pregnancy %K newborn %K infant %K baby %K ethnic %K ethnicity %K visible minority %K culture %D 2023 %7 24.4.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Due to interconnected structural determinants including low maternal health knowledge, economic marginalization, and remoteness from low-capacity health centers, ethnic minority women in remote areas of Vietnam face severe maternal, newborn, and child health (MNCH) inequities. As ethnic minorities represent 15% of the Vietnamese population, these disparities are significant. mMOM—a pilot mobile health (mHealth) intervention using SMS text messaging to improve MNCH outcomes among ethnic minority women in northern Vietnam—was implemented from 2013-2016 with promising results. Despite mMOM’s findings, exacerbated MNCH inequities, and digital health becoming more salient amid COVID-19, mHealth has not yet been scaled to address MNCH among ethnic minority women in Vietnam. Objective: We describe the protocol for adapting, expanding, and exponentially scaling the mMOM intervention qualitatively through adding COVID-19–related MNCH guidance and novel technological components (mobile app and artificial intelligence chatbots) and quantitatively through broadening the geographical area to reach exponentially more participants, within the evolving COVID-19 context. Methods: dMOM will be conducted in 4 phases. (1) Drawing on a review of international literature and government guidelines on MNCH amid COVID-19, mMOM project components will be updated to respond to COVID-19 and expanded to include a mobile app and artificial intelligence chatbots to more deeply engage participants. (2) Using an intersectionality lens and participatory action research approach, a scoping study and rapid ethnographic fieldwork will explore ethnic minority women’s unmet MNCH needs; acceptability and accessibility of digital health; technical capacity of commune health centers; gendered power dynamics and cultural, geographical, and social determinants impacting health outcomes; and multilevel impacts of COVID-19. Findings will be applied to further refine the intervention. (3) dMOM will be implemented and incrementally scaled across 71 project communes. (4) dMOM will be evaluated to assess whether SMS text messaging or mobile app delivery engenders better MNCH outcomes among ethnic minority women. The documentation of lessons learned and dMOM models will be shared with Vietnam’s Ministry of Health for adoption and further scaling up. Results: The dMOM study was funded by the International Development Research Centre (IDRC) in November 2021, cofacilitated by the Ministry of Health, and is being coimplemented by provincial health departments in 2 mountainous provinces. Phase 1 was initiated in May 2022, and phase 2 is planned to begin in December 2022. The study is expected to be complete in June 2025. Conclusions: dMOM research outcomes will generate important empirical evidence on the effectiveness of leveraging digital health to address intractable MNCH inequities among ethnic minority women in low-resource settings in Vietnam and provide critical information on the processes of adapting mHealth interventions to respond to COVID-19 and future pandemics. Finally, dMOM activities, models, and findings will inform a national intervention led by the Ministry of Health. International Registered Report Identifier (IRRID): PRR1-10.2196/44720 %M 37058576 %R 10.2196/44720 %U https://www.researchprotocols.org/2023/1/e44720 %U https://doi.org/10.2196/44720 %U http://www.ncbi.nlm.nih.gov/pubmed/37058576 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e39409 %T Application of Phylodynamic Tools to Inform the Public Health Response to COVID-19: Qualitative Analysis of Expert Opinions %A Rich,Shannan N %A Richards,Veronica %A Mavian,Carla %A Rife Magalis,Brittany %A Grubaugh,Nathan %A Rasmussen,Sonja A %A Dellicour,Simon %A Vrancken,Bram %A Carrington,Christine %A Fisk-Hoffman,Rebecca %A Danso-Odei,Demi %A Chacreton,Daniel %A Shapiro,Jerne %A Seraphin,Marie Nancy %A Hepp,Crystal %A Black,Allison %A Dennis,Ann %A Trovão,Nídia Sequeira %A Vandamme,Anne-Mieke %A Rasmussen,Angela %A Lauzardo,Michael %A Dean,Natalie %A Salemi,Marco %A Prosperi,Mattia %+ Department of Epidemiology, College of Public Health and Health Professions, University of Florida, 2004 Mowry Road, Gainesville, FL, 32610, United States, 1 3522735468, shannanrich@ufl.edu %K COVID-19 %K SARS-CoV-2 %K molecular epidemiology %K genomic surveillance %K variants %K pandemic %K phylogenetic %K genomic %K epidemiology %K data %K virology %K bioinformatics %K response %K phylodynamic %K monitoring %K surveillance %K transmission %D 2023 %7 21.4.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: In the wake of the SARS-CoV-2 pandemic, scientists have scrambled to collect and analyze SARS-CoV-2 genomic data to inform public health responses to COVID-19 in real time. Open source phylogenetic and data visualization platforms for monitoring SARS-CoV-2 genomic epidemiology have rapidly gained popularity for their ability to illuminate spatial-temporal transmission patterns worldwide. However, the utility of such tools to inform public health decision-making for COVID-19 in real time remains to be explored. Objective: The aim of this study is to convene experts in public health, infectious diseases, virology, and bioinformatics—many of whom were actively engaged in the COVID-19 response—to discuss and report on the application of phylodynamic tools to inform pandemic responses. Methods: In total, 4 focus groups (FGs) occurred between June 2020 and June 2021, covering both the pre- and postvariant strain emergence and vaccination eras of the ongoing COVID-19 crisis. Participants included national and international academic and government researchers, clinicians, public health practitioners, and other stakeholders recruited through purposive and convenience sampling by the study team. Open-ended questions were developed to prompt discussion. FGs I and II concentrated on phylodynamics for the public health practitioner, while FGs III and IV discussed the methodological nuances of phylodynamic inference. Two FGs per topic area to increase data saturation. An iterative, thematic qualitative framework was used for data analysis. Results: We invited 41 experts to the FGs, and 23 (56%) agreed to participate. Across all the FG sessions, 15 (65%) of the participants were female, 17 (74%) were White, and 5 (22%) were Black. Participants were described as molecular epidemiologists (MEs; n=9, 39%), clinician-researchers (n=3, 13%), infectious disease experts (IDs; n=4, 17%), and public health professionals at the local (PHs; n=4, 17%), state (n=2, 9%), and federal (n=1, 4%) levels. They represented multiple countries in Europe, the United States, and the Caribbean. Nine major themes arose from the discussions: (1) translational/implementation science, (2) precision public health, (3) fundamental unknowns, (4) proper scientific communication, (5) methods of epidemiological investigation, (6) sampling bias, (7) interoperability standards, (8) academic/public health partnerships, and (9) resources. Collectively, participants felt that successful uptake of phylodynamic tools to inform the public health response relies on the strength of academic and public health partnerships. They called for interoperability standards in sequence data sharing, urged careful reporting to prevent misinterpretations, imagined that public health responses could be tailored to specific variants, and cited resource issues that would need to be addressed by policy makers in future outbreaks. Conclusions: This study is the first to detail the viewpoints of public health practitioners and molecular epidemiology experts on the use of viral genomic data to inform the response to the COVID-19 pandemic. The data gathered during this study provide important information from experts to help streamline the functionality and use of phylodynamic tools for pandemic responses. %M 36848460 %R 10.2196/39409 %U https://formative.jmir.org/2023/1/e39409 %U https://doi.org/10.2196/39409 %U http://www.ncbi.nlm.nih.gov/pubmed/36848460 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e45249 %T Disruptions in the Cystic Fibrosis Community’s Experiences and Concerns During the COVID-19 Pandemic: Topic Modeling and Time Series Analysis of Reddit Comments %A Yao,Lean Franzl %A Ferawati,Kiki %A Liew,Kongmeng %A Wakamiya,Shoko %A Aramaki,Eiji %+ Social Computing Laboratory, Nara Institute of Science and Technology, Informationa Science Building A, 6th Floor, 8916-5 Takayama-cho, Nara Prefecture, Ikoma, 630-0192, Japan, 81 743 72 5250, aramaki@is.naist.jp %K COVID-19 %K Reddit %K time series analysis %K BERTopic %K topic modeling %K cystic fibrosis %D 2023 %7 20.4.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic disrupted the needs and concerns of the cystic fibrosis community. Patients with cystic fibrosis were particularly vulnerable during the pandemic due to overlapping symptoms in addition to the challenges patients with rare diseases face, such as the need for constant medical aid and limited information regarding their disease or treatments. Even before the pandemic, patients vocalized these concerns on social media platforms like Reddit and formed communities and networks to share insight and information. This data can be used as a quick and efficient source of information about the experiences and concerns of patients with cystic fibrosis in contrast to traditional survey- or clinical-based methods. Objective: This study applies topic modeling and time series analysis to identify the disruption caused by the COVID-19 pandemic and its impact on the cystic fibrosis community’s experiences and concerns. This study illustrates the utility of social media data in gaining insight into the experiences and concerns of patients with rare diseases. Methods: We collected comments from the subreddit r/CysticFibrosis to represent the experiences and concerns of the cystic fibrosis community. The comments were preprocessed before being used to train the BERTopic model to assign each comment to a topic. The number of comments and active users for each data set was aggregated monthly per topic and then fitted with an autoregressive integrated moving average (ARIMA) model to study the trends in activity. To verify the disruption in trends during the COVID-19 pandemic, we assigned a dummy variable in the model where a value of “1” was assigned to months in 2020 and “0” otherwise and tested for its statistical significance. Results: A total of 120,738 comments from 5827 users were collected from March 24, 2011, until August 31, 2022. We found 22 topics representing the cystic fibrosis community’s experiences and concerns. Our time series analysis showed that for 9 topics, the COVID-19 pandemic was a statistically significant event that disrupted the trends in user activity. Of the 9 topics, only 1 showed significantly increased activity during this period, while the other 8 showed decreased activity. This mixture of increased and decreased activity for these topics indicates a shift in attention or focus on discussion topics during this period. Conclusions: There was a disruption in the experiences and concerns the cystic fibrosis community faced during the COVID-19 pandemic. By studying social media data, we were able to quickly and efficiently study the impact on the lived experiences and daily struggles of patients with cystic fibrosis. This study shows how social media data can be used as an alternative source of information to gain insight into the needs of patients with rare diseases and how external factors disrupt them. %M 37079359 %R 10.2196/45249 %U https://www.jmir.org/2023/1/e45249 %U https://doi.org/10.2196/45249 %U http://www.ncbi.nlm.nih.gov/pubmed/37079359 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 10 %N %P e42870 %T A Medical Assistive Robot for Telehealth Care During the COVID-19 Pandemic: Development and Usability Study in an Isolation Ward %A Wang,Ruohan %A Lv,Honghao %A Lu,Zhangli %A Huang,Xiaoyan %A Wu,Haiteng %A Xiong,Junjie %A Yang,Geng %+ State Key Laboratory of Fluid Power & Mechatronic Systems, School of Mechanical Engineering, Zhejiang University, 38 Zheda Road, Hangzhou, 310027, China, 86 18757132667, yanggeng@zju.edu.cn %K COVID-19 %K MAR %K telehealth care %K video chat system %K mental health care %D 2023 %7 20.4.2023 %9 Original Paper %J JMIR Hum Factors %G English %X Background: The COVID-19 pandemic is affecting the mental and emotional well-being of patients, family members, and health care workers. Patients in the isolation ward may have psychological problems due to long-term hospitalization, the development of the epidemic, and the inability to see their families. A medical assistive robot (MAR), acting as an intermediary of communication, can be deployed to address these mental pressures. Objective: CareDo, a MAR with telepresence and teleoperation functions, was developed in this work for remote health care. The aim of this study was to investigate its practical performance in the isolation ward during the pandemic. Methods: Two systems were integrated into the CareDo robot. For the telepresence system, a web real-time communications solution is used for the multiuser chat system and a convolutional neural network is used for expression recognition. For the teleoperation system, an incremental motion mapping method is used for operating the robot remotely. A clinical trial of this system was conducted at First Affiliated Hospital, Zhejiang University. Results: During the clinical trials, tasks such as video chatting, emotion detection, and medical supplies delivery were performed via the CareDo robot. Seven voice commands were set for performing system wakeup, video chatting, and system exiting. Durations from 1 to 3 seconds of common commands were set to improve voice command detection. The facial expression was recorded 152 times for a patient in 1 day for the psychological intervention. The recognition accuracy reached 95% and 92.8% for happy and neutral expressions, respectively. Conclusions: Patients and health care workers can use this MAR in the isolation ward for telehealth care during the COVID-19 pandemic. This can be a useful approach to break the chains of virus transmission and can also be an effective way to conduct remote psychological intervention. %M 36634269 %R 10.2196/42870 %U https://humanfactors.jmir.org/2023/1/e42870 %U https://doi.org/10.2196/42870 %U http://www.ncbi.nlm.nih.gov/pubmed/36634269 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 3 %N %P e40913 %T Potential Impact of the COVID-19 Pandemic on Public Perception of Water Pipes on Reddit: Observational Study %A Zheng,Zihe %A Xie,Zidian %A Goniewicz,Maciej %A Rahman,Irfan %A Li,Dongmei %+ Department of Clinical and Translational Research, University of Rochester Medical Center, 265 Crittenden Boulevard Cu 420708, Rochester, NY, 14642-0001, United States, 1 5852767285, Dongmei_Li@urmc.rochester.edu %K water pipes %K Reddit %K COVID-19 %K COVID-19 pandemic %K public perception %D 2023 %7 20.4.2023 %9 Original Paper %J JMIR Infodemiology %G English %X Background: Socializing is one of the main motivations for water pipe smoking. Restrictions on social gatherings during the COVID-19 pandemic might have influenced water pipe smokers’ behaviors. As one of the most popular social media platforms, Reddit has been used to study public opinions and user experiences. Objective: In this study, we aimed to examine the influence of the COVID-19 pandemic on public perception and discussion of water pipe tobacco smoking using Reddit data. Methods: We collected Reddit posts between December 1, 2018, and June 30, 2021, from a Reddit archive (PushShift) using keywords such as “waterpipe,” “hookah,” and “shisha.” We examined the temporal trend in Reddit posts mentioning water pipes and different locations (such as homes and lounges or bars). The temporal trend was further tested using interrupted time series analysis. Sentiment analysis was performed to study the change in sentiment of water pipe–related posts before and during the pandemic. Topic modeling using latent Dirichlet allocation (LDA) was used to examine major topics discussed in water pipe–related posts before and during the pandemic. Results: A total of 45,765 nonpromotion water pipe–related Reddit posts were collected and used for data analysis. We found that the weekly number of Reddit posts mentioning water pipes significantly increased at the beginning of the COVID-19 pandemic (P<.001), and gradually decreased afterward (P<.001). In contrast, Reddit posts mentioning water pipes and lounges or bars showed an opposite trend. Compared to the period before the COVID-19 pandemic, the average number of Reddit posts mentioning lounges or bars was lower at the beginning of the pandemic but gradually increased afterward, while the average number of Reddit posts mentioning the word “home” remained similar during the COVID-19 pandemic (P=.29). While water pipe–related posts with a positive sentiment were dominant (12,526/21,182, 59.14% before the pandemic; 14,686/24,583, 59.74% after the pandemic), there was no change in the proportion of water pipe–related posts with different sentiments before and during the pandemic (P=.19, P=.26, and P=.65 for positive, negative, and neutral posts, respectively). Most topics related to water pipes on Reddit were similar before and during the pandemic. There were more discussions about the opening and closing of hookah lounges or bars during the pandemic. Conclusions: This study provides a first evaluation of the possible impact of the COVID-19 pandemic on public perceptions of and discussions about water pipes on Reddit. %M 37124245 %R 10.2196/40913 %U https://infodemiology.jmir.org/2023/1/e40913 %U https://doi.org/10.2196/40913 %U http://www.ncbi.nlm.nih.gov/pubmed/37124245 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e41838 %T End Users' Perspectives on the Quality and Design of mHealth Technologies During the COVID-19 Pandemic in the Philippines: Qualitative Study %A Gonzales,Aldren %A Custodio,Razel %A Lapitan,Marie Carmela %A Ladia,Mary Ann %+ Medical Informatics Unit, College of Medicine, University of the Philippines Manila, 547 Pedro Gil Street, Ermita, Manila, 1000, Philippines, 63 2027511303, abgonzales2@up.edu.ph %K mHealth %K COVID-19 %K pandemic %K digital health %K mobile health %K end-user engagement %K focus group %K technology implementation %K Philippines %K technology use %K privacy %K user engagement %D 2023 %7 20.4.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic has expanded the use of mobile health (mHealth) technologies in contact tracing, communicating COVID-19–related information, and monitoring the health conditions of the general population in the Philippines. However, the limited end-user engagement in the features and feedback along the development cycle of mHealth technologies results in risks in adoption. The World Health Organization (WHO) recommends user-centric design and development of mHealth technologies to ensure responsiveness to the needs of the end users. Objective: The goal of the study is to understand, using end users’ perspectives, the design and quality of mHealth technology implementations in the Philippines during the COVID-19 pandemic, with a focus on the areas identified by stakeholders: (1) utility, (2) technology readiness level, (3) design, (4) information, (5) usability, (6) features, and (7) security and privacy. Methods: Using a descriptive qualitative design, we conducted 5 interviews and 3 focus group discussions (FGDs) with a total of 16 participants (6, 37.5%, males and 10, 62.5%, females). Questions were based on the Mobile App Rating Scale (MARS). Using the cyclical coding approach, transcripts were analyzed with NVivo 12. Themes were identified. Results: The qualitative analysis identified 18 themes that were organized under the 7 focus areas: (1) utility: use of mHealth technologies and motivations in using mHealth; (2) technology readiness: mobile technology literacy and user segmentation; (3) design: user interface design, language and content accessibility, and technology design; (4) information: accuracy of information and use of information; (5) usability: design factors, dependency on human processes, and technical issues; (6) features: interoperability and data integration, other feature and design recommendations, and technology features and upgrades; and (7) privacy and security: trust that mHealth can secure data, lack of information, and policies. To highlight, accessibility, privacy and security, a simple interface, and integration are some of the design and quality areas that end users find important and consider in using mHealth tools. Conclusions: Engaging end users in the development and design of mHealth technologies ensures adoption and accessibility, making it a valuable tool in curbing the pandemic. The 6 principles for developers, researchers, and implementers to consider when scaling up or developing a new mHealth solution in a low-resource setting are that it should (1) be driven by value in its implementation, (2) be inclusive, (3) address users’ physical and cognitive restrictions, (4) ensure privacy and security, (5) be designed in accordance with digital health systems’ standards, and (6) be trusted by end users. %M 36943932 %R 10.2196/41838 %U https://formative.jmir.org/2023/1/e41838 %U https://doi.org/10.2196/41838 %U http://www.ncbi.nlm.nih.gov/pubmed/36943932 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e34579 %T COVID-19 Testing Practices, Preventive Behaviors, and Factors Associated With Test Positivity: Population-Based Statewide Survey Study %A Kanyangarara,Mufaro %A Daguise,Virginie %A Gual-Gonzalez,Lídia %A Litwin,Alain H %A Korte,Jeffrey %A Ross,Connor %A Nolan,Melissa S %A , %+ Department of Epidemiology and Biostatistics, University of South Carolina Arnold School of Public Health, 915 Greene Street, Columbia, SC, 29208, United States, 1 8037777563, mufaro@mailbox.sc.edu %K SARS-CoV-2 %K South Carolina %K surveillance %K attitude %K behavior %K COVID-19 %K testing %K prevention %K United States %K population %K survey %K risk %K perception %K risk factor %D 2023 %7 19.4.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The COVID-19 pandemic has challenged public health efforts globally. Timely population-based surveillance is crucial to support public health programs and policies to limit the spread of COVID-19. The South Carolina (SC) Sampling and Testing Representative Outreach for Novel Coronavirus Guidance (SC STRONG) statewide initiative was established to estimate population-level prevalence and immunity and characterize the transmission dynamics of SARS-CoV-2 using community testing and online surveys. Objective: This paper aimed to leverage the survey data collected as part of the initiative to understand risk perceptions, testing practices, and preventive behaviors and identify risk factors for COVID-19 test positivity in SC over time. Methods: Probability proportionate to size cluster random sampling was used to select SC residents to participate in testing for COVID-19 infection and antibodies and to complete an online survey. This paper focuses on data from the online surveys completed between November 2020 and June 2021. Descriptive statistics were used to describe risk perceptions, attitudes and behaviors, and associated changes over time. Univariate and multivariate logistic regression models were used to identify factors associated with self-reported COVID-19 test positivity. Results: Among the 7170 online survey respondents, 58.7% (4213/7170) self-reported ever testing for COVID-19. The most commonly cited barriers to testing were inconvenient dates, time, and location, as well as discomfort. Overall, 18.7% (790/7170) of respondents reported a history of COVID-19 test positivity. Multivariate logistic regression results indicated that individuals who were aged 50 years or older, self-identified as Black/African American, were obese, and were employed as frontline health care workers or nursing home staff were more likely to self-report COVID-19 test positivity. By contrast, there was a decreased likelihood of test positivity among respondents who were concerned about the burden of COVID-19 in their community and about being infected. Conclusions: Strategies to remove testing barriers should be implemented to improve access. Our findings provide insights on statewide testing patterns, adoption of prevention behaviors, and risk factors for infection and may inform public health strategies to curb transmission. %M 36720159 %R 10.2196/34579 %U https://publichealth.jmir.org/2023/1/e34579 %U https://doi.org/10.2196/34579 %U http://www.ncbi.nlm.nih.gov/pubmed/36720159 %0 Journal Article %@ 2562-0959 %I JMIR Publications %V 6 %N %P e39451 %T Patient Engagement With the Myderma Platform for Psoriasis During the COVID-19 Pandemic %A Sfaelos,Konstantinos %A Kontodimas,Stathis %A Charisiadi,Theodora %A Chantzara,Nagia %A Pesiridis,George %A Tampouratzi,Eleftheria %+ Dermatological Department, Tzaneio General Hospital, Zanni and Afentouli Avenue, Piraeus, 18536, Greece, 30 2132081000, elefteria_tab@yahoo.gr %K psoriasis %K social media %K online health-related information %K COVID-19 %K disease awareness %K disease awareness website %K digital campaigns %K patient activation %K patient engagement %K COVID-19 pandemic %D 2023 %7 19.4.2023 %9 Research Letter %J JMIR Dermatol %G English %X %M 37124952 %R 10.2196/39451 %U https://derma.jmir.org/2023/1/e39451 %U https://doi.org/10.2196/39451 %U http://www.ncbi.nlm.nih.gov/pubmed/37124952 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 9 %N %P e38377 %T A Web Tool to Help Counter the Spread of Misinformation and Fake News: Pre-Post Study Among Medical Students to Increase Digital Health Literacy %A Moretti,Valentina %A Brunelli,Laura %A Conte,Alessandro %A Valdi,Giulia %A Guelfi,Maria Renza %A Masoni,Marco %A Anelli,Filippo %A Arnoldo,Luca %+ Dipartimento di Area Medica, Università degli Studi di Udine, via Colugna 50, Udine, 33100, Italy, 39 0432554768, laura.brunelli@uniud.it %K infodemic %K fake news %K education %K digital health literacy %K medical education %K medical student %K health information %K social media %K health literacy %K online learning %K digital education %K COVID-19 %D 2023 %7 18.4.2023 %9 Original Paper %J JMIR Med Educ %G English %X Background: The COVID-19 pandemic was accompanied by the spread of uncontrolled health information and fake news, which also quickly became an infodemic. Emergency communication is a challenge for public health institutions to engage the public during disease outbreaks. Health professionals need a high level of digital health literacy (DHL) to cope with difficulties; therefore, efforts should be made to address this issue starting from undergraduate medical students. Objective: The aim of this study was to investigate the DHL skills of Italian medical students and the effectiveness of an informatics course offered by the University of Florence (Italy). This course focuses on assessing the quality of medical information using the “dottoremaeveroche” (DMEVC) web resource offered by the Italian National Federation of Orders of Surgeons and Dentists, and on health information management. Methods: A pre-post study was conducted at the University of Florence between November and December 2020. First-year medical students participated in a web-based survey before and after attending the informatics course. The DHL level was self-assessed using the eHealth Literacy Scale for Italy (IT-eHEALS) tool and questions about the features and quality of the resources. All responses were rated on a 5-point Likert scale. Change in the perception of skills was assessed using the Wilcoxon test. Results: A total of 341 students participated in the survey at the beginning of the informatics course (women: n=211, 61.9%; mean age 19.8, SD 2.0) and 217 of them (64.2%) completed the survey at the end of the course. At the first assessment, the DHL level was moderate, with a mean total score of the IT-eHEALS of 2.9 (SD 0.9). Students felt confident about finding health-related information on the internet (mean score of 3.4, SD 1.1), whereas they doubted the usefulness of the information they received (mean score of 2.0, SD 1.0). All scores improved significantly in the second assessment. The overall mean score of the IT-eHEALS significantly increased (P<.001) to 4.2 (SD 0.6). The item with the highest score related to recognizing the quality of health information (mean score of 4.5, SD 0.7), whereas confidence in the practical application of the information received remained the lowest (mean of 3.7, SD 1.1) despite improvement. Almost all students (94.5%) valued the DMEVC as an educational tool. Conclusions: The DMEVC tool was effective in improving medical students’ DHL skills. Effective tools and resources such as the DMEVC website should be used in public health communication to facilitate access to validated evidence and understanding of health recommendations. %M 36996010 %R 10.2196/38377 %U https://mededu.jmir.org/2023/1/e38377 %U https://doi.org/10.2196/38377 %U http://www.ncbi.nlm.nih.gov/pubmed/36996010 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e40028 %T Incidence and Characterization of Post-COVID-19 Symptoms in Hospitalized COVID-19 Survivors to Recognize Syndemic Connotations in India: Single-Center Prospective Observational Cohort Study %A Nair,Chithira V %A Moni,Merlin %A Edathadathil,Fabia %A A,Appukuttan %A Prasanna,Preetha %A Pushpa Raghavan,Roshni %A Sathyapalan,Dipu T %A Jayant,Aveek %+ Division of Infectious Diseases, Department of General Medicine, Amrita Institute of Medical Science and Research Centre, Edappally, Kochi, 682041, India, 91 7034028181, diputsmck@gmail.com %K COVID-19 %K follow-up %K incidence %K fatigue %K long COVID %K post-COVID %K post-COVID-19 symptoms %K questionnaire %K tertiary-care center %K intensive care %K symptom monitoring %K prospective observational study %K treatment %K steroid %K viral therapy %K postdischarge %D 2023 %7 18.4.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Long COVID, or post-COVID-19 syndrome, is the persistence of signs and symptoms that develop during or after COVID-19 infection for more than 12 weeks and are not explained by an alternative diagnosis. In spite of health care recouping to prepandemic states, the post-COVID-19 state tends to be less recognized from low- and middle-income country settings and holistic therapeutic protocols do not exist. Owing to the syndemic nature of COVID-19, it is important to characterize post-COVID-19 syndrome. Objective: We aimed to determine the incidence of post-COVID-19 symptoms in a cohort of inpatients who recovered from COVID-19 from February to July 2021 at a tertiary-care center in South India. In addition, we aimed at comparing the prevalence of post-COVID-19 manifestations in intensive care unit (ICU) and non-ICU patients, assessing the persistence, severity, and characteristics of post-COVID-19 manifestations, and elucidating the risk factors associated with the presence of post-COVID-19 manifestations. Methods: A total of 120 adult patients admitted with COVID-19 in the specified time frame were recruited into the study after providing informed written consent. The cohort included 50 patients requiring intensive care and 70 patients without intensive care. The follow-up was conducted on the second and sixth weeks after discharge with a structured questionnaire. The questionnaire was filled in by the patient/family member of the patient during their visit to the hospital for follow-up at 2 weeks and through telephone follow-up at 6 weeks. Results: The mean age of the cohort was 55 years and 55% were men. Only 5% of the cohort had taken the first dose of COVID-19 vaccination. Among the 120 patients, 58.3% had mild COVID-19 and 41.7% had moderate to severe COVID-19 infection. In addition, 60.8% (n=73) of patients had at least one persistent symptom at the sixth week of discharge and 50 (41.7%) patients required intensive care during their inpatient stay. The presence of persistent symptoms at 6 weeks was not associated with severity of illness, age, or requirement for intensive care. Fatigue was the most common reported persistent symptom with a prevalence of 55.8%, followed by dyspnea (20%) and weight loss (16.7%). Female sex (odds ratio [OR] 2.4, 95% CI 1.03-5.58; P=.04) and steroid administration during hospital stay (OR 4.43, 95% CI 1.9-10.28; P=.001) were found to be significant risk factors for the presence of post-COVID-19 symptoms at 6 weeks as revealed by logistic regression analysis. Conclusions: Overall, 60.8% of inpatients treated for COVID-19 had post-COVID-19 symptoms at 6 weeks postdischarge from the hospital. The incidence of post-COVID-19 syndrome in the cohort did not significantly differ across the mild, moderate, and severe COVID-19 severity categories. Female sex and steroid administration during the hospital stay were identified as predictors of the persistence of post-COVID-19 symptoms at 6 weeks. %M 36920842 %R 10.2196/40028 %U https://formative.jmir.org/2023/1/e40028 %U https://doi.org/10.2196/40028 %U http://www.ncbi.nlm.nih.gov/pubmed/36920842 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e45711 %T Digital Interventions for Treating Post-COVID or Long-COVID Symptoms: Scoping Review %A Rinn,Robin %A Gao,Lingling %A Schoeneich,Sarah %A Dahmen,Alina %A Anand Kumar,Vinayak %A Becker,Petra %A Lippke,Sonia %+ Constructor University, Campus Ring 1, Bremen, 28759, Germany, 49 4212004730, rrinn@constructor.university %K post-COVID/long-COVID symptom recovery %K postacute COVID-19 symptoms %K treatment %K therapy %K mHealth %K mobile health %K rehabilitation %K COVID-19 %D 2023 %7 17.4.2023 %9 Review %J J Med Internet Res %G English %X Background: Patients with post-COVID/long-COVID symptoms need support, and health care professionals need to be able to provide evidence-based patient care. Digital interventions can meet these requirements, especially if personal contact is limited. Objective: We reviewed evidence-based digital interventions that are currently available to help manage physical and mental health in patients with post-COVID/long-COVID symptoms. Methods: A scoping review was carried out summarizing novel digital health interventions for treating post-COVID/long-COVID patients. Using the PICO (population, intervention, comparison, outcome) scheme, original studies were summarized, in which patients with post-COVID/long-COVID symptoms used digital interventions to help aid recovery. Results: From all scanned articles, 8 original studies matched the inclusion criteria. Of the 8 studies, 3 were “pretest” studies, 3 described the implementation of a telerehabilitation program, 1 was a post-COVID/long-COVID program, and 1 described the results of qualitative interviews with patients who used an online peer-support group. Following the PICO scheme, we summarized previous studies. Studies varied in terms of participants (P), ranging from adults in different countries, such as former hospitalized patients with COVID-19, to individuals in disadvantaged communities in the United Kingdom, as well as health care workers. In addition, the studies included patients who had previously been infected with COVID-19 and who had ongoing symptoms. Some studies focused on individuals with specific symptoms, including those with either post–COVID-19 or long-term symptoms, while other studies included patients based on participation in online peer-support groups. The interventions (I) also varied. Most interventions used a combination of psychological and physical exercises, but they varied in duration, frequency, and social dimensions. The reviewed studies investigated the physical and mental health conditions of patients with post-COVID/long-COVID symptoms. Most studies had no control (C) group, and most studies reported outcomes (O) or improvements in physiological health perception, some physical conditions, fatigue, and some psychological aspects such as depression. However, some studies found no improvements in bowel or bladder problems, concentration, short-term memory, unpleasant dreams, physical ailments, perceived bodily pain, emotional ailments, and perceived mental health. Conclusions: More systematic research with larger sample sizes is required to overcome sampling bias and include health care professionals’ perspectives, as well as help patients mobilize support from health care professionals and social network partners. The evidence so far suggests that patients should be provided with digital interventions to manage symptoms and reintegrate into everyday life, including work. %M 36943909 %R 10.2196/45711 %U https://www.jmir.org/2023/1/e45711 %U https://doi.org/10.2196/45711 %U http://www.ncbi.nlm.nih.gov/pubmed/36943909 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e41822 %T Changes in Online Food Access During the COVID-19 Pandemic and Associations With Deprivation: Longitudinal Analysis %A Keeble,Matthew %A Adams,Jean %A Burgoine,Thomas %+ MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Level 3, Institute of Metabolic Science, Cambridge, CB2 0SL, United Kingdom, 44 1223 330315, matthew.keeble@mrc-epid.cam.ac.uk %K COVID-19 %K digital food environment %K fast foods %K online food delivery services %K public health %D 2023 %7 17.4.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Food prepared out of home is typically energy-dense and nutrient-poor. Online food delivery services have become a popular way to purchase such food. The number of accessible food outlets through these services can influence how frequently they are used. Anecdotally, food outlet access through online food delivery services increased in England between 2020 and 2022, in the context of the COVID-19 pandemic. However, the extent to which this access changed is poorly understood. Objective: We aimed to investigate monthly changes in online access to food prepared out of home in England in the context of the first 2 years of the COVID-19 pandemic compared with November 2019 and the extent to which any changes were associated with deprivation. Methods: In November 2019 and monthly between June 2020 and March 2022, we used automated data collection to construct a data set containing information about all food outlets in England registered to accept orders through the leading online food delivery service. Across postcode districts, we identified the number and percentage of food outlets registered to accept orders and the number that was accessible. We used generalized estimating equations (adjusted for population density, the number of food outlets in the physical food environment, and rural/urban classification) to investigate the change in outcomes compared with prepandemic levels (November 2019). We stratified analyses by deprivation quintile (Q). Results: Across England, the summed number of food outlets registered to accept orders online increased from 29,232 in November 2019 to 49,752 in March 2022. Across postcode districts, the median percentage of food outlets registered to accept orders online increased from 14.3 (IQR 3.8-26.0) in November 2019 to 24.0 (IQR 6.2-43.5) in March 2022. The median number of food outlets accessible online decreased from 63.5 (IQR 16.0-156.0) in November 2019 to 57.0 (IQR 11.0-163.0) in March 2022. However, we observed variation by deprivation. In March 2022, the median number of outlets accessible online was 175.0 (IQR 104.0-292.0) in the most deprived areas (Q5) compared with 27.0 (IQR 8.5-60.5) in the least deprived (Q1). In adjusted analyses, we estimated that the number of outlets accessible online in the most deprived areas was 10% higher in March 2022 compared with November 2019 (incidence rate ratios: 1.10, 95% CI 1.07-1.13). In the least deprived areas, we estimated a 19% decrease (incidence rate ratios: 0.81, 95% CI 0.79-0.83). Conclusions: The number of food outlets accessible online increased only in the most deprived areas in England. Future research might attempt to understand the extent to which changes in online food access were associated with changes in online food delivery service use and the possible implications on diet quality and health. %M 36848236 %R 10.2196/41822 %U https://publichealth.jmir.org/2023/1/e41822 %U https://doi.org/10.2196/41822 %U http://www.ncbi.nlm.nih.gov/pubmed/36848236 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e41394 %T The Relationship Between Health Literacy, Knowledge, Fear, and COVID-19 Prevention Behavior in Different Age Groups: Cross-sectional Web-Based Study %A Ishizuka-Inoue,Mami %A Shimoura,Kanako %A Nagai-Tanima,Momoko %A Aoyama,Tomoki %+ Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, 53, Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan, 81 075 751 3964, tanima.momoko.8s@kyoto-u.ac.jp %K infodemic %K COVID-19 %K health literacy %K fear of COVID-19 %K cross-sectional study %K behavior %K age group %K misinformation %K influence %K prevention %K disease %D 2023 %7 17.4.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: COVID-19 prevention behaviors have become part of our lives, and they have been reported to be associated with health literacy, knowledge, and fear. However, the COVID-19 pandemic may be characterized by different situations in each age group. Since the severity of the infection and the means of accessing information differ by age group, the relationship between health literacy, knowledge, and fear may differ. Thus, factors that promote preventive behavior may differ by age group. Clarifying the factors related to prevention behaviors by age may help us consider age-appropriate promotion. Objective: This study aims to examine the association between COVID-19 prevention behaviors and health literacy, COVID-19 knowledge, and fear of COVID-19 by age group. Methods: A cross-sectional study was conducted among 512 participants aged 20-69 years, recruited from a web-based sample from November 1 to November 5, 2021. A web-based self-administered questionnaire was used to obtain the participants’ characteristics, COVID-19 prevention behaviors, health literacy, COVID-19 knowledge, and fear of COVID-19. The Kruskal-Wallis rank sum test was used to compare the scores of each item for each age group. The relationships among COVID-19 prevention behaviors, health literacy, COVID-19 knowledge, and fear of COVID-19 were analyzed using the Spearman rank correlation analysis. Additionally, multiple regression analysis was conducted with COVID-19 prevention behaviors as dependent variables; health literacy, COVID-19 knowledge, and fear of COVID-19 as independent variables; and sex and age as adjustment variables. Results: For all participants, correlation and multiple regression analyses revealed that prevention behaviors were significantly related to health literacy, COVID-19 knowledge, and fear of COVID-19 (P<.001). Additionally, correlation analysis revealed that fear of COVID-19 was significantly negatively correlated with COVID-19 knowledge (P<.001). There was also a significant positive correlation between health literacy and COVID-19 knowledge (P<.001). Furthermore, analysis by age revealed that the factors associated with prevention behaviors differed by age group. In the age groups 20-29, 30-39, and 40-49 years, multiple factors, including health literacy, influenced COVID-19 prevention behaviors, whereas in the age groups 50-59 and 60-69 years, only fear of COVID-19 had an impact. Conclusions: The results of this study revealed that the factors associated with prevention behaviors differ by age. Age-specific approaches should be considered to prevent infection. %M 37011226 %R 10.2196/41394 %U https://formative.jmir.org/2023/1/e41394 %U https://doi.org/10.2196/41394 %U http://www.ncbi.nlm.nih.gov/pubmed/37011226 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e42278 %T Identification of Key Factors for Optimized Health Care Services: Protocol for a Multiphase Study of the Dubai Vaccination Campaign %A Faroun,Hayette %A Zary,Nabil %A Baqer,Khalifa %A Alkhaja,Farida %A Gad,Kareem %A Alameddine,Mohamad %A Al Suwaidi,Hanan %+ College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Building 14, Dubai Healthcare City, Dubai, P.O Box 505055, United Arab Emirates, 971 506522747, Hanan.Alsuwaidi@mbru.ac.ae %K COVID-19 %K mass vaccination center %K MVC %K health care services %K key success factors %K critical success factors %K CSFs %K service-oriented architecture %K SOA %K campaign %K vaccine %K immunize %K immunization %K inoculation %K health information system %K HIS %K information system %K semistructured interviews %K Q-methodology %K vaccination %K health promotion %K vaccine campaign %K health information %K global health %K health care service %K simulation modeling %D 2023 %7 17.4.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Mass vaccination of the global population against the novel COVID-19 outbreak posed multiple challenges, including effectively administering millions of doses in a short period of time while ensuring public safety and accessibility. The government of Dubai launched a mass campaign in December 2020 to vaccinate all its citizens and residents, targeting the population aged >18 years against COVID-19. The vaccination campaign involved a transformation of multiple commercial spaces into mass vaccination centers across the city of Dubai, the largest of which was the Dubai One Central (DOC) vaccination center. It was operational between January 17, 2021, and 27 January 27, 2022. Objective: The multiphase research study aims to empirically explore the opinions of multiple health care stakeholders, elicit the key success factors that can influence the effective delivery of emergency health care services such as a COVID-19 mass vaccination center, and explore how these factors relate to one another. Methods: To understand more about the operations of the DOC vaccination center, the study follows a multiphase design divided into 2 phases. The study is being conducted by the Institute for Excellence in Health Professions Education at Mohammed Bin Rashid University of Medicine and Health Sciences between December 2021 and January 2023. To elicit the key success factors that contributed to the vaccination campaign administered at DOC, the research team conducted 30 semistructured interviews (SSIs) with a sample of staff and volunteers who worked at the DOC vaccination center. Stratified random sampling was used to select the participants, and the interview cohort included representatives from the management team, team leaders, the administration and registration team, vaccinators, and volunteers. A total of 103 people were invited to take part in the research study, and 30 agreed to participate in the SSIs. To validate the participation of various stakeholders, phase 2 will analytically investigate one’s subjectivity through Q-methodology and empirically investigate the opinions obtained from the research participants during phase 1. Results: As of July 2022, 30 SSIs were conducted with the research participants. Conclusions: The study will provide a comprehensive 2-phase approach to obtaining the key success factors that can influence the delivery of high-quality health care services such as emergency services launched during a global pandemic. The study’s findings will be translated into key factors that could support designing future health care services utilizing evidence-based practice. In line with future plans, a study will use data, collected through the DOC vaccination center, to develop a simulation model outlining the process of the customer journey and center workflow. International Registered Report Identifier (IRRID): DERR1-10.2196/42278 %M 36541889 %R 10.2196/42278 %U https://www.researchprotocols.org/2023/1/e42278 %U https://doi.org/10.2196/42278 %U http://www.ncbi.nlm.nih.gov/pubmed/36541889 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e45051 %T COVID-19 Vaccine–Related Information on the WeChat Public Platform: Topic Modeling and Content Analysis %A Wu,Xiaoqian %A Li,Ziyu %A Xu,Lin %A Li,Pengfei %A Liu,Ming %A Huang,Cheng %+ College of Medical Informatics, Chongqing Medical University, 1 Yixueyuan Road, Yuzhong District, Chongqing, 400016, China, 86 023 6848 0060, huangcheng@cqmu.edu.cn %K health belief model %K COVID-19 vaccines %K WeChat %K content analysis %K topic modeling %K public health %K COVID-19 %D 2023 %7 14.4.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 vaccine is an effective tool in the fight against the COVID-19 outbreak. As the main channel of information dissemination in the context of the epidemic, social media influences public trust and acceptance of the vaccine. The rational application of health behavior theory is a guarantee of effective public health information dissemination. However, little is known about the application of health behavior theory in web-based COVID-19 vaccine messages, especially from Chinese social media posts. Objective: This study aimed to understand the main topics and communication characteristics of hot papers related to COVID-19 vaccine on the WeChat platform and assess the health behavior theory application with the aid of health belief model (HBM). Methods: A systematic search was conducted on the Chinese social media platform WeChat to identify COVID-19 vaccine–related papers. A coding scheme was established based on the HBM, and the sample was managed and coded using NVivo 12 (QSR International) to assess the application of health behavior theory. The main topics of the papers were extracted through the Latent Dirichlet Allocation algorithm. Finally, temporal analysis was used to explore trends in the evolution of themes and health belief structures in the papers. Results: A total of 757 papers were analyzed. Almost all (671/757, 89%) of the papers did not have an original logo. By topic modeling, 5 topics were identified, which were vaccine development and effectiveness (267/757, 35%), disease infection and protection (197/757, 26%), vaccine safety and adverse reactions (52/757, 7%), vaccine access (136/757, 18%), and vaccination science popularization (105/757, 14%). All papers identified at least one structure in the extended HBM, but only 29 papers included all of the structures. Descriptions of solutions to obstacles (585/757, 77%) and benefit (468/757, 62%) were the most emphasized components in all samples. Relatively few elements of susceptibility (208/757, 27%) and the least were descriptions of severity (135/757, 18%). Heat map visualization revealed the change in health belief structure before and after vaccine entry into the market. Conclusions: To the best of our knowledge, this is the first study to assess the structural expression of health beliefs in information related to the COVID-19 vaccine on the WeChat public platform based on an HBM. The study also identified topics and communication characteristics before and after the market entry of vaccines. Our findings can inform customized education and communication strategies to promote vaccination not only in this pandemic but also in future pandemics. %M 37058349 %R 10.2196/45051 %U https://www.jmir.org/2023/1/e45051 %U https://doi.org/10.2196/45051 %U http://www.ncbi.nlm.nih.gov/pubmed/37058349 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e44410 %T Development and Validation of a Respiratory-Responsive Vocal Biomarker–Based Tool for Generalizable Detection of Respiratory Impairment: Independent Case-Control Studies in Multiple Respiratory Conditions Including Asthma, Chronic Obstructive Pulmonary Disease, and COVID-19 %A Kaur,Savneet %A Larsen,Erik %A Harper,James %A Purandare,Bharat %A Uluer,Ahmet %A Hasdianda,Mohammad Adrian %A Umale,Nikita Arun %A Killeen,James %A Castillo,Edward %A Jariwala,Sunit %+ Montefiore Medical Center, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY, 10461, United States, 1 3478064503, savneetkaur@hsph.harvard.edu %K vocal biomarkers %K COVID-19 %K respiratory-responsive vocal biomarker %K RRVB %K artificial intelligence %K machine learning %K asthma %K smartphones %K mobile phone %K eHealth %K mobile health %K mHealth %K respiratory symptom %K respiratory %K voice %K vocal %K sound %K speech %D 2023 %7 14.4.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Vocal biomarker–based machine learning approaches have shown promising results in the detection of various health conditions, including respiratory diseases, such as asthma. Objective: This study aimed to determine whether a respiratory-responsive vocal biomarker (RRVB) model platform initially trained on an asthma and healthy volunteer (HV) data set can differentiate patients with active COVID-19 infection from asymptomatic HVs by assessing its sensitivity, specificity, and odds ratio (OR). Methods: A logistic regression model using a weighted sum of voice acoustic features was previously trained and validated on a data set of approximately 1700 patients with a confirmed asthma diagnosis and a similar number of healthy controls. The same model has shown generalizability to patients with chronic obstructive pulmonary disease, interstitial lung disease, and cough. In this study, 497 participants (female: n=268, 53.9%; <65 years old: n=467, 94%; Marathi speakers: n=253, 50.9%; English speakers: n=223, 44.9%; Spanish speakers: n=25, 5%) were enrolled across 4 clinical sites in the United States and India and provided voice samples and symptom reports on their personal smartphones. The participants included patients who are symptomatic COVID-19 positive and negative as well as asymptomatic HVs. The RRVB model performance was assessed by comparing it with the clinical diagnosis of COVID-19 confirmed by reverse transcriptase–polymerase chain reaction. Results: The ability of the RRVB model to differentiate patients with respiratory conditions from healthy controls was previously demonstrated on validation data in asthma, chronic obstructive pulmonary disease, interstitial lung disease, and cough, with ORs of 4.3, 9.1, 3.1, and 3.9, respectively. The same RRVB model in this study in COVID-19 performed with a sensitivity of 73.2%, specificity of 62.9%, and OR of 4.64 (P<.001). Patients who experienced respiratory symptoms were detected more frequently than those who did not experience respiratory symptoms and completely asymptomatic patients (sensitivity: 78.4% vs 67.4% vs 68%, respectively). Conclusions: The RRVB model has shown good generalizability across respiratory conditions, geographies, and languages. Results using data set of patients with COVID-19 demonstrate its meaningful potential to serve as a prescreening tool for identifying individuals at risk for COVID-19 infection in combination with temperature and symptom reports. Although not a COVID-19 test, these results suggest that the RRVB model can encourage targeted testing. Moreover, the generalizability of this model for detecting respiratory symptoms across different linguistic and geographic contexts suggests a potential path for the development and validation of voice-based tools for broader disease surveillance and monitoring applications in the future. %M 36881540 %R 10.2196/44410 %U https://www.jmir.org/2023/1/e44410 %U https://doi.org/10.2196/44410 %U http://www.ncbi.nlm.nih.gov/pubmed/36881540 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e45110 %T The Role of Community Cohesion in Older Adults During the COVID-19 Epidemic: Cross-sectional Study %A Li,Ying %A Ding,XiWen %A Aierken,Ayizuhere %A Pan,YiYang %A Chen,Yuan %A Hu,DongBin %+ Department of Social Medicine, School of Public Health, Zhejiang University, 866 Yu-hang-tang Road, HangZhou, 310058, China, 86 0571(8820)8590, liying2012@zju.edu.cn %K community cohesion %K physical and mental health %K community services %K environmental resources %K COVID-19 epidemic %K older adults %D 2023 %7 14.4.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The community environment plays a vital role in the health of older adults. During the COVID-19 epidemic, older adults, who were considered the most impacted and most vulnerable social group, were confined to their homes during the implementation of management and control measures for the epidemic. In such situations, older adults may have to contend with a lack of resources and experience anxiety. Therefore, identifying the environmental factors that are beneficial for their physical and mental health is critical. Objective: This study aimed to assess the association between community cohesion and the physical and mental health of older adults and to identify the related community services and environmental factors that may promote community cohesion. Methods: This community-based cross-sectional study was designed during the COVID-19 epidemic. A multistage sampling method was applied to this study. A total of 2036 participants aged ≥60 years were sampled from 27 locations in China. Data were collected through face-to-face interviews. The neighborhood cohesion instrument consisting of scales on 3 dimensions was used to assess community cohesion. Self-efficacy and life satisfaction, cognitive function and depression, and community services and environmental factors were also measured using standard instruments. Statistical analyses were restricted to 99.07% (2017/2036) of the participants. Separate logistic regression analysis was conducted to assess the association among community cohesion and physical and mental health factors, related community services, and environmental factors among older adults. Results: The results showed that high levels of community cohesion were associated with good self-perceived health status and life satisfaction (odds ratio [OR] 1.27, 95% CI 1.01-1.59 and OR 1.20, 95% CI 1.15-1.27, respectively) and high levels of self-efficacy and psychological resilience (OR 1.09, 95% CI 1.05-1.13 and OR 1.05, 95% CI 1.03-1.06, respectively). The length of stay in the community and the level of physical activity were positively associated with community cohesion scores, whereas the education level was negatively associated with community cohesion scores (P=.009). Community cohesion was also associated with low levels of depression and high levels of cognitive function. Community cohesion was significantly associated with community services and environmental factors on 4 dimensions. High levels of community cohesion were associated with transportation services and rehabilitation equipment rental services as well as high levels of satisfaction with community physicians’ technical expertise and community waste disposal (OR 3.14, 95% CI 1.87-5.28; OR 3.62, 95% CI 2.38-5.52; OR 1.37, 95% CI 1.08-1.73; and OR 1.23, 95% CI 1.01-1.50, respectively). Conclusions: Community cohesion was found to be associated with the physical and mental health of older adults. Our research suggests that enhancing community services and environmental resources may be an effective strategy to increase community cohesion during major infectious disease epidemics. %M 36921236 %R 10.2196/45110 %U https://publichealth.jmir.org/2023/1/e45110 %U https://doi.org/10.2196/45110 %U http://www.ncbi.nlm.nih.gov/pubmed/36921236 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e40821 %T The Relationship Between a History of High-risk and Destructive Behaviors and COVID-19 Infection: Preliminary Study %A Vike,Nicole L %A Bari,Sumra %A Stetsiv,Khrystyna %A Woodward,Sean %A Lalvani,Shamal %A Stefanopoulos,Leandros %A Kim,Byoung Woo %A Maglaveras,Nicos %A Katsaggelos,Aggelos K %A Breiter,Hans C %+ Department of Computer Science, University of Cincinnati, 2901 Woodside Drive, Cincinnati, OH, 45219, United States, 1 617 413 0953, breitehs@ucmail.uc.edu %K substance use %K gambling %K violent behaviors %K COVID-19 %K destructive behaviors %K mental health %D 2023 %7 14.4.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic has heightened mental health concerns, but the temporal relationship between mental health conditions and SARS-CoV-2 infection has not yet been investigated. Specifically, psychological issues, violent behaviors, and substance use were reported more during the COVID-19 pandemic than before the pandemic. However, it is unknown whether a prepandemic history of these conditions increases an individual’s susceptibility to SARS-CoV-2. Objective: This study aimed to better understand the psychological risks underlying COVID-19, as it is important to investigate how destructive and risky behaviors may increase a person’s susceptibility to COVID-19. Methods: In this study, we analyzed data from a survey of 366 adults across the United States (aged 18 to 70 years); this survey was administered between February and March of 2021. The participants were asked to complete the Global Appraisal of Individual Needs–Short Screener (GAIN-SS) questionnaire, which indicates an individual’s history of high-risk and destructive behaviors and likelihood of meeting diagnostic criteria. The GAIN-SS includes 7 questions related to externalizing behaviors, 8 related to substance use, and 5 related to crime and violence; responses were given on a temporal scale. The participants were also asked whether they ever tested positive for COVID-19 and whether they ever received a clinical diagnosis of COVID-19. GAIN-SS responses were compared between those who reported and those who did not report COVID-19 to determine if those who reported COVID-19 also reported GAIN-SS behaviors (Wilcoxon rank sum test, α=.05). In total, 3 hypotheses surrounding the temporal relationships between the recency of GAIN-SS behaviors and COVID-19 infection were tested using proportion tests (α=.05). GAIN-SS behaviors that significantly differed (proportion tests, α=.05) between COVID-19 responses were included as independent variables in multivariable logistic regression models with iterative downsampling. This was performed to assess how well a history of GAIN-SS behaviors statistically discriminated between those who reported and those who did not report COVID-19. Results: Those who reported COVID-19 more frequently indicated past GAIN-SS behaviors (Q<0.05). Furthermore, the proportion of those who reported COVID-19 was higher (Q<0.05) among those who reported a history of GAIN-SS behaviors; specifically, gambling and selling drugs were common across the 3 proportion tests. Multivariable logistic regression revealed that GAIN-SS behaviors, particularly gambling, selling drugs, and attention problems, accurately modeled self-reported COVID-19, with model accuracies ranging from 77.42% to 99.55%. That is, those who exhibited destructive and high-risk behaviors before and during the pandemic could be discriminated from those who did not exhibit these behaviors when modeling self-reported COVID-19. Conclusions: This preliminary study provides insights into how a history of destructive and risky behaviors influences infection susceptibility, offering possible explanations for why some persons may be more susceptible to COVID-19, potentially in relation to reduced adherence to prevention guidelines or not seeking vaccination. %M 36888554 %R 10.2196/40821 %U https://formative.jmir.org/2023/1/e40821 %U https://doi.org/10.2196/40821 %U http://www.ncbi.nlm.nih.gov/pubmed/36888554 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e40186 %T COVID-19 Vaccine Acceptance and Uptake in Bangkok, Thailand: Cross-sectional Online Survey %A Remmel,Christopher %A Tuli,Gaurav %A Varrelman,Tanner J %A Han,Aimee R %A Angkab,Pakkanan %A Kosiyaporn,Hathairat %A Netrpukdee,Chanikarn %A Sorndamrih,Supatnuj %A Thamarangsi,Thaksaphon %A Brownstein,John S %A Astley,Christina M %+ Computational Epidemiology Lab, Boston Children’s Hospital, 300 Longwood Ave, Boston, MA, 02115, United States, 1 617 355 6000, Christopher.Remmel@childrens.harvard.edu %K COVID-19 vaccines %K Thailand %K survey %K vaccines %K COVID-19 %K pandemic %K public health %K health policy %K epidemiology %K social media %K vaccine hesitancy %D 2023 %7 13.4.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The third most severe COVID-19 wave in the middle of 2021 coincided with the dual challenges of limited vaccine supply and lagging acceptance in Bangkok, Thailand. Understanding of persistent vaccine hesitancy during the “608” campaign to vaccinate those aged over 60 years and 8 medical risk groups was needed. On-the-ground surveys place further demands on resources and are scale limited. We leveraged the University of Maryland COVID-19 Trends and Impact Survey (UMD-CTIS), a digital health survey conducted among daily Facebook user samples, to fill this need and inform regional vaccine rollout policy. Objective: The aims of this study were to characterize COVID-19 vaccine hesitancy, frequent reasons for hesitancy, mitigating risk behaviors, and the most trusted sources of COVID-19 information through which to combat vaccine hesitancy in Bangkok, Thailand during the 608 vaccine campaign. Methods: We analyzed 34,423 Bangkok UMD-CTIS responses between June and October 2021, coinciding with the third COVID-19 wave. Sampling consistency and representativeness of the UMD-CTIS respondents were evaluated by comparing distributions of demographics, 608 priority groups, and vaccine uptake over time with source population data. Estimates of vaccine hesitancy in Bangkok and 608 priority groups were tracked over time. Frequently cited hesitancy reasons and trusted information sources were identified according to the 608 group and degree of hesitancy. Kendall tau was used to test statistical associations between vaccine acceptance and vaccine hesitancy. Results: The Bangkok UMD-CTIS respondents had similar demographics over weekly samples and compared to the Bangkok source population. Respondents self-reported fewer pre-existing health conditions compared to census data overall but had a similar prevalence of the important COVID-19 risk factor diabetes. UMD-CTIS vaccine uptake rose in parallel with national vaccination statistics, while vaccine hesitancy and degree of hesitancy declined (−7% hesitant per week). Concerns about vaccination side effects (2334/3883, 60.1%) and wanting to wait and see (2410/3883, 62.1%) were selected most frequently, while “not liking vaccines” (281/3883, 7.2%) and “religious objections” (52/3883, 1.3%) were selected least frequently. Greater vaccine acceptance was associated positively with wanting to “wait and see” and negatively with “don’t believe I need (the vaccine)” (Kendall tau 0.21 and −0.22, respectively; adjusted P<.001). Scientists and health experts were most frequently cited as trusted COVID-19 information sources (13,600/14,033, 96.9%), even among vaccine hesitant respondents. Conclusions: Our findings provide policy and health experts with evidence that vaccine hesitancy was declining over the study timeframe. Hesitancy and trust analyses among the unvaccinated support Bangkok policy measures to address vaccine safety and efficacy concerns through health experts rather than government or religious officials. Large-scale surveys enabled by existing widespread digital networks offer an insightful minimal-infrastructure resource for informing region-specific health policy needs. %M 36811852 %R 10.2196/40186 %U https://publichealth.jmir.org/2023/1/e40186 %U https://doi.org/10.2196/40186 %U http://www.ncbi.nlm.nih.gov/pubmed/36811852 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 10 %N %P e39512 %T SARS-CoV-2–Related Adaptation Mechanisms of Rehabilitation Clinics Affecting Patient-Centered Care: Qualitative Study of Online Patient Reports %A Kühn,Lukas %A Lindert,Lara %A Kuper,Paulina %A Choi,Kyung-Eun Anna %+ Center for Health Services Research, Brandenburg Medical School, Seebad 82/83, Rüdersdorf bei Berlin, 15562, Germany, 49 015783035009, Lukas.Kuehn@mhb-fontane.de %K patient-led care %K patient autonomy %K patient report %K satisfaction %K pandemic %K coronavirus %K inpatient %K health care delivery %K service delivery %K rehabilitation %K internet %K web-based %K reviews %K complaint %K rating %K COVID-19 %D 2023 %7 13.4.2023 %9 Original Paper %J JMIR Rehabil Assist Technol %G English %X Background: The SARS-CoV-2 pandemic impacted access to inpatient rehabilitation services. At the current state of research, it is unclear to what extent the adaptation of rehabilitation services to infection-protective standards affected patient-centered care in Germany. Objective: The aim of this study was to determine the most relevant aspects of patient-centered care for patients in inpatient rehabilitation clinics under early phase pandemic conditions. Methods: A deductive-inductive framework analysis of online patient reports posted on a leading German hospital rating website, Klinikbewertungen (Clinic Reviews), was performed. This website is a third-party, patient-centered commercial platform that operates independently of governmental entities. Following a theoretical sampling approach, online reports of rehabilitation stays in two federal states of Germany (Brandenburg and Saarland) uploaded between March 2020 and September 2021 were included. Independent of medical specialty groups, all reports were included. Keywords addressing framework domains were analyzed descriptively. Results: In total, 649 online reports reflecting inpatient rehabilitation services of 31 clinics (Brandenburg, n=23; Saarland, n=8) were analyzed. Keywords addressing the care environment were most frequently reported (59.9%), followed by staff prerequisites (33.0%), patient-centered processes (4.5%), and expected outcomes (2.6%). Qualitative in-depth analysis revealed SARS-CoV-2–related reports to be associated with domains of patient-centered processes and staff prerequisites. Discontinuous communication of infection protection standards was perceived to threaten patient autonomy. This was amplified by a tangible gratification crisis of medical staff. Established and emotional supportive relationships to clinicians and peer groups offered the potential to mitigate the adverse effects of infection protection standards. Conclusions: Patients predominantly reported feedback associated with the care environment. SARS-CoV-2–related reports were strongly affected by increased staff workloads as well as patient-centered processes addressing discontinuous communication and organizationally demanding implementation of infection protection standards, which were perceived to threaten patient autonomy. Peer relationships formed during inpatient rehabilitation had the potential to mitigate these mechanisms. %M 36947585 %R 10.2196/39512 %U https://rehab.jmir.org/2023/1/e39512 %U https://doi.org/10.2196/39512 %U http://www.ncbi.nlm.nih.gov/pubmed/36947585 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e46661 %T Impact of Social Media Usage on Users’ COVID-19 Protective Behavior: Survey Study in Indonesia %A Handayani,Putu Wuri %A Zagatti,Guilherme Augusto %A Kefi,Hajer %A Bressan,Stéphane %+ Information Systems Undergraduate Study Program, University of Indonesia, Faculty of Computer Science Kampus UI Depok, Depok, 16424, Indonesia, 62 217863419 ext 3200, Putu.wuri@cs.ui.ac.id %K COVID-19 %K pandemic %K infectious diseases %K social media %K trust %K behavior %K Indonesia %D 2023 %7 13.4.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Social media have become the source of choice for many users to search for health information on COVID-19 despite possible detrimental consequences. Several studies have analyzed the association between health information–searching behavior and mental health. Some of these studies examined users’ intentions in searching health information on social media and the impact of social media use on mental health in Indonesia. Objective: This study investigates both active and passive participation in social media, shedding light on cofounding effects from these different forms of engagement. In addition, this study analyses the role of trust in social media platforms and its effect on public health outcomes. Thus, the purpose of this study is to analyze the impact of social media usage on COVID-19 protective behavior in Indonesia. The most commonly used social media platforms are Instagram, Facebook, YouTube, TikTok, and Twitter. Methods: We used primary data from an online survey. We processed 414 answers to a structured questionnaire to evaluate the relationship between these users’ active and passive participation in social media, trust in social media, anxiety, self-efficacy, and protective behavior to COVID-19. We modeled the data using partial least square structural equation modeling. Results: This study reveals that social media trust is a crucial antecedent, where trust in social media is positively associated with active contribution and passive consumption of COVID-19 content in social media, users’ anxiety, self-efficacy, and protective behavior. This study found that active contribution of content related to COVID-19 on social media is positively correlated with anxiety, while passive participation increases self-efficacy and, in turn, protective behavior. This study also found that active participation is associated with negative health outcomes, while passive participation has the opposite effects. The results of this study can potentially be used for other infectious diseases, for example, dengue fever and diseases that can be transmitted through the air and have handling protocols similar to that of COVID-19. Conclusions: Public health campaigns can use social media for health promotion. Public health campaigns should post positive messages and distil the received information parsimoniously to avoid unnecessary and possibly counterproductive increased anxiety of the users. %M 37052987 %R 10.2196/46661 %U https://formative.jmir.org/2023/1/e46661 %U https://doi.org/10.2196/46661 %U http://www.ncbi.nlm.nih.gov/pubmed/37052987 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e41319 %T Dynamics of the Negative Discourse Toward COVID-19 Vaccines: Topic Modeling Study and an Annotated Data Set of Twitter Posts %A Lindelöf,Gabriel %A Aledavood,Talayeh %A Keller,Barbara %+ Department of Computer Science, Aalto University, P.O. Box 11000 (Otakaari 1B), FI-00076 AALTO, Espoo, 02150, Finland, 358 9 47001, gabriel.lindeloef@gmail.com %K COVID-19 vaccines %K SARS-CoV-2 %K vaccine hesitancy %K social media %K Twitter %K natural language processing %K machine learning %K stance detection %K topic modeling %D 2023 %7 12.4.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Since the onset of the COVID-19 pandemic, vaccines have been an important topic in public discourse. The discussions around vaccines are polarized, as some see them as an important measure to end the pandemic, and others are hesitant or find them harmful. A substantial portion of these discussions occurs openly on social media platforms. This allows us to closely monitor the opinions of different groups and their changes over time. Objective: This study investigated posts related to COVID-19 vaccines on Twitter (Twitter Inc) and focused on those that had a negative stance toward vaccines. It examined the evolution of the percentage of negative tweets over time. It also examined the different topics discussed in these tweets to understand the concerns and discussion points of those holding a negative stance toward the vaccines. Methods: A data set of 16,713,238 English tweets related to COVID-19 vaccines was collected, covering the period from March 1, 2020, to July 31, 2021. We used the scikit-learn Python library to apply a support vector machine classifier to identify the tweets with a negative stance toward COVID-19 vaccines. A total of 5163 tweets were used to train the classifier, of which a subset of 2484 tweets was manually annotated by us and made publicly available along with this paper. We used the BERTopic model to extract the topics discussed within the negative tweets and investigate them, including how they changed over time. Results: We showed that the negativity with respect to COVID-19 vaccines has decreased over time along with the vaccine rollouts. We identified 37 topics of discussion and presented their respective importance over time. We showed that popular topics not only consisted of conspiratorial discussions, such as 5G towers and microchips, but also contained legitimate concerns around vaccination safety and side effects as well as concerns about policies. The most prevalent topic among vaccine-hesitant tweets was related to the use of messenger RNA and fears about its speculated negative effects on our DNA. Conclusions: Hesitancy toward vaccines existed before the COVID-19 pandemic. However, given the dimension of and circumstances surrounding the COVID-19 pandemic, some new areas of hesitancy and negativity toward COVID-19 vaccines have arisen, for example, whether there has been enough time for them to be properly tested. There is also an unprecedented number of conspiracy theories associated with them. Our study shows that even unpopular opinions or conspiracy theories can become widespread when paired with a widely popular discussion topic such as COVID-19 vaccines. Understanding the concerns, the discussed topics, and how they change over time is essential for policy makers and public health authorities to provide better in-time information and policies to facilitate the vaccination of the population in future similar crises. %M 36877804 %R 10.2196/41319 %U https://www.jmir.org/2023/1/e41319 %U https://doi.org/10.2196/41319 %U http://www.ncbi.nlm.nih.gov/pubmed/36877804 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e40077 %T Examining Recruitment Strategies in the Enrollment Cascade of Youth Living With HIV: Descriptive Findings From a Nationwide Web-Based Adherence Protocol %A Gurung,Sitaji %A Jones,Stephen Scott %A Mehta,Kripa %A Budhwani,Henna %A MacDonell,Karen %A Belzer,Marvin %A Naar,Sylvie %+ Department of Health Sciences, New York City College of Technology, The City University of New York, 285 Jay Street, A811F, Brooklyn, NY, 11201, United States, 1 718 260 5673, Sitaji.Gurung65@citytech.cuny.edu %K recruitment methods %K enrollment challenges %K digital technology %K adherence protocol %K youth living with HIV %K COVID-19 %D 2023 %7 12.4.2023 %9 Early Reports %J JMIR Form Res %G English %X Background: Digital strategies and broadened eligibility criteria may optimize the enrollment of youth living with HIV in mobile health adaptive interventions. Prior research suggests that digital recruitment strategies are more efficient than traditional methods for overcoming enrollment challenges of youth living with HIV in the United States. Objective: This study highlights the challenges and strategies that explain screening and enrollment milestones in a national web-based adherence protocol for youth living with HIV. Methods: Baseline data from a national web-based HIV adherence protocol for youth living with HIV, collected from July 2018 to February 2021, were analyzed. A centralized recruitment procedure was developed, which used web-based recruitment via Online Master Screener; paid targeted advertisements on social media platforms (eg, Facebook and Reddit) and geosocial networking dating apps (eg, Grindr and Jack’d); and site and provider referrals from Subject Recruitment Venues and other AIDS service organizations, website referrals, and text-in recruitment. Results: A total of 3 distinct cohorts of youth living with HIV were identified, marked by changes in recruitment strategies. Overall, 3270 individuals consented to screening, 2721 completed screening, 581 were eligible, and 83 completed enrollment. We examined sociodemographic and behavioral differences in completing milestones from eligibility to full enrollment (ie, submitting antiretroviral therapy and viral load data and completing the baseline web-based survey). Those with the most recent viral load tests >6 months ago were half as likely to enroll (odds ratio 0.45, 95% CI 0.21-0.94). Moreover, eligible participants with self-reported antiretroviral therapy adherence (SRA) between 50% and 80% were statistically significant (P<.001 to P=.03) and more likely to enroll than those with SRA >80%. Conclusions: The findings add to our knowledge on the use of digital technologies for youth living with HIV before and during the COVID-19 pandemic and provide insight into the impact of expanding eligibility criteria on enrollment. As the COVID-19 pandemic continues and the use of and engagement with social media and dating apps among youth living with HIV changes, these platforms should continue to be investigated as potential recruitment tools. Using a wide variety of recruitment strategies such as using social media and dating apps as well as provider referral mechanisms, increasing compensation amounts, and including SRA in enrollment criteria should continue to be studied with respect to their ability to successfully recruit and enroll eligible participants. International Registered Report Identifier (IRRID): RR2-10.2196/11183 %M 36745773 %R 10.2196/40077 %U https://formative.jmir.org/2023/1/e40077 %U https://doi.org/10.2196/40077 %U http://www.ncbi.nlm.nih.gov/pubmed/36745773 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 12 %N %P e39455 %T Effects of Antidepressants on COVID-19 Outcomes: Retrospective Study on Large-Scale Electronic Health Record Data %A Rahman,Md Mahmudur %A Mahi,Atqiya Munawara %A Melamed,Rachel %A Alam,Mohammad Arif Ul %+ The Richard A Miner School of Computer & Information Sciences, University of Massachusetts, 220 Pawtucket St, Lowell, MA, 01854, United States, 1 978 934 1971, mohammadariful_alam@uml.edu %K causal inference %K treatment effect %K drug effect %K COVID-19 outcomes %K COVID-19 severity %K drug repurposing %K COVID-19 %K depression %K mental health %K data mining %K electronic health record %K machine learning %K antidepressant %K causal inference method %D 2023 %7 11.4.2023 %9 Original Paper %J Interact J Med Res %G English %X Background: Antidepressants exert an anticholinergic effect in varying degrees, and various classes of antidepressants can produce a different effect on immune function. While the early use of antidepressants has a notional effect on COVID-19 outcomes, the relationship between the risk of COVID-19 severity and the use of antidepressants has not been properly investigated previously owing to the high costs involved with clinical trials. Large-scale observational data and recent advancements in statistical analysis provide ample opportunity to virtualize a clinical trial to discover the detrimental effects of the early use of antidepressants. Objective: We primarily aimed to investigate electronic health records for causal effect estimation and use the data for discovering the causal effects of early antidepressant use on COVID-19 outcomes. As a secondary aim, we developed methods for validating our causal effect estimation pipeline. Methods: We used the National COVID Cohort Collaborative (N3C), a database aggregating health history for over 12 million people in the United States, including over 5 million with a positive COVID-19 test. We selected 241,952 COVID-19–positive patients (age >13 years) with at least 1 year of medical history. The study included a 18,584-dimensional covariate vector for each person and 16 different antidepressants. We used propensity score weighting based on the logistic regression method to estimate causal effects on the entire data. Then, we used the Node2Vec embedding method to encode SNOMED-CT (Systematized Nomenclature of Medicine-Clinical Terms) medical codes and applied random forest regression to estimate causal effects. We used both methods to estimate causal effects of antidepressants on COVID-19 outcomes. We also selected few negatively effective conditions for COVID-19 outcomes and estimated their effects using our proposed methods to validate their efficacy. Results: The average treatment effect (ATE) of using any one of the antidepressants was −0.076 (95% CI −0.082 to −0.069; P<.001) with the propensity score weighting method. For the method using SNOMED-CT medical embedding, the ATE of using any one of the antidepressants was −0.423 (95% CI −0.382 to −0.463; P<.001). Conclusions: We applied multiple causal inference methods with novel application of health embeddings to investigate the effects of antidepressants on COVID-19 outcomes. Additionally, we proposed a novel drug effect analysis–based evaluation technique to justify the efficacy of the proposed method. This study offers causal inference methods on large-scale electronic health record data to discover the effects of common antidepressants on COVID-19 hospitalization or a worse outcome. We found that common antidepressants may increase the risk of COVID-19 complications and uncovered a pattern where certain antidepressants were associated with a lower risk of hospitalization. While discovering the detrimental effects of these drugs on outcomes could guide preventive care, identification of beneficial effects would allow us to propose drug repurposing for COVID-19 treatment. %M 36881541 %R 10.2196/39455 %U https://www.i-jmr.org/2023/1/e39455 %U https://doi.org/10.2196/39455 %U http://www.ncbi.nlm.nih.gov/pubmed/36881541 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e41010 %T The Evaluation of Health Care Services for Children and Adolescents With Post–COVID-19 Condition: Protocol for a Prospective Longitudinal Study %A Rathgeb,Chiara %A Pawellek,Maja %A Behrends,Uta %A Alberer,Martin %A Kabesch,Michael %A Gerling,Stephan %A Brandstetter,Susanne %A Apfelbacher,Christian %+ Institute of Social Medicine and Health Systems Research, Otto von Guericke University Magdeburg, Leipziger Str 44, Magdeburg, 39120, Germany, 49 0391 6724316, christian.apfelbacher@med.ovgu.de %K post-COVID %K long COVID %K post–COVID-19 condition %K PCC %K post–COVID-19 syndrome %K PCS %K CFS/ME %K children and adolescents %K health care services %K EQ-5D %K SDQ %K PROMIS %K DSQ-PEM %K COVID-19 %K pediatrics %K child %K adolescent %K service delivery %K healthcare delivery %K healthcare service %K care network %K healthcare %K therapeutic service %K healthcare utilization %K patient reported outcome %D 2023 %7 11.4.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Some children and adolescents suffer from late effects of a SARS-CoV-2 infection despite a frequently mild course of the disease. Nevertheless, extensive care for post–COVID-19 condition, also known as post–COVID-19 syndrome, in children and young people is not yet available. A comprehensive care network, Post-COVID Kids Bavaria (PoCo), for children and adolescents with post–COVID-19 condition has been set up as a model project in Bavaria, Germany. Objective: The aim of this study is to evaluate the health care services provided within this network structure of care for children and adolescents with post–COVID-19 condition in a pre-post study design. Methods: We have already recruited 117 children and adolescents aged up to 17 years with post–COVID-19 condition who were diagnosed and treated in 16 participating outpatient clinics. Health care use, treatment satisfaction, patient-reported outcomes related to health-related quality of life (the primary endpoint), fatigue, postexertional malaise, and mental health are being assessed at different time points (at baseline and after 4 weeks, 3 months, and 6 months) using routine data, interviews, and self-report questionnaires. Results: The study recruitment process ran from April 2022 until December 2022. Interim analyses will be carried out. A full analysis of the data will be conducted after follow-up assessment is completed, and the results will be published. Conclusions: The results will contribute to the evaluation of therapeutic services provided for post–COVID-19 condition in children and adolescents, and avenues for optimizing care may be identified. International Registered Report Identifier (IRRID): DERR1-10.2196/41010 %M 36867709 %R 10.2196/41010 %U https://www.researchprotocols.org/2023/1/e41010 %U https://doi.org/10.2196/41010 %U http://www.ncbi.nlm.nih.gov/pubmed/36867709 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e39765 %T Implementation of a Hardware-Assisted Bluetooth-Based COVID-19 Tracking Device in a High School: Mixed Methods Study %A Li,Dan %A Shelby,Tyler %A Brault,Marie %A Manohar,Rajit %A Vermund,Sten %A Hagaman,Ashley %A Forastiere,Laura %A Caruthers,Tyler %A Egger,Emilie %A Wang,Yizhou %A Manohar,Nathan %A Manohar,Peter %A Davis,J Lucian %A Zhou,Xin %+ Yale School of Public Health, Yale University, 60 College Street, New Haven, CT, 06511, United States, 1 5037199624, dan.li@yale.edu %K contact tracing %K COVID-19 %K digital contact tracing %K Bluetooth device %K school health %K secondary school %K implementation science %K mixed methods %D 2023 %7 7.4.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Contact tracing is a vital public health tool used to prevent the spread of infectious diseases. However, traditional interview-format contact tracing (TCT) is labor-intensive and time-consuming and may be unsustainable for large-scale pandemics such as COVID-19. Objective: In this study, we aimed to address the limitations of TCT. The Yale School of Engineering developed a Hardware-Assisted Bluetooth-based Infection Tracking (HABIT) device. Following the successful implementation of HABIT in a university setting, this study sought to evaluate the performance and implementation of HABIT in a high school setting using an embedded mixed methods design. Methods: In this pilot implementation study, we first assessed the performance of HABIT using mock case simulations in which we compared contact tracing data collected from mock case interviews (TCT) versus Bluetooth devices (HABIT). For each method, we compared the number of close contacts identified and identification of unique contacts. We then conducted an embedded mixed methods evaluation of the implementation outcomes of HABIT devices using pre- and postimplementation quantitative surveys and qualitative focus group discussions with users and implementers according to the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework. Results: In total, 17 students and staff completed mock case simulations in which 161 close contact interactions were detected by interview or Bluetooth devices. We detected significant differences in the number of close contacts detected by interview versus Bluetooth devices (P<.001), with most (127/161, 78.9%) contacts being reported by interview only. However, a significant number (26/161, 16.1%; P<.001) of contacts were uniquely identified by Bluetooth devices. The interface, ease of use, coherence, and appropriateness were highly rated by both faculty and students. HABIT provided emotional security to users. However, the prototype design and technical difficulties presented barriers to the uptake and sustained use of HABIT. Conclusions: Implementation of HABIT in a high school was impeded by technical difficulties leading to decreased engagement and adherence. Nonetheless, HABIT identified a significant number of unique contacts not reported by interview, indicating that electronic technologies may augment traditional contact tracing once user preferences are accommodated and technical glitches are overcome. Participants indicated a high degree of acceptance, citing emotional reassurance and a sense of security with the device. %M 36525333 %R 10.2196/39765 %U https://formative.jmir.org/2023/1/e39765 %U https://doi.org/10.2196/39765 %U http://www.ncbi.nlm.nih.gov/pubmed/36525333 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e43839 %T The Efficacy and Usability of an Unguided Web-Based Grief Intervention for Adults Who Lost a Loved One During the COVID-19 Pandemic: Randomized Controlled Trial %A Dominguez-Rodriguez,Alejandro %A Sanz-Gomez,Sergio %A González Ramírez,Leivy Patricia %A Herdoiza-Arroyo,Paulina Erika %A Trevino Garcia,Lorena Edith %A de la Rosa-Gómez,Anabel %A González-Cantero,Joel Omar %A Macias-Aguinaga,Valeria %A Miaja,Melina %+ School of Psychology, Universidad Internacional del Ecuador, Av. Simón Bolívar and Av. Jorge Fernández, Quito, 170102, Ecuador, 593 22985 600, pherdoiza@uide.edu.ec %K web-based intervention %K usability %K complicated grief %K hopelessness %K suicidal risk %K depression %K anxiety %K posttraumatic stress %K mobile phone %D 2023 %7 6.4.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: The death of a loved one was a challenge many people faced during the COVID-19 pandemic within the context of extraordinary circumstances and great uncertainty. Grief is an unavoidable part of life, and for most people, feelings of grief decrease naturally over time. However, for some people, grieving can become a particularly painful process with clinical symptoms that may require professional help to resolve. To provide psychological support to people who had lost a loved one during the COVID-19 pandemic, an unguided web-based psychological intervention was developed. Objective: The main objective of this study was to evaluate the efficacy of the web-based treatment, Grief COVID (Duelo COVID in Spanish; ITLAB), in reducing clinical symptoms of complicated grief, depression, posttraumatic stress, hopelessness, anxiety, and suicidal risk in adults. The secondary aim was to validate the usability of the self-applied intervention system. Methods: We used a randomized controlled trial with an intervention group (IG) and a waitlist control group (CG). The groups were assessed 3 times (before beginning the intervention, upon completing the intervention, and 3 months after the intervention). The intervention was delivered on the web in an asynchronous format through the Duelo COVID web page. Participants created an account that could be used on their computers, smartphones, or tablets. The evaluation process was automated as part of the intervention. Results: A total of 114 participants were randomly assigned to the IG or CG and met criteria for inclusion in the study (n=45, 39.5% completed the intervention and n=69, 60.5% completed the waitlist period). Most participants (103/114, 90.4%) were women. The results indicated that the treatment significantly reduced baseline clinical symptoms in the IG for all variables (P<.001 to P=.006), with larger effect sizes for depression, hopelessness, grief, anxiety, and risk of suicide (all effect sizes ≥0.5). The follow-up evaluation showed that symptom reduction was maintained at 3 months after the intervention. The results from the CG showed that participants experienced significantly decreased levels of hopelessness after completing the time on the waitlist (P<.001), but their suicidal risk scores increased. Regarding the usability of the self-applied intervention system, the results indicated a high level of satisfaction with the Grief COVID. Conclusions: The self-applied web-based intervention Grief COVID was effective in reducing symptoms of anxiety, depression, hopelessness, risk of suicide risk, posttraumatic stress disorder, and complicated grief disorder. Grief COVID was evaluated by the participants, who reported that the system was easy to use. These results affirm the importance of developing additional web-based psychological tools to help reduce clinical symptoms in people experiencing grief because of the loss of a loved one during a pandemic. Trial Registration: ClinicalTrials.gov NCT04638842; https://clinicaltrials.gov/ct2/show/NCT04638842 %M 36877800 %R 10.2196/43839 %U https://www.jmir.org/2023/1/e43839 %U https://doi.org/10.2196/43839 %U http://www.ncbi.nlm.nih.gov/pubmed/36877800 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e43836 %T COVID-19 Contact Tracing as an Indicator for Evaluating a Pandemic Situation: Simulation Study %A Marques-Cruz,Manuel %A Nogueira-Leite,Diogo %A Alves,João Miguel %A Fernandes,Francisco %A Fernandes,José Miguel %A Almeida,Miguel Ângelo %A Cunha Correia,Patrícia %A Perestrelo,Paula %A Cruz-Correia,Ricardo %A Pita Barros,Pedro %+ Department of Community Medicine, Information and Decision in Health, Faculty of Medicine, University of Porto, Faculdade de Medicina da Universidade do Porto, Rua Dr. Plácido da Costa, Porto, 4200-450, Portugal, 351 225513622, up201000048@up.pt %K COVID-19 %K public health %K public health surveillance %K quarantine %K infection transmission %K epidemiological models %D 2023 %7 6.4.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Contact tracing is a fundamental intervention in public health. When systematically applied, it enables the breaking of chains of transmission, which is important for controlling COVID-19 transmission. In theoretically perfect contact tracing, all new cases should occur among quarantined individuals, and an epidemic should vanish. However, the availability of resources influences the capacity to perform contact tracing. Therefore, it is necessary to estimate its effectiveness threshold. We propose that this effectiveness threshold may be indirectly estimated using the ratio of COVID-19 cases arising from quarantined high-risk contacts, where higher ratios indicate better control and, under a threshold, contact tracing may fail and other restrictions become necessary. Objective: This study assessed the ratio of COVID-19 cases in high-risk contacts quarantined through contact tracing and its potential use as an ancillary pandemic control indicator. Methods: We built a 6-compartment epidemiological model to emulate COVID-19 infection flow according to publicly available data from Portuguese authorities. Our model extended the usual susceptible-exposed-infected-recovered model by adding a compartment Q with individuals in mandated quarantine who could develop infection or return to the susceptible pool and a compartment P with individuals protected from infection because of vaccination. To model infection dynamics, data on SARS-CoV-2 infection risk (IR), time until infection, and vaccine efficacy were collected. Estimation was needed for vaccine data to reflect the timing of inoculation and booster efficacy. In total, 2 simulations were built: one adjusting for the presence and absence of variants or vaccination and another maximizing IR in quarantined individuals. Both simulations were based on a set of 100 unique parameterizations. The daily ratio of infected cases arising from high-risk contacts (q estimate) was calculated. A theoretical effectiveness threshold of contact tracing was defined for 14-day average q estimates based on the classification of COVID-19 daily cases according to the pandemic phases and was compared with the timing of population lockdowns in Portugal. A sensitivity analysis was performed to understand the relationship between different parameter values and the threshold obtained. Results: An inverse relationship was found between the q estimate and daily cases in both simulations (correlations >0.70). The theoretical effectiveness thresholds for both simulations attained an alert phase positive predictive value of >70% and could have anticipated the need for additional measures in at least 4 days for the second and fourth lockdowns. Sensitivity analysis showed that only the IR and booster dose efficacy at inoculation significantly affected the q estimates. Conclusions: We demonstrated the impact of applying an effectiveness threshold for contact tracing on decision-making. Although only theoretical thresholds could be provided, their relationship with the number of confirmed cases and the prediction of pandemic phases shows the role as an indirect indicator of the efficacy of contact tracing. %M 36877958 %R 10.2196/43836 %U https://publichealth.jmir.org/2023/1/e43836 %U https://doi.org/10.2196/43836 %U http://www.ncbi.nlm.nih.gov/pubmed/36877958 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e43165 %T Using the Pan American Health Organization Digital Conversational Agent to Educate the Public on Alcohol Use and Health: Preliminary Analysis %A Monteiro,Maristela Goldnadel %A Pantani,Daniela %A Pinsky,Ilana %A Hernandes Rocha,Thiago Augusto %+ Department of Noncommunicable Diseases and Mental Health, Pan American Health Organization, 525 23rd St NW, Washington, DC, 20037, United States, 1 2029743108, monteirm@paho.org %K alcohol use %K alcohol risk assessment %K digital health worker %K artificial intelligence %K health literacy %K digital health %K chatbot %K misinformation %K online health information %K digital health education %K alcohol use %K health risk %K COVID-19 %D 2023 %7 6.4.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: There is widespread misinformation about the effects of alcohol consumption on health, which was amplified during the COVID-19 pandemic through social media and internet channels. Chatbots and conversational agents became an important piece of the World Health Organization (WHO) response during the COVID-19 pandemic to quickly disseminate evidence-based information related to COVID-19 and tobacco to the public. The Pan American Health Organization (PAHO) seized the opportunity to develop a conversational agent to talk about alcohol-related topics and therefore complement traditional forms of health education that have been promoted in the past. Objective: This study aimed to develop and deploy a digital conversational agent to interact with an unlimited number of users anonymously, 24 hours a day, about alcohol topics, including ways to reduce risks from drinking, that is accessible in several languages, at no cost, and through various devices. Methods: The content development was based on the latest scientific evidence on the impacts of alcohol on health, social norms about drinking, and data from the WHO and PAHO. The agent itself was developed through a nonexclusive license agreement with a private company (Soul Machines) and included Google Digital Flow ES as the natural language processing software and Amazon Web Services for cloud services. Another company was contracted to program all the conversations, following the technical advice of PAHO staff. Results: The conversational agent was named Pahola, and it was deployed on November 19, 2021, through the PAHO website after a launch event with high publicity. No identifiable data were used and all interactions were anonymous, and therefore, this was not considered research with human subjects. Pahola speaks in English, Spanish, and Portuguese and interacts anonymously with a potentially infinite number of users through various digital devices. Users were required to accept the terms and conditions to enable access to their camera and microphone to interact with Pahola. Pahola attracted good attention from the media and reached 1.6 million people, leading to 236,000 clicks on its landing page, mostly through mobile devices. Only 1532 users had a conversation after clicking to talk to Pahola. The average time users spent talking to Pahola was 5 minutes. Major dropouts were observed in different steps of the conversation flow. Some questions asked by users were not anticipated during programming and could not be answered. Conclusions: Our findings showed several limitations to using a conversational agent for alcohol education to the general public. Improvements are needed to expand the content to make it more meaningful and engaging to the public. The potential of chatbots to educate the public on alcohol-related topics seems enormous but requires a long-term investment of resources and research to be useful and reach many more people. %M 36961920 %R 10.2196/43165 %U https://formative.jmir.org/2023/1/e43165 %U https://doi.org/10.2196/43165 %U http://www.ncbi.nlm.nih.gov/pubmed/36961920 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e43134 %T Compliance Challenges in a Longitudinal COVID-19 Cohort Using Wearables for Continuous Monitoring: Observational Study %A Mekhael,Mario %A Ho,Chan %A Noujaim,Charbel %A Assaf,Ala %A Younes,Hadi %A El Hajjar,Abdel Hadi %A Chaudhry,Humza A %A Lanier,Brennan %A Chouman,Nour %A Makan,Noor %A Shan,Botao %A Zhang,Yichi %A Dagher,Lilas %A Kreidieh,Omar %A Marrouche,Nassir %A Donnellan,Eoin %+ Tulane University School of Medicine, 1324 Tulane Avenue, 1324 Tulane Ave, Suite A128, New Orleans, LA, 70112, United States, 1 504 988 3072, nmarrouche@tulane.edu %K COVID-19 %K digital health %K wearables %K compliance %K cardiovascular health %K heart disease %K wearable device %K biometric %K remote monitoring %D 2023 %7 5.4.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: The WEAICOR (Wearables to Investigate the Long Term Cardiovascular and Behavioral Impacts of COVID-19) study was a prospective observational study that used continuous monitoring to detect and analyze biometrics. Compliance to wearables was a major challenge when conducting the study and was crucial for the results. Objective: The aim of this study was to evaluate patients’ compliance to wearable wristbands and determinants of compliance in a prospective COVID-19 cohort. Methods: The Biostrap (Biostrap USA LLC) wearable device was used to monitor participants’ biometric data. Compliance was calculated by dividing the total number of days in which transmissions were sent by the total number of days spent in the WEAICOR study. Univariate correlation analyses were performed, with compliance and days spent in the study as dependent variables and age, BMI, sex, symptom severity, and the number of complications or comorbidities as independent variables. Multivariate linear regression was then performed, with days spent in the study as a dependent variable, to assess the power of different parameters in determining the number of days patients spent in the study. Results: A total of 122 patients were included in this study. Patients were on average aged 41.32 years, and 46 (38%) were female. Age was found to correlate with compliance (r=0.23; P=.01). In addition, age (r=0.30; P=.001), BMI (r=0.19; P=.03), and the severity of symptoms (r=0.19; P=.03) were found to correlate with days spent in the WEAICOR study. Per our multivariate analysis, in which days spent in the study was a dependent variable, only increased age was a significant determinant of compliance with wearables (adjusted R2=0.1; β=1.6; P=.01). Conclusions: Compliance is a major obstacle in remote monitoring studies, and the reasons for a lack of compliance are multifactorial. Patient factors such as age, in addition to environmental factors, can affect compliance to wearables. %M 36763647 %R 10.2196/43134 %U https://www.jmir.org/2023/1/e43134 %U https://doi.org/10.2196/43134 %U http://www.ncbi.nlm.nih.gov/pubmed/36763647 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e44491 %T Enhancing Public Health Communication Regarding Vaccine Trials: Design and Development of the Pan-European VACCELERATE Toolkit %A Argyropoulos,Christos D %A Leckler,Janina %A Salmanton-García,Jon %A Constantinou,Marinos %A Alexandrou,Alexandra %A Themistocleous,Sophia %A Noula,Evgenia %A Shiamakkides,George %A Nearchou,Andria %A Stewart,Fiona A %A Albus,Kerstin %A Koniordou,Markela %A Kopsidas,Ioannis %A Spivak,Orly %A Hellemans,Margot %A Hendrickx,Greet %A Davis,Ruth Joanna %A Azzini,Anna Maria %A Simon,Paula Valle %A Carcas-Sansuan,Antonio Javier %A Askling,Helena Hervius %A Vene,Sirkka %A Prellezo,Jana Baranda %A Álvarez-Barco,Elena %A Macken,Alan J %A Di Marzo,Romina %A Luís,Catarina %A Olesen,Ole F %A Frias Iniesta,Jesus A %A Barta,Imre %A Tóth,Krisztina %A Akova,Murat %A Bonten,Marc M J %A Cohen-Kandli,Miriam %A Cox,Rebecca Jane %A Součková,Lenka %A Husa,Petr %A Jancoriene,Ligita %A Launay,Odile %A Lundgren,Jens %A Mallon,Patrick %A Armeftis,Charis %A Marques,Laura %A Naucler,Pontus %A Ochando,Jordi %A Tacconelli,Evelina %A van Damme,Pierre %A Zaoutis,Theoklis %A Hofstraat,Sanne %A Bruijning-Verhagen,Patricia %A Zeitlinger,Markus %A Cornely,Oliver A %A Pana,Zoi Dorothea %+ School of Medicine, European University Cyprus, 6 Diogenis Str, Egkomi, Nicosia, 2404, Cyprus, 357 94049474, z.pana@euc.ac.cy %K vaccine trials %K volunteer registry %K educational material %K promotional material %K patient education %K health communication %K health promotion %K public health %K COVID-19 %K coronavirus %K SARS-CoV-2 %K pandemic %K vaccine %K vaccination %K hesitancy %K campaign %K misinformation %D 2023 %7 3.4.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The pan-European VACCELERATE network aims to implement the first transnational harmonized and sustainable vaccine trial Volunteer Registry, being a single entry point for potential volunteers of large-scale vaccine trials across Europe. This work exhibits a set of harmonized vaccine trial–related educational and promotional tools for the general public, designed and disseminated by the pan-European VACCELERATE network. Objective: This study primarily aimed to design and develop a standard toolkit to increase positive attitudes and access to trustworthy information for better access and increased recruitment to vaccine trials for the public. More specifically, the produced tools are focused on inclusiveness and equity, and are targeting different population groups, including underserved ones, as potential volunteers for the VACCELERATE Volunteer Registry (older individuals, migrants, children, and adolescents). The promotional and educational material is aligned with the main objectives of the Volunteer Registry to increase public literacy and awareness regarding vaccine-related clinical research or trials and trial participation, including informed consent and legal issues, side effects, and frequently asked questions regarding vaccine trial design. Methods: Tools were developed per the aims and principles of the VACCELERATE project, focusing on trial inclusiveness and equity, and are adjusted to local country-wise requirements to improve public health communication. The produced tools are selected based on the cognitive theory, inclusiveness, and equity of differently aged and underrepresented groups, and standardized material from several official trustworthy sources (eg, COVID-19 Vaccines Global Access; the European Centre for Disease Prevention and Control; the European Patients’ Academy on Therapeutic Innovation; Gavi, the Vaccine Alliance; and the World Health Organization). A team of multidisciplinary specialists (infectious diseases, vaccine research, medicine, and education) edited and reviewed the subtitles and scripts of the educational videos, extended brochures, interactive cards, and puzzles. Graphic designers selected the color palette, audio settings, and dubbing for the video story-tales and implemented QR codes. Results: This study presents the first set of harmonized promotional and educational materials and tools (ie, educational cards, educational and promotional videos, extended brochures, flyers, posters, and puzzles) for vaccine clinical research (eg, COVID-19 vaccines). These tools inform the public about possible benefits and disadvantages of trial participation and build confidence among participants about the safety and efficacy of COVID-19 vaccines and the health care system. This material has been translated into several languages and is intended to be freely and easily accessible to facilitate dissemination among VACCELERATE network participant countries and the European and global scientific, industrial, and public community. Conclusions: The produced material could help fill knowledge gaps of health care personnel, providing the appropriate future patient education for vaccine trials, and tackling vaccine hesitancy and parents’ concerns for potential participation of children in vaccine trials. %M 36878478 %R 10.2196/44491 %U https://publichealth.jmir.org/2023/1/e44491 %U https://doi.org/10.2196/44491 %U http://www.ncbi.nlm.nih.gov/pubmed/36878478 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 10 %N %P e43135 %T Evaluating User Experience With a Chatbot Designed as a Public Health Response to the COVID-19 Pandemic in Brazil: Mixed Methods Study %A Chagas,Bruno Azevedo %A Pagano,Adriana Silvina %A Prates,Raquel Oliveira %A Praes,Elisa Cordeiro %A Ferreguetti,Kícila %A Vaz,Helena %A Reis,Zilma Silveira Nogueira %A Ribeiro,Leonardo Bonisson %A Ribeiro,Antonio Luiz Pinho %A Pedroso,Thais Marques %A Beleigoli,Alline %A Oliveira,Clara Rodrigues Alves %A Marcolino,Milena Soriano %+ Telehealth Center, University Hospital, Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena, 110 1o andar Sala 107 Ala Sul, Belo Horizonte, 30130-100, Brazil, 55 31 3307 9201, milenamarc@gmail.com %K user experience %K chatbots %K telehealth %K COVID-19 %K human-computer interaction %K HCI %K empirical studies in human-computer interaction %K empirical studies in HCI %K health care information systems %D 2023 %7 3.4.2023 %9 Original Paper %J JMIR Hum Factors %G English %X Background: The potential of chatbots for screening and monitoring COVID-19 was envisioned since the outbreak of the disease. Chatbots can help disseminate up-to-date and trustworthy information, promote healthy social behavior, and support the provision of health care services safely and at scale. In this scenario and in view of its far-reaching postpandemic impact, it is important to evaluate user experience with this kind of application. Objective: We aimed to evaluate the quality of user experience with a COVID-19 chatbot designed by a large telehealth service in Brazil, focusing on the usability of real users and the exploration of strengths and shortcomings of the chatbot, as revealed in reports by participants in simulated scenarios. Methods: We examined a chatbot developed by a multidisciplinary team and used it as a component within the workflow of a local public health care service. The chatbot had 2 core functionalities: assisting web-based screening of COVID-19 symptom severity and providing evidence-based information to the population. From October 2020 to January 2021, we conducted a mixed methods approach and performed a 2-fold evaluation of user experience with our chatbot by following 2 methods: a posttask usability Likert-scale survey presented to all users after concluding their interaction with the bot and an interview with volunteer participants who engaged in a simulated interaction with the bot guided by the interviewer. Results: Usability assessment with 63 users revealed very good scores for chatbot usefulness (4.57), likelihood of being recommended (4.48), ease of use (4.44), and user satisfaction (4.38). Interviews with 15 volunteers provided insights into the strengths and shortcomings of our bot. Comments on the positive aspects and problems reported by users were analyzed in terms of recurrent themes. We identified 6 positive aspects and 15 issues organized in 2 categories: usability of the chatbot and health support offered by it, the former referring to usability of the chatbot and how users can interact with it and the latter referring to the chatbot’s goal in supporting people during the pandemic through the screening process and education to users through informative content. We found 6 themes accounting for what people liked most about our chatbot and why they found it useful—3 themes pertaining to the usability domain and 3 themes regarding health support. Our findings also identified 15 types of problems producing a negative impact on users—10 of them related to the usability of the chatbot and 5 related to the health support it provides. Conclusions: Our results indicate that users had an overall positive experience with the chatbot and found the health support relevant. Nonetheless, qualitative evaluation of the chatbot indicated challenges and directions to be pursued in improving not only our COVID-19 chatbot but also health chatbots in general. %M 36634267 %R 10.2196/43135 %U https://humanfactors.jmir.org/2023/1/e43135 %U https://doi.org/10.2196/43135 %U http://www.ncbi.nlm.nih.gov/pubmed/36634267 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e43497 %T Twitter's Role in Combating the Magnetic Vaccine Conspiracy Theory: Social Network Analysis of Tweets %A Ahmed,Wasim %A Das,Ronnie %A Vidal-Alaball,Josep %A Hardey,Mariann %A Fuster-Casanovas,Aïna %+ Unitat de Suport a la Recerca de la Catalunya Central, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, C/ Pica d'Estats 13-15, Sant Fruitós de Bages, 08272, Spain, 34 93 693 0040, jvidal.cc.ics@gencat.cat %K COVID-19 %K coronavirus %K Twitter %K social network analysis %K misinformation %K online social capital %D 2023 %7 31.3.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: The popularity of the magnetic vaccine conspiracy theory and other conspiracy theories of a similar nature creates challenges to promoting vaccines and disseminating accurate health information. Objective: Health conspiracy theories are gaining in popularity. This study's objective was to evaluate the Twitter social media network related to the magnetic vaccine conspiracy theory and apply social capital theory to analyze the unique social structures of influential users. As a strategy for web-based public health surveillance, we conducted a social network analysis to identify the important opinion leaders sharing the conspiracy, the key websites, and the narratives. Methods: A total of 18,706 tweets were retrieved and analyzed by using social network analysis. Data were retrieved from June 1 to June 13, 2021, using the keyword vaccine magnetic. Tweets were retrieved via a dedicated Twitter application programming interface. More specifically, the Academic Track application programming interface was used, and the data were analyzed by using NodeXL Pro (Social Media Research Foundation) and Gephi. Results: There were a total of 22,762 connections between Twitter users within the data set. This study found that the most influential user within the network consisted of a news account that was reporting on the magnetic vaccine conspiracy. There were also several other users that became influential, such as an epidemiologist, a health economist, and a retired sports athlete who exerted their social capital within the network. Conclusions: Our study found that influential users were effective broadcasters against the conspiracy, and their reach extended beyond their own networks of Twitter followers. We emphasize the need for trust in influential users with regard to health information, particularly in the context of the widespread social uncertainty resulting from the COVID-19 pandemic, when public sentiment on social media may be unpredictable. This study highlights the potential of influential users to disrupt information flows of conspiracy theories via their unique social capital. %M 36927550 %R 10.2196/43497 %U https://www.jmir.org/2023/1/e43497 %U https://doi.org/10.2196/43497 %U http://www.ncbi.nlm.nih.gov/pubmed/36927550 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e45697 %T US Adults Practicing Healthy Lifestyles Before and During COVID-19: Comparative Analysis of National Surveys %A Tam,Hon Lon %A Chair,Sek Ying %A Leung,Isaac Sze Him %A Leung,Leona Yuen Ling %A Chan,Alex Siu Wing %+ The Nethersole School of Nursing, The Chinese University of Hong Kong, Rm 704B, 7/F, Esther Lee Building, Shatin, NT, China (Hong Kong), 852 39439306, hltam@cuhk.edu.hk %K healthy lifestyle %K health risk behaviors %K habits %K noncommunicable diseases %K population surveillance %K Behavioural Risk Factor Surveillance System %K BRFSS %D 2023 %7 31.3.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Practicing healthy lifestyles can reduce the risk to develop noncommunicable diseases and the related mortality. Studies showed that practicing healthy lifestyles could enhance disease-free life expectancy and preserve bodily functions. However, engagement in healthy lifestyle behavior was suboptimal. Objective: This study aimed to define individuals’ lifestyle characteristics before and during COVID-19 and determine the factors associated with practicing a healthy lifestyle. This cross-sectional study was conducted using data from the 2019 and 2021 Behavioral Risk Factor Surveillance System surveys. Methods: US individuals aged ≥18 years were interviewed via phone call. Healthy lifestyles were assessed through corresponding questions regarding the maintenance of optimal body weight, physical activity, daily consumption of at least five portions of fruits and vegetables, current smoking status, and alcohol consumption. Missing data were imputed using a package in the R statistical software. The effects of practicing a healthy lifestyle on cases without missing data and those with imputation were reported. Results: There were 550,607 respondents (272,543 and 278,064 from 2019 and 2021, respectively) included in this analysis. The rates of practicing a healthy lifestyle were 4% (10,955/272,543) and 3.6% (10,139/278,064) in 2019 and 2021, respectively. Although 36.6% (160,629/438,693) of all 2021 respondents had missing data, the results of the logistic regression analysis for cases without missing data and those with imputation were similar. Of the cases with imputation, women (odds ratio [OR] 1.87) residing in urban areas (OR 1.24) with high education levels (OR 1.73) and good or better health status (OR 1.59) were more likely to practice healthier lifestyles than young individuals (OR 0.51-0.67) with a low household income (OR 0.74-0.78) and chronic health conditions (OR 0.48-0.74). Conclusions: A healthy lifestyle should be strongly promoted at the community level. In particular, factors associated with a low rate of practice of healthy lifestyles should be targeted. %M 36940169 %R 10.2196/45697 %U https://publichealth.jmir.org/2023/1/e45697 %U https://doi.org/10.2196/45697 %U http://www.ncbi.nlm.nih.gov/pubmed/36940169 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e43786 %T Lifestyle Behavior Changes and Associated Risk Factors During the COVID-19 Pandemic: Results from the Canadian COVIDiet Online Cohort Study %A Tessier,Anne-Julie %A Moyen,Audrey %A Lawson,Claire %A Rappaport,Aviva Ilysse %A Yousif,Hiba %A Fleurent-Grégoire,Chloé %A Lalonde-Bester,Sophie %A Brazeau,Anne-Sophie %A Chevalier,Stéphanie %+ School of Human Nutrition, Faculty of Agriculture and Environmental Sciences, McGill University, 21111 Lakeshore, Sainte-Anne-de-Bellevue, QC, H9X 3V9, Canada, 1 514 398 7925, anne-julie.tessier@mail.mcgill.ca %K healthy lifestyle %K behaviors %K pandemic %K COVID-19 %K public health %K body image %K gender %K stress %K risk factor %K physical activity %K public health %K mental well-being %K depression %D 2023 %7 30.3.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The COVID-19 pandemic and related lockdowns have impacted lifestyle behaviors, including eating habits and physical activity; yet, few studies have identified the emerging patterns of such changes and associated risk factors. Objective: This study aims to identify the patterns of weight and lifestyle behavior changes, and the potential risk factors, resulting from the pandemic in Canadian adults. Methods: Analyses were conducted on 1609 adults (18-89 years old; n=1450, 90.1%, women; n=1316, 81.8%, White) of the Canadian COVIDiet study baseline data (May-December 2020). Self-reported current and prepandemic weight, physical activity, smoking status, perceived eating habits, alcohol intake, and sleep quality were collected through online questionnaires. Based on these 6 indicator variables, latent class analysis (LCA) was used to identify lifestyle behavior change patterns. Associations with potential risk factors, including age, gender, ethnicity, education, income, chronic diseases, body image perception, and changes in the stress level, living situation, and work arrangement, were examined with logistic regressions. Results: Participants’ mean BMI was 26.1 (SD 6.3) kg/m2. Of the 1609 participants, 980 (60.9%) had a bachelor’s degree or above. Since the pandemic, 563 (35%) had decreased income and 788 (49%) changed their work arrangement. Most participants reported unchanged weight, sleep quality, physical activity level, and smoking and alcohol consumption, yet 708 (44%) reported a perceived decrease in eating habit quality. From LCA, 2 classes of lifestyle behavior change emerged: healthy and less healthy (probability: 0.605 and 0.395, respectively; Bayesian information criterion [BIC]=15574, entropy=4.8). The healthy lifestyle behavior change group more frequently reported unchanged weight, sleep quality, smoking and alcohol intake, unchanged/improved eating habits, and increased physical activity. The less healthy lifestyle behavior change group reported significant weight gain, deteriorated eating habits and sleep quality, unchanged/increased alcohol intake and smoking, and decreased physical activity. Among risk factors, body image dissatisfaction (odds ratio [OR] 8.8, 95% CI 5.3-14.7), depression (OR 1.8, 95% CI 1.3-2.5), increased stress level (OR 3.4, 95% CI 2.0-5.8), and gender minority identity (OR 5.5, 95% CI 1.3-22.3) were associated with adopting less healthy behaviors in adjusted models. Conclusions: The COVID-19 pandemic has appeared to have influenced lifestyle behaviors unfavorably in some but favorably in others. Body image perception, change in stress level, and gender identity are factors associated with behavior change patterns; whether these will sustain over time remains to be studied. Findings provide insights into developing strategies for supporting adults with poorer mental well-being in the postpandemic context and promoting healthful behaviors during future disease outbreaks. Trial Registration: ClinicalTrials.gov NCT04407533; https://clinicaltrials.gov/ct2/show/NCT04407533 %M 36848226 %R 10.2196/43786 %U https://publichealth.jmir.org/2023/1/e43786 %U https://doi.org/10.2196/43786 %U http://www.ncbi.nlm.nih.gov/pubmed/36848226 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e38404 %T Understanding the Public’s Attitudes Toward COVID-19 Vaccines in Nottinghamshire, United Kingdom: Qualitative Social Media Analysis %A Jones,Leah Ffion %A Bonfield,Stefanie %A Farrell,Jade %A Weston,Dale %+ UK Health Security Agency, Manor Farm Road, Porton Down, Salisbury, SP4 0JG, United Kingdom, 44 2084953256, leah.jones@bupa.com %K COVID-19 %K vaccine %K social media %K qualitative %K vaccine hesitancy %K infodemic %K misinformation %K infodemiology %K online health information %K content analysis %K Facebook %K Twitter %K transmission %D 2023 %7 29.3.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: COVID-19 vaccines remain central to the UK government’s plan for tackling the COVID-19 pandemic. Average uptake of 3 doses in the United Kingdom stood at 66.7% as of March 2022; however, this rate varies across localities. Understanding the views of groups who have low vaccine uptake is crucial to guide efforts to improve vaccine uptake. Objective: This study aims to understand the public’s attitudes toward COVID-19 vaccines in Nottinghamshire, United Kingdom. Methods: A qualitative thematic analysis of social media posts from Nottinghamshire-based profiles and data sources was conducted. A manual search strategy was used to search the Nottingham Post website and local Facebook and Twitter accounts from September 2021 to October 2021. Only comments in the public domain and in English were included in the analysis. Results: A total of 3508 comments from 1238 users on COVID-19 vaccine posts by 10 different local organizations were analyzed, and 6 overarching themes were identified: trust in the vaccines, often characterized by a lack of trust in vaccine information, information sources including the media, and the government; beliefs about safety including doubts about the speed of development and approval process, the severity of side effects, and belief that the ingredients are harmful; belief that the vaccines are not effective as people can still become infected and spread the virus and that the vaccines may increase transmission through shedding; belief that the vaccines are not necessary due to low perceived risk of death and severe outcomes and use of other protective measures such as natural immunity, ventilation, testing, face coverings, and self-isolation; individual rights and freedoms to be able to choose to be vaccinated or not without judgement or discrimination; and barriers to physical access. Conclusions: The findings revealed a wide range of beliefs and attitudes toward COVID-19 vaccination. Implications for the vaccine program in Nottinghamshire include communication strategies delivered by trusted sources to address the gaps in knowledge identified while acknowledging some negatives such as side effects alongside emphasizing the benefits. These strategies should avoid perpetuating myths and avoid using scare tactics when addressing risk perceptions. Accessibility should also be considered with a review of current vaccination site locations, opening hours, and transport links. Additional research may benefit from using qualitative interviews or focus groups to further probe on the themes identified and explore the acceptability of the recommended interventions. %M 36812390 %R 10.2196/38404 %U https://www.jmir.org/2023/1/e38404 %U https://doi.org/10.2196/38404 %U http://www.ncbi.nlm.nih.gov/pubmed/36812390 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 6 %N %P e41692 %T Pandemic-Related Changes in Technology Use Among a Sample of Previously Hospitalized Older Adult New Yorkers: Observational Study %A Drazich,Brittany F %A Lee,Ji Won %A Bowles,Kathryn H %A Taylor,Janiece L %A Shah,Shivani %A Resnick,Barbara %A Kim,Nayeon %A Szanton,Sarah L %+ School of Nursing, University of Maryland, 655 W Lombard St, Baltimore, MD, 21201, United States, 1 410 706 0501, brittdrazich@gmail.com %K older adults %K technology %K COVID-19 %K well-being %K elderly population %K technology use %K physical disability %K virtual health %K social interaction %K digital gaming %K digital learning %D 2023 %7 29.3.2023 %9 Original Paper %J JMIR Aging %G English %X Background: The COVID-19 pandemic increased the importance of technology for all Americans, including older adults. Although a few studies have indicated that older adults might have increased their technology use during the COVID-19 pandemic, further research is needed to confirm these findings, especially among different populations, and using validated surveys. In particular, research on changes in technology use among previously hospitalized community-dwelling older adults, especially those with physical disability, is needed because older adults with multimorbidity and hospital associated deconditioning were a population greatly impacted by COVID-19 and related distancing measures. Obtaining knowledge regarding previously hospitalized older adults’ technology use, before and during the pandemic, could inform the appropriateness of technology-based interventions for vulnerable older adults. Objective: In this paper, we 1) described changes in older adult technology-based communication, technology-based phone use, and technology-based gaming during the COVID-19 pandemic, compared to before the COVID-19 pandemic and 2) tested whether technology use moderated the association between changes in in-person visits and well-being, controlling for covariates. Methods: Between December 2020 and January 2021 we conducted a telephone-based objective survey with 60 previously hospitalized older New Yorkers with physical disability. We measured technology-based communication through three questions pulled from the National Health and Aging Trends Study COVID-19 Questionnaire. We measured technology-based smart phone use and technology-based video gaming through the Media Technology Usage and Attitudes Scale. We used paired t tests and interaction models to analyze survey data. Results: This sample of previously hospitalized older adults with physical disability consisted of 60 participants, 63.3% of whom identified as female, 50.0% of whom identified as White, and 63.8% of whom reported an annual income of $25,000 or less. This sample had not had physical contact (such as friendly hug or kiss) for a median of 60 days and had not left their home for a median of 2 days. The majority of older adults from this study reported using the internet, owning smart phones, and nearly half learned a new technology during the pandemic. During the pandemic, this sample of older adults significantly increased their technology-based communication (mean difference=.74, P=.003), smart phone use (mean difference=2.9, P=.016), and technology-based gaming (mean difference=.52, P=.030). However, this technology use during the pandemic did not moderate the association between changes in in-person visits and well-being, controlling for covariates. Conclusions: These study findings suggest that previously hospitalized older adults with physical disability are open to using or learning technology, but that technology use might not be able to replace in-person social interactions. Future research might explore the specific components of in-person visits that are missing in virtual interactions, and if they could be replicated in the virtual environment, or through other means. %M 36881528 %R 10.2196/41692 %U https://aging.jmir.org/2023/1/e41692 %U https://doi.org/10.2196/41692 %U http://www.ncbi.nlm.nih.gov/pubmed/36881528 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e44242 %T Perceptions and Use of Telehealth Among Diverse Communities: Multisite Community-Engaged Mixed Methods Study %A Barwise,Amelia %A Huschka,Todd %A Woo,Cecelia %A Egginton,Jason %A Huang,Lily %A Allen,Jay-Sheree %A Johnson,Matthew %A Hamm,Kathryn %A Wolfersteig,Wendy %A Phelan,Sean %A Allyse,Megan %+ Division of Pulmonary and Critical Care Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, United States, 1 507 250 1789, barwise.amelia@mayo.edu %K telehealth %K telemedicine %K digital health %K community-based research %K mixed methods research %K COVID-19 %K health care system %K community health %K health delivery %K patient experience %K quality of care %D 2023 %7 28.3.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Telehealth has been increasingly adopted by health care systems since the start of the COVID-19 pandemic. Although telehealth may provide convenience for patients and clinicians, there are several barriers to accessing it and using it effectively to provide high-quality patient care. Objective: This study was part of a larger multisite community-engaged study conducted to understand the impact of COVID-19 on diverse communities. The work described here explored the perceptions of and experience with telehealth use among diverse and underserved community members during COVID-19. Methods: We used mixed methods across three regions in the United States (Midwest, Arizona, and Florida) from January to November 2021. We promoted our study through social media and community partnerships, disseminating flyers in English and Spanish. We developed a moderator guide and conducted focus groups in English and Spanish, mostly using a videoconferencing platform. Participants were placed in focus groups with others who shared similar demographic attributes and geographic location. Focus groups were audio-recorded and transcribed. We analyzed our qualitative data using the framework analytic approach. We developed our broader survey using validated scales and with input from community and scientific leaders, which was then distributed through social media in both English and Spanish. We included a previously published questionnaire that had been used to assess perceptions about telehealth among patients with HIV. We analyzed our quantitative data using SAS software and standard statistical approaches. We examined the effect of region, age, ethnicity/race, and education on the use and perceptions of telehealth. Results: We included data from 47 focus groups. Owing to our mode of dissemination, we were not able to calculate a response rate for the survey. However, we received 3447 English-language and 146 Spanish-language responses. Over 90% of participants had internet access and 94% had used telehealth. Approximately half of all participants agreed or strongly agreed that telehealth would be beneficial in the future because it better fit their schedules and they would not need to travel. However, approximately half of the participants also agreed or strongly agreed they would not be able to express themselves well and could not be examined when using telehealth. Indigenous participants were especially concerned about these issues when compared to other racial groups. Conclusions: This work describes findings from a mixed methods community-engaged research study about telehealth, including perceived benefits and concerns. Although participants enjoyed the benefits of telehealth (eg, not having to travel and easier scheduling), they also had concerns (eg, not being able to express themselves well and not having a physical exam) about telehealth. These sentiments were especially notable among the Indigenous population. Our work highlights the importance of fully understanding the impact of these novel health delivery modalities on the patient experience and actual or perceived quality of care received. %M 36867682 %R 10.2196/44242 %U https://www.jmir.org/2023/1/e44242 %U https://doi.org/10.2196/44242 %U http://www.ncbi.nlm.nih.gov/pubmed/36867682 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e40587 %T COVID-19 Vaccination Preferences Among Non-Chinese Migrants in Hong Kong: Discrete Choice Experiment %A Asim,Saba %A Wang,Kailu %A Nichini,Elena %A Yip,Faustina Fu %A Zhu,Liling %A Fung,Hin Chung Eddy %A Zeng,Yan %A Fang,Zhilan %A Cheung,Annie Wai-Ling %A Wong,Eliza Lai-yi %A Dong,Dong %A Yeoh,Eng-Kiong %+ Centre for Health Systems and Policy Research, The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, 4/F School of Public Health Building, Prince of Wales Hospital, Shatin, Hong Kong, 852 22528461, dongdong@cuhk.edu.hk %K COVID-19 vaccination %K migrants %K discrete choice experiment %K ethnic minorities %K vaccine attributes %K Hong Kong %K COVID-19 %D 2023 %7 27.3.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Studies have shown increasing COVID-19 vaccination hesitancy among migrant populations in certain settings compared to the general population. Hong Kong has a growing migrant population with diverse ethnic backgrounds. Apart from individual-level factors, little is known about the migrants’ preference related to COVID-19 vaccines. Objective: This study aims to investigate which COVID-19 vaccine–related attributes combined with individual factors may lead to vaccine acceptance or refusal among the migrant population in Hong Kong. Methods: An online discrete choice experiment (DCE) was conducted among adults, including Chinese people, non-Chinese Asian migrants (South, Southeast and Northeast Asians), and non-Asian migrants (Europeans, Americans, and Africans) in Hong Kong from February 26 to April 26, 2021. The participants were recruited using quota sampling and sent a link to a web survey. The vaccination attributes included in 8 choice sets in each of the 4 blocks were vaccine brand, safety and efficacy, vaccine uptake by people around, professionals’ recommendation, vaccination venue, and quarantine exemption for vaccinated travelers. A nested logistic model (NLM) and a latent-class logit (LCL) model were used for statistical analysis. Results: A total of 208 (response rate 62.1%) migrant participants were included. Among the migrants, those with longer local residential years (n=31, 27.7%, for ≥10 years, n=7, 20.6%, for 7-9 years, n=2, 6.7%, for 4-6 years, and n=3, 9.7%, for ≤3 years; P=.03), lower education level (n=28, 28.3%, vs n=15, 13.9%, P=.01), and lower income (n=33, 25.2%, vs n=10, 13.2%, P=.04) were more likely to refuse COVID-19 vaccination irrespective of vaccination attributes. The BioNTech vaccine compared with Sinovac (adjusted odds ratio [AOR]=1.75, 95% CI 1.14-2.68), vaccine with 90% (AOR=1.44, 95% CI 1.09-1.91) and 70% efficacy (AOR=1.21, 95% CI 1.03-1.44) compared with 50% efficacy, vaccine with fewer serious adverse events (1/100,000 compared with 1/10,000; AOR=1.12, 95% CI 1.00-1.24), and quarantine exemption for cross-border travelers (AOR=1.14, 95% CI 1.01-1.30) were the vaccine attributes that could increase the likelihood of vaccination among migrants. For individual-level factors, full-time homemakers (AOR=0.44, 95% CI 0.29-0.66), those with chronic conditions (AOR=0.61, 95% CI 0.41-0.91) and more children, and those who frequently received vaccine-related information from the workplace (AOR=0.42, 95% CI 0.31-0.57) were found to be reluctant to accept the vaccine. Those with a higher income (AOR=1.79, 95% CI 1.26-2.52), those knowing anyone infected with COVID-19 (AOR=1.73, 95% CI 1.25-2.38), those having greater perceived susceptibility of COVID-19 infection (AOR=3.42, 95% CI 2.52-4.64), those who received the influenza vaccine (AOR=2.15, 95% CI 1.45-3.19), and those who frequently received information from social media (AOR=1.52, 95% CI 1.12-2.05) were more likely to accept the vaccine. Conclusions: This study implies that migrants have COVID-19 vaccination preference heterogeneity and that more targeted and tailored approaches are needed to promote vaccine acceptance for different subgroups of the migrant population in Hong Kong. Vaccination promotion strategies are needed for low-education and low-income migrant groups, migrants with chronic diseases, the working migrant population, homemakers, and parents. %M 36848242 %R 10.2196/40587 %U https://publichealth.jmir.org/2023/1/e40587 %U https://doi.org/10.2196/40587 %U http://www.ncbi.nlm.nih.gov/pubmed/36848242 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e38633 %T Adaptation and Utilization of a Postmarket Evaluation Model for Digital Contact Tracing Mobile Health Tools in the United States: Observational Cross-sectional Study %A Cevasco,Kevin E %A Roess,Amira A %+ College of Health and Human Services, George Mason University, 4400 University Dr, Fairfax, VA, 22030, United States, 1 703 993 1923, aroess@gmu.edu %K COVID-19 %K contact tracing %K postmarketing %K mobile apps %K public health %K digital %K interventions %K tool %K adoption %K effectiveness %K prevention %K application %K transmission %D 2023 %7 22.3.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Case investigation and contact tracing are core public health activities used to interrupt disease transmission. These activities are traditionally conducted manually. During periods of high COVID-19 incidence, US health departments were unable to scale up case management staff to deliver effective and timely contact-tracing services. In response, digital contact tracing (DCT) apps for mobile phones were introduced to automate these activities. DCT apps detect when other DCT users are close enough to transmit COVID-19 and enable alerts to notify users of potential disease exposure. These apps were deployed quickly during the pandemic without an opportunity to conduct experiments to determine effectiveness. However, it is unclear whether these apps can effectively supplement understaffed manual contact tracers. Objective: The aims of this study were to (1) evaluate the effectiveness of COVID-19 DCT apps deployed in the United States during the COVID-19 pandemic and (2) determine if there is sufficient DCT adoption and interest in adoption to meet a minimum population use rate to be effective (56%). To assess uptake, interest and safe use covariates were derived from evaluating DCTs using the American Psychological Association App Evaluation Model (AEM) framework. Methods: We analyzed data from a nationally representative survey of US adults about their COVID-19–related behaviors and experiences. Survey respondents were divided into three segments: those who adopted a DCT app, those who are interested but did not adopt, and those not interested. Descriptive statistics were used to characterize factors of the three groups. Multivariable logistic regression models were used to analyze the characteristics of segments adopting and interested in DCT apps against AEM framework covariates. Results: An insufficient percentage of the population adopted or was interested in DCTs to achieve our minimum national target effectiveness rate (56%). A total of 17.4% (n=490) of the study population reported adopting a DCT app, 24.7% (n=697) reported interest, and 58.0% (n=1637) were not interested. Younger, high-income, and uninsured individuals were more likely to adopt a DCT app. In contrast, people in fair to poor health were interested in DCT apps but did not adopt them. App adoption was positively associated with visiting friends and family outside the home (odds ratio [OR] 1.63, 95% CI 1.28-2.09), not wearing masks (OR 0.52, 95% CI 0.38-0.71), and adopters thinking they have or had COVID-19 (OR 1.60, 95% CI 1.21-2.12). Conclusions: Overall, a small percentage of the population adopted DCT apps. These apps may not be effective in protecting adopters’ friends and family from their maskless contacts outside the home given low adoption rates. The public health community should account for safe use behavioral factors in future public health contact-tracing app design. The AEM framework was useful in developing a study design to evaluate DCT effectiveness and safety. %M 36947135 %R 10.2196/38633 %U https://publichealth.jmir.org/2023/1/e38633 %U https://doi.org/10.2196/38633 %U http://www.ncbi.nlm.nih.gov/pubmed/36947135 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e43759 %T Effects of COVID-19 Acute Respiratory Distress Syndrome Intensive Care Unit Survivor Telemedicine Clinic on Patient Readmission, Pain Perception, and Self-Assessed Health Scores: Randomized, Prospective, Single-Center, Exploratory Study %A Balakrishnan,Bathmapriya %A Hamrick,Lucas %A Alam,Ariful %A Thompson,Jesse %+ Section of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, West Virginia University, 64 Medical Center Drive, PO Box 9166, Morgantown, WV, 26505, United States, 1 937 304 8855, p.bala1286@gmail.com %K acute respiratory distress syndrome %K aftercare %K COVID-19 pneumonia %K critical care %K survivor %K telemedicine %D 2023 %7 22.3.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Post-intensive care syndrome (PICS) affects up to 50% of intensive care unit (ICU) survivors, leading to long-term neurocognitive, psychosocial, and physical impairments. Approximately 80% of COVID-19 pneumonia ICU patients are at elevated risk for developing acute respiratory distress syndrome (ARDS). Survivors of COVID-19 ARDS are at high risk of unanticipated health care utilization postdischarge. This patient group commonly has increased readmission rates, long-term decreased mobility, and poorer outcomes. Most multidisciplinary post-ICU clinics for ICU survivors are in large urban academic medical centers providing in-person consultation. Data are lacking on the feasibility of providing telemedicine post-ICU care for COVID-19 ARDS survivors. Objective: We explored the feasibility of instituting a COVID-19 ARDS ICU survivor telemedicine clinic and examined its effect on health care utilization post-hospital discharge. Methods: This randomized, unblinded, single-center, parallel-group, exploratory study was conducted at a rural, academic medical center. Study group (SG) participants underwent a telemedicine visit within 14 days of discharge, during which a 6-minute walk test (6MWT), EuroQoL 5-Dimension (EQ-5D) questionnaire, and vital signs logs were reviewed by an intensivist. Additional appointments were arranged as needed based on the outcome of this review and tests. The control group (CG) underwent a telemedicine visit within 6 weeks of discharge and completed the EQ-5D questionnaire; additional care was provided as needed based on findings in this telemedicine visit. Results: Both SG (n=20) and CG (n=20) participants had similar baseline characteristics and dropout rate (10%). Among SG participants, 72% (13/18) agreed to pulmonary clinic follow-up, compared with 50% (9/18) of CG participants (P=.31). Unanticipated visits to the emergency department occurred for 11% (2/18) of the SG compared with 6% (1/18) of the CG (>.99). The rate of pain or discomfort was 67% (12/18) in the SG compared with 61% (11/18) in the CG (P=.72). The anxiety or depression rate was 72% (13/18) in the SG versus 61% (11/18; P=.59) in the CG. Participants’ mean self-assessed health rating scores were 73.9 (SD 16.1) in the SG compared with 70.6 (SD 20.9) in the CG (P=.59). Both primary care physicians (PCPs) and participants in the SG perceived the telemedicine clinic as a favorable model for postdischarge critical illness follow-up in an open-ended questionnaire regarding care. Conclusions: This exploratory study found no statistically significant results in reducing health care utilization postdischarge and health-related quality of life. However, PCPs and patients perceived telemedicine as a feasible and favorable model for postdischarge care among COVID-19 ICU survivors to facilitate expedited subspecialty assessment, decrease unanticipated postdischarge health care utilization, and reduce PICS. Further investigation is warranted to determine the feasibility of incorporating telemedicine-based post-hospitalization follow-up for all medical ICU survivors that may show improvement in health care utilization in a larger population. %M 36877802 %R 10.2196/43759 %U https://formative.jmir.org/2023/1/e43759 %U https://doi.org/10.2196/43759 %U http://www.ncbi.nlm.nih.gov/pubmed/36877802 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e43652 %T Decisions and Decisional Needs of Canadians From all Provinces and Territories During the COVID-19 Pandemic: Population-Based Cross-sectional Surveys %A Stacey,Dawn %A Ludwig,Claire %A Archambault,Patrick %A Smith,Maureen %A Taljaard,Monica %A Carley,Meg %A Plourde,Karine %A Boland,Laura %A Gogovor,Amédé %A Graham,Ian %A Kobewka,Daniel %A McLean,Robert K D %A Nelson,Michelle L A %A Vanderspank-Wright,Brandi %A Légaré,France %+ School of Nursing, Faculty of Health Sciences, University of Ottawa, 451 Smyth Road, Ottawa, ON, K1H 8M5, Canada, 1 613 562 5800 ext 8413, dstacey@uottawa.ca %K health care decisions %K decisional conflict %K decision regret %K shared decision-making %K COVID-19 %K older adults %K caregivers %K parents %K public health decision %K health care %K health outcome %K pandemic preparedness %K public health policy %D 2023 %7 21.3.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Never before COVID-19 had Canadians faced making health-related decisions in a context of significant uncertainty. However, little is known about which type of decisions and the types of difficulties that they faced. Objective: We sought to identify the health-related decisions and decisional needs of Canadians. Methods: Our study was codesigned by researchers and knowledge users (eg, patients, clinicians). Informed by the CHERRIES (the Checklist for Reporting Results of Internet E-Surveys) reporting guideline, we conducted 2 online surveys of random samples drawn from the Leger consumer panel of 400,000 Canadians. Eligible participants were adults (≥18 years) who received or were receiving any health services in the past 12 months for themselves (adults) or for their child (parent) or senior with cognitive impairment (caregiver). We assessed decisions and decisional needs using questions informed by the Ottawa Decision Support Framework, including decisional conflict and decision regret using the Decision Conflict Scale (DCS) and the Decision Regret Scale (DRS), respectively. Descriptive statistics were conducted for adults who had decided for themselves or on behalf of someone else. Significant decisional conflict (SDC) was defined as a total DCS score of >37.5 out of 100, and significant decision regret was defined as a total DRS score of >25 out of 100. Results: From May 18 to June 4, 2021, 14,459 adults and 6542 parents/caregivers were invited to participate. The invitation view rate was 15.5% (2236/14,459) and 28.3% (1850/6542); participation rate, 69.3% (1549/2236) and 28.7% (531/1850); and completion rate, 97.3% (1507/1549) and 95.1% (505/531), respectively. The survey was completed by 1454 (97.3%) adults and 438 (95.1%) parents/caregivers in English (1598/1892, 84.5%) or French (294/1892, 15.5%). Respondents from all 10 Canadian provinces and the northern territories represented a range of ages, education levels, civil statuses, ethnicities, and annual household income. Of 1892 respondents, 541 (28.6%) self-identified as members of marginalized groups. The most frequent decisions were (adults vs parents/caregivers) as follows: COVID-19 vaccination (490/1454, 33.7%, vs 87/438, 19.9%), managing a health condition (253/1454, 17.4%, vs 47/438, 10.7%), other COVID-19 decisions (158/1454, 10.9%, vs 85/438, 19.4%), mental health care (128/1454, 8.8%, vs 27/438, 6.2%), and medication treatments (115/1454, 7.9%, vs 23/438, 5.3%). Caregivers also reported decisions about moving family members to/from nursing or retirement homes (48/438, 11.0%). Adults (323/1454, 22.2%) and parents/caregivers (95/438, 21.7%) had SDC. Factors making decisions difficult were worrying about choosing the wrong option (557/1454, 38.3%, vs 184/438, 42.0%), worrying about getting COVID-19 (506/1454, 34.8%, vs 173/438, 39.5%), public health restrictions (427/1454, 29.4%, vs 158/438, 36.1%), information overload (300/1454, 20.6%, vs 77/438, 17.6%), difficulty separating misinformation from scientific evidence (297/1454, 20.4%, vs 77/438, 17.6%), and difficulty discussing decisions with clinicians (224/1454, 15.4%, vs 51/438, 11.6%). For 1318 (90.6%) adults and 366 (83.6%) parents/caregivers who had decided, 353 (26.8%) and 125 (34.2%) had significant decision regret, respectively. In addition, 1028 (50%) respondents made their decision alone without considering the opinions of clinicians. Conclusions: During COVID-19, Canadians who responded to the survey faced several new health-related decisions. Many reported unmet decision-making needs, resulting in SDC and decision regret. Interventions can be designed to address their decisional needs and support patients facing new health-related decisions. %M 36688986 %R 10.2196/43652 %U https://publichealth.jmir.org/2023/1/e43652 %U https://doi.org/10.2196/43652 %U http://www.ncbi.nlm.nih.gov/pubmed/36688986 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e45812 %T General Practitioners’ Experiences With Potentials and Pitfalls of Video Consultations in Norway During the COVID-19 Lockdown: Qualitative Analysis of Free-Text Survey Answers %A Norberg,Børge Lønnebakke %A Getz,Linn Okkenhaug %A Johnsen,Tor Magne %A Austad,Bjarne %A Zanaboni,Paolo %+ General Practice Research Unit, Department of Public Health and Nursing, Norwegian University of Science and Technology, PO Box 8905, Trondheim, 7491, Norway, 47 73595000, borge.lonnebakke.norberg@ehealthresearch.no %K general practice %K video consultations %K remote consultations %K e-consultations %K communication %K patient safety %K COVID-19 %K pandemic %K lockdown %K telehealth %K telemedicine %K healthcare %K health care %K user experience %D 2023 %7 20.3.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: The use of video consultations (VCs) in Norwegian general practice rapidly increased during the COVID-19 pandemic. During societal lockdowns, VCs were used for nearly all types of clinical problems, as in-person consultations were kept to a minimum. Objective: This study aimed to explore general practitioners’ (GPs’) experiences of potentials and pitfalls associated with the use of VCs during the first pandemic lockdown. Methods: Between April 14 and May 3, 2020, all regular Norwegian GPs (N=4858) were invited to answer a web-based survey, which included open-ended questions about their experiences with the advantages and pitfalls of VCs. A total of 2558 free-text answers were provided by 657 of the 1237 GPs who participated in the survey. The material was subjected to reflexive thematic analysis. Results: Four main themes were identified. First, VCs are described as being particularly convenient, informative, and effective for consultations with previously known patients. Second, strategically planned VCs may facilitate effective tailoring of clinical trajectories that optimize clinical workflow. VCs allow for an initial overview of the problem (triage), follow-up evaluation after an in-person consultation, provision of advice and information concerning test results and discharge notes, extension of sick leaves, and delivery of other medical certificates. VCs may, in certain situations, enhance the GPs’ insight in their patients’ relational and socioeconomical resources and vulnerabilities, and even facilitate relationship-building with patients in need of care who might otherwise be reluctant to seek help. Third, VCs are characterized by a demarcated communication style and the “one problem approach,” which may entail effectiveness in the short run. However, the web-based communication climate implies degradation of valuable nonverbal signals that are more evidently present in in-person consultations. Finally, overreliance on VCs may, in a longer perspective, undermine the establishment and maintenance of relational trust, with a negative impact on the quality of care and patient safety. Compensatory mechanisms include clarifying with the patient what the next step is, answering any questions and giving further advice on treatment if conditions do not improve or there is a need for follow-up. Participation of family members can also be helpful to improve reciprocal understanding and safety. Conclusions: The findings have relevance for future implementation of VCs and deserve further exploration under less stressful circumstances. %M 36939814 %R 10.2196/45812 %U https://www.jmir.org/2023/1/e45812 %U https://doi.org/10.2196/45812 %U http://www.ncbi.nlm.nih.gov/pubmed/36939814 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 10 %N %P e43819 %T Web-Based COVID-19 Dashboards and Trackers in the United States: Survey Study %A Clarkson,Melissa D %+ Division of Biomedical Informatics, University of Kentucky, 725 Rose Street, Lexington, KY, 40536, United States, 1 859 323 7232, mclarkson@uky.edu %K COVID-19 %K data visualization %K data dashboard %K public health reporting %K human information interaction %K transparency %K trust %D 2023 %7 20.3.2023 %9 Original Paper %J JMIR Hum Factors %G English %X Background: The SARS-CoV-2 pandemic provided an opportunity to use public-facing web data visualization tools to help citizens understand the evolving status of the outbreak. Given the heterogeneity of data sources, developers, tools, and designs used in this effort, it raised questions about how visualizations were constructed during a time when daily batches of data were available, but issues of data quality and standardization were unresolved. Objective: This paper surveyed web-based COVID-19 dashboards and trackers that are likely to be used by the residents of the United States to monitor the spread of infection on a local, national, and global scale. This study is intended to provide insights that will help application developers increase the usefulness, transparency, and trustworthiness of dashboards and trackers for public health data in the future. Methods: Websites of coronavirus dashboards and trackers were identified in August 2020 using the Google search engine. They were examined to determine the data sources used, types of data presented, types of data visualizations, characteristics of the visualizations, and issues with messy data. The websites were surveyed 3 more times for changes in design and data sources with the final survey conducted in June 2022. Themes were developed to highlight the issues concerning challenges in presenting COVID-19 data and techniques of effective visualization. Results: In total, 111 websites were identified and examined (84 state focused, 11 nationwide, and 16 with global data), and this study found an additional 17 websites providing access to the state vaccination data. This study documents how data aggregators have played a central role in making data accessible to visualization developers. The designs of dashboards and tracker visualizations vary in type and quality, with some well-designed displays supporting the interpretation of the data and others obscuring the meaning of the data and potentially misleading the viewers. Five themes were identified to describe challenges in presenting COVID-19 data and techniques of effective visualization. Conclusions: This analysis reveals the extent to which dashboards and trackers informing the American public about the COVID-19 pandemic relied on an ad hoc pipeline of data sources and data aggregators. The dashboards and trackers identified in this survey offer an opportunity to compare different approaches for the display of similar data. %M 36696270 %R 10.2196/43819 %U https://humanfactors.jmir.org/2023/1/e43819 %U https://doi.org/10.2196/43819 %U http://www.ncbi.nlm.nih.gov/pubmed/36696270 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 10 %N %P e43436 %T Using Wearable Technology to Quantify Physical Activity Recovery: Secondary Report From the AFTER (App-Facilitated Tele-Rehabilitation) Program for COVID-19 Survivors Randomized Study %A Churchill,Laura %A Morrow,Mary %A Capin,Jacob J %A Jolley,Sarah E %A Hare,Kristine %A MaWhinney,Samantha %A Stevens-Lapsley,Jennifer E %A Erlandson,Kristine M %+ Department of Medicine, University of Colorado Anschutz Medical Campus, 12700 E 19th Ave, Mail Stop B168, Aurora, CO, 80045, United States, 1 303 724 4941, Kristine.erlandson@cuanschutz.edu %K Fitbit %K steps %K COVID-19 %K hospitalization %K rehabilitation %K digital health intervention %K physical activity %K step count %K mHealth application %K tele-rehabilitation %D 2023 %7 20.3.2023 %9 Original Paper %J JMIR Rehabil Assist Technol %G English %X Background: Knowledge on physical activity recovery after COVID-19 survival is limited. The AFTER (App-Facilitated Tele-Rehabilitation) program for COVID-19 survivors randomized participants, following hospital discharge, to either education and unstructured physical activity or a telerehabilitation program. Step count data were collected as a secondary outcome, and we found no significant differences in total step count trajectories between groups at 6 weeks. Further step count data were not analyzed. Objective: The purpose of this analysis was to examine step count trajectories and correlates among all participants (combined into a single group) across the 12-week study period. Methods: Linear mixed models with random effects were used to model daily steps over the number of study days. Models with 0, 1, and 2 inflection points were considered, and the final model was selected based on the highest log-likelihood value. Results: Participants included 44 adults (41 with available Fitbit [Fitbit LLC] data). Initially, step counts increased by an average of 930 (95% CI 547-1312; P<.001) steps per week, culminating in an average daily step count of 7658 (95% CI 6257-9059; P<.001) at the end of week 3. During the remaining 9 weeks of the study, weekly step counts increased by an average of 67 (95% CI −30 to 163; P<.001) steps per week, resulting in a final estimate of 8258 (95% CI 6933-9584; P<.001) steps. Conclusions: Participants showed a marked improvement in daily step counts during the first 3 weeks of the study, followed by more gradual improvement in the remaining 9 weeks. Physical activity data and step count recovery trajectories may be considered surrogates for physiological recovery, although further research is needed to examine this relationship. Trial Registration: ClinicalTrials.gov NCT04663945; https://tinyurl.com/2p969ced %M 36939818 %R 10.2196/43436 %U https://rehab.jmir.org/2023/1/e43436 %U https://doi.org/10.2196/43436 %U http://www.ncbi.nlm.nih.gov/pubmed/36939818 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e43183 %T Rapid SARS-CoV-2 Antigen Detection Self-Tests to Increase COVID-19 Case Detection in Peru: Qualitative Study %A Torres-Slimming,Paola A %A Carcamo,Cesar %A Martínez-Pérez,Guillermo Z %A Mallma,Patricia %A Pflucker,Cristina %A Shilton,Sonjelle %+ Universidad Peruana Cayetano Heredia, Av Honorio Delgado 430, San Martín de Porres, Lima, 15102, Peru, 51 3190000, paola.torres.s@upch.pe %K Peru, COVID-19 %K self-testing %K diagnostics %K qualitative research %K testing %K virus %K detection %K health %K decision-making %K public %K willingness %K health system %D 2023 %7 17.3.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic heavily impacted many low- and middle-income countries (LMICs), such as Peru, overwhelming their health systems. Rapid antigen detection self-tests for SARS-CoV-2, the virus that causes COVID-19, have been proposed as a portable, safe, affordable, and easy-to-perform approach to improve early detection and surveillance of SARS-CoV-2 in resource-constrained populations where there are gaps in access to health care. Objective: This study aims to explore decision makers’ values and attitudes around SARS-CoV-2 self-testing. Methods: In 2021, we conducted a qualitative study in 2 areas of Peru (urban Lima and rural Valle del Mantaro). Purposive sampling was used to identify representatives of civil society groups (RSCs), health care workers (HCWs), and potential implementers (PIs) to act as informants whose voices would provide a proxy for the public’s attitudes around self-testing. Results: In total, 30 informants participated in individual, semistructured interviews (SSIs) and 29 informants participated in 5 focus group discussions (FGDs). Self-tests were considered to represent an approach to increase access to testing that both the rural and urban public in Peru would accept. Results showed that the public would prefer saliva-based self-tests and would prefer to access them in their community pharmacies. In addition, information about how to perform a self-test should be clear for each population subgroup in Peru. The tests should be of high quality and low cost. Health-informed communication strategies must also accompany any introduction of self-testing. Conclusions: In Peru, decision makers consider that the public would be willing to accept SARS-CoV-2 self-tests if they are accurate, safe to use, easily available, and affordable. Adequate information about the self-tests’ features and instructions, as well as about postuse access to counseling and care, must be made available through the Ministry of Health in Peru. %M 36867689 %R 10.2196/43183 %U https://formative.jmir.org/2023/1/e43183 %U https://doi.org/10.2196/43183 %U http://www.ncbi.nlm.nih.gov/pubmed/36867689 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e44209 %T Usability of Telehealth Systems for Noncommunicable Diseases in Primary Care From the COVID-19 Pandemic Onward: Systematic Review %A Gonçalves,Roberta Lins %A Pagano,Adriana Silvina %A Reis,Zilma Silveira Nogueira %A Brackstone,Ken %A Lopes,Tainá Costa Pereira %A Cordeiro,Sarah Almeida %A Nunes,Julia Macedo %A Afagbedzi,Seth Kwaku %A Head,Michael %A Meira Jr,Wagner %A Batchelor,James %A Ribeiro,Antônio Luiz Pinho %+ Hospital das Clínicas da Universidade Federal de Minas Gerais, Universidade Federal de Minas Gerais, 110 Av Prof Alfredo Balena, Belo Horizonte, 30130-100, Brazil, 55 92995229966, betalinsfisio@yahoo.com.br %K health care professional %K telehealth %K noncommunicable disease %K usability %K COVID-19 pandemic %K COVID-19 %D 2023 %7 16.3.2023 %9 Review %J J Med Internet Res %G English %X Background: During the COVID-19 pandemic, telehealth was expanded without the opportunity to extensively evaluate the adopted technology’s usability. Objective: We aimed to synthesize evidence on health professionals’ perceptions regarding the usability of telehealth systems in the primary care of individuals with noncommunicable diseases (NCDs; hypertension and diabetes) from the COVID-19 pandemic onward. Methods: A systematic review was performed of clinical trials, prospective cohort studies, retrospective observational studies, and studies that used qualitative data collection and analysis methods published in English, Spanish, and Portuguese from March 2020 onward. The databases queried were MEDLINE, Embase, BIREME, IEEE Xplore, BVS, Google Scholar, and grey literature. Studies involving health professionals who used telehealth systems in primary care and managed patients with NCDs from the COVID-19 pandemic onward were considered eligible. Titles, abstracts, and full texts were reviewed. Data were extracted to provide a narrative qualitative evidence synthesis of the included articles. The risk of bias and methodological quality of the included studies were analyzed. The primary outcome was the usability of telehealth systems, while the secondary outcomes were satisfaction and the contexts in which the telehealth system was used. Results: We included 11 of 417 retrieved studies, which had data from 248 health care professionals. These health care professionals were mostly doctors and nurses with prior experience in telehealth in high- and middle-income countries. Overall, 9 studies (82%) were qualitative studies and 2 (18%) were quasiexperimental or multisite trial studies. Moreover, 7 studies (64%) addressed diabetes, 1 (9%) addressed diabetes and hypertension, and 3 (27%) addressed chronic diseases. Most studies used a survey to assess usability. With a moderate confidence level, we concluded that health professionals considered the usability of telehealth systems to be good and felt comfortable and satisfied. Patients felt satisfied using telehealth. The most important predictor for using digital health technologies was ease of use. The main barriers were technological challenges, connectivity issues, low computer literacy, inability to perform complete physical examination, and lack of training. Although the usability of telehealth systems was considered good, there is a need for research that investigates factors that may influence the perceptions of telehealth usability, such as differences between private and public services; differences in the level of experience of professionals, including professional experience and experience with digital tools; and differences in gender, age groups, occupations, and settings. Conclusions: The COVID-19 pandemic has generated incredible demand for virtual care. Professionals’ favorable perceptions of the usability of telehealth indicate that it can facilitate access to quality care. Although there are still challenges to telehealth, more than infrastructure challenges, the most reported challenges were related to empowering people for digital health. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42021296887; https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=296887 International Registered Report Identifier (IRRID): RR2-10.21801/ppcrj.2022.82.6 %M 36787223 %R 10.2196/44209 %U https://www.jmir.org/2023/1/e44209 %U https://doi.org/10.2196/44209 %U http://www.ncbi.nlm.nih.gov/pubmed/36787223 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e44965 %T Emotional Distress During COVID-19 by Mental Health Conditions and Economic Vulnerability: Retrospective Analysis of Survey-Linked Twitter Data With a Semisupervised Machine Learning Algorithm %A Ueda,Michiko %A Watanabe,Kohei %A Sueki,Hajime %+ Department of Public Administration and International Affairs, The Maxwell School of Citizenship and Public Affairs, Syracuse University, 426 Eggers Hall, Syracuse, NY, 13244, United States, 1 3154439046, miueda@syr.edu %K mental health %K COVID-19 %K Twitter %K social media %K depression %K suicidal ideation %K loneliness %K public health crisis %K psychological well-being %K infodemiology %K machine learning framework %K digital surveillance %K emotional distress %K online survey %D 2023 %7 16.3.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Monitoring the psychological conditions of social media users during rapidly developing public health crises, such as the COVID-19 pandemic, using their posts on social media has rapidly gained popularity as a relatively easy and cost-effective method. However, the characteristics of individuals who created these posts are largely unknown, making it difficult to identify groups of individuals most affected by such crises. In addition, large annotated data sets for mental health conditions are not easily available, and thus, supervised machine learning algorithms can be infeasible or too costly. Objective: This study proposes a machine learning framework for the real-time surveillance of mental health conditions that does not require extensive training data. Using survey-linked tweets, we tracked the level of emotional distress during the COVID-19 pandemic by the attributes and psychological conditions of social media users in Japan. Methods: We conducted online surveys of adults residing in Japan in May 2022 and collected their basic demographic information, socioeconomic status, and mental health conditions, along with their Twitter handles (N=2432). We computed emotional distress scores for all the tweets posted by the study participants between January 1, 2019, and May 30, 2022 (N=2,493,682) using a semisupervised algorithm called latent semantic scaling (LSS), with higher values indicating higher levels of emotional distress. After excluding users by age and other criteria, we examined 495,021 (19.85%) tweets generated by 560 (23.03%) individuals (age 18-49 years) in 2019 and 2020. We estimated fixed-effect regression models to examine their emotional distress levels in 2020 relative to the corresponding weeks in 2019 by the mental health conditions and characteristics of social media users. Results: The estimated level of emotional distress of our study participants increased in the week when school closure started (March 2020), and it peaked at the beginning of the state of emergency (estimated coefficient=0.219, 95% CI 0.162-0.276) in early April 2020. Their level of emotional distress was unrelated to the number of COVID-19 cases. We found that the government-induced restrictions disproportionately affected the psychological conditions of vulnerable individuals, including those with low income, precarious employment, depressive symptoms, and suicidal ideation. Conclusions: This study establishes a framework to implement near-real-time monitoring of the emotional distress level of social media users, highlighting a great potential to continuously monitor their well-being using survey-linked social media posts as a complement to administrative and large-scale survey data. Given its flexibility and adaptability, the proposed framework is easily extendable for other purposes, such as detecting suicidality among social media users, and can be used on streaming data for continuous measurement of the conditions and sentiment of any group of interest. %M 36809798 %R 10.2196/44965 %U https://www.jmir.org/2023/1/e44965 %U https://doi.org/10.2196/44965 %U http://www.ncbi.nlm.nih.gov/pubmed/36809798 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e37550 %T A Digital Health Initiative (COVIDsmart) for Remote Data Collection and Study of COVID-19’s Impact on the State of Virginia: Prospective Cohort Study %A Schilling,Josh %A Klein,Dave %A Bartholmae,Marilyn M %A Shokouhi,Sepideh %A Toepp,Angela J %A Roess,Amira A %A Sill,Joshua M %A Karpov,Matvey V %A Maney,Kathleen %A Brown,K Pearson %A Levy,Brian L %A Renshaw,Keith D %A Dodani,Sunita %A Jain,Praduman %+ Vibrent Health, 4114 Legato Rd, Fairfax, VA, 22033, United States, 1 571 459 2372, pj@vibrenthealth.com %K COVID-19 %K digital health technology %K human subjects %K partnership %K community health %K diversity %K mobile health %K mHealth %K medical subject headings %K MeSH %K medical informatics %K internet %K digital health %K digital solution %K digital recruitment %K precision medicine %K digital marketing %K decision-making %K COVIDsmart %D 2023 %7 15.3.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic has affected people's lives beyond severe and long-term physical health symptoms. Social distancing and quarantine have led to adverse mental health outcomes. COVID-19–induced economic setbacks have also likely exacerbated the psychological distress affecting broader aspects of physical and mental well-being. Remote digital health studies can provide information about the pandemic's socioeconomic, mental, and physical impact. COVIDsmart was a collaborative effort to deploy a complex digital health research study to understand the impact of the pandemic on diverse populations. We describe how digital tools were used to capture the effects of the pandemic on the overall well-being of diverse communities across large geographical areas within the state of Virginia. Objective: The aim is to describe the digital recruitment strategies and data collection tools applied in the COVIDsmart study and share the preliminary study results. Methods: COVIDsmart conducted digital recruitment, e-Consent, and survey collection through a Health Insurance Portability and Accountability Act–compliant digital health platform. This is an alternative to the traditional in-person recruitment and onboarding method used for studies. Participants in Virginia were actively recruited over 3 months using widespread digital marketing strategies. Six months of data were collected remotely on participant demographics, COVID-19 clinical parameters, health perceptions, mental and physical health, resilience, vaccination status, education or work functioning, social or family functioning, and economic impact. Data were collected using validated questionnaires or surveys, completed in a cyclical fashion and reviewed by an expert panel. To retain a high level of engagement throughout the study, participants were incentivized to stay enrolled and complete more surveys to further their chances of receiving a monthly gift card and one of multiple grand prizes. Results: Virtual recruitment demonstrated relatively high rates of interest in Virginia (N=3737), and 782 (21.1%) consented to participate in the study. The most successful recruitment technique was the effective use of newsletters or emails (n=326, 41.7%). The primary reason for contributing as a study participant was advancing research (n=625, 79.9%), followed by the need to give back to their community (n=507, 64.8%). Incentives were only reported as a reason among 21% (n=164) of the consented participants. Overall, the primary reason for contributing as a study participant was attributed to altruism at 88.6% (n=693). Conclusions: The COVID-19 pandemic has accelerated the need for digital transformation in research. COVIDsmart is a statewide prospective cohort to study the impact of COVID-19 on Virginians' social, physical, and mental health. The study design, project management, and collaborative efforts led to the development of effective digital recruitment, enrollment, and data collection strategies to evaluate the pandemic’s effects on a large, diverse population. These findings may inform effective recruitment techniques across diverse communities and participants' interest in remote digital health studies. %M 36795656 %R 10.2196/37550 %U https://formative.jmir.org/2023/1/e37550 %U https://doi.org/10.2196/37550 %U http://www.ncbi.nlm.nih.gov/pubmed/36795656 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e45419 %T Trend and Co-occurrence Network of COVID-19 Symptoms From Large-Scale Social Media Data: Infoveillance Study %A Wu,Jiageng %A Wang,Lumin %A Hua,Yining %A Li,Minghui %A Zhou,Li %A Bates,David W %A Yang,Jie %+ School of Public Health and the Second Affiliated Hospital, Zhejiang University School of Medicine, 866 Yuhangtang Road, Hangzhou, 310058, China, 86 057187077982, jieynlp@gmail.com %K social media %K network analysis %K public health %K data mining %K COVID-19 %D 2023 %7 14.3.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: For an emergent pandemic, such as COVID-19, the statistics of symptoms based on hospital data may be biased or delayed due to the high proportion of asymptomatic or mild-symptom infections that are not recorded in hospitals. Meanwhile, the difficulty in accessing large-scale clinical data also limits many researchers from conducting timely research. Objective: Given the wide coverage and promptness of social media, this study aimed to present an efficient workflow to track and visualize the dynamic characteristics and co-occurrence of symptoms for the COVID-19 pandemic from large-scale and long-term social media data. Methods: This retrospective study included 471,553,966 COVID-19–related tweets from February 1, 2020, to April 30, 2022. We curated a hierarchical symptom lexicon for social media containing 10 affected organs/systems, 257 symptoms, and 1808 synonyms. The dynamic characteristics of COVID-19 symptoms over time were analyzed from the perspectives of weekly new cases, overall distribution, and temporal prevalence of reported symptoms. The symptom evolutions between virus strains (Delta and Omicron) were investigated by comparing the symptom prevalence during their dominant periods. A co-occurrence symptom network was developed and visualized to investigate inner relationships among symptoms and affected body systems. Results: This study identified 201 COVID-19 symptoms and grouped them into 10 affected body systems. There was a significant correlation between the weekly quantity of self-reported symptoms and new COVID-19 infections (Pearson correlation coefficient=0.8528; P<.001). We also observed a 1-week leading trend (Pearson correlation coefficient=0.8802; P<.001) between them. The frequency of symptoms showed dynamic changes as the pandemic progressed, from typical respiratory symptoms in the early stage to more musculoskeletal and nervous symptoms in the later stages. We identified the difference in symptoms between the Delta and Omicron periods. There were fewer severe symptoms (coma and dyspnea), more flu-like symptoms (throat pain and nasal congestion), and fewer typical COVID symptoms (anosmia and taste altered) in the Omicron period than in the Delta period (all P<.001). Network analysis revealed co-occurrences among symptoms and systems corresponding to specific disease progressions, including palpitations (cardiovascular) and dyspnea (respiratory), and alopecia (musculoskeletal) and impotence (reproductive). Conclusions: This study identified more and milder COVID-19 symptoms than clinical research and characterized the dynamic symptom evolution based on 400 million tweets over 27 months. The symptom network revealed potential comorbidity risk and prognostic disease progression. These findings demonstrate that the cooperation of social media and a well-designed workflow can depict a holistic picture of pandemic symptoms to complement clinical studies. %M 36812402 %R 10.2196/45419 %U https://www.jmir.org/2023/1/e45419 %U https://doi.org/10.2196/45419 %U http://www.ncbi.nlm.nih.gov/pubmed/36812402 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 3 %N %P e43694 %T The Early Detection of Fraudulent COVID-19 Products From Twitter Chatter: Data Set and Baseline Approach Using Anomaly Detection %A Sarker,Abeed %A Lakamana,Sahithi %A Liao,Ruqi %A Abbas,Aamir %A Yang,Yuan-Chi %A Al-Garadi,Mohammed %+ Department of Biomedical Informatics, School of Medicine, Emory University, 101 Woodruff Circle, Suite 4101, Atlanta, GA, 30030, United States, 1 6024746203, abeed@dbmi.emory.edu %K coronavirus %K COVID-19 drug treatment %K social media %K infodemiology %K public health surveillance %K COVID-19 %K misinformation %K natural language processing %K neural network %K data mining %D 2023 %7 14.3.2023 %9 Original Paper %J JMIR Infodemiology %G English %X Background: Social media has served as a lucrative platform for spreading misinformation and for promoting fraudulent products for the treatment, testing, and prevention of COVID-19. This has resulted in the issuance of many warning letters by the US Food and Drug Administration (FDA). While social media continues to serve as the primary platform for the promotion of such fraudulent products, it also presents the opportunity to identify these products early by using effective social media mining methods. Objective: Our objectives were to (1) create a data set of fraudulent COVID-19 products that can be used for future research and (2) propose a method using data from Twitter for automatically detecting heavily promoted COVID-19 products early. Methods: We created a data set from FDA-issued warnings during the early months of the COVID-19 pandemic. We used natural language processing and time-series anomaly detection methods for automatically detecting fraudulent COVID-19 products early from Twitter. Our approach is based on the intuition that increases in the popularity of fraudulent products lead to corresponding anomalous increases in the volume of chatter regarding them. We compared the anomaly signal generation date for each product with the corresponding FDA letter issuance date. We also performed a brief manual analysis of chatter associated with 2 products to characterize their contents. Results: FDA warning issue dates ranged from March 6, 2020, to June 22, 2021, and 44 key phrases representing fraudulent products were included. From 577,872,350 posts made between February 19 and December 31, 2020, which are all publicly available, our unsupervised approach detected 34 out of 44 (77.3%) signals about fraudulent products earlier than the FDA letter issuance dates, and an additional 6 (13.6%) within a week following the corresponding FDA letters. Content analysis revealed misinformation, information, political, and conspiracy theories to be prominent topics. Conclusions: Our proposed method is simple, effective, easy to deploy, and does not require high-performance computing machinery unlike deep neural network–based methods. The method can be easily extended to other types of signal detection from social media data. The data set may be used for future research and the development of more advanced methods. %M 37113382 %R 10.2196/43694 %U https://infodemiology.jmir.org/2023/1/e43694 %U https://doi.org/10.2196/43694 %U http://www.ncbi.nlm.nih.gov/pubmed/37113382 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e38491 %T Contraceptive Access and Use Among Undergraduate and Graduate Students During COVID-19: Online Survey Study %A Chen,Emily %A Hollowell,Adam %A Truong,Tracy %A Bentley-Edwards,Keisha %A Myers,Evan %A Erkanli,Alaattin %A Holt,Lauren %A Swartz,Jonas J %+ Department of Obstetrics & Gynecology, Duke University Medical Center, DUMC 3084, Durham, NC, 27710, United States, 1 919 668 7594, jonas.swartz@duke.edu %K COVID-19 %K contraception %K college %K disparities %K LARC %K sexual health %K social media %K health promotion %K telehealth %K health messaging %K health resource %K health disparity %K risk factor %K healthcare access %D 2023 %7 14.3.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic led to widespread college campus closures in the months of March to June 2020, endangering students’ access to on-campus health resources, including reproductive health services. Objective: To assess contraceptive access and use among undergraduate and graduate students in North Carolina during the COVID-19 pandemic. Methods: We conducted a cross-sectional web-based survey of undergraduate and graduate students enrolled at degree-granting institutions in North Carolina. Participants were recruited using targeted Instagram advertisements. The survey queried several aspects of participants’ sexual behavior, including sex drive, level of sexual experience, number of sexual partners, digital sexual experience, dating patterns, and types of contraception used. Participants were asked to compare many of these behaviors before and after the pandemic. The survey also assessed several sociodemographic factors that we hypothesized would be associated with contraceptive use based on prior data, including educational background, sexual orientation and gender minority status (ie, lesbian, gay, bisexual, transgender, queer), health insurance status, race, ethnicity, degree of sensation seeking, religiosity, and desire to become pregnant. Results: Over 10 days, 2035 Instagram users began our survey, of whom 1002 met eligibility criteria. Of these 1002 eligible participants, 934 completed the survey, for a 93% completion rate. Our respondents were mostly female (665/934, 71%), cisgender (877/934, 94%), heterosexual (592/934, 64%), white (695/934 75%), not Hispanic (835/934, 89%), and enrolled at a 4-year college (618/934, 66%). Over 95% (895/934) of respondents reported that they maintained access to their preferred contraception during the COVID-19 pandemic. In a multivariable analysis, participants who were enrolled in a 4-year college or graduate program were less likely to lose contraceptive access when compared to participants enrolled in a 2-year college (risk ratio [RR] 0.34, 95% CI 0.16-0.71); in addition, when compared to cisgender participants, nonbinary and transgender participants were more likely to lose contraceptive access (RR 2.43, 95% CI 1.01-5.87). Respondents reported that they were more interested in using telehealth to access contraception during the pandemic. The contraceptive methods most commonly used by our participants were, in order, condoms (331/934, 35.4%), oral contraception (303/934, 32.4%), and long-acting reversible contraception (LARC; 221/934, 23.7%). The rate of LARC use among our participants was higher than the national average for this age group (14%). Emergency contraception was uncommonly used (25/934, 2.7%). Conclusions: Undergraduate and graduate students in North Carolina overwhelmingly reported that they maintained access to their preferred contraceptive methods during the COVID-19 pandemic and through changing patterns of health care access, including telehealth. Gender nonbinary and transgender students and 2-year college students may have been at greater risk of losing access to contraception during the first year of the COVID-19 pandemic. %M 36827491 %R 10.2196/38491 %U https://formative.jmir.org/2023/1/e38491 %U https://doi.org/10.2196/38491 %U http://www.ncbi.nlm.nih.gov/pubmed/36827491 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e38080 %T Protecting Older Adult Residents in Care Facilities Against Influenza and COVID-19 Using the Influenza Communication, Advice and Reporting (FluCARE) App: Prospective Cohort Mixed Methods Study %A Quinn,Emma %A Hsiao,Kai Hsun %A Johnstone,Travers %A Gomez,Maria %A Parasuraman,Arun %A Ingleton,Andrew %A Hirst,Nicholas %A Najjar,Zeina %A Gupta,Leena %+ Public Health Unit, Sydney Local Health District, Royal Prince Alfred Hospital Campus, Missenden Road, Camperdown, Sydney, 2050, Australia, 61 2 95159420, emma.quinn@health.nsw.gov.au %K web app %K digital health %K influenza %K COVID-19 %K outbreak %K monitoring %K disease control %K infection spread %K infection control %K detect %K aged care %K elderly %K elderly population %K older adult %K long term care %K care home %K AFC %K LTC %K nursing home %K retirement home %K mobile application %K health application %K mHealth %K care facility %K online training %K health impact %K feasibility %K efficacy %K satisfaction %K prevention %K disease spread %K notification %D 2023 %7 13.3.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Early detection and response to influenza and COVID-19 outbreaks in aged care facilities (ACFs) are critical to minimizing health impacts. The Sydney Local Health District (SLHD) Public Health Unit (PHU) has developed and implemented a novel web-based app with integrated functions for online line listings, detection algorithms, and automatic notifications to responders, to assist ACFs in outbreak response. The goal of the Influenza Outbreak Communication, Advice and Reporting (FluCARE) app is to reduce time delays to notifications, which we hope will reduce the spread, duration, and health impacts of an influenza or COVID-19 outbreak, as well as ease workload burdens on ACF staff. Objective: The specific aims of the study were to (1) evaluate the acceptability and user satisfaction of the implementation and use of FluCARE in helping ACFs recognize, notify, and manage influenza and COVID-19 outbreaks in their facility; (2) identify the safety of FluCARE and any potential adverse outcomes of using the app; and (3) identify any perceived barriers or facilitators to the implementation and use of FluCARE from the ACF user perspective. Methods: The FluCARE app was piloted from September 2019 to December 2020 in the SLHD. Associated implementation included promotion and engagement, user training, and operational policies. Participating ACF staff were invited to complete a posttraining survey. Staff were also invited to complete a postpilot evaluation survey that included the user Mobile Application Rating Scale (uMARS) measuring app acceptance, utility, and barriers and facilitators to use. An issues log was also prospectively maintained to assess safety. Survey data were analyzed descriptively or via content analysis where appropriate. Results: Surveys were completed by 31 consenting users from 27 ACFs. FluCARE was rated 3.91 of 5 overall on the uMARS. Of the 31 users, 25 (80%) would definitely use FluCARE for future outbreaks, and all users agreed that the app was useful for identifying influenza and COVID-19 outbreaks at their facilities. There were no reported critical issues with incorrect or missed outbreak detection. User training, particularly online training modules, and technical support were identified as key facilitators to FluCARE use. Conclusions: FluCARE is an acceptable, useful, and safe app to assist ACF staff with early detection and response to influenza and COVID-19 outbreaks. This study supports feasibility for ongoing implementation and efficacy evaluation, followed by scale-up into other health districts in New South Wales. %M 36763638 %R 10.2196/38080 %U https://formative.jmir.org/2023/1/e38080 %U https://doi.org/10.2196/38080 %U http://www.ncbi.nlm.nih.gov/pubmed/36763638 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e39054 %T Engagement With the Centers for Disease Control and Prevention Coronavirus Self-Checker and Guidance Provided to Users in the United States From March 23, 2020, to April 19, 2021: Thematic and Trend Analysis %A Shah,Ami B %A Oyegun,Eghosa %A Hampton,William Brett %A Neri,Antonio %A Maddox,Nicole %A Raso,Danielle %A Sandhu,Paramjit %A Patel,Anita %A Koonin,Lisa M %A Lee,Leslie %A Roper,Lauren %A Whitfield,Geoffrey %A Siegel,David A %A Koumans,Emily H %+ Centers for Disease Control and Prevention, COVID-19 Emergency Response, 1600 Clifton Road, Atlanta, GA, 30329, United States, 1 4046394091, hiz4@cdc.gov %K COVID-19 %K automated symptom checker %K Self-Checker %K triage %K medical care %K online information seeking %K clinical assessment tool %D 2023 %7 10.3.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: In 2020, at the onset of the COVID-19 pandemic, the United States experienced surges in healthcare needs, which challenged capacity throughout the healthcare system. Stay-at-home orders in many jurisdictions, cancellation of elective procedures, and closures of outpatient medical offices disrupted patient access to care. To inform symptomatic persons about when to seek care and potentially help alleviate the burden on the healthcare system, Centers for Disease Control and Prevention (CDC) and partners developed the CDC Coronavirus Self-Checker (“Self-Checker”). This interactive tool assists individuals seeking information about COVID-19 to determine the appropriate level of care by asking demographic, clinical, and nonclinical questions during an online “conversation.” Objective: This paper describes user characteristics, trends in use, and recommendations delivered by the Self-Checker between March 23, 2020, and April 19, 2021, for pursuing appropriate levels of medical care depending on the severity of user symptoms. Methods: User characteristics and trends in completed conversations that resulted in a care message were analyzed. Care messages delivered by the Self-Checker were manually classified into three overarching conversation themes: (1) seek care immediately; (2) take no action, or stay home and self-monitor; and (3) conversation redirected. Trends in 7-day averages of conversations and COVID-19 cases were examined with development and marketing milestones that potentially impacted Self-Checker user engagement. Results: Among 16,718,667 completed conversations, the Self-Checker delivered recommendations for 69.27% (n=11,580,738) of all conversations to “take no action, or stay home and self-monitor”; 28.8% (n=4,822,138) of conversations to “seek care immediately”; and 1.89% (n=315,791) of conversations were redirected to other resources without providing any care advice. Among 6.8 million conversations initiated for self-reported sick individuals without life-threatening symptoms, 59.21% resulted in a recommendation to “take no action, or stay home and self-monitor.” Nearly all individuals (99.8%) who were not sick were also advised to “take no action, or stay home and self-monitor.” Conclusions: The majority of Self-Checker conversations resulted in advice to take no action, or stay home and self-monitor. This guidance may have reduced patient volume on the medical system; however, future studies evaluating patients’ satisfaction, intention to follow the care advice received, course of action, and care modality pursued could clarify the impact of the Self-Checker and similar tools during future public health emergencies. %M 36745776 %R 10.2196/39054 %U https://www.jmir.org/2023/1/e39054 %U https://doi.org/10.2196/39054 %U http://www.ncbi.nlm.nih.gov/pubmed/36745776 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e43049 %T The Impact of the COVID-19 Pandemic on the Registration and Care Provision of Mental Health Problems in General Practice: Registry-Based Study %A Vandamme,Jan %A Beerten,Simon Gabriël %A Crèvecoeur,Jonas %A Van den Bulck,Steve %A Aertgeerts,Bert %A Delvaux,Nicolas %A Van Pottelbergh,Gijs %A Vermandere,Mieke %A Tops,Laura %A Neyens,Thomas %A Vaes,Bert %+ Academic Center for General Practice, Department of Public Health and Primary Care, KU Leuven, Kapucijnenvoer 7 blok h, bus 7001, Leuven, 3000, Belgium, 32 16 19 40 50, simon.beerten@kuleuven.be %K COVID-19 %K mental health %K care provision %K general practice %K socioeconomic status %D 2023 %7 10.3.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The impact of the COVID-19 pandemic on mental health in general practice remains uncertain. Several studies showed an increase in terms of mental health problems during the pandemic. In Belgium, especially during the first waves of the pandemic, access to general practice was limited. Specifically, it is unclear how this impacted not only the registration of mental health problems itself but also the care for patients with an existing mental health problem. Objective: This study aimed to know the impact of the COVID-19 pandemic on (1) the incidence of newly registered mental health problems and (2) the provision of care for patients with mental health problems in general practice, both using a pre–COVID-19 baseline. Methods: The prepandemic volume of provided care (care provision) for patients with mental health problems was compared to that from 2020-2021 by using INTEGO, a Belgian general practice morbidity registry. Care provision was defined as the total number of new registrations in a patient’s electronic medical record. Regression models evaluated the association of demographic factors and care provision in patients with mental health problems, both before and during the pandemic. Results: During the COVID-19 pandemic as compared to before the COVID-19 pandemic, the incidence of registered mental health problems showed a fluctuating course, with a sharp drop in registrations during the first wave. Registrations for depression and anxiety increased, whereas the incidence of registered eating disorders, substance abuse, and personality problems decreased. During the 5 COVID-19 waves, the overall incidence of registered mental health problems dropped during the wave and rose again when measures were relaxed. A relative rise of 8.7% and 40% in volume of provided care, specifically for patients with mental health problems, was seen during the first and second years of the COVID-19 pandemic, respectively. Care provision for patients with mental health problems was higher in older patients, male patients, patients living in center cities (centrumsteden), patients with lower socioeconomic status (SES), native Belgian patients, and patients with acute rather than chronic mental health problems. Compared to prepandemic care provision, a reduction of 10% was observed in people with a low SES. Conclusions: This study showed (1) a relative overall increase in the registrations of mental health problems in general practice and (2) an increase in care provision for patients with mental health problems in the first 2 years of the COVID-19 pandemic. Low SES remained a determining factor for more care provision, but care provision dropped significantly in people with mental health problems with a low SES. Our findings suggest that the pandemic in Belgium was also largely a “syndemic,” affecting different layers of the population disproportionately. %M 36599160 %R 10.2196/43049 %U https://publichealth.jmir.org/2023/1/e43049 %U https://doi.org/10.2196/43049 %U http://www.ncbi.nlm.nih.gov/pubmed/36599160 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 3 %N %P e40575 %T Public Figure Vaccination Rhetoric and Vaccine Hesitancy: Retrospective Twitter Analysis %A Honcharov,Vlad %A Li,Jiawei %A Sierra,Maribel %A Rivadeneira,Natalie A %A Olazo,Kristan %A Nguyen,Thu T %A Mackey,Tim K %A Sarkar,Urmimala %+ Division of General Internal Medicine at Zuckerberg San Francisco General Hospital and Trauma Center, University of California San Francisco, Department of Medicine, Box 1364, 1001 Potrero Ave, Building 10, Floor 3, San Francisco, CA, 94143, United States, 1 628 206 4273, usarkar@medsfgh.ucsf.edu %K Twitter %K anti-vaccination %K Biterm Topic modeling %K inductive content analysis %K COVID-19 %K social media %K health information %K vaccination %K vaccine hesitancy %K infodemiology %K misinformation %D 2023 %7 10.3.2023 %9 Original Paper %J JMIR Infodemiology %G English %X Background: Social media has emerged as a critical mass communication tool, with both health information and misinformation now spread widely on the web. Prior to the COVID-19 pandemic, some public figures promulgated anti-vaccine attitudes, which spread widely on social media platforms. Although anti-vaccine sentiment has pervaded social media throughout the COVID-19 pandemic, it is unclear to what extent interest in public figures is generating anti-vaccine discourse. Objective: We examined Twitter messages that included anti-vaccination hashtags and mentions of public figures to assess the connection between interest in these individuals and the possible spread of anti-vaccine messages. Methods: We used a data set of COVID-19–related Twitter posts collected from the public streaming application programming interface from March to October 2020 and filtered it for anti-vaccination hashtags “antivaxxing,” “antivaxx,” “antivaxxers,” “antivax,” “anti-vaxxer,” “discredit,” “undermine,” “confidence,” and “immune.” Next, we applied the Biterm Topic model (BTM) to output topic clusters associated with the entire corpus. Topic clusters were manually screened by examining the top 10 posts most highly correlated in each of the 20 clusters, from which we identified 5 clusters most relevant to public figures and vaccination attitudes. We extracted all messages from these clusters and conducted inductive content analysis to characterize the discourse. Results: Our keyword search yielded 118,971 Twitter posts after duplicates were removed, and subsequently, we applied BTM to parse these data into 20 clusters. After removing retweets, we manually screened the top 10 tweets associated with each cluster (200 messages) to identify clusters associated with public figures. Extraction of these clusters yielded 768 posts for inductive analysis. Most messages were either pro-vaccination (n=329, 43%) or neutral about vaccination (n=425, 55%), with only 2% (14/768) including anti-vaccination messages. Three main themes emerged: (1) anti-vaccination accusation, in which the message accused the public figure of holding anti-vaccination beliefs; (2) using “anti-vax” as an epithet; and (3) stating or implying the negative public health impact of anti-vaccination discourse. Conclusions: Most discussions surrounding public figures in common hashtags labelled as “anti-vax” did not reflect anti-vaccination beliefs. We observed that public figures with known anti-vaccination beliefs face scorn and ridicule on Twitter. Accusing public figures of anti-vaccination attitudes is a means of insulting and discrediting the public figure rather than discrediting vaccines. The majority of posts in our sample condemned public figures expressing anti-vax beliefs by undermining their influence, insulting them, or expressing concerns over public health ramifications. This points to a complex information ecosystem, where anti-vax sentiment may not reside in common anti-vax–related keywords or hashtags, necessitating further assessment of the influence that public figures have on this discourse. %M 37113377 %R 10.2196/40575 %U https://infodemiology.jmir.org/2023/1/e40575 %U https://doi.org/10.2196/40575 %U http://www.ncbi.nlm.nih.gov/pubmed/37113377 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e43762 %T Community-Level Social Support to Mitigate the Impact of Combined Frailty and Multimorbidity on Psychological Distress Among Rural Chinese Older Adults During the COVID-19 Pandemic: Multilevel Modeling Study %A Wang,Yi %A Fu,Peipei %A Li,Jie %A Gao,Tingting %A Jing,Zhengyue %A Wang,Qiong %A Zhao,Dan %A Zhou,Chengchao %+ Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, 44 Wen-hua-xi Road, Jinan, 250012, China, 86 531 8838 1567, zhouchengchao@sdu.edu.cn %K psychological distress %K frailty %K multimorbidity %K community-level social support %K COVID-19 pandemic %K psychological %K rural %K older adults %K community %K support %K effectiveness %D 2023 %7 9.3.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Accumulating research provides evidence that the psychological health of older people deteriorated from before to during the COVID-19 pandemic. Unlike robust individuals, coexisting frailty and multimorbidity expose older adults to more complicated and wide-ranging stressors. Community-level social support (CSS) is also an important impetus for age-friendly interventions, and it is 1 of the components of social capital that is seen as an ecological-level property. To date, we have not found research that examines whether CSS buffered the adverse impacts of combined frailty and multimorbidity on psychological distress in a rural setting during COVID-19 in China. Objective: This study explores the combined effect of frailty and multimorbidity on psychological distress in rural Chinese older adults during the COVID-19 pandemic and examines whether CSS would buffer the aforementioned association. Methods: Data used in this study were extracted from 2 waves of the Shandong Rural Elderly Health Cohort (SREHC), and the final analytic sample included 2785 respondents who participated in both baseline and follow-up surveys. Multilevel linear mixed effects models were used to quantify the strength of the longitudinal association between frailty and multimorbidity combinations and psychological distress using 2 waves of data for each participant, and then, cross-level interactions between CSS and combined frailty and multimorbidity were included to test whether CSS would buffer the adverse impact of coexisting frailty and multimorbidity on psychological distress. Results: Frail older adults with multimorbidity reported the most psychological distress compared to individuals with only 1 or none of the conditions (β=.68, 95% CI 0.60-0.77, P<.001), and baseline coexisting frailty and multimorbidity predicted the most psychological distress during the COVID-19 pandemic (β=.32, 95% CI 0.22-0.43, P<.001). Further, CSS moderated the aforementioned association (β=–.16, 95% CI –0.23 to –0.09, P<.001), and increased CSS buffered the adverse effect of coexisting frailty and multimorbidity on psychological distress during the COVID-19 pandemic (β=–.11, 95% CI –0.22 to –0.01, P=.035). Conclusions: Our findings suggest that more public health and clinical attention should be paid to psychological distress among multimorbid older adults with frailty when facing public health emergencies. This research also suggests that community-level interventions prioritizing social support mechanisms, specifically improving the average levels of social support within communities, may be an effective approach to alleviate psychological distress for rural older adults who concurrently manifest frailty and multimorbidity. %M 36811848 %R 10.2196/43762 %U https://publichealth.jmir.org/2023/1/e43762 %U https://doi.org/10.2196/43762 %U http://www.ncbi.nlm.nih.gov/pubmed/36811848 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e38072 %T Tracking Changes in Mobility Before and After the First SARS-CoV-2 Vaccination Using Global Positioning System Data in England and Wales (Virus Watch): Prospective Observational Community Cohort Study %A Nguyen,Vincent %A Liu,Yunzhe %A Mumford,Richard %A Flanagan,Benjamin %A Patel,Parth %A Braithwaite,Isobel %A Shrotri,Madhumita %A Byrne,Thomas %A Beale,Sarah %A Aryee,Anna %A Fong,Wing Lam Erica %A Fragaszy,Ellen %A Geismar,Cyril %A Navaratnam,Annalan M D %A Hardelid,Pia %A Kovar,Jana %A Pope,Addy %A Cheng,Tao %A Hayward,Andrew %A Aldridge,Robert %A , %+ Centre for Public Health Data Science, Institute of Health Informatics, University College London, 222 Euston Road, London, NW1 2DA, United Kingdom, 44 20 3549 5541, r.aldridge@ucl.ac.uk %K COVID-19 %K SARS-CoV-2 %K vaccination %K global positioning system %K GPS %K movement tracking %K geographical tracking %K mobile app %K health application %K surveillance %K public health %K mHealth %K mobile surveillance %K tracking device %K geolocation %D 2023 %7 8.3.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Evidence suggests that individuals may change adherence to public health policies aimed at reducing the contact, transmission, and spread of the SARS-CoV-2 virus after they receive their first SARS-CoV-2 vaccination when they are not fully vaccinated. Objective: We aimed to estimate changes in median daily travel distance of our cohort from their registered addresses before and after receiving a SARS-CoV-2 vaccine. Methods: Participants were recruited into Virus Watch starting in June 2020. Weekly surveys were sent out to participants, and vaccination status was collected from January 2021 onward. Between September 2020 and February 2021, we invited 13,120 adult Virus Watch participants to contribute toward our tracker subcohort, which uses the GPS via a smartphone app to collect data on movement. We used segmented linear regression to estimate the median daily travel distance before and after the first self-reported SARS-CoV-2 vaccine dose. Results: We analyzed the daily travel distance of 249 vaccinated adults. From 157 days prior to vaccination until the day before vaccination, the median daily travel distance was 9.05 (IQR 8.06-10.09) km. From the day of vaccination to 105 days after vaccination, the median daily travel distance was 10.08 (IQR 8.60-12.42) km. From 157 days prior to vaccination until the vaccination date, there was a daily median decrease in mobility of 40.09 m (95% CI –50.08 to –31.10; P<.001). After vaccination, there was a median daily increase in movement of 60.60 m (95% CI 20.90-100; P<.001). Restricting the analysis to the third national lockdown (January 4, 2021, to April 5, 2021), we found a median daily movement increase of 18.30 m (95% CI –19.20 to 55.80; P=.57) in the 30 days prior to vaccination and a median daily movement increase of 9.36 m (95% CI 38.6-149.00; P=.69) in the 30 days after vaccination. Conclusions: Our study demonstrates the feasibility of collecting high-volume geolocation data as part of research projects and the utility of these data for understanding public health issues. Our various analyses produced results that ranged from no change in movement after vaccination (during the third national lock down) to an increase in movement after vaccination (considering all periods, up to 105 days after vaccination), suggesting that, among Virus Watch participants, any changes in movement distances after vaccination are small. Our findings may be attributable to public health measures in place at the time such as movement restrictions and home working that applied to the Virus Watch cohort participants during the study period. %M 36884272 %R 10.2196/38072 %U https://publichealth.jmir.org/2023/1/e38072 %U https://doi.org/10.2196/38072 %U http://www.ncbi.nlm.nih.gov/pubmed/36884272 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 3 %N %P e39209 %T Analyzing Discussions Around Rural Health on Twitter During the COVID-19 Pandemic: Social Network Analysis of Twitter Data %A Ahmed,Wasim %A Vidal-Alaball,Josep %A Vilaseca Llobet,Josep Maria %+ Stirling University Management School, University of Stirling, Airthrey Road, Stirling, FK9 4LA, United Kingdom, 44 01786 467333, Wasim.Ahmed@stir.ac.uk %K rural health %K Twitter messaging %K social media %K COVID-19 %K SARS-CoV-2 %K coronavirus %K social network analysis %D 2023 %7 8.3.2023 %9 Original Paper %J JMIR Infodemiology %G English %X Background: Individuals from rural areas are increasingly using social media as a means of communication, receiving information, or actively complaining of inequalities and injustices. Objective: The aim of our study is to analyze conversations about rural health taking place on Twitter during a particular phase of the COVID-19 pandemic. Methods: This study captured 57 days’ worth of Twitter data related to rural health from June to August 2021, using English-language keywords. The study used social network analysis and natural language processing to analyze the data. Results: It was found that Twitter served as a fruitful platform to raise awareness of problems faced by users living in rural areas. Overall, Twitter was used in rural areas to express complaints, debate, and share information. Conclusions: Twitter could be leveraged as a powerful social listening tool for individuals and organizations that want to gain insight into popular narratives around rural health. %M 36936067 %R 10.2196/39209 %U https://infodemiology.jmir.org/2023/1/e39209 %U https://doi.org/10.2196/39209 %U http://www.ncbi.nlm.nih.gov/pubmed/36936067 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e41694 %T Technology Use During the COVID-19 Pandemic and the Ways in Which Technology Can Support Adolescent Well-being: Qualitative Exploratory Study %A Rimel,Sarah E %A Bam,Dina %A Farren,Laura %A Thaanum,Ayana %A Smith,Alessandro %A Park,Susanna Y %A Boeldt,Debra L %A Nicksic Sigmon,Chloe A %+ National Mental Health Innovation Center, University of Colorado Anschutz Medical Campus, 1890 N Revere Ct, Aurora, CO, 80045, United States, 1 8433430100, sarah@vxvymentalhealth.com %K adolescents %K mental health %K technology use %K well-being %K COVID-19 %K compassion %K social connectedness %K mobile phone %D 2023 %7 8.3.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Most adolescents in the United States engage with technology. Social isolation and disruptions in activities owing to the COVID-19 pandemic have been linked to worsening mood and overall decreased well-being in adolescents. Although studies on the direct impacts of technology on adolescent well-being and mental health are inconclusive, there are both positive and negative associations depending on various factors, such as how the technology is used and by whom under certain settings. Objective: This study applied a strengths-based approach and focused on the potential to leverage technology to benefit adolescent well-being during a public health emergency. This study aimed to gain an initial and nuanced understanding of how adolescents have used technology to support their wellness throughout the pandemic. In addition, this study aimed to further motivate future large-scale research on how technology can be leveraged to benefit adolescent well-being. Methods: This study used an exploratory qualitative approach and was conducted in 2 phases. Phase 1 consisted of interviewing subject matter experts who work with adolescents to inform the creation of a semistructured interview for phase 2. Subject matter experts were recruited from existing connections with the Hemera Foundation and National Mental Health Innovation Center’s (NMHIC) networks. In phase 2, adolescents (aged 14-18 years) were recruited nationally through social media (eg, Facebook, Twitter, LinkedIn, and Instagram) and via email to institutions (eg, high schools, hospitals, and health technology companies). High school and early college interns at NMHIC led the interviews via Zoom (Zoom Video Communications) with an NMHIC staff member on the call in an observational role. A total of 50 adolescents completed interviews regarding their technology use and its role during the COVID-19 pandemic. Results: The overarching themes identified from the data were COVID-19’s impact on adolescent lives, positive role of technology, negative role of technology, and resiliency. Adolescents engaged with technology as a way to foster and maintain connection in a time of extended isolation. However, they also demonstrated an awareness of when technology was negatively affecting their well-being, prompting them to turn to other fulfilling activities that do not involve technology. Conclusions: This study highlights how adolescents have used technology for well-being throughout the COVID-19 pandemic. Guidelines based on insights from the results of this study were created for adolescents, parents, caregivers, and teachers to provide recommendations for how adolescents can use technology to bolster overall well-being. Adolescents’ ability to recognize when they need to engage in nontechnology-related activities and their ability to use technology to reach a larger community indicate that technology can be facilitated in positive ways to benefit their overall well-being. Future research should focus on increasing the generalizability of recommendations and identifying additional ways to leverage mental health technologies. %M 36795671 %R 10.2196/41694 %U https://formative.jmir.org/2023/1/e41694 %U https://doi.org/10.2196/41694 %U http://www.ncbi.nlm.nih.gov/pubmed/36795671 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e44251 %T Dining-Out Behavior as a Proxy for the Superspreading Potential of SARS-CoV-2 Infections: Modeling Analysis %A Chong,Ka Chun %A Li,Kehang %A Guo,Zihao %A Jia,Katherine Min %A Leung,Eman Yee Man %A Zhao,Shi %A Hung,Chi Tim %A Yam,Carrie Ho Kwan %A Chow,Tsz Yu %A Dong,Dong %A Wang,Huwen %A Wei,Yuchen %A Yeoh,Eng Kiong %+ Centre for Health Systems and Policy Research, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Room 415, School of Public Health Building, Prince of Wales Hospital, Shatin, New Territories, Hong Kong, 852 22528702, yeoh_ek@cuhk.edu.hk %K COVID-19 %K contact tracing %K unlinked %K superspreading %K dispersion %K public health %K surveillance %K digital health surveillance %K digital surveillance %K disease spread %D 2023 %7 7.3.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: While many studies evaluated the reliability of digital mobility metrics as a proxy of SARS-CoV-2 transmission potential, none examined the relationship between dining-out behavior and the superspreading potential of COVID-19. Objective: We employed the mobility proxy of dining out in eateries to examine this association in Hong Kong with COVID-19 outbreaks highly characterized by superspreading events. Methods: We retrieved the illness onset date and contact-tracing history of all laboratory-confirmed cases of COVID-19 from February 16, 2020, to April 30, 2021. We estimated the time-varying reproduction number (Rt) and dispersion parameter (k), a measure of superspreading potential, and related them to the mobility proxy of dining out in eateries. We compared the relative contribution to the superspreading potential with other common proxies derived by Google LLC and Apple Inc. Results: A total of 6391 clusters involving 8375 cases were used in the estimation. A high correlation between dining-out mobility and superspreading potential was observed. Compared to other mobility proxies derived by Google and Apple, the mobility of dining-out behavior explained the highest variability of k (ΔR-sq=9.7%, 95% credible interval: 5.7% to 13.2%) and Rt (ΔR-sq=15.7%, 95% credible interval: 13.6% to 17.7%). Conclusions: We demonstrated that there was a strong link between dining-out behaviors and the superspreading potential of COVID-19. The methodological innovation suggests a further development using digital mobility proxies of dining-out patterns to generate early warnings of superspreading events. %M 36811849 %R 10.2196/44251 %U https://publichealth.jmir.org/2023/1/e44251 %U https://doi.org/10.2196/44251 %U http://www.ncbi.nlm.nih.gov/pubmed/36811849 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e42315 %T Epidemiology, Symptomatology, and Risk Factors for Long COVID Symptoms: Population-Based, Multicenter Study %A Wong,Martin Chi-Sang %A Huang,Junjie %A Wong,Yuet-Yan %A Wong,Grace Lai-Hung %A Yip,Terry Cheuk-Fung %A Chan,Rachel Ngan-Yin %A Chau,Steven Wai-Ho %A Ng,Siew-Chien %A Wing,Yun-Kwok %A Chan,Francis Ka-Leung %+ Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Room 41028, 2/F, Special Block E, Sha Tin, China, 852 35051339, fklchan@cuhk.edu.hk %K COVID-19 %K epidemiology %K symptom %K risk factor %K long COVID %K multicenter survey %K general population %D 2023 %7 7.3.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Long COVID induces a substantial global burden of disease. The pathogenesis, complications, and epidemiological and clinical characteristics of patients with COVID-19 in the acute phase have been evaluated, while few studies have characterized the epidemiology, symptomatology, and risk factors of long COVID symptoms. Its characteristics among patients with COVID-19 in the general population remain unaddressed. Objective: We examined the prevalence of long COVID symptoms, its symptom patterns, and its risk factors in 4 major Chinese cities in order to fill the knowledge gap. Methods: We performed a population-based, multicenter survey using a representative sampling strategy via the Qualtrics platform in Beijing, Shanghai, Guangzhou, and Hong Kong in June 2022. We included 2712 community-dwelling patients with COVID-19 and measured the prevalence of long COVID symptoms defined by the World Health Organization (WHO), and their risk factors. The primary outcomes were the symptoms of long COVID, with various levels of impact. A descriptive analysis of the prevalence and distribution of long COVID symptoms according to disease severity was conducted. A sensitivity analysis of increasing the number of long COVID symptoms was also conducted. Univariate and multivariate regression analyses were performed to examine the risk factors of severe long COVID symptoms, including age, gender, marital status, current occupation, educational level, living status, smoking habits, monthly household income, self-perceived health status, the presence of chronic diseases, the use of chronic medication, COVID-19 vaccination status, and the severity of COVID-19. Results: The response rate was 63.6% (n=2712). The prevalence of long COVID, moderate or severe long COVID, and severe long COVID was 90.4% (n=2452), 62.4% (n=1692), and 31.0% (n=841), respectively. Fatigue (n=914, 33.7%), cough (n=865, 31.9%), sore throat (n=841, 31.0%), difficulty in concentrating (n=828, 30.5%), feeling of anxiety (n=817, 30.2%), myalgia (n=811, 29.9%), and arthralgia (n=811, 29.9%) were the most common severe long COVID symptoms. From multivariate regression analysis, female gender (adjusted odds ratio [aOR]=1.49, 95% CI 1.13-1.95); engagement in transportation, logistics, or the discipline workforce (aOR=2.52, 95% CI 1.58-4.03); living with domestic workers (aOR=2.37, 95% CI 1.39-4.03); smoking (aOR=1.55, 95% CI 1.17-2.05); poor or very poor self-perceived health status (aOR=15.4, 95% CI 7.88-30.00); ≥3 chronic diseases (aOR=2.71, 95% CI 1.54-4.79); chronic medication use (aOR=4.38, 95% CI 1.66-11.53); and critical severity of COVID-19 (aOR=1.52, 95% CI 1.07-2.15) were associated with severe long COVID. Prior vaccination with ≥2 doses of COVID-19 vaccines was a protective factor (aOR=0.35-0.22, 95% CI 0.08-0.90). Conclusions: We examined the prevalence of long COVID symptoms in 4 Chinese cities according to the severity of COVID-19. We also evaluated the pattern of long COVID symptoms and their risk factors. These findings may inform early identification of patients with COVID-19 at risk of long COVID and planning of rehabilitative services. %M 36645453 %R 10.2196/42315 %U https://publichealth.jmir.org/2023/1/e42315 %U https://doi.org/10.2196/42315 %U http://www.ncbi.nlm.nih.gov/pubmed/36645453 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e42128 %T Spatiotemporal Trends in Self-Reported Mask-Wearing Behavior in the United States: Analysis of a Large Cross-sectional Survey %A Taube,Juliana C %A Susswein,Zachary %A Bansal,Shweta %+ Department of Biology, Georgetown University, Reiss Science Building, Room 406, 37th and O Streets, NW, Washington, DC, 20057, United States, 1 202 687 9256, shweta.bansal@georgetown.edu %K COVID-19 %K face mask %K nonpharmaceutical interventions %K spatiotemporal %K United States %K survey bias %K survey %K US %K behavior %K effectiveness %K disease %K decision-making %K community %K surveillance %D 2023 %7 6.3.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Face mask wearing has been identified as an effective strategy to prevent the transmission of SARS-CoV-2, yet mask mandates were never imposed nationally in the United States. This decision resulted in a patchwork of local policies and varying compliance, potentially generating heterogeneities in the local trajectories of COVID-19 in the United States. Although numerous studies have investigated the patterns and predictors of masking behavior nationally, most suffer from survey biases and none have been able to characterize mask wearing at fine spatial scales across the United States through different phases of the pandemic. Objective: Urgently needed is a debiased spatiotemporal characterization of mask-wearing behavior in the United States. This information is critical to further assess the effectiveness of masking, evaluate the drivers of transmission at different time points during the pandemic, and guide future public health decisions through, for example, forecasting disease surges. Methods: We analyzed spatiotemporal masking patterns in over 8 million behavioral survey responses from across the United States, starting in September 2020 through May 2021. We adjusted for sample size and representation using binomial regression models and survey raking, respectively, to produce county-level monthly estimates of masking behavior. We additionally debiased self-reported masking estimates using bias measures derived by comparing vaccination data from the same survey to official records at the county level. Lastly, we evaluated whether individuals’ perceptions of their social environment can serve as a less biased form of behavioral surveillance than self-reported data. Results: We found that county-level masking behavior was spatially heterogeneous along an urban-rural gradient, with mask wearing peaking in winter 2021 and declining sharply through May 2021. Our results identified regions where targeted public health efforts could have been most effective and suggest that individuals’ frequency of mask wearing may be influenced by national guidance and disease prevalence. We validated our bias correction approach by comparing debiased self-reported mask-wearing estimates with community-reported estimates, after addressing issues of a small sample size and representation. Self-reported behavior estimates were especially prone to social desirability and nonresponse biases, and our findings demonstrated that these biases can be reduced if individuals are asked to report on community rather than self behaviors. Conclusions: Our work highlights the importance of characterizing public health behaviors at fine spatiotemporal scales to capture heterogeneities that may drive outbreak trajectories. Our findings also emphasize the need for a standardized approach to incorporating behavioral big data into public health response efforts. Even large surveys are prone to bias; thus, we advocate for a social sensing approach to behavioral surveillance to enable more accurate estimates of health behaviors. Finally, we invite the public health and behavioral research communities to use our publicly available estimates to consider how bias-corrected behavioral estimates may improve our understanding of protective behaviors during crises and their impact on disease dynamics. %M 36877548 %R 10.2196/42128 %U https://publichealth.jmir.org/2023/1/e42128 %U https://doi.org/10.2196/42128 %U http://www.ncbi.nlm.nih.gov/pubmed/36877548 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e41304 %T Digital Practices by Citizens During the COVID-19 Pandemic: Findings From an International Multisite Study %A Marston,Hannah Ramsden %A Ko,Pei-Chun %A Girishan Prabhu,Vishnunarayan %A Freeman,Shannon %A Ross,Christopher %A Sharaievska,Iryna %A Browning,Matthew HEM %A Earle,Sarah %A Ivan,Loredana %A Kanozia,Rubal %A Öztürk Çalıkoğlu,Halime %A Arslan,Hasan %A Bilir-Koca,Burcu %A Alexandra Silva,Paula %A Buttigieg,Sandra C %A Großschädl,Franziska %A Schüttengruber,Gerhilde %+ School of Health, Wellbeing and Social Care, The Open University, Horlock Building, Walton Hall, Milton Keynes, MK7 6AA, United Kingdom, 44 7815507547, Hannah.Marston@open.ac.uk %K COVID-19 %K communication %K gerontology %K community living %K technology %K social media %D 2023 %7 6.3.2023 %9 Original Paper %J JMIR Ment Health %G English %X Background: The COVID-19 pandemic brought digital practices and engagement to the forefront of society, which were based on behavioral changes associated with adhering to different government mandates. Further behavioral changes included transitioning from working in the office to working from home, with the use of various social media and communication platforms to maintain a level of social connectedness, especially given that many people who were living in different types of communities, such as rural, urban, and city spaces, were socially isolated from friends, family members, and community groups. Although there is a growing body of research exploring how technology is being used by people, there is limited information and insight about the digital practices employed across different age cohorts living in different physical spaces and residing in different countries. Objective: This paper presents the findings from an international multisite study exploring the impact of social media and the internet on the health and well-being of individuals in different countries during the COVID-19 pandemic. Methods: Data were collected via a series of online surveys deployed between April 4, 2020, and September 30, 2021. The age of respondents varied from 18 years to over 60 years across the 3 regions of Europe, Asia, and North America. On exploring the associations of technology use, social connectedness, and sociodemographic factors with loneliness and well-being through bivariate and multivariate analyses, significant differences were observed. Results: The levels of loneliness were higher among respondents who used social media messengers or many social media apps than among those who did not use social media messengers or used ≤1 social media app. Additionally, the levels of loneliness were higher among respondents who were not members of an online community support group than among those who were members of an online community support group. Psychological well-being was significantly lower and loneliness was significantly higher among people living in small towns and rural areas than among those living in suburban and urban communities. Younger respondents (18-29 years old), single adults, unemployed individuals, and those with lower levels of education were more likely to experience loneliness. Conclusions: From an international and interdisciplinary perspective, policymakers and stakeholders should extend and explore interventions targeting loneliness experienced by single young adults and further examine how this may vary across geographies. The study findings have implications across the fields of gerontechnology, health sciences, social sciences, media communication, computers, and information technology. International Registered Report Identifier (IRRID): RR2-10.3389/fsoc.2020.574811 %M 36877558 %R 10.2196/41304 %U https://mental.jmir.org/2023/1/e41304 %U https://doi.org/10.2196/41304 %U http://www.ncbi.nlm.nih.gov/pubmed/36877558 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e40308 %T Evaluating the Impact of Mask Mandates and Political Party Affiliation on Mental Health Internet Search Behavior in the United States During the COVID-19 Pandemic: Generalized Additive Mixed Model Framework %A Gyorda,Joseph A %A Lekkas,Damien %A Price,George %A Jacobson,Nicholas C %+ Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, 46 Centerra Pkwy, Lebanon, NH, 03766, United States, 1 (603) 646 7000, joseph.a.gyorda.gr@dartmouth.edu %K mental health %K Google Trends %K mask mandates %K political party %K generalized additive mixed modeling %K COVID-19 %D 2023 %7 3.3.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: The impacts of the COVID-19 pandemic on mental health worldwide and in the United States have been well documented. However, there is limited research examining the long-term effects of the pandemic on mental health, particularly in relation to pervasive policies such as statewide mask mandates and political party affiliation. Objective: The goal of this study was to examine whether statewide mask mandates and political party affiliations yielded differential changes in mental health symptoms across the United States by leveraging state-specific internet search query data. Methods: This study leveraged Google search queries from March 24, 2020, to March 29, 2021, in each of the 50 states in the United States. Of the 50 states, 39 implemented statewide mask mandates—with 16 of these states being Republican—to combat the spread of COVID-19. This study investigated whether mask mandates were associated differentially with mental health in states with and without mandates by exploring variations in mental health search queries across the United States. In addition, political party affiliation was examined as a potential covariate to determine whether mask mandates had differential associations with mental health in Republican and Democratic states. Generalized additive mixed models were implemented to model associations among mask mandates, political party affiliation, and mental health search volume for up to 7 months following the implementation of a mask mandate. Results: The results of generalized additive mixed models revealed that search volume for “restless” significantly increased following a mask mandate across all states, whereas the search volume for “irritable” and “anxiety” increased and decreased, respectively, following a mandate for Republican states in comparison with Democratic states. Most mental health search terms did not exhibit significant changes in search volume in relation to mask mandate implementation. Conclusions: These findings suggest that mask mandates were associated nonlinearly with significant changes in mental health search behavior, with the most notable associations occurring in anxiety-related search terms. Therefore, policy makers should consider monitoring and providing additional support for these mental health symptoms following the implementation of public health–related mandates such as mask mandates. Nevertheless, these results do not provide evidence for an overwhelming impact of mask mandates on population-level mental health in the United States. %M 36735836 %R 10.2196/40308 %U https://www.jmir.org/2023/1/e40308 %U https://doi.org/10.2196/40308 %U http://www.ncbi.nlm.nih.gov/pubmed/36735836 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 12 %N %P e36765 %T Web-Based Co-design in Health Care: Considerations for Renewed Participation %A Mallakin,Maryam %A Dery,Christina %A Vaillancourt,Samuel %A Gupta,Sahil %A Sellen,Katherine %+ Health Design Studio, OCAD University, 42 Parkway Ave, Toronto, ON, M6R 1T5, Canada, 1 647 448 4902, katherinesellen@gmail.com %K web-based design research %K co-design %K web-based co-design %K virtual platform %K virtual learning platforms %K internet research ethics %K collaboration %K health communication %K sensemaking %K health design %K tangible tools and games %D 2023 %7 3.3.2023 %9 Viewpoint %J Interact J Med Res %G English %X The COVID-19 pandemic has shifted the work environment to a new reality of remote work and virtual collaboration. This shift has occurred in various work settings with an impact on spaces, approaches, applied techniques, and tools. This has resulted in the broad use of virtual tools in the health care sector to avoid physical encounters and in-person interactions that will likely outlast the COVID-19 pandemic. Developing effective virtual approaches requires the knowledge and skills of using digital technologies collaboratively combined with a deep understanding of the context or contexts in which these approaches may be used. The implementation of virtual health design methods, including web-based co-design, has increased to meet the realities of COVID-19 restrictions and is likely to outlast them. Adapting the use of co-design methodologies to a virtual configuration requires rethinking methods of collaboration and communication, adapting to virtual environments, and creating new methods of engagement and facilitation. With this viewpoint, we reviewed the current work on co-design (in person and web based) to propose techniques for the design, planning, and implementation of web-based co-design. We propose 7 considerations that may enable web-based co-design projects in the health care sector. The key considerations that affect the success of a web-based co-design approach should be considered in the process of planning, developing, and conducting web-based co-design sessions. These include facilitation, collaboration, accessibility and equity, communication, sensemaking, tangible tools and games, and web-based research ethics. We illustrate this work with a case study of co-design for an emergency department discharge tool developed during the pandemic. %M 36595738 %R 10.2196/36765 %U https://www.i-jmr.org/2023/1/e36765 %U https://doi.org/10.2196/36765 %U http://www.ncbi.nlm.nih.gov/pubmed/36595738 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e41575 %T Improving Implementation of an Electronic Prescription System for COVID-19 Vaccination in the Czech Republic: Process Modeling Approach %A Berger,Jiri %A Bruthans,Jan %A Kofránek,Jiří %+ Department of Biomedical Technology, Faculty of Biomedical Engineering, Czech Technical University in Prague, Nám Sítná 3105, Kladno, 27201, Czech Republic, 420 723426288, jan@bruthans.cz %K eHealth %K electronic prescription %K process modeling %K state diagram %K COVID-19 %K vaccination %K vaccine %K medical %K communication %K platform %D 2023 %7 3.3.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: It is very difficult to find a consensus that will be accepted by most players when creating health care legislation. The Czech electronic prescription system was launched in 2011 and new functions were introduced in 2018. To ensure that these functions will not conflict with any other existing law, a process modeling tool based on the patent “Method and system for automated requirements modeling” was used successfully in the Czech Republic for the first time. Objective: The aim of this project was to develop another successful application of process modeling to add COVID-19 vaccination records to the existing electronic prescription system. Methods: The method employed was based on the mathematical theory of hierarchical state diagrams and process models. In the first step, sketches that record the results of informal discussions, interviews, meetings, and workshops were prepared. Subsequently, the architecture containing the main participants and their high-level interactions was drafted. Finally, detailed process diagrams were drawn. Each semiresult was discussed with all involved team members and stakeholders to incorporate all comments. By repeating this procedure, individual topics were gradually resolved and the areas of discussion were narrowed down until reaching complete agreement. Results: This method proved to be faster, clearer, and significantly simpler than other methods. Owing to the use of graphic tools and symbols, the risk of errors, inaccuracies, and misunderstandings was significantly reduced. The outcome was used as an annex to the bill in the legislative process. One of the main benefits of this approach is gaining a higher level of understanding for all parties involved (ie, legislators, the medical community, patient organizations, and information technology professionals). The process architecture model in a form of a graphic scheme has proven to be a valuable communication platform and facilitated negotiation between stakeholders. Moreover, this model helped to avoid several inconsistencies that appeared during workshops and discussions. Our method worked successfully even when participants were from different knowledge areas. Conclusions: The vaccination record process model was drafted in 3 weeks and it took a total of 2 months to pass the bill. In comparison, the initial introduction of the electronic prescription system using conventional legislative methods took over 1 year, involving immediate creation of a text with legislative intent, followed by paragraph-by-section wording of the legislation that was commented on directly. These steps are repeated over and over, as any change in any part of the text has to be checked and rechecked within the entire document. Compared with conventional methods, we have shown that using our method for the process of modification of legislation related to such a complex issue as the integration of COVID-19 vaccination into an electronic prescription model significantly simplifies the preparation of a legislative standard. %M 36787233 %R 10.2196/41575 %U https://formative.jmir.org/2023/1/e41575 %U https://doi.org/10.2196/41575 %U http://www.ncbi.nlm.nih.gov/pubmed/36787233 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e40518 %T Hangover-Related Internet Searches Before and During the COVID-19 Pandemic in England: Observational Study %A Robinson,Eric %A Jones,Andrew %+ Institute of Population Health, Department of Psychology, University of Liverpool, Waterhouse Building, Block B, Brownlow Street, Liverpool, L69 7ZA, United Kingdom, 44 01517941187, eric.robinson@liv.ac.uk %K alcohol %K COVID-19 %K hangover %K Google Trends %K social media %K public health %K online information %K alcohol use %K internet search %D 2023 %7 3.3.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: It is unclear whether heavy alcohol use and associated hangover symptoms changed as a result of the COVID-19 pandemic. Due to a lack of available accurate and nonretrospective self-reported data, it is difficult to directly assess hangover symptoms during the COVID-19 pandemic. Objective: This study aimed to examine whether alcohol-induced hangover-related internet searches (eg, “how to cure a hangover?”) increased, decreased, or remained the same in England before versus during the COVID-19 pandemic (2020-2021) and during periods of national lockdown. Secondary aims were to examine if hangover-related internet searches in England differed compared to a country that did not impose similar COVID-19 lockdown restrictions. Methods: Using historical data from Google Trends for England, we compared the relative search volume (RSV) of hangover-related searches in the years before (2016-2019) versus during the COVID-19 pandemic (2020-2021), as well as in periods of national lockdown versus the same periods in 2016-2019. We also compared the RSV of hangover-related searches during the same time frames in a European country that did not introduce national COVID-19 lockdowns at the beginning of the pandemic (Sweden). Hangover-related search terms were identified through consultation with a panel of alcohol researchers and a sample from the general public. Statistical analyses were preregistered prior to data collection. Results: There was no overall significant difference in the RSV of hangover-related terms in England during 2016-2019 versus 2020-2021 (P=.10; robust d=0.02, 95% CI 0.00-0.03). However, during national lockdowns, searches for hangover-related terms were lower, particularly during the first national lockdown in England (P<.001; d=.19, 95% CI 0.16-0.24; a 44% relative decrease). In a comparison country that did not introduce a national lockdown in the early stages of the pandemic (Sweden), there was no significant decrease in hangover-related searches during the same time period (P=.06). However, across both England and Sweden, during later periods of COVID-19 restrictions in 2020 and 2021, the RSV of hangover-related terms was lower than that in the same periods during 2016-2019. Exploratory analyses revealed that national monthly variation in alcohol sales both before and during the COVID-19 pandemic were positively correlated with the frequency of hangover-related searches, suggesting that changes in hangover-related searches may act as a proxy for changes in alcohol consumption. Conclusions: Hangover-related internet searches did not differ before versus during the COVID-19 pandemic in England but did reduce during periods of national lockdown. Further research is required to confirm how changes in hangover-related search volume relate to heavy episodic alcohol use. Trial Registration: Open Science Framework 2Y86E; https://osf.io/2Y86E %M 36827489 %R 10.2196/40518 %U https://formative.jmir.org/2023/1/e40518 %U https://doi.org/10.2196/40518 %U http://www.ncbi.nlm.nih.gov/pubmed/36827489 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e38667 %T COVID-19 Response Resource Engagement and User Characteristics of the Wichealth Web-Based Nutrition Education System: Comparative Cross-sectional Study %A Brusk,John J %A Bensley,Robert J %+ School of Interdisciplinary Health Programs, Western Michigan University, 2414 CHHS Bldng, 1903 W. Michigan Ave., Kalamazoo, MI, 49008, United States, 1 2697162301, bobbensley@gmail.com %K COVID-19 %K user engagement %K infodemic %K Women, Infants, and Children %K WIC %K educational resource %K health care %K digital health %K nutrition %K web-based education %K web-based nutrition %K pediatric %K parenting %K dashboard %D 2023 %7 2.3.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: In response to the COVID-19 pandemic, Wichealth launched 4 information resources on the site’s user landing dashboard page. These resources were used consistently during the period in which they were available (April 1, 2020, through October 31, 2021); however, only 9% (n=50,888) of Wichealth users eligible for inclusion in the study accessed at least one resource. User engagement with emergency response resources within the context of a web-based health educational tool has not been well investigated due to a paucity of opportunities and a lack of the ability to evaluate relevant users at scale. Objective: This investigation was carried out to understand if user characteristics and behaviors measured by the Wichealth web-based education system are associated with a participant's motivation, or lack thereof, to engage with the added COVID-19 resources. Methods: Sociodemographic characteristics were gathered from Wichealth users with at least one lesson completed and a complete user profile to identify which factors increase the likelihood of user access of any of the Wichealth COVID-19 response resources during the 19-month period between April 1, 2020, and October 31, 2021. A logistic regression analysis was conducted to determine the relative importance of all factors on the likelihood of a user accessing the COVID-19 resources. Results: A total of 50,888 unique Wichealth users included in the study accessed the COVID-19 response resources 66,849 times during the time period. During the same period, 510,939 unique Wichealth users completed at least one lesson about how to engage in healthy behaviors with respect to parent-child feeding but did not access any COVID-19 resources. Therefore, only 9% of Wichealth users who completed a lesson during the time when COVID-19 response resources were available accessed any of the information in those resources. Users of the Spanish language Wichealth version, older users, those less educated, and users with prior Wichealth lesson engagement demonstrated the greatest likelihood of COVID-19 resource use. Conclusions: This investigation presents findings that demonstrate significant differences between Wichealth users that opted to access COVID-19–specific resources and those who chose not to during their web-based educational session. Reaching users of a web-based educational system with supplemental information may require multiple strategies to increase coverage and ensure the widest possible distribution. %M 36787232 %R 10.2196/38667 %U https://formative.jmir.org/2023/1/e38667 %U https://doi.org/10.2196/38667 %U http://www.ncbi.nlm.nih.gov/pubmed/36787232 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e37527 %T Faculty-Wide Peer-Support Program During the COVID-19 Pandemic: Design and Preliminary Results %A Liu,Jenny J W %A Lum,P Andrea %A Foxcroft,Laura %A Lim,Rod %A Richardson,J Don %+ Schulich School of Medicine & Dentistry, Western University, Mental Health Care Building, F4-430, London, ON, N6A 5C1, Canada, 1 519 685 8500 ext 75694, jenny.liu@sjhc.london.on.ca %K physician %K doctor %K medical professional %K health care professional %K peer support %K burnout %K mental distress %K stress %K work %K job %K peer leadership %K mental health %K occupational health %K COVID-19 %D 2023 %7 2.3.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Physicians experience higher rates of burnout relative to the general population. Concerns of confidentiality, stigma, and professional identities as health care providers act as barriers to seeking and receiving appropriate support. In the context of the COVID-19 pandemic, factors that contribute to burnout and barriers to seeking support have been amplified, elevating the overall risks of mental distress and burnout for physicians. Objective: This paper aimed to describe the rapid development and implementation of a peer support program within a health care organization located in London, Ontario, Canada. Methods: A peer support program leveraging existing infrastructures within the health care organization was developed and launched in April 2020. The “Peers for Peers” program drew from the work of Shapiro and Galowitz in identifying key components within hospital settings that contributed to burnout. The program design was derived from a combination of the peer support frameworks from the Airline Pilot Assistance Program and the Canadian Patient Safety Institute. Results: Data gathered over 2 waves of peer leadership training and program evaluations highlighted a diversity of topics covered through the peer support program. Further, enrollment continued to increase in size and scope over the 2 waves of program deployments into 2023. Conclusions: Findings suggest that the peer support program is acceptable to physicians and can be easily and feasibly implemented within a health care organization. The structured program development and implementation can be adopted by other organizations in support of emerging needs and challenges. %M 36862464 %R 10.2196/37527 %U https://formative.jmir.org/2023/1/e37527 %U https://doi.org/10.2196/37527 %U http://www.ncbi.nlm.nih.gov/pubmed/36862464 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e40899 %T Trends in Language Use During the COVID-19 Pandemic and Relationship Between Language Use and Mental Health: Text Analysis Based on Free Responses From a Longitudinal Study %A Weger,Rachel %A Lossio-Ventura,Juan Antonio %A Rose-McCandlish,Margaret %A Shaw,Jacob S %A Sinclair,Stephen %A Pereira,Francisco %A Chung,Joyce Y %A Atlas,Lauren Yvette %+ National Center for Complementary and Integrative Health, National Institutes of Health, 10 Center Drive, Rm 4-1741, Bethesda, MD, 20892, United States, 1 301 827 0214, lauren.atlas@nih.gov %K COVID-19 %K mental health %K natural language processing %K sentiment analysis %K free response %K qualitative %K text analysis %K mental illness %K text %K mental state %K language %K pandemic %K age %K education %D 2023 %7 1.3.2023 %9 Original Paper %J JMIR Ment Health %G English %X Background: The COVID-19 pandemic and its associated restrictions have been a major stressor that has exacerbated mental health worldwide. Qualitative data play a unique role in documenting mental states through both language features and content. Text analysis methods can provide insights into the associations between language use and mental health and reveal relevant themes that emerge organically in open-ended responses. Objective: The aim of this web-based longitudinal study on mental health during the early COVID-19 pandemic was to use text analysis methods to analyze free responses to the question, “Is there anything else you would like to tell us that might be important that we did not ask about?” Our goals were to determine whether individuals who responded to the item differed from nonresponders, to determine whether there were associations between language use and psychological status, and to characterize the content of responses and how responses changed over time. Methods: A total of 3655 individuals enrolled in the study were asked to complete self-reported measures of mental health and COVID-19 pandemic–related questions every 2 weeks for 6 months. Of these 3655 participants, 2497 (68.32%) provided at least 1 free response (9741 total responses). We used various text analysis methods to measure the links between language use and mental health and to characterize response themes over the first year of the pandemic. Results: Response likelihood was influenced by demographic factors and health status: those who were male, Asian, Black, or Hispanic were less likely to respond, and the odds of responding increased with age and education as well as with a history of physical health conditions. Although mental health treatment history did not influence the overall likelihood of responding, it was associated with more negative sentiment, negative word use, and higher use of first-person singular pronouns. Responses were dynamically influenced by psychological status such that distress and loneliness were positively associated with an individual’s likelihood to respond at a given time point and were associated with more negativity. Finally, the responses were negative in valence overall and exhibited fluctuations linked with external events. The responses covered a variety of topics, with the most common being mental health and emotion, social or physical distancing, and policy and government. Conclusions: Our results identify trends in language use during the first year of the pandemic and suggest that both the content of responses and overall sentiments are linked to mental health. %M 36525362 %R 10.2196/40899 %U https://mental.jmir.org/2023/1/e40899 %U https://doi.org/10.2196/40899 %U http://www.ncbi.nlm.nih.gov/pubmed/36525362 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e36608 %T Protection Motivation Perspective Regarding the Use of COVID-19 Mobile Tracing Apps Among Public Users: Empirical Study %A Howell,Pamella %A Abdelhamid,Mohamed %+ Department of Information Systems, California State University Long Beach, 1250 Bellflower Blvd., Long Beach, CA, 90480, United States, 1 562 985 2361, mohamed.abdelhamid@csulb.edu %K COVID-19 %K mobile tracing app %K protection motivation theory %K privacy concerns %K global health %D 2023 %7 1.3.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Access to data is crucial for decision-making; this fact has become more evident during the pandemic. Data collected using mobile apps can positively influence diagnosis and treatment, the supply chain, and the staffing resources of health care facilities. Developers and health care professionals have worked to create apps that can track a person’s COVID-19 status. For example, these apps can monitor positive COVID-19 test results and vaccination status. Regrettably, people may be concerned about sharing their data with government or private sector organizations that are developing apps. Understanding user perceptions is essential; without substantial user adoption and the use of mobile tracing apps, benefits cannot be achieved. Objective: This study aimed to assess the factors that positively and negatively affect the use of COVID-19 tracing apps by examining individuals’ perceptions about sharing data on mobile apps, such as testing regularity, infection, and immunization status. Methods: The hypothesized research model was tested using a cross-sectional survey instrument. The survey contained 5 reflective constructs and 4 control variables selected after reviewing the literature and interviewing health care professionals. A digital copy of the survey was created using Qualtrics. After receiving approval, data were collected from 367 participants through Amazon Mechanical Turk (MTurk). Participants of any gender who were 18 years or older were considered for inclusion to complete the anonymized survey. We then analyzed the theoretical model using structural equation modeling. Results: After analyzing the quality of responses, 325 participants were included. Of these 325 participants, 216 (66.5%) were male and 109 (33.5%) were female. Among the participants in the final data set, 72.6% (236/325) were employed. The results of structural equation modeling showed that perceived vulnerability (β=0.688; P<.001), self-efficacy (β=0.292; P<.001), and an individual’s prior infection with COVID-19 (β=0.194; P=.002) had statistically significant positive impacts on the intention to use mobile tracing apps. Privacy concerns (β=−0.360; P<.001), risk aversion (β=−0.150; P=.09), and a family member’s prior infection with COVID-19 (β=−0.139; P=.02) had statistically significant negative influences on a person’s intention to use mobile tracing apps. Conclusions: This study illustrates that various user perceptions affect whether individuals use COVID-19 tracing apps. By working collaboratively on legislation and the messaging provided to potential users before releasing an app, developers, health care professionals, and policymakers can improve the use of tracking apps. Health care professionals need to emphasize disease vulnerability to motivate people to use mobile tracing apps, which can help reduce the spread of viruses and diseases. In addition, more work is needed at the policy-making level to protect the privacy of users, which in return can increase user engagement. %M 36735838 %R 10.2196/36608 %U https://formative.jmir.org/2023/1/e36608 %U https://doi.org/10.2196/36608 %U http://www.ncbi.nlm.nih.gov/pubmed/36735838 %0 Journal Article %@ 2562-0959 %I JMIR Publications %V 6 %N %P e43983 %T Demographic Data Associated With Digital Inequity Reported in Patient-to-Provider Teledermatology Studies in the United States From 2011 to 2021: Scoping Review %A Miller,John %A Ioffreda,Patrick %A Nugent,Shannon %A Jones,Elizabeth %+ Department of Dermatology and Cutaneous Biology, Sidney Kimmel Medical College, Thomas Jefferson University, 833 Chestnut Street, Philadelphia, PA, 19107, United States, 1 215 955 6680, elizabeth.jones@jefferson.edu %K teledermatology %K equity %K inequity %K scoping review %K digital divide %K dermatology %K racial minority %K ethnic minority %K digital inequity %K patient care %K COVID-19 %D 2023 %7 28.2.2023 %9 Review %J JMIR Dermatol %G English %X Background: Patient-to-provider teledermatology relies on a patient’s access to technology to ensure a successful visit. However, access to broadband internet and technology varies across populations in the United States—leading to the digital divide. While teledermatology has been recognized as a model to improve access, little is known about how often demographic data associated with digital inequity are captured in studies. Objective: Given the expansion of teledermatology over the past decade, we sought to determine how often demographic data associated with digital inequity are reported in patient-to-provider teledermatology studies. Methods: A scoping literature review search was conducted using the search term teledermatology in the following databases: PubMed, Embase, and the Cochrane Database of Systematic Reviews. All studies published between December 31, 2011, and December 31, 2021, that evaluated patient-to-provider teledermatology were eligible. Results: In total, 1412 publications describing teledermatology were identified, of which 46 met the inclusion criteria. Race or ethnicity was the most frequently reported demographic characteristic (28/46, 61%). However, only 41% (19/46) of studies were representative of race or ethnicity, defined as including >20% nonwhite participants. Studies rarely reported the number of participants greater than 65 years of age (14/46, 30%), preferred language (9/46, 20%), income (6/46, 13%), highest level of education (5/46, 11%), or access to a device (4/46, 9%). Studies conducted after the onset of the COVID-19 pandemic were significantly more likely to report preferred language (9/25, 36% vs 0%; P=.002) and appeared more likely to report other demographic data associated with digital inequity, without reaching statistical significance (P>.05). Conclusions: Demographic data associated with digital inequity are rarely reported in patient-to-provider teledermatology studies to date. These studies frequently lack adequate representation of racial and ethnic minorities. With increased calls for equitable representation in dermatology studies, future teledermatology studies can improve the reporting of race and ethnicity and consider demographic data associated with digital inequity as an important criterion in research design. %M 36938315 %R 10.2196/43983 %U https://derma.jmir.org/2023/1/e43983 %U https://doi.org/10.2196/43983 %U http://www.ncbi.nlm.nih.gov/pubmed/36938315 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 12 %N %P e41308 %T The Use of Digital Technology for COVID-19 Detection and Response Management in Indonesia: Mixed Methods Study %A Nur Aisyah,Dewi %A Lokopessy,Alfiano Fawwaz %A Naman,Maryan %A Diva,Haniena %A Manikam,Logan %A Adisasmito,Wiku %A Kozlakidis,Zisis %+ Department of Epidemiology and Public Health, Institute of Epidemiology and Health Care, University College London, 1-19 Torrington Place, London, WC1E 7HB, United Kingdom, 44 (0)207 679 2000, logan.manikam.10@ucl.ac.uk %K COVID-19 %K Indonesia %K digital technology %K digital innovation %K digital health %K response management %K robot innovation %K decontamination %D 2023 %7 28.2.2023 %9 Original Paper %J Interact J Med Res %G English %X Background: The COVID-19 pandemic has triggered a greater use of digital technologies as part of the health care response in many countries, including Indonesia. It is the world’s fourth-most populous nation and Southeast Asia’s most populous country, with considerable public health pressures. Objective: The aim of our study is to identify and review the use of digital health technologies in COVID-19 detection and response management in Indonesia. Methods: We conducted a literature review of publicly accessible information in technical and scientific journals, as well as news articles from September 2020 to August 2022 to identify the use case examples of digital technologies in COVID-19 detection and response management in Indonesia. Results: The results are presented in 3 groups, namely (1) big data, artificial intelligence, and machine learning (technologies for the collection or processing of data); (2) health care system technologies (acting at the public health level); and (3) COVID-19 screening, population treatment, and prevention population treatment (acting at the individual patient level). Some of these technologies are the result of government-academia-private sector collaborations during the pandemic, which represent a novel, multisectoral practice in Indonesia within the public health care ecosystem. A small number of the identified technologies pre-existed the pandemic but were upgraded and adapted for current needs. Conclusions: Digital technologies were developed in Indonesia during the pandemic, with a direct impact on supporting COVID-19 management, detection, response, and treatment. They addressed different areas of the technological spectrum and with different levels of adoption, ranging from local to regional to national. The indirect impact of this wave of technological creation and use is a strong foundation for fostering future multisectoral collaboration within the national health care system of Indonesia. %M 36623206 %R 10.2196/41308 %U https://www.i-jmr.org/2023/1/e41308 %U https://doi.org/10.2196/41308 %U http://www.ncbi.nlm.nih.gov/pubmed/36623206 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e43101 %T Improving the Engagement of Underrepresented People in Health Research Through Equity-Centered Design Thinking: Qualitative Study and Process Evaluation for the Development of the Grounding Health Research in Design Toolkit %A Bazzano,Alessandra N %A Noel,Lesley-Ann %A Patel,Tejal %A Dominique,C Chantel %A Haywood,Catherine %A Moore,Shenitta %A Mantsios,Andrea %A Davis,Patricia A %+ Department of Social, Behavioral, and Population Sciences, Tulane University School of Public Health and Tropical Medicine, 1440 Canal St, New Orleans, LA, 70112, United States, 1 5049882338, abazzano@tulane.edu %K health equity %K patient participation %K health behavior %K universal design %K human-centered design %K COVID-19 %D 2023 %7 28.2.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Health inequalities are rooted in historically unjust differences in economic opportunities, environment, access to health care services, and other social determinants. Owing to these health inequalities, the COVID-19 pandemic has disproportionately affected underserved populations, notably people of color, incarcerated and formerly incarcerated individuals, and those unable to physically distance themselves from others. However, people most strongly impacted by health disparities, and the pandemic, are not frequently engaged in research, either as researchers or as participants, resulting in slow progress toward improving health equity. Establishing ways to foster the engagement of historically excluded people is crucial to improving health equity through patient-centered health research. Objective: This study aimed to assess the use of equity-centered design thinking (EDT) for engaging community members in research prioritization related to COVID-19. The co-design methods and subsequent production of a toolkit that can be used for engagement were assessed through process evaluation and qualitative methods. Methods: Process evaluation and qualitative inquiry, using reflexive thematic analysis, were undertaken to examine the use of EDT. Patient community members and stakeholders remotely partnered with design and health researchers in a year-long digital process to cocreate capacity-building tools for setting agenda for research regarding the impact of COVID-19 on health outcomes. Through a series of 3 workshops, 5 community partners engaged in EDT activities to identify critical challenges for the health and well-being of their communities. The subsequent tools were tested with 10 health researchers who provided critical input over the course of 2 workshops. Interviews with co-designers, project materials, and feedback sessions were used in the process evaluation and finalization of an equity-centered toolkit for community engagement in research. Data from the co-design process, meetings, workshops, and interviews were analyzed using reflexive thematic analysis to identify salient themes. Results: Process evaluation illustrated how the EDT co-design process offered an approach to engage patient partners and community stakeholders in health-related research around COVID-19. The participants expressed satisfaction with design thinking approaches, including creative activities and iterative co-design, as a means of working together. Thematic analysis identified 3 key themes: the value of authentic partnerships, building trust and empathy through design, and fostering candid dialogue around health and social issues impacting historically underrepresented and underinvested communities. Conclusions: The project addressed the need to test EDT strategies for fostering inclusive community engagement in health research agenda setting and provided an alternative to traditional top-down models. Despite the increasing use of human-centered design in health, few projects explicitly include equity in design thinking approaches. The use of methods and tools to intentionally engage underrepresented stakeholders in the process of research agenda setting and equitably sharing power between researchers and community members may improve health research, ultimately improving health equity. %M 36649162 %R 10.2196/43101 %U https://formative.jmir.org/2023/1/e43101 %U https://doi.org/10.2196/43101 %U http://www.ncbi.nlm.nih.gov/pubmed/36649162 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e42324 %T Classifying COVID-19 Patients From Chest X-ray Images Using Hybrid Machine Learning Techniques: Development and Evaluation %A Phumkuea,Thanakorn %A Wongsirichot,Thakerng %A Damkliang,Kasikrit %A Navasakulpong,Asma %+ Division of Computational Science, Faculty of Science, Prince of Songkla University, 15 Kanjanavanich Road, Hat Yai, Songkhla, 90110, Thailand, 66 846414784, thakerng.w@psu.ac.th %K COVID-19 %K machine learning %K medical informatics %K coronavirus %K diagnosis %K model %K detection %K healthy %K unhealthy %K public %K usage %K data %K database %K accuracy %K development %K x-ray %K imaging %D 2023 %7 28.2.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic has raised global concern, with moderate to severe cases displaying lung inflammation and respiratory failure. Chest x-ray (CXR) imaging is crucial for diagnosis and is usually interpreted by experienced medical specialists. Machine learning has been applied with acceptable accuracy, but computational efficiency has received less attention. Objective: We introduced a novel hybrid machine learning model to accurately classify COVID-19, non-COVID-19, and healthy patients from CXR images with reduced computational time and promising results. Our proposed model was thoroughly evaluated and compared with existing models. Methods: A retrospective study was conducted to analyze 5 public data sets containing 4200 CXR images using machine learning techniques including decision trees, support vector machines, and neural networks. The images were preprocessed to undergo image segmentation, enhancement, and feature extraction. The best performing machine learning technique was selected and combined into a multilayer hybrid classification model for COVID-19 (MLHC-COVID-19). The model consisted of 2 layers. The first layer was designed to differentiate healthy individuals from infected patients, while the second layer aimed to classify COVID-19 and non-COVID-19 patients. Results: The MLHC-COVID-19 model was trained and evaluated on unseen COVID-19 CXR images, achieving reasonably high accuracy and F measures of 0.962 and 0.962, respectively. These results show the effectiveness of the MLHC-COVID-19 in classifying COVID-19 CXR images, with improved accuracy and a reduction in interpretation time. The model was also embedded into a web-based MLHC-COVID-19 computer-aided diagnosis system, which was made publicly available. Conclusions: The study found that the MLHC-COVID-19 model effectively differentiated CXR images of COVID-19 patients from those of healthy and non-COVID-19 individuals. It outperformed other state-of-the-art deep learning techniques and showed promising results. These results suggest that the MLHC-COVID-19 model could have been instrumental in early detection and diagnosis of COVID-19 patients, thus playing a significant role in controlling and managing the pandemic. Although the pandemic has slowed down, this model can be adapted and utilized for future similar situations. The model was also integrated into a publicly accessible web-based computer-aided diagnosis system. %M 36780315 %R 10.2196/42324 %U https://formative.jmir.org/2023/1/e42324 %U https://doi.org/10.2196/42324 %U http://www.ncbi.nlm.nih.gov/pubmed/36780315 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e40403 %T Development of a COVID-19–Related Anti-Asian Tweet Data Set: Quantitative Study %A Mokhberi,Maryam %A Biswas,Ahana %A Masud,Zarif %A Kteily-Hawa,Roula %A Goldstein,Abby %A Gillis,Joseph Roy %A Rayana,Shebuti %A Ahmed,Syed Ishtiaque %+ Department of Computer Science, University of Toronto, 145 Cosburn Ave, East York, Toronto, ON, M4J 2L2, Canada, 1 4166680689, zarif.masud@gmail.com %K COVID-19 %K stigma %K hate speech %K classification %K annotation %K data set %K Sinophobia %K Twitter %K BERT %K pandemic %K data %K online %K community %K Asian %K research %K discrimination %D 2023 %7 28.2.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Since the advent of the COVID-19 pandemic, individuals of Asian descent (colloquial usage prevalent in North America, where “Asian” is used to refer to people from East Asia, particularly China) have been the subject of stigma and hate speech in both offline and online communities. One of the major venues for encountering such unfair attacks is social networks, such as Twitter. As the research community seeks to understand, analyze, and implement detection techniques, high-quality data sets are becoming immensely important. Objective: In this study, we introduce a manually labeled data set of tweets containing anti-Asian stigmatizing content. Methods: We sampled over 668 million tweets posted on Twitter from January to July 2020 and used an iterative data construction approach that included 3 different stages of algorithm-driven data selection. Finally, we found volunteers who manually annotated the tweets by hand to arrive at a high-quality data set of tweets and a second, more sampled data set with higher-quality labels from multiple annotators. We presented this final high-quality Twitter data set on stigma toward Chinese people during the COVID-19 pandemic. The data set and instructions for labeling can be viewed in the Github repository. Furthermore, we implemented some state-of-the-art models to detect stigmatizing tweets to set initial benchmarks for our data set. Results: Our primary contributions are labeled data sets. Data Set v3.0 contained 11,263 tweets with primary labels (unknown/irrelevant, not-stigmatizing, stigmatizing-low, stigmatizing-medium, stigmatizing-high) and tweet subtopics (eg, wet market and eating habits, COVID-19 cases, bioweapon). Data Set v3.1 contained 4998 (44.4%) tweets randomly sampled from Data Set v3.0, where a second annotator labeled them only on the primary labels and then a third annotator resolved conflicts between the first and second annotators. To demonstrate the usefulness of our data set, preliminary experiments on the data set showed that the Bidirectional Encoder Representations from Transformers (BERT) model achieved the highest accuracy of 79% when detecting stigma on unseen data with traditional models, such as a support vector machine (SVM) performing at 73% accuracy. Conclusions: Our data set can be used as a benchmark for further qualitative and quantitative research and analysis around the issue. It first reaffirms the existence and significance of widespread discrimination and stigma toward the Asian population worldwide. Moreover, our data set and subsequent arguments should assist other researchers from various domains, including psychologists, public policy authorities, and sociologists, to analyze the complex economic, political, historical, and cultural underlying roots of anti-Asian stigmatization and hateful behaviors. A manually annotated data set is of paramount importance for developing algorithms that can be used to detect stigma or problematic text, particularly on social media. We believe this contribution will help predict and subsequently design interventions that will significantly help reduce stigma, hate, and discrimination against marginalized populations during future crises like COVID-19. %M 36693148 %R 10.2196/40403 %U https://formative.jmir.org/2023/1/e40403 %U https://doi.org/10.2196/40403 %U http://www.ncbi.nlm.nih.gov/pubmed/36693148 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e40706 %T Evolving Face Mask Guidance During a Pandemic and Potential Harm to Public Perception: Infodemiology Study of Sentiment and Emotion on Twitter %A Ramjee,Divya %A Pollack,Catherine C %A Charpignon,Marie-Laure %A Gupta,Shagun %A Rivera,Jessica Malaty %A El Hayek,Ghinwa %A Dunn,Adam G %A Desai,Angel N %A Majumder,Maimuna S %+ Department of Internal Medicine, Division of Infectious Diseases, University of California-Davis Health Medical Center, 4301 X St., Sacramento, CA, 95817, United States, 1 916 734 2011, angel.n.desai@gmail.com %K face masks %K COVID-19 %K Twitter %K science communication %K political communication %K public policy %K public health %K sentiment analysis %K emotion analysis %K infodemiology %K infoveillance %D 2023 %7 27.2.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Throughout the COVID-19 pandemic, US Centers for Disease Control and Prevention policies on face mask use fluctuated. Understanding how public health communications evolve around key policy decisions may inform future decisions on preventative measures by aiding the design of communication strategies (eg, wording, timing, and channel) that ensure rapid dissemination and maximize both widespread adoption and sustained adherence. Objective: We aimed to assess how sentiment on masks evolved surrounding 2 changes to mask guidelines: (1) the recommendation for mask use on April 3, 2020, and (2) the relaxation of mask use on May 13, 2021. Methods: We applied an interrupted time series method to US Twitter data surrounding each guideline change. Outcomes were changes in the (1) proportion of positive, negative, and neutral tweets and (2) number of words within a tweet tagged with a given emotion (eg, trust). Results were compared to COVID-19 Twitter data without mask keywords for the same period. Results: There were fewer neutral mask-related tweets in 2020 (β=–3.94 percentage points, 95% CI –4.68 to –3.21; P<.001) and 2021 (β=–8.74, 95% CI –9.31 to –8.17; P<.001). Following the April 3 recommendation (β=.51, 95% CI .43-.59; P<.001) and May 13 relaxation (β=3.43, 95% CI 1.61-5.26; P<.001), the percent of negative mask-related tweets increased. The quantity of trust-related terms decreased following the policy change on April 3 (β=–.004, 95% CI –.004 to –.003; P<.001) and May 13 (β=–.001, 95% CI –.002 to 0; P=.008). Conclusions: The US Twitter population responded negatively and with less trust following guideline shifts related to masking, regardless of whether the guidelines recommended or relaxed mask usage. Federal agencies should ensure that changes in public health recommendations are communicated concisely and rapidly. %M 36763687 %R 10.2196/40706 %U https://www.jmir.org/2023/1/e40706 %U https://doi.org/10.2196/40706 %U http://www.ncbi.nlm.nih.gov/pubmed/36763687 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e42227 %T One Year of COVID-19 Vaccine Misinformation on Twitter: Longitudinal Study %A Pierri,Francesco %A DeVerna,Matthew R %A Yang,Kai-Cheng %A Axelrod,David %A Bryden,John %A Menczer,Filippo %+ Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Via Giuseppe Ponzio 34, Milano, 20129, Italy, 39 02 2399 3400, francesco.pierri@polimi.it %K content analysis %K COVID-19 %K infodemiology %K misinformation %K online health information %K social media %K trend analysis %K Twitter %K vaccines %K vaccine hesitancy %D 2023 %7 24.2.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Vaccinations play a critical role in mitigating the impact of COVID-19 and other diseases. Past research has linked misinformation to increased hesitancy and lower vaccination rates. Gaps remain in our knowledge about the main drivers of vaccine misinformation on social media and effective ways to intervene. Objective: Our longitudinal study had two primary objectives: (1) to investigate the patterns of prevalence and contagion of COVID-19 vaccine misinformation on Twitter in 2021, and (2) to identify the main spreaders of vaccine misinformation. Given our initial results, we further considered the likely drivers of misinformation and its spread, providing insights for potential interventions. Methods: We collected almost 300 million English-language tweets related to COVID-19 vaccines using a list of over 80 relevant keywords over a period of 12 months. We then extracted and labeled news articles at the source level based on third-party lists of low-credibility and mainstream news sources, and measured the prevalence of different kinds of information. We also considered suspicious YouTube videos shared on Twitter. We focused our analysis of vaccine misinformation spreaders on verified and automated Twitter accounts. Results: Our findings showed a relatively low prevalence of low-credibility information compared to the entirety of mainstream news. However, the most popular low-credibility sources had reshare volumes comparable to those of many mainstream sources, and had larger volumes than those of authoritative sources such as the US Centers for Disease Control and Prevention and the World Health Organization. Throughout the year, we observed an increasing trend in the prevalence of low-credibility news about vaccines. We also observed a considerable amount of suspicious YouTube videos shared on Twitter. Tweets by a small group of approximately 800 “superspreaders” verified by Twitter accounted for approximately 35% of all reshares of misinformation on an average day, with the top superspreader (@RobertKennedyJr) responsible for over 13% of retweets. Finally, low-credibility news and suspicious YouTube videos were more likely to be shared by automated accounts. Conclusions: The wide spread of misinformation around COVID-19 vaccines on Twitter during 2021 shows that there was an audience for this type of content. Our findings are also consistent with the hypothesis that superspreaders are driven by financial incentives that allow them to profit from health misinformation. Despite high-profile cases of deplatformed misinformation superspreaders, our results show that in 2021, a few individuals still played an outsized role in the spread of low-credibility vaccine content. As a result, social media moderation efforts would be better served by focusing on reducing the online visibility of repeat spreaders of harmful content, especially during public health crises. %M 36735835 %R 10.2196/42227 %U https://www.jmir.org/2023/1/e42227 %U https://doi.org/10.2196/42227 %U http://www.ncbi.nlm.nih.gov/pubmed/36735835 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 3 %N %P e38676 %T State and Federal Legislators’ Responses on Social Media to the Mental Health and Burnout of Health Care Workers Throughout the COVID-19 Pandemic: Natural Language Processing and Sentiment Analysis %A Abrams,Matthew P %A Pelullo,Arthur P %A Meisel,Zachary F %A Merchant,Raina M %A Purtle,Jonathan %A Agarwal,Anish K %+ Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, 8th Fl, 3600 Civic Center Blvd, Philadelphia, PA, 19104, United States, 1 619 227 9228, mattpabrams@knights.ucf.edu %K burnout %K wellness %K mental health %K social media %K policy %K health care workforce %K COVID-19 %K infodemiology %K healthcare worker %K mental well-being %K psychological distress %K Twitter %K content analysis %K thematic analysis %K policy maker %K healthcare workforce %K legislator %D 2023 %7 24.2.2023 %9 Original Paper %J JMIR Infodemiology %G English %X Background: Burnout and the mental health burden of the COVID-19 pandemic have disproportionately impacted health care workers. The links between state policies, federal regulations, COVID-19 case counts, strains on health care systems, and the mental health of health care workers continue to evolve. The language used by state and federal legislators in public-facing venues such as social media is important, as it impacts public opinion and behavior, and it also reflects current policy-leader opinions and planned legislation. Objective: The objective of this study was to examine legislators’ social media content on Twitter and Facebook throughout the COVID-19 pandemic to thematically characterize policy makers’ attitudes and perspectives related to mental health and burnout in the health care workforce. Methods: Legislators’ social media posts about mental health and burnout in the health care workforce were collected from January 2020 to November 2021 using Quorum, a digital database of policy-related documents. The total number of relevant social media posts per state legislator per calendar month was calculated and compared with COVID-19 case volume. Differences between themes expressed in Democratic and Republican posts were estimated using the Pearson chi-square test. Words within social media posts most associated with each political party were determined. Machine-learning was used to evaluate naturally occurring themes in the burnout- and mental health–related social media posts. Results: A total of 4165 social media posts (1400 tweets and 2765 Facebook posts) were generated by 2047 unique state and federal legislators and 38 government entities. The majority of posts (n=2319, 55.68%) were generated by Democrats, followed by Republicans (n=1600, 40.34%). Among both parties, the volume of burnout-related posts was greatest during the initial COVID-19 surge. However, there was significant variation in the themes expressed by the 2 major political parties. Themes most correlated with Democratic posts were (1) frontline care and burnout, (2) vaccines, (3) COVID-19 outbreaks, and (4) mental health services. Themes most correlated with Republican social media posts were (1) legislation, (2) call for local action, (3) government support, and (4) health care worker testing and mental health. Conclusions: State and federal legislators use social media to share opinions and thoughts on key topics, including burnout and mental health strain among health care workers. Variations in the volume of posts indicated that a focus on burnout and the mental health of the health care workforce existed early in the pandemic but has waned. Significant differences emerged in the content posted by the 2 major US political parties, underscoring how each prioritized different aspects of the crisis. %M 37013000 %R 10.2196/38676 %U https://infodemiology.jmir.org/2023/1/e38676 %U https://doi.org/10.2196/38676 %U http://www.ncbi.nlm.nih.gov/pubmed/37013000 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e37711 %T Effects of Social Media Use on Connectivity and Emotions During Pandemic-Induced School Closures: Qualitative Interview Study Among Adolescents %A Liang,Elisa %A Kutok,Emily R %A Rosen,Rochelle K %A Burke,Taylor A %A Ranney,Megan L %+ Brown-Lifespan Center for Digital Health, 139 Point St., Providence, RI, 02903, United States, 1 401 444 2557, megan_ranney@brown.edu %K social media %K adolescents %K COVID-19 %K emotions %K connectivity %D 2023 %7 23.2.2023 %9 Original Paper %J JMIR Ment Health %G English %X Background: The COVID-19 pandemic provided a unique opportunity to examine social media and technology use during a time in which technology served as adolescents’ primary form of socialization. The literature is mixed regarding how increased screen time during this period affected adolescent mental health and well-being. The mechanisms by which screen time use affected adolescent psychosocial outcomes are also unknown. Objective: We aimed to deepen our understanding of how social media and technology use, social connectivity, and emotional well-being intersected during pandemic-related school closures. Methods: English-speaking adolescents aged 13 to 17 years were recruited on Instagram for a brief screening survey; 39 participants were purposefully selected to complete a semistructured interview regarding their social media and technology use during the pandemic. Interview summaries were abstracted from recordings, and deductive codes were created for the primary question stems. These codes were subsequently reviewed for the main themes. Results: The main themes were as follows: adolescent social media and technology use during school closures usually allowed for more and easier social connectivity, but the amount and relative ease of connectivity differed according to purpose and type of use. Emotions, particularly those of stress and happiness, were connected to whether adolescents actively or passively engaged with social media and technology. Conclusions: Our results suggest a nuanced relationship among social media and technology use, adolescent social support, and emotional well-being, including during the pandemic. Specifically, how adolescents use or engage with web-based platforms greatly influences their ability to connect with others and their feelings of stress and happiness. In the context of the COVID-19 pandemic and as technology in general remains at the core of the adolescent experience, future research should continue to examine how adolescents navigate and use web-based spaces in beneficial and harmful ways. This will inform education and interventions that foster healthy social media and technological habits. %M 36054613 %R 10.2196/37711 %U https://mental.jmir.org/2023/1/e37711 %U https://doi.org/10.2196/37711 %U http://www.ncbi.nlm.nih.gov/pubmed/36054613 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 9 %N %P e42412 %T The Use of Open-Source Online Course Content for Training in Public Health Emergencies: Mixed Methods Case Study of a COVID-19 Course Series for Health Professionals %A Skinner,Nadine Ann %A Job,Nophiwe %A Krause,Julie %A Frankel,Ariel %A Ward,Victoria %A Johnston,Jamie Sewan %+ Stanford Center for Health Education, Stanford University, 408 Panama Mall, Stanford, CA, 94305, United States, 1 650 725 3000, nas2@stanford.edu %K global health education %K digital education %K digital health %K COVID-19 pandemic %K health care access %K partnerships for health %K community health workers %K remote learning %D 2023 %7 23.2.2023 %9 Original Paper %J JMIR Med Educ %G English %X Background: The onset of the COVID-19 pandemic generated an urgent need for credible and actionable information to guide public health responses. The massive open-source online course (MOOC) format may be a valuable path for disseminating timely and widely accessible training for health professionals during public health crises; however, the reach and effectiveness of health worker–directed online courses during the pandemic remain largely unexplored. Objective: This study investigated the use of an open-source online course series designed to provide critical COVID-19 knowledge to frontline health workers and public health professionals globally. The study investigated how open-source online educational content can be optimized to support knowledge sharing among health professionals in public health emergencies, particularly in resource-limited contexts. Methods: The study examined global course enrollment patterns (N=2185) and performed in-depth interviews with a purposive subsample of health professionals enrolled in the course series (N=12) to investigate the sharing of online content in pandemic responses. Interviewed learners were from Ethiopia, India, Kenya, Liberia, Malawi, Rwanda, Thailand, Uganda, the United Arab Emirates, and the United States. Inductive analysis and constant comparative methods were used to systematically code data and identify key themes emerging from interview data. Results: The analysis revealed that the online course content helped fill a critical gap in trustworthy COVID-19 information for pandemic responses and was shared through health worker professional and personal networks. Enrollment patterns and qualitative data illustrate how health professionals shared information within their professional networks. While learners shared the knowledge they gained from the course, they expressed a need for contextualized information to more effectively educate others in their networks and in their communities. Due to technological and logistical barriers, participants did not attempt to adapt the content to share with others. Conclusions: This study illustrates that health professional networks can facilitate the sharing of online open-source health education content; however, to fully leverage potential benefits, additional support is required to facilitate the adaptation of course content to more effectively reach communities globally. %M 36735834 %R 10.2196/42412 %U https://mededu.jmir.org/2023/1/e42412 %U https://doi.org/10.2196/42412 %U http://www.ncbi.nlm.nih.gov/pubmed/36735834 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e36023 %T Clinical Outcomes After Use of Inhaled Corticosteroids or Oral Steroids in a COVID-19 Telemedicine Clinic Cohort: Retrospective Chart Review %A Cellai,Michele %A Roberts,Jodi %A Moore,Miranda A %A Gandrakota,Nikhila %+ General Internal Medicine Seavey Clinic, School of Nursing, Emory University, 1365 General Internal Medicine, Atlanta, GA, 30338, United States, 1 404 778 0972, michele.cellai@emoryhealthcare.org %K COVID-19 %K lung %K post-acute sequela %K steroid use %K ICS %K pandemic %K therapy %K treatment %K steroid treatment %K COVID-19 treatment %K patient outcome %K pulmonary %K COVID symptoms %K telehealth %D 2023 %7 23.2.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: COVID-19 concerns remain among health care providers, as there are few outpatient treatment options. In the early days of the pandemic, treatment options for nonhospitalized patients were limited, and symptomatic treatment and home-grown guidelines that used recommendations from the Global Initiative for Asthma Management and Treatment were used. Objective: The possibility that inhaled corticosteroids (ICS) might reduce the risk of respiratory symptoms and promote recovery was the impetus for this review, as it has already been shown that in the nonhospitalized patient population, oral corticosteroids (OCS) in the acute phase could have an adverse effect on recovery. We investigated if (1) patients treated with ICS were less likely to require referral to a post–COVID-19 clinic or pulmonary specialist than patients without ICS treatment or with OCS therapy, and (2) if OCS use was associated with worse health outcomes. Methods: In a retrospective chart review, we identified all patients with acute illness due to COVID-19 that were followed and managed by a telemedicine clinic team between June and December 2020. The data were electronically pulled from electronic medical records through April 2021 and reviewed to determine which patients eventually required referral to a post–COVID-19 clinic or pulmonary specialist due to persistent respiratory symptoms of COVID-19. The data were then analyzed to compare outcomes between patients prescribed OCS and those prescribed ICS. We specifically looked at patients treated acutely with ICS or OCS that then required referral to a pulmonary specialist or post–COVID-19 clinic. We excluded any patients with a history of chronic OCS or ICS use for any reason. Results: Prescribing ICS during the acute phase did not reduce the possibility of developing persistent symptoms. There was no difference in the referral rate to a pulmonary specialist or post–COVID-19 clinic between patients treated with OCS versus ICS. However, our data may not be generalizable to other populations, as it represents a patient population enrolled in a telemedicine program at a single center. Conclusions: We found that ICS, as compared to OCS, did not reduce the risk of developing persistent respiratory symptoms. This finding adds to the body of knowledge that ICS and OCS medications remain potent treatments in patients with acute and postacute COVID-19 seen in an outpatient setting. %M 36480687 %R 10.2196/36023 %U https://formative.jmir.org/2023/1/e36023 %U https://doi.org/10.2196/36023 %U http://www.ncbi.nlm.nih.gov/pubmed/36480687 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e42677 %T Association of Depression With Precautionary Behavior Compliance, COVID-19 Fear, and Health Behaviors in South Korea: National Cross-sectional Study %A Shin,Hyerine %A Kim,Ji-Su %A Lee,HyunHae %+ Department of Nursing, Chung-ang University, 84 Heukseok-ro, Dongjak-gu, Seoul, 06974, Republic of Korea, 82 10 7117 5088, jisu80@cau.ac.kr %K COVID-19 %K precautionary behaviors %K COVID-19 fear %K health behavior deterioration %K gender differences %D 2023 %7 22.2.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: As of January 2022, the number of people infected with COVID-19 worldwide has exceeded 350 million. As the COVID-19 pandemic continues, people are affected in a wide range of areas of life, which in turn causes numerous psychological problems. Depression is a serious problem for people who have suffered from COVID-19. Depression can worsen COVID-19 precautionary behavior compliance or the health behavior itself. In addition, these depressive symptoms may have different characteristics depending on the individual’s gender. Objective: The aim of this study was to determine whether depression is a factor that may affect COVID-19 fear, precautionary behavior compliance, and health behavior, and how these characteristic trends differ by gender. Methods: This was a secondary analysis of data from the 2020 Korea Community Health Survey (KCHS), a national cross-sectional survey conducted with complex sampling analysis. In 2020, the KCHS included COVID-19–related questions. For this study, we used the KCHS data from both the COVID-19–related questions and the Patient Health Questionnaire-9 scale. After weighting the data according to the KCHS guidelines, we calculated the distribution of men and women according to depression level. The data were collected using multiple-choice questions related to precautionary behavior compliance, COVID-19–related fears, and health behavior changes. Results: Of the 204,787 participants, those who were clinically depressed had a greater tendency to not comply with precautionary behaviors. Regarding COVID-19, “fear” showed a decreasing trend in both men (adjusted odds ratio [AOR] 0.72, 95% CI 0.61-0.83) and women (AOR 0.74, 95% CI 0.63-0.86) with clinically relevant depression. Moreover, for both men and women, health behaviors deteriorated as depression intensified; the AOR for sleep duration changes was 2.28 (95% CI 2.00-2.59) in men and was 2.15 (95% CI 1.96-2.36) in women. Notably, the responses of clinically depressed women revealed a doubled increase in both their drinking (AOR 2.25, 95% CI 1.88-2.70) and smoking (AOR 2.71, 95% CI 1.95-3.77) habits compared with those of nondepressed women. Conclusions: Both men and women with more severe depression were more likely to violate precautionary health behaviors as their depression worsened. Health behaviors also deteriorated for both genders, but women tended to show a greater change. Therefore, additional studies and interventions for vulnerable groups such as severely depressed people are needed. More research is also necessary to develop interventions based on statistical comparisons of men and women. %M 36716130 %R 10.2196/42677 %U https://publichealth.jmir.org/2023/1/e42677 %U https://doi.org/10.2196/42677 %U http://www.ncbi.nlm.nih.gov/pubmed/36716130 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e40552 %T Changes in Mobile Health Apps Usage Before and After the COVID-19 Outbreak in China: Semilongitudinal Survey %A Yang,Le %A Wu,Jiadong %A Mo,Xiaoxiao %A Chen,Yaqin %A Huang,Shanshan %A Zhou,Linlin %A Dai,Jiaqi %A Xie,Linna %A Chen,Siyu %A Shang,Hao %A Rao,Beibei %A Weng,Bingtao %A Abulimiti,Ayiguli %A Wu,Siying %A Xie,Xiaoxu %+ School of Public Health, Fujian Medical University, No. 1 Xuefu North Road, Fuzhou University New District, Fuzhou, 350122, China, 86 059122862023, xiexiaoxu@aliyun.com %K application %K China %K COVID-19 %K mHealth %K health management %K mobile health %K technology %K app %K survey %K data %K user %K user experience %K vaccination %K download %K healthcare %K development %D 2023 %7 22.2.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Mobile health (mHealth) apps are rapidly emerging technologies in China due to strictly controlled medical needs during the COVID-19 pandemic while continuing essential services for chronic diseases. However, there have been no large-scale, systematic efforts to evaluate relevant apps. Objective: We aim to provide a landscape of mHealth apps in China by describing and comparing digital health concerns before and after the COVID-19 outbreak, including mHealth app data flow and user experience, and analyze the impact of COVID-19 on mHealth apps. Methods: We conducted a semilongitudinal survey of 1593 mHealth apps to study the app data flow and clarify usage changes and influencing factors. We selected mHealth apps in app markets, web pages from the Baidu search engine, the 2018 top 100 hospitals with internet hospitals, and online shopping sites with apps that connect to smart devices. For user experience, we recruited residents from a community in southeastern China from October 2019 to November 2019 (before the outbreak) and from June 2020 to August 2020 (after the outbreak) comparing the attention of the population to apps. We also examined associations between app characteristics, functions, and outcomes at specific quantiles of distribution in download changes using quantile regression models. Results: Rehabilitation medical support was the top-ranked functionality, with a median 1.44 million downloads per app prepandemic and a median 2.74 million downloads per app postpandemic. Among the top 10 functions postpandemic, 4 were related to maternal and child health: pregnancy preparation (ranked second; fold change 4.13), women's health (ranked fifth; fold change 5.16), pregnancy (ranked sixth; fold change 5.78), and parenting (ranked tenth; fold change 4.03). Quantile regression models showed that rehabilitation (P75, P90), pregnancy preparation (P90), bodybuilding (P50, P90), and vaccination (P75) were positively associated with an increase in downloads after the outbreak. In the user experience survey, the attention given to health information (prepandemic: 249/375, 66.4%; postpandemic: 146/178, 82.0%; P=.006) steadily increased after the outbreak. Conclusions: mHealth apps are an effective health care approach gaining in popularity among the Chinese population following the COVID-19 outbreak. This research provides direction for subsequent mHealth app development and promotion in the postepidemic era, supporting medical model reformation in China as a reference, which may provide new avenues for designing and evaluating indirect public health interventions such as health education and health promotion. %M 36634256 %R 10.2196/40552 %U https://publichealth.jmir.org/2023/1/e40552 %U https://doi.org/10.2196/40552 %U http://www.ncbi.nlm.nih.gov/pubmed/36634256 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 3 %N %P e42357 %T Attitudes of Swedish Language Twitter Users Toward COVID-19 Vaccination: Exploratory Qualitative Study %A Beirakdar,Safwat %A Klingborg,Leon %A Herzig van Wees,Sibylle %+ Karolinska Institute, Department of Global Public Health, K9 Global folkhälsa, Tomtebodavägen 18A, Stockholm, 17177, Sweden, 46 735351190, sibylle.hvw@ki.se %K COVID-19 %K vaccine hesitancy %K COVID-19 vaccines %K social media %K Twitter %K qualitative analysis %K World Health Organization %K WHO’s 3C model %D 2023 %7 22.2.2023 %9 Original Paper %J JMIR Infodemiology %G English %X Background: Social media have played an important role in shaping COVID-19 vaccine choices during the pandemic. Understanding people’s attitudes toward the vaccine as expressed on social media can help address the concerns of vaccine-hesitant individuals. Objective: The aim of this study was to understand the attitudes of Swedish-speaking Twitter users toward COVID-19 vaccines. Methods: This was an exploratory qualitative study that used a social media–listening approach. Between January and March 2022, a total of 2877 publicly available tweets in Swedish were systematically extracted from Twitter. A deductive thematic analysis was conducted using the World Health Organization’s 3C model (confidence, complacency, and convenience). Results: Confidence in the safety and effectiveness of the COVID-19 vaccine appeared to be a major concern expressed on Twitter. Unclear governmental strategies in managing the pandemic in Sweden and the belief in conspiracy theories have further influenced negative attitudes toward vaccines. Complacency—the perceived risk of COVID-19 was low and booster vaccination was unnecessary; many expressed trust in natural immunity. Convenience—in terms of accessing the right information and the vaccine—highlighted a knowledge gap about the benefits and necessity of the vaccine, as well as complaints about the quality of vaccination services. Conclusions: Swedish-speaking Twitter users in this study had negative attitudes toward COVID-19 vaccines, particularly booster vaccines. We identified attitudes toward vaccines and misinformation, indicating that social media monitoring can help policy makers respond by developing proactive health communication interventions. %M 37012999 %R 10.2196/42357 %U https://infodemiology.jmir.org/2023/1/e42357 %U https://doi.org/10.2196/42357 %U http://www.ncbi.nlm.nih.gov/pubmed/37012999 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e39992 %T Regional Difference in the Impact of COVID-19 Pandemic on Domain-Specific Physical Activity, Sedentary Behavior, Sleeping Time, and Step Count: Web-Based Cross-sectional Nationwide Survey and Accelerometer-Based Observational Study %A Yamada,Yosuke %A Namba,Hideyuki %A Date,Heiwa %A Kitayama,Shinobu %A Nakayama,Yui %A Kimura,Misaka %A Fujita,Hiroyuki %A Miyachi,Motohiko %+ Department of Physical Activity Research, National Institute of Biomedical Innovation, Health and Nutrition, 3-17, Senrioka-shinmachi, Settsu-shi, Osaka, 5660002, Japan, 81 9078318291, yamaday@nibiohn.go.jp %K web-based survey %K social distancing measure %K transportation %K physical activity record system %K physical activity %K sedentary %K sleep %K sleeping time %K COVID-19 %K impact %K pandemic %K sleeping pattern %K surveillance %K demographic %K regional %K differences %D 2023 %7 20.2.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Physical activity (PA) and sedentary behavior (SB) have been affected by the COVID-19 pandemic and its restrictive environments, such as social distancing and lockdown measures. However, regional differences in the changes in domain-specific PA and SB in response to the COVID-19 pandemic are not clearly understood. Objective: This study aimed to examine regional differences in domain-specific PA and SB, as well as sleeping time in response to the COVID-19 pandemic in Japan. Methods: A web-based cross-sectional nationwide survey and an accelerometer-based longitudinal observation were conducted. In the web-based survey, we recruited 150 Japanese men and 150 Japanese women for each of the following age groups: 20s, 30s, 40s, 50s, 60s, and 70s (n=1800). A total of 1627 adults provided valid responses to web-based surveillance from June to July 2020. Participants were recruited from urban (Greater Tokyo Area, n=1028), urban-rural (regional core cities, n=459), or rural (regional small and medium cities, n=140) areas. They answered sociodemographic and health-related questions and retrospectively registered the PA data of their average day before and during the COVID-19 pandemic in a web-based PA record system. In the accelerometer-based observation, PA and step count data were obtained using a triaxial accelerometer on people living in urban (n=370) and rural (n=308) areas. Results: Before the COVID-19 pandemic, there were no significant differences between these 3 regions in the time spent sleeping, staying at home, working or studying, and exercising (P>.05). By contrast, people living in urban areas had a longer duration of SB and transportation and a shorter duration of moderate-to-vigorous PA and lying or napping time compared with people living in rural areas (P>.05). During the COVID-19 pandemic, a significant decrease was observed in transportation time in urban (–7.2 min/day, P<.001) and urban-rural (–2.0 min/day, P=.009) areas but not in rural (–0.4 min/day, P=.52) areas. The moderate-to-vigorous PA was decreased in urban (–31.3 min/day, P<.001) and urban-rural (–30.0 min/day, P<.001) areas but not in rural areas (–17.3 min/day, P=.08). A significant increase was observed in time spent sleeping in urban (+22.4 min/day, P<.001) and urban-rural (+24.2 min/day, P<.001) but not in rural areas (+3.9 min/day, P=.74). Lying or napping was increased in urban (+14.9 min/day, P<.001) but not in rural areas (−6.9 min/day, P=.68). PA and step count obtained using an accelerometer significantly decreased in urban (P<.05) but not in rural areas (P>.05). Conclusions: The effect of the COVID-19 pandemic on PA and SB was significantly dependent on living area, even in a single country. The effects of PA and SB were greater in the Greater Tokyo Area and regional core cities but were not observed in regional small and medium cities in Japan. %M 36634262 %R 10.2196/39992 %U https://publichealth.jmir.org/2023/1/e39992 %U https://doi.org/10.2196/39992 %U http://www.ncbi.nlm.nih.gov/pubmed/36634262 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 3 %N %P e44207 %T Measuring the Burden of Infodemics: Summary of the Methods and Results of the Fifth WHO Infodemic Management Conference %A Wilhelm,Elisabeth %A Ballalai,Isabella %A Belanger,Marie-Eve %A Benjamin,Peter %A Bertrand-Ferrandis,Catherine %A Bezbaruah,Supriya %A Briand,Sylvie %A Brooks,Ian %A Bruns,Richard %A Bucci,Lucie M %A Calleja,Neville %A Chiou,Howard %A Devaria,Abhinav %A Dini,Lorena %A D'Souza,Hyjel %A Dunn,Adam G %A Eichstaedt,Johannes C %A Evers,Silvia M A A %A Gobat,Nina %A Gissler,Mika %A Gonzales,Ian Christian %A Gruzd,Anatoliy %A Hess,Sarah %A Ishizumi,Atsuyoshi %A John,Oommen %A Joshi,Ashish %A Kaluza,Benjamin %A Khamis,Nagwa %A Kosinska,Monika %A Kulkarni,Shibani %A Lingri,Dimitra %A Ludolph,Ramona %A Mackey,Tim %A Mandić-Rajčević,Stefan %A Menczer,Filippo %A Mudaliar,Vijaybabu %A Murthy,Shruti %A Nazakat,Syed %A Nguyen,Tim %A Nilsen,Jennifer %A Pallari,Elena %A Pasternak Taschner,Natalia %A Petelos,Elena %A Prinstein,Mitchell J %A Roozenbeek,Jon %A Schneider,Anton %A Srinivasan,Varadharajan %A Stevanović,Aleksandar %A Strahwald,Brigitte %A Syed Abdul,Shabbir %A Varaidzo Machiri,Sandra %A van der Linden,Sander %A Voegeli,Christopher %A Wardle,Claire %A Wegwarth,Odette %A White,Becky K %A Willie,Estelle %A Yau,Brian %A Purnat,Tina D %+ Department of Epidemic and Pandemic Preparedness and Prevention, World Health Organization, Avenue Appia 20, Geneva, 1211, Switzerland, 41 22 791 21 11, purnatt@who.int %K COVID-19 %K infodemic %K burden of infodemic %K infodemic management %K infodemic metrics %K World Health Organization %K technical consultation %K infodemiology %D 2023 %7 20.2.2023 %9 Original Paper %J JMIR Infodemiology %G English %X Background: An infodemic is excess information, including false or misleading information, that spreads in digital and physical environments during a public health emergency. The COVID-19 pandemic has been accompanied by an unprecedented global infodemic that has led to confusion about the benefits of medical and public health interventions, with substantial impact on risk-taking and health-seeking behaviors, eroding trust in health authorities and compromising the effectiveness of public health responses and policies. Standardized measures are needed to quantify the harmful impacts of the infodemic in a systematic and methodologically robust manner, as well as harmonizing highly divergent approaches currently explored for this purpose. This can serve as a foundation for a systematic, evidence-based approach to monitoring, identifying, and mitigating future infodemic harms in emergency preparedness and prevention. Objective: In this paper, we summarize the Fifth World Health Organization (WHO) Infodemic Management Conference structure, proceedings, outcomes, and proposed actions seeking to identify the interdisciplinary approaches and frameworks needed to enable the measurement of the burden of infodemics. Methods: An iterative human-centered design (HCD) approach and concept mapping were used to facilitate focused discussions and allow for the generation of actionable outcomes and recommendations. The discussions included 86 participants representing diverse scientific disciplines and health authorities from 28 countries across all WHO regions, along with observers from civil society and global public health–implementing partners. A thematic map capturing the concepts matching the key contributing factors to the public health burden of infodemics was used throughout the conference to frame and contextualize discussions. Five key areas for immediate action were identified. Results: The 5 key areas for the development of metrics to assess the burden of infodemics and associated interventions included (1) developing standardized definitions and ensuring the adoption thereof; (2) improving the map of concepts influencing the burden of infodemics; (3) conducting a review of evidence, tools, and data sources; (4) setting up a technical working group; and (5) addressing immediate priorities for postpandemic recovery and resilience building. The summary report consolidated group input toward a common vocabulary with standardized terms, concepts, study designs, measures, and tools to estimate the burden of infodemics and the effectiveness of infodemic management interventions. Conclusions: Standardizing measurement is the basis for documenting the burden of infodemics on health systems and population health during emergencies. Investment is needed into the development of practical, affordable, evidence-based, and systematic methods that are legally and ethically balanced for monitoring infodemics; generating diagnostics, infodemic insights, and recommendations; and developing interventions, action-oriented guidance, policies, support options, mechanisms, and tools for infodemic managers and emergency program managers. %M 37012998 %R 10.2196/44207 %U https://infodemiology.jmir.org/2023/1/e44207 %U https://doi.org/10.2196/44207 %U http://www.ncbi.nlm.nih.gov/pubmed/37012998 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e38439 %T Nighttime Continuous Contactless Smartphone-Based Cough Monitoring for the Ward: Validation Study %A Barata,Filipe %A Cleres,David %A Tinschert,Peter %A Iris Shih,Chen-Hsuan %A Rassouli,Frank %A Boesch,Maximilian %A Brutsche,Martin %A Fleisch,Elgar %+ Center for Digital Health Interventions, Department of Management, Technology, and Economics, ETH Zurich, Weinbergstrasse 56/58, Zurich, 8092, Switzerland, 41 44 632 35 0, fbarata@ethz.ch %K cough monitoring %K ward monitoring %K mobile sensing %K machine learning %K convolutional neural network %K COVID-19 %K mobile phone %D 2023 %7 20.2.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Clinical deterioration can go unnoticed in hospital wards for hours. Mobile technologies such as wearables and smartphones enable automated, continuous, noninvasive ward monitoring and allow the detection of subtle changes in vital signs. Cough can be effectively monitored through mobile technologies in the ward, as it is not only a symptom of prevalent respiratory diseases such as asthma, lung cancer, and COVID-19 but also a predictor of acute health deterioration. In past decades, many efforts have been made to develop an automatic cough counting tool. To date, however, there is neither a standardized, sufficiently validated method nor a scalable cough monitor that can be deployed on a consumer-centric device that reports cough counts continuously. These shortcomings limit the tracking of coughing and, consequently, hinder the monitoring of disease progression in prevalent respiratory diseases such as asthma, chronic obstructive pulmonary disease, and COVID-19 in the ward. Objective: This exploratory study involved the validation of an automated smartphone-based monitoring system for continuous cough counting in 2 different modes in the ward. Unlike previous studies that focused on evaluating cough detection models on unseen data, the focus of this work is to validate a holistic smartphone-based cough detection system operating in near real time. Methods: Automated cough counts were measured consistently on devices and on computers and compared with cough and noncough sounds counted manually over 8-hour long nocturnal recordings in 9 patients with pneumonia in the ward. The proposed cough detection system consists primarily of an Android app running on a smartphone that detects coughs and records sounds and secondarily of a backend that continuously receives the cough detection information and displays the hourly cough counts. Cough detection is based on an ensemble convolutional neural network developed and trained on asthmatic cough data. Results: In this validation study, a total of 72 hours of recordings from 9 participants with pneumonia, 4 of whom were infected with SARS-CoV-2, were analyzed. All the recordings were subjected to manual analysis by 2 blinded raters. The proposed system yielded a sensitivity and specificity of 72% and 99% on the device and 82% and 99% on the computer, respectively, for detecting coughs. The mean differences between the automated and human rater cough counts were −1.0 (95% CI −12.3 to 10.2) and −0.9 (95% CI −6.5 to 4.8) coughs per hour within subject for the on-device and on-computer modes, respectively. Conclusions: The proposed system thus represents a smartphone cough counter that can be used for continuous hourly assessment of cough frequency in the ward. %M 36655551 %R 10.2196/38439 %U https://formative.jmir.org/2023/1/e38439 %U https://doi.org/10.2196/38439 %U http://www.ncbi.nlm.nih.gov/pubmed/36655551 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e40161 %T Community-Based Public Health Vaccination Campaign (VaccinateLA) in Los Angeles’ Black and Latino Communities: Protocol for a Participatory Study %A Kipke,Michele D %A Karimipour,Nicki %A Wolfe,Nicole %A Orechwa,Allison %A Stoddard,Laura %A Rubio-Diaz,Mayra %A North,Gemma %A Dezfuli,Ghazal %A Murphy,Sheila %A Phelps,Ashley %A Kagan,Jeremy %A De La Haye,Kayla %A Perry,Christina %A Baezconde-Garbanati,Lourdes %+ Southern California Clinical and Translational Science Institute, University of Southern California, 2250 Alcazar street, ste 200, Los Angeles, CA, 90089, United States, 1 323 630 4816, mkipke@chla.usc.edu %K community engagement %K COVID-19 %K vaccine %K vaccination %K public health %K population health %K health equity %K social media %K vaccine hesitancy %D 2023 %7 20.2.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: The COVID-19 pandemic has significantly affected Los Angeles County and disproportionately impacted Black and Latino populations who experienced disparities in rates of infection, hospitalizations, morbidity, and mortality. The University of Southern California (USC), USC Keck School of Medicine, Southern California Clinical and Translational Science Institute, USC Mann School of Pharmacy and Pharmaceutical Sciences, Annenberg School for Journalism and Communication, and Children’s Hospital Los Angeles will launch a collaborative public health campaign called VaccinateLA. Objective: VaccinateLA will implement a community-based, community-partnered public health campaign that (1) delivers culturally tailored information about COVID-19 and available vaccines; and (2) addresses misinformation and disinformation, which serves as a barrier to vaccine uptake. The campaign will be targeted to communities in Los Angeles with the highest rates of COVID-19 infection and the lowest vaccination rates. Using these criteria, the campaign will be targeted to neighborhoods located in 34 zip codes in the Eastside and South Los Angeles. The primary aim of VaccinateLA will be to design and deliver an evidence-based multimedia public health campaign tailored for Black and Latino populations. A secondary aim will be to train and deploy community vaccine navigators to deliver COVID-19 education, help individuals overcome barriers to getting vaccinated (eg, transportation and challenges registering), and assist with delivering vaccinations in our targeted communities. Methods: We will use a community-based, participatory research approach to shape VaccinateLA’s public health campaign to address community members’ attitudes and concerns in developing campaign content. We will conduct focus groups, establish a community advisory board, and engage local leaders and stakeholders to develop and implement a broad array of educational, multimedia, and field-based activities. Results: As of February 2023, target communities have been identified. The activities will be initiated and evaluated over the course of this year-long initiative, and dissemination will occur following the completion of the project. Conclusions: Engaging the community is vital to developing culturally tailored public health messages that will resonate with intended audiences. VaccinateLA will serve as a model for how an academic institution can quickly mobilize to address a pressing public health crisis, particularly in underrepresented and underresourced communities. Our work has important implications for future public health campaigns. By leveraging community partnerships and deploying community health workers or promotores into the community, we hope to demonstrate that urban universities can successfully partner with local communities to develop and deliver a range of culturally tailored educational, multimedia, and field-based activities, which in turn may change the course of an urgent public health crisis, such as the COVID-19 pandemic. International Registered Report Identifier (IRRID): PRR1-10.2196/40161 %M 36757953 %R 10.2196/40161 %U https://www.researchprotocols.org/2023/1/e40161 %U https://doi.org/10.2196/40161 %U http://www.ncbi.nlm.nih.gov/pubmed/36757953 %0 Journal Article %I %V %N %P %T %D %7 .. %9 %J %G English %X %U %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e38163 %T Substance Use From Social Distancing and Isolation by US Nativity During the Time of COVID-19: Cross-sectional Study %A Montiel Ishino,Francisco Alejandro %A Villalobos,Kevin %A Williams,Faustine %+ Division of Intramural Research, National Institute of Environmental Health Sciences, National Institutes of Health, 111 TW Alexander Dr, Durham, NC, 27709, United States, 1 6143643314, francisco.montielishino@nih.gov %K substance use %K COVID-19 %K US nativity %D 2023 %7 17.2.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The COVID-19 pandemic had many unprecedented secondary outcomes resulting in various mental health issues leading to substance use as a coping behavior. The extent of changes in substance use in a US sample by nativity has not been previously described. Objective: This study aimed to design a web-based survey to assess the social distancing and isolation issues exacerbated by the COVID-19 pandemic to describe substance use as a coping behavior by comparing substance use changes before and during the pandemic. Methods: A comprehensive 116-item survey was designed to understand the impact of COVID-19 and social distancing on physical and psychosocial mental health and chronic diseases. Approximately 10,000 web-based surveys were distributed by Qualtrics LLC between May 13, 2021, and January 09, 2022, across the United States (ie, continental United States, Hawaii, Alaska, and territories) to adults aged ≥18 years. We oversampled low-income and rural adults among non-Hispanic White, non-Hispanic Black, Hispanic or Latino, and foreign-born participants. Of the 5938 surveys returned, 5413 (91.16%) surveys were used after proprietary expert review fraud detection (Qualtrics) and detailed assessments of the completion rate and the timing to complete the survey. Participant demographics, substance use coping behaviors, and substance use before and during the pandemic are described by the overall US resident sample, followed by US-born and foreign-born self-reports. Substance use included the use of tobacco, e-cigarettes or nicotine vapes, alcohol, marijuana, and other illicit substances. Marginal homogeneity based on the Stuart-Maxwell test was used to assess changes in self-reported substance use before and during the pandemic. Results: The sample mostly included White (2182/5413, 40.31%) and women participants (3369/5406, 62.32%) who identified as straight or heterosexual (4805/5406, 88.88%), reported making ≥US $75,000 (1405/5355, 26.23%), and had vocational or technical training (1746/5404, 32.31%). Similarities were observed between the US-born and the foreign-born participants on increased alcohol consumption: from no alcohol consumption before the pandemic to consuming alcohol once to several times a month and from once to several times per week to every day to several times per day. Although significant changes were observed from no prior alcohol use to some level of increased use, the opposite was also observed and was more pronounced among foreign-born participants. That is, there was a 5.1% overall change in some level of alcohol use before the pandemic to no alcohol use during the pandemic among foreign-born individuals, compared with a 4.3% change among US-born individuals. Conclusions: To better prepare for the inadvertent effects of public health policies meant to protect individuals, we must understand the mental health burdens that can precipitate into substance use coping mechanisms that not only have a deleterious effect on physical and mental health but also exacerbate morbidity and mortality in a disease like COVID-19. %M 36265162 %R 10.2196/38163 %U https://publichealth.jmir.org/2023/1/e38163 %U https://doi.org/10.2196/38163 %U http://www.ncbi.nlm.nih.gov/pubmed/36265162 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e42717 %T Deep Learning With Chest Radiographs for Making Prognoses in Patients With COVID-19: Retrospective Cohort Study %A Lee,Hyun Woo %A Yang,Hyun Jun %A Kim,Hyungjin %A Kim,Ue-Hwan %A Kim,Dong Hyun %A Yoon,Soon Ho %A Ham,Soo-Youn %A Nam,Bo Da %A Chae,Kum Ju %A Lee,Dabee %A Yoo,Jin Young %A Bak,So Hyeon %A Kim,Jin Young %A Kim,Jin Hwan %A Kim,Ki Beom %A Jung,Jung Im %A Lim,Jae-Kwang %A Lee,Jong Eun %A Chung,Myung Jin %A Lee,Young Kyung %A Kim,Young Seon %A Lee,Sang Min %A Kwon,Woocheol %A Park,Chang Min %A Kim,Yun-Hyeon %A Jeong,Yeon Joo %A Jin,Kwang Nam %A Goo,Jin Mo %+ Department of Radiology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, 20, Boramae-ro 5-gil, Dongjak-gu, Seoul, 07061, Republic of Korea, 82 2 870 2536, wlsrhkdska@gmail.com %K COVID-19 %K deep learning %K artificial intelligence %K radiography, thoracic %K prognosis %K AI model %K prediction model %K clinical outcome %K medical imaging %K machine learning %D 2023 %7 16.2.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: An artificial intelligence (AI) model using chest radiography (CXR) may provide good performance in making prognoses for COVID-19. Objective: We aimed to develop and validate a prediction model using CXR based on an AI model and clinical variables to predict clinical outcomes in patients with COVID-19. Methods: This retrospective longitudinal study included patients hospitalized for COVID-19 at multiple COVID-19 medical centers between February 2020 and October 2020. Patients at Boramae Medical Center were randomly classified into training, validation, and internal testing sets (at a ratio of 8:1:1, respectively). An AI model using initial CXR images as input, a logistic regression model using clinical information, and a combined model using the output of the AI model (as CXR score) and clinical information were developed and trained to predict hospital length of stay (LOS) ≤2 weeks, need for oxygen supplementation, and acute respiratory distress syndrome (ARDS). The models were externally validated in the Korean Imaging Cohort of COVID-19 data set for discrimination and calibration. Results: The AI model using CXR and the logistic regression model using clinical variables were suboptimal to predict hospital LOS ≤2 weeks or the need for oxygen supplementation but performed acceptably in the prediction of ARDS (AI model area under the curve [AUC] 0.782, 95% CI 0.720-0.845; logistic regression model AUC 0.878, 95% CI 0.838-0.919). The combined model performed better in predicting the need for oxygen supplementation (AUC 0.704, 95% CI 0.646-0.762) and ARDS (AUC 0.890, 95% CI 0.853-0.928) compared to the CXR score alone. Both the AI and combined models showed good calibration for predicting ARDS (P=.079 and P=.859). Conclusions: The combined prediction model, comprising the CXR score and clinical information, was externally validated as having acceptable performance in predicting severe illness and excellent performance in predicting ARDS in patients with COVID-19. %M 36795468 %R 10.2196/42717 %U https://www.jmir.org/2023/1/e42717 %U https://doi.org/10.2196/42717 %U http://www.ncbi.nlm.nih.gov/pubmed/36795468 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e42671 %T Evolution of Public Attitudes and Opinions Regarding COVID-19 Vaccination During the Vaccine Campaign in China: Year-Long Infodemiology Study of Weibo Posts %A Hong,Yimin %A Xie,Fang %A An,Xinyu %A Lan,Xue %A Liu,Chunhe %A Yan,Lei %A Zhang,Han %+ School of Health Management, China Medical University, No.77 Puhe Road, Shenyang North New Area, Shenyang, 110122, China, 86 13314208697, zhanghan@cmu.edu.cn %K COVID-19 vaccines %K social media %K infodemiology %K sentiment analysis %K opinion analysis %K monitoring public attitude %K gender differences %K LDA %K COVID-19 %D 2023 %7 16.2.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Monitoring people’s perspectives on the COVID-19 vaccine is crucial for understanding public vaccination hesitancy and developing effective, targeted vaccine promotion strategies. Although this is widely recognized, studies on the evolution of public opinion over the course of an actual vaccination campaign are rare. Objective: We aimed to track the evolution of public opinion and sentiment toward COVID-19 vaccines in online discussions over an entire vaccination campaign. Moreover, we aimed to reveal the pattern of gender differences in attitudes and perceptions toward vaccination. Methods: We collected COVID-19 vaccine–related posts by the general public that appeared on Sina Weibo from January 1, 2021, to December 31, 2021; this period covered the entire vaccination process in China. We identified popular discussion topics using latent Dirichlet allocation. We further examined changes in public sentiment and topics during the 3 stages of the vaccination timeline. Gender differences in perceptions toward vaccination were also investigated. Results: Of 495,229 crawled posts, 96,145 original posts from individual accounts were included. Most posts presented positive sentiments (positive: 65,981/96,145, 68.63%; negative: 23,184/96,145, 24.11%; neutral: 6980/96,145, 7.26%). The average sentiment scores were 0.75 (SD 0.35) for men and 0.67 (SD 0.37) for women. The overall trends in sentiment scores showed a mixed response to the number of new cases and significant events related to vaccine development and important holidays. The sentiment scores showed a weak correlation with new case numbers (R=0.296; P=.03). Significant sentiment score differences were observed between men and women (P<.001). Common and distinguishing characteristics were found among frequently discussed topics during the different stages, with significant differences in topic distribution between men and women (January 1, 2021, to March 31, 2021: χ23=3030.9; April 1, 2021, to September 30, 2021: χ24=8893.8; October 1, 2021, to December 31, 2021: χ25=3019.5; P<.001). Women were more concerned with side effects and vaccine effectiveness. In contrast, men reported broader concerns around the global pandemic, the progress of vaccine development, and economics affected by the pandemic. Conclusions: Understanding public concerns regarding vaccination is essential for reaching vaccine-induced herd immunity. This study tracked the year-long evolution of attitudes and opinions on COVID-19 vaccines according to the different stages of vaccination in China. These findings provide timely information that will enable the government to understand the reasons for low vaccine uptake and promote COVID-19 vaccination nationwide. %M 36795467 %R 10.2196/42671 %U https://www.jmir.org/2023/1/e42671 %U https://doi.org/10.2196/42671 %U http://www.ncbi.nlm.nih.gov/pubmed/36795467 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e39166 %T Using Location Intelligence to Evaluate the COVID-19 Vaccination Campaign in the United States: Spatiotemporal Big Data Analysis %A Li,Qingfeng %A Peng,James Cheng %A Mohan,Diwakar %A Lake,Brennan %A Euler,Alex Ruiz %A Weir,Brian %A Kan,Lena %A Yang,Cui %A Labrique,Alain %+ Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, United States, 1 4106141419, qli28@jhu.edu %K COVID-19 vaccine %K vaccine campaign %K big data %K vaccination %K vaccine %K COVID-19 %K uptake %K effectiveness %K barriers %K hesitancy %K health information %D 2023 %7 16.2.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Highly effective COVID-19 vaccines are available and free of charge in the United States. With adequate coverage, their use may help return life back to normal and reduce COVID-19–related hospitalization and death. Many barriers to widespread inoculation have prevented herd immunity, including vaccine hesitancy, lack of vaccine knowledge, and misinformation. The Ad Council and COVID Collaborative have been conducting one of the largest nationwide targeted campaigns (“It’s Up to You”) to communicate vaccine information and encourage timely vaccination across the United States. More than 300 major brands, digital and print media companies, and community-based organizations support the campaigns to reach distinct audiences. Objective: The goal of this study was to use aggregated mobility data to assess the effectiveness of the campaign on COVID-19 vaccine uptake. Methods: Campaign exposure data were collected from the Cuebiq advertising impact measurement platform consisting of about 17 million opted-in and deidentified mobile devices across the country. A Bayesian spatiotemporal hierarchical model was developed to assess campaign effectiveness through estimating the association between county-level campaign exposure and vaccination rates reported by the Centers for Disease Control and Prevention. To minimize potential bias in exposure to the campaign, the model included several control variables (eg, age, race or ethnicity, income, and political affiliation). We also incorporated conditional autoregressive residual models to account for apparent spatiotemporal autocorrelation. Results: The data set covers a panel of 3104 counties from 48 states and the District of Columbia during a period of 22 weeks (March 29 to August 29, 2021). Officially launched in February 2021, the campaign reached about 3% of the anonymous devices on the Cuebiq platform by the end of March, which was the start of the study period. That exposure rate gradually declined to slightly above 1% in August 2021, effectively ending the study period. Results from the Bayesian hierarchical model indicate a statistically significant positive association between campaign exposure and vaccine uptake at the county level. A campaign that reaches everyone would boost the vaccination rate by 2.2% (95% uncertainty interval: 2.0%-2.4%) on a weekly basis, compared to the baseline case of no campaign. Conclusions: The “It’s Up to You” campaign is effective in promoting COVID-19 vaccine uptake, suggesting that a nationwide targeted mass media campaign with multisectoral collaborations could be an impactful health communication strategy to improve progress against this and future pandemics. Methodologically, the results also show that location intelligence and mobile phone–based monitoring platforms can be effective in measuring impact of large-scale digital campaigns in near real time. %M 36626835 %R 10.2196/39166 %U https://publichealth.jmir.org/2023/1/e39166 %U https://doi.org/10.2196/39166 %U http://www.ncbi.nlm.nih.gov/pubmed/36626835 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e40772 %T The Impact of the COVID-19 Pandemic on Female Sexual Function in Jordan: Cross-sectional Study %A Aolymat,Iman %A Abdul Kadir,Lina %A Al Nsour,Mohannad %A Taha,Hana %+ Department of Anatomy, Physiology and Biochemistry, Faculty of Medicine, The Hashemite University, PO Box 330127, Zarqa, 13133, Jordan, 962 53903333 ext 5426, imank@hu.edu.jo %K COVID-19 %K pandemic %K female sexual function %K sexual dysfunction %K stress physiology %K Jordan %D 2023 %7 16.2.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Sexual function is a complex physiological process controlled by neurovascular and endocrine mechanisms that are affected by stressful events. The sexual response cycle consists of four main phases, which are sexual desire or libido, arousal or excitement, orgasm, and resolution. The COVID-19 outbreak is one of the most stressful events historically, causing several unpleasant consequences, including major physical and mental disorders, and sexual dysfunction and alteration in sexual behavior are possible anticipated consequences of the pandemic. Moreover, there are social taboos related to sexual behavior in Jordan, and the current knowledge on changes in Jordanian female sexual function during COVID-19 pandemic is limited. Objective: This study aims to evaluate the impact of COVID‐19 on women's sexual function during the early COVID-19 pandemic in Jordan. Methods: This is a cross-sectional study that employed a web-based survey to follow 200 female individuals from the general population in Jordan. The survey evaluated sexual function both during COVID-19 and 6 months prior to the pandemic. The primary outcomes investigated in this study were the changes in sexual intercourse frequency and sexual function aspects, including desire, arousal, satisfaction, orgasm, lubrication, and pain during sexual activity. Data were analyzed using paired t test, McNemar test, Pearson correlations, and multiple linear regression using SPSS 25. Results: During the COVID-19 pandemic, the participants’ sexual intercourse frequency increased while their sexual satisfaction was significantly changed. The proportion of participants who had 0-2 times per week of sexual intercourse was decreased during the COVID-19 pandemic compared with that before the pandemic (n=90, 45% vs n=103, 51.5%; P=.02). Conversely, the number of female individuals with 3-7 times per week of sexual intercourse increased after the pandemic compared with the prepandemic state (n=103, 51.5% vs n=91, 45.5%; P=.04). Female sexual satisfaction was significantly reduced after the COVID-19 pandemic compared with that before the pandemic (3.39 vs 3.30; P=.049). The other categories of sexual function, including desire, arousal, satisfaction, orgasm, lubrication, and dyspareunia showed no significant changes during the COVID-19 pandemic compared with the previous 6 months. There were no significant differences between the total sexual function mean scores during COVID-19 (15.73) compared with the prepandemic scores (15.85; P=.41). The total score of female sexual function during the pandemic was negatively associated with the participants’ age and education level. Correlations between various demographics and sexual function categories during the COVID-19 pandemic were identified. Conclusions: This is the first study exploring female sexual function during the COVID-19 outbreak in Jordan. The results suggest that COVID-19–associated stress is influencing women's sexual function, necessitating the provision of adequate emotional and physiological well-being support for women during similar crises. %M 36745774 %R 10.2196/40772 %U https://formative.jmir.org/2023/1/e40772 %U https://doi.org/10.2196/40772 %U http://www.ncbi.nlm.nih.gov/pubmed/36745774 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e42985 %T Examining Rural and Urban Sentiment Difference in COVID-19–Related Topics on Twitter: Word Embedding–Based Retrospective Study %A Liu,Yongtai %A Yin,Zhijun %A Ni,Congning %A Yan,Chao %A Wan,Zhiyu %A Malin,Bradley %+ Department of Computer Science, Vanderbilt University, 2525 West End Ave. Suite 8058, Nashville, TN, 37203, United States, 1 615 343 9096, yongtai.liu@vanderbilt.edu %K COVID-19 %K social media %K word embedding %K topic analysis %K sentiment analysis %K Twitter %K data %K vaccination %K prevention %K urban %K rural %K epidemic %K management %K model %K training %K machine learning %D 2023 %7 15.2.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: By the end of 2022, more than 100 million people were infected with COVID-19 in the United States, and the cumulative death rate in rural areas (383.5/100,000) was much higher than in urban areas (280.1/100,000). As the pandemic spread, people used social media platforms to express their opinions and concerns about COVID-19–related topics. Objective: This study aimed to (1) identify the primary COVID-19–related topics in the contiguous United States communicated over Twitter and (2) compare the sentiments urban and rural users expressed about these topics. Methods: We collected tweets containing geolocation data from May 2020 to January 2022 in the contiguous United States. We relied on the tweets’ geolocations to determine if their authors were in an urban or rural setting. We trained multiple word2vec models with several corpora of tweets based on geospatial and timing information. Using a word2vec model built on all tweets, we identified hashtags relevant to COVID-19 and performed hashtag clustering to obtain related topics. We then ran an inference analysis for urban and rural sentiments with respect to the topics based on the similarity between topic hashtags and opinion adjectives in the corresponding urban and rural word2vec models. Finally, we analyzed the temporal trend in sentiments using monthly word2vec models. Results: We created a corpus of 407 million tweets, 350 million (86%) of which were posted by users in urban areas, while 18 million (4.4%) were posted by users in rural areas. There were 2666 hashtags related to COVID-19, which clustered into 20 topics. Rural users expressed stronger negative sentiments than urban users about COVID-19 prevention strategies and vaccination (P<.001). Moreover, there was a clear political divide in the perception of politicians by urban and rural users; these users communicated stronger negative sentiments about Republican and Democratic politicians, respectively (P<.001). Regarding misinformation and conspiracy theories, urban users exhibited stronger negative sentiments about the “covidiots” and “China virus” topics, while rural users exhibited stronger negative sentiments about the “Dr. Fauci” and “plandemic” topics. Finally, we observed that urban users’ sentiments about the economy appeared to transition from negative to positive in late 2021, which was in line with the US economic recovery. Conclusions: This study demonstrates there is a statistically significant difference in the sentiments of urban and rural Twitter users regarding a wide range of COVID-19–related topics. This suggests that social media can be relied upon to monitor public sentiment during pandemics in disparate types of regions. This may assist in the geographically targeted deployment of epidemic prevention and management efforts. %M 36790847 %R 10.2196/42985 %U https://www.jmir.org/2023/1/e42985 %U https://doi.org/10.2196/42985 %U http://www.ncbi.nlm.nih.gov/pubmed/36790847 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 6 %N %P e40371 %T Web-Based Conversations Regarding Fathers Before and During the COVID-19 Pandemic: Qualitative Content Analysis %A Bouchacourt,Lindsay %A Henson-García,Mike %A Sussman,Kristen Leah %A Mandell,Dorothy %A Wilcox,Gary %A Mackert,Michael %+ Stan Richards School of Advertising and Public Relations, The University of Texas at Austin, 300 W Dean Keeton St, Austin, TX, 78712, United States, 1 512 471 5775, lbouchacourt@utexas.edu %K social media %K expecting fathers %K new fathers %K Twitter %K Reddit %K content analysis %K topic model %K topic analysis %K parent %K father %D 2023 %7 15.2.2023 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Studies of new and expecting parents largely focus on the mother, leaving a gap in knowledge about fathers. Objective: This study aimed to understand web-based conversations regarding new and expecting fathers on social media and to explore whether the COVID-19 pandemic has changed the web-based conversation. Methods: A social media analysis was conducted. Brandwatch (Cision) captured social posts related to new and expecting fathers between February 1, 2019, and February 12, 2021. Overall, 2 periods were studied: 1 year before and 1 year during the pandemic. SAS Text Miner analyzed the data and produced 47% (9/19) of the topics in the first period and 53% (10/19) of the topics in the second period. The 19 topics were organized into 6 broad themes. Results: Overall, 26% (5/19) of the topics obtained during each period were the same, showing consistency in conversation. In total, 6 broad themes were created: fatherhood thoughts, fatherhood celebrations, advice seeking, fatherhood announcements, external parties targeting fathers, and miscellaneous. Conclusions: Fathers use social media to make announcements, celebrate fatherhood, seek advice, and interact with other fathers. Others used social media to advertise baby products and promote baby-related resources for fathers. Overall, the arrival of the COVID-19 pandemic appeared to have little impact on the excitement and resiliency of new fathers as they transition to parenthood. Altogether, these findings provide insight and guidance on the ways in which public health professionals can rapidly gather information about special populations—such as new and expecting fathers via the web—to monitor their beliefs, attitudes, emotional reactions, and unique lived experiences in context (ie, throughout a global pandemic). %M 36790850 %R 10.2196/40371 %U https://pediatrics.jmir.org/2023/1/e40371 %U https://doi.org/10.2196/40371 %U http://www.ncbi.nlm.nih.gov/pubmed/36790850 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 6 %N %P e42378 %T Understanding Transgender and Gender-Diverse Youth’s Experiences Receiving Care via Telemedicine: Qualitative Interview Study %A Kahn,Nicole F %A Anan,Yomna H %A Bocek,Kevin M %A Christakis,Dimitri A %A Richardson,Laura P %A Pratt,Wanda %A Sequeira,Gina M %+ Center for Child Health, Behavior and Development, Seattle Children's Research Institute, 1920 Terry Ave, Seattle, WA, 98101, United States, 1 206 987 0988, nicole.kahn@seattlechildrens.org %K transgender and gender diverse youth %K adolescent %K telemedicine %K gender-affirming care %K qualitative methods %K COVID-19 %K pandemic %K youth %K gender %K care %K technical %K implementation %K transgender %K telemedicine %K gender diverse %K complexity %D 2023 %7 14.2.2023 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Access to virtual care has increased since the beginning of the COVID-19 pandemic, yet little is known about transgender and gender-diverse (TGD) youth’s experiences and perspectives on receiving care via telemedicine. Objective: The purpose of this study was to explore these experiences to (1) inform necessary changes to the provision of pediatric gender-affirming care and (2) help providers and health systems determine if and how telemedicine should be made available post pandemic. Methods: Youth (aged 14-17 years) who completed a telemedicine visit in the Seattle Children’s Gender Clinic were invited to participate in a semistructured interview exploring perceived advantages or disadvantages of telemedicine and preferred visit modalities. Interview transcriptions were analyzed by 2 research team members using an inductive thematic analysis framework. Results: A total of 15 TGD youth completed an interview. Commonly cited advantages of telemedicine were convenience and comfort with having visits in their own environments. Reported disadvantages included technical issues, discomfort with the impersonal nature, lack of familiarity with the platform, and privacy concerns. Overall, slightly more youth preferred in-person visits over telemedicine, referencing both specific characteristics of the clinical visit (ie, initial vs return and complexity) and proximity to the clinic as reasons for this preference. Although a plurality of TGD youth preferred in-person visits, they also recognized the value of telemedicine and the impact it may have in facilitating access to care. Conclusions: Given the variations in needs and visit complexity, our study supports the provision of both in-person and telemedicine modalities as options for pediatric gender-affirming care. %M 36745775 %R 10.2196/42378 %U https://pediatrics.jmir.org/2023/1/e42378 %U https://doi.org/10.2196/42378 %U http://www.ncbi.nlm.nih.gov/pubmed/36745775 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e43730 %T The Usability, Feasibility, Acceptability, and Efficacy of Digital Mental Health Services in the COVID-19 Pandemic: Scoping Review, Systematic Review, and Meta-analysis %A Zhong,Shaoling %A Yang,Xinhu %A Pan,Zihua %A Fan,Yu %A Chen,Yanan %A Yu,Xin %A Zhou,Liang %+ The Affiliated Brain Hospital of Guangzhou Medical University, 36 Mingxin Road, Liwan District, Guangzhou, 510370, China, 86 81268045, liangzhou_csu@vip.163.com %K digital medicine %K COVID-19 %K mental health services %K psychological well-being %K COVID-19 pandemic %D 2023 %7 13.2.2023 %9 Review %J JMIR Public Health Surveill %G English %X Background: After the rapid spread of the novel SARS-CoV-2, the short-term and long-term mental health impacts of the pandemic on the public, in particular on susceptible individuals, have been reported worldwide. Although digital mental health services expand accessibility while removing many barriers to in-person therapy, their usability, feasibility, acceptability, and efficacy require continued monitoring during the initial phase of the pandemic and its aftermath. Objective: In this study, we aimed to understand what mental health services are offered, whether they are practical or acceptable, and to what extent digital mental health services are effective in response to the COVID-19 pandemic across high-income and low- and middle-income countries. Methods: This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and the PRISMA Extension for Scoping Reviews (PRISMA-ScR) guideline. We implemented searches in PubMed (MEDLINE), Embase, PsycINFO, and Cochrane databases for studies that were published between December 2019 and November 2021 and that involved the use of digital mental health services. Two review authors screened, assessed, and extracted studies independently. The protocol was registered on the International Prospective Register of Systematic Reviews. Results: This review identified 7506 articles through database searching. In total, 65 (0.9%) studies from 18 countries with 67,884 participants were eligible for the scoping review. Of the 65 studies, 16 (24.6%) were included in the meta-analysis. A total of 15 (23.1%) studies measured the usability; 31 (47.7%) studies evaluated the feasibility; 29 (44.6%) studies assessed the acceptability; and 51 (78.5%) studies assessed the efficacy. Web-based programs (21/65, 32.3%), videoconferencing platforms (16/65, 24.6%), smartphone apps (14/65, 21.5%), and SMS text messaging (5/65, 7.7%) were the main techniques. Psychotherapy (44/65, 67.7%) followed by psychoeducation (6/65, 9.2%) and psychological support (5/65, 7.7%) were commonly used. The results of the meta-analysis showed that digital mental health interventions were associated with a small reduction in depressive symptoms (standardized mean difference=−0.49; 95% CI −0.74 to −0.24; P<.001) and a moderate reduction in anxiety symptoms (standardized mean difference=−0.66; 95% CI −1.23 to −1.0; P=.02) significantly. Conclusions: The findings suggest that digital mental health interventions may be practical and helpful for the general population, at-risk individuals, and patients with preexisting mental disorders across high-income and middle-income countries. An expanded research agenda is needed to apply different strategies for addressing diverse psychological needs and develop integrated mental health services in the post–COVID-19 era. Trial Registration: PROSPERO CRD42022307695; https://tinyurl.com/2jcuwjym %M 36634261 %R 10.2196/43730 %U https://publichealth.jmir.org/2023/1/e43730 %U https://doi.org/10.2196/43730 %U http://www.ncbi.nlm.nih.gov/pubmed/36634261 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e41240 %T Tough Talks COVID-19 Digital Health Intervention for Vaccine Hesitancy Among Black Young Adults: Protocol for a Hybrid Type 1 Effectiveness Implementation Randomized Controlled Trial %A Budhwani,Henna %A Maragh-Bass,Allysha C %A Tolley,Elizabeth E %A Comello,Maria Leonora G %A Stoner,Marie C D %A Adams Larsen,Margo %A Brambilla,Donald %A Muessig,Kathryn E %A Pettifor,Audrey %A Bond,Christyenne L %A Toval,Christina %A Hightow-Weidman,Lisa B %+ Intervention Research and Implementation Science Lab, College of Nursing, Florida State University, 98 Varsity Way, Tallahassee, FL, 32306, United States, 1 8506443296, hbudhwani@fsu.edu %K COVID-19 %K COVID %K vaccine hesitancy framework %K African American %K young adults %K implementation science %K digital health %K mHealth %K behavioral intervention %K vaccination %K intervention %K mortality %K USA %D 2023 %7 13.2.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Interventions for increasing the uptake of COVID-19 vaccination among Black young adults are central to ending the pandemic. Black young adults experience harms from structural forces, such as racism and stigma, that reduce receptivity to traditional public health messaging due to skepticism and distrust. As such, Black young adults continue to represent a priority population on which to focus efforts for promoting COVID-19 vaccine uptake. Objective: In aims 1 and 2, the Tough Talks digital health intervention for HIV disclosure will be adapted to address COVID-19 vaccine hesitancy and tailored to the experiences of Black young adults in the southern United States (Tough Talks for COVID-19). In aim 3, the newly adapted Tough Talks for COVID-19 digital health intervention will be tested across the following three southern states: Alabama, Georgia, and North Carolina. Methods: Our innovative digital health intervention study will include qualitative and quantitative assessments. A unique combination of methodological techniques, including web-based surveys, choose-your-own-adventures, digital storytelling, user acceptability testing, and community-based participatory approaches, will culminate in a 2-arm hybrid type 1 effectiveness implementation randomized controlled trial, wherein participants will be randomized to the Tough Talks for COVID-19 intervention arm or a standard-of-care control condition (N=360). Logistic regression will be used to determine the effect of the treatment arm on the probability of vaccination uptake (primary COVID-19 vaccine series or recommended boosters). Concurrently, the inner and outer contexts of implementation will be ascertained and catalogued to inform future scale-up. Florida State University’s institutional review board approved the study (STUDY00003617). Results: Our study was funded at the end of April 2021. Aim 1 data collection concluded in early 2022. The entire study is expected to conclude in January 2025. Conclusions: If effective, our digital health intervention will be poised for broad, rapid dissemination to reduce COVID-19 mortality among unvaccinated Black young adults in the southern United States. Our findings will have the potential to inform efforts that seek to address medical mistrust through participatory approaches. The lessons learned from the conduct of our study could be instrumental in improving health care engagement among Black young adults for several critical areas that disproportionately harm this community, such as tobacco control and diabetes prevention. Trial Registration: ClinicalTrials.gov NCT05490329; https://clinicaltrials.gov/ct2/show/NCT05490329 International Registered Report Identifier (IRRID): DERR1-10.2196/41240 %M 36689557 %R 10.2196/41240 %U https://www.researchprotocols.org/2023/1/e41240 %U https://doi.org/10.2196/41240 %U http://www.ncbi.nlm.nih.gov/pubmed/36689557 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e40057 %T Applications of Social Media and Digital Technologies in COVID-19 Vaccination: Scoping Review %A Zang,Shujie %A Zhang,Xu %A Xing,Yuting %A Chen,Jiaxian %A Lin,Leesa %A Hou,Zhiyuan %+ School of Public Health, Fudan University, 130 Dong’an Road, Shanghai, 200032, China, 86 21 33563935, zyhou@fudan.edu.cn %K social media %K digital health %K COVID-19 %K vaccination %K review %D 2023 %7 10.2.2023 %9 Review %J J Med Internet Res %G English %X Background: Social media and digital technologies have played essential roles in disseminating information and promoting vaccination during the COVID-19 pandemic. There is a need to summarize the applications and analytical techniques of social media and digital technologies in monitoring vaccine attitudes and administering COVID-19 vaccines. Objective: We aimed to synthesize the global evidence on the applications of social media and digital technologies in COVID-19 vaccination and to explore their avenues to promote COVID-19 vaccination. Methods: We searched 6 databases (PubMed, Scopus, Web of Science, Embase, EBSCO, and IEEE Xplore) for English-language articles from December 2019 to August 2022. The search terms covered keywords relating to social media, digital technology, and COVID-19 vaccines. Articles were included if they provided original descriptions of applications of social media or digital health technologies/solutions in COVID-19 vaccination. Conference abstracts, editorials, letters, commentaries, correspondence articles, study protocols, and reviews were excluded. A modified version of the Appraisal Tool for Cross-Sectional Studies (AXIS tool) was used to evaluate the quality of social media–related studies. The review was undertaken with the guidance of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. Results: A total of 178 articles were included in our review, including 114 social media articles and 64 digital technology articles. Social media has been applied for sentiment/emotion analysis, topic analysis, behavioral analysis, dissemination and engagement analysis, and information quality analysis around COVID-19 vaccination. Of these, sentiment analysis and topic analysis were the most common, with social media data being primarily analyzed by lexicon-based and machine learning techniques. The accuracy and reliability of information on social media can seriously affect public attitudes toward COVID-19 vaccines, and misinformation often leads to vaccine hesitancy. Digital technologies have been applied to determine the COVID-19 vaccination strategy, predict the vaccination process, optimize vaccine distribution and delivery, provide safe and transparent vaccination certificates, and perform postvaccination surveillance. The applied digital technologies included algorithms, blockchain, mobile health, the Internet of Things, and other technologies, although with some barriers to their popularization. Conclusions: The applications of social media and digital technologies in addressing COVID-19 vaccination–related issues represent an irreversible trend. Attention should be paid to the ethical issues and health inequities arising from the digital divide while applying and promoting these technologies. %M 36649235 %R 10.2196/40057 %U https://www.jmir.org/2023/1/e40057 %U https://doi.org/10.2196/40057 %U http://www.ncbi.nlm.nih.gov/pubmed/36649235 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e38371 %T Utility of the Comprehensive Health and Stringency Indexes in Evaluating Government Responses for Containing the Spread of COVID-19 in India: Ecological Time-Series Study %A Kishore,Kamal %A Jaswal,Vidushi %A Pandey,Anuj Kumar %A Verma,Madhur %A Koushal,Vipin %+ Department of Biostatistics, Post Graduate Institute of Medical Education and Research, Madhya Marg, Sector 12,, Chandigarh, 160012, India, 91 9591349768, kkishore.pgi@gmail.com %K COVID-19 %K government response %K nonpharmaceutical interventions %K lockdown %K Comprehensive Health Index %K Stringency Index %K time-series modeling %K ARIMA %K SARIMA %K Oxford COVID-19 Government Response Tracker %K public health %K surveillance %K Oxford tracker %K ecological study %K health data %K health policy %K Bayesian information criteria %D 2023 %7 10.2.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Many nations swiftly designed and executed government policies to contain the rapid rise in COVID-19 cases. Government actions can be broadly segmented as movement and mass gathering restrictions (such as travel restrictions and lockdown), public awareness (such as face covering and hand washing), emergency health care investment, and social welfare provisions (such as poor welfare schemes to distribute food and shelter). The Blavatnik School of Government, University of Oxford, tracked various policy initiatives by governments across the globe and released them as composite indices. We assessed the overall government response using the Oxford Comprehensive Health Index (CHI) and Stringency Index (SI) to combat the COVID-19 pandemic. Objective: This study aims to demonstrate the utility of CHI and SI to gauge and evaluate the government responses for containing the spread of COVID-19. We expect a significant inverse relationship between policy indices (CHI and SI) and COVID-19 severity indices (morbidity and mortality). Methods: In this ecological study, we analyzed data from 2 publicly available data sources released between March 2020 and October 2021: the Oxford Covid-19 Government Response Tracker and the World Health Organization. We used autoregressive integrated moving average (ARIMA) and seasonal ARIMA to model the data. The performance of different models was assessed using a combination of evaluation criteria: adjusted R2, root mean square error, and Bayesian information criteria. Results: implementation of policies by the government to contain the COVID-19 crises resulted in higher CHI and SI in the beginning. Although the value of CHI and SI gradually fell, they were consistently higher at values of >80% points. During the initial investigation, we found that cases per million (CPM) and deaths per million (DPM) followed the same trend. However, the final CPM and DPM models were seasonal ARIMA (3,2,1)(1,0,1) and ARIMA (1,1,1), respectively. This study does not support the hypothesis that COVID-19 severity (CPM and DPM) is associated with stringent policy measures (CHI and SI). Conclusions: Our study concludes that the policy measures (CHI and SI) do not explain the change in epidemiological indicators (CPM and DPM). The study reiterates our understanding that strict policies do not necessarily lead to better compliance but may overwhelm the overstretched physical health systems. Twenty-first–century problems thus demand 21st-century solutions. The digital ecosystem was instrumental in the timely collection, curation, cloud storage, and data communication. Thus, digital epidemiology can and should be successfully integrated into existing surveillance systems for better disease monitoring, management, and evaluation. %M 36395334 %R 10.2196/38371 %U https://publichealth.jmir.org/2023/1/e38371 %U https://doi.org/10.2196/38371 %U http://www.ncbi.nlm.nih.gov/pubmed/36395334 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 6 %N %P e38593 %T Use of Digital Technologies to Maintain Older Adults’ Social Ties During Visitation Restrictions in Long-Term Care Facilities: Scoping Review %A Lemaire,Célia %A Humbert,Christophe %A Sueur,Cédric %A Racin,Céline %+ Magellan (EA 3713), iaelyon, Université Jean Moulin Lyon 3, 1C, avenue des Frères Lumière - CS 78242, Lyon, 69372, CEDEX 08, France, 33 0649054213, celia.lemaire@univ-lyon3.fr %K social isolation %K COVID-19 pandemic %K remote care %K nursing homes %K social ties %K digital devices %K older adults %D 2023 %7 10.2.2023 %9 Review %J JMIR Aging %G English %X Background: Digital technologies were implemented to address the disruption of long-term care facility residents’ socialization needs during the COVID-19 pandemic. A literature review regarding this topic is needed to inform public policy, facility managers, family caregivers, and nurses and allied health professionals involved in mediating the use of digital devices for residents’ social ties. Objective: Our study outlines key concepts, methodologies, results, issues, and gaps in articles published during pandemic-related visitation restrictions. Methods: Following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) protocol, a scoping review was conducted by searching 3 database aggregator platforms (EBSCO, ProQuest, and PubMed) for studies published in peer-reviewed journals from early 2020 to the end of June 2021, when the most stringent restrictions were in place. We included qualitative and quantitative studies, reviews, commentaries, viewpoints, and letters to the editors in French or English focusing on digital technologies aiming to support the social contact of residents in long-term care facilities during pandemic-related visitation restrictions. Results: Among 763 screened articles, 29 met our selection criteria. For each study, we characterized the (1) authors, title, and date of the publication; (2) country of the first author; (3) research fields; (4) article type; and (5) type of technology mentioned. The analysis distinguished 3 main themes emerging from the literature: (1) impact and expectations of remote social contact on the physical and mental health and well-being of the residents (n=12), (2) with whom or what the social contact took place (n=17), and (3) limitations and barriers to significant social contact related to digital technologies (n=14). The results first underlined the highly positive impact expected by the authors of the digital technologies on health and quality of life of residents of long-term care facilities. Second, they highlighted the plurality of ties to consider, since social contact takes place not only with family caregivers to maintain contact but also for other purposes (end-of-life videoconferences) and with other types of contact (eg, with staff and robots). Third, they exposed the limitations and barriers to significant contact using digital technologies and outlined the required conditions to enable them. Conclusions: The review demonstrated the opportunities and risks outlined by the literature about the implementation of digital technologies to support remote social contact. It showed the plurality of ties to consider and revealed the need to evaluate the positive impact of remote contact from the residents’ perspectives. Therefore, to go beyond the risk of digital solutionism, there is a need for studies considering the holistic impact on health regarding the implementation of digital technologies, including the meaning residents give to interpersonal exchanges and the organizational constraints. Trial Registration: OSF Registries osf.io/yhpx3; https://osf.io/yhpx3 %M 36599164 %R 10.2196/38593 %U https://aging.jmir.org/2023/1/e38593 %U https://doi.org/10.2196/38593 %U http://www.ncbi.nlm.nih.gov/pubmed/36599164 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 6 %N %P e43602 %T Canadian Pediatric Intensive Care Adaptations for Critically Ill Adults During the COVID-19 Pandemic: Survey Study %A Parchomchuk,Evan %A Holt,Tanya %A Hansen,Gregory %+ Jim Pattison Children's Hospital, Pediatric Intensive Care Unit, 103 Hospital Drive, Saskatoon, SK, S7N 0W8, Canada, 1 306 844 1068, gregory.hansen@usask.ca %K Canada %K COVID-19 pandemic %K delivery of health care %K pediatrics %K population health %K health care %K intensive care %K patient care %D 2023 %7 10.2.2023 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: The COVID-19 pandemic overwhelmed Canadian hospitals with adult admissions. A large number of adult patients required critical care therapies, placing significant strain on hospital resources. In order to decompress adult intensive care units, pediatric intensive care units (PICUs) introduced adapted models of traditional care to lessen these burdens. Objective: We aimed to evaluate how PICUs across Canada adapted care for the high volumes of critically ill adults. Methods: A survey containing 40 questions was sent to the medical directors of 14 Canadian PICUs where English was the primary clinical language. The survey was designed to gain perspective on the various adaptations that PICUs instituted during the COVID-19 pandemic. Results: Of the 13 PICUs that returned survey responses (response rate: 13/14, 93%), 10 (77%) participated in at least one adaptation to support the influx of admitted adults with COVID-19. The key challenges included disorganization, loss of autonomy, and compromised patient care. The significant advantages of these adaptations included a sense of learning and comradery. Conclusions: Our study highlighted an unpreparedness in critical care surge capacity. During the COVID-19 pandemic, adaptations rapidly emerged in Canada that involved PICUs with adult care. In the future, preplanned adaptations for optimizing robust critical care services should be developed based on what has been learned from the COVID-19 pandemic. %M 36724349 %R 10.2196/43602 %U https://pediatrics.jmir.org/2023/1/e43602 %U https://doi.org/10.2196/43602 %U http://www.ncbi.nlm.nih.gov/pubmed/36724349 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e41404 %T Multimorbidity and SARS-CoV-2–Related Outcomes: Analysis of a Cohort of Italian Patients %A Catalano,Alberto %A Dansero,Lucia %A Gilcrease,Winston %A Macciotta,Alessandra %A Saugo,Carlo %A Manfredi,Luca %A Gnavi,Roberto %A Strippoli,Elena %A Zengarini,Nicolás %A Caramello,Valeria %A Costa,Giuseppe %A Sacerdote,Carlotta %A Ricceri,Fulvio %+ Centre for Biostatistics, Epidemiology, and Public Health, Department of Clinical and Biological Sciences, University of Turin, Regione Gonzole 10, Orbassano (TO), 10043, Italy, 39 0116705443, alberto.catalano@unito.it %K multimorbidity %K SARS-CoV-2 %K mortality %K intensive care unit %K epidemiology %K COVID-19 %K pandemic %K severity %K cardiovascular %K respiratory %K disease %K risk %K public health %K intervention %D 2023 %7 9.2.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Since the outbreak of the COVID-19 pandemic, identifying the main risk factors has been imperative to properly manage the public health challenges that the pandemic exposes, such as organizing effective vaccination campaigns. In addition to gender and age, multimorbidity seems to be 1 of the predisposing factors coming out of many studies investigating the possible causes of increased susceptibility to SARS-CoV-2 infection and adverse outcomes. However, only a few studies conducted have used large samples. Objective: The objective is to evaluate the association between multimorbidity, the probability to be tested, susceptibility, and the severity of SARS-CoV-2 infection in the Piedmont population (Northern Italy, about 4 million inhabitants). For this purpose, we considered 5 main outcomes: access to the swab, positivity to SARS-CoV-2, hospitalization, intensive care unit (ICU) admission, and death within 30 days from the first positive swab. Methods: Data were obtained from different Piedmont health administrative databases. Subjects aged from 45 to 74 years and infections diagnosed from February to May 2020 were considered. Multimorbidity was defined both with the Charlson Comorbidity Index (CCI) and by identifying patients with previous comorbidities, such as diabetes and oncological, cardiovascular, and respiratory diseases. Multivariable logistic regression models (adjusted for age and month of infection and stratified by gender) were performed for each outcome. Analyses were also conducted by separating 2 age groups (45-59 and 60-74 years). Results: Of 1,918,549 subjects, 85,348 (4.4%) performed at least 1 swab, of whom 12,793 (14.9%) tested positive for SARS-CoV-2. Of these 12,793 subjects, 4644 (36.3%) were hospitalized, 1508 (11.8%) were admitted to the ICU, and 749 (5.9%) died within 30 days from the first positive swab. Individuals with a higher CCI had a higher probability of being swabbed but a lower probability of testing positive. We observed the same results when analyzing subjects with previous oncological and cardiovascular diseases. Moreover, especially in the youngest group, we identified a greater risk of being hospitalized and dying. Among comorbidities considered in the study, respiratory diseases seemed to be the most likely to increase the risk of having a positive swab and worse disease outcomes. Conclusions: Our study shows that patients with multimorbidity, although swabbed more frequently, are less likely to get infected with SARS-CoV-2, probably due to greater attention on protective methods. Moreover, a history of respiratory diseases is a risk factor for a worse prognosis of COVID-19. Nonetheless, whatever comorbidities affect the patients, a strong dose-response effect was observed between an increased CCI score and COVID-19 hospitalization, ICU admission, and death. These results are important in terms of public health because they help in identifying a group of subjects who are more prone to worse SARS-CoV-2 outcomes. This information is important for promoting targeted prevention and developing policies for the prioritization of public health interventions. %M 36626821 %R 10.2196/41404 %U https://publichealth.jmir.org/2023/1/e41404 %U https://doi.org/10.2196/41404 %U http://www.ncbi.nlm.nih.gov/pubmed/36626821 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e42796 %T Experiences and Expectations of Information and Communication Technologies in Flexible Assertive Community Treatment Teams: Qualitative Study %A Bønes,Erlend %A Granja,Conceição %A Solvoll,Terje %+ Norwegian Centre for e-Health Research, University Hospital of North Norway, PO Box 35, Tromsø, 9019, Norway, 47 97655680, erlend.bones@ehealthresearch.no %K mental health %K FACT %K electronic health records %K eHealth %K EHR %K electronic whiteboards %K community %K treatment %K qualitative %K COVID-19 %K patient care %K mental illness %K information technology %K thematic analysis %K data access %K information and communication solutions %K ICT %K Norway %K semistructured interviews %D 2023 %7 9.2.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Flexible Assertive Community Treatment (FACT) is a model of integrated care for patients with long-term serious mental illness. FACT teams deliver services using assertive outreach to treat patients who can be hard to reach by the health care service, and focus on both the patient’s health and their social situation. However, in Norway, FACT team members have challenges with their information and communication (ICT) solutions. Objective: The aim of this study was to explore Norwegian FACT teams’ experiences and expectations of their ICT solutions, including electronic health records, electronic whiteboards, and calendars. Methods: We gathered data in two phases. In the first phase, we conducted semistructured interviews with team leaders and team coordinators, and made observations in FACT teams targeting adults. In the second phase, we conducted semistructured group interviews in FACT teams targeting youth. We performed a thematic analysis of the data in a theoretical manner to address the specific objectives of the study. Results: A total of 8 teams were included, with 5 targeting adults and 3 targeting youth. Due to the COVID-19 pandemic, we were not able to perform observations in 2 of the teams targeting adults. Team leaders and coordinators in all 5 teams targeting adults were interviewed, with a total of 7 team members participating in the teams targeting youth. We found various challenges with communication, documentation, and organization for FACT teams. The COVID-19 pandemic was challenging for the teams and changed the way they used ICT solutions. There were issues with some technical solutions used in the teams, including electronic health records, electronic whiteboards, and calendars. Lack of integration and access to data were some of the main issues identified. Conclusions: Despite the FACT model being successfully implemented in Norway, there are several issues regarding the ICT solutions they use, mainly related to access to data and integration. Further research is required to detail how improved ICT solutions should be designed. While FACT teams targeting adults and youth differ in some ways, their needs for ICT solutions are largely similar. %M 36730062 %R 10.2196/42796 %U https://formative.jmir.org/2023/1/e42796 %U https://doi.org/10.2196/42796 %U http://www.ncbi.nlm.nih.gov/pubmed/36730062 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e43798 %T The Factors Associated With Telehealth Use and Avoidance During the COVID-19 Pandemic: Longitudinal Survey %A Farrer,Louise M %A Batterham,Philip J %A Gulliver,Amelia %A Morse,Alyssa %A Calear,Alison L %A McCallum,Sonia %A Banfield,Michelle %A Shou,Yiyun %A Newman,Eryn %A Dawel,Amy %+ Centre for Mental Health Research, The Australian National University, Bld 63, Eggleston Rd, Canberra, 2601, Australia, 61 2 6125 8859, louise.farrer@anu.edu.au %K telehealth %K access %K inequity %K health care %K COVID-19 %K telemedicine %K health care service %K longitudinal survey %K health care system %K technology acceptance %K health care delivery %K Australian population %D 2023 %7 8.2.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Social distancing requirements due to the COVID-19 pandemic saw a rapid increase in the delivery of telehealth consultations as an alternative to face-to-face health care services. Objective: The aims of this study were to assess the use and acceptability of telehealth during the early stages of the pandemic and identify factors associated with telehealth avoidance during this period. Methods: Data were obtained from waves 4 and 7 of a longitudinal survey designed to assess the impact of the COVID-19 pandemic on the health and behavior of a representative sample of Australian adults. Participants reported on their use or avoidance of telehealth during the assessment period, as well as the mode of telehealth used and acceptability. Results: Approximately 30% of participants reported using telehealth during the assessment periods, with the most common telehealth modality being the telephone. Acceptance of telehealth was generally high and was higher among those who used telehealth compared with those who did not. Approximately 18% of participants reported avoiding health care due to telehealth. Across assessment waves, avoidance was associated with younger age, speaking a language other than or in addition to English, having a current medical diagnosis, and lower levels of telehealth acceptability. Conclusions: While most participants in this study were accepting of telehealth services, there remain barriers to use, especially among those from particular sociodemographic groups. At a population level, avoidance of health services in nearly one in five adults may have considerable long-term impacts on morbidity and potentially mortality. Targeted efforts to promote engagement with telehealth services are critical if these adverse outcomes are to be avoided, particularly during periods when access to face-to-face services may be limited. %M 36649254 %R 10.2196/43798 %U https://www.jmir.org/2023/1/e43798 %U https://doi.org/10.2196/43798 %U http://www.ncbi.nlm.nih.gov/pubmed/36649254 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e43007 %T Voice Assistants’ Responses to Questions About the COVID-19 Vaccine: National Cross-sectional Study %A Sossenheimer,Philip %A Hong,Grace %A Devon-Sand,Anna %A Lin,Steven %+ Department of Medicine, Stanford University School of Medicine, 211 Quarry Road, Suite 405, Palo Alto, CA, 94304, United States, 1 650 725 7966, stevenlin@stanford.edu %K artificial intelligence %K mHealth %K misinformation %K public health %K vaccination hesitancy %K vaccination %K online %K COVID-19 %K public health %K information %K users %K smartphone %K mobile phone %D 2023 %7 8.2.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Artificial intelligence-powered voice assistants (VAs), such as Apple Siri, Google Assistant, and Amazon Alexa, interact with users in natural language and are capable of responding to simple commands, searching the internet, and answering questions. Despite being an increasingly popular way for the public to access health information, VAs could be a source of ambiguous or potentially biased information. Objective: In response to the ongoing prevalence of vaccine misinformation and disinformation, this study aims to evaluate how smartphone VAs respond to information- and recommendation-seeking inquiries regarding the COVID-19 vaccine. Methods: A national cross-sectional survey of English-speaking adults who owned a smartphone with a VA installed was conducted online from April 22 to 28, 2021. The primary outcomes were the VAs’ responses to 2 questions: “Should I get the COVID vaccine?” and “Is the COVID vaccine safe?” Directed content analysis was used to assign a negative, neutral, or positive connotation to each response and website title provided by the VAs. Statistical significance was assessed using the t test (parametric) or Mann-Whitney U (nonparametric) test for continuous variables and the chi-square or Fisher exact test for categorical variables. Results: Of the 466 survey respondents included in the final analysis, 404 (86.7%) used Apple Siri, 53 (11.4%) used Google Assistant, and 9 (1.9%) used Amazon Alexa. In response to the question “Is the COVID vaccine safe?” 419 (89.9%) users received a direct response, of which 408 (97.3%) had a positive connotation encouraging users to get vaccinated. Of the websites presented, only 5.3% (11/207) had a positive connotation and 94.7% (196/207) had a neutral connotation. In response to the question “Should I get the COVID vaccine?” 93.1% (434/466) of users received a list of websites, of which 91.5% (1155/1262) had a neutral connotation. For both COVID-19 vaccine–related questions, there was no association between the connotation of a response and the age, gender, zip code, race or ethnicity, and education level of the respondent. Conclusions: Our study found that VAs were much more likely to respond directly with positive connotations to the question “Is the COVID vaccine safe?” but not respond directly and provide a list of websites with neutral connotations to the question “Should I get the COVID vaccine?” To our knowledge, this is the first study to evaluate how VAs respond to both information- and recommendation-seeking inquiries regarding the COVID-19 vaccine. These findings add to our growing understanding of both the opportunities and pitfalls of VAs in supporting public health information dissemination. %M 36719815 %R 10.2196/43007 %U https://formative.jmir.org/2023/1/e43007 %U https://doi.org/10.2196/43007 %U http://www.ncbi.nlm.nih.gov/pubmed/36719815 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e41877 %T The Relationship Between Exercise Habits and Stress Among Individuals With Access to Internet-Connected Home Fitness Equipment: Single-Group Prospective Analysis %A Schneider,Margaret %A Woodworth,Amanda %A Mehrabadi,Milad Asgari %+ Institute for Clinical and Translational Science, University of California, Irvine, 843 Health Science Rd, Irvine, CA, 92697, United States, 1 949 824 8853 ext 48853, mls@uci.edu %K stress %K exercise %K internet-connected home fitness equipment %K physical activity %K healthcare cost %K health care %K psychological well-being %K COVID-19 %K online survey %K user data %K Peloton %D 2023 %7 8.2.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Physical activity (PA) confers numerous benefits to health and health care costs, yet most adults are not meeting recommended PA guidelines. Stress may be a factor that influences PA behavior. Research investigating the impact of stress on PA has yielded inconsistent findings. Most studies find that stress negatively impacts PA, but there is some evidence that habitual exercising buffers this association. Objective: This study aims to examine the relationship between stress and exercise habits among habitual exercisers with internet-connected home fitness equipment (Peloton Bike) during the COVID-19 lockdown. Methods: Participants were recruited through Facebook (N=146) and asked to complete an internet-based survey that assessed COVID-19–related stressors, perceived stress associated with those stressors, and general perceived stress. Self-reported exercise was assessed on the survey using the Godin Leisure-time Exercise Questionnaire (GLTEQ). Participants were also asked for consent to access their Peloton usage data through the Peloton platform. From their usage data, the frequency and duration of cycling classes was calculated for 4 weeks prior to and 12 weeks following the survey. Hierarchical regression equations tested the association between stress reported on the survey and subsequent exercise participation. Exercise participation was quantified both as the frequency and duration of Peloton cycling over the 12 weeks following the survey and as self-reported moderate to vigorous activity on a second survey completed by a subset of participants 12 weeks after the initial survey. Results: There were 146 participants in our Peloton analysis sample and 66 in the self-reported exercise analysis. Peloton user data showed that study participants cycled frequently (mean 5.9 times per week) in the month prior to the initial survey, and that presurvey Peloton use was a strong predictor of exercise frequency (R2=0.57; F2,143=95.27; P<.001) and duration (R2=0.58; F2,143=102.58; P<.001) for the 12 subsequent weeks. Self-reported overall exercise likewise showed that this sample was very active, with an average of more than 8 times per week of moderate to vigorous exercise at the initial survey. Self-reported exercise on the initial survey was a strong predictor of self-reported exercise 12 weeks later (R2=0.31; F1,64=29.03; P<.001). Perceived stress did not impact Peloton cycling duration or frequency (P=.81 and .76, respectively) or self-reported exercise (P=.28). Conclusions: The results suggest that stress did not negatively impact exercise participation among habitually active adults with access to internet-connected home fitness equipment. Habitual exercise may buffer the impact of stress on participation in regular moderate to vigorous activity. Future research should examine the role that the availability of home-based internet-connected exercise equipment may play in this buffering. %M 36719817 %R 10.2196/41877 %U https://formative.jmir.org/2023/1/e41877 %U https://doi.org/10.2196/41877 %U http://www.ncbi.nlm.nih.gov/pubmed/36719817 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e39384 %T Use of General Practitioner Telehealth Services During the COVID-19 Pandemic in Regional Victoria, Australia: Retrospective Analysis %A Savira,Feby %A Orellana,Liliana %A Hensher,Martin %A Gao,Lan %A Sanigorski,Andrew %A Mc Namara,Kevin %A Versace,Vincent L %A Szakiel,John %A Swann,Jamie %A Manias,Elizabeth %A Peeters,Anna %+ Institute for Health Transformation, School of Health and Social Development, Deakin University, 221 Burwood Highway, Burwood, 3125, Australia, 61 392445423, anna.peeters@deakin.edu.au %K telehealth %K rural %K Australia %K COVID-19 %K eHealth %K primary care %K general practitioner %K GP %K trend %K pandemic %K equity %K video %K virtual %K consultation %K telephone %D 2023 %7 7.2.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: In March 2020, the Australian Government expanded general practitioner (GP) telehealth services in response to the COVID-19 pandemic. Objective: This study sought to assess use patterns of GP telehealth services in response to changing circumstances (before and during the COVID-19 pandemic and with or without a lockdown) in regional Victoria, Australia. Methods: We conducted a secondary analysis of monthly Medicare claims data from July 2019 to June 2021 from 140 regional GP practices in Western Victoria. The longitudinal patterns of proportion of GP telehealth consultations stratified by type of consultation (ie, videoconference vs telephone) and by geographical, consumer, and consultation characteristics were analyzed. Results: Telehealth comprised 25.8% (522,932/2,025,615) of GP consultations over the 2-year period. After the introduction of the Australian telehealth expansion policy in March 2020, there was a rapid uptake in GP telehealth services (including telephone and video services), from 0% before COVID-19 to 15% (11,854/80,922) of all consultations in March 2020, peaking at 55% (50,828/92,139) in August 2020. Thereafter, the use of telehealth declined steadily to 31% (23,941/77,344) in January 2021 and tapered off to 28% (29,263/103,798) in June 2021. Telephone services and shorter consultations were the most dominant form, and those aged 15-64 years had higher telehealth use rates than younger or older age groups. The proportion of video consultations was higher during periods with government-imposed lockdowns and higher in the most socioeconomically advantaged areas compared to less socioeconomically advantaged areas. Conclusions: Our findings support the continuation of telehealth use in rural and regional Australia post pandemic. Future policy must identify mechanisms to reduce existing equity gaps in video consultations and consider patient- and system-level implications of the dominant use of short telephone consultations. %M 36649230 %R 10.2196/39384 %U https://www.jmir.org/2023/1/e39384 %U https://doi.org/10.2196/39384 %U http://www.ncbi.nlm.nih.gov/pubmed/36649230 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e43689 %T Caregiver Perceptions of Children’s and Adolescents’ Psychosocial Functioning During the Stringent COVID-19 Lockdown Restrictions in Shanghai: Cross-sectional Study %A Liu,Xu %A Wu,Jing %A Yang,Hongyang %A Zhao,Fangjie %A Qin,Yuchen %A Wu,Jiali %A Yan,Hongli %A Xu,Yan %A Zhang,Lulu %+ College of Health Service, Second Military Medical University, 800# Xiangyin Road, Yangpu, Shanghai, 200433, China, 86 02181871421, zllrmit@163.com %K COVID-19 exposure %K psychosocial function %K parenting %K children and adolescents %K China %D 2023 %7 7.2.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The COVID-19 pandemic represents a global health crisis. The Shanghai municipal government in China implemented strict and comprehensive pandemic control strategies in the first half of 2022 to eliminate a wave of COVID-19 infection. The pandemic and the resulting government responses have led to abrupt changes to families’ daily lives, including the mental health of children and adolescents. Objective: The aim of this paper is to examine the impact of COVID-19 exposure and the stringent lockdown measures on the daily life and mental health of children and adolescents and to provide suggestions on maintaining their mental health when similar public health emergencies occur in the future. Methods: In this cross-sectional study, an anonymous survey was distributed online in May 1-15, 2022, in Shanghai. Individuals were eligible to participate if they were currently the caregiver of a child or adolescent (aged 4-17 years). Outcomes were psychosocial functioning of children and adolescents, as reported by parents, using the Pediatric Symptom Checklist-17. COVID-19 exposure and life changes were also reported. Multivariate logistic regression was used to analyze risk factors for poor psychosocial functioning. Results: In total, 2493 valid questionnaires were analyzed. The rate of positive scores on the global Pediatric Symptom Checklist-17 scale was 16.5% (n=411). Internalizing, attention, and externalizing problem subscale positivity rates were 17.3% (n=431), 10.9% (n=272), and 8.9% (n=221), respectively. Caregivers reported that 64.2% (n=1601) and 20.7% (n=516) of the children’s interactions with friends or peers and parents deteriorated, respectively. Compared with male caregivers, female caregivers were less likely to report psychosocial problems in children and adolescents (adjusted odds ratio [aOR] 0.68; 95% CI 0.53-0.88). Older children and those with lower COVID-19 Exposure and Family Impact Scales scores were less likely to have psychological problems (aOR 1.15; 95% CI 1.10-1.21). Compared with children with screen times <1 hour per day for recreation, those using screens for >3 hours had higher odds of psychological distress (aOR 2.09; 95% CI 1.47-1.97). Children who spent 1-2 hours exercising and had better interactions with friends or peers and parents showed a trend toward lower odds of psychological problems. Children and adolescents with worse sleep compared with preclosure were more likely to have psychological problems. Conclusions: The prevalence of psychosocial problems among children and adolescents is relatively high. Being young, having more COVID-19 exposure, and having more screen times (>3 h/day), less exercise time (<30 min), worse sleep, and deteriorated interactions with friends or peers and parents were risk factors for poor psychosocial functioning. It is necessary for governments, communities, schools, and families to take appropriate countermeasures to reduce the negative impact of the stringent control measures on caregivers’ parenting and psychosocial functioning of children and adolescents. %M 36749625 %R 10.2196/43689 %U https://publichealth.jmir.org/2023/1/e43689 %U https://doi.org/10.2196/43689 %U http://www.ncbi.nlm.nih.gov/pubmed/36749625 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 9 %N %P e42783 %T Use of Online Health Forums by People Living With Breast Cancer During the COVID-19 Pandemic: Thematic Analysis %A Sanger,Sally %A Duffin,Suzanne %A Gough,Rosemarie E %A Bath,Peter A %+ Information School, Faculty of Social Sciences, University of Sheffield, 211 Portobello, Sheffield, S1 4DP, United Kingdom, 44 114 222 ext 2646, p.a.bath@sheffield.ac.uk %K online health forum %K breast cancer %K COVID-19 %K pandemic %K discussion forum %K coronavirus %K web-based communities %K information use %D 2023 %7 7.2.2023 %9 Original Paper %J JMIR Cancer %G English %X Background: At the time of the UK COVID-19 lockdowns, online health forums (OHFs) were one of the relatively few remaining accessible sources of peer support for people living with breast cancer. Cancer services were heavily affected by the pandemic in many ways, including the closure of many of the customary support services. Previous studies indicate that loneliness, anxiety, distress, and depression caused by COVID-19 were common among people living with breast cancer, and this suggests that the role of OHFs in providing users with support, information, and empathy could have been of increased importance at that time. Objective: This study aimed to examine how people living with breast cancer shared information, experiences, and emotions in an OHF during the COVID-19 pandemic. Methods: This qualitative study thematically analyzed posts from the discussion forums of an OHF provided by the UK charity, Breast Cancer Now. We selected 1053 posts from the time of 2 UK lockdowns: March 16, 2020, to June 15, 2020 (lockdown 1), and January 6, 2021, to March 8, 2021 (lockdown 3), for analysis, from 2 of the forum’s boards (for recently diagnosed people and for those undergoing chemotherapy). We analyzed the data using the original 6 steps for thematic analysis by Braun and Clarke but by following a codebook approach. Descriptive statistics for posts were also derived. Results: We found that COVID-19 amplified the forum’s value to its users. As patients with cancer, participants were in a situation that was “bad enough already,” and the COVID-19 pandemic heightened this difficult situation. The forum’s value, which was already high for the information and peer support it provided, increased because COVID-19 caused some special information needs that forum users were uniquely well placed to fulfill as people experiencing the combined effects of having breast cancer during the pandemic. The forum also met the emotional needs generated by the COVID-19 pandemic and was valued as a place where loneliness during the pandemic may be relieved and users’ spirits lifted in a variety of ways specific to this period. We found some differences in use between the 2 periods and the 2 boards—most noticeable was the great fear and anxiety expressed at the beginning of lockdown 1. Both the beginning and end of lockdown periods were particularly difficult for participants, with the ends seen as potentially increasing isolation. Conclusions: The forums were an important source of support and information to their users, with their value increasing during the lockdowns for a variety of reasons. Our findings will be helpful to organizations offering OHFs and to health care workers advising people living with breast cancer about sources of support. %M 36473015 %R 10.2196/42783 %U https://cancer.jmir.org/2023/1/e42783 %U https://doi.org/10.2196/42783 %U http://www.ncbi.nlm.nih.gov/pubmed/36473015 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e39994 %T Understanding Drivers of Vaccine Hesitancy During the COVID-19 Pandemic Among Older Adults in Jiangsu Province, China: Cross-sectional Survey %A Yang,Liuqing %A Ji,Lili %A Wang,Qiang %A Yang,Guoping %A Xiu,Shixin %A Cui,Tingting %A Shi,Naiyang %A Zhu,Lin %A Xu,Xuepeng %A Jin,Hui %A Zhen,Shiqi %+ Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, 87# Dingjiaqiao, Nanjing, 210009, China, 86 025 8327 2572, jinhui_hld@163.com %K vaccine hesitancy %K older adults %K socioeconomic status %K vaccination history %K COVID-19 %K 3Cs model %K confidence, complacency, and convenience %D 2023 %7 7.2.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Older adults are particularly at risk from infectious diseases, including serve complications, hospitalization, and death. Objective: This study aimed to explore the drivers of vaccine hesitancy among older adults based on the “3Cs” (confidence, complacency, and convenience) framework, where socioeconomic status and vaccination history played the role of moderators. Methods: A cross-sectional questionnaire survey was conducted in Jiangsu Province, China, between June 1 and July 20, 2021. Older adults (aged ≥60 years) were recruited using a stratified sampling method. Vaccine hesitancy was influenced by the 3Cs in the model. Socioeconomic status and vaccination history processed through the item parceling method were used to moderate associations between the 3Cs and hesitancy. Hierarchical regression analyses and structural equation modeling were used to test the validity of the new framework. We performed 5000 trials of bootstrapping to calculate the 95% CI of the pathway’s coefficients. Results: A total of 1341 older adults participated. The mean age was 71.3 (SD 5.4) years, and 44.7% (599/1341) of participants were men. Confidence (b=0.967; 95% CI 0.759-1.201; P=.002), convenience (b=0.458; 95% CI 0.333-0.590; P=.002), and less complacency (b=0.301; 95% CI 0.187-0.408; P=.002) were positively associated with less vaccine hesitancy. Socioeconomic status weakened the positive effect of low complacency (b=–0.065; P=.03) on low vaccine hesitancy. COVID-19 vaccination history negatively moderated the positive association between confidence (b=–0.071; P=.02) and lower vaccine hesitancy. Conclusions: Our study identified that confidence was the more influential dimension in reducing vaccine hesitancy among older adults. COVID-19 vaccination history, as well as confidence, had a positive association with less vaccine hesitancy and could weaken the role of confidence in vaccine hesitancy. Socioeconomic status had a substitution relationship with less complacency, which suggested a competitive positive association between them on less vaccine hesitancy. %M 36693149 %R 10.2196/39994 %U https://formative.jmir.org/2023/1/e39994 %U https://doi.org/10.2196/39994 %U http://www.ncbi.nlm.nih.gov/pubmed/36693149 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e38555 %T mHealth App to Facilitate Remote Care for Patients With COVID-19: Rapid Development of the DrCovid+ App %A Tan,Jamaica Pei Ying %A Tan,Michelle W J %A Towle,Rachel Marie %A Lee,Joanne Sze Win %A Lei,Xiaofeng %A Liu,Yong %A Goh,Rick Siow Mong %A Chee Ping,Franklin Tan %A Tan,Teck Choon %A Ting,Daniel Shu Wei %A Lee,Chen Ee %A Low,Lian Leng %+ Population Health and Integrated Care Office, Singapore General Hospital, 10 Hospital Boulevard, SingHealth Tower Level 7, Singapore, 168582, Singapore, 65 69703018, low.lian.leng@singhealth.com.sg %K mobile health %K mHealth %K rapid development %K remote care %K COVID-19 %K hospital-at-home %K mobile app %K app development %K virtual care %K Telegram service %K clinical care %K continuity of care %K digital health %D 2023 %7 7.2.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: The 2019 novel COVID-19 has severely burdened the health care system through its rapid transmission. Mobile health (mHealth) is a viable solution to facilitate remote monitoring and continuity of care for patients with COVID-19 in a home environment. However, the conceptualization and development of mHealth apps are often time and labor-intensive and are laden with concerns relating to data security and privacy. Implementing mHealth apps is also a challenging feat as language-related barriers limit adoption, whereas its perceived lack of benefits affects sustained use. The rapid development of an mHealth app that is cost-effective, secure, and user-friendly will be a timely enabler. Objective: This project aimed to develop an mHealth app, DrCovid+, to facilitate remote monitoring and continuity of care for patients with COVID-19 by using the rapid development approach. It also aimed to address the challenges of mHealth app adoption and sustained use. Methods: The Rapid Application Development approach was adopted. Stakeholders including decision makers, physicians, nurses, health care administrators, and research engineers were engaged. The process began with requirements gathering to define and finalize the project scope, followed by an iterative process of developing a working prototype, conducting User Acceptance Tests, and improving the prototype before implementation. Co-designing principles were applied to ensure equal collaborative efforts and collective agreement among stakeholders. Results: DrCovid+ was developed on Telegram Messenger and hosted on a cloud server. It features a secure patient enrollment and data interface, a multilingual communication channel, and both automatic and personalized push messaging. A back-end dashboard was also developed to collect patients’ vital signs for remote monitoring and continuity of care. To date, 400 patients have been enrolled into the system, amounting to 2822 hospital bed–days saved. Conclusions: The rapid development and implementation of DrCovid+ allowed for timely clinical care management for patients with COVID-19. It facilitated early patient hospital discharge and continuity of care while addressing issues relating to data security and labor-, time-, and cost-effectiveness. The use case for DrCovid+ may be extended to other medical conditions to advance patient care and empowerment within the community, thereby meeting existing and rising population health challenges. %M 36649223 %R 10.2196/38555 %U https://formative.jmir.org/2023/1/e38555 %U https://doi.org/10.2196/38555 %U http://www.ncbi.nlm.nih.gov/pubmed/36649223 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e38298 %T Developing and Evaluating a Measure of the Willingness to Use Pandemic-Related mHealth Tools Using National Probability Samples in the United States: Quantitative Psychometric Analyses and Tests of Sociodemographic Group Differences %A Vincent,Wilson %+ Department of Psychology and Neuroscience, Temple University, Weiss Hall, 1701 N 13th St, Philadelphia, PA, 19122, United States, 1 404 200 4193, wvincent1804@gmail.com %K COVID-19 %K psychometric properties %K mHealth %K digital health %K digital screening %K digital tracking %K pandemic %K national survey %K mobile health %K digital health tool %K vulnerable population %K demographic characteristic %K instrument validation %D 2023 %7 7.2.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: There are no psychometrically validated measures of the willingness to engage in public health screening and prevention efforts, particularly mobile health (mHealth)–based tracking, that can be adapted to future crises post–COVID-19. Objective: The psychometric properties of a novel measure of the willingness to participate in pandemic-related screening and tracking, including the willingness to use pandemic-related mHealth tools, were tested. Methods: Data were from a cross-sectional, national probability survey deployed in 3 cross-sectional stages several weeks apart to adult residents of the United States (N=6475; stage 1 n=2190, 33.82%; stage 2 n=2238, 34.56%; and stage 3 n=2047, 31.62%) from the AmeriSpeak probability-based research panel covering approximately 97% of the US household population. Five items asked about the willingness to use mHealth tools for COVID-19–related screening and tracking and provide biological specimens for COVID-19 testing. Results: In the first, exploratory sample, 3 of 5 items loaded onto 1 underlying factor, the willingness to use pandemic-related mHealth tools, based on exploratory factor analysis (EFA). A 2-factor solution, including the 3-item factor, fit the data (root mean square error of approximation [RMSEA]=0.038, comparative fit index [CFI]=1.000, standardized root mean square residual [SRMR]=0.005), and the factor loadings for the 3 items ranged from 0.849 to 0.893. In the second, validation sample, the reliability of the 3-item measure was high (Cronbach α=.90), and 1 underlying factor for the 3 items was confirmed using confirmatory factor analysis (CFA): RMSEA=0, CFI=1.000, SRMR=0 (a saturated model); factor loadings ranged from 1.000 to 0.962. The factor was independently associated with COVID-19–preventive behaviors (eg, “worn a face mask”: r=0.313, SE=0.041, P<.001; “kept a 6-foot distance from those outside my household”: r=0.282, SE=0.050, P<.001) and the willingness to provide biological specimens for COVID-19 testing (ie, swab to cheek or nose: r=0.709, SE=0.017, P<.001; small blood draw: r=0.684, SE=0.019, P<.001). In the third, multiple-group sample, the measure was invariant, or measured the same thing in the same way (ie, difference in CFI [ΔCFI]<0.010 across all grouping categories), across age groups, gender, racial/ethnic groups, education levels, US geographic region, and population density (ie, rural, suburban, urban). When repeated across different samples, factor-analytic findings were essentially the same. Additionally, there were mean differences (ΔM) in the willingness to use mHealth tools across samples, mainly based on race or ethnicity and population density. For example, in SD units, suburban (ΔM=–0.30, SE=0.13, P=.001) and urban (ΔM=–0.42, SE=0.12, P<.001) adults showed less willingness to use mHealth tools than rural adults in the third sample collected on May 30-June 8, 2020, but no differences were detected in the first sample collected on April 20-26, 2020. Conclusions: Findings showed that the screener is psychometrically valid. It can also be adapted to future public health crises. Racial and ethnic minority adults showed a greater willingness to use mHealth tools than White adults. Rural adults showed more mHealth willingness than suburban and urban adults. Findings have implications for public health screening and tracking and understanding digital health inequities, including lack of uptake. %M 36689545 %R 10.2196/38298 %U https://formative.jmir.org/2023/1/e38298 %U https://doi.org/10.2196/38298 %U http://www.ncbi.nlm.nih.gov/pubmed/36689545 %0 Journal Article %@ 2562-7600 %I JMIR Publications %V 6 %N %P e40676 %T Nurses’ Work Concerns and Disenchantment During the COVID-19 Pandemic: Machine Learning Analysis of Web-Based Discussions %A Jiang,Haoqiang %A Castellanos,Arturo %A Castillo,Alfred %A Gomes,Paulo J %A Li,Juanjuan %A VanderMeer,Debra %+ College of Informatics, Northern Kentucky University, Louie B Nunn Dr, Highland Heights, KY, 41099, United States, 1 7867172976, jiangh1@nku.edu %K text mining %K machine learning %K blog data %K COVID-19 %K pandemic %K work concerns %K stressors %K natural language processing %D 2023 %7 6.2.2023 %9 Original Paper %J JMIR Nursing %G English %X Background: Web-based forums provide a space for communities of interest to exchange ideas and experiences. Nurse professionals used these forums during the COVID-19 pandemic to share their experiences and concerns. Objective: The objective of this study was to examine the nurse-generated content to capture the evolution of nurses’ work concerns during the COVID-19 pandemic. Methods: We analyzed 14,060 posts related to the COVID-19 pandemic from March 2020 to April 2021. The data analysis stage included unsupervised machine learning and thematic qualitative analysis. We used an unsupervised machine learning approach, latent Dirichlet allocation, to identify salient topics in the collected posts. A human-in-the-loop analysis complemented the machine learning approach, categorizing topics into themes and subthemes. We developed insights into nurses’ evolving perspectives based on temporal changes. Results: We identified themes for biweekly periods and grouped them into 20 major themes based on the work concern inventory framework. Dominant work concerns varied throughout the study period. A detailed analysis of the patterns in how themes evolved over time enabled us to create narratives of work concerns. Conclusions: The analysis demonstrates that professional web-based forums capture nuanced details about nurses’ work concerns and workplace stressors during the COVID-19 pandemic. Monitoring and assessment of web-based discussions could provide useful data for health care organizations to understand how their primary caregivers are affected by external pressures and internal managerial decisions and design more effective responses and planning during crises. %M 36608261 %R 10.2196/40676 %U https://nursing.jmir.org/2023/1/e40676 %U https://doi.org/10.2196/40676 %U http://www.ncbi.nlm.nih.gov/pubmed/36608261 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 12 %N %P e40883 %T COVID-19 in Vietnam and Its Impact on Road Trauma: Retrospective Study Based on National Data %A Nguyen,Ba Tuan %A Blizzard,Christopher Leigh %A Palmer,Andrew %A Nguyen,Huu Tu %A Cong Quyet,Thang %A Tran,Viet %A Nelson,Mark %+ Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool Street, Hobart, 7000, Australia, 61 460918919, batuan.nguyen@utas.edu.au %K COVID-19 %K impact %K road trauma %K low- and middle-income country %K LMIC %K mortality %K pandemic %K trauma %K social distancing %K lockdown %K Vietnam %K disease %K policy %K deaths %D 2023 %7 6.2.2023 %9 Original Paper %J Interact J Med Res %G English %X Background: Despite significant improvement in the last decade, road trauma remains a substantial contributor to deaths in Vietnam. The COVID-19 pandemic necessitated public health measures that had an unforeseen benefit on road trauma in high-income countries. We investigate if this reduction was also seen in a low- to middle-income country like Vietnam. Objective: Our aim was to investigate how the COVID-19 pandemic and the government policies implemented in response to it impacted road trauma fatalities in Vietnam. We also compared this impact to other government policies related to road trauma implemented in the preceding 14 years (2007-2020). Methods: COVID-19 data were extracted from the Vietnamese Ministry of Health database. Road traffic deaths from 2007 to 2021 were derived from the Vietnamese General Statistical Office. We used Stata software (version 17; StataCorp) for statistical analysis. Poisson regression modeling was used to estimate trends in road fatality rates based on annual national mortality data for the 2007-2021 period. The actual change in road traffic mortality in 2021 was compared with calculated figures to demonstrate the effect of COVID-19 on road trauma fatalities. We also compared this impact to other government policies that aimed to reduce traffic-related fatalities from 2007 to 2020. Results: Between 2007 and 2020, the number of annual road traffic deaths decreased by more than 50%, from 15.3 to 7 per 100,000 population, resulting in an average reduction of 5.4% per annum. We estimated that the road traffic mortality rate declined by 12.1% (95% CI 8.9-15.3%) in 2021 relative to this trend. The actual number of road trauma deaths fell by 16.4%. This reduction was largely seen from August to October 2021 when lockdown and social distancing measures were in force. Conclusions: In 2021, the road traffic–related death reduction in Vietnam was 3 times greater than the trend seen in the preceding 14 years. The public health response to the COVID-19 pandemic in Vietnam was associated with a third of this reduction. It can thus be concluded that government policies implemented to address the COVID-19 pandemic resulted in a 4.3% decrease in road traffic deaths in 2021. This has been observed in high-income countries, but we have demonstrated this for the first time in a low- and middle-income country. %M 36718815 %R 10.2196/40883 %U https://www.i-jmr.org/2023/1/e40883 %U https://doi.org/10.2196/40883 %U http://www.ncbi.nlm.nih.gov/pubmed/36718815 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e41729 %T The Nurse-Physician Relationship During the COVID-19 Pandemic in Shanghai, China: Cross-sectional Study %A Shi,Yueping %A Gu,Pinhua %A Wang,Qiufeng %A Zhang,Xuelian %+ Department of Cardiology, Songjiang Hospital Affiliated to Shanghai Jiaotong University School of Medicine (Preparatory Stage), Zhongshan Zhong Road No 746, Songjiang, Shanghai, 201600, China, 86 18918285320, zxuelian2003@sina.com %K nurse %K physician %K collaboration %K online survey %K nursing %K COVID-19 %K structural equation modeling %K equation modeling %K nurse-physician %K ordinal logistic regression %D 2023 %7 6.2.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: The nurse-physician relationship is important for the stability of collaboration. The COVID-19 pandemic has put unprecedented pressure on the health care system and has placed greater demands on nurse-physician collaboration. Nurses and physicians often struggle to share mutual responsibility and communicate effectively. Objective: This study aimed to evaluate the relationship between nurses and physicians during the COVID-19 pandemic and construct a new model combining the attitude and behaviors of the 2 groups to assess various factors’ impacts on job satisfaction and confrontational behavior. Methods: We conducted this quantitative cross-sectional study to assess the relationship between nurses and physicians based on the attitudes and behaviors toward nurse-physician collaboration. We first investigated the satisfaction of nurses and physicians with their relationship and how they thought the COVID-19 pandemic had affected that relationship. We used an adapted and modified Jefferson Scale of Attitudes Toward Physician-Nurse Collaboration questionnaire that consisted of 17 items under 5 dimensions. Structural equation modeling was used to assess the relationships between domains. Ordinal logistic regression was used to evaluate the relationship between different domains of the questionnaire and the satisfaction of the current nurse-physician relationship. Results: We included a total of 176 nurses and 124 physicians in this study. Compared to 7.2% (9/124) of physicians, 22.7% (40/176) of nurses were dissatisfied with the current nurse-physician relationship. Most physicians (101/124, 81.5%) and nurses (131/176, 74.5%) agreed that the nurse-physician relationship had become better because of the COVID-19 pandemic and that the public had greater respect for them. However, significantly fewer nurses (59/176, 33.5% vs 79/124, 63.7%; P<.001) thought that physicians and nurses were treated with the same respect. Nurses scored significantly higher scores in caring versus curing (mean 16.27, SD 2.88 vs mean 17.43, SD 2.50; P<.001) and physician’s authority (mean 8.72, SD 3.21 vs mean 7.24, SD 3.32; P<.001) subscales compared with physicians. The shared education and collaboration subscale had a significantly positive relationship with the nurse’s autonomy subscale (standardized coefficient=0.98; P<.001). Logistic regression showed that 4 subscales (shared education and collaboration: P<.001; caring versus curing: P<.001; nurse’s autonomy: P<.001; and confrontation: P=.01) were significantly associated with the level of satisfaction of the current nurse-physician relationship. Conclusions: This study showed that nurses were more dissatisfied with the current nurse-physician relationship than physicians in Shanghai. Policy makers and managers in the medical and educational system should emphasize an interprofessional collaboration between nurses and physicians. Positive attitudes toward shared collaboration and responsibility may help to improve the relationship between the 2 parties. %M 36745499 %R 10.2196/41729 %U https://formative.jmir.org/2023/1/e41729 %U https://doi.org/10.2196/41729 %U http://www.ncbi.nlm.nih.gov/pubmed/36745499 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e40958 %T Associations of Country-Specific and Sociodemographic Factors With Self-Reported COVID-19–Related Symptoms: Multivariable Analysis of Data From the CoronaCheck Mobile Health Platform %A Humer,Elke %A Keil,Thomas %A Stupp,Carolin %A Schlee,Winfried %A Wildner,Manfred %A Heuschmann,Peter %A Winter,Michael %A Probst,Thomas %A Pryss,Rüdiger %+ Institute of Clinical Epidemiology and Biometry, University of Würzburg, Am Schwarzenberg Haus A15, Würzburg, 97078, Germany, 49 931201 ext 46471, pryss_r@ukw.de %K COVID-19 %K COVID-19 symptoms %K gender %K India %K South Africa %K Germany %K symptoms %K app %K information %K English %K sociodemographic %K weakness %K muscle pain %K pain %K age %K education %D 2023 %7 3.2.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The COVID-19 symptom-monitoring apps provide direct feedback to users about the suspected risk of infection with SARS-CoV-2 and advice on how to proceed to prevent the spread of the virus. We have developed the CoronaCheck mobile health (mHealth) platform, the first free app that provides easy access to valid information about the risk of infection with SARS-CoV-2 in English and German. Previous studies have suggested that the clinical characteristics of individuals infected with SARS-CoV-2 vary by age, gender, and viral variant; however, potential differences between countries have not been adequately studied. Objective: The aim of this study is to describe the characteristics of the users of the CoronaCheck mHealth platform and to determine country-specific and sociodemographic associations of COVID-19–related symptoms and previous contacts with individuals infected with COVID-19. Methods: Between April 8, 2020, and February 3, 2022, data on sociodemographic characteristics, symptoms, and reports of previous close contacts with individuals infected with COVID-19 were collected from CoronaCheck users in different countries. Multivariable logistic regression analyses were performed to examine whether self-reports of COVID-19–related symptoms and recent contact with a person infected with COVID-19 differed between countries (Germany, India, South Africa), gender identities, age groups, education, and calendar year. Results: Most app users (N=23,179) were from Germany (n=8116, 35.0%), India (n=6622, 28.6%), and South Africa (n=3705, 16.0%). Most data were collected in 2020 (n=19,723, 85.1%). In addition, 64% (n=14,842) of the users were male, 52.1% (n=12,077) were ≥30 years old, and 38.6% (n=8953) had an education level of more than 11 years of schooling. Headache, muscle pain, fever, loss of smell, loss of taste, and previous contacts with individuals infected with COVID-19 were reported more frequently by users in India (adjusted odds ratios [aORs] 1.3-8.3, 95% CI 1.2-9.2) and South Africa (aORs 1.1-2.6, 95% CI 1.0-3.0) than those in Germany. Cough, general weakness, sore throat, and shortness of breath were more frequently reported in India (aORs 1.3-2.6, 95% CI 1.2-2.9) compared to Germany. Gender-diverse users reported symptoms and contacts with confirmed COVID-19 cases more often compared to male users. Conclusions: Patterns of self-reported COVID-19–related symptoms and awareness of a previous contact with individuals infected with COVID-19 seemed to differ between India, South Africa, and Germany, as well as by gender identity in these countries. Viral symptom–collecting apps, such as the CoronaCheck mHealth platform, may be promising tools for pandemics to support appropriate assessments. Future mHealth research on country-specific differences during a pandemic should aim to recruit representative samples. %M 36515987 %R 10.2196/40958 %U https://publichealth.jmir.org/2023/1/e40958 %U https://doi.org/10.2196/40958 %U http://www.ncbi.nlm.nih.gov/pubmed/36515987 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e43241 %T Promoting Hand Hygiene During the COVID-19 Pandemic: Parallel Randomized Trial for the Optimization of the Soapp App %A Baretta,Dario %A Amrein,Melanie Alexandra %A Bäder,Carole %A Ruschetti,Gian Giacomo %A Rüttimann,Carole %A Del Rio Carral,Maria %A Fabian,Carlo %A Inauen,Jennifer %+ Institute of Psychology, University of Bern, Fabrikstrasse 8, Bern, 3012, Switzerland, 41 31 684 58 96, dario.baretta@unibe.ch %K COVID-19 %K hand hygiene %K behavior change intervention %K Multiphase Optimization Strategy %K MOST %K smartphone apps %K motivation %K habit %K social norm %K mobile phone %D 2023 %7 3.2.2023 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Hand hygiene is an effective behavior for preventing the spread of the respiratory disease COVID-19 and was included in public health guidelines worldwide. Behavior change interventions addressing hand hygiene have the potential to support the adherence to public health recommendations and, thereby, prevent the spread of COVID-19. However, randomized trials are largely absent during a pandemic; therefore, there is little knowledge about the most effective strategies to promote hand hygiene during an ongoing pandemic. This study addresses this gap by presenting the results of the optimization phase of a Multiphase Optimization Strategy of Soapp, a smartphone app for promoting hand hygiene in the context of the COVID-19 pandemic. Objective: This study aimed to identify the most effective combination and sequence of 3 theory- and evidence-based intervention modules (habit, motivation, and social norms) for promoting hand hygiene. To this end, 9 versions of Soapp were developed (conditions), and 2 optimization criteria were defined: the condition with the largest increase in hand hygiene at follow-up and condition with the highest engagement, usability, and satisfaction based on quantitative and qualitative analyses. Methods: This study was a parallel randomized trial with 9 intervention conditions defined by the combination of 2 intervention modules and their sequence. The trial was conducted from March to August 2021 with interested participants from the Swiss general population (N=232; randomized). Randomization was performed using Qualtrics (Qualtrics International Inc), and blinding was ensured. The duration of the intervention was 34 days. The primary outcome was self-reported hand hygiene at follow-up, which was assessed using an electronic diary. The secondary outcomes were user engagement, usability, and satisfaction assessed at follow-up. Nine participants were further invited to participate in semistructured exit interviews. A set of ANOVAs was performed to test the main hypotheses, whereas a thematic analysis was performed to analyze the qualitative data. Results: The results showed a significant increase in hand hygiene over time across all conditions. There was no interaction effect between time and intervention condition. Similarly, no between-group differences in engagement, usability, and satisfaction emerged. Seven themes (eg, “variety and timeliness of the task load” and “social interaction”) were found in the thematic analysis. Conclusions: The effectiveness of Soapp in promoting hand hygiene laid the foundation for the next evaluation phase of the app. More generally, the study supported the value of digital interventions in pandemic contexts. The findings showed no differential effect of intervention conditions involving different combinations and sequences of the habit, motivation, and social norms modules on hand hygiene, engagement, usability, and satisfaction. In the absence of quantitative differences, we relied on the results from the thematic analysis to select the best version of Soapp for the evaluation phase. Trial Registration: ClinicalTrials.gov NCT04830761; https://clinicaltrials.gov/ct2/show/NCT04830761 International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2021-055971 %M 36599056 %R 10.2196/43241 %U https://mhealth.jmir.org/2023/1/e43241 %U https://doi.org/10.2196/43241 %U http://www.ncbi.nlm.nih.gov/pubmed/36599056 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 3 %N %P e40156 %T Lessons Learned From Interdisciplinary Efforts to Combat COVID-19 Misinformation: Development of Agile Integrative Methods From Behavioral Science, Data Science, and Implementation Science %A Myneni,Sahiti %A Cuccaro,Paula %A Montgomery,Sarah %A Pakanati,Vivek %A Tang,Jinni %A Singh,Tavleen %A Dominguez,Olivia %A Cohen,Trevor %A Reininger,Belinda %A Savas,Lara S %A Fernandez,Maria E %+ School of Biomedical Informatics, The University of Texas Health Science Center, 7000 Fannin St., Houston, TX, 77030, United States, 1 713 500 3900, tavleen.kaur.ranjit.singh@uth.tmc.edu %K COVID-19 %K misinformation %K social media %K health belief model %K deep learning %K community engagement %D 2023 %7 3.2.2023 %9 Original Paper %J JMIR Infodemiology %G English %X Background: Despite increasing awareness about and advances in addressing social media misinformation, the free flow of false COVID-19 information has continued, affecting individuals’ preventive behaviors, including masking, testing, and vaccine uptake. Objective: In this paper, we describe our multidisciplinary efforts with a specific focus on methods to (1) gather community needs, (2) develop interventions, and (3) conduct large-scale agile and rapid community assessments to examine and combat COVID-19 misinformation. Methods: We used the Intervention Mapping framework to perform community needs assessment and develop theory-informed interventions. To supplement these rapid and responsive efforts through large-scale online social listening, we developed a novel methodological framework, comprising qualitative inquiry, computational methods, and quantitative network models to analyze publicly available social media data sets to model content-specific misinformation dynamics and guide content tailoring efforts. As part of community needs assessment, we conducted 11 semistructured interviews, 4 listening sessions, and 3 focus groups with community scientists. Further, we used our data repository with 416,927 COVID-19 social media posts to gather information diffusion patterns through digital channels. Results: Our results from community needs assessment revealed the complex intertwining of personal, cultural, and social influences of misinformation on individual behaviors and engagement. Our social media interventions resulted in limited community engagement and indicated the need for consumer advocacy and influencer recruitment. The linking of theoretical constructs underlying health behaviors to COVID-19–related social media interactions through semantic and syntactic features using our computational models has revealed frequent interaction typologies in factual and misleading COVID-19 posts and indicated significant differences in network metrics such as degree. The performance of our deep learning classifiers was reasonable, with an F-measure of 0.80 for speech acts and 0.81 for behavior constructs. Conclusions: Our study highlights the strengths of community-based field studies and emphasizes the utility of large-scale social media data sets in enabling rapid intervention tailoring to adapt grassroots community interventions to thwart misinformation seeding and spread among minority communities. Implications for consumer advocacy, data governance, and industry incentives are discussed for the sustainable role of social media solutions in public health. %M 37113378 %R 10.2196/40156 %U https://infodemiology.jmir.org/2023/1/e40156 %U https://doi.org/10.2196/40156 %U http://www.ncbi.nlm.nih.gov/pubmed/37113378 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e34074 %T The Impact of COVID-19 on the Prevalence and Perception of Telehealth Use in the Middle East and North Africa Region: Survey Study %A Shamiyah,Khalid Adnan %A Whitebridge,Simon %A Kumar,Nitya %A Aljenaee,Khaled %A Atkin,Stephen L %A Ali,Khawla Fuad %+ Royal College of Surgeons in Ireland-Medical University of Bahrain, Building No 2441, Road 2835, Alsayh, Busaiteen, 228, Bahrain, 973 16660081, kali@rcsi-mub.com %K COVID-19 %K telehealth %K Instagram %K WhatsApp %K social media %K telemedicine %K impact %K prevalence %K perception %K view %K usage %K utilization %K safety %K acceptability %K survey %D 2023 %7 2.2.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Due to the COVID-19 pandemic, telehealth has become a safer way to access health care. The telehealth industry has rapidly expanded over the last decade as a modality to provide patient-centered care. However, the prevalence of its use and patient acceptability remains unclear in the Middle East and North Africa (MENA) region. Objective: The primary aim was to assess the prevalence of telehealth use before and during the pandemic by using social media (Instagram) as an online platform for survey administration across different countries simultaneously. Our secondary aim was to assess the perceptions regarding telehealth among those using it. Methods: An Instagram account that reaches 130,000 subjects daily was used to administer a questionnaire that assessed the current prevalence of telehealth use and public attitudes and acceptability toward this modality of health care delivery during the COVID-19 pandemic. Results: A total of 1524 respondents participated in the survey (n=1356, 89% female; median age 31 years), of whom 97.6% (n=1487) lived in the Gulf Cooperation Council (GCC) region. Prior to COVID-19, 1350 (88.6%) had no exposure to telehealth. Following the COVID-19 pandemic, telehealth use increased by 251% to a total of 611 users (40% of all users). About 89% (571/640) of telehealth users used virtual visits for specialist visits. Of the 642 participants who reported using telehealth, 236 (36.8%) reported their willingness to continue using telehealth, 241 (37.5%) were unsure, and 164 (25.5%) did not wish to continue to use telehealth after the COVID-19 pandemic. An inverse trend, although not statistically significant, was seen between willingness to continue telehealth use and the number of medical comorbidities (odds ratio [OR] 0.81, 95% CI 0.64-1.03; P=.09). Compared to the respondents who chose only messaging as the modality they used for telehealth, respondents who chose both messaging and phone calls were significantly less likely to recommend telehealth (OR 0.42, 95% CI 0.22-0.80; P=.009). Overall, there was general satisfaction with telehealth, and respondents reported that telehealth consultations made them feel safer and saved both time and money. Conclusions: Telehealth use increased dramatically after the COVID-19 pandemic, and telehealth was found to be acceptable among some young adult groups on Instagram. However, further innovation is warranted to increase acceptability and willingness to continue telehealth use for the delivery of health care. %M 36652596 %R 10.2196/34074 %U https://formative.jmir.org/2023/1/e34074 %U https://doi.org/10.2196/34074 %U http://www.ncbi.nlm.nih.gov/pubmed/36652596 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e42586 %T Targeting Patients’ Cognitive Load for Telehealth Video Visits Through Student-Delivered Helping Sessions at a United States Federally Qualified Health Center: Equity-Focused, Mixed Methods Pilot Intervention Study %A Antonio,Marcy G %A Williamson,Alicia %A Kameswaran,Vaishnav %A Beals,Ashley %A Ankrah,Elizabeth %A Goulet,Shannon %A Wang,Yucen %A Macias,Grecia %A James-Gist,Jade %A Brown,Lindsay K %A Davis,Sage %A Pillai,Srijanani %A Buis,Lorraine %A Dillahunt,Tawanna %A Veinot,Tiffany C %+ School of Information, University of Michigan, 105 S State St, Ann Arbor, MI, 48109, United States, 1 2508588116, marcyant@umich.edu %K COVID-19 %K cognitive load %K health services accessibility %K health equity %K human-computer interaction %K pilot projects %K learning %K telemedicine and telehealth %K recruit methods %K digital health intervention %K patient portal %K video consultation %K mobile phone %D 2023 %7 1.2.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: The task complexity involved in connecting to telehealth video visits may disproportionately impact health care access in populations already experiencing inequities. Human intermediaries can be a strategy for addressing health care access disparities by acting as technology helpers to reduce the cognitive load demands required to learn and use patient-facing telehealth technologies. Objective: We conducted a cognitive load theory–informed pilot intervention involving warm accompaniment telehealth helping sessions with patients at a Federally Qualified Health Center (FQHC). We demonstrate how to design and report recruitment methods, reach, delivery process, and the preliminary impact of a novel equity-focused intervention. Methods: Early into the COVID-19 pandemic a telehealth helping session was offered to patients at FQHC via phone. Graduate students led the sessions on conducting a telehealth video test run or helping with patient portal log-in. They systematically recorded their recruitment efforts, intervention observations, and daily reflection notes. Following the intervention, we asked the intervention participants to participate in an interview and all patients who had telehealth visits during and 4 weeks before and after the intervention period to complete a survey. Electronic health records were reviewed to assess telehealth visit format changes. Descriptive and inferential statistical analyses of the recruitment records, electronic health record data, and surveys were performed. Through integrative analysis, we developed process-related themes and recommendations for future equity-focused telehealth interventions. Results: Of the 239 eligible patients, 34 (14.2%) completed the intervention and 3 (1.2%) completed subsequent interviews. The intervention participants who completed the survey (n=15) had lower education and less technological experience than the nonintervention survey participants (n=113). We identified 3 helping strategies for cognitive load reduction: providing step-by-step guidance for configuring and learning, building rapport to create confidence while problem-solving, and being on the same page to counter informational distractions. Intervention participants reported increased understanding but found that learning the video visit software was more difficult than nonintervention participants. A comparison of visit experiences did not find differences in difficulty (cognitive load measure) using telehealth-related technologies, changes to visit modality, or reported technical problems during the visit. However, the intervention participants were significantly less satisfied with the video visits. Conclusions: Although a limited number of people participated in the intervention, it may have reached individuals more likely to need technology assistance. We postulate that significant differences between intervention and nonintervention participants were rooted in baseline differences between the groups’ education level, technology experience, and technology use frequency; however, small sample sizes limit conclusions. The barriers encountered during the intervention suggest that patients at FQHC may require both improved access to web-based technologies and human intermediary support to make telehealth video visits feasible. Future large, randomized, equity-focused studies should investigate blended strategies to facilitate video visit access. %M 36525332 %R 10.2196/42586 %U https://www.jmir.org/2023/1/e42586 %U https://doi.org/10.2196/42586 %U http://www.ncbi.nlm.nih.gov/pubmed/36525332 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e44234 %T The Association Between Pediatric COVID-19 Vaccination and Socioeconomic Position: Nested Case-Control Study From the Pedianet Veneto Cohort %A Batzella,Erich %A Cantarutti,Anna %A Caranci,Nicola %A Giaquinto,Carlo %A Barbiellini Amidei,Claudio %A Canova,Cristina %+ Unit of Biostatistics, Epidemiology and Public Health, Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padova, Via Loredan 18, Padua, 35131, Italy, 39 0498275391, cristina.canova@unipd.it %K SEP %K socioeconomic position %K quantile-g-computation %K nested case-control study %K COVID-19 vaccine %K children %K area deprivation index %D 2023 %7 1.2.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The success of pediatric COVID-19 vaccination strongly depends on parents' willingness to vaccinate their children. To date, the role of socioeconomic position (SEP) in pediatric COVID-19 vaccination has not been thoroughly examined. Objective: We evaluated the association between COVID-19 vaccination and SEP in a large pediatric cohort. Methods: A case-control study design nested into a pediatric cohort of children born between 2007 and 2017, living in the Veneto Region and followed up to at least January 1, 2022, was adopted. Data on children were collected from the Pedianet database and linked with the regional COVID-19 registry. Each child vaccinated with at least one dose of any COVID-19 vaccine between July 1, 2021, and March 31, 2022, was matched by sex, year of birth, and family pediatrician to up to 5 unvaccinated children. Unvaccinated children with a positive outcome on the swab test within 180 days before the index date were excluded from the analyses. Children were geo-referenced to determine their area deprivation index (ADI)—a social and material deprivation measure calculated at the census block level and consisting of 5 socioeconomic items. The index was then categorized in quintiles based on the regional ADI level. The association between ADI quintiles and vaccination status was measured using conditioned logistic regression models to estimate odds ratios and the corresponding 95% CIs. Quantile-g-computation regression models were applied to develop a weighted combination of the individual items to estimate how much each component influenced the likelihood of vaccination. All analyses were stratified by age at vaccination (5-11 and 12-14 years). Results: The study population consisted of 6475 vaccinated children, who were matched with 32,124 unvaccinated children. Increasing area deprivation was associated with a lower probability of being vaccinated, with approximately a linear dose-response relationship. Children in the highest deprivation quintile were 36% less likely to receive a COVID-19 vaccine than those with the lowest area deprivation (95% CI 0.59-0.70). The results were similar in the 2 age groups, with a slightly stronger association in 5-11–year-old children. When assessing the effects of the weighted combination of the individual items, a quintile increase was associated with a 17% decrease in the probability of being vaccinated (95% CI 0.80-0.86). The conditions that influenced the probability of vaccination the most were living on rent, being unemployed, and being born in single-parent families. Conclusions: This study has shown a significant reduction in the likelihood of receiving a COVID-19 vaccine among children living in areas characterized by a lower SEP. Findings were robust among multiple analyses and definitions of the deprivation index. These findings suggest that SEP plays an important role in vaccination coverage, emphasizing the need to promote targeted public health efforts to ensure global vaccine equity. %M 36645419 %R 10.2196/44234 %U https://publichealth.jmir.org/2023/1/e44234 %U https://doi.org/10.2196/44234 %U http://www.ncbi.nlm.nih.gov/pubmed/36645419 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e42623 %T A Comprehensive Analysis of COVID-19 Vaccine Discourse by Vaccine Brand on Twitter in Korea: Topic and Sentiment Analysis %A Park,Susan %A Suh,Young-Kyoon %+ School of Computer Science and Engineering, Kyungpook National University, 80, Daehak-ro, Buk-gu, Daegu, 41566, Republic of Korea, 82 539506372, yksuh@knu.ac.kr %K COVID-19 %K vaccine %K vaccination %K Pfizer %K Moderna %K AstraZeneca %K Janssen %K Novavax %D 2023 %7 31.1.2023 %9 Original Paper %J J Med Internet Res %G English %X Background:  The unprecedented speed of COVID-19 vaccine development and approval has raised public concern about its safety. However, studies on public discourses and opinions on social media focusing on adverse events (AEs) related to COVID-19 vaccine are rare. Objective:  This study aimed to analyze Korean tweets about COVID-19 vaccines (Pfizer, Moderna, AstraZeneca, Janssen, and Novavax) after the vaccine rollout, explore the topics and sentiments of tweets regarding COVID-19 vaccines, and examine their changes over time. We also analyzed topics and sentiments focused on AEs related to vaccination using only tweets with terms about AEs. Methods:  We devised a sophisticated methodology consisting of 5 steps: keyword search on Twitter, data collection, data preprocessing, data analysis, and result visualization. We used the Twitter Representational State Transfer application programming interface for data collection. A total of 1,659,158 tweets were collected from February 1, 2021, to March 31, 2022. Finally, 165,984 data points were analyzed after excluding retweets, news, official announcements, advertisements, duplicates, and tweets with <2 words. We applied a variety of preprocessing techniques that are suitable for the Korean language. We ran a suite of analyses using various Python packages, such as latent Dirichlet allocation, hierarchical latent Dirichlet allocation, and sentiment analysis. Results:  The topics related to COVID-19 vaccines have a very large spectrum, including vaccine-related AEs, emotional reactions to vaccination, vaccine development and supply, and government vaccination policies. Among them, the top major topic was AEs related to COVID-19 vaccination. The AEs ranged from the adverse reactions listed in the safety profile (eg, myalgia, fever, fatigue, injection site pain, myocarditis or pericarditis, and thrombosis) to unlisted reactions (eg, irregular menstruation, changes in appetite and sleep, leukemia, and deaths). Our results showed a notable difference in the topics for each vaccine brand. The topics pertaining to the Pfizer vaccine mainly mentioned AEs. Negative public opinion has prevailed since the early stages of vaccination. In the sentiment analysis based on vaccine brand, the topics related to the Pfizer vaccine expressed the strongest negative sentiment. Conclusions:  Considering the discrepancy between academic evidence and public opinions related to COVID-19 vaccination, the government should provide accurate information and education. Furthermore, our study suggests the need for management to correct the misinformation related to vaccine-related AEs, especially those affecting negative sentiments. This study provides valuable insights into the public discourses and opinions regarding COVID-19 vaccination. %M 36603153 %R 10.2196/42623 %U https://www.jmir.org/2023/1/e42623 %U https://doi.org/10.2196/42623 %U http://www.ncbi.nlm.nih.gov/pubmed/36603153 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e43055 %T Preference and Willingness to Pay for the Regular COVID-19 Booster Shot in the Vietnamese Population: Theory-Driven Discrete Choice Experiment %A Tran,Bach Xuan %A Do,Anh Linh %A Boyer,Laurent %A Auquier,Pascal %A Le,Huong Thi %A Le Vu,Minh Ngoc %A Dang,Trang Huyen Thi %A Cao,Khuy Minh %A Le,Linh Dieu Thi %A Cu,Lam Tung Ngoc %A Ly,Bang Viet %A Nguyen,Duong Anh Thi %A Nguyen,Manh Duc %A Latkin,Carl A %A Ho,Roger C M %A Ho,Cyrus S H %A Zhang,Melvyn W B %+ Institute for Preventive Medicine and Public Health, Hanoi Medical University, 1 Ton That Tung Street, Kim Lien Ward, Dong Da District, Hanoi, 100000, Vietnam, 84 888288399, bach.ipmph@gmail.com %K COVID-19 %K epidemic %K vaccine %K booster %K willingness to take %K willingness to pay %K Vietnam %K policy %K feasibility %K acceptability %K infection %K vaccination %K social media %K intervention %D 2023 %7 31.1.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The COVID-19 booster vaccination rate has declined despite the wide availability of vaccines. As COVID-19 is becoming endemic and charges for regular booster vaccination are being introduced, measuring public acceptance and the willingness to pay for regular COVID-19 boosters is ever more crucial. Objective: This study aims to (1) investigate public acceptance for regular COVID-19 boosters, (2) assess the willingness to pay for a COVID-19 booster shot, and (3) identify factors associated with vaccine hesitancy. Our results will provide crucial insights into and implications for policy response as well as the development of a feasible and effective vaccination campaign during Vietnam’s waning vaccine immunity period. Methods: A cross-sectional study was conducted among 871 Vietnamese online participants from April to August 2022. An online questionnaire based on the discrete choice experiment (DCE) design was developed, distributed using the snowball sampling method, and subsequently conjointly analyzed on the Qualtrics platform. A history of COVID-19 infection and vaccination, health status, willingness to vaccinate, willingness to pay, and other factors were examined. Results: Among the participants, 761 (87.4%) had received or were waiting for a COVID-19 booster shot. However, the willingness to pay was low at US $8.02, and most participants indicated an unwillingness to pay (n=225, 25.8%) or a willingness to pay for only half of the vaccine costs (n=222, 25.4%). Although information insufficiency and a wariness toward vaccines were factors most associated with the unwillingness to pay, long-term side effects, immunity duration, and mortality rate were the attributes the participants were most concerned with during the vaccine decision-making period. Participants who had children less than 18 years old in their homes infected with COVID-19 had a lower willingness to pay (odds ratio [OR] 0.54, 95% CI 0.39-0.74). Respondents who had children under 12 years old in their family who received at least 1 vaccine dose had a higher willingness to pay (OR 2.03, 95% CI 1.12-3.66). The burden of medical expenses (OR 0.33, 95% CI 0.25-0.45) and fear of the vaccine (OR 0.93, 95% CI 0.86-1.00) were negative factors associated with the level of willingness to pay. Conclusions: A significant inconsistency between high acceptance and a low willingness to pay underscores the role of vaccine information and public trust. In addition to raising awareness about the most concerning characteristics of the COVID-19 booster, social media and social listening should be used in collaboration with health professionals to establish a 2-way information exchange. Work incentives and suitable mandates should continue to encourage workforce participation. Most importantly, all interventions should be conducted with informational transparency to strengthen trust between the public and authorities. %M 36599156 %R 10.2196/43055 %U https://publichealth.jmir.org/2023/1/e43055 %U https://doi.org/10.2196/43055 %U http://www.ncbi.nlm.nih.gov/pubmed/36599156 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e43003 %T The Association of Acute Signs and Symptoms of COVID-19 and Exacerbation of Depression and Anxiety in Patients With Clinically Mild COVID-19: Retrospective Observational Study %A Sung,Sumi %A Kim,Su Hwan %A Lee,Changwoo %A Kim,Youlim %A Bae,Ye Seul %A Chie,Eui Kyu %+ Office of Hospital Information, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea, 82 2 2072 7600, ekchie93@snu.ac.kr %K COVID-19 %K depression %K anxiety %K vital signs %K symptoms %K electronic health records %D 2023 %7 30.1.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: To date, the association between acute signs and symptoms of COVID-19 and the exacerbation of depression and anxiety in patients with clinically mild COVID-19 has not been evaluated. Objective: This study was designed to assess the correlation between acute signs and symptoms of COVID-19 and the exacerbation of depression and anxiety in patients with clinically mild COVID-19 at a residential treatment center in South Korea. Methods: This retrospective study assessed 2671 patients with COVID-19 admitted to 4 residential treatment centers operated by Seoul National University Hospital, South Korea, from March 2020 to April 2022. Depression and anxiety were assessed using the 2-item Patient Health Questionnaire (PHQ-2) and 2-item Generalized Anxiety Disorder (GAD-2) scale, respectively. The exacerbation of depression and anxiety symptoms was identified from the differences in PHQ-2 and GAD-2 scores between admission and discharge, respectively. The patients’ clinical characteristics, including acute signs and symptoms of COVID-19, GAD-2 and PHQ-2 scores, were obtained from electronic health records. Demographic characteristics, a summary of vital signs, and COVID-19 symptoms were analyzed and compared between the patient groups with and those without exacerbated PHQ-2 and GAD-2 scores using the chi-square test. We applied logistic regression to identify the association between acute signs and symptoms of COVID-19 and the exacerbation of depression and anxiety. Results: Sleep disorders were associated with exacerbated depression (odds ratio [OR] 1.09, 95% CI 1.05-1.13) and anxiety (OR 1.1, 95% CI 1.06-1.14), and the sore throat symptom was associated with exacerbated anxiety symptoms (OR 1.03, 95% CI 1.00-1.07). Patients with abnormal oxygen saturation during quarantine were more likely to have exacerbated depression (OR 1.27, 95% CI 1.00-1.62), and those with an abnormal body temperature during quarantine were more likely to experience anxiety (OR 1.08, 95% CI 1.01-1.16). As anticipated, patients who experienced psychological symptoms at admission were more likely to experience depression (OR 1.91, 95% CI 1.52-2.41) and anxiety (OR 1.98, 95% CI 1.54-2.53). Meanwhile, the PHQ-2 and GAD-2 scores measured at admission revealed that lower the score, higher the possibility of exacerbation of both depression (OR 0.15, 95% CI 0.11-0.22) and anxiety (OR 0.13, 95% CI 0.10-0.19). Conclusions: Results from this study suggest the importance of further interventions for patients with abnormal oxygen saturation, abnormal body temperatures, sore throat, and sleep disorder symptoms or initial psychological symptoms to mitigate the exacerbation of depression and anxiety. In addition, this study highlights the usability of short and efficient scales such as the PHQ-2 and GAD-2 in the assessment of the mental health of patients with clinically mild COVID-19 symptoms who were quarantined at home during the pandemic era. %M 36645439 %R 10.2196/43003 %U https://publichealth.jmir.org/2023/1/e43003 %U https://doi.org/10.2196/43003 %U http://www.ncbi.nlm.nih.gov/pubmed/36645439 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 10 %N %P e40533 %T Usability and Credibility of a COVID-19 Vaccine Chatbot for Young Adults and Health Workers in the United States: Formative Mixed Methods Study %A Weeks,Rose %A Sangha,Pooja %A Cooper,Lyra %A Sedoc,João %A White,Sydney %A Gretz,Shai %A Toledo,Assaf %A Lahav,Dan %A Hartner,Anna-Maria %A Martin,Nina M %A Lee,Jae Hyoung %A Slonim,Noam %A Bar-Zeev,Naor %+ International Vaccine Access Center, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 415 N Washington Street 5th Floor, Baltimore, MD, 21231, United States, 1 443 287 4832, rweeks@jhu.edu %K COVID-19 %K chatbot development %K risk communication %K vaccine hesitancy %K conversational agent %K health information %K chatbot %K natural language processing %K usability %K user feedback %D 2023 %7 30.1.2023 %9 Original Paper %J JMIR Hum Factors %G English %X Background: The COVID-19 pandemic raised novel challenges in communicating reliable, continually changing health information to a broad and sometimes skeptical public, particularly around COVID-19 vaccines, which, despite being comprehensively studied, were the subject of viral misinformation. Chatbots are a promising technology to reach and engage populations during the pandemic. To inform and communicate effectively with users, chatbots must be highly usable and credible. Objective: We sought to understand how young adults and health workers in the United States assessed the usability and credibility of a web-based chatbot called Vira, created by the Johns Hopkins Bloomberg School of Public Health and IBM Research using natural language processing technology. Using a mixed method approach, we sought to rapidly improve Vira’s user experience to support vaccine decision-making during the peak of the COVID-19 pandemic. Methods: We recruited racially and ethnically diverse young people and health workers, with both groups from urban areas of the United States. We used the validated Chatbot Usability Questionnaire to understand the tool’s navigation, precision, and persona. We also conducted 11 interviews with health workers and young people to understand the user experience, whether they perceived the chatbot as confidential and trustworthy, and how they would use the chatbot. We coded and categorized emerging themes to understand the determining factors for participants’ assessment of chatbot usability and credibility. Results: In all, 58 participants completed a web-based usability questionnaire and 11 completed in-depth interviews. Most questionnaire respondents said the chatbot was “easy to navigate” (51/58, 88%) and “very easy to use” (50/58, 86%), and many (45/58, 78%) said its responses were relevant. The mean Chatbot Usability Questionnaire score was 70.2 (SD 12.1) and scores ranged from 40.6 to 95.3. Interview participants felt the chatbot achieved high usability due to its strong functionality, performance, and perceived confidentiality and that the chatbot could attain high credibility with a redesign of its cartoonish visual persona. Young people said they would use the chatbot to discuss vaccination with hesitant friends or family members, whereas health workers used or anticipated using the chatbot to support community outreach, save time, and stay up to date. Conclusions: This formative study conducted during the pandemic’s peak provided user feedback for an iterative redesign of Vira. Using a mixed method approach provided multidimensional feedback, identifying how the chatbot worked well—being easy to use, answering questions appropriately, and using credible branding—while offering tangible steps to improve the product’s visual design. Future studies should evaluate how chatbots support personal health decision-making, particularly in the context of a public health emergency, and whether such outreach tools can reduce staff burnout. Randomized studies should also be conducted to measure how chatbots countering health misinformation affect user knowledge, attitudes, and behavior. %M 36409300 %R 10.2196/40533 %U https://humanfactors.jmir.org/2023/1/e40533 %U https://doi.org/10.2196/40533 %U http://www.ncbi.nlm.nih.gov/pubmed/36409300 %0 Journal Article %@ 2817-1705 %I JMIR Publications %V 2 %N %P e38397 %T The Application of Artificial Intelligence in Health Care Resource Allocation Before and During the COVID-19 Pandemic: Scoping Review %A Wu,Hao %A Lu,Xiaoyu %A Wang,Hanyu %+ School of International Studies, Peking University, No 5 Yiheyuan Road, Haidian District, Beijing, 100871, China, 86 13261712766, wang.hanyu@outlook.com %K artificial intelligence %K resource distribution %K health care %K COVID-19 %K health equality %K eHealth %K digital health %D 2023 %7 30.1.2023 %9 Review %J JMIR AI %G English %X Background: Imbalanced health care resource distribution has been central to unequal health outcomes and political tension around the world. Artificial intelligence (AI) has emerged as a promising tool for facilitating resource distribution, especially during emergencies. However, no comprehensive review exists on the use and ethics of AI in health care resource distribution. Objective: This study aims to conduct a scoping review of the application of AI in health care resource distribution, and explore the ethical and political issues in such situations. Methods: A scoping review was conducted following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews). A comprehensive search of relevant literature was conducted in MEDLINE (Ovid), PubMed, Web of Science, and Embase from inception to February 2022. The review included qualitative and quantitative studies investigating the application of AI in health care resource allocation. Results: The review involved 22 articles, including 9 on model development and 13 on theoretical discussions, qualitative studies, or review studies. Of the 9 on model development and validation, 5 were conducted in emerging economies, 3 in developed countries, and 1 in a global context. In terms of content, 4 focused on resource distribution at the health system level and 5 focused on resource allocation at the hospital level. Of the 13 qualitative studies, 8 were discussions on the COVID-19 pandemic and the rest were on hospital resources, outbreaks, screening, human resources, and digitalization. Conclusions: This scoping review synthesized evidence on AI in health resource distribution, focusing on the COVID-19 pandemic. The results suggest that the application of AI has the potential to improve efficacy in resource distribution, especially during emergencies. Efficient data sharing and collecting structures are needed to make reliable and evidence-based decisions. Health inequality, distributive justice, and transparency must be considered when deploying AI models in real-world situations. %M 27917920 %R 10.2196/38397 %U https://ai.jmir.org/2023/1/e38397 %U https://doi.org/10.2196/38397 %U http://www.ncbi.nlm.nih.gov/pubmed/27917920 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 12 %N %P e42540 %T Using Decision Trees as an Expert System for Clinical Decision Support for COVID-19 %A Chrimes,Dillon %+ School of Health Information Science, Human and Social Development, University of Victoria, HSD Building, A202, Victoria, BC, V8W2Y2, Canada, 1 250 472 4474, dchrimes@uvic.ca %K assessment tool %K chatbot %K clinical decision support %K COVID-19 %K decision tree %K digital health tool %K framework %K health informatics %K health intervention %K prototype %D 2023 %7 30.1.2023 %9 Viewpoint %J Interact J Med Res %G English %X COVID-19 has impacted billions of people and health care systems globally. However, there is currently no publicly available chatbot for patients and care providers to determine the potential severity of a COVID-19 infection or the possible biological system responses and comorbidities that can contribute to the development of severe cases of COVID-19. This preliminary investigation assesses this lack of a COVID-19 case-by-case chatbot into consideration when building a decision tree with binary classification that was stratified by age and body system, viral infection, comorbidities, and any manifestations. After reviewing the relevant literature, a decision tree was constructed using a suite of tools to build a stratified framework for a chatbot application and interaction with users. A total of 212 nodes were established that were stratified from lung to heart conditions along body systems, medical conditions, comorbidities, and relevant manifestations described in the literature. This resulted in a possible 63,360 scenarios, offering a method toward understanding the data needed to validate the decision tree and highlighting the complicated nature of severe cases of COVID-19. The decision tree confirms that stratification of the viral infection with the body system while incorporating comorbidities and manifestations strengthens the framework. Despite limitations of a viable clinical decision tree for COVID-19 cases, this prototype application provides insight into the type of data required for effective decision support. %M 36645840 %R 10.2196/42540 %U https://www.i-jmr.org/2023/1/e42540 %U https://doi.org/10.2196/42540 %U http://www.ncbi.nlm.nih.gov/pubmed/36645840 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e40922 %T User-Chatbot Conversations During the COVID-19 Pandemic: Study Based on Topic Modeling and Sentiment Analysis %A Chin,Hyojin %A Lima,Gabriel %A Shin,Mingi %A Zhunis,Assem %A Cha,Chiyoung %A Choi,Junghoi %A Cha,Meeyoung %+ Data Science Group, Institute for Basic Science, 55, Expo-ro, Yuseong-gu, Daejeon, 34126, Republic of Korea, 82 428788114, meeyoung.cha@gmail.com %K chatbot %K COVID-19 %K topic modeling %K sentiment analysis %K infodemiology %K discourse %K public perception %K public health %K infoveillance %K conversational agent %K global health %K health information %D 2023 %7 27.1.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Chatbots have become a promising tool to support public health initiatives. Despite their potential, little research has examined how individuals interacted with chatbots during the COVID-19 pandemic. Understanding user-chatbot interactions is crucial for developing services that can respond to people’s needs during a global health emergency. Objective: This study examined the COVID-19 pandemic–related topics online users discussed with a commercially available social chatbot and compared the sentiment expressed by users from 5 culturally different countries. Methods: We analyzed 19,782 conversation utterances related to COVID-19 covering 5 countries (the United States, the United Kingdom, Canada, Malaysia, and the Philippines) between 2020 and 2021, from SimSimi, one of the world’s largest open-domain social chatbots. We identified chat topics using natural language processing methods and analyzed their emotional sentiments. Additionally, we compared the topic and sentiment variations in the COVID-19–related chats across countries. Results: Our analysis identified 18 emerging topics, which could be categorized into the following 5 overarching themes: “Questions on COVID-19 asked to the chatbot” (30.6%), “Preventive behaviors” (25.3%), “Outbreak of COVID-19” (16.4%), “Physical and psychological impact of COVID-19” (16.0%), and “People and life in the pandemic” (11.7%). Our data indicated that people considered chatbots as a source of information about the pandemic, for example, by asking health-related questions. Users turned to SimSimi for conversation and emotional messages when offline social interactions became limited during the lockdown period. Users were more likely to express negative sentiments when conversing about topics related to masks, lockdowns, case counts, and their worries about the pandemic. In contrast, small talk with the chatbot was largely accompanied by positive sentiment. We also found cultural differences, with negative words being used more often by users in the United States than by those in Asia when talking about COVID-19. Conclusions: Based on the analysis of user-chatbot interactions on a live platform, this work provides insights into people’s informational and emotional needs during a global health crisis. Users sought health-related information and shared emotional messages with the chatbot, indicating the potential use of chatbots to provide accurate health information and emotional support. Future research can look into different support strategies that align with the direction of public health policy. %M 36596214 %R 10.2196/40922 %U https://www.jmir.org/2023/1/e40922 %U https://doi.org/10.2196/40922 %U http://www.ncbi.nlm.nih.gov/pubmed/36596214 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e44820 %T Ethical Challenges of the COVID-19 Pandemic: A Japanese Perspective %A Kodama,Satoshi %+ Kyoto University Graduate School of Letters, Yoshida Honmachi, Sakyo, Kyoto, 606-8501, Japan, 81 757532815, kodama.satoshi.4v@kyoto-u.ac.jp %K pandemic %K Japan %K lockdown %K disaster preparedness and management %K digital technologies %K intensive care unit %K COVID-19 %K ICU triage %K ethics %K emergency preparedness %K digital health intervention %D 2023 %7 26.1.2023 %9 Viewpoint %J J Med Internet Res %G English %X This article focuses on how Japan experienced the COVID-19 pandemic. It delineates the various challenges the country faced and the measures the national government took to stop the spread of the infection. The article begins with the author’s personal experience of COVID-19. The second section explains how the Japanese government lacked the legal sanctions to enforce a state of emergency. The third section deals with the current pandemic response as characterized by the increased use of digital technologies to control the spread of the virus. I argue that the lack of effective governance hampered Japan’s timely use of digital technologies. The fourth section will touch on the issues created by the rapid spread of the infection and an increase in the hospitalization rate, focusing on intensive care unit triage and the ethical debates that ensued in Japan. The fifth section discusses the pandemic from the perspective of disaster preparedness and management, exploring the ways the pandemic responses share ethical challenges with responses to other disasters such as earthquakes and typhoons. %M 36652597 %R 10.2196/44820 %U https://www.jmir.org/2023/1/e44820 %U https://doi.org/10.2196/44820 %U http://www.ncbi.nlm.nih.gov/pubmed/36652597 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e42563 %T Overcoming Access Barriers for Veterans: Cohort Study of the Distribution and Use of Veterans Affairs’ Video-Enabled Tablets Before and During the COVID-19 Pandemic %A Dhanani,Zainub %A Ferguson,Jacqueline M %A Van Campen,James %A Slightam,Cindie %A Jacobs,Josephine C %A Heyworth,Leonie %A Zulman,Donna %+ Department of Health Policy, Stanford School of Medicine, Encina Commons, 615 Crothers Way, Stanford, CA, 94305, United States, 1 650 723 4581, zdhanani@stanford.edu %K COVID-19 %K veterans %K health care access %K video-based care %K telehealth %K barriers to care %K telemedicine %K veteran's association %K health disparity %K sociodemographic %K virtual health %D 2023 %7 26.1.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: During the COVID-19 pandemic, as health care services shifted to video- and phone-based modalities for patient and provider safety, the Veterans Affairs (VA) Office of Connected Care widely expanded its video-enabled tablet program to bridge digital divides for veterans with limited video care access. Objective: This study aimed to characterize veterans who received and used US Department of VA–issued video-enabled tablets before versus during the COVID-19 pandemic. Methods: We compared sociodemographic and clinical characteristics of veterans who received VA-issued tablets during 6-month prepandemic and pandemic periods (ie, from March 11, 2019, to September 10, 2019, and from March 11, 2020, to September 10, 2020). Then, we examined characteristics associated with video visit use for primary and mental health care within 6 months after tablet shipment, stratifying models by timing of tablet receipt. Results: There was a nearly 6-fold increase in the number of veterans who received tablets in the pandemic versus prepandemic study periods (n=36,107 vs n=6784, respectively). Compared to the prepandemic period, tablet recipients during the pandemic were more likely to be older (mean age 64 vs 59 years), urban-dwelling (24,504/36,107, 67.9% vs 3766/6784, 55.5%), and have a history of housing instability (8633/36,107, 23.9% vs 1022/6784, 15.1%). Pandemic recipients were more likely to use video care (21,090/36,107, 58.4% vs 2995/6784, 44.2%) and did so more frequently (5.6 vs 2.3 average encounters) within 6 months of tablet receipt. In adjusted models, pandemic and prepandemic video care users were significantly more likely to be younger, stably housed, and have a mental health condition than nonusers. Conclusions: Although the COVID-19 pandemic led to increased distribution of VA-issued tablets to veterans with complex clinical and social needs, tablet recipients who were older or unstably housed remained less likely to have a video visit. The VA’s tablet distribution program expanded access to video-enabled devices, but interventions are needed to bridge disparities in video visit use among device recipients. %M 36630650 %R 10.2196/42563 %U https://www.jmir.org/2023/1/e42563 %U https://doi.org/10.2196/42563 %U http://www.ncbi.nlm.nih.gov/pubmed/36630650 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e41913 %T Understanding Digital Mental Health Needs and Usage With an Artificial Intelligence–Led Mental Health App (Wysa) During the COVID-19 Pandemic: Retrospective Analysis %A Sinha,Chaitali %A Meheli,Saha %A Kadaba,Madhura %+ Wysa, 131 Dartmouth St, Boston, MA, 02116, United States, 1 6177129979, chaitali@wysa.io %K digital mental health %K COVID-19 %K engagement %K retention %K perceived needs %K pandemic waves %K chatbot %K conversational agent %K mental health app %K mobile health %K digital health intervention %D 2023 %7 26.1.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: There has been a surge in mental health concerns during the COVID-19 pandemic, which has prompted the increased use of digital platforms. However, there is little known about the mental health needs and behaviors of the global population during the pandemic. This study aims to fill this knowledge gap through the analysis of real-world data collected from users of a digital mental health app (Wysa) regarding their engagement patterns and behaviors, as shown by their usage of the service. Objective: This study aims to (1) examine the relationship between mental health distress, digital health uptake, and COVID-19 case numbers; (2) evaluate engagement patterns with the app during the study period; and (3) examine the efficacy of the app in improving mental health outcomes for its users during the pandemic. Methods: This study used a retrospective observational design. During the COVID-19 pandemic, the app’s installations and emotional utterances were measured from March 2020 to October 2021 for the United Kingdom, the United States of America, and India and were mapped against COVID-19 case numbers and their peaks. The engagement of the users from this period (N=4541) with the Wysa app was compared to that of equivalent samples of users from a pre–COVID-19 period (1000 iterations). The efficacy was assessed for users who completed pre-post assessments for symptoms of depression (n=2061) and anxiety (n=1995) on the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) test measures, respectively. Results: Our findings demonstrate a significant positive correlation between the increase in the number of installs of the Wysa mental health app and the peaks of COVID-19 case numbers in the United Kingdom (P=.02) and India (P<.001). Findings indicate that users (N=4541) during the COVID period had a significantly higher engagement than the samples from the pre-COVID period, with a medium to large effect size for 80% of these 1000 iterative samples, as observed on the Mann-Whitney test. The PHQ-9 and GAD-7 pre-post assessments indicated statistically significant improvement with a medium effect size (PHQ-9: P=.57; GAD-7: P=.56). Conclusions: This study demonstrates that emotional distress increased substantially during the pandemic, prompting the increased uptake of an artificial intelligence–led mental health app (Wysa), and also offers evidence that the Wysa app could support its users and its usage could result in a significant reduction in symptoms of anxiety and depression. This study also highlights the importance of contextualizing interventions and suggests that digital health interventions can provide large populations with scalable and evidence-based support for mental health care. %M 36540052 %R 10.2196/41913 %U https://formative.jmir.org/2023/1/e41913 %U https://doi.org/10.2196/41913 %U http://www.ncbi.nlm.nih.gov/pubmed/36540052 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e44121 %T Financial and Clinical Impact of Virtual Care During the COVID-19 Pandemic: Difference-in-Differences Analysis %A Walter,Robert J %A Schwab,Stephen D %A Wilkes,Matt %A Yourk,Daniel %A Zahradka,Nicole %A Pugmire,Juliana %A Wolfberg,Adam %A Merritt,Amanda %A Boster,Joshua %A Loudermilk,Kevin %A Hipp,Sean J %A Morris,Michael J %+ Current Health Ltd, Level 3, The Stamp Office, 10 Waterloo Place, Edinburgh, EH1 3EG, United Kingdom, 44 07976962609, matt.wilkes@currenthealth.com %K remote patient monitoring %K digital health %K telemedicine %K telehealth %K finance %K financial %K cost %K economic %K remote care %K readmission %K cost savings %K virtual care %K patient care %K digital health intervention %K military health system %K clinical outcome %K military %K soldier %K difference-in-differences %D 2023 %7 25.1.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Virtual care (VC) and remote patient monitoring programs were deployed widely during the COVID-19 pandemic. Deployments were heterogeneous and evolved as the pandemic progressed, complicating subsequent attempts to quantify their impact. The unique arrangement of the US Military Health System (MHS) enabled direct comparison between facilities that did and did not implement a standardized VC program. The VC program enrolled patients symptomatic for COVID-19 or at risk for severe disease. Patients’ vital signs were continuously monitored at home with a wearable device (Current Health). A central team monitored vital signs and conducted daily or twice-daily reviews (the nurse-to-patient ratio was 1:30). Objective: Our goal was to describe the operational model of a VC program for COVID-19, evaluate its financial impact, and detail its clinical outcomes. Methods: This was a retrospective difference-in-differences (DiD) evaluation that compared 8 military treatment facilities (MTFs) with and 39 MTFs without a VC program. Tricare Prime beneficiaries diagnosed with COVID-19 (Medicare Severity Diagnosis Related Group 177 or International Classification of Diseases–10 codes U07.1/07.2) who were eligible for care within the MHS and aged 21 years and or older between December 2020 and December 2021 were included. Primary outcomes were length of stay and associated cost savings; secondary outcomes were escalation to physical care from home, 30-day readmissions after VC discharge, adherence to the wearable, and alarms per patient-day. Results: A total of 1838 patients with COVID-19 were admitted to an MTF with a VC program of 3988 admitted to the MHS. Of these patients, 237 (13%) were enrolled in the VC program. The DiD analysis indicated that centers with the program had a 12% lower length of stay averaged across all COVID-19 patients, saving US $2047 per patient. The total cost of equipping, establishing, and staffing the VC program was estimated at US $3816 per day. Total net savings were estimated at US $2.3 million in the first year of the program across the MHS. The wearables were activated by 231 patients (97.5%) and were monitored through the Current Health platform for a total of 3474 (median 7.9, range 3.2-16.5) days. Wearable adherence was 85% (IQR 63%-94%). Patients triggered a median of 1.6 (IQR 0.7-5.2) vital sign alarms per patient per day; 203 (85.7%) were monitored at home and then directly discharged from VC; 27 (11.4%) were escalated to a physical hospital bed as part of their initial admission. There were no increases in 30-day readmissions or emergency department visits. Conclusions: Monitored patients were adherent to the wearable device and triggered a manageable number of alarms/day for the monitoring–team-to-patient ratio. Despite only enrolling 13% of COVID-19 patients at centers where it was available, the program offered substantial savings averaged across all patients in those centers without adversely affecting clinical outcomes. %M 36630301 %R 10.2196/44121 %U https://www.jmir.org/2023/1/e44121 %U https://doi.org/10.2196/44121 %U http://www.ncbi.nlm.nih.gov/pubmed/36630301 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 6 %N %P e40940 %T Feasibility of Video Consultation for Preterm Neurodevelopmental Follow-up Care During the COVID-19 Pandemic: Cohort Study %A Albayrak,Bilge %A Cordier,Larissa Jane %A Greve,Sandra %A Teschler,Uta %A Dathe,Anne-Kathrin %A Felderhoff-Müser,Ursula %A Hüning,Britta Maria %+ Department of Pediatrics I, Neonatology, Pediatric Intensive Care and Pediatric Neurology, University Hospital Essen, University of Duisburg-Essen, Department of Pediatrics I, Hufelandstraße 55, Essen, 45147, Germany, 49 201723 ext 82831, larissa.cordier@uk-essen.de %K COVID-19 %K very preterm infant %K video consultation %K follow-up care %K COVID-19 pandemic %K neurodevelopmental outcome %D 2023 %7 25.1.2023 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: During the COVID-19 pandemic, parents of infants born very preterm or at risk were exceptionally worried about being infected. The only means of protection during the onset of the pandemic was social distancing. Video consultations for neurodevelopmental follow-up care were offered as an alternative way to stay in contact with patients and their families, to provide expert support, and to monitor and assess children’s development. Objective: To assess the feasibility of and family satisfaction with video consultations, interviews were conducted after video and in-person consultations. Methods: An interview with 28 questions was created to evaluate parental satisfaction with the consultations (eg, their confidentiality and the children’s behavior). A total of 93 interviews with parents were conducted between March 2020 and February 2021 and compared (58 after video consultations and 35 after in-person consultations). The interviews were conducted at the end of the consultations by a trained professional. The video consultations were conducted using a certified platform created by Zava Sprechstunde Online, maintaining data protection with end-to-end encryption. Follow-up consultations (video or in-person) were performed at corrected ages of 3, 6, and 12 months as well as 2, 3, 4, and 5 years. The rate of total follow-up appointments attended during the survey period was evaluated and compared with the previous year. Results: There were no significant differences between the video and in-person consultation groups in satisfaction, attitudes on the confidentiality of the consultation, or discussion of private and sensitive information. Following video consultations, parents were significantly more likely to report that they were avoiding contact with medical professionals during the pandemic (P=.045; Shapiro-Wilk W=1094.5, Cohen d=–0.1782146) than the in-person consultation group. Parents in the video-consultation group stated that performing a guided examination on their child was comfortable and helped them understand their child’s development. In fact, they agreed to take advantage of future video consultations. The rate of total follow-up appointments increased compared to the previous year. Between March 2019 and February 2020, 782 of 984 (79.5%) children born at Essen University Hospital attended a follow-up appointment. During the survey period, between March 2020 and February 2021, a total of 788 of 1086 children (73%) attended a follow-up appointment, of which 117 (14.9%) were video consultations. Conclusions: The feasibility of attending video consultations for follow-up care of very preterm or at-risk infants and parental satisfaction with these consultations were as high as for in-person consultations. Parents rated video consultations as being as confidential as in-person appointments. Telemedicine can be offered as an equivalent alternative to in-person consultations and is particularly useful under certain circumstances, such as for very sick children who require assistive devices or respiratory support and oxygen or for those living a long distance away. %M 36409307 %R 10.2196/40940 %U https://pediatrics.jmir.org/2023/1/e40940 %U https://doi.org/10.2196/40940 %U http://www.ncbi.nlm.nih.gov/pubmed/36409307 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e39045 %T COVID-19 Vaccine Equity and Access: Case Study for Health Care Chatbots %A Perez-Ramos,Jose G %A Leon-Thomas,Mariela %A Smith,Sabrina L %A Silverman,Laura %A Perez-Torres,Claudia %A Hall,Wyatte C %A Iadarola,Suzannah %+ Department of Public Health Sciences, School of Medicine and Dentistry, University of Rochester, 265 Crittenden Blvd, Box 420644, Rochester, NY, 14642, United States, 1 585 276 8755, jose_perez-ramos@urmc.rochester.edu %K mHealth %K ICT %K Information and Communication Technology %K community %K chatbot %K COVID-19 %K health equity %K mobile health %K health outcome %K health disparity %K minority population %K health care gap %K chatbot tool %K user experience %K chatbot development %K health information %D 2023 %7 25.1.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Disparities in COVID-19 information and vaccine access have emerged during the pandemic. Individuals from historically excluded communities (eg, Black and Latin American) experience disproportionately negative health outcomes related to COVID-19. Community gaps in COVID-19 education, social, and health care services (including vaccines) should be prioritized as a critical effort to end the pandemic. Misinformation created by the politicization of COVID-19 and related public health measures has magnified the pandemic’s challenges, including access to health care, vaccination and testing efforts, as well as personal protective equipment. Information and Communication Technology (ICT) has been demonstrated to reduce the gaps of marginalization in education and access among communities. Chatbots are an increasingly present example of ICTs, particularly in health care and in relation to the COVID-19 pandemic. Objective: This project aimed to (1) follow an inclusive and theoretically driven design process to develop and test a COVID-19 information ICT bilingual (English and Spanish) chatbot tool named “Ana” and (2) characterize and evaluate user experiences of these innovative technologies. Methods: Ana was developed following a multitheoretical framework, and the project team was comprised of public health experts, behavioral scientists, community members, and medical team. A total of 7 iterations of ß chatbots were tested, and a total of 22 ß testers participated in this process. Content was curated primarily to provide users with factual answers to common questions about COVID-19. To ensure relevance of the content, topics were driven by community concerns and questions, as ascertained through research. Ana’s repository of educational content was based on national and international organizations as well as interdisciplinary experts. In the context of this development and pilot project, we identified an evaluation framework to explore reach, engagement, and satisfaction. Results: A total of 626 community members used Ana from August 2021 to March 2022. Among those participants, 346 used the English version, with an average of 43 users per month; and 280 participants used the Spanish version, with an average of 40 users monthly. Across all users, 63.87% (n=221) of English users and 22.14% (n=62) of Spanish users returned to use Ana at least once; 18.49% (n=64) among the English version users and 18.57% (n=52) among the Spanish version users reported their ranking. Positive ranking comprised the “smiley” and “loved” emojis, and negative ranking comprised the “neutral,” “sad,” and “mad” emojis. When comparing negative and positive experiences, the latter was higher across Ana’s platforms (English: n=41, 64.06%; Spanish: n=41, 77.35%) versus the former (English: n=23, 35.93%; Spanish: n=12, 22.64%). Conclusions: This pilot project demonstrated the feasibility and capacity of an innovative ICT to share COVID-19 information within diverse communities. Creating a chatbot like Ana with bilingual content contributed to an equitable approach to address the lack of accessible COVID-19–related information. %M 36630649 %R 10.2196/39045 %U https://formative.jmir.org/2023/1/e39045 %U https://doi.org/10.2196/39045 %U http://www.ncbi.nlm.nih.gov/pubmed/36630649 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e38500 %T Supporting Autonomous Motivation for Physical Activity With Chatbots During the COVID-19 Pandemic: Factorial Experiment %A Wlasak,Wendy %A Zwanenburg,Sander Paul %A Paton,Chris %+ Department of Information Science, University of Otago, 60 Clyde Street, Dunedin, 9016, New Zealand, 64 3 479 8142, chris.paton@otago.ac.nz %K autonomous motivation %K chatbots %K self-determination theory %K physical activity %K factorial experiment %K mobile phone %K COVID-19 %D 2023 %7 25.1.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Although physical activity can mitigate disease trajectories and improve and sustain mental health, many people have become less physically active during the COVID-19 pandemic. Personal information technology, such as activity trackers and chatbots, can technically converse with people and possibly enhance their autonomous motivation to engage in physical activity. The literature on behavior change techniques (BCTs) and self-determination theory (SDT) contains promising insights that can be leveraged in the design of these technologies; however, it remains unclear how this can be achieved. Objective: This study aimed to evaluate the feasibility of a chatbot system that improves the user’s autonomous motivation for walking based on BCTs and SDT. First, we aimed to develop and evaluate various versions of a chatbot system based on promising BCTs. Second, we aimed to evaluate whether the use of the system improves the autonomous motivation for walking and the associated factors of need satisfaction. Third, we explored the support for the theoretical mechanism and effectiveness of various BCT implementations. Methods: We developed a chatbot system using the mobile apps Telegram (Telegram Messenger Inc) and Google Fit (Google LLC). We implemented 12 versions of this system, which differed in 3 BCTs: goal setting, experimenting, and action planning. We then conducted a feasibility study with 102 participants who used this system over the course of 3 weeks, by conversing with a chatbot and completing questionnaires, capturing their perceived app support, need satisfaction, physical activity levels, and motivation. Results: The use of the chatbot systems was satisfactory, and on average, its users reported increases in autonomous motivation for walking. The dropout rate was low. Although approximately half of the participants indicated that they would have preferred to interact with a human instead of the chatbot, 46.1% (47/102) of the participants stated that the chatbot helped them become more active, and 42.2% (43/102) of the participants decided to continue using the chatbot for an additional week. Furthermore, the majority thought that a more advanced chatbot could be very helpful. The motivation was associated with the satisfaction of the needs of competence and autonomy, and need satisfaction, in turn, was associated with the perceived system support, providing support for SDT underpinnings. However, no substantial differences were found across different BCT implementations. Conclusions: The results provide evidence that chatbot systems are a feasible means to increase autonomous motivation for physical activity. We found support for SDT as a basis for the design, laying a foundation for larger studies to confirm the effectiveness of the selected BCTs within chatbot systems, explore a wider range of BCTs, and help the development of guidelines for the design of interactive technology that helps users achieve long-term health benefits. %M 36512402 %R 10.2196/38500 %U https://formative.jmir.org/2023/1/e38500 %U https://doi.org/10.2196/38500 %U http://www.ncbi.nlm.nih.gov/pubmed/36512402 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e40036 %T Syndromic Surveillance Using Structured Telehealth Data: Case Study of the First Wave of COVID-19 in Brazil %A Boaventura,Viviane S %A Grave,Malú %A Cerqueira-Silva,Thiago %A Carreiro,Roberto %A Pinheiro,Adélia %A Coutinho,Alvaro %A Barral Netto,Manoel %+ Laboratório de Doenças Infecciosas Transmitidas por Vetores, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Rua Waldemar Falcao, 121, Salvador, 40296-710, Brazil, 55 71 9619 4245, viviane.boaventura@fiocruz.br %K telehealth %K telemedicine %K disease surveillance %K mathematical model %K COVID-19 %K prediction %K cases %K detection %K monitoring %K surveillance %K computational modeling %K spread %K transmission %K disease %K infectious diseases %K syndromic %D 2023 %7 24.1.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Telehealth has been widely used for new case detection and telemonitoring during the COVID-19 pandemic. It safely provides access to health care services and expands assistance to remote, rural areas and underserved communities in situations of shortage of specialized health professionals. Qualified data are systematically collected by health care workers containing information on suspected cases and can be used as a proxy of disease spread for surveillance purposes. However, the use of this approach for syndromic surveillance has yet to be explored. Besides, the mathematical modeling of epidemics is a well-established field that has been successfully used for tracking the spread of SARS-CoV-2 infection, supporting the decision-making process on diverse aspects of public health response to the COVID-19 pandemic. The response of the current models depends on the quality of input data, particularly the transmission rate, initial conditions, and other parameters present in compartmental models. Telehealth systems may feed numerical models developed to model virus spread in a specific region. Objective: Herein, we evaluated whether a high-quality data set obtained from a state-based telehealth service could be used to forecast the geographical spread of new cases of COVID-19 and to feed computational models of disease spread. Methods: We analyzed structured data obtained from a statewide toll-free telehealth service during 4 months following the first notification of COVID-19 in the Bahia state, Brazil. Structured data were collected during teletriage by a health team of medical students supervised by physicians. Data were registered in a responsive web application for planning and surveillance purposes. The data set was designed to quickly identify users, city, residence neighborhood, date, sex, age, and COVID-19–like symptoms. We performed a temporal-spatial comparison of calls reporting COVID-19–like symptoms and notification of COVID-19 cases. The number of calls was used as a proxy of exposed individuals to feed a mathematical model called “susceptible, exposed, infected, recovered, deceased.” Results: For 181 (43%) out of 417 municipalities of Bahia, the first call to the telehealth service reporting COVID-19–like symptoms preceded the first notification of the disease. The calls preceded, on average, 30 days of the notification of COVID-19 in the municipalities of the state of Bahia, Brazil. Additionally, data obtained by the telehealth service were used to effectively reproduce the spread of COVID-19 in Salvador, the capital of the state, using the “susceptible, exposed, infected, recovered, deceased” model to simulate the spatiotemporal spread of the disease. Conclusions: Data from telehealth services confer high effectiveness in anticipating new waves of COVID-19 and may help understand the epidemic dynamics. %M 36692925 %R 10.2196/40036 %U https://publichealth.jmir.org/2023/1/e40036 %U https://doi.org/10.2196/40036 %U http://www.ncbi.nlm.nih.gov/pubmed/36692925 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e43639 %T Use of and Satisfaction With Mobile Health Education During the COVID-19 Pandemic in Thailand: Cross-sectional Study %A Kittipimpanon,Kamonrat %A Noyudom,Angun %A Panjatharakul,Pawanrat %A Visudtibhan,Poolsuk Janepanish %+ Ramathibodi School of Nursing, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Thung Phaya Thai, Ratchathewi, Bangkok, 10400, Thailand, 66 814376763, angun.ket@mahidol.ac.th %K mHealth %K COVID-19 %K chatbot %K use %K satisfaction %D 2023 %7 24.1.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: RamaCovid is a mobile health (mHealth) education system that provides the Thai population with information about COVID-19 and self-risk assessment. RamaCovid has a chatbot system that provides automatic conversations (available 24 hours per day) and a live chat function that allows users to directly communicate with health professionals (available 4 hours per day in the evening). The system consists of (1) COVID-19 vaccine information, (2) self-care after vaccination, (3) frequently asked questions, (4) self-risk assessment, (5) hospital finding, (6) contact number finding, and (7) live chat with a health professional. Objective: This study investigates the use of and satisfaction with the RamaCovid system. Methods: Overall, 400 people were recruited via RamaCovid by broadcasting an infographic about the study. Questionnaires collected demographic data, users’ experiences of RamaCovid, and the use of and satisfaction with the system. The questions were answered using a 5-point Likert scale. Descriptive statistics were used to describe the participant characteristics and their use of and satisfaction with the RamaCovid system. The Mann-Whitney U test was performed to examine the difference in use and satisfaction between the adult and older adult groups. Results: The participants showed high use of and satisfaction with the RamaCovid system. They used the information to take care of themselves and their family, and they gained information about their COVID-19 risk. The users were satisfied with the system because the information was easy to understand, trustworthy, and up to date. However, the older adult group had lower use of and satisfaction with the system compared to the adult group. Conclusions: RamaCovid is an example of the successful implementation of mHealth education. It was an alternative way to work with the call center during the COVID-19 pandemic and increased access to health information and health care services. Providing ongoing updated information, improving the attractiveness of the media information, and the age group difference are important issues for further system development. %M 36596210 %R 10.2196/43639 %U https://formative.jmir.org/2023/1/e43639 %U https://doi.org/10.2196/43639 %U http://www.ncbi.nlm.nih.gov/pubmed/36596210 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e35748 %T Social Support and Technology Use and Their Association With Mental and Physical Health During the COVID-19 Pandemic Among Asian Americans: The COMPASS Cross-sectional Study %A Park,Linda G %A Meyer,Oanh L %A Dougan,Marcelle M %A Golden,Bethany %A Ta,Kevin %A Nam,Bora %A Tsoh,Janice Y %A Tzuang,Marian %A Park,Van M Ta %+ Department of Community Health Systems, School of Nursing, University of California, San Francisco, 2 Koret Way, San Francisco, CA, 94143, United States, 1 415 502 6616, Linda.Park@ucsf.edu %K health disparities %K mental health %K depression %K anxiety %K social support technology %K COVID-19 %K pandemic %K disparity %K support %K technology %K physical health %K race %K survey %K population %K discrimination %K outcome %K AAPI %D 2023 %7 23.1.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The global COVID-19 pandemic disproportionately affected Asian Americans and Pacific Islanders (AAPIs) and revealed significant health disparities with reports of increased discrimination and xenophobia. Among AAPIs, the pandemic exacerbated their social, linguistic, and geographic isolation. Social support may be especially important for AAPIs given the salience of collectivism as a cultural value. Another mechanism for support among AAPIs was technology use, as it is generally widespread among this population. However, older adults may not perceive the same benefits. Objective: We examined social support and technology use and their relationships with mental and physical health outcomes through the COVID-19 pandemic among AAPIs. Methods: Data were drawn from the COVID-19 Effects on the Mental and Physical Health of AAPI Survey Study (COMPASS) for the time period of October 2020 to February 2021. COMPASS was a cross-sectional, multilingual, national survey conducted online, by phone, and in person with AAPI adults who were ≥18 years of age, in collaboration with academic and community partners in the United States. Data were analyzed using multivariable linear regression using the outcome variables of mental and physical health with various predictors such as social support and technology use. We tested for interactions specific to age and ethnicity. Results: Among 4631 AAPIs (mean age 45.9, SD 16.3 years; 2992/4631, 63.1% female), we found that (1) increased social support was associated with better physical health, (2) total social support was positively associated with better mental health, (3) higher technology use was associated with poorer mental health and inversely associated with poorer physical health, (4) the association of technology use with mental health was weaker among those with low social support (vs those with high social support), (5) adults younger than 60 years old (vs ≥60 years old) were more negatively affected with social support and mental health, and (6) Korean Americans appeared to be a high-risk group for poor physical health with increased technology use. Conclusions: Our paper identified mental and physical health needs along with supportive therapies observed among AAPIs during the pandemic. Future research on how social support can be leveraged, especially among AAPIs younger than 60 years old, and how various types of technology are being utilized are important to guide the recovery efforts to address both mental and physical disparities across communities as a result of the COVID-19 pandemic. %M 36395324 %R 10.2196/35748 %U https://publichealth.jmir.org/2023/1/e35748 %U https://doi.org/10.2196/35748 %U http://www.ncbi.nlm.nih.gov/pubmed/36395324 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 3 %N %P e38390 %T Detecting Tweets Containing Cannabidiol-Related COVID-19 Misinformation Using Transformer Language Models and Warning Letters From Food and Drug Administration: Content Analysis and Identification %A Turner,Jason %A Kantardzic,Mehmed %A Vickers-Smith,Rachel %A Brown,Andrew G %+ Data Mining Lab, Department of Computer Science and Engineering, Speed School of Engineering, University of Louisville, Louisville, KY, 40292, United States, 1 859 302 0189, jason.turner@louisville.edu %K transformer %K misinformation %K deep learning %K COVID-19 %K infodemic %K pandemic %K language model %K health information %K social media %K Twitter %K content analysis %K cannabidiol %K sentence vector %K infodemiology %D 2023 %7 23.1.2023 %9 Original Paper %J JMIR Infodemiology %G English %X Background: COVID-19 has introduced yet another opportunity to web-based sellers of loosely regulated substances, such as cannabidiol (CBD), to promote sales under false pretenses of curing the disease. Therefore, it has become necessary to innovate ways to identify such instances of misinformation. Objective: We sought to identify COVID-19 misinformation as it relates to the sales or promotion of CBD and used transformer-based language models to identify tweets semantically similar to quotes taken from known instances of misinformation. In this case, the known misinformation was the publicly available Warning Letters from Food and Drug Administration (FDA). Methods: We collected tweets using CBD- and COVID-19–related terms. Using a previously trained model, we extracted the tweets indicating commercialization and sales of CBD and annotated those containing COVID-19 misinformation according to the FDA definitions. We encoded the collection of tweets and misinformation quotes into sentence vectors and then calculated the cosine similarity between each quote and each tweet. This allowed us to establish a threshold to identify tweets that were making false claims regarding CBD and COVID-19 while minimizing the instances of false positives. Results: We demonstrated that by using quotes taken from Warning Letters issued by FDA to perpetrators of similar misinformation, we can identify semantically similar tweets that also contain misinformation. This was accomplished by identifying a cosine distance threshold between the sentence vectors of the Warning Letters and tweets. Conclusions: This research shows that commercial CBD or COVID-19 misinformation can potentially be identified and curbed using transformer-based language models and known prior instances of misinformation. Our approach functions without the need for labeled data, potentially reducing the time at which misinformation can be identified. Our approach shows promise in that it is easily adapted to identify other forms of misinformation related to loosely regulated substances. %M 36844029 %R 10.2196/38390 %U https://infodemiology.jmir.org/2023/1/e38390 %U https://doi.org/10.2196/38390 %U http://www.ncbi.nlm.nih.gov/pubmed/36844029 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 6 %N %P e42223 %T The Changes in Levels and Barriers of Physical Activity Among Community-Dwelling Older Adults During and After the Fifth Wave of COVID-19 Outbreak in Hong Kong: Repeated Random Telephone Surveys %A Wang,Zixin %A Fang,Yuan %A Chan,Paul Shing-Fong %A Yu,Fuk Yuen %A Sun,Fenghua %+ Jockey Club School of Public Health and Primary Care, Chinese University of Hong Kong, Room 508, School of Public Health, Prince of Wales Hospital, Ngan Shing St, Sha Tin, Hong Kong, Hong Kong, 852 22528740, wangzx@cuhk.edu.hk %K COVID-19 %K physical activity %K older adults %K barriers %K changes %K repeated random telephone survey %K China %K aging %K elderly population %K community-dwelling older adults %K health promotion %K telehealth %D 2023 %7 23.1.2023 %9 Original Paper %J JMIR Aging %G English %X Background: COVID-19 has had an impact on physical activity (PA) among older adults; however, it is unclear whether this effect would be long-lasting, and there is a dearth of studies assessing the changes in barriers to performing PA among older adults before and after entering the “postpandemic era.” Objective: The aim of this study was to compare the levels and barriers of PA among a random sample of community-dwelling older adults recruited during (February to April 2022) and after the fifth wave of the COVID-19 outbreak (May to July 2022) in Hong Kong. In addition, we investigated factors associated with a low PA level among participants recruited at different time points. Methods: This study involved two rounds of random telephone surveys. Participants were community-dwelling Chinese-speaking individuals aged 65 years or above and having a Hong Kong ID card. Household telephone numbers were randomly selected from the most updated telephone directories. Experienced interviewers carried out telephone interviews between 6 PM and 10 PM on weekdays and between 2 PM and 9 PM on Saturdays to avoid undersampling of working individuals. We called 3900 and 3840 households in the first and second round, respectively; for each round, 640 and 625 households had an eligible older adult and 395 and 370 completed the telephone survey, respectively. Results: As compared to participants in the first round, fewer participants indicated a low level of PA in the second round (28.6% vs 45.9%, P<.001). Participants in the second round had higher metabolic equivalent of tasks-minutes/week (median 1707.5 vs 840, P<.001) and minutes of moderate-to-vigorous PA per week (median 240 vs 105, P<.001) than those in the first round. After adjustment for significant background characteristics, participants who perceived a lack of physical capacity to perform PA (first round: adjusted odds ratio [AOR] 3.34, P=.001; second round: 2.92, P=.002) and believed that PA would cause pain and discomfort (first round: AOR 2.04, P=.02; second round: 2.82, P=.001) were more likely to have a low level of PA in both rounds. Lack of time (AOR 4.19, P=.01) and concern about COVID-19 infection during PA (AOR 1.73, P=.02) were associated with a low level of PA among participants in the first round, but not in the second round. A perceived lack of space and facility to perform PA at home (AOR 2.03, P=.02) and unable to find people to do PA with (AOR 1.80, P=.04) were associated with a low PA level in the second round, but not in the first round. Conclusions: The level of PA increased significantly among older adults after Hong Kong entered the “postpandemic era.” Different factors influenced older adults’ PA level during and after the fifth wave of the COVID-19 outbreak. Regular monitoring of the PA level and its associated factors should be conducted to guide health promotion and policy-making. %M 36599172 %R 10.2196/42223 %U https://aging.jmir.org/2023/1/e42223 %U https://doi.org/10.2196/42223 %U http://www.ncbi.nlm.nih.gov/pubmed/36599172 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e43905 %T What Makes a Quality Health App—Developing a Global Research-Based Health App Quality Assessment Framework for CEN-ISO/TS 82304-2: Delphi Study %A Hoogendoorn,Petra %A Versluis,Anke %A van Kampen,Sanne %A McCay,Charles %A Leahy,Matt %A Bijlsma,Marlou %A Bonacina,Stefano %A Bonten,Tobias %A Bonthuis,Marie-José %A Butterlin,Anouk %A Cobbaert,Koen %A Duijnhoven,Thea %A Hallensleben,Cynthia %A Harrison,Stuart %A Hastenteufel,Mark %A Holappa,Terhi %A Kokx,Ben %A Morlion,Birgit %A Pauli,Norbert %A Ploeg,Frank %A Salmon,Mark %A Schnoor,Kyma %A Sharp,Mary %A Sottile,Pier Angelo %A Värri,Alpo %A Williams,Patricia %A Heidenreich,Georg %A Oughtibridge,Nicholas %A Stegwee,Robert %A Chavannes,Niels H %+ National eHealth Living Lab, Department of Public Health and Primary Care, Leiden University Medical Center, Albinusdreef 2, Leiden, 2333 ZA, Netherlands, 31 654341785, a.p.y.hoogendoorn@lumc.nl %K health app %K wellness app %K mobile health %K mHealth %K Delphi technique %K quality assessment %K assessment framework %K standard %K standardization %K COVID-19 %D 2023 %7 23.1.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: The lack of an international standard for assessing and communicating health app quality and the lack of consensus about what makes a high-quality health app negatively affect the uptake of such apps. At the request of the European Commission, the international Standard Development Organizations (SDOs), European Committee for Standardization, International Organization for Standardization, and International Electrotechnical Commission have joined forces to develop a technical specification (TS) for assessing the quality and reliability of health and wellness apps. Objective: This study aimed to create a useful, globally applicable, trustworthy, and usable framework to assess health app quality. Methods: A 2-round Delphi technique with 83 experts from 6 continents (predominantly Europe) participating in one (n=42, 51%) or both (n=41, 49%) rounds was used to achieve consensus on a framework for assessing health app quality. Aims included identifying the maximum 100 requirement questions for the uptake of apps that do or do not qualify as medical devices. The draft assessment framework was built on 26 existing frameworks, the principles of stringent legislation, and input from 20 core experts. A follow-up survey with 28 respondents informed a scoring mechanism for the questions. After subsequent alignment with related standards, the quality assessment framework was tested and fine-tuned with manufacturers of 11 COVID-19 symptom apps. National mirror committees from the 52 countries that participated in the SDO technical committees were invited to comment on 4 working drafts and subsequently vote on the TS. Results: The final quality assessment framework includes 81 questions, 67 (83%) of which impact the scores of 4 overarching quality aspects. After testing with people with low health literacy, these aspects were phrased as “Healthy and safe,” “Easy to use,” “Secure data,” and “Robust build.” The scoring mechanism enables communication of the quality assessment results in a health app quality score and label, alongside a detailed report. Unstructured interviews with stakeholders revealed that evidence and third-party assessment are needed for health app uptake. The manufacturers considered the time needed to complete the assessment and gather evidence (2-4 days) acceptable. Publication of CEN-ISO/TS 82304-2:2021 Health software – Part 2: Health and wellness apps – Quality and reliability was approved in May 2021 in a nearly unanimous vote by 34 national SDOs, including 6 of the 10 most populous countries worldwide. Conclusions: A useful and usable international standard for health app quality assessment was developed. Its quality, approval rate, and early use provide proof of its potential to become the trusted, commonly used global framework. The framework will help manufacturers enhance and efficiently demonstrate the quality of health apps, consumers, and health care professionals to make informed decisions on health apps. It will also help insurers to make reimbursement decisions on health apps. %M 36538379 %R 10.2196/43905 %U https://formative.jmir.org/2023/1/e43905 %U https://doi.org/10.2196/43905 %U http://www.ncbi.nlm.nih.gov/pubmed/36538379 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e37811 %T Public Use of the “Your COVID Recovery” Website Designed to Help Individuals Manage Their COVID-19 Recovery: Observational Study %A Baldwin,Molly M %A Daynes,Enya %A Chaplin,Emma %A Goddard,Amye %A Lloyd-Evans,Phoebe H I %A Mills,George %A Hong,Annabel %A Gardiner,Nikki %A Singh,Sally J %+ Centre for Exercise and Rehabilitation Science, NIHR Leicester Biomedical Research Centre - Respiratory, University Hospitals of Leicester, Glenfield Hospital, Groby Road, Leicester, LE3 9QP, United Kingdom, 44 116 258 ext 3652, molly.baldwin@uhl-tr.nhs.uk %K COVID-19 %K coronavirus %K pandemic %K symptom management %K digital healthcare %K Google Analytics %K website analysis %K digital health tool %K user behavior %K healthcare platform %D 2023 %7 20.1.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: At the start of the COVID-19 pandemic, unprecedented pressure was placed on health care services globally. An opportunity to alleviate this pressure was to introduce a digital health platform that provided COVID-19–related advice and helped individuals understand and manage their COVID-19 symptoms. Therefore, in July 2020, the Your COVID Recovery website was launched by the National Health Service of England with the aim of creating a practical tool that provides advice and support to individuals recovering from COVID-19. The website includes information on many of the key COVID-19 symptoms. To date, public use of the Your COVID Recovery website and user behavior remain unknown. However, this information is likely to afford insight into the impact of the website and most commonly experienced COVID-19 symptoms. Objective: This study aimed to evaluate public use of the Your COVID Recovery website, a digital health platform that provides support to individuals recovering from COVID-19, and determine user behavior during its first year of operation. Methods: Google Analytics software that was integrated into the Your COVID Recovery website was used to assess website use and user behavior between July 31, 2020, and July 31, 2021. Variables that were tracked included the number of users, user country of residence, traffic source, number of page views, number of session views, and mean session duration. User data were compared to COVID-19 case data downloaded from the UK government’s website. Results: During the study period, 2,062,394 users accessed the Your COVID Recovery website. The majority of users were located in the United Kingdom (1,265,061/2,062,394, 61.30%) and accessed the website via a search engine (1,443,057/2,062,394, 69.97%). The number of daily website users (n=15,298) peaked on January 18, 2021, during the second wave of COVID-19 in the United Kingdom. The most frequently visited pages after the home page were for the following COVID-19 symptoms: Cough (n=550,190, 12.17%), Fatigue (n=432,421, 9.56%), Musculoskeletal pain (n=406,859, 9.00%), Taste and smell (n=270,599, 5.98%), and Breathlessness (n=203,136, 4.49%). The average session duration was 1 minute 13 seconds. Conclusions: A large cohort of individuals actively sought help with their COVID-19 recovery from the website, championing the potential of this tool to target an unmet health care need. User behavior demonstrated that individuals were primarily seeking advice on how to relieve and manage COVID-19 symptoms, especially symptoms of cough, fatigue, and musculoskeletal pain. COVID-19 rehabilitation programs should use the results of this study to ensure that the program content meets the needs of the post–COVID-19 population. %M 36626648 %R 10.2196/37811 %U https://formative.jmir.org/2023/1/e37811 %U https://doi.org/10.2196/37811 %U http://www.ncbi.nlm.nih.gov/pubmed/36626648 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e39002 %T Resident Willingness to Participate in Digital Contact Tracing in a COVID-19 Hotspot: Findings From a Detroit Panel Study %A Wileden,Lydia %A Anthony,Denise %A Campos-Castillo,Celeste %A Morenoff,Jeffrey %+ Mansueto Institute for Urban Innovation, University of Chicago, 1155 E 60th St, Chicago, IL, United States, 1 773 702 7894, lwileden@uchicago.edu %K COVID-19 %K contact tracing %K surveillance %K informatics %K trust %K racial disparities %D 2023 %7 19.1.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Digital surveillance tools and health informatics show promise in counteracting diseases but have limited uptake. A notable illustration of the limits of such tools is the general failure of digital contact tracing in the United States in response to COVID-19. Objective: We investigated the associations between individual characteristics and the willingness to use app-based contact tracing in Detroit, a majority-minority city that experienced multiple waves of COVID-19 outbreaks and deaths since the start of the pandemic. The aim of this study was to examine variations among residents in the willingness to download a contact tracing app on their phones to provide public health officials with information about close COVID-19 contact during summer 2020. Methods: To examine residents’ willingness to participate in digital contact tracing, we analyzed data from 2 waves of the Detroit Metro Area Communities Study, a population-based survey of Detroit, Michigan residents. The data captured 1873 responses from 991 Detroit residents collected in June and July 2020. We estimated a series of multilevel logit models to gain insights into differences in the willingness to participate in digital contact tracing across a variety of individual attributes, including race/ethnicity, degree of trust in the government, and level of education, as well as interactions among these variables. Results: Our results reflected widespread reluctance to participate in digital contact tracing in response to COVID-19, as less than half (826/1873, 44.1%) of the respondents said they would be willing to participate in app-based contact tracing. Compared to White respondents, Black (odds ratio [OR] 0.45, 95% CI 0.23-0.86) and Latino (OR 0.32, 95% CI 0.11-0.99) respondents were significantly less willing to participate in digital contact tracing. Trust in the government was positively associated with the willingness to participate in digital contact tracing (OR 1.17, 95% CI 1.07-1.27), but this effect was the strongest for White residents (OR 2.14, 95% CI 1.55-2.93). We found similarly divergent patterns of the effects of education by race. While there were no significant differences among noncollege-educated residents, White college-educated residents showed greater willingness to use app-based contact tracing (OR 6.12, 95% CI 1.86-20.15) and Black college-educated residents showed less willingness (OR 0.46, 95% CI 0.26-0.81). Conclusions: Trust in the government and education contribute to Detroit residents’ wariness of digital contact tracing, reflecting concerns about surveillance that cut across race but likely arise from different sources. These findings point to the importance of a culturally informed understanding of health hesitancy for future efforts hoping to leverage digital contact tracing. Though contact tracing technologies have the potential to advance public health, unequal uptake may exacerbate disparate impacts of health crises. %M 36240029 %R 10.2196/39002 %U https://publichealth.jmir.org/2023/1/e39002 %U https://doi.org/10.2196/39002 %U http://www.ncbi.nlm.nih.gov/pubmed/36240029 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e42837 %T The Evaluation of Web-Based Communication Interventions to Support Decisions About COVID-19 Vaccination Among Patients With Underlying Medical Conditions: Protocol for a Randomized Controlled Trial %A Lee,Minjung %A Oh,Bumjo %A Yoon,Nan-He %A Kim,Shinkyeong %A Jung,Young-Il %+ Department of Environmental Health, Korea National Open University, 86, Daehak-ro, Jongno-gu, Seoul, 03087, Republic of Korea, 82 02 3668 4701, extra012@knou.ac.kr %K COVID-19 %K vaccine %K decision-making %K randomized controlled trial %K patient decision aid %D 2023 %7 19.1.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: The timeliness of raising vaccine acceptance and uptake among the public is essential to overcoming COVID-19; however, the decision-making process among patients with underlying medical conditions is complex, leading individuals to vaccine hesitancy because of their health status. Although vaccine implementation is more effective when deployed as soon as possible, vaccine hesitancy is a significant threat to the success of vaccination programs. Objective: This study aims to evaluate the effectiveness of a communication tool for patients with underlying medical conditions who should decide whether to receive a COVID-19 vaccine. Methods: This 3-arm prospective randomized controlled trial will test the effect of the developed communication intervention, which is fully automated, patient decision aid (SMART-DA), and user-centered information (SMART-DA-α). The web-based intervention was developed to help decision-making regarding COVID-19 vaccination among patients with underlying medical conditions. Over 450 patients will be enrolled on the web from a closed panel access website and randomly assigned to 1 of 3 equal groups stratified by their underlying disease, sex, age, and willingness to receive a COVID-19 vaccine. SMART-DA-α provides additional information targeted at helping patients’ decision-making regarding COVID-19 vaccination. Implementation outcomes are COVID-19 vaccination intention, vaccine knowledge, decisional conflict, stress related to decision-making, and attitudes toward vaccination, and was self-assessed through questionnaires. Results: This study was funded in 2020 and approved by the Clinical Research Information Service, Republic of Korea. Data were collected from December 2021 to January 2022. This paper was initially submitted before data analysis. The results are expected to be published in the winter of 2023. Conclusions: We believe that the outcomes of this study will provide valuable new insights into the potential of decision aids for supporting informed decision-making regarding COVID-19 vaccination and discovering the barriers to making informed decisions regarding COVID-19 vaccination, especially among patients with underlying medical conditions. This study will provide knowledge about the common needs, fears, and perceptions concerning vaccines among patients, which can help tailor information for individuals and develop policies to support them. Trial Registration: Korea Clinical Information Service KCT0006945; https://cris.nih.go.kr/cris/search/detailSearch.do/20965 International Registered Report Identifier (IRRID): DERR1-10.2196/42837 %M 36599054 %R 10.2196/42837 %U https://www.researchprotocols.org/2023/1/e42837 %U https://doi.org/10.2196/42837 %U http://www.ncbi.nlm.nih.gov/pubmed/36599054 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e35784 %T The Determinants of Adherence to Public Health and Social Measures Against COVID-19 Among the General Population in South Korea: National Survey Study %A Hong,Hye Chong %A Lee,Hyeonkyeong %A Lee,Suk Jeong %A Park,Chang %A Lee,Mikyung %+ College of Nursing, Mo-Im Kim Nursing Research Institute, Yonsei University, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea, 82 2 2228 3373, hlee39@yuhs.ac %K COVID-19 %K preventive measures %K health literacy %K trust %K national survey %K Tobit regression %D 2023 %7 17.1.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The COVID-19 pandemic has created devastating health, social, economic, and political effects that will have long-lasting impacts. Public health efforts to reduce the spread of COVID-19 are the priority of national policies for responding to the pandemic globally. Public health and social measures (PHSMs) have been shown to be effective when used alone or in combination with other measures, reducing the risk of spreading COVID-19. However, there is insufficient evidence on the status of compliance with PHSMs in the general population for the prevention of COVID-19 in public areas, including Korea. Objective: The aim of this study was to assess levels of compliance with the recommended PHSMs against SARS-CoV-2 infection and their predictors among the general population by using national data. Methods: This study was a secondary data analysis of the National Survey of Infectious Disease Preventive Behaviors in Community, which was conducted by the Korea Centers for Disease Control and Prevention Agency (KDCA) between October 12 and October 30, 2020. The primary study was cross-sectional, using stratified sampling via an adjusted proportional allocation method to select representative samples and ensure the stability of samples. The data were collected through phone interviews conducted by trained enumerators using a structured questionnaire. PHSM adherence was measured using a 10-item comprehensive infectious disease prevention behavior (CIDPB) scale, and each sociocognitive factor, including perceived susceptibility to SARS-CoV-2 infection, perceived severity of SARS-CoV-2 infection, perceived confidence in performing preventive behaviors related to COVID-19, information comprehension ability, and trust in information from the KDCA, was measured. A total of 4003 participants were included in the final analysis. Tobit regression and a decision tree analysis were performed to identify the predictors of preventive measures and the target groups for intervention. Results: We discovered that women scored 1.34 points higher on the CIDPB scale than men (P<.001). Compared to the group aged 19 to 29 years, those aged 50 to 59 years and those older than 60 years scored 1.89 and 2.48 points higher on the CIDPB scale (P<.001), respectively. The perceived severity of infection, confidence in preventive behaviors, information comprehension ability, and trust in information from the KDCA were significant positive determinants of CIDPBs (P<.001). The perceived susceptibility to infection showed a significant negative relationship with CIDPBs (P<.001). Conclusions: Female sex, older age, lower income, and sociocognitive factors were found to be significant determinants of adhering to PHSMs. The findings suggest the need for tailored interventions for target groups; specifically, the age group that was the most active at work indicated the highest potential to spread infection. Adequate public health education and health communication for promoting adherence to PHSMs should be emphasized, and behavior change strategies for those with low perceived confidence in performing PHSMs should be prioritized. %M 36446132 %R 10.2196/35784 %U https://publichealth.jmir.org/2023/1/e35784 %U https://doi.org/10.2196/35784 %U http://www.ncbi.nlm.nih.gov/pubmed/36446132 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 9 %N %P e42334 %T Telehealth Use Following COVID-19 Within Patient-Sharing Physician Networks at a Rural Comprehensive Cancer Center: Cross-sectional Analysis %A Yu,Liyang %A Liu,You-Chi %A Cornelius,Sarah L %A Scodari,Bruno T %A Brooks,Gabriel A %A O'Malley,Alistair James %A Onega,Tracy %A Moen,Erika L %+ Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth College, 1 Medical Center Dr, Lebanon, NH, 03756, United States, 1 603 646 5722, Erika.L.Moen@dartmouth.edu %K telehealth %K rural cancer care %K patient-sharing networks %K network analysis %K COVID-19 %K cancer care %K telemedicine %K oncology %K oncologist %K electronic health record data %K health system %K patient network %D 2023 %7 17.1.2023 %9 Original Paper %J JMIR Cancer %G English %X Background: In response to the COVID-19 pandemic, cancer centers rapidly adopted telehealth to deliver care remotely. Telehealth will likely remain a model of care for years to come and may not only affect the way oncologists deliver care to their own patients but also the physicians with whom they share patients. Objective: This study aimed to examine oncologist characteristics associated with telehealth use and compare patient-sharing networks before and after the COVID-19 pandemic in a rural catchment area with a particular focus on the ties between physicians at the comprehensive cancer center and regional facilities. Methods: In this retrospective observational study, we obtained deidentified electronic health record data for individuals diagnosed with breast, colorectal, or lung cancer at Dartmouth Health in New Hampshire from 2018-2020. Hierarchical logistic regression was used to identify physician factors associated with telehealth encounters post COVID-19. Patient-sharing networks for each cancer type before and post COVID-19 were characterized with global network measures. Exponential-family random graph models were performed to estimate homophily terms for the likelihood of ties existing between physicians colocated at the hub comprehensive cancer center. Results: Of the 12,559 encounters between patients and oncologists post COVID-19, 1228 (9.8%) were via telehealth. Patient encounters with breast oncologists who practiced at the hub hospital were over twice as likely to occur via telehealth compared to encounters with oncologists who practiced in regional facilities (odds ratio 2.2, 95% CI 1.17-4.15; P=.01). Patient encounters with oncologists who practiced in multiple locations were less likely to occur via telehealth, and this association was statistically significant for lung cancer care (odds ratio 0.26, 95% CI 0.09-0.76; P=.01). We observed an increase in ties between oncologists at the hub hospital and oncologists at regional facilities in the lung cancer network post COVID-19 compared to before COVID-19 (93/318, 29.3%, vs 79/370, 21.6%, respectively), which was also reflected in the lower homophily coefficients post COVID-19 compared to before COVID-19 for physicians being colocated at the hub hospital (estimate: 1.92, 95% CI 1.46-2.51, vs 2.45, 95% CI 1.98-3.02). There were no significant differences observed in breast cancer or colorectal cancer networks. Conclusions: Telehealth use and associated changes to patient-sharing patterns associated with telehealth varied by cancer type, suggesting disparate approaches for integrating telehealth across clinical groups within this health system. The limited changes to the patient-sharing patterns between oncologists at the hub hospital and regional facilities suggest that telehealth was less likely to create new referral patterns between these types of facilities and rather replace care that would otherwise have been delivered in person. However, this study was limited to the 2 years immediately following the initial outbreak of COVID-19, and longer-term follow-up may uncover delayed effects that were not observed in this study period. %M 36595737 %R 10.2196/42334 %U https://cancer.jmir.org/2023/1/e42334 %U https://doi.org/10.2196/42334 %U http://www.ncbi.nlm.nih.gov/pubmed/36595737 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e39231 %T Accuracy of COVID-19–Like Illness Diagnoses in Electronic Health Record Data: Retrospective Cohort Study %A Rao,Suchitra %A Bozio,Catherine %A Butterfield,Kristen %A Reynolds,Sue %A Reese,Sarah E %A Ball,Sarah %A Steffens,Andrea %A Demarco,Maria %A McEvoy,Charlene %A Thompson,Mark %A Rowley,Elizabeth %A Porter,Rachael M %A Fink,Rebecca V %A Irving,Stephanie A %A Naleway,Allison %+ Department of Pediatrics, Hospital Medicine and Infectious Diseases, University of Colorado School of Medicine, 13123 E 16th Ave, Aurora, CO, 80045, United States, 1 7207772823, suchitra.rao@childrenscolorado.org %K COVID-19 %K COVID-like illness %K COVID-19 case definition %K sensitivity %K specificity %K positive predictive value %K negative predictive value %D 2023 %7 17.1.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Electronic health record (EHR) data provide a unique opportunity to study the epidemiology of COVID-19, clinical outcomes of the infection, comparative effectiveness of therapies, and vaccine effectiveness but require a well-defined computable phenotype of COVID-19–like illness (CLI). Objective: The objective of this study was to evaluate the performance of pathogen-specific and other acute respiratory illness (ARI) International Statistical Classification of Diseases-9 and -10 codes in identifying COVID-19 cases in emergency department (ED) or urgent care (UC) and inpatient settings. Methods: We conducted a retrospective observational cohort study using EHR, claims, and laboratory information system data of ED or UC and inpatient encounters from 4 health systems in the United States. Patients who were aged ≥18 years, had an ED or UC or inpatient encounter for an ARI, and underwent a SARS-CoV-2 polymerase chain reaction test between March 1, 2020, and March 31, 2021, were included. We evaluated various CLI definitions using combinations of International Statistical Classification of Diseases-10 codes as follows: COVID-19–specific codes; CLI definition used in VISION network studies; ARI signs, symptoms, and diagnosis codes only; signs and symptoms of ARI only; and random forest model definitions. We evaluated the sensitivity, specificity, positive predictive value, and negative predictive value of each CLI definition using a positive SARS-CoV-2 polymerase chain reaction test as the reference standard. We evaluated the performance of each CLI definition for distinct hospitalization and ED or UC cohorts. Results: Among 90,952 hospitalizations and 137,067 ED or UC visits, 5627 (6.19%) and 9866 (7.20%) were positive for SARS-CoV-2, respectively. COVID-19–specific codes had high sensitivity (91.6%) and specificity (99.6%) in identifying patients with SARS-CoV-2 positivity among hospitalized patients. The VISION CLI definition maintained high sensitivity (95.8%) but lowered specificity (45.5%). By contrast, signs and symptoms of ARI had low sensitivity and positive predictive value (28.9% and 11.8%, respectively) but higher specificity and negative predictive value (85.3% and 94.7%, respectively). ARI diagnoses, signs, and symptoms alone had low predictive performance. All CLI definitions had lower sensitivity for ED or UC encounters. Random forest approaches identified distinct CLI definitions with high performance for hospital encounters and moderate performance for ED or UC encounters. Conclusions: COVID-19–specific codes have high sensitivity and specificity in identifying adults with positive SARS-CoV-2 test results. Separate combinations of COVID-19-specific codes and ARI codes enhance the utility of CLI definitions in studies using EHR data in hospital and ED or UC settings. %M 36383633 %R 10.2196/39231 %U https://formative.jmir.org/2023/1/e39231 %U https://doi.org/10.2196/39231 %U http://www.ncbi.nlm.nih.gov/pubmed/36383633 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e42401 %T The Effect of the COVID-19 Pandemic on Digital Health–Seeking Behavior: Big Data Interrupted Time-Series Analysis of Google Trends %A van Kessel,Robin %A Kyriopoulos,Ilias %A Wong,Brian Li Han %A Mossialos,Elias %+ LSE Health, Department of Health Policy, London School of Economics and Political Science, Houghton Street, London, WC2A 2AE, United Kingdom, 44 7772707841, e.a.mossialos@lse.ac.uk %K digital health %K healthcare seeking behaviour %K big data %K real-world data %K data %K COVID-19 %K pandemic %K Google Trends %K telehealth %D 2023 %7 16.1.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Due to the emergency responses early in the COVID-19 pandemic, the use of digital health in health care increased abruptly. However, it remains unclear whether this introduction was sustained in the long term, especially with patients being able to decide between digital and traditional health services once the latter regained their functionality throughout the COVID-19 pandemic. Objective: We aim to understand how the public interest in digital health changed as proxy for digital health–seeking behavior and to what extent this change was sustainable over time. Methods: We used an interrupted time-series analysis of Google Trends data with break points on March 11, 2020 (declaration of COVID-19 as a pandemic by the World Health Organization), and December 20, 2020 (the announcement of the first COVID-19 vaccines). Nationally representative time-series data from February 2019 to August 2021 were extracted from Google Trends for 6 countries with English as their dominant language: Canada, the United States, the United Kingdom, New Zealand, Australia, and Ireland. We measured the changes in relative search volumes of the keywords online doctor, telehealth, online health, telemedicine, and health app. In doing so, we capture the prepandemic trend, the immediate change due to the announcement of COVID-19 being a pandemic, and the gradual change after the announcement. Results: Digital health search volumes immediately increased in all countries under study after the announcement of COVID-19 being a pandemic. There was some variation in what keywords were used per country. However, searches declined after this immediate spike, sometimes reverting to prepandemic levels. The announcement of COVID-19 vaccines did not consistently impact digital health search volumes in the countries under study. The exception is the search volume of health app, which was observed as either being stable or gradually increasing during the pandemic. Conclusions: Our findings suggest that the increased public interest in digital health associated with the pandemic did not sustain, alluding to remaining structural barriers. Further building of digital health capacity and developing robust digital health governance frameworks remain crucial to facilitating sustainable digital health transformation. %M 36603152 %R 10.2196/42401 %U https://www.jmir.org/2023/1/e42401 %U https://doi.org/10.2196/42401 %U http://www.ncbi.nlm.nih.gov/pubmed/36603152 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e40602 %T Engagement With mHealth COVID-19 Digital Biomarker Measurements in a Longitudinal Cohort Study: Mixed Methods Evaluation %A Rennie,Kirsten L %A Lawlor,Emma R %A Yassaee,Arrash %A Booth,Adam %A Westgate,Kate %A Sharp,Stephen J %A Tyrrell,Carina S B %A Aral,Mert %A Wareham,Nicholas J %+ Medical Research Council Epidemiology Unit, University of Cambridge, Box 285, Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, United Kingdom, 44 1223 330315, kirsten.rennie@mrc-epid.cam.ac.uk %K smartphone %K apps %K engagement %K COVID-19 %K pandemic %K cohort studies %K epidemiology %K mobile health %K digital health %K biomarker %K mobile phone %D 2023 %7 13.1.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic accelerated the interest in implementing mobile health (mHealth) in population-based health studies, but evidence is lacking on engagement and adherence in studies. We conducted a fully remote study for ≥6 months tracking COVID-19 digital biomarkers and symptoms using a smartphone app nested within an existing cohort of adults. Objective: We aimed to investigate participant characteristics associated with initial and sustained engagement in digital biomarker collection from a bespoke smartphone app and if engagement changed over time or because of COVID-19 factors and explore participants’ reasons for consenting to the smartphone substudy and experiences related to initial and continued engagement. Methods: Participants in the Fenland COVID-19 study were invited to the app substudy from August 2020 to October 2020 until study closure (April 30, 2021). Participants were asked to complete digital biomarker modules (oxygen saturation, body temperature, and resting heart rate [RHR]) and possible COVID-19 symptoms in the app 3 times per week. Participants manually entered the measurements, except RHR that was measured using the smartphone camera. Engagement was categorized by median weekly frequency of completing the 3 digital biomarker modules (categories: 0, 1-2, and ≥3 times per week). Sociodemographic and health characteristics of those who did or did not consent to the substudy and by engagement category were explored. Semistructured interviews were conducted with 35 participants who were purposively sampled by sex, age, educational attainment, and engagement category, and data were analyzed thematically; 63% (22/35) of the participants consented to the app substudy, and 37% (13/35) of the participants did not consent. Results: A total of 62.61% (2524/4031) of Fenland COVID-19 study participants consented to the app substudy. Of those, 90.21% (2277/2524) completed the app onboarding process. Median time in the app substudy was 34.5 weeks (IQR 34-37) with no change in engagement from 0 to 3 months or 3 to 6 months. Completion rates (≥1 per week) across the study between digital biomarkers were similar (RHR: 56,517/77,664, 72.77%; temperature: 56,742/77,664, 73.06%; oxygen saturation: 57,088/77,664, 73.51%). Older age groups and lower managerial and intermediate occupations were associated with higher engagement, whereas working, being a current smoker, being overweight or obese, and high perceived stress were associated with lower engagement. Continued engagement was facilitated through routine and personal motivation, and poor engagement was caused by user error and app or equipment malfunctions preventing data input. From these results, we developed key recommendations to improve engagement in population-based mHealth studies. Conclusions: This mixed methods study demonstrated both high initial and sustained engagement in a large mHealth COVID-19 study over a ≥6-month period. Being nested in a known cohort study enabled the identification of participant characteristics and factors associated with engagement to inform future applications in population-based health research. %M 36194866 %R 10.2196/40602 %U https://www.jmir.org/2023/1/e40602 %U https://doi.org/10.2196/40602 %U http://www.ncbi.nlm.nih.gov/pubmed/36194866 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e42616 %T The Impact of Mask Mandates on Face Mask Use During the COVID-19 Pandemic: Longitudinal Survey Study %A Binka,Mawuena %A Adu,Prince Asumadu %A Jeong,Dahn %A Vadlamudi,Nirma Khatri %A Velásquez García,Héctor Alexander %A Mahmood,Bushra %A Buller-Taylor,Terri %A Otterstatter,Michael %A Janjua,Naveed Zafar %+ British Columbia Centre for Disease Control, 655 W 12th Ave, Vancouver, BC, V5Z 4R4, Canada, 1 6047072400, mawuena.binka@bccdc.ca %K face mask %K face covering %K COVID-19 %K SARS-CoV-2 %K outbreak %K public health %K health policy %K trend analysis %K logistic regression %D 2023 %7 11.1.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Face mask use has been associated with declines in COVID-19 incidence rates worldwide. A handful of studies have examined the factors associated with face mask use in North America during the COVID-19 pandemic; however, much less is known about the patterns of face mask use and the impact of mask mandates during this time. This information could have important policy implications, now and in the event of future pandemics. Objective: To address existing knowledge gaps, we assessed face mask usage patterns among British Columbia COVID-19 Population Mixing Patterns (BC-Mix) survey respondents and evaluated the impact of the provincial mask mandate on these usage patterns. Methods: Between September 2020 and July 2022, adult British Columbia residents completed the web-based BC-Mix survey, answering questions on the circumstances surrounding face mask use or lack thereof, movement patterns, and COVID-19–related beliefs. Trends in face mask use over time were assessed, and associated factors were evaluated using multivariable logistic regression. A stratified analysis was done to examine effect modification by the provincial mask mandate. Results: Of the 44,301 respondents, 81.9% reported wearing face masks during the 23-month period. In-store and public transit mask mandates supported monthly face mask usage rates of approximately 80%, which was further bolstered up to 92% with the introduction of the provincial mask mandate. Face mask users mostly visited retail locations (51.8%) and travelled alone by car (49.6%), whereas nonusers mostly traveled by car with others (35.2%) to their destinations—most commonly parks (45.7%). Nonusers of face masks were much more likely to be male than female, especially in retail locations and restaurants, bars, and cafés. In a multivariable logistic regression model adjusted for possible confounders, factors associated with face mask use included age, ethnicity, health region, mode of travel, destination, and time period. The odds of face mask use were 3.68 times greater when the provincial mask mandate was in effect than when it was not (adjusted odds ratio [aOR] 3.68, 95% CI 3.33-4.05). The impact of the mask mandate was greatest in restaurants, bars, or cafés (mandate: aOR 7.35, 95% CI 4.23-12.78 vs no mandate: aOR 2.81, 95% CI 1.50-5.26) and in retail locations (mandate: aOR 19.94, 95% CI 14.86-26.77 vs no mandate: aOR 7.71, 95% CI 5.68-10.46). Conclusions: Study findings provide added insight into the dynamics of face mask use during the COVID-19 pandemic. Mask mandates supported increased and sustained high face mask usage rates during the first 2 years of the pandemic, having the greatest impact in indoor public locations with limited opportunity for physical distancing targeted by these mandates. These findings highlight the utility of mask mandates in supporting high face mask usage rates during the COVID-19 pandemic. %M 36446134 %R 10.2196/42616 %U https://publichealth.jmir.org/2023/1/e42616 %U https://doi.org/10.2196/42616 %U http://www.ncbi.nlm.nih.gov/pubmed/36446134 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e40201 %T The Prevalence, Features, Influencing Factors, and Solutions for COVID-19 Vaccine Misinformation: Systematic Review %A Zhao,Sihong %A Hu,Simeng %A Zhou,Xiaoyu %A Song,Suhang %A Wang,Qian %A Zheng,Hongqiu %A Zhang,Ying %A Hou,Zhiyuan %+ School of Public Health, Global Health Institute, National Health Commission Key Laboratory of Health Technology Assessment, Fudan University, 220 Handan Road, Yangpu District, Shanghai, 200437, China, 86 21 6564 2222, zyhou@fudan.edu.cn %K COVID-19 %K COVID-19 vaccine %K misinformation %K anti-vaccine %K review %K social media %K survey %D 2023 %7 11.1.2023 %9 Review %J JMIR Public Health Surveill %G English %X Background: During the COVID-19 pandemic, infodemic spread even more rapidly than the pandemic itself. The COVID-19 vaccine hesitancy has been prevalent worldwide and hindered pandemic exiting strategies. Misinformation around COVID-19 vaccines is a vital contributor to vaccine hesitancy. However, no evidence systematically summarized COVID-19 vaccine misinformation. Objective: This review aims to synthesize the global evidence on misinformation related to COVID-19 vaccines, including its prevalence, features, influencing factors, impacts, and solutions for combating misinformation. Methods: We performed a systematic review by searching 5 peer-reviewed databases (PubMed, Embase, Web of Science, Scopus, and EBSCO). We included original articles that investigated misinformation related to COVID-19 vaccines and were published in English from January 1, 2020, to August 18, 2022. We excluded publications that did not cover or focus on COVID-19 vaccine misinformation. The Appraisal tool for Cross-Sectional Studies, version 2 of the Cochrane risk-of-bias tool for randomized trials (RoB 2), and Critical Appraisal Skills Programme Checklist were used to assess the study quality. The review was guided by PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and registered with PROSPERO (CRD42021288929). Results: Of the 8864 studies identified, 91 observational studies and 11 interventional studies met the inclusion criteria. Misinformation around COVID-19 vaccines covered conspiracy, concerns on vaccine safety and efficacy, no need for vaccines, morality, liberty, and humor. Conspiracy and safety concerns were the most prevalent misinformation. There was a great variation in misinformation prevalence, noted among 2.5%-55.4% in the general population and 6.0%-96.7% in the antivaccine/vaccine hesitant groups from survey-based studies, and in 0.1%-41.3% on general online data and 0.5%-56% on antivaccine/vaccine hesitant data from internet-based studies. Younger age, lower education and economic status, right-wing and conservative ideology, and having psychological problems enhanced beliefs in misinformation. The content, format, and source of misinformation influenced its spread. A 5-step framework was proposed to address vaccine-related misinformation, including identifying misinformation, regulating producers and distributors, cutting production and distribution, supporting target audiences, and disseminating trustworthy information. The debunking messages/videos were found to be effective in several experimental studies. Conclusions: Our review provides comprehensive and up-to-date evidence on COVID-19 vaccine misinformation and helps responses to vaccine infodemic in future pandemics. Trial Registration: PROSPERO CRD42021288929; https://tinyurl.com/2prejtfa %M 36469911 %R 10.2196/40201 %U https://publichealth.jmir.org/2023/1/e40201 %U https://doi.org/10.2196/40201 %U http://www.ncbi.nlm.nih.gov/pubmed/36469911 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e40291 %T Prepandemic Antivaccination Websites' COVID-19 Vaccine Behavior: Content Analysis of Archived Websites %A Kaplan,Samantha %A von Isenburg,Megan %A Waldrop,Lucy %+ Duke University Medical Center Library & Archives, 10 Searle Drive, Durham, NC, 27710, United States, 1 919 660 1124, samantha.kaplan@duke.edu %K antivaccination behavior %K web archiving %K content analysis %K COVID-19 vaccines %K COVID-19 %K vaccine %K website %K web %K pandemic %K safety %K science %K content %D 2023 %7 11.1.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: The onset of the COVID-19 pandemic and the concurrent development of vaccines offered a rare and somewhat unprecedented opportunity to study antivaccination behavior as it formed over time via the use of archived versions of websites. Objective: This study aims to assess how existing antivaccination websites modified their content to address COVID-19 vaccines and pandemic restrictions. Methods: Using a preexisting collection of 25 antivaccination websites curated by the IvyPlus Web Collection Program prior to the pandemic and crawled every 6 months via Archive-It, we conducted a content analysis to see how these websites acknowledged or ignored COVID-19 vaccines and pandemic restrictions. Websites were assessed for financial behaviors such as having storefronts, mention of COVID-19 vaccines in general or by manufacturer name, references to personal freedom such as masking, safety concerns like side effects, and skepticism of science. Results: The majority of websites addressed COVID-19 vaccines in a negative fashion, with more websites making appeals to personal freedom or expressing skepticism of science than questioning safety. This can potentially be attributed to the lack of available safety data about the vaccines at the time of data collection. Many of the antivaccination websites we evaluated actively sought donations and had a membership option, evidencing these websites have financial motivations and actively build a community around these issues. The content analysis also offered the opportunity to test the viability of archived websites for use in scholarly research. The archived versions of the websites had significant shortcomings, particularly in search functionality, and required supplementation with the live websites. For web archiving to be a viable source of stand-alone content for research, the technology needs to make significant improvements in its capture abilities. Conclusions: In summary, we found antivaccination websites existing prior to the COVID-19 pandemic largely adapted their messaging to address COVID-19 vaccines with very few sites ignoring the pandemic altogether. This study also demonstrated the timely and significant need for more robust web archiving capabilities as web-based environments become more ephemeral and unstable. %M 36548948 %R 10.2196/40291 %U https://formative.jmir.org/2023/1/e40291 %U https://doi.org/10.2196/40291 %U http://www.ncbi.nlm.nih.gov/pubmed/36548948 %0 Journal Article %@ 2563-3570 %I JMIR Publications %V 4 %N %P e42700 %T SARS-CoV-2 Omicron Variant Genomic Sequences and Their Epidemiological Correlates Regarding the End of the Pandemic: In Silico Analysis %A Kumar,Ashutosh %A Asghar,Adil %A Singh,Himanshu N %A Faiq,Muneeb A %A Kumar,Sujeet %A Narayan,Ravi K %A Kumar,Gopichand %A Dwivedi,Prakhar %A Sahni,Chetan %A Jha,Rakesh K %A Kulandhasamy,Maheswari %A Prasoon,Pranav %A Sesham,Kishore %A Kant,Kamla %A Pandey,Sada N %+ Department of Anatomy, All India Institute of Medical Sciences-Patna, Phulwari Sharif, Patna, 801507, India, 91 0612245 ext 1335, drashutoshkumar@aiimspatna.org %K COVID-19 %K pandemic %K variants %K immune escape %K transmissibility %K virulence %K policy %K mutations %K epidemiology %K data %K Omicron %K virus %K transmission %K genomic %D 2023 %7 10.1.2023 %9 Original Paper %J JMIR Bioinform Biotech %G English %X Background: Emergence of the new SARS-CoV-2 variant B.1.1.529 worried health policy makers worldwide due to a large number of mutations in its genomic sequence, especially in the spike protein region. The World Health Organization (WHO) designated this variant as a global variant of concern (VOC), which was named “Omicron.” Following Omicron’s emergence, a surge of new COVID-19 cases was reported globally, primarily in South Africa. Objective: The aim of this study was to understand whether Omicron had an epidemiological advantage over existing variants. Methods: We performed an in silico analysis of the complete genomic sequences of Omicron available on the Global Initiative on Sharing Avian Influenza Data (GISAID) database to analyze the functional impact of the mutations present in this variant on virus-host interactions in terms of viral transmissibility, virulence/lethality, and immune escape. In addition, we performed a correlation analysis of the relative proportion of the genomic sequences of specific SARS-CoV-2 variants (in the period from October 1 to November 29, 2021) with matched epidemiological data (new COVID-19 cases and deaths) from South Africa. Results: Compared with the current list of global VOCs/variants of interest (VOIs), as per the WHO, Omicron bears more sequence variation, specifically in the spike protein and host receptor-binding motif (RBM). Omicron showed the closest nucleotide and protein sequence homology with the Alpha variant for the complete sequence and the RBM. The mutations were found to be primarily condensed in the spike region (n=28-48) of the virus. Further mutational analysis showed enrichment for the mutations decreasing binding affinity to angiotensin-converting enzyme 2 receptor and receptor-binding domain protein expression, and for increasing the propensity of immune escape. An inverse correlation of Omicron with the Delta variant was noted (r=–0.99, P<.001; 95% CI –0.99 to –0.97) in the sequences reported from South Africa postemergence of the new variant, subsequently showing a decrease. There was a steep rise in new COVID-19 cases in parallel with the increase in the proportion of Omicron isolates since the report of the first case (74%-100%). By contrast, the incidence of new deaths did not increase (r=–0.04, P>.05; 95% CI –0.52 to 0.58). Conclusions: In silico analysis of viral genomic sequences suggests that the Omicron variant has more remarkable immune-escape ability than existing VOCs/VOIs, including Delta, but reduced virulence/lethality than other reported variants. The higher power for immune escape for Omicron was a likely reason for the resurgence in COVID-19 cases and its rapid rise as the globally dominant strain. Being more infectious but less lethal than the existing variants, Omicron could have plausibly led to widespread unnoticed new, repeated, and vaccine breakthrough infections, raising the population-level immunity barrier against the emergence of new lethal variants. The Omicron variant could have thus paved the way for the end of the pandemic. %M 36688013 %R 10.2196/42700 %U https://bioinform.jmir.org/2023/1/e42700 %U https://doi.org/10.2196/42700 %U http://www.ncbi.nlm.nih.gov/pubmed/36688013 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 12 %N %P e42549 %T Closed Endotracheal Suction Systems for COVID-19: Rapid Review %A Ramírez-Torres,Carmen Amaia %A Rivera-Sanz,Félix %A Sufrate-Sorzano,Teresa %A Pedraz-Marcos,Azucena %A Santolalla-Arnedo,Ivan %+ Health and Care Research Group, University of La Rioja, 88, Duquesa de la Victoria, Logroño, 26004, Spain, 34 941299050, caramit@unirioja.es %K endotracheal suctioning %K closed suction system %K rapid review %K suction %K mechanical ventilation %K COVID-19 %K intensive care unit %K health intervention %K endotracheal %K patient care %K healthcare %K ventilator %K health benefit %D 2023 %7 10.1.2023 %9 Review %J Interact J Med Res %G English %X Background: The increase in admissions to intensive care units (ICUs) in 2020 and the morbidity and mortality associated with SARS-CoV-2 infection pose a challenge to the analysis of evidence of health interventions carried out in ICUs. One of the most common interventions in patients infected with the virus and admitted to ICUs is endotracheal aspiration. Endotracheal suctioning has also been considered one of the most contaminating interventions. Objective: This review aims to analyze the benefits and risks of endotracheal suctioning using closed suction systems (CSS) in COVID-19 patients. Methods: A rapid review was carried out using the following databases: PubMed, MEDLINE, CINAHL, LILACS, the Cochrane Library, and IBECS. The data search included articles in English and Spanish, published between 2010 and 2020, concerning adult patients, and using the key words “endotracheal,” “suction,” and “closed system.” Results: A total of 15 articles were included. The benefits and risks were divided into 3 categories: patient, care, and organization. Relating to the patient, we found differences in cardiorespiratory variables and changes in the ventilator, for example, improvement in patients with elevated positive and end-expiratory pressure due to maladaptation and alveolar collapse. Relating to care, we found a shorter suctioning time, by up to 1 minute. Relating to organization, we found fewer microorganisms on staff gloves. Other conflicting results between studies were related to ventilator-associated pneumonia, bacterial colonization, or mortality. Conclusions: Aside from the need for quality research comparing open suction systems and CSS as used to treat COVID-19 patients, closed endotracheal suctioning has benefits in terms of shorter stay in the ICU and reduced environmental contamination, preventing ventilator disconnection from the patient, reducing the suctioning time—though it does produce the greatest number of mucosal occlusions—and preventing interpatient and patient-staff environmental contamination. New evidence in the context of the SARS-CoV-2 virus is required in order to compare results and establish new guidelines. %M 36548950 %R 10.2196/42549 %U https://www.i-jmr.org/2023/1/e42549 %U https://doi.org/10.2196/42549 %U http://www.ncbi.nlm.nih.gov/pubmed/36548950 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e36538 %T A Spatiotemporal Solution to Control COVID-19 Transmission at the Community Scale for Returning to Normalcy: COVID-19 Symptom Onset Risk Spatiotemporal Analysis %A Tong,Chengzhuo %A Shi,Wenzhong %A Zhang,Anshu %A Shi,Zhicheng %+ Research Institute for Smart Cities, School of Architecture and Urban Planning, Shenzhen University, 3688 Nanhai Avenue, Nanshan District, Shenzhen, 518060, China, 86 0755 26531244, shizhic@hotmail.com %K return to normalcy %K precise prevention and control %K risk prediction %K COVID-19 symptom onset %K symptom %K COVID-19 %D 2023 %7 6.1.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Following the recent COVID-19 pandemic, returning to normalcy has become the primary goal of global cities. The key for returning to normalcy is to avoid affecting social and economic activities while supporting precise epidemic control. Estimation models for the spatiotemporal spread of the epidemic at the refined scale of cities that support precise epidemic control are limited. For most of 2021, Hong Kong has remained at the top of the “global normalcy index” because of its effective responses. The urban-community-scale spatiotemporal onset risk prediction model of COVID-19 symptom has been used to assist in the precise epidemic control of Hong Kong. Objective: Based on the spatiotemporal prediction models of COVID-19 symptom onset risk, the aim of this study was to develop a spatiotemporal solution to assist in precise prevention and control for returning to normalcy. Methods: Over the years 2020 and 2021, a spatiotemporal solution was proposed and applied to support the epidemic control in Hong Kong. An enhanced urban-community-scale geographic model was proposed to predict the risk of COVID-19 symptom onset by quantifying the impact of the transmission of SARS-CoV-2 variants, vaccination, and the imported case risk. The generated prediction results could be then applied to establish the onset risk predictions over the following days, the identification of high–onset-risk communities, the effectiveness analysis of response measures implemented, and the effectiveness simulation of upcoming response measures. The applications could be integrated into a web-based platform to assist the antiepidemic work. Results: Daily predicted onset risk in 291 tertiary planning units (TPUs) of Hong Kong from January 18, 2020, to April 22, 2021, was obtained from the enhanced prediction model. The prediction accuracy in the following 7 days was over 80%. The prediction results were used to effectively assist the epidemic control of Hong Kong in the following application examples: identified communities within high–onset-risk always only accounted for 2%-25% in multiple epidemiological scenarios; effective COVID-19 response measures, such as prohibiting public gatherings of more than 4 people were found to reduce the onset risk by 16%-46%; through the effect simulation of the new compulsory testing measure, the onset risk was found to be reduced by more than 80% in 42 (14.43%) TPUs and by more than 60% in 96 (32.99%) TPUs. Conclusions: In summary, this solution can support sustainable and targeted pandemic responses for returning to normalcy. Faced with the situation that may coexist with SARS-CoV-2, this study can not only assist global cities in responding to the future epidemics effectively but also help to restore social and economic activities and people’s normal lives. %M 36508488 %R 10.2196/36538 %U https://publichealth.jmir.org/2023/1/e36538 %U https://doi.org/10.2196/36538 %U http://www.ncbi.nlm.nih.gov/pubmed/36508488 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 3 %N %P e38607 %T COVID-19–Associated Misinformation Across the South Asian Diaspora: Qualitative Study of WhatsApp Messages %A Sharma,Anjana E %A Khosla,Kiran %A Potharaju,Kameswari %A Mukherjea,Arnab %A Sarkar,Urmimala %+ Department of Family and Community Medicine, University of California San Francisco, 1001 Potrero Avenue, Zuckerberg San Francisco General Hospital, San Francisco, CA, 94143, United States, 1 628 206 4943, anjana.sharma@ucsf.edu %K misinformation %K COVID-19 %K South Asians %K disparities %K social media %K infodemiology %K WhatsApp %K messages %K apps %K health information %K reliability %K communication %K Asian %K English %K community %K health %K organization %K public health %K pandemic %D 2023 %7 5.1.2023 %9 Original Paper %J JMIR Infodemiology %G English %X Background: South Asians, inclusive of individuals originating in India, Pakistan, Maldives, Bangladesh, Sri Lanka, Bhutan, and Nepal, comprise the largest diaspora in the world, with large South Asian communities residing in the Caribbean, Africa, Europe, and elsewhere. There is evidence that South Asian communities have disproportionately experienced COVID-19 infections and mortality. WhatsApp, a free messaging app, is widely used in transnational communication within the South Asian diaspora. Limited studies exist on COVID-19–related misinformation specific to the South Asian community on WhatsApp. Understanding communication on WhatsApp may improve public health messaging to address COVID-19 disparities among South Asian communities worldwide. Objective: We developed the COVID-19–Associated misinfoRmation On Messaging apps (CAROM) study to identify messages containing misinformation about COVID-19 shared via WhatsApp. Methods: We collected messages forwarded globally through WhatsApp from self-identified South Asian community members between March 23 and June 3, 2021. We excluded messages that were in languages other than English, did not contain misinformation, or were not relevant to COVID-19. We deidentified each message and coded them for one or more content categories, media types (eg, video, image, text, web link, or a combination of these elements), and tone (eg, fearful, well intentioned, or pleading). We then performed a qualitative content analysis to arrive at key themes of COVID-19 misinformation. Results: We received 108 messages; 55 messages met the inclusion criteria for the final analytic sample; 32 (58%) contained text, 15 (27%) contained images, and 13 (24%) contained video. Content analysis revealed the following themes: “community transmission” relating to misinformation on how COVID-19 spreads in the community; “prevention” and “treatment,” including Ayurvedic and traditional remedies for how to prevent or treat COVID-19 infection; and messaging attempting to sell “products or services” to prevent or cure COVID-19. Messages varied in audience from the general public to South Asians specifically; the latter included messages alluding to South Asian pride and solidarity. Scientific jargon and references to major organizations and leaders in health care were included to provide credibility. Messages with a pleading tone encouraged users to forward them to friends or family. Conclusions: Misinformation in the South Asian community on WhatsApp spreads erroneous ideas regarding disease transmission, prevention, and treatment. Content evoking solidarity, “trustworthy” sources, and encouragement to forward messages may increase the spread of misinformation. Public health outlets and social media companies must actively combat misinformation to address health disparities among the South Asian diaspora during the COVID-19 pandemic and in future public health emergencies. %M 37113380 %R 10.2196/38607 %U https://infodemiology.jmir.org/2023/1/e38607 %U https://doi.org/10.2196/38607 %U http://www.ncbi.nlm.nih.gov/pubmed/37113380 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e41132 %T A Metasynthesis and Meta-analysis of the Impact and Diagnostic Safety of COVID-19 Symptom Agnostic Rapid Testing in Low- and Middle-Income Countries: Protocol for a Systematic Review %A Mbwogge,Mathew %A Kumar,Pratyush %A Abhishek,Kumar %+ See Acknowledgments, Alumni Relations, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, United Kingdom, 44 07405900707, m.mbwoge@gmail.com %K SARS-CoV-2 %K 2019-nCoV %K rapid test %K diagnostic accuracy %K meta-analysis %K metasynthesis %K COVID-19 %K low- and middle-income countries %D 2023 %7 5.1.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Amid all public health measures to contain COVID-19, the most challenging has been how to break the transmission chain. This has been even more challenging in low- and middle-income countries (LMICs). A public health emergency warrants a public health perspective, which comes down to prevention. Rapid mass testing has been advocated throughout the pandemic as a way to promptly deal with asymptomatic infections, but its usefulness in LMICs is yet to be fully understood. Objective: The study objectives of this paper are to (1) investigate the impact of the different rapid mass testing options for SARS-CoV-2 that have been delivered at point of care in LMICs and (2) evaluate the diagnostic safety (accuracy) of rapid mass testing for SARS-CoV-2 in LMICs. Methods: This review will systematically search records in PubMed, EBSCOhost, Cochrane library, Global Index Medicus COVID-19 Register, and Scopus. Records will be managed using Mendeley reference manager and SWIFT-Review. Risk of bias for randomized controlled trials will be assessed using the RoB 2 assessment tool, while nonrandomized interventions will be assessed using the tool developed by the Evidence Project. A narrative approach will be used to synthesize data under the first objective, and either a meta-analysis or synthesis without meta-analysis for the second objective. Tables, figures, and textual descriptions will be used to present findings. The overall body of evidence for the first objective will be assessed using the Grading of Recommendations Assessment, Development, and Evaluation–Confidence in the Evidence from Reviews of Qualitative research (GRADE-CERQual) approach, and for the second objective using GRADE. Results: The screening of records has been finalized. We hope to finalize the synthesis by the end of February 2023 and to prepare the manuscript for publication by April 2023. The study will be reported in accordance with standard guidelines for the reporting of systematic reviews. Review results will be disseminated through conferences and their peer-reviewed publication in a relevant journal. Conclusions: This review highlights the role of a preventive approach in infection control using rapid mass testing. It also flags the overriding need to involve users and providers in the evaluation of such tests in the settings for which they are intended. This will be the first review to the best of our knowledge to generate both qualitative and quantitative evidence regarding rapid mass testing specific to LMICs. Trial Registration: PROSPERO CRD42022283776; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=283776 International Registered Report Identifier (IRRID): PRR1-10.2196/41132 %M 36602849 %R 10.2196/41132 %U https://www.researchprotocols.org/2023/1/e41132 %U https://doi.org/10.2196/41132 %U http://www.ncbi.nlm.nih.gov/pubmed/36602849 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 12 %P e41529 %T Natural Language Processing for Improved Characterization of COVID-19 Symptoms: Observational Study of 350,000 Patients in a Large Integrated Health Care System %A Malden,Deborah E %A Tartof,Sara Y %A Ackerson,Bradley K %A Hong,Vennis %A Skarbinski,Jacek %A Yau,Vincent %A Qian,Lei %A Fischer,Heidi %A Shaw,Sally F %A Caparosa,Susan %A Xie,Fagen %+ Department of Research & Evaluation, Kaiser Permanente Southern California, 100 S. Los Robles, 2nd Floor, Pasadena, CA, 91101, United States, 1 310 456 4324, debbie.e.malden@kp.org %K natural language processing %K NLP %K COVID-19 %K symptoms %K disease characterization %K artificial intelligence %K symptoms %K application %K data %K cough %K fever %K headache %K surveillance %D 2022 %7 30.12.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Natural language processing (NLP) of unstructured text from electronic medical records (EMR) can improve the characterization of COVID-19 signs and symptoms, but large-scale studies demonstrating the real-world application and validation of NLP for this purpose are limited. Objective: The aim of this paper is to assess the contribution of NLP when identifying COVID-19 signs and symptoms from EMR. Methods: This study was conducted in Kaiser Permanente Southern California, a large integrated health care system using data from all patients with positive SARS-CoV-2 laboratory tests from March 2020 to May 2021. An NLP algorithm was developed to extract free text from EMR on 12 established signs and symptoms of COVID-19, including fever, cough, headache, fatigue, dyspnea, chills, sore throat, myalgia, anosmia, diarrhea, vomiting or nausea, and abdominal pain. The proportion of patients reporting each symptom and the corresponding onset dates were described before and after supplementing structured EMR data with NLP-extracted signs and symptoms. A random sample of 100 chart-reviewed and adjudicated SARS-CoV-2–positive cases were used to validate the algorithm performance. Results: A total of 359,938 patients (mean age 40.4 [SD 19.2] years; 191,630/359,938, 53% female) with confirmed SARS-CoV-2 infection were identified over the study period. The most common signs and symptoms identified through NLP-supplemented analyses were cough (220,631/359,938, 61%), fever (185,618/359,938, 52%), myalgia (153,042/359,938, 43%), and headache (144,705/359,938, 40%). The NLP algorithm identified an additional 55,568 (15%) symptomatic cases that were previously defined as asymptomatic using structured data alone. The proportion of additional cases with each selected symptom identified in NLP-supplemented analysis varied across the selected symptoms, from 29% (63,742/220,631) of all records for cough to 64% (38,884/60,865) of all records with nausea or vomiting. Of the 295,305 symptomatic patients, the median time from symptom onset to testing was 3 days using structured data alone, whereas the NLP algorithm identified signs or symptoms approximately 1 day earlier. When validated against chart-reviewed cases, the NLP algorithm successfully identified signs and symptoms with consistently high sensitivity (ranging from 87% to 100%) and specificity (94% to 100%). Conclusions: These findings demonstrate that NLP can identify and characterize a broad set of COVID-19 signs and symptoms from unstructured EMR data with enhanced detail and timeliness compared with structured data alone. %M 36446133 %R 10.2196/41529 %U https://publichealth.jmir.org/2022/12/e41529 %U https://doi.org/10.2196/41529 %U http://www.ncbi.nlm.nih.gov/pubmed/36446133 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 12 %P e39336 %T Crowdsourced Perceptions of Human Behavior to Improve Computational Forecasts of US National Incident Cases of COVID-19: Survey Study %A Braun,David %A Ingram,Daniel %A Ingram,David %A Khan,Bilal %A Marsh,Jessecae %A McAndrew,Thomas %+ Department of Psychology, Lehigh University, 17 Memorial Dr E, Bethlehem, PA, 18015, United States, 1 6107583000, dab414@lehigh.edu %K crowdsourcing %K COVID-19 %K forecasting %K human judgment %D 2022 %7 30.12.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Past research has shown that various signals associated with human behavior (eg, social media engagement) can benefit computational forecasts of COVID-19. One behavior that has been shown to reduce the spread of infectious agents is compliance with nonpharmaceutical interventions (NPIs). However, the extent to which the public adheres to NPIs is difficult to measure and consequently difficult to incorporate into computational forecasts of infectious diseases. Soliciting judgments from many individuals (ie, crowdsourcing) can lead to surprisingly accurate estimates of both current and future targets of interest. Therefore, asking a crowd to estimate community-level compliance with NPIs may prove to be an accurate and predictive signal of an infectious disease such as COVID-19. Objective: We aimed to show that crowdsourced perceptions of compliance with NPIs can be a fast and reliable signal that can predict the spread of an infectious agent. We showed this by measuring the correlation between crowdsourced perceptions of NPIs and US incident cases of COVID-19 1-4 weeks ahead, and evaluating whether incorporating crowdsourced perceptions improves the predictive performance of a computational forecast of incident cases. Methods: For 36 weeks from September 2020 to April 2021, we asked 2 crowds 21 questions about their perceptions of community adherence to NPIs and public health guidelines, and collected 10,120 responses. Self-reported state residency was compared to estimates from the US census to determine the representativeness of the crowds. Crowdsourced NPI signals were mapped to 21 mean perceived adherence (MEPA) signals and analyzed descriptively to investigate features, such as how MEPA signals changed over time and whether MEPA time series could be clustered into groups based on response patterns. We investigated whether MEPA signals were associated with incident cases of COVID-19 1-4 weeks ahead by (1) estimating correlations between MEPA and incident cases, and (2) including MEPA into computational forecasts. Results: The crowds were mostly geographically representative of the US population with slight overrepresentation in the Northeast. MEPA signals tended to converge toward moderate levels of compliance throughout the survey period, and an unsupervised analysis revealed signals clustered into 4 groups roughly based on the type of question being asked. Several MEPA signals linearly correlated with incident cases of COVID-19 1-4 weeks ahead at the US national level. Including questions related to social distancing, testing, and limiting large gatherings increased out-of-sample predictive performance for probabilistic forecasts of incident cases of COVID-19 1-3 weeks ahead when compared to a model that was trained on only past incident cases. Conclusions: Crowdsourced perceptions of nonpharmaceutical adherence may be an important signal to improve forecasts of the trajectory of an infectious agent and increase public health situational awareness. %M 36219845 %R 10.2196/39336 %U https://publichealth.jmir.org/2022/12/e39336 %U https://doi.org/10.2196/39336 %U http://www.ncbi.nlm.nih.gov/pubmed/36219845 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 12 %P e38533 %T A Smartphone-Based Platform Assisted by Artificial Intelligence for Reading and Reporting Rapid Diagnostic Tests: Evaluation Study in SARS-CoV-2 Lateral Flow Immunoassays %A Bermejo-Peláez,David %A Marcos-Mencía,Daniel %A Álamo,Elisa %A Pérez-Panizo,Nuria %A Mousa,Adriana %A Dacal,Elena %A Lin,Lin %A Vladimirov,Alexander %A Cuadrado,Daniel %A Mateos-Nozal,Jesús %A Galán,Juan Carlos %A Romero-Hernandez,Beatriz %A Cantón,Rafael %A Luengo-Oroz,Miguel %A Rodriguez-Dominguez,Mario %+ Spotlab, P.º de Juan XXIII, 36B, Madrid, 28040, Spain, 34 916256927, miguel@spotlab.ai %K rapid diagnostic test %K artificial intelligence %K AI %K telemedicine platform %K COVID-19 %K rapid test %K diagnostics %K epidemiology %K surveillance %K automatic %K automated %K tracking %D 2022 %7 30.12.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Rapid diagnostic tests (RDTs) are being widely used to manage COVID-19 pandemic. However, many results remain unreported or unconfirmed, altering a correct epidemiological surveillance. Objective: Our aim was to evaluate an artificial intelligence–based smartphone app, connected to a cloud web platform, to automatically and objectively read RDT results and assess its impact on COVID-19 pandemic management. Methods: Overall, 252 human sera were used to inoculate a total of 1165 RDTs for training and validation purposes. We then conducted two field studies to assess the performance on real-world scenarios by testing 172 antibody RDTs at two nursing homes and 96 antigen RDTs at one hospital emergency department. Results: Field studies demonstrated high levels of sensitivity (100%) and specificity (94.4%, CI 92.8%-96.1%) for reading IgG band of COVID-19 antibody RDTs compared to visual readings from health workers. Sensitivity of detecting IgM test bands was 100%, and specificity was 95.8% (CI 94.3%-97.3%). All COVID-19 antigen RDTs were correctly read by the app. Conclusions: The proposed reading system is automatic, reducing variability and uncertainty associated with RDTs interpretation and can be used to read different RDT brands. The web platform serves as a real-time epidemiological tracking tool and facilitates reporting of positive RDTs to relevant health authorities. %M 36265136 %R 10.2196/38533 %U https://publichealth.jmir.org/2022/12/e38533 %U https://doi.org/10.2196/38533 %U http://www.ncbi.nlm.nih.gov/pubmed/36265136 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 12 %P e37587 %T Pilot Evaluation of Possible Airborne Transmission in a Geriatric Care Facility Using Carbon Dioxide Tracer Gas: Case Study %A Ishigaki,Yo %A Yokogawa,Shinji %A Minamoto,Yuki %A Saito,Akira %A Kitamura,Hiroko %A Kawauchi,Yuto %+ Graduate School of Informatics and Engineering, University of Electro-communications, 1-5-1, Chofu-gaoka, Chofu, Tokyo, 182-8585, Japan, 81 42 443 5662, ishigaki@uec.ac.jp %K nursing home %K care home %K airborne transmission %K ventilation frequency %K air change rate %K ACR %K computational fluid dynamics %K CFD %K mobile phone %D 2022 %7 30.12.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Although several COVID-19 outbreaks have occurred in older adult care facilities throughout Japan, no field studies focusing on airborne infections within these settings have been reported. Countermeasures against airborne infection not only consider the air change rate (ACR) in a room but also the airflow in and between rooms. However, a specific method has not yet been established by Japanese public health centers or infectious disease–related organizations. Objective: In April 2021, 59 COVID-19 cases were reported in an older adult care facility in Miyagi, Japan, and airborne transmission was suspected. The objective of this study was to simultaneously reproduce the ACR and aerosol advection in this facility using the carbon dioxide (CO2) tracer gas method to elucidate the specific location and cause of the outbreak. These findings will guide our recommendations to the facility to prevent recurrence. Methods: In August 2021, CO2 sensors were placed in 5 rooms where airborne infection was suspected, and the CO2 concentration was intentionally increased using dry ice, which was subsequently removed. The ACR was then estimated by applying the Seidel equation to the time-series changes in the CO2 concentration due to ventilation. By installing multiple sensors outside the room, advection outside the room was monitored simultaneously. Aerosol advection was verified using computer simulations. Although the windows were closed at the time of the outbreak, we conducted experiments under open-window conditions to quantify the effects of window opening. Results: The ACR values at the time of the outbreak were estimated to be 2.0 to 6.8 h−1 in the rooms of the facility. A low-cost intervention of opening windows improved the ventilation frequency by a factor of 2.2 to 5.7. Ventilation depended significantly on the window-opening conditions (P values ranging from .001 to .03 for all rooms). Aerosol advection was detected from the private room to the day room in agreement with the simulation results. Considering that the individual who initiated the infection was in the private room on the day of infection, and several residents, who later became secondarily infected, were gathered in the day room, it was postulated that the infectious aerosol was transmitted by this air current. Conclusions: The present results suggest that secondary infections can occur owing to aerosol advection driven by large-scale flow, even when the building design adheres to the ventilation guidelines established in Japan. Moreover, the CO2 tracer gas method facilitates the visualization of areas at a high risk of airborne infection and demonstrates the effectiveness of window opening, which contributes to improved facility operations and recurrence prevention. %M 36583933 %R 10.2196/37587 %U https://formative.jmir.org/2022/12/e37587 %U https://doi.org/10.2196/37587 %U http://www.ncbi.nlm.nih.gov/pubmed/36583933 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 12 %P e37533 %T IT and the Quality and Efficiency of Mental Health Care in a Time of COVID-19: Case Study of Mental Health Providers in England %A Konteh,Frederick Hassan %A Mannion,Russell %A Jacobs,Rowena %+ Health Services Management Centre, School of Social Policy, University of Birmingham, 40 Edgbaston Park Road, Park House, Birmingham, B15 2RT, United Kingdom, 44 7401415960, f.konteh@sky.com %K COVID-19 %K mental health care %K information technology %K digital %K inequalities %K sociotechnical systems %D 2022 %7 29.12.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: In England, COVID-19 has significantly affected mental health care and tested the resilience of health care providers. In many areas, the increased use of IT has enabled traditional modes of service delivery to be supported or even replaced by remote forms of provision. Objective: This study aimed to assess the use and impact of IT, in remote service provision, on the quality and efficiency of mental health care during the pandemic. We drew on sociotechnical systems theory as a conceptual framework to help structure the gathering, analysis, and interpretation of data. Methods: We conducted a national scoping survey that involved documentary analysis and semistructured interviews with 6 national stakeholders and case studies of 4 purposefully selected mental health providers in England involving interviews with 53 staff members. Results: Following the outbreak of COVID-19, mental health providers rapidly adjusted their traditional forms of service delivery, switching to digital and telephone consultations for most services. The informants provided nuanced perspectives on the impact on the quality and efficiency of remote service delivery during the pandemic. Notably, it has allowed providers to attend to as many patients as possible in the face of COVID-19 restrictions, to the convenience of both patients and staff. Among its negative effects are concerns about the unsuitability of remote consultation for some people with mental health conditions and the potential to widen the digital divide and exacerbate existing inequalities. Sociotechnical systems theory was found to be a suitable framework for understanding the range of systemic and sociotechnical factors that influence the use of technology in mental health care delivery in times of crisis and normalcy. Conclusions: Although the use of IT has boosted mental health care delivery during the pandemic, it has had mixed effects on quality and efficiency. In general, patients have benefited from the convenience of remote consultation when face-to-face contact was impossible. In contrast, patient choice was often compromised, and patient experience and outcomes might have been affected for some people with mental health conditions for which remote consultation is less suitable. However, the full impact of IT on the quality and efficiency of mental health care provision along with the systemic and sociotechnical determinants requires more sustained and longitudinal research. %M 36423321 %R 10.2196/37533 %U https://formative.jmir.org/2022/12/e37533 %U https://doi.org/10.2196/37533 %U http://www.ncbi.nlm.nih.gov/pubmed/36423321 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 12 %P e41517 %T Sentiment Analysis of Insomnia-Related Tweets via a Combination of Transformers Using Dempster-Shafer Theory: Pre– and Peri–COVID-19 Pandemic Retrospective Study %A Maghsoudi,Arash %A Nowakowski,Sara %A Agrawal,Ritwick %A Sharafkhaneh,Amir %A Kunik,Mark E %A Naik,Aanand D %A Xu,Hua %A Razjouyan,Javad %+ Department of Medicine, Baylor College of Medicine, One Baylor Plaza, Houston, TX, 77030, United States, 1 713 798 4951, javad.razjouyan@bcm.edu %K COVID-19 %K coronavirus %K sleep %K Twitter %K natural language processing %K sentiment analysis %K transformers %K Dempster-Shafer theory %K sleeping %K social media %K pandemic %K effect %K viral infection %D 2022 %7 27.12.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic has imposed additional stress on population health that may result in a change of sleeping behavior. Objective: In this study, we hypothesized that using natural language processing to explore social media would help with assessing the mental health conditions of people experiencing insomnia after the outbreak of COVID-19. Methods: We designed a retrospective study that used public social media content from Twitter. We categorized insomnia-related tweets based on time, using the following two intervals: the prepandemic (January 1, 2019, to January 1, 2020) and peripandemic (January 1, 2020, to January 1, 2021) intervals. We performed a sentiment analysis by using pretrained transformers in conjunction with Dempster-Shafer theory (DST) to classify the polarity of emotions as positive, negative, and neutral. We validated the proposed pipeline on 300 annotated tweets. Additionally, we performed a temporal analysis to examine the effect of time on Twitter users’ insomnia experiences, using logistic regression. Results: We extracted 305,321 tweets containing the word insomnia (prepandemic tweets: n=139,561; peripandemic tweets: n=165,760). The best combination of pretrained transformers (combined via DST) yielded 84% accuracy. By using this pipeline, we found that the odds of posting negative tweets (odds ratio [OR] 1.39, 95% CI 1.37-1.41; P<.001) were higher in the peripandemic interval compared to those in the prepandemic interval. The likelihood of posting negative tweets after midnight was 21% higher than that before midnight (OR 1.21, 95% CI 1.19-1.23; P<.001). In the prepandemic interval, while the odds of posting negative tweets were 2% higher after midnight compared to those before midnight (OR 1.02, 95% CI 1.00-1.07; P=.008), they were 43% higher (OR 1.43, 95% CI 1.40-1.46; P<.001) in the peripandemic interval. Conclusions: The proposed novel sentiment analysis pipeline, which combines pretrained transformers via DST, is capable of classifying the emotions and sentiments of insomnia-related tweets. Twitter users shared more negative tweets about insomnia in the peripandemic interval than in the prepandemic interval. Future studies using a natural language processing framework could assess tweets about other types of psychological distress, habit changes, weight gain resulting from inactivity, and the effect of viral infection on sleep. %M 36417585 %R 10.2196/41517 %U https://www.jmir.org/2022/12/e41517 %U https://doi.org/10.2196/41517 %U http://www.ncbi.nlm.nih.gov/pubmed/36417585 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 12 %P e40035 %T A Hybrid Architecture (CO-CONNECT) to Facilitate Rapid Discovery and Access to Data Across the United Kingdom in Response to the COVID-19 Pandemic: Development Study %A Jefferson,Emily %A Cole,Christian %A Mumtaz,Shahzad %A Cox,Samuel %A Giles,Thomas Charles %A Adejumo,Sam %A Urwin,Esmond %A Lea,Daniel %A Macdonald,Calum %A Best,Joseph %A Masood,Erum %A Milligan,Gordon %A Johnston,Jenny %A Horban,Scott %A Birced,Ipek %A Hall,Christopher %A Jackson,Aaron S %A Collins,Clare %A Rising,Sam %A Dodsley,Charlotte %A Hampton,Jill %A Hadfield,Andrew %A Santos,Roberto %A Tarr,Simon %A Panagi,Vasiliki %A Lavagna,Joseph %A Jackson,Tracy %A Chuter,Antony %A Beggs,Jillian %A Martinez-Queipo,Magdalena %A Ward,Helen %A von Ziegenweidt,Julie %A Burns,Frances %A Martin,Joanne %A Sebire,Neil %A Morris,Carole %A Bradley,Declan %A Baxter,Rob %A Ahonen-Bishopp,Anni %A Smith,Paul %A Shoemark,Amelia %A Valdes,Ana M %A Ollivere,Benjamin %A Manisty,Charlotte %A Eyre,David %A Gallant,Stephanie %A Joy,George %A McAuley,Andrew %A Connell,David %A Northstone,Kate %A Jeffery,Katie %A Di Angelantonio,Emanuele %A McMahon,Amy %A Walker,Mat %A Semple,Malcolm Gracie %A Sims,Jessica Mai %A Lawrence,Emma %A Davies,Bethan %A Baillie,John Kenneth %A Tang,Ming %A Leeming,Gary %A Power,Linda %A Breeze,Thomas %A Murray,Duncan %A Orton,Chris %A Pierce,Iain %A Hall,Ian %A Ladhani,Shamez %A Gillson,Natalie %A Whitaker,Matthew %A Shallcross,Laura %A Seymour,David %A Varma,Susheel %A Reilly,Gerry %A Morris,Andrew %A Hopkins,Susan %A Sheikh,Aziz %A Quinlan,Philip %+ Health Informatics Centre, Division of Population and Health Genomics, School of Medicine, University of Dundee, Ninewells Hospital, Dundee, DD1 9SY, United Kingdom, 44 01382 383 353, e.r.jefferson@dundee.ac.uk %K COVID-19 %K clinical care %K public health %K infrastructure model %K health data %K meta-analysis %K federated network %K health care record %K data extraction %K data privacy %K data governance %K health care %D 2022 %7 27.12.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: COVID-19 data have been generated across the United Kingdom as a by-product of clinical care and public health provision, as well as numerous bespoke and repurposed research endeavors. Analysis of these data has underpinned the United Kingdom’s response to the pandemic, and informed public health policies and clinical guidelines. However, these data are held by different organizations, and this fragmented landscape has presented challenges for public health agencies and researchers as they struggle to find relevant data to access and interrogate the data they need to inform the pandemic response at pace. Objective: We aimed to transform UK COVID-19 diagnostic data sets to be findable, accessible, interoperable, and reusable (FAIR). Methods: A federated infrastructure model (COVID - Curated and Open Analysis and Research Platform [CO-CONNECT]) was rapidly built to enable the automated and reproducible mapping of health data partners’ pseudonymized data to the Observational Medical Outcomes Partnership Common Data Model without the need for any data to leave the data controllers’ secure environments, and to support federated cohort discovery queries and meta-analysis. Results: A total of 56 data sets from 19 organizations are being connected to the federated network. The data include research cohorts and COVID-19 data collected through routine health care provision linked to longitudinal health care records and demographics. The infrastructure is live, supporting aggregate-level querying of data across the United Kingdom. Conclusions: CO-CONNECT was developed by a multidisciplinary team. It enables rapid COVID-19 data discovery and instantaneous meta-analysis across data sources, and it is researching streamlined data extraction for use in a Trusted Research Environment for research and public health analysis. CO-CONNECT has the potential to make UK health data more interconnected and better able to answer national-level research questions while maintaining patient confidentiality and local governance procedures. %M 36322788 %R 10.2196/40035 %U https://www.jmir.org/2022/12/e40035 %U https://doi.org/10.2196/40035 %U http://www.ncbi.nlm.nih.gov/pubmed/36322788 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 12 %P e35903 %T User Experience of COVID-19 Chatbots: Scoping Review %A White,Becky K %A Martin,Annegret %A White,James Angus %+ Reach Health Promotion Innovations, PO Box 372, Mount Hawthorn, Perth, 6915, Australia, 61 450169891, becky@rhpi.com.au %K COVID-19 %K chatbot %K engagement %K user experience %K pandemic %K global health %K pandemic %K digital health %K health information %D 2022 %7 27.12.2022 %9 Review %J J Med Internet Res %G English %X Background: The COVID-19 pandemic has had global impacts and caused some health systems to experience substantial pressure. The need for accurate health information has been felt widely. Chatbots have great potential to reach people with authoritative information, and a number of chatbots have been quickly developed to disseminate information about COVID-19. However, little is known about user experiences of and perspectives on these tools. Objective: This study aimed to describe what is known about the user experience and user uptake of COVID-19 chatbots. Methods: A scoping review was carried out in June 2021 using keywords to cover the literature concerning chatbots, user engagement, and COVID-19. The search strategy included databases covering health, communication, marketing, and the COVID-19 pandemic specifically, including MEDLINE Ovid, Embase, CINAHL, ACM Digital Library, Emerald, and EBSCO. Studies that assessed the design, marketing, and user features of COVID-19 chatbots or those that explored user perspectives and experience were included. We excluded papers that were not related to COVID-19; did not include any reporting on user perspectives, experience, or the general use of chatbot features or marketing; or where a version was not available in English. The authors independently screened results for inclusion, using both backward and forward citation checking of the included papers. A thematic analysis was carried out with the included papers. Results: A total of 517 papers were sourced from the literature, and 10 were included in the final review. Our scoping review identified a number of factors impacting adoption and engagement including content, trust, digital ability, and acceptability. The papers included discussions about chatbots developed for COVID-19 screening and general COVID-19 information, as well as studies investigating user perceptions and opinions on COVID-19 chatbots. Conclusions: The COVID-19 pandemic presented a unique and specific challenge for digital health interventions. Design and implementation were required at a rapid speed as digital health service adoption accelerated globally. Chatbots for COVID-19 have been developed quickly as the pandemic has challenged health systems. There is a need for more comprehensive and routine reporting of factors impacting adoption and engagement. This paper has shown both the potential of chatbots to reach users in an emergency and the need to better understand how users engage and what they want. %M 36520624 %R 10.2196/35903 %U https://www.jmir.org/2022/12/e35903 %U https://doi.org/10.2196/35903 %U http://www.ncbi.nlm.nih.gov/pubmed/36520624 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 12 %P e38196 %T The Importance of Incorporating At-Home Testing Into SARS-CoV-2 Point Prevalence Estimates: Findings From a US National Cohort, February 2022 %A Qasmieh,Saba A %A Robertson,McKaylee M %A Rane,Madhura S %A Shen,Yanhan %A Zimba,Rebecca %A Picchio,Camila A %A Parcesepe,Angela M %A Chang,Mindy %A Kulkarni,Sarah G %A Grov,Christian %A Nash,Denis %+ Institute for Implementation Science in Population Health, City University of New York, 6th Floor, 55 W 125th St, New York, NY, 10027, United States, 1 646 364 9618, saba.qasmieh@sph.cuny.edu %K COVID-19 prevalence %K at-home rapid SARS-CoV-2 tests %K population-based surveys %K COVID-19 %K surveillance %K public health %K rapid test %K Omicron variant %K point prevalence %D 2022 %7 27.12.2022 %9 Short Paper %J JMIR Public Health Surveill %G English %X Background: Passive, case-based surveillance underestimates the true extent of active infections in the population due to undiagnosed and untested cases, the exclusion of probable cases diagnosed point-of-care rapid antigen tests, and the exclusive use of at-home rapid tests which are not reported as part of case-based surveillance. The extent in which COVID-19 surveillance may be underestimating the burden of infection is likely due to time-varying factors such as decreased test-seeking behaviors and increased access to and availability of at-home testing. Objective: The objective of this study is to estimate the prevalence of SARS-CoV-2 based on different definitions of a case to ascertain the extent to which cases of SARS-CoV-2 may be underestimated by case-based surveillance. Methods: A survey on COVID-19 exposure, infection, and testing was administered to calculate point prevalence of SARS-CoV-2 among a diverse sample of cohort adults from February 8, 2022, to February 22, 2022. Three-point prevalence estimates were calculated among the cohort, as follows: (1) proportion positives based on polymerase chain reaction (PCR) and rapid antigen tests; (2) proportion positives based on testing exclusively with rapid at-home tests; and (3) proportion of probable undiagnosed cases. Test positivity and prevalence differences across booster status were also examined. Results: Among a cohort of 4328, there were a total of 644 (14.9%) cases. The point prevalence estimate based on PCR or rapid antigen tests was 5.5% (95% CI 4.8%-6.2%), 3.7% (95% CI 3.1%-4.2%) based on at-home rapid tests, and 5.7% (95% CI 5.0%-6.4%) based on the case definition of a probable case. The total point prevalence across all definitions was 14.9% (95% CI 13.8%-16.0%). The percent positivity among PCR or rapid tests was 50.2%. No statistically significant differences were observed in prevalence between participants with a COVID-19 booster compared to fully vaccinated and nonboosted participants except among exclusive at-home rapid testers. Conclusions: Our findings suggest a substantial number of cases were missed by case-based surveillance systems during the Omicron B.1.1.529 surge, when at-home testing was common. Point prevalence surveys may be a rapid tool to be used to understand SARS-CoV-2 prevalence and would be especially important during case surges to measure the scope and spread of active infections in the population. %M 36240020 %R 10.2196/38196 %U https://publichealth.jmir.org/2022/12/e38196 %U https://doi.org/10.2196/38196 %U http://www.ncbi.nlm.nih.gov/pubmed/36240020 %0 Journal Article %@ 2563-3570 %I JMIR Publications %V 3 %N 1 %P e40473 %T Use of Artificial Intelligence in the Search for New Information Through Routine Laboratory Tests: Systematic Review %A Cardozo,Glauco %A Tirloni,Salvador Francisco %A Pereira Moro,Antônio Renato %A Marques,Jefferson Luiz Brum %+ Federal Institute of Santa Catarina, Av. Mauro Ramos, 950 - Centro, Florianópolis, 88020-300, Brazil, 55 48984060740, glauco.cardozo@ifsc.edu.br %K review %K laboratory tests %K machine learning %K prediction %K diagnosis %K COVID-19 %D 2022 %7 23.12.2022 %9 Review %J JMIR Bioinform Biotech %G English %X Background: In recent decades, the use of artificial intelligence has been widely explored in health care. Similarly, the amount of data generated in the most varied medical processes has practically doubled every year, requiring new methods of analysis and treatment of these data. Mainly aimed at aiding in the diagnosis and prevention of diseases, this precision medicine has shown great potential in different medical disciplines. Laboratory tests, for example, almost always present their results separately as individual values. However, physicians need to analyze a set of results to propose a supposed diagnosis, which leads us to think that sets of laboratory tests may contain more information than those presented separately for each result. In this way, the processes of medical laboratories can be strongly affected by these techniques. Objective: In this sense, we sought to identify scientific research that used laboratory tests and machine learning techniques to predict hidden information and diagnose diseases. Methods: The methodology adopted used the population, intervention, comparison, and outcomes principle, searching the main engineering and health sciences databases. The search terms were defined based on the list of terms used in the Medical Subject Heading database. Data from this study were presented descriptively and followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses; 2020) statement flow diagram and the National Institutes of Health tool for quality assessment of articles. During the analysis, the inclusion and exclusion criteria were independently applied by 2 authors, with a third author being consulted in cases of disagreement. Results: Following the defined requirements, 40 studies presenting good quality in the analysis process were selected and evaluated. We found that, in recent years, there has been a significant increase in the number of works that have used this methodology, mainly because of COVID-19. In general, the studies used machine learning classification models to predict new information, and the most used parameters were data from routine laboratory tests such as the complete blood count. Conclusions: Finally, we conclude that laboratory tests, together with machine learning techniques, can predict new tests, thus helping the search for new diagnoses. This process has proved to be advantageous and innovative for medical laboratories. It is making it possible to discover hidden information and propose additional tests, reducing the number of false negatives and helping in the early discovery of unknown diseases. %M 36644762 %R 10.2196/40473 %U https://bioinform.jmir.org/2022/1/e40473 %U https://doi.org/10.2196/40473 %U http://www.ncbi.nlm.nih.gov/pubmed/36644762 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 11 %N 2 %P e37232 %T The Impact of Heating, Ventilation, and Air-Conditioning Design Features on the Transmission of Viruses, Including SARS-CoV-2: Overview of Reviews %A Thornton,Gail M %A Kroeker,Emily %A Fleck,Brian A %A Zhong,Lexuan %A Hartling,Lisa %+ Department of Mechanical Engineering, Faculty of Engineering, University of Alberta, 116 Street and 85 Avenue, Edmonton, AB, T6G 2R3, Canada, 1 780 492 3111, gail.thornton@ualberta.ca %K COVID-19 %K public health %K epidemiology %K outbreak %K pandemic %K environment %K literature review %K virus transmission %K ventilation %K coronavirus %D 2022 %7 23.12.2022 %9 Review %J Interact J Med Res %G English %X Background: The COVID-19 or SARS-CoV-2 outbreak was declared a pandemic by the World Health Organization in March 2020. Almost 2 years later (early February 2022), the World Health Organization reported over 383 million cases of the disease caused by the virus, with over 5.6 million deaths worldwide. Debate regarding the routes of transmission was substantial early in the pandemic; however, airborne transmission emerged as an important consideration. Infectious airborne agents can spread within the built environment through heating, ventilation, and air-conditioning (HVAC) systems. Multiple features of HVAC systems can influence transmission (eg, ventilation, filtration, UV radiation, and humidity). Understanding how HVAC features influence airborne transmission is critical to mitigate the spread of infectious agents. Objective: Given the airborne transmission of SARS-CoV-2, an overview of reviews was conducted to understand what is already known from the scientific literature about how virus transmission may be affected by HVAC design features in the built environment. Methods: Ovid MEDLINE and Compendex were searched from inception to January 2021. Two reviewers independently screened the titles, abstracts, and full text of potentially relevant reviews, using a priori inclusion criteria: systematic reviews examining the effects of HVAC design features on virus transmission. Two reviewers independently assessed the methodological quality using AMSTAR2. Results: Searching identified 361 citations, of which 45 (12.5%) were potentially relevant and 7 (2%) were included. Reviews were published between 2007 and 2021 and included 47 virus studies. Two earlier reviews (2007 and 2016) of 21 studies found sufficient evidence that mechanical ventilation (airflow patterns and ventilation rates) plays a role in airborne transmission; however, both found insufficient evidence to quantify the minimum mechanical ventilation requirements. One review (2017) of 9 studies examining humidity and indoor air quality found that influenza virus survival was lowest between 40% and 80% relative humidity; the authors noted that ventilation rates were a confounding variable. Two reviews (2021) examined mitigation strategies for coronavirus transmission, finding that transmission decreased with increasing temperature and relative humidity. One review (2020) identified 14 studies examining coronavirus transmission in air-conditioning systems, finding that HVAC systems played a role in virus spread during previous coronavirus outbreaks. One review (2020) examined virus transmission interventions in public ground transportation, finding ventilation and filtration to be effective. Conclusions: Seven reviews synthesizing 47 studies demonstrated a role for HVAC in mitigating airborne virus transmission. Ventilation, humidity, temperature, and filtration can play a role in the viability and transmission of viruses, including coronaviruses. Recommendations for minimum standards were not possible owing to few studies investigating a given HVAC parameter. This overview examining HVAC design features and their effects on the airborne transmission of viruses serves as a starting point for future systematic reviews and identifying priorities for primary research. %M 36343208 %R 10.2196/37232 %U https://www.i-jmr.org/2022/2/e37232 %U https://doi.org/10.2196/37232 %U http://www.ncbi.nlm.nih.gov/pubmed/36343208 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 12 %P e40825 %T State-Level COVID-19 Symptom Searches and Case Data: Quantitative Analysis of Political Affiliation as a Predictor for Lag Time Using Google Trends and Centers for Disease Control and Prevention Data %A Turvy,Alex %+ City, Culture, and Community, Department of Sociology, Tulane University, 6823 St Charles Ave, New Orleans, LA, 70118, United States, 1 504 865 5231, aturvy@tulane.edu %K COVID-19 %K search trends %K prediction %K case %K political %K symptom %K pandemic %K data %K google %K disease %K prevention %K model %D 2022 %7 23.12.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Across each state, the emergence of the COVID-19 pandemic in the United States was marked by policies and rhetoric that often corresponded to the political party in power. These diverging responses have sparked broad ongoing discussion about how the political leadership of a state may affect not only the COVID-19 case numbers in a given state but also the subjective individual experience of the pandemic. Objective: This study leverages state-level data from Google Search Trends and Centers for Disease Control and Prevention (CDC) daily case data to investigate the temporal relationship between increases in relative search volume for COVID-19 symptoms and corresponding increases in case data. I aimed to identify whether there are state-level differences in patterns of lag time across each of the 4 spikes in the data (RQ1) and whether the political climate in a given state is associated with these differences (RQ2). Methods: Using publicly available data from Google Trends and the CDC, linear mixed modeling was utilized to account for random state-level intercepts. Lag time was operationalized as number of days between a peak (a sustained increase before a sustained decline) in symptom search data and a corresponding spike in case data and was calculated manually for each of the 4 spikes in individual states. Google offers a data set that tracks the relative search incidence of more than 400 potential COVID-19 symptoms, which is normalized on a 0-100 scale. I used the CDC’s definition of the 11 most common COVID-19 symptoms and created a single construct variable that operationalizes symptom searches. To measure political climate, I considered the proportion of 2020 Trump popular votes in a state as well as a dummy variable for the political party that controls the governorship and a continuous variable measuring proportional party control of federal Congressional representatives. Results: The strongest overall fit was for a linear mixed model that included proportion of 2020 Trump votes as the predictive variable of interest and included controls for mean daily cases and deaths as well as population. Additional political climate variables were discarded for lack of model fit. Findings indicated evidence that there are statistically significant differences in lag time by state but that no individual variable measuring political climate was a statistically significant predictor of these differences. Conclusions: Given that there will likely be future pandemics within this political climate, it is important to understand how political leadership affects perceptions of and corresponding responses to public health crises. Although this study did not fully model this relationship, I believe that future research can build on the state-level differences that I identified by approaching the analysis with a different theoretical model, method for calculating lag time, or level of geographic modeling. %M 36446048 %R 10.2196/40825 %U https://formative.jmir.org/2022/12/e40825 %U https://doi.org/10.2196/40825 %U http://www.ncbi.nlm.nih.gov/pubmed/36446048 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 12 %P e41928 %T Evolution of Public Opinion on COVID-19 Vaccination in Japan: Large-Scale Twitter Data Analysis %A Kobayashi,Ryota %A Takedomi,Yuka %A Nakayama,Yuri %A Suda,Towa %A Uno,Takeaki %A Hashimoto,Takako %A Toyoda,Masashi %A Yoshinaga,Naoki %A Kitsuregawa,Masaru %A Rocha,Luis E C %+ Graduate School of Frontier Sciences, The University of Tokyo, 5-1-5 Kashiwanoha, Kashiwa, 277-8561, Japan, 81 4 7136 4134, r-koba@k.u-tokyo.ac.jp %K COVID-19 %K vaccine %K vaccination %K Twitter %K public opinion %K topic modeling %K longitudinal study %K topic dynamics %K social events %K interrupted time series regression %D 2022 %7 22.12.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Vaccines are promising tools to control the spread of COVID-19. An effective vaccination campaign requires government policies and community engagement, sharing experiences for social support, and voicing concerns about vaccine safety and efficiency. The increasing use of online social platforms allows us to trace large-scale communication and infer public opinion in real time. Objective: This study aimed to identify the main themes in COVID-19 vaccine-related discussions on Twitter in Japan and track how the popularity of the tweeted themes evolved during the vaccination campaign. Furthermore, we aimed to understand the impact of critical social events on the popularity of the themes. Methods: We collected more than 100 million vaccine-related tweets written in Japanese and posted by 8 million users (approximately 6.4% of the Japanese population) from January 1 to October 31, 2021. We used Latent Dirichlet Allocation to perform automated topic modeling of tweet text during the vaccination campaign. In addition, we performed an interrupted time series regression analysis to evaluate the impact of 4 critical social events on public opinion. Results: We identified 15 topics grouped into the following 4 themes: (1) personal issue, (2) breaking news, (3) politics, and (4) conspiracy and humor. The evolution of the popularity of themes revealed a shift in public opinion, with initial sharing of attention over personal issues (individual aspect), collecting information from news (knowledge acquisition), and government criticism to focusing on personal issues. Our analysis showed that the Tokyo Olympic Games affected public opinion more than other critical events but not the course of vaccination. Public opinion about politics was significantly affected by various social events, positively shifting attention in the early stages of the vaccination campaign and negatively shifting attention later. Conclusions: This study showed a striking shift in public interest in Japan, with users splitting their attention over various themes early in the vaccination campaign and then focusing only on personal issues, as trust in vaccines and policies increased. An interrupted time series regression analysis showed that the vaccination rollout to the general population (under 65 years) increased the popularity of tweets about practical advice and personal vaccination experience, and the Tokyo Olympic Games disrupted public opinion but not the course of the vaccination campaign. The methodology developed here allowed us to monitor the evolution of public opinion and evaluate the impact of social events on public opinion, using large-scale Twitter data. %M 36343186 %R 10.2196/41928 %U https://www.jmir.org/2022/12/e41928 %U https://doi.org/10.2196/41928 %U http://www.ncbi.nlm.nih.gov/pubmed/36343186 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 10 %N 12 %P e37591 %T Synchronous Teleconsultation and Monitoring Service Targeting COVID-19: Leveraging Insights for Postpandemic Health Care %A Marcolino,Milena Soriano %A Diniz,Clara Sousa %A Chagas,Bruno Azevedo %A Mendes,Mayara Santos %A Prates,Raquel %A Pagano,Adriana %A Ferreira,Thiago Castro %A Alkmim,Maria Beatriz Moreira %A Oliveira,Clara Rodrigues Alves %A Borges,Isabela Nascimento %A Raposo,Magda César %A Reis,Zilma Silveira Nogueira %A Paixão,Maria Cristina %A Ribeiro,Leonardo Bonisson %A Rocha,Gustavo Machado %A Cardoso,Clareci Silva %A Ribeiro,Antonio Luiz Pinho %+ Telehealth Center, University Hospital and Telehealth Network of Minas Gerais, Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena, 110 Room 107 Ala Sul, Santa Efigênia, Belo Horizonte, 30130-100, Brazil, 55 31 33079201, milenamarc@gmail.com %K COVID-19 %K telemonitoring %K remote consultation %K telemedicine %K primary health care %K delivery of health care %K telehealth %K text message %K mobile health %K public health %K remote care %K digital health %K usability %D 2022 %7 22.12.2022 %9 Original Paper %J JMIR Med Inform %G English %X Background: Although a great number of teleconsultation services have been developed during the COVID-19 pandemic, studies assessing usability and health care provider satisfaction are still incipient. Objective: This study aimed to describe the development, implementation, and expansion of a synchronous teleconsultation service targeting patients with symptoms of COVID-19 in Brazil, as well as to assess its usability and health care professionals’ satisfaction. Methods: This mixed methods study was developed in 5 phases: (1) the identification of components, technical and functional requirements, and system architecture; (2) system and user interface development and validation; (3) pilot-testing in the city of Divinópolis; (4) expansion in the cities of Divinópolis, Teófilo Otoni, and Belo Horizonte for Universidade Federal de Minas Gerais faculty and students; and (5) usability and satisfaction assessment, using Likert-scale and open-ended questions. Results: During pilot development, problems contacting users were solved by introducing standardized SMS text messages, which were sent to users to obtain their feedback and keep track of them. Until April 2022, the expanded system served 31,966 patients in 146,158 teleconsultations. Teleconsultations were initiated through chatbot in 27.7% (40,486/146,158) of cases. Teleconsultation efficiency per city was 93.7% (13,317/14,212) in Teófilo Otoni, 92.4% (11,747/12,713) in Divinópolis, and 98.8% (4981/5041) in Belo Horizonte (university campus), thus avoiding in-person assistance for a great majority of patients. In total, 50 (83%) out of 60 health care professionals assessed the system’s usability as satisfactory, despite a few system instability problems. Conclusions: The system provided updated information about COVID-19 and enabled remote care for thousands of patients, which evidenced the critical role of telemedicine in expanding emergency services capacity during the pandemic. The dynamic nature of the current pandemic required fast planning, implementation, development, and updates in the system. Usability and satisfaction assessment was key to identifying areas for improvement. The experience reported here is expected to inform telemedicine strategies to be implemented in a postpandemic scenario. %M 36191175 %R 10.2196/37591 %U https://medinform.jmir.org/2022/12/e37591 %U https://doi.org/10.2196/37591 %U http://www.ncbi.nlm.nih.gov/pubmed/36191175 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 9 %N 4 %P e40094 %T A Telerehabilitation Program for Maintaining Functional Capacity in Patients With Chronic Lung Diseases During a Period of COVID-19 Social Isolation: Quasi-Experimental Retrospective Study %A Miozzo,Aline Paula %A Camponogara Righi,Natiele %A Yumi Shizukuishi,Maria Luiza %A Marques Ferreira Aguilar,Hérica %A Florian,Juliessa %A da Costa Machado,Scheila %A Schardong,Jociane %A Della Méa Plentz,Rodrigo %+ Physiotherapy Department, Universidade Federal de Ciências da Saúde de Porto Alegre, Rua Sarmento Leite, 245, Porto Alegre, 90050-170, Brazil, 55 51991131651, rodrigop@ufcspa.edu.br %K telerehabilitation %K lung diseases %K social isolation %K COVID-19 %K pulmonary rehabilitation %K pulmonary %K rehabilitation %K quality of life %K chronic disease %K mental health %K social functioning %K patient outcome %D 2022 %7 22.12.2022 %9 Original Paper %J JMIR Rehabil Assist Technol %G English %X Background: Pulmonary diseases represent a great cause of disability and mortality in the world, and given the progression of these pathologies, pulmonary rehabilitation programs have proven to be effective for people with chronic respiratory diseases. During the COVID-19 pandemic, telerehabilitation has become an alternative for patients with such diseases. Objective: The aim of this study was to compare the outcomes (ie, functional capacity and quality of life) of telerehabilitation to those of usual care among patients who previously participated in face-to-face pulmonary rehabilitation programs. Methods: We conducted a quasi-experimental retrospective study from April 2020 to August 2021. A total of 32 patients with chronic lung diseases were included and divided into the control and intervention groups. The intervention group performed telerehabilitation synchronously twice per week and was supervised by a physical therapist during breathing, strengthening, and aerobic exercises. Changes in the degree of dyspnea and leg discomfort were assessed based on changes in Borg scale scores. The control group did not perform any activities during the period of social isolation. Functional capacity was assessed with the 6-minute walk test, and quality of life was assessed with the Medical Outcomes Study 36-item Short Form Health Survey. Results: The telerehabilitation group’s mean 6-minute walk distance decreased by 39 m, while that of the control group decreased by 120 m. There was a difference of 81 m between the groups’ mean 6-minute walk distances (P=.02). In relation to the quality of life, telerehabilitation was shown to improve the following two domains: social functioning and mental health. Conclusions: Telerehabilitation programs for patients with chronic lung diseases can ease the deleterious effects of disease progression, be used to maintain functional capacity, and improve aspects of quality of life. %M 36473024 %R 10.2196/40094 %U https://rehab.jmir.org/2022/4/e40094 %U https://doi.org/10.2196/40094 %U http://www.ncbi.nlm.nih.gov/pubmed/36473024 %0 Journal Article %@ 2563-3570 %I JMIR Publications %V 3 %N 1 %P e42243 %T Mutational Patterns Observed in SARS-CoV-2 Genomes Sampled From Successive Epochs Delimited by Major Public Health Events in Ontario, Canada: Genomic Surveillance Study %A Chen,David %A Randhawa,Gurjit S %A Soltysiak,Maximillian PM %A de Souza,Camila PE %A Kari,Lila %A Singh,Shiva M %A Hill,Kathleen A %+ Department of Biology, Western University, 1151 Richmond Street, London, ON, N6A 5B7, Canada, 1 519 661 2111 ext 81337, khill22@uwo.ca %K SARS-CoV-2 %K COVID-19 %K Ontario %K virus %K genetics %K evolution %K selection %K mutation %K epidemiology %K variant %D 2022 %7 22.12.2022 %9 Original Paper %J JMIR Bioinform Biotech %G English %X Background: The emergence of SARS-CoV-2 variants with mutations associated with increased transmissibility and virulence is a public health concern in Ontario, Canada. Characterizing how the mutational patterns of the SARS-CoV-2 genome have changed over time can shed light on the driving factors, including selection for increased fitness and host immune response, that may contribute to the emergence of novel variants. Moreover, the study of SARS-CoV-2 in the microcosm of Ontario, Canada can reveal how different province-specific public health policies over time may be associated with observed mutational patterns as a model system. Objective: This study aimed to perform a comprehensive analysis of single base substitution (SBS) types, counts, and genomic locations observed in SARS-CoV-2 genomic sequences sampled in Ontario, Canada. Comparisons of mutational patterns were conducted between sequences sampled during 4 different epochs delimited by major public health events to track the evolution of the SARS-CoV-2 mutational landscape over 2 years. Methods: In total, 24,244 SARS-CoV-2 genomic sequences and associated metadata sampled in Ontario, Canada from January 1, 2020, to December 31, 2021, were retrieved from the Global Initiative on Sharing All Influenza Data database. Sequences were assigned to 4 epochs delimited by major public health events based on the sampling date. SBSs from each SARS-CoV-2 sequence were identified relative to the MN996528.1 reference genome. Catalogues of SBS types and counts were generated to estimate the impact of selection in each open reading frame, and identify mutation clusters. The estimation of mutational fitness over time was performed using the Augur pipeline. Results: The biases in SBS types and proportions observed support previous reports of host antiviral defense activity involving the SARS-CoV-2 genome. There was an increase in U>C substitutions associated with adenosine deaminase acting on RNA (ADAR) activity uniquely observed during Epoch 4. The burden of novel SBSs observed in SARS-CoV-2 genomic sequences was the greatest in Epoch 2 (median 5), followed by Epoch 3 (median 4). Clusters of SBSs were observed in the spike protein open reading frame, ORF1a, and ORF3a. The high proportion of nonsynonymous SBSs and increasing dN/dS metric (ratio of nonsynonymous to synonymous mutations in a given open reading frame) to above 1 in Epoch 4 indicate positive selection of the spike protein open reading frame. Conclusions: Quantitative analysis of the mutational patterns of the SARS-CoV-2 genome in the microcosm of Ontario, Canada within early consecutive epochs of the pandemic tracked the mutational dynamics in the context of public health events that instigate significant shifts in selection and mutagenesis. Continued genomic surveillance of emergent variants will be useful for the design of public health policies in response to the evolving COVID-19 pandemic. %R 10.2196/42243 %U https://bioinform.jmir.org/2022/1/e42243 %U https://doi.org/10.2196/42243 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 12 %P e43089 %T How COVID-19 Affected the Journal Impact Factor of High Impact Medical Journals: Bibliometric Analysis %A Delardas,Orestis %A Giannos,Panagiotis %+ Department of Life Sciences, Faculty of Natural Sciences, Imperial College London, South Kensignton, London, SW7 2AZ, United Kingdom, 44 7765071907, panagiotis.giannos19@imperial.ac.uk %K COVID-19 %K journal impact factor %K scientometrics %K bibliometrics %K infometrics %K journal %K assessment %K research %K resources %K medical journal %K literature %K database %K community %K behavior %D 2022 %7 21.12.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Journal impact factor (IF) is the leading method of scholarly assessment in today’s research world, influencing where scholars submit their research and where funders distribute their resources. COVID-19, one of the most serious health crises, resulted in an unprecedented surge of publications across all areas of knowledge. An important question is whether COVID-19 affected the gold standard of scholarly assessment. Objective: In this paper, we aimed to comprehensively compare the productivity trends of COVID-19 and non–COVID-19 literature as well as track their evolution and scholarly impact across 3 consecutive calendar years. Methods: We took as an example 6 high-impact medical journals (Annals of Internal Medicine [Annals], The British Medical Journal [The BMJ], Journal of the American Medical Association [JAMA], The Lancet, Nature Medicine [NatMed], and The New England Journal of Medicine [NEJM]) and searched the literature using the Web of Science database for manuscripts published between January 1, 2019, and December 31, 2021. To assess the effect of COVID-19 and non–COVID-19 literature in their scholarly impact, we calculated their annual IFs and percentage changes. Thereafter, we estimated the citation probability of COVID-19 and non–COVID-19 publications along with their rates of publication and citation by journal. Results: A significant increase in IF change for manuscripts including COVID-19 published from 2019 to 2020 (P=.002; Annals: 283%; The BMJ: 199%; JAMA: 208%; The Lancet: 392%; NatMed: 111%; and NEJM: 196%) and to 2021 (P=.007; Annals: 41%; The BMJ: 90%; JAMA: 6%; The Lancet: 22%; NatMed: 53%; and NEJM: 72%) was seen, against non–COVID-19 ones. The likelihood of highly cited publications was significantly increased in COVID-19 manuscripts between 2019 and 2021 (Annals: z=3.4, P<.001; The BMJ: z=4.0, P<.001; JAMA: z=3.8, P<.001; The Lancet: z=3.5, P<.001; NatMed: z=5.2, P<.001; and NEJM: z=4.7, P<.001). The publication and citation rates of COVID-19 publications followed a positive trajectory, as opposed to non–COVID-19. The citation rate for COVID-19 publications peaked by the second quarter of 2020 while that of the publication rate approximately a year later. Conclusions: The rapid surge of COVID-19 publications emphasized the capacity of scientific communities to respond against a global health emergency, yet inflated IFs create ambiguity as benchmark tools for assessing scholarly impact. The immediate implication is a loss in value of and trust in journal IFs as metrics of research and scientific rigor perceived by academia and society. Loss of confidence toward procedures employed by highly reputable publishers may incentivize authors to exploit the publication process by monopolizing their research on COVID-19 and encourage them to publish in journals of predatory behavior. %M 36454727 %R 10.2196/43089 %U https://www.jmir.org/2022/12/e43089 %U https://doi.org/10.2196/43089 %U http://www.ncbi.nlm.nih.gov/pubmed/36454727 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 12 %P e42781 %T The Effect of Nonpharmaceutical Interventions Implemented in Response to the COVID-19 Pandemic on Seasonal Respiratory Syncytial Virus: Analysis of Google Trends Data %A Ravkin,Hersh D %A Yom-Tov,Elad %A Nesher,Lior %+ Microsoft Research, 3 Alan Turing, Herzeliya, 4672415, Israel, 972 779391359, eladyt@microsoft.com %K RSV %K respiratory syncytial virus %K search engine %K Google Trends %K Google %K respiratory %K children %K pharmaceutical %K intervention %K COVID-19 %K pandemic %K virus %K infection %K health %D 2022 %7 21.12.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Respiratory syncytial virus (RSV) is a major cause of respiratory infection in children. Despite usually following a consistent seasonal pattern, the 2020-2021 RSV season in many countries was delayed and changed in magnitude. Objective: This study aimed to test if these changes can be attributed to nonpharmaceutical interventions (NPIs) instituted around the world to combat SARS-CoV-2. Methods: We used the internet search volume for RSV, as obtained from Google Trends, as a proxy to investigate these abnormalities. Results: Our analysis shows a breakdown of the usual correlation between peak latency and magnitude during the year of the pandemic. Analyzing latency and magnitude separately, we found that the changes therein are associated with implemented NPIs. Among several important interventions, NPIs affecting population mobility are shown to be particularly relevant to RSV incidence. Conclusions: The 2020-2021 RSV season served as a natural experiment to test NPIs that are likely to restrict RSV spread, and our findings can be used to guide health authorities to possible interventions. %M 36476385 %R 10.2196/42781 %U https://www.jmir.org/2022/12/e42781 %U https://doi.org/10.2196/42781 %U http://www.ncbi.nlm.nih.gov/pubmed/36476385 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 8 %N 4 %P e40106 %T Defining a Role for Webinars in Surgical Training Beyond the COVID-19 Pandemic in the United Kingdom: Trainee Consensus Qualitative Study %A Barlow,Emma %A Zahra,Wajiha %A Hornsby,Jane %A Wilkins,Alex %A Davies,Benjamin M %A Burke,Joshua %+ Department of Neurosurgery, University of Cambridge, Box 167, Cambridge Biomedical Campus, Addenbrooke’s Hospital, Cambridge, CB2 0QQ, United Kingdom, 44 207973030, bd375@cam.ac.uk %K webinars %K surgical training %K trainee consensus %K teaching %K training %K integration %K trainee experience %K user experience %K perception %K education %K medical education %K surgical skills %D 2022 %7 21.12.2022 %9 Original Paper %J JMIR Med Educ %G English %X Background: The COVID-19 pandemic posed several challenges for surgical training, including the suspension of many in-person teaching sessions in lieu of webinars. As restrictions have eased, both prepandemic and postpandemic training methods should be used. Objective: This study investigates trainees’ experiences of webinars during the COVID-19 pandemic to develop recommendations for their effective integration into surgical training going forward. Methods: This project was led by the Association of Surgeons in Training and used an iterative process with mixed qualitative methods to consolidate arguments for and against webinars, and the drivers and barriers to their effective delivery, into recommendations. This involved 3 phases: (1) a web-based survey, (2) focus group interviews, and (3) a consensus session using a nominal group technique. Results: Trainees (N=281) from across specialties and grades confirmed that the COVID-19 pandemic led to an increase in webinars for surgical training. While there were concerns, particularly around the utility for practical training (80.9%), the majority agreed that webinars had a role in training following the COVID-19 pandemic (90.2%). The cited benefits included improved access or flexibility and potential standardization of training. The majority of limitations were technical. These perspectives were refined through focus group interviews (n=18) into 25 recommendations, 23 of which were ratified at a consensus meeting, which was held at the Association of Surgeons in Training 2021 conference. Conclusions: Webinars have a role in surgical training following the COVID-19 pandemic. The 23 recommendations encompass indications and technical considerations but also discuss important knowledge gaps. They should serve as an initial framework for ensuring that webinars add value and continue to evolve as a tool for training. Trial Registration: Chinese Clinical Trial Registry ChiCTR2200055325; http://www.chictr.org.cn/showprojen.aspx?proj=142802 %M 36542431 %R 10.2196/40106 %U https://mededu.jmir.org/2022/4/e40106 %U https://doi.org/10.2196/40106 %U http://www.ncbi.nlm.nih.gov/pubmed/36542431 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 11 %N 2 %P e41144 %T Health System Resilience in the Eastern Mediterranean Region: Perspective on the Recent Lessons Learned %A Amiri,Mirwais %A Al Nsour,Mohannad %A Alonso-Garbayo,Alvaro %A Al Serouri,Abdulwahed %A Maiteh,Adna %A Badr,Elsheikh %+ Global Health Development, Eastern Mediterranean Public Health Network, Shmeisani, Abdallah Ben Abbas Street, Bldg No 42, Amman, 11196, Jordan, 962 792985349, mamiri@globalhealthdev.org %K health systems resilience %K resilience %K vulnerability %K public health %K Eastern Mediterranean Region countries %K COVID-19 %D 2022 %7 21.12.2022 %9 Viewpoint %J Interact J Med Res %G English %X Background: Public health has a pivotal role in strengthening resilience at individual, community, and system levels as well as building healthy communities. During crises, resilient health systems can effectively adapt in response to evolving situations and reduce vulnerability across and beyond the systems. To engage national, regional, and international public health entities and experts in a discussion of challenges hindering achievement of health system resilience (HSR) in the Eastern Mediterranean Region, the Eastern Mediterranean Public Health Network (EMPHNET) held its seventh regional conference in Amman, Jordan, between November 15 and 18, 2021, under the theme “Towards Resilient Health Systems in the Eastern Mediterranean: Breaking Barriers.” This viewpoint paper portrays the roundtable discussion of experts on the core themes of that conference. Objective: Our aim was to provide insights on lessons learned from the past and explore new opportunities to attain more resilient health systems to break current barriers. Methods: The roundtable brought together a panel of public health experts representing Field Epidemiology Training Programs (FETPs), Centers for Disease Control and Prevention in Atlanta, World Health Organization, EMPHNET, universities or academia, and research institutions at regional and global levels. To set the ground, the session began with four 10-12–minute presentations introducing the concept of HSR and its link to workforce development with an overall reflection on the matter and lessons learned through collective experiences. The presentations were followed by an open question and answer session to allow for an interactive debate among panel members and the roundtable audience. Results: The panel discussed challenges faced by health systems and lessons learned in times of the new public health threats to move toward more resilient health systems, overcome current barriers, and explore new opportunities to enhance the HSR. They presented field experiences in building resilient health systems and the role of FETPs with an example from Yemen FETP. Furthermore, they debated the lessons learned from COVID-19 response and how it can reshape our thinking and strategies for approaching HSR. Finally, the panel discussed how health systems can effectively adapt and prosper in the face of challenges and barriers to recover from extreme disruptions while maintaining the core functions of the health systems. Conclusions: Considering the current situation in the region, there is a need to strengthen both pandemic preparedness and health systems, through investing in essential public health functions including those required for all-hazards emergency risk management. Institutionalized mechanisms for whole-of-society engagement, strengthening primary health care approaches for health security and universal health coverage, as well as promoting enabling environments for research, innovation, and learning should be ensured. Investing in building epidemiological capacity through continuous support to FETPs to work toward strengthening surveillance systems and participating in regional and global efforts in early response to outbreaks is crucial. %M 36480685 %R 10.2196/41144 %U https://www.i-jmr.org/2022/2/e41144 %U https://doi.org/10.2196/41144 %U http://www.ncbi.nlm.nih.gov/pubmed/36480685 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 2 %N 2 %P e40198 %T Platform Effects on Public Health Communication: A Comparative and National Study of Message Design and Audience Engagement Across Twitter and Facebook %A DePaula,Nic %A Hagen,Loni %A Roytman,Stiven %A Alnahass,Dana %+ School of Information Sciences, Wayne State University, 42 W Warren Ave, Detroit, MI, 48202, United States, 1 313 577 1825, ndepaula@wayne.edu %K platform effects %K COVID-19 %K social media %K health communication %K message design %K risk communication %K Twitter %K Facebook %K user engagement %K e-government %D 2022 %7 20.12.2022 %9 Original Paper %J JMIR Infodemiology %G English %X Background: Public health agencies widely adopt social media for health and risk communication. Moreover, different platforms have different affordances, which may impact the quality and nature of the messaging and how the public engages with the content. However, these platform effects are not often compared in studies of health and risk communication and not previously for the COVID-19 pandemic. Objective: This study measures the potential media effects of Twitter and Facebook on public health message design and engagement by comparing message elements and audience engagement in COVID-19–related posts by local, state, and federal public health agencies in the United States during the pandemic, to advance theories of public health messaging on social media and provide recommendations for tailored social media communication strategies. Methods: We retrieved all COVID-19–related posts from major US federal agencies related to health and infectious disease, all major state public health agencies, and selected local public health departments on Twitter and Facebook. A total of 100,785 posts related to COVID-19, from 179 different accounts of 96 agencies, were retrieved for the entire year of 2020. We adopted a framework of social media message elements to analyze the posts across Facebook and Twitter. For manual content analysis, we subsampled 1677 posts. We calculated the prevalence of various message elements across the platforms and assessed the statistical significance of differences. We also calculated and assessed the association between message elements with normalized measures of shares and likes for both Facebook and Twitter. Results: Distributions of message elements were largely similar across both sites. However, political figures (P<.001), experts (P=.01), and nonpolitical personalities (P=.01) were significantly more present on Facebook posts compared to Twitter. Infographics (P<.001), surveillance information (P<.001), and certain multimedia elements (eg, hyperlinks, P<.001) were more prevalent on Twitter. In general, Facebook posts received more (normalized) likes (0.19%) and (normalized) shares (0.22%) compared to Twitter likes (0.08%) and shares (0.05%). Elements with greater engagement on Facebook included expressives and collectives, whereas posts related to policy were more engaged with on Twitter. Science information (eg, scientific explanations) comprised 8.5% (73/851) of Facebook and 9.4% (78/826) of Twitter posts. Correctives of misinformation only appeared in 1.2% (11/851) of Facebook and 1.4% (12/826) of Twitter posts. Conclusions: In general, we find a data and policy orientation for Twitter messages and users and a local and personal orientation for Facebook, although also many similarities across platforms. Message elements that impact engagement are similar across platforms but with some notable distinctions. This study provides novel evidence for differences in COVID-19 public health messaging across social media sites, advancing knowledge of public health communication on social media and recommendations for health and risk communication strategies on these online platforms. %M 36575712 %R 10.2196/40198 %U https://infodemiology.jmir.org/2022/2/e40198 %U https://doi.org/10.2196/40198 %U http://www.ncbi.nlm.nih.gov/pubmed/36575712 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 12 %P e37582 %T Using Twitter Data to Estimate the Prevalence of Symptoms of Mental Disorders in the United States During the COVID-19 Pandemic: Ecological Cohort Study %A Cai,Ruilie %A Zhang,Jiajia %A Li,Zhenlong %A Zeng,Chengbo %A Qiao,Shan %A Li,Xiaoming %+ Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, 921 Assembly Street, Columbia, SC, 29208, United States, 1 8039556789, rcai@email.sc.edu %K mental health %K anxiety disorder %K depressive disorder %K COVID-19 %K national survey %K social media %K Twitter %K mixed model %K anxiety %K National Household Pulse survey %K geospatial %D 2022 %7 20.12.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Existing research and national surveillance data suggest an increase of the prevalence of mental disorders during the COVID-19 pandemic. Social media platforms, such as Twitter, could be a source of data for estimation owing to its real-time nature, high availability, and large geographical coverage. However, there is a dearth of studies validating the accuracy of the prevalence of mental disorders on Twitter compared to that reported by the Centers for Disease Control and Prevention (CDC). Objective: This study aims to verify the feasibility of Twitter-based prevalence of mental disorders symptoms being an instrument for prevalence estimation, where feasibility is gauged via correlations between Twitter-based prevalence of mental disorder symptoms (ie, anxiety and depressive symptoms) and that based on national surveillance data. In addition, this study aims to identify how the correlations changed over time (ie, the temporal trend). Methods: State-level prevalence of anxiety and depressive symptoms was retrieved from the national Household Pulse Survey (HPS) of the CDC from April 2020 to July 2021. Tweets were retrieved from the Twitter streaming application programming interface during the same period and were used to estimate the prevalence of symptoms of mental disorders for each state using keyword analysis. Stratified linear mixed models were used to evaluate the correlations between the Twitter-based prevalence of symptoms of mental disorders and those reported by the CDC. The magnitude and significance of model parameters were considered to evaluate the correlations. Temporal trends of correlations were tested after adding the time variable to the model. Geospatial differences were compared on the basis of random effects. Results: Pearson correlation coefficients between the overall prevalence reported by the CDC and that on Twitter for anxiety and depressive symptoms were 0.587 (P<.001) and 0.368 (P<.001), respectively. Stratified by 4 phases (ie, April 2020, August 2020, October 2020, and April 2021) defined by the HPS, linear mixed models showed that Twitter-based prevalence for anxiety symptoms had a positive and significant correlation with CDC-reported prevalence in phases 2 and 3, while a significant correlation for depressive symptoms was identified in phases 1 and 3. Conclusions: Positive correlations were identified between Twitter-based and CDC-reported prevalence, and temporal trends of these correlations were found. Geospatial differences in the prevalence of symptoms of mental disorders were found between the northern and southern United States. Findings from this study could inform future investigation on leveraging social media platforms to estimate symptoms of mental disorders and the provision of immediate prevention measures to improve health outcomes. %M 36459569 %R 10.2196/37582 %U https://formative.jmir.org/2022/12/e37582 %U https://doi.org/10.2196/37582 %U http://www.ncbi.nlm.nih.gov/pubmed/36459569 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 12 %P e39141 %T Representativeness, Vaccination Uptake, and COVID-19 Clinical Outcomes 2020-2021 in the UK Oxford-Royal College of General Practitioners Research and Surveillance Network: Cohort Profile Summary %A Leston,Meredith %A Elson,William H %A Watson,Conall %A Lakhani,Anissa %A Aspden,Carole %A Bankhead,Clare R %A Borrow,Ray %A Button,Elizabeth %A Byford,Rachel %A Elliot,Alex J %A Fan,Xuejuan %A Hoang,Uy %A Linley,Ezra %A Macartney,Jack %A Nicholson,Brian D %A Okusi,Cecilia %A Ramsay,Mary %A Smith,Gillian %A Smith,Sue %A Thomas,Mark %A Todkill,Dan %A Tsang,Ruby SM %A Victor,William %A Williams,Alice J %A Williams,John %A Zambon,Maria %A Howsam,Gary %A Amirthalingam,Gayatri %A Lopez-Bernal,Jamie %A Hobbs,F D Richard %A de Lusignan,Simon %+ Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, United Kingdom, 44 01865 617855, simon.delusignan@phc.ox.ac.uk %K cohort profile %K computerized medical record systems %K general practice %K influenza %K COVID-19 %K sentinel surveillance %K syndromic surveillance %K serology %K virology %K public health %K digital surveillance %K vaccination %K primary care data %K health data %K cohort %K virus %K immunology %K surveillance %K representation %K uptake %K outcome %K hospital %K sampling %K monitoring %D 2022 %7 19.12.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The Oxford-Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC) is one of Europe’s oldest sentinel systems, working with the UK Health Security Agency (UKHSA) and its predecessor bodies for 55 years. Its surveillance report now runs twice weekly, supplemented by online observatories. In addition to conducting sentinel surveillance from a nationally representative group of practices, the RSC is now also providing data for syndromic surveillance. Objective: The aim of this study was to describe the cohort profile at the start of the 2021-2022 surveillance season and recent changes to our surveillance practice. Methods: The RSC’s pseudonymized primary care data, linked to hospital and other data, are held in the Oxford-RCGP Clinical Informatics Digital Hub, a Trusted Research Environment. We describe the RSC’s cohort profile as of September 2021, divided into a Primary Care Sentinel Cohort (PCSC)—collecting virological and serological specimens—and a larger group of syndromic surveillance general practices (SSGPs). We report changes to our sampling strategy that brings the RSC into alignment with European Centre for Disease Control guidance and then compare our cohort’s sociodemographic characteristics with Office for National Statistics data. We further describe influenza and COVID-19 vaccine coverage for the 2020-2021 season (week 40 of 2020 to week 39 of 2021), with the latter differentiated by vaccine brand. Finally, we report COVID-19–related outcomes in terms of hospitalization, intensive care unit (ICU) admission, and death. Results: As a response to COVID-19, the RSC grew from just over 500 PCSC practices in 2019 to 1879 practices in 2021 (PCSC, n=938; SSGP, n=1203). This represents 28.6% of English general practices and 30.59% (17,299,780/56,550,136) of the population. In the reporting period, the PCSC collected >8000 virology and >23,000 serology samples. The RSC population was broadly representative of the national population in terms of age, gender, ethnicity, National Health Service Region, socioeconomic status, obesity, and smoking habit. The RSC captured vaccine coverage data for influenza (n=5.4 million) and COVID-19, reporting dose one (n=11.9 million), two (n=11 million), and three (n=0.4 million) for the latter as well as brand-specific uptake data (AstraZeneca vaccine, n=11.6 million; Pfizer, n=10.8 million; and Moderna, n=0.7 million). The median (IQR) number of COVID-19 hospitalizations and ICU admissions was 1181 (559-1559) and 115 (50-174) per week, respectively. Conclusions: The RSC is broadly representative of the national population; its PCSC is geographically representative and its SSGPs are newly supporting UKHSA syndromic surveillance efforts. The network captures vaccine coverage and has expanded from reporting primary care attendances to providing data on onward hospital outcomes and deaths. The challenge remains to increase virological and serological sampling to monitor the effectiveness and waning of all vaccines available in a timely manner. %M 36534462 %R 10.2196/39141 %U https://publichealth.jmir.org/2022/12/e39141 %U https://doi.org/10.2196/39141 %U http://www.ncbi.nlm.nih.gov/pubmed/36534462 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 10 %N 4 %P e38417 %T Integrating a Video Game Recording Into a Qualitative Research Methods Course to Overcome COVID-19 Barriers to Teaching: Qualitative Analysis %A Stetten,Nichole %A LeBeau,Kelsea %A King,Lindsey %A Pomeranz,Jamie %+ Department of Occupational Therapy, University of Florida, 1225 Center Drive, PO Box 100164, Gainesville, FL, 32610, United States, 1 3522739789, n.e.stetten@phhp.ufl.edu %K qualitative research %K pedagogy %K COVID-19 %K video games %K educational technology %K web-based learning %D 2022 %7 16.12.2022 %9 Original Paper %J JMIR Serious Games %G English %X Background: Because of the COVID-19 pandemic, a doctoral-level public health qualitative research methods course was moved to a web-based format. One module originally required students to conduct in-person observations within the community, but the curriculum was adapted using a web-based video game exercise. Objective: This study sought to evaluate students’ perceptions of this adaptation and determine whether the new pilot format successfully met the module’s original learning objectives. Methods: Recorded footage of a video game session was used for students to observe, take field notes, and compare the results. Qualitative methods were used to evaluate student feedback on the curriculum and determine whether the original learning objectives were met. Data were analyzed using a directed content analysis. Results: The findings demonstrate that all the learning objectives of this adapted qualitative observational research assignment using a web-based video game exercise were successfully met; namely, the students learned how to compare and contrast the observational notes of peers and to evaluate how personal bias and environmental factors can affect qualitative data collection. The assignment was also positively received by the students. Conclusions: The results align with the constructivist learning theory and other successful COVID-19 implementations. Our study demonstrates that the learning objectives of a qualitative observational assignment can be addressed given that there are proper forethought and delivery when the assignment is adapted to a web-based context using a video game exercise. %M 36322922 %R 10.2196/38417 %U https://games.jmir.org/2022/4/e38417 %U https://doi.org/10.2196/38417 %U http://www.ncbi.nlm.nih.gov/pubmed/36322922 %0 Journal Article %@ 2562-7600 %I JMIR Publications %V 5 %N 1 %P e42731 %T Nurse-Led Virtual Delivery of PIECES in Canadian Long-Term Care Homes to Support the Care of Older Adults Experiencing Responsive Behaviors During COVID-19: Qualitative Descriptive Study %A Garnett,Anna %A Connelly,Denise %A Yous,Marie-Lee %A Hung,Lillian %A Snobelen,Nancy %A Hay,Melissa %A Furlan-Craievich,Cherie %A Snelgrove,Shannon %A Babcock,Melissa %A Ripley,Jacqueline %A Hamilton,Pam %A Sturdy-Smith,Cathy %A O’Connell,Maureen %+ Arthur Labatt Family School of Nursing, Western University, 1151 Richmond St, London, ON, N6A 3K7, Canada, 1 519 661 2111, agarnet6@uwo.ca %K long-term care %K older adults %K families %K responsive behaviors %K qualitative %K COVID-19 %K PIECES %K nurse(s) %K care home %K infection %K therapeutic %K anxiety %K depression %K cognitive %K fear %K death %K dementia %K communication %K technology %D 2022 %7 13.12.2022 %9 Original Paper %J JMIR Nursing %G English %X Background: Worldwide, the COVID-19 pandemic has resulted in profound loss of life among older adults living in long-term care (LTC) homes. As a pandemic response, LTC homes enforced infection control processes, including isolating older adults in their rooms, canceling therapeutic programs, and restricting family member visits. Social isolation negatively impacts older adults in LTC, which may result in increased rates of anxiety, depression, physical and cognitive decline, disorientation, fear, apathy, and premature death. Isolation of older adults can also cause an increase in responsive behaviors (eg, yelling, hitting, calling out) to express frustration, fear, restricted movement, and boredom. To respond to the challenges in LTC and support frontline staff, older adults, and family members, a novel registered practical nurse (RPN)-led delivery of the PIECES approach for addressing responsive behaviors among older adults with dementia using virtual training/mentoring was implemented in Canadian LTC homes. PIECES employs a person- and family/care partner–centered collaborative team-based approach to provide education and capacity-building for nurses; engages families as active participants in care; and embeds evidence-informed practices to provide person- and family-centered care to older adults with complex needs, including dementia. Objective: The aim of this study was to describe the experiences of LTC staff, family/care partners, and older adult research partners with implementation of a novel RPN-led virtual adaptation of the PIECES care-planning approach for responsive behaviors in two Canadian LTC homes during the COVID-19 pandemic. Methods: Using a qualitative descriptive design, two focus groups were held with three to four staff members (eg, RPNs, managers) per LTC home in Ontario. A third focus group was held with three PIECES mentors. Individual semistructured interviews were conducted with RPN champions, family/care partners, and older adult research partners. Research team meeting notes provided an additional source of data. Content analysis was performed. Results: A total of 22 participants took part in a focus group (n=11) or an in-depth individual interview (n=11). Participant experiences suggest that implementation of RPN-led virtual PIECES fostered individualized care, included family as partners in care, increased interdisciplinary collaboration, and improved staff practices. However, virtual PIECES, as delivered, lacked opportunities for family member feedback on older adult outcomes. Implementation facilitators included the provision of mentorship and leadership at all levels of implementation and suitable technological infrastructure. Barriers were related to availability and use of virtual communication technology (family members) and older adults became upset due to lack of comprehension during virtual care conferences. Conclusions: These findings offer promising support to adopting virtual PIECES, a team approach to gather valuable family input and engagement to address residents’ unmet needs and responsive behaviors in LTC. Future research should investigate a hybridized communication format to foster sustainable person- and family-centered care-planning practices to include active collaboration of families in individualized care plans. %M 36446050 %R 10.2196/42731 %U https://nursing.jmir.org/2022/1/e42731 %U https://doi.org/10.2196/42731 %U http://www.ncbi.nlm.nih.gov/pubmed/36446050 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 11 %N 2 %P e41520 %T Frailty, Comorbidity, and Associations With In-Hospital Mortality in Older COVID-19 Patients: Exploratory Study of Administrative Data %A Heyl,Johannes %A Hardy,Flavien %A Tucker,Katie %A Hopper,Adrian %A Marchã,Maria J M %A Navaratnam,Annakan V %A Briggs,Tim W R %A Yates,Jeremy %A Day,Jamie %A Wheeler,Andrew %A Eve-Jones,Sue %A Gray,William K %+ Department of Physics and Astronomy, University College London, Gower St, London, WC1E 6BT, United Kingdom, 44 020 7679 7155, johannes.heyl.19@ucl.ac.uk %K COVID-19 %K coronavirus %K SARS-CoV-2 %K frailty %K comorbidity %K mortality %K death %K hospitalization %K hospital admission %K hospitalisation %K patient %K age %K sex %K ethnicity %K disease %K hospital %K cancer %K heart %K heart failure %K weight loss %K weight %K renal disease %K support %K geriatric %K older adult %K elder %K descriptive statistics %K machine learning %K model %D 2022 %7 12.12.2022 %9 Original Paper %J Interact J Med Res %G English %X Background: Older adults have worse outcomes following hospitalization with COVID-19, but within this group there is substantial variation. Although frailty and comorbidity are key determinants of mortality, it is less clear which specific manifestations of frailty and comorbidity are associated with the worst outcomes. Objective: We aimed to identify the key comorbidities and domains of frailty that were associated with in-hospital mortality in older patients with COVID-19 using models developed for machine learning algorithms. Methods: This was a retrospective study that used the Hospital Episode Statistics administrative data set from March 1, 2020, to February 28, 2021, for hospitalized patients in England aged 65 years or older. The data set was split into separate training (70%), test (15%), and validation (15%) data sets during model development. Global frailty was assessed using the Hospital Frailty Risk Score (HFRS) and specific domains of frailty were identified using the Global Frailty Scale (GFS). Comorbidity was assessed using the Charlson Comorbidity Index (CCI). Additional features employed in the random forest algorithms included age, sex, deprivation, ethnicity, discharge month and year, geographical region, hospital trust, disease severity, and International Statistical Classification of Disease, 10th Edition codes recorded during the admission. Features were selected, preprocessed, and input into a series of random forest classification algorithms developed to identify factors strongly associated with in-hospital mortality. Two models were developed; the first model included the demographic, hospital-related, and disease-related items described above, as well as individual GFS domains and CCI items. The second model was similar to the first but replaced the GFS domains and CCI items with the HFRS as a global measure of frailty. Model performance was assessed using the area under the receiver operating characteristic (AUROC) curve and measures of model accuracy. Results: In total, 215,831 patients were included. The model using the individual GFS domains and CCI items had an AUROC curve for in-hospital mortality of 90% and a predictive accuracy of 83%. The model using the HFRS had similar performance (AUROC curve 90%, predictive accuracy 82%). The most important frailty items in the GFS were dementia/delirium, falls/fractures, and pressure ulcers/weight loss. The most important comorbidity items in the CCI were cancer, heart failure, and renal disease. Conclusions: The physical manifestations of frailty and comorbidity, particularly a history of cognitive impairment and falls, may be useful in identification of patients who need additional support during hospitalization with COVID-19. %M 36423306 %R 10.2196/41520 %U https://www.i-jmr.org/2022/2/e41520 %U https://doi.org/10.2196/41520 %U http://www.ncbi.nlm.nih.gov/pubmed/36423306 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 12 %P e39570 %T Using a Proximity-Detection Technology to Nudge for Physical Distancing in a Swedish Workplace During the COVID-19 Pandemic: Retrospective Case Study %A Villius Zetterholm,My %A Nilsson,Lina %A Jokela,Päivi %+ Department of Informatics, Faculty of Technology, Linnaeus University, Universitetsplatsen 1, Kalmar, 39231, Sweden, 46 480497711, my.villiuszetterholm@lnu.se %K case study %K COVID-19 %K feasibility %K mixed methods %K nudging %K physical distance %K preventive behavior %K preventive technologies %K proximity detecting technology %K wearables %D 2022 %7 12.12.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The recent COVID-19 pandemic has contributed to the emergence of several technologies for infectious disease management. Although much focus has been placed on contact-tracing apps, another promising new tactic is proximity tracing, which focuses on health-related behavior and can be used for primary prevention. Underpinned by theories on behavioral design, a proximity-detection system can be devised that provides a user with immediate nudges to maintain physical distance from others. However, the practical feasibility of proximity detection during an infectious disease outbreak has not been sufficiently investigated. Objective: We aimed to evaluate the feasibility of using a wearable device to nudge for distance and to gather important insights about how functionality and interaction are experienced by users. The results of this study can guide future research and design efforts in this emerging technology. Methods: In this retrospective case study, a wearable proximity-detection technology was used in a workplace for 6 weeks during the production of a music competition. The purpose of the technology was to nudge users to maintain their physical distance using auditory feedback. We used a mixed methods sequential approach, including interviews (n=8) and a survey (n=30), to compile the experiences of using wearable technology in a real-life setting. Results: We generated themes from qualitative analysis based on data from interviews and open-text survey responses. The quantitative data were subsequently integrated into these themes: feasibility (implementation and acceptance—establishing a shared problem; distance tags in context—strategy, environment, and activities; understanding and learning; and accomplishing the purpose) and design aspects (a purposefully annoying device; timing, tone, and proximity; and additional functions). Conclusions: This empirical study reports on the feasibility of using wearable technology based on proximity detection to nudge individuals to maintain physical distance in the workplace. The technology supports attention to distance, but the usability of this approach is dependent on the context and situation. In certain situations, the audio signal is frustrating, but most users agree that it needs to be annoying to ensure sufficient behavioral adaption. We proposed a dual nudge that involves vibration followed by sound. There are indications that the technology also facilitates learning how to maintain a greater distance from others, and that this behavior can persist beyond the context of technology use. This study demonstrates that the key value of this technology is that it places the user in control and enables immediate action when the distance to others is not maintained. This study provides insights into the emerging field of personal and wearable technologies used for primary prevention during infectious disease outbreaks. Future research is needed to evaluate the preventive effect on transmission and investigate behavioral changes in detail and in relation to different forms of feedback. %M 36343202 %R 10.2196/39570 %U https://formative.jmir.org/2022/12/e39570 %U https://doi.org/10.2196/39570 %U http://www.ncbi.nlm.nih.gov/pubmed/36343202 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 2 %N 2 %P e41198 %T Unmasking the Twitter Discourses on Masks During the COVID-19 Pandemic: User Cluster–Based BERT Topic Modeling Approach %A Xu,Weiai Wayne %A Tshimula,Jean Marie %A Dubé,Ève %A Graham,Janice E %A Greyson,Devon %A MacDonald,Noni E %A Meyer,Samantha B %+ Department of Communication, University of Massachusetts Amherst, 650 N Pleasant St, Amherst, MA, 01003, United States, 1 (413) 545 1311, weiaixu@umass.edu %K infoveillance %K data analytics %K Twitter %K social media %K user classification %K COVID-19 %D 2022 %7 9.12.2022 %9 Original Paper %J JMIR Infodemiology %G English %X Background: The COVID-19 pandemic has spotlighted the politicization of public health issues. A public health monitoring tool must be equipped to reveal a public health measure’s political context and guide better interventions. In its current form, infoveillance tends to neglect identity and interest-based users, hence being limited in exposing how public health discourse varies by different political groups. Adopting an algorithmic tool to classify users and their short social media texts might remedy that limitation. Objective: We aimed to implement a new computational framework to investigate discourses and temporal changes in topics unique to different user clusters. The framework was developed to contextualize how web-based public health discourse varies by identity and interest-based user clusters. We used masks and mask wearing during the early stage of the COVID-19 pandemic in the English-speaking world as a case study to illustrate the application of the framework. Methods: We first clustered Twitter users based on their identities and interests as expressed through Twitter bio pages. Exploratory text network analysis reveals salient political, social, and professional identities of various user clusters. It then uses BERT Topic modeling to identify topics by the user clusters. It reveals how web-based discourse has shifted over time and varied by 4 user clusters: conservative, progressive, general public, and public health professionals. Results: This study demonstrated the importance of a priori user classification and longitudinal topical trends in understanding the political context of web-based public health discourse. The framework reveals that the political groups and the general public focused on the science of mask wearing and the partisan politics of mask policies. A populist discourse that pits citizens against elites and institutions was identified in some tweets. Politicians (such as Donald Trump) and geopolitical tensions with China were found to drive the discourse. It also shows limited participation of public health professionals compared with other users. Conclusions: We conclude by discussing the importance of a priori user classification in analyzing web-based discourse and illustrating the fit of BERT Topic modeling in identifying contextualized topics in short social media texts. %M 36536763 %R 10.2196/41198 %U https://infodemiology.jmir.org/2022/2/e41198 %U https://doi.org/10.2196/41198 %U http://www.ncbi.nlm.nih.gov/pubmed/36536763 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 12 %P e38158 %T Machine Learning Techniques to Explore Clinical Presentations of COVID-19 Severity and to Test the Association With Unhealthy Opioid Use: Retrospective Cross-sectional Cohort Study %A Thompson,Hale M %A Sharma,Brihat %A Smith,Dale L %A Bhalla,Sameer %A Erondu,Ihuoma %A Hazra,Aniruddha %A Ilyas,Yousaf %A Pachwicewicz,Paul %A Sheth,Neeral K %A Chhabra,Neeraj %A Karnik,Niranjan S %A Afshar,Majid %+ Section of Community Behavioral Health, Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Suite 302, 1645 W. Jackson Boulevard, Chicago, IL, 60612, United States, 1 4153108569, hale_thompson@rush.edu %K unhealthy opioid use %K substance misuse %K COVID-19 %K severity of illness %K overdose %K topic modeling %K machine learning %K opioid use %K pandemic %K health outcome %K public health %K disease severity %K electronic health record %K COVID-19 outcome %K risk factor %K patient data %D 2022 %7 8.12.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The COVID-19 pandemic has exacerbated health inequities in the United States. People with unhealthy opioid use (UOU) may face disproportionate challenges with COVID-19 precautions, and the pandemic has disrupted access to opioids and UOU treatments. UOU impairs the immunological, cardiovascular, pulmonary, renal, and neurological systems and may increase severity of outcomes for COVID-19. Objective: We applied machine learning techniques to explore clinical presentations of hospitalized patients with UOU and COVID-19 and to test the association between UOU and COVID-19 disease severity. Methods: This retrospective, cross-sectional cohort study was conducted based on data from 4110 electronic health record patient encounters at an academic health center in Chicago between January 1, 2020, and December 31, 2020. The inclusion criterion was an unplanned admission of a patient aged ≥18 years; encounters were counted as COVID-19-positive if there was a positive test for COVID-19 or 2 COVID-19 International Classification of Disease, Tenth Revision codes. Using a predefined cutoff with optimal sensitivity and specificity to identify UOU, we ran a machine learning UOU classifier on the data for patients with COVID-19 to estimate the subcohort of patients with UOU. Topic modeling was used to explore and compare the clinical presentations documented for 2 subgroups: encounters with UOU and COVID-19 and those with no UOU and COVID-19. Mixed effects logistic regression accounted for multiple encounters for some patients and tested the association between UOU and COVID-19 outcome severity. Severity was measured with 3 utilization metrics: low-severity unplanned admission, medium-severity unplanned admission and receiving mechanical ventilation, and high-severity unplanned admission with in-hospital death. All models controlled for age, sex, race/ethnicity, insurance status, and BMI. Results: Topic modeling yielded 10 topics per subgroup and highlighted unique comorbidities associated with UOU and COVID-19 (eg, HIV) and no UOU and COVID-19 (eg, diabetes). In the regression analysis, each incremental increase in the classifier’s predicted probability of UOU was associated with 1.16 higher odds of COVID-19 outcome severity (odds ratio 1.16, 95% CI 1.04-1.29; P=.009). Conclusions: Among patients hospitalized with COVID-19, UOU is an independent risk factor associated with greater outcome severity, including in-hospital death. Social determinants of health and opioid-related overdose are unique comorbidities in the clinical presentation of the UOU patient subgroup. Additional research is needed on the role of COVID-19 therapeutics and inpatient management of acute COVID-19 pneumonia for patients with UOU. Further research is needed to test associations between expanded evidence-based harm reduction strategies for UOU and vaccination rates, hospitalizations, and risks for overdose and death among people with UOU and COVID-19. Machine learning techniques may offer more exhaustive means for cohort discovery and a novel mixed methods approach to population health. %M 36265163 %R 10.2196/38158 %U https://publichealth.jmir.org/2022/12/e38158 %U https://doi.org/10.2196/38158 %U http://www.ncbi.nlm.nih.gov/pubmed/36265163 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 2 %N 2 %P e37331 %T The Asymmetric Influence of Emotion in the Sharing of COVID-19 Science on Social Media: Observational Study %A Luo,Kai %A Yang,Yang %A Teo,Hock Hai %+ National University of Singapore, 15 Computing Drive, Singapore, 117418, Singapore, 65 65162979, teohh@comp.nus.edu.sg %K COVID-19 %K science communication %K emotion %K COVID-19 science %K online social networks %K computational social science %K social media %D 2022 %7 8.12.2022 %9 Original Paper %J JMIR Infodemiology %G English %X Background: Unlike past pandemics, COVID-19 is different to the extent that there is an unprecedented surge in both peer-reviewed and preprint research publications, and important scientific conversations about it are rampant on online social networks, even among laypeople. Clearly, this new phenomenon of scientific discourse is not well understood in that we do not know the diffusion patterns of peer-reviewed publications vis-à-vis preprints and what makes them viral. Objective: This paper aimed to examine how the emotionality of messages about preprint and peer-reviewed publications shapes their diffusion through online social networks in order to inform health science communicators’ and policy makers’ decisions on how to promote reliable sharing of crucial pandemic science on social media. Methods: We collected a large sample of Twitter discussions of early (January to May 2020) COVID-19 medical research outputs, which were tracked by Altmetric, in both preprint servers and peer-reviewed journals, and conducted statistical analyses to examine emotional valence, specific emotions, and the role of scientists as content creators in influencing the retweet rate. Results: Our large-scale analyses (n=243,567) revealed that scientific publication tweets with positive emotions were transmitted faster than those with negative emotions, especially for messages about preprints. Our results also showed that scientists’ participation in social media as content creators could accentuate the positive emotion effects on the sharing of peer-reviewed publications. Conclusions: Clear communication of critical science is crucial in the nascent stage of a pandemic. By revealing the emotional dynamics in the social media sharing of COVID-19 scientific outputs, our study offers scientists and policy makers an avenue to shape the discussion and diffusion of emerging scientific publications through manipulation of the emotionality of tweets. Scientists could use emotional language to promote the diffusion of more reliable peer-reviewed articles, while avoiding using too much positive emotional language in social media messages about preprints if they think that it is too early to widely communicate the preprint (not peer reviewed) data to the public. %M 36536762 %R 10.2196/37331 %U https://infodemiology.jmir.org/2022/2/e37331 %U https://doi.org/10.2196/37331 %U http://www.ncbi.nlm.nih.gov/pubmed/36536762 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 12 %P e40302 %T Continued Use of Contact-Tracing Apps in the United States and the United Kingdom: Insights From a Comparative Study Through the Lens of the Health Belief Model %A Zhang,Zhan %A Vaghefi,Isaac %+ Zicklin School of Business, Baruch College, City University of New York, 55 Lexington Ave,, New York, NY, 10010, United States, 1 (646) 312 3409, isaac.vaghefi@baruch.cuny.edu %K contact tracing %K app adoption %K app continued use %K public attitudes %K health belief model %K COVID-19 %D 2022 %7 8.12.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: To contain the spread of SARS-CoV-2, contact-tracing (CT) mobile apps were developed and deployed to identify and notify individuals who have exposure to the virus. However, the effectiveness of these apps depends not only on their adoption by the general population but also on their continued use in the long term. Limited research has investigated the facilitators of and barriers to the continued use of CT apps. Objective: In this study, we aimed to examine factors influencing the continued use intentions of CT apps based on the health belief model. In addition, we investigated the differences between users and nonusers and between the US and UK populations. Methods: We administered a survey in the United States and the United Kingdom. Respondents included individuals who had previously used CT technologies and those without experience. We used the structural equation modeling technique to validate the proposed research model and hypotheses. Results: Analysis of data collected from 362 individuals showed that perceived benefits, self-efficacy, perceived severity, perceived susceptibility, and cues to action positively predicted the continued use intentions of CT apps, while perceived barriers could reduce them. We observed few differences between the US and UK groups; the only exception was the effect of COVID-19 threat susceptibility, which was significant for the UK group but not for the US group. Finally, we found that the only significant difference between users and nonusers was related to perceived barriers, which may not influence nonusers’ continued use intentions but significantly reduce experienced users’ intentions. Conclusions: Our findings have implications for technological design and policy. These insights can potentially help governments, technology companies, and media outlets to create strategies and policies to promote app adoption for new users and sustain continued use for existing users in the long run. %M 36351080 %R 10.2196/40302 %U https://formative.jmir.org/2022/12/e40302 %U https://doi.org/10.2196/40302 %U http://www.ncbi.nlm.nih.gov/pubmed/36351080 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 12 %P e42358 %T Desperately Seeking Intersectionality in Digital Health Disparity Research: Narrative Review to Inform a Richer Theorization of Multiple Disadvantage %A Husain,Laiba %A Greenhalgh,Trisha %A Hughes,Gemma %A Finlay,Teresa %A Wherton,Joseph %+ Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Rd, Oxford, OX2 6GG, United Kingdom, 44 7398850015, laiba.husain@phc.ox.ac.uk %K digital health disparities %K video consultations %K intersectionality %K health inequity %K narrative review %K digital capital %K fundamental cause theory %K mobile phone %D 2022 %7 7.12.2022 %9 Review %J J Med Internet Res %G English %X Background: Digital consultations between patients and clinicians increased markedly during the COVID-19 pandemic, raising questions about equity. Objective: This study aimed to review the literature on how multiple disadvantage—specifically, older age, lower socioeconomic status, and limited English proficiency—has been conceptualized, theorized, and studied empirically in relation to digital consultations. We focused mainly on video consultations as they have wider disparities than telephone consultations and relevant data on e-consultations are sparse. Methods: Using keyword and snowball searching, we identified relevant papers published between 2012 and 2022 using Ovid MEDLINE, Web of Science, Google Scholar, and PubMed. The first search was completed in July 2022. Papers meeting the inclusion criteria were analyzed thematically and summarized, and their key findings were tabulated using the Grading of Recommendations Assessment, Development, and Evaluation Confidence in the Evidence from Reviews of Qualitative Research criteria. Explanations for digital disparities were critically examined, and a search was undertaken in October 2022 to identify theoretical lenses on multiple disadvantage. Results: Of 663 articles from the initial search, 27 (4.1%) met our inclusion criteria. In total, 37% (10/27) were commentaries, and 63% (17/27) were peer-reviewed empirical studies (11/27, 41% quantitative; 5/27, 19% qualitative; 1/27, 4% mixed methods; 1/27, 4% systematic reviews; and 1/27, 4% narrative reviews). Empirical studies were mostly small, rapidly conducted, and briefly reported. Most studies (25/27, 93%) identified marked digital disparities but lacked a strong theoretical lens. Proposed solutions focused on identifying and removing barriers, but the authors generally overlooked the pervasive impact of multiple layers of disadvantage. The data set included no theoretically informed studies that examined how different dimensions of disadvantage combined to affect digital health disparities. In our subsequent search, we identified 3 theoretical approaches that might help account for these digital disparities. Fundamental cause theory by Link and Phelan addresses why the association between socioeconomic status and health is pervasive and persists over time. Digital capital theory by Ragnedda and Ruiu explains how people mobilize resources to participate in digitally mediated activities and services. Intersectionality theory by Crenshaw states that systems of oppression are inherently bound together, creating singular social experiences for people who bear the force of multiple adverse social structures. Conclusions: A limitation of our initial sample was the sparse and undertheorized nature of the primary literature. The lack of attention to how digital health disparities emerge and play out both within and across categories of disadvantage means that solutions proposed to date may be oversimplistic and insufficient. Theories of multiple disadvantage have bearing on digital health, and there may be others of relevance besides those discussed in this paper. We call for greater interdisciplinary dialogue between theoretical research on multiple disadvantage and empirical studies on digital health disparities. %M 36383632 %R 10.2196/42358 %U https://www.jmir.org/2022/12/e42358 %U https://doi.org/10.2196/42358 %U http://www.ncbi.nlm.nih.gov/pubmed/36383632 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 12 %P e42031 %T Engagement, Use, and Impact of Digital Mental Health Resources for Diverse Populations in COVID-19: Community-Partnered Evaluation %A Wells,Kenneth %A Thames,April Denise %A Young,Alexander S %A Zhang,Lily %A Heilemann,MarySue V %A Romero,Daniela Flores %A Oliva,Adrian %A Jones,Felica %A Tang,Lingqi %A Brymer,Melissa %A Elliott,Thomas %A Arevian,Armen %A , %+ Research Center for Health Services and Society, Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, 10920 Wilshire Blvd Suite 300, Los Angeles, CA, 90024, United States, 1 310 794 3728, KWells@mednet.ucla.edu %K digital mental health %K prevention %K COVID-19 %K depression %K hotline use %K health disparity %K community health %K public health %K health resource %K mental well-being %K ethnic %K website engagement %K minority population %K digital resource %D 2022 %7 7.12.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic increased disparities for communities burdened by structural barriers such as reduced affordable housing, with mental health consequences. Limited data are available on digital resources for public mental health prevention during the COVID-19 pandemic. Objective: The study aim was to evaluate engagement in and impact of free digital resources on the Together for Wellness/Juntos por Nuestro Bienestar (T4W/Juntos) website during COVID-19 in California. Methods: A pilot evaluation of T4W/Juntos was performed, with partner agencies inviting providers, clients, and partners to visit the website and complete surveys at baseline (September 20, 2021, to April 4, 2022) and at 4-6–week follow-up (October 22, 2021, to May 17, 2022). Website use was assessed by three engagement items (ease of use, satisfaction, relevance), comfort in use, and use of six resource categories. Primary outcomes at follow-up were depression and anxiety (scores≥3 on Patient Health Questionnaire-2 item [PHQ2] and Generalized Anxiety Disorder-2 item [GAD2] scales). Secondary outcomes were post-pre differences in PHQ2 and GAD2 scores, and use of behavioral health hotlines and services the month before follow-up. Results: Of 366 eligible participants, 315 (86.1%) completed baseline and 193 (61.3%) completed follow-up surveys. Of baseline participants, 72.6% identified as female, and 21.3% identified as lesbian, gay, bisexual, transgender, queer/questioning, and others (LGBTQ+). In terms of ethnicity, 44.0% identified as Hispanic, 17.8% as African American, 26.9% as non-Hispanic white, and 11.4% as other ethnicity. Overall, 32.7% had moderate anxiety or depression (GAD2/PHQ2≥3) at baseline. Predictors of baseline website engagement included being Hispanic versus other race/ethnicity (β=.27, 95% CI .10-.44; P=.002) and number of COVID-19–related behavior changes (β=.09, 95% CI .05-.13; P<.001). Predictors of comfort using the website were preferring English for website use (odds ratio [OR] 5.57, 95% CI 2.22-13.96; P<.001) and COVID-19–related behavior changes (OR 1.37, 95% CI 1.12-1.66; P=.002); receiving overnight behavioral health treatment in the prior 6 months (OR 0.15, 95% CI 0.03-0.69, P=.015) was associated with less comfort in website use. The main predictor of depression at follow-up (PHQ2≥3) was baseline depression (OR 6.24, 95% CI 2.77-14.09; P<.001). Engagement in T4W/Juntos was associated with lower likelihood of depression (OR 0.54, 95% CI 0.34-0.86; P=.01). Website use the month before follow-up was associated with a post-pre reduction in PHQ2 score (β=–.62, 95% CI –1.04 to –0.20; P=.004). The main predictor of GAD2≥3 at follow-up was baseline GAD2≥3 (OR 13.65, 95% CI 6.06-30.72; P<.001). Greater baseline website engagement predicted reduced hotline use (OR 0.36, 95% CI 0.18-0.71; P=.004). Conclusions: Ethnicity/language and COVID-19–related behavior changes were associated with website engagement; engagement and use predicted reduced follow-up depression and behavioral hotline use. Findings are based on participants recommended by community agencies with moderate follow-up rates; however, significance was similar when weighting for nonresponse. This study may inform research and policy on digital mental health prevention resources. %M 36346902 %R 10.2196/42031 %U https://formative.jmir.org/2022/12/e42031 %U https://doi.org/10.2196/42031 %U http://www.ncbi.nlm.nih.gov/pubmed/36346902 %0 Journal Article %@ 2561-9128 %I JMIR Publications %V 5 %N 1 %P e40209 %T Experiences of Health Care Professionals Working Extra Weekends to Reduce COVID-19–Related Surgical Backlog: Cross-sectional Study %A Matava,Clyde %A So,Jeannette P %A Hossain,Alomgir %A Kelley,Simon %+ Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada, 1 416 813 7445, clyde.matava@sickkids.ca %K staff %K wait-list %K surgery %K health care delivery %K patient safety %K quality improvement %K patient satisfaction %K COVID-19 %K practice redesign %K burnout %K preoperative %K pediatric %K perioperative %K surgery %K surgical staff %K surgeon %K healthcare %K health care %K staff perception %K workforce %K stress %K work %K occupational health %K occupational safety %K perception %K workload %K nurse %K nursing %K anesthesiologist %K health care provider %K health care professional %K cross-sectional %K online survey %D 2022 %7 6.12.2022 %9 Original Paper %J JMIR Perioper Med %G English %X Background: During the quiescent periods of the COVID-19 pandemic in 2020, we implemented a weekend-scheduled pediatric surgery program to reduce COVID-19–related backlogs. Over 100 staff members from anesthesiologists to nurses, surgeons, and administrative and supporting personnel signed up to work extra weekends as part of a novel weekend elective pediatric surgery program to reduce COVID-19–related backlog: Operating Room Ramp-Up After COVID-19 Lockdown Ends-Extra Lists (ORRACLE-Xtra). Objective: In this study, we sought to evaluate staff perceptions and their level of satisfaction and experiences with working extra scheduled weekend elective surgical cases at the end of the 3-month pilot phase of ORRACLE-Xtra and identify key factors for participation. Methods: Following the pilot of ORRACLE-Xtra, all perioperative staff who worked at least 1 weekend list were invited to complete an online survey that was developed and tested prior to distribution. The survey collected information on the impact of working weekends on well-being, overall satisfaction, and likelihood of and preferences for working future weekend lists. Logistic regression was used to estimate the association of well-being with satisfaction and willingness to work future weekend lists. Results: A total of 82 out of 118 eligible staff responded to the survey for a response rate of 69%. Staff worked a median of 2 weekend lists (IQR 1-9). Of 82 staff members, 65 (79%) were satisfied or very satisfied with working the extra weekend elective lists, with surgeons and surgical trainees reporting the highest levels of satisfaction. Most respondents (72/82, 88%) would continue working weekend lists. A sense of accomplishment was associated with satisfaction with working on the weekend (odds ratio [OR] 19.97, 95% CI 1.79-222.63; P=.02) and willingness to participate in future weekend lists (OR 17.74, 95% CI 1.50-200.70; P=.02). Many (56/82, 68%) were willing to work weekend lists that included longer, more complex cases, which was associated with a sense of community (OR 0.12, 95% CI 0.02-0.63; P=.01). Conclusions: Staff participating in the first 3 months of the ORRACLE-Xtra program reported satisfaction with working weekends and a willingness to continue with the program, including doing longer, more complex cases. Institutions planning on implementing COVID-19 surgical backlog work may benefit from gathering key information from their staff. %M 36423322 %R 10.2196/40209 %U https://periop.jmir.org/2022/1/e40209 %U https://doi.org/10.2196/40209 %U http://www.ncbi.nlm.nih.gov/pubmed/36423322 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 12 %P e37507 %T Assessing Associations Between COVID-19 Symptomology and Adverse Outcomes After Piloting Crowdsourced Data Collection: Cross-sectional Survey Study %A Flaks-Manov,Natalie %A Bai,Jiawei %A Zhang,Cindy %A Malpani,Anand %A Ray,Stuart C %A Taylor,Casey Overby %+ Johns Hopkins University School of Medicine, 3101 Wyman Park Dr., Baltimore, MD, 21218, United States, 1 443 287 6657, cot@jhu.edu %K COVID-19 %K coronavirus %K symptoms %K symptomology %K crowdsourcing %K adverse outcomes %K data quality %D 2022 %7 6.12.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Crowdsourcing is a useful way to rapidly collect information on COVID-19 symptoms. However, there are potential biases and data quality issues given the population that chooses to participate in crowdsourcing activities and the common strategies used to screen participants based on their previous experience. Objective: The study aimed to (1) build a pipeline to enable data quality and population representation checks in a pilot setting prior to deploying a final survey to a crowdsourcing platform, (2) assess COVID-19 symptomology among survey respondents who report a previous positive COVID-19 result, and (3) assess associations of symptomology groups and underlying chronic conditions with adverse outcomes due to COVID-19. Methods: We developed a web-based survey and hosted it on the Amazon Mechanical Turk (MTurk) crowdsourcing platform. We conducted a pilot study from August 5, 2020, to August 14, 2020, to refine the filtering criteria according to our needs before finalizing the pipeline. The final survey was posted from late August to December 31, 2020. Hierarchical cluster analyses were performed to identify COVID-19 symptomology groups, and logistic regression analyses were performed for hospitalization and mechanical ventilation outcomes. Finally, we performed a validation of study outcomes by comparing our findings to those reported in previous systematic reviews. Results: The crowdsourcing pipeline facilitated piloting our survey study and revising the filtering criteria to target specific MTurk experience levels and to include a second attention check. We collected data from 1254 COVID-19–positive survey participants and identified the following 6 symptomology groups: abdominal and bladder pain (Group 1); flu-like symptoms (loss of smell/taste/appetite; Group 2); hoarseness and sputum production (Group 3); joint aches and stomach cramps (Group 4); eye or skin dryness and vomiting (Group 5); and no symptoms (Group 6). The risk factors for adverse COVID-19 outcomes differed for different symptomology groups. The only risk factor that remained significant across 4 symptomology groups was influenza vaccine in the previous year (Group 1: odds ratio [OR] 6.22, 95% CI 2.32-17.92; Group 2: OR 2.35, 95% CI 1.74-3.18; Group 3: OR 3.7, 95% CI 1.32-10.98; Group 4: OR 4.44, 95% CI 1.53-14.49). Our findings regarding the symptoms of abdominal pain, cough, fever, fatigue, shortness of breath, and vomiting as risk factors for COVID-19 adverse outcomes were concordant with the findings of other researchers. Some high-risk symptoms found in our study, including bladder pain, dry eyes or skin, and loss of appetite, were reported less frequently by other researchers and were not considered previously in relation to COVID-19 adverse outcomes. Conclusions: We demonstrated that a crowdsourced approach was effective for collecting data to assess symptomology associated with COVID-19. Such a strategy may facilitate efficient assessments in a dynamic intersection between emerging infectious diseases, and societal and environmental changes. %M 36343205 %R 10.2196/37507 %U https://formative.jmir.org/2022/12/e37507 %U https://doi.org/10.2196/37507 %U http://www.ncbi.nlm.nih.gov/pubmed/36343205 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 12 %P e37669 %T Digitalizing and Upgrading Severe Acute Respiratory Infections Surveillance in Malta: System Development %A Cauchi,John Paul %A Borg,Maria-Louise %A Džiugytė,Aušra %A Attard,Jessica %A Melillo,Tanya %A Zahra,Graziella %A Barbara,Christopher %A Spiteri,Michael %A Drago,Allan %A Zammit,Luke %A Debono,Joseph %A Souness,Jorgen %A Agius,Steve %A Young,Sharon %A Dimech,Alan %A Chetcuti,Ian %A Camenzuli,Mark %A Borg,Ivan %A Calleja,Neville %A Tabone,Lorraine %A Gauci,Charmaine %A Vassallo,Pauline %A Baruch,Joaquin %+ Health Promotion and Disease Prevention Directorate, 1, St. Luke's Square, Gwardamanġa, Msida, PTA 1010, Malta, 356 79899999, john-paul.cauchi@gov.mt %K surveillance %K public health %K epidemiology %K COVID-19 %K disease prevention %K disease surveillance %K digital health %K health system %K pandemic %K public hospital %K patient data %K health data %K electronic record %K monitoring %D 2022 %7 5.12.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: In late 2020, the European Centre for Disease Prevention and Control and Epiconcept started implementing a surveillance system for severe acute respiratory infections (SARI) across Europe. Objective: We sought to describe the process of digitizing and upgrading SARI surveillance in Malta, an island country with a centralized health system, during the COVID-19 pandemic from February to November 2021. We described the characteristics of people included in the surveillance system and compared different SARI case definitions, including their advantages and disadvantages. This study also discusses the process, output, and future for SARI and other public health surveillance opportunities. Methods: Malta has one main public hospital where, on admission, patient data are entered into electronic records as free text. Symptoms and comorbidities are manually extracted from these records, whereas other data are collected from registers. Collected data are formatted to produce weekly and monthly reports to inform public health actions. From October 2020 to February 2021, we established an analogue incidence-based system for SARI surveillance. From February 2021 onward, we mapped key stakeholders and digitized most surveillance processes. Results: By November 30, 2021, 903 SARI cases were reported, with 380 (42.1%) positive for SARS-CoV-2. Of all SARI hospitalizations, 69 (7.6%) were admitted to the intensive care unit, 769 (85.2%) were discharged, 27 (3%) are still being treated, and 107 (11.8%) died. Among the 107 patients who died, 96 (89.7%) had more than one underlying condition, the most common of which were hypertension (n=57, 53.3%) and chronic heart disease (n=49, 45.8%). Conclusions: The implementation of enhanced SARI surveillance in Malta was completed by the end of May 2021, allowing the monitoring of SARI incidence and patient characteristics. A future shift to register-based surveillance should improve SARI detection through automated processes. %M 36227157 %R 10.2196/37669 %U https://publichealth.jmir.org/2022/12/e37669 %U https://doi.org/10.2196/37669 %U http://www.ncbi.nlm.nih.gov/pubmed/36227157 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 12 %P e38821 %T Impact of Telehealth on the Delivery of Prenatal Care During the COVID-19 Pandemic: Mixed Methods Study of the Barriers and Opportunities to Improve Health Care Communication in Discussions About Pregnancy and Prenatal Genetic Testing %A Craighead,Caitlin G %A Collart,Christina %A Frankel,Richard %A Rose,Susannah %A Misra-Hebert,Anita D %A Tucker Edmonds,Brownsyne %A Michie,Marsha %A Chien,Edward %A Coleridge,Marissa %A Goje,Oluwatosin %A Ranzini,Angela C %A Farrell,Ruth M %+ Obstetrics and Gynecology and Women's Health Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, United States, 1 216 445 7085, farrelr@ccf.org %K prenatal health care delivery %K health care communication %K telehealth %K access to health care %K COVID-19 %K pregnancy %D 2022 %7 5.12.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic brought significant changes in health care, specifically the accelerated use of telehealth. Given the unique aspects of prenatal care, it is important to understand the impact of telehealth on health care communication and quality, and patient satisfaction. This mixed methods study examined the challenges associated with the rapid and broad implementation of telehealth for prenatal care delivery during the pandemic. Objective: In this study, we examined patients’ perspectives, preferences, and experiences during the COVID-19 pandemic, with the aim of supporting the development of successful models to serve the needs of pregnant patients, obstetric providers, and health care systems during this time. Methods: Pregnant patients who received outpatient prenatal care in Cleveland, Ohio participated in in-depth interviews and completed the Coronavirus Perinatal Experiences-Impact Survey (COPE-IS) between January and December 2021. Transcripts were coded using NVivo 12, and qualitative analysis was used, an approach consistent with the grounded theory. Quantitative data were summarized and integrated during analysis. Results: Thematic saturation was achieved with 60 interviews. We learned that 58% (35/60) of women had telehealth experience prior to their current pregnancy. However, only 8% (5/60) of women had used both in-person and virtual visits during this pregnancy, while the majority (54/60, 90%) of women participated in only in-person visits. Among 59 women who responded to the COPE-IS, 59 (100%) felt very well supported by their provider, 31 (53%) were moderately to highly concerned about their child’s health, and 17 (29%) reported that the single greatest stress of COVID-19 was its impact on their child. Lead themes focused on establishing patient-provider relationships that supported shared decision-making, accessing the information needed for shared decision-making, and using technology effectively to foster discussions during the COVID-19 pandemic. Key findings indicated that participants felt in-person visits were more personal, established greater rapport, and built better trust in the patient-provider relationship as compared to telehealth visits. Further, participants felt they could achieve a greater dialogue and ask more questions regarding time-sensitive information, including prenatal genetic testing information, through an in-person visit. Finally, privacy concerns arose if prenatal genetic testing or general pregnancy conversations were to take place outside of the health care facility. Conclusions: While telehealth was recognized as an option to ensure timely access to prenatal care during the COVID-19 pandemic, it also came with multiple challenges for the patient-provider relationship. These findings highlighted the barriers and opportunities to achieve effective and patient-centered communication with the continued integration of telehealth in prenatal care delivery. It is important to address the unique needs of this population during the pandemic and as health care increasingly adopts a telehealth model. %M 36383634 %R 10.2196/38821 %U https://formative.jmir.org/2022/12/e38821 %U https://doi.org/10.2196/38821 %U http://www.ncbi.nlm.nih.gov/pubmed/36383634 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 12 %P e40713 %T A Smartphone-Based Intervention for Anxiety and Depression in Racially and Ethnically Diverse Adults (EASE): Protocol for a Randomized Controlled Trial %A Garey,Lorra %A Zvolensky,Michael J %A Gallagher,Matthew W %A Vujanovic,Anka %A Kendzor,Darla E %A Stephens,Lancer %A Cheney,Marshall K %A Cole,Ashley B %A Kezbers,Krista %A Matoska,Cameron T %A Robison,Jillian %A Montgomery,Audrey %A Zappi,Christopher V %A Businelle,Michael S %+ Department of Psychology, University of Houston, Fred J. Heyne Building, Suite 104, 3695 Cullen Blvd, Houston, TX, 77204, United States, 1 713 743 8056, llgarey@uh.edu %K COVID-19 %K just-in-time adaptive intervention %K anxiety %K depression %K mHealth %K minority populations %K death %K behavioral %K care %K mobile application %K app %K public health %K symptoms %K risk %D 2022 %7 5.12.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Clear health disparities have emerged in the rates of COVID-19 exposure, hospitalization, and death among Black, Hispanic, and American Indian (BHAI) individuals, relative to non-Hispanic White (NHW) individuals. BHAI populations have been disproportionately affected by lower behavioral health access and heightened negative mental health outcomes during the pandemic. Objective: This project directly addresses health disparities in access to behavioral health care during the COVID-19 pandemic among BHAI populations via an adaptation of the established, initially validated, low-cost, mobile app Easing Anxiety Sensitivity for Everyone (EASE) among individuals with symptoms of elevated anxiety or depression or both. Methods: The EASE trial is a 2-arm, prospective, randomized, blinded-assessor study with intention-to-treat analysis. Participants (N=800; n=200, 25%, Black; n=200, 25%, Hispanic; n=200, 25%, American Indian; and n=200, 25%, NHW) are randomized to receive either EASE or an active comparison condition for anxiety and depression. Participants compete an online prescreener, an enrollment call to provide informed consent, a baseline survey, a 6-month intervention period, and 3- and 6-month postbaseline assessments. Select participants also complete a 3- and 6-month postbaseline qualitative interview via phone or an online platform (eg, Zoom). Participants complete 2 scheduled daily ecological momentary assessments (EMAs) during the 6-month study period. These twice-daily EMAs guide a just-in-time approach to immediate, personalized behavioral health care. Results: Outcomes include reductions in anxiety and depressive symptoms and functional impairment at 3 and 6 months postrandomization. We also will examine putative mechanisms (eg, anxiety sensitivity [AS] and COVID-19–specific stress and fear) of the intervention effects. Further, as treatment effects may differ across sociocultural factors, perceived discrimination, social support, and socioeconomic status (SES) will be evaluated as potential moderators of treatment effects on the primary outcomes. Process evaluation using data collected during the study, as well as individual interviews with participants, will complement quantitative data. Conclusions: Data from this efficacy trial will determine whether EASE successfully improves symptoms of anxiety and depression and whether these improvements outperform an active comparison control app. If successful, findings from this study have the potential to decrease anxiety and depression symptoms among vulnerable populations determined to be most at risk of exacerbated, long-lasting negative health sequelae. Data from this study may be used to support an implementation and dissemination trial of EASE within real-world behavioral health and social service settings. Trial Registration: ClinicalTrials.gov NCT05074693; https://clinicaltrials.gov/ct2/show/NCT05074693 International Registered Report Identifier (IRRID): DERR1-10.2196/40713 %M 36409958 %R 10.2196/40713 %U https://www.researchprotocols.org/2022/12/e40713 %U https://doi.org/10.2196/40713 %U http://www.ncbi.nlm.nih.gov/pubmed/36409958 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 12 %P e40341 %T Building Digital Literacy in Older Adults of Low Socioeconomic Status in Singapore (Project Wire Up): Nonrandomized Controlled Trial %A Ngiam,Nerice Heng Wen %A Yee,Wan Qi %A Teo,Nigel %A Yow,Ka Shing %A Soundararajan,Amrish %A Lim,Jie Xin %A Lim,Haikel A %A Tey,Angeline %A Tang,Kai Wen Aaron %A Tham,Celine Yi Xin %A Tan,Jamaica Pei Ying %A Lu,Si Yinn %A Yoon,Sungwon %A Ng,Kennedy Yao Yi %A Low,Lian Leng %+ Population Health and Integrated Care Office, Singapore General Hospital, 10 Hospital Boulevard, Level 7, Singapore, 168582, Singapore, 65 69703018, low.lian.leng@singhealth.com.sg %K digital literacy %K health determinants %K COVID-19 pandemic %K social distancing %K older adults %K loneliness %K social connectedness %K quality of life %K well-being %K digital inclusivity %K web-based %K information and communication technology %D 2022 %7 2.12.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: In a rapidly digitalizing world, the inability of older adults to leverage digital technology has been associated with weaker social connections and poorer health outcomes. Despite the widespread digital adoption in Singapore, older adults, especially those of lower socioeconomic status (SES), still face difficulties in adopting information and communications technology and are typically digitally excluded. Objective: We aimed to examine the impact of the volunteer-led, one-on-one, and home-based digital literacy program on digital literacy and health-related outcomes such as self-reported loneliness, social connectedness, quality of life, and well-being for older adults of low SES. Methods: A nonrandomized controlled study was carried out in Singapore between July 2020 and November 2021 involving 138 digitally excluded community-dwelling older adults aged ≥55 years and of lower SES. Older adults awaiting participation in the program served as controls. Older adults under the intervention were equipped with a smartphone and cellular data, underwent fortnightly to monthly digital literacy training with volunteers to learn digital skills, and digitally connected to their existing social networks. Primary outcome was the improvement in self-reported digital literacy. Secondary outcomes included improvements in University of California, Los Angeles 3-item loneliness scale, Lubben Social Network Scale-6, EQ-5D-3L and EQ visual analogue scale scores, and Personal Wellbeing Score. Results: There were significant improvements in digital literacy scores in the intervention group as compared to controls (mean difference 2.28, 95% CI 1.37-3.20; P<.001). Through multiple linear regression analyses, this difference in digital literacy scores remained independently associated with group membership after adjusting for differences in baseline scores, age, gender, education, living arrangement, housing type, and baseline social connectivity and loneliness status. There was no statistically significant difference in University of California, Los Angeles 3-item loneliness scale, Lubben Social Network Scale-6, Personal Wellbeing Score, or EQ-5D Utility and visual analogue scale score. Conclusions: This study adds to the growing research on digital inclusion by showing that a volunteer-led, one-on-one, and home-based digital literacy program contributed to increase digital literacy in older adults of low SES. Future studies should look into developing more older adult–friendly digital spaces and technology design to encourage continued digital adoption in older adults and, eventually, impact health-related outcomes. %M 36459398 %R 10.2196/40341 %U https://www.jmir.org/2022/12/e40341 %U https://doi.org/10.2196/40341 %U http://www.ncbi.nlm.nih.gov/pubmed/36459398 %0 Journal Article %@ 2562-0959 %I JMIR Publications %V 5 %N 4 %P e41739 %T Multiple Keratoacanthomas Following Moderna Messenger RNA-1273 COVID-19 Vaccination Resolved With 5-Fluorouracil Treatment: Case Report %A Ahmed,Fahad %A Memon,Nashwah %A Haque,Adel %+ Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Blvd, 6th Floor, Philadelphia, PA, 19104, United States, 1 7729409756, fahad.ahmed@pennmedicine.upenn.edu %K keratoacanthoma %K COVID-19 vaccine %K COVID-19 %K vaccine %K treatment %K Moderna %K messenger RNA %K side effects %K vaccination %K case report %K oncology %K tumor %D 2022 %7 1.12.2022 %9 Case Report %J JMIR Dermatol %G English %X Cutaneous reactions have been commonly associated with the Moderna messenger RNA (mRNA) COVID-19 vaccine. Among the reported cutaneous side effects, there have not been any associations reported yet regarding keratoacanthoma development after COVID-19 mRNA vaccination. We report a novel case of an 86-year-old man who experienced an eruption of multiple keratoacanthomas 2 weeks after inoculation with the Moderna mRNA-1273 vaccine that resolved following treatment with intralesional 5-fluorouracil. %M 36504544 %R 10.2196/41739 %U https://derma.jmir.org/2022/4/e41739 %U https://doi.org/10.2196/41739 %U http://www.ncbi.nlm.nih.gov/pubmed/36504544 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 12 %P e39109 %T Influences, Barriers, and Facilitators to COVID-19 Vaccination: Cross-sectional Survey on Vaccine Hesitancy in 2 Rural States %A Nguyen,Elaine %A Wright,Melanie %A Holmes,John %A Cleveland,Kevin %A Oliphant,Catherine %A Nies,Mary %A Robinson,Renee %+ Department of Pharmacy Practice and Administration, College of Pharmacy, University of Alaska/Idaho State University, 2533 Providence Drive PSB111, Anchorage, AK, 99508, United States, 1 907 786 6233, robiren2@isu.edu %K COVID-19 %K COVID-19 vaccines %K vaccine hesitancy %K cross-sectional studies %K rural populations %D 2022 %7 1.12.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Vaccination remains one of the most effective ways to limit the spread of infectious diseases such as that caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus responsible for COVID-19. Unfortunately, vaccination hesitancy continues to be a threat to national and global health. Further research is necessary to determine the modifiable and nonmodifiable factors contributing to COVID-19 vaccine hesitancy in under-resourced, underserved, and at-risk rural and urban communities. Objective: This study aimed to identify, understand, and address modifiable barriers and factors contributing to COVID-19 vaccine hesitancy among vaccine-eligible individuals with access to the vaccine in Alaska and Idaho. Methods: An electronic survey based on the World Health Organization (WHO) Strategic Advisory Group on Experts (SAGE) on Immunization survey tool and investigators’ previous work was created and distributed in June 2021 and July 2021. To be eligible to participate in the survey, individuals had to be ≥18 years of age and reside in Alaska or Idaho. Responses were grouped into 4 mutually exclusive cohorts for data analysis and reporting based on intentions to be vaccinated. Respondent characteristics and vaccine influences between cohorts were compared using Chi-square tests and ANOVA. Descriptive statistics were also used. Results: There were data from 736 usable surveys with 40 respondents who did not intend to be vaccinated, 27 unsure of their intentions, 8 who intended to be fully vaccinated with no doses received, and 661 fully vaccinated or who intended to be vaccinated with 1 dose received. There were significant differences in characteristics and influences between those who were COVID-19 vaccine-hesitant and those who had been vaccinated. Concerns related to possible side effects, enough information on long-term side effects, and enough information that is specific to the respondent’s health conditions were seen in those who did not intend to be fully vaccinated and unsure about vaccination. In all cohorts except those who did not intend to be fully vaccinated, more information about how well the vaccine works was a likely facilitator to vaccination. Conclusions: These survey results from 2 rural states indicate that recognition of individual characteristics may influence vaccine choices. However, these individual characteristics represent only a starting point to delivering tailored messages that should come from trusted sources to address vaccination barriers. %M 36067411 %R 10.2196/39109 %U https://formative.jmir.org/2022/12/e39109 %U https://doi.org/10.2196/39109 %U http://www.ncbi.nlm.nih.gov/pubmed/36067411 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 11 %P e38357 %T Enrollment and Completion Characteristics for Novel Remote Delivery Modes of the Self-management Programs During the COVID-19 Pandemic: Exploratory Analysis %A Pullyblank,Kristin %A Atav,Serdar %+ Center for Rural Community Health, Bassett Research Institute, Bassett Medical Center, One Atwell Road, Cooperstown, NY, 13326, United States, 1 6075476711, kristin.pullyblank@bassett.org %K self-management programs %K self management %K internet-based intervention %K health promotion %K COVID-19 %K health equity %K socioeconomic status %K remote healthcare %K health delivery %K virtual care %K remote care %K remote delivery %K videoconference %K videoconferencing %K adherence %K attrition %K completion %K virtual health %D 2022 %7 30.11.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: In-person, evidence-based, peer-facilitated chronic disease self-management programs have been shown to be effective for individuals from a variety of backgrounds, including rural and minority populations and those with lower socioeconomic status. Based in social learning theory, these programs use group processes to help participants better manage their chronic disease symptoms and improve their quality of life. During the pandemic, these in-person programs were forced to rapidly transition to remote delivery platforms, and it was unclear whether doing so increased disparities within our rural population. Objective: The objectives of this analysis were to ascertain self-management program enrollment and completion characteristics between 2 remote delivery platforms, as well as determine the individual level characteristics that drove enrollment and completion across delivery modes. Methods: We analyzed enrollment and completion characteristics of 183 individuals who either enrolled in a self-management workshop delivered through a web-based videoconference (VC) system or through a traditional, audio-only conference call (CC) offered by our health care network between April and December 2020. Chi-square tests of association were used to describe the characteristics of and differences between groups. Logistic regression analysis was used to determine significant predictors of enrollment and completion. Results: Those who enrolled in the VC platform were significantly likelier to be younger and college educated than those who enrolled in the CC platform. Those who completed a program, regardless of delivery mode, were likelier to be older and college educated than those who did not complete a program. Multivariate analyses indicated that of those enrolled in the CC platform, completers were likelier to not be enrolled in Medicaid. Among those enrolled in the VC platform, completers were older, college graduates, female, and likelier to have reported poorer health than those who did not complete the program. Conclusions: The transition of self-management programs to remote delivery modes, particularly to those that rely on VC platforms, revealed that certain demographic groups may no longer be able or willing to access the service. Efforts need to be made to increase engagement in remote self-management workshops. In addition, equivalent quality services that do not rely on a digital platform must continue to be offered in order to promote health equity. %M 36413622 %R 10.2196/38357 %U https://formative.jmir.org/2022/11/e38357 %U https://doi.org/10.2196/38357 %U http://www.ncbi.nlm.nih.gov/pubmed/36413622 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 11 %P e26041 %T Digital mHealth and Virtual Care Use During COVID-19 in 4 Countries: Rapid Landscape Review %A Müller,Alison %A Cau,Alessandro %A Muhammed,Semakula %A Abdullahi,Osman %A Hayward,Andrew %A Nsanzimana,Sabin %A Lester,Richard %+ Division of Infectious Diseases, Department of Medicine, University of British Columbia, 575 - Vancouver General Hospital Research Pavilion, 828 W 10th Ave, Vancouver, BC, V5Z1M9, Canada, 1 604 875 4111 ext 66294, amuller8@mail.ubc.ca %K COVID-19 %K virtual care %K public health %K mHealth %K contact tracing %K telehealth %K Canada %K United Kingdom %K Kenya %K Rwanda %K global health %K apps %D 2022 %7 30.11.2022 %9 Review %J JMIR Form Res %G English %X Background: As a result of the COVID-19 pandemic, providing health care while maintaining social distancing has resulted in the need to provide care remotely, support quarantined or isolated individuals, monitor infected individuals and their close contacts, as well as disseminate accurate information regarding COVID-19 to the public. This has led to an unprecedented rapid expansion of digital tools to provide digitized virtual care globally, especially mobile phone–facilitated health interventions, called mHealth. To help keep abreast of different mHealth and virtual care technologies being used internationally to facilitate patient care and public health during the COVID-19 pandemic, we carried out a rapid investigation of solutions being deployed and considered in 4 countries. Objective: The aim of this paper was to describe mHealth and the digital and contact tracing technologies being used in the health care management of the COVID-19 pandemic among 2 high-income and 2 low-middle income countries. Methods: We compared virtual care interventions used for COVID-19 management among 2 high-income countries (the United Kingdom and Canada) and 2 low-middle income (Kenya and Rwanda) countries. We focused on interventions used to facilitate patient care and public health. Information regarding specific virtual care technologies was procured from a variety of resources including gray literature, government and health organization websites, and coauthors’ personal experiences as implementers of COVID-19 virtual care strategies. Search engine queries were performed to find health information that would be easily accessible to the general public, with keywords including “COVID-19,” “contact-tracing,” “tool-kit,” “telehealth,” and “virtual care,” in conjunction with corresponding national health authorities. Results: We identified a variety of technologies in Canada, the United Kingdom, Rwanda, and Kenya being used for patient care and public health. These countries are using both video and text message–based platforms to facilitate communication with health care providers (eg, WelTel and Zoom). Nationally developed contact tracing apps are provided free to the public, with most of them using Bluetooth-based technology. We identified that often multiple complimentary technologies are being utilized for different aspects of patient care and public health with the common purpose to disseminate information safely. There was a negligible difference among the types of technologies used in both high-income and low-middle income countries, although the latter implemented virtual care interventions earlier during the pandemic’s first wave, which may account for their effective response. Conclusions: Virtual care and mHealth technologies have evolved rapidly as a tool for health care support for both patient care and public health. It is evident that, on an international level, a variety of mHealth and virtual care interventions, often in combination, are required to be able to address patient care and public health concerns during the COVID-19 pandemic, independent of a country’s economic standing. %M 34932498 %R 10.2196/26041 %U https://formative.jmir.org/2022/11/e26041 %U https://doi.org/10.2196/26041 %U http://www.ncbi.nlm.nih.gov/pubmed/34932498 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 10 %N 11 %P e40469 %T Visit Types in Primary Care With Telehealth Use During the COVID-19 Pandemic: Systematic Review %A Ward,Kanesha %A Vagholkar,Sanjyot %A Sakur,Fareeya %A Khatri,Neha Nafees %A Lau,Annie Y S %+ Centre for Health Informatics, Australian Institute for Health Innovation, Macquarie University, 75 Talavera Rd, North Ryde NSW, North Ryde, 2113, Australia, 61 48355552, kanesha_ward@iinet.net.au %K primary care %K general practitioners %K telehealth %K telemedicine %K COVID-19 %K remote consultation %K video consultation %K eHealth %D 2022 %7 28.11.2022 %9 Review %J JMIR Med Inform %G English %X Background: Telehealth was rapidly incorporated into primary care during the COVID-19 pandemic. However, there is limited evidence on which primary care visits used telehealth. Objective: The objective of this study was to conduct a systematic review to assess what visit types in primary care with use of telehealth during the COVID-19 pandemic were reported; for each visit type identified in primary care, under what circumstances telehealth was suitable; and reported benefits and drawbacks of using telehealth in primary care during the COVID-19 pandemic. Methods: This study was a systematic review using narrative synthesis. Studies were obtained from four databases (Ovid [MEDLINE], CINAHL Complete, PDQ-Evidence, and ProQuest) and gray literature (NSW Health, Royal Australian College of General Practitioners guidelines, and World Health Organization guidelines). In total, 3 independent reviewers screened studies featuring telehealth use during the COVID-19 pandemic in primary care. Levels of evidence were assessed according to the Grading of Recommendations Assessment, Development, and Evaluation. Critical appraisal was conducted using the Mixed Methods Appraisal Tool. Benefits and drawbacks of telehealth were assessed according to the National Quality Forum Telehealth Framework. Results: A total of 19 studies, predominately cross-sectional surveys or interviews (13/19, 68%), were included. Seven primary care visit types were identified: chronic condition management (17/19, 89%), existing patients (17/19, 89%), medication management (17/19, 89%), new patients (16/19, 84%), mental health/behavioral management (15/19, 79%), post–test result follow-up (14/19, 74%), and postdischarge follow-up (7/19, 37%). Benefits and drawbacks of telehealth were reported across all visit types, with chronic condition management being one of the visits reporting the greatest use because of a pre-existing patient-provider relationship, established diagnosis, and lack of complex physical examinations. Both patients and clinicians reported benefits of telehealth, including improved convenience, focused discussions, and continuity of care despite social distancing. Reported drawbacks included technical barriers, impersonal interactions, and semi-established reimbursement models. Conclusions: Telehealth was used for different visit types during the COVID-19 pandemic in primary care, with most visits for chronic condition management, existing patients, and medication management. Further research is required to validate our findings and explore the long-term impact of hybrid models of care for different visit types in primary care. Trial Registration: PROSPERO CRD42022312202; https://tinyurl.com/5n82znf4 %M 36265039 %R 10.2196/40469 %U https://medinform.jmir.org/2022/11/e40469 %U https://doi.org/10.2196/40469 %U http://www.ncbi.nlm.nih.gov/pubmed/36265039 %0 Journal Article %@ 2561-1011 %I JMIR Publications %V 6 %N 2 %P e39566 %T Racial and Socioeconomic Differences in Heart Failure Hospitalizations and Telemedicine Follow-up During the COVID-19 Pandemic: Retrospective Cohort Study %A Hughes,Zachary %A Simkowski,Julia %A Mendapara,Parry %A Fink,Nicolas %A Gupta,Sparsh %A Youmans,Quentin %A Khan,Sadiya %A Wilcox,Jane %A Mutharasan,R Kannan %+ Division of Cardiology, Northwestern University Feinberg School of Medicine, 676 N St Clair St, Arkes Suite 2330, Chicago, IL, United States, 1 3129266895, kannanm@northwestern.edu %K heart failure %K disparities %K disparity %K SARS-CoV-2 %K Coronavirus %K pandemic %K COVID-19 %K hospitalization %K telemedicine %K heart disease %K heart %K socioeconomic %K cardiology %K cardiac %K hospital admission %K intensive care unit %K ICU admission %K mortality %K inequality %K inequalities %K minority %K socioeconomic %K health disparity %K racial %K ethnic %D 2022 %7 28.11.2022 %9 Original Paper %J JMIR Cardio %G English %X Background: Low rates of heart failure (HF) hospitalizations were observed during the 2020 peak of the COVID-19 pandemic. Additionally, posthospitalization follow-up transitioned to a predominantly telemedicine model. It is unknown whether the shift to telemedicine impacted disparities in posthospitalization follow-up or HF readmissions. Objective: The aim of this paper is to determine whether the shift to telemedicine impacted racial and ethnic as well as socioeconomic disparities in acute decompensated heart failure (ADHF) follow-up and HF readmissions. We additionally sought to investigate the impact of the COVID-19 pandemic on the severity of ADHF hospitalizations. Methods: This was a retrospective cohort study of HF admissions across 8 participating hospitals during the initial peak of the COVID-19 pandemic (March 15 to June 1, 2020), compared to the same time frame in 2019. Patients were stratified by race, ethnicity, and median neighborhood income. Hospital and intensive care unit (ICU) admission rates, inpatient mortality, 7-day follow-up, and 30-day readmissions were assessed. Results: From March 15, 2019, to June 1, 2020, there were 1162 hospitalizations for ADHF included in the study. There were significantly fewer admissions for ADHF in 2020, compared with 2019 (442 vs 720; P<.001). Patients in 2020 had higher rates of ICU admission, compared with 2019 (15.8% vs 11.1%; P=.02). This trend was seen across all subgroups and was significant for patients from the highest income quartile (17.89% vs 10.99%; P=.02). While there was a trend toward higher inpatient mortality in 2020 versus 2019 (4.3% vs 2.8%; P=.17), no difference was seen among different racial and socioeconomic groups. Telemedicine comprised 81.6% of 7-day follow-up in 2020, with improvement in 7-day follow-up rates (40.5% vs 29.6%; P<.001). Inequities in 7-day follow-up for patients from non-Hispanic Black racial backgrounds compared to those from non-Hispanic White backgrounds decreased during the pandemic. Additionally, those with telemedicine follow-up were less likely to be readmitted in 30 days when compared to no follow-up (13.8% vs 22.4%; P=.03). Conclusions: There were no major differences in HF ICU admissions or inpatient mortality for different racial and socioeconomic groups during the COVID-19 pandemic. Inequalities in 7-day follow-up were reduced with the advent of telemedicine and decreased 30-day readmission rates for those who had telemedicine follow-up. %M 36409959 %R 10.2196/39566 %U https://cardio.jmir.org/2022/2/e39566 %U https://doi.org/10.2196/39566 %U http://www.ncbi.nlm.nih.gov/pubmed/36409959 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 11 %P e41847 %T The Impact of the COVID-19 Pandemic on eHealth Use in the Daily Practice and Life of Dutch-Speaking General Practitioners in Belgium: Qualitative Study With Semistructured Interviews %A Yagiz,Jan Ismail %A Goderis,Geert %+ Leuven Institute for Healthcare Policy, Medical Faculty, KU Leuven, Kapucijnenvoer 35, blok d - bus 7001 - 3rd floor, Leuven, 3000, Belgium, 32 16 32 12 59, yagizmd@msn.com %K COVID-19 %K impact %K eHealth %K GPs %K Flemish %K practice %K qualitative study %K semistructured interviews %D 2022 %7 28.11.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 crisis has led to rapid and far-reaching changes in digital health care, but little is known about what, why, and how changes occurred in eHealth use in Flemish general practice during the pandemic. Objective: This study aims to understand how general practitioners (GPs) perceive and evaluate eHealth solutions and their eHealth experience during the COVID-19 pandemic. Methods: This qualitative study was conducted using in-depth 1-on-1 semistructured interviews with the help of an interview guide. Several areas were identified beforehand to help assess the impact of the COVID-19 pandemic: perceptions of digital technologies in GP practices; changes in the use of these technologies during and after the COVID-19 pandemic; GPs’ adaptation to digitalization, benefits, risks, and challenges of eHealth; GPs motivations to change practice; and future perspectives on eHealth. In this study, purposive sampling and snowballing methods were used. Between October 2021 and April 2022, we interviewed 15 Dutch-speaking GPs in the Flemish region via the Zoom online conferencing tool. Results: GPs indicated that eHealth was used more frequently during the COVID-19 pandemic than before, a change that helped them reduce their workload, enabling greater accessibility to health care services and the complementary use of digital and physical consultations. Our findings suggest that physicians underwent a significant cognitive shift in their perceptions, causing them to be more open and prepared to adopt eHealth solutions. However, there remains significant doubt and uncertainty about digital literacy for certain groups, privacy, data security, reimbursement, and the burden of technical information and communication technologies (ICT) issues. Conclusions: The COVID-19 pandemic seems to have been a turning point for eHealth by Flemish GPs. eHealth is an essential complementary health care service that can reduce pressure on health care as well as increase health care accessibility. Sensitive aspects, such as privacy, data security, digital literacy, reimbursement, and the burden of technical ICT issues, are particularly emphasized. With our results, we can offer recommendations to health IT policymakers and developers that will help maintain the continuity of eHealth solutions beyond the COVID-19 pandemic, considering the expectations and sensitivities presented in the study. %M 36399650 %R 10.2196/41847 %U https://formative.jmir.org/2022/11/e41847 %U https://doi.org/10.2196/41847 %U http://www.ncbi.nlm.nih.gov/pubmed/36399650 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 11 %P e40866 %T New Surveillance Metrics for Alerting Community-Acquired Outbreaks of Emerging SARS-CoV-2 Variants Using Imported Case Data: Bayesian Markov Chain Monte Carlo Approach %A Yen,Amy Ming-Fang %A Chen,Tony Hsiu-Hsi %A Chang,Wei-Jung %A Lin,Ting-Yu %A Jen,Grace Hsiao-Hsuan %A Hsu,Chen-Yang %A Wang,Sen-Te %A Dang,Huong %A Chen,Sam Li-Sheng %+ School of Oral Hygiene, College of Oral Medicine, Taipei Medical University, No 250, Wuxing St, Taipei, 110, Taiwan, 886 27361661 ext 5211, samchen@tmu.edu.tw %K COVID-19 %K imported case %K surveillance metric %K early detection %K community-acquired outbreak %D 2022 %7 25.11.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Global transmission from imported cases to domestic cluster infections is often the origin of local community-acquired outbreaks when facing emerging SARS-CoV-2 variants. Objective: We aimed to develop new surveillance metrics for alerting emerging community-acquired outbreaks arising from new strains by monitoring the risk of small domestic cluster infections originating from few imported cases of emerging variants. Methods: We used Taiwanese COVID-19 weekly data on imported cases, domestic cluster infections, and community-acquired outbreaks. The study period included the D614G strain in February 2020, the Alpha and Delta variants of concern (VOCs) in 2021, and the Omicron BA.1 and BA.2 VOCs in April 2022. The number of cases arising from domestic cluster infection caused by imported cases (Dci/Imc) per week was used as the SARS-CoV-2 strain-dependent surveillance metric for alerting local community-acquired outbreaks. Its upper 95% credible interval was used as the alert threshold for guiding the rapid preparedness of containment measures, including nonpharmaceutical interventions (NPIs), testing, and vaccination. The 2 metrics were estimated by using the Bayesian Monte Carlo Markov Chain method underpinning the directed acyclic graphic diagram constructed by the extra-Poisson (random-effect) regression model. The proposed model was also used to assess the most likely week lag of imported cases prior to the current week of domestic cluster infections. Results: A 1-week lag of imported cases prior to the current week of domestic cluster infections was considered optimal. Both metrics of Dci/Imc and the alert threshold varied with SARS-CoV-2 variants and available containment measures. The estimates were 9.54% and 12.59%, respectively, for D614G and increased to 14.14% and 25.10%, respectively, for the Alpha VOC when only NPIs and testing were available. The corresponding figures were 10.01% and 13.32% for the Delta VOC, but reduced to 4.29% and 5.19% for the Omicron VOC when NPIs, testing, and vaccination were available. The rapid preparedness of containment measures guided by the estimated metrics accounted for the lack of community-acquired outbreaks during the D614G period, the early Alpha VOC period, the Delta VOC period, and the Omicron VOC period between BA.1 and BA.2. In contrast, community-acquired outbreaks of the Alpha VOC in mid-May 2021, Omicron BA.1 VOC in January 2022, and Omicron BA.2 VOC from April 2022 onwards, were indicative of the failure to prepare containment measures guided by the alert threshold. Conclusions: We developed new surveillance metrics for estimating the risk of domestic cluster infections with increasing imported cases and its alert threshold for community-acquired infections varying with emerging SARS-CoV-2 strains and the availability of containment measures. The use of new surveillance metrics is important in the rapid preparedness of containment measures for averting large-scale community-acquired outbreaks arising from emerging imported SARS-CoV-2 variants. %M 36265134 %R 10.2196/40866 %U https://publichealth.jmir.org/2022/11/e40866 %U https://doi.org/10.2196/40866 %U http://www.ncbi.nlm.nih.gov/pubmed/36265134 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 2 %N 2 %P e38441 %T COVID-19 Messaging on Social Media for American Indian and Alaska Native Communities: Thematic Analysis of Audience Reach and Web Behavior %A Weeks,Rose %A White,Sydney %A Hartner,Anna-Maria %A Littlepage,Shea %A Wolf,Jennifer %A Masten,Kristin %A Tingey,Lauren %+ Center for Indigenous Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 415 N Washington Street, 5th Floor, Baltimore, MD, 21231, United States, 1 443 287 4832, rweeks@jhu.edu %K COVID-19 %K American Indian or Alaska Native %K social media %K communication %K tribal organization %K community health %K infodemiology %K Twitter %K online behavior %K content analysis %K thematic analysis %D 2022 %7 25.11.2022 %9 Original Paper %J JMIR Infodemiology %G English %X Background: During the COVID-19 pandemic, tribal and health organizations used social media to rapidly disseminate public health guidance highlighting protective behaviors such as masking and vaccination to mitigate the pandemic’s disproportionate burden on American Indian and Alaska Native (AI/AN) communities. Objective: Seeking to provide guidance for future communication campaigns prioritizing AI/AN audiences, this study aimed to identify Twitter post characteristics associated with higher performance, measured by audience reach (impressions) and web behavior (engagement rate). Methods: We analyzed Twitter posts published by a campaign by the Johns Hopkins Center for Indigenous Health from July 2020 to June 2021. Qualitative analysis was informed by in-depth interviews with members of a Tribal Advisory Board and thematically organized according to the Health Belief Model. A general linearized model was used to analyze associations between Twitter post themes, impressions, and engagement rates. Results: The campaign published 162 Twitter messages, which organically generated 425,834 impressions and 6016 engagements. Iterative analysis of these Twitter posts identified 10 unique themes under theory- and culture-related categories of framing knowledge, cultural messaging, normalizing mitigation strategies, and interactive opportunities, which were corroborated by interviews with Tribal Advisory Board members. Statistical analysis of Twitter impressions and engagement rate by theme demonstrated that posts featuring culturally resonant community role models (P=.02), promoting web-based events (P=.002), and with messaging as part of Twitter Chats (P<.001) were likely to generate higher impressions. In the adjusted analysis controlling for the date of posting, only the promotion of web-based events (P=.003) and Twitter Chat messaging (P=.01) remained significant. Visual, explanatory posts promoting self-efficacy (P=.01; P=.01) and humorous posts (P=.02; P=.01) were the most likely to generate high–engagement rates in both the adjusted and unadjusted analysis. Conclusions: Results from the 1-year Twitter campaign provide lessons to inform organizations designing social media messages to reach and engage AI/AN social media audiences. The use of interactive events, instructional graphics, and Indigenous humor are promising practices to engage community members, potentially opening audiences to receiving important and time-sensitive guidance. %M 36471705 %R 10.2196/38441 %U https://infodemiology.jmir.org/2022/2/e38441 %U https://doi.org/10.2196/38441 %U http://www.ncbi.nlm.nih.gov/pubmed/36471705 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 4 %P e40110 %T International Collaboration to Develop a Remote Monitoring Web App for COVID-19 Patients in Armenia: Design and Development With Agile Methodology %A Sikder,Abu %A Dickhoner,James %A Kysh,Lynn %A Musheghyan,Lusine %A Shekherdimian,Shant %A Levine,Barry %A Espinoza,Juan %+ Department of Pediatrics, Keck School of Medicine, University of Southern California, 4650 Sunset Blvd, Los Angeles, CA, 90027, United States, 1 323 660 2450, jespinoza@chla.usc.edu %K COVID-19 %K global health %K software %K mHealth %K Armenia %K web app %K home monitoring %K software development %K human-centered design %K remote monitoring %K patient care %D 2022 %7 25.11.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: COVID-19 has led to over 500 million cases and 6.2 million deaths around the world. Low- and middle-income countries (LMICs) like Armenia face unique infrastructure, financial, and capacity challenges that in many cases result in worse outcomes. Health care facilities across Armenia experienced a shortage of resources, including hospital beds and oxygen, which was further exacerbated by the war with neighboring Azerbaijan. Without a framework for home-based care, health care facilities were severely strained by COVID-19 patients who had prolonged oxygen requirements but were otherwise clinically stable. Objective: This paper describes our approach to establishing an international collaboration to develop a web app to support home monitoring of patients with COVID-19 with persistent oxygen requirements. Methods: The app was developed using a rapid, coordinated, and collaborative approach involving an international group of clinicians, developers, and collaborators. Health screening, monitoring, and discharge forms were developed into a lightweight OpenMRS web app and customized for the local Armenian context. Results: The software was designed and developed over 2 months using human-centered design and agile sprints. Once live, 5087 patient records were created for 439 unique patients. Conclusions: This project suggests a promising framework for designing and implementing remote monitoring programs in LMICs, despite pandemic and geopolitical challenges. %M 36350739 %R 10.2196/40110 %U https://humanfactors.jmir.org/2022/4/e40110 %U https://doi.org/10.2196/40110 %U http://www.ncbi.nlm.nih.gov/pubmed/36350739 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 8 %N 4 %P e39012 %T Scientific Publications on Nursing for COVID-19 in Patients With Cancer: Scoping Review %A Lima,Vivian Cristina Gama Souza %A Soares,Raquel de Souza %A Santos,Willian Alves dos %A Alves,Paulo %A Fuly,Patricia dos Santos Claro %+ Academic Program in Health Care Sciences, Fluminense Federal University, Rua Doutor Celestino, 74 - Centro, Niterói - RJ, 24020-091, Brazil, 55 21 2629 5215, vcgslima@gmail.com %K COVID-19 %K review %K nursing %K coronavirus infection %K oncology nursing %D 2022 %7 25.11.2022 %9 Review %J JMIR Cancer %G English %X Background: The needs of patients with cancer must be met, especially in times of crisis. The advent of the pandemic triggered a series of strategic actions by the nursing team to preserve the health of patients and professionals—hence the importance of studies on nursing care actions provided to patients with cancer during the COVID-19 pandemic. It is known that these patients are susceptible to severe COVID-19. However, no previous review has summarized the findings of scientific studies on nursing for COVID-19 in patients with cancer. Objective: This study aims to map the topics addressed in scientific studies on nursing for COVID-19 in patients with cancer. Methods: A scoping review was conducted using the methodology described in the Joanna Briggs Institute Reviewers' Manual 2015. The research question was elaborated using the population, concept, and context framework: What topics have been studied in nursing publications about COVID-19 in adult patients with cancer? The searches were carried out in 8 databases between April and November 2021 without time restrictions. Results: In total, 973 publications were identified using the search strategies in the databases, and 12 papers were retrieved by consulting the references. A total of 31 (3.2%) publications were included in the final analysis, generating 4 thematic categories on the subject: “restructuring the services: how oncology nursing was adapted during the pandemic,” “experiences of patients and performance of the nursing team during the COVID-19 pandemic,” “protocols and recommendations for dealing with the COVID-19 pandemic,” and “challenges and the role of oncology nurses facing the COVID-19 pandemic.” Conclusions: Several strategies used by oncology nurses to face the COVID-19 pandemic in the international scenario were identified. Reports about the restructuring of services and the team's reactions to the pandemic predominated. However, there is a lack of reports regarding emotional support strategies for health care professionals. Another gap identified was the scarcity of clinical studies on the activities developed by oncology nurses. Therefore, there is a need for clinical research in the oncology area and emotional coping strategies to support oncology nurses. %M 36219752 %R 10.2196/39012 %U https://cancer.jmir.org/2022/4/e39012 %U https://doi.org/10.2196/39012 %U http://www.ncbi.nlm.nih.gov/pubmed/36219752 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 11 %P e39185 %T Lessons Learned From the SoBeezy Program for Older Adults During the COVID-19 Pandemic: Experimentation and Evaluation %A Pech,Marion %A Gbessemehlan,Antoine %A Dupuy,Lucile %A Sauzéon,Hélène %A Lafitte,Stéphane %A Bachelet,Philippe %A Amieva,Hélène %A Pérès,Karine %+ Bordeaux Population Health Research Center, Inserm, UMR 1219, University of Bordeaux, 146 rue Léo Saignat, Bordeaux, 33076, France, 33 667455145, marion.pech@u-bordeaux.fr %K voice assistance %K social isolation %K healthy aging %K living in place %K acceptability %K technologies %K digital divide %K older adults %K aging %K elderly population %K voice assistant %K COVID-19 %D 2022 %7 24.11.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The SoBeezy program is an innovative intervention aimed at promoting and fostering healthy aging and aging in place by proposing to older adults concrete solutions to face daily life, tackle loneliness, promote social participation, and reduce the digital divide, thanks to a specific, easy-to-use voice assistant (the BeeVA smart display). Objective: This study aims to assess the acceptability of the SoBeezy program and its voice assistant and to identify potential areas of improvement. Methods: A 12-month experimentation of the program was deployed in real-life conditions among older adults living in the community in 4 pilot cities of France. Launched during the first lockdown of the COVID-19 crisis, this multisite study aimed to assess acceptability using questionnaires and interviews conducted at baseline and at the end of the experimentation. In addition, a series of meetings were conducted with SoBeezy staff members to obtain direct feedback from the ground. Results: In total, 109 older individuals were equipped with BeeVA to use the SoBeezy program; of these, 32 (29.4%) left the experimentation before its end and 69 (63.3%) completed the final questionnaires. In total, 335 interventions were conducted and 27 (39%) of the participants requested services, mainly for supportive calls and visits and assistance with shopping, transportation, and crafting-gardening. Of the whole sample, 52 (75%) considered BeeVA as a reassuring presence, and few persons (15/69, 22%) reported a negative opinion about the program. Among the participants, the voice assistant appeared easy to use (n=57, 82%) and useful (n=53, 77%). They also were positive about the BeeVA smart display and the SoBeezy intervention. Conclusions: This multisite study conducted in real-life conditions among more than 100 older adults living in the community provides enlightening results of the reality from the ground of digital tools designed for the aging population. The COVID-19 context appeared both as an opportunity, given the massive needs of the older adults during this crisis, and as limiting due to sanitary constraints. Nevertheless, the experimentation showed overall good acceptability of the voice assistant and a high level of satisfaction of the participants among those who really used the system and could be a way of improving the autonomy and well-being of older adults and their families. However, the findings also highlighted resistance to change and difficulties for the users to ask for help. The experimentation also emphasized levers for next deployments and future research. The next step will be the experimentation of the activity-sharing component that could not be tested due to the COVID-19 context. %M 36355629 %R 10.2196/39185 %U https://formative.jmir.org/2022/11/e39185 %U https://doi.org/10.2196/39185 %U http://www.ncbi.nlm.nih.gov/pubmed/36355629 %0 Journal Article %@ 1947-2579 %I JMIR Publications %V 14 %N 1 %P e12449 %T Roles of Health Literacy in Relation to Social Determinants of Health and Recommendations for Informatics-Based Interventions: Systematic Review %D 2022 %7 ..2022 %9 %J Online J Public Health Inform %G English %X ObjectivesHealth department personnel conduct daily active symptom monitoring for persons potentially exposed to SARS-CoV-2. This can be resource-intensive. Automation and digital tools can improve efficiency. We describe use of a digital tool, Sara Alert, for automated daily symptom monitoring across multiple public health jurisdictions.MethodsEleven of the 20 U.S. public health jurisdictions using Sara Alert provided average daily activity data during June 29 to August 30, 2021. Data elements included demographics, communication preferences, timeliness of symptom monitoring initiation, responsiveness to daily messages, and reports of symptoms.ResultsParticipating jurisdictions served a U.S. population of over 22 million persons. Health department personnel used this digital tool to monitor more than 12,000 persons per day on average for COVID-19 symptoms. On average, monitoring began 3.9 days following last exposure and was conducted for an average of 5.7 days. Monitored persons were frequently < 18 years old (45%, 5,474/12,450) and preferred communication via text message (47%). Seventy-four percent of monitored persons responded to at least one daily automated symptom message.ConclusionsIn our geographically diverse sample, we found that use of an automated digital tool might improve public health capacity for daily symptom monitoring, allowing staff to focus their time on interventions for persons most at risk or in need of support. Future work should include identifying jurisdictional successes and challenges implementing digital tools; the effectiveness of digital tools in identifying symptomatic individuals, ensuring appropriate isolation, and testing to disrupt transmission; and impact on public health staff efficiency and program costs. %M 36457349 %R 10.5210/ojphi.v14i1.12449 %U %U https://doi.org/10.5210/ojphi.v14i1.12449 %U http://www.ncbi.nlm.nih.gov/pubmed/36457349 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 11 %N 2 %P e40289 %T Association of Continuously Measured Vital Signs With Respiratory Insufficiency in Hospitalized COVID-19 Patients: Retrospective Cohort Study %A van Goor,Harriet M R %A Vernooij,Lisette M %A Breteler,Martine J M %A Kalkman,Cor J %A Kaasjager,Karin A H %A van Loon,Kim %+ Department of Anesthesiology, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, 3584CX, Netherlands, 31 887567967, h.m.r.vangoor-3@umcutrecht.nl %K continuous monitoring %K vital sign monitoring %K COVID-19 %K general ward %K vital sign %K monitoring %K respiration %K data %K respiratory insufficiency %K cohort study %K respiratory rate %K heart rate %K oxygen %K clinical %D 2022 %7 23.11.2022 %9 Original Paper %J Interact J Med Res %G English %X Background: Continuous monitoring of vital signs has the potential to assist in the recognition of deterioration of patients admitted to the general ward. However, methods to efficiently process and use continuously measured vital sign data remain unclear. Objective: The aim of this study was to explore methods to summarize continuously measured vital sign data and evaluate their association with respiratory insufficiency in COVID-19 patients at the general ward. Methods: In this retrospective cohort study, we included patients admitted to a designated COVID-19 cohort ward equipped with continuous vital sign monitoring. We collected continuously measured data of respiratory rate, heart rate, and oxygen saturation. For each patient, 7 metrics to summarize vital sign data were calculated: mean, slope, variance, occurrence of a threshold breach, number of episodes, total duration, and area above/under a threshold. These summary measures were calculated over timeframes of either 4 or 8 hours, with a pause between the last data point and the endpoint (the “lead”) of 4, 2, 1, or 0 hours, and with 3 predefined thresholds per vital sign. The association between each of the summary measures and the occurrence of respiratory insufficiency was calculated using logistic regression analysis. Results: Of the 429 patients that were monitored, 334 were included for analysis. Of these, 66 (19.8%) patients developed respiratory insufficiency. Summarized continuously measured vital sign data in timeframes close to the endpoint showed stronger associations than data measured further in the past (ie, lead 0 vs 1, 2, or 4 hours), and summarized estimates over 4 hours of data had stronger associations than estimates taken over 8 hours of data. The mean was consistently strongly associated with respiratory insufficiency for the three vital signs: in a 4-hour timeframe without a lead, the standardized odds ratio for heart rate, respiratory rate, and oxygen saturation was 2.59 (99% CI 1.74-4.04), 5.05 (99% CI 2.87-10.03), and 3.16 (99% CI 1.78-6.26), respectively. The strength of associations of summary measures varied per vital sign, timeframe, and lead. Conclusions: The mean of a vital sign showed a relatively strong association with respiratory insufficiency for the majority of vital signs and timeframes. The type of vital sign, length of the timeframe, and length of the lead influenced the strength of associations. Highly associated summary measures and their combinations could be used in a clinical prediction score or algorithm for an automatic alarm system. %M 36256803 %R 10.2196/40289 %U https://www.i-jmr.org/2022/2/e40289 %U https://doi.org/10.2196/40289 %U http://www.ncbi.nlm.nih.gov/pubmed/36256803 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 11 %P e40089 %T The Use of a Health Compliance Monitoring System During the COVID-19 Pandemic in Indonesia: Evaluation Study %A Aisyah,Dewi Nur %A Manikam,Logan %A Kiasatina,Thifal %A Naman,Maryan %A Adisasmito,Wiku %A Kozlakidis,Zisis %+ Department of Epidemiology and Public Health, Institute of Epidemiology and Health Care, University College London, 1-19 Torrington Place, London, WC1E 7HB, United Kingdom, 44 207 679 2000, logan.manikam.10@ucl.ac.uk %K COVID-19, public health informatics %K behavioral change %K digital health %K public health policy %K monitoring %K Asia %K mask %K social distance %K mobile app %K app %K transmission %K policy %K health compliance %D 2022 %7 22.11.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: COVID-19 cases are soaring in Asia. Indonesia, Southeast Asia’s most populous country, is now ranked second in the number of cases and deaths in Asia, after India. The compliance toward mask wearing, social distancing, and hand washing needs to be monitored to assess public behavioral changes that can reduce transmission. Objective: This study aimed to evaluate this compliance in Indonesia between October 2020 and May 2021 and demonstrate the use of the Bersatu Lawan COVID-19 (BLC) mobile app in monitoring this compliance. Methods: Data were collected in real time by the BLC app from reports submitted by personnel of military services, police officers, and behavioral change ambassadors. Subsequently, the data were analyzed automatically by the system managed by the Indonesia National Task Force for the Acceleration of COVID-19 Mitigation. Results: Between October 1, 2020, and May 2, 2021, the BLC app generated more than 165 million reports, with 469 million people monitored and 124,315,568 locations under observation in 514 districts/cities in 34 provinces in Indonesia. This paper grouped them into 4 colored zones, based on the degree of compliance, and analyzed variations among regions and locations. Conclusions: Compliance rates vary among the 34 provinces and among the districts and cities of those provinces. However, compliance to mask wearing seems slightly higher than social distancing. This finding suggests that policy makers need to promote higher compliance in other measures, including social distancing and hand washing, whose efficacies have been proven to break the chain of transmission when combined with masks wearing. %M 36219836 %R 10.2196/40089 %U https://publichealth.jmir.org/2022/11/e40089 %U https://doi.org/10.2196/40089 %U http://www.ncbi.nlm.nih.gov/pubmed/36219836 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 2 %N 2 %P e39849 %T Identifying Profiles and Symptoms of Patients With Long COVID in France: Data Mining Infodemiology Study Based on Social Media %A Déguilhem,Amélia %A Malaab,Joelle %A Talmatkadi,Manissa %A Renner,Simon %A Foulquié,Pierre %A Fagherazzi,Guy %A Loussikian,Paul %A Marty,Tom %A Mebarki,Adel %A Texier,Nathalie %A Schuck,Stephane %+ Kap Code, 146 Rue Montmartre, Paris, 75002, France, 33 09 72 60 57 55, malaabjoelle@gmail.com %K long COVID %K social media %K Long Haulers %K difficulties encountered %K symptoms %K infodemiology study %K infodemiology %K symptoms %K COVID-19 %K patient-reported outcomes %K persistent %K condition %K topics %K discussion %K social media %K content %D 2022 %7 22.11.2022 %9 Original Paper %J JMIR Infodemiology %G English %X Background: Long COVID—a condition with persistent symptoms post COVID-19 infection—is the first illness arising from social media. In France, the French hashtag #ApresJ20 described symptoms persisting longer than 20 days after contracting COVID-19. Faced with a lack of recognition from medical and official entities, patients formed communities on social media and described their symptoms as long-lasting, fluctuating, and multisystemic. While many studies on long COVID relied on traditional research methods with lengthy processes, social media offers a foundation for large-scale studies with a fast-flowing outburst of data. Objective: We aimed to identify and analyze Long Haulers’ main reported symptoms, symptom co-occurrences, topics of discussion, difficulties encountered, and patient profiles. Methods: Data were extracted based on a list of pertinent keywords from public sites (eg, Twitter) and health-related forums (eg, Doctissimo). Reported symptoms were identified via the MedDRA dictionary, displayed per the volume of posts mentioning them, and aggregated at the user level. Associations were assessed by computing co-occurrences in users’ messages, as pairs of preferred terms. Discussion topics were analyzed using the Biterm Topic Modeling; difficulties and unmet needs were explored manually. To identify patient profiles in relation to their symptoms, each preferred term’s total was used to create user-level hierarchal clusters. Results: Between January 1, 2020, and August 10, 2021, overall, 15,364 messages were identified as originating from 6494 patients of long COVID or their caregivers. Our analyses revealed 3 major symptom co-occurrences: asthenia-dyspnea (102/289, 35.3%), asthenia-anxiety (65/289, 22.5%), and asthenia-headaches (50/289, 17.3%). The main reported difficulties were symptom management (150/424, 35.4% of messages), psychological impact (64/424,15.1%), significant pain (51/424, 12.0%), deterioration in general well-being (52/424, 12.3%), and impact on daily and professional life (40/424, 9.4% and 34/424, 8.0% of messages, respectively). We identified 3 profiles of patients in relation to their symptoms: profile A (n=406 patients) reported exclusively an asthenia symptom; profile B (n=129) expressed anxiety (n=129, 100%), asthenia (n=28, 21.7%), dyspnea (n=15, 11.6%), and ageusia (n=3, 2.3%); and profile C (n=141) described dyspnea (n=141, 100%), and asthenia (n=45, 31.9%). Approximately 49.1% of users (79/161) continued expressing symptoms after more than 3 months post infection, and 20.5% (33/161) after 1 year. Conclusions: Long COVID is a lingering condition that affects people worldwide, physically and psychologically. It impacts Long Haulers’ quality of life, everyday tasks, and professional activities. Social media played an undeniable role in raising and delivering Long Haulers’ voices and can potentially rapidly provide large volumes of valuable patient-reported information. Since long COVID was a self-titled condition by patients themselves via social media, it is imperative to continuously include their perspectives in related research. Our results can help design patient-centric instruments to be further used in clinical practice to better capture meaningful dimensions of long COVID. %M 36447795 %R 10.2196/39849 %U https://infodemiology.jmir.org/2022/2/e39849 %U https://doi.org/10.2196/39849 %U http://www.ncbi.nlm.nih.gov/pubmed/36447795 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 4 %P e39312 %T Reinterpretation of Health Information in the Context of an Emerging Infectious Disease: A Digital Focus Group Study %A Tan,Rayner Kay Jin %A Lim,Jane Mingjie %A Neo,Pearlyn Hui Min %A Ong,Suan Ee %+ University of North Carolina Project-China, 2 Lujing Road, Guangzhou, 510095, China, 65 91878576, rayner.tan@nus.edu.sg %K health communication %K infodemic %K SARS-CoV-2 %K coronavirus %K Singapore %K WhatsApp %K COVID-19 %K health information %K misinformation %K mobile health %K smartphone %K information quality %K online health information %D 2022 %7 22.11.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Misinformation related to the COVID-19 pandemic has accelerated global public concern and panic. The glut of information, or “infodemic,” has caused concern for authorities due to its negative impacts on COVID-19 prevention and control, spurring calls for a greater scholarly focus on health literacy during the pandemic. Nevertheless, few studies have sought to qualitatively examine how individuals interpreted and assimilated health information at the initial wave of COVID-19 restrictions. Objective: We developed this qualitative study adopting chat-based focus group discussions to investigate how individuals interpreted COVID-19 health information during the first wave of COVID-19 restrictions. Methods: We conducted a qualitative study in Singapore to investigate how individuals perceive and interpret information that they receive on COVID-19. Data were generated through online focus group discussions conducted on the mobile messaging smartphone app WhatsApp. From March 28 to April 13, 2020, we held eight WhatsApp-based focus groups (N=60) with participants stratified by age groups, namely 21-30 years, 31-40 years, 41-50 years, and 51 years and above. Data were thematically analyzed. Results: A total of four types of COVID-19 health information were generated from the thematic analysis, labeled as formal health information, informal health information, suspicious health information, and fake health information, respectively. How participants interpreted these categories of information depended largely on the perceived trustworthiness of the information source as well as the perceived veracity of information. Both factors were instrumental in determining individuals’ perceptions, and their subsequent treatment and assimilation of COVID-19–related information. Conclusions: Both perceived trustworthiness of the information source and perceived veracity of information were instrumental concepts in determining one’s perception, and thus subsequent treatment and assimilation of such information for one’s knowledge of COVID-19 or the onward propagation to their social networks. These findings have implications for how policymakers and health authorities communicate with the public and deal with fake health information in the context of COVID-19. %M 36099011 %R 10.2196/39312 %U https://humanfactors.jmir.org/2022/4/e39312 %U https://doi.org/10.2196/39312 %U http://www.ncbi.nlm.nih.gov/pubmed/36099011 %0 Journal Article %@ 2561-1011 %I JMIR Publications %V 6 %N 2 %P e40764 %T Analyzing Public Conversations About Heart Disease and Heart Health on Facebook From 2016 to 2021: Retrospective Observational Study Applying Latent Dirichlet Allocation Topic Modeling %A Xue,Haoning %A Zhang,Jingwen %A Sagae,Kenji %A Nishimine,Brian %A Fukuoka,Yoshimi %+ Department of Communication, University of California, One Shields Avenue, Davis, CA, 95616, United States, 1 5303048532, hnxue@ucdavis.edu %K heart health %K heart disease %K topic modeling %K sentiment analysis %K social media %K Facebook %K COVID-19 %K women’s heart health %D 2022 %7 22.11.2022 %9 Original Paper %J JMIR Cardio %G English %X Background: Heart disease continues to be the leading cause of death in men and women in the United States. The COVID-19 pandemic has further led to increases in various long-term cardiovascular complications. Objective: This study analyzed public conversations related to heart disease and heart health on Facebook in terms of their thematic topics and sentiments. In addition, it provided in-depth analyses of 2 subtopics with important practical implications: heart health for women and heart health during the COVID-19 pandemic. Methods: We collected 34,885 posts and 51,835 comments spanning from June 2016 to June 2021 that were related to heart disease and health from public Facebook pages and groups. We used latent Dirichlet allocation topic modeling to extract discussion topics illuminating the public’s interests and concerns regarding heart disease and heart health. We also used Linguistic Inquiry and Word Count (Pennebaker Conglomerates, Inc) to identify public sentiments regarding heart health. Results: We observed an increase in discussions related to heart health on Facebook. Posts and comments increased from 3102 and 3632 in 2016 to 8550 (176% increase) and 14,617 (302% increase) in 2021, respectively. Overall, 35.37% (12,340/34,885) of the posts were created after January 2020, the start of the COVID-19 pandemic. In total, 39.21% (13,677/34,885) of the posts were by nonprofit health organizations. We identified 6 topics in the posts (heart health promotion, personal experiences, risk-reduction education, heart health promotion for women, educational information, and physicians’ live discussion sessions). We identified 6 topics in the comments (personal experiences, survivor stories, risk reduction, religion, medical questions, and appreciation of physicians and information on heart health). During the pandemic (from January 2020 to June 2021), risk reduction was a major topic in both posts and comments. Unverified information on alternative treatments and promotional content was also prevalent. Among all posts, 14.91% (5200/34,885) were specifically about heart health for women centering on local event promotion and distinctive symptoms of heart diseases for women. Conclusions: Our results tracked the public’s ongoing discussions on heart disease and heart health on one prominent social media platform, Facebook. The public’s discussions and information sharing on heart health increased over time, especially since the start of the COVID-19 pandemic. Various levels of health organizations on Facebook actively promoted heart health information and engaged a large number of users. Facebook presents opportunities for more targeted heart health interventions that can reach and engage diverse populations. %M 36318640 %R 10.2196/40764 %U https://cardio.jmir.org/2022/2/e40764 %U https://doi.org/10.2196/40764 %U http://www.ncbi.nlm.nih.gov/pubmed/36318640 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 9 %N 4 %P e42157 %T The Impact of COVID-19 Lockdown Restrictions on Exercise Behavior Among People With Multiple Sclerosis Enrolled in an Exercise Trial: Qualitative Interview Study %A Palmer,Louise C %A Neal,Whitney N %A Motl,Robert W %A Backus,Deborah %+ Crawford Research Institute, Shepherd Center, 2020 Peachtree Rd NW, Atlanta, GA, 30309, United States, 1 404 350 7513, louise.palmer@shepherd.org %K multiple sclerosis %K exercise %K physical activity %K COVID-19 %K COVID-19 lockdown restrictions %K telerehabilitation %K interview study %D 2022 %7 22.11.2022 %9 Original Paper %J JMIR Rehabil Assist Technol %G English %X Background: During spring and summer 2020, US states implemented COVID-19 pandemic restrictions, resulting in the closure of rehabilitation facilities and, with them, some of the clinical trials that were taking place. One such trial was the Supervised Versus Telerehabilitation Exercise Program for Multiple Sclerosis (“STEP for MS”) comparative effectiveness multiple sclerosis (MS) exercise trial. Although 1 study arm was implemented via telerehabilitation, the comparative arm took place in rehabilitation facilities nationwide and was subsequently closed during this time frame. The experience of the STEP for MS participants provides insights into the impact of lockdown restrictions on exercise behavior by mode of exercise delivery (telerehabilitation vs conventional facility based). Objective: This study sought to understand the impact of COVID-19 lockdown restrictions on exercise behavior among people with MS enrolled in an exercise trial at the time of the restrictions. Methods: Semistructured phone and video interviews were conducted with a convenience sample of 8 participants representing both arms of the exercise trial. We applied reflexive thematic analysis to identify, analyze, and interpret common themes in the data. Results: We identified 7 main themes and 2 different narratives describing the exercise experiences during lockdown restrictions. Although the telerehabilitation participants continued exercising without interruption, facility-based participants experienced a range of barriers that impeded their ability to exercise. In particular, the loss of perceived social support gained from exercising in a facility with exercise coaches and other people with MS eroded both the accountability and motivation to exercise. Aerobic exercises via walking were the most impacted, with participants pointing to the need for at-home treadmills. Conclusions: The unprecedented disruption of COVID-19 lockdown restrictions in spring and summer 2020 impacted the ability of facility-based STEP for MS exercise trial participants to exercise in adherence to the intervention protocol. By contrast, the participants in the telerehabilitation-delivered exercise arm continued exercising without interruption and reported positive impacts of the intervention during this time. Telerehabilitation exercise programs may hold promise for overcoming barriers to exercise for people with MS during COVID-19 lockdown restrictions, and potentially other lockdown scenarios, if the participation in telerehabilitation has already been established. %M 36269870 %R 10.2196/42157 %U https://rehab.jmir.org/2022/4/e42157 %U https://doi.org/10.2196/42157 %U http://www.ncbi.nlm.nih.gov/pubmed/36269870 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 11 %P e40242 %T Chatbot-Delivered Cognitive Behavioral Therapy in Adolescents With Depression and Anxiety During the COVID-19 Pandemic: Feasibility and Acceptability Study %A Nicol,Ginger %A Wang,Ruoyun %A Graham,Sharon %A Dodd,Sherry %A Garbutt,Jane %+ Division of Child and Adolescent Psychiatry, Department of Psychiatry, Washington University School of Medicine, 600 S Taylor Ave, Suite 121, St Louis, MO, 63110, United States, 1 3143625939, nicolg@wustl.edu %K COVID-19 %K adolescent depression %K mobile health %K cognitive behavioral therapy %K chatbot %K relational conversational agent %K depression %K anxiety %K suicide %K self-harm %K pandemic %K pediatric %K youth %K adolescent %K adolescence %K psychiatry %K conversational agent %K CBT %K clinic %K data %K acceptability %K feasibility %K usability %K primary care %K intervention %K mental health %K digital health %K technology mediated %K computer mediated %D 2022 %7 22.11.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Symptoms of depression and anxiety, suicidal ideation, and self-harm have escalated among adolescents to crisis levels during the COVID-19 pandemic. As a result, primary care providers (PCPs) are often called on to provide first-line care for these youth. Digital health interventions can extend mental health specialty care, but few are evidence based. We evaluated the feasibility of delivering an evidence-based mobile health (mHealth) app with an embedded conversational agent to deliver cognitive behavioral therapy (CBT) to symptomatic adolescents presenting in primary care settings during the pandemic. Objective: In this 12-week pilot study, we evaluated the feasibility of delivering the app-based intervention to adolescents aged 13 to 17 years with moderate depressive symptoms who were treated in a practice-based research network (PBRN) of academically affiliated primary care clinics. We also obtained preliminary estimates of app acceptability, effectiveness, and usability. Methods: This small, pilot randomized controlled trial (RCT) evaluated depressive symptom severity in adolescents randomized to the app or to a wait list control condition. The primary end point was depression severity at 4-weeks, measured by the 9-item Patient Health Questionnaire (PHQ-9). Data on acceptability, feasibility, and usability were collected from adolescents and their parent or legal guardian. Qualitative interviews were conducted with 13 PCPs from 11 PBRN clinics to identify facilitators and barriers to incorporating mental health apps in treatment planning for adolescents with depression and anxiety. Results: The pilot randomized 18 participants to the app (n=10, 56%) or to a wait list control condition (n=8, 44%); 17 participants were included in the analysis, and 1 became ineligible upon chart review due to lack of eligibility based on documented diagnosis. The overall sample was predominantly female (15/17, 88%), White (15/17, 88%), and privately insured (15/17, 88%). Mean PHQ-9 scores at 4 weeks decreased by 3.3 points in the active treatment group (representing a shift in mean depression score from moderate to mild symptom severity categories) and 2 points in the wait list control group (no shift in symptom severity category). Teen- and parent-reported usability, feasibility, and acceptability of the app was high. PCPs reported preference for introducing mHealth interventions like the one in this study early in the course of care for individuals presenting with mild or moderate symptoms. Conclusions: In this small study, we demonstrated the feasibility, acceptability, usability, and safety of using a CBT-based chatbot for adolescents presenting with moderate depressive symptoms in a network of PBRN-based primary care clinics. This pilot study could not establish effectiveness, but our results suggest that further study in a larger pediatric population is warranted. Future study inclusive of rural, socioeconomically disadvantaged, and underrepresented communities is needed to establish generalizability of effectiveness and identify implementation-related adaptations needed to promote broader uptake in pediatric primary care. Trial Registration: ClinicalTrials.gov NCT04603053; https://clinicaltrials.gov/ct2/show/NCT04603053 %M 36413390 %R 10.2196/40242 %U https://formative.jmir.org/2022/11/e40242 %U https://doi.org/10.2196/40242 %U http://www.ncbi.nlm.nih.gov/pubmed/36413390 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 11 %P e40719 %T Mental Health Chatbot for Young Adults With Depressive Symptoms During the COVID-19 Pandemic: Single-Blind, Three-Arm Randomized Controlled Trial %A He,Yuhao %A Yang,Li %A Zhu,Xiaokun %A Wu,Bin %A Zhang,Shuo %A Qian,Chunlian %A Tian,Tian %+ Institute of Applied Psychology, College of Education, Tianjin University, 135 Yaguan Road, Jinnan District, Tianjin, 300354, China, 86 13752183496, yangli@tju.edu.cn %K chatbot %K conversational agent %K depression %K mental health %K mHealth %K digital medicine %K randomized controlled trial %K evaluation %K cognitive behavioral therapy %K young adult %K youth %K health service %K mobile health %K COVID-19 %D 2022 %7 21.11.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Depression has a high prevalence among young adults, especially during the COVID-19 pandemic. However, mental health services remain scarce and underutilized worldwide. Mental health chatbots are a novel digital technology to provide fully automated interventions for depressive symptoms. Objective: The purpose of this study was to test the clinical effectiveness and nonclinical performance of a cognitive behavioral therapy (CBT)–based mental health chatbot (XiaoE) for young adults with depressive symptoms during the COVID-19 pandemic. Methods: In a single-blind, 3-arm randomized controlled trial, participants manifesting depressive symptoms recruited from a Chinese university were randomly assigned to a mental health chatbot (XiaoE; n=49), an e-book (n=49), or a general chatbot (Xiaoai; n=50) group in a ratio of 1:1:1. Participants received a 1-week intervention. The primary outcome was the reduction of depressive symptoms according to the 9-item Patient Health Questionnaire (PHQ-9) at 1 week later (T1) and 1 month later (T2). Both intention-to-treat and per-protocol analyses were conducted under analysis of covariance models adjusting for baseline data. Controlled multiple imputation and δ-based sensitivity analysis were performed for missing data. The secondary outcomes were the level of working alliance measured using the Working Alliance Questionnaire (WAQ), usability measured using the Usability Metric for User Experience-LITE (UMUX-LITE), and acceptability measured using the Acceptability Scale (AS). Results: Participants were on average 18.78 years old, and 37.2% (55/148) were female. The mean baseline PHQ-9 score was 10.02 (SD 3.18; range 2-19). Intention-to-treat analysis revealed lower PHQ-9 scores among participants in the XiaoE group compared with participants in the e-book group and Xiaoai group at both T1 (F2,136=17.011; P<.001; d=0.51) and T2 (F2,136=5.477; P=.005; d=0.31). Better working alliance (WAQ; F2,145=3.407; P=.04) and acceptability (AS; F2,145=4.322; P=.02) were discovered with XiaoE, while no significant difference among arms was found for usability (UMUX-LITE; F2,145=0.968; P=.38). Conclusions: A CBT-based chatbot is a feasible and engaging digital therapeutic approach that allows easy accessibility and self-guided mental health assistance for young adults with depressive symptoms. A systematic evaluation of nonclinical metrics for a mental health chatbot has been established in this study. In the future, focus on both clinical outcomes and nonclinical metrics is necessary to explore the mechanism by which mental health chatbots work on patients. Further evidence is required to confirm the long-term effectiveness of the mental health chatbot via trails replicated with a longer dose, as well as exploration of its stronger efficacy in comparison with other active controls. Trial Registration: Chinese Clinical Trial Registry ChiCTR2100052532; http://www.chictr.org.cn/showproj.aspx?proj=135744 %M 36355633 %R 10.2196/40719 %U https://www.jmir.org/2022/11/e40719 %U https://doi.org/10.2196/40719 %U http://www.ncbi.nlm.nih.gov/pubmed/36355633 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 11 %P e40701 %T Opinion Leaders and Structural Hole Spanners Influencing Echo Chambers in Discussions About COVID-19 Vaccines on Social Media in China: Network Analysis %A Wang,Dandan %A Zhou,Yadong %A Ma,Feicheng %+ School of Information Management, Wuhan University, No.16 Luojia Mountain, Wuchang District, Wuhan, 430072, China, 86 1 350 711 9710, fchma@whu.edu.cn %K COVID-19 %K COVID-19 vaccine %K echo chamber %K opinion leader %K structural hole spanner %K topic %K sentiment %K social media %K vaccine hesitancy %K public health %K vaccination %K health promotion %K online campaign %K social network analysis %D 2022 %7 18.11.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Social media provide an ideal medium for breeding and reinforcing vaccine hesitancy, especially during public health emergencies. Algorithmic recommendation–based technology along with users’ selective exposure and group pressure lead to online echo chambers, causing inefficiency in vaccination promotion. Avoiding or breaking echo chambers largely relies on key users’ behavior. Objective: With the ultimate goal of eliminating the impact of echo chambers related to vaccine hesitancy on social media during public health emergencies, the aim of this study was to develop a framework to quantify the echo chamber effect in users’ topic selection and attitude contagion about COVID-19 vaccines or vaccinations; detect online opinion leaders and structural hole spanners based on network attributes; and explore the relationships of their behavior patterns and network locations, as well as the relationships of network locations and impact on topic-based and attitude-based echo chambers. Methods: We called the Sina Weibo application programming interface to crawl tweets related to the COVID-19 vaccine or vaccination and user information on Weibo, a Chinese social media platform. Adopting social network analysis, we examined the low echo chamber effect based on topics in representational networks of information, according to attitude in communication flow networks of users under different interactive mechanisms (retweeting, commenting). Statistical and visual analyses were used to characterize behavior patterns of key users (opinion leaders, structural hole spanners), and to explore their function in avoiding or breaking topic-based and attitude-based echo chambers. Results: Users showed a low echo chamber effect in vaccine-related topic selection and attitude interaction. For the former, the homophily was more obvious in retweeting than in commenting, whereas the opposite trend was found for the latter. Speakers, replicators, and monologists tended to be opinion leaders, whereas common users, retweeters, and networkers tended to be structural hole spanners. Both leaders and spanners tended to be “bridgers” to disseminate diverse topics and communicate with users holding cross-cutting attitudes toward COVID-19 vaccines. Moreover, users who tended to echo a single topic could bridge multiple attitudes, while users who focused on diverse topics also tended to serve as bridgers for different attitudes. Conclusions: This study not only revealed a low echo chamber effect in vaccine hesitancy, but further elucidated the underlying reasons from the perspective of users, offering insights for research about the form, degree, and formation of echo chambers, along with depolarization, social capital, stakeholder theory, user portraits, dissemination pattern of topic, and sentiment. Therefore, this work can help to provide strategies for public health and public opinion managers to cooperate toward avoiding or correcting echo chamber chaos and effectively promoting online vaccine campaigns. %M 36367965 %R 10.2196/40701 %U https://www.jmir.org/2022/11/e40701 %U https://doi.org/10.2196/40701 %U http://www.ncbi.nlm.nih.gov/pubmed/36367965 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 11 %P e40160 %T Using Natural Language Processing to Explore “Dry January” Posts on Twitter: Longitudinal Infodemiology Study %A Russell,Alex M %A Valdez,Danny %A Chiang,Shawn C %A Montemayor,Ben N %A Barry,Adam E %A Lin,Hsien-Chang %A Massey,Philip M %+ Center for Public Health and Technology, Department of Health, Human Performance, and Recreation, University of Arkansas, HPER Building, 308-V, Fayetteville, AR, 72701, United States, 1 479 575 8672, ar117@uark.edu %K alcohol %K drinking %K social media %K Twitter %K Dry January %K infodemiology %K infoveillance %K natural language processing %D 2022 %7 18.11.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Dry January, a temporary alcohol abstinence campaign, encourages individuals to reflect on their relationship with alcohol by temporarily abstaining from consumption during the month of January. Though Dry January has become a global phenomenon, there has been limited investigation into Dry January participants’ experiences. One means through which to gain insights into individuals’ Dry January-related experiences is by leveraging large-scale social media data (eg, Twitter chatter) to explore and characterize public discourse concerning Dry January. Objective: We sought to answer the following questions: (1) What themes are present within a corpus of tweets about Dry January, and is there consistency in the language used to discuss Dry January across multiple years of tweets (2020-2022)? (2) Do unique themes or patterns emerge in Dry January 2021 tweets after the onset of the COVID-19 pandemic? and (3) What is the association with tweet composition (ie, sentiment and human-authored vs bot-authored) and engagement with Dry January tweets? Methods: We applied natural language processing techniques to a large sample of tweets (n=222,917) containing the term “dry january” or “dryjanuary” posted from December 15 to February 15 across three separate years of participation (2020-2022). Term frequency inverse document frequency, k-means clustering, and principal component analysis were used for data visualization to identify the optimal number of clusters per year. Once data were visualized, we ran interpretation models to afford within-year (or within-cluster) comparisons. Latent Dirichlet allocation topic modeling was used to examine content within each cluster per given year. Valence Aware Dictionary and Sentiment Reasoner sentiment analysis was used to examine affect per cluster per year. The Botometer automated account check was used to determine average bot score per cluster per year. Last, to assess user engagement with Dry January content, we took the average number of likes and retweets per cluster and ran correlations with other outcome variables of interest. Results: We observed several similar topics per year (eg, Dry January resources, Dry January health benefits, updates related to Dry January progress), suggesting relative consistency in Dry January content over time. Although there was overlap in themes across multiple years of tweets, unique themes related to individuals’ experiences with alcohol during the midst of the COVID-19 global pandemic were detected in the corpus of tweets from 2021. Also, tweet composition was associated with engagement, including number of likes, retweets, and quote-tweets per post. Bot-dominant clusters had fewer likes, retweets, or quote tweets compared with human-authored clusters. Conclusions: The findings underscore the utility for using large-scale social media, such as discussions on Twitter, to study drinking reduction attempts and to monitor the ongoing dynamic needs of persons contemplating, preparing for, or actively pursuing attempts to quit or cut down on their drinking. %M 36343184 %R 10.2196/40160 %U https://www.jmir.org/2022/11/e40160 %U https://doi.org/10.2196/40160 %U http://www.ncbi.nlm.nih.gov/pubmed/36343184 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 11 %P e40751 %T The Association Between Clinical Severity and Incubation Period of SARS-CoV-2 Delta Variants: Retrospective Observational Study %A Wang,Kai %A Luan,Zemin %A Guo,Zihao %A Ran,Jinjun %A Tian,Maozai %A Zhao,Shi %+ JC School of Public Health and Primary Care, Chinese University of Hong Kong, Rm 417, Public Health Building, Prince of Wales Hospital, 30-32 Ngan Shing St, Hong Kong, China (Hong Kong), 852 22528865, zhaoshi.cmsa@gmail.com %K COVID-19 %K Delta variant %K incubation period %K clinical severity %K China %D 2022 %7 18.11.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: As of August 25, 2021, Jiangsu province experienced the largest COVID-19 outbreak in eastern China that was seeded by SARS-CoV-2 Delta variants. As one of the key epidemiological parameters characterizing the transmission dynamics of COVID-19, the incubation period plays an essential role in informing public health measures for epidemic control. The incubation period of COVID-19 could vary by different age, sex, disease severity, and study settings. However, the impacts of these factors on the incubation period of Delta variants remains uninvestigated. Objective: The objective of this study is to characterize the incubation period of the Delta variant using detailed contact tracing data. The effects of age, sex, and disease severity on the incubation period were investigated by multivariate regression analysis and subgroup analysis. Methods: We extracted contact tracing data of 353 laboratory-confirmed cases of SARS-CoV-2 Delta variants’ infection in Jiangsu province, China, from July to August 2021. The distribution of incubation period of Delta variants was estimated by using likelihood-based approach with adjustment for interval-censored observations. The effects of age, sex, and disease severity on the incubation period were expiated by using multivariate logistic regression model with interval censoring. Results: The mean incubation period of the Delta variant was estimated at 6.64 days (95% credible interval: 6.27-7.00). We found that female cases and cases with severe symptoms had relatively longer mean incubation periods than male cases and those with nonsevere symptoms, respectively. One-day increase in the incubation period of Delta variants was associated with a weak decrease in the probability of having severe illness with an adjusted odds ratio of 0.88 (95% credible interval: 0.71-1.07). Conclusions: In this study, the incubation period was found to vary across different levels of sex, age, and disease severity of COVID-19. These findings provide additional information on the incubation period of Delta variants and highlight the importance of continuing surveillance and monitoring of the epidemiological characteristics of emerging SARS-CoV-2 variants as they evolve. %M 36346940 %R 10.2196/40751 %U https://publichealth.jmir.org/2022/11/e40751 %U https://doi.org/10.2196/40751 %U http://www.ncbi.nlm.nih.gov/pubmed/36346940 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 11 %P e35025 %T Effect of Comorbidities on the Infection Rate and Severity of COVID-19: Nationwide Cohort Study With Propensity Score Matching %A Kim,Jiyong %A Park,Seong Hun %A Kim,Jong Moon %+ Department of Rehabilitation Medicine, CHA Bundang Medical Center, CHA University, 59 Yatap-ro, Bundang-gu, Seongnam, 13496, Republic of Korea, 82 31 780 5456, jmkim1013@gmail.com %K COVID-19 %K comorbidity %K infection rate %K severity of illness index %K hyperlipidemia %D 2022 %7 18.11.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: A vaccine against COVID-19 has been developed; however, COVID-19 transmission continues. Although there have been many studies of comorbidities that have important roles in COVID-19, some studies have reported contradictory results. Objective: This study was conducted using real-world data from COVID-19 patients in South Korea and aimed to investigate the impact of patient demographics and comorbidities on the infection rate and severity of COVID-19. Methods: Data were derived from a nationwide South Korean COVID-19 cohort study with propensity score (PS) matching. We included infected individuals who were COVID-19–positive between January 1, 2020, and May 30, 2020, and PS-matched uninfected controls. PS matching was performed to balance the baseline characteristics of each comorbidity and to adjust for potential confounders, such as age, sex, Charlson Comorbidity Index, medication, and other comorbidities, that were matched with binary variables. The outcomes were the confirmed comorbidities affecting the infection rate and severity of COVID-19. The endpoints were COVID-19 positivity and severe clinical outcomes of COVID-19 (such as tracheostomy, continuous renal replacement therapy, intensive care unit admission, ventilator use, cardiopulmonary resuscitation, and death). Results: The COVID-19 cohort with PS matching included 8070 individuals with positive COVID-19 test results and 8070 matched controls. The proportions of patients in the severe group were higher for individuals 60 years or older (severe clinical outcomes for those 60 years or older, 16.52%; severe clinical outcomes for those of other ages, 2.12%), those insured with Medicaid (Medicaid, 10.81%; other insurance, 5.61%), and those with disabilities (with disabilities, 18.26%; without disabilities, 5.07%). The COVID-19 infection rate was high for patients with pulmonary disease (odds ratio [OR] 1.88; 95% CI 1.70-2.03), dementia (OR 1.75; 95% CI 1.40-2.20), gastrointestinal disease (OR 1.74; 95% CI 1.62-1.88), stroke (OR 1.67; 95% CI 1.23-2.27), hepatobiliary disease (OR 1.31; 95% CI 1.19-1.44), diabetes mellitus (OR 1.28; 95% CI 1.16-1.43), and cardiovascular disease (OR 1.20; 95% CI 1.07-1.35). In contrast, it was lower for individuals with hyperlipidemia (OR 0.73; 95% CI 0.67-0.80), autoimmune disease (OR 0.73; 95% CI 0.60-0.89), and cancer (OR 0.73; 95% CI 0.62-0.86). The severity of COVID-19 was high for individuals with kidney disease (OR 5.59; 95% CI 2.48-12.63), hypertension (OR 2.92; 95% CI 1.91-4.47), dementia (OR 2.92; 95% CI 1.91-4.47), cancer (OR 1.84; 95% CI 1.15-2.94), pulmonary disease (OR 1.72; 95% CI 1.35-2.19), cardiovascular disease (OR 1.54; 95% CI 1.17-2.04), diabetes mellitus (OR 1.43; 95% CI 1.09-1.87), and psychotic disorders (OR 1.29; 95% CI 1.01-6.52). However, it was low for those with hyperlipidemia (OR 0.78; 95% CI 0.60-1.00). Conclusions: Upon PS matching considering the use of statins, it was concluded that people with hyperlipidemia could have lower infection rates and disease severity of COVID-19. %M 36265125 %R 10.2196/35025 %U https://publichealth.jmir.org/2022/11/e35025 %U https://doi.org/10.2196/35025 %U http://www.ncbi.nlm.nih.gov/pubmed/36265125 %0 Journal Article %@ 2371-4379 %I JMIR Publications %V 7 %N 4 %P e38869 %T Use of Telecommunication and Diabetes-Related Technologies in Older Adults With Type 1 Diabetes During a Time of Sudden Isolation: Mixed Methods Study %A Toschi,Elena %A Slyne,Christine %A Weinger,Katie %A Sy,Sarah %A Sifre,Kayla %A Michals,Amy %A Davis,DaiQuann %A Dewar,Rachel %A Atakov-Castillo,Astrid %A Haque,Saira %A Cummings,Stirling %A Brown,Stephen %A Munshi,Medha %+ Joslin Diabetes Center, 1 Joslin Place, Boston, MA, 02215, United States, 1 617 309 4648, elena.toschi@joslin.harvard.edu %K type 1 diabetes %K older adults %K COVID-19 %K diabetes technology %K continuous glucose monitoring %K telehealth %K diabetes %K glucose monitoring %K older population %K health technology %D 2022 %7 18.11.2022 %9 Original Paper %J JMIR Diabetes %G English %X Background: The COVID-19 lockdown imposed a sudden change in lifestyle with self-isolation and a rapid shift to the use of technology to maintain clinical care and social connections. Objective: In this mixed methods study, we explored the impact of isolation during the lockdown on the use of technology in older adults with type 1 diabetes (T1D). Methods: Older adults (aged ≥65 years) with T1D using continuous glucose monitoring (CGM) participated in semistructured interviews during the COVID-19 lockdown. A multidisciplinary team coded the interviews. In addition, CGM metrics from a subgroup of participants were collected before and during the lockdown. Results: We evaluated 34 participants (mean age 71, SD 5 years). Three themes related to technology use emerged from the thematic analysis regarding the impact of isolation on (1) insulin pump and CGM use to manage diabetes, including timely access to supplies, and changing Medicare eligibility regulations; (2) technology use for social interaction; and (3) telehealth use to maintain medical care. The CGM data from a subgroup (19/34, 56%; mean age 74, SD 5 years) showed an increase in time in range (mean 57%, SD 17% vs mean 63%, SD 15%; P=.001), a decrease in hyperglycemia (>180 mg/dL; mean 41%, SD 19% vs mean 35%, SD 17%; P<.001), and no change in hypoglycemia (<70 mg/dL; median 0.7%, IQR 0%-2% vs median 1.1%, IQR 0%-4%; P=.40) during the lockdown compared to before the lockdown. Conclusions: These findings show that our cohort of older adults successfully used technology during isolation. Participants provided the positive and negative perceptions of technology use. Clinicians can benefit from our findings by identifying barriers to technology use during times of isolation and developing strategies to overcome these barriers. %M 36256804 %R 10.2196/38869 %U https://diabetes.jmir.org/2022/4/e38869 %U https://doi.org/10.2196/38869 %U http://www.ncbi.nlm.nih.gov/pubmed/36256804 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 11 %P e42261 %T Uncovering the Reasons Behind COVID-19 Vaccine Hesitancy in Serbia: Sentiment-Based Topic Modeling %A Ljajić,Adela %A Prodanović,Nikola %A Medvecki,Darija %A Bašaragin,Bojana %A Mitrović,Jelena %+ The Institute for Artificial Intelligence Research and Development of Serbia, Fruškogorska 1, Novi Sad, 21000, 381 652626347, adela.ljajic@ivi.ac.rs %K topic modeling %K sentiment analysis %K LDA %K NMF %K BERT %K vaccine hesitancy %K COVID-19 %K Twitter %K Serbian language processing %K vaccine %K public health %K NLP %K vaccination %K Serbia %D 2022 %7 17.11.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Since the first COVID-19 vaccine appeared, there has been a growing tendency to automatically determine public attitudes toward it. In particular, it was important to find the reasons for vaccine hesitancy, since it was directly correlated with pandemic protraction. Natural language processing (NLP) and public health researchers have turned to social media (eg, Twitter, Reddit, and Facebook) for user-created content from which they can gauge public opinion on vaccination. To automatically process such content, they use a number of NLP techniques, most notably topic modeling. Topic modeling enables the automatic uncovering and grouping of hidden topics in the text. When applied to content that expresses a negative sentiment toward vaccination, it can give direct insight into the reasons for vaccine hesitancy. Objective: This study applies NLP methods to classify vaccination-related tweets by sentiment polarity and uncover the reasons for vaccine hesitancy among the negative tweets in the Serbian language. Methods: To study the attitudes and beliefs behind vaccine hesitancy, we collected 2 batches of tweets that mention some aspects of COVID-19 vaccination. The first batch of 8817 tweets was manually annotated as either relevant or irrelevant regarding the COVID-19 vaccination sentiment, and then the relevant tweets were annotated as positive, negative, or neutral. We used the annotated tweets to train a sequential bidirectional encoder representations from transformers (BERT)-based classifier for 2 tweet classification tasks to augment this initial data set. The first classifier distinguished between relevant and irrelevant tweets. The second classifier used the relevant tweets and classified them as negative, positive, or neutral. This sequential classifier was used to annotate the second batch of tweets. The combined data sets resulted in 3286 tweets with a negative sentiment: 1770 (53.9%) from the manually annotated data set and 1516 (46.1%) as a result of automatic classification. Topic modeling methods (latent Dirichlet allocation [LDA] and nonnegative matrix factorization [NMF]) were applied using the 3286 preprocessed tweets to detect the reasons for vaccine hesitancy. Results: The relevance classifier achieved an F-score of 0.91 and 0.96 for relevant and irrelevant tweets, respectively. The sentiment polarity classifier achieved an F-score of 0.87, 0.85, and 0.85 for negative, neutral, and positive sentiments, respectively. By summarizing the topics obtained in both models, we extracted 5 main groups of reasons for vaccine hesitancy: concern over vaccine side effects, concern over vaccine effectiveness, concern over insufficiently tested vaccines, mistrust of authorities, and conspiracy theories. Conclusions: This paper presents a combination of NLP methods applied to find the reasons for vaccine hesitancy in Serbia. Given these reasons, it is now possible to better understand the concerns of people regarding the vaccination process. %M 36301673 %R 10.2196/42261 %U https://www.jmir.org/2022/11/e42261 %U https://doi.org/10.2196/42261 %U http://www.ncbi.nlm.nih.gov/pubmed/36301673 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 11 %P e38425 %T Prevalence and Correlates of COVID-19 Vaccine Information on Family Medicine Practices’ Websites in the United States: Cross-sectional Website Content Analysis %A Ackleh-Tingle,Jonathan V %A Jordan,Natalie M %A Onwubiko,Udodirim N %A Chandra,Christina %A Harton,Paige E %A Rentmeester,Shelby T %A Chamberlain,Allison T %+ Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA, 30322, United States, 1 404 727 6159, jonathan.tingle@emory.edu %K primary care %K vaccine hesitancy %K COVID-19 %K health communications %K health information %K health website %K family practice %K primary care %K vaccine information %K online health %K health platform %K online information %D 2022 %7 17.11.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Primary care providers are regarded as trustworthy sources of information about COVID-19 vaccines. Although primary care practices often provide information about common medical and public health topics on their practice websites, little is known about whether they also provide information about COVID-19 vaccines on their practice websites. Objective: This study aimed to investigate the prevalence and correlates of COVID-19 vaccine information on family medicine practices’ website home pages in the United States. Methods: We used the Centers for Medicare and Medicaid National Provider Identifier records to create a sampling frame of all family medicine providers based in the United States, from which we constructed a nationally representative random sample of 964 family medicine providers. Between September 20 and October 8, 2021, we manually examined the practice websites of these providers and extracted data on the availability of COVID-19 vaccine information, and we implemented a 10% cross-review quality control measure to resolve discordances in data abstraction. We estimated the prevalence of COVID-19 vaccine information on practice websites and website home pages and used Poisson regression with robust error variances to estimate crude and adjusted prevalence ratios for correlates of COVID-19 vaccine information, including practice size, practice region, university affiliation, and presence of information about seasonal influenza vaccines. Additionally, we performed sensitivity analyses to account for multiple comparisons. Results: Of the 964 included family medicine practices, most (n=509, 52.8%) had ≥10 distinct locations, were unaffiliated with a university (n=838, 87.2%), and mentioned seasonal influenza vaccines on their websites (n=540, 56.1%). In total, 550 (57.1%) practices mentioned COVID-19 vaccines on their practices’ website home page, specifically, and 726 (75.3%) mentioned COVID-19 vaccines anywhere on their practice website. As practice size increased, the likelihood of finding COVID-19 vaccine information on the home page increased (n=66, 27.7% among single-location practices, n=114, 52.5% among practices with 2-9 locations, n=66, 56.4% among practices with 10-19 locations, and n=304, 77.6% among practices with 20 or more locations, P<.001 for trend). Compared to clinics in the Northeast, those in the West and Midwest United States had a similar prevalence of COVID-19 vaccine information on website home pages, but clinics in the south had a lower prevalence (adjusted prevalence ratio 0.8, 95% CI 0.7 to 1.0; P=.02). Our results were largely unchanged in sensitivity analyses accounting for multiple comparisons. Conclusions: Given the ongoing COVID-19 pandemic, primary care practitioners who promote and provide vaccines should strongly consider utilizing their existing practice websites to share COVID-19 vaccine information. These existing platforms have the potential to serve as an extension of providers’ influence on established and prospective patients who search the internet for information about COVID-19 vaccines. %M 36343211 %R 10.2196/38425 %U https://formative.jmir.org/2022/11/e38425 %U https://doi.org/10.2196/38425 %U http://www.ncbi.nlm.nih.gov/pubmed/36343211 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 11 %P e35730 %T Fear of COVID-19 and Prevention Behaviors: Cross-Lagged Panel Analysis %A Anderson,Katherine M %A Stockman,Jamila K %+ Department of Medicine, School of Medicine, University of California San Diego, 9500 Gilman Dr, MC 0507, La Jolla, CA, 92093, United States, 1 7209036196, k4anderson@health.ucsd.edu %K fear appeals %K structural equation modelling %K cross-lagged model %K prevention behavior %K COVID-19 %K fear %K women %K behavior %K change %K health %K physical distance %K relationships %K pandemic %K research %K association %K prevention %K experience %K panel %K interest %K public %K distancing %D 2022 %7 17.11.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The ongoing COVID-19 pandemic has brought forth conversations about effective behavior change models for increasing prevention behavior, ranging from wearing masks in public to physical distancing. Among the considered behavior change techniques is the use of fear appeals, through which a negative possible outcome is emphasized to invoke fear, which in turn may promote prevention behaviors to counter the likelihood of the negative outcome. Although fear is hypothesized as health promoting in some theories of health behavior, little research has rigorously assessed the relationship. Objective: In our exploratory analyses, we aim to examine the association, including directionality of the association between fear of COVID-19 and COVID-19 prevention behaviors across 2 time points during the early COVID-19 pandemic among a sample of US women. Methods: The COPE study, a web-based survey of US women’s COVID-19 experiences, was deployed in May-June 2020 (time 1) with follow-up in December 2020-January 2021 (time 2; n=200). Demographic characteristics as well as fear of COVID-19 and COVID-19 prevention behaviors (eg, staying home except for essential activities, physical distancing in public, and masking in public) were measured. Descriptive and bivariate analyses were used to characterize COVID-19 prevention behaviors and fear of COVID-19 among participants. Cross-lagged panel analysis, a type of structural equation modeling that assesses directionality of temporal associations, was used to understand relationships, if any, between variables of interest. Results: We found cross-sectional associations between fear of COVID-19 and staying home and physical distancing, as well as temporal associations between fear at time 1 and time 2 and prevention behaviors at time 1 and time 2. However, results of the cross-lagged panel analysis indicated no cross-lagged temporal relationships between fear of COVID-19 and COVID-19 prevention behaviors 6 months apart. Conclusions: Fear of COVID-19 did not appear to predict COVID-19 prevention behaviors 6 months after initial measurements among the sample of women recruited for our study. Future research should rigorously test these associations longitudinally, and alternative methods of public health prevention promotion should be considered. %M 36346895 %R 10.2196/35730 %U https://formative.jmir.org/2022/11/e35730 %U https://doi.org/10.2196/35730 %U http://www.ncbi.nlm.nih.gov/pubmed/36346895 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 11 %P e39662 %T Determinants of e-Mental Health Use During COVID-19: Cross-sectional Canadian Study %A Yu,Ellie %A Xu,Bowen %A Sequeira,Lydia %+ Canada Health Infoway, 150 King St W, Ste 1300, Toronto, ON, M5H 1J9, Canada, 1 4163039181, lsequeira@infoway-inforoute.ca %K digital health %K mental health %K e-Mental health %K user profile %K determinants %K health service %K use %K utilization %K COVID-19 %K pandemic %K Canada %K users %K factors %D 2022 %7 16.11.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Access to mental health treatment across Canada remains a challenge, with many reporting unmet care needs. National and provincial e-Mental health (eMH) programs have been developed over the past decade across Canada, with many more emerging during COVID-19 in an attempt to reduce barriers related to geography, isolation, transportation, physical disability, and availability. Objective: The aim of this study was to identify factors associated with the utilization of eMH services across Canada during the COVID-19 pandemic using Andersen and Newman’s framework of health service utilization. Methods: This study used data gathered from the 2021 Canadian Digital Health Survey, a cross-sectional, web-based survey of 12,052 Canadians aged 16 years and older with internet access. Bivariate associations between the use of eMH services and health service utilization factors (predisposing, enabling, illness level) of survey respondents were assessed using χ2 tests for categorical variables and t tests for the continuous variable. Logistic regression was used to predict the probability of using eMH services given the respondents’ predisposing, enabling, and illness-level factors while adjusting for respondents’ age and gender. Results: The proportion of eMH service users among survey respondents was small (883/12,052, 7.33%). Results from the logistic regression suggest that users of eMH services were likely to be those with regular family physician access (odds ratio [OR] 1.57, P=.02), living in nonrural communities (OR 1.08, P<.001), having undergraduate (OR 1.40, P=.001) or postgraduate (OR 1.48, P=.003) education, and being eHealth literate (OR 1.05, P<.001). Those with lower eMH usage were less likely to speak English at home (OR 0.06, P<.001). Conclusions: Our study provides empirical evidence on the impact of individual health utilization factors on the use of eMH among Canadians during the COVID-19 pandemic. Given the opportunities and promise of eMH services in increasing access to care, future digital interventions should both tailor themselves toward users of these services and consider awareness campaigns to reach nonusers. Future research should also focus on understanding the reasons behind the use and nonuse of eMH services. %M 36191173 %R 10.2196/39662 %U https://www.jmir.org/2022/11/e39662 %U https://doi.org/10.2196/39662 %U http://www.ncbi.nlm.nih.gov/pubmed/36191173 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 11 %P e38862 %T The Use of 2 e-Learning Modalities for Diabetes Education Using Facebook in 2 Cities of Argentina During the COVID-19 Pandemic: Qualitative Study %A Moyano,Daniela Luz %A Lopez,María Victoria %A Cavallo,Ana %A Candia,Julia Patricia %A Kaen,Aaron %A Irazola,Vilma %A Beratarrechea,Andrea %+ Department of Research on Chronic Diseases, Institute for Clinical Effectiveness and Health Policy, Dr Emilio Ravignani 2024, Buenos Aires, C1414CPV, Argentina, 54 114777 8767, dmoyano@iecs.org.ar %K COVID-19 %K social media %K diabetes mellitus %K public health %K qualitative research %K COVID-19 pandemic %K teaching and learning settings %K online learning %K eHealth literacy %D 2022 %7 16.11.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic and the confinement that was implemented in Argentina generated a need to implement innovative tools for the strengthening of diabetes care. Diabetes self-management education (DSME) is a core element of diabetes care; however, because of COVID-19 restrictions, in-person diabetes educational activities were suspended. Social networks have played an instrumental role in this context to provide DSME in 2 cities of Argentina and help persons with diabetes in their daily self-management. Objective: The aim of this study is to evaluate 2 diabetes education modalities (synchronous and asynchronous) using the social media platform Facebook through the content of posts on diabetes educational sessions in 2 cities of Argentina during the COVID-19 pandemic. Methods: In this qualitative study, we explored 2 modalities of e-learning (synchronous and asynchronous) for diabetes education that used the Facebook pages of public health institutions in Chaco and La Rioja, Argentina, in the context of confinement. Social media metrics and the content of the messages posted by users were analyzed. Results: A total of 332 messages were analyzed. We found that in the asynchronous modality, there was a higher number of visualizations, while in the synchronous modality, there were more posts and interactions between educators and users. We also observed that the number of views increased when primary care clinics were incorporated as disseminators, sharing educational videos from the sessions via social media. Positive aspects were observed in the posts, consisting of messages of thanks and, to a lesser extent, reaffirmations, reflections or personal experiences, and consultations related to the subject treated. Another relevant finding was that the educator/moderator role had a greater presence in the synchronous modality, where posts were based on motivation for participation, help to resolve connectivity problems, and answers to specific user queries. Conclusions: Our findings show positive contributions of an educational intervention for diabetes care using the social media platform Facebook in the context of the COVID-19 pandemic. Although each modality (synchronous vs asynchronous) could have differential and particular advantages, we believe that these strategies have potential to be replicated and adapted to other contexts. However, more documented experiences are needed to explore their sustainability and long-term impact from the users' perspective. %M 36322794 %R 10.2196/38862 %U https://formative.jmir.org/2022/11/e38862 %U https://doi.org/10.2196/38862 %U http://www.ncbi.nlm.nih.gov/pubmed/36322794 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 11 %P e39080 %T Psychotherapeutic and Psychiatric Intervention in Patients With COVID-19 and Their Relatives: Protocol for the DigiCOVID Trial %A Cantù,Filippo %A Biagianti,Bruno %A Lisi,Ilaria %A R Zanier,Elisa %A Bottino,Nicola %A Fornoni,Chiara %A Gallo,Francesca %A Ginex,Valeria %A Tombola,Valentina %A Zito,Silvana %A Colombo,Elisa %A Stocchetti,Nino %A Brambilla,Paolo %+ Department of Pathophysiology and Transplantation, University of Milan, Via Francesco Sforza 53, Milano, 20122, Italy, 39 0255035982, paolo.brambilla1@unimi.it %K telepsychiatry %K telemedicine %K COVID-19 %K mental health %K digital mental health %K digital support %K clinical outcome %K telehealth %K psychiatric health %K health intervention %D 2022 %7 16.11.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: The COVID-19 pandemic is negatively impacting the mental health of both patients with COVID-19 and the general population. As current guidelines are limiting in-person contacts to reduce the spread of the virus, the development of a digital approach to implement in psychiatric and psychological consultations is needed. In this paper, we present the DigiCOVID protocol, a digital approach to offer remote, personalized psychological and psychiatric support to former or current patients with COVID-19 and their relatives. Objective: The main goal of this project is to evaluate the feasibility, acceptability, and usability of the DigiCOVID protocol. Furthermore, we also aim to assess the impact of the abovementioned protocol by means of pre-post changes in psychological clinical variables. Methods: Participants undergo an initial telephonic screening to ensure inclusion criteria are met. Secondly, participants complete a video-assisted neuropsychological IQ test as well as web-based self-reports of health and general well-being. Participants are then assigned to a psychotherapist who offers 8 teletherapy sessions. At the end of the therapy cycle, the web-based questionnaires are administered for a posttreatment evaluation. Results: As of April 2022, we enrolled a total of 122 participants, of which 94 have completed neuropsychological tests and web-based questionnaires. Conclusions: Our study aims at testing the feasibility and preliminary efficacy of DigiCOVID, a remote telemedicine protocol for the improvement of psychological and psychiatric health in patients with COVID-19 and their relatives. To date, the approach used seems to be feasible and highly customizable to patients’ needs, and therefore, the DigiCOVID protocol might pave the way for future telepsychiatry-based interventions. Trial Registration: ClinicalTrials.gov NCT05231018; https://clinicaltrials.gov/ct2/show/NCT05231018?term=NCT05231018 &draw=2&rank=1 International Registered Report Identifier (IRRID): DERR1-10.2196/39080 %M 36228130 %R 10.2196/39080 %U https://www.researchprotocols.org/2022/11/e39080 %U https://doi.org/10.2196/39080 %U http://www.ncbi.nlm.nih.gov/pubmed/36228130 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 11 %P e37426 %T Efficacy and Safety of Direct Hemoperfusion Using Polymyxin B-Immobilized Polystyrene Column for Patients With COVID-19: Protocol for an Exploratory Study %A Terada-Hirashima,Junko %A Izumi,Shinyu %A Katagiri,Daisuke %A Uemura,Yukari %A Mikami,Ayako %A Sugiura,Wataru %A Abe,Shinji %A Azuma,Arata %A Sugiyama,Haruhito %+ Center for Clinical Sciences, National Center for Global Health and Medicine, 1-21-1 Toyama Shinjuku-ku, Tokyo, 162-8655, Japan, 81 813 3202 7181, jterada@hosp.ncgm.go.jp %K polymyxin B-immobilized fiber column %K PMX %K diffuse alveolar damage %K DAD %K COVID-19 %K pneumonia %K fibrinogenolysis %K systemic inflammatory response syndrome %K lung disease %K lung damage %K pulmonary %K treatment %K prospective intervention %K health information %K treatment information %K therapy %K COVID-19 therapy %D 2022 %7 16.11.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Polymyxin B-immobilized fiber column (PMX; Toraymyxin column) was approved for the relief of systemic inflammatory response syndrome caused by bacterial infection or endotoxemia. PMX reduces lung damage by removing leukocytes and cytokines in addition to endotoxin removal in the setting of idiopathic pulmonary fibrosis. Acute exacerbation of interstitial pneumonia pathologically presents with diffuse alveolar damage (DAD). PMX direct hemoperfusion (PMX-DHP) demonstrated efficacy, improving oxygenation. The SARS-CoV-2 virus causes COVID-19, which emerged in December 2019. The condition may become severe about 1 week after onset, and respiratory failure rapidly develops, requiring intensive care management. A characteristic of COVID-19–related severe pneumonia is ground-glass opacities rapidly progressing in both lungs, which subsequently turn into infiltrative shadows. This condition could be classified as DAD. As for the congealing fibrinogenolysis system, D-dimer, fibrin/fibrinogen degradation product quantity, and prolonged prothrombin time were significant factors in nonsurviving COVID-19 cases, associated with aggravated pneumonia. Clinical trials are being conducted, but except for remdesivir and dexamethasone, no treatments have yet been approved. COVID-19 aggravates with the deterioration of oxygen saturation, decrease in lymphocytes, and the occurrence of an abnormal congealing fibrinogenolysis system, leading to diffuse lung damage. Once the condition transitions from moderate to severe, it is necessary to prevent further exacerbation by providing treatment that will suppress the aforementioned symptoms as soon as possible. Objective: This study aims to access treatment options to prevent the transition from acute exacerbation of interstitial pneumonia to DAD. The mechanism of action envisioned for PMX-DHP is to reduce congealing fibrinogenolysis system abnormalities and increase oxygenation by removing activated leukocytes and cytokines, which are risk factors for the aggravation of COVID-19–related pneumonia. Methods: We will conduct a multicenter, prospective, intervention, single-group study to evaluate the efficacy and safety of direct hemoperfusion using PMX-DHP for patients with COVID-19. Efficacy will be evaluated by the primary end point, which is the rate of Ordinal Scale for Clinical Improvement after PMX-DHP of at least 1 point from a status of 4, 5, or 6 on day 15. The effect of PMX-DHP will be estimated by setting a control group with background factors from non–PMX-DHP patients enrolled in the COVID-19 registry. This study will be carried out as a single-group open-label study and will be compared with a historical control. The historical control will be selected from the COVID-19 registry according to age, gender, and severity of pneumonia. Results: The study period is scheduled from September 28, 2020, through April 30, 2023. Patient enrollment was scheduled from the Japan Registry of Clinical Trials publication for March 31, 2022. Data fixation is scheduled for October 2022, with the publication of the results by March 2023. Conclusions: From a clinical perspective, PMX-DHP is expected to become an adjunctive therapy to address unmet medical needs and prevent the exacerbation from moderate to severe acute respiratory distress syndrome in COVID-19 cases. International Registered Report Identifier (IRRID): DERR1-10.2196/37426 %M 36126219 %R 10.2196/37426 %U https://www.researchprotocols.org/2022/11/e37426 %U https://doi.org/10.2196/37426 %U http://www.ncbi.nlm.nih.gov/pubmed/36126219 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 11 %P e36174 %T Developing an mHealth Intervention to Reduce COVID-19–Associated Psychological Distress Among Health Care Workers in Nigeria: Protocol for a Design and Feasibility Study %A Akinsulore,Adesanmi %A Aloba,Olutayo %A Oginni,Olakunle %A Oloniniyi,Ibidunni %A Ibigbami,Olanrewaju %A Seun-Fadipe,Champion Tobi %A Opakunle,Tolulope %A Owojuyigbe,Afolabi Muyiwa %A Olibamoyo,Olushola %A Mapayi,Boladale %A Okorie,Victor Ogbonnaya %A Adewuya,Abiodun Olugbenga %+ Department of Mental Health, Faculty of Clinical Sciences, Obafemi Awolowo University, College of Health Sciences Building, Road 1, Ile-Ife, 220005, Nigeria, 234 8033968554, sanmilore@oauife.edu.ng %K COVID-19 %K psychological distress %K Nigeria %K health care workers %K mental health %K well-being %K pandemic %K mHealth %K mobile health %K digital health intervention %K health intervention %K health care %K smartphone %K mobile phone %D 2022 %7 16.11.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Globally, COVID-19–related psychological distress is seriously eroding health care workers’ mental health and well-being, especially in low-income countries like Nigeria. The use of mobile health (mHealth) interventions is now increasingly recognized as an innovative approach that may improve mental health and well-being. This project aims to develop an mHealth psychological intervention (mPsyI) to reduce COVID-19–related psychological distress among health care workers in Nigeria. Objective: Our objective is to present a study protocol to determine the level of COVID-19–related psychological distress among health care workers in Nigeria; explore health care workers’ experience of COVID-19–related psychological distress; develop and pilot test mPsyI to reduce this distress; and assess the feasibility of this intervention (such as usability, engagement, and satisfaction). Methods: A mixed (quantitative and qualitative) methods approach is used in which health care workers will be recruited from 2 tertiary health care facilities in southwest Nigeria. The study is divided into 4 phases based on the study objectives. Phase 1 involves a quantitative survey to assess the type and levels of psychosocial distress. Phase 2 collects qualitative data on psychosocial distress among health care workers. Phase 3 involves development of the mHealth-based psychological intervention, and phase 4 is a mixed methods study to assess the feasibility and acceptability of the intervention. Results: This study was funded in November 2020 by the Global Effort on COVID-19 Health Research, and collection of preliminary baseline data started in July 2021. Conclusions: This is the first study to report the development of an mHealth-based intervention to reduce COVID-19–related psychological distress among health care workers in Nigeria. Using a mixed methods design in this study can potentially facilitate the adaptation of an evidence-based treatment method that is culturally sensitive and cost-effective for the management of COVID-19–related psychological distress among health care workers in Nigeria. International Registered Report Identifier (IRRID): DERR1-10.2196/36174 %M 36318638 %R 10.2196/36174 %U https://www.researchprotocols.org/2022/11/e36174 %U https://doi.org/10.2196/36174 %U http://www.ncbi.nlm.nih.gov/pubmed/36318638 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 11 %P e40977 %T Outcomes of a Community Engagement and Information Gathering Program to Support Telephone-Based COVID-19 Contact Tracing: Descriptive Analysis %A Udeagu,Chi-Chi N %A Pitiranggon,Masha %A Misra,Kavita %A Huang,Jamie %A Terilli,Thomas %A Ramos,Yasmin %A Alexander,Martha %A Kim,Christine %A Lee,David %A Blaney,Kathleen %A Keeley,Chris %A Long,Theodore %A Vora,Neil M %+ New York City Test & Trace Corps, New York City Department of Health & Mental Hygiene, 42-09 28th Street, Queens, NY, 11101, United States, 1 3473864909, cudeagu@health.nyc.gov %K COVID-19 %K contact tracing %K home visits %K community health workers %K health equity %D 2022 %7 15.11.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Contact tracing is an important public health tool for curbing the spread of infectious diseases. Effective and efficient contact tracing involves the rapid identification of individuals with infection and their exposed contacts and ensuring their isolation or quarantine, respectively. Manual contact tracing via telephone call and digital proximity app technology have been key strategies in mitigating the spread of COVID-19. However, many people are not reached for COVID-19 contact tracing due to missing telephone numbers or nonresponse to telephone calls. The New York City COVID-19 Trace program augmented the efforts of telephone-based contact tracers with information gatherers (IGs) to search and obtain telephone numbers or residential addresses, and community engagement specialists (CESs) made home visits to individuals that were not contacted via telephone calls. Objective: The aim of this study was to assess the contribution of information gathering and home visits to the yields of COVID-19 contact tracing in New York City. Methods: IGs looked for phone numbers or addresses when records were missing phone numbers to locate case-patients or contacts. CESs made home visits to case-patients and contacts with no phone numbers or those who were not reached by telephone-based tracers. Contact tracing management software was used to triage and queue assignments for the telephone-based tracers, IGs, and CESs. We measured the outcomes of contact tracing–related tasks performed by the IGs and CESs from July 2020 to June 2021. Results: Of 659,484 cases and 861,566 contact records in the Trace system, 28% (185,485) of cases and 35% (303,550) of contacts were referred to IGs. IGs obtained new phone numbers for 33% (61,804) of case-patients and 11% (31,951) of contacts; 50% (31,019) of the case-patients and 46% (14,604) of the contacts with new phone numbers completed interviews; 25% (167,815) of case-patients and 8% (72,437) of contacts were referred to CESs. CESs attempted 80% (132,781) of case and 69% (49,846) of contact investigations, of which 47% (62,733) and 50% (25,015) respectively, completed interviews. An additional 12,192 contacts were identified following IG investigations and 13,507 following CES interventions. Conclusions: Gathering new or missing locating information and making home visits increased the number of case-patients and contacts interviewed for contact tracing and resulted in additional contacts. When possible, contact tracing programs should add information gathering and home visiting strategies to increase COVID-19 contact tracing coverage and yields as well as promote equity in the delivery of this public health intervention. %M 36240019 %R 10.2196/40977 %U https://publichealth.jmir.org/2022/11/e40977 %U https://doi.org/10.2196/40977 %U http://www.ncbi.nlm.nih.gov/pubmed/36240019 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 2 %N 2 %P e38453 %T COVID-19–Related Health Inequalities Induced by the Use of Social Media: Systematic Review %A Shan,Yi %A Ji,Meng %A Xie,Wenxiu %A Zhang,Xiaomin %A Ng Chok,Harrison %A Li,Rongying %A Qian,Xiaobo %A Lam,Kam-Yiu %A Chow,Chi-Yin %A Hao,Tianyong %+ Nantong University, No. 9, Seyuan Rd., Nantong University, Nantong, 226019, China, 86 15558121896, victorsyhz@hotmail.com %K systematic review %K social media use %K health inequalities %K COVID-19 %K mobile phone %D 2022 %7 15.11.2022 %9 Review %J JMIR Infodemiology %G English %X Background: COVID-19–related health inequalities were reported in some studies, showing the failure in public health and communication. Studies investigating the contexts and causes of these inequalities pointed to the contribution of communication inequality or poor health literacy and information access to engagement with health care services. However, no study exclusively dealt with health inequalities induced by the use of social media during COVID-19. Objective: This review aimed to identify and summarize COVID-19–related health inequalities induced by the use of social media and the associated contributing factors and to characterize the relationship between the use of social media and health disparities during the COVID-19 pandemic. Methods: A systematic review was conducted on this topic in light of the protocol of the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 statement. Keyword searches were performed to collect papers relevant to this topic in multiple databases: PubMed (which includes MEDLINE [Ovid] and other subdatabases), ProQuest (which includes APA PsycINFO, Biological Science Collection, and others), ACM Digital Library, and Web of Science, without any year restriction. Of the 670 retrieved publications, 10 were initially selected based on the predefined selection criteria. These 10 articles were then subjected to quality analysis before being analyzed in the final synthesis and discussion. Results: Of the 10 articles, 1 was further removed for not meeting the quality assessment criteria. Finally, 9 articles were found to be eligible and selected for this review. We derived the characteristics of these studies in terms of publication years, journals, study locations, locations of study participants, study design, sample size, participant characteristics, and potential risk of bias, and the main results of these studies in terms of the types of social media, social media use–induced health inequalities, associated factors, and proposed resolutions. On the basis of the thematic synthesis of these extracted data, we derived 4 analytic themes, namely health information inaccessibility–induced health inequalities and proposed resolutions, misinformation-induced health inequalities and proposed resolutions, disproportionate attention to COVID-19 information and proposed resolutions, and higher odds of social media–induced psychological distress and proposed resolutions. Conclusions: This paper was the first systematic review on this topic. Our findings highlighted the great value of studying the COVID-19–related health knowledge gap, the digital technology–induced unequal distribution of health information, and the resulting health inequalities, thereby providing empirical evidence for understanding the relationship between social media use and health inequalities in the context of COVID-19 and suggesting practical solutions to such disparities. Researchers, social media, health practitioners, and policy makers can draw on these findings to promote health equality while minimizing social media use–induced health inequalities. %M 36420437 %R 10.2196/38453 %U https://infodemiology.jmir.org/2022/2/e38453 %U https://doi.org/10.2196/38453 %U http://www.ncbi.nlm.nih.gov/pubmed/36420437 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 11 %N 2 %P e40655 %T Recommendations for Successful Implementation of the Use of Vocal Biomarkers for Remote Monitoring of COVID-19 and Long COVID in Clinical Practice and Research %A Fischer,Aurelie %A Elbeji,Abir %A Aguayo,Gloria %A Fagherazzi,Guy %+ Deep Digital Phenotyping Research Unit, Department of Precision Health, Luxembourg Institute of Health, 1A-B, rue Thomas Edison, Strassen, L-1445, Luxembourg, 352 26970230, aurelie.fischer@lih.lu %K vocal biomarker %K COVID-19 symptoms %K digital health %K remote monitoring %K artificial intelligence %K voice %K COVID-19 %K Long COVID %K digital health solution %K voice-based technology %K health technology %K health monitoring %K digital health monitoring %K health care application %K remote patient monitoring %D 2022 %7 15.11.2022 %9 Viewpoint %J Interact J Med Res %G English %X The COVID-19 pandemic accelerated the use of remote patient monitoring in clinical practice or research for safety and emergency reasons, justifying the need for innovative digital health solutions to monitor key parameters or symptoms related to COVID-19 or Long COVID. The use of voice-based technologies, and in particular vocal biomarkers, is a promising approach, voice being a rich, easy-to-collect medium with numerous potential applications for health care, from diagnosis to monitoring. In this viewpoint, we provide an overview of the potential benefits and limitations of using voice to monitor COVID-19, Long COVID, and related symptoms. We then describe an optimal pipeline to bring a vocal biomarker candidate from research to clinical practice and discuss recommendations to achieve such a clinical implementation successfully. %M 36378504 %R 10.2196/40655 %U https://www.i-jmr.org/2022/2/e40655 %U https://doi.org/10.2196/40655 %U http://www.ncbi.nlm.nih.gov/pubmed/36378504 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 11 %P e34388 %T Students' Emotional Well-being and Academic Functioning Before, During, and After Lockdown in Germany: Cohort Study %A Nuñez,Tania R %A Pallasch,Nina %A Radtke,Theda %+ Department of Health Psychology and Applied Diagnostics, Institute of Psychology, University of Wuppertal, Gaußstraße 20, Wuppertal, 42119, Germany, 49 0202 439 2301, nunez@uni-wuppertal.de %K self-efficacy %K academic self-concept %K test anxiety %K achievement motivation %K positive and negative affect %K mobile phone %K COVID-19 %D 2022 %7 15.11.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 lockdowns have led to social detriments and altered learning environments among university students. Recent research indicates that such ramifications may engender various impairments to students’ mental health. However, such research has major limitations, such as the lack of a prepandemic control measure, the focus on singular well-being parameters, or the investigation of only the early phases of the pandemic. Objective: To address these research gaps, this comprehensive and nationwide study compared 3 student cohorts (aged 17-48 years) in Germany: a prepandemic cohort (January-February 2020), a postlockdown cohort (May 2020-July 2020), and an intralockdown cohort (January-February 2021) regarding students’ general emotional well-being and academic functioning. It was hypothesized that, because of rigorous lockdown-related restrictions, students in the intralockdown cohort would report diminished general emotional well-being compared with the other cohorts. Furthermore, because of ongoing remote learning since the beginning of the pandemic, it was expected that students’ academic functioning would decrease across all 3 cohorts. Methods: The data collection was performed over 3 consecutive semesters (fall semester 2019-2020, spring semester 2020, and fall semester 2020-2021). Students were surveyed on the web on various aspects regarding their general emotional well-being (eg, stress and general well-being) and academic functioning (eg, concentration and study-related flow). Data analyses were performed using multivariate ANOVAs. Results: A total of 787 students participated in this study. Results indicated higher general well-being in the postlockdown cohort than in the intralockdown cohort (P=.02). As for students’ academic functioning, our results revealed that students in the prepandemic cohort reported higher study-related flow (P=.007) and concentration (P=.001) than those in the intralockdown cohort. In addition, students reported higher flow (P=.04) and concentration (P=.04) in the postlockdown cohort than those in the intralockdown cohort. No cohort effects were revealed for other aspects of general emotional well-being (eg, perceived stress) and academic functioning (eg, procrastination). Conclusions: This study indicates that students’ general emotional well-being as well as motivational and attentional components of academic functioning can be impaired owing to the COVID-19 lockdowns and ongoing remote learning formats. The necessity and design of interventional programs remedying such effects in light of the ongoing crisis need to be addressed. %M 36228133 %R 10.2196/34388 %U https://formative.jmir.org/2022/11/e34388 %U https://doi.org/10.2196/34388 %U http://www.ncbi.nlm.nih.gov/pubmed/36228133 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 11 %P e37203 %T Factors Associated With the Intention to Receive the COVID-19 Vaccine: Cross-sectional National Study %A Kasting,Monica L %A Macy,Jonathan T %A Grannis,Shaun J %A Wiensch,Ashley J %A Lavista Ferres,Juan M %A Dixon,Brian E %+ Department of Public Health, Purdue University, 812 W. State Street, Room 216, West Lafayette, IN, 47907, United States, 1 765 496 9483, mlkastin@purdue.edu %K SARS-CoV-2 %K COVID-19 vaccines %K vaccination intention %K vaccine hesitancy %K Health Belief Model %K reasoned action approach %K COVID-19 %K vaccination %K public health %K online survey %K health intervention %K logistic regression %K demographic %D 2022 %7 14.11.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The COVID-19 pandemic is an unprecedented public health crisis, and vaccines are the most effective means of preventing severe consequences of this disease. Hesitancy regarding vaccines persists among adults in the United States, despite overwhelming scientific evidence of safety and efficacy. Objective: The purpose of this study was to use the Health Belief Model (HBM) and reasoned action approach (RAA) to examine COVID-19 vaccine hesitancy by comparing those who had already received 1 vaccine to those who had received none. Methods: This study examined demographic and theory-based factors associated with vaccine uptake and intention among 1643 adults in the United States who completed an online survey during February and March 2021. Survey items included demographic variables (eg, age, sex, political ideology), attitudes, and health belief variables (eg, perceived self-efficacy, perceived susceptibility). Hierarchical logistic regression analyses were used for vaccine uptake/intent. The first model included demographic variables. The second model added theory-based factors to examine the association of health beliefs and vaccine uptake above and beyond the associations explained by demographic characteristics alone. Results: The majority of participants were male (n=974, 59.3%), White (n=1347, 82.0%), and non-Hispanic (n=1518, 92.4%) and reported they had already received a COVID-19 vaccine or definitely would when it was available to them (n=1306, 79.5%). Demographic variables significantly associated with vaccine uptake/intent included age (adjusted odds ratio [AOR] 1.05, 95% CI 1.04-1.06), other race (AOR 0.47, 95% CI 0.27-0.83 vs White), and political ideology (AOR 15.77, 95% CI 7.03-35.35 very liberal vs very conservative). The theory-based factors most strongly associated with uptake/intention were attitudes (AOR 3.72, 95% CI 2.42-5.73), self-efficacy (AOR 1.75, 95% CI 1.34-2.29), and concerns about side effects (AOR 0.59, 95% CI 0.46-0.76). Although race and political ideology were significant in the model of demographic characteristics, they were not significant when controlling for attitudes and beliefs. Conclusions: Vaccination represents one of the best tools to combat the COVID-19 pandemic, as well as other possible pandemics in the future. This study showed that older age, attitudes, injunctive norms, descriptive norms, and self-efficacy are positively associated with vaccine uptake and intent, whereas perceived side effects and lack of trust in the vaccine are associated with lower uptake and intent. Race and political ideology were not significant predictors when attitudes and beliefs were considered. Before vaccine hesitancy can be addressed, researchers and clinicians must understand the basis of vaccine hesitancy and which populations may show higher hesitancy to the vaccination so that interventions can be adequately targeted. %M 36219842 %R 10.2196/37203 %U https://publichealth.jmir.org/2022/11/e37203 %U https://doi.org/10.2196/37203 %U http://www.ncbi.nlm.nih.gov/pubmed/36219842 %0 Journal Article %@ 2562-7600 %I JMIR Publications %V 5 %N 1 %P e39866 %T Digital Health Literacy During the COVID-19 Pandemic Among Health Care Providers in Resource-Limited Settings: Cross-sectional Study %A Ahmed,Mohammedjud Hassen %A Guadie,Habtamu Alganeh %A Ngusie,Habtamu Setegn %A Teferi,Gizaw Hailiye %A Gullslett,Monika Knudsen %A Hailegebreal,Samuel %A Hunde,Mekonnen Kenate %A Donacho,Dereje Oljira %A Tilahun,Binyam %A Siraj,Shuayib Shemsu %A Debele,Gebiso Roba %A Hajure,Mohammedamin %A Mengiste,Shegaw Anagaw %+ Department of Management Information Systems, University of South East Norway, Dalegårdsveien 24 C, Drammen, 3028, Norway, 47 31009832, Shegaw.Mengiste@usn.no %K digital, health %K literacy %K COVID-19 %K professionals %K Ethiopia %K health professionals %K digital literacy %K skills %K knowledge %K perception %K use %K education %K training %D 2022 %7 14.11.2022 %9 Original Paper %J JMIR Nursing %G English %X Background: Digital health literacy is the use of information and communication technology to support health and health care. Digital health literacy is becoming increasingly important as individuals continue to seek medical advice from various web-based sources, especially social media, during the pandemics such as COVID-19. Objective: The study aimed to assess health professionals’ digital health literacy level and associated factors in Southwest Ethiopia in 2021. Methods: An institution-based cross-sectional study was conducted from January to April 2021 in Ethiopia. Simple random sampling technique was used to select 423 study participants among health professionals. SPSS (version 20) software was used for data entry and analysis. A pretested self-administered questionnaire was used to collect the required data. Multivariable logistic regression was used to examine the association between the digital health literacy skill and associated factors. Significance value was obtained at 95% CI and P<.05. Results: In total, 401 study subjects participated in the study. Overall, 43.6% (n=176) of respondents had high digital health literacy skills. High computer literacy (adjusted odds ratio [AOR] 4.43, 95% CI 2.34-5.67; P=.01); master’s degree and above (AOR 3.42, 95% CI 2.31-4.90; P=.02); internet use (AOR 4.00, 95% CI 1.78-4.02; P=.03); perceived ease of use (AOR 2.65, 95% CI 1.35-4.65; P=.04); monthly income of >15,000 Ethiopian birr (>US $283.68; AOR 7.55, 95% CI 6.43-9.44; P<.001); good knowledge of eHealth (AOR 2.22, 95% CI 1.32-4.03; P=.04); favorable attitudes (AOR 3.11, 95% CI 2.11-4.32; P=.04); and perceived usefulness (AOR 3.43, 95% CI 2.43-5.44; P=.02) were variables associated with eHealth literacy level. Conclusions: In general, less than half of the study participants had a high digital health literacy level. High computer literacy, master’s degree and above, frequent internet use, perceived ease to use, income of >15,000 Ethiopian birr (>US $283.68), good knowledge of digital health literacy, favorable attitude, and perceived usefulness were the most determinant factors in the study. Having high computer literacy, frequent use of internet, perceived ease of use, perceived usefulness, favorable attitude, and a high level of education will help to promote a high level of digital health literacy. %M 36301671 %R 10.2196/39866 %U https://nursing.jmir.org/2022/1/e39866 %U https://doi.org/10.2196/39866 %U http://www.ncbi.nlm.nih.gov/pubmed/36301671 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 11 %P e37698 %T The Emotional Anatomy of the Wuhan Lockdown: Sentiment Analysis Using Weibo Data %A Chen,Xi %A Yik,Michelle %+ Division of Social Science, Hong Kong University of Science and Technology, Clear Water Bay, Kowloon, Hong Kong, China, 852 23587815, Michelle.Yik@ust.hk %K Wuhan lockdown %K COVID-19 %K public health emergency %K emotion %K circumplex model of affect %K Weibo %K jiayou %D 2022 %7 14.11.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: On January 23, 2020, the city of Wuhan, China, was sealed off in response to the COVID-19 pandemic. Studies have found that the lockdown was associated with both positive and negative emotions, although their findings are not conclusive. In these studies, emotional responses to the Wuhan lockdown were identified using lexicons based on limited emotion types. Objective: This study aims to map Chinese people’s emotional responses to the Wuhan lockdown and compare Wuhan residents’ emotions with those of people elsewhere in China by analyzing social media data from Weibo using a lexicon based on the circumplex model of affect. Methods: Social media posts on Weibo from 2 weeks before to 2 weeks after the Wuhan lockdown was imposed (January 9, 2020, to February 6, 2020) were collected. Each post was coded using a valence score and an arousal score. To map emotional trajectories during the study period, we used a data set of 359,190 posts. To compare the immediate emotional responses to the lockdown and its longer-term emotional impact on Wuhan residents (n=1236) and non-Hubei residents (n=12,714), we used a second data set of 57,685 posts for multilevel modeling analyses. Results: Most posts (248,757/359,190, 69.25%) made during the studied lockdown period indicated a pleasant mood with low arousal. A gradual increase in both valence and arousal before the lockdown was observed. The posts after the lockdown was imposed had higher valence and arousal than prelockdown posts. On the day of lockdown, the non-Hubei group had a temporarily boosted valence (γ20=0.118; SE 0.021; P<.001) and arousal (γ30=0.293; SE 0.022; P<.001). Compared with non-Hubei residents, the Wuhan group had smaller increases in valence (γ21=−0.172; SE 0.052; P<.001) and arousal (γ31=−0.262; SE 0.053; P<.001) on the day of lockdown. Weibo users’ emotional valence (γ40=0.000; SE 0.001; P=.71) and arousal (γ40=0.001; SE 0.001; P=.56) remained stable over the 2 weeks after the lockdown was imposed regardless of geographical location (valence: γ41=−0.004, SE 0.003, and P=.16; arousal: γ41=0.003, SE 0.003, and P=.26). Conclusions: During the early stages of the pandemic, most Weibo posts indicated a pleasant mood with low arousal. The overall increase in the posts’ valence and arousal after the lockdown announcement might indicate collective cohesion and mutual support in web-based communities during a public health crisis. Compared with the temporary increases in valence and arousal of non-Hubei users on the day of lockdown, Wuhan residents’ emotions were less affected by the announcement. Overall, our data suggest that Weibo users were not influenced by the lockdown measures in the 2 weeks after the lockdown announcement. Our findings offer policy makers insights into the usefulness of social connections in maintaining the psychological well-being of people affected by a lockdown. %M 36166650 %R 10.2196/37698 %U https://formative.jmir.org/2022/11/e37698 %U https://doi.org/10.2196/37698 %U http://www.ncbi.nlm.nih.gov/pubmed/36166650 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 11 %P e36712 %T Outcomes of COVID-19 Infection in People Previously Vaccinated Against Influenza: Population-Based Cohort Study Using Primary Health Care Electronic Records %A Giner-Soriano,Maria %A de Dios,Vanessa %A Ouchi,Dan %A Vilaplana-Carnerero,Carles %A Monteagudo,Mònica %A Morros,Rosa %+ Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Gran Via de les Corts Catalanes 587, àtic, Barcelona, 08007, Spain, 34 934824110, mginer@idiapjgol.info %K SARS-CoV-2 %K COVID-19 %K influenza vaccines %K pneumonia %K electronic health records %K primary health care %K vaccination %K public health %K cohort study %K epidemiology %K eHeatlh %K health outcome %K mortality %D 2022 %7 11.11.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: A possible link between influenza immunization and susceptibility to the complications of COVID-19 infection has been previously suggested owing to a boost in the immunity against SARS-CoV-2. Objective: This study aimed to investigate whether individuals with COVID-19 could have benefited from vaccination against influenza. We hypothesized that the immunity resulting from the previous influenza vaccination would boost part of the immunity against SARS-CoV-2. Methods: We performed a population-based cohort study including all patients with COVID-19 with registered entries in the primary health care (PHC) electronic records during the first wave of the COVID-19 pandemic (March 1 to June 30, 2020) in Catalonia, Spain. We compared individuals who took an influenza vaccine before being infected with COVID-19, with those who had not taken one. Data were obtained from Information System for Research in Primary Care, capturing PHC information of 5.8 million people from Catalonia. The main outcomes assessed during follow-up were a diagnosis of pneumonia, hospital admission, and mortality. Results: We included 309,039 individuals with COVID-19 and compared them on the basis of their influenza immunization status, with 114,181 (36.9%) having been vaccinated at least once and 194,858 (63.1%) having never been vaccinated. In total, 21,721 (19%) vaccinated individuals and 11,000 (5.7%) unvaccinated individuals had at least one of their outcomes assessed. Those vaccinated against influenza at any time (odds ratio [OR] 1.14, 95% CI 1.10-1.19), recently (OR 1.13, 95% CI 1.10-1.18), or recurrently (OR 1.10, 95% CI 1.05-1.15) before being infected with COVID-19 had a higher risk of presenting at least one of the outcomes than did unvaccinated individuals. When we excluded people living in long-term care facilities, the results were similar. Conclusions: We could not establish a protective role of the immunity conferred by the influenza vaccine on the outcomes of COVID-19 infection, as the risk of COVID-19 complications was higher in vaccinated than in unvaccinated individuals. Our results correspond to the first wave of the COVID-19 pandemic, where more complications and mortalities due to COVID-19 had occurred. Despite that, our study adds more evidence for the analysis of a possible link between the quality of immunity and COVID-19 outcomes, particularly in the PHC setting. %M 36265160 %R 10.2196/36712 %U https://publichealth.jmir.org/2022/11/e36712 %U https://doi.org/10.2196/36712 %U http://www.ncbi.nlm.nih.gov/pubmed/36265160 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 11 %P e41004 %T Performance of the Swiss Digital Contact-Tracing App Over Various SARS-CoV-2 Pandemic Waves: Repeated Cross-sectional Analyses %A Daniore,Paola %A Nittas,Vasileios %A Ballouz,Tala %A Menges,Dominik %A Moser,André %A Höglinger,Marc %A Villiger,Petra %A Schmitz-Grosz,Krisztina %A Von Wyl,Viktor %+ Institute for Implementation Science in Healthcare, University of Zurich, Universitatstrasse 84, Zurich, 8006, Switzerland, 41 044 634 37 62, viktor.vonwyl@uzh.ch %K digital contact tracing %K exposure notification %K COVID-19 %K SARS-CoV-2 %K public health %K surveillance %K digital proximity %K contact-tracing app %K mobile app %K Switzerland %K variant of concern %K SwissCovid app %K digital tool %D 2022 %7 11.11.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Digital proximity-tracing apps have been deployed in multiple countries to assist with SARS-CoV-2 pandemic mitigation efforts. However, it is unclear how their performance and effectiveness were affected by changing pandemic contexts and new viral variants of concern. Objective: The aim of this study is to bridge these knowledge gaps through a countrywide digital proximity-tracing app effectiveness assessment, as guided by the World Health Organization/European Center for Prevention and Disease Control (WHO/ECDC) indicator framework to evaluate the public health effectiveness of digital proximity-tracing solutions. Methods: We performed a descriptive analysis of the digital proximity-tracing app SwissCovid in Switzerland for 3 different periods where different SARS-CoV-2 variants of concern (ie, Alpha, Delta, and Omicron, respectively) were most prevalent. In our study, we refer to the indicator framework for the evaluation of public health effectiveness of digital proximity-tracing apps of the WHO/ECDC. We applied this framework to compare the performance and effectiveness indicators of the SwissCovid app. Results: Average daily registered SARS-CoV-2 case rates during our assessment period from January 25, 2021, to March 19, 2022, were 20 (Alpha), 54 (Delta), and 350 (Omicron) per 100,000 inhabitants. The percentages of overall entered authentication codes from positive tests into the SwissCovid app were 9.9% (20,273/204,741), 3.9% (14,372/365,846), and 4.6% (72,324/1,581,506) during the Alpha, Delta, and Omicron variant phases, respectively. Following receipt of an exposure notification from the SwissCovid app, 58% (37/64, Alpha), 44% (7/16, Delta), and 73% (27/37, Omicron) of app users sought testing or performed self-tests. Test positivity among these exposure-notified individuals was 19% (7/37) in the Alpha variant phase, 29% (2/7) in the Delta variant phase, and 41% (11/27) in the Omicron variant phase compared to 6.1% (228,103/3,755,205), 12% (413,685/3,443,364), and 41.7% (1,784,951/4,285,549) in the general population, respectively. In addition, 31% (20/64, Alpha), 19% (3/16, Delta), and 30% (11/37, Omicron) of exposure-notified app users reported receiving mandatory quarantine orders by manual contact tracing or through a recommendation by a health care professional. Conclusions: In constantly evolving pandemic contexts, the effectiveness of digital proximity-tracing apps in contributing to mitigating pandemic spread should be reviewed regularly and adapted based on changing requirements. The WHO/ECDC framework allowed us to assess relevant domains of digital proximity tracing in a holistic and systematic approach. Although the Swisscovid app mostly worked, as reasonably expected, our analysis revealed room for optimizations and further performance improvements. Future implementation of digital proximity-tracing apps should place more emphasis on social, psychological, and organizational aspects to reduce bottlenecks and facilitate their use in pandemic contexts. %M 36219833 %R 10.2196/41004 %U https://publichealth.jmir.org/2022/11/e41004 %U https://doi.org/10.2196/41004 %U http://www.ncbi.nlm.nih.gov/pubmed/36219833 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 8 %N 4 %P e40600 %T Esophagogastroduodenoscopy Screening Intentions During the COVID-19 Pandemic in Japan: Web-Based Survey %A Akahane,Takemi %A Nakanishi,Yasuhiro %A Yoshiji,Hitoshi %A Akahane,Manabu %+ Department of Gastroenterology, Nara Medical University, 840 Shijo-cho, Kashihara, 634-8522, Japan, 81 744223051, stakemi@naramed-u.ac.jp %K COVID-19 %K cancer screening %K esophagogastroduodenoscopy %K EGD %K intention %K survey %K cancer %K Japan %K screening %K men %K women %K anxiety %K information %K infection %D 2022 %7 11.11.2022 %9 Original Paper %J JMIR Cancer %G English %X Background: The number of people undergoing cancer screening decreased during the COVID-19 pandemic. The pandemic may have affected the willingness and motivation of undergoing cancer screening by those eligible for it. Objective: This study aims to clarify the effect of the COVID-19 pandemic on the intention to undergo cancer and esophagogastroduodenoscopy (EGD) screening. Methods: We performed a web-based survey on the intention to undergo screening among 1236 men and women aged 20-79 years. The numbers of participants by sex and 10-year age groups were equal. The survey was conducted in January 2021, during which the government declared a state of emergency because of the third wave of the COVID-19 pandemic in Japan. Emergency declarations were issued in 11 prefectures among all the 47 prefectures in Japan. Results: In total, 66.1% (817/1236) of the participants felt anxious about undergoing screening due to COVID-19. More women than men were anxious about undergoing screening. By modality, EGD had the highest percentage of participants with anxiety due to COVID-19. Regarding the intention to change the participants’ appointment for screening, the most common strategies were to book an appointment for a time during nonpeak hours, postpone the appointment to a later date, and change the mode of transportation. In addition, 35.8% (442/1236) of the participants were willing to cancel this year’s screening appointment. Among the 1236 participants, 757 (61.2%) were scheduled for screening in 2020. Of the 757 participants in this subgroup, 68% (n=515) did not change the schedule, 6.1% (n=46) cancelled, and 26% (n=197) made some changes, including changing the appointment date, hospital, or mode of transportation. Among the 296 participants scheduled for EGD screening, 18.9% (n=56) made some changes, 5.7% (n=17) cancelled on their own, and 2.7% (n=8) cancelled on the hospital’s order. Based on the previous screening results, the percentage of participants who felt anxious about EGD due to the COVID-19 pandemic was higher in the order of those who had not undergone screening and those who were judged to be in need of further examination in screening but did not visit a hospital for it. In the logistic regression analysis, the factors associated with anxiety about EGD screening due to the COVID-19 pandemic were “viral infection prevention measures,” “waiting time,” “fees (medical expenses),” “mode of transportation,” “worry about my social position if I contracted COVID-19,” and “perceived the risk of gastric cancer.” However, “residence in declared emergency area” was not associated with EGD anxiety due to COVID-19. Conclusions: Excessive anxiety about COVID-19 may lead to serious outcomes, such as a “decreasing intention to undergo EGD screening,” and it is necessary to thoroughly implement infection prevention measures and provide correct information to examinees. %M 36343187 %R 10.2196/40600 %U https://cancer.jmir.org/2022/4/e40600 %U https://doi.org/10.2196/40600 %U http://www.ncbi.nlm.nih.gov/pubmed/36343187 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 11 %P e39634 %T Providers’ Perspectives on Telemental Health Usage After the COVID-19 Pandemic: Retrospective Analysis %A Wilczewski,Hattie %A Paige,Samantha R %A Ong,Triton %A Soni,Hiral %A Barrera,Janelle F %A Welch,Brandon M %A Bunnell,Brian E %+ Doxy.me Research, Doxy.me Inc, 3445 Winton Pl, Suite 114, Rochester, NY, 14623, United States, 1 8444369963, hattie.wilczewski@doxy.me %K telemedicine %K telehealth %K COVID-19 %K telemental health %K mental health %K pandemic %K perception %K use %K usefulness %K usage %K workflow %D 2022 %7 11.11.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Mental health care pivoted to telemedicine during the COVID-19 pandemic, and there is uncertainty around the sustainability of this rapid shift. Objective: This study examined how intentions to continue using telemedicine after the COVID-19 pandemic are influenced by provider perceptions of usefulness, ease of use, and professional social influence, facilitating organizational conditions. Methods: We conducted a web-based, cross-sectional survey of 369 telemental health providers between February and March 2021. A hierarchical linear regression analysis was conducted to predict intentions to continue using telemedicine after the COVID-19 pandemic. Results: Most providers began using telemedicine in March 2020 or later (257/369, 69.6%) and attended to ≥50% of their clients via telemedicine (299/369, 81.0%). Intention to continue using telemedicine after the COVID-19 pandemic was predicted by the telemedicine caseload (β=.10; P=.005), perceived usefulness in general (β=.10; P=.008), ease of use (β=.08; P=.04), social influence (β=.68; P<.001), and facilitating conditions (β=.08; P=.047). Conclusions: Exploration of the predictors of telemedicine usage beyond the COVID-19 pandemic aids in surveillance of telemedicine usage, integration with future clinic workflows, and the shaping of public policy. It is important to consider telemedicine services as not only a response to a crisis but also an effective and useful solution for everyday life. Our results suggest widespread, sustainable telemedicine adoption. %M 36322787 %R 10.2196/39634 %U https://formative.jmir.org/2022/11/e39634 %U https://doi.org/10.2196/39634 %U http://www.ncbi.nlm.nih.gov/pubmed/36322787 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 11 %P e42320 %T The Effect of the First UK COVID-19 Lockdown on Users of the Drink Less App: Interrupted Time Series Analysis of Sociodemographic Characteristics, Engagement, and Alcohol Reduction %A Oldham,Melissa %A Perski,Olga %A Loebenberg,Gemma %A Brown,Jamie %A Garnett,Claire %+ Department of Behavioural Science and Health, University College London, 1-19 Torrington Pl, London, WC1E 7HB, United Kingdom, 44 7507712530, m.oldham@ucl.ac.uk %K alcohol reduction %K COVID-19 %K digital intervention %K smartphone app %K United Kingdom %K alcohol %K app %K Drink Less %K engagement %K users %K lockdown %K female %D 2022 %7 10.11.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: The first UK COVID-19 lockdown had a polarizing impact on drinking behavior and may have impacted engagement with digital interventions to reduce alcohol consumption. Objective: We examined the effect of lockdown on engagement, alcohol reduction, and the sociodemographic characteristics of users of the popular and widely available alcohol reduction app Drink Less. Methods: This was a natural experiment. The study period spanned 468 days between March 24, 2019, and July 3, 2020, with the introduction of UK lockdown measures beginning on March 24, 2020. Users were 18 years or older, based in the United Kingdom, and interested in drinking less. Interrupted time series analyses using generalized additive mixed models (GAMMs) were conducted for each outcome variable (ie, sociodemographic characteristics, app downloads and engagement levels, alcohol consumption, and extent of alcohol reduction) for existing (downloaded the app prelockdown) and new (downloaded the app during the lockdown) users of the app. Results: Among existing users of the Drink Less app, there were increases in the time spent on the app per day (B=0.01, P=.01), mean units of alcohol recorded per day (B>0.00 P=.02), and mean heavy drinking (>6 units) days (B>0.00, P=.02) during the lockdown. Previous declines in new app downloads plateaued during the lockdown (incidence rate ratio [IRR]=1.00, P=.18). Among new app users, there was an increase in the proportion of female users (B>0.00, P=.04) and those at risk of alcohol dependence (B>0.00, P=.01) and a decrease in the proportion of nonmanual workers (B>–0.00, P=.04). Among new app users, there were step increases in the mean number of alcohol units per day (B=20.12, P=.03), heavy-drinking days (B=1.38, P=.01), and the number of days the app was used (B=2.05, P=.02), alongside a step decrease in the percentage of available screens viewed (B=–0.03, P=.04), indicating users were using less of the intervention components within the app. Conclusions: Following the first UK lockdown, there was evidence of increases in engagement and alcohol consumption among new and existing users of the Drink Less app. %M 36240461 %R 10.2196/42320 %U https://www.jmir.org/2022/11/e42320 %U https://doi.org/10.2196/42320 %U http://www.ncbi.nlm.nih.gov/pubmed/36240461 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 11 %P e42431 %T The Role of Information Infrastructures in Scaling up Video Consultations During COVID-19: Mixed Methods Case Study Into Opportunity, Disruption, and Exposure %A Wherton,Joseph %A Greenhalgh,Trisha %A Hughes,Gemma %A Shaw,Sara E %+ Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Oxford, OX2 6GG, United Kingdom, 44 865 617855, joseph.wherton@phc.ox.ac.uk %K information infrastructure %K video consultations %K organizational ethnography %K COVID-19 %K health care organization %K telehealth %K health care delivery %K agile governance %K knowledge transfer %D 2022 %7 10.11.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Until COVID-19, implementation and uptake of video consultations in health care was slow. However, the pandemic created a “burning platform” for scaling up such services. As health care organizations look to expand and maintain the use of video in the “new normal,” it is important to understand infrastructural influences and changes that emerged during the pandemic and that may influence sustainability going forward. Objective: This study aims to draw lessons from 4 National Health Service (NHS) organizations on how information infrastructures shaped, and were shaped by, the rapid scale-up of video consultations during COVID-19. Methods: A mixed methods case study of 4 NHS trusts in England was conducted before and during the pandemic. Data comprised 90 interviews with 49 participants (eg, clinicians, managers, administrators, and IT support), ethnographic field notes, and video consultation activity data. We sought examples of infrastructural features and challenges related to the rapid scale-up of video. Analysis was guided by Gkeredakis et al’s 3 perspectives on crisis and digital change: as opportunity (for accelerated innovation and removal of barriers to experimentation), disruption (to organizational practices, generating new dependencies and risks), and exposure (of vulnerabilities in both people and infrastructure). Results: Before COVID-19, there was a strong policy push for video consultations as a way of delivering health care efficiently. However, the spread of video was slow, and adopting clinicians described their use as ad hoc rather than business as usual. When the pandemic hit, video was rapidly scaled up. The most rapid increase in use was during the first month of the pandemic (March-April 2020), from an average of 8 video consultations per week to 171 per week at each site. Uptake continued to increase during the pandemic, averaging approximately 800 video consultations per week by March 2021. From an opportunity perspective, participants talked about changes to institutional elements of infrastructure, which had historically restricted the introduction and use of video. This was supported by an “organizing vision” for video, bringing legitimacy and support. Perspectives on disruption centered on changes to social, technical, and material work environments and the emergence of new patterns of action. Retaining positive elements of such change required a judicious balance between managerial (top-down) and emergent (bottom-up) approaches. Perspectives on exposure foregrounded social and technical impediments to video consulting. This highlighted the need to attend to the materiality and dependability of the installed base, as well as the social and cultural context of use. Conclusions: For sustained adoption at scale, health care organizations need to enable incremental systemic change and flexibility through agile governance and knowledge transfer pathways, support process multiplicity within virtual clinic workflows, attend to the materiality and dependability of the IT infrastructure within and beyond organizational boundaries, and maintain an overall narrative within which the continued use of video can be framed. %M 36282978 %R 10.2196/42431 %U https://www.jmir.org/2022/11/e42431 %U https://doi.org/10.2196/42431 %U http://www.ncbi.nlm.nih.gov/pubmed/36282978 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 10 %N 11 %P e37945 %T The Real-World Experiences of Persons With Multiple Sclerosis During the First COVID-19 Lockdown: Application of Natural Language Processing %A Chiavi,Deborah %A Haag,Christina %A Chan,Andrew %A Kamm,Christian Philipp %A Sieber,Chloé %A Stanikić,Mina %A Rodgers,Stephanie %A Pot,Caroline %A Kesselring,Jürg %A Salmen,Anke %A Rapold,Irene %A Calabrese,Pasquale %A Manjaly,Zina-Mary %A Gobbi,Claudio %A Zecca,Chiara %A Walther,Sebastian %A Stegmayer,Katharina %A Hoepner,Robert %A Puhan,Milo %A von Wyl,Viktor %+ Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, Zurich, 8001, Switzerland, 41 44 63 46380, viktor.vonwyl@uzh.ch %K natural language processing %K multiple sclerosis %K COVID-19 %K nervous system disease %K nervous system disorder %K textual data %K health data %K patient data %K topic modeling %K sentiment analysis %K linguistic inquiry %K medical informatics %K clinical informatics %D 2022 %7 10.11.2022 %9 Original Paper %J JMIR Med Inform %G English %X Background: The increasing availability of “real-world” data in the form of written text holds promise for deepening our understanding of societal and health-related challenges. Textual data constitute a rich source of information, allowing the capture of lived experiences through a broad range of different sources of information (eg, content and emotional tone). Interviews are the “gold standard” for gaining qualitative insights into individual experiences and perspectives. However, conducting interviews on a large scale is not always feasible, and standardized quantitative assessment suitable for large-scale application may miss important information. Surveys that include open-text assessments can combine the advantages of both methods and are well suited for the application of natural language processing (NLP) methods. While innovations in NLP have made large-scale text analysis more accessible, the analysis of real-world textual data is still complex and requires several consecutive steps. Objective: We developed and subsequently examined the utility and scientific value of an NLP pipeline for extracting real-world experiences from textual data to provide guidance for applied researchers. Methods: We applied the NLP pipeline to large-scale textual data collected by the Swiss Multiple Sclerosis (MS) registry. Such textual data constitute an ideal use case for the study of real-world text data. Specifically, we examined 639 text reports on the experienced impact of the first COVID-19 lockdown from the perspectives of persons with MS. The pipeline has been implemented in Python and complemented by analyses of the “Linguistic Inquiry and Word Count” software. It consists of the following 5 interconnected analysis steps: (1) text preprocessing; (2) sentiment analysis; (3) descriptive text analysis; (4) unsupervised learning–topic modeling; and (5) results interpretation and validation. Results: A topic modeling analysis identified the following 4 distinct groups based on the topics participants were mainly concerned with: “contacts/communication;” “social environment;” “work;” and “errands/daily routines.” Notably, the sentiment analysis revealed that the “contacts/communication” group was characterized by a pronounced negative emotional tone underlying the text reports. This observed heterogeneity in emotional tonality underlying the reported experiences of the first COVID-19–related lockdown is likely to reflect differences in emotional burden, individual circumstances, and ways of coping with the pandemic, which is in line with previous research on this matter. Conclusions: This study illustrates the timely and efficient applicability of an NLP pipeline and thereby serves as a precedent for applied researchers. Our study thereby contributes to both the dissemination of NLP techniques in applied health sciences and the identification of previously unknown experiences and burdens of persons with MS during the pandemic, which may be relevant for future treatment. %M 36252126 %R 10.2196/37945 %U https://medinform.jmir.org/2022/11/e37945 %U https://doi.org/10.2196/37945 %U http://www.ncbi.nlm.nih.gov/pubmed/36252126 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 4 %P e39670 %T Understanding Human Factors Challenges on the Front Lines of Mass COVID-19 Vaccination Clinics: Human Systems Modeling Study %A Tennant,Ryan %A Tetui,Moses %A Grindrod,Kelly %A Burns,Catherine M %+ Department of Systems Design Engineering, Faculty of Engineering, University of Waterloo, 200 University Ave W, Waterloo, ON, N2L 3G1, Canada, 1 519 888 4567, drtennan@uwaterloo.ca %K cognitive work analysis %K contextual design %K COVID-19 %K decision making %K health care system %K pandemic %K vaccination clinics %K workplace stress %D 2022 %7 10.11.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Implementing mass vaccination clinics for COVID-19 immunization has been a successful public health activity worldwide. However, this tightly coupled system has many logistical challenges, leading to increased workplace stress, as evidenced throughout the pandemic. The complexities of mass vaccination clinics that combine multidisciplinary teams working within nonclinical environments are yet to be understood through a human systems perspective. Objective: This study aimed to holistically model mass COVID-19 vaccination clinics in the Region of Waterloo, Ontario, Canada, to understand the challenges centered around frontline workers and to inform clinic design and technological recommendations that can minimize the systemic inefficiencies that contribute to workplace stress. Methods: An ethnographic approach was guided by contextual inquiry to gather data on work as done in these ad-hoc immunization settings. Observation data were clarified by speaking with clinic staff, and the research team discussed the observation data regularly throughout the data collection period. Data were analyzed by combining aspects of the contextual design framework and cognitive work analysis, and building workplace models that can identify the stress points and interconnections within mass vaccination clinic flow, developed artifacts, culture, physical layouts, and decision-making. Results: Observations were conducted at 6 mass COVID-19 vaccination clinics over 4 weeks in 2021. The workflow model depicted challenges with maintaining situational awareness about client intake and vaccine preparation among decision-makers. The artifacts model visualized how separately developed tools for the vaccine lead and clinic lead may support cognitive tasks through data synthesis. However, their effectiveness depends on sharing accurate and timely data. The cultural model indicated that perspectives on how to effectively achieve mass immunization might impact workplace stress with changes to responsibilities. This depends on the aggressive or relaxed approach toward minimizing vaccine waste while adapting to changing policies, regulations, and vaccine scarcity. The physical model suggested that the co-location of workstations may influence decision-making coordination. Finally, the decision ladder described the decision-making steps for managing end-of-day doses, highlighting challenges with data uncertainty and ways to support expertise. Conclusions: Modeling mass COVID-19 vaccination clinics from a human systems perspective identified 2 high-level opportunities for improving the inefficiencies within this health care delivery system. First, clinics may become more resilient to unexpected changes in client intake or vaccine preparation using strategies and artifacts that standardize data gathering and synthesis, thereby reducing uncertainties for end-of-day dose decision-making. Second, improving data sharing among staff by co-locating their workstations and implementing collaborative artifacts that support a collective understanding of the state of the clinic may reduce system complexity by improving shared situational awareness. Future research should examine how the developed models apply to immunization settings beyond the Region of Waterloo and evaluate the impact of the recommendations on workflow coordination, stress, and decision-making. %M 36219839 %R 10.2196/39670 %U https://humanfactors.jmir.org/2022/4/e39670 %U https://doi.org/10.2196/39670 %U http://www.ncbi.nlm.nih.gov/pubmed/36219839 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 11 %P e38562 %T Stressors and Destressors in Working From Home Based on Context and Physiology From Self-Reports and Smartwatch Measurements: International Observational Study Trial %A Tump,Danielle %A Narayan,Nitin %A Verbiest,Vera %A Hermsen,Sander %A Goris,Annelies %A Chiu,Chui-De %A Van Stiphout,Ruud %+ OnePlanet Research Center, Stichting imec Nederland, Plus Ultra 2, Bronland 10, Wageningen, 6708 WE, Netherlands, 31 611231567, danielle.tump@imec.nl %K stress %K telework %K wearables %K COVID-19 %K pandemic %K remote working %K employees %K stressors %K destressors %K remote work %K mental health %K psychological health %K smartphone %K digital questionnaire %K stress management %K occupational health %K stress detection %K prediction model %D 2022 %7 10.11.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic has greatly boosted working from home as a way of working, which is likely to continue for most companies in the future, either in fully remote or in hybrid form. To manage stress levels in employees working from home, insights into the stressors and destressors in a home office first need to be studied. Objective: We present an international remote study with employees working from home by making use of state-of-the-art technology (ie, smartwatches and questionnaires through smartphones) first to determine stressors and destressors in people working from home and second to identify smartwatch measurements that could represent these stressors and destressors. Methods: Employees working from home from 3 regions of the world (the United States, the United Kingdom, and Hong Kong) were asked to wear a smartwatch continuously for 7 days and fill in 5 questionnaires each day and 2 additional questionnaires before and after the measurement week. The entire study was conducted remotely. Univariate statistical analyses comparing variable distributions between low and high stress levels were followed by multivariate analysis using logistic regression, considering multicollinearity by using variance inflation factor (VIF) filtering. Results: A total of 202 people participated, with 198 (98%) participants finishing the experiment. Stressors found were other people and daily life getting in the way of work (P=.05), job intensity (P=.01), a history of burnout (P=.03), anxiety toward the pandemic (P=.04), and environmental noise (P=.01). Destressors found were access to sunlight (P=.02) and fresh air (P<.001) during the workday and going outdoors (P<.001), taking breaks (P<.001), exercising (P<.001), and having social interactions (P<.001). The smartwatch measurements positively related to stress were the number of active intensity periods (P<.001), the number of highly active intensity periods (P=.04), steps (P<.001), and the SD in the heart rate (HR; P<.001). In a multivariate setting, only a history of burnout (P<.001) and family and daily life getting in the way of work (P<.001) were positively associated with stress, while self-reports of social activities (P<.001) and going outdoors (P=.03) were negatively associated with stress. Stress prediction models based on questionnaire data had a similar performance (F1=0.51) compared to models based on automatic measurable data alone (F1=0.47). Conclusions: The results show that there are stressors and destressors when working from home that should be considered when managing stress in employees. Some of these stressors and destressors are (in)directly measurable with unobtrusive sensors, and prediction models based on these data show promising results for the future of automatic stress detection and management. Trial Registration: Netherlands Trial Register NL9378; https://trialsearch.who.int/Trial2.aspx?TrialID=NL9378 %M 36265030 %R 10.2196/38562 %U https://formative.jmir.org/2022/11/e38562 %U https://doi.org/10.2196/38562 %U http://www.ncbi.nlm.nih.gov/pubmed/36265030 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 11 %P e34075 %T The COVID-19 Schools Infection Survey in England: Protocol and Participation Profile for a Prospective Observational Cohort Study %A Halliday,Katherine E %A Nguipdop-Djomo,Patrick %A Oswald,William E %A Sturgess,Joanna %A Allen,Elizabeth %A Sundaram,Neisha %A Ireland,Georgina %A Poh,John %A Ijaz,Samreen %A Shute,Justin %A Diamond,Ian %A Rourke,Emma %A Dawe,Fiona %A Judd,Alison %A Clark,Taane %A Edmunds,W John %A Bonell,Chris %A Mangtani,Punam %A Ladhani,Shamez N %A Langan,Sinéad M %A Hargreaves,James %A , %+ Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, United Kingdom, 44 0207 927 2614, katherine.halliday@lshtm.ac.uk %K COVID-19 %K SARS-CoV-2 %K school-based %K epidemiology %K infection control %D 2022 %7 10.11.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: One of the most debated questions in the COVID-19 pandemic has been the role of schools in SARS-CoV-2 transmission. The COVID-19 Schools Infection Survey (SIS) aims to provide much-needed evidence addressing this issue. Objective: We present the study protocol and participation profile for the SIS study, aimed at assessing the role of schools in SARS-CoV-2 infection and transmission within school settings, and investigating how transmission within and from schools could be mitigated through the implementation of school COVID-19 control measures. Methods: SIS was a multisite, prospective, observational cohort study conducted in a stratified random sample of primary and secondary schools in selected local authorities in England. A total of 6 biobehavioral surveys were planned among participating students and staff during the 2020-2021 academic year, between November 2020 and July 2021. Key measurements were SARS-CoV-2 virus prevalence, assessed by nasal swab polymerase chain reaction; anti-SARS-CoV-2 (nucleocapsid protein) antibody prevalence and conversion, assessed in finger-prick blood for staff and oral fluid for students; student and staff school attendance rates; feasibility and acceptability of school-level implementation of SARS-CoV-2 control measures; and investigation of selected school outbreaks. The study was approved by the United Kingdom Health Security Agency Research Support and Governance Office (NR0237) and London School of Hygiene & Tropical Medicine Ethics Review Committee (reference 22657). Results: Data collection and laboratory analyses were completed by September 2021. A total of 22,585 individuals—1891 staff and 4654 students from 59 primary schools and 5852 staff and 10,188 students from 97 secondary schools—participated in at least one survey. Across all survey rounds, staff and student participation rates were 45.2% and 16.4%, respectively, in primary schools and 30% and 15.2%, respectively, in secondary schools. Although primary student participation increased over time, and secondary student participation remained reasonably consistent, staff participation declined across rounds, especially for secondary school staff (3165/7583, 41.7% in round 1 and 2290/10,374, 22.1% in round 6). Although staff participation overall was generally reflective of the eligible staff population, student participation was higher in schools with low absenteeism, a lower proportion of students eligible for free school meals, and from schools in the least deprived locations (in primary schools, 446/4654, 9.6% of participating students were from schools in the least deprived quintile compared with 1262/22,225, 5.7% of eligible students). Conclusions: We outline the study design, methods, and participation, and reflect on the strengths of the SIS study as well as the practical challenges encountered and the strategies implemented to address these challenges. The SIS study, by measuring current and incident infection over time, alongside the implementation of control measures in schools across a range of settings in England, aims to inform national guidance and public health policy for educational settings. International Registered Report Identifier (IRRID): RR1-10.2196/34075 %M 35635843 %R 10.2196/34075 %U https://www.researchprotocols.org/2022/11/e34075 %U https://doi.org/10.2196/34075 %U http://www.ncbi.nlm.nih.gov/pubmed/35635843 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 11 %P e40175 %T Mass Screening of SARS-CoV-2 With Rapid Antigen Tests in a Receding Omicron Wave: Population-Based Survey for Epidemiologic Evaluation %A Kwan,Tsz Ho %A Wong,Ngai Sze %A Chan,Chin Pok %A Yeoh,Eng Kiong %A Wong,Samuel Yeung-shan %A Lee,Shui Shan %+ Stanley Ho Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, Room 207, Postgraduate Education Centre, Prince of Wales Hospital, Shatin, Hong Kong, 852 22528862, sslee@cuhk.edu.hk %K COVID-19 %K SARS-CoV-2 antigen testing %K COVID-19 vaccine %K mass screening %K antigen test %K epidemiology %K Omicron %K Hong Kong %K public health %K outbreak %K epidemic %K screening %K transmission %K online %K vaccination %K vaccines %K surveillance %D 2022 %7 9.11.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The COVID-19 Omicron BA.2 epidemic wave in Hong Kong peaked in the first quarter of 2022. Following the implementation of stringent public health measures, the daily number of reported cases fell from over 50,000 to below 2000. Although outbreaks steadily receded, the government rolled out a 3-day “voluntary universal rapid testing” campaign to invite all citizens to self-perform a rapid antigen test (RAT) daily to identify undetected prevalent infections. Objective: This study aimed to evaluate the uptake and results of RAT mass screening to estimate the population’s residual epidemic burden and assess the risk of further transmission. Methods: A cross-sectional study comprising an open web-based population-based survey was conducted a week after the RAT campaign. Participants were asked to report their COVID-19 vaccination and infection history and the RAT performance and test result during the period. They were also invited to report their coliving individuals’ test performance and results. Reasons for nonuptake were enquired. Testing and positive rates were age-adjusted. Determinants of undergoing RAT were identified using univariable and multivariable logistic regression models. Results: In total, particulars from 21,769 individuals were reported by 8338 participants. The overall age-adjusted testing rate was 74.94% (95% CI 73.71%-76.18%), with over 80% of participants in the age groups between 45-84 years having self-performed RAT during the campaign period. After age-adjustment, 1.03% (95% CI 0.86%-1.21%) of participants tested positive. The positive rates in the age groups between 20-29 years and >84 years exceeded 2%. Taking into account the positive rate and 5819 reported cases during the period, the cases identified in the campaign might account for 7.65% (95% CI 6.47%-9.14%) of all infections. Testers were more likely to be female, older, not previously diagnosed with COVID-19, and have received COVID-19 vaccination. Adjusting for the number of household members, those living with a child aged <12 years and whose household members were also tested were more likely to have self-performed an RAT. Main reasons for not performing an RAT included the absence of symptoms (598/1108, 53.97%), disbelief of the appropriateness of the campaign as an antiepidemic measure (355/1108, 32.04%), and a recent COVID-19 diagnosis (332/1108, 29.96%). Conclusions: The residual population burden remained substantial in spite of the clear evidence of a receding epidemic wave. Despite caution in generalization to the Hong Kong population, the high participation rate in mass screening indicated that the voluntary RAT was well accepted, making it a feasible option for implementation as a complementary means of public health surveillance. %M 36240027 %R 10.2196/40175 %U https://publichealth.jmir.org/2022/11/e40175 %U https://doi.org/10.2196/40175 %U http://www.ncbi.nlm.nih.gov/pubmed/36240027 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 11 %P e40286 %T Adapting DIALOG+ in a School Setting—A Tool to Support Well-being and Resilience in Adolescents Living in Postconflict Areas During the COVID-19 Pandemic: Protocol for a Cluster Randomized Exploratory Study %A Gómez-Restrepo,Carlos %A Sarmiento-Suárez,María José %A Alba-Saavedra,Magda %A Bird,Victoria Jane %A Priebe,Stefan %A van Loggerenberg,Francois %+ The Unit for Social and Community Psychiatry, Wolfson Institute of Population Health, Queen Mary University of London, Newham Centre for Mental Health, London, E13 8SP, United Kingdom, 44 2078825555, f.vanloggerenberg@qmul.ac.uk %K mental health %K mental disorder %K eHealth %K digital health %K digital intervention %K psychosocial intervention %K resilience %K psychological support %K psychosocial well-being %K mental well-being %K resource-oriented approach %K computer-mediated intervention %K armed conflict %K post-conflict %K adolescent health %K adolescent %K adolescence %K child %K youth %K school %K teacher %K student %K acceptability %K feasibility %K vulnerable %D 2022 %7 9.11.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Colombia has a long history of an armed conflict that has severely affected communities with forced internal displacement and violence. Victims of violence and armed conflicts have higher rates of mental health disorders, and children and adolescents are particularly affected. However, the mental health needs of this population are often overlooked, especially in low- and middle-Income countries, where scarcity of resources exacerbates the problem that has been further compounded by the global COVID-19 pandemic. Thus, special attention should be paid to the development of interventions that target this population. Objective: Our research aims to adapt an existing patient-centered digital intervention called DIALOG+ from a clinical setting to an educational setting using stakeholders’ (teachers’ and students’) perspectives. We aim to evaluate the feasibility, acceptability, and estimated effect of implementing this intervention as a tool for the identification and mobilization of personal and social resources to mitigate the impact of social difficulties and to promote mental well-being. Methods: We will conduct an exploratory mixed methods study in public schools of postconflict areas in Tolima, Colombia. The study consists of 3 phases: adaptation, exploration, and consolidation of the DIALOG+ tool. The adaptation phase will identify possible changes that the intervention requires on the basis of data from focus groups with teachers and students. The exploration phase will be an exploratory cluster randomized trial with teachers and school counselors to assess the acceptability, feasibility, and estimated effect of DIALOG+ for adolescents in school settings. Adolescents’ data about mental health symptoms and wellness will be collected before and after DIALOG+ implementation. During this phase, teachers or counselors who were part of the intervention group will share their opinions through the think-aloud method. Lastly, the consolidation phase will consist of 2 focus groups with teachers and students to discuss their experiences and to understand acceptability. Results: Study recruitment was completed in March 2022, and follow-up is anticipated to last through November 2022. Conclusions: This exploratory study will evaluate the acceptability, feasibility, and estimated effect of DIALOG+ for adolescents in postconflict school settings in Colombia. The use of this technology-supported tool aims to support interactions between teachers or counselors and students and to provide an effective student-centered communication guide. This is an innovative approach in both the school and the postconflict contexts that could help improve the mental health and wellness of adolescents in vulnerable zones in Colombia. Subsequent studies will be needed to evaluate the effectiveness of DIALOG+ in an educational context as a viable option to reduce the gap and inequities of mental health care access. Trial Registration: ISRCTN Registry ISRCTN14396374; https://www.isrctn.com/ISRCTN14396374?q=ISRCTN14396374 International Registered Report Identifier (IRRID): DERR1-10.2196/40286 %M 36350703 %R 10.2196/40286 %U https://www.researchprotocols.org/2022/11/e40286 %U https://doi.org/10.2196/40286 %U http://www.ncbi.nlm.nih.gov/pubmed/36350703 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 11 %P e38898 %T The Risk of Hospitalization and Mortality After Breakthrough SARS-CoV-2 Infection by Vaccine Type: Observational Study of Medical Claims Data %A Kshirsagar,Meghana %A Nasir,Md %A Mukherjee,Sumit %A Becker,Nicholas %A Dodhia,Rahul %A Weeks,William B %A Ferres,Juan Lavista %A Richardson,Barbra %+ Microsoft, 1 Microsoft Way, Redmond, WA, 98052, United States, 1 425 638 7777, meghana.ksagar@gmail.com %K breakthroughs %K vaccines %K Pfizer %K Moderna %K Janssen %K SARS-CoV-2 %K COVID-19 %K coronavirus %K infectious disease %K viral infection %K vaccination %K breakthrough infection %K public health %K health policy %K decision making %K booster vaccine %K mortality %K hospitalization %K healthcare system %D 2022 %7 8.11.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Several risk factors have been identified for severe COVID-19 disease by the scientific community. In this paper, we focus on understanding the risks for severe COVID-19 infections after vaccination (ie, in breakthrough SARS-CoV-2 infections). Studying these risks by vaccine type, age, sex, comorbidities, and any prior SARS-CoV-2 infection is important to policy makers planning further vaccination efforts. Objective: We performed a comparative study of the risks of hospitalization (n=1140) and mortality (n=159) in a SARS-CoV-2 positive cohort of 19,815 patients who were all fully vaccinated with the Pfizer, Moderna, or Janssen vaccines. Methods: We performed Cox regression analysis to calculate the risk factors for developing a severe breakthrough SARS-CoV-2 infection in the study cohort by controlling for vaccine type, age, sex, comorbidities, and a prior SARS-CoV-2 infection. Results: We found lower hazard ratios for those receiving the Moderna vaccine (P<.001) and Pfizer vaccine (P<.001), with the lowest hazard rates being for Moderna, as compared to those who received the Janssen vaccine, independent of age, sex, comorbidities, vaccine type, and prior SARS-CoV-2 infection. Further, individuals who had a SARS-CoV-2 infection prior to vaccination had some increased protection over and above the protection already provided by the vaccines, from hospitalization (P=.001) and death (P=.04), independent of age, sex, comorbidities, and vaccine type. We found that the top statistically significant risk factors for severe breakthrough SARS-CoV-2 infections were age of >50, male gender, moderate and severe renal failure, severe liver disease, leukemia, chronic lung disease, coagulopathy, and alcohol abuse. Conclusions: Among individuals who were fully vaccinated, the risk of severe breakthrough SARS-CoV-2 infection was lower for recipients of the Moderna or Pfizer vaccines and higher for recipients of the Janssen vaccine. These results from our analysis at a population level will be helpful to public health policy makers. Our result on the influence of a previous SARS-CoV-2 infection necessitates further research into the impact of multiple exposures on the risk of developing severe COVID-19. %M 36265135 %R 10.2196/38898 %U https://publichealth.jmir.org/2022/11/e38898 %U https://doi.org/10.2196/38898 %U http://www.ncbi.nlm.nih.gov/pubmed/36265135 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 11 %P e36424 %T The Relationship Between Population-Level SARS-CoV-2 Cycle Threshold Values and Trend of COVID-19 Infection: Longitudinal Study %A Dehesh,Paria %A Baradaran,Hamid Reza %A Eshrati,Babak %A Motevalian,Seyed Abbas %A Salehi,Masoud %A Donyavi,Tahereh %+ Department of Epidemiology, School of Public Health, Iran University of Medical Sciences, Hemmat Highway, Tehran, 1449614535, Iran, 98 9183616737, babak.eshrati@gmail.com %K cycle threshold value %K COVID-19 %K trend %K surveillance %K epidemiology %K disease surveillance %K surveillance %K digital surveillance %K prediction model %K epidemic modeling %K health system %K infectious disease %D 2022 %7 8.11.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The distribution of population-level real-time reverse transcription-polymerase chain reaction (RT-PCR) cycle threshold (Ct) values as a proxy of viral load may be a useful indicator for predicting COVID-19 dynamics. Objective: The aim of this study was to determine the relationship between the daily trend of average Ct values and COVID-19 dynamics, calculated as the daily number of hospitalized patients with COVID-19, daily number of new positive tests, daily number of COVID-19 deaths, and number of hospitalized patients with COVID-19 by age. We further sought to determine the lag between these data series. Methods: The samples included in this study were collected from March 21, 2021, to December 1, 2021. Daily Ct values of all patients who were referred to the Molecular Diagnostic Laboratory of Iran University of Medical Sciences in Tehran, Iran, for RT-PCR tests were recorded. The daily number of positive tests and the number of hospitalized patients by age group were extracted from the COVID-19 patient information registration system in Tehran province, Iran. An autoregressive integrated moving average (ARIMA) model was constructed for the time series of variables. Cross-correlation analysis was then performed to determine the best lag and correlations between the average daily Ct value and other COVID-19 dynamics–related variables. Finally, the best-selected lag of Ct identified through cross-correlation was incorporated as a covariate into the autoregressive integrated moving average with exogenous variables (ARIMAX) model to calculate the coefficients. Results: Daily average Ct values showed a significant negative correlation (23-day time delay) with the daily number of newly hospitalized patients (P=.02), 30-day time delay with the daily number of new positive tests (P=.02), and daily number of COVID-19 deaths (P=.02). The daily average Ct value with a 30-day delay could impact the daily number of positive tests for COVID-19 (β=–16.87, P<.001) and the daily number of deaths from COVID-19 (β=–1.52, P=.03). There was a significant association between Ct lag (23 days) and the number of COVID-19 hospitalizations (β=–24.12, P=.005). Cross-correlation analysis showed significant time delays in the average Ct values and daily hospitalized patients between 18-59 years (23-day time delay, P=.02) and in patients over 60 years old (23-day time delay, P<.001). No statistically significant relation was detected in the number of daily hospitalized patients under 5 years old (9-day time delay, P=.27) and aged 5-17 years (13-day time delay, P=.39). Conclusions: It is important for surveillance of COVID-19 to find a good indicator that can predict epidemic surges in the community. Our results suggest that the average daily Ct value with a 30-day delay can predict increases in the number of positive confirmed COVID-19 cases, which may be a useful indicator for the health system. %M 36240022 %R 10.2196/36424 %U https://publichealth.jmir.org/2022/11/e36424 %U https://doi.org/10.2196/36424 %U http://www.ncbi.nlm.nih.gov/pubmed/36240022 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 10 %N 11 %P e35622 %T Discovery and Analytical Validation of a Vocal Biomarker to Monitor Anosmia and Ageusia in Patients With COVID-19: Cross-sectional Study %A Higa,Eduardo %A Elbéji,Abir %A Zhang,Lu %A Fischer,Aurélie %A Aguayo,Gloria A %A Nazarov,Petr V %A Fagherazzi,Guy %+ Deep Digital Phenotyping Research Unit, Department of Population Health, Luxembourg Institute of Health, 1A-B, rue Thomas Edison, Strassen, L1445, Luxembourg, 1 26970 457, guy.fagherazzi@gmail.com %K vocal biomarker %K COVID-19 %K ageusia %K anosmia %K loss of smell %K loss of taste %K digital assessment tool %K digital health %K medical informatics %K telehealth %K telemonitoring %K biomarker %K pandemic %K symptoms %K tool %K disease %K noninvasive %K AI %K artificial intelligence %K digital %K device %D 2022 %7 8.11.2022 %9 Original Paper %J JMIR Med Inform %G English %X Background: The COVID-19 disease has multiple symptoms, with anosmia and ageusia being the most prevalent, varying from 75% to 95% and from 50% to 80% of infected patients, respectively. An automatic assessment tool for these symptoms will help monitor the disease in a fast and noninvasive manner. Objective: We hypothesized that people with COVID-19 experiencing anosmia and ageusia had different voice features than those without such symptoms. Our objective was to develop an artificial intelligence pipeline to identify and internally validate a vocal biomarker of these symptoms for remotely monitoring them. Methods: This study used population-based data. Participants were assessed daily through a web-based questionnaire and asked to register 2 different types of voice recordings. They were adults (aged >18 years) who were confirmed by a polymerase chain reaction test to be positive for COVID-19 in Luxembourg and met the inclusion criteria. Statistical methods such as recursive feature elimination for dimensionality reduction, multiple statistical learning methods, and hypothesis tests were used throughout this study. The TRIPOD (Transparent Reporting of a multivariable prediction model for Individual Prognosis Or Diagnosis) Prediction Model Development checklist was used to structure the research. Results: This study included 259 participants. Younger (aged <35 years) and female participants showed higher rates of ageusia and anosmia. Participants were aged 41 (SD 13) years on average, and the data set was balanced for sex (female: 134/259, 51.7%; male: 125/259, 48.3%). The analyzed symptom was present in 94 (36.3%) out of 259 participants and in 450 (27.5%) out of 1636 audio recordings. In all, 2 machine learning models were built, one for Android and one for iOS devices, and both had high accuracy—88% for Android and 85% for iOS. The final biomarker was then calculated using these models and internally validated. Conclusions: This study demonstrates that people with COVID-19 who have anosmia and ageusia have different voice features from those without these symptoms. Upon further validation, these vocal biomarkers could be nested in digital devices to improve symptom assessment in clinical practice and enhance the telemonitoring of COVID-19–related symptoms. Trial Registration: Clinicaltrials.gov NCT04380987; https://clinicaltrials.gov/ct2/show/NCT04380987 %M 36265042 %R 10.2196/35622 %U https://medinform.jmir.org/2022/11/e35622 %U https://doi.org/10.2196/35622 %U http://www.ncbi.nlm.nih.gov/pubmed/36265042 %0 Journal Article %@ 2562-0959 %I JMIR Publications %V 5 %N 4 %P e38694 %T Patient Factors Associated With Teledermatology Visit Type and Submission of Photographs During the COVID-19 Pandemic: Cross-sectional Analysis %A Lamb,Jordan E %A Fitzsimmons,Robert %A Sevagamoorthy,Anjana %A Kovarik,Carrie L %A Shin,Daniel B %A Takeshita,Junko %+ Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Office 728, 7th Floor, South Tower, 3400 Civic Center Blvd, Philadelphia, PA, 19104, United States, 1 215 349 5551, Junko.Takeshita@pennmedicine.upenn.edu %K teledermatology %K telemedicine %K COVID-19 pandemic %K healthcare disparities %K photographs %K virtual %K skin examination %K dermatology %D 2022 %7 8.11.2022 %9 Original Paper %J JMIR Dermatol %G English %X Background: The COVID-19 pandemic necessitated the widespread adoption of teledermatology, and this continues to account for a significant proportion of dermatology visits after clinics have reopened for in-person care. Delivery of high-quality teledermatology care requires adequate visualization of the patient’s skin, with photographs being preferred over live video for remote skin examination. It remains unknown which patients face the greatest barriers to participating in a teledermatology visit with photographs. Objective: The aim of this study was to identify patient characteristics associated with type of telemedicine visit and the factors associated with participating in teledermatology visits with digital photographs versus those without photographs. Methods: We performed a cross-sectional analysis of the University of Pennsylvania Health System electronic health record data for adult patients who participated in at least 1 teledermatology appointment between March 1, 2020, and June 30, 2020. The primary outcomes were participation in a live-interactive video visit versus a telephone visit and participation in any teledermatology visit with photographs versus one without photographs. Multivariable logistic regression was performed to evaluate the associations between patient characteristics and the primary outcomes. Results: In total, 5717 unique patients completed at least 1 teledermatology visit during the study period; 68.25% (n=3902) of patients participated in a video visit, and 31.75% (n=1815) participated in a telephone visit. A minority of patients (n=1815, 31.75%) submitted photographs for their video or telephone appointment. Patients who submitted photographs for their teledermatology visit were more likely to be White, have commercial insurance, and live in areas with higher income, better education, and greater access to a computer and high-speed internet (P<.001 for all). In adjusted analysis, older age (age group >75 years: odds ratio [OR] 0.60, 95% CI 0.44-0.82), male sex (OR 0.85, 95% CI 0.75-0.97), Black race (OR 0.79, 95% CI 0.65-0.96), and Medicaid insurance (OR 0.81, 95% CI 0.66-0.99) were each associated with lower odds of a patient submitting photographs for their video or telephone visit. Older age (age group >75 years: OR 0.37, 95% CI 0.27-0.50) and Black race (OR 0.82, 95% CI 0.68-0.98) were also associated with lower odds of a patient participating in a video visit versus telephone visit. Conclusions: Patients who were older, male, or Black, or who had Medicaid insurance were less likely to participate in teledermatology visits with photographs and may be particularly vulnerable to disparities in teledermatology care. Further research is necessary to identify the barriers to patients providing photographs for remote dermatology visits and to develop targeted interventions to facilitate equitable participation in teledermatology care. %M 37632882 %R 10.2196/38694 %U https://derma.jmir.org/2022/4/e38694 %U https://doi.org/10.2196/38694 %U http://www.ncbi.nlm.nih.gov/pubmed/37632882 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 11 %P e36933 %T Risk Assessment of COVID-19 Cases in Emergency Departments and Clinics With the Use of Real-World Data and Artificial Intelligence: Observational Study %A Logaras,Evangelos %A Billis,Antonis %A Kyparissidis Kokkinidis,Ilias %A Ketseridou,Smaranda Nafsika %A Fourlis,Alexios %A Tzotzis,Aristotelis %A Imprialos,Konstantinos %A Doumas,Michael %A Bamidis,Panagiotis %+ Laboratory of Medical Physics and Digital Innovation, School of Medicine, Aristotle University of Thessaloniki, University Campus, Building D, Gate 8, Thessaloniki, 54124, Greece, 30 2310999237, ampillis@med.auth.gr %K COVID-19 pandemic %K risk assessment %K wearable device %K respiration evaluation %K emergency department %K artificial intelligence %K real-world data %D 2022 %7 8.11.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The recent COVID-19 pandemic has highlighted the weaknesses of health care systems around the world. In the effort to improve the monitoring of cases admitted to emergency departments, it has become increasingly necessary to adopt new innovative technological solutions in clinical practice. Currently, the continuous monitoring of vital signs is only performed in patients admitted to the intensive care unit. Objective: The study aimed to develop a smart system that will dynamically prioritize patients through the continuous monitoring of vital signs using a wearable biosensor device and recording of meaningful clinical records and estimate the likelihood of deterioration of each case using artificial intelligence models. Methods: The data for the study were collected from the emergency department and COVID-19 inpatient unit of the Hippokration General Hospital of Thessaloniki. The study was carried out in the framework of the COVID-X H2020 project, which was funded by the European Union. For the training of the neural network, data collection was performed from COVID-19 cases hospitalized in the respective unit. A wearable biosensor device was placed on the wrist of each patient, which recorded the primary characteristics of the visual signal related to breathing assessment. Results: A total of 157 adult patients diagnosed with COVID-19 were recruited. Lasso penalty function was used for selecting 18 out of 48 predictors and 2 random forest–based models were implemented for comparison. The high overall performance was maintained, if not improved, by feature selection, with random forest achieving accuracies of 80.9% and 82.1% when trained using all predictors and a subset of them, respectively. Preliminary results, although affected by pandemic limitations and restrictions, were promising regarding breathing pattern recognition. Conclusions: This study represents a novel approach that involves the use of machine learning methods and Edge artificial intelligence to assist the prioritization and continuous monitoring procedures of patients with COVID-19 in health departments. Although initial results appear to be promising, further studies are required to examine its actual effectiveness. %M 36197836 %R 10.2196/36933 %U https://formative.jmir.org/2022/11/e36933 %U https://doi.org/10.2196/36933 %U http://www.ncbi.nlm.nih.gov/pubmed/36197836 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 11 %P e39728 %T Virtual Care and Electronic Patient Communication During COVID-19: Cross-sectional Study of Inequities Across a Canadian Tertiary Cancer Center %A Safavi,Amir H %A Lovas,Mike %A Liu,Zhihui Amy %A Melwani,Sheena %A Truong,Tran %A Devonish,Shayla %A Abdelmutti,Nazek %A Sayani,Ambreen %A Rodin,Danielle %A Berlin,Alejandro %+ Radiation Medicine Program, Princess Margaret Cancer Centre, 700 University Ave, 7th Floor - RMP, Toronto, ON, M5G 2M9, Canada, 1 4169462983, alejandro.berlin@rmp.uhn.ca %K digital health %K telehealth %K telemedicine %K eHealth %K oncology %K cancer care %K virtual care %K health inequities %K health inequality %K digital divide %K COVID-19 %K electronic mail %K cross sectional %K engagement %K satisfaction %K patient reported %K experience %D 2022 %7 4.11.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Virtual care (VC) visits (telephone or video) and email-based patient communication have been rapidly adopted to facilitate cancer care during the COVID-19 pandemic. Inequities in access and patient experience may arise as these digital health tools become prevalent. Objective: We aimed to characterize inequities in access and patient-reported experience following adoption of digital health tools at a tertiary cancer center during the COVID-19 pandemic. Methods: We designed a cross-sectional study of outpatients with visits from September to December 2020. Patient characteristics and responses to an email-based patient-experience survey were collated. Inequities in access were assessed across three pairs of comparison groups: (1) patients with VC and in-person visits, (2) patients with and without documented email addresses, and (3) responders and nonresponders to the survey. Inequities in patient-reported experience were assessed among survey responders. Demographics were mapped to area-level averages from national census data. Socioeconomic status was mapped to area-level dimensions of the Canadian Index of Multiple Deprivation. Covariate balance between comparison groups was assessed using standardized mean differences (SMDs), with SMD≥0.2 indicating differences between groups. Associations between patient experience satisfaction scores and covariates were assessed using multivariable analyses, with P<.05 indicating statistical significance. Results: Among the 42,194 patients who had outpatient visits, 62.65% (n=26,435) had at least one VC visit and 31.15% (n=13,144) were emailable. Access to VC and email was similar across demographic and socioeconomic indices (SMD<0.2). Among emailable patients, 21.84% (2870/13,144) responded to the survey. Survey responsiveness was similar across indices, aside from a small difference by age (SMD=0.24). Among responders, 24.4% received VC and were similar to in-person responders across indices (SMD<0.2). VC and in-person responders had similar satisfaction levels with all care domains surveyed (all P>.05). Regardless of visit type, patients had variable satisfaction with care domains across demographic and socioeconomic indices. Patients with higher ethnocultural composition scores were less satisfied with the cultural appropriateness of their care (odds ratio [OR] 0.70, 95% CI 0.57-0.86). Patients with higher situational vulnerability scores were less satisfied with discussion of physical symptoms (OR 0.67, 95% CI 0.48-0.93). Patients with higher residential instability scores were less satisfied with discussion of both physical (OR 0.81, 95% CI 0.68-0.97) and emotional (OR 0.86, 95% CI 0.77-0.96) symptoms, and also with the duration of their visit (OR 0.85, 95% CI 0.74-0.98; P=.02). Male patients were more satisfied with how their health care provider had listened to them (OR 1.64, 95% CI 1.11-2.44; P=.01). Conclusions: Adoption of VC and email can equitably maintain access and patient-reported experience in cancer care across demographics and socioeconomic indices. Existing health inequities among structurally marginalized patients must continue to be addressed to improve their care experience. %M 36331536 %R 10.2196/39728 %U https://www.jmir.org/2022/11/e39728 %U https://doi.org/10.2196/39728 %U http://www.ncbi.nlm.nih.gov/pubmed/36331536 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 11 %P e38743 %T A Chatbot to Support Young People During the COVID-19 Pandemic in New Zealand: Evaluation of the Real-World Rollout of an Open Trial %A Ludin,Nicola %A Holt-Quick,Chester %A Hopkins,Sarah %A Stasiak,Karolina %A Hetrick,Sarah %A Warren,Jim %A Cargo,Tania %+ School of Computer Science, The University of Auckland, University of Auckland Private Bag 92019, Auckland, 1142, New Zealand, 64 21 739 632, jim@cs.auckland.ac.nz %K COVID-19 %K youth %K chatbots %K adolescent mental health %K dialog-based intervention %K digital mental health %D 2022 %7 4.11.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: The number of young people in New Zealand (Aotearoa) who experience mental health challenges is increasing. As those in Aotearoa went into the initial COVID-19 lockdown, an ongoing digital mental health project was adapted and underwent rapid content authoring to create the Aroha chatbot. This dynamic digital support was designed with and for young people to help manage pandemic-related worry. Objective: Aroha was developed to provide practical evidence-based tools for anxiety management using cognitive behavioral therapy and positive psychology. The chatbot included practical ideas to maintain social and cultural connection, and to stay active and well. Methods: Stay-at-home orders under Aotearoa’s lockdown commenced on March 20, 2020. By leveraging previously developed chatbot technology and broader existing online trial infrastructure, the Aroha chatbot was launched promptly on April 7, 2020. Dissemination of the chatbot for an open trial was via a URL, and feedback on the experience of the lockdown and the experience of Aroha was gathered via online questionnaires and a focus group, and from community members. Results: In the 2 weeks following the launch of the chatbot, there were 393 registrations, and 238 users logged into the chatbot, of whom 127 were in the target age range (13-24 years). Feedback guided iterative and responsive content authoring to suit the dynamic situation and motivated engineering to dynamically detect and react to a range of conversational intents. Conclusions: The experience of the implementation of the Aroha chatbot highlights the feasibility of providing timely event-specific digital mental health support and the technology requirements for a flexible and enabling chatbot architectural framework. %M 36219754 %R 10.2196/38743 %U https://www.jmir.org/2022/11/e38743 %U https://doi.org/10.2196/38743 %U http://www.ncbi.nlm.nih.gov/pubmed/36219754 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 4 %P e38701 %T A Mobile App Leveraging Citizenship Engagement to Perform Anonymized Longitudinal Studies in the Context of COVID-19 Adverse Drug Reaction Monitoring: Development and Usability Study %A Di Filippo,Marzia %A Avellone,Alessandro %A Belingheri,Michael %A Paladino,Maria Emilia %A Riva,Michele Augusto %A Zambon,Antonella %A Pescini,Dario %+ Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Via Bicocca degli Arcimboldi 8, Milan, 20126, Italy, 39 0264485835, dario.pescini@unimib.it %K ADR reporting %K adverse drug reaction–reporting systems %K mobile apps %K longitudinal studies %K COVID-19 vaccination campaign %K COVID-19 %K vaccine %K apps %K adverse drug reaction %K pharmacovigilance %K anonymity %D 2022 %7 4.11.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Over the past few years, studies have increasingly focused on the development of mobile apps as complementary tools to existing traditional pharmacovigilance surveillance systems for improving and facilitating adverse drug reaction (ADR) reporting. Objective: In this research, we evaluated the potentiality of a new mobile app (vaxEffect@UniMiB) to perform longitudinal studies, while preserving the anonymity of the respondents. We applied the app to monitor the ADRs during the COVID-19 vaccination campaign in a sample of the Italian population. Methods: We administered vaxEffect@UniMiB to a convenience sample of academic subjects vaccinated at the Milano-Bicocca University hub for COVID-19 during the Italian national vaccination campaign. vaxEffect@UniMiB was developed for both Android and iOS devices. The mobile app asks users to send their medical history and, upon every vaccine administration, their vaccination data and the ADRs that occurred within 7 days postvaccination, making it possible to follow the ADR dynamics for each respondent. The app sends data over the web to an application server. The server, along with receiving all user data, saves the data in a SQL database server and reminds patients to submit vaccine and ADR data by push notifications sent to the mobile app through Firebase Cloud Messaging (FCM). On initial startup of the app, a unique user identifier (UUID) was generated for each respondent, so its anonymity was completely ensured, while enabling longitudinal studies. Results: A total of 3712 people were vaccinated during the first vaccination wave. A total of 2733 (73.6%) respondents between the ages of 19 and 80 years, coming from the University of Milano-Bicocca (UniMiB) and the Politecnico of Milan (PoliMi), participated in the survey. Overall, we collected information about vaccination and ADRs to the first vaccine dose for 2226 subjects (60.0% of the first dose vaccinated), to the second dose for 1610 subjects (43.4% of the second dose vaccinated), and, in a nonsponsored fashion, to the third dose for 169 individuals (4.6%). Conclusions: vaxEffect@UniMiB was revealed to be the first attempt in performing longitudinal studies to monitor the same subject over time in terms of the reported ADRs after each vaccine administration, while guaranteeing complete anonymity of the subject. A series of aspects contributed to the positive involvement from people in using this app to report their ADRs to vaccination: ease of use, availability from multiple platforms, anonymity of all survey participants and protection of the submitted data, and the health care workers’ support. %M 35930561 %R 10.2196/38701 %U https://humanfactors.jmir.org/2022/4/e38701 %U https://doi.org/10.2196/38701 %U http://www.ncbi.nlm.nih.gov/pubmed/35930561 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 11 %P e39861 %T Early Learning From a Low-Resource COVID-Response Virtual Mental Health Crisis Ward: Mixed Methods Study %A Lee,Katherine %A Bolton,Shay-Lee %A Shterenberg,Ravit %A Bolton,James M %A Hensel,Jennifer M %+ Department of Psychiatry, University of Manitoba, PsycHealth Centre, 771 Bannatyne Ave, Winnipeg, MB, R3E 3N4, Canada, 1 204 787 3621, jhensel@hsc.mb.ca %K virtual ward %K mental health %K COVID-19 %K implementation %K driver diagram %K virtual care %K virtual health care %K acceptance %K psychiatric support %K crisis support %K provider perspectives %D 2022 %7 4.11.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic was accompanied by the accelerated uptake of virtual care, leading to a proliferation of virtual ward models as alternatives to facility-based care. Early in the pandemic, our program implemented a virtual mental health crisis ward (vWard) to provide options for individuals requiring intense psychiatric and/or crisis support but who preferred to remain in the community and were deemed safe to do so. Objective: The aim of this study was to identify early learnings from the vWard, which was implemented rapidly in a resource-constrained environment, to inform the future state should it be sustained beyond the pandemic. Methods: Mixed methods of data collection were used to evaluate provider perspectives on the vWard, develop archetypes for individuals who are a good fit for the vWard model, and create a driver diagram. Data sources included an anonymous survey of clinical and managerial staff involved in the vWard, a service planning workshop, and program discharge forms for all individuals admitted between March 2020 and April 2021. Survey responses were coded for themes under categories of “benefits” and “challenges.” Discharge forms where the team indicated that the vWard was a good fit for an individual were examined for characteristics common to these admissions. These findings were reviewed in the service planning workshop and refined with input from the participants into patient archetypes. A driver diagram was created for the future state. Results: Survey respondents (N=60) represented diverse roles in crisis services and the vWard team. Ten providers took part in the service planning workshop. A total of 467 discharge forms were reviewed. The vWard was felt to be a model that worked by 39 survey respondents, one respondent felt it did not work, and the remaining participants had no response. Several benefits for the individual and the system were identified alongside challenges, including certain processes and materials related to the nature of rapid implementation during the pandemic, and others due to lack of fit for certain individuals. The model was felt to be a good fit for 67.5% of admissions. Four patient archetypes representing a good fit with the model were developed. The driver diagram connected the program aim with primary drivers of (1) reduce barriers to care; (2) improve outcomes; and (3) provide collaborative, patient- and family-centered care to secondary drivers and interventions that leveraged virtual technology among other crisis care interventions. Conclusions: Despite some challenges, the vWard demonstrated high levels of provider acceptance and a range of mechanisms by which the model works for a variety of patient archetypes. These early learnings provide a foundation for growth, sustainability, and spread of this model going forward beyond the pandemic. %M 36252139 %R 10.2196/39861 %U https://formative.jmir.org/2022/11/e39861 %U https://doi.org/10.2196/39861 %U http://www.ncbi.nlm.nih.gov/pubmed/36252139 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 11 %P e38904 %T The Dutch COVID-19 Notification App: Lessons Learned From a Mixed Methods Evaluation Among End Users and Contact-Tracing Employees %A van Gend,Joris Elmar %A van 't Klooster,Jan Willem Jaap Roderick %A Bolman,Catherine Adriana Wilhelmina %A van Gemert-Pijnen,Julia Elisabeth Wilhelmina Cornelia %+ The BMS Lab, Faculty of Behavioural, Management and Social Sciences, University of Twente, De Zul 10, Enschede, 7522 NB, Netherlands, 31 0534892525, bmslab@utwente.nl %K eHealth %K contact tracing %K digital contact tracing %K contact-tracing apps %K COVID-19 %K adherence %K public health %K mobile health %K topic analysis %K health service %K user experience %K eHealth intervention %K mobile phone %D 2022 %7 4.11.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The Dutch CoronaMelder (CM) app is the official Dutch contact-tracing app (CTA). It has been used to contain the spread of the SARS-CoV-2 in the Netherlands. It allows its users and those of connected apps to anonymously exchange warnings about potentially high-risk contacts with individuals infected with the SARS-CoV-2. Objective: The goal of this mixed methods study is to understand the use of CTA in the pandemic and its integration into the Municipal Health Services (MHS) efforts of containment through contact tracing. Moreover, the study aims to investigate both the motivations and user experience–related factors concerning adherence to quarantine and isolation measures. Methods: A topic analysis of 56 emails and a web-based survey of 1937 adults from the Netherlands, combined with a series of 48 in-depth interviews with end users of the app and 14 employees of the Dutch MHS involved in contact tracing, were conducted. Mirroring sessions were held (n=2) with representatives from the development (n=2) and communication teams (n=2) responsible for the creation and implementation of the CM app. Results: Topic analysis and interviews identified procedural and technical issues in the use of the CTA. Procedural issues included the lack of training of MHS employees in the use of CTAs. Technical issues identified for the end users included the inability to send notifications without phone contact with the MHS, unwarranted notifications, and nightly notifications. Together, these issues undermined confidence in and satisfaction with the app’s use. The interviews offered a deeper understanding of the various factors at play and their effects on users; for example, the mixed experiences of the app’s users, the end user’s own fears, and uncertainties concerning the SARS-CoV-2; problematic infrastructure at the time of the app’s implementation on the side of the health services; the effects of the society-wide efforts in containment of the SARS-CoV-2 on the CM app’s perception, resulting in further doubts concerning the app’s effectiveness among MHS workers and citizens; and problems with adherence to behavioral measures propagated by the app because of the lack of confidence in the app and uncertainty concerning the execution of the behavioral measures. All findings were evaluated with the app’s creators and have since contributed to improvements. Conclusions: Although most participants perceived the app positively, procedural and technical issues identified in this study limited satisfaction and confidence in the CM app and affected its adoption and long-term use. Moreover, these same issues negatively affected the CM app’s effectiveness in improving compliance with behavioral measures aimed at reducing the spread of the SARS-CoV-2. This study offers lessons learned for future eHealth interventions in pandemics. Lessons that can aid in more effective design, implementation, and communication for more effective and readily adoptable eHealth applications. %M 36074930 %R 10.2196/38904 %U https://formative.jmir.org/2022/11/e38904 %U https://doi.org/10.2196/38904 %U http://www.ncbi.nlm.nih.gov/pubmed/36074930 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 5 %N 4 %P e40431 %T Evaluating the Effectiveness of a Family-Based Virtual Childhood Obesity Management Program Delivered During the COVID-19 Pandemic in Canada: Prospective Study %A Nuss,Kayla %A Coulter,Rebecca %A DeSilva,Bianca %A Buenafe,Jeann %A Sheikhi,Ronak %A Naylor,Patti-Jean %A Liu,Sam %+ School of Exercise Science, Physical and Health Education, University of Victoria, PO Box 1700 STN CSC, Victoria, BC, V8W 2Y2, Canada, 1 250 721 8392, samliu@uvic.ca %K childhood obesity management %K virtual intervention %K COVID-19 pandemic %K COVID-19 %K children %K healthy lifestyle %K health promotion %K virtual health %K digital health intervention %K parenting %K obesity %K childhood obesity %D 2022 %7 3.11.2022 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Generation Health (GH) is a 10-week family-based lifestyle program designed to promote a healthy lifestyle for families with children who are off the healthy weight trajectory in British Columbia, Canada. GH uses a blended delivery format that involves 10 weekly in-person sessions, and self-guided lessons and activities on a web portal. The blended program was adapted to be delivered virtually due to the COVID-19 pandemic. Currently, the effectiveness of the virtual GH program compared with that of the blended GH program remains unclear. Objective: We aimed to (1) compare the effectiveness of the virtual GH program delivered during the COVID-19 pandemic with that of the blended GH program delivered prior to the pandemic for changing child physical activity, sedentary and dietary behaviors, screen time, and parental support–related behaviors for child physical activity and healthy eating, and (2) explore virtual GH program engagement and satisfaction. Methods: This study used a single-arm pre-post design. The blended GH program (n=102) was delivered from January 2019 to February 2020, and the virtual GH program (n=90) was delivered during the COVID-19 pandemic from April 2020 to March 2021. Families with children aged 8-12 years and considered overweight or obese (BMI ≥85th percentile according to age and sex) were recruited. Participants completed preintervention and postintervention questionnaires to assess the children’s physical activity, dietary and sedentary behaviors, and screen time, and the parent’s support behaviors. Intervention feedback was obtained by interviews. Repeated measures ANOVA was used to evaluate the difference between the virtual and blended GH programs over time. Qualitative interviews were analyzed using thematic analyses. Results: Both the virtual and blended GH programs improved children’s moderate-to-vigorous physical activity (F1,380=18.37; P<.001; ηp2=0.07) and reduced screen time (F1,380=9.17; P=.003; ηp2=0.06). However, vegetable intake was significantly greater in the virtual GH group than in the blended GH group at the 10-week follow-up (F1,380=15.19; P<.001; ηp2=0.004). Parents in both groups showed significant improvements in support behaviors for children’s physical activity (F1,380=5.55; P=.02; ηp2=0.002) and healthy eating (F1,380=3.91; P<.001; ηp2=0.01), as well as self-regulation of parental support for children’s physical activity (F1,380=49.20; P<.001; ηp2=0.16) and healthy eating (F1,380=91.13; P<.001; ηp2=0.28). Families in both groups were satisfied with program delivery. There were no significant differences in attendance for the weekly in-person or group video chat sessions; however, portal usage was significantly greater in the virtual GH group (mean 50, SD 55.82 minutes) than in the blended GH group (mean 17, SD 15.3 minutes; P<.001). Conclusions: The study findings suggested that the virtual GH program was as effective as the blended program for improving child lifestyle behaviors and parental support–related behaviors. The virtual program has the potential to improve the flexibility and scalability of family-based childhood obesity management interventions. %M 36054663 %R 10.2196/40431 %U https://pediatrics.jmir.org/2022/4/e40431 %U https://doi.org/10.2196/40431 %U http://www.ncbi.nlm.nih.gov/pubmed/36054663 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 11 %P e34067 %T Predicting Emerging Themes in Rapidly Expanding COVID-19 Literature With Unsupervised Word Embeddings and Machine Learning: Evidence-Based Study %A Pal,Ridam %A Chopra,Harshita %A Awasthi,Raghav %A Bandhey,Harsh %A Nagori,Aditya %A Sethi,Tavpritesh %+ Department of Computational Biology, Indraprastha Institute of Information Technology Delhi, Third Floor, New Academic Block, Okhla Industrial Estate, Phase-III, New Delhi, 110020, India, 91 9779908630, tavpriteshsethi@iiitd.ac.in %K COVID-19 %K named entity recognition %K unsupervised word embeddings %K machine learning %K natural language preprocessing %D 2022 %7 2.11.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Evidence from peer-reviewed literature is the cornerstone for designing responses to global threats such as COVID-19. In massive and rapidly growing corpuses, such as COVID-19 publications, assimilating and synthesizing information is challenging. Leveraging a robust computational pipeline that evaluates multiple aspects, such as network topological features, communities, and their temporal trends, can make this process more efficient. Objective: We aimed to show that new knowledge can be captured and tracked using the temporal change in the underlying unsupervised word embeddings of the literature. Further imminent themes can be predicted using machine learning on the evolving associations between words. Methods: Frequently occurring medical entities were extracted from the abstracts of more than 150,000 COVID-19 articles published on the World Health Organization database, collected on a monthly interval starting from February 2020. Word embeddings trained on each month’s literature were used to construct networks of entities with cosine similarities as edge weights. Topological features of the subsequent month’s network were forecasted based on prior patterns, and new links were predicted using supervised machine learning. Community detection and alluvial diagrams were used to track biomedical themes that evolved over the months. Results: We found that thromboembolic complications were detected as an emerging theme as early as August 2020. A shift toward the symptoms of long COVID complications was observed during March 2021, and neurological complications gained significance in June 2021. A prospective validation of the link prediction models achieved an area under the receiver operating characteristic curve of 0.87. Predictive modeling revealed predisposing conditions, symptoms, cross-infection, and neurological complications as dominant research themes in COVID-19 publications based on the patterns observed in previous months. Conclusions: Machine learning–based prediction of emerging links can contribute toward steering research by capturing themes represented by groups of medical entities, based on patterns of semantic relationships over time. %M 36040993 %R 10.2196/34067 %U https://www.jmir.org/2022/11/e34067 %U https://doi.org/10.2196/34067 %U http://www.ncbi.nlm.nih.gov/pubmed/36040993 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 5 %N 4 %P e40614 %T An Internet-Based Parent Training With Telephone Coaching on Managing Disruptive Behavior in Children at Special Family Counseling Centers During the COVID-19 Pandemic: Feasibility Study %A Sourander,Saana %A Sourander,Andre %A Hinkka-Yli-Salomäki,Susanna %A Ristkari,Terja %A Kurki,Marjo %+ Department of Child Psychiatry, University of Turku, Lemminkäisenkatu 3, Teutori 3rd floor, Turku, 20014, Finland, 358 469212562, saana.sourander@utu.fi %K parent training %K disruptive behavior %K child psychopathology %K child functioning %K internet-based %K COVID-19 pandemic %K COVID-19 %K mental health %K psychological well-being %K digital health %K parenting %K telehealth %K behavioral problem %K psychopathology %D 2022 %7 2.11.2022 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: There is growing concern about the short- and long-term impacts that the COVID-19 pandemic will have on the mental health and psychosocial well-being of children and families. There are no existing studies about feasibility and outcomes using internet-based parent training programs with telephone coaching for disruptive behavioral problems in childhood during the COVID-19 pandemic in clinical settings. Objective: This study explored how the Strongest Families Smart Website (SFSW) parent training program, with telephone coaching, provided support during the COVID-19 pandemic at specialist family counseling centers in Helsinki, Finland, when restrictions made face-to-face counseling impossible. This study followed the success of a randomized controlled trial (RCT) and its implementation study of the SFSW parent training program by primary care child health clinics. The aim was to improve parenting skills, so that parents could tackle disruptive behavior by developing positive parent-child relationships. It started in May 2020, when the COVID-19 pandemic was at its height in Finland. Methods: In total, 8 family counseling centers in Helsinki identified 50 referrals aged 3-8 years with high levels of parent-reported disruptive behavioral problems. Child psychopathology and functioning and parental skills and well-being were measured at baseline, posttreatment, and 6 months later using a range of tools. The data were extracted from questionnaires completed by the parents. Results: We found that 44 (88%) of the 50 families completed the whole 11-session parent training program. Most of the children (n=48, 96%) had definitive or severe behavioral problems when they were initially screened by the centers, but with those assessed at the 6-month follow-up (n=45, 90%), this dropped to 58% (n=26). There were significant changes from baseline to 6-month follow-up in most of the child psychopathology measures, including the Child Behavior Checklist-Parent Report Form (CBCL) total score (mean change 16.3, SE 3.0, 95% CI 10.2-22.3; P<.001) and externalizing score (mean change 7.0, SE 1.0, 95% CI 4.9-9.0; P<.001). When parenting skills were measured with the Parenting Scale (PS), they showed significant changes from baseline to 6-month follow-up in total scores (mean change 0.5, SE 0.1, 95% CI 0.4-0.7; P<.001). Parents showed significant change in the stress subscore (mean change 3.9, SE 0.8, 95% CI 2.2-5.6; P<.001). Of the parents who filled in the satisfaction questionnaire (n=45, 90%), 42 (93%) reported high satisfaction in the skills and 44 (98%) in the professionalism of the family coaches. Conclusions: The program proved to be an effective method for improving parenting skills and child psychopathology and functioning. The parents were satisfied with the program, and the dropout rate was exceptionally low. The study shows that the training program could be implemented in specialist clinical settings and during crisis conditions, such as the COVID-19 pandemic. %M 36194895 %R 10.2196/40614 %U https://pediatrics.jmir.org/2022/4/e40614 %U https://doi.org/10.2196/40614 %U http://www.ncbi.nlm.nih.gov/pubmed/36194895 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 11 %P e38794 %T The Experience of Health Professionals With Misinformation and Its Impact on Their Job Practice: Qualitative Interview Study %A Ismail,Nashwa %A Kbaier,Dhouha %A Farrell,Tracie %A Kane,Annemarie %+ School of Computing and Communications, The Open University, Walton Hall, Kents Hill, Milton Keynes, MK7 6AA, United Kingdom, 44 07778649257, dhouha.kbaier@open.ac.uk %K health misinformation %K social media %K health professional %K patients %K trust %K communication, COVID-19 %K intervention %K qualitative research %K interpretive phenomenological analysis %K thematic analysis %K misinformation %K health practitioner %K infodemiology %D 2022 %7 2.11.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Misinformation is often disseminated through social media, where information is spread rapidly and easily. Misinformation affects many patients' decisions to follow a treatment prescribed by health professionals (HPs). For example, chronic patients (eg, those with diabetes) may not follow their prescribed treatment plans. During the recent pandemic, misinformed people rejected COVID-19 vaccines and public health measures, such as masking and physical distancing, and used unproven treatments. Objective: This study investigated the impact of health-threatening misinformation on the practices of health care professionals in the United Kingdom, especially during the outbreaks of diseases where a great amount of health-threatening misinformation is produced and released. The study examined the misinformation surrounding the COVID-19 outbreak to determine how it may have impacted practitioners' perceptions of misinformation and how that may have influenced their practice. In particular, this study explored the answers to the following questions: How do HPs react when they learn that a patient has been misinformed? What misinformation do they believe has the greatest impact on medical practice? What aspects of change and intervention in HPs' practice are in response to misinformation? Methods: This research followed a qualitative approach to collect rich data from a smaller subset of health care practitioners working in the United Kingdom. Data were collected through 1-to-1 online interviews with 13 health practitioners, including junior and senior physicians and nurses in the United Kingdom. Results: Research findings indicated that HPs view misinformation in different ways according to the scenario in which it occurs. Some HPs consider it to be an acute incident exacerbated by the pandemic, while others see it as an ongoing phenomenon (always present) and address it as part of their daily work. HPs are developing pathways for dealing with misinformation. Two main pathways were identified: first, to educate the patient through coaching, advising, or patronizing and, second, to devote resources, such as time and effort, to facilitate 2-way communication between the patient and the health care provider through listening and talking to them. Conclusions: HPs do not receive the confidence they deserve from patients. The lack of trust in health care practitioners has been attributed to several factors, including (1) trusting alternative sources of information (eg, social media) (2) patients' doubts about HPs' experience (eg, a junior doctor with limited experience), and (3) limited time and availability for patients, especially during the pandemic. There are 2 dimensions of trust: patient-HP trust and patient-information trust. There are 2 necessary actions to address the issue of lack of trust in these dimensions: (1) building trust and (2) maintaining trust. The main recommendations of the HPs are to listen to patients, give them more time, and seek evidence-based resources. %M 36252133 %R 10.2196/38794 %U https://formative.jmir.org/2022/11/e38794 %U https://doi.org/10.2196/38794 %U http://www.ncbi.nlm.nih.gov/pubmed/36252133 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 11 %P e36412 %T Using Digital Tools for Contact Tracing to Improve COVID-19 Safety in Schools: Qualitative Study Exploring Views and Experiences Among School Staff %A Chantziara,Sofia %A Brigden L C,Amberly %A Mccallum,Claire H %A Craddock,Ian J %+ Faculty of Engineering, University of Bristol, Merchant Venturers Building, 75 Woodland Rd, Bristol, BS81UB, United Kingdom, 44 0117 928, amberly.brigden@bristol.ac.uk %K schools %K contact tracing %K COVID-19 mitigation %K COVID-19 %K pandemic %K disease prevention %K health technology %K COVID-19 management %K technology support %K digital tool %K mobile health %K mobile technology %D 2022 %7 1.11.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Throughout the pandemic, governments worldwide have issued guidelines to manage the spread and impact of COVID-19 in schools, including measures around social distancing and contact tracing. Whether schools required support to implement these guidelines has not yet been explored in depth. Despite the development of a range of technologies to tackle COVID-19, such as contact-tracing apps and electronic vaccine certificates, research on their usefulness in school settings has been limited. Objective: The aim of the study was to explore the needs of school staff in managing COVID-19 and their experiences and perspectives on technological support in relation to contact tracing. School staff are the ones likely to make key implementation decisions regarding new technologies, and they are also the ones responsible for using the new tools daily. Including both management staff and class teachers in the development of school-based technologies can lead to their successful adoption by schools. Methods: Semistructured interviews were conducted with UK school staff, including primary and secondary school teachers and school managers. Thematic analysis, facilitated by NVivo, was used to analyze the data. Two of the authors independently coded 5 (28%) of the interviews and reached a consensus on a coding framework. Results: Via purposive sampling, we recruited 18 participants from 5 schools. Findings showed that primary schools did not perform contact tracing, while in secondary schools, digital seating plans were used to identify close contacts in the classroom and manual investigations were also conducted identify social contacts. Participants reported that despite their efforts, high-risk interactions between students were not adequately monitored. There was a need to improve accuracy when identifying close contacts in common areas where students congregate. Proximity tracking, use of access cards, and closed-circuit television (CCTV) emerged as potential solutions, but there were concerns surrounding false alerts, burden, and security. Conclusions: School staff have found it difficult to monitor and implement social distancing and contact-tracing provisions. There are opportunities for mobile digital technologies and CCTV to support school staff in keeping their students and colleagues safe; however, these must place minimal demands on staff and prioritize security measures. Study findings can help researchers and practitioners who work in different contexts and settings understand what particular challenges are faced by school staff, and inform further research on the design and application of digital solutions for contact tracing. %M 36191172 %R 10.2196/36412 %U https://formative.jmir.org/2022/11/e36412 %U https://doi.org/10.2196/36412 %U http://www.ncbi.nlm.nih.gov/pubmed/36191172 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 10 %P e37258 %T Sexually Transmitted Disease–Related Reddit Posts During the COVID-19 Pandemic: Latent Dirichlet Allocation Analysis %A Johnson,Amy K %A Bhaumik,Runa %A Nandi,Debarghya %A Roy,Abhishikta %A Mehta,Supriya D %+ The Potocsnak Family Division of Adolescent and Young Adult Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E Chicago, Box 161, Chicago, IL, 60611, United States, 1 3122277733, akjohnson@luriechildrens.org %K infodemiology %K Latent Dirichlet Allocation %K natural language processing %K Reddit %K sexually transmitted infections %K surveillance %K social media %K COVID-19 %K social media content %K content analysis %K health outcome %K infoveillance %K health information %K sexually transmitted disease %K STD %D 2022 %7 31.10.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Sexually transmitted diseases (STDs) are common and costly, impacting approximately 1 in 5 people annually. Reddit, the sixth most used internet site in the world, is a user-generated social media discussion platform that may be useful in monitoring discussion about STD symptoms and exposure. Objective: This study sought to define and identify patterns and insights into STD-related discussions on Reddit over the course of the COVID-19 pandemic. Methods: We extracted posts from Reddit from March 2019 through July 2021. We used a topic modeling method, Latent Dirichlet Allocation, to identify the most common topics discussed in the Reddit posts. We then used word clouds, qualitative topic labeling, and spline regression to characterize the content and distribution of the topics observed. Results: Our extraction resulted in 24,311 total posts. Latent Dirichlet Allocation topic modeling showed that with 8 topics for each time period, we achieved high coherence values (pre–COVID-19=0.41, prevaccination=0.42, and postvaccination=0.44). Although most topic categories remained the same over time, the relative proportion of topics changed and new topics emerged. Spline regression revealed that some key terms had variability in the percentage of posts that coincided with pre–COVID-19 and post–COVID-19 periods, whereas others were uniform across the study periods. Conclusions: Our study’s use of Reddit is a novel way to gain insights into STD symptoms experienced, potential exposures, testing decisions, common questions, and behavior patterns (eg, during lockdown periods). For example, reduction in STD screening may result in observed negative health outcomes due to missed cases, which also impacts onward transmission. As Reddit use is anonymous, users may discuss sensitive topics with greater detail and more freely than in clinical encounters. Data from anonymous Reddit posts may be leveraged to enhance the understanding of the distribution of disease and need for targeted outreach or screening programs. This study provides evidence in favor of establishing Reddit as having feasibility and utility to enhance the understanding of sexual behaviors, STD experiences, and needed health engagement with the public. %M 36219757 %R 10.2196/37258 %U https://www.jmir.org/2022/10/e37258 %U https://doi.org/10.2196/37258 %U http://www.ncbi.nlm.nih.gov/pubmed/36219757 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 2 %N 2 %P e37861 %T COVID-19 Health Beliefs Regarding Mask Wearing and Vaccinations on Twitter: Deep Learning Approach %A Ke,Si Yang %A Neeley-Tass,E Shannon %A Barnes,Michael %A Hanson,Carl L %A Giraud-Carrier,Christophe %A Snell,Quinn %+ Computer Science Department, Brigham Young University, 3361 TMCB, Provo, UT, 84602, United States, 1 801 422 5098, snell@cs.byu.edu %K COVID-19 %K Health Belief Model %K deep learning %K mask %K vaccination %K machine learning %K vaccine data set %K Twitter %K content analysis %K infodemic %K infodemiology %K misinformation %K health belief %D 2022 %7 31.10.2022 %9 Original Paper %J JMIR Infodemiology %G English %X Background: Amid the global COVID-19 pandemic, a worldwide infodemic also emerged with large amounts of COVID-19–related information and misinformation spreading through social media channels. Various organizations, including the World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC), and other prominent individuals issued high-profile advice on preventing the further spread of COVID-19. Objective: The purpose of this study is to leverage machine learning and Twitter data from the pandemic period to explore health beliefs regarding mask wearing and vaccines and the influence of high-profile cues to action. Methods: A total of 646,885,238 COVID-19–related English tweets were filtered, creating a mask-wearing data set and a vaccine data set. Researchers manually categorized a training sample of 3500 tweets for each data set according to their relevance to Health Belief Model (HBM) constructs and used coded tweets to train machine learning models for classifying each tweet in the data sets. Results: In total, 5 models were trained for both the mask-related and vaccine-related data sets using the XLNet transformer model, with each model achieving at least 81% classification accuracy. Health beliefs regarding perceived benefits and barriers were most pronounced for both mask wearing and immunization; however, the strength of those beliefs appeared to vary in response to high-profile cues to action. Conclusions: During both the COVID-19 pandemic and the infodemic, health beliefs related to perceived benefits and barriers observed through Twitter using a big data machine learning approach varied over time and in response to high-profile cues to action from prominent organizations and individuals. %M 36348979 %R 10.2196/37861 %U https://infodemiology.jmir.org/2022/2/e37861 %U https://doi.org/10.2196/37861 %U http://www.ncbi.nlm.nih.gov/pubmed/36348979 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 10 %P e38153 %T The #VaccinesWork Hashtag on Twitter in the Context of the COVID-19 Pandemic: Network Analysis %A Fuster-Casanovas,Aïna %A Das,Ronnie %A Vidal-Alaball,Josep %A Lopez Segui,Francesc %A Ahmed,Wasim %+ Unitat de Suport a la Recerca de la Catalunya Central, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, Pica d'Estats 13-15, Sant Fruitós de Bages, 08272, Spain, 34 93 693 0040, jvidal.cc.ics@gencat.cat %K Twitter %K social media %K COVID-19 %K misinformation %K vaccination %K public health %K vaccine hesitancy %K infodemiology %K health campaign %K content analysis %K social network %K layout algorithm %D 2022 %7 28.10.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Vaccination is one of the most successful public health interventions for the prevention of COVID-19. Toward the end of April 2021, UNICEF (United Nations International Children’s Emergency Fund), alongside other organizations, were promoting the hashtag #VaccinesWork. Objective: The aim of this paper is to analyze the #VaccinesWork hashtag on Twitter in the context of the COVID-19 pandemic, analyzing the main messages shared and the organizations involved. Methods: The data set used in this study consists of 11,085 tweets containing the #VaccinesWork hashtag from the 29th to the 30th of April 2021. The data set includes tweets that may not have the hashtag but were replies or mentions in those tweets. The data were retrieved using NodeXL, and the network graph was laid out using the Harel-Koren fast multiscale layout algorithm. Results: The study found that organizations such as the World Health Organization, UNICEF, and Gavi were the key opinion leaders and had a big influence on the spread of information among users. Furthermore, the most shared URLs belonged to academic journals with a high impact factor. Provaccination users had other vaccination-promoting hashtags in common, not only in the COVID-19 scenario. Conclusions: This study investigated the discussions surrounding the #VaccinesWork hashtag. Social media networks containing conspiracy theories tend to contain dubious accounts leading the discussions and are often linked to unverified information. This kind of analysis can be useful to detect the optimal moment for launching health campaigns on Twitter. %M 36219832 %R 10.2196/38153 %U https://publichealth.jmir.org/2022/10/e38153 %U https://doi.org/10.2196/38153 %U http://www.ncbi.nlm.nih.gov/pubmed/36219832 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 10 %P e40233 %T Effectiveness, Policy, and User Acceptance of COVID-19 Contact-Tracing Apps in the Post–COVID-19 Pandemic Era: Experience and Comparative Study %A Liu,MingXin %A Zhou,SiYu %A Jin,Qun %A Nishimura,Shoji %A Ogihara,Atsushi %+ Graduate School of Human Sciences, Waseda University, 2-579-15 Mikajima, Tokorozawa, 3591192, Japan, 81 04 2949 8111, liumingxin98@akane.waseda.jp %K COVID-19 %K contact-tracing app %K digital contact tracing %K mobile phone %D 2022 %7 27.10.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: In the post–COVID-19 pandemic era, many countries have launched apps to trace contacts of COVID-19 infections. Each contact-tracing app (CTA) faces a variety of issues owing to different national policies or technologies for tracing contacts. Objective: In this study, we aimed to investigate all the CTAs used to trace contacts in various countries worldwide, including the technology used by each CTA, the availability of knowledge about the CTA from official websites, the interoperability of CTAs in various countries, and the infection detection rates and policies of the specific country that launched the CTA, and to summarize the current problems of the apps based on the information collected. Methods: We investigated CTAs launched in all countries through Google, Google Scholar, and PubMed. We experimented with all apps that could be installed and compiled information about apps that could not be installed or used by consulting official websites and previous literature. We compared the information collected by us on CTAs with relevant previous literature to understand and analyze the data. Results: After screening 166 COVID-19 apps developed in 197 countries worldwide, we selected 98 (59%) apps from 95 (48.2%) countries, of which 63 (66.3%) apps were usable. The methods of contact tracing are divided into 3 main categories: Bluetooth, geolocation, and QR codes. At the technical level, CTAs face 3 major problems. First, the distance and time for Bluetooth- and geolocation-based CTAs to record contact are generally set to 2 meters and 15 minutes; however, this distance should be lengthened, and the time should be shortened for more infectious variants. Second, Bluetooth- or geolocation-based CTAs also face the problem of lack of accuracy. For example, individuals in 2 adjacent vehicles during traffic jams may be at a distance of ≤2 meters to make the CTA trace contact, but the 2 users may actually be separated by car doors, which could prevent transmission and infection. In addition, we investigated infection detection rates in 33 countries, 16 (48.5%) of which had significantly low infection detection rates, wherein CTAs could have lacked effectiveness in reducing virus propagation. Regarding policy, CTAs in most countries can only be used in their own countries and lack interoperability among other countries. In addition, 7 countries have already discontinued CTAs, but we believe that it was too early to discontinue them. Regarding user acceptance, 28.6% (28/98) of CTAs had no official source of information that could reduce user acceptance. Conclusions: We surveyed all CTAs worldwide, identified their technological policy and acceptance issues, and provided solutions for each of the issues we identified. This study aimed to provide useful guidance and suggestions for updating the existing CTAs and the subsequent development of new CTAs. %M 36190741 %R 10.2196/40233 %U https://publichealth.jmir.org/2022/10/e40233 %U https://doi.org/10.2196/40233 %U http://www.ncbi.nlm.nih.gov/pubmed/36190741 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 10 %P e39157 %T COVID-Bot, an Intelligent System for COVID-19 Vaccination Screening: Design and Development %A Okonkwo,Chinedu Wilfred %A Amusa,Lateef Babatunde %A Twinomurinzi,Hossana %+ Centre for Applied Data Sciences, College of Business and Economics, University of Johannesburg, Bunting Road Campus, Auckland Park, Johannesburg, 2006, South Africa, 27 0835796557, chineduo@uj.ac.za %K chatbot %K COVID-Bot %K COVID-19 %K students %K vaccine %K exemption letter %K vaccination %K artificial intelligence %D 2022 %7 27.10.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Coronavirus continues to spread worldwide, causing various health and economic disruptions. One of the most important approaches to controlling the spread of this disease is to use an artificial intelligence (AI)–based technological intervention, such as a chatbot system. Chatbots can aid in the fight against the spread of COVID-19. Objective: This paper introduces COVID-Bot, an intelligent interactive system that can help screen students and confirm their COVID-19 vaccination status. Methods: The design and development of COVID-Bot followed the principles of the design science research (DSR) process, which is a research method for creating a new scientific artifact. COVID-Bot was developed and implemented using the SnatchBot chatbot application programming interface (API) and its predefined tools, which are driven by various natural language processing algorithms. Results: An evaluation was carried out through a survey that involved 106 university students in determining the functionality, compatibility, reliability, and usability of COVID-Bot. The findings indicated that 92 (86.8%) of the participants agreed that the chatbot functions well, 85 (80.2%) agreed that it fits well with their mobile devices and their lifestyle, 86 (81.1%) agreed that it has the potential to produce accurate and consistent responses, and 85 (80.2%) agreed that it is easy to use. The average obtained α was .87, indicating satisfactory reliability. Conclusions: This study demonstrates that incorporating chatbot technology into the educational system can combat the spread of COVID-19 among university students. The intelligent system does this by interacting with students to determine their vaccination status. %M 36301616 %R 10.2196/39157 %U https://formative.jmir.org/2022/10/e39157 %U https://doi.org/10.2196/39157 %U http://www.ncbi.nlm.nih.gov/pubmed/36301616 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 10 %P e40989 %T The Preferences of Transgender and Nonbinary People for Virtual Health Care After the COVID-19 Pandemic in Canada: Cross-sectional Study %A Navarro,Jose M %A Scheim,Ayden I %A Bauer,Greta R %+ Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, Western Centre for Public Health and Family Medicine, 3rd Fl, 1465 Richmond Street, London, ON, N6G 2M1, Canada, 1 647 678 5673, jnavarr9@uwo.ca %K virtual care %K telemedicine %K telehealth %K eHealth %K transgender %K gender identity %K COVID-19 %K gender-affirming care %K older adult %K mental health %K chronic condition %K social support %D 2022 %7 26.10.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Virtual health care use has dramatically increased in response to the COVID-19 pandemic, raising the question of its potential role after the pandemic. For transgender (trans) and nonbinary (TNB) people, virtual care is promising because it may expand access to appropriate health care providers. However, emerging research indicates potential disparities in virtual care access related to sociodemographic, health, and social factors. There is a paucity of research on the factors affecting patient preferences for virtual versus in-person care, particularly in TNB communities. Objective: This study aimed to identify the sociodemographic, health, and social factors associated with postpandemic virtual care preferences in TNB communities. Methods: The 2020 Trans PULSE Canada COVID survey examined the health, social, and economic impacts of the COVID-19 pandemic among 820 TNB participants who previously completed the prepandemic 2019 Trans PULSE Canada survey (n=2783). Data were weighted to the demographics of the 2019 sample. Chi-square tests were used to compare postpandemic preferences for virtual versus in-person care across sociodemographic, health, and social characteristics. Participants provided open-text responses explaining their preferences, which were used to contextualize quantitative findings. Results: Among 812 participants who indicated whether they would prefer virtual or in-person care after the pandemic, a weighted 32.7% (n=275) would prefer virtual care and 67.3% (n=537) would prefer in-person care. Preference for in-person over virtual care was associated with being in the 14-19 (49/56, weighted 85.0%), 50-64 (51/62, weighted 80.0%), and ≥65 (9/10, weighted 90.7%) age groups (χ25=19.0; P=.002). Preference for virtual over in-person care was associated with having a chronic health condition (125/317, weighted 37.7% versus 150/495, weighted 29.9%; χ21=4.7; P=.03) and having probable anxiety (229/645, weighted 34.7% versus 46/167, weighted 25.7%; χ21=4.3; P=.04). Among participants with romantic partners, preferences varied based on the partner’s level of support for gender identity or expression (χ23=13.3; P=.004). Participants with moderately supportive partners were more likely than participants with very supportive partners to prefer in-person care (36/43, weighted 85.1% versus 275/445, weighted 62.3%). Care preferences did not vary significantly based on the indicators of socioeconomic status. Open-text responses showed that multiple factors often interacted to influence participant preferences, and that some factors, such as having a chronic condition, simultaneously led some participants to prefer virtual care and others to prefer in-person care. Conclusions: TNB people may have differential interest in virtual care based on factors including age, chronic and mental health conditions, and gender-unsupportive home environments. Future research examining virtual care preferences would benefit from mixed methods intersectional approaches across these factors, to explore complexity in the barriers and facilitators of virtual care access and quality. These observed differences support flexibility with options to choose between in-person and virtual health care to meet TNB patients’ specific health needs. %M 36170497 %R 10.2196/40989 %U https://www.jmir.org/2022/10/e40989 %U https://doi.org/10.2196/40989 %U http://www.ncbi.nlm.nih.gov/pubmed/36170497 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 10 %P e38718 %T Long-term Consequences of COVID-19 and the Pandemic: Protocol for a Web-Based, Longitudinal Observational Study (DEFEAT) %A Mikuteit,Marie %A Heinemann,Stephanie %A Roder,Sascha %A Niewolik,Jacqueline %A Schröder,Dominik %A Vahldiek,Kai %A Klawitter,Sandra %A Cossmann,Anne %A Bergemann,Torsten %A Degen,Chantal %A Klawonn,Frank %A Behrens,Georg Martin Norbert %A Müller,Frank %A Dopfer-Jablonka,Alexandra %A Steffens,Sandra %+ Department for Rheumatology and Immunology, Hannover Medical School, Carl-Neuberg-Straße 1, Hannover, 30625, Germany, 49 5115320, steffens.sandra@mh-hannover.de %K SARS-CoV-2 %K COVID-19 %K long COVID %K post–COVID-19 %K long haulers %K pandemic %K long-term effects %K symptoms %K long-term %K risk factors %K Germany %K population study %K quality of life %K social participation %K engagement %D 2022 %7 26.10.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: With population-wide vaccination availability, the global COVID-19 pandemic entered a new phase. Despite vaccination status, some people who were infected with SARS-CoV-2 experience long-term symptoms. Objective: In this study, we aim to characterize the long-term effects of SARS-CoV-2 infection and the pandemic. We also aim to build symptom clusters and determine risk factors for developing long COVID symptoms. Furthermore, we assess social participation and health-related quality of life in patients with long COVID and in the general population during a global pandemic. Methods: With a mixed-methods, web-based approach, we aim to recruit 2000 people in Germany who are older than 18 years and can provide informed consent. In the quantitative arm of the study, we identify symptoms of and predictive factors for long COVID manifestations with cluster analysis and assess social participation during the pandemic with standardized questionnaires. The qualitative arm of the study uses individual interviews and focus group discussions to better understand the illness experience of persons who experience long COVID. Results: Recruitment started in September 2021. Up until July 2022, we recruited approximately 4500 participants via our web-based database. Conclusions: This study aims to build an innovative, patient-centered, web-based research platform appropriate for the pandemic by minimizing physical contact between study personnel and participants. All study activities are designed to better understand the long COVID syndrome, social participation during the pandemic, and the illness experiences of persons affected by long COVID. Trial Registration: German Clinical Trial Registry DRKS00026007; https://tinyurl.com/yh282fkt International Registered Report Identifier (IRRID): DERR1-10.2196/38718 %M 36108134 %R 10.2196/38718 %U https://www.researchprotocols.org/2022/10/e38718 %U https://doi.org/10.2196/38718 %U http://www.ncbi.nlm.nih.gov/pubmed/36108134 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 10 %P e38604 %T Patient and Provider Experiences With Virtual Care in a Large, Ambulatory Care Hospital in Ontario, Canada During the COVID-19 Pandemic: Observational Study %A Chu,Cherry %A Nayyar,Dhruv %A Bhattacharyya,Onil %A Martin,Danielle %A Agarwal,Payal %A Mukerji,Geetha %+ Women's College Hospital Institute for Health System Solutions and Virtual Care, 76 Grenville St, Toronto, ON, M5S 1B2, Canada, 1 416 323 6400, geetha.mukerji@wchospital.ca %K virtual care %K telehealth %K COVID-19 pandemic %K patient experience %K provider experience %K virtual %K telemedicine %K COVID-19 %K ethnicity %K social factors %K experience %D 2022 %7 25.10.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Virtual care use increased during the COVID-19 pandemic. The impact of that shift on patient and provider experiences is unclear. Objective: We evaluated patient and provider experiences with virtual visits across an academic, ambulatory hospital in Toronto, Canada and assessed predictors of positive experience with virtual care. Methods: Survey data were analyzed from consenting patients who attended at least one virtual visit (video or telephone) and from consenting providers who delivered at least one virtual visit. Distributions for demographic variables and responses to survey questions are reported, with statistical significance assessed using chi-square tests and t tests. Ordinal logistic regression analysis was used to identify any patient predictors of responses. Results: During the study period, 253 patients (mean age 45.1, SD 15.6 years) completed 517 video visit surveys, and 147 patients (mean age 41.6, SD 16.4 years) completed 209 telephone visit surveys. A total of 75 and 94 providers completed the survey in June 2020 and June 2021, respectively. On a scale from 1 to 10 regarding likelihood to recommend virtual care to others, fewer providers rated a score of 8 or above compared with patients (providers: 62/94, 66% for video and 49/94, 52% for telephone; patients: 415/517, 80% for video and 150/209, 72% for telephone). Patients of non-White ethnicity had lower odds of rating a high score of 9 or 10 compared with White patients (odds ratio 0.52, 95% CI 0.28-0.99). Conclusions: Patient experiences with virtual care were generally positive, but provider experiences were less so. Findings suggest potential differences in patient experience by ethnicity, warranting further investigation into equity concerns with virtual care. %M 36194862 %R 10.2196/38604 %U https://www.jmir.org/2022/10/e38604 %U https://doi.org/10.2196/38604 %U http://www.ncbi.nlm.nih.gov/pubmed/36194862 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 10 %N 4 %P e35000 %T Virtual Reality Applications in Medicine During the COVID-19 Pandemic: Systematic Review %A Pallavicini,Federica %A Pepe,Alessandro %A Clerici,Massimo %A Mantovani,Fabrizia %+ Department of Human Sciences for Education, Università degli Studi di Milano-Bicocca, Piazza dell'Ateneo Nuovo 1, Milano, 20126, Italy, 39 0264484931, federica.pallavicini@unimib.it %K virtual reality %K medicine %K mental health %K physical health %K education %K training %K COVID-19 %D 2022 %7 25.10.2022 %9 Review %J JMIR Serious Games %G English %X Background: Virtual reality can play an important role during the COVID-19 pandemic in the health care sector. This technology has the potential to supplement the traditional in-hospital medical training and treatment, and may increase access to training and therapies in various health care settings. Objective: This systematic review aimed to describe the literature on health care–targeted virtual reality applications during the COVID-19 crisis. Methods: We conducted a systematic search of the literature on the PsycINFO, Web of Science, and MEDLINE databases, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. The search string was as follows: “[(virtual reality)] AND [(COVID-19) OR (coronavirus) OR (SARS-CoV-2) OR (healthcare)].” Papers published in English after December 2019 in peer-reviewed journals were selected and subjected to the inclusion and exclusion criteria. We used the Mixed Methods Appraisal Tool to assess the quality of studies and the risk of bias. Results: Thirty-nine studies met the inclusion criteria. Seventeen studies showed the usefulness of virtual reality during the COVID-19 crisis for reducing stress, anxiety, depression, and pain, and promoting physical activity. Twenty-two studies revealed that virtual reality was a helpful learning and training tool during the COVID-19 crisis in several areas, including emergency medicine, nursing, and pediatrics. This technology was also used as an educational tool for increasing public understanding of the COVID-19 pandemic. Different levels of immersion (ie, immersive and desktop virtual reality), types of head-mounted displays (ie, PC-based, mobile, and standalone), and content (ie, 360° videos and photos, virtual environments, virtual reality video games, and embodied virtual agents) have been successfully used. Virtual reality was helpful in both face-to-face and remote trials. Conclusions: Virtual reality has been applied frequently in medicine during the COVID-19 pandemic, with positive effects for treating several health conditions and for medical education and training. Some barriers need to be overcome for the broader adoption of virtual reality in the health care panorama. Trial Registration: International Platform of Registered Systematic Review and Meta-analysis Protocols (INPLASY) INPLASY202190108; https://inplasy.com/inplasy-2021-9-0108/ %M 36282554 %R 10.2196/35000 %U https://games.jmir.org/2022/4/e35000 %U https://doi.org/10.2196/35000 %U http://www.ncbi.nlm.nih.gov/pubmed/36282554 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 2 %N 2 %P e38316 %T Investigating COVID-19 Vaccine Communication and Misinformation on TikTok: Cross-sectional Study %A van Kampen,Katherine %A Laski,Jeremi %A Herman,Gabrielle %A Chan,Teresa M %+ Division of Emergency Medicine, Department of Medicine, Faculty of Health Sciences, McMaster University, 100 Main St W, Room 5003, Hamilton, ON, L8P 1H6, Canada, 1 905 525 9140, teresa.chan@medportal.ca %K TikTok %K COVID-19 vaccines %K vaccinations %K misinformation %K COVID-19 %K Infodemiology %K social media %K health information %K content analysis %K vaccine hesitancy %K public health %K web-based health information %D 2022 %7 25.10.2022 %9 Original Paper %J JMIR Infodemiology %G English %X Background: The COVID-19 pandemic has highlighted the need for reliable information, especially around vaccines. Vaccine hesitancy is a growing concern and a great threat to broader public health. The prevalence of social media within our daily lives emphasizes the importance of accurately analyzing how health information is being disseminated to the public. TikTok is of particular interest, as it is an emerging social media platform that young adults may be increasingly using to access health information. Objective: The objective of this study was to examine and describe the content within the top 100 TikToks trending with the hashtag #covidvaccine. Methods: The top 250 most viewed TikToks with the hashtag #covidvaccine were batch downloaded on July 1, 2021, with their respective metadata. Each TikTok was subsequently viewed and encoded by 2 independent reviewers. Coding continued until 100 TikToks could be included based on language and content. Descriptive features were recorded including health care professional (HCP) status of creator, verification of HCP status, genre, and misinformation addressed. Primary inclusion criteria were any TikToks in English with discussion of a COVID-19 vaccine. Results: Of 102 videos included, the median number of plays was 1,700,000, with median shares of 9224 and 62,200 followers. Upon analysis, 14.7% (15/102) of TikToks included HCPs, of which 80% (12/102) could be verified via social media or regulatory body search; 100% (15/15) of HCP-created TikToks supported vaccine use, and overall, 81.3% (83/102) of all TikToks (created by either a layperson or an HCP) supported vaccine use. Conclusions: As the pandemic continues, vaccine hesitancy poses a threat to lifting restrictions, and discovering reasons for this hesitancy is important to public health measures. This study summarizes the discourse around vaccine use on TikTok. Importantly, it opens a frank discussion about the necessity to incorporate new social media platforms into medical education, so we might ensure our trainees are ready to engage with patients on novel platforms. %M 36338548 %R 10.2196/38316 %U https://infodemiology.jmir.org/2022/2/e38316 %U https://doi.org/10.2196/38316 %U http://www.ncbi.nlm.nih.gov/pubmed/36338548 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 11 %N 2 %P e39366 %T How Face Masks Affect the Use of Echolocation by Individuals With Visual Impairments During COVID-19: International Cross-sectional Online Survey %A Kreidy,Chantal %A Martiniello,Natalina %A Nemargut,Joseph Paul %A Wittich,Walter %+ School of Optometry, University of Montreal, 3744, rue Jean-Brillant Bureau 260-7, Montréal, QC, H3T 1P1, Canada, 1 514 343 7962, chantal.kreidy@umontreal.ca %K visual impairment %K echolocation %K COVID-19 %K orientation and mobility %K vision rehabilitation %K online survey %K rehabilitation %K face mask %K visual disability %K vision disorder %K quality of life %K health intervention %D 2022 %7 25.10.2022 %9 Original Paper %J Interact J Med Res %G English %X Background: Although a critical safety measure, preliminary studies have suggested that the use of a face mask may pose a problem for some users with disabilities. To date, little is known about how the wearing of a traditional face mask may pose a barrier to individuals with visual impairments who draw on auditory cues and echolocation techniques during independent travel. Objective: The goal of this study was to document the difficulties, if any, encountered during orientation and mobility due to the use of a face mask during the COVID-19 pandemic and the strategies used to address these barriers. Methods: In total, 135 individuals aged 18 years and older who self-identified as being blind, being deafblind, or having low vision and who could communicate in either English or French completed an anonymous cross-sectional online survey between March 29 and August 23, 2021. Results: In total, 135 respondents (n=52, 38.5%, men; n=83, 61.5%, women) between the ages of 18 and 79 (mean 48.22, SD 14.48) years participated. Overall, 78 (57.7%) self-identified as blind and 57 (42.3%) as having low vision. In addition, 13 (9.6%) identified as having a combined vision and hearing loss and 3 (2.2%) as deafblind. The most common face coverings used were cloth (n=119, 88.1%) and surgical masks (n=74, 54.8%). Among the barriers raised, participants highlighted that face masks made it more difficult to locate people (n=86, 63.7%), communicate with others (n=101, 74.8%), and locate landmarks (n=82, 60.7%). Although the percentage of those who used a white cane before the pandemic did not substantially change, 6 (14.6%) of the 41 participants who were guide dog users prior to the pandemic reported no longer working with a guide dog at the time of the survey. Moreover, although guide dog users reported the highest level of confidence with independent travel before the pandemic, they indicated the lowest level of confidence a year after the pandemic began. Conclusions: These results suggest that participants were less able to draw on nonvisual cues during independent travel and social interactions due to the use of a facemask, contributing to a reduction in perceived self-confidence and independence. Findings inform the development of evidence-based recommendations to address identified barriers. %M 36223434 %R 10.2196/39366 %U https://www.i-jmr.org/2022/2/e39366 %U https://doi.org/10.2196/39366 %U http://www.ncbi.nlm.nih.gov/pubmed/36223434 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 10 %P e36656 %T Anxiety, Post–COVID-19 Syndrome-Related Depression, and Suicidal Thoughts and Behaviors in COVID-19 Survivors: Cross-sectional Study %A Woodward,Sean F %A Bari,Sumra %A Vike,Nicole %A Lalvani,Shamal %A Stetsiv,Khrystyna %A Kim,Byoung Woo %A Stefanopoulos,Leandros %A Maglaveras,Nicos %A Breiter,Hans %A Katsaggelos,Aggelos K %+ Department of Electrical and Computer Engineering, Northwestern University, 2145 Sheridan Road, Evanston, IL, 60208, United States, 1 847 491 3451, a-katsaggelos@northwestern.edu %K COVID-19 %K post–COVID-19 syndrome %K suicidality %K depression %K Patient Health Questionnaire-9 %K PHQ-9 %K State Trait Anxiety Index %K STAI %D 2022 %7 25.10.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Although the mental health impacts of COVID-19 on the general population have been well studied, studies of the long-term impacts of COVID-19 on infected individuals are relatively new. To date, depression, anxiety, and neurological symptoms associated with post–COVID-19 syndrome (PCS) have been observed in the months following COVID-19 recovery. Suicidal thoughts and behavior (STB) have also been preliminarily proposed as sequelae of COVID-19. Objective: We asked 3 questions. First, do participants reporting a history of COVID-19 diagnosis or a close relative having severe COVID-19 symptoms score higher on depression (Patient Health Questionnaire-9 [PHQ-9]) or state anxiety (State Trait Anxiety Index) screens than those who do not? Second, do participants reporting a COVID-19 diagnosis score higher on PCS-related PHQ-9 items? Third, do participants reporting a COVID-19 diagnosis or a close relative having severe COVID-19 symptoms score higher in STB before, during, or after the first year of the pandemic? Methods: This preliminary study analyzed responses to a COVID-19 and mental health questionnaire obtained from a US population sample, whose data were collected between February 2021 and March 2021. We used the Mann-Whitney U test to detect differences in the medians of the total PHQ-9 scores, PHQ-9 component scores, and several STB scores between participants claiming a past clinician diagnosis of COVID-19 and those denying one, as well as between participants claiming severe COVID-19 symptoms in a close relative and those denying them. Where significant differences existed, we created linear regression models to predict the scores based on COVID-19 response as well as demographics to identify potential confounding factors in the Mann-Whitney relationships. Moreover, for STB scores, which corresponded to 5 questions asking about 3 different time intervals (i.e., past 1 year or more, past 1 month to 1 year, and past 1 month), we developed repeated-measures ANOVAs to determine whether scores tended to vary over time. Results: We found greater total depression (PHQ-9) and state anxiety (State Trait Anxiety Index) scores in those with COVID-19 history than those without (Bonferroni P=.001 and Bonferroni P=.004) despite a similar history of diagnosed depression and anxiety. Greater scores were noted for a subset of depression symptoms (PHQ-9 items) that overlapped with the symptoms of PCS (all Bonferroni Ps<.05). Moreover, we found greater overall STB scores in those with COVID-19 history, equally in time windows preceding, during, and proceeding infection (all Bonferroni Ps<.05). Conclusions: We confirm previous studies linking depression and anxiety diagnoses to COVID-19 recovery. Moreover, our findings suggest that depression diagnoses associated with COVID-19 history relate to PCS symptoms, and that STB associated with COVID-19 in some cases precede infection. %M 35763757 %R 10.2196/36656 %U https://formative.jmir.org/2022/10/e36656 %U https://doi.org/10.2196/36656 %U http://www.ncbi.nlm.nih.gov/pubmed/35763757 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 10 %P e37436 %T Understanding How the Design and Implementation of Online Consultations Affect Primary Care Quality: Systematic Review of Evidence With Recommendations for Designers, Providers, and Researchers %A Darley,Sarah %A Coulson,Tessa %A Peek,Niels %A Moschogianis,Susan %A van der Veer,Sabine N %A Wong,David C %A Brown,Benjamin C %+ Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, The University of Manchester, Oxford Road, Manchester, M13 9PL, United Kingdom, 44 7919103175, Benjamin.brown@manchester.ac.uk %K general practice %K systematic review %K remote consultation %K OC %K triage %K primary health care %K care provider %K health care professional %K workforce %K telemedicine %K COVID-19 %K pandemic %K primary care %K health outcome %K patient care %D 2022 %7 24.10.2022 %9 Review %J J Med Internet Res %G English %X Background: Online consultations (OCs) allow patients to contact their care providers on the web. Worldwide, OCs have been rolled out in primary care rapidly owing to policy initiatives and COVID-19. There is a lack of evidence regarding how OC design and implementation influence care quality. Objective: We aimed to synthesize research on the impacts of OCs on primary care quality, and how these are influenced by system design and implementation. Methods: We searched databases from January 2010 to February 2022. We included quantitative and qualitative studies of real-world OC use in primary care. Quantitative data were transformed into qualitative themes. We used thematic synthesis informed by the Institute of Medicine domains of health care quality, and framework analysis informed by the nonadoption, abandonment, scale-up, spread, and sustainability framework. Strength of evidence was judged using the GRADE-CERQual approach. Results: We synthesized 63 studies from 9 countries covering 31 OC systems, 14 (22%) of which used artificial intelligence; 41% (26/63) of studies were published from 2020 onward, and 17% (11/63) were published after the COVID-19 pandemic. There was no quantitative evidence for negative impacts of OCs on patient safety, and qualitative studies suggested varied perceptions of their safety. Some participants believed OCs improved safety, particularly when patients could describe their queries using free text. Staff workload decreased when sufficient resources were allocated to implement OCs and patients used them for simple problems or could describe their queries using free text. Staff workload increased when OCs were not integrated with other software or organizational workflows and patients used them for complex queries. OC systems that required patients to describe their queries using multiple-choice questionnaires increased workload for patients and staff. Health costs decreased when patients used OCs for simple queries and increased when patients used them for complex queries. Patients using OCs were more likely to be female, younger, and native speakers, with higher socioeconomic status. OCs increased primary care access for patients with mental health conditions, verbal communication difficulties, and barriers to attending in-person appointments. Access also increased by providing a timely response to patients’ queries. Patient satisfaction increased when using OCs owing to better primary care access, although it decreased when using multiple-choice questionnaire formats. Conclusions: This is the first theoretically informed synthesis of research on OCs in primary care and includes studies conducted during the COVID-19 pandemic. It contributes new knowledge that, in addition to having positive impacts on care quality such as increased access, OCs also have negative impacts such as increased workload. Negative impacts can be mitigated through appropriate OC system design (eg, free text format), incorporation of advanced technologies (eg, artificial intelligence), and integration into technical infrastructure (eg, software) and organizational workflows (eg, timely responses). Trial Registration: PROSPERO CRD42020191802; https://tinyurl.com/2p84ezjy %M 36279172 %R 10.2196/37436 %U https://www.jmir.org/2022/10/e37436 %U https://doi.org/10.2196/37436 %U http://www.ncbi.nlm.nih.gov/pubmed/36279172 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 10 %P e37441 %T Exponential Growth Bias of Infectious Diseases: Protocol for a Systematic Review %A Berg,Siv Hilde %A Lungu,Daniel Adrian %A Brønnick,Kolbjørn %A Harthug,Stig %A Røislien,Jo %+ Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, SHARE – Centre for Resilience in Healthcare, Kjell Arholmsgate 43, Stavanger, 4021, Norway, 47 90022463, siv.h.berg@uis.no %K exponential growth bias %K pandemic %K infectious diseases %K COVID-19 %K health communication %K risk communication %D 2022 %7 24.10.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Humans struggle to grasp the extent of exponential growth, which is essential to comprehend the spread of an infectious disease. Exponential growth bias is the tendency to linearize exponential functions when assessing them intuitively. Effective public health communication about the nonlinear nature of infectious diseases has strong implications for the public’s compliance with strict restrictions. However, there is a lack of synthesized knowledge on the communication of the exponential growth of infectious diseases and on the outcomes of exponential growth bias. Objective: This systematic review identifies, evaluates, and synthesizes the findings of empirical studies on exponential growth bias of infectious diseases. Methods: A systematic review will be conducted using the PRISMA-P (Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols) 2015 statement. Eligibility criteria include empirical studies of exponential growth bias of infectious diseases regardless of methodology. We include studies both with and without interventions/strategies. For information sources, we include the following five bibliographic databases: MEDLINE, Embase, Cochrane Library, PsychINFO, and Web of Science Core Collection. The risk of bias will be assessed using RoB 2 (Risk of Bias 2) and STROBE (Strengthening the Reporting of Observational Studies in Epidemiology). Data synthesis will be achieved through a narrative synthesis. Results: By February 2022, we included 11 experimental studies and 1 cross-sectional survey study. Preliminary themes identified are the presence of exponential growth bias, the effect of exponential growth bias, and communication strategies to mitigate exponential growth bias. Data extraction, narrative synthesis, and the risk of bias assessment are to be completed by February 2023. Conclusions: We anticipate that this systematic review will draw some lines related to how people comprehend and misperceive exponential growth and its consequences for infectious disease mitigation and communication. Furthermore, the study will conclude with the limitations of the research and suggestions for future research. International Registered Report Identifier (IRRID): DERR1-10.2196/37441 %M 36279166 %R 10.2196/37441 %U https://www.researchprotocols.org/2022/10/e37441 %U https://doi.org/10.2196/37441 %U http://www.ncbi.nlm.nih.gov/pubmed/36279166 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 10 %P e36001 %T Home-Based Respiratory Physiotherapy and Telephone-Based Psychological Support for COVID-19 Survivors in Peru: Protocol for a Randomized Controlled Trial %A Soriano-Moreno,Anderson N %A Flores,Elaine C %A Hartinger,Stella M %A Mallma,Claudia Y %A Diaz,Arnold A %A Gianella,Gonzalo E %A Galvez-Buccollini,Juan A %A Coico-Lama,Abdiel H %A Malaga,German %A Fajardo,Eufemia %A Paredes-Angeles,Rubí %A Otazú-Alfaro,Sharlyn %A Lescano,Andres G %A Checkley,William %A , %+ Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, 1830 E Monument St, Suite 555, Baltimore, MD, 21287, United States, 1 410 926 7251, wcheckl1@jhmi.edu %K COVID-19 %K pulmonary rehabilitation %K psychiatric rehabilitation %K mental health %K clinical trial %D 2022 %7 24.10.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Both pulmonary and mental health are affected following hospitalization for COVID-19 pneumonia. Pulmonary rehabilitation therapy has demonstrated benefits in improving mental health, but no validated combined programs that include mental health have been proposed. Objective: This article presents the design of a trial that aimed to assess whether the participation in a combined rehabilitation program that includes home-based respiratory physiotherapy and telephone-based psychological support is associated with a greater improvement of pulmonary and mental health outcomes 7-12 weeks after COVID-19 hospitalization discharge compared with posthospital usual care provided by a public Peruvian hospital. Methods: WAYRA (the word for air in the Quechua language) was an open-label, unblinded, two-arm randomized controlled trial. We recruited 108 participants aged 18-75 years who were discharged from the hospital after COVID-19 pneumonia that required >6 liters/minute of supplemental oxygen during treatment. Participants were randomly assigned at a 1:1 ratio to receive the combined rehabilitation program or usual posthospital care provided by a public Peruvian hospital. The intervention consisted of 12 at-home respiratory rehabilitation sessions and 6 telephone-based psychological sessions. The primary outcome was the 6-minute walk distance. Secondary outcomes included lung function, mental health status (depression, anxiety, and trauma), and quality of life. Outcomes were assessed at baseline (before randomization) and at 7 and 12 weeks after hospital discharge to assess the difference between arms. Results: This study was funded by the Peruvian National Council of Science Technology and Technology Innovation in July 2020. Ethics approval was obtained on September 2, 2020. Recruitment and data collection occurred between October 2020 and June 2021. Results are expected to be published by the end of 2022. Conclusions: WAYRA was the first randomized controlled trial evaluating combined pulmonary-mental health rehabilitation for hospitalized COVID-19 survivors in resource-limited settings, potentially providing a foundation for the cost-effective scale-up of similar multidisciplinary rehabilitation programs. Trial Registration: ClinicalTrials.gov NCT04649736; https://clinicaltrials.gov/ct2/show/NCT04649736 International Registered Report Identifier (IRRID): RR1-10.2196/36001 %M 36108135 %R 10.2196/36001 %U https://www.researchprotocols.org/2022/10/e36001 %U https://doi.org/10.2196/36001 %U http://www.ncbi.nlm.nih.gov/pubmed/36108135 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 10 %P e39218 %T Using a Chatbot as an Alternative Approach for In-Person Toothbrushing Training During the COVID-19 Pandemic: Comparative Study %A Pithpornchaiyakul,Samerchit %A Naorungroj,Supawadee %A Pupong,Kittiwara %A Hunsrisakhun,Jaranya %+ Department of Preventive Dentistry, Faculty of Dentistry, Prince of Songkla University, 15 Kanjanavanich Rd, Hatyai, Songkhla, 90112, Thailand, 66 74429875, hjaranya@hotmail.com %K mHealth %K tele-dentistry %K digital health %K chatbot %K conversional agents %K oral hygiene %K oral health behaviors %K protection motivation theory %K young children %K caregiver %K in-person toothbrushing training %K COVID-19 %D 2022 %7 21.10.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: It is recommended that caregivers receive oral health education and in-person training to improve toothbrushing for young children. To strengthen oral health education before COVID-19, the 21-Day FunDee chatbot with in-person toothbrushing training for caregivers was used. During the pandemic, practical experience was difficult to implement. Therefore, the 30-Day FunDee chatbot was created to extend the coverage of chatbots from 21 days to 30 days by incorporating more videos on toothbrushing demonstrations and dialogue. This was a secondary data comparison of 2 chatbots in similar rural areas of Pattani province: Maikan district (Study I) and Maelan district (Study II). Objective: This study aimed to evaluate the effectiveness and usability of 2 chatbots, 21-Day FunDee (Study I) and 30-Day FunDee (Study II), based on the protection motivation theory (PMT). This study explored the feasibility of using the 30-Day FunDee chatbot to increase toothbrushing behaviors for caregivers in oral hygiene care for children aged 6 months to 36 months without in-person training during the COVID-19 pandemic. Methods: A pre-post design was used in both studies. The effectiveness was evaluated among caregivers in terms of oral hygiene practices, knowledge, and oral health care perceptions based on PMT. In Study I, participants received in-person training and a 21-day chatbot course during October 2018 to February 2019. In Study II, participants received only daily chatbot programming for 30 days during December 2021 to February 2022. Data were gathered at baseline of each study and at 30 days and 60 days after the start of Study I and Study II, respectively. After completing their interventions, the chatbot's usability was assessed using open-ended questions. Study I evaluated the plaque score, whereas Study II included an in-depth interview. The 2 studies were compared to determine the feasibility of using the 30-Day FunDee chatbot as an alternative to in-person training. Results: There were 71 pairs of participants: 37 in Study I and 34 in Study II. Both chatbots significantly improved overall knowledge (Study I: P<.001; Study II: P=.001), overall oral health care perceptions based on PMT (Study I: P<.001; Study II: P<.001), and toothbrushing for children by caregivers (Study I: P=.02; Study II: P=.04). Only Study I had statistically significant differences in toothbrushing at least twice a day (P=.002) and perceived vulnerability (P=.003). The highest overall chatbot satisfaction was 9.2 (SD 0.9) in Study I and 8.6 (SD 1.2) in Study II. In Study I, plaque levels differed significantly (P<.001). Conclusions: This was the first study using a chatbot in oral health education. We established the effectiveness and usability of 2 chatbot programs for promoting oral hygiene care of young children by caregivers. The 30-Day FunDee chatbot showed the possibility of improving toothbrushing skills without requiring in-person training. Trial Registration: Thai Clinical Trials Registry TCTR20191223005; http://www.thaiclinicaltrials.org/show/TCTR20191223005 and TCTR20210927004; https://www.thaiclinicaltrials.org/show/TCTR20210927004 %M 36179147 %R 10.2196/39218 %U https://www.jmir.org/2022/10/e39218 %U https://doi.org/10.2196/39218 %U http://www.ncbi.nlm.nih.gov/pubmed/36179147 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 10 %P e35860 %T Characterizing Thrombotic Complication Risk Factors Associated With COVID-19 via Heterogeneous Patient Data: Retrospective Observational Study %A Rosario,Bedda %A Zhang,Andrew %A Patel,Mehool %A Rajmane,Amol %A Xie,Ning %A Weeraratne,Dilhan %A Alterovitz,Gil %+ Biomedical Cybernetics Laboratory, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, United States, 1 617 329 1445, ga@alum.mit.edu %K COVID-19 %K thrombotic complications %K logistic regression %K EHR %K electronic health record %K insurance claims data %D 2022 %7 21.10.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: COVID-19 has been observed to be associated with venous and arterial thrombosis. The inflammatory disease prolongs hospitalization, and preexisting comorbidities can intensity the thrombotic burden in patients with COVID-19. However, venous thromboembolism, arterial thrombosis, and other vascular complications may go unnoticed in critical care settings. Early risk stratification is paramount in the COVID-19 patient population for proactive monitoring of thrombotic complications. Objective: The aim of this exploratory research was to characterize thrombotic complication risk factors associated with COVID-19 using information from electronic health record (EHR) and insurance claims databases. The goal is to develop an approach for analysis using real-world data evidence that can be generalized to characterize thrombotic complications and additional conditions in other clinical settings as well, such as pneumonia or acute respiratory distress syndrome in COVID-19 patients or in the intensive care unit. Methods: We extracted deidentified patient data from the insurance claims database IBM MarketScan, and formulated hypotheses on thrombotic complications in patients with COVID-19 with respect to patient demographic and clinical factors using logistic regression. The hypotheses were then verified with analysis of deidentified patient data from the Research Patient Data Registry (RPDR) Mass General Brigham (MGB) patient EHR database. Data were analyzed according to odds ratios, 95% CIs, and P values. Results: The analysis identified significant predictors (P<.001) for thrombotic complications in 184,831 COVID-19 patients out of the millions of records from IBM MarketScan and the MGB RPDR. With respect to age groups, patients 60 years and older had higher odds (4.866 in MarketScan and 6.357 in RPDR) to have thrombotic complications than those under 60 years old. In terms of gender, men were more likely (odds ratio of 1.245 in MarketScan and 1.693 in RPDR) to have thrombotic complications than women. Among the preexisting comorbidities, patients with heart disease, cerebrovascular diseases, hypertension, and personal history of thrombosis all had significantly higher odds of developing a thrombotic complication. Cancer and obesity were also associated with odds>1. The results from RPDR validated the IBM MarketScan findings, as they were largely consistent and afford mutual enrichment. Conclusions: The analysis approach adopted in this study can work across heterogeneous databases from diverse organizations and thus facilitates collaboration. Searching through millions of patient records, the analysis helped to identify factors influencing a phenotype. Use of thrombotic complications in COVID-19 patients represents only a case study; however, the same design can be used across other disease areas by extracting corresponding disease-specific patient data from available databases. %M 36044652 %R 10.2196/35860 %U https://www.jmir.org/2022/10/e35860 %U https://doi.org/10.2196/35860 %U http://www.ncbi.nlm.nih.gov/pubmed/36044652 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 10 %P e37713 %T Dialogic Health Education to Reduce COVID-19 Disparities and Increase Health Literacy in Community and Correctional Settings: Protocol for a Two-Pronged Health Education Program %A Kader,Farah %A Kruchten,Stephanie %A Campo,Marc %A Collica-Cox,Kimberly %A Davidson,Charis %A Wald,Adrienne %A Hewlett Jr,Dial %+ Westchester County Department of Health, 148 Martine Ave, White Plains, NY, 10601, United States, 1 9149957731, fxkt@westchestergov.com %K community engagement %K dialogic learning %K training of trainers %K COVID-19 %K health literacy %K correctional facility health %K health equity %K racial disparities %K community participation %D 2022 %7 21.10.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: COVID-19 vaccines significantly reduce rates of hospitalization and death for those infected with the SARS-CoV-2 virus. Those facing social oppression, including people of color, experience heightened risk for COVID-19 and comorbidities, but are often mistrustful of governmental agencies and initiatives, contributing to low vaccine uptake and a reluctance to access vital health care services. Dialogue-based health literacy interventions may mitigate mistrust and increase access to health services and information, subsequently increasing rates of vaccination and other behaviors that reduce COVID-19 risk. Objective: To improve health literacy and reduce COVID-19 disparities, the Westchester County Department of Health, in partnership with two universities, community- and faith-based organizations, and the Westchester County Department of Correction, co-developed a health education program for community members, correctional officers, and incarcerated jail residents in Westchester, New York. Specific objectives are to increase preventative health behaviors, positive attitudes toward use of public health protocols, full vaccination or intentions to vaccinate, health care information understanding, health provider care access, clear communication with health care providers, and personal health care decision-making. Methods: Grounded in dialogic learning, the program entails training community-based “trusted messengers” and correctional officers to lead health information sessions in community and correctional settings. During the grant period, the program intends for 80 community-based trusted messengers to receive training from the Department of Health and will be expected to reach a goal of 100 members (N=8000) of their communities. Correctional staff with experience delivering educational programs will be trained to facilitate sessions among 400 correctional facility residents and 600 correctional staff. Results: Pre-post surveys will assess changes in health behaviors, attitudes, and perceptions. The program has been administered in the correctional facility since February 2022, with information sessions expected to cease for correctional staff and residents in June 2022 and November 2022, respectively. An initial cohort of community-based trusted messengers began training in February 2022, and information sessions have been scheduled in various virtual and community settings since March 2022. As of April 2022, the two-pronged health education program has reached 439 correctional officers, 98 jail residents, and 201 community members countywide. Program evaluation findings will be released in future publications after study implementation is complete. Conclusions: Few studies have evaluated the combined effects of training-of-trainers (ToT) and dialogical learning models on behavior and health literacy. As the first known COVID-19–specific dialogue-based health education program that applies a ToT model in the community-based, correctional, and virtual settings simultaneously, this study fills a gap in current knowledge about health literacy and health behavior in marginalized populations. Thus, this evidence-based framework can remedy COVID-19 disparities while also addressing risks for a host of health-related issues at the community level, potentially serving as a best-practice model for future health programs. International Registered Report Identifier (IRRID): PRR1-10.2196/37713 %M 36194870 %R 10.2196/37713 %U https://www.researchprotocols.org/2022/10/e37713 %U https://doi.org/10.2196/37713 %U http://www.ncbi.nlm.nih.gov/pubmed/36194870 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 10 %P e38450 %T Prediction of COVID-19 Infections for Municipalities in the Netherlands: Algorithm Development and Interpretation %A van der Ploeg,Tjeerd %A Gobbens,Robbert J J %+ Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, De Boelelaan 1109, Amsterdam, 1081 HV, Netherlands, 31 653519264, tvdploeg@quicknet.nl %K municipality properties %K data merging %K modeling technique %K variable selection %K prediction model %K public health %K COVID-19 %K surveillance %K static data %K Dutch public domain %K pandemic %K Wuhan %K virus %K public %K infections %K fever %K cough %K congestion %K fatigue %K symptoms %K pneumonia %K dyspnea %K death %D 2022 %7 20.10.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: COVID-19 was first identified in December 2019 in the city of Wuhan, China. The virus quickly spread and was declared a pandemic on March 11, 2020. After infection, symptoms such as fever, a (dry) cough, nasal congestion, and fatigue can develop. In some cases, the virus causes severe complications such as pneumonia and dyspnea and could result in death. The virus also spread rapidly in the Netherlands, a small and densely populated country with an aging population. Health care in the Netherlands is of a high standard, but there were nevertheless problems with hospital capacity, such as the number of available beds and staff. There were also regions and municipalities that were hit harder than others. In the Netherlands, there are important data sources available for daily COVID-19 numbers and information about municipalities. Objective: We aimed to predict the cumulative number of confirmed COVID-19 infections per 10,000 inhabitants per municipality in the Netherlands, using a data set with the properties of 355 municipalities in the Netherlands and advanced modeling techniques. Methods: We collected relevant static data per municipality from data sources that were available in the Dutch public domain and merged these data with the dynamic daily number of infections from January 1, 2020, to May 9, 2021, resulting in a data set with 355 municipalities in the Netherlands and variables grouped into 20 topics. The modeling techniques random forest and multiple fractional polynomials were used to construct a prediction model for predicting the cumulative number of confirmed COVID-19 infections per 10,000 inhabitants per municipality in the Netherlands. Results: The final prediction model had an R2 of 0.63. Important properties for predicting the cumulative number of confirmed COVID-19 infections per 10,000 inhabitants in a municipality in the Netherlands were exposure to particulate matter with diameters <10 μm (PM10) in the air, the percentage of Labour party voters, and the number of children in a household. Conclusions: Data about municipality properties in relation to the cumulative number of confirmed infections in a municipality in the Netherlands can give insight into the most important properties of a municipality for predicting the cumulative number of confirmed COVID-19 infections per 10,000 inhabitants in a municipality. This insight can provide policy makers with tools to cope with COVID-19 and may also be of value in the event of a future pandemic, so that municipalities are better prepared. %M 36219835 %R 10.2196/38450 %U https://publichealth.jmir.org/2022/10/e38450 %U https://doi.org/10.2196/38450 %U http://www.ncbi.nlm.nih.gov/pubmed/36219835 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 4 %P e38546 %T The Impact of COVID-19 on Older Adults’ Perceptions of Virtual Care: Qualitative Study %A Abdallah,Lama %A Stolee,Paul %A Lopez,Kimberly J %A Whate,Alexandra %A Boger,Jennifer %A Tong,Catherine %+ School of Public Health Sciences, University of Waterloo, 200 University Ave. West, Waterloo, ON, N2L3G1, Canada, 1 5198884567, catherine.tong@uwaterloo.ca %K virtual care %K older adult %K qualitative %K COVID-19 %K elderly population %K aging %K telehealth %K digital care %K technology usability %K patient perspective %K technology access %D 2022 %7 20.10.2022 %9 Original Paper %J JMIR Aging %G English %X Background: In response to the COVID-19 pandemic, older adults worldwide have increasingly received health care virtually, and health care organizations and professional bodies have indicated that virtual care is “here to stay.” As older adults are the highest users of the health care system, virtual care implementation can have a significant impact on them and may pose a need for additional support. Objective: This research aims to understand older adults’ perspectives and experiences of virtual care during the pandemic. Methods: As part of a larger study on older adults’ technology use during the pandemic, we conducted semistructured interviews with 20 diverse older Canadians (mean age 76.9 years, SD 6.5) at 2 points: summer of 2020 and winter/early spring of 2021. Participants were asked about their technology skills, experiences with virtual appointments, and perspectives on this type of care delivery. Interviews were digitally recorded and transcribed. A combination of team-based and framework analyses was used to interpret the data. Results: Participants described their experiences with both in-person and virtual care during the pandemic, including issues with accessing care and long gaps between appointments. Overall, participants were generally satisfied with the virtual care they received during the pandemic. Participants described the benefits of virtual care (eg, increased convenience, efficiency, and safety), the limitations of virtual care (eg, need for physical examination and touch, lack of nonverbal communication, difficulties using technology, and systemic barriers in access), and their perspectives on the future of virtual care. Half of our participants preferred a return to in-person care after the COVID-19 pandemic, while the other half preferred a combination of in-person and virtual services. Many participants who preferred to access in-person services were not opposed to virtual care options, as needed; however, they wanted virtual care as an option alongside in-person care. Participants emphasized a need for training and support to be meaningfully implemented to support both older adults and providers in using virtual care. Conclusions: Overall, our research identified both perceived benefits and perceived limitations of virtual care, and older adult participants emphasized their wish for a hybrid model of virtual care, in which virtual care is viewed as an addendum, not a replacement for in-person care. We recognize the limitations of our sample (small, not representative of all older Canadians, and more likely to use technology); this body of literature would greatly benefit from more research with older adults who do not/cannot use technology to receive care. Findings from this study can be mobilized as part of broader efforts to support older patients and providers engaged in virtual and in-person care, particularly post–COVID-19. %M 36054599 %R 10.2196/38546 %U https://aging.jmir.org/2022/4/e38546 %U https://doi.org/10.2196/38546 %U http://www.ncbi.nlm.nih.gov/pubmed/36054599 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 5 %N 4 %P e37424 %T Experiences of Using the Digital Support Tool MeeToo: Mixed Methods Study %A Ravaccia,Giulia Gaia %A Johnson,Sophie Laura %A Morgan,Nicholas %A Lereya,Suzet Tanya %A Edbrooke-Childs,Julian %+ Evidence Based Practice Unit, Anna Freud National Centre for Children and Families, 4-8 Rodney Street, London, N1 9JH, United Kingdom, 44 02077942313, julian.childs@annafreud.org %K mHealth %K mental health %K peer support %K COVID-19 %K well-being %K young people %D 2022 %7 20.10.2022 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Digital peer support is an increasingly used form of mental health support for young people. However, there is a need for more research on the impact of digital peer support and why it has an impact. Objective: The aim of this research is to examine young people’s experiences of using a digital peer support tool: MeeToo. After the time of writing, MeeToo has changed their name to Tellmi. MeeToo is an anonymous, fully moderated peer support tool for young people aged 11-25 years. There were two research questions: (1) What impacts did using MeeToo have on young people? (2) Why did using MeeToo have these impacts on young people? Methods: A mixed methods study was conducted. It involved secondary analysis of routinely collected feedback questionnaires, which were completed at two time points (T1 and T2) 2-3 months apart. Questionnaires asked about young people’s (N=876) experience of using MeeToo, mental health empowerment, and well-being. Primary data were collected from semistructured interviews with 10 young people. Results: Overall, 398 (45.4%) of 876 young people completed the T1 questionnaire, 559 (63.8%) completed the T2 questionnaire, and 81 (9.2%) completed both. Descriptive statistics from the cross-sectional analysis of the questionnaires identified a range of positive impacts of using MeeToo, which included making it easier to talk about difficult things, being part of a supportive community, providing new ways to help oneself, feeling better, and feeling less alone. Subgroup analysis (paired-sample t test) of 58 young females who had completed both T1 and T2 questionnaires showed a small but statistically significant increase in levels of patient activation, one of the subscales of the mental health empowerment scale: time 1 mean=1.83 (95% CI 1.72-1.95), time 2 mean=2.00 (95% CI 1.89-2.11), t59=2.15, and P=.04. Anonymity and the MeeToo sense of community were identified from interviews as possible reasons for why using MeeToo had these impacts. Anonymity helped to create a safe space in which users could express their feelings, thoughts, and experiences freely without the fear of being judged by others. The MeeToo sense of community was described as a valuable form of social connectedness, which in turn had a positive impact on young people’s mental health and made them feel less isolated and alone. Conclusions: The findings of this research showed a range of positive impacts and possible processes for young people using MeeToo. Future research is needed to examine how these impacts and processes can be sustained. %M 36264619 %R 10.2196/37424 %U https://pediatrics.jmir.org/2022/4/e37424 %U https://doi.org/10.2196/37424 %U http://www.ncbi.nlm.nih.gov/pubmed/36264619 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 10 %P e37877 %T A Cognitive Behavioral Therapy Chatbot (Otis) for Health Anxiety Management: Mixed Methods Pilot Study %A Goonesekera,Yenushka %A Donkin,Liesje %+ Department of Psychology and Neuroscience, Auckland University of Technology, 55 Wellesley Street East, Private Bag 92006, Auckland, 1010, New Zealand, 64 21847886, liesje.donkin@aut.ac.nz %K health anxiety %K conversational agent %K illness anxiety disorder %K COVID-19 %K iCBT %K user experience %K anthropomorphism %D 2022 %7 20.10.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: An increase in health anxiety was observed during the COVID-19 pandemic. However, due to physical distancing restrictions and a strained mental health system, people were unable to access support to manage health anxiety. Chatbots are emerging as an interactive means to deliver psychological interventions in a scalable manner and provide an opportunity for novel therapy delivery to large groups of people including those who might struggle to access traditional therapies. Objective: The aim of this mixed methods pilot study was to investigate the feasibility, acceptability, engagement, and effectiveness of a cognitive behavioral therapy (CBT)–based chatbot (Otis) as an early health anxiety management intervention for adults in New Zealand during the COVID-19 pandemic. Methods: Users were asked to complete a 14-day program run by Otis, a primarily decision tree–based chatbot on Facebook Messenger. Health anxiety, general anxiety, intolerance of uncertainty, personal well-being, and quality of life were measured pre-intervention, postintervention, and at a 12-week follow-up. Paired samples t tests and 1-way ANOVAs were conducted to investigate the associated changes in the outcomes over time. Semistructured interviews and written responses in the self-report questionnaires and Facebook Messenger were thematically analyzed. Results: The trial was completed by 29 participants who provided outcome measures at both postintervention and follow-up. Although an average decrease in health anxiety did not reach significance at postintervention (P=.55) or follow-up (P=.08), qualitative analysis demonstrated that participants perceived benefiting from the intervention. Significant improvement in general anxiety, personal well-being, and quality of life was associated with the use of Otis at postintervention and follow-up. Anthropomorphism, Otis’ appearance, and delivery of content facilitated the use of Otis. Technical difficulties and high performance and effort expectancy were, in contrast, barriers to acceptance and engagement of Otis. Conclusions: Otis may be a feasible, acceptable, and engaging means of delivering CBT to improve anxiety management, quality of life, and personal well-being but might not significantly reduce health anxiety. %M 36150049 %R 10.2196/37877 %U https://formative.jmir.org/2022/10/e37877 %U https://doi.org/10.2196/37877 %U http://www.ncbi.nlm.nih.gov/pubmed/36150049 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 10 %P e41395 %T The Potential Role of an Adjunctive Real-Time Locating System in Preventing Secondary Transmission of SARS-CoV-2 in a Hospital Environment: Retrospective Case-Control Study %A Kim,Min Hyung %A Ryu,Un Hyoung %A Heo,Seok-Jae %A Kim,Yong Chan %A Park,Yoon Soo %+ Division of Infectious Diseases, Department of Internal Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Dongbaekjukjeon-daero, Giheung-gu, Yongin-si, 16995, Republic of Korea, 82 10 8502 5825, ysparkok2@yuhs.ac %K real-time locating system %K COVID-19 %K contact tracing %K secondary transmission %K SARS-CoV-2 %D 2022 %7 18.10.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: There has been an increasing demand for new technologies regarding infection control in hospital settings to reduce the burden of contact tracing. Objective: This study aimed to compare the validity of a real-time locating system (RTLS) with that of the conventional contact tracing method for identifying high-risk contact cases associated with the secondary transmission of SARS-CoV-2. Methods: A retrospective case-control study involving in-hospital contact cases of confirmed COVID-19 patients, who were diagnosed from January 23 to March 25, 2022, was conducted at a university hospital in South Korea. Contact cases were identified using either the conventional method or the RTLS. The primary endpoint of this study was secondary transmission of SARS-CoV-2 among contact cases. Univariate and multivariable logistic regression analysis comparing test positive and versus negative contact cases were performed. Results: Overall, 509 and 653 cases were confirmed by the conventional method and the RTLS, respectively. Only 74 contact cases were identified by both methods, which could be attributed to the limitations of each method. Sensitivity was higher for the RTLS tracing method (653/1088, 60.0%) than the conventional tracing method (509/1088, 46.8%) considering all contact cases identified by both methods. The secondary transmission rate in the RTLS model was 8.1%, while that in the conventional model was 5.3%. The multivariable logistic regression model revealed that the RTLS was more capable of detecting secondary transmission than the conventional method (adjusted odds ratio 6.15, 95% CI 1.92-28.69; P=.007). Conclusions: This study showed that the RTLS is beneficial when used as an adjunctive approach to the conventional method for contact tracing associated with secondary transmission. However, the RTLS cannot completely replace traditional contact tracing. %M 36197844 %R 10.2196/41395 %U https://www.jmir.org/2022/10/e41395 %U https://doi.org/10.2196/41395 %U http://www.ncbi.nlm.nih.gov/pubmed/36197844 %0 Journal Article %@ 2562-0959 %I JMIR Publications %V 5 %N 4 %P e39952 %T The Evolution of Live Patient Viewing in the Era of COVID-19: Survey Study %A Sally,Rachel %A Shaw,Katharina %A Ho,Roger %+ Ronald O Perelman Department of Dermatology, New York University Grossman School of Medicine, 240 East 38th Street, 12th Floor, New York, NY, 10016, United States, 1 212 263 5253, Roger.Ho@nyulangone.org %K COVID-19 pandemic %K live patient viewing %K dermatology education %K dermatology %K COVID-19 %K residency program %K residency %K dermatology residency %K medical education %K virtual education %K didactic %D 2022 %7 18.10.2022 %9 Research Letter %J JMIR Dermatol %G English %X %M 36937784 %R 10.2196/39952 %U https://derma.jmir.org/2022/4/e39952 %U https://doi.org/10.2196/39952 %U http://www.ncbi.nlm.nih.gov/pubmed/36937784 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 10 %P e35426 %T Feasibility of At-Home Serial Testing Using Over-the-Counter SARS-CoV-2 Tests With a Digital Smartphone App for Assistance: Longitudinal Cohort Study %A Herbert,Carly %A Broach,John %A Heetderks,William %A Qashu,Felicia %A Gibson,Laura %A Pretz,Caitlin %A Woods,Kelsey %A Kheterpal,Vik %A Suvarna,Thejas %A Nowak,Christopher %A Lazar,Peter %A Ayturk,Didem %A Barton,Bruce %A Achenbach,Chad %A Murphy,Robert %A McManus,David %A Soni,Apurv %+ Program in Digital Medicine, Department of Medicine, University of Massachusetts Chan Medical School, 55 N Lake Ave, Worcester, MA, 01655, United States, 1 4047180676, carly.herbert@umassmed.edu %K COVID-19 %K SARS-CoV-2 %K rapid tests %K MyDataHelps smartphone app %K mHealth %K mobile health %K serial self-testing %K digital health %K pandemic %K self test %D 2022 %7 18.10.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The ongoing SARS-CoV-2 pandemic necessitates the development of accurate, rapid, and affordable diagnostics to help curb disease transmission, morbidity, and mortality. Rapid antigen tests are important tools for scaling up testing for SARS-CoV-2; however, little is known about individuals’ use of rapid antigen tests at home and how to facilitate the user experience. Objective: This study aimed to describe the feasibility and acceptability of serial self-testing with rapid antigen tests for SARS-CoV-2, including need for assistance and the reliability of self-interpretation. Methods: A total of 206 adults in the United States with smartphones were enrolled in this single-arm feasibility study in February and March 2021. All participants were asked to self-test for COVID-19 at home using rapid antigen tests daily for 14 days and use a smartphone app for testing assistance and to report their results. The main outcomes were adherence to the testing schedule, the acceptability of testing and smartphone app experiences, and the reliability of participants versus study team’s interpretation of test results. Descriptive statistics were used to report the acceptability, adherence, overall rating, and experience of using the at-home test and MyDataHelps app. The usability, acceptability, adherence, and quality of at-home testing were analyzed across different sociodemographic, age, and educational attainment groups. Results: Of the 206 enrolled participants, 189 (91.7%) and 159 (77.2%) completed testing and follow-up surveys, respectively. In total, 51.3% (97/189) of study participants were women, the average age was 40.7 years, 34.4% (65/189) were non-White, and 82% (155/189) had a bachelor’s degree or higher. Most (n=133/206, 64.6%) participants showed high testing adherence, meaning they completed over 75% of the assigned tests. Participants’ interpretations of test results demonstrated high agreement (2106/2130, 98.9%) with the study verified results, with a κ score of 0.29 (P<.001). Participants reported high satisfaction with self-testing and the smartphone app, with 98.7% (157/159) reporting that they would recommend the self-test and smartphone app to others. These results were consistent across age, race/ethnicity, and gender. Conclusions: Participants’ high adherence to the recommended testing schedule, significant reliability between participants and study staff’s test interpretation, and the acceptability of the smartphone app and self-test indicate that self-tests for SARS-CoV-2 with a smartphone app for assistance and reporting is a highly feasible testing modality among a diverse population of adults in the United States. %M 36041004 %R 10.2196/35426 %U https://formative.jmir.org/2022/10/e35426 %U https://doi.org/10.2196/35426 %U http://www.ncbi.nlm.nih.gov/pubmed/36041004 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 10 %P e40408 %T Fine-tuned Sentiment Analysis of COVID-19 Vaccine–Related Social Media Data: Comparative Study %A Melton,Chad A %A White,Brianna M %A Davis,Robert L %A Bednarczyk,Robert A %A Shaban-Nejad,Arash %+ Center for Biomedical Informatics, Department of Pediatrics, College of Medicine, University of Tennessee Health Science Center, 50 N Dunlap Street, 492R, Memphis, TN, 38103, United States, 1 9012875836, ashabann@uthsc.edu %K sentiment analysis %K DistilRoBERTa %K natural language processing %K social media %K Twitter %K Reddit %K COVID-19 %K vaccination %K vaccine %K content analysis %K public health %K surveillance %K misinformation %K infodemiology %K information quality %D 2022 %7 17.10.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: The emergence of the novel coronavirus (COVID-19) and the necessary separation of populations have led to an unprecedented number of new social media users seeking information related to the pandemic. Currently, with an estimated 4.5 billion users worldwide, social media data offer an opportunity for near real-time analysis of large bodies of text related to disease outbreaks and vaccination. These analyses can be used by officials to develop appropriate public health messaging, digital interventions, educational materials, and policies. Objective: Our study investigated and compared public sentiment related to COVID-19 vaccines expressed on 2 popular social media platforms—Reddit and Twitter—harvested from January 1, 2020, to March 1, 2022. Methods: To accomplish this task, we created a fine-tuned DistilRoBERTa model to predict the sentiments of approximately 9.5 million tweets and 70 thousand Reddit comments. To fine-tune our model, our team manually labeled the sentiment of 3600 tweets and then augmented our data set through back-translation. Text sentiment for each social media platform was then classified with our fine-tuned model using Python programming language and the Hugging Face sentiment analysis pipeline. Results: Our results determined that the average sentiment expressed on Twitter was more negative (5,215,830/9,518,270, 54.8%) than positive, and the sentiment expressed on Reddit was more positive (42,316/67,962, 62.3%) than negative. Although the average sentiment was found to vary between these social media platforms, both platforms displayed similar behavior related to the sentiment shared at key vaccine-related developments during the pandemic. Conclusions: Considering this similar trend in shared sentiment demonstrated across social media platforms, Twitter and Reddit continue to be valuable data sources that public health officials can use to strengthen vaccine confidence and combat misinformation. As the spread of misinformation poses a range of psychological and psychosocial risks (anxiety and fear, etc), there is an urgency in understanding the public perspective and attitude toward shared falsities. Comprehensive educational delivery systems tailored to a population’s expressed sentiments that facilitate digital literacy, health information–seeking behavior, and precision health promotion could aid in clarifying such misinformation. %M 36174192 %R 10.2196/40408 %U https://www.jmir.org/2022/10/e40408 %U https://doi.org/10.2196/40408 %U http://www.ncbi.nlm.nih.gov/pubmed/36174192 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 10 %P e38949 %T Empowering Health Care Workers on Social Media to Bolster Trust in Science and Vaccination During the Pandemic: Making IMPACT Using a Place-Based Approach %A Jain,Shikha %A Dhaon,Serena R %A Majmudar,Shivani %A Zimmermann,Laura J %A Mordell,Lisa %A Walker,Garth %A Wallia,Amisha %A Akbarnia,Halleh %A Khan,Ali %A Bloomgarden,Eve %A Arora,Vineet M %+ Department of Medicine, University of Illinois at Chicago, 1740 W Taylor St, Chicago, IL, 60612, United States, 1 773 960 2567, sjain03@gmail.com %K misinformation %K COVID-19 %K place-based %K infodemic %K infographic %K social media %K advocacy %K infodemiology %K vaccination %K health care worker %K policy maker %K health policy %K community health %D 2022 %7 17.10.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Given the widespread and concerted efforts to propagate health misinformation on social media, particularly centered around vaccination during the pandemic, many groups of clinicians and scientists were organized on social media to tackle misinformation and promote vaccination, using a national or international lens. Although documenting the impact of such social media efforts, particularly at the community level, can be challenging, a more hyperlocal or “place-based approach” for social media campaigns could be effective in tackling misinformation and improving public health outcomes at a community level. Objective: We aimed to describe and document the effectiveness of a place-based strategy for a coordinated group of Chicago health care workers on social media to tackle misinformation and improve vaccination rates in the communities they serve. Methods: The Illinois Medical Professionals Action Collaborative Team (IMPACT) was founded in March 2020 in response to the COVID-19 pandemic, with representatives from major academic teaching hospitals in Chicago (eg, University of Chicago, Northwestern University, University of Illinois, and Rush University) and community-based organizations. Through crowdsourcing on multiple social media platforms (eg, Facebook, Twitter, and Instagram) with a place-based approach, IMPACT engaged grassroots networks of thousands of Illinois health care workers and the public to identify gaps, needs, and viewpoints to improve local health care delivery during the pandemic. Results: To address vaccine misinformation, IMPACT created 8 “myth debunking” infographics and a “vaccine information series” of 14 infographics that have generated >340,000 impressions and informed the development of vaccine education for the Chicago Public Libraries. IMPACT delivered 13 policy letters focusing on different topics, such as health care worker personal protective equipment, universal masking, and vaccination, with >4000 health care workers signatures collected through social media and delivered to policy makers; it published over 50 op-eds on COVID-19 topics in high-impact news outlets and contributed to >200 local and national news features. Using the crowdsourcing approach on IMPACT social media channels, IMPACT mobilized health care and lay volunteers to staff >400 vaccine events for >120,000 individuals, many in Chicago’s hardest-hit neighborhoods. The group’s recommendations have influenced public health awareness campaigns and initiatives, as well as research, advocacy, and policy recommendations, and they have been recognized with local and national awards. Conclusions: A coordinated group of health care workers on social media, using a hyperlocal place-based approach, can not only work together to address misinformation but also collaborate to boost vaccination rates in their surrounding communities. %M 35917489 %R 10.2196/38949 %U https://www.jmir.org/2022/10/e38949 %U https://doi.org/10.2196/38949 %U http://www.ncbi.nlm.nih.gov/pubmed/35917489 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 8 %N 4 %P e39023 %T Health Literacy in Health Professionals Two Years into the COVID-19 Pandemic: Results From a Scoping Review %A Grepmeier,Eva-Maria %A Pawellek,Maja %A Curbach,Janina %A Sommoggy,Julia von %A Drewitz,Karl Philipp %A Hasenpusch,Claudia %A Bitzer,Eva Maria %A Apfelbacher,Christian %A Matterne,Uwe %+ Institute of Social Medicine and Health Systems Research, Otto von Guericke University Magdeburg, Leipziger Str 44, Magdeburg, 39120, Germany, 49 39124300, eva-maria.grepmeier@med.ovgu.de %K SARS-CoV-2 %K COVID-19 %K health competence %K COVID-19–related health literacy %K health care worker %D 2022 %7 17.10.2022 %9 Review %J JMIR Med Educ %G English %X Background: Health literacy (HL) is an important public health goal but also crucial in individuals providing medical care. During the pandemic, COVID-19–related HL of health professionals (HPs) has gained momentum; it helps to minimize the risk of self-infection, on the one hand, and to protect patients and relatives from infection, on the other. However, comprehensive information about the levels of individual pandemic-related HL in HPs is scarce. Objective: In this paper, we aimed at describing the extent of existing research on HL (concept) conducted in HPs (population) in the COVID-19 pandemic (context). The review intends to map the literature on HL in HPs, thereby highlighting research gaps. Methods: This scoping review was conducted using the methodology of Khalil et al (2016). This involved an electronic search of PubMed (MEDLINE) and PsycInfo and a hand search. The included studies were iteratively examined to find items representing the four HL dimensions of access, understand, critically appraise, and apply COVID-19–related health information. Results: The search yielded a total of 3875 references. Only 7 (1.4%) of the 489 included studies explicitly stated to have addressed HL; 2 (0.4%) studies attempted to develop an instrument measuring COVID-19–related HL in HPs; 6 (1.2%) studies included an HL measure in an observational survey design. Of the remainder, the vast majority used a cross-sectional design. The dimensions access and understand were frequently examined, but few studies looked at the dimensions critical appraisal or apply. Very few studies reported an intervention aiming to improve a COVID-19–related HL outcome. Conclusions: High levels of COVID-19–related HL among HPs are necessary to ensure not only safe practice with necessary protection of HPs, their patients, and relatives, but also successful care delivery and subsequently improved health outcomes in the long term. To advance our understanding of how high COVID-19–related HL manifests itself in HPs, how it relates to health outcomes, and how it can be improved, more research is necessary. Trial Registration: Open Science Framework dbfa5; https://osf.io/dbfa5/ %M 36179148 %R 10.2196/39023 %U https://mededu.jmir.org/2022/4/e39023 %U https://doi.org/10.2196/39023 %U http://www.ncbi.nlm.nih.gov/pubmed/36179148 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 9 %N 4 %P e36842 %T Telehealth and Remote Interventions for Children With Cerebral Palsy: Scoping Review %A Pagaki-Skaliora,Marina %A Morrow,Eileen %A Theologis,Tim %+ Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Botnar Centre, Windmill Road, Oxford, OX3 7LE, United Kingdom, 44 1865227607, eileen.morrow@ouh.nhs.uk %K cerebral palsy %K CP %K assistive technology %K scoping review %K software %K application %K telehealth %K telerehabilitation %K rehabilitation %K COVID-19 %K children %K health intervention %K health care %K digital intervention %D 2022 %7 17.10.2022 %9 Review %J JMIR Rehabil Assist Technol %G English %X Background: Remote treatment, or telehealth, has shown promise for children with cerebral palsy (CP) prior to 2020; however, the beginning of the global COVID-19 pandemic limiting access to hospitals for face-to-face treatments has driven the need for telehealth and led to a surge in its development. Due to the recent developments, there has been limited synthesis of the available evidence of telehealth for children with CP. Objective: This study aimed to analyze and summarize the existing evidence for telehealth interventions for the treatment of children with CP and identify any areas requiring further research. Methods: A scoping review was performed. A systematic search of available literature in MEDLINE and PubMed was performed during July 2021. Inclusion criteria for articles were primary research and systematic reviews that investigated telehealth, included children with CP, were published between 2010-2021, and were written in English. Exclusion criteria were secondary research other than systematic reviews; interventions that did not meet the World Health Organization definition of telehealth; or studies where all participants were aged >18 years, children’s results were not reported separately, or there were no results reported for children with CP. A scoping review was chosen due to the expected heterogeneity of the participants, as well as the expected small sample sizes and inconsistency of measured outcomes; therefore, a narrative reporting of the results was considered appropriate. Results: In all, 5 papers were identified, which included the results of 11 studies—2 of the included articles were systematic reviews, which included the results of 3 studies each. These 6 studies, together with 5 primary research articles, were included in this scoping review. The existing evidence is of low methodological quality, primarily consisting of case series. There is some evidence that the requirements of telehealth differ depending on the children’s developmental stage and functional level. Telehealth is reported to reduce caregiver burden. There is mixed evidence on children’s compliance with telehealth. Overall, the results of telehealth interventions for the treatment of children with CP were positive, indicating either comparable or improved results compared with children receiving usual face-to-face care. Conclusions: The evidence base is lacking in breadth and methodological quality to provide robust clinical recommendations. Most studies investigated hand function only, indicating the limited scope of existing research. However, this review shows that telehealth has demonstrated potential to improve function for children with CP while making health care services more accessible and reducing caregiver burden. Areas requiring further research include telehealth interventions for the lower limb, postural management, and pain control and the barriers to implementing telehealth. %M 36041012 %R 10.2196/36842 %U https://rehab.jmir.org/2022/4/e36842 %U https://doi.org/10.2196/36842 %U http://www.ncbi.nlm.nih.gov/pubmed/36041012 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 10 %P e40215 %T Population Health Metrics During the Early Stages of the COVID-19 Pandemic: Correlative Pilot Study %A Severson,Marie A %A Cassada,David A %A Huber,Victor C %A Snow,Daniel D %A McFadden,Lisa M %+ Division of Basic Biomedical Sciences, University of South Dakota, 414 East Clark Street, Vermillion, SD, 57069, United States, 1 605 658 6476, lisa.mcfadden@usd.edu %K COVID-19 %K ethyl glucuronide %K wastewater %K stress %K helpline %D 2022 %7 17.10.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: COVID-19 has caused nearly 1 million deaths in the United States, not to mention job losses, business and school closures, stay-at-home orders, and mask mandates. Many people have suffered increased anxiety and depression since the pandemic began. Not only have mental health symptoms become more prevalent, but alcohol consumption has also increased during this time. Helplines offer important insight into both physical and mental wellness of a population by offering immediate, anonymous, cheap, and accessible resources for health and substance use disorders (SUD) that was unobstructed by many of the mandates of the pandemic. Further, the pandemic also launched the use of wastewater surveillance, which has the potential for tracking not only population infections but also consumption of substances such as alcohol. Objective: This study assessed the feasibility of using multiple public surveillance metrics, such as helpline calls, COVID-19 cases, and alcohol metabolites in wastewater, to better understand the need for interventions or public health programs in the time of a public health emergency. Methods: Ethanol metabolites were analyzed from wastewater collected twice weekly from September 29 to December 4, 2020, in a Midwestern state. Calls made to the helpline regarding housing, health care, and mental health/SUD were correlated with ethanol metabolites analyzed from wastewater samples, as well as the number of COVID-19 cases during the sampling period. Results: Correlations were observed between COVID-19 cases and helpline calls regarding housing and health care needs. No correlation was observed between the number of COVID-19 cases and mental health/SUD calls. COVID-19 cases on Tuesdays were correlated with the alcohol metabolite ethyl glucuronide (EtG). Finally, EtG levels were negatively associated with mental health/SUD helpline calls. Conclusions: Although helpline calls provided critical services for health care and housing-related concerns early in the pandemic, evidence suggests helpline calls for mental health/SUD-related concerns were unrelated to COVID-19 metrics. Instead, COVID metrics were associated with alcohol metabolites in wastewater. Although this research was formative, with continued and expanded monitoring of population metrics, such as helpline usage, COVID-19 metrics, and wastewater, strategies can be implemented to create precision programs to address the needs of the population. %M 36219745 %R 10.2196/40215 %U https://formative.jmir.org/2022/10/e40215 %U https://doi.org/10.2196/40215 %U http://www.ncbi.nlm.nih.gov/pubmed/36219745 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 10 %P e41012 %T Understanding the Influence of Web-Based Information, Misinformation, Disinformation, and Reinformation on COVID-19 Vaccine Acceptance: Protocol for a Multicomponent Study %A Dubé,Eve %A MacDonald,Shannon E %A Manca,Terra %A Bettinger,Julie A %A Driedger,S Michelle %A Graham,Janice %A Greyson,Devon %A MacDonald,Noni E %A Meyer,Samantha %A Roch,Geneviève %A Vivion,Maryline %A Aylsworth,Laura %A Witteman,Holly O %A Gélinas-Gascon,Félix %A Marques Sathler Guimaraes,Lucas %A Hakim,Hina %A Gagnon,Dominique %A Béchard,Benoît %A Gramaccia,Julie A %A Khoury,Richard %A Tremblay,Sébastien %+ Department of Anthropology, Laval University, Pavillon Charles-De Koninck, 1030 Avenue des Sciences humaines, Quebec, QC, G1V0A6, Canada, 1 418 650 2131 ext 404062, eve.dube.ant@ulaval.ca %K vaccine hesitancy %K COVID-19 %K misinformation %K vaccine decisions %K disinformation %K online %K vaccine %K vaccination %D 2022 %7 17.10.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: The COVID-19 pandemic has generated an explosion in the amount of information shared on the internet, including false and misleading information on SARS-CoV-2 and recommended protective behaviors. Prior to the pandemic, web-based misinformation and disinformation were already identified as having an impact on people’s decision to refuse or delay recommended vaccination for themselves or their children. Objective: The overall aims of our study are to better understand the influence of web-based misinformation and disinformation on COVID-19 vaccine decisions and investigate potential solutions to reduce the impact of web-based misinformation and disinformation about vaccines. Methods: Based on different research approaches, the study will involve (1) the use of artificial intelligence techniques, (2) a web-based survey, (3) interviews, and (4) a scoping review and an environmental scan of the literature. Results: As of September 1, 2022, data collection has been completed for all objectives. The analysis is being conducted, and results should be disseminated in the upcoming months. Conclusions: The findings from this study will help with understanding the underlying determinants of vaccine hesitancy among Canadian individuals and identifying effective, tailored interventions to improve vaccine acceptance among them. International Registered Report Identifier (IRRID): DERR1-10.2196/41012 %M 36191171 %R 10.2196/41012 %U https://www.researchprotocols.org/2022/10/e41012 %U https://doi.org/10.2196/41012 %U http://www.ncbi.nlm.nih.gov/pubmed/36191171 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 10 %P e40381 %T The National and Global Impact of Systemic and Structural Violence on the Effective Prevention, Treatment, and Management of COVID-19 in African or Black Communities: Protocol for a Scoping Review %A Timothy,Roberta %A Chin-see,Robert Ainsley %A Martyniuk,Julia %A Djiadeu,Pascal %+ Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON, M5T 3M7, Canada, 1 4168840138, roberta.timothy@utoronto.ca %K African %K Black people %K COVID-19 %K systemic and structural barriers %K health disparities %K minority health %K racism %K racial health inequity %K structural violence %K anti-Black racism %K decolonizing %K resistance %K social justice %D 2022 %7 17.10.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: As COVID-19 ravages the globe and cases increase rapidly, countries are presented with challenging policy choices to contain and mitigate its spread. In Canada and globally, the COVID-19 pandemic has added a new stratum to the debate concerning the root causes of global and racial health inequities and disparities. Individuals who exist as targets of systemic inequities are not only more susceptible to contracting COVID-19, but also more likely to bear the greatest social, economic, and physical burdens. Therefore, data collection that focuses on the impact of COVID-19 on the lives and health of African/Black communities worldwide is needed to develop intersectional, culturally relative, antiracist/antioppression, and empowerment-centered interventions and social policies for supporting affected communities. Objective: The primary objective of this review is to investigate the impact and management of COVID-19 among African/Black individuals and communities, and understand how anti-Black racism and intersectional violence impact the health of African/Black communities during the pandemic. Moreover, the study aims to explore research pertaining to the impact of COVID-19 on Black communities in the global context. We seek to determine how Black communities are impacted with regard to structural violence, systematic racism, and health outcomes, and the ways in which attempts have been made to mitigate or manage the consequences of the pandemic and other injurious agents. Methods: A systematic search of quantitative and qualitative studies published on COVID-19 will be conducted in MEDLINE (Ovid), Embase (Ovid), Cumulative Index to Nursing and Allied Health Literature (EBSCO), Cochrane Library, PsychInfo (Ovid), CAB Abstracts (Ovid), Scopus (Elsevier), Web of Science (Clarivate), and Global Index Medicus. To be included in the review, studies should present data on COVID-19 in relation to African/Black individuals, populations, and communities in the global sphere. Studies must discuss racism, oppression, antioppression, or systemic and structural violence and be published in English, French, Spanish, or Portuguese. According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines, the findings will be synthesized quantitatively and qualitatively through thematic analysis. The risk of bias will not be assessed. Results: Title, abstract, and full-text screening concluded in June 2022. Data collection is in progress and is expected to be completed by December 2022. Data analysis and drafting of the manuscript will be done thereafter. Findings from the scoping review are expected to be provided for peer review in 2023. Conclusions: This review will collect important data and evidence related to COVID-19 in African/Black communities. The findings could help identify existing gaps in COVID-19 management in African/Black communities and inform future research paradigms. Furthermore, the findings could be applied to decision-making for health policy and promotion, and could potentially influence services provided by health care facilities and community organizations around the globe. International Registered Report Identifier (IRRID): DERR1-10.2196/40381 %M 36219749 %R 10.2196/40381 %U https://www.researchprotocols.org/2022/10/e40381 %U https://doi.org/10.2196/40381 %U http://www.ncbi.nlm.nih.gov/pubmed/36219749 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 10 %P e40558 %T Understanding Trust and Changes in Use After a Year With the NHS COVID-19 Contact Tracing App in the United Kingdom: Longitudinal Mixed Methods Study %A Pepper,Cecily %A Reyes-Cruz,Gisela %A Pena,Ana Rita %A Dowthwaite,Liz %A Babbage,Camilla M %A Wagner,Hanne %A Nichele,Elena %A Fischer,Joel E %+ Horizon Centre for Doctoral Training, School of Computer Science, University of Nottingham, Triumph Road, Nottingham, NG8 1AW, United Kingdom, 44 1158232316, cecily.pepper@nottingham.ac.uk %K COVID-19 %K tracing app %K digital contact tracing %K trust %K public health %K technology adoption %K compliance %K longitudinal %K mixed methods %K thematic analysis %K mobile phone %D 2022 %7 14.10.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Digital contact tracing (DCT) apps have been implemented as a response to the COVID-19 pandemic. Research has focused on understanding acceptance and adoption of these apps, but more work is needed to understand the factors that may contribute to their sustained use. This is key to public health because DCT apps require a high uptake rate to decrease the transmission of the virus within the general population. Objective: This study aimed to understand changes in the use of the National Health Service Test & Trace (T&T) COVID-19 DCT app and explore how public trust in the app evolved over a 1-year period. Methods: We conducted a longitudinal mixed methods study consisting of a digital survey in December 2020 followed by another digital survey and interview in November 2021, in which responses from 9 participants were explored in detail. Thematic analysis was used to analyze the interview transcripts. This paper focuses on the thematic analysis to unpack the reasoning behind participants’ answers. Results: In this paper, 5 themes generated through thematic analysis are discussed: flaws in the T&T app, usefulness and functionality affecting trust in the app, low trust in the UK government, varying degrees of trust in other stakeholders, and public consciousness and compliance dropping over time. Mistrust evolved from participants experiencing sociotechnical flaws in the app and led to concerns about the app’s usefulness. Similarly, mistrust in the government was linked to perceived poor pandemic handling and the creation and procurement of the app. However, more variability in trust in other stakeholders was highlighted depending on perceived competence and intentions. For example, Big Tech companies (ie, Apple and Google), large hospitality venues, and private contractors were seen as more capable, but participants mistrust their intentions, and small hospitality venues, local councils, and the National Health Service (ie, public health system) were seen as well-intentioned but there is mistrust in their ability to handle pandemic matters. Participants reported complying, or not, with T&T and pandemic guidance to different degrees but, overall, observed a drop in compliance over time. Conclusions: These findings contribute to the wider implications of changes in DCT app use over time for public health. Findings suggest that trust in the wider T&T app ecosystem could be linked to changes in the use of the app; however, further empirical and theoretical work needs to be done to generalize the results because of the small, homogeneous sample. Initial novelty effects occurred with the app, which lessened over time as public concern and media representation of the pandemic decreased and normalization occurred. Trust in the sociotechnical capabilities of the app, stakeholders involved, and salience maintenance of the T&T app in conjunction with other measures are needed for sustained use. %M 36112732 %R 10.2196/40558 %U https://www.jmir.org/2022/10/e40558 %U https://doi.org/10.2196/40558 %U http://www.ncbi.nlm.nih.gov/pubmed/36112732 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 10 %P e37939 %T Teaching Telepsychiatry Skills: Building on the Lessons of the COVID-19 Pandemic to Enhance Mental Health Care in the Future %A Smith,Katharine %A Torous,John %A Cipriani,Andrea %+ Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, United Kingdom, 44 01865618200, andrea.cipriani@psych.ox.ac.uk %K mHealth %K mental health %K smartphones %K telehealth %K telepsychiatry %K COVID-19 %D 2022 %7 14.10.2022 %9 Editorial %J JMIR Ment Health %G English %X COVID-19 has accelerated the use of telehealth and technology in mental health care, creating new avenues to increase both access to and quality of care. As video visits and synchronous telehealth become more routine, the field is now on the verge of embracing asynchronous telehealth, with the potential to radically transform mental health. However, sustaining the use of basic synchronous telehealth, let alone embracing asynchronous telehealth, requires new and immediate effort. Programs to increase digital literacy and competencies among both clinicians and patients are now critical to ensure all parties have the knowledge, confidence, and ability to equitably benefit from emerging innovations. This editorial outlines the immediate potential as well as concrete steps toward realizing the potential of a new, more personalized, scalable mental health system. %M 35358948 %R 10.2196/37939 %U https://mental.jmir.org/2022/10/e37939 %U https://doi.org/10.2196/37939 %U http://www.ncbi.nlm.nih.gov/pubmed/35358948 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 5 %N 4 %P e41356 %T Women’s Satisfaction With Telehealth Services During The COVID-19 Pandemic: Cross-sectional Survey Study %A Mittone,Diletta F %A Bailey,Caitlin P %A Eddy,Ebony L %A Napolitano,Melissa A %A Vyas,Amita %+ Department of Prevention and Community Health, Milken Institute School of Public Health, The George Washington University, 950 New Hampshire Ave NW, Washington, DC, DC, 20052, United States, 1 202 994 3695, avyas@gwu.edu %K telehealth %K COVID-19 %K maternal-child health %K Perinatal %K pediatrics %K telemedicine %K pregnancy %K women's health %K patient outcome %D 2022 %7 14.10.2022 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Since March 2020, the need to reduce patients’ exposure to COVID-19 has resulted in a large-scale pivot to telehealth service delivery. Although studies report that pregnant women have been generally satisfied with their prenatal telehealth experiences during the pandemic, less is known about telehealth satisfaction among postpartum women. Objective: This study examined telehealth satisfaction among both pregnant and recently pregnant women during the COVID-19 pandemic, to determine whether demographic factors (ie, race, age, marital status, education level, household income, and employment status) are associated with telehealth satisfaction in this population. Methods: A web-based cross-sectional survey designed to capture data on health-related behaviors and health care experiences of pregnant and recently pregnant women in the United States was disseminated in Spring 2022. Eligible participants were at least 18 years old, identified as a woman, and were currently pregnant or had been pregnant in the last 3 years. Results: In the final analytic sample of N=403, the mean telehealth satisfaction score was 3.97 (SD 0.66; score range 1-5). In adjusted linear regression models, being aged 35-44 years (vs 18-24 years), having an annual income of ≥ US $100,000 (vs < US $50,000), and being recently (vs currently) pregnant were associated with greater telehealth satisfaction (P≤.049). Conclusions: Although perinatal women are generally satisfied with telehealth, disparities exist. Specifically, being aged 18-24 years, having an annual income of < US $50,000, and being currently pregnant were associated with lower telehealth satisfaction. It is critical that public health policies or programs consider these factors, especially if the expanded use of telehealth is to persist beyond the pandemic. %M 36125862 %R 10.2196/41356 %U https://pediatrics.jmir.org/2022/4/e41356 %U https://doi.org/10.2196/41356 %U http://www.ncbi.nlm.nih.gov/pubmed/36125862 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 10 %P e37642 %T COVID-Washing in US Food and Beverage Marketing on Twitter: Content Analysis %A Tsai,Krystle A %A Cassidy,Omni %A Arshonsky,Josh %A Bond,Sara %A Del Giudice,Inés M %A Bragg,Marie A %+ Department of Population Health, New York University Grossman School of Medicine, 180 Madison Ave, 3rd Fl, New York City, NY, 10016, United States, 1 646 501 2717, marie.bragg@nyulangone.org %K COVID-19 %K food and beverage marketing %K Twitter %K obesity %K social media %K nutrition %K Twitter %K risk factor %K health advertising %K marketing %D 2022 %7 14.10.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Food companies have increased digital and social media ad expenditures during the COVID-19 pandemic, capitalizing on the coinciding increase in social media use during the pandemic. The extent of pandemic-related social media advertising and marketing tactics have been previously reported. No studies, however, have evaluated how food and beverage companies used COVID-washing on social media posts in the United States or analyzed the nutritional content of advertised food and beverage products. This study was designed to address these gaps by evaluating how food and beverage companies capitalize on the COVID-19 pandemic to promote unhealthy foods and sugary beverages. Objective: We aimed to document the types and frequencies of COVID-19–related themes in US food and beverage companies’ Twitter posts during the first wave of the pandemic in the United States, and assess the nutritional quality of food and beverage products featured in these tweets. Methods: Research assistants visited the Twitter accounts of the most-marketed food and beverage brands, and screen-captured all tweets posted between March 1 and May 31, 2020. Researchers documented the date of the tweet; the number of likes, views, comments, and “retweets”; and the type of food and beverage products. We coded tweets for the following 10 COVID-19 themes: (1) social distancing, staying home, or working remotely; (2) contactless delivery or pick-up; (3) handwashing or sanitizing; (4) masks; (5) safety or protection; (6) staying connected with others; (7) staying active; (8) frontline or essential workers; (9) monetary relief, donations, or unemployment; and (10) pandemic, unprecedented, or difficult times. Researchers calculated the nutrient profile index scores for featured foods and sorted beverages into categories based on sugar content. Results: Our final sample included 874 COVID-19–themed tweets from 52 food and beverage brands. Social distancing themes appeared most frequently (n=367, 42%), followed by pandemic, unprecedented, or difficult times (n=246, 28.2%), and contactless delivery (n=237, 27.1%). The majority of tweets (n=682, 78%) promoted foods and beverages. Among those tweets featuring foods and beverages, 89.6% (n=611) promoted unhealthy products, whereas 17.2% (n=117) promoted healthy products. Conclusions: Our findings point to a concerning marketing tactic in which major food and beverage companies promote unhealthy foods and sugary beverages during the COVID-19 pandemic. Given that nutrition-related diseases such as obesity and diabetes are risk factors for COVID-19 morbidity and mortality, food and beverage companies should reduce the promotion of unhealthy products to help decrease the prevalence of health conditions that place people at higher risk for severe illness and death due to COVID-19. %M 36040957 %R 10.2196/37642 %U https://formative.jmir.org/2022/10/e37642 %U https://doi.org/10.2196/37642 %U http://www.ncbi.nlm.nih.gov/pubmed/36040957 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 10 %P e38661 %T Evidence for Telemedicine’s Ongoing Transformation of Health Care Delivery Since the Onset of COVID-19: Retrospective Observational Study %A Mandal,Soumik %A Wiesenfeld,Batia M %A Mann,Devin %A Lawrence,Katharine %A Chunara,Rumi %A Testa,Paul %A Nov,Oded %+ Department of Population Health, New York University Grossman School of Medicine, New York University, 180 Madison Ave, New York, NY, 10016, United States, 1 6465013442, mandal.soumik@gmail.com %K digital health %K telemedicine %K urgent care %K COVID-19 %K health care delivery %D 2022 %7 14.10.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The surge of telemedicine use during the early stages of the COVID-19 pandemic has been well documented. However, scarce evidence considers the use of telemedicine in the subsequent period. Objective: This study aims to evaluate use patterns of video-based telemedicine visits for ambulatory care and urgent care provision over the course of recurring pandemic waves in 1 large health system in New York City (NYC) and what this means for health care delivery. Methods: Retrospective electronic health record (EHR) data of patients from January 1, 2020, to February 28, 2022, were used to longitudinally track and analyze telemedicine and in-person visit volumes across ambulatory care specialties and urgent care, as well as compare them to a prepandemic baseline (June-November 2019). Diagnosis codes to differentiate suspected COVID-19 visits from non–COVID-19 visits, as well as evaluating COVID-19–based telemedicine use over time, were compared to the total number of COVID-19–positive cases in the same geographic region (city level). The time series data were segmented based on change-point analysis, and variances in visit trends were compared between the segments. Results: The emergence of COVID-19 prompted an early increase in the number of telemedicine visits across the urgent care and ambulatory care settings. This use continued throughout the pandemic at a much higher level than the prepandemic baseline for both COVID-19 and non–COVID-19 suspected visits, despite the fluctuation in COVID-19 cases throughout the pandemic and the resumption of in-person clinical services. The use of telemedicine-based urgent care services for COVID-19 suspected visits showed more variance in response to each pandemic wave, but telemedicine visits for ambulatory care have remained relatively steady after the initial crisis period. During the Omicron wave, the use of all visit types, including in-person activities, decreased. Patients between 25 and 34 years of age were the largest users of telemedicine-based urgent care. Patient satisfaction with telemedicine-based urgent care remained high despite the rapid scaling of services to meet increased demand. Conclusions: The trend of the increased use of telemedicine as a means of health care delivery relative to the pre–COVID-19 baseline has been maintained throughout the later pandemic periods despite fluctuating COVID-19 cases and the resumption of in-person care delivery. Overall satisfaction with telemedicine-based care is also high. The trends in telemedicine use suggest that telemedicine-based health care delivery has become a mainstream and sustained supplement to in-person-based ambulatory care, particularly for younger patients, for both urgent and nonurgent care needs. These findings have implications for the health care delivery system, including practice leaders, insurers, and policymakers. Further investigation is needed to evaluate telemedicine adoption by key demographics, identify ongoing barriers to adoption, and explore the impacts of sustained use of telemedicine on health care outcomes and experience. %M 36103553 %R 10.2196/38661 %U https://formative.jmir.org/2022/10/e38661 %U https://doi.org/10.2196/38661 %U http://www.ncbi.nlm.nih.gov/pubmed/36103553 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 10 %P e41410 %T Digital Peer-Supported Self-Management Intervention Codesigned by People With Long COVID: Mixed Methods Proof-of-Concept Study %A Wright,Hayley %A Turner,Andrew %A Ennis,Stuart %A Percy,Carol %A Loftus,Garry %A Clyne,Wendy %A Matouskova,Gabriela %A Martin,Faith %+ Centre for Intelligent Healthcare, Coventry University, Richard Crossman Building, Jordan Well, Coventry, CV1 5RW, United Kingdom, 44 02477659509, ab7764@coventry.ac.uk %K long COVID %K self-management %K peer support %K digital intervention %K goal setting %K psychological %K physical %K cognitive %K intervention %K United Kingdom %K UK %K efficacy %K COVID-19 %D 2022 %7 14.10.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: There are around 1.3 million people in the United Kingdom with the devastating psychological, physical, and cognitive consequences of long COVID (LC). UK guidelines recommend that LC symptoms be managed pragmatically with holistic support for patients’ biopsychosocial needs, including psychological, emotional, and physical health. Self-management strategies, such as pacing, prioritization, and goal setting, are vital for the self-management of many LC symptoms. Objective: This paper describes the codevelopment and initial testing of a digital intervention combining peer support with positive psychology approaches for self-managing the physical, emotional, psychological, and cognitive challenges associated with LC. The objectives of this study were to (1) codesign an intervention with and for people with LC; (2) test the intervention and study methods; (3) measure changes in participant well-being, self-efficacy, fatigue, and loneliness; and (4) understand the types of self-management goals and strategies used by people with LC. Methods: The study used a pre-post, mixed methods, pragmatic, uncontrolled design. Digital intervention content was codeveloped with a lived-experience group to meet the needs uncovered during the intervention development and logic mapping phase. The resulting 8-week digital intervention, Hope Programme for Long COVID, was attended by 47 participants, who completed pre- and postprogram measures of well-being, self-efficacy, fatigue, and loneliness. Goal-setting data were extracted from the digital platform at the end of the intervention. Results: The recruitment rate (n=47, 83.9%) and follow-up rate (n=28, 59.6%) were encouraging. Positive mental well-being (mean difference 6.5, P<.001) and self-efficacy (mean difference 1.1, P=.009) improved from baseline to postcourse. All goals set by participants mapped onto the 5 goal-oriented domains in the taxonomy of everyday self-management strategies (TEDSS). The most frequent type of goals was related to activity strategies, followed by health behavior and internal strategies. Conclusions: The bespoke self-management intervention, Hope Programme for Long COVID, was well attended, and follow-up was encouraging. The sample characteristics largely mirrored those of the wider UK population with LC. Although not powered to detect statistically significant changes, the preliminary data show improvements in self-efficacy and positive mental well-being. Our next trial (ISRCTN: 11868601) will use a nonrandomized waitlist control design to further examine intervention efficacy. %M 36166651 %R 10.2196/41410 %U https://formative.jmir.org/2022/10/e41410 %U https://doi.org/10.2196/41410 %U http://www.ncbi.nlm.nih.gov/pubmed/36166651 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 10 %P e37704 %T An Artificial Intelligence–Driven Digital Health Solution to Support Clinical Management of Patients With Long COVID-19: Protocol for a Prospective Multicenter Observational Study %A Fuster-Casanovas,Aïna %A Fernandez-Luque,Luis %A Nuñez-Benjumea,Francisco J %A Moreno Conde,Alberto %A Luque-Romero,Luis G %A Bilionis,Ioannis %A Rubio Escudero,Cristina %A Chicchi Giglioli,Irene Alice %A Vidal-Alaball,Josep %+ Adhera Health Inc, 1001 Page Mill Rd Building One, Suite 200, Palo Alto, CA, 94304, United States, 34 656930901, luis@adherahealth.com %K COVID-19 syndrome %K artificial intelligence %K AI %K primary health care %K Postacute COVID-19 syndrome %K COVID-19 %K health system %K health care %K health care resource %K public health policy %K long COVID-19 %K mHealth %K digital health solution %K patient %K clinical information %K clinical decision support %D 2022 %7 14.10.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: COVID-19 pandemic has revealed the weaknesses of most health systems around the world, collapsing them and depleting their available health care resources. Fortunately, the development and enforcement of specific public health policies, such as vaccination, mask wearing, and social distancing, among others, has reduced the prevalence and complications associated with COVID-19 in its acute phase. However, the aftermath of the global pandemic has called for an efficient approach to manage patients with long COVID-19. This is a great opportunity to leverage on innovative digital health solutions to provide exhausted health care systems with the most cost-effective and efficient tools available to support the clinical management of this population. In this context, the SENSING-AI project is focused on the research toward the implementation of an artificial intelligence–driven digital health solution that supports both the adaptive self-management of people living with long COVID-19 and the health care staff in charge of the management and follow-up of this population. Objective: The objective of this protocol is the prospective collection of psychometric and biometric data from 10 patients for training algorithms and prediction models to complement the SENSING-AI cohort. Methods: Publicly available health and lifestyle data registries will be consulted and complemented with a retrospective cohort of anonymized data collected from clinical information of patients diagnosed with long COVID-19. Furthermore, a prospective patient-generated data set will be captured using wearable devices and validated patient-reported outcomes questionnaires to complement the retrospective cohort. Finally, the ‘Findability, Accessibility, Interoperability, and Reuse’ guiding principles for scientific data management and stewardship will be applied to the resulting data set to encourage the continuous process of discovery, evaluation, and reuse of information for the research community at large. Results: The SENSING-AI cohort is expected to be completed during 2022. It is expected that sufficient data will be obtained to generate artificial intelligence models based on behavior change and mental well-being techniques to improve patients’ self-management, while providing useful and timely clinical decision support services to health care professionals based on risk stratification models and early detection of exacerbations. Conclusions: SENSING-AI focuses on obtaining high-quality data of patients with long COVID-19 during their daily life. Supporting these patients is of paramount importance in the current pandemic situation, including supporting their health care professionals in a cost-effective and efficient management of long COVID-19. Trial Registration: Clinicaltrials.gov NCT05204615; https://clinicaltrials.gov/ct2/show/NCT05204615 International Registered Report Identifier (IRRID): DERR1-10.2196/37704 %M 36166648 %R 10.2196/37704 %U https://www.researchprotocols.org/2022/10/e37704 %U https://doi.org/10.2196/37704 %U http://www.ncbi.nlm.nih.gov/pubmed/36166648 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 10 %P e39676 %T Tracking the Impact of COVID-19 and Lockdown Policies on Public Mental Health Using Social Media: Infoveillance Study %A Li,Minghui %A Hua,Yining %A Liao,Yanhui %A Zhou,Li %A Li,Xue %A Wang,Ling %A Yang,Jie %+ Department of Big Data in Health Science School of Public Health, Center of Clinical Big Data and Analytics of The Second Affiliated Hospital, Zhejiang University School of Medicine, 866 Yuhangtang Road, Hangzhou, 310058, China, 86 19157731185, jieynlp@gmail.com %K COVID-19 %K mental health %K social media %K Twitter %K topic model %K health care workers %D 2022 %7 13.10.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic and its corresponding preventive and control measures have increased the mental burden on the public. Understanding and tracking changes in public mental status can facilitate optimizing public mental health intervention and control strategies. Objective: This study aimed to build a social media–based pipeline that tracks public mental changes and use it to understand public mental health status regarding the pandemic. Methods: This study used COVID-19–related tweets posted from February 2020 to April 2022. The tweets were downloaded using unique identifiers through the Twitter application programming interface. We created a lexicon of 4 mental health problems (depression, anxiety, insomnia, and addiction) to identify mental health–related tweets and developed a dictionary for identifying health care workers. We analyzed temporal and geographic distributions of public mental health status during the pandemic and further compared distributions among health care workers versus the general public, supplemented by topic modeling on their underlying foci. Finally, we used interrupted time series analysis to examine the statewide impact of a lockdown policy on public mental health in 12 states. Results: We extracted 4,213,005 tweets related to mental health and COVID-19 from 2,316,817 users. Of these tweets, 2,161,357 (51.3%) were related to “depression,” whereas 1,923,635 (45.66%), 225,205 (5.35%), and 150,006 (3.56%) were related to “anxiety,” “insomnia,” and “addiction,” respectively. Compared to the general public, health care workers had higher risks of all 4 types of problems (all P<.001), and they were more concerned about clinical topics than everyday issues (eg, “students’ pressure,” “panic buying,” and “fuel problems”) than the general public. Finally, the lockdown policy had significant associations with public mental health in 4 out of the 12 states we studied, among which Pennsylvania showed a positive association, whereas Michigan, North Carolina, and Ohio showed the opposite (all P<.05). Conclusions: The impact of COVID-19 and the corresponding control measures on the public’s mental status is dynamic and shows variability among different cohorts regarding disease types, occupations, and regional groups. Health agencies and policy makers should primarily focus on depression (reported by 51.3% of the tweets) and insomnia (which has had an ever-increasing trend since the beginning of the pandemic), especially among health care workers. Our pipeline timely tracks and analyzes public mental health changes, especially when primary studies and large-scale surveys are difficult to conduct. %M 36191167 %R 10.2196/39676 %U https://www.jmir.org/2022/10/e39676 %U https://doi.org/10.2196/39676 %U http://www.ncbi.nlm.nih.gov/pubmed/36191167 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 4 %P e37693 %T Food Delivery Drivers’ Health Literacy Regarding COVID-19 Prevention and Protective Behaviors During the COVID-19 Pandemic: Cross-sectional Survey in Southern Thailand %A Jandee,Kasemsak %A Thanapop,Chamnong %+ Department of Community Public Health, School of Public Health, Walailak University, 222 Thaiburi, Thasala District, Nakhon Sri Thammarat, 80160, Thailand, 66 7 567 6671, kasemsak.ja@wu.ac.th %K health literacy %K health information %K preventive behavior %K COVID-19 %K food delivery %K delivery drivers %D 2022 %7 13.10.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: In 2019, COVID-19 spread worldwide, causing a pandemic that has posed unprecedented challenges and pressure for health systems and economies. Food delivery services have become an important medium for consumer food purchases to limit human-to-human contact. Thus, delivery drivers are at high risk of exposure to COVID-19 infection at work. To the best of our knowledge, no studies have analyzed the dimensions of health literacy (HL) regarding COVID-19 prevention in this population. Objective: This study aims to explore the HL status toward COVID-19 prevention and its associated factors among food delivery drivers in southern Thailand. Methods: Following a cross-sectional survey from July to August 2021, Thai food delivery drivers in the upper-south and lower-south regions of southern Thailand were recruited to participate during the compulsory COVID-19 lockdown. An online structured questionnaire was administered verbally and recorded by the interviewer. Univariate and multivariate linear regressions were used to explore independently associated factors. Results: Of 401 drivers, 291 (72.6%) were men. The median age was 31 years (range 19-64 years). The median number of months working as a driver was 12 months, and the median number of working hours was 9 hours per day. The median number of daily food orders was 20, while the median daily income was Thai baht (THB) 600 (US $15.90). Social media (Facebook and Line) was a common source of health information. The most common information required was about the COVID-19 vaccine, medications, and treatment. Most drivers (285/401, 71.1%) had excellent HL levels regarding COVID-19 prevention. Only the practical application of information was statistically correlated with behavior (r=0.38, P<.001). Drivers in the lower south of Thailand were more likely to have excellent HL than other drivers (β=7.03, P<.001). Those who frequently accessed information through YouTube (β=–2.17, P=.01) and relatives (β=–4.19, P<.001) were less likely to have excellent HL levels. Conclusions: Understanding HL among food delivery drivers would be useful for planning effective interventions that target this population. Conventional health education through social media alone may not be effective at educating people about COVID-19 prevention. Information literacy skills could determine individuals’ HL and drivers’ behaviors. %M 36227652 %R 10.2196/37693 %U https://humanfactors.jmir.org/2022/4/e37693 %U https://doi.org/10.2196/37693 %U http://www.ncbi.nlm.nih.gov/pubmed/36227652 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 4 %P e39102 %T Answering Hospital Caregivers’ Questions at Any Time: Proof-of-Concept Study of an Artificial Intelligence–Based Chatbot in a French Hospital %A Daniel,Thomas %A de Chevigny,Alix %A Champrigaud,Adeline %A Valette,Julie %A Sitbon,Marine %A Jardin,Meryam %A Chevalier,Delphine %A Renet,Sophie %+ Department of Pharmacy, Paris Saint-Joseph Hospital Group, 185 Raymond Losserand Street, Paris, 75014, France, 33 144127191, srenet@ghpsj.fr %K chatbot %K artificial intelligence %K pharmacy %K hospital %K health care %K drugs %K medication %K information quality %K health information %K caregiver %K healthcare staff %K digital health tool %K COVID-19 %K information technology %D 2022 %7 11.10.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Access to accurate information in health care is a key point for caregivers to avoid medication errors, especially with the reorganization of staff and drug circuits during health crises such as the COVID‑19 pandemic. It is, therefore, the role of the hospital pharmacy to answer caregivers’ questions. Some may require the expertise of a pharmacist, some should be answered by pharmacy technicians, but others are simple and redundant, and automated responses may be provided. Objective: We aimed at developing and implementing a chatbot to answer questions from hospital caregivers about drugs and pharmacy organization 24 hours a day and to evaluate this tool. Methods: The ADDIE (Analysis, Design, Development, Implementation, and Evaluation) model was used by a multiprofessional team composed of 3 hospital pharmacists, 2 members of the Innovation and Transformation Department, and the IT service provider. Based on an analysis of the caregivers’ needs about drugs and pharmacy organization, we designed and developed a chatbot. The tool was then evaluated before its implementation into the hospital intranet. Its relevance and conversations with testers were monitored via the IT provider’s back office. Results: Needs analysis with 5 hospital pharmacists and 33 caregivers from 5 health services allowed us to identify 7 themes about drugs and pharmacy organization (such as opening hours and specific prescriptions). After a year of chatbot design and development, the test version obtained good evaluation scores: its speed was rated 8.2 out of 10, usability 8.1 out of 10, and appearance 7.5 out of 10. Testers were generally satisfied (70%) and were hoping for the content to be enhanced. Conclusions: The chatbot seems to be a relevant tool for hospital caregivers, helping them obtain reliable and verified information they need on drugs and pharmacy organization. In the context of significant mobility of nursing staff during the health crisis due to the COVID-19 pandemic, the chatbot could be a suitable tool for transmitting relevant information related to drug circuits or specific procedures. To our knowledge, this is the first time that such a tool has been designed for caregivers. Its development further continued by means of tests conducted with other users such as pharmacy technicians and via the integration of additional data before the implementation on the 2 hospital sites. %M 35930555 %R 10.2196/39102 %U https://humanfactors.jmir.org/2022/4/e39102 %U https://doi.org/10.2196/39102 %U http://www.ncbi.nlm.nih.gov/pubmed/35930555 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 10 %P e37968 %T A Digital Mental Health Intervention (Inuka) for Common Mental Health Disorders in Zimbabwean Adults in Response to the COVID-19 Pandemic: Feasibility and Acceptability Pilot Study %A Dambi,Jermaine %A Norman,Clara %A Doukani,Asmae %A Potgieter,Stephan %A Turner,Jean %A Musesengwa,Rosemary %A Verhey,Ruth %A Chibanda,Dixon %+ Rehabilitation Sciences Unit, Faculty of Medicine and Health Sciences, University of Zimbabwe, Mt Pleasant, Harare, Zimbabwe, 263 773444911, jermainedambi@gmail.com %K acceptability %K COVID-19 %K feasibility %K Friendship Bench %K Inuka %K pilot %K task-shifting %K Zimbabwe %D 2022 %7 7.10.2022 %9 Original Paper %J JMIR Ment Health %G English %X Background: Common mental health disorders (CMDs) are leading causes of disability globally. The ongoing COVID-19 pandemic has further exacerbated the burden of CMDs. COVID-19 containment measures, including lockdowns, have disrupted access to in-person mental health care. It is therefore imperative to explore the utility of digital mental health interventions to bridge the treatment gap. Mobile health technologies are effective tools for increasing access to treatment at a lower cost. This study explores the utility of Inuka, a chat-based app hinged on the Friendship Bench problem-solving therapy intervention. The Inuka app offers double anonymity, and clients can book or cancel a session at their convenience. Inuka services can be accessed either through a mobile app or the web. Objective: We aimed to explore the feasibility of conducting a future clinical trial. Additionally, we evaluated the feasibility, acceptability, appropriateness, scalability, and preliminary effectiveness of Inuka. Methods: Data were collected using concurrent mixed methods. We used a pragmatic quasiexperimental design to compare the feasibility, acceptability, and preliminary clinical effectiveness of Inuka (experimental group) and WhatsApp chat-based counseling (control). Participants received 6 problem-solving therapy sessions delivered by lay counselors. A reduction in CMDs was the primary clinical outcome. The secondary outcomes were health-related quality of life (HRQoL), disability and functioning, and social support. Quantitative outcomes were analyzed using descriptive and bivariate statistics. Finally, we used administrative data and semistructured interviews to gather data on acceptability and feasibility; this was analyzed using thematic analysis. Results: Altogether, 258 participants were screened over 6 months, with 202 assessed for eligibility, and 176 participants were included in the study (recruitment ratio of 29 participants/month). The participants’ mean age was 24.4 (SD 5.3) years, and most participants were female and had tertiary education. The mean daily smartphone usage was 8 (SD 3.5) hours. Eighty-three users signed up and completed at least one session. The average completion rate was 3 out of 4 sessions. Inuka was deemed feasible and acceptable in the local context, with connectivity challenges, app instability, expensive mobile data, and power outages cited as potential barriers to scale up. Generally, there was a decline in CMDs (F2,73=2.63; P=.08), depression (F2,73=7.67; P<.001), and anxiety (F2,73=2.95; P=.06) and a corresponding increase in HRQoL (F2,73=7.287; P<.001) in both groups. Conclusions: Study outcomes showed that it is feasible to run a future large-scale randomized clinical trial (RCT) and lend support to the feasibility and acceptability of Inuka, including evidence of preliminary effectiveness. The app’s double anonymity and structured support were the most salient features. There is a great need for iterative app updates before scaling up. Finally, a large-scale hybrid RCT with a longer follow-up to evaluate the clinical implementation and cost-effectiveness of the app is needed. %M 35960595 %R 10.2196/37968 %U https://mental.jmir.org/2022/10/e37968 %U https://doi.org/10.2196/37968 %U http://www.ncbi.nlm.nih.gov/pubmed/35960595 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 8 %N 4 %P e35310 %T COVID-19 Diagnosis and Risk of Death Among Adults With Cancer in Indiana: Retrospective Cohort Study %A Valvi,Nimish %A Patel,Hetvee %A Bakoyannis,Giorgos %A Haggstrom,David A %A Mohanty,Sanjay %A Dixon,Brian E %+ Richard M. Fairbanks School of Public Health, Indiana University, 1050 Wishard Boulevard, Floors 5 and 6, Indianapolis, IN, 46202-2872, United States, 1 3172783072, bedixon@regenstrief.org %K COVID-19 %K SARS-CoV-2 %K coronavirus %K cancer %K survival %K mortality %K death %K oncology %K cancer experience %K outcome %K electronic health record %K EHR %K patient with cancer %K cancer population %K Kaplan-Meier %K Cox proportional hazards model %K hazard ratio %K risk %D 2022 %7 6.10.2022 %9 Original Paper %J JMIR Cancer %G English %X Background: Prior studies, generally conducted at single centers with small sample sizes, found that individuals with cancer experience more severe outcomes due to COVID-19, caused by SARS-CoV-2 infection. Although early examinations revealed greater risk of severe outcomes for patients with cancer, the magnitude of the increased risk remains unclear. Furthermore, prior studies were not typically performed using population-level data, especially those in the United States. Given robust prevention measures (eg, vaccines) are available for populations, examining the increased risk of patients with cancer due to SARS-CoV-2 infection using robust population-level analyses of electronic medical records is warranted. Objective: The aim of this paper is to evaluate the association between SARS-CoV-2 infection and all-cause mortality among recently diagnosed adults with cancer. Methods: We conducted a retrospective cohort study of newly diagnosed adults with cancer between January 1, 2019, and December 31, 2020, using electronic health records linked to a statewide SARS-CoV-2 testing database. The primary outcome was all-cause mortality. We used the Kaplan-Meier estimator to estimate survival during the COVID-19 period (January 15, 2020, to December 31, 2020). We further modeled SARS-CoV-2 infection as a time-dependent exposure (immortal time bias) in a multivariable Cox proportional hazards model adjusting for clinical and demographic variables to estimate the hazard ratios (HRs) among newly diagnosed adults with cancer. Sensitivity analyses were conducted using the above methods among individuals with cancer-staging information. Results: During the study period, 41,924 adults were identified with newly diagnosed cancer, of which 2894 (6.9%) tested positive for SARS-CoV-2. The population consisted of White (n=32,867, 78.4%), Black (n=2671, 6.4%), Hispanic (n=832, 2.0%), and other (n=5554, 13.2%) racial backgrounds, with both male (n=21,354, 50.9%) and female (n=20,570, 49.1%) individuals. In the COVID-19 period analysis, after adjusting for age, sex, race or ethnicity, comorbidities, cancer type, and region, the risk of death increased by 91% (adjusted HR 1.91; 95% CI 1.76-2.09) compared to the pre–COVID-19 period (January 1, 2019, to January 14, 2020) after adjusting for other covariates. In the adjusted time-dependent analysis, SARS-CoV-2 infection was associated with an increase in all-cause mortality (adjusted HR 6.91; 95% CI 6.06-7.89). Mortality increased 2.5 times among adults aged 65 years and older (adjusted HR 2.74; 95% CI 2.26-3.31) compared to adults 18-44 years old, among male (adjusted HR 1.23; 95% CI 1.14-1.32) compared to female individuals, and those with ≥2 chronic conditions (adjusted HR 2.12; 95% CI 1.94-2.31) compared to those with no comorbidities. Risk of mortality was 9% higher in the rural population (adjusted HR 1.09; 95% CI 1.01-1.18) compared to adult urban residents. Conclusions: The findings highlight increased risk of death is associated with SARS-CoV-2 infection among patients with a recent diagnosis of cancer. Elevated risk underscores the importance of adhering to social distancing, mask adherence, vaccination, and regular testing among the adult cancer population. %M 36201388 %R 10.2196/35310 %U https://cancer.jmir.org/2022/4/e35310 %U https://doi.org/10.2196/35310 %U http://www.ncbi.nlm.nih.gov/pubmed/36201388 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 10 %P e38914 %T Understanding Racial Disparities in COVID-19–Related Complications: Protocol for a Mixed Methods Study %A Harding,Jessica L %A Patel,Shivani A %A Davis,Teaniese %A Patzer,Rachel E %A McDonald,Bennett %A Walker-Williams,Doraina %A Jagannathan,Ram %A Teunis,Larissa %A Gander,Jennifer %+ Department of Surgery, Emory University, 101 Woodruff Circle Suite 1019, Atlanta, GA, 30322, United States, 1 404 824 1483, jessica.harding@emory.edu %K COVID-19 %K social determinants of health %K race %K mixed methods %K equity %K disparity %K health %K pandemic %K disease severity %K mortality %K racial %K ethnicity %K complications %D 2022 %7 6.10.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: In the United States, the COVID-19 pandemic has magnified the disproportionate and long-standing health disparities experienced by Black communities. Although it is acknowledged that social determinants of health (SDOH) rather than biological factors likely contribute to this disparity, few studies using rigorous analytic approaches in large, information-rich community-based data sets are dedicated to understanding the underlying drivers of these racial disparities. Objective: The overall aim of our study is to elucidate the mechanisms by which racial disparities in severe COVID-19 outcomes arise, using both quantitative and qualitative methods. Methods: In this protocol, we outline a convergent parallel mixed methods approach to identifying, quantifying, and contextualizing factors that contribute to the dramatic disparity in COVID-19 severity (ie, hospitalization, mortality) in Black versus white COVID-19 patients within the integrated health care system of Kaiser Permanente Georgia (KPGA). Toward this end, we will generate two quantitative cohorts of KPGA members with a confirmed COVID-19 diagnosis between January 1, 2020, and September 30, 2021: (1) an electronic medical record (EMR) cohort including routinely captured data on diagnoses, medications, and laboratory values, and a subset of patients hospitalized at Emory Healthcare to capture additional in-hospital data; and (2) a survey cohort, where participants will answer a range of questions related to demographics (eg, race, education), usual health behaviors (eg, physical activity, smoking), impact of COVID-19 (eg, job loss, caregiving responsibilities), and medical mistrust. Key outcomes of interest for these two cohorts include hospitalization, mortality, intensive care unit admission, hospital readmission, and long COVID-19. Finally, we will conduct qualitative semistructured interviews to capture perceptions of and experiences of being hospitalized with COVID-19 as well as related interactions with KPGA health care providers. We will analyze and interpret the quantitative and qualitative data separately, and then integrate the qualitative and quantitative findings using a triangulation design approach. Results: This study has been funded by a Woodruff Health Sciences grant from December 2020 to December 2022. As of August 31, 2022, 31,500 KPGA members diagnosed with COVID-19 have been included in the EMR cohort, including 3028 who were hospitalized at Emory Healthcare, and 482 KPGA members completed the survey. In addition, 20 KPGA members (10 Black and 10 white) have been interviewed about their experiences navigating care with COVID-19. Quantitative and qualitative data cleaning and coding have been completed. Data analysis is underway with results anticipated to be published in December 2022. Conclusions: Results from this mixed methods pilot study in a diverse integrated care setting in the southeastern United States will provide insights into the mechanisms underpinning racial disparities in COVID-19 complications. The quantitative and qualitative data will provide important context to generate hypotheses around the mechanisms for racial disparities in COVID-19, and may help to inform the development of multilevel strategies to reduce the burden of racial disparities in COVID-19 and its ongoing sequelae. Incorporating contextual information, elucidated from qualitative interviews, will increase the efficacy, adoption, and sustainability of such strategies. International Registered Report Identifier (IRRID): RR1-10.2196/38914 %M 36166652 %R 10.2196/38914 %U https://www.researchprotocols.org/2022/10/e38914 %U https://doi.org/10.2196/38914 %U http://www.ncbi.nlm.nih.gov/pubmed/36166652 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 10 %P e40323 %T Emotions and Topics Expressed on Twitter During the COVID-19 Pandemic in the United Kingdom: Comparative Geolocation and Text Mining Analysis %A Alhuzali,Hassan %A Zhang,Tianlin %A Ananiadou,Sophia %+ Department of Computer Science, National Centre for Text Mining, The University of Manchester, 131 Princess Street, Manchester, M1 7DN, United Kingdom, 44 161 306 3092, sophia.ananiadou@manchester.ac.uk %K Twitter %K COVID-19 %K geolocation %K emotion detection %K sentiment analysis %K topic modeling %K social media %K natural language processing %K deep learning %D 2022 %7 5.10.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: In recent years, the COVID-19 pandemic has brought great changes to public health, society, and the economy. Social media provide a platform for people to discuss health concerns, living conditions, and policies during the epidemic, allowing policymakers to use this content to analyze the public emotions and attitudes for decision-making. Objective: The aim of this study was to use deep learning–based methods to understand public emotions on topics related to the COVID-19 pandemic in the United Kingdom through a comparative geolocation and text mining analysis on Twitter. Methods: Over 500,000 tweets related to COVID-19 from 48 different cities in the United Kingdom were extracted, with the data covering the period of the last 2 years (from February 2020 to November 2021). We leveraged three advanced deep learning–based models for topic modeling to geospatially analyze the sentiment, emotion, and topics of tweets in the United Kingdom: SenticNet 6 for sentiment analysis, SpanEmo for emotion recognition, and combined topic modeling (CTM). Results: We observed a significant change in the number of tweets as the epidemiological situation and vaccination situation shifted over the 2 years. There was a sharp increase in the number of tweets from January 2020 to February 2020 due to the outbreak of COVID-19 in the United Kingdom. Then, the number of tweets gradually declined as of February 2020. Moreover, with identification of the COVID-19 Omicron variant in the United Kingdom in November 2021, the number of tweets grew again. Our findings reveal people’s attitudes and emotions toward topics related to COVID-19. For sentiment, approximately 60% of tweets were positive, 20% were neutral, and 20% were negative. For emotion, people tended to express highly positive emotions in the beginning of 2020, while expressing highly negative emotions over time toward the end of 2021. The topics also changed during the pandemic. Conclusions: Through large-scale text mining of Twitter, our study found meaningful differences in public emotions and topics regarding the COVID-19 pandemic among different UK cities. Furthermore, efficient location-based and time-based comparative analysis can be used to track people’s thoughts and feelings, and to understand their behaviors. Based on our analysis, positive attitudes were common during the pandemic; optimism and anticipation were the dominant emotions. With the outbreak and epidemiological change, the government developed control measures and vaccination policies, and the topics also shifted over time. Overall, the proportion and expressions of emojis, sentiments, emotions, and topics varied geographically and temporally. Therefore, our approach of exploring public emotions and topics on the pandemic from Twitter can potentially lead to informing how public policies are received in a particular geographical area. %M 36150046 %R 10.2196/40323 %U https://www.jmir.org/2022/10/e40323 %U https://doi.org/10.2196/40323 %U http://www.ncbi.nlm.nih.gov/pubmed/36150046 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 4 %P e35882 %T The Development and Use of Chatbots in Public Health: Scoping Review %A Wilson,Lee %A Marasoiu,Mariana %+ Centre for Policy Futures, University of Queensland, Level 3, Michie Building (9), St Lucia, Queensland, 4072, Australia, 61 0795318198, l.wilson7@uq.edu.au %K chatbots %K conversational agents %K public health %K evidence %K scoping review %K health care system %K chatbot development %K digital health %K mental health %K health technology %K COVID-19 %K pandemic %K chatbot application %D 2022 %7 5.10.2022 %9 Review %J JMIR Hum Factors %G English %X Background: Chatbots are computer programs that present a conversation-like interface through which people can access information and services. The COVID-19 pandemic has driven a substantial increase in the use of chatbots to support and complement traditional health care systems. However, despite the uptake in their use, evidence to support the development and deployment of chatbots in public health remains limited. Recent reviews have focused on the use of chatbots during the COVID-19 pandemic and the use of conversational agents in health care more generally. This paper complements this research and addresses a gap in the literature by assessing the breadth and scope of research evidence for the use of chatbots across the domain of public health. Objective: This scoping review had 3 main objectives: (1) to identify the application domains in public health in which there is the most evidence for the development and use of chatbots; (2) to identify the types of chatbots that are being deployed in these domains; and (3) to ascertain the methods and methodologies by which chatbots are being evaluated in public health applications. This paper explored the implications for future research on the development and deployment of chatbots in public health in light of the analysis of the evidence for their use. Methods: Following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines for scoping reviews, relevant studies were identified through searches conducted in the MEDLINE, PubMed, Scopus, Cochrane Central Register of Controlled Trials, IEEE Xplore, ACM Digital Library, and Open Grey databases from mid-June to August 2021. Studies were included if they used or evaluated chatbots for the purpose of prevention or intervention and for which the evidence showed a demonstrable health impact. Results: Of the 1506 studies identified, 32 were included in the review. The results show a substantial increase in the interest of chatbots in the past few years, shortly before the pandemic. Half (16/32, 50%) of the research evaluated chatbots applied to mental health or COVID-19. The studies suggest promise in the application of chatbots, especially to easily automated and repetitive tasks, but overall, the evidence for the efficacy of chatbots for prevention and intervention across all domains is limited at present. Conclusions: More research is needed to fully understand the effectiveness of using chatbots in public health. Concerns with the clinical, legal, and ethical aspects of the use of chatbots for health care are well founded given the speed with which they have been adopted in practice. Future research on their use should address these concerns through the development of expertise and best practices specific to public health, including a greater focus on user experience. %M 36197708 %R 10.2196/35882 %U https://humanfactors.jmir.org/2022/4/e35882 %U https://doi.org/10.2196/35882 %U http://www.ncbi.nlm.nih.gov/pubmed/36197708 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 10 %P e39063 %T Efficacy, Usability, and Acceptability of a Chatbot for Promoting COVID-19 Vaccination in Unvaccinated or Booster-Hesitant Young Adults: Pre-Post Pilot Study %A Luk,Tzu Tsun %A Lui,Judy Hiu Tung %A Wang,Man Ping %+ School of Nursing, The University of Hong Kong, 3 Sassoon Road, Pokfulam, China (Hong Kong), 852 39176636, mpwang@hku.hk %K COVID-19 %K coronavirus %K vaccine %K immunization %K booster %K vaccine hesitancy %K chatbot %K conversational agent %K virtual assistant %K Chinese %K young adult %K youth %K health promotion %K health intervention %K chatbot usability %K pandemic %K booster hesitancy %K web-based survey %K students %K university students %D 2022 %7 4.10.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: COVID-19 vaccines are highly effective in preventing severe disease and death but are underused. Interventions to address COVID-19 vaccine hesitancy are paramount to reducing the burden of COVID-19. Objective: We aimed to evaluate the preliminary efficacy, usability, and acceptability of a chatbot for promoting COVID-19 vaccination and examine the factors associated with COVID-19 vaccine hesitancy. Methods: In November 2021, we conducted a pre-post pilot study to evaluate “Vac Chat, Fact Check,” a web-based chatbot for promoting COVID-19 vaccination. We conducted a web-based survey (N=290) on COVID-19 vaccination at a university in Hong Kong. A subset of 46 participants who were either unvaccinated (n=22) or were vaccinated but hesitant to receive boosters (n=24) were selected and given access to the chatbot for a 7-day trial period. The chatbot provided information about COVID-19 vaccination (eg, efficacy and common side effects), debunked common myths about the vaccine, and included a decision aid for selecting vaccine platforms (inactivated and mRNA vaccines). The main efficacy outcome was changes in the COVID-19 Vaccine Hesitancy Scale (VHS) score (range 9-45) from preintervention (web-based survey) to postintervention (immediately posttrial). Other efficacy outcomes included changes in intention to vaccinate or receive boosters and willingness to encourage others to vaccinate on a scale from 1 (not at all) to 5 (very). Usability was assessed by the System Usability Scale (range 0-100). Linear regression was used to examine the factors associated with COVID-19 VHS scores in all survey respondents. Results: The mean (SD) age of all survey respondents was 21.4 (6.3) years, and 61% (177/290) of respondents were female. Higher eHealth literacy (B=–0.26; P<.001) and perceived danger of COVID-19 (B=–0.17; P=.009) were associated with lower COVID-19 vaccine hesitancy, adjusting for age, sex, chronic disease status, previous flu vaccination, and perceived susceptibility to COVID-19. The main efficacy outcome of COVID-19 VHS score significantly decreased from 28.6 (preintervention) to 24.5 (postintervention), with a mean difference of –4.2 (P<.001) and an effect size (Cohen d) of 0.94. The intention to vaccinate increased from 3.0 to 3.9 (P<.001) in unvaccinated participants, whereas the intention to receive boosters increased from 1.9 to 2.8 (P<.001) in booster-hesitant participants. Willingness to encourage others to vaccinate increased from 2.7 to 3.0 (P=.04). At postintervention, the median (IQR) System Usability Scale score was 72.5 (65-77.5), whereas the median (IQR) recommendation score was 7 (6-8) on a scale from 0 to 10. In a post hoc 4-month follow-up, 82% (18/22) of initially unvaccinated participants reported having received the COVID-19 vaccine, whereas 29% (7/24) of booster-hesitant participants received boosters. Conclusions: This pilot study provided initial evidence to support the efficacy, usability, and acceptability of a chatbot for promoting COVID-19 vaccination in young adults who were unvaccinated or booster-hesitant. %M 36179132 %R 10.2196/39063 %U https://www.jmir.org/2022/10/e39063 %U https://doi.org/10.2196/39063 %U http://www.ncbi.nlm.nih.gov/pubmed/36179132 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 10 %P e35744 %T Collective Value Promotes the Willingness to Share Provaccination Messages on Social Media in China: Randomized Controlled Trial %A Fu,Chunye %A Lyu,Xiaokang %A Mi,Mingdi %+ Department of Social Psychology, Zhou Enlai School of Government, Nankai University, 38 Tongyan Road, Haihe Education Park, Tianjin, 300350, China, 86 13920214514, luxk@nankai.edu.cn %K individual value %K collective value %K vaccination %K message-sharing willingness %K perceived responsibility %K misinformation %K vaccine misinformation %K public health %K influenza vaccine %K social media %K COVID-19 %D 2022 %7 4.10.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The proliferation of vaccine misinformation on social media has seriously corrupted the public’s confidence in vaccination. Proactively sharing provaccination messages on social media is a cost-effective way to enhance global vaccination rates and resist vaccine misinformation. However, few strategies for encouraging the public to proactively share vaccine-related knowledge on social media have been developed. Objective: This research examines the effect of value type (individual vs collective) and message framing (gain vs loss) on influenza vaccination intention (experiment 1) and the willingness to share provaccination messages (experiment 2) among Chinese adults during the COVID-19 pandemic. The primary aim was to evaluate whether messages that emphasized collective value were more effective in increasing the willingness to share than messages that emphasized individual value. Methods: We enrolled 450 Chinese adults for experiment 1 (n=250, 55.6%) and experiment 2 (n=200, 44.4%). Participants were randomly assigned to individual-gain, individual-loss, collective-gain, or collective-loss conditions with regard to the message in each experiment using the online survey platform’s randomization function. Experiment 1 also included a control group. The primary outcome was influenza vaccination intention in experiment 1 and the willingness to share provaccination messages in experiment 2. Results: The valid sample included 213 adults in experiment 1 (females: n=151, 70.9%; mean age 29 [SD 9] years; at least some college education: n=202, 94.8%; single: n=131, 61.5%) and 171 adults in experiment 2 (females: n=106, 62.0%; mean age 28 [SD 7] years; at least some college education: n=163, 95.3%; single: n=95, 55.6%). Influenza vaccination intention was stronger in the individual-value conditions than in the collective-value conditions (F3,166=4.96, P=.03, η2=0.03). The reverse result was found for the willingness to share provaccination messages (F3,165=6.87, P=.01, η2=0.04). Specifically, participants who received a message emphasizing collective value had a higher intention to share the message than participants who read a message emphasizing individual value (F3,165=6.87, P=.01, η2=0.04), and the perceived responsibility for message sharing played a mediating role (indirect effect=0.23, 95% lower limit confidence interval [LLCI] 0.41, 95% upper limit confidence interval [ULCI] 0.07). In addition, gain framing facilitated influenza vaccination intention more than loss framing (F3,166=5.96, P=.02, η2=0.04). However, experiment 2 did not find that message framing affected message-sharing willingness. Neither experiment found an interaction between value type and message framing. Conclusions: Strengthened individual value rather than collective value is more likely to persuade Chinese adults to vaccinate. However, these adults are more likely to share a message that emphasizes collective rather than individual value, and the perceived responsibility for message sharing plays a mediating role. %M 36067417 %R 10.2196/35744 %U https://formative.jmir.org/2022/10/e35744 %U https://doi.org/10.2196/35744 %U http://www.ncbi.nlm.nih.gov/pubmed/36067417 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 5 %N 4 %P e31579 %T Association of Pregnancy With Coronavirus Cytokine Storm: Systematic Review and Meta-analysis %A Muthuka,John %A Kiptoo,Michael %A Oluoch,Kelly %A Nzioki,Japheth Mativo %A Nyamai,Everlyn Musangi %+ Head Quaters, Kenya Medical Training College, PO Box 30195-00100, Nairobi, Kenya, 254 724274843, johnmuthuka@gmail.com %K COVID-19 %K pandemic %K pregnancy %K maternal health %K cytokine %K cytokine storm %K immune response %K infectious disease %K coronavirus %K respiratory %K virus %K pregnant %D 2022 %7 4.10.2022 %9 Review %J JMIR Pediatr Parent %G English %X Background: COVID-19 was first identified in Wuhan, China, in December 2019, spreading to the rest of the globe, becoming a pandemic. Some studies have shown an association between pregnancy status and severe COVID-19 with a cytokine storm, whereas others have shown contrasting results. Objective: The aim of this study was to examine the relationship between pregnancy status and the clinical COVID-19 severity characterized by the cytokine storm through a systematic review and meta-analysis. Methods: We searched the Google Scholar, PubMed, Scopus, Web of Science, and Embase databases to identify clinical studies suitable for inclusion in this meta-analysis. Studies reporting pregnancy status and comparing the COVID-19 severity cytokine storm outcome were included. COVID-19 severity characterized by a cytokine storm was described using parameters such as intensive care unit admission, invasive mechanical ventilation, mechanical ventilation, hospital admission, pro- and anti-inflammatory cytokine levels, consolidation on chest computed tomography scan, pulmonary infiltration, extreme fevers as characteristic of a cytokine storm, syndromic severity, higher neutrophil count indicative of a cytokine storm, and severe COVID-19 presentation. Results: A total of 17 articles including data for 840,332 women with COVID-19 were included. This meta-analysis revealed a correlation between positive pregnancy status and severe COVID-19 with a cytokine storm (random-effects model odds ratio [OR] 2.47, 95% CI 1.63-3.73; P<.001), with a cumulative incidence of 6432 (14.1%) and 24,352 (3.1%) among pregnant and nonpregnant women with COVID-19, respectively. The fixed-effects model also showed a correlation between pregnancy status and severe COVID-19 with a cytokine storm (OR 7.41, 95% CI 7.02-7.83; P<.001). Considerable heterogeneity was found among all pooled studies (I²=98%, P<.001). Furthermore, the updated analysis showed substantially low heterogeneity (I²=29 %, P=.19), and the funnel plot revealed no publication bias. The subanalysis between single-center and multicenter studies demonstrated similar heterogeneity (I2=72% and 98%, respectively). Sensitivity analysis on each subgroup revealed that pregnancy was significantly related to severe COVID-19 with a cytokine storm from single-center studies (fixed-effects model OR 3.97, 95% CI 2.26-6.95; P<.001) with very low heterogeneity (I²=2%, P=.42). Conclusions: Being pregnant is clearly associated with experiencing a severe course of COVID-19 characterized by a cytokine storm. The COVID-19 pandemic should serve as an impetus for further research on pregnant women diagnosed with COVID-19 to map out the salient risk factors associated with its severity. Trial Registration: PROSPERO CRD42021242011; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=242011. %M 35319475 %R 10.2196/31579 %U https://pediatrics.jmir.org/2022/4/e31579 %U https://doi.org/10.2196/31579 %U http://www.ncbi.nlm.nih.gov/pubmed/35319475 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 10 %P e34927 %T COVID-19 Cases Among Congregate Care Facility Staff by Neighborhood of Residence and Social and Structural Determinants: Observational Study %A Ma,Huiting %A Yiu,Kristy C Y %A Baral,Stefan D %A Fahim,Christine %A Moloney,Gary %A Darvin,Dariya %A Landsman,David %A Chan,Adrienne K %A Straus,Sharon %A Mishra,Sharmistha %+ St Michael's Hospital, Unity Health Toronto, Room 315, 209 Victoria Street, Toronto, ON, M5B 1T8, Canada, 1 416 864 6060 ext 5568, sharmistha.mishra@utoronto.ca %K long-term care %K nursing home %K staff %K essential worker %K retirement home %K shelter %K congregate living %K COVID-19 %K observational %K risk %K transmission %K elderly %K older adults %K retirement %K nurse %K health care worker %K congregate %K trend %K geography %K Canada %K Toronto %D 2022 %7 4.10.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Disproportionate risks of COVID-19 in congregate care facilities including long-term care homes, retirement homes, and shelters both affect and are affected by SARS-CoV-2 infections among facility staff. In cities across Canada, there has been a consistent trend of geographic clustering of COVID-19 cases. However, there is limited information on how COVID-19 among facility staff reflects urban neighborhood disparities, particularly when stratified by the social and structural determinants of community-level transmission. Objective: This study aimed to compare the concentration of cumulative cases by geography and social and structural determinants across 3 mutually exclusive subgroups in the Greater Toronto Area (population: 7.1 million): community, facility staff, and health care workers (HCWs) in other settings. Methods: We conducted a retrospective, observational study using surveillance data on laboratory-confirmed COVID-19 cases (January 23 to December 13, 2020; prior to vaccination rollout). We derived neighborhood-level social and structural determinants from census data and generated Lorenz curves, Gini coefficients, and the Hoover index to visualize and quantify inequalities in cases. Results: The hardest-hit neighborhoods (comprising 20% of the population) accounted for 53.87% (44,937/83,419) of community cases, 48.59% (2356/4849) of facility staff cases, and 42.34% (1669/3942) of other HCW cases. Compared with other HCWs, cases among facility staff reflected the distribution of community cases more closely. Cases among facility staff reflected greater social and structural inequalities (larger Gini coefficients) than those of other HCWs across all determinants. Facility staff cases were also more likely than community cases to be concentrated in lower-income neighborhoods (Gini 0.24, 95% CI 0.15-0.38 vs 0.14, 95% CI 0.08-0.21) with a higher household density (Gini 0.23, 95% CI 0.17-0.29 vs 0.17, 95% CI 0.12-0.22) and with a greater proportion working in other essential services (Gini 0.29, 95% CI 0.21-0.40 vs 0.22, 95% CI 0.17-0.28). Conclusions: COVID-19 cases among facility staff largely reflect neighborhood-level heterogeneity and disparities, even more so than cases among other HCWs. The findings signal the importance of interventions prioritized and tailored to the home geographies of facility staff in addition to workplace measures, including prioritization and reach of vaccination at home (neighborhood level) and at work. %M 35867901 %R 10.2196/34927 %U https://publichealth.jmir.org/2022/10/e34927 %U https://doi.org/10.2196/34927 %U http://www.ncbi.nlm.nih.gov/pubmed/35867901 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 2 %N 2 %P e39504 %T Monitoring Mentions of COVID-19 Vaccine Side Effects on Japanese and Indonesian Twitter: Infodemiological Study %A Ferawati,Kiki %A Liew,Kongmeng %A Aramaki,Eiji %A Wakamiya,Shoko %+ Graduate School of Science and Technology, Nara Institute of Science and Technology, 8916-5, Takayama-cho, Ikoma, 630-0192, Japan, 81 743725250, wakamiya@is.naist.jp %K COVID-19 %K vaccine %K COVID-19 vaccine %K Pfizer %K Moderna %K vaccine side effects %K side effects %K Twitter %K logistic regression %D 2022 %7 4.10.2022 %9 Original Paper %J JMIR Infodemiology %G English %X Background: The year 2021 was marked by vaccinations against COVID-19, which spurred wider discussion among the general population, with some in favor and some against vaccination. Twitter, a popular social media platform, was instrumental in providing information about the COVID-19 vaccine and has been effective in observing public reactions. We focused on tweets from Japan and Indonesia, 2 countries with a large Twitter-using population, where concerns about side effects were consistently stated as a strong reason for vaccine hesitancy. Objective: This study aimed to investigate how Twitter was used to report vaccine-related side effects and to compare the mentions of these side effects from 2 messenger RNA (mRNA) vaccine types developed by Pfizer and Moderna, in Japan and Indonesia. Methods: We obtained tweet data from Twitter using Japanese and Indonesian keywords related to COVID-19 vaccines and their side effects from January 1, 2021, to December 31, 2021. We then removed users with a high frequency of tweets and merged the tweets from multiple users as a single sentence to focus on user-level analysis, resulting in a total of 214,165 users (Japan) and 12,289 users (Indonesia). Then, we filtered the data to select tweets mentioning Pfizer or Moderna only and removed tweets mentioning both. We compared the side effect counts to the public reports released by Pfizer and Moderna. Afterward, logistic regression models were used to compare the side effects for the Pfizer and Moderna vaccines for each country. Results: We observed some differences in the ratio of side effects between the public reports and tweets. Specifically, fever was mentioned much more frequently in tweets than would be expected based on the public reports. We also observed differences in side effects reported between Pfizer and Moderna vaccines from Japan and Indonesia, with more side effects reported for the Pfizer vaccine in Japanese tweets and more side effects with the Moderna vaccine reported in Indonesian tweets. Conclusions: We note the possible consequences of vaccine side effect surveillance on Twitter and information dissemination, in that fever appears to be over-represented. This could be due to fever possibly having a higher severity or measurability, and further implications are discussed. %M 36277140 %R 10.2196/39504 %U https://infodemiology.jmir.org/2022/2/e39504 %U https://doi.org/10.2196/39504 %U http://www.ncbi.nlm.nih.gov/pubmed/36277140 %0 Journal Article %@ 2562-7600 %I JMIR Publications %V 5 %N 1 %P e37631 %T Digital Technologies and the Role of Health Care Professionals: Scoping Review Exploring Nurses’ Skills in the Digital Era and in the Light of the COVID-19 Pandemic %A Isidori,Valentina %A Diamanti,Francesco %A Gios,Lorenzo %A Malfatti,Giulia %A Perini,Francesca %A Nicolini,Andrea %A Longhini,Jessica %A Forti,Stefano %A Fraschini,Federica %A Bizzarri,Giancarlo %A Brancorsini,Stefano %A Gaudino,Alessandro %+ Department of Medicine and Surgery, University of Perugia, Viale Tristano di Joannuccio, Terni, 05100, Italy, 39 3398830048, valeisi97@gmail.com %K role of the nurse in telemedicine %K telenursing %K new technological approaches %K communication and technological skills %K leadership %K nursing training %K nursing %K health care %K digital knowledge %K online health %K digital health %K COVID-19 %K telehealth %K telemedicine %D 2022 %7 4.10.2022 %9 Review %J JMIR Nursing %G English %X Background: The nursing role significantly changed following reforms in the nurse training process. Nowadays, nurses are increasingly trained to promote and improve the quality of clinical practice and to provide support in the assistance of patients and communities. Opportunities and threats are emerging as a consequence of the introduction of new disruptive technologies in public health, which requires the health care staff to develop new digital skills. Objective: The aim of this paper is to review and define the role of nurses and the skills they are asked to master in terms of new methodological approaches and digital knowledge in a continuously evolving health care scenario that relies increasingly more on technology and digital solutions. Methods: This scoping review was conducted using a thematic summary of previous studies. Authors collected publications through a cross-database search (PubMed, Web of Science, Google Scholar) related to new telemedicine approaches impacting the nurses’ role, considering the time span of 2011-2021 and therefore including experiences and publications related to the first phase of the COVID-19 pandemic. Results: The assessment was completed between April and July 2021. After a cross-database search, authors reviewed a selection of 60 studies. The results obtained were organized into 5 emerging macro areas: (1) leadership (nurses are expected to show leadership capabilities when introducing new technologies in health care practices, considering their pivotal role in coordinating various professional figures and the patient), (2) soft skills (new communication skills, adaptiveness, and problem solving are needed to adapt the interaction to the level of digital skills and digital knowledge of the patient), (3) training (specific subjects need to be added to nursing training to boost the adoption of new communication and technological skills, enabling health care professionals to largely and effectively use new digital tools), (4) remote management of COVID-19 or chronic patients during the pandemic (a role that has proved to be fundamental is the community and family nurse and health care systems are adopting novel assistance models to support patients at home and to enable decentralization of services from hospitals to the territory), and (5) management of interpersonal relationships with patients through telemedicine (a person-centered approach with an open and sensitive attitude seems to be even more important in the framework of telemedicine where a face-to-face session is not possible and therefore nonverbal indicators are more problematic to be noticed). Conclusions: Further advancing nurses’ readiness in adopting telemedicine requires an integrated approach, including combination of technical knowledge, management abilities, soft skills, and communication skills. This scoping review provides a wide-ranging and general—albeit valuable—starting point to identify these core competences and better understand their implications in terms of present and future health care professionals’ roles. %M 36194466 %R 10.2196/37631 %U https://nursing.jmir.org/2022/1/e37631 %U https://doi.org/10.2196/37631 %U http://www.ncbi.nlm.nih.gov/pubmed/36194466 %0 Journal Article %@ 2563-3570 %I JMIR Publications %V 3 %N 1 %P e36660 %T Multiple-Inputs Convolutional Neural Network for COVID-19 Classification and Critical Region Screening From Chest X-ray Radiographs: Model Development and Performance Evaluation %A Li,Zhongqiang %A Li,Zheng %A Yao,Luke %A Chen,Qing %A Zhang,Jian %A Li,Xin %A Feng,Ji-Ming %A Li,Yanping %A Xu,Jian %+ Division of Electrical and Computer Engineering, College of Engineering, Louisiana State University, Patrick F Taylor Hall, 3304 S Quad Dr, Baton Rouge, LA, 70803, United States, 1 (225) 578 4483, jianxu1@lsu.edu %K COVID-19 %K chest X-ray radiography %K multiple-inputs convolutional neural network %K screening critical COVID regions %D 2022 %7 4.10.2022 %9 Original Paper %J JMIR Bioinform Biotech %G English %X Background: The COVID-19 pandemic is becoming one of the largest, unprecedented health crises, and chest X-ray radiography (CXR) plays a vital role in diagnosing COVID-19. However, extracting and finding useful image features from CXRs demand a heavy workload for radiologists. Objective: The aim of this study was to design a novel multiple-inputs (MI) convolutional neural network (CNN) for the classification of COVID-19 and extraction of critical regions from CXRs. We also investigated the effect of the number of inputs on the performance of our new MI-CNN model. Methods: A total of 6205 CXR images (including 3021 COVID-19 CXRs and 3184 normal CXRs) were used to test our MI-CNN models. CXRs could be evenly segmented into different numbers (2, 4, and 16) of individual regions. Each region could individually serve as one of the MI-CNN inputs. The CNN features of these MI-CNN inputs would then be fused for COVID-19 classification. More importantly, the contributions of each CXR region could be evaluated through assessing the number of images that were accurately classified by their corresponding regions in the testing data sets. Results: In both the whole-image and left- and right-lung region of interest (LR-ROI) data sets, MI-CNNs demonstrated good efficiency for COVID-19 classification. In particular, MI-CNNs with more inputs (2-, 4-, and 16-input MI-CNNs) had better efficiency in recognizing COVID-19 CXRs than the 1-input CNN. Compared to the whole-image data sets, the efficiency of LR-ROI data sets showed approximately 4% lower accuracy, sensitivity, specificity, and precision (over 91%). In considering the contributions of each region, one of the possible reasons for this reduced performance was that nonlung regions (eg, region 16) provided false-positive contributions to COVID-19 classification. The MI-CNN with the LR-ROI data set could provide a more accurate evaluation of the contribution of each region and COVID-19 classification. Additionally, the right-lung regions had higher contributions to the classification of COVID-19 CXRs, whereas the left-lung regions had higher contributions to identifying normal CXRs. Conclusions: Overall, MI-CNNs could achieve higher accuracy with an increasing number of inputs (eg, 16-input MI-CNN). This approach could assist radiologists in identifying COVID-19 CXRs and in screening the critical regions related to COVID-19 classifications. %M 36277075 %R 10.2196/36660 %U https://bioinform.jmir.org/2022/1/e36660 %U https://doi.org/10.2196/36660 %U http://www.ncbi.nlm.nih.gov/pubmed/36277075 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 10 %P e40011 %T Tracking Openness and Topic Evolution of COVID-19 Publications January 2020-March 2021: Comprehensive Bibliometric and Topic Modeling Analysis %A San Torcuato,Maider %A Bautista-Puig,Núria %A Arrizabalaga,Olatz %A Méndez,Eva %+ Innovation Unit, Biodonostia Health Research Institute, Paseo Dr Beguiristain s/n, 20014, San Sebastián, Spain, 34 943006001, olatz.arrizabalaga@biodonostia.org %K COVID-19 %K open access %K OA %K SARS-CoV-2 %K scholarly communication %K topic modeling %K research %K dissemination %K accessibility %K scientometry %K publications %K communication %K research topics %D 2022 %7 3.10.2022 %9 Review %J J Med Internet Res %G English %X Background: The COVID-19 outbreak highlighted the importance of rapid access to research. Objective: The aim of this study was to investigate research communication related to COVID-19, the level of openness of papers, and the main topics of research into this disease. Methods: Open access (OA) uptake (typologies, license use) and the topic evolution of publications were analyzed from the start of the pandemic (January 1, 2020) until the end of a year of widespread lockdown (March 1, 2021). Results: The sample included 95,605 publications; 94.1% were published in an OA form, 44% of which were published as Bronze OA. Among these OA publications, 42% do not have a license, which can limit the number of citations and thus the impact. Using a topic modeling approach, we found that articles in Hybrid and Green OA publications are more focused on patients and their effects, whereas the strategy to combat the pandemic adopted by different countries was the main topic of articles selecting publication via the Gold OA route. Conclusions: Although OA scientific production has increased, some weaknesses in OA practice, such as lack of licensing or under-researched topics, still hold back its effective use for further research. %M 36190742 %R 10.2196/40011 %U https://www.jmir.org/2022/10/e40011 %U https://doi.org/10.2196/40011 %U http://www.ncbi.nlm.nih.gov/pubmed/36190742 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 10 %P e39582 %T Social Media Mining of Long-COVID Self-Medication Reported by Reddit Users: Feasibility Study to Support Drug Repurposing %A Koss,Jonathan %A Bohnet-Joschko,Sabine %+ Department of Management and Entrepreneurship, Faculty of Management, Economics and Society, Witten/Herdecke University, Alfred-Herrhausen-Str. 50, Witten, 58455, Germany, 49 2302926475, jonathan.koss@uni-wh.de %K social media mining %K drug repurposing %K long-COVID %K crowdsourcing %K COVID-19 %K Reddit %K social media %K content analysis %K network analysis %K recognition algorithm %K treatment %D 2022 %7 3.10.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Since the beginning of the COVID-19 pandemic, over 480 million people have been infected and more than 6 million people have died from COVID-19 worldwide. In some patients with acute COVID-19, symptoms manifest over a longer period, which is also called “long-COVID.” Unmet medical needs related to long-COVID are high, since there are no treatments approved. Patients experiment with various medications and supplements hoping to alleviate their suffering. They often share their experiences on social media. Objective: The aim of this study was to explore the feasibility of social media mining methods to extract important compounds from the perspective of patients. The goal is to provide an overview of different medication strategies and important agents mentioned in Reddit users’ self-reports to support hypothesis generation for drug repurposing, by incorporating patients’ experiences. Methods: We used named-entity recognition to extract substances representing medications or supplements used to treat long-COVID from almost 70,000 posts on the “/r/covidlonghaulers” subreddit. We analyzed substances by frequency, co-occurrences, and network analysis to identify important substances and substance clusters. Results: The named-entity recognition algorithm achieved an F1 score of 0.67. A total of 28,447 substance entities and 5789 word co-occurrence pairs were extracted. “Histamine antagonists,” “famotidine,” “magnesium,” “vitamins,” and “steroids” were the most frequently mentioned substances. Network analysis revealed three clusters of substances, indicating certain medication patterns. Conclusions: This feasibility study indicates that network analysis can be used to characterize the medication strategies discussed in social media. Comparison with existing literature shows that this approach identifies substances that are promising candidates for drug repurposing, such as antihistamines, steroids, or antidepressants. In the context of a pandemic, the proposed method could be used to support drug repurposing hypothesis development by prioritizing substances that are important to users. %M 36007131 %R 10.2196/39582 %U https://formative.jmir.org/2022/10/e39582 %U https://doi.org/10.2196/39582 %U http://www.ncbi.nlm.nih.gov/pubmed/36007131 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 9 %P e37846 %T Public Health Information Seeking, Trust, and COVID-19 Prevention Behaviors: Cross-sectional Study %A Tetteh,Emmanuel Kwabena %A Combs,Todd %A Geng,Elvin Hsing %A McKay,Virginia Ruth %+ Center for Public Health Systems Science, Washington University in St Louis, One Brookings Drive, St Louis, MO, 63130, United States, 1 314 935 5740, virginia.mckay@wustl.edu %K COVID-19 %K public health %K health communication %K trust and mistrust %K disease prevention %K health measure %K health information %K cross-sectional study %K Health Belief Model %D 2022 %7 30.9.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Preventative health measures such as shelter in place and mask wearing have been widely encouraged to curb the spread of the COVID-19 disease. People’s attitudes toward preventative behaviors may be dependent on their sources of information and trust in the information. Objective: The aim of this study was to understand the relationship between trusting in COVID-19 information and preventative behaviors in a racially and politically diverse metropolitan area in the United States. Methods: We conducted a web-based cross-sectional survey of residents in St. Louis City and County in Missouri. Individuals aged ≥18 years were eligible to participate. Participants were recruited using a convenience sampling approach through social media and email. The Health Belief Model and the Socioecological Model informed instrument development, as well as COVID-19–related questions from the Centers for Disease Control and Prevention. We performed an ordinary least squares linear regression model to estimate social distancing practices, perceptions, and trust in COVID-19 information sources. Results: Of the 1650 eligible participants, the majority (n=1381, 83.7%) had sought or received COVID-19–related information from a public health agency, the Centers for Disease Control and Prevention, or both. Regression analysis showed a 1% increase in preventative behaviors for every 12% increase in trust in governmental health agencies. At their lowest levels of trust, women were 68% more likely to engage in preventative behaviors than men. Overall, those aged 18-45 years without vulnerable medical conditions were the least likely to engage in preventative behaviors. Conclusions: Trust in COVID-19 information increases an individual’s likelihood of practicing preventative behaviors. Effective health communication strategies should be used to effectively disseminate health information during disease outbreaks. %M 36084197 %R 10.2196/37846 %U https://www.jmir.org/2022/9/e37846 %U https://doi.org/10.2196/37846 %U http://www.ncbi.nlm.nih.gov/pubmed/36084197 %0 Journal Article %@ 2373-6658 %I JMIR Publications %V 6 %N 1 %P e40436 %T Online Food Security Discussion Before and During the COVID-19 Pandemic in Native Hawaiian and Pacific Islander Community Groups and Organizations: Content Analysis of Facebook Posts %A Nguyen,Cassandra Jean %A Pham,Christian %A Jackson,Alexandra M %A Ellison,Nicole Lee Kamakahiolani %A Sinclair,Ka`imi %+ Institute for Research and Education to Advance Community Health, Washington State University, 1100 Olive Way, Suite 1200, Seattle, WA, 98101, United States, 1 2067088621, cassandra.nikolaus@wsu.edu %K social media %K oceanic ancestry group %K food insecurity %K social networking %K COVID-19 %K Facebook %K community %K Hawaiian %K Pacific Islander %K online %K food %K risk factor %K disease %K cardiometabolic %K diabetes %K hypertension %K food security %K digital %K support %K culture %D 2022 %7 30.9.2022 %9 Original Paper %J Asian Pac Isl Nurs J %G English %X Background: The Native Hawaiian and Pacific Islander (NHPI) population experiences disproportionately higher rates of food insecurity, which is a risk factor for cardiometabolic diseases such as cardiovascular disease, type 2 diabetes, obesity, and hypertension, when compared to white individuals. Novel and effective approaches that address food insecurity are needed for the NHPI population, particularly in areas of the continental United States, which is a popular migration area for many NHPI families. Social media may serve as an opportune setting to reduce food insecurity and thus the risk factors for cardiometabolic diseases among NHPI people; however, it is unclear if and how food insecurity is discussed in online communities targeting NHPI individuals. Objective: The objective of this study was to characterize the quantity, nature, and audience engagement of messages related to food insecurity posted online in community groups and organizations that target NHPI audiences. Methods: Publicly accessible Facebook pages and groups focused on serving NHPI community members living in the states of Washington or Oregon served as the data source. Facebook posts between March and June 2019 (before the COVID-19 pandemic) and from March to June 2020 (during the COVID-19 pandemic) that were related to food security were identified using a set of 36 related keywords. Data on the post and any user engagement (ie, comments, shares, or digital reactions) were extracted for all relevant posts. A content analytical approach was used to identify and quantify the nature of the identified posts and any related comments. The codes resulting from the content analysis were described and compared by year, page type, and engagement. Results: Of the 1314 nonduplicated posts in the 7 relevant Facebook groups and pages, 88 were related to food security (8 in 2019 and 80 in 2020). The nature of posts was broadly classified into literature-based codes, food assistance (the most common), perspectives of food insecurity, community gratitude and support, and macrolevel contexts. Among the 88 posts, 74% (n=65) had some form of engagement, and posts reflecting community gratitude and support or culture had more engagement than others (mean 19.9, 95% CI 11.2-28.5 vs mean 6.1, 95% CI 1.7-10.4; and mean 26.8, 95% CI 12.7-40.9 vs mean 5.3, 95% CI 3.0-7.7, respectively). Conclusions: Food security–related posts in publicly accessible Facebook groups targeting NHPI individuals living in Washington and Oregon largely focused on food assistance, although cultural values of gratitude, maintaining NHPI culture, and supporting children were also reflected. Future work should capitalize on social media as a potential avenue to reach a unique cultural group in the United States experiencing inequitably high rates of food insecurity and risk of cardiometabolic diseases. %M 36212246 %R 10.2196/40436 %U https://apinj.jmir.org/2022/1/e40436 %U https://doi.org/10.2196/40436 %U http://www.ncbi.nlm.nih.gov/pubmed/36212246 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 9 %P e35973 %T A Standard-Based Citywide Health Information Exchange for Public Health in Response to COVID-19: Development Study %A Hota,Bala %A Casey,Paul %A McIntyre,Anne F %A Khan,Jawad %A Rab,Shafiq %A Chopra,Aneesh %A Lateef,Omar %A Layden,Jennifer E %+ Tendo Systems, Inc, 5617 S Oak St, Hinsdale, IL, 60521, United States, 1 708 362 3767, bala.hota@gmail.com %K public health %K informatics %K surveillance %K disease surveillance %K epidemiology %K health data %K electronic health record %K data hub %K acute care hospital %K COVID-19 %K pandemic %K data governance %D 2022 %7 27.9.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Disease surveillance is a critical function of public health, provides essential information about the disease burden and the clinical and epidemiologic parameters of disease, and is an important element of effective and timely case and contact tracing. The COVID-19 pandemic demonstrates the essential role of disease surveillance in preserving public health. In theory, the standard data formats and exchange methods provided by electronic health record (EHR) meaningful use should enable rapid health care data exchange in the setting of disruptive health care events, such as a pandemic. In reality, access to data remains challenging and, even if available, often lacks conformity to regulated standards. Objective: We sought to use regulated interoperability standards already in production to generate awareness of regional bed capacity and enhance the capture of epidemiological risk factors and clinical variables among patients tested for SARS-CoV-2. We described the technical and operational components, governance model, and timelines required to implement the public health order that mandated electronic reporting of data from EHRs among hospitals in the Chicago jurisdiction. We also evaluated the data sources, infrastructure requirements, and the completeness of data supplied to the platform and the capacity to link these sources. Methods: Following a public health order mandating data submission by all acute care hospitals in Chicago, we developed the technical infrastructure to combine multiple data feeds from those EHR systems—a regional data hub to enhance public health surveillance. A cloud-based environment was created that received ELR, consolidated clinical data architecture, and bed capacity data feeds from sites. Data governance was planned from the project initiation to aid in consensus and principles for data use. We measured the completeness of each feed and the match rate between feeds. Results: Data from 88,906 persons from CCDA records among 14 facilities and 408,741 persons from ELR records among 88 facilities were submitted. Most (n=448,380, 90.1%) records could be matched between CCDA and ELR feeds. Data fields absent from ELR feeds included travel histories, clinical symptoms, and comorbidities. Less than 5% of CCDA data fields were empty. Merging CCDA with ELR data improved race, ethnicity, comorbidity, and hospitalization information data availability. Conclusions: We described the development of a citywide public health data hub for the surveillance of SARS-CoV-2 infection. We were able to assess the completeness of existing ELR feeds, augment those feeds with CCDA documents, establish secure transfer methods for data exchange, develop a cloud-based architecture to enable secure data storage and analytics, and produce dashboards for monitoring of capacity and the disease burden. We consider this public health and clinical data registry as an informative example of the power of common standards across EHRs and a potential template for future use of standards to improve public health surveillance. %M 35544440 %R 10.2196/35973 %U https://publichealth.jmir.org/2022/9/e35973 %U https://doi.org/10.2196/35973 %U http://www.ncbi.nlm.nih.gov/pubmed/35544440 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 2 %N 2 %P e36941 %T Perspectives of the COVID-19 Pandemic on Reddit: Comparative Natural Language Processing Study of the United States, the United Kingdom, Canada, and Australia %A Hu,Mengke %A Conway,Mike %+ Department of Biomedical Informatics, University of Utah, 6301 S Madrid St, Salt Lake City, UT, 84121, United States, 1 2159150417, mengke.hu@utah.edu %K COVID-19 %K social media %K natural language processing %K Reddit %D 2022 %7 27.9.2022 %9 Original Paper %J JMIR Infodemiology %G English %X Background: Since COVID-19 was declared a pandemic by the World Health Organization on March 11, 2020, the disease has had an unprecedented impact worldwide. Social media such as Reddit can serve as a resource for enhancing situational awareness, particularly regarding monitoring public attitudes and behavior during the crisis. Insights gained can then be utilized to better understand public attitudes and behaviors during the COVID-19 crisis, and to support communication and health-promotion messaging. Objective: The aim of this study was to compare public attitudes toward the 2020-2021 COVID-19 pandemic across four predominantly English-speaking countries (the United States, the United Kingdom, Canada, and Australia) using data derived from the social media platform Reddit. Methods: We utilized a topic modeling natural language processing method (more specifically latent Dirichlet allocation). Topic modeling is a popular unsupervised learning technique that can be used to automatically infer topics (ie, semantically related categories) from a large corpus of text. We derived our data from six country-specific, COVID-19–related subreddits (r/CoronavirusAustralia, r/CoronavirusDownunder, r/CoronavirusCanada, r/CanadaCoronavirus, r/CoronavirusUK, and r/coronavirusus). We used topic modeling methods to investigate and compare topics of concern for each country. Results: Our consolidated Reddit data set consisted of 84,229 initiating posts and 1,094,853 associated comments collected between February and November 2020 for the United States, the United Kingdom, Canada, and Australia. The volume of posting in COVID-19–related subreddits declined consistently across all four countries during the study period (February 2020 to November 2020). During lockdown events, the volume of posts peaked. The UK and Australian subreddits contained much more evidence-based policy discussion than the US or Canadian subreddits. Conclusions: This study provides evidence to support the contention that there are key differences between salient topics discussed across the four countries on the Reddit platform. Further, our approach indicates that Reddit data have the potential to provide insights not readily apparent in survey-based approaches. %M 36196144 %R 10.2196/36941 %U https://infodemiology.jmir.org/2022/2/e36941 %U https://doi.org/10.2196/36941 %U http://www.ncbi.nlm.nih.gov/pubmed/36196144 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 8 %N 3 %P e35983 %T The Use of Telegram in Surgical Education: Exploratory Study %A Soon,Marcus Khai Siang %A Martinengo,Laura %A Lu,Junde %A Car,Lorainne Tudor %A Chia,Clement Luck Khng %+ Lee Kong Chian School of Medicine, Nanyang Technological University, 11 Mandalay Rd 69047142 Clinical Sciences Building Level 18, Singapore, 308232, Singapore, 65 69047142, lorainne.tudor.car@ntu.edu.sg %K COVID-19 %K undergraduate medical education %K distance education %K social media %K Telegram %K general surgery %K messaging apps %D 2022 %7 27.9.2022 %9 Original Paper %J JMIR Med Educ %G English %X Background: The COVID-19 pandemic has disrupted medical education, shifting learning online. Social media platforms, including messaging apps, are well integrated into medical education. However, Telegram’s role in medical education remains relatively unexplored. Objective: This study aims to explore the perceptions of medical students regarding the role of messaging apps in medical education and their experience of using Telegram for surgical education. Methods: A Telegram channel “Telegram Education for Surgery Learning and Application (TESLA)” was created to supplement medical students’ learning. We invited 13 medical students who joined the TESLA channel for at least a month to participate in individual semistructured interviews. Interviews were conducted via videoconferencing using an interview guide and were then transcribed and analyzed by 2 researchers using inductive thematic content analysis. Results: Two themes were identified: (1) learning as a medical student and (2) the role of mobile learning (mLearning) in medical education. Students shared that pandemic-related safety measures, such as reduced clinic allocations and the inability to cross between wards, led to a decrease in clinical exposure. Mobile apps, which included proprietary study apps and messaging apps, were increasingly used by students to aid their learning. Students favored Telegram over other messaging apps and reported the development of TESLA as beneficial, particularly for revision and increasing knowledge. Conclusions: The use of apps for medical education increased during the COVID-19 pandemic. Medical students commonly used apps to consolidate their learning and revise examination topics. They found TESLA useful, relevant, and trustworthy. %M 36099020 %R 10.2196/35983 %U https://mededu.jmir.org/2022/3/e35983 %U https://doi.org/10.2196/35983 %U http://www.ncbi.nlm.nih.gov/pubmed/36099020 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 9 %P e35114 %T Exploring Socioeconomic Status as a Global Determinant of COVID-19 Prevalence, Using Exploratory Data Analytic and Supervised Machine Learning Techniques: Algorithm Development and Validation Study %A Winston,Luke %A McCann,Michael %A Onofrei,George %+ Department of Computing, Atlantic Technological University, Port Road, Letterkenny, F92 FC93, Ireland, 353 862435617, L00162644@student.lyit.ie %K COVID-19 %K machine learning %K data analysis %K epidemiology %K human development index %D 2022 %7 27.9.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic represents the most unprecedented global challenge in recent times. As the global community attempts to manage the pandemic in the long term, it is pivotal to understand what factors drive prevalence rates and to predict the future trajectory of the virus. Objective: This study had 2 objectives. First, it tested the statistical relationship between socioeconomic status and COVID-19 prevalence. Second, it used machine learning techniques to predict cumulative COVID-19 cases in a multicountry sample of 182 countries. Taken together, these objectives will shed light on socioeconomic status as a global risk factor of the COVID-19 pandemic. Methods: This research used exploratory data analysis and supervised machine learning methods. Exploratory analysis included variable distribution, variable correlations, and outlier detection. Following this, the following 3 supervised regression techniques were applied: linear regression, random forest, and adaptive boosting (AdaBoost). Results were evaluated using k-fold cross-validation and subsequently compared to analyze algorithmic suitability. The analysis involved 2 models. First, the algorithms were trained to predict 2021 COVID-19 prevalence using only 2020 reported case data. Following this, socioeconomic indicators were added as features and the algorithms were trained again. The Human Development Index (HDI) metrics of life expectancy, mean years of schooling, expected years of schooling, and gross national income were used to approximate socioeconomic status. Results: All variables correlated positively with the 2021 COVID-19 prevalence, with R2 values ranging from 0.55 to 0.85. Using socioeconomic indicators, COVID-19 prevalence was predicted with a reasonable degree of accuracy. Using 2020 reported case rates as a lone predictor to predict 2021 prevalence rates, the average predictive accuracy of the algorithms was low (R2=0.543). When socioeconomic indicators were added alongside 2020 prevalence rates as features, the average predictive performance improved considerably (R2=0.721) and all error statistics decreased. Thus, adding socioeconomic indicators alongside 2020 reported case data optimized the prediction of COVID-19 prevalence to a considerable degree. Linear regression was the strongest learner with R2=0.693 on the first model and R2=0.763 on the second model, followed by random forest (0.481 and 0.722) and AdaBoost (0.454 and 0.679). Following this, the second model was retrained using a selection of additional COVID-19 risk factors (population density, median age, and vaccination uptake) instead of the HDI metrics. However, average accuracy dropped to 0.649, which highlights the value of socioeconomic status as a predictor of COVID-19 cases in the chosen sample. Conclusions: The results show that socioeconomic status is an important variable to consider in future epidemiological modeling, and highlights the reality of the COVID-19 pandemic as a social phenomenon and a health care phenomenon. This paper also puts forward new considerations about the application of statistical and machine learning techniques to understand and combat the COVID-19 pandemic. %M 36001798 %R 10.2196/35114 %U https://formative.jmir.org/2022/9/e35114 %U https://doi.org/10.2196/35114 %U http://www.ncbi.nlm.nih.gov/pubmed/36001798 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 9 %P e35556 %T Chatbots for Smoking Cessation: Scoping Review %A Whittaker,Robyn %A Dobson,Rosie %A Garner,Katie %+ National Institute for Health Innovation, University of Auckland, 22-30 Park Ave, Grafton, Auckland, 1142, New Zealand, 64 9373 7599, r.whittaker@auckland.ac.nz %K chatbot %K conversational agent %K COVID-19 %K smoking cessation %D 2022 %7 26.9.2022 %9 Review %J J Med Internet Res %G English %X Background: Despite significant progress in reducing tobacco use over the past 2 decades, tobacco still kills over 8 million people every year. Digital interventions, such as text messaging, have been found to help people quit smoking. Chatbots, or conversational agents, are new digital tools that mimic instantaneous human conversation and therefore could extend the effectiveness of text messaging. Objective: This scoping review aims to assess the extent of research in the chatbot literature for smoking cessation and provide recommendations for future research in this area. Methods: Relevant studies were identified through searches conducted in Embase, MEDLINE, APA PsycINFO, Google Scholar, and Scopus, as well as additional searches on JMIR, Cochrane Library, Lancet Digital Health, and Digital Medicine. Studies were considered if they were conducted with tobacco smokers, were conducted between 2000 and 2021, were available in English, and included a chatbot intervention. Results: Of 323 studies identified, 10 studies were included in the review (3 framework articles, 1 study protocol, 2 pilot studies, 2 trials, and 2 randomized controlled trials). Most studies noted some benefits related to smoking cessation and participant engagement; however, outcome measures varied considerably. The quality of the studies overall was low, with methodological issues and low follow-up rates. Conclusions: More research is needed to make a firm conclusion about the efficacy of chatbots for smoking cessation. Researchers need to provide more in-depth descriptions of chatbot functionality, mode of delivery, and theoretical underpinnings. Consistency in language and terminology would also assist in reviews of what approaches work across the field. %M 36095295 %R 10.2196/35556 %U https://www.jmir.org/2022/9/e35556 %U https://doi.org/10.2196/35556 %U http://www.ncbi.nlm.nih.gov/pubmed/36095295 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 9 %P e38070 %T Digital Storytelling Methods to Empower Young Black Adults in COVID-19 Vaccination Decision-Making: Feasibility Study and Demonstration %A Maragh-Bass,Allysha %A Comello,Maria Leonora %A Tolley,Elizabeth Ellen %A Stevens Jr,Darrell %A Wilson,Jade %A Toval,Christina %A Budhwani,Henna %A Hightow-Weidman,Lisa %+ Behavioral, Epidemiological, Clinical Sciences Division, FHI 360, 359 Blackwell Street #200, Durham, NC, 27701, United States, 1 919 544 7040 ext 11966, AMaraghBass@fhi360.org %K young Black adults %K COVID-19 %K vaccine hesitancy %K digital storytelling %K community-based participatory research %K digital health intervention %D 2022 %7 26.9.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Despite high rates of novel COVID-19, acceptance of COVID-19 vaccination is low among Black adults. In response, we developed a digital health intervention (Tough Talks-COVID) that includes digital stories created in a workshop we held with young Black adults. Objective: Our formative research using digital storytelling workshops asked 3 research questions: (1) What issues did participants have in conceptualizing their stories, and what themes emerged from the stories they created? (2) What issues did participants have related to production techniques, and which techniques were utilized in stories? and (3) Overall, how did participants evaluate their workshop experience? Methods: Participants were workshop-eligible if they were vaccine-accepting based on a baseline survey fielded in late 2021. Final participants (N=11) completed a consent process, all 3 workshops, and a media release form for their digital story. The first 2 workshops provided background information and hands-on digital storytelling skills from pre- to postproduction. The third workshop served as a screening and feedback session for participants’ final videos. Qualitative and quantitative feedback elements were incorporated into all 3 sessions. Results: Digital stories addressed one or more of 4 broad themes: (1) COVID-19 vulnerability, (2) community connections, (3) addressing vaccine hesitancy, and (4) countering vaccine misinformation. Participants incorporated an array of technical approaches, including unique creative elements such as cartoon images and instant messaging tools to convey social interactions around COVID-19 decision-making. Most (9/11, 82%) strongly agreed the digital storytelling workshops were delivered as expected; 10 of 11 agreed (n=5) or strongly agreed (n=5) that they had some ideas about what story to tell by the end of the first workshop, and most (8/11, 73%) strongly agreed they had narrowed down their ideas by workshop two. Of the participants, 9 felt they would very likely (n=6) or likely (n=3) use digital storytelling techniques for personal use in the future, and even more were very likely (n=7) to use the techniques for professional use. Conclusions: Our study is one of the first to incorporate digital storytelling as a central component to a digital health intervention and the only one to do so with exclusive focus on young Black adults. Our emphasis on digital storytelling was shown to be highly acceptable. Similar approaches, including careful consideration of the ethical challenges of community-based participatory approaches, are applicable to other populations experiencing both COVID-19 inequities and marginalization, such as other age demographics and people of color. %M 36155984 %R 10.2196/38070 %U https://formative.jmir.org/2022/9/e38070 %U https://doi.org/10.2196/38070 %U http://www.ncbi.nlm.nih.gov/pubmed/36155984 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 9 %P e40331 %T The Influence of Provaping “Gatewatchers” on the Dissemination of COVID-19 Misinformation on Twitter: Analysis of Twitter Discourse Regarding Nicotine and the COVID-19 Pandemic %A Silver,Nathan %A Kierstead,Elexis %A Kostygina,Ganna %A Tran,Hy %A Briggs,Jodie %A Emery,Sherry %A Schillo,Barbara %+ Schroeder Institute, Truth Initiative, 900 G St NW, Washington, DC, 20006, United States, 1 2024545555, nsilver@truthinitiative.org %K social media %K tobacco %K COVID-19 %K nicotine %K misinformation %K Twitter %K information %K infodemiology %K vaping %K therapeutic %K influence %K environment %K harmful %K consequences %D 2022 %7 22.9.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: There is a lot of misinformation about a potential protective role of nicotine against COVID-19 spread on Twitter despite significant evidence to the contrary. We need to examine the role of vape advocates in the dissemination of such information through the lens of the gatewatching framework, which posits that top users can amplify and exert a disproportionate influence over the dissemination of certain content through curating, sharing, or, in the case of Twitter, retweeting it, serving more as a vector for misinformation rather than the source. Objective: This research examines the Twitter discourse at the intersection of COVID-19 and tobacco (1) to identify the extent to which the most outspoken contributors to this conversation self-identify as vaping advocates and (2) to understand how and to what extent these vape advocates serve as gatewatchers through disseminating content about a therapeutic role of tobacco, nicotine, or vaping against COVID-19. Methods: Tweets about tobacco, nicotine, or vaping and COVID-19 (N=1,420,271) posted during the first 9 months of the pandemic (January-September 2020) were identified from within a larger corpus of tobacco-related tweets using validated keyword filters. The top posters (ie, tweeters and retweeters) were identified and characterized, along with the most shared Uniform Resource Locators (URLs), most used hashtags, and the 1000 most retweeted posts. Finally, we examined the role of both top users and vape advocates in retweeting the most retweeted posts about the therapeutic role of nicotine, tobacco, or vaping against COVID-19. Results: Vape advocates comprised between 49.7% (n=81) of top 163 and 88% (n=22) of top 25 users discussing COVID-19 and tobacco on Twitter. Content about the ability of tobacco, nicotine, or vaping to treat or prevent COVID-19 was disseminated broadly, accounting for 22.5% (n=57) of the most shared URLs and 10% (n=107) of the most retweeted tweets. Finally, among top users, retweets comprised an average of 78.6% of the posts from vape advocates compared to 53.1% from others (z=3.34, P<.001). Vape advocates were also more likely to retweet the top tweeted posts about a therapeutic role of nicotine, with 63% (n=51) of vape advocates retweeting at least 1 post compared to 40.3% (n=29) of other top users (z=2.80, P=.01). Conclusions: Provaping users dominated discussions of tobacco use during the COVID-19 pandemic on Twitter and were instrumental in disseminating the most retweeted posts about a potential therapeutic role of tobacco use against the virus. Subsequent research is needed to better understand the extent of this influence and how to mitigate the influence of vape advocates over the broader narrative of tobacco regulation on Twitter. %M 36070451 %R 10.2196/40331 %U https://www.jmir.org/2022/9/e40331 %U https://doi.org/10.2196/40331 %U http://www.ncbi.nlm.nih.gov/pubmed/36070451 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 9 %P e38244 %T Engagement With HIV and COVID-19 Prevention: Nationwide Cross-sectional Analysis of Users on a Geosocial Networking App %A Gaither,Thomas W %A Sigalos,John T %A Landovitz,Raphael J %A Mills,Jesse N %A Litwin,Mark S %A Eleswarapu,Sriram V %+ Department of Urology, David Geffen School of Medicine at UCLA, University of California, Los Angeles, 10833 Le Conte Avenue, CHS 27-139, Los Angeles, CA, 90095, United States, 1 310 794 7700, tgaither@mednet.ucla.edu %K geosocial networking apps %K pre-exposure prophylaxis %K vaccination %K rural %K men who have sex with men %K surveillance %K digital surveillance %K COVID-19 %K digital application %K geosocial network %K public health %K surveillance platform %K health platform %K mobile health %D 2022 %7 22.9.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Geosocial networking (GSN) apps play a pivotal role in catalyzing sexual partnering, especially among men who have sex with men. Objective: To quantify the prevalence and disparities in disclosure of pre-exposure prophylaxis (PrEP) use and COVID-19 vaccination among GSN app users, mostly men who have sex with men, in the United States. Methods: Web-based Grindr profiles from the top 50 metropolitan areas as well as the 50 most rural counties in the United States by population were randomly sampled. Grindr provides an option to disclose current PrEP use (HIV positive, HIV negative, or HIV negative with PrEP use). The free text in all profiles was analyzed, and any mention of COVID-19 vaccination was recorded. Multivariable logistic regression to assess independent associations with PrEP disclosure and COVID-19 vaccination was performed. Imputation analyses were used to test the robustness of the results. Results: We evaluated 1889 urban and 384 rural profiles. Mean age among urban profiles was 32.9 (SD 9.6) years; mean age among rural profiles was 33.5 (SD 12.1) years (P=.41). Among the urban profiles, 16% reported being vaccinated against COVID-19 and 23% reported PrEP use compared to 10% and 8% in rural profiles, respectively (P=.002 and P<.001, respectively). Reporting COVID-19 vaccination (adjusted odds ratio [aOR] 1.7, 95% CI 1.2-2.4), living in an urban center (aOR 3.2, 95% CI 1.8-5.7), and showing a face picture as part of the Grindr profile (aOR 4.0, 95% CI 2.3-7.0) were positively associated with PrEP disclosure. Self-identified Black and Latino users were less likely to report PrEP use (aOR 0.6, 95% CI 0.4-0.9 and aOR 0.5, 95% CI 0.4-0.9, respectively). Reporting PrEP use (aOR 1.7, 95% CI 1.2-2.4), living in an urban center (aOR 2.5, 95% CI 1.4-4.5), having a “discreet” status (aOR 1.6, 95% CI 1.0-2.5), and showing a face picture (aOR 2.7, 95% CI 1.5-4.8) were positively associated with reporting COVID-19 vaccination on their profile. Users in the southern United States were less likely to report COVID-19 vaccination status than those in the northeast United States (aOR 0.6, 95% CI 0.3-0.9). Conclusions: Variations in PrEP disclosure are associated with race, whereas COVID-19 vaccination disclosure is associated with geographic area. However, rural GSN users were less likely to report both PrEP use and COVID-19 vaccination. The data demonstrate a need to expand health preventative services in the rural United States for sexual minorities. GSN platforms may be ideal for deployment of preventative interventions to improve access for this difficult-to-reach population. %M 36026586 %R 10.2196/38244 %U https://www.jmir.org/2022/9/e38244 %U https://doi.org/10.2196/38244 %U http://www.ncbi.nlm.nih.gov/pubmed/36026586 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 9 %P e38359 %T Co-Development of a Web Application (COVID-19 Social Site) for Long-Term Care Workers (“Something for Us”): User-Centered Design and Participatory Research Study %A Saunders,Catherine H %A Sierpe,Ailyn %A Stevens,Gabrielle %A Elwyn,Glyn %A Cantrell,Matthew %A Engel,Jaclyn %A Gonzalez,Melissa %A Hayward,Martha %A Huebner,Joellen %A Johnson,Lisa %A Jimenez,Alejandro %A Little,Nancy Ruth %A McKenna,Corinne %A Onteeru,Manu %A Oo Khine,May %A Pogue,Jacqueline %A Salinas Vargas,José Luis %A Schmidt,Peter %A Thomeer,Rachael %A , %A Durand,Marie-Anne %+ The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, 1 Medical Center Dr, Lebanon, NH, 03766, United States, 1 (603) 653 0800, catherine.hylas.saunders@dartmouth.edu %K COVID-19 %K vaccine hesitancy %K long-term care %K social media %K web application %K website %K intervention development, information and communications technology %D 2022 %7 22.9.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Improving confidence in and uptake of COVID-19 vaccines and boosters among long-term care workers (LTCWs) is a crucial public health goal, given their role in the care of elderly people and people at risk. While difficult to reach with workplace communication interventions, most LTCWs regularly use social media and smartphones. Various social media interventions have improved attitudes and uptake for other vaccines and hold promise for the LTCW population. Objective: We aimed to develop a curated social web application (interactive website) to increase COVID-19 vaccine confidence (a 3-arm randomized trial is underway). Methods: Following user-centric design and participatory research approaches, we undertook the following 3 steps: (1) content identification, (2) platform development, and (3) community building. A LTCW and stakeholder advisory group provided iterative input. For content identification (step 1), we identified topics of concern about COVID-19 vaccines via desktop research (published literature, public opinion polls, and social media monitoring), refined by interviewing and polling LTCWs. We also conducted a national online panel survey. We curated and fact-checked posts from popular social media platforms that addressed the identified concerns. During platform development (step 2), we solicited preferences for design and functionality via interviews and user experience testing with LTCWs. We also identified best practices for online community building (step 3). Results: In the interviews (n=9), we identified 3 themes: (1) LTCWs are proud of their work but feel undervalued; (2) LTCWs have varying levels of trust in COVID-19–related information; and (3) LTCWs would welcome a curated COVID-19 resource that is easy to understand and use-"something for us". Through desktop research, LTCW interviews, and our national online panel survey (n=592) we found that participants are interested in information about COVID-19 in general, vaccine benefits, vaccine risks, and vaccine development. Content identification resulted in 434 posts addressing these topic areas, with 209 uploaded to the final web application. Our LTCW poll (n=8) revealed preferences for personal stories and video content. The platform we developed is an accessible WordPress-based social media web application, refined through formal (n=3) and informal user experience testing. Users can sort posts by topic or subtopic and react to or comment on posts. To build an online community, we recruited 3 LTCW “community ambassadors” and instructed them to encourage discussion, acknowledge concerns, and offer factual information on COVID-19 vaccines. We also set “community standards” for the web application. Conclusions: An iterative, user-centric, participatory approach led to the launch of an accessible social media web application with curated content for COVID-19 vaccines targeting LTCWs in the United States. Through our trial, we will determine if this approach successfully improves vaccine confidence. If so, a similar social media resource could be used to develop curated social media interventions in other populations and with other public health goals. %M 35926074 %R 10.2196/38359 %U https://www.jmir.org/2022/9/e38359 %U https://doi.org/10.2196/38359 %U http://www.ncbi.nlm.nih.gov/pubmed/35926074 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 2 %N 2 %P e38839 %T Data Exploration and Classification of News Article Reliability: Deep Learning Study %A Zhan,Kevin %A Li,Yutong %A Osmani,Rafay %A Wang,Xiaoyu %A Cao,Bo %+ Department of Psychiatry, University of Alberta, 4-142 KATZ Group Centre for Pharmacy and Health Research, 87 Avenue and 114 Street, Edmonton, AB, T6G 2E1, Canada, 1 403 926 6628, yutong5@ualberta.ca %K COVID-19 %K deep learning %K news article reliability %K false information %K infodemic %K ensemble model %D 2022 %7 22.9.2022 %9 Original Paper %J JMIR Infodemiology %G English %X Background: During the ongoing COVID-19 pandemic, we are being exposed to large amounts of information each day. This “infodemic” is defined by the World Health Organization as the mass spread of misleading or false information during a pandemic. This spread of misinformation during the infodemic ultimately leads to misunderstandings of public health orders or direct opposition against public policies. Although there have been efforts to combat misinformation spread, current manual fact-checking methods are insufficient to combat the infodemic. Objective: We propose the use of natural language processing (NLP) and machine learning (ML) techniques to build a model that can be used to identify unreliable news articles online. Methods: First, we preprocessed the ReCOVery data set to obtain 2029 English news articles tagged with COVID-19 keywords from January to May 2020, which are labeled as reliable or unreliable. Data exploration was conducted to determine major differences between reliable and unreliable articles. We built an ensemble deep learning model using the body text, as well as features, such as sentiment, Empath-derived lexical categories, and readability, to classify the reliability. Results: We found that reliable news articles have a higher proportion of neutral sentiment, while unreliable articles have a higher proportion of negative sentiment. Additionally, our analysis demonstrated that reliable articles are easier to read than unreliable articles, in addition to having different lexical categories and keywords. Our new model was evaluated to achieve the following performance metrics: 0.906 area under the curve (AUC), 0.835 specificity, and 0.945 sensitivity. These values are above the baseline performance of the original ReCOVery model. Conclusions: This paper identified novel differences between reliable and unreliable news articles; moreover, the model was trained using state-of-the-art deep learning techniques. We aim to be able to use our findings to help researchers and the public audience more easily identify false information and unreliable media in their everyday lives. %M 36193330 %R 10.2196/38839 %U https://infodemiology.jmir.org/2022/2/e38839 %U https://doi.org/10.2196/38839 %U http://www.ncbi.nlm.nih.gov/pubmed/36193330 %0 Journal Article %@ 2563-3570 %I JMIR Publications %V 3 %N 1 %P e36860 %T A Bioinformatics Tool for Predicting Future COVID-19 Waves Based on a Retrospective Analysis of the Second Wave in India: Model Development Study %A Kumar,Ashutosh %A Asghar,Adil %A Dwivedi,Prakhar %A Kumar,Gopichand %A Narayan,Ravi K %A Jha,Rakesh K %A Parashar,Rakesh %A Sahni,Chetan %A Pandey,Sada N %+ Department of Anatomy, All India Institute of Medical Sciences - Patna, Phulwari Sharif, Patna, 801507, India, 91 612 245 ext 1335, drashutoshkumar@aiimspatna.org %K COVID-19 %K epidemiology %K genomic surveillance %K second wave %K SARS-CoV-2 %D 2022 %7 22.9.2022 %9 Original Paper %J JMIR Bioinform Biotech %G English %X Background: Since the start of the COVID-19 pandemic, health policymakers globally have been attempting to predict an impending wave of COVID-19. India experienced a devastating second wave of COVID-19 in the late first week of May 2021. We retrospectively analyzed the viral genomic sequences and epidemiological data reflecting the emergence and spread of the second wave of COVID-19 in India to construct a prediction model. Objective: We aimed to develop a bioinformatics tool that can predict an impending COVID-19 wave. Methods: We analyzed the time series distribution of genomic sequence data for SARS-CoV-2 and correlated it with epidemiological data for new cases and deaths for the corresponding period of the second wave. In addition, we analyzed the phylodynamics of circulating SARS-CoV-2 variants in the Indian population during the study period. Results: Our prediction analysis showed that the first signs of the arrival of the second wave could be seen by the end of January 2021, about 2 months before its peak in May 2021. By the end of March 2021, it was distinct. B.1.617 lineage variants powered the wave, most notably B.1.617.2 (Delta variant). Conclusions: Based on the observations of this study, we propose that genomic surveillance of SARS-CoV-2 variants, complemented with epidemiological data, can be a promising tool to predict impending COVID-19 waves. %M 36193192 %R 10.2196/36860 %U https://bioinform.jmir.org/2022/1/e36860 %U https://doi.org/10.2196/36860 %U http://www.ncbi.nlm.nih.gov/pubmed/36193192 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 9 %P e38944 %T Social Media News Use and COVID-19 Misinformation Engagement: Survey Study %A Ahmed,Saifuddin %A Rasul,Muhammad Ehab %+ Wee Kim Wee School of Communication and Information, Nanyang Technological University, 31 Nanyang Link, #03-43, Singapore, 637718, Singapore, 65 63168910, sahmed@ntu.edu.sg %K COVID-19 %K misinformation %K personality %K cognitive ability %K social media %K Singapore %D 2022 %7 20.9.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Social media is widely used as a source of news and information regarding COVID-19. However, the abundance of misinformation on social media platforms has raised concerns regarding the spreading infodemic. Accordingly, many have questioned the utility and impact of social media news use on users’ engagement with (mis)information. Objective: This study offers a conceptual framework for how social media news use influences COVID-19 misinformation engagement. More specifically, we examined how news consumption on social media leads to COVID-19 misinformation sharing by inducing belief in such misinformation. We further explored if the effects of social media news use on COVID-19 misinformation engagement depend on individual differences in cognition and personality traits. Methods: We used data from an online survey panel administered by a survey agency (Qualtrics) in Singapore. The survey was conducted in March 2022, and 500 respondents answered the survey. All participants were older than 21 years and provided consent before taking part in the study. We used linear regression, mediation, and moderated mediation analyses to explore the proposed relationships between social media news use, cognitive ability, personality traits, and COVID-19 misinformation belief and sharing intentions. Results: The results suggested that those who frequently used social media for news consumption were more likely to believe COVID-19 misinformation and share it on social media. Further probing the mechanism suggested that social media news use translated into sharing intent via the perceived accuracy of misinformation. Simply put, social media news users shared COVID-19 misinformation because they believed it to be accurate. We also found that those with high levels of extraversion than those with low levels were more likely to perceive the misinformation to be accurate and share it. Those with high levels of neuroticism and openness than those with low levels were also likely to perceive the misinformation to be accurate. Finally, it was observed that personality traits did not significantly influence misinformation sharing at higher levels of cognitive ability, but low cognitive users largely drove misinformation sharing across personality traits. Conclusions: The reliance on social media platforms for news consumption during the COVID-19 pandemic has amplified, with dire consequences for misinformation sharing. This study shows that increased social media news consumption is associated with believing and sharing COVID-19 misinformation, with low cognitive users being the most vulnerable. We offer recommendations to newsmakers, social media moderators, and policymakers toward efforts in limiting COVID-19 misinformation propagation and safeguarding citizens. %M 36067414 %R 10.2196/38944 %U https://www.jmir.org/2022/9/e38944 %U https://doi.org/10.2196/38944 %U http://www.ncbi.nlm.nih.gov/pubmed/36067414 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 2 %N 2 %P e35121 %T Quantifying Changes in Vaccine Coverage in Mainstream Media as a Result of the COVID-19 Outbreak: Text Mining Study %A Christensen,Bente %A Laydon,Daniel %A Chelkowski,Tadeusz %A Jemielniak,Dariusz %A Vollmer,Michaela %A Bhatt,Samir %A Krawczyk,Konrad %+ Department of Mathematics and Computer Science, University of Southern Denmark, Campusvej 55, Odense, 5230, Denmark, 45 5551122, konradk@imada.sdu.dk %K data mining %K COVID-19 %K vaccine %K text mining %K change %K coverage %K communication %K media %K social media %K news %K outbreak %K acceptance %K hesitancy %K understanding %K knowledge %K sentiment %D 2022 %7 20.9.2022 %9 Original Paper %J JMIR Infodemiology %G English %X Background: Achieving herd immunity through vaccination depends upon the public’s acceptance, which in turn relies on their understanding of its risks and benefits. The fundamental objective of public health messaging on vaccines is therefore the clear communication of often complex information and, increasingly, the countering of misinformation. The primary outlet shaping public understanding is mainstream online news media, where coverage of COVID-19 vaccines was widespread. Objective: We used text-mining analysis on the front pages of mainstream online news to quantify the volume and sentiment polarization of vaccine coverage. Methods: We analyzed 28 million articles from 172 major news sources across 11 countries between July 2015 and April 2021. We employed keyword-based frequency analysis to estimate the proportion of overall articles devoted to vaccines. We performed topic detection using BERTopic and named entity recognition to identify the leading subjects and actors mentioned in the context of vaccines. We used the Vader Python module to perform sentiment polarization quantification of all collated English-language articles. Results: The proportion of front-page articles mentioning vaccines increased from 0.1% to 4% with the outbreak of COVID-19. The number of negatively polarized articles increased from 6698 in 2015-2019 to 28,552 in 2020-2021. However, overall vaccine coverage before the COVID-19 pandemic was slightly negatively polarized (57% negative), whereas coverage during the pandemic was positively polarized (38% negative). Conclusions: Throughout the pandemic, vaccines have risen from a marginal to a widely discussed topic on the front pages of major news outlets. Mainstream online media has been positively polarized toward vaccines, compared with mainly negative prepandemic vaccine news. However, the pandemic was accompanied by an order-of-magnitude increase in vaccine news that, due to low prepandemic frequency, may contribute to a perceived negative sentiment. These results highlight important interactions between the volume of news and overall polarization. To the best of our knowledge, our work is the first systematic text mining study of front-page vaccine news headlines in the context of COVID-19. %M 36348981 %R 10.2196/35121 %U https://infodemiology.jmir.org/2022/2/e35121 %U https://doi.org/10.2196/35121 %U http://www.ncbi.nlm.nih.gov/pubmed/36348981 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 9 %P e35828 %T The Impact of the COVID-19 Pandemic on Internet Use and the Use of Digital Health Tools: Secondary Analysis of the 2020 Health Information National Trends Survey %A Zeng,Billy %A Rivadeneira,Natalie A %A Wen,Anita %A Sarkar,Urmimala %A Khoong,Elaine C %+ Division of General Internal Medicine at Zuckerberg San Francisco General Hospital, Department of Medicine, University of California San Francisco, 1001 Potrero Avenue, Bldg 10, Ward 13, San Francisco, CA, 94110, United States, 1 6282063188, elaine.khoong@ucsf.edu %K COVID-19 %K digital divide %K eHealth %K telehealth %D 2022 %7 19.9.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic increased the use of digital tools in health care (eg, patient portal, telemedicine, and web-based scheduling). Studies have shown that older individuals, racial/ethnic minority groups, or populations with lower educational attainment or income have lower rates of using digital health tools. Digitalization of health care may exacerbate already existing access barriers in these populations. Objective: This study evaluated how use of digital tools to asynchronously communicate with clinicians, schedule appointments, and view medical records changed near the beginning of the pandemic. Methods: Using 2020 Health Information National Trends Survey (HINTS) data, we examined internet use and 7 digital health technology use outcomes (electronic communication with a provider, electronic appointment scheduling, electronic test result viewing, patient portal access, portal use to download health records, portal use for patient-provider communication, and portal use to view test results). The HINTS surveyors designated surveys received after March 11, 2020, as postpandemic responses. Using weighted logistic regression, we investigated the impact of the pandemic after adjusting for sociodemographic traits (age, race/ethnicity, income, education, and gender), digital access (having ever used the internet and smartphone/tablet ownership), and health-related factors (insurance coverage, caregiver status, having a regular provider, and chronic diseases). To explore differences in changes in outcomes among key sociodemographic groups, we tested for significant interaction terms between the pandemic variable and race/ethnicity, age, income, and educational attainment. Results: There were 3865 respondents (1437 prepandemic and 2428 postpandemic). Of the 8 outcomes investigated, the pandemic was only significantly associated with higher odds (adjusted odds ratio 1.99, 95% CI 1.18-3.35) of using electronic communication with a provider. There were significant interactions between the pandemic variable and 2 key sociodemographic traits. Relative to the lowest income group (8.5 million completed questionnaires, with >280,000 unique users. Although the COVID Radar app is a valid tool for population-level surveillance, high user engagement is critical to the success of the COVID Radar app in maintaining validity. Objective: This study aimed to identify optimization targets of the COVID Radar app to improve its acceptability, adherence, and inclusiveness. Methods: The main component of the COVID Radar app is a self-report questionnaire that assesses COVID-19 symptoms and social distancing behaviors. A total of 3 qualitative substudies were conducted. First, 3 semistructured focus group interviews with end users (N=14) of the app were conducted to gather information on user experiences. The output was transcribed and thematically coded using the framework method. Second, a similar qualitative thematic analysis was conducted on 1080 end-user emails. Third, usability testing was conducted in one-on-one sessions with 4 individuals with low literacy levels. Results: All 3 substudies identified optimization targets in terms of design and content. The results of substudy 1 showed that the participants generally evaluated the app positively. They reported the app to be user-friendly and were satisfied with its design and functionalities. Participants’ main motivation to use the app was to contribute to science. Participants suggested adding motivational tools to stimulate user engagement. A larger national publicity campaign for the app was considered potentially helpful for increasing the user population. In-app updates informing users about the project and its outputs motivated users to continue using the app. Feedback on the self-report questionnaire, stemming from substudies 1 and 2, mostly concerned the content and phrasing of the questions. Furthermore, the section of the app allowing users to compare their symptoms and behaviors to those of their peers was found to be suboptimal because of difficulties in interpreting the figures presented in the app. Finally, the output of substudy 3 resulted in recommendations primarily related to simplification of the text to render it more accessible and comprehensible for individuals with low literacy levels. Conclusions: The convenience of app use, enabling personal adjustments of the app experience, and considering motivational factors for continued app use (ie, altruism and collectivism) were found to be crucial to procuring and maintaining a population of active users of the COVID Radar app. Further, there seems to be a need to increase the accessibility of public health tools for individuals with low literacy levels. These results can be used to improve the this and future public health apps and improve the representativeness of their user populations and user engagement, ultimately increasing the validity of the tools. %M 35781492 %R 10.2196/36003 %U https://formative.jmir.org/2022/9/e36003 %U https://doi.org/10.2196/36003 %U http://www.ncbi.nlm.nih.gov/pubmed/35781492 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 9 %P e41747 %T Using Normative Language When Describing Scientific Findings: Protocol for a Randomized Controlled Trial of Effects on Trust and Credibility %A Agley,Jon %A Xiao,Yunyu %A Thompson,Esi E %A Golzarri-Arroyo,Lilian %+ Prevention Insights, Department of Applied Health Science, School of Public Health Bloomington, Indiana University Bloomington, 809 E 9th St, Bloomington, IN, 47405, United States, 1 812 855 3123, jagley@indiana.edu %K trust %K trust in science %K scientific communication %K meta-science %K RCT %K randomized controlled trial %K infodemic %K COVID-19 %K misinformation %K normative language %K meta-cognitive %K cognitive %K scientific information %K credible %K credibility %D 2022 %7 9.9.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Trust in science and scientists has received renewed attention because of the “infodemic” occurring alongside COVID-19. A robust evidence basis shows that such trust is associated with belief in misinformation and willingness to engage in public and personal health behaviors. At the same time, trust and the associated construct of credibility are complex meta-cognitive concepts that often are oversimplified in quantitative research. The discussion of research often includes both normative language (what one ought to do based on a study’s findings) and cognitive language (what a study found), but these types of claims are very different, since normative claims make assumptions about people’s interests. Thus, this paper presents a protocol for a large randomized controlled trial to experimentally test whether some of the variability in trust in science and scientists and perceived message credibility is attributable to the use of normative language when sharing study findings in contrast to the use of cognitive language alone. Objective: The objective of this trial will be to examine if reading normative and cognitive claims about a scientific study, compared to cognitive claims alone, results in lower trust in science and scientists as well as lower perceived credibility of the scientist who conducted the study, perceived credibility of the research, trust in the scientific information on the post, and trust in scientific information coming from the author of the post. Methods: We will conduct a randomized controlled trial consisting of 2 parallel groups and a 1:1 allocation ratio. A sample of 1500 adults aged ≥18 years who represent the overall US population distribution by gender, race/ethnicity, and age will randomly be assigned to either an “intervention” arm (normative and cognitive claims) or a control arm (cognitive claims alone). In each arm, participants will view and verify their understanding of an ecologically valid claim or set of claims (ie, from a highly cited, published research study) designed to look like a social media post. Outcomes will be trust in science and scientists, the perceived credibility of the scientist who conducted the study, the perceived credibility of the research, trust in the scientific information on the post, and trust in scientific information coming from the author of the post. Analyses will incorporate 9 covariates. Results: This study will be conducted without using any external funding mechanisms. Conclusions: If there is a measurable effect attributable to the inclusion of normative language when writing about scientific findings, it should generate discussion about how such findings are presented and disseminated. Trial Registration: Open Science Framework n7yfc; https://osf.io/n7yfc International Registered Report Identifier (IRRID): PRR1-10.2196/41747 %M 36044639 %R 10.2196/41747 %U https://www.researchprotocols.org/2022/9/e41747 %U https://doi.org/10.2196/41747 %U http://www.ncbi.nlm.nih.gov/pubmed/36044639 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 9 %P e34675 %T Psychometric Properties of the COVID-19 Pandemic Fatigue Scale: Cross-sectional Online Survey Study %A Rodriguez-Blazquez,Carmen %A Romay-Barja,Maria %A Falcon,Maria %A Ayala,Alba %A Forjaz,Maria João %+ School of Medicine, University of Murcia, Campus de Espinardo, Murcia, 31000, Spain, 34 868887583, falcon@um.es %K COVID-19 %K pandemic fatigue %K psychometric properties %K Rasch analysis %K validation %K online survey %K pandemic %K fatigue %K mental health %K information seeking %K health information %D 2022 %7 8.9.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Pandemic fatigue is defined as feelings of demotivation to follow preventive measures against COVID-19, together with decreased trust in government and frequency of information-seeking behaviors. Objective: This study aims to analyze the psychometric properties of the COVID-19–specific pandemic fatigue scale according to classical test theory (CTT) and Rasch model approaches in the general Spanish population. Methods: This was a cross-sectional study in a representative sample of 1018 adults who completed an online survey in November 2020 in the framework of the COVID-19 Snapshot Monitoring (COSMO)-Spain project. The assessments included the 6-item COVID-19 Pandemic Fatigue Scale (CPFS) and other COVID-19–related variables: COVID-19 infection, adherence to preventive behaviors, information-seeking behavior, self-efficacy, worry, and cognitive and affective risk perception. Data quality, acceptability, reliability, and validity were analyzed according to CTT, and the fit to the Rasch model, unidimensionality, appropriateness of the response scale, item local independency, reliability (person-separation index [PSI]), and item-person distribution were also calculated. Results: The mean CPFS score was 17.06 (SD 5.04, range 6-30), with higher scores for women, younger participants, participants who never seek information on COVID-19, those who think they would contract a mild disease in case of infection, those with higher level of worry about coronavirus/COVID-19, and those who felt depressed or felt the coronavirus/COVID-19 is spreading slowly (all P<.01). The Cronbach alpha for the CPFS was 0.74. In the confirmatory factor analysis, one factor was identified (root mean square error of approximation [RMSEA]=.02; comparative fit index [CFI]=.99; χ25=8.06, P=.15). The CPFS showed good fit to the Rasch model (χ 224=42.025, P=.01, PSI=.642), unidimensionality (binomial 95% CI –.005 to .045), and item local independency. Conclusions: Our results suggest that the CPFS has moderate reliability and internal consistency and it is composed of a single dimension. It is a useful tool to ascertain the level of pandemic fatigue in the general population, which may help to guide the communication and information strategies to face the COVID-19 pandemic. %M 35785547 %R 10.2196/34675 %U https://publichealth.jmir.org/2022/9/e34675 %U https://doi.org/10.2196/34675 %U http://www.ncbi.nlm.nih.gov/pubmed/35785547 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 9 %P e37509 %T Circulating Illness and Changes in Thermometer Use Behavior: Series of Cross-sectional Analyses %A Seifarth,Jack %A Pinaire,Megan %A Zicker,John %A Singh,Inder %A Bloch,Danielle %+ Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 West 168th St, New York, NY, 10032, United States, 1 717 887 2685, jack.seifarth@kinsahealth.com %K thermometer %K health behavior %K influenza %K COVID-19 %K fever %K surveillance %K perceived risk %K percent positivity %K smart technology %K smart thermometer %K population demography %K older adult %K elderly population %K health monitoring %D 2022 %7 8.9.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Temperature-taking behaviors vary with levels of circulating infectious illness; however, little is known about how these behaviors differ by demographic characteristics. Populations with higher perceived risks of illness are more likely to adopt protective health behaviors. Objective: We investigated differences in temperature-taking frequency and the proportion of readings that were feverish among demographic groups (age, gender, urban/rural status) over influenza offseason; influenza season; and waves 1, 2, and 3 of the COVID-19 pandemic. Methods: Using data from smart thermometers collected from May 1, 2019, to February 28, 2021, across the United States, we calculated the frequency of temperature-taking and the proportion of temperature readings that were feverish. Mixed-effects negative binomial and mixed-effects logistic regression analyses were performed to identify demographic characteristics associated with temperature-taking frequency and the proportion of feverish readings, respectively. Separate models were fit over five study periods: influenza offseason (n=122,480), influenza season (n=174,191), wave 1 of COVID-19 (n=350,385), wave 2 (n=366,489), and wave 3 (n=391,578). Results: Both temperature-taking frequency and the proportion of feverish readings differed by study period (ANOVA P<.001) and were the highest during influenza season. During all periods, children aged 2-5 years and 6-11 years had significantly higher frequencies of temperature-taking than users aged 19-30 years, and children had the highest proportion of feverish readings of all age groups, after adjusting for covariates. During wave 1 of COVID-19, users over the age of 60 years had 1.79 times (95% CI 1.76-1.83) the rate of temperature-taking as users aged 19-30 years and 74% lower odds (95% CI 72%-75%) of a reading being feverish. Across all periods, men had significantly lower temperature-taking frequency and significantly higher odds of having a feverish reading compared to women. Users living in urban areas had significantly higher frequencies of temperature-taking than rural users during all periods, except wave 2 of COVID-19, and urban users had higher odds of a reading being feverish in all study periods except wave 1 of COVID-19. Conclusions: Temperature-taking behavior and the proportion of readings that were feverish are associated with both population disease levels and individual demographic characteristics. Differences in the health behavior of temperature-taking may reflect changes in both perceived and actual illness risk. Specifically, older adults may have experienced an increase in perceived risk during the first three waves of COVID-19, leading to increased rates of temperature monitoring, even when their odds of fever were lower than those of younger adults. Men’s perceived risk of circulating infectious illnesses such as influenza and COVID-19 may be lower than that of women, since men took their temperature less frequently and each temperature had a higher odds of being feverish across all study periods. Infectious disease surveillance should recognize and incorporate how behavior impacts illness monitoring and testing. %M 35998174 %R 10.2196/37509 %U https://formative.jmir.org/2022/9/e37509 %U https://doi.org/10.2196/37509 %U http://www.ncbi.nlm.nih.gov/pubmed/35998174 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 9 %P e37984 %T Discovering Long COVID Symptom Patterns: Association Rule Mining and Sentiment Analysis in Social Media Tweets %A Matharaarachchi,Surani %A Domaratzki,Mike %A Katz,Alan %A Muthukumarana,Saman %+ Department of Statistics, University of Manitoba, 66 Chancellors Cir, Winnipeg, MB, R3T 2N2, Canada, 1 431 338 5077, matharas@myumanitoba.ca %K COVID-19 %K long COVID symptoms %K social media analysis %K association rule mining %K bigram analysis %K natural language processing %K Twitter %K content analysis %K data mining %K infodemiology %K health information %D 2022 %7 7.9.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic is a substantial public health crisis that negatively affects human health and well-being. As a result of being infected with the coronavirus, patients can experience long-term health effects called long COVID syndrome. Multiple symptoms characterize this syndrome, and it is crucial to identify these symptoms as they may negatively impact patients’ day-to-day lives. Breathlessness, fatigue, and brain fog are the 3 most common continuing and debilitating symptoms that patients with long COVID have reported, often months after the onset of COVID-19. Objective: This study aimed to understand the patterns and behavior of long COVID symptoms reported by patients on the Twitter social media platform, which is vital to improving our understanding of long COVID. Methods: Long COVID–related Twitter data were collected from May 1, 2020, to December 31, 2021. We used association rule mining techniques to identify frequent symptoms and establish relationships between symptoms among patients with long COVID in Twitter social media discussions. The highest confidence level–based detection was used to determine the most significant rules with 10% minimum confidence and 0.01% minimum support with a positive lift. Results: Among the 30,327 tweets included in our study, the most frequent symptoms were brain fog (n=7812, 25.8%), fatigue (n=5284, 17.4%), breathing/lung issues (n=4750, 15.7%), heart issues (n=2900, 9.6%), flu symptoms (n=2824, 9.3%), depression (n=2256, 7.4%) and general pains (n=1786, 5.9%). Loss of smell and taste, cold, cough, chest pain, fever, headache, and arm pain emerged in 1.6% (n=474) to 5.3% (n=1616) of patients with long COVID. Furthermore, the highest confidence level–based detection successfully demonstrates the potential of association analysis and the Apriori algorithm to establish patterns to explore 57 meaningful relationship rules among long COVID symptoms. The strongest relationship revealed that patients with lung/breathing problems and loss of taste are likely to have a loss of smell with 77% confidence. Conclusions: There are very active social media discussions that could support the growing understanding of COVID-19 and its long-term impact. These discussions enable a potential field of research to analyze the behavior of long COVID syndrome. Exploratory data analysis using natural language processing methods revealed the symptoms and medical conditions related to long COVID discussions on the Twitter social media platform. Using Apriori algorithm–based association rules, we determined interesting and meaningful relationships between symptoms. %M 36069846 %R 10.2196/37984 %U https://formative.jmir.org/2022/9/e37984 %U https://doi.org/10.2196/37984 %U http://www.ncbi.nlm.nih.gov/pubmed/36069846 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 10 %N 9 %P e39235 %T Issues With Variability in Electronic Health Record Data About Race and Ethnicity: Descriptive Analysis of the National COVID Cohort Collaborative Data Enclave %A Cook,Lily %A Espinoza,Juan %A Weiskopf,Nicole G %A Mathews,Nisha %A Dorr,David A %A Gonzales,Kelly L %A Wilcox,Adam %A Madlock-Brown,Charisse %A , %+ Department of Medical Informatics and Clinical Epidemiology, School of Medicine, Oregon Health & Science University, Biomedical Information Communication Center, 3280 S.W. Sam Jackson Park Rd., Portland, OR, 97239, United States, 1 503 494 4502, lilyjune25@gmail.com %K social determinants of health %K health equity %K bias %K data quality %K data harmonization %K data standards %K terminology %K data aggregation %D 2022 %7 6.9.2022 %9 Original Paper %J JMIR Med Inform %G English %X Background: The adverse impact of COVID-19 on marginalized and under-resourced communities of color has highlighted the need for accurate, comprehensive race and ethnicity data. However, a significant technical challenge related to integrating race and ethnicity data in large, consolidated databases is the lack of consistency in how data about race and ethnicity are collected and structured by health care organizations. Objective: This study aims to evaluate and describe variations in how health care systems collect and report information about the race and ethnicity of their patients and to assess how well these data are integrated when aggregated into a large clinical database. Methods: At the time of our analysis, the National COVID Cohort Collaborative (N3C) Data Enclave contained records from 6.5 million patients contributed by 56 health care institutions. We quantified the variability in the harmonized race and ethnicity data in the N3C Data Enclave by analyzing the conformance to health care standards for such data. We conducted a descriptive analysis by comparing the harmonized data available for research purposes in the database to the original source data contributed by health care institutions. To make the comparison, we tabulated the original source codes, enumerating how many patients had been reported with each encoded value and how many distinct ways each category was reported. The nonconforming data were also cross tabulated by 3 factors: patient ethnicity, the number of data partners using each code, and which data models utilized those particular encodings. For the nonconforming data, we used an inductive approach to sort the source encodings into categories. For example, values such as “Declined” were grouped with “Refused,” and “Multiple Race” was grouped with “Two or more races” and “Multiracial.” Results: “No matching concept” was the second largest harmonized concept used by the N3C to describe the race of patients in their database. In addition, 20.7% of the race data did not conform to the standard; the largest category was data that were missing. Hispanic or Latino patients were overrepresented in the nonconforming racial data, and data from American Indian or Alaska Native patients were obscured. Although only a small proportion of the source data had not been mapped to the correct concepts (0.6%), Black or African American and Hispanic/Latino patients were overrepresented in this category. Conclusions: Differences in how race and ethnicity data are conceptualized and encoded by health care institutions can affect the quality of the data in aggregated clinical databases. The impact of data quality issues in the N3C Data Enclave was not equal across all races and ethnicities, which has the potential to introduce bias in analyses and conclusions drawn from these data. Transparency about how data have been transformed can help users make accurate analyses and inferences and eventually better guide clinical care and public policy. %M 35917481 %R 10.2196/39235 %U https://medinform.jmir.org/2022/9/e39235 %U https://doi.org/10.2196/39235 %U http://www.ncbi.nlm.nih.gov/pubmed/35917481 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 9 %P e34212 %T The Effect of Persuasive Design on the Adoption of Exposure Notification Apps: Quantitative Study Based on COVID Alert %A Oyibo,Kiemute %A Morita,Plinio Pelegrini %+ School of Public Health Sciences, Faculty of Health, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada, 1 5198884567 ext 41372, plinio.morita@uwaterloo.ca %K contact tracing app %K exposure notification app %K COVID Alert %K COVID-19 %K persuasive technology %K behavior change %K exposure %K behavior %K effect %K design %K adoption %K use %K case study %K effectiveness %K user interface %K mobile phone %D 2022 %7 6.9.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The adoption of contact tracing apps worldwide has been low. Although considerable research has been conducted on technology acceptance, little has been done to show the benefit of incorporating persuasive principles. Objective: This research aimed to investigate the effect of persuasive features in the COVID Alert app, created by Health Canada, by focusing on the no-exposure status, exposure status, and diagnosis report interfaces. Methods: We conducted a study among 181 Canadian residents, including 65 adopters and 116 nonadopters. This study was based on screenshots of the 3 interfaces, of which each comprised a persuasive design and a control design. The persuasive versions of the first two interfaces supported self-monitoring (of exposure levels), and that of the third interface supported social learning (about how many other users have reported their diagnosis). The 6 screenshots were randomly assigned to 6 groups of participants to provide feedback on perceived persuasiveness and adoption willingness. Results: A multivariate repeated-measure ANOVA showed that there is an interaction among interface, app design, and adoption status regarding the perceived persuasiveness of the interfaces. This resulted in a 2-way ANOVA for each interface. For the no-exposure interface, there was an interaction between adoption status and app design. Among adopters, there was no significant difference P=.31 between the persuasive design (mean 5.36, SD 1.63) and the control design (mean 5.87, SD 1.20). However, among nonadopters, there was an effect of app design (P<.001), with participants being more motivated by the persuasive design (mean 5.37, SD 1.30) than by the control design (mean 4.57, SD 1.19). For the exposure interface, adoption status had a main effect (P<.001), with adopters (mean 5.91, SD 1.01) being more motivated by the designs than nonadopters (mean 4.96, SD 1.43). For the diagnosis report interface, there was an interaction between adoption status and app design. Among nonadopters, there was no significant difference P=.99 between the persuasive design (mean 4.61, SD 1.84) and the control design (mean 4.77, SD 1.21). However, among adopters, there was an effect of app design (P=.006), with participants being more likely to report their diagnosis using the persuasive design (mean 6.00, SD 0.97) than using the control design (mean 5.03, SD 1.22). Finally, with regard to willingness to download the app, pairwise comparisons showed that nonadopters were more likely to adopt the app after viewing the persuasive version of the no-exposure interface (13/21, 62% said yes) and the diagnosis report interface (12/17, 71% said yes) than after viewing the control versions (3/17, 18% and 7/16, 44%, respectively, said yes). Conclusions: Exposure notification apps are more likely to be effective if equipped with persuasive features. Incorporating self-monitoring into the no-exposure status interface and social learning into the diagnosis report interface can increase adoption by >30%. %M 35580138 %R 10.2196/34212 %U https://formative.jmir.org/2022/9/e34212 %U https://doi.org/10.2196/34212 %U http://www.ncbi.nlm.nih.gov/pubmed/35580138 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 10 %N 9 %P e37770 %T Identifying the Perceived Severity of Patient-Generated Telemedical Queries Regarding COVID: Developing and Evaluating a Transfer Learning–Based Solution %A Gatto,Joseph %A Seegmiller,Parker %A Johnston,Garrett %A Preum,Sarah Masud %+ Department of Computer Science, Dartmouth College, 15 Thayer Drive, Hanover, NH, 03755, United States, 1 603 646 1110, joseph.m.gatto.gr@dartmouth.edu %K natural language processing %K transfer learning %K telemedicine triage %K COVID-19 %K health resource %K health care %K patient query %K learning solution %K telemedical %K lexical model %K machine learning %K BERT %K telehealth %D 2022 %7 2.9.2022 %9 Original Paper %J JMIR Med Inform %G English %X Background: Triage of textual telemedical queries is a safety-critical task for medical service providers with limited remote health resources. The prioritization of patient queries containing medically severe text is necessary to optimize resource usage and provide care to those with time-sensitive needs. Objective: We aim to evaluate the effectiveness of transfer learning solutions on the task of telemedical triage and provide a thorough error analysis, identifying telemedical queries that challenge state-of-the-art natural language processing (NLP) systems. Additionally, we aim to provide a publicly available telemedical query data set with labels for severity classification for telemedical triage of respiratory issues. Methods: We annotated 573 medical queries from 3 online health platforms: HealthTap, HealthcareMagic, and iCliniq. We then evaluated 6 transfer learning solutions utilizing various text-embedding strategies. Specifically, we first established a baseline using a lexical classification model with term frequency–inverse document frequency (TF-IDF) features. Next, we investigated the effectiveness of global vectors for text representation (GloVe), a pretrained word-embedding method. We evaluated the performance of GloVe embeddings in the context of support vector machines (SVMs), bidirectional long short-term memory (bi-LSTM) networks, and hierarchical attention networks (HANs). Finally, we evaluated the performance of contextual text embeddings using transformer-based architectures. Specifically, we evaluated bidirectional encoder representation from transformers (BERT), Bio+Clinical-BERT, and Sentence-BERT (SBERT) on the telemedical triage task. Results: We found that a simple lexical model achieved a mean F1 score of 0.865 (SD 0.048) on the telemedical triage task. GloVe-based models using SVMs, HANs, and bi-LSTMs achieved a 0.8-, 1.5-, and 2.1-point increase in the F1 score, respectively. Transformer-based models, such as BERT, Bio+Clinical-BERT, and SBERT, achieved a mean F1 score of 0.914 (SD 0.034), 0.904 (SD 0.041), and 0.917 (SD 0.037), respectively. The highest-performing model, SBERT, provided a statistically significant improvement compared to all GloVe-based and lexical baselines. However, no statistical significance was found when comparing transformer-based models. Furthermore, our error analysis revealed highly challenging query types, including those with complex negations, temporal relationships, and patient intents. Conclusions: We showed that state-of-the-art transfer learning techniques work well on the telemedical triage task, providing significant performance increase over lexical models. Additionally, we released a public telemedical triage data set using labeled questions from online medical question-and-answer (Q&A) platforms. Our analysis highlights various avenues for future works that explicitly model such query challenges. %M 35981230 %R 10.2196/37770 %U https://medinform.jmir.org/2022/9/e37770 %U https://doi.org/10.2196/37770 %U http://www.ncbi.nlm.nih.gov/pubmed/35981230 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 9 %P e39144 %T Exploring Motivations for COVID-19 Vaccination Among Black Young Adults in 3 Southern US States: Cross-sectional Study %A Stoner,Marie CD %A Browne,Erica N %A Tweedy,David %A Pettifor,Audrey E %A Maragh-Bass,Allysha C %A Toval,Christina %A Tolley,Elizabeth E %A Comello,Maria Leonora G %A Muessig,Kathryn E %A Budhwani,Henna %A Hightow-Weidman,Lisa B %+ RTI International, 2150 Shattuck Avenue, Berkeley, CA, 94704, United States, 1 510 665 8285 ext 34285, mcstoner@rti.org %K COVID-19 %K COVID-19 vaccination %K young people %K vaccination motivations %K vaccination beliefs %K online survey %K health disparity %K minority population %K vaccine hesitancy %K misinformation %K vaccine safety %D 2022 %7 2.9.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Few studies have focused on attitudes toward COVID-19 vaccination among Black or African American young adults (BYA) in the Southern United States, despite high levels of infection in this population. Objective: To understand this gap, we conducted an online survey to explore beliefs and experiences related to COVID-19 vaccination among BYA (aged 18-29 years) in 3 southern states. Methods: We recruited 150 BYA to participate in an online survey as formative research for an intervention to address vaccine hesitancy in Alabama, Georgia, and North Carolina from September 22, 2021, to November 18, 2021. Participants were recruited through social media ads on Facebook, Twitter, Instagram, and YouTube. Additionally, we distributed information about the survey through organizations working with BYA in Alabama, Georgia, and North Carolina; our community partners; and network collaborations. We used measures that had been used and were previously validated in prior surveys, adapting them to the context of this study. Results: Roughly 28 (19%) of the participants had not received any doses of the COVID-19 vaccine. Half of the unvaccinated respondents (n=14, 50%) reported they wanted to wait longer before getting vaccinated. Motivators to get vaccinated were similar between unvaccinated and vaccinated respondents (eg, if required, to protect the health of others), but the main motivator for those vaccinated was to protect one’s own health. Among unvaccinated individuals, reasons for not receiving the COVID-19 vaccine included concern about vaccine side effects (n=15, 54%) and mistrust of vaccine safety (n=13, 46%), of effectiveness (n=12, 43%), and of the government’s involvement with vaccines (n=12, 43%). Experiences of discrimination (n=60, 40%) and mistrust of vaccines (n=54, 36%) were common overall. Among all respondents, those who said they would be motivated to get vaccinated if it was required for school, work, or travel were more likely to endorse negative beliefs about vaccines compared to those motivated for other reasons. Conclusions: Mistrust in COVID-19 vaccine safety and efficacy is common among BYA in the Southern United States, irrespective of vaccination status. Other motivators, such as safety of family and community and vaccination requirements, may be able to tip the scales toward a decision to be vaccinated among those who are initially hesitant. However, it is unclear how vaccine requirements among BYA in the South affect trust in the government or health care in the long term. Interventions that include BYA in vaccination messaging and programs may more proactively build feelings of trust and combat misinformation. %M 35969516 %R 10.2196/39144 %U https://formative.jmir.org/2022/9/e39144 %U https://doi.org/10.2196/39144 %U http://www.ncbi.nlm.nih.gov/pubmed/35969516 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 8 %P e38802 %T The Disparities in Patient Portal Use Among Patients With Rheumatic and Musculoskeletal Diseases: Retrospective Cross-sectional Study %A Sun,Enid Y %A Alvarez,Carolina %A Callahan,Leigh F %A Sheikh,Saira Z %+ Thurston Arthritis Research Center, University of North Carolina, 3300 Thurston Building, CB #7280, Chapel Hill, NC, 27599, United States, 1 919 843 6619, szsheikh@email.unc.edu %K COVID-19 %K telemedicine %K telehealth %K health technology %K health care disparities %K patient portal %K rheumatology %K musculoskeletal diseases %K chronic disease %K digital health %K MyChart %K rural area %K minority population %K virtual care %D 2022 %7 31.8.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: During the COVID-19 pandemic, the shift to virtual care became essential for the continued care of patients. Individuals with rheumatic and musculoskeletal diseases (RMDs) especially require frequent provider visits and close monitoring. To date, there have been limited studies examining inequities in health technology use among patients with RMDs. Objective: Our goal was to identify characteristics associated with patient portal use before and after the COVID-19 pandemic in a convenience sample of patients with RMDs from a large academic medical center. Methods: In this cross-sectional study, Epic electronic medical record data were queried to identify established patients of the University of North Carolina Hospitals adult rheumatology clinic between November 1, 2017, through November 30, 2019. Demographic and clinical data were collected to compare MyChart (Epic’s patient portal) users with nonusers before and after the COVID-19 pandemic. MyChart activation and use were modeled using logistic regression and adjusted odds ratios, and confidence intervals were estimated. Results: We identified 5075 established patients with RMDs who met the inclusion criteria. Prior to the pandemic, we found that younger age (P<.001), suburban residence (P=.05), commercial/state insurance (P<.001), military insurance (P=.05), and median income >US $50,000 (P<.001) were associated with significantly higher odds of MyChart activation. Male sex (P<.001), being of Black or African American (P<.001) or “other” race (P<.001), Spanish as a primary language (P<.001), rural residence (P=.007), Medicaid insurance (P<.001), and median income of 1 year ago among the distributions of people who answered whether they tested positive or were diagnosed with COVID-19 by a clinician. We also used multivariable logistic regression with iterative resampling to investigate the relationship between these variables occurring >1 year ago (ie, before the pandemic) and the likelihood of contracting COVID-19. Results: We observed a significantly higher frequency of self-reported violent ideation, disruptive behavior, and psychotic symptoms, for all 3 time windows of people who tested positive or were diagnosed with COVID-19 by a clinician. Using multivariable logistic regression, we observed 72% to 94% model accuracy for an increased incidence of COVID-19 in participants who reported violent ideation, disruptive behavior, or psychotic symptoms >1 year ago. Conclusions: This preliminary study found that people who reported a test or clinician diagnosis of COVID-19 also reported higher frequencies of violent ideation, disruptive behavior, or psychotic symptoms across multiple time windows, indicating that they were not likely to be the result of COVID-19. In parallel, participants who reported these behaviors >1 year ago (ie, before the pandemic) were more likely to be diagnosed with COVID-19, suggesting that violent ideation, disruptive behavior, in addition to psychotic symptoms, were associated with COVID-19 with an approximately 70% to 90% likelihood. %M 35763758 %R 10.2196/36444 %U https://formative.jmir.org/2022/8/e36444 %U https://doi.org/10.2196/36444 %U http://www.ncbi.nlm.nih.gov/pubmed/35763758 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 9 %N 3 %P e36836 %T Feasibility of Virtual Reality Exercises at Home for Post–COVID-19 Condition: Cohort Study %A Groenveld,Tjitske %A Achttien,Retze %A Smits,Merlijn %A de Vries,Marjan %A van Heerde,Ron %A Staal,Bart %A van Goor,Harry %A , %+ Department of Surgery, Radboud Institute for Health Sciences, Radboud University Medical Center, Geert Grooteplein Zuid 10, Nijmegen, 6525GA, Netherlands, 31 243667331, tjitske.groenveld@radboudumc.nl %K virtual reality %K rehabilitation %K COVID-19 %K long COVID %K feasibility %K physical function %K quality of life %K pandemic %K multimodal virtual reality %K outpatient care %K physiotherapy %K digital health %K patient care %D 2022 %7 15.8.2022 %9 Original Paper %J JMIR Rehabil Assist Technol %G English %X Background: Between 30% to 76% of COVID-19 patients have persistent physical and mental symptoms, sometimes up to 9 months after acute COVID-19. Current rehabilitation is mostly focused on the physical symptoms, whereas experts have agreed on the need for a biopsychosocial approach. A novel approach such as virtual reality (VR) rehabilitation at home might benefit patients and therapists, especially considering the expected rush of patients with post–COVID-19 condition needing rehabilitation. Objective: The aim of this study was to investigate the feasibility of self-administered VR exercises at home for post–COVID-19 condition. Methods: This was a single-arm feasibility study in an outpatient care setting. Patients who needed physiotherapy because of post–COVID-19 condition were included as determined by the treating physiotherapist. Participants performed VR physical exercises at home for a period of 6 weeks and were allowed to perform VR mental exercise through applications available on the VR platform to reduce stress and anxiety and promote cognitive functioning. The main outcomes were related to feasibility (ie, duration and frequency of VR use), safety (ie, adverse events), patient satisfaction, and reasons to withdraw. Physical performance, daily activities, cognitive functioning, anxiety and depression, and the quality of life were measured before and after. Results: In total, 48 patients were included; 1 (2%) patient did not start VR, and 7 (15%) patients withdrew, mostly due to dizziness. Almost 70% (33/47) of participants reported experiencing any adverse event during VR exercising. However, only 25% (9/36) recalled these events at the end of the intervention period. The majority (27/36, 75%) of the patients described VR as having a positive influence on their recovery, and the global satisfaction score was 67%. The average VR use was 30 minutes per session, 3-4 times a week for 3-6 weeks. The overall use of VR applications was almost equally distributed over the 3 sets of VR exercises (physical, relaxing, and cognitive). However, the use frequency of physical exercises seemed to decrease over time, whereas the use of cognitive and relaxation exercises remained stable. Physical performance and quality of life outcomes were significantly improved after 6 weeks. Conclusions: VR physical exercises at home is feasible and safe with good acceptance in a significant percentage of patient with post–COVID-19 condition. Trial Registration: ClinicalTrials.gov NCT04505761; https://clinicaltrials.gov/ct2/show/NCT04505761 %M 35858254 %R 10.2196/36836 %U https://rehab.jmir.org/2022/3/e36836 %U https://doi.org/10.2196/36836 %U http://www.ncbi.nlm.nih.gov/pubmed/35858254 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 8 %P e40288 %T Factors Associated With the Utilization of Outpatient Virtual Clinics: Retrospective Observational Study Using Multilevel Analysis %A Tzeng,Yun-Hsuan %A Yin,Wei-Hsian %A Lin,Kuan-Chia %A Wei,Jeng %A Liou,Hao-Ren %A Sung,Hung-Ju %A Lang,Hui-Chu %+ Institute of Hospital and Health Care Administration, National Yang Ming Chiao Tung University, No 155, Sec 2, Linong Street, Beitou District, Taipei, 112, Taiwan, 886 2 28267000 ext 67015, hclang@nycu.edu.tw %K telemedicine %K remote consultation %K e-consult %K virtual clinic %K outpatient %K virtual care %K virtual consult %K physicians %K health policy %K health care delivery %K COVID-19 %K multilevel analysis %K outpatient clinic %K telehealth %K virtual health %K health care system %K adoption %K attitude %K perception %D 2022 %7 12.8.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Although the COVID-19 pandemic has accelerated the adoption of telemedicine and virtual consultations worldwide, complex factors that may affect the use of virtual clinics are still unclear. Objective: This study aims to identify factors associated with the utilization of virtual clinics in the experience of virtual clinic service implementation in Taiwan. Methods: We retrospectively analyzed a total of 187,742 outpatient visits (176,815, 94.2%, in-person visits and 10,927, 5.8%, virtual visits) completed at a large general hospital in Taipei City from May 19 to July 31, 2021, after rapid implementation of virtual outpatient clinic visits due to the COVID-19 pandemic. Data of patients’ demographic characteristics, disease type, physicians’ features, and specialties/departments were collected, and physicians’ opinions regarding virtual clinics were surveyed and evaluated using a 5-point Likert scale. Multilevel analysis was conducted to determine the factors associated with the utilization of virtual clinics. Results: Patient-/visit-, physician-, and department-level factors accounted for 67.5%, 11.1%, and 21.4% of the total variance in the utilization of virtual clinics, respectively. Female sex (odds ratio [OR] 1.27, 95% CI 1.22-1.33, P<.001); residing at a greater distance away from the hospital (OR 2.36, 95% CI 2.15-2.58 if distance>50 km, P<.001; OR 3.95, 95% CI 3.11-5.02 if extensive travel required, P<.001); reimbursement by the National Health Insurance (NHI; OR 7.29, 95% CI 5.71-9.30, P<.001); seeking care for a major chronic disease (OR 1.33, 95% CI 1.24-1.42, P<.001); the physician’s positive attitude toward virtual clinics (OR 1.50, 95% CI 1.16-1.93, P=.002); and visits within certain departments, including the heart center, psychiatry, and internal medicine (OR 2.55, 95% CI 1.46-4.46, P=.004), were positively associated with the utilization of virtual clinics. The patient’s age, the physician’s age, and the physician’s sex were not associated with the utilization of virtual clinics in our study. Conclusions: Our results show that in addition to previously demonstrated patient-level factors that may influence telemedicine use, including the patient’s sex and distance from the hospital, factors at the visit level (insurance type, disease type), physician level (physician’s attitude toward virtual clinics), and department level also contribute to the utilization of virtual clinics. Although there was a more than 300-fold increase in the number of virtual visits during the pandemic compared with the prepandemic period, the majority (176,815/187,742, 94.2%) of the outpatient visits were still in-person visits during the study period. Therefore, it is of great importance to understand the factors impacting the utilization of virtual clinics to accelerate the implementation of telemedicine. The findings of our study may help direct policymaking for expanding the use of virtual clinics, especially in countries struggling with the development and promotion of telemedicine virtual clinic services. %M 35917486 %R 10.2196/40288 %U https://www.jmir.org/2022/8/e40288 %U https://doi.org/10.2196/40288 %U http://www.ncbi.nlm.nih.gov/pubmed/35917486 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 8 %P e36989 %T Developing a Long COVID Phenotype for Postacute COVID-19 in a National Primary Care Sentinel Cohort: Observational Retrospective Database Analysis %A Mayor,Nikhil %A Meza-Torres,Bernardo %A Okusi,Cecilia %A Delanerolle,Gayathri %A Chapman,Martin %A Wang,Wenjuan %A Anand,Sneha %A Feher,Michael %A Macartney,Jack %A Byford,Rachel %A Joy,Mark %A Gatenby,Piers %A Curcin,Vasa %A Greenhalgh,Trisha %A Delaney,Brendan %A de Lusignan,Simon %+ Nuffield Department of Primary Care Health Sciences, University of Oxford, Eagle House, 7 Walton Well Road, Oxford, OX2 6ED, United Kingdom, 44 01865 616600, simon.delusignan@phc.ox.ac.uk %K medical record systems %K computerized %K Systematized Nomenclature of Medicine %K postacute COVID-19 syndrome %K phenotype %K COVID-19 %K long COVID %K ethnicity %K social class %K general practitioners %K data accuracy %K data extracts %K biomedical ontologies %K SARS-CoV-2 %K hospitalization %K epidemiology %K surveillance %K public health %K BioPortal %K electronic health record %K disease management %K digital tool %D 2022 %7 11.8.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Following COVID-19, up to 40% of people have ongoing health problems, referred to as postacute COVID-19 or long COVID (LC). LC varies from a single persisting symptom to a complex multisystem disease. Research has flagged that this condition is underrecorded in primary care records, and seeks to better define its clinical characteristics and management. Phenotypes provide a standard method for case definition and identification from routine data and are usually machine-processable. An LC phenotype can underpin research into this condition. Objective: This study aims to develop a phenotype for LC to inform the epidemiology and future research into this condition. We compared clinical symptoms in people with LC before and after their index infection, recorded from March 1, 2020, to April 1, 2021. We also compared people recorded as having acute infection with those with LC who were hospitalized and those who were not. Methods: We used data from the Primary Care Sentinel Cohort (PCSC) of the Oxford Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC) database. This network was recruited to be nationally representative of the English population. We developed an LC phenotype using our established 3-step ontological method: (1) ontological step (defining the reasoning process underpinning the phenotype, (2) coding step (exploring what clinical terms are available, and (3) logical extract model (testing performance). We created a version of this phenotype using Protégé in the ontology web language for BioPortal and using PhenoFlow. Next, we used the phenotype to compare people with LC (1) with regard to their symptoms in the year prior to acquiring COVID-19 and (2) with people with acute COVID-19. We also compared hospitalized people with LC with those not hospitalized. We compared sociodemographic details, comorbidities, and Office of National Statistics–defined LC symptoms between groups. We used descriptive statistics and logistic regression. Results: The long-COVID phenotype differentiated people hospitalized with LC from people who were not and where no index infection was identified. The PCSC (N=7.4 million) includes 428,479 patients with acute COVID-19 diagnosis confirmed by a laboratory test and 10,772 patients with clinically diagnosed COVID-19. A total of 7471 (1.74%, 95% CI 1.70-1.78) people were coded as having LC, 1009 (13.5%, 95% CI 12.7-14.3) had a hospital admission related to acute COVID-19, and 6462 (86.5%, 95% CI 85.7-87.3) were not hospitalized, of whom 2728 (42.2%) had no COVID-19 index date recorded. In addition, 1009 (13.5%, 95% CI 12.73-14.28) people with LC were hospitalized compared to 17,993 (4.5%, 95% CI 4.48-4.61; P<.001) with uncomplicated COVID-19. Conclusions: Our LC phenotype enables the identification of individuals with the condition in routine data sets, facilitating their comparison with unaffected people through retrospective research. This phenotype and study protocol to explore its face validity contributes to a better understanding of LC. %M 35861678 %R 10.2196/36989 %U https://publichealth.jmir.org/2022/8/e36989 %U https://doi.org/10.2196/36989 %U http://www.ncbi.nlm.nih.gov/pubmed/35861678 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 2 %N 2 %P e33713 %T Physical Distancing and Social Media Use in Emerging Adults and Adults During the COVID-19 Pandemic: Large-scale Cross-sectional and Longitudinal Survey Study %A van Woudenberg,Thabo %A Buijzen,Moniek %A Hendrikx,Roy %A van Weert,Julia %A van den Putte,Bas %A Kroese,Floor %A Bouman,Martine %A de Bruin,Marijn %A Lambooij,Mattijs %+ Erasmus School of Social and Behavioural Sciences, Erasmus University Rotterdam, Burgemeester Oudlaan 50, Rotterdam, 3062 PA, Netherlands, 31 10 408 2135, vanwoudenberg@eur.nl %K COVID-19 %K physical distancing %K compliance %K emerging adults %K social media %D 2022 %7 11.8.2022 %9 Original Paper %J JMIR Infodemiology %G English %X Background: Although emerging adults play a role in the spread of COVID-19, they are less likely to develop severe symptoms after infection. Emerging adults’ relatively high use of social media as a source of information raises concerns regarding COVID-19–related behavioral compliance (ie, physical distancing) in this age group. Objective: This study aimed to investigate physical distancing among emerging adults in comparison with adults and examine the role of using social media for COVID-19 news and information in this regard. In addition, this study explored the relationship between physical distancing and using different social media platforms and sources. Methods: The secondary data of a large-scale longitudinal national survey (N=123,848) between April and November 2020 were used. Participants indicated, ranging from 1 to 8 waves, how often they were successful in keeping a 1.5-m distance on a 7-point Likert scale. Participants aged between 18 and 24 years were considered emerging adults, and those aged >24 years were considered adults. In addition, a dummy variable was created to indicate per wave whether participants used social media for COVID-19 news and information. A subset of participants received follow-up questions to determine which platforms they used and what sources of news and information they had seen on social media. All preregistered hypotheses were tested with linear mixed-effects models and random intercept cross-lagged panel models. Results: Emerging adults reported fewer physical distancing behaviors than adults (β=−.08, t86,213.83=−26.79; P<.001). Moreover, emerging adults were more likely to use social media for COVID-19 news and information (b=2.48; odds ratio 11.93 [95% CI=9.72-14.65]; SE 0.11; Wald=23.66; P<.001), which mediated the association with physical distancing but only to a small extent (indirect effect: b=−0.03, 95% CI −0.04 to −0.02). Contrary to our hypothesis, the longitudinal random intercept cross-lagged panel model showed no evidence that physical distancing was not influenced by social media use in the previous wave. However, evidence indicated that social media use affects subsequent physical distancing behavior. Moreover, additional analyses showed that the use of most social media platforms (ie, YouTube, Facebook, and Instagram) and interpersonal communication were negatively associated with physical distancing, whereas other platforms (ie, LinkedIn and Twitter) and government messages had no or small positive associations with physical distancing. Conclusions: In conclusion, we should be vigilant with regard to the physical distancing of emerging adults, but the study results did not indicate concerns regarding the role of social media for COVID-19 news and information. However, as the use of some social media platforms and sources showed negative associations with physical distancing, future studies should more carefully examine these factors to better understand the associations between social media use for news and information and behavioral interventions in times of crisis. %M 35996459 %R 10.2196/33713 %U https://infodemiology.jmir.org/2022/2/e33713 %U https://doi.org/10.2196/33713 %U http://www.ncbi.nlm.nih.gov/pubmed/35996459 %0 Journal Article %@ 1947-2579 %I JMIR Publications %V 14 %N 1 %P e12419 %T Roles of Health Literacy in Relation to Social Determinants of Health and Recommendations for Informatics-Based Interventions: Systematic Review %D 2022 %7 ..2022 %9 %J Online J Public Health Inform %G English %X Objective: The aims of the study were to examine the association between social media sentiments surrounding COVID-19 vaccination and the effects on vaccination rates in the United States (US), as well as other contributing factors to the COVID-19 vaccine hesitancy.Method: The dataset used in this study consists of vaccine-related English tweets collected in real-time from January 4 - May 11, 2021, posted within the US, as well as health literacy (HL), social vulnerability index (SVI), and vaccination rates at the state level.Results: The findings presented in this study demonstrate a significant correlation between the sentiments of the tweets and the vaccination rate in the US. The results also suggest a significant negative association between HL and SVI and that the state demographics correlate with both HL and SVI.Discussion: Social media activity provides insights into public opinion about vaccinations and helps determine the required public health interventions to increase the vaccination rate in the US.Conclusion: Health literacy, social vulnerability index and monitoring of social media sentiments need to be considered in public health interventions as part of vaccination campaigns.Keywords: COVID–19, Health Literacy, COVID–19 Vaccine Hesitancy, Social Vulnerability Index, Social Media, Social Determinants of HealthAbbreviations: Health Literacy (HL), Social Vulnerability Index (SVI), Social Determinants of Health (SDOH), United States (US)Correspondence: gabriela.wilson@uta.edu %M 36120165 %R 10.5210/ojphi.v14i1.12419 %U %U https://doi.org/10.5210/ojphi.v14i1.12419 %U http://www.ncbi.nlm.nih.gov/pubmed/36120165 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 3 %P e34952 %T Understanding the Experience of Geriatric Care Professionals in Using Telemedicine to Care for Older Patients in Response to the COVID-19 Pandemic: Mixed Methods Study %A Chen,Wenwen %A Flanagan,Ashley %A Nippak,Pria MD %A Nicin,Michael %A Sinha,Samir K %+ National Institute on Ageing, Ted Rogers School of Management, Toronto Metropolitan University, 350 Victoria Street, Toronto, ON, M5B 2K3, Canada, 1 416 586 4800 ext 7859, Samir.Sinha@sinaihealth.ca %K telemedicine %K virtual care visit %K geriatric care professionals %K aging population %K Consolidated Framework for Implementation Research %K geriatric care %K older adults %K elderly care %K telehealth %K digital health %K COVID-19 %K pandemic %K technology usability %D 2022 %7 10.8.2022 %9 Original Paper %J JMIR Aging %G English %X Background: Geriatric care professionals were forced to rapidly adopt the use of telemedicine technologies to ensure the continuity of care for their older patients in response to the COVID-19 pandemic. However, there is little current literature that describes how telemedicine technologies can best be used to meet the needs of geriatric care professionals in providing care to frail older patients, their caregivers, and their families. Objective: This study aims to identify the benefits and challenges geriatric care professionals face when using telemedicine technologies with frail older patients, their caregivers, and their families and how to maximize the benefits of this method of providing care. Methods: This was a mixed methods study that recruited geriatric care professionals to complete an online survey regarding their personal demographics and experiences with using telemedicine technologies and participate in a semistructured interview. Interview responses were analyzed using the Consolidated Framework for Implementation Research (CFIR). Results: Quantitative and qualitative data were obtained from 30 practicing geriatric care professionals (22, 73%, geriatricians, 5, 17%, geriatric psychiatrists, and 3, 10%, geriatric nurse practitioners) recruited from across the Greater Toronto Area. Analysis of interview data identified 5 CFIR contextual barriers (complexity, design quality and packaging, patient needs and resources, readiness for implementation, and culture) and 13 CFIR contextual facilitators (relative advantage, adaptability, tension for change, available resources, access to knowledge, networks and communications, compatibility, knowledge and beliefs, self-efficacy, champions, external agents, executing, and reflecting and evaluating). The CFIR concept of external policy and incentives was found to be a neutral construct. Conclusions: This is the first known study to use the CFIR to develop a comprehensive narrative to characterize the experiences of Ontario geriatric care professionals using telemedicine technologies in providing care. Overall, telemedicine can significantly enable most of the geriatric care that is traditionally provided in person but is less useful in providing specific aspects of geriatric care to frail older patients, their caregivers, and their families. %M 35830331 %R 10.2196/34952 %U https://aging.jmir.org/2022/3/e34952 %U https://doi.org/10.2196/34952 %U http://www.ncbi.nlm.nih.gov/pubmed/35830331 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 8 %P e38443 %T Racial Bias Beliefs Related to COVID-19 Among Asian Americans, Native Hawaiians, and Pacific Islanders: Findings From the COVID-19 Effects on the Mental and Physical Health of Asian Americans and Pacific Islanders Survey Study (COMPASS) %A Park,Van Ta %A Tsoh,Janice Y %A Dougan,Marcelle %A Nam,Bora %A Tzuang,Marian %A Park,Linda G %A Vuong,Quyen N %A Bang,Joon %A Meyer,Oanh L %+ Department of Community Health Systems, School of Nursing, University of California San Francisco, 2 Koret Way, San Francisco, CA, 94143, United States, 1 (415) 514 3318, van.park@ucsf.edu %K COVID-19 %K racial bias %K Asian American %K Native Hawaiian and Pacific Islander %K mobile phone %D 2022 %7 9.8.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: During the COVID-19 pandemic, there have been increased reports of racial biases against Asian American and Native Hawaiian and Pacific Islander individuals. However, the extent to which different Asian American and Native Hawaiian and Pacific Islander groups perceive and experience (firsthand or as a witness to such experiences) how COVID-19 has negatively affected people of their race has not received much attention. Objective: This study used data from the COVID-19 Effects on the Mental and Physical Health of Asian Americans and Pacific Islanders Survey Study (COMPASS), a nationwide, multilingual survey, to empirically examine COVID-19–related racial bias beliefs among Asian American and Native Hawaiian and Pacific Islander individuals and the factors associated with these beliefs. Methods: COMPASS participants were Asian American and Native Hawaiian and Pacific Islander adults who were able to speak English, Chinese (Cantonese or Mandarin), Korean, Samoan, or Vietnamese and who resided in the United States during the time of the survey (October 2020 to May 2021). Participants completed the survey on the web, via phone, or in person. The Coronavirus Racial Bias Scale (CRBS) was used to assess COVID-19–related racial bias beliefs toward Asian American and Native Hawaiian and Pacific Islander individuals. Participants were asked to rate the degree to which they agreed with 9 statements on a 5-point Likert scale (ie, 1=strongly disagree to 5=strongly agree). Multivariable linear regression was used to examine the associations between demographic, health, and COVID-19–related characteristics and perceived racial bias. Results: A total of 5068 participants completed the survey (mean age 45.4, SD 16.4 years; range 18-97 years). Overall, 73.97% (3749/5068) agreed or strongly agreed with ≥1 COVID-19–related racial bias belief in the past 6 months (during the COVID-19 pandemic). Across the 9 racial bias beliefs, participants scored an average of 2.59 (SD 0.96, range 1-5). Adjusted analyses revealed that compared with Asian Indians, those who were ethnic Chinese, Filipino, Hmong, Japanese, Korean, Vietnamese, and other or multicultural had significantly higher mean CRBS scores, whereas no significant differences were found among Native Hawaiian and Pacific Islander individuals. Nonheterosexual participants had statistically significant and higher mean CRBS scores than heterosexual participants. Compared with participants aged ≥60 years, those who were younger (aged <30, 30-39, 40-49, and 50-59 years) had significantly higher mean CRBS scores. US-born participants had significantly higher mean CRBS scores than foreign-born participants, whereas those with limited English proficiency (relative to those reporting no limitation) had lower mean CRBS scores. Conclusions: Many COMPASS participants reported racial bias beliefs because of the COVID-19 pandemic. Relevant sociodemographic contexts and pre-existing and COVID-19–specific factors across individual, community, and society levels were associated with the perceived racial bias of being Asian during the pandemic. The findings underscore the importance of addressing the burden of racial bias on Asian American and Native Hawaiian and Pacific Islander communities among other COVID-19–related sequelae. %M 35658091 %R 10.2196/38443 %U https://www.jmir.org/2022/8/e38443 %U https://doi.org/10.2196/38443 %U http://www.ncbi.nlm.nih.gov/pubmed/35658091 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 8 %P e35840 %T Investigating Linkages Between Spatiotemporal Patterns of the COVID-19 Delta Variant and Public Health Interventions in Southeast Asia: Prospective Space-Time Scan Statistical Analysis Method %A Luo,Wei %A Liu,Zhaoyin %A Zhou,Yuxuan %A Zhao,Yumin %A Li,Yunyue Elita %A Masrur,Arif %A Yu,Manzhu %+ Department of Geography, National University of Singapore, 1 Arts Link, #04-32 Block AS2, Singapore, 117570, Singapore, 65 65163851, geowl@nus.edu.sg %K COVID-19 %K Delta variant %K space-time scan %K intervention %K Southeast Asia %D 2022 %7 9.8.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The COVID-19 Delta variant has presented an unprecedented challenge to countries in Southeast Asia (SEA). Its transmission has shown spatial heterogeneity in SEA after countries have adopted different public health interventions during the process. Hence, it is crucial for public health authorities to discover potential linkages between epidemic progression and corresponding interventions such that collective and coordinated control measurements can be designed to increase their effectiveness at reducing transmission in SEA. Objective: The purpose of this study is to explore potential linkages between the spatiotemporal progression of the COVID-19 Delta variant and nonpharmaceutical intervention (NPI) measures in SEA. We detected the space-time clusters of outbreaks of COVID-19 and analyzed how the NPI measures relate to the propagation of COVID-19. Methods: We collected district-level daily new cases of COVID-19 from June 1 to October 31, 2021, and district-level population data in SEA. We adopted prospective space-time scan statistics to identify the space-time clusters. Using cumulative prospective space-time scan statistics, we further identified variations of relative risk (RR) across each district at a half-month interval and their potential public health intervention linkages. Results: We found 7 high-risk clusters (clusters 1-7) of COVID-19 transmission in Malaysia, the Philippines, Thailand, Vietnam, and Indonesia between June and August, 2021, with an RR of 5.45 (P<.001), 3.50 (P<.001), 2.30 (P<.001), 1.36 (P<.001), 5.62 (P<.001), 2.38 (P<.001), 3.45 (P<.001), respectively. There were 34 provinces in Indonesia that have successfully mitigated the risk of COVID-19, with a decreasing range between –0.05 and –1.46 due to the assistance of continuous restrictions. However, 58.6% of districts in Malaysia, Singapore, Thailand, and the Philippines saw an increase in the infection risk, which is aligned with their loosened restrictions. Continuous strict interventions were effective in mitigating COVID-19, while relaxing restrictions may exacerbate the propagation risk of this epidemic. Conclusions: The analyses of space-time clusters and RRs of districts benefit public health authorities with continuous surveillance of COVID-19 dynamics using real-time data. International coordination with more synchronized interventions amidst all SEA countries may play a key role in mitigating the progression of COVID-19. %M 35861674 %R 10.2196/35840 %U https://publichealth.jmir.org/2022/8/e35840 %U https://doi.org/10.2196/35840 %U http://www.ncbi.nlm.nih.gov/pubmed/35861674 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 8 %P e38776 %T Increased Online Aggression During COVID-19 Lockdowns: Two-Stage Study of Deep Text Mining and Difference-in-Differences Analysis %A Hsu,Jerome Tze-Hou %A Tsai,Richard Tzong-Han %+ Center for Geographic Information Science, Research Center for Humanities and Social Sciences, Academia Sinica, 128 Academia Road, Section 2, Nankang, Taipei, 11529, Taiwan, 886 2 27898150, rthtsai@gate.sinica.edu.tw %K natural language processing %K lockdown %K online aggression %K infoveillance %K causal relationship %K social media %K neural networks %K computer %K pandemic %K COVID-19 %K emotions %K internet %K sentiment analysis %K Twitter %K content analysis %K infodemiology %D 2022 %7 9.8.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic caused a critical public health crisis worldwide, and policymakers are using lockdowns to control the virus. However, there has been a noticeable increase in aggressive social behaviors that threaten social stability. Lockdown measures might negatively affect mental health and lead to an increase in aggressive emotions. Discovering the relationship between lockdown and increased aggression is crucial for formulating appropriate policies that address these adverse societal effects. We applied natural language processing (NLP) technology to internet data, so as to investigate the social and emotional impacts of lockdowns. Objective: This research aimed to understand the relationship between lockdown and increased aggression using NLP technology to analyze the following 3 kinds of aggressive emotions: anger, offensive language, and hate speech, in spatiotemporal ranges of tweets in the United States. Methods: We conducted a longitudinal internet study of 11,455 Twitter users by analyzing aggressive emotions in 1,281,362 tweets they posted from 2019 to 2020. We selected 3 common aggressive emotions (anger, offensive language, and hate speech) on the internet as the subject of analysis. To detect the emotions in the tweets, we trained a Bidirectional Encoder Representations from Transformers (BERT) model to analyze the percentage of aggressive tweets in every state and every week. Then, we used the difference-in-differences estimation to measure the impact of lockdown status on increasing aggressive tweets. Since most other independent factors that might affect the results, such as seasonal and regional factors, have been ruled out by time and state fixed effects, a significant result in this difference-in-differences analysis can not only indicate a concrete positive correlation but also point to a causal relationship. Results: In the first 6 months of lockdown in 2020, aggression levels in all users increased compared to the same period in 2019. Notably, users under lockdown demonstrated greater levels of aggression than those not under lockdown. Our difference-in-differences estimation discovered a statistically significant positive correlation between lockdown and increased aggression (anger: P=.002, offensive language: P<.001, hate speech: P=.005). It can be inferred from such results that there exist causal relations. Conclusions: Understanding the relationship between lockdown and aggression can help policymakers address the personal and societal impacts of lockdown. Applying NLP technology and using big data on social media can provide crucial and timely information for this effort. %M 35943771 %R 10.2196/38776 %U https://www.jmir.org/2022/8/e38776 %U https://doi.org/10.2196/38776 %U http://www.ncbi.nlm.nih.gov/pubmed/35943771 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 8 %P e38247 %T Programmatic Adoption and Implementation of Video-Observed Therapy in Minnesota: Prospective Observational Cohort Study %A Bachina,Preetham %A Lippincott,Christopher Kirk %A Perry,Allison %A Munk,Elizabeth %A Maltas,Gina %A Bohr,Rebecca %A Rock,Robert Bryan %A Shah,Maunank %+ Division of Infectious Diseases, Johns Hopkins School of Medicine, CRB-II, 1M-10, 1550 Orleans St, Baltimore, MD, 21287, United States, 1 4432870401, mshah28@jhmi.edu %K video directly observed therapy %K vDOT %K mobile health %K mHealth %K tuberculosis %K medication adherence %K telemedicine %K treatment %K telehealth %K observed therapy %K COVID-19 %K primary outcome %K treatment adherence %K technology adoption %K virtual health %D 2022 %7 5.8.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: In-person directly observed therapy (DOT) is standard of care for tuberculosis (TB) treatment adherence monitoring in the US, with increasing use of video-DOT (vDOT). In Minneapolis, vDOT became available in 2019. Objective: In this paper, we aimed to evaluate the use and effectiveness of vDOT in a program setting, including comparison of verified adherence among those receiving vDOT and in-person DOT. We also sought to understand the impact of COVID-19 on TB treatment adherence and technology adoption. Methods: We abstracted routinely collected data on individuals receiving therapy for TB in Minneapolis, MN, between September 2019 and June 2021. Our primary outcomes were to assess vDOT use and treatment adherence, defined as the proportion of prescribed doses (7 days per week) verified by observation (in person versus video-DOT), and to compare individuals receiving therapy in the pre–COVID-19 (before March 2020), and post–COVID-19 (after March 2020) periods; within the post–COVID-19 period, we evaluated early COVID-19 (March-August 2020), and intra–COVID-19 (after August 2020) periods. Results: Among 49 patients with TB (mean age 41, SD 19; n=27, 55% female and n=47, 96% non–US born), 18 (36.7%) received treatment during the post–COVID-19 period. Overall, verified adherence (proportion of observed doses) was significantly higher when using vDOT (mean 81%, SD 17.4) compared to in-person DOT (mean 54.5%, SD 10.9; P=.001). The adoption of vDOT increased significantly from 35% (11/31) of patients with TB in the pre–COVID-19 period to 67% (12/18) in the post–COVID-19 period (P=.04). Consequently, overall verified (ie, observed) adherence among all patients with TB in the clinic improved across the study periods (56%, 67%, and 79%, P=.001 for the pre–, early, and intra–COVID-19 periods, respectively). Conclusions: vDOT use increased after the COVID-19 period, was more effective than in-person DOT at verifying ingestion of prescribed treatment, and led to overall increased verified adherence in the clinic despite the onset of the COVID-19 pandemic. %M 35834671 %R 10.2196/38247 %U https://formative.jmir.org/2022/8/e38247 %U https://doi.org/10.2196/38247 %U http://www.ncbi.nlm.nih.gov/pubmed/35834671 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 8 %P e33964 %T Sleep Patterns and Affect Dynamics Among College Students During the COVID-19 Pandemic: Intensive Longitudinal Study %A Mousavi,Zahra Avah %A Lai,Jocelyn %A Simon,Katharine %A Rivera,Alexander P %A Yunusova,Asal %A Hu,Sirui %A Labbaf,Sina %A Jafarlou,Salar %A Dutt,Nikil D %A Jain,Ramesh C %A Rahmani,Amir M %A Borelli,Jessica L %+ Department of Psychological Science, University of California, Irvine, Social & Behavioral Sciences Gateway, Irvine, CA, 92697, United States, 1 949 824 6803, mousaviz@uci.edu %K sleep %K objective sleep outcomes %K COVID-19 %K affect variability %K affect dynamics %D 2022 %7 5.8.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Sleep disturbance is a transdiagnostic risk factor that is so prevalent among young adults that it is considered a public health epidemic, which has been exacerbated by the COVID-19 pandemic. Sleep may contribute to mental health via affect dynamics. Prior literature on the contribution of sleep to affect is largely based on correlational studies or experiments that do not generalize to the daily lives of young adults. Furthermore, the literature examining the associations between sleep variability and affect dynamics remains scant. Objective: In an ecologically valid context, using an intensive longitudinal design, we aimed to assess the daily and long-term associations between sleep patterns and affect dynamics among young adults during the COVID-19 pandemic. Methods: College student participants (N=20; female: 13/20, 65%) wore an Oura ring (Ōura Health Ltd) continuously for 3 months to measure sleep patterns, such as average and variability in total sleep time (TST), wake after sleep onset (WASO), sleep efficiency, and sleep onset latency (SOL), resulting in 1173 unique observations. We administered a daily ecological momentary assessment by using a mobile health app to evaluate positive affect (PA), negative affect (NA), and COVID-19 worry once per day. Results: Participants with a higher sleep onset latency (b=−1.09, SE 0.36; P=.006) and TST (b=−0.15, SE 0.05; P=.008) on the prior day had lower PA on the next day. Further, higher average TST across the 3-month period predicted lower average PA (b=−0.36, SE 0.12; P=.009). TST variability predicted higher affect variability across all affect domains. Specifically, higher variability in TST was associated higher PA variability (b=0.09, SE 0.03; P=.007), higher negative affect variability (b=0.12, SE 0.05; P=.03), and higher COVID-19 worry variability (b=0.16, SE 0.07; P=.04). Conclusions: Fluctuating sleep patterns are associated with affect dynamics at the daily and long-term scales. Low PA and affect variability may be potential pathways through which sleep has implications for mental health. %M 35816447 %R 10.2196/33964 %U https://formative.jmir.org/2022/8/e33964 %U https://doi.org/10.2196/33964 %U http://www.ncbi.nlm.nih.gov/pubmed/35816447 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 8 %P e37367 %T Misinformation About COVID-19 Vaccines on Social Media: Rapid Review %A Skafle,Ingjerd %A Nordahl-Hansen,Anders %A Quintana,Daniel S %A Wynn,Rolf %A Gabarron,Elia %+ Faculty of Health, Welfare, and Organisation, Østfold University College, B R A Veien 4, Halden, 1757, Norway, 47 69 60 80 00, ingjerd.skafle@hiof.no %K social media %K misinformation %K COVID-19 vaccines %K vaccination hesitancy %K autism spectrum disorder %D 2022 %7 4.8.2022 %9 Review %J J Med Internet Res %G English %X Background: The development of COVID-19 vaccines has been crucial in fighting the pandemic. However, misinformation about the COVID-19 pandemic and vaccines is spread on social media platforms at a rate that has made the World Health Organization coin the phrase infodemic. False claims about adverse vaccine side effects, such as vaccines being the cause of autism, were already considered a threat to global health before the outbreak of COVID-19. Objective: We aimed to synthesize the existing research on misinformation about COVID-19 vaccines spread on social media platforms and its effects. The secondary aim was to gain insight and gather knowledge about whether misinformation about autism and COVID-19 vaccines is being spread on social media platforms. Methods: We performed a literature search on September 9, 2021, and searched PubMed, PsycINFO, ERIC, EMBASE, Cochrane Library, and the Cochrane COVID-19 Study Register. We included publications in peer-reviewed journals that fulfilled the following criteria: original empirical studies, studies that assessed social media and misinformation, and studies about COVID-19 vaccines. Thematic analysis was used to identify the patterns (themes) of misinformation. Narrative qualitative synthesis was undertaken with the guidance of the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 Statement and the Synthesis Without Meta-analysis reporting guideline. The risk of bias was assessed using the Joanna Briggs Institute Critical Appraisal tool. Ratings of the certainty of evidence were based on recommendations from the Grading of Recommendations Assessment, Development and Evaluation Working Group. Results: The search yielded 757 records, with 45 articles selected for this review. We identified 3 main themes of misinformation: medical misinformation, vaccine development, and conspiracies. Twitter was the most studied social media platform, followed by Facebook, YouTube, and Instagram. A vast majority of studies were from industrialized Western countries. We identified 19 studies in which the effect of social media misinformation on vaccine hesitancy was measured or discussed. These studies implied that the misinformation spread on social media had a negative effect on vaccine hesitancy and uptake. Only 1 study contained misinformation about autism as a side effect of COVID-19 vaccines. Conclusions: To prevent these misconceptions from taking hold, health authorities should openly address and discuss these false claims with both cultural and religious awareness in mind. Our review showed that there is a need to examine the effect of social media misinformation on vaccine hesitancy with a more robust experimental design. Furthermore, this review also demonstrated that more studies are needed from the Global South and on social media platforms other than the major platforms such as Twitter and Facebook. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42021277524; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021277524 International Registered Report Identifier (IRRID): RR2-10.31219/osf.io/tyevj %M 35816685 %R 10.2196/37367 %U https://www.jmir.org/2022/8/e37367 %U https://doi.org/10.2196/37367 %U http://www.ncbi.nlm.nih.gov/pubmed/35816685 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 10 %N 3 %P e36850 %T Social Media Users’ Perceptions of a Wearable Mixed Reality Headset During the COVID-19 Pandemic: Aspect-Based Sentiment Analysis %A Jeong,Heejin %A Bayro,Allison %A Umesh,Sai Patipati %A Mamgain,Kaushal %A Lee,Moontae %+ Department of Mechanical and Industrial Engineering, University of Illinois Chicago, 842 W Taylor St, Chicago, IL, 60607, United States, 1 312 355 5558, heejinj@uic.edu %K HoloLens 2 %K sentiment analysis %K natural language processing, Twitter %K COVID-19 %K usability evaluation %D 2022 %7 4.8.2022 %9 Original Paper %J JMIR Serious Games %G English %X Background: Mixed reality (MR) devices provide real-time environments for physical-digital interactions across many domains. Owing to the unprecedented COVID-19 pandemic, MR technologies have supported many new use cases in the health care industry, enabling social distancing practices to minimize the risk of contact and transmission. Despite their novelty and increasing popularity, public evaluations are sparse and often rely on social interactions among users, developers, researchers, and potential buyers. Objective: The purpose of this study is to use aspect-based sentiment analysis to explore changes in sentiment during the onset of the COVID-19 pandemic as new use cases emerged in the health care industry; to characterize net insights for MR developers, researchers, and users; and to analyze the features of HoloLens 2 (Microsoft Corporation) that are helpful for certain fields and purposes. Methods: To investigate the user sentiment, we collected 8492 tweets on a wearable MR headset, HoloLens 2, during the initial 10 months since its release in late 2019, coinciding with the onset of the pandemic. Human annotators rated the individual tweets as positive, negative, neutral, or inconclusive. Furthermore, by hiring an interannotator to ensure agreements between the annotators, we used various word vector representations to measure the impact of specific words on sentiment ratings. Following the sentiment classification for each tweet, we trained a model for sentiment analysis via supervised learning. Results: The results of our sentiment analysis showed that the bag-of-words tokenizing method using a random forest supervised learning approach produced the highest accuracy of the test set at 81.29%. Furthermore, the results showed an apparent change in sentiment during the COVID-19 pandemic period. During the onset of the pandemic, consumer goods were severely affected, which aligns with a drop in both positive and negative sentiment. Following this, there is a sudden spike in positive sentiment, hypothesized to be caused by the new use cases of the device in health care education and training. This pandemic also aligns with drastic changes in the increased number of practical insights for MR developers, researchers, and users and positive net sentiments toward the HoloLens 2 characteristics. Conclusions: Our approach suggests a simple yet effective way to survey public opinion about new hardware devices quickly. The findings of this study contribute to a holistic understanding of public perception and acceptance of MR technologies during the COVID-19 pandemic and highlight several new implementations of HoloLens 2 in health care. We hope that these findings will inspire new use cases and technological features. %M 35708916 %R 10.2196/36850 %U https://games.jmir.org/2022/3/e36850 %U https://doi.org/10.2196/36850 %U http://www.ncbi.nlm.nih.gov/pubmed/35708916 %0 Journal Article %@ 2561-1011 %I JMIR Publications %V 6 %N 2 %P e36442 %T The Association Between Telemedicine Use and Changes in Health Care Usage and Outcomes in Patients With Congestive Heart Failure: Retrospective Cohort Study %A Chu,Cherry %A Stamenova,Vess %A Fang,Jiming %A Shakeri,Ahmad %A Tadrous,Mina %A Bhatia,R Sacha %+ Ontario Health, 500-505 University Ave, Toronto, ON, M5G 2L3, Canada, 1 877 280 8538, sacha.bhatia@ontariohealth.ca %K telemedicine %K telehealth %K eHealth %K digital health %K population %K outcomes %K health service %K health system %K utilization %K congestive heart failure %K cardiology %K health outcome %K clinical outcome %K patient outcome %K heart %K cardiac %K cardiology %K ambulatory %K COVID-19 %D 2022 %7 4.8.2022 %9 Original Paper %J JMIR Cardio %G English %X Background: Telemedicine use has become widespread owing to the COVID-19 pandemic, but its impact on patient outcomes remains unclear. Objective: We sought to investigate the effect of telemedicine use on changes in health care usage and clinical outcomes in patients diagnosed with congestive heart failure (CHF). Methods: We conducted a population-based retrospective cohort study using administrative data in Ontario, Canada. Patients were included if they had at least one ambulatory visit between March 14 and September 30, 2020, and a heart failure diagnosis any time prior to March 14, 2020. Telemedicine users were propensity score–matched with unexposed users based on several baseline characteristics. Monthly use of various health care services was compared between the 2 groups during 12 months before to 3 months after their index in-person or telemedicine ambulatory visit after March 14, 2020, using generalized estimating equations. Results: A total of 11,131 pairs of telemedicine and unexposed patients were identified after matching (49% male; mean age 78.9, SD 12.0 years). All patients showed significant reductions in health service usage from pre- to postindex visit. There was a greater decline across time in the unexposed group than in the telemedicine group for CHF admissions (ratio of slopes for high- vs low-frequency users 1.02, 95% CI 1.02-1.03), cardiovascular admissions (1.03, 95% CI 1.02-1.04), any-cause admissions (1.03, 95% CI 1.02-1.04), any-cause ED visits (1.03, 95% CI 1.03-1.04), visits with any cardiologist (1.01, 95% CI 1.01-1.02), laboratory tests (1.02, 95% CI 1.02-1.03), diagnostic tests (1.04, 95% CI 1.03-1.05), and new prescriptions (1.02, 95% CI 1.01-1.03). However, the decline in primary care visit rates was steeper among telemedicine patients than among unexposed patients (ratio of slopes 0.99, 95% CI 0.99-1.00). Conclusions: Overall health care usage over time appeared higher among telemedicine users than among low-frequency users or nonusers, suggesting that telemedicine was used by patients with the greatest need or that it allowed patients to have better access or continuity of care among those who received it. %M 35881831 %R 10.2196/36442 %U https://cardio.jmir.org/2022/2/e36442 %U https://doi.org/10.2196/36442 %U http://www.ncbi.nlm.nih.gov/pubmed/35881831 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 8 %P e38351 %T Knowledge, Attitude, Practices, and Vaccine Hesitancy Among the Latinx Community in Southern California Early in the COVID-19 Pandemic: Cross-sectional Survey %A Mehta,Shivani N %A Burger,Zoe C %A Meyers-Pantele,Stephanie A %A Garfein,Richard S %A Ortiz,Dayanna O %A Mudhar,Pavan K %A Kothari,Smit B %A Kothari,Jigna %A Meka,Meena %A Rodwell,Timothy %+ San Diego School Of Medicine, University of California, 9500 Gilman Dr #0039, La Jolla, CA, 92093, United States, 1 7146790080, s1mehta@ucsd.edu %K COVID-19 %K knowledge %K attitude %K practices %K KAP survey %K vaccine hesitancy %K Latinx %K Latinx cohort %K minority population %K primary care %K sociodemographic characteristic %K public health %K vulnerable population %K epidemiology %D 2022 %7 4.8.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The Latinx population in the United States has experienced high rates of infection, hospitalization, and death since the beginning of the COVID-19 pandemic. There is little data on the knowledge, attitude, and practices (KAP) specifically in Latinx communities in the United States. Objective: We aimed to assess COVID-19 KAP and vaccine hesitancy among a Latinx cohort in the early stages of the COVID-19 pandemic (from July 2020 to October 2020), at a unique time when a vaccine was not available.  Methods: Participants aged ≥18 years were recruited at a primary care clinic in Southern California and asked to self-report sociodemographic characteristics, KAP, and vaccine hesitancy. A subset of the participants answered the vaccine hesitancy assessment as it was added after the start of data collection. KAP items were summed to create composite scores, with higher scores reflecting increased COVID-19 knowledge, positive attitudes toward the COVID-19 pandemic, and disease prevention practices. Bivariate and multivariable regression models were fitted to test associations between sociodemographic characteristics and KAP scores. For our analysis, we only included patients who self-identified as Latinx. Results: Our final data set included 265 participants. The participants had a mean age of 49 (IQR 38.5-59) years, and 72.1% (n=191) were female, 77% (n=204) had at most a high school degree, 34.7% (n=92) had an annual income .05). A significant difference was observed in the check-out time between the two groups in the two time periods, with checking out taking longer during the COVID-19 period (P<.001). Conclusions: Our results show that our theater start times were earlier during the COVID-19 pandemic, and the overall theater efficiency was maintained despite the additional COVID-19 infection control protocols that were in place. These findings suggest that well-planned infection control protocols do not need to impede trauma theater efficiency in certain settings. %M 35704770 %R 10.2196/35805 %U https://www.i-jmr.org/2022/2/e35805 %U https://doi.org/10.2196/35805 %U http://www.ncbi.nlm.nih.gov/pubmed/35704770 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 7 %P e36029 %T Physicians’ Perceptions of Telemedicine Use During the COVID-19 Pandemic in Riyadh, Saudi Arabia: Cross-sectional Study %A Idriss,Sarah %A Aldhuhayyan,Abdullah %A Alanazi,Ahmad Abdullah %A Alasaadi,Walaa %A Alharbi,Reem %A Alshahwan,Ghadah %A Baitalmal,Mohammad %A Alonazi,Wadi %+ Ministry of Health, Prince Abdulrahman Bin Abdulaziz St, Riyadh, Saudi Arabia, 966 555070628, s.idriss@hotmail.com %K burnout %K COVID-19 %K patient experience %K perception %K physicians %K telemedicine %K virtual %D 2022 %7 12.7.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The term “telemedicine” refers to the use of communication technology to deliver health care remotely. The COVID-19 pandemic had substantial impacts on health care delivery from 2020 onward, and it was necessary to adapt high-quality care in a manner that limited the potential for viral exposure of both patients and health care workers. Physicians employed video, phone, and electronic written (e-consultation) visits, all of which provided quality of care comparable to that of face-to-face visits while reducing barriers of adopting telemedicine. Objective: This study sought to assess physicians’ perspectives and attitudes regarding the use of telemedicine in Riyadh hospitals during the COVID-19 pandemic. The main objects of assessment were as follows: (1) physicians’ experience using telemedicine, (2) physicians’ willingness to use telemedicine in the future, (3) physicians’ perceptions of patient experiences, and (4) the influence of telemedicine on burnout. Methods: This study employed SurveyMonkey to develop and distribute an anonymous 28-question cross-sectional survey among physicians across all specialty disciplines in Riyadh hospitals. A chi-square test was used to determine the level of association between variables, with significance set to P<.05. Results: The survey was distributed among 500 physicians who experienced telemedicine between October 2021 and December 2021. A total of 362 doctors were included, of whom 28.7% (n=104) were consultants, 30.4% (n=110) were specialists, and 40.9% (n=148) were residents. Male doctors formed the majority 56.1% (n=203), and female doctors accounted for 43.9% (n=159). Overall, 34% (n=228) agreed or somewhat agreed that the “quality of care during telemedicine is comparable with that of face-to-face visits.” Approximately 70% (n=254) believed that telemedicine consultation is cost-effective. Regarding burnout, 4.1% (n=15), 7.5% (n=27), and 27.3% (n=99) of the doctors reported feeling burnout every day, a few times a week, and a few times per month, respectively. Conclusions: The physicians had generally favorable attitudes toward telemedicine, believing that its quality of health care delivery is comparable to that of in-person care. However, further research is necessary to determine how physicians’ attitudes toward telemedicine have changed since the pandemic and how this virtual technology can be used to improve physicians’ professional and personal well-being. %M 35714293 %R 10.2196/36029 %U https://formative.jmir.org/2022/7/e36029 %U https://doi.org/10.2196/36029 %U http://www.ncbi.nlm.nih.gov/pubmed/35714293 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 10 %N 3 %P e37026 %T Effect of the “Art Coloring” Online Coloring Game on Subjective Well-Being Increase and Anxiety Reduction During the COVID-19 Pandemic: Development and Evaluation %A Xi,JuZhe %A Gao,YuHan %A Lyu,Na %A She,Zhuang %A Wang,XinYue %A Zhang,Xin-An %A Yu,XiaoYu %A Ji,WeiDong %A Wei,MengSheng %A Dai,WeiHui %A Qian,Xuesheng %+ School of Management, Fudan University, Room 722, Siyuan Building, 670 Guoshun Road, Shanghai, 200433, China, 86 13916208229, qianxuesheng@fudan.edu.cn %K coloring game %K online intervention %K mental health %K COVID-19 pandemic %K gamification %K game-based intervention %K commercially released game %D 2022 %7 8.7.2022 %9 Original Paper %J JMIR Serious Games %G English %X Background: COVID-19 has spread worldwide and generated tremendous stress on human beings. Unfortunately, it is often hard for distressed individuals to access mental health services under conditions of restricted movement or even lockdown. Objective: The study first aims to develop an online digital intervention package based on a commercially released coloring game. The second aim is to test the effectiveness of difference intervention packages for players to increase subjective well-being (SWB) and reduce anxiety during the pandemic. Methods: An evidence-based coloring intervention package was developed and uploaded to an online coloring game covering almost 1.5 million players worldwide in January 2021. Players worldwide participated to color either 4 rounds of images characterized by awe, pink, nature, and blue or 4 rounds of irrelevant images. Participants' SWB and anxiety and the perceived effectiveness of the game in reducing anxiety (subjective effectiveness [SE]) were assessed 1 week before the intervention (T1), after the participants completed pictures in each round (T2-T5), and after the intervention (T6). Independent 2-tailed t tests were conducted to examine the general intervention (GI) effect and the intervention effect of each round. Univariate analysis was used to examine whether these outcome variables were influenced by the number of rounds completed. Results: In total, 1390 players worldwide responded and completed at least 1 assessment. Overall, the GI group showed a statistical significantly greater increase in SWB than the general control (GC) group (N=164, t162=3.59, Cohen d=0.59, 95% CI 0.36-1.24, P<.001). Compared to the control group, the best effectiveness of the intervention group was seen in the awe round, in which the increase in SWB was significant (N=171, t169=2.51, Cohen d=0.39, 95% CI 0.10-0.82, P=.01), and players who colored all 4 pictures had nearly significant improvements in SWB (N=171, F4,170=2.34, partial ŋ2=0.053, P=.06) and a significant decrease in anxiety (N=171, F4,170=3.39, partial ŋ2=0.075, P=.01). Conclusions: These data indicate the effectiveness of online psychological interventions, such as coloring games, for mental health in the specific period. They also show the feasibility of applying existing commercial games embedded with scientific psychological interventions that can fill the gap in mental crises and services for a wider group of people during the pandemic. The results would inspire innovations to prevent the psychological problems caused by public emergencies and encourage more games, especially the most popular ones, to take more positive action for the common crises of humankind. %M 35575761 %R 10.2196/37026 %U https://games.jmir.org/2022/3/e37026 %U https://doi.org/10.2196/37026 %U http://www.ncbi.nlm.nih.gov/pubmed/35575761 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 7 %P e29337 %T Understanding the Security and Privacy Concerns About the Use of Identifiable Health Data in the Context of the COVID-19 Pandemic: Survey Study of Public Attitudes Toward COVID-19 and Data-Sharing %A Summers,Charlotte %A Griffiths,Frances %A Cave,Jonathan %A Panesar,Arjun %+ DDM Health, Technology House, Science Park, University of Warwick, Coventry, CV4 7EZ, United Kingdom, 44 7969091134, charlotte@ddm.health %K COVID-19 %K data %K data ethics %K privacy %K sharing %K ethics %K attitude %K perception %K data sharing %K survey %K understanding %K security %K health data %K willingness %D 2022 %7 7.7.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic increased the availability and use of population and individual health data to optimize tracking and analysis of the spread of the virus. Many health care services have had to rapidly digitalize in order to maintain the continuity of care provision. Data collection and dissemination have provided critical support for defending against the spread of the virus since the beginning of the pandemic; however, little is known about public perceptions of and attitudes toward the use, privacy, and security of data. Objective: The goal of this study is to better understand people’s willingness to share data in the context of the COVID-19 pandemic. Methods: A web-based survey was conducted on individuals’ use of and attitudes toward health data for individuals aged 18 years and older, and in particular, with a reported diagnosis of a chronic health condition placing them at the highest risk of severe COVID-19. Results: In total, 4764 individuals responded to this web-based survey, of whom 4674 (98.1%) reported a medical diagnosis of at least 1 health condition (3 per person on average), with type 2 diabetes (n=2974, 62.7%), hypertension (n=2147, 45.2%), and type 1 diabetes (n=1299, 27.4%) being most prominent in our sample. In general, more people are comfortable with sharing anonymized data than personally identifiable data. People reported feeling comfortable sharing data that were able to benefit others; 66% (3121 respondents) would share personal identifiable data if its primary purpose was deemed beneficial for the health of others. Almost two-thirds (n=3026; 63.9%) would consent to sharing personal, sensitive health data with government or health authority organizations. Conversely, over a quarter of respondents (n=1297, 27.8%) stated that they did not trust any organization to protect their data, and 54% (n=2528) of them reported concerns about the implications of sharing personal information. Almost two-thirds (n=3054, 65%) of respondents were concerned about the provisions of appropriate legislation that seeks to prevent data misuse and hold organizations accountable in the case of data misuse. Conclusions: Although our survey focused mainly on the views of those living with chronic health conditions, the results indicate that data sensitivity is highly contextual. More people are more comfortable with sharing anonymized data rather than personally identifiable data. Willingness to share data also depended on the receiving body, highlighting trust as a key theme, in particular who may have access to shared personal health data and how they may be used in the future. The nascency of legal guidance in this area suggests a need for humanitarian guidelines for data responsibility during disaster relief operations such as pandemics and for involving the public in their development. %M 35609306 %R 10.2196/29337 %U https://formative.jmir.org/2022/7/e29337 %U https://doi.org/10.2196/29337 %U http://www.ncbi.nlm.nih.gov/pubmed/35609306 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 7 %P e38523 %T Health Misinformation Across Multiple Digital Ecologies: Qualitative Study of Data From Interviews With International Students %A Bahl,Rashika %A Chang,Shanton %A McKay,Dana %A Buchanan,George %+ School of Computing and Information Systems, University of Melbourne, Grattan Street, Parkville, 3053, Australia, 61 83441583, rashikabahl@gmail.com %K international students %K social media %K COVID-19 %K misinformation %K infodemic %K digital ecology %K health information %K information seeking %K web-based health information %D 2022 %7 6.7.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Transient migrants such as international students have received limited support from host country governments throughout the COVID-19 pandemic. An increase in misinformation, resulting in poor health outcomes for individuals, may impact an already vulnerable group. Objective: Existing research examines the spread of misinformation. Similarly, there is extensive literature on the health information behavior of international students. However, there is a gap in the literature focusing on international students’ interaction with health misinformation. This exploratory research aims to address this gap by examining international students’ interaction with health misinformation during the COVID-19 pandemic. Methods: A total of 11 participants took part in semistructured interviews and a health misinformation-identification exercise via Zoom. The data collected were subjected to qualitative thematic analysis. Multiple rounds of coding, checked by other coders, revealed 2 themes and 6 subthemes. Results: The 2 main themes that emerged were (1) approaches to dealing with health misinformation and (2) how international students navigate across multiple digital ecologies. Results show that international students who draw on multiple digital ecologies for information reliably identify misinformation, suggesting that the use of multiple digital ecologies may have a protective effect against health misinformation. Conclusions: Findings show that international students encounter health misinformation across multiple digital ecologies, and they also compare information across multiple ecologies. This comparison may support them in identifying health misinformation. Thus, the findings of this study combat narratives of international students’ susceptibility to misinformation. %M 35727960 %R 10.2196/38523 %U https://www.jmir.org/2022/7/e38523 %U https://doi.org/10.2196/38523 %U http://www.ncbi.nlm.nih.gov/pubmed/35727960 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 7 %P e38418 %T Chatbot-Delivered COVID-19 Vaccine Communication Message Preferences of Young Adults and Public Health Workers in Urban American Communities: Qualitative Study %A Weeks,Rose %A Cooper,Lyra %A Sangha,Pooja %A Sedoc,João %A White,Sydney %A Toledo,Assaf %A Gretz,Shai %A Lahav,Dan %A Martin,Nina %A Michel,Alexandra %A Lee,Jae Hyoung %A Slonim,Noam %A Bar-Zeev,Naor %+ International Vaccine Access Center, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 415 N Washington Street 5th Floor, Baltimore, MD, 21231, United States, 1 3478046526, rweeks@jhu.edu %K vaccine hesitancy %K COVID-19 %K chatbots %K AI %K artificial intelligence %K natural language processing %K social media %K vaccine communication %K digital health %K misinformation %K infodemic %K infodemiology %K conversational agent %K public health %K user need %K vaccination %K health communication %K online health information %D 2022 %7 6.7.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Automated conversational agents, or chatbots, have a role in reinforcing evidence-based guidance delivered through other media and offer an accessible, individually tailored channel for public engagement. In early-to-mid 2021, young adults and minority populations disproportionately affected by COVID-19 in the United States were more likely to be hesitant toward COVID-19 vaccines, citing concerns regarding vaccine safety and effectiveness. Successful chatbot communication requires purposive understanding of user needs. Objective: We aimed to review the acceptability of messages to be delivered by a chatbot named VIRA from Johns Hopkins University. The study investigated which message styles were preferred by young, urban-dwelling Americans as well as public health workers, since we anticipated that the chatbot would be used by the latter as a job aid. Methods: We conducted 4 web-based focus groups with 20 racially and ethnically diverse young adults aged 18-28 years and public health workers aged 25-61 years living in or near eastern-US cities. We tested 6 message styles, asking participants to select a preferred response style for a chatbot answering common questions about COVID-19 vaccines. We transcribed, coded, and categorized emerging themes within the discussions of message content, style, and framing. Results: Participants preferred messages that began with an empathetic reflection of a user concern and concluded with a straightforward, fact-supported response. Most participants disapproved of moralistic or reasoning-based appeals to get vaccinated, although public health workers felt that such strong statements appealing to communal responsibility were warranted. Responses tested with humor and testimonials did not appeal to the participants. Conclusions: To foster credibility, chatbots targeting young people with vaccine-related messaging should aim to build rapport with users by deploying empathic, reflective statements, followed by direct and comprehensive responses to user queries. Further studies are needed to inform the appropriate use of user-customized testimonials and humor in the context of chatbot communication. %M 35737898 %R 10.2196/38418 %U https://www.jmir.org/2022/7/e38418 %U https://doi.org/10.2196/38418 %U http://www.ncbi.nlm.nih.gov/pubmed/35737898 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 7 %P e37806 %T Impact of COVID-19 Vaccine Misinformation on Social Media Virality: Content Analysis of Message Themes and Writing Strategies %A Ngai,Cindy Sing Bik %A Singh,Rita Gill %A Yao,Le %+ Department of Chinese and Bilingual Studies, Hong Kong Polytechnic University, AG520b, Kowloon, Hong Kong, 852 27667465, cindy.sb.ngai@polyu.edu.hk %K antivaccine misinformation %K content themes %K writing strategies %K COVID-19 %K virality %K social media %K content analysis %D 2022 %7 6.7.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Vaccines serve an integral role in containing pandemics, yet vaccine hesitancy is prevalent globally. One key reason for this hesitancy is the pervasiveness of misinformation on social media. Although considerable research attention has been drawn to how exposure to misinformation is closely associated with vaccine hesitancy, little scholarly attention has been given to the investigation or robust theorizing of the various content themes pertaining to antivaccine misinformation about COVID-19 and the writing strategies in which these content themes are manifested. Virality of such content on social media exhibited in the form of comments, shares, and reactions has practical implications for COVID-19 vaccine hesitancy. Objective: We investigated whether there were differences in the content themes and writing strategies used to disseminate antivaccine misinformation about COVID-19 and their impact on virality on social media. Methods: We constructed an antivaccine misinformation database from major social media platforms during September 2019-August 2021 to examine how misinformation exhibited in the form of content themes and how these themes manifested in writing were associated with virality in terms of likes, comments, and shares. Antivaccine misinformation was retrieved from two globally leading and widely cited fake news databases, COVID Global Misinformation Dashboard and International Fact-Checking Network Corona Virus Facts Alliance Database, which aim to track and debunk COVID-19 misinformation. We primarily focused on 140 Facebook posts, since most antivaccine misinformation posts on COVID-19 were found on Facebook. We then employed quantitative content analysis to examine the content themes (ie, safety concerns, conspiracy theories, efficacy concerns) and manifestation strategies of misinformation (ie, mimicking of news and scientific reports in terms of the format and language features, use of a conversational style, use of amplification) in these posts and their association with virality of misinformation in the form of likes, comments, and shares. Results: Our study revealed that safety concern was the most prominent content theme and a negative predictor of likes and shares. Regarding the writing strategies manifested in content themes, a conversational style and mimicking of news and scientific reports via the format and language features were frequently employed in COVID-19 antivaccine misinformation, with the latter being a positive predictor of likes. Conclusions: This study contributes to a richer research-informed understanding of which concerns about content theme and manifestation strategy need to be countered on antivaccine misinformation circulating on social media so that accurate information on COVID-19 vaccines can be disseminated to the public, ultimately reducing vaccine hesitancy. The liking of COVID-19 antivaccine posts that employ language features to mimic news or scientific reports is perturbing since a large audience can be reached on social media, potentially exacerbating the spread of misinformation and hampering global efforts to combat the virus. %M 35731969 %R 10.2196/37806 %U https://www.jmir.org/2022/7/e37806 %U https://doi.org/10.2196/37806 %U http://www.ncbi.nlm.nih.gov/pubmed/35731969 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 7 %P e38584 %T Deep Denoising of Raw Biomedical Knowledge Graph From COVID-19 Literature, LitCovid, and Pubtator: Framework Development and Validation %A Jiang,Chao %A Ngo,Victoria %A Chapman,Richard %A Yu,Yue %A Liu,Hongfang %A Jiang,Guoqian %A Zong,Nansu %+ Department of Artificial Intelligence and Informatics Research, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, United States, 1 507 284 2511, Zong.Nansu@mayo.edu %K adversarial generative network %K knowledge graph %K deep denoising %K machine learning %K COVID-19 %K biomedical %K neural network %K network model %K training data %D 2022 %7 6.7.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Multiple types of biomedical associations of knowledge graphs, including COVID-19–related ones, are constructed based on co-occurring biomedical entities retrieved from recent literature. However, the applications derived from these raw graphs (eg, association predictions among genes, drugs, and diseases) have a high probability of false-positive predictions as co-occurrences in the literature do not always mean there is a true biomedical association between two entities. Objective: Data quality plays an important role in training deep neural network models; however, most of the current work in this area has been focused on improving a model’s performance with the assumption that the preprocessed data are clean. Here, we studied how to remove noise from raw knowledge graphs with limited labeled information. Methods: The proposed framework used generative-based deep neural networks to generate a graph that can distinguish the unknown associations in the raw training graph. Two generative adversarial network models, NetGAN and Cross-Entropy Low-rank Logits (CELL), were adopted for the edge classification (ie, link prediction), leveraging unlabeled link information based on a real knowledge graph built from LitCovid and Pubtator. Results: The performance of link prediction, especially in the extreme case of training data versus test data at a ratio of 1:9, demonstrated that the proposed method still achieved favorable results (area under the receiver operating characteristic curve >0.8 for the synthetic data set and 0.7 for the real data set), despite the limited amount of testing data available. Conclusions: Our preliminary findings showed the proposed framework achieved promising results for removing noise during data preprocessing of the biomedical knowledge graph, potentially improving the performance of downstream applications by providing cleaner data. %M 35658098 %R 10.2196/38584 %U https://www.jmir.org/2022/7/e38584 %U https://doi.org/10.2196/38584 %U http://www.ncbi.nlm.nih.gov/pubmed/35658098 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 7 %P e34605 %T Assessing the Implementation of Digital Innovations in Response to the COVID-19 Pandemic to Address Key Public Health Functions: Scoping Review of Academic and Nonacademic Literature %A Francombe,Joseph %A Ali,Gemma-Claire %A Gloinson,Emily Ryen %A Feijao,Carolina %A Morley,Katherine I %A Gunashekar,Salil %A de Carvalho Gomes,Helena %+ European Centre for Disease Prevention and Control, Gustav III:s Boulevard 40, Solna, Stockholm, 169 73, Sweden, 46 858601000, helena.gomes@ecdc.europa.eu %K digital technologies %K COVID-19 %K key public health functions %K scoping review %K digital health %K pandemic %K surveillance %K mobile phone %D 2022 %7 6.7.2022 %9 Review %J JMIR Public Health Surveill %G English %X Background: Digital technologies have been central to efforts to respond to the COVID-19 pandemic. In this context, a range of literature has reported on developments regarding the implementation of new digital technologies for COVID-19–related surveillance, prevention, and control. Objective: In this study, scoping reviews of academic and nonacademic literature were undertaken to obtain an overview of the evidence regarding digital innovations implemented to address key public health functions in the context of the COVID-19 pandemic. This study aimed to expand on the work of existing reviews by drawing on additional data sources (including nonacademic sources) by considering literature published over a longer time frame and analyzing data in terms of the number of unique digital innovations. Methods: We conducted a scoping review of the academic literature published between January 1, 2020, and September 15, 2020, supplemented by a further scoping review of selected nonacademic literature published between January 1, 2020, and October 13, 2020. Both reviews followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) approach. Results: A total of 226 academic articles and 406 nonacademic articles were included. The included articles provided evidence of 561 (academic literature) and 497 (nonacademic literature) unique digital innovations. The most common implementation settings for digital innovations were the United States, China, India, and the United Kingdom. Technologies most commonly used by digital innovations were those belonging to the high-level technology group of integrated and ubiquitous fixed and mobile networks. The key public health functions most commonly addressed by digital innovations were communication and collaboration and surveillance and monitoring. Conclusions: Digital innovations implemented in response to the COVID-19 pandemic have been wide ranging in terms of their implementation settings, the digital technologies used, and the public health functions addressed. However, evidence gathered through this study also points to a range of barriers that have affected the successful implementation of digital technologies for public health functions. It is also evident that many digital innovations implemented in response to the COVID-19 pandemic are yet to be formally evaluated or assessed. %M 35605152 %R 10.2196/34605 %U https://publichealth.jmir.org/2022/7/e34605 %U https://doi.org/10.2196/34605 %U http://www.ncbi.nlm.nih.gov/pubmed/35605152 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 7 %P e38000 %T Studying the Effect of Long COVID-19 Infection on Sleep Quality Using Wearable Health Devices: Observational Study %A Mekhael,Mario %A Lim,Chan Ho %A El Hajjar,Abdel Hadi %A Noujaim,Charbel %A Pottle,Christopher %A Makan,Noor %A Dagher,Lilas %A Zhang,Yichi %A Chouman,Nour %A Li,Dan L %A Ayoub,Tarek %A Marrouche,Nassir %+ Tulane University School of Medicine, Suite A128, 1324 Tulane Ave, New Orleans, LA, 70112, United States, 1 5049883072, nmarrouche@tulane.edu %K COVID-19 %K digital health %K wearables %K sleep %K long COVID-19 %K wearable device %K demographic %K biometric %K patient data %K sleep architecture %K health data %K health monitoring %D 2022 %7 5.7.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Patients with COVID-19 have increased sleep disturbances and decreased sleep quality during and after the infection. The current published literature focuses mainly on qualitative analyses based on surveys and subjective measurements rather than quantitative data. Objective: In this paper, we assessed the long-term effects of COVID-19 through sleep patterns from continuous signals collected via wearable wristbands. Methods: Patients with a history of COVID-19 were compared to a control arm of individuals who never had COVID-19. Baseline demographics were collected for each subject. Linear correlations among the mean duration of each sleep phase and the mean daily biometrics were performed. The average duration for each subject’s total sleep time and sleep phases per night was calculated and compared between the 2 groups. Results: This study includes 122 patients with COVID-19 and 588 controls (N=710). Total sleep time was positively correlated with respiratory rate (RR) and oxygen saturation (SpO2). Increased awake sleep phase was correlated with increased heart rate, decreased RR, heart rate variability (HRV), and SpO2. Increased light sleep time was correlated with increased RR and SpO2 in the group with COVID-19. Deep sleep duration was correlated with decreased heart rate as well as increased RR and SpO2. When comparing different sleep phases, patients with long COVID-19 had decreased light sleep (244, SD 67 vs 258, SD 67; P=.003) and decreased deep sleep time (123, SD 66 vs 128, SD 58; P=.02). Conclusions: Regardless of the demographic background and symptom levels, patients with a history of COVID-19 infection demonstrated altered sleep architecture when compared to matched controls. The sleep of patients with COVID-19 was characterized by decreased total sleep and deep sleep. %M 35731968 %R 10.2196/38000 %U https://www.jmir.org/2022/7/e38000 %U https://doi.org/10.2196/38000 %U http://www.ncbi.nlm.nih.gov/pubmed/35731968 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 7 %P e37567 %T Participant Experiences of a COVID-19 Virtual Clinical Study Using the Current Health Remote Monitoring Platform: Case Study and Qualitative Analysis %A Pugmire,Juliana %A Lever Taylor,Jessie %A Wilkes,Matt %A Wolfberg,Adam %A Zahradka,Nicole %+ Current Health Ltd, Suite 2, Ground Floor, Orchard Brae House, 30 Queensferry Road, Edinburgh, EH4 2HS, United Kingdom, 44 131 285 8101, juliana.pugmire@currenthealth.com %K virtual trial designs %K virtual enrollment %K digitalized health %K theoretical domains framework %K thematic analysis %K remote patient monitoring %D 2022 %7 5.7.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: During the COVID-19 pandemic, individuals with a positive viral test were enrolled in a study, within 48 hours, to remotely monitor their vital signs to characterize disease progression and recovery. A virtual trial design was adopted to reduce risks to participants and the research community in a study titled Risk Stratification and Early Alerting Regarding COVID-19 Hospitalization (RiskSEARCH). The Food and Drug Administration–cleared Current Health platform with a wearable device is a continuous remote patient monitoring technology that supports hospital-at-home care and is used as a data collection tool. Enrolled participants wore the Current Health wearable device continuously for up to 30 days and took a daily symptom survey via a tablet that was provided. A qualitative substudy was conducted in parallel to better understand virtual trial implementation, including barriers and facilitators for participants. Objective: This study aimed to understand the barriers and facilitators of the user experience of interacting with a virtual care platform and research team, while participating in a fully virtual study using qualitative and quantitative data. Methods: Semistructured interviews were conducted to understand participants’ experience of participating in a virtual study during a global pandemic. The schedule included their experience of enrollment and their interactions with equipment and study staff. A total of 3 RiskSEARCH participants were interviewed over telephone, and transcriptions were inductively coded and analyzed using thematic analysis. Themes were mapped onto the Theoretical Domains Framework (TDF) to identify and describe the factors that influenced study adherence. Quantitative metrics, including adherence to wearable and scheduled tasks collected as part of the RiskSEARCH main study, were paired with the interviews to present an overall picture of participation. Results: All participants exceeded our definition of a fully adherent participant and reported that participation was feasible and had a low burden. The symptoms progressively resolved during the trial. Inductive thematic analysis identified 13 main themes from the interview data, which were deductively mapped onto 11 of the 14 TDF domains, highlighting barriers and facilitators for each. Conclusions: Participants in the RiskSEARCH substudy showed high levels of adherence and engagement throughout participation. Although participants experienced some challenges in setting up and maintaining the Current Health kit (eg, charging devices), they reported feeling that the requirements of participation were both reasonable and realistic. We demonstrated that the TDF can be used for inductive thematic analysis. We anticipate expanding this work in future virtual studies and trials to identify barriers and enabling factors for implementation. %M 35671408 %R 10.2196/37567 %U https://formative.jmir.org/2022/7/e37567 %U https://doi.org/10.2196/37567 %U http://www.ncbi.nlm.nih.gov/pubmed/35671408 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 7 %P e37920 %T Use of Random Domain Intercept Technology to Track COVID-19 Vaccination Rates in Real Time Across the United States: Survey Study %A Sargent,Rikki H %A Laurie,Shaelyn %A Weakland,Leo F %A Lavery,James V %A Salmon,Daniel A %A Orenstein,Walter A %A Breiman,Robert F %+ RIWI Corp, 180 Bloor Street West, Suite 1000, Toronto, ON, M5S2V6, Canada, 1 888 505 7494, rsargent@riwi.com %K COVID-19 %K vaccination rates %K Random Domain Intercept Technology %K health technology %K vaccination %K vaccine tracker %K web-based survey %K epidemiology %K health data %K digital tool %K online intercept sampling %K health service %D 2022 %7 1.7.2022 %9 Short Paper %J J Med Internet Res %G English %X Background: Accurate and timely COVID-19 vaccination coverage data are vital for informing targeted, effective messaging and outreach and identifying barriers to equitable health service access. However, gathering vaccination rate data is challenging, and efforts often result in information that is either limited in scope (eg, limited to administrative data) or delayed (impeding the ability to rapidly respond). The evaluation of innovative technologies and approaches that can assist in addressing these limitations globally are needed. Objective: The objective of this survey study was to assess the validity of Random Domain Intercept Technology (RDIT; RIWI Corp) for tracking self-reported vaccination rates in real time at the US national and state levels. RDIT—a form of online intercept sampling—has the potential to address the limitations of current vaccination tracking systems by allowing for the measurement of additional data (eg, attitudinal data) and real-time, rapid data collection anywhere there is web access. Methods: We used RDIT from June 30 to July 26, 2021, to reach a broad sample of US adult (aged ≥18 years) web users and asked questions related to COVID-19 vaccination. Self-reported vaccination status was used as the focus of this validation exercise. National- and state-level RDIT-based vaccination rates were compared to Centers for Disease Control and Prevention (CDC)–reported national and state vaccination rates. Johns Hopkins University’s and Emory University’s institutional review boards designated this project as public health practice to inform message development (not human subjects research). Results: By using RDIT, 63,853 adult web users reported their vaccination status (6.2% of the entire 1,026,850 American web-using population that was exposed to the survey). At the national level, the RDIT-based estimate of adult COVID-19 vaccine coverage was slightly higher (44,524/63,853, 69.7%; 95% CI 69.4%-70.1%) than the CDC-reported estimate (67.9%) on July 15, 2021 (ie, midway through data collection; t63,852=10.06; P<.001). The RDIT-based and CDC-reported state-level estimates were strongly and positively correlated (r=0.90; P<.001). RDIT-based estimates were within 5 percentage points of the CDC’s estimates for 29 states. Conclusions: This broad-reaching, real-time data stream may provide unique advantages for tracking the use of a range of vaccines and for the timely evaluation of vaccination interventions. Moreover, RDIT could be harnessed to rapidly assess demographic, attitudinal, and behavioral constructs that are not available in administrative data, which could allow for deeper insights into the real-time predictors of vaccine uptake–enabling targeted and timely interventions. %M 35709335 %R 10.2196/37920 %U https://www.jmir.org/2022/7/e37920 %U https://doi.org/10.2196/37920 %U http://www.ncbi.nlm.nih.gov/pubmed/35709335 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 7 %P e38361 %T Lessons From the COVID-19 Pandemic to Improve the Health, Social Care, and Well-being of Minoritized Ethnic Groups With Chronic Conditions or Impairments: Protocol for a Mixed Methods Study %A Rivas,Carol %A Anand,Kusha %A Wu,Alison Fang-Wei %A Goff,Louise %A Dobson,Ruth %A Eccles,Jessica %A Ball,Elizabeth %A Kumar,Sarabajaya %A Camaradou,Jenny %A Redclift,Victoria %A Nasim,Bilal %A Aksoy,Ozan %+ Social Research Institute, University College London, 18 Woburn Square, London, WC1H 0NR, United Kingdom, 44 2076126923, c.rivas@ucl.ac.uk %K racism %K minoritized ethnic group %K disabled %K social care %K intersectional %K pandemic %K social networks %K public health %K migrant %K COVID-19 %D 2022 %7 1.7.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: The COVID-19 pandemic has inequitably impacted the experiences of people living with ill health/impairments or from minoritized ethnic groups across all areas of life. Given possible parallels in inequities for disabled people and people from minoritized ethnic backgrounds, their existence before the pandemic and increase since, and the discriminations that each group faces, our interest is in understanding the interplay between being disabled AND being from a minoritized ethnic group. Objective: The overarching aim of the Coronavirus Chronic Conditions and Disabilities Awareness (CICADA) project, building on this understanding, is to improve pandemic and longer-term support networks, and access to and experiences of care, services, and resources for these underserved groups, both during the pandemic and longer term, thereby reducing inequities and enhancing social, health, and well-being outcomes. Methods: This mixed methods study involves three “sweeps” of a new UK survey; secondary analyses of existing cohort and panel surveys; a rapid scoping review; a more granular review; and qualitative insights from over 200 semistructured interviews, including social network/map/photo elicitation methods and two subsequent sets of remote participatory research workshops. Separate stakeholder cocreation meetings, running throughout the study, will develop analyses and outputs. Our longitudinal study design enables the exploration of significant relationships between variables in the survey data collected and to the assessment of changes in variables over time, including consideration of varying pandemic contexts. The qualitative data will provide more granular detail. We will take a strengths and assets–based approach, underpinned by the social model of disability and by intersectional considerations to challenge discrimination. Our exploration of the social determinants of health and well-being is framed by the social ecological model. Results: The CICADA project was funded by the Health and Social Care Delivery Research (HSDR) Programme of the United Kingdom (UK) National Institute for Health and Care Research (NIHR) in March 2021 and began in May 2021. Further work within the project (84 interviews) was commissioned in March 2022, a substudy focusing on mental health, specifically in Northeast England, Greater Manchester, and the Northwest Coast of the United Kingdom. Data collection began in August 2021, with the last participants due to be recruited in September 2022. As of January 2022, 5792 survey respondents and 227 interviewees had provided data. From April 2022, the time of article submission, we will recruit participants for the substudy and wave 2 of the surveys and qualitative work. We expect results to be published by winter 2022. Conclusions: In studying the experiences of disabled people with impairments and those living with chronic conditions who come from certain minoritized ethnic groups, we are aiming for transformative research to improve their health and well-being. International Registered Report Identifier (IRRID): DERR1-10.2196/38361 %M 35609311 %R 10.2196/38361 %U https://www.researchprotocols.org/2022/7/e38361 %U https://doi.org/10.2196/38361 %U http://www.ncbi.nlm.nih.gov/pubmed/35609311 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 6 %P e33995 %T Reasons for COVID-19 Vaccine Hesitancy Among Chinese People Living With HIV/AIDS: Structural Equation Modeling Analysis %A Yao,Yan %A Chai,Ruiyu %A Yang,Jianzhou %A Zhang,Xiangjun %A Huang,Xiaojie %A Yu,Maohe %A Fu,Geng-feng %A Lan,Guanghua %A Qiao,Ying %A Zhou,Qidi %A Li,Shuyue %A Xu,Junjie %+ Clinical Research Academy, Peking University Shenzhen Hospital, Peking University, 1120, Lianhua Road, Futian District, Shenzhen, 518036, China, 86 755 8392333, xjjcmu@163.com %K COVID-19 vaccine %K vaccine hesitancy %K PLWHA %K structural equation modeling %D 2022 %7 30.6.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Many countries and organizations recommended people living with HIV/AIDS (PLWHA) receive the COVID-19 vaccine. However, vaccine hesitancy still exists and becomes a barrier for promoting COVID-19 vaccination among PLWHA. Objective: This study aims to investigate factors that contributed to COVID-19 vaccine hesitancy among PLWHA. Methods: The study used a multicenter cross-sectional design and an online survey mode. We recruited PLWHA aged 18-65 years from 5 metropolitan cities in China between January 2021 and February 2021. Participants completed an online survey through Golden Data, a widely used encrypted web-based survey platform. Multiple linear regression models were used to assess the background characteristics in relation to COVID-19 vaccine hesitancy, and structural equation modeling was performed to assess the relationships among perceived benefits, perceived risks, self-efficacy, subjective norms, and COVID-19 vaccine hesitancy. Results: Among 1735 participants, 41.61% (722/1735) reported COVID-19 vaccine hesitancy. Older age, no other vaccinations in the past 3 years, and having chronic disease history were positively associated with COVID-19 vaccine hesitancy. Structural equation modeling revealed a direct relationship of perceived benefits, perceived risks, and subjective norms with self-efficacy and vaccine hesitancy and an indirect relationship of perceived benefits, perceived risks, and subjective norms with vaccine hesitancy. Moreover, self-efficacy toward COVID-19 vaccination was low. PLWHA had concerns of HIV disclosure during COVID-19 vaccination. Family member support could have an impact on COVID-19 vaccination decision-making. Conclusions: COVID-19 vaccine hesitancy was high among PLWHA in China. To reduce COVID-19 vaccine hesitancy, programs and strategies should be adopted to eliminate the concerns for COVID-19 vaccination, disseminate accurate information on the safety and efficacy of the COVID-19 vaccine, encourage family member support for COVID-19 vaccination, and improve PLWHA’s trust of medical professionals. %M 35486810 %R 10.2196/33995 %U https://publichealth.jmir.org/2022/6/e33995 %U https://doi.org/10.2196/33995 %U http://www.ncbi.nlm.nih.gov/pubmed/35486810 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 2 %N 1 %P e34231 %T The Role of Influential Actors in Fostering the Polarized COVID-19 Vaccine Discourse on Twitter: Mixed Methods of Machine Learning and Inductive Coding %A Hagen,Loni %A Fox,Ashley %A O'Leary,Heather %A Dyson,DeAndre %A Walker,Kimberly %A Lengacher,Cecile A %A Hernandez,Raquel %+ School of Information, University of South Florida, 4202 E Fowler Ave, Tampa, FL, 33620, United States, 1 (813) 974 3520, lonihagen@usf.edu %K COVID-19, vaccine hesitancy, social media, influential actors %K influencer %K Twitter %D 2022 %7 30.6.2022 %9 Original Paper %J JMIR Infodemiology %G English %X Background: Since COVID-19 vaccines became broadly available to the adult population, sharp divergences in uptake have emerged along partisan lines. Researchers have indicated a polarized social media presence contributing to the spread of mis- or disinformation as being responsible for these growing partisan gaps in uptake. Objective: The major aim of this study was to investigate the role of influential actors in the context of the community structures and discourse related to COVID-19 vaccine conversations on Twitter that emerged prior to the vaccine rollout to the general population and discuss implications for vaccine promotion and policy. Methods: We collected tweets on COVID-19 between July 1, 2020, and July 31, 2020, a time when attitudes toward the vaccines were forming but before the vaccines were widely available to the public. Using network analysis, we identified different naturally emerging Twitter communities based on their internal information sharing. A PageRank algorithm was used to quantitively measure the level of “influentialness” of Twitter accounts and identifying the “influencers,” followed by coding them into different actor categories. Inductive coding was conducted to describe discourses shared in each of the 7 communities. Results: Twitter vaccine conversations were highly polarized, with different actors occupying separate “clusters.” The antivaccine cluster was the most densely connected group. Among the 100 most influential actors, medical experts were outnumbered both by partisan actors and by activist vaccine skeptics or conspiracy theorists. Scientists and medical actors were largely absent from the conservative network, and antivaccine sentiment was especially salient among actors on the political right. Conversations related to COVID-19 vaccines were highly polarized along partisan lines, with “trust” in vaccines being manipulated to the political advantage of partisan actors. Conclusions: These findings are informative for designing improved vaccine information communication strategies to be delivered on social media especially by incorporating influential actors. Although polarization and echo chamber effect are not new in political conversations in social media, it was concerning to observe these in health conversations on COVID-19 vaccines during the vaccine development process. %M 35814809 %R 10.2196/34231 %U https://infodemiology.jmir.org/2022/1/e34231 %U https://doi.org/10.2196/34231 %U http://www.ncbi.nlm.nih.gov/pubmed/35814809 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 10 %N 6 %P e37365 %T Combating COVID-19 Using Generative Adversarial Networks and Artificial Intelligence for Medical Images: Scoping Review %A Ali,Hazrat %A Shah,Zubair %+ College of Science and Engineering, Hamad Bin Khalifa University, Al Luqta St, Ar-Rayyan, Doha, 34110, Qatar, 974 50744851, zshah@hbku.edu.qa %K augmentation %K artificial intelligence %K COVID-19 %K diagnosis %K generative adversarial networks %K diagnostic %K lung image %K imaging %K data augmentation %K X-ray %K CT scan %K data scarcity %K image data %K neural network %K clinical informatics %D 2022 %7 29.6.2022 %9 Review %J JMIR Med Inform %G English %X Background: Research on the diagnosis of COVID-19 using lung images is limited by the scarcity of imaging data. Generative adversarial networks (GANs) are popular for synthesis and data augmentation. GANs have been explored for data augmentation to enhance the performance of artificial intelligence (AI) methods for the diagnosis of COVID-19 within lung computed tomography (CT) and X-ray images. However, the role of GANs in overcoming data scarcity for COVID-19 is not well understood. Objective: This review presents a comprehensive study on the role of GANs in addressing the challenges related to COVID-19 data scarcity and diagnosis. It is the first review that summarizes different GAN methods and lung imaging data sets for COVID-19. It attempts to answer the questions related to applications of GANs, popular GAN architectures, frequently used image modalities, and the availability of source code. Methods: A search was conducted on 5 databases, namely PubMed, IEEEXplore, Association for Computing Machinery (ACM) Digital Library, Scopus, and Google Scholar. The search was conducted from October 11-13, 2021. The search was conducted using intervention keywords, such as “generative adversarial networks” and “GANs,” and application keywords, such as “COVID-19” and “coronavirus.” The review was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines for systematic and scoping reviews. Only those studies were included that reported GAN-based methods for analyzing chest X-ray images, chest CT images, and chest ultrasound images. Any studies that used deep learning methods but did not use GANs were excluded. No restrictions were imposed on the country of publication, study design, or outcomes. Only those studies that were in English and were published from 2020 to 2022 were included. No studies before 2020 were included. Results: This review included 57 full-text studies that reported the use of GANs for different applications in COVID-19 lung imaging data. Most of the studies (n=42, 74%) used GANs for data augmentation to enhance the performance of AI techniques for COVID-19 diagnosis. Other popular applications of GANs were segmentation of lungs and superresolution of lung images. The cycleGAN and the conditional GAN were the most commonly used architectures, used in 9 studies each. In addition, 29 (51%) studies used chest X-ray images, while 21 (37%) studies used CT images for the training of GANs. For the majority of the studies (n=47, 82%), the experiments were conducted and results were reported using publicly available data. A secondary evaluation of the results by radiologists/clinicians was reported by only 2 (4%) studies. Conclusions: Studies have shown that GANs have great potential to address the data scarcity challenge for lung images in COVID-19. Data synthesized with GANs have been helpful to improve the training of the convolutional neural network (CNN) models trained for the diagnosis of COVID-19. In addition, GANs have also contributed to enhancing the CNNs’ performance through the superresolution of the images and segmentation. This review also identified key limitations of the potential transformation of GAN-based methods in clinical applications. %M 35709336 %R 10.2196/37365 %U https://medinform.jmir.org/2022/6/e37365 %U https://doi.org/10.2196/37365 %U http://www.ncbi.nlm.nih.gov/pubmed/35709336 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 6 %P e36050 %T Impact of a Long Lockdown on Mental Health and the Role of Media Use: Web-Based Survey Study %A Grygarová,Dominika %A Adámek,Petr %A Juríčková,Veronika %A Horáček,Jiří %A Bakštein,Eduard %A Fajnerová,Iveta %A Kesner,Ladislav %+ Center for Advanced Studies of Brain and Consciousness, National Institute of Mental Health, Topolová 748, Klecany, 250 67, Czech Republic, 420 283 088 264, dominika.grygarova@nudz.cz %K mental health %K COVID-19 %K lockdown %K media use %K anxiety %K depression %K nationally representative data %K survey %K longitudinal study %K pandemic %K social isolation %K social media %K psychological trauma %K mental stress %K media news %D 2022 %7 28.6.2022 %9 Original Paper %J JMIR Ment Health %G English %X Background: Due to the COVID-19 pandemic, the Czech population experienced a second lockdown lasting for about half a year, restricting free movement and imposing social isolation. However, it is not known whether the impact of this long lockdown resulted in habituation to the adverse situation or in the traumatization of the Czech population, and whether the media and specific media use contributed to these effects. Objective: The aim of this study was to elucidate the effect of the long lockdown on the mental health of the Czech population, and the role of exposure to COVID-19 news reports and specific forms of media news use in mental health. Methods: We conducted two consecutive surveys in the early (November 2020) and late (March/April 2021) phases of the nationwide lockdown on the same nationally representative group of Czech adults (N=1777) participating in a longitudinal panel study. Results: Our findings showed that the self-reported symptoms of anxiety and depression increased in the second observation period, confirming the negative effect of the pandemic lockdown as it unfolded, suggesting that restrictive measures and continuous exposure to a collective stressor did not result in the strengthening of resilience but rather in ongoing traumatization. The results also suggest a negative role of the media’s coverage of the COVID-19 pandemic in mental health during the early, and particularly late, phases of the lockdown. Furthermore, we found several risk and protective factors of specific media news use. The media practice in news consumption connected to social media use was the strongest predictor of exacerbated mental health symptoms, particularly in the late phase of the lockdown. Moreover, news media use characterized by internalization of information learned from the news, as well as negative attitudes toward media news, were associated with higher levels of anxiety and depression. Conversely, the use of infotainment, together with an in-depth and contextual style of reading news articles, were related to improvement of mental health. Conclusions: Our study showed that the long lockdown resulted in traumatization rather than habituation, and in more pronounced effects (both negative and positive) of media use in mental health. %M 35605112 %R 10.2196/36050 %U https://mental.jmir.org/2022/6/e36050 %U https://doi.org/10.2196/36050 %U http://www.ncbi.nlm.nih.gov/pubmed/35605112 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 10 %N 6 %P e37196 %T Virtual Specialist Care During the COVID-19 Pandemic: Multimethod Patient Experience Study %A Dainty,Katie N %A Seaton,M Bianca %A Estacio,Antonio %A Hicks,Lisa K %A Jamieson,Trevor %A Ward,Sarah %A Yu,Catherine H %A Mosko,Jeffrey D %A Kassardjian,Charles D %+ North York General Hospital, 4001 Leslie Street, LE-140, Toronto, ON, M2K 1E1, Canada, 1 16474482485, katie.dainty@utoronto.ca %K virtual care %K specialist care %K patient experience %K COVID-19 %K medical care %K virtual health %K care data %K decision support %K telehealth %K video consultation %D 2022 %7 28.6.2022 %9 Original Paper %J JMIR Med Inform %G English %X Background: Transitioning nonemergency, ambulatory medical care to virtual visits in light of the COVID-19 global pandemic has been a massive shift in philosophy and practice that naturally came with a steep learning curve for patients, physicians, and clinic administrators. Objective: We undertook a multimethod study to understand the key factors associated with successful and less successful experiences of virtual specialist care, particularly as they relate to the patient experience of care. Methods: This study was designed as a multimethod patient experience study using survey methods, descriptive qualitative interview methodology, and administrative virtual care data collected by the hospital decision support team. Six specialty departments participated in the study (endoscopy, orthopedics, neurology, hematology, rheumatology, and gastroenterology). All patients who could speak and read English and attended a virtual specialist appointment in a participating clinic at St. Michael’s Hospital (Toronto, Ontario, Canada) between October 1, 2020, and January 30, 2021, were eligible to participate. Results: During the study period, 51,702 virtual specialist visits were conducted in the departments that participated in the study. Of those, 96% were conducted by telephone and 4% by video. In both the survey and interview data, there was an overall consensus that virtual care is a satisfying alternative to in-person care, with benefits such as reduced travel, cost, time, and SARS-CoV-2 exposure, and increased convenience. Our analysis further revealed that the specific reason for the visit and the nature and status of the medical condition are important considerations in terms of guidance on where virtual care is most effective. Technology issues were not reported as a major challenge in our data, given that the majority of “virtual” visits reported by our participants were conducted by telephone, which is an important distinction. Despite the positive value of virtual care discussed by the majority of interview participants, 50% of the survey respondents still indicated they would prefer to see their physician in person. Conclusions: Patient experience data collected in this study indicate a high level of satisfaction with virtual specialty care, but also signal that there are nuances to be considered to ensure it is an appropriate and sustainable part of the standard of care. %M 35482950 %R 10.2196/37196 %U https://medinform.jmir.org/2022/6/e37196 %U https://doi.org/10.2196/37196 %U http://www.ncbi.nlm.nih.gov/pubmed/35482950 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 2 %P e35091 %T Implementation and Evaluation of COVIDCare@Home, a Family Medicine–Led Remote Monitoring Program for Patients With COVID-19: Multimethod Cross-sectional Study %A Laur,Celia %A Agarwal,Payal %A Thai,Kelly %A Kishimoto,Vanessa %A Kelly,Shawna %A Liang,Kyle %A Bhatia,R Sacha %A Bhattacharyya,Onil %A Martin,Danielle %A Mukerji,Geetha %+ Women’s College Hospital, 76 Grenville St, Toronto, ON, M5S 1B2, Canada, 1 416 323 6400, Geetha.Mukerji@wchospital.ca %K virtual care %K COVID-19 pandemic %K remote monitoring programs %K social determinants of health %K digital health %K COVID-19 %K pandemic %K health care %K remote monitoring %K clinical outcome %K patient %K health care cost %K patient experience %D 2022 %7 28.6.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: COVIDCare@Home (CC@H) is a multifaceted, interprofessional team-based remote monitoring program led by family medicine for patients diagnosed with COVID-19, based at Women’s College Hospital (WCH), an ambulatory academic center in Toronto, Canada. CC@H offers virtual visits (phone and video) to address the clinical needs and broader social determinants of the health of patients during the acute phase of COVID-19 infection, including finding a primary care provider (PCP) and support for food insecurity. Objective: The objective of this evaluation is to understand the implementation and quality outcomes of CC@H within the Quadruple Aim framework of patient experience, provider experience, cost, and population health. Methods: This multimethod cross-sectional evaluation follows the Quadruple Aim framework to focus on implementation and service quality outcomes, including feasibility, adoption, safety, effectiveness, equity, and patient centeredness. These measures were explored using clinical and service utilization data, patient experience data (an online survey and a postdischarge questionnaire), provider experience data (surveys, interviews, and focus groups), and stakeholder interviews. Descriptive analysis was conducted for surveys and utilization data. Deductive analysis was conducted for interviews and focus groups, mapping to implementation and quality domains. The Ontario Marginalization Index (ON-Marg) measured the proportion of underserved patients accessing CC@H. Results: In total, 3412 visits were conducted in the first 8 months of the program (April 8-December 8, 2020) for 616 discrete patients, including 2114 (62.0%) visits with family physician staff/residents and 149 (4.4%) visits with social workers/mental health professionals. There was a median of 5 (IQR 4) visits per patient, with a median follow-up of 7 days (IQR 27). The net promoter score was 77. In addition, 144 (23.3%) of the patients were in the most marginalized populations based on the residential postal code (as per ON-Marg). Interviews with providers and stakeholders indicated that the program continued to adapt to meet the needs of patients and the health care system. Conclusions: Future remote monitoring should integrate support for addressing the social determinants of health and ensure patient-centered care through comprehensive care teams. %M 35499974 %R 10.2196/35091 %U https://humanfactors.jmir.org/2022/2/e35091 %U https://doi.org/10.2196/35091 %U http://www.ncbi.nlm.nih.gov/pubmed/35499974 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 6 %P e38754 %T Practices and Attitudes of Bavarian Stakeholders Regarding the Secondary Use of Health Data for Research Purposes During the COVID-19 Pandemic: Qualitative Interview Study %A McLennan,Stuart %A Rachut,Sarah %A Lange,Johannes %A Fiske,Amelia %A Heckmann,Dirk %A Buyx,Alena %+ Institute of History and Ethics in Medicine, TUM School of Medicine, Technical University of Munich, Ismaninger Straße 22, Munich, 81675, Germany, 49 089 4140 404, stuart.mclennan@tum.de %K COVID-19 %K data sharing %K General Data Protection Regulation %K GDPR %K research exemption %K public health %K research %K digital health %K electronic health records %D 2022 %7 27.6.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic is a threat to global health and requires collaborative health research efforts across organizations and countries to address it. Although routinely collected digital health data are a valuable source of information for researchers, benefiting from these data requires accessing and sharing the data. Health care organizations focusing on individual risk minimization threaten to undermine COVID-19 research efforts, and it has been argued that there is an ethical obligation to use the European Union’s General Data Protection Regulation (GDPR) scientific research exemption during the COVID-19 pandemic to support collaborative health research. Objective: This study aims to explore the practices and attitudes of stakeholders in the German federal state of Bavaria regarding the secondary use of health data for research purposes during the COVID-19 pandemic, with a specific focus on the GDPR scientific research exemption. Methods: Individual semistructured qualitative interviews were conducted between December 2020 and January 2021 with a purposive sample of 17 stakeholders from 3 different groups in Bavaria: researchers involved in COVID-19 research (n=5, 29%), data protection officers (n=6, 35%), and research ethics committee representatives (n=6, 35%). The transcripts were analyzed using conventional content analysis. Results: Participants identified systemic challenges in conducting collaborative secondary-use health data research in Bavaria; secondary health data research generally only happens when patient consent has been obtained, or the data have been fully anonymized. The GDPR research exemption has not played a significant role during the pandemic and is currently seldom and restrictively used. Participants identified 3 key groups of barriers that led to difficulties: the wider ecosystem at many Bavarian health care organizations, legal uncertainty that leads to risk-adverse approaches, and ethical positions that patient consent ought to be obtained whenever possible to respect patient autonomy. To improve health data research in Bavaria and across Germany, participants wanted greater legal certainty regarding the use of pseudonymized data for research purposes without the patient’s consent. Conclusions: The current balance between enabling the positive goals of health data research and avoiding associated data protection risks is heavily skewed toward avoiding risks; so much so that it makes reaching the goals of health data research extremely difficult. This is important, as it is widely recognized that there is an ethical imperative to use health data to improve care. The current approach also creates a problematic conflict with the ambitions of Germany, and the federal state of Bavaria, to be a leader in artificial intelligence. A recent development in the field of German public administration known as norm screening (Normenscreening) could potentially provide a systematic approach to minimize legal barriers. This approach would likely be beneficial to other countries. %M 35696598 %R 10.2196/38754 %U https://www.jmir.org/2022/6/e38754 %U https://doi.org/10.2196/38754 %U http://www.ncbi.nlm.nih.gov/pubmed/35696598 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 2 %P e38363 %T Examining the Impact of COVID-19 on People With Dementia From the Perspective of Family and Friends: Thematic Analysis of Tweets %A Bacsu,Juanita-Dawne R %A O'Connell,Megan E %A Cammer,Allison %A Ahmadi,Soheila %A Berger,Corinne %A Azizi,Mehrnoosh %A Gowda-Sookochoff,Rory %A Grewal,Karl S %A Green,Shoshana %A Knight,Sheida %A Spiteri,Raymond J %+ Department of Psychology, University of Saskatchewan, Arts 182, 9 Campus Drive, Saskatoon, SK, S7N 5A5, Canada, 1 3062504399, juanita.bacsu@usask.ca %K coronavirus 2019 %K COVID-19 %K Twitter %K social media %K dementia %K Alzheimer disease %K thematic analysis %K aging %K older adult %K elderly population %K caregiver %K support service %K peer support %K online health community %D 2022 %7 27.6.2022 %9 Original Paper %J JMIR Aging %G English %X Background: The COVID-19 pandemic is taking a serious toll on people with dementia. Given the rapidly evolving COVID-19 context, policymakers and practitioners require timely, evidence-informed research to address the changing needs and challenges of people with dementia and their family care partners. Objective: Using Twitter data, the objective of this study was to examine the COVID-19 impact on people with dementia from the perspective of their family members and friends. Methods: Using the Twint application in Python, we collected 6243 relevant tweets over a 15-month time frame. The tweets were divided among 11 coders and analyzed using a 6-step thematic analysis process. Results: Based on our analysis, 3 main themes were identified: (1) frustration and structural inequities (eg, denied dignity and inadequate supports), (2) despair due to loss (eg, isolation, decline, and death), and (3) resiliency, survival, and hope for the future. Conclusions: As the COVID-19 pandemic persists and new variants emerge, people with dementia and their family care partners are facing complex challenges that require timely interventions. More specifically, tackling COVID-19 challenges requires revisiting pandemic policies and protocols to ensure equitable access to health and support services, recognizing the essential role of family care partners, and providing financial assistance and resources to help support people with dementia in the pandemic. Revaluating COVID-19 policies is critical to mitigating the pandemic’s impact on people with dementia and their family care partners. %M 35667087 %R 10.2196/38363 %U https://aging.jmir.org/2022/2/e38363 %U https://doi.org/10.2196/38363 %U http://www.ncbi.nlm.nih.gov/pubmed/35667087 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 6 %P e33538 %T Enablers and Barriers to HIV Services for Gay and Bisexual Men in the COVID-19 Era: Fusing Data Sets from Two Global Online Surveys Via File Concatenation With Adjusted Weights %A Ayala,George %A Arreola,Sonya %A Howell,Sean %A Hoffmann,Thomas J %A Santos,Glenn-Milo %+ Department of Epidemiology and Biostatistics, University of California San Francisco, UCSF Medical Center at Mission Bay, 550 16th St 2nd floor, San Francisco, CA, 94158, United States, 1 4155020955, glenn-milo.santos@ucsf.edu %K COVID-19 %K HIV services %K gay and bisexual men %K sexual health %D 2022 %7 27.6.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Gay and bisexual men are 26 times more likely to acquire HIV than other adult men and represent nearly 1 in 4 new HIV infections worldwide. There is concern that the COVID-19 pandemic may be complicating efforts to prevent new HIV infections, reduce AIDS-related deaths, and expand access to HIV services. The impact of the COVID-19 pandemic on gay and bisexual men’s ability to access services is not fully understood. Objective: The aim of this study was to understand access to HIV services at the start of the COVID-19 pandemic. Methods: Our study used data collected from two independent global online surveys conducted with convenience samples of gay and bisexual men. Both data sets had common demographic measurements; however, only the COVID-19 Disparities Survey (n=13,562) collected the outcomes of interest (HIV services access at the height of the first COVID-19 wave) and only the Global Men’s Health and Rights Survey 4 (GMHR-4; n=6188) gathered pre-COVID-19 pandemic exposures/covariates of interest (social/structural enablers of and barriers to HIV services access). We used data fusion methods to combine these data sets utilizing overlapping demographic variables and assessed relationships between exposures and outcomes. We hypothesized that engagement with the gay community and comfort with one’s health care provider would be positively associated with HIV services access and negatively associated with poorer mental health and economic instability as the COVID-19 outbreaks took hold. Conversely, we hypothesized that sexual stigma and experiences of discrimination by a health care provider would be negatively associated with HIV services access and positively associated with poorer mental health and economic instability. Results: With 19,643 observations after combining data sets, our study confirmed hypothesized associations between enablers of and barriers to HIV prevention, care, and treatment. For example, community engagement was positively associated with access to an HIV provider (regression coefficient=0.81, 95% CI 0.75 to 0.86; P<.001), while sexual stigma was negatively associated with access to HIV treatment (coefficient=–1.39, 95% CI –1.42 to –1.36; P<.001). Conclusions: HIV services access for gay and bisexual men remained obstructed and perhaps became worse during the first wave of the COVID-19 pandemic. Community-led research that utilizes novel methodological approaches can be helpful in times of crisis to inform urgently needed tailored responses that can be delivered in real time. More research is needed to understand the full impact COVID-19 is having on gay and bisexual men worldwide. %M 35377321 %R 10.2196/33538 %U https://publichealth.jmir.org/2022/6/e33538 %U https://doi.org/10.2196/33538 %U http://www.ncbi.nlm.nih.gov/pubmed/35377321 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 2 %N 1 %P e37077 %T The Association Between Dissemination and Characteristics of Pro-/Anti-COVID-19 Vaccine Messages on Twitter: Application of the Elaboration Likelihood Model %A Saini,Vipin %A Liang,Li-Lin %A Yang,Yu-Chen %A Le,Huong Mai %A Wu,Chun-Ying %+ Institute of Public Health, College of Medicine, National Yang Ming Chiao Tung University, No 155, Sec 2, Linong St, Beitou Dist, Taipei, 112, Taiwan, 886 228267000 ext 67156, liang.lilin@nycu.edu.tw %K COVID-19 %K Twitter %K provaccine %K antivaccine %K elaboration likelihood model %K infodemiology %K dissemination %K content analysis %K emotional valence %K social media %D 2022 %7 27.6.2022 %9 Original Paper %J JMIR Infodemiology %G English %X Background: Messages on one’s stance toward vaccination on microblogging sites may affect the reader’s decision on whether to receive a vaccine. Understanding the dissemination of provaccine and antivaccine messages relating to COVID-19 on social media is crucial; however, studies on this topic have remained limited. Objective: This study applies the elaboration likelihood model (ELM) to explore the characteristics of vaccine stance messages that may appeal to Twitter users. First, we examined the associations between the characteristics of vaccine stance tweets and the likelihood and number of retweets. Second, we identified the relative importance of the central and peripheral routes in decision-making on sharing a message. Methods: English-language tweets from the United States that contained provaccine and antivaccine hashtags (N=150,338) were analyzed between April 26 and August 26, 2021. Logistic and generalized negative binomial regressions were conducted to predict retweet outcomes. The content-related central-route predictors were measured using the numbers of hashtags and mentions, emotional valence, emotional intensity, and concreteness. The content-unrelated peripheral-route predictors were measured using the numbers of likes and followers and whether the source was a verified user. Results: Content-related characteristics played a prominent role in shaping decisions regarding whether to retweet antivaccine messages. Particularly, positive valence (incidence rate ratio [IRR]=1.32, P=.03) and concreteness (odds ratio [OR]=1.17, P=.01) were associated with higher numbers and likelihood of retweets of antivaccine messages, respectively; emotional intensity (subjectivity) was associated with fewer retweets of antivaccine messages (OR=0.78, P=.03; IRR=0.80, P=.04). However, these factors had either no or only small effects on the sharing of provaccine tweets. Retweets of provaccine messages were primarily determined by content-unrelated characteristics, such as the numbers of likes (OR=2.55, IRR=2.24, P<.001) and followers (OR=1.31, IRR=1.28, P<.001). Conclusions: The dissemination of antivaccine messages is associated with both content-related and content-unrelated characteristics. By contrast, the dissemination of provaccine messages is primarily driven by content-unrelated characteristics. These findings signify the importance of leveraging the peripheral route to promote the dissemination of provaccine messages. Because antivaccine tweets with positive emotions, objective content, and concrete words are more likely to be disseminated, policymakers should pay attention to antivaccine messages with such characteristics. %M 35783451 %R 10.2196/37077 %U https://infodemiology.jmir.org/2022/1/e37077 %U https://doi.org/10.2196/37077 %U http://www.ncbi.nlm.nih.gov/pubmed/35783451 %0 Journal Article %@ 2371-4379 %I JMIR Publications %V 7 %N 2 %P e37882 %T Evaluating the Implementation of the GREAT4Diabetes WhatsApp Chatbot to Educate People With Type 2 Diabetes During the COVID-19 Pandemic: Convergent Mixed Methods Study %A Mash,Robert %A Schouw,Darcelle %A Fischer,Alex Emilio %+ Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Rd, Tygerberg, Cape Town, 7505, South Africa, 27 219389170, rm@sun.ac.za %K COVID-19 %K diabetes %K primary care %K patient education and counseling %K mobile health %K mHealth %K eHealth %K telemedicine %K South Africa %K mobile phone %D 2022 %7 24.6.2022 %9 Original Paper %J JMIR Diabetes %G English %X Background: In South Africa, diabetes is a leading cause of morbidity and mortality, which was exacerbated during the COVID-19 pandemic. Most education and counseling activities were stopped during the lockdown, and the GREAT4Diabetes WhatsApp Chatbot was innovated to fill this gap. Objective: This study aimed to evaluate the implementation of the chatbot in Cape Town, South Africa, between May and October 2021. Methods: Convergent mixed methods were used to evaluate the implementation outcomes: acceptability, adoption, appropriateness, feasibility, fidelity, cost, coverage, effects, and sustainability. Quantitative data were derived from the chatbot and analyzed using the SPSS. Qualitative data were collected from key informants and analyzed using the framework method assisted by Atlas-ti. The chatbot provided users with 16 voice messages and graphics in English, Afrikaans, or Xhosa. Messages focused on COVID-19 infection and self-management of type 2 diabetes. Results: The chatbot was adopted by the Metro Health Services to assist people with diabetes who had restricted health care during the lockdown and were at a higher risk of hospitalization and death from COVID-19 infection. The chatbot was disseminated via health care workers in primary care facilities and local nonprofit organizations and via local media and television. Two technical glitches interrupted the dissemination but did not substantially affect user behavior. Minor changes were made to the chatbot to improve its utility. Many patients had access to smartphones and were able to use the chatbot via WhatsApp. Overall, 8158 people connected with the chatbot and 4577 (56.1%) proceeded to listen to the messages, with 12.56% (575/4577) of them listening to all 16 messages, mostly within 32 days. The incremental setup costs were ZAR 255,000 (US $16,876) and operational costs over 6 months were ZAR 462,473 (US $30,607). More than 90% of the users who listened to each message found them useful. Of the 533 who completed the whole program, 351 (71.1%) said they changed their self-management a lot and 87.6% (369/421) were more confident. Most users changed their lifestyles in terms of diet (315/414, 76.1%) and physical activity (222/414, 53.6%). Health care workers also saw benefits to patients and recommended that the service continues. Sustainability of the chatbot will depend on the future policy of the provincial Department of Health toward mobile health and the willingness to contract with Aviro Health. There is the potential to go to scale and include other languages and chronic conditions. Conclusions: The chatbot shows great potential to complement traditional health care approaches for people with diabetes and assist with more comprehensive patient education. Further research is needed to fully explore the patient’s experience of the chatbot and evaluate its effectiveness in our context. %M 35537057 %R 10.2196/37882 %U https://diabetes.jmir.org/2022/2/e37882 %U https://doi.org/10.2196/37882 %U http://www.ncbi.nlm.nih.gov/pubmed/35537057 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 6 %P e35343 %T Changes in Temporal Properties of Notifiable Infectious Disease Epidemics in China During the COVID-19 Pandemic: Population-Based Surveillance Study %A Zhao,Xixi %A Li,Meijia %A Haihambo,Naem %A Jin,Jianhua %A Zeng,Yimeng %A Qiu,Jinyi %A Guo,Mingrou %A Zhu,Yuyao %A Li,Zhirui %A Liu,Jiaxin %A Teng,Jiayi %A Li,Sixiao %A Zhao,Ya-nan %A Cao,Yanxiang %A Wang,Xuemei %A Li,Yaqiong %A Gao,Michel %A Feng,Xiaoyang %A Han,Chuanliang %+ Brain Cognition and Brain Disease Institute, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, 1068 Xueyuan Avenue, Shenzhen University Town, Nanshan District, Shenzhen, 518055, China, 86 18800129802, hanchuanliang2014@163.com %K class B infectious disease %K COVID-19 %K event-related trough %K infection selectivity %K oscillation %K public health interventions %K pandemic %K surveillance %K health policy %K epidemiology %K prevention policy %K public health %K risk prevention %D 2022 %7 23.6.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: COVID-19 was first reported in 2019, and the Chinese government immediately carried out stringent and effective control measures in response to the epidemic. Objective: Nonpharmaceutical interventions (NPIs) may have impacted incidences of other infectious diseases as well. Potential explanations underlying this reduction, however, are not clear. Hence, in this study, we aim to study the influence of the COVID-19 prevention policies on other infectious diseases (mainly class B infectious diseases) in China. Methods: Time series data sets between 2017 and 2021 for 23 notifiable infectious diseases were extracted from public data sets from the National Health Commission of the People’s Republic of China. Several indices (peak and trough amplitudes, infection selectivity, preferred time to outbreak, oscillatory strength) of each infectious disease were calculated before and after the COVID-19 outbreak. Results: We found that the prevention and control policies for COVID-19 had a strong, significant reduction effect on outbreaks of other infectious diseases. A clear event-related trough (ERT) was observed after the outbreak of COVID-19 under the strict control policies, and its decreasing amplitude is related to the infection selectivity and preferred outbreak time of the disease before COVID-19. We also calculated the oscillatory strength before and after the COVID-19 outbreak and found that it was significantly stronger before the COVID-19 outbreak and does not correlate with the trough amplitude. Conclusions: Our results directly demonstrate that prevention policies for COVID-19 have immediate additional benefits for controlling most class B infectious diseases, and several factors (infection selectivity, preferred outbreak time) may have contributed to the reduction in outbreaks. This study may guide the implementation of nonpharmaceutical interventions to control a wider range of infectious diseases. %M 35649394 %R 10.2196/35343 %U https://publichealth.jmir.org/2022/6/e35343 %U https://doi.org/10.2196/35343 %U http://www.ncbi.nlm.nih.gov/pubmed/35649394 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e38162 %T Digital Screening and Automated Resource Identification System to Address COVID-19–Related Behavioral Health Disparities: Feasibility Study %A Stiles-Shields,Colleen %A Batts,Kathryn R %A Reyes,Karen M %A Archer,Joseph %A Crosby,Sharad %A Draxler,Janel M %A Lennan,Nia %A Held,Philip %+ Section of Community Behavioral Health, Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, 1645 W Jackson Blvd, Suite 302, Chicago, IL, 60612, United States, 1 312 942 9998, colleen_stiles-shields@rush.edu %K digital mental health %K underserved %K health disparities %K COVID-19 %K screening %K referral %K mental health %K digital health %K feasibility study %K mobile app %K mHealth %K mobile health %K emotional need %K digital health tool %K health resource %K health care cost %D 2022 %7 22.6.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital mental health (DMH) tools use technology (eg, websites and mobile apps) to conveniently deliver mental health resources to users in real time, reducing access barriers. Underserved communities facing health care provider shortages and limited mental health resources may benefit from DMH tools, as these tools can help improve access to resources. Objective: This study described the development and feasibility evaluation of the Emotional Needs Evaluation and Resource Guide for You (ENERGY) System, a DMH tool to meet the mental health and resource needs of youth and their families developed in the context of the COVID-19 pandemic. The ENERGY System offers a brief assessment of resource needs; problem-solving capabilities; and symptoms of depression, anxiety, trauma, and alcohol and substance use followed by automated, personalized feedback based on the participant’s responses. Methods: Individuals aged ≥15 years were recruited through community partners, community events, targeted electronic health record messages, and social media. Participants completed screening questions to establish eligibility, entered demographic information, and completed the ENERGY System assessment. Based on the participant’s responses, the ENERGY System immediately delivered digital resources tailored to their identified areas of need (eg, relaxation). A subset of participants also voluntarily completed the following: COVID-19 Exposure and Family Impact Survey (CEFIS) or COVID-19 Exposure and Family Impact Survey Adolescent and Young Adult Version (CEFIS-AYA); resource needs assessment; and feedback on their experience using the ENERGY System. If resource needs (eg, housing and food insecurity) were endorsed, lists of local resources were provided. Results: A total of 212 individuals accessed the ENERGY System link, of which 96 (45.3%) completed the screening tool and 86 (40.6%) received resources. Participant responses on the mental health screening questions triggered on average 2.04 (SD 1.94) intervention domains. Behavioral Activation/Increasing Activities was the most frequently launched intervention domain (56%, 54/96), and domains related to alcohol or substance use were the least frequent (4%, 4/96). The most frequently requested support areas were finances (33%, 32/96), transportation (26%, 25/96), and food (24%, 23/96). The CEFIS and CEFIS-AYA indicated higher than average impacts from the pandemic (ie, average scores >2.5). Participants were satisfied with the ENERGY System overall (65%, 39/60) as well as the length of time it took to answer the questions (90%, 54/60), which they found easy to answer (87%, 52/60). Conclusions: This study provided initial support for the feasibility of the ENERGY System, a DMH tool capable of screening for resource and mental health needs and providing automated, personalized, and free resources and techniques to meet the identified needs. Future studies should seek direct feedback from community members to further improve the ENERGY System and its dissemination to encourage use. %M 35696607 %R 10.2196/38162 %U https://formative.jmir.org/2022/6/e38162 %U https://doi.org/10.2196/38162 %U http://www.ncbi.nlm.nih.gov/pubmed/35696607 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 6 %P e38423 %T COVID-19 Vaccine Fact-Checking Posts on Facebook: Observational Study %A Xue,Haoning %A Gong,Xuanjun %A Stevens,Hannah %+ Department of Communication, University of California, Davis, One Shields Avenue, Davis, CA, 95616, United States, 1 5303048532, hnxue@ucdavis.edu %K COVID-19 vaccine %K fact checking %K misinformation correction %K sentiment analysis %K social media %K COVID-19 %K vaccination %K misinformation %K health information %K online information %K infodemic %K public sentiment %D 2022 %7 21.6.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Effective interventions aimed at correcting COVID-19 vaccine misinformation, known as fact-checking messages, are needed to combat the mounting antivaccine infodemic and alleviate vaccine hesitancy. Objective: This work investigates (1) the changes in the public's attitude toward COVID-19 vaccines over time, (2) the effectiveness of COVID-19 vaccine fact-checking information on social media engagement and attitude change, and (3) the emotional and linguistic features of the COVID-19 vaccine fact-checking information ecosystem. Methods: We collected a data set of 12,553 COVID-19 vaccine fact-checking Facebook posts and their associated comments (N=122,362) from January 2020 to March 2022 and conducted a series of natural language processing and statistical analyses to investigate trends in public attitude toward the vaccine in COVID-19 vaccine fact-checking posts and comments, and emotional and linguistic features of the COVID-19 fact-checking information ecosystem. Results: The percentage of fact-checking posts relative to all COVID-19 vaccine posts peaked in May 2020 and then steadily decreased as the pandemic progressed (r=–0.92, df=21, t=–10.94, 95% CI –0.97 to –0.82, P<.001). The salience of COVID-19 vaccine entities was significantly lower in comments (mean 0.03, SD 0.03, t=39.28, P<.001) than in posts (mean 0.09, SD 0.11). Third-party fact checkers have been playing a more important role in more fact-checking over time (r=0.63, df=25, t=4.06, 95% CI 0.33-0.82, P<.001). COVID-19 vaccine fact-checking posts continued to be more analytical (r=0.81, df=25, t=6.88, 95% CI 0.62-0.91, P<.001) and more confident (r=0.59, df=25, t=3.68, 95% CI 0.27-0.79, P=.001) over time. Although comments did not exhibit a significant increase in confidence over time, tentativeness in comments significantly decreased (r=–0.62, df=25, t=–3.94, 95% CI –0.81 to –0.31, P=.001). In addition, although hospitals receive less engagement than other information sources, the comments expressed more positive attitudinal valence in comments compared to other information sources (b=0.06, 95% CI 0.00-0.12, t=2.03, P=.04). Conclusions: The percentage of fact-checking posts relative to all posts about the vaccine steadily decreased after May 2020. As the pandemic progressed, third-party fact checkers played a larger role in posting fact-checking COVID-19 vaccine posts. COVID-19 vaccine fact-checking posts continued to be more analytical and more confident over time, reflecting increased confidence in posts. Similarly, tentativeness in comments decreased; this likewise suggests that public uncertainty diminished over time. COVID-19 fact-checking vaccine posts from hospitals yielded more positive attitudes toward vaccination than other information sources. At the same time, hospitals received less engagement than other information sources. This suggests that hospitals should invest more in generating engaging public health campaigns on social media. %M 35671409 %R 10.2196/38423 %U https://www.jmir.org/2022/6/e38423 %U https://doi.org/10.2196/38423 %U http://www.ncbi.nlm.nih.gov/pubmed/35671409 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 6 %P e37004 %T Exploring Longitudinal Cough, Breath, and Voice Data for COVID-19 Progression Prediction via Sequential Deep Learning: Model Development and Validation %A Dang,Ting %A Han,Jing %A Xia,Tong %A Spathis,Dimitris %A Bondareva,Erika %A Siegele-Brown,Chloë %A Chauhan,Jagmohan %A Grammenos,Andreas %A Hasthanasombat,Apinan %A Floto,R Andres %A Cicuta,Pietro %A Mascolo,Cecilia %+ Department of Computer Science and Technology, University of Cambridge, 15 JJ Thomson Ave, Cambridge, CB3 0FD, United Kingdom, 44 7895587796, td464@cam.ac.uk %K COVID-19 %K audio %K COVID-19 progression %K deep learning %K mobile health %K longitudinal study %D 2022 %7 21.6.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Recent work has shown the potential of using audio data (eg, cough, breathing, and voice) in the screening for COVID-19. However, these approaches only focus on one-off detection and detect the infection, given the current audio sample, but do not monitor disease progression in COVID-19. Limited exploration has been put forward to continuously monitor COVID-19 progression, especially recovery, through longitudinal audio data. Tracking disease progression characteristics and patterns of recovery could bring insights and lead to more timely treatment or treatment adjustment, as well as better resource management in health care systems. Objective: The primary objective of this study is to explore the potential of longitudinal audio samples over time for COVID-19 progression prediction and, especially, recovery trend prediction using sequential deep learning techniques. Methods: Crowdsourced respiratory audio data, including breathing, cough, and voice samples, from 212 individuals over 5-385 days were analyzed, alongside their self-reported COVID-19 test results. We developed and validated a deep learning–enabled tracking tool using gated recurrent units (GRUs) to detect COVID-19 progression by exploring the audio dynamics of the individuals’ historical audio biomarkers. The investigation comprised 2 parts: (1) COVID-19 detection in terms of positive and negative (healthy) tests using sequential audio signals, which was primarily assessed in terms of the area under the receiver operating characteristic curve (AUROC), sensitivity, and specificity, with 95% CIs, and (2) longitudinal disease progression prediction over time in terms of probability of positive tests, which was evaluated using the correlation between the predicted probability trajectory and self-reported labels. Results: We first explored the benefits of capturing longitudinal dynamics of audio biomarkers for COVID-19 detection. The strong performance, yielding an AUROC of 0.79, a sensitivity of 0.75, and a specificity of 0.71 supported the effectiveness of the approach compared to methods that do not leverage longitudinal dynamics. We further examined the predicted disease progression trajectory, which displayed high consistency with longitudinal test results with a correlation of 0.75 in the test cohort and 0.86 in a subset of the test cohort with 12 (57.1%) of 21 COVID-19–positive participants who reported disease recovery. Our findings suggest that monitoring COVID-19 evolution via longitudinal audio data has potential in the tracking of individuals’ disease progression and recovery. Conclusions: An audio-based COVID-19 progression monitoring system was developed using deep learning techniques, with strong performance showing high consistency between the predicted trajectory and the test results over time, especially for recovery trend predictions. This has good potential in the postpeak and postpandemic era that can help guide medical treatment and optimize hospital resource allocations. The changes in longitudinal audio samples, referred to as audio dynamics, are associated with COVID-19 progression; thus, modeling the audio dynamics can potentially capture the underlying disease progression process and further aid COVID-19 progression prediction. This framework provides a flexible, affordable, and timely tool for COVID-19 tracking, and more importantly, it also provides a proof of concept of how telemonitoring could be applicable to respiratory diseases monitoring, in general. %M 35653606 %R 10.2196/37004 %U https://www.jmir.org/2022/6/e37004 %U https://doi.org/10.2196/37004 %U http://www.ncbi.nlm.nih.gov/pubmed/35653606 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 6 %P e38614 %T Beyond Pathogen Filtration: Possibility of Smart Masks as Wearable Devices for Personal and Group Health and Safety Management %A Lee,Peter %A Kim,Heepyung %A Kim,Yongshin %A Choi,Woohyeok %A Zitouni,M Sami %A Khandoker,Ahsan %A Jelinek,Herbert F %A Hadjileontiadis,Leontios %A Lee,Uichin %A Jeong,Yong %+ Department of Bio and Brain Engineering, Korea Advanced Institute of Science and Technology, 291 Daehak-ro Yuseong gu, Daejeon, 34141, Republic of Korea, 82 423507165, yong@kaist.ac.kr %K smart mask %K pathogen filtration %K COVID-19 %K protective equipment %K digital health %K wearable %K smart device %K wearable device %K sensor %K health monitoring %D 2022 %7 21.6.2022 %9 Viewpoint %J JMIR Mhealth Uhealth %G English %X Face masks are an important way to combat the COVID-19 pandemic. However, the prolonged pandemic has revealed confounding problems with the current face masks, including not only the spread of the disease but also concurrent psychological, social, and economic complications. As face masks have been worn for a long time, people have been interested in expanding the purpose of masks from protection to comfort and health, leading to the release of various “smart” mask products around the world. To envision how the smart masks will be extended, this paper reviewed 25 smart masks (12 from commercial products and 13 from academic prototypes) that emerged after the pandemic. While most smart masks presented in the market focus on resolving problems with user breathing discomfort, which arise from prolonged use, academic prototypes were designed for not only sensing COVID-19 but also general health monitoring aspects. Further, we investigated several specific sensors that can be incorporated into the mask for expanding biophysical features. On a larger scale, we discussed the architecture and possible applications with the help of connected smart masks. Namely, beyond a personal sensing application, a group or community sensing application may share an aggregate version of information with the broader population. In addition, this kind of collaborative sensing will also address the challenges of individual sensing, such as reliability and coverage. Lastly, we identified possible service application fields and further considerations for actual use. Along with daily-life health monitoring, smart masks may function as a general respiratory health tool for sports training, in an emergency room or ambulatory setting, as protection for industry workers and firefighters, and for soldier safety and survivability. For further considerations, we investigated design aspects in terms of sensor reliability and reproducibility, ergonomic design for user acceptance, and privacy-aware data-handling. Overall, we aim to explore new possibilities by examining the latest research, sensor technologies, and application platform perspectives for smart masks as one of the promising wearable devices. By integrating biomarkers of respiration symptoms, a smart mask can be a truly cutting-edge device that expands further knowledge on health monitoring to reach the next level of wearables. %M 35679029 %R 10.2196/38614 %U https://mhealth.jmir.org/2022/6/e38614 %U https://doi.org/10.2196/38614 %U http://www.ncbi.nlm.nih.gov/pubmed/35679029 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 2 %P e35173 %T Self-care Behaviors and Technology Used During COVID-19: Systematic Review %A Sakur,Fareeya %A Ward,Kanesha %A Khatri,Neha Nafees %A Lau,Annie Y S %+ Australian Institute of Health Innovation, Macquarie University, 75 Talavera Rd, North Ryde, NSW 2113, Australia, 61 (02) 9850 2400, fareeya.sakur@hdr.mq.edu.au %K self-care %K self-management %K chronic conditions %K COVID-19 %K pandemic %K technology %K digital health %K telehealth %K health technology %D 2022 %7 21.6.2022 %9 Review %J JMIR Hum Factors %G English %X Background: Self-care behaviors are essential for people living with chronic conditions; however, the outbreak of the COVID-19 pandemic has imposed additional complications on their daily routines. Few studies have analyzed how self-care behaviors have changed during COVID-19 and the role of digital technology, especially among people with chronic conditions. Objective: This study aims to review how self-care behaviors have changed for people with chronic conditions during the COVID-19 pandemic, and what technology they have adopted to manage their conditions during that period. Methods: A systematic review was conducted using narrative synthesis. Data were extracted from PubMed, MEDLINE, EMBASE, PsycINFO, CINAHL, and Google Scholar, including articles from December 2019 onward. Eligible studies focused on adults diagnosed with chronic conditions undertaking any self-care tasks in line with the middle-range theory of self-care of chronic illness (ie, self-care maintenance, monitoring, and management). The methodological quality of the included articles was assessed with the McMaster Critical Review Forms for Quantitative or Qualitative Studies. Results: In total, 36 primary research articles were included. Changes to self-care behaviors during COVID-19 among people with chronic conditions were organized according to the middle-range theory of self-care of chronic illness focusing on self-care maintenance (ie, medication adherence, physical activity, and diet control), self-care monitoring (ie, monitoring signs and symptoms), and self-care management (ie, consultations with health care providers). Positive self-care behaviors observed include the following: individuals trying to maintain good glycemic control during COVID-19 increased their medication adherence in 27% (10/36) of studies; and diet control improved in 50% (18/36) of studies. Negative self-care behaviors observed include the following: decline in physical activities and increased sedentariness were observed in 65% (23/36) of studies; poor diet control was observed in 57% (21/36) of studies; and self-monitoring of health status dropped in 43% (15/36) of studies. The use of technology to support self-care of chronic conditions during COVID-19 was reported in 72% (26/36) of studies. The actual use of telehealth in place of physical consultations during COVID-19 was observed in 50% (18/36) of studies, and other digital technologies (eg, social media apps, smartphone apps, web-based platforms, and web browsing) were used in 50% (18/36) of studies. Telehealth was discussed and recommended as the default technology in delivering future health care services during COVID-19 and beyond in 77% (28/36) of studies. Conclusions: This review highlighted the necessity to rethink how models of self-care should continue to address the demands of chronic conditions while being responsive to the imminent threats of infectious diseases. Perhaps the silver lining of COVID-19 is that adoption of digital technology (especially telehealth) among a vast cross-section of people with chronic conditions is possible. Future research should investigate effective ways to incorporate evidence-based digital health tools into these new models of self-care that address the challenges of chronic and infectious conditions. %M 35442904 %R 10.2196/35173 %U https://humanfactors.jmir.org/2022/2/e35173 %U https://doi.org/10.2196/35173 %U http://www.ncbi.nlm.nih.gov/pubmed/35442904 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e35754 %T Mandatory Vaccination Against COVID-19: Twitter Poll Analysis on Public Health Opinion %A Ritschl,Valentin %A Eibensteiner,Fabian %A Mosor,Erika %A Omara,Maisa %A Sperl,Lisa %A Nawaz,Faisal A %A Siva Sai,Chandragiri %A Cenanovic,Merisa %A Devkota,Hari Prasad %A Hribersek,Mojca %A De,Ronita %A Klager,Elisabeth %A Schaden,Eva %A Kletecka-Pulker,Maria %A Völkl-Kernstock,Sabine %A Willschke,Harald %A Aufricht,Christoph %A Atanasov,Atanas G %A Stamm,Tanja %+ Section for Outcomes Research, Medical University of Vienna, Spitalgasse 23, Vienna, 1190, Austria, 43 140400 ext 16370, tanja.stamm@meduniwien.ac.at %K COVID-19 %K SARS-CoV-2 %K vaccine %K vaccination %K Twitter %K survey %K mandatory vaccination %K vaccination hesitancy %K coronavirus %K hesitancy %K social media %K questionnaire %K mandatory %K support %K poll %K opinion %K public health %K perception %D 2022 %7 21.6.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: On January 30, 2020, the World Health Organization Emergency Committee declared the rapid worldwide spread of COVID-19 a global health emergency. By December 2020, the safety and efficacy of the first COVID-19 vaccines had been demonstrated. However, international vaccination coverage rates have remained below expectations (in Europe at the time of manuscript submission). Controversial mandatory vaccination is currently being discussed and has already been introduced in some countries (Austria, Greece, and Italy). We used the Twitter survey system as a viable method to quickly and comprehensively gather international public health insights on mandatory vaccination against COVID-19. Objective: The purpose of this study was to better understand the public’s perception of mandatory COVID-19 vaccination in real time using Twitter polls. Methods: Two Twitter polls were developed (in the English language) to seek the public’s opinion on the possibility of mandatory vaccination. The polls were pinned to the Digital Health and Patient Safety Platform’s (based in Vienna, Austria) Twitter timeline for 1 week in mid-November 2021, 3 days after the official public announcement of mandatory COVID-19 vaccination in Austria. Twitter users were asked to participate and retweet the polls to reach the largest possible audience. Results: Our Twitter polls revealed two extremes on the topic of mandatory vaccination against COVID-19. Almost half of the 2545 respondents (n=1246, 49%) favor mandatory vaccination, at least in certain areas. This attitude contrasts with the 45.7% (n=1162) who categorically reject mandatory vaccination. Over one-quarter (n=621, 26.3%) of participating Twitter users said they would never get vaccinated, as reflected by the current Western European and North American vaccination coverage rate. Concatenating interpretation of these two polls should be done cautiously as participating populations might substantially differ. Conclusions: Mandatory vaccination against COVID-19 (in at least certain areas) is favored by less than 50%, whereas it is opposed by almost half of the surveyed Twitter users. Since (social) media strongly influences public perceptions and views, and social media discussions and surveys are specifically susceptible to the “echo chamber effect,” the results should be interpreted as a momentary snapshot. Therefore, the results of this study need to be complemented by long-term surveys to maintain their validity. %M 35617671 %R 10.2196/35754 %U https://formative.jmir.org/2022/6/e35754 %U https://doi.org/10.2196/35754 %U http://www.ncbi.nlm.nih.gov/pubmed/35617671 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e35021 %T UK Adults’ Exercise Locations, Use of Digital Programs, and Associations with Physical Activity During the COVID-19 Pandemic: Longitudinal Analysis of Data From the Health Behaviours During the COVID-19 Pandemic Study %A Schneider,Verena %A Kale,Dimitra %A Herbec,Aleksandra %A Beard,Emma %A Fisher,Abigail %A Shahab,Lion %+ Department of Behavioural Science and Health, University College London, 1–19 Torrington Place, London, WC1E 6BT, United Kingdom, 44 20 7679 1720, verena.schneider.19@ucl.ac.uk %K pandemic %K physical activity %K longitudinal %K United Kingdom %K digital health %K tele-exercise %K moderate-to-vigorous physical activity %K muscle-strengthening activity %K COVID-19 %K home-based exercise %K exercise %K telemedicine %K longitudinal %K health behavior %K behavior %K data %D 2022 %7 21.6.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital physical activity (PA) program use has been associated with higher PA guideline adherence during COVID-19 pandemic confinements. However, little is known longitudinally about exercise locations (inside vs outside the home environment), digital program use, and their associations with moderate-to-vigorous PA (MVPA) and muscle-strengthening activities (MSAs) during the pandemic. Objective: The aims of this study were to assess the relationship between exercise location and use of digital programs with PA guideline adherence during the COVID-19 pandemic, describe how individuals exercised inside and outside of their home environments, and explore which sociodemographic and contextual factors were associated with exercise locations and digital PA program use. Methods: Active UK adults (N=1938) who participated in the 1-month follow-up survey of the Health Behaviours During the COVID-19 Pandemic (HEBECO) study (FU1, June-July 2020) and at least one more follow-up survey (FU2, August-September; FU3, November-December 2020) reported exercise locations and types of exercises inside and outside their homes, including digital programs (online/app-based fitness classes/programs), MVPA, and MSA. Generalized linear mixed models were used to assess associations of exercise location and digital PA program use with PA guideline adherence (MVPA, MSA, full [combined] adherence), and predictors of exercise location and digital program use. Results: As the pandemic progressed, active UK adults were less likely to exercise inside or to use digital PA programs compared with periods of initial confinement: 61% (95% CI 58%-63%; weighted n=1024), 50% (95% CI 48%-53%; weighted n=786), and 49% (95% CI 46%-51%; weighted n=723) performed any exercise inside their homes at FU1, FU2, and FU3, respectively. At FU1, FU2, and FU3, 22% (95% CI 21%-25%; weighted n=385), 17% (95% CI 15%-19%; weighted n=265), and 16% (95% CI 14%-18%; weighted n=241) used digital PA programs, respectively. Most participants who exercised inside already owned indoor equipment, used digital PA programs, or had their own workout routines, whereas MVPA and gentle walking were the most common exercise types performed outside the home. Being female, nonwhite, having a condition limiting PA, indoor exercising space, a lower BMI, and living in total isolation were associated with increased odds of exercising inside the home or garden compared with outside exercise only. Digital PA program users were more likely to be younger, female, highly educated, have indoor space to exercise, and a lower BMI. While exercising inside was positively associated with MSA and exercising outside was positively associated with MVPA guideline adherence, both inside (vs outside only) and outside (vs inside only) activities contributed to full PA guideline adherence (odds ratio [OR] 5.05, 95% CI 3.17-8.03 and OR 1.89, 95% CI 1.10-3.23, respectively). Digital PA program use was associated with a higher odds of MSA (OR 3.97-8.71) and full PA (OR 2.24-3.95), but not with MVPA guideline adherence. Conclusions: During the COVID-19 pandemic, full PA guideline adherence was associated with exercising inside and outside of one’s home environment and using digital PA programs. More research is needed to understand the reach, long-term adherence, and differences between digital PA solutions. %M 35584123 %R 10.2196/35021 %U https://formative.jmir.org/2022/6/e35021 %U https://doi.org/10.2196/35021 %U http://www.ncbi.nlm.nih.gov/pubmed/35584123 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e35717 %T A Scalable Risk-Scoring System Based on Consumer-Grade Wearables for Inpatients With COVID-19: Statistical Analysis and Model Development %A Föll,Simon %A Lison,Adrian %A Maritsch,Martin %A Klingberg,Karsten %A Lehmann,Vera %A Züger,Thomas %A Srivastava,David %A Jegerlehner,Sabrina %A Feuerriegel,Stefan %A Fleisch,Elgar %A Exadaktylos,Aristomenis %A Wortmann,Felix %+ Department of Emergency Medicine, Inselspital, Bern, University Hospital, University of Bern, Freiburgstrasse 16C, Bern, 3010, Switzerland, 41 31632244, Aristomenis.Exadaktylos@insel.ch %K COVID-19 %K risk scoring %K wearable devices %K wearable %K smartwatches %K smartwatch %K Bayesian survival analysis %K remote monitoring %K patient monitoring %K remote patient monitoring %K smart device %K digital health %K risk score %K scalable %K general ward %K hospital %K measurement tool %K measurement instrument %D 2022 %7 21.6.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: To provide effective care for inpatients with COVID-19, clinical practitioners need systems that monitor patient health and subsequently allow for risk scoring. Existing approaches for risk scoring in patients with COVID-19 focus primarily on intensive care units (ICUs) with specialized medical measurement devices but not on hospital general wards. Objective: In this paper, we aim to develop a risk score for inpatients with COVID-19 in general wards based on consumer-grade wearables (smartwatches). Methods: Patients wore consumer-grade wearables to record physiological measurements, such as the heart rate (HR), heart rate variability (HRV), and respiration frequency (RF). Based on Bayesian survival analysis, we validated the association between these measurements and patient outcomes (ie, discharge or ICU admission). To build our risk score, we generated a low-dimensional representation of the physiological features. Subsequently, a pooled ordinal regression with time-dependent covariates inferred the probability of either hospital discharge or ICU admission. We evaluated the predictive performance of our developed system for risk scoring in a single-center, prospective study based on 40 inpatients with COVID-19 in a general ward of a tertiary referral center in Switzerland. Results: First, Bayesian survival analysis showed that physiological measurements from consumer-grade wearables are significantly associated with patient outcomes (ie, discharge or ICU admission). Second, our risk score achieved a time-dependent area under the receiver operating characteristic curve (AUROC) of 0.73-0.90 based on leave-one-subject-out cross-validation. Conclusions: Our results demonstrate the effectiveness of consumer-grade wearables for risk scoring in inpatients with COVID-19. Due to their low cost and ease of use, consumer-grade wearables could enable a scalable monitoring system. Trial Registration: Clinicaltrials.gov NCT04357834; https://www.clinicaltrials.gov/ct2/show/NCT04357834 %M 35613417 %R 10.2196/35717 %U https://formative.jmir.org/2022/6/e35717 %U https://doi.org/10.2196/35717 %U http://www.ncbi.nlm.nih.gov/pubmed/35613417 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 6 %P e37623 %T Understanding How and by Whom COVID-19 Misinformation is Spread on Social Media: Coding and Network Analyses %A Zhao,Yuehua %A Zhu,Sicheng %A Wan,Qiang %A Li,Tianyi %A Zou,Chun %A Wang,Hao %A Deng,Sanhong %+ School of Information Management, Nanjing University, 163 Xianlin Road, Qixia District, Nanjing, 210023, China, 86 2589685996, sanhong@nju.edu.cn %K health misinformation %K COVID-19 %K social media %K misinformation spread %K infodemiology %K global health crisis %K misinformation %K theoretical model %K medical information %K epidemic %K pandemic %D 2022 %7 20.6.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: During global health crises such as the COVID-19 pandemic, rapid spread of misinformation on social media has occurred. The misinformation associated with COVID-19 has been analyzed, but little attention has been paid to developing a comprehensive analytical framework to study its spread on social media. Objective: We propose an elaboration likelihood model–based theoretical model to understand the persuasion process of COVID-19–related misinformation on social media. Methods: The proposed model incorporates the central route feature (content feature) and peripheral features (including creator authority, social proof, and emotion). The central-level COVID-19–related misinformation feature includes five topics: medical information, social issues and people’s livelihoods, government response, epidemic spread, and international issues. First, we created a data set of COVID-19 pandemic–related misinformation based on fact-checking sources and a data set of posts that contained this misinformation on real-world social media. Based on the collected posts, we analyzed the dissemination patterns. Results: Our data set included 11,450 misinformation posts, with medical misinformation as the largest category (n=5359, 46.80%). Moreover, the results suggest that both the least (4660/11,301, 41.24%) and most (2320/11,301, 20.53%) active users are prone to sharing misinformation. Further, posts related to international topics that have the greatest chance of producing a profound and lasting impact on social media exhibited the highest distribution depth (maximum depth=14) and width (maximum width=2355). Additionally, 97.00% (2364/2437) of the spread was characterized by radiation dissemination. Conclusions: Our proposed model and findings could help to combat the spread of misinformation by detecting suspicious users and identifying propagation characteristics. %M 35671411 %R 10.2196/37623 %U https://www.jmir.org/2022/6/e37623 %U https://doi.org/10.2196/37623 %U http://www.ncbi.nlm.nih.gov/pubmed/35671411 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 6 %P e34615 %T Testing the Efficacy of Attitudinal Inoculation Videos to Enhance COVID-19 Vaccine Acceptance: Quasi-Experimental Intervention Trial %A Piltch-Loeb,Rachael %A Su,Max %A Hughes,Brian %A Testa,Marcia %A Goldberg,Beth %A Braddock,Kurt %A Miller-Idriss,Cynthia %A Maturo,Vanessa %A Savoia,Elena %+ Department of Biostatistics, Harvard TH Chan School of Public Health, 90 Smith St, Boston, MA, 02120, United States, 1 3393649813, piltch-loeb@hsph.harvard.edu %K attitudinal inoculation %K intervention %K COVID-19 vaccine %K vaccine hesitancy %K COVID-19 %K vaccine %K vaccination %K public health %K health intervention %K misinformation %K infodemiology %K vaccine misinformation %D 2022 %7 20.6.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Over the course of the COVID-19 pandemic, a variety of COVID-19-related misinformation has spread and been amplified online. The spread of misinformation can influence COVID-19 beliefs and protective actions, including vaccine hesitancy. Belief in vaccine misinformation is associated with lower vaccination rates and higher vaccine resistance. Attitudinal inoculation is a preventative approach to combating misinformation and disinformation, which leverages the power of narrative, rhetoric, values, and emotion. Objective: This study seeks to test inoculation messages in the form of short video messages to promote resistance against persuasion by COVID-19 vaccine misinformation. Methods: We designed a series of 30-second inoculation videos and conducted a quasi-experimental study to test the use of attitudinal inoculation in a population of individuals who were unvaccinated (N=1991). The 3 intervention videos were distinguished by their script design, with intervention video 1 focusing on narrative/rhetorical (“Narrative”) presentation of information, intervention video 2 focusing on delivering a fact-based information (“Fact”), and intervention video 3 using a hybrid design (“Hybrid”). Analysis of covariance (ANCOVA) models were used to compare the main effect of the intervention on the 3 outcome variables: ability to recognize misinformation tactics (“Recognize”), willingness to share misinformation (“Share”), and willingness to take the COVID-19 vaccine (“Willingness”). Results: There were significant effects across all 3 outcome variables comparing inoculation intervention groups to controls. For the Recognize outcome, the ability to recognize rhetorical strategies, there was a significant intervention group effect (P<.001). For the Share outcome, support for sharing the mis- and disinformation, the intervention group main effect was statistically significant (P=.02). For the Willingness outcome, there was a significant intervention group effect; intervention groups were more willing to get the COVID-19 vaccine compared to controls (P=.01). Conclusions: Across all intervention groups, inoculated individuals showed greater resistance to misinformation than their noninoculated counterparts. Relative to those who were not inoculated, inoculated participants showed significantly greater ability to recognize and identify rhetorical strategies used in misinformation, were less likely to share false information, and had greater willingness to get the COVID-19 vaccine. Attitudinal inoculation delivered through short video messages should be tested in public health messaging campaigns to counter mis- and disinformation. %M 35483050 %R 10.2196/34615 %U https://publichealth.jmir.org/2022/6/e34615 %U https://doi.org/10.2196/34615 %U http://www.ncbi.nlm.nih.gov/pubmed/35483050 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e33637 %T Applying the Health Belief Model to Characterize Racial/Ethnic Differences in Digital Conversations Related to Depression Pre- and Mid-COVID-19: Descriptive Analysis %A Castilla-Puentes,Ruby %A Pesa,Jacqueline %A Brethenoux,Caroline %A Furey,Patrick %A Gil Valletta,Liliana %A Falcone,Tatiana %+ Center for Public Health Practice, Drexel University, 530 S 2nd st Suite 743, Philadelphia, PA, 19147, United States, 1 6108642528, rcastil4@its.jnj.com %K depression %K COVID-19 %K treatment %K race/ethnicity %K digital conversations %K health belief model %K artificial intelligence %K natural language processing %D 2022 %7 20.6.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The prevalence of depression in the United States is >3 times higher mid-COVID-19 versus prepandemic. Racial/ethnic differences in mindsets around depression and the potential impact of the COVID-19 pandemic are not well characterized. Objective: This study aims to describe attitudes, mindsets, key drivers, and barriers related to depression pre- and mid-COVID-19 by race/ethnicity using digital conversations about depression mapped to health belief model (HBM) concepts. Methods: Advanced search, data extraction, and artificial intelligence–powered tools were used to harvest, mine, and structure open-source digital conversations of US adults who engaged in conversations about depression pre- (February 1, 2019-February 29, 2020) and mid-COVID-19 pandemic (March 1, 2020-November 1, 2020) across the internet. Natural language processing, text analytics, and social data mining were used to categorize conversations that included a self-identifier into racial/ethnic groups. Conversations were mapped to HBM concepts (ie, perceived susceptibility, perceived severity, perceived benefits, perceived barriers, cues to action, and self-efficacy). Results are descriptive in nature. Results: Of 2.9 and 1.3 million relevant digital conversations pre- and mid-COVID-19, race/ethnicity was determined among 1.8 million (62.2%) and 979,000 (75.3%) conversations, respectively. Pre-COVID-19, 1.3 million (72.1%) conversations about depression were analyzed among non-Hispanic Whites (NHW), 227,200 (12.6%) among Black Americans (BA), 189,200 (10.5%) among Hispanics, and 86,800 (4.8%) among Asian Americans (AS). Mid-COVID-19, a total of 736,100 (75.2%) conversations about depression were analyzed among NHW, 131,800 (13.5%) among BA, 78,300 (8.0%) among Hispanics, and 32,800 (3.3%) among AS. Conversations among all racial/ethnic groups had a negative tone, which increased pre- to mid-COVID-19; finding support from others was seen as a benefit among most groups. Hispanics had the highest rate of any racial/ethnic group of conversations showing an avoiding mindset toward their depression. Conversations related to external barriers to seeking treatment (eg, stigma, lack of support, and lack of resources) were generally more prevalent among Hispanics, BA, and AS than among NHW. Being able to benefit others and building a support system were key drivers to seeking help or treatment for all racial/ethnic groups. Conclusions: There were considerable racial/ethnic differences in drivers and barriers to seeking help and treatment for depression pre- and mid-COVID-19. As expected, COVID-19 has made conversations about depression more negative and with frequent discussions of barriers to seeking care. Applying concepts of the HBM to data on digital conversation about depression allowed organization of the most frequent themes by race/ethnicity. Individuals of all groups came online to discuss their depression. These data highlight opportunities for culturally competent and targeted approaches to addressing areas amenable to change that might impact the ability of people to ask for or receive mental health help, such as the constructs that comprise the HBM. %M 35275834 %R 10.2196/33637 %U https://formative.jmir.org/2022/6/e33637 %U https://doi.org/10.2196/33637 %U http://www.ncbi.nlm.nih.gov/pubmed/35275834 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 6 %P e38269 %T Navigating the Credibility of Web-Based Information During the COVID-19 Pandemic: Using Mnemonics to Empower the Public to Spot Red Flags in Health Information on the Internet %A Stokes-Parish,Jessica %+ Faculty of Health Sciences and Medicine, Bond University, 14 University Drive, Robina, 4227, Australia, 61 755951468, jstokesp@bond.edu.au %K science communication %K critical appraisal %K social media %K health literacy %K digital literacy %K misinformation %K COVID-19 %K online health %K infodemic %K infodemiology %D 2022 %7 17.6.2022 %9 Viewpoint %J J Med Internet Res %G English %X Misinformation creates challenges for the general public in differentiating truth from fiction in web-based content. During the COVID-19 pandemic, this issue has been amplified due to high volumes of news and changing information. Evidence on misinformation largely focuses on understanding the psychology of misinformation and debunking strategies but neglects to explore critical thinking education for the general public. This viewpoint outlines the science of misinformation and the current resources available to the public. This paper describes the development and theoretical underpinnings of a mnemonic (Conflict of Interest, References, Author, Buzzwords, Scope of Practice [CRABS]) for identifying misinformation in web-based health content. Leveraging evidence-based educational strategies may be a promising approach for empowering the public with the confidence needed to differentiate truth from fiction in an infodemic. %M 35649183 %R 10.2196/38269 %U https://www.jmir.org/2022/6/e38269 %U https://doi.org/10.2196/38269 %U http://www.ncbi.nlm.nih.gov/pubmed/35649183 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 6 %P e36882 %T Nursing Workflow Change in a COVID-19 Inpatient Unit Following the Deployment of Inpatient Telehealth: Observational Study Using a Real-Time Locating System %A Vilendrer,Stacie %A Lough,Mary E %A Garvert,Donn W %A Lambert,Monique H %A Lu,Jonathan Hsijing %A Patel,Birju %A Shah,Nigam H %A Williams,Michelle Y %A Kling,Samantha M R %+ Evaluation Sciences Unit, Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, 1265 Welch Road, Stanford, CA, 94305, United States, 1 587 206 4043, staciev@stanford.edu %K telemedicine %K telehealth %K informatics %K real-time locating system %K COVID-19 %K pandemic %K nursing %K patient safety %K PPE %K virtual care %K nurses %K patient outcomes %K pathogen exposure %K health risk %K health care staff %K health care professional %D 2022 %7 17.6.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic prompted widespread implementation of telehealth, including in the inpatient setting, with the goals to reduce potential pathogen exposure events and personal protective equipment (PPE) utilization. Nursing workflow adaptations in these novel environments are of particular interest given the association between nursing time at the bedside and patient safety. Understanding the frequency and duration of nurse-patient encounters following the introduction of a novel telehealth platform in the context of COVID-19 may therefore provide insight into downstream impacts on patient safety, pathogen exposure, and PPE utilization. Objective: The aim of this study was to evaluate changes in nursing workflow relative to prepandemic levels using a real-time locating system (RTLS) following the deployment of inpatient telehealth on a COVID-19 unit. Methods: In March 2020, telehealth was installed in patient rooms in a COVID-19 unit and on movable carts in 3 comparison units. The existing RTLS captured nurse movement during 1 pre- and 5 postpandemic stages (January-December 2020). Change in direct nurse-patient encounters, time spent in patient rooms per encounter, and total time spent with patients per shift relative to baseline were calculated. Generalized linear models assessed difference-in-differences in outcomes between COVID-19 and comparison units. Telehealth adoption was captured and reported at the unit level. Results: Change in frequency of encounters and time spent per encounter from baseline differed between the COVID-19 and comparison units at all stages of the pandemic (all P<.001). Frequency of encounters decreased (difference-in-differences range –6.6 to –14.1 encounters) and duration of encounters increased (difference-in-differences range 1.8 to 6.2 minutes) from baseline to a greater extent in the COVID-19 units relative to the comparison units. At most stages of the pandemic, the change in total time nurses spent in patient rooms per patient per shift from baseline did not differ between the COVID-19 and comparison units (all P>.17). The primary COVID-19 unit quickly adopted telehealth technology during the observation period, initiating 15,088 encounters that averaged 6.6 minutes (SD 13.6) each. Conclusions: RTLS movement data suggest that total nursing time at the bedside remained unchanged following the deployment of inpatient telehealth in a COVID-19 unit. Compared to other units with shared mobile telehealth units, the frequency of nurse-patient in-person encounters decreased and the duration lengthened on a COVID-19 unit with in-room telehealth availability, indicating “batched” redistribution of work to maintain total time at bedside relative to prepandemic periods. The simultaneous adoption of telehealth suggests that virtual care was a complement to, rather than a replacement for, in-person care. However, study limitations preclude our ability to draw a causal link between nursing workflow change and telehealth adoption. Thus, further evaluation is needed to determine potential downstream implications on disease transmission, PPE utilization, and patient safety. %M 35635840 %R 10.2196/36882 %U https://www.jmir.org/2022/6/e36882 %U https://doi.org/10.2196/36882 %U http://www.ncbi.nlm.nih.gov/pubmed/35635840 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 6 %P e33099 %T Characterizing Anchoring Bias in Vaccine Comparator Selection Due to Health Care Utilization With COVID-19 and Influenza: Observational Cohort Study %A Ostropolets,Anna %A Ryan,Patrick B %A Schuemie,Martijn J %A Hripcsak,George %+ Department of Biomedical Informatics, Columbia University Irving Medical Center, 622 West 168th Street, PH20, New York, NY, 10032, United States, 1 2123055334, gh13@cumc.columbia.edu %K COVID-19 %K vaccine %K anchoring %K comparator selection %K time-at-risk %K vaccination %K bias %K observational %K utilization %K flu %K influenza %K index %K cohort %D 2022 %7 17.6.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Observational data enables large-scale vaccine safety surveillance but requires careful evaluation of the potential sources of bias. One potential source of bias is the index date selection procedure for the unvaccinated cohort or unvaccinated comparison time (“anchoring”). Objective: Here, we evaluated the different index date selection procedures for 2 vaccinations: COVID-19 and influenza. Methods: For each vaccine, we extracted patient baseline characteristics on the index date and up to 450 days prior and then compared them to the characteristics of the unvaccinated patients indexed on (1) an arbitrary date or (2) a date of a visit. Additionally, we compared vaccinated patients indexed on the date of vaccination and the same patients indexed on a prior date or visit. Results: COVID-19 vaccination and influenza vaccination differ drastically from each other in terms of the populations vaccinated and their status on the day of vaccination. When compared to indexing on a visit in the unvaccinated population, influenza vaccination had markedly higher covariate proportions, and COVID-19 vaccination had lower proportions of most covariates on the index date. In contrast, COVID-19 vaccination had similar covariate proportions when compared to an arbitrary date. These effects attenuated, but were still present, with a longer lookback period. The effect of day 0 was present even when the patients served as their own controls. Conclusions: Patient baseline characteristics are sensitive to the choice of the index date. In vaccine safety studies, unexposed index event should represent vaccination settings. Study designs previously used to assess influenza vaccination must be reassessed for COVID-19 to account for a potentially healthier population and lack of medical activity on the day of vaccination. %M 35482996 %R 10.2196/33099 %U https://publichealth.jmir.org/2022/6/e33099 %U https://doi.org/10.2196/33099 %U http://www.ncbi.nlm.nih.gov/pubmed/35482996 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 6 %P e35266 %T Enhancing COVID-19 Epidemic Forecasting Accuracy by Combining Real-time and Historical Data From Multiple Internet-Based Sources: Analysis of Social Media Data, Online News Articles, and Search Queries %A Li,Jingwei %A Huang,Wei %A Sia,Choon Ling %A Chen,Zhuo %A Wu,Tailai %A Wang,Qingnan %+ National Center for Applied Mathematics Shenzhen, No. 1088, Xueyuan Avenue, Nanshan District, Shenzhen, 518055, China, 86 15129077179, waynehuangwei@163.com %K SARS-CoV-2 %K COVID 19 %K epidemic forecasting %K disease surveillance %K infectious disease epidemiology %K social medial %K online news %K search query %K autoregression model %D 2022 %7 16.6.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The SARS-COV-2 virus and its variants pose extraordinary challenges for public health worldwide. Timely and accurate forecasting of the COVID-19 epidemic is key to sustaining interventions and policies and efficient resource allocation. Internet-based data sources have shown great potential to supplement traditional infectious disease surveillance, and the combination of different Internet-based data sources has shown greater power to enhance epidemic forecasting accuracy than using a single Internet-based data source. However, existing methods incorporating multiple Internet-based data sources only used real-time data from these sources as exogenous inputs but did not take all the historical data into account. Moreover, the predictive power of different Internet-based data sources in providing early warning for COVID-19 outbreaks has not been fully explored. Objective: The main aim of our study is to explore whether combining real-time and historical data from multiple Internet-based sources could improve the COVID-19 forecasting accuracy over the existing baseline models. A secondary aim is to explore the COVID-19 forecasting timeliness based on different Internet-based data sources. Methods: We first used core terms and symptom-related keyword-based methods to extract COVID-19–related Internet-based data from December 21, 2019, to February 29, 2020. The Internet-based data we explored included 90,493,912 online news articles, 37,401,900 microblogs, and all the Baidu search query data during that period. We then proposed an autoregressive model with exogenous inputs, incorporating real-time and historical data from multiple Internet-based sources. Our proposed model was compared with baseline models, and all the models were tested during the first wave of COVID-19 epidemics in Hubei province and the rest of mainland China separately. We also used lagged Pearson correlations for COVID-19 forecasting timeliness analysis. Results: Our proposed model achieved the highest accuracy in all 5 accuracy measures, compared with all the baseline models of both Hubei province and the rest of mainland China. In mainland China, except for Hubei, the COVID-19 epidemic forecasting accuracy differences between our proposed model (model i) and all the other baseline models were statistically significant (model 1, t198=–8.722, P<.001; model 2, t198=–5.000, P<.001, model 3, t198=–1.882, P=.06; model 4, t198=–4.644, P<.001; model 5, t198=–4.488, P<.001). In Hubei province, our proposed model's forecasting accuracy improved significantly compared with the baseline model using historical new confirmed COVID-19 case counts only (model 1, t198=–1.732, P=.09). Our results also showed that Internet-based sources could provide a 2- to 6-day earlier warning for COVID-19 outbreaks. Conclusions: Our approach incorporating real-time and historical data from multiple Internet-based sources could improve forecasting accuracy for epidemics of COVID-19 and its variants, which may help improve public health agencies' interventions and resource allocation in mitigating and controlling new waves of COVID-19 or other relevant epidemics. %M 35507921 %R 10.2196/35266 %U https://publichealth.jmir.org/2022/6/e35266 %U https://doi.org/10.2196/35266 %U http://www.ncbi.nlm.nih.gov/pubmed/35507921 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e38113 %T Design and Preliminary Findings of Adherence to the Self-Testing for Our Protection From COVID-19 (STOP COVID-19) Risk-Based Testing Protocol: Prospective Digital Study %A Herbert,Carly %A Kheterpal,Vik %A Suvarna,Thejas %A Broach,John %A Marquez,Juan Luis %A Gerber,Ben %A Schrader,Summer %A Nowak,Christopher %A Harman,Emma %A Heetderks,William %A Fahey,Nisha %A Orvek,Elizabeth %A Lazar,Peter %A Ferranto,Julia %A Noorishirazi,Kamran %A Valpady,Shivakumar %A Shi,Qiming %A Lin,Honghuang %A Marvel,Kathryn %A Gibson,Laura %A Barton,Bruce %A Lemon,Stephenie %A Hafer,Nathaniel %A McManus,David %A Soni,Apurv %+ Division of Clinical Informatics, Department of Medicine, University of Massachusetts Chan Medical School, 55 Lake Avenue North, Worcester, MA, 01655, United States, 1 774 442 4107, apurv.soni@umassmed.edu %K COVID-19 %K rapid antigen tests %K COVID-19 testing %K infectious disease %K disease spread %K prevention %K coronavirus %K adherence %K reporting %K mHealth %K health application %K mobile health %K digital health %K public health %K surveillance %K health care %K smartphone app %K vaccination %K digital surveillance %D 2022 %7 16.6.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Serial testing for SARS-CoV-2 is recommended to reduce spread of the virus; however, little is known about adherence to recommended testing schedules and reporting practices to health departments. Objective: The Self-Testing for Our Protection from COVID-19 (STOP COVID-19) study aims to examine adherence to a risk-based COVID-19 testing strategy using rapid antigen tests and reporting of test results to health departments. Methods: STOP COVID-19 is a 12-week digital study, facilitated using a smartphone app for testing assistance and reporting. We are recruiting 20,000 participants throughout the United States. Participants are stratified into high- and low-risk groups based on history of COVID-19 infection and vaccination status. High-risk participants are instructed to perform twice-weekly testing for COVID-19 using rapid antigen tests, while low-risk participants test only in the case of symptoms or exposure to COVID-19. All participants complete COVID-19 surveillance surveys, and rapid antigen results are recorded within the smartphone app. Primary outcomes include participant adherence to a risk-based serial testing protocol and percentage of rapid tests reported to health departments. Results: As of February 2022, 3496 participants have enrolled, including 1083 high-risk participants. Out of 13,730 tests completed, participants have reported 13,480 (98.18%, 95% CI 97.9%-98.4%) results to state public health departments with full personal identifying information or anonymously. Among 622 high-risk participants who finished the study period, 35.9% showed high adherence to the study testing protocol. Participants with high adherence reported a higher percentage of test results to the state health department with full identifying information than those in the moderate- or low-adherence groups (high: 71.7%, 95% CI 70.3%-73.1%; moderate: 68.3%, 95% CI 66.0%-70.5%; low: 63.1%, 59.5%-66.6%). Conclusions: Preliminary results from the STOP COVID-19 study provide important insights into rapid antigen test reporting and usage, and can thus inform the use of rapid testing interventions for COVID-19 surveillance. %M 35649180 %R 10.2196/38113 %U https://formative.jmir.org/2022/6/e38113 %U https://doi.org/10.2196/38113 %U http://www.ncbi.nlm.nih.gov/pubmed/35649180 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e35317 %T Integration vs Collaborative Redesign Strategies of Health Systems’ Supply Chains in the Post-COVID-19 New Normal: Cross-sectional Survey Across the United States %A Khuntia,Jiban %A Mejia,Frances J %A Ning,Xue %A Helton,Jeff %A Stacey,Rulon %+ Health Administration Research Consortium, University of Colorado Denver, 1475 Lawrence St., Denver, CO, 80202, United States, 1 303 315 8424, jiban.khuntia@ucdenver.edu %K COVID-19 %K post-COVID-19 %K health systems %K supply chain integration %K supply chain collaboration %K supply chain resilience %D 2022 %7 15.6.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Given the widespread disruptions to supply chains in 2020 because of the COVID-19 pandemic, questions such as how health systems are shaping strategies to restore the supply chain disruptions are essential to have confidence in health systems’ supply chain model strategies. Plausibly, health systems have an opportunity for redesign, growth, and innovation by utilizing collaborative strategies now, compared to the usual strategies of integrating their existing supply chains to reduce inefficiencies. Objective: This study focuses on teasing out the nuance of supply chain integration versus collaborative redesign strategies for health systems in the post-COVID-19 new normal. We focus on 2 research questions. First, we explore the impact of perceived supply chain challenges and disruptions on health systems’ supply chain integration (SC-INTEGRATION) and collaborative redesign (SC-REDESIGN) strategies. Second, we examine the outcomes of integration and collaborative redesign strategic choices on growth and service outcomes. Methods: We used data for this study collected through a consultant from a robust group of health system chief executive officers (CEOs) across the United States from February to March 2021. Among the 625 health system CEOs contacted, 135 (21.6%) responded to our survey. We considered supply chain–relevant strategy and outcome variables from the literature and ratified them via expert consensus. We collected secondary data from the Agency for Healthcare Research and Quality (AHRQ) Compendium of the US Health Systems, leading to a matched data set from the 124 health systems. Next, we used ordered logit model estimation to examine CEO preferences for partnership strategies to address current supply disruptions and the outcomes of strategy choices. Results: Health systems with higher disruptions would choose integration (positive, P<.001) over redesign, indicating that they still trust the existing partners. Integration strategy is perceived to result in better service outcomes (P<.01), while collaborations are perceived to lead to greater growth opportunities (P<.05); however, the role of integration in growth is not entirely ruled out (combined model, P<.001). Plausibly, some health systems would choose integration and collaborative redesign models, which have a significant relationship with both services (combined model, P<.01) and growth, establishing the importance of mixed strategies for health systems. Conclusions: The cost of health care continues to rise, and supply-related costs constitute a large portion of a hospital’s expenditure. Understanding supply chain strategic choices are essential for a health system’s success. Although collaboration is an option, focusing on and improving existing integration dynamics is helpful to foster both growth and services for health systems. %M 35452405 %R 10.2196/35317 %U https://formative.jmir.org/2022/6/e35317 %U https://doi.org/10.2196/35317 %U http://www.ncbi.nlm.nih.gov/pubmed/35452405 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 6 %P e34020 %T Social Determinants in Self-Protective Behavior Related to COVID-19: Association Rule–Mining Study %A Urbanin,Gabriel %A Meira,Wagner %A Serpa,Alexandre %A Costa,Danielle de Souza %A Baldaçara,Leonardo %A da Silva,Ana Paula %A Guatimosim,Rafaela %A Lacerda,Anísio Mendes %A Oliveira,Eduardo Araújo %A Braule,Andre %A Romano-Silva,Marco Aurélio %A da Silva,Antônio Geraldo %A Malloy-Diniz,Leandro %A Pappa,Gisele %A Miranda,Débora Marques %+ Departamento de Pediatria, Universidade Federal de Minas Gerais, Av Alfredo Balena 190, Belo Horizonte, 30130-100, Brazil, 55 31971380711, debora.m.miranda@gmail.com %K social determinants %K data mining %K self-protective behavior %K COVID-19 %K protection %K behavior %K sanitation %K characteristic %K Brazil %K compliance %K public health %K policy %K mask %K risk %D 2022 %7 15.6.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Human behavior is crucial in health outcomes. Particularly, individual behavior is a determinant of the success of measures to overcome critical conditions, such as a pandemic. In addition to intrinsic public health challenges associated with COVID-19, in many countries, some individuals decided not to get vaccinated, streets were crowded, parties were happening, and businesses struggling to survive were partially open, despite lockdown or stay-at-home instructions. These behaviors contrast with the instructions for potential benefits associated with social distancing, use of masks, and vaccination to manage collective and individual risks. Objective: Considering that human behavior is a result of individuals' social and economic conditions, we investigated the social and working characteristics associated with reports of appropriate protective behavior in Brazil. Methods: We analyzed data from a large web survey of individuals reporting their behavior during the pandemic. We selected 3 common self-care measures: use of protective masks, distancing by at least 1 m when out of the house, and handwashing or use of alcohol, combined with assessment of the social context of respondents. We measured the frequency of the use of these self-protective measures. Using a frequent pattern–mining perspective, we generated association rules from a set of answers to questions that co-occur with at least a given frequency, identifying the pattern of characteristics of the groups divided according to protective behavior reports. Results: The rationale was to identify a pool of working and social characteristics that might have better adhesion to behaviors and self-care measures, showing these are more socially determined than previously thought. We identified common patterns of socioeconomic and working determinants of compliance with protective self-care measures. Data mining showed that social determinants might be important to shape behavior in different stages of the pandemic. Conclusions: Identification of context determinants might be helpful to identify unexpected facilitators and constraints to fully follow public policies. The context of diseases contributes to psychological and physical health outcomes, and context understanding might change the approach to a disease. Hidden social determinants might change protective behavior, and social determinants of protective behavior related to COVID-19 are related to work and economic conditions. Trial Registration: Not applicable. %M 35704360 %R 10.2196/34020 %U https://publichealth.jmir.org/2022/6/e34020 %U https://doi.org/10.2196/34020 %U http://www.ncbi.nlm.nih.gov/pubmed/35704360 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 5 %N 2 %P e34115 %T Experience of Pediatricians and Pediatric Surgeons With Virtual Care During the COVID-19 Pandemic: Descriptive Study %A McCrady,Emma %A Strychowsky,Julie E %A Woolfson,Jessica P %+ Department of Pediatrics, London Health Sciences Centre Children's Hospital, Office B3-444, London, ON, N6A 5W9, Canada, 1 5198789608, emccrad@uwo.ca %K virtual care %K web-based care %K COVID-19 %K pediatrics %K pandemic %K physicians %K digital health %K pediatricians %K telehealth %D 2022 %7 15.6.2022 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Prior to the COVID-19 pandemic, in-clinic visits were the standard of care for pediatric physicians and surgeons at our center. At the pandemic onset, web-based care was adopted at an unprecedented scale and pace. Objective: This descriptive study explores the web-based care experience of pediatric physicians and surgeons during the pandemic by determining factors that supported and challenged web-based care adoption. Methods: This study took place at the Children’s Hospital at London Health Sciences Centre, a children’s hospital in London, Ontario, Canada, which provides pediatric care for patients from the London metropolitan area and the rest of Southwestern Ontario. The Donabedian model was used to structure a web-based survey evaluating web-based care experience, which was distributed to 121 department-affiliated pediatric physicians (including generalists and subspecialists in surgery and medicine). Recruitment occurred via department listserv email. Qualitative data were collected through discrete and free-text survey responses. Results: Survey response rate was 52.1% (63/121). Before the pandemic, few physicians within the Department of Paediatrics used web-based care, and physicians saw <10% of patients digitally. During March-May 2020, the majority transitioned to web-based care, seeing >50% of patients digitally. Web-based care use in our sample fell from June to September 2020, with the majority seeing <50% of patients digitally. Telephone and Ontario Telemedicine Network were the platforms most used from March to September 2020. Web-based care was rated to be convenient for most providers and their patients, despite the presence of technical difficulties. Challenges included lack of physical exam, lower patient volumes, and poor patient digital care etiquette. Regardless of demographics, 96.4% (116/121) would continue web-based care, ideally for patients who live far away and for follow-ups or established diagnoses. Conclusions: Transition to web-based care during COVID-19 was associated with challenges but also positive experiences. Willingness among pediatricians and pediatric surgeons to continue web-based care was high. Web-based care experiences at our center could be improved with patient education and targeting select populations. Future research is needed to improve practice efficiency and to inform regulatory guidelines for web-based care. %M 35666938 %R 10.2196/34115 %U https://pediatrics.jmir.org/2022/2/e34115 %U https://doi.org/10.2196/34115 %U http://www.ncbi.nlm.nih.gov/pubmed/35666938 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e36289 %T General Practitioners’ Experiences of Professional Uncertainties Emerging from the Introduction of Video Consultations in General Practice: Qualitative Study %A Nordtug,Maja %A Assing Hvidt,Elisabeth %A Lüchau,Elle Christine %A Grønning,Anette %+ Department of Social Work, Child Welfare and Social Policy, Oslo Metropolitan University, Stensberggata 26, Oslo, 0170, Norway, 47 67236935, majanord@oslomet.no %K video consultation technology %K general practice, COVID-19, doctor-patient communication %K uncertainties %K general practitioners %K video consultation %K virtual health %K physician %K digital health %K pandemic %D 2022 %7 14.6.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Uncertainties are omnipresent in health care, but little is known about general practitioners’ (GPs) professional uncertainties concerning digital consultations. This is problematic, as many countries have undergone an extensive digital transformation. Objective: The aim of this study was to explore the professional uncertainties that emerged among Danish GPs with the introduction of video consultations. Methods: We conducted qualitative interviews with 15 Danish GPs during the beginning of the COVID-19 pandemic in 2020. The interviews were analyzed using an abductive approach. Results: We identified 3 categories of uncertainty: integrity, setting, and interaction. Respectively, these 3 categories of uncertainty refer to (1) uncertainties related to how technology may impede the provision of health care; (2) uncertainties related to the potentials of video technology; and (3) uncertainties related to how the video consultation technology affects interactions with patients. Conclusions: The uncertainties experienced by Danish GPs appear to be a typical reaction to the introduction of new technology. Embedding video consultation technology into GPs’ working routines will take time, and GPs do not necessarily feel intuitively capable of transferring their abilities, such as being good and socially present for video-mediated consultations. The heterogeneity of professional uncertainties experienced among the GPs suggests that they are the product of individual GP-technology relationships—not of the technology in itself. Consequently, we cannot expect that uncertainties can be remedied by changing or precluding new technology. %M 35653607 %R 10.2196/36289 %U https://formative.jmir.org/2022/6/e36289 %U https://doi.org/10.2196/36289 %U http://www.ncbi.nlm.nih.gov/pubmed/35653607 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e32964 %T Remote Consulting in Primary Health Care in Low- and Middle-Income Countries: Feasibility Study of an Online Training Program to Support Care Delivery During the COVID-19 Pandemic %A Downie,Andrew %A Mashanya,Titus %A Chipwaza,Beatrice %A Griffiths,Frances %A Harris,Bronwyn %A Kalolo,Albino %A Ndegese,Sylvester %A Sturt,Jackie %A De Valliere,Nicole %A Pemba,Senga %+ Warwick Medical School, University of Warwick, Medical School Building, Coventry, CV4 7HL, United Kingdom, 44 024 7657 4880, F.E.Griffiths@warwick.ac.uk %K remote consultation %K mobile consulting %K digital health %K telehealth %K mHealth %K eHealth %K mobile health %K health care %K cascade %K train the trainer %K low- and middle-income countries %K rural areas %K Tanzania %K Kirkpatrick %K consultation %K training %K low- and middle-income %K rural %K COVID-19 %D 2022 %7 14.6.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Despite acceleration of remote consulting throughout the COVID-19 pandemic, many health care professionals are practicing without training to offer teleconsultation to their patients. This is especially challenging in resource-poor countries, where the telephone has not previously been widely used for health care. Objective: As the COVID-19 pandemic dawned, we designed a modular online training program for REmote Consulting in primary Health care (REaCH). To optimize upscaling of knowledge and skills, we employed a train-the-trainer approach, training health workers (tier 1) to cascade the training to others (tier 2) in their locality. We aimed to determine whether REaCH training was acceptable and feasible to health workers in rural Tanzania to support their health care delivery during the pandemic. Methods: We developed and pretested the REaCH training program in July 2020 and created 8 key modules. The program was then taught remotely via Moodle and WhatsApp (Meta Platforms) to 12 tier 1 trainees and cascaded to 63 tier 2 trainees working in Tanzania’s rural Ulanga District (August-September 2020). We evaluated the program using a survey (informed by Kirkpatrick's model of evaluation) to capture trainee satisfaction with REaCH, the knowledge gained, and perceived behavior change; qualitative interviews to explore training experiences and views of remote consulting; and documentary analysis of emails, WhatsApp texts, and training reports generated through the program. Quantitative data were analyzed using descriptive statistics. Qualitative data were analyzed thematically. Findings were triangulated and integrated during interpretation. Results: Of the 12 tier 1 trainees enrolled in the program, all completed the training; however, 2 (17%) encountered internet difficulties and failed to complete the evaluation. In addition, 1 (8%) opted out of the cascading process. Of the 63 tier 2 trainees, 61 (97%) completed the cascaded training. Of the 10 (83%) tier 1 trainees who completed the survey, 9 (90%) would recommend the program to others, reported receiving relevant skills and applying their learning to their daily work, demonstrating satisfaction, learning, and perceived behavior change. In qualitative interviews, tier 1 and 2 trainees identified several barriers to implementation of remote consulting, including lacking digital infrastructure, few resources, inflexible billing and record-keeping systems, and limited community awareness. The costs of data or airtime emerged as the greatest immediate barrier to supporting both the upscaling of REaCH training and subsequently the delivery of safe and trustworthy remote health care. Conclusions: The REaCH training program is feasible, acceptable, and effective in changing trainees’ behavior. However, government and organizational support is required to facilitate the expansion of the program and remote consulting in Tanzania and other low-resource settings. %M 35507772 %R 10.2196/32964 %U https://formative.jmir.org/2022/6/e32964 %U https://doi.org/10.2196/32964 %U http://www.ncbi.nlm.nih.gov/pubmed/35507772 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 6 %P e36445 %T Excess Google Searches for Child Abuse and Intimate Partner Violence During the COVID-19 Pandemic: Infoveillance Approach %A Riddell,Corinne A %A Neumann,Krista %A Santaularia,N Jeanie %A Farkas,Kriszta %A Ahern,Jennifer %A Mason,Susan M %+ Division of Epidemiology, School of Public Health, University of California, 2121 Berkeley Way West, Room #5404, Berkeley, CA, 94720, United States, 1 5106424618, c.riddell@berkeley.edu %K child abuse %K household violence %K infoveillance %K violence %K domestic violence %K abuse %K Google %K COVID-19 %D 2022 %7 13.6.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic has created environments with increased risk factors for household violence, such as unemployment and financial uncertainty. At the same time, it led to the introduction of policies to mitigate financial uncertainty. Further, it hindered traditional measurements of household violence. Objective: Using an infoveillance approach, our goal was to determine if there were excess Google searches related to exposure to child abuse, intimate partner violence (IPV), and child-witnessed IPV during the COVID-19 pandemic and if any excesses are temporally related to shelter-in-place and economic policies. Methods: Data on relative search volume for each violence measure was extracted using the Google Health Trends application programming interface for each week from 2017 to 2020 for the United States. Using linear regression with restricted cubic splines, we analyzed data from 2017 to 2019 to characterize the seasonal variation shared across prepandemic years. Parameters from prepandemic years were used to predict the expected number of Google searches and 95% prediction intervals (PI) for each week in 2020. Weeks with searches above the upper bound of the PI are in excess of the model’s prediction. Results: Relative search volume for exposure to child abuse was greater than expected in 2020, with 19% (10/52) of the weeks falling above the upper bound of the PI. These excesses in searches began a month after the Pandemic Unemployment Compensation program ended. Relative search volume was also heightened in 2020 for child-witnessed IPV, with 33% (17/52) of the weeks falling above the upper bound of the PI. This increase occurred after the introduction of shelter-in-place policies. Conclusions: Social and financial disruptions, which are common consequences of major disasters such as the COVID-19 pandemic, may increase risks for child abuse and child-witnessed IPV. %M 35700024 %R 10.2196/36445 %U https://www.jmir.org/2022/6/e36445 %U https://doi.org/10.2196/36445 %U http://www.ncbi.nlm.nih.gov/pubmed/35700024 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 6 %P e37327 %T COVID-19 Surveillance in the Biobank at the Colorado Center for Personalized Medicine: Observational Study %A Johnson,Randi K %A Marker,Katie M %A Mayer,David %A Shortt,Jonathan %A Kao,David %A Barnes,Kathleen C %A Lowery,Jan T %A Gignoux,Christopher R %+ Division of Biomedical Informatics and Personalized Medicine, Department of Medicine, University of Colorado School of Medicine, 13001 E 17th Place, Mail Stop 563, Aurora, CO, 80045, United States, 1 3037245375, randi.johnson@cuanschutz.edu %K COVID-19 %K surveillance %K pandemic %K biobank %K EHR %K public health %K integrated data %K population health %K health monitoring %K electronic health record %K eHealth %K health record %K emergency response %K vaccination status %K vaccination %K testing %K symptom %K disease impact %D 2022 %7 13.6.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Characterizing the experience and impact of the COVID-19 pandemic among various populations remains challenging due to the limitations inherent in common data sources, such as electronic health records (EHRs) or cross-sectional surveys. Objective: This study aims to describe testing behaviors, symptoms, impact, vaccination status, and case ascertainment during the COVID-19 pandemic using integrated data sources. Methods: In summer 2020 and 2021, we surveyed participants enrolled in the Biobank at the Colorado Center for Personalized Medicine (CCPM; N=180,599) about their experience with COVID-19. The prevalence of testing, symptoms, and impacts of COVID-19 on employment, family life, and physical and mental health were calculated overall and by demographic categories. Survey respondents who reported receiving a positive COVID-19 test result were considered a “confirmed case” of COVID-19. Using EHRs, we compared COVID-19 case ascertainment and characteristics in EHRs versus the survey. Positive cases were identified in EHRs using the International Statistical Classification of Diseases, 10th revision (ICD-10) diagnosis codes, health care encounter types, and encounter primary diagnoses. Results: Of the 25,063 (13.9%) survey respondents, 10,661 (42.5%) had been tested for COVID-19, and of those, 1366 (12.8%) tested positive. Nearly half of those tested had symptoms or had been exposed to someone who was infected. Young adults (18-29 years) and Hispanics were more likely to have positive tests compared to older adults and persons of other racial/ethnic groups. Mental health (n=13,688, 54.6%) and family life (n=12,233, 48.8%) were most negatively affected by the pandemic and more so among younger groups and women; negative impacts on employment were more commonly reported among Black respondents. Of the 10,249 individuals who responded to vaccination questions from version 2 of the survey (summer 2021), 9770 (95.3%) had received the vaccine. After integration with EHR data up to the time of the survey completion, 1006 (4%) of the survey respondents had a discordant COVID-19 case status between EHRs and the survey. Using all longitudinal EHR and survey data, we identified 11,472 (6.4%) COVID-19-positive cases among Biobank participants. In comparison to COVID-19 cases identified through the survey, EHR-identified cases were younger and more likely to be Hispanic. Conclusions: We found that the COVID-19 pandemic has had far-reaching and varying effects among our Biobank participants. Integrated data assets, such as the Biobank at the CCPM, are key resources for population health monitoring in response to public health emergencies, such as the COVID-19 pandemic. %M 35486493 %R 10.2196/37327 %U https://publichealth.jmir.org/2022/6/e37327 %U https://doi.org/10.2196/37327 %U http://www.ncbi.nlm.nih.gov/pubmed/35486493 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 2 %P e33951 %T Modeling Trust in COVID-19 Contact-Tracing Apps Using the Human-Computer Trust Scale: Online Survey Study %A Sousa,Sonia %A Kalju,Tiina %+ School of Digital Technologies, Tallinn University, Narva mnt, 29, Tallinn, 10120, Estonia, 372 53921116, scs@tlu.ee %K human-computer interaction %K COVID-19 %K human factors %K trustworthy AI %K contact-tracing %K app %K safety %K trust %K artificial intelligence %K Estonia %K case study %K monitoring %K surveillance %K perspective %K awareness %K design %K covid %K mobile app %K mHealth %K mobile health %D 2022 %7 13.6.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: The COVID-19 pandemic has caused changes in technology use worldwide, both socially and economically. This pandemic crisis has brought additional measures such as contact-tracing apps (CTAs) to help fight against spread of the virus. Unfortunately, the low adoption rate of these apps affected their success. There could be many reasons for the low adoption, including concerns of security and privacy, along with reported issues of trust in CTAs. Some concerns are related with how CTAs could be used as surveillance tools or their potential threats to privacy as they involve health data. For example, in Estonia, the CTA named HOIA had approximately 250,000 downloads in the middle of January 2021. However, in 2021, only 4.7% of the population used HOIA as a COVID-19 CTA. The reasons for the low adoption include lack of competency, and privacy and security concerns. This lower adoption and the lack of trustworthiness persist despite efforts of the European Union in building ethics and trustworthy artificial intelligence (AI)-based apps. Objective: The aim of this study was to understand how to measure trust in health technologies. Specifically, we assessed the usefulness of the Human-Computer Trust Scale (HCTS) to measure Estonians’ trust in the HOIA app and the causes for this lack of trust. Methods: The main research question was: Can the HCTS be used to assess citizens’ perception of trust in health technologies? We established four hypotheses that were tested with a survey. We used a convenience sample for data collection, including sharing the questionnaire on social network sites and using the snowball method to reach all potential HOIA users in the Estonian population. Results: Among the 78 respondents, 61 had downloaded the HOIA app with data on usage patterns. However, 20 of those who downloaded the app admitted that it was never opened despite most claiming to regularly use mobile apps. The main reasons included not understanding how it works, and privacy and security concerns. Significant correlations were found between participants’ trust in CTAs in general and their perceived trust in the HOIA app regarding three attributes: competency (P<.001), risk perception (P<.001), and reciprocity (P=.01). Conclusions: This study shows that trust in the HOIA app among Estonian residents did affect their predisposition to use the app. Participants did not generally believe that HOIA could help to control the spread of the virus. The result of this work is limited to HOIA and health apps that use similar contact-tracing methods. However, the findings can contribute to gaining a broader understanding and awareness of the need for designing trustworthy technologies. Moreover, this work can help to provide design recommendations that ensure trustworthiness in CTAs, and the ability of AI to use highly sensitive data and serve society. %M 35699973 %R 10.2196/33951 %U https://humanfactors.jmir.org/2022/2/e33951 %U https://doi.org/10.2196/33951 %U http://www.ncbi.nlm.nih.gov/pubmed/35699973 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e37858 %T COVID-19 Variant Surveillance and Social Determinants in Central Massachusetts: Development Study %A Shi,Qiming %A Herbert,Carly %A Ward,Doyle V %A Simin,Karl %A McCormick,Beth A %A Ellison III,Richard T %A Zai,Adrian H %+ Center for Clinical and Translational Science, UMass Chan Medical School, 362 Plantation Street, Ambulatory Care Center, 7th Floor, Worcester, MA, 01605, United States, 1 5088568989, qiming.shi@umassmed.edu %K geographic information science %K GIS %K COVID-19 %K SARS-CoV-2 %K variants %K surveillance %K dashboard %K web mapping %K public health %K web-based information %K digital health %K epidemiology %D 2022 %7 13.6.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Public health scientists have used spatial tools such as web-based Geographical Information System (GIS) applications to monitor and forecast the progression of the COVID-19 pandemic and track the impact of their interventions. The ability to track SARS-CoV-2 variants and incorporate the social determinants of health with street-level granularity can facilitate the identification of local outbreaks, highlight variant-specific geospatial epidemiology, and inform effective interventions. We developed a novel dashboard, the University of Massachusetts’ Graphical user interface for Geographic Information (MAGGI) variant tracking system that combines GIS, health-associated sociodemographic data, and viral genomic data to visualize the spatiotemporal incidence of SARS-CoV-2 variants with street-level resolution while safeguarding protected health information. The specificity and richness of the dashboard enhance the local understanding of variant introductions and transmissions so that appropriate public health strategies can be devised and evaluated. Objective: We developed a web-based dashboard that simultaneously visualizes the geographic distribution of SARS-CoV-2 variants in Central Massachusetts, the social determinants of health, and vaccination data to support public health efforts to locally mitigate the impact of the COVID-19 pandemic. Methods: MAGGI uses a server-client model–based system, enabling users to access data and visualizations via an encrypted web browser, thus securing patient health information. We integrated data from electronic medical records, SARS-CoV-2 genomic analysis, and public health resources. We developed the following functionalities into MAGGI: spatial and temporal selection capability by zip codes of interest, the detection of variant clusters, and a tool to display variant distribution by the social determinants of health. MAGGI was built on the Environmental Systems Research Institute ecosystem and is readily adaptable to monitor other infectious diseases and their variants in real-time. Results: We created a geo-referenced database and added sociodemographic and viral genomic data to the ArcGIS dashboard that interactively displays Central Massachusetts’ spatiotemporal variants distribution. Genomic epidemiologists and public health officials use MAGGI to show the occurrence of SARS-CoV-2 genomic variants at high geographic resolution and refine the display by selecting a combination of data features such as variant subtype, subject zip codes, or date of COVID-19–positive sample collection. Furthermore, they use it to scale time and space to visualize association patterns between socioeconomics, social vulnerability based on the Centers for Disease Control and Prevention’s social vulnerability index, and vaccination rates. We launched the system at the University of Massachusetts Chan Medical School to support internal research projects starting in March 2021. Conclusions: We developed a COVID-19 variant surveillance dashboard to advance our geospatial technologies to study SARS-CoV-2 variants transmission dynamics. This real-time, GIS-based tool exemplifies how spatial informatics can support public health officials, genomics epidemiologists, infectious disease specialists, and other researchers to track and study the spread patterns of SARS-CoV-2 variants in our communities. %M 35658093 %R 10.2196/37858 %U https://formative.jmir.org/2022/6/e37858 %U https://doi.org/10.2196/37858 %U http://www.ncbi.nlm.nih.gov/pubmed/35658093 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e37777 %T Experiences With a Postpartum mHealth Intervention During the COVID-19 Pandemic: Key Informant Interviews Among Patients, Health Care Providers, and Stakeholders %A Sadural,Ernani %A Riley,Kristen E %A Zha,Peijia %A Pacquiao,Dula %A Faust,Amanda %+ Department of Obstetrics and Gynecology, Cooperman Barnabas Medical Center, RWJBarnabas Health, 94 Old Short Hills Road, Suite 3148, Livingston, NJ, 07039, United States, 1 973 885 9190, ernani.sadural@rwjbh.org %K maternal mortality %K health disparity %K mHealth %K patient engagement %K postbirth warning signs %D 2022 %7 13.6.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Maternal morbidity and mortality in the United States continue to be a worsening public health crisis, with persistent racial disparities among Black women during the COVID-19 pandemic. Innovations in mobile health (mHealth) technology are being developed as a strategy to connect birthing women to their health care providers during the first 6 weeks of the postpartum period. Objective: This study aimed to inform a process to evaluate the barriers to mHealth implementation in the context of the COVID-19 pandemic by exploring the experiences of mothers and stakeholders who were directly involved in the pilot program. Methods: The qualitative design used GoToMeeting (GoTo) individual interviews of 13 mothers and 7 stakeholders at a suburban teaching hospital in New Jersey. Mothers were aged ≥18 years, able to read and write in English or Spanish, had a vaginal or cesarean birth at >20 weeks of estimated gestational age, and were admitted for delivery at the hospital with at least a 24-hour postpartum stay. Stakeholders were part of the hospital network’s obstetrics collaborative subcommittee comprising administrators, physicians, registered nurses, and informatics. Responses were transcribed verbatim and analyzed for emerging themes. The socioecological framework provided a holistic lens for analyzing the multilevel influences on individual experiences. Results: A total of 3 major themes were identified: mothers experienced barriers from personal situations at home and with services in the hospital and community, which were intensified by the COVID-19 pandemic; the COVID-19 pandemic negatively impacted hospital services, priorities, and individual staff; and mothers and stakeholders had positive experiences and perceptions of the mHealth intervention. Conclusions: The use and reach of the mHealth intervention were negatively influenced by interrelated factors operating at multiple levels. The system-wide and multilevel impact of the pandemic was reflected in participants’ responses, providing evidence for the need to re-evaluate mHealth implementation with more adaptable systems and structures in place using a socioecological framework. %M 35699998 %R 10.2196/37777 %U https://formative.jmir.org/2022/6/e37777 %U https://doi.org/10.2196/37777 %U http://www.ncbi.nlm.nih.gov/pubmed/35699998 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 6 %P e36429 %T Promoting Physical Activity Among University Students During the COVID-19 Pandemic: Protocol for a Randomized Controlled Trial %A Goncalves,Aurelie %A Bernal,Caroline %A Korchi,Karim %A Nogrette,Maxence %A Deshayes,Maxime %A Philippe,Antony G %A Gisclard,Béatrice %A Charbonnier,Elodie %+ APSY-V, Université de Nîmes, Rue du docteur Georges Salan CS13019, Nîmes, F-30021, France, 33 04 66 36 45 18, aurelie.goncalves@unimes.fr %K physical activity %K psychological factors %K university student %K COVID-19 %D 2022 %7 13.6.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Since the beginning of the COVID-19 pandemic, sanitary context and e-learning have greatly modified student lifestyles and led to deteriorations in their mental health. An increase in anxiety and depressive symptoms and sedentary behaviors, reduction in physical activity, and a stronger tendency to move toward unhealthy diet have been demonstrated. This finding highlights the need for innovative interventions to promote healthy lifestyle among students. Objective: This research protocol aims to evaluate the effects of an intervention program on the lifestyle and psychological state of students. Methods: Students from University of Nîmes were recruited and randomly assigned to 1 of 2 following conditions: an intervention group and a control group. Participants in the intervention group were engaged in an 8-week physical activity program. Prior to the start of the program, design-based innovative workshops were conducted with participants to ensure that the program was co-constructed by the users and met their specific needs. Students in the control group did not receive any intervention. For each group, measures of physical activity, sedentary time, anthropometric data, sleep, physical condition, and psychological variables (eg, anxiety, depression, motivation, body appreciation, perceived control, well-being) were conducted at baseline and 9 weeks later. Results: A total of 110 participants were initially included. Reporting of the results is projected for the spring of 2022. Conclusions: It is anticipated that this innovative intervention co-constructed by pairs will promote a healthier lifestyle and psychological health in students. There is every reason to believe that a mobilized co-construction approach is a promising strategy to limit unhealthy habits and promote physical activity while increasing motivation. The development and evaluation of interventions to address the specific needs of university students is essential and could be transferred to other vulnerable populations such as people with chronic diseases or older people. Trial Registration: ClinicalTrials.gov NCT05019482; https://clinicaltrials.gov/ct2/show/NCT05019482 International Registered Report Identifier (IRRID): DERR1-10.2196/36429 %M 35700019 %R 10.2196/36429 %U https://www.researchprotocols.org/2022/6/e36429 %U https://doi.org/10.2196/36429 %U http://www.ncbi.nlm.nih.gov/pubmed/35700019 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 8 %N 2 %P e35020 %T The Cancer Research Database (CRDB): Integrated Platform to Gain Statistical Insight Into the Correlation Between Cancer and COVID-19 %A Ullah,Shahid %A Ullah,Farhan %A Rahman,Wajeeha %A Karras,Dimitrios A %A Ullah,Anees %A Ahmad,Gulzar %A Ijaz,Muhammad %A Gao,Tianshun %+ Research Center, The Seventh Affiliated Hospital of Sun Yat-sen University, No 628, Zhenyuan Rd, Guangming (New) Dist, Shenzhen, 511464, China, 86 18126408738, gts.hust@gmail.com %K cancer database %K COVID-19 %K CRDB %K genomics %K PHP %K CRDB %K cancer and COVID-19 %K cancer statistics %K cancer research %K health database %K research platform %D 2022 %7 10.6.2022 %9 Original Paper %J JMIR Cancer %G English %X Background: The advancement of cancer research has been facilitated through freely available cancer literature, databases, and tools. The age of genomics and big data has given rise to the need for cooperation and data sharing in order to make efficient use of this new information in the COVID-19 pandemic. Although there are many databases for cancer research, their access is not easy owing to different ways of processing and managing the data. There is an absence of a unified platform to manage all of them in a transparent and more comprehensible way. Objective: In this study, an improved integrated cancer research database and platform is provided to facilitate a deeper statistical insight into the correlation between cancer and the COVID-19 pandemic, unifying the collection of almost all previous published cancer databases and defining a model web database for cancer research, and scoring databases on the basis of the variety types of cancer, sample size, completeness of omics results, and user interface. Methods: Databases examined and integrated include the Data Portal database, Genomic database, Proteomic database, Expression database, Gene database, and Mutation database; and it is expected that this launch will sort, save, advance the understanding and encourage the use of these resources in the cancer research environment. Results: To make it easy to search valuable information, 85 cancer databases are provided in the form of a table, and a database of databases named the Cancer Research Database (CRDB) has been built and presented herein. Furthermore, the CRDB has been herein equipped with unique navigation tools in order to be explored by three methods; that is, any single database can be browsed by typing the name in the given search bar, while all categories can be browsed by clicking on the name of the category or image expression icon, thus serving as a facility that could provide all the category databases on a single click. Conclusions: The computational platform (PHP, HTML, CSS, and MySQL) used to build CRDB for the cancer scientific community can be freely investigated and browsed on the internet and is planned to be updated in a timely manner. In addition, based on the proposed platform, the status and diagnoses statistics of cancer during the COVID-19 pandemic have been thoroughly investigated herein using CRDB, thus providing an easy-to-manage, understandable framework that mines knowledge for future researchers. %M 35430561 %R 10.2196/35020 %U https://cancer.jmir.org/2022/2/e35020 %U https://doi.org/10.2196/35020 %U http://www.ncbi.nlm.nih.gov/pubmed/35430561 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 11 %N 1 %P e37880 %T The Logistics of Medication and Patient Flow in Video-Based Virtual Clinics During a Sudden COVID-19 Outbreak in Taiwan: Observational Study %A Chen,Ying-Hsien %A Wu,Hui-Wen %A Huang,Ching-Chang %A Lee,Jen-Kuang %A Yang,Li-Tan %A Hsu,Tse-Pin %A Hung,Chi-Sheng %A Ho,Yi-Lwun %+ Department of Internal Medicine, National Taiwan University Hospital, No 7 Chung Shan S Rd, Taipei, 100225, Taiwan, 886 02 23123456 ext 262152, ylho@ntu.edu.tw %K COVID-19 %K telemedicine %K video-based virtual clinic %D 2022 %7 10.6.2022 %9 Original Paper %J Interact J Med Res %G English %X Background: The COVID-19 pandemic was well controlled in Taiwan until an outbreak in May 2021. Telemedicine was rapidly implemented to avoid further patient exposure and to unload the already burdened medical system. Objective: To understand the effect of COVID-19 on the implementation of video-based virtual clinic visits during this outbreak, we analyzed the logistics of prescribing medications and patient flow for such virtual visits at a tertiary medical center. Methods: We retrospectively collected information on video-based virtual clinic visits and face-to-face outpatient visits from May 1 to August 31, 2021, from the administrative database at National Taiwan University Hospital. The number of daily new confirmed COVID-19 cases in Taiwan was obtained from an open resource. Results: There were 782 virtual clinic visits during these 3 months, mostly for the departments of internal medicine, neurology, and surgery. The 3 most common categories of medications prescribed were cardiovascular, diabetic, and gastrointestinal, of which cardiovascular medications comprised around one-third of all medications prescribed during virtual clinic visits. The number of virtual clinic visits was significantly correlated with the number of daily new confirmed COVID-19 cases, with approximately a 20-day delay (correlation coefficient 0.735; P<.001). The patient waiting time for video-based virtual clinic visits was significantly shorter compared with face-to-face clinic visits during the same period (median 3, IQR 2-6 min vs median 20, IQR 9-42 min; rank sum P<.001). Although the time saved was appreciated by the patients, online payment with direct delivery of medications without the need to visit a hospital was still their major concern. Conclusions: Our data showed that video-based virtual clinics can be implemented rapidly after a COVID-19 outbreak. The virtual clinics were efficient, as demonstrated by the significantly reduced waiting time. However, there are still some barriers to the large-scale implementation of video-based virtual clinics. Better preparation is required to improve performance in possible future large outbreaks. %M 35687404 %R 10.2196/37880 %U https://www.i-jmr.org/2022/1/e37880 %U https://doi.org/10.2196/37880 %U http://www.ncbi.nlm.nih.gov/pubmed/35687404 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 6 %P e37466 %T The Effect of Fear of Infection and Sufficient Vaccine Reservation Information on Rapid COVID-19 Vaccination in Japan: Evidence From a Retrospective Twitter Analysis %A Niu,Qian %A Liu,Junyu %A Kato,Masaya %A Nagai-Tanima,Momoko %A Aoyama,Tomoki %+ Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, 53, Kawahara-Cho, Shogoin, Sakyo-Ku, Kyoto, 606-8507, Japan, 81 075 751 3964, tanima.momoko.8s@kyoto-u.ac.jp %K COVID-19 %K vaccine hesitancy %K Japan %K social media %K text mining %D 2022 %7 9.6.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: The global public health and socioeconomic impacts of the COVID-19 pandemic have been substantial, rendering herd immunity by COVID-19 vaccination an important factor for protecting people and retrieving the economy. Among all the countries, Japan became one of the countries with the highest COVID-19 vaccination rates in several months, although vaccine confidence in Japan is the lowest worldwide. Objective: We attempted to find the reasons for rapid COVID-19 vaccination in Japan given its lowest vaccine confidence levels worldwide, through Twitter analysis.  Methods: We downloaded COVID-19–related Japanese tweets from a large-scale public COVID-19 Twitter chatter data set within the timeline of February 1 and September 30, 2021. The daily number of vaccination cases was collected from the official website of the Prime Minister’s Office of Japan. After preprocessing, we applied unigram and bigram token analysis and then calculated the cross-correlation and Pearson correlation coefficient (r) between the term frequency and daily vaccination cases. We then identified vaccine sentiments and emotions of tweets and used the topic modeling to look deeper into the dominant emotions.  Results: We selected 190,697 vaccine-related tweets after filtering. Through n-gram token analysis, we discovered the top unigrams and bigrams over the whole period. In all the combinations of the top 6 unigrams, tweets with both keywords “reserve” and “venue” showed the largest correlation with daily vaccination cases (r=0.912; P<.001). On sentiment analysis, negative sentiment overwhelmed positive sentiment, and fear was the dominant emotion across the period. For the latent Dirichlet allocation model on tweets with fear emotion, the two topics were identified as “infect” and “vaccine confidence.” The expectation of the number of tweets generated from topic “infect” was larger than that generated from topic “vaccine confidence.” Conclusions: Our work indicates that awareness of the danger of COVID-19 might increase the willingness to get vaccinated. With a sufficient vaccine supply, effective delivery of vaccine reservation information may be an important factor for people to get vaccinated. We did not find evidence for increased vaccine confidence in Japan during the period of our study. We recommend policy makers to share accurate and prompt information about the infectious diseases and vaccination and to make efforts on smoother delivery of vaccine reservation information. %M 35649182 %R 10.2196/37466 %U https://www.jmir.org/2022/6/e37466 %U https://doi.org/10.2196/37466 %U http://www.ncbi.nlm.nih.gov/pubmed/35649182 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 2 %P e36831 %T Use of Health Care Chatbots Among Young People in China During the Omicron Wave of COVID-19: Evaluation of the User Experience of and Satisfaction With the Technology %A Shan,Yi %A Ji,Meng %A Xie,Wenxiu %A Zhang,Xiaomin %A Qian,Xiaobo %A Li,Rongying %A Hao,Tianyong %+ School of Foreign Studies, Nantong University, No. 9, Seyuan Rd, Nantong, 226019, China, 86 15558121896, victorsyhz@hotmail.com %K health care chatbots %K COVID-19 %K user experience %K user satisfaction %K theory of consumption values %K chatbots %K adolescent %K youth %K digital health %K health care %K omicron wave %K omicron %K health care system %K conversational agent %D 2022 %7 9.6.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Long before the outbreak of COVID-19, chatbots had been playing an increasingly crucial role and gaining growing popularity in health care. In the current omicron waves of this pandemic when the most resilient health care systems at the time are increasingly being overburdened, these conversational agents (CA) are being resorted to as preferred alternatives for health care information. For many people, especially adolescents and the middle-aged, mobile phones are the most favored source of information. As a result of this, it is more important than ever to investigate the user experience of and satisfaction with chatbots on mobile phones. Objective: The objective of this study was twofold: (1) Informed by Deneche and Warren’s evaluation framework, Zhu et al’s measures of variables, and the theory of consumption values (TCV), we designed a new assessment model for evaluating the user experience of and satisfaction with chatbots on mobile phones, and (2) we aimed to validate the newly developed model and use it to gain an understanding of the user experience of and satisfaction with popular health care chatbots that are available for use by young people aged 17-35 years in southeast China in self-diagnosis and for acquiring information about COVID-19 and virus variants that are currently spreading. Methods: First, to assess user experience and satisfaction, we established an assessment model based on relevant literature and TCV. Second, the chatbots were prescreened and selected for investigation. Subsequently, 413 informants were recruited from Nantong University, China. This was followed by a questionnaire survey soliciting the participants’ experience of and satisfaction with the selected health care chatbots via wenjuanxing, an online questionnaire survey platform. Finally, quantitative and qualitative analyses were conducted to find the informants’ perception. Results: The data collected were highly reliable (Cronbach α=.986) and valid: communalities=0.632-0.823, Kaiser-Meyer-Olkin (KMO)=0.980, and percentage of cumulative variance (rotated)=75.257% (P<.001). The findings of this study suggest a considerable positive impact of functional, epistemic, emotional, social, and conditional values on the participants’ overall user experience and satisfaction and a positive correlation between these values and user experience and satisfaction (Pearson correlation P<.001). The functional values (mean 1.762, SD 0.630) and epistemic values (mean 1.834, SD 0.654) of the selected chatbots were relatively more important contributors to the students’ positive experience and overall satisfaction than the emotional values (mean 1.993, SD 0.683), conditional values (mean 1.995, SD 0.718), and social values (mean 1.998, SD 0.696). All the participants (n=413, 100%) had a positive experience and were thus satisfied with the selected health care chatbots. The 5 grade categories of participants showed different degrees of user experience and satisfaction: Seniors (mean 1.853, SD 0.108) were the most receptive to health care chatbots for COVID-19 self-diagnosis and information, and second-year graduate candidates (mean 2.069, SD 0.133) were the least receptive; freshmen (mean 1.883, SD 0.114) and juniors (mean 1.925, SD 0.087) felt slightly more positive than sophomores (mean 1.989, SD 0.092) and first-year graduate candidates (mean 1.992, SD 0.116) when engaged in conversations with the chatbots. In addition, female informants (mean 1.931, SD 0.098) showed a relatively more receptive attitude toward the selected chatbots than male respondents (mean 1.999, SD 0.051). Conclusions: This study investigated the use of health care chatbots among young people (aged 17-35 years) in China, focusing on their user experience and satisfaction examined through an assessment framework. The findings show that the 5 domains in the new assessment model all have a positive impact on the participants’ user experience and satisfaction. In this paper, we examined the usability of health care chatbots as well as actual chatbots used for other purposes, enriching the literature on the subject. This study also provides practical implication for designers and developers as well as for governments of all countries, especially in the critical period of the omicron waves of COVID-19 and other future public health crises. %M 35576058 %R 10.2196/36831 %U https://humanfactors.jmir.org/2022/2/e36831 %U https://doi.org/10.2196/36831 %U http://www.ncbi.nlm.nih.gov/pubmed/35576058 %0 Journal Article %@ 2562-0959 %I JMIR Publications %V 5 %N 2 %P e33833 %T Using Implementation Science to Understand Teledermatology Implementation Early in the COVID-19 Pandemic: Cross-sectional Study %A Briggs,Shanelle Mariah %A Lipoff,Jules Benjamin %A Collier,Sigrid Marie %+ Division of Dermatology, University of Washington, BB-1353 Health Sciences Center, Box 356524, 1959 NE Pacific Street, Seattle, WA, 98195-6524, United States, 1 206 543 5290, coll0640@uw.edu %K teledermatology %K telemedicine %K telehealth %K COVID-19 %K remote care %K implementation science %K store and forward %K Organizational Readiness to Change Assessment %K acceptability %K feasibility %K digital health %K dermatology %K dermatologist %K health technology %D 2022 %7 9.6.2022 %9 Original Paper %J JMIR Dermatol %G English %X Background: Implementation science has been recognized for its potential to improve the integration of evidence-based practices into routine dermatologic care. The COVID-19 pandemic has resulted in rapid teledermatology implementation worldwide. Although several studies have highlighted patient and care provider satisfaction with teledermatology during the COVID-19 pandemic, less is known about the implementation process. Objective: Our goal was to use validated tools from implementation science to develop a deeper understanding of the implementation of teledermatology during the COVID-19 pandemic. Our primary aims were to describe (1) the acceptability and feasibility of the implementation of teledermatology and (2) organizational readiness for the implementation of teledermatology during the COVID-19 pandemic. We also sought to offer an example of how implementation science can be used in dermatologic research. Methods: An anonymous, web-based survey was distributed to Association of Professors of Dermatology members. It focused on (1) the acceptability, feasibility, and appropriateness of teledermatology and (2) organizational readiness for implementing teledermatology. It incorporated subscales from the Organizational Readiness to Change Assessment—a validated measure of organizational characteristics that predict implementation success. Results: Of the 518 dermatologists emailed, 35 (7%) responded, and all implemented or scaled up teledermatology during the pandemic. Of the 11 care providers with the highest level of organizational readiness, 11 (100%) said that they plan to continue using teledermatology after the pandemic. Most respondents agreed or strongly agreed that they had sufficient training (24/35, 69%), financial resources (20/35, 57%), and facilities (20/35, 57%). However, of the 35 respondents, only 15 (43%) agreed or strongly agreed that they had adequate staffing support. Most respondents considered the most acceptable teledermatology modality to be synchronous audio and video visits with supplemental stored digital photos (23/35, 66%) and considered the least acceptable modality to be telephone visits without stored digital photos (6/35, 17%). Overall, most respondents thought that the implementation of synchronous audio and video with stored digital photos (31/35, 89%) and telephone visits with stored digital photos (31/35, 89%) were the most feasible. When asked about types of visits that were acceptable for synchronous video/audio visits (with stored digital photos), 18 of the 31 respondents (58%) said “new patients,” 27 (87%) said “existing patients,” 19 (61%) said “medication monitoring,” 3 (10%) said “total body skin exams,” and 22 (71%) said “lesions of concern.” Conclusions: This study serves as an introduction to how implementation science research methods can be used to understand the implementation of novel technologies in dermatology. Our work builds upon prior studies by further characterizing the acceptability and feasibility of different teledermatology modalities. Our study may suggest initial insights on how dermatology practices and health care systems can support dermatologists in successfully incorporating teledermatology after the pandemic. %M 35720247 %R 10.2196/33833 %U https://derma.jmir.org/2022/2/e33833 %U https://doi.org/10.2196/33833 %U http://www.ncbi.nlm.nih.gov/pubmed/35720247 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 6 %P e37479 %T Public Health Implications of Adapting HIV Pre-exposure Prophylaxis Programs for Virtual Service Delivery in the Context of the COVID-19 Pandemic: Systematic Review %A Patel,Pragna %A Kerzner,Michael %A Reed,Jason B %A Sullivan,Patrick Sean %A El-Sadr,Wafaa M %+ COVID-19 Response Team, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA, 30329, United States, 1 4046396132, plp3@cdc.gov %K HIV %K pre-exposure prophylaxis %K COVID-19 %K virtual service delivery %K HIV prevention %K public health %K systematic review %K virtual service %K health intervention %K digital intervention %K health technology %K social media platform %K telehealth %K public health message %D 2022 %7 7.6.2022 %9 Review %J JMIR Public Health Surveill %G English %X Background: The novel coronavirus disease COVID-19 caused by SARS-CoV-2 threatens to disrupt global progress toward HIV epidemic control. Opportunities exist to leverage ongoing public health responses to mitigate the impacts of COVID-19 on HIV services, and novel approaches to care provision might help address both epidemics. Objective: As the COVID-19 pandemic continues, novel approaches to maintain comprehensive HIV prevention service delivery are needed. The aim of this study was to summarize the related literature to highlight adaptations that could address potential COVID-19–related service interruptions. Methods: We performed a systematic review and searched six databases, OVID/Medline, Scopus, Cochrane Library, CINAHL, PsycINFO, and Embase, for studies published between January 1, 2010, and October 26, 2021, related to recent technology-based interventions for virtual service delivery. Search terms included “telemedicine,” “telehealth,” “mobile health,” “eHealth,” “mHealth,” “telecommunication,” “social media,” “mobile device,” and “internet,” among others. Of the 6685 abstracts identified, 1259 focused on HIV virtual service delivery, 120 of which were relevant for HIV prevention efforts; 48 pertained to pre-exposure prophylaxis (PrEP) and 19 of these focused on evaluations of interventions for the virtual service delivery of PrEP. Of the 16 systematic reviews identified, three were specific to PrEP. All 35 papers were reviewed for outcomes of efficacy, feasibility, and/or acceptability. Limitations included heterogeneity of the studies’ methodological approaches and outcomes; thus, a meta-analysis was not performed. We considered the evidence-based interventions found in our review and developed a virtual service delivery model for HIV prevention interventions. We also considered how this platform could be leveraged for COVID-19 prevention and care. Results: We summarize 19 studies of virtual service delivery of PrEP and 16 relevant reviews. Examples of technology-based interventions that were effective, feasible, and/or acceptable for PrEP service delivery include: use of SMS, internet, and smartphone apps such as iText (50% [95% CI 16%-71%] reduction in discontinuation of PrEP) and PrEPmate (OR 2.62, 95% CI 1.24-5.5.4); telehealth and eHealth platforms for virtual visits such as PrEPTECH and IowaTelePrEP; and platforms for training of health care workers such as Extension for Community Healthcare Outcomes (ECHO). We suggest a virtual service delivery model for PrEP that can be leveraged for COVID-19 using the internet and social media for demand creation, community-based self-testing, telehealth platforms for risk assessment and follow-up, applications for support groups and adherence/appointment reminders, and applications for monitoring. Conclusions: Innovations in the virtual service provision of PrEP occurred before COVID-19 but have new relevance during the COVID-19 pandemic. The innovations we describe might strengthen HIV prevention service delivery during the COVID-19 pandemic and in the long run by engaging traditionally hard-to-reach populations, reducing stigma, and creating a more accessible health care platform. These virtual service delivery platforms can mitigate the impacts of the COVID-19 pandemic on HIV services, which can be leveraged to facilitate COVID-19 pandemic control now and for future responses. %M 35486813 %R 10.2196/37479 %U https://publichealth.jmir.org/2022/6/e37479 %U https://doi.org/10.2196/37479 %U http://www.ncbi.nlm.nih.gov/pubmed/35486813 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 6 %P e33484 %T Attitudes Toward the Global Allocation of Chinese COVID-19 Vaccines: Cross-sectional Online Survey of Adults Living in China %A Yu,Hanzhi %A Du,Runming %A Wang,Minmin %A Yu,Fengyun %A Yang,Juntao %A Jiao,Lirui %A Wang,Zhuoran %A Liu,Haitao %A Wu,Peixin %A Bärnighausen,Till %A Xue,Lan %A Wang,Chen %A McMahon,Shannon %A Geldsetzer,Pascal %A Chen,Simiao %+ Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Postfach 10 57 60 69047, Heidelberg, 69047, Germany, 49 6221 54 0, simiao.chen@uni-heidelberg.de %K COVID-19 vaccines %K China %K global allocation %K public attitudes %K cross-sectional %K survey %K vaccines %K COVID-19 %K pandemic %K public health %K health policy %K epidemiology %D 2022 %7 7.6.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: COVID-19 vaccines are in short supply worldwide. China was among the first countries to pledge supplies of the COVID-19 vaccine as a global public product, and to date, the country has provided more than 600 million vaccines to more than 200 countries and regions with low COVID-19 vaccination rates. Understanding the public’s attitude in China toward the global distribution of COVID-19 vaccines could inform global and national decisions, policies, and debates. Objective: The aim of this study was to determine the attitudes of adults living in China regarding the global allocation of COVID-19 vaccines developed in China and how these attitudes vary across provinces and by sociodemographic characteristics. Methods: We conducted a cross-sectional online survey among adults registered with the survey company KuRunData. The survey asked participants 31 questions about their attitudes regarding the global allocation of COVID-19 vaccines developed in China. We disaggregated responses by province and sociodemographic characteristics. All analyses used survey sampling weights. Results: A total of 10,000 participants completed the questionnaire. Participants generally favored providing COVID-19 vaccines to foreign countries before fulfilling domestic needs (75.6%, 95% CI 74.6%-76.5%). Women (3778/4921, 76.8%; odds ratio 1.18, 95% CI 1.07-1.32; P=.002) and those living in rural areas (3123/4065, 76.8%; odds ratio 1.13, 95% CI 1.01-1.27; P=.03) were especially likely to hold this opinion. Most respondents preferred providing financial support through international platforms rather than directly offering support to individual countries (72.1%, 95% CI 71%-73.1%), while for vaccine products they preferred direct provision to relevant countries instead of via a delivery platform such as COVAX (77.3%, 95% CI 76.3%-78.2%). Conclusions: Among our survey sample, we found that adults are generally supportive of the international distribution of COVID-19 vaccines, which may encourage policy makers to support and implement the distribution of COVID-19 vaccines developed in China worldwide. Conducting similar surveys in other countries could help align policy makers’ actions on COVID-19 vaccine distribution with the preferences of their constituencies. %M 35483084 %R 10.2196/33484 %U https://publichealth.jmir.org/2022/6/e33484 %U https://doi.org/10.2196/33484 %U http://www.ncbi.nlm.nih.gov/pubmed/35483084 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 6 %P e33011 %T Media Use During the COVID-19 Pandemic: Cross-sectional Study %A Rivest-Beauregard,Marjolaine %A Fortin,Justine %A Guo,Connie %A Cipolletta,Sabrina %A Sapkota,Ram P %A Lonergan,Michelle %A Brunet,Alain %+ Division of Psychosocial Research, Douglas Mental Health University Institute, Perry Building, Third Floor, 6875 bd LaSalle, Montréal, QC, H4H 1R3, Canada, 1 514 761 6131 ext 3473, marjolaine.rivest-beauregard@mail.mcgill.ca %K media use %K support %K information-seeking behaviors %K trauma- and stressor-related symptoms %K COVID-19 %K media %K information-seeking %K behavior %K trauma %K stress %K symptom %K frequency %K risk %K distress %D 2022 %7 7.6.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Throughout the pandemic, the general population was encouraged to use media to be kept informed about sanitary measures while staying connected with others to obtain social support. However, due to mixed findings in the literature, it is not clear whether media use in such a context would be pathogenic or salutogenic. Objective: Therefore, the associations between COVID-19–related stressors and frequency of media use for information-seeking on trauma- and stressor-related (TSR) symptoms were examined while also investigating how social media use for support-seeking and peritraumatic distress interact with those variables. Methods: A path model was tested in a sample of 5913 adults who completed an online survey. Results: The number of COVID-19–related stressors (β=.25; P<.001) and extent of information-seeking through media (β=.24; P=.006) were significantly associated with the severity of TSR symptoms in bivariate comparisons. Associations between levels of peritraumatic distress and both COVID-19–related stressors and information-seeking through media, and social media use for support- and information-seeking through media were found (βCOVID-19 stressors: Peritraumatic Distress Inventory=.49, P<.001; βseeking information: Peritraumatic Distress Inventory=.70, P<.001; βseeking information–seeking support=.04, P<.001). Conclusions: Results suggest that exposure to COVID-19–related stressors and seeking COVID-19–related information through the media are associated with higher levels of peritraumatic distress that, in turn, lead to higher levels of TSR symptoms. Although exposure to the stress of the COVID-19 pandemic may be unavoidable, the frequency of COVID-19–related information consumption through various media should be approached with caution. %M 3553703 %R 10.2196/33011 %U https://www.jmir.org/2022/6/e33011 %U https://doi.org/10.2196/33011 %U http://www.ncbi.nlm.nih.gov/pubmed/3553703 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 9 %N 2 %P e35569 %T The Current State of Remote Physiotherapy in Finland: Cross-sectional Web-Based Questionnaire Study %A Hellstén,Thomas %A Arokoski,Jari %A Sjögren,Tuulikki %A Jäppinen,Anna-Maija %A Kettunen,Jyrki %+ Faculty of Medicine, University of Helsinki, P O Box 63, Haartmaninkatu 8, Helsinki, 00014, Finland, 358 407733154, thomas.hellsten@helsinki.fi %K COVID-19 %K remote physiotherapy %K COVID-19 pandemic %K current state %K suitability in disease groups %K competence of physiotherapist %D 2022 %7 7.6.2022 %9 Original Paper %J JMIR Rehabil Assist Technol %G English %X Background: The ongoing COVID-19 pandemic has required social, health, and rehabilitation organizations to implement remote physiotherapy (RP) as a part of physiotherapists’ daily practice. RP may improve access to physiotherapy as it delivers physiotherapy services to rehabilitees through information and communications technology. Even if RP has already been introduced in this century, physiotherapists’ opinion, amount of use, and form in daily practice have not been studied extensively. Objective: This study aims to investigate physiotherapists’ opinions of the current state of RP in Finland. Methods: A quantitative, cross-sectional, web-based questionnaire was sent to working-aged members of the Finnish Association of Physiotherapists (n=5905) in March 2021 and to physiotherapists in a private physiotherapy organization (n=620) in May 2021. The questionnaire included questions on the suitability of RP in different diseases and the current state and implementation of RP in work among physiotherapists. Results: Of the 6525 physiotherapists, a total of 9.9% (n=662; n=504, 76.1% female; mean age 46.1, SD 12 years) answered the questionnaire. The mean suitability “score” (0=not suitable at all to 10=fully suitable) of RP in different disease groups varied from 3.3 (neurological diseases) to 6.1 (lung diseases). Between early 2020 (ie, just before the COVID-19 pandemic) and spring 2021, the proportion of physiotherapists who used RP increased from 33.8% (21/62) to 75.4% (46/61; P<.001) in the public sector and from 19.7% (42/213) to 76.6% (163/213; P<.001) in the private sector. However, only 11.7% (32/274) of physiotherapists reported that they spent >20% of their practice time for RP in 2021. The real-time method was the most common RP method in both groups (public sector 46/66, 69.7% vs private sector 157/219, 71.7%; P=.47). The three most commonly used technical equipments were computers/tablets (229/290, 79%), smartphones (149/290, 51.4%), and phones (voice call 51/290, 17.6%). The proportion of physiotherapists who used computers/tablets in RP was higher in the private sector than in the public sector (183/221, 82.8% vs 46/68, 67.6%; P=.01). In contrast, a higher proportion of physiotherapists in the public sector than in the private sector used phones (18/68, 26.5% vs 33/221, 14.9%; P=.04). Conclusions: During the COVID-19 pandemic, physiotherapists increased their use of RP in their everyday practice, although practice time in RP was still low. When planning RP for rehabilitees, it should be considered that the suitability of RP in different diseases seems to vary in the opinion of physiotherapists. Furthermore, our results brought up important new information for developing social, health, and rehabilitation education for information and communications technologies. %M 3560 %R 10.2196/35569 %U https://rehab.jmir.org/2022/2/e35569 %U https://doi.org/10.2196/35569 %U http://www.ncbi.nlm.nih.gov/pubmed/3560 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 2 %P e34793 %T The Factors Associated With Nonuse of Social Media or Video Communications to Connect With Friends and Family During the COVID-19 Pandemic in Older Adults: Web-Based Survey Study %A Savage,Rachel D %A Di Nicolo,Sophia %A Wu,Wei %A Li,Joyce %A Lawson,Andrea %A Grieve,Jim %A Goel,Vivek %A Rochon,Paula A %+ Women's Age Lab, Women's College Hospital, 76 Grenville Street, Toronto, ON, M5S 1B2, Canada, 1 416 351 3732 ext 3822, rachel.savage@wchospital.ca %K digital technology %K loneliness %K older adults %K COVID-19 %K elderly %K lonely %K mental health %K factor %K usage %K social media %K video %K communication %K connection %K connect %K family %K friend %K age %K support %D 2022 %7 6.6.2022 %9 Original Paper %J JMIR Aging %G English %X Background: Digital technologies have enabled social connection during prolonged periods of physical distancing and travel restrictions throughout the COVID-19 pandemic. These solutions may exclude older adults, who are at higher risk for social isolation, loneliness, and severe outcomes if infected with SARS-CoV-2. Objective: This study investigated factors associated with nonuse of social media or video communications to connect with friends and family among older adults during the pandemic’s first wave. Methods: A web-based, cross-sectional survey was administered to members of a national retired educators’ organization based in Ontario, Canada, between May 6 and 19, 2020. Respondents (N=4879) were asked about their use of social networking websites or apps to communicate with friends and family, their internet connection and smartphone access, loneliness, and sociodemographic characteristics. Factors associated with nonuse were evaluated using multivariable logistic regression. A thematic analysis was performed on open-ended survey responses that described experiences with technology and virtual connection. Results: Overall, 15.4% (751/4868) of respondents did not use social networking websites or apps. After adjustment, male gender (odds ratio [OR] 1.60, 95% CI 1.33-1.92), advanced age (OR 1.88, 95% CI 1.38-2.55), living alone (OR 1.68, 95% CI 1.39-2.02), poorer health (OR 1.33, 95% CI 1.04-1.71), and lower social support (OR 1.44, 95% CI 1.20-1.71) increased the odds of nonuse. The reliability of internet connection and access to a smartphone also predicted nonuse. Many respondents viewed these technologies as beneficial, especially for maintaining pre–COVID-19 social contacts and routines, despite preferences for in-person connection. Conclusions: Several factors including advanced age, living alone, and low social support increased the odds of nonuse of social media in older adults to communicate with friends and family during COVID-19’s first wave. Our findings identified socially vulnerable subgroups who may benefit from intervention (eg, improved access, digital literacy, and telephone outreach) to improve social connection. %M 35344502 %R 10.2196/34793 %U https://aging.jmir.org/2022/2/e34793 %U https://doi.org/10.2196/34793 %U http://www.ncbi.nlm.nih.gov/pubmed/35344502 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 6 %P e37377 %T Overlapping Delta and Omicron Outbreaks During the COVID-19 Pandemic: Dynamic Panel Data Estimates %A Lundberg,Alexander L %A Lorenzo-Redondo,Ramon %A Hultquist,Judd F %A Hawkins,Claudia A %A Ozer,Egon A %A Welch,Sarah B %A Prasad,P V Vara %A Achenbach,Chad J %A White,Janine I %A Oehmke,James F %A Murphy,Robert L %A Havey,Robert J %A Post,Lori A %+ Buehler Center for Health Policy and Economics, Robert J Havey, MD Institute for Global Health, Northwestern University, 750 N. Lake Shore Drive, Chicago, IL, 60611, United States, 1 3125031706, lori.post@northwestern.edu %K Omicron variant of concern %K Delta %K COVID-19 %K SARS-CoV-2 %K B.1.1.529 %K outbreak %K Arellano-Bond estimator %K dynamic panel data %K stringency index %K surveillance %K disease transmission metrics %D 2022 %7 3.6.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The Omicron variant of SARS-CoV-2 is more transmissible than prior variants of concern (VOCs). It has caused the largest outbreaks in the pandemic, with increases in mortality and hospitalizations. Early data on the spread of Omicron were captured in countries with relatively low case counts, so it was unclear how the arrival of Omicron would impact the trajectory of the pandemic in countries already experiencing high levels of community transmission of Delta. Objective: The objective of this study is to quantify and explain the impact of Omicron on pandemic trajectories and how they differ between countries that were or were not in a Delta outbreak at the time Omicron occurred. Methods: We used SARS-CoV-2 surveillance and genetic sequence data to classify countries into 2 groups: those that were in a Delta outbreak (defined by at least 10 novel daily transmissions per 100,000 population) when Omicron was first sequenced in the country and those that were not. We used trend analysis, survival curves, and dynamic panel regression models to compare outbreaks in the 2 groups over the period from November 1, 2021, to February 11, 2022. We summarized the outbreaks in terms of their peak rate of SARS-CoV-2 infections and the duration of time the outbreaks took to reach the peak rate. Results: Countries that were already in an outbreak with predominantly Delta lineages when Omicron arrived took longer to reach their peak rate and saw greater than a twofold increase (2.04) in the average apex of the Omicron outbreak compared to countries that were not yet in an outbreak. Conclusions: These results suggest that high community transmission of Delta at the time of the first detection of Omicron was not protective, but rather preluded larger outbreaks in those countries. Outbreak status may reflect a generally susceptible population, due to overlapping factors, including climate, policy, and individual behavior. In the absence of strong mitigation measures, arrival of a new, more transmissible variant in these countries is therefore more likely to lead to larger outbreaks. Alternately, countries with enhanced surveillance programs and incentives may be more likely to both exist in an outbreak status and detect more cases during an outbreak, resulting in a spurious relationship. Either way, these data argue against herd immunity mitigating future outbreaks with variants that have undergone significant antigenic shifts. %M 35500140 %R 10.2196/37377 %U https://publichealth.jmir.org/2022/6/e37377 %U https://doi.org/10.2196/37377 %U http://www.ncbi.nlm.nih.gov/pubmed/35500140 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 6 %P e34296 %T Estimating COVID-19 Hospitalizations in the United States With Surveillance Data Using a Bayesian Hierarchical Model: Modeling Study %A Couture,Alexia %A Iuliano,A Danielle %A Chang,Howard H %A Patel,Neha N %A Gilmer,Matthew %A Steele,Molly %A Havers,Fiona P %A Whitaker,Michael %A Reed,Carrie %+ Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA, 30329, United States, 1 4044985984, njh6@cdc.gov %K COVID-19 %K SARS-CoV-2 %K hospitalization %K Bayesian %K COVID-NET %K extrapolation %K hospital %K estimation %K prediction %K United States %K surveillance %K data %K model %K modeling %K hierarchical %K rate %K novel %K framework %K monitoring %D 2022 %7 2.6.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: In the United States, COVID-19 is a nationally notifiable disease, meaning cases and hospitalizations are reported by states to the Centers for Disease Control and Prevention (CDC). Identifying and reporting every case from every facility in the United States may not be feasible in the long term. Creating sustainable methods for estimating the burden of COVID-19 from established sentinel surveillance systems is becoming more important. Objective: We aimed to provide a method leveraging surveillance data to create a long-term solution to estimate monthly rates of hospitalizations for COVID-19. Methods: We estimated monthly hospitalization rates for COVID-19 from May 2020 through April 2021 for the 50 states using surveillance data from the COVID-19-Associated Hospitalization Surveillance Network (COVID-NET) and a Bayesian hierarchical model for extrapolation. Hospitalization rates were calculated from patients hospitalized with a lab-confirmed SARS-CoV-2 test during or within 14 days before admission. We created a model for 6 age groups (0-17, 18-49, 50-64, 65-74, 75-84, and ≥85 years) separately. We identified covariates from multiple data sources that varied by age, state, and month and performed covariate selection for each age group based on 2 methods, Least Absolute Shrinkage and Selection Operator (LASSO) and spike and slab selection methods. We validated our method by checking the sensitivity of model estimates to covariate selection and model extrapolation as well as comparing our results to external data. Results: We estimated 3,583,100 (90% credible interval [CrI] 3,250,500-3,945,400) hospitalizations for a cumulative incidence of 1093.9 (992.4-1204.6) hospitalizations per 100,000 population with COVID-19 in the United States from May 2020 through April 2021. Cumulative incidence varied from 359 to 1856 per 100,000 between states. The age group with the highest cumulative incidence was those aged ≥85 years (5575.6; 90% CrI 5066.4-6133.7). The monthly hospitalization rate was highest in December (183.7; 90% CrI 154.3-217.4). Our monthly estimates by state showed variations in magnitudes of peak rates, number of peaks, and timing of peaks between states. Conclusions: Our novel approach to estimate hospitalizations for COVID-19 has potential to provide sustainable estimates for monitoring COVID-19 burden as well as a flexible framework leveraging surveillance data. %M 35452402 %R 10.2196/34296 %U https://publichealth.jmir.org/2022/6/e34296 %U https://doi.org/10.2196/34296 %U http://www.ncbi.nlm.nih.gov/pubmed/35452402 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 6 %P e36065 %T Monitoring Symptoms of COVID-19: Review of Mobile Apps %A Schmeelk,Suzanna %A Davis,Alison %A Li,Qiaozheng %A Shippey,Caroline %A Utah,Michelle %A Myers,Annie %A Reading Turchioe,Meghan %A Masterson Creber,Ruth %+ Weill Cornell Medicine, 425 E 61st Street, New York, NY, 10065, United States, 1 9144340731, rmc2009@med.cornell.edu %K COVID-19 %K mobile apps %K mobile health %K mHealth %K symptom assessment %K symptom tracking %K public health %K mobile health application %K surveillance %K digital surveillance %K monitoring system %K digital health %D 2022 %7 1.6.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile health (mHealth) apps have facilitated symptom monitoring of COVID-19 symptoms globally and have been used to share data with health care professionals and support disease prediction, prevention, management, diagnostics, and improvements in treatments and patient education. Objective: The aim of this review is to evaluate the quality and functionality of COVID-19 mHealth apps that support tracking acute and long-term symptoms of COVID-19. Methods: We systematically reviewed commercially available mHealth apps for COVID-19 symptom monitoring by searching Google Play and Apple iTunes using search terms such as “COVID-19,” “Coronavirus,” and “COVID-19 and symptoms.” All apps underwent three rounds of screening. The final apps were independently assessed using the Mobile Application Rating Scale (MARS), an informatics functionality scoring system, and the Center for Disease Control and World Health Organization symptom guidelines. The MARS is a 19-item standardized tool to evaluate the quality of mHealth apps on engagement, functionality, aesthetics, and information quality. Functionality was quantified across the following criteria: inform, instruct, record (collect, share, evaluate, and intervene), display, guide, remind or alert, and communicate. Interrater reliability between the reviewers was calculated. Results: A total of 1017 mobile apps were reviewed, and 20 (2%) met the inclusion criteria. The majority of the 20 included apps (n=18, 90%) were designed to track acute COVID-19 symptoms, and only 2 (10%) addressed long-term symptoms. Overall, the apps scored high on quality, with an overall MARS rating of 3.89 out of 5, and the highest domain score for functionality (4.2). The most common functionality among all apps was the instruct function (n=19, 95%). The most common symptoms included in the apps for tracking were fever and dry cough (n=18, 90%), aches and pains (n=17, 85%), difficulty breathing (n=17, 85%), tiredness, sore throat, headache, loss of taste or smell (n=16, 80%), and diarrhea (n=15, 75%). Only 2 (10%) apps specifically tracked long-term symptoms of COVID-19. The top 4 rated apps overall were state-specific apps developed and deployed for public use. Conclusions: Overall, mHealth apps designed to monitor symptoms of COVID-19 were of high quality, but the majority of apps focused almost exclusively on acute symptoms. Future apps should also incorporate monitoring long-term symptoms of COVID-19 and evidence-based educational materials; they should also include a feature that would allow patients to communicate their symptoms to specific caregivers or their own health care team. App developers should also follow updated technical and clinical guidelines from the Center for Disease Control and the World Health Organization. %M 35609313 %R 10.2196/36065 %U https://mhealth.jmir.org/2022/6/e36065 %U https://doi.org/10.2196/36065 %U http://www.ncbi.nlm.nih.gov/pubmed/35609313 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 10 %N 6 %P e37042 %T Experiences and Challenges of Emerging Online Health Services Combating COVID-19 in China: Retrospective, Cross-Sectional Study of Internet Hospitals %A Ge,Fangmin %A Qian,Huan %A Lei,Jianbo %A Ni,Yiqi %A Li,Qian %A Wang,Song %A Ding,Kefeng %+ The Second Affiliated Hospital, School of Medicine, Zhejiang University, No 88 Jiefang Road, Hangzhou, 310000, China, 86 13906504783, dingkefeng@zju.edu.cn %K COVID-19 %K telehealth %K e-consultation %K dynamics of health care topics %K China health system %D 2022 %7 1.6.2022 %9 Original Paper %J JMIR Med Inform %G English %X Background: Internet-based online virtual health services were originally an important way for the Chinese government to resolve unmet medical service needs due to inadequate medical institutions. Its initial development was not well received. Then, the unexpected COVID-19 pandemic produced a tremendous demand for telehealth in a short time, which stimulated the explosive development of internet hospitals. The Second Affiliated Hospital of Zhejiang University (SAHZU) has taken a leading role in the construction of internet hospitals in China. The pandemic triggered the hospital to develop unique research on health service capacity under strict quarantine policies and to predict long-term trends. Objective: This study aims to provide policy enlightenment for the construction of internet-based health services to better fight against COVID-19 and to elucidate future directions through an in-depth analysis of 2 years of online health service data gleaned from SAHZU’s experiences and lessons learned. Methods: We collected data from SAHZU Internet Hospital from November 1, 2019, to September 16, 2021. Data from over 900,000 users were analyzed with respect to demographic characteristics, demands placed on departments by user needs, new registrations, and consultation behaviors. Interrupted time series (ITS) analysis was adopted to evaluate the impact of this momentous emergency event and its long-term trends. With theme analysis and a defined 2D model, 3 investigations were conducted synchronously to determine users’ authentic demands on online hospitals. Results: The general profile of internet hospital users is young or middle-aged women who live in Zhejiang and surrounding provinces. The ITS model indicated that, after the intervention (the strict quarantine policies) was implemented during the outbreak, the number of internet hospital users significantly increased (β_2=105.736, P<.001). Further, long-term waves of COVID-19 led to an increasing number of users following the outbreak (β_3=0.167, P<.001). In theme analysis, we summarized 8 major demands by users of the SAHZU internet hospital during the national shutdown period and afterwards. Online consultations and information services were persistent and universal demands, followed by concerns about medical safety and quality, time, and cost. Users’ medical behavior patterns changed from onsite to online as internet hospital demands increased. Conclusions: The pandemic has spawned the explosive growth of telehealth; as a public tertiary internet hospital, the SAHZU internet hospital is partially and irreversibly integrated into the traditional medical system. As we shared the practical examples of 1 public internet hospital in China, we put forward suggestions about the future direction of telehealth. Vital experience in the construction of internet hospitals was provided in the normalization of COVID-19 prevention and control, which can be demonstrated as a model of internet hospital management practice for other medical institutions. %M 35500013 %R 10.2196/37042 %U https://medinform.jmir.org/2022/6/e37042 %U https://doi.org/10.2196/37042 %U http://www.ncbi.nlm.nih.gov/pubmed/35500013 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 2 %P e35380 %T Digital Health Opportunities to Improve Primary Health Care in the Context of COVID-19: Scoping Review %A Silva,Cícera Renata Diniz Vieira %A Lopes,Rayssa Horácio %A de Goes Bay Jr,Osvaldo %A Martiniano,Claudia Santos %A Fuentealba-Torres,Miguel %A Arcêncio,Ricardo Alexandre %A Lapão,Luís Velez %A Dias,Sonia %A Uchoa,Severina Alice da Costa %+ Faculty of Health Sciences, Federal University of Rio Grande do Norte, 601 General Gustavo Cordeiro de Faria Street, Natal, 59012-570, Brazil, 55 84 3221 0862, renatadiniz_enf@yahoo.com.br %K digital health %K telehealth %K telemedicine %K primary health care %K quality of care %K COVID-19 %K pandemic %K science database %K gray literature %D 2022 %7 31.5.2022 %9 Review %J JMIR Hum Factors %G English %X Background: The COVID-19 pandemic brought social, economic, and health impacts, requiring fast adaptation of health systems. Although information and communication technologies were essential for achieving this objective, the extent to which health systems incorporated this technology is unknown. Objective: The aim of this study was to map the use of digital health strategies in primary health care worldwide and their impact on quality of care during the COVID-19 pandemic. Methods: We performed a scoping review based on the Joanna Briggs Institute manual and guided by the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) Extension for Scoping Reviews. A systematic and comprehensive three-step search was performed in June and July 2021 in multidisciplinary health science databases and the gray literature. Data extraction and eligibility were performed by two authors independently and interpreted using thematic analysis. Results: A total of 44 studies were included and six thematic groups were identified: characterization and geographic distribution of studies; nomenclatures of digital strategies adopted; types of information and communication technologies; characteristics of digital strategies in primary health care; impacts on quality of care; and benefits, limitations, and challenges of digital strategies in primary health care. The impacts on organization of quality of care were investigated by the majority of studies, demonstrating the strengthening of (1) continuity of care; (2) economic, social, geographical, time, and cultural accessibility; (3) coordination of care; (4) access; (5) integrality of care; (6) optimization of appointment time; (7) and efficiency. Negative impacts were also observed in the same dimensions, such as reduced access to services and increased inequity and unequal use of services offered, digital exclusion of part of the population, lack of planning for defining the role of professionals, disarticulation of actions with real needs of the population, fragile articulation between remote and face-to-face modalities, and unpreparedness of professionals to meet demands using digital technologies. Conclusions: The results showed the positive and negative impacts of remote strategies on quality of care in primary care and the inability to take advantage of the potential of technologies. This may demonstrate differences in the organization of fast and urgent implementation of digital strategies in primary health care worldwide. Primary health care must strengthen its response capacity, expand the use of information and communication technologies, and manage challenges using scientific evidence since digital health is important and must be integrated into public service. %M 35319466 %R 10.2196/35380 %U https://humanfactors.jmir.org/2022/2/e35380 %U https://doi.org/10.2196/35380 %U http://www.ncbi.nlm.nih.gov/pubmed/35319466 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 5 %P e34438 %T A Novel Tool for Real-time Estimation of Epidemiological Parameters of Communicable Diseases Using Contact-Tracing Data: Development and Deployment %A Silenou,Bernard C %A Verset,Carolin %A Kaburi,Basil B %A Leuci,Olivier %A Ghozzi,Stéphane %A Duboudin,Cédric %A Krause,Gérard %+ Department of Epidemiology, Helmholtz Centre for Infection Research, Inhoffenstraße 7, Braunschweig, 38124, Germany, 49 5316181 3100, Gerard.Krause@helmholtz-hzi.de %K COVID-19 %K disease outbreak %K contact tracing %K serial interval %K basic reproduction number %K infectious disease incubation period %K superspreading events %K telemedicine %K public health %K epidemiology %K surveillance tool %K outbreak response %K pandemic %K digital health application %K response strategy %D 2022 %7 31.5.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The Surveillance Outbreak Response Management and Analysis System (SORMAS) contains a management module to support countries in their epidemic response. It consists of the documentation, linkage, and follow-up of cases, contacts, and events. To allow SORMAS users to visualize data, compute essential surveillance indicators, and estimate epidemiological parameters from such network data in real-time, we developed the SORMAS Statistics (SORMAS-Stats) application. Objective: This study aims to describe the essential visualizations, surveillance indicators, and epidemiological parameters implemented in the SORMAS-Stats application and illustrate the application of SORMAS-Stats in response to the COVID-19 outbreak. Methods: Based on findings from a rapid review and SORMAS user requests, we included the following visualization and estimation of parameters in SORMAS-Stats: transmission network diagram, serial interval (SI), time-varying reproduction number R(t), dispersion parameter k, and additional surveillance indicators presented in graphs and tables. We estimated SI by fitting lognormal, gamma, and Weibull distributions to the observed distribution of the number of days between symptom onset dates of infector-infectee pairs. We estimated k by fitting a negative binomial distribution to the observed number of infectees per infector. Furthermore, we applied the Markov Chain Monte Carlo approach and estimated R(t) using the incidence data and the observed SI computed from the transmission network data. Results: Using COVID-19 contact-tracing data of confirmed cases reported between July 31 and October 29, 2021, in the Bourgogne-Franche-Comté region of France, we constructed a network diagram containing 63,570 nodes. The network comprises 1.75% (1115/63,570) events, 19.59% (12,452/63,570) case persons, and 78.66% (50,003/63,570) exposed persons, including 1238 infector-infectee pairs and 3860 transmission chains with 24.69% (953/3860) having events as the index infector. The distribution with the best fit to the observed SI data was a lognormal distribution with a mean of 4.30 (95% CI 4.09-4.51) days. We estimated a dispersion parameter k of 21.11 (95% CI 7.57-34.66) and an effective reproduction number R of 0.9 (95% CI 0.58-0.60). The weekly estimated R(t) values ranged from 0.80 to 1.61. Conclusions: We provide an application for real-time estimation of epidemiological parameters, which is essential for informing outbreak response strategies. The estimates are commensurate with findings from previous studies. The SORMAS-Stats application could greatly assist public health authorities in the regions using SORMAS or similar tools by providing extensive visualizations and computation of surveillance indicators. %M 35486812 %R 10.2196/34438 %U https://publichealth.jmir.org/2022/5/e34438 %U https://doi.org/10.2196/34438 %U http://www.ncbi.nlm.nih.gov/pubmed/35486812 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 5 %P e31968 %T COVID-19 Vaccination and Public Health Countermeasures on Variants of Concern in Canada: Evidence From a Spatial Hierarchical Cluster Analysis %A Adeyinka,Daniel A %A Neudorf,Cory %A Camillo,Cheryl A %A Marks,Wendie N %A Muhajarine,Nazeem %+ Department of Community Health and Epidemiology, College of Medicine, University of Saskatchewan, 104 Clinic Place, Health Sciences Bldg, Saskatoon, SK, S7N 2Z4, Canada, 1 306 227 2982, nazeem.muhajarine@usask.ca %K COVID-19 %K variants of concern %K stringency index %K mobility index %K vaccination coverage %K machine learning %K Canada %D 2022 %7 31.5.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: There is mounting evidence that the third wave of COVID-19 incidence is declining, yet variants of concern (VOCs) continue to present public health challenges in Canada. The emergence of VOCs has sparked debate on how to effectively control their impacts on the Canadian population. Objective: Provincial and territorial governments have implemented a wide range of policy measures to protect residents against community transmission of COVID-19, but research examining the specific impact of policy countermeasures on the VOCs in Canada is needed. Our study objective was to identify provinces with disproportionate prevalence of VOCs relative to COVID-19 mitigation efforts in provinces and territories in Canada. Methods: We analyzed publicly available provincial- and territorial-level data on the prevalence of VOCs in relation to mitigating factors, summarized in 3 measures: (1) strength of public health countermeasures (stringency index), (2) the extent to which people moved about outside their homes (mobility index), and (3) the proportion of the provincial or territorial population that was fully vaccinated (vaccine uptake). Using spatial agglomerative hierarchical cluster analysis (unsupervised machine learning), provinces and territories were grouped into clusters by stringency index, mobility index, and full vaccine uptake. The Kruskal-Wallis test was used to compare the prevalence of VOCs (Alpha, or B.1.1.7; Beta, or B.1.351; Gamma, or P.1; and Delta, or B.1.617.2 variants) across the clusters. Results: We identified 3 clusters of vaccine uptake and countermeasures. Cluster 1 consisted of the 3 Canadian territories and was characterized by a higher degree of vaccine deployment and fewer countermeasures. Cluster 2 (located in Central Canada and the Atlantic region) was typified by lower levels of vaccine deployment and moderate countermeasures. The third cluster, which consisted of provinces in the Pacific region, Central Canada, and the Prairies, exhibited moderate vaccine deployment but stronger countermeasures. The overall and variant-specific prevalences were significantly different across the clusters. Conclusions: This “up to the point” analysis found that implementation of COVID-19 public health measures, including the mass vaccination of populations, is key to controlling VOC prevalence rates in Canada. As of June 15, 2021, the third wave of COVID-19 in Canada is declining, and those provinces and territories that had implemented more comprehensive public health measures showed lower VOC prevalence. Public health authorities and governments need to continue to communicate the importance of sociobehavioural preventive measures, even as populations in Canada continue to receive their primary and booster doses of vaccines. %M 35486447 %R 10.2196/31968 %U https://publichealth.jmir.org/2022/5/e31968 %U https://doi.org/10.2196/31968 %U http://www.ncbi.nlm.nih.gov/pubmed/35486447 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 5 %P e30897 %T Effect of the COVID-19 Pandemic on Stimulant Use and Antiretroviral Therapy Adherence Among Men Who Have Sex With Men Living With HIV: Qualitative Focus Group Study %A Petrova,Mariya %A Miller-Perusse,Michael %A Hirshfield,Sabina %A Carrico,Adam %A Horvath,Keith %+ Miller School of Medicine, University of Miami, 1120 NW 14th Street, Office 1085, Miami, FL, 33136, United States, 1 5857541204, Petrova.mariya@gmail.com %K stimulants %K HIV %K ART %K antiretroviral therapy %K MSM %K men who have sex with men %K COVID-19 %K pandemic %K therapy %K drug use %K virtual focus groups %K virtual health %K medication adherence %D 2022 %7 31.5.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Evidence suggests that economic, social, and psychological circumstances brought about by the COVID-19 pandemic may have a serious impact on behavioral health. Men who have sex with men (MSM) are disproportionally impacted by HIV and stimulant use, the co-occurrence of which heightens HIV transmission risk and undermines nationwide treatment strategies as prevention efforts for ending the HIV epidemic. There is a paucity of information regarding the potential impact of the COVID-19 pandemic on the substance use and HIV medication adherence in this key vulnerable population—MSM who use stimulants and are living with HIV. Objective: The aim of this qualitative study was to identify ways in which the COVID-19 pandemic has affected stimulant use and antiretroviral therapy (ART) adherence among a sample of MSM living with HIV. Methods: Two focus groups were conducted in August 2020 via videoconferencing technology compliant with the Health Insurance Portability and Accountability Act. Potential participants from an established research participant registry at State University of New York Downstate Health Sciences University were invited and screened for study participation on the basis of inclusion criteria. A semistructured interview guide was followed. A general inductive approach was used to analyze the data. Findings in two general areas of interest, the impact of the COVID-19 pandemic on stimulant use and ART adherence, emerged directly from the raw data. Results: A total of 12 ethnically diverse participants over the age of 25 years took part in the study. Results were heterogeneous in terms of the effects of the pandemic on both stimulant use and ART adherence among MSM living with HIV. Some men indicated increased or sustained stimulant use and ART adherence, and others reported decreased stimulant use and ART adherence. Reasons for these behavioral changes ranged from concerns about their own health and that of their loved ones to challenges brought about by the lack of daily structure during the lockdown phase of the pandemic and emotion regulation difficulties. Conclusions: The COVID-19 pandemic has had a differential impact on stimulant use and ART medication adherence among MSM living with HIV. The reasons for behavioral change identified in this study may be salient intervention targets to support ART medication adherence and lower stimulant use among MSM in the aftermath of the of the COVID-19 pandemic, as well as beyond. %M 35275839 %R 10.2196/30897 %U https://formative.jmir.org/2022/5/e30897 %U https://doi.org/10.2196/30897 %U http://www.ncbi.nlm.nih.gov/pubmed/35275839 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 5 %P e34710 %T COVID-19 News and Its Association With the Mental Health of Sexual and Gender Minority Adults: Cross-sectional Study %A Clark,Kristen D %A Lunn,Mitchell R %A Sherman,Athena D F %A Bosley,Hannah G %A Lubensky,Micah E %A Obedin-Maliver,Juno %A Dastur,Zubin %A Flentje,Annesa %+ Department of Nursing, University of New Hampshire, 4 Library Way, Durham, NH, 03824, United States, 1 603 862 2271, kristen.clark@unh.edu %K PTSD %K posttraumatic stress disorder %K anxiety %K minority populations %K vicarious trauma %K tertiary trauma %K COVID-19 %K pandemic %K public health %K sexual orientation %K gender identity %K mental health %D 2022 %7 30.5.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Sexual and gender minority (SGM; people whose sexual orientation is not heterosexual or whose gender identity varies from what is traditionally associated with the sex assigned to them at birth) people experience high rates of trauma and substantial disparities in anxiety and posttraumatic stress disorder (PTSD). Exposure to traumatic stressors such as news related to COVID-19 may be associated with symptoms of anxiety and PTSD. Objective: This study aims to evaluate the relationship of COVID-19 news exposure with anxiety and PTSD symptoms in a sample of SGM adults in the United States. Methods: Data were collected between March 23 and August 2, 2020, from The PRIDE Study, a national longitudinal cohort study of SGM people. Regression analyses were used to analyze the relationship between self-reported news exposure and symptoms of anxiety using the Generalized Anxiety Disorder-7 and symptoms of COVID-19–related PTSD using the Impact of Events Scale-Revised. Results: Our sample included a total of 3079 SGM participants. Each unit increase in COVID-19–related news exposure was associated with greater anxiety symptoms (odds ratio 1.77, 95% CI 1.63-1.93; P<.001) and 1.93 greater odds of PTSD (95% CI 1.74-2.14; P<.001). Conclusions: Our study found that COVID-19 news exposure was positively associated with greater symptoms of anxiety and PTSD among SGM people. This supports previous literature in other populations where greater news exposure was associated with poorer mental health. Further research is needed to determine the direction of this relationship and to evaluate for differences among SGM subgroups with multiple marginalized identities. %M 35486805 %R 10.2196/34710 %U https://publichealth.jmir.org/2022/5/e34710 %U https://doi.org/10.2196/34710 %U http://www.ncbi.nlm.nih.gov/pubmed/35486805 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 5 %P e37328 %T The Efficacy of a Brief, Altruism-Eliciting Video Intervention in Enhancing COVID-19 Vaccination Intentions Among a Population-Based Sample of Younger Adults: Randomized Controlled Trial %A Zhu,Patricia %A Tatar,Ovidiu %A Griffin-Mathieu,Gabrielle %A Perez,Samara %A Haward,Ben %A Zimet,Gregory %A Tunis,Matthew %A Dubé,Ève %A Rosberger,Zeev %+ Lady Davis Institute for Medical Research, Jewish General Hospital, 4333 Cote Ste-Catherine Road, Montreal, QC, H3T1E4, Canada, 1 514 340 8222 ext 23978, ovidiu.tatar@mail.mcgill.ca %K COVID-19 %K vaccination %K altruism %K prosocial motives %K video intervention %K randomized controlled trial %K younger adults %K vaccine hesitancy %K public health %K youth %K digital intervention %K health intervention %K health promotion %K web survey %K digital health %K online health %K health information %D 2022 %7 30.5.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: High COVID-19 vaccine uptake is crucial to containing the pandemic and reducing hospitalizations and deaths. Younger adults (aged 20-39 years) have demonstrated lower levels of vaccine uptake compared to older adults, while being more likely to transmit the virus due to a higher number of social contacts. Consequently, this age group has been identified by public health authorities as a key target for vaccine uptake. Previous research has demonstrated that altruistic messaging and motivation is associated with vaccine acceptance. Objective: This study had 2 objectives: (1) to evaluate the within-group efficacy of an altruism-eliciting short, animated video intervention in increasing COVID-19 vaccination intentions amongst unvaccinated Canadian younger adults and (2) to examine the video’s efficacy compared to a text-based intervention focused exclusively on non-vaccine-related COVID-19 preventive health measures. Methods: Using a web-based survey in a pre-post randomized control trial (RCT) design, we recruited Canadians aged 20-39 years who were not yet vaccinated against COVID-19 and randomized them in a 1:1 ratio to receive either the video intervention or an active text control. The video intervention was developed by our team in collaboration with a digital media company. The measurement of COVID-19 vaccination intentions before and after completing their assigned intervention was informed by the multistage Precaution Adoption Process Model (PAPM). The McNemar chi-square test was performed to evaluate within-group changes of vaccine intentions. Exact tests of symmetry using pairwise McNemar tests were applied to evaluate changes in multistaged intentions. Between-group vaccine intentions were assessed using the Pearson chi-square test postintervention. Results: Analyses were performed on 1373 participants (n=686, 50%, in the video arm, n=687, 50%, in the text arm). Within-group results for the video intervention arm showed that there was a significant change in the intention to receive the vaccine (χ21=20.55, P<.001). The between-group difference in postintervention intentions (χ23=1.70, P=.64) was not significant. When administered the video intervention, we found that participants who had not thought about or were undecided about receiving a COVID-19 vaccine were more amenable to change than participants who had already decided not to vaccinate. Conclusions: Although the video intervention was limited in its effect on those who had firmly decided not to vaccinate, our study demonstrates that prosocial and altruistic messages could increase COVID-19 vaccine uptake, especially when targeted to younger adults who are undecided or unengaged regarding vaccination. This might indicate that altruistic messaging provides a “push” for those who are tentative toward, or removed from, the decision to receive the vaccine. The results of our study could also be applied to more current COVID-19 vaccination recommendations (eg, booster shots) and for other vaccine-preventable diseases. Trial Registration: ClinicalTrials.gov NCT04960228; https://clinicaltrials.gov/ct2/show/NCT04960228 %M 35544437 %R 10.2196/37328 %U https://publichealth.jmir.org/2022/5/e37328 %U https://doi.org/10.2196/37328 %U http://www.ncbi.nlm.nih.gov/pubmed/35544437 %0 Journal Article %@ 2563-3570 %I JMIR Publications %V 3 %N 1 %P e37391 %T In Silico Comparative Analysis of the Functional, Structural, and Evolutionary Properties of SARS-CoV-2 Variant Spike Proteins %A Math,Renukaradhya K %A Mudennavar,Nayana %A Javaregowda,Palaksha Kanive %A Savanur,Ambuja %+ SDM Research Institute for Biomedical Sciences, Shri Dharmasthala Manjunatheshwara University, 5th floor, Manjushree building, SDM College of Medical Sciences & Hospital Campus, Dharwad, 580009, India, 91 7019982929, aradhya.swamy@gmail.com %K spike protein variants %K NCBI %K bioinformatics tools %K pI %K isoelectric point %K 2D map %K phylogenetic tree %K COVID-19 %K COVID therapy %K SARS-CoV-2 treatment %K therapeutic %K spike protein %K protein %K prophylactic %K sequence analysis %K genomic %K bioinformatics %K viral protein %D 2022 %7 30.5.2022 %9 Original Paper %J JMIR Bioinform Biotech %G English %X Background: A recent global outbreak of COVID-19 caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) created a pandemic and emerged as a potential threat to humanity. The analysis of virus genetic composition has revealed that the spike protein, one of the major structural proteins, facilitates the entry of the virus to host cells. Objective: The spike protein has become the main target for prophylactics and therapeutics studies. Here, we compared the spike proteins of SARS-CoV-2 variants using bioinformatics tools. Methods: The spike protein sequences of wild-type SARS-CoV-2 and its 6 variants—D614G, alpha (B.1.1.7), beta (B.1.351), delta (B.1.617.2), gamma (P.1), and omicron (B.1.1.529)—were retrieved from the NCBI database. The ClustalX program was used to sequence multiple alignment and perform mutational analysis. Several online bioinformatics tools were used to predict the physiological, immunological, and structural features of the spike proteins of SARS-CoV-2 variants. A phylogenetic tree was constructed using CLC software. Statistical analysis of the data was done using jamovi 2 software. Results: Multiple sequence analysis revealed that the P681R mutation in the delta variant, which changed an amino acid from histidine (H) to arginine (R), made the protein more alkaline due to arginine’s high pKa value (12.5) compared to histidine’s (6.0). Physicochemical properties revealed the relatively higher isoelectric point (7.34) and aliphatic index (84.65) of the delta variant compared to other variants. Statistical analysis of the isoelectric point, antigenicity, and immunogenicity of all the variants revealed significant correlation, with P values ranging from <.007 to .04. The generation of a 2D gel map showed the separation of the delta spike protein from a grouping of the other variants. The phylogenetic tree of the spike proteins showed that the delta variant was close to and a mix of the Rousettus bat coronavirus and MERS-CoV. Conclusions: The comparative analysis of SARS-CoV-2 variants revealed that the delta variant is more aliphatic in nature, which provides more stability to it and subsequently influences virus behavior. %M 35669291 %R 10.2196/37391 %U https://bioinform.jmir.org/2022/1/e37391 %U https://doi.org/10.2196/37391 %U http://www.ncbi.nlm.nih.gov/pubmed/35669291 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 5 %P e30371 %T The Associations Between Racially/Ethnically Stratified COVID-19 Tweets and COVID-19 Cases and Deaths: Cross-sectional Study %A Liu,Xiaohui %A Kar,Bandana %A Montiel Ishino,Francisco Alejandro %A Onega,Tracy %A Williams,Faustine %+ National Institute on Minority Health and Health Disparities, National Institutes of Health, 6707 Democracy Boulevard, Suite 800, Bethesda, MD, 20892, United States, 1 8016464179, xiaohuiliugis@gmail.com %K racial/ethnic stratification %K geo-tagged COVID-19 tweets %K racial/ethnic disparity %K surveillance %D 2022 %7 30.5.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic exacerbated existing racial/ethnic health disparities in the United States. Monitoring nationwide Twitter conversations about COVID-19 and race/ethnicity could shed light on the impact of the pandemic on racial/ethnic minorities and help address health disparities. Objective: This paper aims to examine the association between COVID-19 tweet volume and COVID-19 cases and deaths, stratified by race/ethnicity, in the early onset of the pandemic. Methods: This cross-sectional study used geotagged COVID-19 tweets from within the United States posted in April 2020 on Twitter to examine the association between tweet volume, COVID-19 surveillance data (total cases and deaths in April), and population size. The studied time frame was limited to April 2020 because April was the earliest month when COVID-19 surveillance data on racial/ethnic groups were collected. Racially/ethnically stratified tweets were extracted using racial/ethnic group–related keywords (Asian, Black, Latino, and White) from COVID-19 tweets. Racially/ethnically stratified tweets, COVID-19 cases, and COVID-19 deaths were mapped to reveal their spatial distribution patterns. An ordinary least squares (OLS) regression model was applied to each stratified dataset. Results: The racially/ethnically stratified tweet volume was associated with surveillance data. Specifically, an increase of 1 Asian tweet was correlated with 288 Asian cases (P<.001) and 93.4 Asian deaths (P<.001); an increase of 1 Black tweet was linked to 47.6 Black deaths (P<.001); an increase of 1 Latino tweet was linked to 719 Latino deaths (P<.001); and an increase of 1 White tweet was linked to 60.2 White deaths (P<.001). Conclusions: Using racially/ethnically stratified Twitter data as a surveillance indicator could inform epidemiologic trends to help estimate future surges of COVID-19 cases and potential future outbreaks of a pandemic among racial/ethnic groups. %M 35537056 %R 10.2196/30371 %U https://formative.jmir.org/2022/5/e30371 %U https://doi.org/10.2196/30371 %U http://www.ncbi.nlm.nih.gov/pubmed/35537056 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 5 %P e38034 %T A Web-Based Public Health Intervention for Addressing Vaccine Misinformation: Protocol for Analyzing Learner Engagement and Impacts on the Hesitancy to Vaccinate %A Powell,Leigh %A Nour,Radwa %A Zidoun,Youness %A Kaladhara,Sreelekshmi %A Al Suwaidi,Hanan %A Zary,Nabil %+ Institute for Excellence in Health Professions Education, Mohammed Bin Rashid University of Medicine and Health Sciences, Building 14, Dubai Healthcare City, PO Box 505055, Dubai, United Arab Emirates, 971 585960762, nabil.zary@icloud.com %K public health %K population health %K education %K gamification %K COVID-19 %K vaccination %K misinformation %K infodemic %K vaccine hesitancy %K web-based health %K web-based intervention %K learning design %K dissemination %D 2022 %7 30.5.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: A barrier to successful COVID-19 vaccine campaigns is the ongoing misinformation pandemic, or infodemic, which is contributing to vaccine hesitancy. Web-based population health interventions have been shown to impact health behaviors positively. For web-based interventions to be successful, they must use effective learning design strategies that seek to address known issues with learner engagement and retention. To know if an intervention successfully addresses vaccine hesitancy, there must be some embedded measure for comparing learners preintervention and postintervention. Objective: This protocol aims to describe a study on the effectiveness of a web-based population health intervention that is designed to address vaccine misinformation and hesitancy. The study will examine learner analytics to understand what aspects of the learning design for the intervention were effective and implement a validated instrument—the Adult Vaccine Hesitancy Scale—to measure if any changes in vaccine hesitancy were observed preintervention and postintervention. Methods: We developed a fully web-based population health intervention to help learners identify misinformation concerning COVID-19 and share the science behind vaccinations. Intervention development involves using a design-based research approach to output more effective interventions in which data can be analyzed to improve future health interventions. The study will use a quasi-experimental design in which a pre-post survey will be provided and compared statistically. Learning analytics will also be generated based on the engagement and retention data collected through the intervention to understand what aspects of our learning design are effective. Results: The web-based intervention was released to the public in September 2021, and data collection is ongoing. No external marketing or advertising has been done to market the course, making our current population of 486 participants our pilot study population. An analysis of this initial population will enable the revision of the intervention, which will then be marketed to a broader audience. Study outcomes are expected to be published by August 2022. We anticipate the release of the revised intervention by May 2022. Conclusions: Disseminating accurate information to the public during pandemic situations is vital to contributing to positive health outcomes, such as those among people getting vaccinated. Web-based interventions are valuable, as they can reach people anytime and anywhere. However, web-based interventions must use sound learning design to help incentivize engagement and motivate learners to learn and must provide a means of evaluating the intervention to determine its impact. Our study will examine both the learning design and the effectiveness of the intervention by using the analytics collected within the intervention and a statistical analysis of a validated instrument to determine if learners had a change in vaccine hesitancy as a result of what they learned. International Registered Report Identifier (IRRID): DERR1-10.2196/38034 %M 35451967 %R 10.2196/38034 %U https://www.researchprotocols.org/2022/5/e38034 %U https://doi.org/10.2196/38034 %U http://www.ncbi.nlm.nih.gov/pubmed/35451967 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 5 %P e32543 %T Artificial Intelligence–Enabled Social Media Analysis for Pharmacovigilance of COVID-19 Vaccinations in the United Kingdom: Observational Study %A Hussain,Zain %A Sheikh,Zakariya %A Tahir,Ahsen %A Dashtipour,Kia %A Gogate,Mandar %A Sheikh,Aziz %A Hussain,Amir %+ Edinburgh Medical School, College of Medicine and Veterinary Medicine, University of Edinburgh, 47 Little France Crescent, Edinburgh, EH16 4TJ, United Kingdom, 44 131 242 9100, zhuss95@gmail.com %K COVID-19 %K artificial intelligence %K deep learning %K Facebook %K health informatics %K natural language processing %K public health %K sentiment analysis %K social media %K Twitter %K infodemiology %K vaccination %D 2022 %7 27.5.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background:  The rollout of vaccines for COVID-19 in the United Kingdom started in December 2020. Uptake has been high, and there has been a subsequent reduction in infections, hospitalizations, and deaths among vaccinated individuals. However, vaccine hesitancy remains a concern, in particular relating to adverse effects following immunization (AEFIs). Social media analysis has the potential to inform policy makers about AEFIs being discussed by the public as well as public attitudes toward the national immunization campaign. Objective:  We sought to assess the frequency and nature of AEFI-related mentions on social media in the United Kingdom and to provide insights on public sentiments toward COVID-19 vaccines. Methods:  We extracted and analyzed over 121,406 relevant Twitter and Facebook posts, from December 8, 2020, to April 30, 2021. These were thematically filtered using a 2-step approach, initially using COVID-19–related keywords and then using vaccine- and manufacturer-related keywords. We identified AEFI-related keywords and modeled their word frequency to monitor their trends over 2-week periods. We also adapted and utilized our recently developed hybrid ensemble model, which combines state-of-the-art lexicon rule–based and deep learning–based approaches, to analyze sentiment trends relating to the main vaccines available in the United Kingdom. Results:  Our COVID-19 AEFI search strategy identified 46,762 unique Facebook posts by 14,346 users and 74,644 tweets (excluding retweets) by 36,446 users over the 4-month period. We identified an increasing trend in the number of mentions for each AEFI on social media over the study period. The most frequent AEFI mentions were found to be symptoms related to appetite (n=79,132, 14%), allergy (n=53,924, 9%), injection site (n=56,152, 10%), and clots (n=43,907, 8%). We also found some rarely reported AEFIs such as Bell palsy (n=11,909, 2%) and Guillain-Barre syndrome (n=9576, 2%) being discussed as frequently as more well-known side effects like headache (n=10,641, 2%), fever (n=12,707, 2%), and diarrhea (n=16,559, 3%). Overall, we found public sentiment toward vaccines and their manufacturers to be largely positive (58%), with a near equal split between negative (22%) and neutral (19%) sentiments. The sentiment trend was relatively steady over time and had minor variations, likely based on political and regulatory announcements and debates. Conclusions:  The most frequently discussed COVID-19 AEFIs on social media were found to be broadly consistent with those reported in the literature and by government pharmacovigilance. We also detected potential safety signals from our analysis that have been detected elsewhere and are currently being investigated. As such, we believe our findings support the use of social media analysis to provide a complementary data source to conventional knowledge sources being used for pharmacovigilance purposes. %M 35144240 %R 10.2196/32543 %U https://publichealth.jmir.org/2022/5/e32543 %U https://doi.org/10.2196/32543 %U http://www.ncbi.nlm.nih.gov/pubmed/35144240 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 10 %N 2 %P e36707 %T Effectiveness and Utility of Virtual Reality Infection Control Simulation for Children With COVID-19: Quasi-Experimental Study %A Yu,Mi %A Yang,Mi Ran %+ College of Nursing, Institute of Health Sciences, Gyeongsang National University, 816 beongil-15, Jinju-daero, Jinju, 52727, Republic of Korea, 82 10 5258 7075, yumi825@gnu.ac.kr %K children %K infection control %K nursing student %K simulation training %K virtual reality %K digital health %K medical education %K COVID-19 %K patient management %K pediatrics %K nursing education %K respiratory care skills %K program usability %K digital learning %D 2022 %7 27.5.2022 %9 Original Paper %J JMIR Serious Games %G English %X Background: It is essential that nurses quickly learn the proper methods for preventing and controlling nosocomial infection and managing intensive care patients during the COVID-19 pandemic, including the donning and doffing of personal protective equipment (PPE). Virtual reality (VR) simulation offers the advantage of learning in a safe environment with a sense of realism similar to that of an actual clinical setting and has been reported to enhance self-efficacy in infection control, safety performance, and learning satisfaction among students. Objective: This study aims to develop a virtual reality infection control simulation (VRICS) program regarding donning and doffing of PPE and respiratory care for pediatric patients admitted to an isolation unit for COVID-19 and to identify the effects of the program on PPE knowledge, infection control performance, and self-efficacy for nursing students. Additionally, the realism of the VRICS program and the students’ level of satisfaction with the program were assessed. Methods: This was a quasi-experimental study based on a controlled pretest-posttest design. Third- and fourth-year nursing students were divided into an experimental group (n=25) who participated in a VRICS program and a control group (n=25) with no participation. Data were collected from November 13 to December 10, 2021, and analyzed using descriptive statistics and the t test, paired t test, Mann-Whitney U test, and Wilcoxon matched-pair signed-rank test. The VRICS program consisted of a prebriefing, including direct practice of donning and doffing PPE, VR simulation, and debriefing. The VR simulation comprised 3 sessions: donning and inspection of PPE in the dressing room before entering the negative-pressure isolation unit; assessing for suction care, nasopharyngeal suctioning, and checking of COVID-19 patients in the negative-pressure isolation unit; and doffing PPE in the dressing room. The total execution time for the program was 180 min. Results: Compared with the control group, the experimental group showed significantly greater improvements in PPE knowledge (z=–3.28, P<.001), infection control performance (t48=4.89, P<.001), and self-efficacy (t36.2=4.93, P<.001). The experimental group’s mean scores for realistic immersion and learner satisfaction were 4.49 (SD 0.50) points and 4.75 (SD 0.38) points (on a 5-point Likert scale), respectively. Conclusions: The VR simulation training program involving pediatric COVID-19 patients combined skills training effectively and enhanced theoretical knowledge, respiratory care skills, and infectious disease preparedness. Thus, it could be applied to training nurses to respond more effectively to public health situations involving infectious diseases, including the COVID-19 pandemic. %M 35575818 %R 10.2196/36707 %U https://games.jmir.org/2022/2/e36707 %U https://doi.org/10.2196/36707 %U http://www.ncbi.nlm.nih.gov/pubmed/35575818 %0 Journal Article %@ 2563-6316 %I JMIR Publications %V 3 %N 2 %P e31955 %T Mask Use to Curtail Influenza in a Post–COVID-19 World: Modeling Study %A Froese,Henri %A A Prempeh,Angel G %+ Saginaw Valley State University, 7400 Bay Road, University Center, MI, 48604, United States, 1 9893555177, prempehresearch@gmail.com %K mask %K protection %K COVID-19 %K influenza %K transmission %K intervention %K infectious disease %K respiratory %K simulation %K model %K prevalence %K efficacy %D 2022 %7 27.5.2022 %9 Original Paper %J JMIRx Med %G English %X Background: Face mask mandates have been instrumental in the reduction of transmission of airborne COVID-19. Thus, the question arises whether comparatively mild measures should be kept in place after the pandemic to reduce other airborne diseases such as influenza. Objective: In this study, we aim to simulate the quantitative impact of face masks on the rate of influenza illnesses in the United States. Methods: Using the Centers for Disease Control and Prevention data from 2010 to 2019, we used a series of differential equations to simulate past influenza seasons, assuming that people wore face masks. This was achieved by introducing a variable to account for the efficacy and prevalence of masks and then analyzing its impact on influenza transmission rate in a susceptible-exposed-infected-recovered model fit to the actual past seasons. We then compared influenza rates in this hypothetical scenario with the actual rates over the seasons. Results: Our results show that several combinations of mask efficacy and prevalence can substantially reduce the burden of seasonal influenza. Across all the years modeled, a mask prevalence of 0.2 (20%) and assumed moderate inward and outward mask efficacy of 0.45 (45%) reduced influenza infections by >90%. Conclusions: A minority of individuals wearing masks substantially reduced the number of influenza infections across seasons. Considering the efficacy rates of masks and the relatively insignificant monetary cost, we highlight that it may be a viable alternative or complement to influenza vaccinations. %M 35666696 %R 10.2196/31955 %U https://med.jmirx.org/2022/2/e31955 %U https://doi.org/10.2196/31955 %U http://www.ncbi.nlm.nih.gov/pubmed/35666696 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 5 %P e32278 %T Factors Associated With Protective Mask-Wearing Behavior to Avoid COVID-19 Infection in China: Internet-Based Cross-sectional Study %A Xu,Yue %A Wu,Qingqing %A Xu,Shuiyang %A Zhao,Yusui %A Zhang,Xuehai %+ Department of Health Education, Zhejiang Provincial Center for Disease Control and Prevention, 3399 Binsheng Road, Hangzhou, 310051, China, 86 87115248, xhzhang@cdc.zj.cn %K COVID-19 %K internet-based %K disease prevention %K mask %K knowledge %K behavior %D 2022 %7 26.5.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The novel coronavirus disease COVID-19 is likely to spread from person to person in close-contact settings. The Chinese Center for Disease Control and Prevention released a handbook on COVID-19, which introduced health information to the public, specifically related to wearing masks correctly and adopting preventive measures to avoid COVID-19 infection. Objective: The aim of this study was to assess the level of mask knowledge, behavior related to mask usage, and major information channels used for obtaining mask- and COVID-19–related information in China. Methods: An internet-based survey was conducted primarily using DingXiang Doctor WeChat public accounts. The data about mask knowledge and behavior were collected and analyzed. In addition to descriptive statistics, logistic regression was used to analyze significant risk factors contributing to protective mask behavior. Results: Data were collected from a total of 10,304 respondents to the survey. More than half of the respondents were under 30 years old and nearly three-quarters were women. Over 80% of participants had a bachelor’s degree or higher, and the largest proportion of respondents (n=4204, 40.80%) were employed as business/service workers. Over half of the study participants were married (n=5302, 51.46%). The findings revealed that 67.49% (6954/10,304) of the participants practiced protective mask behavior; 97.93% (10,091/10,304) believed that wearing masks is an effective protective measure against COVID-19; 96.85% (9979/10,304) chose a mask that has two or more layers of washable, breathable fabric; and 70.57% (7272/10,304) wore the masks correctly. Gender, age, occupation, and education level had significant effects on behavior, whereas marital status and the infection status of family members were not significantly related to mask-wearing behavior. In addition, WeChat public accounts (9227/10,304, 89.55%) were the most prominent source of obtaining health information for Chinese netizens after the outbreak of COVID-19. Conclusions: This study elucidated that Chinese netizens’ protective mask behavior is far lower than their mask-related knowledge. Improved information channels and adequate information on wearing masks are necessary to improve the public’s protective mask behavior, particularly among men, the elderly, and people with less education. %M 35486491 %R 10.2196/32278 %U https://publichealth.jmir.org/2022/5/e32278 %U https://doi.org/10.2196/32278 %U http://www.ncbi.nlm.nih.gov/pubmed/35486491 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 5 %P e30070 %T The Impacts of the COVID-19 Pandemic on HIV Testing Utilization Among Men Who Have Sex With Men in China: Cross-sectional Online Survey %A Zhang,Ke Chun %A Fang,Yuan %A Cao,He %A Chen,Hongbiao %A Hu,Tian %A Chen,Ya Qi %A Zhou,Xiaofeng %A Wang,Zixin %+ JC School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Room 508, School of Public Health, Prince of Wales Hospital, Shatin, NT, Hong Kong, 666888, Hong Kong, 852 22528740, wangzx@cuhk.edu.hk %K COVID-19 %K HIV testing %K sexual risk behaviors %K structural barriers %K perception %K men who have sex with men %K China %K MSM %K HIV %K testing %K impact %K utilization %K cross-sectional %K online survey %K barrier %K access %D 2022 %7 25.5.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The COVID-19 pandemic has created disruptions in HIV prevention and sexual health services for men who have sex with men (MSM). Objective: This study compared HIV testing utilization in 3 different reference periods (period 1: before the COVID-19 outbreak, November 2019-January 2020; period 2: after the outbreak, February-April 2020; and period 3: after the pandemic was under initial control, May-July 2020). Factors associated with HIV testing utilization after the COVID-19 outbreak (combined periods 2 and 3) were also investigated. Methods: Participants were MSM aged ≥18 years living in Shenzhen, China. Those self-reporting as HIV positive were excluded. A total of 595 participants recruited through multiple sources completed a self-administered online survey during August-September 2020. HIV testing utilization after the COVID-19 outbreak was the dependent variable, and multivariate logistic regression models were fitted. Results: HIV testing utilization was significantly lower in period 2 than in period 1 (n=262 vs 363, 44.0% vs 61.0%, P<.001). However, HIV testing utilization was not significantly higher in period 3 than in period 2 (n=277 vs 262, 46.6% vs 44.0%, P=.21). The prevalence of HIV testing utilization after the COVID-19 outbreak was seen in 331 (55.6%) participants. After adjusting for significant background characteristics, condomless anal intercourse (CAI) with regular male sex partners (RPs; adjusted odds ratio [AOR] 2.15, 95% CI 1.29-3.57) and sexualized drug use (SDU; AOR 2.94, 95% CI 1.41-6.06) both before and after the COVID-19 outbreak, CAI with RPs (AOR 2.07, 95% CI 1.06-4.07) and nonregular male sex partners (NRPs; AOR 3.57, 95%CI: 1.43-8.89) only after the COVID-19 outbreak was positively associated with the dependent variable. Regarding HIV prevention service utilization, HIV testing utilization before the COVID-19 outbreak (AOR 10.75, 95% CI 7.22-16.02) and the use of sexually transmitted infection (STI) testing (AOR 7.02, 95% CI 4.10-12.02), other HIV/STI prevention (AOR 3.15, 95% CI 2.16-4.60), and preexposure prophylaxis (PrEP; AOR 3.58, 95% CI 1.54-8.34) after the COVID-19 outbreak were associated with higher HIV testing utilization. The current perceived risk of HIV infection was higher than that before the COVID-19 outbreak (AOR 1.15, 95% CI 1.01-1.30), and perceived COVID-19 preventive measures taken by HIV testing service providers to be effective (AOR 1.52, 95% CI 1.29-1.78) and perceived higher behavioral control to undergo HIV testing (AOR 1.18, 95% CI 1.00-1.40) were positively associated with HIV testing utilization. Concerns about COVID-19 infection during HIV testing (AOR 0.78, 95% CI 0.68-0.89), avoiding crowded places (AOR 0.68, 95% CI 0.48-0.98), and HIV testing service providers reducing their working hours (AOR 0.59, 95% CI 0.48-0.98) were negatively associated with the dependent variable. Conclusions: HIV testing utilization among Chinese MSM declined after the COVID-19 outbreak and did not increase after the pandemic was under initial control. Removing structural barriers to accessing HIV testing caused by COVID-19, modifying perceptions related to HIV testing, and making use of HIV self-testing (HIVST) might be useful strategies to improve HIV testing among MSM during the pandemic. %M 35486811 %R 10.2196/30070 %U https://publichealth.jmir.org/2022/5/e30070 %U https://doi.org/10.2196/30070 %U http://www.ncbi.nlm.nih.gov/pubmed/35486811 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 5 %P e36966 %T The Mental Health Impact of Daily News Exposure During the COVID-19 Pandemic: Ecological Momentary Assessment Study %A Kellerman,John K %A Hamilton,Jessica L %A Selby,Edward A %A Kleiman,Evan M %+ Department of Psychology, Rutgers, The State University of New Jersey, 152 Frelinghuysen Rd, Piscataway, NJ, 08854, United States, 1 848 445 2576, jk1684@rutgers.edu %K news consumption %K worry %K hopelessness %K ecological momentary assessment %K news media %K COVID-19 %K pandemic %K mental health %K depression %K stress %K psychological distress %K mediation model %K digital health %D 2022 %7 25.5.2022 %9 Original Paper %J JMIR Ment Health %G English %X Background: Consumption of distressing news media, which substantially increased during the COVID-19 pandemic, has demonstrable negative effects on mental health. Objective: This study examines the proximal impact of daily exposure to news about COVID-19 on mental health in the first year of the pandemic. Methods: A sample of 546 college students completed daily ecological momentary assessments (EMAs) for 8 weeks, measuring exposure to news about COVID-19, worry and optimism specifically related to COVID-19, hopelessness, and general worry. Results: Participants completed >80,000 surveys. Multilevel mediation models indicated that greater daily exposure to news about COVID-19 is associated with higher same-day and next-day worry about the pandemic. Elevations in worry specifically about COVID-19 were in turn associated with greater next-day hopelessness and general worry. Optimism about COVID-19 mediated the relationship between daily exposure to COVID-19 news and next-day general worry but was not related to hopelessness. Conclusions: This study demonstrates the mental health impact of daily exposure to COVID-19 news and highlights how worry about the pandemic contributes over time to hopelessness and general worry. %M 35377320 %R 10.2196/36966 %U https://mental.jmir.org/2022/5/e36966 %U https://doi.org/10.2196/36966 %U http://www.ncbi.nlm.nih.gov/pubmed/35377320 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 10 %N 5 %P e34306 %T Deep Neural Networks for Simultaneously Capturing Public Topics and Sentiments During a Pandemic: Application on a COVID-19 Tweet Data Set %A Boukobza,Adrien %A Burgun,Anita %A Roudier,Bertrand %A Tsopra,Rosy %+ Department of Medical Informatics, Assistance Publique – Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, 20 rue Leblanc, Paris, F-75015, France, 1 156092167, hadrien_b@hotmail.fr %K neural network %K deep learning %K COVID-19 %K explainable artificial intelligence %K decision support %K natural language processing %D 2022 %7 25.5.2022 %9 Original Paper %J JMIR Med Inform %G English %X Background: Public engagement is a key element for mitigating pandemics, and a good understanding of public opinion could help to encourage the successful adoption of public health measures by the population. In past years, deep learning has been increasingly applied to the analysis of text from social networks. However, most of the developed approaches can only capture topics or sentiments alone but not both together. Objective: Here, we aimed to develop a new approach, based on deep neural networks, for simultaneously capturing public topics and sentiments and applied it to tweets sent just after the announcement of the COVID-19 pandemic by the World Health Organization (WHO). Methods: A total of 1,386,496 tweets were collected, preprocessed, and split with a ratio of 80:20 into training and validation sets, respectively. We combined lexicons and convolutional neural networks to improve sentiment prediction. The trained model achieved an overall accuracy of 81% and a precision of 82% and was able to capture simultaneously the weighted words associated with a predicted sentiment intensity score. These outputs were then visualized via an interactive and customizable web interface based on a word cloud representation. Using word cloud analysis, we captured the main topics for extreme positive and negative sentiment intensity scores. Results: In reaction to the announcement of the pandemic by the WHO, 6 negative and 5 positive topics were discussed on Twitter. Twitter users seemed to be worried about the international situation, economic consequences, and medical situation. Conversely, they seemed to be satisfied with the commitment of medical and social workers and with the collaboration between people. Conclusions: We propose a new method based on deep neural networks for simultaneously extracting public topics and sentiments from tweets. This method could be helpful for monitoring public opinion during crises such as pandemics. %M 35533390 %R 10.2196/34306 %U https://medinform.jmir.org/2022/5/e34306 %U https://doi.org/10.2196/34306 %U http://www.ncbi.nlm.nih.gov/pubmed/35533390 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 10 %N 5 %P e36709 %T The Architecture of a Feasibility Query Portal for Distributed COVID-19 Fast Healthcare Interoperability Resources (FHIR) Patient Data Repositories: Design and Implementation Study %A Gruendner,Julian %A Deppenwiese,Noemi %A Folz,Michael %A Köhler,Thomas %A Kroll,Björn %A Prokosch,Hans-Ulrich %A Rosenau,Lorenz %A Rühle,Mathias %A Scheidl,Marc-Anton %A Schüttler,Christina %A Sedlmayr,Brita %A Twrdik,Alexander %A Kiel,Alexander %A Majeed,Raphael W %+ Chair of Medical Informatics, Friedrich-Alexander University Erlangen-Nürnberg, Wetterkreuz 15, Erlangen, 91058, Germany, 49 9131 8567787, julian.gruendner@fau.de %K federated feasibility queries %K FHIR %K distributed analysis %K feasibility study %K HL7 FHIR %K FHIR Search %K CQL %K COVID-19 %K pandemic %K health data %K query %K patient data %K consensus data set %K medical informatics %K Fast Healthcare Interoperability Resources %D 2022 %7 25.5.2022 %9 Original Paper %J JMIR Med Inform %G English %X Background: An essential step in any medical research project after identifying the research question is to determine if there are sufficient patients available for a study and where to find them. Pursuing digital feasibility queries on available patient data registries has proven to be an excellent way of reusing existing real-world data sources. To support multicentric research, these feasibility queries should be designed and implemented to run across multiple sites and securely access local data. Working across hospitals usually involves working with different data formats and vocabularies. Recently, the Fast Healthcare Interoperability Resources (FHIR) standard was developed by Health Level Seven to address this concern and describe patient data in a standardized format. The Medical Informatics Initiative in Germany has committed to this standard and created data integration centers, which convert existing data into the FHIR format at each hospital. This partially solves the interoperability problem; however, a distributed feasibility query platform for the FHIR standard is still missing. Objective: This study described the design and implementation of the components involved in creating a cross-hospital feasibility query platform for researchers based on FHIR resources. This effort was part of a large COVID-19 data exchange platform and was designed to be scalable for a broad range of patient data. Methods: We analyzed and designed the abstract components necessary for a distributed feasibility query. This included a user interface for creating the query, backend with an ontology and terminology service, middleware for query distribution, and FHIR feasibility query execution service. Results: We implemented the components described in the Methods section. The resulting solution was distributed to 33 German university hospitals. The functionality of the comprehensive network infrastructure was demonstrated using a test data set based on the German Corona Consensus Data Set. A performance test using specifically created synthetic data revealed the applicability of our solution to data sets containing millions of FHIR resources. The solution can be easily deployed across hospitals and supports feasibility queries, combining multiple inclusion and exclusion criteria using standard Health Level Seven query languages such as Clinical Quality Language and FHIR Search. Developing a platform based on multiple microservices allowed us to create an extendable platform and support multiple Health Level Seven query languages and middleware components to allow integration with future directions of the Medical Informatics Initiative. Conclusions: We designed and implemented a feasibility platform for distributed feasibility queries, which works directly on FHIR-formatted data and distributed it across 33 university hospitals in Germany. We showed that developing a feasibility platform directly on the FHIR standard is feasible. %M 35486893 %R 10.2196/36709 %U https://medinform.jmir.org/2022/5/e36709 %U https://doi.org/10.2196/36709 %U http://www.ncbi.nlm.nih.gov/pubmed/35486893 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 5 %P e35311 %T Risk Factors Associated With SARS-CoV-2 Breakthrough Infections in Fully mRNA-Vaccinated Individuals: Retrospective Analysis %A Liu,Cong %A Lee,Junghwan %A Ta,Casey %A Soroush,Ali %A Rogers,James R %A Kim,Jae Hyun %A Natarajan,Karthik %A Zucker,Jason %A Perl,Yehoshua %A Weng,Chunhua %+ Department of Biomedical Informatics, Columbia University Irving Medical Center, PH-20, 622 W 168 Street, New York, NY, 10032, United States, 1 212 304 7907, cw2384@cumc.columbia.edu %K COVID-19 %K medical informatics %K real-word evidence %K vaccination %K electronic health records %D 2022 %7 24.5.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: COVID-19 messenger RNA (mRNA) vaccines have demonstrated efficacy and effectiveness in preventing symptomatic COVID-19, while being relatively safe in trial studies. However, vaccine breakthrough infections have been reported. Objective: This study aims to identify risk factors associated with COVID-19 breakthrough infections among fully mRNA-vaccinated individuals. Methods: We conducted a series of observational retrospective analyses using the electronic health records (EHRs) of the Columbia University Irving Medical Center/New York Presbyterian (CUIMC/NYP) up to September 21, 2021. New York City (NYC) adult residences with at least 1 polymerase chain reaction (PCR) record were included in this analysis. Poisson regression was performed to assess the association between the breakthrough infection rate in vaccinated individuals and multiple risk factors—including vaccine brand, demographics, and underlying conditions—while adjusting for calendar month, prior number of visits, and observational days in the EHR. Results: The overall estimated breakthrough infection rate was 0.16 (95% CI 0.14-0.18). Individuals who were vaccinated with Pfizer/BNT162b2 (incidence rate ratio [IRR] against Moderna/mRNA-1273=1.66, 95% CI 1.17-2.35) were male (IRR against female=1.47, 95% CI 1.11-1.94) and had compromised immune systems (IRR=1.48, 95% CI 1.09-2.00) were at the highest risk for breakthrough infections. Among all underlying conditions, those with primary immunodeficiency, a history of organ transplant, an active tumor, use of immunosuppressant medications, or Alzheimer disease were at the highest risk. Conclusions: Although we found both mRNA vaccines were effective, Moderna/mRNA-1273 had a lower incidence rate of breakthrough infections. Immunocompromised and male individuals were among the highest risk groups experiencing breakthrough infections. Given the rapidly changing nature of the SARS-CoV-2 pandemic, continued monitoring and a generalizable analysis pipeline are warranted to inform quick updates on vaccine effectiveness in real time. %M 35486806 %R 10.2196/35311 %U https://publichealth.jmir.org/2022/5/e35311 %U https://doi.org/10.2196/35311 %U http://www.ncbi.nlm.nih.gov/pubmed/35486806 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 5 %P e30294 %T A Mobile App for Stress Management in Middle-Aged Men and Women (Calm): Feasibility Randomized Controlled Trial %A Laird,Breanne %A Puzia,Megan %A Larkey,Linda %A Ehlers,Diane %A Huberty,Jennifer %+ Arizona State University, 425 N 5th St, Phoenix, AZ, 85004, United States, 1 7046043782, bmlaird@asu.edu %K stress %K meditation %K mHealth %K COVID-19 %K mobile app %K mental health %K mindfulness %K digital intervention %K psychological outcomes %D 2022 %7 24.5.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Middle-aged adults (40-65 years) report higher stress levels than most other age groups. There is a need to determine the feasibility of using a meditation app to reduce stress and improve stress-related outcomes in middle-aged adults with a focus on men, as previous meditation app–based studies have reported a low proportion of or even no male participants. Objective: This study aims to (1) determine the feasibility (ie, acceptability and demand with a focus on men) of a consumer-based meditation app (Calm), to reduce stress among middle-aged adults reporting elevated stress levels, and (2) explore the preliminary effects of Calm on perceived stress, psychological outcomes (anxiety, depressive symptoms, mindfulness, and general coping), health behaviors (physical activity and eating habits), and COVID-19 perceptions. Methods: This feasibility randomized controlled trial evaluated an app-based meditation intervention in middle-aged adults (N=83) with elevated stress levels (ie, Perceived Stress Scale score ≥15) and limited or no previous experience with meditation. Participants were randomized to the intervention group (Calm app) or a control (educational podcasts; POD) group. Participants completed self-report assessments at baseline and postintervention (week 4). Feasibility was measured as acceptability and demand using Bowen framework. Feasibility and COVID-19 perceptions data were examined using descriptive statistics, and preliminary effects were evaluated using repeated measures analysis of variance. Results: Participants were satisfied with Calm (27/28, 96%) and found it appropriate or useful (26/28, 93%). Most reported they would likely continue using the Calm app (18/28, 64%). More Calm users reported satisfaction, appropriateness or usefulness, and intent to continue app use than POD users. Calm users (n=33) completed a mean of 20 (SD 31.1) minutes of meditation on the days they meditated and 103 (SD 109.1) minutes of meditation per week. The average adherence rate to the prescribed meditation was 71% among Calm app users, compared to 62% among POD users. Recruitment rate of men was 35% (29/83). Of those randomized to Calm, 55% (15/29) were men, and retention among them was higher (14/15, 93%) than that among women (12/20, 60%). No significant within or between group differences were observed. Conclusions: A 4-week, app-based mindfulness meditation intervention (Calm) may be feasible for middle-aged adults and a useful stress-management tool. Calm users expressed satisfaction with the app and felt it was appropriate and useful. Significant improvements in perceived stress and psychological outcomes or stress-related health behaviors were not observed. Even though men spent less time in meditation than women did and completed fewer weekly sessions, they were more likely to adhere to the prescription. Further research is needed for improving stress and stress-related outcomes among middle-aged adults with emphasis on the effects of mindfulness meditation apps for men. Trial Registration: ClinicalTrials.gov NCT04272138; https://clinicaltrials.gov/ct2/show/NCT04272138 %M 34989677 %R 10.2196/30294 %U https://formative.jmir.org/2022/5/e30294 %U https://doi.org/10.2196/30294 %U http://www.ncbi.nlm.nih.gov/pubmed/34989677 %0 Journal Article %@ 2563-6316 %I JMIR Publications %V 3 %N 2 %P e32935 %T The Influence of SARS-CoV-2 Variants on National Case-Fatality Rates: Correlation and Validation Study %A Barletta,William A %+ Department of Physics, Massachusetts Institute of Technology, Bldg. 24-402b, 77 Massachusetts Avenue, Cambridge, MA, 02139, United States, 1 510 788 4592, barletta@mit.edu %K SARS-CoV-2 %K COVID-19 %K variants of concern %K case-fatality rates %K virulence %K vaccine effectiveness %K correlation study %D 2022 %7 24.5.2022 %9 Original Paper %J JMIRx Med %G English %X Background: In 2021, new variants of the SARS-CoV-2 virus appeared with increased transmissibility and virulence as compared with the original wild variant. The first variants of concern (VoCs), Alpha (B1.1.7) and Gamma (P.1), first appeared in the United Kingdom and Brazil, respectively. The Delta (B.1.617.2) variant, seen in India in October 2020, dominated COVID-19 infections across all regions through the second half of 2021. Objective: This research explores the degree to which SARS-CoV-2 VoCs generate waves of fluctuations in case-fatality rates (CFRs) across countries in several regions, increase the risk of mortality to persons with certain comorbidities, and decrease the risk of mortality as the percentage of fully vaccinated populations increases. Methods: This analysis introduces a measure of the temporal dynamics of COVID-19 infections in the form of a proxy CFR (pCFR), which can be compared among countries. It uses economic and demographic data reported by the World Bank and International Monetary Fund, plus publicly available epidemiological and medical statistics reported to the relevant national and international public health authorities. From these ecological data, pandemic average and daily COVID-19 CFRs and their correlations with potential cofactors were computed for 2021, a year dominated by the spread of World Health Organization–designated VoCs. The study does not investigate disease pathology; rather, it compares the daily case rates and pCFRs to reveal underlying contributing factors that vary from country to country and region to region. Results: The in-depth global regression analysis of cofactors found that the strongest single correlation with COVID-19 fatality was 0.36 (SD 0.02) with P<.001 for chronic kidney disease. No other single physiological cofactors display positive correlations exceeding 0.26 (SD 0.26), with P=.008 (asthma) and P=.01 (coronary disease). The study confirms that the pCFR is a valuable metric for tracking waves of infection due to different VoCs within countries. Conclusions: The influence of social, economic, and medical cofactors on the CFR due to VoCs remains qualitatively similar, albeit strengthened, to the levels found for the wild strain. The strong regional variations of the influence of all cofactors observed for the wild strain persists in infections for all VoCs with very strong correlation coefficients seen in the Middle East for asthma (0.76), coronary heart disease (0.60), lung disease (0.70), and chronic kidney disease (0.52). Strong regional variations emphasize the influence on COVID-19 mortality due to regional differences in national economics, patterns of health care policies, and variations in cultural practices and environment. The pCFR-based analysis reveals clear patterns of the spread of VoCs across regions, but there is little evidence for the spread of the Lambda and Mu (B.1.621) variants of interest outside of South America. %M 35969709 %R 10.2196/32935 %U https://med.jmirx.org/2022/2/e32935 %U https://doi.org/10.2196/32935 %U http://www.ncbi.nlm.nih.gov/pubmed/35969709 %0 Journal Article %@ 2563-6316 %I JMIR Publications %V 3 %N 2 %P e30344 %T Supporting Technologies for COVID-19 Prevention: Systemized Review %A Zhao,Zhuo %A Li,Rui %A Ma,Yangmyung %A Islam,Iman %A Rajper,Abdul M Azam %A Song,WenZhan %A Ren,Hongliang %A Tse,Zion Tsz Ho %+ Department of Electronic Engineering, University of York, Heslington, York, YO10 5DD, United Kingdom, 44 (0)1904322342, zion.tse@york.ac.uk %K COVID-19 %K medical treatments %K personal protective equipment %K testing methods %D 2022 %7 24.5.2022 %9 Review %J JMIRx Med %G English %X Background: During COVID-19, clinical and health care demands have been on the rapid rise. Major challenges that have arisen during the pandemic have included a lack of testing kits, shortages of ventilators to treat severe cases of COVID-19, and insufficient accessibility to personal protective equipment for both hospitals and the public. New technologies have been developed by scientists, researchers, and companies in response to these demands. Objective: The primary objective of this review is to compare different supporting technologies in the subjugation of the COVID-19 spread. Methods: In this paper, 150 news articles and scientific reports on COVID-19–related innovations during 2020-2021 were checked, screened, and shortlisted to yield a total of 23 articles for review. The keywords “COVID-19 technology,” “COVID-19 invention,” and “COVID-19 equipment” were used in a Google search to generate related news articles and scientific reports. The search was performed on February 1, 2021. These were then categorized into three sections, which are personal protective equipment (PPE), testing methods, and medical treatments. Each study was analyzed for its engineering characteristics and potential social impact on the COVID-19 pandemic. Results: A total of 9 articles were selected for review concerning PPE. In general, the design and fabrication of PPE were moving toward the direction of additive manufacturing and intelligent information feedback while being eco-friendly. Moreover, 8 articles were selected for reviewing testing methods within the two main categories of molecular and antigen tests. All the inventions endeavored to increase sensitivity while reducing the turnaround time. However, the inventions reported in this review paper were not sufficiently tested for their safety and efficiency. Most of the inventions are temporary solutions intended to be used only during shortages of medical resources. Finally, 6 articles were selected for the review of COVID-19 medical treatment. The major challenge identified was the uncertainty in applying novel ideas to speed up the production of ventilators. Conclusions: The technologies developed during the COVID-19 pandemic were considered for review. In order to better respond to future pandemics, national reserves of critical medical supplies should be increased to improve preparation. This pandemic has also highlighted the need for the automation and optimization of medical manufacturing. %M 35695850 %R 10.2196/30344 %U https://med.jmirx.org/2022/2/e30344 %U https://doi.org/10.2196/30344 %U http://www.ncbi.nlm.nih.gov/pubmed/35695850 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 5 %P e35958 %T Korea's Response to COVID-19 According to Set Time Frames, With a Focus on the Network Between the Government and Responding Agencies: Social Network Analysis %A Cho,Jungyun %A Kang,Wook %A Lee,Julak %+ Department of Industrial Security, Chung-Ang University, 84 Heukseok-ro, Seoul, 06974, Republic of Korea, 82 1096231289, julaklee71@cau.ac.kr %K COVID-19 %K government departments’ networks %K network structure %K contagious disease response %K social network analysis %D 2022 %7 23.5.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: In December 2019, COVID-19 was first confirmed in Wuhan, China, and as the respiratory disease spread around the globe, there was a spike in interest worldwide in combating such contagious diseases. When such disasters occur, the central government of South Korea and its affiliated local governments—together with nongovernmental organizations—play a crucial role in crisis management systems. Objective: The purpose of this paper is to corroborate the characteristics government ministries and domestic and foreign institutions exhibit through their interconnection when the parties are undergoing a disease-related catastrophe such as the COVID-19 pandemic. Methods: Using the social network analysis technique, the span of the COVID-19 pandemic was segmented into 3 time frames, and the relational characteristics of the COVID-19 contagious disease response department and related agencies at home and abroad were analyzed based on 3 centralities. Results: Evidence from the second and third time frames indicates that the agents reacting to contagious diseases do not necessarily hold the central position in the network. From this, it can be inferred that it is not only the primary host that plays a pivotal role but the key to a successful response to various disasters also lies in cooperation with the relevant parties. Conclusions: The incongruency between the findings of this paper and the existing disaster response system gives rise to the corollary that both the essential parties and the adjoining ones need to collaborate for a coordinated crisis response in disaster situations. Furthermore, much significance lies in the fact that this paper explores the various aspects that could surface among the host and relevant parties in a real-life pandemic. %M 35486100 %R 10.2196/35958 %U https://publichealth.jmir.org/2022/5/e35958 %U https://doi.org/10.2196/35958 %U http://www.ncbi.nlm.nih.gov/pubmed/35486100 %0 Journal Article %@ 2561-9128 %I JMIR Publications %V 5 %N 1 %P e29045 %T The Impact of the COVID-19 Pandemic on Hepatobiliary and Pancreatic Surgical Services in Singapore: Retrospective Quantitative Study %A Teo,Zhe Hao Timothy %A Huey,Cheong Wei Terence %A Low,Jee Keem %A Junnarkar,Sameer Padmakumar %A Shelat,Vishalkumar G %+ Department of General Surgery, Tan Tock Seng Hospital, 11 Jln Tan Tock Seng, Singapore, 308433, Singapore, 65 98557225, timothy.teo@mohh.com.sg %K audit %K coronavirus %K COVID-19 %K pandemic %K surgery %K impact %K cancer %K liver, pancreas %K resource %K elective surgery %D 2022 %7 23.5.2022 %9 Original Paper %J JMIR Perioper Med %G English %X Background: At the height of the COVID-19 pandemic, the hepatopancreatobiliary (HPB) unit had to reorganize its surgical case volume due to the rationing of health care resources. We report on a local audit evaluating the impact of COVID-19 on the HPB unit and the HPB surgical oncology practice. Objective: The aim of this study was to review the impact of the COVID-19 pandemic on the HPB unit’s elective and emergency surgical cases. The secondary aims were to investigate the impact on the HPB surgical oncology operative case volume. Methods: We performed a comparative audit of the HPB unit surgical case volume for January-June 2019 (baseline) and 2020 (COVID-19). Elective and emergency cases performed under general anesthesia were audited. Elective cases included hernia and gallbladder operations and liver and pancreatic resections. Emergency cases included cholecystectomies and laparotomies performed for general surgical indications. We excluded endoscopies and procedures done under local anesthesia. The retrospective data collected during the 2 time periods were compared. This study was registered in the Chinese Clinical Trial Registry (ChiCTR2000040265). Results: The elective surgical case volume decreased by 41.8% (351 cases in 2019 compared to 204 cases in 2020) during the COVID-19 pandemic. The number of hernia operations decreased by 63.9% (155 in 2019 compared to 56 in 2020; P<.001) and cholecystectomies decreased by 40.1% (157 in 2019 compared to 94 in 2020; P=.83). The liver and pancreatic resection volume increased by 16.7% (30 cases in 2019 compared to 35 cases in 2020; P=.004) and 111.1% (9 cases in 2019 compared to 19 cases in 2020; P=.001), respectively. The emergency surgical workload decreased by 40.9% (193 cases in 2019 compared to 114 cases in 2020). The most significant reduction in the emergency workload was observed in March (41 to 23 cases, a 43.9% reduction; P=.94), April (35 to 8 cases, a 77.1% reduction; P=.01), and May (32 to 14 cases, a 56.3% reduction; P=.39); however, only April had a statistically significant reduction in workload (P=.01). Conclusions: The reallocation of resources due to the COVID-19 pandemic did not adversely impact elective HPB oncology work. With prudent measures in place, essential surgical services can be maintained during a pandemic. Trial Registration: Chinese Clinical Trial Registry (ChiCTR2000040265); https://tinyurl.com/ms9kpr6x %M 35486909 %R 10.2196/29045 %U https://periop.jmir.org/2022/1/e29045 %U https://doi.org/10.2196/29045 %U http://www.ncbi.nlm.nih.gov/pubmed/35486909 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 5 %P e37674 %T Exploring Online Peer Support Groups for Adults Experiencing Long COVID in the United Kingdom: Qualitative Interview Study %A Day,Hannah L S %+ Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, United Kingdom, 44 2079272700, hannah.day1@alumni.lshtm.ac.uk %K COVID-19 %K long COVID %K post-COVID-19 syndrome %K peer support %K online health communities %K self-help groups %K internet %K qualitative %K interview %K patient experience %K digital health %K digital peer support %K online health %D 2022 %7 20.5.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Long COVID is an emerging public health concern. A growing number of individuals are experiencing prolonged, multifaceted health challenges and accompanying social impacts after COVID-19 infections. Support services in the United Kingdom remain insufficient and fraught with complexity. Responding to persistent gaps in care, patients joined forces in online peer support groups. However, little is known about how these groups impact patients with long COVID and their lived experiences of the condition. Objective: The aim of this study is to explore the roles that online peer support groups take on and the impact they have on patients experiencing and recovering from long COVID in the United Kingdom. In doing so, this study aims to identify ways to inform future long COVID care, including online peer support and broader long COVID care structures. Methods: I conducted 11 semistructured interviews virtually on Zoom in July 2021. Participants had long COVID, were UK-based, and used long COVID online peer support groups. Topics discussed in interviews included what led participants to these groups, experiences within them, and feelings about the roles that the groups took on. I analyzed the results by manually conducting thematic analysis. Results: Long COVID online peer support groups had numerous roles, significantly impacting users. I identified 5 themes and 13 subthemes through thematic analysis. The identified themes were as follows: (1) filling professional care gaps, (2) societal awareness, (3) engagement behavior, (4) diversity, and (5) social connections. Given the void of professional support, those experiencing long COVID gained some benefit from these groups. However, participants emphasized notable concerns about the all-encompassing roles these groups embody and speculated over potential improvements. Conclusions: If used appropriately, online peer support groups could be immensely beneficial for patient well-being, beyond simply filling gaps in long COVID care. However, it appears many groups take on more than they can manage and become potentially harmful. Through prioritizing patient voices, long COVID care could be restructured to maximize peer support’s benefits within broader care structures. %M 35468083 %R 10.2196/37674 %U https://www.jmir.org/2022/5/e37674 %U https://doi.org/10.2196/37674 %U http://www.ncbi.nlm.nih.gov/pubmed/35468083 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 5 %P e35054 %T The Effectiveness of Pfizer-BioNTech and Oxford-AstraZeneca Vaccines to Prevent Severe COVID-19 in Costa Rica: Nationwide, Ecological Study of Hospitalization Prevalence %A Rosero-Bixby,Luis %+ Centro Centroamericano de Población, Universidad de Costa Rica, Ciudad Universitaria Rodrigo Facio, San Pedro, 11501, Costa Rica, 506 25111452, roserobixby@gmail.com %K COVID-19 %K vaccine %K effectiveness %K hospitalization %K epidemiology %K prevention %K severity %K Costa Rica %K observational %K prevalence %K real-world %K virus %K variant %K policy %K monitoring %K surveillance %D 2022 %7 20.5.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The Costa Rican COVID-19 vaccination program has used Pfizer-BioNTech and Oxford-AstraZeneca vaccines. Real-world estimates of the effectiveness of these vaccines to prevent hospitalizations range from 90%-98% for two doses and from 70%-91% for a single dose. Almost all of these estimates predate the Delta variant. Objective: The aim of this study is to estimate the dose-dependent effectiveness of COVID-19 vaccines to prevent severe illness in real-world conditions in Costa Rica, after the Delta variant became dominant. Methods: This observational study is a secondary analysis of hospitalization prevalence. The sample is all 3.67 million adult residents living in Costa Rica by mid-2021. The study is based on public aggregated data of 5978 COVID-19–related hospital records from September 14, 2021, to October 20, 2021, and 6.1 million vaccination doses administered to determine hospitalization prevalence by dose-specific vaccination status. The intervention retrospectively evaluated is vaccination with Pfizer-BioNTech (78%) and Oxford-AstraZeneca (22%). The main outcome studied is being hospitalized. Results: Vaccine effectiveness against hospitalization (VEH) was estimated as 93.4% (95% CI 93.0-93.9) for complete vaccination and 76.7% (95% CI 75.0-78.3) for single-dose vaccination among adults of all ages. VEH was lower and more uncertain among older adults aged ≥58 years: 92% (95% CI 91%-93%) for those who had received full vaccination and 64% (95% CI 58%-69%) for those who had received partial vaccination. Single-dose VEH declined over time during the study period, especially in the older age group. Estimates were sensitive to possible errors in the population count used to determine the residual number of unvaccinated people when vaccine coverage is high. Conclusions: The Costa Rican COVID-19 vaccination program that administered Pfizer-BioNTech and Oxford-AstraZeneca vaccines seems to be highly effective at preventing COVID-19–related hospitalization after the Delta variant became dominant. Even a single dose seems to provide some degree of protection, which is good news for people whose second dose of the Pfizer-BioNTech vaccine was postponed several weeks to more rapidly increase the number of people vaccinated with a first dose. Timely monitoring of vaccine effectiveness is important to detect eventual failures and motivate the public to get vaccinated by providing information regarding the effectiveness of the vaccines. %M 35483079 %R 10.2196/35054 %U https://publichealth.jmir.org/2022/5/e35054 %U https://doi.org/10.2196/35054 %U http://www.ncbi.nlm.nih.gov/pubmed/35483079 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 5 %P e35347 %T Misinformation in Italian Online Mental Health Communities During the COVID-19 Pandemic: Protocol for a Content Analysis Study %A Bizzotto,Nicole %A Morlino,Susanna %A Schulz,Peter Johannes %+ Faculty of Communication, Culture and Society, Università della Svizzera italiana, Via Buffi 13, Lugano, 6900, Switzerland, 41 586 664 724, schulzp@usi.ch %K online communities %K social media %K mental health %K misinformation %K COVID-19 %K empowerment %K content analysis %D 2022 %7 20.5.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Social media platforms are widely used by people suffering from mental illnesses to cope with their conditions. One modality of coping with these conditions is navigating online communities where people can receive emotional support and informational advice. Benefits have been documented in terms of impact on health outcomes. However, the pitfalls are still unknown, as not all content is necessarily helpful or correct. Furthermore, the advent of the COVID-19 pandemic and related problems, such as worsening mental health symptoms, the dissemination of conspiracy narratives, and medical distrust, may have impacted these online communities. The situation in Italy is of particular interest, being the first Western country to experience a nationwide lockdown. Particularly during this challenging time, the beneficial role of community moderators with professional mental health expertise needs to be investigated in terms of uncovering misleading information and regulating communities. Objective: The aim of the proposed study is to investigate the potentially harmful content found in online communities for mental health symptoms in the Italian language. Besides descriptive information about the content that posts and comments address, this study aims to analyze the content from two viewpoints. The first one compares expert-led and peer-led communities, focusing on differences in misinformation. The second one unravels the impact of the COVID-19 pandemic, not by merely investigating differences in topics but also by investigating the needs expressed by community members. Methods: A codebook for the content analysis of Facebook communities has been developed, and a content analysis will be conducted on bundles of posts. Among 14 Facebook groups that were interested in participating in this study, two groups were selected for analysis: one was being moderated by a health professional (n=12,058 members) and one was led by peers (n=5598 members). Utterances from 3 consecutive calendar years will be studied by comparing the months from before the pandemic, the months during the height of the pandemic, and the months during the postpandemic phase (2019-2021). This method permits the identification of different types of misinformation and the context in which they emerge. Ethical approval was obtained by the Università della Svizzera italiana ethics committee. Results: The usability of the codebook was demonstrated with a pretest. Subsequently, 144 threads (1534 utterances) were coded by the two coders. Intercoder reliability was calculated on 293 units (19.10% of the total sample; Krippendorff α=.94, range .72-1). Aside from a few analyses comparing bundles, individual utterances will constitute the unit of analysis in most cases. Conclusions: This content analysis will identify deleterious content found in online mental health support groups, the potential role of moderators in uncovering misleading information, and the impact of COVID-19 on the content. International Registered Report Identifier (IRRID): PRR1-10.2196/35347 %M 35594142 %R 10.2196/35347 %U https://www.researchprotocols.org/2022/5/e35347 %U https://doi.org/10.2196/35347 %U http://www.ncbi.nlm.nih.gov/pubmed/35594142 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 5 %P e35653 %T Individual-Level Evaluation of the Exposure Notification Cascade in the SwissCovid Digital Proximity Tracing App: Observational Study %A Ballouz,Tala %A Menges,Dominik %A Aschmann,Hélène E %A Jung,Ruedi %A Domenghino,Anja %A Fehr,Jan S %A Puhan,Milo A %A von Wyl,Viktor %+ Institute for Implementation Science in Health Care, University of Zurich, Universitätstrasse 84, Zurich, 8006, Switzerland, 41 44 63 46380, viktor.vonwyl@uzh.ch %K digital proximity tracing %K contact tracing %K SwissCovid %K mobile app %K COVID-19 %K SARS-CoV-2 %K epidemiology %K public health %K tracking %K surveillance %K app %K mHealth %K evaluation %K exposure %K notification %K observational %D 2022 %7 19.5.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Digital proximity tracing (DPT) aims to complement manual contact tracing (MCT) in identifying exposed contacts and preventing further transmission of SARS-CoV-2 in the population. Although several DPT apps, including SwissCovid, have shown to have promising effects on mitigating the pandemic, several challenges have impeded them from fully achieving the desired results. A key question now relates to how the effectiveness of DPT can be improved, which requires a better understanding of factors influencing its processes. Objective: In this study, we aim to provide a detailed examination of the exposure notification (EN) cascade and to evaluate potential contextual influences for successful receipt of an EN and subsequent actions taken by cases and contacts in different exposure settings. Methods: We used data from 285 pairs of SARS-CoV-2-infected cases and their contacts within an observational cohort study of cases and contacts identified by MCT and enrolled between August 6, 2020, and January 17, 2021, in the canton of Zurich, Switzerland. We surveyed participants with electronic questionnaires. Data were summarized descriptively and stratified by exposure setting. Results: We found that only 79 (58.5%) of 135 contacts using the SwissCovid app whose corresponding cases reported to have triggered the EN also received one. Of these, 18 (22.8%) received the EN before MCT. Compared to those receiving an EN after MCT (61/79, 77.2%), we observed that a higher proportion of contacts receiving an EN before MCT were exposed in nonhousehold settings (11/18, 61.1%, vs 34/61, 55.7%) and their corresponding cases had more frequently reported mild-to-moderate symptoms (14/18, 77.8%, vs 42/61, 68.9%). Of the 18 contacts receiving an EN before MCT, 14 (77.8%) took recommended measures: 12 (66.7%) were tested for SARS-CoV-2, and 7 (38.9%) called the SwissCovid Infoline. In nonhousehold settings, the proportion of contacts taking preventive actions after receiving an EN was higher compared to same-household settings (82%, vs 67%). In addition, 1 (9%) of 11 ENs received in the nonhousehold setting before MCT led to the identification of a SARS-CoV-2-infected case by prompting the contact to get tested. This corresponds to 1 in 85 exposures of a contact to a case in a nonhousehold setting, in which both were app users and the case triggered the EN. Conclusions: Our descriptive evaluation of the DPT notification cascade provides further evidence that DPT is an important complementary tool in pandemic mitigation, especially in nonhousehold exposure settings. However, the effect of DPT apps can only be exerted if code generation processes are efficient and exposed contacts are willing to undertake preventive actions. This highlights the need to focus efforts on keeping barriers to efficient code generation as low as possible and promoting not only app adoption but also compliance with the recommended measures upon an EN. Trial Registration: International Standard Randomised Controlled Trial Number Registry 14990068; https://doi.org/10.1186/ISRCTN14990068 %M 35476726 %R 10.2196/35653 %U https://publichealth.jmir.org/2022/5/e35653 %U https://doi.org/10.2196/35653 %U http://www.ncbi.nlm.nih.gov/pubmed/35476726 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 5 %P e29183 %T Types of Racism and Twitter Users’ Responses Amid the COVID-19 Outbreak: Content Analysis %A Lloret-Pineda,Amanda %A He,Yuelu %A Haro,Josep Maria %A Cristóbal-Narváez,Paula %+ Research and Development Unit, Parc Sanitari Sant Joan de Déu, Sant Rafael Bldg, 1st Fl, 42 Dr Antoni Pujades Street, Sant Boi de Llobregat, Barcelona, 08830, Spain, 34 93 640 63 50, a.lloret@pssjd.org %K COVID-19 %K racism %K Chinese %K advocacy %K Twitter %D 2022 %7 19.5.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: When the first COVID-19 cases were noticed in China, many racist comments against Chinese individuals spread. As there is a huge need to better comprehend why all of these targeted comments and opinions developed specifically at the start of the outbreak, we sought to carefully examine racism and advocacy efforts on Twitter in the first quarter of 2020 (January 15 to March 3, 2020). Objective: The first research question aimed to understand the main type of racism displayed on Twitter during the first quarter of 2020. The second research question focused on evaluating Twitter users’ positive and negative responses regarding racism toward Chinese individuals. Methods: Content analysis of tweets was utilized to address the two research questions. Using the NCapture browser link and NVivo software, tweets in English and Spanish were pulled from the Twitter data stream from January 15 to March 3, 2020. A total of 19,150 tweets were captured using the advanced Twitter search engine with the keywords and hashtags #nosoyunvirus, #imNotAVirus, #ChineseDon’tComeToJapan, #racism, “No soy un virus,” and “Racismo Coronavirus.” After cleaning the data, a total of 402 tweets were codified and analyzed. Results: The data confirmed clear sentiments of racism against Chinese individuals during the first quarter of 2020. The tweets displayed individual, cultural, and institutional racism. Individual racism was the most commonly reported form of racism, specifically displaying physical and verbal aggression. As a form of resistance, Twitter users created spaces for advocacy and activism. The hashtag “I am not a virus” helped to break stereotypes, prejudice, and discrimination on Twitter. Conclusions: Advocacy efforts were enormous both inside and outside the Chinese community; an allyship sentiment was fostered by some white users, and an identification with the oppression experienced by the Chinese population was expressed in the Black and Muslim worldwide communities. Activism through social media manifested through art, food sharing, and community support. %M 35446780 %R 10.2196/29183 %U https://formative.jmir.org/2022/5/e29183 %U https://doi.org/10.2196/29183 %U http://www.ncbi.nlm.nih.gov/pubmed/35446780 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 5 %P e37931 %T Distinguishing Admissions Specifically for COVID-19 From Incidental SARS-CoV-2 Admissions: National Retrospective Electronic Health Record Study %A Klann,Jeffrey G %A Strasser,Zachary H %A Hutch,Meghan R %A Kennedy,Chris J %A Marwaha,Jayson S %A Morris,Michele %A Samayamuthu,Malarkodi Jebathilagam %A Pfaff,Ashley C %A Estiri,Hossein %A South,Andrew M %A Weber,Griffin M %A Yuan,William %A Avillach,Paul %A Wagholikar,Kavishwar B %A Luo,Yuan %A , %A Omenn,Gilbert S %A Visweswaran,Shyam %A Holmes,John H %A Xia,Zongqi %A Brat,Gabriel A %A Murphy,Shawn N %+ Laboratory of Computer Science, Department of Medicine, Massachusetts General Hospital, 50 Staniford St, Suite 750, Boston, MA, 02114, United States, 1 6142822222, jeff.klann@mgh.harvard.edu %K COVID-19 %K medical informatics %K public health %K phenotype %K electronic health records %K clinical research informatics %K health data %K SARS-CoV-2 %K patient data %K health care %D 2022 %7 18.5.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Admissions are generally classified as COVID-19 hospitalizations if the patient has a positive SARS-CoV-2 polymerase chain reaction (PCR) test. However, because 35% of SARS-CoV-2 infections are asymptomatic, patients admitted for unrelated indications with an incidentally positive test could be misclassified as a COVID-19 hospitalization. Electronic health record (EHR)–based studies have been unable to distinguish between a hospitalization specifically for COVID-19 versus an incidental SARS-CoV-2 hospitalization. Although the need to improve classification of COVID-19 versus incidental SARS-CoV-2 is well understood, the magnitude of the problems has only been characterized in small, single-center studies. Furthermore, there have been no peer-reviewed studies evaluating methods for improving classification. Objective: The aims of this study are to, first, quantify the frequency of incidental hospitalizations over the first 15 months of the pandemic in multiple hospital systems in the United States and, second, to apply electronic phenotyping techniques to automatically improve COVID-19 hospitalization classification. Methods: From a retrospective EHR-based cohort in 4 US health care systems in Massachusetts, Pennsylvania, and Illinois, a random sample of 1123 SARS-CoV-2 PCR-positive patients hospitalized from March 2020 to August 2021 was manually chart-reviewed and classified as “admitted with COVID-19” (incidental) versus specifically admitted for COVID-19 (“for COVID-19”). EHR-based phenotyping was used to find feature sets to filter out incidental admissions. Results: EHR-based phenotyped feature sets filtered out incidental admissions, which occurred in an average of 26% of hospitalizations (although this varied widely over time, from 0% to 75%). The top site-specific feature sets had 79%-99% specificity with 62%-75% sensitivity, while the best-performing across-site feature sets had 71%-94% specificity with 69%-81% sensitivity. Conclusions: A large proportion of SARS-CoV-2 PCR-positive admissions were incidental. Straightforward EHR-based phenotypes differentiated admissions, which is important to assure accurate public health reporting and research. %M 35476727 %R 10.2196/37931 %U https://www.jmir.org/2022/5/e37931 %U https://doi.org/10.2196/37931 %U http://www.ncbi.nlm.nih.gov/pubmed/35476727 %0 Journal Article %@ 2371-4379 %I JMIR Publications %V 7 %N 2 %P e36181 %T The Associations of COVID-19 Lockdown Restrictions With Longer-Term Activity Levels of Working Adults With Type 2 Diabetes: Cohort Study %A Brakenridge,Christian John %A Salim,Agus %A Healy,Genevieve Nissa %A Grigg,Ruth %A Carver,Alison %A Rickards,Kym %A Owen,Neville %A Dunstan,David Wayne %+ Baker Heart and Diabetes Institute, 99 Commercial Rd, Melbourne, 3004, Australia, 61 385321853, christian.brakenridge@baker.edu.au %K COVID-19 %K Fitbit %K activity %K sedentary behavior %K type 2 diabetes %K digital health %K pandemic %K physical activity %K wearable %K health technology %D 2022 %7 18.5.2022 %9 Original Paper %J JMIR Diabetes %G English %X Background: Lockdown restrictions reduce COVID-19 community transmission; however, they may pose challenges for noncommunicable disease management. A 112-day hard lockdown in Victoria, Australia (commencing March 23, 2020) coincided with an intervention trial of reducing and breaking up sitting time in desk workers with type 2 diabetes who were using a provided consumer-grade activity tracker (Fitbit). Objective: This study aims to compare continuously recorded activity levels preceding and during COVID-19 lockdown restrictions among working adults with type 2 diabetes participating in a sitting less and moving more intervention. Methods: A total of 11 participants (n=8 male; mean age 52.8, SD 5 years) in Melbourne, Australia had Fitbit activity tracked before (mean 122.7, SD 47.9 days) and during (mean 99.7, SD 62.5 days) citywide COVID-19 lockdown restrictions. Regression models compared device (Fitbit Inspire HR)–derived activity (steps; metabolic equivalent tasks [METs]; mean time in sedentary, lightly, fairly, and very active minutes; and usual bout durations) during restrictions to prerestrictions. Changes in activity were statistically significant when estimates (Δ%) did not intercept zero. Results: Overall, there was a decrease in mean steps (–1584 steps/day; Δ% –9%, 95% CI –11% to –7%); METs (–83 METs/day; Δ% –5%, 95% CI –6% to –5%); and lightly active (Δ% –4%, 95% CI –8% to –1%), fairly active (Δ% –8%, 95% CI –21% to –15%), and very active (Δ% –8%, 95% CI –11% to –5%) intensity minutes per day, and increases in mean sedentary minutes per day (51 mins/day; Δ% 3%, 95% CI 1%-6%). Only very active (+5.1 mins) and sedentary (+4.3 mins) bout durations changed significantly. Conclusions: In a convenience sample of adults with type 2 diabetes, COVID-19 lockdown restrictions were associated with decreases in overall activity levels and increases in very active and sedentary bout durations. A Fitbit monitor provided meaningful continuous long-term data in this context. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12618001159246; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12618001159246 %M 35486904 %R 10.2196/36181 %U https://diabetes.jmir.org/2022/2/e36181 %U https://doi.org/10.2196/36181 %U http://www.ncbi.nlm.nih.gov/pubmed/35486904 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 10 %N 5 %P e37831 %T An Analysis of French-Language Tweets About COVID-19 Vaccines: Supervised Learning Approach %A Sauvayre,Romy %A Vernier,Jessica %A Chauvière,Cédric %+ Polytech Clermont, Clermont Auvergne INP, 2, avenue Blaise Pascal, Aubiere, 63178, France, 33 4 73 40 55 4, romy.sauvayre@uca.fr %K social media %K natural language processing %K public health %K vaccine %K machine learning %K CamemBERT language model %K method %K epistemology %K COVID-19 %K disinformation %K language model %D 2022 %7 17.5.2022 %9 Original Paper %J JMIR Med Inform %G English %X Background: As the COVID-19 pandemic progressed, disinformation, fake news, and conspiracy theories spread through many parts of society. However, the disinformation spreading through social media is, according to the literature, one of the causes of increased COVID-19 vaccine hesitancy. In this context, the analysis of social media posts is particularly important, but the large amount of data exchanged on social media platforms requires specific methods. This is why machine learning and natural language processing models are increasingly applied to social media data. Objective: The aim of this study is to examine the capability of the CamemBERT French-language model to faithfully predict the elaborated categories, with the knowledge that tweets about vaccination are often ambiguous, sarcastic, or irrelevant to the studied topic. Methods: A total of 901,908 unique French-language tweets related to vaccination published between July 12, 2021, and August 11, 2021, were extracted using Twitter’s application programming interface (version 2; Twitter Inc). Approximately 2000 randomly selected tweets were labeled with 2 types of categorizations: (1) arguments for (pros) or against (cons) vaccination (health measures included) and (2) type of content (scientific, political, social, or vaccination status). The CamemBERT model was fine-tuned and tested for the classification of French-language tweets. The model’s performance was assessed by computing the F1-score, and confusion matrices were obtained. Results: The accuracy of the applied machine learning reached up to 70.6% for the first classification (pro and con tweets) and up to 90% for the second classification (scientific and political tweets). Furthermore, a tweet was 1.86 times more likely to be incorrectly classified by the model if it contained fewer than 170 characters (odds ratio 1.86; 95% CI 1.20-2.86). Conclusions: The accuracy of the model is affected by the classification chosen and the topic of the message examined. When the vaccine debate is jostled by contested political decisions, tweet content becomes so heterogeneous that the accuracy of the model drops for less differentiated classes. However, our tests showed that it is possible to improve the accuracy by selecting tweets using a new method based on tweet length. %M 35512274 %R 10.2196/37831 %U https://medinform.jmir.org/2022/5/e37831 %U https://doi.org/10.2196/37831 %U http://www.ncbi.nlm.nih.gov/pubmed/35512274 %0 Journal Article %@ 2562-0959 %I JMIR Publications %V 5 %N 2 %P e34228 %T A Glance at the Practice of Pediatric Teledermatology Pre- and Post–COVID-19: Narrative Review %A Long,Valencia %A Chandran,Nisha Suyien %+ Division of Dermatology, Department of Medicine, National University Hospital, National University Health System, Singapore, Singapore, 65 88292608, valencialong@gmail.com %K teledermatology %K telehealth %K telemedicine %K pediatric teledermatology %K COVID-19 %K pandemic %K dermatology %K pediatric %K children %D 2022 %7 17.5.2022 %9 Review %J JMIR Dermatol %G English %X Background: The COVID-19 pandemic has accelerated the use of pediatric teledermatology, with centers showing increased uptake of teledermatology. Pediatric patients possess unique characteristics that pose different challenges with teledermatology compared to adults, in turn affecting the feasibility and uptake of pediatric teledermatology in the community. Objective: This narrative review summarizes the evolution of pediatric teledermatology from pre–COVID-19 pandemic times to the post–COVID-19 period. Methods: A search of MEDLINE, PubMed, and Embase was performed for original articles written in English and published from December 1, 2019, to April 1, 2022. Results: A total of 22 publications were included. Conclusions: Teledermatology will continue to play an increasing role in the management of skin diseases. A mindset shift in the types of conditions deemed suitable for pediatric teledermatology is needed. %M 35610984 %R 10.2196/34228 %U https://derma.jmir.org/2022/2/e34228 %U https://doi.org/10.2196/34228 %U http://www.ncbi.nlm.nih.gov/pubmed/35610984 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 5 %P e35674 %T Using Mixed Reality Headsets to Deliver Remote Bedside Teaching During the COVID-19 Pandemic: Feasibility Trial of HoloLens 2 %A Sivananthan,Arun %A Gueroult,Aurelien %A Zijlstra,Geiske %A Martin,Guy %A Baheerathan,Aravindhan %A Pratt,Philip %A Darzi,Ara %A Patel,Nisha %A Kinross,James %+ Institute of Global Health Innovation, Imperial College London, Praed Street, London, W2 1NY, United Kingdom, 44 020 3312 6666, arun.sivananthan@nhs.net %K mixed reality %K remote learning %K HoloLens %K bedside teaching %K COVID-19 %K personal protective equipment %K digital education %K medical education %K e-learning %K protection %K feasibility %K medical student %K virtual reality %D 2022 %7 17.5.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: COVID-19 has had a catastrophic impact in terms of human lives lost. Medical education has also been impacted as appropriately stringent infection control policies precluded medical trainees from attending clinical teaching. Lecture-based education has been easily transferred to a digital platform, but bedside teaching has not. Objective: This study aims to assess the feasibility of using a mixed reality (MR) headset to deliver remote bedside teaching. Methods: Two MR sessions were led by senior doctors wearing the HoloLens headset. The trainers selected patients requiring their specialist input. The headset allowed bidirectional audiovisual communication between the trainer and trainee doctors. Trainee doctor conceptions of bedside teaching, impact of the COVID-19 pandemic on bedside teaching, and the MR sessions were evaluated using pre- and postround questionnaires, using Likert scales. Data related to clinician exposure to at-risk patients and use of personal protective equipment (PPE) were collected. Results: Prequestionnaire respondents (n=24) strongly agreed that bedside teaching is key to educating clinicians (median 7, IQR 6-7). Postsession questionnaires showed that, overall, users subjectively agreed the MR session was helpful to their learning (median 6, IQR 5.25-7) and that it was worthwhile (median 6, IQR 5.25-7). Mixed reality versus in-person teaching led to a 79.5% reduction in cumulative clinician exposure time and 83.3% reduction in PPE use. Conclusions: This study is proof of principle that HoloLens can be used effectively to deliver clinical bedside teaching. This novel format confers significant advantages in terms of minimizing exposure of trainees to COVID-19, reducing PPE use, enabling larger attendance, and delivering convenient and accessible real-time clinical training. %M 35389347 %R 10.2196/35674 %U https://formative.jmir.org/2022/5/e35674 %U https://doi.org/10.2196/35674 %U http://www.ncbi.nlm.nih.gov/pubmed/35389347 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 5 %P e34363 %T Examining the Implementation of Digital Health to Strengthen the COVID-19 Pandemic Response and Recovery and Scale up Equitable Vaccine Access in African Countries %A Olusanya,Olufunto A %A White,Brianna %A Melton,Chad A %A Shaban-Nejad,Arash %+ Department of Pediatrics, The University of Tennessee Health Science Center, 50 N Dunlap, Memphis, TN, 38103, United States, 1 9792043683, oolusan1@uthsc.edu %K COVID-19 %K SARS-CoV-2 %K Africa %K preparedness %K response %K recovery %K digital health %K artificial intelligence %K vaccine equity %D 2022 %7 17.5.2022 %9 Viewpoint %J JMIR Form Res %G English %X The COVID-19 pandemic has profoundly impacted the world, having taken the lives of over 6 million individuals. Accordingly, this pandemic has caused a shift in conversations surrounding the burden of diseases worldwide, welcoming insights from multidisciplinary fields including digital health and artificial intelligence. Africa faces a heavy disease burden that exacerbates the current COVID-19 pandemic and limits the scope of public health preparedness, response, containment, and case management. Herein, we examined the potential impact of transformative digital health technologies in mitigating the global health crisis with reference to African countries. Furthermore, we proposed recommendations for scaling up digital health technologies and artificial intelligence–based platforms to tackle the transmission of the SARS-CoV-2 and enable equitable vaccine access. Challenges related to the pandemic are numerous. Rapid response and management strategies—that is, contract tracing, case surveillance, diagnostic testing intensity, and most recently vaccine distribution mapping—can overwhelm the health care delivery system that is fragile. Although challenges are vast, digital health technologies can play an essential role in achieving sustainable resilient recovery and building back better. It is plausible that African nations are better equipped to rapidly identify, diagnose, and manage infected individuals for COVID-19, other diseases, future outbreaks, and pandemics. %M 35512271 %R 10.2196/34363 %U https://formative.jmir.org/2022/5/e34363 %U https://doi.org/10.2196/34363 %U http://www.ncbi.nlm.nih.gov/pubmed/35512271 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 5 %P e37876 %T Health-Related Quality of Life Outcomes With Regular Yoga and Heartfulness Meditation Practice: Results From a Multinational, Cross-sectional Study %A Thimmapuram,Jayaram %A Patel,Kamlesh %A Madhusudhan,Divya K %A Deshpande,Snehal %A Bouderlique,Ekta %A Nicolai,Veronique %A Rao,Raghavendra %+ Internal Medicine Department, Wellspan York Hospital, 1001 S George St, York, PA, 17405, United States, 1 7174956027, drthimmapuram@yahoo.com %K yoga %K meditation %K health-related quality of life %K Heartfulness %K COVID-19 %K healthy living %K wellness %K quality of life %K stress %K mental health %K psychological health %K online survey %K cross-sectional study %K health outcome %D 2022 %7 17.5.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Although the benefits of yoga are well established across the world, there are limited studies exploring the long-term interrelation between yoga, meditation, and health. Specifically, there is limited research exploring the differences in health-related quality of life (HRQOL) among regular meditators and nonmeditators. Objective: This study explored the differences in 7 domains of HRQOL (including quality of life, ability to adopt a healthy lifestyle, ability to relax, frequency of nervousness and stress, coping with day-to-day stress, workplace productivity, and staying healthy during the COVID-19 pandemic) among practitioners of yoga and meditation. Methods: A cross-sectional, online survey was distributed to all members who participated in a 100-day yoga and meditation program, culminating in the International Day of Yoga event, organized by the Heartfulness Institute in partnership with the Central Council for Research in Yoga and Naturopathy, Ministry of Ayush, SVYASA Yoga University, and Patanjali Yoga Institute, India. The program consisted of daily virtual yoga, meditation, and speaker sessions. The data were analyzed by nonparametric Mann-Whitney U test and Kruskal-Wallis tests for continuous variables and chi-square test for categorical variables. Results: A total of 3164 participants from 39 countries completed the survey. Mean age was 33.8 (SD 13.6) years. The majority of the participants were female (n=1643, 52%) and students (n=1312, 41.5%). Regular yoga and meditation practice was associated with a positive impact on all 7 domains of HRQOL (Mann-Whitney P<.05 and χ2P<.05). Notably, experienced Heartfulness (≥2 years) meditators reported better outcomes in all the domains of HRQOL as compared to those not currently practicing this form of meditation and participants with ≤1 year of Heartfulness meditation experience (P<.05). Conclusions: This is one of the first cross-sectional studies to explore HRQOL outcomes among participants of a 100-day virtual yoga and meditation program. Overall, a yoga and meditation practice was found to be an effective tool for promoting HRQOL. Regular yoga and meditation practice was associated with factors promoting health and well-being, with long-term meditation practice associated with increased benefits. %M 35470800 %R 10.2196/37876 %U https://formative.jmir.org/2022/5/e37876 %U https://doi.org/10.2196/37876 %U http://www.ncbi.nlm.nih.gov/pubmed/35470800 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 2 %N 1 %P e36215 %T COVID-19 and Tweets About Quitting Cigarette Smoking: Topic Model Analysis of Twitter Posts 2018-2020 %A Westmaas,J Lee %A Masters,Matthew %A Bandi,Priti %A Majmundar,Anuja %A Asare,Samuel %A Diver,W Ryan %+ Population Science Department, American Cancer Society, 3380 Chastain Meadows Pkwy NW Suite 200, Kennesaw, GA, 30144, United States, 1 404 909 4338, lee.westmaas@cancer.org %K COVID-19 %K machine learning %K pandemic %K quit smoking %K topic model analysis %K Twitter %K social media %K smoking cessation %K latent Dirichlet allocation %K tweet %K public health %D 2022 %7 16.5.2022 %9 Original Paper %J JMIR Infodemiology %G English %X Background: The risk of infection and severity of illness by SARS-CoV-2 infection is elevated for people who smoke cigarettes and may motivate quitting. Organic public conversations on Twitter about quitting smoking could provide insight into quitting motivations or behaviors associated with the pandemic. Objective: This study explored key topics of conversation about quitting cigarette smoking and examined their trajectory during 2018-2020. Methods: Topic model analysis with latent Dirichlet allocation (LDA) identified themes in US tweets with the term “quit smoking.” The model was trained on posts from 2018 and was then applied to tweets posted in 2019 and 2020. Analysis of variance and follow-up pairwise tests were used to compare the daily frequency of tweets within and across years by quarter. Results: The mean numbers of daily tweets on quitting smoking in 2018, 2019, and 2020 were 133 (SD 36.2), 145 (SD 69.4), and 127 (SD 32.6), respectively. Six topics were extracted: (1) need to quit, (2) personal experiences, (3) electronic cigarettes (e-cigarettes), (4) advice/success, (5) quitting as a component of general health behavior change, and (6) clinics/services. Overall, the pandemic was not associated with changes in posts about quitting; instead, New Year’s resolutions and the 2019 e-cigarette or vaping use–associated lung injury (EVALI) epidemic were more plausible explanations for observed changes within and across years. Fewer second-quarter posts in 2020 for the topic e-cigarettes may reflect lower pandemic-related quitting interest, whereas fourth-quarter increases in 2020 for other topics pointed to a late-year upswing. Conclusions: Twitter posts suggest that the pandemic did not generate greater interest in quitting smoking, but possibly a decrease in motivation when the rate of infections was increasing in the second quarter of 2020. Public health authorities may wish to craft messages for specific Twitter audiences (eg, using hashtags) to motivate quitting during pandemics. %M 35611092 %R 10.2196/36215 %U https://infodemiology.jmir.org/2022/1/e36215 %U https://doi.org/10.2196/36215 %U http://www.ncbi.nlm.nih.gov/pubmed/35611092 %0 Journal Article %@ 2562-7600 %I JMIR Publications %V 5 %N 1 %P e38063 %T Understanding Whole-Person Health and Resilience During the COVID-19 Pandemic and Beyond: A Cross-sectional and Descriptive Correlation Study %A Rajamani,Sripriya %A Austin,Robin %A Geiger-Simpson,Elena %A Jantraporn,Ratchada %A Park,Suhyun %A Monsen,Karen A %+ University of Minnesota, 5-140 Weaver-Densford Hall; 308 Harvard St SE, Minneapolis, MN, 55455, United States, 1 6512787426, sripriya@umn.edu %K Omaha System %K whole-person health %K strengths %K resilience %K assessment %K app %K health information technology %K health informatics %K nursing %K health care %K mobile health %K health application %K mHealth %K health data %K health community %K digital health %D 2022 %7 16.5.2022 %9 Original Paper %J JMIR Nursing %G English %X Background: The COVID-19 pandemic has prompted an interest in whole-person health and emotional well-being. Informatics solutions through user-friendly tools such as mobile health apps offer immense value. Prior research developed a consumer-facing app MyStrengths + MyHealth using Simplified Omaha System Terms (SOST) to assess whole-person health. The MyStrengths + MyHealth app assesses strengths, challenges, and needs (SCN) for 42 concepts across four domains (My Living, My Mind and Networks, My Body, My Self-care; eg, Income, Emotions, Pain, and Nutrition, respectively). Given that emotional well-being was a predominant concern during the COVID-19 pandemic, we sought to understand whole-person health for participants with/without Emotions challenges. Objective: This study aims to use visualization techniques and data from attendees at a Midwest state fair to examine SCN overall and by groups with/without Emotions challenges, and to explore the resilience of participants. Methods: This cross-sectional and descriptive correlational study surveyed adult attendees at a 2021 Midwest state fair. Data were visualized using Excel and analyzed using descriptive and inferential statistics using SPSS. Results: The study participants (N=182) were primarily female (n=123, 67.6%), aged ≥45 years (n=112, 61.5%), White (n=154, 84.6%), and non-Hispanic (n=177, 97.3%). Compared to those without Emotions challenges, those with Emotions challenges were aged 18-44 (P<.001) years, more often female (P=.02), and not married (P=.01). Overall, participants had more strengths (mean 28.6, SD 10.5) than challenges (mean 12, SD 7.5) and needs (mean 4.2, SD 7.5). The most frequent needs were in Emotions, Nutrition, Income, Sleeping, and Exercising. Compared to those without Emotions challenges, those with Emotions challenges had fewer strengths (P<.001), more challenges (P<.001), and more needs (P<.001), along with fewer strengths for Emotions (P<.001) and for the cluster of health-related behaviors domain concepts, Sleeping (P=.002), Nutrition (P<.001), and Exercising (P<.001). Resilience was operationalized as correlations among strengths for SOST concepts and visualized for participants with/without an Emotions challenge. Those without Emotions challenges had more positive strengths correlations across multiple concepts/domains. Conclusions: This survey study explored a large community-generated data set to understand whole-person health and showed between-group differences in SCN and resilience for participants with/without Emotions challenges. It contributes to the literature regarding an app-aided and data-driven approach to whole-person health and resilience. This research demonstrates the power of health informatics and provides researchers with a data-driven methodology for additional studies to build evidence on whole-person health and resilience. %M 35576563 %R 10.2196/38063 %U https://nursing.jmir.org/2022/1/e38063 %U https://doi.org/10.2196/38063 %U http://www.ncbi.nlm.nih.gov/pubmed/35576563 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 5 %P e32819 %T Accelerating Virtual Health Implementation Following the COVID-19 Pandemic: Questionnaire Study %A Stahl,Melissa %A Cheung,James %A Post,Kevin %A Valin,James P %A Jacobs,Ira %+ Pfizer Inc, 235 East 42nd Street, New York, NY, 10017-5755, United States, 1 212 733 0876, Ira.Jacobs@pfizer.com %K virtual health %K eHealth %K mHealth %K telemedicine %K telehealth %K COVID-19 %K health system %K care delivery %K strategy %K business model %D 2022 %7 16.5.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic accelerated drivers for virtual health adoption and triggered the US federal government to implement regulatory changes to reduce barriers to virtual health implementation. Consequently, virtual health solutions have been increasingly adopted, and health systems in the United States have been reorganizing their care delivery process with unprecedented speed. Objective: This study aimed to assess and make recommendations on the strategy, business model, implementation, and future considerations for scaling and sustaining virtual health solutions based on the views of executives from the largest health systems in the United States. Methods: In September 2020 and October 2020, the Health Management Academy conducted 29 quantitative surveys and 23 qualitative interviews involving 58 executives from 41 of the largest health systems in the United States. Participating health systems were approximately equally distributed across size categories (small, medium, and large, defined as annual total operating revenue US $2-3 billion, $3-6 billion, and >$6 billion, respectively) and US Census Bureau regions (Northeast, Midwest, South, and West). Results: Based on the Health Management Academy’s assessment of approaches to governance, financing, data infrastructure, and clinical integration of virtual health, most participating health systems (13/24, 54%) had a mid-stage level of maturity in virtual health implementation. Executives reported the pandemic is forcing health systems to re-examine strategic priorities; the most commonly raised key impacts were increased access (15/21, 71%) and flexibility (10/21, 48%) as well as lower costs of care delivery (9/21, 43%). Most executives (16/28, 57%) reported their organization had a defined budget for virtual health, and many noted that virtual health is best supported through value-based payment models. Irrespective of health system maturity, reimbursement was consistently rated as a key challenge to virtual health scaling, along with patient access to and understanding of virtual health technology. The success of virtual health implementation was most commonly measured by patient satisfaction, health care provider engagement, and proportion of health care providers using virtual health solutions (reported by 7/8, 88%; 6/8, 75%; and 7/8, 75% of information technology executives, respectively). Almost all health systems (27/29, 93%) expect to continue growing their virtual health offerings for the foreseeable future, with user-friendliness and ease of integration into the electronic medical record as key factors in making go-forward decisions on virtual health solutions (each selected by 9/10, 90% executives). Conclusions: The increased demand for virtual health solutions during the COVID-19 pandemic is expected to continue postpandemic. Consequently, health systems are re-evaluating their current platforms, processes, and strategy to develop a sustainable, long-term approach to virtual health. To ensure future success, health system leaders need to proactively build on their virtual health solutions; advocate for payment, site flexibility, and reimbursement parity for virtual health; and demonstrate continued engagement and boldness to evolve care beyond established models. %M 35323115 %R 10.2196/32819 %U https://formative.jmir.org/2022/5/e32819 %U https://doi.org/10.2196/32819 %U http://www.ncbi.nlm.nih.gov/pubmed/35323115 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 5 %P e34284 %T The Korean 3T Practice: New Biosurveillance Model Utilizing New Information Technology and Digital Tools %A Kim,HyunJung %+ Barun Information Communications Technology Research Center, Yonsei University, #720 Samsung-Haksulkwan,, 50 Yonsei-ro, Seodaemun-gu,, Seoul, 03722, Republic of Korea, 82 2 2123 6694, hkim76@gmu.edu %K biodefense %K biosurveillance %K public health %K health security %K COVID-19 %K defense %K surveillance %K security %K South Korea %K information technology %K digital health %K pandemic %K testing %K tracing %K treating %K strategy %K privacy %D 2022 %7 16.5.2022 %9 Viewpoint %J JMIR Form Res %G English %X In South Korea, COVID-19 pandemic responses, namely the 3T (testing, tracing, and treating) strategy, emerged as a new biosurveillance regime actively using new information technology (IT) and digital tools. The foundation of the Korean 3T system is epidemiological investigation efforts and clinical practices exploiting the use of new digital and IT tools. Due to these unique features, the Korean 3T system can be referred to as a “contact-based biosurveillance system,” which is an advanced version of the traditional biosurveillance models (indicator-based or event-based models). This article illustrates how the contact-based biosurveillance system originated from the experience with the 2015 Middle East Respiratory Syndrome (MERS) outbreak. The post-MERS Korean biosurveillance regime actively adopted the utility of new digital and IT tools to strengthen not only the ex-ante epidemic intelligence capabilities (by traditional models) but also the ex-post response and recovery capabilities (digital contact tracing and digital health intervention). However, critics claim that the Korean 3T system may violate individuals’ privacy and human rights by addressing the fact that the Korean biosurveillance system would strengthen social surveillance and population control by the government as a “digital big brother” in the cyber age. Nevertheless, 3T biosurveillance promises a positive future direction for digital health practice in the current biosurveillance regimes. %M 35442902 %R 10.2196/34284 %U https://formative.jmir.org/2022/5/e34284 %U https://doi.org/10.2196/34284 %U http://www.ncbi.nlm.nih.gov/pubmed/35442902 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 5 %P e35115 %T Monitoring User Opinions and Side Effects on COVID-19 Vaccines in the Twittersphere: Infodemiology Study of Tweets %A Portelli,Beatrice %A Scaboro,Simone %A Tonino,Roberto %A Chersoni,Emmanuele %A Santus,Enrico %A Serra,Giuseppe %+ Department of Mathematics, Computer Science and Physics, University of Udine, 206 via delle Scienze, Udine, 33100, Italy, 39 0432558400, portelli.beatrice@spes.uniud.it %K adverse drug events %K COVID-19 %K digital pharmacovigilance %K opinion mining %K vaccines %K social media %K machine learning %K deep learning %K learning models %K sentiment analysis %K Twitter analysis %K Twitter %K web portal %K public health %D 2022 %7 13.5.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: In the current phase of the COVID-19 pandemic, we are witnessing the most massive vaccine rollout in human history. Like any other drug, vaccines may cause unexpected side effects, which need to be investigated in a timely manner to minimize harm in the population. If not properly dealt with, side effects may also impact public trust in the vaccination campaigns carried out by national governments. Objective: Monitoring social media for the early identification of side effects, and understanding the public opinion on the vaccines are of paramount importance to ensure a successful and harmless rollout. The objective of this study was to create a web portal to monitor the opinion of social media users on COVID-19 vaccines, which can offer a tool for journalists, scientists, and users alike to visualize how the general public is reacting to the vaccination campaign. Methods: We developed a tool to analyze the public opinion on COVID-19 vaccines from Twitter, exploiting, among other techniques, a state-of-the-art system for the identification of adverse drug events on social media; natural language processing models for sentiment analysis; statistical tools; and open-source databases to visualize the trending hashtags, news articles, and their factuality. All modules of the system are displayed through an open web portal. Results: A set of 650,000 tweets was collected and analyzed in an ongoing process that was initiated in December 2020. The results of the analysis are made public on a web portal (updated daily), together with the processing tools and data. The data provide insights on public opinion about the vaccines and its change over time. For example, users show a high tendency to only share news from reliable sources when discussing COVID-19 vaccines (98% of the shared URLs). The general sentiment of Twitter users toward the vaccines is negative/neutral; however, the system is able to record fluctuations in the attitude toward specific vaccines in correspondence with specific events (eg, news about new outbreaks). The data also show how news coverage had a high impact on the set of discussed topics. To further investigate this point, we performed a more in-depth analysis of the data regarding the AstraZeneca vaccine. We observed how media coverage of blood clot–related side effects suddenly shifted the topic of public discussions regarding both the AstraZeneca and other vaccines. This became particularly evident when visualizing the most frequently discussed symptoms for the vaccines and comparing them month by month. Conclusions: We present a tool connected with a web portal to monitor and display some key aspects of the public’s reaction to COVID-19 vaccines. The system also provides an overview of the opinions of the Twittersphere through graphic representations, offering a tool for the extraction of suspected adverse events from tweets with a deep learning model. %M 35446781 %R 10.2196/35115 %U https://www.jmir.org/2022/5/e35115 %U https://doi.org/10.2196/35115 %U http://www.ncbi.nlm.nih.gov/pubmed/35446781 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 5 %P e33235 %T Changes in Parental Attitudes Toward COVID-19 Vaccination and Routine Childhood Vaccination During the COVID-19 Pandemic: Repeated Cross-sectional Survey Study %A Wang,Qiang %A Xiu,Shixin %A Yang,Liuqing %A Han,Ying %A Cui,Tingting %A Shi,Naiyang %A Liu,Minqi %A Yi,Youqin %A Liu,Chang %A Wang,Xuwen %A Yang,Guoping %A Ji,Lili %A Zhou,Weijie %A Jin,Hui %A Zhen,Shiqi %A Lin,Leesa %+ Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, 87# Dingjiaqiao, Nanjing, 210009, China, 86 02583272572, jinhui_hld@163.com %K childhood vaccination %K COVID-19 vaccine %K vaccine hesitancy %K repeated cross-section survey %D 2022 %7 13.5.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: It was reported that one in four parents were hesitant about vaccinating their children in China. Previous studies have revealed a declining trend in the vaccine willingness rate in China. There is a need to monitor the level of parental vaccine hesitancy toward routine childhood vaccination and hesitancy toward the COVID-19 vaccine during the ongoing COVID-19 pandemic. Objective: This study aims to assess changes in trends of parental attitudes toward routine childhood vaccines and COVID-19 vaccinations across different time periods in China. Methods: Three waves of cross-sectional surveys were conducted on parents residing in Wuxi City in Jiangsu Province, China from September to October 2020, February to March 2021, and May to June 2021. Participants were recruited from immunization clinics. Chi-square tests were used to compare the results of the three surveys, controlling for sociodemographic factors. Binary and multivariable logistic regression analysis was used to examine factors related to parental vaccine hesitancy and COVID-19 vaccine willingness. Results: Overall, 2881, 1038, and 1183 participants were included in the survey’s three waves. Using the Vaccine Hesitancy Scale, 7.8% (225/2881), 15.1% (157/1038), and 5.5% (65/1183) of parents showed hesitancy to childhood vaccination (P<.001), and 59.3% (1709/2881), 64.6% (671/1038), and 92% (1088/1183) of parents agreed to receive a COVID-19 vaccine themselves in the first, second, and third surveys, respectively (P<.001). In all three surveys, “concerns about vaccine safety and side effects” was the most common reason for refusal. Conclusions: There has been an increasing acceptance of COVID-19 vaccination in Wuxi City, China. Effective interventions are needed to mitigate public concerns about vaccine safety. %M 35486516 %R 10.2196/33235 %U https://publichealth.jmir.org/2022/5/e33235 %U https://doi.org/10.2196/33235 %U http://www.ncbi.nlm.nih.gov/pubmed/35486516 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 10 %N 5 %P e37215 %T Construction of a Linked Data Set of COVID-19 Knowledge Graphs: Development and Applications %A Wang,Haofen %A Du,Huifang %A Qi,Guilin %A Chen,Huajun %A Hu,Wei %A Chen,Zhuo %+ College of Design and Innovation, Tongji University, No. 281 Fuxin Road, Yangpu District, Shanghai, 200092, China, 86 13918586855, carter.whfcarter@gmail.com %K knowledge graph %K linked data %K COVID-19 %K knowledge extraction %K knowledge fusion %K natural language processing %K artificial intelligence %K data set %K schema modeling %K semantic search %D 2022 %7 13.5.2022 %9 Original Paper %J JMIR Med Inform %G English %X Background: With the continuous spread of COVID-19, information about the worldwide pandemic is exploding. Therefore, it is necessary and significant to organize such a large amount of information. As the key branch of artificial intelligence, a knowledge graph (KG) is helpful to structure, reason, and understand data. Objective: To improve the utilization value of the information and effectively aid researchers to combat COVID-19, we have constructed and successively released a unified linked data set named OpenKG-COVID19, which is one of the largest existing KGs related to COVID-19. OpenKG-COVID19 includes 10 interlinked COVID-19 subgraphs covering the topics of encyclopedia, concept, medical, research, event, health, epidemiology, goods, prevention, and character. Methods: In this paper, we introduce the key techniques exploited in building COVID-19 KGs in a top-down manner. First, the schema of the modeling process for each KG in OpenKG-COVID19 is described. Second, we propose different methods for extracting knowledge from open government sites, professional texts, public domain–specific sources, and public encyclopedia sites. The curated 10 COVID-19 KGs are further linked together at both the schema and data levels. In addition, we present the naming convention for OpenKG-COVID19. Results: OpenKG-COVID19 has more than 2572 concepts, 329,600 entities, 513 properties, and 2,687,329 facts, and the data set will be updated continuously. Each COVID-19 KG was evaluated, and the average precision was found to be above 93%. We have developed search and browse interfaces and a SPARQL endpoint to improve user access. Possible intelligent applications based on OpenKG-COVID19 for further development are also described. Conclusions: A KG is useful for intelligent question-answering, semantic searches, recommendation systems, visualization analysis, and decision-making support. Research related to COVID-19, biomedicine, and many other communities can benefit from OpenKG-COVID19. Furthermore, the 10 KGs will be continuously updated to ensure that the public will have access to sufficient and up-to-date knowledge. %M 35476822 %R 10.2196/37215 %U https://medinform.jmir.org/2022/5/e37215 %U https://doi.org/10.2196/37215 %U http://www.ncbi.nlm.nih.gov/pubmed/35476822 %0 Journal Article %@ 2563-6316 %I JMIR Publications %V 3 %N 2 %P e32859 %T Cognitive Factors Associated With Public Acceptance of COVID-19 Nonpharmaceutical Prevention Measures: Cross-sectional Study %A Constant,Aymery %A Conserve,Donaldson %A Gallopel-Morvan,Karine %A Raude,Jocelyn %+ Ecole des Hautes Etudes en Santé Publique, 15 Avenue du Prof Leon Bernard, Rennes, 35043, France, 33 2 99 02 25 93, Aymery.constant@ehesp.Fr %K Extended Parallel Process Model %K COVID-19 %K lockdown %K public acceptance %K nonpharmaceutical measures %K Likert scale %K France %D 2022 %7 13.5.2022 %9 Original Paper %J JMIRx Med %G English %X Background: During the COVID-19 crisis, protests against restrictions emerged and rule violations increased, provoking peaks in new positive cases, forcing authorities in France to impose fines to slow down the spread of the disease. Due to these challenges, subsequent implementations of preventive measures in response to COVID-19 recurrences or other pandemics could present difficulties for decision makers. A better understanding of the factors underlying the public acceptance of COVID-19 nonpharmaceutical preventive measures may therefore contribute greatly to the design of more effective public communication during future pandemics. Objective: The aim of this study was to evaluate the acceptance of COVID-19 nonpharmaceutical prevention measures in France. The specific objectives were (1) to examine the public’s acceptance of COVID-19 nonpharmaceutical prevention measures and (2) to assess the association of the public’s acceptance of these prevention measures and their perception of COVID-19. Methods: Data were collected from 2004 individuals through an online survey conducted 6-8 weeks after the first lockdown in France. For objective 1, participants were asked the extent to which they supported 8 COVID-19 nonpharmaceutical preventive measures using a 4-point Likert scale. For objective 2, COVID-19–related perceptions were assessed using a 5-point Likert scale from an adapted version of Witte’s Extended Parallel Process Model. Sociodemographic and environmental variables were also collected. The public’s acceptance factors were estimated using an unweighted least squares factorial analysis, and their associations with perceptions of COVID-19, expressed as rate ratios (RR) and 95% CIs, were estimated using generalized linear Poisson regression models. Statistical analyses were performed using the SPSS statistical package. Results: The acceptance rate reached 86.1% for individual protective measures, such as making masks mandatory in public open spaces, and 70.0% for collective restrictions, such as isolating the most vulnerable people (1604/2004, 80%) or forbidding public gatherings (n=1590, 79.3%). The least popular restrictions were closing all schools/universities and nonessential commerce such as bars and restaurants (n=1146, 57.2%). Acceptance of collective restrictions was positively associated with their perceived efficacy (RR 1.02, 95% CI 1.01-1.03), fear of COVID-19 (RR 1.04, 95% CI 1.03-1.05), and perceived severity of COVID-19 (RR 1.04, 95% CI 1.03-1.06), and negatively with age >60 years (RR 0.89, 95% CI 0.81-0.98). Acceptance of individual protective measures was associated with their perceived efficacy (RR 1.03, 95% CI 1.03-1.04), fear of COVID-19 (RR 1.02, 1.01-1.03), and perceived severity of COVID-19 (RR 1.03, 1.01-1.05). Conclusions: Acceptance rates of COVID-19 nonpharmaceutical measures were rather high, but varied according to their perceived social cost, and were more related to collective than personal protection. Nonpharmaceutical measures that minimize social costs while controlling the spread of the disease are more likely to be accepted during pandemics. %M 35648730 %R 10.2196/32859 %U https://med.jmirx.org/2022/2/e32859 %U https://doi.org/10.2196/32859 %U http://www.ncbi.nlm.nih.gov/pubmed/35648730 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 5 %P e37012 %T Patient Telemedicine Perceptions During the COVID-19 Pandemic Within a Multi-State Medical Institution: Qualitative Study %A Sharma,Pravesh %A Sinicrope,Anthony R %A Sinicrope,Pamela %A Brockman,Tabetha A %A Reinicke,Nicole M %A West,Ian W %A Wiepert,Liana M %A Glasgow,Amy E %A Sangaralingham,Lindsey R %A Holland,Ashley L %A Patten,Christi A %+ Behavioral Health Research Program, Pyschology, Mayo Clinic, 221 Whipple St, Eau Claire, WI, 54703, United States, 1 5072842511, sharma.pravesh@mayo.edu %K COVID-19 %K telehealth %K video appointment %K telemedicine %K qualitative %K pandemic %K outpatient %K clinical care %K virtual health %K patient perspective %K healthcare %K clinical practice %D 2022 %7 13.5.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: During the COVID-19 pandemic, to prevent the spread of the virus, federal regulatory barriers around telemedicine were lifted, and health care institutions encouraged patients to use telemedicine, including video appointments. Many patients, however, still chose face-2-face (f2f) appointments for nonemergent clinical care. Objective: We explored patients’ personal and environmental barriers to the use of video appointments from April 2020 to December 2020. Methods: We conducted qualitative telephone interviews of Mayo Clinic patients who attended f2f appointments at the Mayo Clinic from April 2020 to December 2020 but did not utilize Mayo Clinic video appointment services during that time frame. Results: We found that, although most patients were concerned about preventing COVID-19 transmission, they trusted Mayo Clinic to keep them safe when attending f2f appointments. Many expressed that a video appointment made it difficult to establish rapport with their providers. Other common barriers to video appointments were perceived therapeutic benefits of f2f appointments, low digital literacy, and concerns about privacy and security. Conclusions: Our study provides an in-depth investigation into barriers to engaging in video appointments for nonemergent clinical care in the context of the COVID-19 pandemic. Our findings corroborate many barriers prevalent in the prepandemic literature and suggest that rapport barriers need to be analyzed and problem-solved at a granular level. %M 35452401 %R 10.2196/37012 %U https://formative.jmir.org/2022/5/e37012 %U https://doi.org/10.2196/37012 %U http://www.ncbi.nlm.nih.gov/pubmed/35452401 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 5 %P e34480 %T Implementing Infection Control and Quality of Life Best Practices in Nursing Homes With Project ECHO: Protocol for a Patient-Centered Randomized Controlled Trial %A Calo,William A %A Francis,Erica %A Kong,Lan %A Hogentogler,Ruth %A Heilbrunn,Emily %A Fisher,Abbey %A Hood,Nancy %A Kraschnewski,Jennifer %+ Department of Medicine, College of Medicine, Penn State University, 90 Hope Dr, Hershey, PA, 17033, United States, 1 202 329 1973, efrancis@pennstatehealth.psu.edu %K infection control %K COVID-19 %K nursing home %K telementoring %K Project ECHO %K case-based learning %K patient-centered outcome %K RE-AIM %K randomized controlled trial %K implementation %K quality of life %K best practice %K guideline %K comparison %K effectiveness %K intervention %D 2022 %7 13.5.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Nursing homes in the United States were devastated by COVID-19, with 710,000 cases and 138,000 deaths nationally through October 2021. Although facilities are required to have infection control staff, only 3% of designated infection preventionists have taken a basic infection control course prior to the COVID-19 pandemic. Most research has focused on infection control in the acute care setting. However, little is known about the implementation of infection control practices and effective interventions in nursing homes. This study utilizes Project ECHO (Extension for Community Health Outcomes), an evidence-based telementoring model, to connect Penn State University subject matter experts with nursing home staff and administrators to proactively support evidence-based infection control guideline implementation. Objective: Our study seeks to answer the research question of how evidence-based infection control guidelines can be implemented effectively in nursing homes, including comparing the effectiveness of two ECHO-delivered training interventions on key patient-centered outcomes such as reducing the number of residents with a COVID-19 diagnosis. Methods: A stratified cluster randomized design was utilized. Using a 1:1 ratio, we randomly assigned 136 nursing homes to ECHO or ECHO Plus arms. Randomization was stratified by geographic location, baseline COVID-19 infection rate, and facility capacity. The study had two phases. In phase one, completed in July 2021, nursing homes in both study arms received a 16-week infectious disease and quality improvement training intervention via real-time, interactive videoconferencing and the ECHO learning model. Phase one sessions were up to 90 minutes in duration. In phase two, completed in November 2021, the ECHO group was offered optional 60-minute office hours for 9 weeks and the ECHO Plus group received 9 weeks of 60-minute sessions on emerging topics and an additional 8-session refresher series on infection control. Results: A total of 290 nursing home facilities were assessed for eligibility, with 136 nursing homes recruited and randomly assigned to ECHO or ECHO Plus. Guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework, we will simultaneously evaluate the study’s effectiveness and implementation outcomes at baseline (intervention start date), and at 4, 6, 12, and 18 months. The primary outcome is the COVID-19 infection rate in nursing homes. Secondary outcomes include COVID-19 hospitalizations and deaths, flu-like illness, and quality of life. Surveys and interviews with participants will also provide data as to the adoption, implementation, and maintenance of best practices taught throughout ECHO sessions. Conclusions: A multipronged approach to improving infection control and emergency preparedness in nursing homes is important, given the toll that the COVID-19 pandemic has taken on residents and staff. The ECHO model has significant strengths when compared to traditional training, as it allows for remote learning delivered by a multidisciplinary team of experts, and utilizes case discussions that match the context and capacity of nursing homes. Trial Registration: ClinicalTrials.gov NCT04499391; https://clinicaltrials.gov/ct2/show/NCT04499391 %M 35476823 %R 10.2196/34480 %U https://www.researchprotocols.org/2022/5/e34480 %U https://doi.org/10.2196/34480 %U http://www.ncbi.nlm.nih.gov/pubmed/35476823 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 10 %N 5 %P e38308 %T Exploring Sentiment and Care Management of Hospitalized Patients During the First Wave of the COVID-19 Pandemic Using Electronic Nursing Health Records: Descriptive Study %A Cuenca-Zaldívar,Juan Nicolás %A Torrente-Regidor,Maria %A Martín-Losada,Laura %A Fernández-De-Las-Peñas,César %A Florencio,Lidiane Lima %A Sousa,Pedro Alexandre %A Palacios-Ceña,Domingo %+ Research Group in Nursing and Health Care, Puerta de Hierro Health Research Institute - Segovia de Arana, C Joaquín Rodrigo, 1, Majadahonda, 28222, Spain, 34 639962935, jcuenzal@yahoo.es %K electronic health records %K COVID-19 %K pandemic %K content text analysis %D 2022 %7 12.5.2022 %9 Original Paper %J JMIR Med Inform %G English %X Background: The COVID-19 pandemic has changed the usual working of many hospitalization units (or wards). Few studies have used electronic nursing clinical notes (ENCN) and their unstructured text to identify alterations in patients' feelings and therapeutic procedures of interest. Objective: This study aimed to analyze positive or negative sentiments through inspection of the free text of the ENCN, compare sentiments of ENCN with or without hospitalized patients with COVID-19, carry out temporal analysis of the sentiments of the patients during the start of the first wave of the COVID-19 pandemic, and identify the topics in ENCN. Methods: This is a descriptive study with analysis of the text content of ENCN. All ENCNs between January and June 2020 at Guadarrama Hospital (Madrid, Spain) extracted from the CGM Selene Electronic Health Records System were included. Two groups of ENCNs were analyzed: one from hospitalized patients in post–intensive care units for COVID-19 and a second group from hospitalized patients without COVID-19. A sentiment analysis was performed on the lemmatized text, using the National Research Council of Canada, Affin, and Bing dictionaries. A polarity analysis of the sentences was performed using the Bing dictionary, SO Dictionaries V1.11, and Spa dictionary as amplifiers and decrementators. Machine learning techniques were applied to evaluate the presence of significant differences in the ENCN in groups of patients with and those without COVID-19. Finally, a structural analysis of thematic models was performed to study the abstract topics that occur in the ENCN, using Latent Dirichlet Allocation topic modeling. Results: A total of 37,564 electronic health records were analyzed. Sentiment analysis in ENCN showed that patients with subacute COVID-19 have a higher proportion of positive sentiments than those without COVID-19. Also, there are significant differences in polarity between both groups (Z=5.532, P<.001) with a polarity of 0.108 (SD 0.299) in patients with COVID-19 versus that of 0.09 (SD 0.301) in those without COVID-19. Machine learning modeling reported that despite all models presenting high values, it is the neural network that presents the best indicators (>0.8) and with significant P values between both groups. Through Structural Topic Modeling analysis, the final model containing 10 topics was selected. High correlations were noted among topics 2, 5, and 8 (pressure ulcer and pharmacotherapy treatment), topics 1, 4, 7, and 9 (incidences related to fever and well-being state, and baseline oxygen saturation) and topics 3 and 10 (blood glucose level and pain). Conclusions: The ENCN may help in the development and implementation of more effective programs, which allows patients with COVID-19 to adopt to their prepandemic lifestyle faster. Topic modeling could help identify specific clinical problems in patients and better target the care they receive. %M 354869 %R 10.2196/38308 %U https://medinform.jmir.org/2022/5/e38308 %U https://doi.org/10.2196/38308 %U http://www.ncbi.nlm.nih.gov/pubmed/354869 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 5 %P e29343 %T Factors Associated With COVID-19 Death in the United States: Cohort Study %A Chen,Uan-I %A Xu,Hua %A Krause,Trudy Millard %A Greenberg,Raymond %A Dong,Xiao %A Jiang,Xiaoqian %+ School of Biomedical Informatics, The University of Texas Health Science Center at Houston, 7000 Fannin St., Houston, TX, 77030, United States, 1 713 500 3930, xiaoqian.jiang@uth.tmc.edu %K COVID-19 %K risk factors %K survival analysis %K cohort studies %K EHR data %D 2022 %7 12.5.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Since the initial COVID-19 cases were identified in the United States in February 2020, the United States has experienced a high incidence of the disease. Understanding the risk factors for severe outcomes identifies the most vulnerable populations and helps in decision-making. Objective: This study aims to assess the factors associated with COVID-19–related deaths from a large, national, individual-level data set. Methods: A cohort study was conducted using data from the Optum de-identified COVID-19 electronic health record (EHR) data set; 1,271,033 adult participants were observed from February 1, 2020, to August 31, 2020, until their deaths due to COVID-19, deaths due to other reasons, or the end of the study. Cox proportional hazards models were constructed to evaluate the risks for each patient characteristic. Results: A total of 1,271,033 participants (age: mean 52.6, SD 17.9 years; male: 507,574/1,271,033, 39.93%) were included in the study, and 3315 (0.26%) deaths were attributed to COVID-19. Factors associated with COVID-19–related death included older age (≥80 vs 50-59 years old: hazard ratio [HR] 13.28, 95% CI 11.46-15.39), male sex (HR 1.68, 95% CI 1.57-1.80), obesity (BMI ≥40 vs <30 kg/m2: HR 1.71, 95% CI 1.50-1.96), race (Hispanic White, African American, Asian vs non-Hispanic White: HR 2.46, 95% CI 2.01-3.02; HR 2.27, 95% CI 2.06-2.50; HR 2.06, 95% CI 1.65-2.57), region (South, Northeast, Midwest vs West: HR 1.62, 95% CI 1.33-1.98; HR 2.50, 95% CI 2.06-3.03; HR 1.35, 95% CI 1.11-1.64), chronic respiratory disease (HR 1.21, 95% CI 1.12-1.32), cardiac disease (HR 1.10, 95% CI 1.01-1.19), diabetes (HR 1.92, 95% CI 1.75-2.10), recent diagnosis of lung cancer (HR 1.70, 95% CI 1.14-2.55), severely reduced kidney function (HR 1.92, 95% CI 1.69-2.19), stroke or dementia (HR 1.25, 95% CI 1.15-1.36), other neurological diseases (HR 1.77, 95% CI 1.59-1.98), organ transplant (HR 1.35, 95% CI 1.09-1.67), and other immunosuppressive conditions (HR 1.21, 95% CI 1.01-1.46). Conclusions: This is one of the largest national cohort studies in the United States; we identified several patient characteristics associated with COVID-19–related deaths, and the results can serve as the basis for policy making. The study also offered directions for future studies, including the effect of other socioeconomic factors on the increased risk for minority groups. %M 35377319 %R 10.2196/29343 %U https://publichealth.jmir.org/2022/5/e29343 %U https://doi.org/10.2196/29343 %U http://www.ncbi.nlm.nih.gov/pubmed/35377319 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 5 %P e36820 %T Video Game to Attenuate Pandemic-Related Stress From an Equity Lens: Development and Usability Study %A Minian,Nadia %A Saiva,Anika %A Gayapersad,Allison %A Dragonetti,Rosa %A Proulx,Catherine %A Debergue,Patricia %A Lecce,Julia %A Hussain,Sarwar %A Desjardins,Eric %A Selby,Peter %+ Nicotine Dependence Service, Centre for Addiction and Mental Health, 1025 Queen St W, Toronto, ON, M6H 1H4, Canada, 1 416 535 8501, peter_selby@camh.net %K video games %K cognitive behavioral therapy %K usability study %K self-care %K digital health %K technological infrastructure %K video game development %K user engagement %K user perception %K COVID-19 %K Mental health %K mental health care system %K depression %K anxiety %K digital therapy %D 2022 %7 12.5.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The emergence of the novel coronavirus (COVID-19) has introduced additional pressures on an already fragile mental health care system due to a significant rise in depression, anxiety, and stress among Canadians. Although cognitive behavioral therapy (CBT) is known to be an efficacious treatment to reduce such mental health issues, few people have access to CBT in an engaging and sustainable manner. To address this gap, a collaboration between the Centre for Addiction and Mental Health (CAMH) and the National Research Council of Canada (NRC) developed CBT-based self-led, online, clinician-tested modules in the form of a video game, named Legend of Evelys, and evaluated its usability in the attenuation of a COVID-19–related increase in stress. Objective: We here present the conceptualization and design of new self-care modules in the form of a video game, its implementation in a technological infrastructure, and inclusivity and privacy considerations that informed the development. A usability study of the modules was performed to assess the video game’s usability, user engagement, and user perceptions. Methods: The development of the video game involved establishment of a technology infrastructure for secure implementation of the software for the modules and a clinician-led assessment of the clinical utility of these modules through two “whiteboard” sessions. The usability study was informed by a mixed methods sequential explanatory design to evaluate the intervention of the mobile app through two distinct phases: quantitative data collection using in-app analytics data and two surveys, followed by qualitative data collection by semistructured interviews. Results: A total of 32 participants trialed the app for 2 weeks. They used the video game an average of six times and rated the game as “good” based on the Systems Usability Scale score. In terms of stress reduction, the study demonstrated a significant difference in the participants’ Perceived Stress Scale score at baseline (mean 22.14, SD 6.187) compared with that at the 2-week follow-up (mean 18.04, SD 6.083; t27=3.628, P=.001). Qualitative interviews helped participants identify numerous functionality issues and provided specific recommendations, most of which were successfully integrated into the video game for future release. Conclusions: Through this collaboration, we have established that it is possible to incorporate CBT exercises into a video game and have these exercises adopted to address stress. While video games are a promising strategy to help people with their stress and anxiety, there is a further need to examine the real-world effectiveness of the Legend of Evelys in reducing anxiety. %M 35413001 %R 10.2196/36820 %U https://formative.jmir.org/2022/5/e36820 %U https://doi.org/10.2196/36820 %U http://www.ncbi.nlm.nih.gov/pubmed/35413001 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 5 %P e36673 %T Long COVID Optimal Health Program (LC-OHP) to Enhance Psychological and Physical Health: Protocol for a Feasibility Randomized Controlled Trial %A Al-Jabr,Hiyam %A Windle,Karen %A Thompson,David R %A Jenkins,Zoe M %A Castle,David J %A Ski,Chantal F %+ Integrated Care Academy, University of Suffolk, Waterfront Building, 19 Neptune Quay, Ipswich, IP4 1QJ, United Kingdom, 44 01473 338845, h.al-jabr@uos.ac.uk %K long COVID %K COVID-19 %K optimal health program %K telemedicine %K integrated care %K telehealth %K patient care %K health intervention %K mental health %K physical health %K psychological health %K pandemic %K patient support %D 2022 %7 12.5.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Long COVID is a collection of symptoms that develop during or following a confirmed or suspected case of COVID-19, which continue for more than 12 weeks. Despite the negative impact of long COVID on people’s lives and functioning, there is no validated treatment or even rehabilitation guidance. What has been recommended thus far is the adoption of holistic management approaches. The Optimal Health Program (OHP) is a brief 5-session, plus booster, psychosocial program designed to support mental and physical well-being that has been used effectively for a range of chronic conditions. Objective: This study examines the feasibility and acceptability of employing an especially customized version of OHP (long COVID OHP [LC-OHP]) to improve psychological and physical health of people with long COVID. Methods: This is a feasibility randomized controlled trial that will be running from November 2021 to February 2023. Eligible participants aged 18 years or older who are experiencing symptoms of long COVID will be identified through their secondary practitioners with recruitment to be undertaken by the research team. A total of 60 participants will be randomized into a control (usual care) or an intervention (LC-OHP) group. Outcomes will be feasibility and acceptability of the program (primary); and efficacy of the LC-OHP in improving anxiety, depression, fatigue, self-efficacy, and quality of life (secondary). Up to 20 participants will be interviewed at the end of the trial to explore their experience with the program. Quantitative data will be analyzed using SPSS, and differences between groups will be compared using inferential tests where appropriate. Qualitative data will be transcribed and thematically analyzed to identify common emerging themes. Results: This is an ongoing study, which began in November 2021. Conclusions: Long COVID has a significant impact on an individual’s mental and physical functioning. The LC-OHP has a potential to provide people living with long COVID with additional support and to improve self-efficacy. The findings of this study would identify the feasibility of delivering this program to this population and will provide an indication for the program’s effectiveness. Trial Registration: ISRCTN Registry ISRCTN38746119; https://www.isrctn.com/ISRCTN38746119 International Registered Report Identifier (IRRID): DERR1-10.2196/36673 %M 35468586 %R 10.2196/36673 %U https://www.researchprotocols.org/2022/5/e36673 %U https://doi.org/10.2196/36673 %U http://www.ncbi.nlm.nih.gov/pubmed/35468586 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 5 %P e35764 %T A Crowdsourcing Open Contest to Design a Latino-Specific COVID-19 Campaign: Mixed Methods Analysis %A Shah,Harita S %A Dolwick Grieb,Suzanne %A Flores-Miller,Alejandra %A Phillips,Katherine H %A Page,Kathleen R %A Cervantes,Ana %A Yang,Cui %+ Department of Medicine, University of Chicago, 5841 S Maryland Ave, MC 3051, Chicago, IL, 60637, United States, 1 773 702 6840, harita@uchicago.edu %K crowdsourcing %K Latino %K open contest %K community engagement %K social marketing %K COVID-19 %K mixed method %K implementation %K thematic analysis %D 2022 %7 12.5.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Latino communities are among the most heavily impacted populations by the COVID-19 pandemic in the United States due to intersectional barriers to care. Crowdsourcing open contests can be an effective means of community engagement but have not been well studied in Latino populations nor in addressing the COVID-19 pandemic. Objective: The aims of this study are to (1) implement and evaluate a crowdsourcing open contest to solicit a name for a COVID-19 social marketing campaign for Latino populations in Maryland and (2) conduct a thematic analysis of submitted entries to guide campaign messaging. Methods: To assess the level of community engagement in this crowdsourcing open contest, we used descriptive statistics to analyze data on entries, votes, and demographic characteristics of participants. The submitted text was analyzed through inductive thematic analysis. Results: We received 74 entries within a 2-week period. The top 10 entries were chosen by community judges and the winner was decided by popular vote. We received 383 votes within 1 week. The most common themes were collective efficacy, self-efficacy, and perceived benefits of COVID-19 testing. We used these themes to directly inform our social marketing intervention and found that advertisements based on these themes became the highest performing. Conclusions: Crowdsourcing open contests are an effective means of community engagement and an agile tool for guiding interventions to address COVID-19, including in populations impacted by health care disparities, such as Latino communities. The thematic analysis of contest entries can be a valuable strategy to inform the development of social marketing campaign materials. %M 35357317 %R 10.2196/35764 %U https://formative.jmir.org/2022/5/e35764 %U https://doi.org/10.2196/35764 %U http://www.ncbi.nlm.nih.gov/pubmed/35357317 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 5 %P e31797 %T The Influence of Perceived Social Presence on the Willingness to Communicate in Mobile Medical Consultations: Experimental Study %A Chen,Lijuan %A Zhang,Danyang %A Hou,Mutian %+ Department of Journalism and Communication, School of Media and Communication, Shanghai Jiao Tong University, 800 Dongchuan Rd, Shanghai, 200240, China, 86 138 6752 9369, zdytiffany@163.com %K mobile medical consultation %K mobile medical service %K perceived social presence %K willingness to communicate about health %K COVID-19 %D 2022 %7 11.5.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: With the rise of online health care service, there is growing discussion on the relationship between physicians and patients online, yet few researchers have paid attention to patients’ perception of social presence, especially its influence on their willingness to communicate (WTC). Objective: The goal of the research is to investigate the influence of perceived social presence (PSP) on WTC in mobile medical consultations. Methods: Participants living in Yunnan province during the period of middle to high risk of COVID-19 infection were recruited via the internet. They were assigned randomly into 2 groups interacting with a virtual physician presenting high and low levels of social presence and then asked to complete a questionnaire. Based on the theoretical framework, the study puts forward a model evaluating the relationships among participants’ PSP, communication apprehension (CA), self-perceived communication competence (SPCC), and willingness to communicate about health (WTCH) in the computer-mediated communication between virtual physicians and patients. Results: In total 206 (106 in group 1 and 100 in group 2) valid samples were gathered (from 276 log-ins) and 88.8% (183/206) of them were aged 18 to 44 years, which approximately resembles the age distribution of the main population engaging in online medical consultation in China. Independent t test shows that there is significant difference between the PSP of the 2 groups (P=.04), indicating a successful manipulation of social presence. The total effect of PSP on WTCH is 0.56 (P<.001), among which 74.4% is direct effect (P<.001). Among the indirect effects between PSP and WTCH, the mediating effect of SPCC accounts for 68.8% (P<.001) and the sequential mediating effect of CA→SPCC accounts for 19.2% (P<.001), while the mediating effect of CA alone is not significant (P=.08). Conclusions: This study provides a comprehensible model, demonstrating that PSP is an important antecedent of WTCH, and the sequential mediating effect of CA and SPCC found in this study also proves that in the environment of online mobile medical services, CA cannot affect communication directly. The findings will provide some practical inspiration for the popularization of online medical service, especially for the promotion of online physician-patient communication. %M 35544293 %R 10.2196/31797 %U https://www.jmir.org/2022/5/e31797 %U https://doi.org/10.2196/31797 %U http://www.ncbi.nlm.nih.gov/pubmed/35544293 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 2 %N 1 %P e30167 %T Themes Surrounding COVID-19 and Its Infodemic: Qualitative Analysis of the COVID-19 Discussion on the Multidisciplinary Healthcare Information for All Health Forum %A Gangireddy,Rakshith %A Chakraborty,Stuti %A Pakenham-Walsh,Neil %A Nagarajan,Branavan %A Krishan,Prerna %A McGuire,Richard %A Vaghela,Gladson %A Sriharan,Abi %+ Institute of Health Policy, Management, and Evaluation, University of Toronto, 155 College St 4th Floor, Toronto, ON, M5T 3M6, Canada, 1 416 978 4326, abi.sriharan@utoronto.ca %K infodemic %K infodemiology %K COVID-19 %K pandemic %K misinformation %K health information %K theme %K public health %K qualitative study %K global health %D 2022 %7 11.5.2022 %9 Original Paper %J JMIR Infodemiology %G English %X Background: Healthcare Information for All (HIFA) is a multidisciplinary global campaign consisting of more than 20,000 members worldwide committed to improving the availability and use of health care information in low- and middle-income countries (LMICs). During the COVID-19 pandemic, online HIFA forums saw a tremendous amount of discussion regarding the lack of information about COVID-19, the spread of misinformation, and the pandemic’s impact on different communities. Objective: This study aims to analyze the themes and perspectives shared in the COVID-19 discussion on English HIFA forums. Methods: Over a period of 8 months, a qualitative thematic content analysis of the COVID-19 discussion on English HIFA forums was conducted. In total, 865 posts between January 24 and October 31, 2020, from 246 unique study participants were included and analyzed. Results: In total, 6 major themes were identified: infodemic, health system, digital health literacy, economic consequences, marginalized peoples, and mental health. The geographical distribution of study participants involved in the discussion spanned across 46 different countries in every continent except Antarctica. Study participants’ professions included public health workers, health care providers, and researchers, among others. Study participants’ affiliation included nongovernment organizations (NGOs), commercial organizations, academic institutions, the United Nations (UN), the World Health Organization (WHO), and others. Conclusions: The themes that emerged from this analysis highlight personal recounts, reflections, suggestions, and evidence around addressing COVID-19 related misinformation and might also help to understand the timeline of information evolution, focus, and needs surrounding the COVID-19 pandemic. %M 35586197 %R 10.2196/30167 %U https://infodemiology.jmir.org/2022/1/e30167 %U https://doi.org/10.2196/30167 %U http://www.ncbi.nlm.nih.gov/pubmed/35586197 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 5 %P e36238 %T Global User-Level Perception of COVID-19 Contact Tracing Applications: Data-Driven Approach Using Natural Language Processing %A Ahmad,Kashif %A Alam,Firoj %A Qadir,Junaid %A Qolomany,Basheer %A Khan,Imran %A Khan,Talhat %A Suleman,Muhammad %A Said,Naina %A Hassan,Syed Zohaib %A Gul,Asma %A Househ,Mowafa %A Al-Fuqaha,Ala %+ Information and Computing Technology Division, College of Science and Engineering, Hamad Bin Khalifa University, LAS Building, Education City, Doha, Qatar, 974 50694322, aalfuqaha@hbku.edu.qa %K COVID-19 %K sentiment analysis %K contact tracing applications %K NLP %K text classification %K BERT %K fastText %K transformers %K RoBerta %D 2022 %7 11.5.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Contact tracing has been globally adopted in the fight to control the infection rate of COVID-19. To this aim, several mobile apps have been developed. However, there are ever-growing concerns over the working mechanism and performance of these applications. The literature already provides some interesting exploratory studies on the community’s response to the applications by analyzing information from different sources, such as news and users’ reviews of the applications. However, to the best of our knowledge, there is no existing solution that automatically analyzes users’ reviews and extracts the evoked sentiments. We believe such solutions combined with a user-friendly interface can be used as a rapid surveillance tool to monitor how effective an application is and to make immediate changes without going through an intense participatory design method. Objective: In this paper, we aim to analyze the efficacy of AI and NLP techniques for automatically extracting and classifying the polarity of users’ sentiments by proposing a sentiment analysis framework to automatically analyze users’ reviews on COVID-19 contact tracing mobile apps. We also aim to provide a large-scale annotated benchmark data set to facilitate future research in the domain. As a proof of concept, we also developed a web application based on the proposed solutions, which is expected to help the community quickly analyze the potential of an application in the domain. Methods: We propose a pipeline starting from manual annotation via a crowd-sourcing study and concluding with the development and training of artificial intelligence (AI) models for automatic sentiment analysis of users’ reviews. In detail, we collected and annotated a large-scale data set of user reviews on COVID-19 contact tracing applications. We used both classical and deep learning methods for classification experiments. Results: We used 8 different methods on 3 different tasks, achieving up to an average F1 score of 94.8%, indicating the feasibility of the proposed solution. The crowd-sourcing activity resulted in a large-scale benchmark data set composed of 34,534 manually annotated reviews. Conclusions: The existing literature mostly relies on the manual or exploratory analysis of users’ reviews on applications, which is tedious and time-consuming. In existing studies, generally, data from fewer applications are analyzed. In this work, we showed that AI and natural language processing techniques provide good results for analyzing and classifying users’ sentiments’ polarity and that automatic sentiment analysis can help to analyze users’ responses more accurately and quickly. We also provided a large-scale benchmark data set. We believe the presented analysis, data set, and proposed solutions combined with a user-friendly interface can be used as a rapid surveillance tool to analyze and monitor mobile apps deployed in emergency situations leading to rapid changes in the applications without going through an intense participatory design method. %M 35389357 %R 10.2196/36238 %U https://formative.jmir.org/2022/5/e36238 %U https://doi.org/10.2196/36238 %U http://www.ncbi.nlm.nih.gov/pubmed/35389357 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 5 %N 2 %P e36858 %T Social Media and Online Digital Technology Use Among Muslim Young People and Parents: Qualitative Focus Group Study %A Douglass,Caitlin H %A Borthwick,Aidan %A Lim,Megan S C %A Erbas,Bircan %A Eren,Senem %A Higgs,Peter %+ Burnet Institute, 85 Commercial Road, Melbourne, 3004, Australia, 61 (03) 9282 2111, caitlin.douglass@burnet.edu.au %K Muslim %K social media %K young adult %K qualitative research %K social connection %K parenting %K pediatrics %K digital health %K youth %K adolescent %K parent %K digital technology %K user experience %K mental health %K psychological effect %K diverse population %K COVID-19 %D 2022 %7 10.5.2022 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Digital technology and social media use are common among young people in Australia and worldwide. Research suggests that young people have both positive and negative experiences online, but we know little about the experiences of Muslim communities. Objective: This study aims to explore the positive and negative experiences of digital technology and social media use among young people and parents from Muslim backgrounds in Melbourne, Victoria, Australia. Methods: This study involved a partnership between researchers and a not-for-profit organization that work with culturally and linguistically diverse communities. We adopted a participatory and qualitative approach and designed the research in consultation with young people from Muslim backgrounds. Data were collected through in-person and online focus groups with 33 young people aged 16-22 years and 15 parents aged 40-57 years. Data were thematically analyzed. Results: We generated 3 themes: (1) maintaining local and global connections, (2) a paradoxical space: identity, belonging and discrimination, and (3) the digital divide between young Muslims and parents. Results highlighted that social media was an important extension of social and cultural connections, particularly during COVID-19, when people were unable to connect through school or places of worship. Young participants perceived social media as a space where they could establish their identity and feel a sense of belonging. However, participants were also at risk of being exposed to discrimination and unrealistic standards of beauty and success. Although parents and young people shared some similar concerns, there was a large digital divide in online experiences. Both groups implemented strategies to reduce social media use, with young people believing that having short technology-free breaks during prayer and quality family time was beneficial for their mental well-being. Conclusions: Programs that address technology-related harms must acknowledge the benefits of social media for young Muslims across identity, belonging, representation, and social connection. Further research is required to understand how parents and young people can create environments that foster technology-free breaks to support mental well-being. %M 35536616 %R 10.2196/36858 %U https://pediatrics.jmir.org/2022/2/e36858 %U https://doi.org/10.2196/36858 %U http://www.ncbi.nlm.nih.gov/pubmed/35536616 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 10 %N 2 %P e36768 %T Modification in the Motor Skills of Seniors in Care Homes Using Serious Games and the Impact of COVID-19: Field Study %A Kleschnitzki,Jana Marina %A Grossmann,Inga %A Beyer,Reinhard %A Beyer,Luzi %+ Institute of Psychology, Faculty of Human Sciences, Humboldt-University of Berlin, Rudower Chaussee 18, Berlin, 12489, Germany, 49 15231964606, janakleschnitzki@posteo.de %K serious games %K motor skills %K motor %K long-term care %K exercise %K movement %K coronavirus effects %K eHealth %K seniors %K older adult %K elder %K senior population %K aged %K care home %K intervention effects analysis %K COVID-19 %K pandemic %K digital game %K digital health %K physical activity %D 2022 %7 10.5.2022 %9 Original Paper %J JMIR Serious Games %G English %X Background: The pandemic has highlighted the importance of low-threshold opportunities for exercise and physical activity. At the beginning of 2020, the COVID-19 pandemic led to many restrictions, which affected seniors in care facilities in the form of severe isolation. The isolation led, among other things, to a lack of exercise, which has led to a multitude of negative effects for this target group. Serious games can potentially help by being used anywhere at any time to strengthen skills with few resources. Objective: The aim of this study is to evaluate the effectiveness of a serious game to strengthen motor skills (study 1) and the influence of pandemic restrictions (study 2) on seniors in care facilities. Methods: The data on motor skills (measured by the Tinetti test) originated from an intervention study with repeated measurements that was interrupted by the pandemic conditions. Data were collected 4 times every 3 months with an intervention group (IG, training 3 times for 1 hour per week) and a control group (CG, no intervention). There were 2 substudies. The first considered the first 6 months until the pandemic restrictions, while the second considered the influence of the restrictions on motor skills. Results: The sample size was 70. The IG comprised 31 (44%) participants, with 22 (71%) female and 9 (29%) male seniors with an average age of 85 years. The CG comprised 39 (56%) participants, with 31 (79%) female and 8 (21%) male seniors with an average age of 87 years. In study 1, mixed-design ANOVA showed no significant interaction between measurement times and group membership for the first measurements (F2.136=1.414, P<.25, partial η2=.044), but there was a significant difference between the CG (mean 16.23, SD 1.1) and the IG (mean 19.81, SD 1.2) at the third time of measurement (P=.02). In study 2 the mixed-design ANOVA (used to investigate motor skills before and after the pandemic conditions between the 2 groups) couldn’t reveal any significant interaction between measurement times and group membership: F1.67=2.997, P<.09, partial η2=.043. However, there was a significant main effect of the time of measurement: F1.67=5.44, P<.02, partial η²=.075. Conclusions: During the first 6 months, the IG showed increased motor skills, whereas the motor skills of the CG slightly deteriorated and showed a statistically significant difference after 6 months. The pandemic restrictions leveled the difference and showed a significant negative effect on motor skills over 3 months. As our results show, digital games have the potential to break down access barriers and promote necessary maintenance for important skills. The pandemic has highlighted the importance of low-threshold opportunities for exercise and physical activity. This potentially great benefit for the challenges of tomorrow shows the relevance of the topic and demonstrates the urgent need for action and research. Trial Registration: Deutsches Register klinischer Studien DRKS00016633; https://tinyurl.com/yckmj4px %M 35536610 %R 10.2196/36768 %U https://games.jmir.org/2022/2/e36768 %U https://doi.org/10.2196/36768 %U http://www.ncbi.nlm.nih.gov/pubmed/35536610 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 2 %N 1 %P e32335 %T Public Opinion and Sentiment Before and at the Beginning of COVID-19 Vaccinations in Japan: Twitter Analysis %A Niu,Qian %A Liu,Junyu %A Kato,Masaya %A Shinohara,Yuki %A Matsumura,Natsuki %A Aoyama,Tomoki %A Nagai-Tanima,Momoko %+ Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, 53, Kawahara-cho, Shogoin Sakyo-ku, Kyoto, 606-8507, Japan, 81 075 751 3964, tanima.momoko.8s@kyoto-u.ac.jp %K COVID-19 %K Japan %K vaccine %K Twitter %K sentiment %K latent dirichlet allocation %K natural language processing %D 2022 %7 9.5.2022 %9 Original Paper %J JMIR Infodemiology %G English %X Background: COVID-19 vaccines are considered one of the most effective ways for containing the COVID-19 pandemic, but Japan lagged behind other countries in vaccination in the early stages. A deeper understanding of the slow progress of vaccination in Japan can be instructive for COVID-19 booster vaccination and vaccinations during future pandemics. Objective: This retrospective study aims to analyze the slow progress of early-stage vaccination in Japan by exploring opinions and sentiment toward the COVID-19 vaccine in Japanese tweets before and at the beginning of vaccination. Methods: We collected 144,101 Japanese tweets containing COVID-19 vaccine-related keywords between August 1, 2020, and June 30, 2021. We visualized the trend of the tweets and sentiments and identified the critical events that may have triggered the surges. Correlations between sentiments and the daily infection, death, and vaccination cases were calculated. The latent dirichlet allocation model was applied to identify topics of negative tweets from the beginning of vaccination. We also conducted an analysis of vaccine brands (Pfizer, Moderna, AstraZeneca) approved in Japan. Results: The daily number of tweets continued with accelerating growth after the start of large-scale vaccinations in Japan. The sentiments of around 85% of the tweets were neutral, and negative sentiment overwhelmed the positive sentiment in the other tweets. We identified 6 public-concerned topics related to the negative sentiment at the beginning of the vaccination process. Among the vaccines from the 3 manufacturers, the attitude toward Moderna was the most positive, and the attitude toward AstraZeneca was the most negative. Conclusions: Negative sentiment toward vaccines dominated positive sentiment in Japan, and the concerns about side effects might have outweighed fears of infection at the beginning of the vaccination process. Topic modeling on negative tweets indicated that the government and policy makers should take prompt actions in building a safe and convenient vaccine reservation and rollout system, which requires both flexibility of the medical care system and the acceleration of digitalization in Japan. The public showed different attitudes toward vaccine brands. Policy makers should provide more evidence about the effectiveness and safety of vaccines and rebut fake news to build vaccine confidence. %M 35578643 %R 10.2196/32335 %U https://infodemiology.jmir.org/2022/1/e32335 %U https://doi.org/10.2196/32335 %U http://www.ncbi.nlm.nih.gov/pubmed/35578643 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 8 %N 2 %P e33565 %T An Alternative to Traditional Bedside Teaching During COVID-19: High-Fidelity Simulation-Based Study %A Ajab,Shereen %A Pearson,Emma %A Dumont,Steven %A Mitchell,Alicia %A Kastelik,Jack %A Balaji,Packianathaswamy %A Hepburn,David %+ Hull York Medical School, Hull University Teaching Hospitals NHS Trust, Allam Medical Building, Cottingham Road, Hull, HU6 7RX, United Kingdom, 44 1482875875, shereen.ajab@nhs.net %K simulation %K high fidelity %K low fidelity %K COVID-19 %K bedside teaching %K undergraduate medical education %K fidelity %K medical education %K medical student %K review %K innovation %K risk %K design %K implementation %D 2022 %7 9.5.2022 %9 Original Paper %J JMIR Med Educ %G English %X Background: Bedside teaching is integral to medical education and has been highlighted to improve clinical and communication skills, as well as clinical reasoning. Despite the significant advantages of bedside teaching, its usage within medical education has been declining, and COVID-19 has added additional challenges. The pandemic has resulted in a significant reduction in opportunities to deliver bedside teaching due to risk of viral exposure, patients declining student interactions, and ward closures. Educators have therefore been required to be innovative in their teaching methods, leading to the use of online learning, social media platforms, and simulation. Simulation-based education allows for learning in a low-risk environment and affords the opportunity for deliberated repeated practice with case standardization. The results demonstrate that simulation-based training can increase students’ confidence, increase the rates of correct clinical diagnoses, and improve retention of skills and knowledge when compared with traditional teaching methods. Objective: To mitigate the impact of COVID-19 upon bedside teaching for third year students at Hull York Medical School amid closure of the cardiorespiratory wards, a high-fidelity simulation-based model of traditional bedside teaching was designed and implemented. The objectives of the teaching session were to enable students to perform history taking and a focused cardiorespiratory clinical examination in a COVID-19–safe environment using SimMan 3G. Methods: Four clinical teaching fellows with experience of simulation-based medical education scripted histories for 2 common cardiorespiratory cases, which were asthma and aortic stenosis. The simulation sessions were designed for students to take a focused cardiorespiratory history and clinical examination using SimMan 3G. All cases involved dynamic vital signs, and the simulator allowed for auscultation of an ejection systolic murmur and wheezing in accordance with the cases chosen. Key aspects of the pathologies, including epidemiology, differential diagnoses, investigations, and management, were summarized using an interactive PowerPoint presentation, followed by a debriefing session. Results: In total, 12 third year medical students undertook the sessions, and overall feedback was highly positive. Of the 10 students who completed the feedback questionnaires, 90% (n=9) felt more confident in their clinical examination skills following the teaching; 100% (n=10) of the students responded that they would recommend the session to a colleague; and implementation of regular simulation was frequently requested on feedback. These results are in keeping with the current literature. Conclusions: Bedside teaching continues to face ongoing challenges from the COVID-19 pandemic as well as declining patient recruitment and fluctuations in clinical findings. The support for simulation-based medical education is derived from high-quality studies; however, studies describing the use of this technology for bedside teaching in the undergraduate curriculum are limited. The authors describe a highly effective teaching session amid the pandemic, which allowed for maintenance of staff and student safety alongside continued education during a challenging time for educators globally. %M 35404828 %R 10.2196/33565 %U https://mededu.jmir.org/2022/2/e33565 %U https://doi.org/10.2196/33565 %U http://www.ncbi.nlm.nih.gov/pubmed/35404828 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 5 %P e34808 %T Valuing Diversity and Inclusion in Health Care to Equip the Workforce: Survey Study and Pathway Analysis %A Khuntia,Jiban %A Ning,Xue %A Cascio,Wayne %A Stacey,Rulon %+ Health Administration Research Consortium, Business School, University of Colorado, 1475 Lawrence Street, Denver, CO, 80202, United States, 1 3038548024, jiban.khuntia@ucdenver.edu %K health system %K workforce %K workplace %K diversity %K inclusion %K improve %K recruit %K collaborate %K health care %K worker %K employee %K CEO %K chief executive officer %K United States %K North America %K characteristic %K benefit %K influence %K strategy %K pathway %K hiring %K hire %K collaboration %K talent %K student %D 2022 %7 6.5.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic, with all its virus variants, remains a serious situation. Health systems across the United States are trying their best to respond. On average, the health care workforce is relatively homogenous, even though it cares for a highly diverse array of patients. This perennial problem in the US health care workforce has only been accentuated during the COVID-19 pandemic. Medical workers should reflect on the variety of patients they care for and strive to understand their mindsets within the larger contexts of culture, gender, sexual orientation, religious beliefs, and socioeconomic realities. Along with talent and skills, diversity and inclusion (D&I) are essential for maintaining a workforce that can treat the myriad needs and populations that health systems serve. Developing hiring strategies that will help achieve greater workforce diversity remains a challenge for health system leaders. Objective: The primary aims of this study were to: (1) explore the characteristics of US health systems and their associations with D&I practices and benefits, (2) examine the associations between D&I practices and three pathways to equip workforces, and (3) examine the associations between the three pathways to better equip workforces and business and service benefits. The three pathways are: (1) improving D&I among existing employees (IMPROVE), (2) using multiple channels to find and recruit the workforce (RECRUIT), and (3) collaborating with universities to find new talent and establish plans to train students (COLLABORATE). Methods: During February to March 2021, 625 health systems in the United States were surveyed with the help of a consultant, 135 (21.6%) of whom responded. We assessed workforce talent- and diversity-relevant factors. We collected secondary data from the Agency for Healthcare Research and Quality Compendium of the US Health Systems, leading to a matched data set of 124 health systems for analysis. We first explored differences in diversity practices and benefits across the health systems. We then examined the relationships among diversity practices, pathways, and benefits. Results: Health system characteristics such as size, location, ownership, teaching, and revenue have varying associations with diversity practices and outcomes. D&I and talent strategies exhibited different associations with the three workforce pathways. Regarding the mediating effects, the IMPROVE pathway seems to be more effective than the RECRUIT and COLLABORATE pathways, enabling the diversity strategy to prompt business or service benefits. Moreover, these pathway effects go hand-in-hand with a talent strategy, indicating that both talent and diversity strategies need to be aligned to achieve the best results for a health system. Conclusions: Diversity and talent plans can be aligned to realize multiple desired benefits for health systems. However, a one-size-fits-all approach is not a viable strategy for improving D&I. Health systems need to follow a multipronged approach based on their characteristics. To get D&I right, proactive plans and genuine efforts are essential. %M 35452404 %R 10.2196/34808 %U https://formative.jmir.org/2022/5/e34808 %U https://doi.org/10.2196/34808 %U http://www.ncbi.nlm.nih.gov/pubmed/35452404 %0 Journal Article %@ 2561-9128 %I JMIR Publications %V 5 %N 1 %P e36208 %T Automated Intraoperative Short Messaging Service Updates: Quality Improvement Initiative to Relieve Caregivers’ Worries %A Mignault,Alexandre %A Tchouaket Nguemeleu,Éric %A Robins,Stephanie %A Maillet,Éric %A Matetsa,Edwige %A Dupuis,Stéphane %+ Département des sciences infirmières, Université du Québec en Outaouais, 5 Rue St Joseph, St-Jérome, QC, J7Z 0B7, Canada, 1 450 530 7616 ext 4039, Eric.Tchouaket@uqo.ca %K COVID-19 %K surgery %K intraoperative %K OR nurse %K communication %K technology %K short messaging service %K SMS %K text message %K caregiver %K anxiety %K perioperative %K surgical %K surgical procedure %K mHealth %K mental health %K digital health %K digital health care %D 2022 %7 6.5.2022 %9 Original Paper %J JMIR Perioper Med %G English %X Background: Undergoing a surgical procedure is anxiety provoking for patients and their caregivers. During the intraoperative period, caregivers seek out informational updates from health care professionals, a situation complicated by COVID-19 health measures that require caregivers to wait outside the hospital. Short messaging service (SMS)-based communication that allows caregivers to follow their loved ones through surgery has shown promise in relieving anxiety and improving satisfaction with overall care. This form of communication is also well accepted by health care professionals and may be effective at relieving staff burden. Objective: Here, we describe a quality improvement initiative of a standardized and integrated intraoperative SMS-based system to improve communication between surgical teams and caregivers. The main goal was to improve satisfaction with care, while the secondary goal was to reduce caregiver anxiety. Methods: The initiative followed the framework of the Model for Improvement. A large tertiary care hospital offered the SMS to caregivers who were waiting for loved ones undergoing surgery. SMS messages were integrated into the clinical information system software and sent at key points during the surgical journey to phone numbers provided by caregivers. A satisfaction survey was sent to caregivers 1 business day after surgery. Data were collected between February 16 and July 14, 2021. Results: Of the 8129 surgeries scheduled, caregivers waiting for 6149 (75.6%) surgeries agreed to receive SMS messages. A total of 34,129 messages were sent. The satisfaction survey was completed by 2088 (34%) of the 6149 caregivers. Satisfaction with messages was high, with the majority of respondents reporting that the messages received were adequate (1476/2085, 70.8%), clear (1545/2077, 74.4%), informative (1488/2078, 71.6%), and met their needs (1234/2077, 59.4%). The overall satisfaction score was high (4.5 out of 5), and caregivers reported that receiving text messages resulted in a reduction in anxiety (score=8.2 out of 10). Technical errors were reported by 69 (3.3%) caregivers. Suggestions for improvements included having messages sent more often; providing greater patient details, including the patient’s health status; and the service being offered in other languages. Conclusions: This digital health initiative provided SMS messages that were systematically sent to caregivers waiting for their loved ones undergoing surgery, just as COVID-19 restrictions began preventing waiting onsite. The messages were used across 15 surgical specialties and have since been implemented hospital-wide. Digital health care innovations have the capacity to improve family-centered communication; what patients and their families find useful and appreciate will ultimately determine their success. %M 35436760 %R 10.2196/36208 %U https://periop.jmir.org/2022/1/e36208 %U https://doi.org/10.2196/36208 %U http://www.ncbi.nlm.nih.gov/pubmed/35436760 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 5 %P e37292 %T A Group-Facilitated, Internet-Based Intervention to Promote Mental Health and Well-Being in a Vulnerable Population of University Students: Randomized Controlled Trial of the Be Well Plan Program %A Fassnacht,Daniel B %A Ali,Kathina %A van Agteren,Joep %A Iasiello,Matthew %A Mavrangelos,Teri %A Furber,Gareth %A Kyrios,Michael %+ College of Education, Psychology and Social Work, Flinders University, Sturt Road, Bedford Park, Adelaide, 5042, Australia, 61 8 8201 2621, dan.fassnacht@flinders.edu.au %K COVID-19 %K mental health %K well-being %K depression %K anxiety %K online %K digital %K intervention %K Be Well Plan %K health outcome %K online health %K digital health %K health intervention %K primary outcome %K cognition %K randomized control trial %K resilience %K participant satisfaction %K student %D 2022 %7 5.5.2022 %9 Original Paper %J JMIR Ment Health %G English %X Background: A growing literature supports the use of internet-based interventions to improve mental health outcomes. However, most programs target specific symptoms or participant groups and are not tailored to facilitate improvements in mental health and well-being or do not allow for needs and preferences of individual participants. The Be Well Plan, a 5-week group-facilitated, internet-based mental health and well-being group intervention addresses these gaps, allowing participants to select a range of activities that they can tailor to their specific characteristics, needs, and preferences. Objective: This study aims to test whether the Be Well Plan program was effective in improving primary outcomes of mental well-being, resilience, anxiety, and depression compared to a waitlist control group during the COVID-19 pandemic; secondary outcomes included self-efficacy, a sense of control, and cognitive flexibility. The study further seeks to examine participants’ engagement and satisfaction with the program. Methods: A randomized controlled trial (RCT) was conducted with 2 parallel arms, an intervention and a waitlist control group. The intervention involved 5 weekly 2-hour sessions, which were facilitated in group format using Zoom videoconferencing software. University students were recruited via social media posts, lectures, emails, flyers, and posters. Results: Using an intentional randomization 2:1 allocation strategy, we recruited 215 participants to the trial (n=126, 58.6%, intervention group; n=89, 41.4%, waitlist control group). Of the 126 participants assigned to the intervention group, 75 (59.5%) commenced the program and were included in modified intention-to-treat (mITT) analyses. mITT intervention participants attended, on average, 3.41 sessions (SD 1.56, median 4); 55 (73.3%) attended at least 4 sessions, and 25 (33.3%) attended all 5 sessions. Of the 49 intervention group participants who completed the postintervention assessment, 47 (95.9%) were either very satisfied (n=31, 66%) or satisfied (n=16, 34%). The mITT analysis for well-being (F1,162=9.65, P=.002, Cohen d=0.48) and resilience (F1,162=7.85, P=.006, Cohen d=0.44) showed significant time × group interaction effects, suggesting that both groups improved over time, but the Be Well Plan (intervention) group showed significantly greater improvement compared to the waitlist control group. A similar pattern of results was observed for depression and anxiety (Cohen d=0.32 and 0.37, respectively), as well as the secondary outcomes (self-efficacy, Cohen d=0.50; sense of control, Cohen d=0.42; cognitive flexibility, Cohen d=0.65). Larger effect sizes were observed in the completer analyses. Reliable change analysis showed that the majority of mITT participants (58/75, 77.3%) demonstrated a significant reliable improvement in at least 1 of the primary outcomes. Conclusions: The Be Well Plan program was effective in improving mental health and well-being, including mental well-being, resilience, depression, and anxiety. Participant satisfaction scores and attendance indicated a high degree of engagement and satisfaction with the program. Trial Registration: Australian New Zealand Clinical Trial Registry ACTRN12621000180819; https://tinyurl.com/2p8da5sk %M 35471196 %R 10.2196/37292 %U https://mental.jmir.org/2022/5/e37292 %U https://doi.org/10.2196/37292 %U http://www.ncbi.nlm.nih.gov/pubmed/35471196 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 2 %P e35187 %T Patient Portal Messaging for Asynchronous Virtual Care During the COVID-19 Pandemic: Retrospective Analysis %A Huang,Ming %A Khurana,Aditya %A Mastorakos,George %A Wen,Andrew %A He,Huan %A Wang,Liwei %A Liu,Sijia %A Wang,Yanshan %A Zong,Nansu %A Prigge,Julie %A Costello,Brian %A Shah,Nilay %A Ting,Henry %A Fan,Jungwei %A Patten,Christi %A Liu,Hongfang %+ Department of Artificial Intelligence and Informatics, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, United States, 1 507 293 0057, Liu.Hongfang@mayo.edu %K patient portal %K patient portal message %K asynchronous communication %K COVID-19 %K utilization %K digital health %K healthcare %K health care %K remote healthcare %K virtual care %K pandemic %D 2022 %7 5.5.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: During the COVID-19 pandemic, patient portals and their message platforms allowed remote access to health care. Utilization patterns in patient messaging during the COVID-19 crisis have not been studied thoroughly. In this work, we propose characterizing patients and their use of asynchronous virtual care for COVID-19 via a retrospective analysis of patient portal messages. Objective: This study aimed to perform a retrospective analysis of portal messages to probe asynchronous patient responses to the COVID-19 crisis. Methods: We collected over 2 million patient-generated messages (PGMs) at Mayo Clinic during February 1 to August 31, 2020. We analyzed descriptive statistics on PGMs related to COVID-19 and incorporated patients’ sociodemographic factors into the analysis. We analyzed the PGMs on COVID-19 in terms of COVID-19–related care (eg, COVID-19 symptom self-assessment and COVID-19 tests and results) and other health issues (eg, appointment cancellation, anxiety, and depression). Results: The majority of PGMs on COVID-19 pertained to COVID-19 symptom self-assessment (42.50%) and COVID-19 tests and results (30.84%). The PGMs related to COVID-19 symptom self-assessment and COVID-19 test results had dynamic patterns and peaks similar to the newly confirmed cases in the United States and in Minnesota. The trend of PGMs related to COVID-19 care plans paralleled trends in newly hospitalized cases and deaths. After an initial peak in March, the PGMs on issues such as appointment cancellations and anxiety regarding COVID-19 displayed a declining trend. The majority of message senders were 30-64 years old, married, female, White, or urban residents. This majority was an even higher proportion among patients who sent portal messages on COVID-19. Conclusions: During the COVID-19 pandemic, patients increased portal messaging utilization to address health care issues about COVID-19 (in particular, symptom self-assessment and tests and results). Trends in message usage closely followed national trends in new cases and hospitalizations. There is a wide disparity for minority and rural populations in the use of PGMs for addressing the COVID-19 crisis. %M 35171108 %R 10.2196/35187 %U https://humanfactors.jmir.org/2022/2/e35187 %U https://doi.org/10.2196/35187 %U http://www.ncbi.nlm.nih.gov/pubmed/35171108 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 5 %P e35706 %T An Agreement of Antigen Tests on Oral Pharyngeal Swabs or Less Invasive Testing With Reverse Transcription Polymerase Chain Reaction for Detecting SARS-CoV-2 in Adults: Protocol for a Prospective Nationwide Observational Study %A Schneider,Uffe Vest %A Knudsen,Jenny Dahl %A Koch,Anders %A Kirkby,Nikolai Søren %A Lisby,Jan Gorm %+ Department of Clinical Microbiology, Copenhagen University Hospital Hvidovre, Kettegaard Alle 30, Hvidovre, 2650, Denmark, 45 38623189, uffe.vest.schneider@regionh.dk %K SARS-CoV-2 %K COVID-19 %K point of care %K PoC %K antigen test %K anatomic sampling location %K Reverse Transcription Polymerase Chain Reaction %K RT-PCR %K rapid antigen test %K RAT %K testing %K antigen %K sampling %K PCR %K rapid %K protocol %K prospective %K observational %K agreement %K oral %K adult %K sensitivity %K specificity %K test location %K anatomy %K saliva %K swab %K nasopharyngeal %K nasal %D 2022 %7 4.5.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: The SARS-CoV-2 pandemic has resulted in an unprecedented level of worldwide testing for epidemiologic and diagnostic purposes, and due to the extreme need for tests, the gold-standard Reverse Transcription Polymerase Chain Reaction (RT-PCR) testing capacity has been unable to meet the overall worldwide testing demand. Consequently, although the current literature has shown the sensitivity of rapid antigen tests (RATs) to be inferior to RT-PCR, RATs have been implemented on a large scale without solid data on performance. Objective: This study will compare analytical and clinical sensitivities and specificities of 50 lateral flow– or laboratory-based RATs and 3 strand invasion–based amplification (SIBA)-RT-PCR tests from 30 manufacturers to RT-PCR testing of samples obtained from the deep oropharynx. In addition, the study will compare sensitivities and specificities of the included RATs as well as RT-PCR on clinical samples obtained from the deep oropharynx, the anterior nasal cavity, saliva, the deep nasopharynx, and expired air to RT-PCR on deep oropharyngeal samples. Methods: In the prospective part of the study, 200 individuals found SARS-CoV-2 positive and 200 individuals found SARS-CoV-2 negative by routine RT-PCR testing will be retested with each RAT, applying RT-PCR as the reference method. In the retrospective part of the study, 304 deep oropharyngeal cavity swabs divided into 4 groups based on RT-PCR quantification cycle (Cq) levels will be tested with each RAT. Results: The results will be reported in several papers with different aims. The first paper will report retrospective (analytical sensitivity, overall and stratified into different Cq range groups) and prospective (clinical sensitivity) data for RATs, with RT-PCR as the reference method. The second paper will report results for RAT based on anatomical sampling location. The third paper will compare different anatomical sampling locations by RT-PCR testing. The fourth paper will focus on RATs that rely on central laboratory testing. Tests from 4 different manufacturers will be compared for analytical performance data on retrospective deep oropharyngeal swab samples. The fifth paper will report the results of 4 RATs applied both as professional use and as self-tests. The last paper will report the results from 2 breath tests in the study. A comparison of sensitivity and specificity between RATs will be conducted using the McNemar test for paired samples and the chi-squared test for unpaired samples. Comparison of the positive predictive value (PPV) and negative predictive value (NPV) between RATs will be performed by the bootstrap test, and 95% CIs for sensitivity, specificity, PPV, and NPV will be calculated as bootstrap CIs. Conclusions: The study will compare the sensitivities of a large number of RATs for SARS-CoV-2 to with those of RT-PCR and will address whether lateral flow–based RATs differ significantly from laboratory-based RATs. The anatomical test locations for both RATs and RT-PCR will also be compared. Trial Registration: ClinicalTrials.gov NCT04913116; https://clinicaltrials.gov/ct2/show/NCT04913116 International Registered Report Identifier (IRRID): DERR1-10.2196/35706 %M 35394449 %R 10.2196/35706 %U https://www.researchprotocols.org/2022/5/e35706 %U https://doi.org/10.2196/35706 %U http://www.ncbi.nlm.nih.gov/pubmed/35394449 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 9 %N 2 %P e25494 %T Using Smartwatches to Observe Changes in Activity During Recovery From Critical Illness Following COVID-19 Critical Care Admission: 1-Year, Multicenter Observational Study %A Hunter,Alex %A Leckie,Todd %A Coe,Oliver %A Hardy,Benjamin %A Fitzpatrick,Daniel %A Gonçalves,Ana-Carolina %A Standing,Mary-Kate %A Koulouglioti,Christina %A Richardson,Alan %A Hodgson,Luke %+ Department of Intensive Care Medicine, Worthing Hospital, University Hospitals Sussex National Health Service Trust, Lyndhurst Road, Worthing, United Kingdom, 44 1903 205111, alexander.hunter2@nhs.net %K COVID-19 %K telemedicine %K rehabilitation %K critical illness %K smartphone %K digital health %K mobile health %K remote therapy %K device usability %D 2022 %7 2.5.2022 %9 Original Paper %J JMIR Rehabil Assist Technol %G English %X Background: As a sequela of the COVID-19 pandemic, a large cohort of critical illness survivors have had to recover in the context of ongoing societal restrictions. Objective: We aimed to use smartwatches (Fitbit Charge 3; Fitbit LLC) to assess changes in the step counts and heart rates of critical care survivors following hospital admission with COVID-19, use these devices within a remote multidisciplinary team (MDT) setting to support patient recovery, and report on our experiences with this. Methods: We conducted a prospective, multicenter observational trial in 8 UK critical care units. A total of 50 participants with moderate or severe lung injury resulting from confirmed COVID-19 were recruited at discharge from critical care and given a smartwatch (Fitbit Charge 3) between April and June 2020. The data collected included step counts and daily resting heart rates. A subgroup of the overall cohort at one site—the MDT site (n=19)—had their smartwatch data used to inform a regular MDT meeting. A patient feedback questionnaire and direct feedback from the MDT were used to report our experience. Participants who did not upload smartwatch data were excluded from analysis. Results: Of the 50 participants recruited, 35 (70%) used and uploaded data from their smartwatch during the 1-year period. At the MDT site, 74% (14/19) of smartwatch users uploaded smartwatch data, whereas 68% (21/31) of smartwatch users at the control sites uploaded smartwatch data. For the overall cohort, we recorded an increase in mean step count from 4359 (SD 3488) steps per day in the first month following discharge to 7914 (SD 4146) steps per day at 1 year (P=.003). The mean resting heart rate decreased from 79 (SD 7) beats per minute in the first month to 69 (SD 4) beats per minute at 1 year following discharge (P<.001). The MDT subgroup’s mean step count increased more than that of the control group (176% increase vs 42% increase, respectively; +5474 steps vs +2181 steps, respectively; P=.04) over 1 year. Further, 71% (10/14) of smartwatch users at the MDT site and 48% (10/21) of those at the control sites strongly agreed that their Fitbit motivated them to recover, and 86% (12/14) and 48% (10/21), respectively, strongly agreed that they aimed to increase their activity levels over time. Conclusions: This is the first study to use smartwatch data to report on the 1-year recovery of patients who survived a COVID-19 critical illness. This is also the first study to report on smartwatch use within a post–critical care MDT. Future work could explore the role of smartwatches as part of a randomized controlled trial to assess clinical and economic effectiveness. International Registered Report Identifier (IRRID): RR2-10.12968/ijtr.2020.0102 %M 35417402 %R 10.2196/25494 %U https://rehab.jmir.org/2022/2/e25494 %U https://doi.org/10.2196/25494 %U http://www.ncbi.nlm.nih.gov/pubmed/35417402 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 5 %P e37413 %T Authors Reply to: Research Using Social Media to Recruit Research Participants Should Proceed With Caution. Comment on “Telemanagement of Home-Isolated COVID-19 Patients Using Oxygen Therapy With Noninvasive Positive Pressure Ventilation and Physical Therapy Techniques: Randomized Clinical Trial” %A Adly,Aya Sedky %A Adly,Mahmoud Sedky %A Adly,Afnan Sedky %+ Faculty of Engineering and Technology, Badr University in Cairo (BUC), Cairo Suez Road, Badr City, Cairo, 11511, Egypt, 20 1145559778, aya.sedky@gmail.com %K telemedicine %K oxygen therapy %K noninvasive positive airway pressure %K BiPAP %K osteopathic medicine %K physical therapy %K SARS-CoV-2 %K COVID-19 %K teletherapy %K telemanagement %D 2022 %7 2.5.2022 %9 Letter to the Editor %J J Med Internet Res %G English %X %M 35476751 %R 10.2196/37413 %U https://www.jmir.org/2022/5/e37413 %U https://doi.org/10.2196/37413 %U http://www.ncbi.nlm.nih.gov/pubmed/35476751 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 5 %P e34437 %T Research Using Social Media to Recruit Research Participants Should Proceed With Caution. Comment on “Telemanagement of Home-Isolated COVID-19 Patients Using Oxygen Therapy With Noninvasive Positive Pressure Ventilation and Physical Therapy Techniques: Randomized Clinical Trial” %A Chen,Chih-Wei %A Wei,James Cheng-Chung %+ Institute of Medicine, Chung Shan Medical University, No 110, Sec 1, Jianguo N Rd, South District, Taichung, 40201, Taiwan, 886 4 24739595, jccwei@gmail.com %K telemedicine %K oxygen therapy %K noninvasive positive airway pressure %K BiPAP %K osteopathic medicine %K physical therapy %K SARS-CoV-2 %K COVID-19 %K teletherapy %K telemanagement %D 2022 %7 2.5.2022 %9 Letter to the Editor %J J Med Internet Res %G English %X %M 35476637 %R 10.2196/34437 %U https://www.jmir.org/2022/5/e34437 %U https://doi.org/10.2196/34437 %U http://www.ncbi.nlm.nih.gov/pubmed/35476637 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 2 %N 1 %P e35014 %T Health Literacy, Equity, and Communication in the COVID-19 Era of Misinformation: Emergence of Health Information Professionals in Infodemic Management %A Kyabaggu,Ramona %A Marshall,Deneice %A Ebuwei,Patience %A Ikenyei,Uche %+ Johnson-Shoyama Graduate School of Public Policy, University of Regina, 3rd Floor, 2155 College Avenue, College Avenue Campus, Regina, SK, S4S 0A2, Canada, 1 306 585 4548, ramona.kyabaggu@uregina.ca %K COVID-19 %K social media %K infodemiology %K infoveillance %K equity %K health literacy %K digital literacy %K health information management %K pandemic %K health information %K public policy %K infodemic %D 2022 %7 28.4.2022 %9 Viewpoint %J JMIR Infodemiology %G English %X The health information management (HIM) field’s contribution to health care delivery is invaluable in a pandemic context where the need for accurate diagnoses will hasten responsive, evidence-based decision-making. The COVID-19 pandemic offers a unique opportunity to transform the practice of HIM and bring more awareness to the role that frontline workers play behind the scenes in safeguarding reliable, comprehensive, accurate, and timely health information. This transformation will support future research, utilization management, public health surveillance, and forecasting and enable key stakeholders to plan and ensure equitable health care resource allocation, especially for the most vulnerable populations. In this paper, we juxtapose critical health literacy, public policy, and HIM perspectives to understand the COVID-19 infodemic and new opportunities for HIM in infodemic management. %M 35529308 %R 10.2196/35014 %U https://infodemiology.jmir.org/2022/1/e35014 %U https://doi.org/10.2196/35014 %U http://www.ncbi.nlm.nih.gov/pubmed/35529308 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 10 %N 4 %P e37771 %T Predicting COVID-19 Symptoms From Free Text in Medical Records Using Artificial Intelligence: Feasibility Study %A Van Olmen,Josefien %A Van Nooten,Jens %A Philips,Hilde %A Sollie,Annet %A Daelemans,Walter %+ Department of Family Medicine and Population Health, University of Antwerp, Prinsstraat 13, Antwerp, 2000, Belgium, 32 475892225, josefien.vanolmen@uantwerpen.be %K natural language processing %K text mining %K electronic medical records %K COVID-19 %K structured registry %K coding procedure %K prediction model %K feasibility study %K precision model %K artificial intelligence %K primary care %D 2022 %7 27.4.2022 %9 Original Paper %J JMIR Med Inform %G English %X Background: Electronic medical records have opened opportunities to analyze clinical practice at large scale. Structured registries and coding procedures such as the International Classification of Primary Care further improved these procedures. However, a large part of the information about the state of patient and the doctors’ observations is still entered in free text fields. The main function of those fields is to report the doctor’s line of thought, to remind oneself and his or her colleagues on follow-up actions, and to be accountable for clinical decisions. These fields contain rich information that can be complementary to that in coded fields, and until now, they have been hardly used for analysis. Objective: This study aims to develop a prediction model to convert the free text information on COVID-19–related symptoms from out of hours care electronic medical records into usable symptom-based data that can be analyzed at large scale. Methods: The design was a feasibility study in which we examined the content of the raw data, steps and methods for modelling, as well as the precision and accuracy of the models. A data prediction model for 27 preidentified COVID-19–relevant symptoms was developed for a data set derived from the database of primary-care out-of-hours consultations in Flanders. A multiclass, multilabel categorization classifier was developed. We tested two approaches, which were (1) a classical machine learning–based text categorization approach, Binary Relevance, and (2) a deep neural network learning approach with BERTje, including a domain-adapted version. Ethical approval was acquired through the Institutional Review Board of the Institute of Tropical Medicine and the ethics committee of the University Hospital of Antwerpen (ref 20/50/693). Results: The sample set comprised 3957 fields. After cleaning, 2313 could be used for the experiments. Of the 2313 fields, 85% (n=1966) were used to train the model, and 15% (n=347) for testing. The normal BERTje model performed the best on the data. It reached a weighted F1 score of 0.70 and an exact match ratio or accuracy score of 0.38, indicating the instances for which the model has identified all correct codes. The other models achieved respectable results as well, ranging from 0.59 to 0.70 weighted F1. The Binary Relevance method performed the best on the data without a frequency threshold. As for the individual codes, the domain-adapted version of BERTje performs better on several of the less common objective codes, while BERTje reaches higher F1 scores for the least common labels especially, and for most other codes in general. Conclusions: The artificial intelligence model BERTje can reliably predict COVID-19–related information from medical records using text mining from the free text fields generated in primary care settings. This feasibility study invites researchers to examine further possibilities to use primary care routine data. %M 35442903 %R 10.2196/37771 %U https://medinform.jmir.org/2022/4/e37771 %U https://doi.org/10.2196/37771 %U http://www.ncbi.nlm.nih.gov/pubmed/35442903 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 10 %N 4 %P e35789 %T Generation of a Fast Healthcare Interoperability Resources (FHIR)-based Ontology for Federated Feasibility Queries in the Context of COVID-19: Feasibility Study %A Rosenau,Lorenz %A Majeed,Raphael W %A Ingenerf,Josef %A Kiel,Alexander %A Kroll,Björn %A Köhler,Thomas %A Prokosch,Hans-Ulrich %A Gruendner,Julian %+ IT Center for Clinical Research, Gebäude 64, 2.OG, Raum 05, Ratzeburger Allee 160, Lübeck, 23562, Germany, 49 451 3101 5636, lorenz.rosenau@uni-luebeck.de %K federated queries %K feasibility study %K Fast Healthcare Interoperability Resource %K FHIR Search %K CQL %K ontology %K terminology server %K query %K feasibility %K FHIR %K terminology %K development %K COVID-19 %K automation %K user interface %K map %K input %K hospital %K data %K Germany %K accessibility %K harmonized %D 2022 %7 27.4.2022 %9 Original Paper %J JMIR Med Inform %G English %X Background: The COVID-19 pandemic highlighted the importance of making research data from all German hospitals available to scientists to respond to current and future pandemics promptly. The heterogeneous data originating from proprietary systems at hospitals' sites must be harmonized and accessible. The German Corona Consensus Dataset (GECCO) specifies how data for COVID-19 patients will be standardized in Fast Healthcare Interoperability Resources (FHIR) profiles across German hospitals. However, given the complexity of the FHIR standard, the data harmonization is not sufficient to make the data accessible. A simplified visual representation is needed to reduce the technical burden, while allowing feasibility queries. Objective: This study investigates how a search ontology can be automatically generated using FHIR profiles and a terminology server. Furthermore, it describes how this ontology can be used in a user interface (UI) and how a mapping and a terminology tree created together with the ontology can translate user input into FHIR queries. Methods: We used the FHIR profiles from the GECCO data set combined with a terminology server to generate an ontology and the required mapping files for the translation. We analyzed the profiles and identified search criteria for the visual representation. In this process, we reduced the complex profiles to code value pairs for improved usability. We enriched our ontology with the necessary information to display it in a UI. We also developed an intermediate query language to transform the queries from the UI to federated FHIR requests. Separation of concerns resulted in discrepancies between the criteria used in the intermediate query format and the target query language. Therefore, a mapping was created to reintroduce all information relevant for creating the query in its target language. Further, we generated a tree representation of the ontology hierarchy, which allows resolving child concepts in the process. Results: In the scope of this project, 82 (99%) of 83 elements defined in the GECCO profile were successfully implemented. We verified our solution based on an independently developed test patient. A discrepancy between the test data and the criteria was found in 6 cases due to different versions used to generate the test data and the UI profiles, the support for specific code systems, and the evaluation of postcoordinated Systematized Nomenclature of Medicine (SNOMED) codes. Our results highlight the need for governance mechanisms for version changes, concept mapping between values from different code systems encoding the same concept, and support for different unit dimensions. Conclusions: We developed an automatic process to generate ontology and mapping files for FHIR-formatted data. Our tests found that this process works for most of our chosen FHIR profile criteria. The process established here works directly with FHIR profiles and a terminology server, making it extendable to other FHIR profiles and demonstrating that automatic ontology generation on FHIR profiles is feasible. %M 35380548 %R 10.2196/35789 %U https://medinform.jmir.org/2022/4/e35789 %U https://doi.org/10.2196/35789 %U http://www.ncbi.nlm.nih.gov/pubmed/35380548 %0 Journal Article %@ 2561-9128 %I JMIR Publications %V 5 %N 1 %P e33926 %T Evaluation of Telemedicine Use for Anesthesiology Pain Division: Retrospective, Observational Case Series Study %A Jalilian,Laleh %A Wu,Irene %A Ing,Jakun %A Dong,Xuezhi %A Sadik,Joshua %A Pan,George %A Hitson,Heather %A Thomas,Erin %A Grogan,Tristan %A Simkovic,Michael %A Kamdar,Nirav %+ Department of Anesthesiology and Perioperative Medicine, University of California, Los Angeles, 757 Westwood Plaza, Suite 3325, Los Angeles, CA, 90095, United States, 1 (310) 267 6629, ljalilian@mednet.ucla.edu %K COVID-19 %K pain management %K telemedicine %K cost savings %K patient satisfaction %D 2022 %7 27.4.2022 %9 Original Paper %J JMIR Perioper Med %G English %X Background: An increasing number of patients require outpatient and interventional pain management. To help meet the rising demand for anesthesia pain subspecialty care in rural and metropolitan areas, health care providers have used telemedicine for pain management of both interventional patients and those with chronic pain. Objective: In this study, we aimed to describe the implementation of a telemedicine program for pain management in an academic pain division in a large metropolitan area. We also aimed to estimate patient cost savings from telemedicine, before and after the California COVID-19 “Safer at Home” directive, and to estimate patient satisfaction with telemedicine for pain management care. Methods: This was a retrospective, observational case series study of telemedicine use in a pain division at an urban academic medical center. From August 2019 to June 2020, we evaluated 1398 patients and conducted 2948 video visits for remote pain management care. We used the publicly available Internal Revenue Service’s Statistics of Income data to estimate hourly earnings by zip code in order to estimate patient cost savings. We estimated median travel time and travel distance with Google Maps’ Distance Matrix application programming interface, direct cost of travel with median value for regular fuel cost in California, and time-based opportunity savings from estimated hourly earnings and round-trip time. We reported patient satisfaction scores derived from a postvisit satisfaction survey containing questions with responses on a 5-point Likert scale. Results: Patients who attended telemedicine visits avoided an estimated median round-trip driving distance of 26 miles and a median travel time of 69 minutes during afternoon traffic conditions. Within the sample, their median hourly earnings were US $28 (IQR US $21-$39) per hour. Patients saved a median of US $22 on gas and parking and a median total of US $52 (IQR US $36-$75) per telemedicine visit based on estimated hourly earnings and travel time. Patients who were evaluated serially with telemedicine for medication management saved a median of US $156 over a median of 3 visits. A total of 91.4% (286/313) of patients surveyed were satisfied with their telemedicine experience. Conclusions: Telemedicine use for pain management reduced travel distance, travel time, and travel and time-based opportunity costs for patients with pain. We achieved the successful implementation of telemedicine across a pain division in an urban academic medical center with high patient satisfaction and patient cost savings. %M 35023841 %R 10.2196/33926 %U https://periop.jmir.org/2022/1/e33926 %U https://doi.org/10.2196/33926 %U http://www.ncbi.nlm.nih.gov/pubmed/35023841 %0 Journal Article %@ 2562-0959 %I JMIR Publications %V 5 %N 2 %P e37271 %T Correlation Between Interest in COVID-19 Hair Loss and COVID-19 Surges: Analysis of Google Trends %A Han,Joseph %A Kamat,Samir %A Agarwal,Aneesh %A O'Hagan,Ross %A Tukel,Connor %A Owji,Shayan %A Ghalili,Sabrina %A Luu,Yen %A Dautriche Svidzinski,Cula %A Abittan,Brian J %A Ungar,Jonathan %A Gulati,Nicholas %+ Department of Dermatology, Icahn School of Medicine at Mount Sinai, 5 East 98th Street, 5th Floor, New York, NY, 10029, United States, 1 212 241 3288, nicholas.gulati@mssm.edu %K COVID-19 %K SARS-CoV-2 virus %K pandemic %K hair loss %K telogen effluvium %K Google Trends %K omicron %K omicron variant %K delta variant %K public interest %K stress %K dermatology %K public perception %K social media %K online health %K digital dermatology %D 2022 %7 27.4.2022 %9 Research Letter %J JMIR Dermatol %G English %X %M 35505684 %R 10.2196/37271 %U https://derma.jmir.org/2022/2/e37271 %U https://doi.org/10.2196/37271 %U http://www.ncbi.nlm.nih.gov/pubmed/35505684 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 4 %P e32528 %T Empowering Patients Through Virtual Care Delivery: Qualitative Study With Micropractice Clinic Patients and Health Care Providers %A Burton,Lindsay %A Rush,Kathy L %A Smith,Mindy A %A Davis,Selena %A Rodriguez Echeverria,Patricia %A Suazo Hidalgo,Lina %A Görges,Matthias %+ Department of Anesthesiology Pharmacology & Therapeutics, The University of British Columbia, Rm V3-324, 950 West 28th Ave, Vancouver, BC, V5Z 4H4, Canada, 1 604 875 2000 ext 5616, mgorges@bcchr.ubc.ca %K virtual care %K micropractice %K focus groups %K patient portals %K COVID-19 %K family practice %K rural care %K digital health technology %K telehealth %D 2022 %7 27.4.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Prior to the wider adoption of digital health technologies during the COVID-19 pandemic, applications of virtual care were largely limited to specialist visits and remote care using telehealth (phone or video) applications. Data sharing approaches using tethered patient portals were mostly built around hospitals and larger care systems. These portals offer opportunities for improved communication, but despite a belief that care has improved, they have so far shown few outcome improvements beyond medication adherence. Less is known about use of virtual care and related tools in the outpatient context and particularly in rural community contexts. Objective: This study aims to reflect on the opportunities and barriers for sustainable virtual care through an example of a digitally enabled rural micropractice, which has provided 10%-15% virtual care since 2016 and 70% virtual care since March 2020. Methods: Three focus groups, 1 with providers (physician and medical office manager) and 2 with a total of 8 patients from a rural micropractice in British Columbia, were conducted in November 2020 and December 2020. Virtual care delivery was explored through the topics of communication approach, mixing virtual and in-person care, the practice team’s journey in developing these approaches, and provider and patient satisfaction with the care model. Interviews were transcribed, checked for accuracy against recordings, and thematically analyzed. Results: Both patients and providers reported ease of communication and high satisfaction. Either could initiate communication, and patients found the ability to share health information asynchronously through the portal allowed time to reflect and prepare their thoughts. Patients were highly engaged and reported feeling empowered and true partners in their health care, although they noted limited care coordination with specialists. The mix of virtual and in-person visits was highly regarded by patients and providers, and patients reported feeling safe and cared for 24/7, although both expressed concern about work spilling into the provider’s home life. The physician worried about missed diagnoses with virtual care. With respect to establishing the micropractice, solutions took about 5 years to optimize, with providers noting a learning curve requiring technical support for both themselves and their patients and a willingness to respond to patient feedback to identify the best solutions. Despite a mature virtual practice, patients reported deferred care due to COVID-19. Conclusions: The micropractice’s hybrid care model encouraged patients to be true partners in their care and resulted in high patient engagement and satisfaction; yet, success may rely on the patient population being willing to engage and being comfortable with technology. Barriers lie in gaps in care coordination and provider fear that signs or symptoms more evident with an in-person exam could be missed. Even in this setting, deferral of care in light of COVID-19 was present, and opportunities to address care gaps should be sought. %M 35413002 %R 10.2196/32528 %U https://formative.jmir.org/2022/4/e32528 %U https://doi.org/10.2196/32528 %U http://www.ncbi.nlm.nih.gov/pubmed/35413002 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 4 %P e34321 %T The Mutual Influence of the World Health Organization (WHO) and Twitter Users During COVID-19: Network Agenda-Setting Analysis %A Tahamtan,Iman %A Potnis,Devendra %A Mohammadi,Ehsan %A Singh,Vandana %A Miller,Laura E %+ School of Information Sciences, The University of Tennessee, 1345 Circle Park Drive, 451 Communications Building, Knoxville, TN, 37996-0332, United States, 1 865 974 1000, iman.tahamtan@gmail.com %K COVID-19 %K agenda setting %K network agenda setting %K Twitter %K social media %K public opinion %K content analysis %K public health %K WHO %D 2022 %7 26.4.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Little is known about the role of the World Health Organization (WHO) in communicating with the public on social media during a global health emergency. More specifically, there is no study about the relationship between the agendas of the WHO and Twitter users during the COVID-19 pandemic. Objective: This study utilizes the network agenda-setting model to investigate the mutual relationship between the agenda of the WHO’s official Twitter account and the agenda of 7.5 million of its Twitter followers regarding COVID-19. Methods: Content analysis was applied to 7090 tweets posted by the WHO on Twitter from January 1, 2020, to July 31, 2020, to identify the topics of tweets. The quadratic assignment procedure (QAP) was used to investigate the relationship between the WHO agenda network and the agenda network of the 6 Twitter user categories, including “health care professionals,” “academics,” “politicians,” “print and electronic media,” “legal professionals,” and the “private sector.” Additionally, 98 Granger causality statistical tests were performed to determine which topic in the WHO agenda had an effect on the corresponding topic in each Twitter user category and vice versa. Results: Content analysis revealed 7 topics that reflect the WHO agenda related to the COVID-19 pandemic, including “prevention,” “solidarity,” “charity,” “teamwork,” “ill-effect,” “surveillance,” and “credibility.” Results of the QAP showed significant and strong correlations between the WHO agenda network and the agenda network of each Twitter user category. These results provide evidence that WHO had an overall effect on different types of Twitter users on the identified topics. For instance, the Granger causality tests indicated that the WHO tweets influenced politicians and print and electronic media about “surveillance.” The WHO tweets also influenced academics and the private sector about “credibility” and print and electronic media about “ill-effect.” Additionally, Twitter users affected some topics in the WHO. For instance, WHO followers affected “charity” and “prevention” in the WHO. Conclusions: This paper extends theorizing on agenda setting by providing empirical evidence that agenda-setting effects vary by topic and types of Twitter users. Although prior studies showed that network agenda setting is a “one-way” model, the novel findings of this research confirm a “2-way” or “multiway” effect of agenda setting on social media due to the interactions between the content creators and audiences. The WHO can determine which topics should be promoted on social media during different phases of a pandemic and collaborate with other public health gatekeepers to collectively make them salient in the public. %M 35275836 %R 10.2196/34321 %U https://www.jmir.org/2022/4/e34321 %U https://doi.org/10.2196/34321 %U http://www.ncbi.nlm.nih.gov/pubmed/35275836 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 4 %P e36830 %T The Prevalence and Impact of Fake News on COVID-19 Vaccination in Taiwan: Retrospective Study of Digital Media %A Chen,Yen-Pin %A Chen,Yi-Ying %A Yang,Kai-Chou %A Lai,Feipei %A Huang,Chien-Hua %A Chen,Yun-Nung %A Tu,Yi-Chin %+ Department of Computer Science and Information Engineering, National Taiwan University, No 1, Sec 4, Roosevelt Rd, Taipei, 106, Taiwan, 886 2 3366 3366, yvchen@csie.ntu.edu.tw %K misinformation %K vaccine hesitancy %K vaccination %K infodemic %K infodemiology %K COVID-19 %K public immunity %K social media %K fake news %D 2022 %7 26.4.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Vaccination is an important intervention to prevent the incidence and spread of serious diseases. Many factors including information obtained from the internet influence individuals’ decisions to vaccinate. Misinformation is a critical issue and can be hard to detect, although it can change people's minds, opinions, and decisions. The impact of misinformation on public health and vaccination hesitancy is well documented, but little research has been conducted on the relationship between the size of the population reached by misinformation and the vaccination decisions made by that population. A number of fact-checking services are available on the web, including the Islander news analysis system, a free web service that provides individuals with real-time judgment on web news. In this study, we used such services to estimate the amount of fake news available and used Google Trends levels to model the spread of fake news. We quantified this relationship using official public data on COVID-19 vaccination in Taiwan. Objective: In this study, we aimed to quantify the impact of the magnitude of the propagation of fake news on vaccination decisions. Methods: We collected public data about COVID-19 infections and vaccination from Taiwan's official website and estimated the popularity of searches using Google Trends. We indirectly collected news from 26 digital media sources, using the news database of the Islander system. This system crawls the internet in real time, analyzes the news, and stores it. The incitement and suspicion scores of the Islander system were used to objectively judge news, and a fake news percentage variable was produced. We used multivariable linear regression, chi-square tests, and the Johnson-Neyman procedure to analyze this relationship, using weekly data. Results: A total of 791,183 news items were obtained over 43 weeks in 2021. There was a significant increase in the proportion of fake news in 11 of the 26 media sources during the public vaccination stage. The regression model revealed a positive adjusted coefficient (β=0.98, P=.002) of vaccine availability on the following week's vaccination doses, and a negative adjusted coefficient (β=–3.21, P=.04) of the interaction term on the fake news percentage with the Google Trends level. The Johnson-Neiman plot of the adjusted effect for the interaction term showed that the Google Trends level had a significant negative adjustment effect on vaccination doses for the following week when the proportion of fake news exceeded 39.3%. Conclusions: There was a significant relationship between the amount of fake news to which the population was exposed and the number of vaccination doses administered. Reducing the amount of fake news and increasing public immunity to misinformation will be critical to maintain public health in the internet age. %M 35380546 %R 10.2196/36830 %U https://www.jmir.org/2022/4/e36830 %U https://doi.org/10.2196/36830 %U http://www.ncbi.nlm.nih.gov/pubmed/35380546 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 4 %P e32411 %T Design of a Vaccine Passport Validation System Using Blockchain-based Architecture: Development Study %A Lee,Hsiu An %A Wu,Wei-Chen %A Kung,Hsin-Hua %A Udayasankaran,Jai Ganesh %A Wei,Yu-Chih %A Kijsanayotin,Boonchai %A Marcelo,Alvin B %A Hsu,Chien-Yeh %+ Department of Information Management, National Taipei University of Nursing and Health Sciences, No.365, Ming-te Road, Peitou District, Taipei, 112, Taiwan, 886 0939193212, cyhsu@ntunhs.edu.tw %K COVID-19 %K vaccine passport %K global border control %K health policy %K international infectious disease strategy %K vaccine %K policy %K strategy %K blockchain %K privacy %K security %K testing %K verification %K certification %K Fast Healthcare Interoperability Resource %D 2022 %7 26.4.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: COVID-19 is an ongoing global pandemic caused by SARS-CoV-2. As of June 2021, 5 emergency vaccines were available for COVID-19 prevention, and with the improvement of vaccination rates and the resumption of activities in each country, verification of vaccination has become an important issue. Currently, in most areas, vaccination and reverse transcription polymerase chain reaction (RT-PCR) test results are certified and validated on paper. This leads to the problem of counterfeit documents. Therefore, a global vaccination record is needed. Objective: The main objective of this study is to design a vaccine passport (VP) validation system based on a general blockchain architecture for international use in a simulated environment. With decentralized characteristics, the system is expected to have the advantages of low cost, high interoperability, effectiveness, security, and verifiability through blockchain architecture. Methods: The blockchain decentralized mechanism was used to build an open and anticounterfeiting information platform for VPs. The contents of a vaccination card are recorded according to international Fast Healthcare Interoperability Resource (FHIR) standards, and blockchain smart contracts (SCs) are used for authorization and authentication to achieve hierarchical management of various international hospitals and people receiving injections. The blockchain stores an encrypted vaccination path managed by the user who manages the private key. The blockchain uses the proof-of-authority (PoA) public chain and can access all information through the specified chain. This will achieve the goal of keeping development costs low and streamlining vaccine transit management so that countries in different economies can use them. Results: The openness of the blockchain helps to create transparency and data accuracy. This blockchain architecture contains a total of 3 entities. All approvals are published on Open Ledger. Smart certificates enable authorization and authentication, and encryption and decryption mechanisms guarantee data protection. This proof of concept demonstrates the design of blockchain architecture, which can achieve accurate global VP verification at an affordable price. In this study, an actual VP case was established and demonstrated. An open blockchain, an individually approved certification mechanism, and an international standard vaccination record were introduced. Conclusions: Blockchain architecture can be used to build a viable international VP authentication process with the advantages of low cost, high interoperability, effectiveness, security, and verifiability. %M 35377316 %R 10.2196/32411 %U https://publichealth.jmir.org/2022/4/e32411 %U https://doi.org/10.2196/32411 %U http://www.ncbi.nlm.nih.gov/pubmed/35377316 %0 Journal Article %@ 2563-3570 %I JMIR Publications %V 3 %N 1 %P e32401 %T Identification of Potential Vaccine Candidates Against SARS-CoV-2 to Fight COVID-19: Reverse Vaccinology Approach %A Gupta,Ekta %A Mishra,Rupesh Kumar %A Kumar Niraj,Ravi Ranjan %+ Amity University Rajasthan, SP-1, Kant Kalwar, RIICO Industrial Area, Jaipur, 303002, India, 91 9729559580, rrkniraj@gmail.com %K COVID-19 %K SARS-CoV-2 %K reverse vaccinology %K molecular docking %K molecular dynamics simulation %K vaccine candidates %K vaccine %K simulation %K virus %K peptide %K antigen %K immunology %K biochemistry %K genetics %D 2022 %7 26.4.2022 %9 Original Paper %J JMIR Bioinform Biotech %G English %X Background: The recent emergence of COVID-19 has caused an immense global public health crisis. The etiological agent of COVID-19 is the novel coronavirus SARS-CoV-2. More research in the field of developing effective vaccines against this emergent viral disease is indeed a need of the hour. Objective: The aim of this study was to identify effective vaccine candidates that can offer a new milestone in the battle against COVID-19. Methods: We used a reverse vaccinology approach to explore the SARS-CoV-2 genome among strains prominent in India. Epitopes were predicted and then molecular docking and simulation were used to verify the molecular interaction of the candidate antigenic peptide with corresponding amino acid residues of the host protein. Results: A promising antigenic peptide, GVYFASTEK, from the surface glycoprotein of SARS-CoV-2 (protein accession number QIA98583.1) was predicted to interact with the human major histocompatibility complex (MHC) class I human leukocyte antigen (HLA)-A*11-01 allele, showing up to 90% conservancy and a high antigenicity value. After vigorous analysis, this peptide was predicted to be a suitable epitope capable of inducing a strong cell-mediated immune response against SARS-CoV-2. Conclusions: These results could facilitate selecting SARS-CoV-2 epitopes for vaccine production pipelines in the immediate future. This novel research will certainly pave the way for a fast, reliable, and effective platform to provide a timely countermeasure against this dangerous virus responsible for the COVID-19 pandemic. %M 35506029 %R 10.2196/32401 %U https://bioinform.jmir.org/2022/1/e32401 %U https://doi.org/10.2196/32401 %U http://www.ncbi.nlm.nih.gov/pubmed/35506029 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 11 %N 1 %P e33360 %T Learning Agility of Learning and Development Professionals in the Life Sciences Field During the COVID-19 Pandemic: Empirical Study %A Peng,XinYun %A Wang-Trexler,Nicole %A Magagna,William %A Land,Susan %A Peck,Kyle %+ Department of Learning and Performance Systems, Pennsylvania State University, 301 Keller Building, University Park, PA, 16802, United States, 1 4154201314, xypeng@psu.edu %K COVID-19 %K learning agility %K learning and development professionals %K life sciences professionals %K training and development %K mixed methods %D 2022 %7 26.4.2022 %9 Original Paper %J Interact J Med Res %G English %X Background: The COVID-19 pandemic has impacted the life sciences field worldwide. Life sciences organizations (eg, pharmaceutical and med-tech companies) faced a rapidly increasing need for vital medical products, patient support, and vaccine development. Learning and development (L&D) departments play a crucial role in life sciences organizations as they apply learning initiatives to organizational strategy within a constantly evolving sector. During the COVID-19 pandemic, the work of L&D professionals in life sciences organizations changed profoundly during the abrupt shift to remote work, since learning and training normally occur in a face-to-face environment. Given the complex and dynamic situation of the pandemic, both individuals and organizations needed to learn quickly and apply what they learned to solve new, unprecedented problems. This situation presents an opportunity to study how characteristics of learning agility were evidenced by life sciences organizations and individual employees in the remote working mode. Objective: In collaboration with Life Sciences Trainers & Educators Networks (LTEN), this study investigated the responses and learning agility of L&D professionals and their organizational leadership within the life sciences sector to the work changes due to the pandemic. The study answered the following questions: (1) How did L&D professionals in the life sciences sector respond to the changes in their work environment during the COVID-19 pandemic? (2) How did L&D professionals in the life sciences sector demonstrate learning agility during remote working? Methods: We adopted a mixed methods approach that included a semistructured interview and a survey. Participants who were life sciences or health care L&D practitioners and in relevant positions were recruited via email through the LTEN and its partner pharmaceutical, biotech, or medical devices organizations. Interviews with 12 L&D professionals were conducted between June and August 2020 through phone or online conferencing, covering 22 open-ended questions to stimulate ideas that could be explored further in the survey. The semistructured interview questions were grounded in theory on learning agility. In total, 4 themes were developed from the interviews, which formed the basis for developing the survey items. The subsequent survey regarding 4 specific themes was conducted from August to October 2020 using Qualtrics. Both interview and survey data were analyzed based on a learning agility framework. Results: Findings revealed generally positive organizational and individual responses toward the changes brought about by the pandemic. Results also indicated that a disruptive crisis, such as the shift from working in the office to working from home (WFH), required professionals’ learning agility to both self-initiate their own learning and to support the learning agility of others in the organization. Conclusions: This study was designed to better understand education and training in the life sciences field, particularly during the unique circumstances of the global COVID-19 pandemic. We put forward several directions for future research on the learning agility of L&D professionals in life sciences organizations. %M 35417403 %R 10.2196/33360 %U https://www.i-jmr.org/2022/1/e33360 %U https://doi.org/10.2196/33360 %U http://www.ncbi.nlm.nih.gov/pubmed/35417403 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 10 %N 4 %P e37500 %T The Factors Associated With Nonuse of and Dissatisfaction With the National Patient Portal in Finland in the Era of COVID-19: Population-Based Cross-sectional Survey %A Kainiemi,Emma %A Vehko,Tuulikki %A Kyytsönen,Maiju %A Hörhammer,Iiris %A Kujala,Sari %A Jormanainen,Vesa %A Heponiemi,Tarja %+ Finnish Institute for Health and Welfare, PO Box 30, Mannerheimintie 166, Helsinki, 00271, Finland, 358 295248292, emma.kainiemi@thl.fi %K patient portal %K digital technology %K eHealth %K nonuse %K dissatisfaction %K COVID-19 %K digital health %K patient empowerment %K epidemiology %K population survey %K national survey %D 2022 %7 22.4.2022 %9 Original Paper %J JMIR Med Inform %G English %X Background: In the abnormal circumstances caused by the COVID-19 pandemic, patient portals have supported patient empowerment and engagement by providing patients with access to their health care documents and medical information. However, the potential benefits of patient portals cannot be utilized unless the patients accept and use the services. Disparities in the use of patient portals may exacerbate the already existing inequalities in health care access and health outcomes, possibly increasing the digital inequality in societies. Objective: The aim of this study is to examine the factors associated with nonuse of and dissatisfaction with the Finnish nationwide patient portal My Kanta Pages among the users of health care services during the COVID-19 outbreak. Several factors related to sociodemographic characteristics, health, and the use of health care services; experiences of guidance concerning electronic services; and digital skills and attitudes were evaluated. Methods: A national population survey was sent using stratified sampling to 13,200 Finnish residents who had reached the age of 20 years. Data were collected from September 2020 to February 2021 during the COVID-19 pandemic. Respondents who had used health care services and the internet for transactions or for searching for information in the past 12 months were included in the analyses. Bivariate logistic regression analyses were used to examine the adjusted associations of respondent characteristics with the nonuse of My Kanta Pages and dissatisfaction with the service. The inverse probability weighting (IPW) method was applied in all statistical analyses to correct for bias. Results: In total, 3919 (64.9%) of 6034 respondents were included in the study. Most respondents (3330/3919, 85.0%) used My Kanta Pages, and 2841 (85.3%) of them were satisfied. Nonusers (589/3919, 15%) were a minority among all respondents, and only 489 (14.7%) of the 3330 users were dissatisfied with the service. Especially patients without a long-term illness (odds ratio [OR] 2.14, 95% CI 1.48-3.10), those who were not referred to electronic health care services by a professional (OR 2.51, 95% CI 1.70-3.71), and those in need of guidance using online social and health care services (OR 2.26, 95% CI 1.41-3.65) were more likely nonusers of the patient portal. Perceptions of poor health (OR 2.10, 95% CI 1.51-2.93) and security concerns (OR 1.87, 95% CI 1.33-2.62) were associated with dissatisfaction with the service. Conclusions: Patients without long-term illnesses, those not referred to electronic health care services, and those in need of guidance on the use of online social and health care services seemed to be more likely nonusers of the Finnish nationwide patient portal. Moreover, poor health and security concerns appeared to be associated with dissatisfaction with the service. Interventions to promote referral to electronic health care services by professionals are needed. Attention should be targeted to information security of the service and promotion of the public’s confidence in the protection of their confidential data. %M 35404831 %R 10.2196/37500 %U https://medinform.jmir.org/2022/4/e37500 %U https://doi.org/10.2196/37500 %U http://www.ncbi.nlm.nih.gov/pubmed/35404831 %0 Journal Article %@ 2563-6316 %I JMIR Publications %V 3 %N 2 %P e35862 %T COVID-19 Return to Sport: NFL Injury Prevalence Analysis %A Puga,Troy B %A Schafer,Joshua %A Agbedanu,Prince N %A Treffer,Kevin %+ College of Osteopathic Medicine, Kansas City University, 1750 Independence Ave, Kansas City, MO, 64106, United States, 1 719 821 9272, troy.puga@kansascity.edu %K COVID-19 %K sport %K injury %K prevalence %K cause %K data %K statistics %K pain %K training %K practice %K physiology %K adaptation %D 2022 %7 22.4.2022 %9 Original Paper %J JMIRx Med %G English %X Background: Sport injuries have been common among athletes across the globe for decades and have the potential to disrupt athletic careers, performance, and psyche. Many health professionals and organizations have undertaken injury mitigation strategies to prevent sport injuries through protective equipment, training protocols, and a host of other evidence-based practices. Many of these specialized training methods were disrupted due to protocols to mitigate the spread of COVID-19. This research examines the effects of the COVID-19 pandemic in relation to the prevalence of athletic injuries in the National Football League (NFL). Objective: During the COVID-19 pandemic, NFL teams and athletes across all levels of sport were reported to have reduced training in preparation for their seasons due to protocols to mitigate the spread of COVID-19. This study compares the prevalence of injury during the 2018, 2019, and 2020 NFL seasons, with the aim to determine the potential causes of the differences in injury prevalence. Methods: Official injury reports from each team were counted during the 17-week regular season of each year (2018, 2019, and 2020). The data were analyzed using an unpaired t test to compare the injury prevalence between each of the three seasons. Results: The 2018 season produced a total of 1561 injuries and a mean of 48.8 injuries per team. The 2019 season produced a total of 1897 injuries and a mean of 59.3 injuries per team, while the 2020 season produced a total of 2484 injuries and a mean of 77.6 injuries per team. An unpaired t test was performed using the data to compare the mean number of injuries per team during each of the seasons. Comparison of the 2020 season against the 2019 season showed a statistically significant difference (P<.001); comparison of the 2020 season to the 2018 season found a statistically significant difference (P<.001); and comparison between the 2019 and the 2018 seasons found a statistically significant difference (P=.03). Conclusions: Although the 2019 and 2018 seasons showed a statistically significant difference (P=.03), this difference is not as large when we compare the 2020 seasons versus the 2019 (P<.001) and 2018 (P<.001) seasons. The astronomical increase in injury prevalence during the 2020 season over the previous years raises the possibility that there was a reduced physiological adaptation to stress, due to the limited amount of training as a result of the closure of practice facilities in order to slow the spread of COVID-19. %M 35511457 %R 10.2196/35862 %U https://med.jmirx.org/2022/2/e35862 %U https://doi.org/10.2196/35862 %U http://www.ncbi.nlm.nih.gov/pubmed/35511457 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 4 %P e35971 %T The Effect of the COVID-19 Pandemic on Glycemic Monitoring and Other Processes of Care for Type 2 Diabetes: Protocol for a Retrospective Cohort Study %A Mathew,Mekha %A van Vlymen,Jeremy %A Meza-Torres,Bernardo %A Hinton,William %A Delanerolle,Gayathri %A Yonova,Ivelina %A Feher,Michael %A Fan,Xuejuan %A Liyanage,Harshana %A Joy,Mark %A Carinci,Fabrizio %A de Lusignan,Simon %+ Nuffield Department of Primary Care Health Sciences, University of Oxford, Eagle House, Walton Well Road, Jericho, Oxford, OX2 6ED, United Kingdom, 44 01865 617283, simon.delusignan@phc.ox.ac.uk %K cohort studies %K COVID-19 %K computerized medical record systems %K primary health care %K type 2 diabetes mellitus %K diabetes %K glycemic control %K monitoring %D 2022 %7 22.4.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Social distancing and other nonpharmaceutical interventions to reduce the spread of COVID-19 infection in the United Kingdom have led to substantial changes in delivering ongoing care for patients with chronic conditions, including type 2 diabetes mellitus (T2DM). Clinical guidelines for the management and prevention of complications for people with T2DM delivered in primary care services advise routine annual reviews and were developed when face-to-face consultations were the norm. The shift in consultations from face-to-face to remote consultations caused a reduction in direct clinical contact and may impact the process of care for people with T2DM. Objective: The aim of this study is to explore the impact of the COVID-19 pandemic’s first year on the monitoring of people with T2DM using routine annual reviews from a national primary care perspective in England. Methods: A retrospective cohort study of adults with T2DM will be performed using routinely collected primary care data from the Oxford-Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC). We will describe the change in the rate of monitoring of hemoglobin A1c (HbA1c) between the first year of the COVID-19 pandemic (2020) and the preceding year (2019). We will also report any change in the eight checks that make up the components of these reviews. The change in HbA1c monitoring rates will be determined using a multilevel logistic regression model, adjusting for patient and practice characteristics, and similarly, the change in a composite measure of the completeness of all eight checks will be modeled using ordinal regression. The models will be adjusted for the following patient-level variables: age, gender, socioeconomic status, ethnicity, COVID-19 shielding status, duration of diabetes, and comorbidities. The model will also be adjusted for the following practice-level variables: urban versus rural, practice size, Quality and Outcomes Framework achievement, the National Health Service region, and the proportion of face-to-face consultations. Ethical approval was provided by the University of Oxford Medical Sciences Interdivisional Research Ethics Committee (September 2, 2021, reference R77306/RE001). Results: The analysis of the data extract will include 3.96 million patients with T2DM across 700 practices, which is 6% of the available Oxford-RCGP RSC adult population. The preliminary results will be submitted to a conference under the domain of primary care. The resulting publication will be submitted to a peer-reviewed journal on diabetes and endocrinology. Conclusions: The COVID-19 pandemic has impacted the delivery of care, but little is known about the process of caring for people with T2DM. This study will report the impact of the COVID-19 pandemic on these processes of care. International Registered Report Identifier (IRRID): DERR1-10.2196/35971 %M 35417404 %R 10.2196/35971 %U https://www.researchprotocols.org/2022/4/e35971 %U https://doi.org/10.2196/35971 %U http://www.ncbi.nlm.nih.gov/pubmed/35417404 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 2 %N 1 %P e30885 %T US Black Maternal Health Advocacy Topics and Trends on Twitter: Temporal Infoveillance Study %A Grigsby-Toussaint,Diana %A Champagne,Ashley %A Uhr,Justin %A Silva,Elizabeth %A Noh,Madeline %A Bradley,Adam %A Rashleigh,Patrick %+ Department of Epidemiology, School of Public Health, Brown University, 121 S Main Street, Providence, RI, 02903, United States, 1 401 863 6164, diana_grigsby-toussaint@brown.edu %K Black maternal health %K disparity %K COVID-19 %K Twitter %K topic modeling %K digital humanities %K infoveillance %K maternal health %K minority %K women %K advocacy %K social media %K model %K trend %K feasibility %D 2022 %7 20.4.2022 %9 Original Paper %J JMIR Infodemiology %G English %X Background: Black women in the United States disproportionately suffer adverse pregnancy and birth outcomes compared to White women. Economic adversity and implicit bias during clinical encounters may lead to physiological responses that place Black women at higher risk for adverse birth outcomes. The novel coronavirus disease of 2019 (COVID-19) further exacerbated this risk, as safety protocols increased social isolation in clinical settings, thereby limiting opportunities to advocate for unbiased care. Twitter, 1 of the most popular social networking sites, has been used to study a variety of issues of public interest, including health care. This study considers whether posts on Twitter accurately reflect public discourse during the COVID-19 pandemic and are being used in infodemiology studies by public health experts. Objective: This study aims to assess the feasibility of Twitter for identifying public discourse related to social determinants of health and advocacy that influence maternal health among Black women across the United States and to examine trends in sentiment between 2019 and 2020 in the context of the COVID-19 pandemic. Methods: Tweets were collected from March 1 to July 13, 2020, from 21 organizations and influencers and from 4 hashtags that focused on Black maternal health. Additionally, tweets from the same organizations and hashtags were collected from the year prior, from March 1 to July 13, 2019. Twint, a Python programming library, was used for data collection and analysis. We gathered the text of approximately 17,000 tweets, as well as all publicly available metadata. Topic modeling and k-means clustering were used to analyze the tweets. Results: A variety of trends were observed when comparing the 2020 data set to the 2019 data set from the same period. The percentages listed for each topic are probabilities of that topic occurring in our corpus. In our topic models, tweets on reproductive justice, maternal mortality crises, and patient care increased by 67.46% in 2020 versus 2019. Topics on community, advocacy, and health equity increased by over 30% in 2020 versus 2019. In contrast, tweet topics that decreased in 2020 versus 2019 were as follows: tweets on Medicaid and medical coverage decreased by 27.73%, and discussions about creating space for Black women decreased by just under 30%. Conclusions: The results indicate that the COVID-19 pandemic may have spurred an increased focus on advocating for improved reproductive health and maternal health outcomes among Black women in the United States. Further analyses are needed to capture a longer time frame that encompasses more of the pandemic, as well as more diverse voices to confirm the robustness of the findings. We also concluded that Twitter is an effective source for providing a snapshot of relevant topics to guide Black maternal health advocacy efforts. %M 35578642 %R 10.2196/30885 %U https://infodemiology.jmir.org/2022/1/e30885 %U https://doi.org/10.2196/30885 %U http://www.ncbi.nlm.nih.gov/pubmed/35578642 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 5 %N 2 %P e35320 %T Lessons Learned Recruiting and Retaining Pregnant and Postpartum Individuals in Digital Trials: Viewpoint %A Parks,Amanda M %A Duffecy,Jennifer %A McCabe,Jennifer E %A Blankstein Breman,Rachel %A Milgrom,Jeannette %A Hirshler,Yafit %A Gemmill,Alan W %A Segre,Lisa S %A Felder,Jennifer N %A Uscher-Pines,Lori %+ Department of Psychology, Virginia Commonwealth University, 806 West Franklin Street, Box 842018, Richmond, VA, 23284-2018, United States, 1 301 395 7925, parksam2@vcu.edu %K digital trials %K maternal and child health %K pregnant and postpartum individuals %K fraudulent enrollment %K retention and recruitment %K pediatrics %K parenting %K pregnant women %K COVID-19 %K pandemic %K postpartum %K digital health %D 2022 %7 20.4.2022 %9 Viewpoint %J JMIR Pediatr Parent %G English %X In an increasingly connected world and in the midst of a global pandemic, digital trials offer numerous advantages over traditional trials that rely on physical study sites. Digital trials have the potential to improve access to research and clinical treatments for the most vulnerable and minoritized, including pregnant and postpartum individuals. However, digital trials are underutilized in maternal and child health research, and there is limited evidence to inform the design and conduct of digital trials. Our research collaborative, consisting of 5 research teams in the U.S. and Australia, aimed to address this gap. We collaborated to share lessons learned from our experiences recruiting and retaining pregnant and postpartum individuals in digital trials of social and behavioral interventions. We first discuss the promise of digital trials in improving participation in research during the perinatal period, as well as the unique challenges they pose. Second, we present lessons learned from 12 completed and ongoing digital trials that have used platforms such as Ovia, Facebook, and Instagram for recruitment. Our trials evaluated interventions for breastfeeding, prenatal and postpartum depression, insomnia, decision making, and chronic pain. We focus on challenges and lessons learned in 3 key areas: (1) rapid recruitment of large samples with a diversity of minoritized identities, (2) retention of study participants in longitudinal studies, and (3) prevention of fraudulent enrollment. We offer concrete strategies that we pilot-tested to address these challenges. Strategies presented in this commentary can be incorporated, as well as formally evaluated, in future studies. %M 35107422 %R 10.2196/35320 %U https://pediatrics.jmir.org/2022/2/e35320 %U https://doi.org/10.2196/35320 %U http://www.ncbi.nlm.nih.gov/pubmed/35107422 %0 Journal Article %@ 2561-1011 %I JMIR Publications %V 6 %N 1 %P e30661 %T Physical Activity in Patients With Heart Failure During and After COVID-19 Lockdown: Single-Center Observational Retrospective Study %A Brasca,Francesco Maria Angelo %A Casale,Maria Carla %A Canevese,Fabio Lorenzo %A Tortora,Giovanni %A Pagano,Giulia %A Botto,Giovanni Luca %+ Department of Electrophysiology and Clinical Arrhythmology, Azienda Socio Sanitaria Territoriale Rhodense, Via Forlanini 95, Garbagnate Milanese, Milano, 20024, Italy, 39 02994303391, fmabrasca@gmail.com %K heart failure %K physical activity %K COVID-19 %K remote monitoring %K implantable cardiac device %K monitoring %K exercise %K surveillance %K lockdown %K cardiovascular %K heart %K retrospective %K burden %D 2022 %7 19.4.2022 %9 Original Paper %J JMIR Cardio %G English %X Background: The COVID-19 pandemic forced several European governments to impose severe lockdown measures. The reduction of physical activity during the lockdown could have been deleterious. Objective: The aim of this observational, retrospective study was to investigate the effect of the lockdown strategy on the physical activity burden and subsequent reassessment in a group of patients with heart failure who were followed by means of remote monitoring. Methods: We analyzed remote monitoring transmissions during the 3-month period immediately preceding the lockdown, 69 days of lockdown, and 3-month period after the first lockdown in a cohort of patients with heart failure from a general hospital in Lombardy, Italy. We compared variation of daily physical activity measured by cardiac implantable electrical devices with clinical variables collected in a hospital database. Results: We enrolled 41 patients with heart failure that sent 176 transmissions. Physical activity decreased during the lockdown period (mean 3.4, SD 1.9 vs mean 2.9, SD 1.8 hours/day; P<.001) but no significant difference was found when comparing the period preceding and following the lockdown (–0.0007 hours/day; P=.99). We found a significant correlation between physical activity reduction during and after the lockdown (R2=0.45, P<.001). The only significant predictor of exercise variation in the postlockdown period was the lockdown to prelockdown physical activity ratio. Conclusions: An excessive reduction of exercise in patients with heart failure decreased the tolerance to exercise, especially in patients with more comorbidities. Remote monitoring demonstrated exercise reduction, suggesting its potential utility to encourage patients to maintain their usual physical activity levels. %M 35103602 %R 10.2196/30661 %U https://cardio.jmir.org/2022/1/e30661 %U https://doi.org/10.2196/30661 %U http://www.ncbi.nlm.nih.gov/pubmed/35103602 %0 Journal Article %@ 2563-6316 %I JMIR Publications %V 3 %N 2 %P e35356 %T Google Trends as a Predictive Tool for COVID-19 Vaccinations in Italy: Retrospective Infodemiological Analysis %A Rovetta,Alessandro %+ R&C Research, Via Brede Traversa II, Bovezzo, 25073, Italy, 39 3927112808, rovetta.mresearch@gmail.com %K COVID-19 %K epidemiology %K Google Trends %K infodemiology %K infoveillance %K Italy %K public health %K SARS-CoV-2 %K vaccinations %K vaccines %K social media analysis %K social media %D 2022 %7 19.4.2022 %9 Original Paper %J JMIRx Med %G English %X Background: Google Trends is an infoveillance tool widely used by the scientific community to investigate different user behaviors related to COVID-19. However, several limitations regarding its adoption are reported in the literature. Objective: This paper aims to provide an effective and efficient approach to investigating vaccine adherence against COVID-19 via Google Trends. Methods: Through the cross-correlational analysis of well-targeted hypotheses, we investigate the predictive capacity of web searches related to COVID-19 toward vaccinations in Italy from November 2020 to November 2021. The keyword “vaccine reservation” query (VRQ) was chosen as it reflects a real intention of being vaccinated (V). Furthermore, the impact of the second most read Italian newspaper (vaccine-related headlines [VRH]) on vaccine-related web searches was investigated to evaluate the role of the mass media as a confounding factor. Fisher r-to-z transformation (z) and percentage difference (δ) were used to compare Spearman coefficients. A regression model V=f(VRH, VRQ) was built to validate the results found. The Holm-Bonferroni correction was adopted (P*). SEs are reported. Results: Simple and generic keywords are more likely to identify the actual web interest in COVID-19 vaccines than specific and elaborated keywords. Cross-correlations between VRQ and V were very strong and significant (min r²=0.460, P*<.001, lag 0 weeks; max r²=0.903, P*<.001, lag 6 weeks). The remaining cross-correlations have been markedly lower (δ>55.8%; z>5.8; P*<.001). The regression model confirmed the greater significance of VRQ versus VRH (P*<.001 vs P=.03, P*=.29). Conclusions: This research provides preliminary evidence in favor of using Google Trends as a surveillance and prediction tool for vaccine adherence against COVID-19 in Italy. Further research is needed to establish the appropriate use and limits of Google Trends for vaccination tracking. However, these findings prove that the search for suitable keywords is a fundamental step to reduce confounding factors. Additionally, targeting hypotheses helps diminish the likelihood of spurious correlations. It is recommended that Google Trends be leveraged as a complementary infoveillance tool by government agencies to monitor and predict vaccine adherence in this and future crises by following the methods proposed in this paper. %M 35481982 %R 10.2196/35356 %U https://med.jmirx.org/2022/2/e35356 %U https://doi.org/10.2196/35356 %U http://www.ncbi.nlm.nih.gov/pubmed/35481982 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 2 %N 1 %P e33909 %T Examining Public Sentiments and Attitudes Toward COVID-19 Vaccination: Infoveillance Study Using Twitter Posts %A Chandrasekaran,Ranganathan %A Desai,Rashi %A Shah,Harsh %A Kumar,Vivek %A Moustakas,Evangelos %+ Department of Information and Decision Sciences, University of Illinois at Chicago, 2428 Univ Hall MC 294, 601 S Morgan St, Chicago, IL, 60607, United States, 1 3129962676, ranga@uic.edu %K coronavirus %K infoveillance %K COVID-19 %K vaccination %K social media %K Twitter study %K text mining %K sentiment analysis %K topic modeling %K tweets %K content analysis %D 2022 %7 15.4.2022 %9 Original Paper %J JMIR Infodemiology %G English %X Background: A global rollout of vaccinations is currently underway to mitigate and protect people from the COVID-19 pandemic. Several individuals have been using social media platforms such as Twitter as an outlet to express their feelings, concerns, and opinions about COVID-19 vaccines and vaccination programs. This study examined COVID-19 vaccine–related tweets from January 1, 2020, to April 30, 2021, to uncover the topics, themes, and variations in sentiments of public Twitter users. Objective: The aim of this study was to examine key themes and topics from COVID-19 vaccine–related English tweets posted by individuals, and to explore the trends and variations in public opinions and sentiments. Methods: We gathered and assessed a corpus of 2.94 million COVID-19 vaccine–related tweets made by 1.2 million individuals. We used CoreX topic modeling to explore the themes and topics underlying the tweets, and used VADER sentiment analysis to compute sentiment scores and examine weekly trends. We also performed qualitative content analysis of the top three topics pertaining to COVID-19 vaccination. Results: Topic modeling yielded 16 topics that were grouped into 6 broader themes underlying the COVID-19 vaccination tweets. The most tweeted topic about COVID-19 vaccination was related to vaccination policy, specifically whether vaccines needed to be mandated or optional (13.94%), followed by vaccine hesitancy (12.63%) and postvaccination symptoms and effects (10.44%) Average compound sentiment scores were negative throughout the 16 weeks for the topics postvaccination symptoms and side effects and hoax/conspiracy. However, consistent positive sentiment scores were observed for the topics vaccination disclosure, vaccine efficacy, clinical trials and approvals, affordability, regulation, distribution and shortage, travel, appointment and scheduling, vaccination sites, advocacy, opinion leaders and endorsement, and gratitude toward health care workers. Reversal in sentiment scores in a few weeks was observed for the topics vaccination eligibility and hesitancy. Conclusions: Identification of dominant themes, topics, sentiments, and changing trends about COVID-19 vaccination can aid governments and health care agencies to frame appropriate vaccination programs, policies, and rollouts. %M 35462735 %R 10.2196/33909 %U https://infodemiology.jmir.org/2022/1/e33909 %U https://doi.org/10.2196/33909 %U http://www.ncbi.nlm.nih.gov/pubmed/35462735 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 4 %P e33733 %T Interactive Versus Static Decision Support Tools for COVID-19: Randomized Controlled Trial %A Röbbelen,Alice %A Schmieding,Malte L %A Kopka,Marvin %A Balzer,Felix %A Feufel,Markus A %+ Institute of Medical Informatics, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, Berlin, 10117, Germany, 49 30 450 570 425, malte.schmieding@charite.de %K clinical decision support %K usability %K COVID-19 %K consumer health %K medical informatic %K symptom checker %K decision support %K symptom %K support %K decision making %K algorithm %K flowchart %K agent %D 2022 %7 15.4.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: During the COVID-19 pandemic, medical laypersons with symptoms indicative of a COVID-19 infection commonly sought guidance on whether and where to find medical care. Numerous web-based decision support tools (DSTs) have been developed, both by public and commercial stakeholders, to assist their decision making. Though most of the DSTs’ underlying algorithms are similar and simple decision trees, their mode of presentation differs: some DSTs present a static flowchart, while others are designed as a conversational agent, guiding the user through the decision tree’s nodes step-by-step in an interactive manner. Objective: This study aims to investigate whether interactive DSTs provide greater decision support than noninteractive (ie, static) flowcharts. Methods: We developed mock interfaces for 2 DSTs (1 static, 1 interactive), mimicking patient-facing, freely available DSTs for COVID-19-related self-assessment. Their underlying algorithm was identical and based on the Centers for Disease Control and Prevention’s guidelines. We recruited adult US residents online in November 2020. Participants appraised the appropriate social and care-seeking behavior for 7 fictitious descriptions of patients (case vignettes). Participants in the experimental groups received either the static or the interactive mock DST as support, while the control group appraised the case vignettes unsupported. We determined participants’ accuracy, decision certainty (after deciding), and mental effort to measure the quality of decision support. Participants’ ratings of the DSTs’ usefulness, ease of use, trust, and future intention to use the tools served as measures to analyze differences in participants’ perception of the tools. We used ANOVAs and t tests to assess statistical significance. Results: Our survey yielded 196 responses. The mean number of correct assessments was higher in the intervention groups (interactive DST group: mean 11.71, SD 2.37; static DST group: mean 11.45, SD 2.48) than in the control group (mean 10.17, SD 2.00). Decisional certainty was significantly higher in the experimental groups (interactive DST group: mean 80.7%, SD 14.1%; static DST group: mean 80.5%, SD 15.8%) compared to the control group (mean 65.8%, SD 20.8%). The differences in these measures proved statistically significant in t tests comparing each intervention group with the control group (P<.001 for all 4 t tests). ANOVA detected no significant differences regarding mental effort between the 3 study groups. Differences between the 2 intervention groups were of small effect sizes and nonsignificant for all 3 measures of the quality of decision support and most measures of participants’ perception of the DSTs. Conclusions: When the decision space is limited, as is the case in common COVID-19 self-assessment DSTs, static flowcharts might prove as beneficial in enhancing decision quality as interactive tools. Given that static flowcharts reveal the underlying decision algorithm more transparently and require less effort to develop, they might prove more efficient in providing guidance to the public. Further research should validate our findings on different use cases, elaborate on the trade-off between transparency and convenience in DSTs, and investigate whether subgroups of users benefit more with 1 type of user interface than the other. Trial Registration: Deutsches Register Klinischer Studien DRKS00028136; https://tinyurl.com/4bcfausx (retrospectively registered) %M 34882571 %R 10.2196/33733 %U https://publichealth.jmir.org/2022/4/e33733 %U https://doi.org/10.2196/33733 %U http://www.ncbi.nlm.nih.gov/pubmed/34882571 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 4 %P e35854 %T Decreased Physical Activity Among Youth Resulting From COVID-19 Pandemic–Related School Closures: Natural Experimental Study %A Grimes,Amanda %A Lightner,Joseph S %A Eighmy,Katlyn %A Steel,Chelsea %A Shook,Robin P %A Carlson,Jordan %+ School of Nursing and Health Studies, University of Missouri-Kansas City, 2464 Charlotte St, Kansas City, MO, 64108, United States, 1 8162106043, grimesa@umkc.edu %K intervention %K physical activity %K nutrition %K adolescents %K formative research %K COVID-19 %K pandemic %K school closure %K children %K youth %D 2022 %7 15.4.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic has resulted in the closure of schools and may have inadvertently resulted in decreased physical activity for youth. Emerging evidence suggests that school closures due to the COVID-19 pandemic could have hastened the inactivity of youth, possibly due to a lack of structure outside of school and increased access to sedentary activities. Objective: The purpose of this study was to assess changes in physical activity from pre–school closure (before the pandemic) to post–school closure (during the pandemic) among youth in spring 2020. Methods: This study used a natural experimental design; youth were enrolled in a physical activity study prior to the lockdown, which was enforced due to the pandemic. The number of device-assessed steps per day and moderate-to-vigorous physical activity minutes per week were measured by using a Garmin Vivofit 4 (Garmin Ltd) accelerometer over 8 weeks. Mixed effects models were used to compare physical activity variables, which were measured before and during the COVID-19 pandemic. Results: Youth were primarily Hispanic or Latinx (8/17, 47%) and female (10/17, 59%). The number of daily steps decreased by 45.4% during the school closure, from a pre–school closure mean of 8003 steps per day to a post–school closure mean of 4366 steps per day. Daily moderate-to-vigorous physical activity decreased by 42.5%, from a pre–school closure mean of 80.18 minutes per week to a post–school closure mean of 46.13 minutes per week. Conclusions: Youth are engaging in roughly half as much physical activity during the school closure as they were prior to the school closure. If additional evidence supports these claims, interventions are needed to support youths’ engagement in physical activity in the Midwest. %M 35297778 %R 10.2196/35854 %U https://formative.jmir.org/2022/4/e35854 %U https://doi.org/10.2196/35854 %U http://www.ncbi.nlm.nih.gov/pubmed/35297778 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 4 %P e26438 %T Single-Session, Internet-Based Cognitive Behavioral Therapy to Improve Parenting Skills to Help Children Cope With Anxiety During the COVID-19 Pandemic: Feasibility Study %A Korpilahti-Leino,Tarja %A Luntamo,Terhi %A Ristkari,Terja %A Hinkka-Yli-Salomäki,Susanna %A Pulkki-Råback,Laura %A Waris,Otto %A Matinolli,Hanna-Maria %A Sinokki,Atte %A Mori,Yuko %A Fukaya,Mami %A Yamada,Yuko %A Sourander,Andre %+ Research Centre for Child Psychiatry, Department of Clinical Medicine, Faculty of Medicine, University of Turku, Lemminkäisenkatu 3, Turku, 20520, Finland, 358 50 365 3447, andre.sourander@utu.fi %K adolescent %K anxiety %K child %K cognitive behavioral therapy %K coping %K COVID-19 %K Internet %K mental health %K parents %K web-based %D 2022 %7 13.4.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic has had a major impact on families’ daily routines and psychosocial well-being, and technology has played a key role in providing socially distanced health care services. Objective: The first objective of this paper was to describe the content and delivery of a single-session, internet-based cognitive behavioral therapy (iCBT) intervention, which has been developed to help parents cope with children’s anxiety and manage daily situations with their children. The second objective was to report user adherence and satisfaction among the first participants who completed the intervention. Methods: The Let’s Cope Together intervention has been developed by our research group. It combines evidence-based CBT elements, such as psychoeducation and skills to manage anxiety, with parent training programs that strengthen how parents interact with their child and handle daily situations. A pre-post design was used to examine user satisfaction and the skills the parents learned. Participants were recruited using advertisements, media activity, day care centers, and schools and asked about background characteristics, emotional symptoms, and parenting practices before they underwent the iCBT. After they completed the 7 themes, they were asked what new parenting skills they had learned from the iCBT and how satisfied they were with the program. Results: Of the 602 participants who filled in the baseline survey, 196 (32.6%) completed the program’s 7 themes, and 189 (31.4%) completed the postintervention survey. Most (138/189, 73.0%) of the participants who completed the postintervention survey were satisfied with the program and had learned skills that eased both their anxiety (141/189, 74.6%) and their children’s anxiety (157/189, 83.1%). The majority (157/189, 83.1%) reported that they learned how to organize their daily routines better, and just over one-half (100/189, 53.0%) reported that the program improved how they planned each day with their children. Conclusions: The single-session iCBT helped parents to face the psychological demands of the COVID-19 pandemic. Future studies should determine how the participation rate and adherence can be optimized in digital, universal interventions. This will help to determine what kinds of programs should be developed, including their content and delivery. %M 35138265 %R 10.2196/26438 %U https://www.jmir.org/2022/4/e26438 %U https://doi.org/10.2196/26438 %U http://www.ncbi.nlm.nih.gov/pubmed/35138265 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 2 %P e30523 %T Requirements for a Bespoke Intensive Care Unit Dashboard in Response to the COVID-19 Pandemic: Semistructured Interview Study %A Davidson,Brittany %A Ferrer Portillo,Katiuska Mara %A Wac,Marceli %A McWilliams,Chris %A Bourdeaux,Christopher %A Craddock,Ian %+ Department of Electrical & Electronic Engineering, University of Bristol, 1 Cathedral Square, Bristol, BS1 5DD, United Kingdom, 44 07774286342, m.wac@bristol.ac.uk %K intensive care %K critical care %K COVID-19 %K human-centered design %K dashboard %K eHealth %K disease monitoring %K monitoring %K ICU %K design %K development %K interview %D 2022 %7 13.4.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Intensive care units (ICUs) around the world are in high demand due to patients with COVID-19 requiring hospitalization. As researchers at the University of Bristol, we were approached to develop a bespoke data visualization dashboard to assist two local ICUs during the pandemic that will centralize disparate data sources in the ICU to help reduce the cognitive load on busy ICU staff in the ever-evolving pandemic. Objective: The aim of this study was to conduct interviews with ICU staff in University Hospitals Bristol and Weston National Health Service Foundation Trust to elicit requirements for a bespoke dashboard to monitor the high volume of patients, particularly during the COVID-19 pandemic. Methods: We conducted six semistructured interviews with clinical staff to obtain an overview of their requirements for the dashboard and to ensure its ultimate suitability for end users. Interview questions aimed to understand the job roles undertaken in the ICU, potential uses of the dashboard, specific issues associated with managing COVID-19 patients, key data of interest, and any concerns about the introduction of a dashboard into the ICU. Results: From our interviews, we found the following design requirements: (1) a flexible dashboard, where the functionality can be updated quickly and effectively to respond to emerging information about the management of this new disease; (2) a mobile dashboard, which allows staff to move around on wards with a dashboard, thus potentially replacing paper forms to enable detailed and consistent data entry; (3) a customizable and intuitive dashboard, where individual users would be able to customize the appearance of the dashboard to suit their role; (4) real-time data and trend analysis via informative data visualizations that help busy ICU staff to understand a patient’s clinical trajectory; and (5) the ability to manage tasks and staff, tracking both staff and patient movements, handovers, and task monitoring to ensure the highest quality of care. Conclusions: The findings of this study confirm that digital solutions for ICU use would potentially reduce the cognitive load of ICU staff and reduce clinical errors at a time of notably high demand of intensive health care. %M 35038301 %R 10.2196/30523 %U https://humanfactors.jmir.org/2022/2/e30523 %U https://doi.org/10.2196/30523 %U http://www.ncbi.nlm.nih.gov/pubmed/35038301 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 2 %N 1 %P e33827 %T Identifying Frames of the COVID-19 Infodemic: Thematic Analysis of Misinformation Stories Across Media %A Mohammadi,Ehsan %A Tahamtan,Iman %A Mansourian,Yazdan %A Overton,Holly %+ School of Information Sciences, University of South Carolina, Davis College, Room 207, 1501 Greene Street, Columbia, SC, 29208, United States, 1 803 777 2324, ehsan2@sc.edu %K COVID-19 %K pandemic %K misinformation %K fake news %K framing theory %K social media %K infodemic %K thematic analysis %K theme %K social media %K pattern %K prevalence %D 2022 %7 13.4.2022 %9 Original Paper %J JMIR Infodemiology %G English %X Background: The word “infodemic” refers to the deluge of false information about an event, and it is a global challenge for today’s society. The sheer volume of misinformation circulating during the COVID-19 pandemic has been harmful to people around the world. Therefore, it is important to study different aspects of misinformation related to the pandemic. Objective: This paper aimed to identify the main subthemes related to COVID-19 misinformation on various platforms, from traditional outlets to social media. This paper aimed to place these subthemes into categories, track the changes, and explore patterns in prevalence, over time, across different platforms and contexts. Methods: From a theoretical perspective, this research was rooted in framing theory; it also employed thematic analysis to identify the main themes and subthemes related to COVID-19 misinformation. The data were collected from 8 fact-checking websites that formed a sample of 127 pieces of false COVID-19 news published from January 1, 2020 to March 30, 2020. Results: The findings revealed 4 main themes (attribution, impact, protection and solutions, and politics) and 19 unique subthemes within those themes related to COVID-19 misinformation. Governmental and political organizations (institutional level) and administrators and politicians (individual level) were the 2 most frequent subthemes, followed by origination and source, home remedies, fake statistics, treatments, drugs, and pseudoscience, among others. Results indicate that the prevalence of misinformation subthemes had altered over time between January 2020 and March 2020. For instance, false stories about the origin and source of the virus were frequent initially (January). Misinformation regarding home remedies became a prominent subtheme in the middle (February), while false information related to government organizations and politicians became popular later (March). Although conspiracy theory web pages and social media outlets were the primary sources of misinformation, surprisingly, results revealed trusted platforms such as official government outlets and news organizations were also avenues for creating COVID-19 misinformation. Conclusions: The identified themes in this study reflect some of the information attitudes and behaviors, such as denial, uncertainty, consequences, and solution-seeking, that provided rich information grounds to create different types of misinformation during the COVID-19 pandemic. Some themes also indicate that the application of effective communication strategies and the creation of timely content were used to persuade human minds with false stories in different phases of the crisis. The findings of this study can be beneficial for communication officers, information professionals, and policy makers to combat misinformation in future global health crises or related events. %M 37113806 %R 10.2196/33827 %U https://infodemiology.jmir.org/2022/1/e33827 %U https://doi.org/10.2196/33827 %U http://www.ncbi.nlm.nih.gov/pubmed/37113806 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 2 %P e33165 %T The Acceptability of Digital Technology and Tele-Exercise in the Age of COVID-19: Cross-sectional Study %A Ho,Vanda %A Merchant,Reshma A %+ Division of Geriatric Medicine, Department of Medicine, National University Hospital, 1E Kent Ridge Rd, Tower Block Level 10, Division of Geriatric Medicine, Singapore, 119228, Singapore, 65 6779 5555, reshmaa@nuhs.edu.sg %K senior %K telehealth %K digital exercise %K acceptability %K telemedicine %K elderly %K older adults %K outcome %K isolation %K decline %K function %K adoption %K perception %K exercise %K physical activity %K questionnaire %K COVID-19 %D 2022 %7 13.4.2022 %9 Original Paper %J JMIR Aging %G English %X Background: With the COVID-19 pandemic, telehealth has been increasingly used to offset the negative outcomes of social isolation and functional decline in older adults. Crucial to the success of telehealth is end user adoption. Objective: This study aims to investigate perception and acceptability of digital technology among Asian older adults. Methods: The Healthy Ageing Promotion Program for You (HAPPY) dual-task exercise was conducted virtually to participants aged ≥60 years. Questionnaires were administered digitally and collected data on demographics, perceptions of digital technology and evaluation of HAPPY, the 6-item Lubben Social Network Scale, intrinsic capacity using the Integrated Care for Older People tool, and a functional screening with the FRAIL scale and five chair rises. Descriptive analysis was used. Results: A total of 42 participants were digitally interviewed. The mean age was 69.1 (4.7) years. Hearing, vision, and 3-item recall difficulty were present in 14% (n=6), 12% (n=5), and 24% (n=10) of participants, respectively. Of the participants, 29% (n=12) had possible sarcopenia and 14% (n=6) were prefrail. Around 24% (n=10) were at risk of social isolation. Most of the participants (n=38, 91%) agreed that technology is good, and 79% (n=33) agreed that technology would allow them to be independent for longer. Over three-quarters of participants (n=33, 79%) agreed that they have the necessary knowledge, and 91% (n=38) had technological assistance available. However, 57% (n=24) were still apprehensive about using technology. Despite 71% (n=30) of older adults owning their devices, 36% (n=15) felt finances were limiting. Through digital HAPPY, 45% (n=19) of participants reported feeling stronger, 48% (n=20) had improved spirits, and 40% (n=17) and 38% (n=16) had improved mood and memory, respectively. Conclusions: The majority of older adults in this study believed in digital technology and had the necessary knowledge and help, but almost half still felt apprehensive and had financial barriers to adopting technology. A digitally administered exercise program especially in a group setting is a feasible option to enhance intrinsic capacity in older adults. However, more work is needed in elucidating sources of apprehension and financial barriers to adopting technology. %M 35294921 %R 10.2196/33165 %U https://aging.jmir.org/2022/2/e33165 %U https://doi.org/10.2196/33165 %U http://www.ncbi.nlm.nih.gov/pubmed/35294921 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 4 %P e26335 %T Discussions and Misinformation About Electronic Nicotine Delivery Systems and COVID-19: Qualitative Analysis of Twitter Content %A Sidani,Jaime E %A Hoffman,Beth %A Colditz,Jason B %A Wolynn,Riley %A Hsiao,Lily %A Chu,Kar-Hai %A Rose,Jason J %A Shensa,Ariel %A Davis,Esa %A Primack,Brian %+ Center for Social Dynamics and Community Health, Department of Behavioral and Community Health Sciences, University of Pittsburgh School of Public Health, 130 DeSoto Street, Pittsburgh, PA, 15261, United States, 1 412 383 0733, jaime.sidani@pitt.edu %K COVID-19 %K coronavirus %K e-cigarette %K electronic nicotine delivery systems %K Twitter %K social media %K misinformation %K discussion %K public health %K communication %K concern %K severity %K conspiracy %D 2022 %7 13.4.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Misinformation and conspiracy theories related to COVID-19 and electronic nicotine delivery systems (ENDS) are increasing. Some of this may stem from early reports suggesting a lower risk of severe COVID-19 in nicotine users. Additionally, a common conspiracy is that the e-cigarette or vaping product use–associated lung injury (EVALI) outbreak of 2019 was actually an early presentation of COVID-19. This may have important public health ramifications for both COVID-19 control and ENDS use. Objective: Twitter is an ideal tool for analyzing real-time public discussions related to both ENDS and COVID-19. This study seeks to collect and classify Twitter messages (“tweets”) related to ENDS and COVID-19 to inform public health messaging. Methods: Approximately 2.1 million tweets matching ENDS-related keywords were collected from March 1, 2020, through June 30, 2020, and were then filtered for COVID-19–related keywords, resulting in 67,321 original tweets. A 5% (n=3366) subsample was obtained for human coding using a systematically developed codebook. Tweets were coded for relevance to the topic and four overarching categories. Results: A total of 1930 (57.3%) tweets were coded as relevant to the research topic. Half (n=1008, 52.2%) of these discussed a perceived association between ENDS use and COVID-19 susceptibility or severity, with 42.4% (n=818) suggesting that ENDS use is associated with worse COVID-19 symptoms. One-quarter (n=479, 24.8%) of tweets discussed the perceived similarity/dissimilarity of COVID-19 and EVALI, and 13.8% (n=266) discussed ENDS use behavior. Misinformation and conspiracy theories were present throughout all coding categories. Conclusions: Discussions about ENDS use and COVID-19 on Twitter frequently highlight concerns about the susceptibility and severity of COVID-19 for ENDS users; however, many contain misinformation and conspiracy theories. Public health messaging should capitalize on these concerns and amplify accurate Twitter messaging. %M 35311684 %R 10.2196/26335 %U https://formative.jmir.org/2022/4/e26335 %U https://doi.org/10.2196/26335 %U http://www.ncbi.nlm.nih.gov/pubmed/35311684 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 4 %P e36804 %T Social Media, Public Health, and Community Mitigation of COVID-19: Challenges, Risks, and Benefits %A Basch,Corey H %A Basch,Charles E %A Hillyer,Grace C %A Meleo-Erwin,Zoe C %+ Department of Public Health, William Paterson University, 300 Pompton Rd, Wayne, NJ, 07470, United States, 1 9737202603, baschc@wpunj.edu %K COVID-19 pandemic %K social media %K misinformation %K disinformation %K COVID-19 %K pandemic %K infodemiology %K health literacy %K health information %K public health %K COVID risk %K information seeking %D 2022 %7 12.4.2022 %9 Viewpoint %J J Med Internet Res %G English %X Shortly after the first case reports in 2019, COVID-19 was declared a pandemic. Early messages from trusted experts, which later proved to be inadequate or incorrect, highlight the need for continual adjustment of messages to the public as scientific knowledge evolves. During this time, social media exploded with greatly sought-after information, some of which was misinformation based on incomplete or incorrect facts or disinformation purposefully spread to advance a specific agenda. Because of the nature of social media, information, whether accurate or not at the time posted, lives on and remains accessible to the public even when its usefulness has been discredited. While the impact of mis/disinformation on COVID-19 risk-reducing behaviors is debatable, it is clear that social media has played a significant role in both extending the reach of COVID-19–related falsehoods and promoting evidence-based content. Over the last decade, social media has become a dominant source of information that consumers turn to for health information. A great deal of misinformation and disinformation has reached large numbers of social media users, which points to a need for the agencies of the US Public Health Service to create communications to convey accurate and current information and appeals that will actually be viewed. This viewpoint highlights the challenges, risks, and potential benefits that social media present in mitigating the COVID-19 pandemic. %M 35380539 %R 10.2196/36804 %U https://www.jmir.org/2022/4/e36804 %U https://doi.org/10.2196/36804 %U http://www.ncbi.nlm.nih.gov/pubmed/35380539 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 4 %P e33473 %T Web-Based Single Session Intervention for Perceived Control Over Anxiety During COVID-19: Randomized Controlled Trial %A Mullarkey,Michael %A Dobias,Mallory %A Sung,Jenna %A Ahuvia,Isaac %A Shumake,Jason %A Beevers,Christopher %A Schleider,Jessica %+ Department of Psychology, Stony Brook University, 100 Nicolls Rd, Stony Brook, NY, 11794, United States, 1 6316326000, Michael.Mullarkey@stonybrook.edu %K anxiety %K COVID-19 %K single-session intervention %K SSI %K perceived control %K intervention %K mental health %K control %K online intervention %K telemedicine %K telehealth %K scalable %D 2022 %7 12.4.2022 %9 Original Paper %J JMIR Ment Health %G English %X Background: Anxiety is rising across the United States during the COVID-19 pandemic, and social distancing mandates preclude in-person mental health care. Greater perceived control over anxiety has predicted decreased anxiety pathology, including adaptive responses to uncontrollable stressors. Evidence suggests that no-therapist, single-session interventions can strengthen perceived control over emotions like anxiety; similar programs, if designed for the COVID-19 context, could hold substantial public health value. Objective: Our registered report evaluated a no-therapist, single-session, online intervention targeting perceived control over anxiety in the COVID-19 context against a placebo intervention encouraging handwashing. We tested whether the intervention could (1) decrease generalized anxiety and increase perceived control over anxiety and (2) achieve this without decreasing social-distancing intentions. Methods: We tested these questions using a between-subjects design in a weighted-probability sample of US adults recruited via a closed online platform (ie, Prolific). All outcomes were indexed via online self-report questionnaires. Results: Of 522 randomized individuals, 500 (95.8%) completed the baseline survey and intervention. Intent-to-treat analyses using all randomized participants (N=522) found no support for therapeutic or iatrogenic effects; effects on generalized anxiety were d=–0.06 (95% CI –0.27 to 0.15; P=.48), effects on perceived control were d=0.04 (95% CI –0.08 to 0.16; P=.48), and effects on social-distancing intentions were d=–0.02 (95% CI –0.23 to 0.19; P=.83). Conclusions: Strengths of this study included a large, nationally representative sample and adherence to open science practices. Implications for scalable interventions, including the challenge of targeting perceived control over anxiety, are discussed. Trial Registration: ClinicalTrials.gov NCT04459455; https://clinicaltrials.gov/show/NCT04459455 %M 35230962 %R 10.2196/33473 %U https://mental.jmir.org/2022/4/e33473 %U https://doi.org/10.2196/33473 %U http://www.ncbi.nlm.nih.gov/pubmed/35230962 %0 Journal Article %@ 2563-6316 %I JMIR Publications %V 3 %N 2 %P e30144 %T Modeling Years of Life Lost Due to COVID-19, Socioeconomic Status, and Nonpharmaceutical Interventions: Development of a Prediction Model %A John,Jari %+ Institute of Political Science, University of Heidelberg, Bergheimer Str. 58, Heidelberg, 69115, Germany, 49 1636057958, jari.john@uni-heidelberg.de %K COVID-19 %K pandemic %K socioeconomic status %K mortality %K nonpharmaceutical interventions %K prediction model %K low-income status %K life expectancy %K public health %K income groups %D 2022 %7 12.4.2022 %9 Original Paper %J JMIRx Med %G English %X Background: Research in the COVID-19 pandemic focused on the health burden, thereby largely neglecting the potential harm to life from welfare losses. Objective: This paper develops a model that compares the years of life lost (YLL) due to COVID-19 and the potential YLL due to the socioeconomic consequences of its containment. Methods: It improves on existing estimates by conceptually disentangling YLL due to COVID-19 and socioeconomic status. By reconciling the normative life table approach with socioeconomic differences in life expectancy, it accounts for the fact that people with low socioeconomic status are hit particularly hard by the pandemic. The model also draws on estimates of socioeconomic differences in life expectancy to ascertain potential YLL due to income loss, school closures, and extreme poverty. Results: Tentative results suggest that if only one-tenth of the current socioeconomic damage becomes permanent in the future, it may carry a higher YLL burden than COVID-19 in the more likely pandemic scenarios. The model further suggests that the socioeconomic harm outweighs the disease burden due to COVID-19 more quickly in poorer and more unequal societies. Most urgently, the substantial increase in extreme poverty needs immediate attention. Avoiding a relatively minor number of 4 million unemployed, 1 million extremely poor, and 2 million students with a higher learning loss may save a similar amount of life years as saving 1 million people from dying from COVID-19. Conclusions: Primarily, the results illustrate the urgent need for redistributive policy interventions and global solidarity. In addition, the potentially high YLL burden from income and learning losses raises the burden of proof for the efficacy and necessity of school and business closures in the containment of the pandemic, especially where social safety nets are underdeveloped. %M 35438949 %R 10.2196/30144 %U https://med.jmirx.org/2022/2/e30144 %U https://doi.org/10.2196/30144 %U http://www.ncbi.nlm.nih.gov/pubmed/35438949 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 4 %P e33680 %T The Impact and Applications of Social Media Platforms for Public Health Responses Before and During the COVID-19 Pandemic: Systematic Literature Review %A Gunasekeran,Dinesh Visva %A Chew,Alton %A Chandrasekar,Eeshwar K %A Rajendram,Priyanka %A Kandarpa,Vasundhara %A Rajendram,Mallika %A Chia,Audrey %A Smith,Helen %A Leong,Choon Kit %+ National University of Singapore, 10 Medical Drive, Singapore, 117597, Singapore, 65 67723737, dineshvg@hotmail.sg %K digital health %K social media %K big data %K population health %K blockchain %K COVID-19 %K review %K benefit %K challenge %K public health %D 2022 %7 11.4.2022 %9 Review %J J Med Internet Res %G English %X Background:  Social media platforms have numerous potential benefits and drawbacks on public health, which have been described in the literature. The COVID-19 pandemic has exposed our limited knowledge regarding the potential health impact of these platforms, which have been detrimental to public health responses in many regions. Objective: This review aims to highlight a brief history of social media in health care and report its potential negative and positive public health impacts, which have been characterized in the literature. Methods:  We searched electronic bibliographic databases including PubMed, including Medline and Institute of Electrical and Electronics Engineers Xplore, from December 10, 2015, to December 10, 2020. We screened the title and abstracts and selected relevant reports for review of full text and reference lists. These were analyzed thematically and consolidated into applications of social media platforms for public health. Results:  The positive and negative impact of social media platforms on public health are catalogued on the basis of recent research in this report. These findings are discussed in the context of improving future public health responses and incorporating other emerging digital technology domains such as artificial intelligence. However, there is a need for more research with pragmatic methodology that evaluates the impact of specific digital interventions to inform future health policy. Conclusions:  Recent research has highlighted the potential negative impact of social media platforms on population health, as well as potentially useful applications for public health communication, monitoring, and predictions. More research is needed to objectively investigate measures to mitigate against its negative impact while harnessing effective applications for the benefit of public health. %M 35129456 %R 10.2196/33680 %U https://www.jmir.org/2022/4/e33680 %U https://doi.org/10.2196/33680 %U http://www.ncbi.nlm.nih.gov/pubmed/35129456 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 4 %P e28504 %T Association Between Mobile App Use and Caregivers’ Support System, Time Spent on Caregiving, and Perceived Well-being: Survey Study From a Large Employer %A Ozluk,Pelin %A Cobb,Rebecca %A Hoots,Alyson %A Sylwestrzak,Malgorzata %+ HealthCore Inc, 123 Justison Street Suite 200, Wilmington, DE, 19801, United States, 1 302 230 2023, pozluk@healthcore.com %K caregiving %K mobile app %K mobile phone %D 2022 %7 11.4.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Mobile technology to address caregiver needs has been on the rise. There is limited evidence of effectiveness of such technologies on caregiver experiences. Objective: This study evaluates the effectiveness of ianacare, a mobile app, among employees of a large employer. ianacare mobilizes personal social circles to help with everyday tasks. Through the use of ianacare, we evaluate the associations between coordinating caregiving tasks among a caregiver’s personal support network and outcomes related to the caregiver’s support system, time use, perceived productivity, and perceived health and well-being. Caregiver tasks include tasks such as meal preparation, respite care, pet care, and transportation. Time use is the measure of a caregiver’s time spent on caregiving tasks and how much time they had to take off from work to attend planned or unplanned caregiving tasks. Methods: We conducted 2 surveys to assess within-participant changes in outcomes for the unpaid, employed, caregivers after 6 weeks of using the mobile app (n=176) between March 30, 2020, and May 11, 2020. The surveys contained questions in three domains: the caregiver’s support system, time use and perceived productivity, and perceived health and well-being. The results of the linear probability models are presented below. Results: App use was significantly associated with decreasing the probability of doing most caregiving tasks alone by 9.1% points (SE 0.04; P=.01) and increasing the probability of at least one person helping the primary caregiver by 8.0% points (SE 0.035; P=.02). App use was also associated with improving the time use of the primary caregiver who took significantly less time off work to attend to caregiving duties by 12.5% points (SE 0.04; P=.003) and decreased the probability of spending more than 30 hours weekly on caregiving by 9.1% points (SE 0.04; P=.02). Additional findings on the positive impact of the app included a decrease in the probability of reporting feeling overwhelmed by caregiving tasks by 12.5% points (SE 0.04; P=.003) and a decrease in the probability of reporting negative health effects by 6.8% points (SE 0.04; P=.07) because of caregiving. Although subjects reported that COVID-19 increased their stress attributed to caregiving and prevented them from requesting help for some caregiving tasks, using the app was still associated with improvements in receiving help and lessening of the negative effects of caregiving on the caregivers. Conclusions: App use was associated with improvements in 7 of 11 caregiver outcomes across three main categories: their support system, time spent on caregiving, and perceived health and well-being. These findings provide encouraging evidence that the mobile app can significantly reduce caregiver burden by leveraging a caregiver’s support network despite the additional challenges brought by COVID-19 on caregivers. %M 35404266 %R 10.2196/28504 %U https://www.jmir.org/2022/4/e28504 %U https://doi.org/10.2196/28504 %U http://www.ncbi.nlm.nih.gov/pubmed/35404266 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 4 %P e34072 %T Pre2Pub—Tracking the Path From Preprint to Journal Article: Algorithm Development and Validation %A Langnickel,Lisa %A Podorskaja,Daria %A Fluck,Juliane %+ ZB MED - Information Centre for Life Sciences, Gleueler Straße 60, Cologne, 50931, Germany, 49 2287360355, langnickel@zbmed.de %K preprints %K information retrieval %K COVID-19 %K metadata %K BERT %K Bidirectional Encoder Representations from Transformers %D 2022 %7 8.4.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: The current COVID-19 crisis underscores the importance of preprints, as they allow for rapid communication of research results without delay in review. To fully integrate this type of publication into library information systems, we developed preview: a publicly available, central search engine for COVID-19–related preprints, which clearly distinguishes this source from peer-reviewed publications. The relationship between the preprint version and its corresponding journal version should be stored as metadata in both versions so that duplicates can be easily identified and information overload for researchers is reduced. Objective: In this work, we investigated the extent to which the relationship information between preprint and corresponding journal publication is present in the published metadata, how it can be further completed, and how it can be used in preVIEW to identify already republished preprints and filter those duplicates in search results. Methods: We first analyzed the information content available at the preprint servers themselves and the information that can be retrieved via Crossref. Moreover, we developed the algorithm Pre2Pub to find the corresponding reviewed article for each preprint. We integrated the results of those different resources into our search engine preVIEW, presented the information in the result set overview, and added filter options accordingly. Results: Preprints have found their place in publication workflows; however, the link from a preprint to its corresponding journal publication is not completely covered in the metadata of the preprint servers or in Crossref. Our algorithm Pre2Pub is able to find approximately 16% more related journal articles with a precision of 99.27%. We also integrate this information in a transparent way within preVIEW so that researchers can use it in their search. Conclusions: Relationships between the preprint version and its journal version is valuable information that can help researchers finding only previously unknown information in preprints. As long as there is no transparent and complete way to store this relationship in metadata, the Pre2Pub algorithm is a suitable extension to retrieve this information. %M 35285808 %R 10.2196/34072 %U https://www.jmir.org/2022/4/e34072 %U https://doi.org/10.2196/34072 %U http://www.ncbi.nlm.nih.gov/pubmed/35285808 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 4 %P e30055 %T The Strategies for Quantitative and Qualitative Remote Data Collection: Lessons From the COVID-19 Pandemic %A Tiersma,Keenae %A Reichman,Mira %A Popok,Paula J %A Nelson,Zoe %A Barry,Maura %A Elwy,A Rani %A Flores,Efrén J %A Irwin,Kelly E %A Vranceanu,Ana-Maria %+ Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, 1 Bowdoin Square, Suite 100, Boston, MA, 02114, United States, 1 6177244977, avranceanu@mgh.harvard.edu %K web-based research %K remote research %K remote data collection %K blended design %K electronic data collection %K mobile phone %D 2022 %7 8.4.2022 %9 Viewpoint %J JMIR Form Res %G English %X The COVID-19 pandemic has necessitated a rapid shift to web-based or blended design models for both ongoing and future clinical research activities. Research conducted virtually not only has the potential to increase the patient-centeredness of clinical research but may also further widen existing disparities in research participation among underrepresented individuals. In this viewpoint, we discuss practical strategies for quantitative and qualitative remote research data collection based on previous literature and our own ongoing clinical research to overcome challenges presented by the shift to remote data collection. We aim to contribute to and catalyze the dissemination of best practices related to remote data collection methodologies to address the opportunities presented by this shift and develop strategies for inclusive research. %M 35394441 %R 10.2196/30055 %U https://formative.jmir.org/2022/4/e30055 %U https://doi.org/10.2196/30055 %U http://www.ncbi.nlm.nih.gov/pubmed/35394441 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 4 %P e33982 %T Developing a Clinic-Based, Vaccine-Promoting Intervention for African American Youth in Rural Alabama: Protocol for a Pilot Cluster-Randomized Controlled Implementation Science Trial %A Budhwani,Henna %A Sharma,Vinita %A Long,Dustin %A Simpson,Tina %+ Department of Health Policy and Organization, School of Public Health, University of Alabama at Birmingham, 1720 University Blvd, Birmingham, AL, 35294, United States, 1 2059757613, budhwani@uab.edu %K human papillomavirus %K COVID-19 %K vaccine %K adolescents %K rural %K African American %K implementation science %D 2022 %7 8.4.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: African American youth in rural Alabama are clinically underserved and have limited knowledge about the human papillomavirus and the novel coronavirus 2019 (COVID-19) vaccines, including knowledge about the risk for developing cervical or oropharyngeal cancers or COVID-19. Objective: In this 30-month study, we propose to develop an in-clinic, youth-tailored, vaccine-promoting intervention for vaccine hesitancy reduction that can be seamlessly integrated into the existing environments of pediatric and family practice settings in rural Alabama. Methods: This exploratory, sequential mixed methods study will be conducted in 3 phases. In the first phase, we will assess stakeholders’ knowledge, sentiments, and beliefs related to vaccination in general, COVID-19 vaccination, and human papillomavirus vaccination. We will also assess stakeholders’ perceptions of barriers to vaccination that exist in rural Alabama. This will be followed by a second phase wherein we will use the data collected in the first phase to inform the development and finalization of a noninvasive, modular, synchronous counseling intervention that targets the behaviors of 15- to 26-year-old adolescents. In the third phase, we will conduct a pilot hybrid type 1 effectiveness-implementation cluster-randomized controlled trial to assess intervention acceptability and feasibility (clinics: N=4; African American youth: N=120) while assessing a “clinical signal” of effectiveness. We will document implementation contexts to provide real-world insight and support dissemination and scale-up. Results: The study was funded at the end of December 2020. Approval from the University of Alabama at Birmingham Institutional Review Board was obtained in May 2021, and the qualitative data collection process outlined in the first phase of this project concluded in November 2021. The entire study is expected to be complete at the end of December 2023. Conclusions: The results of the trial will provide much needed information on vaccine hesitancy in rural Alabama, and if found efficacious, the intervention could notably increase rates of vaccinations in one of the most underserved parts of the United States. The results from the trial will provide information that is valuable to public health practitioners and providers in rural settings to inform their efforts in increasing vaccination rates among 15- to 26-year-old African American youth in rural southern United States. Trial Registration: ClinicalTrials.gov NCT04604743; https://clinicaltrials.gov/ct2/show/NCT04604743 International Registered Report Identifier (IRRID): DERR1-10.2196/33982 %M 35212640 %R 10.2196/33982 %U https://www.researchprotocols.org/2022/4/e33982 %U https://doi.org/10.2196/33982 %U http://www.ncbi.nlm.nih.gov/pubmed/35212640 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 4 %P e36022 %T The Impact of COVID-19 on Mortality in Italy: Retrospective Analysis of Epidemiological Trends %A Rovetta,Alessandro %A Bhagavathula,Akshaya Srikanth %+ R & C Research, via Brede T2, Bovezzo (Brescia), 25073, Italy, 39 3927112808, rovetta.mresearch@gmail.com %K COVID-19 %K deniers %K excess deaths %K epidemiology %K infodemic %K infodemiology %K Italy %K longitudinal analysis %K mortality %K time series %K pandemic %K public health %D 2022 %7 7.4.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Despite the available evidence on its severity, COVID-19 has often been compared with seasonal flu by some conspirators and even scientists. Various public discussions arose about the noncausal correlation between COVID-19 and the observed deaths during the pandemic period in Italy. Objective: This paper aimed to search for endogenous reasons for the mortality increase recorded in Italy during 2020 to test this controversial hypothesis. Furthermore, we provide a framework for epidemiological analyses of time series. Methods: We analyzed deaths by age, sex, region, and cause of death in Italy from 2011 to 2019. Ordinary least squares (OLS) linear regression analyses and autoregressive integrated moving average (ARIMA) were used to predict the best value for 2020. A Grubbs 1-sided test was used to assess the significance of the difference between predicted and observed 2020 deaths/mortality. Finally, a 1-sample t test was used to compare the population of regional excess deaths to a null mean. The relationship between mortality and predictive variables was assessed using OLS multiple regression models. Since there is no uniform opinion on multicomparison adjustment and false negatives imply great epidemiological risk, the less-conservative Siegel approach and more-conservative Holm-Bonferroni approach were employed. By doing so, we provided the reader with the means to carry out an independent analysis. Results: Both ARIMA and OLS linear regression models predicted the number of deaths in Italy during 2020 to be between 640,000 and 660,000 (range of 95% CIs: 620,000-695,000) against the observed value of above 750,000. We found strong evidence supporting that the death increase in all regions (average excess=12.2%) was not due to chance (t21=7.2; adjusted P<.001). Male and female national mortality excesses were 18.4% (P<.001; adjusted P=.006) and 14.1% (P=.005; adjusted P=.12), respectively. However, we found limited significance when comparing male and female mortality residuals’ using the Mann-Whitney U test (P=.27; adjusted P=.99). Finally, mortality was strongly and positively correlated with latitude (R=0.82; adjusted P<.001). In this regard, the significance of the mortality increases during 2020 varied greatly from region to region. Lombardy recorded the highest mortality increase (38% for men, adjusted P<.001; 31% for women, P<.001; adjusted P=.006). Conclusions: Our findings support the absence of historical endogenous reasons capable of justifying the mortality increase observed in Italy during 2020. Together with the current knowledge on SARS-CoV-2, these results provide decisive evidence on the devastating impact of COVID-19. We suggest that this research be leveraged by government, health, and information authorities to furnish proof against conspiracy hypotheses that minimize COVID-19–related risks. Finally, given the marked concordance between ARIMA and OLS regression, we suggest that these models be exploited for public health surveillance. Specifically, meaningful information can be deduced by comparing predicted and observed epidemiological trends. %M 35238784 %R 10.2196/36022 %U https://publichealth.jmir.org/2022/4/e36022 %U https://doi.org/10.2196/36022 %U http://www.ncbi.nlm.nih.gov/pubmed/35238784 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 4 %P e29781 %T Frequency and Correlates of Online Consultations With Doctors or Therapists in Middle-Aged and Older Adults: Nationally Representative Cross-sectional Study %A Hajek,André %A König,Hans-Helmut %+ Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Martinistraße 52, Hamburg, 20246, Germany, 49 40 7410 528 77, a.hajek@uke.de %K online consultations %K doctor %K therapists %K telehealth %K COVID-19 %K SARS-CoV-2 %K digital health %D 2022 %7 7.4.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: A few studies have identified the frequency and correlates of online consultations with doctors or therapists. However, there is a lack of studies using nationally representative data from middle-aged and older adults in Germany. Objective: This study aims to determine the frequency and correlates of online consultations with doctors or therapists in Germany. Methods: For this study, cross-sectional data were taken from the nationally representative German Ageing Survey (DEAS; n=3067 in the analytical sample; age range 46-98 years). As part of the DEAS, a short survey was conducted between June 8 and July 22, 2020, examining the everyday life and living conditions among these middle-aged and older individuals during the COVID-19 pandemic. The frequency of online consultations with doctors or therapists served as the dependent variable (daily, several times a week, once a week, 1-3 times a month, less often, and never). Multiple logistic regressions were performed. Results: In sum, 10.02% (381/3806) of individuals with access to the internet had online consultations with doctors or therapists. Multiple logistic regressions showed that the likelihood of using online consultations with doctors or therapists (compared with those never using such services) was positively associated with higher education (compared with medium education; odds ratio [OR] 1.31, 95% CI 1.01-1.70), living with a partner in the same household (compared with single; OR 1.53, 95% CI 1.05-2.22), poorer self-rated health (OR 1.42, 95% CI 1.16-1.74), increased loneliness (OR 1.45, 95% CI 1.10-1.90), and increased satisfaction with life (OR 1.30, 95% CI 1.03-1.64). Conclusions: Study findings suggest that a non-negligible proportion of about 1 out of 10 individuals aged 46 years and over had online consultations with doctors or therapists. However, compared with other countries, this proportion remains small. Knowledge about the correlates of (non)use may assist in identifying corresponding individuals. In times of reshaping the health care system, these efforts in online consultations with doctors or therapists may contribute to addressing patient needs. Moreover, increased use of such services may reduce the risk of getting infected with SARS-CoV-2 by reducing social contact. %M 35389360 %R 10.2196/29781 %U https://www.jmir.org/2022/4/e29781 %U https://doi.org/10.2196/29781 %U http://www.ncbi.nlm.nih.gov/pubmed/35389360 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 10 %N 4 %P e35073 %T Investigating Health Context Using a Spatial Data Analytical Tool: Development of a Geospatial Big Data Ecosystem %A Haithcoat,Timothy %A Liu,Danlu %A Young,Tiffany %A Shyu,Chi-Ren %+ Institute for Data Science and Informatics, University of Missouri, 22 Heinkel Building, Columbia, MO, 65211, United States, 1 573 882 3884, shyuc@missouri.edu %K context %K Geographic Information System %K big data %K equity %K population health %K public health %K digital health %K eHealth %K location %K geospatial %K data analytics %K analytical framework %K medical informatics %K research knowledgebase %D 2022 %7 6.4.2022 %9 Original Paper %J JMIR Med Inform %G English %X Background: Enabling the use of spatial context is vital to understanding today’s digital health problems. Any given location is associated with many different contexts. The strategic transformation of population health, epidemiology, and eHealth studies requires vast amounts of integrated digital data. Needed is a novel analytical framework designed to leverage location to create new contextual knowledge. The Geospatial Analytical Research Knowledgebase (GeoARK), a web-based research resource has robust, locationally integrated, social, environmental, and infrastructural information to address today’s complex questions, investigate context, and spatially enable health investigations. GeoARK is different from other Geographic Information System (GIS) resources in that it has taken the layered world of the GIS and flattened it into a big data table that ties all the data and information together using location and developing its context. Objective: It is paramount to build a robust spatial data analytics framework that integrates social, environmental, and infrastructural knowledge to empower health researchers’ use of geospatial context to timely answer population health issues. The goal is twofold in that it embodies an innovative technological approach and serves to ease the educational burden for health researchers to think spatially about their problems. Methods: A unique analytical tool using location as the key was developed. It allows integration across source, geography, and time to create a geospatial big table with over 162 million individual locations (X-Y points that serve as rows) and 5549 attributes (represented as columns). The concept of context (adjacency, proximity, distance, etc) is quantified through geoanalytics and captured as new distance, density, or neighbor attributes within the system. Development of geospatial analytics permits contextual extraction and investigator-initiated eHealth and mobile health (mHealth) analysis across multiple attributes. Results: We built a unique geospatial big data ecosystem called GeoARK. Analytics on this big table occur across resolution groups, sources, and geographies for extraction and analysis of information to gain new insights. Case studies, including telehealth assessment in North Carolina, national income inequality and health outcome disparity, and a Missouri COVID-19 risk assessment, demonstrate the capability to support robust and efficient geospatial understanding of a wide spectrum of population health questions. Conclusions: This research identified, compiled, transformed, standardized, and integrated multifaceted data required to better understand the context of health events within a large location-enabled database. The GeoARK system empowers health professionals to engage more complex research where the synergisms of health and geospatial information will be robustly studied beyond what could be accomplished today. No longer is the need to know how to perform geospatial processing an impediment to the health researcher, but rather the development of how to think spatially becomes the greater challenge. %M 35311683 %R 10.2196/35073 %U https://medinform.jmir.org/2022/4/e35073 %U https://doi.org/10.2196/35073 %U http://www.ncbi.nlm.nih.gov/pubmed/35311683 %0 Journal Article %@ 2563-6316 %I JMIR Publications %V 3 %N 2 %P e31272 %T Lessons Learned From the Resilience of Chinese Hospitals to the COVID-19 Pandemic: Scoping Review %A Stennett,Jack %A Hou,Renyou %A Traverson,Lola %A Ridde,Valéry %A Zinszer,Kate %A Chabrol,Fanny %+ Centre Population et Développement, Institut de Recherche pour le Développement, Université de Paris, 45 Rue des Saints-Pères, Paris, 75006, France, 33 01 76 53 34 52, jack.stennett@sciencespo.fr %K COVID-19 %K pandemic %K SARS-CoV-2 %K health care %K hospitals %K health care strategy %K hospital resilience %K interventions %K crisis response %K crisis preparedness %K public health %D 2022 %7 6.4.2022 %9 Review %J JMIRx Med %G English %X Background: The SARS-CoV-2 pandemic has brought substantial strain on hospitals worldwide; however, although the success of China’s COVID-19 strategy has been attributed to the achievements of the government, public health officials, and the attitudes of the public, the resilience shown by China’s hospitals appears to have been a critical factor in their successful response to the pandemic. Objective: This paper aims to determine the key findings, recommendations, and lessons learned in terms of hospital resilience during the pandemic; analyze the quality and limitations of research in this field at present; and contribute to the evaluation of the Chinese response to the COVID-19 outbreak, building on a growing literature on the role of hospital resilience in crisis situations. Methods: We conducted a scoping review of evidence on the resilience of hospitals in China during the COVID-19 crisis in the first half of 2020. Two online databases (the China National Knowledge Infrastructure and World Health Organization databases) were used to identify papers meeting the eligibility criteria. After extracting the data, we present an information synthesis using a resilience framework. Articles were included in the review if they were peer-reviewed studies published between December 2019 and July 2020 in English or Chinese and included empirical results pertaining to the resilience of Chinese hospitals in the COVID-19 pandemic. Results: From the publications meeting the criteria (n=59), we found that substantial research was rapidly produced in the first half of 2020 and described numerous strategies used to improve hospital resilience, particularly in three key areas: human resources; management and communication; and security, hygiene, and planning. Our search revealed a focus on interventions related to training, health care worker well-being, eHealth/telemedicine, and workplace organization, while other areas such as hospital financing, information systems, and health care infrastructure were less well represented in the literature. We also noted that the literature was dominated by descriptive case studies, often lacking consideration of methodological limitations, and that there was a lack of both highly focused research on specific interventions and holistic research that attempted to unite the topics within a resilience framework. Conclusions: We identified a number of lessons learned regarding how China’s hospitals have demonstrated resilience when confronted with the SARS-CoV-2 pandemic. Strategies involving interprovincial reinforcements, online platforms and technological interventions, and meticulous personal protective equipment use and disinfection, combined with the creation of new interdisciplinary teams and management strategies, reflect a proactive hospital response to the pandemic, with high levels of redundancy. Research on Chinese hospitals would benefit from a greater range of analyses to draw more nuanced and contextualized lessons from the responses to the crisis. %M 35435649 %R 10.2196/31272 %U https://med.jmirx.org/2022/2/e31272 %U https://doi.org/10.2196/31272 %U http://www.ncbi.nlm.nih.gov/pubmed/35435649 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 4 %P e32619 %T The Rapid Development of Virtual Care Tools in Response to COVID-19: Case Studies in Three Australian Health Services %A Gray,Kathleen %A Chapman,Wendy %A Khan,Urooj R %A Borda,Ann %A Budge,Marc %A Dutch,Martin %A Hart,Graeme K %A Gilbert,Cecily %A Wani,Tafheem Ahmad %+ Centre for Digital Transformation of Health, University of Melbourne, Level 13, 305 Grattan Street, Melbourne, 3000, Australia, 61 3 8344 8936, kgray@unimelb.edu.au %K COVID-19 %K health system innovation %K rapid development and deployment methods %K remote patient monitoring %K software development %D 2022 %7 6.4.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: News of the impact of COVID-19 around the world delivered a brief opportunity for Australian health services to plan new ways of delivering care to large numbers of people while maintaining staff safety through greater physical separation. The rapid pivot to telemedicine and virtual care provided immediate and longer term benefits; however, such rapid-cycle development also created risks. Objective: The aim of this study was to understand the sociotechnical aspects of the rapid-cycle development of seven different COVID-19 virtual care tools, and to identify enablers, barriers, and risks at three health services in Victoria, Australia. Methods: A qualitative, embedded, multiple case study design was adopted. Researchers from three health services collaborated with university researchers who were independent from those health services to gather and analyze structured interview data from key people involved in either clinical or technical aspects of designing and deploying seven different virtual care tools. Results: The overall objectives of each health service reflected the international requirements for managing large numbers of patients safely but remotely and for protecting staff. However, the governance, digital maturity, and specific use cases at each institution shaped the methodology and specific outcomes required. Dependence on key individuals and their domain knowledge within an existing governance framework generally enabled rapid deployment, but sometimes posed barriers. Existing relationships with technical service developers enabled strong solutions, which in some cases were highly scalable. Conventional project methodologies such as steering committees, scope, budget control, tight functional specification, consumer engagement and codesign, universal accessibility, and postimplementation evaluation were ignored almost universally in this environment. Conclusions: These three health services took a variety of approaches to the rapid-cycle development of virtual care tools to meet their urgent needs for triaging and remote monitoring during the first year of the COVID-19 pandemic. Their experiences provided insights into many social and technical barriers and enablers to the development of virtual care tools. If these are addressed proactively, they will improve clinical governance and technical management of future virtual care. Some changes can be made within individual health services, while others entail health system policy reforms. Enhancing the environment for virtual care tool design and implementation now will yield returns not only during future health emergencies but also in many more routine care settings. %M 35297765 %R 10.2196/32619 %U https://formative.jmir.org/2022/4/e32619 %U https://doi.org/10.2196/32619 %U http://www.ncbi.nlm.nih.gov/pubmed/35297765 %0 Journal Article %@ 2561-9128 %I JMIR Publications %V 5 %N 1 %P e34936 %T Influence of the COVID-19 Pandemic on Clinical Trial Discontinuation in Anesthesiology: Cross-sectional Analysis %A Traxler,Brett D %A Rucker,Brayden M %A Greenough,Mary C %A Sajjadi,Nicholas B %A Hartwell,Micah %+ Office of Medical Student Research, College of Osteopathic Medicine, Oklahoma State University Center for Health Sciences, 1111 W 17th Street, Tulsa, OK, 74107, United States, 1 9185821972, nicholas.sajjadi@okstate.edu %K clinical trials %K anesthesia %K anesthesiology %K COVID-19 %K pandemic %K perioperative care %K lockdown %D 2022 %7 5.4.2022 %9 Original Paper %J JMIR Perioper Med %G English %X Background: The COVID-19 pandemic drastically altered perioperative medical practice owing to safety concerns, postponing elective or nonemergent procedures, supply chain shortages, and reallocating perioperative staff to care for patients with COVID-19. However, the impact of the pandemic on the conduct on anesthesiology clinical research is unknown. Objective: The primary objective was to quantify the magnitude of the COVID-19 pandemic’s impact on anesthesiology clinical research. Methods: We performed a systematic search using ClinicalTrials.gov to identify clinical trials related to the practice of anesthesiology. We screened trials with status updates from January 1, 2020, through October 1, 2021, to capture trials potentially affected by the COVID-19 pandemic by the time of our search. Investigators screened for relevant studies and extracted trial characteristics along with the reason for discontinuation reported on the clinical trial registry. Results: A total of 823 clinical trials met inclusion criteria, and 146 clinical trials were discontinued within the designated date range. In total, 24 (16.4%) of the 146 clinical trials were halted explicitly owing to the COVID-19 pandemic. A significant association existed between trial enrollment numbers and the likelihood of discontinuation due to the COVID-19 pandemic, as larger trials were more likely to be disrupted (z=–2.914, P=.004). Conclusions: The COVID-19 pandemic is reportedly associated with the discontinuation of anesthesiology-related clinical trials. With the uncertain course of the COVID-19 pandemic, developing anesthesia trial protocols to help minimize social interaction and prevent premature trial disruption are imperative. %M 35358057 %R 10.2196/34936 %U https://periop.jmir.org/2022/1/e34936 %U https://doi.org/10.2196/34936 %U http://www.ncbi.nlm.nih.gov/pubmed/35358057 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 4 %P e36217 %T Predicting Uptake of the COVID Coach App Among US Military Veterans: Funnel Analysis Using a Probability-Based Panel %A Jaworski,Beth K %A Taylor,Katherine %A Ramsey,Kelly M %A Heinz,Adrienne J %A Steinmetz,Sarah %A Owen,Jason E %A Tsai,Jack %A Pietrzak,Robert H %+ National Center for Posttraumatic Stress Disorder, Dissemination & Training Division, US Department of Veterans Affairs, 795 Willow Road, Menlo Park, CA, 94025, United States, 1 18312781567, beth.jaworski@nih.gov %K COVID-19 %K coronavirus %K mobile app %K mHealth %K digital health %K mental health %K public mental health %K stress %K coping %K older adults %K veterans %D 2022 %7 5.4.2022 %9 Original Paper %J JMIR Ment Health %G English %X Background: Although the COVID-19 pandemic has not led to a uniform increase of mental health concerns among older adults, there is evidence to suggest that some older veterans did experience an exacerbation of preexisting mental health conditions, and that mental health difficulties were associated with a lack of social support and increasing numbers of pandemic-related stressors. Mobile mental health apps are scalable, may be a helpful resource for managing stress during the pandemic and beyond, and could potentially provide services that are not accessible due to the pandemic. However, overall comfort with mobile devices and factors influencing the uptake and usage of mobile apps during the pandemic among older veterans are not well known. COVID Coach is a free, evidence-informed mobile app designed for pandemic-related stress. Public usage data have been evaluated; however, the uptake and usage of the app among older veterans have not been explored. Objective: The purpose of this study was to characterize smartphone ownership rates among US veterans, identify veteran characteristics associated with downloading and use of COVID Coach, and characterize key content usage within the app. Methods: Data were analyzed from the 2019-2020 National Health and Resilience in Veterans Study (NHRVS), which surveyed a nationally representative, prospective cohort of 3078 US military veterans before and 1 year into the pandemic. The NHRVS sample was drawn from KnowledgePanel, a research panel of more than 50,000 households maintained by Ipsos, Inc. The median time to complete the survey was nearly 32 minutes. The research version of COVID Coach was offered to all veterans who completed the peripandemic follow-up assessment on a mobile device (n=814; weighted 34.2% of total sample). App usage data from all respondents who downloaded the app (n=34; weighted 3.3% of the mobile completers sample) were collected between November 14, 2020, and November 7, 2021. Results: We found that most US veterans (81.5%) own smartphones, and that veterans with higher education, greater number of adverse childhood experiences, higher extraversion, and greater severity of pandemic-related posttraumatic stress disorder symptoms were more likely to download COVID Coach. Although uptake and usage of COVID Coach were relatively low (3.3% of eligible participants, n=34), 50% of the participants returned to the app for more than 1 day of use. The interactive tools for managing stress were used most frequently. Conclusions: The COVID-19 pandemic has increased the need for and creation of digital mental health tools. However, these resources may require tailoring for older veteran populations. Future research is needed to better understand how to optimize digital mental health tools such as apps to ensure uptake and usage among older adults, particularly those who have experienced traumas across the lifespan. %M 35245204 %R 10.2196/36217 %U https://mental.jmir.org/2022/4/e36217 %U https://doi.org/10.2196/36217 %U http://www.ncbi.nlm.nih.gov/pubmed/35245204 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 4 %P e34002 %T Brief Digital Interventions to Support the Psychological Well-being of NHS Staff During the COVID-19 Pandemic: 3-Arm Pilot Randomized Controlled Trial %A De Kock,Johannes H %A Latham,Helen Ann %A Cowden,Richard G %A Cullen,Breda %A Narzisi,Katia %A Jerdan,Shaun %A Munoz,Sarah-Anne %A Leslie,Stephen J %A Stamatis,Andreas %A Eze,Jude %+ Division of Rural Health and Wellbeing, Institute of Health Research and Innovation, School of Health, University of the Highlands and Islands, 12b Ness Walk, Inverness, IV3 5SQ, United Kingdom, 44 01463 255000, Hannes.De@nhs.scot %K eHealth %K public health %K depression %K anxiety %K well-being %K mobile health %K intervention studies %K staff %K occupational health %K NHS %K intervention %K support %K COVID-19 %K randomized controlled trial %D 2022 %7 4.4.2022 %9 Original Paper %J JMIR Ment Health %G English %X Background: Health and social care staff are at high risk of experiencing adverse mental health (MH) outcomes during the COVID-19 pandemic. Hence, there is a need to prioritize and identify ways to effectively support their psychological well-being (PWB). Compared to traditional psychological interventions, digital psychological interventions are cost-effective treatment options that allow for large-scale dissemination and transcend social distancing, overcome rurality, and minimize clinician time. Objective: This study reports MH outcomes of a Consolidated Standards of Reporting Trials (CONSORT)-compliant parallel-arm pilot randomized controlled trial (RCT) examining the potential usefulness of an existing and a novel digital psychological intervention aimed at supporting psychological health among National Health Service (NHS) staff working through the COVID-19 pandemic. Methods: NHS Highland (NHSH) frontline staff volunteers (N=169) were randomly assigned to the newly developed NHSH Staff Wellbeing Project (NHSWBP), an established digital intervention (My Possible Self [MPS]), or a waitlist (WL) group for 4 weeks. Attempts were made to blind participants to which digital intervention they were allocated. The interventions were fully automated, without any human input or guidance. We measured 5 self-reported psychological outcomes over 3 time points: before (baseline), in the middle of (after 2 weeks), and after treatment (4 weeks). The primary outcomes were anxiety (7-item General Anxiety Disorder), depression (Patient Health Questionnaire), and mental well-being (Warwick-Edinburgh Mental Well-being Scale). The secondary outcomes included mental toughness (Mental Toughness Index) and gratitude (Gratitude Questionnaire-6). Results: Retention rates mid- and postintervention were 77% (n=130) and 63.3% (n=107), respectively. Postintervention, small differences were noted between the WL and the 2 treatment groups on anxiety (vs MPS: Cohen d=0.07, 95% CI –0.20 to 0.33; vs NHSWBP: Cohen d=0.06, 95% CI –0.19 to 0.31), depression (vs MPS: Cohen d=0.37, 95% CI 0.07-0.66; vs NHSWBP: Cohen d=0.18, 95% CI –0.11 to 0.46), and mental well-being (vs MPS: Cohen d=–0.04, 95% CI –0.62 to –0.08; vs NHSWBP: Cohen d=–0.15, 95% CI –0.41 to 0.10). A similar pattern of between-group differences was found for the secondary outcomes. The NHSWBP group generally had larger within-group effects than the other groups and displayed a greater rate of change compared to the other groups on all outcomes, except for gratitude, where the rate of change was greatest for the MPS group. Conclusions: Our analyses provided encouraging results for the use of brief digital psychological interventions in improving PWB among health and social care workers. Future multisite RCTs, with power to reliably detect differences, are needed to determine the efficacy of contextualized interventions relative to existing digital treatments. Trial Registration: ISRCTN Registry (ISRCTN) ISRCTN18107122; https://www.isrctn.com/ISRCTN18107122 %M 35044927 %R 10.2196/34002 %U https://mental.jmir.org/2022/4/e34002 %U https://doi.org/10.2196/34002 %U http://www.ncbi.nlm.nih.gov/pubmed/35044927 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 2 %P e34134 %T Application of a Web-based Self-assessment Triage Tool During the COVID-19 Pandemic: Descriptive Study %A Nowicka,Anna %A Jaszczak,Jakub %A Szymanek Pasternak,Anna %A Simon,Krzysztof %+ Provincial Specialist Hospital them. J. Gromkowski, Koszarowa 5, Wrocław, 51-149, Poland, 48 660427576, nowickanna@gmail.com %K COVID-19 %K symptom checker %K preclinical triage %K self-assessment tool %K online applications %K COVID-19 remote triage %K COVID-19 self-assessment %D 2022 %7 4.4.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: The COVID-19 pandemic has sped up the implementation of telehealth solutions in medicine. A few symptom checkers dedicated for COVID-19 have been described, but it remains unclear whether and how they can affect patients and health systems. Objective: This paper demonstrates our experiences with the COVID-19 risk assessment (CRA) tool. We tried to determine who the user of the web-based COVID-19 triage app is and compare this group with patients in the infectious diseases ward’s admission room to evaluate who could benefit from implementing the COVID-19 online symptom checker as a remote triage solution. Methods: We analyzed the answers of 248,862 people interacting with an online World Health Organization–based triage tool for assessing the probability of SARS-CoV-2 infection. These users filled in an online questionnaire between April 7 and August 6, 2020. Based on the presented symptoms, risk factors, and demographics, the tool assessed whether the user’s answers were suggestive of COVID-19 and recommended appropriate action. Subsequently, we compared the sociodemographic and clinical characteristics of tool users with patients admitted to the Infectious Diseases Admission Room of J. Gromkowski Hospital in Wrocław. Results: The CRA tool tended to be used by asymptomatic or oligosymptomatic individuals (171,226 [68.80%] of all users). Most users were young (162,432 [65.27%] were below 40 years of age) and without comorbidities. Only 77,645 (31.20%) of the self-assessment app users were suspected of COVID-19 based on their reported symptoms. On the contrary, most admission room patients were symptomatic—symptoms such as fever, cough, and dyspnea were prevalent in both COVID-19-positive and COVID-19-negative patients. COVID-19-suspected patients in the CRA tool group presented similar COVID-19 symptoms as those who presented to the admission room. These were cough (25,062/40,007 [62.64%] in the CRA tool group vs 138/232 [59.48%] in the admission room group), fever (23,123/40,007 [57.80%] in the CRA tool group vs 146/232 [62.93%] in the admission room group), and shortness of breath (15,157/40,007 [37.89%] in the CRA tool group vs 87/232 [37.50%] in the admission room group). Conclusions: The comparison between the symptomatology of the users interacting with the CRA tool and those visiting the admission room revealed 2 major patient groups who could have benefited from the implementation of the self-assessment app in preclinical triage settings. The primary users of the CRA tool were young, oligosymptomatic individuals looking for screening for COVID-19 and reassurance early in the COVID-19 pandemic. The other group were users presenting the typical symptoms suggestive of COVID-19 at that time. The CRA tool recognized these individuals as potentially COVID-19 positive and directed them to the proper level of care. These use cases fulfil the idea of preclinical triage; however, the accuracy and influence on health care must be examined in the clinical setting. %M 35168192 %R 10.2196/34134 %U https://humanfactors.jmir.org/2022/2/e34134 %U https://doi.org/10.2196/34134 %U http://www.ncbi.nlm.nih.gov/pubmed/35168192 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 4 %P e32387 %T Effects of COVID-19 on Physical Activity and Its Relationship With Mental Health in a US Community Sample: Cross-sectional, Convenience Sampling–based Online Survey %A Zhang,Wei %A Velez,Dominick %+ Department of Psychology, New Jersey City University, 2039 John F. Kennedy Blvd, Jersey City, NJ, 07305, United States, 1 2012002000 ext 3063, wzhang@njcu.edu %K physical activity %K COVID-19 %K mental health %K depression %K anxiety %K United States %K survey %K cross-sectional %K distress %K risk %D 2022 %7 4.4.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: COVID-19 restrictions may make it difficult for people to engage in the recommended amounts of physical activity (PA). Objective: The influence of the COVID-19 pandemic on PA, as well as the links between PA and mental health, was investigated in this study. Methods: Participants were recruited using convenience sampling and responded to an online survey between April 15 and July 1, 2021, with ages ranging from 18 to 24 years (n=156, 40.9% of the sample) to ≥55 years (n=28, 7.4% of the sample). To assess general psychological distress, depression, anxiety, and pandemic anxiety, a battery of mental health assessments was used. The International Physical Activity Questionnaire - Short Form was used to collect PA data from participants, who were then classified as inactive, minimally active, or highly active. Participants also indicated the locations where they performed PA before and during COVID-19. Results: A sample of 381 individuals was included in this research. The logistic regression analysis results were interpreted as odds ratios (ORs), where an OR higher than 1 indicated a greater chance of an event occurring and an OR less than 1 implied a lower likelihood of an event occurring. Logistic regression results revealed that inactive individuals were more likely to develop psychological distress (OR 2.17, 95% CI 1.27-3.69, P=.004), depression (OR 3.81, 95% CI 1.92-7.57, P<.001), and anxiety (OR 1.86, 95% CI 0.99-3.47, P=.05) as compared to highly active individuals. Furthermore, when compared to highly active people, those who were only minimally active had a higher risk of depression (OR 2.14, 95% CI 1.05-4.33, P=.04). Wilcoxon signed-rank tests revealed that COVID-19 has a greater impact on reducing the chances of less active individuals engaging in PA outside and in public spaces. Highly active people's physical exercise locations had changed less, and their exercise frequency at home increased. Conclusions: Programmatic and policy interventions geared particularly toward enhancing PA among those less active may be a helpful strategy for addressing the worldwide pandemic’s mental health crisis. %M 35302509 %R 10.2196/32387 %U https://formative.jmir.org/2022/4/e32387 %U https://doi.org/10.2196/32387 %U http://www.ncbi.nlm.nih.gov/pubmed/35302509 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 3 %P e36200 %T Physician Burnout and the Electronic Health Record Leading Up to and During the First Year of COVID-19: Systematic Review %A Kruse,Clemens Scott %A Mileski,Michael %A Dray,Gevin %A Johnson,Zakia %A Shaw,Cameron %A Shirodkar,Harsha %+ School of Health Administration, College of Health Professions, Texas State University, 601 University Dr, San Marcos, TX, 78666, United States, 1 5122454462, scottkruse@txstate.edu %K electronic health record %K physician burnout %K quality improvement %K psychiatry %K medical informatics %K COVID-19 %K pandemic %K health informatic %K health care %K health care professional %K health care infrastructure %K health care system %K mental health %K cognitive fatigue %D 2022 %7 31.3.2022 %9 Review %J J Med Internet Res %G English %X Background: Physician burnout was first documented in 1974, and the electronic health record (EHR) has been known to contribute to the symptoms of physician burnout. Authors pondered the extent of this effect, recognizing the increased use of telemedicine during the first year of COVID-19. Objective: The aim of this review was to objectively analyze the literature over the last 5 years for empirical evidence of burnout incident to the EHR and to identify barriers to, facilitators to, and associated patient satisfaction with using the EHR to improve symptoms of burnout. Methods: No human participants were involved in this review; however, 100% of participants in studies analyzed were adult physicians. We queried 4 research databases and 1 targeted journal for studies commensurate with the objective statement from January 1, 2016 through January 31, 2021 (n=25). Results: The hours spent in documentation and workflow are responsible for the sense of loss of autonomy, lack of work-life balance, lack of control of one’s schedule, cognitive fatigue, a general loss of autonomy, and poor relationships with colleagues. Researchers have identified training, local customization of templates and workflow, and the use of scribes as strategies to alleviate the administrative burden of the EHR and decrease symptoms of burnout. Conclusions: The solutions provided in the literature only addressed 2 of the 3 factors (workflow and documentation time) but not the third factor (usability). Practitioners and administrators should focus on the former 2 factors because they are within their sphere of control. EHR vendors should focus on empirical evidence to identify and improve the usability features with the greatest impact. Researchers should design experiments to explore solutions that address all 3 factors of the EHR that contribute to burnout. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42020201820; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=201820 International Registered Report Identifier (IRRID): RR2-10.2196/15490 %M 35120019 %R 10.2196/36200 %U https://www.jmir.org/2022/3/e36200 %U https://doi.org/10.2196/36200 %U http://www.ncbi.nlm.nih.gov/pubmed/35120019 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 10 %N 3 %P e32949 %T Disease-Course Adapting Machine Learning Prognostication Models in Elderly Patients Critically Ill With COVID-19: Multicenter Cohort Study With External Validation %A Jung,Christian %A Mamandipoor,Behrooz %A Fjølner,Jesper %A Bruno,Raphael Romano %A Wernly,Bernhard %A Artigas,Antonio %A Bollen Pinto,Bernardo %A Schefold,Joerg C %A Wolff,Georg %A Kelm,Malte %A Beil,Michael %A Sviri,Sigal %A van Heerden,Peter V %A Szczeklik,Wojciech %A Czuczwar,Miroslaw %A Elhadi,Muhammed %A Joannidis,Michael %A Oeyen,Sandra %A Zafeiridis,Tilemachos %A Marsh,Brian %A Andersen,Finn H %A Moreno,Rui %A Cecconi,Maurizio %A Leaver,Susannah %A De Lange,Dylan W %A Guidet,Bertrand %A Flaatten,Hans %A Osmani,Venet %+ Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Duesseldorf, University Hospital Duesseldorf, Moorenstraße 5, Duesseldorf, 40225, Germany, 49 2118118800, christian.jung@med.uni-duesseldorf.de %K machine-based learning %K outcome prediction %K COVID-19 %K pandemic %K machine learning %K prediction models %K clinical informatics %K patient data %K elderly population %D 2022 %7 31.3.2022 %9 Original Paper %J JMIR Med Inform %G English %X Background: The COVID-19 pandemic caused by SARS-CoV-2 is challenging health care systems globally. The disease disproportionately affects the elderly population, both in terms of disease severity and mortality risk. Objective: The aim of this study was to evaluate machine learning–based prognostication models for critically ill elderly COVID-19 patients, which dynamically incorporated multifaceted clinical information on evolution of the disease. Methods: This multicenter cohort study (COVIP study) obtained patient data from 151 intensive care units (ICUs) from 26 countries. Different models based on the Sequential Organ Failure Assessment (SOFA) score, logistic regression (LR), random forest (RF), and extreme gradient boosting (XGB) were derived as baseline models that included admission variables only. We subsequently included clinical events and time-to-event as additional variables to derive the final models using the same algorithms and compared their performance with that of the baseline group. Furthermore, we derived baseline and final models on a European patient cohort, which were externally validated on a non-European cohort that included Asian, African, and US patients. Results: In total, 1432 elderly (≥70 years old) COVID-19–positive patients admitted to an ICU were included for analysis. Of these, 809 (56.49%) patients survived up to 30 days after admission. The average length of stay was 21.6 (SD 18.2) days. Final models that incorporated clinical events and time-to-event information provided superior performance (area under the receiver operating characteristic curve of 0.81; 95% CI 0.804-0.811), with respect to both the baseline models that used admission variables only and conventional ICU prediction models (SOFA score, P<.001). The average precision increased from 0.65 (95% CI 0.650-0.655) to 0.77 (95% CI 0.759-0.770). Conclusions: Integrating important clinical events and time-to-event information led to a superior accuracy of 30-day mortality prediction compared with models based on the admission information and conventional ICU prediction models. This study shows that machine-learning models provide additional information and may support complex decision-making in critically ill elderly COVID-19 patients. Trial Registration: ClinicalTrials.gov NCT04321265; https://clinicaltrials.gov/ct2/show/NCT04321265 %M 35099394 %R 10.2196/32949 %U https://medinform.jmir.org/2022/3/e32949 %U https://doi.org/10.2196/32949 %U http://www.ncbi.nlm.nih.gov/pubmed/35099394 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 2 %N 1 %P e32449 %T Using Natural Language Processing to Explore Mental Health Insights From UK Tweets During the COVID-19 Pandemic: Infodemiology Study %A Marshall,Christopher %A Lanyi,Kate %A Green,Rhiannon %A Wilkins,Georgina C %A Pearson,Fiona %A Craig,Dawn %+ National Institute for Health Research Innovation Observatory, Newcastle University, The Catalyst, Newcastle, NE4 5TG, United Kingdom, 44 0191 2082259, chris.marshall@io.nihr.ac.uk %K Twitter %K mental health %K COVID-19 %K sentiment %K lockdown %K soft intelligence %K artificial intelligence %K machine learning %K natural language processing %D 2022 %7 31.3.2022 %9 Original Paper %J JMIR Infodemiology %G English %X Background: There is need to consider the value of soft intelligence, leveraged using accessible natural language processing (NLP) tools, as a source of analyzed evidence to support public health research outputs and decision-making. Objective: The aim of this study was to explore the value of soft intelligence analyzed using NLP. As a case study, we selected and used a commercially available NLP platform to identify, collect, and interrogate a large collection of UK tweets relating to mental health during the COVID-19 pandemic. Methods: A search strategy comprised of a list of terms related to mental health, COVID-19, and lockdown restrictions was developed to prospectively collate relevant tweets via Twitter’s advanced search application programming interface over a 24-week period. We deployed a readily and commercially available NLP platform to explore tweet frequency and sentiment across the United Kingdom and identify key topics of discussion. A series of keyword filters were used to clean the initial data retrieved and also set up to track specific mental health problems. All collated tweets were anonymized. Results: We identified and analyzed 286,902 tweets posted from UK user accounts from July 23, 2020 to January 6, 2021. The average sentiment score was 50%, suggesting overall neutral sentiment across all tweets over the study period. Major fluctuations in volume (between 12,622 and 51,340) and sentiment (between 25% and 49%) appeared to coincide with key changes to any local and/or national social distancing measures. Tweets around mental health were polarizing, discussed with both positive and negative sentiment. Key topics of consistent discussion over the study period included the impact of the pandemic on people’s mental health (both positively and negatively), fear and anxiety over lockdowns, and anger and mistrust toward the government. Conclusions: Using an NLP platform, we were able to rapidly mine and analyze emerging health-related insights from UK tweets into how the pandemic may be impacting people’s mental health and well-being. This type of real-time analyzed evidence could act as a useful intelligence source that agencies, local leaders, and health care decision makers can potentially draw from, particularly during a health crisis. %M 36406146 %R 10.2196/32449 %U https://infodemiology.jmir.org/2022/1/e32449 %U https://doi.org/10.2196/32449 %U http://www.ncbi.nlm.nih.gov/pubmed/36406146 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 1 %P e35677 %T Using Twitter to Examine Stigma Against People With Dementia During COVID-19: Infodemiology Study %A Bacsu,Juanita-Dawne %A Fraser,Sarah %A Chasteen,Alison L %A Cammer,Allison %A Grewal,Karl S %A Bechard,Lauren E %A Bethell,Jennifer %A Green,Shoshana %A McGilton,Katherine S %A Morgan,Debra %A O’Rourke,Hannah M %A Poole,Lisa %A Spiteri,Raymond J %A O'Connell,Megan E %+ Department of Psychology, Canadian Centre for Health and Safety in Agriculture, University of Saskatchewan, Arts 182, 9 Campus Drive, Saskatoon, SK, S7N 5A5, Canada, 1 306 250 4399, juanita.bacsu@usask.ca %K coronavirus 2019 %K social media %K stigma %K dementia %K ageism %K COVID-19 %K Twitter %K bias %K infodemiology %K attention %K risk %K impact %K misinformation %K belief %K cognition %K cognitive impairment %D 2022 %7 31.3.2022 %9 Original Paper %J JMIR Aging %G English %X Background: During the pandemic, there has been significant social media attention focused on the increased COVID-19 risks and impacts for people with dementia and their care partners. However, these messages can perpetuate misconceptions, false information, and stigma. Objective: This study used Twitter data to understand stigma against people with dementia propagated during the COVID-19 pandemic. Methods: We collected 1743 stigma-related tweets using the GetOldTweets application in Python from February 15 to September 7, 2020. Thematic analysis was used to analyze the tweets. Results: Based on our analysis, 4 main themes were identified: (1) ageism and devaluing the lives of people with dementia, (2) misinformation and false beliefs about dementia and COVID-19, (3) dementia used as an insult for political ridicule, and (4) challenging stigma against dementia. Social media has been used to spread stigma, but it can also be used to challenge negative beliefs, stereotypes, and false information. Conclusions: Dementia education and awareness campaigns are urgently needed on social media to address COVID-19-related stigma. When stigmatizing discourse on dementia is widely shared and consumed amongst the public, it has public health implications. How we talk about dementia shapes how policymakers, clinicians, and the public value the lives of people with dementia. Stigma perpetuates misinformation, pejorative language, and patronizing attitudes that can lead to discriminatory actions, such as the limited provision of lifesaving supports and health services for people with dementia during the pandemic. COVID-19 policies and public health messages should focus on precautions and preventive measures rather than labeling specific population groups. %M 35290197 %R 10.2196/35677 %U https://aging.jmir.org/2022/1/e35677 %U https://doi.org/10.2196/35677 %U http://www.ncbi.nlm.nih.gov/pubmed/35290197 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 8 %N 1 %P e31080 %T Perception of Web-Based Didactic Activities During the COVID-19 Pandemic Among Anesthesia Residents: Pilot Questionnaire Study %A Nozari,Ala %A Mukerji,Shivali %A Lok,Ling-Ling %A Gu,Qingrou %A Buhl,Lauren %A Jain,Sanjay %A Ortega,Rafael %+ Boston University School of Medicine, 72 E Concord St, Boston, MA, United States, 1 6176386956, smukerji@bu.edu %K resident education %K COVID-19 %K barriers to education %K didactic %K medical education %K online education %K web-based education %K virtual training %K anesthesiology residents %K medical residents %K pandemic %K virtual didactics %D 2022 %7 31.3.2022 %9 Original Paper %J JMIR Med Educ %G English %X Background: Physical and social distancing recommendations aimed at limiting exposure during the COVID-19 pandemic have forced residency programs to increasingly rely on videoconferencing and web-based resources. Objective: In this pilot study, we aimed to explore the effects of the COVID-19 pandemic on residency training experience, and to delineate the perceived barriers to the successful implementation of web-based medical education. Methods: A 19-item survey was compiled and distributed electronically using Qualtrics. This anonymous survey included information on the training level of each resident, their participation in formal didactics before and during the pandemic, and their perception of the ease and limitations of virtual didactics. The resident’s opinions on specific educational resources were assessed, and the effectiveness of new delivery methods on resident engagement and learning was examined. Results: Thirty anesthesiology residents were surveyed, 19 of whom agreed to participate in the pilot study. One participant with incomplete responses was excluded, yielding a final cohort of 18 respondents. Most residents (56%, 10/18) reported that the COVID-19 pandemic negatively affected their residency training. The time spent on didactic training and independent studies was, nevertheless, not affected by the pandemic for 90% (16/18) of respondents. Nonetheless, 72% (13/18) of residents were less engaged during virtual lectures in comparison to in-person didactics. Important limitations included distraction from the physical environment (67%, 12/18), internet instability (67%, 12/18), less obligation to participate (44%, 8/18), technical difficulty and unmuted microphones (33%, 6/18, each), and people speaking over each other (28%, 5/18). Despite these limitations, most residents stated that they would like to keep a combination of virtual didactics including live Zoom lectures (56%, 10/18), prerecorded web didactics (56%, 10/18), and virtual ground rounds via Zoom (50%, 9/18) as the “new normal.” Conclusions: Despite important limitations listed in this report, anesthesia residents would like to keep a combination of virtual lectures and presentations as the new normal after the COVID-19 pandemic. %M 35275840 %R 10.2196/31080 %U https://mededu.jmir.org/2022/1/e31080 %U https://doi.org/10.2196/31080 %U http://www.ncbi.nlm.nih.gov/pubmed/35275840 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e27402 %T A Web-Based App for Emotional Management During the COVID-19 Pandemic: Platform Development and Retrospective Analysis of its Use Throughout Two Waves of the Outbreak in Spain %A Fidel Kinori,Sara Guila %A Carot-Sans,Gerard %A Cuartero,Andrés %A Valero-Bover,Damià %A Roma Monfa,Rosa %A Garcia,Elisabet %A Pérez Sust,Pol %A Blanch,Jordi %A Piera-Jiménez,Jordi %A Ramos-Quiroga,Josep Antoni %+ Information Systems Directorate, Servei Català de la Salut, Barcelona, Spain, 34 651041515, jpieraj@uoc.edu %K web-based app %K emotional management %K lockdown %K COVID-19 %K posttraumatic stress disorder %K anxiety %K quarantine %K PTSD %K app %K emotion %K development %K platform %K retrospective %K usage %K utilization %D 2022 %7 31.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Quarantines and nationwide lockdowns implemented for containing the spread of the COVID-19 pandemic may lead to distress and increase the frequency of anxiety and depression symptoms among the general population. During the nationwide lockdown of the first wave of the COVID-19 outbreak in Spain, we developed and launched a web-based app to promote emotional self-care in the general population and facilitate contact with health care professionals. Objective: This study aimed to describe a web-based app and analyze its utilization pattern throughout 2 successive waves of the COVID-19 outbreak in Spain. Methods: Our web-based app targeted all individuals aged 18 years or more and was designed by adapting the contents of a mobile app for adjuvant treatment of posttraumatic stress disorder (ie, the PTSD Coach app) to the general population and the pandemic or lockdown scenario. We retrospectively assessed the utilization pattern of the web-based app using data systematically retrieved from Google Analytics. Data were grouped into 3 time periods, defined using Joinpoint regression analysis of COVID-19 incidence in our area: first wave, between-wave period, and second wave. Results: The resulting web-based app, named gesioemocional.cat, maintains the navigation structure of the PTSD Coach app, with three main modules: tools for emotional self-care, a self-assessment test, and professional resources for on-demand contact. The self-assessment test combines the Patient Health Questionnaire-2 and the 7-item Generalized Anxiety Disorder scale and offers professional contact in the advent of a high level of depression and anxiety; contact is prioritized in accordance with a screening questionnaire administered at the time of obtaining individual consent to be contacted. The tools for emotional self-care can be accessed either on-demand or symptom-driven. The utilization analysis showed a high number of weekly accesses during the first wave. In this period, press releases regarding critical events of the pandemic progression and government decisions on containment measures were followed by a utilization peak, irrespective of the sense (ie, positive or negative) of the information. Positive information pieces (eg, relaxation of containment measures due to a reduction of COVID-19 cases) resulted in a sharp increase in utilization immediately after information release, followed by a successive decline in utilization. The second wave was characterized by a lower and less responsive utilization of the web-based app. Conclusions: mHealth tools may help the general population cope with stressful conditions associated with the pandemic scenario. Future studies shall investigate the effectiveness of these tools among the general population—including individuals without diagnosed mental illnesses—and strategies to reach as many people as possible. %M 35142638 %R 10.2196/27402 %U https://formative.jmir.org/2022/3/e27402 %U https://doi.org/10.2196/27402 %U http://www.ncbi.nlm.nih.gov/pubmed/35142638 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 10 %N 3 %P e35190 %T Mining Electronic Health Records for Drugs Associated With 28-day Mortality in COVID-19: Pharmacopoeia-wide Association Study (PharmWAS) %A Lerner,Ivan %A Serret-Larmande,Arnaud %A Rance,Bastien %A Garcelon,Nicolas %A Burgun,Anita %A Chouchana,Laurent %A Neuraz,Antoine %+ Inserm, Centre de Recherche des Cordeliers, Sorbonne Université, Université de Paris, 15 Rue de l'École de Médecine, Paris, 75006, France, 33 01 44 27 64 82, antoine.neuraz@aphp.fr %K COVID-19 %K drug repurposing %K wide association studies %K clinical data %K pharmacopeia %K electronic medical records %K health data %K mortality rate %K hospitalization %K patient data %D 2022 %7 30.3.2022 %9 Original Paper %J JMIR Med Inform %G English %X Background: Patients hospitalized for a given condition may be receiving other treatments for other contemporary conditions or comorbidities. The use of such observational clinical data for pharmacological hypothesis generation is appealing in the context of an emerging disease but particularly challenging due to the presence of drug indication bias. Objective: With this study, our main objective was the development and validation of a fully data-driven pipeline that would address this challenge. Our secondary objective was to generate pharmacological hypotheses in patients with COVID-19 and demonstrate the clinical relevance of the pipeline. Methods: We developed a pharmacopeia-wide association study (PharmWAS) pipeline inspired from the PheWAS methodology, which systematically screens for associations between the whole pharmacopeia and a clinical phenotype. First, a fully data-driven procedure based on adaptive least absolute shrinkage and selection operator (LASSO) determined drug-specific adjustment sets. Second, we computed several measures of association, including robust methods based on propensity scores (PSs) to control indication bias. Finally, we applied the Benjamini and Hochberg procedure of the false discovery rate (FDR). We applied this method in a multicenter retrospective cohort study using electronic medical records from 16 university hospitals of the Greater Paris area. We included all adult patients between 18 and 95 years old hospitalized in conventional wards for COVID-19 between February 1, 2020, and June 15, 2021. We investigated the association between drug prescription within 48 hours from admission and 28-day mortality. We validated our data-driven pipeline against a knowledge-based pipeline on 3 treatments of reference, for which experts agreed on the expected association with mortality. We then demonstrated its clinical relevance by screening all drugs prescribed in more than 100 patients to generate pharmacological hypotheses. Results: A total of 5783 patients were included in the analysis. The median age at admission was 69.2 (IQR 56.7-81.1) years, and 3390 (58.62%) of the patients were male. The performance of our automated pipeline was comparable or better for controlling bias than the knowledge-based adjustment set for 3 reference drugs: dexamethasone, phloroglucinol, and paracetamol. After correction for multiple testing, 4 drugs were associated with increased in-hospital mortality. Among these, diazepam and tramadol were the only ones not discarded by automated diagnostics, with adjusted odds ratios of 2.51 (95% CI 1.52-4.16, Q=.01) and 1.94 (95% CI 1.32-2.85, Q=.02), respectively. Conclusions: Our innovative approach proved useful in generating pharmacological hypotheses in an outbreak setting, without requiring a priori knowledge of the disease. Our systematic analysis of early prescribed treatments from patients hospitalized for COVID-19 showed that diazepam and tramadol are associated with increased 28-day mortality. Whether these drugs could worsen COVID-19 needs to be further assessed. %M 35275837 %R 10.2196/35190 %U https://medinform.jmir.org/2022/3/e35190 %U https://doi.org/10.2196/35190 %U http://www.ncbi.nlm.nih.gov/pubmed/35275837 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 3 %P e30032 %T Subphenotyping of Mexican Patients With COVID-19 at Preadmission To Anticipate Severity Stratification: Age-Sex Unbiased Meta-Clustering Technique %A Zhou,Lexin %A Romero-García,Nekane %A Martínez-Miranda,Juan %A Conejero,J Alberto %A García-Gómez,Juan M %A Sáez,Carlos %+ Biomedical Data Science Lab, Instituto Universitario de Tecnologías de la Información y Comunicaciones, Universitat Politècnica de València, Camino de Vera s/n, Valencia, 46022, Spain, 34 963877000 ext 75278, carsaesi@upv.es %K COVID-19 %K subphenotypes %K clustering %K characterization %K observational %K epidemiology %K Mexico %D 2022 %7 30.3.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The COVID-19 pandemic has led to an unprecedented global health care challenge for both medical institutions and researchers. Recognizing different COVID-19 subphenotypes—the division of populations of patients into more meaningful subgroups driven by clinical features—and their severity characterization may assist clinicians during the clinical course, the vaccination process, research efforts, the surveillance system, and the allocation of limited resources. Objective: We aimed to discover age-sex unbiased COVID-19 patient subphenotypes based on easily available phenotypical data before admission, such as pre-existing comorbidities, lifestyle habits, and demographic features, to study the potential early severity stratification capabilities of the discovered subgroups through characterizing their severity patterns, including prognostic, intensive care unit (ICU), and morbimortality outcomes. Methods: We used the Mexican Government COVID-19 open data, including 778,692 SARS-CoV-2 population-based patient-level data as of September 2020. We applied a meta-clustering technique that consists of a 2-stage clustering approach combining dimensionality reduction (ie, principal components analysis and multiple correspondence analysis) and hierarchical clustering using the Ward minimum variance method with Euclidean squared distance. Results: In the independent age-sex clustering analyses, 56 clusters supported 11 clinically distinguishable meta-clusters (MCs). MCs 1-3 showed high recovery rates (90.27%-95.22%), including healthy patients of all ages, children with comorbidities and priority in receiving medical resources (ie, higher rates of hospitalization, intubation, and ICU admission) compared with other adult subgroups that have similar conditions, and young obese smokers. MCs 4-5 showed moderate recovery rates (81.30%-82.81%), including patients with hypertension or diabetes of all ages and obese patients with pneumonia, hypertension, and diabetes. MCs 6-11 showed low recovery rates (53.96%-66.94%), including immunosuppressed patients with high comorbidity rates, patients with chronic kidney disease with a poor survival length and probability of recovery, older smokers with chronic obstructive pulmonary disease, older adults with severe diabetes and hypertension, and the oldest obese smokers with chronic obstructive pulmonary disease and mild cardiovascular disease. Group outcomes conformed to the recent literature on dedicated age-sex groups. Mexican states and several types of clinical institutions showed relevant heterogeneity regarding severity, potentially linked to socioeconomic or health inequalities. Conclusions: The proposed 2-stage cluster analysis methodology produced a discriminative characterization of the sample and explainability over age and sex. These results can potentially help in understanding the clinical patient and their stratification for automated early triage before further tests and laboratory results are available and even in locations where additional tests are not available or to help decide resource allocation among vulnerable subgroups such as to prioritize vaccination or treatments. %M 35144239 %R 10.2196/30032 %U https://publichealth.jmir.org/2022/3/e30032 %U https://doi.org/10.2196/30032 %U http://www.ncbi.nlm.nih.gov/pubmed/35144239 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e32791 %T The Successes and Challenges of Implementing Telehealth for Diverse Patient Populations Requiring Prenatal Care During COVID-19: Qualitative Study %A Farrell,Ruth %A Collart,Christina %A Craighead,Caitlin %A Pierce,Madelyn %A Chien,Edward %A Frankel,Richard %A Tucker Edmonds,Brownsyne %A Perni,Uma %A Coleridge,Marissa %A Ranzini,Angela C %A Rose,Susannah %+ Obstetrics and Gynecology and Women's Health Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, United States, 1 216 445 7085, farrelr@ccf.org %K prenatal health care delivery %K telehealth %K COVID-19 %K patient experience %K challenge %K telemedicine %K pregnancy %K women %K diversity %K prenatal %K obstetric %K reception %K experience %K development %D 2022 %7 30.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Although telehealth appears to have been accepted among some obstetric populations before the COVID-19 pandemic, patients’ receptivity and experience with the rapid conversion of this mode of health care delivery are unknown. Objective: In this study, we examine patients' prenatal care needs, preferences, and experiences during the COVID-19 pandemic, with the aim of supporting the development of successful models to serve the needs of pregnant patients, obstetric providers, and health care systems during this time. Methods: This study involved qualitative methods to explore pregnant patients’ experiences with prenatal health care delivery at the onset of the COVID-19 pandemic. We conducted in-depth interviews with pregnant patients in the first and second trimester of pregnancy who received prenatal care in Cleveland, Ohio, from May to July 2020. An interview guide was used to probe experiences with health care delivery as it rapidly evolved at the onset of the pandemic. Results: Although advantages of telehealth were noted, there were several concerns noted with the broad implementation of telehealth for prenatal care during the pandemic. This included concerns about monitoring the pregnancy at home; the need for additional reassurance for the pregnancy, given the uncertainties presented by the pandemic; and the ability to have effective patient-provider discussions via a telehealth visit. The need to tailor telehealth to prenatal health care delivery was noted. Conclusions: Although previous studies have demonstrated that telehealth is a flexible and convenient alternative for some prenatal appointments, our study suggests that there may be specific needs and concerns among the diverse patient groups using this modality during the pandemic. More research is needed to understand patients' experiences with telehealth during the pandemic and develop approaches that are responsive to the needs and preferences of patients. %M 35275833 %R 10.2196/32791 %U https://formative.jmir.org/2022/3/e32791 %U https://doi.org/10.2196/32791 %U http://www.ncbi.nlm.nih.gov/pubmed/35275833 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e32933 %T Patient Perspectives of Inpatient Telemedicine During the COVID-19 Pandemic: Qualitative Assessment %A Vilendrer,Stacie %A Sackeyfio,Sarah %A Akinbami,Eliel %A Ghosh,Roy %A Luu,Jacklyn Ha %A Pathak,Divya %A Shimada,Masahiro %A Williamson,Emmanuelle Elise %A Shieh,Lisa %+ Division of Primary Care and Population Health, Stanford University School of Medicine, 1265 Welch Rd, Stanford, CA, 94305, United States, 1 952 913 8883, staciev@stanford.edu %K telemedicine %K inpatient %K patient experience %K COVID-19 %K infection control %K quality of health care %K communication %K hospital %K perspective %K qualitative %D 2022 %7 30.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Telemedicine has been adopted in the inpatient setting to facilitate clinical interactions between on-site clinicians and isolated hospitalized patients. Such remote interactions have the potential to reduce pathogen exposure and use of personal protective equipment but may also pose new safety concerns given prior evidence that isolated patients can receive suboptimal care. Formal evaluations of the use and practical acceptance of inpatient telemedicine among hospitalized patients are lacking. Objective: We aimed to evaluate the experience of patients hospitalized for COVID-19 with inpatient telemedicine introduced as an infection control measure during the pandemic. Methods: We conducted a qualitative evaluation in a COVID-19 designated non–intensive care hospital unit at a large academic health center (Stanford Health Care) from October 2020 through January 2021. Semistructured qualitative interviews focused on patient experience, impact on quality of care, communication, and mental health. Purposive sampling was used to recruit participants representing diversity across varying demographics until thematic saturation was reached. Interview transcripts were qualitatively analyzed using an inductive-deductive approach. Results: Interviews with 20 hospitalized patients suggested that nonemergency clinical care and bridging to in-person care comprised the majority of inpatient telemedicine use. Nurses were reported to enter the room and call on the tablet far more frequently than physicians, who typically entered the room at least daily. Patients reported broad acceptance of the technology, citing improved convenience and reduced anxiety, but preferred in-person care where possible. Quality of care was believed to be similar to in-person care with the exception of a few patients who wanted more frequent in-person examinations. Ongoing challenges included low audio volume, shifting tablet location, and inconsistent verbal introductions from the clinical team. Conclusions: Patient experiences with inpatient telemedicine were largely favorable. Although most patients expressed a preference for in-person care, telemedicine was acceptable given the circumstances associated with the COVID-19 pandemic. Improvements in technical and care team use may enhance acceptability. Further evaluation is needed to understand the impact of inpatient telemedicine and the optimal balance between in-person and virtual care in the hospital setting. %M 35147510 %R 10.2196/32933 %U https://formative.jmir.org/2022/3/e32933 %U https://doi.org/10.2196/32933 %U http://www.ncbi.nlm.nih.gov/pubmed/35147510 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 10 %N 3 %P e35216 %T Pandemic-Related Impairment in the Monitoring of Patients With Hypertension and Diabetes and the Development of a Digital Solution for the Community Health Worker: Quasiexperimental and Implementation Study %A Cimini,Christiane Correa Rodrigues %A Maia,Junia Xavier %A Pires,Magda Carvalho %A Ribeiro,Leonardo Bonisson %A Pinto,Vânia Soares de Oliveira e Almeida %A Batchelor,James %A Ribeiro,Antonio Luiz Pinho %A Marcolino,Milena Soriano %+ Medical School and Telehealth Center, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Rua do Cruzeiro, 01, Bairro Jardim São Paulo, Teófilo Otoni-MG, 38803-371, Brazil, 55 33988900906, christiane.cimini@gmail.com %K hypertension %K diabetes mellitus %K COVID-19 %K pandemic %K primary health care %K telemedicine %K clinical decision support systems %K patient care management %D 2022 %7 29.3.2022 %9 Original Paper %J JMIR Med Inform %G English %X Background: The restrictions imposed by the COVID-19 pandemic reduced health service access by patients with chronic diseases. The discontinuity of care is a cause of great concern, mainly in vulnerable regions. Objective: This study aimed to assess the impact of the COVID-19 pandemic on people with hypertension and diabetes mellitus (DM) regarding the frequency of consultations and whether their disease was kept under control. The study also aimed to develop and implement a digital solution to improve monitoring at home. Methods: This is a multimethodological study. A quasiexperimental evaluation assessed the impact of the pandemic on the frequency of consultations and control of patients with hypertension and DM in 34 primary health care centers in 10 municipalities. Then, an implementation study developed an app with a decision support system (DSS) for community health workers (CHWs) to identify and address at-risk patients with uncontrolled hypertension or DM. An expert panel assessment evaluated feasibility, usability, and utility of the software. Results: Of 5070 patients, 4810 (94.87%) had hypertension, 1371 (27.04%) had DM, and 1111 (21.91%) had both diseases. There was a significant reduction in the weekly number of consultations (107, IQR 60.0-153.0 before vs 20.0, IQR 7.0-29.0 after social restriction; P<.001). Only 15.23% (772/5070) of all patients returned for a consultation during the pandemic. Individuals with hypertension had lower systolic (120.0, IQR 120.0-140.0 mm Hg) and diastolic (80.0, IQR 80.0-80.0 mm Hg) blood pressure than those who did not return (130.0, IQR 120.0-140.0 mm Hg and 80.0, IQR 80.0-90.0 mm Hg, respectively; P<.001). Also, those who returned had a higher proportion of controlled hypertension (64.3% vs 52.8%). For DM, there were no differences in glycohemoglobin levels. Concerning the DSS, the experts agreed that the CHWs can easily incorporate it into their routines and the app can identify patients at risk and improve treatment. Conclusions: The COVID-19 pandemic caused a significant drop in the number of consultations for patients with hypertension and DM in primary care. A DSS for CHW has proved to be feasible, useful, and easily incorporated into their routines. %M 35191842 %R 10.2196/35216 %U https://medinform.jmir.org/2022/3/e35216 %U https://doi.org/10.2196/35216 %U http://www.ncbi.nlm.nih.gov/pubmed/35191842 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 3 %P e35016 %T Tracking Public Attitudes Toward COVID-19 Vaccination on Tweets in Canada: Using Aspect-Based Sentiment Analysis %A Jang,Hyeju %A Rempel,Emily %A Roe,Ian %A Adu,Prince %A Carenini,Giuseppe %A Janjua,Naveed Zafar %+ British Columbia Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC, V5Z 4R4, Canada, 1 778 580 9113, hyejuj@cs.ubc.ca %K COVID-19 %K vaccination %K Twitter %K aspect-based sentiment analysis %K Canada %K social media %K pandemic %K content analysis %K vaccine rollout %K sentiment analysis %K public sentiment %K public health %K health promotion %K vaccination promotion %D 2022 %7 29.3.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: The development and approval of COVID-19 vaccines have generated optimism for the end of the COVID-19 pandemic and a return to normalcy. However, vaccine hesitancy, often fueled by misinformation, poses a major barrier to achieving herd immunity. Objective: We aim to investigate Twitter users’ attitudes toward COVID-19 vaccination in Canada after vaccine rollout. Methods: We applied a weakly supervised aspect-based sentiment analysis (ABSA) technique, which involves the human-in-the-loop system, on COVID-19 vaccination–related tweets in Canada. Automatically generated aspect and opinion terms were manually corrected by public health experts to ensure the accuracy of the terms and make them more domain-specific. Then, based on these manually corrected terms, the system inferred sentiments toward the aspects. We observed sentiments toward key aspects related to COVID-19 vaccination, and investigated how sentiments toward “vaccination” changed over time. In addition, we analyzed the most retweeted or liked tweets by observing most frequent nouns and sentiments toward key aspects. Results: After applying the ABSA system, we obtained 170 aspect terms (eg, “immunity” and “pfizer”) and 6775 opinion terms (eg, “trustworthy” for the positive sentiment and “jeopardize” for the negative sentiment). While manually verifying or editing these terms, our public health experts selected 20 key aspects related to COVID-19 vaccination for analysis. The sentiment analysis results for the 20 key aspects revealed negative sentiments related to “vaccine distribution,” “side effects,” “allergy,” “reactions,” and “anti-vaxxer,” and positive sentiments related to “vaccine campaign,” “vaccine candidates,” and “immune response.” These results indicate that the Twitter users express concerns about the safety of vaccines but still consider vaccines as the option to end the pandemic. In addition, compared to the sentiment of the remaining tweets, the most retweeted or liked tweets showed more positive sentiment overall toward key aspects (P<.001), especially vaccines (P<.001) and vaccination (P=.009). Further investigation of the most retweeted or liked tweets revealed two opposing trends in Twitter users who showed negative sentiments toward vaccines: the “anti-vaxxer” population that used negative sentiments as a means to discourage vaccination and the “Covid Zero” population that used negative sentiments to encourage vaccinations while critiquing the public health response. Conclusions: Our study examined public sentiments toward COVID-19 vaccination on tweets over an extended period in Canada. Our findings could inform public health agencies to design and implement interventions to promote vaccination. %M 35275835 %R 10.2196/35016 %U https://www.jmir.org/2022/3/e35016 %U https://doi.org/10.2196/35016 %U http://www.ncbi.nlm.nih.gov/pubmed/35275835 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e31342 %T Notes From the Field: A Voice-Activated Video Communication System for Nurses to Communicate With Inpatients With COVID-19 %A Dunn,Mimi %A Landman,Adam %A Cartright,Jennifer %A Bane,Anne %A Brogan,Anne %A Coy,Caroline %A Zhang,Haipeng %+ Brigham Digital Innovation Hub, Brigham and Women's Hospital, Mass General Brigham, 60 Fenwood Road, Boston, MA, 02115, United States, 1 8573075995, mdunn15@bwh.harvard.edu %K Internet of Things %K IoT %K voice assistant %K telehealth %K hospital systems %K COVID-19 %K nurses %K nursing %K public health %K virtual care %D 2022 %7 28.3.2022 %9 Notes From the Field %J JMIR Form Res %G English %X With the relaxing of telehealth regulations through the Health Insurance Portability and Accountability Act (HIPAA) waiver notification for Telehealth Remote Communications during the COVID-19 Nationwide Public Health Emergency, our organization had the opportunity to pilot an innovative virtual care solution using a modified consumer-grade voice-activated video communication system (Amazon Echo Show 8) within one inpatient COVID-19 unit. In this brief report, we describe our experiences with implementing the system and general feedback from clinicians, and discuss areas for future development required to enable future scaling of this solution. Our pilot demonstrates the feasibility of deploying a consumer-grade voice assistant device in COVID-19 patient rooms. We found the devices engaging due to the voice technologies and Alexa functionalities for both clinician and patient entertainment. To enable future deployment at scale, enhancements to the Echo Show and data analytics will need to be further explored. %M 35156929 %R 10.2196/31342 %U https://formative.jmir.org/2022/3/e31342 %U https://doi.org/10.2196/31342 %U http://www.ncbi.nlm.nih.gov/pubmed/35156929 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e34539 %T Recommendations for Researchers on Synchronous, Online, Nominal Group Sessions in Times of COVID-19: Fishbone Analysis %A Timmermans,Lotte %A Huybrechts,Ine %A Decat,Peter %A Foulon,Veerle %A Van Hecke,Ann %A Vermandere,Mieke %A Schoenmakers,Birgitte %+ Academic Centre of General Practice, KU Leuven, Kapucijnenvoer 7, Box 7001, Leuven, 3000, Belgium, 32 16 37 45 98, lotte.timmermans@kuleuven.be %K COVID-19 %K fishbone diagram %K nominal group technique %K video conferencing %K primary health care %K qualitative research %D 2022 %7 25.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: In times of COVID-19, we are challenged to experiment with alternative platforms or software to connect people. In particular, the struggle that arose in health research was how to interact with patients and care professionals. The latter is additionally faced with an extreme workload to fight the pandemic crisis. Creative strategies have been developed to continue research among patients and care professionals to improve quality of care. This paper addresses the issue of synchronous, online, nominal group sessions, a common consensus method used for group brainstorming. Objective: The purpose of this study was to share our experiences with performing online, nominal group sessions using the video conference software Microsoft Teams. In addition, we aimed to create a practical guide with recommendations for researchers. Methods: We critically analyzed the procedures for the online nominal group technique, according to the Fishbone methodology. Results: Performing synchronous, online, nominal group sessions is challenging but offers opportunities. Although interaction with and among the attendees complicates the process, the major advantage of online sessions is their accessibility and comfort because of reduced barriers to participation (eg, lower time investment). The role of the moderators is of major importance, and good preparation beforehand is required. Recommendations for future online, nominal research were formulated. Conclusions: Online, nominal group sessions seem to be a promising alternative for the real-life commonly used technique. Especially during the COVID-19 pandemic, the benefits must be highlighted. More expertise is needed to further refine the practical guide for using digital software in research and to achieve optimal performance. %M 35225814 %R 10.2196/34539 %U https://formative.jmir.org/2022/3/e34539 %U https://doi.org/10.2196/34539 %U http://www.ncbi.nlm.nih.gov/pubmed/35225814 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 3 %P e34544 %T The Evaluation of a Social Media Campaign to Increase COVID-19 Testing in Migrant Groups: Cluster Randomized Trial %A Elgersma,Ingeborg Hess %A Fretheim,Atle %A Indseth,Thor %A Munch,Anita Thorolvsen %A Johannessen,Live Bøe %A Hansen,Christine Engh %+ Centre for Epidemic Interventions Research, Norwegian Institute of Public Health, Postboks 222, Skøyen, Oslo, 0213, Norway, 47 91584782, ingeborghess.elgersma@fhi.no %K COVID-19 %K SARS-CoV-2 %K social media %K campaign %K cluster randomized trial %K nonpharmaceutical interventions %K migrant %K intervention %K testing %K strategy %K public health %K Facebook %K communication %D 2022 %7 24.3.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: A low test positivity rate is key to keeping the COVID-19 pandemic under control. Throughout the pandemic, several migrant groups in Norway have seen higher rates of confirmed COVID-19 and related hospitalizations, while test positivity has remained high in the same groups. The Norwegian government has used several platforms for communication, and targeted social media advertisements have in particular been an important part of the communication strategy to reach these groups. Objective: In this study, we aimed to investigate whether such a targeted Facebook campaign increased the rate of COVID-19 tests performed in certain migrant groups. Methods: We randomly assigned 386 Norwegian municipalities and city districts to intervention or control groups. Individuals born in Eritrea, Iraq, Pakistan, Poland, Russia, Somalia, Syria, and Turkey residing in intervention areas were targeted with a social media campaign aiming at increasing the COVID-19 test rate. The campaign message was in a simple language and conveyed in the users’ main language or in English. Results: During the 2-week follow-up period, the predicted probability of having a COVID-19 test taken was 4.82% (95% CI 4.47%-5.18%) in the control group, and 5.58% (95% CI 5.20%-5.99%) in the intervention group (P=.004). Conclusions: Our targeted social media intervention led to a modest increase in test rates among certain migrant groups in Norway. Trial Registration: ClinicalTrials.gov NCT04866589; https://clinicaltrials.gov/ct2/show/NCT04866589 %M 35285811 %R 10.2196/34544 %U https://www.jmir.org/2022/3/e34544 %U https://doi.org/10.2196/34544 %U http://www.ncbi.nlm.nih.gov/pubmed/35285811 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 3 %P e36269 %T Strengthening Social Capital to Address Isolation and Loneliness in Long-term Care Facilities During the COVID-19 Pandemic: Protocol for a Systematic Review of Research on Information and Communication Technologies %A Beogo,Idrissa %A Sia,Drissa %A Tchouaket Nguemeleu,Eric %A Zhao,Junqiang %A Gagnon,Marie-Pierre %A Etowa,Josephine %+ School of Nursing, Faculty of Health Sciences, University of Ottawa, 451 Smith road, Roger-Guindon Hall, Ottawa, ON, K1H 8M5, Canada, 1 6135625800 ext 8148, ibeogo@uottawa.ca %K ICT, long-term care facilities, COVID-19, social isolation, loneliness, pandemic, implementation sciences, protocol %K nursing home %K long-term care %K mental health %K aging %K older adults %K virtual communication %K virtual care %K information technology %K healthcare %K healthcare sector %K health care %D 2022 %7 24.3.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: The COVID-19 pandemic has had the greatest impact in long-term care facilities (LTCFs) by disproportionately harming older adults and heightening social isolation and loneliness (SIL). Living in close quarters with others and in need of around-the-clock assistance, interactions with older adults, which were previously in person, have been replaced by virtual chatting using information and communication technologies (ICTs). ICT applications such as FaceTime, Zoom, and Microsoft Teams video chatting have been overwhelmingly used by families to maintain residents’ social capital and subsequently reduce their SIL. Objective: Because of the lack of substantive knowledge on this ever-increasing form of social communication, this systematic review intends to synthesize the effects of ICT interventions to address SIL among residents in LTCFs during the COVID-19 period. Methods: We will include studies published in Chinese, English, and French from December 2019 onwards. Beyond the traditional search strategy approach, 4 of the 12 electronic databases to be queried will be in Chinese. We will include quantitative and intervention studies as well as qualitative and mixed methods designs. Using a 2-person approach, the principal investigator and one author will blindly screen eligible articles, extract data, and assess risk of bias. In order to improve the first round of screening, a pilot-tested algorithm will be used. Disagreements will be resolved through discussion with a third author. Results will be presented as structured summaries of the included studies. We plan to conduct a meta-analysis if sufficient data are available. Results: A total of 1803 articles have been retrieved to date. Queries of the Chinese databases are ongoing. The systematic review and subsequent manuscript will be completed by the fall of 2022. Conclusions: ICT applications have become a promising avenue to reduce SIL by providing a way to maintain communication between LTCF residents and their families and will certainly remain in the post–COVID-19 period. This review will investigate and describe context-pertinent and high-quality programs and initiatives to inform, at the macro level, policy makers and researchers, frontline managers, and families. These methods will remain relevant in the post–COVID-19 era. International Registered Report Identifier (IRRID): DERR1-10.2196/36269 %M 35275841 %R 10.2196/36269 %U https://www.researchprotocols.org/2022/3/e36269 %U https://doi.org/10.2196/36269 %U http://www.ncbi.nlm.nih.gov/pubmed/35275841 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e32477 %T Competition and Integration of US Health Systems in the Post-COVID-19 New Normal: Cross-sectional Survey %A Khuntia,Jiban %A Ning,Xue %A Stacey,Rulon %+ Business School, University of Colorado Denver, 1475 Lawrence St., Denver, CO, 80202, United States, 1 303 315 8424, jiban.khuntia@ucdenver.edu %K post-COVID-19 %K health system %K competition %K vertical integration %K horizontal integration %K COVID-19 %K integration %K cross-sectional %K survey %K United States %K characteristic %K perception %K decision %D 2022 %7 24.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: How do health systems in the United States view the concept of merger and acquisition (M&A) in a post-COVID 19 “new normal”? How do new entrants to the market and incumbents influence horizontal and vertical integration of health systems? Traditionally, it has been argued that M&A activity is designed to reduce inequities in the market, shift toward value-based care, or enhance the number and quality of health care offerings in a given market. However, the recent history of M&A activity has yielded fewer noble results. As might be expected, the smaller the geographical region in which M&A activity is pursued, the higher the likelihood that monopolistic tendencies will result. Objective: We focused on three types of competition perceptions, external environment uncertainty–related competition, technology disruption–driven competition, and customer service–driven competition, and two integration plans, vertical integration and horizontal integration. We examined (1) how health system characteristics help discern competition perceptions and integration decisions, and (2) how environment-, technology-, and service-driven competition aspects influence vertical and horizontal integration among US health systems in the post-COVID-19 new normal. Methods: We used data for this study collected through a consultant from a robust group of health system chief executive officers (CEOs) across the United States from February to March 2021. Among the 625 CEOs, 135 (21.6%) responded to our survey. We considered competition and integration aspects from the literature and ratified them via expert consensus. We collected secondary data from the Agency for Healthcare Research and Quality (AHRQ) Compendium of the US Health Systems, leading to a matched data set for 124 health systems. We used inferential statistical comparisons to assess differences across health systems regarding competition and integration, and we used ordered logit estimations to relate competition and integration. Results: Health systems generally have a high level of the four types of competition perceptions, with the greatest concern being technology disruption–driven competition rather than environment uncertainty–related competition and customer service–driven competition. The first set of estimation results showed that size, teaching status, revenue, and uncompensated care burden are the main contingent factors influencing the three competition perceptions. The second set of estimation results revealed the relationships between different competition perceptions and integration plans. For vertical integration, environment uncertainty–related competition had a significant positive influence (P<.001), while the influence of technology disruption–driven competition was significant but negative (P<.001). The influence of customer service–driven competition on vertical integration was not evident. For horizontal integration, the results were similar for environment uncertainty–related competition and technology disruption–driven competition; however, the significance of technology disruption–driven competition was weak (P=.05). The influence of customer service–driven competition in the combined model was significant and negative (P<.001). Conclusions: Competition-driven integration has subtle influences across health systems. Environment uncertainty–related competition is a significant factor, with underlying contingent factors such as revenue concerns and leadership as the leading causes of integration plans. However, technology disruption may hinder integrations. Undoubtedly, small- and low-revenue health systems facing a high level of competition are likely to merge to navigate the health care business successfully. This trend should be a focus of policy to avoid monopolistic markets. %M 35133973 %R 10.2196/32477 %U https://formative.jmir.org/2022/3/e32477 %U https://doi.org/10.2196/32477 %U http://www.ncbi.nlm.nih.gov/pubmed/35133973 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 3 %P e31449 %T Social Media–Delivered Patient Education to Enhance Self-management and Attitudes of Patients with Type 2 Diabetes During the COVID-19 Pandemic: Randomized Controlled Trial %A Leong,Cheng Man %A Lee,Ting-I %A Chien,Yu-Mei %A Kuo,Li-Na %A Kuo,Yu-Feng %A Chen,Hsiang-Yin %+ Department of Clinical Pharmacy, School of Pharmacy, Taipei Medical University, R714, 7th Floor, Health and Science Building, No.250, Wuxing St., Xinyi Dist., Taipei, 110, Taiwan, 886 2 2736 1661 ext 6175, shawn@tmu.edu.tw %K diabetes %K COVID-19 %K education %K video %K social media %K health literacy %K self-care activity %K type 2 diabetes %K attitude %K mHealth %D 2022 %7 23.3.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: The use of mobile health technologies has been necessary to deliver patient education to patients with diabetes during the COVID-19 pandemic. Objective: This open-label randomized controlled trial evaluated the effects of a diabetes educational platform—Taipei Medical University–LINE Oriented Video Education—delivered through a social media app. Methods: Patients with type 2 diabetes were recruited from a clinic through physician referral. The social media–based program included 51 videos: 10 about understanding diabetes, 10 about daily care, 6 about nutrition care, 21 about diabetes drugs, and 4 containing quizzes. The intervention group received two or three videos every week and care messages every 2 weeks through the social media platform for 3 months, in addition to usual care. The control group only received usual care. Outcomes were measured at clinical visits through self-reported face-to-face questionnaires at baseline and at 3 months after the intervention, including the Simplified Diabetes Knowledge Scale (true/false version), the Diabetes Care Profile–Attitudes Toward Diabetes Scales, the Summary of Diabetes Self-Care Activities, and glycated hemoglobin (HbA1c) levels. Health literacy was measured at baseline using the Newest Vital Sign tool. Differences in HbA1c levels and questionnaire scores before and after the intervention were compared between groups. The associations of knowledge, attitudes, and self-care activities with health literacy were assessed. Results: Patients with type 2 diabetes completed the 3-month study, with 91 out of 181 (50.3%) patients in the intervention group and 90 (49.7%) in the control group. The change in HbA1c did not significantly differ between groups (intervention group: mean 6.9%, SD 0.8% to mean 7.0%, SD 0.9%, P=.34; control group: mean 6.7%, SD 0.6% to mean 6.7%, SD 0.7%, P=.91). Both groups showed increased mean knowledge scores at 12 weeks, increasing from 68.3% (SD 16.4%) to 76.7% (SD 11.7%; P<.001) in the intervention group and from 64.8% (SD 18.2%) to 73.2% (SD 12.6%; P<.001) in the control group. Positive improvements in attitudes and self-care activities were only observed in the intervention group (attitudes: mean difference 0.2, SD 0.5, P=.001; self-care activities: mean difference 0.3, SD 1.2, P=.03). A 100% utility rate was achieved for 8 out of 21 (38%) medication-related videos. Low health literacy was a significant risk factor for baseline knowledge scores in the intervention group, with an odds ratio of 2.80 (95% CI 1.28-6.12; P=.01); this became insignificant after 3 months. Conclusions: The social media–based program was effective at enhancing the knowledge, attitudes, and self-care activities of patients with diabetes. This intervention was also helpful for patients with low health literacy in diabetes knowledge. The program represents a potentially useful tool for delivering diabetes education to patients through social media, especially during the COVID-19 pandemic. Trial Registration: ClinicalTrials.gov NCT04876274; https://clinicaltrials.gov/ct2/show/results/NCT04876274 %M 35319478 %R 10.2196/31449 %U https://www.jmir.org/2022/3/e31449 %U https://doi.org/10.2196/31449 %U http://www.ncbi.nlm.nih.gov/pubmed/35319478 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 11 %N 1 %P e29513 %T Occurrence Patterns of Traumatic Brain Injury Within the Emergency Department and Internal Screening Process Efficacy During the COVID-19 Pandemic: Retrospective Analysis %A Paralkar,Tapasvini Anmol %A Lay,Phoebe %A Stubbs,Sawyer %A Ahmed,Syed Hadi %A Ghani,Minha %A Osier,Nico %+ School of Nursing, The University of Texas at Austin, 1710 Red River Street, Austin, TX, 78712, United States, 1 (512) 471 7913, nicoosier@utexas.edu %K COVID-19 %K coronavirus %K pandemic %K clinical recruitment %K traumatic brain injury %K children %K participant-focused %K recruitment %K enrollment %K digital screening %K brain %K EHR %K electronic health record %K database %D 2022 %7 23.3.2022 %9 Original Paper %J Interact J Med Res %G English %X Background: Traumatic brain injury (TBI) is one of the leading causes of death in pediatric patients. Continued recruitment of pediatric TBI participants into a biobank amidst the COVID-19 pandemic not only necessitates adaptive changes to traditional recruitment methods but also requires an evaluation of emergency department (ED) utilization by TBI-presenting patients. Objective: The primary objective of this exploratory retrospective study was to evaluate pediatric TBI-related ED utilization during the pandemic. The secondary objective was to appraise the efficacy of the research team’s internal screening processes. Methods: Potential participants (ie, individuals who met all inclusion criteria and would be approached by a consenter) were screened from an ED’s electronic health record system. Data regarding their visit were recorded in a Health Insurance Portability and Accountability Act–compliant manner, which were cleaned through Google Sheets. Cleaned data were then coded as either a screening variable or a hospital utilization variable to examine the effects of the pandemic on internal operations and hospital utilization patterns. The variables were compared between select months during the pandemic in 2020 to analogous months in 2019 in the R programming language via the two-sample Student t test and the Mann-Whitney-Wilcoxon rank-sum test. Results: The sample (N=2321) consisted of 1245 entries from 2019 and 1076 entries from 2020. A significantly greater proportion of potential participants (P<.001) were identified in 2020 (222/633, 35.1%) than in 2019 (195/908, 21.4%). A significantly greater proportion of potential participants (P<.001) had a visit reason indicative of a TBI in 2020 (181/222, 81.5%) than in 2019 (103/195, 52.8%). A significantly greater proportion of these injuries (P=.02) occurred inside (39/181, 21.5%) in 2020 than in 2019 (11/103, 10.7%). No significant difference was found across the mechanism of injury categories reported for potential participants between 2019 and 2020. Potential participants were significantly older (P=.006) in 2019 (mean 8.93 years) than in 2020 (mean 7.31 years). Screeners spent significantly longer (P=.03) to identify potential participants in March 2020 (55 minutes) than in March 2019 (32 minutes), but spent significantly less time (P=.01) to do so in July 2020 (22 minutes) than in July 2019 (42 minutes). Screening coverage was significantly lower (P<.001) in March 2020 (241.8 hours) than in March 2019 (346.5 hours). Screening coverage was significantly greater (P<.001) in April 2020 (611.5 hours) and July 2020 (513.5 hours) than in April 2019 (470.5 hours) and July 2019 (404.3 hours), respectively. Conclusions: There was a significant increase in the rate of incoming TBI cases to the ED during the COVID-19 pandemic, warranting continued enrollment with added safety measures. Additionally, refinement of internal processes improved the accuracy of data collection. As demonstrated in this study, researchers can leverage ongoing data collection to facilitate process improvements and evaluate the impact of unexpected global events on their research. %M 35225820 %R 10.2196/29513 %U https://www.i-jmr.org/2022/1/e29513 %U https://doi.org/10.2196/29513 %U http://www.ncbi.nlm.nih.gov/pubmed/35225820 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e35066 %T How Vaccine Ambivalence Can Lead People Who Inject Drugs to Decline COVID-19 Vaccination and Ways This Can Be Addressed: Qualitative Study %A Aronson,Ian David %A Bennett,Alex S %A Ardouin-Guerrier,Mary-Andrée %A Rivera-Castellar,German %A Gibson,Brent %A Santoscoy,Samantha %A Vargas-Estrella,Brittney %+ Department of Social and Behavioral Sciences, School of Global Public Health, New York University, 708 Broadway, New York, NY, 10003, United States, 1 (212) 992 6741, ia14@nyu.edu %K SARS-CoV-2 %K COVID-19 %K people who inject drugs %K vaccine %K vaccine hesitancy %K barrier %K vaccination %K drugs %K hesitancy %K qualitative %K impact %K interview %K United States %K communication %K danger %K community %D 2022 %7 23.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: People who inject drugs are disproportionately impacted by SARS-CoV-2 and COVID-19, yet they do not frequently accept vaccination against SARS-CoV-2 when offered. Objective: This study aimed to explore why people who inject drugs decline free vaccines against SARS-CoV-2 and how barriers to vaccination can potentially be addressed. Methods: We conducted semistructured qualitative interviews with 17 unvaccinated adult persons who inject drugs during August and September 2021 at a New York City syringe service program, where approximately three-fourth of participants identified as Latino (55%) or African American (22%). Interviews lasted roughly 20 minutes. The interview guide examined reasons for declining vaccination, participants’ understanding of COVID-19 risks, and how messages could be developed to encourage vaccine uptake among people who inject drugs. Results: Participants acknowledged that they faced increased risk from SARS-CoV-2 owing to their injection drug use but feared that long-term substance use may have weakened their health, making them especially vulnerable to side effects. Fears of possible side effects, compounded by widespread medical mistrust and questions about the overall value of vaccination contributed to marked ambivalence among our sample. The desire to protect children and older family members emerged as key potential facilitators of vaccination. Conclusions: Community-developed messages are needed in outreach efforts to explain the importance of vaccination, including the far greater dangers of COVID-19 compared to possible unintended side effects. Messages that emphasize vaccines’ ability to prevent inadvertently infecting loved ones, may help increase uptake. Community-focused messaging strategies, such as those used to increase HIV and hepatitis C virus testing and overdose prevention among people who inject drugs, may prove similarly effective. %M 35191841 %R 10.2196/35066 %U https://formative.jmir.org/2022/3/e35066 %U https://doi.org/10.2196/35066 %U http://www.ncbi.nlm.nih.gov/pubmed/35191841 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e32403 %T The Impact of Telemedicine Visits on the Controlling High Blood Pressure Quality Measure During the COVID-19 Pandemic: Retrospective Cohort Study %A Ye,Siqin %A Anstey,D Edmund %A Grauer,Anne %A Metser,Gil %A Moise,Nathalie %A Schwartz,Joseph %A Kronish,Ian %A Abdalla,Marwah %+ Department of Medicine, Columbia University Irving Medical Center, 622 West 168th Street, PH 9-318, New York, NY, 10033, United States, 1 7737100114, sy2357@cumc.columbia.edu %K telemedicine %K hypertension %K blood pressure %K quality of care %K impact %K COVID-19 %K cohort %K cardiology %K telehealth %K retrospective %D 2022 %7 23.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Telemedicine visit use vastly expanded during the COVID-19 pandemic, and this has had an uncertain impact on cardiovascular care quality. Objective: We sought to examine the association between telemedicine visits and the failure to meet the Controlling High Blood Pressure (BP) quality measure from the Centers for Medicare & Medicaid Services. Methods: This was a retrospective cohort study of 32,727 adult patients with hypertension who were seen in primary care and cardiology clinics at an urban, academic medical center from February to December 2020. The primary outcome was a failure to meet the Controlling High Blood Pressure quality measure, which was defined as having no BP recorded or having a last recorded BP of ≥140/90 mm Hg (ie, poor BP control). Multivariable logistic regression was used to assess the association between telemedicine visit use during the study period (none, 1 telemedicine visit, or ≥2 telemedicine visits) and poor BP control; we adjusted for demographic and clinical characteristics. Results: During the study period, no BP was recorded for 2.3% (486/20,745) of patients with in-person visits only, 27.1% (1863/6878) of patients with 1 telemedicine visit, and 25% (1277/5104) of patients with ≥2 telemedicine visits. After adjustment, telemedicine use was associated with poor BP control (1 telemedicine visit: odds ratio [OR] 2.06, 95% CI 1.94-2.18; P<.001; ≥2 telemedicine visits: OR 2.49, 95% CI 2.31-2.68; P<.001; reference: in-person visits only). This effect disappeared when the analysis was restricted to patients with at least 1 recorded BP (1 telemedicine visit: OR 0.89, 95% CI 0.83-0.95; P=.001; ≥2 telemedicine visits: OR 0.91, 95% CI 0.83-0.99; P=.03). Conclusions: Increased telemedicine visit use is associated with poorer performance on the Controlling High Blood Pressure quality measure. However, telemedicine visit use may not negatively impact BP control when BP is recorded. %M 35138254 %R 10.2196/32403 %U https://formative.jmir.org/2022/3/e32403 %U https://doi.org/10.2196/32403 %U http://www.ncbi.nlm.nih.gov/pubmed/35138254 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 3 %P e31088 %T Stratified Impacts of the Infodemic During the COVID-19 Pandemic: Cross-sectional Survey in 6 Asian Jurisdictions %A Chen,Xi %A Lin,Fen %A Cheng,Edmund W %+ Department of Media and Communication, City University of Hong Kong, M5086, 5/F, Run Run Shaw Creative Media Centre, 18 Tat Hong Avenue, Kowloon Tong, Hong Kong, 852 34428691, fenlin@cityu.edu.hk %K infodemic %K information overload %K psychological distress %K protective behavior %K cross-national survey %K Asia %K COVID-19 %D 2022 %7 22.3.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Although timely and accurate information during the COVID-19 pandemic is essential for containing the disease and reducing mental distress, an infodemic, which refers to an overabundance of information, may trigger unpleasant emotions and reduce compliance. Prior research has shown the negative consequences of an infodemic during the pandemic; however, we know less about which subpopulations are more exposed to the infodemic and are more vulnerable to the adverse psychological and behavioral effects. Objective: This study aimed to examine how sociodemographic factors and information-seeking behaviors affect the perceived information overload during the COVID-19 pandemic. We also investigated the effect of perceived information overload on psychological distress and protective behavior and analyzed the socioeconomic differences in the effects. Methods: The data for this study were obtained from a cross-national survey of residents in 6 jurisdictions in Asia in May 2020. The survey targeted residents aged 18 years or older. A probability-based quota sampling strategy was adopted to ensure that the selected samples matched the population’s geographical and demographic characteristics released by the latest available census in each jurisdiction. The final sample included 10,063 respondents. Information overload about COVID-19 was measured by asking the respondents to what extent they feel overwhelmed by news related to COVID-19. The measure of psychological distress was adapted from the Posttraumatic Stress Disorder Checklist for Diagnostic and Statistical Manual of Mental Disorders 5 (DSM-5). Protective behaviors included personal hygienic behavior and compliance with social distancing measures. Results: Younger respondents and women (b=0.20, 95% CI 0.14 to 0.26) were more likely to perceive information overload. Participants self-perceived as upper or upper-middle class (b=0.19, 95% CI 0.09 to 0.30) and those with full-time jobs (b=0.11, 95% CI 0.04 to 0.17) tended to perceive higher information overload. Respondents who more frequently sought COVID-19 information from newspapers (b=0.12, 95% CI 0.11 to 0.14), television (b=0.07, 95% CI 0.05 to 0.09), and family and friends (b=0.11, 95% CI 0.09 to 0.14) were more likely to feel overwhelmed. In contrast, obtaining COVID-19 information from online news outlets and social media was not associated with perceived information overload. There was a positive relationship between perceived information overload and psychological distress (b=2.18, 95% CI 2.09 to 2.26). Such an association was stronger among urban residents, full-time employees, and those living in privately owned housing. The effect of perceived information overload on protective behavior was not significant. Conclusions: Our findings revealed that respondents who were younger, were female, had a higher socioeconomic status (SES), and had vulnerable populations in the household were more likely to feel overwhelmed by COVID-19 information. Perceived information overload tended to increase psychological distress, and people with higher SES were more vulnerable to this adverse psychological consequence. Effective policies and interventions should be promoted to target vulnerable populations who are more susceptible to the occurrence and negative psychological influence of perceived information overload. %M 35103601 %R 10.2196/31088 %U https://www.jmir.org/2022/3/e31088 %U https://doi.org/10.2196/31088 %U http://www.ncbi.nlm.nih.gov/pubmed/35103601 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 10 %N 3 %P e31557 %T The Disparity and Dynamics of Social Distancing Behaviors in Japan: Investigation of Mobile Phone Mobility Data %A Lyu,Zeyu %A Takikawa,Hiroki %+ Graduate School, Faculty of Arts and Letters, Tohoku University, 27-1 Kawauchi, Aoba-ku, Sendai, 980-8576, Japan, 81 08081510072, lyu.zeyu.r8@dc.tohoku.ac.jp %K COVID-19 %K social distancing %K mobility %K time series %K tracking %K policy %D 2022 %7 22.3.2022 %9 Original Paper %J JMIR Med Inform %G English %X Background: The availability of large-scale and fine-grained aggregated mobility data has allowed researchers to observe the dynamics of social distancing behaviors at high spatial and temporal resolutions. Despite the increasing attention paid to this research agenda, limited studies have focused on the demographic factors related to mobility, and the dynamics of social distancing behaviors have not been fully investigated. Objective: This study aims to assist in designing and implementing public health policies by exploring how social distancing behaviors varied among various demographic groups over time. Methods: We combined several data sources, including mobile tracking mobility data and geographical statistics, to estimate the visiting population of entertainment venues across demographic groups, which can be considered the proxy of social distancing behaviors. Next, we used time series analysis methods to investigate how voluntary and policy-induced social distancing behaviors shifted over time across demographic groups. Results: Our findings demonstrate distinct patterns of social distancing behaviors and their dynamics across age groups. On the one hand, although entertainment venues’ population comprises mainly individuals aged 20-40 years, a more significant proportion of the youth has adopted social distancing behaviors and complied with policy implementations compared to older age groups. From this perspective, the increasing contribution to infections by the youth should be more likely to be attributed to their number rather than their violation of social distancing behaviors. On the other hand, although risk perception and self-restriction recommendations can induce social distancing behaviors, their impact and effectiveness appear to be largely weakened during Japan’s second state of emergency. Conclusions: This study provides a timely reference for policymakers about the current situation on how different demographic groups adopt social distancing behaviors over time. On the one hand, the age-dependent disparity requires more nuanced and targeted mitigation strategies to increase the intention of elderly individuals to adopt mobility restriction behaviors. On the other hand, considering that the effectiveness of policy implementations requesting social distancing behaviors appears to decline over time, in extreme cases, the government should consider imposing stricter social distancing interventions, as they are necessary to promote social distancing behaviors and mitigate the transmission of COVID-19. %M 35297764 %R 10.2196/31557 %U https://medinform.jmir.org/2022/3/e31557 %U https://doi.org/10.2196/31557 %U http://www.ncbi.nlm.nih.gov/pubmed/35297764 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 1 %P e35221 %T Socioeconomic Disparities in the Demand for and Use of Virtual Visits Among Senior Adults During the COVID-19 Pandemic: Cross-sectional Study %A Yu,Ellie %A Hagens,Simon %+ Canada Health Infoway, 150 King Street Unit 1300, Toronto, ON, M5H 1J9, Canada, 1 6476406189, ellieyuyaoyu@gmail.com %K virtual care %K virtual visit %K COVID-19 %K survey %K virtual care demand %K virtual care use %K older adults %K elderly care %K aging %K digital health %K pandemic %D 2022 %7 22.3.2022 %9 Original Paper %J JMIR Aging %G English %X Background: The COVID-19 pandemic has limited the provision of in-person care and accelerated the need for virtual care. Older adults (65+ years) were 1 of the highest user groups of in-person health care services prior to the pandemic. Social distancing guidelines and high rates of mortality from coronavirus infections among older adults made receiving in-person health care services challenging for older adults. The provision of virtual care technologies can help to ensure continuity of care and provide essential health care services during the pandemic to those at high risk of contracting the COVID-19 coronavirus, including older adults. It is also essential to understand and address potential socioeconomic, demographic, and health disparities in the demand for and use of virtual care technologies among older adults. Objective: The objective of this study is to investigate socioeconomic disparities in the demand for and use of virtual visits during the COVID-19 pandemic among older adults in Canada. Methods: A cross-sectional web survey was conducted with 12,052 Canadians over the age of 16 years, selected from Leger’s Léger Opinion panel from July 14 to August 6, 2021. Associations between socioeconomic factors and the demand for and use of virtual visits were tested using χ2 tests and logistic regression models for telephone visits, video visits, and secure messaging. Weighting was applied using the 2016 census reference variables to render a representative sample of the Canadian population. Results: A total of 2303 older adults were surveyed. Older adults expressed the highest demand for and use of telephone visits, following by video visits and secure messaging. eHealth literacy was positively associated with the use of all 3 virtual care modalities. Higher income was negatively associated with the use of video visits (odds ratio [OR] 0.65, 95% CI 0.428-0.974, P=.03). Having no private insurance coverage was negatively associated with use of secure messaging (OR 0.73, 95% CI 0.539-0.983, P=.04), but living in a rural community (OR 0.172, 95% CI 1.12-2.645, P=.01) and being born outside of Canada (OR 0.150, 95% CI 1.041-2.173, P=.03) were positively associated with the use of secure messaging. Higher education (OR 0.078, 95% CI 0.633-0.97, P=.02) and being non-White (OR=0.054, 95% CI 0.312-0.92, P=.02) were negatively associated with the use of the telephone. Conclusions: This study found that compared to video visits and secure messaging, the demand for and use of telephone visits were more prevalent among older adults during the pandemic. The gaps between the demand for and use of video and secure messaging services remain substantial. Our results highlight socioeconomic disparities among older adults that could potentially explain this trend. Lower income and a lower education level may act as barriers for older adults in acquiring the skills and technologies necessary to use more complex solutions, such as video and secure messaging. In addition, higher eHealth literacy was found to be critical for older adults to successfully navigate all types of virtual visit technologies. %M 35134746 %R 10.2196/35221 %U https://aging.jmir.org/2022/1/e35221 %U https://doi.org/10.2196/35221 %U http://www.ncbi.nlm.nih.gov/pubmed/35134746 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e35280 %T COVID-19 Mental Health Stressors of Health Care Providers in the Pandemic Acceptance and Commitment to Empowerment Response (PACER) Intervention: Qualitative Study %A Sato,Christa %A Adumattah,Anita %A Abulencia,Maria Krisel %A Garcellano,Peter Dennis %A Li,Alan Tai-Wai %A Fung,Kenneth %A Poon,Maurice Kwong-Lai %A Vahabi,Mandana %A Wong,Josephine Pui-Hing %+ Daphne Cockwell School of Nursing, Ryerson University, 350 Victoria Street, Toronto, ON, M5B2K3, Canada, 1 416 979 5000 ext 556303, jph.wong@ryerson.ca %K COVID-19 %K COVID-19 in Canada %K health care providers %K pandemic stressors %K health impact %K caregiving roles %K situational identities %K emotional labor %K hero discourse %K social ecological framework %D 2022 %7 22.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Since the pandemic, more Canadians have reported poorer mental health. A vital group experiencing a high level of stressors consists of health care providers (HCPs) caring for COVID-19 patients, carrying out public health responses, or working with vulnerable populations. The mental health of HCPs is negatively affected by the pandemic, not only at work but also at home and in the community. Intersecting stressors at multiple levels contribute to HCPs’ experiences of fatigue, insomnia, anxiety, depression, and posttraumatic stress symptoms. Objective: The aim of this qualitative study was to explore the pandemic stressors experienced by HCPs at work, at home, and in the community before participating in the Pandemic Acceptance and Commitment to Empowerment Response (PACER) online intervention. Methods: Informed by a social ecological approach, we used a qualitative reflective approach to engage 74 HCPs in diverse roles. Data were collected during the first 2 waves of the COVID-19 pandemic (June 2020 to February 2021) in Canada. Results: Informed by a social ecological framework, 5 overarching themes were identified in our thematic analysis: (1) personal level stressors that highlight HCPs’ identities and responsibilities beyond the workplace; (2) interpersonal level stressors from disrupted social relationships; (3) organizational stressors that contributed to unsettled workplaces and moral distress; (4) community and societal stressors attributed to vicarious trauma and emotional labor; and (5) the multilevel and cumulative impacts of COVID-19 stressors on HCPs’ health. Conclusions: COVID-19 is not merely a communicable disease but also a social and political phenomenon that intensifies the effects of social inequities. Current understanding of pandemic stressors affecting HCPs is largely partial in nature. Although workplace stressors of HCPs are real and intense, they need to be explored and understood in the context of stressors that exist in other domains of HCPs’ lives such as family and community to ensure these experiences are not being silenced by the “hero” discourses or overshadowed by professional demands. %M 35138256 %R 10.2196/35280 %U https://formative.jmir.org/2022/3/e35280 %U https://doi.org/10.2196/35280 %U http://www.ncbi.nlm.nih.gov/pubmed/35138256 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 1 %P e34674 %T Evaluating Voice Assistants' Responses to COVID-19 Vaccination in Portuguese: Quality Assessment %A Seródio Figueiredo,Carlos Maurício %A de Melo,Tiago %A Goes,Raphaela %+ Escola Superior de Tecnologia, Universidade do Estado do Amazonas, Av. Darcy Vargas, 1.200 - Parque Dez de Novembro, Manaus, 69050-020, Brazil, 55 92988120877, cfigueiredo@uea.edu.br %K voice assistant %K natural user interface %K Portuguese language %K health information %K COVID-19 %K vaccine %K immunization %K health device %K digital health %D 2022 %7 21.3.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Voice assistants (VAs) are devices that respond to human voices and can be commanded to do a variety of tasks. Nowadays, VAs are being used to obtain health information, which has become a critical point of analysis for researchers in terms of question understanding and quality of response. Particularly, the COVID-19 pandemic has and still is severely affecting people worldwide, which demands studies on how VAs can be used as a tool to provide useful information. Objective: This work aimed to perform a quality analysis of different VAs’ responses regarding the actual and important subject of COVID-19 vaccines. We focused on this important subject since vaccines are now available and society has urged for the population to be rapidly immunized. Methods: The proposed study was based on questions that were collected from the official World Health Organization website. These questions were submitted to the 5 dominant VAs (Alexa, Bixby, Cortana, Google Assistant, and Siri), and responses were evaluated according to a rubric based on the literature. We focused this study on the Portuguese language as an additional contribution, since previous works are mainly focused on the English language, and we believe that VAs cannot be optimized to foreign languages. Results: Results showed that Google Assistant has a better overall performance, and only this VA and Samsung Bixby achieved high scores on question understanding in the Portuguese language. Regarding the obtained answers, the study also showed the best Google Assistant overall performance. Conclusions: Under the urgent context of COVID-19 vaccination, this work can help to understand how VAs must be improved to be more useful to the society and how careful people must be when considering VAs as a source of health information. VAs have been demonstrated to perform well regarding comprehension and user-friendliness. However, this work has found that they must be better integrated to their information sources to be useful as health information tools. %M 35041617 %R 10.2196/34674 %U https://humanfactors.jmir.org/2022/1/e34674 %U https://doi.org/10.2196/34674 %U http://www.ncbi.nlm.nih.gov/pubmed/35041617 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e30486 %T Exploring Patient and Staff Experiences With Video Consultations During COVID-19 in an English Outpatient Care Setting: Secondary Data Analysis of Routinely Collected Feedback Data %A Bradwell,Hannah %A Baines,Rebecca %A Edwards,Katie J %A Stevens,Sebastian %A Atkinson,Kate %A Wilkinson,Ellen %A Chatterjee,Arunangsu %A Jones,Ray B %+ Centre for Health Technology, University of Plymouth, Drake Circus, Plymouth, PL4 8AA, United Kingdom, 44 07975927341, hannah.bradwell@plymouth.ac.uk %K COVID-19 %K video consultations %K remote consultation %K Attend Anywhere %K patient feedback %K patient experience %K staff feedback %K outpatients %K pandemic %D 2022 %7 21.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Video consultations (VCs) were rapidly implemented in response to COVID-19 despite modest progress before. Objective: We aim to explore staff and patient experiences with VCs implemented during COVID-19 and use feedback insights to support quality improvement and service development. Methods: Secondary data analysis was conducted on 955 patient and 521 staff responses (from 4234 consultations; 955/4234, 22.6% and 521/4234, 12.3%, respectively) routinely collected following a VC between June and July 2020 in a rural, older adult, and outpatient care setting at a National Health Service Trust. Responses were summarized using descriptive statistics and inductive thematic analysis and presented to Trust stakeholders. Results: Most patients (890/955, 93.2%) reported having good (210/955, 22%) or very good (680/955, 71.2%) experience with VCs and felt listened to and understood (904/955, 94.7%). Most patients accessed their VC alone (806/955, 84.4%) except for those aged ≥71 years (23/58, 40%), with ease of joining VCs negatively associated with age (P<.001). Despite more difficulties joining, older adults were most likely to be satisfied with the technology (46/58, 79%). Patients and staff generally felt that patients’ needs had been met (860/955, 90.1% and 453/521, 86.9%, respectively), although staff appeared to overestimate patient dissatisfaction with VC outcomes (P=.02). Patients (848/955, 88.8%) and staff (419/521, 80.5%) felt able to communicate everything they wanted, although patients were significantly more positive than staff (P<.001). Patient satisfaction with communication was positively associated with technical performance satisfaction (P<.001). Most staff members (466/521, 89.4%) reported positive (185/521, 35.5%) or very positive (281/521, 53.9%) experiences with joining and managing VCs. Staff reported reductions in carbon footprint (380/521, 72.9%) and time (373/521, 71.6%). Most patients (880/955, 92.1%) would choose VCs again. We identified three themes in responses: barriers, including technological difficulties, patient information, and suitability concerns; potential benefits, including reduced stress, enhanced accessibility, cost, and time savings; and suggested improvements, including trial calls, turning music off, photo uploads, expanding written character limit, supporting other internet browsers, and shared online screens. This routine feedback, including evidence to suggest that patients were more satisfied than clinicians had anticipated, was presented to relevant Trust stakeholders, allowing for improved processes and supporting the development of a business case to inform the Trust decision on continuing VCs beyond COVID-19 restrictions. Conclusions: The findings highlight the importance of regularly reviewing and responding to routine feedback following digital service implementation. The feedback helped the Trust improve the VC service, challenge clinician-held assumptions about patient experience, and inform future use of VCs. It has focused improvement efforts on patient information; technological improvements such as blurred backgrounds and interactive whiteboards; and responding to the needs of patients with dementia, communication or cognitive impairment, or lack of appropriate technology. These findings have implications for other health care providers. %M 35311688 %R 10.2196/30486 %U https://formative.jmir.org/2022/3/e30486 %U https://doi.org/10.2196/30486 %U http://www.ncbi.nlm.nih.gov/pubmed/35311688 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 3 %P e32598 %T The Impact of COVID-19 Lockdown on Daily Activities, Cognitions, and Stress in a Lonely and Distressed Population: Temporal Dynamic Network Analysis %A Haucke,Matthias %A Heinz,Andreas %A Liu,Shuyan %A Heinzel,Stephan %+ Department of Psychiatry and Neurosciences, Charité–Universitätsmedizin Berlin, Campus Charité Mitte, Charitéplatz 1, Berlin, 10117, Germany, 49 015155710318, matthias.haucke@fu-berlin.de %K COVID-19 %K mental health %K outbreak %K epidemic %K pandemic %K psychological response %K emotional well-being %K ecological momentary assessment %K risk %K protective factors %K lockdown measures %K loneliness %K mood inertia %K stressors %K mobile apps %K mHealth %K digital health %K EMA %K smartphone apps %K network model %K cognition %K stress %K temporal dynamic network %K permutation testing %K network comparison %K network characteristics %K multilevel vector autoregressive model %K mlVAR %D 2022 %7 17.3.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic and its associated lockdown measures impacted mental health worldwide. However, the temporal dynamics of causal factors that modulate mental health during lockdown are not well understood. Objective: We aimed to understand how a COVID-19 lockdown changes the temporal dynamics of loneliness and other factors affecting mental health. This is the first study that compares network characteristics between lockdown stages to prioritize mental health intervention targets. Methods: We combined ecological momentary assessments with wrist-worn motion tracking to investigate the mechanism and changes in network centrality of symptoms and behaviors before and during lockdown. A total of 258 participants who reported at least mild loneliness and distress were assessed 8 times a day for 7 consecutive days over a 213-day period from August 8, 2020, through March 9, 2021, in Germany, covering a “no-lockdown” and a “lockdown” stage. COVID-19–related worry, information-seeking, perceived restriction, and loneliness were assessed by digital visual analog scales ranging from 0 to 100. Social activity was assessed on a 7-point Likert scale, while physical activity was recorded from wrist-worn actigraphy devices. Results: We built a multilevel vector autoregressive model to estimate dynamic networks. To compare network characteristics between a no-lockdown stage and a lockdown stage, we performed permutation tests. During lockdown, loneliness had the highest impact within the network, as indicated by its centrality index (ie, an index to identify variables that have a strong influence on the other variables). Moreover, during lockdown, the centrality of loneliness significantly increased. Physical activity contributed to a decrease in loneliness amid the lockdown stage. Conclusions: The COVID-19 lockdown increased the central role of loneliness in triggering stress-related behaviors and cognition. Our study indicates that loneliness should be prioritized in mental health interventions during lockdown. Moreover, physical activity can serve as a buffer for loneliness amid social restrictions. %M 35191843 %R 10.2196/32598 %U https://www.jmir.org/2022/3/e32598 %U https://doi.org/10.2196/32598 %U http://www.ncbi.nlm.nih.gov/pubmed/35191843 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 3 %P e22544 %T Leveraging Polio Geographic Information System Platforms in the African Region for Mitigating COVID-19 Contact Tracing and Surveillance Challenges: Viewpoint %A Akpan,Godwin Ubong %A Bello,Isah Mohammed %A Touray,Kebba %A Ngofa,Reuben %A Oyaole,Daniel Rasheed %A Maleghemi,Sylvester %A Babona,Marie %A Chikwanda,Chanda %A Poy,Alain %A Mboussou,Franck %A Ogundiran,Opeayo %A Impouma,Benido %A Mihigo,Richard %A Yao,Nda Konan Michel %A Ticha,Johnson Muluh %A Tuma,Jude %A A Mohamed,Hani Farouk %A Kanmodi,Kehinde %A Ejiofor,Nonso Ephraim %A Kipterer,John Kapoi %A Manengu,Casimir %A Kasolo,Francis %A Seaman,Vincent %A Mkanda,Pascal %+ Regional Office of Africa, World Health Organization, World Health Organization,Regional Office for Africa, Cite Du Djoue, Brazzaville, 500101, Congo, 242 055736476, akpang@who.int %K contact tracing %K GIS %K COVID-19 %K surveillance %D 2022 %7 17.3.2022 %9 Viewpoint %J JMIR Mhealth Uhealth %G English %X Background: The ongoing COVID-19 pandemic in Africa is an urgent public health crisis. Estimated models projected over 150,000 deaths and 4,600,000 hospitalizations in the first year of the disease in the absence of adequate interventions. Therefore, electronic contact tracing and surveillance have critical roles in decreasing COVID-19 transmission; yet, if not conducted properly, these methods can rapidly become a bottleneck for synchronized data collection, case detection, and case management. While the continent is currently reporting relatively low COVID-19 cases, digitized contact tracing mechanisms and surveillance reporting are necessary for standardizing real-time reporting of new chains of infection in order to quickly reverse growing trends and halt the pandemic. Objective: This paper aims to describe a COVID-19 contact tracing smartphone app that includes health facility surveillance with a real-time visualization platform. The app was developed by the AFRO (African Regional Office) GIS (geographic information system) Center, in collaboration with the World Health Organization (WHO) emergency preparedness and response team. The app was developed through the expertise and experience gained from numerous digital apps that had been developed for polio surveillance and immunization via the WHO’s polio program in the African region. Methods: We repurposed the GIS infrastructures of the polio program and the database structure that relies on mobile data collection that is built on the Open Data Kit. We harnessed the technology for visualization of real-time COVID-19 data using dynamic dashboards built on Power BI, ArcGIS Online, and Tableau. The contact tracing app was developed with the pragmatic considerations of COVID-19 peculiarities. The app underwent testing by field surveillance colleagues to meet the requirements of linking contacts to cases and monitoring chains of transmission. The health facility surveillance app was developed from the knowledge and assessment of models of surveillance at the health facility level for other diseases of public health importance. The Integrated Supportive Supervision app was added as an appendage to the pre-existing paper-based surveillance form. These two mobile apps collected information on cases and contact tracing, alongside alert information on COVID-19 reports at the health facility level; the information was linked to visualization platforms in order to enable actionable insights. Results: The contact tracing app and platform were piloted between April and June 2020; they were then put to use in Zimbabwe, Benin, Cameroon, Uganda, Nigeria, and South Sudan, and their use has generated some palpable successes with respect to COVID-19 surveillance. However, the COVID-19 health facility–based surveillance app has been used more extensively, as it has been used in 27 countries in the region. Conclusions: In light of the above information, this paper was written to give an overview of the app and visualization platform development, app and platform deployment, ease of replicability, and preliminary outcome evaluation of their use in the field. From a regional perspective, integration of contact tracing and surveillance data into one platform provides the AFRO with a more accurate method of monitoring countries’ efforts in their response to COVID-19, while guiding public health decisions and the assessment of risk of COVID-19. %M 34854813 %R 10.2196/22544 %U https://mhealth.jmir.org/2022/3/e22544 %U https://doi.org/10.2196/22544 %U http://www.ncbi.nlm.nih.gov/pubmed/34854813 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 1 %P e31552 %T The Use of Technology Among Persons With Memory Concerns and Their Caregivers in the United States During the COVID-19 Pandemic: Qualitative Study %A Albers,Elizabeth A %A Mikal,Jude %A Millenbah,Ashley %A Finlay,Jessica %A Jutkowitz,Eric %A Mitchell,Lauren %A Horn,Brenna %A Gaugler,Joseph E %+ Division of Health Policy and Management, School of Public Health, University of Minnesota, D351 Mayo, 420 Delaware St SE, Minneapolis, MN, 55455, United States, 1 6124540415, alber304@umn.edu %K social isolation %K dementia %K caregiving - informal %K aging in place %K caregivers %K aging %K elderly %K pandemic %K COVID-19 %K mental health %K technology use %K health technology %D 2022 %7 17.3.2022 %9 Original Paper %J JMIR Aging %G English %X Background: Stay-at-home orders and other public health measures designed to mitigate the spread of COVID-19 have increased isolation among persons with memory concerns (PWMCs: individuals diagnosed with cognitive impairment or Alzheimer disease or related dementias). The pandemic has also exacerbated challenges for family members who care for PWMCs. Although technology has demonstrated the potential to improve the social connections and mental health of PWMCs and their family caregivers (CGs), previous research shows that older adults may be reluctant to adopt new technologies. Objective: We aimed to understand why and how some PWMCs and their CGs altered their use of mainstream technology, such as smartphones and fitness trackers, and assistive technology to adapt to lifestyle changes (eg, increased isolation) during the COVID-19 pandemic. Methods: Using data collected in 20 qualitative interviews from June to August 2020 with 20 PWMCs and family CG dyads, we assessed changes in and barriers to everyday technology use following the implementation of COVID-19 mitigation strategies in the United States. Zoom videoconferencing was utilized to conduct the interviews to protect the health of the participants who were primarily older adults. Results: Using qualitative thematic analysis, we identified 3 themes that explained motivations for using technology during a pandemic: (1) maintaining social connections, (2) alleviating boredom, and (3) increasing CG respite. Results further revealed lingering barriers to PWMC and CG adoption of technologies, including: (1) PWMC dependence upon CGs, (2) low technological literacy, and (3) limitations of existing technology. Conclusions: This in-depth investigation suggests that technology can provide PWMCs with more independence and offer CGs relief from CG burden during periods of prolonged isolation. %M 35134748 %R 10.2196/31552 %U https://aging.jmir.org/2022/1/e31552 %U https://doi.org/10.2196/31552 %U http://www.ncbi.nlm.nih.gov/pubmed/35134748 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e35181 %T Impact of a Conformité Européenne (CE) Certification–Marked Medical Software Sensor on COVID-19 Pandemic Progression Prediction: Register-Based Study Using Machine Learning Methods %A Limingoja,Leevi %A Antila,Kari %A Jormanainen,Vesa %A Röntynen,Joel %A Jägerroos,Vilma %A Soininen,Leena %A Nordlund,Hanna %A Vepsäläinen,Kristian %A Kaikkonen,Risto %A Lallukka,Tea %+ Department of Public Health, University of Helsinki, PO Box 20 (Tukholmankatu 8 B), Helsinki, FIN-00014, Finland, 358 400344644, leevi.limingoja@helsinki.fi %K health care %K health technology assessment %K machine learning %K COVID-19 %K COVID-19 forecasting %K pandemic %K health technology %K digital health %K online symptom checker %K health data %K admission data %K viral spread %D 2022 %7 17.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: To address the current COVID-19 and any future pandemic, we need robust, real-time, and population-scale collection and analysis of data. Rapid and comprehensive knowledge on the trends in reported symptoms in populations provides an earlier window into the progression of viral spread, and helps to predict the needs and timing of professional health care. Objective: The objective of this study was to use a Conformité Européenne (CE)-marked medical online symptom checker service, Omaolo, and validate the data against the national demand for COVID-19–related care to predict the pandemic progression in Finland. Methods: Our data comprised real-time Omaolo COVID-19 symptom checker responses (414,477 in total) and daily admission counts in nationwide inpatient and outpatient registers provided by the Finnish Institute for Health and Welfare from March 16 to June 15, 2020 (the first wave of the pandemic in Finland). The symptom checker responses provide self-triage information input to a medically qualified algorithm that produces a personalized probability of having COVID-19, and provides graded recommendations for further actions. We trained linear regression and extreme gradient boosting (XGBoost) models together with F-score and mutual information feature preselectors to predict the admissions once a week, 1 week in advance. Results: Our models reached a mean absolute percentage error between 24.2% and 36.4% in predicting the national daily patient admissions. The best result was achieved by combining both Omaolo and historical patient admission counts. Our best predictor was linear regression with mutual information as the feature preselector. Conclusions: Accurate short-term predictions of COVID-19 patient admissions can be made, and both symptom check questionnaires and daily admissions data contribute to the accuracy of the predictions. Thus, symptom checkers can be used to estimate the progression of the pandemic, which can be considered when predicting the health care burden in a future pandemic. %M 35179497 %R 10.2196/35181 %U https://formative.jmir.org/2022/3/e35181 %U https://doi.org/10.2196/35181 %U http://www.ncbi.nlm.nih.gov/pubmed/35179497 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 2 %N 1 %P e31732 %T Sustained Reductions in Online Search Interest for Communicable Eye and Other Conditions During the COVID-19 Pandemic: Infodemiology Study %A Deiner,Michael S %A Seitzman,Gerami D %A Kaur,Gurbani %A McLeod,Stephen D %A Chodosh,James %A Lietman,Thomas M %A Porco,Travis C %+ Francis I Proctor Foundation, University of California San Francisco, Floor 2 Box 0944, 490 Illinois St, San Francisco, CA, 94143, United States, 1 4154764101, travis.porco@ucsf.edu %K COVID-19 %K pandemic %K communicable disease %K social distancing %K infodemiology %K Google Trends %K influenza %K conjunctivitis %K ocular symptoms %K seasonality %K trend %K online health information %K information-seeking %D 2022 %7 16.3.2022 %9 Original Paper %J JMIR Infodemiology %G English %X Background: In a prior study at the start of the pandemic, we reported reduced numbers of Google searches for the term “conjunctivitis” in the United States in March and April 2020 compared with prior years. As one explanation, we conjectured that reduced information-seeking may have resulted from social distancing reducing contagious conjunctivitis cases. Here, after 1 year of continued implementation of social distancing, we asked if there have been persistent reductions in searches for “conjunctivitis,” and similarly for other communicable disease terms, compared to control terms. Objective: The aim of this study was to determine if reduction in searches in the United States for terms related to conjunctivitis and other common communicable diseases occurred in the spring-winter season of the COVID-19 pandemic, and to compare this outcome to searches for terms representing noncommunicable conditions, COVID-19, and to seasonality. Methods: Weekly relative search frequency volume data from Google Trends for 68 search terms in English for the United States were obtained for the weeks of March 2011 through February 2021. Terms were classified a priori as 16 terms related to COVID-19, 29 terms representing communicable conditions, and 23 terms representing control noncommunicable conditions. To reduce bias, all analyses were performed while masked to term names, classifications, and locations. To test for the significance of changes during the pandemic, we detrended and compared postpandemic values to those expected based on prepandemic trends, per season, computing one- and two-sided P values. We then compared these P values between term groups using Wilcoxon rank-sum and Fisher exact tests to assess if non-COVID-19 terms representing communicable diseases were more likely to show significant reductions in searches in 2020-2021 than terms not representing such diseases. We also assessed any relationship between a term’s seasonality and a reduced search trend for the term in 2020-2021 seasons. P values were subjected to false discovery rate correction prior to reporting. Data were then unmasked. Results: Terms representing conjunctivitis and other communicable conditions showed a sustained reduced search trend in the first 4 seasons of the 2020-2021 COVID-19 pandemic compared to prior years. In comparison, the search for noncommunicable condition terms was significantly less reduced (Wilcoxon and Fisher exact tests, P<.001; summer, autumn, winter). A significant correlation was also found between reduced search for a term in 2020-2021 and seasonality of that term (Theil-Sen, P<.001; summer, autumn, winter). Searches for COVID-19–related conditions were significantly elevated compared to those in prior years, and searches for influenza-related terms were significantly lower than those for prior years in winter 2020-2021 (P<.001). Conclusions: We demonstrate the low-cost and unbiased use of online search data to study how a wide range of conditions may be affected by large-scale interventions or events such as social distancing during the COVID-19 pandemic. Our findings support emerging clinical evidence implicating social distancing and the COVID-19 pandemic in the reduction of communicable disease and on ocular conditions. %M 35320981 %R 10.2196/31732 %U https://infodemiology.jmir.org/2022/1/e31732 %U https://doi.org/10.2196/31732 %U http://www.ncbi.nlm.nih.gov/pubmed/35320981 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 2 %N 1 %P e33587 %T Spread of COVID-19 Vaccine Misinformation in the Ninth Inning: Retrospective Observational Infodemic Study %A Calac,Alec J %A Haupt,Michael R %A Li,Zhuoran %A Mackey,Tim %+ Global Health Program, Department of Anthropology, University of California San Diego, 9500 Gilman Drive, Mail Code: 0505, La Jolla, CA, 92093, United States, 1 9514914161, tmackey@ucsd.edu %K infoveillance %K infodemiology %K COVID-19 %K vaccine %K Twitter %K social listening %K social media %K misinformation %K spread %K observational %K hesitancy %K communication %K discourse %D 2022 %7 16.3.2022 %9 Original Paper %J JMIR Infodemiology %G English %X Background: Shortly after Pfizer and Moderna received emergency use authorizations from the Food and Drug Administration, there were increased reports of COVID-19 vaccine-related deaths in the Vaccine Adverse Event Reporting System (VAERS). In January 2021, Major League Baseball legend and Hall of Famer, Hank Aaron, passed away at the age of 86 years from natural causes, just 2 weeks after he received the COVID-19 vaccine. Antivaccination groups attempted to link his death to the Moderna vaccine, similar to other attempts misrepresenting data from the VAERS to spread COVID-19 misinformation. Objective: This study assessed the spread of misinformation linked to erroneous claims about Hank Aaron’s death on Twitter and then characterized different vaccine misinformation and hesitancy themes generated from users who interacted with this misinformation discourse. Methods: An initial sample of tweets from January 31, 2021, to February 6, 2021, was queried from the Twitter Search Application Programming Interface using the keywords “Hank Aaron” and “vaccine.” The sample was manually annotated for misinformation, reporting or news media, and public reaction. Nonmedia user accounts were also classified if they were verified by Twitter. A second sample of tweets, representing direct comments or retweets to misinformation-labeled content, was also collected. User sentiment toward misinformation, positive (agree) or negative (disagree), was recorded. The Strategic Advisory Group of Experts Vaccine Hesitancy Matrix from the World Health Organization was used to code the second sample of tweets for factors influencing vaccine confidence. Results: A total of 436 tweets were initially sampled from the Twitter Search Application Programming Interface. Misinformation was the most prominent content type (n=244, 56%) detected, followed by public reaction (n=122, 28%) and media reporting (n=69, 16%). No misinformation-related content reviewed was labeled as misleading by Twitter at the time of the study. An additional 1243 comments on misinformation-labeled tweets from 973 unique users were also collected, with 779 comments deemed relevant to study aims. Most of these comments expressed positive sentiment (n=612, 78.6%) to misinformation and did not refute it. Based on the World Health Organization Strategic Advisory Group of Experts framework, the most common vaccine hesitancy theme was individual or group influences (n=508, 65%), followed by vaccine or vaccination-specific influences (n=110, 14%) and contextual influences (n=93, 12%). Common misinformation themes observed included linking the death of Hank Aaron to “suspicious” elderly deaths following vaccination, claims about vaccines being used for depopulation, death panels, federal officials targeting Black Americans, and misinterpretation of VAERS reports. Four users engaging with or posting misinformation were verified on Twitter at the time of data collection. Conclusions: Our study found that the death of a high-profile ethnic minority celebrity led to the spread of misinformation on Twitter. This misinformation directly challenged the safety and effectiveness of COVID-19 vaccines at a time when ensuring vaccine coverage among minority populations was paramount. Misinformation targeted at minority groups and echoed by other verified Twitter users has the potential to generate unwarranted vaccine hesitancy at the expense of people such as Hank Aaron who sought to promote public health and community immunity. %M 35320982 %R 10.2196/33587 %U https://infodemiology.jmir.org/2022/1/e33587 %U https://doi.org/10.2196/33587 %U http://www.ncbi.nlm.nih.gov/pubmed/35320982 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 3 %P e32831 %T Risk Factors of COVID-19 Critical Outcomes in the Eastern Mediterranean Region: Multicountry Retrospective Study %A Lami,Faris %A Elfadul,Maisa %A Rashak,Hiba %A Al Nsour,Mohannad %A Akhtar,Hashaam %A Khader,Yousef %A Hussein,Ahmed M %A Naciri,Mariam %A Samy,Sahar %A Ghaleb,Yasser %A Taha,Hana %A Hussein,Alaa %A Ali,Nameer A %A Hussein,Raheem %A Ikram,Aamer %A Rahman,Fazal ur %A Khan,Mohammad Mujeeb %A Adam,Reema %A Ahmed,Abdulrazaq Yusuf %A Afifi,Salma %+ Public and Tropical Health Programs, Epidemiology and Biostatistics, University of Medical Sciences and Technology, Airport Avenue, PO Box 12810, Khartoum, 11111, Sudan, 249 924622759, melfadul7@gmail.com %K critical outcomes %K COVID-19 %K severity %K mortality %K outcome %K risk factor %K retrospective %K implementation %K demographic %K pattern %K trend %K risk %D 2022 %7 15.3.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The establishment of empirical evidence in the Eastern Mediterranean Region necessitates the implementation of wide-scale studies to describe the demographic, clinical features, and severity profile of patients with COVID-19. Objective: This study aims to assess the patterns of COVID-19 severity and mortality in seven countries, and to determine the risk factors of COVID-19 severity and mortality. Methods: This multicountry study was based on a retrospective review of medical records of hospitalized patients confirmed to have COVID-19. This study includes data from Iraq, Pakistan, Sudan, Somalia, Morocco, Egypt, and Yemen. All demographic and clinical data were extracted from hospital records (paper files) by trained data collectors. Results: A total of 4141 patients were included in this study from seven countries. Comorbidities were reported by nearly half of the patients, with hypertension (n=1021, 24.7%) and diabetes (n=939, 22.7%) being the most common. Older age, diabetes mellitus, hypertension, and heart diseases were significantly associated with COVID-19 severity and mortality. Ever smoking and renal diseases were significantly associated with severity but not mortality, while male gender, respiratory diseases, and malignancy were significantly associated with mortality but not severity. Conclusions: The study confirms the role of comorbidities and demographic features on the severity and mortality of COVID-19. Understanding the contributing factors ensures attentive care and informs clinical management of patients with poorer prognoses in the early stages of diseases. %M 34736222 %R 10.2196/32831 %U https://publichealth.jmir.org/2022/3/e32831 %U https://doi.org/10.2196/32831 %U http://www.ncbi.nlm.nih.gov/pubmed/34736222 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 3 %P e34003 %T Official Websites Providing Information on COVID-19 Vaccination: Readability and Content Analysis %A Yeung,Andy Wai Kan %A Wochele-Thoma,Thomas %A Eibensteiner,Fabian %A Klager,Elisabeth %A Hribersek,Mojca %A Parvanov,Emil D %A Hrg,Dalibor %A Völkl-Kernstock,Sabine %A Kletecka-Pulker,Maria %A Schaden,Eva %A Willschke,Harald %A Atanasov,Atanas G %+ Ludwig Boltzmann Institute for Digital Health and Patient Safety, Spitalgasse 23, Vienna, 1090, Austria, 43 664 1929 852, atanas.atanasov@univie.ac.at %K COVID-19 %K coronavirus %K SARS-CoV-2 %K vaccine %K readability %K content quality %K online health information %K side effect %K public health %K medicine %K quality %K perception %D 2022 %7 15.3.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Online information on COVID-19 vaccination may influence people’s perception and willingness to be vaccinated. Official websites of vaccination programs have not been systematically assessed before. Objective: This study aims to assess and compare the readability and content quality of web-based information on COVID-19 vaccination posted on official/governmental websites. Furthermore, the relationship between evaluated website parameters and country vaccination rates were calculated. Methods: By referring to an open data set hosted at Our World in Data, the 58 countries/regions with the highest total vaccination count as of July 8, 2021, were identified. Together with the websites from the World Health Organization and European Union, a total of 60 vaccination campaign websites were targeted. The “frequently asked questions” or “questions and answers” section of the websites were evaluated in terms of readability (Flesch Reading Ease score and Flesch-Kincaid Grade Level), quality (Health On the Net Foundation code [HONcode] certification and Quality Evaluation Scoring Tool), and content stating vaccination duration of protection and potential side effects. Results: In terms of readability, the Flesch Reading Ease score of the vaccination frequently asked questions websites ranged between 11.2 and 69.5, with a mean of 40.9 (SD 13.2). Meanwhile, the Flesch-Kincaid Grade Level ranged between 6.5 and 17.6, with a mean of 12.1 (SD 2.8). In terms of quality, only 2 websites were HONcode certified, and the Quality Evaluation Scoring Tool score of the websites ranged between 7 and 20, with a mean of 15.3 (SD 3.1). Half of the websites (25/50) did not present a publication date or date of the last update. Regarding the duration of protection offered by the vaccines, 46% (23/50) of the websites stated that they do not know, and another 40% (20/50) did not address it. Five side effects of the vaccinations were most frequently mentioned, namely, fever/chill (41/50, 82%), various injection site discomfort events (eg, swelling, redness, or pain; 39/50, 78%), headache (36/50, 72%), fatigue (33/50, 66%), and muscle/joint pain (31/50, 62%). Conclusions: In general, the content quality of most of the evaluated websites was good, but HONcode certification should be considered, content should be written in a more readable manner, and a publication date or date of the last update should be presented. %M 35073276 %R 10.2196/34003 %U https://publichealth.jmir.org/2022/3/e34003 %U https://doi.org/10.2196/34003 %U http://www.ncbi.nlm.nih.gov/pubmed/35073276 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 3 %P e30778 %T Influence of Forced Online Distance Education During the COVID-19 Pandemic on the Perceived Stress of Postsecondary Students: Cross-sectional Study %A Šorgo,Andrej %A Crnkovič,Nuša %A Gabrovec,Branko %A Cesar,Katarina %A Selak,Špela %+ National Institute of Public Health, Trubarjeva cesta 2, Ljubljana, 1000, Slovenia, 386 1 620 36 45, spela.selak@nijz.si %K online study %K stress %K COVID-19 %K postsecondary students %K pandemic %K epidemiology %K educational institutions %K online education %K pedagogy %K mental health %D 2022 %7 15.3.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: One of the most significant changes in the majority of postsecondary educational institutions was the closure of those institutions and the shift of educational activities to online distance learning formats as a result of the COVID-19 pandemic. Closure combined with forced online distance education (FODE) was a cure with many side effects, 1 of them being the effect on students’ mental health and, more specifically, levels of stress. Due to the novelty of the situation, there have been no studies so far designed to link satisfaction with online study, feelings toward the study obligations, and stress among students. Objective: The aim of the study is to assess the perceived stress of Slovenian postsecondary students in order to identify the online study–related factors affecting or acting as a covariate during the COVID-19 lockdown. Methods: Data collection was conducted through a self-reported survey as part of a large cross-sectional study based on data collected from postsecondary students from a number of higher educational institutions. The random sample consisted of 4455 individuals. The Perceived Stress Scale (PSS-4), Satisfaction with Online Study Scale (SAT-5), and Feelings Towards Study Obligations Scale (FETSOS) were used to assess the constructs and the relations observed within the study. Results: The results indicate that more than half of all respondents reported high levels of stress. The difference in the reported levels of perceived stress between genders were statistically significant (N=4454, F2=56.719, P<.001, Cohen d=0.35). Overall, the results suggest that a decline in the motivation to study, the quality of internet and mobile connections, and the presence of distracting factors in the study space were the 3 main factors related to the students’ negative emotions as associated with the timeliness, performance, and quality of the study obligations. Furthermore, the results show that the level of satisfaction with online study affected stress such that the higher the satisfaction, the lower the stress. Moreover, the more positive feelings connected with the timeliness, performance, and quality of the study obligations that the students felt, the more satisfaction they reported with online study and, thus indirectly, lower stress and less negative feelings. Conclusions: The findings of this study call for implementing structures and measures targeted at stress reduction, working conditions, and pedagogy with regard to FODE. %M 35171098 %R 10.2196/30778 %U https://www.jmir.org/2022/3/e30778 %U https://doi.org/10.2196/30778 %U http://www.ncbi.nlm.nih.gov/pubmed/35171098 %0 Journal Article %@ 2561-9128 %I JMIR Publications %V 5 %N 1 %P e35584 %T A Canadian Weekend Elective Pediatric Surgery Program to Reduce the COVID-19–Related Backlog: Operating Room Ramp-Up After COVID-19 Lockdown Ends—Extra Lists (ORRACLE-Xtra) Implementation Study %A Matava,Clyde %A So,Jeannette %A Williams,RJ %A Kelley,Simon %A , %+ Department of Anesthesia and Pain Medicine, Hospital for Sick Children, 555 University Ave, Toronto, ON, M5G 1X8, Canada, 1 4168137445, clyde.matava@sickkids.ca %K waiting lists %K quality improvement %K patient satisfaction %K COVID-19 %K ambulatory surgery %K pandemics %K Canada %D 2022 %7 15.3.2022 %9 Original Paper %J JMIR Perioper Med %G English %X Background: The COVID-19 pandemic caused by the SARS-COV-2 virus has resulted in unprecedented challenges for the health care system. A decrease of surgical services led to substantial backlogs for time-sensitive scheduled pediatric patients. We designed and implemented a novel pilot weekend surgical quality improvement project called Operating Room Ramp-Up After COVID Lockdown Ends—Extra Lists (ORRACLE-Xtra). Objective: Our overall goals are to increase patient access to surgery (and reduce the wait list), improve operating room efficiencies, and optimize parent and staff experience. Methods: Using the DMAIC (define, measure, analyze, improve, control) framework, we implemented ORRACLE-Xtra in a tertiary care academic pediatric hospital during a quiescent period of the COVID-19 pandemic. We defined process and outcome measures based on provincial targets of out-of-window cases. Parental and staff satisfaction was tracked by surveys. Results: ORRACLE-Xtra led to 247 patients receiving surgery during the pilot period, resulting in a 5% decrease in the total number of patients on our wait list with Paediatric Canadian Access Targets for Surgery IV (147/247, 59.5%), with 38.1% (94/247) out-of-window of provincial targets. Most of the process and outcome measures were met or exceeded. Overall parental satisfaction was at 95.8% (110/121), with 79% (64/81) of staff reporting satisfaction with working weekends. Conclusions: Through the ORRACLE-Xtra pilot program, we have shown that hospitals impacted by COVID-19 can reduce the surgical backlog using innovative models of service delivery in a Canadian context. Sustained funding is critical to achieving more meaningful reductions in wait times for scheduled surgeries over the longer term and needs to be balanced with staff well-being. %M 34887242 %R 10.2196/35584 %U https://periop.jmir.org/2022/1/e35584 %U https://doi.org/10.2196/35584 %U http://www.ncbi.nlm.nih.gov/pubmed/34887242 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 3 %P e27921 %T Lessons From a Rapid Project Management Exercise in the Time of Pandemic: Methodology for a Global COVID-19 VIRUS Registry Database %A Turek,Janice R %A Bansal,Vikas %A Tekin,Aysun %A Singh,Shuchita %A Deo,Neha %A Sharma,Mayank %A Bogojevic,Marija %A Qamar,Shahraz %A Singh,Romil %A Kumar,Vishakha %A Kashyap,Rahul %+ Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 1216 2nd St SW, Rochester, MN, 55902, United States, 1 507 255 7196, kashyap.rahul@mayo.edu %K COVID-19 %K critical care %K global %K program management %K registry %D 2022 %7 15.3.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: The rapid emergence of the COVID-19 pandemic globally collapsed health care organizations worldwide. Incomplete knowledge of best practices, progression of disease, and its impact could result in fallible care. Data on symptoms and advancement of the SARS-CoV-2 virus leading to critical care admission have not been captured or communicated well between international organizations experiencing the same impact from the virus. This led to the expedited need for establishing international communication and data collection on the critical care patients admitted with COVID-19. Objective: Developing a global registry to collect patient data in the critical care setting was imperative with the goal of analyzing and ameliorating outcomes. Methods: A prospective, observational global registry database was put together to record extensive deidentified clinical information for patients hospitalized with COVID-19. Results: Project management was crucial for prompt implementation of the registry for synchronization, improving efficiency, increasing innovation, and fostering global collaboration for valuable data collection. The Society of Critical Care Medicine Discovery VIRUS (Viral Infection and Respiratory Illness Universal Study): COVID-19 Registry would compile data for crucial longitudinal outcomes for disease, treatment, and research. The agile project management approach expedited establishing the registry in 15 days and submission of institutional review board agreement for 250 participating sites. There has been enrollment of sites every month with a total of 306 sites from 28 countries and 64,114 patients enrolled (as of June 7, 2021). Conclusions: This protocol addresses project management lessons in a time of crises which can be a precept for rapid project management for a large-scale health care data registry. We aim to discuss the approach and methodology for establishing the registry, the challenges faced, and the factors contributing to successful outcomes. Trial Registration: ClinicalTrials.gov NCT04323787; https://clinicaltrials.gov/ct2/show/NCT04323787 %M 34762062 %R 10.2196/27921 %U https://www.researchprotocols.org/2022/3/e27921 %U https://doi.org/10.2196/27921 %U http://www.ncbi.nlm.nih.gov/pubmed/34762062 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 3 %P e36263 %T Telehealth Services for Substance Use Disorders During the COVID-19 Pandemic: Longitudinal Assessment of Intensive Outpatient Programming and Data Collection Practices %A Gliske,Kate %A Welsh,Justine W %A Braughton,Jacqueline E %A Waller,Lance A %A Ngo,Quyen M %+ Butler Center for Research, Hazelden Betty Ford Foundation, 15251 Pleasant Valley Road, BC4, Center City, MN, 55012, United States, 1 6512134347, KGLISKE@hazeldenbettyford.org %K telehealth %K substance use disorder %K COVID-19 %K substance use treatment %K feasibility study %K routine outcome monitoring data %K mental health %K addiction %K digital health %K telemedicine %K outpatient program %K virtual health %K addiction treatment %K virtual care %K patient outcomes %D 2022 %7 14.3.2022 %9 Original Paper %J JMIR Ment Health %G English %X Background: The onset of the COVID-19 pandemic necessitated the rapid transition of many types of substance use disorder (SUD) treatments to telehealth formats, despite limited information about what makes treatment effective in this novel format. Objective: This study aims to examine the feasibility and effectiveness of virtual intensive outpatient programming (IOP) treatment for SUD in the context of a global pandemic, while considering the unique challenges posed to data collection during an unprecedented public health crisis. Methods: The study is based on a longitudinal study with a baseline sample of 3642 patients who enrolled in intensive outpatient addiction treatment (in-person, hybrid, or virtual care) from January 2020 to March 2021 at a large substance use treatment center in the United States. The analytical sample consisted of patients who completed the 3-month postdischarge outcome survey as part of routine outcome monitoring (n=1060, 29.1% response rate). Results: No significant differences were detected by delivery format in continuous abstinence (χ22=0.4, P=.81), overall quality of life (F2,826=2.06, P=.13), financial well-being (F2,767=2.30, P=.10), psychological well-being (F2,918=0.72, P=.49), and confidence in one’s ability to stay sober (F2,941=0.21, P=.81). Individuals in hybrid programming were more likely to report a higher level of general health than those in virtual IOP (F2,917=4.19, P=.01). Conclusions: Virtual outpatient care for the treatment of SUD is a feasible alternative to in-person-only programming, leading to similar self-reported outcomes at 3 months postdischarge. Given the many obstacles presented throughout data collection during a pandemic, further research is needed to better understand under what conditions telehealth is an acceptable alternative to in-person care. %M 35285807 %R 10.2196/36263 %U https://mental.jmir.org/2022/3/e36263 %U https://doi.org/10.2196/36263 %U http://www.ncbi.nlm.nih.gov/pubmed/35285807 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 2 %N 1 %P e32452 %T COVID-19 and Vitamin D Misinformation on YouTube: Content Analysis %A Quinn,Emma K %A Fenton,Shelby %A Ford-Sahibzada,Chelsea A %A Harper,Andrew %A Marcon,Alessandro R %A Caulfield,Timothy %A Fazel,Sajjad S %A Peters,Cheryl E %+ Department of Occupational and Environmental Hygiene, School of Population and Public Health, University of British Columbia, 2206 E Mall, Vancouver, BC, T2T 1Z3, Canada, 1 403 809 1289, equinn99@student.ubc.ca %K COVID-19 %K vitamin D %K misinformation %K YouTube %K content analysis %K social media %K video %K infodemic %K risk %K prevention %K health information %K immunity %K immune system %K supplements %K natural medicine %D 2022 %7 14.3.2022 %9 Original Paper %J JMIR Infodemiology %G English %X Background: The “infodemic” accompanying the SARS-CoV-2 virus pandemic has the potential to increase avoidable spread as well as engagement in risky health behaviors. Although social media platforms, such as YouTube, can be an inexpensive and effective method of sharing accurate health information, inaccurate and misleading information shared on YouTube can be dangerous for viewers. The confusing nature of data and claims surrounding the benefits of vitamin D, particularly in the prevention or cure of COVID-19, influences both viewers and the general “immune boosting” commercial interest. Objective: The aim of this study was to ascertain how information on vitamin D and COVID-19 was presented on YouTube in 2020. Methods: YouTube video results for the search terms “COVID,” “coronavirus,” and “vitamin D” were collected and analyzed for content themes and deemed useful or misleading based on the accuracy or inaccuracy of the content. Qualitative content analysis and simple statistical analysis were used to determine the prevalence and frequency of concerning content, such as confusing correlation with causation regarding vitamin D benefits. Results: In total, 77 videos with a combined 10,225,763 views (at the time of data collection) were included in the analysis, with over three-quarters of them containing misleading content about COVID-19 and vitamin D. In addition, 45 (58%) of the 77 videos confused the relationship between vitamin D and COVID-19, with 46 (85%) of 54 videos stating that vitamin D has preventative or curative abilities. The major contributors to these videos were medical professionals with YouTube accounts. Vitamin D recommendations that do not align with the current literature were frequently suggested, including taking supplementation higher than the recommended safe dosage or seeking intentional solar UV radiation exposure. Conclusions: The spread of misinformation is particularly alarming when spread by medical professionals, and existing data suggesting vitamin D has immune-boosting abilities can add to viewer confusion or mistrust in health information. Further, the suggestions made in the videos may increase the risks of other poor health outcomes, such as skin cancer from solar UV radiation. %M 35310014 %R 10.2196/32452 %U https://infodemiology.jmir.org/2022/1/e32452 %U https://doi.org/10.2196/32452 %U http://www.ncbi.nlm.nih.gov/pubmed/35310014 %0 Journal Article %@ 2563-3570 %I JMIR Publications %V 3 %N 1 %P e31536 %T The Easy-to-Use SARS-CoV-2 Assembler for Genome Sequencing: Development Study %A Rueca,Martina %A Giombini,Emanuela %A Messina,Francesco %A Bartolini,Barbara %A Di Caro,Antonino %A Capobianchi,Maria Rosaria %A Gruber,Cesare EM %+ Laboratory of Microbiology and Biological Bank, National Institute for Infectious Diseases “Lazzaro Spallanzani”, Istituto di Ricovero e Cura a Carattere Scientifico, Via Portuense 292, Rome, 00149, Italy, 39 0655170668, francesco.messina@inmi.it %K SARS-CoV-2 genome %K bioinformatics tool %K NGS data analysis %K COVID-19 %K genome %K health informatics %K bioinformatic %K digital tools %K algorithms %D 2022 %7 14.3.2022 %9 Original Paper %J JMIR Bioinform Biotech %G English %X Background: Early sequencing and quick analysis of the SARS-CoV-2 genome have contributed to the understanding of the dynamics of COVID-19 epidemics and in designing countermeasures at a global level. Objective: Amplicon-based next-generation sequencing (NGS) methods are widely used to sequence the SARS-CoV-2 genome and to identify novel variants that are emerging in rapid succession as well as harboring multiple deletions and amino acid–changing mutations. Methods: To facilitate the analysis of NGS sequencing data obtained from amplicon-based sequencing methods, here, we propose an easy-to-use SARS-CoV-2 genome assembler: the Easy-to-use SARS-CoV-2 Assembler (ESCA) pipeline. Results: Our results have shown that ESCA could perform high-quality genome assembly from Ion Torrent and Illumina raw data and help the user in easily correct low-coverage regions. Moreover, ESCA includes the possibility of comparing assembled genomes of multisample runs through an easy table format. Conclusions: In conclusion, ESCA automatically furnished a variant table output file, fundamental to rapidly recognizing variants of interest. Our pipeline could be a useful method for obtaining a complete, rapid, and accurate analysis even with minimal knowledge in bioinformatics. %M 35309411 %R 10.2196/31536 %U https://bioinform.jmir.org/2022/1/e31536 %U https://doi.org/10.2196/31536 %U http://www.ncbi.nlm.nih.gov/pubmed/35309411 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 3 %P e34409 %T Viability of an Early Sleep Intervention to Mitigate Poor Sleep and Improve Well-being in the COVID-19 Pandemic: Protocol for a Feasibility Randomized Controlled Trial %A O'Hora,Kathleen Patricia %A Osorno,Raquel A %A Sadeghi-Bahmani,Dena %A Lopez,Mateo %A Morehouse,Allison %A Kim,Jane P %A Manber,Rachel %A Goldstein-Piekarski,Andrea N %+ Psychiatry and Behavioral Sciences, Stanford University, 401 Quarry Road, Stanford, CA, 94304, United States, 1 (650) 721 4780, agoldpie@stanford.edu %K insomnia %K COVID-19 %K pandemic %K telehealth %K cognitive behavioral therapy %K CBT-I %K sleep %K depression %K well-being %K telemedicine %K impact %K mental health %K therapy %D 2022 %7 14.3.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: The COVID-19 pandemic has led to drastic increases in the prevalence and severity of insomnia symptoms. These increases in insomnia complaints have been paralleled by significant decreases in well-being, including increased symptoms of depression, anxiety, and suicidality and decreased quality of life. However, the efficacy and impact of early treatment of insomnia symptoms on future sleep and well-being remain unknown. Objective: Here, we present the framework and protocol for a novel feasibility, pilot study that aims to investigate whether a brief telehealth insomnia intervention targeting new insomnia that developed during the pandemic prevents deterioration of well-being, including symptoms of insomnia, depression, anxiety, suicidality, and quality of life. Methods: The protocol details a 2-arm randomized controlled feasibility trial to investigate the efficacy of a brief, telehealth-delivered, early treatment of insomnia and evaluate its potential to prevent deterioration of well-being. Participants with clinically significant insomnia symptoms that began during the pandemic were randomized to either a treatment group or a 28-week waitlist control group. Treatment consists of 4 telehealth sessions of cognitive behavioral therapy for insomnia (CBT-I) delivered over 5 weeks. All participants will complete assessments of insomnia symptom severity, well-being, and daily habits checklist at baseline (week 0) and at weeks 1-6, 12, 28, and 56. Results: The trial began enrollment on June 3, 2020 and closed enrollment on June 17, 2021. As of October 2021, 49 participants had been randomized to either immediate treatment or a 28-week waitlist; 23 participants were still active in the protocol. Conclusions: To our knowledge, this protocol would represent the first study to test an early sleep intervention for improving insomnia that emerged during the COVID-19 pandemic. The findings of this feasibility study could provide information about the utility of CBT-I for symptoms that emerge in the context of other stressors before they develop a chronic course and deepen understanding of the relationship between sleep and well-being. Trial Registration: ClinicalTrials.gov NCT04409743; https://clinicaltrials.gov/ct2/show/NCT04409743 International Registered Report Identifier (IRRID): DERR1-10.2196/34409 %M 34995204 %R 10.2196/34409 %U https://www.researchprotocols.org/2022/3/e34409 %U https://doi.org/10.2196/34409 %U http://www.ncbi.nlm.nih.gov/pubmed/34995204 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 3 %P e30691 %T Digital Contact Tracing Apps for COVID-19: Development of a Citizen-Centered Evaluation Framework %A Tsvyatkova,Damyanka %A Buckley,Jim %A Beecham,Sarah %A Chochlov,Muslim %A O’Keeffe,Ian R %A Razzaq,Abdul %A Rekanar,Kaavya %A Richardson,Ita %A Welsh,Thomas %A Storni,Cristiano %A , %+ Department of Computer Science and Information Systems, University of Limerick, Computer Science Building, Plassey Park Rd, Limerick, V94 T9PX, Ireland, 353 61 202632, Cristiano.Storni@ul.ie %K COVID-19 %K mHealth %K digital contact tracing apps %K framework %K evaluation %K mobile health %K health apps %K digital health %K contact tracing %D 2022 %7 11.3.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The silent transmission of COVID-19 has led to an exponential growth of fatal infections. With over 4 million deaths worldwide, the need to control and stem transmission has never been more critical. New COVID-19 vaccines offer hope. However, administration timelines, long-term protection, and effectiveness against potential variants are still unknown. In this context, contact tracing and digital contact tracing apps (CTAs) continue to offer a mechanism to help contain transmission, keep people safe, and help kickstart economies. However, CTAs must address a wide range of often conflicting concerns, which make their development/evolution complex. For example, the app must preserve citizens’ privacy while gleaning their close contacts and as much epidemiological information as possible. Objective: In this study, we derived a compare-and-contrast evaluative framework for CTAs that integrates and expands upon existing works in this domain, with a particular focus on citizen adoption; we call this framework the Citizen-Focused Compare-and-Contrast Evaluation Framework (C3EF) for CTAs. Methods: The framework was derived using an iterative approach. First, we reviewed the literature on CTAs and mobile health app evaluations, from which we derived a preliminary set of attributes and organizing pillars. These attributes and the probing questions that we formulated were iteratively validated, augmented, and refined by applying the provisional framework against a selection of CTAs. Each framework pillar was then subjected to internal cross-team scrutiny, where domain experts cross-checked sufficiency, relevancy, specificity, and nonredundancy of the attributes, and their organization in pillars. The consolidated framework was further validated on the selected CTAs to create a finalized version of C3EF for CTAs, which we offer in this paper. Results: The final framework presents seven pillars exploring issues related to CTA design, adoption, and use: (General) Characteristics, Usability, Data Protection, Effectiveness, Transparency, Technical Performance, and Citizen Autonomy. The pillars encompass attributes, subattributes, and a set of illustrative questions (with associated example answers) to support app design, evaluation, and evolution. An online version of the framework has been made available to developers, health authorities, and others interested in assessing CTAs. Conclusions: Our CTA framework provides a holistic compare-and-contrast tool that supports the work of decision-makers in the development and evolution of CTAs for citizens. This framework supports reflection on design decisions to better understand and optimize the design compromises in play when evolving current CTAs for increased public adoption. We intend this framework to serve as a foundation for other researchers to build on and extend as the technology matures and new CTAs become available. %M 35084338 %R 10.2196/30691 %U https://mhealth.jmir.org/2022/3/e30691 %U https://doi.org/10.2196/30691 %U http://www.ncbi.nlm.nih.gov/pubmed/35084338 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 8 %N 1 %P e37401 %T Authors’ Reply to: Techniques to Teach Students Effectively Using Telemedicine. Comment on “Incorporating Medical Students Into Primary Care Telehealth Visits: Tutorial” %A Balaji,Aanika %A Clever,Sarah Lou %+ Johns Hopkins University School of Medicine, 1600 McElderry, Baltimore, MD, 21287, United States, 1 4109555000, sclever@jhmi.edu %K medical student %K education %K primary care %K telehealth %K video visits %K internal medicine %K medical education %K teleconsultation %K digital health %K COVID-19 %K teaching %K telemedicine %K clerkships %D 2022 %7 11.3.2022 %9 Letter to the Editor %J JMIR Med Educ %G English %X   %M 35191840 %R 10.2196/37401 %U https://mededu.jmir.org/2022/1/e37401 %U https://doi.org/10.2196/37401 %U http://www.ncbi.nlm.nih.gov/pubmed/35191840 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 8 %N 1 %P e30703 %T Techniques to Teach Students Effectively Using Telemedicine. Comment on “Incorporating Medical Students Into Primary Care Telehealth Visits: Tutorial” %A Kandola,Hardeep %A Minhas,Sonica %+ Barts and the London School of Medicine and Dentistry, Queen Mary University of London, Turner Street, London, E1 2AD, United Kingdom, 44 02078822239, h.kandola@smd18.qmul.ac.uk %K medical student %K education %K primary care %K telehealth %K video visits %K internal medicine %K medical education %K teleconsultation %K digital health %K COVID-19 %K teaching %K telemedicine %K clerkships %D 2022 %7 11.3.2022 %9 Letter to the Editor %J JMIR Med Educ %G English %X %M 35191846 %R 10.2196/30703 %U https://mededu.jmir.org/2022/1/e30703 %U https://doi.org/10.2196/30703 %U http://www.ncbi.nlm.nih.gov/pubmed/35191846 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 3 %P e34275 %T Creating Effective, Evidence-Based Video Communication of Public Health Science (COVCOM Study): Protocol for a Sequential Mixed Methods Effect Study %A Røislien,Jo %A O'Hara,Jane K %A Smeets,Ionica %A Brønnick,Kolbjørn %A Berg,Siv Hilde %A Shortt,Marie Therese %A Lungu,Daniel Adrian %A Thune,Henriette %A Wiig,Siri %+ SHARE - Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Kjell Arholms gate 41, Stavanger, 4021, Norway, 47 51 83 10 00, jo.roislien@uis.no %K pandemics %K risk %K public health %K science communication %K mixed methods %K evidence-based medicine %K COVID-19 %D 2022 %7 11.3.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: The nonlinear nature of contagious diseases and the potential for exponential growth can be difficult to grasp for the general public. This has strong implications for public health communication, which needs to be both easily accessible and efficient. A pandemic is an extreme situation, and the accompanying strict societal measures are generally easier to accept if one understands the underlying reasoning behind them. Bringing about informed attitude change and achieving compliance to strict restrictions requires explanations of scientific concepts and terminologies that laypersons can understand. Objective: The aim of the project is to develop effective, evidence-based modes of video communication for translating complex, but important, health messages about pandemics to both the general population and decision makers. The study uses COVID-19 as a case to learn and prepare society for handling the ongoing and future pandemics, as well as to provide evidence-based tools for the science communication toolbox. Methods: The project applies a mixed methods design, combining qualitative methods (eg, interviews, observational studies, literature reviews) and quantitative methods (eg, randomized controlled trials [RCTs]). The project brings together researchers from a wide range of academic fields, as well as communication industry professionals. Results: This study has received funding from the Trond Mohn Foundation through the Research Council of Norway’s “COVID-19 Emergency Call for Proposals” March 2020. Recruitment and data collection for the exploratory first phase of the project ran from February 2021 to March 2021. Creative communication work started in May 2021, and the production of videos for use in the RCTs in the final phase of the project started in September 2021. Conclusions: The COVCOM project will take on several grand challenges within the field of communicating science and provide evidence-based tools to the science communication toolbox. A long-term goal of the project is to contribute to the creation of a more resilient health care system by developing communication responses tailormade for different audiences, preparing society for any future pandemic. International Registered Report Identifier (IRRID): DERR1-10.2196/34275 %M 35147500 %R 10.2196/34275 %U https://www.researchprotocols.org/2022/3/e34275 %U https://doi.org/10.2196/34275 %U http://www.ncbi.nlm.nih.gov/pubmed/35147500 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e33883 %T The Effect of the Imacoco Care Psychoeducation Website on Improving Psychological Distress Among Workers During the COVID-19 Pandemic: Randomized Controlled Trial %A Imamura,Kotaro %A Sasaki,Natsu %A Sekiya,Yuki %A Watanabe,Kazuhiro %A Sakuraya,Asuka %A Matsuyama,Yutaka %A Nishi,Daisuke %A Kawakami,Norito %+ Department of Mental Health, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan, 81 3 5841 3522, nkawakami@m.u-tokyo.ac.jp %K COVID-19 %K education %K internet-based intervention %K occupational groups %K psychological distress %K mental health %K digital health %K health intervention %K psychoeducation %D 2022 %7 10.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The prolonged COVID-19 pandemic has affected mental health among workers. Psychoeducational intervention via a website could be effective for primary prevention of mental illness among workers in the current COVID-19 pandemic. Objective: The aim of this randomized controlled trial is to examine the effect of a newly developed online psychoeducational website named Imacoco Care on reducing psychological distress and fear about COVID-19 infection among workers. Methods: Participants in the study were recruited from registered members of a web survey company in Japan. Participants who fulfilled the eligibility criteria were randomly allocated to the intervention or control group. Participants in the intervention group were invited to access the Imacoco Care program within a month after the baseline survey. The Kessler Psychological Distress Scale (K6) and the Fear of COVID-19 Scale (FCV-19S) scores were obtained at baseline and at 1- and 3-month follow-ups. Results: A total of 1200 workers were randomly allocated to the intervention and control groups (n=600 [50%] per group). The Imacoco Care intervention group showed a significant favorable effect on K6 scores (P=.03) with a small effect size (ES; Cohen d=–0.14) and an adverse effect on FCV-19S scores (P=.01) with a small ES (Cohen d=0.16) at 3-month follow-up. In the per protocol analysis (including only participants who had read the Imacoco Care content at least 1 time), the Imacoco Care intervention group also showed a significant favorable effect on reducing K6 scores (P=.03), while an adverse effect on FCV-19S scores was not significant (P=.06) in the intervention group at 3-month follow-up. Conclusions: A web-based psychoeducation approach may be effective for improving psychological distress among workers; however, it may be important not only to distribute information but also to encourage active engagement with the content of the program to prevent adverse effects of psychoeducational intervention. Trial Registration: University Hospital Medical Information Network Clinical Trials Registry (UMIN-CTR) UMIN000042556; https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000048548 %M 35133972 %R 10.2196/33883 %U https://formative.jmir.org/2022/3/e33883 %U https://doi.org/10.2196/33883 %U http://www.ncbi.nlm.nih.gov/pubmed/35133972 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 3 %P e34152 %T Evaluating the Effect of Supported Systematic Work Environment Management During the COVID-19 Pandemic: Protocol for a Mixed Methods Study %A Haraldsson,Patrik %A Ros,Axel %A Jonker,Dirk %A Areskoug Josefsson,Kristina %+ School of Health and Welfare, Jönköping Academy for Improvement of Health and Welfare, Jönköping University, Gjuterigatan 5, Jönköping, 553 18, Sweden, 46 10 2447892, patrik.haraldsson@ju.se %K occupational health interventions %K implementation %K mixed methods %K COVID-19 pandemic %K COVID-19 %K pandemic %K occupational health %K health interventions %K health care %K support services %K employee health %D 2022 %7 10.3.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: The work environment is a complex phenomenon in which many factors interact. Scientific research indicates a relation between the work environment and employee health, staff turnover, patient satisfaction, and patient safety. There is a great need for knowledge on how to conduct work environment interventions and practical work environment management to maximize benefits to the employees. Objective: The aim of this study is to explore how Occupational Health Service (OHS) support will affect the work environment, sick leave, staff turnover, patient satisfaction, and patient safety during and following the COVID-19 pandemic in a medical ward setting. Methods: A mixed methods evaluation of a concurrent work environment quality improvement project at the Department of Internal Medicine and Geriatrics in a local hospital in the south of Sweden will be performed. Results: The mixed methods evaluation of the quality improvement project received funding from Futurum–Academy for Health and Care, Jönköping County Council and Region Jönköping County, and the study protocol was approved by the Swedish Ethical Review Authority. The work environment quality improvement project will continue between May 2020 and December 2021. Conclusions: The study might contribute to increased knowledge of how work environment interventions and practical work environment management can impact the work environment, and employee health, staff turnover, patient satisfaction, and patient safety. There is a need for knowledge in this area for OHS management to provide increased benefits to employees, employers, and society as a whole. International Registered Report Identifier (IRRID): DERR1-10.2196/34152 %M 35234649 %R 10.2196/34152 %U https://www.researchprotocols.org/2022/3/e34152 %U https://doi.org/10.2196/34152 %U http://www.ncbi.nlm.nih.gov/pubmed/35234649 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e34088 %T System-Level Factors Associated With Telephone and Video Visit Use: Survey of Safety-Net Clinicians During the Early Phase of the COVID-19 Pandemic %A Sharma,Anjana E %A Khoong,Elaine C %A Sierra,Maribel %A Rivadeneira,Natalie A %A Nijagal,Malini A %A Su,George %A Lyles,Courtney R %A DeFries,Triveni %A Tuot,Delphine S %A Sarkar,Urmimala %+ Department of Family & Community Medicine, University of California San Francisco, 995 Potrero Ave, Ward 83, San Francisco, CA, 94110, United States, 1 4155708619, anjana.sharma@ucsf.edu %K telemedicine %K safety-net hospitals %K health care delivery %K ambulatory care %K vulnerable populations %K COVID-19 %K survey %K vulnerable %K telehealth %K hospital %K safety %K delivery %K video %K implementation %K health system %D 2022 %7 10.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic prompted safety-net health care systems to rapidly implement telemedicine services with little prior experience, causing disparities in access to virtual visits. While much attention has been given to patient barriers, less is known regarding system-level factors influencing telephone versus video-visit adoption. As telemedicine remains a preferred service for patients and providers, and reimbursement parity will not continue for audio visits, health systems must evaluate how to support higher-quality video visit access. Objective: This study aimed to assess health system–level factors and their impact on telephone and video visit adoption to inform sustainability of telemedicine for ambulatory safety-net sites. Methods: We conducted a cross-sectional survey among ambulatory care clinicians at a hospital-linked ambulatory clinic network serving a diverse, publicly insured patient population between May 28 and July 14, 2020. We conducted bivariate analyses assessing health care system–level factors associated with (1) high telephone adoption (4 or more visits on average per session); and (2) video visit adoption (at least 1 video visit on average per session). Results: We collected 311 responses from 643 eligible clinicians, yielding a response rate of 48.4%. Clinician respondents (N=311) included 34.7% (n=108) primary or urgent care, 35.1% (n=109) medical, and 7.4% (n=23) surgical specialties. Our sample included 178 (57.2%) high telephone adopters and 81 (26.05%) video adopters. Among high telephone adopters, 72.2% utilized personal devices for telemedicine (vs 59.0% of low telephone adopters, P=.04). Video nonadopters requested more training in technical aspects than adopters (49.6% vs 27.2%, P<.001). Primary or urgent care had the highest proportion of high telephone adoption (84.3%, compared to 50.4% of medical and 37.5% of surgical specialties, P<.001). Medical specialties had the highest proportion of video adoption (39.1%, compared to 14.8% of primary care and 12.5% of surgical specialties, P<.001). Conclusions: Personal device access and department specialty were major factors associated with high telephone and video visit adoption among safety-net clinicians. Desire for training was associated with lower video visit use. Secure device access, clinician technical trainings, and department-wide assessments are priorities for safety-net systems implementing telemedicine. %M 35148271 %R 10.2196/34088 %U https://formative.jmir.org/2022/3/e34088 %U https://doi.org/10.2196/34088 %U http://www.ncbi.nlm.nih.gov/pubmed/35148271 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e27469 %T The Mental Health Impact of the COVID-19 Pandemic Among Physicians, Nurses, and Other Health Care Providers in Alberta: Cross-sectional Survey %A El Gindi,Hany %A Shalaby,Reham %A Gusnowski,April %A Vuong,Wesley %A Surood,Shireen %A Hrabok,Marianne %A Greenshaw,Andrew J %A Agyapong,Vincent %+ Department of Psychiatry, University of Alberta, 1E1 Walter Mackenzie Health Sciences Centre, 8440 112 St NW, Edmonton, AB, T6G 2B7, Canada, 1 780 215 7771, agyapong@ualberta.ca %K COVID-19 %K health care worker %K mobile technology %K Text4Hope %K anxiety %K depression %K stress %K pandemic %K e-mental health %K mental health %K impact %K physician %K nurse %K Canada %D 2022 %7 9.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: During the COVID-19 pandemic, threats to mental health, psychological safety, and well-being are evident, particularly among the first responders and the health care staff. Objective: This study aims to examine the prevalence and potential predictors of the likely stress, generalized anxiety disorder, and major depressive disorder among health care workers (HCWs). Methods: A cross-sectional survey was used through a survey link sent to gather demographic information and responses on several self-report scales, including the Perceived Stress Scale, the Generalized Anxiety Disorder 7-item scale, and the Patient Health Questionnaire-9 among HCWs enrolled in the Text4Hope program. Results: The result from this study suggests that during the COVID-19 pandemic, HCWs reported a high likelihood of moderate-to-high perceived stress (n=840, 81.2%), moderate-to-severe anxiety (n=369, 38.6%), and depression (n=317, 32.7%) symptoms. Nurses and other HCWs were significantly more likely to report depressive symptoms compared to physicians (F(2, 159.47)=15.89, 95% CI –5.05 to –2.04). Younger age groups of HCWs (≤30 years) were more prone to report likely stress, anxiety, and depressive symptoms compared to HCWs 41-50 and >50 years old (odds ratio [OR] 1.82-3.03). Similarly, females and those who reported a lack of social support (separated/divorced and single) among HCWs had a higher likelihood to report likely stress and depressive symptoms, respectively (OR 1.8 and 1.6, respectively). Conclusions: This cross-sectional study explored a high level of mental health burdens during the COVID-19 pandemic among HCWs in Alberta. Levels of psychological symptoms were more noticeable in the female gender and the nursing profession. %M 34995203 %R 10.2196/27469 %U https://formative.jmir.org/2022/3/e27469 %U https://doi.org/10.2196/27469 %U http://www.ncbi.nlm.nih.gov/pubmed/34995203 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 3 %P e34601 %T The Essential Network (TEN): Protocol for an Implementation Study of a Digital-First Mental Health Solution for Australian Health Care Workers During COVID-19 %A Coleshill,Matthew James %A Baldwin,Peter %A Black,Melissa %A Newby,Jill %A Shrestha,Tanya %A Haffar,Sam %A Mills,Llewellyn %A Stensel,Andrew %A Cockayne,Nicole %A Tennant,Jon %A Harvey,Samuel %A Christensen,Helen %+ Black Dog Institute, Hospital Road, Randwick, New South Wales, Sydney, 2031, Australia, 61 02 9065 9149, m.coleshill@blackdog.org.au %K blended care %K mental health %K burnout %K health care workers %K COVID-19 %K health care service %K health service %D 2022 %7 9.3.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: The COVID-19 pandemic has placed health care workers (HCWs) under severe stress, compounded by barriers to seeking mental health support among HCWs. The Essential Network (TEN) is a blend of digital and person-to-person (blended care) mental health support services for HCWs, funded by the Australian Federal Department of Health as part of their national COVID-19 response strategy. TEN is designed as both a preventative measure and treatment for common mental health problems faced by HCWs. New blended services need to demonstrate improvements in mental health symptoms and test acceptability in their target audience, as well as review implementation strategies to improve engagement. Objective: The primary objective of this implementation study is to design and test an implementation strategy to improve uptake of TEN. The secondary objectives are examining the acceptability of TEN among HCWs, changes in mental health outcomes associated with the use of TEN, and reductions in mental health stigma among HCWs following the use of TEN. Methods: The implementation study contains 3 components: (1) a consultation study with up to 39 stakeholders or researchers with implementation experience to design an implementation strategy, (1) a longitudinal observational study of at least 105 HCWs to examine the acceptability of TEN and the effectiveness of TEN at 1 and 6 months in improving mental health (as assessed by the Distress Questionnaire [DQ-5], Patient Health Questionnaire [PHQ-9], Generalized Anxiety Disorder [GAD-7], Oldenburg Burnout Inventory [OBI-16], and Work and Social Adjustment Scale [WSAS]) and reducing mental health stigma (the Endorsed and Anticipated Stigma Inventory [EASI]), and (3) an implementation study where TEN service uptake analytics will be examined for 3 months before and after the introduction of the implementation strategy. Results: The implementation strategy, designed with input from the consultation and observational studies, is expected to lead to an increased number of unique visits to the TEN website in the 3 months following the introduction of the implementation strategy. The observational study is expected to observe high service acceptability. Moderate improvements to general mental health (DQ-5, WSAS) and a reduction in workplace- and treatment-related mental health stigma (EASI) between the baseline and 1-month time points are expected. Conclusions: TEN is a first-of-a-kind blended mental health service available to Australian HCWs. The results of this project have the potential to inform the implementation and development of blended care mental health services, as well as how such services can be effectively implemented during a crisis. International Registered Report Identifier (IRRID): DERR1-10.2196/34601 %M 35148269 %R 10.2196/34601 %U https://www.researchprotocols.org/2022/3/e34601 %U https://doi.org/10.2196/34601 %U http://www.ncbi.nlm.nih.gov/pubmed/35148269 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e33066 %T Effects of a National Preventive Intervention Against Potential COVID-19–Related Gambling Problems in Online Gamblers: Self-Report Survey Study %A Håkansson,Anders %A Sundvall,Andreas %A Lyckberg,Axel %+ Department of Clinical Sciences Lund, Psychiatry, Faculty of Medicine, Lund University, Baravägen 1, Lund, 22100, Sweden, 46 46175596, anders_c.hakansson@med.lu.se %K gambling disorder %K problem gambling %K COVID-19 %K harm reduction %K behavioral addiction %D 2022 %7 9.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic has been suspected to increase gambling problems in the population. Several governments introduced COVID-19–specific interventions early with the aim to prevent gambling problems, but their effects have not been evaluated. Objective: This study aimed to evaluate a Swedish COVID-19–related temporary legislation imposing an automated weekly deposit limit for online casino gambling. Methods: The study was an anonymous survey sent by a state-owned gambling operator to online gamblers (N=619), among whom 54.0% (n=334) were moderate-risk/problem gamblers who reached the weekly limit on online gambling during the summer of 2020. Results: Overall, 60.1% (372/619) were aware of having been limited by the COVID-19–related deposit limit, and a minority (145/619, 23.4%) perceived the intervention as fairly bad or very bad. Among those aware of the intervention, 38.7% (144/372) believed the intervention decreased their overall gambling, whereas 7.8% (29/372) believed it rather increased it. However, 82.5% (307/372) reported having gambled at more than one operator after the limit, and the most common gambling type reported to have increased at another operator was online casino (42% among moderate-risk/problem gamblers and 19% among others; P<.001). An increase in gambling following the intervention was associated with being a moderate-risk/problem gambler and having negative attitudes toward the intervention. Conclusions: The weekly deposit limit had relatively high acceptability, but the study highlights the limitations of a single-operator deposit limit, given the high number of gamblers also reporting gambling at other operators and the lower effect in clients with gambling problems. %M 34678751 %R 10.2196/33066 %U https://formative.jmir.org/2022/3/e33066 %U https://doi.org/10.2196/33066 %U http://www.ncbi.nlm.nih.gov/pubmed/34678751 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 3 %P e36119 %T Identifying COVID-19 Outbreaks From Contact-Tracing Interview Forms for Public Health Departments: Development of a Natural Language Processing Pipeline %A Caskey,John %A McConnell,Iain L %A Oguss,Madeline %A Dligach,Dmitriy %A Kulikoff,Rachel %A Grogan,Brittany %A Gibson,Crystal %A Wimmer,Elizabeth %A DeSalvo,Traci E %A Nyakoe-Nyasani,Edwin E %A Churpek,Matthew M %A Afshar,Majid %+ University of Wisconsin–Madison, 1685 Highland Avenue, 5158 Medical Foundation Centennial Building, Madison, WI, 53705, United States, 1 3125459462, majid.afshar@wisc.edu %K natural language processing %K public health informatics %K named entity recognition %K contact tracing %K COVID-19 %K outbreaks %K neural language model %K disease surveillance %K digital health %K electronic surveillance %K public health %K digital surveillance tool %D 2022 %7 8.3.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: In Wisconsin, COVID-19 case interview forms contain free-text fields that need to be mined to identify potential outbreaks for targeted policy making. We developed an automated pipeline to ingest the free text into a pretrained neural language model to identify businesses and facilities as outbreaks. Objective: We aimed to examine the precision and recall of our natural language processing pipeline against existing outbreaks and potentially new clusters. Methods: Data on cases of COVID-19 were extracted from the Wisconsin Electronic Disease Surveillance System (WEDSS) for Dane County between July 1, 2020, and June 30, 2021. Features from the case interview forms were fed into a Bidirectional Encoder Representations from Transformers (BERT) model that was fine-tuned for named entity recognition (NER). We also developed a novel location-mapping tool to provide addresses for relevant NER. Precision and recall were measured against manually verified outbreaks and valid addresses in WEDSS. Results: There were 46,798 cases of COVID-19, with 4,183,273 total BERT tokens and 15,051 unique tokens. The recall and precision of the NER tool were 0.67 (95% CI 0.66-0.68) and 0.55 (95% CI 0.54-0.57), respectively. For the location-mapping tool, the recall and precision were 0.93 (95% CI 0.92-0.95) and 0.93 (95% CI 0.92-0.95), respectively. Across monthly intervals, the NER tool identified more potential clusters than were verified in WEDSS. Conclusions: We developed a novel pipeline of tools that identified existing outbreaks and novel clusters with associated addresses. Our pipeline ingests data from a statewide database and may be deployed to assist local health departments for targeted interventions. %M 35144241 %R 10.2196/36119 %U https://publichealth.jmir.org/2022/3/e36119 %U https://doi.org/10.2196/36119 %U http://www.ncbi.nlm.nih.gov/pubmed/35144241 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 3 %P e32694 %T The Transition of Social Isolation and Related Psychological Factors in 2 Mild Lockdown Periods During the COVID-19 Pandemic in Japan: Longitudinal Survey Study %A Sugaya,Nagisa %A Yamamoto,Tetsuya %A Suzuki,Naho %A Uchiumi,Chigusa %+ Graduate School of Technology, Industrial and Social Sciences, Tokushima University, 1-1, Minamijosanjima-cho, Tokushima, 770-8502, Japan, 81 88 656 7617, t.yamamoto@tokushima-u.ac.jp %K coronavirus disease 2019 %K mild lockdown %K social isolation %K longitudinal survey %K public health %K surveillance %K epidemiology %K COVID-19 %K pandemic %K lockdown %K psychological behavior %K social factors %K mental health %D 2022 %7 8.3.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Lockdowns and stay-at-home orders announced internationally for COVID-19 have led to physical and social distancing, with reports of many individuals experiencing social isolation (SI) and loneliness. Although the emergency declaration in Japan was declared as a “mild” lockdown requested by the government without penalties for violations, the lockdown measures, including SI, had several influences on people’s lives and mental health as in other countries. Furthermore, Japan declared a state of emergency multiple times; thus, it is necessary to examine the influence of the transition of SI caused by repeated emergency declarations and the deterioration of mental health associated with these changes. Objective: This study longitudinally investigated the transition of SI and its related factors during the mild lockdown under 2 declared states of emergency in Japan and analyzed psychosocial characteristics by extracting clusters where people with specific transition patterns of SI predominated. Methods: We collected data on 7893 inhabitants (3694 [46.8%] women, 49.6 [SD 13.7] years old) living in the 7 prefectures where the initial emergency declaration was applied. The investigations took place online in the final phase of the first and second states of emergency: phase 1 (between May 11 and 12, 2020) and phase 2 (between February 24 and 28, 2021). Nonparametric Bayesian coclustering was used to visualize the exhaustive interaction structure between the transition pattern of SI and the psychosocial variables. Results: There were no improvements in social networks and loneliness between the 2 phases, although psychological distress significantly improved and depression slightly decreased. Overall, 3868 (49%) of the 7893 participants remained socially isolated through phases 1 and 2, and 947 (12%) were socially isolated in phase 2, even though they were not socially isolated in phase 1. More participants experienced persistent SI in unmarried, childless, and low-household-income groups. The persistent-SI group had fewer cohabitants than other transition pattern groups. The nonparametric Bayesian coclustering results showed that most clusters, including participants without SI throughout phases 1 and 2, had healthy behaviors, more interactions, good relationships, and less loneliness and psychological stress. Furthermore, the cluster in which relationships deteriorated in phase 1 recovered in phase 2. Comparatively, the clusters with SI throughout phases 1 and 2 were divided into clusters with increased loneliness and psychological stress; clusters were close to participants’ average scores in this study. The clusters with increased loneliness and psychological stress were notable for deteriorating relationships and less online interaction. Conclusions: This study revealed the actual state of transition of SI and related psychological, social, and behavioral factors under repeated declarations of a state of emergency. These results should help construct intervention methods that fit individual characteristics of people in SI during a pandemic. %M 35107428 %R 10.2196/32694 %U https://publichealth.jmir.org/2022/3/e32694 %U https://doi.org/10.2196/32694 %U http://www.ncbi.nlm.nih.gov/pubmed/35107428 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 1 %P e32957 %T Exploring Older Adults’ Adoption and Use of a Tablet Computer During COVID-19: Longitudinal Qualitative Study %A Kim,Sunyoung %A Yao,Willow %A Du,Xiaotong %+ School of Communication and Information, Rutgers University, 4 Huntington Street, New Brunswick, NJ, 08901, United States, 1 8489327585, sunyoung.kim@rutgers.edu %K older adults %K tablet computer %K technology acceptance %K mental model %K longitudinal study %K COVID-19 %D 2022 %7 8.3.2022 %9 Original Paper %J JMIR Aging %G English %X Background: As mobile computing technology evolves, such as smartphones and tablet computers, it increasingly offers features that may be particularly beneficial to older adults. However, the digital divide exists, and many older adults have been shown to have difficulty using these devices. The COVID-19 pandemic has magnified how much older adults need but are excluded from having access to technologies to meet essential daily needs and overcome physical distancing restrictions. Objective: This study sought to understand how older adults who had never used a tablet computer learn to use it, what they want to use it for, and what barriers they experience as they continue to use it during social isolation caused by the COVID-19 pandemic. Methods: We conducted a series of semistructured interviews with eight people aged 65 years and older for 16 weeks, investigating older novice users’ adoption and use of a tablet computer during the nationwide lockdown due to COVID-19. Results: Participants were gradually yet successfully accustomed to using a tablet computer to serve various daily needs, including entertainment, social connectedness, and information-seeking. However, this success was not achieved through developing sufficient digital skills but rather by applying the methods they were already familiar with in its operation, such as taking and referring to instruction notes. Conclusions: Our findings imply that older adults without digital literacy can still benefit from a digital device for quality of later life if proper traditional methods they are already familiar with are offered in its use. %M 35134747 %R 10.2196/32957 %U https://aging.jmir.org/2022/1/e32957 %U https://doi.org/10.2196/32957 %U http://www.ncbi.nlm.nih.gov/pubmed/35134747 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e25055 %T Engagement With Web-Based Fitness Videos on YouTube and Instagram During the COVID-19 Pandemic: Longitudinal Study %A Sui,Wuyou %A Rush,Jonathan %A Rhodes,Ryan E %+ Exercise and Health Psychology Lab, Western University, 1151 Richmond St, London, ON, N6A 3K7, Canada, 1 5196612111 ext 81189, yoahsui@gmail.com %K eHealth %K physical activity %K adults %K adherence %K COVID-19 %K fitness %K video %K YouTube %K Instagram %K social media %K longitudinal %D 2022 %7 8.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic has drastically changed the physical activity (PA) landscape through the closures of gymnasiums, schools, and many outdoor spaces. Physical distancing guidelines have also reduced opportunity for PA. The popularity of free web-based home fitness videos on video hosting platforms (eg, YouTube and Instagram) has spiked during the pandemic. Many web-based fitness videos offer a convenient, accessible, and cost-effective means of engaging in PA through regularly posted videos or discrete programs. Notably, traditional PA programs often suffer from poor adherence and high dropout rates, despite many advantages over web-based workout programs (eg, equipment, feedback, and in-person engagement). Thus, notwithstanding clear advantages of these web-based fitness videos, their ability to maintain long-term engagement and adherence is unknown. Objective: We explored patterns of engagement (ie, views, likes, and comments) for channels posting daily or program-based web-based fitness videos since the declaration of COVID-19 as a pandemic, over 4 months. Our secondary objective was to examine potential moderators of engagement metrics. Methods: An environmental scan was used to identify eligible channels. Eligible channels were (1) freely available on YouTube or Instagram and (2) posted daily or weekday series workouts or offered quarantine-specific workout programs. Searches for eligible channels were conducted on June 1 and 4, 2020. Engagement metrics of views, likes, and comments were then collected from channels’ videos posted between March 11 and June 26 or 30, 2020, inclusive, on June 26 or July 8, 2020. A series of multilevel modeling analyses were conducted to examine longitudinal changes in each of the 3 outcome variables. Results: Ten channels were deemed eligible and included in analyses; 6 posted regularly, while the other 4 posted discrete workout programs. Multilevel models revealed that both views and likes significantly decreased across days. Visually, channels display the sharpest drop in engagement within the first week. Linear change estimate indicates that the number of views initially declined by 24,700 per day (95% CI –44,400 to –11,300, P=.01) on average across all the channels. Channels with more subscribers declined in their views, likes, and comments at a significantly higher rate than those with fewer subscribers (P≤.04). The day of the week a video is posted, “virality,” and content of a video appear to influence engagement. Integrating behavior change techniques and posting new and varied videos often may help garner further engagement with these videos. Future research should examine common elements of videos, which drive engagement. Conclusions: Despite raw engagement metrics, each channel demonstrated peak engagement with the initial video followed by decreased engagement with subsequent videos. As many countries maintain restrictions on traditional PA facilities owing to the COVID-19 pandemic, determining methods to improve engagement and adherence with web-based fitness videos becomes increasingly important. %M 35258459 %R 10.2196/25055 %U https://formative.jmir.org/2022/3/e25055 %U https://doi.org/10.2196/25055 %U http://www.ncbi.nlm.nih.gov/pubmed/35258459 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 3 %P e34040 %T Social-Cyber Maneuvers During the COVID-19 Vaccine Initial Rollout: Content Analysis of Tweets %A Blane,Janice T %A Bellutta,Daniele %A Carley,Kathleen M %+ School of Computer Science, Carnegie Mellon University, 5000 Forbes Ave, Pittsburgh, PA, 15213, United States, 1 412 268 6016, jblane@andrew.cmu.edu %K social cybersecurity %K social-cyber maneuvers %K social network analysis %K disinformation %K BEND maneuvers %K COVID-19 %K coronavirus %K social media %K vaccine %K anti-vaccine %K pro-vaccine %K ORA-PRO %K cybersecurity %K security %K Twitter %K community %K communication %K health information %K manipulation %K belief %D 2022 %7 7.3.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: During the time surrounding the approval and initial distribution of Pfizer-BioNTech’s COVID-19 vaccine, large numbers of social media users took to using their platforms to voice opinions on the vaccine. They formed pro- and anti-vaccination groups toward the purpose of influencing behaviors to vaccinate or not to vaccinate. The methods of persuasion and manipulation for convincing audiences online can be characterized under a framework for social-cyber maneuvers known as the BEND maneuvers. Previous studies have been conducted on the spread of COVID-19 vaccine disinformation. However, these previous studies lacked comparative analyses over time on both community stances and the competing techniques of manipulating both the narrative and network structure to persuade target audiences. Objective: This study aimed to understand community response to vaccination by dividing Twitter data from the initial Pfizer-BioNTech COVID-19 vaccine rollout into pro-vaccine and anti-vaccine stances, identifying key actors and groups, and evaluating how the different communities use social-cyber maneuvers, or BEND maneuvers, to influence their target audiences and the network as a whole. Methods: COVID-19 Twitter vaccine data were collected using the Twitter application programming interface (API) for 1-week periods before, during, and 6 weeks after the initial Pfizer-BioNTech rollout (December 2020 to January 2021). Bot identifications and linguistic cues were derived for users and tweets, respectively, to use as metrics for evaluating social-cyber maneuvers. Organization Risk Analyzer (ORA)-PRO software was then used to separate the vaccine data into pro-vaccine and anti-vaccine communities and to facilitate identification of key actors, groups, and BEND maneuvers for a comparative analysis between each community and the entire network. Results: Both the pro-vaccine and anti-vaccine communities used combinations of the 16 BEND maneuvers to persuade their target audiences of their particular stances. Our analysis showed how each side attempted to build its own community while simultaneously narrowing and neglecting the opposing community. Pro-vaccine users primarily used positive maneuvers such as excite and explain messages to encourage vaccination and backed leaders within their group. In contrast, anti-vaccine users relied on negative maneuvers to dismay and distort messages with narratives on side effects and death and attempted to neutralize the effectiveness of the leaders within the pro-vaccine community. Furthermore, nuking through platform policies showed to be effective in reducing the size of the anti-vaccine online community and the quantity of anti-vaccine messages. Conclusions: Social media continues to be a domain for manipulating beliefs and ideas. These conversations can ultimately lead to real-world actions such as to vaccinate or not to vaccinate against COVID-19. Moreover, social media policies should be further explored as an effective means for curbing disinformation and misinformation online. %M 35044302 %R 10.2196/34040 %U https://www.jmir.org/2022/3/e34040 %U https://doi.org/10.2196/34040 %U http://www.ncbi.nlm.nih.gov/pubmed/35044302 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 3 %P e36006 %T Epidemiology, Secondary School Curricula, and Preparing the Next Generation for Global Citizenship %A Basch,Charles E %A Basch,Corey H %+ William Paterson University, 300 Pompton Rd, Wayne, NJ, 07470, United States, 1 973 720 2603, baschc@wpunj.edu %K COVID-19 %K epidemiology %K secondary school %K global citizenship %K emerging infectious disease %K public health %K teaching %K student %K high school education %K population health %D 2022 %7 7.3.2022 %9 Viewpoint %J JMIR Public Health Surveill %G English %X Because COVID-19 and other emerging infectious diseases are likely to play an increasingly important role in shaping American and global society in years to come, there is a need to prepare young people to make informed decisions in this changing global context. One way to do so is teaching and learning about basic principles of epidemiology in secondary schools. Improved understanding about the agent of infection, mechanisms of transmission, factors that increase or decrease susceptibility, place variation and environmental factors that facilitate or hinder transmission, reservoirs of infection (where the agent lives and multiplies), and when the disease is more or less likely to occur comprise the main facts about an infectious disease relevant to prevention and control. Improved understanding of these basic concepts could help future generations make informed decisions in a changing global context with emerging infectious diseases and a plethora of widely disseminated misinformation and disinformation. This viewpoint considers why learning about epidemiology in secondary school would benefit population health using COVID-19 as an illustration. %M 35254281 %R 10.2196/36006 %U https://publichealth.jmir.org/2022/3/e36006 %U https://doi.org/10.2196/36006 %U http://www.ncbi.nlm.nih.gov/pubmed/35254281 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 8 %N 1 %P e33612 %T Student-Run Online Journal Club Initiative During a Time of Crisis: Survey Study %A Ozkara,Burak Berksu %A Karabacak,Mert %A Alpaydin,Duygu Demet %+ Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, İstanbul Üniversitesi-Cerrahpaşa Tıp Fakültesi, Kocamustafapaşa Cd. No 53, Istanbul, 34098, Turkey, 90 5542993096, berksuozkara@gmail.com %K online journal club %K medical student %K distance learning %K COVID-19 %K undergraduate education %K student journal club %K online education %K establishment %K initiative %K literature %K research %K publishing %K education %D 2022 %7 7.3.2022 %9 Original Paper %J JMIR Med Educ %G English %X Background: Since the closure of university campuses due to COVID-19 in spring 2020 necessitated a quick transition to online courses, medical students were isolated from hospitals and universities, negatively impacting their education. During this time, medical students had no opportunity to participate in academic discussions and were also socially isolated. Furthermore, medical doctors and professors of medical schools were given additional responsibilities during the pandemic because they were the frontliners in the fight against COVID-19. As a result, they did not have enough time to contribute effectively to medical student education. Objective: This paper describes the establishment of the Cerrahpasa Neuroscience Society Journal Clubs, a group of entirely student-run online journal clubs at Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa. Methods: The website, mass emailing, and social media accounts were used to announce the online journal clubs. Only medical students were eligible to apply. Journal clubs included psychiatry, neuroradiology, neurosurgery, neurology, and neuroscience. Following the last journal club meeting, a questionnaire created by the society’s board was distributed to the participants. SPSS Statistics (version 26) was used for statistical analysis. Results: Since March 15, 2021, synchronous online journal club meetings have been held every 2 weeks on a weekday using Google Meet, Microsoft Teams, or Zoom. Meetings of each journal club lasted approximately 1 hour on average. Interstudent interaction across multiple institutions was achieved since a total of 45 students from 11 different universities attended the meetings on a regular basis. Students on the society’s board served as academic mentors for the clubs. The clubs received excellent feedback from participants, with an overall contentment score of 4.32 out of 5. Conclusions: By establishing these clubs, we have created a venue for academic discussions, which helps to reduce the negative impact of the pandemic on education. In addition, we believe it greatly aided students in staying in touch with their peers, thereby reducing the sense of isolation. We realize that traditional journal clubs are run by faculty; however, we believe that this experience demonstrated that medical students could run a journal club on their own since the feedback from participants was excellent. Additionally, as a medical student, being a journal club academic mentor is a challenging responsibility; however, having this responsibility significantly improved our academic mentors’ leadership abilities. %M 35148270 %R 10.2196/33612 %U https://mededu.jmir.org/2022/1/e33612 %U https://doi.org/10.2196/33612 %U http://www.ncbi.nlm.nih.gov/pubmed/35148270 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 3 %P e35252 %T Adaptation of an In-Person Internship to a Virtual Format for Public Health Undergraduates %A Kernan,William D %A Basch,Corey H %+ Department of Public Health, William Paterson University of New Jersey, 300 Pompton Road, Wayne, NJ, 07470, United States, 1 973 720 3479, kernanw@wpunj.edu %K internship %K remote learning %K high-impact practice %K COVID-19 %K public health education %K learning outcomes %K virtual learning %K virtual internship %K public health %K health education %K undergraduate education %K virtual education %D 2022 %7 4.3.2022 %9 Viewpoint %J JMIR Public Health Surveill %G English %X The disruption of traditional, in-person learning due to the COVID-19 pandemic necessitated the rapid development and use of revised and novel learning opportunities using a variety of remote instructional methodologies. This viewpoint describes the process used by an undergraduate Public Health program to transition a traditional, in-person, semester-long, 480-hour internship to a virtual-only learning experience guided by the existing student learning outcomes. Working closely with public health professionals at existing internship agencies, alumni from the program, student interns, and program faculty developed a modified virtual internship composed of 6 components. The development of this modified virtual internship model was guided by previous research on the components of successful internships and the elements of high-impact learning practices. %M 35089869 %R 10.2196/35252 %U https://publichealth.jmir.org/2022/3/e35252 %U https://doi.org/10.2196/35252 %U http://www.ncbi.nlm.nih.gov/pubmed/35089869 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 3 %P e33277 %T Precision Public Health and Structural Racism in the United States: Promoting Health Equity in the COVID-19 Pandemic Response %A Geneviève,Lester Darryl %A Martani,Andrea %A Wangmo,Tenzin %A Elger,Bernice Simone %+ Institute for Biomedical Ethics, University of Basel, Bernoullistrasse 28, Basel, 4056, Switzerland, 41 612071782, lester.genevieve@unibas.ch %K precision public health %K structural racism %K COVID-19 %K pandemic %K social justice %K health equity %K SARS-CoV-2 %K stigma %K discrimination %K disparity %K inequality %K precision health %K public health %K racism %K inequality %K equity %K mortality %K morbidity %D 2022 %7 4.3.2022 %9 Viewpoint %J JMIR Public Health Surveill %G English %X The COVID-19 pandemic has revealed deeply entrenched structural inequalities that resulted in an excess of mortality and morbidity in certain racial and ethnic groups in the United States. Therefore, this paper examines from the US perspective how structural racism and defective data collection on racial and ethnic minorities can negatively influence the development of precision public health (PPH) approaches to tackle the ongoing COVID-19 pandemic. Importantly, the effects of structural and data racism on the development of fair and inclusive data-driven components of PPH interventions are discussed, such as with the use of machine learning algorithms to predict public health risks. The objective of this viewpoint is thus to inform public health policymaking with regard to the development of ethically sound PPH interventions against COVID-19. Particular attention is given to components of structural racism (eg, hospital segregation, implicit and organizational bias, digital divide, and sociopolitical influences) that are likely to hinder such approaches from achieving their social justice and health equity goals. %M 35089868 %R 10.2196/33277 %U https://publichealth.jmir.org/2022/3/e33277 %U https://doi.org/10.2196/33277 %U http://www.ncbi.nlm.nih.gov/pubmed/35089868 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e33314 %T Public Perception of the Use of Digital Contact-Tracing Tools After the COVID-19 Lockdown: Sentiment Analysis and Opinion Mining %A Huang,Zhilian %A Tay,Evonne %A Wee,Dillon %A Guo,Huiling %A Lim,Hannah Yee-Fen %A Chow,Angela %+ Department of Clinical Epidemiology, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore, 65 63577477, Angela_Chow@ttsh.com.sg %K infectious disease %K sentiment analysis %K opinion mining %K COVID-19 %K contact tracing %K public health %K opinion %K data mining %K survey %K cross-sectional %D 2022 %7 4.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Singapore’s national digital contact-tracing (DCT) tool—TraceTogether—attained an above 70% uptake by December 2020 after a slew of measures. Sentiment analysis can help policymakers to assess public sentiments on the implementation of new policy measures in a short time, but there is a paucity of sentiment analysis studies on the usage of DCT tools. Objective: We sought to understand the public’s knowledge of, concerns with, and sentiments on the use of TraceTogether over time and their preferences for the type of TraceTogether tool. Methods: We conducted a cross-sectional survey at a large public hospital in Singapore after the COVID-19 lockdown, from July 2020 through February 2021. In total, 4097 respondents aged 21-80 years were sampled proportionately by sex and 4 age groups. The open-ended responses were processed and analyzed using natural language processing tools. We manually corrected the language and logic errors and replaced phrases with words available in the syuzhet sentiment library without altering the original meaning of the phrases. The sentiment scores were computed by summing the scores of all the tokens (phrases split into smaller units) in the phrase. Stopwords (prepositions and connectors) were removed, followed by implementing the bag-of-words model to calculate the bigram and trigram occurrence in the data set. Demographic and time filters were applied to segment the responses. Results: Respondents’ knowledge of and concerns with TraceTogether changed from a focus on contact tracing and Bluetooth activation in July-August 2020 to QR code scanning and location check-ins in January-February 2021. Younger males had the highest TraceTogether uptake (24/40, 60%), while older females had the lowest uptake (8/34, 24%) in the first half of July 2020. This trend was reversed in mid-October after the announcement on mandatory TraceTogether check-ins at public venues. Although their TraceTogether uptake increased over time, older females continued to have lower sentiment scores. The mean sentiment scores were the lowest in January 2021 when the media reported that data collected by TraceTogether were used for criminal investigations. Smartphone apps were initially preferred over tokens, but the preference for the type of TraceTogether tool equalized over time as tokens became accessible to the whole population. The sentiments on token-related comments became more positive as the preference for tokens increased. Conclusions: The public’s knowledge of and concerns with the use of a mandatory DCT tool varied with the national regulations and public communications over time with the evolution of the COVID-19 pandemic. Effective communications tailored to subpopulations and greater transparency in data handling will help allay public concerns with data misuse and improve trust in the authorities. Having alternative forms of the DCT tool can increase the uptake of and positive sentiments on DCT. %M 35120017 %R 10.2196/33314 %U https://formative.jmir.org/2022/3/e33314 %U https://doi.org/10.2196/33314 %U http://www.ncbi.nlm.nih.gov/pubmed/35120017 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 5 %N 1 %P e29250 %T Community Mental Health Clinicians’ Perspectives on Telehealth During the COVID-19 Pandemic: Mixed Methods Study %A Schriger,Simone H %A Klein,Melanie R %A Last,Briana S %A Fernandez-Marcote,Sara %A Dallard,Natalie %A Jones,Bryanna %A Beidas,Rinad S %+ Department of Psychology, University of Pennsylvania, 425 S University Ave, Stephen A Levin Building, Philadelphia, PA, 19104-6241, United States, 1 215 898 7300, schriger@sas.upenn.edu %K telehealth %K COVID-19 %K evidence-based practice %K community mental health %K trauma-focused cognitive behavioral therapy %K implementation science %K youth mental health %D 2022 %7 3.3.2022 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: In March 2020, a rapid shift to telehealth occurred in community mental health settings in response to the need for physical distancing to decrease transmission of the virus causing COVID-19. Whereas treatment delivered over telehealth was previously utilized sparingly in community settings, it quickly became the primary mode of treatment delivery for the vast majority of clinicians, many of whom had little time to prepare for this shift and limited to no experience using telehealth. Little is known about community mental health clinicians’ experiences using telehealth. Although telehealth may make mental health treatment more accessible for some clients, it may create additional barriers for others given the high rates of poverty among individuals seeking treatment from community mental health centers. Objective: We examined community mental health clinicians’ perspectives on using telehealth to deliver trauma-focused cognitive behavioral therapy to youth. We sought to better understand the acceptability of using telehealth, as well as barriers and facilitators to usage. Methods: We surveyed 45 clinicians across 15 community clinics in Philadelphia. Clinicians rated their satisfaction with telehealth using a quantitative scale and shared their perspectives on telehealth in response to open-ended questions. Therapists’ responses were coded using an open-coding approach wherein coders generated domains, themes, and subthemes. Results: Clinicians rated telehealth relatively positively on the quantitative survey, expressing overall satisfaction with their current use of telehealth during the pandemic, and endorsing telehealth as a helpful mode of connecting with clients. Responses to open-ended questions fell into five domains. Clinicians noted that (1) telehealth affects the content (ie, what is discussed) and process (ie, how it is discussed) of therapy; (2) telehealth alters engagement, retention, and attendance; (3) technology is a crucial component of utilizing telehealth; (4) training, resources, and support are needed to facilitate telehealth usage; and (5) the barriers, facilitators, and level of acceptability of telehealth differ across individual clinicians and clients. Conclusions: First, telehealth is likely a better fit for some clients and clinicians than others, and attention should be given to better understanding who is most likely to succeed using this modality. Second, although telehealth increased convenience and accessibility of treatment, clinicians noted that across the board, it was difficult to engage clients (eg, young clients were easily distracted), and further work is needed to identify better telehealth engagement strategies. Third, for many clients, the telehealth modality may actually create an additional barrier to care, as children from families living in poverty may not have the requisite devices or quality broadband connection to make telehealth workable. Better strategies to address disparities in access to and quality of digital technologies are needed to render telehealth an equitable option for all youth seeking mental health services. %M 35023839 %R 10.2196/29250 %U https://pediatrics.jmir.org/2022/1/e29250 %U https://doi.org/10.2196/29250 %U http://www.ncbi.nlm.nih.gov/pubmed/35023839 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 3 %P e24787 %T Social Media Images as an Emerging Tool to Monitor Adherence to COVID-19 Public Health Guidelines: Content Analysis %A Young,Sean D %A Zhang,Qingpeng %A Zeng,Daniel Dajun %A Zhan,Yongcheng %A Cumberland,William %+ Department of Informatics, University of California Institute for Prediction Technology, University of California, Irvine, 6091 Bren Hall, Irvine, CA, 92617, United States, 1 650 223 5448, syoung5@hs.uci.edu %K internet %K social media %K health informatics %K tool %K monitor %K adherence %K COVID-19 %K public health %K guidelines %K content analysis %K policy %D 2022 %7 3.3.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Innovative surveillance methods are needed to assess adherence to COVID-19 recommendations, especially methods that can provide near real-time or highly geographically targeted data. Use of location-based social media image data (eg, Instagram images) is one possible approach that could be explored to address this problem. Objective: We seek to evaluate whether publicly available near real-time social media images might be used to monitor COVID-19 health policy adherence. Methods: We collected a sample of 43,487 Instagram images in New York from February 7 to April 11, 2020, from the following location hashtags: #Centralpark (n=20,937), #Brooklyn Bridge (n=14,875), and #Timesquare (n=7675). After manually reviewing images for accuracy, we counted and recorded the frequency of valid daily posts at each of these hashtag locations over time, as well as rated and counted whether the individuals in the pictures at these location hashtags were social distancing (ie, whether the individuals in the images appeared to be distanced from others vs next to or touching each other). We analyzed the number of images posted over time and the correlation between trends among hashtag locations. Results: We found a statistically significant decline in the number of posts over time across all regions, with an approximate decline of 17% across each site (P<.001). We found a positive correlation between hashtags (#Centralpark and #Brooklynbridge: r=0.40; #BrooklynBridge and #Timesquare: r=0.41; and #Timesquare and #Centralpark: r=0.33; P<.001 for all correlations). The logistic regression analysis showed a mild statistically significant increase in the proportion of posts over time with people appearing to be social distancing at Central Park (P=.004) and Brooklyn Bridge (P=.02) but not for Times Square (P=.16). Conclusions: Results suggest the potential of using location-based social media image data as a method for surveillance of COVID-19 health policy adherence. Future studies should further explore the implementation and ethical issues associated with this approach. %M 34995205 %R 10.2196/24787 %U https://www.jmir.org/2022/3/e24787 %U https://doi.org/10.2196/24787 %U http://www.ncbi.nlm.nih.gov/pubmed/34995205 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 3 %P e32364 %T United States Influenza Search Patterns Since the Emergence of COVID-19: Infodemiology Study %A Cai,Owen %A Sousa-Pinto,Bernardo %+ Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Rua Plácido Costa s/n, Porto, 4200-450, Portugal, 351 225513622, bernardosousapinto@protonmail.com %K COVID-19 %K influenza %K surveillance %K media coverage %K Google Trends %K infodemiology %K monitoring %K trend %K United States %K information-seeking %K online health information %D 2022 %7 3.3.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The emergence and media coverage of COVID-19 may have affected influenza search patterns, possibly affecting influenza surveillance results using Google Trends. Objective: We aimed to investigate if the emergence of COVID-19 was associated with modifications in influenza search patterns in the United States. Methods: We retrieved US Google Trends data (relative number of searches for specified terms) for the topics influenza, Coronavirus disease 2019, and symptoms shared between influenza and COVID-19. We calculated the correlations between influenza and COVID-19 search data for a 1-year period after the first COVID-19 diagnosis in the United States (January 21, 2020 to January 20, 2021). We constructed a seasonal autoregressive integrated moving average model and compared predicted search volumes, using the 4 previous years, with Google Trends relative search volume data. We built a similar model for shared symptoms data. We also assessed correlations for the past 5 years between Google Trends influenza data, US Centers for Diseases Control and Prevention influenza-like illness data, and influenza media coverage data. Results: We observed a nonsignificant weak correlation (ρ= –0.171; P=0.23) between COVID-19 and influenza Google Trends data. Influenza search volumes for 2020-2021 distinctly deviated from values predicted by seasonal autoregressive integrated moving average models—for 6 weeks within the first 13 weeks after the first COVID-19 infection was confirmed in the United States, the observed volume of searches was higher than the upper bound of 95% confidence intervals for predicted values. Similar results were observed for shared symptoms with influenza and COVID-19 data. The correlation between Google Trends influenza data and CDC influenza-like-illness data decreased after the emergence of COVID-19 (2020-2021: ρ=0.643; 2019-2020: ρ=0.902), while the correlation between Google Trends influenza data and influenza media coverage volume remained stable (2020-2021: ρ=0.746; 2019-2020: ρ=0.707). Conclusions: Relevant differences were observed between predicted and observed influenza Google Trends data the year after the onset of the COVID-19 pandemic in the United States. Such differences are possibly due to media coverage, suggesting limitations to the use of Google Trends as a flu surveillance tool. %M 34878996 %R 10.2196/32364 %U https://publichealth.jmir.org/2022/3/e32364 %U https://doi.org/10.2196/32364 %U http://www.ncbi.nlm.nih.gov/pubmed/34878996 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 2 %N 1 %P e31813 %T Identifying the Socioeconomic, Demographic, and Political Determinants of Social Mobility and Their Effects on COVID-19 Cases and Deaths: Evidence From US Counties %A Jalali,Niloofar %A Tran,N Ken %A Sen,Anindya %A Morita,Plinio Pelegrini %+ School of Public Health and Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada, 1 5198884567 ext 31372, plinio.morita@uwaterloo.ca %K COVID-19 %K cases %K deaths %K mobility %K Google mobility data %K clustering %D 2022 %7 3.3.2022 %9 Original Paper %J JMIR Infodemiology %G English %X Background: The spread of COVID-19 at the local level is significantly impacted by population mobility. The U.S. has had extremely high per capita COVID-19 case and death rates. Efficient nonpharmaceutical interventions to control the spread of COVID-19 depend on our understanding of the determinants of public mobility. Objective: This study used publicly available Google data and machine learning to investigate population mobility across a sample of US counties. Statistical analysis was used to examine the socioeconomic, demographic, and political determinants of mobility and the corresponding patterns of per capita COVID-19 case and death rates. Methods: Daily Google population mobility data for 1085 US counties from March 1 to December 31, 2020, were clustered based on differences in mobility patterns using K-means clustering methods. Social mobility indicators (retail, grocery and pharmacy, workplace, and residence) were compared across clusters. Statistical differences in socioeconomic, demographic, and political variables between clusters were explored to identify determinants of mobility. Clusters were matched with daily per capita COVID-19 cases and deaths. Results: Our results grouped US counties into 4 Google mobility clusters. Clusters with more population mobility had a higher percentage of the population aged 65 years and over, a greater population share of Whites with less than high school and college education, a larger percentage of the population with less than a college education, a lower percentage of the population using public transit to work, and a smaller share of voters who voted for Clinton during the 2016 presidential election. Furthermore, clusters with greater population mobility experienced a sharp increase in per capita COVID-19 case and death rates from November to December 2020. Conclusions: Republican-leaning counties that are characterized by certain demographic characteristics had higher increases in social mobility and ultimately experienced a more significant incidence of COVID-19 during the latter part of 2020. %M 35287305 %R 10.2196/31813 %U https://infodemiology.jmir.org/2022/1/e31813 %U https://doi.org/10.2196/31813 %U http://www.ncbi.nlm.nih.gov/pubmed/35287305 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 5 %N 1 %P e29189 %T COVID-19 and Pregnancy: Citation Network Analysis and Evidence Synthesis %A Ruiz-Roman,Rebeca %A Martinez-Perez,Clara %A Gil Prados,Inés %A Cristóbal,Ignacio %A Sánchez-Tena,Miguel Ángel %+ Department of Gynecology and Obstetrics, Hospital Clínico San Carlos, Calle del Prof Martín Lagos, s/n, Madrid, 28040, Spain, 34 913303000, rebecaruizroman@gmail.com %K pandemic %K COVID-19 %K SARS-CoV-2 %K pregnancy %K perinatal %K citation %K bibliometric %K network analysis %K women %K maternal health %K fetal health %K research %K literature %K transmission %K delivery %K impact %D 2022 %7 3.3.2022 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: COVID-19 spread quickly around the world shortly after the first outbreaks of the new coronavirus disease at the end of December 2019, affecting all populations, including pregnant women. Objective: The aim of this study was to analyze the relationship between different publications on COVID-19 in pregnancy and their authors through citation networks, as well as to identify the research areas and to determine the publication that has been the most highly cited. Methods: The search for publications was carried out through the Web of Science database using terms such as “pregnancy,” “SARS-CoV-2,” “pregnant,” and “COVID-19” for the period between January and December 2020. Citation Network Explorer software was used for publication analysis and VOSviewer software was used to construct the figures. This approach enabled an in-depth network analysis to visualize the connections between the related elements and explain their network structure. Results: A total of 1330 publications and 5531 citation networks were identified in the search, with July being the month with the largest number of publications, and the United States, China, and England as the countries with the greatest number of publications. The most cited publication was “Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records” by Chen and colleagues, which was published in March 2020. Six groups identified as being close in the citation network reflect multidisciplinary research, including clinical characteristics and outcomes in pregnancy, vertical transmission, delivery mode, and psychological impacts of the pandemic on pregnant women. Conclusions: Thousands of articles on COVID-19 have been published in several journals since the disease first emerged. Identifying relevant publications and obtaining a global view of the main papers published on COVID-19 and pregnancy can lead to a better understanding of the topic. With the accumulation of scientific knowledge, we now know that the clinical features of COVID-19 during pregnancy are generally similar to those of infected nonpregnant women. There is a small increase in frequency of preterm birth and cesarean birth, related to severe maternal illness. Vaccination for all pregnant women is recommended. Several agents are being evaluated for the treatment of COVID-19, but with minimal or no information on safety in pregnancy. These results could form the basis for further research. Future bibliometric and scientometric studies on COVID-19 should provide updated information to analyze other relevant indicators in this field. %M 35044301 %R 10.2196/29189 %U https://pediatrics.jmir.org/2022/1/e29189 %U https://doi.org/10.2196/29189 %U http://www.ncbi.nlm.nih.gov/pubmed/35044301 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e32871 %T Informal Coping Strategies Among People Who Use Opioids During COVID-19: Thematic Analysis of Reddit Forums %A Arshonsky,Josh %A Krawczyk,Noa %A Bunting,Amanda M %A Frank,David %A Friedman,Samuel R %A Bragg,Marie A %+ Department of Population Health, New York University Grossman School of Medicine, 180 Madison Ave, New York, NY, 10016, United States, 1 646 501 2717, SeedProgramPaperSubmissions@nyulangone.org %K opioid use %K Reddit %K coping strategies %K COVID-19 %K opioid %K drug %K coping %K social media %K strategy %K content analysis %K abstain %K addiction %K data mining %K support %D 2022 %7 3.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic has transformed how people seeking to reduce opioid use access treatment services and navigate efforts to abstain from using opioids. Social distancing policies have drastically reduced access to many forms of social support, but they may have also upended some perceived barriers to reducing or abstaining from opioid use. Objective: This qualitative study aims to identify informal coping strategies for reducing and abstaining from opioid use among Reddit users who have posted in opioid-related subreddits at the beginning of the COVID-19 pandemic. Methods: We extracted data from 2 major opioid-related subreddits. Thematic data analysis was used to evaluate subreddit posts dated from March 5 to May 13, 2020, that referenced COVID-19 and opioid use, resulting in a final sample of 300 posts that were coded and analyzed. Results: Of the 300 subreddit posts, 100 (33.3%) discussed at least 1 type of informal coping strategy. Those strategies included psychological and behavioral coping skills, adoption of healthy habits, and use of substances to manage withdrawal symptoms. In addition, 12 (4%) subreddit posts explicitly mentioned using social distancing as an opportunity for cessation of or reduction in opioid use. Conclusions: Reddit discussion forums have provided a community for people to share strategies for reducing opioid use and support others during the COVID-19 pandemic. Future research needs to assess the impact of COVID-19 on opioid use behaviors, especially during periods of limited treatment access and isolation, as these can inform future efforts in curbing the opioid epidemic and other substance-related harms. %M 35084345 %R 10.2196/32871 %U https://formative.jmir.org/2022/3/e32871 %U https://doi.org/10.2196/32871 %U http://www.ncbi.nlm.nih.gov/pubmed/35084345 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e30085 %T Readability of Korean-Language COVID-19 Information from the South Korean National COVID-19 Portal Intended for the General Public: Cross-sectional Infodemiology Study %A Moon,Hana %A Lee,Geon Ho %A Cho,Yoon Jeong %+ Department of Family Medicine, Daegu Catholic University School of Medicine, 33, Duryugongwon-ro 17-gil, Nam-gu, Daegu, 42472, Republic of Korea, 82 53 650 4696, totoslee@cu.ac.kr %K COVID-19 %K health literacy %K readability %K public health %K health equity %K consumer health information %K information dissemination %K health education %K eHealth %K online %K social media %K pandemic %K infodemic %D 2022 %7 3.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The coronavirus pandemic has increased reliance on the internet as a tool for disseminating information; however, information is useful only when it can be understood. Prior research has shown that web-based health information is not always easy to understand. It is not yet known whether the Korean-language COVID-19 information from the internet is easy for the general public to understand. Objective: We aimed to evaluate the readability of Korean-language COVID-19 information intended for the general public from the national COVID-19 portal of South Korea. Methods: A total of 122 publicly available COVID-19 information documents written in Korean were obtained from the South Korean national COVID-19 portal. We determined the level of readability (at or below ninth grade, 10th to 12th grade, college, or professional) of each document using a readability tool for Korean-language text. We measured the reading time, character count, word count, sentence count, and paragraph count for each document. We also evaluated the characteristics of difficult-to-read documents to modify the readability from difficult to easy. Results: The median readability level was at a professional level; 90.2% (110/122) of the information was difficult to read. In all 4 topics, few documents were easy to read (overview: 5/12, 41.7%; prevention: 6/97, 6.2%; test: 0/5, 0%; treatment: 1/8, 12.5%; P=.006), with a median 11th-grade readability level for overview, a median professional readability level for prevention, and median college readability levels for test and treatment. Difficult-to-read information had the following characteristics in common: literacy style, medical jargon, and unnecessary detail. Conclusions: In all 4 topics, most of the Korean-language COVID-19 web-based information intended for the general public provided by the national COVID-19 portal of South Korea was difficult to read; the median readability levels exceeded the recommended ninth-grade level. Readability should be a key consideration in developing public health documents, which play an important role in disease prevention and health promotion. %M 35072633 %R 10.2196/30085 %U https://formative.jmir.org/2022/3/e30085 %U https://doi.org/10.2196/30085 %U http://www.ncbi.nlm.nih.gov/pubmed/35072633 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 3 %P e35117 %T The Efficacy of a Smartphone Game to Prevent HIV Among Young Africans: Protocol for a Randomized Controlled Trial in the Context of COVID-19 %A Mudhune,Victor %A Sabben,Gaëlle %A Ondenge,Ken %A Mbeda,Calvin %A Morales,Marissa %A Lyles,Robert H %A Arego,Judith %A Ndivo,Richard %A Bednarczyk,Robert A %A Komro,Kelli %A Winskell,Kate %+ Hubert Department of Global Health, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA, 30322, United States, 1 404 7275286, swinske@emory.edu %K HIV %K young Africans %K adolescent %K Kenya %K serious game %K game for health %K randomized controlled trial %K mHealth %K prevention %K smartphone %K teenager %K young adult %K Africa %K gaming %K COVID-19 %K efficacy %D 2022 %7 3.3.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Adolescents contribute slightly less than one-third of all new HIV infections in sub-Saharan Africa. There is a need for more effective intervention approaches to help young adolescents safely navigate through adolescence and into adulthood. We are assessing the efficacy of Tumaini, a smartphone game designed to prevent HIV among young Africans. Against the background of COVID-19, meaningful alteration of the research protocol was necessary to ensure successful implementation and retention of the study participants in ongoing research. Objective: The objective of our protocol is to determine (1) if Tumaini delays sexual debut and increases condom use at first sex and (2) whether it influences behavioral mediators of early and unprotected sex. Methods: Participants were recruited from Kisumu County in Western Kenya. This study is a 2-arm, individual-randomized controlled trial that enrolled 1004 adolescents aged between 12 years and 15 years. The intervention arm participants are playing Tumaini, while the control arm is provided with Brainilis, a commercially available control game. The study period will last 45 months. At baseline, participants in both arms completed a baseline survey and biological testing for HIV and herpes simplex virus, type 2 (HSV-2); participants will have annual game play periods in years 1-3. They will also complete a total of 12 follow-up surveys. At endline, repeat biological testing will be conducted. Protocol adaptations were necessitated by the COVID-19 pandemic and implemented in accordance with local public health guidelines. Results: Participants were enrolled between October 2020 and November 2020. We plan to complete study procedures in September 2024. The enrolled participant sample was 50.1% (499/996) female and had a mean age of 14.0 (SD 0.6) years. Conclusions: This ongoing research demonstrates that, with appropriate revisions to planned protocol activities guided by the need to maintain study integrity, protect both study participants and staff, and adhere to institutional review board and local health authority guidelines, human subject research is possible in the context of a global pandemic. If the trial demonstrates efficacy, Tumaini would provide an alternative, remote means of delivering age-appropriate education to adolescents on safer sex, HIV prevention, and effective life skills on a highly scalable, low-cost, and culturally adaptable platform. Trial Registration: ClinicalTrials.gov NCT04437667; https://clinicaltrials.gov/ct2/show/NCT04437667 International Registered Report Identifier (IRRID): DERR1-10.2196/35117 %M 35030090 %R 10.2196/35117 %U https://www.researchprotocols.org/2022/3/e35117 %U https://doi.org/10.2196/35117 %U http://www.ncbi.nlm.nih.gov/pubmed/35030090 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 3 %P e34831 %T The Challenge of Debunking Health Misinformation in Dynamic Social Media Conversations: Online Randomized Study of Public Masking During COVID-19 %A Mourali,Mehdi %A Drake,Carly %+ Haskayne School of Business, University of Calgary, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada, 1 403 220 6684, mehdi.mourali@haskayne.ucalgary.ca %K misinformation %K debunking %K correction %K social media %K truth objectivity %K COVID-19 %K infodemiology %K health information %K digital health %K public health %K health professional %D 2022 %7 2.3.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: The spread of false and misleading health information on social media can cause individual and social harm. Research on debunking has shown that properly designed corrections can mitigate the impact of misinformation, but little is known about the impact of correction in the context of prolonged social media debates. For example, when a social media user takes to Facebook to make a false claim about a health-related practice and a health expert subsequently refutes the claim, the conversation rarely ends there. Often, the social media user proceeds by rebuking the critic and doubling down on the claim. Objective: The aim of this study was to examine the impact of such extended back and forth between false claims and debunking attempts on observers’ dispositions toward behavior that science favors. We tested competing predictions about the effect of extended exposure on people’s attitudes and intentions toward masking in public during the early days of the COVID-19 pandemic and explored several psychological processes potentially underlying this effect. Methods: A total of 500 US residents took part in an online experiment in October 2020. They reported on their attitudes and intentions toward wearing masks in public. They were then randomly assigned to one of four social media exposure conditions (misinformation only vs misinformation+correction vs misinformation+correction+rebuke vs misinformation+correction+rebuke+second correction), and reported their attitudes and intentions for a second time. They also indicated whether they would consider sharing the thread if they were to see it on social media and answered questions on potential mediators and covariates. Results: Exposure to misinformation had a negative impact on attitudes and intentions toward masking (β=–.35, 95% CI –.42 to –.29; P<.001). Moreover, initial debunking of a false claim generally improved attitudes and intentions toward masking (β=.35, 95% CI .16 to .54; P<.001). However, this improvement was washed out by further exposure to false claims and debunking attempts (β=–.53, 95% CI –.72 to –.34; P<.001). The latter result is partially explained by a decrease in the perceived objectivity of truth. That is, extended exposure to false claims and debunking attempts appear to weaken the belief that there is an objectively correct answer to how people ought to behave in this situation, which in turn leads to less positive reactions toward masking as the prescribed behavior. Conclusions: Health professionals and science advocates face an underappreciated challenge in attempting to debunk misinformation on social media. Although engaging in extended debates with science deniers and other purveyors of bunk appears necessary, more research is needed to address the unintended consequences of such engagement. %M 35156933 %R 10.2196/34831 %U https://www.jmir.org/2022/3/e34831 %U https://doi.org/10.2196/34831 %U http://www.ncbi.nlm.nih.gov/pubmed/35156933 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 3 %P e34870 %T The Unclear Role of the Physician on Social Media During the COVID-19 Pandemic. Comment on “Emergency Physician Twitter Use in the COVID-19 Pandemic as a Potential Predictor of Impending Surge: Retrospective Observational Study” %A MacLeod,Spencer %A Singh,Nikhi Paul %A Boyd,Carter Joseph %+ School of Medicine, The University of Alabama at Birmingham, 1670 University Blvd, Birmingham, AL, 35233, United States, 1 205 563 3208, nsingh@uab.edu %K COVID-19 pandemic %K emergency medicine %K disaster medicine %K crisis standards of care %K latent Dirichlet allocation %K topic modeling %K Twitter %K sentiment analysis %K surge capacity %K physician wellness %K social media %K internet %K infodemiology %K COVID-19 %D 2022 %7 2.3.2022 %9 Letter to the Editor %J J Med Internet Res %G English %X   %M 35120018 %R 10.2196/34870 %U https://www.jmir.org/2022/3/e34870 %U https://doi.org/10.2196/34870 %U http://www.ncbi.nlm.nih.gov/pubmed/35120018 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e31992 %T Psychometric Evaluation of a Fear of COVID-19 Scale in China: Cross-sectional Study %A Choi,Edmond P H %A Duan,Wenjie %A Fong,Daniel Y T %A Lok,Kris Y W %A Ho,Mandy %A Wong,Janet Y H %A Lin,Chia-Chin %+ School of Nursing, The University of Hong Kong, 21 Sassoon Road, Pokfulam, Hong Kong, China (Hong Kong), 852 39176645, dytfong@hku.hk %K Chinese %K COVID-19 %K fear %K psychometric %K validation %K scale %K mental health %K information %K cross-sectional %K validity %K reliability %K support %D 2022 %7 2.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: At the very beginning of the COVID-19 pandemic, information about fear of COVID-19 was very limited in Chinese populations, and there was no standardized and validated scale to measure the fear associated with the pandemic. Objective: This cross-sectional study aimed to adapt and validate a fear scale to determine the levels of fear of COVID-19 among the general population in mainland China and Hong Kong. Methods: A web-based questionnaire platform was developed for data collection; the study instruments were an adapted version of the 8-item Breast Cancer Fear Scale (“Fear Scale”) and the 4-item Patient Health Questionnaire. The internal construct validity, convergent validity, known group validity, and reliability of the adapted Fear Scale were assessed, and descriptive statistics were used to summarize the participants’ fear levels. Results: A total of 2822 study participants aged 18 years or older were included in the analysis. The reliability of the adapted scale was satisfactory, with a Cronbach α coefficient of .93. The item-total correlations corrected for overlap were >0.4, confirming their internal construct validity. Regarding convergent validity, a small-to-moderate correlation between the Fear Scale and the 4-item Patient Health Questionnaire scores was found. Regarding known group validity, we found that the study participants who were recruited from Hong Kong had a higher level of fear than the study participants from mainland China. Older adults had a higher level of fear compared with younger adults. Furthermore, having hypertension, liver disease, heart disease, cancer, anxiety, and insomnia were associated with a higher fear level. The descriptive analysis found that more than 40% of the study participants reported that the thought of COVID-19 scared them. About one-third of the study participants reported that when they thought about COVID-19, they felt nervous, uneasy, and depressed. Conclusions: The psychometric properties of the adapted Fear Scale are acceptable to measure the fear of COVID-19 among Chinese people. Our study stresses the need for more psychosocial support and care to help this population cope with their fears during the pandemic. %M 35072632 %R 10.2196/31992 %U https://formative.jmir.org/2022/3/e31992 %U https://doi.org/10.2196/31992 %U http://www.ncbi.nlm.nih.gov/pubmed/35072632 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 2 %P e30397 %T Monitoring COVID-19 on Social Media: Development of an End-to-End Natural Language Processing Pipeline Using a Novel Triage and Diagnosis Approach %A Hasan,Abul %A Levene,Mark %A Weston,David %A Fromson,Renate %A Koslover,Nicolas %A Levene,Tamara %+ Department of Computer Science and Information Systems, Birkbeck, University of London, Malet Street, Bloomsbury, London, WC1E 7HX, United Kingdom, 44 020 7631 8147, abulhasan@dcs.bbk.ac.uk %K COVID-19 %K conditional random fields %K disease detection and surveillance %K medical social media %K natural language processing %K severity and prevalence %K support vector machines %K triage and diagnosis %D 2022 %7 28.2.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic has created a pressing need for integrating information from disparate sources in order to assist decision makers. Social media is important in this respect; however, to make sense of the textual information it provides and be able to automate the processing of large amounts of data, natural language processing methods are needed. Social media posts are often noisy, yet they may provide valuable insights regarding the severity and prevalence of the disease in the population. Here, we adopt a triage and diagnosis approach to analyzing social media posts using machine learning techniques for the purpose of disease detection and surveillance. We thus obtain useful prevalence and incidence statistics to identify disease symptoms and their severities, motivated by public health concerns. Objective: This study aims to develop an end-to-end natural language processing pipeline for triage and diagnosis of COVID-19 from patient-authored social media posts in order to provide researchers and public health practitioners with additional information on the symptoms, severity, and prevalence of the disease rather than to provide an actionable decision at the individual level. Methods: The text processing pipeline first extracted COVID-19 symptoms and related concepts, such as severity, duration, negations, and body parts, from patients’ posts using conditional random fields. An unsupervised rule-based algorithm was then applied to establish relations between concepts in the next step of the pipeline. The extracted concepts and relations were subsequently used to construct 2 different vector representations of each post. These vectors were separately applied to build support vector machine learning models to triage patients into 3 categories and diagnose them for COVID-19. Results: We reported macro- and microaveraged F1 scores in the range of 71%-96% and 61%-87%, respectively, for the triage and diagnosis of COVID-19 when the models were trained on human-labeled data. Our experimental results indicated that similar performance can be achieved when the models are trained using predicted labels from concept extraction and rule-based classifiers, thus yielding end-to-end machine learning. In addition, we highlighted important features uncovered by our diagnostic machine learning models and compared them with the most frequent symptoms revealed in another COVID-19 data set. In particular, we found that the most important features are not always the most frequent ones. Conclusions: Our preliminary results show that it is possible to automatically triage and diagnose patients for COVID-19 from social media natural language narratives, using a machine learning pipeline in order to provide information on the severity and prevalence of the disease for use within health surveillance systems. %M 35142636 %R 10.2196/30397 %U https://www.jmir.org/2022/2/e30397 %U https://doi.org/10.2196/30397 %U http://www.ncbi.nlm.nih.gov/pubmed/35142636 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 2 %P e29519 %T Telehealth Before and During the COVID-19 Pandemic: Analysis of Health Care Workers' Opinions %A Nitiema,Pascal %+ Division of Management Information Systems, Price College of Business, University of Oklahoma, 307 W Brooks Suite 307, Norman, OK, 73019, United States, 1 4053255721, pascal.nitiema-1@ou.edu %K telehealth %K telemedicine %K COVID-19 %K pandemic %K physical examination %K sentiment score %K structural topic modeling %K opinion %K health care worker %K social media %K discussion %D 2022 %7 25.2.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic and the lockdowns for controlling the spread of infection have led to a surge in telehealth adoption by many health care organizations. It is unclear how this pandemic has impacted health professionals’ view about telehealth. The analysis of textual data, such as comments posted on a discussion forum, can uncover information that may not be captured by a structured survey. Objective: This study aims to examine the opinions of health care workers about telehealth services during the time frame of March 2013-December 2020. Methods: Comments about telehealth posted by health care workers from at least 46 countries were collected from an online discussion forum dedicated to health professionals. The analysis included the computation of sentiment scores from the textual data and the use of structural topic modeling to identify the topics of discussions as well as the factors that may be associated with the prevalence of these topics. Results: The analysis of the comments revealed positive opinions about the perceived benefits of telehealth services before and during the pandemic, especially the ability to reach patients who cannot come to the health facility for diverse reasons. However, opinions about these benefits were less positive during the pandemic compared to the prepandemic period. Specific issues raised during the pandemic included technical difficulties encountered during telehealth sessions and the inability to perform certain care routines through telehealth platforms. Although comments on the quality of care provided through telehealth were associated with a negative sentiment score overall, the average score was less negative during the pandemic compared to the prepandemic period, signaling a shift in opinion about the quality of telehealth services. In addition, the analysis uncovered obstacles to the adoption of telehealth, including the absence of adequate legal dispositions for telehealth services and issues regarding the payment of these services by health insurance organizations. Conclusions: Enhancing the adoption of telehealth services beyond the pandemic requires addressing issues related to the quality of care, payment of services, and legal dispositions for delivering these services. %M 34978532 %R 10.2196/29519 %U https://www.jmir.org/2022/2/e29519 %U https://doi.org/10.2196/29519 %U http://www.ncbi.nlm.nih.gov/pubmed/34978532 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 2 %N 1 %P e33029 %T The Moderating Role of Community Capacity for Age-friendly Communication in Mitigating Anxiety of Older Adults During the COVID-19 Infodemic: Cross-sectional Survey %A Wong,Frankie Ho Chun %A Leung,Dara Kiu Yi %A Wong,Edwin Lok Yan %A Liu,Tianyin %A Lu,Shiyu %A Chan,On Fung %A Wong,Gloria Hoi Yan %A Lum,Terry Yat Sang %+ Department of Social Work and Social Administration, The University of Hong Kong, CJT-514, The Jockey Club Tower, Centennial Campus, Hong Kong, China (Hong Kong), 852 39178569, tlum@hku.hk %K COVID-19 %K mental health %K information technology %K media trust %K social media %K Hong Kong %D 2022 %7 25.2.2022 %9 Original Paper %J JMIR Infodemiology %G English %X Background: Older adults were perceived as a vulnerable group during the COVID-19 pandemic due to the health and mental health challenges they faced. The pandemic was accompanied by an “infodemic” of overabundant and questionable information that has affected older adults’ mental health. As the infodemic and ageist narratives were prevalent online, more anxiety symptoms have been induced among older adults who used social media. Age-friendly communication, advocated by the World Health Organization’s Age-friendly City (AFC) guide, could be an antidote by providing tailored information via appropriate channels for older adults. Objective: This study investigated the role of community capacity for age-friendly communication in mitigating anxiety during the pandemic. We hypothesized that age-friendly communication would moderate the effects of infection risks and social media use on anxiety. A double-moderating effect was hypothesized in the context of diminished trust in traditional media. Methods: Data were collected from a cross-sectional telephone survey conducted in Hong Kong in 2020. Older adults (N=3421, age≥60 years) were interviewed about their well-being and daily lives. Community capacity for age-friendly communication was measured in a living district–based evaluation. It had 2 components: the reach of appropriate information to older adults (AFC-Information) and the age-friendliness of communication technologies (AFC-Communication Technology) in the community. We tested the hypothesized moderation and double-moderation effects with ordinary least squares regressions. Results: Perceived COVID-19 infection risk (b=0.002, P=.02) and use of social media for COVID-19 information (b=0.08, P=.04) were associated with more anxiety symptoms. The effect of using social media was moderated by AFC-Information (b=–0.39, P=.002) and AFC-Communication Technology (b=–1.06, P<.001), and the effect of perceived COVID-19 infection risk was moderated by AFC-Information (b=–0.03, P=.002) and AFC-Communication Technology (b=–0.05, P<.001). Lower trust in traditional media exacerbated anxiety symptoms associated with social media use (b=–0.08, P=.02). Higher AFC-Information alleviated this moderation effect (AFC-Information × media trust b=–0.65, P<.001; AFC-Information × social media use b=–2.18, P<.001; 3-way interaction b=0.40, P=.003). Conclusions: Our findings highlight the role of community age-friendly communication in mitigating anxiety related to the infodemic. Although using social media may have exacerbated the impact of the infodemic on older adults, it has the potential to deliver timely information for an adequate health response. Although the amplifying effects of low media trust was associated with social media use, age-friendly communication determined its strength. Instead of discouraging the use of digital technologies for COVID-19 information, efforts should be made in tailoring information and communication technologies in local communities for older adults. %M 35257090 %R 10.2196/33029 %U https://infodemiology.jmir.org/2022/1/e33029 %U https://doi.org/10.2196/33029 %U http://www.ncbi.nlm.nih.gov/pubmed/35257090 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 5 %N 1 %P e32274 %T Changes in Use of a Leisure Activity Mobile App for Children With Disabilities During the COVID-19 Pandemic: Retrospective Study %A Yoo,Paul Yejong %A Movahed,Mehrnoosh %A Rue,Ishana %A Santos,Carlos Denner Dos %A Majnemer,Annette %A Shikako,Keiko %+ Faculty of Medicine and Health Sciences, McGill University, 3654 prom Sir-William-Osler, Montreal, QC, H3G 1Y5, Canada, 1 514 398 4400 ext 0802, keiko.thomas@mcgill.ca %K COVID-19 %K participation %K childhood disability %K online leisure %K app engagement %K mHealth %K children %K parents %K mobile apps %K mobile health %K digital health %K pandemic %K online leisure activities %K user engagement %K app usability %D 2022 %7 25.2.2022 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Participation in leisure activities is essential for child development and a human right as per the United Nations Convention on the Rights of the Child. Children with disabilities face several restrictions when participating in leisure activities as compared to same age peers without disabilities. Access to information about accessible, inclusive leisure activities is one of the barriers limiting participation, and one potential health promotion strategy is to provide access to information to increase participation. The Jooay App is a mobile app listing such activities in Canada and Australia. With the COVID-19 global pandemic and subsequent public health measures, most community-based facilities providing the activities listed on Jooay were closed. The app therefore started listing online activities offered with the expectation of continuing to provide information for families and understanding the extent to which users relied on the mobile app as a tool to identify new safe leisure opportunities. Objective: This study aims to describe the engagement of the Jooay app before and during COVID-19, and to estimate the extent to which the listing of online activities was related to the engagement of the Jooay app. Methods: We conducted a retrospective study comparing Jooay app use between March 2020 and February 2021 to the engagement between March 2019 and February 2020 by Jooay users. Spearman rank correlations were carried out to identify associations between the activities listed and the users’ engagement from May 2020 to February 2021. Results: Active engagement with the Jooay app from March 2020 to February 2021 dropped by an average of 135 engagements (64.2%) compared to engagements in 2019-2020. The largest monthly drop in engagement was observed in May 2020 by 239 engagements (88.8%). There was a strong positive correlation between the number of active users and the number of online activities listed on the app (rs=0.900). Conclusions: The engagement with the Jooay App presented an expected decrease during the first wave of the COVID-19 pandemic. The addition of online adapted leisure activities to the app’s listings during the pandemic increased app use. Access to information about inclusive activities is a barrier for children with disabilities to engage in leisure. Mobile health solutions can be responsive to contextual factors and consider the social determinants of health such as socioeconomic and public health emergency issues that can impact the participation of vulnerable populations such as children with disabilities and help eliminate barriers to participation. The provision of online leisure opportunities during the pandemic could facilitate participation in these activities during the pandemic and beyond, which is essential and beneficial for the physical and mental well-being of children with disabilities and their families. %M 35100129 %R 10.2196/32274 %U https://pediatrics.jmir.org/2022/1/e32274 %U https://doi.org/10.2196/32274 %U http://www.ncbi.nlm.nih.gov/pubmed/35100129 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 2 %P e35776 %T A Brief, Daily, Online Mental Health and Well-being Intervention for University Staff During the COVID-19 Pandemic: Program Description and Outcomes Using a Mixed Methods Design %A Parker,Alexandra %A Dash,Sarah %A Bourke,Matthew %A Patten,Rhiannon %A Craike,Melinda %A Baldwin,Peter %A Hosking,Warwick %A Levinger,Itamar %A Apostolopoulos,Vasso %A de Courten,Maximilian %A Sharples,Jenny %A Naslund,Monika %A Stavropoulos,Vasileios %A Woessner,Mary %A Sonn,Christopher %A Stansen,Caroline %A Pascoe,Michaela %+ Institute for Health and Sport, Victoria University, Ballarat Road, Melbourne, 3011, Australia, 61 399195874, alex.parker@vu.edu.au %K workplace mental health %K well-being %K mental health promotion %K online intervention %K telehealth %K COVID-19 pandemic %K COVID-19 %K pandemic %K health promotion %D 2022 %7 25.2.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The unprecedented changes and isolation measures to contain COVID-19 have had multiple psychological and social impacts, with implications for professional and personal functioning. Evidence-informed interventions that can be rapidly implemented under pandemic conditions to support mental health during such times are urgently needed. Objective: The aim of this study was to determine the acceptability and preliminary outcomes of a daily online mental health promotion program for tertiary education staff during the COVID-19 pandemic. Methods: The “Victoria University (VU) Elevenses” program was delivered as an uncontrolled intervention at Victoria University (VU) in the western metropolitan region of Melbourne, Australia. In April 2020, an email invitation was sent to all academic and professional staff inviting them to: (1) participate in the program and (2) opt-in to the research component. The “VU Elevenses” program provided 10-15–minute microinterventions comprising lifestyle and well-being strategies to promote mental health via an online meeting platform at 11 AM each weekday. A mixed methods approach was used to evaluate the program, combining structured questionnaires with semistructured interviews to investigate the experiences of staff who participated in the program. Results: Between 16 and 90 participants provided weekly program feedback. A total of 106 university staff opted into the longitudinal research component and 10 staff participated in the interviews. Participants reported high levels of satisfaction with sessions and perceived benefits for mental health. Approximately one quarter of participants reported moderate to severe symptoms of depression, anxiety, and stress at baseline, with significant reductions in these symptoms in the first 7 weeks of the program, corresponding with easing in mandatory isolation (“lockdown”) restrictions. Symptoms of depression, anxiety, and stress all increased when lockdown measures were reintroduced, but not to the same levels as found during the initial lockdown period. Overall changes in depression and anxiety from baseline to the end of the program were explained by changes in COVID-19–related distress, whereas changes in self-compassion explained changes in stress. Conclusions: We show that it is feasible and acceptable to develop and deliver a program of brief interventions in a timely manner, using a simple and accessible online platform. Although participation in the program was initially associated with reduced symptoms of depression, anxiety, and stress, participants’ mental health worsened with the reintroduction of a “lockdown” period. However, as symptoms of depression, anxiety, and stress did not return to levels observed at the start of the VU Elevenses program, participation in the uncontrolled intervention may have offered a protective benefit against the impact of the second significant lockdown period. %M 35044304 %R 10.2196/35776 %U https://formative.jmir.org/2022/2/e35776 %U https://doi.org/10.2196/35776 %U http://www.ncbi.nlm.nih.gov/pubmed/35044304 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 2 %P e31533 %T Use of Social Networks in the Context of the Dietitian’s Practice in Brazil and Changes During the COVID-19 Pandemic: Exploratory Study %A Sbardelotto,Jackson %A Martins,Bárbara Birck %A Buss,Caroline %+ Department of Nutrition, Graduate Study Program in Health Sciences, Federal University of Health Sciences of Porto Alegre, R. Sarmento Leite, 245, Porto Alegre, 90050-170, Brazil, 55 513303 8830, carolinebuss@ufcspa.edu.br %K dietitian %K social networks %K nutrition %K health communication %K COVID-19 %K social media %K Brazil %K perception %K health information %K usage %K behavior %D 2022 %7 25.2.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Social networks have been pointed out as 1 of the greatest means of spreading information. A large part of the population is already present on these platforms, looking up subjects such as health, nutrition, and food. To reach this audience, it may be important for dietitians to explore social networks. However, there is a gap in scientific studies on exploring the ways in which these platforms are used by dietitians in Brazil, and the roles they play in the profession have not been well defined. Objective: This study aims to describe the roles that social networks play in dietitians' practice in Brazil and their mode of use of social networks. This study also aims to identify professionals’ perceptions and opinions regarding the use of these tools, as well as changes in behavior on social network usage caused by the COVID-19 pandemic. Methods: We carried out a quantitative cross-sectional study, collecting data through an online questionnaire, submitted between October 2020 and January 2021 to dietitians registered on the Federal Council of Dietitians. All participants included in the study answered questions about the use of social networks in their professional context. Results: In total, 264 (91.7%) of the 288 participants reported using social networks for professional practice. Instagram was the social network most often used by professionals (224/264, 84.8%). Dietitians (N=288) related to the use of social networks (always to almost always) for sharing information about their services (n=114-72 [39.6%-25%], respectively), following the work of other dietitians (n=172-64 [59.7%-22.2%], respectively), and writing about topics related to food and nutrition (n=166-53 [57.6%-18.4%], respectively). The roles played by social networks in the professional context of dietitians were attracting more clients (210/289, 72.7%) and keeping in touch with them (195/289, 67.5%). Furthermore, 227 (78.5%) of the 289 dietitians strongly agreed that social networks are good tools to promote their services. During the COVID-19 pandemic, 216 (74.7%) of the 289 participants noticed changes in their behavior, feelings, or beliefs on the use of social networks related to professional practice, and 149 (51.6%) have increased the frequency of sharing information about nutrition and health in general on social networks. Conclusions: The main roles of social networks in the professional context of dietitians are to attract clients and to facilitate the contact between professional and client. The modes of use reported by the professionals included sharing information about their services, following the work of professional colleagues, and writing about topics related to nutrition. Most of them reported believing that social networks are an effective way to disseminate their services. Moreover, most professionals claimed to have noticed changes in their behaviors or beliefs on social media during the COVID-19 pandemic. %M 35023837 %R 10.2196/31533 %U https://formative.jmir.org/2022/2/e31533 %U https://doi.org/10.2196/31533 %U http://www.ncbi.nlm.nih.gov/pubmed/35023837 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 2 %P e28737 %T COVID-19 Surveillance Updates in US Metropolitan Areas: Dynamic Panel Data Modeling %A Oehmke,Theresa B %A Moss,Charles B %A Oehmke,James F %+ Department of Civil and Environmental Engineering, University of California, Berkeley, 202 O'Brien Hall, Berkeley, CA, 94720, United States, 1 5108986406, toehmke@berkeley.edu %K surveillance system %K COVID-19 %K coronavirus %K Sars-CoV-2 %K Houston %K dynamic panel data model %K speed %K jerk %K acceleration %K 7-Day persistence %K modeling %K data %K surveillance %K monitoring %K public health %K United States %K transmission %K response %D 2022 %7 24.2.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Despite the availability of vaccines, the US incidence of new COVID-19 cases per day nearly doubled from the beginning of July to the end of August 2021, fueled largely by the rapid spread of the Delta variant. While the “Delta wave” appears to have peaked nationally, some states and municipalities continue to see elevated numbers of new cases. Vigilant surveillance including at a metropolitan level can help identify any reignition and validate continued and strong public health policy responses in problem localities. Objective: This surveillance report aimed to provide up-to-date information for the 25 largest US metropolitan areas about the rapidity of descent in the number of new cases following the Delta wave peak, as well as any potential reignition of the pandemic associated with declining vaccine effectiveness over time, new variants, or other factors. Methods: COVID-19 pandemic dynamics for the 25 largest US metropolitan areas were analyzed through September 19, 2021, using novel metrics of speed, acceleration, jerk, and 7-day persistence, calculated from the observed data on the cumulative number of cases as reported by USAFacts. Statistical analysis was conducted using dynamic panel data models estimated with the Arellano-Bond regression techniques. The results are presented in tabular and graphic forms for visual interpretation. Results: On average, speed in the 25 largest US metropolitan areas declined from 34 new cases per day per 100,000 population, during the week ending August 15, 2021, to 29 new cases per day per 100,000 population, during the week ending September 19, 2021. This average masks important differences across metropolitan areas. For example, Miami’s speed decreased from 105 for the week ending August 15, 2021, to 40 for the week ending September 19, 2021. Los Angeles, San Francisco, Riverside, and San Diego had decreasing speed over the sample period and ended with single-digit speeds for the week ending September 19, 2021. However, Boston, Washington DC, Detroit, Minneapolis, Denver, and Charlotte all had their highest speed of the sample during the week ending September 19, 2021. These cities, as well as Houston and Baltimore, had positive acceleration for the week ending September 19, 2021. Conclusions: There is great variation in epidemiological curves across US metropolitan areas, including increasing numbers of new cases in 8 of the largest 25 metropolitan areas for the week ending September 19, 2021. These trends, including the possibility of waning vaccine effectiveness and the emergence of resistant variants, strongly indicate the need for continued surveillance and perhaps a return to more restrictive public health guidelines for some areas. %M 34882569 %R 10.2196/28737 %U https://publichealth.jmir.org/2022/2/e28737 %U https://doi.org/10.2196/28737 %U http://www.ncbi.nlm.nih.gov/pubmed/34882569 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 2 %P e33704 %T The Impact of Long COVID-19 on Mental Health: Observational 6-Month Follow-Up Study %A Houben-Wilke,Sarah %A Goërtz,Yvonne MJ %A Delbressine,Jeannet M %A Vaes,Anouk W %A Meys,Roy %A Machado,Felipe VC %A van Herck,Maarten %A Burtin,Chris %A Posthuma,Rein %A Franssen,Frits ME %A Vijlbrief,Herman %A Spies,Yvonne %A van 't Hul,Alex J %A Spruit,Martijn A %A Janssen,Daisy JA %+ Department of Research and Education, Ciro, Hornerheide 1, Horn, 6085 NM, Netherlands, 31 475587602, sarahwilke@ciro-horn.nl %K SARS-CoV-2 %K corona %K COVID-19 %K post-traumatic stress disorder %K anxiety %K depression %K PASC %D 2022 %7 24.2.2022 %9 Original Paper %J JMIR Ment Health %G English %X Background: The psychological impact of COVID-19 can be substantial. However, knowledge about long-term psychological outcomes in patients with COVID-19 is scarce. Objective: In this longitudinal, observational study, we aimed to reveal symptoms of posttraumatic stress disorder (PTSD) and symptoms of anxiety and depression up to 6 months after the onset of COVID-19–related symptoms in patients with confirmed COVID-19 and persistent complaints. To demonstrate the impact in nonhospitalized patients, we further aimed to compare these outcomes between nonhospitalized and hospitalized patients. Methods: Demographics, symptoms of PTSD (Trauma Screening Questionnaire [TSQ] ≥6 points) and symptoms of anxiety and depression (Hospital Anxiety and Depression Scale [HADS] ≥8 points) were assessed at 3 and 6 months after the onset of COVID-19–related symptoms in members of online long COVID-19 peer support groups. Results: Data from 239 patients with confirmed COVID-19 (198/239, 82.8% female; median age: 50 [IQR 39-56] years) were analyzed. At the 3-month follow-up, 37.2% (89/239) of the patients had symptoms of PTSD, 35.6% (85/239) had symptoms of anxiety, and 46.9% (112/239) had symptoms of depression, which remained high at the 6-month follow-up (64/239, 26.8%, P=.001; 83/239, 34.7%, P=.90; 97/239, 40.6%, P=.08, respectively; versus the 3-month follow-up). TSQ scores and HADS anxiety and depression scores were strongly correlated at the 3- and 6-month follow-ups (r=0.63-0.71, P<.001). Symptoms of PTSD, anxiety, and depression were comparable between hospitalized (n=62) and nonhospitalized (n=177) patients. Conclusions: A substantial percentage of patients with confirmed COVID-19 and persistent complaints reported symptoms of PTSD, anxiety, or depression 3 and 6 months after the onset of COVID-19–related symptoms. The prevalence rates of symptoms of PTSD, anxiety, and depression were comparable between hospitalized and nonhospitalized patients and merely improved over time. Health care professionals need to be aware of these psychological complications and intervene on time in post-COVID-19 patients with persistent complaints. Trial Registration: Netherlands Trial Register NTR8705; https://www.trialregister.nl/trial/8705. %M 35200155 %R 10.2196/33704 %U https://mental.jmir.org/2022/2/e33704 %U https://doi.org/10.2196/33704 %U http://www.ncbi.nlm.nih.gov/pubmed/35200155 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 2 %N 1 %P e31793 %T (Mis)Information on Digital Platforms: Quantitative and Qualitative Analysis of Content From Twitter and Sina Weibo in the COVID-19 Pandemic %A Kreps,Sarah %A George,Julie %A Watson,Noah %A Cai,Gloria %A Ding,Keyi %+ Department of Government, Cornell University, 313 White Hall, Ithaca, NY, 14853, United States, 1 703 403 6550, sarah.kreps@cornell.edu %K internet %K social media %K misinformation %K COVID-19 %K Twitter %K Weibo %K prevalence %K discourse %K content %K communication %K public health %K context %K content analysis %D 2022 %7 24.2.2022 %9 Original Paper %J JMIR Infodemiology %G English %X Background: Misinformation about COVID-19 on social media has presented challenges to public health authorities during the pandemic. This paper leverages qualitative and quantitative content analysis on cross-platform, cross-national discourse and misinformation in the context of COVID-19. Specifically, we investigated COVID-19-related content on Twitter and Sina Weibo—the largest microblogging sites in the United States and China, respectively. Objective: Using data from 2 prominent microblogging platform, Twitter, based in the United States, and Sina Weibo, based in China, we compared the content and relative prevalence of misinformation to better understand public discourse of public health issues across social media and cultural contexts. Methods: A total of 3,579,575 posts were scraped from both Sina Weibo and Twitter, focusing on content from January 30, 2020, within 24 hours of when WHO declared COVID-19 a “public health emergency of international concern,” and a week later, on February 6, 2020. We examined how the use and engagement measured by keyword frequencies and hashtags differ across the 2 platforms. A 1% random sample of tweets that contained both the English keywords “coronavirus” and “covid-19” and the equivalent Chinese characters was extracted and analyzed based on changes in the frequencies of keywords and hashtags and the Viterbi algorithm. We manually coded a random selection of 5%-7% of the content to identify misinformation on each platform and compared posts using the WHO fact-check page to adjudicate accuracy of content. Results: Both platforms posted about the outbreak and transmission, but posts on Sina Weibo were less likely to reference topics such as WHO, Hong Kong, and death and more likely to cite themes of resisting, fighting, and cheering against coronavirus. Misinformation constituted 1.1% of Twitter content and 0.3% of Sina Weibo content—almost 4 times as much on Twitter compared to Sina Weibo. Conclusions: Quantitative and qualitative analysis of content on both platforms points to lower degrees of misinformation, more content designed to bolster morale, and less reference to topics such as WHO, death, and Hong Kong on Sina Weibo than on Twitter. %M 36406147 %R 10.2196/31793 %U https://infodemiology.jmir.org/2022/1/e31793 %U https://doi.org/10.2196/31793 %U http://www.ncbi.nlm.nih.gov/pubmed/36406147 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 8 %N 1 %P e34895 %T Clinicians’ Perceptions of the Benefits and Challenges of Teleoncology as Experienced Through the COVID-19 Pandemic: Qualitative Study %A Alpert,Jordan M %A Taylor,Greenberry %A Hampton,Chelsea N %A Paige,Samantha %A Markham,Merry Jennifer %A Bylund,Carma L %+ College of Journalism and Communications, University of Florida, 2093 Weimer Hall, 1885 Stadium Road, Gainesville, FL, 32611, United States, 1 3523920453, jordan.alpert@ufl.edu %K teleoncology %K telemedicine %K qualitative %K COVID-19 %K telehealth %K cancer care %K cancer %K oncology %K digital health %K pandemic %D 2022 %7 24.2.2022 %9 Original Paper %J JMIR Cancer %G English %X Background: COVID-19 thrust both patients and clinicians to use telemedicine in place of traditional in-person visits. Prepandemic, limited research had examined clinician-patient communication in telemedicine visits. The shift to telemedicine in oncology, or teleoncology, has placed attention on how the technology can be utilized to provide care for patients with cancer. Objective: Our objective was to describe oncology clinicians’ experiences with teleoncology and to uncover its benefits and challenges during the first 10 months of the COVID-19 pandemic. Methods: In-depth, semistructured qualitative interviews were conducted with oncology clinicians. Using an inductive, thematic approach, the most prevalent themes were identified. Results: In total, 21 interviews with oncology clinicians revealed the following themes: benefits of teleoncology, such as (1) reducing patients’ travel time and expenses, (2) limiting COVID-19 exposure, and (3) enabling clinicians to “see” a patients’ lifestyle and environment, and challenges, such as (1) technological connection difficulties, (2) inability to physically examine patients, and (3) patients’ frustration related to clinicians being late to teleoncology appointments. Conclusions: Teleoncology has many benefits and is well suited for specific types of appointments. Challenges could be addressed through improved communication when scheduling appointments to make patients aware about what to expect. Ensuring patients have the proper technology to participate in teleoncology and an understanding about how it functions are necessary. %M 35142622 %R 10.2196/34895 %U https://cancer.jmir.org/2022/1/e34895 %U https://doi.org/10.2196/34895 %U http://www.ncbi.nlm.nih.gov/pubmed/35142622 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 8 %N 1 %P e34392 %T Cancer Screening Recommendations During the COVID-19 Pandemic: Scoping Review %A Shah,Sumit K %A McElfish,Pearl A %+ College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 N College Avenue, Fayetteville, AR, 72703, United States, 1 (479) 713 8680, pamcelfish@uams.edu %K COVID-19 %K cancer prevention and early detection %K cancer screenings %K breast cancer screening %K cervical cancer screening %K colorectal cancer screening %D 2022 %7 24.2.2022 %9 Review %J JMIR Cancer %G English %X Background: Cancer screening tests are recommended to prevent cancer-associated mortality by detecting precancerous and cancerous lesions in early stages. The COVID-19 pandemic disrupted the use of preventive health care services. Although there was an increase in the number of cancer screening tests beginning in late 2020, screenings remained 29% to 36% lower than in the prepandemic era. Objective: The aim of this review is to assist health care providers in identifying approaches for prioritizing patients and increasing breast, cervical, and colorectal cancer screening during the uncertainty of the COVID-19 pandemic. Methods: We used the scoping review framework to identify articles on PubMed and EBSCO databases. A total of 403 articles were identified, and 23 articles were selected for this review. The literature review ranged from January 1, 2020, to September 30, 2021. Results: The articles included two primary categories of recommendations: (1) risk stratification and triage to prioritize screenings and (2) alternative methods to conduct cancer screenings. Risk stratification and triage recommendations focused on prioritizing high-risk patients with an abnormal or suspicious result on the previous screening test, patients in certain age groups and sex, patients with a personal medical or family cancer history, patients that are currently symptomatic, and patients that are predisposed to hereditary cancers and cancer-causing mutations. Other recommended strategies included identifying areas facing the most disparities, creating algorithms and using artificial intelligence to create cancer risk scores, leveraging in-person visits to assess cancer risk, and providing the option of open access screenings where patients can schedule screenings and can be assigned a priority category by health care staff. Some recommended using telemedicine to categorize patients and determine screening eligibility for patients with new complaints. Several articles noted the importance of implementing preventive measures such as COVID-19 screening prior to the procedures, maintaining hygiene measures, and social distancing in waiting rooms. Alternative screening methods that do not require an in-person clinic visit and can effectively screen patients for cancers included mailing self-collection sampling kits for cervical and colorectal cancers, and implementing or expanding mobile screening units. Conclusions: Although the COVID-19 pandemic had devastating effects on population health globally, it could be an opportunity to adapt and evolve cancer screening methods. Disruption often creates innovation, and focus on alternative methods for cancer screenings may help reach rural and underresourced areas after the pandemic has ended. %M 35142621 %R 10.2196/34392 %U https://cancer.jmir.org/2022/1/e34392 %U https://doi.org/10.2196/34392 %U http://www.ncbi.nlm.nih.gov/pubmed/35142621 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 2 %P e31909 %T Crowdsourced Community Support Resources Among Patients Discharged From the Emergency Department During the COVID-19 Pandemic: Pilot Feasibility Study %A Agarwal,Anish K %A Southwick,Lauren %A Schneider,Rachelle %A Pelullo,Arthur %A Ortiz,Robin %A Klinger,Elissa V %A Gonzales,Rachel E %A Rosin,Roy %A Merchant,Raina M %+ Department of Emergency Medicine, University of Pennsylvania, 3600 Civic Center Boulevard, Philadelphia, PA, 19104, United States, 1 2674280125, Anish.Agarwal@pennmedicine.upenn.edu %K COVID-19 %K mHealth %K CHW %K digital health %K platform %K crowdsource %K support %K community %K health system %K monitoring %K virtual care %K text message %K model %K community health worker %K pilot study %K feasibility %D 2022 %7 23.2.2022 %9 Original Paper %J JMIR Ment Health %G English %X Background: The COVID-19 pandemic has placed strains on communities. During this public health crisis, health systems have created remote methods of monitoring symptom progression and delivering care virtually. Objective: Using an SMS text message-based system, we sought to build and test a remote model to explore community needs, connect individuals to curated resources, and facilitate community health worker intervention when needed during the pandemic. The primary aims of this pilot study were to establish the feasibility (ie, engagement with the text line) and acceptability (ie, participant ratings of resources and service) of delivering automated well-being resources via smartphone technology. Methods: Eligible patients (aged 18 years or older, having a cell phone with SMS text messaging capability, and recently visited the emergency department) were identified using the electronic health record. The patients were consented to enroll and begin receiving COVID-19–related information and links to community resources. We collected open-ended and close-ended resource and mood ratings. We calculated the frequencies and conducted a thematic review of the open-ended responses. Results: In 7 weeks, 356 participants were enrolled; 13,917 messages were exchanged including 333 resource ratings (mean 4) and 673 well-being scores (mean 6.8). We received and coded 386 open-ended responses, most of which elaborated upon their self-reported mood score (29%). Overall, 77% (n=274) of our participants rated the platform as a service they would highly recommend to a family member or friend. Conclusions: This approach is designed to broaden the reach of health systems, tailor to community needs in real time, and connect at-risk individuals with robust community health support. %M 35037886 %R 10.2196/31909 %U https://mental.jmir.org/2022/2/e31909 %U https://doi.org/10.2196/31909 %U http://www.ncbi.nlm.nih.gov/pubmed/35037886 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 2 %P e31978 %T Getting a Vaccine, Jab, or Vax Is More Than a Regular Expression. Comment on “COVID-19 Vaccine-Related Discussion on Twitter: Topic Modeling and Sentiment Analysis” %A Cummins,Jack Alexander %+ Manchester Essex Regional High School, 36 Lincoln Street, Manchester, MA, 01944, United States, 1 9788101169, 2jackcummins@gmail.com %K COVID-19 %K vaccine %K vaccination %K Twitter %K infodemiology %K infoveillance %K topic %K sentiment %K opinion %K discussion %K communication %K social media %K perception %K concern %K emotion %K natural language processing %D 2022 %7 23.2.2022 %9 Letter to the Editor %J J Med Internet Res %G English %X %M 35195531 %R 10.2196/31978 %U https://www.jmir.org/2022/2/e31978 %U https://doi.org/10.2196/31978 %U http://www.ncbi.nlm.nih.gov/pubmed/35195531 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 8 %N 1 %P e23845 %T A Comprehensive COVID-19 Daily News and Medical Literature Briefing to Inform Health Care and Policy in New Mexico: Implementation Study %A Jarratt,LynnMarie %A Situ,Jenny %A King,Rachel D %A Montanez Ramos,Estefania %A Groves,Hannah %A Ormesher,Ryen %A Cossé,Melissa %A Raboff,Alyse %A Mahajan,Avanika %A Thompson,Jennifer %A Ko,Randy F %A Paltrow-Krulwich,Samantha %A Price,Allison %A Hurwitz,Ariel May-Ling %A CampBell,Timothy %A Epler,Lauren T %A Nguyen,Fiona %A Wolinsky,Emma %A Edwards-Fligner,Morgan %A Lobo,Jolene %A Rivera,Danielle %A Langsjoen,Jens %A Sloane,Lori %A Hendrix,Ingrid %A Munde,Elly O %A Onyango,Clinton O %A Olewe,Perez K %A Anyona,Samuel B %A Yingling,Alexandra V %A Lauve,Nicolas R %A Kumar,Praveen %A Stoicu,Shawn %A Nestsiarovich,Anastasiya %A Bologa,Cristian G %A Oprea,Tudor I %A Tollestrup,Kristine %A Myers,Orrin B %A Anixter,Mari %A Perkins,Douglas J %A Lambert,Christophe Gerard %+ Center for Global Health, Division of Translational Informatics, Department of Internal Medicine, University of New Mexico Health Sciences Center, BRF #323A, MSC10-5550, 915 Camino de Salud NE, Albuquerque, NM, 87131, United States, 1 505 272 9709, cglambert@unm.edu %K COVID-19 %K pandemic %K daily report %K policy %K epidemics %K global health %K SARS-CoV-2 %K New Mexico %K medical education %D 2022 %7 23.2.2022 %9 Original Paper %J JMIR Med Educ %G English %X Background: On March 11, 2020, the New Mexico Governor declared a public health emergency in response to the COVID-19 pandemic. The New Mexico medical advisory team contacted University of New Mexico (UNM) faculty to form a team to consolidate growing information on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and its disease to facilitate New Mexico’s pandemic management. Thus, faculty, physicians, staff, graduate students, and medical students created the “UNM Global Health COVID-19 Intelligence Briefing.” Objective: In this paper, we sought to (1) share how to create an informative briefing to guide public policy and medical practice and manage information overload with rapidly evolving scientific evidence; (2) determine the qualitative usefulness of the briefing to its readers; and (3) determine the qualitative effect this project has had on virtual medical education. Methods: Microsoft Teams was used for manual and automated capture of COVID-19 articles and composition of briefings. Multilevel triaging saved impactful articles to be reviewed, and priority was placed on randomized controlled studies, meta-analyses, systematic reviews, practice guidelines, and information on health care and policy response to COVID-19. The finalized briefing was disseminated by email, a listserv, and posted on the UNM digital repository. A survey was sent to readers to determine briefing usefulness and whether it led to policy or medical practice changes. Medical students, unable to partake in direct patient care, proposed to the School of Medicine that involvement in the briefing should count as course credit, which was approved. The maintenance of medical student involvement in the briefings as well as this publication was led by medical students. Results: An average of 456 articles were assessed daily. The briefings reached approximately 1000 people by email and listserv directly, with an unknown amount of forwarding. Digital repository tracking showed 5047 downloads across 116 countries as of July 5, 2020. The survey found 108 (95%) of 114 participants gained relevant knowledge, 90 (79%) believed it decreased misinformation, 27 (24%) used the briefing as their primary source of information, and 90 (79%) forwarded it to colleagues. Specific and impactful public policy decisions were informed based on the briefing. Medical students reported that the project allowed them to improve on their scientific literature assessment, stay current on the pandemic, and serve their community. Conclusions: The COVID-19 briefings succeeded in informing and guiding New Mexico policy and clinical practice. The project received positive feedback from the community and was shown to decrease information burden and misinformation. The virtual platforms allowed for the continuation of medical education. Variability in subject matter expertise was addressed with training, standardized article selection criteria, and collaborative editing led by faculty. %M 35142625 %R 10.2196/23845 %U https://mededu.jmir.org/2022/1/e23845 %U https://doi.org/10.2196/23845 %U http://www.ncbi.nlm.nih.gov/pubmed/35142625 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 2 %P e27286 %T The Beneficial Effect of the First COVID-19 Lockdown on Undergraduate Students of Education: Prospective Cohort Study %A Joseph,Gili %A Schori,Hadas %+ Department of Physical Activity and Movement, Faculty of Science, Seminar Hakibbutzim College of Education, 149 Namir Drive, Tel Aviv, 6250769, Israel, 972 544577095, gilijosephphd@gmail.com %K sleep quality %K exercise %K well-being %K undergraduate students %K COVID-19 lockdown %K COVID-19 %D 2022 %7 23.2.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic has been spreading consistently since the beginning of 2020. On February 27, 2020, the first patient with coronavirus was diagnosed in Israel. On March 14, 2020, the Israeli government declared a general lockdown that lasted about a month, which altered the lives of the entire population. Objective: The objective of this paper is to evaluate the change in the well-being, physical activity, and sleep quality of undergraduate students of education at 2 time points: before (November 2019) and during (April 2020) the first COVID-19 lockdown. Methods: In total, 533 undergraduate students of education submitted an online questionnaire before the lockdown and at its end. The questionnaire comprised 4 parts: a (1) sociodemographic and (2) weekly exercise questionnaire taken from the International Physical Activity Questionnaire–Short Form; (3) sleep quality, rated using the Mini Sleep Questionnaire; and (4) well-being, rated using the short version of the Mental Health Inventory. This was a pre-post prospective cohort questionnaire study. Results: It was predicted that there would be a decrease in the aforementioned parameters. Contrary to all expectations, an increase was observed in all 3. Results showed that during the lockdown, there was an increase in the level of exercise students engaged in. Overall, 102 (61.4%) of 166 students engaged in a greater amount of physical activity during the COVID-19 lockdown compared to 150 (40.9%) of 367 students who engaged in a greater amount of physical activity before COVID-19. Levels of sleep quality (mean 5.34 [SD 0.92] vs mean 5.12 [SD 0.46], P=.02) and well-being (mean 3.79 [SD 0.62] vs mean 3.67 [SD 0.59], P=.02) were also higher during the COVID-19 lockdown. Conclusions: These findings indicate that undergraduate students seem to have taken advantage of the change in lifestyle due to the lockdown, directing the free time toward improving health by engaging in more physical activity, thus improving sleep quality and well-being. %M 35072635 %R 10.2196/27286 %U https://formative.jmir.org/2022/2/e27286 %U https://doi.org/10.2196/27286 %U http://www.ncbi.nlm.nih.gov/pubmed/35072635 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 2 %P e30598 %T The Impact of COVID-19 Confinement on Cognition and Mental Health and Technology Use Among Socially Vulnerable Older People: Retrospective Cohort Study %A Dura-Perez,Elena %A Goodman-Casanova,Jessica Marian %A Vega-Nuñez,Amanda %A Guerrero-Pertiñez,Gloria %A Varela-Moreno,Esperanza %A Garolera,Maite %A Quintana,Maria %A Cuesta-Vargas,Antonio I %A Barnestein-Fonseca,Pilar %A Gómez Sánchez-Lafuente,Carlos %A Mayoral-Cleries,Fermin %A Guzman-Parra,Jose %+ Department of Mental Health, Regional University Hospital of Málaga, Biomedical Research Institute of Malaga (IBIMA), Plaza del Hospital, s/n, Málaga, 29009, Spain, 34 660901966, jmariangoodman@gmail.com %K COVID-19 %K cognition %K quality of life %K social isolation %K mental health %K social support %K technology %K physical distancing %K leisure activities %K nursing %D 2022 %7 22.2.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: COVID-19 forced the implementation of restrictive measures in Spain, such as lockdown, home confinement, social distancing, and isolation. It is necessary to study whether limited access to basic services and decreased family and social support could have deleterious effects on cognition, quality of life, and mental health in vulnerable older people. Objective: This study aims to explore the impact of the COVID-19 outbreak on cognition in older adults with mild cognitive impairment or dementia as the main outcome and the quality of life, perceived health status, and depression as secondary outcomes and to analyze the association of living alone and a change in living arrangements with those outcomes and other variables related with the use of technology and health services. Likewise, this study aims to analyze the association of high and low technophilia with those variables, to explore the access and use of health care and social support services, and, finally, to explore the informative-, cognitive-, entertainment-, and socialization-related uses of information and communications technologies (ICTs) during the COVID-19 outbreak. Methods: This cohort study was conducted in Málaga (Spain). In total, 151 participants with mild cognitive impairment or mild dementia, from the SMART4MD (n=75, 49.7%) and TV-AssistDem (n=76, 50.3%) randomized clinical trials, were interviewed by telephone between May 11 and June 26, 2020. All participants had undergone 1-3 assessments (in 6-month intervals) on cognition, quality of life, and mood prior to the COVID-19 breakout. Results: The outbreak did not significantly impact the cognition, quality of life, and mood of our study population when making comparisons with baseline assessments prior to the outbreak. Perceived stress was reported as moderate during the outbreak. After correction for multiple comparisons, living alone, a change in living arrangements, and technophilia were not associated with negative mental health outcomes. However, being alone was nominally associated with self-perceived fear and depression, and higher technophilia with better quality of life, less boredom, perceived stress and depression, and also less calmness. Overall, health care and social support service access and utilization were high. The most used ICTs during the COVID-19 outbreak were the television for informative, cognitive, and entertainment-related uses and the smartphone for socialization. Conclusions: Our findings show that the first months of the outbreak did not significantly impact the cognition, quality of life, perceived health status, and depression of our study population when making comparisons with baseline assessments prior to the outbreak. Living alone and low technophilia require further research to establish whether they are risk factors of mental health problems during lockdowns in vulnerable populations. Moreover, although ICTs have proven to be useful for informative-, cognitive-, entertainment-, and socialization-related uses during the pandemic, more evidence is needed to support these interventions. Trial Registration: ClinicalTrials.gov NCT04385797; https://clinicaltrials.gov/ct2/show/NCT04385797 International Registered Report Identifier (IRRID): RR2-10.2196/26431 %M 35049505 %R 10.2196/30598 %U https://www.jmir.org/2022/2/e30598 %U https://doi.org/10.2196/30598 %U http://www.ncbi.nlm.nih.gov/pubmed/35049505 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 2 %N 1 %P e31259 %T Understanding the #longCOVID and #longhaulers Conversation on Twitter: Multimethod Study %A Santarossa,Sara %A Rapp,Ashley %A Sardinas,Saily %A Hussein,Janine %A Ramirez,Alex %A Cassidy-Bushrow,Andrea E %A Cheng,Philip %A Yu,Eunice %+ Department of Public Health Sciences, Henry Ford Health System, 1 Ford Place, Detroit, MI, 48202, United States, 1 3138747960, ssantar1@hfhs.org %K COVID-19 %K postacute sequela of COVID-19 %K PASC %K patient-centered care %K social media %K social network analysis %K long term %K symptom %K Twitter %K communication %K insight %K perception %K experience %K patient-centered %D 2022 %7 22.2.2022 %9 Original Paper %J JMIR Infodemiology %G English %X Background: The scientific community is just beginning to uncover the potential long-term effects of COVID-19, and one way to start gathering information is by examining the present discourse on the topic. The conversation about long COVID-19 on Twitter provides insight into related public perception and personal experiences. Objective: The aim of this study was to investigate the #longCOVID and #longhaulers conversations on Twitter by examining the combined effects of topic discussion and social network analysis for discovery on long COVID-19. Methods: A multipronged approach was used to analyze data (N=2500 records from Twitter) about long COVID-19 and from people experiencing long COVID-19. A text analysis was performed by both human coders and Netlytic, a cloud-based text and social networks analyzer. The social network analysis generated Name and Chain networks that showed connections and interactions between Twitter users. Results: Among the 2010 tweets about long COVID-19 and 490 tweets by COVID-19 long haulers, 30,923 and 7817 unique words were found, respectively. For both conversation types, “#longcovid” and “covid” were the most frequently mentioned words; however, through visually inspecting the data, words relevant to having long COVID-19 (ie, symptoms, fatigue, pain) were more prominent in tweets by COVID-19 long haulers. When discussing long COVID-19, the most prominent frames were “support” (1090/1931, 56.45%) and “research” (435/1931, 22.53%). In COVID-19 long haulers conversations, “symptoms” (297/483, 61.5%) and “building a community” (152/483, 31.5%) were the most prominent frames. The social network analysis revealed that for both tweets about long COVID-19 and tweets by COVID-19 long haulers, networks are highly decentralized, fragmented, and loosely connected. Conclusions: This study provides a glimpse into the ways long COVID-19 is framed by social network users. Understanding these perspectives may help generate future patient-centered research questions. %M 35229074 %R 10.2196/31259 %U https://infodemiology.jmir.org/2022/1/e31259 %U https://doi.org/10.2196/31259 %U http://www.ncbi.nlm.nih.gov/pubmed/35229074 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 2 %P e32426 %T The Use of Cremation Data for Timely Mortality Surveillance During the COVID-19 Pandemic in Ontario, Canada: Validation Study %A Postill,Gemma %A Murray,Regan %A Wilton,Andrew S %A Wells,Richard A %A Sirbu,Renee %A Daley,Mark J %A Rosella,Laura %+ Epidemiology Division, Dalla Lana School of Public Health, 155 College Street, Suite 600, Toronto, ON, M5T 3M7, Canada, 1 416 978 0901, laura.rosella@utoronto.ca %K excess deaths %K real-time mortality %K cremation %K COVID-19 %K SARS-CoV-2 %K mortality %K estimate %K impact %K public health %K validation %K pattern %K trend %K utility %K Canada %K mortality data %K pandemic %K death %K cremation data %K cause of death %K vital statistics %K excess mortality %D 2022 %7 21.2.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Early estimates of excess mortality are crucial for understanding the impact of COVID-19. However, there is a lag of several months in the reporting of vital statistics mortality data for many jurisdictions, including across Canada. In Ontario, a Canadian province, certification by a coroner is required before cremation can occur, creating real-time mortality data that encompasses the majority of deaths within the province. Objective: This study aimed to validate the use of cremation data as a timely surveillance tool for all-cause mortality during a public health emergency in a jurisdiction with delays in vital statistics data. Specifically, this study aimed to validate this surveillance tool by determining the stability, timeliness, and robustness of its real-time estimation of all-cause mortality. Methods: Cremation records from January 2020 until April 2021 were compared to the historical records from 2017 to 2019, grouped according to week, age, sex, and whether COVID-19 was the cause of death. Cremation data were compared to Ontario’s provisional vital statistics mortality data released by Statistics Canada. The 2020 and 2021 records were then compared to previous years (2017-2019) to determine whether there was excess mortality within various age groups and whether deaths attributed to COVID-19 accounted for the entirety of the excess mortality. Results: Between 2017 and 2019, cremations were performed for 67.4% (95% CI 67.3%-67.5%) of deaths. The proportion of cremated deaths remained stable throughout 2020, even within age and sex categories. Cremation records are 99% complete within 3 weeks of the date of death, which precedes the compilation of vital statistics data by several months. Consequently, during the first wave (from April to June 2020), cremation records detected a 16.9% increase (95% CI 14.6%-19.3%) in all-cause mortality, a finding that was confirmed several months later with cremation data. Conclusions: The percentage of Ontarians cremated and the completion of cremation data several months before vital statistics did not change meaningfully during the COVID-19 pandemic period, establishing that the pandemic did not significantly alter cremation practices. Cremation data can be used to accurately estimate all-cause mortality in near real-time, particularly when real-time mortality estimates are needed to inform policy decisions for public health measures. The accuracy of this excess mortality estimation was confirmed by comparing it with official vital statistics data. These findings demonstrate the utility of cremation data as a complementary data source for timely mortality information during public health emergencies. %M 35038302 %R 10.2196/32426 %U https://publichealth.jmir.org/2022/2/e32426 %U https://doi.org/10.2196/32426 %U http://www.ncbi.nlm.nih.gov/pubmed/35038302 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 2 %P e29279 %T SMART COVID Navigator, a Clinical Decision Support Tool for COVID-19 Treatment: Design and Development Study %A Suraj,Varun %A Del Vecchio Fitz,Catherine %A Kleiman,Laura B %A Bhavnani,Suresh K %A Jani,Chinmay %A Shah,Surbhi %A McKay,Rana R %A Warner,Jeremy %A Alterovitz,Gil %+ Medicine and Biomedical Informatics, Vanderbilt University, 2525 West End Ave, Suite 1500, Nashville, TN, 37203, United States, 1 615 936 3524, jeremy.warner@vumc.org %K COVID-19 %K clinical decision support %K precision medicine %K web application %K FHIR %D 2022 %7 18.2.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: COVID-19 caused by SARS-CoV-2 has infected 219 million individuals at the time of writing of this paper. A large volume of research findings from observational studies about disease interactions with COVID-19 is being produced almost daily, making it difficult for physicians to keep track of the latest information on COVID-19’s effect on patients with certain pre-existing conditions. Objective: In this paper, we describe the creation of a clinical decision support tool, the SMART COVID Navigator, a web application to assist clinicians in treating patients with COVID-19. Our application allows clinicians to access a patient’s electronic health records and identify disease interactions from a large set of observational research studies that affect the severity and fatality due to COVID-19. Methods: The SMART COVID Navigator takes a 2-pronged approach to clinical decision support. The first part is a connection to electronic health record servers, allowing the application to access a patient’s medical conditions. The second is accessing data sets with information from various observational studies to determine the latest research findings about COVID-19 outcomes for patients with certain medical conditions. By connecting these 2 data sources, users can see how a patient’s medical history will affect their COVID-19 outcomes. Results: The SMART COVID Navigator aggregates patient health information from multiple Fast Healthcare Interoperability Resources–enabled electronic health record systems. This allows physicians to see a comprehensive view of patient health records. The application accesses 2 data sets of over 1100 research studies to provide information on the fatality and severity of COVID-19 for several pre-existing conditions. We also analyzed the results of the collected studies to determine which medical conditions result in an increased chance of severity and fatality of COVID-19 progression. We found that certain conditions result in a higher likelihood of severity and fatality probabilities. We also analyze various cancer tissues and find that the probabilities for fatality vary greatly depending on the tissue being examined. Conclusions: The SMART COVID Navigator allows physicians to predict the fatality and severity of COVID-19 progression given a particular patient’s medical conditions. This can allow physicians to determine how aggressively to treat patients infected with COVID-19 and to prioritize different patients for treatment considering their prior medical conditions. %M 34932493 %R 10.2196/29279 %U https://www.jmir.org/2022/2/e29279 %U https://doi.org/10.2196/29279 %U http://www.ncbi.nlm.nih.gov/pubmed/34932493 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 2 %N 1 %P e32372 %T Partisan Differences in Legislators’ Discussion of Vaccination on Twitter During the COVID-19 Era: Natural Language Processing Analysis %A Engel-Rebitzer,Eden %A Stokes,Daniel C %A Meisel,Zachary F %A Purtle,Jonathan %A Doyle,Rebecca %A Buttenheim,Alison M %+ School of Nursing, University of Pennsylvania, 418 Curie Blvd, Philadelphia, PA, 19104, United States, 1 (215) 898 8281, abutt@nursing.upenn.edu %K social media %K Twitter %K vaccination %K partisanship %K COVID-19 %K vaccine %K natural language processing %K NLP %K hesitancy %K politicization %K communication %K linguistic %K pattern %D 2022 %7 18.2.2022 %9 Original Paper %J JMIR Infodemiology %G English %X Background: The COVID-19 era has been characterized by the politicization of health-related topics. This is especially concerning given evidence that politicized discussion of vaccination may contribute to vaccine hesitancy. No research, however, has examined the content and politicization of legislator communication with the public about vaccination during the COVID-19 era. Objective: The aim of this study was to examine vaccine-related tweets produced by state and federal legislators during the COVID-19 era to (1) describe the content of vaccine-related tweets; (2) examine the differences in vaccine-related tweet content between Democrats and Republicans; and (3) quantify (and describe trends over time in) partisan differences in vaccine-related communication. Methods: We abstracted all vaccine-related tweets produced by state and federal legislators between February 01, 2020, and December 11, 2020. We used latent Dirichlet allocation to define the tweet topics and used descriptive statistics to describe differences by party in the use of topics and changes in political polarization over time. Results: We included 14,519 tweets generated by 1463 state legislators and 521 federal legislators. Republicans were more likely to use words (eg, “record time,” “launched,” and “innovation”) and topics (eg, Operation Warp Speed success) that were focused on the successful development of a SARS-CoV-2 vaccine. Democrats used a broader range of words (eg, “anti-vaxxers,” “flu,” and “free”) and topics (eg, vaccine prioritization, influenza, and antivaxxers) that were more aligned with public health messaging related to the vaccine. Polarization increased over most of the study period. Conclusions: Republican and Democratic legislators used different language in their Twitter conversations about vaccination during the COVID-19 era, leading to increased political polarization of vaccine-related tweets. These communication patterns have the potential to contribute to vaccine hesitancy. %M 35229075 %R 10.2196/32372 %U https://infodemiology.jmir.org/2022/1/e32372 %U https://doi.org/10.2196/32372 %U http://www.ncbi.nlm.nih.gov/pubmed/35229075 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 2 %P e32716 %T Think-Aloud Testing of a Novel Safer Drinking App for College Students During COVID-19: Usability Study %A Smith,Jessica Gomez %A Alamiri,Nour Sami %A Biegger,Grace %A Frederick,Christina %A Halbert,Jennifer P %A Ingersoll,Karen S %+ Center for Behavioral Health & Technology, Department of Psychiatry and Neurobehavioral Sciences, University of Virginia School of Medicine, 560 Ray C Hunt Dr, Charlottesville, VA, 22903, United States, 1 434 243 0581, KES7A@hscmail.mcc.virginia.edu %K app development %K college binge drinking %K think aloud testing %K formative research %K mobile phone %D 2022 %7 17.2.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Hazardous alcohol consumption, and binge drinking in particular, continues to be common among college students, posing the greatest risk for their health and safety. Despite widespread exposure to evidence-based preventive interventions among US undergraduates, only modest and temporary effects on risky drinking occur. Formative studies have demonstrated that students want a more engaging intervention tool for risky drinking that can be used just in time. Objective: The purpose of this study is to test the appeal, relevance, and perceived utility of a draft mobile app for safer student drinking at a public university in Virginia. Methods: Undergraduate student participants tested the draft mobile app via a web-based prototype that tailors to individual feedback with hot spots that responded to their taps to mimic app functionality. They narrated their impressions, navigation, and comments in a standardized think-aloud procedure. After each round of think-aloud interviews, researchers debriefed the investigators and developers to discuss findings and brainstorm app modifications. Results: Minor changes to the functionality and aesthetics would improve usability of the app (eg, option for light mode in app settings). Student testers recommended tailoring the app to the needs of college students and to aspects of the local university’s drinking culture. Conclusions: Findings from this study will be synthesized with information gained from other formative work to determine the final app features. We will test the app in a pilot randomized trial to assess app use and the impact of the app on college student drinking behavior over several months. %M 35175210 %R 10.2196/32716 %U https://formative.jmir.org/2022/2/e32716 %U https://doi.org/10.2196/32716 %U http://www.ncbi.nlm.nih.gov/pubmed/35175210 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 2 %P e34385 %T Concerns Around Opposition to the Green Pass in Italy: Social Listening Analysis by Using a Mixed Methods Approach %A Spitale,Giovanni %A Biller-Andorno,Nikola %A Germani,Federico %+ Institute of Biomedical Ethics and History of Medicine, University of Zurich, Winterthurerstrasse 30, Zurich, 8006, Switzerland, 1 44 634 40 14, federico.germani@ibme.uzh.ch %K green pass %K COVID-19 %K COVID-19 pandemic %K vaccines %K vaccination hesitancy %K freedom %K social listening %K social media %K infodemic %K bioethics %K telegram %D 2022 %7 16.2.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: The recent introduction of COVID-19 certificates in several countries, including the introduction of the European green pass, has been met with protests and concerns by a fraction of the population. In Italy, the green pass has been used as a nudging measure to incentivize vaccinations because a valid green pass is needed to enter restaurants, bars, museums, or stadiums. As of December 2021, a valid green pass can be obtained by being fully vaccinated with an approved vaccine, recovered from COVID-19, or tested. However, a green pass obtained with a test has a short validity (48 hours for the rapid test, 72 hours for the polymerase chain reaction test) and does not allow access to several indoor public places. Objective: This study aims to understand and describe the concerns of individuals opposed to the green pass in Italy, the main arguments of their discussions, and their characterization. Methods: We collected data from Telegram chats and analyzed the arguments and concerns that were raised by the users by using a mixed methods approach. Results: Most individuals opposing the green pass share antivaccine views, but doubts and concerns about vaccines are generally not among the arguments raised to oppose the green pass. Instead, the discussion revolves around the legal aspects and the definition of personal freedom. We explain the differences and similarities between antivaccine and anti–green pass discourses, and we discuss the ethical ramifications of our research, focusing on the use of Telegram chats as a social listening tool for public health. Conclusions: A large portion of individuals opposed to the green pass share antivaccine views. We suggest public health and political institutions to provide a legal explanation and a context for the use of the green pass, as well as to continue focusing on vaccine communication to inform vaccine-hesitant individuals. Further work is needed to define a consensual ethical framework for social listening for public health. %M 35156930 %R 10.2196/34385 %U https://www.jmir.org/2022/2/e34385 %U https://doi.org/10.2196/34385 %U http://www.ncbi.nlm.nih.gov/pubmed/35156930 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 2 %P e27704 %T COVID-19 Treatments Sold Online Without Prescription Requirements in the United States: Cross-sectional Study Evaluating Availability, Safety and Marketing of Medications %A Ozawa,Sachiko %A Billings,Joanna %A Sun,Yujiao %A Yu,Sushan %A Penley,Benjamin %+ Division of Practice Advancement and Clinical Education, Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, CB# 7574, Beard Hall 115G, Chapel Hill, NC, 27599, United States, 1 919 966 2626, ozawa@unc.edu %K COVID-19 %K medication %K internet %K online pharmacy %K drug %D 2022 %7 16.2.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic has increased online purchases and heightened interest in existing treatments. Dexamethasone, hydroxychloroquine, and lopinavir-ritonavir have been touted as potential COVID-19 treatments. Objective: This study assessed the availability of 3 potential COVID-19 treatments online and evaluated the safety and marketing characteristics of websites selling these products during the pandemic. Methods: A cross-sectional study was conducted in the months of June 2020 to August 2020, by searching the first 100 results on Google, Bing, and Yahoo! mimicking a US consumer. Unique websites were included if they sold targeted medicines, were in English, offered US shipping, and were free to access. Identified online pharmacies were categorized as rogue, unclassified, or legitimate based on LegitScript classifications. Patient safety characteristics, marketing techniques, price, legitimacy, IP addresses, and COVID-19 mentions were recorded. Results: We found 117 websites: 30 selling dexamethasone (19/30, 63% rogue), 39 selling hydroxychloroquine (22/39, 56% rogue), and 48 selling lopinavir-ritonavir (33/48, 69% rogue). This included 89 unique online pharmacies: 70% were rogue (n=62), 22% were unapproved (n=20), and 8% were considered legitimate (n=7). Prescriptions were not required among 100% (19/19), 61% (20/33), and 50% (11/22) of rogue websites selling dexamethasone, lopinavir-ritonavir, and hydroxychloroquine, respectively. Overall, only 32% (24/74) of rogue websites required prescriptions to buy these medications compared with 94% (31/33) of unapproved and 100% (10/10) of legitimate websites (P<.001). Rogue sites rarely offered pharmacist counseling (1/33, 3% for lopinavir-ritonavir to 2/22, 9% for hydroxychloroquine). Drug warnings were unavailable in 86% (6/7) of unapproved dexamethasone sites. It was difficult to distinguish between rogue, unapproved, and legitimate online pharmacies solely based on website marketing characteristics. Illegitimate pharmacies were more likely to offer bulk discounts and claim price discounts, yet dexamethasone and hydroxychloroquine were more expensive online. An inexpensive generic version of lopinavir-ritonavir that is not authorized for use in the United States was available online offering US shipping. Some websites claimed hydroxychloroquine and lopinavir-ritonavir were effective COVID-19 treatments despite lack of scientific evidence. In comparing IP addresses to locations claimed on the websites, only 8.5% (7/82) matched their claimed locations. Conclusions: The lack of safety measures by illegitimate online pharmacies endanger patients, facilitating access to medications without appropriate oversight by health care providers to monitor clinical response, drug interactions, and adverse effects. We demonstrated how easy it is to go online to buy medications that are touted to treat COVID-19 even when current clinical evidence does not support their use for self-treatment. We documented that illegitimate online pharmacies sidestep prescription requirements, skirt pharmacist counseling, and make false claims regarding efficacy for COVID-19 treatment. Health care professionals must urgently educate the public of the dangers of purchasing drugs from illegitimate websites and highlight the importance of seeking treatment through authentic avenues of care. %M 34662286 %R 10.2196/27704 %U https://www.jmir.org/2022/2/e27704 %U https://doi.org/10.2196/27704 %U http://www.ncbi.nlm.nih.gov/pubmed/34662286 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 2 %P e33959 %T Longitudinal Changes of COVID-19 Symptoms in Social Media: Observational Study %A Sarabadani,Sarah %A Baruah,Gaurav %A Fossat,Yan %A Jeon,Jouhyun %+ Applied Sciences, Klick Inc, 175 Bloor Street East, Suite 300, Toronto, ON, M4W 3R8, Canada, 1 4162144977, cjeon@klick.com %K COVID-19 %K symptom %K diagnosis %K treatment %K social media %K Reddit %K longitudinal %K observational %K machine learning %D 2022 %7 16.2.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: In December 2019, the COVID-19 outbreak started in China and rapidly spread around the world. Many studies have been conducted to understand the clinical characteristics of COVID-19, and recently postinfection sequelae of this disease have begun to be investigated. However, there is little consensus on the longitudinal changes of lasting physical or psychological symptoms from prior COVID-19 infection. Objective: This study aims to investigate and analyze public social media data from Reddit to understand the longitudinal impact of COVID-19 symptoms before and after recovery from COVID-19. Methods: We collected 22,890 Reddit posts that were generated by 14,401 authors from March 14 to December 16, 2020. Using active learning and intensive manual inspection, 292 (2.03%) active authors, who were infected by COVID-19 and frequently reported disease progress on Reddit, along with their 2213 (9.67%) longitudinal posts, were identified. Machine learning tools to extract biomedical information were applied to identify COVID-19 symptoms mentioned in the Reddit posts. We then examined longitudinal changes in individual physiological and psychological characteristics before and after recovery from COVID-19 infection. Results: In total, 58 physiological and 3 psychological symptoms were identified in social media before and after recovery from COVID-19 infection. From the analyses, we found that symptoms of patients with COVID-19 lasted 2.5 months. On average, symptoms appeared around a month before recovery and remained for 1.5 months after recovery. Well-known COVID-19 symptoms, such as fever, cough, and chest congestion, appeared relatively earlier in patient journeys and were frequently observed before recovery from COVID-19. Meanwhile, mental discomfort or distress, such as brain fog or stress, fatigue, and manifestations on toes or fingers, were frequently mentioned after recovery and remained as intermediate- and longer-term sequelae. Conclusions: In this study, we showed the dynamic changes in COVID-19 symptoms during the infection and recovery phases of the disease. Our findings suggest the feasibility of using social media data for investigating disease states and understanding the evolution of the physiological and psychological characteristics of COVID-19 infection over time. %M 35076400 %R 10.2196/33959 %U https://www.jmir.org/2022/2/e33959 %U https://doi.org/10.2196/33959 %U http://www.ncbi.nlm.nih.gov/pubmed/35076400 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 2 %P e33149 %T Control Centre for Intensive Care as a Tool for Effective Coordination, Real-Time Monitoring, and Strategic Planning During the COVID-19 Pandemic %A Komenda,Martin %A Černý,Vladimír %A Šnajdárek,Petr %A Karolyi,Matěj %A Hejný,Miloš %A Panoška,Petr %A Jarkovský,Jiří %A Gregor,Jakub %A Bulhart,Vojtěch %A Šnajdrová,Lenka %A Májek,Ondřej %A Vymazal,Tomáš %A Blatný,Jan %A Dušek,Ladislav %+ Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Kamenice 126/3, Brno, 62500, Czech Republic, 420 549 49 4469, komenda@iba.muni.cz %K COVID-19 %K coronavirus %K intensive care %K inpatient care %K online control center %K prescription %K open data %K ICU %K monitoring %K strategy %K development %K app %K function %K Czech Republic %K inpatient %K crisis management %D 2022 %7 16.2.2022 %9 Viewpoint %J J Med Internet Res %G English %X In the Czech Republic, the strategic data-based and organizational support for individual regions and for providers of acute care at the nationwide level is coordinated by the Ministry of Health. At the beginning of the COVID-19 pandemic, the country needed to very quickly implement a system for the monitoring, reporting, and overall management of hospital capacities. The aim of this viewpoint is to describe the purpose and basic functions of a web-based application named “Control Centre for Intensive Care,” which was developed and made available to meet the needs of systematic online technical support for the management of intensive inpatient care across the Czech Republic during the first wave of the pandemic in spring 2020. Two tools of key importance are described in the context of national methodology: one module for regular online updates and overall monitoring of currently free capacities of intensive care in real time, and a second module for online entering and overall record-keeping of requirements on medications for COVID-19 patients. A total of 134 intensive care providers and 927 users from hospitals across all 14 regions of the Czech Republic were registered in the central Control Centre for Intensive Care database as of March 31, 2021. This web-based application enabled continuous monitoring and decision-making during the mass surge of critical care from autumn 2020 to spring 2021. The Control Center for Intensive Care has become an indispensable part of a set of online tools that are employed on a regular basis for crisis management at the time of the COVID-19 pandemic. %M 34995207 %R 10.2196/33149 %U https://www.jmir.org/2022/2/e33149 %U https://doi.org/10.2196/33149 %U http://www.ncbi.nlm.nih.gov/pubmed/34995207 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 2 %P e32240 %T Digital Interventions to Reduce Distress Among Health Care Providers at the Frontline: Protocol for a Feasibility Trial %A Nguyen,Binh %A Torres,Andrei %A Sim,Walter %A Kenny,Deborah %A Campbell,Douglas M %A Beavers,Lindsay %A Lou,Wendy %A Kapralos,Bill %A Peter,Elizabeth %A Dubrowski,Adam %A Krishnan,Sridhar %A Bhat,Venkat %+ Interventional Psychiatry Program, St Michael’s Hospital, Unity Health Toronto, 193 Yonge Street, Suite 6-013, Toronto, ON, M5B 1M8, Canada, 1 416 360 4000 ext 76404, venkat.bhat@utoronto.ca %K virtual reality %K mobile app %K moral distress %K simulation %K moral injury %K COVID-19 %D 2022 %7 16.2.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Stress, anxiety, distress, and depression are high among health care workers during the COVID-19 pandemic, and they have reported acting in ways that are contrary to their moral values and professional commitments that degrade their integrity. This creates moral distress and injury due to constraints they have encountered, such as limited resources. Objective: The purpose of this study is to develop and show the feasibility of digital platforms (a virtual reality and a mobile platform) to understand the causes and ultimately reduce the moral distress of health care providers during the COVID-19 pandemic. Methods: This will be a prospective, single cohort, pre- and posttest study examining the effect of a brief informative video describing moral distress on perceptual, psychological, and physiological indicators of stress and decision-making during a scenario known to potentially elicit moral distress. To accomplish this, we have developed a virtual reality simulation that will be used before and after the digital intervention for monitoring short-term impacts. The simulation involves an intensive care unit setting during the COVID-19 pandemic, and participants will be placed in morally challenging situations. The participants will be engaged in an educational intervention at the individual, team, and organizational levels. During each test, data will be collected for (1) physiological measures of stress and after each test, data will be collected regarding (2) thoughts, feelings and behaviors during a morally challenging situation, and (3) perceptual estimates of psychological stress. In addition, participants will continue to be monitored for moral distress and other psychological stresses for 8 weeks through our Digital intervention/intelligence Group mobile platform. Finally, a comparison will be conducted using machine learning and biostatistical techniques to analyze the short- and long-term impacts of the virtual reality intervention. Results: The study was funded in November 2020 and received research ethics board approval in March 2021. The study is ongoing. Conclusions: This project is a proof-of-concept integration to demonstrate viability over 6 months and guide future studies to develop these state-of-the-art technologies to help frontline health care workers work in complex moral contexts. In addition, the project will develop innovations that can be used for future pandemics and in other contexts prone to producing moral distress and injury. This project aims to demonstrate the feasibility of using digital platforms to understand the continuum of moral distress that can lead to moral injury. Demonstration of feasibility will lead to future studies to examine the efficacy of digital platforms to reduce moral distress. Trial Registration: ClinicalTrials.gov NCT05001542; https://clinicaltrials.gov/ct2/show/NCT05001542 International Registered Report Identifier (IRRID): DERR1-10.2196/32240 %M 34871178 %R 10.2196/32240 %U https://www.researchprotocols.org/2022/2/e32240 %U https://doi.org/10.2196/32240 %U http://www.ncbi.nlm.nih.gov/pubmed/34871178 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 10 %N 2 %P e32373 %T Exploring Quality Differences in Telemedicine Between Hospital Outpatient Departments and Community Clinics: Cross-sectional Study %A Alhajri,Noora %A Simsekler,Mecit Can Emre %A Alfalasi,Buthaina %A Alhashmi,Mohamed %A Memon,Hamda %A Housser,Emma %A Abdi,Abdulhamid Mustafa %A Balalaa,Nahed %A Al Ali,Maryam %A Almaashari,Raghda %A Al Memari,Shammah %A Al Hosani,Farida %A Al Zaabi,Yousif %A Almazrouei,Shereena %A Alhashemi,Hamed %+ College of Medicine and Health Science, Khalifa University, Al-Saada Road, Zone 1, P O Box 11001, Abu Dhabi, United Arab Emirates, 971 552277490, nalhajri007@gmail.com %K COVID-19 %K patient satisfaction %K technology acceptance %K hospital %K community clinic %K video consultation %K audio consultation %K outpatient department %K OPD %K policy making %K UAE %D 2022 %7 15.2.2022 %9 Original Paper %J JMIR Med Inform %G English %X Background: Telemedicine is a care delivery modality that has the potential to broaden the reach and flexibility of health care services. In the United Arab Emirates, telemedicine services are mainly delivered through either integrated hospital outpatient department (OPDs) or community clinics. However, it is unknown if patients’ perceptions of, and satisfaction with, telemedicine services differ between these two types of health care systems during the COVID-19 pandemic. Objective: We aimed to explore the differences in patients’ perceptions of, and satisfaction with, telemedicine between hospital OPDs and community clinics during the COVID-19 pandemic. We also aimed to identify patient- or visit-related characteristics contributing to patient satisfaction with telemedicine. Methods: In this cross-sectional study that was conducted at Abu Dhabi health care centers, we invited outpatients aged 18 years or over, who completed a telemedicine visit during the COVID-19 pandemic, to participate in our study. Patients’ perceptions of, and satisfaction with, telemedicine regarding the two system types (ie, hospital OPDs and community clinics) were assessed using an online survey that was sent as a link through the SMS system. Regression models were used to describe the association between patient- and visit-related characteristics, as well as the perception of, and satisfaction with, telemedicine services. Results: A total of 515 patients participated in this survey. Patients’ satisfaction with telemedicine services was equally high among the settings, with no statistically significant difference between the two setting types (hospital OPDs: 253/343, 73.8%; community clinics: 114/172, 66.3%; P=.19). Video consultation was significantly associated with increased patient satisfaction (odds ratio [OR] 2.57, 95% CI 1.04-6.33; P=.04) and patients’ support of the transition to telemedicine use during and after the pandemic (OR 2.88, 95% CI 1.18-7.07; P=.02). Patients who used video consultations were more likely to report that telemedicine improved access to health care services (OR 3.06, 95% CI 1.71-8.03; P=.02), reduced waiting times and travel costs (OR 4.94, 95% CI 1.15-21.19; P=.03), addressed patients’ needs (OR 2.63, 95% CI 1.13-6.11; P=.03), and eased expression of patients’ medical concerns during the COVID-19 pandemic (OR 2.19, 95% CI 0.89-5.38; P=.09). Surprisingly, middle-aged patients were two times more likely to be satisfied with telemedicine services (OR 2.12, 95% CI 1.09-4.14; P=.03), as compared to any other age group in this study. Conclusions: These findings suggest that patient satisfaction was unaffected by the health system setting in which patients received the teleconsultations, whether they were at hospitals or community clinics. Video consultation was associated with increased patient satisfaction with telemedicine services. Efforts should be focused on strategic planning for enhanced telemedicine services, video consultation in particular, for both emergent circumstances, such as the COVID-19 pandemic, and day-to-day health care delivery. %M 34978281 %R 10.2196/32373 %U https://medinform.jmir.org/2022/2/e32373 %U https://doi.org/10.2196/32373 %U http://www.ncbi.nlm.nih.gov/pubmed/34978281 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 2 %P e34176 %T The Accessibility of YouTube Fitness Videos for Individuals Who Are Disabled Before and During the COVID-19 Pandemic: Preliminary Application of a Text Analytics Approach %A Kadakia,Shevali %A Stratton,Catherine %A Wu,Yinfei %A Feliciano,Josemari %A Tuakli-Wosornu,Yetsa A %+ Department of Physical Medicine and Rehabilitation, University of Pittsburgh Medical Center, 3471 Fifth Ave, Pittsburgh, PA, 15213, United States, 1 4436104322, yetsa.tuakli-wosornu@yale.edu %K persons with disabilities %K disability %K exercise %K physical activity %K digital health %K YouTube %K accessibility %K fitness %K COVID-19 %K text analysis %K social media %K video %D 2022 %7 15.2.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: People with disabilities face barriers to in-person physical activity (PA), including a lack of adaptive equipment and knowledgeable instructors. Given this and the increased need for digital resources due to widespread COVID-19 lockdowns, it is necessary to assess the accessibility of digital fitness resources for people with disabilities. To investigate whether YouTube fitness content creators have made videos accessible to people with disabilities would be informative about access to PA during COVID-19 and could also provide insight into the feasibility of individuals who are disabled relying on YouTube for PA in a post–COVID-19 world. Objective: This study aims to ascertain if disability-friendly PA videos on YouTube are accessible through searching general fitness terms and whether a change in the availability of accessible fitness resources for people with disabilities occurred on YouTube between before and during the COVID-19 pandemic on “Hospital/Medical Institutions,” “Individual(s),” and “Other(s)” channels. Secondary aims are to investigate if different categories of YouTube channels produce more accessible fitness content and highlight any disparities in disability-friendly PA content on YouTube. Methods: A cross-sectional text analysis of exercise-related YouTube videos was conducted. The authors used Python (version 3.0) to access the YouTube database via its data application programming interface. Terms pertaining to PA that were searched on YouTube were at-home exercise, exercise at home, exercise no equipment, home exercise, home-based exercise, no equipment workout, and workout no equipment. Various elements (eg, view count and content generation) of the videos published between January 1 and June 30, 2019 (n=700), were compared to the elements of videos published between January 1 and June 30, 2020 (n=700). To capture a broad idea of disability-friendly videos on YouTube, videos were labeled “accessible” if they were found in the first 100 video results and if their title, description, or tags contained the following terms: para, paralympic, adaptive, adapted, disabled, disability, differently abled, disability-friendly, wheelchair accessible, and inclusive. Each video and channel were categorized as “Hospitals/Medical Institutions,” “Individuals,” or “Other(s).” Results: The analysis revealed a statistically significant increase in viewership of fitness content on YouTube (P=.001) and in fitness content generated by Hospitals/Medical Institutions (P=.004). Accessible terms applicable to people with disabilities had minimal appearances in 2019 (21 videos) and 2020 (19 videos). None of the top viewed fitness videos that populated on YouTube from 2019 or 2020 were accessible. Conclusions: The proportion of accessible disability-friendly videos remains diminutive relative to the prevalence of disability in the general population, revealing that disability-friendly videos are seldom findable on YouTube. Thus, the need for disability-friendly fitness content to be easily searched and found remains urgent if access to digital fitness resources is to improve. %M 35044305 %R 10.2196/34176 %U https://formative.jmir.org/2022/2/e34176 %U https://doi.org/10.2196/34176 %U http://www.ncbi.nlm.nih.gov/pubmed/35044305 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 2 %P e32443 %T Assessing COVID-19 Health Information on Google Using the Quality Evaluation Scoring Tool (QUEST): Cross-sectional and Readability Analysis %A Bachu,Vismaya S %A Mahjoub,Heba %A Holler,Albert E %A Crihalmeanu,Tudor %A Bachu,Dheevena M %A Ayyaswami,Varun %A Parker,Pearman D %A Prabhu,Arpan V %+ Department of Radiation Oncology, University of Arkansas for Medical Sciences, Winthrop P Rockefeller Cancer Institute, 4130 Shuffield Dr, Little Rock, AR, 72205, United States, 1 5016644568, avprabhu@uams.edu %K COVID-19 %K COVID-19 pandemic %K health literacy %K readability %K QUEST %K online health information %K cross-sectional %K trend %K internet %K spread %K symptom %K quality %K United States %D 2022 %7 11.2.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic spurred an increase in online information regarding disease spread and symptomatology. Objective: Our purpose is to systematically assess the quality and readability of articles resulting from frequently Google-searched COVID-19 terms in the United States. Methods: We used Google Trends to determine the 25 most commonly searched health-related phrases between February 29 and April 30, 2020. The first 30 search results for each term were collected, and articles were analyzed using the Quality Evaluation Scoring Tool (QUEST). Three raters scored each article in authorship, attribution, conflict of interest, currency, complementarity, and tone. A readability analysis was conducted. Results: Exactly 709 articles were screened, and 195 fulfilled inclusion criteria. The mean article score was 18.4 (SD 2.6) of 28, with 7% (14/189) scoring in the top quartile. National news outlets published the largest share (70/189, 36%) of articles. Peer-reviewed journals attained the highest average QUEST score compared to national/regional news outlets, national/state government sites, and global health organizations (all P<.05). The average reading level was 11.7 (SD 1.9, range 5.4-16.9). Only 3 (1.6%) articles were written at the recommended sixth grade level. Conclusions: COVID-19–related articles are vastly varied in their attributes and levels of bias, and would benefit from revisions for increased readability. %M 34995206 %R 10.2196/32443 %U https://formative.jmir.org/2022/2/e32443 %U https://doi.org/10.2196/32443 %U http://www.ncbi.nlm.nih.gov/pubmed/34995206 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 2 %P e32638 %T Determining the Case Fatality Rate of COVID-19 in Italy: Novel Epidemiological Study %A Yan,Mengqing %A Kang,Wenjun %A Guo,Zhifeng %A Wang,Qi %A Wang,Peizhong Peter %A Zhu,Yun %A Yang,Yongli %A Wang,Wei %+ Department of Occupational and Environmental Health, College of Public Health, Zhengzhou University, No.100, Science Avenue, Zhengzhou, 450001, China, 86 371 67781466, ww375@zzu.edu.cn %K COVID-19 %K case fatality rate %K discharged case fatality rate %K new infectious diseases %D 2022 %7 10.2.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: COVID-19, which emerged in December 2019, has spread rapidly around the world and has become a serious public health event endangering human life. With regard to COVID-19, there are still many unknowns, such as the exact case fatality rate (CFR). Objective: The main objective of this study was to explore the value of the discharged CFR (DCFR) to make more accurate forecasts of epidemic trends of COVID-19 in Italy. Methods: We retrieved the epidemiological data of COVID-19 in Italy published by the John Hopkins Coronavirus Resource Center. We then used the proportion of deaths to discharged cases（including deaths and recovered cases） to calculate the total DCFR (tDCFR), monthly DCFR (mDCFR), and stage DCFR (sDCFR). Furthermore, we analyzed the trend in the mDCFR between January and December 2020 using joinpoint regression analysis, used ArcGIS version 10.7 to visualize the spatial distribution of the epidemic CFR, and assigned different colors to each province based on the CFR or tDCFR. Results: We calculated the numbers and obtained the new indices of the tDCFR and mDCFR for calculating the fatality rate. The results showed that the tDCFR and mDCFR fluctuated greatly from January to May. They first showed a rapid increase followed by a rapid decline after reaching the peak. The map showed that the provinces with a high tDCFR were Emilia-Romagna, Puglia, and Lombardia. The change trend of the mDCFR over time was divided into the following 2 stages: the first stage (from January to May) and the second stage (from June to December). With regard to worldwide COVID-19 statistics, among 6 selected countries, the United States had the highest tDCFR (4.26%), while the tDCFR of the remaining countries was between 0.98% and 2.72%. Conclusions: We provide a new perspective for assessing the fatality of COVID-19 in Italy, which can use ever-changing data to calculate a more accurate CFR and scientifically predict the development trend of the epidemic. %M 34963659 %R 10.2196/32638 %U https://publichealth.jmir.org/2022/2/e32638 %U https://doi.org/10.2196/32638 %U http://www.ncbi.nlm.nih.gov/pubmed/34963659 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 9 %N 1 %P e31502 %T Patient Outcomes and Lessons Learned From Treating Patients With Severe COVID-19 at a Long-term Acute Care Hospital: Single-Center Retrospective Study %A Grevelding,Pete %A Hrdlicka,Henry Charles %A Holland,Steve %A Cullen,Lorraine %A Meyer,Amanda %A Connors,Catherine %A Cooper,Darielle %A Greco,Allison %+ Milne Institute for Healthcare Innovation, Gaylord Specialty Healthcare, 50 Gaylord Farm Road, Wallingford, CT, 06492, United States, 1 203 741 3386, pgrevelding@gaylord.org %K COVID-19 %K SARS-CoV-2 %K post–COVID-19 %K subacute COVID-19 %K postacute care %K long-term acute care hospital %K pulmonary %K speech therapy %K speech-language pathology %K rehabilitation %K physical therapy %K occupational therapy %K respiratory therapy %D 2022 %7 10.2.2022 %9 Original Paper %J JMIR Rehabil Assist Technol %G English %X Background: With the continuation of the COVID-19 pandemic, shifting active COVID-19 care from short-term acute care hospitals (STACHs) to long-term acute care hospitals (LTACHs) could decrease STACH census during critical stages of the pandemic and maximize limited resources. Objective: This study aimed to describe the characteristics, clinical management, and patient outcomes during and after the acute COVID-19 phase in an LTACH in the Northeastern United States. Methods: This was a single-center group comparative retrospective analysis of the electronic medical records of patients treated for COVID-19–related impairments from March 19, 2020, through August 14, 2020, and a reference population of medically complex patients discharged between December 1, 2019, and February 29, 2020. This study was conducted to evaluate patient outcomes in response to the holistic treatment approach of the facility. Results: Of the 127 total COVID-19 admissions, 118 patients were discharged by the data cutoff. At admission, 29.9% (38/127) of patients tested positive for SARS-CoV-2 infection. The mean age of the COVID-19 cohort was lower than that of the reference cohort (63.3, 95% CI 61.1-65.4 vs 65.5, 95% CI 63.2-67.8 years; P=.04). There were similar proportions of males and females between cohorts (P=.38); however, the proportion of non-White/non-Caucasian patients was higher in the COVID-19 cohort than in the reference cohort (odds ratio 2.79, 95% CI 1.5-5.2; P=.001). The mean length of stay in the COVID-19 cohort was similar to that in the reference cohort (25.5, 95% CI 23.2-27.9 vs 29.9, 95% CI 24.7-35.2 days; P=.84). Interestingly, a positive correlation between patient age and length of stay was observed in the COVID-19 cohort (r2=0.05; P=.02), but not in the reference cohort. Ambulation assistance scores improved in both the reference and COVID-19 cohorts from admission to discharge (P<.001). However, the mean assistance score was greater in the COVID-19 cohort than in the reference cohort at discharge (4.9, 95% CI 4.6-5.3 vs 4.1, 95% CI 3.7-4.7; P=.001). Similarly, the mean change in gait distance was greater in the COVID-19 cohort than in the reference cohort (221.1, 95% CI 163.2-279.2 vs 146.4, 95% CI 85.6-207.3 feet; P<.001). Of the 16 patients mechanically ventilated at admission, 94% (15/16) were weaned before discharge (mean 11.3 days). Of the 75 patients admitted with a restricted diet, 75% (56/75) were discharged on a regular diet. Conclusions: The majority of patients treated at the LTACH for severe COVID-19 and related complications benefited from coordinated care and rehabilitation. In comparison to the reference cohort, patients treated for COVID-19 were discharged with greater improvements in ambulation distance and assistance needs during a similar length of stay. These findings indicate that other patients with COVID-19 would benefit from care in an LTACH. %M 35023835 %R 10.2196/31502 %U https://rehab.jmir.org/2022/1/e31502 %U https://doi.org/10.2196/31502 %U http://www.ncbi.nlm.nih.gov/pubmed/35023835 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 9 %N 1 %P e30794 %T Occupational and Physical Therapy Strategies for the Rehabilitation of COVID-19-Related Guillain-Barré Syndrome in the Long-term Acute Care Hospital Setting: Case Report %A Connors,Catherine %A McNeill,Stephanie %A Hrdlicka,Henry Charles %+ Milne Institute for Healthcare Innovation, Gaylord Specialty Healthcare, 50 Gaylord Farm Road, Wallingford, CT, 06492, United States, 1 203 284 2864, hhrdlicka@gaylord.org %K Gullian-Barre syndrome %K COVID-19 %K SARS-CoV-2 %K occupational therapy %K physical therapy %K long-term acute care hospital %K rehabilitation %K case report %K treatment %K diagnosis %D 2022 %7 10.2.2022 %9 Original Paper %J JMIR Rehabil Assist Technol %G English %X Background: Although several reports have described the diagnosis and treatment of patients with COVID-19-associated Guillain-Barré syndrome (GBS), there is a paucity of literature describing the occupational and physical therapy (OT and PT) strategies used in the long-term acute care hospital (LTACH) setting to rehabilitate these patients. Objective: To expand this body of literature, we present a case report highlighting the treatment strategies used to rehabilitate and discharge an individual from an independent LTACH facility, following diagnosis and treatment of COVID-19-related GBS at a regional ACH. Methods: A 61-year-old male was admitted to an LTACH for the rehabilitation of GBS following COVID-19 infection and intravenous immunoglobulin treatment. Rehabilitation in the LTACH setting uses a variety of skilled treatment interventions to meet patient-driven goals and maximize their function to the highest level possible in preparation of their discharge to a subacute or homecare setting. In this case, this was accomplished through individual OT and PT sessions, OT/PT cotreatment sessions, and targeted group therapy sessions focused on leg, arm, and fine motor coordination exercises. Results: With the OT and PT standard of care, the patient’s improvement was demonstrated by several outcome measures, including manual muscle testing, range of motion, grip strength, and the activity measure for postacute care. The patient was successfully rehabilitated and returned to the community after presenting with COVID-19-associated GBS. Conclusions: This report highlights the complex rehabilitation needs patients require to regain independence after diagnosis of COVID-19-associated GBS. %M 35023838 %R 10.2196/30794 %U https://rehab.jmir.org/2022/1/e30794 %U https://doi.org/10.2196/30794 %U http://www.ncbi.nlm.nih.gov/pubmed/35023838 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 2 %P e34645 %T Risk Factors for COVID-19 in College Students Identified by Physical, Mental, and Social Health Reported During the Fall 2020 Semester: Observational Study Using the Roadmap App and Fitbit Wearable Sensors %A Gilley,Kristen N %A Baroudi,Loubna %A Yu,Miao %A Gainsburg,Izzy %A Reddy,Niyanth %A Bradley,Christina %A Cislo,Christine %A Rozwadowski,Michelle Lois %A Clingan,Caroline Ashley %A DeMoss,Matthew Stephen %A Churay,Tracey %A Birditt,Kira %A Colabianchi,Natalie %A Chowdhury,Mosharaf %A Forger,Daniel %A Gagnier,Joel %A Zernicke,Ronald F %A Cunningham,Julia Lee %A Cain,Stephen M %A Tewari,Muneesh %A Choi,Sung Won %+ Department of Pediatrics, University of Michigan Medical School, 1200 E Hospital Dr, Medical Professional Building D4118, Ann Arbor, MI, 48109, United States, 1 734 615 2263, sungchoi@med.umich.edu %K mHealth %K mobile health %K college student %K mental health %K wearable devices %K wearable %K student %K risk factor %K risk %K COVID-19 %K physical health %K observational %K crisis %K self-report %K outcome %K physical activity %K wellbeing %K well-being %D 2022 %7 10.2.2022 %9 Original Paper %J JMIR Ment Health %G English %X Background: The COVID-19 pandemic triggered a seismic shift in education to web-based learning. With nearly 20 million students enrolled in colleges across the United States, the long-simmering mental health crisis in college students was likely further exacerbated by the pandemic. Objective: This study leveraged mobile health (mHealth) technology and sought to (1) characterize self-reported outcomes of physical, mental, and social health by COVID-19 status; (2) assess physical activity through consumer-grade wearable sensors (Fitbit); and (3) identify risk factors associated with COVID-19 positivity in a population of college students prior to release of the vaccine. Methods: After completing a baseline assessment (ie, at Time 0 [T0]) of demographics, mental, and social health constructs through the Roadmap 2.0 app, participants were instructed to use the app freely, wear the Fitbit, and complete subsequent assessments at T1, T2, and T3, followed by a COVID-19 assessment of history and timing of COVID-19 testing and diagnosis (T4: ~14 days after T3). Continuous measures were described using mean (SD) values, while categorical measures were summarized as n (%) values. Formal comparisons were made on the basis of COVID-19 status. The multivariate model was determined by entering all statistically significant variables (P<.05) in univariable associations at once and then removing one variable at a time through backward selection until the optimal model was obtained. Results: During the fall 2020 semester, 1997 participants consented, enrolled, and met criteria for data analyses. There was a high prevalence of anxiety, as assessed by the State Trait Anxiety Index, with moderate and severe levels in 465 (24%) and 970 (49%) students, respectively. Approximately one-third of students reported having a mental health disorder (n=656, 33%). The average daily steps recorded in this student population was approximately 6500 (mean 6474, SD 3371). Neither reported mental health nor step count were significant based on COVID-19 status (P=.52). Our analyses revealed significant associations of COVID-19 positivity with the use of marijuana and alcohol (P=.02 and P=.046, respectively) and with lower belief in public health measures (P=.003). In addition, graduate students were less likely and those with ≥20 roommates were more likely to report a COVID-19 diagnosis (P=.009). Conclusions: Mental health problems were common in this student population. Several factors, including substance use, were associated with the risk of COVID-19. These data highlight important areas for further attention, such as prioritizing innovative strategies that address health and well-being, considering the potential long-term effects of COVID-19 on college students. Trial Registration: ClinicalTrials.gov NCT04766788; https://clinicaltrials.gov/ct2/show/NCT04766788 International Registered Report Identifier (IRRID): RR2-10.2196/29561 %M 34992051 %R 10.2196/34645 %U https://mental.jmir.org/2022/2/e34645 %U https://doi.org/10.2196/34645 %U http://www.ncbi.nlm.nih.gov/pubmed/34992051 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 2 %P e33585 %T Depressive Symptoms and Anxiety During the COVID-19 Pandemic: Large, Longitudinal, Cross-sectional Survey %A MacDonald,James J %A Baxter-King,Ryan %A Vavreck,Lynn %A Naeim,Arash %A Wenger,Neil %A Sepucha,Karen %A Stanton,Annette L %+ Department of Psychology, University of California, Los Angeles, 1285 Franz Hall, Los Angeles, CA, 90025-1563, United States, 1 7742701642, jamesjmacdonald7@gmail.com %K COVID-19 %K depression %K anxiety %K pandemic %K mental health %K public health %K psychological variables %K younger adults %K symptom monitoring %K health intervention %D 2022 %7 10.2.2022 %9 Original Paper %J JMIR Ment Health %G English %X Background: The COVID-19 pandemic has influenced the mental health of millions across the globe. Understanding factors associated with depressive symptoms and anxiety across 12 months of the pandemic can help identify groups at higher risk and psychological processes that can be targeted to mitigate the long-term mental health impact of the pandemic. Objective: This study aims to determine sociodemographic features, COVID-19-specific factors, and general psychological variables associated with depressive symptoms and anxiety over 12 months of the pandemic. Methods: Nationwide, cross-sectional electronic surveys were implemented in May (n=14,636), July (n=14,936), October (n=14,946), and December (n=15,265) 2020 and March/April 2021 (n=14,557) in the United States. Survey results were weighted to be representative of the US population. The samples were drawn from a market research platform, with a 69% cooperation rate. Surveys assessed depressive symptoms in the past 2 weeks and anxiety in the past week, as well as sociodemographic features; COVID-19 restriction stress, worry, perceived risk, coping strategies, and exposure; intolerance of uncertainty; and loneliness. Results: Across 12 months, an average of 24% of respondents reported moderate-to-severe depressive symptoms and 32% reported moderate-to-severe anxiety. Of the sociodemographic variables, age was most consistently associated with depressive symptoms and anxiety, with younger adults more likely to report higher levels of those outcomes. Intolerance of uncertainty and loneliness were consistently and strongly associated with the outcomes. Of the COVID-19-specific variables, stress from COVID-19 restrictions, worry about COVID-19, coping behaviors, and having COVID-19 were associated with a higher likelihood of depressive symptoms and anxiety. Conclusions: Depressive symptoms and anxiety were high in younger adults, adults who reported restriction stress or worry about COVID-19 or who had had COVID-19, and those with intolerance of uncertainty and loneliness. Symptom monitoring as well as early and accessible intervention are recommended. %M 35142619 %R 10.2196/33585 %U https://mental.jmir.org/2022/2/e33585 %U https://doi.org/10.2196/33585 %U http://www.ncbi.nlm.nih.gov/pubmed/35142619 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 2 %N 1 %P e31473 %T The Evolution of Public Sentiments During the COVID-19 Pandemic: Case Comparisons of India, Singapore, South Korea, the United Kingdom, and the United States %A Lwin,May O %A Sheldenkar,Anita %A Lu,Jiahui %A Schulz,Peter Johannes %A Shin,Wonsun %A Panchapakesan,Chitra %A Gupta,Raj Kumar %A Yang,Yinping %+ Wee Kim Wee School of Communication and Information, Nanyang Technological University, 31 Nanyang Link, Singapore, 637718, Singapore, 65 82623610, anitas@ntu.edu.sg %K COVID-19 %K public sentiment %K Twitter %K crisis communication %K cross-country comparison %K sentiment %K social media %K communication %K public health %K health information %K emotion %K perception %K health literacy %K information literacy %K digital literacy %K community health %D 2022 %7 10.2.2022 %9 Original Paper %J JMIR Infodemiology %G English %X Background: Public sentiments are an important indicator of crisis response, with the need to balance exigency without adding to panic or projecting overconfidence. Given the rapid spread of the COVID-19 pandemic, governments have enacted various nationwide measures against the disease with social media platforms providing the previously unparalleled communication space for the global populations. Objective: This research aims to examine and provide a macro-level narrative of the evolution of public sentiments on social media at national levels, by comparing Twitter data from India, Singapore, South Korea, the United Kingdom, and the United States during the current pandemic. Methods: A total of 67,363,091 Twitter posts on COVID-19 from January 28, 2020, to April 28, 2021, were analyzed from the 5 countries with “wuhan,” “corona,” “nCov,” and “covid” as search keywords. Change in sentiments (“very negative,” “negative,” “neutral or mixed,” “positive,” “very positive”) were compared between countries in connection with disease milestones and public health directives. Results: Country-specific assessments show that negative sentiments were predominant across all 5 countries during the initial period of the global pandemic. However, positive sentiments encompassing hope, resilience, and support arose at differing intensities across the 5 countries, particularly in Asian countries. In the next stage of the pandemic, India, Singapore, and South Korea faced escalating waves of COVID-19 cases, resulting in negative sentiments, but positive sentiments appeared simultaneously. In contrast, although negative sentiments in the United Kingdom and the United States increased substantially after the declaration of a national public emergency, strong parallel positive sentiments were slow to surface. Conclusions: Our findings on sentiments across countries facing similar outbreak concerns suggest potential associations between government response actions both in terms of policy and communications, and public sentiment trends. Overall, a more concerted approach to government crisis communication appears to be associated with more stable and less volatile public sentiments over the evolution of the COVID-19 pandemic. %M 37113803 %R 10.2196/31473 %U https://infodemiology.jmir.org/2022/1/e31473 %U https://doi.org/10.2196/31473 %U http://www.ncbi.nlm.nih.gov/pubmed/37113803 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 2 %P e35164 %T Loss of Weight Gained During the COVID-19 Pandemic: Content Analysis of YouTube Videos %A Tang,Hao %A Kim,Sungwoo %A Laforet,Priscila E %A Tettey,Naa-Solo %A Basch,Corey H %+ Department of Health and Behavior Studies, Teachers College, Columbia University, 528 West 121st Street, New York, NY, 10027, United States, 1 2126783964, ht2489@tc.columbia.edu %K COVID-19 %K quarantine %K weight loss %K weight gain %K social media %K YouTube %D 2022 %7 9.2.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Many people experienced unintended weight gain during the COVID-19 pandemic, which has been discussed widely on social media. Objective: This study aims to describe the content of weight loss videos on YouTube (Google LLC) during the COVID-19 pandemic. Methods: By using the keywords weight loss during quarantine, the 100 most viewed English-language videos were identified and coded for content related to losing weight gained during the COVID-19 pandemic. Results: In total, 9 videos were excluded due to having non-English content or posting data before the COVID-19 pandemic. The 91 videos included in the study sample acquired 407,326 views at the time of study and were roughly 14 minutes long. A total of 48% (44/91) of the sample videos included graphic comparisons to illustrate weight change. Videos that included a graphic comparison were more likely to have content related to trigger warnings (χ21=6.05; P=.01), weight loss (χ21=13.39; P<.001), negative feelings during quarantine (χ21=4.75; P=.03), instructions for losing weight (χ21=9.17; P=.002), self-love (χ21=6.01; P=.01), body shaming (χ21=4.36; P=.04), and special dietary practices (χ21=11.10; P<.001) but were less likely to include food recipes (χ21=5.05; P=.03). Our regression analysis results suggested that mentioning quarantine (P=.05), fat-gaining food (P=.04), self-care and self-love (P=.05), and body shaming (P=.008) and having presenters from both sexes (P<.001) are significant predictors for a higher number of views. Our adjusted regression model suggested that videos with content about routine change have significantly lower view counts (P=.03) than those of videos without such content. Conclusions: The findings of this study indicate the ways in which YouTube is being used to showcase COVID-19–related weight loss in a pre-post fashion. The use of graphic comparisons garnered a great deal of attention. Additional studies are needed to understand the role of graphic comparisons in social media posts. Further studies that focus on people’s attitudes and behaviors toward weight change during the COVID-19 pandemic and the implications of social media on these attitudes and behaviors are warranted. %M 34978534 %R 10.2196/35164 %U https://formative.jmir.org/2022/2/e35164 %U https://doi.org/10.2196/35164 %U http://www.ncbi.nlm.nih.gov/pubmed/34978534 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 2 %P e30063 %T COVID-19 Assessment and Testing in Rural Communities During the Pandemic: Cross-sectional Analysis %A Fitzsimon,Jonathan %A Gervais,Oliver %A Lanos,Chelsea %+ Department of Family Medicine, University of Ottawa, Suite 201, 600 Peter Morand Crescent, Ottawa, ON, K1G 5Z3, Canada, 1 613 878 8225, jfitzsi2@uottawa.ca %K healthcare %K virtual care %K access %K COVID-19 %K pandemic %K assessment %K testing %K community paramed %K digital health %K online health %K physician %K virtual health %D 2022 %7 8.2.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The COVID-19 pandemic exacerbated the need for urgent improvements in access to health care for rural, remote, and underserviced communities. The Renfrew County Virtual Triage and Assessment Centre (VTAC) was designed to provide access to COVID-19 testing and assessment with a family physician. The goal was to protect emergency departments and 911 paramedics while ensuring that nobody was left at home, suffering in silence. Residents were encouraged to call their own family physician for any urgent health needs. If they did not have a family physician or could not access their usual primary care provider, then they could call VTAC. This study reports on the output of a service model offering access to assessment and COVID-19 testing through a blend of virtual and in-person care options by a multidisciplinary team. Objective: The purpose of this study was to assess the ability of VTAC to provide access to COVID-19 assessment and testing across rural, remote, and underserviced communities. Methods: We conducted a cross-sectional analysis of the data derived from the cases handled by VTAC between March 27, 2020 (launch day), and September 30, 2020. Results: Residents from all 19 census subdivisions and municipalities of Renfrew County accessed VTAC. A total of 10,086 family physician assessments were completed (average 64 per day). Of these, 8535 (84.6%) assessments were to unique patient users. Thirty physicians provided care. Using digital equipment setup in the patients’ home, 31 patients were monitored remotely. VTAC community paramedics completed 14,378 COVID-19 tests and 3875 home visits. Conclusions: Renfrew County’s experience suggests that there is tremendous synergy between family physicians and community paramedics in providing access to COVID-19 assessment and COVID-19 testing. The blended model of virtual and in-person care is well suited to provide improved access to other aspects of health care post pandemic, particularly for patients without a family physician. %M 35022158 %R 10.2196/30063 %U https://publichealth.jmir.org/2022/2/e30063 %U https://doi.org/10.2196/30063 %U http://www.ncbi.nlm.nih.gov/pubmed/35022158 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 2 %P e31726 %T COVID-19 Vaccine Tweets After Vaccine Rollout: Sentiment–Based Topic Modeling %A Huangfu,Luwen %A Mo,Yiwen %A Zhang,Peijie %A Zeng,Daniel Dajun %A He,Saike %+ The State Key Laboratory of Management and Control for Complex Systems, Institute of Automation, Chinese Academy of Sciences, 95 Zhongguancun East Road, Haidian District, Beijing, 100190, China, 86 (010)82544537, saike.he@ia.ac.cn %K COVID-19 %K COVID-19 vaccine %K sentiment evolution %K topic modeling %K social media %K text mining %D 2022 %7 8.2.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: COVID-19 vaccines are one of the most effective preventive strategies for containing the pandemic. Having a better understanding of the public’s conceptions of COVID-19 vaccines may aid in the effort to promptly and thoroughly vaccinate the community. However, because no empirical research has yet fully explored the public’s vaccine awareness through sentiment–based topic modeling, little is known about the evolution of public attitude since the rollout of COVID-19 vaccines. Objective: In this study, we specifically focused on tweets about COVID-19 vaccines (Pfizer, Moderna, AstraZeneca, and Johnson & Johnson) after vaccines became publicly available. We aimed to explore the overall sentiments and topics of tweets about COVID-19 vaccines, as well as how such sentiments and main concerns evolved. Methods: We collected 1,122,139 tweets related to COVID-19 vaccines from December 14, 2020, to April 30, 2021, using Twitter’s application programming interface. We removed retweets and duplicate tweets to avoid data redundancy, which resulted in 857,128 tweets. We then applied sentiment–based topic modeling by using the compound score to determine sentiment polarity and the coherence score to determine the optimal topic number for different sentiment polarity categories. Finally, we calculated the topic distribution to illustrate the topic evolution of main concerns. Results: Overall, 398,661 (46.51%) were positive, 204,084 (23.81%) were negative, 245,976 (28.70%) were neutral, 6899 (0.80%) were highly positive, and 1508 (0.18%) were highly negative sentiments. The main topics of positive and highly positive tweets were planning for getting vaccination (251,979/405,560, 62.13%), getting vaccination (76,029/405,560, 18.75%), and vaccine information and knowledge (21,127/405,560, 5.21%). The main concerns in negative and highly negative tweets were vaccine hesitancy (115,206/205,592, 56.04%), extreme side effects of the vaccines (19,690/205,592, 9.58%), and vaccine supply and rollout (17,154/205,592, 8.34%). During the study period, negative sentiment trends were stable, while positive sentiments could be easily influenced. Topic heatmap visualization demonstrated how main concerns changed during the current widespread vaccination campaign. Conclusions: To the best of our knowledge, this is the first study to evaluate public COVID-19 vaccine awareness and awareness trends on social media with automated sentiment–based topic modeling after vaccine rollout. Our results can help policymakers and research communities track public attitudes toward COVID-19 vaccines and help them make decisions to promote the vaccination campaign. %M 34783665 %R 10.2196/31726 %U https://www.jmir.org/2022/2/e31726 %U https://doi.org/10.2196/31726 %U http://www.ncbi.nlm.nih.gov/pubmed/34783665 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 2 %N 1 %P e32378 %T Charting the Information and Misinformation Landscape to Characterize Misinfodemics on Social Media: COVID-19 Infodemiology Study at a Planetary Scale %A Chen,Emily %A Jiang,Julie %A Chang,Ho-Chun Herbert %A Muric,Goran %A Ferrara,Emilio %+ Information Sciences Institute, University of Southern California, 4676 Admiralty Way, #1001, Marina del Rey, CA, 90292, United States, 1 310 448 8661, emiliofe@usc.edu %K social media %K social networks %K Twitter %K COVID-19 %K infodemics %K misinfodemics %K infodemiology %K misinformation %D 2022 %7 8.2.2022 %9 Original Paper %J JMIR Infodemiology %G English %X Background: The novel coronavirus, also known as SARS-CoV-2, has come to define much of our lives since the beginning of 2020. During this time, countries around the world imposed lockdowns and social distancing measures. The physical movements of people ground to a halt, while their online interactions increased as they turned to engaging with each other virtually. As the means of communication shifted online, information consumption also shifted online. Governing authorities and health agencies have intentionally shifted their focus to use social media and online platforms to spread factual and timely information. However, this has also opened the gate for misinformation, contributing to and accelerating the phenomenon of misinfodemics. Objective: We carried out an analysis of Twitter discourse on over 1 billion tweets related to COVID-19 over a year to identify and investigate prevalent misinformation narratives and trends. We also aimed to describe the Twitter audience that is more susceptible to health-related misinformation and the network mechanisms driving misinfodemics. Methods: We leveraged a data set that we collected and made public, which contained over 1 billion tweets related to COVID-19 between January 2020 and April 2021. We created a subset of this larger data set by isolating tweets that included URLs with domains that had been identified by Media Bias/Fact Check as being prone to questionable and misinformation content. By leveraging clustering and topic modeling techniques, we identified major narratives, including health misinformation and conspiracies, which were present within this subset of tweets. Results: Our focus was on a subset of 12,689,165 tweets that we determined were representative of COVID-19 misinformation narratives in our full data set. When analyzing tweets that shared content from domains known to be questionable or that promoted misinformation, we found that a few key misinformation narratives emerged about hydroxychloroquine and alternative medicines, US officials and governing agencies, and COVID-19 prevention measures. We further analyzed the misinformation retweet network and found that users who shared both questionable and conspiracy-related content were clustered more closely in the network than others, supporting the hypothesis that echo chambers can contribute to the spread of health misinfodemics. Conclusions: We presented a summary and analysis of the major misinformation discourse surrounding COVID-19 and those who promoted and engaged with it. While misinformation is not limited to social media platforms, we hope that our insights, particularly pertaining to health-related emergencies, will help pave the way for computational infodemiology to inform health surveillance and interventions. %M 35190798 %R 10.2196/32378 %U https://infodemiology.jmir.org/2022/1/e32378 %U https://doi.org/10.2196/32378 %U http://www.ncbi.nlm.nih.gov/pubmed/35190798 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 2 %P e32680 %T An Evaluation of the Text Illness Monitoring (TIM) Platform for COVID-19: Cross-sectional Online Survey of Public Health Users %A Joseph,Heather A %A Ingber,Susan Z %A Austin,Chelsea %A Westnedge,Caroline %A Strona,F V %A Lee,Leslie %A Shah,Ami B %A Roper,Lauren %A Patel,Anita %+ Division of Environmental Health Science and Practice, National Center for Environmental Health, Centers for Disease Control and Prevention, Mailstop 106, 4770 Buford Hwy, Chamblee, GA, 30341, United States, 1 4046392636, hbj7@cdc.gov %K COVID-19 %K contact tracing %K SMS text system %K symptom monitoring %D 2022 %7 7.2.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The US public health response to the COVID-19 pandemic has required contact tracing and symptom monitoring at an unprecedented scale. The US Centers for Disease Control and Prevention and several partners created the Text Illness Monitoring (TIM) platform in 2015 to assist US public health jurisdictions with symptom monitoring for potential novel influenza virus outbreaks. Since May 2020, 142 federal, state, and local public health agencies have deployed TIM for COVID-19 symptom monitoring. Objective: The aim of this study was to evaluate the utility, benefits, and challenges of TIM to help guide decision-making for improvements and expansion to support future public health emergency response efforts. Methods: We conducted a brief online survey of previous and current TIM administrative users (admin users) from November 28 through December 21, 2020. Closed- and open-ended questions inquired about the onboarding process, decision to use TIM, groups monitored with TIM, comparison of TIM to other symptom monitoring systems, technical challenges and satisfaction with TIM, and user support. A total of 1479 admin users were invited to participate. Results: A total of 97 admin users from 43 agencies responded to the survey. Most admin users represented the Indian Health Service (35/97, 36%), state health departments (26/97, 27%), and local or county health departments (18/97, 19%), and almost all were current users of TIM (85/94, 90%). Among the 43 agencies represented, 11 (26%) used TIM for monitoring staff exclusively, 13 (30%) monitored community members exclusively, and 19 (44%) monitored both staff and community members. Agencies most frequently used TIM to monitor symptom development in contacts of cases among community members (28/43, 65%), followed by symptom development among staff (27/43, 63%) and among staff contacts of cases (24/43, 56%). Agencies also reported using TIM to monitor patients with COVID-19 for the worsening of symptoms among staff (21/43, 49%) and community members (18/43, 42%). When asked to compare TIM to previous monitoring systems, 78% (40/51) of respondents rated TIM more favorably than their previous monitoring system, 20% (10/51) said there was no difference, and 2% (1/51) rated the previous monitoring system more favorably than TIM. Most respondents found TIM favorable in terms of time burden, staff burden, timeliness of the data, and the ability to monitor large population sizes. TIM compared negatively to other systems in terms of effort to enroll participants (ie, persons TIM monitors) and accuracy of the data. Most respondents (76/85, 89%) reported that they would highly or somewhat recommend TIM to others for symptom monitoring. Conclusions: This evaluation of TIM showed that agencies used TIM for a variety of purposes and rated TIM favorably compared to previously used monitoring systems. We also identified opportunities to improve TIM; for example, enhancing the flexibility of alert deliveries would better meet admin users’ varying needs. We also suggest continuous program evaluation practices to assess and respond to implementation gaps. %M 34882572 %R 10.2196/32680 %U https://publichealth.jmir.org/2022/2/e32680 %U https://doi.org/10.2196/32680 %U http://www.ncbi.nlm.nih.gov/pubmed/34882572 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 2 %P e32000 %T Fertility Workup With Video Consultation During the COVID-19 Pandemic: Pilot Quantitative and Qualitative Study %A Grens,Hilde %A de Bruin,Jan Peter %A Huppelschoten,Aleida %A Kremer,Jan A M %+ Department of Obstetrics and Gynaecology, Jeroen Bosch Hospital, Henri Dunantstraat 1, 's-Hertogenbosch, 5223 GZ, Netherlands, 31 073 5538660, h.grens@jbz.nl %K COVID-19 %K patient centeredness %K video consultation %K fertility care %K telemedicine %K shared decision making %D 2022 %7 7.2.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Due to the COVID-19 pandemic, major parts of elective health care in the Netherlands, such as reproductive medicine, were paused. When health care was resumed, video consultation was used as a new solution to continue consultations with the new governmental rules of social distancing. Prior to this COVID-19 situation, video consultation was not used extensively in the Netherlands; therefore, physicians and patients are not familiar with this way of consultation. Objective: The purpose of this study was to measure the level of patient centeredness and shared decision making in infertile couples who have undergone fertility workup through video consultation. Methods: This is a questionnaire study with an additional qualitative part for a more in depth understanding. Infertile couples (ie, male and female partners with an unfulfilled wish for a child after 1 year of unprotected intercourse) were referred to a fertility center and underwent fertility workup through video consultation. The fertility workup consisted of 2 separate video consultations, with diagnostic tests according to a protocol. After the last video consultation couples received a digital questionnaire, which consisted of a modified version of the Patient-Centered Questionnaire-Infertility (PCQ-I) and CollaboRATE questionnaire. Fifty-three eligible infertile couples were approached, and of these, 22 participated. Four women were approached for a semistructured interview. Results: The median score on the modified PCQ-I (scale of 0 to 3) was 2.64. The highest rating was for the subscale communication and information, and the lowest rating was for the subscale organization of care. The median score on the CollaboRATE questionnaire (scale of 1 to 9) was 8 for all 3 subquestions. Patients mentioned privacy, less travel time, and easy use of the program as possible benefits of video consultation. However, patients preferred the first consultation with their physician to be face-to-face consultation as video consultation was considered less personal. Conclusions: The high levels of patient centeredness and shared decision making show that video consultation is a promising way of providing care remotely, although attention has to be payed to mitigate the more impersonal setting of video consultation when compared with face-to-face consultation. %M 34936981 %R 10.2196/32000 %U https://formative.jmir.org/2022/2/e32000 %U https://doi.org/10.2196/32000 %U http://www.ncbi.nlm.nih.gov/pubmed/34936981 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 1 %P e30359 %T Opportunities and Challenges for Professionals in Psychiatry and Mental Health Care Using Digital Technologies During the COVID-19 Pandemic: Systematic Review %A Kane,Hélène %A Gourret Baumgart,Jade %A El-Hage,Wissam %A Deloyer,Jocelyn %A Maes,Christine %A Lebas,Marie-Clotilde %A Marazziti,Donatella %A Thome,Johannes %A Fond-Harmant,Laurence %A Denis,Frédéric %+ Laboratoire Éducation, Éthique, Santé, Université de Tours, Boulevard Tonnellé, Tours, 37032, France, 33 279060019, helene.kane@gmail.com %K COVID-19 %K e–mental health %K professional practices %K quality of care %K telepsychiatry %K videoconferencing %D 2022 %7 4.2.2022 %9 Review %J JMIR Hum Factors %G English %X Background: The COVID-19 pandemic has required psychiatric and mental health professionals to change their practices to reduce the risk of transmission of SARS-CoV-2, in particular by favoring remote monitoring and assessment via digital technologies. Objective: As part of a research project that was cofunded by the French National Research Agency (ARN) and the Centre-Val de Loire Region, the aim of this systematic literature review was to investigate how such uses of digital technologies have been developing. Methods: This systematic review was conducted following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The search was carried out in the MEDLINE (ie, PubMed) and Cairn databases, as well as in a platform specializing in mental health, Ascodocpsy. The search yielded 558 results for the year 2020. After applying inclusion and exclusion criteria, first on titles and abstracts and then on full texts, 61 articles were included. Results: The analysis of the literature revealed a heterogeneous integration of digital technologies, not only depending on countries, contexts, and local regulations, but also depending on the modalities of care. Notwithstanding these variations, the use of videoconferencing has developed significantly, affecting working conditions and therapeutic relationships. For many psychiatric and mental health professionals, the pandemic has been an opportunity to build up their experience of remote care and, thus, better identify the possibilities and limits of these digital technologies. Conclusions: New uses of such technologies essentially consist of a transition from the classic consultation model toward teleconsultation and make less use of the specific potential of artificial intelligence. As professionals were not prepared for these uses, they were confronted with practical difficulties and ethical questions, such as the place of digital technology in care, confidentiality and protection of personal data, and equity in access to care. The COVID-19 health crisis questions how the organization of health care integrates the possibilities offered by digital technology, in particular to promote the autonomy and empowerment of mental health service users. %M 34736224 %R 10.2196/30359 %U https://humanfactors.jmir.org/2022/1/e30359 %U https://doi.org/10.2196/30359 %U http://www.ncbi.nlm.nih.gov/pubmed/34736224 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 2 %P e32193 %T An mHealth App for Fibromyalgia-like Post–COVID-19 Syndrome: Protocol for the Analysis of User Experience and Clinical Data %A Blanchard,Marc %A Backhaus,Lars %A Ming Azevedo,Pedro %A Hügle,Thomas %+ Department of Rheumatology, University Hospital of Lausanne, University of Lausanne, Avenue Pierre-Decker 4, Lausanne, Vaud, 1005, Switzerland, 41 794266883, marc_blanchard@bluewin.ch %K post–COVID-19 syndrome %K COVID-19 %K SARS-CoV-2 %K mobile health %K application %K user experience %K testing %K user interface %K long-covid syndrome %K mHealth %K app %K user interface %K protocol %K reinforcement %K learning %K strategy %K symptom %K outcome %K patient-reported outcome %K therapy %K rehabilitation %K monitoring %D 2022 %7 4.2.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Post–COVID-19 syndrome, also referred as “long covid,” describes persisting symptoms after SARS-CoV-2 infection, including myalgia, fatigue, respiratory, or neurological symptoms. Objective symptoms are often lacking, thus resembling a fibromyalgia-like syndrome. Digital therapeutics have shown efficiency in similar chronic disorders such as fibromyalgia, offering specific disease monitoring and interventions such as cognitive behavioral therapy or physical and respiratory exercise guidance. Objective: This protocol aims to study the requirements and features of a new mobile health (mHealth) app among patients with fibromyalgia-like post–COVID-19 syndrome in a clinical trial. Methods: We created a web application prototype for the post–COVID-19 syndrome called “POCOS,” as a web-based rehabilitation tool aiming to improve clinical outcomes. Patients without organ damage or ongoing inflammation will be included in the study. App use will be assessed through user experience questionnaires, focus groups, and clinical data analysis. Subsequently, we will analyze cross-sectional and longitudinal clinical data. Results: The developed mHealth app consists of a clinically adapted app interface with a simplified patient-reported outcome assessment, monitoring of medical interventions, and disease activity as well as web-based instructions for specific physical and respiratory exercises, stress reduction, and lifestyle instructions. The enrollment of participants is expected to be carried out in November 2021. Conclusions: User experience plays an important role in digital therapeutics and needs to be clinically tested to allow further improvement. We here describe this process for a new app for the treatment of the fibromyalgia-like post–COVID-19 syndrome and discuss the relevance of the potential outcomes such as natural disease course and disease phenotypes. International Registered Report Identifier (IRRID): PRR1-10.2196/32193 %M 34982039 %R 10.2196/32193 %U https://www.researchprotocols.org/2022/2/e32193 %U https://doi.org/10.2196/32193 %U http://www.ncbi.nlm.nih.gov/pubmed/34982039 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 2 %P e34702 %T Digital Inclusion as a Foundation for Health Equity. Comment on “Expanding Video Consultation Services at Pace and Scale in Scotland During the COVID-19 Pandemic: National Mixed Methods Case Study” %A Weatherburn,Christopher %+ National Health Service National Services Scotland, Gyle Square 1, South Gyle Crescent, Edinburgh, EH12 9EB, United Kingdom, 44 1382 436343 ext 6337, christopher.weatherburn@nhs.scot %K technology-enabled care %K video consultations %K quality improvement %K COVID-19 %K PERCS framework %K remote consultation %K Scotland %K general practice %K digital inclusion %K digital divide %K digital health equity %D 2022 %7 3.2.2022 %9 Letter to the Editor %J J Med Internet Res %G English %X   %M 35038303 %R 10.2196/34702 %U https://www.jmir.org/2022/2/e34702 %U https://doi.org/10.2196/34702 %U http://www.ncbi.nlm.nih.gov/pubmed/35038303 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 8 %N 1 %P e31392 %T Preparing Medical Students for the Final Examinations During the COVID-19 Crisis: A Bumpy Ride to the Finishing Line %A Mageswaran,Nanthini %A Ismail,Noor Akmal Shareela %+ Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, Kuala Lumpur, 56000, Malaysia, 60 391459552, nasismail@ukm.edu.my %K COVID-19 %K undergraduate medical education %K medical students %K clinical competency %K pandemic %D 2022 %7 3.2.2022 %9 Viewpoint %J JMIR Med Educ %G English %X In this viewpoint, we share and reflect on the experiences of final-year students preparing for a high-stakes examination at the Faculty of Medicine, Universiti Kebangsaan Malaysia during the COVID-19 pandemic. We highlight the new challenges faced during web-based remote learning and major differences in the clinical learning environment at our teaching hospital, which was one of the designated COVID-19 centers in Malaysia. We also document how a face-to-face professional examination was conducted for final-year medical students at our institution despite in times of a global health crisis. The lessons learned throughout this process address the importance of resilience and adaptability in unprecedented times. Further, we recommend appropriate measures that could be applied by medical schools across the world to improve the delivery of quality medical education during a crisis in the years to come. %M 35084354 %R 10.2196/31392 %U https://mededu.jmir.org/2022/1/e31392 %U https://doi.org/10.2196/31392 %U http://www.ncbi.nlm.nih.gov/pubmed/35084354 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 1 %P e33034 %T Trends in Remote Health Care Consumption in Sweden: Comparison Before and During the First Wave of the COVID-19 Pandemic %A Milos Nymberg,Veronica %A Ellegård,Lina Maria %A Kjellsson,Gustav %A Wolff,Moa %A Borgström Bolmsjö,Beata %A Wallman,Thorne %A Calling,Susanna %+ Center for Primary Health Care Research, Department of Clinical Sciences Malmö, Lund University, Building 28, Floor 11, Jan Waldenströms Street 35, Malmö, 20502, Sweden, 46 767700240, veronica.milos_nymberg@med.lu.se %K remote health care %K telemedicine %K primary health care %K respiratory tract infections %K COVID-19 %D 2022 %7 2.2.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Remote assessment of respiratory tract infections (RTIs) has been a controversial topic during the fast development of private telemedicine providers in Swedish primary health care. The possibility to unburden the traditional care has been put against a questionable quality of care as well as risks of increased utilization and costs. The COVID-19 pandemic has contributed to a changed management of patient care to decrease viral spread, with an expected shift in contact types from in-person to remote ones. Objective: The main aim of this study was to compare health care consumption and type of contacts (in-person or remote) for RTIs before and during the COVID-19 pandemic. The second aim was to study whether the number of follow-up contacts after an index contact for RTIs changed during the study period, and whether the number of follow-up contacts differed if the index contact was in-person or remote. A third aim was to study whether the pattern of follow-up contacts differed depending on whether the index contact was with a traditional or a private telemedicine provider. Methods: The study design was an observational retrospective analysis with a description of all index contacts and follow-up contacts with physicians in primary care and emergency rooms in a Swedish region (Skåne) for RTIs including patients of all ages and comparison for the same periods in 2018, 2019, and 2020. Results: Compared with 2018 and 2019, there were fewer index contacts for RTIs per 1000 inhabitants in 2020. By contrast, the number of follow-up contacts, both per 1000 inhabitants and per index contact, was higher in 2020. The composition of both index and follow-up contacts changed as the share of remote contacts, in particular for traditional care providers, increased. Conclusions: During the COVID-19 pandemic in 2020, fewer index contacts for RTIs but more follow-up contacts were conducted, compared with 2018-2019. The share of both index and follow-up contacts that were conducted remotely increased. Further studies are needed to study the reasons behind the increase in remote contacts, and if it will last after the pandemic, and more clinical guidelines for remote assessments of RTI are warranted. %M 34846304 %R 10.2196/33034 %U https://humanfactors.jmir.org/2022/1/e33034 %U https://doi.org/10.2196/33034 %U http://www.ncbi.nlm.nih.gov/pubmed/34846304 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 2 %P e35552 %T A Deadly Infodemic: Social Media and the Power of COVID-19 Misinformation %A Gisondi,Michael A %A Barber,Rachel %A Faust,Jemery Samuel %A Raja,Ali %A Strehlow,Matthew C %A Westafer,Lauren M %A Gottlieb,Michael %+ The Precision Education and Assessment Research Lab, Department of Emergency Medicine, Stanford University, 900 Welch Road - Suite 350, Palo Alto, CA, 94304, United States, 1 650 721 4023, mgisondi@stanford.edu %K COVID-19 %K social media %K misinformation %K disinformation %K infodemic %K ethics %K vaccination %K vaccine hesitancy %K infoveillance %K vaccine %D 2022 %7 1.2.2022 %9 Editorial %J J Med Internet Res %G English %X COVID-19 is currently the third leading cause of death in the United States, and unvaccinated people continue to die in high numbers. Vaccine hesitancy and vaccine refusal are fueled by COVID-19 misinformation and disinformation on social media platforms. This online COVID-19 infodemic has deadly consequences. In this editorial, the authors examine the roles that social media companies play in the COVID-19 infodemic and their obligations to end it. They describe how fake news about the virus developed on social media and acknowledge the initially muted response by the scientific community to counteract misinformation. The authors then challenge social media companies to better mitigate the COVID-19 infodemic, describing legal and ethical imperatives to do so. They close with recommendations for better partnerships with community influencers and implementation scientists, and they provide the next steps for all readers to consider. This guest editorial accompanies the Journal of Medical Internet Research special theme issue, “Social Media, Ethics, and COVID-19 Misinformation.” %M 35007204 %R 10.2196/35552 %U https://www.jmir.org/2022/2/e35552 %U https://doi.org/10.2196/35552 %U http://www.ncbi.nlm.nih.gov/pubmed/35007204 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 2 %P e29012 %T The Impact of Artificial Intelligence on Waiting Time for Medical Care in an Urgent Care Service for COVID-19: Single-Center Prospective Study %A Bin,Kaio Jia %A Melo,Adler Araujo Ribeiro %A da Rocha,José Guilherme Moraes Franco %A de Almeida,Renata Pivi %A Cobello Junior,Vilson %A Maia,Fernando Liebhart %A de Faria,Elizabeth %A Pereira,Antonio José %A Battistella,Linamara Rizzo %A Ono,Suzane Kioko %+ Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo, Rua Dr. Ovidio Pires de Campos 225, Sao Paulo, 05403-110, Brazil, 55 1126616208, kaiobin@gmail.com %K COVID-19 %K artificial intelligence %K robotic process automation %K digital health %K health care management %K pandemic %K waiting time %K queue %K nonvalue-added activities %D 2022 %7 1.2.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: To demonstrate the value of implementation of an artificial intelligence solution in health care service, a winning project of the Massachusetts Institute of Technology Hacking Medicine Brazil competition was implemented in an urgent care service for health care professionals at Hospital das Clínicas of the Faculdade de Medicina da Universidade de São Paulo during the COVID-19 pandemic. Objective: The aim of this study was to determine the impact of implementation of the digital solution in the urgent care service, assessing the reduction of nonvalue-added activities and its effect on the nurses’ time required for screening and the waiting time for patients to receive medical care. Methods: This was a single-center, comparative, prospective study designed according to the Public Health England guide “Evaluating Digital Products for Health.” A total of 38,042 visits were analyzed over 18 months to determine the impact of implementing the digital solution. Medical care registration, health screening, and waiting time for medical care were compared before and after implementation of the digital solution. Results: The digital solution automated 92% of medical care registrations. The time for health screening increased by approximately 16% during the implementation and in the first 3 months after the implementation. The waiting time for medical care after automation with the digital solution was reduced by approximately 12 minutes compared with that required for visits without automation. The total time savings in the 12 months after implementation was estimated to be 2508 hours. Conclusions: The digital solution was able to reduce nonvalue-added activities, without a substantial impact on health screening, and further saved waiting time for medical care in an urgent care service in Brazil during the COVID-19 pandemic. %M 35103611 %R 10.2196/29012 %U https://formative.jmir.org/2022/2/e29012 %U https://doi.org/10.2196/29012 %U http://www.ncbi.nlm.nih.gov/pubmed/35103611 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 1 %P e35763 %T Has Omicron Changed the Evolution of the Pandemic? %A Lundberg,Alexander L %A Lorenzo-Redondo,Ramon %A Ozer,Egon A %A Hawkins,Claudia A %A Hultquist,Judd F %A Welch,Sarah B %A Prasad,PV Vara %A Oehmke,James F %A Achenbach,Chad J %A Murphy,Robert L %A White,Janine I %A Havey,Robert J %A Post,Lori Ann %+ Buehler Center for Health Policy and Economics, Robert J. Havey, MD Institute for Global Health, Northwestern University, 750 N. Lake Shore Drive, Chicago, IL, 60611, United States, 1 312 503 5659, lori.post@northwestern.edu %K Omicron %K SARS-CoV-2 %K public health surveillance %K VOC %K variant of concern %K Delta %K Beta %K COVID-19 %K sub-Saharan Africa %K public health %K pandemic %K epidemiology %D 2022 %7 31.1.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Variants of the SARS-CoV-2 virus carry differential risks to public health. The Omicron (B.1.1.529) variant, first identified in Botswana on November 11, 2021, has spread globally faster than any previous variant of concern. Understanding the transmissibility of Omicron is vital in the development of public health policy. Objective: The aim of this study is to compare SARS-CoV-2 outbreaks driven by Omicron to those driven by prior variants of concern in terms of both the speed and magnitude of an outbreak. Methods: We analyzed trends in outbreaks by variant of concern with validated surveillance metrics in several southern African countries. The region offers an ideal setting for a natural experiment given that most outbreaks thus far have been driven primarily by a single variant at a time. With a daily longitudinal data set of new infections, total vaccinations, and cumulative infections in countries in sub-Saharan Africa, we estimated how the emergence of Omicron has altered the trajectory of SARS-CoV-2 outbreaks. We used the Arellano-Bond method to estimate regression coefficients from a dynamic panel model, in which new infections are a function of infections yesterday and last week. We controlled for vaccinations and prior infections in the population. To test whether Omicron has changed the average trajectory of a SARS-CoV-2 outbreak, we included an interaction between an indicator variable for the emergence of Omicron and lagged infections. Results: The observed Omicron outbreaks in this study reach the outbreak threshold within 5-10 days after first detection, whereas other variants of concern have taken at least 14 days and up to as many as 35 days. The Omicron outbreaks also reach peak rates of new cases that are roughly 1.5-2 times those of prior variants of concern. Dynamic panel regression estimates confirm Omicron has created a statistically significant shift in viral spread. Conclusions: The transmissibility of Omicron is markedly higher than prior variants of concern. At the population level, the Omicron outbreaks occurred more quickly and with larger magnitude, despite substantial increases in vaccinations and prior infections, which should have otherwise reduced susceptibility to new infections. Unless public health policies are substantially altered, Omicron outbreaks in other countries are likely to occur with little warning. %M 35072638 %R 10.2196/35763 %U https://publichealth.jmir.org/2022/1/e35763 %U https://doi.org/10.2196/35763 %U http://www.ncbi.nlm.nih.gov/pubmed/35072638 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 1 %P e32368 %T Intensive Care Unit–Specific Virtual Reality for Critically Ill Patients With COVID-19: Multicenter Randomized Controlled Trial %A Vlake,Johan H %A van Bommel,Jasper %A Wils,Evert-Jan %A Bienvenu,Joe %A Hellemons,Merel E %A Korevaar,Tim IM %A Schut,Anna FC %A Labout,Joost AM %A Schreuder,Lois LH %A van Bavel,Marten P %A Gommers,Diederik %A van Genderen,Michel E %+ Department of Intensive Care, Erasmus MC, Dr Molewaterplein 40, Rotterdam, 3015 GD, Netherlands, 31 107039881, m.vangenderen@erasmusmc.nl %K SARS-CoV-2 %K intensive care %K post-intensive care syndrome %K virtual reality %K quality of life %K satisfaction %K COVID-19 %D 2022 %7 31.1.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Although psychological sequelae after intensive care unit (ICU) treatment are considered quite intrusive, robustly effective interventions to treat or prevent these long-term sequelae are lacking. Recently, it was demonstrated that ICU-specific virtual reality (ICU-VR) is a feasible and acceptable intervention with potential mental health benefits. However, its effect on mental health and ICU aftercare in COVID-19 ICU survivors is unknown. Objective: This study aimed to explore the effects of ICU-VR on mental health and on patients’ perceived quality of, satisfaction with, and rating of ICU aftercare among COVID-19 ICU survivors. Methods: This was a multicenter randomized controlled trial. Patients were randomized to either the ICU-VR (intervention) or the control group. All patients were invited to an COVID-19 post-ICU follow-up clinic 3 months after hospital discharge, during which patients in the intervention group received ICU-VR. One month and 3 months later (4 and 6 months after hospital discharge), mental health, quality of life, perceived quality, satisfaction with, and rating of ICU aftercare were scored using questionnaires. Results: Eighty-nine patients (median age 58 years; 63 males, 70%) were included. The prevalence and severity of psychological distress were limited throughout follow-up, and no differences in psychological distress or quality of life were observed between the groups. ICU-VR improved satisfaction with (mean score 8.7, SD 1.6 vs 7.6, SD 1.6 [ICU-VR vs control]; t64=–2.82, P=.006) and overall rating of ICU aftercare (mean overall rating of aftercare 8.9, SD 0.9 vs 7.8, SD 1.7 [ICU-VR vs control]; t64=–3.25; P=.002) compared to controls. ICU-VR added to the quality of ICU aftercare according to 81% of the patients, and all patients would recommend ICU-VR to other ICU survivors. Conclusions: ICU-VR is a feasible and acceptable innovative method to improve satisfaction with and rating of ICU aftercare and adds to its perceived quality. We observed a low prevalence of psychological distress after ICU treatment for COVID-19, and ICU-VR did not improve psychological recovery or quality of life. Future research is needed to confirm our results in other critical illness survivors to potentially facilitate ICU-VR’s widespread availability and application during follow-up. Trial Registration: Netherlands Trial Register NL8835; https://www.trialregister.nl/trial/8835 International Registered Report Identifier (IRRID): RR2-10.1186/s13063-021-05271-z %M 34978530 %R 10.2196/32368 %U https://www.jmir.org/2022/1/e32368 %U https://doi.org/10.2196/32368 %U http://www.ncbi.nlm.nih.gov/pubmed/34978530 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 1 %P e32552 %T The Impact of the COVID-19 Infodemic on Depression and Sleep Disorders: Focusing on Uncertainty Reduction Strategies and Level of Interpretation Theory %A Jung,Soyoung %A Jung,Sooin %+ The School of Journalism and Communication, Renmin University of China, 59 Zhongguancun Street, Haidian District, Room 502, Mingde Building, Beijing, 100872, China, 86 10 62514835, soyoungjungs@gmail.com %K COVID-19 %K social media %K infodemic %K construal level theory %K uncertainty reduction strategy %K depression %K sleep disorder %K preventive actions, affective reaction %K infodemiology %K misinformation %K uncertainty %K strategy %K mental health %K sleep %K prevention %K survey %K usage %K behavior %D 2022 %7 31.1.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: During the COVID-19 pandemic, information diffusion about the COVID-19 has attracted public attention through social media. The World Health Organization declared an infodemic of COVID-19 on February 15, 2020. Misinformation and disinformation, including overwhelming amounts of information about COVID-19 on social media, could promote adverse psychological effects. Objective: This study used the Psychological Distance and Level of Construal theory (CLT) to predict peoples’ negative psychological symptoms from social media usage. In this study, the CLT intended to show peoples’ psychological proximity to objects and events with respect to the COVID-19 pandemic. Furthermore, this study links the uncertainty reduction strategy (URS) and CLT for COVID-19–related preventive behaviors and affective reactions to assess their effects on mental health problems. Methods: A path model was tested (N=297) with data from a web-based survey to examine how social media usage behaviors are associated with URS and psychological distance with COVID-19 (based on the CLT), leading to preventive behaviors and affective reactions. Finally, the path model was used to examine how preventive behaviors and affective reactions are associated with mental health problems including anxiety and sleep disorder. Results: After measuring participants’ social media usage behavior, we found that an increase in general social media usage led to higher use of the URS and lower construal level on COVID-19. The URS is associated with preventive behaviors, but the CLT did not show any association with preventive behaviors; however, it increases affective reactions. Moreover, increased preventive behavior showed negative associations with symptoms of mental health problems; that is, depression and sleep disorder. However, the affective reaction tends to be positively associated with depression and sleep disorder. Owing to the infodemic of COVID-19, the psychological perception of the pandemic negatively influenced users’ mental health problems. Conclusions: Our results imply that the information from social media usage heightened concerns and had a lower construal level; this does not facilitate taking preventive actions but rather reinforces the negative emotional reaction and mental health problems. Thus, higher URS usage is desirable. %M 34870609 %R 10.2196/32552 %U https://formative.jmir.org/2022/1/e32552 %U https://doi.org/10.2196/32552 %U http://www.ncbi.nlm.nih.gov/pubmed/34870609 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 1 %P e33114 %T Problematic Internet Use Before and During the COVID-19 Pandemic in Youth in Outpatient Mental Health Treatment: App-Based Ecological Momentary Assessment Study %A Gansner,Meredith %A Nisenson,Melanie %A Lin,Vanessa %A Pong,Sovannarath %A Torous,John %A Carson,Nicholas %+ Department of Psychiatry, Cambridge Health Alliance, 1493 Cambridge Street, Cambridge, MA, 02139, United States, 1 617 575 5498, meredith.gansner@gmail.com %K COVID-19 %K problematic internet use %K ecological momentary assessment %K internet %K app %K youth %K young adult %K teenager %K outpatient %K mental health %K treatment %K pilot %K cohort %K change %D 2022 %7 28.1.2022 %9 Original Paper %J JMIR Ment Health %G English %X Background: Youth with existing psychiatric illness are more apt to use the internet as a coping skill. Because many “in-person” coping skills were not easily accessible during the COVID-19 pandemic, youth in outpatient mental health treatment may have been particularly vulnerable to the development of problematic internet use (PIU). The identification of a pandemic-associated worsening of PIU in this population is critical in order to guide clinical care; if these youth have become dependent upon the internet to regulate their negative emotions, PIU must be addressed as part of mental health treatment. However, many existing studies of youth digital media use in the pandemic do not include youth in psychiatric treatment or are reliant upon cross-sectional methodology and self-report measures of digital media use. Objective: This is a retrospective cohort study that used data collected from an app-based ecological momentary assessment protocol to examine potential pandemic-associated changes in digital media youth in outpatient mental health treatment. Secondary analyses assessed for differences in digital media use dependent upon personal and familial COVID-19 exposure and familial hospitalization, as well as factors associated with PIU in this population. Methods: The participants were aged 12-23 years and were receiving mental health treatment in an outpatient community hospital setting. All participants completed a 6-week daily ecological momentary assessment protocol on their personal smartphones. Questions were asked about depression (PHQ-8 [8-item Patient Health Questionnaire]), anxiety (GAD-7 [7-item General Anxiety Disorder]), PIU (PIU-SF-6 [Problematic Internet Use Short Form 6]), digital media use based on Apple’s daily screen time reports, and personal and familial COVID-19 exposure. The analyses compared screen time, psychiatric symptoms, and PIU between cohorts, as well as between youth with personal or familial COVID-19 exposures and those without. The analyses also assessed for demographic and psychiatric factors associated with clinically significant PIU-SF-6 scores. Results: A total of 69 participants completed the study. The participants recruited during the pandemic were significantly more likely to meet the criteria for PIU based on their average PIU-SF-6 score (P=.02) and to spend more time using social media each day (P=.049). The overall amount of daily screen time did not differ between cohorts. Secondary analyses revealed a significant increase in average daily screen time among subjects who were exposed to COVID-19 (P=.01). Youth with clinically significant PIU-SF-6 scores were younger and more likely to have higher PHQ-8 (P=.003) and GAD-7 (P=.003) scores. No differences in scale scores or media use were found between subjects based on familial COVID-19 exposure or hospitalization. Conclusions: Our findings support our hypothesis that PIU may have worsened for youth in mental health treatment during the pandemic, particularly the problematic use of social media. Mental health clinicians should incorporate screening for PIU into routine clinical care in order to prevent potential familial conflict and subsequent psychiatric crises that might stem from unrecognized PIU. %M 35089157 %R 10.2196/33114 %U https://mental.jmir.org/2022/1/e33114 %U https://doi.org/10.2196/33114 %U http://www.ncbi.nlm.nih.gov/pubmed/35089157 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 1 %P e30204 %T Patient Satisfaction and Recommendations for Delivering a Group-Based Intensive Outpatient Program via Telemental Health During the COVID-19 Pandemic: Cross-sectional Cohort Study %A Skime,Michelle K %A Puspitasari,Ajeng J %A Gentry,Melanie T %A Heredia Jr,Dagoberto %A Sawchuk,Craig N %A Moore,Wendy R %A Taylor-Desir,Monica J %A Schak,Kathryn M %+ Department of Psychiatry and Psychology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55902, United States, 1 507 255 0501, skime.michelle@mayo.edu %K COVID-19 %K telemental health %K teletherapy %K telepsychiatry %K telemedicine %K intensive outpatient %K patient satisfaction %D 2022 %7 28.1.2022 %9 Original Paper %J JMIR Ment Health %G English %X Background: Although group-based intensive outpatient programs (IOPs) are a level of care commonly utilized by adults with serious mental illness, few studies have examined the acceptability of group-based IOPs that required rapid transition to a telemental health (TMH) format during the COVID-19 pandemic. Objective: The aim of this study was to evaluate patient satisfaction and future recommendations for a group-based IOP that was transitioned to a TMH format during the COVID-19 pandemic. Methods: A 17-item patient satisfaction questionnaire was completed by patients at discharge and covered 3 areas: IOP TMH satisfaction, future recommendations, and video technology challenges. Descriptive and content analyses were conducted for the quantitative and open-ended questions, respectively. Results: A total of 76 patients completed the program in 2020. A subset of patients (n=40, 53%) responded to the survey at program discharge. The results indicated that the patients were satisfied overall with the TMH program format; 50% (n=20) of the patients preferred the program continue offering the TMH format, and the rest preferred returning to in-person formats after the pandemic. The patients indicated the elements of the program that they found most valuable and provided recommendations for future program improvement. Conclusions: Overall, adults with serious mental illness reported high satisfaction with the group-based IOP delivered via TMH. Health care systems may want to consider offering both TMH and in-person formats regardless of the state of the pandemic. Patients’ feedback on future improvements should be considered to help ensure long-term success. %M 34878999 %R 10.2196/30204 %U https://mental.jmir.org/2022/1/e30204 %U https://doi.org/10.2196/30204 %U http://www.ncbi.nlm.nih.gov/pubmed/34878999 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 11 %N 1 %P e29880 %T Quantifying the Impact of COVID-19 on Telemedicine Utilization: Retrospective Observational Study %A Vogt,Emily Louise %A Welch,Brandon M %A Bunnell,Brian E %A Barrera,Janelle F %A Paige,Samantha R %A Owens,Marisa %A Coffey,Patricia %A Diazgranados,Nancy %A Goldman,David %+ Lab of Neurogenetics, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, 5625 Fishers Lane, Rm 3S-32: MSC 9412, Rockville, MD, 20892, United States, 1 301 443 0059, davidgoldman@mail.nih.gov %K telemedicine %K COVID-19 %K utilization %K impact %K retrospective %K observational %K trend %K telehealth %K health policy %K policy %D 2022 %7 28.1.2022 %9 Original Paper %J Interact J Med Res %G English %X Background: While telemedicine has been expanding over the past decade, the COVID-19–related restrictions regarding in-person care have led to unprecedented levels of telemedicine utilization. To the authors’ knowledge, no studies to date have quantitatively analyzed both national and regional trends in telemedicine utilization during the pandemic, both of which have key implications for informing health policy. Objective: This study aimed to investigate how trends in telemedicine utilization changed across the course of the COVID-19 pandemic. Methods: Using data from doxy.me, the largest free telemedicine platform, and the NIH (National Institutes of Health) Clinical Center, the largest clinical research hospital in the United States, we assessed changes in total telemedicine minutes, new provider registrations, monthly sessions, and average session length from March to November 2020. We also conducted a state-level analysis of how telemedicine expansion differed by region. Results: National telemedicine utilization peaked in April 2020 at 291 million minutes and stabilized at 200 to 220 million monthly minutes from May to November 2020. Surges were strongest in New England and weakest in the South and West. Greater telemedicine expansion during the COVID-19 pandemic was geographically associated with fewer COVID-19 cases per capita. The nature of telemedicine visits also changed, as the average monthly visits per provider doubled and the average visit length decreased by 60%. Conclusions: The COVID-19 pandemic led to an abrupt and subsequently sustained uptick in telemedicine utilization. Regional and institute-level differences in telemedicine utilization should be further investigated to inform policy and procedures for sustaining meaningful telemedicine use in clinical practice. %M 34751158 %R 10.2196/29880 %U https://www.i-jmr.org/2022/1/e29880 %U https://doi.org/10.2196/29880 %U http://www.ncbi.nlm.nih.gov/pubmed/34751158 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 1 %P e34475 %T The Use of a Computerized Cognitive Assessment to Improve the Efficiency of Primary Care Referrals to Memory Services: Protocol for the Accelerating Dementia Pathway Technologies (ADePT) Study %A Kalafatis,Chris %A Modarres,Mohammad Hadi %A Apostolou,Panos %A Tabet,Naji %A Khaligh-Razavi,Seyed-Mahdi %+ Cognetivity Neurosciences Ltd, 3 Waterhouse Square, London, EC1N 2SW, United Kingdom, 44 020 3002 362, seyed@cognetivity.com %K primary health care %K general practice %K dementia %K cognitive assessment %K artificial intelligence %K early diagnosis %K cognition %K assessment %K efficiency %K diagnosis %K COVID-19 %K memory %K mental health %K impairment %K screening %K detection %K efficiency %D 2022 %7 27.1.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Existing primary care cognitive assessment tools are crude or time-consuming screening instruments which can only detect cognitive impairment when it is well established. Due to the COVID-19 pandemic, memory services have adapted to the new environment by moving to remote patient assessments to continue meeting service user demand. However, the remote use of cognitive assessments has been variable while there has been scant evaluation of the outcome of such a change in clinical practice. Emerging research in remote memory clinics has highlighted computerized cognitive tests, such as the Integrated Cognitive Assessment (ICA), as prominent candidates for adoption in clinical practice both during the pandemic and for post-COVID-19 implementation as part of health care innovation. Objective: The aim of the Accelerating Dementia Pathway Technologies (ADePT) study is to develop a real-world evidence basis to support the adoption of ICA as an inexpensive screening tool for the detection of cognitive impairment to improve the efficiency of the dementia care pathway. Methods: Patients who have been referred to a memory clinic by a general practitioner (GP) are recruited. Participants complete the ICA either at home or in the clinic along with medical history and usability questionnaires. The GP referral and ICA outcome are compared with the specialist diagnosis obtained at the memory clinic. The clinical outcomes as well as National Health Service reference costing data will be used to assess the potential health and economic benefits of the use of the ICA in the dementia diagnosis pathway. Results: The ADePT study was funded in January 2020 by Innovate UK (Project Number 105837). As of September 2021, 86 participants have been recruited in the study, with 23 participants also completing a retest visit. Initially, the study was designed for in-person visits at the memory clinic; however, in light of the COVID-19 pandemic, the study was amended to allow remote as well as face-to-face visits. The study was also expanded from a single site to 4 sites in the United Kingdom. We expect results to be published by the second quarter of 2022. Conclusions: The ADePT study aims to improve the efficiency of the dementia care pathway at its very beginning and supports systems integration at the intersection between primary and secondary care. The introduction of a standardized, self-administered, digital assessment tool for the timely detection of neurodegeneration as part of a decision support system that can signpost accordingly can reduce unnecessary referrals, service backlog, and assessment variability. Trial Registration: ISRCTN 16596456; https://www.isrctn.com/ISRCTN16596456 International Registered Report Identifier (IRRID): DERR1-10.2196/34475 %M 34932495 %R 10.2196/34475 %U https://www.researchprotocols.org/2022/1/e34475 %U https://doi.org/10.2196/34475 %U http://www.ncbi.nlm.nih.gov/pubmed/34932495 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 1 %P e32731 %T Using the COVID-19 Pandemic to Assess the Influence of News Affect on Online Mental Health-Related Search Behavior Across the United States: Integrated Sentiment Analysis and the Circumplex Model of Affect %A Lekkas,Damien %A Gyorda,Joseph A %A Price,George D %A Wortzman,Zoe %A Jacobson,Nicholas C %+ Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, 46 Centerra Parkway, Suite 300, Office #313S, Lebanon, NH, 03766, United States, 1 603 646 7000, Damien.Lekkas.GR@dartmouth.edu %K affect %K sentiment %K circumplex %K news %K mental health %K online search behavior %K generalized mixed models %K natural language processing %K anxiety %K depression %K coronavirus %K internet %K information seeking %K behavior %K online health information %K COVID-19 %D 2022 %7 27.1.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: The digital era has ushered in an unprecedented volume of readily accessible information, including news coverage of current events. Research has shown that the sentiment of news articles can evoke emotional responses from readers on a daily basis with specific evidence for increased anxiety and depression in response to coverage of the recent COVID-19 pandemic. Given the primacy and relevance of such information exposure, its daily impact on the mental health of the general population within this modality warrants further nuanced investigation. Objective: Using the COVID-19 pandemic as a subject-specific example, this work aimed to profile and examine associations between the dynamics of semantic affect in online local news headlines and same-day online mental health term search behavior over time across the United States. Methods: Using COVID-19–related news headlines from a database of online news stories in conjunction with mental health–related online search data from Google Trends, this paper first explored the statistical and qualitative affective properties of state-specific COVID-19 news coverage across the United States from January 23, 2020, to October 22, 2020. The resultant operationalizations and findings from the joint application of dictionary-based sentiment analysis and the circumplex theory of affect informed the construction of subsequent hypothesis-driven mixed effects models. Daily state-specific counts of mental health search queries were regressed on circumplex-derived features of semantic affect, time, and state (as a random effect) to model the associations between the dynamics of news affect and search behavior throughout the pandemic. Search terms were also grouped into depression symptoms, anxiety symptoms, and nonspecific depression and anxiety symptoms to model the broad impact of news coverage on mental health. Results: Exploratory efforts revealed patterns in day-to-day news headline affect variation across the first 9 months of the pandemic. In addition, circumplex mapping of the most frequently used words in state-specific headlines uncovered time-agnostic similarities and differences across the United States, including the ubiquitous use of negatively valenced and strongly arousing language. Subsequent mixed effects modeling implicated increased consistency in affective tone (SpinVA β=–.207; P<.001) as predictive of increased depression-related search term activity, with emotional language patterns indicative of affective uncontrollability (FluxA β=.221; P<.001) contributing generally to an increase in online mental health search term frequency. Conclusions: This study demonstrated promise in applying the circumplex model of affect to written content and provided a practical example for how circumplex theory can be integrated with sentiment analysis techniques to interrogate mental health–related associations. The findings from pandemic-specific news headlines highlighted arousal, flux, and spin as potentially significant affect-based foci for further study. Future efforts may also benefit from more expansive sentiment analysis approaches to more broadly test the practical application and theoretical capabilities of the circumplex model of affect on text-based data. %M 34932494 %R 10.2196/32731 %U https://www.jmir.org/2022/1/e32731 %U https://doi.org/10.2196/32731 %U http://www.ncbi.nlm.nih.gov/pubmed/34932494 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 2 %N 1 %P e29894 %T Misinformation About and Interest in Chlorine Dioxide During the COVID-19 Pandemic in Mexico Identified Using Google Trends Data: Infodemiology Study %A Chejfec-Ciociano,Jonathan Matias %A Martínez-Herrera,Juan Pablo %A Parra-Guerra,Alexa Darianna %A Chejfec,Ricardo %A Barbosa-Camacho,Francisco José %A Ibarrola-Peña,Juan Carlos %A Cervantes-Guevara,Gabino %A Cervantes-Cardona,Guillermo Alonso %A Fuentes-Orozco,Clotilde %A Cervantes-Pérez,Enrique %A García-Reyna,Benjamín %A González-Ojeda,Alejandro %+ Unidad de Investigación Biomédica 02, Hospital de Especialidades del Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Belisario Domínguez 1000, Guadalajara, 44349, Mexico, 52 3331294165, avygail5@gmail.com %K coronavirus %K COVID-19 %K Google Trends %K chlorine dioxide %K COVID-19 misinformation %K public health surveillance %K infodemiology %K internet behavior %K digital epidemiology %K internet %K mHealth %K mobile health %K pandemic %K tele-epidemiology %D 2022 %7 27.1.2022 %9 Original Paper %J JMIR Infodemiology %G English %X Background: The COVID-19 pandemic has prompted the increasing popularity of several emerging therapies or preventives that lack scientific evidence or go against medical directives. One such therapy involves the consumption of chlorine dioxide, which is commonly used in the cleaning industry and is available commercially as a mineral solution. This substance has been promoted as a preventive or treatment agent for several diseases, including SARS-CoV-2 infection. As interest in chlorine dioxide has grown since the start of the pandemic, health agencies, institutions, and organizations worldwide have tried to discourage and restrict the consumption of this substance. Objective: The aim of this study is to analyze search engine trends in Mexico to evaluate changes in public interest in chlorine dioxide since the beginning of the COVID-19 pandemic. Methods: We retrieved public query data for the Spanish equivalent of the term “chlorine dioxide” from the Google Trends platform. The location was set to Mexico, and the time frame was from March 3, 2019, to February 21, 2021. A descriptive analysis was performed. The Kruskal-Wallis and Dunn tests were used to identify significant changes in search volumes for this term between four consecutive time periods, each of 13 weeks, from March 1, 2020, to February 27, 2021. Results: From the start of the pandemic in Mexico (February 2020), an upward trend was observed in the number of searches compared with that in 2019. Maximum volume trends were recorded during the week of July 19-25, 2020. The search volumes declined between September and November 2020, but another peak was registered in December 2020 through February 2021, which reached a maximum value on January 10. Percentage change from the first to the fourth time periods was +312.85, –71.35, and +228.18, respectively. Pairwise comparisons using the Kruskal-Wallis and Dunn tests showed significant differences between the four periods (P<.001). Conclusions: Misinformation is a public health risk because it can lower compliance with the recommended measures and encourage the use of therapies that have not been proven safe. The ingestion of chlorine dioxide presents a danger to the population, and several adverse reactions have been reported. Programs should be implemented to direct those interested in this substance to accurate medical information. %M 35155994 %R 10.2196/29894 %U https://infodemiology.jmir.org/2022/1/e29894 %U https://doi.org/10.2196/29894 %U http://www.ncbi.nlm.nih.gov/pubmed/35155994 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 1 %P e30361 %T Pulse Oximeter App Privacy Policies During COVID-19: Scoping Assessment %A Hendricks-Sturrup,Rachele %+ Future of Privacy Forum, 1400 I St NW, Suite 450, Washington, DC, 20005, United States, 1 202 768 8950, rachele.hendricks.sturrup@duke.edu %K COVID-19 %K pulse oximeters %K mobile apps %K mHealth %K privacy %D 2022 %7 27.1.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Pulse oximeter apps became of interest to consumers during the COVID-19 pandemic, particularly when traditional over-the-counter pulse oximeter devices were in short supply. Yet, no study to date has examined or scoped the state of privacy policies and notices for the top-rated and most downloaded pulse oximeter apps during COVID-19. Objective: The aim of this study was to examine, through a high-level qualitative assessment, the state and nature of privacy policies for the downloaded and top-rated pulse oximeter apps during the COVID-19 pandemic to (1) compare findings against comparable research involving other mobile health (mHealth) apps and (2) begin discussions on opportunities for future research or investigation. Methods: During August-October 2020, privacy policies were reviewed for pulse oximeter apps that had either at least 500 downloads (Google Play Store apps only) or a three out of five-star rating (Apple Store apps only). In addition to determining if the apps had an accessible privacy policy, other key privacy policy–related details that were extracted included, but were not limited to, app developer location (country); whether the app was free or required paid use/subscription; whether an ads disclosure was provided on the app’s site; the scope of personal data collected; proportionality, fundamental rights, and data protection and privacy issues; and privacy safeguards. Results: Six pulse oximeter apps met the inclusion criteria and only 33% (n=2) of the six apps had an accessible privacy policy that was specific to the pulse oximeter app feature (vs the app developer’s website or at all). Variation was found in both the regulatory nature and data privacy protections offered by pulse oximeter apps, with notable privacy protection limitations and gaps, although each app provided at least some information about the scope of personal data collected upon installing the app. Conclusions: Pulse oximeter app developers should invest in offering stronger privacy protections for their app users, and should provide more accessible and transparent privacy policies. This is a necessary first step to ensure that the data privacy of mHealth consumers is not exploited during public health emergency situations such as the COVID-19 pandemic, where over-the-counter personal health monitoring devices could be in short supply and patients and consumers may, as a result, turn to mHealth apps to fill such supply gaps. Future research considerations and recommendations are also suggested for mHealth technology and privacy researchers who are interested in examining privacy implications associated with the use of pulse oximeter apps during and after the COVID-19 pandemic. %M 35084348 %R 10.2196/30361 %U https://mhealth.jmir.org/2022/1/e30361 %U https://doi.org/10.2196/30361 %U http://www.ncbi.nlm.nih.gov/pubmed/35084348 %0 Journal Article %@ 2563-6316 %I JMIR Publications %V 3 %N 1 %P e29539 %T COVID-19 Infection and Symptoms Among Emergency Medicine Residents and Fellows in an Urban Academic Hospital Setting: Cross-sectional Questionnaire Study %A Frisch,Stacey %A Jones,Sarah %A Willis,James %A Sinert,Richard %+ Department of Emergency Medicine, SUNY Downstate Health Sciences University, 450 Clarkson Ave, Brooklyn, NY, 11203, United States, 1 718 245 3318, staceyfrischmd@gmail.com %K COVID-19 %K emergency medicine %K housestaff wellness %K medical education %K training %K frontline health care workers %K frontline %K personal protective equipment %K pandemic %K infectious disease %K emergency %D 2022 %7 27.1.2022 %9 Original Paper %J JMIRx Med %G English %X Background: COVID-19, an illness caused by the novel coronavirus SARS-CoV-2, affected many aspects of health care worldwide in 2020. From March to May 2020, New York City experienced a large surge of cases. Objective: The aim of this study is to characterize the prevalence of illness and symptoms experienced by residents and fellows in 2 New York City hospitals during the period of March to May 2020. Methods: An institutional review board–exempt survey was distributed to emergency medicine housestaff in May 2020, and submissions were accepted through August 2020. Results: Out of 104 residents and fellows, 64 responded to our survey (a 61.5% response rate). Out of 64 responders, 27 (42%) tested positive for SARS-CoV-2 antibodies. Most residents experienced symptoms that are consistent with COVID-19; however, few received polymerase chain reaction testing. Out of 27 housestaff with SARS-CoV-2 antibodies, 18 (67%) experienced fever and chills, compared with 8 out of 34 housestaff (24%) without SARS-CoV-2 antibodies. Of the 27 housestaff with SARS-CoV-2 antibodies, 19 (70%) experienced loss of taste and smell, compared with 2 out of 34 housestaff (6%) without SARS-CoV-2 antibodies. Both fever and chills and loss of taste and smell were significantly more commonly experienced by antibody-positive compared to antibody-negative housestaff (P=.002 and <.001, respectively). All 13 housestaff who reported no symptoms during the study period tested negative for SARS-CoV-2 antibodies. Conclusions: Our study demonstrated that in our hospitals, the rate of COVID-19 illness among emergency department housestaff was much higher than previously reported. Further studies are needed to characterize illness among medical staff in emergency departments across the nation. The high infection rate among emergency medicine trainees stresses the importance of supplying adequate personal protective equipment for health care professionals. %M 35263391 %R 10.2196/29539 %U https://med.jmirx.org/2022/1/e29539 %U https://doi.org/10.2196/29539 %U http://www.ncbi.nlm.nih.gov/pubmed/35263391 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 1 %P e32713 %T The Role of Unobtrusive Home-Based Continuous Sensing in the Management of Postacute Sequelae of SARS CoV-2 %A Corman,Benjamin Harris Peterson %A Rajupet,Sritha %A Ye,Fan %A Schoenfeld,Elinor Randi %+ Department of Electrical and Computer Engineering, College of Engineering and Applied Science, Stony Brook University, Light Engineering Building, Room 217, Stony Brook, NY, 11794-2350, United States, 1 631 632 8393, fan.ye@stonybrook.edu %K SARS CoV-2 %K COVID-19 %K post-acute sequelae of SARS CoV-2 (PASC) %K post-COVID %K long COVID %K continuous sensing %K passive monitoring %K wearable sensors %K contactless sensors %K vital sign monitoring %D 2022 %7 26.1.2022 %9 Viewpoint %J J Med Internet Res %G English %X Amid the COVID-19 pandemic, it has been reported that greater than 35% of patients with confirmed or suspected COVID-19 develop postacute sequelae of SARS CoV-2 (PASC). PASC is still a disease for which preliminary medical data are being collected—mostly measurements collected during hospital or clinical visits—and pathophysiological understanding is yet in its infancy. The disease is notable for its prevalence and its variable symptom presentation, and as such, management plans could be more holistically made if health care providers had access to unobtrusive home-based wearable and contactless continuous physiologic and physical sensor data. Such between-hospital or between-clinic data can quantitatively elucidate a majority of the temporal evolution of PASC symptoms. Although not universally of comparable accuracy to gold standard medical devices, home-deployed sensors offer great insights into the development and progression of PASC. Suitable sensors include those providing vital signs and activity measurements that correlate directly or by proxy to documented PASC symptoms. Such continuous, home-based data can give care providers contextualized information from which symptom exacerbation or relieving factors may be classified. Such data can also improve the collective academic understanding of PASC by providing temporally and activity-associated symptom cataloging. In this viewpoint, we make a case for the utilization of home-based continuous sensing that can serve as a foundation from which medical professionals and engineers may develop and pursue long-term mitigation strategies for PASC. %M 34932496 %R 10.2196/32713 %U https://www.jmir.org/2022/1/e32713 %U https://doi.org/10.2196/32713 %U http://www.ncbi.nlm.nih.gov/pubmed/34932496 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 1 %P e33697 %T Patient Preferences for Patient Portal–Based Telepsychiatry in a Safety Net Hospital Setting During COVID-19: Cross-sectional Study %A Yue,Han %A Mail,Victoria %A DiSalvo,Maura %A Borba,Christina %A Piechniczek-Buczek,Joanna %A Yule,Amy M %+ Department of Psychiatry, Boston Medical Center, 720 Harrison Avenue, Suite 915, Boston, MA, 02118, United States, 1 2402719122, han.yue@bmc.org %K patient portal %K telemedicine %K telepsychiatry %K COVID-19 %K portal %K mental health %K psychiatry %K engagement %K behavior %K video %K hospital %K urban %K outreach %D 2022 %7 26.1.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Patient portals are a safe and secure way for patients to connect with providers for video-based telepsychiatry and help to overcome the financial and logistical barriers associated with face-to-face mental health care. Due to the COVID-19 pandemic, telepsychiatry has become increasingly important to obtaining mental health care. However, financial and technological barriers, termed the “digital divide,” prevent some patients from accessing the technology needed to use telepsychiatry services. Objective: As an extension to a clinic’s outreach project during COVID-19 to improve patient engagement with video-based visits through the hospital’s patient portal among adult behavioral health patients at an urban safety net hospital, we aim to assess patient preference for patient portal–based video visits or telephone-only visits and to identify the demographic variables associated with their preference. Methods: Patients in an outpatient psychiatry clinic were contacted by phone, and preference for telepsychiatry by phone or video through a patient portal, as well as device preference for video-based visits, were documented. Patient demographic characteristics were collected from the electronic medical record. Results: A total of 128 patients were reached by phone. A total of 79 (61.7%) patients chose video-based visits, and 69.6% (n=55) of these patients preferred to access the patient portal through a smartphone. Older patients were significantly less likely to agree to video-based visits. Conclusions: Among behavioral health patients at a safety net hospital, there was relatively low engagement with video-based visits through the hospital’s patient portal, particularly among older adults. %M 34932497 %R 10.2196/33697 %U https://formative.jmir.org/2022/1/e33697 %U https://doi.org/10.2196/33697 %U http://www.ncbi.nlm.nih.gov/pubmed/34932497 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 1 %P e34616 %T Telehealth Availability and Use of Related Technologies Among Medicare-Enrolled Cancer Survivors: Cross-sectional Findings From the Onset of the COVID-19 Pandemic %A Lama,Yuki %A Davidoff,Amy J %A Vanderpool,Robin C %A Jensen,Roxanne E %+ Outcomes Research Branch, Healthcare Delivery Research Program, National Cancer Institute, 9609 Medical Center Drive, Bethesda, MD, 20892-9761, United States, 1 240 276 7588, roxanne.jensen@nih.gov %K cancer survivor %K Medicare %K telehealth %K COVID-19 %K availability %K use %K elderly %K older adults %K cancer %K sociodemographic %K internet %K communication %K population %K access %D 2022 %7 25.1.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: There has been rapid integration of telehealth into care delivery during the COVID-19 pandemic. However, little is known about technology ownership, internet access and use for communication, and telehealth availability among cancer survivors, particularly those enrolled in Medicare. Objective: This study aims to identify sociodemographic associations with technology ownership, internet access and use for communication, and telehealth availability in a population-based sample of Medicare-enrolled cancer survivors. Methods: Data are from the Medicare Current Beneficiary Survey COVID-19 Summer 2020 Supplement administered between June 10 and July 15, 2020. Analyses were restricted to beneficiaries who reported a prior (nonskin) cancer diagnosis and a usual source of care (N=2044). Dichotomous outcomes included technology ownership, internet access, internet use for communication, and telehealth availability from providers. Sociodemographic correlates included sex, age, race/ethnicity, Medicare/Medicaid dual enrollment, rurality, census region, and self-reported comorbidities. Results: Over half (957/2044, 53%) of cancer survivors reported using the internet for communication purposes, and 62% (1218/2044) reported that their usual provider had telehealth services available. Using the internet for communication purposes was reported less frequently for rural compared to urban survivors (adjusted probability of 28% vs 46%; P<.001) and for Hispanic and Black survivors compared to non-Hispanic White survivors (29%, 31%, and 44%, respectively; all P<.01). Rural survivors reported lower telehealth availability (53% vs 63%; P<.001); no significant differences in telehealth availability were identified by race/ethnicity. Conclusions: During the COVID-19 pandemic, study findings highlight a complex digital divide among Medicare beneficiaries with a history of cancer related to device ownership necessary for telehealth, internet access and use for communication, and reports of providers having telehealth available. Multilevel approaches are needed to increase equitable telehealth availability and use for cancer survivors. Suggested strategies include increasing broadband internet access to providers and patients in at-risk communities, supporting telehealth implementation among providers that serve populations with known health disparities, raising awareness of providers’ available telehealth services among patients, and screening for technology use and provision of telehealth-related technical assistance among older and historically underserved cancer survivors. %M 34978531 %R 10.2196/34616 %U https://www.jmir.org/2022/1/e34616 %U https://doi.org/10.2196/34616 %U http://www.ncbi.nlm.nih.gov/pubmed/34978531 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 1 %P e28152 %T Medical and Health-Related Misinformation on Social Media: Bibliometric Study of the Scientific Literature %A Yeung,Andy Wai Kan %A Tosevska,Anela %A Klager,Elisabeth %A Eibensteiner,Fabian %A Tsagkaris,Christos %A Parvanov,Emil D %A Nawaz,Faisal A %A Völkl-Kernstock,Sabine %A Schaden,Eva %A Kletecka-Pulker,Maria %A Willschke,Harald %A Atanasov,Atanas G %+ Ludwig Boltzmann Institute for Digital Health and Patient Safety, Medical University of Vienna, Spitalgasse 23, Vienna, 1090, Austria, 43 664 1929 852, Atanas.Atanasov@dhps.lbg.ac.at %K COVID-19 %K Twitter %K health %K social media %K bibliometric %K dissemination %K knowledge exchange %D 2022 %7 25.1.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Social media has been extensively used for the communication of health-related information and consecutively for the potential spread of medical misinformation. Conventional systematic reviews have been published on this topic to identify original articles and to summarize their methodological approaches and themes. A bibliometric study could complement their findings, for instance, by evaluating the geographical distribution of the publications and determining if they were well cited and disseminated in high-impact journals. Objective: The aim of this study was to perform a bibliometric analysis of the current literature to discover the prevalent trends and topics related to medical misinformation on social media. Methods: The Web of Science Core Collection electronic database was accessed to identify relevant papers with the following search string: ALL=(misinformati* OR “wrong informati*” OR disinformati* OR “misleading informati*” OR “fake news*”) AND ALL=(medic* OR illness* OR disease* OR health* OR pharma* OR drug* OR therap*) AND ALL=(“social media*” OR Facebook* OR Twitter* OR Instagram* OR YouTube* OR Weibo* OR Whatsapp* OR Reddit* OR TikTok* OR WeChat*). Full records were exported to a bibliometric software, VOSviewer, to link bibliographic information with citation data. Term and keyword maps were created to illustrate recurring terms and keywords. Results: Based on an analysis of 529 papers on medical and health-related misinformation on social media, we found that the most popularly investigated social media platforms were Twitter (n=90), YouTube (n=67), and Facebook (n=57). Articles targeting these 3 platforms had higher citations per paper (>13.7) than articles covering other social media platforms (Instagram, Weibo, WhatsApp, Reddit, and WeChat; citations per paper <8.7). Moreover, social media platform–specific papers accounted for 44.1% (233/529) of all identified publications. Investigations on these platforms had different foci. Twitter-based research explored cyberchondria and hypochondriasis, YouTube-based research explored tobacco smoking, and Facebook-based research studied vaccine hesitancy related to autism. COVID-19 was a common topic investigated across all platforms. Overall, the United States contributed to half of all identified papers, and 80% of the top 10 most productive institutions were based in this country. The identified papers were mostly published in journals of the categories public environmental and occupational health, communication, health care sciences services, medical informatics, and medicine general internal, with the top journal being the Journal of Medical Internet Research. Conclusions: There is a significant platform-specific topic preference for social media investigations on medical misinformation. With a large population of internet users from China, it may be reasonably expected that Weibo, WeChat, and TikTok (and its Chinese version Douyin) would be more investigated in future studies. Currently, these platforms present research gaps that leave their usage and information dissemination warranting further evaluation. Future studies should also include social platforms targeting non-English users to provide a wider global perspective. %M 34951864 %R 10.2196/28152 %U https://www.jmir.org/2022/1/e28152 %U https://doi.org/10.2196/28152 %U http://www.ncbi.nlm.nih.gov/pubmed/34951864 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 10 %N 1 %P e33059 %T Gaming Activity and Possible Changes in Gaming Behavior Among Young People During the COVID-19 Pandemic: Cross-sectional Online Survey Study %A Claesdotter-Knutsson,Emma %A André,Frida %A Håkansson,Anders %+ Department of Clinical Sciences Lund, Faculty of Medicine, Lund University, Barav. 1, Lund, 22185, Sweden, 46 768871765, emma.claesdotter-knutsson@med.lu.se %K COVID-19 pandemic %K gaming %K screen time %K psychological distress %D 2022 %7 25.1.2022 %9 Original Paper %J JMIR Serious Games %G English %X Background: Young people’s daily lives and social interactions changed remarkably during the COVID-19 pandemic as schools and cinemas closed, leisure activities were cancelled, and gatherings were regulated. Questions have been raised by the media, schools, policy makers, and research communities about the effect on young people’s online behaviors. Objective: This cross-sectional study aimed to study self-reported changes in gaming, focusing on a younger section of the population during the COVID-19 pandemic in Sweden. We also wanted to look at potential risk factors behind problematic gaming during the pandemic, including gaming patterns, gambling behavior, psychological distress, certain sociodemographic characteristics, health factors, and school situation. Methods: This was an anonymous online survey study of web panel participants in Sweden (n=1501) to study changes in gaming behaviors during the COVID-19 pandemic. Self-reported increases in gaming were analyzed in logistic regression analyses against sociodemographic and health factors. Results: Within the study population that reported changes in gaming activity, we found significant differences in age, employment status, disposable income, whether they ever played on loot boxes, time spent at home, school attendance, psychological distress, and gambling and gaming problems, as well as significant differences in changes in alcohol consumption and exercise habits. When examining the 16–24-year-old age group who reported changes in gaming activity, we found significant differences within the group in disposable income, time at home, and school attendance. When examining the 25–39-year-old age group who reported changes in gaming activity, we found significant differences within the group in employment status, disposable income, time spent at home, whether the respondents were studying, school attendance level, psychological distress, and gaming problems, as well as significant differences in changes in alcohol consumption and exercise habits. Psychological distress (all age groups analyzed together; 25–39-year-old age group), drinking less alcohol (all age groups analyzed together), spending more time at home (all age groups analyzed together), gaming problems, and exercising less (25–39-year-old age group) were positively correlated with a self-reported increase in gaming activity. Being employed (25–39-year-old age group) and being over 40 years of age (all age groups analyzed together) were negatively correlated with increased gaming. We found no significant correlations in the 16–24-year-old age group. Conclusions: Those who reported increased gaming during the COVID-19 pandemic were more likely to be 16 years to 39 years old. In the age group of 25 years to 39 years old, the increase was associated with psychological distress, reporting less exercise, and being unemployed. COVID-19 may present as a risk factor of increased online gaming in a small but vulnerable group. More research and preferably longitudinal studies are needed in the field of gaming and effects of the COVID-19 pandemic. %M 34817386 %R 10.2196/33059 %U https://games.jmir.org/2022/1/e33059 %U https://doi.org/10.2196/33059 %U http://www.ncbi.nlm.nih.gov/pubmed/34817386 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 1 %P e29892 %T Immune-Mediated Mechanisms in Patients Testing Positive for SARS-CoV-2: Protocol for a Multianalysis Study %A Ietto,Giuseppe %A Mortara,Lorenzo %A Dalla Gasperina,Daniela %A Iovino,Domenico %A Azzi,Lorenzo %A Baj,Andreina %A Ageno,Walter %A Genoni,Angelo Paolo %A Acquati,Francesco %A Gallazzi,Matteo %A Spina,Giorgia %A Coco,Grace %A Pierin,Federica %A Noonan,Douglas %A Vigezzi,Andrea %A Monti,Elisa %A Iori,Valentina %A Masci,Federica %A Franchi,Caterina %A Di Saverio,Salomone %A Carcano,Giulio %+ General Emergency and Transplant Surgery Department, University of Insubria, V Guicciardini, 9, Varese, 21100, Italy, 39 3398758024, giuseppe.ietto@gmail.com %K SARS-CoV-2 %K COVID-19 %K immunomodulation %K severe acute respiratory syndrome %K mechanism %K phenotype %K immunology %K white blood cell %K immune system %K monocyte %K natural killer cell %K blood %K infectious disease %K immune response %K antigen %K vaccine %K immunity %K protection %K genetics %K epidemiology %D 2022 %7 25.1.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: The novel coronavirus has a high mortality rate (over 1% for patients older than 50 years). This can only be partially ascribed to other comorbidities. A possible explanation is a factor that assures a prompt response to SARS-CoV-2 in younger people, independent from the novelty of the virus itself. A factor is believed to stimulate the immune system and provide immunity against more antigens. The only external stimulation received by healthy people is vaccination (eg, the diphtheria, tetanus, and pertussis [DTP] vaccine). One hypothesis is that vaccination helps develop specific immunity but generates sprouting immunity against antigens in transit. The underlying immunological phenomena are the “bystander effect” and “trained immunity.” The developed immunity gives protection for years until it naturally fades out. After the fifth decade of life, the immune system is almost incompetent when a viral infection occurs, and thus, at this stage, the novel coronavirus can enter the body and cause acute respiratory distress syndrome. Objective: The initial aim is to demonstrate that blood monocytes and natural killer cells show overpowering hyperactivity, while CD4+ and CD8+ T cells experience impediments to their defensive functions in patients with severe SARS-CoV-2 infection. The secondary objectives are to correlate clinical data and vaccination history with laboratory immune patterns in order to identify protective factors. Subsequently, we are also interested in characterizing the phenotypes and state of the degree of activation of peripheral blood mononuclear cells, including monocytes, natural killer cells, and CD4+ and CD8+ T cells, in healthy subjects vaccinated with the Pfizer vaccine. Methods: Data will be collected using the following 3 approaches: (1) an experimental analysis to study the innate immune response and to identify genetic profiles; (2) an epidemiological analysis to identify the patients’ vaccination history; and (3) a clinical analysis to detect the immunological profile. Results: The protocol was approved by the Ethics Committee on April 16, 2020, and the study started on April 27, 2020. As of February 2021, enrollment has been completed. Immunological analysis is ongoing, and we expect to complete this analysis by December 2022. Conclusions: We will recognize different populations of patients, each one with a specific immunological pattern in terms of cytokines, soluble factor serum levels, and immune cell activity. Anamnestic data, such as preceding vaccinations and comorbidities, biochemical findings like lymphocyte immunophenotyping, and pre-existing persistent cytomegalovirus infection, allow depicting the risk profile of severe COVID-19. Proof of the roles of these immunological phenomena in the development of COVID-19 can be the basis for the implementation of therapeutic immunomodulatory treatments. Trial Registration: ClinicalTrials.gov NCT04375176; https://clinicaltrials.gov/ct2/show/NCT04375176 International Registered Report Identifier (IRRID): DERR1-10.2196/29892 %M 34854818 %R 10.2196/29892 %U https://www.researchprotocols.org/2022/1/e29892 %U https://doi.org/10.2196/29892 %U http://www.ncbi.nlm.nih.gov/pubmed/34854818 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 1 %P e31857 %T Attitudes Toward Mobile Apps for Pandemic Research Among Smartphone Users in Germany: National Survey %A Buhr,Lorina %A Schicktanz,Silke %A Nordmeyer,Eike %+ Department of Medical Ethics and History of Medicine, University Medical Center Göttingen, Humboldtallee 36, Göttingen, 37073, Germany, 49 5513969009, sschick@gwdg.de %K user %K pandemic %K smartphone apps %K mobile apps %K telephone-based survey %K Germany %K data sharing %K data donation %K ethics %K trust %K COVID-19 %K mHealth %K mobile applications %K digital health %K health applications %D 2022 %7 24.1.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: During the COVID-19 pandemic, but also in the context of previous epidemic diseases, mobile apps for smartphones were developed with different goals and functions, such as digital contact tracing, test management, symptom monitoring, quarantine compliance, and epidemiological and public health research. Objective: The aim of this study was to explore the potential for the acceptance of research-orientated apps (ROAs) in the German population. To this end, we identified distinctive attitudes toward pandemic apps and data sharing for research purposes among smartphone users in general and with a focus on differences in attitudes between app users and nonusers in particular. Methods: We conducted a cross-sectional, national, telephone-based survey of 1003 adults in Germany, of which 924 were useable for statistical analysis. The 17-item survey assessed current usage of pandemic apps, motivations for using or not using pandemic apps, trust in app distributors and attitudes toward data handling (data storage and transmission), willingness to share coded data with researchers using a pandemic app, social attitudes toward app use, and demographic and personal characteristics. Results: A vast majority stated that they used a smartphone (778/924, 84.2%), but less than half of the smartphone users stated that they used a pandemic app (326/778, 41.9%). The study focused on the subsample of smartphone users. Interestingly, when asked about preferred organizations for data storage and app distribution, trust in governmental (federal or state government, regional health office), public-appointed (statutory health insurance), or government-funded organizations (research institutes) was much higher than in private organizations (private research institutions, clinics, health insurances, information technology [IT] companies). Having a university degree significantly (P<.001) increased the likelihood of using a pandemic app, while having a migration background significantly (P<.001) decreased it. The overwhelming majority (653/778, 83.9%) of smartphone users were willing to provide their app data for state-funded research. Regarding attitudes toward app usage, striking differences between users and nonusers were found. Almost all app users (317/327, 96.9%) stated they would be willing to share data, whereas only 74.3% (336/452) of nonusers supported data sharing via an app. Two-thirds (216/326, 66.3%) of app users fully or rather agreed with the statement that using a pandemic app is a social duty, whereas almost the same proportion of nonusers entirely or rather disagreed with that statement (273/451, 60.5%). Conclusions: These findings indicate a high potential for the adoption of ROAs among smartphone users in Germany as long as organizational providers engaged in development, operation, and distribution are state-funded or governmental institutions and transparency about data-using research institutions is provided. %M 35072646 %R 10.2196/31857 %U https://mhealth.jmir.org/2022/1/e31857 %U https://doi.org/10.2196/31857 %U http://www.ncbi.nlm.nih.gov/pubmed/35072646 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 8 %N 1 %P e34171 %T An Online International Collaborative Learning Program During the COVID-19 Pandemic for Nursing Students: Mixed Methods Study %A Jung,Dukyoo %A De Gagne,Jennie C %A Choi,Eunju %A Lee,Kyuri %+ College of Nursing, University of Iowa, 50 Newton Road, Iowa City, IA, 52242, United States, 1 3199369033, kyurilee2501@gmail.com %K COVID-19 %K distance education %K global competencies %K nursing students %K program evaluation %K synchronous virtual classroom %K video conferencing %D 2022 %7 24.1.2022 %9 Original Paper %J JMIR Med Educ %G English %X Background: Given the limitations imposed by the COVID-19 pandemic, a better understanding of how nursing programs around the globe have implemented distance education methods and related initiatives to provide international collaborative learning opportunities as well as complementary aspects of practical education would be constructive for nursing students. It is expected that international collaboratives through web-based communication will continue to be increasingly utilized after the pandemic; therefore, it is time to discuss the effects and direction of these developments. Objective: We aimed to examine the impact of an online international collaborative learning program on prelicensure nursing students’ international and global competencies in South Korea. Methods: We conducted a mixed methods study (web-based surveys and focus group interviews). A total of 15 students participated in the study. The surveys were used to examine changes in participants’ global leadership competencies, and the focus group interviews were used to evaluate the program’s effectiveness and to identify opportunities for improvement. The online international collaborative program consisted of 7 synchronous web-based classroom sessions. Each session ran for 60 to 90 minutes. Faculty experts and nurses working in the United States discussed various topics with students, such as nursing education in the United States and evidence-based teaching and learning. The students gave presentations on the South Korean nursing education system. Data were analyzed with descriptive statistics, the Mann-Whitney U test, and content analysis methods. Results: Participants reported improvement in their global leadership competencies. Four main categories emerged from analysis of the focus interviews: (1) realistic applicability, (2) clarification, (3) expansion of perspectives, and (4) initiative. Conclusions: The online international collaborative learning program had a positive impact on the development of students’ international competencies. The findings support the further development of international exchange programs through web-based meetings in the postpandemic era. %M 34982035 %R 10.2196/34171 %U https://mededu.jmir.org/2022/1/e34171 %U https://doi.org/10.2196/34171 %U http://www.ncbi.nlm.nih.gov/pubmed/34982035 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 1 %P e34966 %T COVID-19 Preventive Behaviors and Health Literacy, Information Evaluation, and Decision-making Skills in Japanese Adults: Cross-sectional Survey Study %A Nakayama,Kazuhiro %A Yonekura,Yuki %A Danya,Hitomi %A Hagiwara,Kanako %+ Department of Nursing Informatics, Graduate School of Nursing Science, St. Luke’s International University, 10-1, Akashi-cho, Chuo-ku, Tokyo, 104-0044, Japan, 81 3 5550 2284, nakayama@slcn.ac.jp %K coronavirus %K COVID-19 %K health literacy %K health information %K decision-making %K health promotion %K prevention %K behavior %K survey %K evaluation %D 2022 %7 24.1.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Health literacy is important for the prevention of COVID-19 transmission. Research in Japan shows that health literacy is related to skills in evaluating information and decision-making (skills that are not necessarily limited to information about health). Such basic skills are important, particularly when individuals encounter new health issues for which there is insufficient evidence. Objective: We aimed to determine the extent to which COVID-19 preventive behaviors were associated with health literacy and skills in evaluating information and making decisions. Methods: A web-based questionnaire survey was conducted using a Japanese internet research company. The measures comprised 8 items on COVID-19 preventive behaviors, health literacy items (European Health Literacy Survey Questionnaire), 5 items on information evaluation, and 4 items on decision-making process. Pearson correlations between these variables were calculated. Multivariable analyses were also conducted using the COVID-19 preventive behavior score as a dependent variable. Results: A total of 3914 valid responses were received.COVID-19 preventive behaviors were significantly correlated with health literacy (r=0.23), information evaluation (r=0.24), and decision-making process (r=0.30). Standardized regression coefficients (health literacy: β=.11; information evaluation: β=.13; decision-making: β=.18) showed that decision-making process contributed the most. Conclusions: Although comprehensive health literacy is necessary for COVID-19 preventive behaviors, the skills to evaluate a wide range of information and to make appropriate decisions are no less important. Opportunities for people to acquire these skills should be available at all times. %M 34982036 %R 10.2196/34966 %U https://formative.jmir.org/2022/1/e34966 %U https://doi.org/10.2196/34966 %U http://www.ncbi.nlm.nih.gov/pubmed/34982036 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 1 %P e31549 %T The Development and Validation of Simplified Machine Learning Algorithms to Predict Prognosis of Hospitalized Patients With COVID-19: Multicenter, Retrospective Study %A He,Fang %A Page,John H %A Weinberg,Kerry R %A Mishra,Anirban %+ Amgen Inc, Center for Observational Research, 1120 Veterans Boulevard, South San Francisco, CA, 94080, United States, 1 925 216 1658, fhe01@amgen.com %K COVID-19 %K predictive algorithm %K prognostic model %K machine learning %D 2022 %7 21.1.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: The current COVID-19 pandemic is unprecedented; under resource-constrained settings, predictive algorithms can help to stratify disease severity, alerting physicians of high-risk patients; however, there are only few risk scores derived from a substantially large electronic health record (EHR) data set, using simplified predictors as input. Objective: The objectives of this study were to develop and validate simplified machine learning algorithms that predict COVID-19 adverse outcomes; to evaluate the area under the receiver operating characteristic curve (AUC), sensitivity, specificity, and calibration of the algorithms; and to derive clinically meaningful thresholds. Methods: We performed machine learning model development and validation via a cohort study using multicenter, patient-level, longitudinal EHRs from the Optum COVID-19 database that provides anonymized, longitudinal EHR from across the United States. The models were developed based on clinical characteristics to predict 28-day in-hospital mortality, intensive care unit (ICU) admission, respiratory failure, and mechanical ventilator usages at inpatient setting. Data from patients who were admitted from February 1, 2020, to September 7, 2020, were randomly sampled into development, validation, and test data sets; data collected from September 7, 2020, to November 15, 2020, were reserved as the postdevelopment prospective test data set. Results: Of the 3.7 million patients in the analysis, 585,867 patients were diagnosed or tested positive for SARS-CoV-2, and 50,703 adult patients were hospitalized with COVID-19 between February 1 and November 15, 2020. Among the study cohort (n=50,703), there were 6204 deaths, 9564 ICU admissions, 6478 mechanically ventilated or EMCO patients, and 25,169 patients developed acute respiratory distress syndrome or respiratory failure within 28 days since hospital admission. The algorithms demonstrated high accuracy (AUC 0.89, 95% CI 0.89-0.89 on the test data set [n=10,752]), consistent prediction through the second wave of the pandemic from September to November (AUC 0.85, 95% CI 0.85-0.86) on the postdevelopment prospective test data set [n=14,863], great clinical relevance, and utility. Besides, a comprehensive set of 386 input covariates from baseline or at admission were included in the analysis; the end-to-end pipeline automates feature selection and model development. The parsimonious model with only 10 input predictors produced comparably accurate predictions; these 10 predictors (age, blood urea nitrogen, SpO2, systolic and diastolic blood pressures, respiration rate, pulse, temperature, albumin, and major cognitive disorder excluding stroke) are commonly measured and concordant with recognized risk factors for COVID-19. Conclusions: The systematic approach and rigorous validation demonstrate consistent model performance to predict even beyond the period of data collection, with satisfactory discriminatory power and great clinical utility. Overall, the study offers an accurate, validated, and reliable prediction model based on only 10 clinical features as a prognostic tool to stratifying patients with COVID-19 into intermediate-, high-, and very high-risk groups. This simple predictive tool is shared with a wider health care community, to enable service as an early warning system to alert physicians of possible high-risk patients, or as a resource triaging tool to optimize health care resources. %M 34951865 %R 10.2196/31549 %U https://www.jmir.org/2022/1/e31549 %U https://doi.org/10.2196/31549 %U http://www.ncbi.nlm.nih.gov/pubmed/34951865 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 1 %P e32394 %T The Evolution and Disparities of Online Attitudes Toward COVID-19 Vaccines: Year-long Longitudinal and Cross-sectional Study %A Zhang,Chunyan %A Xu,Songhua %A Li,Zongfang %A Liu,Ge %A Dai,Duwei %A Dong,Caixia %+ Institute of Medical Artificial Intelligence, The Second Affiliated Hospital of Xi'an Jiaotong University, No.157 Xiwu Road, Xi'an, 710004, China, 86 18710823698, songhua_xu1@163.com %K COVID-19 %K vaccine %K attitude %K Twitter %K data mining %K pandemic %K population group %K evolution %K disparity %D 2022 %7 21.1.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Due to the urgency caused by the COVID-19 pandemic worldwide, vaccine manufacturers have to shorten and parallel the development steps to accelerate COVID-19 vaccine production. Although all usual safety and efficacy monitoring mechanisms remain in place, varied attitudes toward the new vaccines have arisen among different population groups. Objective: This study aimed to discern the evolution and disparities of attitudes toward COVID-19 vaccines among various population groups through the study of large-scale tweets spanning over a whole year. Methods: We collected over 1.4 billion tweets from June 2020 to July 2021, which cover some critical phases concerning the development and inoculation of COVID-19 vaccines worldwide. We first developed a data mining model that incorporates a series of deep learning algorithms for inferring a range of individual characteristics, both in reality and in cyberspace, as well as sentiments and emotions expressed in tweets. We further conducted an observational study, including an overall analysis, a longitudinal study, and a cross-sectional study, to collectively explore the attitudes of major population groups. Results: Our study derived 3 main findings. First, the whole population’s attentiveness toward vaccines was strongly correlated (Pearson r=0.9512) with official COVID-19 statistics, including confirmed cases and deaths. Such attentiveness was also noticeably influenced by major vaccine-related events. Second, after the beginning of large-scale vaccine inoculation, the sentiments of all population groups stabilized, followed by a considerably pessimistic trend after June 2021. Third, attitude disparities toward vaccines existed among population groups defined by 8 different demographic characteristics. By crossing the 2 dimensions of attitude, we found that among population groups carrying low sentiments, some had high attentiveness ratios, such as males and individuals aged ≥40 years, while some had low attentiveness ratios, such as individuals aged ≤18 years, those with occupations of the 3rd category, those with account age <5 years, and those with follower number <500. These findings can be used as a guide in deciding who should be given more attention and what kinds of help to give to alleviate the concerns about vaccines. Conclusions: This study tracked the year-long evolution of attitudes toward COVID-19 vaccines among various population groups defined by 8 demographic characteristics, through which significant disparities in attitudes along multiple dimensions were revealed. According to these findings, it is suggested that governments and public health organizations should provide targeted interventions to address different concerns, especially among males, older people, and other individuals with low levels of education, low awareness of news, low income, and light use of social media. Moreover, public health authorities may consider cooperating with Twitter users having high levels of social influence to promote the acceptance of COVID-19 vaccines among all population groups. %M 34878410 %R 10.2196/32394 %U https://www.jmir.org/2022/1/e32394 %U https://doi.org/10.2196/32394 %U http://www.ncbi.nlm.nih.gov/pubmed/34878410 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 1 %P e33322 %T Designing an Adaptive Adolescent Physical Activity and Nutrition Intervention for COVID-19–Related Health Challenges: Formative Research Study %A Grimes,Amanda %A Lightner,Joseph S %A Pina,Kimberly %A Donis de Miranda,Evelyn S %A Meissen-Sebelius,Emily %A Shook,Robin P %A Hurley,Emily A %+ School of Nursing and Health Studies, University of Missouri-Kansas City, 2464 Charlotte St, Kansas City, MO, 64108, United States, 1 816 235 1737, grimesa@umkc.edu %K intervention %K physical activity %K nutrition %K adolescents %K formative research %K COVID-19 %K exercise %K young adult %K teenager %K focus group %K qualitative %K interview %K urban %K barrier %D 2022 %7 21.1.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: With rates of childhood obesity continually increasing, effective physical activity and nutrition interventions are needed. Formative research is used to tailor interventions to different cultural and geographic contexts and can be vital in adapting intervention strategies in the face of significant disruptive circumstances (like COVID-19). Objective: We conducted formative research via in-person and web-based focus groups among middle schoolers and parents to better understand the facilitators and barriers to physical activity and fruit and vegetable consumption and to inform the design of a large intervention for a low-income, urban setting in the US Midwest. Methods: We conducted 2 phases of qualitative focus groups with parents (n=20) and 6th-9th grade middle schoolers (n=23). Phase 1 was conducted prior to the COVID-19 pandemic in late 2019, and phase 2 was conducted during the COVID-19 pandemic in the summer of 2020. Focus groups were transcribed and thematically coded using the Dedoose software. Results: The main facilitators of physical activity prior to the pandemic included the opportunity to have fun, peer influence, competition (for some), and incentives, while the main barriers to physical activity were time constraints and social discomfort. The main facilitators of eating fruits and vegetables included parental influence, preparation technique, and convenience, while barriers included dislike of vegetables, time constraints, and preparation or freshness. During the pandemic, facilitators of physical activity remained the same, while additional barriers to physical activity such as lack of motivation and limited time spent outside of the home were reported. For fruit and vegetable consumption, both facilitators and barriers remained the same for both time periods. Additionally, for some participants, the pandemic offered an opportunity to offer more fruits and vegetables to middle schoolers throughout the day. Conclusions: Some themes identified were common to those reported in previous studies, such as peer influence on physical activity and parental influence on fruit and vegetable consumption. Novel themes such as lack of motivation to be active and limited time outside the home helped improve intervention adaptation, specifically during the COVID-19 pandemic. The continuity of formative research after a major unexpected change in the intervention context can be essential in targeting areas of an intervention that can be retained and those that need to be adjusted. %M 34932499 %R 10.2196/33322 %U https://formative.jmir.org/2022/1/e33322 %U https://doi.org/10.2196/33322 %U http://www.ncbi.nlm.nih.gov/pubmed/34932499 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 1 %P e29635 %T Health Care Providers’ and Professionals’ Experiences With Telehealth Oncology Implementation During the COVID-19 Pandemic: A Qualitative Study %A Turner,Kea %A Bobonis Babilonia,Margarita %A Naso,Cristina %A Nguyen,Oliver %A Gonzalez,Brian D %A Oswald,Laura B %A Robinson,Edmondo %A Elston Lafata,Jennifer %A Ferguson,Robert J %A Alishahi Tabriz,Amir %A Patel,Krupal B %A Hallanger-Johnson,Julie %A Aldawoodi,Nasrin %A Hong,Young-Rock %A Jim,Heather S L %A Spiess,Philippe E %+ Department of Health Outcomes and Behavior, Moffitt Cancer Center, 12902 USF Magnolia Drive, MRC-CANCONT, Tampa, FL, 33612-9416, United States, 1 (813) 745 5213, kea.turner@moffitt.org %K telehealth %K telemedicine %K teleoncology %K digital health %K remote monitoring %K cancer %K oncology %K coronavirus disease %K COVID-19 %D 2022 %7 19.1.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Rapid implementation of telehealth for cancer care during COVID-19 required innovative and adaptive solutions among oncology health care providers and professionals (HPPs). Objective: The aim of this qualitative study was to explore oncology HPPs’ experiences with telehealth implementation during the COVID-19 pandemic. Methods: This study was conducted at Moffitt Cancer Center (Moffitt), an NCI (National Cancer Institute)-Designated Comprehensive Cancer Center. Prior to COVID-19, Moffitt piloted telehealth visits on a limited basis. After COVID-19, Moffitt rapidly expanded telehealth visits. Telehealth visits included real-time videoconferencing between HPPs and patients and virtual check-ins (ie, brief communication with an HPP by telephone only). We conducted semistructured interviews with 40 oncology HPPs who implemented telehealth during COVID-19. The interviews were recorded, transcribed verbatim, and analyzed for themes using Dedoose software (version 4.12). Results: Approximately half of the 40 participants were physicians (n=22, 55%), and one-quarter of the participants were advanced practice providers (n=10, 25%). Other participants included social workers (n=3, 8%), psychologists (n=2, 5%), dieticians (n=2, 5%), and a pharmacist (n=1, 3%). Five key themes were identified: (1) establishing and maintaining patient-HPP relationships, (2) coordinating care with other HPPs and informal caregivers, (3) adapting in-person assessments for telehealth, (4) developing workflows and allocating resources, and (5) future recommendations. Participants described innovative strategies for implementing telehealth, such as coordinating interdisciplinary visits with multiple HPPs and inviting informal caregivers (eg, spouse) to participate in telehealth visits. Health care workers discussed key challenges, such as workflow integration, lack of physical exam and biometric data, and overcoming the digital divide (eg, telehealth accessibility among patients with communication-related disabilities). Participants recommended policy advocacy to support telehealth (eg, medical licensure policies) and monitoring how telehealth affects patient outcomes and health care delivery. Conclusions: To support telehealth growth, implementation strategies are needed to ensure that HPPs and patients have the tools necessary to effectively engage in telehealth. At the same time, cancer care organizations will need to engage in advocacy to ensure that policies are supportive of oncology telehealth and develop systems to monitor the impact of telehealth on patient outcomes, health care quality, costs, and equity. %M 34907900 %R 10.2196/29635 %U https://www.jmir.org/2022/1/e29635 %U https://doi.org/10.2196/29635 %U http://www.ncbi.nlm.nih.gov/pubmed/34907900 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 10 %N 1 %P e29987 %T Immersive Virtual Reality Exergames for Persons Living With Dementia: User-Centered Design Study as a Multistakeholder Team During the COVID-19 Pandemic %A Muñoz,John %A Mehrabi,Samira %A Li,Yirou %A Basharat,Aysha %A Middleton,Laura E %A Cao,Shi %A Barnett-Cowan,Michael %A Boger,Jennifer %+ Department of Systems Design Engineering, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada, 1 (519) 888 4567, john.munoz.hci@uwaterloo.ca %K virtual reality %K exergames %K persons living with dementia %K physical activity %K head mounted displays %K participatory design %K co-development %K gaming %K older adults %K elderly %K design %K dementia %K VR %K user-centered %K physical activity %K exercise %K COVID-19 %D 2022 %7 19.1.2022 %9 Original Paper %J JMIR Serious Games %G English %X Background: Advancements in supporting personalized health care and well-being using virtual reality (VR) have created opportunities to use immersive games to support a healthy lifestyle for persons living with dementia and mild cognitive impairment (MCI). Collaboratively designing exercise video games (exergames) as a multistakeholder team is fundamental to creating games that are attractive, effective, and accessible. Objective: This research extensively explores the use of human-centered design methods that involve persons living with dementia in long-term care facilitates, exercise professionals, content developers, game designers, and researchers in the creation of VR exergames targeting physical activity promotion for persons living with dementia/MCI. Methods: Conceptualization, collaborative design, and playtesting activities were carried out to design VR exergames to engage persons living with dementia in exercises to promote upper limb flexibility, strength, and aerobic endurance. We involved a total of 7 persons living with dementia/MCI, 5 exercise professionals, 5 community-dwelling older adults, a VR company for content creation, and a multidisciplinary research team with game designers, engineers, and kinesiology experts. Results: An immersive VR exergame called Seas the Day was jointly designed and developed and it is freely available to be played in state-of-the-art VR headsets (Oculus Quest 1, 2). A model for the triadic interaction (health care institution, industry partner, academia) is also presented to illustrate how different stakeholders contribute to the design of VR exergames that consider/complement complex needs, preferences, and motivators of an underrepresented group of end users. Conclusions: This study provides evidence that a collaborative multistakeholder design results in more tailored and context-aware VR games for persons living with dementia. The insights and lessons learned from this research can be used by others to co-design games, including remote engagement techniques that were used during the COVID-19 pandemic. %M 35044320 %R 10.2196/29987 %U https://games.jmir.org/2022/1/e29987 %U https://doi.org/10.2196/29987 %U http://www.ncbi.nlm.nih.gov/pubmed/35044320 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 1 %P e32567 %T Dissemination and Implementation of a Google Apple Exposure Notification System for COVID-19 Risk Mitigation at a National Public University: Protocol for a Pilot Evaluation Study in a Real-World Setting %A Melvin,Cathy Lee %A Sterba,Katherine Regan %A Gimbel,Ron %A Lenert,Leslie Andrew %A Cartmell,Kathleen B %A , %+ Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, 68 President St. Room BE103, Charleston, SC, 29425, United States, 1 843 876 2426, melvinc@musc.edu %K COVID-19 %K risk %K mitigation %K mobile phone technology %K exposure notification system %K university setting %K implementation science %K implementation %K dissemination %K notification %K university %K exposure %K transmission %K communication %K strategy %K outcome %K acceptability %K adoption %K usage %D 2022 %7 19.1.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: As SARS-CoV-2, the virus that causes COVID-19, spread rapidly across the United States in the spring of 2020, institutions of higher education faced numerous challenges associated with minimizing risk of exposure to COVID-19 among their students, faculty, staff, and surrounding communities. This paper describes the protocol, South Carolina (SC) Safer Together, developed by Clemson University (Clemson) to design, deploy, and evaluate multi-level communication and dissemination and implementation (D&I) strategies in line with recommendations from governmental and educational agencies to mitigate the risk of exposure to COVID-19. Safer Together was enhanced by the addition of the Google/Apple Exposure Notification app, an alternative strategy to support a recommendation of COVID-19 testing outcomes: contact tracing, isolation, and quarantine. Objective: This study aimed to (1) describe the content and intended audiences of D&I strategies used to deploy recommended COVID-19 mitigation strategies on a major college campus; (2) determine the reach, acceptability, adoption, and use of D&I strategies among target audiences among university students, faculty, and staff; and (3) characterize barriers and facilitators to the implementation and use of recommended mitigation strategies. Methods: The study team incorporated elements of the Health Belief Model, the Technology Acceptance Model, communication and social marketing models, and the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework to identify and develop appropriate constructs and specific outcomes for inclusion in our approach to evaluate the communication, dissemination and implementation processes related to deployment of Safer Together at Clemson. A parallel convergent mixed methods design was used to (1) inform implementation strategies used to launch the program and (2) evaluate program reach, acceptability, adoption, and use guided by the RE-AIM framework. Data collection tools include surveys, data analytics–tracking, and focus groups or interviews with key stakeholders (students, employees, and university leadership). Results: Rigorously studying both the dissemination and implementation of Safer Together in a national public university setting is expected to yield lessons that will be valuable at many organizational and governmental settings. On a local level, broad adoption and use of the Safer Together may help reduce COVID-19 transmission and keep the university “open.” On a larger scale, lessons learned on how to influence student and employee behavior with respect to the use of a public health outbreak prevention tool including Safer Together may be applicable in future pandemic and outbreak situations. Conclusions: This study proposes a structured, theory-driven approach to evaluate dissemination and implementation strategies associated with the deployment of Safer Together in a university setting from the viewpoint of students, employees, and university leadership. Our results will inform future implementation of apps such as Safer Together at major state universities in SC. International Registered Report Identifier (IRRID): DERR1-10.2196/32567 %M 34978533 %R 10.2196/32567 %U https://www.researchprotocols.org/2022/1/e32567 %U https://doi.org/10.2196/32567 %U http://www.ncbi.nlm.nih.gov/pubmed/34978533 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 1 %P e26868 %T COVID-19 Mask Usage and Social Distancing in Social Media Images: Large-scale Deep Learning Analysis %A Singh,Asmit Kumar %A Mehan,Paras %A Sharma,Divyanshu %A Pandey,Rohan %A Sethi,Tavpritesh %A Kumaraguru,Ponnurangam %+ Indraprastha Institute of Information Technology Delhi, Okhla Industrial Estate, Phase III, New Delhi, 110020, India, 91 11 26907533, tavpriteshsethi@iiitd.ac.in %K COVID-19 %K mask detection %K deep learning %K classification %K segmentation %K social media analysis %D 2022 %7 18.1.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The adoption of nonpharmaceutical interventions and their surveillance are critical for detecting and stopping possible transmission routes of COVID-19. A study of the effects of these interventions can help shape public health decisions. The efficacy of nonpharmaceutical interventions can be affected by public behaviors in events, such as protests. We examined mask use and mask fit in the United States, from social media images, especially during the Black Lives Matter (BLM) protests, representing the first large-scale public gatherings in the pandemic. Objective: This study assessed the use and fit of face masks and social distancing in the United States and events of large physical gatherings through public social media images from 6 cities and BLM protests. Methods: We collected and analyzed 2.04 million public social media images from New York City, Dallas, Seattle, New Orleans, Boston, and Minneapolis between February 1, 2020, and May 31, 2020. We evaluated correlations between online mask usage trends and COVID-19 cases. We looked for significant changes in mask use patterns and group posting around important policy decisions. For BLM protests, we analyzed 195,452 posts from New York and Minneapolis from May 25, 2020, to July 15, 2020. We looked at differences in adopting the preventive measures in the BLM protests through the mask fit score. Results: The average percentage of group pictures dropped from 8.05% to 4.65% after the lockdown week. New York City, Dallas, Seattle, New Orleans, Boston, and Minneapolis observed increases of 5.0%, 7.4%, 7.4%, 6.5%, 5.6%, and 7.1%, respectively, in mask use between February 2020 and May 2020. Boston and Minneapolis observed significant increases of 3.0% and 7.4%, respectively, in mask use after the mask mandates. Differences of 6.2% and 8.3% were found in group pictures between BLM posts and non-BLM posts for New York City and Minneapolis, respectively. In contrast, the differences in the percentage of masked faces in group pictures between BLM and non-BLM posts were 29.0% and 20.1% for New York City and Minneapolis, respectively. Across protests, 35% of individuals wore a mask with a fit score greater than 80%. Conclusions: The study found a significant drop in group posting when the stay-at-home laws were applied and a significant increase in mask use for 2 of 3 cities where masks were mandated. Although a positive trend toward mask use and social distancing was observed, a high percentage of posts showed disregard for the guidelines. BLM-related posts captured the lack of seriousness to safety measures, with a high percentage of group pictures and low mask fit scores. Thus, the methodology provides a directional indication of how government policies can be indirectly monitored through social media. %M 34479183 %R 10.2196/26868 %U https://publichealth.jmir.org/2022/1/e26868 %U https://doi.org/10.2196/26868 %U http://www.ncbi.nlm.nih.gov/pubmed/34479183 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 1 %P e32140 %T Patterns of Suicide Ideation Across Eight Countries in Four Continents During the COVID-19 Pandemic Era: Repeated Cross-sectional Study %A Schluter,Philip J %A Généreux,Mélissa %A Hung,Kevin KC %A Landaverde,Elsa %A Law,Ronald P %A Mok,Catherine Pui Yin %A Murray,Virginia %A O'Sullivan,Tracey %A Qadar,Zeeshan %A Roy,Mathieu %+ School of Health Sciences, University of Canterbury - Te Whare Wananga o Waitaha, Private Bag 4800, Christchurch, 8140, New Zealand, 64 275106239, philip.schluter@canterbury.ac.nz %K pandemic %K infodemic %K psychosocial impacts %K sense of coherence %K suicide ideation %K epidemiology %K suicide %K pattern %K COVID-19 %K cross-sectional %K mental health %K misinformation %K risk %K prevalence %K gender %K age %K sociodemographic %D 2022 %7 17.1.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The COVID-19 pandemic and countries’ response measures have had a globally significant mental health impact. This mental health burden has also been fueled by an infodemic: an information overload that includes misinformation and disinformation. Suicide, the worst mental health outcome, is a serious public health problem that can be prevented with timely, evidence-based, and often low-cost interventions. Suicide ideation, one important risk factor for suicide, is thus important to measure and monitor, as are the factors that may impact on it. Objective: This investigation had 2 primary aims: (1) to estimate and compare country-specific prevalence of suicide ideation at 2 different time points, overall and by gender and age groups, and (2) to investigate the influence of sociodemographic and infodemic variables on suicide ideation. Methods: A repeated, online, 8-country (Canada, the United States, England, Switzerland, Belgium, Hong Kong, Philippines, and New Zealand), cross-sectional study was undertaken with adults aged ≥18 years, with measurement wave 1 conducted from May 29, 2020 to June 12, 2020 and measurement wave 2 conducted November 6-18, 2021. Self-reported suicide ideation was derived from item 9 of the Patient Health Questionnaire-9 (PHQ-9). Age-standardized suicide ideation rates were reported, a binomial regression model was used to estimate suicide ideation indication rates for each country and measurement wave, and logistic regression models were then employed to relate sociodemographic, pandemic, and infodemic variables to suicide ideation. Results: The final sample totaled 17,833 adults: 8806 (49.4%) from measurement wave 1 and 9027 (50.6%) from wave 2. Overall, 24.2% (2131/8806) and 27.5% (2486/9027) of participants reported suicide ideation at measurement waves 1 and 2, respectively, a difference that was significant (P<.001). Considerable variability was observed in suicide ideation age-standardized rates between countries, ranging from 15.6% in Belgium (wave 1) to 42.9% in Hong Kong (wave 2). Frequent social media usage was associated with increased suicide ideation at wave 2 (adjusted odds ratio [AOR] 1.47, 95% CI 1.25-1.72; P<.001) but not wave 1 (AOR 1.11, 95% CI 0.96-1.23; P=.16). However, having a weaker sense of coherence (SOC; AOR 3.80, 95% CI 3.18-4.55 at wave 1 and AOR 4.39, 95% CI 3.66-5.27 at wave 2; both P<.001) had the largest overall effect size. Conclusions: Suicide ideation is prevalent and significantly increasing over time in this COVID-19 pandemic era, with considerable variability between countries. Younger adults and those residing in Hong Kong carried disproportionately higher rates. Social media appears to have an increasingly detrimental association with suicide ideation, although having a stronger SOC had a larger protective effect. Policies and promotion of SOC, together with disseminating health information that explicitly tackles the infodemic’s misinformation and disinformation, may importantly reduce the rising mental health morbidity and mortality triggered by this pandemic. %M 34727524 %R 10.2196/32140 %U https://publichealth.jmir.org/2022/1/e32140 %U https://doi.org/10.2196/32140 %U http://www.ncbi.nlm.nih.gov/pubmed/34727524 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 1 %P e22113 %T Reasons for Nonuse, Discontinuation of Use, and Acceptance of Additional Functionalities of a COVID-19 Contact Tracing App: Cross-sectional Survey Study %A Walrave,Michel %A Waeterloos,Cato %A Ponnet,Koen %+ MIOS Research Group and GOVTRUST Centre of Excellence, Department of Communication Studies, Faculty of Social Sciences, University of Antwerp, Sint-Jacobstraat 2, Antwerp, 2000, Belgium, 32 475459785, michel.walrave@uantwerp.be %K COVID-19 %K SARS-CoV-2 %K coronavirus %K contact tracing %K proximity tracing %K mHealth %K mobile app %K user acceptability %K surveillance %K privacy %D 2022 %7 14.1.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: In several countries, contact tracing apps (CTAs) have been introduced to warn users if they have had high-risk contacts that could expose them to SARS-CoV-2 and could, therefore, develop COVID-19 or further transmit the virus. For CTAs to be effective, a sufficient critical mass of users is needed. Until now, adoption of these apps in several countries has been limited, resulting in questions on which factors prevent app uptake or stimulate discontinuation of app use. Objective: The aim of this study was to investigate individuals’ reasons for not using, or stopping use of, a CTA, in particular, the Coronalert app. Users’ and nonusers’ attitudes toward the app’s potential impact was assessed in Belgium. To further stimulate interest and potential use of a CTA, the study also investigated the population’s interest in new functionalities. Methods: An online survey was administered in Belgium to a sample of 1850 respondents aged 18 to 64 years. Data were collected between October 30 and November 2, 2020. Sociodemographic differences were assessed between users and nonusers. We analyzed both groups’ attitudes toward the potential impact of CTAs and their acceptance of new app functionalities. Results: Our data showed that 64.9% (1201/1850) of our respondents were nonusers of the CTA under study; this included individuals who did not install the app, those who downloaded but did not activate the app, and those who uninstalled the app. While we did not find any sociodemographic differences between users and nonusers, attitudes toward the app and its functionalities seemed to differ. The main reasons for not downloading and using the app were a perceived lack of advantages (308/991, 31.1%), worries about privacy (290/991, 29.3%), and, to a lesser extent, not having a smartphone (183/991, 18.5%). Users of the CTA agreed more with the potential of such apps to mitigate the consequences of the pandemic. Overall, nonusers found the possibility of extending the CTA with future functionalities to be less acceptable than users. However, among users, acceptability also tended to differ. Among users, functionalities relating to access and control, such as digital certificates or “green cards” for events, were less accepted (358/649, 55.2%) than functionalities focusing on informing citizens about the spread of the virus (453/649, 69.8%) or making an appointment to get tested (525/649, 80.9%). Conclusions: Our results show that app users were more convinced of the CTA’s utility and more inclined to accept new app features than nonusers. Moreover, nonusers had more CTA-related privacy concerns. Therefore, to further stimulate app adoption and use, its potential advantages and privacy-preserving mechanisms need to be stressed. Building further knowledge on the forms of resistance among nonusers is important for responding to these barriers through the app’s further development and communication campaigns. %M 34794117 %R 10.2196/22113 %U https://publichealth.jmir.org/2022/1/e22113 %U https://doi.org/10.2196/22113 %U http://www.ncbi.nlm.nih.gov/pubmed/34794117 %0 Journal Article %@ 2562-7600 %I JMIR Publications %V 5 %N 1 %P e35274 %T Investigating #covidnurse Messages on TikTok: Descriptive Study %A Yalamanchili,Bhavya %A Donelle,Lorie %A Jurado,Leo-Felix %A Fera,Joseph %A Basch,Corey H %+ William Paterson University, 300 Pompton Rd, Wayne, NJ, 07470, United States, 1 9737202603, baschc@wpunj.edu %K COVID-19 pandemic %K nurse %K burnout %K social media %K stress %K TikTok %K nursing %K COVID-19 %K pandemic %K social support %K digital peer support %K health communication %K peer support %D 2022 %7 14.1.2022 %9 Original Paper %J JMIR Nursing %G English %X Background: During a time of high stress and decreased social interaction, nurses have turned to social media platforms like TikTok as an outlet for expression, entertainment, and communication. Objective: The purpose of this cross-sectional content analysis study is to describe the content of videos with the hashtag #covidnurse on TikTok, which included 100 videos in the English language. Methods: At the time of the study, this hashtag had 116.9 million views. Each video was coded for content-related to what nurses encountered and were feeling during the COVID-19 pandemic. Results: Combined, the 100 videos sampled received 47,056,700 views; 76,856 comments; and 5,996,676 likes. There were 4 content categories that appeared in a majority (>50) of the videos: 83 showed the individual as a nurse, 72 showed the individual in professional attire, 58 mentioned/suggested stress, 55 used music, and 53 mentioned/suggested frustration. Those that mentioned stress and those that mentioned frustration received less than 50% of the total views (n=21,726,800, 46.17% and n=16,326,300, 34.69%, respectively). Although not a majority, 49 of the 100 videos mentioned the importance of nursing. These videos garnered 37.41% (n=17,606,000) of the total views, 34.82% (n=26,759) of the total comments, and 23.85% (n=1,430,213) of the total likes. So, despite nearly half of the total videos mentioning how important nurses are, these videos received less than half of the total views, comments, and likes. Conclusions: Social media and increasingly video-related online messaging such as TikTok are important platforms for social networking, social support, entertainment, and education on diverse topics, including health in general and COVID-19 specifically. This presents an opportunity for future research to assess the utility of the TikTok platform for meaningful engagement and health communication on important public health issues. %M 35029536 %R 10.2196/35274 %U https://nursing.jmir.org/2022/1/e35274 %U https://doi.org/10.2196/35274 %U http://www.ncbi.nlm.nih.gov/pubmed/35029536 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 1 %P e26717 %T A Mobile App for Wound and Symptom Surveillance After Colorectal Surgery: Protocol for a Feasibility Randomized Controlled Trial %A Valk,Heather Anne %A Garcia-Ochoa,Carlos %A Fontaine Calder,Jessica %A Miller,Toba %A Rashidi,Babak %A McIsaac,Corrine %A Musselman,Reilly %+ Division of General Surgery, Faculty of Medicine, University of Ottawa, 725 Parkdale Ave, Ottawa, ON, K1Y4E9, Canada, 1 6137378899, hsmit037@uottawa.ca %K eHealth %K mobile app %K surgical site infection %K colorectal surgery %K app %K surgery %K infection %K wound %K surveillance %K feasibility %K randomized controlled trial %K tracking %K patient experience %K COVID-19 %K transmission %D 2022 %7 14.1.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Surgical site infections (SSIs) are the most common nosocomial infection and occur in 16.3% of patients undergoing colorectal surgery at our institution (The Ottawa Hospital), the majority of which are identified after discharge from hospital. Patients who suspect having an SSI generally present to the emergency department or surgery clinic. Both options for in-person interaction are costly to the health care system and patients. A mobile app, how2trak, has proven to be beneficial for patients with complex wounds at our institution by facilitating at-home monitoring and virtual consultations. Objective: This study aims to assess the feasibility of a randomized controlled trial to assess if how2trak can improve patients’ experience and increase detection of SSIs after colorectal surgery while reducing patients’ risk of COVID-19 exposure. Methods: In this single-center prospective feasibility trial, eligible patients undergoing colorectal surgery will be randomized to either standard care or how2trak postoperative monitoring of their incision, symptoms, and ostomy function. Patient self-assessments will be monitored by a nurse specialized in wound and ostomy care who will follow-up with patients with a suspected SSI. The primary outcome is feasibility as measured by enrollment, randomization, app usability, data extraction, and resource capacity. Results: This study was approved by our institution’s ethics board on February 26, 2021, and received support from The Ottawa Hospital Innovation and Care Funding on November 12, 2021. Recruitment started June 3, 2021, and 29 were patients enrolled as of September 2021. We expect to publish results in spring 2022. Conclusions: This study will determine the feasibility of using a mobile app to monitor patients’ wounds and detect SSIs after colorectal surgery. If feasible, we plan to assess if this mobile app facilitates SSI detection, enhances patient experience, and optimizes their care. Trial Registration: ClinicalTrials.gov NCT04869774; https://clinicaltrials.gov/ct2/show/NCT04869774 International Registered Report Identifier (IRRID): DERR1-10.2196/26717 %M 34854816 %R 10.2196/26717 %U https://www.researchprotocols.org/2022/1/e26717 %U https://doi.org/10.2196/26717 %U http://www.ncbi.nlm.nih.gov/pubmed/34854816 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 10 %N 1 %P e28183 %T Effects of Social Media Use for Health Information on COVID-19–Related Risk Perceptions and Mental Health During Pregnancy: Web-Based Survey %A Wang,Qian %A Xie,Luyao %A Song,Bo %A Di,Jiangli %A Wang,Linhong %A Mo,Phoenix Kit-Han %+ Center for Health Behaviours Research, Faculty of Medicine, School of Public Health and Primary Care, The Chinese University of Hong Kong, Prince of Wales Hospital, 202D, Hong Kong, Hong Kong, 852 2252 8765, phoenix.mo@cuhk.edu.hk %K COVID-19 %K pregnant %K social media use %K risk perception %K worry %K depression %D 2022 %7 13.1.2022 %9 Original Paper %J JMIR Med Inform %G English %X Background: Social media has become an important source of health information during the COVID-19 pandemic. Very little is known about the potential mental impact of social media use on pregnant women. Objective: This study aims to examine the association between using social media for health information and risk perception for COVID-19, worry due to COVID-19, and depression among pregnant women in China. Methods: A total of 4580 pregnant women were recruited from various provinces of China. The participants completed a cross-sectional, web-based survey in March 2020. Results: More than one-third (1794/4580, 39.2%) of the participants reported always using social media for obtaining health information. Results of structural equation modeling showed that the frequency of social media use for health information was positively associated with perceived susceptibility (β=.05; P<.001) and perceived severity (β=.12; P<.001) of COVID-19, which, in turn, were positively associated with worry due to COVID-19 (β=.19 and β=.72, respectively; P<.001). Perceived susceptibility (β=.09; P<.001), perceived severity (β=.08; P<.001), and worry due to COVID-19 (β=.15; P<.001) all had a positive association with depression. Bootstrapping analysis showed that the indirect effects of frequency of social media use for health information on both worry due to COVID-19 (β=.09, 95% CI 0.07-0.12) and depression (β=.05, 95% CI 0.02-0.07) were statistically significant. Conclusions: This study provides empirical evidence on how social media use for health information might have a negative impact on the mental health of pregnant women. Interventions are needed to equip this population with the skills to use social media properly and with caution. %M 34762065 %R 10.2196/28183 %U https://medinform.jmir.org/2022/1/e28183 %U https://doi.org/10.2196/28183 %U http://www.ncbi.nlm.nih.gov/pubmed/34762065 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 1 %P e30640 %T Toward Designs of Workplace Stress Management Mobile Apps for Frontline Health Workers During the COVID-19 Pandemic and Beyond: Mixed Methods Qualitative Study %A Chaudhry,Beenish Moalla %A Islam,Ashraful %A Matthieu,Monica %+ University of Louisiana at Lafayette, School of Computing and Informatics, 104 E University Circle, Lafayette, LA, 70508, United States, 1 4134616440, Beenish.chaudhry@louisiana.edu %K mental health %K stress %K mHealth %K frontline health worker %K design requirements %K pandemic %K COVID-19 %K design %K intervention %K burnout %K perspective %K need %K user design %D 2022 %7 13.1.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: In recent years, mobile apps have been developed to prevent burnout, promote anxiety management, and provide health education to workers in various workplace settings. However, there remains a paucity of such apps for frontline health workers (FHWs), even though FHWs are the most susceptible to stress due to the nature of their jobs. Objective: The goal of this study was to provide suggestions for designing stress management apps to address workplace stressors of FHWs based on the understanding of their needs from FHWs’ own perspectives and theories of stress. Methods: A mixed methods qualitative study was conducted. Using a variety of search strings, we first collected 41 relevant web-based news articles published between December 2019 and May 2020 through the Google search engine. We then conducted a cross-sectional survey with 20 FHWs. Two researchers independently conducted qualitative analysis of all the collected data using a deductive followed by an inductive approach. Results: Prevailing uncertainty and fear of contracting the infection was causing stress among FHWs. Moral injury associated with seeing patients die from lack of care and lack of experience in handling various circumstances were other sources of stress. FHWs mentioned 4 coping strategies. Quick coping strategies such as walking away from stressful situations, entertainment, and exercise were the most common ways to mitigate the impact of stress at work. Peer support and counseling services were other popular methods. Building resilience and driving oneself forward using internal motivation were also meaningful ways of overcoming stressful situations. Time constraints and limited management support prevented FHWs from engaging in stress management activities. Conclusions: Our study identified stressors, coping strategies, and challenges with applying coping strategies that can guide the design of stress management apps for FHWs. Given that the pandemic is ongoing and health care crises continue, FHWs remain a vulnerable population in need of attention. %M 34806985 %R 10.2196/30640 %U https://formative.jmir.org/2022/1/e30640 %U https://doi.org/10.2196/30640 %U http://www.ncbi.nlm.nih.gov/pubmed/34806985 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 1 %P e32442 %T COVID-19’s Influence on Information and Communication Technologies in Long-Term Care: Results From a Web-Based Survey With Long-Term Care Administrators %A Schuster,Amy M %A Cotten,Shelia R %+ Department of Sociology, Anthropology, and Criminal Justice, Clemson University, 132 Brackett Hall, Clemson, SC, 29634, United States, 1 904 294 7893, amschus@clemson.edu %K COVID-19 %K pandemic %K socioemotional needs %K long-term care %K nursing home facility %K assisted living facility %K elderly %K older adults %K information and communication technologies %K support %K emotion %K needs %K access %K connection %K communication %K engagement %D 2022 %7 12.1.2022 %9 Original Paper %J JMIR Aging %G English %X Background: The prevalence of COVID-19 in the United States led to mandated lockdowns for long-term care (LTC) facilities, resulting in loss of in-person contact with social ties for LTC residents. Though information and communication technologies (ICTs) can be used by LTC residents to support their socioemotional needs, residents must have access to ICTs to use them. Objective: This study explored ICT access and use in LTC facilities and how LTC facilities adapted to try to enhance social connections for their residents during the COVID-19 pandemic. Methods: LTC administrators in South Carolina (United States) were invited to complete a web-based survey exploring ICT access and use in LTC facilities and whether access and use changed as a result of the COVID-19 pandemic. Results: LTC administrators (N=70, 12 nursing homes [NHs], and 58 assisted living facilities [ALFs]) completed the web-based survey. Since March 2020, a total of 53% (37/70) of the LTC facilities have purchased ICTs for residents’ use. ICTs have mainly been used for videoconferencing with family members (31/36, 86%), friends (25/36, 69%), and health care providers (26/36, 72%). NHs were 10.23 times more likely to purchase ICTs for residents’ use during the COVID-19 pandemic than ALFs (odds ratio 11.23, 95% CI 1.12-113.02; P=.04). Benefits of ICT use included residents feeling connected to their family members, friends, and other residents. Barriers to ICT use included staff not having time to assist residents with using the technology, nonfunctional technology, and residents who do not want to share technology. Conclusions: Our results suggest that over half of the LTC facilities in this study were able to acquire ICTs for their residents to use during the COVID-19 pandemic. Additional research is needed to explore how residents adapted to using the ICTs and whether LTC facilities developed and adopted technology integration plans, which could help them be prepared for future situations that may affect LTC residents’ engagement and communication opportunities, such as another pandemic. %M 34878989 %R 10.2196/32442 %U https://aging.jmir.org/2022/1/e32442 %U https://doi.org/10.2196/32442 %U http://www.ncbi.nlm.nih.gov/pubmed/34878989 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 1 %P e30749 %T Determining the Prevalence and Incidence of SARS-CoV-2 Infection in Prisons in England: Protocol for a Repeated Panel Survey and Enhanced Outbreak Study %A Plugge,Emma %A Burke,Danielle %A Czachorowski,Maciej %A Gutridge,Kerry %A Maxwell,Fiona %A McGrath,Nuala %A O'Mara,Oscar %A O'Moore,Eamonn %A Parkes,Julie %+ University of Southampton, Southampton General Hospital, Southampton, SO16 6YD, United Kingdom, 44 07789033336, emma.plugge@phe.gov.uk %K COVID-19 %K epidemiology %K prison %K outbreak %K testing %K health inequalities %K SARS-CoV-2 %D 2022 %7 12.1.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: There are over 80,000 people imprisoned in England and Wales in 117 prisons. The management of the COVID-19 pandemic presents particular challenges in this setting where confined, crowded, and poorly ventilated conditions facilitate the rapid spread of infectious diseases. Objective: The COVID-19 in Prison Study aims to examine the epidemiology of SARS-CoV-2 in prisons in England in order to inform public health policy and practice during the pandemic and recovery. The primary objective is to estimate the proportion of positive tests of SARS-CoV-2 infection among residents and staff within selected prisons. The secondary objectives include estimating the incidence rate of SARS-CoV-2 infection and examining how the proportion of positive tests and the incidence rate vary among individual, institutional, and system level factors. Methods: Phase 1 comprises a repeated panel survey of prison residents and staff in a representative sample of 28 prisons across England. All residents and staff in the study prisons are eligible for inclusion. Participants will be tested for SARS-CoV-2 using a nasopharyngeal swab twice (6 weeks apart). Staff will also be tested for antibodies to SARS-CoV-2. Phase 2 focuses on SARS-CoV-2 infection in prisons with recognized COVID-19 outbreaks. Any prison in England will be eligible to participate if an outbreak is declared. In 3 outbreak prisons, all participating staff and residents will be tested for SARS-CoV-2 antigens at the following 3 timepoints: as soon as possible after the outbreak is declared (day 0), 7 days later (day 7), and at day 28. They will be swabbed twice (a nasal swab for lateral flow device testing and a nasopharyngeal swab for polymerase chain reaction testing). Testing will be done by external contractors. Data will also be collected on individual, prison level, and community factors. Data will be stored and handled at the University of Southampton and Public Health England. Summary statistics will summarize the prison and participant characteristics. For the primary objective, simple proportions of individuals testing positive for SARS-CoV-2 and incidence rates will be calculated. Linear regression will examine the individual, institutional, system, and community factors associated with SARS-CoV-2 infection within prisons. Results: The UK Government’s Department for Health and Social Care funds the study. Data collection started on July 20, 2020, and will end on May 31, 2021. As of May 2021, we had enrolled 4192 staff members and 6496 imprisoned people in the study. Data analysis has started, and we expect to publish the initial findings in summer/autumn 2021. The main ethical consideration is the inclusion of prisoners, who are vulnerable participants. Conclusions: This study will provide unique data to inform the public health management of SARS-CoV-2 in prisons. Its findings will be of relevance to health policy makers and practitioners working in prisons. International Registered Report Identifier (IRRID): DERR1-10.2196/30749 %M 34751157 %R 10.2196/30749 %U https://www.researchprotocols.org/2022/1/e30749 %U https://doi.org/10.2196/30749 %U http://www.ncbi.nlm.nih.gov/pubmed/34751157 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 1 %P e34984 %T Well-being of Canadian Armed Forces Veterans and Spouses of Veterans During the COVID-19 Pandemic: Protocol for a Prospective Longitudinal Survey %A Forchuk,Callista A %A Nazarov,Anthony %A Plouffe,Rachel A %A Liu,Jenny J W %A Deda,Erisa %A Le,Tri %A Gargala,Dominic %A Soares,Vanessa %A Bourret-Gheysen,Jesse %A St Cyr,Kate %A Nouri,Maede S %A Hosseiny,Fardous %A Smith,Patrick %A Dupuis,Gabrielle %A Roth,Maya %A Marlborough,Michelle %A Jetly,Rakesh %A Heber,Alexandra %A Lanius,Ruth %A Richardson,J Don %+ The MacDonald Franklin Operational Stress Injury Research Centre, Parkwood Institute, St. Joseph's Health Care, 550 Wellington Rd, London, ON, N6C 5J1, Canada, 1 519 685 4292 ext 42399, don.richardson@sjhc.london.on.ca %K well-being %K mental health %K veterans %K military %K survey %K COVID-19 %K protocol %K veteran %K physical health %K pandemic %K longitudinal survey %K healthcare %K treatment %K family support %K peer support %D 2022 %7 11.1.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: The COVID-19 pandemic has resulted in significant changes to everyday life, including social distancing mandates, changes to health care, and a heightened risk of infection. Previous research has shown that Canadian Armed Forces (CAF) veterans are at higher risk of developing mental and physical health conditions. Veterans and their families may face unique social challenges that can compound with pandemic-related disruptions to negatively impact well-being. Objective: This study aims to longitudinally characterize the mental health of CAF veterans and spouses of CAF veterans throughout the pandemic and to understand the dynamic influences of pandemic-related stressors on psychological health over time. Methods: We employed a prospective longitudinal panel design using an online data collection platform. Study participation was open to all CAF veterans and spouses of CAF veterans residing in Canada. Participants were asked to complete a comprehensive battery of assessments representing psychological well-being, chronic pain, health care access patterns, physical environment, employment, social integration, and adjustment to pandemic-related lifestyle changes. Follow-up assessments were conducted every 3 months over an 18-month period. This study was approved by the Western University Health Sciences and Lawson Health Research Institute Research Ethics Boards. Results: Baseline data were collected between July 2020 and February 2021. There were 3 population segments that participated in the study: 1047 veterans, 366 spouses of veterans, and 125 veterans who are also spouses of veterans completed baseline data collection. As of November 2021, data collection is ongoing, with participants completing the 9- or 12-month follow-up surveys depending on their date of self-enrollment. Data collection across all time points will be complete in September 2022. Conclusions: This longitudinal survey is unique in its comprehensive assessment of domains relevant to veterans and spouses of veterans during the COVID-19 pandemic, ranging from occupational, demographic, social, mental, and physical domains, to perceptions and experiences with health care treatments and access. The results of this study will be used to inform policy for veteran and veteran family support, and to best prepare for similar emergencies should they occur in the future. International Registered Report Identifier (IRRID): DERR1-10.2196/34984 %M 34935624 %R 10.2196/34984 %U https://www.researchprotocols.org/2022/1/e34984 %U https://doi.org/10.2196/34984 %U http://www.ncbi.nlm.nih.gov/pubmed/34935624 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 1 %P e29876 %T The Future of Virtual Care for Older Ethnic Adults Beyond the COVID-19 Pandemic %A Pham,Quynh %A El-Dassouki,Noor %A Lohani,Raima %A Jebanesan,Aravinth %A Young,Karen %+ Centre for Global eHealth Innovation, Techna Institute, University Health Network, 190 Elizabeth Street, Toronto, ON, M5G 2C4, Canada, 1 416 340 4800 ext 4765, Q.Pham@uhn.ca %K virtual care %K digital health %K health equity %K cultural equity %K chronic disease %K caregivers %K ethnocultural minority %K older adults %K ethnicity %K ethnic patients %K technology-mediated care %K equity %K diversity %K family %D 2022 %7 7.1.2022 %9 Viewpoint %J J Med Internet Res %G English %X The COVID-19 pandemic has fundamentally changed how Canadians access health care. Although it is undeniable that the rapid adoption of virtual care has played a critical role in reducing viral transmission, the gap in equitable access to virtual care remains pervasive for Canada’s aging and ethnocultural minority communities. Existing virtual care solutions are designed for the English-speaking, health-literate, and tech-savvy patient population, excluding older ethnic adults who often do not see themselves reflected in these identities. In acknowledging the permanency of virtual care brought on by the pandemic, we have a collective responsibility to co-design new models that serve our older ethnic patients who have been historically marginalized by the status quo. Building on existing foundations of caregiving within ethnocultural minority communities, one viable strategy to realize culturally equitable virtual care may be to engage the highly motivated and skilled family caregivers of older ethnic adults as partners in the technology-mediated management of their chronic disease. The time is now to build a model of shared virtual care that embraces Canada’s diverse cultures, while also providing its older ethnic adults with access to health innovations in partnership with equally invested family caregivers who have their health at heart. %M 34994707 %R 10.2196/29876 %U https://www.jmir.org/2022/1/e29876 %U https://doi.org/10.2196/29876 %U http://www.ncbi.nlm.nih.gov/pubmed/34994707 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 1 %P e31066 %T The Role of Information and Communications Technology Policies and Infrastructure in Curbing the Spread of the Novel Coronavirus: Cross-country Comparative Study %A Eum,Nam Ji %A Kim,Seung Hyun %+ School of Business, Yonsei University, 50 Yonsei-ro, Sinchon-dong, Seodaemun-gu, Seoul, 03722, Republic of Korea, 82 2 2123 2506, seungkim@yonsei.ac.kr %K health policy %K telehealth %K physical distancing %K disease transmission %K COVID-19 %D 2022 %7 7.1.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Despite worldwide efforts, control of COVID-19 transmission and its after effects is lagging. As seen from the cases of SARS-CoV-2 and influenza, worldwide crises associated with infections and their side effects are likely to recur in the future because of extensive international interactions. Consequently, there is an urgent need to identify the factors that can mitigate disease spread. We observed that the transmission speed and severity of consequences of COVID-19 varied substantially across countries, signaling the need for a country-level investigation. Objective: We aimed to investigate how distancing-enabling information and communications technology (ICT) infrastructure and medical ICT infrastructure, and related policies have affected the cumulative number of confirmed cases, fatality rate, and initial speed of transmission across different countries. Methods: We analyzed the determinants of COVID-19 transmission during the relatively early days of the pandemic by conducting regression analysis based on our data for country-level characteristics, including demographics, culture, ICT infrastructure, policies, economic status, and transmission of COVID-19. To gain further insights, we conducted a subsample analysis for countries with low population density. Results: Our full sample analysis showed that implied telehealth policy, which refers to the lack of a specific telehealth-related policy but presence of a general eHealth policy, was associated with lower fatality rates when controlled for cultural characteristics (P=.004). In particular, the fatality rate for countries with an implied telehealth policy was lower than that for others by 2.7%. Interestingly, stated telehealth policy, which refers to the existence of a specified telehealth policy, was found to not be associated with lower fatality rates (P=.30). Furthermore, countries with a government-run health website had 36% fewer confirmed cases than those without it, when controlled for cultural characteristics (P=.03). Our analysis further revealed that the interaction between implied telehealth policy and training ICT health was significant (P=.01), suggesting that implied telehealth policy may be more effective when in-service training on ICT is provided to health professionals. In addition, credit card ownership, as an enabler of convenient e-commerce transactions and distancing, showed a negative association with fatality rates in the full sample analysis (P=.04), but not in the subsample analysis (P=.76), highlighting that distancing-enabling ICT is more useful in densely populated countries. Conclusions: Our findings demonstrate important relationships between national traits and COVID-19 infections, suggesting guidelines for policymakers to minimize the negative consequences of pandemics. The findings suggest physicians’ autonomous use of medical ICT and strategic allocation of distancing-enabling ICT infrastructure in countries with high population density to maximize efficiency. This study also encourages further research to investigate the role of health policies in combatting COVID-19 and other pandemics. %M 34817392 %R 10.2196/31066 %U https://publichealth.jmir.org/2022/1/e31066 %U https://doi.org/10.2196/31066 %U http://www.ncbi.nlm.nih.gov/pubmed/34817392 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 1 %P e33399 %T Exploring the COVID-19 Pandemic as a Catalyst for Behavior Change Among Patient Health Record App Users in Taiwan: Development and Usability Study %A Tseng,Chinyang Henry %A Chen,Ray-Jade %A Tsai,Shang-Yu %A Wu,Tsung-Ren %A Tsaur,Woei-Jiunn %A Chiu,Hung-Wen %A Yang,Cheng-Yi %A Lo,Yu-Sheng %+ Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, 250 Wuxing Street, Taipei, 110, Taiwan, 886 +886227361661, Loyusen@tmu.edu.tw %K personal health records %K COVID-19 %K My Health Bank %K blockchain %K public health %D 2022 %7 6.1.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: During the COVID-19 pandemic, personal health records (PHRs) have enabled patients to monitor and manage their medical data without visiting hospitals and, consequently, minimize their infection risk. Taiwan’s National Health Insurance Administration (NHIA) launched the My Health Bank (MHB) service, a national PHR system through which insured individuals to access their cross-hospital medical data. Furthermore, in 2019, the NHIA released the MHB software development kit (SDK), which enables development of mobile apps with which insured individuals can retrieve their MHB data. However, the NHIA MHB service has its limitations, and the participation rate among insured individuals is low. Objective: We aimed to integrate the MHB SDK with our developed blockchain-enabled PHR mobile app, which enables patients to access, store, and manage their cross-hospital PHR data. We also collected and analyzed the app’s log data to examine patients’ MHB use during the COVID-19 pandemic. Methods: We integrated our existing blockchain-enabled mobile app with the MHB SDK to enable NHIA MHB data retrieval. The app utilizes blockchain technology to encrypt the downloaded NHIA MHB data. Existing and new indexes can be synchronized between the app and blockchain nodes, and high security can be achieved for PHR management. Finally, we analyzed the app’s access logs to compare patients’ activities during high and low COVID-19 infection periods. Results: We successfully integrated the MHB SDK into our mobile app, thereby enabling patients to retrieve their cross-hospital medical data, particularly those related to COVID-19 rapid and polymerase chain reaction testing and vaccination information and progress. We retrospectively collected the app’s log data for the period of July 2019 to June 2021. From January 2020, the preliminary results revealed a steady increase in the number of people who applied to create a blockchain account for access to their medical data and the number of app subscribers among patients who visited the outpatient department (OPD) and emergency department (ED). Notably, for patients who visited the OPD and ED, the peak proportions with respect to the use of the app for OPD and ED notes and laboratory test results also increased year by year. The highest proportions were 52.40% for ED notes in June 2021, 88.10% for ED laboratory test reports in May 2021, 34.61% for OPD notes in June 2021, and 41.87% for OPD laboratory test reports in June 2021. These peaks coincided with Taiwan’s local COVID-19 outbreak lasting from May to June 2021. Conclusions: This study developed a blockchain-enabled mobile app, which can periodically retrieve and integrate PHRs from the NHIA MHB's cross-hospital data and the investigated hospital's self-pay medical data. Analysis of users’ access logs revealed that the COVID-19 pandemic substantially increased individuals’ use of PHRs and their health awareness with respect to COVID-19 prevention. %M 34951863 %R 10.2196/33399 %U https://www.jmir.org/2022/1/e33399 %U https://doi.org/10.2196/33399 %U http://www.ncbi.nlm.nih.gov/pubmed/34951863 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 1 %P e32329 %T Direct and Indirect Associations of Media Use With COVID-19 Vaccine Hesitancy in South Korea: Cross-sectional Web-Based Survey %A Lee,Minjung %A You,Myoungsoon %+ Department of Public Health Sciences, Graduate School of Public Health, Seoul National University, Gwanak-ro 1, Gwanak-gu, Seoul, 08826, Republic of Korea, 82 02 880 2773, msyou@snu.ac.kr %K COVID-19 %K coronavirus %K vaccination %K vaccine hesitancy %K media use %K social media %K public health %K pandemic %K epidemiology %K online information %K health information %D 2022 %7 6.1.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: The battle against the 2019 novel coronavirus (COVID-19) has not concluded. Despite the availability of vaccines, the high prevalence of vaccine hesitancy represents a significant challenge to public health, and raising vaccine acceptance among the public is critical. Although media has become an increasingly popular source of COVID-19 vaccine-related information, the question of whether and how media use is related to the public’s vaccine hesitancy warrants exploration. Objective: This study aimed to (1) examine the level of COVID-19 vaccine hesitancy, (2) identify factors associated with COVID-19 vaccine hesitancy, and (3) explore the direct and indirect relationship between media use and vaccine hesitancy through psychological factors. Methods: A month before COVID-19 vaccination was initiated in South Korea, we conducted a cross-sectional web-based survey over 6 days (January 20-25, 2021). This study included 1016 participants, and a logit model for regression analyzed associations between sociodemographic factors, health-related factors, psychological factors, and media use toward one’s COVID-19 vaccine hesitancy. Additionally, we conducted a path analysis to examine the indirect effects of media use on vaccine hesitancy by using psychological factors (ie, perceived risk of COVID-19 infection, perceived benefits, and perceived barriers of COVID-19 vaccination). Results: Among the participants (N=1016), 53.3% (541/1016) hesitated to take the COVID-19 vaccine, while 46.7% (475/1016) agreed to accept the vaccine. Of the sociodemographic factors, female gender (odds ratio [OR] 1.967, 95% CI 1.36-2.86; P<.001), age in 50s (OR 0.47, 95% CI 0.23-0.96; P=.004), and age over 60s (OR 0.49, 95% CI 0.24-0.99; P=.04) were significant individual predictors of COVID-19 vaccine hesitancy. Perceived susceptibility of infection (OR 0.69, 95% CI 0.52-0.91; P=.01) and perceived benefits of vaccination (OR 0.69, 95% CI 0.52-0.91; P=.01) were associated with lower vaccine hesitancy. Perceived barriers of vaccination (OR 1.63, 95% CI 1.29-2.07; P<.001) and lower trust in government (OR 0.72, 95% CI 0.53-0.98; P=.04) were related to vaccine hesitancy. The use of offline and online media as sources for the perceived benefits of vaccination was associated with vaccine hesitancy, resulting in lower vaccine hesitancy. Moreover, perceived susceptibility of the disease and perceived barriers of vaccination mediated the association between social media use and vaccine hesitancy. Conclusions: Our findings revealed a considerable level of COVID-19 vaccine hesitancy in South Korea. Gender-based and generation-based public health policies and communication are recommended. Efforts to lower the perceived risk of vaccine side effects and heighten perceived benefits of the vaccine are required. Although the use of media has a positive and negative effect on the population’s vaccine hesitancy, efforts should be made to disseminate reliable and timely information on media while confronting misinformation or disinformation for successive implementation of vaccine programs during pandemics. %M 34870605 %R 10.2196/32329 %U https://www.jmir.org/2022/1/e32329 %U https://doi.org/10.2196/32329 %U http://www.ncbi.nlm.nih.gov/pubmed/34870605 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 1 %P e30006 %T Individuals With SARS-CoV-2 Infection During the First and Second Waves in Catalonia, Spain: Retrospective Observational Study Using Daily Updated Data %A Alves-Cabratosa,Lia %A Comas-Cufí,Marc %A Blanch,Jordi %A Martí-Lluch,Ruth %A Ponjoan,Anna %A Castro-Guardiola,Antoni %A Hurtado-Ganoza,Abelardo %A Pérez-Jaén,Ana %A Rexach-Fumaña,Maria %A Faixedas-Brunsoms,Delfi %A Gispert-Ametller,Maria Angels %A Guell-Cargol,Anna %A Rodriguez-Batista,Maria %A Santaularia-Font,Ferran %A Orriols,Ramon %A Bonnin-Vilaplana,Marc %A Calderón López,Juan Carlos %A Sabater-Talaverano,Gladis %A Queralt Moles,Francesc Xavier %A Rodriguez-Requejo,Sara %A Avellana-Revuelta,Esteve %A Balló,Elisabet %A Fages-Masmiquel,Ester %A Sirvent,Josep-Maria %A Lorencio,Carol %A Morales-Pedrosa,Josep Miquel %A Ortiz-Ballujera,Patricia %A Ramos,Rafel %+ Vascular Health Research Group of Girona, Institut Universitari per a la Recerca en Atenció Primària Jordi Gol i Gurina, Maluquer Salvador, 11, Girona, 17002, Spain, 34 972487968, rramos.girona.ics@gencat.cat %K epidemiology %K SARS-CoV-2 %K COVID-19 %K timeline %K comparison %K pandemic %K waves %K population characteristics %D 2022 %7 6.1.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: A description of individuals with SARS-CoV-2 infection comparing the first and second waves could help adapt health services to manage this highly transmissible infection. Objective: We aimed to describe the epidemiology of individuals with suspected SARS-CoV-2 infection, and the characteristics of patients with a positive test comparing the first and second waves in Catalonia, Spain. Methods: This study had 2 stages. First, we analyzed daily updated data on SARS-CoV-2 infection in individuals from Girona (Catalonia). Second, we compared 2 retrospective cohorts of patients with a positive reverse-transcription polymerase chain reaction or rapid antigen test for SARS-CoV-2. The severity of patients with a positive test was defined by their admission to hospital, admission to intermediate respiratory care, admission to the intensive care unit, or death. The first wave was from March 1, 2020, to June 24, 2020, and the second wave was from June 25, 2020, to December 8, 2020. Results: The numbers of tests and cases were lower in the first wave than in the second wave (26,096 tests and 3140 cases in the first wave versus 140,332 tests and 11,800 cases in the second wave), but the percentage of positive results was higher in the first wave than in the second wave (12.0% versus 8.4%). Among individuals with a positive diagnostic test, 818 needed hospitalization in the first wave and 680 in the second; however, the percentage of hospitalized individuals was higher in the first wave than in the second wave (26.1% versus 5.8%). The group that was not admitted to hospital included older people and those with a higher percentage of comorbidities in the first wave, whereas the characteristics of the groups admitted to hospital were more alike. Conclusions: Screening systems for SARS-CoV-2 infection were scarce during the first wave, but were more adequate during the second wave, reflecting the usefulness of surveillance systems to detect a high number of asymptomatic infected individuals and their contacts, to help control this pandemic. The characteristics of individuals with SARS-CoV-2 infection in the first and second waves differed substantially; individuals in the first wave were older and had a worse health condition. %M 34797774 %R 10.2196/30006 %U https://publichealth.jmir.org/2022/1/e30006 %U https://doi.org/10.2196/30006 %U http://www.ncbi.nlm.nih.gov/pubmed/34797774 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 10 %N 1 %P e28981 %T Patient Perspectives on the Digitization of Personal Health Information in the Emergency Department: Mixed Methods Study During the COVID-19 Pandemic %A Ly,Sophia %A Tsang,Ricky %A Ho,Kendall %+ Faculty of Medicine, University of British Columbia, 3312-818 West 10th Avenue, Vancouver, BC, V5Z 1M9, Canada, 1 6048220327, sophia.ly@alumni.ubc.ca %K emergency medicine %K digital health %K health informatics %K electronic health record %K patient portal %K patient-physician relationship %K COVID-19 %D 2022 %7 6.1.2022 %9 Original Paper %J JMIR Med Inform %G English %X Background: Although the digitization of personal health information (PHI) has been shown to improve patient engagement in the primary care setting, patient perspectives on its impact in the emergency department (ED) are unknown. Objective: The primary objective was to characterize the views of ED users in British Columbia, Canada, on the impacts of PHI digitization on ED care. Methods: This was a mixed methods study consisting of an online survey followed by key informant interviews with a subset of survey respondents. ED users in British Columbia were asked about their ED experiences and attitudes toward PHI digitization in the ED. Results: A total of 108 participants submitted survey responses between January and April 2020. Most survey respondents were interested in the use of electronic health records (79/105, 75%) and patient portals (91/107, 85%) in the ED and were amenable to sharing their ED PHI with ED staff (up to 90% in emergencies), family physicians (up to 91%), and family caregivers (up to 75%). In addition, 16 survey respondents provided key informant interviews in August 2020. Interviewees expected PHI digitization in the ED to enhance PHI access by health providers, patient-provider relationships, patient self-advocacy, and postdischarge care management, although some voiced concerns about patient privacy risk and limited access to digital technologies (eg, smart devices, internet connection). Many participants thought the COVID-19 pandemic could provide momentum for the digitization of health care. Conclusions: Patients overwhelmingly support PHI digitization in the form of electronic health records and patient portals in the ED. The COVID-19 pandemic may represent a critical moment for the development and implementation of these tools. %M 34818211 %R 10.2196/28981 %U https://medinform.jmir.org/2022/1/e28981 %U https://doi.org/10.2196/28981 %U http://www.ncbi.nlm.nih.gov/pubmed/34818211 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 1 %P e33792 %T Toward Using Twitter Data to Monitor COVID-19 Vaccine Safety in Pregnancy: Proof-of-Concept Study of Cohort Identification %A Klein,Ari Z %A O'Connor,Karen %A Gonzalez-Hernandez,Graciela %+ Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Blockley Hall, 4th Fl., 423 Guardian Dr., Philadelphia, PA, 19104, United States, 1 215 746 1101, ariklein@pennmedicine.upenn.edu %K natural language processing %K social media %K COVID-19 %K data mining %K COVID-19 vaccine %K pregnancy outcomes %D 2022 %7 6.1.2022 %9 Short Paper %J JMIR Form Res %G English %X Background: COVID-19 during pregnancy is associated with an increased risk of maternal death, intensive care unit admission, and preterm birth; however, many people who are pregnant refuse to receive COVID-19 vaccination because of a lack of safety data. Objective: The objective of this preliminary study was to assess whether Twitter data could be used to identify a cohort for epidemiologic studies of COVID-19 vaccination in pregnancy. Specifically, we examined whether it is possible to identify users who have reported (1) that they received COVID-19 vaccination during pregnancy or the periconception period, and (2) their pregnancy outcomes. Methods: We developed regular expressions to search for reports of COVID-19 vaccination in a large collection of tweets posted through the beginning of July 2021 by users who have announced their pregnancy on Twitter. To help determine if users were vaccinated during pregnancy, we drew upon a natural language processing (NLP) tool that estimates the timeframe of the prenatal period. For users who posted tweets with a timestamp indicating they were vaccinated during pregnancy, we drew upon additional NLP tools to help identify tweets that reported their pregnancy outcomes. Results: We manually verified the content of tweets detected automatically, identifying 150 users who reported on Twitter that they received at least one dose of COVID-19 vaccination during pregnancy or the periconception period. We manually verified at least one reported outcome for 45 of the 60 (75%) completed pregnancies. Conclusions: Given the limited availability of data on COVID-19 vaccine safety in pregnancy, Twitter can be a complementary resource for potentially increasing the acceptance of COVID-19 vaccination in pregnant populations. The results of this preliminary study justify the development of scalable methods to identify a larger cohort for epidemiologic studies. %M 34870607 %R 10.2196/33792 %U https://formative.jmir.org/2022/1/e33792 %U https://doi.org/10.2196/33792 %U http://www.ncbi.nlm.nih.gov/pubmed/34870607 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 1 %P e33989 %T Administration of Parenteral Vitamin C in Patients With Severe Infection: Protocol for a Systematic Review and Meta-analysis %A Agarwal,Arnav %A Basmaji,John %A Fernando,Shannon M %A Ge,Fang Zhou %A Xiao,Yingqi %A Faisal,Haseeb %A Honarmand,Kimia %A Hylands,Mathieu %A Lau,Vincent I %A Lewis,Kimberley %A Couban,Rachel %A Lamontagne,François %A Adhikari,Neill KJ %+ Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Room D1 08, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada, 1 4164804522, neill.adhikari@utoronto.ca %K vitamin C %K ascorbic acid %K severe infection %K sepsis %K COVID-19 %K SARS-CoV-2 %K infection %K parenteral %K vitamin %K infectious disease %K protocol %K review %K meta-analysis %K treatment %K inflammation %K oxidation %K effectiveness %K safety %K critical care %D 2022 %7 6.1.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Severe infections are characterized by inflammation and oxidative damage. Ascorbic acid (vitamin C) administration may attenuate oxidative damage and, in turn, reduce vascular endothelial injury in pulmonary and systemic vasculature. Objective: We aim to describe a protocol for a living systematic review that will evaluate the effectiveness and safety of parenteral vitamin C administration in adults with severe infections, including those with COVID-19. Methods: We searched Ovid MEDLINE, Embase, CINAHL, the Centers for Disease Control and Prevention COVID-19 database, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov from inception to March 30, 2021, for randomized controlled trials evaluating parenteral vitamin C versus no parenteral vitamin C in hospitalized adults with severe infection. Eligible studies will include at least 1 arm involving any dose of parenteral vitamin C alone or in combination with other cointerventions and at least 1 arm not involving parenteral vitamin C. The primary outcomes of interest will include in-hospital, 30-day, and 90-day mortality. Title and abstract screening, full-text screening, data extraction, and risk of bias evaluation via a modified Risk of Bias 2.0 tool will be conducted independently and in pairs. We will perform random effects modeling for meta-analyses, in which study weights will be generated by using the inverse variance method. We will assess certainty in effect estimates by using the Grading of Recommendations Assessment, Development and Evaluation methodology. Meta-analyses will be updated iteratively as new trial evidence becomes available. Results: Among the 1386 citations identified as of March 30, 2021, a total of 17 eligible randomized controlled trials have been identified as of September 2021. We are in the process of updating the search strategy and associated data analyses. Conclusions: The results will be of importance to critical care physicians and hospitalists who manage severe infection and COVID-19 in daily practice, and they may directly inform international clinical guidance. Although our systematic review will incorporate the most recent trial evidence, ongoing trials may change our confidence in the estimates of effects, thereby necessitating iterative updates in the form of a living review. Trial Registration: PROSPERO CRD42020209187; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=209187 International Registered Report Identifier (IRRID): RR1-10.2196/33989 %M 34910661 %R 10.2196/33989 %U https://www.researchprotocols.org/2022/1/e33989 %U https://doi.org/10.2196/33989 %U http://www.ncbi.nlm.nih.gov/pubmed/34910661 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 1 %P e24931 %T COCARDE Study–Cardiac Imaging Phenotype in Patients With COVID-19: Protocol for a Prospective Observational Study %A Lairez,Olivier %A Blanchard,Virginie %A Balardy,Laurent %A Vardon-Bounes,Fanny %A Cazalbou,Stéphanie %A Ruiz,Stéphanie %A Collot,Samia %A Houard,Valérie %A Rolland,Yves %A Conil,Jean-Marie %A Minville,Vincent %+ Department of Cardiology, Rangueil University Hospital, 1 Avenue Jean Poulhès, Toulouse, 1059, France, 33 5 61 32 28 73, lairez@gmail.com %K COVID-19 %K SARS-CoV-2 %K cardiac imaging %K echocardiography %K cardiac MRI %K cardiac imaging %K hyperinflammation %K inflammation %D 2022 %7 6.1.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: The effects of SARS-CoV-2 (COVID-19) on the myocardium and their role in the clinical course of infected patients are still unknown. The severity of SARS-CoV-2 is driven by hyperinflammation, and the effects of SARS-CoV-2 on the myocardium may be significant. This study proposes to use bedside observations and biomarkers to characterize the association of COVID-19 with myocardial injury. Objective: The aim of the study is to describe the myocardial function and its evolution over time in patients infected with SARS-CoV-2 and to investigate the link between inflammation and cardiac injury. Methods: This prospective, monocentric, observational study enrolled 150 patients with suspected or confirmed SARS-CoV-2 infection at Toulouse University Hospital, Toulouse, France. Patients admitted to the intensive care unit (ICU), regular cardiologic ward, and geriatric ward of our tertiary university hospital were included during the pandemic period. Blood sampling, electrocardiography, echocardiography, and morphometric and demographic data were prospectively collected. Results: A total of 100 patients were included. The final enrolment day was March 31, 2020, with first report of results at the end of the first quarter of 2021. The first echocardiographic results at admission of 31 patients of the COCARDE-ICU substudy population show that biological myocardial injury in COVID-19 has low functional impact on left ventricular systolic function. Conclusions: A better understanding of the effects of COVID-19 on myocardial function and its link with inflammation would improve patient follow-up and care. Trial Registration: Clinicaltrials.gov NCT04358952; https://clinicaltrials.gov/ct2/show/NCT04358952 International Registered Report Identifier (IRRID): DERR1-10.2196/24931 %M 34751159 %R 10.2196/24931 %U https://www.researchprotocols.org/2022/1/e24931 %U https://doi.org/10.2196/24931 %U http://www.ncbi.nlm.nih.gov/pubmed/34751159 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 1 %P e29872 %T COVID-19 Vaccine Hesitancy and Acceptance Among Individuals With Cancer, Autoimmune Diseases, or Other Serious Comorbid Conditions: Cross-sectional, Internet-Based Survey %A Tsai,Richard %A Hervey,John %A Hoffman,Kathleen %A Wood,Jessica %A Johnson,Jennifer %A Deighton,Dana %A Clermont,Donald %A Loew,Brian %A Goldberg,Stuart L %+ Inspire, 3101 Wilson Boulevard, Suite 220, Arlington, VA, 22201, United States, 1 800 945 0381, richard@inspire.com %K COVID-19 %K vaccine %K hesitancy %K cancer %K autoimmune diseases %K vaccination %K comorbidities %K SARS-CoV-2 %K survey %K cross-sectional %K survey %K incidence %K safety %K vulnerable %K perception %K attitude %D 2022 %7 5.1.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Individuals with comorbid conditions have been disproportionately affected by COVID-19. Since regulatory trials of COVID-19 vaccines excluded those with immunocompromising conditions, few patients with cancer and autoimmune diseases were enrolled. With limited vaccine safety data available, vulnerable populations may have conflicted vaccine attitudes. Objective: We assessed the prevalence and independent predictors of COVID-19 vaccine hesitancy and acceptance among individuals with serious comorbidities and assessed self-reported side effects among those who had been vaccinated. Methods: We conducted a cross-sectional, 55-item, online survey, fielded January 15, 2021 through February 22, 2021, among a random sample of members of Inspire, an online health community of over 2.2 million individuals with comorbid conditions. Multivariable regression analysis was utilized to determine factors independently associated with vaccine hesitancy and acceptance. Results: Of the 996,500 members of the Inspire health community invited to participate, responses were received from 21,943 individuals (2.2%). Respondents resided in 123 countries (United States: 16,277/21,943, 74.2%), had a median age range of 56-65 years, were highly educated (college or postgraduate degree: 10,198/17,298, 58.9%), and had diverse political leanings. All respondents self-reported at least one comorbidity: cancer, 27.3% (5459/19,980); autoimmune diseases, 23.2% (4946/21,294); chronic lung diseases: 35.4% (7544/21,294). COVID-19 vaccine hesitancy was identified in 18.6% (3960/21,294), with 10.3% (2190/21,294) declaring that they would not, 3.5% (742/21,294) stating that they probably would not, and 4.8% (1028/21,294) not sure whether they would agree to be vaccinated. Hesitancy was expressed by the following patients: cancer, 13.4% (731/5459); autoimmune diseases, 19.4% (962/4947); chronic lung diseases: 17.8% (1344/7544). Positive predictors of vaccine acceptance included routine influenza vaccination (odds ratio [OR] 1.53), trust in responsible vaccine development (OR 14.04), residing in the United States (OR 1.31), and never smoked (OR 1.06). Hesitancy increased with a history of prior COVID-19 (OR 0.86), conservative political leaning (OR 0.93), younger age (OR 0.83), and lower education level (OR 0.90). One-quarter (5501/21,294, 25.8%) had received at least one COVID-19 vaccine injection, and 6.5% (1390/21,294) completed a 2-dose series. Following the first injection, 69.0% (3796/5501) self-reported local reactions, and 40.0% (2200/5501) self-reported systemic reactions, which increased following the second injection to 77.0% (1070/1390) and 67.0% (931/1390), respectively. Conclusions: In this survey of individuals with serious comorbid conditions, significant vaccine hesitancy remained. Assumptions that the most vulnerable would automatically accept COVID-19 vaccination are erroneous and thus call for health care team members to initiate discussions focusing on the impact of the vaccine on an individual’s underlying condition. Early self-reported side effect experiences among those who had already been vaccinated, as expressed by our population, should be reassuring and might be utilized to alleviate vaccine fears. Health care–related social media forums that rapidly disseminate accurate information about the COVID-19 vaccine may play an important role. %M 34709184 %R 10.2196/29872 %U https://publichealth.jmir.org/2022/1/e29872 %U https://doi.org/10.2196/29872 %U http://www.ncbi.nlm.nih.gov/pubmed/34709184 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 1 %P e31752 %T Facilitators and Barriers to the Adoption of Telemedicine During the First Year of COVID-19: Systematic Review %A Kruse,Clemens %A Heinemann,Katharine %+ School of Health Administration, Texas State University, Encino Hall, Room 250, 601 University Dr, San Marcos, TX, 78666, United States, 1 5122454462, scottkruse@txstate.edu %K telemedicine %K pandemic %K technology acceptance %K COVID-19 %K digital health %K telehealth %K health policy %K health care %D 2022 %7 4.1.2022 %9 Review %J J Med Internet Res %G English %X Background: The virulent and unpredictable nature of COVID-19 combined with a change in reimbursement mechanisms both forced and enabled the rapid adoption of telemedicine around the world. Thus, it is important to now assess the effects of this rapid adoption and to determine whether the barriers to such adoption are the same today as they were under prepandemic conditions. Objective: The objective of this systematic literature review was to examine the research literature published during the COVID-19 pandemic to identify facilitators, barriers, and associated medical outcomes as a result of adopting telemedicine, and to determine if changes have occurred in the industry during this time. Methods: The systematic review was performed in accordance with the Kruse protocol and the results are reported in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. We analyzed 46 research articles from five continents published during the first year of the COVID-19 pandemic that were retrieved from searches in four research databases: PubMed (MEDLINE), CINAHL, Science Direct, and Web of Science. Results: Reviewers identified 25 facilitator themes and observations, 12 barrier themes and observations, and 14 results (compared to a control group) themes and observations. Overall, 22% of the articles analyzed reported strong satisfaction or satisfaction (zero reported a decline in satisfaction), 27% reported an improvement in administrative or efficiency results (as compared with a control group), 14% reported no statistically significant difference from the control group, and 40% and 10% reported an improvement or no statistically significant difference in medical outcomes using the telemedicine modality over the control group, respectively. Conclusions: The pandemic encouraged rapid adoption of telemedicine, which also encouraged practices to adopt the modality regardless of the challenges identified in previous research. Several barriers remain for health policymakers to address; however, health care administrators can feel confident in the modality as the evidence largely shows that it is safe, effective, and widely accepted. %M 34854815 %R 10.2196/31752 %U https://www.jmir.org/2022/1/e31752 %U https://doi.org/10.2196/31752 %U http://www.ncbi.nlm.nih.gov/pubmed/34854815 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 1 %P e32564 %T A Telemedicine-Guided Self-Collection Approach for PCR-Based SARS-CoV-2 Testing: Comparative Study %A Würstle,Silvia %A Erber,Johanna %A Hanselmann,Michael %A Hoffmann,Dieter %A Werfel,Stanislas %A Hering,Svenja %A Weidlich,Simon %A Schneider,Jochen %A Franke,Ralf %A Maier,Michael %A Henkel,Andreas G %A Schmid,Roland M %A Protzer,Ulrike %A Laxy,Michael %A Spinner,Christoph D %+ Department of Internal Medicine II, School of Medicine, University Hospital rechts der Isar, Technical University of Munich, Ismaninger Str 22, Munich, 81675, Germany, 49 8941404375, Christoph.Spinner@mri.tum.de %K self-sampling %K telemedicine %K test strategy effectiveness %K simulation model %K SARS-CoV-2 %K COVID-19 %D 2022 %7 4.1.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Large-scale, polymerase chain reaction (PCR)-based SARS-CoV-2 testing is expensive, resource intensive, and time consuming. A self-collection approach is a probable alternative; however, its feasibility, cost, and ability to prevent infections need to be evaluated. Objective: This study aims to compare an innovative self-collection approach with a regular SARS-CoV-2 testing strategy in a large European industrial manufacturing site. Methods: The feasibility of a telemedicine-guided PCR-based self-collection approach was assessed for 150 employees (intervention group) and compared with a regular SARS-CoV-2 testing approach used for 143 employees (control group). Acceptance, ergonomics, and efficacy were evaluated using a software application. A simulation model was implemented to evaluate the effectiveness. An interactive R shiny app was created to enable customized simulations. Results: The test results were successfully communicated to and interpreted without uncertainty by 76% (114/150) and 76.9% (110/143) of the participants in the intervention and control groups, respectively (P=.96). The ratings for acceptability, ergonomics, and efficacy among intervention group participants were noninferior when compared to those among control group participants (acceptability: 71.6% vs 37.6%; ergonomics: 88.1% vs 74.5%; efficacy: 86.4% vs 77.5%). The self-collection approach was found to be less time consuming (23 min vs 38 min; P<.001). The simulation model indicated that both testing approaches reduce the risk of infection, and the self-collection approach tends to be slightly less effective owing to its lower sensitivity. Conclusions: The self-collection approach for SARS-CoV-2 diagnosis was found to be technically feasible and well rated in terms of acceptance, ergonomics, and efficacy. The simulation model facilitates the evaluation of test effectiveness; nonetheless, considering context specificity, appropriate adaptation by companies is required. %M 34803022 %R 10.2196/32564 %U https://formative.jmir.org/2022/1/e32564 %U https://doi.org/10.2196/32564 %U http://www.ncbi.nlm.nih.gov/pubmed/34803022 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 12 %P e32846 %T Patterns of SARS-CoV-2 Testing Preferences in a National Cohort in the United States: Latent Class Analysis of a Discrete Choice Experiment %A Zimba,Rebecca %A Romo,Matthew L %A Kulkarni,Sarah G %A Berry,Amanda %A You,William %A Mirzayi,Chloe %A Westmoreland,Drew A %A Parcesepe,Angela M %A Waldron,Levi %A Rane,Madhura S %A Kochhar,Shivani %A Robertson,McKaylee M %A Maroko,Andrew R %A Grov,Christian %A Nash,Denis %+ Institute for Implementation Science in Population Health, CUNY Graduate School of Public Health & Health Policy, 55 W 125th St, 6th Floor, New York, NY, 10027, United States, 1 646 364 9618, rebecca.zimba@sph.cuny.edu %K SARS-CoV-2 %K testing %K discrete choice experiment %K latent class analysis %K COVID-19 %K pattern %K trend %K preference %K cohort %K United States %K discrete choice %K diagnostic %K transmission %K vaccine %K uptake %K public health %D 2021 %7 30.12.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Inadequate screening and diagnostic testing in the United States throughout the first several months of the COVID-19 pandemic led to undetected cases transmitting disease in the community and an underestimation of cases. Though testing supply has increased, maintaining testing uptake remains a public health priority in the efforts to control community transmission considering the availability of vaccinations and threats from variants. Objective: This study aimed to identify patterns of preferences for SARS-CoV-2 screening and diagnostic testing prior to widespread vaccine availability and uptake. Methods: We conducted a discrete choice experiment (DCE) among participants in the national, prospective CHASING COVID (Communities, Households, and SARS-CoV-2 Epidemiology) Cohort Study from July 30 to September 8, 2020. The DCE elicited preferences for SARS-CoV-2 test type, specimen type, testing venue, and result turnaround time. We used latent class multinomial logit to identify distinct patterns of preferences related to testing as measured by attribute-level part-worth utilities and conducted a simulation based on the utility estimates to predict testing uptake if additional testing scenarios were offered. Results: Of the 5098 invited cohort participants, 4793 (94.0%) completed the DCE. Five distinct patterns of SARS-CoV-2 testing emerged. Noninvasive home testers (n=920, 19.2% of participants) were most influenced by specimen type and favored less invasive specimen collection methods, with saliva being most preferred; this group was the least likely to opt out of testing. Fast-track testers (n=1235, 25.8%) were most influenced by result turnaround time and favored immediate and same-day turnaround time. Among dual testers (n=889, 18.5%), test type was the most important attribute, and preference was given to both antibody and viral tests. Noninvasive dual testers (n=1578, 32.9%) were most strongly influenced by specimen type and test type, preferring saliva and cheek swab specimens and both antibody and viral tests. Among hesitant home testers (n=171, 3.6%), the venue was the most important attribute; notably, this group was the most likely to opt out of testing. In addition to variability in preferences for testing features, heterogeneity was observed in the distribution of certain demographic characteristics (age, race/ethnicity, education, and employment), history of SARS-CoV-2 testing, COVID-19 diagnosis, and concern about the pandemic. Simulation models predicted that testing uptake would increase from 81.6% (with a status quo scenario of polymerase chain reaction by nasal swab in a provider’s office and a turnaround time of several days) to 98.1% by offering additional scenarios using less invasive specimens, both viral and antibody tests from a single specimen, faster turnaround time, and at-home testing. Conclusions: We identified substantial differences in preferences for SARS-CoV-2 testing and found that offering additional testing options would likely increase testing uptake in line with public health goals. Additional studies may be warranted to understand if preferences for testing have changed since the availability and widespread uptake of vaccines. %M 34793320 %R 10.2196/32846 %U https://publichealth.jmir.org/2021/12/e32846 %U https://doi.org/10.2196/32846 %U http://www.ncbi.nlm.nih.gov/pubmed/34793320 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 1 %N 1 %P e31671 %T Temporal Variations and Spatial Disparities in Public Sentiment Toward COVID-19 and Preventive Practices in the United States: Infodemiology Study of Tweets %A Kahanek,Alexander %A Yu,Xinchen %A Hong,Lingzi %A Cleveland,Ana %A Philbrick,Jodi %+ College of Information, University of North Texas, E292, 3940 N Elm St, Denton, TX, 76203, United States, 1 9192607578, lingzi.hong@unt.edu %K COVID-19 %K preventive practices %K temporal variations %K spatial disparities %K Twitter %K public sentiment %K socioeconomic factors %D 2021 %7 30.12.2021 %9 Original Paper %J JMIR Infodemiology %G English %X Background: During the COVID-19 pandemic, US public health authorities and county, state, and federal governments recommended or ordered certain preventative practices, such as wearing masks, to reduce the spread of the disease. However, individuals had divergent reactions to these preventive practices. Objective: The purpose of this study was to understand the variations in public sentiment toward COVID-19 and the recommended or ordered preventive practices from the temporal and spatial perspectives, as well as how the variations in public sentiment are related to geographical and socioeconomic factors. Methods: The authors leveraged machine learning methods to investigate public sentiment polarity in COVID-19–related tweets from January 21, 2020 to June 12, 2020. The study measured the temporal variations and spatial disparities in public sentiment toward both general COVID-19 topics and preventive practices in the United States. Results: In the temporal analysis, we found a 4-stage pattern from high negative sentiment in the initial stage to decreasing and low negative sentiment in the second and third stages, to the rebound and increase in negative sentiment in the last stage. We also identified that public sentiment to preventive practices was significantly different in urban and rural areas, while poverty rate and unemployment rate were positively associated with negative sentiment to COVID-19 issues. Conclusions: The differences between public sentiment toward COVID-19 and the preventive practices imply that actions need to be taken to manage the initial and rebound stages in future pandemics. The urban and rural differences should be considered in terms of the communication strategies and decision making during a pandemic. This research also presents a framework to investigate time-sensitive public sentiment at the county and state levels, which could guide local and state governments and regional communities in making decisions and developing policies in crises. %M 35013722 %R 10.2196/31671 %U https://infodemiology.jmir.org/2021/1/e31671 %U https://doi.org/10.2196/31671 %U http://www.ncbi.nlm.nih.gov/pubmed/35013722 %0 Journal Article %@ 1947-2579 %I JMIR Publications %V 13 %N 3 %P e11617 %T Roles of Health Literacy in Relation to Social Determinants of Health and Recommendations for Informatics-Based Interventions: Systematic Review %D 2021 %7 ..2021 %9 %J Online J Public Health Inform %G English %X Background: The initial limited supply of COVID-19 vaccine in the U.S. presented significant allocation, distribution, and delivery challenges. Information that can assist health officials, hospital administrators and other decision makers with readily identifying who and where to target vaccine resources and efforts can improve public health response.Objective: The objective of this project was to develop a publicly available geographical information system (GIS) web mapping tool that would assist North Carolina health officials readily identify high-risk, high priority population groups and facilities in the immunization decision making process.Methods: Publicly available data were used to identify 14 key health and socio-demographic variables and 5 differing themes (social and economic status; minority status and language; housing situation; at risk population; and health status). Vaccine priority population index (VPI) scores were created by calculating a percentile rank for each variable over each N.C. Census tract. All Census tracts (N = 2,195) values were ranked from lowest to highest (0.0 to 1.0) with a non-zero population and mapped using ArcGIS.Results: The VPI tool was made publicly available (https://enchealth.org/) during the pandemic to readily assist with identifying high risk population priority areas in N.C. for the planning, distribution, and delivery of COVID-19 vaccine.Discussion: While health officials may have benefitted by using the VPI tool during the pandemic, a more formal evaluation process is needed to fully assess its usefulness, functionality, and limitations.Conclusion: When considering COVID-19 immunization efforts, the VPI tool can serve as an added component in the decision-making process. %M 35082975 %R 10.5210/ojphi.v13i3.11617 %U %U https://doi.org/10.5210/ojphi.v13i3.11617 %U http://www.ncbi.nlm.nih.gov/pubmed/35082975 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 12 %P e31540 %T Infoveillance of the Croatian Online Media During the COVID-19 Pandemic: One-Year Longitudinal Study Using Natural Language Processing %A Beliga,Slobodan %A Martinčić-Ipšić,Sanda %A Matešić,Mihaela %A Petrijevčanin Vuksanović,Irena %A Meštrović,Ana %+ Department of Informatics, University of Rijeka, Radmile Matejčić 2, Rijeka, 51000, Croatia, 385 51584726, sbeliga@inf.uniri.hr %K COVID-19 %K pandemic %K online media %K news coverage %K infoveillance %K infodemic %K infodemiology %K natural language processing %K name entity recognition %K longitudinal study %D 2021 %7 24.12.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Online media play an important role in public health emergencies and serve as essential communication platforms. Infoveillance of online media during the COVID-19 pandemic is an important step toward gaining a better understanding of crisis communication. Objective: The goal of this study was to perform a longitudinal analysis of the COVID-19–related content on online media based on natural language processing. Methods: We collected a data set of news articles published by Croatian online media during the first 13 months of the pandemic. First, we tested the correlations between the number of articles and the number of new daily COVID-19 cases. Second, we analyzed the content by extracting the most frequent terms and applied the Jaccard similarity coefficient. Third, we compared the occurrence of the pandemic-related terms during the two waves of the pandemic. Finally, we applied named entity recognition to extract the most frequent entities and tracked the dynamics of changes during the observation period. Results: The results showed no significant correlation between the number of articles and the number of new daily COVID-19 cases. Furthermore, there were high overlaps in the terminology used in all articles published during the pandemic with a slight shift in the pandemic-related terms between the first and the second waves. Finally, the findings indicate that the most influential entities have lower overlaps for the identified people and higher overlaps for locations and institutions. Conclusions: Our study shows that online media have a prompt response to the pandemic with a large number of COVID-19–related articles. There was a high overlap in the frequently used terms across the first 13 months, which may indicate the narrow focus of reporting in certain periods. However, the pandemic-related terminology is well-covered. %M 34739388 %R 10.2196/31540 %U https://publichealth.jmir.org/2021/12/e31540 %U https://doi.org/10.2196/31540 %U http://www.ncbi.nlm.nih.gov/pubmed/34739388 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 12 %P e27339 %T COVID-19–Related Rumor Content, Transmission, and Clarification Strategies in China: Descriptive Study %A Ning,Peishan %A Cheng,Peixia %A Li,Jie %A Zheng,Ming %A Schwebel,David C %A Yang,Yang %A Lu,Peng %A Mengdi,Li %A Zhang,Zhuo %A Hu,Guoqing %+ Department of Epidemiology and Health Statistics, Hunan Provincial Key Laboratory of Clinical Epidemiology, Xiangya School of Public Health, Central South University, 110 Xiangya Road, Changsha, 410078, China, 86 731 84805414, huguoqing009@gmail.com %K COVID-19 %K rumor %K strategy %K China %K social media %D 2021 %7 23.12.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Given the permeation of social media throughout society, rumors spread faster than ever before, which significantly complicates government responses to public health emergencies such as the COVID-19 pandemic. Objective: We aimed to examine the characteristics and propagation of rumors during the early months of the COVID-19 pandemic in China and evaluated the effectiveness of health authorities’ release of correction announcements. Methods: We retrieved rumors widely circulating on social media in China during the early stages of the COVID-19 pandemic and assessed the effectiveness of official government clarifications and popular science articles refuting those rumors. Results: We show that the number of rumors related to the COVID-19 pandemic fluctuated widely in China between December 1, 2019 and April 15, 2020. Rumors mainly occurred in 3 provinces: Hubei, Zhejiang, and Guangxi. Personal social media accounts constituted the major source of media reports of the 4 most widely distributed rumors (the novel coronavirus can be prevented with “Shuanghuanglian”: 7648/10,664, 71.7%; the novel coronavirus is the SARS coronavirus: 14,696/15,902, 92.4%; medical supplies intended for assisting Hubei were detained by the local government: 3911/3943, 99.2%; asymptomatically infected persons were regarded as diagnosed COVID-19 patients with symptoms in official counts: 322/323, 99.7%). The number of rumors circulating was positively associated with the severity of the COVID-19 epidemic (ρ=0.88, 95% CI 0.81-0.93). The release of correction articles was associated with a substantial decrease in the proportion of rumor reports compared to accurate reports. The proportions of negative sentiments appearing among comments by citizens in response to media articles disseminating rumors and disseminating correct information differ insignificantly (both correct reports: χ12=0.315, P=.58; both rumors: χ12=0.025, P=.88; first rumor and last correct report: χ12=1.287, P=.26; first correct report and last rumor: χ12=0.033, P=.86). Conclusions: Our results highlight the importance and urgency of monitoring and correcting false or misleading reports on websites and personal social media accounts. The circulation of rumors can influence public health, and government bodies should establish guidelines to monitor and mitigate the negative impact of such rumors. %M 34806992 %R 10.2196/27339 %U https://www.jmir.org/2021/12/e27339 %U https://doi.org/10.2196/27339 %U http://www.ncbi.nlm.nih.gov/pubmed/34806992 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 12 %P e34218 %T Tracking Private WhatsApp Discourse About COVID-19 in Singapore: Longitudinal Infodemiology Study %A Tan,Edina YQ %A Wee,Russell RE %A Saw,Young Ern %A Heng,Kylie JQ %A Chin,Joseph WE %A Tong,Eddie MW %A Liu,Jean CJ %+ Division of Social Sciences, Yale-NUS College, 28 College Ave West, Singapore, 138527, Singapore, 65 66013694, jeanliu@yale-nus.edu.sg %K social media %K WhatsApp %K infodemiology %K misinformation %K COVID-19 %K tracking %K surveillance %K app %K longitudinal %K Singapore %K characteristic %K usage %K pattern %K well-being %K communication %K risk %D 2021 %7 23.12.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Worldwide, social media traffic increased following the onset of the COVID-19 pandemic. Although the spread of COVID-19 content has been described for several social media platforms (eg, Twitter and Facebook), little is known about how such content is spread via private messaging platforms, such as WhatsApp (WhatsApp LLC). Objective: In this study, we documented (1) how WhatsApp is used to transmit COVID-19 content, (2) the characteristics of WhatsApp users based on their usage patterns, and (3) how usage patterns link to COVID-19 concerns. Methods: We used the experience sampling method to track day-to-day WhatsApp usage during the COVID-19 pandemic. For 1 week, participants reported each day the extent to which they had received, forwarded, or discussed COVID-19 content. The final data set comprised 924 data points, which were collected from 151 participants. Results: During the weeklong monitoring process, most participants (143/151, 94.7%) reported at least 1 COVID-19–related use of WhatsApp. When a taxonomy was generated based on usage patterns, around 1 in 10 participants (21/151, 13.9%) were found to have received and shared a high volume of forwarded COVID-19 content, akin to super-spreaders identified on other social media platforms. Finally, those who engaged with more COVID-19 content in their personal chats were more likely to report having COVID-19–related thoughts throughout the day. Conclusions: Our findings provide a rare window into discourse on private messaging platforms. Such data can be used to inform risk communication strategies during the pandemic. Trial Registration: ClinicalTrials.gov NCT04367363; https://clinicaltrials.gov/ct2/show/NCT04367363 %M 34881720 %R 10.2196/34218 %U https://www.jmir.org/2021/12/e34218 %U https://doi.org/10.2196/34218 %U http://www.ncbi.nlm.nih.gov/pubmed/34881720 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 12 %P e30106 %T Availability and Suitability of Digital Health Tools in Africa for Pandemic Control: Scoping Review and Cluster Analysis %A Silenou,Bernard C %A Nyirenda,John L Z %A Zaghloul,Ahmed %A Lange,Berit %A Doerrbecker,Juliane %A Schenkel,Karl %A Krause,Gérard %+ Department of Epidemiology, Helmholtz Centre for Infection Research, Inhoffenstraße 7, Braunschweig, 38124, Germany, 49 5316181 3100, Gerard.Krause@helmholtz-hzi.de %K mobile applications %K mHealth %K epidemiological surveillance %K communicable diseases %K outbreak response %K health information management %K public health %K review %K transmission network %D 2021 %7 23.12.2021 %9 Review %J JMIR Public Health Surveill %G English %X Background: Gaining oversight into the rapidly growing number of mobile health tools for surveillance or outbreak management in Africa has become a challenge. Objective: The aim of this study is to map the functional portfolio of mobile health tools used for surveillance or outbreak management of communicable diseases in Africa. Methods: We conducted a scoping review by combining data from a systematic review of the literature and a telephone survey of experts. We applied the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines by searching for articles published between January 2010 and December 2020. In addition, we used the respondent-driven sampling method and conducted a telephone survey from October 2019 to February 2020 among representatives from national public health institutes from all African countries. We combined the findings and used a hierarchical clustering method to group the tools based on their functionalities (attributes). Results: We identified 30 tools from 1914 publications and 45 responses from 52% (28/54) of African countries. Approximately 13% of the tools (4/30; Surveillance Outbreak Response Management and Analysis System, Go.Data, CommCare, and District Health Information Software 2) covered 93% (14/15) of the identified attributes. Of the 30 tools, 17 (59%) tools managed health event data, 20 (67%) managed case-based data, and 28 (97%) offered a dashboard. Clustering identified 2 exceptional attributes for outbreak management, namely contact follow-up (offered by 8/30, 27%, of the tools) and transmission network visualization (offered by Surveillance Outbreak Response Management and Analysis System and Go.Data). Conclusions: There is a large range of tools in use; however, most of them do not offer a comprehensive set of attributes, resulting in the need for public health workers having to use multiple tools in parallel. Only 13% (4/30) of the tools cover most of the attributes, including those most relevant for response to the COVID-19 pandemic, such as laboratory interface, contact follow-up, and transmission network visualization. %M 34941551 %R 10.2196/30106 %U https://publichealth.jmir.org/2021/12/e30106 %U https://doi.org/10.2196/30106 %U http://www.ncbi.nlm.nih.gov/pubmed/34941551 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 12 %P e30424 %T COVID-19 Vaccine–Related Attitudes and Beliefs in Canada: National Cross-sectional Survey and Cluster Analysis %A Benham,Jamie L %A Atabati,Omid %A Oxoby,Robert J %A Mourali,Mehdi %A Shaffer,Blake %A Sheikh,Hasan %A Boucher,Jean-Christophe %A Constantinescu,Cora %A Parsons Leigh,Jeanna %A Ivers,Noah M %A Ratzan,Scott C %A Fullerton,Madison M %A Tang,Theresa %A Manns,Braden J %A Marshall,Deborah A %A Hu,Jia %A Lang,Raynell %+ Department of Medicine, University of Calgary, 1820 Richmond Road SW, Calgary, AB, T2T5C7, Canada, 1 4039558987, jlbenham@ucalgary.ca %K coronavirus %K COVID-19 %K public health %K marketing %K behavior %K risk reduction %K attitudes %K compliance %K vaccine %K hesitancy %K risk %K belief %K communication %K cross-sectional %K Canada %K gender %K education %K income %K race %K ethnicity %D 2021 %7 23.12.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: There are concerns that vaccine hesitancy may impede COVID-19 vaccine rollout and prevent the achievement of herd immunity. Vaccine hesitancy is a delay in acceptance or refusal of vaccines despite their availability. Objective: We aimed to identify which people are more and less likely to take a COVID-19 vaccine and factors associated with vaccine hesitancy to inform public health messaging. Methods: A Canadian cross-sectional survey was conducted in Canada in October and November 2020, prior to the regulatory approval of the COVID-19 vaccines. Vaccine hesitancy was measured by respondents answering the question “what would you do if a COVID-19 vaccine were available to you?” Negative binomial regression was used to identify the factors associated with vaccine hesitancy. Cluster analysis was performed to identify distinct clusters based on intention to take a COVID-19 vaccine, beliefs about COVID-19 and COVID-19 vaccines, and adherence to nonpharmaceutical interventions. Results: Of 4498 participants, 2876 (63.9%) reported COVID-19 vaccine hesitancy. Vaccine hesitancy was significantly associated with (1) younger age (18-39 years), (2) lower education, and (3) non-Liberal political leaning. Participants that reported vaccine hesitancy were less likely to believe that a COVID-19 vaccine would end the pandemic or that the benefits of a COVID-19 vaccine outweighed the risks. Individuals with vaccine hesitancy had higher prevalence of being concerned about vaccine side effects, lower prevalence of being influenced by peers or health care professionals, and lower prevalence of trust in government institutions. Conclusions: These findings can be used to inform targeted public health messaging to combat vaccine hesitancy as COVID-19 vaccine administration continues. Messaging related to preventing COVID among friends and family, highlighting the benefits, emphasizing safety and efficacy of COVID-19 vaccination, and ensuring that health care workers are knowledgeable and supported in their vaccination counselling may be effective for vaccine-hesitant populations. %M 34779784 %R 10.2196/30424 %U https://publichealth.jmir.org/2021/12/e30424 %U https://doi.org/10.2196/30424 %U http://www.ncbi.nlm.nih.gov/pubmed/34779784 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 12 %P e34178 %T Predicting New Daily COVID-19 Cases and Deaths Using Search Engine Query Data in South Korea From 2020 to 2021: Infodemiology Study %A Husnayain,Atina %A Shim,Eunha %A Fuad,Anis %A Su,Emily Chia-Yu %+ Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, 172-1 Keelung Rd, Sec 2, Taipei, 106, Taiwan, 886 266382736 ext 1515, emilysu@tmu.edu.tw %K prediction %K internet search %K COVID-19 %K South Korea %K infodemiology %D 2021 %7 22.12.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Given the ongoing COVID-19 pandemic situation, accurate predictions could greatly help in the health resource management for future waves. However, as a new entity, COVID-19’s disease dynamics seemed difficult to predict. External factors, such as internet search data, need to be included in the models to increase their accuracy. However, it remains unclear whether incorporating online search volumes into models leads to better predictive performances for long-term prediction. Objective: The aim of this study was to analyze whether search engine query data are important variables that should be included in the models predicting new daily COVID-19 cases and deaths in short- and long-term periods. Methods: We used country-level case-related data, NAVER search volumes, and mobility data obtained from Google and Apple for the period of January 20, 2020, to July 31, 2021, in South Korea. Data were aggregated into four subsets: 3, 6, 12, and 18 months after the first case was reported. The first 80% of the data in all subsets were used as the training set, and the remaining data served as the test set. Generalized linear models (GLMs) with normal, Poisson, and negative binomial distribution were developed, along with linear regression (LR) models with lasso, adaptive lasso, and elastic net regularization. Root mean square error values were defined as a loss function and were used to assess the performance of the models. All analyses and visualizations were conducted in SAS Studio, which is part of the SAS OnDemand for Academics. Results: GLMs with different types of distribution functions may have been beneficial in predicting new daily COVID-19 cases and deaths in the early stages of the outbreak. Over longer periods, as the distribution of cases and deaths became more normally distributed, LR models with regularization may have outperformed the GLMs. This study also found that models performed better when predicting new daily deaths compared to new daily cases. In addition, an evaluation of feature effects in the models showed that NAVER search volumes were useful variables in predicting new daily COVID-19 cases, particularly in the first 6 months of the outbreak. Searches related to logistical needs, particularly for “thermometer” and “mask strap,” showed higher feature effects in that period. For longer prediction periods, NAVER search volumes were still found to constitute an important variable, although with a lower feature effect. This finding suggests that search term use should be considered to maintain the predictive performance of models. Conclusions: NAVER search volumes were important variables in short- and long-term prediction, with higher feature effects for predicting new daily COVID-19 cases in the first 6 months of the outbreak. Similar results were also found for death predictions. %M 34762064 %R 10.2196/34178 %U https://www.jmir.org/2021/12/e34178 %U https://doi.org/10.2196/34178 %U http://www.ncbi.nlm.nih.gov/pubmed/34762064 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 12 %P e31834 %T The Spread of COVID-19 Crisis Communication by German Public Authorities and Experts on Twitter: Quantitative Content Analysis %A Drescher,Larissa S %A Roosen,Jutta %A Aue,Katja %A Dressel,Kerstin %A Schär,Wiebke %A Götz,Anne %+ C³ team GbR, Zennerstraße 13, Munich, 81379, Germany, 49 1726099031, larissa.drescher@c3team.de %K COVID-19 %K crisis communication %K content analysis %K Twitter %K experts %K authorities %K Germany %K negative binomial regression %K social media %K communication %K crisis %K information %K development %D 2021 %7 22.12.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The COVID-19 pandemic led to the necessity of immediate crisis communication by public health authorities. In Germany, as in many other countries, people choose social media, including Twitter, to obtain real-time information and understanding of the pandemic and its consequences. Next to authorities, experts such as virologists and science communicators were very prominent at the beginning of German Twitter COVID-19 crisis communication. Objective: The aim of this study was to detect similarities and differences between public authorities and individual experts in COVID-19 crisis communication on Twitter during the first year of the pandemic. Methods: Descriptive analysis and quantitative content analysis were carried out on 8251 original tweets posted from January 1, 2020, to January 15, 2021. COVID-19–related tweets of 21 authorities and 18 experts were categorized into structural, content, and style components. Negative binomial regressions were performed to evaluate tweet spread measured by the retweet and like counts of COVID-19–related tweets. Results: Descriptive statistics revealed that authorities and experts increasingly tweeted about COVID-19 over the period under study. Two experts and one authority were responsible for 70.26% (544,418/774,865) of all retweets, thus representing COVID-19 influencers. Altogether, COVID-19 tweets by experts reached a 7-fold higher rate of retweeting (t8,249=26.94, P<.001) and 13.9 times the like rate (t8,249=31.27, P<.001) compared with those of authorities. Tweets by authorities were much more designed than those by experts, with more structural and content components; for example, 91.99% (4997/5432) of tweets by authorities used hashtags in contrast to only 19.01% (536/2819) of experts’ COVID-19 tweets. Multivariate analysis revealed that such structural elements reduce the spread of the tweets, and the incidence rate of retweets for authorities’ tweets using hashtags was approximately 0.64 that of tweets without hashtags (Z=–6.92, P<.001). For experts, the effect of hashtags on retweets was insignificant (Z=1.56, P=.12). Conclusions: Twitter data are a powerful information source and suitable for crisis communication in Germany. COVID-19 tweet activity mirrors the development of COVID-19 cases in Germany. Twitter users retweet and like communications regarding COVID-19 by experts more than those delivered by authorities. Tweets have higher coverage for both authorities and experts when they are plain and for authorities when they directly address people. For authorities, it appears that it was difficult to win recognition during COVID-19. For all stakeholders studied, the association between number of followers and number of retweets was highly significantly positive (authorities Z=28.74, P<.001; experts Z=25.99, P<.001). Updated standards might be required for successful crisis communication by authorities. %M 34710054 %R 10.2196/31834 %U https://publichealth.jmir.org/2021/12/e31834 %U https://doi.org/10.2196/31834 %U http://www.ncbi.nlm.nih.gov/pubmed/34710054 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 12 %P e26644 %T Understanding Health Communication Through Google Trends and News Coverage for COVID-19: Multinational Study in Eight Countries %A Ming,Wai-kit %A Huang,Fengqiu %A Chen,Qiuyi %A Liang,Beiting %A Jiao,Aoao %A Liu,Taoran %A Wu,Huailiang %A Akinwunmi,Babatunde %A Li,Jia %A Liu,Guan %A Zhang,Casper J P %A Huang,Jian %A Liu,Qian %+ School of Journalism and Communication, National Media Experimental Teaching Demonstration Center, Jinan University, 601 Huangpu Dadao West, Guangzhou, 510632, China, 86 13302292599, tsusanliu@jnu.edu.cn %K COVID-19 %K Google Trends %K search peaks %K news coverage %K public concerns %D 2021 %7 21.12.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Due to the COVID-19 pandemic, health information related to COVID-19 has spread across news media worldwide. Google is among the most used internet search engines, and the Google Trends tool can reflect how the public seeks COVID-19–related health information during the pandemic. Objective: The aim of this study was to understand health communication through Google Trends and news coverage and to explore their relationship with prevention and control of COVID-19 at the early epidemic stage. Methods: To achieve the study objectives, we analyzed the public’s information-seeking behaviors on Google and news media coverage on COVID-19. We collected data on COVID-19 news coverage and Google search queries from eight countries (ie, the United States, the United Kingdom, Canada, Singapore, Ireland, Australia, South Africa, and New Zealand) between January 1 and April 29, 2020. We depicted the characteristics of the COVID-19 news coverage trends over time, as well as the search query trends for the topics of COVID-19–related “diseases,” “treatments and medical resources,” “symptoms and signs,” and “public measures.” The search query trends provided the relative search volume (RSV) as an indicator to represent the popularity of a specific search term in a specific geographic area over time. Also, time-lag correlation analysis was used to further explore the relationship between search terms trends and the number of new daily cases, as well as the relationship between search terms trends and news coverage. Results: Across all search trends in eight countries, almost all search peaks appeared between March and April 2020, and declined in April 2020. Regarding COVID-19–related “diseases,” in most countries, the RSV of the term “coronavirus” increased earlier than that of “covid-19”; however, around April 2020, the search volume of the term “covid-19” surpassed that of “coronavirus.” Regarding the topic “treatments and medical resources,” the most and least searched terms were “mask” and “ventilator,” respectively. Regarding the topic “symptoms and signs,” “fever” and “cough” were the most searched terms. The RSV for the term “lockdown” was significantly higher than that for “social distancing” under the topic “public health measures.” In addition, when combining search trends with news coverage, there were three main patterns: (1) the pattern for Singapore, (2) the pattern for the United States, and (3) the pattern for the other countries. In the time-lag correlation analysis between the RSV for the topic “treatments and medical resources” and the number of new daily cases, the RSV for all countries except Singapore was positively correlated with new daily cases, with a maximum correlation of 0.8 for the United States. In addition, in the time-lag correlation analysis between the overall RSV for the topic “diseases” and the number of daily news items, the overall RSV was positively correlated with the number of daily news items, the maximum correlation coefficient was more than 0.8, and the search behavior occurred 0 to 17 days earlier than the news coverage. Conclusions: Our findings revealed public interest in masks, disease control, and public measures, and revealed the potential value of Google Trends in the face of the emergence of new infectious diseases. Also, Google Trends combined with news media can achieve more efficient health communication. Therefore, both news media and Google Trends can contribute to the early prevention and control of epidemics. %M 34591781 %R 10.2196/26644 %U https://publichealth.jmir.org/2021/12/e26644 %U https://doi.org/10.2196/26644 %U http://www.ncbi.nlm.nih.gov/pubmed/34591781 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 7 %N 4 %P e33130 %T Telerehabilitation’s Safety, Feasibility, and Exercise Uptake in Cancer Survivors: Process Evaluation %A Dennett,Amy %A Harding,Katherine E %A Reimert,Jacoba %A Morris,Rebecca %A Parente,Phillip %A Taylor,Nicholas F %+ Allied Health Clinical Research Office, Eastern Health, Level 2, 5 Arnold St, Box Hill, 3128, Australia, 61 411288261, a.dennett@latrobe.edu.au %K telehealth %K exercise %K telerehabilitation %K physical activity %K supportive care %K COVID-19 %K feasibility %K cancer %K cancer survivor %K evaluation %K rehabilitation %K impact %K development %K implementation %D 2021 %7 21.12.2021 %9 Original Paper %J JMIR Cancer %G English %X Background: Access to exercise for cancer survivors is poor despite global recognition of its benefits. Telerehabilitation may overcome barriers to exercise for cancer survivors but is not routinely offered. Objective: Following the rapid implementation of an exercise-based telerehabilitation program in response to COVID-19, a process evaluation was conducted to understand the impact on patients, staff, and the health service with the aim of informing future program development. Methods: A mixed methods evaluation was completed for a telerehabilitation program for cancer survivors admitted between March and December 2020. Interviews were conducted with patients and staff involved in implementation. Routinely collected hospital data (adverse events, referrals, admissions, wait time, attendance, physical activity, and quality of life) were also assessed. Patients received an 8-week telerehabilitation intervention including one-on-one health coaching via telehealth, online group exercise and education, information portal, and home exercise prescription. Quantitative data were reported descriptively, and qualitative interview data were coded and mapped to the Proctor model for implementation research. Results: The telerehabilitation program received 175 new referrals over 8 months. Of those eligible, 123 of 150 (82%) commenced the study. There were no major adverse events. Adherence to health coaching was high (674/843, 80% of scheduled sessions), but participation in online group exercise classes was low (n=36, 29%). Patients improved their self-reported physical activity levels by a median of 110 minutes per week (IQR 90-401) by program completion. Patients were satisfied with telerehabilitation, but clinicians reported a mixed experience of pride in rapid care delivery contrasting with loss of personal connections. The average health service cost per patient was Aus $1104 (US $790). Conclusions: Telerehabilitation is safe, feasible, and improved outcomes for cancer survivors. Learnings from this study may inform the ongoing implementation of cancer telerehabilitation. %M 34854817 %R 10.2196/33130 %U https://cancer.jmir.org/2021/4/e33130 %U https://doi.org/10.2196/33130 %U http://www.ncbi.nlm.nih.gov/pubmed/34854817 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 12 %P e32427 %T The Plebeian Algorithm: A Democratic Approach to Censorship and Moderation %A Fedoruk,Benjamin %A Nelson,Harrison %A Frost,Russell %A Fucile Ladouceur,Kai %+ Faculty of Science, University of Ontario, Institute of Technology, 2000 Simcoe St N, Oshawa, ON, L1G 0C5, Canada, 1 905 721 8668, benjamin.fedoruk@ontariotechu.net %K infodemiology %K misinformation %K algorithm %K social media %K plebeian %K natural language processing %K sentiment analysis %K sentiment %K trust %K decision-making %K COVID-19 %D 2021 %7 21.12.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The infodemic created by the COVID-19 pandemic has created several societal issues, including a rise in distrust between the public and health experts, and even a refusal of some to accept vaccination; some sources suggest that 1 in 4 Americans will refuse the vaccine. This social concern can be traced to the level of digitization today, particularly in the form of social media. Objective: The goal of the research is to determine an optimal social media algorithm, one which is able to reduce the number of cases of misinformation and which also ensures that certain individual freedoms (eg, the freedom of expression) are maintained. After performing the analysis described herein, an algorithm was abstracted. The discovery of a set of abstract aspects of an optimal social media algorithm was the purpose of the study. Methods: As social media was the most significant contributing factor to the spread of misinformation, the team decided to examine infodemiology across various text-based platforms (Twitter, 4chan, Reddit, Parler, Facebook, and YouTube). This was done by using sentiment analysis to compare general posts with key terms flagged as misinformation (all of which concern COVID-19) to determine their verity. In gathering the data sets, both application programming interfaces (installed using Python’s pip) and pre-existing data compiled by standard scientific third parties were used. Results: The sentiment can be described using bimodal distributions for each platform, with a positive and negative peak, as well as a skewness. It was found that in some cases, misinforming posts can have up to 92.5% more negative sentiment skew compared to accurate posts. Conclusions: From this, the novel Plebeian Algorithm is proposed, which uses sentiment analysis and post popularity as metrics to flag a post as misinformation. This algorithm diverges from that of the status quo, as the Plebeian Algorithm uses a democratic process to detect and remove misinformation. A method was constructed in which content deemed as misinformation to be removed from the platform is determined by a randomly selected jury of anonymous users. This not only prevents these types of infodemics but also guarantees a more democratic way of using social media that is beneficial for repairing social trust and encouraging the public’s evidence-informed decision-making. %M 34854812 %R 10.2196/32427 %U https://formative.jmir.org/2021/12/e32427 %U https://doi.org/10.2196/32427 %U http://www.ncbi.nlm.nih.gov/pubmed/34854812 %0 Journal Article %@ 2561-9128 %I JMIR Publications %V 4 %N 2 %P e26613 %T Management of Acute Appendicitis in Children During COVID-19 and Perspectives of Pediatric Surgeons From South Asia: Survey Study %A Hannan,Md Jafrul %A Parveen,Mosammat Kohinoor %A Hoque,Md Mozammel %A Chowdhury,Tanvir Kabir %A Hasan,Md Samiul %A Nandy,Alak %+ Department of Pediatric Surgery, South Point Hospital, Apt B3, House 72/A, Road 1, Panchlaish, Chittagong, 4100, Bangladesh, 880 1819345305, jafrulhannan@gmail.com %K COVID-19 %K gastrointestinal %K pediatric %K global surgery %D 2021 %7 21.12.2021 %9 Original Paper %J JMIR Perioper Med %G English %X Background: Nonoperative treatment (NOT) of pediatric appendicitis as opposed to surgery elicits great debate and is potentially influenced by physician preferences. Owing to the effects of the COVID-19 pandemic on health care, the practice of NOT has generally increased by necessity and may, in a post–COVID-19 world, change surgeons’ perceptions of NOT. Objective: The aim of this study was to determine whether the use of NOT has increased in South Asia and whether these levels of practice would be sustained after the pandemic subsides. Methods: A survey was conducted among pediatric surgeons regarding their position, institute, and country; the number of appendicitis cases they managed; and their mode of treatment between identical time periods in 2019 and 2020 (April 1 to August 31). The survey also directly posed the question as to whether they would continue with the COVID-19–imposed level of NOT after the effect of the pandemic diminishes. Results: A total of 134 responses were collected out of 200 (67.0%). A significant increase in the practice of NOT was observed for the entire cohort, although no effect was observed when grouped by country or institute. When grouped by position, senior physicians increased the practice of NOT the most, while junior physicians reported the least change. The data suggest that only professors would be inclined to maintain the COVID-19–level of NOT practice after the pandemic. Conclusions: Increased practice of NOT during the COVID-19 pandemic was observed in South Asia, particularly by senior surgeons. Only professors appeared inclined to consider maintaining this increased level of practice in the post–COVID-19 world. %M 34818209 %R 10.2196/26613 %U https://periop.jmir.org/2021/2/e26613 %U https://doi.org/10.2196/26613 %U http://www.ncbi.nlm.nih.gov/pubmed/34818209 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 12 %P e28416 %T Predictors to Use Mobile Apps for Monitoring COVID-19 Symptoms and Contact Tracing: Survey Among Dutch Citizens %A Jansen-Kosterink,Stephanie %A Hurmuz,Marian %A den Ouden,Marjolein %A van Velsen,Lex %+ eHealth Department, Roessingh Research and Development, Roessinghsbleekweg 33b, Enschede, 7522 AH, Netherlands, 31 88 0875 777, s.jansen@rrd.nl %K COVID-19 %K eHealth %K mHealth %K contact tracing %K symptom management %K intention to use %D 2021 %7 20.12.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: eHealth apps have been recognized as a valuable tool to reduce COVID-19’s effective reproduction number. The factors that determine the acceptance of COVID-19 apps remain unknown. The exception here is privacy. Objective: The aim of this article was to identify antecedents of acceptance of (1) a mobile app for COVID-19 symptom recognition and monitoring and (2) a mobile app for contact tracing, both by means of an online survey among Dutch citizens. Methods: Next to the demographics, the online survey contained questions focusing on perceived health, fear of COVID-19, and intention to use. We used snowball sampling via posts on social media and personal connections. To identify antecedents of the model for acceptance of the 2 mobile apps, we conducted multiple linear regression analyses. Results: In total, 238 Dutch adults completed the survey; 59.2% (n=141) of the responders were female and the average age was 45.6 years (SD 17.4 years). For the symptom app, the final model included the predictors age, attitude toward technology, and fear of COVID-19. The model had an r2 of 0.141. The final model for the tracing app included the same predictors and had an r2 of 0.156. The main reason to use both mobile apps was to control the spread of the COVID-19 virus. Concerns about privacy was mentioned as the main reason to not use the mobile apps. Conclusions: Age, attitude toward technology, and fear of COVID-19 are important predictors of the acceptance of COVID-19 mobile apps for symptom recognition and monitoring and for contact tracing. These predictors should be taken into account during the development and implementation of these mobile apps to secure acceptance. %M 34818210 %R 10.2196/28416 %U https://formative.jmir.org/2021/12/e28416 %U https://doi.org/10.2196/28416 %U http://www.ncbi.nlm.nih.gov/pubmed/34818210 %0 Journal Article %@ 2563-6316 %I JMIR Publications %V 2 %N 4 %P e31503 %T COVID-19 Outcomes and Genomic Characterization of SARS-CoV-2 Isolated From Veterans in New England States: Retrospective Analysis %A Lee,Megan %A Sallah,Ya Haddy %A Petrone,Mary %A Ringer,Matthew %A Cosentino,Danielle %A Vogels,Chantal B F %A Fauver,Joseph R %A Alpert,Tara D %A Grubaugh,Nathan D %A Gupta,Shaili %+ VA Connecticut Healthcare System, 950 Campbell Ave, Bldg 1, Floor 5, Dept of Medicine, Mailstop 111a, West Haven, CT, 06516, United States, 1 203 932 5711 ext 4412, shaili.gupta@yale.edu %K infectious disease %K COVID-19 %K epidemiology %K veteran %K outcome %K sequencing %K genetics %K virus %K United States %K impact %K testing %K severity %K mortality %K cohort %D 2021 %7 17.12.2021 %9 Original Paper %J JMIRx Med %G English %X Background: Clinical and virologic characteristics of COVID-19 infections in veterans in New England have not been described. The average US veteran is a male older than the general US population. SARS-CoV-2 infection is known to cause poorer outcomes among men and older adults, making the veteran population an especially vulnerable group for COVID-19. Objective: This study aims to evaluate clinical and virologic factors impacting COVID-19 outcomes. Methods: This retrospective chart review included 476 veterans in six New England states with confirmed SARS-CoV-2 infection between April and September 2020. Whole genome sequencing was performed on SARS-CoV-2 RNA isolated from these veterans, and the correlation of genomic data to clinical outcomes was evaluated. Clinical and demographic variables were collected by manual chart review and were correlated to the end points of peak disease severity (based on oxygenation requirements), hospitalization, and mortality using multivariate regression analyses. Results: Of 476 veterans, 274 had complete and accessible charts. Of the 274 veterans, 92.7% (n=254) were men and 83.2% (n=228) were White, and the mean age was 63 years. In the multivariate regression, significant predictors of hospitalization (C statistic 0.75) were age (odds ratio [OR] 1.05, 95% CI 1.03-1.08) and non-White race (OR 2.39, 95% CI 1.13-5.01). Peak severity (C statistic 0.70) also varied by age (OR 1.07, 95% CI 1.03-1.11) and O2 requirement on admission (OR 45.7, 95% CI 18.79-111). Mortality (C statistic 0.87) was predicted by age (OR 1.06, 95% CI 1.01-1.11), dementia (OR 3.44, 95% CI 1.07-11.1), and O2 requirement on admission (OR 6.74, 95% CI 1.74-26.1). Most (291/299, 97.3%) of our samples were dominated by the spike protein D614G substitution and were from SARS-CoV-2 B.1 lineage or one of 37 different B.1 sublineages, with none representing more than 8.7% (26/299) of the cases. Conclusions: In a cohort of veterans from the six New England states with a mean age of 63 years and a high comorbidity burden, age was the largest predictor of hospitalization, peak disease severity, and mortality. Non-White veterans were more likely to be hospitalized, and patients who required oxygen on admission were more likely to have severe disease and higher rates of mortality. Multiple SARS-CoV-2 lineages were distributed in patients in New England early in the COVID-19 era, mostly related to viruses from New York State with D614G mutation. %M 35014989 %R 10.2196/31503 %U https://med.jmirx.org/2021/4/e31503 %U https://doi.org/10.2196/31503 %U http://www.ncbi.nlm.nih.gov/pubmed/35014989 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 12 %P e27521 %T An Early Warning Mobile Health Screening and Risk Scoring App for Preventing In-Hospital Transmission of COVID-19 by Health Care Workers: Development and Feasibility Study %A Mbiine,Ronald %A Nakanwagi,Cephas %A Lekuya,Herve Monka %A Aine,Joan %A Hakim,Kawesi %A Nabunya,Lilian %A Tomusange,Henry %+ Makerere University College of Health Sciences, Mulago Hill Road, Kampala, 7072, Uganda, 256 774338585, mbiineron@gmail.com %K mHealth %K risk score for Covid-19 %K Africa %K mobile health %K digital health %K pandemic %K COVID-19 %K COVID %K screening tool %K healthcare workers %K transmission %K warning system %D 2021 %7 17.12.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Hospitals have been identified as very high-risk places for COVID-19 transmission between health care workers and patients who do not have COVID-19. Health care workers are the most at-risk population to contract and transmit the infection, especially to already vulnerable patients who do not have COVID-19. In low-income countries, routine testing is not feasible due to the high cost of testing; therefore, presenting the risk of uncontrolled transmission within non–COVID-19 treatment wards. This challenge necessitated the development of an affordable intermediary screening tool that would enable early identification of potentially infected health care workers and for early real time DNA–polymerase chain reaction testing prioritization. This would limit the contact time of potentially infected health care workers with the patients but also enable efficient use of the limited testing kits. Objective: The aims of this study are to describe an early warning in-hospital mobile risk analysis app for screening COVID-19 and to determine the feasibility and user-friendliness of the app among health care workers. Methods: The primary result of this research project was the development of a mobile-based daily early warning system for in-hospital transmission of COVID-19. Overall, the Early Warning System for In-Hospital Transmission of COVID-19 (EWAS) mobile app was found to be feasible, with over 69% of the health care workers having logged more than 67% of the required times. Over 93% of the participants reported that the tool was easy to use. Results: The primary result of this research project was the development of a mobile-based daily early warning system for in-hospital transmission of COVID-19. Overall, the Early Warning System for In-Hospital Transmission of COVID-19 (EWAS) mobile app was found to be feasible, with 69% of the health care workers (69/100) having logged more than 67% of the required times. Of the 100 participants, 93 reported that the tool was easy to use. Conclusions: The EWAS mobile app is a feasible and user-friendly daily risk scoring tool for preventing in-hospital transmission of COVID-19. Although it was not designed to be a diagnostic tool but rather a screening tool, there is a need to evaluate its sensitivity in predicting persons likely to have contracted COVID-19. %M 34793321 %R 10.2196/27521 %U https://formative.jmir.org/2021/12/e27521 %U https://doi.org/10.2196/27521 %U http://www.ncbi.nlm.nih.gov/pubmed/34793321 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 12 %P e30221 %T Core Competencies to Promote Consistency and Standardization of Best Practices for Digital Peer Support: Focus Group Study %A Collins-Pisano,Caroline %A Velez Court,Juan %A Johnson,Michael %A Mois,George %A Brooks,Jessica %A Myers,Amanda %A Muralidharan,Anjana %A Storm,Marianne %A Wright,Maggie %A Berger,Nancy %A Kasper,Ann %A Fox,Anthony %A MacDonald,Sandi %A Schultze,Sarah %A Fortuna,Karen %+ Department of Psychiatry, Geisel School of Medicine, Dartmouth College, 1 Rope Ferry Rd, Hanover, NH, 03755, United States, 1 (603) 650 1200, Karen.L.Fortuna@dartmouth.edu %K COVID-19 %K peer support %K competencies %K training %K digital %D 2021 %7 16.12.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: As digital peer support is quickly expanding across the globe in the wake of the COVID-19 pandemic, standardization in the training and delivery of digital peer support can advance the professionalism of this field. While telehealth competencies exist for other fields of mental health practice, such as social work, psychiatry, and psychology, limited research has been done to develop and promote digital peer support competencies. Objective: The goal of this study is to introduce the coproduction of core competencies that can guide digital peer support. Methods: Peer support specialists were recruited through an international listserv and participated in a 1-hour virtual focus group. A total of four focus groups were conducted with 59 peer support specialists from 11 US states and three countries. Results: Analysis was conducted using the rigorous and accelerated data reduction (RADaR) technique, and 10 themes were identified: (1) protecting the rights of service users, (2) technical knowledge and skills in the practice of digital peer support, (3) available technologies, (4) equity of access, (5) digital communication skills, (6) performance-based training, (7) self-care, (8) monitoring digital peer support and addressing digital crisis, (9) peer support competencies, and (10) health literacy (emerging). The authors present recommendations based on these themes. Conclusions: The introduction of digital peer support core competencies is an initial first step to promote the standardization of best practices in digital peer support. The established competencies can potentially act as a guide for training and skill development to be integrated into US state peer support specialist competencies and to enhance competencies endorsed by the Substance Abuse and Mental Health Services Administration (SAMHSA). %M 34736223 %R 10.2196/30221 %U https://mental.jmir.org/2021/12/e30221 %U https://doi.org/10.2196/30221 %U http://www.ncbi.nlm.nih.gov/pubmed/34736223 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 12 %P e33739 %T COVID-19 Vaccine Perceptions, Intentions, and Uptake Among Young Adults in the United States: Prospective College-Based Cohort Study %A Gurley,Stephen %A Bennett,Brady %A Sullivan,Patrick Sean %A Kiley,Maryellen %A Linde,Jamie %A Szczerbacki,David %A Guest,Jodie %+ School of Medicine, Emory University, 100 Woodruff Circle, Atlanta, GA, 30322, United States, 1 404 727 0520, sgurley@emory.edu %K COVID-19 %K vaccine %K hesitancy %K college %K higher education %K race %K perception %K intention %K uptake %K prospective %K cohort %K demographic %K minority %K young adult %D 2021 %7 15.12.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Uptake of the COVID-19 vaccine among US young adults, particularly those that belong to racial and ethnic minorities, remains low compared to their older peers. Understanding vaccine perceptions and their influence on vaccination uptake among this population remains crucial to achieving population herd immunity. Objective: We sought to study perceptions of COVID-19 vaccines as well as intended and actual vaccine uptake among one population of college students, faculty, and staff. Methods: As part of a larger study aimed at investigating the dynamics of COVID-19 transmission, serology, and perception on a college campus, participants were asked about their views on the COVID-19 vaccine in February 2021. Vaccination status was assessed by self-report in April 2021. Logistic regression was used to calculate prevalence ratios with marginal standardization. Results: We found that non-White participants were 25% less likely to report COVID-19 vaccination compared to White participants. Among those who were unvaccinated, Black and other non-White participants were significantly more likely to indicate they were unwilling to receive a COVID-19 vaccine compared to White participants. The most common reason for unwillingness to receive the vaccine was belief that the vaccine approval process was rushed. Conclusions: There are racial differences in perceptions of the COVID-19 vaccine among young adults, and these differences might differentially impact vaccine uptake among young racial and ethnic minorities. Efforts to increase vaccine uptake among college populations might require campaigns specifically tailored to these minority groups. %M 34847054 %R 10.2196/33739 %U https://publichealth.jmir.org/2021/12/e33739 %U https://doi.org/10.2196/33739 %U http://www.ncbi.nlm.nih.gov/pubmed/34847054 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 8 %N 4 %P e33364 %T Digitally Disconnected: Qualitative Study of Patient Perspectives on the Digital Divide and Potential Solutions %A Alkureishi,Maria Alcocer %A Choo,Zi-Yi %A Rahman,Ali %A Ho,Kimberly %A Benning-Shorb,Jonah %A Lenti,Gena %A Velázquez Sánchez,Itzel %A Zhu,Mengqi %A Shah,Sachin D %A Lee,Wei Wei %+ Department of Pediatrics, University of Chicago, 5841 S Maryland Avenue, MC 6082 Room C124, Chicago, IL, 60637, United States, 1 773 834 8927, malkureishi@peds.bsd.uchicago.edu %K telemedicine %K digital divide %K patient experience %K qualitative study %D 2021 %7 15.12.2021 %9 Original Paper %J JMIR Hum Factors %G English %X Background: As telemedicine utilization increased during the COVID-19 pandemic, divergent usage patterns for video and audio-only telephone visits emerged. Older, low-income, minority, and non-English speaking Medicaid patients are at highest risk of experiencing technology access and digital literacy barriers. This raises concern for disparities in health care access and widening of the “digital divide,” the separation of those with technological access and knowledge and those without. While studies demonstrate correlation between racial and socioeconomic demographics and technological access and ability, individual patients’ perspectives of the divide and its impacts remain unclear. Objective: We aimed to interview patients to understand their perspectives on (1) the definition, causes, and impact of the digital divide; (2) whose responsibility it is to address this divide, and (3) potential solutions to mitigate the digital divide. Methods: Between December 2020 and March 2021, we conducted 54 semistructured telephone interviews with adult patients and parents of pediatric patients who had virtual visits (phone, video, or both) between March and September 2020 at the University of Chicago Medical Center (UCMC) primary care clinics. A grounded theory approach was used to analyze interview data. Results: Patients were keenly aware of the digital divide and described impacts beyond health care, including employment, education, community and social contexts, and personal economic stability. Patients described that individuals, government, libraries, schools, health care organizations, and even private businesses all shared the responsibility to address the divide. Proposed solutions to address the divide included conducting community technology needs assessments and improving technology access, literacy training, and resource awareness. Recognizing that some individuals will never cross the divide, patients also emphasized continued support of low-tech communication methods and health care delivery to prevent widening of the digital divide. Furthermore, patients viewed technology access and literacy as drivers of the social determinants of health (SDOH), profoundly influencing how SDOH function to worsen or improve health disparities. Conclusions: Patient perspectives provide valuable insight into the digital divide and can inform solutions to mitigate health and resulting societal inequities. Future work is needed to understand the digital needs of disconnected individuals and communities. As clinical care and delivery continue to integrate telehealth, studies are needed to explore whether having a video or audio-only phone visit results in different patient outcomes and utilization. Advocacy efforts to disseminate public and private resources can also expand device and broadband internet access, improve technology literacy, and increase funding to support both high- and low-tech forms of health care delivery for the disconnected. %M 34705664 %R 10.2196/33364 %U https://humanfactors.jmir.org/2021/4/e33364 %U https://doi.org/10.2196/33364 %U http://www.ncbi.nlm.nih.gov/pubmed/34705664 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 12 %P e33617 %T Utility of Facebook’s Social Connectedness Index in Modeling COVID-19 Spread: Exponential Random Graph Modeling Study %A Prusaczyk,Beth %A Pietka,Kathryn %A Landman,Joshua M %A Luke,Douglas A %+ Center for Population Health Informatics, Institute for Informatics, Washington University School of Medicine in St. Louis, 660 S. Euclid Avenue, Saint Louis, MO, 63110, United States, 1 314 330 0537, beth.prusaczyk@wustl.edu %K COVID-19 %K social media %K social networks %K network analysis %K public health %K utility %K Facebook %K connection %K modeling %K spread %K United States %K belief %D 2021 %7 15.12.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The COVID-19 (the disease caused by the SARS-CoV-2 virus) pandemic has underscored the need for additional data, tools, and methods that can be used to combat emerging and existing public health concerns. Since March 2020, there has been substantial interest in using social media data to both understand and intervene in the pandemic. Researchers from many disciplines have recently found a relationship between COVID-19 and a new data set from Facebook called the Social Connectedness Index (SCI). Objective: Building off this work, we seek to use the SCI to examine how social similarity of Missouri counties could explain similarities of COVID-19 cases over time. Additionally, we aim to add to the body of literature on the utility of the SCI by using a novel modeling technique. Methods: In September 2020, we conducted this cross-sectional study using publicly available data to test the association between the SCI and COVID-19 spread in Missouri using exponential random graph models, which model relational data, and the outcome variable must be binary, representing the presence or absence of a relationship. In our model, this was the presence or absence of a highly correlated COVID-19 case count trajectory between two given counties in Missouri. Covariates included each county’s total population, percent rurality, and distance between each county pair. Results: We found that all covariates were significantly associated with two counties having highly correlated COVID-19 case count trajectories. As the log of a county’s total population increased, the odds of two counties having highly correlated COVID-19 case count trajectories increased by 66% (odds ratio [OR] 1.66, 95% CI 1.43-1.92). As the percent of a county classified as rural increased, the odds of two counties having highly correlated COVID-19 case count trajectories increased by 1% (OR 1.01, 95% CI 1.00-1.01). As the distance (in miles) between two counties increased, the odds of two counties having highly correlated COVID-19 case count trajectories decreased by 43% (OR 0.57, 95% CI 0.43-0.77). Lastly, as the log of the SCI between two Missouri counties increased, the odds of those two counties having highly correlated COVID-19 case count trajectories significantly increased by 17% (OR 1.17, 95% CI 1.09-1.26). Conclusions: These results could suggest that two counties with a greater likelihood of sharing Facebook friendships means residents of those counties have a higher likelihood of sharing similar belief systems, in particular as they relate to COVID-19 and public health practices. Another possibility is that the SCI is picking up travel or movement data among county residents. This suggests the SCI is capturing a unique phenomenon relevant to COVID-19 and that it may be worth adding to other COVID-19 models. Additional research is needed to better understand what the SCI is capturing practically and what it means for public health policies and prevention practices. %M 34797775 %R 10.2196/33617 %U https://publichealth.jmir.org/2021/12/e33617 %U https://doi.org/10.2196/33617 %U http://www.ncbi.nlm.nih.gov/pubmed/34797775 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 12 %P e32203 %T Presenting Characteristics, Comorbidities, and Outcomes Among Patients With COVID-19 Hospitalized in Pakistan: Retrospective Observational Study %A Akhtar,Hashaam %A Khalid,Sundas %A Rahman,Fazal ur %A Umar,Muhammad %A Ali,Sabahat %A Afridi,Maham %A Hassan,Faheem %A Saleh Khader,Yousef %A Akhtar,Nasim %A Khan,Muhammad Mujeeb %A Ikram,Aamer %+ Yusra Institute of Pharmaceutical Sciences, Zaraj Housing Society, Opposite DHA Phase 2 Gate III, Main G T Road, Islamabad, 44000, Pakistan, 92 3215272489, hashaamakhtar@gmail.com %K COVID-19 %K indicators %K symptoms %K risk factors %K comorbidities %K severity %K Pakistan %D 2021 %7 14.12.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: COVID-19 became a pandemic rapidly after its emergence in December 2019. It belongs to the coronavirus family of viruses, which have struck a few times before in history. Data based on previous research regarding etiology and epidemiology of other viruses from this family helped played a vital role in formulating prevention and precaution strategies during the initial stages of this pandemic. Data related to COVID-19 in Pakistan were not initially documented on a large scale. In addition, due to a weak health care system and low economic conditions, Pakistan’s population, in general, already suffers from many comorbidities, which can severely affect the outcome of patients infected with COVID-19. Objective: COVID-19 infections are coupled with a manifestation of various notable outcomes that can be documented and characterized clinically. The aim of this study was to examine these clinical manifestations, which can serve as indicators for early detection as well as severity prognosis for COVID-19 infections, especially in high-risk groups. Methods: A retrospective observational study involving abstraction of demographic features, presenting symptoms, and adverse clinical outcomes for 1812 patients with COVID-19 was conducted. Patients were admitted to the four major hospitals in the Rawalpindi-Islamabad region of Pakistan, and the study was conducted from February to August 2020. Multivariate regression analysis was carried out to identify significant indicators of COVID-19 severity, intensive care unit (ICU) admission, ventilator aid, and mortality. The study not only relates COVID-19 infection with comorbidities, but also examines other related factors, such as age and gender. Results: This study identified fever (1592/1812, 87.9%), cough (1433/1812, 79.1%), and shortness of breath (998/1812, 55.1%) at the time of hospital admission as the most prevalent symptoms for patients with COVID-19. These symptoms were common but not conclusive of the outcome of infection. Out of 1812 patients, 24.4% (n=443) required ICU admission and 21.5% (n=390) required ventilator aid at some point of disease progression during their stay at the hospital; 25.9% (n=469) of the patients died. Further analysis revealed the relationship of the presented symptoms and comorbidities with the progression of disease severity in these patients. Older adult patients with comorbidities, such as hypertension, diabetes, chronic kidney disease, and asthma, were significantly affected in higher proportions, resulting in requirement of ICU admission and ventilator aid in some cases and, in many cases, even mortality. Conclusions: Older adult patients with comorbidities, such as hypertension, diabetes, asthma, chronic obstructive pulmonary disorder, and chronic kidney disease, are at increased risk of developing severe COVID-19 infections, with an increased likelihood of adverse clinical outcomes. %M 34710053 %R 10.2196/32203 %U https://publichealth.jmir.org/2021/12/e32203 %U https://doi.org/10.2196/32203 %U http://www.ncbi.nlm.nih.gov/pubmed/34710053 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 8 %N 4 %P e29234 %T Usability of an At-Home Anterior Nares SARS-CoV-2 RT-PCR Sample Collection Kit: Human Factors Feasibility Study %A Strong,Laura E %A Middendorf,Irene %A Turner,Michelle %A Edwards V,David K %A Sama,Varun %A Mou,Joshua %A Adams,K Colleen %+ Exact Sciences Corporation, 5505 Endeavor Lane, Madison, WI, 53719, United States, 1 6088006531, cadams@exactsciences.com %K COVID-19 testing %K at-home collection kit %K SARS-CoV-2 %K feasibility studies %K self-collection %K usability study %K COVID-19 %D 2021 %7 14.12.2021 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Readily available testing for SARS-CoV-2 is necessary to mitigate COVID-19 disease outbreaks. At-home collection kits, in which samples are self-collected without requiring a laboratory or clinic visit and sent to an external laboratory for testing, can provide convenient testing to those with barriers to access. They can prevent unnecessary exposure between patient and clinical staff, increase access for patients with disabilities or remote workers, and decrease burdens on health care resources, such as provider time and personal protective equipment. Exact Sciences developed an at-home collection kit for samples to be tested to detect SARS-CoV-2 that includes an Instructions for Use (IFU) document, which guides people without prior experience on collecting a nasal swab sample. Demonstrating successful sample collection and usability is critical to ensure that these samples meet the same high-quality sample collection standards as samples collected in clinics. Objective: The aim of this study was to determine the usability of a SARS-CoV-2 at-home nasal swab sample collection kit. Methods: A human factors usability study was conducted with 30 subjects without prior medical, laboratory, or health care training and without COVID-19 sample self-collection experience. Subjects were observed while they followed the IFU for the at-home sample collection portion of the SARS-CoV-2 test in a setting that simulated a home environment. IFU usability was further evaluated by requiring the subjects to complete a survey, answer comprehension questions, provide written feedback, and respond to questions from the observer about problems during use. Results: All 30 subjects successfully completed the sample collection process, and all 30 samples were determined by reverse transcription–polymerase chain reaction (RT-PCR) testing to meet quality standards for SARS-CoV-2 testing. The subjects’ written feedback and comments revealed several recommendations to improve the IFU. Conclusions: The study demonstrated the overall usability of an at-home SARS-CoV-2 collection kit. Various feedback mechanisms provided opportunities to improve the wording and graphics for some critical tasks, including placing the label correctly on the tube. A modified IFU was prepared based on study outcomes. %M 34609947 %R 10.2196/29234 %U https://humanfactors.jmir.org/2021/4/e29234 %U https://doi.org/10.2196/29234 %U http://www.ncbi.nlm.nih.gov/pubmed/34609947 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 12 %P e29086 %T Patients’ Perspectives on Qualitative Olfactory Dysfunction: Thematic Analysis of Social Media Posts %A Parker,Jane K %A Kelly,Christine E %A Smith,Barry C %A Kirkwood,Aidan F %A Hopkins,Claire %A Gane,Simon %+ Royal National Ear, Nose and Throat and Eastman Dental Hospitals, 47-49 Huntley Street, London, WC1E 6DG, United Kingdom, 44 7789655222, simongane@nhs.net %K olfactory dysfunction %K parosmia %K phantosmia %K olfactory perseveration %K trigger foods %K mental health %K COVID-19 %K patients’ perspective %K thematic analysis %K social media %K perspective %K smell %K nose %K symptom %K concern %K support %D 2021 %7 14.12.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The impact of qualitative olfactory disorders is underestimated. Parosmia, the distorted perception of familiar odors, and phantosmia, the experience of odors in the absence of a stimulus, can arise following postinfectious anosmia, and the incidences of both have increased substantially since the outbreak of COVID-19. Objective: The aims of this study are to explore the symptoms and sequalae of postinfectious olfactory dysfunction syndrome using unstructured and unsolicited threads from social media, and to articulate the perspectives and concerns of patients affected by these debilitating olfactory disorders. Methods: A thematic analysis and content analysis of posts in the AbScent Parosmia and Phantosmia Support group on Facebook was conducted between June and December 2020. Results: In this paper, we identify a novel symptom, olfactory perseveration, which is a triggered, identifiable, and usually unpleasant olfactory percept that persists in the absence of an ongoing stimulus. We also observe fluctuations in the intensity and duration of symptoms of parosmia, phantosmia, and olfactory perseveration. In addition, we identify a group of the most common items (coffee, meat, onion, and toothpaste) that trigger distortions; however, people have difficulty describing these distortions, using words associated with disgust and revulsion. The emotional aspect of living with qualitative olfactory dysfunction was evident and highlighted the detrimental impact on mental health. Conclusions: Qualitative and unsolicited data acquired from social media has provided useful insights into the patient experience of parosmia and phantosmia, which can inform rehabilitation strategies and ongoing research into understanding the molecular triggers associated with parosmic distortions and research into patient benefit. %M 34904953 %R 10.2196/29086 %U https://formative.jmir.org/2021/12/e29086 %U https://doi.org/10.2196/29086 %U http://www.ncbi.nlm.nih.gov/pubmed/34904953 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 12 %P e32165 %T An Alternative to the Light Touch Digital Health Remote Study: The Stress and Recovery in Frontline COVID-19 Health Care Workers Study %A Goodday,Sarah M %A Karlin,Emma %A Alfarano,Alexandria %A Brooks,Alexa %A Chapman,Carol %A Desille,Rachelle %A Rangwala,Shazia %A Karlin,Daniel R %A Emami,Hoora %A Woods,Nancy Fugate %A Boch,Adrien %A Foschini,Luca %A Wildman,Mackenzie %A Cormack,Francesca %A Taptiklis,Nick %A Pratap,Abhishek %A Ghassemi,Marzyeh %A Goldenberg,Anna %A Nagaraj,Sujay %A Walsh,Elaine %A , %A Friend,Stephen %+ 4YouandMe, 2901 Third Ave Suite 330, Seattle, WA, 98121, United States, 1 2069288254, sarah@4youandme.org %K stress %K wearable %K digital health %K frontline %K COVID-19 %K health care worker %K alternative %K design %K app %K assessment %K sensor %K engagement %K support %K knowledge %D 2021 %7 10.12.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Several app-based studies share similar characteristics of a light touch approach that recruit, enroll, and onboard via a smartphone app and attempt to minimize burden through low-friction active study tasks while emphasizing the collection of passive data with minimal human contact. However, engagement is a common challenge across these studies, reporting low retention and adherence. Objective: This study aims to describe an alternative to a light touch digital health study that involved a participant-centric design including high friction app-based assessments, semicontinuous passive data from wearable sensors, and a digital engagement strategy centered on providing knowledge and support to participants. Methods: The Stress and Recovery in Frontline COVID-19 Health Care Workers Study included US frontline health care workers followed between May and November 2020. The study comprised 3 main components: (1) active and passive assessments of stress and symptoms from a smartphone app, (2) objective measured assessments of acute stress from wearable sensors, and (3) a participant codriven engagement strategy that centered on providing knowledge and support to participants. The daily participant time commitment was an average of 10 to 15 minutes. Retention and adherence are described both quantitatively and qualitatively. Results: A total of 365 participants enrolled and started the study, and 81.0% (n=297) of them completed the study for a total study duration of 4 months. Average wearable sensor use was 90.6% days of total study duration. App-based daily, weekly, and every other week surveys were completed on average 69.18%, 68.37%, and 72.86% of the time, respectively. Conclusions: This study found evidence for the feasibility and acceptability of a participant-centric digital health study approach that involved building trust with participants and providing support through regular phone check-ins. In addition to high retention and adherence, the collection of large volumes of objective measured data alongside contextual self-reported subjective data was able to be collected, which is often missing from light touch digital health studies. Trial Registration: ClinicalTrials.gov NCT04713111; https://clinicaltrials.gov/ct2/show/NCT04713111 %M 34726607 %R 10.2196/32165 %U https://formative.jmir.org/2021/12/e32165 %U https://doi.org/10.2196/32165 %U http://www.ncbi.nlm.nih.gov/pubmed/34726607 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 12 %P e31358 %T Nursing Perspectives on the Impacts of COVID-19: Social Media Content Analysis %A Koren,Ainat %A Alam,Mohammad Arif Ul %A Koneru,Sravani %A DeVito,Alexa %A Abdallah,Lisa %A Liu,Benyuan %+ Solomont School of Nursing, University of Massachusetts Lowell, 113 Wilder Street, Suite 200, Health and Social Science Building, Lowell, MA, 01854-3058, United States, 1 9789344429, Ainat_Koren@uml.edu %K mental health %K information retrieval %K coronavirus %K COVID-19 %K nursing %K nurses %K health care workers %K pandemic %K impact %K social media analytics %D 2021 %7 10.12.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Nurses are at the forefront of the COVID-19 pandemic. During the pandemic, nurses have faced an elevated risk of exposure and have experienced the hazards related to a novel virus. While being heralded as lifesaving heroes on the front lines of the pandemic, nurses have experienced more physical, mental, and psychosocial problems as a consequence of the COVID-19 outbreak. Social media discussions by nursing professionals participating in publicly formed Facebook groups constitute a valuable resource that offers longitudinal insights. Objective: This study aimed to explore how COVID-19 impacted nurses through capturing public sentiments expressed by nurses on a social media discussion platform and how these sentiments changed over time. Methods: We collected over 110,993 Facebook discussion posts and comments in an open COVID-19 group for nurses from March 2020 until the end of November 2020. Scraping of deidentified offline HTML tags on social media posts and comments was performed. Using subject-matter expert opinions and social media analytics (ie, topic modeling, information retrieval, and sentiment analysis), we performed a human-in-a-loop analysis of nursing professionals’ key perspectives to identify trends of the COVID-19 impact among at-risk nursing communities. We further investigated the key insights of the trends of the nursing professionals’ perspectives by detecting temporal changes of comments related to emotional effects, feelings of frustration, impacts of isolation, shortage of safety equipment, and frequency of safety equipment uses. Anonymous quotes were highlighted to add context to the data. Results: We determined that COVID-19 impacted nurses’ physical, mental, and psychosocial health as expressed in the form of emotional distress, anger, anxiety, frustration, loneliness, and isolation. Major topics discussed by nurses were related to work during a pandemic, misinformation spread by the media, improper personal protective equipment (PPE), PPE side effects, the effects of testing positive for COVID-19, and lost days of work related to illness. Conclusions: Public Facebook nursing groups are venues for nurses to express their experiences, opinions, and concerns and can offer researchers an important insight into understanding the COVID-19 impact on health care workers. %M 34623957 %R 10.2196/31358 %U https://formative.jmir.org/2021/12/e31358 %U https://doi.org/10.2196/31358 %U http://www.ncbi.nlm.nih.gov/pubmed/34623957 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 12 %P e34381 %T An eHealth Intervention for Promoting COVID-19 Knowledge and Protective Behaviors and Reducing Pandemic Distress Among Sexual and Gender Minorities: Protocol for a Randomized Controlled Trial (#SafeHandsSafeHearts) %A Newman,Peter A %A Chakrapani,Venkatesan %A Williams,Charmaine %A Massaquoi,Notisha %A Tepjan,Suchon %A Roungprakhon,Surachet %A Akkakanjanasupar,Pakorn %A Logie,Carmen %A Rawat,Shruta %+ Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, ON, M5S 1V4, Canada, 1 416 946 8611, p.newman@utoronto.ca %K COVID-19 %K eHealth %K RCT %K protective behaviors %K psychological distress %K LGBT+ %K India %K Thailand %D 2021 %7 10.12.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Existing data on COVID-19 disparities among vulnerable populations portend excess risk for lesbian, gay, bisexual, transgender (LGBT) and other persons outside of heteronormative and cisgender identities (ie, LGBT+). Owing to adverse social determinants of health, including pervasive HIV and sexual stigma, harassment, violence, barriers in access to health care, and existing health and mental health disparities, sexual and gender minorities in India and Thailand are at disproportionate risk for SARS-CoV-2 infection and severe disease. Despite global health disparities among LGBT+ populations, there is a lack of coordinated, community-engaged interventions to address the expected excess burden of COVID-19 and public health–recommended protective measures. Objective: We will implement a randomized controlled trial (RCT) to evaluate the effectiveness of a brief, peer-delivered eHealth intervention to increase COVID-19 knowledge and public health–recommended protective behaviors, and reduce psychological distress among LGBT+ people residing in Bangkok, Thailand, and Mumbai, India. Subsequent to the RCT, we will conduct exit interviews with purposively sampled subgroups, including those with no intervention effect. Methods: SafeHandsSafeHearts is a 2-site, parallel waitlist-controlled RCT to test the efficacy of a 3-session, peer counselor–delivered eHealth intervention based on motivational interviewing and psychoeducation. The study methods, online infrastructure, and content were pilot-tested with LGBT+ individuals in Toronto, Canada, before adaptation and rollout in the other contexts. The primary outcomes are COVID-19 knowledge (index based on US Centers for Disease Control and Prevention [CDC] items), protective behaviors (index based on World Health Organization and US CDC guidelines), depression (Patient Health Questionnaire-2), and anxiety (Generalized Anxiety Disorder-2). Secondary outcomes include loneliness, COVID-19 stress, and intended care-seeking. We will enroll 310 participants in each city aged 18 years and older. One-third of the participants will be cisgender gay, bisexual, and other men who have sex with men; one-third will be cisgender lesbian, bisexual, and other women who have sex with women; and one-third will be transfeminine, transmasculine, and gender nonbinary people. Participants will be equally stratified in the immediate intervention and waitlist control groups. Participants are mainly recruited from online social media accounts of community-based partner organizations. They can access the intervention on a computer, tablet, or mobile phone. SafeHandsSafeHearts involves 3 sessions delivered weekly over 3 successive weeks. Exit interviews will be conducted online with 3 subgroups (n=12 per group, n=36 in each city) of purposively selected participants to be informed by RCT outcomes and focal populations of concern. Results: The RCT was funded in 2020. The trials started recruitment as of August 1, 2021, and all RCT data collection will likely be completed by January 31, 2022. Conclusions: The SafeHandsSafeHearts RCT will provide evidence about the effectiveness of a brief, peer-delivered eHealth intervention developed for LGBT+ populations amid the COVID-19 pandemic. If the intervention proves effective, it will provide a basis for future scale-up in India and Thailand, and other low- and middle-income countries. Trial Registration: ClinicalTrials.gov NCT04870723; https://clinicaltrials.gov/ct2/show/NCT04870723 International Registered Report Identifier (IRRID): DERR1-10.2196/34381 %M 34726610 %R 10.2196/34381 %U https://www.researchprotocols.org/2021/12/e34381 %U https://doi.org/10.2196/34381 %U http://www.ncbi.nlm.nih.gov/pubmed/34726610 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 12 %P e31746 %T Implementation, Adoption, and Perceptions of Telemental Health During the COVID-19 Pandemic: Systematic Review %A Appleton,Rebecca %A Williams,Julie %A Vera San Juan,Norha %A Needle,Justin J %A Schlief,Merle %A Jordan,Harriet %A Sheridan Rains,Luke %A Goulding,Lucy %A Badhan,Monika %A Roxburgh,Emily %A Barnett,Phoebe %A Spyridonidis,Spyros %A Tomaskova,Magdalena %A Mo,Jiping %A Harju-Seppänen,Jasmine %A Haime,Zoë %A Casetta,Cecilia %A Papamichail,Alexandra %A Lloyd-Evans,Brynmor %A Simpson,Alan %A Sevdalis,Nick %A Gaughran,Fiona %A Johnson,Sonia %+ NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, Gower Street, London, WC1E 6BT, United Kingdom, 44 2039872554, r.appleton@ucl.ac.uk %K telemental health %K COVID-19 %K remote care %K telemedicine %K mental health %K systematic review, implementation science %D 2021 %7 9.12.2021 %9 Review %J J Med Internet Res %G English %X Background: Early in 2020, mental health services had to rapidly shift from face-to-face models of care to delivering the majority of treatments remotely (by video or phone call or occasionally messaging) due to the COVID-19 pandemic. This resulted in several challenges for staff and patients, but also in benefits such as convenience or increased access for people with impaired mobility or in rural areas. There is a need to understand the extent and impacts of telemental health implementation, and barriers and facilitators to its effective and acceptable use. This is relevant both to future emergency adoption of telemental health and to debates on its future use in routine mental health care. Objective: To investigate the adoption and impacts of telemental health approaches during the COVID-19 pandemic, and facilitators and barriers to optimal implementation. Methods: Four databases (PubMed, PsycINFO, CINAHL, and Web of Science) were searched for primary research relating to remote working, mental health care, and the COVID-19 pandemic. Preprint servers were also searched. Results of studies were synthesized using framework synthesis. Results: A total of 77 papers met our inclusion criteria. In most studies, the majority of contacts could be transferred to a remote form during the pandemic, and good acceptability to service users and clinicians tended to be reported, at least where the alternative to remote contacts was interrupting care. However, a range of impediments to dealing optimal care by this means were also identified. Conclusions: Implementation of telemental health allowed some continuing support to the majority of service users during the COVID-19 pandemic and has value in an emergency situation. However, not all service users can be reached by this means, and better evidence is now needed on long-term impacts on therapeutic relationships and quality of care, and on impacts on groups at risk of digital exclusion and how to mitigate these. Trial Registration: PROSPERO International prospective register of systematic reviews CRD42021211025; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021211025 %M 34709179 %R 10.2196/31746 %U https://www.jmir.org/2021/12/e31746 %U https://doi.org/10.2196/31746 %U http://www.ncbi.nlm.nih.gov/pubmed/34709179 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 12 %P e28305 %T Anti-Asian Sentiments During the COVID-19 Pandemic Across 20 Countries: Analysis of a 12-Billion-Word News Media Database %A Ng,Reuben %+ Lee Kuan Yew School of Public Policy, National University of Singapore, 469C Bukit Timah Rd, Singapore, 259772, Singapore, 65 66015229, spprng@nus.edu.sg %K racism %K COVID-19 %K anti-Asian sentiments %K psychomics %K quantitative social science %K culture %K text as data %K xenophobia %K digital humanities %D 2021 %7 8.12.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: US president Joe Biden signed an executive action directing federal agencies to combat hate crimes and racism against Asians, which have percolated during the COVID-19 pandemic. This is one of the first known empirical studies to dynamically test whether global societal sentiments toward Asians have become more negative during the COVID-19 pandemic. Objective: This study aimed to investigate whether global societal sentiments toward Asians across 20 countries have become more negative, month by month, from before the pandemic (October 2019) to May 2020, along with the pandemic (incidence and mortality rates) and cultural (Hofstede’s cultural dimensions) predictors of this trend. Methods: We leveraged a 12-billion-word web-based media database, with over 30 million newspaper and magazine articles taken from over 7000 sites across 20 countries, and identified 6 synonyms of “Asian” that are related to the coronavirus. We compiled their most frequently used descriptors (collocates) from October 2019 to May 2020 across 20 countries, culminating in 85,827 collocates that were rated by 2 independent researchers to provide a Cumulative Asian Sentiment Score (CASS) per month. This allowed us to track significant shifts in societal sentiments toward Asians from a baseline period (October to December 2019) to the onset of the pandemic (January to May 2020). We tested the competing predictors of this trend: pandemic variables of incidence and mortality rates measured monthly for all 20 countries taken from the Oxford COVID-19 Government Response Tracker, and Hofstede’s Cultural Dimensions of Individualism, Power Distance, Uncertainty Avoidance, and Masculinity for the 20 countries. Results: Before the pandemic in December 2019, Jamaica and New Zealand evidenced the most negative societal sentiments toward Asians; when news about the coronavirus was released in January 2020, the United States and Nigeria evidenced the most negative sentiments toward Asians among 20 countries. Globally, sentiments of Asians became more negative—a significant linear decline during the COVID-19 pandemic. CASS trended neutral before the pandemic during the baseline period of October to November 2019 and then plummeted in February 2020. CASS were, ironically, not predicted by COVID-19’s incidence and mortality rates, but rather by Hofstede’s cultural dimensions: individualism, power distance, and uncertainty avoidance—as shown by mixed models (N=28,494). Specifically, higher power distance, individualism, and uncertainty avoidance were associated with negative societal sentiments toward Asians. Conclusions: Racism, in the form of Anti-Asian sentiments, are deep-seated, and predicated on structural undercurrents of culture. The COVID-19 pandemic may have indirectly and inadvertently exacerbated societal tendencies for racism. Our study lays the important groundwork to design interventions and policy communications to ameliorate Anti-Asian racism, which are culturally nuanced and contextually appropriate. %M 34678754 %R 10.2196/28305 %U https://www.jmir.org/2021/12/e28305 %U https://doi.org/10.2196/28305 %U http://www.ncbi.nlm.nih.gov/pubmed/34678754 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 12 %P e31645 %T The Pandemic, Infodemic, and People’s Resilience in India: Viewpoint %A Syed Abdul,Shabbir %A Ramaswamy,Meghna %A Fernandez-Luque,Luis %A John,Oommen %A Pitti,Thejkiran %A Parashar,Babita %+ Graduate Institute of Biomedical Informatics, Taipei Medical University, No. 250, Wuxing Street, Xinyi District, Taipei, Taiwan, 886 02 2736 1661 ext 1514, drshabbir@tmu.edu.tw %K pandemic %K COVID-19 %K India %K digital health %K infodemics %K Sustainable Development Goals %K SDGs %D 2021 %7 8.12.2021 %9 Viewpoint %J JMIR Public Health Surveill %G English %X The COVID-19 pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has caused widespread fear and stress. The pandemic has affected everyone, everywhere, and created systemic inequities, leaving no one behind. In India alone, more than 34,094,373 confirmed COVID-19 cases and 452,454 related deaths have been reported as of October 19, 2021. Around May 2021, the daily number of new COVID-19 cases crossed the 400,000 mark, seriously hampering the health care system. Despite the devastating situation, the public response was seen through their efforts to come forward with innovative ideas for potential ways to combat the pandemic, for instance, dealing with the shortage of oxygen cylinders and hospital bed availability. With increasing COVID-19 vaccination rates since September 2021, along with the diminishing number of daily new cases, the country is conducting preventive and preparatory measures for the third wave. In this article, we propose the pivotal role of public participation and digital solutions to re-establish our society and describe how Sustainable Development Goals (SDGs) can support eHealth initiatives and mitigate infodemics to tackle a postpandemic situation. This viewpoint reflects that the COVID-19 pandemic has featured a need to bring together research findings across disciplines, build greater coherence within the field, and be a driving force for multi-sectoral, cross-disciplinary collaboration. The article also highlights the various needs to develop digital solutions that can be applied to pandemic situations and be reprocessed to focus on other SDGs. Promoting the use of digital health care solutions to implement preventive measures can be enhanced by public empowerment and engagement. Wearable technologies can be efficiently used for remote monitoring or home-based care for patients with chronic conditions. Furthermore, the development and implementation of informational tools can aid the improvement of well-being and dissolve panic-ridden behaviors contributing toward infodemics. Thus, a call to action for an observatory of digital health initiatives on COVID-19 is required to share the main conclusions and lessons learned in terms of resilience, crisis mitigation, and preparedness. %M 34787574 %R 10.2196/31645 %U https://publichealth.jmir.org/2021/12/e31645 %U https://doi.org/10.2196/31645 %U http://www.ncbi.nlm.nih.gov/pubmed/34787574 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 1 %N 1 %P e33330 %T Health Care Providers’ Trusted Sources for Information About COVID-19 Vaccines: Mixed Methods Study %A Brauer,Eden %A Choi,Kristen %A Chang,John %A Luo,Yi %A Lewin,Bruno %A Munoz-Plaza,Corrine %A Bronstein,David %A Bruxvoort,Katia %+ School of Nursing, University of California, Los Angeles, 700 Tiverton Ave, Los Angeles, CA, United States, 1 3107947493, krchoi@ucla.edu %K health information %K trust %K health care provider %K COVID-19 %K vaccine %K mixed method %K communication %D 2021 %7 8.12.2021 %9 Original Paper %J JMIR Infodemiology %G English %X Background: Information and opinions shared by health care providers can affect patient vaccination decisions, but little is known about who health care providers themselves trust for information in the context of new COVID-19 vaccines. Objective: The purpose of this study is to investigate which sources of information about COVID-19 vaccines are trusted by health care providers and how they communicate this information to patients. Methods: This mixed methods study involved a one-time, web-based survey of health care providers and qualitative interviews with a subset of survey respondents. Health care providers (physicians, advanced practice providers, pharmacists, nurses) were recruited from an integrated health system in Southern California using voluntary response sampling, with follow-up interviews with providers who either accepted or declined a COVID-19 vaccine. The outcome was the type of information sources that respondents reported trusting for information about COVID-19 vaccines. Bivariate tests were used to compare trusted information sources by provider type; thematic analysis was used to explore perspectives about vaccine information and communicating with patients about vaccines. Results: The survey was completed by 2948 providers, of whom 91% (n=2683) responded that they had received ≥1 dose of a COVID-19 vaccine. The most frequently trusted source of COVID-19 vaccine information was government agencies (n=2513, 84.2%); the least frequently trusted source was social media (n=691, 9.5%). More physicians trusted government agencies (n=1226, 93%) than nurses (n=927, 78%) or pharmacists (n=203, 78%; P<.001), and more physicians trusted their employer (n=1115, 84%) than advanced practice providers (n=95, 67%) and nurses (n=759, 64%; P=.002). Qualitative themes (n=32 participants) about trusted sources of COVID-19 vaccine information were identified: processing new COVID-19 information in a health care work context likened to a “war zone” during the pandemic and communicating information to patients. Some providers were hesitant to recommend vaccines to pregnant people and groups they perceived to be at low risk for COVID-19. Conclusions: Physicians have stronger trust in government sources and their employers for information about COVID-19 vaccines compared with nurses, pharmacists, and advanced practice providers. Strategies such as role modeling, tailored messaging, or talking points with standard language may help providers to communicate accurate COVID-19 vaccine information to patients, and these strategies may also be used with providers with lower levels of trust in reputable information sources. %M 34926995 %R 10.2196/33330 %U https://infodemiology.jmir.org/2021/1/e33330 %U https://doi.org/10.2196/33330 %U http://www.ncbi.nlm.nih.gov/pubmed/34926995 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 12 %P e32587 %T Investigating the Use of Digital Health Technology to Monitor COVID-19 and Its Effects: Protocol for an Observational Study (Covid Collab Study) %A Stewart,Callum %A Ranjan,Yatharth %A Conde,Pauline %A Rashid,Zulqarnain %A Sankesara,Heet %A Bai,Xi %A Dobson,Richard J B %A Folarin,Amos A %+ Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, 16 De Crespigny Park, London, SE5 8AF, United Kingdom, 44 20 7848 0924, amos.folarin@kcl.ac.uk %K mobile health %K COVID-19 %K digital health %K smartphone %K wearable devices %K mental health %K wearable %K data %K crowdsourced %K monitoring %K surveillance %K observational %K feasibility %K infectious disease %K recovery %K mobile phone %D 2021 %7 8.12.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: The ubiquity of mobile phones and increasing use of wearable fitness trackers offer a wide-ranging window into people’s health and well-being. There are clear advantages in using remote monitoring technologies to gain an insight into health, particularly under the shadow of the COVID-19 pandemic. Objective: Covid Collab is a crowdsourced study that was set up to investigate the feasibility of identifying, monitoring, and understanding the stratification of SARS-CoV-2 infection and recovery through remote monitoring technologies. Additionally, we will assess the impacts of the COVID-19 pandemic and associated social measures on people’s behavior, physical health, and mental well-being. Methods: Participants will remotely enroll in the study through the Mass Science app to donate historic and prospective mobile phone data, fitness tracking wearable data, and regular COVID-19–related and mental health–related survey data. The data collection period will cover a continuous period (ie, both before and after any reported infections), so that comparisons to a participant’s own baseline can be made. We plan to carry out analyses in several areas, which will cover symptomatology; risk factors; the machine learning–based classification of illness; and trajectories of recovery, mental well-being, and activity. Results: As of June 2021, there are over 17,000 participants—largely from the United Kingdom—and enrollment is ongoing. Conclusions: This paper introduces a crowdsourced study that will include remotely enrolled participants to record mobile health data throughout the COVID-19 pandemic. The data collected may help researchers investigate a variety of areas, including COVID-19 progression; mental well-being during the pandemic; and the adherence of remote, digitally enrolled participants. International Registered Report Identifier (IRRID): DERR1-10.2196/32587 %M 34784292 %R 10.2196/32587 %U https://www.researchprotocols.org/2021/12/e32587 %U https://doi.org/10.2196/32587 %U http://www.ncbi.nlm.nih.gov/pubmed/34784292 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 12 %P e31961 %T Analyzing Citizens’ and Health Care Professionals’ Searches for Smell/Taste Disorders and Coronavirus in Finland During the COVID-19 Pandemic: Infodemiological Approach Using Database Logs %A Mukka,Milla %A Pesälä,Samuli %A Hammer,Charlotte %A Mustonen,Pekka %A Jormanainen,Vesa %A Pelttari,Hanna %A Kaila,Minna %A Helve,Otto %+ University of Helsinki, Temppelikatu 17 A 5, Helsinki, 00100, Finland, 358 0504397177, milla.mukka@helsinki.fi %K COVID-19 %K SARS-CoV-2 %K smell disorders %K taste disorders %K information-seeking behavior %K health personnel %K statistical models %K medical informatics %D 2021 %7 7.12.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The COVID-19 pandemic has prevailed over a year, and log and register data on coronavirus have been utilized to establish models for detecting the pandemic. However, many sources contain unreliable health information on COVID-19 and its symptoms, and platforms cannot characterize the users performing searches. Prior studies have assessed symptom searches from general search engines (Google/Google Trends). Little is known about how modeling log data on smell/taste disorders and coronavirus from the dedicated internet databases used by citizens and health care professionals (HCPs) could enhance disease surveillance. Our material and method provide a novel approach to analyze web-based information seeking to detect infectious disease outbreaks. Objective: The aim of this study was (1) to assess whether citizens’ and professionals’ searches for smell/taste disorders and coronavirus relate to epidemiological data on COVID-19 cases, and (2) to test our negative binomial regression modeling (ie, whether the inclusion of the case count could improve the model). Methods: We collected weekly log data on searches related to COVID-19 (smell/taste disorders, coronavirus) between December 30, 2019, and November 30, 2020 (49 weeks). Two major medical internet databases in Finland were used: Health Library (HL), a free portal aimed at citizens, and Physician’s Database (PD), a database widely used among HCPs. Log data from databases were combined with register data on the numbers of COVID-19 cases reported in the Finnish National Infectious Diseases Register. We used negative binomial regression modeling to assess whether the case numbers could explain some of the dynamics of searches when plotting database logs. Results: We found that coronavirus searches drastically increased in HL (0 to 744,113) and PD (4 to 5375) prior to the first wave of COVID-19 cases between December 2019 and March 2020. Searches for smell disorders in HL doubled from the end of December 2019 to the end of March 2020 (2148 to 4195), and searches for taste disorders in HL increased from mid-May to the end of November (0 to 1980). Case numbers were significantly associated with smell disorders (P<.001) and taste disorders (P<.001) in HL, and with coronavirus searches (P<.001) in PD. We could not identify any other associations between case numbers and searches in either database. Conclusions: Novel infodemiological approaches could be used in analyzing database logs. Modeling log data from web-based sources was seen to improve the model only occasionally. However, search behaviors among citizens and professionals could be used as a supplementary source of information for infectious disease surveillance. Further research is needed to apply statistical models to log data of the dedicated medical databases. %M 34727525 %R 10.2196/31961 %U https://publichealth.jmir.org/2021/12/e31961 %U https://doi.org/10.2196/31961 %U http://www.ncbi.nlm.nih.gov/pubmed/34727525 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 1 %N 1 %P e31774 %T COVID-19 Information Sources and Health Behaviors During Pregnancy: Results From a Prenatal App-Embedded Survey %A Bohnhoff,James %A Davis,Alexander %A Bruine de Bruin,Wändi %A Krishnamurti,Tamar %+ Division of General Internal Medicine, University of Pittsburgh School of Medicine, 200 Meyran Ave, Suite 200, Pittsburgh, PA, 15213, United States, 1 412 692 4855, tamark@pitt.edu %K COVID-19 %K health behavior %K health behaviour %K pregnancy %K obstetrics %K perinatal %K preventive %K preventative %K mHealth %K risk %K information source %K medical literacy %K media literacy %K information literacy %K protection %K protective %K harm %K women %K engagement %K online health information %K behavior %K information-seeking %K critical appraisal %K communication %D 2021 %7 7.12.2021 %9 Original Paper %J JMIR Infodemiology %G English %X Background: Pregnancy is a time of heightened COVID-19 risk. Pregnant individuals’ choice of specific protective health behaviors during pregnancy may be affected by information sources. Objective: This study examined the association between COVID-19 information sources and engagement in protective health behaviors among a pregnant population in a large academic medical system. Methods: Pregnant patients completed an app-based questionnaire about their sources of COVID-19 information and engagement in protective health behaviors. The voluntary questionnaire was made available to patients using a pregnancy app as part of their routine prenatal care between April 21 and November 27, 2020. Results: In total, 637 pregnant responders routinely accessed a median of 5 sources for COVID-19 information. The most cited source (79%) was the Centers for Disease Control and Prevention (CDC). Self-reporting evidence-based protective actions was relatively common, although 14% self-reported potentially harmful behaviors to avoid COVID-19 infection. The CDC and other sources were positively associated with engaging in protective behaviors while others (eg, US president Donald Trump) were negatively associated with protective behaviors. Participation in protective behaviors was not associated with refraining from potentially harmful behaviors (P=.93). Moreover, participation in protective behaviors decreased (P=.03) and participation in potentially harmful actions increased (P=.001) over the course of the pandemic. Conclusions: Pregnant patients were highly engaged in COVID-19–related information-seeking and health behaviors. Clear, targeted, and regular communication from commonly accessed health organizations about which actions may be harmful, in addition to which actions offer protection, may offer needed support to the pregnant population. %M 34926994 %R 10.2196/31774 %U https://infodemiology.jmir.org/2021/1/e31774 %U https://doi.org/10.2196/31774 %U http://www.ncbi.nlm.nih.gov/pubmed/34926994 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 12 %P e31791 %T Impact of the COVID-19 Pandemic on a Physician Group’s WhatsApp Chat: Qualitative Content Analysis %A Abdel-Razig,Sawsan %A Anglade,Pascale %A Ibrahim,Halah %+ Cleveland Clinic Abu Dhabi, PO box 112412, Abu Dhabi, United Arab Emirates, 971 25019999 ext 48460, razigs@clevelandclinicabudhabi.ae %K WhatsApp %K social media %K physician %K pandemic %K COVID-19 %K qualitative %K communication %K misinformation %K information-seeking behavior %K information seeking %K information sharing %K content analysis %K community %D 2021 %7 7.12.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Social media has emerged as an effective means of information sharing and community building among health professionals. The utility of these platforms is likely heightened during times of health system crises and global uncertainty. Studies have demonstrated that physicians’ social media platforms serve to bridge the gap of information between on-the-ground experiences of health care workers and emerging knowledge. Objective: The primary aim of this study was to characterize the use of a physician WhatsApp (WhatsApp LLC) group chat during the early months of the COVID-19 pandemic. Methods: Through the lens of the social network theory, we performed a qualitative content analysis of the posts of a women physician WhatsApp group located in the United Arab Emirates between February 1, 2020, and May 31, 2020, that is, during the initial surge of COVID-19 cases. Results: There were 6101 posts during the study period, which reflected a 2.6-fold increase in platform use when compared with platform use in the year prior. A total of 8 themes and 9 subthemes were described. The top 3 uses of the platform were requests for information (posts: 2818/6101, 46.2%), member support and promotion (posts: 988/6101, 16.2%), and information sharing (posts: 896/6101, 14.7%). A substantial proportion of posts were related to COVID-19 (2653/6101, 43.5%), with the most popular theme being requests for logistical (nonmedical) information. Among posts containing COVID-19–related medical information, it was notable that two-thirds (571/868, 65.8%) of these posts were from public mass media or unverified sources. Conclusions: Health crises can potentiate the use of social media platforms among physicians. This reflects physicians’ tendency to turn to these platforms for information sharing and community building purposes. However, important questions remain regarding the accuracy and credibility of the information shared. Our findings suggest that the training of physicians in social media practices and information dissemination may be needed. %M 34784291 %R 10.2196/31791 %U https://formative.jmir.org/2021/12/e31791 %U https://doi.org/10.2196/31791 %U http://www.ncbi.nlm.nih.gov/pubmed/34784291 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 12 %P e32948 %T The Application of e-Mental Health in Response to COVID-19: Scoping Review and Bibliometric Analysis %A Ellis,Louise A %A Meulenbroeks,Isabelle %A Churruca,Kate %A Pomare,Chiara %A Hatem,Sarah %A Harrison,Reema %A Zurynski,Yvonne %A Braithwaite,Jeffrey %+ Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, 75 Talavera Rd, Sydney, NSW 2113, Australia, 61 9850 2484, louise.ellis@mq.edu.au %K e-mental health %K mental health %K COVID-19 %K bibliometrics %K health systems %D 2021 %7 6.12.2021 %9 Review %J JMIR Ment Health %G English %X Background: The COVID-19 pandemic and its mitigation measures and impacts, such as shelter-in-place orders, social isolation, restrictions on freedoms, unemployment, financial insecurity, and disrupted routines, have led to declines in mental health worldwide and concomitant escalating demands for mental health services. Under the circumstances, electronic mental health (e-mental health) programs and services have rapidly become the “new normal.” Objective: The aim of this study was to assess key characteristics and evidence gaps in the e-mental health literature published in relation to the COVID-19 pandemic via a scoping review and bibliometric analysis. Methods: We conducted a search of four academic databases (ie, MEDLINE, Embase, PsycInfo, and CINAHL) for documents published from December 31, 2019, to March 31, 2021, using keywords for e-mental health and COVID-19. Article information was extracted that was relevant to the review objective, including journal, type of article, keywords, focus, and corresponding author. Information was synthesized by coding these attributes and was then summarized through descriptive statistics and narrative techniques. Article influence was examined from Altmetric and CiteScore data, and a network analysis was conducted on article keywords. Results: A total of 356 publications were included in the review. Articles on e-mental health quickly thrived early in the pandemic, with most articles being nonempirical, chiefly commentaries or opinions (n=225, 63.2%). Empirical publications emerged later and became more frequent as the pandemic progressed. The United States contributed the most articles (n=160, 44.9%), though a notable number came from middle-income countries (n=59, 16.6%). Articles were spread across 165 journals and had above-average influence (ie, almost half of the articles were in the top 25% of output scores by Altmetric, and the average CiteScore across articles was 4.22). The network analysis of author-supplied keywords identified key topic areas, including specific mental disorders, eHealth modalities, issues and challenges, and populations of interest. These were further explored via full-text analysis. Applications of e-mental health during the pandemic overcame, or were influenced by, system, service, technology, provider, and patient factors. Conclusions: COVID-19 has accelerated applications of e-mental health. Further research is needed to support the implementation of e-mental health across system and service infrastructures, alongside evidence of the relative effectiveness of e-mental health in comparison to traditional modes of care. %M 34666306 %R 10.2196/32948 %U https://mental.jmir.org/2021/12/e32948 %U https://doi.org/10.2196/32948 %U http://www.ncbi.nlm.nih.gov/pubmed/34666306 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 12 %P e30004 %T Using Venn Diagrams to Evaluate Digital Contact Tracing: Panel Survey Analysis %A Daniore,Paola %A Nittas,Vasileios %A Moser,André %A Höglinger,Marc %A von Wyl,Viktor %+ Institute for Implementation Science in Healthcare, University of Zurich, Universitätstrasse 84, Zurich, 8006, Switzerland, 41 446346380, viktor.vonwyl@uzh.ch %K digital contact tracing %K exposure notification %K COVID-19 %K SARS-CoV-2 %K contact tracing %K digital health %K tracing apps %K mHealth %K mobile apps %K key performance indicators %K Venn diagram approach %D 2021 %7 6.12.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Mitigation of the spread of infection relies on targeted approaches aimed at preventing nonhousehold interactions. Contact tracing in the form of digital proximity tracing apps has been widely adopted in multiple countries due to its perceived added benefits of tracing speed and breadth in comparison to traditional manual contact tracing. Assessments of user responses to exposure notifications through a guided approach can provide insights into the effect of digital proximity tracing app use on managing the spread of SARS-CoV-2. Objective: The aim of this study was to demonstrate the use of Venn diagrams to investigate the contributions of digital proximity tracing app exposure notifications and subsequent mitigative actions in curbing the spread of SARS-CoV-2 in Switzerland. Methods: We assessed data from 4 survey waves (December 2020 to March 2021) from a nationwide panel study (COVID-19 Social Monitor) of Swiss residents who were (1) nonusers of the SwissCovid app, (2) users of the SwissCovid app, or (3) users of the SwissCovid app who received exposure notifications. A Venn diagram approach was applied to describe the overlap or nonoverlap of these subpopulations and to assess digital proximity tracing app use and its associated key performance indicators, including actions taken to prevent SARS-CoV-2 transmission. Results: We included 12,525 assessments from 2403 participants, of whom 50.9% (1222/2403) reported not using the SwissCovid digital proximity tracing app, 49.1% (1181/2403) reported using the SwissCovid digital proximity tracing app and 2.5% (29/1181) of the digital proximity tracing app users reported having received an exposure notification. Most digital proximity tracing app users (75.9%, 22/29) revealed taking at least one recommended action after receiving an exposure notification, such as seeking SARS-CoV-2 testing (17/29, 58.6%) or calling a federal information hotline (7/29, 24.1%). An assessment of key indicators of mitigative actions through a Venn diagram approach reveals that 30% of digital proximity tracing app users (95% CI 11.9%-54.3%) also tested positive for SARS-CoV-2 after having received exposure notifications, which is more than 3 times that of digital proximity tracing app users who did not receive exposure notifications (8%, 95% CI 5%-11.9%). Conclusions: Responses in the form of mitigative actions taken by 3 out of 4 individuals who received exposure notifications reveal a possible contribution of digital proximity tracing apps in mitigating the spread of SARS-CoV-2. The application of a Venn diagram approach demonstrates its value as a foundation for researchers and health authorities to assess population-level digital proximity tracing app effectiveness by providing an intuitive approach for calculating key performance indicators. %M 34874890 %R 10.2196/30004 %U https://publichealth.jmir.org/2021/12/e30004 %U https://doi.org/10.2196/30004 %U http://www.ncbi.nlm.nih.gov/pubmed/34874890 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 12 %P e33495 %T Pandemic Acceptance and Commitment to Empowerment Response (PACER) Training: Protocol for the Development and Rapid-Response Deployment %A Fung,Kenneth %A Liu,Jenny JW %A Vahabi,Mandana %A Li,Alan Tai-Wai %A Zurowski,Mateusz %A Wong,Josephine Pui-Hing %+ Department of Psychiatry, Faculty of Medicine, University of Toronto, 399 Bathurst Street, Toronto, ON, M5T 2S8, Canada, 1 (416) 603 5349, ken.fung@uhn.ca %K COVID %K COVID-19 %K coronavirus %K pandemic %K resilience %K acceptance commitment therapy %K group empowerment %D 2021 %7 6.12.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: During a global pandemic, it is critical to rapidly deploy a psychological intervention to support the mental health and resilience of highly affected individuals and communities. Objective: This is the rationale behind the development and implementation of the Pandemic Acceptance and Commitment to Empowerment Response (PACER) Training, an online, blended, skills building intervention to increase the resilience and well-being of participants while promoting their individual and collective empowerment and capacity building. Methods: Based on acceptance and commitment therapy (ACT) and social justice–based group empowerment psychoeducation (GEP), we developed the Acceptance and Commitment to Empowerment (ACE) model to enhance psychological resilience and collective empowerment. The PACER program consists of 6 online, interactive, self-guided modules complemented by 6 weekly, 90-minute, videoconference, facilitator-led, group sessions. Results: As of August 2021, a total of 325 participants had enrolled in the PACER program. Participants include frontline health care providers and Chinese-Canadian community members. Conclusions: The PACER program is an innovative intervention program with the potential for increasing resilience and empowerment while reducing mental distress during the pandemic. International Registered Report Identifier (IRRID): DERR1-10.2196/33495 %M 34726602 %R 10.2196/33495 %U https://www.researchprotocols.org/2021/12/e33495 %U https://doi.org/10.2196/33495 %U http://www.ncbi.nlm.nih.gov/pubmed/34726602 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 12 %P e31271 %T Re-examining COVID-19 Self-Reported Symptom Tracking Programs in the United States: Updated Framework Synthesis %A Janvrin,Miranda Lynn %A Korona-Bailey,Jessica %A Koehlmoos,Tracey Pérez %+ The Henry M Jackson Foundation for the Advancement of Military Medicine, 6720B Rockledge Dr, Suite 100, Bethesda, MD, 20817, United States, 1 6035403059, miranda.janvrin@gmail.com %K COVID-19 %K coronavirus %K framework analysis %K information resources %K monitoring %K patient-reported outcome measures %K self-reported %K surveillance %K symptom tracking %K synthesis %K digital health %D 2021 %7 6.12.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Early in the pandemic, in 2020, Koehlmoos et al completed a framework synthesis of currently available self-reported symptom tracking programs for COVID-19. This framework described relevant programs, partners and affiliates, funding, responses, platform, and intended audience, among other considerations. Objective: This study seeks to update the existing framework with the aim of identifying developments in the landscape and highlighting how programs have adapted to changes in pandemic response. Methods: Our team developed a framework to collate information on current COVID-19 self-reported symptom tracking programs using the “best-fit” framework synthesis approach. All programs from the previous study were included to document changes. New programs were discovered using a Google search for target keywords. The time frame for the search for programs ranged from March 1, 2021, to May 6, 2021. Results: We screened 33 programs, of which 8 were included in our final framework synthesis. We identified multiple common data elements, including demographic information such as race, age, gender, and affiliation (all were associated with universities, medical schools, or schools of public health). Dissimilarities included questions regarding vaccination status, vaccine hesitancy, adherence to social distancing, COVID-19 testing, and mental health. Conclusions: At this time, the future of self-reported symptom tracking for COVID-19 is unclear. Some sources have speculated that COVID-19 may become a yearly occurrence much like the flu, and if so, the data that these programs generate is still valuable. However, it is unclear whether the public will maintain the same level of interest in reporting their symptoms on a regular basis if the prevalence of COVID-19 becomes more common. %M 34792469 %R 10.2196/31271 %U https://formative.jmir.org/2021/12/e31271 %U https://doi.org/10.2196/31271 %U http://www.ncbi.nlm.nih.gov/pubmed/34792469 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 12 %P e29127 %T Content and Dynamics of Websites Shared Over Vaccine-Related Tweets in COVID-19 Conversations: Computational Analysis %A Cruickshank,Iain %A Ginossar,Tamar %A Sulskis,Jason %A Zheleva,Elena %A Berger-Wolf,Tanya %+ Center for Computational Analysis of Social and Organizational Systems, Carnegie Mellon University, 5000 Forbes Ave, Pittsburgh, PA, 15201, United States, 1 7192371515, icruicks@andrew.cmu.edu %K COVID-19 %K agenda setting %K antivaccination %K cross-platform %K data mining of social media %K misinformation %K social media %K Twitter %K vaccinations %K vaccine hesitancy %D 2021 %7 3.12.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The onset of the COVID-19 pandemic and the consequent “infodemic” increased concerns about Twitter’s role in advancing antivaccination messages, even before a vaccine became available to the public. New computational methods allow for analysis of cross-platform use by tracking links to websites shared over Twitter, which, in turn, can uncover some of the content and dynamics of information sources and agenda-setting processes. Such understanding can advance theory and efforts to reduce misinformation. Objective: Informed by agenda-setting theory, this study aimed to identify the content and temporal patterns of websites shared in vaccine-related tweets posted to COVID-19 conversations on Twitter between February and June 2020. Methods: We used triangulation of data analysis methods. Data mining consisted of the screening of around 5 million tweets posted to COVID-19 conversations to identify tweets that related to vaccination and including links to websites shared within these tweets. We further analyzed the content the 20 most-shared external websites using a mixed methods approach. Results: Of 841,896 vaccination-related tweets identified, 185,994 (22.1%) contained links to specific websites. A wide range of websites were shared, with the 20 most-tweeted websites constituting 14.5% (27,060/185,994) of the shared websites and typically being shared for only 2 to 3 days. Traditional media constituted the majority of these 20 websites, along with other social media and governmental sources. We identified markers of inauthentic propagation for some of these links. Conclusions: The topic of vaccination was prevalent in tweets about COVID-19 early in the pandemic. Sharing websites was a common communication strategy, and its “bursty” pattern and inauthentic propagation strategies pose challenges for health promotion efforts. Future studies should consider cross-platform use in dissemination of health information and in counteracting misinformation. %M 34665760 %R 10.2196/29127 %U https://www.jmir.org/2021/12/e29127 %U https://doi.org/10.2196/29127 %U http://www.ncbi.nlm.nih.gov/pubmed/34665760 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 12 %P e30278 %T Acceptance, Use, and Barriers of Telemedicine in Transgender Health Care in Times of SARS-CoV-2: Nationwide Cross-sectional Survey %A Hertling,Stefan %A Hertling,Doreen %A Martin,David %A Graul,Isabel %+ Department of Obstetrics and Gynaecology, University Hospital Jena, Am Klinikum 1, Jena, 07743, Germany, 49 17632251161, stefan.hertling@yahoo.de %K telemedicine %K health services research %K COVID-19 %K transgender health care %K acceptance %K usage %K barrier %K telehealth %K gender %K identity %K transgender %K cross-sectional %K survey %K Germany %K framework %K implementation %D 2021 %7 3.12.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The global incidence in the treatment of transgender people is increasing. During the COVID-19 pandemic, many consultations had to be cancelled, postponed, or converted to a virtual format. Telemedicine in the management of transgender health care could support physicians. Objective: The aim of this study was to analyze the acceptance, use, and barriers of telemedicine in transgender health care in times of SARS-CoV-2 in Germany. Methods: This prospective cross-sectional study was based on a survey of gynecological endocrinologists and transgender patients undergoing gender-affirming hormone treatment in Germany during the COVID-19 pandemic. Descriptive statistics were calculated, and regression analyses were performed to show correlations. Results: We analyzed responses of 269 transgender patients and 202 gynecological endocrinologists treating transgender patients. Most believed that telemedicine was useful. Physicians and patients rated their knowledge of telemedicine as unsatisfactory. The majority of respondents said they did not currently use telemedicine, although they would like to do so. Patients and physicians reported that their attitudes toward telemedicine had changed positively and that their use of telemedicine had increased due to COVID-19. The majority in both groups agreed on the implementation of virtual visits in the context of stable disease conditions. In the treatment phases, 74.3% (150/202) of the physicians said they would use telemedicine during follow-ups. Half of the physicians said they would choose tele-counseling as a specific approach to improving care (128/202, 63.4%). Obstacles to the introduction of telemedicine among physicians included the purchase of technical equipment (132/202, 65.3%), administration (124/202, 61.4%), and poor reimbursement (106/202, 52.5%). Conclusions: Telemedicine in transgender health care found limited use but high acceptance among doctors and patients alike. The absence of a structured framework is an obstacle for effective implementation. Training courses should be introduced to improve the limited knowledge of physicians in the use of telemedicine. More research in tele-endogynecology is needed. Future studies should include large-scale randomized controlled trials, economic analyses, and the exploration of user preferences. %M 34591783 %R 10.2196/30278 %U https://publichealth.jmir.org/2021/12/e30278 %U https://doi.org/10.2196/30278 %U http://www.ncbi.nlm.nih.gov/pubmed/34591783 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 12 %P e33455 %T Learning From a Massive Open Online COVID-19 Vaccination Training Experience: Survey Study %A Goldin,Shoshanna %A Kong,So Yeon Joyce %A Tokar,Anna %A Utunen,Heini %A Ndiaye,Ngouille %A Bahl,Jhilmil %A Appuhamy,Ranil %A Moen,Ann %+ Influenza Preparedness and Response, Organisation Mondiale de la Santé, 20 Avenue Appia, Genève, CH-1211, Switzerland, 41 795165651, goldins@who.int %K COVID-19 %K vaccination %K training %K massive open online course %K pandemic %K vaccine %K education %K online education %K preparation %K evaluation %K user experience %K challenge %K impact %K knowledge %K interest %D 2021 %7 3.12.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: To prepare key stakeholders for the global COVID-19 vaccination rollout, the World Health Organization and partners developed online vaccination training packages. The online course was launched in December 2020 on the OpenWHO learning platform. This paper presents the findings of an evaluation of this course. Objective: The aim of this evaluation was to provide insights into user experiences and challenges, measure the impact of the course in terms of knowledge gained, and anticipate potential interest in future online vaccination courses. Methods: The primary source of data was the anonymized information on course participants, enrollment, completion, and scores from the OpenWHO platform’s statistical data and metric reporting system. Data from the OpenWHO platform were analyzed from the opening of the courses in mid-December 2020 to mid-April 2021. In addition, a learner feedback survey was sent by email to all course participants to complete within a 3-week period (March 19 to April 9, 2021). The survey was designed to determine the perceived strengths and weaknesses of the training packages and to understand barriers to access. Results: During the study period, 53,593 learners enrolled in the course. Of them, 30,034 (56.0%) completed the course, which is substantially higher than the industry benchmark of 5%-10% for a massive open online course (MOOC). Overall, learners averaged 76.5% on the prequiz compared to 85% on the postquiz, resulting in an increase in average score of 9%. A total of 2019 learners from the course participated in the survey. Nearly 98% (n=1647 fully agree, n=308 somewhat agree; N=1986 survey respondents excluding missing values) of respondents fully or somewhat agreed that they had more confidence in their ability to support COVID-19 vaccination following completion of this course. Conclusions: The online vaccine training was well received by the target audience, with a measurable impact on knowledge gained. The key benefits of online training were the convenience, self-paced nature, access to downloadable material, and ability to replay material, as well as an increased ability to concentrate. Online training was identified as a timely, cost-effective way of delivering essential training to a large number of people to prepare for the COVID-19 vaccination rollout. %M 34794116 %R 10.2196/33455 %U https://publichealth.jmir.org/2021/12/e33455 %U https://doi.org/10.2196/33455 %U http://www.ncbi.nlm.nih.gov/pubmed/34794116 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 12 %P e32814 %T Factors Driving the Popularity and Virality of COVID-19 Vaccine Discourse on Twitter: Text Mining and Data Visualization Study %A Zhang,Jueman %A Wang,Yi %A Shi,Molu %A Wang,Xiuli %+ School of New Media, Peking University, 5 Yiheyuan Road, Haidian District, Beijing, 100871, China, 86 10 6276 6689, xiuli.wang@pku.edu.cn %K COVID-19 %K vaccine %K topic modeling %K LDA %K valence %K share %K viral %K Twitter %K social media %D 2021 %7 3.12.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: COVID-19 vaccination is considered a critical prevention measure to help end the pandemic. Social media platforms such as Twitter have played an important role in the public discussion about COVID-19 vaccines. Objective: The aim of this study was to investigate message-level drivers of the popularity and virality of tweets about COVID-19 vaccines using machine-based text-mining techniques. We further aimed to examine the topic communities of the most liked and most retweeted tweets using network analysis and visualization. Methods: We collected US-based English-language public tweets about COVID-19 vaccines from January 1, 2020, to April 30, 2021 (N=501,531). Topic modeling and sentiment analysis were used to identify latent topics and valence, which together with autoextracted information about media presence, linguistic features, and account verification were used in regression models to predict likes and retweets. Among the 2500 most liked tweets and 2500 most retweeted tweets, network analysis and visualization were used to detect topic communities and present the relationship between the topics and the tweets. Results: Topic modeling yielded 12 topics. The regression analyses showed that 8 topics positively predicted likes and 7 topics positively predicted retweets, among which the topic of vaccine development and people’s views and that of vaccine efficacy and rollout had relatively larger effects. Network analysis and visualization revealed that the 2500 most liked and most retweeted retweets clustered around the topics of vaccine access, vaccine efficacy and rollout, vaccine development and people’s views, and vaccination status. The overall valence of the tweets was positive. Positive valence increased likes, but valence did not affect retweets. Media (photo, video, gif) presence and account verification increased likes and retweets. Linguistic features had mixed effects on likes and retweets. Conclusions: This study suggests the public interest in and demand for information about vaccine development and people’s views, and about vaccine efficacy and rollout. These topics, along with the use of media and verified accounts, have enhanced the popularity and virality of tweets. These topics could be addressed in vaccine campaigns to help the diffusion of content on Twitter. %M 34665761 %R 10.2196/32814 %U https://publichealth.jmir.org/2021/12/e32814 %U https://doi.org/10.2196/32814 %U http://www.ncbi.nlm.nih.gov/pubmed/34665761 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 12 %P e34016 %T Predicting the Number of Suicides in Japan Using Internet Search Queries: Vector Autoregression Time Series Model %A Taira,Kazuya %A Hosokawa,Rikuya %A Itatani,Tomoya %A Fujita,Sumio %+ Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, 53, Shogoinkawara-cho, Sakyo-ku, Kyoto, 606-8507, Japan, 81 75 751 3927, taira.kazuya.5m@kyoto-u.ac.jp %K suicide %K internet search engine %K infoveillance %K query %K time series analysis %K vector autoregression model %K COVID-19 %K suicide-related terms %K internet %K information seeking %K time series %K model %K loneliness %K mental health %K prediction %K Japan %K behavior %K trend %D 2021 %7 3.12.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The number of suicides in Japan increased during the COVID-19 pandemic. Predicting the number of suicides is important to take timely preventive measures. Objective: This study aims to clarify whether the number of suicides can be predicted by suicide-related search queries used before searching for the keyword “suicide.” Methods: This study uses the infoveillance approach for suicide in Japan by search trends in search engines. The monthly number of suicides by gender, collected and published by the National Police Agency, was used as an outcome variable. The number of searches by gender with queries associated with “suicide” on “Yahoo! JAPAN Search” from January 2016 to December 2020 was used as a predictive variable. The following five phrases highly relevant to suicide were used as search terms before searching for the keyword “suicide” and extracted and used for analyses: “abuse”; “work, don’t want to go”; “company, want to quit”; “divorce”; and “no money.” The augmented Dickey-Fuller and Johansen tests were performed for the original series and to verify the existence of unit roots and cointegration for each variable, respectively. The vector autoregression model was applied to predict the number of suicides. The Breusch-Godfrey Lagrangian multiplier (BG-LM) test, autoregressive conditional heteroskedasticity Lagrangian multiplier (ARCH-LM) test, and Jarque-Bera (JB) test were used to confirm model convergence. In addition, a Granger causality test was performed for each predictive variable. Results: In the original series, unit roots were found in the trend model, whereas in the first-order difference series, both men (minimum tau 3: −9.24; max tau 3: −5.38) and women (minimum tau 3: −9.24; max tau 3: −5.38) had no unit roots for all variables. In the Johansen test, a cointegration relationship was observed among several variables. The queries used in the converged models were “divorce” for men (BG-LM test: P=.55; ARCH-LM test: P=.63; JB test: P=.66) and “no money” for women (BG-LM test: P=.17; ARCH-LM test: P=.15; JB test: P=.10). In the Granger causality test for each variable, “divorce” was significant for both men (F104=3.29; P=.04) and women (F104=3.23; P=.04). Conclusions: The number of suicides can be predicted by search queries related to the keyword “suicide.” Previous studies have reported that financial poverty and divorce are associated with suicide. The results of this study, in which search queries on “no money” and “divorce” predicted suicide, support the findings of previous studies. Further research on the economic poverty of women and those with complex problems is necessary. %M 34823225 %R 10.2196/34016 %U https://publichealth.jmir.org/2021/12/e34016 %U https://doi.org/10.2196/34016 %U http://www.ncbi.nlm.nih.gov/pubmed/34823225 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 12 %P e28239 %T Pandemic Information Dissemination and Its Associations With the Symptoms of Mental Distress During the COVID-19 Pandemic: Cross-sectional Study %A Amundsen,Ole Myklebust %A Hoffart,Asle %A Johnson,Sverre Urnes %A Ebrahimi,Omid V %+ Department of Clinical Psychology, University of Bergen, Årstadveien 17, Bergen, 5009, Norway, 47 45209507, oleamundsen@me.com %K information sources %K COVID-19 %K avoidance %K psychopathology %D 2021 %7 3.12.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The 2020-2021 COVID-19 pandemic has added to the mental health strain on individuals and groups across the world in a variety of ways. Viral mitigation protocols and viral spread affect people on all continents every day, but at widely different degrees. To understand more about the mental health consequences of the pandemic, it is important to investigate whether or how people gather pandemic-related information and how obtaining this information differentially affects individuals. Objective: This study aimed to investigate whether and to what extent higher levels of COVID-19–related media consumption across information sources are associated with the symptoms of anxiety, health anxiety, and depression, and whether and to what extent using social media and online interactive platforms versus traditional media platforms is associated with the symptoms of anxiety, health anxiety, and depression. Additionally, we aimed to investigate whether and to what extent avoidance of COVID-19–related information is associated with the aforementioned symptoms. Methods: In a cross-sectional preregistered survey, 4936 participants responded between June 22 and July 13, 2020. Eligible participants were adults currently residing in Norway and were thus subjected to identical viral mitigation protocols. This sample was representative of the Norwegian population after utilizing an iterative raking algorithm to conduct poststratification. As 2 subgroups (transgender and intersex individuals) were too small to be analyzed, the final sample for descriptive statistics and regressions included 4921 participants. Multiple regressions were used to investigate associations between the symptoms of psychopathology and COVID-19–related information dissemination. Part correlations were calculated as measures of the effect size for each predictor variable. Due to the large anticipated sample size, the preregistered criterion for significance was set at P<.01. Results: The symptoms of anxiety and health anxiety were significantly associated with obtaining information from newspapers (P<.001), social media (P<.001), and the broader categories of online interactive (P<.001) and traditional media (P<.001). The symptoms of depression were significantly associated with obtaining information from newspapers (P=.003), social media (P=.009), and the broader category of online interactive media (P<.001). Additionally, avoidance of COVID-19–related information showed a significant association in all 3 domains of psychopathological symptoms (anxiety and depression, P<.001; health anxiety, P=.007). Conclusions: This study found significant associations between the symptoms of psychopathology and the use of media for obtaining information related to the COVID-19 pandemic. Significant findings for obtaining information through newspapers, social media, and online interactive media were seen across all 3 measures of psychopathology. Avoidance of COVID-19–related information and associations with the symptoms of psychopathology emerged as core findings, with generally higher effect sizes compared with information attainment. Trial Registration: ClinicalTrials.gov NCT04442360; https://clinicaltrials.gov/ct2/show/NCT04442360 %M 34678750 %R 10.2196/28239 %U https://formative.jmir.org/2021/12/e28239 %U https://doi.org/10.2196/28239 %U http://www.ncbi.nlm.nih.gov/pubmed/34678750 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 12 %P e31574 %T Research on the Epidemiology of SARS-CoV-2 in Essential Response Personnel (RECOVER): Protocol for a Multisite Longitudinal Cohort Study %A Edwards,Laura J %A Fowlkes,Ashley L %A Wesley,Meredith G %A Kuntz,Jennifer L %A Odean,Marilyn J %A Caban-Martinez,Alberto J %A Dunnigan,Kayan %A Phillips,Andrew L %A Grant,Lauren %A Herring,Meghan K %A Groom,Holly C %A Respet,Karley %A Beitel,Shawn %A Zunie,Tnelda %A Hegmann,Kurt T %A Kumar,Archana %A Joseph,Gregory %A Poe,Brandon %A Louzado-Feliciano,Paola %A Smith,Michael E %A Thiese,Matthew S %A Schaefer-Solle,Natasha %A Yoo,Young M %A Silvera,Carlos A %A Mayo Lamberte,Julie %A Mak,Josephine %A McDonald,L Clifford %A Stuckey,Matthew J %A Kutty,Preeta %A Arvay,Melissa L %A Yoon,Sarang K %A Tyner,Harmony L %A Burgess,Jefferey L %A Hunt,Danielle Rentz %A Meece,Jennifer %A Gaglani,Manjusha %A Naleway,Allison L %A Thompson,Mark G %+ Centers for Disease Control and Prevention, 1600 Clifton Rd. NE, Mailstop H24-7, Atlanta, GA, 30333, United States, 1 404 822 1999, ahl4@cdc.gov %K COVID-19 %K SARS-CoV-2 %K incidence %K vaccine effectiveness %K cohort study %K health care personnel %K first responder %K essential and frontline workers %D 2021 %7 3.12.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Workers critical to emergency response and continuity of essential services during the COVID-19 pandemic are at a disproportionally high risk of SARS-CoV-2 infection. Prospective cohort studies are needed for enhancing the understanding of the incidence of symptomatic and asymptomatic SARS-CoV-2 infections, identifying risk factors, assessing clinical outcomes, and determining the effectiveness of vaccination. Objective: The Research on the Epidemiology of SARS-CoV-2 in Essential Response Personnel (RECOVER) prospective cohort study was designed to estimate the incidence of symptomatic and asymptomatic SARS-CoV-2 infections, examine the risk factors for infection and clinical spectrum of illness, and assess the effectiveness of vaccination among essential workers. Methods: The RECOVER multisite network was initiated in August 2020 and aims to enroll 3000 health care personnel (HCP), first responders, and other essential and frontline workers (EFWs) at 6 US locations. Data on participant demographics, medical history, and vaccination history are collected at baseline and throughout the study. Active surveillance for the symptoms of COVID-19–like illness (CLI), access of medical care, and symptom duration is performed by text messages, emails, and direct participant or medical record reports. Participants self-collect a mid-turbinate nasal swab weekly, regardless of symptoms, and 2 additional respiratory specimens at the onset of CLI. Blood is collected upon enrollment, every 3 months, approximately 28 days after a reverse transcription polymerase chain reaction (RT-PCR)–confirmed SARS-CoV-2 infection, and 14 to 28 days after a dose of any COVID-19 vaccine. From February 2021, household members of RT-PCR–confirmed participants are self-collecting mid-turbinate nasal swabs daily for 10 days. Results: The study observation period began in August 2020 and is expected to continue through spring 2022. There are 2623 actively enrolled RECOVER participants, including 280 participants who have been found to be positive for SARS-CoV-2 by RT-PCR. Enrollment is ongoing at 3 of the 6 study sites. Conclusions: Data collected through the cohort are expected to provide important public health information for essential workers at high risk for occupational exposure to SARS-CoV-2 and allow early evaluation of COVID-19 vaccine effectiveness. International Registered Report Identifier (IRRID): DERR1-10.2196/31574 %M 34662287 %R 10.2196/31574 %U https://www.researchprotocols.org/2021/12/e31574 %U https://doi.org/10.2196/31574 %U http://www.ncbi.nlm.nih.gov/pubmed/34662287 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 12 %P e33125 %T Drinking and Social Media Use Among Workers During COVID-19 Pandemic Restrictions: Five-Wave Longitudinal Study %A Oksanen,Atte %A Oksa,Reetta %A Savela,Nina %A Celuch,Magdalena %A Savolainen,Iina %+ Tampere University, Faculty of Social Sciences, Kalevantie 5, Tampere, 33014, Finland, 358 503187279, atte.oksanen@tuni.fi %K excessive drinking %K alcohol %K COVID-19 %K social media %K remote work %K psychological distress %K distress %K pattern %K trend %K prediction %K survey %K app %K risk %D 2021 %7 2.12.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic restricted everyday life during 2020-2021 for many people worldwide. It also affected alcohol consumption patterns and leisure activities, including the use of social media. Objective: The aim of this study was to analyze whether social media use predicts increased risky drinking over time and during the COVID-19 pandemic restrictions in particular. Methods: This 5-wave longitudinal survey study, based on a nationwide sample of workers, was conducted in Finland in 2019-2021. A total of 840 respondents (male: 473/840, 56.31%; age range 18-64 years; mean age 43.90, SD 11.14 years) participated in all 5 waves of the study. The outcome variable was risky drinking, measured using the 3-item Alcohol Use Disorders Identification Test (AUDIT-C). Multilevel linear hybrid modeling enabled the investigation of both within-person and between-person effects. Predictors included social media use and communication, involvement in social media identity bubbles, psychological distress, and remote working. Controls included sociodemographic factors and the Big Five personality traits. Results: Increased involvement in social media identity bubbles was associated with an increase in risky drinking behavior. Of all social media platforms examined, online dating app use was associated with riskier use of alcohol over time during the COVID-19 crisis. Daily social media communication with colleagues about nonwork topics was associated with risky drinking. Female gender, younger age, university education, nonindustrial occupational field, conscientiousness, agreeableness, and neuroticism were associated with lower levels of risky drinking. Conclusions: Social media use during a pandemic carries some risks for alcohol consumption. Involvement in social media identity bubbles and online dating are risk factors for excessive drinking during the COVID-19 pandemic. %M 34662290 %R 10.2196/33125 %U https://www.jmir.org/2021/12/e33125 %U https://doi.org/10.2196/33125 %U http://www.ncbi.nlm.nih.gov/pubmed/34662290 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 12 %P e30702 %T Depression, Anxiety, and Daily Activity Among Adolescents Before and During the COVID-19 Pandemic: Cross-sectional Survey Study %A Jolliff,Anna %A Zhao,Qianqian %A Eickhoff,Jens %A Moreno,Megan %+ Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin - Madison, 2870 University Avenue, Suite 200, Madison, WI, 53705, United States, 1 5035539361, ajolliff@wisc.edu %K COVID-19 %K pandemic %K adolescent %K depression %K anxiety %K socioeconomic status %K survey %K mental health %D 2021 %7 2.12.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic has resulted in significant changes to adolescents’ daily lives and, potentially, to their mental health. The pandemic has also disproportionately affected historically marginalized and at-risk communities, including people of color, socioeconomically disadvantaged people, people identifying as female, and youth. Objective: This study aimed to understand differences in depression and anxiety among 2 groups of adolescents in the United States before and during the COVID-19 pandemic, and to examine demographic and daily activity variables associated with depression and anxiety. Methods: Online surveys were distributed in 2019 and 2020. Demographic questions were asked at the time of enrollment, and included participants’ age, gender, race and ethnicity, and socioeconomic status (SES). The 8-item Patient Health Questionnaire was used to assess symptoms of depression, and the 7-item Generalized Anxiety Disorder scale was used to assess symptoms of anxiety. A total of 4 pandemic-specific daily activity questions were asked only of the pandemic group. Analyses of covariance compared depression and anxiety between prepandemic and pandemic groups. Demographic and lifestyle variables were included as covariates. Results: The sample comprised a total of 234 adolescents, with 100 participants in the prepandemic group and 134 participants in the pandemic group. Within the pandemic group, 94% (n=126) of adolescents reported being out of school due to the pandemic, and another 85.8% (n=115) and 57.1% (n=76) were prevented from extracurricular activities and exercise, respectively. Higher depression was seen in the pandemic group, with a least-squares adjusted mean of 7.62 (SD 1.36) compared to 6.28 (SD 1.42) in the prepandemic group, although the difference was not significant (P=.08). There was no significant difference in anxiety scores between the 2 groups (least-squares adjusted means 5.52, SD 1.30 vs 5.01, SD 1.36; P=.48). Within the pandemic group, lower SES was predictive of anxiety, such that those in the pandemic group of lower SES were more anxious than their higher-SES peers (least-squares adjusted means 11.17, SD 2.34 vs 8.66, SD 2.16; P=.02). Within the pandemic group, being out of work or school and not partaking in extracurricular activities or exercise due to the pandemic were not associated with higher depression or anxiety scores. Conclusions: In this study, neither being in the pandemic group nor experiencing changes in daily activity due to the pandemic was associated with higher depression or anxiety. However, we found that adolescents from lower SES backgrounds experienced significantly more anxiety during the pandemic than their more privileged peers. Both instrumental and mental health interventions for low-income adolescents are imperative. %M 34609316 %R 10.2196/30702 %U https://formative.jmir.org/2021/12/e30702 %U https://doi.org/10.2196/30702 %U http://www.ncbi.nlm.nih.gov/pubmed/34609316 %0 Journal Article %@ 2563-6316 %I JMIR Publications %V 2 %N 4 %P e30708 %T Influence of the COVID-19 Lockdown on the Physical and Psychosocial Well-being and Work Productivity of Remote Workers: Cross-sectional Correlational Study %A Tronco Hernández,Yessica Abigail %A Parente,Fabio %A Faghy,Mark A %A Roscoe,Clare M P %A Maratos,Frances A %+ School of Psychology, College of Health, Psychology and Social Care, University of Derby, Kedleston Road, Derby, DE22 1GB, United Kingdom, 44 7557952316, f.parente@derby.ac.uk %K COVID-19 %K pandemic %K remote workers %K mental health %K health policy %K employment %K policymakers %K wellbeing %D 2021 %7 1.12.2021 %9 Original Paper %J JMIRx Med %G English %X Background: Lockdowns imposed during the COVID-19 pandemic have impacted the living and working habits of millions of people, with potentially important implications for their physical, mental, and social well-being. Objective: The primary objective of this study was to investigate the impact of the COVID-19 pandemic on remote workers who were not directly affected by COVID-19. Methods: This was a correlational cross-sectional study (with an additional qualitative component) of 184 remote workers surveyed during the first COVID-19 lockdown in the United Kingdom. Standard measures of mental health (Kessler-6 Distress Scale), productivity (Brief Instrument to Assess Workers’ Productivity During a Working Day), and physical activity (International Physical Activity Questionnaire) were used, and respondents were further surveyed on changes to their dietary, exercise, smoking, drinking, and socialization habits to produce a well-being change index. Results: The results revealed associations between sedentary behavior and poorer mental health (τb=0.14) and between poorer mental health and low work productivity (τb=–0.39). However, both positive and negative lifestyle changes were reported; a self-reported increase in well-being (with respect to diet, exercise, smoking, alcohol consumption, and socialization) since the start of the pandemic was associated with both better mental health (τb=–0.14) and better work productivity (τb=0.14). Of note, among respondents without a mental health diagnosis (137/184, 74.4%), we observed rates of moderate (76/137, 55.5%) and severe (17/137, 12.4%) psychological distress, which were markedly higher than those reported in large prepandemic studies; moreover, 70.1% (129/184) of our respondents reported more sedentary behavior, 41% (69/168) increased their alcohol consumption, and 38.6% (71/184) increased their overall food intake. However, 46% (75/163), 44.8% (39/87) and 51.8% (57/110) of respondents reported spending more time walking and engaging in more moderate and vigorous exercise, respectively. Qualitative analysis revealed many positive adaptations to lockdowns (eg, decreased commuting expenses, flexibility) but also a number of structural obstacles to remote working (eg, lack of support and high expectations from employers, childcare duties). Conclusions: These findings may be of practical importance for policy makers and employers in a world in which work involves long-term remote or hybrid employment arrangements; strategies to promote more sustainable remote working are discussed. %M 34898665 %R 10.2196/30708 %U https://med.jmirx.org/2021/4/e30708 %U https://doi.org/10.2196/30708 %U http://www.ncbi.nlm.nih.gov/pubmed/34898665 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 12 %P e30648 %T Predicting COVID-19 Transmission to Inform the Management of Mass Events: Model-Based Approach %A Donnat,Claire %A Bunbury,Freddy %A Kreindler,Jack %A Liu,David %A Filippidis,Filippos T %A Esko,Tonu %A El-Osta,Austen %A Harris,Matthew %+ Department of Statistics, University of Chicago, 5747 South Ellis Avenue, Chicago, IL, 60637, United States, 1 773 702 9890, cdonnat@uchicago.edu %K COVID-19 %K transmission dynamics %K live event management %K Monte Carlo simulation %D 2021 %7 1.12.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Modelling COVID-19 transmission at live events and public gatherings is essential to controlling the probability of subsequent outbreaks and communicating to participants their personalized risk. Yet, despite the fast-growing body of literature on COVID-19 transmission dynamics, current risk models either neglect contextual information including vaccination rates or disease prevalence or do not attempt to quantitatively model transmission. Objective: This paper attempted to bridge this gap by providing informative risk metrics for live public events, along with a measure of their uncertainty. Methods: Building upon existing models, our approach ties together 3 main components: (1) reliable modelling of the number of infectious cases at the time of the event, (2) evaluation of the efficiency of pre-event screening, and (3) modelling of the event’s transmission dynamics and their uncertainty using Monte Carlo simulations. Results: We illustrated the application of our pipeline for a concert at the Royal Albert Hall and highlighted the risk’s dependency on factors such as prevalence, mask wearing, and event duration. We demonstrate how this event held on 3 different dates (August 20, 2020; January 20, 2021; and March 20, 2021) would likely lead to transmission events that are similar to community transmission rates (0.06 vs 0.07, 2.38 vs 2.39, and 0.67 vs 0.60, respectively). However, differences between event and background transmissions substantially widened in the upper tails of the distribution of the number of infections (as denoted by their respective 99th quantiles: 1 vs 1, 19 vs 8, and 6 vs 3, respectively, for our 3 dates), further demonstrating that sole reliance on vaccination and antigen testing to gain entry would likely significantly underestimate the tail risk of the event. Conclusions: Despite the unknowns surrounding COVID-19 transmission, our estimation pipeline opens the discussion on contextualized risk assessment by combining the best tools at hand to assess the order of magnitude of the risk. Our model can be applied to any future event and is presented in a user-friendly RShiny interface. Finally, we discussed our model’s limitations as well as avenues for model evaluation and improvement. %M 34583317 %R 10.2196/30648 %U https://publichealth.jmir.org/2021/12/e30648 %U https://doi.org/10.2196/30648 %U http://www.ncbi.nlm.nih.gov/pubmed/34583317 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 12 %P e28734 %T Transitioning From In-Person to Remote Clinical Research on Depression and Traumatic Brain Injury During the COVID-19 Pandemic: Study Modifications and Preliminary Feasibility From a Randomized Controlled Pilot Study %A Fisher,Lauren B %A Tuchman,Sylvie %A Curreri,Andrew J %A Markgraf,Maggie %A Nyer,Maren B %A Cassano,Paolo %A Iverson,Grant L %A Fava,Maurizio %A Zafonte,Ross D %A Pedrelli,Paola %+ Department of Psychiatry, Massachusetts General Hospital, 1 Bowdoin Square, 6th Floor, Boston, MA, 02114, United States, 1 617 643 0877, fisher.lauren@mgh.harvard.edu %K COVID-19 %K telemental health %K clinical trial %K traumatic brain injury %K depression %K cognitive behavioral therapy %D 2021 %7 1.12.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Telehealth has provided many researchers, especially those conducting psychosocial research, with the tools necessary to transition from in-person to remote clinical trials during the COVID-19 pandemic. A growing body of research supports the effectiveness of telemental health for a variety of psychiatric conditions, but few studies have examined telemental health for individuals with comorbid medical diagnoses. Furthermore, little is known about the remote implementation of clinical trials examining telemental health interventions. Objective: This paper outlines the procedural modifications used to facilitate conversion of an in-person randomized controlled trial of cognitive behavioral therapy (CBT) for depression in individuals with traumatic brain injury (TBI; CBT-TBI) to a telemental health study administered remotely. Methods: Given the nature of remote implementation and specific challenges experienced by individuals with TBI, considerations related to treatment delivery, remote consent, data management, neuropsychological assessment, safety monitoring, and delivery of supportive material have been discussed. Feasibility, acceptability, and safety were evaluated by examining attendance and participant responses on self-report measures of treatment satisfaction and suicidal behavior. Results: High rates of treatment attendance, assessment completion, study retention, and satisfaction with the intervention and modality were reported by participants who completed at least one telemental health CBT-TBI session. Conclusions: Study modifications are necessary when conducting a study remotely, and special attention should be paid to comorbidities and population-specific challenges (eg, cognitive impairment). Preliminary data support the feasibility, acceptability, and safety of remotely conducting a randomized controlled trial of CBT-TBI. Trial Registration: ClinicalTrials.gov NCT03307070; https://clinicaltrials.gov/ct2/show/NCT03307070 %M 34662285 %R 10.2196/28734 %U https://formative.jmir.org/2021/12/e28734 %U https://doi.org/10.2196/28734 %U http://www.ncbi.nlm.nih.gov/pubmed/34662285 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 9 %N 11 %P e31510 %T Global Research on Coronaviruses: Metadata-Based Analysis for Public Health Policies %A Warin,Thierry %+ HEC Montréal, 3000, chemin de la Côte-Sainte-Catherine, Montréal, QC, H3T 2A7, Canada, 1 5146082106, thierry.warin@hec.ca %K COVID-19 %K SARS-CoV-2 %K natural language processing %K coronavirus %K unstructured data %K data science %K health 4.0 %D 2021 %7 30.11.2021 %9 Original Paper %J JMIR Med Inform %G English %X Background: Within the context of the COVID-19 pandemic, this paper suggests a data science strategy for analyzing global research on coronaviruses. The application of reproducible research principles founded on text-as-data information, open science, the dissemination of scientific data, and easy access to scientific production may aid public health in the fight against the virus. Objective: The primary goal of this paper was to use global research on coronaviruses to identify critical elements that can help inform public health policy decisions. We present a data science framework to assist policy makers in implementing cutting-edge data science techniques for the purpose of developing evidence-based public health policies. Methods: We used the EpiBibR (epidemiology-based bibliography for R) package to gain access to coronavirus research documents worldwide (N=121,231) and their associated metadata. To analyze these data, we first employed a theoretical framework to group the findings into three categories: conceptual, intellectual, and social. Second, we mapped the results of our analysis in these three dimensions using machine learning techniques (ie, natural language processing) and social network analysis. Results: Our findings, firstly, were methodological in nature. They demonstrated the potential for the proposed data science framework to be applied to public health policies. Additionally, our findings indicated that the United States and China were the primary contributors to global coronavirus research during the study period. They also demonstrated that India and Europe were significant contributors, albeit in a secondary position. University collaborations in this domain were strong between the United States, Canada, and the United Kingdom, confirming the country-level findings. Conclusions: Our findings argue for a data-driven approach to public health policy, particularly when efficient and relevant research is required. Text mining techniques can assist policy makers in calculating evidence-based indices and informing their decision-making process regarding specific actions necessary for effective health responses. %M 34596570 %R 10.2196/31510 %U https://medinform.jmir.org/2021/11/e31510 %U https://doi.org/10.2196/31510 %U http://www.ncbi.nlm.nih.gov/pubmed/34596570 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 11 %P e26743 %T Using Ecological Momentary Assessment to Study the Development of COVID-19 Worries in Sweden: Longitudinal Study %A Schulz,Peter Johannes %A Andersson,Elin M %A Bizzotto,Nicole %A Norberg,Margareta %+ Institute of Communication and Health, Università della Svizzera italiana, Via Giuseppe Buffi 13, Lugano, 6900, Switzerland, 41 58666 ext 4724, schulzp@usi.ch %K COVID-19 %K coronavirus %K longitudinal studies %K EMA %K worry %K fear %K pandemics %D 2021 %7 29.11.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The foray of COVID-19 around the globe has certainly instigated worries in many people, and lockdown measures may well have triggered more specific worries. Sweden, more than other countries, relied on voluntary measures to fight the pandemic. This provides a particularly interesting context to assess people’s reactions to the threat of the pandemic. Objective: The general aim of this study was to better understand the worried reactions to the virus and the associated lockdown measures. As there have been very few longitudinal studies in this area published to date, development of feelings of worry over time was analyzed over a longer range than in previous research. Affective variables, worry in particular, were included because most of the research in this field has focused on cognitive variables. To employ new methodology, ecological momentary assessment was used for data collection and a multilevel modeling approach was adopted for data analysis. Methods: Results were based on an unbalanced panel sample of 260 Swedish participants filling in 3226 interview questionnaires by smartphone over a 7-week period in 2020 during the rapid rise of cases in the early phase of the pandemic. Causal factors considered in this study included the perceived severity of an infection, susceptibility of a person to the threat posed by the virus, perceived efficacy of safeguarding measures, and assessment of government action against the spread of COVID-19. The effect of these factors on worries was traced in two analytical steps: the effects at the beginning of the study and the effect on the trend during the study. Results: The level of general worry related to COVID-19 was modest (mean 6.67, SD 2.54 on an 11-point Likert scale); the increase during the study period was small, but the interindividual variation of both the worry level and its increase over time was large. Findings confirmed that the hypothesized causal factors (severity of infection, susceptibility to the threat of the virus, efficacy of safeguarding, and assessment of government preventive action) did indeed affect the level of worry. Conclusions: The results confirmed earlier research in a very special case and demonstrated the usefulness of a different study design, which takes a longitudinal perspective, and a new type of data analysis borrowed from multilevel study design. %M 34847065 %R 10.2196/26743 %U https://www.jmir.org/2021/11/e26743 %U https://doi.org/10.2196/26743 %U http://www.ncbi.nlm.nih.gov/pubmed/34847065 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 11 %P e30529 %T Mild Adverse Events of Sputnik V Vaccine in Russia: Social Media Content Analysis of Telegram via Deep Learning %A Jarynowski,Andrzej %A Semenov,Alexander %A Kamiński,Mikołaj %A Belik,Vitaly %+ System Modeling Group, Institute for Veterinary Epidemiology and Biostatistics, Freie Universität Berlin, Königsweg 67, Berlin, 14163, Germany, 49 30 838 61129, vitaly.belik@fu-berlin.de %K adverse events %K Sputnik V %K Gam-COVID-Vac %K social media %K Telegram %K COVID-19 %K Sars-CoV-2 %K deep learning %K vaccine safety %D 2021 %7 29.11.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: There is a limited amount of data on the safety profile of the COVID-19 vector vaccine Gam-COVID-Vac (Sputnik V). Previous infodemiology studies showed that social media discourse could be analyzed to assess the most concerning adverse events (AE) caused by drugs. Objective: We aimed to investigate mild AEs of Sputnik V based on a participatory trial conducted on Telegram in the Russian language. We compared AEs extracted from Telegram with other limited databases on Sputnik V and other COVID-19 vaccines. We explored symptom co-occurrence patterns and determined how counts of administered doses, age, gender, and sequence of shots could confound the reporting of AEs. Methods: We collected a unique dataset consisting of 11,515 self-reported Sputnik V vaccine AEs posted on the Telegram group, and we utilized natural language processing methods to extract AEs. Specifically, we performed multilabel classifications using the deep neural language model Bidirectional Encoder Representations from Transformers (BERT) “DeepPavlov,” which was pretrained on a Russian language corpus and applied to the Telegram messages. The resulting area under the curve score was 0.991. We chose symptom classes that represented the following AEs: fever, pain, chills, fatigue, nausea/vomiting, headache, insomnia, lymph node enlargement, erythema, pruritus, swelling, and diarrhea. Results: Telegram users complained mostly about pain (5461/11,515, 47.43%), fever (5363/11,515, 46.57%), fatigue (3862/11,515, 33.54%), and headache (2855/11,515, 24.79%). Women reported more AEs than men (1.2-fold, P<.001). In addition, there were more AEs from the first dose than from the second dose (1.1-fold, P<.001), and the number of AEs decreased with age (β=.05 per year, P<.001). The results also showed that Sputnik V AEs were more similar to other vector vaccines (132 units) than with messenger RNA vaccines (241 units) according to the average Euclidean distance between the vectors of AE frequencies. Elderly Telegram users reported significantly more (5.6-fold on average) systemic AEs than their peers, according to the results of the phase 3 clinical trials published in The Lancet. However, the AEs reported in Telegram posts were consistent (Pearson correlation r=0.94, P=.02) with those reported in the Argentinian postmarketing AE registry. Conclusions: After the Sputnik V vaccination, Russian Telegram users reported mostly pain, fever, and fatigue. The Sputnik V AE profile was comparable with other vector COVID-19 vaccines. Discussion on social media could provide meaningful information about the AE profile of novel vaccines. %M 34662291 %R 10.2196/30529 %U https://www.jmir.org/2021/11/e30529 %U https://doi.org/10.2196/30529 %U http://www.ncbi.nlm.nih.gov/pubmed/34662291 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 11 %P e31635 %T Impact of the COVID-19 Pandemic on the Health Status and Behaviors of Adults in Korea: National Cross-sectional Web-Based Self-report Survey %A Kang,EunKyo %A Lee,Hyejin %A Sohn,Jee Hoon %A Yun,Jieun %A Lee,Jin Yong %A Hong,Yun-Chul %+ Department of Preventive Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea, 82 2 740 8394, ychong1@snu.ac.kr %K COVID-19 %K health status %K health behavior %K self-reported online survey %K pandemic %K epidemiology %K public health %K sociodemographic factors %K health interventions %K lockdown %D 2021 %7 26.11.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The COVID-19 pandemic has radically shifted living practices, thereby influencing changes in the health status and behaviors of every person. Objective: The aim of this study was to investigate the impact of COVID-19 on the self-reported health status and health behaviors along with any associated factors in adults in the Republic of Korea wherein no stringent lockdown measures were implemented during the pandemic. Methods: We conducted a web-based self-reported survey from November 2020 to December 2020. The study participants (N=2097) were identified through quota sampling by age, sex, and geographical regions among residents aged 19 years or older in Korea. The survey collected information on basic demographics, changes in self-reported health status, and health behaviors during the COVID-19 pandemic. Self-reported health status and health behaviors were categorized into 3 groups: unchanged, improved, or worsened. A chi-square test and logistic regression analyses were conducted. Results: With regard to changes in the self-reported health status, the majority (1478/2097, 70.5%) of the participants reported that their health was unchanged, while 20% (420/2097) of the participants reported having worser health after the COVID-19 outbreak. With regard to changes in health behaviors, the proportion of participants who increased tobacco consumption was similar to that of those who decreased tobacco consumption (110/545, 20.2% vs 106/545, 19.5%, respectively), while the proportion of those who decreased their drinking frequency was more than twice as many as those who increased their drinking frequency (578/1603, 36.1% vs 270/1603, 16.8%, respectively). Further, those who decreased their exercising frequency were more than those who increased their exercising frequency (333/823, 15.9% vs 211/823, 10%, respectively). The factor that had the greatest influence on lifestyle was age. In the subgroup analysis, the group aged 20-29 years had the highest number of individuals with both a worsened (100/377, 26.5%) and an improved (218/377, 15.7%) health status. Further, individuals aged 20-29 years had greater odds of increased smoking (6.44, 95% CI 2.15-19.32), increased alcohol use (4.64, 95% CI 2.60-8.28), and decreased moderate or higher intensity aerobic exercise (3.39, 95% CI 1.82-6.33) compared to individuals aged 60 years and older. Younger adults showed deteriorated health behaviors, while older adults showed improved health behaviors. Conclusions: The health status and the behavior of the majority of the Koreans were not found to be heavily affected by the COVID-19 outbreak. However, in some cases, changes in health status or health behavior were identified. This study highlighted that some groups were overwhelmingly affected by COVID-19 compared to others. Certain groups reported experiencing both worsening and improving health, while other groups reported unchanged health status. Age was the most influential factor for behavior change; in particular, the younger generation’s negative health behaviors need more attention in terms of public health. As COVID-19 prolongs, public health interventions for vulnerable groups may be needed. %M 34653017 %R 10.2196/31635 %U https://publichealth.jmir.org/2021/11/e31635 %U https://doi.org/10.2196/31635 %U http://www.ncbi.nlm.nih.gov/pubmed/34653017 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 11 %P e33088 %T Assessing Values and Preferences Toward SARS-CoV-2 Self-testing Among the General Population and Their Representatives, Health Care Personnel, and Decision-Makers: Protocol for a Multicountry Mixed Methods Study %A Shilton,Sonjelle %A Ivanova Reipold,Elena %A Roca Álvarez,Albert %A Martínez-Pérez,Guillermo Z %+ FIND, the global alliance for diagnostics, Chemin des Mines 9, Geneva, 1202, Switzerland, 41 22 710 05 90, sonjelle.shilton@finddx.org %K COVID-19 %K SARS-CoV-2 %K diagnostic %K self-testing %K mixed methods %K testing %K protocol %K preference %K testing %K population %K health care worker %K decision-making %K accessibility %K transmission %K screening %D 2021 %7 26.11.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Accessible, safe, and client-centered SARS-CoV-2 testing services are an effective way to halt its transmission. Testing enables infected individuals to isolate or quarantine to prevent further transmission. In countries with limited health systems and laboratory capacity, it can be challenging to provide accessible and safe screening for COVID-19. Self-testing provides a convenient, private, and safe testing option; however, it also raises important concerns about lack of counseling and ensuring timely reporting of self-test results to national surveillance systems. Investigating community members’ views and perceptions regarding SARS-CoV-2 self-testing is crucial to inform the most effective and safe strategies for implementing said testing. Objective: We aimed to determine whether SARS-CoV-2 self-testing was useful to diagnose and prevent the spread of SARS-CoV-2 for populations in low-resource settings and under which circumstances it would be acceptable. Methods: This multisite, mixed methods, observational study will be conducted in 9 countries—Brazil, India, Indonesia, Kenya, Malawi, Nigeria, Peru, the Philippines, and South Africa—and will consists of 2 components: cross-sectional surveys and interviews (semistructured and group) among 4 respondent groupings: the general population, general population representatives, health care workers, and decision-makers. General population and health care worker survey responses will be analyzed separately from each other, using bivariate and multivariate inferential analysis and descriptive statistics. Semistructured interviews and group interviews will be audiorecorded, transcribed, and coded for thematic comparative analysis. Results: As of November 19, 2021, participant enrollment is ongoing; 4364 participants have been enrolled in the general population survey, and 2233 participants have been enrolled in the health care workers survey. In the qualitative inquiry, 298 participants have been enrolled. We plan to complete data collection by December 31, 2021 and publish results in 2022 via publications, presentations at conferences, and dissemination events specifically targeted at local decision-makers, civil society, and patient groups. Conclusions: The views and perceptions of local populations are crucial in the discussion of the safest strategies for implementing SARS-CoV-2 self-testing. We intend to identify sociocultural specificities that may hinder or accelerate the widespread utilization of SARS-CoV-2 self-testing. International Registered Report Identifier (IRRID): DERR1-10.2196/33088 %M 34726608 %R 10.2196/33088 %U https://www.researchprotocols.org/2021/11/e33088 %U https://doi.org/10.2196/33088 %U http://www.ncbi.nlm.nih.gov/pubmed/34726608 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 11 %P e33231 %T Predictive Modeling of Vaccination Uptake in US Counties: A Machine Learning–Based Approach %A Cheong,Queena %A Au-yeung,Martin %A Quon,Stephanie %A Concepcion,Katsy %A Kong,Jude Dzevela %+ Africa-Canada Artificial Intelligence and Data Innovation Consortium, Department of Mathematics and Statistics, York University, 4700 Keele Street, Toronto, ON, M3J 1P3, Canada, 1 416 736 2100 ext 66093, jdkong@yorku.ca %K COVID-19 %K vaccine %K public health %K machine learning %K XGBoost %K SARS-CoV-2 %K sociodemographic factors %K United States %K sociodemographic %K prediction %K model %K uptake %D 2021 %7 25.11.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Although the COVID-19 pandemic has left an unprecedented impact worldwide, countries such as the United States have reported the most substantial incidence of COVID-19 cases worldwide. Within the United States, various sociodemographic factors have played a role in the creation of regional disparities. Regional disparities have resulted in the unequal spread of disease between US counties, underscoring the need for efficient and accurate predictive modeling strategies to inform public health officials and reduce the burden on health care systems. Furthermore, despite the widespread accessibility of COVID-19 vaccines across the United States, vaccination rates have become stagnant, necessitating predictive modeling to identify important factors impacting vaccination uptake. Objective: This study aims to determine the association between sociodemographic factors and vaccine uptake across counties in the United States. Methods: Sociodemographic data on fully vaccinated and unvaccinated individuals were sourced from several online databases such as the US Centers for Disease Control and Prevention and the US Census Bureau COVID-19 Site. Machine learning analysis was performed using XGBoost and sociodemographic data. Results: Our model predicted COVID-19 vaccination uptake across US counties with 62% accuracy. In addition, it identified location, education, ethnicity, income, and household access to the internet as the most critical sociodemographic features in predicting vaccination uptake in US counties. Lastly, the model produced a choropleth demonstrating areas of low and high vaccination rates, which can be used by health care authorities in future pandemics to visualize and prioritize areas of low vaccination and design targeted vaccination campaigns. Conclusions: Our study reveals that sociodemographic characteristics are predictors of vaccine uptake rates across counties in the United States and, if leveraged appropriately, can assist policy makers and public health officials to understand vaccine uptake rates and craft policies to improve them. %M 34751650 %R 10.2196/33231 %U https://www.jmir.org/2021/11/e33231 %U https://doi.org/10.2196/33231 %U http://www.ncbi.nlm.nih.gov/pubmed/34751650 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 9 %N 4 %P e33003 %T Nationwide Deployment of a Serious Game Designed to Improve COVID-19 Infection Prevention Practices in Switzerland: Prospective Web-Based Study %A Suppan,Melanie %A Stuby,Loric %A Harbarth,Stephan %A Fehlmann,Christophe A %A Achab,Sophia %A Abbas,Mohamed %A Suppan,Laurent %+ Division of Emergency Medicine, Department of Anesthesiology, Clinical Pharmacology, Intensive Care, and Emergency Medicine, University of Geneva Hospitals and Faculty of Medicine, Rue Gabrielle-Perret-Gentil 4, Geneva, 1211, Switzerland, 41 223723311, laurent.suppan@hcuge.ch %K COVID-19 %K serious game %K infection prevention %K SARS-CoV-2 %K prospective %K web-based %K deployment %K prevention %K gaming %K public health %K dissemination %K health information %K behavior %K survey %D 2021 %7 25.11.2021 %9 Original Paper %J JMIR Serious Games %G English %X Background: Lassitude and a rather high degree of mistrust toward the authorities can make regular or overly constraining COVID-19 infection prevention and control campaigns inefficient and even counterproductive. Serious games provide an original, engaging, and potentially effective way of disseminating COVID-19 infection prevention and control guidelines. Escape COVID-19 is a serious game for teaching COVID-19 infection prevention and control practices that has previously been validated in a population of nursing home personnel. Objective: We aimed to identify factors learned from playing the serious game Escape COVID-19 that facilitate or impede intentions of changing infection prevention and control behavior in a large and heterogeneous Swiss population. Methods: This fully automated, prospective web-based study, compliant with the Checklist for Reporting Results of Internet E-Surveys (CHERRIES), was conducted in all 3 main language regions of Switzerland. After creating an account on the platform, participants were asked to complete a short demographic questionnaire before accessing the serious game. The only incentive given to the potential participants was a course completion certificate, which participants obtained after completing the postgame questionnaire. The primary outcome was the proportion of participants who reported that they were willing to change their infection prevention and control behavior. Secondary outcomes were the infection prevention and control areas affected by this willingness and the presumed evolution in the use of specific personal protective equipment items. The elements associated with intention to change infection prevention and control behavior, or lack thereof, were also assessed. Other secondary outcomes were the subjective perceptions regarding length, difficulty, meaningfulness, and usefulness of the serious game; impression of engagement and boredom while playing the serious game; and willingness to recommend its use to friends or colleagues. Results: From March 9 to June 9, 2021, a total of 3227 accounts were created on the platform, and 1104 participants (34.2%) completed the postgame questionnaire. Of the 1104 respondents, 509 respondents (46.1%) answered that they intended to change their infection prevention and control behavior after playing the game. Among the respondents who answered that they did not intend to change their behavior, 86.1% (512/595) answered that they already apply these guidelines. Participants who followed the German version were less likely to intend to change their infection prevention and control behavior (odds ratio [OR] 0.48, 95% CI 0.24-0.96; P=.04) and found the game less engaging (P<.001). Conversely, participants aged 53 years or older had stronger intentions of changing infection prevention and control behavior (OR 2.07, 95% CI 1.44-2.97; P<.001). Conclusions: Escape COVID-19 is a useful tool to enhance correct infection prevention and control measures on a national scale, even after 2 COVID-19 pandemic waves; however, the serious game's impact was affected by language, age category, and previous educational training, and the game should be adapted to enhance its impact on specific populations. %M 34635472 %R 10.2196/33003 %U https://games.jmir.org/2021/4/e33003 %U https://doi.org/10.2196/33003 %U http://www.ncbi.nlm.nih.gov/pubmed/34635472 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 11 %P e28317 %T Impact of the COVID-19 Pandemic on Objectively Measured Physical Activity and Sedentary Behavior Among Overweight Young Adults: Yearlong Longitudinal Analysis %A Lawhun Costello,Victoria %A Chevance,Guillaume %A Wing,David %A Mansour-Assi,Shadia J %A Sharp,Sydney %A Golaszewski,Natalie M %A Young,Elizabeth A %A Higgins,Michael %A Ibarra,Anahi %A Larsen,Britta %A Godino,Job G %+ Center for Wireless and Population Health Systems, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, United States, 1 8582463302, jobg@fhcsd.org %K COVID-19 %K young adults %K physical activity %K sedentary behavior %K activity monitor %K public health %K wearable %K activity monitors %K wrist worn %K sedentary %K lifestyle %K pandemic %D 2021 %7 24.11.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The COVID-19 pandemic has impacted multiple aspects of daily living, including behaviors associated with occupation, transportation, and health. It is unclear how these changes to daily living have impacted physical activity and sedentary behavior. Objective: In this study, we add to the growing body of research on the health impact of the COVID-19 pandemic by examining longitudinal changes in objectively measured daily physical activity and sedentary behavior among overweight or obese young adults participating in an ongoing weight loss trial in San Diego, California. Methods: Data were collected from 315 overweight or obese (BMI: range 25.0-39.9 kg/m2) participants aged from 18 to 35 years between November 1, 2019, and October 30, 2020, by using the Fitbit Charge 3 (Fitbit LLC). After conducting strict filtering to find valid data on consistent wear (>10 hours per day for ≥250 days), data from 97 participants were analyzed to detect multiple structural changes in time series of physical activity and sedentary behavior. An algorithm was designed to detect multiple structural changes. This allowed for the automatic identification and dating of these changes in linear regression models with CIs. The number of breakpoints in regression models was estimated by using the Bayesian information criterion and residual sum of squares; the optimal segmentation corresponded to the lowest Bayesian information criterion and residual sum of squares. To quantify the changes in each outcome during the periods identified, linear mixed effects analyses were conducted. In terms of key demographic characteristics, the 97 participants included in our analyses did not differ from the 210 participants who were excluded. Results: After the initiation of the shelter-in-place order in California on March 19, 2021, there were significant decreases in step counts (−2872 steps per day; 95% CI −2734 to −3010), light physical activity times (−41.9 minutes; 95% CI −39.5 to −44.3), and moderate-to-vigorous physical activity times (−12.2 minutes; 95% CI −10.6 to −13.8), as well as significant increases in sedentary behavior times (+52.8 minutes; 95% CI 47.0-58.5). The decreases were greater than the expected declines observed during winter holidays, and as of October 30, 2020, they have not returned to the levels observed prior to the initiation of shelter-in-place orders. Conclusions: Among overweight or obese young adults, physical activity times decreased and sedentary behavior times increased concurrently with the implementation of COVID-19 mitigation strategies. The health conditions associated with a sedentary lifestyle may be additional, unintended results of the COVID-19 pandemic. %M 34665759 %R 10.2196/28317 %U https://publichealth.jmir.org/2021/11/e28317 %U https://doi.org/10.2196/28317 %U http://www.ncbi.nlm.nih.gov/pubmed/34665759 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 11 %P e28146 %T How Identification With the Social Environment and With the Government Guide the Use of the Official COVID-19 Contact Tracing App: Three Quantitative Survey Studies %A Scholl,Annika %A Sassenberg,Kai %+ Social Processes Lab, Leibniz-Institut fuer Wissensmedien, Schleichstr 6, Tuebingen, 72076, Germany, 49 7071979 ext 257, a.scholl@iwm-tuebingen.de %K COVID-19 %K SARS-CoV-2 %K contact tracing app %K social identification %K technology acceptance %K pandemic %K outbreak %K health technology %D 2021 %7 24.11.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Official contact tracing apps have been implemented and recommended for use across nations to track and contain the spread of COVID-19. Such apps can be effective if people are willing to use them. Accordingly, many attempts are being made to motivate citizens to make use of the officially recommended apps. Objective: The aim of this research was to contribute to an understanding of the preconditions under which people are willing to use a COVID-19 contact tracing app (ie, their use intentions and use). To go beyond personal motives in favor of app use, it is important to take people’s social relationships into account, under the hypothesis that the more people identify with the beneficiaries of app use (ie, people living close by in their social environment) and with the source recommending the app (ie, members of the government), the more likely they will be to accept the officially recommended contact tracing app. Methods: Before, right after, and 5 months after the official contact tracing app was launched in Germany, a total of 1044 people participated in three separate surveys. Structural equation modeling was used to test the hypotheses, examining the same model in all studies at these critical points in time. Results: Across the three surveys, both identification with the beneficiaries (people living in their social environment) and with the source recommending the app (members of the government) predicted greater intention to use and use (installation) of the official contact tracing app. Trust in the source (members of the government) served as a mediator. Other types of identification (with people in Germany or people around the world) did not explain the observed results. The findings were highly consistent across the three surveys. Conclusions: Attempts to motivate people to use new health technology (or potentially new measures more generally) not only for their personal benefit but also for collective benefits should take the social context into account (ie, the social groups people belong to and identify with). The more important the beneficiaries and the sources of such measures are to people’s sense of the self, the more willing they will likely be to adhere to and support such measures. %M 34662289 %R 10.2196/28146 %U https://mhealth.jmir.org/2021/11/e28146 %U https://doi.org/10.2196/28146 %U http://www.ncbi.nlm.nih.gov/pubmed/34662289 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 9 %N 11 %P e30467 %T The Evolution of Rumors on a Closed Social Networking Platform During COVID-19: Algorithm Development and Content Study %A Wang,Andrea W %A Lan,Jo-Yu %A Wang,Ming-Hung %A Yu,Chihhao %+ Information Operations Research Group, 7F-13, No. 103, Sec. 1, Fuxing S. Rd., Da’an Dist., Taipei, 106, Taiwan, 886 933 263 989, chihhao@iorg.tw %K COVID-19 %K rumors %K rumor diffusion %K rumor propagation %K social listening %K infodemic %K social media %K closed platform %K natural language processing %K machine learning %K unsupervised learning %K computers and society %D 2021 %7 23.11.2021 %9 Original Paper %J JMIR Med Inform %G English %X Background: In 2020, the COVID-19 pandemic put the world in a crisis regarding both physical and psychological health. Simultaneously, a myriad of unverified information flowed on social media and online outlets. The situation was so severe that the World Health Organization identified it as an infodemic in February 2020. Objective: The aim of this study was to examine the propagation patterns and textual transformation of COVID-19–related rumors on a closed social media platform. Methods: We obtained a data set of suspicious text messages collected on Taiwan’s most popular instant messaging platform, LINE, between January and July 2020. We proposed a classification-based clustering algorithm that could efficiently cluster messages into groups, with each group representing a rumor. For ease of understanding, a group is referred to as a “rumor group.” Messages in a rumor group could be identical or could have limited textual differences between them. Therefore, each message in a rumor group is a form of the rumor. Results: A total of 936 rumor groups with at least 10 messages each were discovered among 114,124 text messages collected from LINE. Among 936 rumors, 396 (42.3%) were related to COVID-19. Of the 396 COVID-19–related rumors, 134 (33.8%) had been fact-checked by the International Fact-Checking Network–certified agencies in Taiwan and determined to be false or misleading. By studying the prevalence of simplified Chinese characters or phrases in the messages that originated in China, we found that COVID-19–related messages, compared to non–COVID-19–related messages, were more likely to have been written by non-Taiwanese users. The association was statistically significant, with P<.001, as determined by the chi-square independence test. The qualitative investigations of the three most popular COVID-19 rumors revealed that key authoritative figures, mostly medical personnel, were often misquoted in the messages. In addition, these rumors resurfaced multiple times after being fact-checked, usually preceded by major societal events or textual transformations. Conclusions: To fight the infodemic, it is crucial that we first understand why and how a rumor becomes popular. While social media has given rise to an unprecedented number of unverified rumors, it also provides a unique opportunity for us to study the propagation of rumors and their interactions with society. Therefore, we must put more effort into these areas. %M 34623954 %R 10.2196/30467 %U https://medinform.jmir.org/2021/11/e30467 %U https://doi.org/10.2196/30467 %U http://www.ncbi.nlm.nih.gov/pubmed/34623954 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 11 %P e29970 %T Demographics Associated With Stress, Severe Mental Distress, and Anxiety Symptoms During the COVID-19 Pandemic in Japan: Nationwide Cross-sectional Web-Based Survey %A Midorikawa,Haruhiko %A Tachikawa,Hirokazu %A Taguchi,Takaya %A Shiratori,Yuki %A Takahashi,Asumi %A Takahashi,Sho %A Nemoto,Kiyotaka %A Arai,Tetsuaki %+ Department of Disaster and Community Psychiatry, University of Tsukuba, Igakukei Gakukeitou 873, 1-1-1 Tennoudai, Tsukuba, 305-8577, Japan, 81 29 853 3057, tachikawa@md.tsukuba.ac.jp %K COVID-19 %K mental health %K stress %K depression %K anxiety %K occupation %K public health %K demographic factors %K epidemiology %K occupational health %D 2021 %7 22.11.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: With the spread of COVID-19, the deterioration of public mental health has become a major global and social problem. Objective: The purpose of this study was to elucidate the relationship between the 3 mental health problems associated with COVID-19, that is, perceived stress, severe mental distress, and anxiety symptoms, and the various demographic factors, including occupation. Methods: A nationwide web-based questionnaire survey was conducted in Japan from August 4 to 31, 2020. In addition to sociodemographic data, the degrees of perceived stress, severe mental distress, and anxiety symptoms associated with COVID-19 were measured. After performing a descriptive statistical analysis, factors related to stress, severe mental distress, and anxiety symptoms were analyzed using logistic regression analysis. Results: A total of 8203 respondents submitted survey responses, among whom 34.9% (2861/8203) felt intense stress associated with COVID-19, 17.1% (1403/8203) were depressed, and 13.5% (1110/8203) had severe anxiety symptoms. The logistic regression analysis showed that each of the 3 mental health problems were prevalent in females, nonbinary gender, people in their 50s, 60s and older, respondents who visited psychiatrists, and those currently in psychiatric care. Severe mental distress and anxiety symptoms were associated with the number of effective lifestyle coping strategies during the lockdown period. Severe mental distress was only prevalent in teenagers and respondents in their 20s, as students tended to develop stress and severe mental distress. With regard to occupation, working in nursing care and welfare, education and research, and medical and health sectors was associated with stress; however, working in these occupations was not associated with severe mental distress and anxiety symptoms. Unemployment was associated with severe mental distress and anxiety symptoms. All 3 mental health problems were prevalent in part-time workers and those working in entertainment and arts sectors. Conclusions: Gender, age, occupation, history of psychiatric visits, and stress coping mechanisms were associated with mental health during the COVID-19 pandemic, but their associations with stress, severe mental distress, and anxiety symptoms differed. In addition, the actual state of mental health varied according to the respondents’ occupation. It is necessary to consider the impact of the COVID-19 pandemic on mental health not only at the individual level but also at the occupational level. %M 34653018 %R 10.2196/29970 %U https://publichealth.jmir.org/2021/11/e29970 %U https://doi.org/10.2196/29970 %U http://www.ncbi.nlm.nih.gov/pubmed/34653018 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 11 %P e29181 %T To Use or Not to Use a COVID-19 Contact Tracing App: Mixed Methods Survey in Wales %A Jones,Kerina %A Thompson,Rachel %+ Swansea University, Population Data Science, Swansea University Medical School, Singleton Park, Swansea, SA28PP, United Kingdom, 44 01792602764, k.h.jones@swansea.ac.uk %K COVID-19 %K survey %K Wales %K contact tracing %K app %K mHealth %K mobile apps %K digital health %K public health %D 2021 %7 22.11.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Many countries remain in the grip of the COVID-19 global pandemic, with a considerable journey still ahead toward normalcy and free mobility. Contact tracing smartphone apps are among a raft of measures introduced to reduce spread of the virus, but their uptake depends on public choice. Objective: The objective of this study was to ascertain the views of citizens in Wales on their intended use of a COVID-19 contact tracing smartphone app, including self-proposed reasons for or against use and what could lead to a change of decision. Methods: We distributed an anonymous survey among 4000 HealthWise Wales participants in May 2020. We adopted a mixed methods approach: responses to closed questions were analyzed using descriptive and inferential statistics; open question responses were analyzed and grouped into categories. Results: A total of 976 (24.4%) people completed the survey. Smartphone usage was 91.5% overall, but this varied among age groups. In total, 97.1% were aware of contact tracing apps, but only 67.2% felt sufficiently informed. Furthermore, 55.7% intended to use an app, 23.3% refused, and 21.0% were unsure. The top reasons for app use were as follows: controlling the spread of the virus, mitigating risks for others and for oneself, and increasing freedoms. The top reasons against app use were as follows: mistrusting the government, concerns about data security and privacy, and doubts about efficacy. The top response for changing one’s mind about app use from being willing to being unwilling was that nothing would; that is, they felt that nothing would cause them to become unwilling to use a contact tracing app. This was also the top response for changing one’s mind from being unwilling to being willing to use contact tracing apps. Among those who were unsure of using contact tracing apps, the top response was the need for more information. Conclusions: Respondents demonstrated a keenness to help themselves, others, society, and the government to avoid contracting the virus and to control its spread. However, digital inclusion varied among age groups, precluding participation for some people. Nonetheless, unwillingness was significant, and considering the nature of the concerns raised and the perceived lack of information, policy and decision-makers need to do more to act openly, increase communication, and demonstrate trustworthiness if members of the public are to be confident in using an app. %M 34698645 %R 10.2196/29181 %U https://mhealth.jmir.org/2021/11/e29181 %U https://doi.org/10.2196/29181 %U http://www.ncbi.nlm.nih.gov/pubmed/34698645 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 11 %P e32951 %T Digitization and Health in Germany: Cross-sectional Nationwide Survey %A De Santis,Karina Karolina %A Jahnel,Tina %A Sina,Elida %A Wienert,Julian %A Zeeb,Hajo %+ Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology-BIPS, Achterstrasse 30, Bremen, 28359, Germany, 49 42121856 ext 908, desantis@leibniz-bips.de %K digital health %K literacy %K survey %K attitude %K usage %K eHEALS %K COVID-19 %K physical activity %K general population %K misinformation %D 2021 %7 22.11.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Digital technologies are shaping medicine and public health. Objective: The aim of this study was to investigate the attitudes toward and the use of digital technologies for health-related purposes using a nationwide survey. Methods: We performed a cross-sectional study using a panel sample of internet users selected from the general population living in Germany. Responses to a survey with 28 items were collected using computer-assisted telephone interviews conducted in October 2020. The items were divided into four topics: (1) general attitudes toward digitization, (2) COVID-19 pandemic, (3) physical activity, and (4) perceived digital health (eHealth) literacy measured with the eHealth Literacy Scale (eHEALS; sum score of 8=lowest to 40=highest perceived eHealth literacy). The data were analyzed in IBM-SPSS24 using relative frequencies. Three univariate multiple regression analyses (linear or binary logistic) were performed to investigate the associations among the sociodemographic factors (age, gender, education, and household income) and digital technology use. Results: The participants included 1014 internet users (n=528, 52.07% women) aged 14 to 93 years (mean 54, SD 17). Among all participants, 66.47% (674/1014) completed up to tertiary (primary and secondary) education and 45.07% (457/1017) reported a household income of up to 3500 Euro/month (1 Euro=US $1.18). Over half (579/1014, 57.10%) reported having used digital technologies for health-related purposes. The majority (898/1014, 88.56%) noted that digitization will be important for therapy and health care, in the future. Only 25.64% (260/1014) reported interest in smartphone apps for health promotion/prevention and 42.70% (433/1014) downloaded the COVID-19 contact-tracing app. Although 52.47% (532/1014) reported that they come across inaccurate digital information on the COVID-19 pandemic, 78.01% (791/1014) were confident in their ability to recognize such inaccurate information. Among those who use digital technologies for moderate physical activity (n=220), 187 (85.0%) found such technologies easy to use and 140 (63.6%) reported using them regularly (at least once a week). Although the perceived eHealth literacy was high (eHEALS mean score 31 points, SD 6), less than half (43.10%, 400/928) were confident in using digital information for health decisions. The use of digital technologies for health was associated with higher household income (odds ratio [OR] 1.28, 95% CI 1.11-1.47). The use of digital technologies for physical activity was associated with younger age (OR 0.95, 95% CI 0.94-0.96) and more education (OR 1.22, 95% CI 1.01-1.46). A higher perceived eHealth literacy score was associated with younger age (β=–.22, P<.001), higher household income (β=.21, P<.001), and more education (β=.14, P<.001). Conclusions: Internet users in Germany expect that digitization will affect preventive and therapeutic health care in the future. The facilitators and barriers associated with the use of digital technologies for health warrant further research. A gap exists between high confidence in the perceived ability to evaluate digital information and low trust in internet-based information on the COVID-19 pandemic and health decisions. %M 34813493 %R 10.2196/32951 %U https://publichealth.jmir.org/2021/11/e32951 %U https://doi.org/10.2196/32951 %U http://www.ncbi.nlm.nih.gov/pubmed/34813493 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 11 %P e33576 %T Digital SARS-CoV-2 Detection Among Hospital Employees: Participatory Surveillance Study %A Leal-Neto,Onicio %A Egger,Thomas %A Schlegel,Matthias %A Flury,Domenica %A Sumer,Johannes %A Albrich,Werner %A Babouee Flury,Baharak %A Kuster,Stefan %A Vernazza,Pietro %A Kahlert,Christian %A Kohler,Philipp %+ Department of Economics, University of Zurich, Schönberggasse 1, Zurich, 8001, Switzerland, 41 783242116, onicio@gmail.com %K digital epidemiology %K SARS-CoV-2 %K COVID-19 %K health care workers %D 2021 %7 22.11.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The implementation of novel techniques as a complement to traditional disease surveillance systems represents an additional opportunity for rapid analysis. Objective: The objective of this work is to describe a web-based participatory surveillance strategy among health care workers (HCWs) in two Swiss hospitals during the first wave of COVID-19. Methods: A prospective cohort of HCWs was recruited in March 2020 at the Cantonal Hospital of St. Gallen and the Eastern Switzerland Children’s Hospital. For data analysis, we used a combination of the following techniques: locally estimated scatterplot smoothing (LOESS) regression, Spearman correlation, anomaly detection, and random forest. Results: From March 23 to August 23, 2020, a total of 127,684 SMS text messages were sent, generating 90,414 valid reports among 1004 participants, achieving a weekly average of 4.5 (SD 1.9) reports per user. The symptom showing the strongest correlation with a positive polymerase chain reaction test result was loss of taste. Symptoms like red eyes or a runny nose were negatively associated with a positive test. The area under the receiver operating characteristic curve showed favorable performance of the classification tree, with an accuracy of 88% for the training data and 89% for the test data. Nevertheless, while the prediction matrix showed good specificity (80.0%), sensitivity was low (10.6%). Conclusions: Loss of taste was the symptom that was most aligned with COVID-19 activity at the population level. At the individual level—using machine learning–based random forest classification—reporting loss of taste and limb/muscle pain as well as the absence of runny nose and red eyes were the best predictors of COVID-19. %M 34727046 %R 10.2196/33576 %U https://publichealth.jmir.org/2021/11/e33576 %U https://doi.org/10.2196/33576 %U http://www.ncbi.nlm.nih.gov/pubmed/34727046 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 4 %N 4 %P e31908 %T Promoting Safe Sleep, Tobacco Cessation, and Breastfeeding to Rural Women During the COVID-19 Pandemic: Quasi-Experimental Study %A Ahlers-Schmidt,Carolyn R %A Schunn,Christy %A Hervey,Ashley M %A Torres,Maria %A Nelson,Jill Elizabeth V %+ Center for Research for Infant Birth and Survival, University of Kansas School of Medicine-Wichita, 3242 E. Murdock St., Suite 602, Wichita, KS, United States, 1 3169627923, cschmidt3@kumc.edu %K COVID-19 %K SIDS %K sudden infant death syndrome %K safe sleep %K tobacco cessation %K breastfeeding %K virtual education %D 2021 %7 22.11.2021 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Safe Sleep Community Baby Showers address strategies to prevent sleep-related infant deaths. Due to the COVID-19 pandemic, these events transitioned from in-person to virtual. Objective: This study describes outcomes of transitioning Safe Sleep Community Baby Showers to a virtual format and compares outcomes to previous in-person events. Methods: Participants from four rural Kansas counties were emailed the presurvey, provided educational materials (videos, livestream, or digital documents), and completed a postsurvey. Those who completed both surveys received a portable crib and wearable blanket. Within-group comparisons were assessed between pre- and postsurveys; between-group comparisons (virtual vs in-person) were assessed by postsurveys. Results: Based on data from 145 in-person and 74 virtual participants, virtual participants were more likely to be married (P<.001) and have private insurance (P<.001), and were less likely to report tobacco use (P<.001). Both event formats significantly increased knowledge and intentions regarding safe sleep and avoidance of secondhand smoke (all P≤.001). Breastfeeding intentions did not change. Differences were observed between in-person and virtual meetings regarding confidence in the ability to avoid secondhand smoke (in-person: 121/144, 84% vs virtual: 53/74, 72%; P=.03), intention to breastfeed ≥6 months (in-person: 79/128, 62% vs virtual: 52/66, 79%; P=.008), and confidence in the ability to breastfeed ≥6 months (in-person: 58/123, 47% vs virtual: 44/69, 64%; P=.02). Conclusions: Although both event formats demonstrated increased knowledge/intentions to follow safe sleep recommendations, virtual events may further marginalize groups who are at high risk for poor birth outcomes. Strategies to increase technology access, recruit priority populations, and ensure disparities are not exacerbated will be critical for the implementation of future virtual events. %M 34550075 %R 10.2196/31908 %U https://pediatrics.jmir.org/2021/4/e31908 %U https://doi.org/10.2196/31908 %U http://www.ncbi.nlm.nih.gov/pubmed/34550075 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 11 %P e32285 %T Seroepidemiological Survey on the Impact of Smoking on SARS-CoV-2 Infection and COVID-19 Outcomes: Protocol for the Troina Study %A Polosa,Riccardo %A Tomaselli,Venera %A Ferrara,Pietro %A Romeo,Alba Corina %A Rust,Sonja %A Saitta,Daniela %A Caraci,Filippo %A Romano,Corrado %A Thangaraju,Murugesan %A Zuccarello,Pietro %A Rose,Jed %A Cantone,Giulio Giacomo %A Ferrante,Margherita %A Belsey,Jonathan %A Cibella,Fabio %A Interlandi,Elisa %A Ferri,Raffaele %+ Institute of Internal Medicine, Azienda Ospedaliera Universitaria “Policlinico - V. Emanuele”, Via S Sofia, 78, Catania, 95123, Italy, 39 0953781566, polosa@unict.it %K antibody persistence %K cotinine %K COVID-19 %K SARS-CoV-2 %K seroprevalence %K smoking impact %K smoking status %D 2021 %7 22.11.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: After the global spread of SARS-CoV-2, research has highlighted several aspects of the pandemic, focusing on clinical features and risk factors associated with infection and disease severity. However, emerging results on the role of smoking in SARS-CoV-2 infection susceptibility or COVID-19 outcomes are conflicting, and their robustness remains uncertain. Objective: In this context, this study aims at quantifying the proportion of SARS-CoV-2 antibody seroprevalence, studying the changes in antibody levels over time, and analyzing the association between the biochemically verified smoking status and SARS-CoV-2 infection. Methods: The research design involves a 6-month prospective cohort study with a serial sampling of the same individuals. Each participant will be surveyed about their demographics and COVID-19–related information, and blood sampling will be collected upon recruitment and at specified follow-up time points (ie, after 8 and 24 weeks). Blood samples will be screened for the presence of SARS-CoV-2–specific antibodies and serum cotinine, being the latter of the principal metabolite of nicotine, which will be used to assess participants’ smoking status. Results: The study is ongoing. It aims to find a higher antibody prevalence in individuals at high risk for viral exposure (ie, health care personnel) and to refine current estimates on the association between smoking status and SARS-CoV-2/COVID-19. Conclusions: The added value of this research is that the current smoking status of the population to be studied will be biochemically verified to avoid the bias associated with self-reported smoking status. As such, the results from this survey may provide an actionable metric to study the role of smoking in SARS-CoV-2 infection and COVID-19 outcomes, and therefore to implement the most appropriate public health measures to control the pandemic. Results may also serve as a reference for future clinical research, and the methodology could be exploited in public health sectors and policies. International Registered Report Identifier (IRRID): DERR1-10.2196/32285 %M 34678752 %R 10.2196/32285 %U https://www.researchprotocols.org/2021/11/e32285 %U https://doi.org/10.2196/32285 %U http://www.ncbi.nlm.nih.gov/pubmed/34678752 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 11 %P e33509 %T Central COVID-19 Coordination Centers in Germany: Description, Economic Evaluation, and Systematic Review %A Schopow,Nikolas %A Osterhoff,Georg %A von Dercks,Nikolaus %A Girrbach,Felix %A Josten,Christoph %A Stehr,Sebastian %A Hepp,Pierre %+ Department for Orthopedics, Trauma Surgery and Plastic Surgery, University Hospital Leipzig, Liebigstr. 20, Leipzig, 04103, Germany, 49 341 9717849, schopow@medizin.uni-leipzig.de %K telemedical consultation %K patient allocation %K algorithm-based treatment %K telemedicine %K telehealth %K consultation %K allocation %K algorithm %K treatment %K COVID-19 %K coordination %K Germany %K economic %K review %K establishment %K management %D 2021 %7 18.11.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: During the COVID-19 pandemic, Central COVID-19 Coordination Centers (CCCCs) have been established at several hospitals across Germany with the intention to assist local health care professionals in efficiently referring patients with suspected or confirmed SARS-CoV-2 infection to regional hospitals and therefore to prevent the collapse of local health system structures. In addition, these centers coordinate interhospital transfers of patients with COVID-19 and provide or arrange specialized telemedical consultations. Objective: This study describes the establishment and management of a CCCC at a German university hospital. Methods: We performed economic analyses (cost, cost-effectiveness, use, and utility) according to the CHEERS (Consolidated Health Economic Evaluation Reporting Standards) criteria. Additionally, we conducted a systematic review to identify publications on similar institutions worldwide. The 2 months with the highest local incidence of COVID-19 cases (December 2020 and January 2021) were considered. Results: During this time, 17.3 requests per day were made to the CCCC regarding admission or transfer of patients with COVID-19. The majority of requests were made by emergency medical services (601/1068, 56.3%), patients with an average age of 71.8 (SD 17.2) years were involved, and for 737 of 1068 cases (69%), SARS-CoV-2 had already been detected by a positive polymerase chain reaction test. In 59.8% (639/1068) of the concerned patients, further treatment by a general practitioner or outpatient presentation in a hospital could be initiated after appropriate advice, 27.2% (291/1068) of patients were admitted to normal wards, and 12.9% (138/1068) were directly transmitted to an intensive care unit. The operating costs of the CCCC amounted to more than €52,000 (US $60,031) per month. Of the 334 patients with detected SARS-CoV-2 who were referred via EMS or outpatient physicians, 302 (90.4%) were triaged and announced in advance by the CCCC. No other published economic analysis of COVID-19 coordination or management institutions at hospitals could be found. Conclusions: Despite the high cost of the CCCC, we were able to show that it is a beneficial concept to both the providing hospital and the public health system. However, the most important benefits of the CCCC are that it prevents hospitals from being overrun by patients and that it avoids situations in which physicians must weigh one patient’s life against another’s. %M 34623955 %R 10.2196/33509 %U https://publichealth.jmir.org/2021/11/e33509 %U https://doi.org/10.2196/33509 %U http://www.ncbi.nlm.nih.gov/pubmed/34623955 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 9 %N 11 %P e30743 %T Implementation of an Anticoagulation Practice Guideline for COVID-19 via a Clinical Decision Support System in a Large Academic Health System and Its Evaluation: Observational Study %A Shah,Surbhi %A Switzer,Sean %A Shippee,Nathan D %A Wogensen,Pamela %A Kosednar,Kathryn %A Jones,Emma %A Pestka,Deborah L %A Badlani,Sameer %A Butler,Mary %A Wagner,Brittin %A White,Katie %A Rhein,Joshua %A Benson,Bradley %A Reding,Mark %A Usher,Michael %A Melton,Genevieve B %A Tignanelli,Christopher James %+ Department of Surgery, University of Minnesota, 420 Delaware St SE, MMC 195, Minneapolis, MN, 55455, United States, 1 6126261968, ctignane@umn.edu %K COVID-19 %K anticoagulation %K clinical practice guideline %K evidence-based practice %K clinical decision support %K implementation science %K RE-AIM %D 2021 %7 18.11.2021 %9 Original Paper %J JMIR Med Inform %G English %X Background: Studies evaluating strategies for the rapid development, implementation, and evaluation of clinical decision support (CDS) systems supporting guidelines for diseases with a poor knowledge base, such as COVID-19, are limited. Objective: We developed an anticoagulation clinical practice guideline (CPG) for COVID-19, which was delivered and scaled via CDS across a 12-hospital Midwest health care system. This study represents a preplanned 6-month postimplementation evaluation guided by the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework. Methods: The implementation outcomes evaluated were reach, adoption, implementation, and maintenance. To evaluate effectiveness, the association of CPG adherence on hospital admission with clinical outcomes was assessed via multivariable logistic regression and nearest neighbor propensity score matching. A time-to-event analysis was conducted. Sensitivity analyses were also conducted to evaluate the competing risk of death prior to intensive care unit (ICU) admission. The models were risk adjusted to account for age, gender, race/ethnicity, non-English speaking status, area deprivation index, month of admission, remdesivir treatment, tocilizumab treatment, steroid treatment, BMI, Elixhauser comorbidity index, oxygen saturation/fraction of inspired oxygen ratio, systolic blood pressure, respiratory rate, treating hospital, and source of admission. A preplanned subgroup analysis was also conducted in patients who had laboratory values (D-dimer, C-reactive protein, creatinine, and absolute neutrophil to absolute lymphocyte ratio) present. The primary effectiveness endpoint was the need for ICU admission within 48 hours of hospital admission. Results: A total of 2503 patients were included in this study. CDS reach approached 95% during implementation. Adherence achieved a peak of 72% during implementation. Variation was noted in adoption across sites and nursing units. Adoption was the highest at hospitals that were specifically transformed to only provide care to patients with COVID-19 (COVID-19 cohorted hospitals; 74%-82%) and the lowest in academic settings (47%-55%). CPG delivery via the CDS system was associated with improved adherence (odds ratio [OR] 1.43, 95% CI 1.2-1.7; P<.001). Adherence with the anticoagulation CPG was associated with a significant reduction in the need for ICU admission within 48 hours (OR 0.39, 95% CI 0.30-0.51; P<.001) on multivariable logistic regression analysis. Similar findings were noted following 1:1 propensity score matching for patients who received adherent versus nonadherent care (21.5% vs 34.3% incidence of ICU admission within 48 hours; log-rank test P<.001). Conclusions: Our institutional experience demonstrated that adherence with the institutional CPG delivered via the CDS system resulted in improved clinical outcomes for patients with COVID-19. CDS systems are an effective means to rapidly scale a CPG across a heterogeneous health care system. Further research is needed to investigate factors associated with adherence at low and high adopting sites and nursing units. %M 34550900 %R 10.2196/30743 %U https://medinform.jmir.org/2021/11/e30743 %U https://doi.org/10.2196/30743 %U http://www.ncbi.nlm.nih.gov/pubmed/34550900 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 11 %P e32876 %T Machine Learning–Based Predictive Modeling of Anxiety and Depressive Symptoms During 8 Months of the COVID-19 Global Pandemic: Repeated Cross-sectional Survey Study %A Hueniken,Katrina %A Somé,Nibene Habib %A Abdelhack,Mohamed %A Taylor,Graham %A Elton Marshall,Tara %A Wickens,Christine M %A Hamilton,Hayley A %A Wells,Samantha %A Felsky,Daniel %+ Krembil Centre for Neuroinformatics, Centre for Addiction and Mental Health, 250 College St, 12th Floor, Toronto, ON, M5T 1R8, Canada, 1 (416) 535 8501 ext 33587, Daniel.Felsky@camh.ca %K mental health %K machine learning %K COVID-19 %K emotional distress %K emotion %K distress %K prediction %K model %K anxiety %K depression %K symptom %K cross-sectional %K survey %D 2021 %7 17.11.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: The COVID-19 global pandemic has increased the burden of mental illness on Canadian adults. However, the complex combination of demographic, economic, and lifestyle factors and perceived health risks contributing to patterns of anxiety and depression has not been explored. Objective: The aim of this study is to harness flexible machine learning methods to identify constellations of factors related to symptoms of mental illness and to understand their changes over time during the COVID-19 pandemic. Methods: Cross-sectional samples of Canadian adults (aged ≥18 years) completed web-based surveys in 6 waves from May to December 2020 (N=6021), and quota sampling strategies were used to match the English-speaking Canadian population in age, gender, and region. The surveys measured anxiety and depression symptoms, sociodemographic characteristics, substance use, and perceived COVID-19 risks and worries. First, principal component analysis was used to condense highly comorbid anxiety and depression symptoms into a single data-driven measure of emotional distress. Second, eXtreme Gradient Boosting (XGBoost), a machine learning algorithm that can model nonlinear and interactive relationships, was used to regress this measure on all included explanatory variables. Variable importance and effects across time were explored using SHapley Additive exPlanations (SHAP). Results: Principal component analysis of responses to 9 anxiety and depression questions on an ordinal scale revealed a primary latent factor, termed “emotional distress,” that explained 76% of the variation in all 9 measures. Our XGBoost model explained a substantial proportion of variance in emotional distress (r2=0.39). The 3 most important items predicting elevated emotional distress were increased worries about finances (SHAP=0.17), worries about getting COVID-19 (SHAP=0.17), and younger age (SHAP=0.13). Hopefulness was associated with emotional distress and moderated the impacts of several other factors. Predicted emotional distress exhibited a nonlinear pattern over time, with the highest predicted symptoms in May and November and the lowest in June. Conclusions: Our results highlight factors that may exacerbate emotional distress during the current pandemic and possible future pandemics, including a role of hopefulness in moderating distressing effects of other factors. The pandemic disproportionately affected emotional distress among younger adults and those economically impacted. %M 34705663 %R 10.2196/32876 %U https://mental.jmir.org/2021/11/e32876 %U https://doi.org/10.2196/32876 %U http://www.ncbi.nlm.nih.gov/pubmed/34705663 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 11 %P e30642 %T COVID-19 Vaccine Hesitancy on Social Media: Building a Public Twitter Data Set of Antivaccine Content, Vaccine Misinformation, and Conspiracies %A Muric,Goran %A Wu,Yusong %A Ferrara,Emilio %+ Information Sciences Institute, University of Southern California, 4676 Admiralty Way, Suite 1001, Marina del Rey, CA, 90292, United States, 1 213 740 2467, gmuric@isi.edu %K vaccine hesitancy %K COVID-19 vaccines %K dataset %K COVID-19 %K SARS-CoV-2 %K social media %K network analysis %K hesitancy %K vaccine %K Twitter %K misinformation %K conspiracy %K trust %K public health %K utilization %D 2021 %7 17.11.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: False claims about COVID-19 vaccines can undermine public trust in ongoing vaccination campaigns, posing a threat to global public health. Misinformation originating from various sources has been spreading on the web since the beginning of the COVID-19 pandemic. Antivaccine activists have also begun to use platforms such as Twitter to promote their views. To properly understand the phenomenon of vaccine hesitancy through the lens of social media, it is of great importance to gather the relevant data. Objective: In this paper, we describe a data set of Twitter posts and Twitter accounts that publicly exhibit a strong antivaccine stance. The data set is made available to the research community via our AvaxTweets data set GitHub repository. We characterize the collected accounts in terms of prominent hashtags, shared news sources, and most likely political leaning. Methods: We started the ongoing data collection on October 18, 2020, leveraging the Twitter streaming application programming interface (API) to follow a set of specific antivaccine-related keywords. Then, we collected the historical tweets of the set of accounts that engaged in spreading antivaccination narratives between October 2020 and December 2020, leveraging the Academic Track Twitter API. The political leaning of the accounts was estimated by measuring the political bias of the media outlets they shared. Results: We gathered two curated Twitter data collections and made them publicly available: (1) a streaming keyword–centered data collection with more than 1.8 million tweets, and (2) a historical account–level data collection with more than 135 million tweets. The accounts engaged in the antivaccination narratives lean to the right (conservative) direction of the political spectrum. The vaccine hesitancy is fueled by misinformation originating from websites with already questionable credibility. Conclusions: The vaccine-related misinformation on social media may exacerbate the levels of vaccine hesitancy, hampering progress toward vaccine-induced herd immunity, and could potentially increase the number of infections related to new COVID-19 variants. For these reasons, understanding vaccine hesitancy through the lens of social media is of paramount importance. Because data access is the first obstacle to attain this goal, we published a data set that can be used in studying antivaccine misinformation on social media and enable a better understanding of vaccine hesitancy. %M 34653016 %R 10.2196/30642 %U https://publichealth.jmir.org/2021/11/e30642 %U https://doi.org/10.2196/30642 %U http://www.ncbi.nlm.nih.gov/pubmed/34653016 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 11 %P e28956 %T Designing Better Exposure Notification Apps: The Role of Persuasive Design %A Oyibo,Kiemute %A Morita,Plinio Pelegrini %+ School of Public Health Sciences, Faculty of Health, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada, 1 5198884567 ext 41372, plinio.morita@uwaterloo.ca %K contact tracing app %K exposure notification app %K COVID Alert %K COVID-19 %K persuasive technology %K behavior change %D 2021 %7 16.11.2021 %9 Viewpoint %J JMIR Public Health Surveill %G English %X Background: Digital contact tracing apps have been deployed worldwide to limit the spread of COVID-19 during this pandemic and to facilitate the lifting of public health restrictions. However, due to privacy-, trust-, and design-related issues, the apps are yet to be widely adopted. This calls for an intervention to enable a critical mass of users to adopt them. Objective: The aim of this paper is to provide guidelines to design contact tracing apps as persuasive technologies to make them more appealing and effective. Methods: We identified the limitations of the current contact tracing apps on the market using the Government of Canada’s official exposure notification app (COVID Alert) as a case study. Particularly, we identified three interfaces in the COVID Alert app where the design can be improved. The interfaces include the no exposure status interface, exposure interface, and diagnosis report interface. We propose persuasive technology design guidelines to make them more motivational and effective in eliciting the desired behavior change. Results: Apart from trust and privacy concerns, we identified the minimalist and nonmotivational design of exposure notification apps as the key design-related factors that contribute to the current low uptake. We proposed persuasive strategies such as self-monitoring of daily contacts and exposure time to make the no exposure and exposure interfaces visually appealing and motivational. Moreover, we proposed social learning, praise, and reward to increase the diagnosis report interface’s effectiveness. Conclusions: We demonstrated that exposure notification apps can be designed as persuasive technologies by incorporating key persuasive features, which have the potential to improve uptake, use, COVID-19 diagnosis reporting, and compliance with social distancing guidelines. %M 34783673 %R 10.2196/28956 %U https://publichealth.jmir.org/2021/11/e28956 %U https://doi.org/10.2196/28956 %U http://www.ncbi.nlm.nih.gov/pubmed/34783673 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 11 %P e30968 %T Characterization of Unlinked Cases of COVID-19 and Implications for Contact Tracing Measures: Retrospective Analysis of Surveillance Data %A Chong,Ka Chun %A Jia,Katherine %A Lee,Shui Shan %A Hung,Chi Tim %A Wong,Ngai Sze %A Lai,Francisco Tsz Tsun %A Chau,Nancy %A Yam,Carrie Ho Kwan %A Chow,Tsz Yu %A Wei,Yuchen %A Guo,Zihao %A Yeoh,Eng Kiong %+ Centre for Health Systems and Policy Research, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Central Avenue, Hong Kong, Hong Kong, 852 22528716, yeoh_ek@cuhk.edu.hk %K COVID-19 %K contact tracing %K unlinked %K superspreading %K dispersion %K surveillance %K monitoring %K digital health %K testing %K transmission %K epidemiology %K outbreak %K spread %D 2021 %7 16.11.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Contact tracing and intensive testing programs are essential for controlling the spread of COVID-19. However, conventional contact tracing is resource intensive and may not result in the tracing of all cases due to recall bias and cases not knowing the identity of some close contacts. Few studies have reported the epidemiological features of cases not identified by contact tracing (“unlinked cases”) or described their potential roles in seeding community outbreaks. Objective: For this study, we characterized the role of unlinked cases in the epidemic by comparing their epidemiological profile with the linked cases; we also estimated their transmission potential across different settings. Methods: We obtained rapid surveillance data from the government, which contained the line listing of COVID-19 confirmed cases during the first three waves in Hong Kong. We compared the demographics, history of chronic illnesses, epidemiological characteristics, clinical characteristics, and outcomes of linked and unlinked cases. Transmission potentials in different settings were assessed by fitting a negative binomial distribution to the observed offspring distribution. Results: Time interval from illness onset to hospital admission was longer among unlinked cases than linked cases (median 5.00 days versus 3.78 days; P<.001), with a higher proportion of cases whose condition was critical or serious (13.0% versus 8.2%; P<.001). The proportion of unlinked cases was associated with an increase in the weekly number of local cases (P=.049). Cluster transmissions from the unlinked cases were most frequently identified in household settings, followed by eateries and workplaces, with the estimated probability of cluster transmissions being around 0.4 for households and 0.1-0.3 for the latter two settings. Conclusions: The unlinked cases were positively associated with time to hospital admission, severity of infection, and epidemic size—implying a need to design and implement digital tracing methods to complement current conventional testing and tracing. To minimize the risk of cluster transmissions from unlinked cases, digital tracing approaches should be effectively applied in high-risk socioeconomic settings, and risk assessments should be conducted to review and adjust the policies. %M 34591778 %R 10.2196/30968 %U https://publichealth.jmir.org/2021/11/e30968 %U https://doi.org/10.2196/30968 %U http://www.ncbi.nlm.nih.gov/pubmed/34591778 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 11 %P e31337 %T Predicting COVID-19–Related Health Care Resource Utilization Across a Statewide Patient Population: Model Development Study %A Kasturi,Suranga N %A Park,Jeremy %A Wild,David %A Khan,Babar %A Haggstrom,David A %A Grannis,Shaun %+ Regenstrief Institute, 1101 W 10th St, Indianapolis, IN, 46202, United States, 1 (317) 274 9000, snkasthu@iu.edu %K COVID-19 %K machine learning %K population health %K health care utilization %K health disparities %K health information %K epidemiology %K public health %K digital health %K health data %K pandemic %K decision models %K health informatics %K healthcare resources %D 2021 %7 15.11.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic has highlighted the inability of health systems to leverage existing system infrastructure in order to rapidly develop and apply broad analytical tools that could inform state- and national-level policymaking, as well as patient care delivery in hospital settings. The COVID-19 pandemic has also led to highlighted systemic disparities in health outcomes and access to care based on race or ethnicity, gender, income-level, and urban-rural divide. Although the United States seems to be recovering from the COVID-19 pandemic owing to widespread vaccination efforts and increased public awareness, there is an urgent need to address the aforementioned challenges. Objective: This study aims to inform the feasibility of leveraging broad, statewide datasets for population health–driven decision-making by developing robust analytical models that predict COVID-19–related health care resource utilization across patients served by Indiana’s statewide Health Information Exchange. Methods: We leveraged comprehensive datasets obtained from the Indiana Network for Patient Care to train decision forest-based models that can predict patient-level need of health care resource utilization. To assess these models for potential biases, we tested model performance against subpopulations stratified by age, race or ethnicity, gender, and residence (urban vs rural). Results: For model development, we identified a cohort of 96,026 patients from across 957 zip codes in Indiana, United States. We trained the decision models that predicted health care resource utilization by using approximately 100 of the most impactful features from a total of 1172 features created. Each model and stratified subpopulation under test reported precision scores >70%, accuracy and area under the receiver operating curve scores >80%, and sensitivity scores approximately >90%. We noted statistically significant variations in model performance across stratified subpopulations identified by age, race or ethnicity, gender, and residence (urban vs rural). Conclusions: This study presents the possibility of developing decision models capable of predicting patient-level health care resource utilization across a broad, statewide region with considerable predictive performance. However, our models present statistically significant variations in performance across stratified subpopulations of interest. Further efforts are necessary to identify root causes of these biases and to rectify them. %M 34581671 %R 10.2196/31337 %U https://www.jmir.org/2021/11/e31337 %U https://doi.org/10.2196/31337 %U http://www.ncbi.nlm.nih.gov/pubmed/34581671 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 7 %N 4 %P e27073 %T Suggested Modifications to the Management of Patients With Breast Cancer During the COVID-19 Pandemic: Web-Based Survey Study %A Elsamany,Shereef %A Elbaiomy,Mohamed %A Zeeneldin,Ahmed %A Tashkandi,Emad %A Hassanin,Fayza %A Abdelhafeez,Nafisa %A O Al-Shamsi,Humaid %A Bukhari,Nedal %A Elemam,Omima %+ Oncology Center, King Abdullah Medical City, Muzdalifah Rd, Al Mashair, Makkah, 24246, Saudi Arabia, 966 558357452, elemam.o@kamc.med.sa %K breast cancer %K COVID-19 %K pandemic %K web-based survey %K treatment modification %K oncology %K treatment %K modification %K risk %K infection %D 2021 %7 15.11.2021 %9 Original Paper %J JMIR Cancer %G English %X Background: Management of patients with cancer in the current era of the COVID-19 pandemic poses a significant challenge to health care systems. Breast cancer is the most common cancer internationally. Breast cancer is a disease that involves surgery, chemotherapy, hormonal therapy, targeted therapy, radiotherapy, and, more recently, immunotherapy in its management plan. The immune system requires months to recover from these medications, and this condition is even worse in patients with metastatic breast cancer who need ongoing treatment with these drugs. Some of these drugs, such as inhibitors of cyclin-dependent kinases 4 and 6, can cause rare but life-threating lung inflammation. Patients with breast cancer who have metastatic disease to the lungs can experience deterioration of disease symptoms with COVID-19 infection. Oncologists treating patients with breast cancer are facing a difficult situation regarding treatment choice. The impact that COVID-19 has had on breast cancer care is unknown, including how to provide the best care possible without compromising patient and community safety. Objective: The aim of this study was to explore the views of oncologists regarding the management of patients with breast cancer during the COVID-19 pandemic. Methods: A web-based SurveyMonkey questionnaire was submitted to licensed oncologists involved in breast cancer management in Saudi Arabia, Egypt, and United Arab Emirates. The survey focused on characteristics of the participants, infection risk among patients with cancer, and possible treatment modifications related to different types of breast cancer. Results: The survey was completed by 82 participants. For early hormone receptor (HR)–positive, human epidermal growth factor receptor 2 (HER2)–negative breast cancer, 61 of the 82 participants (74%) supported using neoadjuvant hormonal therapy in selected patients, and 58% (48/82) preferred giving 6 over 8 cycles of adjuvant chemotherapy when indicated. Only 43% (35/82) preferred inhibitors of cyclin-dependent kinases 4 and 6 with hormonal therapy as the first-line treatment in all patients with metastatic HR-positive disease. A total of 55 of the 82 participants (67%) supported using adjuvant trastuzumab for 6 instead of 12 months in selected patients with HER2-positive breast cancer. For metastatic HER2-positive, HR-positive breast cancer, 80% of participants (66/82) supported the use of hormonal therapy with dual anti-HER2 blockade in selected patients. The preferred choice of first-line treatment in metastatic triple negative patients with BRCA mutation and programmed cell death 1 ligand 1 (PD-L1) <1% was poly(adenosine diphosphate–ribose) polymerase inhibitor according to 41% (34/82) of the participants, and atezolizumab with nab-paclitaxel was preferred for PD-L1 >1% according to 71% (58/82) of the participants. Conclusions: Several modifications in breast cancer management were supported by the survey participants. These modifications need to be discussed on a local basis, taking into account the local infrastructure and available resources. %M 34726611 %R 10.2196/27073 %U https://cancer.jmir.org/2021/4/e27073 %U https://doi.org/10.2196/27073 %U http://www.ncbi.nlm.nih.gov/pubmed/34726611 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 4 %N 4 %P e32708 %T Acceptability, Feasibility, and Quality of Telehealth for Adolescent Health Care Delivery During the COVID-19 Pandemic: Cross-sectional Study of Patient and Family Experiences %A Wood,Sarah M %A Pickel,Julia %A Phillips,Alexis W %A Baber,Kari %A Chuo,John %A Maleki,Pegah %A Faust,Haley L %A Petsis,Danielle %A Apple,Danielle E %A Dowshen,Nadia %A Schwartz,Lisa A %+ Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, 3401 Civic Center Blvd., Philadelphia, PA, 19104, United States, 1 215 590 1000, woodsa@chop.edu %K telehealth %K telemedicine %K adolescent %K COVID-19 %K acceptability %K feasibility %K young adult %K teenager %K cross-sectional %K patient experience %K experience %K efficiency %K equity %K survey %D 2021 %7 15.11.2021 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Data regarding the acceptability, feasibility, and quality of telehealth among adolescents and young adults (AYA) and their parents and caregivers (caregivers) are lacking. Objective: The aim of this study was to assess the noninferiority of telehealth versus in-person visits by comparing acceptability with respect to efficiency, effectiveness, equity, patient-centeredness, and confidentiality. Methods: Cross-sectional web-based surveys were sent to caregivers and AYA following video visits within an Adolescent Medicine subspecialty clinic in May-July 2020. Proportions of AYA and caregivers who rated telehealth as noninferior were compared using chi-squared tests. Feasibility was assessed via items measuring technical difficulties. Deductive thematic analysis using the Institute of Medicine dimensions of health care quality was used to code open-ended question responses. Results: Survey response rates were 20.5% (55/268) for AYA and 21.8% (123/563) for caregivers. The majority of the respondents were White cisgender females. Most AYA and caregivers rated telehealth as noninferior to in-person visits with respect to confidentiality, communication, medication management, and mental health care. A higher proportion of AYA compared to caregivers found telehealth inferior with respect to confidentiality (11/51, 22% vs 3/118, 2.5%, P<.001). One-quarter (14/55) of the AYA patients and 31.7% (39/123) of the caregivers reported technical difficulties. The dominant themes in the qualitative data included advantages of telehealth for efficiency and equity of health care delivery. However, respondents’ concerns included reduced safety and effectiveness of care, particularly for patients with eating disorders, owing to lack of hands-on examinations, collection of vital signs, and laboratory testing. Conclusions: Telehealth was highly acceptable among AYA and caregivers. Future optimization should include improving privacy, ameliorating technical difficulties, and standardizing at-home methods of obtaining patient data to assure patient safety. %M 34779782 %R 10.2196/32708 %U https://pediatrics.jmir.org/2021/4/e32708 %U https://doi.org/10.2196/32708 %U http://www.ncbi.nlm.nih.gov/pubmed/34779782 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 11 %P e29504 %T Algorithm for Individual Prediction of COVID-19–Related Hospitalization Based on Symptoms: Development and Implementation Study %A Murtas,Rossella %A Morici,Nuccia %A Cogliati,Chiara %A Puoti,Massimo %A Omazzi,Barbara %A Bergamaschi,Walter %A Voza,Antonio %A Rovere Querini,Patrizia %A Stefanini,Giulio %A Manfredi,Maria Grazia %A Zocchi,Maria Teresa %A Mangiagalli,Andrea %A Brambilla,Carla Vittoria %A Bosio,Marco %A Corradin,Matteo %A Cortellaro,Francesca %A Trivelli,Marco %A Savonitto,Stefano %A Russo,Antonio Giampiero %+ Epidemiology Unit, Agency for the Protection of Health of the Metropolitan Area of Milan, Via Conca del Naviglio 45, Milan, 20123, Italy, 39 0285782111, agrusso@ats-milano.it %K COVID-19 %K severe outcome %K prediction %K monitoring system %K symptoms %K risk prediction %K risk %K algorithms %K prediction models %K pandemic %K digital data %K health records %D 2021 %7 15.11.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The COVID-19 pandemic has placed a huge strain on the health care system globally. The metropolitan area of Milan, Italy, was one of the regions most impacted by the COVID-19 pandemic worldwide. Risk prediction models developed by combining administrative databases and basic clinical data are needed to stratify individual patient risk for public health purposes. Objective: This study aims to develop a stratification tool aimed at improving COVID-19 patient management and health care organization. Methods: A predictive algorithm was developed and applied to 36,834 patients with COVID-19 in Italy between March 8 and the October 9, 2020, in order to foresee their risk of hospitalization. Exposures considered were age, sex, comorbidities, and symptoms associated with COVID-19 (eg, vomiting, cough, fever, diarrhea, myalgia, asthenia, headache, anosmia, ageusia, and dyspnea). The outcome was hospitalizations and emergency department admissions for COVID-19. Discrimination and calibration of the model were also assessed. Results: The predictive model showed a good fit for predicting COVID-19 hospitalization (C-index 0.79) and a good overall prediction accuracy (Brier score 0.14). The model was well calibrated (intercept –0.0028, slope 0.9970). Based on these results, 118,804 patients diagnosed with COVID-19 from October 25 to December 11, 2020, were stratified into low, medium, and high risk for COVID-19 severity. Among the overall study population, 67,030 (56.42%) were classified as low-risk patients; 43,886 (36.94%), as medium-risk patients; and 7888 (6.64%), as high-risk patients. In all, 89.37% (106,179/118,804) of the overall study population was being assisted at home, 9% (10,695/118,804) was hospitalized, and 1.62% (1930/118,804) died. Among those assisted at home, most people (63,983/106,179, 60.26%) were classified as low risk, whereas only 3.63% (3858/106,179) were classified at high risk. According to ordinal logistic regression, the odds ratio (OR) of being hospitalized or dead was 5.0 (95% CI 4.6-5.4) among high-risk patients and 2.7 (95% CI 2.6-2.9) among medium-risk patients, as compared to low-risk patients. Conclusions: A simple monitoring system, based on primary care data sets linked to COVID-19 testing results, hospital admissions data, and death records may assist in the proper planning and allocation of patients and resources during the ongoing COVID-19 pandemic. %M 34543227 %R 10.2196/29504 %U https://publichealth.jmir.org/2021/11/e29504 %U https://doi.org/10.2196/29504 %U http://www.ncbi.nlm.nih.gov/pubmed/34543227 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 1 %N 1 %P e32127 %T Online Search Behavior Related to COVID-19 Vaccines: Infodemiology Study %A An,Lawrence %A Russell,Daniel M %A Mihalcea,Rada %A Bacon,Elizabeth %A Huffman,Scott %A Resnicow,Ken %+ Center for Health Communications Research, Rogel Cancer Center, University of Michigan, North Campus Research Complex, Building 16, 2800 Plymouth Rd., Ann Arbor, MI, 48109, United States, 1 734 763 6099, lcan@med.umich.edu %K online health information %K behavior %K search %K COVID-19 %K vaccine %K infodemiology %K internet %K trend %K public health %K awareness %K concern %K interest %K public %K misinformation %K safety %K side effect %K availability %D 2021 %7 12.11.2021 %9 Original Paper %J JMIR Infodemiology %G English %X Background: Vaccination against COVID-19 is an important public health strategy to address the ongoing pandemic. Examination of online search behavior related to COVID-19 vaccines can provide insights into the public's awareness, concerns, and interest regarding COVID-19 vaccination. Objective: The aim of this study is to describe online search behavior related to COVID-19 vaccines during the start of public vaccination efforts in the United States. Methods: We examined Google Trends data from January 1, 2021, through March 16, 2021, to determine the relative search volume for vaccine-related searches on the internet. We also examined search query log data for COVID-19 vaccine-related searches and identified 5 categories of searches: (1) general or other information, (2) vaccine availability, (3) vaccine manufacturer, (4) vaccine side-effects and safety, and (5) vaccine myths and conspiracy beliefs. In this paper, we report on the proportion and trends for these different categories of vaccine-related searches. Results: In the first quarter of 2021, the proportion of all web-based search queries related to COVID-19 vaccines increased from approximately 10% to nearly 50% of all COVID-19–related queries (P<.001). A majority of COVID-19 vaccine queries addressed vaccine availability, and there was a particularly notable increase in the proportion of queries that included the name of a specific pharmacy (from 6% to 27%; P=.01). Queries related to vaccine safety and side-effects (<5% of total queries) or specific vaccine-related myths (<1% of total queries) were uncommon, and the relative frequency of both types of searches decreased during the study period. Conclusions: This study demonstrates an increase in online search behavior related to COVID-19 vaccination in early 2021 along with an increase in the proportion of searches related to vaccine availability at pharmacies. These findings are consistent with an increase in public interest and intention to get vaccinated during the initial phase of public COVID-19 vaccination efforts. %M 34841200 %R 10.2196/32127 %U https://infodemiology.jmir.org/2021/1/e32127 %U https://doi.org/10.2196/32127 %U http://www.ncbi.nlm.nih.gov/pubmed/34841200 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 11 %P e30462 %T The Influence of Normative Perceptions on the Uptake of the COVID-19 TraceTogether Digital Contact Tracing System: Cross-sectional Study %A Lee,Jeong Kyu %A Lin,Lavinia %A Kang,Hyunjin %+ Saw Swee Hock School of Public Health, National University of Singapore, Tahir Foundation Building, 12 Science Drive 2, 10-01, Singapore, 117549, Singapore, 65 66015838, lee.jeongkyu@gmail.com %K COVID-19 %K social norms %K TraceTogether %K Singapore %K contact tracing %K mobile app %K token %D 2021 %7 12.11.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: In 2020, the Singapore government rolled out the TraceTogether program, a digital system to facilitate contact tracing efforts in response to the COVID-19 pandemic. This system is available as a smartphone app and Bluetooth-enabled token to help identify close contacts. As of February 1, 2021, more than 80% of the population has either downloaded the mobile app or received the token in Singapore. Despite the high adoption rate of the TraceTogether mobile app and token (ie, device), it is crucial to understand the role of social and normative perceptions in uptake and usage by the public, given the collective efforts for contact tracing. Objective: This study aimed to examine normative influences (descriptive and injunctive norms) on TraceTogether device use for contact tracing purposes, informed by the theory of normative social behavior, a theoretical framework to explain how perceived social norms are related to behaviors. Methods: From January to February 2021, cross-sectional data were collected by a local research company through emailing their panel members who were (1) Singapore citizens or permanent residents aged 21 years or above; (2) able to read English; and (3) internet users with access to a personal email account. The study sample (n=1137) was restricted to those who had either downloaded the TraceTogether mobile app or received the token. Results: Multivariate (linear and ordinal logistic) regression analyses were carried out to assess the relationships of the behavioral outcome variables (TraceTogether device usage and intention of TraceTogether device usage) with potential correlates, including perceived social norms, perceived community, and interpersonal communication. Multivariate regression analyses indicated that descriptive norms (unstandardized regression coefficient β=0.31, SE=0.05; P<.001) and injunctive norms (unstandardized regression coefficient β=0.16, SE=0.04; P<.001) were significantly positively associated with the intention to use the TraceTogether device. It was also found that descriptive norms were a significant correlate of TraceTogether device use frequency (adjusted odds ratio [aOR] 2.08, 95% CI 1.66-2.61; P<.001). Though not significantly related to TraceTogether device use frequency, injunctive norms moderated the relationship between descriptive norms and the outcome variable (aOR 1.12, 95% CI 1.03-1.21; P=.005). Conclusions: This study provides useful implications for the design of effective intervention strategies to promote the uptake and usage of digital methods for contact tracing in a multiethnic Asian population. Our findings highlight that influence from social networks plays an important role in developing normative perceptions in relation to TraceTogether device use for contact tracing. To promote the uptake of the TraceTogether device and other preventive behaviors for COVID-19, it would be useful to devise norm-based interventions that address these normative perceptions by presenting high prevalence and approval of important social referents, such as family and close friends. %M 34623956 %R 10.2196/30462 %U https://publichealth.jmir.org/2021/11/e30462 %U https://doi.org/10.2196/30462 %U http://www.ncbi.nlm.nih.gov/pubmed/34623956 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 11 %P e32093 %T Mobile Apps Leveraged in the COVID-19 Pandemic in East and South-East Asia: Review and Content Analysis %A Lee,Bohee %A Ibrahim,Siti Aishah %A Zhang,Tiying %+ Centre for Population Health Sciences, Usher Institute, University of Edinburgh, Old Medical School, Teviot Place, Edinburgh, EH8 9AG, United Kingdom, 44 1316503034, bohee.lee@ed.ac.uk %K mobile apps %K applications %K eHealth %K mHealth %K mobile health %K digital health %K telemedicine %K telehealth %K COVID-19 %K coronavirus %K pandemic %K public health %K health policy %D 2021 %7 11.11.2021 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: The COVID-19 pandemic increased attention to digital tools to support governmental public health policies in East and South-East Asia. Mobile apps related to the COVID-19 pandemic continue to emerge and evolve with a wide variety of characteristics and functions. However, there is a paucity of studies evaluating such apps in this region, with most of the available studies conducted in the early days of the pandemic. Objective: This study aimed to examine free apps developed or supported by governments in the East and South-East Asian region and highlight their key characteristics and functions. We also sought to interpret how the release dates of these apps were related to the commencement dates of other COVID-19 public health policies. Methods: We systematically searched for apps in Apple App Store and Google Play Store and analyzed the contents of eligible apps. Mobile apps released or updated with COVID-19–related functions between March 1 and May 7, 2021, in Singapore, Taiwan, South Korea, China (mainland), Japan, Thailand, Hong Kong, Vietnam, Malaysia, Indonesia, and the Philippines were included. The CoronaNet Research Project database was also examined to determine the timeline of public health policy commencement dates in relation to the release dates of the included apps. We assessed each app’s official website, media reports, and literature through content analysis. Descriptive statistics were used to summarize relevant information gathered from the mobile apps using RStudio. Results: Of the 1943 mobile apps initially identified, 46 were eligible, with almost 70% of the apps being intended for the general public. Most apps were from Vietnam (n=9, 20%), followed by Malaysia, Singapore, and Thailand (n=6 each, 13%). Of note, most apps for quarantine monitoring (n=6, 13%) were mandatory for the target users or a population subset. The most common function was health monitoring (32/46, 70%), followed by raising public health awareness (19/46, 41%) through education and information dissemination. Other functions included monitoring quarantine (12/46, 26%), providing health resources (12/46, 26%). COVID-19 vaccination management functions began to appear in parallel with vaccine rollout (7/46, 15%). Regarding the timing of the introduction of mobile solutions, the majority of mobile apps emerged close to the commencement dates of other public health policies in the early stages of the pandemic between March and April 2020. Conclusions: In East and South-East Asia, most governments used mobile health apps as adjuncts to public health measures for tracking COVID-19 cases and delivering credible information. In addition, these apps have evolved by expanding their functions for COVID-19 vaccination. %M 34748515 %R 10.2196/32093 %U https://mhealth.jmir.org/2021/11/e32093 %U https://doi.org/10.2196/32093 %U http://www.ncbi.nlm.nih.gov/pubmed/34748515 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 11 %P e30259 %T Longitudinal Neurocognitive and Pulmonological Profile of Long COVID-19: Protocol for the COVIMMUNE-Clin Study %A Widmann,Catherine N %A Wieberneit,Michelle %A Bieler,Luzie %A Bernsen,Sarah %A Gräfenkämper,Robin %A Brosseron,Frederic %A Schmeel,Carsten %A Tacik,Pawel %A Skowasch,Dirk %A Radbruch,Alexander %A Heneka,Michael T %+ Section Neuropsychology, Department of Neurodegenerative Diseases and Gerontopsychiatry, University of Bonn Medical Center, Venusberg-Campus-1, Building 80, Bonn, 53127, Germany, 49 228 287 13093, catherine.widmann@ukbonn.de %K SARS-CoV-2 %K COVID-19 %K postacute COVID-19 syndrome %K cognition %K neuropsychology %K lung %K magnetic resonance imaging %D 2021 %7 11.11.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: There is a dearth of information about “brain fog,” characterized by concentration, word-finding, or memory problems, which has been listed in the new World Health Organization provisional classification “U09.9 Post-COVID-19 Condition.” Moreover, the extent to which these symptoms may be associated with neurological, pulmonary, or psychiatric difficulties is unclear. Objective: This ongoing cohort study aims to carefully assess neurocognitive function in the context of the neurological, psychiatric, and pulmonary sequelae of SARS-CoV-2 infection among patients with asymptomatic/mild and severe cases of COVID-19 after remission, including actively recruited healthy controls. Methods: A total of 150 participants will be included in this pilot study. The cohort will comprise patients who tested positive for SARS-CoV-2 infection with either an asymptomatic course or a mild course defined as no symptoms except for olfactory and taste dysfunction (n=50), patients who tested positive for SARS-CoV-2 infection with a severe disease course (n=50), and a healthy control group (n=50) with similar age and sex distribution based on frequency matching. A comprehensive neuropsychological assessment will be performed comprising nuanced aspects of complex attention, including language, executive function, verbal and visual learning, and memory. Psychiatric, personality, social and lifestyle factors, sleep, and fatigue will be evaluated. Brain magnetic resonance imaging, neurological and physical assessment, and pulmonological and lung function examinations (including body plethysmography, diffusion capacity, clinical assessments, and questionnaires) will also be performed. Three visits are planned with comprehensive testing at the baseline and 12-month visits, along with brief neurological and neuropsychological examinations at the 6-month assessment. Blood-based biomarkers of neurodegeneration will be quantified at baseline and 12-month follow-up. Results: At the time of submission, the study had begun recruitment through telephone and in-person screenings. The first patient was enrolled in the study at the beginning of April 2021. Interim data analysis of baseline information is expected to be complete by December 2021 and study completion is expected at the end of December 2022. Preliminary group comparisons indicate worse word list learning, short- and long-delayed verbal recall, and verbal recognition in both patient cohorts compared with those of the healthy control group, adjusted for age and sex. Initial volumetric comparisons show smaller grey matter, frontal, and temporal brain volumes in both patient groups compared with those of healthy controls. These results are quite robust but are neither final nor placed in the needed context intended at study completion. Conclusions: To the best of our knowledge, this is the first study to include objective and comprehensive longitudinal analyses of neurocognitive sequelae of COVID-19 in an extreme group comparison stratified by disease severity with healthy controls actively recruited during the pandemic. Results from this study will contribute to the nascent literature on the prolonged effects of COVID-19 on neurocognitive performance via our coassessment of neuroradiological, neurological, pulmonary, psychiatric, and lifestyle factors. Trial Registration: International Clinical Trials Registry Platform DRKS00023806; https://trialsearch.who.int/Trial2.aspx?TrialID=DRKS00023806 International Registered Report Identifier (IRRID): DERR1-10.2196/30259 %M 34559059 %R 10.2196/30259 %U https://www.researchprotocols.org/2021/11/e30259 %U https://doi.org/10.2196/30259 %U http://www.ncbi.nlm.nih.gov/pubmed/34559059 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 11 %P e32591 %T Exploring Online Health Reviews to Monitor COVID-19 Public Health Responses in Alabama State Department of Corrections: Case Example %A Valera,Pamela %A Carmona,David %A Malarkey,Sarah %A Sinangil,Noah %A Owens,Madelyn %A Lefebre,Asia %+ Department of Urban-Global Public Health, Rutgers School of Public Health, 1 Riverfront Plaza, 10th Floor, Newark, NJ, 07102, United States, 1 9739726555, pv181@sph.rutgers.edu %K Alabama %K correctional facilities %K COVID-19 %K online health reviews %K review %K monitoring %K public health %K policy %K response %K prison %K United States %K case study %K formative %K feasibility %K acceptability %K survey %D 2021 %7 10.11.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: COVID-19, caused by SARS-CoV-2, has devastated incarcerated people throughout the United States. Objective: The purpose of this study was to test the feasibility and acceptability of a COVID-19 Health Review for Correctional Facilities. Methods: The COVID-19 Health Review survey for the Department of Corrections was developed in Qualtrics to assess the following: (1) COVID-19 testing, (2) providing personal protective equipment, (3) vaccination procedures, (4) quarantine procedures, (5) COVID-19 mortality rates for inmates, (6) COVID-19 mortality rates for correctional officers and prison staff, (7) COVID-19 infection rates for inmates, (8) COVID-19 infection rates for correctional officers and prison staff, and (9) uptake of COVID-19 vaccines. The estimated time to review the Alabama State Department of Corrections COVID-19 responses on their website and complete the survey items was 45 minutes to 1 hour. Results: Of the 21 participants who completed the COVID-19 Health Review for Correctional Facilities survey, 48% (n=10) identified as female, 43% (n=9) identified as male, and 10% (n=2) identified as transgender. For race, 29% (n=6) self-identified as Black or African American, 24% (n=5) Asian, 24% (n=5) White, 5% (n=1) Pacific Islander or Native Hawaiian, and 19% (n=4) Other. In addition, 5 respondents self-identified as returning citizens. For COVID-19 review questions, the majority concluded that information on personal protective equipment was “poor” and “very poor,” information on COVID-19 testing was “fair” and above, information on COVID-19 death/infection rates between inmates and staff was “good” and “very good,” and information on vaccinations was “good” and “very good.” There was a significant difference observed (P=.03) between nonreturning citizens and returning citizens regarding the health grade review with respect to available information on COVID-19 infection rates. Conclusions: COVID-19 health reviews may provide an opportunity for the public to review the COVID-19 responses in correctional settings. %M 34609313 %R 10.2196/32591 %U https://formative.jmir.org/2021/11/e32591 %U https://doi.org/10.2196/32591 %U http://www.ncbi.nlm.nih.gov/pubmed/34609313 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 11 %P e32936 %T The Impact of Public Health Events on COVID-19 Vaccine Hesitancy on Chinese Social Media: National Infoveillance Study %A Zhang,Zizheng %A Feng,Guanrui %A Xu,Jiahong %A Zhang,Yimin %A Li,Jinhui %A Huang,Jian %A Akinwunmi,Babatunde %A Zhang,Casper J P %A Ming,Wai-kit %+ Department of Infectious Diseases and Public Health, Jockey Club College of Veterinary Medicine and Life Sciences, City University of Hong Kong, To Yuen Building, 31 To Yuen Street, Hong Kong, China (Hong Kong), 852 34426956, wkming2@cityu.edu.hk %K COVID-19 %K vaccine %K hesitancy %K social media %K China %K sentiment analysis %K infoveillance %K public health %K surveillance %K Weibo %K data mining %K sentiment %K attitude %D 2021 %7 9.11.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The ongoing COVID-19 pandemic has brought unprecedented challenges to every country worldwide. A call for global vaccination for COVID-19 plays a pivotal role in the fight against this virus. With the development of COVID-19 vaccines, public willingness to get vaccinated has become an important public health concern, considering the vaccine hesitancy observed worldwide. Social media is powerful in monitoring public attitudes and assess the dissemination, which would provide valuable information for policy makers. Objective: This study aimed to investigate the responses of vaccine positivity on social media when major public events (major outbreaks) or major adverse events related to vaccination (COVID-19 or other similar vaccines) were reported. Methods: A total of 340,783 vaccine-related posts were captured with the poster’s information on Weibo, the largest social platform in China. After data cleaning, 156,223 posts were included in the subsequent analysis. Using pandas and SnowNLP Python libraries, posts were classified into 2 categories, positive and negative. After model training and sentiment analysis, the proportion of positive posts was computed to measure the public positivity toward the COVID-19 vaccine. Results: The positivity toward COVID-19 vaccines in China tends to fluctuate over time in the range of 45.7% to 77.0% and is intuitively correlated with public health events. In terms of gender, males were more positive (70.0% of the time) than females. In terms of region, when regional epidemics arose, not only the region with the epidemic and surrounding regions but also the whole country showed more positive attitudes to varying degrees. When the epidemic subsided temporarily, positivity decreased with varying degrees in each region. Conclusions: In China, public positivity toward COVID-19 vaccines fluctuates over time and a regional epidemic or news on social media may cause significant variations in willingness to accept a vaccine. Furthermore, public attitudes toward COVID-19 vaccination vary from gender and region. It is crucial for policy makers to adjust their policies through the use of positive incentives with prompt responses to pandemic-related news to promote vaccination acceptance. %M 34591782 %R 10.2196/32936 %U https://publichealth.jmir.org/2021/11/e32936 %U https://doi.org/10.2196/32936 %U http://www.ncbi.nlm.nih.gov/pubmed/34591782 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 11 %P e31707 %T Multilevel Determinants of COVID-19 Vaccine Uptake Among South Asian Ethnic Minorities in Hong Kong: Cross-sectional Web-Based Survey %A Singh,Akansha %A Lai,Angel Hor Yan %A Wang,Jingxuan %A Asim,Saba %A Chan,Paul Shing-Fong %A Wang,Zixin %A Yeoh,Eng Kiong %+ Centre for Health Systems and Policy Research, JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Room 508, School of Public Health, Prince of Wales Hospital, Shatin, N.T., Hong Kong, 666888, China (Hong Kong), 852 22528740, wangzx@cuhk.edu.hk %K COVID-19 %K South Asian ethnic minorities %K COVID-19 vaccination %K uptake %K cultural and religious reasons for vaccine hesitancy %K perceptions %K information exposure on social media %K influence of peers %K socioecological model %K Hong Kong %D 2021 %7 9.11.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The COVID-19 pandemic continues to have a disproportionate effect on ethnic minorities. Across countries, greater vaccine hesitancy has been observed among ethnic minorities. After excluding foreign domestic helpers, South Asians make up the largest proportion of ethnic minorities in Hong Kong. It is necessary to plan for COVID-19 vaccination promotional strategies that cater to the unique needs of South Asians in Hong Kong. Objective: This study investigated the prevalence of COVID-19 vaccine uptake among a sample of South Asians in Hong Kong. We examined the effects of sociodemographic data and factors at individual level (perceptions), interpersonal level (information exposure on social media), and sociostructural level (cultural) based on the socioecological model. Methods: A cross-sectional web-based survey was conducted on May 1-31, 2021. Participants were South Asian people aged 18 years or older living in Hong Kong; able to comprehend English, Hindi, Nepali, or Urdu; and having access to a smartphone. Three community-based organizations providing services to South Asians in Hong Kong facilitated the data collection. The staff of the community-based organizations posted the study information in WhatsApp groups involving South Asian clients and invited them to participate in a web-based survey. Logistic regression models were fit for data analysis. Results: Among 245 participants, 81 (33.1%) had taken at least one dose of the COVID-19 vaccine (one dose, 62/245, 25.2%; and both doses, 19/245, 7.9%). After adjusting for significant background characteristics, cultural and religious reasons for COVID-19 vaccine hesitancy were associated with lower COVID-19 vaccine uptake (adjusted odds ratio [AOR] 0.83, 95% CI 0.71-0.97; P=.02). At the individual level, having more positive attitudes toward COVID-19 vaccination (AOR 1.31, 95% CI 1.10-1.55; P=.002), perceived support from significant others (AOR 1.29, 95% CI 1.03-1.60; P=.03), and perceived higher behavioral control to receive COVID-19 vaccination (AOR 2.63, 95% CI 1.65-4.19; P<.001) were associated with higher COVID-19 vaccine uptake, while a negative association was found between negative attitudes and the dependent variable (AOR 0.73, 95% CI 0.62-0.85; P<.001). Knowing more peers who had taken the COVID-19 vaccine was also associated with higher uptake (AOR 1.39, 95% CI 1.11-1.74; P=.01). At the interpersonal level, higher exposure to information about deaths and other serious conditions caused by COVID-19 vaccination was associated with lower uptake (AOR 0.54, 95% CI 0.33-0.86; P=.01). Conclusions: In this study, one-third (81/245) of our participants received at least one dose of the COVID-19 vaccine. Cultural or religious reasons, perceptions, information exposure on social media, and influence of peers were found to be the determinants of COVID-19 vaccine uptake among South Asians. Future programs should engage community groups, champions, and faith leaders, and develop culturally competent interventions. %M 34653014 %R 10.2196/31707 %U https://publichealth.jmir.org/2021/11/e31707 %U https://doi.org/10.2196/31707 %U http://www.ncbi.nlm.nih.gov/pubmed/34653014 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 11 %P e29319 %T Association of Substance Use With Behavioral Adherence to Centers for Disease Control and Prevention Guidelines for COVID-19 Mitigation: Cross-sectional Web-Based Survey %A Monnig,Mollie A %A Treloar Padovano,Hayley %A Sokolovsky,Alexander W %A DeCost,Grace %A Aston,Elizabeth R %A Haass-Koffler,Carolina L %A Szapary,Claire %A Moyo,Patience %A Avila,Jaqueline C %A Tidey,Jennifer W %A Monti,Peter M %A Ahluwalia,Jasjit S %+ Department of Behavioral and Social Sciences, Brown University, Box G-S121-5, Providence, RI, 02912, United States, 1 4018633491, mollie_monnig@brown.edu %K SARS-CoV-2 %K novel coronavirus %K COVID-19 %K alcohol use %K alcohol drinking %K opioid use %K stimulant use %K nicotine %K smoking %K survey %K substance abuse %K addiction %K mental health %K pandemic %D 2021 %7 9.11.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Substance use is a risk factor for COVID-19 infection and adverse outcomes. However, reasons for elevated risk for COVID-19 in substance users are not well understood. Objective: The aim of this study was to evaluate whether alcohol or other drug use is associated with adherence to Centers for Disease Control and Prevention (CDC) guidelines for COVID-19 mitigation. Preregistered analyses tested the hypothesis that greater use of alcohol and other drugs would be associated with lower CDC guideline adherence. A secondary objective was to determine whether substance use was associated with the likelihood of COVID-19 testing or outcome. Methods: A cross-sectional web-based survey was administered to a convenience sample recruited through Amazon’s Mechanical Turk platform from June 18 to July 19, 2020. Individuals aged 18 years or older and residing in Connecticut, Massachusetts, New Jersey, New York, or Rhode Island were eligible to participate. The exposure of interest was past 7-day use of alcohol, cigarettes, electronic cigarettes, cannabis, stimulants, and nonmedical opioids. The primary outcome was CDC guideline adherence measured using a scale developed from behaviors advised to reduce the spread of COVID-19. Secondary outcomes were likelihood of COVID-19 testing and a positive COVID-19 test result. All analyses accounted for the sociodemographic characteristics. Results: The sample consisted of 1084 individuals (mean age 40.9 [SD 13.4] years): 529 (48.8%) men, 543 (50.1%) women, 12 (1.1%) other gender identity, 742 (68.5%) White individuals, 267 (24.6%) Black individuals, and 276 (25.5%) Hispanic individuals. Daily opioid users reported lower CDC guideline adherence than nondaily users (B=–0.24, 95% CI –0.44 to –0.05) and nonusers (B=–0.57, 95% CI –0.76 to –0.38). Daily alcohol drinkers reported lower adherence than nondaily drinkers (B=–0.16, 95% CI –0.30 to –0.02). Nondaily alcohol drinkers reported higher adherence than nondrinkers (B=0.10, 95% CI 0.02-0.17). Daily opioid use was related to greater odds of COVID-19 testing, and daily stimulant use was related to greater odds of a positive COVID-19 test. Conclusions: In a regionally-specific, racially, and ethnically diverse convenience sample, adults who engaged in daily alcohol or opioid use reported lower CDC guideline adherence for COVID-19 mitigation. Any opioid use was associated with greater odds of COVID-19 testing, and daily stimulant use was associated with greater odds of COVID-19 infection. Cigarettes, electronic cigarettes, cannabis, or stimulant use were not statistically associated with CDC guideline adherence, after accounting for sociodemographic covariates and other substance use variables. Findings support further investigation into whether COVID-19 testing and vaccination should be expanded among individuals with substance-related risk factors. %M 34591780 %R 10.2196/29319 %U https://publichealth.jmir.org/2021/11/e29319 %U https://doi.org/10.2196/29319 %U http://www.ncbi.nlm.nih.gov/pubmed/34591780 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 11 %P e31586 %T A Digital Human for Delivering a Remote Loneliness and Stress Intervention to At-Risk Younger and Older Adults During the COVID-19 Pandemic: Randomized Pilot Trial %A Loveys,Kate %A Sagar,Mark %A Pickering,Isabella %A Broadbent,Elizabeth %+ Department of Psychological Medicine, The University of Auckland, Building 507, Level 3, 22-30 Park Avenue, Grafton, Auckland, 1023, New Zealand, 64 9 923 0003, e.broadbent@auckland.ac.nz %K COVID-19 %K loneliness %K stress %K well-being %K eHealth %K digital human %K conversational agent %K older adults %K chronic illness %D 2021 %7 8.11.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: Loneliness is a growing public health issue that has been exacerbated in vulnerable groups during the COVID-19 pandemic. Computer agents are capable of delivering psychological therapies through the internet; however, there is limited research on their acceptability to date. Objective: The objectives of this study were to evaluate (1) the feasibility and acceptability of a remote loneliness and stress intervention with digital human delivery to at-risk adults and (2) the feasibility of the study methods in preparation for a randomized controlled trial. Methods: A parallel randomized pilot trial with a mixed design was conducted. Participants were adults aged 18 to 69 years with an underlying medical condition or aged 70 years or older with a Mini-Mental State Examination score of >24 (ie, at greater risk of developing severe COVID-19). Participants took part from their place of residence (independent living retirement village, 20; community dwelling, 7; nursing home, 3). Participants were randomly allocated to the intervention or waitlist control group that received the intervention 1 week later. The intervention involved completing cognitive behavioral and positive psychology exercises with a digital human facilitator on a website for at least 15 minutes per day over 1 week. The exercises targeted loneliness, stress, and psychological well-being. Feasibility was evaluated using dropout rates and behavioral observation data. Acceptability was evaluated from behavioral engagement data, the Friendship Questionnaire (adapted), self-report items, and qualitative questions. Psychological measures were administered to evaluate the feasibility of the trial methods and included the UCLA Loneliness Scale, the 4-item Perceived Stress Scale, a 1-item COVID-19 distress measure, the Flourishing Scale, and the Scale of Positive and Negative Experiences. Results: The study recruited 30 participants (15 per group). Participants were 22 older adults and 8 younger adults with a health condition. Six participants dropped out of the study. Thus, the data of 24 participants were analyzed (intervention group, 12; waitlist group, 12). The digital human intervention and trial methods were generally found to be feasible and acceptable in younger and older adults living independently, based on intervention completion, and behavioral, qualitative, and some self-report data. The intervention and trial methods were less feasible to nursing home residents who required caregiver assistance. Acceptability could be improved with additional content, tailoring to the population, and changes to the digital human’s design. Conclusions: Digital humans are a promising and novel technological solution for providing at-risk adults with access to remote psychological support during the COVID-19 pandemic. Research should further examine design techniques to improve their acceptability in this application and investigate intervention effectiveness in a randomized controlled trial. Trial Registration: Australia New Zealand Clinical Trials Registry ACTRN12620000786998; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380113 %M 34596572 %R 10.2196/31586 %U https://mental.jmir.org/2021/11/e31586 %U https://doi.org/10.2196/31586 %U http://www.ncbi.nlm.nih.gov/pubmed/34596572 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 11 %P e33022 %T Investigating Unhealthy Alcohol Use As an Independent Risk Factor for Increased COVID-19 Disease Severity: Observational Cross-sectional Study %A Bhalla,Sameer %A Sharma,Brihat %A Smith,Dale %A Boley,Randy %A McCluskey,Connor %A Ilyas,Yousaf %A Afshar,Majid %A Balk,Robert %A Karnik,Niranjan %A Keshavarzian,Ali %+ Center for Circadian Rhythm and Alcohol-Induced Tissue Injury, Rush University Medical Center, 1725 W Harrison St, Chicago, IL, United States, 1 (312) 942 5861, Ali_Keshavarzian@rush.edu %K unhealthy alcohol use %K COVID-19 %K SARS-CoV-2 %K acute respiratory distress syndrome %K substance misuse %K mechanical ventilation %K substance use %D 2021 %7 5.11.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Unhealthy alcohol use (UAU) is known to disrupt pulmonary immune mechanisms and increase the risk of acute respiratory distress syndrome in patients with pneumonia; however, little is known about the effects of UAU on outcomes in patients with COVID-19 pneumonia. To our knowledge, this is the first observational cross-sectional study that aims to understand the effect of UAU on the severity of COVID-19. Objective: We aim to determine if UAU is associated with more severe clinical presentation and worse health outcomes related to COVID-19 and if socioeconomic status, smoking, age, BMI, race/ethnicity, and pattern of alcohol use modify the risk. Methods: In this observational cross-sectional study that took place between January 1, 2020, and December 31, 2020, we ran a digital machine learning classifier on the electronic health record of patients who tested positive for SARS-CoV-2 via nasopharyngeal swab or had two COVID-19 International Classification of Disease, 10th Revision (ICD-10) codes to identify patients with UAU. After controlling for age, sex, ethnicity, BMI, smoking status, insurance status, and presence of ICD-10 codes for cancer, cardiovascular disease, and diabetes, we then performed a multivariable regression to examine the relationship between UAU and COVID-19 severity as measured by hospital care level (ie, emergency department admission, emergency department admission with ventilator, or death). We used a predefined cutoff with optimal sensitivity and specificity on the digital classifier to compare disease severity in patients with and without UAU. Models were adjusted for age, sex, race/ethnicity, BMI, smoking status, and insurance status. Results: Each incremental increase in the predicted probability from the digital alcohol classifier was associated with a greater odds risk for more severe COVID-19 disease (odds ratio 1.15, 95% CI 1.10-1.20). We found that patients in the unhealthy alcohol group had a greater odds risk to develop more severe disease (odds ratio 1.89, 95% CI 1.17-3.06), suggesting that UAU was associated with an 89% increase in the odds of being in a higher severity category. Conclusions: In patients infected with SARS-CoV-2, UAU is an independent risk factor associated with greater disease severity and/or death. %M 34665758 %R 10.2196/33022 %U https://publichealth.jmir.org/2021/11/e33022 %U https://doi.org/10.2196/33022 %U http://www.ncbi.nlm.nih.gov/pubmed/34665758 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 4 %N 4 %P e29049 %T Clinical Characteristics of Children With COVID-19 in the United Arab Emirates: Cross-sectional Multicenter Study %A Ennab,Farah %A ElSaban,Mariam %A Khalaf,Eman %A Tabatabaei,Hanieh %A Khamis,Amar Hassan %A Devi,Bindu Radha %A Hanif,Kashif %A Elhassan,Hiba %A Saravanan,Ketharanathan %A Cremonesini,David %A Popatia,Rizwana %A Malik,Zainab %A Ho,Samuel B %A Abusamra,Rania %+ College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Al Razi St - Umm Hurair 2, Dubai Healthcare City, Dubai, United Arab Emirates, 971 563786236, rania.abdelkarim@mediclinic.ae %K pediatrics %K children %K COVID-19 %K SARS-CoV-2 %K United Arab Emirates %K viral shedding %K pandemic %K treatment %K outcomes %K clinical %K public heath %D 2021 %7 5.11.2021 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: COVID-19 has infected over 123 million people globally. The first confirmed case in the United Arab Emirates (UAE) was reported on January 29, 2020. According to studies conducted in the early epicenters of the pandemic, COVID-19 has fared mildly in the pediatric population. To date, there is a lack of published data about COVID-19 infection among children in the Arabian region. Objective: This study aims to investigate the clinical characteristics, laboratory findings, treatment, and outcomes of children with COVID-19. Methods: This cross-sectional, multicenter study included children with confirmed COVID-19 infection admitted to 3 large hospitals in Dubai, UAE, between March 1 and June 15, 2020. Serial COVID-19 polymerase chain reaction (PCR) testing data were collected, and patients’ demographics, premorbid clinical characteristics, and inpatient hospital courses were examined. Results: In all, 111 children were included in our study and represented 22 nationalities. Of these, 59 (53.2%) were boys. The mean age of the participants was 7 (SD 5.3) years. About 15.3% of children were younger than 1 year. Only 4 (3.6%) of them had pre-existing asthma, all of whom had uneventful courses. At presentation, of the 111 children, 43 (38.7%) were asymptomatic, 68 (61.2%) had mild or moderate symptoms, and none (0%) had severe illness requiring intensive care. Fever (23/111, 20.7%), cough (22/111, 19.8%), and rhinorrhea (17/111, 15.3%) were the most common presenting symptoms, and most reported symptoms resolved by day 5 of hospitalization. Most patients had no abnormality on chest x-ray. The most common laboratory abnormalities on admission included variations in neutrophil count (22/111, 24.7%), aspartate transaminase (18/111, 22.5%), alkaline phosphatase (29/111, 36.7%), and lactate dehydrogenase (31/111, 42.5%). Children were infrequently prescribed targeted medications, with only 4 (3.6%) receiving antibiotics. None of the 52 patients tested for viral coinfections were positive. COVID-19 PCR testing turned negative at a median of 10 days (IQR: 6-14) after the first positive test. Overall, there was no significant difference of time to negative PCR results between symptomatic and asymptomatic children. Conclusions: This study of COVID-19 presentations and characteristics presents a first look into the burden of COVID-19 infection in the pediatric population in the UAE. We conclude that a large percentage of children experienced no symptoms and that severe COVID-19 disease is uncommon in the UAE. Various laboratory abnormalities were observed despite clinical stability. Ongoing surveillance, contact tracing, and public health measures will be important to contain future outbreaks. %M 34643535 %R 10.2196/29049 %U https://pediatrics.jmir.org/2021/4/e29049 %U https://doi.org/10.2196/29049 %U http://www.ncbi.nlm.nih.gov/pubmed/34643535 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 11 %P e29896 %T Psychosocial and Behavioral Effects of the COVID-19 Pandemic in the Indian Population: Protocol for a Cross-sectional Study %A Joshi,Megha %A Shah,Aangi %A Trivedi,Bhavi %A Trivedi,Jaahnavee %A Patel,Viral %A Parghi,Devam %A Thakkar,Manini %A Barot,Kanan %A Jadawala,Vivek %+ Department of Psychiatry, Shrimati Nathiba Hargovandas Lakhamichand Municipal Medical College, Gujarat University, Pritamrai cross road,, Ellisbridge, Paldi, Ahmedabad, 380006, India, 91 9909896196, joshimegha1@gmail.com %K COVID-19 %K mental health %K India %K lockdown %K isolation %K social isolation %K behavior %K psychology %K psychosocial effects %D 2021 %7 5.11.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: During the year 2020, the COVID-19 pandemic spread from China to the rest of the world, which prompted the world to implement a widespread mandated quarantine or social isolation. The impending uncertainty of the pandemic must have resulted in a variety of widespread mental health maladies. There has been documentation in the literature about a lot of these in small populations of the world but limited studies have been conducted in India, leading to limited evidence in the literature. Objective: The main objective of our study is to investigate the mental health effects that the COVID-19 pandemic has had on the general population in India both quantitatively and qualitatively. These results will help contribute to reducing the knowledge gap that is recognized in the literature, which is the result of the unprecedented and novel nature of the pandemic. Methods: We designed and validated our own questionnaire and used the method of circulating the questionnaire via WhatsApp (Facebook Inc). WhatsApp is a social media app that is very popularly used in India; hence, it turned out to be an effective medium for gathering pilot data. We analyzed the pilot data and used them to validate the questionnaire. This was done with the expertise of our mentor, Nilima Shah, MD (psychiatry). We gathered pilot data on 545 subjects and used the results to determine the changes that were needed for the questionnaire while simultaneously validating the questionnaire. Results: The study protocol was approved in September 2020 by the institutional review board at Vadilal Sarabhai General Hospital, Ahmedabad, Gujarat, India. Conclusions: The following preliminary assumptions can be made about the study based on the pilot data: the majority of the survey respondents were male (289/545, 53%), most of them were educated and employed as health care workers (199/545, 36.5%). The majority of the responders were self-employed (185/545, 33.9%), single (297/545, 54.5%), and stayed with their families (427/541, 79%) for the lockdown, which helped them psychologically. Findings that are specific to mental health have been elaborated upon in the manuscript. It is evident from the data collected in previous literature that the pandemic has had significant detrimental effects on the mental health of a vast proportion of the Indian population. International Registered Report Identifier (IRRID): DERR1-10.2196/29896 %M 34519652 %R 10.2196/29896 %U https://www.researchprotocols.org/2021/11/e29896 %U https://doi.org/10.2196/29896 %U http://www.ncbi.nlm.nih.gov/pubmed/34519652 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 11 %P e28344 %T COVID-19 Knowledge, Attitudes, and Practices Among People in Bangladesh: Telephone-Based Cross-sectional Survey %A Rabbani,Md Golam %A Akter,Orin %A Hasan,Md Zahid %A Samad,Nandeeta %A Mahmood,Shehrin Shaila %A Joarder,Taufique %+ Public Health Foundation, Bangladesh, 54 Inner Circular Road, Scaut Market, Naya Paltan, Dhaka, 1217, Bangladesh, 880 1732292488, rabbaniduihe@gmail.com %K COVID-19 %K knowledge %K attitude %K practice %K risk communication and community engagement %K social and behavior change communication %K Bangladesh %K COVID-19 %K risk %K pandemic %K risk communication %D 2021 %7 5.11.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The world has been grappling with the COVID-19 pandemic, a dire public health crisis, since December 2019. Preventive and control measures have been adopted to reduce the spread of COVID-19. To date, the public’s knowledge, attitudes, and practices regarding COVID-19 across Bangladesh have been poorly understood. Therefore, it is important to assess people’s knowledge, attitudes, and practices (KAP) toward the disease and suggest appropriate strategies to combat COVID-19 effectively. Objective: This study aimed to assess the KAP of Bangladeshi people toward COVID-19 and to identify their determinants. Methods: We conducted a country-wide cross-sectional telephonic survey from May 7 to 29, 2020. A purposive sampling method was applied, and adult Bangladeshi citizens who have mobile phones were approached to participate in the survey. Interviews were conducted based on verbal consent. Multiple logistic regression analyses and several tests were performed to identify the factors associated with KAP related to COVID-19. Results: A total of 492 of 576 Bangladeshi adults aged 18 years and above completed the interview, with a response rate of 85.4% (492/576). Of the 492 participants, 321 (65.2%) were male, and 304 (61.8%) lived in a rural area. Mean scores for knowledge, attitudes, and practices were 10.56 (SD 2.86), 1.24 (SD 0.83), and 3.17 (SD 1.5), respectively. Among the 492 respondents, 273 (55.5%) had poor knowledge, and 251 (49%) expressed a negative attitude; 192 out of 359 respondents (53.5%) had poor practices toward COVID-19. Mean scores of knowledge, attitudes, and practices differed significantly across various demographic and socioeconomic groups. Rural residents had lower mean scores of knowledge (mean 9.8, SD 3.1, P<.001) and adherence to appropriate practice measures (mean 4, SD 1.4, P<.001) compared to their urban counterparts. Positive and statistically strong correlations between knowledge and attitudes (r=0.21, P<.001), knowledge and practices (r=0.45, P<.001), and attitudes and practices (r=0.27, P<.001) were observed. Television (53.7%) was identified as the major source of knowledge regarding COVID-19. Almost three-quarters of the respondents (359/492, 73%) went outside the home during the lockdown period. Furthermore, the study found that good knowledge (odds ratio [OR] 3.13, 95% CI 2.03-4.83, and adjusted OR 2.33, 95% CI 1.16-4.68) and a positive attitude (OR 2.43, 95% CI 1.59-3.72, and adjusted OR 3.87, 95% CI 1.95-7.68) are significantly associated with better practice of COVID-19 health measures. Conclusions: Evidence-informed and context-specific risk communication and community engagement, and a social and behavior change communication strategy against COVID-19 should be developed in Bangladesh based on the findings of this study, targeting different socioeconomic groups. %M 34519660 %R 10.2196/28344 %U https://formative.jmir.org/2021/11/e28344 %U https://doi.org/10.2196/28344 %U http://www.ncbi.nlm.nih.gov/pubmed/34519660 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 9 %N 4 %P e30747 %T Changes in Self-Reported Web-Based Gambling Activity During the COVID-19 Pandemic: Cross-sectional Study %A Claesdotter-Knutsson,Emma %A Håkansson,Anders %+ Child and Adolescent Psychiatry, Department of Clinical Sciences, Lund University, Barav 1, Lund, 221 85, Sweden, 46 768871765, emma.claesdotter-knutsson@med.lu.se %K COVID-19 %K pandemic %K web-based gambling %K psychological distress %K gender %D 2021 %7 3.11.2021 %9 Original Paper %J JMIR Serious Games %G English %X Background: The COVID‑19 pandemic has affected not only somatic health with over 3.7 million deaths worldwide, but also has had a huge impact on psychological health, creating what amounts to a mental health crisis. The negative effect of the pandemic on traditional addictions is well described and concerning, and the same has been seen for gambling. Objective: This study explores self-reported web-based gambling behavior during the COVID‑19 pandemic in Sweden. We investigated overall changes, but also changes in specific web-based gambling types, and whether they are associated with certain risk factors or lifestyle changes. Methods: Our study is based on an anonymous web-based survey of web panel participants in Sweden (N=1501) designed to study a range of behavioral changes during the COVID‑19 pandemic. Increases in gambling were analyzed using logistic regression models against sociodemographic data and psychological distress. Results: The majority of the respondents who gambled reported no changes in their gambling habits during the COVID‑19 pandemic. We found significant associations with the problem gambling severity index (PGSI), the Kessler score (indicating psychological distress), employment status, changes in alcohol habits, and self-exclusion when looking at overall changes in gambling activity in the pandemic. In the subgroup that reported an increase in gambling activity, we found an association with both the PGSI and Kessler scores. The PGSI score was also an independent predictor for all specific web-based gambling (horses, sports, poker, and casino) whereas the Kessler score only had a significant impact on changes in casino gambling. In addition, male gender was an independent predictor for gambling on sports and casino gambling. Conclusions: The majority of respondents who gambled reported no changes in their gambling activity during the COVID‑19 pandemic. The group that reported an increase in overall gambling activity during the COVID-19 pandemic represent a group with gambling problems and psychological distress. The group that reported increased sports and casino gambling were often male, and this group seemed to experience more psychological distress. %M 34730540 %R 10.2196/30747 %U https://games.jmir.org/2021/4/e30747 %U https://doi.org/10.2196/30747 %U http://www.ncbi.nlm.nih.gov/pubmed/34730540 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 11 %P e29789 %T Examining the Utility of Social Media in COVID-19 Vaccination: Unsupervised Learning of 672,133 Twitter Posts %A Liew,Tau Ming %A Lee,Cia Sin %+ Department of Psychiatry, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore, 65 62223322, liew.tau.ming@singhealth.com.sg %K social media %K COVID-19 %K vaccine hesitancy %K natural language processing %K machine learning %K infodemiology %D 2021 %7 3.11.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Although COVID-19 vaccines have recently become available, efforts in global mass vaccination can be hampered by the widespread issue of vaccine hesitancy. Objective: The aim of this study was to use social media data to capture close-to-real-time public perspectives and sentiments regarding COVID-19 vaccines, with the intention to understand the key issues that have captured public attention, as well as the barriers and facilitators to successful COVID-19 vaccination. Methods: Twitter was searched for tweets related to “COVID-19” and “vaccine” over an 11-week period after November 18, 2020, following a press release regarding the first effective vaccine. An unsupervised machine learning approach (ie, structural topic modeling) was used to identify topics from tweets, with each topic further grouped into themes using manually conducted thematic analysis as well as guided by the theoretical framework of the COM-B (capability, opportunity, and motivation components of behavior) model. Sentiment analysis of the tweets was also performed using the rule-based machine learning model VADER (Valence Aware Dictionary and Sentiment Reasoner). Results: Tweets related to COVID-19 vaccines were posted by individuals around the world (N=672,133). Six overarching themes were identified: (1) emotional reactions related to COVID-19 vaccines (19.3%), (2) public concerns related to COVID-19 vaccines (19.6%), (3) discussions about news items related to COVID-19 vaccines (13.3%), (4) public health communications about COVID-19 vaccines (10.3%), (5) discussions about approaches to COVID-19 vaccination drives (17.1%), and (6) discussions about the distribution of COVID-19 vaccines (20.3%). Tweets with negative sentiments largely fell within the themes of emotional reactions and public concerns related to COVID-19 vaccines. Tweets related to facilitators of vaccination showed temporal variations over time, while tweets related to barriers remained largely constant throughout the study period. Conclusions: The findings from this study may facilitate the formulation of comprehensive strategies to improve COVID-19 vaccine uptake; they highlight the key processes that require attention in the planning of COVID-19 vaccination and provide feedback on evolving barriers and facilitators in ongoing vaccination drives to allow for further policy tweaks. The findings also illustrate three key roles of social media in COVID-19 vaccination, as follows: surveillance and monitoring, a communication platform, and evaluation of government responses. %M 34583316 %R 10.2196/29789 %U https://publichealth.jmir.org/2021/11/e29789 %U https://doi.org/10.2196/29789 %U http://www.ncbi.nlm.nih.gov/pubmed/34583316 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 11 %P e30293 %T Adapting a Mental Health Intervention for Adolescents During the COVID-19 Pandemic: Web-Based Synchronous Focus Group Study %A Calvo-Valderrama,Maria Gabriela %A Marroquín-Rivera,Arturo %A Burn,Erin %A Ospina-Pinillos,Laura %A Bird,Victoria %A Gómez-Restrepo,Carlos %+ Unit for Social and Community Psychiatry, Institute of Population Health Sciences, Queen Mary University of London, Cherry Tree Way, London, E13 8SP, United Kingdom, 44 20754043802340, v.j.bird@qmul.ac.uk %K pandemic %K COVID-19 %K online focus groups %K qualitative research %K technology %K adolescents %K public health %D 2021 %7 3.11.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Although focus groups are a valuable qualitative research tool, face-to-face meetings may be difficult to arrange and time consuming. This challenge has been further compounded by the global COVID-19 pandemic and the subsequent lockdown and physical distancing measures implemented, which caused exceptional challenges to human activities. Online focus groups (OFGs) are an example of an alternative strategy and require further study. At present, OFGs have mostly been studied and used in high-income countries, with little information relating to their implementation in low- and middle-income countries (LMICs). Objective: The aim of this study is to share our experiences of conducting OFGs through a web conferencing service and provide recommendations for future research. Methods: As part of a broader study, OFGs were developed with adults and adolescents in Colombia during the COVID-19 pandemic. Through a convenience sampling method, we invited eligible participants via email in two different cities of Colombia to participate in OFGs conducted via Microsoft Teams. Researcher notes and discussion were used to capture participant and facilitator experiences, as well as practical considerations. Results: Technical issues were encountered, but various measures were taken to minimize them, such as using a web conferencing service that was familiar to participants, sending written instructions, and performing a trial meeting prior to the OFG. Adolescent participants, unlike their adult counterparts, were fluent in using web conferencing platforms and did not encounter technical challenges. Conclusions: OFGs have great potential in research settings, especially during the current and any future public health emergencies. It is important to keep in mind that even with the advantages that they offer, technical issues (ie, internet speed and access to technology) are major obstacles in LMICs. Further research is required and should carefully consider the appropriateness of OFGs in different settings. %M 34637395 %R 10.2196/30293 %U https://formative.jmir.org/2021/11/e30293 %U https://doi.org/10.2196/30293 %U http://www.ncbi.nlm.nih.gov/pubmed/34637395 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 11 %P e28929 %T A Case Study of an SMS Text Message Community Panel Survey and Its Potential for Use During the COVID-19 Pandemic %A Chan,Lilian %A El-Haddad,Nouhad %A Freeman,Becky %A O'Hara,Blythe J %A Woodland,Lisa %A Harris-Roxas,Ben %+ Prevention Research Collaboration, Sydney School of Public Health and Charles Perkins Centre, The University of Sydney, John Hopkins Drive, Camperdown, 2006, Australia, 61 286277554, lilian.chan@sydney.edu.au %K data collection %K mobile phone %K short message service %K tobacco %K COVID-19 %K survey %D 2021 %7 3.11.2021 %9 Viewpoint %J JMIR Form Res %G English %X During the COVID-19 pandemic many traditional methods of data collection, such as intercept surveys or focus groups, are not feasible. This paper proposes that establishing community panels through SMS text messages may be a useful method during the pandemic, by describing a case study of how an innovative SMS text message community panel was used for the “Shisha No Thanks” project to collect data from young adults of Arabic-speaking background about their attitudes on the harms of waterpipe smoking. Participants were asked to complete an initial recruitment survey, and then subsequently sent 1 survey question per week. The study recruited 133 participants to the SMS text message community panel and the mean response rate for each question was 73.0% (97.1/133) (range 76/133 [57.1%] to 112/133 [84.2%]). The SMS text message community panel approach is not suited for all populations, nor for all types of inquiry, particularly due to limitations of the type of responses that it allows and the required access to mobile devices. However, it is a rapid method for data collection, and therefore during the COVID-19 pandemic, it can provide service providers and policymakers with timely information to inform public health responses. In addition, this method negates the need for in-person interactions and allows for longitudinal data collection. It may be useful in supplementing other community needs assessment activities, and may be particularly relevant for people who are considered to be more difficult to reach, particularly young people, culturally and linguistically diverse communities, and other groups that might otherwise be missed by traditional methods. %M 34612824 %R 10.2196/28929 %U https://formative.jmir.org/2021/11/e28929 %U https://doi.org/10.2196/28929 %U http://www.ncbi.nlm.nih.gov/pubmed/34612824 %0 Journal Article %@ 2371-4379 %I JMIR Publications %V 6 %N 4 %P e23646 %T Telemedicine via Continuous Remote Care: A Proactive, Patient-Centered Approach to Improve Clinical Outcomes %A Hallberg,Sarah %A Harrison,David %+ Virta Health, 733 Warrick St, West Lafayette, IN, 47906, United States, 1 765 775 6550, sarah@virtahealth.com %K telemedicine %K continuous remote care %K diabetes %K COVID-19 %K pandemic %D 2021 %7 2.11.2021 %9 Viewpoint %J JMIR Diabetes %G English %X The COVID-19 pandemic has revolutionized health care for patients and providers alike. Telemedicine has moved from the periphery of our health care system to center stage more rapidly than anyone could have envisioned. Currently, virtual care has quite effectively replicated the traditional health system’s care delivery model and reimbursement structure—a patient makes an appointment, then sees a physician (except with video or phone replacing in-office visits) who makes a care plan, and the patient and physician meet again at a later timepoint to assess progress. Replicating this episodic care paradigm virtually has been invaluable for delivering care swiftly during the COVID-19 pandemic; however, we can and should do more with the connectedness and convenience that telemedicine technology enables. Continuous remote care, with a data-driven, proactive outreach to patients, represents a decisive step forward in contrast to the currently available episodic, reactive, patient-initiated care. In the context of continuous remote care, patient biometric and symptom data (patient entered and connected data) are assimilated in real time by artificial intelligence–enabled clinical platforms to bring physicians' and other health care team members’ attention to those patients who need intervention, whether this is via medication adjustments, acute care management, or lifestyle coaching. In this paper, we discuss how an innovative continuous remote care approach has improved outcomes in another deadly pandemic—type 2 diabetes mellitus. %M 34505578 %R 10.2196/23646 %U https://diabetes.jmir.org/2021/4/e23646 %U https://doi.org/10.2196/23646 %U http://www.ncbi.nlm.nih.gov/pubmed/34505578 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 11 %P e30961 %T An Online Assessment to Evaluate the Role of Cognitive Biases and Emotion Regulation Strategies for Mental Health During the COVID-19 Lockdown of 2020: Structural Equation Modeling Study %A Blanco,Ivan %A Boemo,Teresa %A Sanchez-Lopez,Alvaro %+ Department of Clinical Psychology, School of Psychology, Complutense University of Madrid, Campus de Somosaguas, Pozuelo de Alarcon, 28223, Spain, 34 650692547, ivan.blanco.martinez@ucm.es %K COVID-19 %K emotion regulation %K cognitive biases %K psychological adjustment %K resilience %D 2021 %7 2.11.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: Extant research supports causal roles of cognitive biases in stress regulation under experimental conditions. However, their contribution to psychological adjustment in the face of ecological major stressors has been largely unstudied. Objective: We developed a novel online method for the ecological examination of attention and interpretation biases during major stress (ie, the COVID-19 lockdown in March/April 2020) and tested their relations with the use of emotion regulation strategies (ie, reappraisal and rumination) to account for individual differences in psychological adjustment to major COVID-19–related stressors (ie, low depression and anxiety, and high well-being and resilience). Methods: Participants completed an online protocol evaluating the psychological impact of COVID-19–related stressors and the use of emotion regulation strategies in response to them, during the initial weeks of the lockdown of March/April 2020. They also completed a new online cognitive task designed to remotely assess attention and interpretation biases for negative information. The psychometric properties of the online cognitive bias assessments were very good, supporting their feasibility for ecological evaluation. Results: Structural equation models showed that negative interpretation bias was a direct predictor of worst psychological adjustment (higher depression and anxiety, and lower well-being and resilience; χ29=7.57; root mean square error of approximation=0.000). Further, rumination mediated the influence of interpretation bias in anxiety (P=.045; 95% CI 0.03-3.25) and resilience (P=.001; 95% CI −6.34 to −1.65), whereas reappraisal acted as a mediator of the influence of both attention (P=.047; 95% CI −38.71 to −0.16) and interpretation biases (P=.04; 95% CI −5.25 to −0.12) in well-being. Conclusions: This research highlights the relevance of individual processes of attention and interpretation during periods of adversity and identifies modifiable protective factors that can be targeted through online interventions. %M 34517337 %R 10.2196/30961 %U https://mental.jmir.org/2021/11/e30961 %U https://doi.org/10.2196/30961 %U http://www.ncbi.nlm.nih.gov/pubmed/34517337 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 9 %N 11 %P e32726 %T Optimal Triage for COVID-19 Patients Under Limited Health Care Resources With a Parsimonious Machine Learning Prediction Model and Threshold Optimization Using Discrete-Event Simulation: Development Study %A Kim,Jeongmin %A Lim,Hakyung %A Ahn,Jae-Hyeon %A Lee,Kyoung Hwa %A Lee,Kwang Suk %A Koo,Kyo Chul %+ Department of Urology, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul, 135-720, Republic of Korea, 82 01099480342, gckoo@yuhs.ac %K COVID-19 %K decision support techniques %K machine learning %K prediction %K triage %D 2021 %7 2.11.2021 %9 Original Paper %J JMIR Med Inform %G English %X Background: The COVID-19 pandemic has placed an unprecedented burden on health care systems. Objective: We aimed to effectively triage COVID-19 patients within situations of limited data availability and explore optimal thresholds to minimize mortality rates while maintaining health care system capacity. Methods: A nationwide sample of 5601 patients confirmed with COVID-19 until April 2020 was retrospectively reviewed. Extreme gradient boosting (XGBoost) and logistic regression analysis were used to develop prediction models for the maximum clinical severity during hospitalization, classified according to the World Health Organization Ordinal Scale for Clinical Improvement (OSCI). The recursive feature elimination technique was used to evaluate the maintenance of model performance when clinical and laboratory variables were eliminated. Using populations based on hypothetical patient influx scenarios, discrete-event simulation was performed to find an optimal threshold within limited resource environments that minimizes mortality rates. Results: The cross-validated area under the receiver operating characteristic curve (AUROC) of the baseline XGBoost model that utilized all 37 variables was 0.965 for OSCI ≥6. Compared to the baseline model’s performance, the AUROC of the feature-eliminated model that utilized 17 variables was maintained at 0.963 with statistical insignificance. Optimal thresholds were found to minimize mortality rates in a hypothetical patient influx scenario. The benefit of utilizing an optimal triage threshold was clear, reducing mortality up to 18.1%, compared with the conventional Youden index. Conclusions: Our adaptive triage model and its threshold optimization capability revealed that COVID-19 management can be achieved via the cooperation of both the medical and health care management sectors for maximum treatment efficacy. The model is available online for clinical implementation. %M 34609319 %R 10.2196/32726 %U https://medinform.jmir.org/2021/11/e32726 %U https://doi.org/10.2196/32726 %U http://www.ncbi.nlm.nih.gov/pubmed/34609319 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 11 %P e26136 %T Conducting Health Literacy Research With Hard-to-Reach Regional Culturally and Linguistically Diverse Populations: Evaluation Study of Recruitment and Retention Methods Before and During COVID-19 %A Perrins,Genevieve %A Ferdous,Tabassum %A Hay,Dawn %A Harreveld,Bobby %A Reid-Searl,Kerry %+ Central Queensland Multicultural Association, CQUniversity Rockhampton North, Room 31, Building 41 Buzacott Circle, 554-700 Yaamba Road, Norman Gardens, Rockhampton, 4701, Australia, 61 423853809, evie.perrins@cqma.org.au %K health literacy %K cultural and linguistic diversity %K COVID-19 %K health care barriers %K hard-to-reach research participants %K regional Australia %K health literacy profiles %K literacy %D 2021 %7 2.11.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: In health research, culturally and linguistically diverse (CALD) health care consumers are cited as hidden or hard to reach. This paper evaluates the approach used by researchers to attract and retain hard-to-reach CALD research participants for a study investigating health communication barriers between CALD health care users and health care professionals in regional Australia. As the study was taking place during the COVID-19 pandemic, subsequent restrictions emerged. Thus, recruitment and retention methods were adapted. This evaluation considered the effectiveness of recruitment and retention used throughout the pre-COVID and during-COVID periods. Objective: This evaluation sought to determine the effectiveness of recruitment and retention efforts of researchers during a study that targeted regional hard-to-reach CALD participants. Methods: Recruitment and retention methods were categorized into the following 5 phases: recruitment, preintervention data collection, intervention, postintervention data collection, and interviews. To compare the methods used by researchers, recruitment and retention rates were divided into pre-COVID and during-COVID periods. Thereafter, in-depth reflections of the methods employed within this study were made. Results: This paper provides results relating to participant recruitment and retainment over the course of 5 research phases that occurred before and during COVID. During the pre-COVID recruitment phase, 22 participants were recruited. Of these participants, 15 (68%) transitioned to the next phase and completed the initial data collection phase. By contrast, 18 participants completed the during-COVID recruitment phase, with 13 (72%) continuing to the next phase. The success rate of the intervention phase in the pre-COVID period was 93% (14/15), compared with 84.6% (11/13) in the during-COVID period. Lastly, 93% (13/14) of participants completed the postintervention data collection in the pre-COVID period, compared with 91% (10/11) in the during-COVID period. In total, 40 participants took part in the initial data collection phase, with 23 (58%) completing the 5 research phases. Owing to the small sample size, it was not determined if there was any statistical significance between the groups (pre- and during-COVID periods). Conclusions: The success of this program in recruiting and maintaining regional hard-to-reach CALD populations was preserved over the pre- and during-COVID periods. The pandemic required researchers to adjust study methods, thereby inadvertently contributing to the recruitment and retention success of the project. The maintenance of participants during this period was due to flexibility offered by researchers through adaptive methods, such as the use of cultural gatekeepers, increased visibility of CALD researchers, and use of digital platforms. The major findings of this evaluation are 2-fold. First, increased diversity in the research sample required a high level of flexibility from researchers, meaning that such projects may be more resource intensive. Second, community organizations presented a valuable opportunity to connect with potential hard-to-reach research participants. %M 34581673 %R 10.2196/26136 %U https://formative.jmir.org/2021/11/e26136 %U https://doi.org/10.2196/26136 %U http://www.ncbi.nlm.nih.gov/pubmed/34581673 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 11 %P e28105 %T Utility of a Telephone Triage Hotline in Response to the COVID-19 Pandemic: Longitudinal Observational Study %A Cher,Benjamin A Y %A Wilson,Eric A %A Pinsky,Alexa M %A Townshend,Ryan F %A Wolski,Ann V %A Broderick,Michael %A Milen,Allison M %A Lau,Audrey %A Singh,Amrit %A Cinti,Sandro K %A Engelke,Carl G %A Saha,Anjan K %+ Department of Anesthesiology, Columbia University Irving Medical Center, 622 West 168th Street, 10032, New York, NY, United States, 1 (703) 785 3087, aks9032@nyp.org %K triage %K telephone %K COVID-19 %K utility %K telemedicine %K telehealth %K patient information %K concern %K implementation %K innovation %K hospital %D 2021 %7 1.11.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: During the initial months of the COVID-19 pandemic, rapidly rising disease prevalence in the United States created a demand for patient-facing information exchanges that addressed questions and concerns about the disease. One approach to managing increased patient volumes during a pandemic involves the implementation of telephone-based triage systems. During a pandemic, telephone triage hotlines can be employed in innovative ways to conserve medical resources and offer useful population-level data about disease symptomatology and risk factor profiles. Objective: The aim of this study is to describe and evaluate the COVID-19 telephone triage hotline used by a large academic medical center in the midwestern United States. Methods: Michigan Medicine established a telephone hotline to triage inbound patient calls related to COVID-19. For calls received between March 24, 2020, and May 5, 2020, we described total call volume, data reported by callers including COVID-19 risk factors and symptomatology, and distribution of callers to triage algorithm endpoints. We also described symptomatology reported by callers who were directed to the institutional patient portal (online medical visit questionnaire). Results: A total of 3929 calls (average 91 calls per day) were received by the call center during the study period. The maximum total number of daily calls peaked at 211 on March 24, 2020. Call volumes were the highest from 6 AM to 11 AM and during evening hours. Callers were most often directed to the online patient portal (1654/3929, 42%), nursing hotlines (1338/3929, 34%), or employee health services (709/3929, 18%). Cough (126/370 of callers, 34%), shortness of breath (101/370, 27%), upper respiratory infection (28/111, 25%), and fever (89/370, 24%) were the most commonly reported symptoms. Immunocompromised state (23/370, 6%) and age >65 years (18/370, 5%) were the most commonly reported risk factors. Conclusions: The triage algorithm successfully diverted low-risk patients to suitable algorithm endpoints, while directing high-risk patients onward for immediate assessment. Data collected from hotline calls also enhanced knowledge of symptoms and risk factors that typified community members, demonstrating that pandemic hotlines can aid in the clinical characterization of novel diseases. %M 34559669 %R 10.2196/28105 %U https://www.jmir.org/2021/11/e28105 %U https://doi.org/10.2196/28105 %U http://www.ncbi.nlm.nih.gov/pubmed/34559669 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 11 %P e25298 %T A Text Messaging Intervention (StayWell at Home) to Counteract Depression and Anxiety During COVID-19 Social Distancing: Pre-Post Study %A Aguilera,Adrian %A Hernandez-Ramos,Rosa %A Haro-Ramos,Alein Y %A Boone,Claire Elizabeth %A Luo,Tiffany Christina %A Xu,Jing %A Chakraborty,Bibhas %A Karr,Chris %A Darrow,Sabrina %A Figueroa,Caroline Astrid %+ School of Social Welfare, University of California, Berkeley, 120 Haviland Hall, MC7400, School of Social Welfare, Berkeley, CA, 94720, United States, 1 (510) 642 8564, aguila@berkeley.edu %K mobile health %K COVID-19 %K text messaging %K cognitive behavioral therapy %K anxiety %K depression %K microrandomized trials %K mHealth %K intervention %K mental health %K SMS %D 2021 %7 1.11.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: Social distancing and stay-at-home orders are critical interventions to slow down person-to-person transmission of COVID-19. While these societal changes help contain the pandemic, they also have unintended negative consequences, including anxiety and depression. We developed StayWell, a daily skills-based SMS text messaging program, to mitigate COVID-19–related depression and anxiety symptoms among people who speak English and Spanish in the United States. Objective: This paper describes the changes in StayWell participants’ anxiety and depression levels after 60 days of exposure to skills-based SMS text messages. Methods: We used self-administered, empirically supported web-based questionnaires to assess the demographic and clinical characteristics of StayWell participants. Anxiety and depression were measured using the 2-item Generalized Anxiety Disorder (GAD-2) scale and the 8-item Patient Health Questionnaire-8 (PHQ-8) scale at baseline and 60-day timepoints. We used 2-tailed paired t tests to detect changes in PHQ-8 and GAD-2 scores from baseline to follow-up measured 60 days later. Results: The analytic sample includes 193 participants who completed both the baseline and 60-day exit questionnaires. At the 60-day time point, there were significant reductions in both PHQ-8 and GAD-2 scores from baseline. We found an average reduction of –1.72 (95% CI –2.35 to –1.09) in PHQ-8 scores and –0.48 (95% CI –0.71 to –0.25) in GAD-2 scores. These improvements translated to an 18.5% and 17.2% reduction in mean PHQ-8 and GAD-2 scores, respectively. Conclusions: StayWell is an accessible, low-intensity population-level mental health intervention. Participation in StayWell focused on COVID-19 mental health coping skills and was related to improved depression and anxiety symptoms. In addition to improvements in outcomes, we found high levels of engagement during the 60-day intervention period. Text messaging interventions could serve as an important public health tool for disseminating strategies to manage mental health. Trial Registration: ClinicalTrials.gov NCT04473599; https://clinicaltrials.gov/ct2/show/NCT04473599 International Registered Report Identifier (IRRID): RR2-10.2196/23592 %M 34543230 %R 10.2196/25298 %U https://mental.jmir.org/2021/11/e25298 %U https://doi.org/10.2196/25298 %U http://www.ncbi.nlm.nih.gov/pubmed/34543230 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 11 %P e33653 %T A Novel Risk and Crisis Communication Platform to Bridge the Gap Between Policy Makers and the Public in the Context of the COVID-19 Crisis (PubliCo): Protocol for a Mixed Methods Study %A Spitale,Giovanni %A Merten,Sonja %A Jafflin,Kristen %A Schwind,Bettina %A Kaiser-Grolimund,Andrea %A Biller-Andorno,Nikola %+ Institute of Biomedical Ethics and History of Medicine, University of Zurich, Winterthurerstrasse 30, Zurich, 8006, Switzerland, 41 44 634 40 80, biller-andorno@ibme.uzh.ch %K disease outbreaks %K coronavirus %K COVID-19 surveys %K COVID-19 questionnaires %K qualitative methods %K health literacy %K policy making %K risk and crisis communication %K COVID-19 %D 2021 %7 1.11.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Since the end of 2019, COVID-19 has had a significant impact on people around the globe. As governments institute more restrictive measures, public adherence could decrease and discontent may grow. Providing high-quality information and countering fake news are important. However, we also need feedback loops so that government officials can refine preventive measures and communication strategies. Policy makers need information—preferably based on real-time data—on people’s cognitive, emotional, and behavioral reactions to public health messages and restrictive measures. PubliCo aims to foster effective and tailored risk and crisis communication as well as provide an assessment of the risks and benefits of prevention and control measures, since their effectiveness depends on public trust and cooperation. Objective: Our project aims to develop a tool that helps tackle the COVID-19 infodemic, with a focus on enabling a nuanced and in-depth understanding of public perception. The project adopts a transdisciplinary multistakeholder approach, including participatory citizen science. Methods: We aim to combine a literature and media review and analysis as well as empirical research using mixed methods, including an online survey and diary-based research, both of which are ongoing and continuously updated. Building on real-time data and continuous data collection, our research results will be highly adaptable to the evolving situation. Results: As of September 2021, two-thirds of the proposed tool is operational. The current development cycles are focusing on analytics, user experience, and interface refinement. We have collected a total of 473 responses through PubliCo Survey and 22 diaries through PubliCo Diaries. Conclusions: Pilot data show that PubliCo is a promising and efficient concept for bidirectional risk and crisis communication in the context of public health crises. Further data are needed to assess its function at a larger scale or in the context of an issue other than COVID-19. International Registered Report Identifier (IRRID): DERR1-10.2196/33653 %M 34612823 %R 10.2196/33653 %U https://www.researchprotocols.org/2021/11/e33653 %U https://doi.org/10.2196/33653 %U http://www.ncbi.nlm.nih.gov/pubmed/34612823 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 10 %P e30449 %T Young Adults’ Responses to an African and US-Based COVID-19 Edutainment Miniseries: Real-Time Qualitative Analysis of Online Social Media Engagement %A Baker,Venetia %A Arnold,Georgia %A Piot,Sara %A Thwala,Lesedi %A Glynn,Judith %A Hargreaves,James %A Birdthistle,Isolde %+ Department of Population Health, Faculty of Epidemiology and Population Health, The London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, United Kingdom, 44 20 7636 8636, venetia.baker1@lshtm.ac.uk %K COVID-19 %K adolescents %K young people %K social media %K edutainment %D 2021 %7 29.10.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: In April 2020, as cases of the novel COVID-19 spread across the globe, MTV Staying Alive Foundation created the educational entertainment miniseries MTV Shuga: Alone Together. In 70 short episodes released daily on YouTube, Alone Together aimed to disseminate timely and accurate information to increase young people’s knowledge, motivation, and actions to prevent COVID-19. Objective: We sought to identify Alone Together viewer’s perspectives on the global COVID-19 pandemic and national lockdowns by examining the words, conversations, experiences, and emotions expressed on social media in response to the Alone Together episodes. We also assessed how viewers used the series and its online community as a source of support during the global pandemic. Methods: A total of 3982 comments and 70 live chat conversations were extracted from YouTube between April and October 2020 and analyzed through a data-led inductive thematic approach. Aggregated demographic and geographical data were collected using YouTube Analytics. Results: The miniseries had a global reach across 5 continents, with a total of 7.7 million views across MTV Shuga platforms. The series had over 1 million views over 70 episodes on YouTube and an average of 5683 unique viewers per episode on YouTube. The dominant audience was adults under the age of 35 years and women. Across diverse countries such as Nigeria, Ghana, the United States, and the UK, viewers believed that COVID-19 was serious and expressed that it was socially responsible to follow public health measures. Storylines of the series about the impact of self-isolation on mental health, exposure to violence in lockdowns, and restricted employment opportunities due to the pandemic resonated with young viewers. Tuning in to the miniseries provided viewers with reliable information, entertainment, and an online community during an isolating, confusing, and worrying time. Conclusions: During the first wave of COVID-19, viewers from at least 53 countries connected on social media via the MTV miniseries. The analysis showed how digitally connected people under the age of 35 years, predominantly women, felt compelled to follow COVID-19 safety measures despite the pandemic’s impact on their social, educational, and financial needs. Viewers used social media to reach out to fellow viewers for advice, solace, support, and resources. Organizations, governments, and individuals have been forced to innovate during the pandemic to ensure people can access services safely and remotely. This analysis showed that women under 35 years of age were especially receptive to receiving support from online communities and media services. Peer influence and support online can be a powerful public health tool as people have a great capacity to influence each other and shape norms around public health. However, online services are not accessible to everyone, and COVID-19 has increased disparities between digitally connected and unconnected younger adults. %M 34596568 %R 10.2196/30449 %U https://formative.jmir.org/2021/10/e30449 %U https://doi.org/10.2196/30449 %U http://www.ncbi.nlm.nih.gov/pubmed/34596568 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 10 %P e28613 %T Applications of Blockchain in the Medical Field: Narrative Review %A Xie,Yi %A Zhang,Jiayao %A Wang,Honglin %A Liu,Pengran %A Liu,Songxiang %A Huo,Tongtong %A Duan,Yu-Yu %A Dong,Zhe %A Lu,Lin %A Ye,Zhewei %+ Department of Orthopedics Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Dadao, Wuhan, 430022, China, 86 17771413685, yezhewei@hust.edu.cn %K blockchain %K smart health care %K health care %K health data %K review %K COVID-19 %K electronic health records %D 2021 %7 28.10.2021 %9 Review %J J Med Internet Res %G English %X Background: As a distributed technology, blockchain has attracted increasing attention from stakeholders in the medical industry. Although previous studies have analyzed blockchain applications from the perspectives of technology, business, or patient care, few studies have focused on actual use-case scenarios of blockchain in health care. In particular, the outbreak of COVID-19 has led to some new ideas for the application of blockchain in medical practice. Objective: This paper aims to provide a systematic review of the current and projected uses of blockchain technology in health care, as well as directions for future research. In addition to the framework structure of blockchain and application scenarios, its integration with other emerging technologies in health care is discussed. Methods: We searched databases such as PubMed, EMBASE, Scopus, IEEE, and Springer using a combination of terms related to blockchain and health care. Potentially relevant papers were then compared to determine their relevance and reviewed independently for inclusion. Through a literature review, we summarize the key medical scenarios using blockchain technology. Results: We found a total of 1647 relevant studies, 60 of which were unique studies that were included in this review. These studies report a variety of uses for blockchain and their emphasis differs. According to the different technical characteristics and application scenarios of blockchain, we summarize some medical scenarios closely related to blockchain from the perspective of technical classification. Moreover, potential challenges are mentioned, including the confidentiality of privacy, the efficiency of the system, security issues, and regulatory policy. Conclusions: Blockchain technology can improve health care services in a decentralized, tamper-proof, transparent, and secure manner. With the development of this technology and its integration with other emerging technologies, blockchain has the potential to offer long-term benefits. Not only can it be a mechanism to secure electronic health records, but blockchain also provides a powerful tool that can empower users to control their own health data, enabling a foolproof health data history and establishing medical responsibility. %M 34533470 %R 10.2196/28613 %U https://www.jmir.org/2021/10/e28613 %U https://doi.org/10.2196/28613 %U http://www.ncbi.nlm.nih.gov/pubmed/34533470 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 10 %P e31086 %T Pilot Evaluations of Two Bluetooth Contact Tracing Approaches on a University Campus: Mixed Methods Study %A Shelby,Tyler %A Caruthers,Tyler %A Kanner,Oren Y %A Schneider,Rebecca %A Lipnickas,Dana %A Grau,Lauretta E %A Manohar,Rajit %A Niccolai,Linda %+ Epidemiology of Microbial Diseases Department, Yale School of Public Health, Yale University, 60 College Street, New Haven, CT, United States, 1 6202284003, tyler.shelby@yale.edu %K mHealth %K digital contact tracing %K Bluetooth %K COVID-19 %K mixed methods %D 2021 %7 28.10.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Many have proposed the use of Bluetooth technology to help scale up contact tracing for COVID-19. However, much remains unknown about the accuracy of this technology in real-world settings, the attitudes of potential users, and the differences between delivery formats (mobile app vs carriable or wearable devices). Objective: We pilot tested 2 separate Bluetooth contact tracing technologies on a university campus to evaluate their sensitivity and specificity, and to learn from the experiences of the participants. Methods: We used a convergent mixed methods study design, and participants included graduate students and researchers working on a university campus during June and July 2020. We conducted separate 2-week pilot studies for each Bluetooth technology. The first was for a mobile phone app (“app pilot”), and the second was for a small electronic “tag” (“tag pilot”). Participants validated a list of Bluetooth-identified contacts daily and reported additional close contacts not identified by Bluetooth. We used these data to estimate sensitivity and specificity. Participants completed a postparticipation survey regarding appropriateness, usability, acceptability, and adherence, and provided additional feedback via free text. We used tests of proportions to evaluate differences in survey responses between participants from each pilot, paired t tests to measure differences between compatible survey questions, and qualitative analysis to evaluate the survey’s free-text responses. Results: Among 25 participants in the app pilot, 53 contact interactions were identified by Bluetooth and an additional 61 by self-report. Among 17 participants in the tag pilot, 171 contact interactions were identified by Bluetooth and an additional 4 by self-report. The tag had significantly higher sensitivity compared with the app (46/49, 94% vs 35/61, 57%; P<.001), as well as higher specificity (120/126, 95% vs 123/141, 87%; P=.02). Most participants felt that Bluetooth contact tracing was appropriate on campus (26/32, 81%), while significantly fewer participants felt that using other technologies, such as GPS or Wi-Fi, was appropriate (17/31, 55%; P=.02). Most participants preferred technology developed and managed by the university rather than a third party (27/32, 84%) and preferred not to have tracing apps on their personal phones (21/32, 66%), due to “concerns with privacy.” There were no significant differences in self-reported adherence rates across pilots. Conclusions: Convenient and carriable Bluetooth technology may improve tracing efficiency while alleviating privacy concerns by shifting data collection away from personal devices. With accuracy comparable to, and in this case, superior to, mobile phone apps, such approaches may be suitable for workplace or school settings with the ability to purchase and maintain physical devices. %M 34586078 %R 10.2196/31086 %U https://formative.jmir.org/2021/10/e31086 %U https://doi.org/10.2196/31086 %U http://www.ncbi.nlm.nih.gov/pubmed/34586078 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 10 %P e29820 %T Emotional Tone, Analytical Thinking, and Somatosensory Processes of a Sample of Italian Tweets During the First Phases of the COVID-19 Pandemic: Observational Study %A Monzani,Dario %A Vergani,Laura %A Pizzoli,Silvia Francesca Maria %A Marton,Giulia %A Pravettoni,Gabriella %+ Department of Oncology and Hemato-Oncology, University of Milan, Via Festa del Perdono 7, Milan, 20122, Italy, 39 029 4372099, laura.vergani@ieo.it %K internet %K mHealth %K infodemiology %K infoveillance %K pandemic %K public health %K COVID-19 %K Twitter %K psycholinguistic analysis %K trauma %D 2021 %7 27.10.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic is a traumatic individual and collective chronic experience, with tremendous consequences on mental and psychological health that can also be reflected in people’s use of words. Psycholinguistic analysis of tweets from Twitter allows obtaining information about people’s emotional expression, analytical thinking, and somatosensory processes, which are particularly important in traumatic events contexts. Objective: We aimed to analyze the influence of official Italian COVID-19 daily data (new cases, deaths, and hospital discharges) and the phase of managing the pandemic on how people expressed emotions and their analytical thinking and somatosensory processes in Italian tweets written during the first phases of the COVID-19 pandemic in Italy. Methods: We retrieved 1,697,490 Italian COVID-19–related tweets written from February 24, 2020 to June 14, 2020 and analyzed them using LIWC2015 to calculate 3 summary psycholinguistic variables: emotional tone, analytical thinking, and somatosensory processes. Official daily data about new COVID-19 cases, deaths, and hospital discharges were retrieved from the Italian Prime Minister's Office and Civil Protection Department GitHub page. We considered 3 phases of managing the COVID-19 pandemic in Italy. We performed 3 general models, 1 for each summary variable as the dependent variable and with daily data and phase of managing the pandemic as independent variables. Results: General linear models to assess differences in daily scores of emotional tone, analytical thinking, and somatosensory processes were significant (F6,104=21.53, P<.001, R2= .55; F5,105=9.20, P<.001, R2= .30; F6,104=6.15, P<.001, R2=.26, respectively). Conclusions: The COVID-19 pandemic affects how people express emotions, analytical thinking, and somatosensory processes in tweets. Our study contributes to the investigation of pandemic psychological consequences through psycholinguistic analysis of social media textual data. %M 34516386 %R 10.2196/29820 %U https://www.jmir.org/2021/10/e29820 %U https://doi.org/10.2196/29820 %U http://www.ncbi.nlm.nih.gov/pubmed/34516386 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 10 %P e32345 %T Assessment of an Innovative Mobile Dentistry eHygiene Model Amid the COVID-19 Pandemic in the National Dental Practice–Based Research Network: Protocol for Design, Implementation, and Usability Testing %A Xiao,Jin %A Meyerowitz,Cyril %A Ragusa,Patricia %A Funkhouser,Kimberly %A Lischka,Tamara R %A Mendez Chagoya,Luis Alberto %A Al Jallad,Nisreen %A Wu,Tong Tong %A Fiscella,Kevin %A Ivie,Eden %A Strange,Michelle %A Collins,Jamie %A Kopycka-Kedzierawski,Dorota T %A , %+ Eastman Institute for Oral Health, University of Rochester Medical Center, 625 Elmwood Ave, Rochester, NY, 14620, United States, 1 585 275 0706, Dorota_KopyckaKedzierawski@URMC.Rochester.edu %K teledentistry %K mDentistry %K oral diseases %K virtual visit %K intraoral camera %K pandemic response %K COVID-19 %K mHealth %D 2021 %7 26.10.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Amid COVID-19, and other possible future infectious disease pandemics, dentistry needs to consider modified dental examination regimens that render quality care, are cost effective, and ensure the safety of patients and dental health care personnel (DHCP). Traditional dental examinations, which number more than 300 million per year in the United States, rely on person-to-person tactile examinations, pose challenges to infection control, and consume large quantities of advanced-level personal protective equipment (PPE). Therefore, our long-term goal is to develop an innovative mobile dentistry (mDent) model that takes these issues into account. This model supplements the traditional dental practice with virtual visits, supported by mobile devices such as mobile telephones, tablets, and wireless infrastructure. The mDent model leverages the advantages of digital mobile health (mHealth) tools such as intraoral cameras to deliver virtual oral examinations, treatment planning, and interactive oral health management, on a broad population basis. Conversion of the traditional dental examinations to mDent virtual examinations builds upon (1) the reliability of teledentistry, which uses intraoral photos and live videos to make diagnostic decisions, and (2) rapid advancement in mHealth tool utilization. Objective: In this pilot project, we designed a 2-stage implementation study to assess 2 critical components of the mDent model: virtual hygiene examination (eHygiene) and patient self-taken intraoral photos (SELFIE). Our specific aims are to (1) assess the acceptance and barriers of mDent eHygiene among patients and DHCP, (2) assess the economic impact of mDent eHygiene, and (3) assess the patient’s capability to generate intraoral photos using mHealth tools (exploratory aim, SELFIE). Methods: This study will access the rich resources of the National Dental Practice-Based Research Network to recruit 12 dentists, 12 hygienists, and 144 patients from 12 practices. For aims 1 and 2, we will use role-specific questionnaires to collect quantitative data on eHygiene acceptance and economic impact. The questionnaire components include participant characteristics, the System Usability Scale, a dentist-patient communication scale, practice operation cost, and patient opportunity cost. We will further conduct a series of iterative qualitative research activities using individual interviews to further elicit feedback and suggestion for changes to the mDent eHygiene model. For aim 3, we will use mixed methods (quantitative and qualitative) to assess the patient’s capability of taking intraoral photos, by analyzing obtained photos and recorded videos. Results: The study is supported by the US National Institute of Dental and Craniofacial Research. This study received “single” institutional review board approval in August 2021. Data collection and analysis are expected to conclude by December 2021 and March 2022, respectively. Conclusions: The study results will inform the logistics of conducting virtual dental examinations and empowering patients with mHealth tools, providing better safety and preserving PPE amid the COVID-19 and possible future pandemics. International Registered Report Identifier (IRRID): PRR1-10.2196/32345 %M 34597259 %R 10.2196/32345 %U https://www.researchprotocols.org/2021/10/e32345 %U https://doi.org/10.2196/32345 %U http://www.ncbi.nlm.nih.gov/pubmed/34597259 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 10 %P e31101 %T Using Twitter Comments to Understand People’s Experiences of UK Health Care During the COVID-19 Pandemic: Thematic and Sentiment Analysis %A Ainley,Esther %A Witwicki,Cara %A Tallett,Amy %A Graham,Chris %+ Picker Institute Europe, Buxton Court, 3 West Way, Oxford, OX2 0JB, United Kingdom, 44 01865208168, esther.ainley@pickereurope.ac.uk %K patient experience %K COVID-19 %K remote health care %K phone consultation %K video consultation %K Twitter %K sentiment analysis %K social media %K digital health %K public health %K public opinion %D 2021 %7 25.10.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic has led to changes in health service utilization patterns and a rapid rise in care being delivered remotely. However, there has been little published research examining patients’ experiences of accessing remote consultations since COVID-19. Such research is important as remote methods for delivering some care may be maintained in the future. Objective: The aim of this study was to use content from Twitter to understand discourse around health and care delivery in the United Kingdom as a result of COVID-19, focusing on Twitter users’ views on and attitudes toward care being delivered remotely. Methods: Tweets posted from the United Kingdom between January 2018 and October 2020 were extracted using the Twitter application programming interface. A total of 1408 tweets across three search terms were extracted into Excel; 161 tweets were removed following deduplication and 610 were identified as irrelevant to the research question. The remaining relevant tweets (N=637) were coded into categories using NVivo software, and assigned a positive, neutral, or negative sentiment. To examine views of remote care over time, the coded data were imported back into Excel so that each tweet was associated with both a theme and sentiment. Results: The volume of tweets on remote care delivery increased markedly following the COVID-19 outbreak. Five main themes were identified in the tweets: access to remote care (n=267), quality of remote care (n=130), anticipation of remote care (n=39), online booking and asynchronous communication (n=85), and publicizing changes to services or care delivery (n=160). Mixed public attitudes and experiences to the changes in service delivery were found. The proportion of positive tweets regarding access to, and quality of, remote care was higher in the immediate period following the COVID-19 outbreak (March-May 2020) when compared to the time before COVID-19 onset and the time when restrictions from the first lockdown eased (June-October 2020). Conclusions: Using Twitter data to address our research questions proved beneficial for providing rapid access to Twitter users’ attitudes to remote care delivery at a time when it would have been difficult to conduct primary research due to COVID-19. This approach allowed us to examine the discourse on remote care over a relatively long period and to explore shifting attitudes of Twitter users at a time of rapid changes in care delivery. The mixed attitudes toward remote care highlight the importance for patients to have a choice over the type of consultation that best suits their needs, and to ensure that the increased use of technology for delivering care does not become a barrier for some. The finding that overall sentiment about remote care was more positive in the early stages of the pandemic but has since declined emphasizes the need for a continued examination of people’s preference, particularly if remote appointments are likely to remain central to health care delivery. %M 34469327 %R 10.2196/31101 %U https://www.jmir.org/2021/10/e31101 %U https://doi.org/10.2196/31101 %U http://www.ncbi.nlm.nih.gov/pubmed/34469327 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 10 %P e30217 %T The State of Mind of Health Care Professionals in Light of the COVID-19 Pandemic: Text Analysis Study of Twitter Discourses %A Elyashar,Aviad %A Plochotnikov,Ilia %A Cohen,Idan-Chaim %A Puzis,Rami %A Cohen,Odeya %+ Software and Information Systems Engineering, Ben-Gurion University of the Negev, Rager st. POB 653, Beer Sheva, 8410501, Israel, 972 544764010, puzis@bgu.ac.il %K health care professionals %K Twitter %K COVID-19 %K topic analysis %K emotion analysis %K sentiment analysis %K social media %K machine learning %K active learning %D 2021 %7 22.10.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic has affected populations worldwide, with extreme health, economic, social, and political implications. Health care professionals (HCPs) are at the core of pandemic response and are among the most crucial factors in maintaining coping capacities. Yet, they are also vulnerable to mental health effects caused by managing a long-lasting emergency with a lack of resources and under complicated personal concerns. However, there are a lack of longitudinal studies that investigate the HCP population. Objective: The aim of this study was to analyze the state of mind of HCPs as expressed in online discussions published on Twitter in light of the COVID-19 pandemic, from the onset of the pandemic until the end of 2020. Methods: The population for this study was selected from followers of a few hundred Twitter accounts of health care organizations and common HCP points of interest. We used active learning, a process that iteratively uses machine learning and manual data labeling, to select the large-scale population of Twitter accounts maintained by English-speaking HCPs, focusing on individuals rather than official organizations. We analyzed the topics and emotions in their discourses during 2020. The topic distributions were obtained using the latent Dirichlet allocation algorithm. We defined a measure of topic cohesion and described the most cohesive topics. The emotions expressed in tweets during 2020 were compared to those in 2019. Finally, the emotion intensities were cross-correlated with the pandemic waves to explore possible associations between the pandemic development and emotional response. Results: We analyzed the timelines of 53,063 Twitter profiles, 90% of which were maintained by individual HCPs. Professional topics accounted for 44.5% of tweets by HCPs from January 1, 2019, to December 6, 2020. Events such as the pandemic waves, US elections, or the George Floyd case affected the HCPs’ discourse. The levels of joy and sadness exceeded their minimal and maximal values from 2019, respectively, 80% of the time (P=.001). Most interestingly, fear preceded the pandemic waves, in terms of the differences in confirmed cases, by 2 weeks with a Spearman correlation coefficient of ρ(47 pairs)=0.340 (P=.03). Conclusions: Analyses of longitudinal data over the year 2020 revealed that a large fraction of HCP discourse is directly related to professional content, including the increase in the volume of discussions following the pandemic waves. The changes in emotional patterns (ie, decrease in joy and increase in sadness, fear, and disgust) during the year 2020 may indicate the utmost importance in providing emotional support for HCPs to prevent fatigue, burnout, and mental health disorders during the postpandemic period. The increase in fear 2 weeks in advance of pandemic waves indicates that HCPs are in a position, and with adequate qualifications, to anticipate pandemic development, and could serve as a bottom-up pathway for expressing morbidity and clinical situations to health agencies. %M 34550899 %R 10.2196/30217 %U https://www.jmir.org/2021/10/e30217 %U https://doi.org/10.2196/30217 %U http://www.ncbi.nlm.nih.gov/pubmed/34550899 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 7 %N 4 %P e30613 %T Best Practices for the Implementation and Sustainment of Virtual Health Information System Training: Qualitative Study %A Jeyakumar,Tharshini %A Ambata-Villanueva,Sharon %A McClure,Sarah %A Henderson,Carolyn %A Wiljer,David %+ University Health Network, 190 Elizabeth Street, R. Fraser Elliot Building, RFE 3S-441, Toronto, ON, M5G 2C4, Canada, 1 14163404800, David.Wiljer@uhn.ca %K training %K health care providers %K educational technology %K patient care %K COVID-19 %K development %K practice %K best practice %K pedagogy %K teaching %K implementation %K medical education %K online education %K care delivery %K perception %K effectiveness %D 2021 %7 22.10.2021 %9 Original Paper %J JMIR Med Educ %G English %X Background: The COVID-19 pandemic has necessitated the adoption and implementation of digital technologies to help transform the educational ecosystem and the delivery of care. Objective: We sought to understand instructors’ and learners’ perceptions of the challenges and opportunities faced in implementing health information system virtual training amid the COVID-19 pandemic. Methods: Semistructured interviews were conducted with education specialists and health care staff who provided or had taken part in a virtual instructor-led training at a large Canadian academic health sciences center. Guided by the Technology Acceptance Model and the Community of Inquiry framework, we analyzed interview transcript themes deductively and inductively. Results: Of the 18 individuals participating in the study, 9 were education specialists, 5 were learners, 3 were program coordinators, and 1 was a senior manager at the Centre for Learning, Innovation, and Simulation. We found 3 predominant themes: adopting a learner-centered approach for a meaningful learning experience, embracing the advances in educational technologies to maximize the transfer of learning, and enhancing the virtual user experience. Conclusions: This study adds to the literature on designing and implementing virtual training in health care organizations by highlighting the importance of recognizing learners’ needs and maximizing the transfer of learning. Findings from this study can be used to help inform the design and development of training strategies to support learners across an organization during the current climate and to ensure changes are sustainable. %M 34449402 %R 10.2196/30613 %U https://mededu.jmir.org/2021/4/e30613 %U https://doi.org/10.2196/30613 %U http://www.ncbi.nlm.nih.gov/pubmed/34449402 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 10 %P e25489 %T High Work-Related Stress and Anxiety as a Response to COVID-19 Among Health Care Workers in South Korea: Cross-sectional Online Survey Study %A Ahn,Myung Hee %A Shin,Yong-Wook %A Suh,Sooyeon %A Kim,Jeong Hye %A Kim,Hwa Jung %A Lee,Kyoung-Uk %A Chung,Seockhoon %+ Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea, 82 2 3010 3411, schung@amc.seoul.kr %K COVID-19 %K health personnel %K occupational stress %K anxiety %K depression %K stress %K mental health %K South Korea %K health care worker %K assessment %K intervention %D 2021 %7 22.10.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The COVID-19 outbreak had a severe impact on health care workers' psychological health. It is important to establish a process for psychological assessment and intervention for health care workers during epidemics. Objective: We investigated risk factors associated with psychological impacts for each health care worker group, to help optimize psychological interventions for health care workers in countries affected by the COVID-19 pandemic. Methods: Respondents (n=1787) from 2 hospitals in Korea completed a web-based survey during the period from April 14 to 30, 2020. The web-based survey collected demographic information, psychiatric history, and responses to the 9-item Stress and Anxiety to Viral Epidemics (SAVE-9), 9-item Patient Health Questionnaire (PHQ-9), and 7-item Generalized Anxiety Disorder-7 (GAD-7) scales. We performed logistic regression to assess contributing factors as predictor variables, using health care workers’ depression as outcome variables. Results: Among 1783 health care workers, nursing professionals had significantly higher levels of depression (PHQ-9 score: meannurse 5.5, SD 4.6; meanother 3.8, SD 4.2; P<.001), general anxiety (GAD-7 score: meannurse 4.0, SD 4.1; meanother 2.7, SD 3.6; P<.001), and virus-related anxiety symptoms (SAVE-9 score: meannurse 21.6, SD 5.9; meanother 18.6, SD 6.3; P<.001). Among nursing professionals, single workers reported more severe depressive symptoms than married workers (PHQ-9 score ≥10; meannurse 20.3%; meanother 14.1%; P=.02), and junior (<40 years) workers reported more anxiety about the viral epidemic (SAVE-9 anxiety score; meannurse 15.6, SD 4.1; meanother 14.7, SD 4.4; P=.002). Logistic regression revealed that hospital (adjusted odds ratio [OR] 1.45, 95% CI 1.06-1.99), nursing professionals (adjusted OR 1.37, 95% CI 1.02-1.98), single workers (adjusted OR 1.51, 95% CI 1.05-2.16), higher stress and anxiety to the viral infection (high SAVE-9 score, adjusted OR 1.20, 95% CI 1.17-1.24), and past psychiatric history (adjusted OR 3.26, 95% CI 2.15-4.96) were positively associated with depression. Conclusions: Psychological support and interventions should be considered for health care workers, especially nursing professionals, those who are single, and those with high SAVE-9 scores. %M 34478401 %R 10.2196/25489 %U https://publichealth.jmir.org/2021/10/e25489 %U https://doi.org/10.2196/25489 %U http://www.ncbi.nlm.nih.gov/pubmed/34478401 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 10 %P e28088 %T Perceptions and Feelings of Brazilian Health Care Professionals Regarding the Effects of COVID-19: Cross-sectional Web-Based Survey %A Corrêa,Roberta Pires %A Castro,Helena Carla %A Quaresma,Bruna Maria Castro Salomão %A Stephens,Paulo Roberto Soares %A Araujo-Jorge,Tania Cremonini %A Ferreira,Roberto Rodrigues %+ Laboratory of Innovations in Therapies, Education and Bioproducts, Oswaldo Cruz Institute, Oswaldo Cruz Foundation (Fiocruz), Av Brasil, 4365, Rio de Janeiro, Brazil, 55 21 2562 1295, robertoferreira@ioc.fiocruz.br %K COVID-19 %K SARS-CoV-2 %K health professionals %K Brazil %K pandemic %K mental health %K health planning %D 2021 %7 22.10.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The importance of health professionals has been recognized in COVID-19 pandemic–affected countries, especially in those such as Brazil, which is one of the top 3 countries that have been affected in the world. However, the workers’ perception of the stress and the changes that the pandemic has caused in their lives vary according to the conditions offered by these affected countries, including salaries, individual protection equipment, and psychological support. Objective: The purpose of this study was to identify the perceptions of Brazilian health workers regarding the COVID-19 pandemic impact on their lives, including possible self-contamination and mental health. Methods: This cross-sectional web-based survey was conducted in Brazil by applying a 32-item questionnaire, including multiple-choice questions by using the Google Forms electronic assessment. This study was designed to capture spontaneous perceptions from health professionals. All questions were mandatory and divided into 2 blocks with different proposals: personal profile and COVID-19 pandemic impact. Results: We interviewed Brazilian health professionals from all 5 Brazilian regions (N=1376). Our study revealed that 1 in 5 (23%) complained about inadequate personal protective equipment, including face shields (234/1376, 17.0%), masks (206/1376, 14.9%), and laboratory coats (138/1376, 10.0%), whereas 1 in 4 health professionals did not have enough information to protect themselves from the coronavirus disease. These professionals had anxiety due to COVID-19 (604/1376, 43.9%), difficulties in sleep (593/1376, 43.1%), and concentrating on work (453/1376, 32.9%). Almost one-third experienced traumatic situations at work (385/1376, 28.0%), which may have led to negative feelings of fear of COVID-19 and sadness. Despite this situation, there was hope and empathy among their positive feelings. The survey also showed that 1 in 5 acquired COVID-19 with the most classic and minor symptoms, including headache (274/315, 87.0%), body pain (231/315, 73.3%), tiredness (228/315, 72.4%), and loss of taste and smell (208/315, 66.0%). Some of their negative feelings were higher than those of noninfected professionals (fear of COVID-19, 243/315, 77.1% vs 509/1061, 48.0%; impotence, 142/315, 45.1% vs 297/1061, 28.0%; and fault, 38/315, 12.1% vs 567/1061, 53.4%, respectively). Another worrying outcome was that 61.3% (193/315) reported acquiring an infection while working at a health facility and as expected, most of the respondents felt affected (344/1376, 25.0%) or very affected (619/1376, 45.0%) by the COVID-19. Conclusions: In Brazil, the health professionals were exposed to a stressful situation and to the risk of self-contamination—conditions that can spell future psychological problems for these workers. Our survey findings showed that the psychological support for this group should be included in the future health planning of Brazil and of other hugely affected countries to assure a good mental health condition for the medical teams in the near future. %M 34519656 %R 10.2196/28088 %U https://formative.jmir.org/2021/10/e28088 %U https://doi.org/10.2196/28088 %U http://www.ncbi.nlm.nih.gov/pubmed/34519656 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 10 %P e30765 %T Topics and Sentiments of Public Concerns Regarding COVID-19 Vaccines: Social Media Trend Analysis %A Monselise,Michal %A Chang,Chia-Hsuan %A Ferreira,Gustavo %A Yang,Rita %A Yang,Christopher C %+ College of Computing and Informatics, Drexel University, 3675 Market St, 10th Floor, Philadelphia, PA, 19104, United States, 1 215 895 1631, chris.yang@drexel.edu %K health care informatics %K topic detection %K unsupervised sentiment analysis %K COVID-19 %K vaccine hesitancy %K sentiment %K concern %K vaccine %K social media %K trend %K trust %K health information %K Twitter %K discussion %K communication %K hesitancy %K emotion %K fear %D 2021 %7 21.10.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: As a number of vaccines for COVID-19 are given emergency use authorization by local health agencies and are being administered in multiple countries, it is crucial to gain public trust in these vaccines to ensure herd immunity through vaccination. One way to gauge public sentiment regarding vaccines for the goal of increasing vaccination rates is by analyzing social media such as Twitter. Objective: The goal of this research was to understand public sentiment toward COVID-19 vaccines by analyzing discussions about the vaccines on social media for a period of 60 days when the vaccines were started in the United States. Using the combination of topic detection and sentiment analysis, we identified different types of concerns regarding vaccines that were expressed by different groups of the public on social media. Methods: To better understand public sentiment, we collected tweets for exactly 60 days starting from December 16, 2020 that contained hashtags or keywords related to COVID-19 vaccines. We detected and analyzed different topics of discussion of these tweets as well as their emotional content. Vaccine topics were identified by nonnegative matrix factorization, and emotional content was identified using the Valence Aware Dictionary and sEntiment Reasoner sentiment analysis library as well as by using sentence bidirectional encoder representations from transformer embeddings and comparing the embedding to different emotions using cosine similarity. Results: After removing all duplicates and retweets, 7,948,886 tweets were collected during the 60-day time period. Topic modeling resulted in 50 topics; of those, we selected 12 topics with the highest volume of tweets for analysis. Administration and access to vaccines were some of the major concerns of the public. Additionally, we classified the tweets in each topic into 1 of the 5 emotions and found fear to be the leading emotion in the tweets, followed by joy. Conclusions: This research focused not only on negative emotions that may have led to vaccine hesitancy but also on positive emotions toward the vaccine. By identifying both positive and negative emotions, we were able to identify the public's response to the vaccines overall and to news events related to the vaccines. These results are useful for developing plans for disseminating authoritative health information and for better communication to build understanding and trust. %M 34581682 %R 10.2196/30765 %U https://www.jmir.org/2021/10/e30765 %U https://doi.org/10.2196/30765 %U http://www.ncbi.nlm.nih.gov/pubmed/34581682 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 10 %P e31125 %T Willingness to Receive COVID-19 Vaccination Among People Living With HIV and AIDS in China: Nationwide Cross-sectional Online Survey %A Huang,Xiaojie %A Yu,Maohe %A Fu,Gengfeng %A Lan,Guanghua %A Li,Linghua %A Yang,Jianzhou %A Qiao,Ying %A Zhao,Jin %A Qian,Han-Zhu %A Zhang,Xiangjun %A Liu,Xinchao %A Jin,Xia %A Chen,Guohong %A Jiang,Hui %A Tang,Weiming %A Wang,Zixin %A Xu,Junjie %+ Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Room 508, School of Public Health, Prince of Wales Hospital, Shatin, NT, Hong Kong, 666888, China, 852 22528740, wangzx@cuhk.edu.hk %K people living with HIV and AIDS %K COVID-19 vaccination %K willingness %K perceptions %K internet and social media influences %K interpersonal communication %D 2021 %7 21.10.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: HIV infection is a significant independent risk factor for both severe COVID-19 presentation at hospital admission and in-hospital mortality. Available information has suggested that people living with HIV and AIDS (PLWHA) could benefit from COVID-19 vaccination. However, there is a dearth of evidence on willingness to receive COVID-19 vaccination among PLWHA. Objective: The aim of this study was to investigate willingness to receive COVID-19 vaccination among a national sample of PLWHA in China. Methods: This cross-sectional online survey investigated factors associated with willingness to receive COVID-19 vaccination among PLWHA aged 18 to 65 years living in eight conveniently selected Chinese metropolitan cities between January and February 2021. Eight community-based organizations (CBOs) providing services to PLWHA facilitated the recruitment. Eligible PLWHA completed an online survey developed using a widely used encrypted web-based survey platform in China. We fitted a single logistic regression model to obtain adjusted odds ratios (aORs), which involved one of the independent variables of interest and all significant background variables. Path analysis was also used in the data analysis. Results: Out of 10,845 PLWHA approached by the CBOs, 2740 completed the survey, and 170 had received at least one dose of the COVID-19 vaccine. This analysis was performed among 2570 participants who had never received COVID-19 vaccination. Over half of the participants reported willingness to receive COVID-19 vaccination (1470/2570, 57.2%). Perceptions related to COVID-19 vaccination were significantly associated with willingness to receive COVID-19 vaccination, including positive attitudes (aOR 1.11, 95% CI 1.09-1.12; P<.001), negative attitudes (aOR 0.96, 95% CI 0.94-0.97; P<.001), perceived support from significant others (perceived subjective norm; aOR 1.53, 95% CI 1.46-1.61; P<.001), and perceived behavioral control (aOR 1.13, 95% CI 1.11-1.14; P<.001). At the interpersonal level, receiving advice supportive of COVID-19 vaccination from doctors (aOR 1.99, 95% CI 1.65-2.40; P<.001), CBO staff (aOR 1.89, 95% CI 1.51-2.36; P<.001), friends and/or family members (aOR 3.22, 95% CI 1.93-5.35; P<.001), and PLWHA peers (aOR 2.38, 95% CI 1.85-3.08; P<.001) was associated with higher willingness to receive COVID-19 vaccination. The overall opinion supporting COVID-19 vaccination for PLWHA on the internet or social media was also positively associated with willingness to receive COVID-19 vaccination (aOR 1.59, 95% CI 1.31-1.94; P<.001). Path analysis indicated that interpersonal-level variables were indirectly associated with willingness to receive COVID-19 vaccination through perceptions (β=.43, 95% CI .37-.51; P<.001). Conclusions: As compared to PLWHA in other countries and the general population in most parts of the world, PLWHA in China reported a relatively low willingness to receive COVID-19 vaccination. The internet and social media as well as interpersonal communications may be major sources of influence on PLWHA’s perceptions and willingness to receive COVID-19 vaccination. %M 34543223 %R 10.2196/31125 %U https://publichealth.jmir.org/2021/10/e31125 %U https://doi.org/10.2196/31125 %U http://www.ncbi.nlm.nih.gov/pubmed/34543223 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 10 %P e28519 %T Hospital-Based Contact Tracing of Patients With COVID-19 and Health Care Workers During the COVID-19 Pandemic in Eastern India: Cross-sectional Study %A Sahoo,Durgesh Prasad %A Singh,Arvind Kumar %A Sahu,Dinesh Prasad %A Pradhan,Somen Kumar %A Patro,Binod Kumar %A Batmanabane,Gitanjali %A Mishra,Baijayantimala %A Behera,Bijayini %A Das,Ambarish %A Dora,G Susmita %A Anand,L %A Azhar,S M %A Nair,Jyolsna %A Panigrahi,Sasmita %A Akshaya,R %A Sahoo,Bimal Kumar %A Sahu,Subhakanta %A Sahoo,Suchismita %+ All India Institute of Medical Sciences, Bhubaneswar, Sijua, Patrapada, Bhubaneswar, Odisha, 751019, India, 91 6742476001, director@aiimsbhubaneswar.edu.in %K COVID-19 %K SARS-CoV-2 %K risk categorization %K health care personnel %K virus transmission %K contact tracing %K pandemic %K risk stratification %D 2021 %7 21.10.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The contact tracing and subsequent quarantining of health care workers (HCWs) are essential to minimizing the further transmission of SARS-CoV-2 infection and mitigating the shortage of HCWs during the COVID-19 pandemic situation. Objective: This study aimed to assess the yield of contact tracing for COVID-19 cases and the risk stratification of HCWs who are exposed to these cases. Methods: This was an analysis of routine data that were collected for the contact tracing of COVID-19 cases at the All India Institute of Medical Sciences, Bhubaneswar, in Odisha, India. Data from March 19 to August 31, 2020, were considered for this study. COVID-19 cases were admitted patients, outpatients, or HCWs in the hospital. HCWs who were exposed to COVID-19 cases were categorized, per the risk stratification guidelines, as high-risk contacts or low-risk contacts Results: During contact tracing, 3411 HCWs were identified as those who were exposed to 360 COVID-19 cases. Of these 360 cases, 269 (74.7%) were either admitted patients or outpatients, and 91 (25.3%) were HCWs. After the risk stratification of the 3411 HCWs, 890 (26.1%) were categorized as high-risk contacts, and 2521 (73.9%) were categorized as low-risk contacts. The COVID-19 test positivity rates of high-risk contacts and low-risk contacts were 3.8% (34/890) and 1.9% (48/2521), respectively. The average number of high-risk contacts was significantly higher when the COVID-19 case was an admitted patient (number of contacts: mean 6.6) rather than when the COVID-19 case was an HCW (number of contacts: mean 4.0) or outpatient (number of contacts: mean 0.2; P=.009). Similarly, the average number of high-risk contacts was higher when the COVID-19 case was admitted in a non–COVID-19 area (number of contacts: mean 15.8) rather than when such cases were admitted in a COVID-19 area (number of contacts: mean 0.27; P<.001). There was a significant decline in the mean number of high-risk contacts over the study period (P=.003). Conclusions: Contact tracing and risk stratification were effective and helped to reduce the number of HCWs requiring quarantine. There was also a decline in the number of high-risk contacts during the study period. This indicates the role of the implementation of hospital-based, COVID-19–related infection control strategies. The contact tracing and risk stratification approaches that were designed in this study can also be implemented in other health care settings. %M 34596569 %R 10.2196/28519 %U https://formative.jmir.org/2021/10/e28519 %U https://doi.org/10.2196/28519 %U http://www.ncbi.nlm.nih.gov/pubmed/34596569 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 10 %P e27261 %T Assessing Neonatal Intensive Care Unit Structures and Outcomes Before and During the COVID-19 Pandemic: Network Analysis Study %A Mannering,Hannah %A Yan,Chao %A Gong,Yang %A Alrifai,Mhd Wael %A France,Daniel %A Chen,You %+ Department of Biomedical Informatics, Vanderbilt University Medical Center, 2525 West End Ave, Suite 1475, Nashville, TN, 37203, United States, 1 6153431939, you.chen@vanderbilt.edu %K neonatal intensive care unit %K collaboration %K health care organization structures %K intensive care %K length of stay %K discharge dispositions %K electronic health records %K network analysis %K COVID-19 %K temporal network analysis %D 2021 %7 20.10.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Health care organizations (HCOs) adopt strategies (eg. physical distancing) to protect clinicians and patients in intensive care units (ICUs) during the COVID-19 pandemic. Many care activities physically performed before the COVID-19 pandemic have transitioned to virtual systems during the pandemic. These transitions can interfere with collaboration structures in the ICU, which may impact clinical outcomes. Understanding the differences can help HCOs identify challenges when transitioning physical collaboration to the virtual setting in the post–COVID-19 era. Objective: This study aims to leverage network analysis to determine the changes in neonatal ICU (NICU) collaboration structures from the pre– to the intra–COVID-19 era. Methods: In this retrospective study, we applied network analysis to the utilization of electronic health records (EHRs) of 712 critically ill neonates (pre–COVID-19, n=386; intra–COVID-19, n=326, excluding those with COVID-19) admitted to the NICU of Vanderbilt University Medical Center between September 1, 2019, and June 30, 2020, to assess collaboration between clinicians. We characterized pre–COVID-19 as the period of September-December 2019 and intra–COVID-19 as the period of March-June 2020. These 2 groups were compared using patients’ clinical characteristics, including age, sex, race, length of stay (LOS), and discharge dispositions. We leveraged the clinicians’ actions committed to the patients’ EHRs to measure clinician-clinician connections. We characterized a collaboration relationship (tie) between 2 clinicians as actioning EHRs of the same patient within the same day. On defining collaboration relationship, we built pre– and intra–COVID-19 networks. We used 3 sociometric measurements, including eigenvector centrality, eccentricity, and betweenness, to quantify a clinician’s leadership, collaboration difficulty, and broad skill sets in a network, respectively. We assessed the extent to which the eigenvector centrality, eccentricity, and betweenness of clinicians in the 2 networks are statistically different, using Mann-Whitney U tests (95% CI). Results: Collaboration difficulty increased from the pre– to intra–COVID-19 periods (median eccentricity: 3 vs 4; P<.001). Nurses had reduced leadership (median eigenvector centrality: 0.183 vs 0.087; P<.001), and neonatologists with broader skill sets cared for more patients in the NICU structure during the pandemic (median betweenness centrality: 0.0001 vs 0.005; P<.001). The pre– and intra–COVID-19 patient groups shared similar distributions in sex (~0 difference), race (4% difference in White, and 3% difference in African American), LOS (interquartile range difference in 1.5 days), and discharge dispositions (~0 difference in home, 2% difference in expired, and 2% difference in others). There were no significant differences in the patient demographics and outcomes between the 2 groups. Conclusions: Management of NICU-admitted patients typically requires multidisciplinary care teams. Understanding collaboration structures can provide fine-grained evidence to potentially refine or optimize existing teamwork in the NICU. %M 34637393 %R 10.2196/27261 %U https://www.jmir.org/2021/10/e27261 %U https://doi.org/10.2196/27261 %U http://www.ncbi.nlm.nih.gov/pubmed/34637393 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 10 %P e32328 %T Ethics, Integrity, and Retributions of Digital Detection Surveillance Systems for Infectious Diseases: Systematic Literature Review %A Zhao,Ivy Y %A Ma,Ye Xuan %A Yu,Man Wai Cecilia %A Liu,Jia %A Dong,Wei Nan %A Pang,Qin %A Lu,Xiao Qin %A Molassiotis,Alex %A Holroyd,Eleanor %A Wong,Chi Wai William %+ Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 3/F, Ap Lei Chau Clinic, 161 Main Street, Ap Lei Chau, Hong Kong SAR, China, 86 2518 5657, wongwcw@hku.hk %K artificial intelligence %K electronic medical records %K ethics %K infectious diseases %K machine learning %D 2021 %7 20.10.2021 %9 Review %J J Med Internet Res %G English %X Background: The COVID-19 pandemic has increased the importance of the deployment of digital detection surveillance systems to support early warning and monitoring of infectious diseases. These opportunities create a “double-edge sword,” as the ethical governance of such approaches often lags behind technological achievements. Objective: The aim was to investigate ethical issues identified from utilizing artificial intelligence–augmented surveillance or early warning systems to monitor and detect common or novel infectious disease outbreaks. Methods: In a number of databases, we searched relevant articles that addressed ethical issues of using artificial intelligence, digital surveillance systems, early warning systems, and/or big data analytics technology for detecting, monitoring, or tracing infectious diseases according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, and further identified and analyzed them with a theoretical framework. Results: This systematic review identified 29 articles presented in 6 major themes clustered under individual, organizational, and societal levels, including awareness of implementing digital surveillance, digital integrity, trust, privacy and confidentiality, civil rights, and governance. While these measures were understandable during a pandemic, the public had concerns about receiving inadequate information; unclear governance frameworks; and lack of privacy protection, data integrity, and autonomy when utilizing infectious disease digital surveillance. The barriers to engagement could widen existing health care disparities or digital divides by underrepresenting vulnerable and at-risk populations, and patients’ highly sensitive data, such as their movements and contacts, could be exposed to outside sources, impinging significantly upon basic human and civil rights. Conclusions: Our findings inform ethical considerations for service delivery models for medical practitioners and policymakers involved in the use of digital surveillance for infectious disease spread, and provide a basis for a global governance structure. Trial Registration: PROSPERO CRD42021259180; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=259180 %M 34543228 %R 10.2196/32328 %U https://www.jmir.org/2021/10/e32328 %U https://doi.org/10.2196/32328 %U http://www.ncbi.nlm.nih.gov/pubmed/34543228 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 10 %P e30491 %T Learning About the Current State of Digital Mental Health Interventions for Canadian Youth to Inform Future Decision-Making: Mixed Methods Study %A Kemp,Jessica %A Chorney,Jill %A Kassam,Iman %A MacDonald,Julie %A MacDonald,Tara %A Wozney,Lori %A Strudwick,Gillian %+ Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 1001 Queen St W, Toronto, ON, M6J 1H4, Canada, 1 416 535 8501, gillian.strudwick@camh.ca %K youth mental health %K digital mental health %K COVID-19 %K digital mental health interventions %K e-mental health %D 2021 %7 19.10.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic has increased the demand for youth mental health services in Canada as disruptions to clinical care continue to persist due to the risk of transmission and exposure to the virus. Digital mental health interventions, including web-based resources and mobile apps, have provided opportunities to support youth mental health remotely across Canada. There is a need to better understand how these digital interventions are being selected, recommended, and used in various regions across Canada. Objective: A national jurisdictional scan was completed to (1) determine what web-based programs, apps, and websites are promoted and licensed in Canada for youth mental health; (2) identify criteria and decision-making processes that Canadian jurisdictions use to select web-based programs, apps, and websites for youth mental health; and (3) identify upcoming trends, innovations, and digital mental health possibilities that are emerging in the youth sector. Methods: The aims of the jurisdictional scan were addressed through a review of related academic and grey literature; stakeholder interviews, including individuals involved in various areas of the youth mental health sector; and a social media review of pertinent Twitter content. Results: A total of 66 web-based resources and apps were identified for use by youth in Canada. 16 stakeholder interviews were completed and included discussions with researchers, clinicians, youth organizations, and others involved in digital interventions for youth mental health. These discussions identified a limited use of frameworks used to guide decision-making processes when selecting digital interventions. Many clinicians agreed on a similar set of eligibility requirements for youth mental health apps and digital resources, such as the evidence base and cultural relevance of the intervention. Stakeholders also identified upcoming trends and innovations in the youth digital mental health space, including artificial intelligence, digital phenotyping, and personalized therapy. Over 4 weeks, 2184 tweets were reviewed to identify and compare global and national trends and innovations involving digital mental health and youth. Key trends included the promotion of regional chat services as well as the effects of the COVID-19 pandemic on youth mental health and access to care. Conclusions: As organizations begin to plan for the delivery of mental health care following the pandemic, there are concerns about the sustainability of these digital mental health interventions as well as a need for services to be more informed by the experiences and preferences of youth. %M 34665141 %R 10.2196/30491 %U https://www.jmir.org/2021/10/e30491 %U https://doi.org/10.2196/30491 %U http://www.ncbi.nlm.nih.gov/pubmed/34665141 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 10 %P e28071 %T Psychological Impact of the COVID-19 Pandemic and Social Determinants on the Portuguese Population: Protocol for a Web-Based Cross-sectional Study %A Aguiar,A %A Pinto,M %A Duarte,R %+ EPIUnit, Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas 135, Porto, 4050-600, Portugal, 351 222061820, ana.aguiar@ispup.up.pt %K COVID-19 %K public health %K mental health %K study protocol %K psychological impact %K anxiety %K depression %K grief %K behavior change %D 2021 %7 19.10.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: The COVID-19 outbreak and consequent physical distance measures implemented worldwide have caused significant stress, anxiety, and mental health implications among the general population. Unemployment, working from home, and day-to-day changes may lead to a greater risk of poor mental health outcomes. Objective: This paper describes the protocol for a web-based cross-sectional study that aims to address the impact of the COVID-19 pandemic on mental health. Methods: Individuals from the general population aged 18 years or more and living in Portugal were included in this study. Data collection took place between November 10, 2020, and February 10, 2021. An exponential, nondiscriminative, snowball sampling method was applied to recruit participants. A web-based survey was developed and shared on social media platforms (eg, Facebook, Instagram, Twitter, LinkedIn, and WhatsApp groups) and through e-mail lists for recruitment of the seeds. Results: Data analysis will be performed in accordance with the different variables and outcomes of interest by using quantitative methods, qualitative methods, or mixed methods, as applicable. A total of 929 individuals had completed the web-based survey during the 3-month period; thus, our final sample comprised 929 participants. Results of the survey will be disseminated in national and international scientific journals in 2021-2022. Conclusions: We believe that the findings of this study will have broad implications for understanding the psychological impact of the COVID-19 pandemic on Portuguese residents, as well as aspects related to the informal economy. We also hope that the findings of this study are able to provide insights and guidelines for the Portuguese government to implement action. Finally, we expect this protocol to provide a roadmap for other countries and researchers that would like to implement a similar questionnaire considering the related conclusions. International Registered Report Identifier (IRRID): DERR1-10.2196/28071 %M 34516387 %R 10.2196/28071 %U https://www.researchprotocols.org/2021/10/e28071 %U https://doi.org/10.2196/28071 %U http://www.ncbi.nlm.nih.gov/pubmed/34516387 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 10 %P e31224 %T A Wi-Fi–Based Mask-Type Laryngoscope for Telediagnosis During the COVID-19 Pandemic: Instrument Validation Study %A Moon,Youngjin %A Hyun,Jaeho %A Oh,Jeongmin %A Lee,Kwanhee %A Lee,Yoon Se %A Kim,Jun Ki %+ Biomedical Engineering Research Center, Asan Institute for Life Sciences, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-Gu, Seoul, Republic of Korea, 82 230108619, kim@amc.seoul.kr %K smartphone-based endoscope %K mobile health %K telediagnosis %K continuum segment %K articulable endoscope %K COVID-19 %K point-of-care diagnostics %K validation %K medical device %K endoscope %K sensor %K innovation %K video %K transmission %D 2021 %7 18.10.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Owing to the COVID-19 pandemic, social distancing has become mandatory. Wireless endoscopy in contactless examinations promises to protect health care workers and reduce viral spread. Objective: This study aimed to introduce a contactless endoscopic diagnosis system using a wireless endoscope resembling a mask. Methods: The Wi-Fi–based contactless mask endoscopy system comprises a disposable endoscope and a controller. First, the effective force applied by the tip during insertion was evaluated in a simple transoral model consisting of a force sensor on a simulated oropharynx wall. Second, the delay in video streaming was evaluated by comparing the frame rate and delays between a movement and its image over direct and Wi-Fi connections. Third, the system was applied to a detailed laryngopharyngeal tract phantom. Results: The smartphone-controlled wireless endoscopy system was successfully evaluated. The mean, maximum, and minimum collision forces against the wall of the transoral model were 296 mN (30 gf), 363 mN (37 gf), and 235 mN (24 gf), respectively. The delay resulting from the wireless connection was 0.72 seconds. Using the phantom, an inexperienced user took around 1 minute to orient the endoscope to a desired area via the app. Conclusions: Device articulation does not pose a significant risk of laryngopharyngeal wall penetration, and latency does not significantly impede its use. Contactless wireless video streaming was successful within the access point range regardless of the presence of walls. The mask endoscope can be controlled and articulated wirelessly, minimizing contact between patients and device operators. By minimizing contact, the device can protect health care workers from infectious viruses like the coronavirus. %M 34518154 %R 10.2196/31224 %U https://www.jmir.org/2021/10/e31224 %U https://doi.org/10.2196/31224 %U http://www.ncbi.nlm.nih.gov/pubmed/34518154 %0 Journal Article %@ 2563-6316 %I JMIR Publications %V 2 %N 4 %P e32233 %T Influence of Mass Media on Italian Web Users During the COVID-19 Pandemic: Infodemiological Analysis %A Rovetta,Alessandro %A Castaldo,Lucia %+ Research and Disclosure Division, Mensana srls, Via Malta 12, Brescia, 25124, Italy, 39 3927112808, rovetta.mresearch@gmail.com %K COVID-19 %K Google Trends %K infodemiology %K infoveillance %K infodemic %K media coverage %K mass media influence %K mass media %K social media %D 2021 %7 18.10.2021 %9 Original Paper %J JMIRx Med %G English %X Background: Concurrently with the COVID-19 pandemic, the world has been facing a growing infodemic, which has caused severe damage to economic and health systems and has often compromised the effectiveness of infection containment regulations. Although this infodemic has spread mainly through social media, there are numerous occasions on which mass media outlets have shared dangerous information, giving resonance to statements without a scientific basis. For these reasons, infoveillance and infodemiology methods are increasingly exploited to monitor information traffic on the web and make epidemiological predictions. Objective: The purpose of this paper is to estimate the impact of Italian mass media on users’ web searches to understand the role of press and television channels in both the infodemic and the interest of Italian netizens in COVID-19. Methods: We collected the headlines published from January 2020 to March 2021 containing specific COVID-19–related keywords published on PubMed, Google, the Italian Ministry of Health website, and the most-read newspapers in Italy. We evaluated the percentages of infodemic terms on these platforms. Through Google Trends, we searched for cross-correlations between newspaper headlines and COVID-19–related web searches. Finally, we analyzed the web interest in infodemic content posted on YouTube. Results: During the first wave of COVID-19, the Italian press preferred to draw on infodemic terms (rate of adoption: 1.6%-6.3%) and moderately infodemic terms (rate of adoption: 88%-94%), while scientific sources favored the correct names (rate of adoption: 65%-88%). The correlational analysis showed that the press heavily influenced users in adopting terms to identify the novel coronavirus (cross-correlations of ≥0.74 to ≤0.89, P value <.001; maximum lag=1 day). The use of scientific denominations by the press reached acceptable values only during the third wave (approximately 80%, except for the television services Rai and Mediaset). Web queries about COVID-19 symptoms also appeared to be influenced by the press (best average correlation=0.92, P<.007). Furthermore, web users showed pronounced interest in YouTube videos of an infodemic nature. Finally, the press gave resonance to serious “fake news” on COVID-19, which caused pronounced spikes of interest from web users. Conclusions: Our results suggest that the Italian mass media have played a decisive role in spreading the COVID-19 infodemic and addressing netizens’ web interest, thus favoring the adoption of terms that are unsuitable for identifying COVID-19. Therefore, the directors of news channels and newspapers should be more cautious, and government dissemination agencies should exert more control over such news stories. %M 34842858 %R 10.2196/32233 %U https://med.jmirx.org/2021/4/e32233 %U https://doi.org/10.2196/32233 %U http://www.ncbi.nlm.nih.gov/pubmed/34842858 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 9 %N 10 %P e32303 %T Harnessing the Electronic Health Record and Computerized Provider Order Entry Data for Resource Management During the COVID-19 Pandemic: Development of a Decision Tree %A Luu,Hung S %A Filkins,Laura M %A Park,Jason Y %A Rakheja,Dinesh %A Tweed,Jefferson %A Menzies,Christopher %A Wang,Vincent J %A Mittal,Vineeta %A Lehmann,Christoph U %A Sebert,Michael E %+ Department of Pathology, University of Texas Southwestern Medical Center, 1935 Medical District Drive, Dallas, TX, 75235, United States, 1 2144562168, hung.luu@childrens.com %K COVID-19 %K computerized provider order entry %K electronic health record %K resource utilization %K personal protective equipment %K SARS-CoV-2 testing %K clinical decision support %D 2021 %7 18.10.2021 %9 Original Paper %J JMIR Med Inform %G English %X Background: The COVID-19 pandemic has resulted in shortages of diagnostic tests, personal protective equipment, hospital beds, and other critical resources. Objective: We sought to improve the management of scarce resources by leveraging electronic health record (EHR) functionality, computerized provider order entry, clinical decision support (CDS), and data analytics. Methods: Due to the complex eligibility criteria for COVID-19 tests and the EHR implementation–related challenges of ordering these tests, care providers have faced obstacles in selecting the appropriate test modality. As test choice is dependent upon specific patient criteria, we built a decision tree within the EHR to automate the test selection process by using a branching series of questions that linked clinical criteria to the appropriate SARS-CoV-2 test and triggered an EHR flag for patients who met our institutional persons under investigation criteria. Results: The percentage of tests that had to be canceled and reordered due to errors in selecting the correct testing modality was 3.8% (23/608) before CDS implementation and 1% (262/26,643) after CDS implementation (P<.001). Patients for whom multiple tests were ordered during a 24-hour period accounted for 0.8% (5/608) and 0.3% (76/26,643) of pre- and post-CDS implementation orders, respectively (P=.03). Nasopharyngeal molecular assay results were positive in 3.4% (826/24,170) of patients who were classified as asymptomatic and 10.9% (1421/13,074) of symptomatic patients (P<.001). Positive tests were more frequent among asymptomatic patients with a history of exposure to COVID-19 (36/283, 12.7%) than among asymptomatic patients without such a history (790/23,887, 3.3%; P<.001). Conclusions: The leveraging of EHRs and our CDS algorithm resulted in a decreased incidence of order entry errors and the appropriate flagging of persons under investigation. These interventions optimized reagent and personal protective equipment usage. Data regarding symptoms and COVID-19 exposure status that were collected by using the decision tree correlated with the likelihood of positive test results, suggesting that clinicians appropriately used the questions in the decision tree algorithm. %M 34546942 %R 10.2196/32303 %U https://medinform.jmir.org/2021/10/e32303 %U https://doi.org/10.2196/32303 %U http://www.ncbi.nlm.nih.gov/pubmed/34546942 %0 Journal Article %@ 2563-6316 %I JMIR Publications %V 2 %N 4 %P e29392 %T Machine Learning–Based Prediction of COVID-19 Mortality With Limited Attributes to Expedite Patient Prognosis and Triage: Retrospective Observational Study %A Doyle,Riccardo %+ Stuart Ltd, 2 London Wall Place, Barbican, London, EC2Y 5AU, United Kingdom, 44 7380400958, r.doyle.edu@gmail.com %K COVID-19 %K coronavirus %K medical informatics %K machine learning %K artificial intelligence %K dimensionality reduction %K automation %K model development %K prediction %K hospital %K resource management %K mortality %K prognosis %K triage %K comorbidities %K public data %K epidemiology %K pre-existing conditions %D 2021 %7 15.10.2021 %9 Original Paper %J JMIRx Med %G English %X Background: The onset and development of the COVID-19 pandemic have placed pressure on hospital resources and staff worldwide. The integration of more streamlined predictive modeling in prognosis and triage–related decision-making can partly ease this pressure. Objective: The objective of this study is to assess the performance impact of dimensionality reduction on COVID-19 mortality prediction models, demonstrating the high impact of a limited number of features to limit the need for complex variable gathering before reaching meaningful risk labelling in clinical settings. Methods: Standard machine learning classifiers were employed to predict an outcome of either death or recovery using 25 patient-level variables, spanning symptoms, comorbidities, and demographic information, from a geographically diverse sample representing 17 countries. The effects of feature reduction on the data were tested by running classifiers on a high-quality data set of 212 patients with populated entries for all 25 available features. The full data set was compared to two reduced variations with 7 features and 1 feature, respectively, extracted using univariate mutual information and chi-square testing. Classifier performance on each data set was then assessed on the basis of accuracy, sensitivity, specificity, and received operating characteristic–derived area under the curve metrics to quantify benefit or loss from reduction. Results: The performance of the classifiers on the 212-patient sample resulted in strong mortality detection, with the highest performing model achieving specificity of 90.7% (95% CI 89.1%-92.3%) and sensitivity of 92.0% (95% CI 91.0%-92.9%). Dimensionality reduction provided strong benefits for performance. The baseline accuracy of a random forest classifier increased from 89.2% (95% CI 88.0%-90.4%) to 92.5% (95% CI 91.9%-93.0%) when training on 7 chi-square–extracted features and to 90.8% (95% CI 89.8%-91.7%) when training on 7 mutual information–extracted features. Reduction impact on a separate logistic classifier was mixed; however, when present, losses were marginal compared to the extent of feature reduction, altogether showing that reduction either improves performance or can reduce the variable-sourcing burden at hospital admission with little performance loss. Extreme feature reduction to a single most salient feature, often age, demonstrated large standalone explanatory power, with the best-performing model achieving an accuracy of 81.6% (95% CI 81.1%-82.1%); this demonstrates the relatively marginal improvement that additional variables bring to the tested models. Conclusions: Predictive statistical models have promising performance in early prediction of death among patients with COVID-19. Strong dimensionality reduction was shown to further improve baseline performance on selected classifiers and only marginally reduce it in others, highlighting the importance of feature reduction in future model construction and the feasibility of deprioritizing large, hard-to-source, and nonessential feature sets in real world settings. %M 34843609 %R 10.2196/29392 %U https://med.jmirx.org/2021/4/e29392 %U https://doi.org/10.2196/29392 %U http://www.ncbi.nlm.nih.gov/pubmed/34843609 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 1 %N 1 %P e31983 %T Change in Threads on Twitter Regarding Influenza, Vaccines, and Vaccination During the COVID-19 Pandemic: Artificial Intelligence–Based Infodemiology Study %A Benis,Arriel %A Chatsubi,Anat %A Levner,Eugene %A Ashkenazi,Shai %+ Faculty of Industrial Engineering and Technology Management, Holon Institute of Technology, Golomb St. 52, Holon, 5810201, Israel, 972 35026892, arrielb@hit.ac.il %K influenza %K vaccines %K vaccination %K social media %K social networks %K health communication %K artificial intelligence %K machine learning %K text mining %K infodemiology %K COVID-19 %K SARS-CoV-2 %D 2021 %7 14.10.2021 %9 Original Paper %J JMIR Infodemiology %G English %X Background: Discussions of health issues on social media are a crucial information source reflecting real-world responses regarding events and opinions. They are often important in public health care, since these are influencing pathways that affect vaccination decision-making by hesitant individuals. Artificial intelligence methodologies based on internet search engine queries have been suggested to detect disease outbreaks and population behavior. Among social media, Twitter is a common platform of choice to search and share opinions and (mis)information about health care issues, including vaccination and vaccines. Objective: Our primary objective was to support the design and implementation of future eHealth strategies and interventions on social media to increase the quality of targeted communication campaigns and therefore increase influenza vaccination rates. Our goal was to define an artificial intelligence–based approach to elucidate how threads in Twitter on influenza vaccination changed during the COVID-19 pandemic. Such findings may support adapted vaccination campaigns and could be generalized to other health-related mass communications. Methods: The study comprised the following 5 stages: (1) collecting tweets from Twitter related to influenza, vaccines, and vaccination in the United States; (2) data cleansing and storage using machine learning techniques; (3) identifying terms, hashtags, and topics related to influenza, vaccines, and vaccination; (4) building a dynamic folksonomy of the previously defined vocabulary (terms and topics) to support the understanding of its trends; and (5) labeling and evaluating the folksonomy. Results: We collected and analyzed 2,782,720 tweets of 420,617 unique users between December 30, 2019, and April 30, 2021. These tweets were in English, were from the United States, and included at least one of the following terms: “flu,” “influenza,” “vaccination,” “vaccine,” and “vaxx.” We noticed that the prevalence of the terms vaccine and vaccination increased over 2020, and that “flu” and “covid” occurrences were inversely correlated as “flu” disappeared over time from the tweets. By combining word embedding and clustering, we then identified a folksonomy built around the following 3 topics dominating the content of the collected tweets: “health and medicine (biological and clinical aspects),” “protection and responsibility,” and “politics.” By analyzing terms frequently appearing together, we noticed that the tweets were related mainly to COVID-19 pandemic events. Conclusions: This study focused initially on vaccination against influenza and moved to vaccination against COVID-19. Infoveillance supported by machine learning on Twitter and other social media about topics related to vaccines and vaccination against communicable diseases and their trends can lead to the design of personalized messages encouraging targeted subpopulations’ engagement in vaccination. A greater likelihood that a targeted population receives a personalized message is associated with higher response, engagement, and proactiveness of the target population for the vaccination process. %M 34693212 %R 10.2196/31983 %U https://infodemiology.jmir.org/2021/1/e31983 %U https://doi.org/10.2196/31983 %U http://www.ncbi.nlm.nih.gov/pubmed/34693212 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 10 %P e32425 %T Intervening on Trust in Science to Reduce Belief in COVID-19 Misinformation and Increase COVID-19 Preventive Behavioral Intentions: Randomized Controlled Trial %A Agley,Jon %A Xiao,Yunyu %A Thompson,Esi E %A Chen,Xiwei %A Golzarri-Arroyo,Lilian %+ Prevention Insights, Department of Applied Health Science, School of Public Health Bloomington, Indiana University Bloomington, 809 E. 9th St., Bloomington, IN, 47404, United States, 1 812 855 3123, jagley@indiana.edu %K infodemic %K misinformation %K trust in science %K COVID-19 %K RCT %K randomized controlled trial %D 2021 %7 14.10.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Trust in science meaningfully contributes to our understanding of people’s belief in misinformation and their intentions to take actions to prevent COVID-19. However, no experimental research has sought to intervene on this variable to develop a scalable response to the COVID-19 infodemic. Objective: Our study examined whether brief exposure to an infographic about the scientific process might increase trust in science and thereby affect belief in misinformation and intention to take preventive actions for COVID-19. Methods: This two-arm, parallel-group, randomized controlled trial aimed to recruit a US representative sample of 1000 adults by age, race/ethnicity, and gender using the Prolific platform. Participants were randomly assigned to view either an intervention infographic about the scientific process or a control infographic. The intervention infographic was designed through a separate pilot study. Primary outcomes were trust in science, COVID-19 narrative belief profile, and COVID-19 preventive behavioral intentions. We also collected 12 covariates and incorporated them into all analyses. All outcomes were collected using web-based assessment. Results: From January 22, 2021 to January 24, 2021, 1017 participants completed the study. The intervention slightly improved trust in science (difference-in-difference 0.03, SE 0.01, t1000=2.16, P=.031). No direct intervention effect was observed on belief profile membership, but there was some evidence of an indirect intervention effect mediated by trust in science (adjusted odds ratio 1.06, SE 0.03, 95% CI 1.00-1.12, z=2.01, P=.045) on membership in the “scientific” profile compared with the others. No direct nor indirect effects on preventive behaviors were observed. Conclusions: Briefly viewing an infographic about science appeared to cause a small aggregate increase in trust in science, which may have, in turn, reduced the believability of COVID-19 misinformation. The effect sizes were small but commensurate with our 60-second, highly scalable intervention approach. Researchers should study the potential for truthful messaging about how science works to serve as misinformation inoculation and test how best to do so. Trial Registration: NCT04557241; https://clinicaltrials.gov/ct2/show/NCT04557241 International Registered Report Identifier (IRRID): RR2-10.2196/24383 %M 34581678 %R 10.2196/32425 %U https://www.jmir.org/2021/10/e32425 %U https://doi.org/10.2196/32425 %U http://www.ncbi.nlm.nih.gov/pubmed/34581678 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 10 %P e29984 %T Problems in Coordinating and Accessing Primary Care for Attached and Unattached Patients Exacerbated During the COVID-19 Pandemic Year (the PUPPY Study): Protocol for a Longitudinal Mixed Methods Study %A Marshall,Emily Gard %A Breton,Mylaine %A Cossette,Benoit %A Isenor,Jennifer %A Mathews,Maria %A Ayn,Caitlyn %A Smithman,Mélanie Ann %A Stock,David %A Frymire,Eliot %A Edwards,Lynn %A Green,Michael %+ Primary Care Research Unit, Dalhousie Family Medicine, 1465 Brenton Street Suite 402, Halifax, NS, B3J 3T4, Canada, 1 902 473 4155, emily.marshall@dal.ca %K primary care %K health services research %K health policy %K mixed methods research %K COVID-19 %K protocol %K policy %K longitudinal %K coordination %K access %K impact %K virtual care %K virtual health %K Canada %D 2021 %7 13.10.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: The COVID-19 pandemic has significantly disrupted primary care in Canada, with many walk-in clinics and family practices initially closing or being perceived as inaccessible; pharmacies remaining open with restrictions on patient interactions; rapid uptake of virtual care; and reduced referrals for lab tests, diagnostics, and specialist care. Objective: The PUPPY Study (Problems in Coordinating and Accessing Primary Care for Attached and Unattached Patients Exacerbated During the COVID-19 Pandemic Year) seeks to understand the impact of the COVID-19 pandemic across the quadruple aims of primary care, with particular focus on the effects on patients without attachment to a regular provider and those with chronic health conditions. Methods: The PUPPY study builds on an existing research program exploring patients’ access and attachment to a primary care practice, pivoted to adapt to the emerging COVID-19 context. We intend to undertake a longitudinal mixed methods study to understand critical gaps in primary care access and coordination, as well as compare prepandemic and postpandemic data across 3 Canadian provinces (Quebec, Ontario, and Nova Scotia). Multiple data sources will be used such as a policy review; qualitative interviews with primary care policymakers, providers (ie, family physicians, nurse practitioners, and pharmacists), and patients (N=120); and medication prescriptions and health care billing data. Results: This study has received funding by the Canadian Institutes of Health Research COVID-19 Rapid Funding Opportunity Grant. Ethical approval to conduct this study was granted in Ontario (Queens Health Sciences & Affiliated Teaching Hospitals Research Ethics Board, file 6028052; Western University Health Sciences Research Ethics Board, project 116591; University of Toronto Health Sciences Research Ethics Board, protocol 40335) in November 2020, Québec (Centre intégré universitaire de santé et de services sociaux de l'Estrie, project 2020-3446) in December 2020, and Nova Scotia (Nova Scotia Health Research Ethics Board, file 1024979) in August 2020. Conclusions: To our knowledge, this is the first study of its kind to explore the effects of the COVID-19 pandemic on primary care systems, with particular focus on the issues of patient’s attachment and access to primary care. Through a multistakeholder, cross-jurisdictional approach, the findings of the PUPPY study will inform the strengthening of primary care during and beyond the COVID-19 pandemic, as well as have implications for future policy and practice. International Registered Report Identifier (IRRID): DERR1-10.2196/29984 %M 34559672 %R 10.2196/29984 %U https://www.researchprotocols.org/2021/10/e29984 %U https://doi.org/10.2196/29984 %U http://www.ncbi.nlm.nih.gov/pubmed/34559672 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 7 %N 4 %P e30652 %T e-Learning and Web-Based Tools for Psychosocial Interventions Addressing Neuropsychiatric Symptoms of Dementia During the COVID-19 Pandemic in Tokyo, Japan: Quasi-Experimental Study %A Nakanishi,Miharu %A Yamasaki,Syudo %A Endo,Kaori %A Niimura,Junko %A Ziylan,Canan %A Bakker,Ton J E M %A Granvik,Eva %A Nägga,Katarina %A Nishida,Atsushi %+ Department of Psychiatric Nursing, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai-shi, 980-8575, Japan, 81 22 717 8179, mnakanishi-tky@umin.ac.jp %K dementia %K home care services %K implementation science %K nursing homes %K web-based tool %D 2021 %7 12.10.2021 %9 Original Paper %J JMIR Med Educ %G English %X Background: Concern has been raised that the COVID-19 pandemic and consequent social distancing measures may increase neuropsychiatric symptoms in people with dementia. Thus, we developed and delivered an e-learning training course to professional caregivers on using a web-based tool for psychosocial interventions for people with dementia. Objective: The aim of our study was to evaluate the feasibility and efficacy of an e-learning course in combination with a web-based tool in addressing neuropsychiatric symptoms of dementia. Methods: A quasi-experimental design was used in Tokyo, Japan. The e-learning course was delivered three times to professional caregivers between July and December 2020. Caregivers who completed the course assessed the level of neuropsychiatric symptoms in people with dementia using the total score from the Neuropsychiatric Inventory (NPI) via a web-based tool. The primary outcome measures were the number of caregivers who implemented follow-up NPI evaluations by March 2021 and the change in NPI scores from baseline to their most recent follow-up evaluations. As a control group, information was also obtained from professional caregivers who completed a face-to-face training course using the same web-based tool between July 2019 and March 2020. Results: A total of 268 caregivers completed the e-learning course in 2020. Of the 268 caregivers, 56 (20.9%) underwent follow-up evaluations with 63 persons with dementia. The average NPI score was significantly reduced from baseline (mean 20.4, SD 16.2) to the most recent follow-up evaluations (mean 14.3, SD 13.4). The effect size was assumed to be medium (Cohen drm [repeated measures]=0.40). The control group consisted of 252 caregivers who completed a face-to-face training course. Of the 252 caregivers, 114 (45.2%) underwent follow-up evaluations. Compared to the control group, caregivers who completed the e-learning course were significantly less likely to implement follow-up evaluations (χ21=52.0, P<.001). The change in NPI scores did not differ according to the type of training course (baseline-adjusted difference=–0.61, P=.69). Conclusions: The replacement of face-to-face training with e-learning may have provided professionals with an opportunity to participate in the dementia behavior analysis and support enhancement (DEMBASE) program who may not have participated in the program otherwise. Although the program showed equal efficacy in terms of the two training courses, the feasibility was suboptimal with lower implementation levels for those receiving e-learning training. Thus, further strategies should be developed to improve feasibility by providing motivational triggers for implementation and technical support for care professionals. Using online communities in the program should also be investigated. %M 34543224 %R 10.2196/30652 %U https://mededu.jmir.org/2021/4/e30652 %U https://doi.org/10.2196/30652 %U http://www.ncbi.nlm.nih.gov/pubmed/34543224 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 10 %P e31161 %T Development and Actionability of the Dutch COVID-19 Dashboard: Descriptive Assessment and Expert Appraisal Study %A Bos,Véronique L L C %A Jansen,Tessa %A Klazinga,Niek S %A Kringos,Dionne S %+ Department of Public and Occupational Health, Amsterdam UMC, Amsterdam Public Health Research Institute, Meibergdreef 9, Amsterdam, 1105 AZ, Netherlands, 31 020 5661449, v.l.bos@amsterdamumc.nl %K COVID-19 %K dashboard %K performance intelligence %K Netherlands %K actionability %K communication %K government %K pandemic %K public health %D 2021 %7 12.10.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Web-based public reporting by means of dashboards has become an essential tool for governments worldwide to monitor COVID-19 information and communicate it to the public. The actionability of such dashboards is determined by their fitness for purpose—meeting a specific information need—and fitness for use—placing the right information into the right hands at the right time and in a manner that can be understood. Objective: The aim of this study was to identify specific areas where the actionability of the Dutch government’s COVID-19 dashboard could be improved, with the ultimate goal of enhancing public understanding of the pandemic. Methods: The study was conducted from February 2020 to April 2021. A mixed methods approach was carried out, using (1) a descriptive checklist over time to monitor changes made to the dashboard, (2) an actionability scoring of the dashboard to pinpoint areas for improvement, and (3) a reflection meeting with the dashboard development team to contextualize findings and discuss areas for improvement. Results: The dashboard predominantly showed epidemiological information on COVID-19. It had been developed and adapted by adding more in-depth indicators, more geographic disaggregation options, and new indicator themes. It also changed in target audience from policy makers to the general public; thus, a homepage was added with the most important information, using news-like items to explain the provided indicators and conducting research to enhance public understanding of the dashboard. However, disaggregation options such as sex, socioeconomic status, and ethnicity and indicators on dual-track health system management and social and economic impact that have proven to give important insights in other countries are missing from the Dutch COVID-19 dashboard, limiting its actionability. Conclusions: The Dutch COVID-19 dashboard developed over time its fitness for purpose and use in terms of providing epidemiological information to the general public as a target audience. However, to strengthen the Dutch health system’s ability to cope with upcoming phases of the COVID-19 pandemic or future public health emergencies, we advise (1) establishing timely indicators relating to health system capacity, (2) including relevant data disaggregation options (eg, sex, socioeconomic status), and (3) enabling interoperability between social, health, and economic data sources. %M 34543229 %R 10.2196/31161 %U https://publichealth.jmir.org/2021/10/e31161 %U https://doi.org/10.2196/31161 %U http://www.ncbi.nlm.nih.gov/pubmed/34543229 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 10 %P e31400 %T International Changes in COVID-19 Clinical Trajectories Across 315 Hospitals and 6 Countries: Retrospective Cohort Study %A Weber,Griffin M %A Zhang,Harrison G %A L'Yi,Sehi %A Bonzel,Clara-Lea %A Hong,Chuan %A Avillach,Paul %A Gutiérrez-Sacristán,Alba %A Palmer,Nathan P %A Tan,Amelia Li Min %A Wang,Xuan %A Yuan,William %A Gehlenborg,Nils %A Alloni,Anna %A Amendola,Danilo F %A Bellasi,Antonio %A Bellazzi,Riccardo %A Beraghi,Michele %A Bucalo,Mauro %A Chiovato,Luca %A Cho,Kelly %A Dagliati,Arianna %A Estiri,Hossein %A Follett,Robert W %A García Barrio,Noelia %A Hanauer,David A %A Henderson,Darren W %A Ho,Yuk-Lam %A Holmes,John H %A Hutch,Meghan R %A Kavuluru,Ramakanth %A Kirchoff,Katie %A Klann,Jeffrey G %A Krishnamurthy,Ashok K %A Le,Trang T %A Liu,Molei %A Loh,Ne Hooi Will %A Lozano-Zahonero,Sara %A Luo,Yuan %A Maidlow,Sarah %A Makoudjou,Adeline %A Malovini,Alberto %A Martins,Marcelo Roberto %A Moal,Bertrand %A Morris,Michele %A Mowery,Danielle L %A Murphy,Shawn N %A Neuraz,Antoine %A Ngiam,Kee Yuan %A Okoshi,Marina P %A Omenn,Gilbert S %A Patel,Lav P %A Pedrera Jiménez,Miguel %A Prudente,Robson A %A Samayamuthu,Malarkodi Jebathilagam %A Sanz Vidorreta,Fernando J %A Schriver,Emily R %A Schubert,Petra %A Serrano Balazote,Pablo %A Tan,Byorn WL %A Tanni,Suzana E %A Tibollo,Valentina %A Visweswaran,Shyam %A Wagholikar,Kavishwar B %A Xia,Zongqi %A Zöller,Daniela %A , %A Kohane,Isaac S %A Cai,Tianxi %A South,Andrew M %A Brat,Gabriel A %+ Department of Biomedical Informatics, Harvard Medical School, 10 Shattuck St, Boston, MA, 02115, United States, 1 6175488520, tcai@hsph.harvard.edu %K SARS-CoV-2 %K electronic health records %K federated study %K retrospective cohort study %K meta-analysis %K COVID-19 %K severe COVID-19 %K laboratory trajectory %D 2021 %7 11.10.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Many countries have experienced 2 predominant waves of COVID-19–related hospitalizations. Comparing the clinical trajectories of patients hospitalized in separate waves of the pandemic enables further understanding of the evolving epidemiology, pathophysiology, and health care dynamics of the COVID-19 pandemic. Objective: In this retrospective cohort study, we analyzed electronic health record (EHR) data from patients with SARS-CoV-2 infections hospitalized in participating health care systems representing 315 hospitals across 6 countries. We compared hospitalization rates, severe COVID-19 risk, and mean laboratory values between patients hospitalized during the first and second waves of the pandemic. Methods: Using a federated approach, each participating health care system extracted patient-level clinical data on their first and second wave cohorts and submitted aggregated data to the central site. Data quality control steps were adopted at the central site to correct for implausible values and harmonize units. Statistical analyses were performed by computing individual health care system effect sizes and synthesizing these using random effect meta-analyses to account for heterogeneity. We focused the laboratory analysis on C-reactive protein (CRP), ferritin, fibrinogen, procalcitonin, D-dimer, and creatinine based on their reported associations with severe COVID-19. Results: Data were available for 79,613 patients, of which 32,467 were hospitalized in the first wave and 47,146 in the second wave. The prevalence of male patients and patients aged 50 to 69 years decreased significantly between the first and second waves. Patients hospitalized in the second wave had a 9.9% reduction in the risk of severe COVID-19 compared to patients hospitalized in the first wave (95% CI 8.5%-11.3%). Demographic subgroup analyses indicated that patients aged 26 to 49 years and 50 to 69 years; male and female patients; and black patients had significantly lower risk for severe disease in the second wave than in the first wave. At admission, the mean values of CRP were significantly lower in the second wave than in the first wave. On the seventh hospital day, the mean values of CRP, ferritin, fibrinogen, and procalcitonin were significantly lower in the second wave than in the first wave. In general, countries exhibited variable changes in laboratory testing rates from the first to the second wave. At admission, there was a significantly higher testing rate for D-dimer in France, Germany, and Spain. Conclusions: Patients hospitalized in the second wave were at significantly lower risk for severe COVID-19. This corresponded to mean laboratory values in the second wave that were more likely to be in typical physiological ranges on the seventh hospital day compared to the first wave. Our federated approach demonstrated the feasibility and power of harmonizing heterogeneous EHR data from multiple international health care systems to rapidly conduct large-scale studies to characterize how COVID-19 clinical trajectories evolve. %M 34533459 %R 10.2196/31400 %U https://www.jmir.org/2021/10/e31400 %U https://doi.org/10.2196/31400 %U http://www.ncbi.nlm.nih.gov/pubmed/34533459 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 9 %N 4 %P e29586 %T Effectiveness and Utility of Virtual Reality Simulation as an Educational Tool for Safe Performance of COVID-19 Diagnostics: Prospective, Randomized Pilot Trial %A Birrenbach,Tanja %A Zbinden,Josua %A Papagiannakis,George %A Exadaktylos,Aristomenis K %A Müller,Martin %A Hautz,Wolf E %A Sauter,Thomas Christian %+ Department of Emergency Medicine, Inselspital, University Hospital Bern, Freiburgstrasse 16C, Bern, 3010, Switzerland, 41 31 6322111, tanja.birrenbach@insel.ch %K virtual reality %K VR %K simulation %K medical education %K hand hygiene %K COVID-19 %K PPE %K nasopharyngeal swab %K protection %K effectiveness %K utility %K diagnostic %K testing %K pilot study %D 2021 %7 8.10.2021 %9 Original Paper %J JMIR Serious Games %G English %X Background: Although the proper use of hygiene and personal protective equipment (PPE) is paramount for preventing the spread of diseases such as COVID-19, health care personnel have been shown to use incorrect techniques for donning/doffing of PPE and hand hygiene, leading to a large number of infections among health professionals. Education and training are difficult owing to the social distancing restrictions in place, shortages of PPE and testing material, and lack of evidence on optimal training. Virtual reality (VR) simulation can offer a multisensory, 3-D, fully immersive, and safe training opportunity that addresses these obstacles. Objective: The aim of this study is to explore the short- and long-term effectiveness of a fully immersive VR simulation versus a traditional learning method regarding a COVID-19–related skill set and media-specific variables influencing training outcomes. Methods: This was a prospective, randomized controlled pilot study on medical students (N=29; intervention VR training, n=15, vs control video-based instruction, n=14) to compare the performance of hand disinfection, nasopharyngeal swab taking, and donning/doffing of PPE before and after training and 1 month later as well as variables of media use. Results: Both groups performed significantly better after training, with the effect sustained over one month. After training, the VR group performed significantly better in taking a nasopharyngeal swab, scoring a median of 14 out of 17 points (IQR 13-15) versus 12 out of 17 points (IQR 11-14) in the control group, P=.03. With good immersion and tolerability of the VR simulation, satisfaction was significantly higher in the VR group compared to the control group (median score of User Satisfaction Evaluation Questionnaire 27/30, IQR 23-28, vs 22/30, IQR 20-24, in the control group; P=.01). Conclusions: VR simulation was at least as effective as traditional learning methods in training medical students while providing benefits regarding user satisfaction. These results add to the growing body of evidence that VR is a useful tool for acquiring simple and complex clinical skills. %M 34623315 %R 10.2196/29586 %U https://games.jmir.org/2021/4/e29586 %U https://doi.org/10.2196/29586 %U http://www.ncbi.nlm.nih.gov/pubmed/34623315 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 10 %P e29379 %T Statin Use and COVID-19 Infectivity and Severity in South Korea: Two Population-Based Nationwide Cohort Studies %A Lee,Seung Won %A Kim,So Young %A Moon,Sung Yong %A Yoo,In Kyung %A Yoo,Eun-Gyong %A Eom,Gwang Hyeon %A Kim,Jae-Min %A Shin,Jae Il %A Jeong,Myung Ho %A Yang,Jee Myung %A Yon,Dong Keon %+ Department of Pediatrics, Seoul National University Hospital, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea, 82 2 6935 2476, yonkkang@gmail.com %K COVID-19 %K statin %K susceptibility %K severe clinical outcomes %K length of hospital stay %D 2021 %7 8.10.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Basic studies suggest that statins as add-on therapy may benefit patients with COVID-19; however, real-world evidence of such a beneficial association is lacking. Objective: We investigated differences in SARS-CoV-2 test positivity and clinical outcomes of COVID-19 (composite endpoint: admission to intensive care unit, invasive ventilation, or death) between statin users and nonusers. Methods: Two independent population-based cohorts were analyzed, and we investigated the differences in SARS-CoV-2 test positivity and severe clinical outcomes of COVID-19, such as admission to the intensive care unit, invasive ventilation, or death, between statin users and nonusers. One group comprised an unmatched cohort of 214,207 patients who underwent SARS-CoV-2 testing from the Global Research Collaboration Project (GRCP)-COVID cohort, and the other group comprised an unmatched cohort of 74,866 patients who underwent SARS-CoV-2 testing from the National Health Insurance Service (NHIS)-COVID cohort. Results: The GRCP-COVID cohort with propensity score matching had 29,701 statin users and 29,701 matched nonusers. The SARS-CoV-2 test positivity rate was not associated with statin use (statin users, 2.82% [837/29,701]; nonusers, 2.65% [787/29,701]; adjusted relative risk [aRR] 0.97; 95% CI 0.88-1.07). Among patients with confirmed COVID-19 in the GRCP-COVID cohort, 804 were statin users and 1573 were matched nonusers. Statin users were associated with a decreased likelihood of severe clinical outcomes (statin users, 3.98% [32/804]; nonusers, 5.40% [85/1573]; aRR 0.62; 95% CI 0.41-0.91) and length of hospital stay (statin users, 23.8 days; nonusers, 26.3 days; adjusted mean difference –2.87; 95% CI –5.68 to –0.93) than nonusers. The results of the NHIS-COVID cohort were similar to the primary results of the GRCP-COVID cohort. Conclusions: Our findings indicate that prior statin use is related to a decreased risk of worsening clinical outcomes of COVID-19 and length of hospital stay but not to that of SARS-CoV-2 infection. %M 34623311 %R 10.2196/29379 %U https://publichealth.jmir.org/2021/10/e29379 %U https://doi.org/10.2196/29379 %U http://www.ncbi.nlm.nih.gov/pubmed/34623311 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 10 %P e27739 %T Prevalence of SARS-CoV-2 Infection in Children by Antibody Detection in Saliva: Protocol for a Prospective Longitudinal Study (Coro-Buddy) %A Pinilla,Yudi T %A Friessinger,Evelyn %A Griesbaum,Johanna Marie %A Berner,Lilith %A Heinzel,Constanze %A Elsner,Käthe %A Fendel,Rolf %A Held,Jana %A Kreidenweiss,Andrea %+ Institut für Tropenmedizin, Universitätsklinikum Tübingen, Wilhelmstraße 27, Tübingen, 72074, Germany, 49 7071 2985569, andrea.kreidenweiss@uni-tuebingen.de %K SARS-CoV-2 %K COVID-19 %K antibody %K saliva %K children %K epidemiology %D 2021 %7 8.10.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: The world has been confronted with the COVID-19 pandemic for more than one year. Severe disease is more often found among elderly people, whereas most young children and adolescents show mild symptoms or even remain asymptomatic, so that infection might be undiagnosed. Therefore, only limited epidemiological data on SARS-CoV-2 infection in children and young adults are available. Objective: This study aims to determine the prevalence of SARS-CoV-2 antibodies in children from the city of Tübingen, Germany, and to measure the incidence of new cases over 12 months. Methods: SARS-CoV-2 antibodies will be measured in saliva as a surrogate for a previous SARS-CoV-2 infection. Children will be sampled at their preschools, primary schools, and secondary schools at three time points: July 2020, October to December 2020, and April to July 2021. An adult cohort will be sampled at the same time points (ie, adult comparator group). The saliva-based SARS-CoV-2–antibody enzyme-linked immunosorbent assay will be validated using blood and saliva samples from adults with confirmed previous SARS-CoV-2 infections (ie, adult validation group). Results: The first study participant was enrolled in July 2020, and recruitment and enrollment continued until July 2021. We have recruited and enrolled 1850 children, 560 adults for the comparator group, and 83 adults for the validation group. We have collected samples from the children and the adults for the comparator group at the three time points. We followed up with participants in the adult validation group every 2 months and, as of the writing of this paper, we were at time point 7. We will conduct data analysis after the data collection period. Conclusions: Infection rates in children are commonly underreported due to a lack of polymerase chain reaction testing. This study will report on the prevalence of SARS-CoV-2 infections in infants, school children, and adolescents as well as the incidence change over 12 months in the city of Tübingen, Germany. The saliva sampling approach for SARS-CoV-2–antibody measurement allows for a unique, representative, population-based sample collection process. Trial Registration: ClinicalTrials.gov NCT04581889; https://clinicaltrials.gov/ct2/show/NCT04581889 International Registered Report Identifier (IRRID): DERR1-10.2196/27739 %M 34533472 %R 10.2196/27739 %U https://www.researchprotocols.org/2021/10/e27739 %U https://doi.org/10.2196/27739 %U http://www.ncbi.nlm.nih.gov/pubmed/34533472 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 10 %P e32559 %T Excess Mortality During the COVID-19 Pandemic in Jordan: Secondary Data Analysis %A Khader,Yousef %A Al Nsour,Mohannad %+ Department of Public Health, Faculty of Medicine, Jordan University of Science and Technology, Alramtha-Amman Street, Irbid, 22110, Jordan, 962 796802040, yskhader@just.edu.jo %K COVID-19 %K excess mortality %K pandemic %D 2021 %7 7.10.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: All-cause mortality and estimates of excess deaths are commonly used in different countries to estimate the burden of COVID-19 and assess its direct and indirect effects. Objective: This study aimed to analyze the excess mortality during the COVID-19 pandemic in Jordan in April-December 2020. Methods: Official data on deaths in Jordan for 2020 and previous years (2016-2019) were obtained from the Department of Civil Status. We contrasted mortality rates in 2020 with those in each year and the pooled period 2016-2020 using a standardized mortality ratio (SMR) measure. Expected deaths for 2020 were estimated by fitting the overdispersed Poisson generalized linear models to the monthly death counts for the period of 2016-2019. Results: Overall, a 21% increase in standardized mortality (SMR 1.21, 95% CI 1.19-1.22) occurred in April-December 2020 compared with the April-December months in the pooled period 2016-2019. The SMR was more pronounced for men than for women (SMR 1.26, 95% CI 1.24-1.29 vs SMR 1.12, 95% CI 1.10-1.14), and it was statistically significant for both genders (P<.05). Using overdispersed Poisson generalized linear models, the number of expected deaths in April-December 2020 was 12,845 (7957 for women and 4888 for men). The total number of excess deaths during this period was estimated at 4583 (95% CI 4451-4716), with higher excess deaths in men (3112, 95% CI 3003-3221) than in women (1503, 95% CI 1427-1579). Almost 83.66% of excess deaths were attributed to COVID-19 in the Ministry of Health database. The vast majority of excess deaths occurred in people aged 60 years or older. Conclusions: The reported COVID-19 death counts underestimated mortality attributable to COVID-19. Excess deaths could reflect the increased deaths secondary to the pandemic and its containment measures. The majority of excess deaths occurred among old age groups. It is, therefore, important to maintain essential services for the elderly during pandemics. %M 34617910 %R 10.2196/32559 %U https://publichealth.jmir.org/2021/10/e32559 %U https://doi.org/10.2196/32559 %U http://www.ncbi.nlm.nih.gov/pubmed/34617910 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 10 %P e31374 %T Expanding Video Consultation Services at Pace and Scale in Scotland During the COVID-19 Pandemic: National Mixed Methods Case Study %A Wherton,Joseph %A Greenhalgh,Trisha %A Shaw,Sara E %+ Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Woodstock Rd, Oxford, OX2 6GG, United Kingdom, 44 1865 617855, trish.greenhalgh@phc.ox.ac.uk %K technology-enabled care %K video consultations %K quality improvement %K COVID-19 %K PERCS framework %D 2021 %7 7.10.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Scotland—a country of 5.5 million people—has a rugged geography with many outlying islands, creating access challenges for many citizens. The government has long sought to mitigate these through a range of measures including an ambitious technology-enabled care program. A strategy to develop a nationwide video consultation service began in 2017. Our mixed methods evaluation was commissioned in mid-2019 and extended to cover the pandemic response in 2020. Objective: To draw lessons from a national evaluation of the introduction, spread, and scale-up of Scotland’s video consultation services both before and during the pandemic. Methods: Data sources comprised 223 interviews (with patients, staff, technology providers, and policymakers), 60 hours of ethnographic observation (including in-person visits to remote settings), patient and staff satisfaction surveys (n=20,349), professional and public engagement questionnaires (n=5400), uptake statistics, and local and national documents. Fieldwork during the pandemic was of necessity conducted remotely. Data were analyzed thematically and theorized using the Planning and Evaluating Remote Consultation Services (PERCS) framework which considers multiple influences interacting dynamically and unfolding over time. Results: By the time the pandemic hit, there had been considerable investment in material and technological infrastructure, staff training, and professional and public engagement. Scotland was thus uniquely well placed to expand its video consultation services at pace and scale. Within 4 months (March-June 2020), the number of video consultations increased from about 330 to 17,000 per week nationally. While not everything went smoothly, video was used for a much wider range of clinical problems, vastly extending the prepandemic focus on outpatient monitoring of chronic stable conditions. The technology was generally considered dependable and easy to use. In most cases (14,677/18,817, 78%), patients reported no technical problems during their postconsultation survey. Health care organizations’ general innovativeness and digital maturity had a strong bearing on their ability to introduce, routinize, and expand video consultation services. Conclusions: The national-level groundwork before the pandemic allowed many services to rapidly extend the use of video consultations during the pandemic, supported by a strong strategic vision, a well-resourced quality improvement model, dependable technology, and multiple opportunities for staff to try out the video option. Scotland provides an important national case study from which other countries may learn. %M 34516389 %R 10.2196/31374 %U https://www.jmir.org/2021/10/e31374 %U https://doi.org/10.2196/31374 %U http://www.ncbi.nlm.nih.gov/pubmed/34516389 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 10 %P e29963 %T Attitudes About COVID-19 and Health (ATTACH): Online Survey and Mixed Methods Study %A Hood,Anna M %A Stotesbury,Hanne %A Murphy,Jennifer %A Kölbel,Melanie %A Slee,April %A Springall,Charlie %A Paradis,Matthew %A Corral-Frías,Nadia Saraí %A Reyes-Aguilar,Azalea %A Cuellar Barboza,Alfredo B %A Noser,Amy E %A Gomes,Stacey %A Mitchell,Monica %A Watkins,Sharon M %A Butsch Kovacic,Melinda %A Kirkham,Fenella J %A Crosby,Lori E %+ Developmental Neurosciences Unit and Biomedical Research Centre, University College London Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, United Kingdom, 44 02079052744, a.hood@ucl.ac.uk %K COVID-19 %K mental health %K international %K mitigation strategies %K deprivation %D 2021 %7 7.10.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: Behavioral mitigation strategies to slow the spread of COVID-19 have resulted in sweeping lifestyle changes, with short- and long-term psychological, well-being, and quality of life implications. The Attitudes About COVID-19 and Health (ATTACH) study focuses on understanding attitudes and beliefs while considering the impact on mental and physical health and the influence of broader demographic and geographic factors on attitudes, beliefs, and mental health burden. Objective: In this assessment of our first wave of data collection, we provide baseline cohort description of the ATTACH study participants in the United Kingdom, the United States, and Mexico. Additionally, we assess responses to daily poll questions related to COVID-19 and conduct a cross-sectional analysis of baseline assessments collected in the UK between June 26 and October 31, 2020. Methods: The ATTACH study uses smartphone app technology and online survey data collection. Participants completed poll questions related to COVID-19 2 times daily and a monthly survey assessing mental health, social isolation, physical health, and quality of life. Poll question responses were graphed using 95% Clopper–Pearson (exact) tests with 95% CIs. Pearson correlations, hierarchical linear regression analyses, and generalized linear models assessed relationships, predictors of self-reported outcomes, and group differences, respectively. Results: By October 31, 2020, 1405, 80, and 90 participants had consented to participate in the UK, United States, and Mexico, respectively. Descriptive data for the UK daily poll questions indicated that participants generally followed social distancing measures, but worry and negative impacts on families increased as the pandemic progressed. Although participants generally reported feeling that the reasons for current measures had been made clear, there was low trust that the government was doing everything in its power to meet public needs. In the UK, 1282 participants also completed a monthly survey (94.99% [1326/1396] White, 72.22% [1014/1404] female, and 20.12% [277/1377] key or essential workers); 18.88% (242/1282) of UK participants reported a preexisting mental health disorder, 31.36% (402/1282) reported a preexisting chronic medical illness, and 35.11% (493/1404) were aged over 65; 57.72% (740/1282) of participants reported being more sedentary since the pandemic began, and 41.89% (537/1282) reported reduced access to medical care. Those with poorer mental health outcomes lived in more deprived neighborhoods, in larger households (Ps<.05), had more preexisting mental health disorders and medical conditions, and were younger than 65 years (all Ps<.001). Conclusions: Communities who have been exposed to additional harm during the COVID-19 pandemic were experiencing worse mental outcomes. Factors including having a medical condition, or living in a deprived neighborhood or larger household were associated with heightened risk. Future longitudinal studies should investigate the link between COVID-19 exposure, mental health, and sociodemographic and residential characteristics. %M 34357877 %R 10.2196/29963 %U https://mental.jmir.org/2021/10/e29963 %U https://doi.org/10.2196/29963 %U http://www.ncbi.nlm.nih.gov/pubmed/34357877 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 10 %P e28933 %T Virtual Education Program to Support Providers Caring for People With Intellectual and Developmental Disabilities During the COVID-19 Pandemic: Rapid Development and Evaluation Study %A Thakur,Anupam %A Pereira,Cheryl %A Hardy,Jenny %A Bobbette,Nicole %A Sockalingam,Sanjeev %A Lunsky,Yona %+ Centre for Addiction and Mental Health, Department of Psychiatry, University of Toronto, 1025 Queen Street West, Toronto, ON, M6J 1H1, Canada, 1 6476185764, anupam.thakur@camh.ca %K COVID-19 %K coronavirus %K pandemic %K intellectual disability %K mental health %K community of practice %K ECHO, virtual %K capacity-building %D 2021 %7 7.10.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: People with intellectual and developmental disabilities are at increased health-related risk due to the COVID-19 pandemic. Virtual training programs that support providers in caring for the physical and mental health needs of this population, as well provide psychological support to the providers themselves, are needed during the pandemic. Objective: This paper describes the design, delivery, and evaluation of a virtual educational COVID-19–focused Extension for Community Healthcare Outcomes program to support providers during the COVID-19 pandemic in caring for the mental health of people with intellectual and developmental disabilities. Methods: A rapid design thinking approach was used to develop a 6-session program that incorporates mindfulness practice, a wellness check, COVID-19–related research and policy updates, a didactic presentation on a combination mental health and COVID-19 related topic, and a case-based discussion to encourage practical learning. We used the first 5 outcome levels of Moore’s evaluation framework—focusing on participation, satisfaction, learning, self-efficacy, and change in practice—which were rated (out of 5) by care providers from health and disability service sectors, as well as additional reflection measures about innovations to the program. Qualitative feedback from open-text responses from participants were analyzed using modified manifest content analysis. Results: A total of 104 care providers from health and disability service sectors participated in the program. High levels of engagement (81 participants per session on average) and satisfaction (overall satisfaction score: mean 4.31, SD 0.17) were observed. Self-efficacy (score improvement: 19.8%), support, and coping improved. Participants also rated the newly developed COVID-19 program and its innovative components highly. Open text feedback showed participants felt that the Extension for Community Healthcare Outcomes program expanded their knowledge and competency and created a sense of being part of a community of practice; provided value for the COVID-19 innovations; supported resource-sharing within and beyond program participants; and facilitated changes to participants’ approaches to client care in practice and increased participants’ confidence in supporting clients and families. Conclusions: The Extension for Community Healthcare Outcomes program is an effective model for capacity-building programs with a shared-learning approach. Future iterations should include targeted evaluation of long-term outcomes such as staff burnout. %M 34617917 %R 10.2196/28933 %U https://mental.jmir.org/2021/10/e28933 %U https://doi.org/10.2196/28933 %U http://www.ncbi.nlm.nih.gov/pubmed/34617917 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 10 %P e28873 %T Remote Assessment of Lung Disease and Impact on Physical and Mental Health (RALPMH): Protocol for a Prospective Observational Study %A Ranjan,Yatharth %A Althobiani,Malik %A Jacob,Joseph %A Orini,Michele %A Dobson,Richard JB %A Porter,Joanna %A Hurst,John %A Folarin,Amos A %+ Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, 16 De Crespigny Park, London, SE5 8AF, United Kingdom, 44 02078480924, amos.folarin@kcl.ac.uk %K mHealth %K COVID-19 %K mobile health %K remote monitoring %K wearables %K internet of things %K lung diseases %K respiratory health %K mental health %K cardiopulmonary diseases %D 2021 %7 7.10.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Chronic lung disorders like chronic obstructive pulmonary disease (COPD) and idiopathic pulmonary fibrosis (IPF) are characterized by exacerbations. They are unpleasant for patients and sometimes severe enough to cause hospital admission and death. Moreover, due to the COVID-19 pandemic, vulnerable populations with these disorders are at high risk, and their routine care cannot be done properly. Remote monitoring offers a low cost and safe solution for gaining visibility into the health of people in their daily lives, making it useful for vulnerable populations. Objective: The primary objective is to assess the feasibility and acceptability of remote monitoring using wearables and mobile phones in patients with pulmonary diseases. The secondary objective is to provide power calculations for future studies centered around understanding the number of exacerbations according to sample size and duration. Methods: Twenty participants will be recruited in each of three cohorts (COPD, IPF, and posthospitalization COVID). Data collection will be done remotely using the RADAR-Base (Remote Assessment of Disease And Relapse) mobile health (mHealth) platform for different devices, including Garmin wearable devices and smart spirometers, mobile app questionnaires, surveys, and finger pulse oximeters. Passive data include wearable-derived continuous heart rate, oxygen saturation, respiration rate, activity, and sleep. Active data include disease-specific patient-reported outcome measures, mental health questionnaires, and symptom tracking to track disease trajectory. Analyses will assess the feasibility of lung disorder remote monitoring (including data quality, data completeness, system usability, and system acceptability). We will attempt to explore disease trajectory, patient stratification, and identification of acute clinical events such as exacerbations. A key aspect is understanding the potential of real-time data collection. We will simulate an intervention to acquire responses at the time of the event to assess model performance for exacerbation identification. Results: The Remote Assessment of Lung Disease and Impact on Physical and Mental Health (RALPMH) study provides a unique opportunity to assess the use of remote monitoring in the evaluation of lung disorders. The study started in the middle of June 2021. The data collection apparatus, questionnaires, and wearable integrations were setup and tested by the clinical teams prior to the start of recruitment. While recruitment is ongoing, real-time exacerbation identification models are currently being constructed. The models will be pretrained daily on data of previous days, but the inference will be run in real time. Conclusions: The RALPMH study will provide a reference infrastructure for remote monitoring of lung diseases. It specifically involves information regarding the feasibility and acceptability of remote monitoring and the potential of real-time data collection and analysis in the context of chronic lung disorders. It will help plan and inform decisions in future studies in the area of respiratory health. Trial Registration: ISRCTN Registry ISRCTN16275601; https://www.isrctn.com/ISRCTN16275601 International Registered Report Identifier (IRRID): PRR1-10.2196/28873 %M 34319235 %R 10.2196/28873 %U https://www.researchprotocols.org/2021/10/e28873 %U https://doi.org/10.2196/28873 %U http://www.ncbi.nlm.nih.gov/pubmed/34319235 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 10 %P e27301 %T Positioning Digital Tracing Applications in the Management of the COVID-19 Pandemic in France %A Albouy-Llaty,Marion %A Martin,Caroline %A Benamouzig,Daniel %A Bothorel,Eric %A Munier,Gilles %A Simonin,Catherine %A Guéant,Jean-Louis %A Rusch,Emmanuel %+ Faculty of Medicine and Pharmacy, University of Poitiers, 6 rue de la Milétrie, Poitiers, 86021, France, 33 0669660192, marion.albouy@univ-poitiers.fr %K COVID-19 pandemic %K digital contact tracing applications %K health inequalities %K Europe %K health promotion %D 2021 %7 7.10.2021 %9 Viewpoint %J J Med Internet Res %G English %X To combat the COVID-19 pandemic, many European countries have developed a public health strategy involving the use of digital contact tracing (DCT) applications to improve timely tracking and contact tracing of COVID-19 cases. France’s independent COVID-19 Control and Society Connection Council (CCL) was established by law in May 2020 to issue advice and recommendations on the national epidemic digital systems. In this paper, we present the recommendations by the CCL, with the objective to increase the uptake and utility of French DCT applications. As the country's most vulnerable population has been subjected to greater virus exposure, a stronger impact of the lockdown, and less access to preventive and health care services, the CCL is particularly aware of health inequalities. The French DCT app TousAntiCovid had been downloaded by 13.6 million users (ie, 20% of the French population) in March 2021. To promote the use of DCT apps, the CCL has recommended that communication about the app’s individual and collective objectives be increased. The CCL has also recommended the introduction of clear, simple, accessible, incentivizing, noncoercive information within the digital tools. In addition, the CCL has recommended improving public health policies to address the needs of the underprivileged. The CCL calls for promoting population empowerment with the use of digital tools, improving public health culture for decision-makers dealing with health determinants, taking social considerations into account, and incorporating community participation. %M 34313588 %R 10.2196/27301 %U https://www.jmir.org/2021/10/e27301 %U https://doi.org/10.2196/27301 %U http://www.ncbi.nlm.nih.gov/pubmed/34313588 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 10 %P e26840 %T Adoption of Preventive Measures During the Very Early Phase of the COVID-19 Outbreak in China: National Cross-sectional Survey Study %A Lau,Joseph %A Yu,Yanqiu %A Xin,Meiqi %A She,Rui %A Luo,Sitong %A Li,Lijuan %A Wang,Suhua %A Ma,Le %A Tao,Fangbiao %A Zhang,Jianxin %A Zhao,Junfeng %A Hu,Dongsheng %A Li,Liping %A Zhang,Guohua %A Gu,Jing %A Lin,Danhua %A Wang,Hongmei %A Cai,Yong %A Wang,Zhaofen %A You,Hua %A Hu,Guoqing %A , %+ Centre for Health Behaviours Research, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, 30-32 Ngan Shing Street, Sha Tin, New Territory, Hong Kong, Hong Kong, 852 22528727, jlau@cuhk.edu.hk %K COVID-19 %K health behavior %K prevention %K control %K cognition %K face mask %K hand hygiene %K interpersonal contacts %K China %K protection %K public health %K behavior %K infectious disease %K cross-sectional %K survey %D 2021 %7 7.10.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The outbreak of COVID-19 in China occurred around the Chinese New Year (January 25, 2020), and infections decreased continuously afterward. General adoption of preventive measures during the Chinese New Year period was crucial in driving the decline. It is imperative to investigate preventive behaviors among Chinese university students, who could have spread COVID-19 when travelling home during the Chinese New Year break. Objective: In this study, we investigated levels of COVID-19–related personal measures undertaken during the 7-day Chinese New Year holidays by university students in China, and associated COVID-19–related cognitive factors. Methods: A cross-sectional anonymous web-based survey was conducted during the period from February 1 to 10, 2020. Data from 23,863 students (from 26 universities, 16 cities, 13 provincial-level regions) about personal measures (frequent face-mask wearing, frequent handwashing, frequent home staying, and an indicator that combined the 3 behaviors) were analyzed (overall response rate 70%). Multilevel multiple logistic regression analysis was performed. Results: Only 28.0% of respondents (6684/23,863) had left home for >4 hours, and 49.3% (11,757/23,863) had never left home during the 7-day Chinese New Year period; 79.7% (19,026/23,863) always used face-masks in public areas. The frequency of handwashing with soap was relatively low (6424/23,863, 26.9% for >5 times/day); 72.4% (17,282/23,863) had frequently undertaken ≥2 of these 3 measures. COVID-19–related cognitive factors (perceptions on modes of transmission, permanent bodily damage, efficacy of personal or governmental preventive measures, nonavailability of vaccines and treatments) were significantly associated with preventive measures. Associations with frequent face-mask wearing were stronger than those with frequent home staying. Conclusions: University students had strong behavioral responses during the very early phase of the COVID-19 outbreak. Levels of personal prevention, especially frequent home staying and face-mask wearing, were high. Health promotion may modify cognitive factors. Some structural factors (eg, social distancing policy) might explain why the frequency of home staying was higher than that of handwashing. Other populations might have behaved similarly; however, such data were not available to us. %M 34479184 %R 10.2196/26840 %U https://publichealth.jmir.org/2021/10/e26840 %U https://doi.org/10.2196/26840 %U http://www.ncbi.nlm.nih.gov/pubmed/34479184 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 10 %P e32216 %T Evaluation of Novel Concentrated Interdisciplinary Group Rehabilitation for Patients With Chronic Illnesses: Protocol for a Nonrandomized Clinical Intervention Study %A Kvale,Gerd %A Frisk,Bente %A Jürgensen,Marte %A Børtveit,Tore %A Ødegaard-Olsen,Øystein Theodor %A Wilhelmsen-Langeland,Ane %A Aarli,Bernt Bøgvald %A Sandnes,Kristina %A Rykken,Sidsel %A Haugstvedt,Anne %A Hystad,Sigurd William %A Søfteland,Eirik %+ Division of Psychiatry, Haukeland University Hospital, PO Box 1400, Bergen, 5021, Norway, 47 55975000, gerd.kvale@helse-bergen.no %K COVID-19 %K chronic illnesses %K concentrated rehabilitation %K low back pain %K post–COVID-19 symptoms %K post–COVID-19 syndrome %K long COVID %K fatigue %K type 2 diabetes %K anxiety %K depression %D 2021 %7 7.10.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: An aging population with a growing burden of chronic complex illnesses will seriously challenge the public health care system. Consequently, novel and efficacious treatment approaches are highly warranted. Based on our experiences with concentrated treatment formats for other health challenges, we developed a highly concentrated interdisciplinary group rehabilitation approach for chronic illnesses. Objective: We aim to explore the acceptability of the intervention and describe potential changes in functional impairment at follow-up. Methods: The cornerstones of the intervention are as follows: (1) prepare the patient for change prior to treatment, (2) focus on health promoting microchoices instead of symptoms, and (3) expect the patient to integrate the changes in everyday living with limited hands-on follow-up. The intervention will be delivered to patients with highly diverse primary symptoms, namely patients with low back pain, post–COVID-19 symptoms, anxiety and depression, and type 2 diabetes. Results: Recruitment started between August 2020 and January 2021 (according to the illness category). For initial 3-month results, recruitment is expected to be completed by the end of 2021. Conclusions: If successful, this study may have a substantial impact on the treatment of low back pain, post–COVID-19 symptoms, anxiety and depression, and type 2 diabetes, which together constitute a major socioeconomic cost. Further, the study may widen the evidence base for the use of the concentrated treatment format in a diverse group of medical conditions. International Registered Report Identifier (IRRID): DERR1-10.2196/32216 %M 34505838 %R 10.2196/32216 %U https://www.researchprotocols.org/2021/10/e32216 %U https://doi.org/10.2196/32216 %U http://www.ncbi.nlm.nih.gov/pubmed/34505838 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 10 %P e30757 %T The COVID-19 Study of Healthcare and Support Personnel (CHAMPS): Protocol for a Longitudinal Observational Study %A Kaufmann,Peter G %A Havens,Donna S %A Mensinger,Janell L %A Bradley,Patricia K %A Brom,Heather M %A Copel,Linda C %A Costello,Alexander %A D'Annunzio,Christine %A Dean Durning,Jennifer %A Maldonado,Linda %A Barrow McKenzie,Ann %A Smeltzer,Suzanne C %A Yost,Jennifer %A , %+ M. Louise Fitzapatrick College of Nursing, Villanova University, 800 Lancaster Ave, Villanova, PA, 19085, United States, 1 6105195972, peter.kaufmann@villanova.edu %K COVID-19 %K SARS-CoV-2 %K stress %K depression %K anxiety %K sleep %K social support %K resilience %K mental health %K physical health %D 2021 %7 7.10.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Early in the development of the COVID-19 pandemic, it was evident that health care workers, first responders, and other essential workers would face significant stress and workplace demands related to equipment shortages and rapidly growing infections in the general population. Although the effects of other sources of stress on health have been documented, the effects of these unique conditions of the COVID-19 pandemic on the long-term health and well-being of the health care workforce are not known. Objective: The COVID-19 Study of Healthcare and Support Personnel (CHAMPS) was designed to document early and longitudinal effects of the pandemic on the mental and physical health of essential workers engaged in health care. We will investigate mediators and moderators of these effects and evaluate the influence of exposure to stress, including morbidity and mortality, over time. We will also examine the effect of protective factors and resilience on health outcomes. Methods: The study cohort is a convenience sample recruited nationally through communities, professional organizations, networks, social media, and snowball sampling. Recruitment took place for 13 months to obtain an estimated sample of 2762 adults who provided self-reported information administered on the web through structured questionnaires about their work environment, mental and physical health, and psychosocial factors. Follow-up questionnaires will be administered after 6 months and annually thereafter to ascertain changes in health, well-being, and lifestyle. Participants who consented to be recontacted form the longitudinal cohort and the CHAMPS Registry may be contacted to ascertain their interest in ancillary studies for which they may be eligible. Results: The study was approved by the Institutional Review Board and launched in May 2020, with grants from Travere Therapeutics Inc, McKesson Corporation, anonymous donors, and internal funding from the M. Louise Fitzpatrick College of Nursing at Villanova University. Recruitment ended in June 2021 after enrolling 2762 participants, 1534 of whom agreed to participate in the longitudinal study and the registry as well as to be contacted about eligibility for future studies. Conclusions: The CHAMPS Study and Registry will enable the acquisition of detailed data on the effects of extended psychosocial and workplace stress on morbidity and mortality and serve as a platform for ancillary studies related to the COVID-19 pandemic. Trial Registration: ClinicalTrials.gov NCT04370821; https://clinicaltrials.gov/ct2/show/NCT04370821 International Registered Report Identifier (IRRID): DERR1-10.2196/30757 %M 34582354 %R 10.2196/30757 %U https://www.researchprotocols.org/2021/10/e30757 %U https://doi.org/10.2196/30757 %U http://www.ncbi.nlm.nih.gov/pubmed/34582354 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 10 %P e32468 %T Effectiveness of Contact Tracing for Viral Disease Mitigation and Suppression: Evidence-Based Review %A Thomas Craig,Kelly Jean %A Rizvi,Rubina %A Willis,Van C %A Kassler,William J %A Jackson,Gretchen Purcell %+ Center for AI, Research, and Evaluation, IBM Watson Health, IBM Corporation, 75 Binney Street, Cambridge, MA, 02142, United States, 1 9702613366, kelly.jean.craig@ibm.com %K contact tracing %K non-pharmaceutical interventions %K pandemic %K epidemic %K viral disease %K COVID-19 %K isolation %K testing %K surveillance %K monitoring %K review %K intervention %K effectiveness %K mitigation %K transmission %K spread %K protection %K outcome %D 2021 %7 6.10.2021 %9 Review %J JMIR Public Health Surveill %G English %X Background: Contact tracing in association with quarantine and isolation is an important public health tool to control outbreaks of infectious diseases. This strategy has been widely implemented during the current COVID-19 pandemic. The effectiveness of this nonpharmaceutical intervention is largely dependent on social interactions within the population and its combination with other interventions. Given the high transmissibility of SARS-CoV-2, short serial intervals, and asymptomatic transmission patterns, the effectiveness of contact tracing for this novel viral agent is largely unknown. Objective: This study aims to identify and synthesize evidence regarding the effectiveness of contact tracing on infectious viral disease outcomes based on prior scientific literature. Methods: An evidence-based review was conducted to identify studies from the PubMed database, including preprint medRxiv server content, related to the effectiveness of contact tracing in viral outbreaks. The search dates were from database inception to July 24, 2020. Outcomes of interest included measures of incidence, transmission, hospitalization, and mortality. Results: Out of 159 unique records retrieved, 45 (28.3%) records were reviewed at the full-text level, and 24 (15.1%) records met all inclusion criteria. The studies included utilized mathematical modeling (n=14), observational (n=8), and systematic review (n=2) approaches. Only 2 studies considered digital contact tracing. Contact tracing was mostly evaluated in combination with other nonpharmaceutical interventions and/or pharmaceutical interventions. Although some degree of effectiveness in decreasing viral disease incidence, transmission, and resulting hospitalizations and mortality was observed, these results were highly dependent on epidemic severity (R0 value), number of contacts traced (including presymptomatic and asymptomatic cases), timeliness, duration, and compliance with combined interventions (eg, isolation, quarantine, and treatment). Contact tracing effectiveness was particularly limited by logistical challenges associated with increased outbreak size and speed of infection spread. Conclusions: Timely deployment of contact tracing strategically layered with other nonpharmaceutical interventions could be an effective public health tool for mitigating and suppressing infectious outbreaks by decreasing viral disease incidence, transmission, and resulting hospitalizations and mortality. %M 34612841 %R 10.2196/32468 %U https://publichealth.jmir.org/2021/10/e32468 %U https://doi.org/10.2196/32468 %U http://www.ncbi.nlm.nih.gov/pubmed/34612841 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 1 %N 1 %P e27472 %T The Impact of the Online COVID-19 Infodemic on French Red Cross Actors’ Field Engagement and Protective Behaviors: Mixed Methods Study %A Heyerdahl,Leonardo W %A Lana,Benedetta %A Giles-Vernick,Tamara %+ Department of Global Health, Anthropology and Ecology of Disease Emergence Unit, Institut Pasteur, 25 rue du Docteur Roux, Paris, 75015, France, 33 0140613982, tamara.giles-vernick@pasteur.fr %K COVID-19 %K infodemics %K social listening %K epidemics %K medical anthropology %K nongovernmental organizations %D 2021 %7 6.10.2021 %9 Original Paper %J JMIR Infodemiology %G English %X Background: The COVID-19 pandemic has been widely described as an infodemic, an excess of rapidly circulating information in social and traditional media in which some information may be erroneous, contradictory, or inaccurate. One key theme cutting across many infodemic analyses is that it stymies users’ capacities to identify appropriate information and guidelines, encourages them to take inappropriate or even harmful actions, and should be managed through multiple transdisciplinary approaches. Yet, investigations demonstrating how the COVID-19 information ecosystem influences complex public decision making and behavior offline are relatively few. Objective: The aim of this study was to investigate whether information reported through the social media channel Twitter, linked articles and websites, and selected traditional media affected the risk perception, engagement in field activities, and protective behaviors of French Red Cross (FRC) volunteers and health workers in the Paris region of France from June to October 2020. Methods: We used a hybrid approach that blended online and offline data. We tracked daily Twitter discussions and selected traditional media in France for 7 months, qualitatively evaluating COVID-19 claims and debates about nonpharmaceutical protective measures. We conducted 24 semistructured interviews with FRC workers and volunteers. Results: Social and traditional media debates about viral risks and nonpharmaceutical interventions fanned anxieties among FRC volunteers and workers. Decisions to continue conducting FRC field activities and daily protective practices were also influenced by other factors unrelated to the infodemic: familial and social obligations, gender expectations, financial pressures, FRC rules and communications, state regulations, and relationships with coworkers. Some respondents developed strategies for “tuning out” social and traditional media. Conclusions: This study suggests that during the COVID-19 pandemic, the information ecosystem may be just one among multiple influences on one group’s offline perceptions and behavior. Measures to address users who have disengaged from online sources of health information and who rely on social relationships to obtain information are needed. Tuning out can potentially lead to less informed decision making, leading to worse health outcomes. %M 34661065 %R 10.2196/27472 %U https://infodemiology.jmir.org/2021/1/e27472 %U https://doi.org/10.2196/27472 %U http://www.ncbi.nlm.nih.gov/pubmed/34661065 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 10 %P e31273 %T Supporting Mental Health During the COVID-19 Pandemic Using a Digital Behavior Change Intervention: An Open-Label, Single-Arm, Pre-Post Intervention Study %A Summers,Charlotte %A Wu,Philip %A Taylor,Alisdair J G %+ DDM Health, Technology House, Science Park, University of Warwick, Coventry, CV4 7EZ, United Kingdom, 44 7969091134, charlotte@ddm.health %K stress %K mental health %K COVID-19 %K digital therapy %K mHealth %K support %K behavior %K intervention %K online intervention %K outcome %K wellbeing %K sleep %K activity %K nutrition %D 2021 %7 6.10.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic is taking a toll on people’s mental health, particularly as people are advised to adhere to social distancing, self-isolation measures, and government-imposed national lockdowns. Digital health technologies have an important role to play in keeping people connected and in supporting their mental health and well-being. Even before the COVID-19 pandemic, mental health and social services were already strained. Objective: Our objective was to evaluate the 12-week outcomes of the digitally delivered Gro Health intervention, a holistic digital behavior change app designed for self-management of mental well-being, sleep, activity, and nutrition. Methods: The study used a quasi-experimental research design consisting of an open-label, single-arm, pre-post intervention engagement using a convenience sample. Adults who had joined the Gro Health app (intervention) and had a complete baseline dataset (ie, 7-item Generalized Anxiety Disorder scale, Perceived Stress Scale, and 9-item Patient Health Questionnaire) were followed up at 12 weeks (n=273), including 33 (12.1%) app users who reported a positive COVID-19 diagnosis during the study period. User engagement with the Gro Health platform was tracked by measuring total minutes of app engagement. Paired t tests were used to compare pre-post intervention scores. Linear regression analysis was performed to assess the relationship between minutes of active engagement with the Gro Health app and changes in scores across the different mental health measures. Results: Of the 347 study participants, 273 (78.67%) completed both the baseline and follow-up surveys. Changes in scores for anxiety, perceived stress, and depression were predicted by app engagement, with the strongest effect observed for changes in perceived stress score (F1,271=251.397; R2=0.479; P<.001). Conclusions: A digital behavior change platform that provides remote mental well-being support can be effective in managing depression, anxiety, and perceived stress during times of crisis such as the current COVID-19 pandemic. The outcomes of this study may also support the implementation of remote digital health apps supporting behavior change and providing support for low levels of mental health within the community. %M 34459740 %R 10.2196/31273 %U https://formative.jmir.org/2021/10/e31273 %U https://doi.org/10.2196/31273 %U http://www.ncbi.nlm.nih.gov/pubmed/34459740 %0 Journal Article %@ 2561-9128 %I JMIR Publications %V 4 %N 2 %P e30473 %T Sustaining a Multidisciplinary, Single-Institution, Postoperative Mobilization Clinical Practice Improvement Program Following Hepatopancreatobiliary Surgery During the COVID-19 Pandemic: Prospective Cohort Study %A Chan,Kai Siang %A Wang,Bei %A Tan,Yen Pin %A Chow,Jaclyn Jie Ling %A Ong,Ee Ling %A Junnarkar,Sameer P %A Low,Jee Keem %A Huey,Cheong Wei Terence %A Shelat,Vishal G %+ Department of General Surgery, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore, 65 63577807, vishal_g_shelat@ttsh.com.sg %K enhanced recovery after surgery %K early mobilization %K liver resection %K pancreas surgery %K quality improvement project %K pancreaticoduodenectomy %D 2021 %7 6.10.2021 %9 Original Paper %J JMIR Perioper Med %G English %X Background: The Enhanced Recovery After Surgery (ERAS) protocol has been recently extended to hepatopancreatobiliary (HPB) surgery, with excellent outcomes reported. Early mobilization is an essential facet of the ERAS protocol, but compliance has been reported to be poor. We recently reported our success in a 6-month clinical practice improvement program (CPIP) for early postoperative mobilization. During the COVID-19 pandemic, we experienced reduced staffing and resource availability, which can make CPIP sustainability difficult. Objective: We report outcomes at 1 year following the implementation of our CPIP to improve postoperative mobilization in patients undergoing major HPB surgery during the COVID-19 pandemic. Methods: We divided our study into 4 phases—phase 1: before CPIP implementation (January to April 2019); phase 2: CPIP implementation (May to September 2019); phase 3: post–CPIP implementation but prior to the COVID-19 pandemic (October 2019 to March 2020); and phase 4: post–CPIP implementation and during the pandemic (April 2020 to September 2020). Major HPB surgery was defined as any surgery on the liver, pancreas, and biliary system with a duration of >2 hours and with an anticipated blood loss of ≥500 ml. Study variables included length of hospital stay, distance ambulated on postoperative day (POD) 2, morbidity, balance measures (incidence of fall and accidental dislodgement of drains), and reasons for failure to achieve targets. Successful mobilization was defined as the ability to sit out of bed for >6 hours on POD 1 and ambulate ≥30 m on POD 2. The target mobilization rate was ≥75%. Results: A total of 114 patients underwent major HPB surgery from phases 2 to 4 of our study, with 33 (29.0%), 45 (39.5%), and 36 (31.6%) patients in phases 2, 3, and 4, respectively. No baseline patient demographic data were collected for phase 1 (pre–CPIP implementation). The majority of the patients were male (n=79, 69.3%) and underwent hepatic surgery (n=92, 80.7%). A total of 76 (66.7%) patients underwent ON-Q PainBuster insertion intraoperatively. The median mobilization rate was 22% for phase 1, 78% for phases 2 and 3 combined, and 79% for phase 4. The mean pain score was 2.7 (SD 1.0) on POD 1 and 1.8 (SD 1.5) on POD 2. The median length of hospitalization was 6 days (IQR 5-11.8). There were no falls or accidental dislodgement of drains. Six patients (5.3%) had pneumonia, and 21 (18.4%) patients failed to ambulate ≥30 m on POD 2 from phases 2 to 4. The most common reason for failure to achieve the ambulation target was pain (6/21, 28.6%) and lethargy or giddiness (5/21, 23.8%). Conclusions: This follow-up study demonstrates the sustainability of our CPIP in improving early postoperative mobilization rates following major HPB surgery 1 year after implementation, even during the COVID-19 pandemic. Further large-scale, multi-institutional prospective studies should be conducted to assess compliance and determine its sustainability. %M 34559668 %R 10.2196/30473 %U https://periop.jmir.org/2021/2/e30473 %U https://doi.org/10.2196/30473 %U http://www.ncbi.nlm.nih.gov/pubmed/34559668 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 10 %P e30444 %T Detection of Spatiotemporal Clusters of COVID-19–Associated Symptoms and Prevention Using a Participatory Surveillance App: Protocol for the @choum Study %A De Ridder,David %A Loizeau,Andrea Jutta %A Sandoval,José Luis %A Ehrler,Frédéric %A Perrier,Myriam %A Ritch,Albert %A Violot,Guillemette %A Santolini,Marc %A Greshake Tzovaras,Bastian %A Stringhini,Silvia %A Kaiser,Laurent %A Pradeau,Jean-François %A Joost,Stéphane %A Guessous,Idris %+ Division of Primary Care, Geneva University Hospitals, 4 Rue Gabrielle-Perret-Gentil, Geneva, 1205, Switzerland, 41 22 305 58 61, Idris.Guessous@hcuge.ch %K participatory surveillance %K infectious disease %K COVID-19 %K SARS-CoV-2 %K space-time clustering %K digital health %K mobile app %K mHealth %K epidemiology %K surveillance %K digital surveillance %K public health %D 2021 %7 6.10.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: The early detection of clusters of infectious diseases such as the SARS-CoV-2–related COVID-19 disease can promote timely testing recommendation compliance and help to prevent disease outbreaks. Prior research revealed the potential of COVID-19 participatory syndromic surveillance systems to complement traditional surveillance systems. However, most existing systems did not integrate geographic information at a local scale, which could improve the management of the SARS-CoV-2 pandemic. Objective: The aim of this study is to detect active and emerging spatiotemporal clusters of COVID-19–associated symptoms, and to examine (a posteriori) the association between the clusters’ characteristics and sociodemographic and environmental determinants. Methods: This report presents the methodology and development of the @choum (English: “achoo”) study, evaluating an epidemiological digital surveillance tool to detect and prevent clusters of individuals (target sample size, N=5000), aged 18 years or above, with COVID-19–associated symptoms living and/or working in the canton of Geneva, Switzerland. The tool is a 5-minute survey integrated into a free and secure mobile app (CoronApp-HUG). Participants are enrolled through a comprehensive communication campaign conducted throughout the 12-month data collection phase. Participants register to the tool by providing electronic informed consent and nonsensitive information (gender, age, geographically masked addresses). Symptomatic participants can then report COVID-19–associated symptoms at their onset (eg, symptoms type, test date) by tapping on the @choum button. Those who have not yet been tested are offered the possibility to be informed on their cluster status (information returned by daily automated clustering analysis). At each participation step, participants are redirected to the official COVID-19 recommendations websites. Geospatial clustering analyses are performed using the modified space-time density-based spatial clustering of applications with noise (MST-DBSCAN) algorithm. Results: The study began on September 1, 2020, and will be completed on February 28, 2022. Multiple tests performed at various time points throughout the 5-month preparation phase have helped to improve the tool’s user experience and the accuracy of the clustering analyses. A 1-month pilot study performed among 38 pharmacists working in 7 Geneva-based pharmacies confirmed the proper functioning of the tool. Since the tool’s launch to the entire population of Geneva on February 11, 2021, data are being collected and clusters are being carefully monitored. The primary study outcomes are expected to be published in mid-2022. Conclusions: The @choum study evaluates an innovative participatory epidemiological digital surveillance tool to detect and prevent clusters of COVID-19–associated symptoms. @choum collects precise geographic information while protecting the user’s privacy by using geomasking methods. By providing an evidence base to inform citizens and local authorities on areas potentially facing a high COVID-19 burden, the tool supports the targeted allocation of public health resources and promotes testing. International Registered Report Identifier (IRRID): DERR1-10.2196/30444 %M 34449403 %R 10.2196/30444 %U https://www.researchprotocols.org/2021/10/e30444 %U https://doi.org/10.2196/30444 %U http://www.ncbi.nlm.nih.gov/pubmed/34449403 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 10 %P e30339 %T A Guided Internet-Based Problem-Solving Intervention Delivered Through Smartphones for Secondary School Pupils During the COVID-19 Pandemic in India: Protocol for a Pilot Randomized Controlled Trial %A Gonsalves,Pattie P %A Sharma,Rhea %A Hodgson,Eleanor %A Bhat,Bhargav %A Jambhale,Abhijeet %A Weiss,Helen A %A Fairburn,Christopher G %A Cavanagh,Kate %A Cuijpers,Pim %A Michelson,Daniel %A Patel,Vikram %+ Sangath, E-5, Lane 1, Westend Marg, Saiyad ul ajaib, Saket, New Delhi, 110030, India, 91 9899419704, pattie.gonsalves@sangath.in %K randomized controlled trial %K internet-based intervention %K smartphone %K adolescent %K schools %K mental health %K COVID-19 %K app %K protocol %K problem-solving %K intervention %K teenager %K young adult %K India %K feasibility %K effective %D 2021 %7 6.10.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: “POD Adventures” is a gamified mental health intervention delivered via a smartphone app and supported by counsellors for a target population of secondary school students in India. This paper describes the protocol for a pilot randomized controlled trial of a remotely delivered version of the intervention in the context of COVID-19 restrictions. Objective: Our objectives are to assess the feasibility of research procedures and intervention delivery and to generate preliminary estimates of the effectiveness of the intervention to inform the sample size calculation of a full-scale trial. Methods: We will conduct a parallel, 2-arm, individually randomized pilot controlled trial in 11 secondary schools in Goa, India. This pilot trial aims to recruit 70 participants with a felt need for psychological support. Participants will receive either the POD Adventures intervention delivered over 4 weeks or usual care comprising information about local mental health services and national helplines. Outcomes will be assessed at two timepoints: baseline and 6 weeks post randomization. Results: The first participant was enrolled on January 28, 2021, and 6-week assessment completed on April 4, 2021. Owing to a second wave of the COVID-19 pandemic in India, schools in Goa were closed on April 22, 2021. Trial participants are currently receiving the intervention or completing follow-up assessments. Conclusions: This pilot trial will help understand the feasibility of implementing and evaluating a remotely delivered digital mental health intervention in a low-resource setting. Our findings will be used to design future trials that can address difficulties of accessing psychosocial support in-person and support wider efforts to scale up evidence-based mental health interventions for young people. Trial Registration: ClinicalTrials.gov NCT04672486; https://clinicaltrials.gov/ct2/show/NCT04672486 International Registered Report Identifier (IRRID): DERR1-10.2196/30339 %M 34586075 %R 10.2196/30339 %U https://www.researchprotocols.org/2021/10/e30339 %U https://doi.org/10.2196/30339 %U http://www.ncbi.nlm.nih.gov/pubmed/34586075 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 10 %P e26104 %T A Web-Based Intervention (Germ Defence) to Increase Handwashing During a Pandemic: Process Evaluations of a Randomized Controlled Trial and Public Dissemination %A Miller,Sascha %A Ainsworth,Ben %A Weal,Mark %A Smith,Peter %A Little,Paul %A Yardley,Lucy %A Morrison,Leanne %+ Center for Clinical and Community Applications of Health Psychology, Department of Psychology, University of Southampton, Building 44 Highfield Campus, Southampton, SO17 1BJ, United Kingdom, 44 02380595000, sm2t07@soton.ac.uk %K behavior %K infection %K prevention %K respiratory tract infection %K internet %K evaluation studies %K pandemic %K COVID-19 %K transmission %K virus %K influenza %K respiratory %K intervention %K digital intervention %K dissemination %D 2021 %7 5.10.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Washing hands helps prevent transmission of seasonal and pandemic respiratory viruses. In a randomized controlled trial (RCT) during the swine flu outbreak, participants with access to a fully automated, digital intervention promoting handwashing reported washing their hands more often and experienced fewer respiratory tract infections than those without access to the intervention. Based on these findings, the intervention was adapted, renamed as “Germ Defence,” and a study was designed to assess the preliminary dissemination of the intervention to the general public to help prevent the spread of seasonal colds and flu. Objective: This study compares the process evaluations of the RCT and Germ Defence dissemination to examine (1) how web-based research enrollment procedures affected those who used the intervention, (2) intervention usage in the 2 contexts, and (3) whether increased intentions to wash hands are replicated once disseminated. Methods: The RCT ran between 2010 and 2012 recruiting participants offline from general practices, with restricted access to the intervention (N=9155). Germ Defence was disseminated as an open access website for use by the general public from 2016 to 2019 (N=624). The process evaluation plan was developed using Medical Research Council guidance and the framework for Analyzing and Measuring Usage and Engagement Data. Both interventions contained a goal-setting section where users self-reported current and intended handwashing behavior across 7 situations. Results: During web-based enrolment, 54.3% (17,511/32,250) of the RCT participants dropped out of the study compared to 36.5% (358/982) of Germ Defence users. Having reached the start of the intervention, 93.8% (8586/9155) of RCT users completed the core section, whereas 65.1% (406/624) of Germ Defence users reached the same point. Users across both studies selected to increase their handwashing in 5 out of 7 situations, including before eating snacks (RCT mean difference 1.040, 95% CI 1.016-1.063; Germ Defence mean difference 0.949, 95% CI 0.766-1.132) and after blowing their nose, sneezing, or coughing (RCT mean difference 0.995, 95% CI 0.972-1.019; Germ Defence mean difference 0.842, 95% CI 0.675-1.008). Conclusions: By comparing the preliminary dissemination of Germ Defence to the RCT, we were able to examine the potential effects of the research procedures on uptake and attrition such as the sizeable dropout during the RCT enrolment procedure that may have led to a more motivated sample. The Germ Defence study highlighted the points of attrition within the intervention. Despite sample bias in the trial context, the intervention replicated increases in intentions to handwash when used “in the wild.” This preliminary dissemination study informed the adaptation of the intervention for the COVID-19 health emergency, and it has now been disseminated globally. Trial Registration: ISRCTN Registry ISRCTN75058295; https://www.isrctn.com/ISRCTN75058295 %M 34519661 %R 10.2196/26104 %U https://www.jmir.org/2021/10/e26104 %U https://doi.org/10.2196/26104 %U http://www.ncbi.nlm.nih.gov/pubmed/34519661 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 7 %N 4 %P e29486 %T Evaluating Applicant Perceptions of the Impact of Social Media on the 2020-2021 Residency Application Cycle Occurring During the COVID-19 Pandemic: Survey Study %A Naaseh,Ariana %A Thompson,Sean %A Tohmasi,Steven %A Wiechmann,Warren %A Toohey,Shannon %A Wray,Alisa %A Boysen-Osborn,Megan %+ University of California, Irvine School of Medicine, 1001 Health Sciences Road, Irvine, CA, 92617, United States, 1 (949) 824 4285, mbo@hs.uci.edu %K residency application %K social media %K medical education %K resident %K medical student %K perspective %K residency recruitment %K virtual application %K virtual residency %D 2021 %7 5.10.2021 %9 Original Paper %J JMIR Med Educ %G English %X Background: Due to challenges related to the COVID-19 pandemic, residency programs in the United States conducted virtual interviews during the 2020-2021 application season. As a result, programs and applicants may have relied more heavily on social media–based communication and dissemination of information. Objective: We sought to determine social media’s impact on residency applicants during an entirely virtual application cycle. Methods: An anonymous electronic survey was distributed to 465 eligible 2021 Match applicants at 4 University of California Schools of Medicine in the United States. Results: A total of 72 participants (15.5% of eligible respondents), applying to 16 specialties, responded. Of those who responded, 53% (n=38) reported following prospective residency accounts on social media, and 89% (n=34) of those respondents were positively or negatively influenced by these accounts. The top three digital methods by which applicants sought information about residency programs included the program website, digital conversations with residents and fellows of that program, and Instagram. Among respondents, 53% (n=38) attended virtual information sessions for prospective programs. A minority of applicants (n=19, 26%) adjusted the number of programs they applied to based on information found on social media, with most (n=14, 74%) increasing the number of programs to which they applied. Survey respondents ranked social media’s effectiveness in allowing applicants to learn about programs at 6.7 (SD 2.1) on a visual analogue scale from 1-10. Most applicants (n=61, 86%) felt that programs should use social media in future application cycles even if they are nonvirtual. Conclusions: Social media appears to be an important tool for resident recruitment. Future studies should seek more information on its effect on later parts of the application cycle and the Match. %M 34591779 %R 10.2196/29486 %U https://mededu.jmir.org/2021/4/e29486 %U https://doi.org/10.2196/29486 %U http://www.ncbi.nlm.nih.gov/pubmed/34591779 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 4 %N 4 %P e29953 %T The Association of Delayed Care With Depression Among US Middle-Aged and Older Adults During the COVID-19 Pandemic: Cross-sectional Analysis %A Luo,Yan %+ The University of Alabama, 2106 Forest Lake Dr., Tuscaloosa, AL, 35401, United States, 1 2058868781, yluo30@crimson.ua.edu %K depression %K COVID-19 %K delayed care %K middle-aged adults %K older adults %D 2021 %7 5.10.2021 %9 Original Paper %J JMIR Aging %G English %X Background: During the COVID-19 pandemic, the depression level among US adults has significantly increased. Age disparity in depression during the pandemic has been reported in recent studies. Delay or avoidance of medical care is one of the collateral damages associated with the COVID-19 pandemic, and it can lead to increased morbidity and mortality. Objective: This study aimed to assess the prevalence of depression and delayed care among US middle-aged adults and older adults during the pandemic, as well as investigate the association of delayed care with depression among those 2 age groups. Methods: This cross-sectional study used data from the 2020 Health and Retirement Study (HRS) COVID-19 Project (Early, Version 1.0). Univariate analyses, bivariate analyses, and binary logistic regression were applied. US adults older than 46 years were included. Depression was measured by the Composite International Diagnostic Interview-Short Form (CIDI-SF). Delayed care was measured by the following 4 items: delayed surgery, delayed seeing a doctor, delayed dental care, and other delayed care. Results: A total of 3246 participants were identified. More than half of the participants were older than 65 years (n=1890, 58.2%), and 274 (8.8%) participants had depression during the pandemic. Delayed dental care was positively associated with depression among both middle-aged adults (OR 2.05, 95% CI 1.04-4.03; P=.04) and older adults (OR 3.08, 95% CI 1.07-8.87; P=.04). Delayed surgery was positively associated with depression among older adults (OR 3.69, 95% CI 1.06-12.90; P=.04). Self-reported pain was positively related to depression among both age groups. Middle-aged adults who reported higher education levels (some college or above) or worse self-reported health had a higher likelihood of having depression. While perceived more loneliness was positively associated with depression among older adults, financial difficulty was positively associated with depression among middle-aged adults. Conclusions: This study found that depression was prevalent among middle-aged and older adults during the pandemic. The study highlighted the collateral damage of the COVID-19 pandemic by identifying the association of delayed surgery and dental care with depression during the pandemic. Although surgery and dental care cannot be delivered by telehealth, telehealth services can still be provided to address patients’ concerns on delayed surgery and dental care. Moreover, the implementation of telemental health services is needed to address mental health symptoms among US middle-aged and older adults during the pandemic. Future research that uses more comprehensive measurements for delayed care is needed to decipher the path through which delayed care is associated with depression. %M 34524964 %R 10.2196/29953 %U https://aging.jmir.org/2021/4/e29953 %U https://doi.org/10.2196/29953 %U http://www.ncbi.nlm.nih.gov/pubmed/34524964 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 10 %P e30871 %T Post-COVID Public Health Surveillance and Privacy Expectations in the United States: Scenario-Based Interview Study %A Seberger,John S %A Patil,Sameer %+ College of Communication Arts & Sciences, Michigan State University, 404 Wilson Rd, East Lansing, MI, 48824, United States, 1 (517) 416 0743, seberge1@msu.edu %K COVID-19 %K pandemic-tracking apps %K privacy concerns %K infrastructure %K health surveillance %K scenario %K interview %K thematic analysis %D 2021 %7 5.10.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Smartphone-based apps designed and deployed to mitigate the COVID-19 pandemic may become infrastructure for postpandemic public health surveillance in the United States. Through the lenses of privacy concerns and user expectations of digital pandemic mitigation techniques, we identified possible long-term sociotechnical implications of such an infrastructure. Objective: We explored how people in the United States perceive the possible routinization of pandemic tracking apps for public health surveillance in general. Our interdisciplinary analysis focused on the interplay between privacy concerns, data practices of surveillance capitalism, and trust in health care providers. We conducted this analysis to achieve a richer understanding of the sociotechnical issues raised by the deployment and use of technology for pandemic mitigation. Methods: We conducted scenario-based, semistructured interviews (n=19) with adults in the United States. The interviews focused on how people perceive the short- and long-term privacy concerns associated with a fictional smart thermometer app deployed to mitigate the “outbreak of a contagious disease.” In order to elicit future-oriented discussions, the scenario indicated that the app would continue functioning “after the disease outbreak has dissipated.” We analyzed interview transcripts using reflexive thematic analysis. Results: In the context of pandemic mitigation technology, including app-based tracking, people perceive a core trade-off between public health and personal privacy. People tend to rationalize this trade-off by invoking the concept of “the greater good.” The interplay between the trade-off and rationalization forms the core of sociotechnical issues that pandemic mitigation technologies raise. Participants routinely expected that data collected through apps related to public health would be shared with unknown third parties for the financial gain of the app makers. This expectation suggests a perceived alignment between an app-based infrastructure for public health surveillance and the broader economics of surveillance capitalism. Our results highlight unintended and unexpected sociotechnical impacts of routinizing app-based tracking on postpandemic life, which are rationalized by invoking a nebulous concept of the greater good. Conclusions: While technologies such as app-based tracking could be useful for pandemic mitigation and preparedness, the routinization of such apps as a form of public health surveillance may have broader, unintentional sociotechnical implications for individuals and the societies in which they live. Although technology has the potential to increase the efficacy of pandemic mitigation, it exists within a broader network of sociotechnical concerns. Therefore, it is necessary to consider the long-term implications of pandemic mitigation technologies beyond the immediate needs of addressing the COVID-19 pandemic. Potential negative consequences include the erosion of patient trust in health care systems and providers, grounded in concerns about privacy violations and overly broad surveillance. %M 34519667 %R 10.2196/30871 %U https://mhealth.jmir.org/2021/10/e30871 %U https://doi.org/10.2196/30871 %U http://www.ncbi.nlm.nih.gov/pubmed/34519667 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 10 %P e30083 %T An Early Warning Risk Prediction Tool (RECAP-V1) for Patients Diagnosed With COVID-19: Protocol for a Statistical Analysis Plan %A Fiorentino,Francesca %A Prociuk,Denys %A Espinosa Gonzalez,Ana Belen %A Neves,Ana Luisa %A Husain,Laiba %A Ramtale,Sonny Christian %A Mi,Emma %A Mi,Ella %A Macartney,Jack %A Anand,Sneha N %A Sherlock,Julian %A Saravanakumar,Kavitha %A Mayer,Erik %A de Lusignan,Simon %A Greenhalgh,Trisha %A Delaney,Brendan C %+ Department of Surgery and Cancer, Imperial College London, Queen Elizabeth the Queen Mother Building (10th Floor/1091), St Mary's Hospital, Praed Street, London, W2 1NY, United Kingdom, 44 2033123761, f.fiorentino@imperial.ac.uk %K COVID-19 %K modeling %K remote assessment %K risk score %K early warning %D 2021 %7 5.10.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Since the start of the COVID-19 pandemic, efforts have been made to develop early warning risk scores to help clinicians decide which patient is likely to deteriorate and require hospitalization. The RECAP (Remote COVID-19 Assessment in Primary Care) study investigates the predictive risk of hospitalization, deterioration, and death of patients with confirmed COVID-19, based on a set of parameters chosen through a Delphi process performed by clinicians. We aim to use rich data collected remotely through the use of electronic data templates integrated in the electronic health systems of several general practices across the United Kingdom to construct accurate predictive models. The models will be based on preexisting conditions and monitoring data of a patient’s clinical parameters (eg, blood oxygen saturation) to make reliable predictions as to the patient’s risk of hospital admission, deterioration, and death. Objective: This statistical analysis plan outlines the statistical methods to build the prediction model to be used in the prioritization of patients in the primary care setting. The statistical analysis plan for the RECAP study includes the development and validation of the RECAP-V1 prediction model as a primary outcome. This prediction model will be adapted as a three-category risk score split into red (high risk), amber (medium risk), and green (low risk) for any patient with suspected COVID-19. The model will predict the risk of deterioration and hospitalization. Methods: After the data have been collected, we will assess the degree of missingness and use a combination of traditional data imputation using multiple imputation by chained equations, as well as more novel machine-learning approaches to impute the missing data for the final analysis. For predictive model development, we will use multiple logistic regression analyses to construct the model. We aim to recruit a minimum of 1317 patients for model development and validation. We will then externally validate the model on an independent dataset of 1400 patients. The model will also be applied for multiple different datasets to assess both its performance in different patient groups and its applicability for different methods of data collection. Results: As of May 10, 2021, we have recruited 3732 patients. A further 2088 patients have been recruited through the National Health Service Clinical Assessment Service, and approximately 5000 patients have been recruited through the DoctalyHealth platform. Conclusions: The methodology for the development of the RECAP-V1 prediction model as well as the risk score will provide clinicians with a statistically robust tool to help prioritize COVID-19 patients. Trial Registration: ClinicalTrials.gov NCT04435041; https://clinicaltrials.gov/ct2/show/NCT04435041 International Registered Report Identifier (IRRID): DERR1-10.2196/30083 %M 34468322 %R 10.2196/30083 %U https://www.researchprotocols.org/2021/10/e30083 %U https://doi.org/10.2196/30083 %U http://www.ncbi.nlm.nih.gov/pubmed/34468322 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 10 %P e30697 %T The National COVID Cohort Collaborative: Analyses of Original and Computationally Derived Electronic Health Record Data %A Foraker,Randi %A Guo,Aixia %A Thomas,Jason %A Zamstein,Noa %A Payne,Philip RO %A Wilcox,Adam %A , %+ Division of General Medical Sciences, School of Medicine, Washington University in St. Louis, 600 S. Taylor Avenue, Suite 102, Campus Box 8102, St. Louis, MO, 63110, United States, 1 314 273 2211, randi.foraker@wustl.edu %K synthetic data %K protected health information %K COVID-19 %K electronic health records and systems %K data analysis %D 2021 %7 4.10.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Computationally derived (“synthetic”) data can enable the creation and analysis of clinical, laboratory, and diagnostic data as if they were the original electronic health record data. Synthetic data can support data sharing to answer critical research questions to address the COVID-19 pandemic. Objective: We aim to compare the results from analyses of synthetic data to those from original data and assess the strengths and limitations of leveraging computationally derived data for research purposes. Methods: We used the National COVID Cohort Collaborative’s instance of MDClone, a big data platform with data-synthesizing capabilities (MDClone Ltd). We downloaded electronic health record data from 34 National COVID Cohort Collaborative institutional partners and tested three use cases, including (1) exploring the distributions of key features of the COVID-19–positive cohort; (2) training and testing predictive models for assessing the risk of admission among these patients; and (3) determining geospatial and temporal COVID-19–related measures and outcomes, and constructing their epidemic curves. We compared the results from synthetic data to those from original data using traditional statistics, machine learning approaches, and temporal and spatial representations of the data. Results: For each use case, the results of the synthetic data analyses successfully mimicked those of the original data such that the distributions of the data were similar and the predictive models demonstrated comparable performance. Although the synthetic and original data yielded overall nearly the same results, there were exceptions that included an odds ratio on either side of the null in multivariable analyses (0.97 vs 1.01) and differences in the magnitude of epidemic curves constructed for zip codes with low population counts. Conclusions: This paper presents the results of each use case and outlines key considerations for the use of synthetic data, examining their role in collaborative research for faster insights. %M 34559671 %R 10.2196/30697 %U https://www.jmir.org/2021/10/e30697 %U https://doi.org/10.2196/30697 %U http://www.ncbi.nlm.nih.gov/pubmed/34559671 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 4 %N 4 %P e27769 %T Delivery Outcomes During the COVID-19 Pandemic as Reported in a Pregnancy Mobile App: Retrospective Cohort Study %A Noddin,Katie %A Bradley,Dani %A Wolfberg,Adam %+ Ovia Health, 308 Congress St, Boston, MA, 02210, United States, 1 3392032545, katie@oviahealth.com %K digital health %K COVID-19 %K maternal health %K obstetrics %K COVID %K pandemic %K pregnant women %K birth %K hospital %K delivery %K women's health %K Cesarean sections %D 2021 %7 4.10.2021 %9 Short Paper %J JMIR Pediatr Parent %G English %X Background: The COVID-19 pandemic has presented obstacles for providers and patients in the maternal health care setting, causing changes to many pregnant women’s birth plans, as well as abrupt changes in hospital labor and delivery policies and procedures. Few data exist on the effects of the COVID-19 pandemic on the maternal health care landscape at the national level in the United States. Objective: The aim of this study is to assess the incidence of key obstetrics outcomes (preterm delivery, Cesarean sections, and home births) and length of hospital stay during the COVID-19 pandemic as compared to the 6 months prior. Methods: We conducted a retrospective cohort study of women aged 18-44 years in the United States who delivered between October 1, 2019, and September 30, 2020, had singleton deliveries, and completed a birth report in the Ovia Pregnancy mobile app. Women were assigned to the prepandemic cohort if they delivered between October 2019 and March 2020, and the pandemic cohort if they delivered between April and September 2020. Gestational age at delivery, delivery method, delivery facility type, and length of hospital stay were compared. Results: A total of 304,023 birth reports were collected, with 152,832 (50.26%) in the prepandemic cohort and 151,191 (49.73%) in the pandemic cohort. Compared to the prepandemic cohort, principal findings indicate a 5.67% decrease in preterm delivery rates in the pandemic cohort (P<.001; odds ratio [OR] 0.94, 95% CI 0.91-0.96), a 30.0% increase in home birth rates (P<.001; OR 1.3, 95% CI 1.23-1.4), and a 7.81% decrease in the average hospital length of stay postdelivery (mean 2.48 days, SD 1.35). There were no overall changes in Cesarean section rates between cohorts, but differences were observed between age, race, and ethnicity subgroups. Conclusions: Results suggest a need for continuous monitoring of maternal health trends as the COVID-19 pandemic progresses and underline the important role of digital data collection, particularly during the pandemic. %M 34509975 %R 10.2196/27769 %U https://pediatrics.jmir.org/2021/4/e27769 %U https://doi.org/10.2196/27769 %U http://www.ncbi.nlm.nih.gov/pubmed/34509975 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 10 %P e32353 %T Use of a Guided Imagery Mobile App (See Me Serene) to Reduce COVID-19–Related Stress: Pilot Feasibility Study %A Gordon,Judith S %A Sbarra,David %A Armin,Julie %A Pace,Thaddeus W W %A Gniady,Chris %A Barraza,Yessenya %+ College of Nursing, University of Arizona, 1305 North Martin Avenue, Tucson, AZ, 85721, United States, 1 5206264970, judithg@email.arizona.edu %K COVID-19 %K stress %K anxiety %K isolation %K intervention %K guided imagery %K mobile app %D 2021 %7 4.10.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The SARS-CoV-2 pandemic has led to concerns about mental health resulting from regional and national lockdowns, social isolation, job loss, and concern about disease exposure. Objective: We describe results of the pilot feasibility study of the See Me Serene mHealth app. The app provides users with immersive, vivid, nature experiences to reduce stress and anxiety related to COVID-19 and other isolation. The goals of the study were to develop the See Me Serene app and test the feasibility and acceptability of study procedures, and explore the potential impact of the app on stress and anxiety. Methods: We developed and tested the See Me Serene app and our study procedures for feasibility, and gathered preliminary data with a goal of 100 participants. The research was conducted in 2 phases: (1) development and internal testing of the app; and (2) feasibility and pilot testing with participants recruited online through earned media (eg, news stories), presentations at a university campus, and social media (eg, online sharing of earned media and presentations). The feasibility study employed a mixed methods, within-subjects, pre-/posttest design. At baseline and 30-day follow-up, we assessed stress-related variables via validated self-report measures and saliva samples for determination of cortisol concentrations. Results: We met or surpassed all our feasibility benchmarks for recruitment (101 participants recruited), retention (91% [90/99] of 30-day assessment completed), and data collection (99 participants completed all baseline data; 85% [84/99] of salivary cortisol samples returned). Participants adhered to the intervention. On average, participants listened to 48.2 audio files over 30 days or approximately 1.6 audio files per day. Participants were satisfied with the app, with 87% (78/90) rating the app as helpful in dealing with stress and anxiety. The app showed the potential to reduce stress, anxiety, loneliness, and worry. We did not find significant differences (P=.41) in cortisol levels over time. Our findings suggest that future research is warranted to test the efficacy of the See Me Serene app with a representative, diverse sample. Conclusions: There is a need for evidence-based and easily disseminable stress-reduction interventions. See Me Serene is a feasible intervention and has the potential to reduce stress related to COVID-19 and other forms of social isolation. More research on See Me Serene is warranted. %M 34546941 %R 10.2196/32353 %U https://formative.jmir.org/2021/10/e32353 %U https://doi.org/10.2196/32353 %U http://www.ncbi.nlm.nih.gov/pubmed/34546941 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 10 %P e31722 %T Practical and Emotional Problems Reported by Users of a Self-guided Digital Problem-solving Intervention During the COVID-19 Pandemic: Content Analysis %A Hentati,Amira %A Forsell,Erik %A Ljótsson,Brjánn %A Kraepelien,Martin %+ Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Region Stockholm, Norra Stationsgatan 69, Stockholm, 11364, Sweden, 46 704411425, amira.hentati@ki.se %K digital intervention %K COVID-19 %K problem-solving %K self-guided intervention %K content analysis %K public health %K mental health %K depression %K anxiety %K pandemic %D 2021 %7 4.10.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: To better direct assessments and interventions toward the general population during both the ongoing COVID-19 pandemic and future crises with societal restrictions, data on the types of practical and emotional problems that people are experiencing are needed. Objective: The aim of this study was to examine the types of practical and emotional problems that the general population is experiencing during the COVID-19 pandemic and to construct an empirically derived inventory based on the findings. Methods: A total of 396 participants, recruited among members of the general public in Sweden who were experiencing practical and/or emotional problems during the pandemic, accessed a self-guided digital problem-solving intervention for a period of 1 week to report and solve the problems they experienced. Prior to accessing the intervention, the participants completed a short self-assessment regarding symptoms of depression and anxiety. Content analysis was used to account for the types of problems participants reported. A set of items for an inventory was later proposed based on the problem categories derived from the analysis. Results: A majority of participants had clinically relevant symptoms of either depression or anxiety. The problems reported were categorized as 13 distinct types of problems. The most common problem was difficulty managing daily activities. Based on the categories, a 13-item inventory was proposed. Conclusions: The 13 types of problems, and the proposed inventory, could be valuable when composing assessments and interventions for the general population during the ongoing pandemic or similar crises with societal restrictions. The most common problem was of a practical nature, indicating the importance of including examples of such problems within assessments and interventions. Trial Registration: ClinicalTrials.gov NCT04677270; https://clinicaltrials.gov/ct2/show/NCT04677270 %M 34559670 %R 10.2196/31722 %U https://formative.jmir.org/2021/10/e31722 %U https://doi.org/10.2196/31722 %U http://www.ncbi.nlm.nih.gov/pubmed/34559670 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 7 %N 4 %P e26790 %T Innovation and Inequality: A Medical Student Perspective. Comment on "The Present and Future Applications of Technology in Adapting Medical Education Amidst the COVID-19 Pandemic" %A Pan,Myat %A San,Myat %+ Cardiff University School of Medicine, Neuadd Meirionnydd, Cardiff, CF14 4YS, United Kingdom, 44 (0)29 2068 8113, panmp@cardiff.ac.uk %K medical education %K technology %K coronavirus %K medical students %K COVID-19 %K pandemic %K online lecture %K virtual reality %K education %D 2021 %7 4.10.2021 %9 Letter to the Editor %J JMIR Med Educ %G English %X %M 34081609 %R 10.2196/26790 %U https://mededu.jmir.org/2021/4/e26790 %U https://doi.org/10.2196/26790 %U http://www.ncbi.nlm.nih.gov/pubmed/34081609 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 10 %P e29025 %T Public Sentiment and Discourse on Domestic Violence During the COVID-19 Pandemic in Australia: Analysis of Social Media Posts %A Usher,Kim %A Durkin,Joanne %A Martin,Sam %A Vanderslott,Samantha %A Vindrola-Padros,Cecilia %A Usher,Luke %A Jackson,Debra %+ University of New England, Pat O’Shane Building, Armidale, 2350, Australia, 61 401096117, jdurkin3@myune.edu.au %K COVID-19 %K domestic violence %K social media %K Twitter %K sentiment analysis %K discourse analysis %K keyword analysis %K pandemic %K sentiment %K public health %K public expression %D 2021 %7 1.10.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Measuring public response during COVID-19 is an important way of ensuring the suitability and effectiveness of epidemic response efforts. An analysis of social media provides an approximation of public sentiment during an emergency like the current pandemic. The measures introduced across the globe to help curtail the spread of the coronavirus have led to the development of a situation labeled as a “perfect storm,” triggering a wave of domestic violence. As people use social media to communicate their experiences, analyzing public discourse and sentiment on social platforms offers a way to understand concerns and issues related to domestic violence during the COVID-19 pandemic. Objective: This study was based on an analysis of public discourse and sentiment related to domestic violence during the stay-at-home periods of the COVID-19 pandemic in Australia in 2020. It aimed to understand the more personal self-reported experiences, emotions, and reactions toward domestic violence that were not always classified or collected by official public bodies during the pandemic. Methods: We searched social media and news posts in Australia using key terms related to domestic violence and COVID-19 during 2020 via digital analytics tools to determine sentiments related to domestic violence during this period. Results: The study showed that the use of sentiment and discourse analysis to assess social media data is useful in measuring the public expression of feelings and sharing of resources in relation to the otherwise personal experience of domestic violence. There were a total of 63,800 posts across social media and news media. Within these posts, our analysis found that domestic violence was mentioned an average of 179 times a day. There were 30,100 tweets, 31,700 news reports, 1500 blog posts, 548 forum posts, and 7 comments (posted on news and blog websites). Negative or neutral sentiment centered on the sharp rise in domestic violence during different lockdown periods of the 2020 pandemic, and neutral and positive sentiments centered on praise for efforts that raised awareness of domestic violence as well as the positive actions of domestic violence charities and support groups in their campaigns. There were calls for a positive and proactive handling (rather than a mishandling) of the pandemic, and results indicated a high level of public discontent related to the rising rates of domestic violence and the lack of services during the pandemic. Conclusions: This study provided a timely understanding of public sentiment related to domestic violence during the COVID-19 lockdown periods in Australia using social media analysis. Social media represents an important avenue for the dissemination of information; posts can be widely dispersed and easily accessed by a range of different communities who are often difficult to reach. An improved understanding of these issues is important for future policy direction. Heightened awareness of this could help agencies tailor and target messaging to maximize impact. %M 34519659 %R 10.2196/29025 %U https://www.jmir.org/2021/10/e29025 %U https://doi.org/10.2196/29025 %U http://www.ncbi.nlm.nih.gov/pubmed/34519659 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 10 %P e27358 %T A Novel Mobile App (“CareFit”) to Support Informal Caregivers to Undertake Regular Physical Activity From Home During and Beyond COVID-19 Restrictions: Co-design and Prototype Development Study %A Egan,Kieren J %A Hodgson,William %A Dunlop,Mark D %A Imperatore,Gennaro %A Kirk,Alison %A Maguire,Roma %+ Department of Computer and Information Science, University of Strathclyde, Livingstone Tower, 26 Richmond Street, Glasgow, G1 1XH, United Kingdom, 44 0141 548 3138, kieren.egan@strath.ac.uk %K physical activity %K Android %K COVID-19 %K intervention %K co-design %K exercise %K app %K development %K support %K caregiver %D 2021 %7 1.10.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Informal caregivers, or carers (unpaid family members and friends), are instrumental to millions worldwide for the ongoing delivery of health and well-being needs. The risk of crisis points (eg, hospitalizations) for caregivers increases with the absence of physical activity. The COVID-19 pandemic is highly likely to have increased the risk of crisis points for caregivers by increasing the amount of time spent indoors due to shielding and lockdown restrictions. Thus, accessible evidence-based tools to facilitate physical activity for caregivers indoors are urgently needed. Objective: The aim of this study was to co-design and develop a novel mobile app to educate and support carers in the undertaking of regular physical activity at home during and beyond COVID-19 restrictions via integration of the transtheoretical model of behavior change and UK physical activity guidelines. Methods: We co-designed a mobile app, “CareFit,” by directly involving caregivers, health care professionals, and social care professionals in the requirements, capturing, and evaluation phases of three Agile Scrum design and development sprints. Seven participants representing multistakeholder views took part in three co-design sessions, each of which was followed by a development sprint. Requirements for CareFit were grounded in a combination of behavioral change science and UK government guidelines for physical activity. Results: Participants identified different barriers and enablers to physical activity, such as a lack of time, recognition of existing activities, and concerns regarding safely undertaking physical activity. Requirements analysis highlighted the importance of simplicity in design and a need to anchor development around the everyday needs of caregivers (eg, easy-to-use video instructions). Our final prototype app integrated guidance for undertaking physical activity at home through educational, physical activity, and communication components. Conclusions: Integrating government guidelines with models of behavioral change into a mobile app to support the physical activity of carers is novel. We found that integrating core physical activity guidelines into a co-designed smartphone app with functionality such as a weekly planner and educational material for users is feasible. This work holds promise to fill the gap of effective physical activity solutions for caregivers both during and beyond the COVID-19 pandemic. Further work is now needed to explore the feasibility, acceptability, and usability of the approach in real-world settings. %M 34406969 %R 10.2196/27358 %U https://formative.jmir.org/2021/10/e27358 %U https://doi.org/10.2196/27358 %U http://www.ncbi.nlm.nih.gov/pubmed/34406969 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 10 %P e26980 %T Knowledge, Attitudes, and Practices Regarding COVID-19 Among Health Care Workers in Public Health Facilities in Eastern Ethiopia: Cross-sectional Survey Study %A Farah,Alinoor Mohamed %A Nour,Tahir Yousuf %A Obsiye,Muse %A Aden,Mowlid Akil %A Ali,Omar Moeline %A Hussein,Muktar Arab %A Budul,Abdullahi Bedel %A Omer,Muktar %A Getnet,Fentabil %+ Department of Public Health Nutrition, School of Public Health, College of Medicine and Health Sciences, Jigjiga University, CoMHS Building, 2nd Floor, Jigjiga, 1020, Ethiopia, 251 911053913, alinuriana@yahoo.com %K COVID-19 %K knowledge %K attitude %K practice %K health care workers %K Eastern Ethiopia %D 2021 %7 1.10.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: On March 13, 2020, Ethiopia reported the first confirmed case of COVID-19 in Addis Ababa. COVID-19 is likely to overwhelm an already-fragile health care delivery system and reduce the availability of essential health services. This analysis of data from the Somali Region of Eastern Ethiopia on health care workers’ (HCWs) knowledge, attitudes, and practices regarding the prevention and control of COVID-19 may be used in planning health education programs about the emerging viral disease. Objective: This study aimed to investigate the knowledge, attitudes, and practices of HCWs regarding COVID-19 infection. Methods: This cross-sectional study was conducted among HCWs in three public health facilities in the Somali Region, Eastern Ethiopia. A self-administered questionnaire was shared with all HCWs working at the public health facilities. A total of 15 knowledge questions were scored as 1 or 0 for correct or incorrect responses, respectively. A total of 14 practice questions were scored on a 3-point scale from 1 (“always”) to 3 (“never”). A total of six attitude questions were rated on a 5-point Likert scale, in a negative dimension, as follows: 1 (“strongly agree”), 2 (“agree”), 3 (“neutral”), 4 (“disagree”), and 5 (“strongly disagree”). Mean scores were calculated and used as a cut point to dichotomize the outcome variables (>13.7 indicated good knowledge, <18.8 indicated good practices, and ≤10.5 indicated favorable attitudes). We used t tests and analyses of variance (ie, F tests) to analyze the mean score differences of knowledge, attitudes, and practices between the independent variables. Spearman correlation was used to assess the relationship between mean knowledge and attitude scores. Results: Of the 686 HCWs approached, a total of 434 HCWs responded (63.3% response rate). The mean age of the participants was 27.6 (SD 5.3) years, and the majority of the participants were male (293/434, 67.5%). The mean knowledge score was 13.7 (SD 2.6), and 73.3% (318/434) of participants had sufficient knowledge. The mean attitude score was 10.5 (SD 4.1), and 54.8% (238/434) of the participants had a good attitude toward COVID-19. The mean practice score was 18.8 (SD 5.8), and 61.5% (267/434) of the participants practiced precautionary measures to prevent COVID-19. There was a negative correlation between knowledge and attitude scores (r=–0.295, P<.001) and between knowledge and practice scores (r=–0.298, P<.001). Conclusions: The overall levels of knowledge and practice were relatively better than the attitude level. This highlights the need to implement strategies that enhance the positive attitudes and safe practices of the HCWs for better containment of the pandemic and supporting of essential health care services. %M 34477559 %R 10.2196/26980 %U https://formative.jmir.org/2021/10/e26980 %U https://doi.org/10.2196/26980 %U http://www.ncbi.nlm.nih.gov/pubmed/34477559 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e31122 %T Columbia Open Health Data for COVID-19 Research: Database Analysis %A Lee,Junghwan %A Kim,Jae Hyun %A Liu,Cong %A Hripcsak,George %A Natarajan,Karthik %A Ta,Casey %A Weng,Chunhua %+ Columbia University, Ph-20, 622 W 168 ST, New York, NY, United States, 1 212 304 7907, cw2384@cumc.columbia.edu %K COVID-19 %K open data %K electronic health record %K data science %K research %K data %K access %K database %K symptom %K cohort %K prevalence %D 2021 %7 30.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: COVID-19 has threatened the health of tens of millions of people all over the world. Massive research efforts have been made in response to the COVID-19 pandemic. Utilization of clinical data can accelerate these research efforts to combat the pandemic since important characteristics of the patients are often found by examining the clinical data. Publicly accessible clinical data on COVID-19, however, remain limited despite the immediate need. Objective: To provide shareable clinical data to catalyze COVID-19 research, we present Columbia Open Health Data for COVID-19 Research (COHD-COVID), a publicly accessible database providing clinical concept prevalence, clinical concept co-occurrence, and clinical symptom prevalence for hospitalized patients with COVID-19. COHD-COVID also provides data on hospitalized patients with influenza and general hospitalized patients as comparator cohorts. Methods: The data used in COHD-COVID were obtained from NewYork-Presbyterian/Columbia University Irving Medical Center’s electronic health records database. Condition, drug, and procedure concepts were obtained from the visits of identified patients from the cohorts. Rare concepts were excluded, and the true concept counts were perturbed using Poisson randomization to protect patient privacy. Concept prevalence, concept prevalence ratio, concept co-occurrence, and symptom prevalence were calculated using the obtained concepts. Results: Concept prevalence and concept prevalence ratio analyses showed the clinical characteristics of the COVID-19 cohorts, confirming the well-known characteristics of COVID-19 (eg, acute lower respiratory tract infection and cough). The concepts related to the well-known characteristics of COVID-19 recorded high prevalence and high prevalence ratio in the COVID-19 cohort compared to the hospitalized influenza cohort and general hospitalized cohort. Concept co-occurrence analyses showed potential associations between specific concepts. In case of acute lower respiratory tract infection in the COVID-19 cohort, a high co-occurrence ratio was obtained with COVID-19–related concepts and commonly used drugs (eg, disease due to coronavirus and acetaminophen). Symptom prevalence analysis indicated symptom-level characteristics of the cohorts and confirmed that well-known symptoms of COVID-19 (eg, fever, cough, and dyspnea) showed higher prevalence than the hospitalized influenza cohort and the general hospitalized cohort. Conclusions: We present COHD-COVID, a publicly accessible database providing useful clinical data for hospitalized patients with COVID-19, hospitalized patients with influenza, and general hospitalized patients. We expect COHD-COVID to provide researchers and clinicians quantitative measures of COVID-19–related clinical features to better understand and combat the pandemic. %M 34543225 %R 10.2196/31122 %U https://www.jmir.org/2021/9/e31122 %U https://doi.org/10.2196/31122 %U http://www.ncbi.nlm.nih.gov/pubmed/34543225 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 9 %P e29544 %T Uncovering Clinical Risk Factors and Predicting Severe COVID-19 Cases Using UK Biobank Data: Machine Learning Approach %A Wong,Kenneth Chi-Yin %A Xiang,Yong %A Yin,Liangying %A So,Hon-Cheong %+ School of Biomedical Sciences, The Chinese University of Hong Kong, RM 520A, Lo Kwee Seong Biomedical Sciences Buildiing, Chinese University of Hong Kong, Hong Kong, China, 86 39439255, hcso@cuhk.edu.hk %K prediction %K COVID-19 %K risk factors %K machine learning %K pandemic %K biobank %K public health %K prediction models %K medical informatics %D 2021 %7 30.9.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: COVID-19 is a major public health concern. Given the extent of the pandemic, it is urgent to identify risk factors associated with disease severity. More accurate prediction of those at risk of developing severe infections is of high clinical importance. Objective: Based on the UK Biobank (UKBB), we aimed to build machine learning models to predict the risk of developing severe or fatal infections, and uncover major risk factors involved. Methods: We first restricted the analysis to infected individuals (n=7846), then performed analysis at a population level, considering those with no known infection as controls (ncontrols=465,728). Hospitalization was used as a proxy for severity. A total of 97 clinical variables (collected prior to the COVID-19 outbreak) covering demographic variables, comorbidities, blood measurements (eg, hematological/liver/renal function/metabolic parameters), anthropometric measures, and other risk factors (eg, smoking/drinking) were included as predictors. We also constructed a simplified (lite) prediction model using 27 covariates that can be more easily obtained (demographic and comorbidity data). XGboost (gradient-boosted trees) was used for prediction and predictive performance was assessed by cross-validation. Variable importance was quantified by Shapley values (ShapVal), permutation importance (PermImp), and accuracy gain. Shapley dependency and interaction plots were used to evaluate the pattern of relationships between risk factors and outcomes. Results: A total of 2386 severe and 477 fatal cases were identified. For analyses within infected individuals (n=7846), our prediction model achieved area under the receiving-operating characteristic curve (AUC–ROC) of 0.723 (95% CI 0.711-0.736) and 0.814 (95% CI 0.791-0.838) for severe and fatal infections, respectively. The top 5 contributing factors (sorted by ShapVal) for severity were age, number of drugs taken (cnt_tx), cystatin C (reflecting renal function), waist-to-hip ratio (WHR), and Townsend deprivation index (TDI). For mortality, the top features were age, testosterone, cnt_tx, waist circumference (WC), and red cell distribution width. For analyses involving the whole UKBB population, AUCs for severity and fatality were 0.696 (95% CI 0.684-0.708) and 0.825 (95% CI 0.802-0.848), respectively. The same top 5 risk factors were identified for both outcomes, namely, age, cnt_tx, WC, WHR, and TDI. Apart from the above, age, cystatin C, TDI, and cnt_tx were among the top 10 across all 4 analyses. Other diseases top ranked by ShapVal or PermImp were type 2 diabetes mellitus (T2DM), coronary artery disease, atrial fibrillation, and dementia, among others. For the “lite” models, predictive performances were broadly similar, with estimated AUCs of 0.716, 0.818, 0.696, and 0.830, respectively. The top ranked variables were similar to above, including age, cnt_tx, WC, sex (male), and T2DM. Conclusions: We identified numerous baseline clinical risk factors for severe/fatal infection by XGboost. For example, age, central obesity, impaired renal function, multiple comorbidities, and cardiometabolic abnormalities may predispose to poorer outcomes. The prediction models may be useful at a population level to identify those susceptible to developing severe/fatal infections, facilitating targeted prevention strategies. A risk-prediction tool is also available online. Further replications in independent cohorts are required to verify our findings. %M 34591027 %R 10.2196/29544 %U https://publichealth.jmir.org/2021/9/e29544 %U https://doi.org/10.2196/29544 %U http://www.ncbi.nlm.nih.gov/pubmed/34591027 %0 Journal Article %@ 2561-9128 %I JMIR Publications %V 4 %N 2 %P e27166 %T The Psychological Experience of Frontline Perioperative Health Care Staff in Responding to COVID-19: Qualitative Study %A Withiel,Toni %A Barson,Elizabeth %A Ng,Irene %A Segal,Reny %A Williams,Daryl Lindsay Goulding %A Krieser,Roni Benjamin %A Lee,Keat %A Mezzavia,Paul Mario %A Sindoni,Teresa %A Chen,Yinwei %A Fisher,Caroline Anne %+ Department of Allied Health, Royal Melbourne Hospital, 300 Grattan St, Parkville, 3010, Australia, 61 411729045, toni.withiel@mh.org.au %K COVID-19 %K perioperative %K mental health %K qualitative %K grief %K psychology %K health care worker %K experience %K hospital %K trauma %K thematic analysis %K interview %D 2021 %7 29.9.2021 %9 Original Paper %J JMIR Perioper Med %G English %X Background: The rapid spread of the novel coronavirus (COVID-19) has presented immeasurable challenges to health care workers who remain at the frontline of the pandemic. A rapidly evolving body of literature has quantitatively demonstrated significant psychological impacts of the pandemic on health care workers. However, little is known about the lived experience of the pandemic for frontline medical staff. Objective: This study aimed to explore the qualitative experience of perioperative staff from a large trauma hospital in Melbourne, Australia. Methods: Inductive thematic analysis using a critical realist approach was used to analyze data from 9 semistructured interviews. Results: Four key themes were identified. Hospital preparedness related to the perceived readiness of the hospital to respond to the pandemic and encompassed key subthemes around communication of policy changes, team leadership, and resource availability. Perceptions of readiness contributed to the perceived psychological impacts of the pandemic, which were highly varied and ranged from anger to anxiety. A number of coping strategies were identified in response to psychological impacts which incorporated both internal and external coping mechanisms. Finally, adaptation with time reflected change and growth over time, and encompassed all other themes. Conclusions: While frontline staff and hospitals have rapidly marshalled a response to managing the virus, relatively less consideration was seen regarding staff mental health in our study. Findings highlight the vulnerability of health care workers in response to the pandemic and reinforce the need for a coordinated approach to managing mental health. %M 34346887 %R 10.2196/27166 %U https://periop.jmir.org/2021/2/e27166 %U https://doi.org/10.2196/27166 %U http://www.ncbi.nlm.nih.gov/pubmed/34346887 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 9 %P e27741 %T Emotional Analysis of Twitter Posts During the First Phase of the COVID-19 Pandemic in Greece: Infoveillance Study %A Geronikolou,Styliani %A Drosatos,George %A Chrousos,George %+ Biomedical Research Foundation of the Academy of Athens, Soranou Ephessiou 4, Athens, 11527, Greece, 30 2106597403, sgeronik@gmail.com %K emotional analysis %K COVID-19 %K Twitter %K Greece %K infodemics %K emotional contagion %K epidemiology %K pandemic %K mental health %D 2021 %7 29.9.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The effectiveness of public health measures depends upon a community’s compliance as well as on its positive or negative emotions. Objective: The purpose of this study was to perform an analysis of the expressed emotions in English tweets by Greek Twitter users during the first phase of the COVID-19 pandemic in Greece. Methods: The period of this study was from January 25, 2020 to June 30, 2020. Data collection was performed by using appropriate search words with the filter-streaming application programming interface of Twitter. The emotional analysis of the tweets that satisfied the inclusion criteria was achieved using a deep learning approach that performs better by utilizing recurrent neural networks on sequences of characters. Emotional epidemiology tools such as the 6 basic emotions, that is, joy, sadness, disgust, fear, surprise, and anger based on the Paul Ekman classification were adopted. Results: The most frequent emotion that was detected in the tweets was “surprise” at the emerging contagion, while the imposed isolation resulted mostly in “anger” (odds ratio 2.108, 95% CI 0.986-4.506). Although the Greeks felt rather safe during the first phase of the COVID-19 pandemic, their positive and negative emotions reflected a masked “flight or fight” or “fear versus anger” response to the contagion. Conclusions: The findings of our study show that emotional analysis emerges as a valid tool for epidemiology evaluations, design, and public health strategy and surveillance. %M 34469328 %R 10.2196/27741 %U https://formative.jmir.org/2021/9/e27741 %U https://doi.org/10.2196/27741 %U http://www.ncbi.nlm.nih.gov/pubmed/34469328 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 9 %P e30305 %T Effectiveness of an Internet-Based Machine-Guided Stress Management Program Based on Cognitive Behavioral Therapy for Improving Depression Among Workers: Protocol for a Randomized Controlled Trial %A Kawakami,Norito %A Imamura,Kotaro %A Watanabe,Kazuhiro %A Sekiya,Yuki %A Sasaki,Natsu %A Sato,Nana %A , %+ Department of Mental Health, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 1130033, Japan, 81 358413521, nkawakami@m.u-tokyo.ac.jp %K deep learning %K unguided intervention %K universal prevention %K workplace %K depression %K machine learning %D 2021 %7 29.9.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: The effect of an unguided internet-based cognitive behavioral therapy (iCBT) stress management program on depression may be enhanced by applying artificial intelligence (AI) technologies to guide participants adopting the program. Objective: The aim of this study is to describe a research protocol to investigate the effect of a newly developed iCBT stress management program adopting AI technologies on improving depression among healthy workers during the COVID-19 pandemic. Methods: This study is a two-arm, parallel, randomized controlled trial. Participants (N=1400) will be recruited, and those who meet the inclusion criteria will be randomly allocated to the intervention or control (treatment as usual) group. A 6-week, six-module, internet-based stress management program, SMART-CBT, has been developed that includes machine-guided exercises to help participants acquire CBT skills, and it applies machine learning and deep learning technologies. The intervention group will participate in the program for 10 weeks. The primary outcome, depression, will be measured using the Beck Depression Inventory II at baseline and 3- and 6-month follow-ups. A mixed model repeated measures analysis will be used to test the intervention effect (group × time interactions) in the total sample (universal prevention) on an intention-to-treat basis. Results: The study was at the stage of recruitment of participants at the time of submission. The data analysis related to the primary outcome will start in January 2022, and the results might be published in 2022 or 2023. Conclusions: This is the first study to investigate the effectiveness of a fully automated machine-guided iCBT program for improving subthreshold depression among workers using a randomized controlled trial design. The study will explore the potential of a machine-guided stress management program that can be disseminated online to a large number of workers with minimal cost in the post–COVID-19 era. Trial Registration: UMIN Clinical Trials Registry（UMIN-CTR) UMIN000043897; https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000050125 International Registered Report Identifier (IRRID): PRR1-10.2196/30305 %M 34460414 %R 10.2196/30305 %U https://www.researchprotocols.org/2021/9/e30305 %U https://doi.org/10.2196/30305 %U http://www.ncbi.nlm.nih.gov/pubmed/34460414 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e30157 %T COVID-19 Mortality Prediction From Deep Learning in a Large Multistate Electronic Health Record and Laboratory Information System Data Set: Algorithm Development and Validation %A Sankaranarayanan,Saranya %A Balan,Jagadheshwar %A Walsh,Jesse R %A Wu,Yanhong %A Minnich,Sara %A Piazza,Amy %A Osborne,Collin %A Oliver,Gavin R %A Lesko,Jessica %A Bates,Kathy L %A Khezeli,Kia %A Block,Darci R %A DiGuardo,Margaret %A Kreuter,Justin %A O’Horo,John C %A Kalantari,John %A Klee,Eric W %A Salama,Mohamed E %A Kipp,Benjamin %A Morice,William G %A Jenkinson,Garrett %+ Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, United States, 1 507 293 9457, Jenkinson.William@mayo.edu %K COVID-19 %K mortality %K prediction %K recurrent neural networks %K missing data %K time series %K deep learning %K machine learning %K neural network %K electronic health record %K EHR %K algorithm %K development %K validation %D 2021 %7 28.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: COVID-19 is caused by the SARS-CoV-2 virus and has strikingly heterogeneous clinical manifestations, with most individuals contracting mild disease but a substantial minority experiencing fulminant cardiopulmonary symptoms or death. The clinical covariates and the laboratory tests performed on a patient provide robust statistics to guide clinical treatment. Deep learning approaches on a data set of this nature enable patient stratification and provide methods to guide clinical treatment. Objective: Here, we report on the development and prospective validation of a state-of-the-art machine learning model to provide mortality prediction shortly after confirmation of SARS-CoV-2 infection in the Mayo Clinic patient population. Methods: We retrospectively constructed one of the largest reported and most geographically diverse laboratory information system and electronic health record of COVID-19 data sets in the published literature, which included 11,807 patients residing in 41 states of the United States of America and treated at medical sites across 5 states in 3 time zones. Traditional machine learning models were evaluated independently as well as in a stacked learner approach by using AutoGluon, and various recurrent neural network architectures were considered. The traditional machine learning models were implemented using the AutoGluon-Tabular framework, whereas the recurrent neural networks utilized the TensorFlow Keras framework. We trained these models to operate solely using routine laboratory measurements and clinical covariates available within 72 hours of a patient’s first positive COVID-19 nucleic acid test result. Results: The GRU-D recurrent neural network achieved peak cross-validation performance with 0.938 (SE 0.004) as the area under the receiver operating characteristic (AUROC) curve. This model retained strong performance by reducing the follow-up time to 12 hours (0.916 [SE 0.005] AUROC), and the leave-one-out feature importance analysis indicated that the most independently valuable features were age, Charlson comorbidity index, minimum oxygen saturation, fibrinogen level, and serum iron level. In the prospective testing cohort, this model provided an AUROC of 0.901 and a statistically significant difference in survival (P<.001, hazard ratio for those predicted to survive, 95% CI 0.043-0.106). Conclusions: Our deep learning approach using GRU-D provides an alert system to flag mortality for COVID-19–positive patients by using clinical covariates and laboratory values within a 72-hour window after the first positive nucleic acid test result. %M 34449401 %R 10.2196/30157 %U https://www.jmir.org/2021/9/e30157 %U https://doi.org/10.2196/30157 %U http://www.ncbi.nlm.nih.gov/pubmed/34449401 %0 Journal Article %@ 2563-6316 %I JMIR Publications %V 2 %N 3 %P e30176 %T Initial SARS-CoV-2 Vaccination Uptake in a Correctional Setting: Cross-sectional Study %A Berk,Justin %A Murphy,Matthew %A Kane,Kimberly %A Chan,Philip %A Rich,Josiah %A Brinkley-Rubinstein,Lauren %+ Warren Alpert Medical School, Brown University, 245 Chapman St, Ste 100, Providence, RI, 02905, United States, 1 401 444 6118, justin_berk@brown.edu %K vaccination %K COVID-19 %K incarcerated individuals %K correctional facility %K public health %K pandemic %K vaccine %K carceral setting %K vaccine implementation %K correctional staff %D 2021 %7 28.9.2021 %9 Original Paper %J JMIRx Med %G English %X Background: The largest outbreaks of COVID-19 in the United States have occurred in correctional facilities, and little is known about the feasibility and acceptability of SARS-CoV-2 vaccine campaigns among incarcerated people. Objective: The aim of this study was to describe a statewide vaccination program among incarcerated people and staff working in a prison setting. Methods: Between December 2020 and February 2021, the Rhode Island Department of Corrections (RIDOC) offered the opportunity for SARS-CoV-2 vaccination to all correctional staff and sentenced individuals. Two RIDOC public health educators provided education on the vaccine, answered questions, and obtained consent before the vaccine clinic day for the incarcerated group. All staff received information on signing up for vaccines and watched an educational video that was created by the medical director. Additional information regarding vaccine education and resources was sent via email to the entire RIDOC department. Results: During this initial campaign, 76.4% (1106/1447) of sentenced individuals and 68.4% (1008/1474) of correctional staff accepted and received the vaccine. Four months after the first vaccine was offered, 77.7% (1124/1447) of the sentenced population and 69.6% (1026/1474) of staff were fully vaccinated. Conclusions: This study demonstrates the feasibility and efficiency of vaccine implementation in a carceral setting. Education and communication likely played an important role in mitigating vaccine refusals. %M 34658368 %R 10.2196/30176 %U https://med.jmirx.org/2021/3/e30176 %U https://doi.org/10.2196/30176 %U http://www.ncbi.nlm.nih.gov/pubmed/34658368 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 9 %P e29413 %T Tracking Self-reported Symptoms and Medical Conditions on Social Media During the COVID-19 Pandemic: Infodemiological Study %A Ding,Qinglan %A Massey,Daisy %A Huang,Chenxi %A Grady,Connor B %A Lu,Yuan %A Cohen,Alina %A Matzner,Pini %A Mahajan,Shiwani %A Caraballo,César %A Kumar,Navin %A Xue,Yuchen %A Dreyer,Rachel %A Roy,Brita %A Krumholz,Harlan M %+ Center for Outcomes Research and Evaluation, Yale New Haven Hospital, 1 Church Street, Suite 200, New Haven, CT, 06510, United States, 1 203 764 5885, harlan.krumholz@yale.edu %K health conditions %K symptoms %K mental health %K social media %K infoveillance %K public health surveillance %K COVID-19 %K pandemic %K natural language processing %D 2021 %7 28.9.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Harnessing health-related data posted on social media in real time can offer insights into how the pandemic impacts the mental health and general well-being of individuals and populations over time. Objective: This study aimed to obtain information on symptoms and medical conditions self-reported by non-Twitter social media users during the COVID-19 pandemic, to determine how discussion of these symptoms and medical conditions changed over time, and to identify correlations between frequency of the top 5 commonly mentioned symptoms post and daily COVID-19 statistics (new cases, new deaths, new active cases, and new recovered cases) in the United States. Methods: We used natural language processing (NLP) algorithms to identify symptom- and medical condition–related topics being discussed on social media between June 14 and December 13, 2020. The sample posts were geotagged by NetBase, a third-party data provider. We calculated the positive predictive value and sensitivity to validate the classification of posts. We also assessed the frequency of health-related discussions on social media over time during the study period, and used Pearson correlation coefficients to identify statistically significant correlations between the frequency of the 5 most commonly mentioned symptoms and fluctuation of daily US COVID-19 statistics. Results: Within a total of 9,807,813 posts (nearly 70% were sourced from the United States), we identified a discussion of 120 symptom-related topics and 1542 medical condition–related topics. Our classification of the health-related posts had a positive predictive value of over 80% and an average classification rate of 92% sensitivity. The 5 most commonly mentioned symptoms on social media during the study period were anxiety (in 201,303 posts or 12.2% of the total posts mentioning symptoms), generalized pain (189,673, 11.5%), weight loss (95,793, 5.8%), fatigue (91,252, 5.5%), and coughing (86,235, 5.2%). The 5 most discussed medical conditions were COVID-19 (in 5,420,276 posts or 66.4% of the total posts mentioning medical conditions), unspecified infectious disease (469,356, 5.8%), influenza (270,166, 3.3%), unspecified disorders of the central nervous system (253,407, 3.1%), and depression (151,752, 1.9%). Changes in posts in the frequency of anxiety, generalized pain, and weight loss were significant but negatively correlated with daily new COVID-19 cases in the United States (r=-0.49, r=-0.46, and r=-0.39, respectively; P<.05). Posts on the frequency of anxiety, generalized pain, weight loss, fatigue, and the changes in fatigue positively and significantly correlated with daily changes in both new deaths and new active cases in the United States (r ranged=0.39-0.48; P<.05). Conclusions: COVID-19 and symptoms of anxiety were the 2 most commonly discussed health-related topics on social media from June 14 to December 13, 2020. Real-time monitoring of social media posts on symptoms and medical conditions may help assess the population’s mental health status and enhance public health surveillance for infectious disease. %M 34517338 %R 10.2196/29413 %U https://publichealth.jmir.org/2021/9/e29413 %U https://doi.org/10.2196/29413 %U http://www.ncbi.nlm.nih.gov/pubmed/34517338 %0 Journal Article %@ 2563-6316 %I JMIR Publications %V 2 %N 3 %P e29638 %T Early Experience With Neutralizing Monoclonal Antibody Therapy for COVID-19: Retrospective Cohort Survival Analysis and Descriptive Study %A Jarrett,Mark %A Licht,Warren %A Bock,Kevin %A Brown,Zenobia %A Hirsch,Jamie %A Coppa,Kevin %A Brar,Rajdeep %A Bello,Stephen %A Nash,Ira %+ Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hofstra University, 500 Hofstra University, Hempstead, NY, 11549, United States, 1 516 463 7516, mjarrett@northwell.edu %K infectious disease %K monoclonal antibody therapy %K COVID-19 %K experience %K therapy %K drug %K patient outcome %K risk %K efficacy %K approach %K treatment %K pandemic %K antibody %K immunotherapy %K immune therapy %D 2021 %7 27.9.2021 %9 Original Paper %J JMIRx Med %G English %X Background: Neutralizing monoclonal antibody (MAB) therapies may benefit patients with mild to moderate COVID-19 at high risk for progressing to severe COVID-19 or hospitalization. Studies documenting approaches to deliver MAB infusions and demonstrating their efficacy are lacking. Objective: We describe our experience and the outcomes of almost 3000 patients who received MAB infusion therapy at Northwell Health, a large integrated health care system in New York. Methods: This is a descriptive study of adult patients who received MAB therapy between November 20, 2020, to January 31, 2021, and a retrospective cohort survival analysis comparing patients who received MAB therapy prior to admission versus those who did not. A multivariable Cox model with inverse probability weighting according to the propensity score including covariates (sociodemographic, comorbidities, and presenting vital signs) was used. The primary outcome was in-hospital mortality; additional evaluations included emergency department use and hospitalization within 28 days of a positive COVID-19 test for patients who received MAB therapy. Results: During the study period, 2818 adult patients received MAB infusion. Following therapy and within 28 days of a COVID-19 test, 123 (4.4%) patients presented to the emergency department and were released, and 145 (5.1%) patients were hospitalized. These 145 patients were compared with 200 controls who were eligible for but did not receive MAB therapy and were hospitalized. In the MAB group, 16 (11%) patients met the primary outcome of in-hospital mortality, versus 21 (10.5%) in the control group. In an unadjusted Cox model, the hazard ratio (HR) for time to in-hospital mortality for the MAB group was 1.38 (95% CI 0.696-2.719). Models adjusting for demographics (HR 1.1, 95% CI 0.53-2.23), demographics and Charlson Comorbidity Index (HR 1.22, 95% CI 0.573-2.59), and with inverse probability weighting according to propensity scores (HR 1.19, 95% CI 0.619-2.29) did not demonstrate significance. The hospitalization rate was 4.4% for patients who received MAB therapy within 0 to 4 days, 5% within 5 to 7 days, and 6.1% in ≥8 days of symptom onset (P=.15). Conclusions: Establishing the capability to provide neutralizing MAB infusion therapy requires substantial planning and coordination. Although this therapy may be an important treatment option for early mild to moderate COVID-19 in patients who are at high risk, further investigations are needed to define the optimal timing of MAB treatment to reduce hospitalization and mortality. %M 34606522 %R 10.2196/29638 %U https://med.jmirx.org/2021/3/e29638 %U https://doi.org/10.2196/29638 %U http://www.ncbi.nlm.nih.gov/pubmed/34606522 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e28700 %T Longitudinal Relationships Among Fear of COVID-19, Smartphone Online Self-Disclosure, Happiness, and Psychological Well-being: Survey Study %A Matthes,Jörg %A Koban,Kevin %A Neureiter,Ariadne %A Stevic,Anja %+ Department of Communication, University of Vienna, Währinger Straße 29, R. 7.45, Vienna, 1090, Austria, 43 1 4277 493 39, kevin.koban@univie.ac.at %K COVID-19 pandemic %K fear %K self-disclosure %K happiness, well-being %K panel study %K smartphones %K online platform %K social media %D 2021 %7 27.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Given that governmental prevention measures restricted most face-to-face communications, online self-disclosure via smartphones emerged as an alternative coping strategy that aimed at reducing the impact of the COVID-19 pandemic on people’s psychological health. Prepandemic research demonstrated that online self-disclosure benefits people’s psychological health by establishing meaningful relationships, obtaining social support, and achieving self-acceptance, particularly in times of crisis. However, it is unclear whether these dynamics transition well to lockdown conditions where online self-disclosure must stand almost entirely on its own. Longitudinal investigations are needed to gain insights into the psychological functionalities of online self-disclosure during the COVID-19 pandemic. Objective: This study aimed to determine the temporal associations between smartphone online self-disclosure (as a communicative behavior) and critical indicators of psychological health (including psychopathological, as well as hedonic and eudaimonic states) during the first COVID-19 lockdown in Austria. Methods: We conducted a representative 2-wave panel survey between late March/April 2020 and May 2020. A total of 416 participants completed both waves (43.1% attrition rate, given n=731 participants who completed the first wave). A partially metric measurement invariant overtime structural equation model was used to determine the temporal associations among online self-disclosure, fear of COVID-19, happiness, and psychological well-being. Results: The analysis revealed that fear of COVID-19 significantly predicted online self-disclosure over time (b=0.24, P=.003) and happiness over time (b=−0.14, P=.04), but not psychological well-being (b=0.03, P=.48), that is, stronger COVID-19 fears at T1 prompted more online self-disclosure and less happiness at T2. Online self-disclosure, on the other hand, significantly predicted happiness (b=0.09, P=.02), but neither fear of COVID-19 (b=−0.01, P=.57) nor psychological well-being (b=−0.01, P=.57) over time. Participants who engaged more strongly in online self-disclosure at T1 felt happier at T2, but they did not differ from less-disclosing participants concerning COVID-19 fears and psychological well-being at T2. Importantly, happiness and psychological well-being were significantly related over time (happiness T1 → psychological well-being T2: b=0.11, P<.001; psychological well-being T1 → happiness T2: b=0.42, P<.001). Conclusions: Our findings suggest that online self-disclosure might play a pivotal role in coping with pandemic stressors. With restrictions on their options, individuals increasingly turn to their smartphones and social media to disclose their feelings, problems, and concerns during lockdown. While online self-disclosure might not alleviate fears or improve psychological well-being, our results demonstrate that it made people experience more happiness during this crisis. This psychological resource may help them withstand the severe psychological consequences of the COVID-19 crisis over longer timeframes. %M 34519657 %R 10.2196/28700 %U https://www.jmir.org/2021/9/e28700 %U https://doi.org/10.2196/28700 %U http://www.ncbi.nlm.nih.gov/pubmed/34519657 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 9 %P e20131 %T The Use of Telemonitoring in Managing the COVID-19 Pandemic: Pilot Implementation Study %A McKinstry,Brian %A Alexander,Helen %A Maxwell,Gabriela %A Blaikie,Lesley %A Patel,Sameer %A Guthrie,Bruce %A , %+ Centre for Informatics, Usher Institute, The University of Edinburgh, 17 Burnside Park, Edinburgh, EH165AG, United Kingdom, 44 07803268660, brian.mckinstry@ed.ac.uk %K telemonitoring %K eHealth %K COVID-19 %K primary care %D 2021 %7 27.9.2021 %9 Viewpoint %J JMIR Form Res %G English %X Background: Most people with COVID-19 self-manage at home. However, the condition can deteriorate quickly, and some people may develop serious hypoxia with relatively few symptoms. Early identification of deterioration allows effective management with oxygen and steroids. Telemonitoring of symptoms and physiological signs may facilitate this. Objective: The aim of this study was to design, implement, and evaluate a telemonitoring system for people with COVID-19 who are self-managing at home and are considered at significant risk of deterioration. Methods: A multidisciplinary team developed a telemonitoring protocol using a commercial platform to record symptoms, pulse oximetry, and temperature. If symptoms or physiological measures breached targets, patients were alerted and asked to phone for an ambulance (red alert) or for advice (amber alert). Patients attending COVID-19 assessment centers, who were considered fit for discharge but at risk of deterioration, were shown how to use a pulse oximeter and the monitoring system, which they were to use twice daily for 2 weeks. Patients could interact with the system via app, SMS, or touch-tone phone. Written guidance on alerts was also provided. Following consent, patient data on telemonitoring usage and alerts were linked to data on the use of service resources. Subsequently, patients who had either used or not used the telemonitoring service, including those who had not followed advice to seek help, agreed to brief telephone interviews to explore their views on, and how they had interacted with, the telemonitoring system. Interviews were recorded and analyzed thematically. Professionals involved in the implementation were sent an online questionnaire asking them about their perceptions of the service. Results: We investigated the first 116 patients who used the service. Of these patients, 71 (61.2%) submitted data and the remainder (n=45, 38.8%) chose to self-monitor without electronic support. Of the 71 patients who submitted data, 35 (49%) received 152 alerts during their 2-week observation. A total of 67 red alerts were for oxygen saturation (SpO2) levels of ≤93%, and 15 red alerts were because patients recorded severe breathlessness. Out of 71 patients, 14 (20%) were admitted to hospital for an average stay of 3.6 (SD 4.5) days. Of the 45 who used written guidance alone, 7 (16%) were admitted to hospital for an average stay of 4.0 (SD 4.2) days and 1 (2%) died. Some patients who were advised to seek help did not do so, some because parameters improved on retesting and others because they felt no worse than before. All patients found self-monitoring to be reassuring. Of the 11 professionals who used the system, most found it to be useful and easy to use. Of these 11 professionals, 5 (45%) considered the system “very safe,” 3 (27%) thought it “could be safer,” and 3 (27%) wished to have more experience with it before deciding. In total, 2 (18%) felt that SpO2 trigger thresholds were too high. Conclusions: Supported self-monitoring of patients with COVID-19 at home is reassuring to patients, is acceptable to clinicians, and can detect important signs of deterioration. Worryingly, some patients, because they felt well, occasionally ignored important signs of deterioration. It is important, therefore, to emphasize the importance of the early investigation and treatment of asymptomatic hypoxia at the time when patients are initiated and in the warning messages that are sent to patients. %M 34449404 %R 10.2196/20131 %U https://formative.jmir.org/2021/9/e20131 %U https://doi.org/10.2196/20131 %U http://www.ncbi.nlm.nih.gov/pubmed/34449404 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 9 %P e32663 %T Exploring the Well-being of Health Care Workers During the COVID-19 Pandemic: Protocol for a Prospective Longitudinal Study %A Liu,Jenny J W %A Nazarov,Anthony %A Plouffe,Rachel A %A Forchuk,Callista A %A Deda,Erisa %A Gargala,Dominic %A Le,Tri %A Bourret-Gheysen,Jesse %A Soares,Vanessa %A Nouri,Maede S %A Hosseiny,Fardous %A Smith,Patrick %A Roth,Maya %A MacDougall,Arlene G %A Marlborough,Michelle %A Jetly,Rakesh %A Heber,Alexandra %A Albuquerque,Joy %A Lanius,Ruth %A Balderson,Ken %A Dupuis,Gabrielle %A Mehta,Viraj %A Richardson,J Don %+ MacDonald Franklin Operational Stress Injury Research Centre, Lawson Health Research Institute, St. Joseph's Health Care London, Parkwood Institute Research, Mental Health Building RM F4-367, 550 Wellington Road, London, ON, N6C 0A7, Canada, 1 519 685 4292 ext 48211, jenny.liu@sjhc.london.on.ca %K COVID-19 %K health care worker %K pandemic %K mental health %K wellbeing %K survey %K design %K longitudinal %K prospective %K protocol %K challenge %K impact %K distress %K perception %D 2021 %7 27.9.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Health care workers (HCWs) have experienced several stressors associated with the COVID-19 pandemic. Structural stressors, including extended work hours, redeployment, and changes in organizational mandates, often intersect with interpersonal and personal stressors, such as caring for those with COVID-19 infections; worrying about infection of self, family, and loved ones; working despite shortages of personal protective equipment; and encountering various difficult moral-ethical dilemmas. Objective: The paper describes the protocol for a longitudinal study seeking to capture the unique experiences, challenges, and changes faced by HCWs during the COVID-19 pandemic. The study seeks to explore the impact of COVID-19 on the mental well-being of HCWs with a particular focus on moral distress, perceptions of and satisfaction with delivery of care, and how changes in work structure are tolerated among HCWs providing clinical services. Methods: A prospective longitudinal design is employed to assess HCWs’ experiences across domains of mental health (depression, anxiety, posttraumatic stress, and well-being), moral distress and moral reasoning, work-related changes and telehealth, organizational responses to COVID-19 concerns, and experiences with COVID-19 infections to self and to others. We recruited HCWs from across Canada through convenience snowball sampling to participate in either a short-form or long-form web-based survey at baseline. Respondents to the baseline survey are invited to complete a follow-up survey every 3 months, for a total of 18 months. Results: A total of 1926 participants completed baseline surveys between June 26 and December 31, 2020, and 1859 participants provided their emails to contact them to participate in follow-up surveys. As of July 2021, data collection is ongoing, with participants nearing the 6- or 9-month follow-up periods depending on their initial time of self-enrollment. Conclusions: This protocol describes a study that will provide unique insights into the immediate and longitudinal impact of the COVID-19 pandemic on the dimensions of mental health, moral distress, health care delivery, and workplace environment of HCWs. The feasibility and acceptability of implementing a short-form and long-form survey on participant engagement and data retention will also be discussed. International Registered Report Identifier (IRRID): DERR1-10.2196/32663 %M 34477557 %R 10.2196/32663 %U https://www.researchprotocols.org/2021/9/e32663 %U https://doi.org/10.2196/32663 %U http://www.ncbi.nlm.nih.gov/pubmed/34477557 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 9 %P e31236 %T Participatory Surveillance of COVID-19 in Lesotho via Weekly Calls: Protocol for Cell Phone Data Collection %A Greenleaf,Abigail R %A Mwima,Gerald %A Lethoko,Molibeli %A Conkling,Martha %A Keefer,George %A Chang,Christiana %A McLeod,Natasha %A Maruyama,Haruka %A Chen,Qixuan %A Farley,Shannon M %A Low,Andrea %+ ICAP at Columbia University, Mailman School of Public Health, Columbia University, 60 Haven Avenue, New York, NY, United States, 1 2123050398, arg2177@cumc.columbia.edu %K COVID-19 %K cell phones %K mHealth %K Africa south of the Sahara %K surveillance %D 2021 %7 27.9.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: The increase in cell phone ownership in low- and middle-income countries (LMIC) has created an opportunity for low-cost, rapid data collection by calling participants on their cell phones. Cell phones can be mobilized for a myriad of data collection purposes, including surveillance. In LMIC, cell phone–based surveillance has been used to track Ebola, measles, acute flaccid paralysis, and diarrheal disease, as well as noncommunicable diseases. Phone-based surveillance in LMIC is a particularly pertinent, burgeoning approach in the context of the COVID-19 pandemic. Participatory surveillance via cell phone could allow governments to assess burden of disease and complements existing surveillance systems. Objective: We describe the protocol for the LeCellPHIA (Lesotho Cell Phone PHIA) project, a cell phone surveillance system that collects weekly population-based data on influenza-like illness (ILI) in Lesotho by calling a representative sample of a recent face-to-face survey. Methods: We established a phone-based surveillance system to collect ILI symptoms from approximately 1700 participants who had participated in a recent face-to-face survey in Lesotho, the Population-based HIV Impact Assessment (PHIA) Survey. Of the 15,267 PHIA participants who were over 18 years old, 11,975 (78.44%) consented to future research and provided a valid phone number. We followed the PHIA sample design and included 342 primary sampling units from 10 districts. We randomly selected 5 households from each primary sampling unit that had an eligible participant and sampled 1 person per household. We oversampled the elderly, as they are more likely to be affected by COVID-19. A 3-day Zoom training was conducted in June 2020 to train LeCellPHIA interviewers. Results: The surveillance system launched July 1, 2020, beginning with a 2-week enrollment period followed by weekly calls that will continue until September 30, 2022. Of the 11,975 phone numbers that were in the sample frame, 3020 were sampled, and 1778 were enrolled. Conclusions: The surveillance system will track COVID-19 in a resource-limited setting. The novel approach of a weekly cell phone–based surveillance system can be used to track other health outcomes, and this protocol provides information about how to implement such a system. International Registered Report Identifier (IRRID): DERR1-10.2196/31236 %M 34351866 %R 10.2196/31236 %U https://www.researchprotocols.org/2021/9/e31236 %U https://doi.org/10.2196/31236 %U http://www.ncbi.nlm.nih.gov/pubmed/34351866 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e32685 %T Comparing Public Sentiment Toward COVID-19 Vaccines Across Canadian Cities: Analysis of Comments on Reddit %A Yan,Cathy %A Law,Melanie %A Nguyen,Stephanie %A Cheung,Janelle %A Kong,Jude %+ Department of Mathematics & Statistics, York University, Ross 533N, 4700 Keele Street, Toronto, ON, M3J 1P3, Canada, 1 416 736 2100 ext 66093, jdkong@yorku.ca %K COVID-19 %K public sentiment %K social media %K Reddit %K Canada %K communication %K sentiment %K opinion %K emotion %K concern %K pandemic %K vaccine %K hesitancy %D 2021 %7 24.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Social media enables the rapid consumption of news related to COVID-19 and serves as a platform for discussions. Its richness in text-based data in the form of posts and comments allows researchers to identify popular topics and assess public sentiment. Nonetheless, the vast majority of topic extraction and sentiment analysis based on social media is performed on the platform or country level and does not account for local culture and policies. Objective: The aim of this study is to use location-based subreddits on Reddit to study city-level variations in sentiments toward vaccine-related topics. Methods: Comments on posts providing regular updates on COVID-19 statistics in the Vancouver (r/vancouver, n=49,291), Toronto (r/toronto, n=20,764), and Calgary (r/calgary, n=21,277) subreddits between July 13, 2020, and June 14, 2021, were extracted. Latent Dirichlet allocation was used to identify frequently discussed topics. Sentiment (joy, sadness, fear, and anger) scores were assigned to comments through random forest regression. Results: The number of comments on the 250 posts from the Vancouver subreddit positively correlated with the number of new daily COVID-19 cases in British Columbia (R=0.51, 95% CI for slope 0.18-0.29; P<.001). From the comments, 13 topics were identified. Two were related to vaccines, 1 regarding vaccine uptake and the other about vaccine supply. The levels of discussion for both topics were linked to the total number of vaccines administered (Granger test for causality, P<.001). Comments pertaining to either topic displayed higher scores for joy than for other topics (P<.001). Calgary and Toronto also discussed vaccine uptake. Sentiment scores for this topic differed across the 3 cities (P<.001). Conclusions: Our work demonstrates that data from city-specific subreddits can be used to better understand concerns and sentiments around COVID-19 vaccines at the local level. This can potentially lead to more targeted and publicly acceptable policies based on content on social media. %M 34519654 %R 10.2196/32685 %U https://www.jmir.org/2021/9/e32685 %U https://doi.org/10.2196/32685 %U http://www.ncbi.nlm.nih.gov/pubmed/34519654 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e28897 %T Content and Communication of Inpatient Family Visitation Policies During the COVID-19 Pandemic: Sequential Mixed Methods Study %A Hart,Joanna %A Summer,Amy %A Yadav,Kuldeep N %A Peace,Summer %A Hong,David %A Konu,Michael %A Clapp,Justin T %+ Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pennsylvania, 423 Guardian Drive, Blockley Hall 305, Philadelphia, PA, 19104, United States, 1 215 573 3976, joanna.hart@pennmedicine.upenn.edu %K family-centered care %K hospital policy %K public health %K health communication %K ethics %K health systems %K public perceptions %K COVID-19 %K pandemic %D 2021 %7 24.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Inpatient health care facilities restricted inpatient visitation due to the COVID-19 pandemic. There is no existing evidence of how they communicated these policies to the public nor the impact of their communication choices on public perception. Objective: This study aims to describe patterns of inpatient visitation policies during the initial peak of the COVID-19 pandemic in the United States and the communication of these policies to the general public, as well as to identify communication strategies that maximize positive impressions of the facility despite visitation restrictions. Methods: We conducted a sequential, exploratory, mixed methods study including a qualitative analysis of COVID-19 era visitation policies published on Pennsylvania-based facility websites, as captured between April 30 and May 20, 2020 (ie, during the first peak of the COVID-19 pandemic in the United States). We also conducted a factorial survey-based experiment to test how key elements of hospitals’ visitation policy communication are associated with individuals’ willingness to seek care in October 2020. For analysis of the policies, we included all inpatient facilities in Pennsylvania. For the factorial experiment, US adults were drawn from internet research panels. The factorial survey-based experiment presented composite policies that varied in their justification for restricted visitation, the degree to which the facility expressed ownership of the policy, and the inclusion of family-centered care support plans. Our primary outcome was participants’ willingness to recommend the hypothetical facility using a 5-point Likert scale. Results: We identified 104 unique policies on inpatient visitation from 363 facilities’ websites. The mean Flesch-Kincaid Grade Level for the policies was 14.2. Most policies prohibited family presence (99/104, 95.2%). Facilities justified the restricted visitation policies on the basis of community protection (59/104, 56.7%), authorities’ guidance or regulations (34/104, 32.7%), or scientific rationale (23/104, 22.1%). A minority (38/104, 36.5%) addressed how restrictive visitation may impair family-centered care. Most of the policies analyzed used passive voice to communicate restrictions. A total of 1321 participants completed the web-based survey. Visitation policy elements significantly associated with willingness to recommend the facility included justifications based on community protection (OR 1.44, 95% CI 1.24-1.68) or scientific rationale (OR 1.30, 95% CI 1.12-1.51), rather than those based on a governing authority. The facility expressed a high degree of ownership over the decision (OR 1.16, 95% CI 1.04-1.29), rather than a low degree of ownership; and inclusion of family-centered care support plans (OR 2.80, 95% CI 2.51-3.12), rather than no such support. Conclusions: Health systems can immediately improve public receptiveness of restrictive visitation policies by emphasizing community protection, ownership over the facility’s policy, and promoting family-centered care. %M 34406968 %R 10.2196/28897 %U https://www.jmir.org/2021/9/e28897 %U https://doi.org/10.2196/28897 %U http://www.ncbi.nlm.nih.gov/pubmed/34406968 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 9 %P e31278 %T The Influence of Social Distancing Behaviors and Psychosocial Factors on Physical Activity During the COVID-19 Pandemic: Cross-sectional Survey Study %A Cross,Troy J %A Isautier,Jennifer M J %A Morris,Sarah J %A Johnson,Bruce D %A Wheatley-Guy,Courtney M %A Taylor,Bryan J %+ Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown Campus, Camperdown, 2006, Australia, 61 2 9351 2222, troy.cross@sydney.edu.au %K physical activity %K COVID-19 %K mental health %K social distancing %K public health %K pandemic %K physical health %K exercise %D 2021 %7 24.9.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The COVID-19 pandemic has arguably facilitated a shift toward increased sedentariness and reduced physical activity. Moreover, there is mounting evidence that mental health has also declined during the pandemic. However, it remains unknown to what extent social distancing (SD) behaviors and mental health have affected the physical activity levels of the general population. Objective: The purpose of this study was to determine the influence of SD behaviors and prevailing mental health on the odds of being physically active during the early COVID-19 pandemic response. Methods: A total of 4819 adults (2474/4819, 51.3%, female) from the US population with a median age of 46 (IQR 35-59) completed an online survey during the early pandemic response (April-June 2020). The survey included questions on adherence to 11 SD behaviors, and validated questionnaires which assessed self-reported physical activity, depression, anxiety, and mental well-being. Respondents were categorized into 2 physical activity groups: inactive (0-599 metabolic equivalent of task [MET]-minutes/week) and active (≥600 MET-minutes/week). A logistic generalized additive model (GAM) was used to determine which SD factors and mental health outcomes were associated with physical activity level. Results: The GAM analysis revealed that wearing a facemask in public (odds ratio [OR] 1.46, 95% CI 1.14-1.79; P=.003), limiting the use of public transport (OR 1.47, 95% CI 1.19-1.83; P=.001), and restricting travel outside the house (OR 1.56, 95% CI 1.19-2.05; P=.002) were SD behaviors associated with higher odds of being more physically active. Conversely, avoiding physical activity outside the house was associated with higher odds of being inactive (OR 0.52, 95% CI 0.46-0.63; P<.001). Leaving the house more frequently, and a higher mental well-being were associated with increasing odds of being physically active (P<.001). Engaging with a moderate number of SD behaviors (3-7 total) was positively associated with physical activity, whereas a very high SD vigilance (ie, engaging with ≥10 total behaviors) decreased the odds of being active during the early pandemic response. Conclusions: Based on the findings of our study, we suggest that future public health messaging of SD guidelines should include (1) a clear portrayal of the benefits of regular exercise on mental health; and (2) a specific focus on how to be physically active outdoors in a COVID-safe manner. %M 34509976 %R 10.2196/31278 %U https://publichealth.jmir.org/2021/9/e31278 %U https://doi.org/10.2196/31278 %U http://www.ncbi.nlm.nih.gov/pubmed/34509976 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 9 %P e29110 %T Low Carb Program Health App Within a Hospital-Based Obesity Setting: Observational Service Evaluation %A Hanson,Petra %A Summers,Charlotte %A Panesar,Arjun %A Oduro-Donkor,Dominic %A Lange,Maria %A Menon,Vinod %A Barber,Thomas M %+ DDM Health, Technology House, Science Park, University of Warwick, Coventry, CV4 7EZ, United Kingdom, 44 2476712201, charlotte@ddm.health %K obesity %K low carb program %K eHealth %K mobile app %K digital health %K health intervention %K mobile health %K COVID-19 %D 2021 %7 23.9.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Obesity underlies much chronic disease. Digitalization of obesity management provides an opportunity to innovate our traditional model of health care delivery within this setting, and to transform its scalability potentially to the population level. Objective: The objective was to assess the feasibility and effectiveness of the Low Carb Program app for weight loss, applied within our hospital-based (tier 3) obesity service. Due to the disrupting effects of the COVID-19 pandemic on our obesity service, we compared the clinical outcomes from the Low Carb Program app applied in the context of remote patient appointments over the telephone with the prepandemic traditional standard of care. Methods: We invited patients who attended our hospital-based obesity service to engage with the Low Carb Program smartphone app. We combined this approach with remote delivery (over the telephone) of obesity management from medical and psychology members of our obesity team during the COVID-19 pandemic. Outcome variables included changes in body weight and changes in HbA1c as a marker of glycemic control. We compared data from the Low Carb Program group with a retrospective control group (n=126) that had received traditional face-to-face obesity management from our team without concomitant use of the Low Carb Program app in the pre–COVID-19 era. T test comparisons were employed, with P<.05 considered significant. Results: The mean weight of participants (n=105) was 130.2 kg, with 59% (n=62) females and a mean age of 48.8 years. Most participants (90/105, 86%) completed the Low Carb Program app registration process and engaged with the Low Carb Program app program; at follow-up, most participants (88/105, 84%) had actively engaged with the Low Carb Program app within the prior 30 days. The majority of participants (58/105, 55%) self-reported outcomes within the app. Mean duration of clinical follow-up for recruited participants who received the app was 7.4 months. Paired data were available for 48 participants for body weight and 41 participants for HbA1c. Paired sample t test analysis revealed a statistically significant mean loss of body weight of 2.7 kg (P=.001) and improvement in HbA1c of 3.3 mmol/mol (P=.01). The mean weight of control group patients (n=126) was 137.1 kg, with 74% (93/126) females and a mean age of 44.4 years. The mean follow-up for this group was 6 months. Data comparisons between the app user group and the pre–COVID-19 retrospective control group revealed equivalence for loss of body weight and change in HbA1c between the two groups. Conclusions: We provide evidence to support the feasibility of implementing the Low Carb Program app combined with remote management; this is the first proof of concept for digitalized management within a hospital-based (tier 3) obesity service. We demonstrate the potential clinical efficacy of the approach in terms of improvements in body weight and glycemic control. %M 34449405 %R 10.2196/29110 %U https://formative.jmir.org/2021/9/e29110 %U https://doi.org/10.2196/29110 %U http://www.ncbi.nlm.nih.gov/pubmed/34449405 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 9 %P e28002 %T “Skip the Small Talk” Virtual Event Intended to Promote Social Connection During a Global Pandemic: Online Survey Study %A Mote,Jasmine %A Gill,Kathryn %A Fulford,Daniel %+ Department of Occupational Therapy, Tufts University, 574 Boston Ave, Medford, MA, 02155, United States, 1 617 627 3781, jasmine.mote@tufts.edu %K COVID-19 %K depression %K digital group %K loneliness %K social connection %K virtual social interaction %K community %K mental health %K connection %K virtual health %D 2021 %7 23.9.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Social distancing measures meant to prevent the spread of COVID-19 in the past year have exacerbated loneliness and depression in the United States. While virtual tools exist to improve social connections, there have been limited attempts to assess community-based, virtual methods to promote new social connections. Objective: In this proof-of-concept study, we examined the extent to which Skip the Small Talk (STST)—a business dedicated to hosting events to facilitate structured, vulnerable conversations between strangers—helped reduce loneliness in a virtual format in the early months of the 2020 COVID-19 pandemic. We predicted that participants who attended STST virtual events would show a reduction in loneliness, improvement in positive affect, and reduction in negative affect after attending an event. We were also interested in exploring the role of depression symptoms on these results as well as the types of goals participants accomplished by attending STST events. Methods: Adult participants who registered for an STST virtual event between March 25 and June 30, 2020, completed a survey before attending the event (pre-event survey; N=64) and a separate survey after attending the event (postevent survey; n=25). Participants reported on their depression symptoms, loneliness, and positive and negative affect. Additionally, participants reported the goals they wished to accomplish as well as those they actually accomplished by attending the STST event. Results: The four most cited goals that participants hoped to accomplish before attending the STST event included the following: “to make new friends,” “to have deeper/better conversations with other people,” “to feel less lonely,” and “to practice social skills.” A total of 34% (20/58) of participants who completed the pre-event survey reported depression symptoms that indicated a high risk of a major depressive episode in the preceding 2 weeks. Of the 25 participants who completed the pre- and postevent surveys, participants reported a significant reduction in loneliness (P=.03, Cohen d=0.48) and negative affect (P<.001, Cohen d=1.52) after attending the STST event compared to before the event. Additionally, depressive symptoms were significantly positively correlated with change in negative affect (P=.03), suggesting that the higher the depression score was prior to attending the STST event, the higher the reduction in negative affect was following the event. Finally, 100% of the participants who wished to reduce their loneliness (11/11) or feel less socially anxious (5/5) prior to attending the STST event reported that they accomplished those goals after the event. Conclusions: Our preliminary assessment suggests that the virtual format of STST was helpful for reducing loneliness and negative affect for participants, including those experiencing depression symptoms, during the COVID-19 pandemic. While encouraging, additional research is necessary to demonstrate whether STST has benefits when compared to other social events and interventions and whether such benefits persist beyond the events themselves. %M 34468326 %R 10.2196/28002 %U https://formative.jmir.org/2021/9/e28002 %U https://doi.org/10.2196/28002 %U http://www.ncbi.nlm.nih.gov/pubmed/34468326 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 9 %P e25615 %T Pretesting a Poster on Recommended Stress Management During the COVID-19 Pandemic in Indonesia: Qualitative Study %A Wati,Risa Laras %A Ulfa,Annisa Sayyidatul %A Kevaladandra,Zulfa %A Shalihat,Shelly %A Syahadatina,Bella %A Pratomo,Hadi %+ Department of Health Education & Behavioral Sciences, Faculty of Public Health, Universitas Indonesia, Jl. Margonda Raya, Pondok Cina, Kecamatan Beji, Depok, 16424, Indonesia, 62 8161841277, hadi.pratomo@ui.ac.id %K pretesting %K media %K stress %K COVID-19 %D 2021 %7 23.9.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 Peritraumatic Distress Index (CPDI) is a self-report questionnaire developed to evaluate the frequency of anxiety and depression symptoms among individuals during the COVID-19 pandemic. A recent study in China showed high CPDI scores among individuals in the 18-30 years age group and those over 60 years. During the COVID-19 outbreak, people were expected to maintain their mental health conditions, especially stress levels. Therefore, many national governments actively published health promotion media in an effort to educate the public. One such media developed by the Ministry of Health, Republic of Indonesia, was a poster titled “Hindari Stres dan Tetap Optimis dengan Melakukan Aktivitas Sehari-hari dan Tetap Menjaga Jarak.” Objective: The aim of this study is to conduct a test on a stress management recommendation poster developed by the Ministry of Health, Republic of Indonesia, in response to the COVID-19 outbreak by using pretesting communication theory. Methods: In-depth interviews were conducted among 8 key informants and 1 graphic design expert. Results: Pretesting can identify the strengths and weaknesses of media. The large amount of text and the lack of illustrations made the poster less attractive to readers. Moreover, there was a discrepancy between the title and contents of the poster. The poster was not able to persuade the informants to change their behavior in the near future. Conclusions: The poster was understood and accepted by the informants, but there was still much to be improved considering the poster was a product of the Ministry of Health, Republic of Indonesia. %M 34254944 %R 10.2196/25615 %U https://formative.jmir.org/2021/9/e25615 %U https://doi.org/10.2196/25615 %U http://www.ncbi.nlm.nih.gov/pubmed/34254944 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 9 %P e29429 %T Implementation of Telehealth Services at the US Department of Veterans Affairs During the COVID-19 Pandemic: Mixed Methods Study %A Der-Martirosian,Claudia %A Wyte-Lake,Tamar %A Balut,Michelle %A Chu,Karen %A Heyworth,Leonie %A Leung,Lucinda %A Ziaeian,Boback %A Tubbesing,Sarah %A Mullur,Rashmi %A Dobalian,Aram %+ Veterans Emergency Management Evaluation Center, US Department of Veterans Affairs, 16111 Plummer St MS-152, North Hills, CA, 91343, United States, 1 818 891 7711 ext 36124, claudia.der-martirosian@va.gov %K telehealth %K telemedicine %K veterans %K US Department of Veterans Affairs %K primary care %K cardiology %K home-based primary care %K COVID-19 %D 2021 %7 23.9.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: At the onset of the COVID-19 pandemic, there was a rapid increase in the use of telehealth services at the US Department of Veterans Affairs (VA), which was accelerated by state and local policies mandating stay-at-home orders and restricting nonurgent in-person appointments. Even though the VA was an early adopter of telehealth in the late 1990s, the vast majority of VA outpatient care continued to be face-to-face visits through February 2020. Objective: We compared telehealth service use at a VA Medical Center, Greater Los Angeles across 3 clinics (primary care [PC], cardiology, and home-based primary care [HBPC]) 12 months before and 12 months after the onset of COVID-19 (March 2020). Methods: We used a parallel mixed methods approach including simultaneous quantitative and qualitative approaches. The distribution of monthly outpatient and telehealth visits, as well as telephone and VA Video Connect encounters were examined for each clinic. Semistructured telephone interviews were conducted with 34 staff involved in telehealth services within PC, cardiology, and HBPC during COVID-19. All audiotaped interviews were transcribed and analyzed by identifying key themes. Results: Prior to COVID-19, telehealth use was minimal at all 3 clinics, but at the onset of COVID-19, telehealth use increased substantially at all 3 clinics. Telephone was the main modality of patient choice. Compared with PC and cardiology, video-based care had the greatest increase in HBPC. Several important barriers (multiple steps for videoconferencing, creation of new scheduling grids, and limited access to the internet and internet-connected devices) and facilitators (flexibility in using different video-capable platforms, technical support for patients, identification of staff telehealth champions, and development of workflows to help incorporate telehealth into treatment plans) were noted. Conclusions: Technological issues must be addressed at the forefront of telehealth evolution to achieve access for all patient populations with different socioeconomic backgrounds, living situations and locations, and health conditions. The unprecedented expansion of telehealth during COVID-19 provides opportunities to create lasting telehealth solutions to improve access to care beyond the pandemic. %M 34477554 %R 10.2196/29429 %U https://formative.jmir.org/2021/9/e29429 %U https://doi.org/10.2196/29429 %U http://www.ncbi.nlm.nih.gov/pubmed/34477554 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e30274 %T Severe Fatigue in Long COVID: Web-Based Quantitative Follow-up Study in Members of Online Long COVID Support Groups %A Van Herck,Maarten %A Goërtz,Yvonne M J %A Houben-Wilke,Sarah %A Machado,Felipe V C %A Meys,Roy %A Delbressine,Jeannet M %A Vaes,Anouk W %A Burtin,Chris %A Posthuma,Rein %A Franssen,Frits M E %A Hajian,Bita %A Vijlbrief,Herman %A Spies,Yvonne %A van 't Hul,Alex J %A Janssen,Daisy J A %A Spruit,Martijn A %+ REVAL Rehabilitation Research Center, BIOMED Research Institute, Faculty of Rehabilitation Sciences, Hasselt University, Agoralaan gebouw A, Diepenbeek, 3590, Belgium, 32 494758248, maarten.vanherck@uhasselt.be %K COVID-19 %K SARS-CoV-2 %K long COVID %K post-COVID-19 syndrome %K post-acute sequelae of COVID-19 %K fatigue %K post-viral fatigue %K pandemic %K online health %K mental health %K online support %D 2021 %7 21.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Fatigue is the most commonly reported symptom in patients with persistent complaints following COVID-19 (ie, long COVID). Longitudinal studies examining the intensity of fatigue and differentiating between physical and mental fatigue are lacking. Objective: The objectives of this study were to (1) assess the severity of fatigue over time in members of online long COVID peer support groups, and (2) assess whether members of these groups experienced mental fatigue, physical fatigue, or both. Methods: A 2-wave web-based follow-up study was conducted in members of online long COVID peer support groups with a confirmed diagnosis approximately 3 and 6 months after the onset of infectious symptoms. Demographics, COVID-19 diagnosis, received health care (from medical professionals or allied health care professionals), fatigue (Checklist Individual Strength–subscale subjective fatigue [CIS-Fatigue]; 8-56 points), and physical and mental fatigue (self-constructed questions; 3-21 points) were assessed. Higher scores indicated more severe fatigue. A CIS-Fatigue score ≥36 points was used to qualify patients as having severe fatigue. Results: A total of 239 patients with polymerase chain reaction/computed tomography–confirmed COVID-19 completed the survey 10 weeks (SD 2) and 23 weeks (SD 2) after onset of infectious symptoms, respectively (T1 and T2). Of these 239 patients, 198 (82.8%) were women; 142 (59.4%) had no self-reported pre-existing comorbidities; 208 (87%) self-reported being in good health before contracting COVID-19; and 62 (25.9%) were hospitalized during acute infection. The median age was 50 years (IQR 39-56). The vast majority of patients had severe fatigue at T1 and T2 (n=204, 85.4%, and n=188, 78.7%, respectively). No significant differences were found in the prevalence of normal, mild, and severe fatigue between T1 and T2 (P=.12). The median CIS-Fatigue score was 48 points (IQR 42-53) at T1, and it decreased from T1 to T2 (median change: –2 points, IQR –7 to 3; P<.001). At T1, a median physical fatigue score of 19 points (IQR 16-20) and a median mental fatigue score of 15 points (IQR 10-17) were reported; these scores were lower at T2 for physical but not for mental fatigue (median change for physical fatigue –1 point, IQR –3 to 0, P<.001; median change for mental fatigue 0 points, IQR –3 to 3, P=.52). At the time of completing the follow-up survey, 194/239 (81.2%) and 164/239 (68.6%) of all patients had received care from at least one medical professional and one allied health care professional, respectively. Conclusions: Fatigue in members of online long COVID support groups with a confirmed COVID-19 diagnosis decreases from 10 to 23 weeks after onset of symptoms. Despite this, severe fatigue remains highly prevalent. Both physical and mental fatigue are present. It remains unclear whether and to what extent fatigue will resolve spontaneously in the longer term. Trial Registration: Netherlands Trial Register NTR8705; https://www.trialregister.nl/trial/8705. %M 34494964 %R 10.2196/30274 %U https://www.jmir.org/2021/9/e30274 %U https://doi.org/10.2196/30274 %U http://www.ncbi.nlm.nih.gov/pubmed/34494964 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 9 %P e28005 %T Clinical, Laboratory, and Imaging Features of COVID-19 in a Cohort of Patients: Cross-Sectional Comparative Study %A Qaisieh,Rami %A Al-Tamimi,Mohammad %A El-Hammuri,Naser %A Shalabi,Marwan %A Kilani,Muna M %A Taha,Hana %A Al-Muhtaseb,Abdallah %A Alfarrajin,Ibrahim %A Abu Shaqra,Marwan %A Hamdan,Almothana %+ Department of Basic Medical Sciences, Faculty of Medicine, Hashemite University, Damascus Highway, Zarqa, Jordan, 962 5 3903333, mohammad.altamimi@hu.edu.jo %K COVID-19 %K gender %K clinical %K laboratory %K imaging %K SARS-CoV2 %K Jordan %D 2021 %7 21.9.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The clinical, laboratory, and imaging features of COVID-19 disease are variable. Multiple factors can affect the disease progression and outcome. Objective: This study aimed to analyze the clinical, laboratory, and imaging features of COVID-19 in Jordan. Methods: Clinical, laboratory, and imaging data were collected for 557 confirmed COVID-19 patients admitted to Prince Hamzah Hospital (PHH), Jordan. Analysis was performed using appropriate statistical tests with SPSS version 24. Results: Of the 557 COVID-19 polymerase chain reaction (PCR)-positive cases admitted to PHH, the mean age was 34.4 years (SD 18.95 years; range 5 weeks to 87 years), 86.0% (479/557) were male, 41% (29/70) were blood group A+, and 57.1% (93/163) were overweight or obese. Significant past medical history was documented in 25.9% (144/557), significant surgical history in 12.6% (70/557), current smoking in 14.9% (83/557), and pregnancy in 0.5% (3/557). The mean duration of hospitalization was 16.4 (SD 9.3; range 5 to 70) days; 52.6% (293/557) were asymptomatic, and 12.9% (72/557) had more than 5 symptoms, with generalized malaise and dry cough the most common symptoms. Only 2.5% (14/557) had a respiratory rate over 25 breaths/minute, and 1.8% (10/557) had an oxygen saturation below 85%. Laboratory investigations showed a wide range of abnormalities, with lymphocytosis and elevated C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and D-dimer the most common abnormalities. Ground glass opacity was the most common imaging finding. Men had a significantly higher frequency of symptoms, incidence of smoking, reduced hemoglobin, increased monocyte %, elevated creatinine levels, and intensive care unit admissions compared with women (P<.05). Hospitalization duration was associated with increased age, male gender, symptom score, history of smoking, elevated systolic blood pressure, elevated respiratory rate, and elevated monocyte %, CRP, ESR, creatinine, and D-dimer (P<.05). Conclusions: Most COVID-19 cases admitted to PHH were asymptomatic. Variabilities in symptoms, signs, laboratory results, and imaging findings should be noted. Increased age, male gender, smoking history, and elevated inflammatory markers were significantly associated with longer duration of hospitalization. %M 34081600 %R 10.2196/28005 %U https://publichealth.jmir.org/2021/9/e28005 %U https://doi.org/10.2196/28005 %U http://www.ncbi.nlm.nih.gov/pubmed/34081600 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e27283 %T Chloe for COVID-19: Evolution of an Intelligent Conversational Agent to Address Infodemic Management Needs During the COVID-19 Pandemic %A Siedlikowski,Sophia %A Noël,Louis-Philippe %A Moynihan,Stephanie Anne %A Robin,Marc %+ Dialogue Health Technologies Inc, 390 Rue Notre-Dame Ouest #200, Montreal, QC, H2Y 1T9, Canada, 1 613 806 0671, marc.robin@dialogue.co %K chatbot %K COVID-19 %K conversational agents %K public health %K artificial intelligence %K infodemic %K infodemiology %K misinformation %K digital health %K virtual care %D 2021 %7 21.9.2021 %9 Viewpoint %J J Med Internet Res %G English %X There is an unprecedented demand for infodemic management due to rapidly evolving information about the novel COVID-19 pandemic. This viewpoint paper details the evolution of a Canadian digital information tool, Chloe for COVID-19, based on incremental leveraging of artificial intelligence techniques. By providing an accessible summary of Chloe’s development, we show how proactive cooperation between health, technology, and corporate sectors can lead to a rapidly scalable, safe, and secure virtual chatbot to assist public health efforts in keeping Canadians informed. We then highlight Chloe’s strengths, the challenges we faced during the development process, and future directions for the role of chatbots in infodemic management. The information presented here may guide future collaborative efforts in health technology in order to enhance access to accurate and timely health information to the public. %M 34375299 %R 10.2196/27283 %U https://www.jmir.org/2021/9/e27283 %U https://doi.org/10.2196/27283 %U http://www.ncbi.nlm.nih.gov/pubmed/34375299 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 9 %P e30280 %T Delivering Mental Health Care Virtually During the COVID-19 Pandemic: Qualitative Evaluation of Provider Experiences in a Scaled Context %A Budhwani,Suman %A Fujioka,Jamie Keiko %A Chu,Cherry %A Baranek,Hayley %A Pus,Laura %A Wasserman,Lori %A Vigod,Simone %A Martin,Danielle %A Agarwal,Payal %A Mukerji,Geetha %+ Women's College Hospital Institute for Health System Solutions & Virtual Care, 76 Grenville Street, Toronto, ON, M5S 1B2, Canada, 1 (416) 323 6400, suman.budhwani@wchospital.ca %K virtual care %K mental health %K quality of care %K implementation %K COVID-19 %K digital health %K pandemic %K ambulatory care %D 2021 %7 21.9.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Virtual care delivery within mental health has increased rapidly during the COVID-19 pandemic. Understanding facilitators and challenges to adoption and perceptions of the quality of virtual care when delivered at scale can inform service planning postpandemic. Objective: We sought to understand consistent facilitators and persistent challenges to adoption of virtual care and perceived impact on quality of care in an initial pilot phase prior to the pandemic and then during scaled use during the pandemic in the mental health department of an ambulatory care hospital. Methods: This study took place at Women’s College Hospital, an academic ambulatory hospital located in Toronto, Canada. We utilized a multimethods approach to collect quantitative data through aggregate utilization data of phone, video, and in-person visits prior to and during COVID-19 lockdown measures and through a provider experience survey administered to mental health providers (n=30). Qualitative data were collected through open-ended questions on provider experience surveys, focus groups (n=4) with mental health providers, and interviews with clinical administrative and implementation hospital staff (n=3). Results: Utilization data demonstrated slower uptake of video visits at launch and prior to COVID-19 lockdown measures in Ontario (pre-March 2020) and subsequent increased uptake of phone and video visits during COVID-19 lockdown measures (post-March 2020). Mental health providers and clinic staff highlighted barriers and facilitators to adoption of virtual care at the operational, behavioral, cultural, and system/policy levels such as required changes in workflows and scheduling, increased provider effort, provider and staff acceptance, and billing codes for physician providers. Much of the described provider experiences focused on perceived impact on quality of mental health care delivery, including perceptions on providing appropriate and patient-centered care, virtual care effectiveness, and equitable access to care for patients. Conclusions: Continued efforts to enhance suggested facilitators, reduce persistent challenges, and address provider concerns about care quality based on these findings can enable a hybrid model of patient-centered and appropriate care to emerge in the future, with options for in-person, video, and phone visits being used to meet patient and clinical needs as required. %M 34406967 %R 10.2196/30280 %U https://formative.jmir.org/2021/9/e30280 %U https://doi.org/10.2196/30280 %U http://www.ncbi.nlm.nih.gov/pubmed/34406967 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 9 %P e30422 %T Trends in Stress Throughout Pregnancy and Postpartum Period During the COVID-19 Pandemic: Longitudinal Study Using Ecological Momentary Assessment and Data From the Postpartum Mothers Mobile Study %A Omowale,Serwaa S %A Casas,Andrea %A Lai,Yu-Hsuan %A Sanders,Sarah A %A Hill,Ashley V %A Wallace,Meredith L %A Rathbun,Stephen L %A Gary-Webb,Tiffany L %A Burke,Lora E %A Davis,Esa M %A Mendez,Dara D %+ Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, 130 De Soto Street, Pittsburgh, PA, 15261, United States, 1 4126243001, ddm11@pitt.edu %K COVID-19 %K ecological momentary assessment %K health status disparities %K pandemics %K postpartum %K pregnancy %K psychological stress %D 2021 %7 21.9.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: Stress is associated with adverse birth and postpartum health outcomes. Few studies have longitudinally explored racial differences in maternal stress in a birthing population in the United States during the ongoing COVID-19 pandemic. Objective: This study aimed to do the following: (1) assess changes in reported stress before, during, and after initial emergency declarations (eg, stay-at-home orders) were in place due to the COVID-19 pandemic, and (2) assess Black-White differences in reported stress in a pregnant and postpartum population from Southwestern Pennsylvania. Methods: We leveraged data from the ongoing Postpartum Mothers Mobile Study (PMOMS), which surveys participants in real time throughout the pregnancy and postpartum periods via ecological momentary assessment (EMA) and smartphone technology. We analyzed data from a subset of PMOMS participants (n=85) who were either Black or White, and who submitted EMA responses regarding stress between November 1, 2019, and August 31, 2020, the time frame of this study. We divided data into four phases based on significant events during the COVID-19 pandemic: “pre” phase (baseline), “early” phase (first case of COVID-19 reported in United States), “during” phase (stay-at-home orders), and “post” phase (stay-at-home orders eased). We assessed mean stress levels at each phase using linear mixed-effects models and post hoc contrasts based on the models. Results: Overall mean stress (0=not at all to 4=a lot) during the pre phase was 0.8 for Black and White participants (range for Black participants: 0-3.9; range for White participants: 0-2.8). There was an increase of 0.3 points (t5649=5.2, P<.001) in the during phase as compared with the pre phase, and an increase of 0.2 points (t5649=3.1, P=.002) in the post phase compared with the pre phase (n=85). No difference was found between Black and White participants in the change in mean stress from the pre phase to the during phase (overall change predicted for the regression coefficient=–0.02, P=.87). There was a significant difference between Black and White participants in the change in mean stress from the during phase to the post phase (overall change predicted for the regression coefficient=0.4, P<.001). Conclusions: There was an overall increase in mean stress levels in this subset of pregnant and postpartum participants during the same time as the emergency declarations/stay-at-home orders in the United States. Compared to baseline, mean stress levels remained elevated when stay-at-home orders eased. We found no significant difference in the mean stress levels by race. Given that stress is associated with adverse birth outcomes and postpartum health, stress induced by the ongoing COVID-19 pandemic may have adverse implications for birthing populations in the United States. International Registered Report Identifier (IRRID): RR2-10.2196/13569 %M 34328420 %R 10.2196/30422 %U https://mental.jmir.org/2021/9/e30422 %U https://doi.org/10.2196/30422 %U http://www.ncbi.nlm.nih.gov/pubmed/34328420 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 9 %P e30460 %T Determinants of Shielding Behavior During the COVID-19 Pandemic and Associations With Well-being Among National Health Service Patients: Longitudinal Observational Study %A Bachtiger,Patrik %A Adamson,Alexander %A Maclean,William A %A Kelshiker,Mihir A %A Quint,Jennifer K %A Peters,Nicholas S %+ National Heart and Lung Institute, Imperial College London, Hammersmith Hospital, Du Cane Road, London, W12 0HS, United Kingdom, 44 020 7589 5111, n.peters@imperial.ac.uk %K COVID-19 %K shielding %K well-being %K personal health record %K determinant %K behavior %K protection %K longitudinal %K observational %K health policy %K mental health %K epidemiology %K public health %D 2021 %7 20.9.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The UK National Health Service (NHS) classified 2.2 million people as clinically extremely vulnerable (CEV) during the first wave of the 2020 COVID-19 pandemic, advising them to “shield” (to not leave home for any reason). Objective: The aim of this study was to measure the determinants of shielding behavior and associations with well-being in a large NHS patient population for informing future health policy. Methods: Patients contributing to an ongoing longitudinal participatory epidemiology study (Longitudinal Effects on Wellbeing of the COVID-19 Pandemic [LoC-19], n=42,924) received weekly email invitations to complete questionnaires (17-week shielding period starting April 9, 2020) within their NHS personal electronic health record. Question items focused on well-being. Participants were stratified into four groups by self-reported CEV status (qualifying condition) and adoption of shielding behavior (baselined at week 1 or 2). The distribution of CEV criteria was reported alongside situational variables and univariable and multivariable logistic regression. Longitudinal trends in physical and mental well-being were displayed graphically. Free-text responses reporting variables impacting well-being were semiquantified using natural language processing. In the lead up to a second national lockdown (October 23, 2020), a follow-up questionnaire evaluated subjective concern if further shielding was advised. Results: The study included 7240 participants. In the CEV group (n=2391), 1133 (47.3%) assumed shielding behavior at baseline, compared with 633 (13.0%) in the non-CEV group (n=4849). CEV participants who shielded were more likely to be Asian (odds ratio [OR] 2.02, 95% CI 1.49-2.76), female (OR 1.24, 95% CI 1.05-1.45), older (OR per year increase 1.01, 95% CI 1.00-1.02), living in a home with an outdoor space (OR 1.34, 95% CI 1.06-1.70) or three to four other inhabitants (three: OR 1.49, 95% CI 1.15-1.94; four: OR 1.49, 95% CI 1.10-2.01), or solid organ transplant recipients (OR 2.85, 95% CI 2.18-3.77), or have severe chronic lung disease (OR 1.63, 95% CI 1.30-2.04). Receipt of a government letter advising shielding was reported in 1115 (46.6%) CEV participants and 180 (3.7%) non-CEV participants, and was associated with adopting shielding behavior (OR 3.34, 95% CI 2.82-3.95 and OR 2.88, 95% CI 2.04-3.99, respectively). In CEV participants, shielding at baseline was associated with a lower rating of mental well-being and physical well-being. Similar results were found for non-CEV participants. Concern for well-being if future shielding was required was most prevalent among CEV participants who had originally shielded. Conclusions: Future health policy must balance the potential protection from COVID-19 against our findings that shielding negatively impacted well-being and was adopted in many in whom it was not indicated and variably in whom it was indicated. This therefore also requires clearer public health messaging and support for well-being if shielding is to be advised in future pandemic scenarios. %M 34298499 %R 10.2196/30460 %U https://publichealth.jmir.org/2021/9/e30460 %U https://doi.org/10.2196/30460 %U http://www.ncbi.nlm.nih.gov/pubmed/34298499 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e30161 %T Information Retrieval in an Infodemic: The Case of COVID-19 Publications %A Teodoro,Douglas %A Ferdowsi,Sohrab %A Borissov,Nikolay %A Kashani,Elham %A Vicente Alvarez,David %A Copara,Jenny %A Gouareb,Racha %A Naderi,Nona %A Amini,Poorya %+ Department of Radiology and Medical Informatics, University of Geneva, Campus Biotech G6-N3 - Chemin des Mines 9, Geneva, 1202, Switzerland, 41 022 379 0225, douglas.teodoro@unige.ch %K information retrieval %K multistage retrieval %K neural search %K deep learning %K COVID-19 %K coronavirus %K infodemic %K infodemiology %K literature %K online information %D 2021 %7 17.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 global health crisis has led to an exponential surge in published scientific literature. In an attempt to tackle the pandemic, extremely large COVID-19–related corpora are being created, sometimes with inaccurate information, which is no longer at scale of human analyses. Objective: In the context of searching for scientific evidence in the deluge of COVID-19–related literature, we present an information retrieval methodology for effective identification of relevant sources to answer biomedical queries posed using natural language. Methods: Our multistage retrieval methodology combines probabilistic weighting models and reranking algorithms based on deep neural architectures to boost the ranking of relevant documents. Similarity of COVID-19 queries is compared to documents, and a series of postprocessing methods is applied to the initial ranking list to improve the match between the query and the biomedical information source and boost the position of relevant documents. Results: The methodology was evaluated in the context of the TREC-COVID challenge, achieving competitive results with the top-ranking teams participating in the competition. Particularly, the combination of bag-of-words and deep neural language models significantly outperformed an Okapi Best Match 25–based baseline, retrieving on average, 83% of relevant documents in the top 20. Conclusions: These results indicate that multistage retrieval supported by deep learning could enhance identification of literature for COVID-19–related questions posed using natural language. %M 34375298 %R 10.2196/30161 %U https://www.jmir.org/2021/9/e30161 %U https://doi.org/10.2196/30161 %U http://www.ncbi.nlm.nih.gov/pubmed/34375298 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e29085 %T Public Adoption of and Trust in the NHS COVID-19 Contact Tracing App in the United Kingdom: Quantitative Online Survey Study %A Dowthwaite,Liz %A Fischer,Joel %A Perez Vallejos,Elvira %A Portillo,Virginia %A Nichele,Elena %A Goulden,Murray %A McAuley,Derek %+ Horizon Digital Economy Research, University of Nottingham, Innovation Park, Triumph Road, Nottingham, NG7 2TU, United Kingdom, 44 07943583035, liz.dowthwaite@gmail.com %K trust %K technology adoption %K COVID-19 %K digital contact tracing %K coronavirus %K vulnerable populations %K attitudes %K SARS-CoV-2 %K digital proximity tracing %K compliance %D 2021 %7 17.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Digital contact tracing is employed to monitor and manage the spread of COVID-19. However, to be effective the system must be adopted by a substantial proportion of the population. Studies of mostly hypothetical contact tracing apps show generally high acceptance, but little is known about the drivers and barriers to adoption of deployed systems. Objective: The aim of this study was to investigate adoption of and attitudes toward the NHS (National Health Service) COVID-19 smartphone app, the digital contact tracing solution in the United Kingdom. Methods: An online survey based on the extended Technology Acceptance Model with the added factor of trust was carried out with a representative sample of the UK population. Statistical analysis showed adoption rates, attitudes toward and trust in the app, and compliance with self-isolation advice and highlighted differences for vulnerable populations (ie, older adults aged 65 years and over and members of Black, Asian, and minority ethnic [BAME] communities). Results: A total of 1001 participants took part in the study. Around half of the participants who had heard of the NHS COVID-19 mobile phone app (490/963, 50.9%; 95% CI 47.8%-54.0%) had downloaded and kept the app, but more than one-third (345/963, 35.8%; 95% CI 32.8%-38.8%) either did not intend to download it or had deleted it. Significantly more BAME respondents than White respondents had deleted the app (16/115, 13.9%; 95% CI 11.8%-16.0%, vs 65/876, 7.4%; 95% CI 5.8%-9.0%), and significantly more older adults 65 years and over than those under 65 years did not intend to download it (44/127, 34.6%; 95% CI 31.7%-37.5%, vs 220/874, 25.2%; 95% CI 22.5%-27.9%). Broadly, one of the reasons for uptake was to help the NHS and other people, especially among older adults, although significantly fewer BAME participants agreed that they did so to help the NHS. Reported compliance with received notifications to self-isolate was high but was significantly lower than reported intended compliance without received notifications. Only one-fifth (136/699, 19.5%; 95% CI 17.0%-22.0%) of participants understood that the decision to send self-isolation notifications was automated by the app. There were a range of significantly more negative views among BAME participants, including lower trust in the NHS, while older adults were often significantly more positive. Respondents without the app reported significantly lower trust and more negative views toward the app and were less likely to report that they understood how the app works. Conclusions: While compliance on the part of the approximately 50% of participants who had the app was fairly high, there were issues surrounding trust and understanding that hindered adoption and, therefore, the effectiveness of digital contact tracing, particularly among BAME communities. This study highlights that more needs to be done to improve adoption among groups who are more vulnerable to the effects of the virus in order to enhance uptake and acceptance of contact tracing apps. %M 34406960 %R 10.2196/29085 %U https://www.jmir.org/2021/9/e29085 %U https://doi.org/10.2196/29085 %U http://www.ncbi.nlm.nih.gov/pubmed/34406960 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 9 %P e31930 %T Morocco's National Response to the COVID-19 Pandemic: Public Health Challenges and Lessons Learned %A Barkia,Abdelaziz %A Laamrani,Hammou %A Belalia,Abdelmounaim %A Benmamoun,Abderrahman %A Khader,Yousef %+ Department of Public Health, Jordan University of Science and technology, Alramtha-Amman street, Irbid, 22110, Jordan, 962 796802040, yskhader@just.edu.jo %K COVID-19 %K public health %K challenges %K prevention %K control %K infectious disease %D 2021 %7 17.9.2021 %9 Viewpoint %J JMIR Public Health Surveill %G English %X This report aimed to provide an overview of the epidemiological situation of COVID-19 in Morocco and to review the actions carried out as part of the national response to this pandemic. The methodology adopted was based on literature review, interviews with officials and actors in the field, and remote discussion workshops with a multidisciplinary and multisectoral working group. Morocco took advantage of the capacities already strengthened within the framework of the application of the provisions of the International Health Regulations (IHR) of 2005. A SWOT analysis made it possible to note that an unprecedented political commitment enabled all the necessary means to face the pandemic and carry out all the response activities, including a campaign of relentless communication. Nevertheless, and despite the efforts made, the shortage of human resources, especially those qualified in intensive care and resuscitation, has been the main drawback to be addressed. The main lesson learned is a need to further strengthen national capacities to prepare for and respond to possible public health emergencies and to embark on a process overhaul of the health system, including research into innovative tools to ensure the continuity of the various disease prevention and control activities. In addition, response to a health crisis is not only the responsibility of the health sector but also intersectoral collaboration is needed to guarantee an optimal coordinated fight. Community-oriented approaches in public health have to be strengthened through more participation and involvement of nongovernmental organizations (NGOs) and civil society in operational and strategic planning. %M 34388104 %R 10.2196/31930 %U https://publichealth.jmir.org/2021/9/e31930 %U https://doi.org/10.2196/31930 %U http://www.ncbi.nlm.nih.gov/pubmed/34388104 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 9 %N 9 %P e27670 %T Social Media Monitoring of the COVID-19 Pandemic and Influenza Epidemic With Adaptation for Informal Language in Arabic Twitter Data: Qualitative Study %A Alsudias,Lama %A Rayson,Paul %+ Information Technology Department, College of Computer and Information Sciences, King Saud University, Prince Turki Bin Abdulaziz Al Awwal Road, Riyadh, 12371, Saudi Arabia, 966 118051044, lalsudias@ksu.edu.sa %K Arabic %K COVID-19 %K infectious disease %K influenza %K infodemiology %K infoveillance %K social listening %K informal language %K multilabel classification %K natural language processing %K named entity recognition %K Twitter %D 2021 %7 17.9.2021 %9 Original Paper %J JMIR Med Inform %G English %X Background: Twitter is a real-time messaging platform widely used by people and organizations to share information on many topics. Systematic monitoring of social media posts (infodemiology or infoveillance) could be useful to detect misinformation outbreaks as well as to reduce reporting lag time and to provide an independent complementary source of data compared with traditional surveillance approaches. However, such an analysis is currently not possible in the Arabic-speaking world owing to a lack of basic building blocks for research and dialectal variation. Objective: We collected around 4000 Arabic tweets related to COVID-19 and influenza. We cleaned and labeled the tweets relative to the Arabic Infectious Diseases Ontology, which includes nonstandard terminology, as well as 11 core concepts and 21 relations. The aim of this study was to analyze Arabic tweets to estimate their usefulness for health surveillance, understand the impact of the informal terms in the analysis, show the effect of deep learning methods in the classification process, and identify the locations where the infection is spreading. Methods: We applied the following multilabel classification techniques: binary relevance, classifier chains, label power set, adapted algorithm (multilabel adapted k-nearest neighbors [MLKNN]), support vector machine with naive Bayes features (NBSVM), bidirectional encoder representations from transformers (BERT), and AraBERT (transformer-based model for Arabic language understanding) to identify tweets appearing to be from infected individuals. We also used named entity recognition to predict the place names mentioned in the tweets. Results: We achieved an F1 score of up to 88% in the influenza case study and 94% in the COVID-19 one. Adapting for nonstandard terminology and informal language helped to improve accuracy by as much as 15%, with an average improvement of 8%. Deep learning methods achieved an F1 score of up to 94% during the classifying process. Our geolocation detection algorithm had an average accuracy of 54% for predicting the location of users according to tweet content. Conclusions: This study identified two Arabic social media data sets for monitoring tweets related to influenza and COVID-19. It demonstrated the importance of including informal terms, which are regularly used by social media users, in the analysis. It also proved that BERT achieves good results when used with new terms in COVID-19 tweets. Finally, the tweet content may contain useful information to determine the location of disease spread. %M 34346892 %R 10.2196/27670 %U https://medinform.jmir.org/2021/9/e27670 %U https://doi.org/10.2196/27670 %U http://www.ncbi.nlm.nih.gov/pubmed/34346892 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 9 %P e30504 %T An App-Based Surveillance System for Undergraduate Students’ Mental Health During the COVID-19 Pandemic: Protocol for a Prospective Cohort Study %A Brogly,Chris %A Bauer,Michael A %A Lizotte,Daniel J %A Press,MacLean L %A MacDougall,Arlene %A Speechley,Mark %A Huner,Erin %A Mitchell,Marc %A Anderson,Kelly K %A Pila,Eva %+ School of Kinesiology, Faculty of Health Sciences, Western University, 1151 Richmond Street, London, ON, N6A 3K7, Canada, 1 519 661 2111, epila@uwo.ca %K undergraduate %K mental health %K smartphone %K app %K COVID-19 %K postsecondary institutions %K mobile apps %K mHealth %K mobile health %D 2021 %7 17.9.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: The COVID-19 pandemic is a public health emergency that poses challenges to the mental health of approximately 1.4 million university students in Canada. Preliminary evidence has shown that the COVID-19 pandemic had a detrimental impact on undergraduate student mental health and well-being; however, existing data are predominantly limited to cross-sectional survey-based studies. Owing to the evolving nature of the pandemic, longer-term prospective surveillance efforts are needed to better anticipate risk and protective factors during a pandemic. Objective: The overarching aim of this study is to use a mobile (primarily smartphone-based) surveillance system to identify risk and protective factors for undergraduate students’ mental health. Factors will be identified from weekly self-report data (eg, affect and living accommodation) and device sensor data (eg, physical activity and device usage) to prospectively predict self-reported mental health and service utilization. Methods: Undergraduate students at Western University (London, Ontario, Canada), will be recruited via email to complete an internet-based baseline questionnaire with the option to participate in the study on a weekly basis, using the Student Pandemic Experience (SPE) mobile app for Android/iOS. The app collects sensor samples (eg, GPS coordinates and steps) and self-reported weekly mental health and wellness surveys. Student participants can opt in to link their mobile data with campus-based administrative data capturing health service utilization. Risk and protective factors that predict mental health outcomes are expected to be estimated from (1) cross-sectional associations among students’ characteristics (eg, demographics) and key psychosocial factors (eg, affect, stress, and social connection), and behaviors (eg, physical activity and device usage) and (2) longitudinal associations between psychosocial and behavioral factors and campus-based health service utilization. Results: Data collection began November 9, 2020, and will be ongoing through to at least October 31, 2021. Retention from the baseline survey (N=427) to app sign-up was 74% (315/427), with 175-215 (55%-68%) app participants actively responding to weekly surveys. From November 9, 2020, to August 8, 2021, a total of 4851 responses to the app surveys and 25,985 sensor samples (consisting of up to 68 individual data items each; eg, GPS coordinates and steps) were collected from the 315 participants who signed up for the app. Conclusions: The results of this real-world longitudinal cohort study of undergraduate students’ mental health based on questionnaires and mobile sensor metrics is expected to show psychosocial and behavioral patterns associated with both positive and negative mental health–related states during pandemic conditions at a relatively large, public, and residential Canadian university campus. The results can be used to support decision-makers and students during the ongoing COVID-19 pandemic and similar future events. For comparable settings, new interventions (digital or otherwise) might be designed using these findings as an evidence base. International Registered Report Identifier (IRRID): DERR1-10.2196/30504 %M 34516391 %R 10.2196/30504 %U https://www.researchprotocols.org/2021/9/e30504 %U https://doi.org/10.2196/30504 %U http://www.ncbi.nlm.nih.gov/pubmed/34516391 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 9 %P e30010 %T Assessing COVID-19 Vaccine Uptake and Effectiveness Through the North West London Vaccination Program: Retrospective Cohort Study %A Glampson,Ben %A Brittain,James %A Kaura,Amit %A Mulla,Abdulrahim %A Mercuri,Luca %A Brett,Stephen J %A Aylin,Paul %A Sandall,Tessa %A Goodman,Ian %A Redhead,Julian %A Saravanakumar,Kavitha %A Mayer,Erik K %+ Department of Surgery and Cancer, Imperial College London, 10th Floor QEQM building, St Mary's Hospital Campus, Praed Street, London, W2 1NY, United Kingdom, 44 2078082076, e.mayer@imperial.ac.uk %K health informatics %K real-word evidence %K COVID-19 %K medical informatics %K vaccine %K vaccination %D 2021 %7 17.9.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: On March 11, 2020, the World Health Organization declared SARS-CoV-2, causing COVID-19, as a pandemic. The UK mass vaccination program commenced on December 8, 2020, vaccinating groups of the population deemed to be most vulnerable to severe COVID-19 infection. Objective: This study aims to assess the early vaccine administration coverage and outcome data across an integrated care system in North West London, leveraging a unique population-level care data set. Vaccine effectiveness of a single dose of the Oxford/AstraZeneca and Pfizer/BioNTech vaccines were compared. Methods: A retrospective cohort study identified 2,183,939 individuals eligible for COVID-19 vaccination between December 8, 2020, and February 24, 2021, within a primary, secondary, and community care integrated care data set. These data were used to assess vaccination hesitancy across ethnicity, gender, and socioeconomic deprivation measures (Pearson product-moment correlations); investigate COVID-19 transmission related to vaccination hubs; and assess the early effectiveness of COVID-19 vaccination (after a single dose) using time-to-event analyses with multivariable Cox regression analysis to investigate if vaccination independently predicted positive SARS-CoV-2 in those vaccinated compared to those unvaccinated. Results: In this study, 5.88% (24,332/413,919) of individuals declined and did not receive a vaccination. Black or Black British individuals had the highest rate of declining a vaccine at 16.14% (4337/26,870). There was a strong negative association between socioeconomic deprivation and rate of declining vaccination (r=–0.94; P=.002) with 13.5% (1980/14,571) of individuals declining vaccination in the most deprived areas compared to 0.98% (869/9609) in the least. In the first 6 days after vaccination, 344 of 389,587 (0.09%) individuals tested positive for SARS-CoV-2. The rate increased to 0.13% (525/389,243) between days 7 and 13, before then gradually falling week on week. At 28 days post vaccination, there was a 74% (hazard ratio 0.26, 95% CI 0.19-0.35) and 78% (hazard ratio 0.22, 95% CI 0.18-0.27) reduction in risk of testing positive for SARS-CoV-2 for individuals that received the Oxford/AstraZeneca and Pfizer/BioNTech vaccines, respectively, when compared with unvaccinated individuals. A very low proportion of hospital admissions were seen in vaccinated individuals who tested positive for SARS-CoV-2 (288/389,587, 0.07% of all patients vaccinated) providing evidence for vaccination effectiveness after a single dose. Conclusions: There was no definitive evidence to suggest COVID-19 was transmitted as a result of vaccination hubs during the vaccine administration rollout in North West London, and the risk of contracting COVID-19 or becoming hospitalized after vaccination has been demonstrated to be low in the vaccinated population. This study provides further evidence that a single dose of either the Pfizer/BioNTech vaccine or the Oxford/AstraZeneca vaccine is effective at reducing the risk of testing positive for COVID-19 up to 60 days across all age groups, ethnic groups, and risk categories in an urban UK population. %M 34265740 %R 10.2196/30010 %U https://publichealth.jmir.org/2021/9/e30010 %U https://doi.org/10.2196/30010 %U http://www.ncbi.nlm.nih.gov/pubmed/34265740 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 9 %P e31052 %T Associations Between the Perceived Severity of the COVID-19 Pandemic, Cyberchondria, Depression, Anxiety, Stress, and Lockdown Experience: Cross-sectional Survey Study %A Han,Lei %A Zhan,Yanru %A Li,Weizi %A Xu,Yuqing %A Xu,Yan %A Zhao,Jinzhe %+ Faculty of Psychology, Beijing Normal University, 19 Xinjiekouwai Street Haidian District, Beijing, 100875, China, 86 19800356013, sszbjz@163.com %K COVID-19 %K cyberchondria %K depression %K anxiety %K stress %K ABC theory of emotions %K lockdown experience %K perceived severity %K cross-sectional %K online health information %D 2021 %7 16.9.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The outbreak of the COVID-19 pandemic has caused great panic among the public, with many people suffering from adverse stress reactions. To control the spread of the pandemic, governments in many countries have imposed lockdown policies. In this unique pandemic context, people can obtain information about pandemic dynamics on the internet. However, searching for health-related information on the internet frequently increases the possibility of individuals being troubled by the information that they find, and consequently, experiencing symptoms of cyberchondria. Objective: We aimed to examine the relationships between people’s perceived severity of the COVID-19 pandemic and their depression, anxiety, and stress to explore the role of cyberchondria, which, in these relationship mechanisms, is closely related to using the internet. In addition, we also examined the moderating role of lockdown experiences. Methods: In February 2020, a total of 486 participants were recruited through a web-based platform from areas in China with a large number of infections. We used questionnaires to measure participants’ perceived severity of the COVID-19 pandemic, to measure the severity of their cyberchondria, depression, anxiety, and stress symptoms, and to assess their lockdown experiences. Confirmatory factor analysis, exploratory factor analysis, common method bias, descriptive statistical analysis, and correlation analysis were performed, and moderated mediation models were examined. Results: There was a positive association between perceived severity of the COVID-19 pandemic and depression (β=0.36, t=8.51, P<.001), anxiety (β=0.41, t=9.84, P<.001), and stress (β=0.46, t=11.45, P<.001), which were mediated by cyberchondria (β=0.36, t=8.59, P<.001). The direct effects of perceived severity of the COVID-19 pandemic on anxiety (β=0.07, t=2.01, P=.045) and stress (β=0.09, t=2.75, P=.006) and the indirect effects of cyberchondria on depression (β=0.10, t=2.59, P=.009) and anxiety (β=0.10, t=2.50, P=.01) were moderated by lockdown experience. Conclusions: The higher the perceived severity of the COVID-19 pandemic, the more serious individuals’ symptoms of depression, anxiety, and stress. In addition, the associations were partially mediated by cyberchondria. Individuals with higher perceived severity of the COVID-19 pandemic were more likely to develop cyberchondria, which aggravated individuals’ depression, anxiety, and stress symptoms. Negative lockdown experiences exacerbated the COVID-19 pandemic’s impact on mental health. %M 34478402 %R 10.2196/31052 %U https://publichealth.jmir.org/2021/9/e31052 %U https://doi.org/10.2196/31052 %U http://www.ncbi.nlm.nih.gov/pubmed/34478402 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 9 %P e30819 %T Early Detection of Symptom Exacerbation in Patients With SARS-CoV-2 Infection Using the Fitbit Charge 3 (DEXTERITY): Pilot Evaluation %A Yamagami,Kan %A Nomura,Akihiro %A Kometani,Mitsuhiro %A Shimojima,Masaya %A Sakata,Kenji %A Usui,Soichiro %A Furukawa,Kenji %A Takamura,Masayuki %A Okajima,Masaki %A Watanabe,Kazuyoshi %A Yoneda,Takashi %+ Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takaramachi, Kanazawa, Japan, 81 076 265 2000, anomura@med.kanazawa-u.ac.jp %K COVID-19 %K silent hypoxia %K wearable device %K Fitbit %K estimated oxygen variation %K detection %K infectious disease %K pilot study %K symptom %K outpatient %K oxygen %K sleep %K wearable %D 2021 %7 16.9.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Some patients with COVID-19 experienced sudden death due to rapid symptom deterioration. Thus, it is important to predict COVID-19 symptom exacerbation at an early stage prior to increasing severity in patients. Patients with COVID-19 could experience a unique “silent hypoxia” at an early stage of the infection when they are apparently asymptomatic, but with rather low SpO2 (oxygen saturation) levels. In order to continuously monitor SpO2 in daily life, a high-performance wearable device, such as the Apple Watch or Fitbit, has become commercially available to monitor several biometric data including steps, resting heart rate (RHR), physical activity, sleep quality, and estimated oxygen variation (EOV). Objective: This study aimed to test whether EOV measured by the wearable device Fitbit can predict COVID-19 symptom exacerbation. Methods: We recruited patients with COVID-19 from August to November 2020. Patients were asked to wear the Fitbit for 30 days, and biometric data including EOV and RHR were extracted. EOV is a relative physiological measure that reflects users’ SpO2 levels during sleep. We defined a high EOV signal as a patient’s oxygen level exhibiting a significant dip and recovery within the index period, and a high RHR signal as daily RHR exceeding 5 beats per day compared with the minimum RHR of each patient in the study period. We defined successful prediction as the appearance of those signals within 2 days before the onset of the primary outcome. The primary outcome was the composite of deaths of all causes, use of extracorporeal membrane oxygenation, use of mechanical ventilation, oxygenation, and exacerbation of COVID-19 symptoms, irrespective of readmission. We also assessed each outcome individually as secondary outcomes. We made weekly phone calls to discharged patients to check on their symptoms. Results: We enrolled 23 patients with COVID-19 diagnosed by a positive SARS-CoV-2 polymerase chain reaction test. The patients had a mean age of 50.9 (SD 20) years, and 70% (n=16) were female. Each patient wore the Fitbit for 30 days. COVID-19 symptom exacerbation occurred in 6 (26%) patients. We were successful in predicting exacerbation using EOV signals in 4 out of 5 cases (sensitivity=80%, specificity=90%), whereas the sensitivity and specificity of high RHR signals were 50% and 80%, respectively, both lower than those of high EOV signals. Coincidental obstructive sleep apnea syndrome confirmed by polysomnography was detected in 1 patient via consistently high EOV signals. Conclusions: This pilot study successfully detected early COVID-19 symptom exacerbation by measuring EOV, which may help to identify the early signs of COVID-19 exacerbation. Trial Registration: University Hospital Medical Information Network Clinical Trials Registry UMIN000041421; https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000047290 %M 34516390 %R 10.2196/30819 %U https://formative.jmir.org/2021/9/e30819 %U https://doi.org/10.2196/30819 %U http://www.ncbi.nlm.nih.gov/pubmed/34516390 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 1 %N 1 %P e30979 %T A Public Health Research Agenda for Managing Infodemics: Methods and Results of the First WHO Infodemiology Conference %A Calleja,Neville %A AbdAllah,AbdelHalim %A Abad,Neetu %A Ahmed,Naglaa %A Albarracin,Dolores %A Altieri,Elena %A Anoko,Julienne N %A Arcos,Ruben %A Azlan,Arina Anis %A Bayer,Judit %A Bechmann,Anja %A Bezbaruah,Supriya %A Briand,Sylvie C %A Brooks,Ian %A Bucci,Lucie M %A Burzo,Stefano %A Czerniak,Christine %A De Domenico,Manlio %A Dunn,Adam G %A Ecker,Ullrich K H %A Espinosa,Laura %A Francois,Camille %A Gradon,Kacper %A Gruzd,Anatoliy %A Gülgün,Beste Sultan %A Haydarov,Rustam %A Hurley,Cherstyn %A Astuti,Santi Indra %A Ishizumi,Atsuyoshi %A Johnson,Neil %A Johnson Restrepo,Dylan %A Kajimoto,Masato %A Koyuncu,Aybüke %A Kulkarni,Shibani %A Lamichhane,Jaya %A Lewis,Rosamund %A Mahajan,Avichal %A Mandil,Ahmed %A McAweeney,Erin %A Messer,Melanie %A Moy,Wesley %A Ndumbi Ngamala,Patricia %A Nguyen,Tim %A Nunn,Mark %A Omer,Saad B %A Pagliari,Claudia %A Patel,Palak %A Phuong,Lynette %A Prybylski,Dimitri %A Rashidian,Arash %A Rempel,Emily %A Rubinelli,Sara %A Sacco,PierLuigi %A Schneider,Anton %A Shu,Kai %A Smith,Melanie %A Sufehmi,Harry %A Tangcharoensathien,Viroj %A Terry,Robert %A Thacker,Naveen %A Trewinnard,Tom %A Turner,Shannon %A Tworek,Heidi %A Uakkas,Saad %A Vraga,Emily %A Wardle,Claire %A Wasserman,Herman %A Wilhelm,Elisabeth %A Würz,Andrea %A Yau,Brian %A Zhou,Lei %A Purnat,Tina D %+ Department of Infectious Hazards Management, Emergency Preparedness Division, World Health Organization, Avenue Appia 20, Geneva, 1211, Switzerland, 41 22 791 21 11, nguyent@who.int %K infodemic %K infodemiology %K infodemic management %K research agenda %K research policy %K COVID-19 %K SARS-CoV-2 %K community resilience %K knowledge translation %K message amplification %K misinformation %K disinformation %K information-seeking behavior %K access to information %K information literacy %K communications media %K internet %K risk communication %K evidence synthesis %K attitudes %K beliefs %D 2021 %7 15.9.2021 %9 Original Paper %J JMIR Infodemiology %G English %X Background: An infodemic is an overflow of information of varying quality that surges across digital and physical environments during an acute public health event. It leads to confusion, risk-taking, and behaviors that can harm health and lead to erosion of trust in health authorities and public health responses. Owing to the global scale and high stakes of the health emergency, responding to the infodemic related to the pandemic is particularly urgent. Building on diverse research disciplines and expanding the discipline of infodemiology, more evidence-based interventions are needed to design infodemic management interventions and tools and implement them by health emergency responders. Objective: The World Health Organization organized the first global infodemiology conference, entirely online, during June and July 2020, with a follow-up process from August to October 2020, to review current multidisciplinary evidence, interventions, and practices that can be applied to the COVID-19 infodemic response. This resulted in the creation of a public health research agenda for managing infodemics. Methods: As part of the conference, a structured expert judgment synthesis method was used to formulate a public health research agenda. A total of 110 participants represented diverse scientific disciplines from over 35 countries and global public health implementing partners. The conference used a laddered discussion sprint methodology by rotating participant teams, and a managed follow-up process was used to assemble a research agenda based on the discussion and structured expert feedback. This resulted in a five-workstream frame of the research agenda for infodemic management and 166 suggested research questions. The participants then ranked the questions for feasibility and expected public health impact. The expert consensus was summarized in a public health research agenda that included a list of priority research questions. Results: The public health research agenda for infodemic management has five workstreams: (1) measuring and continuously monitoring the impact of infodemics during health emergencies; (2) detecting signals and understanding the spread and risk of infodemics; (3) responding and deploying interventions that mitigate and protect against infodemics and their harmful effects; (4) evaluating infodemic interventions and strengthening the resilience of individuals and communities to infodemics; and (5) promoting the development, adaptation, and application of interventions and toolkits for infodemic management. Each workstream identifies research questions and highlights 49 high priority research questions. Conclusions: Public health authorities need to develop, validate, implement, and adapt tools and interventions for managing infodemics in acute public health events in ways that are appropriate for their countries and contexts. Infodemiology provides a scientific foundation to make this possible. This research agenda proposes a structured framework for targeted investment for the scientific community, policy makers, implementing organizations, and other stakeholders to consider. %M 34604708 %R 10.2196/30979 %U https://infodemiology.jmir.org/2021/1/e30979 %U https://doi.org/10.2196/30979 %U http://www.ncbi.nlm.nih.gov/pubmed/34604708 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 9 %P e28044 %T Testing the Differential Impact of an Internet-Based Mental Health Intervention on Outcomes of Well-being and Psychological Distress During COVID-19: Uncontrolled Intervention Study %A van Agteren,Joep %A Ali,Kathina %A Fassnacht,Daniel B %A Iasiello,Matthew %A Furber,Gareth %A Howard,Alexis %A Woodyatt,Lydia %A Musker,Michael %A Kyrios,Mike %+ Wellbeing and Resilience Centre, South Australian Health and Medical Research Institute, North Terrace, Adelaide, 5000, Australia, 61 881284944, joep.vanagteren@sahmri.com %K COVID-19 %K internet-based interventions %K mental health %K well-being %K intervention %K study %K impact %K internet %K online intervention %K distress %K resilience %K depression %K anxiety %K stress %D 2021 %7 15.9.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: During COVID-19, the psychological distress and well-being of the general population has been precarious, increasing the need to determine the impact of complementary internet-based psychological interventions on both positive mental health as well as distress states. Psychological distress and mental well-being represent distinct dimensions of our mental health, and congruent changes in outcomes of distress and well-being do not necessarily co-occur within individuals. When testing intervention impact, it is therefore important to assess change in both outcomes at the individual level, rather than solely testing group differences in average scores at the group level. Objective: This study set out to investigate the differential impact of an internet-based group mental health intervention on outcomes of positive mental health (ie, well-being, life satisfaction, resilience) and indicators of psychological distress (ie, depression, anxiety, stress). Methods: A 5-week mental health intervention was delivered to 89 participants using the Zoom platform during 2020. Impact on outcomes of distress, well-being, and resilience was assessed at the start and end of the program with multiple analysis of variance (MANOVA) and reliable change indices (RCIs) being used to determine program impact at the group and individual levels, respectively. Results: The intervention significantly improved all mental health outcomes measured, (F6,83=5.60, P<.001; Wilks Λ=.71; partial η2=.29) showing small to moderate effect sizes on individual outcomes. The largest effect sizes were observed for life satisfaction and overall well-being (η2=.22 and η2=.2, respectively). Larger effect sizes were noted for those with problematic mental health scores at baseline. A total of 92% (82/89) of participants demonstrated reliable change in at least one mental health outcome. Differential response patterns using RCI revealed that more than one-half of the participants showed improvement in both mental well-being and psychological distress, over one-quarter in outcomes of well-being only, and almost one-fifth in distress only. Conclusions: The results provide evidence for the significant impact of an internet-based mental health intervention during COVID-19 and indicate the importance of assessing dimensions of both well-being and distress when determining mental health intervention effectiveness. %M 34357876 %R 10.2196/28044 %U https://mental.jmir.org/2021/9/e28044 %U https://doi.org/10.2196/28044 %U http://www.ncbi.nlm.nih.gov/pubmed/34357876 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 9 %P e30833 %T Shift in Social Media App Usage During COVID-19 Lockdown and Clinical Anxiety Symptoms: Machine Learning–Based Ecological Momentary Assessment Study %A Ryu,Jihan %A Sükei,Emese %A Norbury,Agnes %A H Liu,Shelley %A Campaña-Montes,Juan José %A Baca-Garcia,Enrique %A Artés,Antonio %A Perez-Rodriguez,M Mercedes %+ Department of Psychiatry, Icahn School of Medicine at Mount Sinai, Icahn (East) Bldg, 4th Floor, L4-53, 1425 Madison Ave, New York, NY, 10029, United States, 1 241 9775, mercedes.perez@mssm.edu %K anxiety disorder %K COVID-19 %K social media %K public health %K digital phenotype %K ecological momentary assessment %K smartphone %K machine learning %K hidden Markov model %D 2021 %7 15.9.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: Anxiety symptoms during public health crises are associated with adverse psychiatric outcomes and impaired health decision-making. The interaction between real-time social media use patterns and clinical anxiety during infectious disease outbreaks is underexplored. Objective: We aimed to evaluate the usage pattern of 2 types of social media apps (communication and social networking) among patients in outpatient psychiatric treatment during the COVID-19 surge and lockdown in Madrid, Spain and their short-term anxiety symptoms (7-item General Anxiety Disorder scale) at clinical follow-up. Methods: The individual-level shifts in median social media usage behavior from February 1 through May 3, 2020 were summarized using repeated measures analysis of variance that accounted for the fixed effects of the lockdown (prelockdown versus postlockdown), group (clinical anxiety group versus nonclinical anxiety group), the interaction of lockdown and group, and random effects of users. A machine learning–based approach that combined a hidden Markov model and logistic regression was applied to predict clinical anxiety (n=44) and nonclinical anxiety (n=51), based on longitudinal time-series data that comprised communication and social networking app usage (in seconds) as well as anxiety-associated clinical survey variables, including the presence of an essential worker in the household, worries about life instability, changes in social interaction frequency during the lockdown, cohabitation status, and health status. Results: Individual-level analysis of daily social media usage showed that the increase in communication app usage from prelockdown to lockdown period was significantly smaller in the clinical anxiety group than that in the nonclinical anxiety group (F1,72=3.84, P=.05). The machine learning model achieved a mean accuracy of 62.30% (SD 16%) and area under the receiver operating curve 0.70 (SD 0.19) in 10-fold cross-validation in identifying the clinical anxiety group. Conclusions: Patients who reported severe anxiety symptoms were less active in communication apps after the mandated lockdown and more engaged in social networking apps in the overall period, which suggested that there was a different pattern of digital social behavior for adapting to the crisis. Predictive modeling using digital biomarkers—passive-sensing of shifts in category-based social media app usage during the lockdown—can identify individuals at risk for psychiatric sequelae. %M 34524091 %R 10.2196/30833 %U https://mental.jmir.org/2021/9/e30833 %U https://doi.org/10.2196/30833 %U http://www.ncbi.nlm.nih.gov/pubmed/34524091 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 9 %P e30802 %T Co-Development of a Web-Based Hub (eSocial-hub) to Combat Social Isolation and Loneliness in Francophone and Anglophone Older People in the Linguistic Minority Context (Quebec, Manitoba, and New Brunswick): Protocol for a Mixed Methods Interventional Study %A Beogo,Idrissa %A Ramdé,Jean %A Nguemeleu Tchouaket,Eric %A Sia,Drissa %A Bationo,Nebila Jean-Claude %A Collin,Stephanie %A Anne,Abdoulaye %A Gagnon,Marie-Pierre %+ École des sciences infirmières, Faculté des sciences de la santé, Université d'Ottawa, 451 Smyth Rd, Ottawa, ON, K1H 8M5, Canada, 1 6135625432, ibeogo@uottawa.ca %K older people %K nursing facility %K nursing home %K long-term care home %K linguistic minority %K digital health %K COVID-19 %K social isolation %K loneliness %K older adults %K development %K isolation %K minority %K community %D 2021 %7 15.9.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: The first wave of the COVID-19 pandemic has severely hit Canadian nursing facilities (81% of deaths). To this toll, public health measures (eg, visitation restriction) have subsequently deepened the social isolation and loneliness of residents in nursing facilities (NFs), especially those in linguistic minority settings: Anglophone institutions in Quebec and Francophone institutions outside Quebec. However, very few COVID-19 initiatives targeting these populations specifically have been documented. Given the limited number of NFs serving linguistic minorities in Canadian populations, families and loved ones often live far from these facilities, sometimes even in other provinces. This context places the digital solutions as particularly relevant for the present COVID-19 pandemic as well as in the post–COVID-19 era. Objective: This project aims to co-develop a virtual community of practice through a web-based platform (eSocial-hub) to combat social isolation and loneliness among the older people in linguistic minority settings in Canada. Methods: An interventional study using a sequential mixed methods design will be conducted. Four purposely selected NFs will be included, 2 among facilities in Manitoba and 2 in New Brunswick; and 2 Anglophone NFs in Quebec will serve as knowledge users. The development of eSocial-hub will include an experimental 4-month phase involving the following end users: (1) older people (n=3 per NF), (2) families of the participating older people (n=3 per NF), and (3) frontline staff (nurse and health care aid; n=2 per NF). Results: Activities and solutions aiming at reducing social isolation and loneliness will be implemented and then evaluated with the project stakeholders, and the best practices generated. The assessment will be conducted using indicators derived from the 5 domains of the Consolidated Framework for Implementation Research. The project will be led by an interdisciplinary team and will involve a multisectoral partnership. Conclusions: The project will develop a promising and generalizable solution that uses virtual technology to help reduce social isolation and loneliness among the older people. International Registered Report Identifier (IRRID): PRR1-10.2196/30802 %M 34464326 %R 10.2196/30802 %U https://www.researchprotocols.org/2021/9/e30802 %U https://doi.org/10.2196/30802 %U http://www.ncbi.nlm.nih.gov/pubmed/34464326 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e29622 %T Characterization and Identification of Variations in Types of Primary Care Visits Before and During the COVID-19 Pandemic in Catalonia: Big Data Analysis Study %A Lopez Segui,Francesc %A Hernandez Guillamet,Guillem %A Pifarré Arolas,Héctor %A Marin-Gomez,Francesc X %A Ruiz Comellas,Anna %A Ramirez Morros,Anna Maria %A Adroher Mas,Cristina %A Vidal-Alaball,Josep %+ Health Promotion in Rural Areas Research Group, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, Pica d'Estats 36, Sant Fruitós de Bages, Spain, 34 93 693 0040, jvidal.cc.ics@gencat.cat %K COVID-19 %K primary care %K diagnose variations %K big data %K ICD10 %K health system %K big data %K primary care %K healthcare system %D 2021 %7 14.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic has turned the care model of health systems around the world upside down, causing the abrupt cancellation of face-to-face visits and redirection of the model toward telemedicine. Digital transformation boosts information systems—the more robust they are, the easier it is to monitor the health care system in a highly complex state and allow for more agile and reliable analysis. Objective: The purpose of this study was to analyze diagnoses from primary care visits and distinguish between those that had higher and lower variations, relative to the 2019 and 2020 periods (roughly before and during COVID-19), to identify clinical profiles that may have been most impaired from the least-used diagnostic codes for visits during the pandemic. Methods: We used a database from the Primary Care Services Information Technologies Information System of Catalonia. We analyzed the register of visits (n=2,824,185) and their International Classification of Diseases (ICD-10) diagnostic codes (n=3,921,974; mean 1.38 per visit), as approximations of the reasons for consultations, at 3 different grouping levels. The data were represented by a term frequency matrix and analyzed recursively in different partitions aggregated according to date. Results: The increase in non–face-to-face visits (+267%) did not counterbalance the decrease in face-to-face visits (–47%), with an overall reduction in the total number of visits of 1.36%, despite the notable increase in nursing visits (10.54%). The largest increases in 2020 were visits with diagnoses related to COVID-19 (ICD-10 codes Z20-Z29: 2.540%), along with codes related to economic and housing problems (ICD-10 codes Z55-Z65: 44.40%). Visits with most of the other diagnostic codes decreased in 2020 relative to those in 2019. The largest reductions were chronic pathologies such as arterial hypertension (ICD-10 codes I10-I16: –32.73%) or diabetes (ICD-10 codes E08-E13: –21.13%), but also obesity (E65-E68: –48.58%) and bodily injuries (ICD-10 code T14: –33.70%). Visits with mental health–related diagnostic codes decreased, but the decrease was less than the average decrease. There was a decrease in consultations—for children, adolescents, and adults—for respiratory infections (ICD-10 codes J00-J06: –40.96%). The results show large year-on-year variations (in absolute terms, an average of 12%), which is representative of the strong shock to the health system. Conclusions: The disruption in the primary care model in Catalonia has led to an explosive increase in the number of non–face-to-face visits. There has been a reduction in the number of visits for diagnoses related to chronic pathologies, respiratory infections, obesity, and bodily injuries. Instead, visits for diagnoses related to socioeconomic and housing problems have increased, which emphasizes the importance of social determinants of health in the context of this pandemic. Big data analytics with routine care data yield findings that are consistent with those derived from intuition in everyday clinical practice and can help inform decision making by health planners in order to use the next few years to focus on the least-treated diseases during the COVID-19 pandemic. %M 34313600 %R 10.2196/29622 %U https://www.jmir.org/2021/9/e29622 %U https://doi.org/10.2196/29622 %U http://www.ncbi.nlm.nih.gov/pubmed/34313600 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e29136 %T Overview of Technologies Implemented During the First Wave of the COVID-19 Pandemic: Scoping Review %A Abd-Alrazaq,Alaa %A Hassan,Asmaa %A Abuelezz,Israa %A Ahmed,Arfan %A Alzubaidi,Mahmood Saleh %A Shah,Uzair %A Alhuwail,Dari %A Giannicchi,Anna %A Househ,Mowafa %+ Division of Information and Computing Technology, College of Science and Engineering, Hamad Bin Khalifa University, Qatar Foundation, P.O. Box 5825, Doha Al Luqta St, Ar-Rayyan, Doha, Qatar, 974 55708549, mhouseh@hbku.edu.qa %K technologies %K digital tools %K COVID-19 %K novel coronavirus %K scoping review %K digital health %K telemedicine %D 2021 %7 14.9.2021 %9 Review %J J Med Internet Res %G English %X Background: Technologies have been extensively implemented to provide health care services for all types of clinical conditions during the COVID-19 pandemic. While several reviews have been conducted regarding technologies used during the COVID-19 pandemic, they were limited by focusing either on a specific technology (or features) or proposed rather than implemented technologies. Objective: This review aims to provide an overview of technologies, as reported in the literature, implemented during the first wave of the COVID-19 pandemic. Methods: We conducted a scoping review using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) Extension for Scoping Reviews. Studies were retrieved by searching 8 electronic databases, checking the reference lists of included studies and relevant reviews (backward reference list checking), and checking studies that cited included studies (forward reference list checking). The search terms were chosen based on the target intervention (ie, technologies) and the target disease (ie, COVID-19). We included English publications that focused on technologies or digital tools implemented during the COVID-19 pandemic to provide health-related services regardless of target health condition, user, or setting. Two reviewers independently assessed the eligibility of studies and extracted data from eligible papers. We used a narrative approach to synthesize extracted data. Results: Of 7374 retrieved papers, 126 were deemed eligible. Telemedicine was the most common type of technology (107/126, 84.9%) implemented in the first wave of the COVID-19 pandemic, and the most common mode of telemedicine was synchronous (100/108, 92.6%). The most common purpose of the technologies was providing consultation (75/126, 59.5%), followed by following up with patients (45/126, 35.7%), and monitoring their health status (22/126, 17.4%). Zoom (22/126, 17.5%) and WhatsApp (12/126, 9.5%) were the most commonly used videoconferencing and social media platforms, respectively. Both health care professionals and health consumers were the most common target users (103/126, 81.7%). The health condition most frequently targeted was COVID-19 (38/126, 30.2%), followed by any physical health conditions (21/126, 16.7%), and mental health conditions (13/126, 10.3%). Technologies were web-based in 84.1% of the studies (106/126). Technologies could be used through 11 modes, and the most common were mobile apps (86/126, 68.3%), desktop apps (73/126, 57.9%), telephone calls (49/126, 38.9%), and websites (45/126, 35.7%). Conclusions: Technologies played a crucial role in mitigating the challenges faced during the COVID-19 pandemic. We did not find papers describing the implementation of other technologies (eg, contact-tracing apps, drones, blockchain) during the first wave. Furthermore, technologies in this review were used for other purposes (eg, drugs and vaccines discovery, social distancing, and immunity passport). Future research on studies on these technologies and purposes is recommended, and further reviews are required to investigate technologies implemented in subsequent waves of the pandemic. %M 34406962 %R 10.2196/29136 %U https://www.jmir.org/2021/9/e29136 %U https://doi.org/10.2196/29136 %U http://www.ncbi.nlm.nih.gov/pubmed/34406962 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 7 %N 3 %P e28495 %T Rates of Assessment of Social Media Use in Psychiatric Interviews Prior to and During COVID-19: Needs Assessment Survey %A Raphaely,Shiri %A Goldberg,Simon B %A Moreno,Megan %A Stowe,Zachary %+ Department of Psychiatry, University of Wisconsin, 6001 Research Park Boulevard, Madison, WI, 53719, United States, 1 2063510110, shiri.raphaely@gmail.com %K social media %K screentime %K problematic Internet use %K psychiatric interview %K psychiatric training %K COVID-19 %K residency %K training %K survey %K psychiatry %K evaluation %K quarantine %D 2021 %7 14.9.2021 %9 Short Paper %J JMIR Med Educ %G English %X Background: Current research suggests that there is a nuanced relationship between mental well-being and social media. Social media offers opportunities for empowerment, information, and connection while also showing links with depression, high-risk behavior, and harassment. As this medium rapidly integrates into interpersonal interactions, incorporation of social media assessment into the psychiatric evaluation warrants attention. Furthermore, the COVID-19 pandemic and containment measures (ie, social distancing) led to increased dependence on social media, allowing an opportunity to assess the adaptation of psychiatric interviews in response to sociocultural changes. Objective: The first aim of this study was to evaluate if general psychiatry residents and child and adolescent psychiatry fellows assessed social media use as part of the clinical interview. Second, the study examined whether changes were made to the social media assessment in response to known increase of social media use secondary to social distancing measures during the COVID-19 pandemic. Methods: As part of a quality improvement project, the authors surveyed general psychiatry residents and child psychiatry fellows in a university-based training program (n=21) about their assessment of social media use in patient evaluations. Soon after the survey closed, “stay-at-home” orders related to the COVID-19 pandemic began. A subsequent survey was sent out with the same questions to evaluate if residents and fellows altered their interview practices in response to the dramatic sociocultural changes (n=20). Results: Pre-COVID-19 pandemic survey results found that 10% (2/21) of respondents incorporated social media questions in patient evaluations. In a follow-up survey after the onset of the pandemic, 20% (4/20) of respondents included any assessment of social media use. Among the 15 participants who completed both surveys, there was a nonsignificant increase in the likelihood of asking about social media use (2/15, 13% vs 4/15, 27%, for pre- and during COVID-19, respectively; McNemar χ21=0.25, P=.617, Cohen d=0.33). Conclusions: These small survey results raise important questions relevant to the training of residents and fellows in psychiatry. The findings suggest that the assessment of social media use is a neglected component of the psychiatric interview by trainees. The burgeoning use and diversity of social media engagement warrant scrutiny with respect to how this is addressed in interview training. Additionally, given minimal adaptation of the interview in the midst of a pandemic, these findings imply an opportunity for improving psychiatric training that incorporates adapting clinical interviews to sociocultural change. %M 34375297 %R 10.2196/28495 %U https://mededu.jmir.org/2021/3/e28495 %U https://doi.org/10.2196/28495 %U http://www.ncbi.nlm.nih.gov/pubmed/34375297 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 1 %N 1 %P e25636 %T Characterization of Vaccine Tweets During the Early Stage of the COVID-19 Outbreak in the United States: Topic Modeling Analysis %A Jiang,Li Crystal %A Chu,Tsz Hang %A Sun,Mengru %+ Department of Media and Communication, City University of Hong Kong, M5082, Run Run Shaw Creative Media Centre, 18 Tat Hong Avenue, Kowloon, Hong Kong, China (Hong Kong), 852 034429332, crystal.jiang@cityu.edu.hk %K topic modeling %K social media %K infoveillance %K vaccine %K coronavirus %K COVID-19 %D 2021 %7 14.9.2021 %9 Original Paper %J JMIR Infodemiology %G English %X Background: During the early stages of the COVID-19 pandemic, developing safe and effective coronavirus vaccines was considered critical to arresting the spread of the disease. News and social media discussions have extensively covered the issue of coronavirus vaccines, with a mixture of vaccine advocacies, concerns, and oppositions. Objective: This study aimed to uncover the emerging themes in Twitter users’ perceptions and attitudes toward vaccines during the early stages of the COVID-19 outbreak. Methods: This study employed topic modeling to analyze tweets related to coronavirus vaccines at the start of the COVID-19 outbreak in the United States (February 21 to March 20, 2020). We created a predefined query (eg, “COVID” AND “vaccine”) to extract the tweet text and metadata (number of followers of the Twitter account and engagement metrics based on likes, comments, and retweeting) from the Meltwater database. After preprocessing the data, we tested Latent Dirichlet Allocation models to identify topics associated with these tweets. The model specifying 20 topics provided the best overall coherence, and each topic was interpreted based on its top associated terms. Results: In total, we analyzed 100,209 tweets containing keywords related to coronavirus and vaccines. The 20 topics were further collapsed based on shared similarities, thereby generating 7 major themes. Our analysis characterized 26.3% (26,234/100,209) of the tweets as News Related to Coronavirus and Vaccine Development, 25.4% (25,425/100,209) as General Discussion and Seeking of Information on Coronavirus, 12.9% (12,882/100,209) as Financial Concerns, 12.7% (12,696/100,209) as Venting Negative Emotions, 9.9% (9908/100,209) as Prayers and Calls for Positivity, 8.1% (8155/100,209) as Efficacy of Vaccine and Treatment, and 4.9% (4909/100,209) as Conspiracies about Coronavirus and Its Vaccines. Different themes demonstrated some changes over time, mostly in close association with news or events related to vaccine developments. Twitter users who discussed conspiracy theories, the efficacy of vaccines and treatments, and financial concerns had more followers than those focused on other vaccine themes. The engagement level—the extent to which a tweet being retweeted, quoted, liked, or replied by other users—was similar among different themes, but tweets venting negative emotions yielded the lowest engagement. Conclusions: This study enriches our understanding of public concerns over new vaccines or vaccine development at early stages of the outbreak, bearing implications for influencing vaccine attitudes and guiding public health efforts to cope with infectious disease outbreaks in the future. This study concluded that public concerns centered on general policy issues related to coronavirus vaccines and that the discussions were considerably mixed with political views when vaccines were not made available. Only a small proportion of tweets focused on conspiracy theories, but these tweets demonstrated high engagement levels and were often contributed by Twitter users with more influence. %M 34604707 %R 10.2196/25636 %U https://infodemiology.jmir.org/2021/1/e25636 %U https://doi.org/10.2196/25636 %U http://www.ncbi.nlm.nih.gov/pubmed/34604707 %0 Journal Article %I JMIR Publications %V 2 %N 1 %P e22446 %T Tracking Exposure to Ads Amid the COVID-19 Pandemic: Development of a Public Google Ads Data Set %A Al Tamime,Reham %A Weber,Ingmar %+ The Web Science Institute, University of Southampton, Building 32, Highfield Campus, University Road, Southampton, SO17 1BJ, United Kingdom, 44 (0) 2380599599, rat1g15@soton.ac.uk %K COVID-19 %K coronavirus %K SARS-CoV-2 %K panic buying %K Google Ads %K data %K database %K tracking %K research %K public availability %K online behaviors %D 2021 %7 14.9.2021 %9 Original Paper %J JMIR Data %G English %X Background: The COVID-19 pandemic has had a substantial impact on economies, governments, businesses, and most importantly, people’s health. To bring the spread of COVID-19 under control, strict lockdown measures have been implemented across the globe. These lockdown measures resulted in a spate of panic buying and increase in demand for hygiene products and other grocery items. Objective: In this paper, we describe a data set from Google Ads that looks at the presentation of ads to people while they browse the web during the COVID-19 pandemic. We are making the data set available to the research community. Methods: We started this ongoing data collection on March 28, 2020, leveraging Developer Tools’ network requests to retrieve Google Ads data. We identified a list of items related and unrelated to panic buying. We then captured these items as targeting criteria under what people are actively researching or planning on Google Ads. Google Ads data has been filtered using additional targeting criteria such as country, gender, and parental status. Results: Since the inception of our collection, we have actively maintained and updated our repository on a monthly basis. In total, we have published over 4116 data points. This paper also presents basic statistics that reveal variations in Google Ads data across countries, gender, and parental status. Conclusions: We hope that this Google Ads data set can increase our understanding of ad exposure during the COVID-19 outbreak. In particular, this data set can lead to further studies that look at the relationship between exposure to ads, time spent web browsing, and health outcomes. %R 10.2196/22446 %U https://data.jmir.org/2021/1/e22446 %U https://doi.org/10.2196/22446 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 4 %N 3 %P e28989 %T A Sociodemographic Profile of Mask Use During the COVID-19 Outbreak Among Young and Elderly Individuals in Brazil: Online Survey Study %A Vancini,Rodrigo L %A Camargo-Neto,Luiz %A Andrade,Marilia S %A de Lira,Claudio A %A dos Santos,Rafaela G %A Nikolaidis,Pantelis T %A Knechtle,Beat %A Piacezzi,Luiz HV %A Teixeira-Lopes,Maria CB %A Assayag-Batista,Ruth E %A Pinto-Okuno,Meiry F %A Vancini-Campanharo,Cássia R %+ Institute of Primary Care, University of Zurich, Pestalozzistrasse 24, Zürich, 8091, Switzerland, 41 44 255 98 55, beat.knechtle@hispeed.ch %K aging %K older adults %K COVID-19 %K pandemic %K sociodemographic profile %K face mask %K social media %K online media %K adolescents %D 2021 %7 14.9.2021 %9 Original Paper %J JMIR Aging %G English %X Background: Sociodemographic variables may impact decision making regarding safety measures. The use and selection of adequate face masks is a safety and health measure that could help minimize the spread of COVID-19 infection. Objective: This study aims to examine sociodemographic variables and factors relating to COVID-19 that could impact decision making or the choice to use or not use face masks in the prevention and care of a possible COVID-19 infection among a large sample of younger and older Brazilian people. Methods: An online survey composed of 14 closed-ended questions about sociodemographic variables and COVID-19 was used. A total of 2673 participants consisted of Brazilian people (aged ≥18 years) from different states of Brazil and were grouped according to age (≤59 years and ≥60 years). To compare the variables of interest (associated with wearing a face mask or not), chi-square and likelihood ratio tests were used (with P<.05 being significant). Results: Most of the participants in both groups were women from the southeast region who had postgraduate degrees. Approximately 61% (1452/2378) of individuals aged ≤59 years and 67.8% (200/295) of those aged ≥60 years were not health professionals. In the group aged ≤59 years, 83.4% (1983/2378) did not show COVID-19 signs and symptoms, and 97.3% (2314/2378) were not diagnosed with COVID-19. In the older adult group, 92.5% (273/295) did not show signs and symptoms of COVID-19, and 98.3% (290/295) were not diagnosed with the disease. The majority of the participants in both groups reported using face masks, and their decision to use face masks was influenced by the level of education and their occupation as a health professional. Conclusions: Younger and older adults have worn face masks during the COVID-19 outbreak. It is difficult to measure how much of a positive impact this attitude, habit, and behavior could have on the degree of infection and spread of the disease. However, it can be a positive indicator of adherence to the population’s security and safety measures during the pandemic. %M 34253508 %R 10.2196/28989 %U https://aging.jmir.org/2021/3/e28989 %U https://doi.org/10.2196/28989 %U http://www.ncbi.nlm.nih.gov/pubmed/34253508 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 9 %P e28028 %T Semisupervised Deep Learning Techniques for Predicting Acute Respiratory Distress Syndrome From Time-Series Clinical Data: Model Development and Validation Study %A Lam,Carson %A Tso,Chak Foon %A Green-Saxena,Abigail %A Pellegrini,Emily %A Iqbal,Zohora %A Evans,Daniel %A Hoffman,Jana %A Calvert,Jacob %A Mao,Qingqing %A Das,Ritankar %+ Dascena, Inc, Suite B, Private Mailbox 65148, 12333 Sowden Rd, Houston, TX, 77080, United States, 1 7149326188, clam@dascena.com %K acute respiratory distress syndrome %K COVID-19 %K semisupervised learning %K deep learning %K machine learning %K algorithm %K prediction %K decision support %D 2021 %7 14.9.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: A high number of patients who are hospitalized with COVID-19 develop acute respiratory distress syndrome (ARDS). Objective: In response to the need for clinical decision support tools to help manage the next pandemic during the early stages (ie, when limited labeled data are present), we developed machine learning algorithms that use semisupervised learning (SSL) techniques to predict ARDS development in general and COVID-19 populations based on limited labeled data. Methods: SSL techniques were applied to 29,127 encounters with patients who were admitted to 7 US hospitals from May 1, 2019, to May 1, 2021. A recurrent neural network that used a time series of electronic health record data was applied to data that were collected when a patient’s peripheral oxygen saturation level fell below the normal range (<97%) to predict the subsequent development of ARDS during the remaining duration of patients’ hospital stay. Model performance was assessed with the area under the receiver operating characteristic curve and area under the precision recall curve of an external hold-out test set. Results: For the whole data set, the median time between the first peripheral oxygen saturation measurement of <97% and subsequent respiratory failure was 21 hours. The area under the receiver operating characteristic curve for predicting subsequent ARDS development was 0.73 when the model was trained on a labeled data set of 6930 patients, 0.78 when the model was trained on the labeled data set that had been augmented with the unlabeled data set of 16,173 patients by using SSL techniques, and 0.84 when the model was trained on the entire training set of 23,103 labeled patients. Conclusions: In the context of using time-series inpatient data and a careful model training design, unlabeled data can be used to improve the performance of machine learning models when labeled data for predicting ARDS development are scarce or expensive. %M 34398784 %R 10.2196/28028 %U https://formative.jmir.org/2021/9/e28028 %U https://doi.org/10.2196/28028 %U http://www.ncbi.nlm.nih.gov/pubmed/34398784 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e31295 %T Factors Associated With Longitudinal Psychological and Physiological Stress in Health Care Workers During the COVID-19 Pandemic: Observational Study Using Apple Watch Data %A Hirten,Robert P %A Danieletto,Matteo %A Tomalin,Lewis %A Choi,Katie Hyewon %A Zweig,Micol %A Golden,Eddye %A Kaur,Sparshdeep %A Helmus,Drew %A Biello,Anthony %A Pyzik,Renata %A Calcagno,Claudia %A Freeman,Robert %A Sands,Bruce E %A Charney,Dennis %A Bottinger,Erwin P %A Murrough,James W %A Keefer,Laurie %A Suarez-Farinas,Mayte %A Nadkarni,Girish N %A Fayad,Zahi A %+ The Dr Henry D Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, 1 Gustave L Levy Place, New York, NY, 10029, United States, 1 212 241 0150, robert.hirten@mountsinai.org %K wearable device %K COVID-19 %K stress %K heart rate variability %K psychological %K psychology %K physiology %K mental health %K health care worker %K observational %K app %K heart rate %K nervous system %K resilience %K emotion %K support %K quality of life %D 2021 %7 13.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic has resulted in a high degree of psychological distress among health care workers (HCWs). There is a need to characterize which HCWs are at an increased risk of developing psychological effects from the pandemic. Given the differences in the response of individuals to stress, an analysis of both the perceived and physiological consequences of stressors can provide a comprehensive evaluation of its impact. Objective: This study aimed to determine characteristics associated with longitudinal perceived stress in HCWs and to assess whether changes in heart rate variability (HRV), a marker of autonomic nervous system function, are associated with features protective against longitudinal stress. Methods: HCWs across 7 hospitals in New York City, NY, were prospectively followed in an ongoing observational digital study using the custom Warrior Watch Study app. Participants wore an Apple Watch for the duration of the study to measure HRV throughout the follow-up period. Surveys measuring perceived stress, resilience, emotional support, quality of life, and optimism were collected at baseline and longitudinally. Results: A total of 361 participants (mean age 36.8, SD 10.1 years; female: n=246, 69.3%) were enrolled. Multivariate analysis found New York City’s COVID-19 case count to be associated with increased longitudinal stress (P=.008). Baseline emotional support, quality of life, and resilience were associated with decreased longitudinal stress (P<.001). A significant reduction in stress during the 4-week period after COVID-19 diagnosis was observed in the highest tertial of emotional support (P=.03) and resilience (P=.006). Participants in the highest tertial of baseline emotional support and resilience had a significantly different circadian pattern of longitudinally collected HRV compared to subjects in the low or medium tertial. Conclusions: High resilience, emotional support, and quality of life place HCWs at reduced risk of longitudinal perceived stress and have a distinct physiological stress profile. Our findings support the use of these characteristics to identify HCWs at risk of the psychological and physiological stress effects of the pandemic. %M 34379602 %R 10.2196/31295 %U https://www.jmir.org/2021/9/e31295 %U https://doi.org/10.2196/31295 %U http://www.ncbi.nlm.nih.gov/pubmed/34379602 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 9 %P e24624 %T Domestic Violence and Mental Health During the COVID-19 Pandemic in Bangladesh %A Rashid Soron,Tanjir %A Ashiq,Md Ashiqur Rahman %A Al-Hakeem,Marzia %A Chowdhury,Zaid Farzan %A Uddin Ahmed,Helal %A Afrooz Chowdhury,Chaman %+ Telepsychiatry Research and Innovation Network Ltd, 3D, 2nd Floor, Rupayan Trade Center, Bangla Motor, Dhaka, 1205, Bangladesh, 880 1718827138, tanjirsoron@gmail.com %K domestic violence %K COVID-19 %K mental health %K violence %K Bangladesh %K lockdown %K isolation %K anxiety %K stress %K telemental health %K telepsychiatry %K web-based survey %D 2021 %7 13.9.2021 %9 Viewpoint %J JMIR Form Res %G English %X Background: The COVID-19 lockdown, the advent of working from home, and other unprecedent events have resulted in multilayer and multidimensional impacts on our personal, social, and occupational lives. Mental health conditions are deteriorating, financial crises are increasing in prevalence, and the need to stay at home has resulted in the increased prevalence of domestic violence. In Bangladesh, where domestic violence is already prevalent, the lockdown period and stay-at-home orders could result in more opportunities and increased scope for perpetrators of domestic violence. Objective: In this study, we aimed to determine the prevalence and pattern of domestic violence during the initial COVID-19 lockdown period in Bangladesh and the perceptions of domestic violence survivors with regard to mental health care. Methods: We conducted this cross-sectional web-based study among the Bangladeshi population and used a semistructured self-reported questionnaire to understand the patterns of domestic violence and perceptions on mental health care from August to September 2020. The questionnaire was disseminated on different organizational websites and social media pages (ie, those of organizations that provide mental health and domestic violence services). Data were analyzed by using IBM SPSS (version 22.0; IBM Corporation). Results: We found that 36.8% (50/136) of respondents had faced domestic violence at some point in their lives; psychological abuse was the most common type of violence. However, the prevalence of the economical abuse domestic violence type increased after the COVID-19 lockdown was enforced. Although 96.3% (102/136) of the participants believed that domestic violence survivors need mental health support, only 25% (34/136) of the respondents had an idea about the mental health services that are available for domestic violence survivors in Bangladesh and how and where they could avail mental health services. Conclusions: Domestic violence is one of the most well-known stressors that have direct impacts on physical and mental health. However, the burden of domestic violence is often underreported, and its impact on mental health is neglected in Bangladesh. The burden of this problem has increased during the COVID-19 crisis, and the cry for mental health support is obvious in the country. However, it is necessary to provide information about available support services; telepsychiatry can be good option for providing immediate mental health support in a convenient and cost-effective manner. %M 34346893 %R 10.2196/24624 %U https://formative.jmir.org/2021/9/e24624 %U https://doi.org/10.2196/24624 %U http://www.ncbi.nlm.nih.gov/pubmed/34346893 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e30854 %T Revealing Public Opinion Towards COVID-19 Vaccines With Twitter Data in the United States: Spatiotemporal Perspective %A Hu,Tao %A Wang,Siqin %A Luo,Wei %A Zhang,Mengxi %A Huang,Xiao %A Yan,Yingwei %A Liu,Regina %A Ly,Kelly %A Kacker,Viraj %A She,Bing %A Li,Zhenlong %+ Department of Geography, National University of Singapore, 1 Arts Link, #04-32 Block AS2, Singapore, 117570, Singapore, 65 65163851, geowl@nus.edu.sg %K Twitter %K public opinion %K COVID-19 vaccines %K sentiment analysis %K emotion analysis %K topic modeling %K COVID-19 %D 2021 %7 10.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic has imposed a large, initially uncontrollable, public health crisis both in the United States and across the world, with experts looking to vaccines as the ultimate mechanism of defense. The development and deployment of COVID-19 vaccines have been rapidly advancing via global efforts. Hence, it is crucial for governments, public health officials, and policy makers to understand public attitudes and opinions towards vaccines, such that effective interventions and educational campaigns can be designed to promote vaccine acceptance. Objective: The aim of this study was to investigate public opinion and perception on COVID-19 vaccines in the United States. We investigated the spatiotemporal trends of public sentiment and emotion towards COVID-19 vaccines and analyzed how such trends relate to popular topics found on Twitter. Methods: We collected over 300,000 geotagged tweets in the United States from March 1, 2020 to February 28, 2021. We examined the spatiotemporal patterns of public sentiment and emotion over time at both national and state scales and identified 3 phases along the pandemic timeline with sharp changes in public sentiment and emotion. Using sentiment analysis, emotion analysis (with cloud mapping of keywords), and topic modeling, we further identified 11 key events and major topics as the potential drivers to such changes. Results: An increasing trend in positive sentiment in conjunction with a decrease in negative sentiment were generally observed in most states, reflecting the rising confidence and anticipation of the public towards vaccines. The overall tendency of the 8 types of emotion implies that the public trusts and anticipates the vaccine. This is accompanied by a mixture of fear, sadness, and anger. Critical social or international events or announcements by political leaders and authorities may have potential impacts on public opinion towards vaccines. These factors help identify underlying themes and validate insights from the analysis. Conclusions: The analyses of near real-time social media big data benefit public health authorities by enabling them to monitor public attitudes and opinions towards vaccine-related information in a geo-aware manner, address the concerns of vaccine skeptics, and promote the confidence that individuals within a certain region or community have towards vaccines. %M 34346888 %R 10.2196/30854 %U https://www.jmir.org/2021/9/e30854 %U https://doi.org/10.2196/30854 %U http://www.ncbi.nlm.nih.gov/pubmed/34346888 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e24081 %T A 3D Hologram With Mixed Reality Techniques to Improve Understanding of Pulmonary Lesions Caused by COVID-19: Randomized Controlled Trial %A Liu,Songxiang %A Xie,Mao %A Zhang,Zhicai %A Wu,Xinghuo %A Gao,Fei %A Lu,Lin %A Zhang,Jiayao %A Xie,Yi %A Yang,Fan %A Ye,Zhewei %+ Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430019, China, 86 13971213880, yezhewei@hust.edu.cn %K COVID-19 %K mixed reality %K hologram %K pulmonary %K lesion %K diagnostic %K imaging %D 2021 %7 10.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 outbreak has now become a pandemic and has had a serious adverse impact on global public health. The effect of COVID-19 on the lungs can be determined through 2D computed tomography (CT) imaging, which requires a high level of spatial imagination on the part of the medical provider. Objective: The purpose of this study is to determine whether viewing a 3D hologram with mixed reality techniques can improve medical professionals’ understanding of the pulmonary lesions caused by COVID-19. Methods: The study involved 60 participants, including 20 radiologists, 20 surgeons, and 20 medical students. Each of the three groups was randomly divided into two groups, either the 2D CT group (n=30; mean age 29 years [range 19-38 years]; males=20) or the 3D holographic group (n=30; mean age 30 years [range 20=38 years]; males=20). The two groups completed the same task, which involved identifying lung lesions caused by COVID-19 for 6 cases using a 2D CT or 3D hologram. Finally, an independent radiology professor rated the participants' performance (out of 100). All participants in two groups completed a Likert scale questionnaire regarding the educational utility and efficiency of 3D holograms. The National Aeronautics and Space Administration Task Load Index (NASA-TLX) was completed by all participants. Results: The mean task score of the 3D hologram group (mean 91.98, SD 2.45) was significantly higher than that of the 2D CT group (mean 74.09, SD 7.59; P<.001). With the help of 3D holograms, surgeons and medical students achieved the same score as radiologists and made obvious progress in identifying pulmonary lesions caused by COVID-19. The Likert scale questionnaire results showed that the 3D hologram group had superior results compared to the 2D CT group (teaching: 2D CT group median 2, IQR 1-2 versus 3D group median 5, IQR 5-5; P<.001; understanding and communicating: 2D CT group median 1, IQR 1-1 versus 3D group median 5, IQR 5-5; P<.001; increasing interest: 2D CT group median 2, IQR 2-2 versus 3D group median 5, IQR 5-5; P<.001; lowering the learning curve: 2D CT group median 2, IQR 1-2 versus 3D group median 4, IQR 4-5; P<.001; spatial awareness: 2D CT group median 2, IQR 1-2 versus 3D group median 5, IQR 5-5; P<.001; learning: 2D CT group median 3, IQR 2-3 versus 3D group median 5, IQR 5-5; P<.001). The 3D group scored significantly lower than the 2D CT group for the “mental,” “temporal,” “performance,” and “frustration” subscales on the NASA-TLX. Conclusions: A 3D hologram with mixed reality techniques can be used to help medical professionals, especially medical students and newly hired doctors, better identify pulmonary lesions caused by COVID-19. It can be used in medical education to improve spatial awareness, increase interest, improve understandability, and lower the learning curve. Trial Registration: Chinese Clinical Trial Registry ChiCTR2100045845; http://www.chictr.org.cn/showprojen.aspx?proj=125761 %M 34061760 %R 10.2196/24081 %U https://www.jmir.org/2021/9/e24081 %U https://doi.org/10.2196/24081 %U http://www.ncbi.nlm.nih.gov/pubmed/34061760 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e31240 %T Using Telehealth to Deliver Primary Care to Adolescents During and After the COVID-19 Pandemic: National Survey Study of US Primary Care Professionals %A Gilkey,Melissa B %A Kong,Wei Yi %A Huang,Qian %A Grabert,Brigid K %A Thompson,Peyton %A Brewer,Noel T %+ Department of Health Behavior, University of North Carolina at Chapel Hill, CB 7440, Chapel Hill, NC, 27599, United States, 1 9199668650, gilkey@email.unc.edu %K adolescent health %K primary care %K telemedicine %K health communication %K health services %K telehealth %K adolescent %K young adult %K teenager %K COVID-19 %K survey %K policy %K access %D 2021 %7 10.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic has led to unprecedented use of telehealth, including by primary care professionals (PCPs) who serve adolescents. Objective: To inform future practice and policies, we sought to characterize PCPs’ recent experience using adolescent telehealth as well as their support for it after the COVID-19 pandemic is over. Methods: From February to March 2021, we conducted a web-based survey of 1047 PCPs in the United States. Our national sample included physicians (747/1047, 71%), advanced practice providers (177/1047, 17%), and nurses (123/1047, 12%) who provided primary care to adolescents aged 11-17 years. Results: Most PCPs reported using telehealth for a low, moderate, or high proportion of their adolescent patients in the three months prior to the survey (424/1047, 40%, 286/1047, 27%, and 219/1047, 21%, respectively); only 11% (118/1047) reported no use. A majority of respondents agreed that adolescent telehealth increases access to care (720/1047, 69%) and enables them to provide high-quality care (560/1047, 53%). Few believed that adolescent telehealth takes too much time (142/1047, 14%) or encourages health care overuse (157/1047, 15%). Most supported giving families the option of adolescent telehealth for primary care after the pandemic is over (683/1047, 65%) and believed that health insurance plans should continue to reimburse for telehealth visits (863/1047, 82%). Approximately two-thirds (702/1047, 67%) wanted to offer adolescent telehealth visits after the pandemic, with intentions being higher among those with recent telehealth experience (P<.001). Conclusions: PCPs in our national sample reported widespread use of and predominantly positive attitudes toward adolescent telehealth. Our findings also suggest broad support among PCPs for continuing to offer adolescent telehealth after the COVID-19 pandemic ends. %M 34406974 %R 10.2196/31240 %U https://www.jmir.org/2021/9/e31240 %U https://doi.org/10.2196/31240 %U http://www.ncbi.nlm.nih.gov/pubmed/34406974 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e30800 %T Framing of and Attention to COVID-19 on Twitter: Thematic Analysis of Hashtags %A Tahamtan,Iman %A Potnis,Devendra %A Mohammadi,Ehsan %A Miller,Laura E %A Singh,Vandana %+ School of Information Sciences, The University of Tennessee, 1345 Circle Park Drive 451 Communications Building, Knoxville, TN, 37996-0332, United States, 1 865 974 2148, iman.tahamtan@gmail.com %K COVID-19 %K framing %K Twitter %K social media %K public opinion %K engagement %K public attention %K thematic analysis %K public health %D 2021 %7 10.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Although past research has focused on COVID-19–related frames in the news media, such research may not accurately capture and represent the perspectives of people from diverse backgrounds. Additionally, research on the public attention to COVID-19 as reflected through frames on social media is scarce. Objective: This study identified the frames about the COVID-19 pandemic in the public discourse on Twitter, which voices diverse opinions. This study also investigated the amount of public attention to those frames on Twitter. Methods: We collected 22 trending hashtags related to COVID-19 in the United States and 694,582 tweets written in English containing these hashtags in March 2020 and analyzed them via thematic analysis. Public attention to these frames was measured by evaluating the amount of public engagement with frames and public adoption of those frames. Results: We identified 9 frames including “public health guidelines,” “quarantine life,” “solidarity,” “evidence and facts,” “call for action,” “politics,” “post-pandemic life,” “shortage panic,” and “conflict.” Results showed that some frames such as “call for action” are more appealing than others during a global pandemic, receiving greater public adoption and engagement. The “call for action” frame had the highest engagement score, followed by “conflict” and “evidence and facts.” Additionally, “post-pandemic life” had the highest adoption score, followed by “call for action” and “shortage panic.” The findings indicated that the frequency of a frame on social media does not necessarily mean greater public adoption of or engagement with the frame. Conclusions: This study contributes to framing theory and research by demonstrating how trending hashtags can be used as new user-generated data to identify frames on social media. This study concludes that the identified frames such as “quarantine life” and “conflict” and themes such as “isolation” and “toilet paper panic” represent the consequences of the COVID-19 pandemic. The consequences could be (1) exclusively related to COVID-19, such as hand hygiene or isolation; (2) related to any health crisis such as social support of vulnerable groups; and (3) generic that are irrespective of COVID-19, such as homeschooling or remote working. %M 34406961 %R 10.2196/30800 %U https://www.jmir.org/2021/9/e30800 %U https://doi.org/10.2196/30800 %U http://www.ncbi.nlm.nih.gov/pubmed/34406961 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e29672 %T Efficacy of a Single-Session “Empowered Relief” Zoom-Delivered Group Intervention for Chronic Pain: Randomized Controlled Trial Conducted During the COVID-19 Pandemic %A Ziadni,Maisa S %A Gonzalez-Castro,Lluvia %A Anderson,Steven %A Krishnamurthy,Parthasarathy %A Darnall,Beth D %+ Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, 1070 Arastradero Road, Palo Alto, CA, 94304, United States, 1 6507365494, mziadni@stanford.edu %K single-session %K empowered relief %K Zoom-delivered %K pain catastrophizing %K pain intensity %K randomized-controlled trial %K chronic pain %D 2021 %7 10.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Cognitive behavioral therapy–pain is an evidence-based treatment for chronic pain that can have significant patient burden, including health care cost, travel, multiple sessions, and lack of access in remote areas. Objective: The study aims to pilot test the efficacy of a single-session videoconference-delivered empowered relief (ER) intervention compared to waitlist control (WLC) conditions among individuals with chronic pain. We hypothesized that ER would be superior to WLC in reducing pain catastrophizing, pain intensity, and other pain-related outcomes at 1-3 months posttreatment. Methods: We conducted a randomized controlled trial involving a web-based sample of adults (N=104) aged 18-80 years with self-reported chronic pain. Participants were randomized (1:1) to 1 of 2 unblinded study groups: ER (50/104, 48.1%) and WLC (54/104, 51.9%). Participants allocated to ER completed a Zoom-delivered class, and all participants completed follow-up surveys at 2 weeks and 1, 2, and 3 months posttreatment. All the study procedures were performed remotely and electronically. The primary outcome was pain catastrophizing 1-month posttreatment, with pain intensity, pain bothersomeness, and sleep disruption as secondary outcomes. We also report a more rigorous test of the durability of treatment effects at 3 months posttreatment. Data were collected from September 2020 to February 2021 and analyzed using intention-to-treat analysis. The analytic data set included participants (18/101, 17.8% clinic patients; 83/101, 82.1% community) who completed at least one study survey: ER (50/101, 49.5%) and WLC (51/104, 49%). Results: Participants (N=101) were 69.3% (70/101) female, with a mean age of 49.76 years (SD 13.90; range 24-78); 32.7% (33/101) had an undergraduate degree and self-reported chronic pain for 3 months. Participants reported high engagement (47/50, 94%), high satisfaction with ER (mean 8.26, SD 1.57; range 0-10), and high satisfaction with the Zoom platform (46/50, 92%). For the between-groups factor, ER was superior to WLC for all primary and secondary outcomes at 3 months posttreatment (highest P<.001), and between-groups Cohen d effect sizes ranged from 0.45 to 0.79, indicating that the superiority was of moderate to substantial clinical importance. At 3 months, clinically meaningful pain catastrophizing scale (PCS) reductions were found for ER but not for WLC (ER: PCS −8.72, 42.25% reduction; WLC: PCS −2.25, 11.13% reduction). ER resulted in significant improvements in pain intensity, sleep disturbance, and clinical improvements in pain bothersomeness. Conclusions: Zoom-delivered ER had high participant satisfaction and very high engagement. Among adults with chronic pain, this single-session, Zoom-delivered, skills-based pain class resulted in clinically significant improvement across a range of pain-related outcomes that was sustained at 3 months. Web-based delivery of ER could allow greater accessibility of home-based pain treatment and could address the inconveniences and barriers faced by patients when attempting to receive in-person care. Trial Registration: ClinicalTrials.gov NCT04546685; https://clinicaltrials.gov/ct2/show/NCT04546685 %M 34505832 %R 10.2196/29672 %U https://www.jmir.org/2021/9/e29672 %U https://doi.org/10.2196/29672 %U http://www.ncbi.nlm.nih.gov/pubmed/34505832 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e28116 %T Using an Individual-Centered Approach to Gain Insights From Wearable Data in the Quantified Flu Platform: Netnography Study %A Greshake Tzovaras,Bastian %A Senabre Hidalgo,Enric %A Alexiou,Karolina %A Baldy,Lukaz %A Morane,Basile %A Bussod,Ilona %A Fribourg,Melvin %A Wac,Katarzyna %A Wolf,Gary %A Ball,Mad %+ Center for Research & Interdisciplinarity, INSERM U1284, Université de Paris, 8bis Rue Charles V, Paris, 75004, France, 33 766752149, bgreshake@googlemail.com %K symptom tracking %K COVID-19 %K wearable devices %K self-tracking %K citizen science %K netnographic analysis %K cocreation %D 2021 %7 10.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Wearables have been used widely for monitoring health in general, and recent research results show that they can be used to predict infections based on physiological symptoms. To date, evidence has been generated in large, population-based settings. In contrast, the Quantified Self and Personal Science communities are composed of people who are interested in learning about themselves individually by using their own data, which are often gathered via wearable devices. Objective: This study aims to explore how a cocreation process involving a heterogeneous community of personal science practitioners can develop a collective self-tracking system for monitoring symptoms of infection alongside wearable sensor data. Methods: We engaged in a cocreation and design process with an existing community of personal science practitioners to jointly develop a working prototype of a web-based tool for symptom tracking. In addition to the iterative creation of the prototype (started on March 16, 2020), we performed a netnographic analysis to investigate the process of how this prototype was created in a decentralized and iterative fashion. Results: The Quantified Flu prototype allowed users to perform daily symptom reporting and was capable of presenting symptom reports on a timeline together with resting heart rates, body temperature data, and respiratory rates measured by wearable devices. We observed a high level of engagement; over half of the users (52/92, 56%) who engaged in symptom tracking became regular users and reported over 3 months of data each. Furthermore, our netnographic analysis highlighted how the current Quantified Flu prototype was a result of an iterative and continuous cocreation process in which new prototype releases sparked further discussions of features and vice versa. Conclusions: As shown by the high level of user engagement and iterative development process, an open cocreation process can be successfully used to develop a tool that is tailored to individual needs, thereby decreasing dropout rates. %M 34505836 %R 10.2196/28116 %U https://www.jmir.org/2021/9/e28116 %U https://doi.org/10.2196/28116 %U http://www.ncbi.nlm.nih.gov/pubmed/34505836 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e24295 %T Data Empowerment of Decision-Makers in an Era of a Pandemic: Intersection of “Classic” and Artificial Intelligence in the Service of Medicine %A Geva,Gil A %A Ketko,Itay %A Nitecki,Maya %A Simon,Shoham %A Inbar,Barr %A Toledo,Itay %A Shapiro,Michael %A Vaturi,Barak %A Votta,Yoni %A Filler,Daniel %A Yosef,Roey %A Shpitzer,Sagi A %A Hir,Nabil %A Peri Markovich,Michal %A Shapira,Shachar %A Fink,Noam %A Glasberg,Elon %A Furer,Ariel %+ Medical Corps, Israel Defense Force, IDF Medical Corps Headquarters, Tel HaShomer, Ramat Gan, 02149, Israel, 972 529277372, furera@gmail.com %K COVID-19 %K medical informatics %K decision-making %K pandemic %K data %K policy %K validation %K accuracy %K data analysis %D 2021 %7 10.9.2021 %9 Viewpoint %J J Med Internet Res %G English %X Background: The COVID-19 outbreak required prompt action by health authorities around the world in response to a novel threat. With enormous amounts of information originating in sources with uncertain degree of validation and accuracy, it is essential to provide executive-level decision-makers with the most actionable, pertinent, and updated data analysis to enable them to adapt their strategy swiftly and competently. Objective: We report here the origination of a COVID-19 dedicated response in the Israel Defense Forces with the assembly of an operational Data Center for the Campaign against Coronavirus. Methods: Spearheaded by directors with clinical, operational, and data analytics orientation, a multidisciplinary team utilized existing and newly developed platforms to collect and analyze large amounts of information on an individual level in the context of SARS-CoV-2 contraction and infection. Results: Nearly 300,000 responses to daily questionnaires were recorded and were merged with other data sets to form a unified data lake. By using basic as well as advanced analytic tools ranging from simple aggregation and display of trends to data science application, we provided commanders and clinicians with access to trusted, accurate, and personalized information and tools that were designed to foster operational changes and mitigate the propagation of the pandemic. The developed tools aided in the in the identification of high-risk individuals for severe disease and resulted in a 30% decline in their attendance to their units. Moreover, the queue for laboratory examination for COVID-19 was optimized using a predictive model and resulted in a high true-positive rate of 20%, which is more than twice as high as the baseline rate (2.28%, 95% CI 1.63%-3.19%). Conclusions: In times of ambiguity and uncertainty, along with an unprecedented flux of information, health organizations may find multidisciplinary teams working to provide intelligence from diverse and rich data a key factor in providing executives relevant and actionable support for decision-making. %M 34313589 %R 10.2196/24295 %U https://www.jmir.org/2021/9/e24295 %U https://doi.org/10.2196/24295 %U http://www.ncbi.nlm.nih.gov/pubmed/34313589 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 7 %N 3 %P e30821 %T Orthopedic Surgery Residency Program Website Content and Accessibility During the COVID-19 Pandemic: Observational Study %A El Shatanofy,Muhammad %A Brown,Lauryn %A Berger,Peter %A Gu,Alex %A Sharma,Abhinav K %A Campbell,Joshua %A Tabaie,Sean %+ Department of Orthopedic Surgery, School of Medicine, University of California, Irvine, 101 The City Drive South, Pavilion III, Building 29A, Orange, CA, 92868, United States, 1 281 633 6088, abhinaks@hs.uci.edu %K orthopedic surgery residency programs %K COVID-19 %K website %K residency applicants %K residency %K medical student %K content %K accessibility %K observational %K surgery %D 2021 %7 10.9.2021 %9 Original Paper %J JMIR Med Educ %G English %X Background: The exceptional competitiveness of the orthopedic surgery specialty, combined with the unclear impact of the COVID-19 pandemic on residency recruitment, has presented significant challenges to applicants and residency program directors. With limited in-person opportunities in the 2020-2021 application cycle, applicants have been pressed to gauge chances and best fit by browsing program websites. Objective: The aim of the study was to assess the accessibility and content of accredited orthopedic surgery residency program websites during the COVID-19 pandemic. Methods: Using the online database of the Electronic Residency Application Service (ERAS), we compiled a list of accredited orthopedic surgery residency programs in the United States. Program websites were evaluated across four domains: program overview, education, research opportunities, and application details. Each website was assessed twice in July 2020, during a period of adjustment to the COVID-19 pandemic, and twice in November 2020, following the October ERAS application deadline. Results: A total of 189 accredited orthopedic surgery residency programs were identified through ERAS. Of these programs, 3 (1.6%) did not have functional website links on ERAS. Data analysis of content in each domain revealed that most websites included program details, a description of the didactic curriculum, and sample rotation schedules. Between the two evaluation periods in July and November 2020, the percentage of program websites containing informative videos and virtual tours rose from 12.2% (23/189) to 48.1% (91/189; P<.001) and from 0.5% (1/189) to 13.2% (25/189; P<.001), respectively. However, the number of programs that included information about a virtual subinternship or virtual interview on their websites did not change. Over the 4-month period, larger residency programs with 5 or more residents were significantly more likely to add a program video (P<.001) or virtual tour (P<.001) to their websites. Conclusions: Most residency program websites offered program details and an overview of educational and research opportunities; however, few addressed the virtual transition of interviews and subinternships during the COVID-19 pandemic. %M 34449406 %R 10.2196/30821 %U https://mededu.jmir.org/2021/3/e30821 %U https://doi.org/10.2196/30821 %U http://www.ncbi.nlm.nih.gov/pubmed/34449406 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 9 %P e30367 %T Adapting to the Pandemic: Protocol of a Web-Based Perinatal Health Study to Improve Maternal and Infant Outcomes %A Tzilos Wernette,Golfo %A Countryman,Kristina %A Mmeje,Okeoma %A Ngo,Quyen M %A Zlotnick,Caron %+ Department of Family Medicine, University of Michigan Medical School, 1018 Fuller Street, Ann Arbor, MI, 48104, United States, 1 17349987120, gtzilos@med.umich.edu %K COVID-19 %K pregnancy %K COVID-19 pandemic %K alcohol use %K drug use %K sexually transmitted infections %K technology-delivered interventions %D 2021 %7 10.9.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: The identification of interconnected health risks during the perinatal period offers an opportunity to prevent negative maternal and infant health outcomes. Marijuana, opioid, and other substance use during pregnancy is a rapidly growing public health concern with significant and costly health consequences for the woman and the developing fetus. Pregnant persons who misuse substances are disproportionately more likely to engage in risky sexual behaviors resulting in sexually transmitted infections (STIs), which are on the rise in this population and can lead to adverse effects on maternal health and on fetal development. Objective: Our goal is to continue testing an innovative and low-cost technology-delivered intervention, the Health Check-Up for Expectant Moms (HCEM), which simultaneously targets alcohol and drug use and STI risk during pregnancy, both of which are on the rise during the COVID-19 pandemic. Methods: We describe the ways in which we have adapted the web-based HCEM intervention to continue recruitment and study enrollment during the pandemic. Results: Study recruitment, visits, and participant safety assessments were all successfully modified during the initial year of the COVID-19 pandemic. Compared to in-person recruitment that occurred prepandemic, remote recruitment yielded a greater proportion of women enrolled in the study (83/136, 61.0% vs 43/52, 83%) in a shorter period (12 months vs 7 months). Conclusions: Despite study challenges related to the pandemic, including time and effort adapting to a remote protocol, remote recruitment and visits for this study were found to constitute a successful approach. Trial Registration: ClinicalTrials.gov NCT03826342; https://clinicaltrials.gov/ct2/show/NCT03826342 International Registered Report Identifier (IRRID): DERR1-10.2196/30367 %M 34351867 %R 10.2196/30367 %U https://www.researchprotocols.org/2021/9/e30367 %U https://doi.org/10.2196/30367 %U http://www.ncbi.nlm.nih.gov/pubmed/34351867 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 9 %P e26220 %T Virtual Clinical and Precision Medicine Tumor Boards—Cloud-Based Platform–Mediated Implementation of Multidisciplinary Reviews Among Oncology Centers in the COVID-19 Era: Protocol for an Observational Study %A Blasi,Livio %A Bordonaro,Roberto %A Serretta,Vincenzo %A Piazza,Dario %A Firenze,Alberto %A Gebbia,Vittorio %+ La Maddalena Cancer Center, via San Lorenzo Colli n 312d, 90100, Palermo, 90100, Italy, 39 +39 091 6806710, vittorio.gebbia@gmail.com %K virtual tumor board %K multidisciplinary collaboration %K oncology %K multidisciplinary communication %K health services %K multidisciplinary oncology consultations %K virtual health %K digital health %K precision medicine %K tumor %K cancer %K cloud-based %K platform %K implementation %K oncology %K COVID-19 %D 2021 %7 10.9.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Multidisciplinary tumor boards play a pivotal role in the patient-centered clinical management and in the decision-making process to provide best evidence-based, diagnostic, and therapeutic care to patients with cancer. Among the barriers to achieve an efficient multidisciplinary tumor board, lack of time and geographical distance play a major role. Therefore, the elaboration of an efficient virtual multidisciplinary tumor board (VMTB) is a key point to successfully obtain an oncology team and implement a network among health professionals and institutions. This need is stronger than ever during the COVID-19 pandemic. Objective: This paper presents a research protocol for an observational study focused on exploring the structuring process and the implementation of a multi-institutional VMTB in Sicily, Italy. Other endpoints include analysis of cooperation between participants, adherence to guidelines, patients’ outcomes, and patient satisfaction. Methods: This protocol encompasses a pragmatic, observational, multicenter, noninterventional, prospective trial. The study’s programmed duration is 5 years, with a half-yearly analysis of the primary and secondary objectives’ measurements. Oncology care health professionals from various oncology subspecialties at oncology departments in multiple hospitals (academic and general hospitals as well as tertiary centers and community hospitals) are involved in a nonhierarchic manner. VMTB employs an innovative, virtual, cloud-based platform to share anonymized medical data that are discussed via a videoconferencing system both satisfying security criteria and compliance with the Health Insurance Portability and Accountability Act. Results: The protocol is part of a larger research project on communication and multidisciplinary collaboration in oncology units and departments spread in the Sicily region. The results of this study will particularly focus on the organization of VMTBs, involving oncology units present in different hospitals spread in the area, and creating a network to allow best patient care pathways and a hub-and-spoke relationship. The present results will also include data concerning organization skills and pitfalls, barriers, efficiency, number, and types with respect to clinical cases and customer satisfaction. Conclusions: VMTB represents a unique opportunity to optimize patient management through a patient-centered approach. An efficient virtualization and data-banking system is potentially time-saving, a source for outcome data, and a detector of possible holes in the hull of clinical pathways. The observations and results from this VMTB study may hopefully be useful to design nonclinical and organizational interventions that enhance multidisciplinary decision-making in oncology. International Registered Report Identifier (IRRID): DERR1-10.2196/26220 %M 34387553 %R 10.2196/26220 %U https://www.researchprotocols.org/2021/9/e26220 %U https://doi.org/10.2196/26220 %U http://www.ncbi.nlm.nih.gov/pubmed/34387553 %0 Journal Article %@ 2563-6316 %I JMIR Publications %V 2 %N 3 %P e24630 %T A Full-Scale Agent-Based Model to Hypothetically Explore the Impact of Lockdown, Social Distancing, and Vaccination During the COVID-19 Pandemic in Lombardy, Italy: Model Development %A Giacopelli,Giuseppe %+ Department of Mathematics and Informatics, University of Palermo, Via Archirafi, 34, Palermo, 90123, Italy, 39 09123891111, giuseppeg94@gmail.com %K epidemiology %K computational %K model %K COVID-19 %K modeling %K outbreak %K virus %K infectious disease %K simulation %K impact %K vaccine %K agent-based model %D 2021 %7 10.9.2021 %9 Original Paper %J JMIRx Med %G English %X Background: The COVID-19 outbreak, an event of global concern, has provided scientists the opportunity to use mathematical modeling to run simulations and test theories about the pandemic. Objective: The aim of this study was to propose a full-scale individual-based model of the COVID-19 outbreak in Lombardy, Italy, to test various scenarios pertaining to the pandemic and achieve novel performance metrics. Methods: The model was designed to simulate all 10 million inhabitants of Lombardy person by person via a simple agent-based approach using a commercial computer. In order to obtain performance data, a collision detection model was developed to enable cluster nodes in small cells that can be processed fully in parallel. Within this collision detection model, an epidemic model based mostly on experimental findings about COVID-19 was developed. Results: The model was used to explain the behavior of the COVID-19 outbreak in Lombardy. Different parameters were used to simulate various scenarios relating to social distancing and lockdown. According to the model, these simple actions were enough to control the virus. The model also explained the decline in cases in the spring and simulated a hypothetical vaccination scenario, confirming, for example, the herd immunity threshold computed in previous works. Conclusions: The model made it possible to test the impact of people’s daily actions (eg, maintaining social distance) on the epidemic and to investigate interactions among agents within a social network. It also provided insight on the impact of a hypothetical vaccine. %M 34606524 %R 10.2196/24630 %U https://med.jmirx.org/2021/3/e24630 %U https://doi.org/10.2196/24630 %U http://www.ncbi.nlm.nih.gov/pubmed/34606524 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 9 %P e26409 %T Estimation of COVID-19 Period Prevalence and the Undiagnosed Population in Canadian Provinces: Model-Based Analysis %A Hamadeh,Abdullah %A Feng,Zeny %A Niergarth,Jessmyn %A Wong,William WL %+ School of Pharmacy, University of Waterloo, 10A Victoria Street S, Kitchener, ON, N2G1C5, Canada, 1 519 888 4567 ext 21323, wwlwong@uwaterloo.ca %K COVID-19 %K prevalence %K undiagnosed proportion %K mathematical modeling %K estimate %K Canada %K diagnosis %K control %K distribution %K infectious disease %K model %K framework %K progression %K transmission %D 2021 %7 9.9.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The development of a successful COVID-19 control strategy requires a thorough understanding of the trends in geographic and demographic distributions of disease burden. In terms of the estimation of the population prevalence, this includes the crucial process of unravelling the number of patients who remain undiagnosed. Objective: This study estimates the period prevalence of COVID-19 between March 1, 2020, and November 30, 2020, and the proportion of the infected population that remained undiagnosed in the Canadian provinces of Quebec, Ontario, Alberta, and British Columbia. Methods: A model-based mathematical framework based on a disease progression and transmission model was developed to estimate the historical prevalence of COVID-19 using provincial-level statistics reporting seroprevalence, diagnoses, and deaths resulting from COVID-19. The framework was applied to three different age cohorts (< 30; 30-69; and ≥70 years) in each of the provinces studied. Results: The estimates of COVID-19 period prevalence between March 1, 2020, and November 30, 2020, were 4.73% (95% CI 4.42%-4.99%) for Quebec, 2.88% (95% CI 2.75%-3.02%) for Ontario, 3.27% (95% CI 2.72%-3.70%) for Alberta, and 2.95% (95% CI 2.77%-3.15%) for British Columbia. Among the cohorts considered in this study, the estimated total number of infections ranged from 2-fold the number of diagnoses (among Quebecers, aged ≥70 years: 26,476/53,549, 49.44%) to 6-fold the number of diagnoses (among British Columbians aged ≥70 years: 3108/18,147, 17.12%). Conclusions: Our estimates indicate that a high proportion of the population infected between March 1 and November 30, 2020, remained undiagnosed. Knowledge of COVID-19 period prevalence and the undiagnosed population can provide vital evidence that policy makers can consider when planning COVID-19 control interventions and vaccination programs. %M 34228626 %R 10.2196/26409 %U https://publichealth.jmir.org/2021/9/e26409 %U https://doi.org/10.2196/26409 %U http://www.ncbi.nlm.nih.gov/pubmed/34228626 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 9 %P e28728 %T COVID-19 Health Crisis and Chronic Illness: Protocol for a Qualitative Study %A Ricadat,Élise %A Béliard,Aude %A Citrini,Marie %A Craus,Yann %A Gabarro,Céline %A Mamzer,Marie-France %A Marques,Ana %A Sannié,Thomas %A Teixeira,Maria %A Tocilovac,Marko %A Velpry,Livia %A Villa,François %A Virole,Louise %A Lefève,Céline %+ Institut La Personne en Médecine, Université de Paris, 5 rue Thomas Mann, Paris, 75013, France, 33 0157275249, louise.virole@sciencespo.fr %K chronic illness %K care %K prevention %K vulnerability %K health democracy %K COVID %K qualitative study %K COVID-19 %K pandemic %K risk %D 2021 %7 9.9.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: The acute nature of the COVID-19 pandemic has put a strain on health resources that are usually dedicated to chronic illnesses. Resulting changes in care practices and networks have had major repercussions on the experience of people with chronic disorders. Objective: This paper presents the protocol of the Parcours, Associations, Réseau, Chronicité, Organisation, Usagers, Retour d’expérience, Soins (PARCOURS)-COVID study. The aim of this study is to evaluate the effects of reorganization of the health system on the usual care network of patients with chronic illness, which fosters and qualifies the quality and continuum of care provided. The first objective of this study is to document these patients’ experiences through transformations and adaptations of their network, both in the practical dimension (ie, daily life and care) and subjective dimension (ie, psychosocial experience of illness and relationship to the health system). The second objective of the study is to understand and acknowledge these reorganizations during the COVID-19 lockdown and postlockdown periods. The third objective is to produce better adapted recommendations for patients with chronic illness and value their experience for the management of future health crisis. Methods: The PARCOURS-COVID study is a qualitative and participatory research involving patient organizations as research partners and members of these organizations as part of the research team. Three group of chronic diseases have been selected regarding the specificities of the care network they mobilize: (1) cystic fibrosis and kidney disease, (2) hemophilia, and (3) mental health disorders. Four consecutive phases will be conducted, including (1) preparatory interviews with medical or associative actors of each pathology field; (2) in-depth individual interviews with patients of each pathology, analyzed using the qualitative method of thematic analysis; (3) results of both these phases will then be triangulated through interviews with members of each patient’s care ecosystem; and finally, (4) focus groups will be organized to discuss the results with research participants (ie, representatives of chronic disease associations; patients; and actors of the medical, psychosocial, and family care network) in a research-action framework. Results: The protocol study has undergone a peer review by the French National Research Agency’s scientific committee and has been approved by the research ethical committee of the University of Paris (registration number: IRB 00012020-59, June 28, 2020). The project received funding from August 2020 through April 2021. Expected results will be disseminated in 2021 and 2022. Conclusions: Our findings will better inform the stakes of the current health crisis on the management of patients with chronic illness and, more broadly, any future crisis for a population deemed to be at risk. They will also improve health democracy by supporting better transferability of knowledge between the scientific and citizen communities. International Registered Report Identifier (IRRID): DERR1-10.2196/28728 %M 34460413 %R 10.2196/28728 %U https://www.researchprotocols.org/2021/9/e28728 %U https://doi.org/10.2196/28728 %U http://www.ncbi.nlm.nih.gov/pubmed/34460413 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e30692 %T The Pandemic Year 2020: World Map of Coronavirus Research %A Klingelhöfer,Doris %A Braun,Markus %A Brüggmann,Dörthe %A Groneberg,David A %+ Institute of Occupational, Social and Environmental Medicine, Goethe University, Theodor-Stern-Kai 7, Frankfurt, 60590, Germany, 49 69 63016650, klingelhoefer@med.uni-frankfurt.de %K COVID-19 %K SARS-CoV-2 %K incidence, research funding %K socioeconomic factors %K bibliometrics %K bibliometric analysis %K global health %K public health %K health database %K online research %K research database %D 2021 %7 8.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: SARS-CoV-2 is one of the most threatening pandemics in human history. As of the date of this analysis, it had claimed about 2 million lives worldwide, and the number is rising sharply. Governments, societies, and scientists are equally challenged under this burden. Objective: This study aimed to map global coronavirus research in 2020 according to various influencing factors to highlight incentives or necessities for further research. Methods: The application of established and advanced bibliometric methods combined with the visualization technique of density-equalizing mapping provided a global picture of incentives and efforts on coronavirus research in 2020. Countries’ funding patterns and their epidemiological and socioeconomic characteristics as well as their publication performance data were included. Results: Research output exploded in 2020 with momentum, including citation and networking parameters. China and the United States were the countries with the highest publication performance. Globally, however, publication output correlated significantly with COVID-19 cases. Research funding has also increased immensely. Conclusions: Nonetheless, the abrupt decline in publication efforts following previous coronavirus epidemics should demonstrate to global researchers that they should not lose interest even after containment, as the next epidemiological challenge is certain to come. Validated reporting worldwide and the inclusion of low-income countries are additionally important for a successful future research strategy. %M 34346891 %R 10.2196/30692 %U https://www.jmir.org/2021/9/e30692 %U https://doi.org/10.2196/30692 %U http://www.ncbi.nlm.nih.gov/pubmed/34346891 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 9 %P e31409 %T COVID-19 Vaccine Perception in South Korea: Web Crawling Approach %A Lee,Hocheol %A Noh,Eun Bi %A Park,Sung Jong %A Nam,Hae Kweun %A Lee,Tae Ho %A Lee,Ga Ram %A Nam,Eun Woo %+ Department of Health Administration, Yonsei University Graduate School, Unit 412, Chang-jo gwan, 1 Yonseidae-gil, Wonju, 26493, Republic of Korea, 82 33 760 2413, ewnam@yonsei.ac.kr %K COVID-19 vaccine %K COVID-19 %K instagram %K social media %K infodemiology %K sentiment analysis %K vaccine perception %K South Korea %K web crawling %K AstraZeneca %K Pfizer %D 2021 %7 8.9.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The US Centers for Disease Control and Prevention and the World Health Organization emphasized vaccination against COVID-19 because physical distancing proved inadequate to mitigate death, illness, and massive economic loss. Objective: This study aimed to investigate Korean citizens’ perceptions of vaccines by examining their views on COVID-19 vaccines, their positive and negative perceptions of each vaccine, and ways to enhance policies to increase vaccine acceptance. Methods: This cross-sectional study analyzed posts on NAVER and Instagram to examine Korean citizens’ perception of COVID-19 vaccines. The keywords searched were “vaccine,” “AstraZeneca,” and “Pfizer.” In total 8100 posts in NAVER and 5291 posts in Instagram were sampled through web crawling. Morphology analysis was performed, overlapping or meaningless words were removed, sentiment analysis was implemented, and 3 public health professionals reviewed the results. Results: The findings revealed a negative perception of COVID-19 vaccines; of the words crawled, the proportion of negative words for AstraZeneca was 71.0% (476/670) and for Pfizer was 56.3% (498/885). Among words crawled with “vaccine,” “good” ranked first, with a frequency of 13.43% (312/2323). Meanwhile, “side effect” ranked highest, with a frequency of 29.2% (163/559) for “AstraZeneca,” but 0.6% (4/673) for “Pfizer.” With “vaccine,” positive words were more frequently used, whereas with “AstraZeneca” and “Pfizer” negative words were prevalent. Conclusions: There is a negative perception of AstraZeneca and Pfizer vaccines in Korea, with 1 in 4 people refusing vaccination. To address this, accurate information needs to be shared about vaccines including AstraZeneca, and the experiences of those vaccinated. Furthermore, government communication about risk management is required to increase the AstraZeneca vaccination rate for herd immunity before the vaccine expires. %M 34348890 %R 10.2196/31409 %U https://publichealth.jmir.org/2021/9/e31409 %U https://doi.org/10.2196/31409 %U http://www.ncbi.nlm.nih.gov/pubmed/34348890 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 9 %P e26318 %T User Experiences of the NZ COVID Tracer App in New Zealand: Thematic Analysis of Interviews %A Tretiakov,Alexei %A Hunter,Inga %+ School of Management, Massey University, Tennent Drive, Palmerston North, 4474, New Zealand, 64 6 951 7905, A.Tretiakov@massey.ac.nz %K COVID-19 %K contact tracing %K app %K New Zealand %K adoption %K use %K civic responsibility %K privacy %D 2021 %7 8.9.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: For mobile app–based COVID-19 contact tracing to be fully effective, a large majority of the population needs to be using the app on an ongoing basis. However, there is a paucity of studies of users, as opposed to potential adopters, of mobile contact tracing apps and of their experiences. New Zealand, a high-income country with western political culture, was successful in managing the COVID-19 pandemic, and its experience is valuable for informing policy responses in similar contexts. Objective: This study asks the following research questions: (1) How do users experience the app in their everyday contexts? and (2) What drives the use of the app? Methods: Residents of New Zealand’s Auckland region, which encompasses the country’s largest city, were approached via Facebook, and 34 NZ COVID Tracer app users were interviewed. Interview transcripts were analyzed using thematic analysis. Results: Interviews ranged in duration from 15 to 50 minutes. Participants ranged in age from those in their late teens to those in their early sixties. Even though about half of the participants identified as White New Zealanders of European origin, different ethnicities were represented, including New Zealanders of South Pacific, Indian, Middle Eastern, South American, and Southeast Asian descent. Out of 34 participants, 2 (6%) identified as Māori (Indigenous New Zealanders). A broad range of careers were represented, from top-middle management to health support work and charity work. Likewise, educational backgrounds ranged broadly, from high school completion to master’s degrees. Out of 34 participants, 2 (6%) were unemployed, having recently lost their jobs because of the pandemic. The thematic analysis resulted in five major themes: perceived benefits, patterns of use, privacy, social influence, and need for collective action. Benefits of using the app to society in general were more salient to the participants than immediate health benefits to the individual. Use, however, depended on the alert level and tended to decline for many participants at low alert levels. Privacy considerations played a small role in shaping adoption and use, even though the participants were highly aware of privacy discourse around the app. Participants were aware of the need for high levels of adoption and use of the app to control the pandemic. Attempts to encourage others to use the app were common, although not always successful. Conclusions: Appeals to civic responsibility are likely to drive the use of a mobile contact tracing app under the conditions of high threat. Under the likely scenario of COVID-19 remaining endemic and requiring ongoing vigilance over the long term, other mechanisms promoting the use of mobile contact tracing apps may be needed, such as offering incentives. As privacy is not an important concern for many users, flexible privacy settings in mobile contact tracing apps allowing users to set their optimal levels of privacy may be appropriate. %M 34292868 %R 10.2196/26318 %U https://mhealth.jmir.org/2021/9/e26318 %U https://doi.org/10.2196/26318 %U http://www.ncbi.nlm.nih.gov/pubmed/34292868 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e29396 %T Using Administrative Data to Explore Potentially Aberrant Provision of Virtual Care During COVID-19: Retrospective Cohort Study of Ontario Provincial Data %A Stamenova,Vess %A Chu,Cherry %A Pang,Andrea %A Tadrous,Mina %A Bhatia,R Sacha %A Cram,Peter %+ Institute for Health System Solutions and Virtual Care, Women's College Hospital, 76 Grenville St, Toronto, ON, M5S 1B2, Canada, 1 416 268 0985, vess.stamenova@wchospital.ca %K telemedicine %K virtual care %K COVID-19 %K pandemic %K virtual health %K telehealth %K ambulatory visits %K physicians %K patients %K digital health %D 2021 %7 7.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic has led to a rapid increase in virtual care use across the globe. Many health care systems have responded by creating virtual care billing codes that allow physicians to see their patients over telephone or video. This rapid liberalization of billing requirements, both in Canada and other countries, has led to concerns about potential abuse, but empirical data are limited. Objective: The objectives of this study were to examine whether there were substantial changes in physicians’ ambulatory visit volumes coinciding with the liberalization of virtual care billing rules and to describe the characteristics of physicians who significantly increased their ambulatory visit volumes during this period. We also sought to describe the relationship between visit volume changes in 2020 and the volumes of virtual care use among individual physicians and across specialties. Methods: We conducted a population-based, retrospective cohort study using health administrative data from the Ontario Health Insurance Plan, which was linked to the ICES Physician Database. We identified a unique cohort of providers based on physicians’ billings and calculated the ratio of total in-person and virtual ambulatory visits over the period from January to June 2020 (virtual predominating) relative to that over the period from January to June 2019 (in-person predominating) for each physician. Based on these ratios, we then stratified physicians into four groups: low-, same-, high-, and very high–use physicians. We then calculated various demographic and practice characteristics of physicians in each group. Results: Among 28,383 eligible physicians in 2020, the mean ratio of ambulatory visits in January to June 2020:2019 was 0.99 (SD 2.53; median 0.81, IQR 0.59-1.0). Out of 28,383 physicians, only 2672 (9.4%) fell into the high-use group and only 291 (1.0%) fell into the very high–use group. High-use physicians were younger, more recent graduates, more likely female, and less likely to be international graduates. They also had, on average, lower-volume practices. There was a significant positive correlation between percent virtual care and the 2020:2019 ratio only in the group of physicians who maintained their practice (R=0.35, P<.001). There was also a significant positive correlation between the 2020:2019 ratio and the percent virtual care per specialty (R=0.59, P<.01). Conclusions: During the early stages of the pandemic, the introduction of virtual care did not lead to significant increases in visit volume. Our results provide reassuring evidence that relaxation of billing requirements early in the COVID-19 pandemic in Ontario were not associated with widespread and aberrant billing behaviors. Furthermore, the strong relationship between the ability to maintain practice volumes and the use of virtual care suggests that the introduction of virtual care allowed for continued access to care for patients. %M 34313590 %R 10.2196/29396 %U https://www.jmir.org/2021/9/e29396 %U https://doi.org/10.2196/29396 %U http://www.ncbi.nlm.nih.gov/pubmed/34313590 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 9 %P e26513 %T Social Networking Site Use During the COVID-19 Pandemic and Its Associations With Social and Emotional Well-being in College Students: Survey Study %A Tuck,Alison B %A Thompson,Renee J %+ Department of Psychological and Brain Sciences, Washington University in St Louis, Campus Box 1125, One Brookings Drive, St Louis, MO, 63130, United States, 1 (314) 935 3502, alison.tuck@wustl.edu %K social media %K social networking sites %K COVID-19 %K loneliness %K well-being %D 2021 %7 7.9.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Social distancing during the COVID-19 pandemic has reduced the frequency of in-person social interactions. College students were highly impacted, since many universities transferred curriculum from in-person to entirely online formats, physically separating students with little notice. With social distancing, their use of social networking sites (SNSs) likely changed during the COVID-19 pandemic, possibly holding implications for well-being. Objective: This study aimed to determine (1) how components of SNS use (ie, weekly frequency, time per day, habitual use, engagement, enjoyment, addiction, and emotional impact) changed from before to during COVID-19, (2) how these changes in SNS use were associated with pandemic-related social and emotional well-being, and (3) how SNS use and changes in use during the pandemic were associated with loneliness. Methods: College students (N=176) were surveyed during the time when their university campus in the United States was operating online. Participants completed the same SNS use questionnaires twice, once with regard to the month preceding the onset of COVID-19 and again with regard to the month since this time. They also reported the extent to which they experienced perceived change in social support resulting from the pandemic, pandemic-related stress, and general loneliness. Results: After the onset of COVID-19, participants showed an increase in daily time spent on SNSs (t169=5.53, d=0.42, P<.001), habitual use (t173=3.60, d=0.27, P<.001), and addiction (t173=4.96, d=0.38, P<.001); further, enjoyment on SNSs decreased (t173=–2.10, d=–0.16, P=.04) and the emotional impact of SNS activities became more negative (t172=–3.76, d=–0.29, P<.001). Increased perceived social support during COVID-19 was associated with changes in frequency of SNS use, time per day, addiction, and engagement (r>0.18 for all). Pandemic-related stress was associated with changes in SNS addiction and the extent to which one’s SNS content was related to the pandemic (r>0.20 for all). Loneliness was positively associated with SNS addiction (r=0.26) and negatively associated with SNS engagement (r=–0.19) during the pandemic. Loneliness was also negatively associated with changes in habit and engagement (r<–0.15 for all). Conclusions: Findings suggest that components of SNS use are associated with both positive and negative pandemic-related social outcomes, but largely negative pandemic-related emotional outcomes. Further, some components of SNS use are positively associated with loneliness (eg, addiction) while others show a negative association (eg, engagement). These findings provide a more nuanced picture of how SNS use is associated with social and emotional well-being during the time of a global health crisis when in-person interactions are scarce. %M 34313587 %R 10.2196/26513 %U https://formative.jmir.org/2021/9/e26513 %U https://doi.org/10.2196/26513 %U http://www.ncbi.nlm.nih.gov/pubmed/34313587 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e29329 %T Health Belief Model Perspective on the Control of COVID-19 Vaccine Hesitancy and the Promotion of Vaccination in China: Web-Based Cross-sectional Study %A Chen,Hao %A Li,Xiaomei %A Gao,Junling %A Liu,Xiaoxi %A Mao,Yimeng %A Wang,Ruru %A Zheng,Pinpin %A Xiao,Qianyi %A Jia,Yingnan %A Fu,Hua %A Dai,Junming %+ Department of Preventive Medicine and Health Education, School of Public Health, Fudan University, No.138# Yixueyuan Road, Xuhui District, Shanghai, 200032, China, 86 021 54237358, jmdai@fudan.edu.cn %K COVID-19 pandemic %K vaccination behavior %K vaccine hesitancy %K health belief model %D 2021 %7 6.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The control of vaccine hesitancy and the promotion of vaccination are key protective measures against COVID-19. Objective: This study assesses the prevalence of vaccine hesitancy and the vaccination rate and examines the association between factors of the health belief model (HBM) and vaccination. Methods: A convenience sample of 2531 valid participants from 31 provinces and autonomous regions of mainland China were enrolled in this online survey study from January 1 to 24, 2021. Multivariable logistic regression was used to identify the associations of the vaccination rate and HBM factors with the prevalence of vaccine hesitancy after other covariates were controlled. Results: The prevalence of vaccine hesitancy was 44.3% (95% CI 42.3%-46.2%), and the vaccination rate was 10.4% (9.2%-11.6%). The factors that directly promoted vaccination behavior were a lack of vaccine hesitancy (odds ratio [OR] 7.75, 95% CI 5.03-11.93), agreement with recommendations from friends or family for vaccination (OR 3.11, 95% CI 1.75-5.52), and absence of perceived barriers to COVID-19 vaccination (OR 0.51, 95% CI 0.35-0.75). The factors that were directly associated with a higher vaccine hesitancy rate were a high level of perceived barriers (OR 1.63, 95% CI 1.36-1.95) and perceived benefits (OR 0.51, 95% CI 0.32-0.79). A mediating effect of self-efficacy, influenced by perceived barriers (standardized structure coefficient [SSC]=−0.71, P<.001), perceived benefits (SSC=0.58, P<.001), agreement with recommendations from authorities (SSC=0.27, P<.001), and agreement with recommendations from friends or family (SSC=0.31, P<.001), was negatively associated with vaccination (SSC=−0.45, P<.001) via vaccine hesitancy (SSC=−0.32, P<.001). Conclusions: It may be possible to increase the vaccination rate by reducing vaccine hesitancy and perceived barriers to vaccination and by encouraging volunteers to advocate for vaccination to their friends and family members. It is also important to reduce vaccine hesitancy by enhancing self-efficacy for vaccination, due to its crucial mediating function. %M 34280115 %R 10.2196/29329 %U https://www.jmir.org/2021/9/e29329 %U https://doi.org/10.2196/29329 %U http://www.ncbi.nlm.nih.gov/pubmed/34280115 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e28975 %T Association Between What People Learned About COVID-19 Using Web Searches and Their Behavior Toward Public Health Guidelines: Empirical Infodemiology Study %A Akpan,Ikpe Justice %A Aguolu,Obianuju Genevieve %A Kobara,Yawo Mamoua %A Razavi,Rouzbeh %A Akpan,Asuama A %A Shanker,Murali %+ Department of Management & Information Systems, Kent State University, 330 University Drive Northeast, New Philadelphia, OH, 44663, United States, 1 3303393391 ext 7572, iakpan@kent.edu %K internet %K novel coronavirus %K SARS-CoV-2 %K COVID-19 %K infodemiology %K misinformation %K conspiracy theories %K public health %D 2021 %7 2.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The use of the internet and web-based platforms to obtain public health information and manage health-related issues has become widespread in this digital age. The practice is so pervasive that the first reaction to obtaining health information is to “Google it.” As SARS-CoV-2 broke out in Wuhan, China, in December 2019 and quickly spread worldwide, people flocked to the internet to learn about the novel coronavirus and the disease, COVID-19. Lagging responses by governments and public health agencies to prioritize the dissemination of information about the coronavirus outbreak through the internet and the World Wide Web and to build trust gave room for others to quickly populate social media, online blogs, news outlets, and websites with misinformation and conspiracy theories about the COVID-19 pandemic, resulting in people’s deviant behaviors toward public health safety measures. Objective: The goals of this study were to determine what people learned about the COVID-19 pandemic through web searches, examine any association between what people learned about COVID-19 and behavior toward public health guidelines, and analyze the impact of misinformation and conspiracy theories about the COVID-19 pandemic on people’s behavior toward public health measures. Methods: This infodemiology study used Google Trends’ worldwide search index, covering the first 6 months after the SARS-CoV-2 outbreak (January 1 to June 30, 2020) when the public scrambled for information about the pandemic. Data analysis employed statistical trends, correlation and regression, principal component analysis (PCA), and predictive models. Results: The PCA identified two latent variables comprising past coronavirus epidemics (pastCoVepidemics: keywords that address previous epidemics) and the ongoing COVID-19 pandemic (presCoVpandemic: keywords that explain the ongoing pandemic). Both principal components were used significantly to learn about SARS-CoV-2 and COVID-19 and explained 88.78% of the variability. Three principal components fuelled misinformation about COVID-19: misinformation (keywords “biological weapon,” “virus hoax,” “common cold,” “COVID-19 hoax,” and “China virus”), conspiracy theory 1 (ConspTheory1; keyword “5G” or “@5G”), and conspiracy theory 2 (ConspTheory2; keyword “ingest bleach”). These principal components explained 84.85% of the variability. The principal components represent two measurements of public health safety guidelines—public health measures 1 (PubHealthMes1; keywords “social distancing,” “wash hands,” “isolation,” and “quarantine”) and public health measures 2 (PubHealthMes2; keyword “wear mask”)—which explained 84.7% of the variability. Based on the PCA results and the log-linear and predictive models, ConspTheory1 (keyword “@5G”) was identified as a predictor of people’s behavior toward public health measures (PubHealthMes2). Although correlations of misinformation (keywords “COVID-19,” “hoax,” “virus hoax,” “common cold,” and more) and ConspTheory2 (keyword “ingest bleach”) with PubHealthMes1 (keywords “social distancing,” “hand wash,” “isolation,” and more) were r=0.83 and r=–0.11, respectively, neither was statistically significant (P=.27 and P=.13, respectively). Conclusions: Several studies focused on the impacts of social media and related platforms on the spreading of misinformation and conspiracy theories. This study provides the first empirical evidence to the mainly anecdotal discourse on the use of web searches to learn about SARS-CoV-2 and COVID-19. %M 34280117 %R 10.2196/28975 %U https://www.jmir.org/2021/9/e28975 %U https://doi.org/10.2196/28975 %U http://www.ncbi.nlm.nih.gov/pubmed/34280117 %0 Journal Article %@ 2563-6316 %I JMIR Publications %V 2 %N 3 %P e28158 %T Impact of the COVID-19 Pandemic on the Mental Health of College Students in India: Cross-sectional Web-Based Study %A Chaudhary,Amar Prashad %A Sonar,Narayan Sah %A TR,Jamuna %A Banerjee,Moumita %A Yadav,Shailesh %+ Department of Pharmacy Practice, Mallige College of Pharmacy, Rajiv Gandhi University of Health Sciences, Silvepura, Chikkabanavara Post, Hessarghatta Road, Bangalore, 560090, India, 91 9304339189, pamar419@gmail.com %K anxiety %K COVID-19 %K depression %K fear %K FCV-19S %K GAD-7 %K mental health %K pandemic %K PHQ-9 %K students %D 2021 %7 2.9.2021 %9 Original Paper %J JMIRx Med %G English %X Background: The COVID-19 pandemic has created a mental health crisis among college students in India due to lockdown restrictions, overwhelming numbers of COVID-19 cases, financial difficulty, etc. This mental health crisis has led to high degrees of fear, anxiety, and depression among college students. Objective: The aim of this study is to investigate symptoms of fear, depression, and anxiety due to the COVID-19 pandemic among college students in India. Methods: This cross-sectional web-based study was conducted using a Google Forms questionnaire. The Google Form included a sociodemographic questionnaire and psychometric scales evaluating the psychological and behavioral impacts of the COVID-19 pandemic. Thus, both qualitative and quantitative analyses were performed in the study. Results: A total of 324 college students participated in this study, of whom 180 (55.6%) were male and 144 (44.4%) were female. After assessment of the psychometric scales, it was found that of the 324 students, 223 (68.8%) had high fear of COVID-19, 93 (28.7%) had moderate to severe depression, and 167 (51.5%) had mild to severe anxiety. Among the identified risk factors, having a family member who was infected with COVID-19 was significantly associated with anxiety and depression, with P values of .02 and .001, respectively. In addition, the correlations of the Fear of COVID-19 Scale with the Generalized Anxiety Disorder-7 scale and the Patient Health Questionnaire-9 were found to be 0.492 and 0.474, respectively. Conclusions: This research concludes that there is a very high fear of COVID-19 among students, along with anxiety and depression symptoms. This study also concludes that the Fear of COVID-19 Scale has a moderate positive correlation with the anxiety and depression scales, respectively. %M 34606521 %R 10.2196/28158 %U https://med.jmirx.org/2021/3/e28158 %U https://doi.org/10.2196/28158 %U http://www.ncbi.nlm.nih.gov/pubmed/34606521 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 9 %P e29310 %T COVID-19 Data Utilization in North Carolina: Qualitative Analysis of Stakeholder Experiences %A Patterson,Jenny Rees %A Shaw,Donna %A Thomas,Sharita R %A Hayes,Julie A %A Daley,Christopher R %A Knight,Stefania %A Aikat,Jay %A Mieczkowska,Joanna O %A Ahalt,Stanley C %A Krishnamurthy,Ashok K %+ University of Iowa, 145 N. Riverside Drive, Iowa City, IA, 52242, United States, 1 3147490050, jennifer-patterson@uiowa.edu %K qualitative research %K interview %K COVID-19 %K SARS-CoV-2 %K pandemic %K data collection %K data reporting %K data %K public health %K coronavirus disease 2019 %D 2021 %7 2.9.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: As the world faced the pandemic caused by the novel coronavirus disease 2019 (COVID-19), medical professionals, technologists, community leaders, and policy makers sought to understand how best to leverage data for public health surveillance and community education. With this complex public health problem, North Carolinians relied on data from state, federal, and global health organizations to increase their understanding of the pandemic and guide decision-making. Objective: We aimed to describe the role that stakeholders involved in COVID-19–related data played in managing the pandemic in North Carolina. The study investigated the processes used by organizations throughout the state in using, collecting, and reporting COVID-19 data. Methods: We used an exploratory qualitative study design to investigate North Carolina’s COVID-19 data collection efforts. To better understand these processes, key informant interviews were conducted with employees from organizations that collected COVID-19 data across the state. We developed an interview guide, and open-ended semistructured interviews were conducted during the period from June through November 2020. Interviews lasted between 30 and 45 minutes and were conducted by data scientists by videoconference. Data were subsequently analyzed using qualitative data analysis software. Results: Results indicated that electronic health records were primary sources of COVID-19 data. Often, data were also used to create dashboards to inform the public or other health professionals, to aid in decision-making, or for reporting purposes. Cross-sector collaboration was cited as a major success. Consistency among metrics and data definitions, data collection processes, and contact tracing were cited as challenges. Conclusions: Findings suggest that, during future outbreaks, organizations across regions could benefit from data centralization and data governance. Data should be publicly accessible and in a user-friendly format. Additionally, established cross-sector collaboration networks are demonstrably beneficial for public health professionals across the state as these established relationships facilitate a rapid response to evolving public health challenges. %M 34298500 %R 10.2196/29310 %U https://publichealth.jmir.org/2021/9/e29310 %U https://doi.org/10.2196/29310 %U http://www.ncbi.nlm.nih.gov/pubmed/34298500 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e29959 %T Disparities in Outpatient and Telehealth Visits During the COVID-19 Pandemic in a Large Integrated Health Care Organization: Retrospective Cohort Study %A Qian,Lei %A Sy,Lina S %A Hong,Vennis %A Glenn,Sungching C %A Ryan,Denison S %A Morrissette,Kerresa %A Jacobsen,Steven J %A Xu,Stanley %+ Department of Research & Evaluation, Kaiser Permanente Southern California, 100 S. Los Robles Ave, 5th Floor, Pasadena, CA, 91101, United States, 1 6266586128, lei.x.qian@kp.org %K COVID-19 %K pandemic %K health care utilization %K telehealth %K disparity %D 2021 %7 1.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Dramatic decreases in outpatient visits and sudden increases in telehealth visits were observed during the COVID-19 pandemic, but it was unclear whether these changes differed by patient demographics and socioeconomic status. Objective: This study aimed to assess the impact of the pandemic on in-person outpatient and telehealth visits (telephone and video) by demographic characteristics and household income in a diverse population. Methods: We calculated weekly rates of outpatient and telehealth visits by age, sex, race/ethnicity, and neighborhood-level median household income among members of Kaiser Permanente Southern California (KPSC) from January 5, 2020, to October 31, 2020, and the corresponding period in 2019. We estimated the percentage change in visit rates during the early pandemic period (March 22 to April 25, 2020) and the late pandemic period (October 4 to October 31, 2020) from the prepandemic period (January 5 to March 7, 2020) in Poisson regression models for each subgroup while adjusting for seasonality using 2019 data. We examined if the changes in visit rates differed by subgroups statistically by comparing their 95% CIs. Results: Among 4.56 million KPSC members enrolled in January 2020, 15.0% (n=682,947) were ≥65 years old, 51.5% (n=2,345,020) were female, 39.4% (n=1,795,994) were Hispanic, and 7.7% (n=350,721) lived in an area of median household income 64 years of age) with no self-reported disability. The number of participants we could recruit from each group was limited, which may impact the validity of some subgroup analyses. Results: This study was approved by the University of British Columbia Behavioural Research Ethics Board (Approval No. H20-01109) on April 17, 2020. A total of 81 participants were enrolled in this study and data are being analyzed. Data analyses are expected to be completed in fall 2021; submission of multiple papers for publication is expected by winter 2021. Conclusions: Findings from our study will inform the development and recommendations of a new resource guide for the post–COVID-19 period and for future public health emergencies. International Registered Report Identifier (IRRID): DERR1-10.2196/28337 %M 34292163 %R 10.2196/28337 %U https://www.researchprotocols.org/2021/9/e28337 %U https://doi.org/10.2196/28337 %U http://www.ncbi.nlm.nih.gov/pubmed/34292163 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 8 %P e25549 %T Patient and Professional Experiences With Virtual Antenatal Clinics During the COVID-19 Pandemic in a UK Tertiary Obstetric Hospital: Questionnaire Study %A Quinn,Lauren Marie %A Olajide,Oluwafumbi %A Green,Marsha %A Sayed,Hazem %A Ansar,Humera %+ University Hospitals of Leicester, Infirmary Square, Leicester, LE1 5WW, United Kingdom, 44 03003031573, lauren.quinn6@nhs.net %K antenatal %K virtual clinic %K technology %K COVID-19 %K United Kingdom %K pandemic %K feasibility %K effective %K telehealth %K virtual health %D 2021 %7 31.8.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic required rapid implementation of virtual antenatal care to keep pregnant women safe. This transition from face-to-face usual care had to be embraced by patients and professionals alike. Objective: We evaluated patients’ and professionals’ experiences with virtual antenatal clinic appointments during the COVID-19 pandemic to determine satisfaction and inquire into the safety and quality of care received. Methods: A total of 148 women who attended a virtual antenatal clinic appointment at our UK tertiary obstetric care center over a 2-week period provided feedback (n=92, 62% response rate). A further 37 health care professionals (HCPs) delivering care in the virtual antenatal clinics participated in another questionnaire study (37/45, 82% response rate). Results: We showed that women were highly satisfied with the virtual clinics, with 86% (127/148) rating their experience as good or very good, and this was not associated with any statistically significant differences in age (P=.23), ethnicity (P=.95), number of previous births (P=.65), or pregnancy losses (P=.94). Even though 56% (83/148) preferred face-to-face appointments, 44% (65/148) either expressed no preference or preferred virtual, and these preferences were not associated with significant differences in patient demographics. For HCPs, 67% (18/27) rated their experience of virtual clinics as good or very good, 78% (21/27) described their experience as the same or better than face-to-face clinics, 15% (4/27) preferred virtual clinics, and 44% (12/27) had no preference. Importantly, 67% (18/27) found it easy or very easy to adapt to virtual clinics. Over 90% of HCPs agreed virtual clinics should be implemented long-term. Conclusions: Our study demonstrates high satisfaction with telephone antenatal clinics during the pandemic, which supports the transition toward widespread digitalization of antenatal care suited to 21st-century patients and professionals. %M 34254940 %R 10.2196/25549 %U https://www.jmir.org/2021/8/e25549 %U https://doi.org/10.2196/25549 %U http://www.ncbi.nlm.nih.gov/pubmed/34254940 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 7 %N 3 %P e30492 %T COVID-19 Communication From Seven Health Care Institutions in North Texas for English- and Spanish-Speaking Cancer Patients: Mixed Method Website Study %A Higashi,Robin T %A Sweetenham,John W %A Israel,Aimee D %A Tiro,Jasmin A %+ University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-8557, United States, 1 214 648 3645, robin.higashi@utsouthwestern.edu %K COVID-19 %K coronavirus %K safety net %K internet %K communication %D 2021 %7 31.8.2021 %9 Original Paper %J JMIR Cancer %G English %X Background: The COVID-19 pandemic has created an urgent need to rapidly disseminate health information, especially to those with cancer, because they face higher morbidity and mortality rates. At the same time, the pandemic’s disproportionate impact on Latinx populations underscores the need for information to reach Spanish speakers. However, the equity of COVID-19 information communicated through institutions’ online media to Spanish-speaking cancer patients is unknown. Objective: We conducted a multimodal, mixed method document review study to evaluate the equity of online information about COVID-19 and cancer available to English- and Spanish-speaking populations from seven health care institutions in North Texas, where one in five adults is Spanish-speaking. Our focus was less on the “digital divide,” which conveys disparities in access to computers and the internet based on the race/ethnicity, education, and income of at-risk populations; rather, our study asks the following question: to what extent is online content useful and culturally appropriate in meeting Spanish speakers’ information needs? Methods: We reviewed 50 websites (33 English and 17 Spanish) over a period of 1 week in the middle of May 2020. We sampled seven institutions’ main oncology and COVID web pages, and both internal (institutional) and external (noninstitutional) linked content. We conducted several analyses for each sampled page, including (1) thematic content analysis, (2) literacy level analysis using Readability Studio software, (3) coding using the Patient Education and Materials Assessment Tool (PEMAT), and (4) descriptive analysis of video and diversity content. Results: The themes most frequently addressed on English and Spanish websites differed. While “resources/FAQs” were frequently cited themes on both websites, English websites more frequently addressed “news/updates” and “cancer+COVID,” and Spanish websites addressed “protection” and “COVID data.” Spanish websites had on average a lower literacy level (11th grade) than English websites (13th grade), although still far above the recommended guideline of 6th to 8th grade. The PEMAT’s overall average accessibility score was the same for English (n=33 pages) and Spanish pages (n=17 pages) at 82%. Among the Dallas-Fort Worth organizations, the average accessibility of Spanish pages (n=7) was slightly lower than that of English pages (n=19) (77% vs 81%), due mostly to the discrepancy in English-only videos and visual aids. Of the 50 websites, 12 (24%) had embedded videos; however, 100% of videos were in English, including one on a Spanish website. Conclusions: We identified an uneven response among the seven health care institutions for providing equitable information to Spanish-speaking Dallas-Fort Worth residents concerned about COVID and cancer. Spanish speakers lack equal access in both diversity of content about COVID-19 and access to other websites, leaving an already vulnerable cancer patient population at greater risk. We recommend several specific actions to enhance content and navigability for Spanish speakers. %M 34346886 %R 10.2196/30492 %U https://cancer.jmir.org/2021/3/e30492 %U https://doi.org/10.2196/30492 %U http://www.ncbi.nlm.nih.gov/pubmed/34346886 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 8 %P e21817 %T Online Search Trends Influencing Anticoagulation in Patients With COVID-19: Observational Study %A Worrall,Amy P %A Kelly,Claire %A O'Neill,Aine %A O'Doherty,Murray %A Kelleher,Eoin %A Cushen,Anne Marie %A McNally,Cora %A McConkey,Samuel %A Glavey,Siobhan %A Lavin,Michelle %A de Barra,Eoghan %+ Department of Infectious Diseases, Beaumont Hospital, P.O. Box 1297, Beaumont Road, Dublin, 9, Ireland, 353 1 8093000, worralap@tcd.ie %K COVID-19 %K coronavirus %K online search engines %K anticoagulation %K thrombosis %K online influence %K health information dissemination %D 2021 %7 31.8.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Early evidence of COVID-19–associated coagulopathy disseminated rapidly online during the first months of 2020, followed by clinical debate about how best to manage thrombotic risks in these patients. The rapid online spread of case reports was followed by online interim guidelines, discussions, and worldwide online searches for further information. The impact of global online search trends and online discussion on local approaches to coagulopathy in patients with COVID-19 has not been studied. Objective: The goal of this study was to investigate the relationship between online search trends using Google Trends and the rate of appropriate venous thromboembolism (VTE) prophylaxis and anticoagulation therapy in a cohort of patients with COVID-19 admitted to a tertiary hospital in Ireland. Methods: A retrospective audit of anticoagulation therapy and VTE prophylaxis among patients with COVID-19 who were admitted to a tertiary hospital was conducted between February 29 and May 31, 2020. Worldwide Google search trends of the term “COVID-19” and anticoagulation synonyms during this time period were determined and correlated against one another using a Spearman correlation. A P value of <.05 was considered significant, and analysis was completed using Prism, version 8 (GraphPad). Results: A statistically significant Spearman correlation (P<.001, r=0.71) was found between the two data sets, showing an increase in VTE prophylaxis in patients with COVID-19 with increasing online searches worldwide. This represents a proxy for online searches and discussion, dissemination of information, and Google search trends relating to COVID-19 and clotting risk, in particular, which correlated with an increasing trend of providing thromboprophylaxis and anticoagulation therapy to patients with COVID-19 in our tertiary center. Conclusions: We described a correlation of local change in clinical practice with worldwide online dialogue and digital search trends that influenced individual clinicians, prior to the publication of formal guidelines or a local quality-improvement intervention. %M 34292865 %R 10.2196/21817 %U https://formative.jmir.org/2021/8/e21817 %U https://doi.org/10.2196/21817 %U http://www.ncbi.nlm.nih.gov/pubmed/34292865 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 8 %P e29957 %T Exploring the Utility of Google Mobility Data During the COVID-19 Pandemic in India: Digital Epidemiological Analysis %A Kishore,Kamal %A Jaswal,Vidushi %A Verma,Madhur %A Koushal,Vipin %+ All India Institute of Medical Sciences, Jodhpur Romana Road, Bathinda, 151001, India, 91 9466445513, drmadhurverma@gmail.com %K COVID-19 %K lockdown %K nonpharmaceutical Interventions %K social distancing %K digital surveillance %K Google Community Mobility Reports %K community mobility %D 2021 %7 30.8.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Association between human mobility and disease transmission has been established for COVID-19, but quantifying the levels of mobility over large geographical areas is difficult. Google has released Community Mobility Reports (CMRs) containing data about the movement of people, collated from mobile devices. Objective: The aim of this study is to explore the use of CMRs to assess the role of mobility in spreading COVID-19 infection in India. Methods: In this ecological study, we analyzed CMRs to determine human mobility between March and October 2020. The data were compared for the phases before the lockdown (between March 14 and 25, 2020), during lockdown (March 25-June 7, 2020), and after the lockdown (June 8-October 15, 2020) with the reference periods (ie, January 3-February 6, 2020). Another data set depicting the burden of COVID-19 as per various disease severity indicators was derived from a crowdsourced API. The relationship between the two data sets was investigated using the Kendall tau correlation to depict the correlation between mobility and disease severity. Results: At the national level, mobility decreased from –38% to –77% for all areas but residential (which showed an increase of 24.6%) during the lockdown compared to the reference period. At the beginning of the unlock phase, the state of Sikkim (minimum cases: 7) with a –60% reduction in mobility depicted more mobility compared to –82% in Maharashtra (maximum cases: 1.59 million). Residential mobility was negatively correlated (–0.05 to –0.91) with all other measures of mobility. The magnitude of the correlations for intramobility indicators was comparatively low for the lockdown phase (correlation ≥0.5 for 12 indicators) compared to the other phases (correlation ≥0.5 for 45 and 18 indicators in the prelockdown and unlock phases, respectively). A high correlation coefficient between epidemiological and mobility indicators was observed for the lockdown and unlock phases compared to the prelockdown phase. Conclusions: Mobile-based open-source mobility data can be used to assess the effectiveness of social distancing in mitigating disease spread. CMR data depicted an association between mobility and disease severity, and we suggest using this technique to supplement future COVID-19 surveillance. %M 34174780 %R 10.2196/29957 %U https://publichealth.jmir.org/2021/8/e29957 %U https://doi.org/10.2196/29957 %U http://www.ncbi.nlm.nih.gov/pubmed/34174780 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 4 %N 3 %P e25873 %T Analysis of Social Determinants and the Utilization of Pediatric Tele–Urgent Care During the COVID-19 Pandemic: Cross-sectional Study %A Khairat,Saif %A McDaniel,Phillip %A Jansen,Matthew %A Francis,Tia %A Edson,Barbara %A Gianforcaro,Robert %+ Cecil G. Sheps Center for Health Services Research, 725 M.L.K. Jr Blvd, Chapel Hill, NC, 27516, United States, 1 9198435413, saif@unc.edu %K telehealth %K pediatrics %K social %K determinants %K COVID-19 %K use %K children %K infant %K consultation %K telemedicine %K urgent care %K vulnerable population %K cross-sectional %K minority %D 2021 %7 30.8.2021 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Telehealth is increasingly used to provide specialty consultations to infants and children receiving care. However, there is uncertainty if the COVID-19 pandemic has influenced the use of telehealth among vulnerable populations. Objective: This research aims to compare the overall use of tele–urgent care visits for pediatric patients before and after the pandemic, especially among vulnerable populations. Methods: We conducted a cross-sectional analysis of pediatric tele–urgent care visits at a virtual care center at a southeastern health care center. The main outcome of this study was the use of pediatrics tele–urgent visits across geographical regions with different levels of social disparities and between 2019 and 2020. Results: Of 584 tele–urgent care visits, 388 (66.4%) visits occurred in 2020 during the pandemic compared to 196 (33.6%) visits in 2019. Among 808 North Carolina zip codes, 181 (22%) consisted of a high concentration of vulnerable populations, where 17.7% (56/317) of the tele–urgent care visits originated from. The majority (215/317, 67.8%) of tele–urgent care visits originated from zip codes with a low concentration of vulnerable populations. There was a significant association between the rate of COVID-19 cases and the concentration level of social factors in a given Zip Code Tabulation Area. Conclusions: The use of tele–urgent care visits for pediatric care doubled during the COVID-19 pandemic. The majority of the tele–urgent care visits after COVID-19 originated from regions where there is a low presence of vulnerable populations. In addition, our geospatial analysis found that geographic regions with a high concentration of vulnerable populations had a significantly higher rate of COVID-19–confirmed cases and deaths compared to regions with a low concentration of vulnerable populations. %M 34459742 %R 10.2196/25873 %U https://pediatrics.jmir.org/2021/3/e25873 %U https://doi.org/10.2196/25873 %U http://www.ncbi.nlm.nih.gov/pubmed/34459742 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 8 %P e30164 %T Association of COVID-19 Risk Misperceptions With Household Isolation in the United States: Survey Study %A Ladapo,Joseph A %A Rothwell,Jonathan T %A Ramirez,Christina M %+ Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California, Los Angeles, 1100 Glendon Ave, Suite 850, Los Angeles, CA, 90024, United States, 1 3107942728, jladapo@mednet.ucla.edu %K COVID-19 %K pandemic %K mental health %K public health %K isolation %K loneliness %K guideline %K risk %K perception %K United States %K health risk %K well-being %D 2021 %7 30.8.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Adverse mental and emotional health outcomes are increasingly recognized as a public health challenge associated with the COVID-19 pandemic. Objective: The goal of this study was to examine the association of COVID-19 risk misperceptions with self-reported household isolation, a potential risk factor for social isolation and loneliness. Methods: We analyzed data from the Franklin Templeton-Gallup Economics of Recovery Study (July to December 2020) of 24,649 US adults. We also analyzed data from the Gallup Panel (March 2020 to February 2021), which included 123,516 observations about loneliness. The primary outcome was self-reported household isolation, which we defined as a respondent having no contact or very little contact with people outside their household, analogous to quarantining. Results: From July to December 2020, 53% to 57% of respondents reported living in household isolation. Most participants reported beliefs about COVID-19 health risks that were inaccurate, and overestimation of health risk was most common. For example, while deaths in persons younger than 55 years old accounted for 7% of total US deaths, respondents estimated that this population represented 43% of deaths. Overestimating COVID-19 health risks was associated with increased self-reported household isolation, with percentage differences ranging from 5.6 to 11.8 (P<.001 at each time point). Characteristics associated with self-reported household isolation from the July and August 2020 surveys and persisting in the December 2020 survey included younger age (18 to 39 years), having a serious medical condition, having a household member with a serious medical condition, and identifying as a Democrat. In the Gallup Panel, self-reported household isolation was associated with a higher prevalence of loneliness. Conclusions: Pandemic-related harms to emotional and mental well-being may be attenuated by reducing risk overestimation and household isolation preferences that exceed public health guidelines. %M 34253507 %R 10.2196/30164 %U https://formative.jmir.org/2021/8/e30164 %U https://doi.org/10.2196/30164 %U http://www.ncbi.nlm.nih.gov/pubmed/34253507 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 8 %P e28169 %T The COVID-19 Citizen Science Study: Protocol for a Longitudinal Digital Health Cohort Study %A Beatty,Alexis L %A Peyser,Noah D %A Butcher,Xochitl E %A Carton,Thomas W %A Olgin,Jeffrey E %A Pletcher,Mark J %A Marcus,Gregory M %+ Division of Cardiology, University of California, San Francisco, 505 Parnassus Ave, San Francisco, CA, 94117, United States, 1 415 476 3450, greg.marcus@ucsf.edu %K COVID-19 %K digital technology %K participant engagement %K electronic health records %K mobile app %K mHealth %K digital health %D 2021 %7 30.8.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: The COVID-19 pandemic has catalyzed a global public response and innovation in clinical study methods. Objective: The COVID-19 Citizen Science study was designed to generate knowledge about participant-reported COVID-19 symptoms, behaviors, and disease occurrence. Methods: COVID-19 Citizen Science is a longitudinal cohort study launched on March 26, 2020, on the Eureka Research Platform. This study illustrates important advances in digital clinical studies, including entirely digital study participation, targeted recruitment strategies, electronic consent, recurrent and time-updated assessments, integration with smartphone-based measurements, analytics for recruitment and engagement, connection with partner studies, novel engagement strategies such as participant-proposed questions, and feedback in the form of real-time results to participants. Results: As of February 2021, the study has enrolled over 50,000 participants. Study enrollment and participation are ongoing. Over the lifetime of the study, an average of 59% of participants have completed at least one survey in the past 4 weeks. Conclusions: Insights about COVID-19 symptoms, behaviors, and disease occurrence can be drawn through digital clinical studies. Continued innovation in digital clinical study methods represents the future of clinical research. International Registered Report Identifier (IRRID): DERR1-10.2196/28169 %M 34310336 %R 10.2196/28169 %U https://www.researchprotocols.org/2021/8/e28169 %U https://doi.org/10.2196/28169 %U http://www.ncbi.nlm.nih.gov/pubmed/34310336 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 8 %P e30715 %T Exploring the Expression Differences Between Professionals and Laypeople Toward the COVID-19 Vaccine: Text Mining Approach %A Luo,Chen %A Ji,Kaiyuan %A Tang,Yulong %A Du,Zhiyuan %+ Institute of Communication Studies, Communication University of China, No 1 Dingfuzhuang East Street, Chaoyang District, Beijing, 100024, China, 86 13217810927, longbao0927@163.com %K COVID-19 %K vaccine %K Zhihu %K structural topic modeling %K medical professional %K laypeople %K adverse reactions %K vaccination %K vaccine effectiveness %K vaccine development %D 2021 %7 27.8.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: COVID-19 is still rampant all over the world. Until now, the COVID-19 vaccine is the most promising measure to subdue contagion and achieve herd immunity. However, public vaccination intention is suboptimal. A clear division lies between medical professionals and laypeople. While most professionals eagerly promote the vaccination campaign, some laypeople exude suspicion, hesitancy, and even opposition toward COVID-19 vaccines. Objective: This study aims to employ a text mining approach to examine expression differences and thematic disparities between the professionals and laypeople within the COVID-19 vaccine context. Methods: We collected 3196 answers under 65 filtered questions concerning the COVID-19 vaccine from the China-based question and answer forum Zhihu. The questions were classified into 5 categories depending on their contents and description: adverse reactions, vaccination, vaccine effectiveness, social implications of vaccine, and vaccine development. Respondents were also manually coded into two groups: professional and laypeople. Automated text analysis was performed to calculate fundamental expression characteristics of the 2 groups, including answer length, attitude distribution, and high-frequency words. Furthermore, structural topic modeling (STM), as a cutting-edge branch in the topic modeling family, was used to extract topics under each question category, and thematic disparities were evaluated between the 2 groups. Results: Laypeople are more prevailing in the COVID-19 vaccine–related discussion. Regarding differences in expression characteristics, the professionals posted longer answers and showed a conservative stance toward vaccine effectiveness than did laypeople. Laypeople mentioned countries more frequently, while professionals were inclined to raise medical jargon. STM discloses prominent topics under each question category. Statistical analysis revealed that laypeople preferred the “safety of Chinese-made vaccine” topic and other vaccine-related issues in other countries. However, the professionals paid more attention to medical principles and professional standards underlying the COVID-19 vaccine. With respect to topics associated with the social implications of vaccines, the 2 groups showed no significant difference. Conclusions: Our findings indicate that laypeople and professionals share some common grounds but also hold divergent focuses toward the COVID-19 vaccine issue. These incongruities can be summarized as “qualitatively different” in perspective rather than “quantitatively different” in scientific knowledge. Among those questions closely associated with medical expertise, the “qualitatively different” characteristic is quite conspicuous. This study boosts the current understanding of how the public perceives the COVID-19 vaccine, in a more nuanced way. Web-based question and answer forums are a bonanza for examining perception discrepancies among various identities. STM further exhibits unique strengths over the traditional topic modeling method in statistically testing the topic preference of diverse groups. Public health practitioners should be keenly aware of the cognitive differences between professionals and laypeople, and pay special attention to the topics with significant inconsistency across groups to build consensus and promote vaccination effectively. %M 34346885 %R 10.2196/30715 %U https://www.jmir.org/2021/8/e30715 %U https://doi.org/10.2196/30715 %U http://www.ncbi.nlm.nih.gov/pubmed/34346885 %0 Journal Article %@ 2563-6316 %I JMIR Publications %V 2 %N 3 %P e29062 %T Utility of the ROX Index in Predicting Intubation for Patients With COVID-19–Related Hypoxemic Respiratory Failure Receiving High-Flow Nasal Therapy: Retrospective Cohort Study %A Patel,Maulin %A Chowdhury,Junad %A Mills,Nicole %A Marron,Robert %A Gangemi,Andrew %A Dorey-Stein,Zachariah %A Yousef,Ibraheem %A Zheng,Matthew %A Tragesser,Lauren %A Giurintano,Julie %A Gupta,Rohit %A Rali,Parth %A D'Alonzo,Gilbert %A Zhao,Huaqing %A Patlakh,Nicole %A Marchetti,Nathaniel %A Criner,Gerard %A Gordon,Matthew %+ Department of Thoracic Medicine and Surgery, Temple University Hospital, 3401 N Broad St, Philadelphia, PA, 19140, United States, 1 7327661029, maulin.patel@tuhs.temple.edu %K respiratory %K medicine %K nasal therapy %K COVID-19 %K mechanical ventilation %K ventilators %K mortality %K morbidity %K intubation %D 2021 %7 27.8.2021 %9 Original Paper %J JMIRx Med %G English %X Background: The use of high-flow nasal therapy (HFNT) to treat COVID-19 pneumonia has been greatly debated around the world due to concerns about increased health care worker transmission and delays in invasive mechanical ventilation (IMV). Herein, we analyzed the utility of the noninvasive ROX (ratio of oxygen saturation) index to predict the need for and timing of IMV. Objective: This study aimed to assess whether the ROX index can be a useful score to predict intubation and IMV in patients receiving HFNT as treatment for COVID-19–related hypoxemic respiratory failure. Methods: This is a retrospective cohort analysis of 129 consecutive patients with COVID-19 admitted to Temple University Hospital in Philadelphia, PA, from March 10, 2020, to May 17, 2020. This is a single-center study conducted in designated COVID-19 units (intensive care unit and other wards) at Temple University Hospital. Patients with moderate and severe hypoxemic respiratory failure treated with HFNT were included in the study. HFNT patients were divided into two groups: HFNT only and intubation (ie, patients who progressed from HFNT to IMV). The primary outcome was the value of the ROX index in predicting the need for IMV. Secondary outcomes were mortality, rate of intubation, length of stay, and rate of nosocomial infections in a cohort treated initially with HFNT. Results: Of the 837 patients with COVID-19, 129 met the inclusion criteria. The mean age was 60.8 (SD 13.6) years, mean BMI was 32.6 (SD 8) kg/m², 58 (45%) were female, 72 (55.8%) were African American, 40 (31%) were Hispanic, and 48 (37.2%) were nonsmokers. The mean time to intubation was 2.5 (SD 3.3) days. An ROX index value of less than 5 at HFNT initiation was suggestive of progression to IMV (odds ratio [OR] 2.137, P=.052). Any further decrease in ROX index value after HFNT initiation was predictive of intubation (OR 14.67, P<.001). Mortality was 11.2% (n=10) in the HFNT-only group versus 47.5% (n=19) in the intubation group (P<.001). Mortality and need for pulmonary vasodilators were higher in the intubation group. Conclusions: The ROX index helps decide which patients need IMV and may limit eventual morbidity and mortality associated with the progression to IMV. %M 34548669 %R 10.2196/29062 %U https://med.jmirx.org/2021/3/e29062 %U https://doi.org/10.2196/29062 %U http://www.ncbi.nlm.nih.gov/pubmed/34548669 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 9 %N 8 %P e27977 %T Factors to Effective Telemedicine Visits During the COVID-19 Pandemic: Cohort Study %A Gmunder,Kristin Nicole %A Ruiz,Jose W %A Franceschi,Dido %A Suarez,Maritza M %+ University of Miami Miller School of Medicine, 1600 NW 10th Ave #1140, Miami, FL, 33136, United States, 1 908 635 9107, kgmunder@med.miami.edu %K telemedicine %K COVID-19 %K patient portals %K delivery of health care %K telehealth %K pandemic %K digital health %D 2021 %7 27.8.2021 %9 Original Paper %J JMIR Med Inform %G English %X Background: With COVID-19 there was a rapid and abrupt rise in telemedicine implementation often without sufficient time for providers or patients to adapt. As telemedicine visits are likely to continue to play an important role in health care, it is crucial to strive for a better understanding of how to ensure completed telemedicine visits in our health system. Awareness of these barriers to effective telemedicine visits is necessary for a proactive approach to addressing issues. Objective: The objective of this study was to identify variables that may affect telemedicine visit completion in order to determine actions that can be enacted across the entire health system to benefit all patients. Methods: Data were collected from scheduled telemedicine visits (n=362,764) at the University of Miami Health System (UHealth) between March 1, 2020 and October 31, 2020. Descriptive statistics, mixed effects logistic regression, and random forest modeling were used to identify the most important patient-agnostic predictors of telemedicine completion. Results: Using descriptive statistics, struggling telemedicine specialties, providers, and clinic locations were identified. Through mixed effects logistic regression (adjusting for clustering at the clinic site level), the most important predictors of completion included previsit phone call/SMS text message reminder status (confirmed vs not answered) (odds ratio [OR] 6.599, 95% CI 6.483-6.717), MyUHealthChart patient portal status (not activated vs activated) (OR 0.315, 95% CI 0.305-0.325), provider’s specialty (primary care vs medical specialty) (OR 1.514, 95% CI 1.472-1.558), new to the UHealth system (yes vs no) (OR 1.285, 95% CI 1.201-1.374), and new to provider (yes vs no) (OR 0.875, 95% CI 0.859-0.891). Random forest modeling results mirrored those from logistic regression. Conclusions: The highest association with a completed telemedicine visit was the previsit appointment confirmation by the patient via phone call/SMS text message. An active patient portal account was the second strongest variable associated with completion, which underscored the importance of patients having set up their portal account before the telemedicine visit. Provider’s specialty was the third strongest patient-agnostic characteristic associated with telemedicine completion rate. Telemedicine will likely continue to have an integral role in health care, and these results should be used as an important guide to improvement efforts. As a first step toward increasing completion rates, health care systems should focus on improvement of patient portal usage and use of previsit reminders. Optimization and intervention are necessary for those that are struggling with implementing telemedicine. We advise setting up a standardized workflow for staff. %M 34254936 %R 10.2196/27977 %U https://medinform.jmir.org/2021/8/e27977 %U https://doi.org/10.2196/27977 %U http://www.ncbi.nlm.nih.gov/pubmed/34254936 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 1 %N 1 %P e26895 %T Public Attitudes and Factors of COVID-19 Testing Hesitancy in the United Kingdom and China: Comparative Infodemiology Study %A Lin,Leesa %A Song,Yi %A Wang,Qian %A Pu,Jialu %A Sun,Fiona Yueqian %A Zhang,Yixuan %A Zhou,Xinyu %A Larson,Heidi J %A Hou,Zhiyuan %+ School of Public Health, Fudan University, 130 Dong’an Road, Shanghai, 200032, China, 86 2133563935, zyhou@fudan.edu.cn %K COVID-19 %K test %K public response %K sentiment %K social listening %K United Kingdom %K China %D 2021 %7 27.8.2021 %9 Original Paper %J JMIR Infodemiology %G English %X Background: Massive community-wide testing has become the cornerstone of management strategies for the COVID-19 pandemic. Objective: This study was a comparative analysis between the United Kingdom and China, which aimed to assess public attitudes and uptake regarding COVID-19 testing, with a focus on factors of COVID-19 testing hesitancy, including effectiveness, access, risk perception, and communication. Methods: We collected and manually coded 3856 UK tweets and 9299 Chinese Sina Weibo posts mentioning COVID-19 testing from June 1 to July 15, 2020. Adapted from the World Health Organization’s 3C Model of Vaccine Hesitancy, we employed social listening analysis examining key factors of COVID-19 testing hesitancy (confidence, complacency, convenience, and communication). Descriptive analysis, time trends, geographical mapping, and chi-squared tests were performed to assess the temporal, spatial, and sociodemographic characteristics that determine the difference in attitudes or uptake of COVID-19 tests. Results: The UK tweets demonstrated a higher percentage of support toward COVID-19 testing than the posts from China. There were much wider reports of public uptake of COVID-19 tests in mainland China than in the United Kingdom; however, uncomfortable experiences and logistical barriers to testing were more expressed in China. The driving forces for undergoing COVID-19 testing were personal health needs, community-wide testing, and mandatory testing policies for travel, with major differences in the ranking order between the two countries. Rumors and information inquiries about COVID-19 testing were also identified. Conclusions: Public attitudes and acceptance toward COVID-19 testing constantly evolve with local epidemic situations. Policies and information campaigns that emphasize the importance of timely testing and rapid communication responses to inquiries and rumors, and provide a supportive environment for accessing tests are key to tackling COVID-19 testing hesitancy and increasing uptake. %M 34541460 %R 10.2196/26895 %U https://infodemiology.jmir.org/2021/1/e26895 %U https://doi.org/10.2196/26895 %U http://www.ncbi.nlm.nih.gov/pubmed/34541460 %0 Journal Article %@ 2563-6316 %I JMIR Publications %V 2 %N 3 %P e28843 %T Risk Factors of SARS-CoV-2 Infection: Global Epidemiological Study %A Barletta,William Alphonse %+ Department of Physics, Massachusetts Institute of Technology, 77 Massachusetts Avenue, Cambridge, MA, 02142, United States, 1 510 282 0240, barletta@mit.edu %K COVID-19 %K pandemic %K public health %K mortality %K infection %K risk %K risk factors %K age %K epidemiology %K infectious disease %D 2021 %7 26.8.2021 %9 Original Paper %J JMIRx Med %G English %X Background: Since the first recognition of the pandemic characteristics of SARS-CoV-2 infection, and before substantial case fatality data were available worldwide, public health agencies warned the public about the increased dangers of SARS-CoV-2 to persons with a variety of underlying physical conditions, many of which are more commonly found in persons over 50 years of age or in certain ethnic groups. Objective: To investigate the statistical rather than the physiological basis in support of the abovementioned warnings, this study examines correlations globally on a nation-by-nation basis between the statistical data concerning COVID-19 fatalities and the statistics of potential comorbidities that may influence the severity of infection. Methods: This study considers the statistics describing the populations of the 99 countries with the greatest numbers of SARS-CoV-2 infections at the time of the data cutoff. As national compilations of direct measures of immune system strength are not publicly available, the frequency of fatalities in those countries due to a variety of serious diseases is used as a proxy for the susceptibility of those populations to those same diseases. Results: The analysis produces plots and calculations of correlations and cross-correlations of COVID-19 case fatality rates and the risks of other potential cofactors. It exposes some reasons that may underlie the degree to which advanced age increases the risk of mortality of infection with SARS-CoV-2. In contrast with the strong influences of comorbidities on the seriousness of consequences of influenzas and their associated pneumonias, the correlations of the same set of risk factors with SARS-CoV-2 infection are considerably weaker. The general characteristics of the observed correlations strengthened through 3 cycles of analysis, starting in September 2020. The strongest correlations were with chronic kidney disease and coronary disease (approximately 0.28 and 0.20, respectively). Conclusions: This study confirms early clinical observations that infection with SARS-CoV-2 presents an increased risk to persons over the age of 65 years. It does not support the suggestions presented by government agencies early in the pandemic that the risks are much greater for persons with certain common potential comorbidities. %M 34547061 %R 10.2196/28843 %U https://med.jmirx.org/2021/3/e28843 %U https://doi.org/10.2196/28843 %U http://www.ncbi.nlm.nih.gov/pubmed/34547061 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 8 %P e24181 %T Implementation of Digital Monitoring Services During the COVID-19 Pandemic for Patients With Chronic Diseases: Design Science Approach %A Lapão,Luís Velez %A Peyroteo,Mariana %A Maia,Melanie %A Seixas,Jorge %A Gregório,João %A Mira da Silva,Miguel %A Heleno,Bruno %A Correia,Jorge César %+ Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Rua da Junqueira, 100, Lisbon, 1349-008, Portugal, 351 213652600, luis.lapao@ihmt.unl.pt %K primary healthcare %K information systems %K telemedicine %K implementation %K design science research %K COVID-19 %K monitoring %K chronic disease %K elderly %K digital health %D 2021 %7 26.8.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic is straining health systems and disrupting the delivery of health care services, in particular, for older adults and people with chronic conditions, who are particularly vulnerable to COVID-19 infection. Objective: The aim of this project was to support primary health care provision with a digital health platform that will allow primary care physicians and nurses to remotely manage the care of patients with chronic diseases or COVID-19 infections. Methods: For the rapid design and implementation of a digital platform to support primary health care services, we followed the Design Science implementation framework: (1) problem identification and motivation, (2) definition of the objectives aligned with goal-oriented care, (3) artefact design and development based on Scrum, (4) solution demonstration, (5) evaluation, and (6) communication. Results: The digital platform was developed for the specific objectives of the project and successfully piloted in 3 primary health care centers in the Lisbon Health Region. Health professionals (n=53) were able to remotely manage their first patients safely and thoroughly, with high degrees of satisfaction. Conclusions: Although still in the first steps of implementation, its positive uptake, by both health care providers and patients, is a promising result. There were several limitations including the low number of participating health care units. Further research is planned to deploy the platform to many more primary health care centers and evaluate the impact on patient’s health related outcomes. %M 34313591 %R 10.2196/24181 %U https://www.jmir.org/2021/8/e24181 %U https://doi.org/10.2196/24181 %U http://www.ncbi.nlm.nih.gov/pubmed/34313591 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 8 %P e27681 %T Development of a COVID-19 Web Information Transmission Structure Based on a Quadruple Helix Model: Webometric Network Approach Using Bing %A Zhu,Yu Peng %A Park,Han Woo %+ Department of Media and Communication, Yeungnam University, 214-1 Dae-dong, Gyeongsan-si, Republic of Korea, 82 53 810 2275, hanpark@ynu.ac.kr %K quadruple helix model %K COVID-19 %K structural analysis %K content analysis %K network analysis %K public health %K webometrics %K infodemiology %K infoveillance %K development %K internet %K online health information %K structure %K communication %K big data %D 2021 %7 26.8.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Developing an understanding of the social structure and phenomenon of pandemic information sources worldwide is immensely significant. Objective: Based on the quadruple helix model, the aim of this study was to construct and analyze the structure and content of the internet information sources regarding the COVID-19 pandemic, considering time and space. The broader goal was to determine the status and limitations of web information transmission and online communication structure during public health emergencies. Methods: By sorting the second top-level domain, we divided the structure of network information sources into four levels: government, educational organizations, companies, and nonprofit organizations. We analyzed the structure of information sources and the evolution of information content at each stage using quadruple helix and network analysis methods. Results: The results of the structural analysis indicated that the online sources of information in Asia were more diverse than those in other regions in February 2020. As the pandemic spread in April, the information sources in non-Asian regions began to diversify, and the information source structure diversified further in July. With the spread of the pandemic, for an increasing number of countries, not only the government authorities of high concern but also commercial and educational organizations began to produce and provide significant amounts of information and advice. Nonprofit organizations also produced information, but to a lesser extent. The impact of the virus spread from the initial public level of the government to many levels within society. After April, the government’s role in the COVID-19 network information was central. The results of the content analysis showed that there was an increased focus on discussion regarding public health–related campaign materials at all stages. The information content changed with the changing stages. In the early stages, the basic situation regarding the virus and its impact on health attracted most of the attention. Later, the content was more focused on prevention. The business and policy environment also changed from the beginning of the pandemic, and the social changes caused by the pandemic became a popular discussion topic. Conclusions: For public health emergencies, some online and offline information sources may not be sufficient. Diversified institutions must pay attention to public health emergencies and actively respond to multihelical information sources. In terms of published messages, the educational sector plays an important role in public health events. However, educational institutions release less information than governments and businesses. This study proposes that the quadruple helix not only has research significance in the field of scientific cooperation but could also be used to perform effective research regarding web information during crises. This is significant for further development of the quadruple helix model in the medical internet research area. %M 34280119 %R 10.2196/27681 %U https://www.jmir.org/2021/8/e27681 %U https://doi.org/10.2196/27681 %U http://www.ncbi.nlm.nih.gov/pubmed/34280119 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 8 %P e30610 %T Psychosomatic Rehabilitation Patients and the General Population During COVID-19: Online Cross-sectional and Longitudinal Study of Digital Trainings and Rehabilitation Effects %A Keller,Franziska Maria %A Dahmen,Alina %A Derksen,Christina %A Kötting,Lukas %A Lippke,Sonia %+ Department of Psychology & Methods, Jacobs University Bremen gGmbH, Campus Ring 1, Bremen, 28759, Germany, 49 421200 ext 4730, s.lippke@jacobs-university.de %K mental health %K COVID-19 %K medical rehabilitation %K psychosomatic rehabilitation %K internet-delivered digital trainings %D 2021 %7 26.8.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: The COVID-19 pandemic has largely affected people’s mental health and psychological well-being. Specifically, individuals with a pre-existing mental health disorder seem more impaired by lockdown measures posing as major stress factors. Medical rehabilitation treatment can help people cope with these stressors. The internet and digital apps provide a platform to contribute to regular treatment and to conduct research on this topic. Objective: Making use of internet-based assessments, this study investigated individuals from the general population and patients from medical, psychosomatic rehabilitation clinics. Levels of depression, anxiety, loneliness, and perceived stress during the COVID-19 pandemic, common COVID-19–related worries, and the intention to use digital apps were compared. Furthermore, we investigated whether participating in internet-delivered digital trainings prior to and during patients’ rehabilitation stay, as well as the perceived usefulness of digital trainings, were associated with improved mental health after rehabilitation. Methods: A large-scale, online, cross-sectional study was conducted among a study sample taken from the general population (N=1812) in Germany from May 2020 to April 2021. Further, a longitudinal study was conducted making use of the internet among a second study sample of psychosomatic rehabilitation patients at two measurement time points—before (N=1719) and after (n=738) rehabilitation—between July 2020 and April 2021. Validated questionnaires and adapted items were used to assess mental health and COVID-19–related worries. Digital trainings were evaluated. Propensity score matching, multivariate analyses of covariance, an exploratory factor analysis, and hierarchical regression analyses were performed. Results: Patients from the psychosomatic rehabilitation clinics reported increased symptoms with regard to depression, anxiety, loneliness, and stress (F4,2028=183.74, P<.001, η2p=0.27) compared to the general population. Patients perceived greater satisfaction in communication with health care professionals (F1,837=31.67, P<.001, η2p=0.04), had lower financial worries (F1,837=38.96, P<.001, η2p=0.04), but had higher household-related worries (F1,837=5.34, P=.02, η2p=0.01) compared to the general population. Symptoms of depression, anxiety, loneliness, and perceived stress were lower postrehabilitation (F1,712=23.21, P<.001, η2p=0.04) than prior to rehabilitation. Psychosomatic patients reported a higher intention to use common apps and digital trainings (F3,2021=51.41, P<.001, η2p=0.07) than the general population. With regard to digital trainings offered prior to and during the rehabilitation stay, the perceived usefulness of digital trainings on rehabilitation goals was associated with decreased symptoms of depression (β=–.14, P<.001), anxiety (β=–.12, P<.001), loneliness (β=–.18, P<.001), and stress postrehabilitation (β=–.19, P<.001). Participation in digital group therapy for depression was associated with an overall change in depression (F1,725=4.82, P=.03, η2p=0.01) and anxiety (F1,725=6.22, P=.01, η2p=0.01) from pre- to postrehabilitation. Conclusions: This study validated the increased mental health constraints of psychosomatic rehabilitation patients in comparison to the general population and the effects of rehabilitation treatment. Digital rehabilitation components are promising tools that could prepare patients for their rehabilitation stay, could integrate well with face-to-face therapy during rehabilitation treatment, and could support aftercare. Trial Registration: ClinicalTrials.gov NCT04453475; https://clinicaltrials.gov/ct2/show/NCT04453475 and ClinicalTrials.gov NCT03855735; https://clinicaltrials.gov/ct2/show/NCT03855735 %M 34270444 %R 10.2196/30610 %U https://mental.jmir.org/2021/8/e30610 %U https://doi.org/10.2196/30610 %U http://www.ncbi.nlm.nih.gov/pubmed/34270444 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 8 %P e26604 %T Identifying Communities at Risk for COVID-19–Related Burden Across 500 US Cities and Within New York City: Unsupervised Learning of the Coprevalence of Health Indicators %A Deonarine,Andrew %A Lyons,Genevieve %A Lakhani,Chirag %A De Brouwer,Walter %+ XY.ai, 56 JFK Street, Cambridge, MA, 02138, United States, 1 8575000461, andrew@xy.ai %K COVID-19 %K satellite imagery %K built environment %K social determinants of health %K machine learning %K artificial intelligence %K community %K risk %K United States %K indicator %K comorbidity %K environment %K population %K determinant %K mortality %K prediction %D 2021 %7 26.8.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Although it is well-known that older individuals with certain comorbidities are at the highest risk for complications related to COVID-19 including hospitalization and death, we lack tools to identify communities at the highest risk with fine-grained spatial resolution. Information collected at a county level obscures local risk and complex interactions between clinical comorbidities, the built environment, population factors, and other social determinants of health. Objective: This study aims to develop a COVID-19 community risk score that summarizes complex disease prevalence together with age and sex, and compares the score to different social determinants of health indicators and built environment measures derived from satellite images using deep learning. Methods: We developed a robust COVID-19 community risk score (COVID-19 risk score) that summarizes the complex disease co-occurrences (using data for 2019) for individual census tracts with unsupervised learning, selected on the basis of their association with risk for COVID-19 complications such as death. We mapped the COVID-19 risk score to corresponding zip codes in New York City and associated the score with COVID-19–related death. We further modeled the variance of the COVID-19 risk score using satellite imagery and social determinants of health. Results: Using 2019 chronic disease data, the COVID-19 risk score described 85% of the variation in the co-occurrence of 15 diseases and health behaviors that are risk factors for COVID-19 complications among ~28,000 census tract neighborhoods (median population size of tracts 4091). The COVID-19 risk score was associated with a 40% greater risk for COVID-19–related death across New York City (April and September 2020) for a 1 SD change in the score (risk ratio for 1 SD change in COVID-19 risk score 1.4; P<.001) at the zip code level. Satellite imagery coupled with social determinants of health explain nearly 90% of the variance in the COVID-19 risk score in the United States in census tracts (r2=0.87). Conclusions: The COVID-19 risk score localizes risk at the census tract level and was able to predict COVID-19–related mortality in New York City. The built environment explained significant variations in the score, suggesting risk models could be enhanced with satellite imagery. %M 34280122 %R 10.2196/26604 %U https://publichealth.jmir.org/2021/8/e26604 %U https://doi.org/10.2196/26604 %U http://www.ncbi.nlm.nih.gov/pubmed/34280122 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 8 %P e29419 %T The Persistence of the Impact of COVID-19–Related Distress, Mood Inertia, and Loneliness on Mental Health During a Postlockdown Period in Germany: An Ecological Momentary Assessment Study %A Haucke,Matthias %A Liu,Shuyan %A Heinzel,Stephan %+ Department of Psychiatry and Psychotherapy, Charité – Universitätsmedizin Berlin, Campus Charité Mitte, Charitéplatz 1, Berlin, Germany, 49 30450517002, siyan908@hotmail.com %K COVID-19 %K outbreaks %K epidemics %K pandemics %K psychological responses and emotional well-being %K ecological momentary assessment %K risk and protective factors %K low incidence and restrictions %D 2021 %7 26.8.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: The first wave of the COVID-19 pandemic in early 2020 increased mental health problems globally. However, little is known about mental health problems during a low-incidence period of the pandemic without strict public health measures. Objective: We aim to investigate whether COVID-19–related risk factors for mental health problems persist beyond lockdown measures. We targeted a vulnerable population that is at risk of developing low mental health and assessed their daily dynamics of mood and emotion regulation after a strict lockdown. Methods: During a postlockdown period in Germany (between August 8, 2020, and November 1, 2020), we conducted an ecological momentary assessment with 131 participants who experienced at least mild COVID-19–related distress and loneliness. To estimate negative mood inertia, we built a lag-1 three-level autoregressive model. Results: We found that information exposure and active daily COVID-19 cases did not have an impact on negative mood amid a postlockdown period. However, there was a day-to-day carryover effect of negative mood. In addition, worrying about COVID-19, feeling restricted by COVID-19, and feeling lonely increased negative mood. Conclusions: The mental health of a vulnerable population is still challenged by COVID-19–related stressors after the lifting of a strict lockdown. This study highlights the need to protect mental health during postpandemic periods. %M 34347622 %R 10.2196/29419 %U https://mental.jmir.org/2021/8/e29419 %U https://doi.org/10.2196/29419 %U http://www.ncbi.nlm.nih.gov/pubmed/34347622 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 8 %P e26227 %T Satisfaction and Usability of an Information and Communications Technology–Based System by Clinically Healthy Patients With COVID-19 and Medical Professionals: Cross-sectional Survey and Focus Group Interview Study %A Bae,Ye Seul %A Kim,Kyung Hwan %A Choi,Sae Won %A Ko,Taehoon %A Lim,Jun Seo %A Piao,Meihua %+ Department of Thoracic & Cardiovascular Surgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea, 82 220727546, kkh726@snu.ac.kr %K COVID-19 %K mobile app %K telemedicine %K wearable device %K vital sign %K satisfaction %K usability %D 2021 %7 26.8.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital health care is an important strategy in the war against COVID-19. South Korea introduced living and treatment support centers (LTSCs) to control regional outbreaks and care for patients with asymptomatic or mild COVID-19. Seoul National University Hospital (SNUH) introduced information and communications technology (ICT)–based solutions to manage clinically healthy patients with COVID-19. Objective: This study aims to investigate satisfaction and usability by patients and health professionals in the optimal use of a mobile app and wearable device that SNUH introduced to the LTSC for clinically healthy patients with COVID-19. Methods: Online surveys and focus group interviews were conducted to collect quantitative and qualitative data. Results: Regarding usability testing of the wearable device, perceived usefulness had the highest mean score of 4.45 (SD 0.57) points out of 5. Regarding usability of the mobile app, perceived usefulness had the highest mean score of 4.62 (SD 0.48) points out of 5. Regarding satisfaction items for the mobile app among medical professionals, the “self-reporting” item had the highest mean score of 4.42 (SD 0.58) points out of 5. In focus group interviews of health care professionals, hospital information system interfacing was the most important functional requirement for ICT-based COVID-19 telemedicine. Conclusions: Improvement of patient safety and reduction of the burden on medical staff were the expected positive outcomes. Stability and reliability of the device, patient education, accountability, and reimbursement issues should be considered as part of the development of remote patient monitoring. In responding to a novel contagious disease, telemedicine and a wearable device were shown to be useful during a global crisis. %M 34254946 %R 10.2196/26227 %U https://formative.jmir.org/2021/8/e26227 %U https://doi.org/10.2196/26227 %U http://www.ncbi.nlm.nih.gov/pubmed/34254946 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 8 %P e30099 %T Evaluating the Impact of COVID-19 on the Adoption of Virtual Care in General Practice in 20 Countries (inSIGHT): Protocol and Rationale Study %A Neves,Ana Luísa %A Li,Edmond %A Serafini,Alice %A Jimenez,Geronimo %A Lingner,Heidrun %A Koskela,Tuomas H %A Hoffman,Robert D %A Collins,Claire %A Petek,Davorina %A Claveria,Ana %A Tsopra,Rosy %A Irving,Greg %A Gusso,Gustavo %A O’Neill,Braden Gregory %A Hoedebecke,Kyle %A Espitia,Sandra Milena %A Ungan,Mehmet %A Nessler,Katarzyna %A Lazic,Vanja %A Laranjo,Liliana %A Memarian,Ensieh %A Fernandez,Maria Jose %A Ghafur,Saira %A Fontana,Gianluca %A Majeed,Azeem %A Car,Josip %A Darzi,Ara %+ Institute of Global Health Innovation, Department of Surgery & Cancer, Faculty of Medicine, Imperial College London, Room 1035/7, QEQM Wing, St Mary’s Hospital Campus, London, W2 1NY, United Kingdom, 44 02033127259, ana.luisa.neves14@imperial.ac.uk %K primary care %K telemedicine %K virtual care %K digital-first models %K quality of care %K patient safety %D 2021 %7 26.8.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: In recent decades, virtual care has emerged as a promising option to support primary care delivery. However, despite the potential, adoption rates remained low. With the outbreak of COVID-19, it has suddenly been pushed to the forefront of care delivery. As we progress into the second year of the COVID-19 pandemic, there is a need and opportunity to review the impact remote care had in primary care settings and reassess its potential future role. Objective: This study aims to explore the perspectives of general practitioners (GPs) and family doctors on the (1) use of virtual care during the COVID-19 pandemic, (2) perceived impact on quality and safety of care, and (3) essential factors for high-quality and sustainable use of virtual care in the future. Methods: This study used an online cross-sectional questionnaire completed by GPs distributed across 20 countries. The survey was hosted in Qualtrics and distributed using email, social media, and the researchers’ personal contact networks. GPs were eligible for the survey if they were working mainly in primary care during the period of the COVID-19 pandemic. Descriptive statistical analysis will be performed for quantitative variables, and relationships between the use of virtual care and perceptions on impact on quality and safety of care and participants’ characteristics may be explored. Qualitative data (free-text responses) will be analyzed using framework analysis. Results: Data collection took place from June 2020 to September 2020. As of this manuscript’s submission, a total of 1605 GP respondents participated in the questionnaire. Further data analysis is currently ongoing. Conclusions: The study will provide a comprehensive overview of the availability of virtual care technologies, perceived impact on quality and safety of care, and essential factors for high-quality future use. In addition, a description of the underlying factors that influence this adoption and perceptions, in both individual GP and family doctor characteristics and the context in which they work, will be provided. While the COVID-19 pandemic may prove the first great stress test of the capabilities, capacity, and robustness of digital systems currently in use, remote care will likely remain an increasingly common approach in the future. There is an imperative to identify the main lessons from this unexpected transformation and use them to inform policy decisions and health service design. International Registered Report Identifier (IRRID): DERR1-10.2196/30099 %M 34292867 %R 10.2196/30099 %U https://www.researchprotocols.org/2021/8/e30099 %U https://doi.org/10.2196/30099 %U http://www.ncbi.nlm.nih.gov/pubmed/34292867 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 8 %P e28716 %T Changes in Public Response Associated With Various COVID-19 Restrictions in Ontario, Canada: Observational Infoveillance Study Using Social Media Time Series Data %A Chum,Antony %A Nielsen,Andrew %A Bellows,Zachary %A Farrell,Eddie %A Durette,Pierre-Nicolas %A Banda,Juan M %A Cupchik,Gerald %+ Department of Applied Health Sciences, Brock University, 1812 Sir Isaac Brock Way, St. Catharines, ON, L2S 3A1, Canada, 1 905 688 5550, antony.chum@gmail.com %K COVID-19 %K public opinion %K social media %K sentiment analysis %K public health restrictions %K infodemiology %K infoveillance %K coronavirus %K evaluation %D 2021 %7 25.8.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: News media coverage of antimask protests, COVID-19 conspiracies, and pandemic politicization has overemphasized extreme views but has done little to represent views of the general public. Investigating the public’s response to various pandemic restrictions can provide a more balanced assessment of current views, allowing policy makers to craft better public health messages in anticipation of poor reactions to controversial restrictions. Objective: Using data from social media, this infoveillance study aims to understand the changes in public opinion associated with the implementation of COVID-19 restrictions (eg, business and school closures, regional lockdown differences, and additional public health restrictions, such as social distancing and masking). Methods: COVID-19–related tweets in Ontario (n=1,150,362) were collected based on keywords between March 12 and October 31, 2020. Sentiment scores were calculated using the VADER (Valence Aware Dictionary and Sentiment Reasoner) algorithm for each tweet to represent its negative to positive emotion. Public health restrictions were identified using government and news media websites. Dynamic regression models with autoregressive integrated moving average errors were used to examine the association between public health restrictions and changes in public opinion over time (ie, collective attention, aggregate positive sentiment, and level of disagreement), controlling for the effects of confounders (ie, daily COVID-19 case counts, holidays, and COVID-19–related official updates). Results: In addition to expected direct effects (eg, business closures led to decreased positive sentiment and increased disagreements), the impact of restrictions on public opinion was contextually driven. For example, the negative sentiment associated with business closures was reduced with higher COVID-19 case counts. While school closures and other restrictions (eg, masking, social distancing, and travel restrictions) generated increased collective attention, they did not have an effect on aggregate sentiment or the level of disagreement (ie, sentiment polarization). Partial (ie, region-targeted) lockdowns were associated with better public response (ie, higher number of tweets with net positive sentiment and lower levels of disagreement) compared to province-wide lockdowns. Conclusions: Our study demonstrates the feasibility of a rapid and flexible method of evaluating the public response to pandemic restrictions using near real-time social media data. This information can help public health practitioners and policy makers anticipate public response to future pandemic restrictions and ensure adequate resources are dedicated to addressing increases in negative sentiment and levels of disagreement in the face of scientifically informed, but controversial, restrictions. %M 34227996 %R 10.2196/28716 %U https://www.jmir.org/2021/8/e28716 %U https://doi.org/10.2196/28716 %U http://www.ncbi.nlm.nih.gov/pubmed/34227996 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 8 %P e29923 %T Prosociality and the Uptake of COVID-19 Contact Tracing Apps: Survey Analysis of Intergenerational Differences in Japan %A Shoji,Masahiro %A Ito,Asei %A Cato,Susumu %A Iida,Takashi %A Ishida,Kenji %A Katsumata,Hiroto %A McElwain,Kenneth Mori %+ Institute of Social Science, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan, 81 3 5841 4927, shoji@iss.u-tokyo.ac.jp %K COVID-19 %K contact tracing app %K place attachment %K place identity %K contact tracing %K pandemic %K mHealth %K health policy %D 2021 %7 19.8.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: To control the COVID-19 pandemic, it is essential to trace and contain infection chains; for this reason, policymakers have endorsed the usage of contact tracing apps. To date, over 50 countries have released such apps officially or semiofficially, but those that rely on citizens’ voluntary uptake suffer from low adoption rates, reducing their effectiveness. Early studies suggest that the low uptake is driven by citizens’ concerns about security and privacy, as well as low perceptions of infection risk and benefits from the usage. However, these do not explore important generational differences in uptake decision or the association between individuals’ prosociality and uptake. Objective: The objective of our study was to examine the role of individuals’ prosociality and other factors discussed in the literature, such as perceived risk and trust in government, in encouraging the usage of contact tracing apps in Japan. We paid particular attention to generational differences. Methods: A web-based survey was conducted in Japan 6 months after the release of a government-sponsored contact tracing app. Participants were recruited from individuals aged between 20 and 69 years. Exploratory factor analyses were conducted to measure prosociality, risk perception, and trust in government. Logistic regression was used to examine the association between these factors and uptake. Results: There was a total of 7084 respondents, and observations from 5402 respondents were used for analysis, of which 791 respondents (14.6%) had ever used the app. Two factors of prosociality were retained: agreeableness and attachment to the community. Full-sample analysis demonstrated app uptake was determined by agreeableness, attachment to the community, concern about health risks, concern about social risks, and trust in the national government; however, important differences existed. The uptake decision of respondents aged between 20 and 39 years was attributed to their attachment to the community (odds ratio [OR] 1.28, 95% CI 1.11-1.48). Agreeable personality (OR 1.18, 95% CI 1.02-1.35), concern about social risk (OR 1.17, 95% CI 1.02-1.35), and trust in national government (OR 1.16, 95% CI 1.05-1.28) were key determinants for those aged between 40 and 59 years. For those aged over 60 years, concerns about health risks determined the uptake decision (OR 1.49, 95% CI 1.24-1.80). Conclusions: Policymakers should implement different interventions for each generation to increase the adoption rate of contact tracing apps. It may be effective to inform older adults about the health benefits of the apps. For middle-age adults, it is important to mitigate concerns about security and privacy issues, and for younger generations, it is necessary to boost their attachment to their community by utilizing social media and other web-based network tools. %M 34313601 %R 10.2196/29923 %U https://mhealth.jmir.org/2021/8/e29923 %U https://doi.org/10.2196/29923 %U http://www.ncbi.nlm.nih.gov/pubmed/34313601 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 8 %P e28736 %T Factors Associated With Psychological Disturbances During the COVID-19 Pandemic: Multicountry Online Study %A Plomecka,Martyna %A Gobbi,Susanna %A Neckels,Rachael %A Radzinski,Piotr %A Skorko,Beata %A Lazzeri,Samuel %A Almazidou,Kristina %A Dedic,Alisa %A Bakalovic,Asja %A Hrustic,Lejla %A Ashraf,Zainab %A Es Haghi,Sarvin %A Rodriguez-Pino,Luis %A Waller,Verena %A Jabeen,Hafsa %A Alp,A Beyza %A Behnam,Mehdi %A Shibli,Dana %A Baranczuk-Turska,Zofia %A Haq,Zeeshan %A Qureshi,Salah %A Strutt,Adriana M %A Jawaid,Ali %+ Center of Excellence for Neural Plasticity and Brain Disorders: BRAINCITY, Nencki Institute of Experimental Biology, Ludwika Pasteura 3, Warsaw, 02-093, Poland, 48 518892048, a.jawaid@nencki.edu.pl %K COVID-19 %K pandemic %K mental health %K depression %K posttraumatic stress disorder %K general psychological disturbance %K global %D 2021 %7 19.8.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: Accumulating evidence suggests that the COVID-19 pandemic has negatively impacted the mental health of individuals. However, the susceptibility of individuals to be impacted by the pandemic is variable, suggesting potential influences of specific factors related to participants’ demographics, attitudes, and practices. Objective: We aimed to identify the factors associated with psychological symptoms related to the effects of the first wave of the pandemic in a multicountry cohort of internet users. Methods: This study anonymously screened 13,332 internet users worldwide for acute psychological symptoms related to the COVID-19 pandemic from March 29 to April 14, 2020, during the first wave of the pandemic amidst strict lockdown conditions. A total of 12,817 responses were considered valid. Moreover, 1077 participants from Europe were screened a second time from May 15 to May 30, 2020, to ascertain the presence of psychological effects after the ease down of restrictions. Results: Female gender, pre-existing psychiatric conditions, and prior exposure to trauma were identified as notable factors associated with increased psychological symptoms during the first wave of COVID-19 (P<.001). The same factors, in addition to being related to someone who died due to COVID-19 and using social media more than usual, were associated with persistence of psychological disturbances in the limited second assessment of European participants after the restrictions had relatively eased (P<.001). Optimism, ability to share concerns with family and friends like usual, positive prediction about COVID-19, and daily exercise were related to fewer psychological symptoms in both assessments (P<.001). Conclusions: This study highlights the significant impact of the COVID-19 pandemic at the worldwide level on the mental health of internet users and elucidates prominent associations with their demographics, history of psychiatric disease risk factors, household conditions, certain personality traits, and attitudes toward COVID-19. %M 34254939 %R 10.2196/28736 %U https://mental.jmir.org/2021/8/e28736 %U https://doi.org/10.2196/28736 %U http://www.ncbi.nlm.nih.gov/pubmed/34254939 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 8 %N 3 %P e19946 %T Tele-Rehabilitation to Combat Rehabilitation Service Disruption During COVID-19 in Hong Kong: Observational Study %A Ku,Benny Pang Shing %A Tse,Ada Wai Shan %A Pang,Benny Chu Hang %A Cheung,Ngai Tseung %A Pang,Joanna Yuk Wa %A Chan,Joyce Ka Yin %A Hui,Hing Loi %A Chu,Dave %A Choi,Kevin Hoi Wa %+ Hospital Authority Information Technology and Health Informatics, Room 117N, 147B Argyle Street, Hospital Authority Building, Kowloon City, Hong Kong, 999077, Hong Kong, 852 23008503, adatse@ha.org.hk %K health information technology %K mobile app %K allied health %K tele-rehabilitation %K telehealth %K rehabilitation %K app %K COVID-19 %D 2021 %7 19.8.2021 %9 Original Paper %J JMIR Rehabil Assist Technol %G English %X Background: A tele-rehabilitation platform was developed to improve access to ambulatory rehabilitation services in Hong Kong. The development was completed in October 2019 and rolled out for use to occupational therapists, physiotherapists, and speech therapists. During the COVID-19 pandemic, rehabilitation services were severely interrupted. Tele-rehabilitation was used extensively to meet the demand for rehabilitation service delivery. Objective: The aims of this study were to (1) describe the design and development process of a tele-rehabilitation service, and (2) study how the tele-rehabilitation platform was used to overcome the disruption of rehabilitation service during the COVID-19 pandemic. Methods: Tele-rehabilitation was developed utilizing 4 core determinants of Unified Theory of Acceptance and Use of Technology as guiding principles. A generic prescription platform, called the activity-based prescription system, and a mobile app, called the Rehabilitation App, were built. Five outcomes were used to examine the utilization of tele-rehabilitation both before and during the pandemic: throughput, patient demographic, patient conditions, workforce, and satisfaction from patients and staff. Results: There was a tremendous increase in the use of tele-rehabilitation during pandemic. The total number of patients (up until July 2020) was 9101, and the main age range was between 51 to 70 years old. Tele-rehabilitation was used for a much wider scope of patient conditions than originally planned. More than 1112 therapists, which constituted 50.6% of the total workforce (1112/2196), prescribed tele-rehabilitation to their patients. Moreover, there was a high satisfaction rate from patients, with a mean rating of 4.2 out of 5, and a high adherence rate to prescribed rehabilitation activities (107840/131995, 81.7%). Conclusions: The findings of our study suggested that tele-rehabilitation in the form of a generic prescription platform and mobile app can be an effective means to provide rehabilitation to patient. During the COVID-19 pandemic, tele-rehabilitation has been used extensively and effectively to mitigate service disruption. Our findings also provide support that there is a high level of satisfaction with tele-rehabilitation; however, a longer duration study is required to demonstrate the sustained use of tele-rehabilitation, especially after the pandemic. %M 34254945 %R 10.2196/19946 %U https://rehab.jmir.org/2021/3/e19946 %U https://doi.org/10.2196/19946 %U http://www.ncbi.nlm.nih.gov/pubmed/34254945 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 8 %P e27892 %T The Roles of General Health and COVID-19 Proximity in Contact Tracing App Usage: Cross-sectional Survey Study %A Witteveen,Dirk %A de Pedraza,Pablo %+ European Commission, DG Joint Research Centre, Directorate I – Competences, Unit I.1 - Monitoring, Indicators and Impact Evaluation, Via E. Fermi 2749, TP 361, Ispra (VA), I-21027, Italy, 39 033278380, pablo.depedraza@ec.europa.eu %K COVID-19 %K contact tracing %K socioeconomic factors %K labor market status %K privacy %K data sharing %K pandemic %K mobile health %K public health %K smartphone %K mobile phone %D 2021 %7 18.8.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Contact tracing apps are considered useful means to monitor SARS-CoV-2 infections during the off-peak stages of the COVID-19 pandemic. Their effectiveness is, however, dependent on the uptake of such COVID-19 apps. Objective: We examined the role of individuals’ general health status in their willingness to use a COVID-19 tracing app as well as the roles of socioeconomic characteristics and COVID-19 proximity. Methods: We drew data from the WageIndicator Foundation Living and Working in Coronavirus Times survey. The survey collected data on labor market status as well as the potential confounders of the relationship between general health and COVID-19 tracing app usage, such as sociodemographics and regular smartphone usage data. The survey also contained information that allowed us to examine the role of COVID-19 proximity, such as whether an individual has contracted SARS-CoV-2, whether an individual has family members and colleagues with COVID-19, and whether an individual exhibits COVID-19 pandemic–induced depressive and anxiety symptoms. We selected data that were collected in Spain, Italy, Germany, and the Netherlands from individuals aged between 18 and 70 years (N=4504). Logistic regressions were used to measure individuals’ willingness to use a COVID-19 tracing app. Results: We found that the influence that socioeconomic factors have on COVID-19 tracing app usage varied dramatically between the four countries, although individuals experiencing forms of not being employed (ie, recent job loss and inactivity) consistently had a lower willingness to use a contact tracing app (effect size: 24.6%) compared to that of employees (effect size: 33.4%; P<.001). Among the selected COVID-19 proximity indicators, having a close family member with SARS-CoV-2 infection was associated with higher contact tracing app usage (effect size: 36.3% vs 27.1%; P<.001). After accounting for these proximity factors and the country-based variations therein, we found that having a poorer general health status was significantly associated with a much higher likelihood of contact tracing app usage; compared to a self-reported “very good” health status (estimated probability of contact tracing app use: 29.6%), the “good” (estimated probability: +4.6%; 95% CI 1.2%-8.1%) and “fair or bad” (estimated probability: +6.3%; 95% CI 2.3%-10.3%) health statuses were associated with a markedly higher willingness to use a COVID-19 tracing app. Conclusions: Current public health policies aim to promote the use of smartphone-based contact tracing apps during the off-peak periods of the COVID-19 pandemic. Campaigns that emphasize the health benefits of COVID-19 tracing apps may contribute the most to the uptake of such apps. Public health campaigns that rely on digital platforms would also benefit from seriously considering the country-specific distribution of privacy concerns. %M 34081602 %R 10.2196/27892 %U https://publichealth.jmir.org/2021/8/e27892 %U https://doi.org/10.2196/27892 %U http://www.ncbi.nlm.nih.gov/pubmed/34081602 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 8 %P e29029 %T Natural Language Processing Insight into LGBTQ+ Youth Mental Health During the COVID-19 Pandemic: Longitudinal Content Analysis of Anxiety-Provoking Topics and Trends in Emotion in LGBTeens Microcommunity Subreddit %A Stevens,Hannah R %A Acic,Irena %A Rhea,Sofia %+ Department of Communication, University of California, Davis, 1 Shields Ave, Davis, CA, 95616, United States, 1 530 752 0966, hrstevens@ucdavis.edu %K COVID-19 %K natural language processing %K LGBTQ+ %K mental health %K anxiety %K emotion %K coronavirus %K outbreak %D 2021 %7 17.8.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Widespread fear surrounding COVID-19, coupled with physical and social distancing orders, has caused severe adverse mental health outcomes. Little is known, however, about how the COVID-19 crisis has impacted LGBTQ+ youth, who disproportionately experienced a high rate of adverse mental health outcomes before the COVID-19 pandemic. Objective: We aimed to address this knowledge gap by harnessing natural language processing methodologies to investigate the evolution of conversation topics in the most popular subreddit for LGBTQ+ youth. Methods: We generated a data set of all r/LGBTeens subreddit posts (n=39,389) between January 1, 2020 and February 1, 2021 and analyzed meaningful trends in anxiety, anger, and sadness in the posts. Because the distribution of anxiety before widespread social distancing orders was meaningfully different from the distribution after (P<.001), we employed latent Dirichlet allocation to examine topics that provoked this shift in anxiety. Results: We did not find any differences in LGBTQ+ youth anger and sadness before and after government-mandated social distancing; however, anxiety increased significantly (P<.001). Further analysis revealed a list of 10 anxiety-provoking topics discussed during the pandemic: attraction to a friend, coming out, coming out to family, discrimination, education, exploring sexuality, gender pronouns, love and relationship advice, starting a new relationship, and struggling with mental health. Conclusions: During the COVID-19 pandemic, LGBTQ+ teens increased their reliance on anonymous discussion forums when discussing anxiety-provoking topics. LGBTQ+ teens likely perceived anonymous forums as safe spaces for discussing lifestyle stressors during COVID-19 disruptions (eg, school closures). The list of prevalent anxiety-provoking topics in LGBTQ+ teens’ anonymous discussions can inform future mental health interventions in LGBTQ+ youth. %M 34402803 %R 10.2196/29029 %U https://publichealth.jmir.org/2021/8/e29029 %U https://doi.org/10.2196/29029 %U http://www.ncbi.nlm.nih.gov/pubmed/34402803 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 8 %P e30453 %T Digital Orientation of Health Systems in the Post–COVID-19 “New Normal” in the United States: Cross-sectional Survey %A Khuntia,Jiban %A Ning,Xue %A Stacey,Rulon %+ CU Business School, University of Colorado Denver, 1475 Lawrence Street, Denver, CO, 80202, United States, 1 3038548024, jiban.khuntia@ucdenver.edu %K post–COVID-19 %K digital orientation %K health systems %K digital transformation %K digital health %K telehealth %K telemedicine %K COVID-19 %K impact %K insight %K cross-sectional %K survey %K United States %K electronic health record %K EHR %D 2021 %7 16.8.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Almost all health systems have developed some form of customer-facing digital technologies and have worked to align these systems to their existing electronic health records to accommodate the surge in remote and virtual care deliveries during the COVID-19 pandemic. Others have developed analytics-driven decision-making capabilities. However, it is not clear how health systems in the United States are embracing digital technologies and there is a gap in health systems’ abilities to integrate workflows with expanding technologies to spur innovation and futuristic growth. There is a lack of reliable and reported estimates of the current and futuristic digital orientations of health systems. Periodic assessments will provide imperatives to policy formulation and align efforts to yield the transformative power of emerging digital technologies. Objective: The aim of this study was to explore and examine differences in US health systems with respect to digital orientations in the post–COVID-19 “new normal” in 2021. Differences were assessed in four dimensions: (1) analytics-oriented digital technologies (AODT), (2) customer-oriented digital technologies (CODT), (3) growth and innovation–oriented digital technologies (GODT), and (4) futuristic and experimental digital technologies (FEDT). The former two dimensions are foundational to health systems’ digital orientation, whereas the latter two will prepare for future disruptions. Methods: We surveyed a robust group of health system chief executive officers (CEOs) across the United States from February to March 2021. Among the 625 CEOs, 135 (22%) responded to our survey. We considered the above four broad digital technology orientations, which were ratified with expert consensus. Secondary data were collected from the Agency for Healthcare Research and Quality Hospital Compendium, leading to a matched usable dataset of 124 health systems for analysis. We examined the relationship of adopting the four digital orientations to specific hospital characteristics and earlier reported factors as barriers or facilitators to technology adoption. Results: Health systems showed a lower level of CODT (mean 4.70) or GODT (mean 4.54) orientations compared with AODT (mean 5.03), and showed the lowest level of FEDT orientation (mean 4.31). The ordered logistic estimation results provided nuanced insights. Medium-sized (P<.001) health systems, major teaching health systems (P<.001), and systems with high-burden hospitals (P<.001) appear to be doing worse with respect to AODT orientations, raising some concerns. Health systems of medium (P<.001) and large (P=.02) sizes, major teaching health systems (P=.07), those with a high revenue (P=.05), and systems with high-burden hospitals (P<.001) have less CODT orientation. Health systems in the midwest (P=.05) and southern (P=.04) states are more likely to adopt GODT, whereas high-revenue (P=.004) and investor-ownership (P=.01) health systems are deterred from GODT. Health systems of a medium size, and those that are in the midwest (P<.001), south (P<.001), and west (P=.01) are more adept to FEDT, whereas medium (P<.001) and high-revenue (P<.001) health systems, and those with a high discharge rate (P=.04) or high burden (P=.003, P=.005) have subdued FEDT orientations. Conclusions: Almost all health systems have some current foundational digital technological orientations to glean intelligence or service delivery to customers, with some notable exceptions. Comparatively, fewer health systems have growth or futuristic digital orientations. The transformative power of digital technologies can only be leveraged by adopting futuristic digital technologies. Thus, the disparities across these orientations suggest that a holistic, consistent, and well-articulated direction across the United States remains elusive. Accordingly, we suggest that a policy strategy and financial incentives are necessary to spur a well-visioned and articulated digital orientation for all health systems across the United States. In the absence of such a policy to collectively leverage digital transformations, differences in care across the country will continue to be a concern. %M 34254947 %R 10.2196/30453 %U https://www.jmir.org/2021/8/e30453 %U https://doi.org/10.2196/30453 %U http://www.ncbi.nlm.nih.gov/pubmed/34254947 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 8 %P e29556 %T Digital Surveillance Through an Online Decision Support Tool for COVID-19 Over One Year of the Pandemic in Italy: Observational Study %A Tozzi,Alberto Eugenio %A Gesualdo,Francesco %A Urbani,Emanuele %A Sbenaglia,Alessandro %A Ascione,Roberto %A Procopio,Nicola %A Croci,Ileana %A Rizzo,Caterina %+ Multifactorial and Complex Diseases Research Area, Bambino Gesù Children's Hospital IRCCS, Piazza S. Onofrio, 4, Rome, 00165, Italy, 39 3388437474, francesco.gesualdo@opbg.net %K COVID-19 %K public health %K surveillance %K digital surveillance %K internet %K online decision support system %K decision support %K support %K online tool %K Italy %K observational %D 2021 %7 13.8.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Italy has experienced severe consequences (ie, hospitalizations and deaths) during the COVID-19 pandemic. Online decision support systems (DSS) and self-triage applications have been used in several settings to supplement health authority recommendations to prevent and manage COVID-19. A digital Italian health tech startup, Paginemediche, developed a noncommercial, online DSS with a chat user interface to assist individuals in Italy manage their potential exposure to COVID-19 and interpret their symptoms since early in the pandemic. Objective: This study aimed to compare the trend in online DSS sessions with that of COVID-19 cases reported by the national health surveillance system in Italy, from February 2020 to March 2021. Methods: We compared the number of sessions by users with a COVID-19–positive contact and users with COVID-19–compatible symptoms with the number of cases reported by the national surveillance system. To calculate the distance between the time series, we used the dynamic time warping algorithm. We applied Symbolic Aggregate approXimation (SAX) encoding to the time series in 1-week periods. We calculated the Hamming distance between the SAX strings. We shifted time series of online DSS sessions 1 week ahead. We measured the improvement in Hamming distance to verify the hypothesis that online DSS sessions anticipate the trends in cases reported to the official surveillance system. Results: We analyzed 75,557 sessions in the online DSS; 65,207 were sessions by symptomatic users, while 19,062 were by contacts of individuals with COVID-19. The highest number of online DSS sessions was recorded early in the pandemic. Second and third peaks were observed in October 2020 and March 2021, respectively, preceding the surge in notified COVID-19 cases by approximately 1 week. The distance between sessions by users with COVID-19 contacts and reported cases calculated by dynamic time warping was 61.23; the distance between sessions by symptomatic users was 93.72. The time series of users with a COVID-19 contact was more consistent with the trend in confirmed cases. With the 1-week shift, the Hamming distance between the time series of sessions by users with a COVID-19 contact and reported cases improved from 0.49 to 0.46. We repeated the analysis, restricting the time window to between July 2020 and December 2020. The corresponding Hamming distance was 0.16 before and improved to 0.08 after the time shift. Conclusions: Temporal trends in the number of online COVID-19 DSS sessions may precede the trend in reported COVID-19 cases through traditional surveillance. The trends in sessions by users with a contact with COVID-19 may better predict reported cases of COVID-19 than sessions by symptomatic users. Data from online DSS may represent a useful supplement to traditional surveillance and support the identification of early warning signals in the COVID-19 pandemic. %M 34292866 %R 10.2196/29556 %U https://www.jmir.org/2021/8/e29556 %U https://doi.org/10.2196/29556 %U http://www.ncbi.nlm.nih.gov/pubmed/34292866 %0 Journal Article %@ 2563-6316 %I JMIR Publications %V 2 %N 3 %P e28049 %T Emergence of the First Strains of SARS-CoV-2 Lineage B.1.1.7 in Romania: Genomic Analysis %A Lobiuc,Andrei %A Dimian,Mihai %A Sturdza,Olga %A Filip,Roxana %A Covasa,Mihai %+ Department of Human Health and Development, College of Physical Exercise and Sport, Stefan cel Mare University of Suceava, Str Universitatii 13, Suceava, 720229, Romania, 40 746900574, mcovasa@usm.ro %K infectious disease %K COVID-19 %K strain %K virus %K Romania %K transmission %K spread %K mutation %K impact %K case study %K genome %K sequencing %K genetics %K epidemiology %K variant %K virology %K lineage %D 2021 %7 13.8.2021 %9 Original Paper %J JMIRx Med %G English %X Background: The United Kingdom reported the emergence of a new and highly transmissible SARS-CoV-2 variant (B.1.1.7) that rapidly spread to other countries. The impact of this new mutation—which occurs in the S protein—on infectivity, virulence, and current vaccine effectiveness is still under evaluation. Objective: The aim of this study is to sequence SARS-CoV-2 samples of cases in Romania to detect the B.1.1.7 variant and compare these samples with sequences submitted to GISAID. Methods: SARS-CoV-2 samples were sequenced and amino acid substitution analysis was performed using the CoV-GLUE platform. Results: We have identified the first cases of the B.1.1.7 variant in samples collected from Romanian patients, of which one was traced to the region of the United Kingdom where the new variant was originally sequenced. Mutations in nonstructural protein 3 (Nsp3; N844S and D455N) and ORF3a (L15F) were also detected, indicating common ancestry with UK strains as well as remote connections with strains from Nagasaki, Japan. Conclusions: These results indicate, for the first time, the presence and characteristics of the new variant B.1.1.7 in Romania and underscore the need for increased genomic sequencing in patients with confirmed COVID-19. %M 34424256 %R 10.2196/28049 %U https://med.jmirx.org/2021/3/e28049 %U https://doi.org/10.2196/28049 %U http://www.ncbi.nlm.nih.gov/pubmed/34424256 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 8 %P e26565 %T Understanding Physicians’ Preferences for Telemedicine During the COVID-19 Pandemic: Cross-sectional Study %A Nies,Sarah %A Patel,Shae %A Shafer,Melissa %A Longman,Laura %A Sharif,Iman %A Pina,Paulo %+ Family Health Centers at New York University Langone, 5800 3rd Avenue, Brooklyn, NY, 11220, United States, 1 2153474369, paulo.pina@nyulangone.org %K telemedicine %K federally qualified health care center %K primary care %K COVID-19 %K telehealth %K physician %K doctor %K preference %K perspective %K dissemination %K appropriate %K cross-sectional %K survey %D 2021 %7 13.8.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: In contrast to the current broad dissemination of telemedicine across medical specialties, previous research focused on the effectiveness of telemedicine in special populations and for behavioral health encounters, demonstrating that both physician and patient factors impact the efficacious use of telemedicine. Objective: We aim to evaluate physician perceptions of the appropriateness of telemedicine for patients attending the primary care practices of a federally qualified health center in New York City. Methods: We used an anonymous cross-sectional survey including closed- and open-ended questions. We used chi-square to test whether providers from certain specialties were more likely to state they would use telemedicine in the future. We used t tests to compare age between those who would versus would not use telemedicine. We then used logistic regression to test whether age and specialty were both correlated with the desire to use telemedicine in the future. We used thematic content analysis to describe the reasons providers felt they would not want to use telemedicine in the future and to describe the situations for which they felt telemedicine would be appropriate. Results: Of 272 health care providers who were sent the electronic survey, 157 (58%) responded within the 2-week survey time frame. The mean age of providers was 45 (range 28-75) years. Overall, 80% (126/157) stated they would use telemedicine in the future. Compared to the family medicine, internal medicine, behavioral health, dental, and obstetrics and gynecology specialties, providers from pediatrics, med-peds, subspecialties, and surgery (protelemedicine specialties) were more likely to believe telemedicine would be useful post pandemic (61/67 [91%] vs 65/90 [72%]; P<.001). Providers who reported they would use telemedicine in the future were younger (mean age 44, range 42-46 years vs mean age 50, range 46-55 years; P=.048). In the regression analysis, both protelemedicine specialties and age were significantly associated with odds of reporting they would use telemedicine in the future (prospecialties: odds ratio 5.2, 95% CI 1.7-16.2; younger age: odds ratio 1.05, 95% CI 1.01-1.08). Providers who did not want to use telemedicine in the future cited concerns about inadequate patient care, lack of physical patient interaction, technology issues, and lack of necessity. Providers who felt telemedicine would be useful cited the following situations: follow-up visits, medication refills, urgent care, patient convenience, and specific conditions such as behavioral health, dermatology visits, and chronic care management. Conclusions: The majority of health providers in this resource-limited setting in a federally qualified health center believed that telemedicine would be useful for providing care after the pandemic is over. %M 34227993 %R 10.2196/26565 %U https://formative.jmir.org/2021/8/e26565 %U https://doi.org/10.2196/26565 %U http://www.ncbi.nlm.nih.gov/pubmed/34227993 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 8 %P e30612 %T Predictors of COVID-19 Preventive Perceptions and Behaviors Among Millennials: Two Cross-sectional Survey Studies %A Beaudoin,Christopher E %A Hong,Traci %+ College of Communication, Boston University, 640 Commonwealth Ave, Boston, MA, 02215, United States, 1 617 353 3450, cebeau@bu.edu %K COVID-19 %K coronavirus %K pandemic %K preventive perceptions %K preventive behaviors %K health information seeking %K political party identification %K COVID-19 testing %D 2021 %7 12.8.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: COVID-19 preventive perceptions and behaviors, especially among US millennials, are an important means by which the pandemic can be slowed and negative health outcomes can be averted. Objective: This manuscript aims to advance knowledge on COVID-19 preventive perceptions and behaviors and their main predictors, including digital health information–seeking behavior (HISB), political party identification, and COVID-19 testing status. Methods: Two cross-sectional online surveys of US millennials were conducted from April 10 to 14, 2020 (N=274) (ie, Study 1), and from April 27 to May 7, 2020 (N=1037) (ie, Study 2). In the regression models, dependent variables included preventive behaviors (eg, wearing a face mask and social distancing) as well as four preventive perceptions: severity (ie, a person’s conception of the seriousness of COVID-19), susceptibility (ie, a person’s conception of the likelihood of being infected with COVID-19), self-efficacy (ie, a person’s perception that he or she can wear a face mask and perform social distancing to prevent COVID-19 infection), and response efficacy (ie, a person’s perception of whether wearing a face mask and social distancing can prevent COVID-19 infection). Key independent variables included digital HISB for self, digital HISB for another person, political party identification, and COVID-19 testing status. Results: Millennials reported lower levels of perceived susceptibility than the other three preventive perceptions (ie, severity, self-efficacy, and response efficacy), as well as fairly high levels of preventive behaviors. Unlike HISB for another person, digital HISB for self was positively associated with preventive perceptions and behaviors. In Study 1, respondents with higher levels of digital HISB for self had significantly higher perceptions of severity (β=.22, P<.001), self-efficacy (β=.15, P=.02), and response efficacy (β=.25, P<.001) as well as, at nearing significance, higher perceptions of susceptibility (β=.11, P=.07). In Study 2, respondents with higher levels of digital HISB for self had significantly higher perceptions of severity (β=.25, P<.001), susceptibility (β=.14, P<.001), and preventive behaviors (β=.24, P<.001). Preventive behaviors did not vary significantly according to political party identification, but preventive perceptions did. In Study 1, respondents who identified as being more Republican had significantly lower perceptions of self-efficacy (β=−.14, P=.02) and response efficacy (β=−.13, P=.03) and, at nearing significance, lower perceptions of severity (β=−.10, P=.08) and susceptibility (β=−.12, P=.06). In Study 2, respondents who identified as being more Republican had significantly lower perceptions of severity (β=−.08, P=.009). There were mixed effects of COVID-19 testing status on preventive perceptions, with respondents who had tested positive for COVID-19 having significantly higher perceptions of susceptibility in Study 1 (β=.17, P=.006) and significantly lower perceptions of severity in Study 2 (β=−.012, P<.001). Conclusions: As the largest and most digitally savvy generation, US millennials saw COVID-19 as a severe threat, but one that they were less susceptible to. For millennials, digital HISB for self, but not for another person, was critical to the development of preventive perceptions and behaviors. %M 34182460 %R 10.2196/30612 %U https://www.jmir.org/2021/8/e30612 %U https://doi.org/10.2196/30612 %U http://www.ncbi.nlm.nih.gov/pubmed/34182460 %0 Journal Article %@ 2563-6316 %I JMIR Publications %V 2 %N 3 %P e29324 %T The Influence of COVID-19 Vaccination on Daily Cases, Hospitalization, and Death Rate in Tennessee, United States: Case Study %A Roghani,Ali %+ Division of Epidemiology, University of Utah, 383 Colorow Drive, Salt Lake City, UT, 84108, United States, 1 210 410 5779, ali_roghani@hotmail.com %K COVID-19 %K pandemic %K vaccination %K vaccine %K strategy %K vaccination strategy %K hospitalization %K mortality rates %K older adults %K mortality %D 2021 %7 12.8.2021 %9 Original Paper %J JMIRx Med %G English %X Background: The COVID-19 outbreak highlights our vulnerability to novel infections, and vaccination remains a foreseeable method to return to normal life. However, infrastructure is inadequate for the immediate vaccination of the whole population. Therefore, policies have adopted a strategy to vaccinate older adults and vulnerable populations while delaying vaccination for others. Objective: This study aimed to understand how age-specific vaccination strategies reduce daily cases, hospitalizations, and death rates using official statistics for Tennessee, United States. Methods: This study used publicly available data on COVID-19, including vaccination rates, positive cases, hospitalizations, and deaths from the Tennessee Department of Health. Data from the first date of vaccination (December 17, 2020) to March 3, 2021, were retrieved. The rates were adjusted by 2019 data from the US Census Bureau, and age groups were stratified into 10-year intervals starting with 21 years of age. Results: The findings showed that vaccination strategy can reduce the numbers of patients with COVID-19 in all age groups, with lower hospitalization and death rates in older populations. Older adults had a 95% lower death rate from December to March; no change in the death rate of other age groups was observed. The hospitalization rate was reduced by 80% for people aged ≥80 years, while people who were 50 to 70 years old had nearly the same hospitalization rate as prior to vaccination. Conclusions: This research indicates that targeting older age groups for vaccination is the optimal way to avoid higher transmissions and reduce hospitalization and death rates. %M 34424255 %R 10.2196/29324 %U https://med.jmirx.org/2021/3/e29324 %U https://doi.org/10.2196/29324 %U http://www.ncbi.nlm.nih.gov/pubmed/34424255 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 8 %P e29150 %T Long-term Effects of the COVID-19 Pandemic on Public Sentiments in Mainland China: Sentiment Analysis of Social Media Posts %A Tan,Hao %A Peng,Sheng-Lan %A Zhu,Chun-Peng %A You,Zuo %A Miao,Ming-Cheng %A Kuai,Shu-Guang %+ Shanghai Key Laboratory of Mental Health and Psychological Crisis Intervention, Key Laboratory of Brain Functional Genomics (Ministry of Education), The Institute of Brain and Education Innovation, School of Psychology and Cognitive Science, East China Normal University, Room 309, Old Library Building, No. 3663, North Zhongshan Road, Shanghai, 200062, China, 86 15618582866, shuguang.kuai@gmail.com %K COVID-19 %K emotional trauma %K public sentiment on social media %K long-term effect %D 2021 %7 12.8.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 outbreak has induced negative emotions among people. These emotions are expressed by the public on social media and are rapidly spread across the internet, which could cause high levels of panic among the public. Understanding the changes in public sentiment on social media during the pandemic can provide valuable information for developing appropriate policies to reduce the negative impact of the pandemic on the public. Previous studies have consistently shown that the COVID-19 outbreak has had a devastating negative impact on public sentiment. However, it remains unclear whether there has been a variation in the public sentiment during the recovery phase of the pandemic. Objective: In this study, we aim to determine the impact of the COVID-19 pandemic in mainland China by continuously tracking public sentiment on social media throughout 2020. Methods: We collected 64,723,242 posts from Sina Weibo, China’s largest social media platform, and conducted a sentiment analysis based on natural language processing to analyze the emotions reflected in these posts. Results: We found that the COVID-19 pandemic not only affected public sentiment on social media during the initial outbreak but also induced long-term negative effects even in the recovery period. These long-term negative effects were no longer correlated with the number of new confirmed COVID-19 cases both locally and nationwide during the recovery period, and they were not attributed to the postpandemic economic recession. Conclusions: The COVID-19 pandemic induced long-term negative effects on public sentiment in mainland China even as the country recovered from the pandemic. Our study findings remind public health and government administrators of the need to pay attention to public mental health even once the pandemic has concluded. %M 34280118 %R 10.2196/29150 %U https://www.jmir.org/2021/8/e29150 %U https://doi.org/10.2196/29150 %U http://www.ncbi.nlm.nih.gov/pubmed/34280118 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 8 %P e29671 %T Mental Health Service User and Worker Experiences of Psychosocial Support Via Telehealth Through the COVID-19 Pandemic: Qualitative Study %A Venville,Annie %A O'Connor,Sarah %A Roeschlein,Hannah %A Ennals,Priscilla %A McLoughlan,Grace %A Thomas,Neil %+ Social Work, College of Health and Biomedicine, Victoria University, Ballarat Road, Footscray, 3011, Australia, 61 +6199194571 ext 4571, annie.venville@vu.edu.au %K telehealth %K mental health %K psychosocial support %K COVID-19 %K service user %K workers %K qualitative %K e-mental health %K support %K telemedicine %K intervention %K user experience %D 2021 %7 12.8.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: During the COVID-19 pandemic, we saw telehealth rapidly become the primary way to receive mental health care. International research has validated many of the benefits and challenges of telehealth known beforehand for specific population groups. However, if telehealth is to assume prominence in future mental health service delivery, greater understanding of its capacity to be used to provide psychosocial support to people with complex and enduring mental health conditions is needed. Objective: We focused on an Australian community-managed provider of psychosocial intervention and support. We aimed to understand service user and worker experiences of psychosocial support via telehealth throughout the COVID-19 pandemic. Methods: This study was jointly developed and conducted by people with lived experience of mental ill health or distress, mental health service providers, and university-based researchers. Semistructured interviews were conducted between August and November 2020 and explored participant experiences of receiving or providing psychosocial support via telehealth, including telephone, text, and videoconferencing. Qualitative data were analyzed thematically; quantitative data were collated and analyzed using descriptive statistics. Results: Service users (n=20) and workers (n=8) completed individual interviews via telephone or videoconferencing platform. Service users received psychosocial support services by telephone (12/20, 60%), by videoconferencing (6/20, 30%), and by both telephone and videoconferencing (2/20, 10%). Of note, 55% (11/20) of service user participants stated a future preference for in-person psychosocial support services, 30% (6/20) preferred to receive a mixture of in-person and telehealth, and 15% (3/20) elected telehealth only. Two meta-themes emerged as integral to worker and service user experience of telehealth during the pandemic: (1) creating safety and comfort and (2) a whole new way of working. The first meta-theme comprises subthemes relating to a sense of safety and comfort while using telehealth; including trusting in the relationship and having and exercising choice and control. The second meta-theme contains subthemes reflecting key challenges and opportunities associated with the shift from in-person psychosocial support to telehealth. Conclusions: Overall, our findings highlighted that most service users experienced telehealth positively, but this was dependent on them continuing to get the support they needed in a way that was safe and comfortable. While access difficulties of a subgroup of service users should not be ignored, most service users and workers were able to adapt to telehealth by focusing on maintaining the relationship and using choice and flexibility to maintain service delivery. Although most research participants expressed a preference for a return to in-person psychosocial support or hybrid in-person and telehealth models, there was a general recognition that intentional use of telehealth could contribute to flexible and responsive service delivery. Challenges to telehealth provision of psychosocial support identified in this study are yet to be fully understood. %M 34182461 %R 10.2196/29671 %U https://mental.jmir.org/2021/8/e29671 %U https://doi.org/10.2196/29671 %U http://www.ncbi.nlm.nih.gov/pubmed/34182461 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 8 %N 3 %P e26336 %T US Physicians’ Perspective on the Sudden Shift to Telehealth: Survey Study %A Walia,Bhavneet %A Shridhar,Anshu %A Arasu,Pratap %A Singh,Gursimar Kaur %+ Department of Public Health, Syracuse University, 430B Barclay, Syracuse, NY, 13244, United States, 1 3154433930, bwalia@syr.edu %K physician survey %K US telehealth training %K US telehealth care %K COVID-19 %K pandemic %K snowball sampling %K health care access %K health care quality %K telehealth %K telemedicine %K survey %K physician %K perspective %K recommendation %K policy %K public health %K implication %K quality %K access %D 2021 %7 12.8.2021 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Given the sudden shift to telemedicine during the early COVID-19 pandemic, we conducted a survey of practicing physicians’ experience with telehealth during the prepandemic and early pandemic periods. Our survey estimates that most patient visits in the United States during the early COVID-19 pandemic period were conducted via telehealth. Given this magnitude and the potential benefits and challenges of telehealth for the US health care system, in this paper, we obtain, summarize, and analyze telehealth views and experiences of US-based practicing-physicians. Objective: The aim of this study was to examine the extent of shift toward telehealth training and care provision during the early pandemic from the US-based practicing physicians’ perspective. We also sought to determine the short- and long-term implications of this shift on the quality, access, and mode of US health care delivery. Methods: We conducted a purposive, snowball-sampled survey of US practicing-physicians. A total of 148 physician completed the survey. Data were collected from July 17, 2020, through September 4, 2020. Results: Sample training intensity scaled 21-fold during the early pandemic period, and patient-care visits conducted via telehealth increased, on average, from 13.1% directly before the pandemic to 59.7% during the early pandemic period. Surveyed physician respondents reported that telehealth patient visits and face-to-face patient visits are comparable in quality. The difference was not statistically significant based on a nonparametric sign test (P=.11). Moreover, physicians feel that telehealth care should continue to play a larger role (44.9% of total visits) in postpandemic health care in the United States. Our survey findings suggest a high market concentration in telehealth software, which is a market structural characteristic that may have implications on the cost and access of telehealth. The results varied markedly by physician employer type. Conclusions: During the shift toward telehealth, there has been a considerable discovery among physicians regarding US telehealth physicians. Physicians are now better prepared to undertake telehealth care from a training perspective. They are favorable toward a permanently expanded telehealth role, with potential for enhanced health care access, and the realization of enhanced access may depend on market structural characteristics of telehealth software platforms. %M 33938813 %R 10.2196/26336 %U https://humanfactors.jmir.org/2021/3/e26336 %U https://doi.org/10.2196/26336 %U http://www.ncbi.nlm.nih.gov/pubmed/33938813 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 1 %N 1 %P e28800 %T Analyzing Social Media to Explore the Attitudes and Behaviors Following the Announcement of Successful COVID-19 Vaccine Trials: Infodemiology Study %A Boucher,Jean-Christophe %A Cornelson,Kirsten %A Benham,Jamie L %A Fullerton,Madison M %A Tang,Theresa %A Constantinescu,Cora %A Mourali,Mehdi %A Oxoby,Robert J %A Marshall,Deborah A %A Hemmati,Hadi %A Badami,Abbas %A Hu,Jia %A Lang,Raynell %+ School of Public Policy and Department of Political Science, University of Calgary, 906 8 Ave SW 5th Floor, Calgary, AB, Canada, 1 403 220 8565, jc.boucher@ucalgary.ca %K coronavirus %K COVID-19 %K public health %K social media %K Twitter %K behavior %K risk reduction %K attitudes %K social network analysis %K machine learning %D 2021 %7 12.8.2021 %9 Original Paper %J JMIR Infodemiology %G English %X Background: The rollout of COVID-19 vaccines has brought vaccine hesitancy to the forefront in managing this pandemic. COVID-19 vaccine hesitancy is fundamentally different from that of other vaccines due to the new technologies being used, rapid development, and widespread global distribution. Attitudes on vaccines are largely driven by online information, particularly information on social media. The first step toward influencing attitudes about immunization is understanding the current patterns of communication that characterize the immunization debate on social media platforms. Objective: We aimed to evaluate societal attitudes, communication trends, and barriers to COVID-19 vaccine uptake through social media content analysis to inform communication strategies promoting vaccine acceptance. Methods: Social network analysis (SNA) and unsupervised machine learning were used to characterize COVID-19 vaccine content on Twitter globally. Tweets published in English and French were collected through the Twitter application programming interface between November 19 and 26, 2020, just following the announcement of initial COVID-19 vaccine trials. SNA was used to identify social media clusters expressing mistrustful opinions on COVID-19 vaccination. Based on the SNA results, an unsupervised machine learning approach to natural language processing using a sentence-level algorithm transfer function to detect semantic textual similarity was performed in order to identify the main themes of vaccine hesitancy. Results: The tweets (n=636,516) identified that the main themes driving the vaccine hesitancy conversation were concerns of safety, efficacy, and freedom, and mistrust in institutions (either the government or multinational corporations). A main theme was the safety and efficacy of mRNA technology and side effects. The conversation around efficacy was that vaccines were unlikely to completely rid the population of COVID-19, polymerase chain reaction testing is flawed, and there is no indication of long-term T-cell immunity for COVID-19. Nearly one-third (45,628/146,191, 31.2%) of the conversations on COVID-19 vaccine hesitancy clusters expressed concerns for freedom or mistrust of institutions (either the government or multinational corporations) and nearly a quarter (34,756/146,191, 23.8%) expressed criticism toward the government’s handling of the pandemic. Conclusions: Social media content analysis combined with social network analysis provides insights into the themes of the vaccination conversation on Twitter. The themes of safety, efficacy, and trust in institutions will need to be considered, as targeted outreach programs and intervention strategies are deployed on Twitter to improve the uptake of COVID-19 vaccination. %M 34447924 %R 10.2196/28800 %U https://infodemiology.jmir.org/2021/1/e28800 %U https://doi.org/10.2196/28800 %U http://www.ncbi.nlm.nih.gov/pubmed/34447924 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 8 %P e28876 %T Forecasting the COVID-19 Epidemic by Integrating Symptom Search Behavior Into Predictive Models: Infoveillance Study %A Rabiolo,Alessandro %A Alladio,Eugenio %A Morales,Esteban %A McNaught,Andrew Ian %A Bandello,Francesco %A Afifi,Abdelmonem A %A Marchese,Alessandro %+ Department of Ophthalmology, Gloucestershire Hospitals NHS Foundation Trust, Sandford Rd, Cheltenham, , United Kingdom, 44 300 422 2527, rabiolo.alessandro@gmail.com %K Google Trends %K symptoms %K coronavirus %K SARS-CoV-2 %K big data %K time series %K predictive models %K Shiny web application %K infodemiology %K infoveillance %K digital health %K COVID-19 %D 2021 %7 11.8.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Previous studies have suggested associations between trends of web searches and COVID-19 traditional metrics. It remains unclear whether models incorporating trends of digital searches lead to better predictions. Objective: The aim of this study is to investigate the relationship between Google Trends searches of symptoms associated with COVID-19 and confirmed COVID-19 cases and deaths. We aim to develop predictive models to forecast the COVID-19 epidemic based on a combination of Google Trends searches of symptoms and conventional COVID-19 metrics. Methods: An open-access web application was developed to evaluate Google Trends and traditional COVID-19 metrics via an interactive framework based on principal component analysis (PCA) and time series modeling. The application facilitates the analysis of symptom search behavior associated with COVID-19 disease in 188 countries. In this study, we selected the data of nine countries as case studies to represent all continents. PCA was used to perform data dimensionality reduction, and three different time series models (error, trend, seasonality; autoregressive integrated moving average; and feed-forward neural network autoregression) were used to predict COVID-19 metrics in the upcoming 14 days. The models were compared in terms of prediction ability using the root mean square error (RMSE) of the first principal component (PC1). The predictive abilities of models generated with both Google Trends data and conventional COVID-19 metrics were compared with those fitted with conventional COVID-19 metrics only. Results: The degree of correlation and the best time lag varied as a function of the selected country and topic searched; in general, the optimal time lag was within 15 days. Overall, predictions of PC1 based on both search terms and COVID-19 traditional metrics performed better than those not including Google searches (median 1.56, IQR 0.90-2.49 versus median 1.87, IQR 1.09-2.95, respectively), but the improvement in prediction varied as a function of the selected country and time frame. The best model varied as a function of country, time range, and period of time selected. Models based on a 7-day moving average led to considerably smaller RMSE values as opposed to those calculated with raw data (median 0.90, IQR 0.50-1.53 versus median 2.27, IQR 1.62-3.74, respectively). Conclusions: The inclusion of digital online searches in statistical models may improve the nowcasting and forecasting of the COVID-19 epidemic and could be used as one of the surveillance systems of COVID-19 disease. We provide a free web application operating with nearly real-time data that anyone can use to make predictions of outbreaks, improve estimates of the dynamics of ongoing epidemics, and predict future or rebound waves. %M 34156966 %R 10.2196/28876 %U https://www.jmir.org/2021/8/e28876 %U https://doi.org/10.2196/28876 %U http://www.ncbi.nlm.nih.gov/pubmed/34156966 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 8 %P e30251 %T Leveraging Transfer Learning to Analyze Opinions, Attitudes, and Behavioral Intentions Toward COVID-19 Vaccines: Social Media Content and Temporal Analysis %A Liu,Siru %A Li,Jili %A Liu,Jialin %+ Department of Medical Informatics, West China Hospital, Sichuan University, No 37 Wainan Guoxuexiang Street, Chengdu, 610041, China, 86 28 85422306, dljl8@163.com %K vaccine %K COVID-19 %K leveraging transfer learning %K pandemic %K infodemiology %K infoveillance %K public health %K social media %K content analysis %K machine learning %K online health %D 2021 %7 10.8.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 vaccine is considered to be the most promising approach to alleviate the pandemic. However, in recent surveys, acceptance of the COVID-19 vaccine has been low. To design more effective outreach interventions, there is an urgent need to understand public perceptions of COVID-19 vaccines. Objective: Our objective was to analyze the potential of leveraging transfer learning to detect tweets containing opinions, attitudes, and behavioral intentions toward COVID-19 vaccines, and to explore temporal trends as well as automatically extract topics across a large number of tweets. Methods: We developed machine learning and transfer learning models to classify tweets, followed by temporal analysis and topic modeling on a dataset of COVID-19 vaccine–related tweets posted from November 1, 2020 to January 31, 2021. We used the F1 values as the primary outcome to compare the performance of machine learning and transfer learning models. The statistical values and P values from the Augmented Dickey-Fuller test were used to assess whether users’ perceptions changed over time. The main topics in tweets were extracted by latent Dirichlet allocation analysis. Results: We collected 2,678,372 tweets related to COVID-19 vaccines from 841,978 unique users and annotated 5000 tweets. The F1 values of transfer learning models were 0.792 (95% CI 0.789-0.795), 0.578 (95% CI 0.572-0.584), and 0.614 (95% CI 0.606-0.622) for these three tasks, which significantly outperformed the machine learning models (logistic regression, random forest, and support vector machine). The prevalence of tweets containing attitudes and behavioral intentions varied significantly over time. Specifically, tweets containing positive behavioral intentions increased significantly in December 2020. In addition, we selected tweets in the following categories: positive attitudes, negative attitudes, positive behavioral intentions, and negative behavioral intentions. We then identified 10 main topics and relevant terms for each category. Conclusions: Overall, we provided a method to automatically analyze the public understanding of COVID-19 vaccines from real-time data in social media, which can be used to tailor educational programs and other interventions to effectively promote the public acceptance of COVID-19 vaccines. %M 34254942 %R 10.2196/30251 %U https://www.jmir.org/2021/8/e30251 %U https://doi.org/10.2196/30251 %U http://www.ncbi.nlm.nih.gov/pubmed/34254942 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 8 %P e29268 %T Self-Focused and Other-Focused Health Concerns as Predictors of the Uptake of Corona Contact Tracing Apps: Empirical Study %A große Deters,Fenne %A Meier,Tabea %A Milek,Anne %A Horn,Andrea B %+ Weizenbaum Institute for the Networked Society, Hardenbergstraße 32, Berlin, 10623, Germany, 49 331977 3710, fenne.grosse.deters@uni-potsdam.de %K COVID-19 %K corona contact tracing app %K digital proximity tracing %K preventive behavior %K health concern %K prosocial motivation %K public health %K risk perception, eHealth, Corona-Warn-App %K SwissCovid %K contact tracing app %K contact tracing %D 2021 %7 10.8.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Corona contact tracing apps are a novel and promising measure to reduce the spread of COVID-19. They can help to balance the need to maintain normal life and economic activities as much as possible while still avoiding exponentially growing case numbers. However, a majority of citizens need to be willing to install such an app for it to be effective. Hence, knowledge about drivers for app uptake is crucial. Objective: This study aimed to add to our understanding of underlying psychological factors motivating app uptake. More specifically, we investigated the role of concern for one’s own health and concern to unknowingly infect others. Methods: A two-wave survey with 346 German-speaking participants from Switzerland and Germany was conducted. We measured the uptake of two decentralized contact tracing apps officially launched by governments (Corona-Warn-App, Germany; SwissCovid, Switzerland), as well as concerns regarding COVID-19 and control variables. Results: Controlling for demographic variables and general attitudes toward the government and the pandemic, logistic regression analysis showed a significant effect of self-focused concerns (odds ratio [OR] 1.64, P=.002). Meanwhile, concern of unknowingly infecting others did not contribute significantly to the prediction of app uptake over and above concern for one’s own health (OR 1.01, P=.92). Longitudinal analyses replicated this pattern and showed no support for the possibility that app uptake provokes changes in levels of concern. Testing for a curvilinear relationship, there was no evidence that “too much” concern leads to defensive reactions and reduces app uptake. Conclusions: As one of the first studies to assess the installation of already launched corona tracing apps, this study extends our knowledge of the motivational landscape of app uptake. Based on this, practical implications for communication strategies and app design are discussed. %M 34227995 %R 10.2196/29268 %U https://www.jmir.org/2021/8/e29268 %U https://doi.org/10.2196/29268 %U http://www.ncbi.nlm.nih.gov/pubmed/34227995 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 8 %P e28249 %T Mining of Opinions on COVID-19 Large-Scale Social Restrictions in Indonesia: Public Sentiment and Emotion Analysis on Online Media %A Tri Sakti,Andi Muhammad %A Mohamad,Emma %A Azlan,Arina Anis %+ Centre for Research in Media and Communication, Faculty of Social Sciences and Humanities, Universiti Kebangsaan Malaysia, UKM Bangi, Bangi, 43600, Malaysia, 60 0123065261, arina@ukm.edu.my %K large-scale social restrictions %K social media %K public sentiment %K Twitter %K COVID-19 %K infodemiology %K infoveillance %D 2021 %7 9.8.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: One of the successful measures to curb COVID-19 spread in large populations is the implementation of a movement restriction order. Globally, it was observed that countries implementing strict movement control were more successful in controlling the spread of the virus as compared with those with less stringent measures. Society’s adherence to the movement control order has helped expedite the process to flatten the pandemic curve as seen in countries such as China and Malaysia. At the same time, there are countries facing challenges with society’s nonconformity toward movement restriction orders due to various claims such as human rights violations as well as sociocultural and economic issues. In Indonesia, society’s adherence to its large-scale social restrictions (LSSRs) order is also a challenge to achieve. Indonesia is regarded as among the worst in Southeast Asian countries in terms of managing the spread of COVID-19. It is proven by the increased number of daily confirmed cases and the total number of deaths, which was more than 6.21% (1351/21,745) of total active cases as of May 2020. Objective: The aim of this study was to explore public sentiments and emotions toward the LSSR and identify issues, fear, and reluctance to observe this restriction among the Indonesian public. Methods: This study adopts a sentiment analysis method with a supervised machine learning approach on COVID-19-related posts on selected media platforms (Twitter, Facebook, Instagram, and YouTube). The analysis was also performed on COVID-19-related news contained in more than 500 online news platforms recognized by the Indonesian Press Council. Social media posts and news originating from Indonesian online media between March 31 and May 31, 2020, were analyzed. Emotion analysis on Twitter platform was also performed to identify collective public emotions toward the LSSR. Results: The study found that positive sentiment surpasses other sentiment categories by 51.84% (n=1,002,947) of the total data (N=1,934,596) collected via the search engine. Negative sentiment was recorded at 35.51% (686,892/1,934,596) and neutral sentiment at 12.65% (244,757/1,934,596). The analysis of Twitter posts also showed that the majority of public have the emotion of “trust” toward the LSSR. Conclusions: Public sentiment toward the LSSR appeared to be positive despite doubts on government consistency in executing the LSSR. The emotion analysis also concluded that the majority of people believe in LSSR as the best method to break the chain of COVID-19 transmission. Overall, Indonesians showed trust and expressed hope toward the government’s ability to manage this current global health crisis and win against COVID-19. %M 34280116 %R 10.2196/28249 %U https://www.jmir.org/2021/8/e28249 %U https://doi.org/10.2196/28249 %U http://www.ncbi.nlm.nih.gov/pubmed/34280116 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 7 %N 3 %P e25355 %T Web-Based Medical Examinations During the COVID-19 Era: Reconsidering Learning as the Main Goal of Examination %A Manteghinejad,Amirreza %+ Cancer Prevention Research Center, Omid Hospital, Isfahan University of Medical Sciences, Hezarjarib St, Isfahan, 81746-73461, Iran, 98 3132371103, manteghinejad@edc.mui.ac.ir %K COVID-19 %K online exam %K e-learning %K medical education %K medical student %K online learning %K online platform %K cheating %K web-based examination %D 2021 %7 9.8.2021 %9 Viewpoint %J JMIR Med Educ %G English %X Like other aspects of the health care system, medical education has been greatly affected by the COVID-19 pandemic. To follow the requirements of lockdown and virtual education, the performance of students has been evaluated via web-based examinations. Although this shift to web-based examinations was inevitable, other mental, educational, and technical aspects should be considered to ensure the efficiency and accuracy of this type of evaluation in this era. The easiest way to address the new challenges is to administer traditional questions via a web-based platform. However, more factors should be accounted for when designing web-based examinations during the COVID-19 era. This article presents an approach in which the opportunity created by the pandemic is used as a basis to reconsider learning as the main goal of web-based examinations. The approach suggests using open-book examinations, using questions that require high cognitive domains, using real clinical scenarios, developing more comprehensive examination blueprints, using advanced platforms for web-based questions, and providing feedback in web-based examinations to ensure that the examinees have acquired the minimum competency levels defined in the course objectives. %M 34329178 %R 10.2196/25355 %U https://mededu.jmir.org/2021/3/e25355 %U https://doi.org/10.2196/25355 %U http://www.ncbi.nlm.nih.gov/pubmed/34329178 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 8 %P e30200 %T Exploring Changes to the Actionability of COVID-19 Dashboards Over the Course of 2020 in the Canadian Context: Descriptive Assessment and Expert Appraisal Study %A Barbazza,Erica %A Ivanković,Damir %A Wang,Sophie %A Gilmore,Kendall Jamieson %A Poldrugovac,Mircha %A Willmington,Claire %A Larrain,Nicolas %A Bos,Véronique %A Allin,Sara %A Klazinga,Niek %A Kringos,Dionne %+ Department of Public and Occupational Health, Amsterdam UMC, Amsterdam Public Health Research Institute, University of Amsterdam, Meibergdreef 9, Amsterdam, 1105AZ, Netherlands, 45 31121711, e.s.barbazza@amsterdamumc.nl %K COVID-19 %K performance measures %K health information management %K dashboards %K public reporting of health care data %K qualitative research %K public health %K medical informatics %K surveillance %K communication %K assessment %K Canada %K decision-making %K dynamic %K development %D 2021 %7 6.8.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Public web-based COVID-19 dashboards are in use worldwide to communicate pandemic-related information. Actionability of dashboards, as a predictor of their potential use for data-driven decision-making, was assessed in a global study during the early stages of the pandemic. It revealed a widespread lack of features needed to support actionability. In view of the inherently dynamic nature of dashboards and their unprecedented speed of creation, the evolution of dashboards and changes to their actionability merit exploration. Objective: We aimed to explore how COVID-19 dashboards evolved in the Canadian context during 2020 and whether the presence of actionability features changed over time. Methods: We conducted a descriptive assessment of a pan-Canadian sample of COVID-19 dashboards (N=26), followed by an appraisal of changes to their actionability by a panel of expert scorers (N=8). Scorers assessed the dashboards at two points in time, July and November 2020, using an assessment tool informed by communication theory and health care performance intelligence. Applying the nominal group technique, scorers were grouped in panels of three, and evaluated the presence of the seven defined features of highly actionable dashboards at each time point. Results: Improvements had been made to the dashboards over time. These predominantly involved data provision (specificity of geographic breakdowns, range of indicators reported, and explanations of data sources or calculations) and advancements enabled by the technologies employed (customization of time trends and interactive or visual chart elements). Further improvements in actionability were noted especially in features involving local-level data provision, time-trend reporting, and indicator management. No improvements were found in communicative elements (clarity of purpose and audience), while the use of storytelling techniques to narrate trends remained largely absent from the dashboards. Conclusions: Improvements to COVID-19 dashboards in the Canadian context during 2020 were seen mostly in data availability and dashboard technology. Further improving the actionability of dashboards for public reporting will require attention to both technical and organizational aspects of dashboard development. Such efforts would include better skill-mixing across disciplines, continued investment in data standards, and clearer mandates for their developers to ensure accountability and the development of purpose-driven dashboards. %M 34280120 %R 10.2196/30200 %U https://www.jmir.org/2021/8/e30200 %U https://doi.org/10.2196/30200 %U http://www.ncbi.nlm.nih.gov/pubmed/34280120 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 7 %N 3 %P e30265 %T Improving Electronic Survey Response Rates Among Cancer Center Patients During the COVID-19 Pandemic: Mixed Methods Pilot Study %A Hathaway,Cassandra A %A Chavez,Melody N %A Kadono,Mika %A Ketcher,Dana %A Rollison,Dana E %A Siegel,Erin M %A Peoples,Anita R %A Ulrich,Cornelia M %A Penedo,Frank J %A Tworoger,Shelley S %A Gonzalez,Brian D %+ Department of Cancer Epidemiology, Moffitt Cancer Center, 13131 USF Magnolia Drive, MRC 2nd Floor, Tampa, FL, 33612, United States, 1 813 745 1810, Shelley.Tworoger@moffitt.org %K response rates %K electronic survey %K cancer %K COVID-19 %K pandemic %K surveillance %K cancer patients %K health promotion %K digital health %K patient experience %K health outcomes %D 2021 %7 6.8.2021 %9 Original Paper %J JMIR Cancer %G English %X Background: Surveys play a vital role in cancer research. During the COVID-19 pandemic, the use of electronic surveys is crucial to improve understanding of the patient experience. However, response rates to electronic surveys are often lower compared with those of paper surveys. Objective: The aim of this study was to determine the best approach to improve response rates for an electronic survey administered to patients at a cancer center during the COVID-19 pandemic. Methods: We contacted 2750 patients seen at Moffitt Cancer Center in the prior 5 years via email to complete a survey regarding their experience during the COVID-19 pandemic, with patients randomly assigned to a series of variations of prenotifications (ie, postcard, letter) or incentives (ie, small gift, modest gift card). In total, eight combinations were evaluated. Qualitative interviews were conducted to understand the level of patient understanding and burden with the survey, and quantitative analysis was used to evaluate the response rates between conditions. Results: A total of 262 (9.5%) patients completed the survey and 9 participated in a qualitative interview. Interviews revealed minimal barriers in understanding or burden, which resulted in minor survey design changes. Compared to sending an email only, sending a postcard or letter prior to the email improved response rates from 3.7% to 9.8%. Similarly, inclusion of an incentive significantly increased the response rate from 5.4% to 16.7%, especially among racial (3.0% to 12.2%) and ethnic (6.4% to 21.0%) minorities, as well as among patients with low socioeconomic status (3.1% to 14.9%). Conclusions: Strategies to promote effective response rates include prenotification postcards or letters as well as monetary incentives. This work can inform future survey development to increase response rates for electronic surveys, particularly among hard-to-reach populations. %M 34156965 %R 10.2196/30265 %U https://cancer.jmir.org/2021/3/e30265 %U https://doi.org/10.2196/30265 %U http://www.ncbi.nlm.nih.gov/pubmed/34156965 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 1 %N 1 %P e29929 %T The Impact of COVID-19 on Conspiracy Hypotheses and Risk Perception in Italy: Infodemiological Survey Study Using Google Trends %A Rovetta,Alessandro %+ Mensana srls, Via Malta 12, Brescia, 25124, Italy, 39 3927112808, rovetta.mresearch@gmail.com %K COVID-19 %K fake news %K Google Trends %K infodemiology %K Italy %K risk perception %D 2021 %7 6.8.2021 %9 Original Paper %J JMIR Infodemiology %G English %X Background: COVID-19 has caused the worst international crisis since World War II. Italy was one of the countries most affected by both the pandemic and the related infodemic. The success of anti–COVID-19 strategies and future public health policies in Italy cannot separate itself from the containment of fake news and the divulgation of correct information. Objective: The aim of this paper was to analyze the impact of COVID-19 on web interest in conspiracy hypotheses and risk perception of Italian web users. Methods: Google Trends was used to monitor users’ web interest in specific topics, such as conspiracy hypotheses, vaccine side effects, and pollution and climate change. The keywords adopted to represent these topics were mined from Bufale.net—an Italian website specializing in detecting online hoaxes—and Google Trends suggestions (ie, related topics and related queries). Relative search volumes (RSVs) of the time-lapse periods of 2016-2020 (pre–COVID-19) and 2020-2021 (post–COVID-19) were compared through percentage difference (∆%) and the Welch t test (t). When data series were not stationary, other ad hoc criteria were used. The trend slopes were assessed through Sen slope (SS). The significance thresholds have been indicatively set at P=.05 and t=1.9. Results: The COVID-19 pandemic drastically increased Italian netizens’ interest in conspiracies (∆% ∈ [60, 288], t ∈ [6, 12]). Web interest in conspiracy-related queries across Italian regions increased and became more homogeneous compared to the pre–COVID-19 period (average RSV=80±2.8, tmin=1.8, ∆min%=+12.4, min∆SD%=–25.8). In addition, a growing trend in web interest in the infodemic YouTube channel ByoBlu has been highlighted. Web interest in hoaxes has increased more than interest in antihoax services (t1=11.3 vs t2=4.5; Δ1%=+157.6 vs Δ2%=+84.7). Equivalently, web interest in vaccine side effects exceeded interest in pollution and climate change (SSvaccines=0.22, P<.001 vs SSpollution=0.05, P<.001; ∆%=+296.4). To date, a significant amount of fake news related to COVID-19 vaccines, unproven remedies, and origin has continued to circulate. In particular, the creation of SARS-CoV-2 in a Chinese laboratory constituted about 0.04% of the entire web interest in the pandemic. Conclusions: COVID-19 has given a significant boost to web interest in conspiracy hypotheses and has made it more uniform across regions in Italy. The pandemic accelerated an already-growing trend in users’ interest toward some fake news sources, including the 500,000-subscriber YouTube channel ByoBlu, which was removed from the platform by YouTube for disinformation in March 2021. The risk perception related to COVID-19 vaccines has been so distorted that vaccine side effect–related queries outweighed those relating to pollution and climate change, which are much more urgent issues. Moreover, a large amount of fake news has circulated about COVID-19 vaccines, remedies, and origin. Based on these findings, it is recommended that the Italian authorities implement more effective infoveillance systems, and that communication by the mass media be less sensationalistic and more consistent with the available scientific evidence. In this context, Google Trends can be used to monitor users’ response to specific infodemiological countermeasures. Further research is needed to understand the psychological mechanisms that regulate risk perception. %M 34447925 %R 10.2196/29929 %U https://infodemiology.jmir.org/2021/1/e29929 %U https://doi.org/10.2196/29929 %U http://www.ncbi.nlm.nih.gov/pubmed/34447925 %0 Journal Article %@ 2563-6316 %I JMIR Publications %V 2 %N 3 %P e29570 %T Social Media Polarization and Echo Chambers in the Context of COVID-19: Case Study %A Jiang,Julie %A Ren,Xiang %A Ferrara,Emilio %+ Information Sciences Institute, University of Southern California, 4676 Admiralty Way #1001, Marina Del Rey, CA, 90292, United States, 1 310 448 8661, ferrarae@isi.edu %K social media %K opinion %K infodemiology %K infoveillance %K COVID-19 %K case study %K polarization %K communication %K Twitter %K echo chamber %D 2021 %7 5.8.2021 %9 Original Paper %J JMIRx Med %G English %X Background: Social media chatter in 2020 has been largely dominated by the COVID-19 pandemic. Existing research shows that COVID-19 discourse is highly politicized, with political preferences linked to beliefs and disbeliefs about the virus. As it happens with topics that become politicized, people may fall into echo chambers, which is the idea that one is only presented with information they already agree with, thereby reinforcing one’s confirmation bias. Understanding the relationship between information dissemination and political preference is crucial for effective public health communication. Objective: We aimed to study the extent of polarization and examine the structure of echo chambers related to COVID-19 discourse on Twitter in the United States. Methods: First, we presented Retweet-BERT, a scalable and highly accurate model for estimating user polarity by leveraging language features and network structures. Then, by analyzing the user polarity predicted by Retweet-BERT, we provided new insights into the characterization of partisan users. Results: We observed that right-leaning users were noticeably more vocal and active in the production and consumption of COVID-19 information. We also found that most of the highly influential users were partisan, which may contribute to further polarization. Importantly, while echo chambers exist in both the right- and left-leaning communities, the right-leaning community was by far more densely connected within their echo chamber and isolated from the rest. Conclusions: We provided empirical evidence that political echo chambers are prevalent, especially in the right-leaning community, which can exacerbate the exposure to information in line with pre-existing users’ views. Our findings have broader implications in developing effective public health campaigns and promoting the circulation of factual information online. %M 34459833 %R 10.2196/29570 %U https://med.jmirx.org/2021/3/e29570 %U https://doi.org/10.2196/29570 %U http://www.ncbi.nlm.nih.gov/pubmed/34459833 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 8 %P e28360 %T Mental Health and the Perceived Usability of Digital Mental Health Tools Among Essential Workers and People Unemployed Due to COVID-19: Cross-sectional Survey Study %A Mata-Greve,Felicia %A Johnson,Morgan %A Pullmann,Michael D %A Friedman,Emily C %A Griffith Fillipo,Isabell %A Comtois,Katherine A %A Arean,Patricia %+ Department of Psychiatry and Behavioral Sciences, University of Washington, 1959 NE Pacific Street, Seattle, WA, 98195, United States, 1 206 616 2129, parean@uw.edu %K digital health %K COVID-19 %K essential worker %K unemployed %K usability %K user burden %K mental health %K e-mental health %K survey %K distress %D 2021 %7 5.8.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: COVID-19 has created serious mental health consequences for essential workers or people who have become unemployed as a result of the pandemic. Digital mental health tools have the potential to address this problem in a timely and efficient manner. Objective: The purpose of this study was to document the extent of digital mental health tool (DMHT) use by essential workers and those unemployed due to COVID-19, including asking participants to rate the usability and user burden of the DMHT they used most to cope. We also explored which aspects and features of DMHTs were seen as necessary for managing stress during a pandemic by having participants design their own ideal DMHT. Methods: A total of 2000 people were recruited from an online research community (Prolific) to complete a one-time survey about mental health symptoms, DMHT use, and preferred digital mental health features. Results: The final sample included 1987 US residents that identified as either an essential worker or someone who was unemployed due to COVID-19. Almost three-quarters of the sample (1479/1987, 74.8%) reported clinically significant emotional distress. Only 14.2% (277/1957) of the sample used a DMHT to cope with stress associated with COVID-19. Of those who used DMHTs to cope with COVID-19, meditation apps were the most common (119/261, 45.6%). Usability was broadly in the acceptable range, although participants unemployed due to COVID-19 were less likely to report user burden with DMHTs than essential workers (t198.1=–3.89, P<.001). Individuals with emotional distress reported higher financial burden for their DMHT than nondistressed individuals (t69.0=–3.21, P=.01). When the sample was provided the option to build their own DMHT, the most desired features were a combination of mindfulness/meditation (1271/1987, 64.0%), information or education (1254/1987, 63.1%), distraction tools (1170/1987, 58.9%), symptom tracking for mood and sleep (1160/1987, 58.4%), link to mental health resources (1140/1987, 57.4%), and positive psychology (1131/1986, 56.9%). Subgroups by employment, distress, and previous DMHT use status had varied preferences. Of those who did not use a DMHT to cope with COVID-19, most indicated that they did not consider looking for such a tool to help with coping (1179/1710, 68.9%). Conclusions: Despite the potential need for DMHTs, this study found that the use of such tools remains similar to prepandemic levels. This study also found that regardless of the level of distress or even past experience using an app to cope with COVID-19, it is possible to develop a COVID-19 coping app that would appeal to a majority of essential workers and unemployed persons. %M 34081592 %R 10.2196/28360 %U https://mental.jmir.org/2021/8/e28360 %U https://doi.org/10.2196/28360 %U http://www.ncbi.nlm.nih.gov/pubmed/34081592 %0 Journal Article %@ 2561-3278 %I JMIR Publications %V 6 %N 3 %P e26047 %T A Simple Ventilator Designed To Be Used in Shortage Crises: Construction and Verification Testing %A Akerib,Daniel S %A Ames,Andrew %A Breidenbach,Martin %A Bressack,Michael %A Breur,Pieter A %A Charles,Eric %A Gaba,David M %A Herbst,Ryan %A Ignarra,Christina M %A Luitz,Steffen %A Miller,Eric H %A Mong,Brian %A Shutt,Tom A %A Wittgen,Matthias %+ SLAC National Accelerator Laboratory, 2575 Sand Hill Rd, Apartment 824, Palo Alto, CA, 94304, United States, 1 6509268549, sanderb@SLAC.Stanford.EDU %K intensive care %K critical care %K medicine %K ventilator %K COVID-19 %K shortage %K equipment %K medical device %K performance %K short-term %K engineering %K cost %K ICU %K intensive care unit %D 2021 %7 5.8.2021 %9 Original Paper %J JMIR Biomed Eng %G English %X Background: The COVID-19 pandemic has demonstrated the possibility of severe ventilator shortages in the near future. Objective: We aimed to develop an acute shortage ventilator. Methods: The ventilator was designed to mechanically compress a self-inflating bag resuscitator, using a modified ventilator patient circuit, which is controlled by a microcontroller and an optional laptop. It was designed to operate in both volume-controlled mode and pressure-controlled assist modes. We tested the ventilator in 4 modes using an artificial lung while measuring the volume, flow, and pressure delivered over time by the ventilator. Results: The ventilator was successful in reaching the desired tidal volume and respiratory rates specified in national emergency use resuscitator system guidelines. The ventilator responded to simulated spontaneous breathing. Conclusions: The key design goals were achieved. We developed a simple device with high performance for short-term use, made primarily from common hospital parts and generally available nonmedical components to avoid any compatibility or safety issues with the patient, and at low cost, with a unit cost per ventilator is less than $400 US excluding the patient circuit parts, that can be easily manufactured. %M 34458681 %R 10.2196/26047 %U https://biomedeng.jmir.org/2021/3/e26047 %U https://doi.org/10.2196/26047 %U http://www.ncbi.nlm.nih.gov/pubmed/34458681 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 1 %N 1 %P e28740 %T Examining the Public’s Most Frequently Asked Questions Regarding COVID-19 Vaccines Using Search Engine Analytics in the United States: Observational Study %A Sajjadi,Nicholas B %A Shepard,Samuel %A Ottwell,Ryan %A Murray,Kelly %A Chronister,Justin %A Hartwell,Micah %A Vassar,Matt %+ Office of Medical Student Research, College of Osteopathic Medicine, Oklahoma State University Center for Health Sciences, 1111 W 17th Street, Tulsa, OK, 74104, United States, 1 9185821972, nicholas.sajjadi@okstate.edu %K content %K COVID-19 %K frequently asked questions %K internet %K machine learning %K natural language processing %K quality %K question %K SARS-CoV-2 %K search analytics %K search engine %K transparency %K vaccine hesitancy %K vaccine %K web-based health information %D 2021 %7 4.8.2021 %9 Original Paper %J JMIR Infodemiology %G English %X Background: The emergency authorization of COVID-19 vaccines has offered the first means of long-term protection against COVID-19–related illness since the pandemic began. It is important for health care professionals to understand commonly held COVID-19 vaccine concerns and to be equipped with quality information that can be used to assist in medical decision-making. Objective: Using Google’s RankBrain machine learning algorithm, we sought to characterize the content of the most frequently asked questions (FAQs) about COVID-19 vaccines evidenced by internet searches. Secondarily, we sought to examine the information transparency and quality of sources used by Google to answer FAQs on COVID-19 vaccines. Methods: We searched COVID-19 vaccine terms on Google and used the “People also ask” box to obtain FAQs generated by Google’s machine learning algorithms. FAQs are assigned an “answer” source by Google. We extracted FAQs and answer sources related to COVID-19 vaccines. We used the Rothwell Classification of Questions to categorize questions on the basis of content. We classified answer sources as either academic, commercial, government, media outlet, or medical practice. We used the Journal of the American Medical Association’s (JAMA’s) benchmark criteria to assess information transparency and Brief DISCERN to assess information quality for answer sources. FAQ and answer source type frequencies were calculated. Chi-square tests were used to determine associations between information transparency by source type. One-way analysis of variance was used to assess differences in mean Brief DISCERN scores by source type. Results: Our search yielded 28 unique FAQs about COVID-19 vaccines. Most COVID-19 vaccine–related FAQs were seeking factual information (22/28, 78.6%), specifically about safety and efficacy (9/22, 40.9%). The most common source type was media outlets (12/28, 42.9%), followed by government sources (11/28, 39.3%). Nineteen sources met 3 or more JAMA benchmark criteria with government sources as the majority (10/19, 52.6%). JAMA benchmark criteria performance did not significantly differ among source types (χ24=7.40; P=.12). One-way analysis of variance revealed a significant difference in mean Brief DISCERN scores by source type (F4,23=10.27; P<.001). Conclusions: The most frequently asked COVID-19 vaccine–related questions pertained to vaccine safety and efficacy. We found that government sources provided the most transparent and highest-quality web-based COVID-19 vaccine–related information. Recognizing common questions and concerns about COVID-19 vaccines may assist in improving vaccination efforts. %M 34458683 %R 10.2196/28740 %U https://infodemiology.jmir.org/2021/1/e28740 %U https://doi.org/10.2196/28740 %U http://www.ncbi.nlm.nih.gov/pubmed/34458683 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 8 %P e28074 %T Association Between Public Opinion and Malaysian Government Communication Strategies About the COVID-19 Crisis: Content Analysis of Image Repair Strategies in Social Media %A Masngut,Nasaai %A Mohamad,Emma %+ Centre for Research in Media and Communication, Faculty of Social Sciences and Humanities, Universiti Kebangsaan Malaysia, Jalan Nik Ahmed Kamil, Bangi, 43600, Malaysia, 60 389215456, emmamohamad@ukm.edu.my %K COVID-19 %K crisis %K health communication %K image repair %K Malaysian government %K sentiment %K communication %K content analysis %K public opinion %K social media %K strategy %D 2021 %7 4.8.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 health crisis has posed an unprecedented challenge for governments worldwide to manage and communicate about the pandemic effectively, while maintaining public trust. Good leadership image in times of a health emergency is paramount to ensure public confidence in governments’ abilities to manage the crisis. Objective: The aim of this study was to identify types of image repair strategies utilized by the Malaysian government in their communication about COVID-19 in the media and analyze public responses to these messages on social media. Methods: Content analysis was employed to analyze 120 media statements and 382 comments retrieved from Facebook pages of 2 mainstream newspapers—Berita Harian and The Star. These media statements and comments were collected within a span of 6 weeks prior to and during the first implementation of Movement Control Order by the Malaysian Government. The media statements were analyzed according to Image Repair Theory to categorize strategies employed in government communications related to COVID-19 crisis. Public opinion responses were measured using modified lexicon-based sentiment analysis to categorize positive, negative, and neutral statements. Results: The Malaysian government employed all 5 Image Repair Theory strategies in their communications in both newspapers. The strategy most utilized was reducing offensiveness (75/120, 62.5%), followed by corrective action (30/120, 25.0%), evading responsibilities (10/120, 8.3%), denial (4/120, 3.3%), and mortification (1/120, 0.8%). This study also found multiple substrategies in government media statements including denial, shifting blame, provocation, defeasibility, accident, good intention, bolstering, minimization, differentiation, transcendence, attacking accuser, resolve problem, prevent recurrence, admit wrongdoing, and apologize. This study also found that 64.7% of public opinion was positive in response to media statements made by the Malaysian government and also revealed a significant positive association (P=.04) between image repair strategies utilized by the Malaysian government and public opinion. Conclusions: Communication in the media may assist the government in fostering positive support from the public. Suitable image repair strategies could garner positive public responses and help build trust in times of crisis. %M 34156967 %R 10.2196/28074 %U https://www.jmir.org/2021/8/e28074 %U https://doi.org/10.2196/28074 %U http://www.ncbi.nlm.nih.gov/pubmed/34156967 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 8 %P e28195 %T Forecasting COVID-19 Hospital Census: A Multivariate Time-Series Model Based on Local Infection Incidence %A Nguyen,Hieu M %A Turk,Philip J %A McWilliams,Andrew D %+ Center for Outcomes Research and Evaluation, Atrium Health, 1300 Scott Ave, Charlotte, NC, 28204, United States, 1 9706914892, hieu.nguyen@atriumhealth.org %K COVID-19 %K forecasting %K time-series model %K vector error correction model %K hospital census %K hospital resource utilization %K infection incidence %D 2021 %7 4.8.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: COVID-19 has been one of the most serious global health crises in world history. During the pandemic, health care systems require accurate forecasts for key resources to guide preparation for patient surges. Forecasting the COVID-19 hospital census is among the most important planning decisions to ensure adequate staffing, number of beds, intensive care units, and vital equipment. Objective: The goal of this study was to explore the potential utility of local COVID-19 infection incidence data in developing a forecasting model for the COVID-19 hospital census. Methods: The study data comprised aggregated daily COVID-19 hospital census data across 11 Atrium Health hospitals plus a virtual hospital in the greater Charlotte metropolitan area of North Carolina, as well as the total daily infection incidence across the same region during the May 15 to December 5, 2020, period. Cross-correlations between hospital census and local infection incidence lagging up to 21 days were computed. A multivariate time-series framework, called the vector error correction model (VECM), was used to simultaneously incorporate both time series and account for their possible long-run relationship. Hypothesis tests and model diagnostics were performed to test for the long-run relationship and examine model goodness of fit. The 7-days-ahead forecast performance was measured by mean absolute percentage error (MAPE), with time-series cross-validation. The forecast performance was also compared with an autoregressive integrated moving average (ARIMA) model in the same cross-validation time frame. Based on different scenarios of the pandemic, the fitted model was leveraged to produce 60-days-ahead forecasts. Results: The cross-correlations were uniformly high, falling between 0.7 and 0.8. There was sufficient evidence that the two time series have a stable long-run relationship at the .01 significance level. The model had very good fit to the data. The out-of-sample MAPE had a median of 5.9% and a 95th percentile of 13.4%. In comparison, the MAPE of the ARIMA had a median of 6.6% and a 95th percentile of 14.3%. Scenario-based 60-days-ahead forecasts exhibited concave trajectories with peaks lagging 2 to 3 weeks later than the peak infection incidence. In the worst-case scenario, the COVID-19 hospital census can reach a peak over 3 times greater than the peak observed during the second wave. Conclusions: When used in the VECM framework, the local COVID-19 infection incidence can be an effective leading indicator to predict the COVID-19 hospital census. The VECM model had a very good 7-days-ahead forecast performance and outperformed the traditional ARIMA model. Leveraging the relationship between the two time series, the model can produce realistic 60-days-ahead scenario-based projections, which can inform health care systems about the peak timing and volume of the hospital census for long-term planning purposes. %M 34346897 %R 10.2196/28195 %U https://publichealth.jmir.org/2021/8/e28195 %U https://doi.org/10.2196/28195 %U http://www.ncbi.nlm.nih.gov/pubmed/34346897 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 8 %P e26111 %T With Great Hopes Come Great Expectations: Access and Adoption Issues Associated With COVID-19 Vaccines %A Su,Zhaohui %A McDonnell,Dean %A Cheshmehzangi,Ali %A Li,Xiaoshan %A Maestro,Daniel %A Šegalo,Sabina %A Ahmad,Junaid %A Hao,Xiaoning %+ Division of Health Security Research, China National Health Development Research Center, National Health Commission, P.R. China, No. 9 Chegongzhuang Street, Xicheng District, Beijing, 100044, China, 86 010 88385748, haoxn@nhei.cn %K COVID-19 %K coronavirus %K COVID-19 vaccine %K made in China %K vaccine efficacy %K vaccine safety %K vaccine %K China %K expectation %K safety %K efficacy %K infectious disease %K public health %K consequence %K public health %K standard %D 2021 %7 4.8.2021 %9 Viewpoint %J JMIR Public Health Surveill %G English %X Although COVID-19 vaccines are becoming increasingly available, their ability to effectively control and contain the spread of the COVID-19 pandemic is highly contingent on an array of factors. This paper discusses how limitations to vaccine accessibility, issues associated with vaccine side effects, concerns regarding vaccine efficacy, along with the persistent prevalence of vaccine hesitancy among the public, including health care professionals, might impact the potential of COVID-19 vaccines to curb the pandemic. We draw insights from the literature to identify practical solutions that could boost people’s adoption of COVID-19 vaccines and their accessibility. We conclude with a discussion on health experts’ and government officials’ moral and ethical responsibilities to the public, even in light of the urgency to adopt and endorse “the greatest amount of good for the greatest number” utilitarian philosophy in controlling and managing the spread of COVID-19. %M 33560997 %R 10.2196/26111 %U https://publichealth.jmir.org/2021/8/e26111 %U https://doi.org/10.2196/26111 %U http://www.ncbi.nlm.nih.gov/pubmed/33560997 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 8 %P e28568 %T Physiologic Response to the Pfizer-BioNTech COVID-19 Vaccine Measured Using Wearable Devices: Prospective Observational Study %A Hajduczok,Alexander G %A DiJoseph,Kara M %A Bent,Brinnae %A Thorp,Audrey K %A Mullholand,Jon B %A MacKay,Stuart A %A Barik,Sabrina %A Coleman,Jamie J %A Paules,Catharine I %A Tinsley,Andrew %+ Division of Internal Medicine, Department of Medicine, Penn State Health Milton S. Hershey Medical Center, 500 University Drive, Hershey, PA, 17033, United States, 1 7168634928, alexander.hajduczok@jefferson.edu %K COVID-19 %K wearable devices %K remote physiologic monitoring %K heart rate %K heart rate variability %K respiratory rate %K sleep %K REM sleep %K deep sleep %K wearable %K vaccine %K monitoring %K respiratory %K physiological %K cohort %D 2021 %7 4.8.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The Pfizer-BioNTech COVID-19 vaccine uses a novel messenger RNA technology to elicit a protective immune response. Short-term physiologic responses to the vaccine have not been studied using wearable devices. Objective: We aim to characterize physiologic changes in response to COVID-19 vaccination in a small cohort of participants using a wearable device (WHOOP Strap 3.0). This is a proof of concept for using consumer-grade wearable devices to monitor response to COVID-19 vaccines. Methods: In this prospective observational study, physiologic data from 19 internal medicine residents at a single institution that received both doses of the Pfizer-BioNTech COVID-19 vaccine was collected using the WHOOP Strap 3.0. The primary outcomes were percent change from baseline in heart rate variability (HRV), resting heart rate (RHR), and respiratory rate (RR). Secondary outcomes were percent change from baseline in total, rapid eye movement, and deep sleep. Exploratory outcomes included local and systemic reactogenicity following each dose and prophylactic analgesic use. Results: In 19 individuals (mean age 28.8, SD 2.2 years; n=10, 53% female), HRV was decreased on day 1 following administration of the first vaccine dose (mean –13.44%, SD 13.62%) and second vaccine dose (mean –9.25%, SD 22.6%). RHR and RR showed no change from baseline after either vaccine dose. Sleep duration was increased up to 4 days post vaccination, after an initial decrease on day 1. Increased sleep duration prior to vaccination was associated with a greater change in HRV. Local and systemic reactogenicity was more severe after dose two. Conclusions: This is the first observational study of the physiologic response to any of the novel COVID-19 vaccines as measured using wearable devices. Using this relatively small healthy cohort, we provide evidence that HRV decreases in response to both vaccine doses, with no significant changes in RHR or RR. Sleep duration initially decreased following each dose with a subsequent increase thereafter. Future studies with a larger sample size and comparison to other inflammatory and immune biomarkers such as antibody response will be needed to determine the true utility of this type of continuous wearable monitoring in regards to vaccine responses. Our data raises the possibility that increased sleep prior to vaccination may impact physiologic responses and may be a modifiable way to increase vaccine response. These results may inform future studies using wearables for monitoring vaccine responses. Trial Registration: ClinicalTrials.gov NCT04304703; https://www.clinicaltrials.gov/ct2/show/NCT04304703 %M 34236995 %R 10.2196/28568 %U https://formative.jmir.org/2021/8/e28568 %U https://doi.org/10.2196/28568 %U http://www.ncbi.nlm.nih.gov/pubmed/34236995 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 8 %P e28947 %T Evaluating Epidemiological Risk by Using Open Contact Tracing Data: Correlational Study %A Piotto,Stefano %A Di Biasi,Luigi %A Marrafino,Francesco %A Concilio,Simona %+ Department of Pharmacy, University of Salerno, Via Giovanni Paolo II, 132, Fisciano, 84084, Italy, 39 3204230068, piotto@unisa.it %K SARS-CoV-2 %K COVID-19 %K contact tracing %K Bluetooth Low Energy %K transmission dynamics %K infection spread %K mobile apps %K mHealth %K digital apps %K mobile phone %D 2021 %7 2.8.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: During the 2020s, there has been extensive debate about the possibility of using contact tracing (CT) to contain the SARS-CoV-2 pandemic, and concerns have been raised about data security and privacy. Little has been said about the effectiveness of CT. In this paper, we present a real data analysis of a CT experiment that was conducted in Italy for 8 months and involved more than 100,000 CT app users. Objective: We aimed to discuss the technical and health aspects of using a centralized approach. We also aimed to show the correlation between the acquired contact data and the number of SARS-CoV-2–positive cases. Finally, we aimed to analyze CT data to define population behaviors and show the potential applications of real CT data. Methods: We collected, analyzed, and evaluated CT data on the duration, persistence, and frequency of contacts over several months of observation. A statistical test was conducted to determine whether there was a correlation between indices of behavior that were calculated from the data and the number of new SARS-CoV-2 infections in the population (new SARS-CoV-2–positive cases). Results: We found evidence of a correlation between a weighted measure of contacts and the number of new SARS-CoV-2–positive cases (Pearson coefficient=0.86), thereby paving the road to better and more accurate data analyses and spread predictions. Conclusions: Our data have been used to determine the most relevant epidemiological parameters and can be used to develop an agent-based system for simulating the effects of restrictions and vaccinations. Further, we demonstrated our system's ability to identify the physical locations where the probability of infection is the highest. All the data we collected are available to the scientific community for further analysis. %M 34227997 %R 10.2196/28947 %U https://www.jmir.org/2021/8/e28947 %U https://doi.org/10.2196/28947 %U http://www.ncbi.nlm.nih.gov/pubmed/34227997 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 7 %P e30709 %T Online-Delivered Group and Personal Exercise Programs to Support Low Active Older Adults’ Mental Health During the COVID-19 Pandemic: Randomized Controlled Trial %A Beauchamp,Mark R %A Hulteen,Ryan M %A Ruissen,Geralyn R %A Liu,Yan %A Rhodes,Ryan E %A Wierts,Colin M %A Waldhauser,Katrina J %A Harden,Samantha H %A Puterman,Eli %+ School of Kinesiology, University of British Columbia, 6081 University Blvd, Vancouver, BC, V6T 1Z1, Canada, 1 604 822 4864, mark.beauchamp@ubc.ca %K COVID-19 %K randomized trial %K mental health %K physical activity %D 2021 %7 30.7.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: In response to the COVID-19 pandemic, experts in mental health science emphasized the importance of developing and evaluating approaches to support and maintain the mental health of older adults. Objective: The aim of this study was to assess whether a group-based exercise program relative to a personal exercise program (both delivered online) and waitlist control (WLC) can improve the psychological health of previously low active older adults during the early stages of the COVID-19 pandemic. Methods: The Seniors COVID-19 Pandemic and Exercise (SCOPE) trial was a 3-arm, parallel randomized controlled trial conducted between May and September 2020 in which low active older adults (aged ≥65 years) were recruited via media outlets and social media. After baseline assessments, consented participants were randomized to one of two 12-week exercise programs (delivered online by older adult instructors) or a WLC condition. A total of 241 older adults (n=187 women) provided baseline measures (via online questionnaires), were randomized (ngroup=80, npersonal=82, ncontrol=79), and completed measures every 2 weeks for the duration of the trial. The trial’s primary outcome was psychological flourishing. Secondary outcomes included global measures of mental and physical health, life satisfaction, and depression symptoms. Results: The results of latent growth modeling revealed no intervention effects for flourishing, life satisfaction, or depression symptoms (P>.05 for all). Participants in the group condition displayed improved mental health relative to WLC participants over the first 10 weeks (effect size [ES]=0.288-0.601), and although the week 12 effect (ES=0.375) was in the same direction the difference was not statistically significant (P=.089). Participants in the personal condition displayed improved mental health, when compared with WLC participants, in the same medium ES range (ES=0.293-0.565) over the first 8 weeks, and while the effects were of a similar magnitude at weeks 10 (ES=0.455, P=.069) and 12 (ES=0.258, P=.353), they were not statistically significant. In addition, participants in the group condition displayed improvements in physical health when compared with the WLC (ES=0.079-0.496) across all 12 weeks of the study following baseline. No differences were observed between the personal exercise condition and WLC for physical health (slope P=.271). Conclusions: There were no intervention effects for the trial’s primary outcome (ie, psychological flourishing). It is possible that the high levels of psychological flourishing at baseline may have limited the extent to which those indicators could continue to improve further through intervention (ie, potential ceiling effects). However, the intervention effects for mental and physical health point to the potential capacity of low-cost and scalable at-home programs to support the mental and physical health of previously inactive adults in the COVID-19 pandemic. Trial Registration: ClinicalTrials.gov NCT04412343; https://clinicaltrials.gov/ct2/show/NCT04412343 %M 34328433 %R 10.2196/30709 %U https://www.jmir.org/2021/7/e30709 %U https://doi.org/10.2196/30709 %U http://www.ncbi.nlm.nih.gov/pubmed/34328433 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 7 %P e28888 %T The Influence of COVID-19 Information Sources on the Attitudes and Practices Toward COVID-19 Among the General Public of Saudi Arabia: Cross-sectional Online Survey Study %A Alshareef,Noor %A Yunusa,Ismaeel %A Al-Hanawi,Mohammed Khaled %+ Department of Health Services and Hospital Administration, Faculty of Economics and Administration, King Abdulaziz University, University Building 125 Faculties Street, Jeddah, 80200, Saudi Arabia, 966 556522222, mkalhanawi@kau.edu.sa %K attitudes %K communications media %K COVID-19 %K information-seeking behavior %K pandemics %K practices %K Saudi Arabia %K social media %K sources %D 2021 %7 30.7.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The COVID-19 pandemic has resulted in panic among the general public, leading many people to seek out information related to COVID-19 through various sources, including social media and traditional media. Identifying public preferences for obtaining such information may help health authorities to effectively plan successful health preventive and educational intervention strategies. Objective: The aim of this study was to examine the impact of the types of sources used for obtaining COVID-19 information on the attitudes and practices of the general public in Saudi Arabia during the pandemic, and to identify the socioeconomic and demographic factors associated with the use of different sources of information. Methods: This study used data from a cross-sectional online survey conducted on residents of Saudi Arabia from March 20 to 24, 2020. Data were analyzed using descriptive, bivariate, and multivariable logistic regression analyses. Bivariate analysis of categorical variables was performed to determine the associations between information sources and socioeconomic and demographic factors. Multivariable logistic regression analyses were employed to examine whether socioeconomic and demographic variables were associated with the source of information used to obtain information about COVID-19. Moreover, univariable and multivariable logistic regression analyses were conducted to examine how sources of information influence attitudes and practices of adhering to preventive measures. Results: In this analysis of cross-sectional survey data, 3358 participants were included. Most participants reported using social media, followed by the Ministry of Health (MOH) of the Kingdom of Saudi Arabia, as their primary source of information. Seeking information via social media was significantly associated with lower odds of having an optimistic attitude (adjusted odds ratio [aOR] 0.845, 95% CI 0.733-0.974; P=.02) and adhering to preventive measures (aOR 0.725, 95% CI 0.630-0.835; P<.001) compared to other sources of information. Participants who obtained their COVID-19 information via the MOH had greater odds of having an optimistic attitude (aOR 1.437, 95% CI 1.234-1.673; P<.001) and adhering to preventive measures (aOR 1.393, 95% CI 1.201-1.615; P<.001) than those who obtained information via other sources. Conclusions: This study provides evidence that different sources of information influence attitudes and preventive actions differently within a pandemic crisis context. Health authorities in Saudi Arabia should pay attention to the use of appropriate social media channels and sources to allow for more effective dissemination of critical information to the public. %M 34081610 %R 10.2196/28888 %U https://publichealth.jmir.org/2021/7/e28888 %U https://doi.org/10.2196/28888 %U http://www.ncbi.nlm.nih.gov/pubmed/34081610 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 7 %P e27618 %T Public Awareness and Utilization of 937-Telephone Health Services in the Kingdom of Saudi Arabia Before and During the COVID-19 Pandemic: Longitudinal Study %A Al-Rayes,Saja A %A Alumran,Arwa %A Aljabri,Duaa %A Aljaffary,Afnan %A Aldoukhi,Ethar %A Alahmedalyousif,Zainab %A Al Madani,Reem %+ Health Information Management and Technology Department, College of Public Health, Imam Abdulrahman bin Faisal University, King Faisal Road, Dammam, Saudi Arabia, 966 1333333766, aaljaffari@iau.edu.sa %K awareness %K COVID-19 %K Kingdom of Saudi Arabia %K telehealth %K telemedicine %K utilization %D 2021 %7 30.7.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Telehealth plays a key role in supporting health care systems and influencing methods of health care delivery. Government laws and medical operating protocols have been largely modified to provide remote care to reduce social contact and ensure a safer patient environment. In the Kingdom of Saudi Arabia (KSA), the Ministry of Health (MOH) introduced several forms of telemedicine as alternatives to face-to-face consultations in clinical settings. Objective: This study aimed to assess the awareness and utilization of telehealth services before and during the COVID-19 outbreak in the KSA. Methods: In this longitudinal study, we compared the awareness and utilization of 937-telephone health services (ie, a toll-free telephone service to provide medical and administrative health care services at any time for the population) before and during the COVID-19 outbreak in the KSA. Using a convenience sampling technique, a validated web-based questionnaire was distributed on social media platforms (Facebook, Twitter, and WhatsApp) at 2 timepoints: before (February 2019) and during (May 2020) the COVID-19 pandemic. Results: The study sample comprised a total of 1961 participants who completed the questionnaire before (n=1303, 66%) and during (n=658, 33%) the COVID-19 pandemic. Both awareness (before=46% vs during=78%) and utilization (before=42% vs during=48%) of the 937-telephone health services increased significantly during the pandemic (P<.001). No significant association of the awareness or utilization of 937-telephone health services before and during the COVID-19 pandemic was found with respect to the participants’ age, education level, having children, or having any chronic disease. Conclusions: Our findings indicate significant increases in the awareness and utilization of 937-telephone health services during the early days of the COVID-19 pandemic, suggesting an increase in public acceptance of the service and providing evidence of an equitable telemedicine service for the population. Further studies are needed to provide a deeper understanding of the barriers and facilitators to the use of 937-telephone health services for different groups of the population. %M 34156963 %R 10.2196/27618 %U https://www.jmir.org/2021/7/e27618 %U https://doi.org/10.2196/27618 %U http://www.ncbi.nlm.nih.gov/pubmed/34156963 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 9 %N 7 %P e29315 %T Development, Acceptance, and Concerns Surrounding App-Based Services to Overcome the COVID-19 Outbreak in South Korea: Web-Based Survey Study %A Park,Jihwan %A Han,Jinhyun %A Kim,Yerin %A Rho,Mi Jung %+ Department of Urology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-Gu, Seoul, 06591, Republic of Korea, 82 222585905, romy1018@naver.com %K COVID-19 %K app-based services %K acceptance %K concerns %K epidemiological investigation, self-route management app, privacy %D 2021 %7 30.7.2021 %9 Original Paper %J JMIR Med Inform %G English %X Background: Since the COVID-19 outbreak, South Korea has been engaged in various efforts to overcome the pandemic. One of them is to provide app-based COVID-19–related services to the public. As the pandemic continues, a need for various apps has emerged, including COVID-19 apps that can support activities aimed at overcoming the COVID-19 pandemic. Objective: We aimed to determine which apps were considered the most necessary according to users and evaluate the current status of the development of COVID-19–related apps in South Korea. We also aimed to determine users’ acceptance and concerns related to using apps to support activities to combat COVID-19. Methods: We collected data from 1148 users from a web-based survey conducted between November 11 and December 6, 2020. Basic statistical analysis, multiple response analysis, and the Wilcoxon rank sum test were performed using R software. We then manually classified the current status of the development of COVID-19–related apps. Results: In total, 68.4% (785/1148) of the respondents showed high willingness to protect themselves from COVID-19 by using related apps. Users considered the epidemiological investigation app to be the most necessary app (709/1148, 61.8%) overall, followed by the self-management app for self-isolation (613/1148, 53.4%), self-route management app (605/1148, 52.7%), COVID-19 symptom management app (483/1148, 42.1%), COVID-19–related information provision app (339/1148, 29.5%), and mental health management app (270/1148, 23.5%). Despite the high intention to use these apps, users were also concerned about privacy issues and media exposure. Those who had an underlying disease and had experience using COVID-19–related apps showed significantly higher intentions to use those apps (P=.05 and P=.01, respectively). Conclusions: Targeting users is very important in order to design and develop the most necessary apps. Furthermore, to gain the public’s trust and make the apps available to as many people as possible, it is vital to develop diverse apps in which privacy protection is maximized. %M 34137726 %R 10.2196/29315 %U https://medinform.jmir.org/2021/7/e29315 %U https://doi.org/10.2196/29315 %U http://www.ncbi.nlm.nih.gov/pubmed/34137726 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 9 %N 7 %P e29195 %T Social Media Opinions on Working From Home in the United States During the COVID-19 Pandemic: Observational Study %A Xiong,Ziyu %A Li,Pin %A Lyu,Hanjia %A Luo,Jiebo %+ University of Rochester, 3101 Wegmans Hall, Rochester, NY, 14627, United States, 1 585 276 5784, jluo@cs.rochester.edu %K characterization %K COVID-19 %K social media %K topic modeling %K Twitter %K work from home %D 2021 %7 30.7.2021 %9 Original Paper %J JMIR Med Inform %G English %X Background: Since March 2020, companies nationwide have started work from home (WFH) owing to the rapid increase of confirmed COVID-19 cases in an attempt to help prevent the disease from spreading and to rescue the economy from the pandemic. Many organizations have conducted surveys to understand people’s opinions toward WFH. However, the findings are limited owing to a small sample size and the dynamic topics over time. Objective: This study aims to understand public opinions regarding WFH in the United States during the COVID-19 pandemic. Methods: We conducted a large-scale social media study using Twitter data to portray different groups of individuals who have positive or negative opinions on WFH. We performed an ordinary least squares regression analysis to investigate the relationship between the sentiment about WFH and user characteristics including gender, age, ethnicity, median household income, and population density. To better understand the public opinion, we used latent Dirichlet allocation to extract topics and investigate how tweet contents are related to people’s attitude. Results: On performing ordinary least squares regression analysis using a large-scale data set of publicly available Twitter posts (n=28,579) regarding WFH during April 10-22, 2020, we found that the sentiment on WFH varies across user characteristics. In particular, women tend to be more positive about WFH (P<.001). People in their 40s are more positive toward WFH than those in other age groups (P<.001). People from high-income areas are more likely to have positive opinions about WFH (P<.001). These nuanced differences are supported by a more fine-grained topic analysis. At a higher level, we found that the most negative sentiment about WFH roughly corresponds to the discussion on government policy. However, people express a more positive sentiment when discussing topics on “remote work or study” and “encouragement.” Furthermore, topic distributions vary across different user groups. Women pay more attention to family activities than men (P<.05). Older people talk more about work and express a more positive sentiment regarding WFH. Conclusions: This paper presents a large-scale social media–based study to understand the public opinion on WFH in the United States during the COVID-19 pandemic. We hope that this study can contribute to policymaking both at the national and institution or company levels to improve the overall population’s experience with WFH. %M 34254941 %R 10.2196/29195 %U https://medinform.jmir.org/2021/7/e29195 %U https://doi.org/10.2196/29195 %U http://www.ncbi.nlm.nih.gov/pubmed/34254941 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 7 %P e31013 %T Practitioners’ and Policymakers’ Successes, Challenges, Innovations, and Learning in Promoting Children’s Well-being During COVID-19: Protocol for a Multinational Smartphone App Survey %A Davidson,Jennifer C %A Karadzhov,Dimitar %A Wilson,Graham %+ Institute for Inspiring Children's Futures, School of Social Work and Social Policy, University of Strathclyde, Curran Building, Level 6, 94 Cathedral Street, Glasgow, G4 0LG, United Kingdom, 44 141 444 8513, jennifer.davidson@strath.ac.uk %K mobile phones %K smartphone app %K qualitative %K mixed method %K international %K survey %K service providers %K policy %K practice %K children’s rights %K well-being %K COVID-19 %K pandemic %K app %K mHealth %K children %D 2021 %7 29.7.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: The advent of COVID-19 abruptly thrust the health and safety of children and families into greater risk around the world. As regional and local governments, nongovernmental organizations, communities, families, and children grapple with the immediate public health impact of COVID-19, the rights and well-being of children, especially those who are already marginalized, have been overlooked. Those working with children have likely encountered unprecedented challenges and responded in innovative ways in efforts to address the needs and rights of all children. Objective: This paper presents a protocol for a large-scale, multinational study using a new smartphone app to capture the real-time experiences and perspectives of practitioners and policymakers supporting children and families during the COVID-19 pandemic around the globe in relation to a children’s human rights 4P framework of protection, provision, prevention, and participation. Methods: This protocol describes a mixed methods survey utilizing a custom-built iOS and Android smartphone app called the COVID 4P Log for Children’s Wellbeing, which was developed in close consultation with 17 international key partner organizations. Practitioners and policymakers working with and for children’s well-being across 29 countries and 5 continents were invited to download the app and respond to questions over the course of 8 weeks. The anticipated large amount of qualitative and quantitative response data will be analyzed using content analysis, descriptive statistics, and word frequencies. Results: Formal data collection took place from October 2020 until March 2021. Data analysis was completed in July 2021. Conclusions: The findings will directly inform the understanding of the ways in which COVID-19 has impacted practitioners’, managers’, and policymakers’ efforts to support children’s well-being in their practices, services, and policies, respectively. Innovative and ambitious in its scope and use of smartphone technology, this project also aims to inform and inspire future multinational research using app-based methodologies—the demand for which is likely to continue to dramatically rise in the COVID-19 era. Mitigating the risks of longitudinal remote data collection will help maximize the acceptability of the app, respondents’ sustained engagement, and data quality. International Registered Report Identifier (IRRID): DERR1-10.2196/31013 %M 34323850 %R 10.2196/31013 %U https://www.researchprotocols.org/2021/7/e31013 %U https://doi.org/10.2196/31013 %U http://www.ncbi.nlm.nih.gov/pubmed/34323850 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 7 %P e29952 %T Measuring the Impact of COVID-19 on Siyan Mental Health Patients Using the Epidemic-Pandemic Impacts Inventory: Survey Study %A Shah,Anish %A Darling,Michele %A Arstein-Kerslake,Olivia %A Morgan,Tiffany %A Vance Tovrea,Aubreen %A Young,James %A Laines,Helen %+ Siyan Clinical Corporation, 480 Tesconi Cir B, Santa Rosa, CA, 95401, United States, 1 707 206 7273, ashah@siyanclinical.com %K COVID-19 %K coronavirus %K pandemic %K mental health %K social isolation %K wellness %D 2021 %7 29.7.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Recent research has shown that the impacts of the COVID-19 pandemic and social isolation on people’s mental health are quite extensive, but there are limited studies on the effects of the pandemic on patients with mental health disorders. Objective: The objective of this study was to assess the negative impacts of the COVID-19 pandemic on individuals who have previously sought treatment for a mental health disorder. Methods: This study uses the newly developed Epidemic-Pandemic Impacts Inventory (EPII) survey. This tool was designed to assess tangible impacts of epidemics and pandemics across personal and social life domains. From November 9, 2020, to February 18, 2021, a total of 245 adults recruited from a mental health clinic completed the consent form and responded to the survey link from the Siyan Clinical Corporation and Siyan Clinical Research practices located in Santa Rosa, California, USA. Results: We found that the least affected age group included individuals aged 75 years or older. This was followed closely by the 65- to 75-year-old age group. People with children under the age of 18 years also reported both more negative indicators associated with the pandemic and more positive indicators compared to those without children at home. Gender queer, nonconforming, and transgender individuals may also be at higher risk for more negative impacts associated with the pandemic. When respondents were assessed with regard to their mental health diagnosis, no differences were noted. Substance use also increased during the pandemic. Conclusions: In conclusion, the data collected here may serve as foundational research in the prevention, care, and treatment of mental health disorders during pandemics such as COVID-19. Populations such as those with previously diagnosed mental health disorders are particularly at risk for negative effects of pandemic-related stressors such as social isolation, especially if they have children in the household, are part of a younger age group, or have substance use disorder. Gender may also be a factor. Further, the EPII survey may prove to be a useful tool in understanding these effects. Overall, these data may be a critical step toward understanding the effects of the COVID-19 pandemic on populations with a mental health diagnosis, which may aid mental health practitioners in understanding the consequences of pandemics on their patients’ overall well-being. Trial Registration: ClinicalTrials.gov NCT04568135; https://clinicaltrials.gov/ct2/show/NCT04568135 %M 34323851 %R 10.2196/29952 %U https://formative.jmir.org/2021/7/e29952 %U https://doi.org/10.2196/29952 %U http://www.ncbi.nlm.nih.gov/pubmed/34323851 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 7 %P e26187 %T Tele–Mental Health for Reaching Out to Patients in a Time of Pandemic: Provider Survey and Meta-analysis of Patient Satisfaction %A Mazziotti,Raffaele %A Rutigliano,Grazia %+ Department of Pathology, University of Pisa, via Savi, 10, Pisa, 56126, Italy, 39 3496117744, grazia.rutigliano.gr@gmail.com %K telepsychiatry %K telepsychology %K e-mental health %K document clustering %K survey %K COVID-19 %K access to care %K patient satisfaction %K mental health %K tele–mental health %K review %K telemedicine %K satisfaction %K access %D 2021 %7 29.7.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: The COVID-19 pandemic threatened to impact mental health by disrupting access to care due to physical distance measures and the unexpected pressure on public health services. Tele–mental health was rapidly implemented to deliver health care services. Objective: The aims of this study were (1) to present state-of-the-art tele–mental health research, (2) to survey mental health providers about care delivery during the pandemic, and (3) to assess patient satisfaction with tele–mental health. Methods: Document clustering was applied to map research topics within tele–mental health research. A survey was circulated among mental health providers. Patient satisfaction was investigated through a meta-analysis of studies that compared satisfaction scores between tele–mental health and face-to-face interventions for mental health disorders, retrieved from Web of Knowledge and Scopus. Hedges g was used as the effect size measure, and effect sizes were pooled using a random-effect model. Sources of heterogeneity and bias were examined. Results: Evidence on tele–mental health has been accumulating since 2000, especially regarding service implementation, depressive or anxiety disorders, posttraumatic stress disorder, and special populations. Research was concentrated in a few countries. The survey (n=174 respondents from Italy, n=120 international) confirmed that, after the onset of COVID-19 outbreak, there was a massive shift from face-to-face to tele–mental health delivery of care. However, respondents held skeptical views about tele–mental health and did not feel sufficiently trained and satisfied. Meta-analysis of 29 studies (n=2143) showed that patients would be equally satisfied with tele–mental health as they are with face-to-face interventions (Hedges g=−0.001, 95% CI −0.116 to 0.114, P=.98, Q=43.83, I2=36%, P=.03) if technology-related issues were minimized. Conclusions: Mental health services equipped with tele–mental health will be better able to cope with public health crises. Both providers and patients need to be actively engaged in digitization, to reshape their reciprocal trust around technological innovations. %M 34114956 %R 10.2196/26187 %U https://mental.jmir.org/2021/7/e26187 %U https://doi.org/10.2196/26187 %U http://www.ncbi.nlm.nih.gov/pubmed/34114956 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 1 %N 1 %P e30971 %T Infodemic Signal Detection During the COVID-19 Pandemic: Development of a Methodology for Identifying Potential Information Voids in Online Conversations %A Purnat,Tina D %A Vacca,Paolo %A Czerniak,Christine %A Ball,Sarah %A Burzo,Stefano %A Zecchin,Tim %A Wright,Amy %A Bezbaruah,Supriya %A Tanggol,Faizza %A Dubé,Ève %A Labbé,Fabienne %A Dionne,Maude %A Lamichhane,Jaya %A Mahajan,Avichal %A Briand,Sylvie %A Nguyen,Tim %+ Emergency Preparedness, World Health Organization, 20 Avenue Appia, Geneva, 1211, Switzerland, 41 (0)227912111, czerniakc@who.int %K infodemic %K COVID-19 %K infodemic management %K social listening %K social monitoring %K social media %K pandemic preparedness %K pandemic response %K risk communication %K information voids %K data deficits %K information overload %D 2021 %7 28.7.2021 %9 Original Paper %J JMIR Infodemiology %G English %X Background: The COVID-19 pandemic has been accompanied by an infodemic: excess information, including false or misleading information, in digital and physical environments during an acute public health event. This infodemic is leading to confusion and risk-taking behaviors that can be harmful to health, as well as to mistrust in health authorities and public health responses. The World Health Organization (WHO) is working to develop tools to provide an evidence-based response to the infodemic, enabling prioritization of health response activities. Objective: In this work, we aimed to develop a practical, structured approach to identify narratives in public online conversations on social media platforms where concerns or confusion exist or where narratives are gaining traction, thus providing actionable data to help the WHO prioritize its response efforts to address the COVID-19 infodemic. Methods: We developed a taxonomy to filter global public conversations in English and French related to COVID-19 on social media into 5 categories with 35 subcategories. The taxonomy and its implementation were validated for retrieval precision and recall, and they were reviewed and adapted as language about the pandemic in online conversations changed over time. The aggregated data for each subcategory were analyzed on a weekly basis by volume, velocity, and presence of questions to detect signals of information voids with potential for confusion or where mis- or disinformation may thrive. A human analyst reviewed and identified potential information voids and sources of confusion, and quantitative data were used to provide insights on emerging narratives, influencers, and public reactions to COVID-19–related topics. Results: A COVID-19 public health social listening taxonomy was developed, validated, and applied to filter relevant content for more focused analysis. A weekly analysis of public online conversations since March 23, 2020, enabled quantification of shifting interests in public health–related topics concerning the pandemic, and the analysis demonstrated recurring voids of verified health information. This approach therefore focuses on the detection of infodemic signals to generate actionable insights to rapidly inform decision-making for a more targeted and adaptive response, including risk communication. Conclusions: This approach has been successfully applied to identify and analyze infodemic signals, particularly information voids, to inform the COVID-19 pandemic response. More broadly, the results have demonstrated the importance of ongoing monitoring and analysis of public online conversations, as information voids frequently recur and narratives shift over time. The approach is being piloted in individual countries and WHO regions to generate localized insights and actions; meanwhile, a pilot of an artificial intelligence–based social listening platform is using this taxonomy to aggregate and compare online conversations across 20 countries. Beyond the COVID-19 pandemic, the taxonomy and methodology may be adapted for fast deployment in future public health events, and they could form the basis of a routine social listening program for health preparedness and response planning. %M 34447926 %R 10.2196/30971 %U https://infodemiology.jmir.org/2021/1/e30971 %U https://doi.org/10.2196/30971 %U http://www.ncbi.nlm.nih.gov/pubmed/34447926 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 7 %P e27992 %T Clinical Utility and Functionality of an Artificial Intelligence–Based App to Predict Mortality in COVID-19: Mixed Methods Analysis %A Abdulaal,Ahmed %A Patel,Aatish %A Al-Hindawi,Ahmed %A Charani,Esmita %A Alqahtani,Saleh A %A Davies,Gary W %A Mughal,Nabeela %A Moore,Luke Stephen Prockter %+ National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, Commonwealth Building 8th Floor, Du Cane Road, London, W12 0NN, United Kingdom, 44 2033158273, l.moore@imperial.ac.uk %K app %K artificial intelligence %K coronavirus %K COVID-19 %K development %K function %K graphical user interface %K machine learning %K model %K mortality %K neural network %K prediction %K usability %K utility %D 2021 %7 28.7.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The artificial neural network (ANN) is an increasingly important tool in the context of solving complex medical classification problems. However, one of the principal challenges in leveraging artificial intelligence technology in the health care setting has been the relative inability to translate models into clinician workflow. Objective: Here we demonstrate the development of a COVID-19 outcome prediction app that utilizes an ANN and assesses its usability in the clinical setting. Methods: Usability assessment was conducted using the app, followed by a semistructured end-user interview. Usability was specified by effectiveness, efficiency, and satisfaction measures. These data were reported with descriptive statistics. The end-user interview data were analyzed using the thematic framework method, which allowed for the development of themes from the interview narratives. In total, 31 National Health Service physicians at a West London teaching hospital, including foundation physicians, senior house officers, registrars, and consultants, were included in this study. Results: All participants were able to complete the assessment, with a mean time to complete separate patient vignettes of 59.35 (SD 10.35) seconds. The mean system usability scale score was 91.94 (SD 8.54), which corresponds to a qualitative rating of “excellent.” The clinicians found the app intuitive and easy to use, with the majority describing its predictions as a useful adjunct to their clinical practice. The main concern was related to the use of the app in isolation rather than in conjunction with other clinical parameters. However, most clinicians speculated that the app could positively reinforce or validate their clinical decision-making. Conclusions: Translating artificial intelligence technologies into the clinical setting remains an important but challenging task. We demonstrate the effectiveness, efficiency, and system usability of a web-based app designed to predict the outcomes of patients with COVID-19 from an ANN. %M 34115603 %R 10.2196/27992 %U https://formative.jmir.org/2021/7/e27992 %U https://doi.org/10.2196/27992 %U http://www.ncbi.nlm.nih.gov/pubmed/34115603 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 7 %P e28905 %T Assessment of Preparedness for Remote Teaching and Learning to Transform Health Professions Education in Sub-Saharan Africa in Response to the COVID-19 Pandemic: Protocol for a Mixed Methods Study With a Case Study Approach %A Kagawa,Mike Nantamu %A Chipamaunga,Shalote %A Prozesky,Detlef %A Kafumukache,Elliot %A Gwini,Rudo %A Kandawasvika,Gwendoline %A Katowa-Mukwato,Patricia %A Masanganise,Rangarirai %A Pretorius,Louise %A Wessels,Quenton %A Dithole,Kefalotse S %A Marimo,Clemence %A Mubuuke,Aloysius Gonzaga %A Mbalinda,Scovia Nalugo %A van der Merwe,Lynette %A Nyoni,Champion N %+ Department of Obstetrics and Gynaecology, School of Medicine, Makerere University College of Health Sciences, PO Box 7072, Kampala, 256, Uganda, 256 0772449313, kagawanm@gmail.com %K Africa %K COVID-19 %K emergency remote teaching %K formal online learning %K pandemic %D 2021 %7 28.7.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: The current COVID-19 pandemic is affecting all aspects of society worldwide. To combat the pandemic, measures such as face mask–wearing, hand-washing and -sanitizing, movement restrictions, and social distancing have been introduced. These measures have significantly disrupted education, particularly health professions education, which depends on student-patient contact for the development of clinical competence. The wide-ranging consequences of the pandemic are immense, and health professions education institutions in sub-Saharan Africa have not been spared. Objective: This paper describes a protocol for assessing the preparedness of selected health professions education institutions in sub-Saharan Africa for remote teaching and learning during the COVID-19 pandemic. Methods: A mixed-methods design with a case study approach will be used. The awareness, desire, knowledge, ability, and reinforcement model of change was selected as the conceptual framework to guide the study. Eight higher education institutions in 6 sub-Saharan countries have participated in this study. Data will be collected through electronic surveys from among whole populations of academic staff, students, and administrators in undergraduate medicine and nursing programs. Qualitative and quantitative data from each institution will be analyzed as a case study, which will yield an inventory of similar cases grouped for comparison. Quantitative data will be analyzed for each institution and then compared to determine associations among variables and differences among programs, institutions, or countries. Results: Our findings will provide information to higher education institutions, particularly those offering health professions education programs, in Africa regarding the preparedness for remote teaching and learning to influence efforts related to web-based teaching and learning, which is envisaged to become the new normal in the future. Conclusions: This study has not received any funding, and any costs involved were borne by individual consortium members at the various institutions. Ethics approval from the institutional review board was obtained at various times across the participating sites, which were free to commence data collection as soon as approval was obtained. Data collection was scheduled to begin on October 1, 2020, and end on February 28, 2021. As of this submission, data collection has been completed, and a total of 1099 participants have been enrolled. Data analysis has not yet commenced. International Registered Report Identifier (IRRID): DERR1-10.2196/28905 %M 34254943 %R 10.2196/28905 %U https://www.researchprotocols.org/2021/7/e28905 %U https://doi.org/10.2196/28905 %U http://www.ncbi.nlm.nih.gov/pubmed/34254943 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 7 %P e29060 %T The Effect of a Wordless, Animated, Social Media Video Intervention on COVID-19 Prevention: Online Randomized Controlled Trial %A Vandormael,Alain %A Adam,Maya %A Greuel,Merlin %A Gates,Jennifer %A Favaretti,Caterina %A Hachaturyan,Violetta %A Bärnighausen,Till %+ Heidelberg Institute of Global Health, Heidelberg University, 130.3 Im Neuenheimer Feld, Heidelberg, 69120, Germany, 49 163 481 3452, alain.vandormael@uni-heidelberg.de %K social media %K cultural and social implications %K randomized controlled trial %K list experiment %K information literacy %K COVID-19 %K pandemic %K digital health %K infodemiology %K global health %K public health %D 2021 %7 27.7.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Innovative approaches to the dissemination of evidence-based COVID-19 health messages are urgently needed to counter social media misinformation about the pandemic. To this end, we designed a short, wordless, animated global health communication video (the CoVideo), which was rapidly distributed through social media channels to an international audience. Objective: The objectives of this study were to (1) establish the CoVideo’s effectiveness in improving COVID-19 prevention knowledge, and (2) establish the CoVideo’s effectiveness in increasing behavioral intent toward COVID-19 prevention. Methods: In May and June 2020, we enrolled 15,163 online participants from the United States, Mexico, the United Kingdom, Germany, and Spain. We randomized participants to (1) the CoVideo arm, (2) an attention placebo control (APC) arm, and (3) a do-nothing arm, and presented 18 knowledge questions about preventive COVID-19 behaviors, which was our first primary endpoint. To measure behavioral intent, our second primary endpoint, we randomized participants in each arm to five list experiments. Results: Globally, the video intervention was viewed 1.2 million times within the first 10 days of its release and more than 15 million times within the first 4 months. Knowledge in the CoVideo arm was significantly higher (mean 16.95, 95% CI 16.91-16.99) than in the do-nothing (mean 16.86, 95% CI 16.83-16.90; P<.001) arm. We observed high baseline levels of behavioral intent to perform many of the preventive behaviors featured in the video intervention. We were only able to detect a statistically significant impact of the CoVideo on one of the five preventive behaviors. Conclusions: Despite high baseline levels, the intervention was effective at boosting knowledge of COVID-19 prevention. We were only able to capture a measurable change in behavioral intent toward one of the five COVID-19 preventive behaviors examined in this study. The global reach of this health communication intervention and the high voluntary engagement of trial participants highlight several innovative features that could inform the design and dissemination of public health messages. Short, wordless, animated videos, distributed by health authorities via social media, may be an effective pathway for rapid global health communication during health crises. Trial Registration: German Clinical Trials Register DRKS00021582; https://tinyurl.com/6r4zkbbn International Registered Report Identifier (IRRID): RR2-10.1186/s13063-020-04942-7 %M 34174778 %R 10.2196/29060 %U https://publichealth.jmir.org/2021/7/e29060 %U https://doi.org/10.2196/29060 %U http://www.ncbi.nlm.nih.gov/pubmed/34174778 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 9 %N 7 %P e20994 %T Experiences With Internet Triaging of 9498 Outpatients Daily at the Largest Public Hospital in Taiwan During the COVID-19 Pandemic: Observational Study %A Lu,Ding-Heng %A Hsu,Chia-An %A Yuan,Eunice J %A Fen,Jun-Jeng %A Lee,Chung-Yuan %A Ming,Jin-Lain %A Chen,Tzeng-Ji %A Lee,Wui-Chiang %A Chen,Shih-Ann %+ Information Management Office, Taipei Veterans General Hospital, No 201, Sec 2, Shih-Pai Road, Taipei, 11217, Taiwan, 886 2 2871 2121, fenjj@vghtpe.gov.tw %K COVID-19 %K hospital %K information services %K outpatients %K patient %K SARS-CoV-2 %K triage %K virus %D 2021 %7 27.7.2021 %9 Original Paper %J JMIR Med Inform %G English %X Background: During pandemics, acquiring outpatients’ travel, occupation, contact, and cluster histories is one of the most important measures in assessing the disease risk among incoming patients. Previous means of acquiring this information in the examination room have been insufficient in preventing disease spread. Objective: This study aimed to demonstrate the deployment of an automatic system to triage outpatients over the internet. Methods: An automatic system was incorporated in the existing web-based appointment system of the hospital and deployed along with its on-site counterpart. Automatic queries to the virtual private network travel and contact history database with each patient’s national ID number were made for each attempt to acquire the patient’s travel and contact histories. Patients with relevant histories were denied registration or entry. Text messages were sent to patients without a relevant history for an expedited route of entry if applicable. Results: A total of 127,857 visits were recorded. Among all visits, 91,195 were registered on the internet. In total, 71,816 of them generated text messages for an expedited route of entry. Furthermore, 65 patients had relevant histories, as revealed by the virtual private network database, and were denied registration or entry. Conclusions: An automatic triage system to acquire outpatients’ relevant travel and contact histories was deployed rapidly in one of the largest academic medical centers in Taiwan. The updated system successfully denied patients with relevant travel or contact histories entry to the hospital, thus preventing long lines outside the hospital. Further efforts could be made to integrate the system with the electronic medical record system. %M 34043524 %R 10.2196/20994 %U https://medinform.jmir.org/2021/7/e20994 %U https://doi.org/10.2196/20994 %U http://www.ncbi.nlm.nih.gov/pubmed/34043524 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 9 %N 3 %P e26520 %T Extended Reality for Enhanced Telehealth During and Beyond COVID-19: Viewpoint %A Ong,Triton %A Wilczewski,Hattie %A Paige,Samantha R %A Soni,Hiral %A Welch,Brandon M %A Bunnell,Brian E %+ Doxy.me, LLC, 3445 Winton Place, Suite #114, Rochester, NY, 14623, United States, 1 1844436996, triton.ong@doxy.me %K extended reality %K virtual reality %K augmented reality %K mixed reality %K telehealth %K telemedicine %K COVID-19 %K telepresence %D 2021 %7 26.7.2021 %9 Viewpoint %J JMIR Serious Games %G English %X The COVID-19 pandemic caused widespread challenges and revealed vulnerabilities across global health care systems. In response, many health care providers turned to telehealth solutions, which have been widely embraced and are likely to become standard for modern care. Immersive extended reality (XR) technologies have the potential to enhance telehealth with greater acceptability, engagement, and presence. However, numerous technical, logistic, and clinical barriers remain to the incorporation of XR technology into telehealth practice. COVID-19 may accelerate the union of XR and telehealth as researchers explore novel solutions to close social distances. In this viewpoint, we highlight research demonstrations of XR telehealth during the COVID-19 pandemic and discuss future directions to make XR the next evolution of remote health care. %M 34227992 %R 10.2196/26520 %U https://games.jmir.org/2021/3/e26520 %U https://doi.org/10.2196/26520 %U http://www.ncbi.nlm.nih.gov/pubmed/34227992 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 7 %P e29240 %T Using a Real-Time Locating System to Evaluate the Impact of Telemedicine in an Emergency Department During COVID-19: Observational Study %A Patel,Birju %A Vilendrer,Stacie %A Kling,Samantha M R %A Brown,Ian %A Ribeira,Ryan %A Eisenberg,Matthew %A Sharp,Christopher %+ Evaluation Sciences Unit, Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, 1265 Welch Road x216, Stanford, CA, 94305, United States, 1 650 723 1146, staciev@stanford.edu %K real-time locating system %K wearable electronic devices %K telemedicine %K COVID-19 %K delivery of health care %K real time %K wearable %K impact %K telehealth %K emergency department %K observational %K transmission %K risk %K infectious disease %D 2021 %7 26.7.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Telemedicine has been deployed by health care systems in response to the COVID-19 pandemic to enable health care workers to provide remote care for both outpatients and inpatients. Although it is reasonable to suspect telemedicine visits limit unnecessary personal contact and thus decrease the risk of infection transmission, the impact of the use of such technology on clinician workflows in the emergency department is unknown. Objective: This study aimed to use a real-time locating system (RTLS) to evaluate the impact of a new telemedicine platform, which permitted clinicians located outside patient rooms to interact with patients who were under isolation precautions in the emergency department, on in-person interaction between health care workers and patients. Methods: A pre-post analysis was conducted using a badge-based RTLS platform to collect movement data including entrances and duration of stay within patient rooms of the emergency department for nursing and physician staff. Movement data was captured between March 2, 2020, the date of the first patient screened for COVID-19 in the emergency department, and April 20, 2020. A new telemedicine platform was deployed on March 29, 2020. The number of entrances and duration of in-person interactions per patient encounter, adjusted for patient length of stay, were obtained for pre- and postimplementation phases and compared with t tests to determine statistical significance. Results: There were 15,741 RTLS events linked to 2662 encounters for patients screened for COVID-19. There was no significant change in the number of in-person interactions between the pre- and postimplementation phases for both nurses (5.7 vs 7.0 entrances per patient, P=.07) and physicians (1.3 vs 1.5 entrances per patient, P=.12). Total duration of in-person interactions did not change (56.4 vs 55.2 minutes per patient, P=.74) despite significant increases in telemedicine videoconference frequency (0.6 vs 1.3 videoconferences per patient, P<.001 for change in daily average) and duration (4.3 vs 12.3 minutes per patient, P<.001 for change in daily average). Conclusions: Telemedicine was rapidly adopted with the intent of minimizing pathogen exposure to health care workers during the COVID-19 pandemic, yet RTLS movement data did not reveal significant changes for in-person interactions between staff and patients under investigation for COVID-19 infection. Additional research is needed to better understand how telemedicine technology may be better incorporated into emergency departments to improve workflows for frontline health care clinicians. %M 34236993 %R 10.2196/29240 %U https://www.jmir.org/2021/7/e29240 %U https://doi.org/10.2196/29240 %U http://www.ncbi.nlm.nih.gov/pubmed/34236993 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 7 %P e28812 %T Evaluation of a Parsimonious COVID-19 Outbreak Prediction Model: Heuristic Modeling Approach Using Publicly Available Data Sets %A Gupta,Agrayan K %A Grannis,Shaun J %A Kasthurirathne,Suranga N %+ Indiana University, 107 S Indiana Ave, Bloomington, IN, 47405, United States, 1 812 855 4848, aggupta@iu.edu %K coronavirus %K COVID-19 %K emerging outbreak %K modeling disease outbreak %K precision public health %K predictive modeling %D 2021 %7 26.7.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic has changed public health policies and human and community behaviors through lockdowns and mandates. Governments are rapidly evolving policies to increase hospital capacity and supply personal protective equipment and other equipment to mitigate disease spread in affected regions. Current models that predict COVID-19 case counts and spread are complex by nature and offer limited explainability and generalizability. This has highlighted the need for accurate and robust outbreak prediction models that balance model parsimony and performance. Objective: We sought to leverage readily accessible data sets extracted from multiple states to train and evaluate a parsimonious predictive model capable of identifying county-level risk of COVID-19 outbreaks on a day-to-day basis. Methods: Our modeling approach leveraged the following data inputs: COVID-19 case counts per county per day and county populations. We developed an outbreak gold standard across California, Indiana, and Iowa. The model utilized a per capita running 7-day sum of the case counts per county per day and the mean cumulative case count to develop baseline values. The model was trained with data recorded between March 1 and August 31, 2020, and tested on data recorded between September 1 and October 31, 2020. Results: The model reported sensitivities of 81%, 92%, and 90% for California, Indiana, and Iowa, respectively. The precision in each state was above 85% while specificity and accuracy scores were generally >95%. Conclusions: Our parsimonious model provides a generalizable and simple alternative approach to outbreak prediction. This methodology can be applied to diverse regions to help state officials and hospitals with resource allocation and to guide risk management, community education, and mitigation strategies. %M 34156964 %R 10.2196/28812 %U https://www.jmir.org/2021/7/e28812 %U https://doi.org/10.2196/28812 %U http://www.ncbi.nlm.nih.gov/pubmed/34156964 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 7 %P e27982 %T Age and Social Disparities in the Use of Telemedicine During the COVID-19 Pandemic in Japan: Cross-sectional Study %A Miyawaki,Atsushi %A Tabuchi,Takahiro %A Ong,Michael K %A Tsugawa,Yusuke %+ Department of Public Health, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 1130033, Japan, 81 3 5841 3494, amiyawaki-tky@umin.ac.jp %K telemedicine %K telehealth %K disparity %K access to care %K COVID-19 %K Japan %D 2021 %7 23.7.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The use of telemedicine outpatient visits has increased dramatically during the COVID-19 pandemic in many countries. Although disparities in access to telemedicine by age and socioeconomic status (SES) have been well-documented, evidence is limited as to how these disparities changed during the COVID-19 pandemic. Moreover, the equity of patient access to telemedicine has been scarcely reported in Japan, despite the huge potential for telemedicine expansion. Objective: We aimed to investigate changes due to age and SES disparities in telemedicine use during the COVID-19 pandemic in Japan. Methods: Using data from a large internet survey conducted between August 25 and September 30, 2020, in Japan, we examined the associations of participant age and SES (educational attainment, urbanicity of residence, and income level) with their telemedicine use in the following two time periods during the pandemic: April 2020 and August-September 2020. Results: Of the 24,526 participants aged 18 to 79 years (50.8% [n=12,446] women), the proportion of individuals who reported using telemedicine increased from 2.0% (n=497) in April 2020 to 4.7% (n=1159) in August-September 2020. After adjusting for potential confounders, younger individuals were more likely to use telemedicine than older individuals in April 2020. Although this pattern persisted in August-September 2020, we also observed a substantial increase in telemedicine use among individuals aged 70 to 79 years (adjusted rates, 0.2% in April 2020 vs 3.8% in August-September 2020; P<.001 after multiple comparisons). We found disparities in telemedicine use by SES in August-September 2020 that did not exist in April 2020. In August-September 2020, individuals with a university degree were more likely to use telemedicine than those with a high school diploma or less (adjusted rates, 6.6% vs 3.5%; P<.001). Individuals living in urban areas exhibited higher rates of telemedicine use than those living in rural areas only in August-September 2020 (adjusted rates, 5.2% vs 3.8%; P<.001). Disparities in telemedicine use by income level were not observed in either time period. Conclusions: In general, younger individuals increased their use of telemedicine compared to older individuals during the pandemic, although individuals in their 70s also increased their use of telemedicine. Disparities in telemedicine use by educational attainment and urbanicity of residence widened during the COVID-19 pandemic. %M 34259641 %R 10.2196/27982 %U https://www.jmir.org/2021/7/e27982 %U https://doi.org/10.2196/27982 %U http://www.ncbi.nlm.nih.gov/pubmed/34259641 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 4 %N 3 %P e24791 %T A Global Overview of COVID-19 Research in the Pediatric Field: Bibliometric Review %A Monzani,Alice %A Tagliaferri,Francesco %A Bellone,Simonetta %A Genoni,Giulia %A Rabbone,Ivana %+ Division of Pediatrics, Department of Health Sciences, Università del Piemonte Orientale, Via Solaroli 17, Novara, 28100, Italy, 39 03213733868, alice.monzani@med.uniupo.it %K COVID-19 %K SARS-CoV-2 %K children %K pediatrics %K bibliometric review %K publications %K research %K literature %K review %D 2021 %7 23.7.2021 %9 Review %J JMIR Pediatr Parent %G English %X Background: Since the beginning of the COVID-19 pandemic, a great number of papers have been published in the pediatric field. Objective: We aimed to assess research around the globe on COVID-19 in the pediatric field by bibliometric analysis, identifying publication trends and topic dissemination and showing the relevance of publishing authors, institutions, and countries. Methods: The Scopus database was comprehensively searched for all indexed documents published between January 1, 2020, and June 11, 2020, dealing with COVID-19 in the pediatric population (0-18 years). A machine learning bibliometric methodology was applied to evaluate the total number of papers and citations, journal and publication types, the top productive institutions and countries and their scientific collaboration, and core keywords. Results: A total of 2301 papers were retrieved, with an average of 4.8 citations per article. Of this, 1078 (46.9%) were research articles, 436 (18.9%) were reviews, 363 (15.8%) were letters, 186 (8.1%) were editorials, 7 (0.3%) were conference papers, and 231 (10%) were categorized as others. The studies were published in 969 different journals, headed by The Lancet. The retrieved papers were published by a total of 12,657 authors from 114 countries. The most productive countries were the United States, China, and Italy. The four main clusters of keywords were pathogenesis and clinical characteristics (keyword occurrences: n=2240), public health issues (n=352), mental health (n=82), and therapeutic aspects (n=70). Conclusions: In the pediatric field, a large number of articles were published within a limited period on COVID-19, testifying to the rush to spread new findings on the topic in a timely manner. The leading authors, countries, and institutions evidently belonged to the most impacted geographical areas. A focus on the pediatric population was often included in general articles, and pediatric research about COVID-19 mainly focused on the clinical features, public health issues, and psychological impact of the disease. %M 34081597 %R 10.2196/24791 %U https://pediatrics.jmir.org/2021/3/e24791 %U https://doi.org/10.2196/24791 %U http://www.ncbi.nlm.nih.gov/pubmed/34081597 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 7 %N 3 %P e27010 %T Taking a Leap of Faith: A Study of Abruptly Transitioning an Undergraduate Medical Education Program to Distance-Learning Owing to the COVID-19 Pandemic %A Du Plessis,Stefan S %A Otaki,Farah %A Zaher,Shroque %A Zary,Nabil %A Inuwa,Ibrahim %A Lakhtakia,Ritu %+ College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Building 14, Dubai Health Care City, Dubai, 505055, United Arab Emirates, 971 521401101, ritu.lakhtakia@mbru.ac.ae %K action research %K change management %K COVID-19 %K curriculum content %K curriculum delivery %K distance-learning %K learning %K medical education %K pandemic %K teaching %D 2021 %7 23.7.2021 %9 Viewpoint %J JMIR Med Educ %G English %X The COVID-19 pandemic has forced universities worldwide to immediately transition to distance-learning. Although numerous studies have investigated the effect of the COVID-19 pandemic on universities in the Middle East, none have reflected on the process through which medical education programs for health professions underwent this transition. This study aimed to elucidate the rapid transition to distance-learning of an undergraduate medical program at the College of Medicine, Mohammad Bin Rashid University of Medicine and Health Sciences (Dubai, United Arab Emirates), owing to the COVID-19 pandemic. An action research approach constituted the foundation of this collaborative effort that involved investigations, reflections, and improvements of practice, through ongoing cycles of planning, acting, observing, and reflecting. Efforts of transitioning to distance-learning were grouped into four interrelated aspects: supporting faculty members in delivering the program content, managing curriculum changes, engaging with the students to facilitate distance-learning experiences, and conducting web-based assessments. Challenges included the high perceived uncertainty, need for making ad hoc decisions, lack of experiential learning and testing of clinical skills, and blurring of work-life boundaries. Our preliminary findings show the successful generation of a strong existing digital base, future prospects for innovation, and a cohesive team that was key to agility, rapid decision-making, and program implementation. %M 34227994 %R 10.2196/27010 %U https://mededu.jmir.org/2021/3/e27010 %U https://doi.org/10.2196/27010 %U http://www.ncbi.nlm.nih.gov/pubmed/34227994 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 7 %P e27865 %T Acceptability and Feasibility of the Transfer of Face-to-Face Group Therapy to Online Group Chats in a Psychiatric Outpatient Setting During the COVID-19 Pandemic: Longitudinal Observational Study %A Scholl,Julia %A Kohls,Elisabeth %A Görges,Frauke %A Steinbrecher,Marc %A Baldofski,Sabrina %A Moessner,Markus %A Rummel-Kluge,Christine %+ Department of Psychiatry and Psychotherapy, Universitätsklinikum Leipzig, Semmelweisstraße 10, Haus 13, Leipzig, 04103, Germany, 49 3419724464, Christine.Rummel-Kluge@medizin.uni-leipzig.de %K online %K group chats %K COVID-19 pandemic %K psychiatric outpatient setting %K online interventions %K e-mental health %K COVID-19 %K pandemic %K mental health %K psychoeducation %K online chat %D 2021 %7 23.7.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: At the height of the COVID-19 pandemic, several mental health care providers were obliged to shut down outpatient services, including group therapy and psychoeducational sessions. The lockdown in many countries is a serious threat to people’s mental well-being, especially for individuals with severe mental illnesses. Discontinued outpatient treatments and disruption of daily routines are considered to be risk factors for destabilization of patients with mental illness. Objective: The aim of this study was to evaluate the acceptability, usability, and feasibility of a group chat program to replace cancelled face-to-face group sessions in an outpatient psychiatric department. Methods: Participants (N=33) were recruited in the outpatient department of a large university medical center in Leipzig, Germany. Former face-to-face group participants were invited to take part in a therapist-guided group-chat for 4 weeks (8 sessions) and were asked to evaluate the program via self-administered standardized questionnaires at baseline (T0, preintervention), after every chat session (T1), and posttreatment (T2, after 4-6 weeks). The chat groups were specific to the following mental disorder diagnoses and based on the same therapeutic principles and techniques as the former face-to-face groups: anxiety, depression, obsessive-compulsive disorder, and adult attention-deficit/hyperactivity disorder (ADHD). Sociodemographic measures, attitudes toward the COVID-19 pandemic, depressive symptoms (Patient Health Questionnaire-9), quality of life (abbreviated World Health Organization Quality of Life assessment), treatment credibility/expectancy (Credibility Expectancy Questionnaire), and participants’ satisfaction (Client Satisfaction Questionnaire-8 [ZUF-8]) were measured. Results: Participants joined an average of 5 out of 8 offered chat sessions. Participation rates in the respective groups were highest in the ADHD group (8.6/11, 78%) and lowest in the anxiety group (3.7/9, 41%). The overall preintervention level of depressive symptoms was moderate and showed a slight, nonsignificant improvement at posttreatment (T0: mean 10.7, SD 5.5; T2: mean 10.2, SD 5.5). A similar result was observed regarding quality of life (T0: median 41.7-68.8; T2: median 50-70.3). Treatment credibility and expectancy scores were medium-high (T0: meancredibility 18.1, SD 3.8; meanexpectancy 11.2, SD 5.1; T2: meancredibility 17.1, SD 4.8; meanexpectancy 10.3, SD 5.8). Further, significant correlations were detected between posttreatment expectancy score and posttreatment PHQ-9 score (r=–0.41, P=.02), posttreatment physical quality of life (r=0.54, P=.001), and posttreatment psychological quality of life (r=0.53, P=.002). Overall, participants’ satisfaction with the program was very high, both after chat sessions and at posttreatment (ZUF-8: mean score 20.6, SD 1.0). Of all participants, a majority (27/31, 87%) rated the program as excellent/good and indicated they would recommend the group chat program to a friend in need of similar help (23/31, 74%). Conclusions: A therapist-guided group chat program to substitute outpatient group setting treatment during the COVID-19 lockdown was shown to be feasible, usable, and highly acceptable for participants. Web-based programs such as this one provide an easy-to-implement tool to successfully stabilize participants during a difficult time, such as the COVID-19 pandemic. Trial Registration: German Clinical Trials Register DRKS00021527; https://tinyurl.com/3btyxc2r %M 34161252 %R 10.2196/27865 %U https://formative.jmir.org/2021/7/e27865 %U https://doi.org/10.2196/27865 %U http://www.ncbi.nlm.nih.gov/pubmed/34161252 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 7 %P e25926 %T Mobile Delivery of Mindfulness-Based Smoking Cessation Treatment Among Low-Income Adults During the COVID-19 Pandemic: Pilot Randomized Controlled Trial %A Mhende,Josephine %A Bell,Sharrill A %A Cottrell-Daniels,Cherell %A Luong,Jackie %A Streiff,Micah %A Dannenfelser,Mark %A Hayat,Matthew J %A Spears,Claire Adams %+ Georgia State University, 140 Decatur Street, Suite 400, Atlanta, GA, 30303, United States, 1 404 413 9335, cspears@gsu.edu %K acceptability %K addiction %K African American %K cessation %K COVID-19 %K feasibility %K income %K low socioeconomic status %K mHealth %K mindfulness %K minority %K smoking %K SMS %K text messaging %K treatment %D 2021 %7 23.7.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Smoking is the leading cause of premature death, and low-income adults experience disproportionate burden from tobacco. Mindfulness interventions show promise for improving smoking cessation. A text messaging program “iQuit Mindfully” was developed to deliver just-in-time support for quitting smoking among low-income adults. A pilot study of iQuit Mindfully was conducted in spring 2020, during the COVID-19 pandemic, among low-income and predominantly African American smokers. Objective: This pilot study examined the acceptability and feasibility of delivering Mindfulness-Based Addiction Treatment via mHealth during the COVID-19 pandemic. Methods: Participants were adult cigarette smokers (n=23), of whom 8 (34.8%) were female, 19 (82.6%) were African American, and 18 (78.3%) had an annual income of .99; diabetes status category: P=.52, medication adjustment category: P=.65; HbA1c category: P=.69; BMI: P>.99). The 21 patients who completed the study rated a mean of 9.0 out of 10 on the Likert scale for both satisfaction questions. For the Yes-No question on benefit of the program, all of the patients selected “Yes.” Mean HbA1c decreased from 7.6% to 7.0% (P=.004). There were no severe hypoglycemia events (glucose level <3.0 mmol/L) reported. Mean weight decreased from 76.8 kg to 73.9 kg (P<.001), a mean decrease of 3.5% from baseline weight. Mean BMI decreased from 27.8 kg/m2 to 26.7 kg/m2 (P<.001). Conclusions: The personalized mHealth program was feasible, acceptable, and produced significant reductions in HbA1c (P=.004) and body weight (P<.001) in individuals with type 2 diabetes. Such mHealth programs could overcome challenges posed to chronic disease management by COVID-19, including disruptions to in-person health care access. %M 34111018 %R 10.2196/25820 %U https://diabetes.jmir.org/2021/3/e25820 %U https://doi.org/10.2196/25820 %U http://www.ncbi.nlm.nih.gov/pubmed/34111018 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 7 %P e28346 %T Changes in Language Style and Topics in an Online Eating Disorder Community at the Beginning of the COVID-19 Pandemic: Observational Study %A Feldhege,Johannes %A Moessner,Markus %A Wolf,Markus %A Bauer,Stephanie %+ Center for Psychotherapy Research, Heidelberg University Hospital, Bergheimer Strasse 54, Heidelberg, 69115, Germany, 49 622156 ext 7876, johannes.feldhege@med.uni-heidelberg.de %K COVID-19 %K eating disorders %K online eating disorder community %K language %K mental health %K social media %K LIWC %K Linguistic Inquiry and Word Count %K Reddit %K topic modeling %D 2021 %7 8.7.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: COVID-19 has affected individuals with lived experience of eating disorders (EDs), with many reporting higher psychological distress, higher prevalence of ED symptoms, and compensatory behaviors. The COVID-19 pandemic and the health and safety measures taken to contain its spread also disrupted routines and reduced access to familiar coping mechanisms, social support networks, and health care services. Social media and the ED communities on social media platforms have been an important source of support for individuals with EDs in the past. So far, it is unknown how discussions in online ED communities changed as offline support networks were disrupted and people spent more time at home in the first months of the COVID-19 pandemic. Objective: The aim of this study is to identify changes in language content and style in an online ED community during the initial onset of the COVID-19 pandemic. Methods: We extracted posts and their comments from the ED community on the social media website Reddit and concatenated them to comment threads. To analyze these threads, we applied top-down and bottom-up language analysis methods based on topic modeling with latent Dirichlet allocation and 13 indicators from the Linguistic Inquiry and Word Count program, respectively. Threads were split into prepandemic (before March 11, 2020) and midpandemic (after March 11, 2020) groups. Standardized mean differences were calculated to estimate change between pre- and midpandemic threads. Results: A total of 17,715 threads (n=8772, 49.5% prepandemic threads; n=8943, 50.5% midpandemic threads) were extracted from the ED community and analyzed. The final topic model contained 21 topics. CIs excluding zero were found for standardized mean differences of 15 topics and 9 Linguistic Inquiry and Word Count categories covering themes such as ED symptoms, mental health, treatment for EDs, cognitive processing, social life, and emotions. Conclusions: Although we observed a reduction in discussions about ED symptoms, an increase in mental health and treatment-related topics was observed at the same time. This points to a change in the focus of the ED community from promoting potentially harmful weight loss methods to bringing attention to mental health and treatments for EDs. These results together with heightened cognitive processing, increased social references, and reduced inhibition of negative emotions detected in discussions indicate a shift in the ED community toward a pro-recovery orientation. %M 34101612 %R 10.2196/28346 %U https://www.jmir.org/2021/7/e28346 %U https://doi.org/10.2196/28346 %U http://www.ncbi.nlm.nih.gov/pubmed/34101612 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 7 %P e27682 %T Overcoming the Digital Divide in the Post–COVID-19 “Reset”: Enhancing Group Virtual Visits with Community Health Workers %A Shah,Megha K %A Gibbs,Ashley Christina %A Ali,Mohammed K %A Narayan,K M Venkat %A Islam,Nadia %+ Department of Family and Preventive Medicine, School of Medicine, Emory University, 4500 N Shallowford Rd, Dunwoody, GA, 30338, United States, 1 4047786944, mkshah@emory.edu %K community health workers %K COVID-19 %K diabetes mellitus %K eHealth %K elderly %K health equity %K telemedicine %K virtual %K vulnerable populations %D 2021 %7 8.7.2021 %9 Viewpoint %J J Med Internet Res %G English %X The COVID-19 pandemic created numerous barriers to the implementation of participant-facing research. For most, the pandemic required rapid transitioning to all virtual platforms. During this pandemic, the most vulnerable populations are at highest risk of falling through the cracks of engagement in clinical care and research. Nonetheless, we argue that we should reframe the discussion to consider how this transition may create opportunities to engage extensively to reach populations. Here, we present our experience in Atlanta (Georgia, United States) in transitioning a group visit model for South Asian immigrants to a virtual platform and the pivotal role community members in the form of community health workers can play in building capacity among participants. We provide details on how this model helped address common barriers to group visit models in clinical practice and how our community health worker team innovatively addressed the digital challenges of working with an elderly population with limited English proficiency. %M 34152995 %R 10.2196/27682 %U https://www.jmir.org/2021/7/e27682 %U https://doi.org/10.2196/27682 %U http://www.ncbi.nlm.nih.gov/pubmed/34152995 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 7 %P e29942 %T The Reliability and Quality of YouTube Videos as a Source of Public Health Information Regarding COVID-19 Vaccination: Cross-sectional Study %A Chan,Calvin %A Sounderajah,Viknesh %A Daniels,Elisabeth %A Acharya,Amish %A Clarke,Jonathan %A Yalamanchili,Seema %A Normahani,Pasha %A Markar,Sheraz %A Ashrafian,Hutan %A Darzi,Ara %+ Department of Surgery & Cancer, Imperial College London, 10th floor, Queen Elizabeth Queen Mother Building, St. Mary's Hospital, South Wharf Road, London, W2 1NY, United Kingdom, 44 02033126666, vs1108@imperial.ac.uk %K COVID-19 %K infodemiology %K public health %K quality %K reliability %K social media %K vaccination %K vaccine %K video %K web-based health information %K YouTube %D 2021 %7 8.7.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Recent emergency authorization and rollout of COVID-19 vaccines by regulatory bodies has generated global attention. As the most popular video-sharing platform globally, YouTube is a potent medium for the dissemination of key public health information. Understanding the nature of available content regarding COVID-19 vaccination on this widely used platform is of substantial public health interest. Objective: This study aimed to evaluate the reliability and quality of information on COVID-19 vaccination in YouTube videos. Methods: In this cross-sectional study, the phrases “coronavirus vaccine” and “COVID-19 vaccine” were searched on the UK version of YouTube on December 10, 2020. The 200 most viewed videos of each search were extracted and screened for relevance and English language. Video content and characteristics were extracted and independently rated against Health on the Net Foundation Code of Conduct and DISCERN quality criteria for consumer health information by 2 authors. Results: Forty-eight videos, with a combined total view count of 30,100,561, were included in the analysis. Topics addressed comprised the following: vaccine science (n=18, 58%), vaccine trials (n=28, 58%), side effects (n=23, 48%), efficacy (n=17, 35%), and manufacturing (n=8, 17%). Ten (21%) videos encouraged continued public health measures. Only 2 (4.2%) videos made nonfactual claims. The content of 47 (98%) videos was scored to have low (n=27, 56%) or moderate (n=20, 42%) adherence to Health on the Net Foundation Code of Conduct principles. Median overall DISCERN score per channel type ranged from 40.3 (IQR 34.8-47.0) to 64.3 (IQR 58.5-66.3). Educational channels produced by both medical and nonmedical professionals achieved significantly higher DISCERN scores than those of other categories. The highest median DISCERN scores were achieved by educational videos produced by medical professionals (64.3, IQR 58.5-66.3) and the lowest median scores by independent users (18, IQR 18-20). Conclusions: The overall quality and reliability of information on COVID-19 vaccines on YouTube remains poor. Videos produced by educational channels, especially by medical professionals, were higher in quality and reliability than those produced by other sources, including health-related organizations. Collaboration between health-related organizations and established medical and educational YouTube content producers provides an opportunity for the dissemination of high-quality information on COVID-19 vaccination. Such collaboration holds potential as a rapidly implementable public health intervention aiming to engage a wide audience and increase public vaccination awareness and knowledge. %M 34081599 %R 10.2196/29942 %U https://publichealth.jmir.org/2021/7/e29942 %U https://doi.org/10.2196/29942 %U http://www.ncbi.nlm.nih.gov/pubmed/34081599 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 7 %P e28656 %T Social Media as a Platform for Recruitment to a National Survey During the COVID-19 Pandemic: Feasibility and Cost Analysis %A Green,Heidi %A Fernandez,Ritin %A MacPhail,Catherine %+ School of Nursing, University of Wollongong, Northfields Ave, 2522, Wollongong, Australia, 61 0412108532, Heidi.Lord@health.nsw.gov.au %K social media %K survey %K online recruitment %K COVID-19 %K pandemic %K methodology %D 2021 %7 6.7.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: With improved accessibility to social media globally, health researchers are capitalizing on social media platforms to recruit participants for research studies. This has particularly been the case during the COVID-19 pandemic, when researchers were not able to use traditional methods of recruitment. Nevertheless, there is limited evidence on the feasibility of social media for recruiting a national sample. Objective: This paper describes the use of social media as a tool for recruiting a national sample of adults to a web-based survey during the COVID-19 pandemic. Methods: Between August and October 2020, participants were recruited through Facebook via two advertisement campaigns (paid option and no-cost option) into a web-based survey exploring the relationship between social determinants of health and well-being of adults during the COVID-19 pandemic. Data were analyzed using SPSS software and Facebook metrics that were autogenerated by Facebook Ads Manager. Poststratification weights were calculated to match the Australian population on the basis of gender, age, and state or territory based on the 2016 Australian census data. Results: In total, 9594 people were reached nationally with the paid option and potentially 902,000 people were reached through the no-cost option, resulting in a total of 1211 survey responses. The total cost of the advertisement campaign was Aus $649.66 (US $489.23), resulting in an overall cost per click of Aus $0.25 (US $0.19). Conclusions: Facebook is a feasible and cost-effective method of recruiting participants for a web-based survey, enabling recruitment of population groups that are considered hard to reach or marginalized. Recruitment through Facebook facilitated diversity, with participants varying in socioeconomic status, geographical location, educational attainment, and age. %M 34133315 %R 10.2196/28656 %U https://formative.jmir.org/2021/7/e28656 %U https://doi.org/10.2196/28656 %U http://www.ncbi.nlm.nih.gov/pubmed/34133315 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 4 %N 3 %P e25327 %T Decreasing COVID-19 Risk Factors for Older Adults by Using Digital Technology to Implement a Plant-Based-Diet: An Opinion %A Benavides,Heidi Lynn %A Meireles,Christiane Lumachi %A Benavente,Viola %A Mays,Mary Helen %A Wang,Jing %+ School of Nursing, UT Health San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229, United States, 1 2103232289, benavidesh@uthscsa.edu %K COVID-19 %K coronavirus %K older adult %K plant-based diet %K eating patterns %K whole foods %K Mediterranean diet %K obesity %K pandemic %K ethnic minorities %K telehealth %K digital technology %K racial disparities %K aging %D 2021 %7 5.7.2021 %9 Viewpoint %J JMIR Aging %G English %X A disproportionate number of COVID-19 cases affect older, minority populations. Obese older adults are at higher risk of developing severe COVID-19 complications and lower survival rates, and minority older adults often experience higher rates of obesity. A plant-based diet intervention may improve COVID-19-related modifiable risk factors for obesity. Encouraging the consumption of plant-based diets comprising vegetables, fruits, whole grains, legumes, seeds, and nuts by utilizing community outreach strategies and digital technology can contribute to improving COVID-19 risk factors among this population. %M 34081595 %R 10.2196/25327 %U https://aging.jmir.org/2021/3/e25327 %U https://doi.org/10.2196/25327 %U http://www.ncbi.nlm.nih.gov/pubmed/34081595 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 7 %P e29213 %T The Psychosocial Impacts of COVID-19 on a Sample of Australian Adults: Cross-sectional Survey and Sentiment Analysis %A Ryan,Jillian %A Sellak,Hamza %A Brindal,Emily %+ Precision Health Future Science Platform, Commonwealth Scientific and Industrial Research Organisation, 13 Kintore Avenue, Adelaide, 5000, Australia, 61 8 8305 0644, jillian.ryan@csiro.au %K COVID-19 %K natural language processing %K behavioural science %K NLP %K behavior %K impact %K Australia %K community %K sentiment %K data set %K machine learning %D 2021 %7 2.7.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The COVID-19 pandemic has had enormous impacts on people’s lives, including disruptions to their normal ways of behaving, working, and interacting with others. Understanding and documenting these experiences is important to inform the ongoing response to COVID-19 and disaster preparedness efforts. Objective: The aim of this study was to examine the psychosocial impacts of COVID-19 on a sample of Australian adults. Methods: The data analyzed were derived from a larger cross-sectional survey of Australian adults that was administered during the month of May 2020. Participants (N=3483) were asked in which ways COVID-19 had most greatly impacted them; the responses produced a text data set containing 1 COVID-19 impact story for each participant, totaling 86,642 words. Participants also completed assessments of their sociodemographic characteristics (sex, age, financial stress), level of concern related to COVID-19, personality trait profile, and satisfaction with life. Impact stories were analyzed using sentiment analysis and compared against the Theoretical Domains Framework to determine the most frequently impacted life domains. Finally, a multinomial regression analysis, stratified by participant sex, was conducted to identify the associations of psychological and demographic socializations with sentiment toward COVID-19. Results: In total, 3483 participants completed the survey, the majority of whom were female (n=2793, 80.2%). Participants’ impact stories were most commonly categorized as neutral (1544/3483, 44.3%), followed by negative (1136/3483, 32.6%) and positive (802/3483, 23.1%). The most frequently impacted life domains included behavioral regulation, environmental context and resources, social influences, and emotions, suggesting that the COVID-19 pandemic was impacting these areas of participants’ lives the most. Finally, the regression results suggested that for women, lower satisfaction with life and higher financial stress were associated with increased likelihood of negative, rather than positive, sentiment (P<.001); however, the proportion of variance in the sentiment that was explained was very small (<5%). Conclusions: Participant sentiment toward COVID-19 varied. High rates of neutral and negative sentiment were identified. Positive sentiment was identified but was not as common. Impacts to different areas of people’s lives were identified, with a major emphasis on behavioral regulation and related domains such as social influences, environmental context and resources, and emotions. Findings may inform the development of mental health and social support resources and interventions to help alleviate the psychosocial consequences of disaster response measures. %M 34081594 %R 10.2196/29213 %U https://publichealth.jmir.org/2021/7/e29213 %U https://doi.org/10.2196/29213 %U http://www.ncbi.nlm.nih.gov/pubmed/34081594 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 6 %P e28097 %T Psychological Crisis Intervention for COVID-19 Lockdown Stress in Patients With Type 1 Diabetes Mellitus: Survey Study and Qualitative Analysis %A Cyranka,Katarzyna %A Dudek,Dominika %A Małecki,Maciej Tadeusz %A Matejko,Bartłomiej %A Klupa,Tomasz %+ Department of Psychiatry, Jagiellonian University Medical College, Kopernika Street 21a, Krakow, 31-501, Poland, 48 124248700, katarzyna.cyranka@gmail.com %K COVID-19 %K pandemic %K type 1 diabetes mellitus %K crisis psychological intervention %K anxiety %K stress %K psychosomatics %K diabetes %K type 1 %K psychology %K crisis situation %K intervention %D 2021 %7 30.6.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: The COVID-19 pandemic has challenged the worldviews of most people. Social isolation after the COVID-19 lockdown has not only led to economic difficulties but also resulted in adverse psychological reactions. As in most countries, including Poland, this situation has been very challenging for patients with type 1 diabetes mellitus (T1DM). In Poland, a crisis intervention team for patients with T1DM was established. The goal of the team was to provide psychological support for these patients, if needed, and to present information concerning how these patients may obtain medical consultations and prescriptions. Objective: We aimed to analyze the psychological parameters and main emotional reactions of patients with T1DM during the COVID-19 lockdown. Methods: An email with information concerning the possibility of having a web-based consultation with psychologists and psychiatrists and an attached set of psychological tests was sent to all patients with T1DM who were under the care of an outpatient diabetes clinic. The consultations were performed by licensed clinical psychologists and psychologists. This study was approved by the Bioethics Committee of the Jagiellonian University in Krakow, Poland. Results: The patients who decided to use psychological support had statistically higher levels of anxiety (state P=.043; trait P=.022), stress (P=.001) than those of patients from the group who did not seek support. Conclusions: The presented intervention team may be perceived as an example of important and successful cooperation and communication between specialists of different fields of medicine (diabetology, psychiatry, and psychology) in a crisis situation. %M 33852411 %R 10.2196/28097 %U https://mental.jmir.org/2021/6/e28097 %U https://doi.org/10.2196/28097 %U http://www.ncbi.nlm.nih.gov/pubmed/33852411 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 6 %P e25331 %T The Impact of Technology-Enabled Care Coordination in a Complex Mental Health System: A Local System Dynamics Model %A Iorfino,Frank %A Occhipinti,Jo-An %A Skinner,Adam %A Davenport,Tracey %A Rowe,Shelley %A Prodan,Ante %A Sturgess,Julie %A Hickie,Ian B %+ Brain and Mind Centre, University of Sydney, 94 Mallet Street, Camperdown, Sydney, 2050, Australia, 61 2 9351 0584, frank.iorfino@sydney.edu.au %K medical informatics %K internet %K care coordination %K complex systems %K simulation %K health systems %K policy %K mental health %D 2021 %7 30.6.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Prior to the COVID-19 pandemic, major shortcomings in the way mental health care systems were organized were impairing the delivery of effective care. The mental health impacts of the pandemic, the recession, and the resulting social dislocation will depend on the extent to which care systems will become overwhelmed and on the strategic investments made across the system to effectively respond. Objective: This study aimed to explore the impact of strengthening the mental health system through technology-enabled care coordination on mental health and suicide outcomes. Methods: A system dynamics model for the regional population catchment of North Coast New South Wales, Australia, was developed that incorporated defined pathways from social determinants of mental health to psychological distress, mental health care, and suicidal behavior. The model reproduced historic time series data across a range of outcomes and was used to evaluate the relative impact of a set of scenarios on attempted suicide (ie, self-harm hospitalizations), suicide deaths, mental health–related emergency department (ED) presentations, and psychological distress over the period from 2021 to 2030. These scenarios include (1) business as usual, (2) increase in service capacity growth rate by 20%, (3) standard telehealth, and (4) technology-enabled care coordination. Each scenario was tested using both pre– and post–COVID-19 social and economic conditions. Results: Technology-enabled care coordination was forecast to deliver a reduction in self-harm hospitalizations and suicide deaths by 6.71% (95% interval 5.63%-7.87%), mental health–related ED presentations by 10.33% (95% interval 8.58%-12.19%), and the prevalence of high psychological distress by 1.76 percentage points (95% interval 1.35-2.32 percentage points). Scenario testing demonstrated that increasing service capacity growth rate by 20% or standard telehealth had substantially lower impacts. This pattern of results was replicated under post–COVID-19 conditions with technology-enabled care coordination being the only tested scenario, which was forecast to reduce the negative impact of the pandemic on mental health and suicide. Conclusions: The use of technology-enabled care coordination is likely to improve mental health and suicide outcomes. The substantially lower effectiveness of targeting individual components of the mental health system (ie, increasing service capacity growth rate by 20% or standard telehealth) reiterates that strengthening the whole system has the greatest impact on patient outcomes. Investments into more of the same types of programs and services alone will not be enough to improve outcomes; instead, new models of care and the digital infrastructure to support them and their integration are needed. %M 34077384 %R 10.2196/25331 %U https://www.jmir.org/2021/6/e25331 %U https://doi.org/10.2196/25331 %U http://www.ncbi.nlm.nih.gov/pubmed/34077384 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 6 %P e22075 %T Advancing Mental Health and Psychological Support for Health Care Workers Using Digital Technologies and Platforms %A Ye,Jiancheng %+ Feinberg School of Medicine, Northwestern University, 633 N Saint Clair St, Chicago, IL, United States, 1 312 503 3690, jiancheng.ye@u.northwestern.edu %K mental health %K health care workers %K health informatics %K digital intervention %K health technology %K mobile health %K COVID-19 %D 2021 %7 30.6.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic is a global public health crisis that has not only endangered the lives of patients but also resulted in increased psychological issues among medical professionals, especially frontline health care workers. As the crisis caused by the pandemic shifts from acute to protracted, attention should be paid to the devastating impacts on health care workers’ mental health and social well-being. Digital technologies are being harnessed to support the responses to the pandemic, which provide opportunities to advance mental health and psychological support for health care workers. Objective: The aim of this study is to develop a framework to describe and organize the psychological and mental health issues that health care workers are facing during the COVID-19 pandemic. Based on the framework, this study also proposes interventions from digital health perspectives that health care workers can leverage during and after the pandemic. Methods: The psychological problems and mental health issues that health care workers have encountered during the COVID-19 pandemic were reviewed and analyzed based on the proposed MEET (Mental Health, Environment, Event, and Technology) framework, which also demonstrated the interactions among mental health, digital interventions, and social support. Results: Health care workers are facing increased risk of experiencing mental health issues due to the COVID-19 pandemic, including burnout, fear, worry, distress, pressure, anxiety, and depression. These negative emotional stressors may cause psychological problems for health care workers and affect their physical and mental health. Digital technologies and platforms are playing pivotal roles in mitigating psychological issues and providing effective support. The proposed framework enabled a better understanding of how to mitigate the psychological effects during the pandemic, recover from associated experiences, and provide comprehensive institutional and societal infrastructures for the well-being of health care workers. Conclusions: The COVID-19 pandemic presents unprecedented challenges due to its prolonged uncertainty, immediate threat to patient safety, and evolving professional demands. It is urgent to protect the mental health and strengthen the psychological resilience of health care workers. Given that the pandemic is expected to exist for a long time, caring for mental health has become a “new normal” that needs a strengthened multisector collaboration to facilitate support and reduce health disparities. The proposed MEET framework could provide structured guidelines for further studies on how technology interacts with mental and psychological health for different populations. %M 34106874 %R 10.2196/22075 %U https://formative.jmir.org/2021/6/e22075 %U https://doi.org/10.2196/22075 %U http://www.ncbi.nlm.nih.gov/pubmed/34106874 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 6 %P e26963 %T Effects of Self-focused Augmented Reality on Health Perceptions During the COVID-19 Pandemic: A Web-Based Between-Subject Experiment %A Seals,Ayanna %A Olaosebikan,Monsurat %A Otiono,Jennifer %A Shaer,Orit %A Nov,Oded %+ New York University, 5 Metrotech Center, 4th Fl, Brooklyn, NY, 11201, United States, 1 646 997 3760, ayannaseals@nyu.edu %K COVID-19 %K health behavior %K augmented reality %K self-focused attention %K vicarious reinforcement %K human-computer interactions %K hand hygiene %K perception %D 2021 %7 29.6.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Self-focused augmented reality (AR) technologies are growing in popularity and present an opportunity to address health communication and behavior change challenges. Objective: We aimed to examine the impact of self-focused AR and vicarious reinforcement on psychological predictors of behavior change during the COVID-19 pandemic. In addition, our study included measures of fear and message minimization to assess potential adverse reactions to the design interventions. Methods: A between-subjects web-based experiment was conducted to compare the health perceptions of participants in self-focused AR and vicarious reinforcement design conditions to those in a control condition. Participants were randomly assigned to the control group or to an intervention condition (ie, self-focused AR, reinforcement, self-focus AR × reinforcement, and avatar). Results: A total of 335 participants were included in the analysis. We found that participants who experienced self-focused AR and vicarious reinforcement scored higher in perceived threat severity (P=.03) and susceptibility (P=.01) when compared to the control. A significant indirect effect of self-focused AR and vicarious reinforcement on intention was found with perceived threat severity as a mediator (b=.06, 95% CI 0.02-0.12, SE .02). Self-focused AR and vicarious reinforcement did not result in higher levels of fear (P=.32) or message minimization (P=.42) when compared to the control. Conclusions: Augmenting one’s reflection with vicarious reinforcement may be an effective strategy for health communication designers. While our study’s results did not show adverse effects in regard to fear and message minimization, utilization of self-focused AR as a health communication strategy should be done with care due to the possible adverse effects of heightened levels of fear. %M 33878017 %R 10.2196/26963 %U https://www.jmir.org/2021/6/e26963 %U https://doi.org/10.2196/26963 %U http://www.ncbi.nlm.nih.gov/pubmed/33878017 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 6 %P e24435 %T COVID-19 Vaccine–Related Discussion on Twitter: Topic Modeling and Sentiment Analysis %A Lyu,Joanne Chen %A Han,Eileen Le %A Luli,Garving K %+ Center for Tobacco Control Research and Education, University of California, San Francisco, 530 Parnassus Avenue, San Francisco, CA, 94143-1390, United States, 1 415 502 4181, chenjoanne.lyu@ucsf.edu %K COVID-19 %K vaccine %K vaccination %K Twitter %K infodemiology %K infoveillance %K topic %K sentiment %K opinion %K discussion %K communication %K social media %K perception %K concern %K emotion %D 2021 %7 29.6.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Vaccination is a cornerstone of the prevention of communicable infectious diseases; however, vaccines have traditionally met with public fear and hesitancy, and COVID-19 vaccines are no exception. Social media use has been demonstrated to play a role in the low acceptance of vaccines. Objective: The aim of this study is to identify the topics and sentiments in the public COVID-19 vaccine–related discussion on social media and discern the salient changes in topics and sentiments over time to better understand the public perceptions, concerns, and emotions that may influence the achievement of herd immunity goals. Methods: Tweets were downloaded from a large-scale COVID-19 Twitter chatter data set from March 11, 2020, the day the World Health Organization declared COVID-19 a pandemic, to January 31, 2021. We used R software to clean the tweets and retain tweets that contained the keywords vaccination, vaccinations, vaccine, vaccines, immunization, vaccinate, and vaccinated. The final data set included in the analysis consisted of 1,499,421 unique tweets from 583,499 different users. We used R to perform latent Dirichlet allocation for topic modeling as well as sentiment and emotion analysis using the National Research Council of Canada Emotion Lexicon. Results: Topic modeling of tweets related to COVID-19 vaccines yielded 16 topics, which were grouped into 5 overarching themes. Opinions about vaccination (227,840/1,499,421 tweets, 15.2%) was the most tweeted topic and remained a highly discussed topic during the majority of the period of our examination. Vaccine progress around the world became the most discussed topic around August 11, 2020, when Russia approved the world’s first COVID-19 vaccine. With the advancement of vaccine administration, the topic of instruction on getting vaccines gradually became more salient and became the most discussed topic after the first week of January 2021. Weekly mean sentiment scores showed that despite fluctuations, the sentiment was increasingly positive in general. Emotion analysis further showed that trust was the most predominant emotion, followed by anticipation, fear, sadness, etc. The trust emotion reached its peak on November 9, 2020, when Pfizer announced that its vaccine is 90% effective. Conclusions: Public COVID-19 vaccine–related discussion on Twitter was largely driven by major events about COVID-19 vaccines and mirrored the active news topics in mainstream media. The discussion also demonstrated a global perspective. The increasingly positive sentiment around COVID-19 vaccines and the dominant emotion of trust shown in the social media discussion may imply higher acceptance of COVID-19 vaccines compared with previous vaccines. %M 34115608 %R 10.2196/24435 %U https://www.jmir.org/2021/6/e24435 %U https://doi.org/10.2196/24435 %U http://www.ncbi.nlm.nih.gov/pubmed/34115608 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 6 %P e28643 %T Making the COVID-19 Pandemic a Driver for Digital Health: Brazilian Strategies %A Donida,Bruna %A da Costa,Cristiano André %A Scherer,Juliana Nichterwitz %+ SOFTWARELAB - Software Innovation Laboratory, Universidade do Vale do Rio dos Sinos, Av. Unisinos 950, São Leopoldo, 93022-750, Brazil, 55 5135908161, cac@unisinos.br %K COVID-19 %K digital technology %K Brazil %K public health %K medical informatics %K digital health %K strategy %K outbreak %K system %K data %K health data %K implementation %K monitoring %D 2021 %7 29.6.2021 %9 Viewpoint %J JMIR Public Health Surveill %G English %X The COVID-19 outbreak exposed several problems faced by health systems worldwide, especially concerning the safe and rapid generation and sharing of health data. However, this pandemic scenario has also facilitated the rapid implementation and monitoring of technologies in the health field. In view of the occurrence of the public emergency caused by SARS-CoV-2 in Brazil, the Department of Informatics of the Brazilian Unified Health System created a contingency plan. In this paper, we aim to report the digital health strategies applied in Brazil and the first results obtained during the fight against COVID-19. Conecte SUS, a platform created to store all the health data of an individual throughout their life, is the center point of the Brazilian digital strategy. Access to the platform can be obtained through an app by the patient and the health professionals involved in the case. Health data sharing became possible due to the creation of the National Health Data Network (Rede Nacional de Dados em Saúde, RNDS). A mobile app was developed to guide citizens regarding the need to go to a health facility and to assist in disseminating official news about the virus. The mobile app can also alert the user if they have had contact with an infected person. The official numbers of cases and available hospital beds are updated and published daily on a website containing interactive graphs. These data are obtained due to creating a web-based notification system that uses the RNDS to share information about the cases. Preclinical care through telemedicine has become essential to prevent overload in health facilities. The exchange of experiences between medical teams from large centers and small hospitals was made possible using telehealth. Brazil took a giant step toward digital health adoption, creating and implementing important initiatives; however, these initiatives do not yet cover the entire health system. It is expected that the sharing of health data that are maintained and authorized by the patient will become a reality in the near future. The intention is to obtain better clinical outcomes, cost reduction, and faster and better services in the public health network. %M 34101613 %R 10.2196/28643 %U https://publichealth.jmir.org/2021/6/e28643 %U https://doi.org/10.2196/28643 %U http://www.ncbi.nlm.nih.gov/pubmed/34101613 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 6 %P e28757 %T Psychological Impacts of the COVID-19 Pandemic Among Portuguese and Swiss Higher-Education Students: Protocol for a Mixed Methods Study %A Querido,Ana %A Aissaoui,Djamel %A Dixe,Maria Dos Anjos %A Schwander-Maire,Françoise %A Cara-Nova,Tanya %A Charepe,Zaida %A Laranjeira,Carlos %+ School of Health Sciences, Polytechnic of Leiria, Campus 2, Morro do Lena - Alto do Vieiro, Apartado 4137, Leiria, 2411-901, Portugal, 351 966936420, ana.querido@ipleiria.pt %K study protocol %K pandemic %K students %K mental health %K COVID-19 %D 2021 %7 29.6.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Higher-education students are particularly vulnerable to both everyday stressors and mental health problems. Public health emergencies may generate a range of unforeseen potential stressors for vulnerable individuals and communities. The current pandemic has apparently led to an increase in psychiatric symptoms among these students. Objective: The goal of this study is to characterize the psychological impact of the COVID-19 pandemic among Portuguese and Swiss higher-education students. Methods: This project will use a mixed methods sequential explanatory design in Portugal and Switzerland, with two consecutive phases. During Phase I, a quantitative study will assess the psychological responses of higher-education students during the COVID-19 pandemic. A convenience sampling method will be used for collecting information from students. The association between variables will be determined with univariable and multivariable analyses. During Phase II, qualitative data will be collected in order to understand the determinants of psychological stress and the strategies adopted by students as a result of the COVID-19 pandemic, as well as to identify their opinions and feelings about the teaching-learning process during quarantine. In this phase, participants will be selected using a maximum-variation sampling method. Data from focus group discussions will be coded and inductively analyzed using a thematic analysis approach. Finally, quantitative and qualitative results will be merged during interpretation to provide complementary perspectives. Results: This paper describes and discusses the protocol for this mixed methods study, which will be completed in December 2021. This study was formally approved by the local ethics committee (CE/IPLEIRIA/22/2020) in Portugal and authorized by the Swiss Association of Research Ethics Committees, swissethics (CER-VD-2020-02889). Conclusions: This research can contribute to the development of teaching tools and methods that reinforce positive mental health strategies, hope, and adaptive coping among students, and to the development of a class on mental health interventions in the context of catastrophic and traumatic events. This project will also help government stakeholders as well as health and education professionals safeguard the psychological well-being of students facing an expanding COVID-19 pandemic. International Registered Report Identifier (IRRID): PRR1-10.2196/28757 %M 34081598 %R 10.2196/28757 %U https://www.researchprotocols.org/2021/6/e28757 %U https://doi.org/10.2196/28757 %U http://www.ncbi.nlm.nih.gov/pubmed/34081598 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 4 %N 2 %P e26571 %T A Data-Free Digital Platform to Reach Families With Young Children During the COVID-19 Pandemic: Online Survey Study %A Richter,Linda Marleine %A Naicker,Sara Naomi %+ DSI-NRF Centre of Excellence in Human Development, University of the Witwatersrand, Office 154 First Floor East Wing, Wits School of Public Health, Education Campus, 27 St Andrews Road, Parktown, Johannesburg, 2193, South Africa, 27 117172382, linda.richter@wits.ac.za %K families %K parenting %K children %K COVID-19 %K digital %K survey %K data-free %D 2021 %7 28.6.2021 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: The COVID-19 pandemic and containment measures have severely affected families around the world. It is frequently assumed that digital technologies can supplement and perhaps even replace services for families. This is challenging in conditions of high device and data costs as well as poor internet provision and access, raising concerns about widening inequalities in availability of support and consequent effects on child and family outcomes. Very few studies have examined these issues, including in low- and middle-income countries. Objective: The study objectives were two-fold. The first objective was to gather data on the impact of the COVID-19 pandemic on families of young children using an online survey. The second objective was to assess the feasibility of using a data-free online platform to conduct regular surveys and, potentially, to provide support for parents and families of young children in South Africa. Methods: We used a data-free mobile messenger platform to conduct a short digital survey of the impact of the COVID-19 pandemic on caring for young children in South Africa. We report on the methodological processes and preliminary findings of the online survey. Results: More than 44,000 individuals accessed the survey link and 16,217 consented to the short survey within 96 hours of its launch. Respondents were predominantly from lower classes and lower-middle classes, representing the majority of the population, with urban residential locations roughly proportionate to national patterns and some underrepresentation of rural households. Mothers comprised 70.2% (11,178/15,912) of respondents and fathers comprised 29.8% (4734/15,912), representing 18,672 children 5 years of age and younger. Response rates per survey item ranged from 74.8% (11,907/15,912) at the start of the survey to 50.3% (8007/15,912) at completion. A total of 82.0% (12,729/15,912) of parents experienced at least one challenge during the pandemic, and 32.4% (2737/8441) did not receive help when needed from listed sources. Aggregate and individual findings in the form of bar graphs were made available to participants to view and download once they had completed the survey. Participants were also able to download contact details for support and referral services at no data cost. Conclusions: Data-free survey methodology breaks new ground and demonstrates potential not previously considered. Reach is greater than achieved through phone surveys and some social media platforms, men are not usually included in parent surveys, costs are lower than phone surveys, and the technology allows for immediate feedback to respondents. These factors suggest that zero-rated, or no-cost, services could provide a feasible, sustainable, and equitable basis for ongoing interactions with families of young children. %M 33852414 %R 10.2196/26571 %U https://pediatrics.jmir.org/2021/2/e26571 %U https://doi.org/10.2196/26571 %U http://www.ncbi.nlm.nih.gov/pubmed/33852414 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 6 %P e29733 %T The Impact of COVID-19 Vaccine Communication, Acceptance, and Practices (CO-VIN-CAP) on Vaccine Hesitancy in an Indian Setting: Protocol for a Cross-sectional Study %A Surapaneni,Krishna Mohan %A Kaur,Mahima %A Kaur,Ritika %A Grover,Ashoo %A Joshi,Ashish %+ Panimalar Medical College Hospital & Research Institute, Varadharajapuram, Poonamallee, Tamil Nadu, Chennai, 600123, India, 91 9789099989, krishnamohan.surapaneni@gmail.com %K COVID-19 vaccine %K vaccine hesitancy %K vaccine acceptance %K unintended consequences %K vaccination %K COVID-19 %K pandemic %K coronavirus %K infectious disease %K protocol %K vaccine %D 2021 %7 24.6.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: COVID-19 vaccines are considered to be a key to limiting and eliminating the infectious disease. However, the success of the vaccination program will rely on the rates of vaccine acceptance among the population. Objective: This study aims to examine the factors that influence vaccine hesitancy and vaccine acceptance, and to explore the unintended consequences of COVID-19 infections. The study will further explore the association between sociodemographic characteristics; health status; COVID-19–related knowledge, attitude, and practices; and its influence on vaccine hesitancy and acceptance among individuals living in urban and rural settings of Chennai, Tamil Nadu in the southern state of India. Methods: A cross-sectional study will be conducted between January 2021 and January 2023. A sample of approximately 25,000 individuals will be recruited and enrolled using a nonprobability complete enumeration sampling method from 11 selected urban and rural settings of Chennai. The data will be collected at one time point by administering the questionnaire to the eligible study participants. The collected data will be used to assess the rates of vaccine acceptance; hesitancy; and knowledge, attitudes, practices, and beliefs regarding COVID-19 and COVID-19 vaccines. Lastly, the study questionnaire will be used to assess the unintended consequences of COVID-19 infection. Results: A pilot of 2500 individuals has been conducted to pretest the survey questionnaire. The data collection was initiated on March 1, 2021, and the initial results are planned for publication by June 2021. Descriptive analysis of the gathered data will be performed using SAS v9.1, and reporting of the results will be done at 95% CIs and P=.049. The study will help explore the burden of vaccine acceptance and hesitancy among individuals living in urban and rural settings of Chennai. Further, it will help to examine the variables that influence vaccine acceptance and hesitancy. Lastly, the findings will help to design and develop a user-centered informatics platform that can deliver multimedia-driven health education modules tailored to facilitate vaccine uptake in varied settings. Conclusions: The proposed study will help in understanding the rate and determinants of COVID-19 vaccine acceptance and hesitancy among the population of Chennai. The findings of the study would further facilitate the development of a multifaceted intervention to enhance vaccine acceptance among the population. International Registered Report Identifier (IRRID): DERR1-10.2196/29733 %R 10.2196/29733 %U https://www.researchprotocols.org/2021/6/e29733/ %U https://doi.org/10.2196/29733 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 6 %P e29561 %T Monitoring Beliefs and Physiological Measures Using Wearable Sensors and Smartphone Technology Among Students at Risk of COVID-19: Protocol for a mHealth Study %A Cislo,Christine %A Clingan,Caroline %A Gilley,Kristen %A Rozwadowski,Michelle %A Gainsburg,Izzy %A Bradley,Christina %A Barabas,Jenny %A Sandford,Erin %A Olesnavich,Mary %A Tyler,Jonathan %A Mayer,Caleb %A DeMoss,Matthew %A Flora,Christopher %A Forger,Daniel B %A Cunningham,Julia Lee %A Tewari,Muneesh %A Choi,Sung Won %+ Division of Pediatric Hematology Oncology, Department of Pediatrics, University of Michigan, 1500 E Medical Center Dr, D4118 Medical Professional Building, Ann Arbor, MI, 48109, United States, 1 7342165349, sungchoi@med.umich.edu %K college students %K COVID-19 %K global pandemic %K mental health %K mHealth %K pandemic %K risk monitoring %K wearable sensors %K well-being %D 2021 %7 24.6.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: The COVID-19 pandemic has significantly impacted lives and greatly affected the mental health and public safety of an already vulnerable population—college students. Social distancing and isolation measures have presented challenges to students’ mental health. mHealth apps and wearable sensors may help monitor students at risk of COVID-19 and support their mental well-being. Objective: This study aimed to monitor students at risk of COVID-19 by using a wearable sensor and a smartphone-based survey. Methods: We conducted a prospective study on undergraduate and graduate students at a public university in the Midwest United States. Students were instructed to download the Fitbit, Social Rhythms, and Roadmap 2.0 apps onto their personal smartphone devices (Android or iOS). Subjects consented to provide up to 10 saliva samples during the study period. Surveys were administered through the Roadmap 2.0 app at five timepoints: at baseline, 1 month later, 2 months later, 3 months later, and at study completion. The surveys gathered information regarding demographics, COVID-19 diagnoses and symptoms, and mental health resilience, with the aim of documenting the impact of COVID-19 on the college student population. Results: This study enrolled 2158 college students between September 2020 and January 2021. Subjects are currently being followed-up for 1 academic year. Data collection and analysis are currently underway. Conclusions: This study examined student health and well-being during the COVID-19 pandemic and assessed the feasibility of using a wearable sensor and a survey in a college student population, which may inform the role of our mHealth tools in assessing student health and well-being. Finally, using data derived from a wearable sensor, biospecimen collection, and self-reported COVID-19 diagnosis, our results may provide key data toward the development of a model for the early prediction and detection of COVID-19. Trial Registration: ClinicalTrials.gov NCT04766788; https://clinicaltrials.gov/ct2/show/NCT04766788 International Registered Report Identifier (IRRID): DERR1-10.2196/29561 %R 10.2196/29561 %U https://www.researchprotocols.org/2021/6/e29561/ %U https://doi.org/10.2196/29561 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 6 %P e28944 %T Determinants of Catalan Public Primary Care Professionals’ Intention to Use Digital Clinical Consultations (eConsulta) in the Post–COVID-19 Context: Mixed Methods Study %A Saigí-Rubió,Francesc %A Vidal-Alaball,Josep %A Torrent-Sellens,Joan %A Jiménez-Zarco,Ana %A López Segui,Francesc %A Carrasco Hernandez,Marta %A Alzaga Reig,Xavier %A Bonet Simó,Josep Maria %A Abizanda González,Mercedes %A Piera-Jimenez,Jordi %A Solans,Oscar %+ Health Promotion in Rural Areas Research Group, Gerencia Territorial de la Catalunya Central, Institut Catala de la Salut, Carrer Pica d'Estats, 36, Sant Fruitos de Bages, 08272, Spain, 34 6930040, jvidal.cc.ics@gencat.cat %K COVID-19 %K teleconsultation %K eConsultation %K eHealth %K intention to use %K digital health %K Technology Acceptance Model %K TAM %K remote consultation %K telemedicine %K digital technology %K intention %K technology assessment %K telehealth %K pandemic %K digital tool %D 2021 %7 24.6.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Telemedicine has become a necessary component of clinical practice for the purpose of providing safer patient care during lockdowns due to the COVID-19 pandemic. It has been used to support the health care needs of patients with COVID-19 and routine primary care patients alike. However, this change has not been fully consolidated. Objective: The objective of this study was to analyze the determinants of health care professionals’ intention to use the eConsulta digital clinical consultation tool in the post–COVID-19 context. Methods: A literature review of the Technology Acceptance Model allowed us to construct a theoretical model and establish a set of hypotheses on the influence of a variety of different factors relating to health care professionals, as well as the institutions where they work, on their intention to use eConsulta. In order to confirm the proposed model, a mixed qualitative and quantitative methodology was used, and a questionnaire was designed to serve as the data collection instrument. The data were analyzed using univariate and bivariate analysis techniques. To confirm the theoretical model, exploratory factor analysis and binary logistic regression were applied. Results: The most important variables were related to perceived benefits (B=2.408) and the type of use that individuals habitually made of eConsulta (B=0.715). Environmental pressure (B=0.678), experience with technology (B=0.542), gender (B=0.639), and the degree to which eConsulta had been implemented (B=0.266) were other variables influencing the intention to use the tool in the post–COVID-19 context. When replicating the previous analysis according to professional group, experience with technology and gender in the physician group, and experience with tool use and the center where a professional worked in the nurse group, were found to be of considerable importance. Conclusions: The implementation and use of eConsulta had increased significantly as a consequence of the COVID-19 pandemic, and the majority of health care professionals were satisfied with its use in practice and planned to incorporate it into their practices in the post–COVID-19 context. Perceived benefits and environmental pressure were determining factors in their attitude toward and intention to use eConsulta. %R 10.2196/28944 %U https://www.jmir.org/2021/6/e28944/ %U https://doi.org/10.2196/28944 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 6 %P e28925 %T COVID-19 Infection, Reinfection, and Vaccine Effectiveness in Arizona Frontline and Essential Workers: Protocol for a Longitudinal Cohort Study %A Lutrick,Karen %A Ellingson,Katherine D %A Baccam,Zoe %A Rivers,Patrick %A Beitel,Shawn %A Parker,Joel %A Hollister,James %A Sun,Xiaoxiao %A Gerald,Joe K %A Komatsu,Kenneth %A Kim,Elizabeth %A LaFleur,Bonnie %A Grant,Lauren %A Yoo,Young M %A Kumar,Archana %A Mayo Lamberte,Julie %A Cowling,Benjamin J %A Cobey,Sarah %A Thornburg,Natalie J %A Meece,Jennifer K %A Kutty,Preeta %A Nikolich-Zugich,Janko %A Thompson,Mark G %A Burgess,Jefferey L %+ Family and Community Medicine, College of Medicine - Tucson, University of Arizona, 655 N Alvernon Way, Suite 228, Tucson, AZ, 85711, United States, 1 520 626 3236, klutrick@arizona.edu %K SARS-CoV-2 %K COVID-19 %K health care personnel %K first responders %K essential workers %D 2021 %7 24.6.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: COVID-19 has spread worldwide since late 2019, with an unprecedented case count and death toll globally. Health care personnel (HCP), first responders, and other essential and frontline workers (OEWs) are at increased risk of SARS-CoV-2 infection because of frequent close contact with others. Objective: The Arizona Healthcare, Emergency Response, and Other Essential Workers Study (AZ HEROES) aims to examine the epidemiology of SARS-CoV-2 infection and COVID-19 illness among adults with high occupational exposure risk. Study objectives include estimating the incidence of SARS-CoV-2 infection in essential workers by symptom presentation and demographic factors, determining independent effects of occupational and community exposures on incidence of SARS-CoV-2 infection, establishing molecular and immunologic characteristics of SARS-CoV-2 infection in essential workers, describing the duration and patterns of real-time reverse transcription–polymerase chain reaction (rRT-PCR) positivity, and examining postvaccine immunologic response. Methods: Eligible participants include Arizona residents aged 18 to 85 years who work at least 20 hours per week in an occupation involving regular direct contact (ie, within 3 feet) with others. Recruitment goals are stratified by demographic characteristics (50% aged 40 years or older, 50% women, and 50% Hispanic or American Indian), by occupation (40% HCP, 30% first responders, and 30% OEWs), and by prior SARS-CoV-2 infection (with up to 50% seropositive at baseline). Information on sociodemographics, health and medical history, vaccination status, exposures to individuals with suspected or confirmed SARS-CoV-2 infection, use of personal protective equipment, and perceived risks are collected at enrollment and updated through quarterly surveys. Every week, participants complete active surveillance for COVID-like illness (CLI) and self-collect nasal swabs. Additional self-collected nasal swab and saliva specimens are collected in the event of CLI onset. Respiratory specimens are sent to Marshfield Laboratories and tested for SARS-CoV-2 by rRT-PCR assay. CLI symptoms and impact on work and productivity are followed through illness resolution. Serum specimens are collected every 3 months and additional sera are collected following incident rRT-PCR positivity and after each COVID-19 vaccine dose. Incidence of SARS-CoV-2 infections will be calculated by person-weeks at risk and compared by occupation and demographic characteristics as well as by seropositivity status and infection and vaccination history. Results: The AZ HEROES study was funded by the US Centers for Disease Control and Prevention. Enrollment began on July 27, 2020; as of May 1, 2021, a total of 3165 participants have been enrolled in the study. Enrollment is expected to continue through December 1, 2021, with data collection continuing through at least April 2022, contingent upon funding. Conclusions: AZ HEROES is unique in aiming to recruit a diverse sample of essential workers and to prospectively follow strata of SARS-CoV-2 seronegative and seropositive adults. Survey results combined with active surveillance data on exposure, CLI, weekly molecular diagnostic testing, and periodic serology will be used to estimate the incidence of symptomatic and asymptomatic SARS-CoV-2 infection, assess the intensity and durability of immune responses to natural infection and COVID-19 vaccination, and contribute to the evaluation of COVID-19 vaccine effectiveness. International Registered Report Identifier (IRRID): DERR1-10.2196/28925 %R 10.2196/28925 %U https://www.researchprotocols.org/2021/6/e28925/ %U https://doi.org/10.2196/28925 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 6 %P e27968 %T Using Emerging Telehealth Technology as a Future Model in Vietnam During the COVID-19 Pandemic: Practical Experience From Phutho General Hospital %A Nguyen,Ngoc Huy %A Nguyen,An Quang %A Ha,Van Thi Bich %A Duong,Phuong Xuan %A Nguyen,Thong Van %+ Department of Health, Phutho Province, Tran Phu Str, Viet Tri, 0084, Vietnam, 84 0985179888, ngochuynguyen8888@gmail.com %K telehealth %K telemedicine %K teleconsultation %K COVID-19 %K Vietnam %K digital health %K pandemic %D 2021 %7 22.6.2021 %9 Viewpoint %J JMIR Form Res %G English %X Telehealth has emerged as a model of modern technology for health care services in Vietnam during the COVID-19 pandemic. To actively prevent the outbreak of COVID-19 by using a national digital transformation program, the Vietnamese Ministry of Health launched project 2628/Quyet dinh-Bo y te, which approved a scheme for remote medical examinations and treatments for 2020 to 2025. The project aims to connect 1000 hospitals to strengthen the quality of medical services by using the expertise of central hospitals to support rural areas via provincial hospitals. Phutho General Hospital (PGH) is one of leading provincial hospitals that participated in and applied the early telehealth systems in Vietnam. By using telehealth systems, PGH can offer valuable support to doctors’ activities by streamlining and facilitating their work. Telehealth was demonstrated to be feasible, acceptable, and effective at PGH in Vietnam, and it resulted in considerable improvements in health care outcomes. The COVID-19 pandemic has facilitated the acceleration and enhancement of telehealth in Vietnam. The success of telehealth in Phutho may be a useful reference for other parts of the world. However, this telehealth system focuses on the connectivity among doctors rather than the connectivity between doctors and patients, which is an area that needs further assessment. %M 34078590 %R 10.2196/27968 %U https://formative.jmir.org/2021/6/e27968 %U https://doi.org/10.2196/27968 %U http://www.ncbi.nlm.nih.gov/pubmed/34078590 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 6 %P e26655 %T Engagement With COVID-19 Public Health Measures in the United States: A Cross-sectional Social Media Analysis from June to November 2020 %A Massey,Daisy %A Huang,Chenxi %A Lu,Yuan %A Cohen,Alina %A Oren,Yahel %A Moed,Tali %A Matzner,Pini %A Mahajan,Shiwani %A Caraballo,César %A Kumar,Navin %A Xue,Yuchen %A Ding,Qinglan %A Dreyer,Rachel %A Roy,Brita %A Krumholz,Harlan %+ Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, 1 Church St, Suite 200, New Haven, CT, United States, 1 203 764 5885, harlan.krumholz@yale.edu %K COVID-19 %K public perception %K social media %K infodemiology %K infoveillance %K infodemic %K social media research %K social listening %K social media analysis %K natural language processing %K Reddit data %K Facebook data %K COVID-19 public health measures %K public health %K surveillance %K engagement %K United States %K cross-sectional %K Reddit %K Facebook %K behavior %K perception %K NLP %D 2021 %7 21.6.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: COVID-19 has continued to spread in the United States and globally. Closely monitoring public engagement and perceptions of COVID-19 and preventive measures using social media data could provide important information for understanding the progress of current interventions and planning future programs. Objective: The aim of this study is to measure the public’s behaviors and perceptions regarding COVID-19 and its effects on daily life during 5 months of the pandemic. Methods: Natural language processing (NLP) algorithms were used to identify COVID-19–related and unrelated topics in over 300 million online data sources from June 15 to November 15, 2020. Posts in the sample were geotagged by NetBase, a third-party data provider, and sensitivity and positive predictive value were both calculated to validate the classification of posts. Each post may have included discussion of multiple topics. The prevalence of discussion regarding these topics was measured over this time period and compared to daily case rates in the United States. Results: The final sample size included 9,065,733 posts, 70% of which were sourced from the United States. In October and November, discussion including mentions of COVID-19 and related health behaviors did not increase as it had from June to September, despite an increase in COVID-19 daily cases in the United States beginning in October. Additionally, discussion was more focused on daily life topics (n=6,210,255, 69%), compared with COVID-19 in general (n=3,390,139, 37%) and COVID-19 public health measures (n=1,836,200, 20%). Conclusions: There was a decline in COVID-19–related social media discussion sourced mainly from the United States, even as COVID-19 cases in the United States increased to the highest rate since the beginning of the pandemic. Targeted public health messaging may be needed to ensure engagement in public health prevention measures as global vaccination efforts continue. %M 34086593 %R 10.2196/26655 %U https://www.jmir.org/2021/6/e26655 %U https://doi.org/10.2196/26655 %U http://www.ncbi.nlm.nih.gov/pubmed/34086593 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 6 %P e29314 %T COVID-19 and Open Notes: A New Method to Enhance Patient Safety and Trust %A Blease,Charlotte %A Salmi,Liz %A Hägglund,Maria %A Wachenheim,Deborah %A DesRoches,Catherine %+ Division of General Medicine, Beth Israel Deaconess Medical Center, 133 Brookline Avenue, HVMA Second Floor Annex, Boston, MA, 02215, United States, 1 6173201281, cblease@bidmc.harvard.edu %K COVID-19 %K patient portals %K electronic health records %K patient safety %K patient-centered care %D 2021 %7 21.6.2021 %9 Viewpoint %J JMIR Ment Health %G English %X From April 5, 2021, as part of the 21st Century Cures Act, all providers in the United States must offer patients access to the medical information housed in their electronic records. Via secure health portals, patients can log in to access lab and test results, lists of prescribed medications, referral appointments, and the narrative reports written by clinicians (so-called open notes). As US providers implement this practice innovation, we describe six promising ways in which patients' access to their notes might help address problems that either emerged with or were exacerbated by the COVID-19 pandemic. %M 34081603 %R 10.2196/29314 %U https://mental.jmir.org/2021/6/e29314 %U https://doi.org/10.2196/29314 %U http://www.ncbi.nlm.nih.gov/pubmed/34081603 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 6 %P e28648 %T Language and Sentiment Regarding Telemedicine and COVID-19 on Twitter: Longitudinal Infodemiology Study %A Pollack,Catherine C %A Gilbert-Diamond,Diane %A Alford-Teaster,Jennifer A %A Onega,Tracy %+ Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth College, 1 Medical Center Drive, Lebanon, NH, 03766, United States, 1 540 497 3419, Catherine.c.pollack.gr@dartmouth.edu %K telemedicine %K telehealth %K COVID-19 pandemic %K social media %K sentiment analysis %K Twitter %K COVID-19 %K pandemic %D 2021 %7 21.6.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic has necessitated a rapid shift in how individuals interact with and receive fundamental services, including health care. Although telemedicine is not a novel technology, previous studies have offered mixed opinions surrounding its utilization. However, there exists a dearth of research on how these opinions have evolved over the course of the current pandemic. Objective: This study aims to evaluate how the language and sentiment surrounding telemedicine has evolved throughout the COVID-19 pandemic. Methods: Tweets published between January 1, 2020, and April 24, 2021, containing at least one telemedicine-related and one COVID-19–related search term (“telemedicine-COVID”) were collected from the Twitter full archive search (N=351,718). A comparator sample containing only COVID-19 terms (“general-COVID”) was collected and sampled based on the daily distribution of telemedicine-COVID tweets. In addition to analyses of retweets and favorites, sentiment analysis was performed on both data sets in aggregate and within a subset of tweets receiving the top 100 most and least retweets. Results: Telemedicine gained prominence during the early stages of the pandemic (ie, March through May 2020) before leveling off and reaching a steady state from June 2020 onward. Telemedicine-COVID tweets had a 21% lower average number of retweets than general-COVID tweets (incidence rate ratio 0.79, 95% CI 0.63-0.99; P=.04), but there was no difference in favorites. A majority of telemedicine-COVID tweets (180,295/351,718, 51.3%) were characterized as “positive,” compared to only 38.5% (135,434/351,401) of general-COVID tweets (P<.001). This trend was also true on a monthly level from March 2020 through April 2021. The most retweeted posts in both telemedicine-COVID and general-COVID data sets were authored by journalists and politicians. Whereas the majority of the most retweeted posts within the telemedicine-COVID data set were positive (55/101, 54.5%), a plurality of the most retweeted posts within the general-COVID data set were negative (44/89, 49.4%; P=.01). Conclusions: During the COVID-19 pandemic, opinions surrounding telemedicine evolved to become more positive, especially when compared to the larger pool of COVID-19–related tweets. Decision makers should capitalize on these shifting public opinions to invest in telemedicine infrastructure and ensure its accessibility and success in a postpandemic world. %M 34086591 %R 10.2196/28648 %U https://www.jmir.org/2021/6/e28648 %U https://doi.org/10.2196/28648 %U http://www.ncbi.nlm.nih.gov/pubmed/34086591 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 7 %N 2 %P e23637 %T Development of a Digital Patient Education Tool for Patients With Cancer During the COVID-19 Pandemic %A Turkdogan,Sena %A Schnitman,Gabriel %A Wang,Tianci %A Gotlieb,Raphael %A How,Jeffrey %A Gotlieb,Walter Henri %+ Department of Physiology, McGill University, 3649 Promenade Sir-William-Osler, Montreal, QC, , Canada, 1 5144757717, tianci.wang@mail.mcgill.ca %K digital health %K eHealth %K patient education %K COVID-19 %D 2021 %7 21.6.2021 %9 Viewpoint %J JMIR Cancer %G English %X Background: Due to the COVID-19 pandemic, a large portion of oncology consultations have been conducted remotely. The maladaptation or compromise of care could negatively impact oncology patients and their disease management. Objective: We aimed to describe the development and implementation process of a web-based, animated patient education tool that supports oncology patients remotely in the context of fewer in-person interactions with health care providers. Methods: The platform created presents multilingual oncology care instructions. Animations concerning cancer care and mental health during the COVID-19 pandemic as well as immunotherapy and chemotherapy guides were the major areas of focus and represented 6 final produced video guides. Results: The videos were watched 1244 times in a period of 6 months. The most watched animation was the COVID-19 & Oncology guide (viewed 565 times), followed by the video concerning general treatment orientations (viewed 249 times) and the video titled “Chemotherapy” (viewed 205 times). Although viewers were equally distributed among the age groups, most were aged 25 to 34 years (342/1244, 27.5%) and were females (745/1244, 59.9%). Conclusions: The implementation of a patient education platform can be designed to prepare patients and their caregivers for their treatment and thus improve outcomes and satisfaction by using a methodical and collaborative approach. Multimedia tools allow a portion of a patient’s care to occur in a home setting, thereby freeing them from the need for hospital resources. %M 34101611 %R 10.2196/23637 %U https://cancer.jmir.org/2021/2/e23637 %U https://doi.org/10.2196/23637 %U http://www.ncbi.nlm.nih.gov/pubmed/34101611 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 6 %P e26368 %T Public Interest in Immunity and the Justification for Intervention in the Early Stages of the COVID-19 Pandemic: Analysis of Google Trends Data %A Lee,Jinhee %A Kwan,Yunna %A Lee,Jun Young %A Shin,Jae Il %A Lee,Keum Hwa %A Hong,Sung Hwi %A Han,Young Joo %A Kronbichler,Andreas %A Smith,Lee %A Koyanagi,Ai %A Jacob,Louis %A Choi,SungWon %A Ghayda,Ramy Abou %A Park,Myung-Bae %+ Department of Gerontology Health and Welfare, Pai Chai University, 155-40, Baejae-ro, Seo-gu, Daejeon, 35345, Republic of Korea, 82 425205037, parkmb@pcu.ac.kr %K COVID-19 %K social big data %K infodemiology %K infoveillance %K social listening %K immune %K vitamin %K big data %K public interest %K intervention %K immune system %K immunity %K trends %K Google Trends %K internet %K digital health %K web-based health information %K correlation %K social media %K infectious disease %D 2021 %7 18.6.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The use of social big data is an important emerging concern in public health. Internet search volumes are useful data that can sensitively detect trends of the public's attention during a pandemic outbreak situation. Objective: Our study aimed to analyze the public’s interest in COVID-19 proliferation, identify the correlation between the proliferation of COVID-19 and interest in immunity and products that have been reported to confer an enhancement of immunity, and suggest measures for interventions that should be implemented from a health and medical point of view. Methods: To assess the level of public interest in infectious diseases during the initial days of the COVID-19 outbreak, we extracted Google search data from January 20, 2020, onward and compared them to data from March 15, 2020, which was approximately 2 months after the COVID-19 outbreak began. In order to determine whether the public became interested in the immune system, we selected coronavirus, immune, and vitamin as our final search terms. Results: The increase in the cumulative number of confirmed COVID-19 cases that occurred after January 20, 2020, had a strong positive correlation with the search volumes for the terms coronavirus (R=0.786; P<.001), immune (R=0.745; P<.001), and vitamin (R=0.778; P<.001), and the correlations between variables were all mutually statistically significant. Moreover, these correlations were confirmed on a country basis when we restricted our analyses to the United States, the United Kingdom, Italy, and Korea. Our findings revealed that increases in search volumes for the terms coronavirus and immune preceded the actual occurrences of confirmed cases. Conclusions: Our study shows that during the initial phase of the COVID-19 crisis, the public’s desire and actions of strengthening their own immune systems were enhanced. Further, in the early stage of a pandemic, social media platforms have a high potential for informing the public about potentially helpful measures to prevent the spread of an infectious disease and provide relevant information about immunity, thereby increasing the public’s knowledge. %M 34038375 %R 10.2196/26368 %U https://www.jmir.org/2021/6/e26368 %U https://doi.org/10.2196/26368 %U http://www.ncbi.nlm.nih.gov/pubmed/34038375 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 6 %P e26267 %T The Anticipated Future of Public Health Services Post COVID-19: Viewpoint %A Bashier,Haitham %A Ikram,Aamer %A Khan,Mumtaz Ali %A Baig,Mirza %A Al Gunaid,Magid %A Al Nsour,Mohannad %A Khader,Yousef %+ Jordan University of Science and Technology, Alramtha-Amman Street, Irbid, 22110, Jordan, 962 796802040, yskhader@just.edu.jo %K COVID-19 %K public health %K health system %K health services %D 2021 %7 18.6.2021 %9 Viewpoint %J JMIR Public Health Surveill %G English %X In March 2020, the World Health Organization declared COVID-19 as a global pandemic. The COVID-19 pandemic has affected various public health functions and essential services in different ways and magnitudes. Although all countries have witnessed the effect of COVID-19, the impact differed based on many factors including the integrity and resiliency of the countries’ health systems. This paper presents opinions and expectations of the authors about the anticipated changes in the future of public health at the global, regional, and national levels. The viewpoint is based on the current efforts and challenges that various stakeholders have carried out to control COVID-19 and the contribution from the literature on the future of public health. Numerous agencies and actors are involved in the fight against COVID-19 with variations in their effectiveness. The public health services showed weaknesses in most of the countries, in addition to the lack of adequate curative medicine settings. The pandemic highlighted the need for better governance and stronger and more resilient health systems and capacities. The COVID-19 experience has also emphasized the importance of coordination and collaboration among the countries and stakeholders. The COVID-19 pandemic might lead to a wide discussion to improve international and national approaches to prepare for and respond to similar events in terms of preparedness and response mechanisms and tools. Public health will not be the same as before COVID-19. New health priorities, approaches, and new agendas will be on the table of the global platforms and initiatives. More investment in research and technology to meet the demand for new vaccines and medicines, innovative methods like distance learning and working, more respect and remuneration to health professionals, and normalization of the public health and social measures that were induced during the COVID-19 pandemic are expected to be seen in future. %M 33592576 %R 10.2196/26267 %U https://publichealth.jmir.org/2021/6/e26267 %U https://doi.org/10.2196/26267 %U http://www.ncbi.nlm.nih.gov/pubmed/33592576 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 6 %P e27140 %T Indications of Depressive Symptoms During the COVID-19 Pandemic in Germany: Comparison of National Survey and Twitter Data %A Cohrdes,Caroline %A Yenikent,Seren %A Wu,Jiawen %A Ghanem,Bilal %A Franco-Salvador,Marc %A Vogelgesang,Felicitas %+ Mental Health Research Unit, Department of Epidemiology and Health Monitoring, Robert Koch Institute, General-Pape-Str. 62-66, Berlin, 12101, Germany, 49 30 18754 2692, CohrdesC@rki.de %K depressive symptoms %K GEDA/EHIS survey %K Twitter %K COVID-19 %K pandemic %K social contact ban %K temporal progression %K data correspondence %K public mental health surveillance %K depression %K survey %K social media %K data %K infodemiology %K infoveillance %K twitter %K mental health %K public health %K surveillance %K monitoring %K symptom %D 2021 %7 18.6.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: The current COVID-19 pandemic is associated with extensive individual and societal challenges, including challenges to both physical and mental health. To date, the development of mental health problems such as depressive symptoms accompanying population-based federal distancing measures is largely unknown, and opportunities for rapid, effective, and valid monitoring are currently a relevant matter of investigation. Objective: In this study, we aim to investigate, first, the temporal progression of depressive symptoms during the COVID-19 pandemic and, second, the consistency of the results from tweets and survey-based self-reports of depressive symptoms within the same time period. Methods: Based on a cross-sectional population survey of 9011 German adolescents and adults (n=4659, 51.7% female; age groups from 15 to 50 years and older) and a sample of 88,900 tweets (n=74,587, 83.9% female; age groups from 10 to 50 years and older), we investigated five depressive symptoms (eg, depressed mood and energy loss) using items from the Patient Health Questionnaire (PHQ-8) before, during, and after relaxation of the first German social contact ban from January to July 2020. Results: On average, feelings of worthlessness were the least frequently reported symptom (survey: n=1011, 13.9%; Twitter: n=5103, 5.7%) and fatigue or loss of energy was the most frequently reported depressive symptom (survey: n=4472, 51.6%; Twitter: n=31,005, 34.9%) among both the survey and Twitter respondents. Young adult women and people living in federal districts with high COVID-19 infection rates were at an increased risk for depressive symptoms. The comparison of the survey and Twitter data before and after the first contact ban showed that German adolescents and adults had a significant decrease in feelings of fatigue and energy loss over time. The temporal progression of depressive symptoms showed high correspondence between both data sources (ρ=0.76-0.93; P<.001), except for diminished interest and depressed mood, which showed a steady increase even after the relaxation of the contact ban among the Twitter respondents but not among the survey respondents. Conclusions: Overall, the results indicate relatively small differences in depressive symptoms associated with social distancing measures during the COVID-19 pandemic and highlight the need to differentiate between positive (eg, energy level) and negative (eg, depressed mood) associations and variations over time. The results also underscore previous suggestions of Twitter data’s potential to help identify hot spots of declining and improving public mental health and thereby help provide early intervention measures, especially for young and middle-aged adults. Further efforts are needed to investigate the long-term consequences of recurring lockdown phases and to address the limitations of social media data such as Twitter data to establish real-time public mental surveillance approaches. %M 34142973 %R 10.2196/27140 %U https://mental.jmir.org/2021/6/e27140 %U https://doi.org/10.2196/27140 %U http://www.ncbi.nlm.nih.gov/pubmed/34142973 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 6 %P e28708 %T Telerehabilitation for Lung Transplant Candidates and Recipients During the COVID-19 Pandemic: Program Evaluation %A Wickerson,Lisa %A Helm,Denise %A Gottesman,Chaya %A Rozenberg,Dmitry %A Singer,Lianne G %A Keshavjee,Shaf %A Sidhu,Aman %+ Toronto Lung Transplant Program, University Health Network, 585 University Ave, Toronto, ON, M5G 2N2, Canada, 1 437 229 0049, lisa.wickerson@uhn.ca %K telerehabilitation %K lung %K transplant %K rehabilitation %K COVID-19 %K usage %K satisfaction %K app %K outcome %K telemedicine %D 2021 %7 17.6.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The COVID-19 pandemic resulted in a rapid shift from center-based rehabilitation to telerehabilitation for chronic respiratory disease and lung transplantation due to infection control precautions. Clinical experience with this delivery model on a large scale has not been described. Objective: The aim of this study is to describe usage and satisfaction of providers and lung transplant (LTx) candidates and recipients and functional outcomes following the broad implementation of telerehabilitation with remote patient monitoring during the first wave of the COVID-19 pandemic. Methods: This study was a program evaluation of providers, LTx candidates, and early LTx recipients who used a web-based, remote monitoring app for at least four weeks between March 16 and September 1, 2020, to participate in telerehabilitation. Within-subjects analysis was performed for physical activity, Self-efficacy For Exercise (SEE) scale score, aerobic and resistance exercise volumes, 6-minute walk test results, and Short Physical Performance Battery (SPPB) results. Results: In total, 78 LTx candidates and 33 recipients were included (57 [51%] males, mean age 58 [SD 12] years, 58 [52%] with interstitial lung disease, 34 [31%] with chronic obstructive pulmonary disease). A total of 50 (64%) LTx candidates and 17 (51%) LTx recipients entered ≥10 prescribed exercise sessions into the app during the study time frame. In addition, 35/42 (83%) candidates agreed the app helped prepare them for surgery and 18/21 (85%) recipients found the app helpful in their self-recovery. The strongest barrier perceived by physiotherapists delivering the telerehabilitation was patient access to home exercise and monitoring equipment. Between the time of app registration and ≥4 weeks on the waiting list, 26 LTx candidates used a treadmill, with sessions increasing in mean duration (from 16 to 22 minutes, P=.002) but not speed (from 1.7 to 1.75 mph, P=.31). Quadriceps weight (pounds) for leg extension did not change (median 3.5, IQR 2.4-5 versus median 4.3, IQR 3-5; P=.08; n=37). On the Rapid Assessment of Physical Activity questionnaire (RAPA), 57% of LTx candidates scored as active, which improved to 87% (P=.02; n=23). There was a decrease in pretransplant 6-minute walk distance (6MWD) from 346 (SD 84) meters to 307 (SD 85) meters (P=.002; n=45) and no change in the SPPB result (12 [IQR 9.5-12] versus 12 [IQR 10-12]; P=.90; n=42). A total of 9 LTx recipients used a treadmill that increased in speed (from 1.9 to 2.7 mph; P=.003) between hospital discharge and three months posttransplant. Quadriceps weight increased (3 [IQR 0-3] pounds versus 5 [IQR 3.8-6.5] pounds; P<.001; n=15). At three months posttransplant, 76% of LTx recipients scored as active (n=17), with a high total SEE score of 74 (SD 11; n=12). In addition, three months posttransplant, 6MWD was 62% (SD 18%) predicted (n=8). Conclusions: We were able to provide telerehabilitation despite challenges around exercise equipment. This early experience will inform the development of a robust and equitable telerehabilitation model beyond the COVID-19 pandemic. %M 34048354 %R 10.2196/28708 %U https://mhealth.jmir.org/2021/6/e28708 %U https://doi.org/10.2196/28708 %U http://www.ncbi.nlm.nih.gov/pubmed/34048354 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 6 %P e27345 %T Development, Status Quo, and Challenges to China’s Health Informatization During COVID-19: Evaluation and Recommendations %A Huang,Mian %A Wang,Jian %A Nicholas,Stephen %A Maitland,Elizabeth %A Guo,Ziyue %+ Dong Fureng Institute of Economic and Social Development, Wuhan University, No 54 Dongsi Lishi Hutong, Dongcheng District, Beijing, 100010, China, 86 13864157135, wangjian993@whu.edu.cn %K health informatization %K COVID-19 %K health policy %K digital health %K health information technology %K China %D 2021 %7 17.6.2021 %9 Viewpoint %J J Med Internet Res %G English %X By applying advanced health information technology to the health care field, health informatization helps optimize health resource allocation, improve health care services, and realize universal health coverage. COVID-19 has tested the status quo of China’s health informatization, revealing challenges to the health care system. This viewpoint evaluates the development, status quo, and practice of China’s health informatization, especially during COVID-19, and makes recommendations to address the health informatization challenges. We collected, assessed, and evaluated data on the development of China’s health informatization from five perspectives—health information infrastructure, information technology (IT) applications, financial and intellectual investment, health resource allocation, and standard system—and discussed the status quo of the internet plus health care service pattern during COVID-19. The main data sources included China’s policy documents and national plans on health informatization, commercial and public welfare sources and websites, public reports, institutional reports, and academic papers. In particular, we extracted data from the 2019 National Health Informatization Survey released by the National Health Commission in China. We found that China developed its health information infrastructure and IT applications, made significant financial and intellectual informatization investments, and improved health resource allocations. Tested during COVID-19, China’s current health informatization system, especially the internet plus health care system, has played a crucial role in monitoring and controlling the pandemic and allocating medical resources. However, an uneven distribution of health resources and insufficient financial and intellectual investment continue to challenge China’s health informatization. China’s rapid development of health informatization played a crucial role during COVID-19, providing a reference point for global pandemic prevention and control. To further promote health informatization, China’s health informatization needs to strengthen top-level design, increase investment and training, upgrade the health infrastructure and IT applications, and improve internet plus health care services. %M 34061761 %R 10.2196/27345 %U https://www.jmir.org/2021/6/e27345 %U https://doi.org/10.2196/27345 %U http://www.ncbi.nlm.nih.gov/pubmed/34061761 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 6 %P e26956 %T Social Media and Research Publication Activity During Early Stages of the COVID-19 Pandemic: Longitudinal Trend Analysis %A Taneja,Sonia L %A Passi,Monica %A Bhattacharya,Sumona %A Schueler,Samuel A %A Gurram,Sandeep %A Koh,Christopher %+ Liver Diseases Branch, National Institutes of Diabetes and Digestive and Kidney Diseases, 10 Center Drive, Clinical Research Center, 5-2740, Bethesda, MD, 20892, United States, 1 301 443 9402, christopher.koh@nih.gov %K coronavirus %K COVID-19 %K social media %K gastroenterology %K SARS-CoV-2 %K research %K literature %K dissemination %K Twitter %K preprint %D 2021 %7 17.6.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic has highlighted the importance of rapid dissemination of scientific and medical discoveries. Current platforms available for the distribution of scientific and clinical research data and information include preprint repositories and traditional peer-reviewed journals. In recent times, social media has emerged as a helpful platform to share scientific and medical discoveries. Objective: This study aimed to comparatively analyze activity on social media (specifically, Twitter) and that related to publications in the form of preprint and peer-reviewed journal articles in the context of COVID-19 and gastroenterology during the early stages of the COVID-19 pandemic. Methods: COVID-19–related data from Twitter (tweets and user data) and articles published in preprint servers (bioRxiv and medRxiv) as well as in the PubMed database were collected and analyzed during the first 6 months of the pandemic, from December 2019 through May 2020. Global and regional geographic and gastrointestinal organ–specific social media trends were compared to preprint and publication activity. Any relationship between Twitter activity and preprint articles published and that between Twitter activity and PubMed articles published overall, by organ system, and by geographic location were identified using Spearman’s rank-order correlation. Results: Over the 6-month period, 73,079 tweets from 44,609 users, 7164 journal publications, and 4702 preprint publications were retrieved. Twitter activity (ie, number of tweets) peaked in March 2020, whereas preprint and publication activity (ie, number of articles published) peaked in April 2020. Overall, strong correlations were identified between trends in Twitter activity and preprint and publication activity (P<.001 for both). COVID-19 data across the three platforms mainly concentrated on pulmonology or critical care, but when analyzing the field of gastroenterology specifically, most tweets pertained to pancreatology, most publications focused on hepatology, and most preprints covered hepatology and luminal gastroenterology. Furthermore, there were significant positive associations between trends in Twitter and publication activity for all gastroenterology topics (luminal gastroenterology: P=.009; hepatology and inflammatory bowel disease: P=.006; gastrointestinal endoscopy: P=.007), except pancreatology (P=.20), suggesting that Twitter activity did not correlate with publication activity for this topic. Finally, Twitter activity was the highest in the United States (7331 tweets), whereas PubMed activity was the highest in China (1768 publications). Conclusions: The COVID-19 pandemic has highlighted the potential of social media as a vehicle for disseminating scientific information during a public health crisis. Sharing and spreading information on COVID-19 in a timely manner during the pandemic has been paramount; this was achieved at a much faster pace on social media, particularly on Twitter. Future investigation could demonstrate how social media can be used to augment and promote scholarly activity, especially as the world begins to increasingly rely on digital or virtual platforms. Scientists and clinicians should consider the use of social media in augmenting public awareness regarding their scholarly pursuits. %M 33974550 %R 10.2196/26956 %U https://www.jmir.org/2021/6/e26956 %U https://doi.org/10.2196/26956 %U http://www.ncbi.nlm.nih.gov/pubmed/33974550 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 6 %P e24251 %T The Interplay Between Policy and COVID-19 Outbreaks in South Asia: Longitudinal Trend Analysis of Surveillance Data %A Welch,Sarah B %A Kulasekere,Dinushi Amanda %A Prasad,P V Vara %A Moss,Charles B %A Murphy,Robert Leo %A Achenbach,Chad J %A Ison,Michael G %A Resnick,Danielle %A Singh,Lauren %A White,Janine %A Issa,Tariq Z %A Culler,Kasen %A Boctor,Michael J %A Mason,Maryann %A Oehmke,James Francis %A Faber,Joshua Marco Mitchell %A Post,Lori Ann %+ Buehler Center for Health Policy & Economics, Feinberg School of Medicine, Northwestern University, Arthur J Rubloff Building, 420 E Superior St, Chicago, IL, 60611, United States, 1 312 503 5017, lori.post@northwestern.edu %K 7-day lag %K acceleration %K Bangladesh %K Bhutan %K COVID-19 surveillance %K COVID-19 %K dynamic panel data %K India %K jerk %K Maldives %K Pakistan %K South Asia %K speed %K Sri Lanka %D 2021 %7 17.6.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: COVID-19 transmission rates in South Asia initially were under control when governments implemented health policies aimed at controlling the pandemic such as quarantines, travel bans, and border, business, and school closures. Governments have since relaxed public health restrictions, which resulted in significant outbreaks, shifting the global epicenter of COVID-19 to India. Ongoing systematic public health surveillance of the COVID-19 pandemic is needed to inform disease prevention policy to re-establish control over the pandemic within South Asia. Objective: This study aimed to inform public health leaders about the state of the COVID-19 pandemic, how South Asia displays differences within and among countries and other global regions, and where immediate action is needed to control the outbreaks. Methods: We extracted COVID-19 data spanning 62 days from public health registries and calculated traditional and enhanced surveillance metrics. We use an empirical difference equation to measure the daily number of cases in South Asia as a function of the prior number of cases, the level of testing, and weekly shifts in variables with a dynamic panel model that was estimated using the generalized method of moments approach by implementing the Arellano–Bond estimator in R. Results: Traditional surveillance metrics indicate that South Asian countries have an alarming outbreak, with India leading the region with 310,310 new daily cases in accordance with the 7-day moving average. Enhanced surveillance indicates that while Pakistan and Bangladesh still have a high daily number of new COVID-19 cases (n=4819 and n=3878, respectively), their speed of new infections declined from April 12-25, 2021, from 2.28 to 2.18 and 3.15 to 2.35 daily new infections per 100,000 population, respectively, which suggests that their outbreaks are decreasing and that these countries are headed in the right direction. In contrast, India’s speed of new infections per 100,000 population increased by 52% during the same period from 14.79 to 22.49 new cases per day per 100,000 population, which constitutes an increased outbreak. Conclusions: Relaxation of public health restrictions and the spread of novel variants fueled the second wave of the COVID-19 pandemic in South Asia. Public health surveillance indicates that shifts in policy and the spread of new variants correlate with a drastic expansion in the pandemic, requiring immediate action to mitigate the spread of COVID-19. Surveillance is needed to inform leaders whether policies help control the pandemic. %M 34081593 %R 10.2196/24251 %U https://publichealth.jmir.org/2021/6/e24251 %U https://doi.org/10.2196/24251 %U http://www.ncbi.nlm.nih.gov/pubmed/34081593 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 6 %P e28269 %T An Urban Population Health Observatory System to Support COVID-19 Pandemic Preparedness, Response, and Management: Design and Development Study %A Brakefield,Whitney S %A Ammar,Nariman %A Olusanya,Olufunto A %A Shaban-Nejad,Arash %+ Center for Biomedical Informatics, Department of Pediatrics, College of Medicine, University of Tennessee Health Science Center, 50 N Dunlap Street, Memphis, TN, 38103, United States, 1 901 287 583, ashabann@uthsc.edu %K causal inference %K COVID-19 surveillance %K COVID-19 %K digital health %K health disparities %K knowledge integration %K SARS-CoV-2 %K Social Determinants of Health %K surveillance %K urban health %D 2021 %7 16.6.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: COVID-19 is impacting people worldwide and is currently a leading cause of death in many countries. Underlying factors, including Social Determinants of Health (SDoH), could contribute to these statistics. Our prior work has explored associations between SDoH and several adverse health outcomes (eg, asthma and obesity). Our findings reinforce the emerging consensus that SDoH factors should be considered when implementing intelligent public health surveillance solutions to inform public health policies and interventions. Objective: This study sought to redefine the Healthy People 2030’s SDoH taxonomy to accommodate the COVID-19 pandemic. Furthermore, we aim to provide a blueprint and implement a prototype for the Urban Population Health Observatory (UPHO), a web-based platform that integrates classified group-level SDoH indicators to individual- and aggregate-level population health data. Methods: The process of building the UPHO involves collecting and integrating data from several sources, classifying the collected data into drivers and outcomes, incorporating data science techniques for calculating measurable indicators from the raw variables, and studying the extent to which interventions are identified or developed to mitigate drivers that lead to the undesired outcomes. Results: We generated and classified the indicators of social determinants of health, which are linked to COVID-19. To display the functionalities of the UPHO platform, we presented a prototype design to demonstrate its features. We provided a use case scenario for 4 different users. Conclusions: UPHO serves as an apparatus for implementing effective interventions and can be adopted as a global platform for chronic and infectious diseases. The UPHO surveillance platform provides a novel approach and novel insights into immediate and long-term health policy responses to the COVID-19 pandemic and other future public health crises. The UPHO assists public health organizations and policymakers in their efforts in reducing health disparities, achieving health equity, and improving urban population health. %M 34081605 %R 10.2196/28269 %U https://publichealth.jmir.org/2021/6/e28269 %U https://doi.org/10.2196/28269 %U http://www.ncbi.nlm.nih.gov/pubmed/34081605 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 10 %N 2 %P e27823 %T Early Identification of COVID-19 Infection Using Remote Cardiorespiratory Monitoring: Three Case Reports %A Polsky,Michael %A Moraveji,Neema %+ Pulmonary Associates of Richmond, 1000 Boulders Parkway, Suite 101, North Chesterfield, VA, 23225, United States, 1 804 320 4243, mpolsky@paraccess.com %K COVID-19 %K remote patient monitoring %K wearable sensors %K monitoring %K case study %K preidentification %K lung %K data collection %K respiration %K prediction %D 2021 %7 16.6.2021 %9 Original Paper %J Interact J Med Res %G English %X Background: The adoption of remote patient monitoring (RPM) in routine medical care requires increased understanding of the physiologic changes accompanying disease development and the proactive interventions that will improve outcomes. Objective: The aim of this study is to present three case reports that highlight the capability of RPM to enable early identification of viral infection with COVID-19 in patients with chronic respiratory disease. Methods: Patients at a large pulmonary practice who were enrolled in a respiratory RPM program and who had contracted COVID-19 were identified. The RPM system (Spire Health) contains three components: (1) Health Tags (Spire Health), undergarment waistband-adhered physiologic monitors that include a respiratory rate sensor; (2) an app on a smartphone; and (3) a web dashboard for use by respiratory therapists. The physiologic data of 9 patients with COVID out of 1000 patients who were enrolled for monitoring were retrospectively reviewed, and 3 instances were identified where the RPM system had notified clinicians of physiologic deviation due to the viral infection. Results: Physiologic deviations from respective patient baselines occurred during infection onset and, although the infection manifested differently in each case, were identified by the RPM system. In the first case, the patient was symptomatic; in the second case, the patient was presymptomatic; and in the third case, the patient varied from asymptomatic to mildly symptomatic. Conclusions: RPM systems intended for long-term use and that use patient-specific baselines can highlight physiologic changes early in the course of acute disease, such as COVID-19 infection. These cases demonstrate opportunities for earlier diagnosis, treatment, and isolation. This study supports the need for further research into how RPM can be effectively integrated into clinical practice. %M 34086588 %R 10.2196/27823 %U https://www.i-jmr.org/2021/2/e27823 %U https://doi.org/10.2196/27823 %U http://www.ncbi.nlm.nih.gov/pubmed/34086588 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 6 %P e26452 %T Inpatient Telemedicine Implementation as an Infection Control Response to COVID-19: Qualitative Process Evaluation Study %A Safaeinili,Nadia %A Vilendrer,Stacie %A Williamson,Emma %A Zhao,Zicheng %A Brown-Johnson,Cati %A Asch,Steven M %A Shieh,Lisa %+ Department of Medicine, School of Medicine, Stanford University, 1265 Welch Rd x216, Stanford, CA, 94305, United States, 1 8053001922, nadiasaf@stanford.edu %K telemedicine %K inpatient %K COVID-19 %K qualitative %K RE-AIM %K infection control %K personal protective equipment %K implementation science %K quality improvement %D 2021 %7 16.6.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic created new challenges to delivering safe and effective health care while minimizing virus exposure among staff and patients without COVID-19. Health systems worldwide have moved quickly to implement telemedicine in diverse settings to reduce infection, but little is understood about how best to connect patients who are acutely ill with nearby clinical team members, even in the next room. Objective: To inform these efforts, this paper aims to provide an early example of inpatient telemedicine implementation and its perceived acceptability and effectiveness. Methods: Using purposive sampling, this study conducted 15 semistructured interviews with nurses (5/15, 33%), attending physicians (5/15, 33%), and resident physicians (5/15, 33%) on a single COVID-19 unit within Stanford Health Care to evaluate implementation outcomes and perceived effectiveness of inpatient telemedicine. Semistructured interview protocols and qualitative analysis were framed around the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework, and key themes were identified using a rapid analytic process and consensus approach. Results: All clinical team members reported wide reach of inpatient telemedicine, with some use for almost all patients with COVID-19. Inpatient telemedicine was perceived to be effective in reducing COVID-19 exposure and use of personal protective equipment (PPE) without significantly compromising quality of care. Physician workflows remained relatively stable, as most standard clinical activities were conducted via telemedicine following the initial intake examination, though resident physicians reported reduced educational opportunities given limited opportunities to conduct physical exams. Nurse workflows required significant adaptations to cover nonnursing duties, such as food delivery and facilitating technology connections for patients and physicians alike. Perceived patient impact included consistent care quality, with some considerations around privacy. Reported challenges included patient–clinical team communication and personal connection with the patient, perceptions of patient isolation, ongoing technical challenges, and certain aspects of the physical exam. Conclusions: Clinical team members reported inpatient telemedicine encounters to be acceptable and effective in reducing COVID-19 exposure and PPE use. Nurses adapted their workflows more than physicians in order to implement the new technology and bore a higher burden of in-person care and technical support. Recommendations for improved inpatient telemedicine use include information technology support and training, increased technical functionality, and remote access for the clinical team. %M 34033576 %R 10.2196/26452 %U https://formative.jmir.org/2021/6/e26452 %U https://doi.org/10.2196/26452 %U http://www.ncbi.nlm.nih.gov/pubmed/34033576 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 6 %P e29036 %T Professional Social Media Usage and Work Engagement Among Professionals in Finland Before and During the COVID-19 Pandemic: Four-Wave Follow-Up Study %A Oksa,Reetta %A Kaakinen,Markus %A Savela,Nina %A Hakanen,Jari J %A Oksanen,Atte %+ Faculty of Social Sciences, Tampere University, Kalevantie 5, Tampere, 33100, Finland, 358 504377619, reetta.oksa@tuni.fi %K COVID-19 %K engagement %K mental health %K moderator %K predictor %K psychological distress %K social media %K social support %K support %K task resources %K usage %K work engagement %D 2021 %7 15.6.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic has changed work life profoundly and concerns regarding the mental well-being of employees’ have arisen. Organizations have made rapid digital advancements and have started to use new collaborative tools such as social media platforms overnight. Objective: Our study aimed to investigate how professional social media communication has affected work engagement before and during the COVID-19 pandemic and the role of perceived social support, task resources, and psychological distress as predictors and moderators of work engagement. Methods: Nationally representative longitudinal survey data were collected in 2019-2020, and 965 respondents participated in all 4 surveys. Measures included work engagement, perceived social support and task resources, and psychological distress. The data were analyzed using a hybrid linear regression model.  Results: Work engagement remained stable and only decreased in autumn 2020. Within-person changes in social media communication at work, social support, task resources, and psychological distress were all associated with work engagement. The negative association between psychological distress and work engagement was stronger in autumn 2020 than before the COVID-19 outbreak. Conclusions: The COVID-19 pandemic has exerted pressure on mental health at work. Fostering social support and task resources at work is important in maintaining work engagement. Social media communication could help maintain a supportive work environment. %M 34048356 %R 10.2196/29036 %U https://www.jmir.org/2021/6/e29036 %U https://doi.org/10.2196/29036 %U http://www.ncbi.nlm.nih.gov/pubmed/34048356 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 6 %P e28140 %T Teleconsultation in the Management of Elective Orthopedic and Spinal Conditions During the COVID-19 Pandemic: Prospective Cohort Study of Patient Experiences %A Melian,Christina %A Frampton,Christopher %A Wyatt,Michael Charles %A Kieser,David %+ Renaissance School of Medicine at Stony Brook University, 101 Nicolls Road, Health Sciences Center, Level 4, Stony Brook, NY, 11794-8434, United States, 1 631 444 2111, christina.melian@stonybrookmedicine.edu %K telemedicine %K patient satisfaction %K orthopedic surgery %K telehealth %K COVID-19 %K pandemic %D 2021 %7 15.6.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The global adoption of teleconsultation has been expedited as a result of the COVID-19 pandemic. By allowing remote communication, teleconsultation may help limit the spread of the virus while maintaining the crucial patient-provider relationship. Objective: The aim of this study is to evaluate the value of teleconsultation compared to in-person visits in the management of elective orthopedic and spinal procedures. Methods: This was a prospective observational cohort study of 853 patients receiving orthopedic and spinal care at a private outpatient clinic in New Zealand. Patients were randomly divided into two groups: (1) patients receiving telephone consultation remotely, and (2) patients receiving in-person office consultations at the outpatient clinic. All patients received telephone consultations for 4 weeks during the mandated COVID-19 lockdown, followed by 4 weeks of telephone or in-person consultation. Patient preference, satisfaction, and duration of visit were recorded. Comparisons of patient preference between groups, visit type, sex, and location were performed using chi-square tests; similarly, satisfaction scores and visit durations were compared using a general linear model. Results: We report that 91% (353/388) of patients in the telephone group preferred teleconsultation over in-person office visits during the COVID-19 lockdown (P<.001). A combined-group analysis showed that 55.3% (446/807) of all patients preferred teleconsultation compared to 31.2% (252/807) who preferred in-person office visits (P<.001). Patients in the telephone group reported significantly higher satisfaction scores (mean 9.95, SD 0.04, 95% CI 9.87-10.03) compared to patients in the in-person group (mean 9.53, SE 0.04, 95% CI 9.45-9.62; P<.001). Additionally, in-person consultations were significantly longer in duration compared to telephone consultations, with a mean visit time of 6.70 (SE 0.18) minutes, 95% CI 6.32-7.02, compared to 5.10 (SE 0.17) minutes, 95% CI 4.73-5.42 (P<.001). Conclusions: Patients who use telephone consultations are more likely to prefer it over traditional, in-person visits in the future. This increased preference, coupled with higher patient satisfaction scores and shorter duration of visits, suggests that teleconsultation has a role in orthopedic surgery, which may even extend beyond the COVID-19 pandemic. %M 34048355 %R 10.2196/28140 %U https://formative.jmir.org/2021/6/e28140 %U https://doi.org/10.2196/28140 %U http://www.ncbi.nlm.nih.gov/pubmed/34048355 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 6 %P e25010 %T Potential Impact of a Paper About COVID-19 and Smoking on Twitter Users’ Attitudes Toward Smoking: Observational Study %A Tao,Chunliang %A Diaz,Destiny %A Xie,Zidian %A Chen,Long %A Li,Dongmei %A O’Connor,Richard %+ Department of Clinical and Translational Research, University of Rochester Medical Center, 265 Crittenden Boulevard CU 420708, Rochester, NY, 14642-0708, United States, 1 5852767285, Dongmei_Li@urmc.rochester.edu %K COVID-19 %K smoking %K Twitter %K infodemiology %K infodemic %K infoveillance %K impact %K attitude %K perception %K observational %K social media %K cross-sectional %K dissemination %K research %D 2021 %7 15.6.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: A cross-sectional study (Miyara et al, 2020) conducted by French researchers showed that the rate of current daily smoking was significantly lower in patients with COVID-19 than in the French general population, implying a potentially protective effect of smoking. Objective: We aimed to examine the dissemination of the Miyara et al study among Twitter users and whether a shift in their attitudes toward smoking occurred after its publication as preprint on April 21, 2020. Methods: Twitter posts were crawled between April 14 and May 4, 2020, by the Tweepy stream application programming interface, using a COVID-19–related keyword query. After filtering, the final 1929 tweets were classified into three groups: (1) tweets that were not related to the Miyara et al study before it was published, (2) tweets that were not related to Miyara et al study after it was published, and (3) tweets that were related to Miyara et al study after it was published. The attitudes toward smoking, as expressed in the tweets, were compared among the above three groups using multinomial logistic regression models in the statistical analysis software R (The R Foundation). Results: Temporal analysis showed a peak in the number of tweets discussing the results from the Miyara et al study right after its publication. Multinomial logistic regression models on sentiment scores showed that the proportion of negative attitudes toward smoking in tweets related to the Miyara et al study after it was published (17.07%) was significantly lower than the proportion in tweets that were not related to the Miyara et al study, either before (44/126, 34.9%; P<.001) or after the Miyara et al study was published (68/198, 34.3%; P<.001). Conclusions: The public’s attitude toward smoking shifted in a positive direction after the Miyara et al study found a lower incidence of COVID-19 cases among daily smokers. %M 33939624 %R 10.2196/25010 %U https://formative.jmir.org/2021/6/e25010 %U https://doi.org/10.2196/25010 %U http://www.ncbi.nlm.nih.gov/pubmed/33939624 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 6 %P e26692 %T Political Partisanship and Antiscience Attitudes in Online Discussions About COVID-19: Twitter Content Analysis %A Rao,Ashwin %A Morstatter,Fred %A Hu,Minda %A Chen,Emily %A Burghardt,Keith %A Ferrara,Emilio %A Lerman,Kristina %+ Information Sciences Institute, University of Southern California, 4676 Admiralty Way, STE 1001, Marina del Rey, CA, 90292, United States, 1 213 505 0363, mohanrao@usc.edu %K COVID-19 %K Twitter %K infodemiology %K infodemic %K infoveillance %K multidimensional polarization %K social media %K social network %D 2021 %7 14.6.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The novel coronavirus pandemic continues to ravage communities across the United States. Opinion surveys identified the importance of political ideology in shaping perceptions of the pandemic and compliance with preventive measures. Objective: The aim of this study was to measure political partisanship and antiscience attitudes in the discussions about the pandemic on social media, as well as their geographic and temporal distributions. Methods: We analyzed a large set of tweets from Twitter related to the pandemic, collected between January and May 2020, and developed methods to classify the ideological alignment of users along the moderacy (hardline vs moderate), political (liberal vs conservative), and science (antiscience vs proscience) dimensions. Results: We found a significant correlation in polarized views along the science and political dimensions. Moreover, politically moderate users were more aligned with proscience views, while hardline users were more aligned with antiscience views. Contrary to expectations, we did not find that polarization grew over time; instead, we saw increasing activity by moderate proscience users. We also show that antiscience conservatives in the United States tended to tweet from the southern and northwestern states, while antiscience moderates tended to tweet from the western states. The proportion of antiscience conservatives was found to correlate with COVID-19 cases. Conclusions: Our findings shed light on the multidimensional nature of polarization and the feasibility of tracking polarized opinions about the pandemic across time and space through social media data. %M 34014831 %R 10.2196/26692 %U https://www.jmir.org/2021/6/e26692 %U https://doi.org/10.2196/26692 %U http://www.ncbi.nlm.nih.gov/pubmed/34014831 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 6 %P e22999 %T Estimating the COVID-19 Spread Through Real-time Population Mobility Patterns: Surveillance in Low- and Middle-Income Countries %A Tyrovolas,Stefanos %A Giné-Vázquez,Iago %A Fernández,Daniel %A Morena,Marianthi %A Koyanagi,Ai %A Janko,Mark %A Haro,Josep Maria %A Lin,Yang %A Lee,Paul %A Pan,William %A Panagiotakos,Demosthenes %A Molassiotis,Alex %+ School of Nursing, Hong Kong Polytechnic University, PQ402, Hung Hom, Kowloon, Hong Kong, 852 2766 5648, stefanos.tyrovolas@polyu.edu.hk %K COVID-19 %K transmission %K digital public health %K social distancing %K policy %K mobile data %K estimate %K real-time %K pattern %K surveillance %K low and middle-income countries %K emerging countries %K database %K surveillance %D 2021 %7 14.6.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: On January 21, 2020, the World Health Organization reported the first case of severe acute respiratory syndrome coronavirus 2, which rapidly evolved to the COVID-19 pandemic. Since then, the virus has also rapidly spread among Latin American, Caribbean, and African countries. Objective: The first aim of this study is to identify new emerging COVID-19 clusters over time and space (from January 21 to mid-May 2020) in Latin American, Caribbean, and African regions, using a prospective space–time scan measurement approach. The second aim is to assess the impact of real-time population mobility patterns between January 21 and May 18, 2020, under the implemented government interventions, measurements, and policy restrictions on COVID-19 spread among those regions and worldwide. Methods: We created a global COVID-19 database, of 218 countries and territories, merging the World Health Organization daily case reports with other measures such as population density and country income levels for January 21 to May 18, 2020. A score of government policy interventions was created for low, intermediate, high, and very high interventions. The population’s mobility patterns at the country level were obtained from Google community mobility reports. The prospective space–time scan statistic method was applied in five time periods between January and May 2020, and a regression mixed model analysis was used. Results: We found that COVID-19 emerging clusters within these five periods of time increased from 7 emerging clusters to 28 by mid-May 2020. We also detected various increasing and decreasing relative risk estimates of COVID-19 spread among Latin American, Caribbean, and African countries within the period of analysis. Globally, population mobility to parks and similar leisure areas during at least a minimum of implemented intermediate-level control policies (when compared to low-level control policies) was related to accelerated COVID-19 spread. Results were almost consistent when regional stratified analysis was applied. In addition, worldwide population mobility due to working during high implemented control policies and very high implemented control policies, when compared to low-level control policies, was related to positive COVID-19 spread. Conclusions: The prospective space–time scan is an approach that low-income and middle-income countries could use to detect emerging clusters in a timely manner and implement specific control policies and interventions to slow down COVID-19 transmission. In addition, real-time population mobility obtained from crowdsourced digital data could be useful for current and future targeted public health and mitigation policies at a global and regional level. %M 33950850 %R 10.2196/22999 %U https://www.jmir.org/2021/6/e22999 %U https://doi.org/10.2196/22999 %U http://www.ncbi.nlm.nih.gov/pubmed/33950850 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 6 %P e24285 %T Real-time Prediction of the Daily Incidence of COVID-19 in 215 Countries and Territories Using Machine Learning: Model Development and Validation %A Peng,Yuanyuan %A Li,Cuilian %A Rong,Yibiao %A Pang,Chi Pui %A Chen,Xinjian %A Chen,Haoyu %+ Joint Shantou International Eye Center, Shantou University & the Chinese University of Hong Kong, Joint Shantou International Eye Center, North Dongxia Road, Shantou, 515041, China, 86 075488393560, drchenhaoyu@gmail.com %K COVID-19 %K daily incidence %K real-time prediction %K machine learning %K Google Trends %K infoveillance %K infodemiology %K digital health %K digital public health %K surveillance %K prediction %K incidence %K policy %K prevention %K model %D 2021 %7 14.6.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Advanced prediction of the daily incidence of COVID-19 can aid policy making on the prevention of disease spread, which can profoundly affect people's livelihood. In previous studies, predictions were investigated for single or several countries and territories. Objective: We aimed to develop models that can be applied for real-time prediction of COVID-19 activity in all individual countries and territories worldwide. Methods: Data of the previous daily incidence and infoveillance data (search volume data via Google Trends) from 215 individual countries and territories were collected. A random forest regression algorithm was used to train models to predict the daily new confirmed cases 7 days ahead. Several methods were used to optimize the models, including clustering the countries and territories, selecting features according to the importance scores, performing multiple-step forecasting, and upgrading the models at regular intervals. The performance of the models was assessed using the mean absolute error (MAE), root mean square error (RMSE), Pearson correlation coefficient, and Spearman correlation coefficient. Results: Our models can accurately predict the daily new confirmed cases of COVID-19 in most countries and territories. Of the 215 countries and territories under study, 198 (92.1%) had MAEs <10 and 187 (87.0%) had Pearson correlation coefficients >0.8. For the 215 countries and territories, the mean MAE was 5.42 (range 0.26-15.32), the mean RMSE was 9.27 (range 1.81-24.40), the mean Pearson correlation coefficient was 0.89 (range 0.08-0.99), and the mean Spearman correlation coefficient was 0.84 (range 0.2-1.00). Conclusions: By integrating previous incidence and Google Trends data, our machine learning algorithm was able to predict the incidence of COVID-19 in most individual countries and territories accurately 7 days ahead. %M 34081607 %R 10.2196/24285 %U https://www.jmir.org/2021/6/e24285 %U https://doi.org/10.2196/24285 %U http://www.ncbi.nlm.nih.gov/pubmed/34081607 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 6 %P e26417 %T A 5-Minute Cognitive Assessment for Safe Remote Use in Patients With COVID-19: Clinical Case Series %A Beresford,Thomas %A Ronan,Patrick J %A Hipp,Daniel %+ Laboratory for Clinical and Translational Research in Psychiatry, Rocky Mountain Regional VA Medical Center, (116), 1700 North Wheeling Street, Aurora, CO, 80045, United States, 1 7207237374, thomas.beresford@ucdenver.edu %K cognition %K COVID-19 %K safety %K remote use %K delirium %K brain injury, brain %K diagnosis %K assessment %K test %K telehealth %K telemedicine %D 2021 %7 14.6.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Early clinical experience during the COVID-19 pandemic has begun to elucidate that the disease can cause brain function changes that may result in compromised cognition both acutely and during variable recovery periods. Reports on cognitive assessment of patients with COVID-19 are often limited to orientation alone. Further assessment may seem to create an inappropriate burden for patients with acute COVID-19, which is characterized by fatigue and confusion, and may also compromise examiner safety. Objective: The aims of this study were to assess cognition in patients with COVID-19 as comprehensively as possible in a brief format, while observing safety precautions, and to establish a clear face value of the external validity of the assessment. Methods: We adapted a brief cognitive assessment, previously applied to liver transplant candidates and medical/surgical inpatients, for remote use in patients hospitalized for COVID-19 treatment. Collecting quality assurance data from telephone-administered assessments, this report presents a series of 6 COVID-19 case vignettes to illustrate the use of this 5-minute assessment in the diagnosis and treatment of brain effects. Primary medical teams referred the cases for neuropsychiatric consultation. Results: The age of the patients varied over four decades, and none of them were able to engage meaningfully with their surroundings on admission. On follow-up examination 6 to 10 days later, 4 of the 6 patients had recovered working memory, and only 1 had recovered calculation ability. Of the 6 patients, 2 were capable of complex judgment responses, while none of the cases completed frontal executive function testing in the normal range. Conclusions: Cognitive assessment in patients with COVID-19 using this remote examination reveals patterns of cognitive recovery that vary among cases and are far more complex than loss of orientation. In this series, testing of specific temporal, parietal, and frontal lobe functions suggests that calculation ability, judgment, and especially frontal executive functions may characterize the effects of COVID-19 on the brain. Used widely and serially, this examination method can potentially inform our understanding of the effects of COVID-19 on the brain and of healing from the virus. %M 34010137 %R 10.2196/26417 %U https://formative.jmir.org/2021/6/e26417 %U https://doi.org/10.2196/26417 %U http://www.ncbi.nlm.nih.gov/pubmed/34010137 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 7 %N 2 %P e26797 %T Adapting Medical Education Initiatives Through Team-Based e-Learning, Telemedicine Objective Structured Clinical Exams, and Student-Led Community Outreach During the COVID-19 Pandemic %A Miao,Julia H %+ Department of Medicine, Renaissance School of Medicine at Stony Brook University, 100 Nicolls Rd, Stony Brook, NY, 11794, United States, 1 4083987805, jhm344@cornell.edu %K medical education %K COVID-19 %K medical student %K community service %K telemedicine %K telehealth %K community outreach %K peer teaching %K student-led initiative %K clinical assessment %K adaptability %K team-based learning %D 2021 %7 14.6.2021 %9 Viewpoint %J JMIR Med Educ %G English %X Although the COVID-19 pandemic has quickly prompted medical schools and students around the world to transition from their traditional classrooms to web-based learning, the global crisis has inspired the development of innovative e-learning solutions that use existing technology and other web-based tools to continue nurturing the education of medical students while ensuring the public health and safety of both students and faculty members alike. Through the perspective of medical students, we share how the COVID-19 pandemic has impacted and transformed small team–based learning in medical education; changed objective structured clinical exam evaluations and the practice of clinical skills through telemedicine; and nurtured nationwide, web-based, student-led initiatives for community outreach, telehealth, and medical services. %M 34061763 %R 10.2196/26797 %U https://mededu.jmir.org/2021/2/e26797 %U https://doi.org/10.2196/26797 %U http://www.ncbi.nlm.nih.gov/pubmed/34061763 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 6 %P e29802 %T Health Information Seeking Behaviors on Social Media During the COVID-19 Pandemic Among American Social Networking Site Users: Survey Study %A Neely,Stephen %A Eldredge,Christina %A Sanders,Ron %+ School of Public Affairs, College of Arts and Sciences, University of South Florida, 4202 E Fowler Ave, Tampa, FL, 33620, United States, 1 8139748423, srneely@usf.edu %K social media %K internet %K communication %K public health %K COVID-19 %K usage %K United States %K information seeking %K web-based health information %K survey %K mistrust %D 2021 %7 11.6.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: In recent years, medical journals have emphasized the increasingly critical role that social media plays in the dissemination of public health information and disease prevention guidelines. However, platforms such as Facebook and Twitter continue to pose unique challenges for clinical health care providers and public health officials alike. In order to effectively communicate during public health emergencies, such as the COVID-19 pandemic, it is increasingly critical for health care providers and public health officials to understand how patients gather health-related information on the internet and adjudicate the merits of such information. Objective: With that goal in mind, we conducted a survey of 1003 US-based adults to better understand how health consumers have used social media to learn and stay informed about the COVID-19 pandemic, the extent to which they have relied on credible scientific information sources, and how they have gone about fact-checking pandemic-related information. Methods: A web-based survey was conducted with a sample that was purchased through an industry-leading market research provider. The results were reported with a 95% confidence level and a margin of error of 3. Participants included 1003 US-based adults (aged ≥18 years). Participants were selected via a stratified quota sampling approach to ensure that the sample was representative of the US population. Balanced quotas were determined (by region of the country) for gender, age, race, and ethnicity. Results: The results showed a heavy reliance on social media during the COVID-19 pandemic; more than three-quarters of respondents (762/1003, 76%) reported that they have relied on social media at least “a little,” and 59.2% (594/1003) of respondents indicated that they read information about COVID-19 on social media at least once per week. According to the findings, most social media users (638/1003, 63.6%) were unlikely to fact-check what they see on the internet with a health professional, despite the high levels of mistrust in the accuracy of COVID-19–related information on social media. We also found a greater likelihood of undergoing vaccination among those following more credible scientific sources on social media during the pandemic (χ216=50.790; φ=0.258; P<.001). Conclusions: The findings suggest that health professionals will need to be both strategic and proactive when engaging with health consumers on social media if they hope to counteract the deleterious effects of misinformation and disinformation. Effective training, institutional support, and proactive collaboration can help health professionals adapt to the evolving patterns of health information seeking. %M 34043526 %R 10.2196/29802 %U https://www.jmir.org/2021/6/e29802 %U https://doi.org/10.2196/29802 %U http://www.ncbi.nlm.nih.gov/pubmed/34043526 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 6 %P e27632 %T Assessing COVID-19 Vaccine Hesitancy, Confidence, and Public Engagement: A Global Social Listening Study %A Hou,Zhiyuan %A Tong,Yixin %A Du,Fanxing %A Lu,Linyao %A Zhao,Sihong %A Yu,Kexin %A Piatek,Simon J %A Larson,Heidi J %A Lin,Leesa %+ School of Public Health, Fudan University, Mailbox 250, 138# Yixueyuan Road, Xuhui District, Shanghai, 200030, China, 86 2133563935, zyhou@fudan.edu.cn %K COVID-19 vaccine %K hesitancy %K infoveillance %K infodemiology %K confidence %K acceptance %K engagement %K social media %K COVID-19 %D 2021 %7 11.6.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Monitoring public confidence and hesitancy is crucial for the COVID-19 vaccine rollout. Social media listening (infoveillance) can not only monitor public attitudes on COVID-19 vaccines but also assess the dissemination of and public engagement with these opinions. Objective: This study aims to assess global hesitancy, confidence, and public engagement toward COVID-19 vaccination. Methods: We collected posts mentioning the COVID-19 vaccine between June and July 2020 on Twitter from New York (United States), London (United Kingdom), Mumbai (India), and Sao Paulo (Brazil), and Sina Weibo posts from Beijing (China). In total, we manually coded 12,886 posts from the five global metropolises with high COVID-19 burdens, and after assessment, 7032 posts were included in the analysis. We manually double-coded these posts using a coding framework developed according to the World Health Organization’s Confidence, Complacency, and Convenience model of vaccine hesitancy, and conducted engagement analysis to investigate public communication about COVID-19 vaccines on social media. Results: Among social media users, 36.4% (571/1568) in New York, 51.3% (738/1440) in London, 67.3% (144/214) in Sao Paulo, 69.8% (726/1040) in Mumbai, and 76.8% (2128/2770) in Beijing indicated that they intended to accept a COVID-19 vaccination. With a high perceived risk of getting COVID-19, more tweeters in New York and London expressed a lack of confidence in vaccine safety, distrust in governments and experts, and widespread misinformation or rumors. Tweeters from Mumbai, Sao Paulo, and Beijing worried more about vaccine production and supply, whereas tweeters from New York and London had more concerns about vaccine distribution and inequity. Negative tweets expressing lack of vaccine confidence and misinformation or rumors had more followers and attracted more public engagement online. Conclusions: COVID-19 vaccine hesitancy is prevalent worldwide, and negative tweets attract higher engagement on social media. It is urgent to develop an effective vaccine campaign that boosts public confidence and addresses hesitancy for COVID-19 vaccine rollouts. %M 34061757 %R 10.2196/27632 %U https://www.jmir.org/2021/6/e27632 %U https://doi.org/10.2196/27632 %U http://www.ncbi.nlm.nih.gov/pubmed/34061757 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 6 %P e25021 %T Digital Solutions to Alleviate the Burden on Health Systems During a Public Health Care Crisis: COVID-19 as an Opportunity %A Willems,Sofie H %A Rao,Jyotsna %A Bhambere,Sailee %A Patel,Dipu %A Biggins,Yvonne %A Guite,Jessica W %+ Center for Advancement in Managing Pain, School of Nursing, The University of Connecticut, 231 Glenbrook Road, Storrs, CT, 06269-4026, United States, 1 215 964 5582, jessica.guite@uconn.com %K coronavirus %K digital health %K multiplatform %K chat %K symptom tracking %K well-being %K COVID-19 %K online platform %K symptom %K monitoring %K follow-up %D 2021 %7 11.6.2021 %9 Viewpoint %J JMIR Mhealth Uhealth %G English %X The COVID-19 pandemic has generated unprecedented and sustained health management challenges worldwide. Health care systems continue to struggle to support the needs of the majority of infected individuals that are either asymptomatic or have mild symptoms. In addition, long-term effects in the form of long-lasting COVID-19 symptoms or widespread mental health issues aggravated by the pandemic pose a burden on health care systems worldwide. This viewpoint article considers aspects of digital health care solutions and how they can play an ongoing role in safely addressing gaps in the health care support available from initially and repeatedly overwhelmed providers and systems. Digital solutions can be readily designed to address this need and can be flexible enough to adapt to the evolving management requirements of various stakeholders to reduce COVID-19 infection rates, acute hospitalizations, and mortality. Multiplatform solutions provide a hybrid model of care, which can include mobile and online platforms accompanied by direct clinician input and feedback. Desirable components to be included are discussed, including symptom tracking, patient education, well-being support, and bidirectional communication between patients and clinicians. Customizable and scalable digital health platforms not only can be readily adapted to further meet the needs of employers and public health stakeholders during the ongoing pandemic, but also hold relevance for flexibly meeting broader care management needs into the future. %M 34033575 %R 10.2196/25021 %U https://mhealth.jmir.org/2021/6/e25021 %U https://doi.org/10.2196/25021 %U http://www.ncbi.nlm.nih.gov/pubmed/34033575 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 6 %P e23250 %T State of the Art in Adoption of Contact Tracing Apps and Recommendations Regarding Privacy Protection and Public Health: Systematic Review %A Kolasa,Katarzyna %A Mazzi,Francesca %A Leszczuk-Czubkowska,Ewa %A Zrubka,Zsombor %A Péntek,Márta %+ Division of Health Economics and Healthcare Management, Kozminski University, 57/59 Jagiellonska St, Warsaw, 03-301, Poland, 48 22 519 21 00, kkolasa@kozminski.edu.pl %K COVID-19 %K contact tracing app %K data accessibility %K data privacy %K mobile app %K digital health %K digital contact tracing %D 2021 %7 10.6.2021 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: During the COVID-19 pandemic, contact tracing apps have received a lot of public attention. The ongoing debate highlights the challenges of the adoption of data-driven innovation. We reflect on how to ensure an appropriate level of protection of individual data and how to maximize public health benefits that can be derived from the collected data. Objective: The aim of the study was to analyze available COVID-19 contact tracing apps and verify to what extent public health interests and data privacy standards can be fulfilled simultaneously in the process of the adoption of digital health technologies. Methods: A systematic review of PubMed and MEDLINE databases, as well as grey literature, was performed to identify available contact tracing apps. Two checklists were developed to evaluate (1) the apps’ compliance with data privacy standards and (2) their fulfillment of public health interests. Based on both checklists, a scorecard with a selected set of minimum requirements was created with the goal of estimating whether the balance between the objective of data privacy and public health interests can be achieved in order to ensure the broad adoption of digital technologies. Results: Overall, 21 contact tracing apps were reviewed. In total, 11 criteria were defined to assess the usefulness of each digital technology for public health interests. The most frequently installed features related to contact alerting and governmental accountability. The least frequently installed feature was the availability of a system of medical or organizational support. Only 1 app out of 21 (5%) provided a threshold for the population coverage needed for the digital solution to be effective. In total, 12 criteria were used to assess the compliance of contact tracing apps with data privacy regulations. Explicit user consent, voluntary use, and anonymization techniques were among the most frequently fulfilled criteria. The least often implemented criteria were provisions of information about personal data breaches and data gathered from children. The balance between standards of data protection and public health benefits was achieved best by the COVIDSafe app and worst by the Alipay Health Code app. Conclusions: Contact tracing apps with high levels of compliance with standards of data privacy tend to fulfill public health interests to a limited extent. Simultaneously, digital technologies with a lower level of data privacy protection allow for the collection of more data. Overall, this review shows that a consistent number of apps appear to comply with standards of data privacy, while their usefulness from a public health perspective can still be maximized. %M 34033581 %R 10.2196/23250 %U https://mhealth.jmir.org/2021/6/e23250 %U https://doi.org/10.2196/23250 %U http://www.ncbi.nlm.nih.gov/pubmed/34033581 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 6 %P e29528 %T Community Mitigation of COVID-19 and Portrayal of Testing on TikTok: Descriptive Study %A Basch,Corey H %A Mohlman,Jan %A Fera,Joseph %A Tang,Hao %A Pellicane,Alessia %A Basch,Charles E %+ Department of Public Health, William Paterson University, University Hall, Wayne, NJ, 07470, United States, 1 9737202603, baschc@wpunj.edu %K TikTok %K social media %K COVID-19 %K testing %K disgust %K anxiety %K content analysis %K communication %K infodemiology %K infoveillance %K public health %K digital public health %K digital health %K community mitigation %D 2021 %7 10.6.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: COVID-19 testing remains an essential element of a comprehensive strategy for community mitigation. Social media is a popular source of information about health, including COVID-19 and testing information. One of the most popular communication channels used by adolescents and young adults who search for health information is TikTok—an emerging social media platform. Objective: The purpose of this study was to describe TikTok videos related to COVID-19 testing. Methods: The hashtag #covidtesting was searched, and the first 100 videos were included in the study sample. At the time the sample was drawn, these 100 videos garnered more than 50% of the views for all videos cataloged under the hashtag #covidtesting. The content characteristics that were coded included mentions, displays, or suggestions of anxiety, COVID-19 symptoms, quarantine, types of tests, results of test, and disgust/unpleasantness. Additional data that were coded included the number and percentage of views, likes, and comments and the use of music, dance, and humor. Results: The 100 videos garnered more than 103 million views; 111,000 comments; and over 12.8 million likes. Even though only 44 videos mentioned or suggested disgust/unpleasantness and 44 mentioned or suggested anxiety, those that portrayed tests as disgusting/unpleasant garnered over 70% of the total cumulative number of views (73,479,400/103,071,900, 71.29%) and likes (9,354,691/12,872,505, 72.67%), and those that mentioned or suggested anxiety attracted about 60% of the total cumulative number of views (61,423,500/103,071,900, 59.59%) and more than 8 million likes (8,339,598/12,872,505, 64.79%). Independent one-tailed t tests (α=.05) revealed that videos that mentioned or suggested that COVID-19 testing was disgusting/unpleasant were associated with receiving a higher number of views and likes. Conclusions: Our finding of an association between TikTok videos that mentioned or suggested that COVID-19 tests were disgusting/unpleasant and these videos’ propensity to garner views and likes is of concern. There is a need for public health agencies to recognize and address connotations of COVID-19 testing on social media. %M 34081591 %R 10.2196/29528 %U https://publichealth.jmir.org/2021/6/e29528 %U https://doi.org/10.2196/29528 %U http://www.ncbi.nlm.nih.gov/pubmed/34081591 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 6 %P e27102 %T Considerations for the Design and Implementation of COVID-19 Contact Tracing Apps: Scoping Review %A Osmanlliu,Esli %A Rafie,Edmond %A Bédard,Sylvain %A Paquette,Jesseca %A Gore,Genevieve %A Pomey,Marie-Pascale %+ Division of Pediatric Emergency Medicine, Department of Pediatrics, Montreal Children’s Hospital, McGill University Health Centre, MUHC Glen Site, 1001 Décarie Blvd, Montreal, QC, H4A 3J1, Canada, 1 514 412 4499, esli.osmanlliu@mcgill.ca %K COVID-19 %K contact tracing %K exposure notification %K app %K design %K implementation %K participatory %K eHealth %K surveillance %K monitoring %K review %D 2021 %7 9.6.2021 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Given the magnitude and speed of SARS-CoV-2 transmission, achieving timely and effective manual contact tracing has been a challenging task. Early in the pandemic, contact tracing apps generated substantial enthusiasm due to their potential for automating tracing and reducing transmission rates while enabling targeted confinement strategies. However, although surveys demonstrate public interest in using such apps, their actual uptake remains limited. Their social acceptability is challenged by issues around privacy, fairness, and effectiveness, among other concerns. Objective: This study aims to examine the extent to which design and implementation considerations for contact tracing apps are detailed in the available literature, focusing on aspects related to participatory and responsible eHealth innovation, and synthesize recommendations that support the development of successful COVID-19 contact tracing apps and related eHealth technologies. Methods: Searches were performed on five databases, and articles were selected based on eligibility criteria. Papers pertaining to the design, implementation, or acceptability of contact tracing apps were included. Articles published since 2019, written in English or French, and for which the full articles were available were considered eligible for analysis. To assess the scope of the knowledge found in the current literature, we used three complementary frameworks: (1) the Holistic Framework to Improve the Uptake and Impact of eHealth Technologies, (2) the Montreal model, and (3) the Responsible Innovation in Health Assessment Tool. Results: A total of 63 articles qualified for the final analysis. Less than half of the selected articles cited the need for a participatory process (n=25, 40%), which nonetheless was the most frequently referenced item of the Framework to Improve the Uptake and Impact of eHealth Technologies. Regarding the Montreal model, stakeholder consultation was the most frequently described level of engagement in the development of contact tracing apps (n=24, 38%), while collaboration and partnership were cited the least (n=2, 3%). As for the Responsible Innovation in Health framework, all the articles (n=63, 100%) addressed population health, whereas only 2% (n=1) covered environmental considerations. Conclusions: Most studies lacked fundamental aspects of eHealth development and implementation. Our results demonstrate that stakeholders of COVID-19 contact tracing apps lack important information to be able to critically appraise this eHealth innovation. This may have contributed to the modest uptake of contact tracing apps worldwide. We make evidence-informed recommendations regarding data management, communication, stakeholder engagement, user experience, and implementation strategies for the successful and responsible development of contact tracing apps. %M 34038376 %R 10.2196/27102 %U https://mhealth.jmir.org/2021/6/e27102 %U https://doi.org/10.2196/27102 %U http://www.ncbi.nlm.nih.gov/pubmed/34038376 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 8 %N 2 %P e26043 %T Age-Related Differences in Experiences With Social Distancing at the Onset of the COVID-19 Pandemic: A Computational and Content Analytic Investigation of Natural Language From a Social Media Survey %A Moore,Ryan C %A Lee,Angela Y %A Hancock,Jeffrey T %A Halley,Meghan C %A Linos,Eleni %+ Department of Communication, Stanford University, 450 Jane Stanford Way, Building 120, Room 110, Stanford, CA, 94305, United States, 1 650 723 5499, hancockj@stanford.edu %K COVID-19 %K natural language processing %K public health messaging %K social distancing compliance %K age differences %K older adults %K younger adults %K age %K NLP %K public health %K elderly %K youth %K adult %K emotion %K compliance %K guideline %D 2021 %7 9.6.2021 %9 Original Paper %J JMIR Hum Factors %G English %X Background: As COVID-19 poses different levels of threat to people of different ages, health communication regarding prevention measures such as social distancing and isolation may be strengthened by understanding the unique experiences of various age groups. Objective: The aim of this study was to examine how people of different ages (1) experienced the impact of the COVID-19 pandemic and (2) their respective rates and reasons for compliance or noncompliance with social distancing and isolation health guidance. Methods: We fielded a survey on social media early in the pandemic to examine the emotional impact of COVID-19 and individuals’ rates and reasons for noncompliance with public health guidance, using computational and content analytic methods of linguistic analysis. Results: A total of 17,287 participants were surveyed. The majority (n=13,183, 76.3%) were from the United States. Younger (18-31 years), middle-aged (32-44 years and 45-64 years), and older (≥65 years) individuals significantly varied in how they described the impact of COVID-19 on their lives, including their emotional experience, self-focused attention, and topical concerns. Younger individuals were more emotionally negative and self-focused, while middle-aged people were other-focused and concerned with family. The oldest and most at-risk group was most concerned with health-related terms but were lower in anxiety (use of fewer anxiety-related terms) and higher in the use of emotionally positive terms than the other less at-risk age groups. While all groups discussed topics such as acquiring essential supplies, they differentially experienced the impact of school closures and limited social interactions. We also found relatively high rates of noncompliance with COVID-19 prevention measures, such as social distancing and self-isolation, with younger people being more likely to be noncompliant than older people (P<.001). Among the 43.1% (n=7456) of respondents who did not fully comply with health orders, people differed substantially in the reasons they gave for noncompliance. The most common reason for noncompliance was not being able to afford to miss work (n=4273, 57.3%). While work obligations proved challenging for participants across ages, younger people struggled more to find adequate space to self-isolate and manage their mental and physical health; middle-aged people had more concerns regarding childcare; and older people perceived themselves as being able to take sufficient precautions. Conclusions: Analysis of natural language can provide insight into rapidly developing public health challenges like the COVID-19 pandemic, uncovering individual differences in emotional experiences and health-related behaviors. In this case, our analyses revealed significant differences between different age groups in feelings about and responses to public health orders aimed to mitigate the spread of COVID-19. To improve public compliance with health orders as the pandemic continues, health communication strategies could be made more effective by being tailored to these age-related differences. %M 33914689 %R 10.2196/26043 %U https://humanfactors.jmir.org/2021/2/e26043 %U https://doi.org/10.2196/26043 %U http://www.ncbi.nlm.nih.gov/pubmed/33914689 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 6 %P e26285 %T Using Fear and Anxiety Related to COVID-19 to Predict Cyberchondria: Cross-sectional Survey Study %A Wu,Xue %A Nazari,Nabi %A Griffiths,Mark D %+ Department of Psychology, Faculty of Literature and Human Sciences, Lorestan University, PO Box 465, Khorramabad, Iran, 98 09197119027, Nazariirani@gmail.com %K COVID-19 %K cyberchondria %K COVID-19 fear %K COVID-19 anxiety %K anxiety sensitivity %K anxiety %K intolerance of uncertainty %K mental health %K survey %K SEM %D 2021 %7 9.6.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Studies have highlighted that fear and anxiety generated by COVID-19 are important psychological factors that affect all populations. There currently remains a lack of research on specific amplification factors regarding fear and anxiety in the context of the COVID-19 pandemic. Despite established associations between anxiety sensitivity, intolerance of uncertainty, and cyberchondria, empirical data investigating the associations between these three variables, particularly in the context of the COVID-19 pandemic, are currently lacking. Urgent research is needed to better understand the role of repeated media consumption concerning COVID-19 in amplifying fear and anxiety related to COVID-19. Objective: This study investigated the associations between fear of COVID-19, COVID-19 anxiety, and cyberchondria. Methods: Convenience sampling was used to recruit respondents to participate in an online survey. The survey, which was distributed via social media and academic forums, comprised the Cyberchondria Severity Scale, Fear of COVID-19 Scale, Coronavirus Anxiety Scale, Anxiety Sensitivity Index, and Intolerance of Uncertainty Scale. Multiple mediation analyses were conducted using structural equation modeling. Results: A total of 694 respondents (males: n=343, females: n=351) completed the online survey. The results showed that fear and anxiety generated by COVID-19 predicted cyberchondria (fear: β=.39, SE 0.04, P<.001, t=11.16, 95% CI 0.31-0.45; anxiety: β=.25, SE 0.03, P<.001, t=7.67, 95% CI 0.19-0.32). In addition, intolerance of uncertainty and anxiety sensitivity mediated the relationship between fear and anxiety generated by COVID-19 with cyberchondria. In a reciprocal model, the standardized total effects of cyberchondria on fear of COVID-19 (β=.45, SE 0.04, P<.001, t=15.31, 95% CI 0.39-0.51) and COVID-19 anxiety (β=.36, SE 0.03, P<.001, t=11.29, 95% CI 0.30-0.41) were statistically significant, with moderate effect sizes. Compared to males, females obtained significantly higher scores for cyberchondria (t1,692=–2.85, P=.004, Cohen d=0.22), COVID-19 anxiety (t1,692=–3.32, P<.001, Cohen d=0.26), and anxiety sensitivity (t1,692=–3.69, P<.001, Cohen d=0.29). Conclusions: The findings provide a better understanding of the role of COVID-19 in amplifying cyberchondria. Based on these results, cyberchondria must be viewed as a significant public health issue. Importantly, increasing awareness about cyberchondria and online behavior at both the individual and collective levels must be prioritized to enhance preparedness and to reduce the adverse effects of current and future medical crises. %M 34014833 %R 10.2196/26285 %U https://www.jmir.org/2021/6/e26285 %U https://doi.org/10.2196/26285 %U http://www.ncbi.nlm.nih.gov/pubmed/34014833 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 6 %P e24312 %T A Wake-up Call for Burnout in Portuguese Physicians During the COVID-19 Outbreak: National Survey Study %A Ferreira,Sónia %A Sousa,Mafalda Machado %A Moreira,Pedro Silva %A Sousa,Nuno %A Picó-Pérez,Maria %A Morgado,Pedro %+ Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Universidade do Minho, Campus de Gualtar, Braga, 4710-057, Portugal, 351 253 604928, pedromorgado@med.uminho.pt %K COVID-19 %K anxiety %K coronavirus %K depression %K frontline %K health care professionals %K health care staff %K obsessive compulsive disorder %K SARS-CoV-2 %K stress %D 2021 %7 9.6.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The COVID-19 outbreak has imposed physical and psychological pressure on health care professionals, including frontline physicians. Hence, evaluating the mental health status of physicians during the current pandemic is important to define future preventive guidelines among health care stakeholders. Objective: In this study, we intended to study alterations in the mental health status of Portuguese physicians working at the frontline during the COVID-19 pandemic and potential sociodemographic factors influencing their mental health status. Methods: A nationwide survey was conducted during May 4-25, 2020, to infer differences in mental health status (depression, anxiety, stress, and obsessive compulsive symptoms) between Portuguese physicians working at the frontline during the COVID-19 pandemic and other nonfrontline physicians. A representative sample of 420 participants stratified by age, sex, and the geographic region was analyzed (200 frontline and 220 nonfrontline participants). Moreover, we explored the influence of several sociodemographic factors on mental health variables including age, sex, living conditions, and household composition. Results: Our results show that being female (β=1.1; t=2.5; P=.01) and working at the frontline (β=1.4; t=2.9; P=.004) are potential risk factors for stress. In contrast, having a house with green space was a potentially beneficial factor for stress (β=–1.5; t=–2.5; P=.01) and anxiety (β=–1.1; t=–2.4; P=.02). Conclusions: It is important to apply protective mental health measures for physicians to avoid the long-term effects of stress, such as burnout. %M 33630744 %R 10.2196/24312 %U https://publichealth.jmir.org/2021/6/e24312 %U https://doi.org/10.2196/24312 %U http://www.ncbi.nlm.nih.gov/pubmed/33630744 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 4 %N 2 %P e27958 %T Building Primary-School Children’s Resilience through a Web-Based Interactive Learning Environment: Quasi-Experimental Pre-Post Study %A Nicolaidou,Iolie %A Stavrou,Evi %A Leonidou,Georgia %+ Department of Communication and Internet Studies, Cyprus University of Technology, PO Box 50329, Limassol, 3603, Cyprus, 357 25 002105, iolie.nicolaidou@cut.ac.cy %K COVID-19 %K interactive learning environment %K internet-based cognitive behavioral therapy %K parents %K prevention intervention %K primary school children %K psychological resilience %K teachers %D 2021 %7 9.6.2021 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Resilience is a person’s mental ability to deal with challenging situations adaptively and is a crucial stress management skill. Psychological resilience and finding ways to cope in crises is a highly relevant topic considering the COVID-19 pandemic, which enforced quarantine, social distancing measures, and school closures worldwide. Parents and children are currently living with increased stress due to COVID-19. We need to respond with immediate ways to strengthen children’s resilience. Internet-based cognitive behavioral therapy interventions for children's stress management overcome accessibility issues such as the inability to visit mental health experts owing to COVID-19 movement restrictions. An interactive learning environment was created, based on the preventive program “Friends,” to overcome accessibility issues associated with delivering cognitive behavioral therapy–based interventions in formal and informal education settings. Objective: This study aimed to examine the effectiveness of a web-based learning environment on resilience in (1) reducing anxiety symptoms and (2) increasing emotion recognition and recognition of stress management techniques among 9-10-year-old children. We also aimed to evaluate the learning environment’s usability. Methods: A quasi-experimental pretest-posttest control group design was used. In total, 20 fourth graders in the experimental group interacted with the learning environment over 6 weekly 80-minute sessions. Further, 21 fourth graders constituted the control group. The main data sources were (1) a psychometric tool to measure children’s anxiety symptoms, namely the Greek translation of the original Spence Children’s Anxiety Scale, (2) 3 open-ended questions assessing emotion recognition and recognition of stress management techniques, and (3) the System Usability Scale to measure the usability of the learning environment. Results: In both groups, there was a small but nonsignificant postintervention reduction in reported anxiety symptoms, except for obsessive-compulsive disorder symptoms in the experimental group. A paired samples t test revealed that students’ reported symptom scores of obsessive-compulsive disorder significantly decreased from 1.06 (SD 0.68) to 0.76 (SD 0.61) (t19= 5.16; P=.01). The experimental group revealed a significant increase in emotion recognition (t19=–6.99; P<.001), identification of somatic symptoms of stress (t19=–7.31; P<.001), and identification of stress management techniques (t19=–6.85; P<.001). The learning environment received a satisfactory usability score. The raw average system usability score was 76.75 (SD 8.28), which is in the 80th percentile rank and corresponds to grade B. Conclusions: This study shows that interactive learning environments might deliver resilience interventions in an accessible and cost-effective manner in formal education, potentially even in distance-learning conditions owing to the COVID-19 pandemic. Interactive learning environments on resilience are also valuable tools for parents who can use them with their children at home, for informal learning, using mobile devices. As such, they could be a promising first-step, low-intensity intervention that children and the youth can easily access. %M 34106080 %R 10.2196/27958 %U https://pediatrics.jmir.org/2021/2/e27958 %U https://doi.org/10.2196/27958 %U http://www.ncbi.nlm.nih.gov/pubmed/34106080 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 6 %P e27888 %T How New Mexico Leveraged a COVID-19 Case Forecasting Model to Preemptively Address the Health Care Needs of the State: Quantitative Analysis %A Castro,Lauren A %A Shelley,Courtney D %A Osthus,Dave %A Michaud,Isaac %A Mitchell,Jason %A Manore,Carrie A %A Del Valle,Sara Y %+ Information Systems & Modeling Group, Analytics, Intelligence and Technology Division, Los Alamos National Laboratory, PO Box 1663, Los Alamos, NM, 87545, United States, 1 505 667 7544, lcastro@lanl.gov %K COVID-19 %K forecasting %K health care %K prediction %K forecast %K model %K quantitative %K hospital %K ICU %K ventilator %K intensive care unit %K probability %K trend %K plan %D 2021 %7 9.6.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Prior to the COVID-19 pandemic, US hospitals relied on static projections of future trends for long-term planning and were only beginning to consider forecasting methods for short-term planning of staffing and other resources. With the overwhelming burden imposed by COVID-19 on the health care system, an emergent need exists to accurately forecast hospitalization needs within an actionable timeframe. Objective: Our goal was to leverage an existing COVID-19 case and death forecasting tool to generate the expected number of concurrent hospitalizations, occupied intensive care unit (ICU) beds, and in-use ventilators 1 day to 4 weeks in the future for New Mexico and each of its five health regions. Methods: We developed a probabilistic model that took as input the number of new COVID-19 cases for New Mexico from Los Alamos National Laboratory’s COVID-19 Forecasts Using Fast Evaluations and Estimation tool, and we used the model to estimate the number of new daily hospital admissions 4 weeks into the future based on current statewide hospitalization rates. The model estimated the number of new admissions that would require an ICU bed or use of a ventilator and then projected the individual lengths of hospital stays based on the resource need. By tracking the lengths of stay through time, we captured the projected simultaneous need for inpatient beds, ICU beds, and ventilators. We used a postprocessing method to adjust the forecasts based on the differences between prior forecasts and the subsequent observed data. Thus, we ensured that our forecasts could reflect a dynamically changing situation on the ground. Results: Forecasts made between September 1 and December 9, 2020, showed variable accuracy across time, health care resource needs, and forecast horizon. Forecasts made in October, when new COVID-19 cases were steadily increasing, had an average accuracy error of 20.0%, while the error in forecasts made in September, a month with low COVID-19 activity, was 39.7%. Across health care use categories, state-level forecasts were more accurate than those at the regional level. Although the accuracy declined as the forecast was projected further into the future, the stated uncertainty of the prediction improved. Forecasts were within 5% of their stated uncertainty at the 50% and 90% prediction intervals at the 3- to 4-week forecast horizon for state-level inpatient and ICU needs. However, uncertainty intervals were too narrow for forecasts of state-level ventilator need and all regional health care resource needs. Conclusions: Real-time forecasting of the burden imposed by a spreading infectious disease is a crucial component of decision support during a public health emergency. Our proposed methodology demonstrated utility in providing near-term forecasts, particularly at the state level. This tool can aid other stakeholders as they face COVID-19 population impacts now and in the future. %M 34003763 %R 10.2196/27888 %U https://publichealth.jmir.org/2021/6/e27888 %U https://doi.org/10.2196/27888 %U http://www.ncbi.nlm.nih.gov/pubmed/34003763 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 7 %N 2 %P e23980 %T Using a Web-Based Platform as an Alternative for Conducting International, Multidisciplinary Medical Conferences During the Novel COVID-19 Pandemic: Analysis of a Conference %A Ko,Po-Jen %A Yu,Sheng-Yueh %A Chang,John Chien-Hwa %A Hsieh,Ming-Ju %A Chu,Sung-Yu %A Tan,Jimmy Wei-Hwa %A Cheng,Wan-Ling %A Ho,Pei %+ Department of Cardiac, Thoracic and Vascular Surgery, National University Health System, Level 9, National University Health System Tower Block, 1E Kent Ridge Road, Singapore, 119228, Singapore, 65 67722002, pei_ho@nuhs.edu.sg %K web-based conference %K live broadcast %K medical education %K dialysis access %K coronavirus %K COVID-19 %K conference %K social media %K web-based platform %K internet %K interaction %K teleconference %D 2021 %7 9.6.2021 %9 Original Paper %J JMIR Med Educ %G English %X Background: The COVID-19 pandemic has stunted medical education activities, resulting in most conferences being cancelled or postponed. To continue professional education during this crisis, web-based conferences can be conducted via livestream and an audience interaction platform as an alternative. Objective: The unprecedented COVID-19 pandemic has affected human connections worldwide. Conventional conferences have been replaced by web-based conferences. However, web-based conferencing has its challenges and limitations. This paper reports the logistics and preparations required for converting an international, on-site, multidisciplinary conference into a completely web-based conference within 3 weeks during the pandemic. Methods: The program was revised, and a teleconference system, live recording system, director system setup, and broadcasting platform were arranged to conduct the web-based conference. Results: We used YouTube (Alphabet Inc) and WeChat (Tencent Holdings Limited) for the web-based conference. Of the 24 hours of the conventional conference, 21.5 hours (90%) were retained in the web-based conference via live broadcasting. The conference was attended by 71% (37/52) of the original international faculties and 71% (27/38) of the overall faculties. In total, 61 out of 66 presentations (92%) were delivered. A special session—“Dialysis access management under the impact of viral epidemics”—was added to replace precongress workshops and competitions. The conference received 1810, 1452, and 1008 visits on YouTube and 6777, 4623, and 3100 visits on WeChat on conference days 1, 2, and 3, respectively. Conclusions: Switching from a conventional on-site conference to a completely web-based format within a short period is a feasible method for maintaining professional education in a socially responsible manner during a pandemic. %M 33970866 %R 10.2196/23980 %U https://mededu.jmir.org/2021/2/e23980 %U https://doi.org/10.2196/23980 %U http://www.ncbi.nlm.nih.gov/pubmed/33970866 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 6 %P e27280 %T Development of the 12-Item Social Media Disinformation Scale and its Association With Social Media Addiction and Mental Health Related to COVID-19 in Tunisia: Survey-Based Pilot Case Study %A Guelmami,Noomen %A Ben Khalifa,Maher %A Chalghaf,Nasr %A Kong,Jude Dzevela %A Amayra,Tannoubi %A Wu,Jianhong %A Azaiez,Fairouz %A Bragazzi,Nicola Luigi %+ Department of Mathematics and Statistics, York University, 4700 Keele Street, Toronto, ON, M3J 1P3, Canada, 1 2818392210, robertobragazzi@gmail.com %K COVID-19 pandemic %K media disinformation %K social media addiction %K mental health %K scale validation %D 2021 %7 9.6.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: In recent years, online disinformation has increased. Fake news has been spreading about the COVID-19 pandemic. Since January 2020, the culprits and antidotes to disinformation have been digital media and social media. Objective: Our study aimed to develop and test the psychometric properties of the 12-item Social Media Disinformation Scale (SMDS-12), which assesses the consumption, confidence, and sharing of information related to COVID-19 by social media users. Methods: A total of 874 subjects were recruited over two phases: the exploratory phase group had a mean age of 28.39 years (SD 9.32) and the confirmatory phase group had a mean age of 32.84 years (SD 12.72). Participants completed the SMDS-12, the Internet Addiction Test, the COVID-19 Fear Scale, and the 10-item Perceived Stress Scale. The SMDS-12 was initially tested by exploratory factor analysis and was subsequently tested by confirmatory factor analysis. Results: The test supported the three-factor structure. In addition, no items were removed from the measurement scale, with three factors explaining up to 73.72% of the total variance, and the items had a lambda factor loading ranging from 0.73 to 0.85. Subsequently, confirmatory factor analysis confirmed the robustness of the measure by referring to a wide range of goodness-of-fit indices that met the recommended standards. The construct validity of the scale was supported by its convergent and discriminant validity. The reliability of the instrument examined by means of three internal consistency indices, and the corrected item-total correlation, demonstrated that the three dimensions of the instrument were reliable: Cronbach α values were .89, .88, and .88 for the consumption, confidence, and sharing subscales, respectively. The corrected item-total correlation ranged from 0.70 to 0.78. The correlation of the instrument’s dimensions with internet addiction and mental health factors showed positive associations. Conclusions: The SMDS-12 can be reliably utilized to measure the credibility of social media disinformation and can be adapted to measure the credibility of disinformation in other contexts. %M 34021742 %R 10.2196/27280 %U https://formative.jmir.org/2021/6/e27280 %U https://doi.org/10.2196/27280 %U http://www.ncbi.nlm.nih.gov/pubmed/34021742 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 4 %N 2 %P e29411 %T “It's Been Negative for Us Just All the Way Across the Board”: Focus Group Study Exploring Parent Perceptions of Child Screen Time During the COVID-19 Pandemic %A Hammons,Amber J %A Villegas,Elizabeth %A Robart,Ryan %+ Department of Child and Family Science, California State University, Fresno, 5241 North Maple Avenue, Fresno, CA, 93740, United States, 1 559 278 1158, ahammons@csufresno.edu %K children %K COVID-19 %K experiences %K family %K outcomes %K pandemic %K parenting %K parents %K screen time %D 2021 %7 8.6.2021 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Child screen time (ST) has soared during the COVID-19 pandemic as lockdowns and restrictions have forced changes to regular family routines. It is important to investigate how families are navigating ST. Objective: This study aimed to explore families’ experiences of ST during the COVID-19 pandemic. Methods: Virtual focus group sessions were conducted between December 2020 and February 2021 in English and Spanish. Transcripts were analyzed using reflexive thematic analysis. Results: In total, 48 parents (predominantly Hispanic) residing in California participated in 1 of 14 focus group sessions. Children were attending school remotely at the time of the study. A total of 6 themes and 1 subtheme were identified: (1) total ST has increased; (2) children are too attached to screens; (3) ST has advantages and disadvantages but parents perceive ST as mostly negative; (4) parents and children have limited options; (5) ST restrictions (subtheme: children react negatively when ST is restricted); and (6) parents are concerned that children are not getting enough exercise. Conclusions: This study provides a cross-sectional insight into how family life has changed with regard to ST during the COVID-19 pandemic. Parents expressed concerns about total ST, the addictive nature of it, and lack of physical activity. It is important that future studies examine the long-term effects of heavy ST and preemptively introduce ways to redirect children’s ST habits as the country attempts to establish a new normal. %M 34081606 %R 10.2196/29411 %U https://pediatrics.jmir.org/2021/2/e29411 %U https://doi.org/10.2196/29411 %U http://www.ncbi.nlm.nih.gov/pubmed/34081606 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 7 %N 2 %P e27384 %T Virtual Mind-Body Programming for Patients With Cancer During the COVID-19 Pandemic: Qualitative Study %A Emard,Nicholas %A Lynch,Kathleen A %A Liou,Kevin T %A Atkinson,Thomas %A Green,Angela K %A Daly,Bobby %A Trevino,Kelly %A Mao,Jun J %+ Bendheim Integrative Medicine Center, Department of Medicine, Memorial Sloan Kettering Cancer Center, 1429 First Ave, New York, NY, 10021, United States, 1 646 888 0866, maoj@mskcc.org %K cancer %K fitness %K meditation %K stress %K COVID-19 %K qualitative %K coping %K wellbeing %K psychosocial %K virtual health %D 2021 %7 8.6.2021 %9 Original Paper %J JMIR Cancer %G English %X Background: Patients with cancer are particularly vulnerable to stress and anxiety during the COVID-19 pandemic. Social distancing is critical for patients with cancer; however, it can also reduce their access to psychosocial coping resources. Objective: The aim of this study was to explore patient experiences to generate a model of how virtual mind-body programs can support the psychosocial well-being of patients with cancer. Methods: We conducted a qualitative study among patients (aged ≥18 years) who participated in a virtual mind-body program offered by a National Cancer Institute–designated Comprehensive Cancer Center during the COVID-19 pandemic. The program consisted of mind-body group therapy sessions of fitness, yoga, tai chi, dance therapy, music therapy, and meditation. Live integrative medicine clinicians held each session via Zoom videoconferencing for 30-45 minutes. In semistructured phone interviews (n=30), patients were asked about their overall impressions and perceptions of the benefits of the sessions, including impacts on stress and anxiety. Interviews were analyzed using grounded theory. Results: Among the 30 participants (average age 64.5 years, SD 9.36, range 40-80, 29 female), three major themes were identified relating to experiences in the virtual mind-body program: (1) the sessions helped the patients maintain structured routines and motivated them to adhere to healthy behaviors; (2) the sessions enhanced coping with COVID-19-related-stressors, allowing patients to “refocus” and “re-energize”; and (3) the sessions allowed patients to connect, fostering social relationships during a time of isolation. These themes informed the constructs of a novel behavioral-psychological-social coping model for patients with cancer. Conclusions: Virtual mind-body programming supported patients with cancer during the COVID-19 pandemic through a behavioral-psychological-social coping model by enhancing psychological coping for external stressors, supporting adherence to motivation and health behaviors, and increasing social connection and camaraderie. These programs have potential to address the behavioral, psychological, and social challenges faced by patients with cancer during and beyond the COVID-19 pandemic. The constructs of the conceptual model proposed in this study can inform future interventions to support isolated patients with cancer. Further clinical trials are needed to confirm the specific benefits of virtual mind-body programming for the psychosocial well-being and healthy behaviors of patients with cancer. %M 33882018 %R 10.2196/27384 %U https://cancer.jmir.org/2021/2/e27384 %U https://doi.org/10.2196/27384 %U http://www.ncbi.nlm.nih.gov/pubmed/33882018 %0 Journal Article %@ 1947-2579 %I JMIR Publications %V 13 %N 1 %P e11694 %T Roles of Health Literacy in Relation to Social Determinants of Health and Recommendations for Informatics-Based Interventions: Systematic Review %D 2021 %7 ..2021 %9 %J Online J Public Health Inform %G English %X Bluetooth exposure notification tools for mobile phones have emerged as one way to support public health contact tracing and mitigate the spread of COVID-19. Many states have launched their own versions of these tools. Washington State''s exposure notification tool, WA Notify, became available on November 30, 2020, following a one-month Seattle campus pilot at the University of Washington. By the end of April 2021, 25% of the state''s population had activated WA Notify, one of the highest adoption rates in the country. Washington State''s formation of an Exposure Notification Advisory Committee, early pilot testing, and use of the EN Express system framework were all important factors in its adoption. Continuous monitoring and willingness to make early adjustments such as switching to automated texting of verification codes have also been important for improving the tool’s value. Evaluation work is ongoing to determine and quantify WA Notify’s effectiveness, timeliness, and accessibility. %M 34178242 %R 10.5210/ojphi.v13i1.11694 %U %U https://doi.org/10.5210/ojphi.v13i1.11694 %U http://www.ncbi.nlm.nih.gov/pubmed/34178242 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 6 %P e27348 %T Patient Empowerment During the COVID-19 Pandemic by Ensuring Safe and Fast Communication of Test Results: Implementation and Performance of a Tracking System %A Völkel,Gunnar %A Fürstberger,Axel %A Schwab,Julian D %A Werle,Silke D %A Ikonomi,Nensi %A Gscheidmeier,Thomas %A Kraus,Johann M %A Groß,Alexander %A Holderried,Martin %A Balig,Julien %A Jobst,Franz %A Kuhn,Peter %A Kuhn,Klaus A %A Kohlbacher,Oliver %A Kaisers,Udo X %A Seufferlein,Thomas %A Kestler,Hans A %+ Institute of Medical Systems Biology, Ulm University, Albert-Einstein-Allee 11, Ulm, 89081, Germany, 49 731 500 24500, hans.kestler@uni-ulm.de %K process optimization %K patient empowerment %K data security %K COVID-19 %K clinical information system %K platform independent %K eHealth %K telemedicine %K quality management %D 2021 %7 7.6.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Overcoming the COVID-19 crisis requires new ideas and strategies for online communication of personal medical information and patient empowerment. Rapid testing of a large number of subjects is essential for monitoring and delaying the spread of SARS-CoV-2 in order to mitigate the pandemic’s consequences. People who do not know that they are infected may not stay in quarantine and, thus, risk infecting others. Unfortunately, the massive number of COVID-19 tests performed is challenging for both laboratories and the units that conduct throat swabs and communicate the results. Objective: The goal of this study was to reduce the communication burden for health care professionals. We developed a secure and easy-to-use tracking system to report COVID-19 test results online that is simple to understand for the tested subjects as soon as these results become available. Instead of personal calls, the system updates the status and the results of the tests automatically. This aims to reduce the delay when informing testees about their results and, consequently, to slow down the virus spread. Methods: The application in this study draws on an existing tracking tool. With this open-source and browser-based online tracking system, we aim to minimize the time required to inform the tested person and the testing units (eg, hospitals or the public health care system). The system can be integrated into the clinical workflow with very modest effort and avoids excessive load to telephone hotlines. Results: The test statuses and results are published on a secured webpage, enabling regular status checks by patients; status checks are performed without the use of smartphones, which has some importance, as smartphone usage diminishes with age. Stress tests and statistics show the performance of our software. CTest is currently running at two university hospitals in Germany—University Hospital Ulm and University Hospital Tübingen—with thousands of tests being performed each week. Results show a mean number of 10 (SD 2.8) views per testee. Conclusions: CTest runs independently of existing infrastructures, aims at straightforward integration, and aims for the safe transmission of information. The system is easy to use for testees. QR (Quick Response) code links allow for quick access to the test results. The mean number of views per entry indicates a reduced amount of time for both health care professionals and testees. The system is quite generic and can be extended and adapted to other communication tasks. %M 33999836 %R 10.2196/27348 %U https://www.jmir.org/2021/6/e27348 %U https://doi.org/10.2196/27348 %U http://www.ncbi.nlm.nih.gov/pubmed/33999836 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 6 %P e27753 %T Best Practice Guidance for Digital Contact Tracing Apps: A Cross-disciplinary Review of the Literature %A O'Connell,James %A Abbas,Manzar %A Beecham,Sarah %A Buckley,Jim %A Chochlov,Muslim %A Fitzgerald,Brian %A Glynn,Liam %A Johnson,Kevin %A Laffey,John %A McNicholas,Bairbre %A Nuseibeh,Bashar %A O'Callaghan,Michael %A O'Keeffe,Ian %A Razzaq,Abdul %A Rekanar,Kaavya %A Richardson,Ita %A Simpkin,Andrew %A Storni,Cristiano %A Tsvyatkova,Damyanka %A Walsh,Jane %A Welsh,Thomas %A O'Keeffe,Derek %+ School of Medicine, National University of Ireland Galway, Clinical Sciences Institute, Costello Road, Galway, H91 V4AY, Ireland, 353 (0)91 495960, derek.okeeffe@nuigalway.ie %K digital contact tracing %K automated contact tracing %K COVID-19 %K SARS-CoV-2 %K mHealth %K mobile app %K app %K tracing %K monitoring %K surveillance %K review %K best practice %K design %D 2021 %7 7.6.2021 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Digital contact tracing apps have the potential to augment contact tracing systems and disrupt COVID-19 transmission by rapidly identifying secondary cases prior to the onset of infectiousness and linking them into a system of quarantine, testing, and health care worker case management. The international experience of digital contact tracing apps during the COVID-19 pandemic demonstrates how challenging their design and deployment are. Objective: This study aims to derive and summarize best practice guidance for the design of the ideal digital contact tracing app. Methods: A collaborative cross-disciplinary approach was used to derive best practice guidance for designing the ideal digital contact tracing app. A search of the indexed and gray literature was conducted to identify articles describing or evaluating digital contact tracing apps. MEDLINE was searched using a combination of free-text terms and Medical Subject Headings search terms. Gray literature sources searched were the World Health Organization Institutional Repository for Information Sharing, the European Centre for Disease Prevention and Control publications library, and Google, including the websites of many health protection authorities. Articles that were acceptable for inclusion in this evidence synthesis were peer-reviewed publications, cohort studies, randomized trials, modeling studies, technical reports, white papers, and media reports related to digital contact tracing. Results: Ethical, user experience, privacy and data protection, technical, clinical and societal, and evaluation considerations were identified from the literature. The ideal digital contact tracing app should be voluntary and should be equitably available and accessible. User engagement could be enhanced by small financial incentives, enabling users to tailor aspects of the app to their particular needs and integrating digital contact tracing apps into the wider public health information campaign. Adherence to the principles of good data protection and privacy by design is important to convince target populations to download and use digital contact tracing apps. Bluetooth Low Energy is recommended for a digital contact tracing app's contact event detection, but combining it with ultrasound technology may improve a digital contact tracing app's accuracy. A decentralized privacy-preserving protocol should be followed to enable digital contact tracing app users to exchange and record temporary contact numbers during contact events. The ideal digital contact tracing app should define and risk-stratify contact events according to proximity, duration of contact, and the infectiousness of the case at the time of contact. Evaluating digital contact tracing apps requires data to quantify app downloads, use among COVID-19 cases, successful contact alert generation, contact alert receivers, contact alert receivers that adhere to quarantine and testing recommendations, and the number of contact alert receivers who subsequently are tested positive for COVID-19. The outcomes of digital contact tracing apps' evaluations should be openly reported to allow for the wider public to review the evaluation of the app. Conclusions: In conclusion, key considerations and best practice guidance for the design of the ideal digital contact tracing app were derived from the literature. %M 34003764 %R 10.2196/27753 %U https://mhealth.jmir.org/2021/6/e27753 %U https://doi.org/10.2196/27753 %U http://www.ncbi.nlm.nih.gov/pubmed/34003764 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 6 %P e25259 %T Coping Styles for Mediating the Effect of Resilience on Depression Among Medical Students in Web-Based Classes During the COVID-19 Pandemic: Cross-sectional Questionnaire Study %A Zhao,Lina %A Sznajder,Kristin %A Cheng,Dan %A Wang,Shimeng %A Cui,Can %A Yang,Xiaoshi %+ Department of Social Medicine, College of Health Management, China Medical University, No 77 Puhe Road, Shenyang North New Area, Shenyang, Liaoning Province, 110122, China, 86 18900910796, xsyang@cmu.edu.cn %K resilience %K coping styles %K depression %K medical students %K COVID-19 %K coping %K mediation %K web-based education %K e-learning %K smartphone %K cross-sectional %D 2021 %7 7.6.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Due to strict, nationwide, comprehensive COVID-19 protective measures, including home quarantine, all Chinese medical students began taking web-based classes beginning in the spring semester of 2020. Home quarantine, web-based classes, and the stress surrounding the COVID-19 pandemic may have triggered an increased incidence of mental health problems among medical students. Although there have been increasing amounts of literature on depression among medical students, studies focusing on positive psychological resources, such as resilience during the COVID-19 pandemic, still need to be expanded. Objective: This study aims to assess depression among medical students who are taking web-based classes during the COVID-19 pandemic and to investigate the role of coping styles as mediators between resilience and depression. Methods: A cross-sectional study of 666 medical students involving stratified sampling in Shenyang, Liaoning Province, China, was completed between March 20 and April 10, 2020. The participants responded to a self-administered, smartphone-based questionnaire, which included the Patient Health Questionnaire-9, Simplified Coping Style Questionnaire, and Ego Resilience 89 Scale. Hierarchical linear regression and structural equation modeling were used in this study. Results: The prevalence of depression among the participants was 9.6% (64/666) in this study. The regression analysis revealed that grade (the year in which the medical student was in training) (P=.013), how well students adapted to web-based classes (P<.001), their levels of resilience (P=.04), and their coping styles were independent predictors for depression (P<.001). Resilience and positive coping styles were negatively related to depression (resilience: P=.04; positive coping styles: P<.001), and negative coping styles were positively related to depression (P<.001). The structural equation modeling analysis showed that the effect of resilience on depression was partially mediated by coping styles (P=.007). Conclusions: In this study, it was found that the prevalence of depression was slightly low and coping styles mediated the association between resilience and depression among medical students during the COVID-19 pandemic. These findings have significant implications for future studies. Future studies and interventions should aim to improve resilience and promote positive coping styles. %M 34033579 %R 10.2196/25259 %U https://www.jmir.org/2021/6/e25259 %U https://doi.org/10.2196/25259 %U http://www.ncbi.nlm.nih.gov/pubmed/34033579 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 6 %P e28055 %T Multimodule Web-Based COVID-19 Anxiety and Stress Resilience Training (COAST): Single-Cohort Feasibility Study With First Responders %A Heyen,Janna Marie %A Weigl,Noé %A Müller,Mario %A Müller,Stefan %A Eberle,Urs %A Manoliu,Andrei %A Vetter,Stefan %A Brown,Adam D %A Berger,Thomas %A Kleim,Birgit %+ Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Lenggstrasse 31, PO Box 1931, Zürich, CH-8032, Switzerland, 41 (0)44 384 21 11, birgit.kleim@pukzh.ch %K anxiety %K COVID-19 %K electronic mental health %K feasibility %K first responder %K mental health %K mindfulness %K resilience %K self-efficacy %K sleep quality %K stress %K training %D 2021 %7 7.6.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Since the emergence of COVID-19, health care workers and first responders have been at a high risk for mental health symptoms owing to their exposure to the virus and increased work stress during the pandemic. Although interventions exist to address mental health issues following exposure to disasters, emergencies, and humanitarian crises, considerably less is known about web-based unguided interventions to help mitigate the negative impacts of such events. Additionally, in contexts in which emergencies reduce access to in-person care, remote forms of support are critical, yet there are limited studies on the use of such interventions. Evidence-based, easy-to-use, scalable interventions are direly needed for this population. Objective: This study aimed to develop and test the feasibility of an unguided electronic mental health program, COVID-19 Anxiety and Stress Resilience Training (COAST), tailored to first responders and health care personnel, based on scientific evidence and empirically based techniques. Methods: We developed COVID-19–specific training modules focusing on several domains that are previously reported as key to resilience and stress recovery: self-efficacy, mindfulness, sleep quality, and positive thinking. The program was made available to 702 first responders between May and August 2020, during the COVID-19 pandemic. Sociodemographic, work-, and COVID-19–related information was collected, and psychometric questionnaires were completed. We examined user acceptance and user activity, including module choice and participant feedback. Results: In total, 52 of 702 (7%) first responders to whom we reached out used the program at least once. COAST use was independent of age, sex, or baseline levels of self-efficacy, mindful awareness, sleep quality, and positive thinking (for all, P>.39). First responders who had tested positive and those who had been quarantined were more likely to engage in the program. A click count analysis per module showed that participants used the self-efficacy and mindfulness modules most often, with 382 and 122 clicks, respectively, over 15 weeks. Overall, first responders expressed satisfaction with the program. Conclusions: Engagement of first responders in the multimodule web-based COAST program was feasible and the first responder cohort expressed overall satisfaction with the program. Those in more difficult circumstances, including those in quarantine and those who tested positive, may be more likely to engage in such programs. Further controlled studies could pave the way for efficacy studies and the development of additional modules, including just-in-time interventions or blended interventions combining individual use of an unguided self-help intervention, such as COAST, with subsequent individual psychotherapy for those who continue to experience stress and psychological symptoms. %M 33999835 %R 10.2196/28055 %U https://formative.jmir.org/2021/6/e28055 %U https://doi.org/10.2196/28055 %U http://www.ncbi.nlm.nih.gov/pubmed/33999835 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 6 %P e28892 %T Mental Health and Behavior of College Students During the COVID-19 Pandemic: Longitudinal Mobile Smartphone and Ecological Momentary Assessment Study, Part II %A Mack,Dante L %A DaSilva,Alex W %A Rogers,Courtney %A Hedlund,Elin %A Murphy,Eilis I %A Vojdanovski,Vlado %A Plomp,Jane %A Wang,Weichen %A Nepal,Subigya K %A Holtzheimer,Paul E %A Wagner,Dylan D %A Jacobson,Nicholas C %A Meyer,Meghan L %A Campbell,Andrew T %A Huckins,Jeremy F %+ Department of Psychological and Brain Sciences, Dartmouth College, Moore Hall, 3 Maynard St, Hanover, NH, 03755, United States, 1 603 646 3181, f002vhk@dartmouth.edu %K anxiety %K college %K COVID-19 %K COVID fatigue %K depression %K George Floyd %K mobile sensing %K phone usage %K sleep %K digital phenotyping %D 2021 %7 4.6.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Since late 2019, the lives of people across the globe have been disrupted by COVID-19. Millions of people have become infected with the disease, while billions of people have been continually asked or required by local and national governments to change their behavioral patterns. Previous research on the COVID-19 pandemic suggests that it is associated with large-scale behavioral and mental health changes; however, few studies have been able to track these changes with frequent, near real-time sampling or compare these changes to previous years of data for the same individuals. Objective: By combining mobile phone sensing and self-reported mental health data in a cohort of college-aged students enrolled in a longitudinal study, we seek to understand the behavioral and mental health impacts associated with the COVID-19 pandemic, measured by interest across the United States in the search terms coronavirus and COVID fatigue. Methods: Behaviors such as the number of locations visited, distance traveled, duration of phone use, number of phone unlocks, sleep duration, and sedentary time were measured using the StudentLife mobile smartphone sensing app. Depression and anxiety were assessed using weekly self-reported ecological momentary assessments, including the Patient Health Questionnaire-4. The participants were 217 undergraduate students. Differences in behaviors and self-reported mental health collected during the Spring 2020 term, as compared to previous terms in the same cohort, were modeled using mixed linear models. Results: Linear mixed models demonstrated differences in phone use, sleep, sedentary time and number of locations visited associated with the COVID-19 pandemic. In further models, these behaviors were strongly associated with increased interest in COVID fatigue. When mental health metrics (eg, depression and anxiety) were added to the previous measures (week of term, number of locations visited, phone use, sedentary time), both anxiety and depression (P<.001) were significantly associated with interest in COVID fatigue. Notably, these behavioral and mental health changes are consistent with those observed around the initial implementation of COVID-19 lockdowns in the spring of 2020. Conclusions: In the initial lockdown phase of the COVID-19 pandemic, people spent more time on their phones, were more sedentary, visited fewer locations, and exhibited increased symptoms of anxiety and depression. As the pandemic persisted through the spring, people continued to exhibit very similar changes in both mental health and behaviors. Although these large-scale shifts in mental health and behaviors are unsurprising, understanding them is critical in disrupting the negative consequences to mental health during the ongoing pandemic. %M 33900935 %R 10.2196/28892 %U https://www.jmir.org/2021/6/e28892 %U https://doi.org/10.2196/28892 %U http://www.ncbi.nlm.nih.gov/pubmed/33900935 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 6 %P e27300 %T Partisan Differences in Twitter Language Among US Legislators During the COVID-19 Pandemic: Cross-sectional Study %A Guntuku,Sharath Chandra %A Purtle,Jonathan %A Meisel,Zachary F %A Merchant,Raina M %A Agarwal,Anish %+ Department of Computer and Information Science, University of Pennsylvania, 3300 Walnut St, Philadelphia, PA, 19103, United States, 1 215 615 3211, sharathg@cis.upenn.edu %K Twitter %K COVID-19 %K digital health %K US legislators %K natural language processing %K policy makers %K social media %K policy %K politics %K language %K cross-sectional %K content %K sentiment %K infodemiology %K infoveillance %D 2021 %7 3.6.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: As policy makers continue to shape the national and local responses to the COVID-19 pandemic, the information they choose to share and how they frame their content provide key insights into the public and health care systems. Objective: We examined the language used by the members of the US House and Senate during the first 10 months of the COVID-19 pandemic and measured content and sentiment based on the tweets that they shared. Methods: We used Quorum (Quorum Analytics Inc) to access more than 300,000 tweets posted by US legislators from January 1 to October 10, 2020. We used differential language analyses to compare the content and sentiment of tweets posted by legislators based on their party affiliation. Results: We found that health care–related themes in Democratic legislators’ tweets focused on racial disparities in care (odds ratio [OR] 2.24, 95% CI 2.22-2.27; P<.001), health care and insurance (OR 1.74, 95% CI 1.7-1.77; P<.001), COVID-19 testing (OR 1.15, 95% CI 1.12-1.19; P<.001), and public health guidelines (OR 1.25, 95% CI 1.22-1.29; P<.001). The dominant themes in the Republican legislators’ discourse included vaccine development (OR 1.51, 95% CI 1.47-1.55; P<.001) and hospital resources and equipment (OR 1.22, 95% CI 1.18-1.25). Nonhealth care–related topics associated with a Democratic affiliation included protections for essential workers (OR 1.55, 95% CI 1.52-1.59), the 2020 election and voting (OR 1.31, 95% CI 1.27-1.35), unemployment and housing (OR 1.27, 95% CI 1.24-1.31), crime and racism (OR 1.22, 95% CI 1.18-1.26), public town halls (OR 1.2, 95% CI 1.16-1.23), the Trump Administration (OR 1.22, 95% CI 1.19-1.26), immigration (OR 1.16, 95% CI 1.12-1.19), and the loss of life (OR 1.38, 95% CI 1.35-1.42). The themes associated with the Republican affiliation included China (OR 1.89, 95% CI 1.85-1.92), small business assistance (OR 1.27, 95% CI 1.23-1.3), congressional relief bills (OR 1.23, 95% CI 1.2-1.27), press briefings (OR 1.22, 95% CI 1.19-1.26), and economic recovery (OR 1.2, 95% CI 1.16-1.23). Conclusions: Divergent language use on social media corresponds to the partisan divide in the first several months of the course of the COVID-19 public health crisis. %M 33939620 %R 10.2196/27300 %U https://www.jmir.org/2021/6/e27300 %U https://doi.org/10.2196/27300 %U http://www.ncbi.nlm.nih.gov/pubmed/33939620 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 6 %P e28265 %T Correlation of Population SARS-CoV-2 Cycle Threshold Values to Local Disease Dynamics: Exploratory Observational Study %A Tso,Chak Foon %A Garikipati,Anurag %A Green-Saxena,Abigail %A Mao,Qingqing %A Das,Ritankar %+ Dascena, Inc, 12333 Sowden Rd, Ste B, Private Mailbox 65148, Houston, TX, 77080-2059, United States, 1 826 9508, qmao@dascena.com %K reverse transcription polymerase chain reaction %K testing %K cycle threshold %K COVID-19 %K epidemiology %K Rt %K exploratory %K correlation %K population %K threshold %K disease dynamic %K distribution %K transmission %D 2021 %7 3.6.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Despite the limitations in the use of cycle threshold (CT) values for individual patient care, population distributions of CT values may be useful indicators of local outbreaks. Objective: We aimed to conduct an exploratory analysis of potential correlations between the population distribution of cycle threshold (CT) values and COVID-19 dynamics, which were operationalized as percent positivity, transmission rate (Rt), and COVID-19 hospitalization count. Methods: In total, 148,410 specimens collected between September 15, 2020, and January 11, 2021, from the greater El Paso area were processed in the Dascena COVID-19 Laboratory. The daily median CT value, daily Rt, daily count of COVID-19 hospitalizations, daily change in percent positivity, and rolling averages of these features were plotted over time. Two-way scatterplots and linear regression were used to evaluate possible associations between daily median CT values and outbreak measures. Cross-correlation plots were used to determine whether a time delay existed between changes in daily median CT values and measures of community disease dynamics. Results: Daily median CT values negatively correlated with the daily Rt values (P<.001), the daily COVID-19 hospitalization counts (with a 33-day time delay; P<.001), and the daily changes in percent positivity among testing samples (P<.001). Despite visual trends suggesting time delays in the plots for median CT values and outbreak measures, a statistically significant delay was only detected between changes in median CT values and COVID-19 hospitalization counts (P<.001). Conclusions: This study adds to the literature by analyzing samples collected from an entire geographical area and contextualizing the results with other research investigating population CT values. %M 33999831 %R 10.2196/28265 %U https://publichealth.jmir.org/2021/6/e28265 %U https://doi.org/10.2196/28265 %U http://www.ncbi.nlm.nih.gov/pubmed/33999831 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 4 %N 2 %P e25876 %T Gender Differences in State Anxiety Related to Daily Function Among Older Adults During the COVID-19 Pandemic: Questionnaire Study %A Rosenblum,Sara %A Cohen Elimelech,Ortal %+ The Laboratory of Complex Human Activity and Participation, Department of Occupational Therapy, University of Haifa, Mount Carmel, Haifa, 31905, Israel, 972 4 8240474, rosens@research.haifa.ac.il %K COVID-19 %K coronavirus %K anxiety %K cognition %K aging %K eHealth %K online data %D 2021 %7 3.6.2021 %9 Original Paper %J JMIR Aging %G English %X Background: The COVID-19 pandemic poses a challenge to people’s day-to-day functioning and emotional and physical health, especially among older adults. Objective: The aim of this study is to analyze gender differences in state anxiety, daily functional self-actualization, and functional cognition as well as the relationships among those factors in older adults during the COVID-19 pandemic lockdown. Methods: We collected data on the web from a sample of 204 people (102 men and 102 women) aged 60 years and older. In addition to a demographic questionnaire, we used the State-Trait Personality Inventory to assess state anxiety, the Daily Functional Actualization questionnaire to evaluate daily functional self-actualization, and the Daily Living Questionnaire to measure functional cognition. Results: Significant gender differences were found for state anxiety (t202=−2.36, P=.02); daily functional self-actualization (t202=2.15, P=.03); and the functional cognition components: complex tasks (Z=−3.07, P=.002); cognitive symptoms that might be interfering (Z=−2.15, P=.028); executive functions (Z=−2.21, P=.024); and executive function monitoring (Z=−2.21, P=.027). Significant medium correlations were found between both state anxiety level and daily functional self-actualization (r=−0.62, P<.001) and functional cognition (r=0.37-0.40, P<.001). Gender predicted 3% of the variance in state anxiety level, while daily functional self-actualization predicted 41% and complex activities (Daily Living Questionnaire) predicted an additional 3% (F3,200=58.01, P<.001). Conclusions: In older adults, anxiety is associated with cognitive decline, which may harm daily functional abilities and lead to social isolation, loneliness, and decreased well-being. Self-awareness and knowledge of gender differences and relationships between common available resources of daily functional self-actualization and functional cognition with anxiety may be strengthening factors in crisis periods such as the COVID-19 pandemic. %M 33939623 %R 10.2196/25876 %U https://aging.jmir.org/2021/2/e25876 %U https://doi.org/10.2196/25876 %U http://www.ncbi.nlm.nih.gov/pubmed/33939623 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 6 %P e27189 %T The Effect of Test Timing on the Probability of Positive SARS-CoV-2 Swab Test Results: Mixed Model Approach %A Benoni,Roberto %A Panunzi,Silvia %A Campagna,Irene %A Moretti,Francesca %A Lo Cascio,Giuliana %A Spiteri,Gianluca %A Porru,Stefano %A Tardivo,Stefano %+ Postgraduate School of Hygiene and Preventive Medicine, University of Verona, Strada Le Grazie, 8, Verona, 37134, Italy, 39 0458027659, roberto.benoni90@gmail.com %K close contact %K COVID-19 %K health care workers %K health surveillance %K swab test timing %D 2021 %7 3.6.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: During the COVID-19 pandemic, swab tests proved to be effective in containing the infection and served as a means for early diagnosis and contact tracing. However, little evidence exists regarding the correct timing for the execution of the swab test, especially for asymptomatic individuals and health care workers. Objective: The objective of this study was to analyze changes in the positive findings over time in individual SARS-CoV-2 swab tests during a health surveillance program. Methods: The study was conducted with 2071 health care workers at the University Hospital of Verona, with a known date of close contact with a patient with COVID-19, between February 29 and April 17, 2020. The health care workers underwent a health surveillance program with repeated swab tests to track their virological status. A generalized additive mixed model was used to investigate how the probability of a positive test result changes over time since the last known date of close contact, in an overall sample of individuals who tested positive for COVID-19 and in a subset of individuals with an initial negative swab test finding before being proven positive, to assess different surveillance time intervals. Results: Among the 2071 health care workers in this study, 191 (9.2%) tested positive for COVID-19, and 103 (54%) were asymptomatic with no differences based on sex or age. Among 49 (25.7%) cases, the initial swab test yielded negative findings after close contact with a patient with COVID-19. Sex, age, symptoms, and the time of sampling were not different between individuals with an initial negative swab test finding and those who initially tested positive after close contact. In the overall sample, the estimated probability of testing positive was 0.74 on day 1 after close contact, which increased to 0.77 between days 5 and 8. In the 3 different scenarios for scheduled repeated testing intervals (3, 5, and 7 days) in the subgroup of individuals with an initially negative swab test finding, the probability peaked on the sixth, ninth and tenth, and 13th and 14th days, respectively. Conclusions: Swab tests can initially yield false-negative outcomes. The probability of testing positive increases from day 1, peaking between days 5 and 8 after close contact with a patient with COVID-19. Early testing, especially in this final time window, is recommended together with a health surveillance program scheduled in close intervals. %M 34003761 %R 10.2196/27189 %U https://publichealth.jmir.org/2021/6/e27189 %U https://doi.org/10.2196/27189 %U http://www.ncbi.nlm.nih.gov/pubmed/34003761 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 9 %N 6 %P e28497 %T Using Electronic Health Records to Mitigate Workplace Burnout Among Clinicians During the COVID-19 Pandemic: Field Study in Iran %A Esmaeilzadeh,Pouyan %A Mirzaei,Tala %+ Department of Information Systems and Business Analytics, College of Business, Florida International University, Modesto A Maidique Campus 11200 SW 8th St, RB 261 B, Miami, FL, 33199, United States, 1 3053483302, pesmaeil@fiu.edu %K COVID-19 %K pandemic %K clinician burnout %K electronic health record %K health information technologies %K hospital intervention %D 2021 %7 3.6.2021 %9 Original Paper %J JMIR Med Inform %G English %X Background: The COVID-19 pandemic spread worldwide in 2020. Notably, in the countries dealing with massive casualties, clinicians have worked in new conditions characterized by a heavy workload and a high risk of being infected. The issue of clinician burnout during the pandemic has attracted considerable attention in health care research. Electronic health records (EHRs) provide health care workers with several features to meet a health system’s clinical needs. Objective: We aim to examine how the use of EHR features affects the burnout of clinicians working in hospitals that have special wards for confirmed COVID-19 cases. Methods: Using an online survey, we collected data from 368 physicians, physician assistants, and nurses working in six hospitals that have implemented EHRs in the city of Tehran in Iran. We used logistic regression to assess the association between burnout and awareness of EHR features, EHR system usability, concerns about COVID-19, technology solutions, hospital technology interventions, hospital preparedness, and professional efficacy adjusted for demographic and practice characteristics. Results: The primary outcome of our study was self-reported burnout during the COVID-19 pandemic. Of the 368 respondents, 36% (n=134) reported having at least one symptom of burnout. Participants indicated that the leading cause of EHR-related stress is inadequate training for using technology (n=159, 43%), followed by having less face-to-face time with patients (n=140, 38%). Positive perceptions about the EHR’s ease of use were associated with lower odds of burnout symptoms. More interventions, such as clear communication of regulations; transparency in policies, expectations, and goals regarding the use of technology in the clinical workflow; and hospital preparedness to cope with the challenges of the pandemic, were associated with lower odds of burnout. Conclusions: The use of EHR applications, hospital pandemic preparation programs, and transparent technology-related policies and procedures throughout the epidemic can be substantial mitigators of technology-based stress and clinician burnout. Hospitals will then be better positioned to devise or modify technology-related policies and procedures to support physicians’ and nurses’ well-being during the COVID-19 pandemic. Training programs, transparency in communications of regulations, and developing a clear channel for informing clinicians of changes in policies may help reduce burnout symptoms among physicians and nurses during a pandemic. Providing easily accessible mentorship through teleconsultation and 24-hour available information technology support may also help to mitigate the odds of burnout. %M 34033578 %R 10.2196/28497 %U https://medinform.jmir.org/2021/6/e28497 %U https://doi.org/10.2196/28497 %U http://www.ncbi.nlm.nih.gov/pubmed/34033578 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 6 %P e28253 %T Quantifying Online News Media Coverage of the COVID-19 Pandemic: Text Mining Study and Resource %A Krawczyk,Konrad %A Chelkowski,Tadeusz %A Laydon,Daniel J %A Mishra,Swapnil %A Xifara,Denise %A Gibert,Benjamin %A Flaxman,Seth %A Mellan,Thomas %A Schwämmle,Veit %A Röttger,Richard %A Hadsund,Johannes T %A Bhatt,Samir %+ Department of Mathematics and Computer Science, University of Southern Denmark, Campusvej 55, Odense, DK-5230, Denmark, 45 6550 2387, konradk@imada.sdu.dk %K text mining %K COVID-19 %K infoveillance %K sentiment analysis %K public health %D 2021 %7 2.6.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Before the advent of an effective vaccine, nonpharmaceutical interventions, such as mask-wearing, social distancing, and lockdowns, have been the primary measures to combat the COVID-19 pandemic. Such measures are highly effective when there is high population-wide adherence, which requires information on current risks posed by the pandemic alongside a clear exposition of the rules and guidelines in place. Objective: Here we analyzed online news media coverage of COVID-19. We quantified the total volume of COVID-19 articles, their sentiment polarization, and leading subtopics to act as a reference to inform future communication strategies. Methods: We collected 26 million news articles from the front pages of 172 major online news sources in 11 countries (available online at SciRide). Using topic detection, we identified COVID-19–related content to quantify the proportion of total coverage the pandemic received in 2020. The sentiment analysis tool Vader was employed to stratify the emotional polarity of COVID-19 reporting. Further topic detection and sentiment analysis was performed on COVID-19 coverage to reveal the leading themes in pandemic reporting and their respective emotional polarizations. Results: We found that COVID-19 coverage accounted for approximately 25.3% of all front-page online news articles between January and October 2020. Sentiment analysis of English-language sources revealed that overall COVID-19 coverage was not exclusively negatively polarized, suggesting wide heterogeneous reporting of the pandemic. Within this heterogenous coverage, 16% of COVID-19 news articles (or 4% of all English-language articles) can be classified as highly negatively polarized, citing issues such as death, fear, or crisis. Conclusions: The goal of COVID-19 public health communication is to increase understanding of distancing rules and to maximize the impact of governmental policy. The extent to which the quantity and quality of information from different communication channels (eg, social media, government pages, and news) influence public understanding of public health measures remains to be established. Here we conclude that a quarter of all reporting in 2020 covered COVID-19, which is indicative of information overload. In this capacity, our data and analysis form a quantitative basis for informing health communication strategies along traditional news media channels to minimize the risks of COVID-19 while vaccination is rolled out. %M 33900934 %R 10.2196/28253 %U https://www.jmir.org/2021/6/e28253 %U https://doi.org/10.2196/28253 %U http://www.ncbi.nlm.nih.gov/pubmed/33900934 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 6 %P e27989 %T Quality and Adoption of COVID-19 Tracing Apps and Recommendations for Development: Systematic Interdisciplinary Review of European Apps %A Kahnbach,Leonie %A Lehr,Dirk %A Brandenburger,Jessica %A Mallwitz,Tim %A Jent,Sophie %A Hannibal,Sandy %A Funk,Burkhardt %A Janneck,Monique %+ Department of Health Psychology and Applied Biological Psychology, Leuphana University of Lüneburg, Universitätsallee 1, C1.120, Lüneburg, 21335, Germany, 49 4131 677 2720, lehr@leuphana.de %K COVID-19 %K contact tracing %K app-based tracing %K Mobile App Rating Scale %K user engagement %K human–computer interaction %D 2021 %7 2.6.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Simulation study results suggest that COVID-19 contact tracing apps have the potential to achieve pandemic control. Concordantly, high app adoption rates were a stipulated prerequisite for success. Early studies on potential adoption were encouraging. Several factors predicting adoption rates were investigated, especially pertaining to user characteristics. Since then, several countries have released COVID-19 contact tracing apps. Objective: This study’s primary aim is to investigate the quality characteristics of national European COVID-19 contact tracing apps, thereby shifting attention from user to app characteristics. The secondary aim is to investigate associations between app quality and adoption. Finally, app features contributing to higher app quality were identified. Methods: Eligible COVID-19 contact tracing apps were those released by national health authorities of European Union member states, former member states, and countries of the European Free Trade Association, all countries with comparable legal standards concerning personal data protection and app use voluntariness. The Mobile App Rating Scale was used to assess app quality. An interdisciplinary team, consisting of two health and two human–computer interaction scientists, independently conducted Mobile App Rating Scale ratings. To investigate associations between app quality and adoption rates and infection rates, Bayesian linear regression analyses were conducted. Results: We discovered 21 national COVID-19 contact tracing apps, all demonstrating high quality overall and high-level functionality, aesthetics, and information quality. However, the average app adoption rate of 22.9% (SD 12.5%) was below the level recommended by simulation studies. Lower levels of engagement-oriented app design were detected, with substantial variations between apps. By regression analyses, the best-case adoption rate was calculated by assuming apps achieve the highest ratings. The mean best-case adoption rates for engagement and overall app quality were 39.5% and 43.6%, respectively. Higher adoption rates were associated with lower cumulative infection rates. Overall, we identified 5 feature categories (symptom assessment and monitoring, regularly updated information, individualization, tracing, and communication) and 14 individual features that contributed to higher app quality. These 14 features were a symptom checker, a symptom diary, statistics on COVID-19, app use, public health instructions and restrictions, information of burden on health care system, assigning personal data, regional updates, control over tracing activity, contact diary, venue check-in, chats, helplines, and app-sharing capacity. Conclusions: European national health authorities have generally released high quality COVID-19 contact tracing apps, with regard to functionality, aesthetics, and information quality. However, the app’s engagement-oriented design generally was of lower quality, even though regression analyses results identify engagement as a promising optimization target to increase adoption rates. Associations between higher app adoption and lower infection rates are consistent with simulation study results, albeit acknowledging that app use might be part of a broader set of protective attitudes and behaviors for self and others. Various features were identified that could guide further engagement-enhancing app development. %M 33890867 %R 10.2196/27989 %U https://www.jmir.org/2021/6/e27989 %U https://doi.org/10.2196/27989 %U http://www.ncbi.nlm.nih.gov/pubmed/33890867 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 6 %P e27185 %T Acceptability of Research and Health Care Visits During the COVID-19 Pandemic: Cross-sectional Survey Study %A Ross,Kathryn M %A Hong,Young-Rock %A Krukowski,Rebecca A %A Miller,Darci R %A Lemas,Dominick J %A Cardel,Michelle I %+ Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, PO Box 10065, Gainesville, FL, 32610, United States, 1 3522948433, kmross@phhp.ufl.edu %K COVID-19 %K health care access %K telehealth %K research recruitment %K telemedicine %K belief %K access %K willingness %K cross-sectional %K survey %D 2021 %7 2.6.2021 %9 Short Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic has had a widespread impact on attendance in biomedical research and health care visits. Objective: This study aimed to identify when and how American adults might feel comfortable about resuming in-person research and health care visits. Methods: Cross-sectional questionnaire data were collected from 135 adults (age: median 48 years; women: n=113, 83.7%; White participants: n=92, 68.2%) who were engaged in health-related research. Results: More than half of the respondents (65/122, 53.3%) felt that the COVID-19 pandemic positively affected their desire to participate in research. Although 73.6% (95/129) of respondents also indicated a willingness to attend in-person health care visits while Centers for Disease Control and Prevention (CDC) guidelines are implemented, 85.8% (109/127) indicated a willingness to attend in-person, outdoor visits, and 92.2% (118/128) reported a willingness to attend drive-through visits (with CDC guidelines implemented during both visit types). Videoconferencing was the most preferred format for intervention visits; however, adults over the age of 65 years preferred this format less than younger adults (P=.001). Conclusions: Researchers and clinicians should continue to provide opportunities for continuing the conduction of remote-based interventions while enforcing CDC guidelines during in-person visits. %M 34033577 %R 10.2196/27185 %U https://formative.jmir.org/2021/6/e27185 %U https://doi.org/10.2196/27185 %U http://www.ncbi.nlm.nih.gov/pubmed/34033577 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 6 %P e29730 %T COVID-19 Knowledge Resource Categorization and Tracking: Conceptual Framework Study %A Afzal,Muhammad %A Hussain,Maqbool %A Hussain,Jamil %A Bang,Jaehun %A Lee,Sungyoung %+ Department of Software, Sejong University, 209 Neungdong-ro, Innovation Center, Office 422, Seoul, 05006, Republic of Korea, 82 234082973, mafzal@sejong.ac.kr %K information organization %K resource management %K knowledge graphs %K interactive dashboard %K dependency tracking %K COVID-19 %K pandemic %K information technology %K tracing information %K dashboards %K digital health %D 2021 %7 1.6.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Since the declaration of COVID-19 as a global pandemic by the World Health Organization, the disease has gained momentum with every passing day. Various private and government sectors of different countries allocated funding for research in multiple capacities. A significant portion of efforts has been devoted to information technology and service infrastructure development, including research on developing intelligent models and techniques for alerts, monitoring, early diagnosis, prevention, and other relevant services. As a result, many information resources have been created globally and are available for use. However, a defined structure to organize these resources into categories based on the nature and origin of the data is lacking. Objective: This study aims to organize COVID-19 information resources into a well-defined structure to facilitate the easy identification of a resource, tracking information workflows, and to provide a guide for a contextual dashboard design and development. Methods: A sequence of action research was performed that involved a review of COVID-19 efforts and initiatives on a global scale during the year 2020. Data were collected according to the defined structure of primary, secondary, and tertiary categories. Various techniques for descriptive statistical analysis were employed to gain insights into the data to help develop a conceptual framework to organize resources and track interactions between different resources. Results: Investigating diverse information at the primary, secondary, and tertiary levels enabled us to develop a conceptual framework for COVID-19–related efforts and initiatives. The framework of resource categorization provides a gateway to access global initiatives with enriched metadata, and assists users in tracking the workflow of tertiary, secondary, and primary resources with relationships between various fragments of information. The results demonstrated mapping initiatives at the tertiary level to secondary level and then to the primary level to reach firsthand data, research, and trials. Conclusions: Adopting the proposed three-level structure allows for a consistent organization and management of existing COVID-19 knowledge resources and provides a roadmap for classifying future resources. This study is one of the earliest studies to introduce an infrastructure for locating and placing the right information at the right place. By implementing the proposed framework according to the stated guidelines, this study allows for the development of applications such as interactive dashboards to facilitate the contextual identification and tracking of interdependent COVID-19 knowledge resources. %M 33999833 %R 10.2196/29730 %U https://www.jmir.org/2021/6/e29730 %U https://doi.org/10.2196/29730 %U http://www.ncbi.nlm.nih.gov/pubmed/33999833 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 9 %N 6 %P e29251 %T Physicians’ Attitudes Toward Telemedicine Consultations During the COVID-19 Pandemic: Cross-sectional Study %A Alhajri,Noora %A Simsekler,Mecit Can Emre %A Alfalasi,Buthaina %A Alhashmi,Mohamed %A AlGhatrif,Majd %A Balalaa,Nahed %A Al Ali,Maryam %A Almaashari,Raghda %A Al Memari,Shammah %A Al Hosani,Farida %A Al Zaabi,Yousif %A Almazroui,Shereena %A Alhashemi,Hamed %A Baltatu,Ovidiu C %+ Khalifa University College of Medicine and Health Science, Saadat St, Zone 1, Abu Dhabi, United Arab Emirates, 971 552277490, ocbaltatu@gmail.com %K audio consultation %K clinical decision-making %K clinical training %K communication %K COVID-19 %K outpatient department %K perception %K telemedicine %K United Arab Emirates %K video consultation %D 2021 %7 1.6.2021 %9 Original Paper %J JMIR Med Inform %G English %X Background: To mitigate the effect of the COVID-19 pandemic, health care systems worldwide have implemented telemedicine technologies to respond to the growing need for health care services during these unprecedented times. In the United Arab Emirates, video and audio consultations have been implemented to deliver health services during the pandemic. Objective: This study aimed to evaluate whether differences exist in physicians’ attitudes and perceptions of video and audio consultations when delivering telemedicine services during the COVID-19 pandemic. Methods: This survey was conducted on a cohort of 880 physicians from outpatient facilities in Abu Dhabi, which delivered telemedicine services during the COVID-19 pandemic between November and December 2020. In total, 623 physicians responded (response rate=70.8%). The survey included a 5-point Likert scale to measure physician’s attitudes and perceptions of video and audio consultations with reference to the quality of the clinical consultation and the professional productivity. Descriptive statistics were used to describe physicians’ sociodemographic characteristics (age, sex, designation, clinical specialty, duration of practice, and previous experience with telemedicine) and telemedicine modality (video vs audio consultations). Regression models were used to assess the association between telemedicine modality and physicians’ characteristics with the perceived outcomes of the web-based consultation. Results: Compared to audio consultations, video consultations were significantly associated with physicians’ confidence toward managing acute consultations (odds ratio [OR] 1.62, 95% CI 1.2-2.21; P=.002) and an increased ability to provide patient education during the web-based consultation (OR 2.21, 95% CI 1.04-4.33; P=.04). There was no significant difference in physicians’ confidence toward managing long-term and follow-up consultations through video or audio consultations (OR 1.35, 95% CI 0.88-2.08; P=.17). Video consultations were less likely to be associated with a reduced overall consultation time (OR 0.69, 95% CI 0.51-0.93; P=.02) and reduced time for patient note-taking compared to face-to-face visits (OR 0.48, 95% CI 0.36-0.65; P<.001). Previous experience with telemedicine was significantly associated with a lower perceived risk of misdiagnosis (OR 0.46, 95% CI 0.3-0.71; P<.001) and an enhanced physician-patient rapport (OR 2.49, 95% CI 1.26-4.9; P=.008). Conclusions: These results indicate that video consultations should be adopted frequently in the new remote clinical consultations. Previous experience with telemedicine was associated with a 2-fold confidence in treating acute conditions, less than a half of the perceived risk of misdiagnosis, and an increased ability to provide patients with health education and enhance the physician-patient rapport. Additionally, these results show that audio consultations are equivalent to video consultations in providing remote follow-up care to patients with chronic conditions. These findings may be beneficial to policymakers of e-health programs in low- and middle-income countries, where audio consultations may significantly increase access to geographically remote health services. %M 34001497 %R 10.2196/29251 %U https://medinform.jmir.org/2021/6/e29251 %U https://doi.org/10.2196/29251 %U http://www.ncbi.nlm.nih.gov/pubmed/34001497 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 6 %P e26385 %T Interests, Motives, and Psychological Burdens in Times of Crisis and Lockdown: Google Trends Analysis to Inform Policy Makers %A Rotter,Dominik %A Doebler,Philipp %A Schmitz,Florian %+ Department of Psychology, University of Duisburg-Essen, Universitätsstraße 2, Essen, 45141, Germany, 49 201 183 2173, dominik.rotter@uni-due.de %K coronavirus %K Google Trends %K infodemiology %K infoveillance %K pandemic %K information search %K trend %K COVID-19 %K burden %K mental health %K policy %K online health information %D 2021 %7 1.6.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: In the face of the COVID-19 pandemic, the German government and the 16 German federal states implemented a variety of nonpharmaceutical interventions (NPIs) to decelerate the spread of the SARS-CoV-2 virus and thus prevent a collapse of the health care system. These measures comprised, among others, social distancing, the temporary closure of shops and schools, and a ban of large public gatherings and meetings with people not living in the same household. Objective: It is fair to assume that the issued NPIs have heavily affected social life and psychological functioning. We therefore aimed to examine possible effects of this lockdown in conjunction with daily new infections and the state of the national economy on people’s interests, motives, and other psychological states. Methods: We derived 249 keywords from the Google Trends database, tapping into 27 empirically and rationally selected psychological domains. To overcome issues with reliability and specificity of individual indicator variables, broad factors were derived by means of time series factor analysis. All domains were subjected to a change point analysis and time series regression analysis with infection rates, NPIs, and the state of the economy as predictors. All keywords and analyses were preregistered prior to analysis. Results: With the pandemic arriving in Germany, significant increases in people’s search interests were observed in virtually all domains. Although most of the changes were short-lasting, each had a distinguishable onset during the lockdown period. Regression analysis of the Google Trends data confirmed pronounced autoregressive effects for the investigated variables, while forecasting by means of the tested predictors (ie, daily new infections, NPIs, and the state of economy) was moderate at best. Conclusions: Our findings indicate that people’s interests, motives, and psychological states are heavily affected in times of crisis and lockdown. Specifically, disease- and virus-related domains (eg, pandemic disease, symptoms) peaked early, whereas personal health strategies (eg, masks, homeschooling) peaked later during the lockdown. Domains addressing social life and psychosocial functioning showed long-term increases in public interest. Renovation was the only domain to show a decrease in search interest with the onset of the lockdown. As changes in search behavior are consistent over multiple domains, a Google Trends analysis may provide information for policy makers on how to adapt and develop intervention, information, and prevention strategies, especially when NPIs are in effect. %M 33999837 %R 10.2196/26385 %U https://www.jmir.org/2021/6/e26385 %U https://doi.org/10.2196/26385 %U http://www.ncbi.nlm.nih.gov/pubmed/33999837 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 9 %N 6 %P e26463 %T Physicians’ Perspectives of Telemedicine During the COVID-19 Pandemic in China: Qualitative Survey Study %A Liu,Jialin %A Liu,Siru %A Zheng,Tao %A Bi,Yongdong %+ Department of Medical Informatics, West China Hospital, Sichuan University, No.37 Guoxuexiang street, Chengdu, 610041, China, 86 2885422306, dljl8@163.com %K telemedicine %K COVID-19 %K survey %K physician %D 2021 %7 1.6.2021 %9 Original Paper %J JMIR Med Inform %G English %X Background: Generalized restriction of movement due to the COVID-19 pandemic, together with unprecedented pressure on the health system, has disrupted routine care for non–COVID-19 patients. Telemedicine should be vigorously promoted to reduce the risk of infections and to offer medical assistance to restricted patients. Objective: The purpose of this study was to understand physicians’ attitudes toward and perspectives of telemedicine during and after the COVID-19 pandemic, in order to provide support for better implementation of telemedicine. Methods: We surveyed all physicians (N=148), from October 17 to 25, 2020, who attended the clinical informatics PhD program at West China Medical School, Sichuan University, China. The physicians came from 57 hospitals in 16 provinces (ie, municipalities) across China, 54 of which are 3A-level hospitals, two are 3B-level hospitals, and one is a 2A-level hospital. Results: Among 148 physicians, a survey response rate of 87.2% (129/148) was attained. The average age of the respondents was 35.6 (SD 3.9) years (range 23-48 years) and 67 out of 129 respondents (51.9%) were female. The respondents come from 37 clinical specialties in 55 hospitals located in 14 provinces (ie, municipalities) across Eastern, Central, and Western China. A total of 94.6% (122/129) of respondents’ hospitals had adopted a telemedicine system; however, 34.1% (44/129) of the physicians had never used a telemedicine system and only 9.3% (12/129) used one frequently (≥1 time/week). A total of 91.5% (118/129) and 88.4% (114/129) of physicians were willing to use telemedicine during and after the COVID-19 pandemic, respectively. Physicians considered the inability to examine patients in person to be the biggest concern (101/129, 78.3%) and the biggest barrier (76/129, 58.9%) to implementing telemedicine. Conclusions: Telemedicine is not yet universally available for all health care needs and has not been used frequently by physicians in this study. However, the willingness of physicians to use telemedicine was high. Telemedicine still has many problems to overcome. %M 33945493 %R 10.2196/26463 %U https://medinform.jmir.org/2021/6/e26463 %U https://doi.org/10.2196/26463 %U http://www.ncbi.nlm.nih.gov/pubmed/33945493 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 7 %N 2 %P e28264 %T Medical Students Learning on the COVID-19 Front Line %A Zimianiti,Ioanna %A Thanaraaj,Vyshnavi %A Watson,Francesca %A Osibona,Oluwapelumi %+ Imperial College London, School of Medicine, Level 2, Faculty Building South Kensington Campus, London, SW7 2AZ, United Kingdom, 44 (0)20 7589 5111, ioanna.zimianiti16@imperial.ac.uk %K medical education %K COVID-19 %K frontline workers %K medical student %K viewpoint %K perspective %K infectious disease %K experience %K barrier %K motivation %D 2021 %7 1.6.2021 %9 Viewpoint %J JMIR Med Educ %G English %X In this viewpoint, we share our perspectives, as medical students at Imperial College London, on our experiences during our Infectious Diseases placement at Northwick Park Hospital, touching upon other students’ experiences at other sites as well. We highlight some of the main drivers of and barriers to medical students seeing patients with COVID-19. %M 34038377 %R 10.2196/28264 %U https://mededu.jmir.org/2021/2/e28264 %U https://doi.org/10.2196/28264 %U http://www.ncbi.nlm.nih.gov/pubmed/34038377 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 6 %P e26784 %T Risk Assessment of Importation and Local Transmission of COVID-19 in South Korea: Statistical Modeling Approach %A Lee,Hyojung %A Kim,Yeahwon %A Kim,Eunsu %A ‍Lee,Sunmi %+ Kyung Hee University, 1732 Deogyeong-daero, Giheung-gu, Yongin-si, 17104, Republic of Korea, 82 312012409, sunmilee@khu.ac.kr %K COVID-19 %K transmission dynamics %K South Korea %K international travels %K imported and local transmission %K basic reproduction number %K effective reproduction number %K mitigation intervention strategies %K risk %K assessment %K transmission %K mitigation %K strategy %K travel %K mobility %K spread %K intervention %K diagnosis %K monitoring %K testing %D 2021 %7 1.6.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Despite recent achievements in vaccines, antiviral drugs, and medical infrastructure, the emergence of COVID-19 has posed a serious threat to humans worldwide. Most countries are well connected on a global scale, making it nearly impossible to implement perfect and prompt mitigation strategies for infectious disease outbreaks. In particular, due to the explosive growth of international travel, the complex network of human mobility enabled the rapid spread of COVID-19 globally. Objective: South Korea was one of the earliest countries to be affected by COVID-19. In the absence of vaccines and treatments, South Korea has implemented and maintained stringent interventions, such as large-scale epidemiological investigations, rapid diagnosis, social distancing, and prompt clinical classification of severely ill patients with appropriate medical measures. In particular, South Korea has implemented effective airport screenings and quarantine measures. In this study, we aimed to assess the country-specific importation risk of COVID-19 and investigate its impact on the local transmission of COVID-19. Methods: The country-specific importation risk of COVID-19 in South Korea was assessed. We investigated the relationships between country-specific imported cases, passenger numbers, and the severity of country-specific COVID-19 prevalence from January to October 2020. We assessed the country-specific risk by incorporating country-specific information. A renewal mathematical model was employed, considering both imported and local cases of COVID-19 in South Korea. Furthermore, we estimated the basic and effective reproduction numbers. Results: The risk of importation from China was highest between January and February 2020, while that from North America (the United States and Canada) was high from April to October 2020. The R0 was estimated at 1.87 (95% CI 1.47-2.34), using the rate of α=0.07 for secondary transmission caused by imported cases. The Rt was estimated in South Korea and in both Seoul and Gyeonggi. Conclusions: A statistical model accounting for imported and locally transmitted cases was employed to estimate R0 and Rt. Our results indicated that the prompt implementation of airport screening measures (contact tracing with case isolation and quarantine) successfully reduced local transmission caused by imported cases despite passengers arriving from high-risk countries throughout the year. Moreover, various mitigation interventions, including social distancing and travel restrictions within South Korea, have been effectively implemented to reduce the spread of local cases in South Korea. %M 33819165 %R 10.2196/26784 %U https://publichealth.jmir.org/2021/6/e26784 %U https://doi.org/10.2196/26784 %U http://www.ncbi.nlm.nih.gov/pubmed/33819165 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 6 %P e23630 %T Health Perceptions and Adopted Lifestyle Behaviors During the COVID-19 Pandemic: Cross-National Survey %A Manjunath,Nandi Krishnamurthy %A Majumdar,Vijaya %A Rozzi,Antonietta %A Huiru,Wang %A Mishra,Avinash %A Kimura,Keishin %A Nagarathna,Raghuram %A Nagendra,Hongasandra Ramarao %+ Swami Vivekananda Yoga Anusandhana Samsthana University, #19, Eknath Bhavan, Gavipuram Circle, KG Naga, Bengaluru, 560019, India, 91 08026995163, vijaya.majumdar@svyasa.edu.in %K health behavior %K self-report %K cross-national survey %K COVID-19 %K behavior %K perception %K lifestyle %K nutrition %K real-time %D 2021 %7 1.6.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Social isolation measures are requisites to control viral spread during the COVID-19 pandemic. However, if these measures are implemented for a long period of time, they can result in adverse modification of people’s health perceptions and lifestyle behaviors. Objective: The aim of this cross-national survey was to address the lack of adequate real-time data on the public response to changes in lifestyle behavior during the crisis of the COVID-19 pandemic. Methods: A cross-national web-based survey was administered using Google Forms during the month of April 2020. The settings were China, Japan, Italy, and India. There were two primary outcomes: (1) response to the health scale, defined as perceived health status, a combined score of health-related survey items; and (2) adoption of healthy lifestyle choices, defined as the engagement of the respondent in any two of three healthy lifestyle choices (healthy eating habits, engagement in physical activity or exercise, and reduced substance use). Statistical associations were assessed with linear and logistic regression analyses. Results: We received 3371 responses; 1342 were from India (39.8%), 983 from China (29.2%), 669 from Italy (19.8%), and 377 (11.2%) from Japan. A differential countrywise response was observed toward perceived health status; the highest scores were obtained for Indian respondents (9.43, SD 2.43), and the lowest were obtained for Japanese respondents (6.81, SD 3.44). Similarly, countrywise differences in the magnitude of the influence of perceptions on health status were observed; perception of interpersonal relationships was most pronounced in the comparatively old Italian and Japanese respondents (β=.68 and .60, respectively), and the fear response was most pronounced in Chinese respondents (β=.71). Overall, 78.4% of the respondents adopted at least two healthy lifestyle choices amid the COVID-19 pandemic. Unlike health status, the influence of perception of interpersonal relationships on the adoption of lifestyle choices was not unanimous, and it was absent in the Italian respondents (odds ratio 1.93, 95% CI 0.65-5.79). The influence of perceived health status was a significant predictor of lifestyle change across all the countries, most prominently by approximately 6-fold in China and Italy. Conclusions: The overall consistent positive influence of increased interpersonal relationships on health perceptions and adopted lifestyle behaviors during the pandemic is the key real-time finding of the survey. Favorable behavioral changes should be bolstered through regular virtual interpersonal interactions, particularly in countries with an overall middle-aged or older population. Further, controlling the fear response of the public through counseling could also help improve health perceptions and lifestyle behavior. However, the observed human behavior needs to be viewed within the purview of cultural disparities, self-perceptions, demographic variances, and the influence of countrywise phase variations of the pandemic. The observations derived from a short lockdown period are preliminary, and real insight could only be obtained from a longer follow-up. %M 33900928 %R 10.2196/23630 %U https://formative.jmir.org/2021/6/e23630 %U https://doi.org/10.2196/23630 %U http://www.ncbi.nlm.nih.gov/pubmed/33900928 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 6 %P e28961 %T Factors Influencing the Adoption of Contact Tracing Applications: Protocol for a Systematic Review %A Oyibo,Kiemute %A Sahu,Kirti Sundar %A Oetomo,Arlene %A Morita,Plinio Pelegrini %+ School of Public Health Sciences, Faculty of Health, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada, 1 5198884567 ext 41372, plinio.morita@uwaterloo.ca %K contact tracing app %K technology acceptance %K user perception %K adoption %K COVID-19 %K review %K perception %K barrier %K challenge %K effective %K usability %D 2021 %7 1.6.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Following the onset of the COVID-19 pandemic, digital contact tracing apps have become prevalent worldwide in a coordinated effort to curb the spread of COVID-19. However, their uptake has been low and slow due to privacy concerns, the lack of trust and motivational affordances, and their minimalist design. Objective: The objective of this article is to present a protocol for a systematic review of the main factors, including facilitators and barriers, that influence the adoption of contact tracing apps. Methods: We searched seven databases, namely, Scopus, CINAHL, PubMed (MEDLINE), IEEE Xplore Digital Library, Association for Computing Machinery (ACM) Digital Library, Web of Science, and Google Scholar, for relevant publications between October 30, 2020, and January 31, 2021. Three authors were involved in removing duplicates, screening, and selection of relevant articles according to the PRISMA-P (Preferred Reporting Items for Systematic Review and Meta-analysis Protocols) guidelines. Results: Altogether, we retrieved 777 articles from the seven databases. As of May 14, 2021, we have completed the screening process and arrived at 13 eligible articles to be included in the systematic review. We hope to elicit, summarize, and report the main findings in the systematic review article by the end of August 2021. We expect to uncover facilitators and barriers related to app utility, data security, ease of use, and persuasive design that are deemed important to adoption of contact tracing apps. Conclusions: The findings of the systematic review will help researchers to uncover the gaps in the adoption of contact tracing apps, and decision makers and designers to focus on the principal adoption factors necessary to create better and more effective contact tracing apps. International Registered Report Identifier (IRRID): DERR1-10.2196/28961 %M 33974551 %R 10.2196/28961 %U https://www.researchprotocols.org/2021/6/e28961 %U https://doi.org/10.2196/28961 %U http://www.ncbi.nlm.nih.gov/pubmed/33974551 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 6 %P e25271 %T The GIMEMA-ALLIANCE Digital Health Platform for Patients With Hematologic Malignancies in the COVID-19 Pandemic and Postpandemic Era: Protocol for a Multicenter, Prospective, Observational Study %A Efficace,Fabio %A Breccia,Massimo %A Fazi,Paola %A Cottone,Francesco %A Holzner,Bernhard %A Vignetti,Marco %+ Data Center and Health Outcomes Research Unit, Italian Group for Adult Haematologic Diseases (GIMEMA), via Casilina 5, Rome, 00182, Italy, 39 06441639831, f.efficace@gimema.it %K digital health %K hematology %K leukemia %K lymphoma %K multiple myeloma %K patient-reported outcomes %K quality of life %K symptoms %K COVID-19 %D 2021 %7 1.6.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: The COVID-19 pandemic has raised unprecedented challenges in the management of patients with cancer and has increased the demands for digital health tools that, for example, could facilitate remote monitoring of patients. Based on this, the Gruppo Italiano Malattie Ematologiche dell’Adulto (GIMEMA) has recently developed a digital health tool dedicated to patients with hematologic malignancies: the GIMEMA-ALLIANCE platform. Objective: The main objectives of this web-based platform are to generate relevant data to better understand quality of life, symptoms, and medication adherence during the COVID-19 pandemic and postpandemic era; to develop a prospective real-life registry on outcomes of patients with hematologic cancer, with or without a diagnosis of COVID-19; and to facilitate patient-centered care in routine practice. Methods: The platform consists of physician- and patient-secure portals and enables electronic patient-reported outcome (ePRO) assessments with real-time graphical presentation to physicians of individual patient symptoms and quality-of-life outcomes. Automated alerts are sent to treating hematologists based on the following predetermined criteria: presence of clinically important problems and symptoms, problems with adherence to therapy, and risk of COVID-19 diagnosis. The platform also allows physicians to set up video consultations. Clinical information regarding disease and treatment as well as clinical and survival outcomes are also prospectively collected. Results: Recruitment of participants started in December 2020. As of April 2021, a total of 116 patients have been enrolled in this study. Use of this platform may help to improve patient-physician communication and help hematologists in the early recognition of clinically important problems and symptoms of their patients. More than 20 community and university-based hospitals have currently agreed to participate. In addition to patient-reported outcome data, the prospective collection of disease- and treatment-related information, as well as data on possible COVID-19 diagnosis and COVID-19 vaccination, will allow the development of a large database to also identify subgroups of patients at risk of poor outcomes. Conclusions: Data generated via this platform will help to answer clinically relevant questions for patients with hematologic malignancies during the COVID-19 pandemic and postpandemic era. The use of the GIMEMA-ALLIANCE platform in routine practice may also contribute to enhancing patient-centered care. Trial Registration: ClinicalTrials.gov NCT04581187; https://clinicaltrials.gov/ct2/show/NCT04581187 International Registered Report Identifier (IRRID): PRR1-10.2196/25271 %M 33890580 %R 10.2196/25271 %U https://www.researchprotocols.org/2021/6/e25271 %U https://doi.org/10.2196/25271 %U http://www.ncbi.nlm.nih.gov/pubmed/33890580 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 5 %P e26282 %T Perceptions of Mobile Health Apps and Features to Support Psychosocial Well-being Among Frontline Health Care Workers Involved in the COVID-19 Pandemic Response: Qualitative Study %A Yoon,Sungwon %A Goh,Hendra %A Nadarajan,Gayathri Devi %A Sung,Sharon %A Teo,Irene %A Lee,Jungup %A Ong,Marcus E H %A Graves,Nicholas %A Teo,Tess Lin %+ Health Services and Systems Research, Duke-NUS Medical School, 8 College Rd, Singapore 169857, Singapore, , Singapore, 65 66013198, sungwon.yoon@duke-nus.edu.sg %K COVID-19 %K frontline health care workers %K mHealth %K well-being %K psychosocial %D 2021 %7 31.5.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Frontline health care workers are experiencing a myriad of physical and psychosocial challenges amid the COVID-19 pandemic. There is growing recognition that digital technologies have the potential to improve the well-being of frontline workers. However, there has been limited development of wellness interventions using mobile health (mHealth) technology. More importantly, little research has been conducted on how frontline workers perceive mHealth-based support to promote their well-being. Objective: This study aimed to explore frontline workers’ experience of conventional psychological wellness programs and their perceptions of the usefulness of mHealth apps and features for promoting well-being. It also sought to identify factors that could potentially influence uptake and retention of an mHealth-based wellness program. Methods: We conducted semistructured interviews using purposive sampling with frontline workers involved in the COVID-19 response. Various visual materials, collated from existing mHealth app features, were presented to facilitate discussion. Interviews were audio-recorded and transcribed verbatim. Thematic analysis based on grounded theory was undertaken. Themes were subsequently mapped to key nudge strategies—those commonly used for mHealth development—to assess participants’ preferences for particular features and their reasoning. Results: A total of 42 frontline workers participated in 12 one-on-one interviews or focus group discussions. Frontline workers generally had a limited ability to identify their own psychological problems and liked the reminders functionality of the app to track their mood over time. A personalized goal-setting feature (ie, tailoring) and in-app resources were generally valued, while frequent coaching and messages (ie, framing) were seen as a distraction. The majority of participants desired a built-in chat function with a counselor (ie, guidance) for reasons of accessibility and protection of privacy. Very few participants appreciated a gamification function. Frontline workers commonly reported the need for ongoing social support and desired access to an in-app peer support community (ie, social influence). There were, however, concerns regarding potential risks from virtual peer interactions. Intrinsic motivational factors, mHealth app technicality, and tangible rewards were identified as critical for uptake and retention. Conclusions: Our study highlights the potential of mHealth apps with relevant features to be used as wellness tools by frontline health care workers. Future work should focus on developing a nonintrusive and personalized mHealth app with in-app counseling, peer support to improve well-being, and tangible and extrinsic rewards to foster continued use. %M 33979296 %R 10.2196/26282 %U https://www.jmir.org/2021/5/e26282 %U https://doi.org/10.2196/26282 %U http://www.ncbi.nlm.nih.gov/pubmed/33979296 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 5 %P e19544 %T Age-Stratified Infection Probabilities Combined With a Quarantine-Modified Model for COVID-19 Needs Assessments: Model Development Study %A Bongolan,Vena Pearl %A Minoza,Jose Marie Antonio %A de Castro,Romulo %A Sevilleja,Jesus Emmanuel %+ Department of Computer Science, University of the Philippines Diliman, UP AECH Bldg, Velasquez St, Quezon City, 1101, Philippines, 63 915 877 2298, bongolan@up.edu.ph %K COVID-19 %K epidemic modeling %K age stratification theory %K infection probability %K SEIR %K mathematical modelling %D 2021 %7 31.5.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Classic compartmental models such as the susceptible-exposed-infectious-removed (SEIR) model all have the weakness of assuming a homogenous population, where everyone has an equal chance of getting infected and dying. Since it was identified in Hubei, China, in December 2019, COVID-19 has rapidly spread around the world and been declared a pandemic. Based on data from Hubei, infection and death distributions vary with age. To control the spread of the disease, various preventive and control measures such as community quarantine and social distancing have been widely used. Objective: Our aim is to develop a model where age is a factor, considering the study area’s age stratification. Additionally, we want to account for the effects of quarantine on the SEIR model. Methods: We use the age-stratified COVID-19 infection and death distributions from Hubei, China (more than 44,672 infections as of February 11, 2020) as an estimate or proxy for a study area’s infection and mortality probabilities for each age group. We then apply these probabilities to the actual age-stratified population of Quezon City, Philippines, to predict infectious individuals and deaths at peak. Testing with different countries shows the predicted number of infectious individuals skewing with the country’s median age and age stratification, as expected. We added a Q parameter to the SEIR model to include the effects of quarantine (Q-SEIR). Results: The projections from the age-stratified probabilities give much lower predicted incidences of infection than the Q-SEIR model. As expected, quarantine tends to delay the peaks for both the exposed and infectious groups, and to “flatten” the curve or lower the predicted values for each compartment. These two estimates were used as a range to inform the local government’s planning and response to the COVID-19 threat. Conclusions: Age stratification combined with a quarantine-modified model has good qualitative agreement with observations on infections and death rates. That younger populations will have lower death rates due to COVID-19 is a fair expectation for a disease where most fatalities are among older adults. %M 33900929 %R 10.2196/19544 %U https://www.jmir.org/2021/5/e19544 %U https://doi.org/10.2196/19544 %U http://www.ncbi.nlm.nih.gov/pubmed/33900929 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 5 %P e26989 %T Use of a Self-guided Computerized Cognitive Behavioral Tool During COVID-19: Evaluation Study %A Detweiler Guarino,Isadora %A Cowan,Devin R %A Fellows,Abigail M %A Buckey,Jay C %+ Space Medicine Innovations Laboratory, Geisel School of Medicine at Dartmouth, One Medical Center Drive, Lebanon, NH, 03756, United States, 1 603 650 6012, Jay.C.Buckey.Jr@dartmouth.edu %K computerized cognitive behavioral therapy %K interactive media %K COVID-19 %K computer-based therapy %K usability %K acceptability %K cognitive behavioral therapy %K therapy %K effectiveness %K digital health %K depression %K stress %D 2021 %7 31.5.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Internet-based programs can help provide accessible and inexpensive behavioral health care to those in need; however, the evaluation of these interventions has been mostly limited to controlled trials. Data regarding patterns of use and effectiveness of self-referred, open-access online interventions are lacking. We evaluated an online-based treatment designed to address stress, depression, and conflict management, the Dartmouth PATH Program, in a freely available and self-guided format during the COVID-19 pandemic. Objective: The primary aim is to determine users’ levels of stress and depression, and the nature of problems and triggers they reported during the COVID-19 pandemic. A secondary objective is to assess the acceptability and usability of the PATH content and determine whether such a program would be useful as a stand-alone open-access resource. The final objective is understanding the high dropout rates associated with online behavioral programs by contrasting the use pattern and program efficacy of individuals who completed session one and did not return to the program with those who came back to complete more sessions. Methods: Cumulative anonymous data from 562 individuals were analyzed. Stress triggers, stress responses, and reported problems were analyzed using qualitative analysis techniques. Scores on usability and acceptability questionnaires were evaluated using the sign test and Wilcoxon signed rank test. Mixed-effects linear modeling was used to evaluate changes in stress and depression over time. Results: A total of 2484 users registered from April through October 2020, most of whom created an account without initiating a module. A total of 562 individuals started the program and were considered in the data analysis. The most common stress triggers individuals reported involved either conflicts with family or spouses and work or workload. The most common problems addressed in the mood module were worry, anxiousness, or stress and difficulty concentrating or procrastination. The attrition rate was high with 13% (21/156) completing the conflict module, 17% (50/289) completing session one of the mood module, and 14% (16/117) completing session one of the stress module. Usability and acceptability scores for the mood and stress modules were significantly better than average. In those who returned to complete sessions, symptoms of stress showed a significant improvement over time (P=.03), and there was a significant decrease in depressive symptoms over all time points (P=.01). Depression severity decreased on average by 20% (SD 35.2%; P=.60) between sessions one and two. Conclusions: Conflicts with others, worry, and difficulty concentrating were some of the most common problems people used the programs to address. Individuals who completed the modules indicated improvements in self-reported stress and depression symptoms. Users also found the modules to be effective and rated the program highly for usability and acceptability. Nevertheless, the attrition rate was very high, as has been found with other freely available online-based interventions. Trial Registration: ClinicalTrials.gov NCT02726061; https://clinicaltrials.gov/ct2/show/NCT02726061 %M 33973856 %R 10.2196/26989 %U https://formative.jmir.org/2021/5/e26989 %U https://doi.org/10.2196/26989 %U http://www.ncbi.nlm.nih.gov/pubmed/33973856 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 5 %P e25713 %T Use of eHealth Platforms and Apps to Support Monitoring and Management of Home-Quarantined Patients With COVID-19 in the Province of Trento, Italy: App Development and Implementation %A Gios,Lorenzo %A Crema Falceri,Giulia %A Micocci,Stefano %A Patil,Luigi %A Testa,Sara %A Sforzin,Simona %A Turra,Ettore %A Conforti,Diego %A Malfatti,Giulia %A Moz,Monica %A Nicolini,Andrea %A Guarda,Paolo %A Bacchiega,Alessandro %A Mion,Carlo %A Marchesoni,Michele %A Maimone,Rosa %A Molini,Pietro Benedetto %A Zanella,Alberto %A Osmani,Venet %A Mayora-Ibarra,Oscar %A Forti,Stefano %+ TrentinoSalute4.0 – Competence Center for Digital Health of the Province of Trento, Via Sommarive, 18. I-38123 POVO (TN), Trento, Italy, 39 3408340665, gios.lorenzo@gmail.com %K telemedicine %K telemonitoring %K quarantine management %K COVID-19 %K connected care %D 2021 %7 31.5.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Italy was the first country to largely experience the COVID-19 epidemic among other Western countries during the so-called first wave of the COVID-19 pandemic. Proper management of an increasing number of home-quarantined individuals created a significant challenge for health care authorities and professionals. This was especially true when considering the importance of remote surveillance to detect signs of disease progression and consequently regulate access to hospitals and intensive care units on a priority basis. Objective: In this paper, we report on an initiative promoted to cope with the first wave of the COVID-19 epidemic in the Spring/Summer of 2020, in the Autonomous Province of Trento, Italy. A purposefully built app named TreCovid19 was designed to provide dedicated health care staff with a ready-to-use tool for remotely monitoring patients with progressive symptoms of COVID-19, who were home-quarantined during the first wave of the epidemic, and to focus on those patients who, based on their self-reported clinical data, required a quick response from health care professionals. Methods: TreCovid19 was rapidly developed to facilitate the monitoring of a selected number of home-quarantined patients with COVID-19 during the very first epidemic wave. The app was built on top of an existing eHealth platform, already in use by the local health authority to provide home care, with the following functionalities: (1) to securely collect and link demographic and clinical information related to the patients and (2) to provide a two-way communication between a multidisciplinary health care team and home-quarantined patients. The system supported patients to self-assess their condition and update the multidisciplinary team on their health status. The system was used between March and June 2020 in the province of Trento. Results: A dedicated multidisciplinary group of health care professionals adopted the platform over a period of approximately 3 months (from March-end to June 2020) to monitor a total of 170 patients with confirmed COVID-19 during home quarantine. All patients used the system until the end of the initiative. The TreCovid19 system has provided useful insights of possible viability and impact of a technological–organizational asset to manage a potentially critical workload for the health care staff involved in the periodic monitoring of a relevant number of quarantined patients, notwithstanding its limitations given the rapid implementation of the whole initiative. Conclusions: The technological and organizational model adopted in response to the COVID-19 pandemic was developed and finalized in a relatively short period during the initial few weeks of the epidemic. The system successfully supported the health care staff involved in the periodic monitoring of an increasing number of home-quarantined patients and provided valuable data in terms of disease surveillance. %M 33909586 %R 10.2196/25713 %U https://formative.jmir.org/2021/5/e25713 %U https://doi.org/10.2196/25713 %U http://www.ncbi.nlm.nih.gov/pubmed/33909586 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 5 %P e29058 %T A Machine Learning Approach for Mortality Prediction in COVID-19 Pneumonia: Development and Evaluation of the Piacenza Score %A Halasz,Geza %A Sperti,Michela %A Villani,Matteo %A Michelucci,Umberto %A Agostoni,Piergiuseppe %A Biagi,Andrea %A Rossi,Luca %A Botti,Andrea %A Mari,Chiara %A Maccarini,Marco %A Pura,Filippo %A Roveda,Loris %A Nardecchia,Alessia %A Mottola,Emanuele %A Nolli,Massimo %A Salvioni,Elisabetta %A Mapelli,Massimo %A Deriu,Marco Agostino %A Piga,Dario %A Piepoli,Massimo %+ Department of Cardiology, Guglielmo Da Saliceto Hospital, Via Taverna 49,, Piacenza, 29121, Italy, 39 3517489495, geza.halasz@gmail.com %K artificial intelligence %K prognostic score %K COVID-19 %K pneumonia %K mortality %K prediction %K machine learning %K modeling %D 2021 %7 31.5.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Several models have been developed to predict mortality in patients with COVID-19 pneumonia, but only a few have demonstrated enough discriminatory capacity. Machine learning algorithms represent a novel approach for the data-driven prediction of clinical outcomes with advantages over statistical modeling. Objective: We aimed to develop a machine learning–based score—the Piacenza score—for 30-day mortality prediction in patients with COVID-19 pneumonia. Methods: The study comprised 852 patients with COVID-19 pneumonia, admitted to the Guglielmo da Saliceto Hospital in Italy from February to November 2020. Patients’ medical history, demographics, and clinical data were collected using an electronic health record. The overall patient data set was randomly split into derivation and test cohorts. The score was obtained through the naïve Bayes classifier and externally validated on 86 patients admitted to Centro Cardiologico Monzino (Italy) in February 2020. Using a forward-search algorithm, 6 features were identified: age, mean corpuscular hemoglobin concentration, PaO2/FiO2 ratio, temperature, previous stroke, and gender. The Brier index was used to evaluate the ability of the machine learning model to stratify and predict the observed outcomes. A user-friendly website was designed and developed to enable fast and easy use of the tool by physicians. Regarding the customization properties of the Piacenza score, we added a tailored version of the algorithm to the website, which enables an optimized computation of the mortality risk score for a patient when some of the variables used by the Piacenza score are not available. In this case, the naïve Bayes classifier is retrained over the same derivation cohort but using a different set of patient characteristics. We also compared the Piacenza score with the 4C score and with a naïve Bayes algorithm with 14 features chosen a priori. Results: The Piacenza score exhibited an area under the receiver operating characteristic curve (AUC) of 0.78 (95% CI 0.74-0.84, Brier score=0.19) in the internal validation cohort and 0.79 (95% CI 0.68-0.89, Brier score=0.16) in the external validation cohort, showing a comparable accuracy with respect to the 4C score and to the naïve Bayes model with a priori chosen features; this achieved an AUC of 0.78 (95% CI 0.73-0.83, Brier score=0.26) and 0.80 (95% CI 0.75-0.86, Brier score=0.17), respectively. Conclusions: Our findings demonstrated that a customizable machine learning–based score with a purely data-driven selection of features is feasible and effective for the prediction of mortality among patients with COVID-19 pneumonia. %M 33999838 %R 10.2196/29058 %U https://www.jmir.org/2021/5/e29058 %U https://doi.org/10.2196/29058 %U http://www.ncbi.nlm.nih.gov/pubmed/33999838 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 5 %P e27965 %T Engagement and Effectiveness of a Healthy-Coping Intervention via Chatbot for University Students During the COVID-19 Pandemic: Mixed Methods Proof-of-Concept Study %A Gabrielli,Silvia %A Rizzi,Silvia %A Bassi,Giulia %A Carbone,Sara %A Maimone,Rosa %A Marchesoni,Michele %A Forti,Stefano %+ Digital Health Lab, Fondazione Bruno Kessler, Via Sommarive 18, Trento, 38123, Italy, 39 0461 312 47 ext 247, sgabrielli@fbk.eu %K mobile mental health %K chatbots %K anxiety %K stress %K university students %K digital health %K healthy-coping intervention %K COVID-19 %D 2021 %7 28.5.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: University students are increasingly reporting common mental health problems, such as stress, anxiety, and depression, and they frequently face barriers to seeking psychological support because of stigma, cost, and availability of mental health services. This issue is even more critical in the challenging time of the COVID-19 pandemic. Digital mental health interventions, such as those delivered via chatbots on mobile devices, offer the potential to achieve scalability of healthy-coping interventions by lowering cost and supporting prevention. Objective: The goal of this study was to conduct a proof-of-concept evaluation measuring the engagement and effectiveness of Atena, a psychoeducational chatbot supporting healthy coping with stress and anxiety, among a population of university students. Methods: In a proof-of-concept study, 71 university students were recruited during the COVID-19 pandemic; 68% (48/71) were female, they were all in their first year of university, and their mean age was 20.6 years (SD 2.4). Enrolled students were asked to use the Atena psychoeducational chatbot for 4 weeks (eight sessions; two per week), which provided healthy-coping strategies based on cognitive behavioral therapy, positive psychology, and mindfulness techniques. The intervention program consisted of conversations combined with audiovisual clips delivered via the Atena chatbot. Participants were asked to complete web-based versions of the 7-item Generalized Anxiety Disorder scale (GAD-7), the 10-item Perceived Stress Scale (PSS-10), and the Five-Facet Mindfulness Questionnaire (FFMQ) at baseline and postintervention to assess effectiveness. They were also asked to complete the User Engagement Scale–Short Form at week 2 to assess engagement with the chatbot and to provide qualitative comments on their overall experience with Atena postintervention. Results: Participants engaged with the Atena chatbot an average of 78 (SD 24.8) times over the study period. A total of 61 out of 71 (86%) participants completed the first 2 weeks of the intervention and provided data on engagement (10/71, 14% attrition). A total of 41 participants out of 71 (58%) completed the full intervention and the postintervention questionnaires (30/71, 42% attrition). Results from the completer analysis showed a significant decrease in anxiety symptoms for participants in more extreme GAD-7 score ranges (t39=0.94; P=.009) and a decrease in stress symptoms as measured by the PSS-10 (t39=2.00; P=.05) for all participants postintervention. Participants also improved significantly in the describing and nonjudging facets, based on their FFMQ subscale scores, and asked for some improvements in the user experience with the chatbot. Conclusions: This study shows the benefit of deploying a digital healthy-coping intervention via a chatbot to support university students experiencing higher levels of distress. While findings collected during the COVID-19 pandemic show promise, further research is required to confirm conclusions. %M 33950849 %R 10.2196/27965 %U https://mhealth.jmir.org/2021/5/e27965 %U https://doi.org/10.2196/27965 %U http://www.ncbi.nlm.nih.gov/pubmed/33950849 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 5 %P e24811 %T Self-Sampling for SARS-CoV-2 Diagnostic Testing by Using Nasal and Saliva Specimens: Protocol for Usability and Clinical Evaluation %A Majam,Mohammed %A Msolomba,Vanessa %A Scott,Lesley %A Stevens,Wendy %A Marange,Fadzai %A Kahamba,Trish %A Venter,Francois %A Conserve,Donaldson Fadael %+ Ezintsha, Wits Health Consortium, University of the Witwatersrand, 31 Princess of Wales, Johannesburg, South Africa, 27 82 826 0180, mmajam@ezintsha.org %K SARS-CoV-2 %K SARS-CoV-2SS %K testing %K COVID-19 %K South Africa %K usabillity %K self-sampling %K diagnostic %K sensitivity %K specificity %D 2021 %7 28.5.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: SARS-CoV-2 is a novel coronavirus discovered in December 2019 and is currently the cause of the global COVID-19 pandemic. A critical aspect of fighting this pandemic is to obtain accurate and timely test results so that patients who have tested positive for COVID-19 can be identified and isolated to reduce the spread of the virus. Research has shown that saliva is a promising candidate for SARS-CoV-2 diagnostics because its collection is minimally invasive and can be reliably self-administered. However, little research has been conducted on saliva testing and SARS-CoV-2 self-sampling (SARS-CoV-2SS) in Sub-Saharan Africa. Objective: The primary objective of this study is to comparatively evaluate the clinical sensitivity and specificity of nasal and oral samples self-collected by individuals for SARS-CoV-2 testing against a reference method involving sample collection and testing by a health care professional. The secondary objectives of this study are to evaluate the usability of nasal self-sampling and saliva self-sampling as a sample collection method for SARS-CoV-2 diagnostic testing by using failure mode and error assessment. Methods: Participants will be recruited from the general population by using various methods, Participants will be screened progressively as they present at the clinical trial sites as well as in primary health care catchment areas in the inner city of Johannesburg, South Africa. In the event that recruitment numbers are low, we will use a mobile van to recruit participants from outlying areas of Johannesburg. We aim to enroll 250 participants into this study in approximately 6 weeks. Two sample types—a self-administered nasal swab and a self-administered saliva sample—will be collected from each participant, and a health care professional will collect a third sample by using a nasopharyngeal swab (ie, the standard reference method). Results: This protocol has been approved by the University of the Witwatersrand Human Research Ethics Committee on July 31, 2020 (Protocol number EzCov003). As of May 13, 2021, 120 participants have been enrolled into the study. Conclusions: SARS-CoV-2SS may offer many benefits to individuals, by allowing for initial self-identification of symptoms and collection of samples without involving third parties and potential risk of infection provided the sample can be safely processed via a collection system. The results of this study will provide preliminary data on the acceptability, feasibility, and usability of SARS-CoV-2SS among the general population for its future implementation. International Registered Report Identifier (IRRID): DERR1-10.2196/24811 %M 33882023 %R 10.2196/24811 %U https://www.researchprotocols.org/2021/5/e24811 %U https://doi.org/10.2196/24811 %U http://www.ncbi.nlm.nih.gov/pubmed/33882023 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 7 %N 2 %P e24300 %T Incorporating Medical Students Into Primary Care Telehealth Visits: Tutorial %A Balaji,Aanika %A Clever,Sarah Lou %+ Johns Hopkins University School of Medicine, 1600 McElderry, Baltimore, MD, , United States, 1 4109555550, sclever@jhmi.edu %K medical student %K education %K primary care %K telehealth %K video visits %K internal medicine %K medical education %K teleconsultation %K digital health %K COVID-19 %D 2021 %7 28.5.2021 %9 Tutorial %J JMIR Med Educ %G English %X Background: The COVID-19 pandemic has brought about sweeping change in health care delivery, which has shifted from in-person consultations to a web-based format. Few medical schools provide web-based medicine or telemedicine training to their learners, though this is likely to be important for future medical practice. Objective: This tutorial communicates a framework for incorporating medical students into primary care telemedicine clinics. Methods: A third-year medical student and internal medicine attending physician from the Johns Hopkins University completed telemedicine clinic visits in April 2020 by using a variety of video platforms and via telephone calls. Results: Nine telemedicine visits were completed over 4 clinic days. Our patients were, on average, aged 68 years. The majority of patients were female (6/9, 67%), and most appointments were completed via a video platform (6/9, 67%). Additionally, our experience is summarized and describe (1) practical tips for how to prepare for a telehealth visit; (2) technology considerations; (3) recommendations for participation during a telehealth visit; (4) debriefing and feedback; (5) challenges to care; and (6) student, care provider, and patient reactions to telemedicine visits. Conclusions: Telemedicine clinics have been successfully used for managing patients with chronic conditions, those who have attended low-risk urgent care visits, and those with mental health concerns. Patients have reported high patient satisfaction scores for telemedicine visits, and the majority of patients are comfortable with having medical students as part of their care team. Moving forward, telemedicine will remain a popular method for receiving health care. This study has highlighted that medical students can successfully be integrated into telemedicine clinics and that they should be exposed to telehealth whenever possible prior to residency. %M 33974552 %R 10.2196/24300 %U https://mededu.jmir.org/2021/2/e24300 %U https://doi.org/10.2196/24300 %U http://www.ncbi.nlm.nih.gov/pubmed/33974552 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 5 %P e28673 %T Pool Testing as a Strategy for Prevention of SARS-CoV-2 Outbreaks in Schools: Protocol for a Feasibility Study %A Sweeney-Reed,Catherine M %A Wolff,Doreen %A Niggel,Jakob %A Kabesch,Michael %A Apfelbacher,Christian %+ Neurocybernetics and Rehabilitation, Department of Neurology, Otto von Guericke University Magdeburg, Leipziger Str. 44, Magdeburg, , Germany, 49 (0)391 6728224, catherine.sweeney-reed@med.ovgu.de %K SARS-CoV-2 %K COVID-19 %K schools %K pool testing %K gargle test %K test strategy %K monitoring %K surveillance %K PCR %D 2021 %7 28.5.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: School closures are a widely implemented strategy for limiting infection spread in the current COVID-19 pandemic. The negative impact of school closures on children and young people is increasingly apparent, however. Objective: We aim to evaluate the feasibility of an infection monitoring program in schools to enable targeted quarantining to replace school closures. The program is currently being implemented in two model schools in Magdeburg, Germany, within the framework of the Study of Coronavirus Outbreak Prevention in Magdeburg Schools (Studie zur Ausbruchsvermeidung von Corona an Magdeburger Schulen [STACAMA]). Methods: Five pupils per class are pseudorandomly selected twice a week and asked to provide a gargle sample over a 16-week evaluation period. RNA is extracted from each sample individually in a laboratory and pooled according to school class for real-time reverse transcription polymerase chain reaction (rRT-PCR) analysis. Immediate individual sample testing will be carried out in the case of a positive pool test. Individual RNA extraction prior to pooling and application of rRT-PCR result in high test sensitivity. Testing will be performed in strict adherence to data protection standards. All participating pupils will receive a 16-digit study code, which they will be able to use to access their test Results: When the study commenced on December 2, 2020, 520 (52%) pupils and their families or guardians had consented to study participation. The study was suspended after four test rounds due to renewed school closures resulting from rising regional infection incidence. Testing resumed when schools reopened on March 8, 2021, at which time consent to participation was provided for 54% of pupils. We will quantitatively and qualitatively evaluate the logistics and acceptability of the program. Conclusions: The findings from this study should inform the design of infection surveillance programs in schools based on gargle samples and a PCR-based pool testing procedure, enabling the identification of aspects that may require adaptation before large-scale implementation. Our focus on each step of the logistics and on the experiences of families should enable a robust assessment of the feasibility of such an approach. International Registered Report Identifier (IRRID): DERR1-10.2196/28673 %M 33979297 %R 10.2196/28673 %U https://www.researchprotocols.org/2021/5/e28673 %U https://doi.org/10.2196/28673 %U http://www.ncbi.nlm.nih.gov/pubmed/33979297 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 5 %P e29507 %T Authors’ Reply to: Redundancy of Terms in Search Strategies. Comment on “Searching PubMed to Retrieve Publications on the COVID-19 Pandemic: Comparative Analysis of Search Strings” %A Rasmussen,Lauge Neimann %A Norgaard,Ole %A Andersen,Tue Helms %A Palayew,Adam %A Nicholson,Joey %A Lazarus,Jeffrey V %+ Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Calle del Rosellón 132, Barcelona, 08036, Spain, Jeffrey.Lazarus@isglobal.org %K coronavirus %K COVID-19 %K pandemic %K scientific publishing %K PubMed %K literature searching %K research %K literature %K search %K performance %K search strategy %D 2021 %7 28.5.2021 %9 Letter to the Editor %J J Med Internet Res %G English %X %M 33989168 %R 10.2196/29507 %U https://www.jmir.org/2021/5/e29507 %U https://doi.org/10.2196/29507 %U http://www.ncbi.nlm.nih.gov/pubmed/33989168 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 5 %P e28666 %T Redundancy of Terms in Search Strategies. Comment on “Searching PubMed to Retrieve Publications on the COVID-19 Pandemic: Comparative Analysis of Search Strings” %A Campos,Daniel Melo De Oliveira %A Fulco,Umberto Laino %A Oliveira,Jonas Ivan Nobre %+ Universidade Federal do Rio Grande do Norte, Departamento de Biofísica e Farmacologia, Natal, 59072-970, Brazil, 55 8432153793, jonasivan@gmail.com %K coronavirus %K COVID-19 %K pandemic %K scientific publishing %K PubMed %K literature searching %K research %K literature %K search %K performance %K search strategy %D 2021 %7 28.5.2021 %9 Letter to the Editor %J J Med Internet Res %G English %X %M 33989165 %R 10.2196/28666 %U https://www.jmir.org/2021/5/e28666 %U https://doi.org/10.2196/28666 %U http://www.ncbi.nlm.nih.gov/pubmed/33989165 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 5 %P e29583 %T Olfactory Training and Visual Stimulation Assisted by a Web Application for Patients With Persistent Olfactory Dysfunction After SARS-CoV-2 Infection: Observational Study %A Denis,Fabrice %A Septans,Anne-Lise %A Periers,Lea %A Maillard,Jean-Michel %A Legoff,Florian %A Gurden,Hirac %A Moriniere,Sylvain %+ Institut Inter-Regional Jean Bernard - ELSAN, 9 Rue Beauverger, Le Mans, France, 33 684190480, fabrice.denis.home@gmail.com %K olfactory dysfunction %K SARS-CoV-2 %K olfactory training %K web application, eHealth %K real-life study %K COVID-19 %K app %K training %K stimulation %K olfactory %K dysfunction %K smell %K observational %K senses %K nose %D 2021 %7 27.5.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Persistent olfactory dysfunction is a significant complication of SARS-CoV-2 infection. Olfactory training involving aromatic oils has been recommended to improve olfactory recovery, but quantitative data are missing. Objective: We aimed to quantify the benefit of olfactory training and visual stimulation assisted by a dedicated web application for patients who experienced olfactory dysfunction for ≥1 month. Methods: We performed an observational, real-life, data-based study on a cohort of patients who experienced at least 1 month of persistent olfactory dysfunction between January 30 and March 26, 2021. An analysis was performed after a mean olfactory training time of 4 weeks, and at least 500 patients were assessable for primary outcome assessment. Participants exposed themselves twice daily to odors from 4 high-concentration oils and visual stimulation assisted by a dedicated web application. Improvement was defined as a 2-point increase on a 10-point, self-assessed olfactory visual analogue scale. Results: In total, 548 patients were assessable for primary outcome assessment. The mean baseline, self-assessed olfactory score was 1.9 (SD 1.7), and this increased to 4.6 (SD 2.8) after a mean olfactory training time of 27.7 days (SD 17.2). Olfactory training was associated with at least a 2-point increase in 64.2% (352/548) of patients. The rate of patients’ olfactory improvement was higher for patients who trained for more than 28 days than that rate for patients who trained for less than 28 days (73.3% vs 59%; P=.002). The time to olfactory improvement was 8 days faster for patients with hyposmia compared to the time to improvement for patients with anosmia (P<.001). This benefit was observed regardless of the duration of the olfactory dysfunction. Conclusions: Olfactory training and visual stimulation assisted by a dedicated web application was associated with significant improvement in olfaction, especially after 28 days of olfactory training. %M 34003765 %R 10.2196/29583 %U https://www.jmir.org/2021/5/e29583 %U https://doi.org/10.2196/29583 %U http://www.ncbi.nlm.nih.gov/pubmed/34003765 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 5 %P e28629 %T Characteristics of Citizens and Their Use of Teleconsultations in Primary Care in the Catalan Public Health System Before and During the COVID-19 Pandemic: Retrospective Descriptive Cross-sectional Study %A Solans,Oscar %A Vidal-Alaball,Josep %A Roig Cabo,Pasqual %A Mora,Núria %A Coma,Ermengol %A Bonet Simó,Josep Maria %A Hermosilla Pérez,Eduardo %A Saigí-Rubió,Francesc %A Olmos Domínguez,Carmen %A Piera-Jiménez,Jordi %A Abizanda González,Mercè %A López Seguí,Francesc %+ Health Promotion in Rural Areas Research Group, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, Carrer Pica d'Estats, 36, Sant Fruitós de Bages, 08272, Spain, 34 936930040, jvidal.cc.ics@gencat.cat %K teleconsultation %K primary care %K remote consultation %K telehealth %K COVID-19 %K e-consultation %D 2021 %7 27.5.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: eConsulta—that is, asynchronous, two-way teleconsultation in primary care—is one of the most important telemedicine developments in the Catalan public health system, a service that has been heavily boosted by the onset of the COVID-19 pandemic. It is vital to know the characteristics of its users in order to be able to meet their needs and understand the coverage of this service in a context where there is reduced accessibility to the health system. Objective: This study aims to analyze the profile of the citizens who use the eConsulta tool and the reasons for their use, as well as to gain an understanding of the elements that characterize their decision to use it while distinguishing between those who used it before and those who have used it since the onset of the COVID-19 pandemic. Methods: A descriptive, observational study based on administrative data was performed. This study differentiates between the COVID-19 pandemic era and the period preceding it, considering the day the state of emergency was declared in Spain (ie, March 12, 2020) as the cut-off point. It also differentiates between eConsulta users who send messages and those who only receive them. Results: During the pandemic, the number of unique users of this teleconsultation service had almost tripled, with up to 33.10 visits per 1000 inhabitants per month reported in the first three months. For the two user profiles analyzed, most users since the start of the COVID-19 outbreak were predominantly female, systematically younger, more actively employed, and with less complex pathologies. Furthermore, eConsulta users received more messages proactively from the health professionals. There was also a relative decrease in the number of conversations initiated by higher-income urban users and an increase in conversations initiated by users in rural areas. Conclusions: The COVID-19 pandemic has helped to generalize the use of telemedicine as a tool to compensate, to some extent, for the decline in face-to-face visits, especially among younger citizens in Catalonia. Telemedicine has made it possible to maintain contact between citizens and the health care system in the context of maximum complexity. %M 33970867 %R 10.2196/28629 %U https://www.jmir.org/2021/5/e28629 %U https://doi.org/10.2196/28629 %U http://www.ncbi.nlm.nih.gov/pubmed/33970867 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 5 %P e25988 %T Using Unsupervised Machine Learning to Identify Age- and Sex-Independent Severity Subgroups Among Patients with COVID-19: Observational Longitudinal Study %A Benito-León,Julián %A del Castillo,Mª Dolores %A Estirado,Alberto %A Ghosh,Ritwik %A Dubey,Souvik %A Serrano,J Ignacio %+ Department of Neurology, University Hospital “12 de Octubre”, Avenida de Córdoba s/n, Madrid, 28041, Spain, 34 639154069, jbenitol67@gmail.com %K COVID-19 %K machine learning %K outcome %K severity %K subgroup %K emergency %K detection %K intervention %K testing %K data set %K characterization %D 2021 %7 27.5.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Early detection and intervention are the key factors for improving outcomes in patients with COVID-19. Objective: The objective of this observational longitudinal study was to identify nonoverlapping severity subgroups (ie, clusters) among patients with COVID-19, based exclusively on clinical data and standard laboratory tests obtained during patient assessment in the emergency department. Methods: We applied unsupervised machine learning to a data set of 853 patients with COVID-19 from the HM group of hospitals (HM Hospitales) in Madrid, Spain. Age and sex were not considered while building the clusters, as these variables could introduce biases in machine learning algorithms and raise ethical implications or enable discrimination in triage protocols. Results: From 850 clinical and laboratory variables, four tests—the serum levels of aspartate transaminase (AST), lactate dehydrogenase (LDH), C-reactive protein (CRP), and the number of neutrophils—were enough to segregate the entire patient pool into three separate clusters. Further, the percentage of monocytes and lymphocytes and the levels of alanine transaminase (ALT) distinguished cluster 3 patients from the other two clusters. The highest proportion of deceased patients; the highest levels of AST, ALT, LDH, and CRP; the highest number of neutrophils; and the lowest percentages of monocytes and lymphocytes characterized cluster 1. Cluster 2 included a lower proportion of deceased patients and intermediate levels of the previous laboratory tests. The lowest proportion of deceased patients; the lowest levels of AST, ALT, LDH, and CRP; the lowest number of neutrophils; and the highest percentages of monocytes and lymphocytes characterized cluster 3. Conclusions: A few standard laboratory tests, deemed available in all emergency departments, have shown good discriminative power for the characterization of severity subgroups among patients with COVID-19. %M 33872186 %R 10.2196/25988 %U https://www.jmir.org/2021/5/e25988 %U https://doi.org/10.2196/25988 %U http://www.ncbi.nlm.nih.gov/pubmed/33872186 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 5 %P e29298 %T Increases in Naloxone Administrations by Emergency Medical Services Providers During the COVID-19 Pandemic: Retrospective Time Series Study %A Khoury,Dalia %A Preiss,Alexander %A Geiger,Paul %A Anwar,Mohd %A Conway,Kevin Paul %+ Research Triangle Institute International, 3040 East Cornwallis Road, Research Triangle Park, NC, 27709, United States, 1 9195411227, dkhoury@rti.org %K opioids %K naloxone %K EMS %K emergency medical services %K COVID-19 %K pandemic %K medical services %K overdose %K outcomes %K opioid crisis %K public health %D 2021 %7 27.5.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The opioid crisis in the United States may be exacerbated by the COVID-19 pandemic. Increases in opioid use, emergency medical services (EMS) runs for opioid-related overdoses, and opioid overdose deaths have been reported. No study has examined changes in multiple naloxone administrations, an indicator of overdose severity, during the COVID-19 pandemic. Objective: This study examines changes in the occurrence of naloxone administrations and multiple naloxone administrations during EMS runs for opioid-related overdoses during the COVID-19 pandemic in Guilford County, North Carolina (NC). Methods: Using a period-over-period approach, we compared the occurrence of opioid-related EMS runs, naloxone administrations, and multiple naloxone administrations during the 29-week period before (September 1, 2019, to March 9, 2020) and after NC’s COVID-19 state of emergency declaration (ie, the COVID-19 period of March 10 to September 30, 2020). Furthermore, historical data were used to generate a quasi-control distribution of period-over-period changes to compare the occurrence of each outcome during the COVID-19 period to each 29-week period back to January 1, 2014. Results: All outcomes increased during the COVID-19 period. Compared to the previous 29 weeks, the COVID-19 period experienced increases in the weekly mean number of opioid-related EMS runs (25.6, SD 5.6 vs 18.6, SD 6.6; P<.001), naloxone administrations (22.3, SD 6.2 vs 14.1, SD 6.0; P<.001), and multiple naloxone administrations (5.0, SD 1.9 vs 2.7, SD 1.9; P<.001), corresponding to proportional increases of 37.4%, 57.8%, and 84.8%, respectively. Additionally, the increases during the COVID-19 period were greater than 91% of all historical 29-week periods analyzed. Conclusions: The occurrence of EMS runs for opioid-related overdoses, naloxone administrations, and multiple naloxone administrations during EMS runs increased during the COVID-19 pandemic in Guilford County, NC. For a host of reasons that need to be explored, the COVID-19 pandemic appears to have exacerbated the opioid crisis. %M 33999828 %R 10.2196/29298 %U https://publichealth.jmir.org/2021/5/e29298 %U https://doi.org/10.2196/29298 %U http://www.ncbi.nlm.nih.gov/pubmed/33999828 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 5 %P e28594 %T An Overview of the Treatment Options Used for the Management of COVID-19 in Pakistan: Retrospective Observational Study %A Akhtar,Hashaam %A Akhtar,Samar %A Rahman,Fazal-Ul %A Afridi,Maham %A Khalid,Sundas %A Ali,Sabahat %A Akhtar,Nasim %A Khader,Yousef S %A Ahmad,Hamaad %A Khan,Muhammad Mujeeb %+ Yusra Institute of Pharmaceutical Sciences, Yusra Medical and Dental College, Zaraj Housing Society, Opposite DHA Phase 2 Gate III, Main GT Road, Islamabad, 44000, Pakistan, 92 515709447, hashaamakhtar@gmail.com %K COVID-19 %K antibiotics %K Pakistan %K multidrug resistant infections %K antibiotic resistance %K first wave %D 2021 %7 27.5.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Since the first reports of COVID-19 infection, the foremost requirement has been to identify a treatment regimen that not only fights the causative agent but also controls the associated complications of the infection. Due to the time-consuming process of drug discovery, physicians have used readily available drugs and therapies for treatment of infections to minimize the death toll. Objective: The aim of this study is to provide a snapshot analysis of the major drugs used in a cohort of 1562 Pakistani patients during the period from May to July 2020, when the first wave of COVID-19 peaked in Pakistan. Methods: A retrospective observational study was performed to provide an overview of the major drugs used in a cohort of 1562 patients with COVID-19 admitted to the four major tertiary-care hospitals in the Rawalpindi-Islamabad region of Pakistan during the peak of the first wave of COVID-19 in the country (May-July 2020). Results: Antibiotics were the most common choice out of all the therapies employed, and they were used as first line of treatment for COVID-19. Azithromycin was the most prescribed drug for treatment. No monthly trend was observed in the choice of antibiotics, and these drugs appeared to be a random but favored choice throughout the months of the study. It was also noted that even antibiotics used for multidrug resistant infections were prescribed irrespective of the severity or progression of the infection. The results of the analysis are alarming, as this approach may lead to antibiotic resistance and complications in immunocompromised patients with COVID-19. A total of 1562 patients (1064 male, 68.1%, and 498 female, 31.9%) with a mean age of 47.35 years (SD 17.03) were included in the study. The highest frequency of patient hospitalizations occurred in June (846/1562, 54.2%). Conclusions: Guidelines for a targeted treatment regime are needed to control related complications and to limit the misuse of antibiotics in the management of COVID-19. %M 33945498 %R 10.2196/28594 %U https://publichealth.jmir.org/2021/5/e28594 %U https://doi.org/10.2196/28594 %U http://www.ncbi.nlm.nih.gov/pubmed/33945498 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 5 %P e23461 %T Digital Phenotypes for Understanding Individuals' Compliance With COVID-19 Policies and Personalized Nudges: Longitudinal Observational Study %A Ibrahim,Ahmed %A Zhang,Heng %A Clinch,Sarah %A Poliakoff,Ellen %A Parsia,Bijan %A Harper,Simon %+ Department of Computer Science, The University of Manchester, LF7, Kilburn Building, Kilburn Buidling, Manchester, M13 9PL, United Kingdom, 44 7427630668, heng.zhang@manchester.ac.uk %K behavior %K compliance %K COVID-19 %K digital phenotyping %K nudges %K personalization %K policy %K sensor %K smartphone %D 2021 %7 27.5.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Governments promote behavioral policies such as social distancing and phased reopening to control the spread of COVID-19. Digital phenotyping helps promote the compliance with these policies through the personalized behavioral knowledge it produces. Objective: This study investigated the value of smartphone-derived digital phenotypes in (1) analyzing individuals’ compliance with COVID-19 policies through behavioral responses and (2) suggesting ways to personalize communication through those policies. Methods: We conducted longitudinal experiments that started before the outbreak of COVID-19 and continued during the pandemic. A total of 16 participants were recruited before the pandemic, and a smartphone sensing app was installed for each of them. We then assessed individual compliance with COVID-19 policies and their impact on habitual behaviors. Results: Our results show a significant change in people’s mobility (P<.001) as a result of COVID-19 regulations, from an average of 10 visited places every week to approximately 2 places a week. We also discussed our results within the context of nudges used by the National Health Service in the United Kingdom to promote COVID-19 regulations. Conclusions: Our findings show that digital phenotyping has substantial value in understanding people’s behavior during a pandemic. Behavioral features extracted from digital phenotypes can facilitate the personalization of and compliance with behavioral policies. A rule-based messaging system can be implemented to deliver nudges on the basis of digital phenotyping. %M 33999832 %R 10.2196/23461 %U https://formative.jmir.org/2021/5/e23461 %U https://doi.org/10.2196/23461 %U http://www.ncbi.nlm.nih.gov/pubmed/33999832 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 5 %P e26372 %T The Influence of the COVID-19 Epidemic on Prevention and Vaccination Behaviors Among Chinese Children and Adolescents: Cross-sectional Online Survey Study %A Hou,Zhiyuan %A Song,Suhang %A Du,Fanxing %A Shi,Lu %A Zhang,Donglan %A Lin,Leesa %A Yu,Hongjie %+ School of Public Health, Fudan University, Mailbox 250, 138# Yixueyuan Road, Xuhui District, Shanghai, 200030, China, 86 2133563935, zyhou@fudan.edu.cn %K COVID-19 %K prevention %K vaccination %K behavior %K children %K China %D 2021 %7 26.5.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The COVID-19 epidemic and the related containment strategies may affect parental and pediatric health behaviors. Objective: The goal of this study was to assess the change in children’s and adolescents’ prevention and vaccination behaviors amid China’s COVID-19 epidemic. Methods: We conducted a cross-sectional online survey in mid-March 2020 using proportional quota sampling in Wuhan (the epidemic epicenter) and Shanghai (a nonepicenter). Data were collected from 1655 parents with children aged 3 to 17 years. Children’s and adolescents’ prevention behaviors and regular vaccination behaviors before and during the epidemic were assessed. Descriptive analyses were used to investigate respondents’ characteristics, public health prevention behaviors, unproven protection behaviors, and vaccination behaviors before and during the COVID-19 epidemic. Univariate analyses were performed to compare differences in outcome measures between cities and family characteristics, using chi-square tests or Fisher exact tests (if expected frequency was <5) and analyses of variance. Multivariate logistic regressions were used to identify the factors and disparities associated with prevention and vaccination behaviors. Results: Parent-reported prevention behaviors increased among children and adolescents during the COVID-19 epidemic compared with those before the epidemic. During the epidemic, 82.2% (638/776) of children or adolescents always wore masks when going out compared with 31.5% (521/1655) before the epidemic; in addition, 25.0% (414/1655) and 79.8% (1321/1655) had increased their frequency and duration of handwashing, respectively, although only 46.9% (776/1655) went out during the epidemic. Meanwhile, 56.1% (928/1655) of the families took unproven remedies against COVID-19. Parent-reported vaccination behaviors showed mixed results, with 74.8% (468/626) delaying scheduled vaccinations and 80.9% (1339/1655) planning to have their children get the influenza vaccination after the epidemic. Regarding socioeconomic status, children and adolescents from larger families and whose parents had lower education levels were less likely to improve prevention behaviors but more likely to take unproven remedies. Girls were less likely than boys to always wear a mask when going out and wash their hands. Conclusions: Prevention behaviors and attitudes toward influenza vaccination have improved during the COVID-19 epidemic. Public health prevention measures should be continuously promoted, particularly among girls, parents with lower education levels, and larger families. Meanwhile, misinformation about COVID-19 remains a serious challenge and needs to be addressed by public health stakeholders. %M 33882450 %R 10.2196/26372 %U https://publichealth.jmir.org/2021/5/e26372 %U https://doi.org/10.2196/26372 %U http://www.ncbi.nlm.nih.gov/pubmed/33882450 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 5 %P e29405 %T Authors’ Reply to: Minimizing Selection and Classification Biases Comment on “Clinical Characteristics and Prognostic Factors for Intensive Care Unit Admission of Patients With COVID-19: Retrospective Study Using Machine Learning and Natural Language Processing” %A Izquierdo,Jose Luis %A Soriano,Joan B %+ Hospital Universitario de La Princesa, Diego de Leon 62, Servicio de Neumología, Madrid, 28006, Spain, jbsoriano2@gmail.com %K artificial intelligence %K big data %K COVID-19 %K electronic health records %K tachypnea %K SARS-CoV-2 %K predictive model %K prognosis %K classification bias %K critical care %D 2021 %7 26.5.2021 %9 Letter to the Editor %J J Med Internet Res %G English %X %M 33989164 %R 10.2196/29405 %U https://www.jmir.org/2021/5/e29405 %U https://doi.org/10.2196/29405 %U http://www.ncbi.nlm.nih.gov/pubmed/33989164 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 5 %P e27142 %T Minimizing Selection and Classification Biases. Comment on “Clinical Characteristics and Prognostic Factors for Intensive Care Unit Admission of Patients With COVID-19: Retrospective Study Using Machine Learning and Natural Language Processing” %A Martos Pérez,Francisco %A Gomez Huelgas,Ricardo %A Martín Escalante,María Dolores %A Casas Rojo,José Manuel %+ Department of Internal Medicine, Hospital Costa del Sol, Autovía A-7, Km 187, Marbella, 29603, Spain, 34 658927715, pacomartos1@gmail.com %K artificial intelligence %K big data %K COVID-19 %K electronic health records %K tachypnea %K SARS-CoV-2 %K predictive model %K prognosis %K classification bias %K critical care %D 2021 %7 26.5.2021 %9 Letter to the Editor %J J Med Internet Res %G English %X %M 33989163 %R 10.2196/27142 %U https://www.jmir.org/2021/5/e27142 %U https://doi.org/10.2196/27142 %U http://www.ncbi.nlm.nih.gov/pubmed/33989163 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 5 %P e27473 %T Digitalizing a Brief Intervention to Reduce Intrusive Memories of Psychological Trauma for Health Care Staff Working During COVID-19: Exploratory Pilot Study With Nurses %A Singh,Laura %A Kanstrup,Marie %A Depa,Katherine %A Falk,Ann-Charlotte %A Lindström,Veronica %A Dahl,Oili %A Göransson,Katarina E %A Rudman,Ann %A Holmes,Emily A %+ Department of Psychology, Uppsala University, Box 1225, Uppsala, 75142, Sweden, 46 018 471 2118, laura.singh@psyk.uu.se %K intrusive memories %K psychological trauma %K prevention %K pilot trial %K COVID-19 %K digital intervention %K remote delivery %K cognitive science %K person-based approach %K mixed methods %K co-design %K health care staff %D 2021 %7 26.5.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic has accelerated the worldwide need for simple remotely delivered (digital) scalable interventions that can also be used preventatively to protect the mental health of health care staff exposed to psychologically traumatic events during their COVID-19–related work. We have developed a brief behavioral intervention that aims to reduce the number of intrusive memories of traumatic events but has only been delivered face-to-face so far. After digitalizing the intervention materials, the intervention was delivered digitally to target users (health care staff) for the first time. The adaption for staff’s working context in a hospital setting used a co-design approach. Objective: The aims of this mixed method exploratory pilot study with health care staff who experienced working in the pandemic were to pilot the intervention that we have digitalized (for remote delivery and with remote support) and adapted for this target population (health care staff working clinically during a pandemic) to explore its ability to reduce the number of intrusive memories of traumatic events and improve related symptoms (eg, posttraumatic stress) and participant’s perception of their functioning, and to explore the feasibility and acceptability of both the digitalized intervention and digitalized data collection. Methods: We worked closely with target users with lived experience of working clinically during the COVID-19 pandemic in a hospital context (registered nurses who experienced intrusive memories from traumatic events at work; N=3). We used a mixed method design and exploratory quantitative and qualitative analysis. Results: After completing the digitalized intervention once with remote researcher support (approximately 25 minutes) and a brief follow-up check-in, participants learned to use the intervention independently. All 3 participants reported zero intrusive memories during week 5 (primary outcome: 100% digital data capture). Prior to study inclusion, two or more intrusions in the week were reported preintervention (assessed retrospectively). There was a general pattern of symptom reduction and improvement in perceived functioning (eg, concentration) at follow-up. The digitalized intervention and data collection were perceived as feasible and rated as acceptable (eg, all 3 participants would recommend it to a colleague). Participants were positive toward the digital intervention as a useful tool that could readily be incorporated into work life and repeated in the face of ongoing or repeated trauma exposure. Conclusions: The intervention when delivered remotely and adapted for this population during the pandemic was well received by participants. Since it could be tailored around work and daily life and used preventatively, the intervention may hold promise for health care staff pending future evaluations of efficacy. Limitations include the small sample size, lack of daily intrusion frequency data in the week before the intervention, and lack of a control condition. Following this co-design process in adapting and improving intervention delivery and evaluation, the next step is to investigate the efficacy of the digitalized intervention in a randomized controlled trial. %M 33886490 %R 10.2196/27473 %U https://formative.jmir.org/2021/5/e27473 %U https://doi.org/10.2196/27473 %U http://www.ncbi.nlm.nih.gov/pubmed/33886490 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 5 %P e26630 %T Authors’ Reply to: And Justice for All? There Is More to the Interoperability of Contact Tracing Apps Than Legal Barriers. Comment on “COVID-19 Contact Tracing Apps: A Technologic Tower of Babel and the Gap for International Pandemic Control” %A Du,Li %A Raposo,Vera Lúcia %A Wang,Meng %+ Faculty of Law, University of Macau, Avenida da Universidade, Taipa, Macau, 999078, China, 853 88224733, stephendu@um.edu.mo %K COVID-19 %K contact tracing %K data protection %K privacy %K interoperability %K global health %K public health %D 2021 %7 26.5.2021 %9 Letter to the Editor %J JMIR Mhealth Uhealth %G English %X %M 33852409 %R 10.2196/26630 %U https://mhealth.jmir.org/2021/5/e26630 %U https://doi.org/10.2196/26630 %U http://www.ncbi.nlm.nih.gov/pubmed/33852409 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 5 %P e26218 %T And Justice for All? There Is More to the Interoperability of Contact Tracing Apps Than Legal Barriers. Comment on “COVID-19 Contact Tracing Apps: A Technologic Tower of Babel and the Gap for International Pandemic Control” %A Crutzen,Rik %+ Department of Health Promotion, Care and Public Health Research Institute, Maastricht University, PO Box 616, Maastricht, 6200 MD, Netherlands, 31 433882828, rik.crutzen@maastrichtuniversity.nl %K COVID-19 %K contact tracing %K data protection %K privacy %K interoperability %K global health %K public health %D 2021 %7 26.5.2021 %9 Letter to the Editor %J JMIR Mhealth Uhealth %G English %X %M 33848974 %R 10.2196/26218 %U https://mhealth.jmir.org/2021/5/e26218 %U https://doi.org/10.2196/26218 %U http://www.ncbi.nlm.nih.gov/pubmed/33848974 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 5 %P e27271 %T Personalized Analytics and a Wearable Biosensor Platform for Early Detection of COVID-19 Decompensation (DeCODe): Protocol for the Development of the COVID-19 Decompensation Index %A Larimer,Karen %A Wegerich,Stephan %A Splan,Joel %A Chestek,David %A Prendergast,Heather %A Vanden Hoek,Terry %+ physIQ, Inc, 200 W Jackson Street Suite 550, Chicago, IL, 60606, United States, 1 7736126205, karen.larimer@physiq.com %K analytic %K artificial intelligence %K biomarker %K cloud %K COVID-19 %K decompensation %K detection %K development %K index %K monitoring %K outcome %K remote monitoring %K symptom validation %K wearable %D 2021 %7 26.5.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: During the COVID-19 pandemic, novel digital health technologies have the potential to improve our understanding of SARS-CoV-2 and COVID-19, improve care delivery, and produce better health outcomes. The National Institutes of Health called on digital health leaders to contribute to a high-quality data repository that will support researchers to make discoveries that are otherwise not possible with small, limited data sets. Objective: To this end, we seek to develop a COVID-19 digital biomarker for early detection of physiological exacerbation or decompensation. We propose the development and validation of a COVID-19 decompensation Index (CDI) in a 2-phase study that builds on existing wearable biosensor-derived analytics generated by physIQ’s end-to-end cloud platform for continuous physiological monitoring with wearable biosensors. This effort serves to achieve two primary objectives: (1) to collect adequate data to help develop the CDI and (2) to collect rich deidentified clinical data correlating with outcomes and symptoms related to COVID-19 progression. Our secondary objectives include evaluation of the feasibility and usability of pinpointIQ, a digital platform through which data are gathered, analyzed, and displayed. Methods: This is a prospective, nonrandomized, open-label, 2-phase study. Phase I will involve data collection for the digital data hub of the National Institutes of Health as well as data to support the preliminary development of the CDI. Phase II will involve data collection for the hub and contribute to continued refinement and validation of the CDI. While this study will focus on the development of a CDI, the digital platform will also be evaluated for feasibility and usability while clinicians deliver care to continuously monitored patients enrolled in the study. Results: Our target CDI will be a binary classifier trained to distinguish participants with and those without decompensation. The primary performance metric for CDI will be the area under the receiver operating characteristic curve with a minimum performance criterion of ≥0.75 (α=.05; power [1–β]=0.80). Furthermore, we will determine the sex or gender and race or ethnicity of the participants, which would account for differences in the CDI performance, as well as the lead time—time to predict decompensation—and its relationship with the ultimate disease severity based on the World Health Organization COVID-19 ordinal scale. Conclusions: Using machine learning techniques on a large data set of patients with COVID-19 could provide valuable insights into the pathophysiology of COVID-19 and a digital biomarker for COVID-19 decompensation. Through this study, we intend to develop a tool that can uniquely reflect physiological data of a diverse population and contribute to high-quality data that will help researchers better understand COVID-19. Trial Registration: ClinicalTrials.gov NCT04575532; https://www.clinicaltrials.gov/ct2/show/NCT04575532 International Registered Report Identifier (IRRID): DERR1-10.2196/27271 %M 33949966 %R 10.2196/27271 %U https://www.researchprotocols.org/2021/5/e27271 %U https://doi.org/10.2196/27271 %U http://www.ncbi.nlm.nih.gov/pubmed/33949966 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 5 %P e25556 %T COVID-19 Rehabilitation With Herbal Medicine and Cardiorespiratory Exercise: Protocol for a Clinical Study %A Gao,Yang %A Zhong,Linda L D %A Quach,Binh %A Davies,Bruce %A Ash,Garrett I %A Lin,Zhi-Xiu %A Feng,Yibin %A Lau,Benson W M %A Wagner,Peter D %A Yang,Xian %A Guo,Yike %A Jia,Wei %A Bian,Zhaoxiang %A Baker,Julien S %+ Centre for Health and Exercise Science Research, Hong Kong Baptist University, Room AAB 926, 9/F, Academic and Administration Building, Baptist University Road Campus, Kowloon, Hong Kong, 852 34118032, jsbaker@hkbu.edu.hk %K COVID-19 %K rehabilitation %K cardiorespiratory exercise %K Chinese medicine %D 2021 %7 26.5.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Recent studies have revealed that many discharged patients with COVID-19 experience ongoing symptoms months later. Rehabilitation interventions can help address the consequences of COVID-19, including medical, physical, cognitive, and psychological problems. To our knowledge, no studies have investigated the effects of rehabilitation following discharge from hospital for patients with COVID-19. Objective: The specific aims of this project are to investigate the effects of a 12-week exercise program on pulmonary fibrosis in patients recovering from COVID-19. A further aim will be to examine how Chinese herbal medicines as well as the gut microbiome and its metabolites regulate immune function and possibly autoimmune deficiency in the rehabilitation process. Methods: In this triple-blinded, randomized, parallel-group, controlled clinical trial, we will recruit adult patients with COVID-19 who have been discharged from hospital in Hong Kong and are experiencing impaired lung function and pulmonary function. A total of 172 eligible patients will be randomized into four equal groups: (1) cardiorespiratory exercise plus Chinese herbal medicines group, (2) cardiorespiratory exercise only group, (3) Chinese herbal medicines only group, and (4) waiting list group (in which participants will receive Chinese herbal medicines after 24 weeks). These treatments will be administered for 12 weeks, with a 12-week follow-up period. Primary outcomes include dyspnea, fatigue, lung function, pulmonary function, blood oxygen levels, immune function, blood coagulation, and related blood biochemistry. Measurements will be recorded prior to initiating the above treatments and repeated at the 13th and 25th weeks of the study. The primary analysis is aimed at comparing the outcomes between groups throughout the study period with an α level of .05 (two-tailed). Results: The trial has been approved by the university ethics committee following the Declaration of Helsinki (approval number: REC/19-20/0504) in 2020. The trial has been recruiting patients. The data collection will be completed in 24 months, from January 1, 2021, to December 31, 2022. Conclusions: Given that COVID-19 and its sequelae would persist in human populations, important findings from this study would provide valuable insights into the mechanisms and processes of COVID-19 rehabilitation. Trial Registration: ClinicalTrials.gov NCT04572360; https://clinicaltrials.gov/ct2/show/NCT04572360 International Registered Report Identifier (IRRID): PRR1-10.2196/25556 %M 33970864 %R 10.2196/25556 %U https://www.researchprotocols.org/2021/5/e25556 %U https://doi.org/10.2196/25556 %U http://www.ncbi.nlm.nih.gov/pubmed/33970864 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 5 %P e27059 %T Mining and Validating Social Media Data for COVID-19–Related Human Behaviors Between January and July 2020: Infodemiology Study %A Daughton,Ashlynn R %A Shelley,Courtney D %A Barnard,Martha %A Gerts,Dax %A Watson Ross,Chrysm %A Crooker,Isabel %A Nadiga,Gopal %A Mukundan,Nilesh %A Vaquera Chavez,Nidia Yadira %A Parikh,Nidhi %A Pitts,Travis %A Fairchild,Geoffrey %+ Analytics, Intelligence, and Technology, Los Alamos National Laboratory, P.O. Box 1663, Los Alamos, NM, 87545, United States, 1 505 664 0062, adaughton@lanl.gov %K Twitter %K social media %K human behavior %K infectious disease %K COVID-19 %K coronavirus %K infodemiology %K infoveillance %K social distancing %K shelter-in-place %K mobility %K COVID-19 intervention %D 2021 %7 25.5.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Health authorities can minimize the impact of an emergent infectious disease outbreak through effective and timely risk communication, which can build trust and adherence to subsequent behavioral messaging. Monitoring the psychological impacts of an outbreak, as well as public adherence to such messaging, is also important for minimizing long-term effects of an outbreak. Objective: We used social media data from Twitter to identify human behaviors relevant to COVID-19 transmission, as well as the perceived impacts of COVID-19 on individuals, as a first step toward real-time monitoring of public perceptions to inform public health communications. Methods: We developed a coding schema for 6 categories and 11 subcategories, which included both a wide number of behaviors as well codes focused on the impacts of the pandemic (eg, economic and mental health impacts). We used this to develop training data and develop supervised learning classifiers for classes with sufficient labels. Classifiers that performed adequately were applied to our remaining corpus, and temporal and geospatial trends were assessed. We compared the classified patterns to ground truth mobility data and actual COVID-19 confirmed cases to assess the signal achieved here. Results: We applied our labeling schema to approximately 7200 tweets. The worst-performing classifiers had F1 scores of only 0.18 to 0.28 when trying to identify tweets about monitoring symptoms and testing. Classifiers about social distancing, however, were much stronger, with F1 scores of 0.64 to 0.66. We applied the social distancing classifiers to over 228 million tweets. We showed temporal patterns consistent with real-world events, and we showed correlations of up to –0.5 between social distancing signals on Twitter and ground truth mobility throughout the United States. Conclusions: Behaviors discussed on Twitter are exceptionally varied. Twitter can provide useful information for parameterizing models that incorporate human behavior, as well as for informing public health communication strategies by describing awareness of and compliance with suggested behaviors. %M 33882015 %R 10.2196/27059 %U https://www.jmir.org/2021/5/e27059 %U https://doi.org/10.2196/27059 %U http://www.ncbi.nlm.nih.gov/pubmed/33882015 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 5 %P e27108 %T Transitioning to Web-Based Learning in Basic Life Support Training During the COVID-19 Pandemic to Battle the Fear of Out-of-Hospital Cardiac Arrest: Presentation of Novel Methods %A Naylor,Katarzyna %A Torres,Kamil %+ Department of Didactics and Medical Simulation, Medical University of Lublin, Chodźki 6, Lublin, 20-093, Poland, 48 814485922, katarzynanaylor@umlub.pl %K COVID-19 %K web-based training %K basic life support %K formative assessment %K out-of-hospital cardiac arrest %K web-based learning %K web-based education %K first aid %K medical education %K life support %K transition %K outcome %K formative %D 2021 %7 25.5.2021 %9 Viewpoint %J J Med Internet Res %G English %X Ongoing training in the area of basic life support aims to encourage and sustain the willingness to act in out-of-hospital cardiac arrest situations among first aiders. The contribution of witnesses and first aiders has diminished rapidly, as suspicion associated with the COVID-19 pandemic has risen. In this paper, we present teaching methods from the medical education field to create a new teaching-learning process for sustaining the prehospital involvement of first aiders and encourage new first aiders. The most important benefit—improving outcomes—can be achieved by introducing a variety of teaching-learning methods and formative assessments that provide participants with immediate feedback to help them move forward in the basic life support course. The new reality of web-based learning that has been introduced by the pandemic requires an innovative approach to traditional training that involves techniques and methods that have been proven to be useful in other fields. %M 33886488 %R 10.2196/27108 %U https://www.jmir.org/2021/5/e27108 %U https://doi.org/10.2196/27108 %U http://www.ncbi.nlm.nih.gov/pubmed/33886488 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 5 %P e22959 %T Artificial Intelligence Can Improve Patient Management at the Time of a Pandemic: The Role of Voice Technology %A Jadczyk,Tomasz %A Wojakowski,Wojciech %A Tendera,Michal %A Henry,Timothy D %A Egnaczyk,Gregory %A Shreenivas,Satya %+ Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Ziolowa 45-47, Katowice, 40-635, Poland, 48 512 099 211, tomasz.jadczyk@gmail.com %K artificial intelligence %K conversational agent %K COVID-19 %K virtual care %K voice assistant %K voice chatbot %D 2021 %7 25.5.2021 %9 Viewpoint %J J Med Internet Res %G English %X Artificial intelligence–driven voice technology deployed on mobile phones and smart speakers has the potential to improve patient management and organizational workflow. Voice chatbots have been already implemented in health care–leveraging innovative telehealth solutions during the COVID-19 pandemic. They allow for automatic acute care triaging and chronic disease management, including remote monitoring, preventive care, patient intake, and referral assistance. This paper focuses on the current clinical needs and applications of artificial intelligence–driven voice chatbots to drive operational effectiveness and improve patient experience and outcomes. %M 33999834 %R 10.2196/22959 %U https://www.jmir.org/2021/5/e22959 %U https://doi.org/10.2196/22959 %U http://www.ncbi.nlm.nih.gov/pubmed/33999834 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 5 %P e26666 %T Characterization of an Open-Access Medical News Platform’s Readership During the COVID-19 Pandemic: Retrospective Observational Study %A Chan,Alex K %A Wu,Constance %A Cheung,Andrew %A Succi,Marc D %+ Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, United States, 1 6179359144, msucci@mgh.harvard.edu %K COVID-19 %K internet %K medical news %K text summaries %K readership trends %K news %K media %K open access %K literature %K web-based health information %K survey %K cross-sectional %K trend %D 2021 %7 25.5.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: There are many alternatives to direct journal access, such as podcasts, blogs, and news sites, that allow physicians and the general public to stay up to date with medical literature. However, there is a scarcity of literature that investigates the readership characteristics of open-access medical news sites and how these characteristics may have shifted during the COVID-19 pandemic. Objective: This study aimed to assess readership and survey data to characterize open-access medical news readership trends related to the COVID-19 pandemic and overall readership trends regarding pandemic-related information delivery. Methods: Anonymous, aggregate readership data were obtained from 2 Minute Medicine, an open-access, physician-run medical news organization that has published over 8000 original, physician-written texts and visual summaries of new medical research since 2013. In this retrospective observational study, the average number of article views, number of actions (defined as the sum of the number of views, shares, and outbound link clicks), read times, and bounce rates (probability of leaving a page in <30 s) were compared between COVID-19 articles published from January 1 to May 31, 2020 (n=40) and non–COVID-19 articles (n=145) published in the same time period. A voluntary survey was also sent to subscribed 2 Minute Medicine readers to further characterize readership demographics and preferences, which were scored on a Likert scale. Results: COVID-19 articles had a significantly higher median number of views than non–COVID-19 articles (296 vs 110; U=748.5; P<.001). There were no significant differences in average read times (P=.12) or bounce rates (P=.12). Non–COVID-19 articles had a higher median number of actions than COVID-19 articles (2.9 vs 2.5; U=2070.5; P=.02). On a Likert scale of 1 (strongly disagree) to 5 (strongly agree), our survey data revealed that 65.5% (78/119) of readers agreed or strongly agreed that they preferred staying up to date with emerging literature about COVID-19 by using sources such as 2 Minute Medicine instead of journals. A greater proportion of survey respondents also indicated that open-access news sources were one of their primary sources for staying informed (86/120, 71.7%) compared to the proportion who preferred direct journal article access (61/120, 50.8%). The proportion of readers indicating they were reading one or less full-length medical studies a month were lower following introduction to 2 Minute Medicine compared to prior (21/120, 17.5% vs 38/120, 31.6%; P=.005). Conclusions: The readership significantly increased for one open-access medical literature platform during the pandemic. This reinforces the idea that open-access, physician-written sources of medical news represent an important alternative to direct journal access for readers who want to stay up to date with medical literature. %M 33866307 %R 10.2196/26666 %U https://www.jmir.org/2021/5/e26666 %U https://doi.org/10.2196/26666 %U http://www.ncbi.nlm.nih.gov/pubmed/33866307 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 5 %P e26109 %T Addressing Biodisaster X Threats With Artificial Intelligence and 6G Technologies: Literature Review and Critical Insights %A Su,Zhaohui %A McDonnell,Dean %A Bentley,Barry L %A He,Jiguang %A Shi,Feng %A Cheshmehzangi,Ali %A Ahmad,Junaid %A Jia,Peng %+ Department of Land Surveying and Geo-Informatics, The Hong Kong Polytechnic University, 181 Chatham Road South, Kowloon, Hong Kong, China, 86 2766 5956, jiapengff@hotmail.com %K 6G %K artificial intelligence %K biodisaster X %K biodisasters %K biosafety %K biosurveillance %K biotechnology %K bioterrorism %K COVID-19 %K disease X %K sixth-generation technologies %D 2021 %7 25.5.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: With advances in science and technology, biotechnology is becoming more accessible to people of all demographics. These advances inevitably hold the promise to improve personal and population well-being and welfare substantially. It is paradoxical that while greater access to biotechnology on a population level has many advantages, it may also increase the likelihood and frequency of biodisasters due to accidental or malicious use. Similar to “Disease X” (describing unknown naturally emerging pathogenic diseases with a pandemic potential), we term this unknown risk from biotechnologies “Biodisaster X.” To date, no studies have examined the potential role of information technologies in preventing and mitigating Biodisaster X. Objective: This study aimed to explore (1) what Biodisaster X might entail and (2) solutions that use artificial intelligence (AI) and emerging 6G technologies to help monitor and manage Biodisaster X threats. Methods: A review of the literature on applying AI and 6G technologies for monitoring and managing biodisasters was conducted on PubMed, using articles published from database inception through to November 16, 2020. Results: Our findings show that Biodisaster X has the potential to upend lives and livelihoods and destroy economies, essentially posing a looming risk for civilizations worldwide. To shed light on Biodisaster X threats, we detailed effective AI and 6G-enabled strategies, ranging from natural language processing to deep learning–based image analysis to address issues ranging from early Biodisaster X detection (eg, identification of suspicious behaviors), remote design and development of pharmaceuticals (eg, treatment development), and public health interventions (eg, reactive shelter-at-home mandate enforcement), as well as disaster recovery (eg, sentiment analysis of social media posts to shed light on the public’s feelings and readiness for recovery building). Conclusions: Biodisaster X is a looming but avoidable catastrophe. Considering the potential human and economic consequences Biodisaster X could cause, actions that can effectively monitor and manage Biodisaster X threats must be taken promptly and proactively. Rather than solely depending on overstretched professional attention of health experts and government officials, it is perhaps more cost-effective and practical to deploy technology-based solutions to prevent and control Biodisaster X threats. This study discusses what Biodisaster X could entail and emphasizes the importance of monitoring and managing Biodisaster X threats by AI techniques and 6G technologies. Future studies could explore how the convergence of AI and 6G systems may further advance the preparedness for high-impact, less likely events beyond Biodisaster X. %M 33961583 %R 10.2196/26109 %U https://www.jmir.org/2021/5/e26109 %U https://doi.org/10.2196/26109 %U http://www.ncbi.nlm.nih.gov/pubmed/33961583 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 5 %P e24623 %T The Differential Effects of Social Media on Depressive Symptoms and Suicidal Ideation Among the Younger and Older Adult Population in Hong Kong During the COVID-19 Pandemic: Population-Based Cross-sectional Survey Study %A Yang,Xue %A Yip,Benjamin H K %A Mak,Arthur D P %A Zhang,Dexing %A Lee,Eric K P %A Wong,Samuel Y S %+ Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, School of Public Health Building, Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, New Territories, Hong Kong, Hong Kong, 852 2252 8488, yeungshanwong@cuhk.edu.hk %K social media %K depression %K suicidal ideation %K social loneliness %K posttraumatic stress %K suicide %K mental health %K COVID-19 %K loneliness %K age %K mediation %D 2021 %7 25.5.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Social media has become a ubiquitous part of daily life during the COVID-19 pandemic isolation. However, the role of social media use in depression and suicidal ideation of the general public remains unclear. Related empirical studies were limited and reported inconsistent findings. Little is known about the potential underlying mechanisms that may illustrate the relationship between social media use and depression and suicidal ideation during the COVID-19 pandemic. Objective: This study tested the mediation effects of social loneliness and posttraumatic stress disorder (PTSD) symptoms on the relationship between social media use and depressive symptoms and suicidal ideation, as well as the moderation effect of age on the mediation models. Methods: We administered a population-based random telephone survey in May and June 2020, when infection control measures were being vigorously implemented in Hong Kong. A total of 1070 adults (658 social media users and 412 nonusers) completed the survey. Structural equation modeling (SEM) and multigroup SEM were conducted to test the mediation and moderation effects. Results: The weighted prevalence of probable depression was 11.6%; 1.6% had suicidal ideation in the past 2 weeks. Both moderated mediation models of depressive symptoms (χ262=335.3; P<.05; comparative fit index [CFI]=0.94; nonnormed fit index [NNFI]=0.92; root mean square error of approximation [RMSEA]=0.06) and suicidal ideation (χ234=50.8; P<.05; CFI=0.99; NNFI=0.99; RMSEA=0.02) showed acceptable model fit. There was a significantly negative direct effect of social media use on depressive symptoms among older people (β=–.07; P=.04) but not among younger people (β=.04; P=.55). The indirect effect via PTSD symptoms was significantly positive among both younger people (β=.09; P=.02) and older people (β=.10; P=.01). The indirect effect via social loneliness was significant among older people (β=–.01; P=.04) but not among younger people (β=.01; P=.31). The direct effect of social media use on suicidal ideation was not statistically significant in either age group (P>.05). The indirect effects via PTSD symptoms were statistically significant among younger people (β=.02; P=.04) and older people (β=.03; P=.01). Social loneliness was not a significant mediator between social media use and suicidal ideation among either age group (P>.05). Conclusions: Social media may be a “double-edged sword” for psychosocial well-being during the COVID-19 pandemic, and its roles vary across age groups. The mediators identified in this study can be addressed by psychological interventions to prevent severe mental health problems during and after the COVID-19 pandemic. %M 33835937 %R 10.2196/24623 %U https://publichealth.jmir.org/2021/5/e24623 %U https://doi.org/10.2196/24623 %U http://www.ncbi.nlm.nih.gov/pubmed/33835937 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 5 %P e29072 %T Predicting Risk of Hospital Admission in Patients With Suspected COVID-19 in a Community Setting: Protocol for Development and Validation of a Multivariate Risk Prediction Tool %A Espinosa-Gonzalez,Ana Belen %A Neves,Ana Luisa %A Fiorentino,Francesca %A Prociuk,Denys %A Husain,Laiba %A Ramtale,Sonny Christian %A Mi,Emma %A Mi,Ella %A Macartney,Jack %A Anand,Sneha N %A Sherlock,Julian %A Saravanakumar,Kavitha %A Mayer,Erik %A de Lusignan,Simon %A Greenhalgh,Trisha %A Delaney,Brendan C %+ Department of Surgery and Cancer, Imperial College London, St Mary's Hospital, Praed St, London, W2 1NY, United Kingdom, 44 747 203 5868, a.espinosa-gonzalez15@imperial.ac.uk %K COVID-19 severity %K risk prediction tool %K early warning score %K hospital admission %K primary care %K electronic health records %D 2021 %7 25.5.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: During the pandemic, remote consultations have become the norm for assessing patients with signs and symptoms of COVID-19 to decrease the risk of transmission. This has intensified the clinical uncertainty already experienced by primary care clinicians when assessing patients with suspected COVID-19 and has prompted the use of risk prediction scores, such as the National Early Warning Score (NEWS2), to assess severity and guide treatment. However, the risk prediction tools available have not been validated in a community setting and are not designed to capture the idiosyncrasies of COVID-19 infection. Objective: The objective of this study is to produce a multivariate risk prediction tool, RECAP-V1 (Remote COVID-19 Assessment in Primary Care), to support primary care clinicians in the identification of those patients with COVID-19 that are at higher risk of deterioration and facilitate the early escalation of their treatment with the aim of improving patient outcomes. Methods: The study follows a prospective cohort observational design, whereby patients presenting in primary care with signs and symptoms suggestive of COVID-19 will be followed and their data linked to hospital outcomes (hospital admission and death). Data collection will be carried out by primary care clinicians in four arms: North West London Clinical Commissioning Groups (NWL CCGs), Oxford-Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC), Covid Clinical Assessment Service (CCAS), and South East London CCGs (Doctaly platform). The study involves the use of an electronic template that incorporates a list of items (known as RECAP-V0) thought to be associated with disease outcome according to previous qualitative work. Data collected will be linked to patient outcomes in highly secure environments. We will then use multivariate logistic regression analyses for model development and validation. Results: Recruitment of participants started in October 2020. Initially, only the NWL CCGs and RCGP RSC arms were active. As of March 24, 2021, we have recruited a combined sample of 3827 participants in these two arms. CCAS and Doctaly joined the study in February 2021, with CCAS starting the recruitment process on March 15, 2021. The first part of the analysis (RECAP-V1 model development) is planned to start in April 2021 using the first half of the NWL CCGs and RCGP RSC combined data set. Posteriorly, the model will be validated with the rest of the NWL CCGs and RCGP RSC data as well as the CCAS and Doctaly data sets. The study was approved by the Research Ethics Committee on May 27, 2020 (Integrated Research Application System number: 283024, Research Ethics Committee reference number: 20/NW/0266) and badged as National Institute of Health Research Urgent Public Health Study on October 14, 2020. Conclusions: We believe the validated RECAP-V1 early warning score will be a valuable tool for the assessment of severity in patients with suspected COVID-19 in the community, either in face-to-face or remote consultations, and will facilitate the timely escalation of treatment with the potential to improve patient outcomes. Trial Registration: ISRCTN registry ISRCTN13953727; https://www.isrctn.com/ISRCTN13953727 International Registered Report Identifier (IRRID): DERR1-10.2196/29072 %M 33939619 %R 10.2196/29072 %U https://www.researchprotocols.org/2021/5/e29072 %U https://doi.org/10.2196/29072 %U http://www.ncbi.nlm.nih.gov/pubmed/33939619 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 5 %P e25016 %T Communication Intervention Using Digital Technology to Facilitate Informed Choices at Childbirth in the Context of the COVID-19 Pandemic: Protocol for a Randomized Controlled Trial %A Diniz,Carmen Simone Grilo %A Franzon,Ana Carolina Arruda %A Fioretti-Foschi,Beatriz %A Niy,Denise Yoshie %A Pedrilio,Livia Sanches %A Amaro Jr,Edson %A Sato,João Ricardo %+ Gender and Evidence on Maternity and Health Study Group, School of Public Health, University of Sao Paulo, Av Dr Arnaldo, 715, Sao Paulo, 01246-904, Brazil, 55 1130617124, denise.niy@gmail.com %K app %K childbirth %K communication %K COVID-19 %K health literacy %K informatics %K internet %K intervention %K maternal health %K neonatal health %K neonate public health %K society %K technology %K women %D 2021 %7 21.5.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: In Brazil and other low- and middle-income countries, excess interventions in childbirth are associated with an increase in preterm and early-term births, contributing to stagnant morbidity and mortality of mothers and neonates. The fact that women often report a negative experience with vaginal childbirth, with physical pain and feelings of unsafety, neglect, or abuse, may explain the high acceptability of elective cesarean sections. The recognition of information needs and of the right to informed choice during childbirth can help change this reality. The internet has been the main source of health information, but its quality is highly variable. Objective: This study aimed to develop and evaluate an information and communication strategy through a smartphone app with respect to childbirth, to facilitate informed choices for access to safer and evidence-based care in the context of the COVID-19 pandemic. Methods: A randomized controlled trial, with 2 arms (intervention and control) and a closed, blind, parallel design, will be conducted with a smartphone app designed for behavior and opinion research in Brazil, with women of reproductive age previously registered on the app. After completing an entry questionnaire to verify the eligibility criteria and obtaining ethical consent, approximately 20,000 participants will be randomly allocated to the intervention and control groups at a 1:1 ratio. Participants allocated to the intervention group will be invited to engage in a digital information and communication strategy, which is designed to expand evidence-based knowledge on the advantages and disadvantages of options for labor and childbirth and the safety of the care processes. The information is based on the guidelines of the Ministry of Health and the World Health Organization for a positive childbirth experience and has been updated to include the new challenges and disruptions in maternity care within the context of the COVID-19 pandemic. The control group will receive information regarding disposable and reusable diapers as a placebo intervention. The groups will be compared in their responses in generating the birth plan and the entry and exit questionnaires, regarding responses less or more aligned with the guidelines for a positive childbirth experience. A qualitative component to map information needs is included. Results: The digital trial started recruiting participants in late October 2020, and data collection has been projected to be complete by December 2020. Conclusions: This study will evaluate an innovative intervention that has the potential to promote better communication between women and providers, such that they can make better choices using an approach suitable for use during the COVID-19 pandemic. Trial Registration: The Brazilian Clinical Trials Registry U1111-1255-8683; http://www.ensaiosclinicos.gov.br/rg/RBR-3g5f9f/ International Registered Report Identifier (IRRID): PRR1-10.2196/25016 %M 33945496 %R 10.2196/25016 %U https://www.researchprotocols.org/2021/5/e25016 %U https://doi.org/10.2196/25016 %U http://www.ncbi.nlm.nih.gov/pubmed/33945496 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 5 %P e27811 %T Willingness to Adopt Health Information Among Social Question-and-Answer Community Users in China: Cross-sectional Survey Study %A Li,PengFei %A Xu,Lin %A Tang,Tingting %A Wu,Xiaoqian %A Huang,Cheng %+ Medical Informatics College, Chongqing Medical University, No 1 Yixueyuan Road, Yuzhong District, Chongqing, China, 86 023 6848 0060, huangcheng@cqmu.edu.cn %K health information adoption %K social question-and-answer community %K structural equation model %K Zhihu %D 2021 %7 21.5.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: COVID-19 has spread around the world and has increased the public’s need for health information in the process. Meanwhile, in the context of lockdowns and other measures for preventing SARS-CoV-2 spread, the internet has surged as a web-based resource for health information. Under these conditions, social question-and-answer communities (SQACs) are playing an increasingly important role in improving public health literacy. There is great theoretical and practical significance in exploring the influencing factors of SQAC users’ willingness to adopt health information. Objective: The aim of this study was to establish an extended unified theory of acceptance and use of technology model that could analyze the influence factors of SQAC users’ willingness to adopt health information. Particularly, we tried to test the moderating effects that different demographic characteristics had on the variables’ influences. Methods: This study was conducted by administering a web-based questionnaire survey and analyzing the responses from a final total of 598 valid questionnaires after invalid data were cleaned. By using structural equation modelling, the influencing factors of SQAC users’ willingness to adopt health information were analyzed. The moderating effects of variables were verified via hierarchical regression. Results: Performance expectation (β=.282; P<.001), social influence (β=.238; P=.02), and facilitating conditions (β=.279; P=.002) positively affected users’ willingness to adopt health information, whereas effort expectancy (P=.79) and perceived risk (P=.41) had no significant effects. Gender had a significant moderating effect in the structural equation model (P<.001). Conclusions: SQAC users’ willingness to adopt health information was evidently affected by multiple factors, such as performance expectation, social influence, and facilitating conditions. The structural equation model proposed in this study has a good fitting degree and good explanatory power for users’ willingness to adopt health information. Suggestions were provided for SQAC operators and health management agencies based on our research results. %M 33970865 %R 10.2196/27811 %U https://www.jmir.org/2021/5/e27811 %U https://doi.org/10.2196/27811 %U http://www.ncbi.nlm.nih.gov/pubmed/33970865 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 5 %P e27818 %T The Impact of the COVID-19 Pandemic on Physical and Mental Health in China and Spain: Cross-sectional Study %A Wang,Cuiyan %A López-Núñez,María Inmaculada %A Pan,Riyu %A Wan,Xiaoyang %A Tan,Yilin %A Xu,Linkang %A Choo,Faith %A Ho,Roger %A Ho,Cyrus %A Aparicio García,Marta E %+ Department of Psychological Medicine, Institute of Health Innovation and Technology, National University of Singapore, Level 9, NUHS Tower Block, 1E Kent Ridge Road, Singapore, 119228, Singapore, 65 97321097, pcmrhcm@nus.edu.sg %K anxiety %K China %K coronavirus %K COVID-19 %K depression %K developing countries %K knowledge %K masks %K pandemic %K physical %K precaution %K psychological impact %K Spain %K stress %D 2021 %7 21.5.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Differences in physical and mental health impact across continents during the COVID-19 pandemic are unknown. Objective: This study compared the levels of impact of COVID-19 on mental health among people from Spain and China and correlated mental health parameters with variables relating to symptoms similar to COVID-19, COVID-19 knowledge, and precautionary measures. Methods: We collected information on demographic data, physical symptoms, contact history with persons with a confirmed COVID-19 diagnosis, COVID-19 knowledge, and precautionary measures. Participants completed the Impact of Event Scale-Revised (IES-R) and the Depression, Anxiety and Stress Scale–21 Items (DASS-21). To analyze the differences in the mental health parameters, the mean scores between Chinese and Spanish respondents were compared using the independent samples t test. The differences in categorical variables between the two samples were analyzed by the chi-square test. Linear regression was used to calculate the univariate associations between the independent variables and mental health parameters for both groups separately, with adjustments made for age, gender, and education. Results: A total of 1528 participants (Spain: n=687; China: n=841) were recruited. The mean age of the Chinese respondents was 24.73 years (SD 7.60; range 18-65 years), and the mean age of the Spanish respondents was 43.06 years (SD 11.95; range 18-76 years). Spanish participants reported significantly more symptoms similar to COVID-19 infection (eg, fever, sore throat, and breathing difficulties), contact history with COVID-19, higher perceived risk of contracting COVID-19, frequent use of medical services, and less confidence in medical services compared with their Chinese counterparts (P<.001). Spanish participants reported significantly higher DASS-21 stress and depression scores, while Chinese participants reported significantly higher IES-R scores (P<.001). Chinese participants encountered more discrimination from other countries (P<.001). Significantly more Chinese participants reported using face masks than Spanish ones (P<.001). More exposure to health information was associated with adverse mental health in Spain (depression: P=.02; anxiety: P=.02; stress: P=.001). Conclusions: Our study found that Spanish respondents reported higher levels of stress and depression as well as more symptoms and use of medical services. In preparation for the next pandemic, Spain needs to establish a prompt policy to implement rapid response and enhance medical services to safeguard physical and mental health. %M 33900933 %R 10.2196/27818 %U https://formative.jmir.org/2021/5/e27818 %U https://doi.org/10.2196/27818 %U http://www.ncbi.nlm.nih.gov/pubmed/33900933 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 5 %P e26543 %T Authors’ Reply to: Screening Tools: Their Intended Audiences and Purposes. Comment on “Diagnostic Accuracy of Web-Based COVID-19 Symptom Checkers: Comparison Study” %A Munsch,Nicolas %A Martin,Alistair %A Gruarin,Stefanie %A Nateqi,Jama %A Abdarahmane,Isselmou %A Weingartner-Ortner,Rafael %A Knapp,Bernhard %+ Data Science Department, Symptoma, Kundmanngasse 21, Vienna, 1030, Austria, 43 662458206, science@symptoma.com %K COVID-19 %K symptom checkers %K benchmark %K digital health %K symptom %K chatbot %K accuracy %D 2021 %7 21.5.2021 %9 Letter to the Editor %J J Med Internet Res %G English %X %M 33989162 %R 10.2196/26543 %U https://www.jmir.org/2021/5/e26543 %U https://doi.org/10.2196/26543 %U http://www.ncbi.nlm.nih.gov/pubmed/33989162 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 5 %P e26148 %T Screening Tools: Their Intended Audiences and Purposes. Comment on “Diagnostic Accuracy of Web-Based COVID-19 Symptom Checkers: Comparison Study” %A Millen,Elizabeth %A Gilsdorf,Andreas %A Fenech,Matthew %A Gilbert,Stephen %+ Ada Health, Karl-Liebknecht-Str 1, Berlin, 10178, Germany, 49 01520713083, elizabeth.millen@ada.com %K COVID-19 %K symptom checkers %K benchmark %K digital health %K symptom %K chatbot %K accuracy %D 2021 %7 21.5.2021 %9 Letter to the Editor %J J Med Internet Res %G English %X %M 33989169 %R 10.2196/26148 %U https://www.jmir.org/2021/5/e26148 %U https://doi.org/10.2196/26148 %U http://www.ncbi.nlm.nih.gov/pubmed/33989169 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 5 %P e29145 %T Authors’ Reply to: Methodological Clarifications and Generalizing From Weibo Data. Comment on “Nature and Diffusion of COVID-19–related Oral Health Information on Chinese Social Media: Analysis of Tweets on Weibo” %A Tao,Zhuo-Ying %A Su,Yu-Xiong %+ Division of Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, 34 Hospital Road, Sai Ying Pun, Hong Kong, Hong Kong (China), 852 2859 0267, richsu@hku.hk %K COVID-19 %K dentistry %K oral health %K dental health %K online health %K social media %K tweet %K Weibo %K China %K health information %D 2021 %7 21.5.2021 %9 Letter to the Editor %J J Med Internet Res %G English %X %M 33989166 %R 10.2196/29145 %U https://www.jmir.org/2021/5/e29145 %U https://doi.org/10.2196/29145 %U http://www.ncbi.nlm.nih.gov/pubmed/33989166 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 5 %P e26255 %T Methodological Clarifications and Generalizing From Weibo Data. Comment on “Nature and Diffusion of COVID-19–related Oral Health Information on Chinese Social Media: Analysis of Tweets on Weibo” %A Yadav,Om Prakash %+ Division of Community Health and Humanities, Memorial University of Newfoundland, 230 Elizabeth Ave, St John's, NL, A1C 5S7, Canada, 1 7097706592, opyadav@mun.ca %K COVID-19 %K dentistry %K oral health %K dental health %K online health %K social media %K tweet %K Weibo %K China %K health information %D 2021 %7 21.5.2021 %9 Letter to the Editor %J J Med Internet Res %G English %X %M 33989161 %R 10.2196/26255 %U https://www.jmir.org/2021/5/e26255 %U https://doi.org/10.2196/26255 %U http://www.ncbi.nlm.nih.gov/pubmed/33989161 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 5 %P e27806 %T A COVID-19 Pandemic Artificial Intelligence–Based System With Deep Learning Forecasting and Automatic Statistical Data Acquisition: Development and Implementation Study %A Yu,Cheng-Sheng %A Chang,Shy-Shin %A Chang,Tzu-Hao %A Wu,Jenny L %A Lin,Yu-Jiun %A Chien,Hsiung-Fei %A Chen,Ray-Jade %+ Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, No.250, Wuxing St.,, Taipei, 11031, Taiwan, 886 227372181 ext 3966, rayjchen@tmu.edu.tw %K COVID-19 %K artificial intelligence %K time series %K deep learning %K machine learning %K statistical analysis %K pandemic %K data visualization %D 2021 %7 20.5.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: More than 79.2 million confirmed COVID-19 cases and 1.7 million deaths were caused by SARS-CoV-2; the disease was named COVID-19 by the World Health Organization. Control of the COVID-19 epidemic has become a crucial issue around the globe, but there are limited studies that investigate the global trend of the COVID-19 pandemic together with each country’s policy measures. Objective: We aimed to develop an online artificial intelligence (AI) system to analyze the dynamic trend of the COVID-19 pandemic, facilitate forecasting and predictive modeling, and produce a heat map visualization of policy measures in 171 countries. Methods: The COVID-19 Pandemic AI System (CPAIS) integrated two data sets: the data set from the Oxford COVID-19 Government Response Tracker from the Blavatnik School of Government, which is maintained by the University of Oxford, and the data set from the COVID-19 Data Repository, which was established by the Johns Hopkins University Center for Systems Science and Engineering. This study utilized four statistical and deep learning techniques for forecasting: autoregressive integrated moving average (ARIMA), feedforward neural network (FNN), multilayer perceptron (MLP) neural network, and long short-term memory (LSTM). With regard to 1-year records (ie, whole time series data), records from the last 14 days served as the validation set to evaluate the performance of the forecast, whereas earlier records served as the training set. Results: A total of 171 countries that featured in both databases were included in the online system. The CPAIS was developed to explore variations, trends, and forecasts related to the COVID-19 pandemic across several counties. For instance, the number of confirmed monthly cases in the United States reached a local peak in July 2020 and another peak of 6,368,591 in December 2020. A dynamic heat map with policy measures depicts changes in COVID-19 measures for each country. A total of 19 measures were embedded within the three sections presented on the website, and only 4 of the 19 measures were continuous measures related to financial support or investment. Deep learning models were used to enable COVID-19 forecasting; the performances of ARIMA, FNN, and the MLP neural network were not stable because their forecast accuracy was only better than LSTM for a few countries. LSTM demonstrated the best forecast accuracy for Canada, as the root mean square error (RMSE), mean absolute error (MAE), and mean absolute percentage error (MAPE) were 2272.551, 1501.248, and 0.2723075, respectively. ARIMA (RMSE=317.53169; MAPE=0.4641688) and FNN (RMSE=181.29894; MAPE=0.2708482) demonstrated better performance for South Korea. Conclusions: The CPAIS collects and summarizes information about the COVID-19 pandemic and offers data visualization and deep learning–based prediction. It might be a useful reference for predicting a serious outbreak or epidemic. Moreover, the system undergoes daily updates and includes the latest information on vaccination, which may change the dynamics of the pandemic. %M 33900932 %R 10.2196/27806 %U https://www.jmir.org/2021/5/e27806 %U https://doi.org/10.2196/27806 %U http://www.ncbi.nlm.nih.gov/pubmed/33900932 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 5 %P e26933 %T Bots and Misinformation Spread on Social Media: Implications for COVID-19 %A Himelein-Wachowiak,McKenzie %A Giorgi,Salvatore %A Devoto,Amanda %A Rahman,Muhammad %A Ungar,Lyle %A Schwartz,H Andrew %A Epstein,David H %A Leggio,Lorenzo %A Curtis,Brenda %+ Intramural Research Program, National Institute on Drug Abuse, 251 Bayview Blvd, Suite 200, Baltimore, MD, 21224, United States, 1 443 740 2126, brenda.curtis@nih.gov %K COVID-19 %K coronavirus %K social media %K bots %K infodemiology %K infoveillance %K social listening %K infodemic %K spambots %K misinformation %K disinformation %K fake news %K online communities %K Twitter %K public health %D 2021 %7 20.5.2021 %9 Viewpoint %J J Med Internet Res %G English %X As of March 2021, the SARS-CoV-2 virus has been responsible for over 115 million cases of COVID-19 worldwide, resulting in over 2.5 million deaths. As the virus spread exponentially, so did its media coverage, resulting in a proliferation of conflicting information on social media platforms—a so-called “infodemic.” In this viewpoint, we survey past literature investigating the role of automated accounts, or “bots,” in spreading such misinformation, drawing connections to the COVID-19 pandemic. We also review strategies used by bots to spread (mis)information and examine the potential origins of bots. We conclude by conducting and presenting a secondary analysis of data sets of known bots in which we find that up to 66% of bots are discussing COVID-19. The proliferation of COVID-19 (mis)information by bots, coupled with human susceptibility to believing and sharing misinformation, may well impact the course of the pandemic. %M 33882014 %R 10.2196/26933 %U https://www.jmir.org/2021/5/e26933 %U https://doi.org/10.2196/26933 %U http://www.ncbi.nlm.nih.gov/pubmed/33882014 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 5 %P e29156 %T Authors' Reply to: COVID-19 as a “Force Majeure” for Non–COVID-19 Clinical and Translational Research. Comment on “Analysis of Scientific Publications During the Early Phase of the COVID-19 Pandemic: Topic Modeling Study” %A Älgå,Andreas %A Eriksson,Oskar %A Nordberg,Martin %+ Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Sjukhusbacken 10, Stockholm, 11883, Sweden, 46 86161000, andreas.alga@ki.se %K COVID-19 %K SARS-CoV-2 %K coronavirus %K pandemic %K topic modeling %K research %K literature %K medical research %K publishing %K force majeure %D 2021 %7 20.5.2021 %9 Letter to the Editor %J J Med Internet Res %G English %X %M 33989170 %R 10.2196/29156 %U https://www.jmir.org/2021/5/e29156 %U https://doi.org/10.2196/29156 %U http://www.ncbi.nlm.nih.gov/pubmed/33989170 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 5 %P e27937 %T COVID-19 as a “Force Majeure” for Non–COVID-19 Clinical and Translational Research. Comment on “Analysis of Scientific Publications During the Early Phase of the COVID-19 Pandemic: Topic Modeling Study” %A Milovanovic,Petar %A Dumic,Igor %+ Faculty of Medicine, University of Belgrade, Dr Subotica 4/2, Belgrade, 11000, 381 66413225, drpmilovanovic@gmail.com %K COVID-19 %K SARS-CoV-2 %K coronavirus %K pandemic %K topic modeling %K research %K literature %K medical research %K publishing %K force majeure %D 2021 %7 20.5.2021 %9 Letter to the Editor %J J Med Internet Res %G English %X %M 33989167 %R 10.2196/27937 %U https://www.jmir.org/2021/5/e27937 %U https://doi.org/10.2196/27937 %U http://www.ncbi.nlm.nih.gov/pubmed/33989167 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 5 %P e26573 %T An App-Based Intervention to Support First Responders and Essential Workers During the COVID-19 Pandemic: Needs Assessment and Mixed Methods Implementation Study %A Vilendrer,Stacie %A Amano,Alexis %A Brown Johnson,Cati G %A Favet,Marissa %A Safaeinili,Nadia %A Villasenor,Jacqueline %A Shaw,Jonathan G %A Hertelendy,Attila J %A Asch,Steven M %A Mahoney,Megan %+ Division of Primary Care and Population Health, Stanford University School of Medicine, 1265 Welch Road, Mail Code 5475, Stanford, CA, 94305, United States, 1 650 736 5211, staciev@stanford.edu %K COVID-19 %K pandemic %K health literacy %K social media %K quality improvement %K police %K emergency responders %K physicians %K disasters %K natural disasters %K health behavior %K literacy %K app %K intervention %K adoption %K accessibility %K usability %K support %K testing %D 2021 %7 20.5.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic has created unprecedented challenges for first responders (eg, police, fire, and emergency medical services) and nonmedical essential workers (eg, workers in food, transportation, and other industries). Health systems may be uniquely suited to support these workers given their medical expertise, and mobile apps can reach local communities despite social distancing requirements. Formal evaluation of real-world mobile app–based interventions is lacking. Objective: We aimed to evaluate the adoption, acceptability, and appropriateness of an academic medical center–sponsored app-based intervention (COVID-19 Guide App) designed to support access of first responders and essential workers to COVID-19 information and testing services. We also sought to better understand the COVID-19–related needs of these workers early in the pandemic. Methods: To understand overall community adoption, views and download data of the COVID-19 Guide App were described. To understand the adoption, appropriateness, and acceptability of the app and the unmet needs of workers, semistructured qualitative interviews were conducted by telephone, by video, and in person with first responders and essential workers in the San Francisco Bay Area who were recruited through purposive, convenience, and snowball sampling. Interview transcripts and field notes were qualitatively analyzed and presented using an implementation outcomes framework. Results: From its launch in April 2020 to September 2020, the app received 8262 views from unique devices and 6640 downloads (80.4% conversion rate, 0.61% adoption rate across the Bay Area). App acceptability was mixed among the 17 first responders interviewed and high among the 10 essential workers interviewed. Select themes included the need for personalized and accurate information, access to testing, and securing personal safety. First responders faced additional challenges related to interprofessional coordination and a “culture of heroism” that could both protect against and exacerbate health vulnerability. Conclusions: First responders and essential workers both reported challenges related to obtaining accurate information, testing services, and other resources. A mobile app intervention has the potential to combat these challenges through the provision of disease-specific information and access to testing services but may be most effective if delivered as part of a larger ecosystem of support. Differentiated interventions that acknowledge and address the divergent needs between first responders and non–first responder essential workers may optimize acceptance and adoption. %M 33878023 %R 10.2196/26573 %U https://www.jmir.org/2021/5/e26573 %U https://doi.org/10.2196/26573 %U http://www.ncbi.nlm.nih.gov/pubmed/33878023 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 5 %P e24742 %T Capturing COVID-19–Like Symptoms at Scale Using Banner Ads on an Online News Platform: Pilot Survey Study %A Dixon,Brian E %A Mukherjee,Sumit %A Wiensch,Ashley %A Gray,Mary L %A Ferres,Juan M Lavista %A Grannis,Shaun J %+ Department of Epidemiology, Richard M Fairbanks School of Public Health, Indiana University, 1050 Wishard Boulevard, Floors 5 and 6, Indianapolis, IN, 46202, United States, 1 317 278 3072, bedixon@regenstrief.org %K COVID-19 %K coronavirus %K epidemiology %K research subject recruitment %K signs and symptoms %D 2021 %7 20.5.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Identifying new COVID-19 cases is challenging. Not every suspected case undergoes testing, because testing kits and other equipment are limited in many parts of the world. Yet populations increasingly use the internet to manage both home and work life during the pandemic, giving researchers mediated connections to millions of people sheltering in place. Objective: The goal of this study was to assess the feasibility of using an online news platform to recruit volunteers willing to report COVID-19–like symptoms and behaviors. Methods: An online epidemiologic survey captured COVID-19–related symptoms and behaviors from individuals recruited through banner ads offered through Microsoft News. Respondents indicated whether they were experiencing symptoms, whether they received COVID-19 testing, and whether they traveled outside of their local area. Results: A total of 87,322 respondents completed the survey across a 3-week span at the end of April 2020, with 54.3% of the responses from the United States and 32.0% from Japan. Of the total respondents, 19,631 (22.3%) reported at least one symptom associated with COVID-19. Nearly two-fifths of these respondents (39.1%) reported more than one COVID-19–like symptom. Individuals who reported being tested for COVID-19 were significantly more likely to report symptoms (47.7% vs 21.5%; P<.001). Symptom reporting rates positively correlated with per capita COVID-19 testing rates (R2=0.26; P<.001). Respondents were geographically diverse, with all states and most ZIP Codes represented. More than half of the respondents from both countries were older than 50 years of age. Conclusions: News platforms can be used to quickly recruit study participants, enabling collection of infectious disease symptoms at scale and with populations that are older than those found through social media platforms. Such platforms could enable epidemiologists and researchers to quickly assess trends in emerging infections potentially before at-risk populations present to clinics and hospitals for testing and/or treatment. %M 33872190 %R 10.2196/24742 %U https://www.jmir.org/2021/5/e24742 %U https://doi.org/10.2196/24742 %U http://www.ncbi.nlm.nih.gov/pubmed/33872190 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 5 %P e23905 %T Telehealth Use by Age and Race at a Single Academic Medical Center During the COVID-19 Pandemic: Retrospective Cohort Study %A Stevens,Jennifer P %A Mechanic,Oren %A Markson,Lawrence %A O'Donoghue,Ashley %A Kimball,Alexa B %+ Center for Healthcare Delivery Science, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA, 02215, United States, 1 6176677165, jpsteven@Bidmc.harvard.edu %K access %K barrier %K cohort %K COVID-19 %K demographic %K equity of care %K equity %K outpatient %K telehealth %D 2021 %7 20.5.2021 %9 Short Paper %J J Med Internet Res %G English %X Background: During the COVID-19 pandemic, many ambulatory clinics transitioned to telehealth, but it remains unknown how this may have exacerbated inequitable access to care. Objective: Given the potential barriers faced by different populations, we investigated whether telehealth use is consistent and equitable across age, race, and gender. Methods: Our retrospective cohort study of outpatient visits was conducted between March 2 and June 10, 2020, compared with the same time period in 2019, at a single academic health center in Boston, Massachusetts. Visits were divided into in-person visits and telehealth visits and then compared by racial designation, gender, and age. Results: At our academic medical center, using a retrospective cohort analysis of ambulatory care delivered between March 2 and June 10, 2020, we found that over half (57.6%) of all visits were telehealth visits, and both Black and White patients accessed telehealth more than Asian patients. Conclusions: Our findings indicate that the rapid implementation of telehealth does not follow prior patterns of health care disparities. %M 33974549 %R 10.2196/23905 %U https://www.jmir.org/2021/5/e23905 %U https://doi.org/10.2196/23905 %U http://www.ncbi.nlm.nih.gov/pubmed/33974549 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 7 %N 2 %P e28733 %T Audiovisual Content for a Radiology Fellowship Selection Process During the COVID-19 Pandemic: Pilot Web-Based Questionnaire Study %A Godoy,Ivan Rodrigues Barros %A Neto,Luís Pecci %A Skaf,Abdalla %A Leão-Filho,Hilton Muniz %A Freddi,Tomás De Andrade Lourenço %A Jasinowodolinski,Dany %A Yamada,André Fukunishi %+ Department of Radiology, Hospital do Coração and Teleimagem, Rua Desembargador Eliseu Guilherme 147, São Paulo, 04004-030, Brazil, 55 11996171704, ivanrbgodoy@gmail.com %K audiovisual reports %K COVID-19 %K fellowship %K radiology %K smartphones %K video recording %K web technology %D 2021 %7 20.5.2021 %9 Original Paper %J JMIR Med Educ %G English %X Background: Traditional radiology fellowships are usually 1- or 2-year clinical training programs in a specific area after completion of a 4-year residency program. Objective: This study aimed to investigate the experience of fellowship applicants in answering radiology questions in an audiovisual format using their own smartphones after answering radiology questions in a traditional printed text format as part of the application process during the COVID-19 pandemic. We hypothesized that fellowship applicants would find that recorded audiovisual radiology content adds value to the conventional selection process, may increase engagement by using their own smartphone device, and facilitate the understanding of imaging findings of radiology-based questions, while maintaining social distancing. Methods: One senior staff radiologist of each subspecialty prepared 4 audiovisual radiology questions for each subspecialty. We conducted a survey using web-based questionnaires for 123 fellowship applications for musculoskeletal (n=39), internal medicine (n=61), and neuroradiology (n=23) programs to evaluate the experience of using audiovisual radiology content as a substitute for the conventional text evaluation. Results: Most of the applicants (n=122, 99%) answered positively (with responses of “agree” or “strongly agree”) that images in digital forms are of superior quality to those printed on paper. In total, 101 (82%) applicants agreed with the statement that the presentation of cases in audiovisual format facilitates the understanding of the findings. Furthermore, 81 (65%) candidates agreed or strongly agreed that answering digital forms is more practical than conventional paper forms. Conclusions: The use of audiovisual content as part of the selection process for radiology fellowships is a new approach to evaluate the potential to enhance the applicant’s experience during this process. This technology also allows for the evaluation of candidates without the need for in-person interaction. Further studies could streamline these methods to minimize work redundancy with traditional text assessments or even evaluate the acceptance of using only audiovisual content on smartphones. %M 33956639 %R 10.2196/28733 %U https://mededu.jmir.org/2021/2/e28733 %U https://doi.org/10.2196/28733 %U http://www.ncbi.nlm.nih.gov/pubmed/33956639 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 5 %P e25446 %T Characterizing Health Care Delays and Interruptions in the United States During the COVID-19 Pandemic: Internet-Based, Cross-sectional Survey Study %A Papautsky,Elizabeth Lerner %A Rice,Dylan R %A Ghoneima,Hana %A McKowen,Anna Laura W %A Anderson,Nicholas %A Wootton,Angie R %A Veldhuis,Cindy %+ Department of Biomedical & Health Information Sciences, College of Applied Health Sciences, University of Illinois at Chicago, 1919 W Taylor St, Chicago, IL, 60612, United States, 1 312 996 0357, elp@uic.edu %K COVID-19 %K health care delays %K internet survey %K preventive care %K delay %K interruption %K lockdown %K precaution %K prevention %K social media %K survey %D 2021 %7 19.5.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic has broader geographic spread and potentially longer lasting effects than those of previous disasters. Necessary preventive precautions for the transmission of COVID-19 has resulted in delays for in-person health care services, especially at the outset of the pandemic. Objective: Among a US sample, we examined the rates of delays (defined as cancellations and postponements) in health care at the outset of the pandemic and characterized the reasons for such delays. Methods: As part of an internet-based survey that was distributed on social media in April 2020, we asked a US–based convenience sample of 2570 participants about delays in their health care resulting from the COVID-19 pandemic. Participant demographics and self-reported worries about general health and the COVID-19 pandemic were explored as potent determinants of health care delays. In addition to all delays, we focused on the following three main types of delays, which were the primary outcomes in this study: dental, preventive, and diagnostic care delays. For each outcome, we used bivariate statistical tests (t tests and chi-square tests) and multiple logistic regression models to determine which factors were associated with health care delays. Results: The top reported barrier to receiving health care was the fear of SARS-CoV-2 infection (126/374, 33.6%). Almost half (1227/2570, 47.7%) of the participants reported experiencing health care delays. Among those who experienced health care delays and further clarified the type of delay they experienced (921/1227, 75.1%), the top three reported types of care that were affected by delays included dental (351/921, 38.1%), preventive (269/921, 29.2%), and diagnostic (151/921, 16.4%) care. The logistic regression models showed that age (P<.001), gender identity (P<.001), education (P=.007), and self-reported worry about general health (P<.001) were significantly associated with experiencing health care delays. Self-reported worry about general health was negatively related to experiencing delays in dental care. However, this predictor was positively associated with delays in diagnostic testing based on the logistic regression model. Additionally, age was positively associated with delays in diagnostic testing. No factors remained significant in the multiple logistic regression for delays in preventive care, and although there was trend between race and delays (people of color experienced fewer delays than White participants), it was not significant (P=.06). Conclusions: The lessons learned from the initial surge of COVID-19 cases can inform systemic mitigation strategies for potential future disruptions. This study addresses the demand side of health care delays by exploring the determinants of such delays. More research on health care delays during the pandemic is needed, including research on their short- and long-term impacts on patient-level outcomes such as mortality, morbidity, mental health, people’s quality of life, and the experience of pain. %M 33886489 %R 10.2196/25446 %U https://www.jmir.org/2021/5/e25446 %U https://doi.org/10.2196/25446 %U http://www.ncbi.nlm.nih.gov/pubmed/33886489 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 5 %P e27331 %T Sleep Disturbances in Frontline Health Care Workers During the COVID-19 Pandemic: Social Media Survey Study %A Stewart,Nancy H %A Koza,Anya %A Dhaon,Serena %A Shoushtari,Christiana %A Martinez,Maylyn %A Arora,Vineet M %+ Department of Medicine, University of Kansas Medical Center, 4000 Cambridge St., Mailstop 3007, Kansas City, KS, 66106, United States, 1 913 588 6045, nstewart5@kumc.edu %K social media %K sleep disorders %K frontline health care workers %K burnout %K insomnia %K sleep %K health care worker %K stress %K survey %K demographic %K outcome %K COVID-19 %D 2021 %7 19.5.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: During the COVID-19 pandemic, health care workers are sharing their challenges, including sleep disturbances, on social media; however, no study has evaluated sleep in predominantly US frontline health care workers during the COVID-19 pandemic. Objective: The aim of this study was to assess sleep among a sample of predominantly US frontline health care workers during the COVID-19 pandemic using validated measures through a survey distributed on social media. Methods: A self-selection survey was distributed on Facebook, Twitter, and Instagram for 16 days (August 31 to September 15, 2020), targeting health care workers who were clinically active during the COVID-19 pandemic. Study participants completed the Pittsburgh Sleep Quality Index (PSQI) and Insomnia Severity Index (ISI), and they reported their demographic and career information. Poor sleep quality was defined as a PSQI score ≥5. Moderate-to-severe insomnia was defined as an ISI score >14. The Mini-Z Burnout Survey was used to measure burnout. Multivariate logistic regression tested associations between demographics, career characteristics, and sleep outcomes. Results: A total of 963 surveys were completed. Participants were predominantly White (894/963, 92.8%), female (707/963, 73.4%), aged 30-49 years (692/963, 71.9%), and physicians (620/963, 64.4%). Mean sleep duration was 6.1 hours (SD 1.2). Nearly 96% (920/963, 95.5%) of participants reported poor sleep (PSQI). One-third (288/963, 30%) reported moderate or severe insomnia. Many participants (554/910, 60.9%) experienced sleep disruptions due to device use or had nightmares at least once per week (420/929, 45.2%). Over 50% (525/932, 56.3%) reported burnout. In multivariable logistic regressions, nonphysician (odds ratio [OR] 2.4, 95% CI 1.7-3.4), caring for patients with COVID-19 (OR 1.8, 95% CI 1.2-2.8), Hispanic ethnicity (OR 2.2, 95% CI 1.4-3.5), female sex (OR 1.6, 95% CI 1.1-2.4), and having a sleep disorder (OR 4.3, 95% CI 2.7-6.9) were associated with increased odds of insomnia. In open-ended comments (n=310), poor sleep was mapped to four categories: children and family, work demands, personal health, and pandemic-related sleep disturbances. Conclusions: During the COVID-19 pandemic, nearly all the frontline health care workers surveyed on social media reported poor sleep, over one-third reported insomnia, and over half reported burnout. Many also reported sleep disruptions due to device use and nightmares. Sleep interventions for frontline health care workers are urgently needed. %M 33875414 %R 10.2196/27331 %U https://www.jmir.org/2021/5/e27331 %U https://doi.org/10.2196/27331 %U http://www.ncbi.nlm.nih.gov/pubmed/33875414 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 5 %P e26953 %T Tweet Topics and Sentiments Relating to COVID-19 Vaccination Among Australian Twitter Users: Machine Learning Analysis %A Kwok,Stephen Wai Hang %A Vadde,Sai Kumar %A Wang,Guanjin %+ Discipline of Information Technology, Media and Communications, Murdoch University, 90 South St, Perth, 6150, Australia, 61 0893607351, Guanjin.Wang@murdoch.edu.au %K COVID-19 %K vaccination %K public topics %K public sentiments %K Twitter %K infodemiology %K infoveillance %K social listening %K infodemic %K social media %K natural language processing %K machine learning %K latent Dirichlet allocation %D 2021 %7 19.5.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: COVID-19 is one of the greatest threats to human beings in terms of health care, economy, and society in recent history. Up to this moment, there have been no signs of remission, and there is no proven effective cure. Vaccination is the primary biomedical preventive measure against the novel coronavirus. However, public bias or sentiments, as reflected on social media, may have a significant impact on the progression toward achieving herd immunity. Objective: This study aimed to use machine learning methods to extract topics and sentiments relating to COVID-19 vaccination on Twitter. Methods: We collected 31,100 English tweets containing COVID-19 vaccine–related keywords between January and October 2020 from Australian Twitter users. Specifically, we analyzed tweets by visualizing high-frequency word clouds and correlations between word tokens. We built a latent Dirichlet allocation (LDA) topic model to identify commonly discussed topics in a large sample of tweets. We also performed sentiment analysis to understand the overall sentiments and emotions related to COVID-19 vaccination in Australia. Results: Our analysis identified 3 LDA topics: (1) attitudes toward COVID-19 and its vaccination, (2) advocating infection control measures against COVID-19, and (3) misconceptions and complaints about COVID-19 control. Nearly two-thirds of the sentiments of all tweets expressed a positive public opinion about the COVID-19 vaccine; around one-third were negative. Among the 8 basic emotions, trust and anticipation were the two prominent positive emotions observed in the tweets, while fear was the top negative emotion. Conclusions: Our findings indicate that some Twitter users in Australia supported infection control measures against COVID-19 and refuted misinformation. However, those who underestimated the risks and severity of COVID-19 may have rationalized their position on COVID-19 vaccination with conspiracy theories. We also noticed that the level of positive sentiment among the public may not be sufficient to increase vaccination coverage to a level high enough to achieve vaccination-induced herd immunity. Governments should explore public opinion and sentiments toward COVID-19 and COVID-19 vaccination, and implement an effective vaccination promotion scheme in addition to supporting the development and clinical administration of COVID-19 vaccines. %M 33886492 %R 10.2196/26953 %U https://www.jmir.org/2021/5/e26953 %U https://doi.org/10.2196/26953 %U http://www.ncbi.nlm.nih.gov/pubmed/33886492 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 5 %P e25447 %T Utilizing Health Behavior Change and Technology Acceptance Models to Predict the Adoption of COVID-19 Contact Tracing Apps: Cross-sectional Survey Study %A Tomczyk,Samuel %A Barth,Simon %A Schmidt,Silke %A Muehlan,Holger %+ Department Health and Prevention, Institute of Psychology, University of Greifswald, Robert-Blum-Straße 13, Greifswald, , Germany, 49 3834 420 3806, samuel.tomczyk@uni-greifswald.de %K mHealth %K COVID-19 %K UTAUT1 %K UTAUT2 %K health behavior change %K theory of planned behavior %K contact tracing %K app %K model %K technology acceptance %K cross-sectional studies %K social norms %K health communication %K privacy %K anxiety %D 2021 %7 19.5.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: To combat the global COVID-19 pandemic, contact tracing apps have been discussed as digital health solutions to track infection chains and provide appropriate information. However, observational studies point to low acceptance in most countries, and few studies have yet examined theory-based predictors of app use in the general population to guide health communication efforts. Objective: This study utilizes established health behavior change and technology acceptance models to predict adoption intentions and frequency of current app use. Methods: We conducted a cross-sectional online survey between May and July 2020 in a German convenience sample (N=349; mean age 35.62 years; n=226, 65.3% female). To inspect the incremental validity of model constructs as well as additional variables (privacy concerns, personalization), hierarchical regression models were applied, controlling for covariates. Results: The theory of planned behavior and the unified theory of acceptance and use of technology predicted adoption intentions (R2=56%-63%) and frequency of current app use (R2=33%-37%). A combined model only marginally increased the predictive value by about 5%, but lower privacy concerns and higher threat appraisals (ie, anticipatory anxiety) significantly predicted app use when included as additional variables. Moreover, the impact of perceived usefulness was positive for adoption intentions but negative for frequency of current app use. Conclusions: This study identified several theory-based predictors of contact tracing app use. However, few constructs, such as social norms, have a consistent positive effect across models and outcomes. Further research is required to replicate these observations, and to examine the interconnectedness of these constructs and their impact throughout the pandemic. Nevertheless, the findings suggest that promulgating affirmative social norms and positive emotional effects of app use, as well as addressing health concerns, might be promising strategies to foster adoption intentions and app use in the general population. %M 33882016 %R 10.2196/25447 %U https://www.jmir.org/2021/5/e25447 %U https://doi.org/10.2196/25447 %U http://www.ncbi.nlm.nih.gov/pubmed/33882016 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 5 %P e28845 %T The Impact of Inpatient Telemedicine on Personal Protective Equipment Savings During the COVID-19 Pandemic: Cross-sectional Study %A Halabi,Reem %A Smith,Geoffrey %A Sylwestrzak,Marc %A Clay,Brian %A Longhurst,Christopher A %A Lander,Lina %+ Department of Family Medicine, University of California, San Diego, 9500 Gilman Drive MC0606, La Jolla, CA, 92093-0606, United States, 1 8582601917, linalander@health.ucsd.edu %K inpatient telemedicine %K bedside iPad %K video visits %K personal protective equipment %K COVID-19 %K virtual visits %K pandemic %K telehealth %K telemedicine %K digital health %D 2021 %7 19.5.2021 %9 Viewpoint %J J Med Internet Res %G English %X With the emergence of the COVID-19 pandemic and shortage of adequate personal protective equipment (PPE), hospitals implemented inpatient telemedicine measures to ensure operational readiness and a safe working environment for clinicians. The utility and sustainability of inpatient telemedicine initiatives need to be evaluated as the number of COVID-19 inpatients is expected to continue declining. In this viewpoint, we describe the use of a rapidly deployed inpatient telemedicine workflow at a large academic medical center and discuss the potential impact on PPE savings. In early 2020, videoconferencing software was installed on patient bedside iPads at two academic medical center teaching hospitals. An internal website allowed providers to initiate video calls with patients in any patient room with an activated iPad, including both COVID-19 and non–COVID-19 patients. Patients were encouraged to use telemedicine technology to connect with loved ones via native apps or videoconferencing software. We evaluated the use of telemedicine technology on patients’ bedside iPads by monitoring traffic to the internal website. Between May 2020 and March 2021, there were a total of 1240 active users of the Video Visits website (mean 112.7, SD 49.0 connection events per month). Of these, 133 (10.7%) connections were made. Patients initiated 63 (47.4%) video calls with family or friends and sent 37 (27.8%) emails with videoconference connection instructions. Providers initiated a total of 33 (24.8%) video calls with the majority of calls initiated in August (n=22, 67%). There was a low level of adoption of inpatient telemedicine capability by providers and patients. With sufficient availability of PPE, inpatient providers did not find a frequent need to use the bedside telemedicine technology, despite a high census of patients with COVID-19. Compared to providers, patients used videoconferencing capabilities more frequently in September and October 2020. We did not find savings of PPE associated with the use of inpatient telemedicine. %M 33945494 %R 10.2196/28845 %U https://www.jmir.org/2021/5/e28845 %U https://doi.org/10.2196/28845 %U http://www.ncbi.nlm.nih.gov/pubmed/33945494 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 5 %P e24496 %T Experiences and Attitudes of Elementary School Students and Their Parents Toward Online Learning in China During the COVID-19 Pandemic: Questionnaire Study %A Cui,Shu %A Zhang,Chao %A Wang,Shijiang %A Zhang,Xingong %A Wang,Lei %A Zhang,Ling %A Yuan,Qiuyu %A Huang,Cui %A Cheng,Fangshuo %A Zhang,Kai %A Zhou,Xiaoqin %+ Department of Psychiatry, Chaohu Hospital, Anhui Medical University, 64 Chaohu Road, Chaohu, Hefei, China, 86 055182324014, zhouxqlulu@126.com %K attitude %K elementary school students %K parents %K online learning %K COVID-19 %D 2021 %7 19.5.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Due to widespread SARS-CoV-2 infection, an emergency homeschooling plan was rigorously implemented throughout China. Objective: This study aimed to investigate the experiences and attitudes of elementary school students and their parents (two generations from the same family) toward online learning in China during the pandemic. Methods: A 16-item questionnaire was distributed at the 10-day and 40-day marks after the start of the first online course to 867 parent-child pairs and 141 parent-child pairs, respectively. The questionnaire was comprised of questions pertaining to course and homework completeness, effectiveness, reliability, and abundance as well as the students’ enthusiasm for taking part in online classes and their satisfaction with the courses. Results: Our findings indicate that 90.7% (786/867) of students exhibited high or moderate enthusiasm for participating in online classes. However, most students performed poorly in online learning classes and after-school homework. With regard to satisfaction, parents' and students' average scores were 7.35 and 7.25, respectively (10-point scoring system). During the second stage of this study, parents' positive evaluations for online learning declined, including those for the effectiveness and reliability of the courses. Furthermore, the proportion of students who completed the courses and homework on time decreased; this difference proved statistically significant (P=.047). The parents’ and students’ overall satisfaction with online learning also declined during the second stage (parents: 7.21; students: 7.23); however, the difference in overall satisfaction between the two stages was not statistically significant (parents: P=.53; students: P=.60). Several of the parents (315/867, 36.2%) indicated that assisting with and supervising the students’ online learning resulted in increased stress. Further, 36% of parents expressed dissatisfaction with or provided suggestions for online learning; most parents and students hoped to return to face-to-face classes (parents: 823/867, 94.9%; students: 811/867, 93.5%). Finally, our results presented the following six main issues that parents were the most concerned about: (1) disappointment regarding timely interaction in courses; (2) apprehensiveness about students’ understanding of the course; (3) the increased burden of annoying adult responsibilities; (4) concern about children's eyesight; (5) the idea that teachers’ explanations were not detailed enough; and (6) concerns about the decline of students' interest in and attention toward online courses. Conclusions: Online learning can prevent the spread of infectious diseases while still allowing elementary school students to attain knowledge. However, in our study, children’s completion of the courses and homework were not satisfactory. Furthermore, their parents often experienced stress and had many concerns and complaints. Measures such as increasing the interactivity of the courses and prohibiting teachers from assigning tasks to parents could improve the effectiveness of these courses and the mental health of parents and students. %M 33878022 %R 10.2196/24496 %U https://www.jmir.org/2021/5/e24496 %U https://doi.org/10.2196/24496 %U http://www.ncbi.nlm.nih.gov/pubmed/33878022 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 5 %P e27609 %T Notes From the Field: The Combined Effects of Tocilizumab and Remdesivir in a Patient With Severe COVID-19 and Cytokine Release Syndrome %A Ali,Sabahat %A Khalid,Sundas %A Afridi,Maham %A Akhtar,Samar %A Khader,Yousef S %A Akhtar,Hashaam %+ Yusra Institute of Pharmaceutical Sciences, Zaraj Housing Society, Main GT Road, Islamabad, 44000, Pakistan, 92 3215272489, hashaamakhtar@gmail.com %K COVID-19 %K remdesivir %K treatment %K tocilizumab %D 2021 %7 19.5.2021 %9 Notes from the Field %J JMIR Public Health Surveill %G English %X SARS-CoV-2 is known to cause severe bilateral pneumonia and acute respiratory distress syndrome or COVID-19 in patients, which can be debilitating and even fatal. With no drugs or vaccines available yet, a wide range of treatment regimens used are being repurposed. The need of the hour is to analyze various currently available regimens and devise a treatment plan that is most effective for COVID-19. Here we describe the case of a 68-year-old man with hypertension and diabetes, exhibiting symptoms of cough and shortness of breath, who presented at the emergency department of our hospital. Chest computed tomography revealed bilateral ground glass opacities that were indicative of COVID-19, and a computed tomography score of 24 was indicative of severe pulmonary pneumonia. He tested positive for COVID-19. His treatment regimen included the use of convalescent plasma, oxygen therapy, steroids, high-dose antibiotics, broad-spectrum antiviral remdesivir, and anti–interleukin-6 monoclonal antibody (Tocilizumab) at various stages of the disease. Oxygen supplementation was required at the time of admission. The patient initially developed a cytokine release storm, and oxygen supplementation was initiated to manage his condition. Supportive care and multiple treatment regimens were used to successfully recover the patient’s health. With a rapid increase in number of confirmed cases worldwide, COVID-19 has become a major challenge to our health care system. With no available vaccines currently, the establishment of a combination of therapeutic drugs that effectively reduce disease progression is of utmost importance. %M 34009133 %R 10.2196/27609 %U https://publichealth.jmir.org/2021/5/e27609 %U https://doi.org/10.2196/27609 %U http://www.ncbi.nlm.nih.gov/pubmed/34009133 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 5 %P e28517 %T Pakistan’s Response to COVID-19: Overcoming National and International Hypes to Fight the Pandemic %A Akhtar,Hashaam %A Afridi,Maham %A Akhtar,Samar %A Ahmad,Hamaad %A Ali,Sabahat %A Khalid,Sundas %A Awan,Sajid Mahmood %A Jahangiri,Shahzaib %A Khader,Yousef Saleh %+ Yusra Institute of Pharmaceutical Sciences, Yusra Medical and Dental College, Zaraj Housing Society, Opposite DHA Phase 2 Gate III, Main GT Road, Islamabad, 44000, Pakistan, 92 3165163945, hashaamakhtar@gmail.com %K community health %K coronavirus %K COVID-19 %K epidemic %K epidemiology %K Pakistan %K pandemic %K public health emergency of international concern %D 2021 %7 19.5.2021 %9 Viewpoint %J JMIR Public Health Surveill %G English %X The COVID-19 outbreak started as pneumonia in December 2019 in Wuhan, China. The subsequent pandemic was declared as the sixth public health emergency of international concern on January 30, 2020, by the World Health Organization. Pakistan could be a potential hotspot for COVID-19 owing to its high population of 204.65 million and its struggling health care and economic systems. Pakistan was able to tackle the challenge with relatively mild repercussions. The present analysis has been conducted to highlight the situation of the disease in Pakistan in 2020 and the measures taken by various stakeholders coupled with support from the community to abate the risk of catastrophic spread of the virus. %M 33877048 %R 10.2196/28517 %U https://publichealth.jmir.org/2021/5/e28517 %U https://doi.org/10.2196/28517 %U http://www.ncbi.nlm.nih.gov/pubmed/33877048 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 5 %P e27039 %T A Mobile Phone–Based Intervention to Reduce Mental Health Problems in Health Care Workers During the COVID-19 Pandemic (PsyCovidApp): Randomized Controlled Trial %A Fiol-DeRoque,Maria Antònia %A Serrano-Ripoll,Maria Jesús %A Jiménez,Rafael %A Zamanillo-Campos,Rocío %A Yáñez-Juan,Aina María %A Bennasar-Veny,Miquel %A Leiva,Alfonso %A Gervilla,Elena %A García-Buades,M Esther %A García-Toro,Mauro %A Alonso-Coello,Pablo %A Pastor-Moreno,Guadalupe %A Ruiz-Pérez,Isabel %A Sitges,Carolina %A García-Campayo,Javier %A Llobera-Cánaves,Joan %A Ricci-Cabello,Ignacio %+ Health Research Institute of the Balearic Islands, Edificio S, Hospital Universitario Son Espases, Carretera de Valldemossa, Palma de Mallorca, 07120, Spain, 34 +34610753696, mariajesus.serranoripoll@ssib.es %K COVID-19 %K randomized controlled trial %K mental health %K health care workers %K mHealth %K app %D 2021 %7 18.5.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The global health emergency generated by the COVID-19 pandemic is posing an unprecedented challenge to health care workers, who are facing heavy workloads under psychologically difficult situations. Mental mobile Health (mHealth) interventions are now being widely deployed due to their attractive implementation features, despite the lack of evidence about their efficacy in this specific population and context. Objective: The aim of this trial is to evaluate the effectiveness of a psychoeducational, mindfulness-based mHealth intervention to reduce mental health problems in health care workers during the COVID-19 pandemic. Methods: We conducted a blinded, parallel-group, controlled trial in Spain. Health care workers providing face-to-face health care to patients with COVID-19 were randomly assigned (1:1) to receive the PsyCovidApp intervention (an app targeting emotional skills, healthy lifestyle behavior, burnout, and social support) or a control app (general recommendations about mental health care) for 2 weeks. The participants were blinded to their group allocation. Data were collected telephonically at baseline and after 2 weeks by trained health psychologists. The primary outcome was a composite of depression, anxiety, and stress (overall score on the Depression Anxiety Stress Scale-21 [DASS-21]). Secondary outcomes were insomnia (Insomnia Severity Index), burnout (Maslach Burnout Inventory Human Services Survey), posttraumatic stress (Davidson Trauma Scale), self-efficacy (General Self-Efficacy Scale), and DASS-21 individual scale scores. Differences between groups were analyzed using general linear modeling according to an intention-to-treat protocol. Additionally, we measured the usability of the PsyCovidApp (System Usability Scale). The outcome data collectors and trial statisticians were unaware of the treatment allocation. Results: Between May 14 and July 25, 2020, 482 health care workers were recruited and randomly assigned to PsyCovidApp (n=248) or the control app (n=234). At 2 weeks, complete outcome data were available for 436/482 participants (90.5%). No significant differences were observed between the groups at 2 weeks in the primary outcome (standardized mean difference –0.04; 95% CI –0.11 to 0.04; P=.15) or in the other outcomes. In our prespecified subgroup analyses, we observed significant improvements among health care workers consuming psychotropic medications (n=79) in the primary outcome (–0.29; 95% CI –0.48 to –0.09; P=.004), and in posttraumatic stress, insomnia, anxiety, and stress. Similarly, among health care workers receiving psychotherapy (n=43), we observed improvements in the primary outcome (–0.25; 95% CI –0.49 to –0.02; P=.02), and in insomnia, anxiety, and stress. The mean usability score of PsyCovidApp was high (87.21/100, SD 12.65). After the trial, 208/221 participants in the intervention group (94.1%) asked to regain access to PsyCovidApp, indicating high acceptability. Conclusions: In health care workers assisting patients with COVID-19 in Spain, PsyCovidApp, compared with a control app, reduced mental health problems at 2 weeks only among health care workers receiving psychotherapy or psychotropic medications. Trial Registration: ClinicalTrials.gov NCT04393818; https://clinicaltrials.gov/ct2/show/NCT04393818. %M 33909587 %R 10.2196/27039 %U https://mhealth.jmir.org/2021/5/e27039 %U https://doi.org/10.2196/27039 %U http://www.ncbi.nlm.nih.gov/pubmed/33909587 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 4 %N 2 %P e28991 %T Use of the Instagram Hashtags #winemom and #momjuice Among Mothers During the COVID-19 Pandemic: Descriptive, Cross-sectional Study %A Basch,Corey H %A Meleo-Erwin,Zoe C %A Mohlman,Jan %A Fera,Joseph %A Quinones,Nasia %+ Department of Public Health, William Paterson University, 300 Pompton Rd, Wayne, NJ, United States, 1 973 720 2603, baschc@wpunj.edu %K Instagram %K alcohol consumption %K COVID-19 %K social media %K communication %K parenting %D 2021 %7 18.5.2021 %9 Short Paper %J JMIR Pediatr Parent %G English %X Background: The tendency of parents to consume alcohol during the COVID-19 pandemic is likely to be moderated by pandemic-related stress combined with the ongoing demands of childcare and home-based education, which are reported to be more burdensome for females than males. Objective: The purpose of this study was to describe alcohol-related content posted by mothers on Instagram during the COVID-19 pandemic. Methods: Using two popular hashtags, #momjuice and #winemom, 50 Instagram posts on each were collected from the “top posts” tab. The coding categories were created inductively and were as follows: displays alcohol (drinking/holding alcohol or alcohol itself), person is making alcoholic beverages, type of alcohol featured or discussed, highlights anxiety and/or depression/mental state, highlights struggling (in general), highlights parenting challenges, encourages alcohol consumption, discourages alcohol consumption, features a person wearing clothing or shows products promoting alcohol, promotes alcohol rehabilitation, highlights caffeine to alcohol daily transition throughout the day, and highlights other drugs besides caffeine and alcohol. Results: Overall, the 100 selected posts had a total of 5108 comments and 94,671 likes. The respective averages were 51.08 (SD 77.94) and 946.71 (SD 1731.72). A majority (>50%) of the posts reviewed encouraged alcohol consumption (n=66) and/or displayed alcohol (n=56). Of the 66 that encouraged and/or displayed alcohol, the common type of alcohol discussed or featured was wine (n=55). Only 6 posts discouraged alcohol use and only 4 provided the audience with a disclaimer. None of the videos promoted or endorsed alcohol rehabilitation in any way. Only 37 posts highlighted struggle. However, these posts garnered more than a majority of the likes (n=50,034, 52.3%). Posts that showed struggle received an average of 1359.57 (SD 2108.02) likes. Those that did not show struggle had an average of 704.24 (SD 1447.46) likes. An independent one-tailed t test demonstrated this difference to be statistically significant (P=.0499). Conclusions: The findings of this investigation suggest that though these hashtags ostensibly exist to valorize excess alcohol consumption, they may be serving as a support system for mothers who are experiencing increased burdens and role stress during the pandemic. Given the strains placed on mothers overall and especially during the COVID-19 pandemic, efforts must be taken to increase access to and affordability of telehealth-based mental health care. %M 33848257 %R 10.2196/28991 %U https://pediatrics.jmir.org/2021/2/e28991 %U https://doi.org/10.2196/28991 %U http://www.ncbi.nlm.nih.gov/pubmed/33848257 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 5 %P e22431 %T SARS-CoV-2: The Second Wave in Europe %A Fokas,Athanassios S %A Kastis,George A %+ Department of Applied Mathematics and Theoretical Physics, University of Cambridge, Wilberforce Rd, Cambridge, CB3 0WA, United Kingdom, 44 1223 339, tf227@cam.ac.uk %K mathematical modelling of epidemics %K COVID-19 %K SARS CoV-2 %K pandemic %K lockdown in Europe %D 2021 %7 18.5.2021 %9 Viewpoint %J J Med Internet Res %G English %X Although the SARS-CoV-2 virus has already undergone several mutations, the impact of these mutations on its infectivity and virulence remains controversial. In this viewpoint, we present arguments suggesting that SARS-CoV-2 mutants responsible for the second wave have less virulence but much higher infectivity. This suggestion is based on the results of the forecasting and mechanistic models developed by our study group. In particular, in May 2020, the analysis of our mechanistic model predicted that the easing of lockdown measures will lead to a dramatic second wave of the COVID-19 outbreak. However, after the lockdown was lifted in many European countries, the resulting number of reported infected cases and especially the number of deaths remained low for approximately two months. This raised the false hope that a substantial second wave will be avoided and that the COVID-19 epidemic in these European countries was nearing an end. Unfortunately, since the first week of August 2020, the number of reported infected cases increased dramatically. Furthermore, this was accompanied by an increasingly large number of deaths. The rate of reported infected cases in the second wave was much higher than that in the first wave, whereas the rate of deaths was lower. This trend is consistent with higher infectivity and lower virulence. Even if the mutated form of SARS-CoV-2 is less virulent, the very high number of reported infected cases implies that a large number of people will perish. %M 33939621 %R 10.2196/22431 %U https://www.jmir.org/2021/5/e22431 %U https://doi.org/10.2196/22431 %U http://www.ncbi.nlm.nih.gov/pubmed/33939621 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 7 %N 2 %P e27169 %T An Imperative for the National Public Health School in Burkina Faso to Promote the Use of Information and Communication Technologies in Education During the COVID-19 Pandemic: Critical Analysis %A Pilabré,Arzouma Hermann %A Ngangue,Patrice %A Barro,Abibata %A Pafadnam,Yacouba %+ Institut de Formation et de Recherche Interdisciplinaires en Sciences de la Santé et de l’Éducation, 09 BP 311 Ouagadougou 09, Ouagadougou, Burkina Faso, 226 702 709 14, hpilabr@yahoo.com %K Burkina Faso %K teaching %K learning %K ICT %K COVID-19 %K critical analysis %K public health %K online learning %K e-learning %K information and communication technology %K challenge %D 2021 %7 18.5.2021 %9 Viewpoint %J JMIR Med Educ %G English %X Background: Several studies have reported the positive impact of information and communication technologies (ICTs) on academic performance and outcomes. Although some equipment is available, the ICTs for education at the National Public Health School (NPHS) of Burkina Faso have many shortcomings. These shortcomings were clearly revealed during the search for responses to the crisis caused by the COVID-19 pandemic. Indeed, to curb the spread of COVID-19, some measures were taken, such as closure of educational institutions. This resulted in a 2.5-month suspension of educational activities. Despite its willingness, the NPHS was unable to use ICTs to continue teaching during the closure period of educational institutions. Objective: In this paper, we aim to propose practical solutions to promote ICT use in teaching at the NPHS by analyzing the weaknesses and challenges related to its use. Methods: We conducted a critical analysis based on information from the gray literature of NPHS. This critical analysis was preceded by a review of systematic reviews on barriers and facilitating factors to using ICTs in higher education and a systematic review of ICT use during the COVID-19 pandemic in higher education. An ICT integration model and a clustering of ICT integration factors guided the analysis. Results: The weaknesses and challenges identified relate to the infrastructure and equipment for the use of ICTs in pedagogical situations in face-to-face and distance learning; training of actors, namely the teachers and students; availability of qualified resource persons and adequate and specific financial resources; motivation of teachers; and stage of use of ICTs. Conclusions: To promote the use of ICTs in teaching at the NPHS, actions must be performed to strengthen the infrastructure and equipment, human resources, the skills of actors and the motivation of teachers in the pedagogical use of ICTs. %M 33970868 %R 10.2196/27169 %U https://mededu.jmir.org/2021/2/e27169 %U https://doi.org/10.2196/27169 %U http://www.ncbi.nlm.nih.gov/pubmed/33970868 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 5 %P e26431 %T Cognitive Outcomes During COVID-19 Confinement Among Older People and Their Caregivers Using Technologies for Dementia: Protocol for an Observational Cohort Study %A Goodman-Casanova,Jessica Marian %A Dura-Perez,Elena %A Guerrero-Pertiñez,Gloria %A Barnestein-Fonseca,Pilar %A Guzman-Parra,Jose %A Vega-Nuñez,Amanda %A Varela-Moreno,Esperanza %A Cuesta-Vargas,Antonio %A Mayoral-Cleries,Fermin %+ Department of Mental Health, Regional University Hospital of Málaga, Biomedical Research Institute of Malaga (IBIMA), Plaza del Hospital Civil s/n, Málaga, 29009, Spain, 34 660901966, jmariangoodman@gmail.com %K caregiver %K cognition %K cognitive impairment %K cohort %K COVID-19 %K dementia %K older people %K informal caregivers %K information and communications technologies %K isolation %K older adults %K outcome %K quality of life %K social isolation %K stress %K technologies %D 2021 %7 18.5.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: The COVID-19 pandemic has led to worldwide implementation of unprecedented restrictions to control its rapid spread and mitigate its impact. The Spanish government has enforced social distancing, quarantine, and home confinement measures. Such restrictions on activities of daily life and separation from loved ones may lead to social isolation and loneliness with health-related consequences among community-dwelling older adults with mild cognitive impairment or mild dementia and their caregivers. Additionally, inadequate access to health care and social support services may aggravate chronic conditions. Home-based technological interventions have emerged for combating social isolation and loneliness, while simultaneously preventing the risk of virus exposure. Objective: The aim of this cohort study is to explore, analyze, and determine the impact of social isolation on (1) cognition, quality of life, mood, technophilia, and perceived stress among community-dwelling older adults with mild cognitive impairment or mild dementia and on the caregiver burden; (2) access to and utilization of health and social care services; and (3) cognitive, social, and entertainment-related uses of information and communication technologies. Methods: This study will be conducted in Málaga (Andalucía, Spain). In total 200 dyads, consisting of a person with mild cognitive impairment or mild dementia and his/her informal caregiver, will be contacted by telephone. Potential respondents will be participants of the following clinical trials: support, monitoring, and reminder technology for mild dementia (n=100) and television-based assistive integrated service to support European adults living with mild dementia or mild cognitive impairment (n=100). Results: As of May 2021, a total of 153 participants have been enrolled and assessed during COVID-19 confinement, of whom 67 have been assessed at 6 months of enrollment. Changes in the mean values of the variables will be analyzed relative to baseline findings of previous studies with those during and after confinement, using repeated-measures analysis of variance or the nonparametric Friedman test, as appropriate. The performance of multivariate analysis of covariance (ANCOVA) to introduce potential covariates will also be considered. Values of 95% CI will be used. Conclusions: If our hypothesis is accepted, these findings will demonstrate the negative impact of social isolation owing to COVID-19 confinement on cognition, quality of life, mood, and perceived stress among community-dwelling older adults with mild cognitive impairment and mild dementia, the impact on technophilia, caregiver burden, the access to and utilization of health and social care services, and the cognitive, social, and entertainment-related use of information and communication technologies during and after COVID-19 confinement. Trial Registration: ClinicalTrials.gov NCT04385797; https://clinicaltrials.gov/ct2/show/NCT04385797 International Registered Report Identifier (IRRID): DERR1-10.2196/26431 %M 33909588 %R 10.2196/26431 %U https://www.researchprotocols.org/2021/5/e26431 %U https://doi.org/10.2196/26431 %U http://www.ncbi.nlm.nih.gov/pubmed/33909588 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 5 %P e26618 %T Understanding Public Perceptions of COVID-19 Contact Tracing Apps: Artificial Intelligence–Enabled Social Media Analysis %A Cresswell,Kathrin %A Tahir,Ahsen %A Sheikh,Zakariya %A Hussain,Zain %A Domínguez Hernández,Andrés %A Harrison,Ewen %A Williams,Robin %A Sheikh,Aziz %A Hussain,Amir %+ Usher Institute, The University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG, United Kingdom, 44 (0)131 651 4151, kathrin.cresswell@ed.ac.uk %K artificial intelligence %K sentiment analysis %K COVID-19 %K contact tracing %K social media %K perception %K app %K exploratory %K suitability %K AI %K Facebook %K Twitter %K United Kingdom %K sentiment %K attitude %K infodemiology %K infoveillance %D 2021 %7 17.5.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The emergence of SARS-CoV-2 in late 2019 and its subsequent spread worldwide continues to be a global health crisis. Many governments consider contact tracing of citizens through apps installed on mobile phones as a key mechanism to contain the spread of SARS-CoV-2. Objective: In this study, we sought to explore the suitability of artificial intelligence (AI)–enabled social media analyses using Facebook and Twitter to understand public perceptions of COVID-19 contact tracing apps in the United Kingdom. Methods: We extracted and analyzed over 10,000 relevant social media posts across an 8-month period, from March 1 to October 31, 2020. We used an initial filter with COVID-19–related keywords, which were predefined as part of an open Twitter-based COVID-19 dataset. We then applied a second filter using contract tracing app–related keywords and a geographical filter. We developed and utilized a hybrid, rule-based ensemble model, combining state-of-the-art lexicon rule-based and deep learning–based approaches. Results: Overall, we observed 76% positive and 12% negative sentiments, with the majority of negative sentiments reported in the North of England. These sentiments varied over time, likely influenced by ongoing public debates around implementing app-based contact tracing by using a centralized model where data would be shared with the health service, compared with decentralized contact-tracing technology. Conclusions: Variations in sentiments corroborate with ongoing debates surrounding the information governance of health-related information. AI-enabled social media analysis of public attitudes in health care can help facilitate the implementation of effective public health campaigns. %M 33939622 %R 10.2196/26618 %U https://www.jmir.org/2021/5/e26618 %U https://doi.org/10.2196/26618 %U http://www.ncbi.nlm.nih.gov/pubmed/33939622 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 5 %P e24412 %T Factors Influencing Anxiety Among WeChat Users During the Early Stages of the COVID-19 Pandemic in Mainland China: Cross-sectional Survey Study %A Zou,Changqing %A Zhang,Weiyu %A Sznajder,Kristin %A Yang,Fengzhi %A Jia,Yajing %A Ma,Ruqing %A Cui,Can %A Yang,Xiaoshi %+ Department of Social Medicine, School of Public Health, China Medical University, No 77 Puhe Road, Shenyang North New Area, Liaoning Province, Shenyang, 110122, China, 86 18900910796, xsyang@cmu.edu.cn %K anxiety %K COVID-19 %K information seeking behavior %K positive psychological response %K health information %K public health emergency %K mental health %K online survey %K China %K cross-sectional study %D 2021 %7 17.5.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The rapid outbreak of COVID-19 around the world has adversely affected the mental health of the public. The prevalence of anxiety among the public has increased dramatically during the COVID-19 pandemic. However, there are few studies evaluating the effects of positive psychological responses and information-seeking behaviors on anxiety experienced among social media users during the COVID-19 pandemic. Objective: This study evaluated the prevalence of anxiety and its associated factors among WeChat users in mainland China during the early stages of the COVID-19 pandemic. Methods: From February 10 to February 24, 2020, a nationwide, web-based cross-sectional survey study was carried out using convenience sampling. Participants’ levels of anxiety, positive psychological responses, and information-seeking behaviors were assessed. The survey was distributed among WeChat users via the WeChat smartphone platform. Chi-square tests and multivariable logistic regression analyses were performed to examine the factors associated with anxiety. Results: This study found that the prevalence of anxiety (Generalized Anxiety Disorder 7-item [GAD-7] scale score ≥7) among WeChat users in China was 17.96% (446/2483) during the early stages of the COVID-19 pandemic. Results of multivariable logistic regression analysis showed that information-seeking behaviors such as cannot stop searching for information on COVID-19, being concerned about the COVID-19 pandemic, and spending more than 1 hour per day consuming information about the pandemic were found to be associated with increased levels of anxiety. Additionally, participants who chose social media and commercial media as the primary sources to obtain information about the COVID-19 pandemic were found more likely to report anxiety. Conversely, participants who were confident or rational about the COVID-19 pandemic were less likely to report anxiety. Conclusions: This study found that positive psychological responses and information-seeking behaviors were closely associated with anxiety among WeChat users during the COVID-19 pandemic in China. It might be paramount to enhance mental well-being by helping people respond to the COVID-19 pandemic more rationally and positively in order to decrease symptoms of anxiety. %M 33878025 %R 10.2196/24412 %U https://www.jmir.org/2021/5/e24412 %U https://doi.org/10.2196/24412 %U http://www.ncbi.nlm.nih.gov/pubmed/33878025 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 5 %P e25273 %T Changes in Perceptions and Use of Mobile Technology and Health Communication in South Africa During the COVID-19 Lockdown: Cross-sectional Survey Study %A Fischer,Alex Emilio %A Van Tonder,Tanya %A Gumede,Siphamandla B %A Lalla-Edward,Samanta T %+ Ezintsha, Faculty of Health Sciences, University of Witwatersrand, Sunnyside Office Park, 31 Princess of Wales Terrace Parktown, Johannesburg, 2193, South Africa, 27 073 776 2705, fischermHealth@gmail.com %K coronavirus %K SARS-CoV-2 %K COVID-19 %K technology %K mHealth %K app %D 2021 %7 17.5.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: In late March 2020, South Africa implemented a 5-stage COVID-19 Risk Adjusted Strategy, which included a lockdown that required all residents to remain home to prevent the spread of COVID-19. Due to this lockdown, individuals have been forced to find and use alternatives for accomplishing tasks including shopping, socializing, working, and finding information, and many have turned to the internet and their mobile devices. Objective: This study aimed to describe how South Africans consume and internalize information surrounding the COVID-19 outbreak in order to determine whether the COVID-19 lockdown and social isolation have influenced technology behavior, particularly in terms of health communication and information. Methods: From June 24 to August 24, 2020, people in South Africa were invited to complete a survey through the Upinion mobile app, an online data collection resource. The survey collected information on demographics, and technology use during the lockdown, and COVID-19 knowledge. Results: There were 405 participants, of which 296 (73.06%) were female. A total of 320 (79.01%) participants had a tertiary school education, 242 (59.75%) were single, and 173 (42.72%) had full-time employment. The lockdown forced 363 (89.63%) participants to use more technology, especially for work (n=140, 24.05%) and social media/communication (n=133, 22.85%). Security or privacy issues (n=46, 38.98%) and unfamiliarity with technology (n=32, 27.12%) were identified as the most common issues faced by the 127 (31.36%) participants who were unsure about using technology prior to the lockdown. Almost all participants (n=392, 96.79%) stated that they would continue using technology after the lockdown. Multimedia (n=215, 53.09%), mobile phone content (n=99, 24.44%), and health organizations and professionals (n=91, 22.47%) were the main sources of COVID-19 information. Most participants (n=282, 69.63%) felt that they had enough information. Two-thirds (n=275, 67.90%) of participants stated that they had used their mobile phones for health information before the lockdown, with web searches (n=109, 26.91%), social media (n=58, 14.32%), and government and institutional websites (n=52; 12.84%) serving as their main sources of information. Overall, the mean COVID-19 knowledge score was 8.8 (out of 10), and 335 (82.72%) had adequate knowledge (scored ≥8). Males were less likely to identify the correct transmission routes, and single participants were less likely to identify the signs and symptoms of the coronavirus. Tertiary school graduates were 4 times more likely to correctly identify the routes and 2 times more likely to identify how to stop the spread of the virus. People aged 43-56 years were 4 times more likely to identify how the coronavirus can be prevented, and participants ≥57 years were 2.6 times more likely to obtain a knowledge score of 10 when compared to those under 29 years of age. Conclusions: This study has shown that the COVID-19 lockdown has forced people to increase technology use, and people plan to continue using technology after the lockdown is lifted. Increased technology use was seen across a variety of fields; however, barriers including privacy, unfamiliarity, and data costs were identified. This population showed high COVID-19 knowledge, although the use of web searches and social media, instead of government and institutional websites, increases the potential for health misinformation to be spread. %M 33956640 %R 10.2196/25273 %U https://formative.jmir.org/2021/5/e25273 %U https://doi.org/10.2196/25273 %U http://www.ncbi.nlm.nih.gov/pubmed/33956640 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 5 %P e26948 %T Suicide Prevention Among College Students Before and During the COVID-19 Pandemic: Protocol for a Systematic Review and Meta-analysis %A Xiao,Yunyu %A Hinrichs,Rachel %A Johnson,Nina %A McKinley,Amanda %A Carlson,Joan %A Agley,Jon %A Yip,Paul Siu Fai %+ School of Social Work, Indiana University–Purdue University Indianapolis, 902 W New York St, 4F, Education/Social Work Building, ES 4119, Indianapolis, IN, 46202, United States, 1 201 253 7264, yx18@iu.edu %K suicide %K suicidal prevention %K college %K university %K health disparities %K equity %K suicidal ideation %K suicide attempt %K COVID-19 %K college student %K young adult %K disparity %K review %D 2021 %7 17.5.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Suicide is the second leading cause of death for college-aged individuals worldwide and in the United States. Recent studies have identified preliminary evidence of widening disparities in suicidal behaviors across sex, sexual orientation, race/ethnicity, age, and socioeconomic status among college students. Few systematic reviews and meta-analyses offer a comprehensive understanding of on-campus and off-campus suicide interventions, nor is collated information available for different types of screening, assessment, treatment, and postvention plans. Further challenges have been identified since the COVID-19 pandemic, calling for cost-effective and innovative interventions to address increased rates of suicidal behaviors among college students facing unprecedented stressors. Objective: This research protocol describes the first systematic review and meta-analysis to identify the most effective and cost-effective intervention components for universal and targeted (indicated and selected) suicide prevention among college students in a global context. Special attention will be placed on disparities in suicide prevention across sociodemographic subgroups, inclusive interventions beyond campus, global context, and intervention responses to the COVID-19 pandemic. Methods: A sensitive search strategy will be executed across MEDLINE (Ovid), EMBASE, PsycINFO (EBSCO), ERIC (EBSCO), Cochrane Library, Dissertations and Theses Global (ProQuest), Scopus, Global Index Medicus, SciELO, African Journals Online, Global Health (CABI), and Google Scholar. Data extraction and evaluation will be conducted by three independent researchers. Risk of bias will be assessed. A multilevel meta-regression model and subgroup analysis will be used to analyze the data and estimate effect sizes. Results: The initial search was completed in December 2020 and updated with additional other-language studies in March 2020. We expect the results to be submitted for publication in mid-2021. Conclusions: Despite increasing rates of suicidal behaviors among college students, few preventative efforts have targeted this population, and fewer focus on factors that might place specific demographic groups at heightened risk. The impact of COVID-19 on suicidal behaviors among college students highlights and exacerbates the urgent need for rapid and effective interventions that might differ from traditional approaches. This equity-focused study will address these gaps and provide a valuable analysis of the effectiveness of suicide prevention programs and interventions. Findings will inform clinicians, researchers, policy makers, families, and organizations about evidence-based interventions for reducing the gaps in the suicide crisis among college students from different sociodemographic groups. Trial Registration: PROSPERO CRD42020225429; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=225429 International Registered Report Identifier (IRRID): DERR1-10.2196/26948 %M 33878016 %R 10.2196/26948 %U https://www.researchprotocols.org/2021/5/e26948 %U https://doi.org/10.2196/26948 %U http://www.ncbi.nlm.nih.gov/pubmed/33878016 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 5 %P e26883 %T The Efficacy of Computerized Cognitive Behavioral Therapy for Depressive and Anxiety Symptoms in Patients With COVID-19: Randomized Controlled Trial %A Liu,Zhifen %A Qiao,Dan %A Xu,Yifan %A Zhao,Wentao %A Yang,Yang %A Wen,Dan %A Li,Xinrong %A Nie,Xiaoping %A Dong,Yongkang %A Tang,Shiyou %A Jiang,Yi %A Wang,Ying %A Zhao,Juan %A Xu,Yong %+ Department of Psychiatry, The First Hospital of Shanxi Medical University, 85 Jiefang South Street, Yingze District, Taiyuan, 030001, China, 86 351 4639641, xuyongsmu@vip.163.com %K mental health %K depression %K anxiety %K COVID-19 %K treatment %K cCBT %K computerized cognitive behavioral therapy %D 2021 %7 14.5.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The prevalence of depressive and anxiety symptoms in patients with COVID-19 is higher than usual. Previous studies have shown that there are drug-to-drug interactions between antiretroviral drugs and antidepressants. Therefore, an effective and safe treatment method was needed. Cognitive behavioral therapy (CBT) is the first-line psychological therapy in clinical treatment. Computerized CBT (cCBT) was proven to be an effective alternative to CBT and does not require face-to-face therapy between a therapist and the patient, which suited the COVID-19 pandemic response. Objective: This study aims to evaluate the efficacy of the cCBT program we developed in improving depressive and anxiety symptoms among patients with COVID-19. Methods: We customized a cCBT program focused on improving depressive and anxiety symptoms among patients with COVID-19, and then, we assessed its effectiveness. Screening was based on symptoms of depression or anxiety for patients who scored ≥7 on the Hamilton Depression Rating Scale (HAMD17) or the Hamilton Anxiety Scale (HAMA). A total of 252 patients with COVID-19 at five sites were randomized into two groups: cCBT + treatment as usual (TAU; n=126) and TAU without cCBT (n=126). The cCBT + TAU group received the cCBT intervention program for 1 week. The primary efficacy measures were the HAMD17 and HAMA scores. The secondary outcome measures were the Self-Rating Depression Scale (SDS), Self-Rating Anxiety Scale (SAS), and Athens Insomnia Scale (AIS). Assessments were carried out pre- and postintervention. The patients’ symptoms of anxiety and depression in one of the centers were assessed again within 1 month after the postintervention assessment. Results: The cCBT + TAU group displayed a significantly decreased score on the HAMD17, HAMA, SDS, SAS, and AIS after the intervention compared to the TAU group (all P<.001). A mixed-effects repeated measures model revealed significant improvement in symptoms of depression (HAMD17 and SDS scores, both P<.001), anxiety (HAMA and SAS scores, both P<.001), and insomnia (AIS score, P=.002) during the postintervention and follow-up periods in the cCBT + TAU group. Additionally, the improvement of insomnia among females (P=.14) and those with middle school education (P=.48) in the cCBT + TAU group showed no significant differences when compared to the TAU group. Conclusions: The findings of this study suggest that the cCBT program we developed was an effective nonpharmacological treatment for symptoms of anxiety, depression, and insomnia among patients with COVID-19. Further research is warranted to investigate the long-term effects of cCBT for symptoms of anxiety, depression, and insomnia in patients with COVID-19. Trial Registration: Chinese Clinical Trial Registry ChiCTR2000030084; http://www.chictr.org.cn/showprojen.aspx?proj=49952 %M 33900931 %R 10.2196/26883 %U https://www.jmir.org/2021/5/e26883 %U https://doi.org/10.2196/26883 %U http://www.ncbi.nlm.nih.gov/pubmed/33900931 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 7 %N 2 %P e25506 %T Remote Teaching in a Preclinical Phantom Course in Operative Dentistry During the COVID-19 Pandemic: Observational Case Study %A Kanzow,Philipp %A Krantz-Schäfers,Christiane %A Hülsmann,Michael %+ Department of Preventive Dentistry, Periodontology and Cariology, University Medical Center Göttingen, Robert-Koch-Str 40, Göttingen, 37075, Germany, 49 551 3922877, philipp.kanzow@med.uni-goettingen.de %K acceptance %K COVID-19 %K dental education %K distance learning %K effectiveness %K e-learning %K medical education %K medical student %K observational %K screencasts %K preclinical education %K remote teaching %D 2021 %7 14.5.2021 %9 Original Paper %J JMIR Med Educ %G English %X Background: During the acute COVID-19 pandemic, physical access to the University Medical Center Göttingen was restricted for students. For the first time at our dental school, theoretical knowledge was imparted to students via asynchronous online screencasts and discussed via synchronous video meetings only. Objective: We aimed to assess the acceptance and effectiveness of distance education as a new teaching format for theoretical knowledge within the preclinical course in Operative Dentistry (sixth semester of the undergraduate dental curriculum in Germany). Methods: The phantom course comprised distance education (first phase, 11 weeks) and subsequent on-site practical demonstrations and training (second phase, 10 weeks). All theoretical knowledge was taught via online screencasts during distance education (except for the first week, 3 screencasts were uploaded per week resulting in a total of 30 screencasts). Until the end of the term, all students (N=33) were able to view the screencasts for an unlimited number of times. Theoretical knowledge was assessed in a summative examination after practical on-site teaching. Acceptance and effectiveness of the new curriculum and distance education were also measured based on an evaluation survey and students’ self-perceived learning outcome, which was compared to the outcome from the two pre–COVID-19 terms. Results: Each screencast was viewed by a mean of 24 (SD 3.3) students and accessed a mean of 5.6 (SD 1.2) times per user (ie, by students who accessed the respective screencast at least once). During distance education, the number of accesses showed a linear trend over time. During the practical training phase, screencast views declined and increased again prior to the examination. Screencasts covering topics in Cariology, Restorative Dentistry, and Preventive Dentistry were viewed by more students than screencasts covering topics in Endodontology or Periodontology (both P=.047). Examination items in Periodontology showed inferior results compared to the other topics (P<.001). Within the different topics, students’ self-perceived learning outcome did not differ from that during the pre–COVID-19 terms. Although most students agreed that the presented screencasts contributed to their learning outcome, pre–COVID-19 term students more strongly felt that lectures significantly contributed to their learning outcome (P=.03). Conclusions: Screencasts showed high acceptance and effectiveness among the students but were not used as a learning tool by all students. However, students who viewed the screencasts accessed each screencast more frequently than they could have attended a conventional lecture. Screencast views were mostly due to intrinsic motivation. %M 33941512 %R 10.2196/25506 %U https://mededu.jmir.org/2021/2/e25506 %U https://doi.org/10.2196/25506 %U http://www.ncbi.nlm.nih.gov/pubmed/33941512 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 7 %N 2 %P e29335 %T Author’s Reply to: Virtual vs Online: Insight From Medical Students. Comment on “Effectiveness of Virtual Medical Teaching During the COVID-19 Crisis: Systematic Review” %A Wilcha,Robyn-Jenia %+ Faculty of Biology, Medicine and Health, University of Manchester, Oxford Road, Manchester, M13 9PL, United Kingdom, 44 (0)161 306 0211, robynwilcha05@gmail.com %K virtual teaching %K medical student %K medical education %K COVID-19 %K review %K search term %K virus %K pandemic %K quarantine %D 2021 %7 14.5.2021 %9 Letter to the Editor %J JMIR Med Educ %G English %X %M 33852412 %R 10.2196/29335 %U https://mededu.jmir.org/2021/2/e29335 %U https://doi.org/10.2196/29335 %U http://www.ncbi.nlm.nih.gov/pubmed/33852412 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 7 %N 2 %P e27020 %T Virtual vs Online: Insight From Medical Students. Comment on “Effectiveness of Virtual Medical Teaching During the COVID-19 Crisis: Systematic Review” %A Kaini,Shahil %A Motie,Lucinda Zahrah %+ University College London, Gower St, Bloomsbury, London, WC1E 6BT, United Kingdom, 44 020 7679 2000, shahilkaini@live.co.uk %K virtual teaching %K medical student %K medical education %K COVID-19 %K review %K search term %K virus %K pandemic %K quarantine %D 2021 %7 14.5.2021 %9 Letter to the Editor %J JMIR Med Educ %G English %X %M 33988518 %R 10.2196/27020 %U https://mededu.jmir.org/2021/2/e27020 %U https://doi.org/10.2196/27020 %U http://www.ncbi.nlm.nih.gov/pubmed/33988518 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 5 %P e26283 %T Influence of COVID-19 Lockdowns on the Usage of a Vision Assistance App Among Global Users With Visual Impairment: Big Data Analytics Study %A Luo,Gang %A Pundlik,Shrinivas %+ Schepens Eye Research Institute, Massachusetts Eye and Ear, Harvard Medical School, 20 Staniford Street, Boston, MA, 02114, United States, 1 617 912 2529, gang_luo@meei.harvard.edu %K assistance %K assistive technology %K COVID-19 %K development %K eye %K low vision %K needs %K smartphone apps %K usage %K vision assistance %K vision %K visual impairment %D 2021 %7 12.5.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Millions of individuals with visual impairment use vision assistance apps to help with their daily activities. The most widely used vision assistance apps are magnifier apps. It is still largely unknown what the apps are used for. Lack of insight into the visual needs of individuals with visual impairment is a hurdle for the development of more effective assistive technologies. Objective: This study aimed to investigate how needs for visual aids may vary with social activities, by observing the changes in the usage of a smartphone magnifier app when many users take breaks from work. Methods: The number of launches of the SuperVision Magnifier app was determined retrospectively from 2018 to 2020 from among active users worldwide. The fluctuation in app usage was examined by comparing weekday vs weekend periods, Christmas and new year vs nonholiday seasons, and COVID-19 lockdowns vs the easing of restriction during the pandemic. Results: On average, the app was used 262,466 times by 38,237 users each month in 2020 worldwide. There were two major trough points on the timeline of weekly app usage, one aligned with the COVID-19 lockdowns in April 2020 and another aligned with the Christmas and new year week in 2018 and 2019. The app launches declined by 6947 (11% decline; P<.001) during the lockdown and by 5212 (9% decline; P=.001) during the holiday weeks. There was no significant decline during March to May 2019. App usage compensated for seasonal changes was 8.6% less during weekends than during weekdays (P<.001). Conclusions: The need for vision assistance technology was slightly lower during breaks and lockdowns, probably because the activities at home were different and less visually demanding. Nevertheless, for the entire user population, the needs for visual aids are still substantial. %M 33945492 %R 10.2196/26283 %U https://www.jmir.org/2021/5/e26283 %U https://doi.org/10.2196/26283 %U http://www.ncbi.nlm.nih.gov/pubmed/33945492 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 5 %P e28118 %T Understanding Behavioral Intentions Toward COVID-19 Vaccines: Theory-Based Content Analysis of Tweets %A Liu,Siru %A Liu,Jialin %+ Department of Medical Informatics, West China Hospital, Sichuan University, No 37 Wainan Guoxuexiang Street, Chengdu, 610041, China, 86 28 85422306, dljl8@163.com %K vaccine %K COVID-19 %K behavior %K tweet %K intention %K content analysis %K Twitter %K social media %K acceptance %K threshold %K willing %K theory %K model %K infodemiology %K infoveillance %D 2021 %7 12.5.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Acceptance rates of COVID-19 vaccines have still not reached the required threshold to achieve herd immunity. Understanding why some people are willing to be vaccinated and others are not is a critical step to develop efficient implementation strategies to promote COVID-19 vaccines. Objective: We conducted a theory-based content analysis based on the capability, opportunity, motivation–behavior (COM-B) model to characterize the factors influencing behavioral intentions toward COVID-19 vaccines mentioned on the Twitter platform. Methods: We collected tweets posted in English from November 1-22, 2020, using a combination of relevant keywords and hashtags. After excluding retweets, we randomly selected 5000 tweets for manual coding and content analysis. We performed a content analysis informed by the adapted COM-B model. Results: Of the 5000 COVID-19 vaccine–related tweets that were coded, 4796 (95.9%) were posted by unique users. A total of 97 tweets carried positive behavioral intent, while 182 tweets contained negative behavioral intent. Of these, 28 tweets were mapped to capability factors, 155 tweets were related to motivation, 23 tweets were related to opportunities, and 74 tweets did not contain any useful information about the reasons for their behavioral intentions (κ=0.73). Some tweets mentioned two or more constructs at the same time. Tweets that were mapped to capability (P<.001), motivation (P<.001), and opportunity (P=.03) factors were more likely to indicate negative behavioral intentions. Conclusions: Most behavioral intentions regarding COVID-19 vaccines were related to the motivation construct. The themes identified in this study could be used to inform theory-based and evidence-based interventions to improve acceptance of COVID-19 vaccines. %M 33939625 %R 10.2196/28118 %U https://www.jmir.org/2021/5/e28118 %U https://doi.org/10.2196/28118 %U http://www.ncbi.nlm.nih.gov/pubmed/33939625 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 5 %P e29562 %T Monitoring Health Care Workers at Risk for COVID-19 Using Wearable Sensors and Smartphone Technology: Protocol for an Observational mHealth Study %A Clingan,Caroline A %A Dittakavi,Manasa %A Rozwadowski,Michelle %A Gilley,Kristen N %A Cislo,Christine R %A Barabas,Jenny %A Sandford,Erin %A Olesnavich,Mary %A Flora,Christopher %A Tyler,Jonathan %A Mayer,Caleb %A Stoneman,Emily %A Braun,Thomas %A Forger,Daniel B %A Tewari,Muneesh %A Choi,Sung Won %+ Division of Pediatric Hematology/Oncology, Department of Pediatrics, University of Michigan, 1500 E Medical Center Dr, D4118 Medical Professional Building, Ann Arbor, MI, 48109, United States, 1 734 615 5707, sungchoi@med.umich.edu %K mobile health %K app %K mHealth %K wearable %K sensor %K COVID-19 %K health care worker %K frontline worker %K smartphone %K digital health %D 2021 %7 12.5.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Health care workers (HCWs) have been working on the front lines of the COVID-19 pandemic with high risks of viral exposure, infection, and transmission. Standard COVID-19 testing is insufficient to protect HCWs from these risks and prevent the spread of disease. Continuous monitoring of physiological data with wearable sensors, self-monitoring of symptoms, and asymptomatic COVID-19 testing may aid in the early detection of COVID-19 in HCWs and may help reduce further transmission among HCWs, patients, and families. Objective: By using wearable sensors, smartphone-based symptom logging, and biospecimens, this project aims to assist HCWs in self-monitoring COVID-19. Methods: We conducted a prospective, longitudinal study of HCWs at a single institution. The study duration was 1 year, wherein participants were instructed on the continuous use of two wearable sensors (Fitbit Charge 3 smartwatch and TempTraq temperature patches) for up to 30 days. Participants consented to provide biospecimens (ie, nasal swabs, saliva swabs, and blood) for up to 1 year from study entry. Using a smartphone app called Roadmap 2.0, participants entered a daily mood score, submitted daily COVID-19 symptoms, and completed demographic and health-related quality of life surveys at study entry and 30 days later. Semistructured qualitative interviews were also conducted at the end of the 30-day period, following completion of daily mood and symptoms reporting as well as continuous wearable sensor use. Results: A total of 226 HCWs were enrolled between April 28 and December 7, 2020. The last participant completed the 30-day study procedures on January 16, 2021. Data collection will continue through January 2023, and data analyses are ongoing. Conclusions: Using wearable sensors, smartphone-based symptom logging and survey completion, and biospecimen collections, this study will potentially provide data on the prevalence of COVID-19 infection among HCWs at a single institution. The study will also assess the feasibility of leveraging wearable sensors and self-monitoring of symptoms in an HCW population. Trial Registration: ClinicalTrials.gov NCT04756869; https://clinicaltrials.gov/ct2/show/NCT04756869 International Registered Report Identifier (IRRID): DERR1-10.2196/29562 %M 33945497 %R 10.2196/29562 %U https://www.researchprotocols.org/2021/5/e29562 %U https://doi.org/10.2196/29562 %U http://www.ncbi.nlm.nih.gov/pubmed/33945497 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 5 %P e27342 %T On-site Dining in Tokyo During the COVID-19 Pandemic: Time Series Analysis Using Mobile Phone Location Data %A Nakanishi,Miharu %A Shibasaki,Ryosuke %A Yamasaki,Syudo %A Miyazawa,Satoshi %A Usami,Satoshi %A Nishiura,Hiroshi %A Nishida,Atsushi %+ Research Center for Social Science & Medicine, Tokyo Metopolitan Institute of Medical Science, 2-1-6 Kamikitazawa, Setagaya-ku, Tokyo, 156-8506, Japan, 81 3 6834 2292, mnakanishi-tky@umin.ac.jp %K COVID-19 %K mobility data %K on-site dining %K public health and social measures %K public health %K mobile phone %K mobility %K protection %K time series %K location %K infectious disease %K transmission %D 2021 %7 11.5.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: During the second wave of COVID-19 in August 2020, the Tokyo Metropolitan Government implemented public health and social measures to reduce on-site dining. Assessing the associations between human behavior, infection, and social measures is essential to understand achievable reductions in cases and identify the factors driving changes in social dynamics. Objective: The aim of this study was to investigate the association between nighttime population volumes, the COVID-19 epidemic, and the implementation of public health and social measures in Tokyo. Methods: We used mobile phone location data to estimate populations between 10 PM and midnight in seven Tokyo metropolitan areas. Mobile phone trajectories were used to distinguish and extract on-site dining from stay-at-work and stay-at-home behaviors. Numbers of new cases and symptom onsets were obtained. Weekly mobility and infection data from March 1 to November 14, 2020, were analyzed using a vector autoregression model. Results: An increase in the number of symptom onsets was observed 1 week after the nighttime population volume increased (coefficient=0.60, 95% CI 0.28 to 0.92). The effective reproduction number significantly increased 3 weeks after the nighttime population volume increased (coefficient=1.30, 95% CI 0.72 to 1.89). The nighttime population volume increased significantly following reports of decreasing numbers of confirmed cases (coefficient=–0.44, 95% CI –0.73 to –0.15). Implementation of social measures to restaurants and bars was not significantly associated with nighttime population volume (coefficient=0.004, 95% CI –0.07 to 0.08). Conclusions: The nighttime population started to increase after decreasing incidence of COVID-19 was announced. Considering time lags between infection and behavior changes, social measures should be planned in advance of the surge of an epidemic, sufficiently informed by mobility data. %M 33886486 %R 10.2196/27342 %U https://mhealth.jmir.org/2021/5/e27342 %U https://doi.org/10.2196/27342 %U http://www.ncbi.nlm.nih.gov/pubmed/33886486 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 5 %P e26186 %T Using Multimodal Assessments to Capture Personalized Contexts of College Student Well-being in 2020: Case Study %A Lai,Jocelyn %A Rahmani,Amir %A Yunusova,Asal %A Rivera,Alexander P %A Labbaf,Sina %A Hu,Sirui %A Dutt,Nikil %A Jain,Ramesh %A Borelli,Jessica L %+ UCI THRIVE Lab, Department of Psychological Science, University of California, Irvine, 4201 Social and Behavioral Sciences Gateway, Irvine, CA, 92697, United States, 1 4086565508, jocelyn.lai@uci.edu %K COVID-19 %K emerging adulthood %K multimodal personal chronicles %K case study %K wearable internet of things %K individualized mHealth %K college students %K mental health %D 2021 %7 11.5.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The year 2020 has been challenging for many, particularly for young adults who have been adversely affected by the COVID-19 pandemic. Emerging adulthood is a developmental phase with significant changes in the patterns of daily living; it is a risky phase for the onset of major mental illness. College students during the pandemic face significant risk, potentially losing several protective factors (eg, housing, routine, social support, job, and financial security) that are stabilizing for mental health and physical well-being. Individualized multiple assessments of mental health, referred to as multimodal personal chronicles, present an opportunity to examine indicators of health in an ongoing and personalized way using mobile sensing devices and wearable internet of things. Objective: To assess the feasibility and provide an in-depth examination of the impact of the COVID-19 pandemic on college students through multimodal personal chronicles, we present a case study of an individual monitored using a longitudinal subjective and objective assessment approach over a 9-month period throughout 2020, spanning the prepandemic period of January through September. Methods: The individual, referred to as Lee, completed psychological assessments measuring depression, anxiety, and loneliness across 4 time points in January, April, June, and September. We used the data emerging from the multimodal personal chronicles (ie, heart rate, sleep, physical activity, affect, behaviors) in relation to psychological assessments to understand patterns that help to explicate changes in the individual’s psychological well-being across the pandemic. Results: Over the course of the pandemic, Lee’s depression severity was highest in April, shortly after shelter-in-place orders were mandated. His depression severity remained mildly severe throughout the rest of the months. Associations in positive and negative affect, physiology, sleep, and physical activity patterns varied across time periods. Lee’s positive affect and negative affect were positively correlated in April (r=0.53, P=.04) whereas they were negatively correlated in September (r=–0.57, P=.03). Only in the month of January was sleep negatively associated with negative affect (r=–0.58, P=.03) and diurnal beats per minute (r=–0.54, P=.04), and then positively associated with heart rate variability (resting root mean square of successive differences between normal heartbeats) (r=0.54, P=.04). When looking at his available contextual data, Lee noted certain situations as supportive coping factors and other situations as potential stressors. Conclusions: We observed more pandemic concerns in April and noticed other contextual events relating to this individual’s well-being, reflecting how college students continue to experience life events during the pandemic. The rich monitoring data alongside contextual data may be beneficial for clinicians to understand client experiences and offer personalized treatment plans. We discuss benefits as well as future directions of this system, and the conclusions we can draw regarding the links between the COVID-19 pandemic and college student mental health. %M 33882022 %R 10.2196/26186 %U https://formative.jmir.org/2021/5/e26186 %U https://doi.org/10.2196/26186 %U http://www.ncbi.nlm.nih.gov/pubmed/33882022 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 7 %N 2 %P e25213 %T Planning Engaging, Remote, Synchronous Didactics in the COVID-19 Pandemic Era %A Rivera,Ronald %A Smart,Jonathan %A Sakaria,Sangeeta %A Wray,Alisa %A Wiechmann,Warren %A Boysen-Osborn,Megan %A Toohey,Shannon %+ Department of Emergency Medicine, University of California Irvine Medical Center, 333 City Boulevard West, Suite 640, Orange, CA, 92868, United States, 1 8186057379, ronald.rivera.md@gmail.com %K distance education %K videoconferencing %K emergency medicine %K teaching %K learning %K web-based lecture %K medical education %K technology %K SARS-CoV-2 %K COVID-19 %D 2021 %7 11.5.2021 %9 Viewpoint %J JMIR Med Educ %G English %X As part of the Accreditation Council for Graduate Medical Education requirements, residents must participate in structured didactic activities. Traditional didactics include lectures, grand rounds, simulations, case discussions, and other forms of in-person synchronous learning. The COVID-19 pandemic has made in-person activities less feasible, as many programs have been forced to transition to remote didactics. Educators must still achieve the goals and objectives of their didactic curriculum despite the new limitations on instructional strategies. There are several strategies that may be useful for organizing and creating a remote residency didactic curriculum. Educators must master new technology, be flexible and creative, and set rules of engagement for instructors and learners. Establishing best practices for remote didactics will result in successful, remote, synchronous didactics; reduce the impact of transitioning to a remote learning environment; and keep educators and learners safe as shelter-at-home orders remain in place. %M 33872191 %R 10.2196/25213 %U https://mededu.jmir.org/2021/2/e25213 %U https://doi.org/10.2196/25213 %U http://www.ncbi.nlm.nih.gov/pubmed/33872191 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 5 %P e23009 %T Learning From the Experiences of COVID-19 Survivors: Web-Based Survey Study %A Prioleau,Temiloluwa %+ Dartmouth College, 9 Maynard Street, Hanover, NH, 03755, United States, 1 6036468730, tprioleau@dartmouth.edu %K patient-reported outcomes %K coronavirus %K COVID-19 %K outcome %K crowdsourcing %K social media %K internet %K survivor %K experience %D 2021 %7 11.5.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: There are still many unanswered questions about the novel coronavirus; however, a largely underutilized source of knowledge is the millions of people who have recovered after contracting the virus. This includes a majority of undocumented cases of COVID-19, which were classified as mild or moderate and received little to no clinical care during the course of illness. Objective: This study aims to document and glean insights from the experiences of individuals with a first-hand experience in dealing with COVID-19, especially the so-called mild-to-moderate cases that self-resolved while in isolation. Methods: This web-based survey study called C19 Insider Scoop recruited adult participants aged 18 years or older who reside in the United States and had tested positive for COVID-19 or antibodies. Participants were recruited through various methods, including online support groups for COVID-19 survivors, advertisement in local news outlets, as well as through professional and other networks. The main outcomes measured in this study included knowledge of contraction or transmission of the virus, symptoms, and personal experiences on the road to recovery. Results: A total of 72 participants (female, n=53; male, n=19; age range: 18-73 years; mean age: 41 [SD 14] years) from 22 US states were enrolled in this study. The top known source of how people contracted SARS-CoV-2, the virus known to cause COVID-19, was through a family or household member (26/72, 35%). This was followed by essential workers contracting the virus through the workplace (13/72, 18%). Participants reported up to 27 less-documented symptoms that they experienced during their illness, such as brain or memory fog, palpitations, ear pain or discomfort, and neurological problems. In addition, 47 of 72 (65%) participants reported that their symptoms lasted longer than the commonly cited 2-week period even for mild cases of COVID-19. The mean recovery time of the study participants was 4.5 weeks, and exactly one-half of participants (50%) still experienced lingering symptoms of COVID-19 after an average of 65 days following illness onset. Additionally, 37 (51%) participants reported that they experienced stigma associated with contracting COVID-19. Conclusions: This study presents preliminary findings suggesting that emphasis on family or household spread of COVID-19 may be lacking and that there is a general underestimation of the recovery time even for mild cases of illness with the virus. Although a larger study is needed to validate these results, it is important to note that as more people experience COVID-19, insights from COVID-19 survivors can enable a more informed public, pave the way for others who may be affected by the virus, and guide further research. %M 33878012 %R 10.2196/23009 %U https://formative.jmir.org/2021/5/e23009 %U https://doi.org/10.2196/23009 %U http://www.ncbi.nlm.nih.gov/pubmed/33878012 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 5 %P e25753 %T SARS-CoV-2 Surveillance System in Canada: Longitudinal Trend Analysis %A Post,Lori %A Boctor,Michael J %A Issa,Tariq Z %A Moss,Charles B %A Murphy,Robert Leo %A Achenbach,Chad J %A Ison,Michael G %A Resnick,Danielle %A Singh,Lauren %A White,Janine %A Welch,Sarah B %A Oehmke,James F %+ Buehler Center for Health Policy and Economics, Feinberg School of Medicine, Northwestern University, 420 E Superior, Chicago, IL, 60611, United States, 1 203 980 7107, lori.post@northwestern.edu %K global COVID surveillance %K COVID-19 %K COVID-21 %K new COVID strains %K Canada Public Health Surveillance %K Great COVID Shutdown %K Canadian COVID-19 %K surveillance metrics %K wave 2 Canada COVID-19 %K dynamic panel data %K generalized method of the moments %K Canadian econometrics %K Canada SARS-CoV-2 %K Canadian COVID-19 surveillance system %K Canadian COVID transmission speed %K Canadian COVID transmission acceleration %K COVID transmission deceleration %K COVID transmission jerk %K COVID 7-day lag %K Alberta %K British Columbia %K Manitoba %K New Brunswick %K Newfoundland and Labrador %K Northwest Territories %K Nova Scotia %K Nunavut %K Ontario %K Prince Edward Island %K Quebec %K Saskatchewan %K Yukon %D 2021 %7 10.5.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The COVID-19 global pandemic has disrupted structures and communities across the globe. Numerous regions of the world have had varying responses in their attempts to contain the spread of the virus. Factors such as public health policies, governance, and sociopolitical climate have led to differential levels of success at controlling the spread of SARS-CoV-2. Ultimately, a more advanced surveillance metric for COVID-19 transmission is necessary to help government systems and national leaders understand which responses have been effective and gauge where outbreaks occur. Objective: The goal of this study is to provide advanced COVID-19 surveillance metrics for Canada at the country, province, and territory level that account for shifts in the pandemic including speed, acceleration, jerk, and persistence. Enhanced surveillance identifies risks for explosive growth and regions that have controlled outbreaks successfully. Methods: Using a longitudinal trend analysis study design, we extracted 62 days of COVID-19 data from Canadian public health registries for 13 provinces and territories. We used an empirical difference equation to measure the daily number of cases in Canada as a function of the prior number of cases, the level of testing, and weekly shift variables based on a dynamic panel model that was estimated using the generalized method of moments approach by implementing the Arellano-Bond estimator in R. Results: We compare the week of February 7-13, 2021, with the week of February 14-20, 2021. Canada, as a whole, had a decrease in speed from 8.4 daily new cases per 100,000 population to 7.5 daily new cases per 100,000 population. The persistence of new cases during the week of February 14-20 reported 7.5 cases that are a result of COVID-19 transmissions 7 days earlier. The two most populous provinces of Ontario and Quebec both experienced decreases in speed from 7.9 and 11.5 daily new cases per 100,000 population for the week of February 7-13 to speeds of 6.9 and 9.3 for the week of February 14-20, respectively. Nunavut experienced a significant increase in speed during this time, from 3.3 daily new cases per 100,000 population to 10.9 daily new cases per 100,000 population. Conclusions: Canada excelled at COVID-19 control early on in the pandemic, especially during the first COVID-19 shutdown. The second wave at the end of 2020 resulted in a resurgence of the outbreak, which has since been controlled. Enhanced surveillance identifies outbreaks and where there is the potential for explosive growth, which informs proactive health policy. %M 33852410 %R 10.2196/25753 %U https://publichealth.jmir.org/2021/5/e25753 %U https://doi.org/10.2196/25753 %U http://www.ncbi.nlm.nih.gov/pubmed/33852410 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 5 %P e24294 %T Enhancing Data Linkage to Break the Chain of COVID-19 Spread: The Taiwan Experience %A Lo,Wei-Cheng %A Wang,Fu-Chung %A Lin,Li-Yin %A Jyan,Hong-Wei %A Wu,Hsuan-Chien %A Huang,Yao-Liang %A Parng,I-Ming %A Chiou,Hung-Yi %+ Institute of Population Health Sciences, National Health Research Institutes, No 35 Keyan Road, Zhunan, Miaoli County, 350, Taiwan, 1 886 2 2736 1661 ext 6512, hychiou@tmu.edu.tw %K COVID-19 %K data linkage %K digital health %K digital technology %K infectious disease %K management %K National Health Insurance System %K prevention %K spread %K Taiwan %D 2021 %7 7.5.2021 %9 Viewpoint %J J Med Internet Res %G English %X Digital technology has been widely used in health care systems and disease management, as well as in controlling the spread of COVID-19. As one of the most successful countries in combating the COVID-19 pandemic, Taiwan has successfully used digital technology to strengthen its efforts in controlling the COVID-19 pandemic. Taiwan has a well-established National Health Insurance System (NHIS), which provides a great opportunity to develop a nationwide data linkage model in an agile manner. Here we provide an overview of the application of data linkage models for strategies in combating COVID-19 in Taiwan, including NHIS centralized data linkage systems and “from border to community” information-driven data linkage systems during the COVID-19 pandemic. Furthermore, we discuss the dual role of digital technologies in being an “enabler” and a “driver” in early disease prevention. Lastly, Taiwan’s experience in applying digital technology to enhance the control of COVID-19 potentially highlights lessons learned and opportunities for other countries to handle the COVID-19 situation better. %M 33882019 %R 10.2196/24294 %U https://www.jmir.org/2021/5/e24294 %U https://doi.org/10.2196/24294 %U http://www.ncbi.nlm.nih.gov/pubmed/33882019 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 5 %P e27412 %T The Impact of Implementing the Egypt Pandemic Preparedness Plan for Acute Respiratory Infections in Combating the Early Stage of the COVID-19 Pandemic, February-July 2020: Viewpoint %A Abu El Sood,Hanaa %A Abu Kamer,Shimaa Ali %A Kamel,Reham %A Magdy,Hesham %A Osman,Fatma S %A Fahim,Manal %A Mohsen,Amira %A AbdelFatah,Mohamad %A Hassany,Mohamed %A Afifi,Salma %A Eid,Alaa %+ Department of Epidemiology and Surveillance, Preventive Sector, Ministry of Health and Population, 3 Magles Elshaab St, Cairo, , Egypt, 20 01282833078 ext 002, hanaaabuelsood@hotmail.com %K pandemic preparedness %K Egypt %K ARI %K epidemic mitigation %K COVID-19 %D 2021 %7 7.5.2021 %9 Viewpoint %J JMIR Public Health Surveill %G English %X This article briefly describes Egypt’s acute respiratory infection (ARI) epidemic preparedness and containment plan and illustrates the impact of implementation of the plan on combating the early stage of the COVID-19 epidemic in Egypt. Pillars of the plan include crisis management, enhancing surveillance systems and contact tracing, case and hospital management, raising community awareness, and quarantine and entry points. To identify the impact of the implementation of the plan on epidemic mitigation, a literature review was performed of studies published from Egypt in the early stage of the pandemic. In addition, data for patients with COVID-19 from February to July 2020 were obtained from the National Egyptian Surveillance system and studied to describe the situation in the early stage of the epidemic in Egypt. The lessons learned indicated that the single most important key to success in early-stage epidemic containment is the commitment of all partners to a predeveloped and agreed-upon preparedness plan. This information could be useful for other countries in the region and worldwide in mitigating future anticipated ARI epidemics and pandemics. Postepidemic evaluation is needed to better assess Egypt’s national response to the COVID-19 epidemic. %M 33830932 %R 10.2196/27412 %U https://publichealth.jmir.org/2021/5/e27412 %U https://doi.org/10.2196/27412 %U http://www.ncbi.nlm.nih.gov/pubmed/33830932 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 9 %N 2 %P e26808 %T Leisure and Problem Gaming Behaviors Among Children and Adolescents During School Closures Caused by COVID-19 in Hong Kong: Quantitative Cross-sectional Survey Study %A Zhu,Shimin %A Zhuang,Yanqiong %A Lee,Paul %A Li,Jessica Chi-Mei %A Wong,Paul W C %+ Department of Social Work and Social Administration, The University of Hong Kong, 511, JC Teaching Tower, Pok Fu Lam, 000, Hong Kong, 852 39175029, paulw@hku.hk %K COVID-19 %K leisure gaming %K excessive gaming %K pathological gaming %K familial factors %K loneliness %K COVID-19 lockdown %K school closure %D 2021 %7 7.5.2021 %9 Original Paper %J JMIR Serious Games %G English %X Background: School closures during the COVID-19 pandemic may have exacerbated students’ loneliness, addictive gaming behaviors, and poor mental health. These mental health issues confronting young people are of public concern. Objective: This study aimed to examine the associations between loneliness and gaming addiction behaviors among young people in Hong Kong and to investigate how familial factors, psychological distress, and gender differences moderate these relationships. Methods: This cross-sectional study was conducted in June 2020 when schools reopened after 6 months of school closures. Participants included 2863 children and adolescents in primary (Grades 4 to 6) and secondary (Grades 7 and 8) schools (female participants: 1502/2863, 52.5%). Chi-square tests, one-way analyses of variance, and independent-samples t tests were performed to compare the differences of distribution in gaming addiction behaviors across gender, age, and other sociodemographic characteristics. Multinomial logistic regression analyses were conducted to identify factors that relate to excessive or pathological gaming behaviors separately, in comparison with leisure gaming. Results: A total of 83.0% (2377/2863) of the participants played video games during the COVID-19 pandemic. The prevalence of excessive and pathological game addiction behaviors was 20.9% (597/2863) and 5.3% (153/2863), respectively. More male students had gaming addiction symptoms than female students. The multinomial logistic regressions showed that feeling lonely was associated with more problematic gaming behaviors, and the association was stronger for older female students. Low socioeconomic status, less parental support and less supervision, and poor mental health were risk factors for gaming addiction behaviors, especially among primary school students. Conclusions: Loneliness was associated with gaming addiction behaviors; the findings from this study suggested that this association was similar across gender and age groups among young people. Familial support and supervision during school closures can protect young people from developing problematic gaming behaviors. Results of this study have implications for prevention and early intervention on behalf of policy makers and game developers. %M 33960954 %R 10.2196/26808 %U https://games.jmir.org/2021/2/e26808 %U https://doi.org/10.2196/26808 %U http://www.ncbi.nlm.nih.gov/pubmed/33960954 %0 Journal Article %@ 2563-6316 %I JMIR Publications %V 2 %N 2 %P e25703 %T Mobile App–Reported Use of Traditional Medicine for Maintenance of Health in India During the COVID-19 Pandemic: Cross-sectional Questionnaire Study %A Srikanth,N %A Rana,Rakesh %A Singhal,Richa %A Jameela,Sophia %A Singh,Rajeshwari %A Khanduri,Shruti %A Tripathi,Arunabh %A Goel,Sumeet %A Chhatre,Leena %A Chandra,Ashwin %A Rao,B C S %A Dhiman,K S %+ Central Council for Research in Ayurvedic Sciences, Ministry of AYUSH, Janakpuri, Delhi, 110058, India, 91 9818478514, rkrana2000@gmail.com %K AYUSH Sanjivani app %K COVID-19 %K traditional medicine %K Ayurveda %K Siddha %K Unani %K homeopathy %D 2021 %7 7.5.2021 %9 Original Paper %J JMIRx Med %G English %X Background: India follows a pluralistic system for strategic and focused health care delivery in which traditional systems of medicine such as Ayurveda, yoga and naturopathy, Unani, Siddha, Sowa Rigpa, and homoeopathy (AYUSH) coexist with contemporary medicine, and this system functions under the Ministry of AYUSH (MoA). The MoA developed a mobile app, called AYUSH Sanjivani, to document the trends of the use of AYUSH-based traditional and holistic measures by the public across India. Analysis of the data generated through this app can help monitor the extent of the use of AYUSH measures for maintenance of health during the COVID-19 pandemic and aid effective health promotion and communication efforts focused on targeted health care delivery during the pandemic. Objective: The purpose of the study was to determine the extent of use of AYUSH measures by the public in India for maintenance of health during the COVID-19 pandemic as reported through the AYUSH Sanjivani mobile app. Methods: Cross-sectional analysis of the data generated through the Ayush Sanjivani app from May 4 to July 31, 2020, was performed to study the pattern and extent of the use of AYUSH-based measures by the Indian population. The responses of the respondents in terms of demographic profile, use pattern, and benefits obtained; the association between the use of AYUSH-based measures and symptomatic status; and the association between the duration of use of AYUSH-based measures and the outcome of COVID-19 testing were evaluated based on bivariate and multivariate logistic regression analysis. Results: Data from 723,459 respondents were used for the analysis, among whom 616,295 (85.2%) reported that they had been using AYUSH measures for maintenance of health during the COVID-19 pandemic. Among these 616,295 users, 553,801 (89.8%) either strongly or moderately agreed to have benefitted from AYUSH measures. Ayurveda and homeopathic measures and interventions were the most preferred by the respondents across India. Among the 359,785 AYUSH users who described their overall improvement in general health, 144,927 (40.3%) rated it as good, 30,848 (8.6%) as moderate, and 133,046 (40.3%) as slight. Respondents who had been using AYUSH measures for less than 30 days were more likely to be COVID-19–positive among those who were tested (odds ratio 1.52, 95% CI 1.44-1.60). The odds of nonusers of AYUSH measures being symptomatic if they tested positive were greater than those of AYUSH users (odds ratio 4.01, 95% CI 3.61-4.59). Conclusions: The findings of this cross-sectional analysis assert that a large proportion of the representative population practiced AYUSH measures across different geographic locations of the country during the COVID-19 pandemic and benefitted considerably in terms of general well-being, with a possible impact on their quality of life and specific domains of health. %M 34032815 %R 10.2196/25703 %U https://xmed.jmir.org/2021/2/e25703 %U https://doi.org/10.2196/25703 %U http://www.ncbi.nlm.nih.gov/pubmed/34032815 %0 Journal Article %@ 2562-0959 %I JMIR Publications %V 4 %N 1 %P e22789 %T Does Wearing a Face Mask During the COVID-19 Pandemic Increase the Incidence of Dermatological Conditions in Health Care Workers? Narrative Literature Review %A Wilcha,Robyn-Jenia %+ Faculty of Biology, Medicine and Health, University of Manchester, Oxford Road, Manchester, M13 9PL, United Kingdom, 44 (0)161 306 021, robynwilcha05@gmail.com %K COVID-19 %K dermatology %K face masks %K health care worker %K incidence %K literature %K mask %K N95 mask %K review %K skin %D 2021 %7 6.5.2021 %9 Review %J JMIR Dermatol %G English %X Background: COVID-19 is a health emergency. SARS-CoV-2 was discovered in Wuhan (Hubei Province, China) and has rapidly spread worldwide, leaving no country untouched. COVID-19 is a respiratory infection characterized by a pneumonia of unknown etiology. It is transmitted through respiratory droplets; for example: through breathing, talking, and coughing. Transmission of the virus is high. Health care workers play important roles in helping those affected by COVID-19; this could not be done without the use of personal protective equipment (PPE). PPE involves the use of goggles, masks, gloves, and gowns and is known to reduce COVID-19 transmission; however, multiple reports of skin disease and damage associated with occupational mask-wearing have emerged. Objective: The objective of this study is to review the literature for newly emerging dermatological conditions as a result of occupational mask-wearing during the COVID-19 pandemic. Methods: A narrative review of new reports of dermatological conditions associated with occupational mask-wearing was carried out in May 2020 by referencing keywords including: “covid mask dermatology,” “covid dermatological damage,” “covid mask skin,” “covid N95 mask damage,” and “covid mask skin damage” from PubMed, supplemented by searches on both Google Scholar and ResearchGate. A total of 287 articles were found, of which 40 were successfully included in this study, and an additional 7 were selected from the reference lists of these 40 articles. The findings were tabulated and analyzed under the following headings: dermatological diagnosis, causes, and management. Results: Qualitative analysis of the reviewed data was carried out. A number of dermatological conditions were found to increasingly occur owing to prolonged and frequent use of face masks. Pressure-related injuries were often the most serious complaint; recommendations to reduce this type of injury include the use of hydrocolloid dressings, plastic handles, education, and regular moisturization. Innovation in PPE as well as services, such as virtual clinics, need to be advanced to protect the welfare of health care staff. Conclusions: In these unprecedented times, PPE has been an effective barrier to the transmission of COVID-19 among health care workers. This has allowed health care workers to provide care to patients, with minimal risk. However, our findings suggest that despite the obvious benefits of using face masks to protect the respiratory system, there are also considerable health consequences to the skin. Future research studies are required to focus on improving face masks to ensure both the protection of the respiratory system as well as skin care, which, according to our study, has been overlooked. %M 34028470 %R 10.2196/22789 %U https://derma.jmir.org/2021/1/e22789 %U https://doi.org/10.2196/22789 %U http://www.ncbi.nlm.nih.gov/pubmed/34028470 %0 Journal Article %@ 2563-6316 %I JMIR Publications %V 2 %N 2 %P e21069 %T COVID-19 and Cybersecurity: Finally, an Opportunity to Disrupt? %A Ferreira,Ana %A Cruz-Correia,Ricardo %+ CINTESIS, Faculty of Medicine, University of Porto, Rua Plácido Costa, s/n, Porto, 4200-450, Portugal, 351 220426964, amlaf@med.up.pt %K COVID-19 %K cybersecurity %K challenges and disruption %K data protection %K privacy %K health data %D 2021 %7 6.5.2021 %9 Viewpoint %J JMIRx Med %G English %X COVID-19 has challenged cybersecurity to meet the ultimate need of guaranteeing the privacy and security of human beings. Although personal and sensitive health data are needed to better understand, detect, and control the disease, many related cybersecurity challenges and vulnerabilities require further analysis and proper discussion. The aims of this viewpoint are to explore the consequences of COVID-19 on cybersecurity and health care as well as to foster awareness regarding the need for a change in paradigm on how cybersecurity is approached. Education and information technology literacy are important when they are suitably provided; however, they are certainly not a complete solution. Disruption needs to occur at the core of human-device interactions. Building trust, providing novel means to interact with technology (eg, digital humans), and supporting people—the most important cybersecurity asset—are only some of the recommendations for a more human and resilient approach to cybersecurity, during or after the pandemic. %M 34032816 %R 10.2196/21069 %U https://xmed.jmir.org/2021/2/e21069 %U https://doi.org/10.2196/21069 %U http://www.ncbi.nlm.nih.gov/pubmed/34032816 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 5 %P e25600 %T Associations Between Health Literacy, eHealth Literacy, and COVID-19–Related Health Behaviors Among Chinese College Students: Cross-sectional Online Study %A Li,Shaojie %A Cui,Guanghui %A Kaminga,Atipatsa Chiwanda %A Cheng,Sixiang %A Xu,Huilan %+ Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, 238 Shangmayuanling Lane, Changsha, 410078, China, 86 13637480958, xhl_csu@163.com %K COVID-19 %K health literacy %K eHealth literacy %K COVID-19–related health behavior questionnaire %K Chinese college students %D 2021 %7 6.5.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: During the COVID-19 pandemic, the internet has significantly spread information, providing people with knowledge and advice about health protection regarding COVID-19. While a previous study demonstrated that health and eHealth literacy are related to COVID-19 prevention behaviors, few studies have focused on the relationship between health literacy, eHealth literacy, and COVID-19–related health behaviors. The latter includes not only preventative behaviors but also conventional health behaviors. Objective: The objective of this study was to develop and verify a COVID-19–related health behavior questionnaire, explore its status and structure, and examine the associations between these behaviors and participants’ health literacy and eHealth literacy. Methods: A snowball sampling method was adopted to recruit participants to complete anonymous cross-sectional questionnaire surveys online that assessed sociodemographic information, self-reported coronavirus knowledge, health literacy, eHealth literacy, and COVID-19–related health behaviors. Results: Of 1873 college students who were recruited, 781 (41.7%) had adequate health literacy; the mean eHealth literacy score was 30.16 (SD 6.31). The COVID-19–related health behavior questionnaire presented a two-factor structure—COVID-19–specific precautionary behaviors and conventional health behaviors—with satisfactory fit indices and internal consistency (Cronbach α=.79). The mean score of COVID-19–related health behaviors was 53.77 (SD 8.03), and scores differed significantly (P<.05) with respect to residence, college year, academic major, family economic level, self-reported health status, having a family member or friend infected with coronavirus, and health literacy level. Linear regression analysis showed that health literacy and eHealth literacy were positively associated with COVID-19–specific precautionary behaviors (βhealth literacy=.149, βeHealth literacy=.368; P<.001) and conventional health behaviors (βhealth literacy=.219, βeHealth literacy=.277; P<.001). Conclusions: The COVID-19–related health behavior questionnaire was a valid and reliable measure for assessing health behaviors during the pandemic. College students with higher health literacy and eHealth literacy can more actively adopt COVID-19–related health behaviors. Additionally, compared to health literacy, eHealth literacy is more closely related to COVID-19–related health behaviors. Public intervention measures based on health and eHealth literacy are required to promote COVID-19–related health behaviors during the pandemic, which may be helpful to reduce the risk of COVID-19 infection among college students. %M 33822734 %R 10.2196/25600 %U https://www.jmir.org/2021/5/e25600 %U https://doi.org/10.2196/25600 %U http://www.ncbi.nlm.nih.gov/pubmed/33822734 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 5 %P e21864 %T COVID-19, Social Isolation, and Mental Health Among Older Adults: A Digital Catch-22 %A Cosco,Theodore D %A Fortuna,Karen %A Wister,Andrew %A Riadi,Indira %A Wagner,Kevin %A Sixsmith,Andrew %+ Gerontology Research Center, Simon Fraser University, 2800 Harbour Centre, 515 West Hastings Street, Vancouver, BC, , Canada, 1 778 782 5065, tdcosco@cantab.net %K social isolation %K mental health %K COVID-19 %K technology %K older adult %K psychology %K digital health %D 2021 %7 6.5.2021 %9 Viewpoint %J J Med Internet Res %G English %X One of the most at-risk groups during the COVID-19 crisis is older adults, especially those who live in congregate living settings and seniors’ care facilities, are immune-compromised, and/or have other underlying illnesses. Measures undertaken to contain the spread of the virus are far-reaching, and older adults were among the first groups to experience restrictions on face-to-face contact. Although reducing viral transmission is critical, physical distancing is associated with negative psychosocial implications, such as increased rates of depression and anxiety. Promising evidence suggests that participatory digital co-design, defined as the combination of user-centered design and community engagement models, is associated with increased levels of engagement with mobile technologies among individuals with mental health conditions. The COVID-19 pandemic has highlighted shortcomings of existing technologies and challenges in their uptake and usage; however, strategies such as co-design may be leveraged to address these challenges both in the adaptation of existing technologies and the development of new technologies. By incorporating these strategies, it is hoped that we can offset some of the negative mental health implications for older adults in the context of physical distancing both during and beyond the current pandemic. %M 33891557 %R 10.2196/21864 %U https://www.jmir.org/2021/5/e21864 %U https://doi.org/10.2196/21864 %U http://www.ncbi.nlm.nih.gov/pubmed/33891557 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 5 %P e23251 %T Survival Analysis of Patients With COVID-19 in India by Demographic Factors: Quantitative Study %A Kundu,Sampurna %A Chauhan,Kirti %A Mandal,Debarghya %+ Department of Mathematical Demography and Statistics, International Institute for Population Sciences, Govandi Station Road, Mumbai, 400088, India, 91 9073111858, sampurna34@gmail.com %K survival analysis %K COVID-19 %K patient data %K Kaplan-Meier %K hazard model %K modeling %K survival %K mortality %K demographic %K India %K transmission %D 2021 %7 6.5.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Studies of the transmission dynamics of COVID-19 have depicted the rate, patterns, and predictions of cases of this pandemic disease. To combat transmission of the disease in India, the government declared a lockdown on March 25, 2020. Even after this strict lockdown was enacted nationwide, the number of COVID-19 cases increased and surpassed 450,000. A positive point to note is that the number of recovered cases began to slowly exceed that of active cases. The survival of patients, taking death as the event that varies by age group and sex, is noteworthy. Objective: The aim of this study was to conduct a survival analysis to establish the variability in survivorship of patients with COVID-19 in India by age group and sex at different levels, that is, the national, state, and district levels. Methods: The study period was taken from the date of the first reported case of COVID-19 in India, which was January 30, 2020, up to June 30, 2020. Due to the amount of underreported data and removal of missing columns, a total sample of 26,815 patients was considered. Kaplan-Meier survival estimation, the Cox proportional hazard model, and the multilevel survival model were used to perform the survival analysis. Results: The Kaplan-Meier survival function showed that the probability of survival of patients with COVID-19 declined during the study period of 5 months, which was supplemented by the log rank test (P<.001) and Wilcoxon test (P<.001) to compare the survival functions. Significant variability was observed in the age groups, as evident from all the survival estimates; with increasing age, the risk of dying of COVID-19 increased. The Cox proportional hazard model reiterated that male patients with COVID-19 had a 1.14 times higher risk of dying than female patients (hazard ratio 1.14; SE 0.11; 95% CI 0.93-1.38). Western and Central India showed decreasing survival rates in the framed time period, while Eastern, North Eastern, and Southern India showed slightly better results in terms of survival. Conclusions: This study depicts a grave scenario of decreasing survival rates in various regions of India and shows variability in these rates by age and sex. In essence, we can safely conclude that the critical appraisal of the survival rate and thorough analysis of patient data in this study equipped us to identify risk groups and perform comparative studies of various segments in India. International Registered Report Identifier (IRRID): RR2-10.1101/2020.08.01.20162115 %M 33882017 %R 10.2196/23251 %U https://formative.jmir.org/2021/5/e23251 %U https://doi.org/10.2196/23251 %U http://www.ncbi.nlm.nih.gov/pubmed/33882017 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 5 %P e25207 %T Chest Computed Tomography for the Diagnosis of COVID-19 in Emergency Trauma Surgery Patients Who Require Urgent Care During the Pandemic: Protocol for an Umbrella Review %A Griswold,Dylan %A Gempeler,Andrés %A Rosseau,Gail %A Kaseje,Neema %A Johnson,Walter D %A Kolias,Angelos %A Hutchinson,Peter J %A Rubiano,Andres M %+ Neuroscience Institute, INUB-MEDITECH Research Group, El Bosque University, Av Cra 9 No 131 A - 02, Bogota, 110121, Colombia, 57 3006154775, rubianoam@gmail.com %K systematic review %K broad-evidence synthesis %K COVID-19 %K global health %K trauma surgery %K evidence-based practice %K chest CT %K rapid testing %K testing %K diagnosis %K scan %K computed tomography %K review %K antigen %K immune system %K health care worker %K surgery %K emergency %K protocol %D 2021 %7 6.5.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Many health care facilities in low- and middle-income countries are inadequately resourced. COVID-19 has the potential to decimate surgical health care services unless health systems take stringent measures to protect health care workers from viral exposure and ensure the continuity of specialized care for patients. Among these measures, the timely diagnosis of COVID-19 is paramount to ensure the use of protective measures and isolation of patients to prevent transmission to health care personnel caring for patients with an unknown COVID-19 status or contact during the pandemic. Besides molecular and antibody tests, chest computed tomography (CT) has been assessed as a potential tool to aid in the screening or diagnosis of COVID-19 and could be valuable in the emergency care setting. Objective: This paper presents the protocol for an umbrella review that aims to identify and summarize the available literature on the diagnostic accuracy of chest CT for COVID-19 in trauma surgery patients requiring urgent care. The objective is to inform future recommendations on emergency care for this category of patients. Methods: We will conduct several searches in the L·OVE (Living Overview of Evidence) platform for COVID-19, a system that performs automated regular searches in PubMed, Embase, Cochrane Central Register of Controlled Trials, and over 30 other sources. The search results will be presented according to PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis). This review will preferentially consider systematic reviews of diagnostic test accuracy studies, as well as individual studies of such design, if not included in the systematic reviews, that assessed the sensitivity and specificity of chest CT in emergency trauma surgery patients. Critical appraisal of the included studies for risk of bias will be conducted. Data will be extracted using a standardized data extraction tool. Findings will be summarized narratively, and the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach will be used to grade the certainty of evidence. Results: Ethics approval is not required for this systematic review, as there will be no patient involvement. The search for this systematic review commenced in October 2020, and we expect to publish the findings in early 2021. The plan for dissemination is to publish the findings in a peer-reviewed journal and present our results at conferences that engage the most pertinent stakeholders. Conclusions: During the COVID-19 pandemic, protecting health care workers from infection is essential. Up-to-date information on the efficacy of diagnostic tests for detecting COVID-19 is essential. This review will serve an important role as a thorough summary to inform evidence-based recommendations on establishing effective policy and clinical guideline recommendations. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42020198267; https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=198267 International Registered Report Identifier (IRRID): PRR1-10.2196/25207 %M 33878019 %R 10.2196/25207 %U https://www.researchprotocols.org/2021/5/e25207 %U https://doi.org/10.2196/25207 %U http://www.ncbi.nlm.nih.gov/pubmed/33878019 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 5 %P e28352 %T YouTube Videos and Informed Decision-Making About COVID-19 Vaccination: Successive Sampling Study %A Basch,Charles E %A Basch,Corey H %A Hillyer,Grace C %A Meleo-Erwin,Zoe C %A Zagnit,Emily A %+ Teachers College, Columbia University, 525 W 120th St, New York, NY, 10027, United States, 1 212 678 3983, ceb35@columbia.edu %K YouTube %K vaccination %K COVID-19 %K social media %K communication %K misinformation %K disinformation %K adverse reactions %D 2021 %7 6.5.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Social media platforms such as YouTube are used by many people to seek and share health-related information that may influence their decision-making about COVID-19 vaccination. Objective: The purpose of this study was to improve the understanding about the sources and content of widely viewed YouTube videos on COVID-19 vaccination. Methods: Using the keywords “coronavirus vaccination,” we searched for relevant YouTube videos, sorted them by view count, and selected two successive samples (with replacement) of the 100 most widely viewed videos in July and December 2020, respectively. Content related to COVID-19 vaccines were coded by two observers, and inter-rater reliability was demonstrated. Results: The videos observed in this study were viewed over 55 million times cumulatively. The number of videos that addressed fear increased from 6 in July to 20 in December 2020, and the cumulative views correspondingly increased from 2.6% (1,449,915 views) to 16.6% (9,553,368 views). There was also a large increase in the number of videos and cumulative views with respect to concerns about vaccine effectiveness, from 6 videos with approximately 6 million views in July to 25 videos with over 12 million views in December 2020. The number of videos and total cumulative views covering adverse reactions almost tripled, from 11 videos with approximately 6.5 million (11.7% of cumulative views) in July to 31 videos with almost 15.7 million views (27.2% of cumulative views) in December 2020. Conclusions: Our data show the potentially inaccurate and negative influence social media can have on population-wide vaccine uptake, which should be urgently addressed by agencies of the United States Public Health Service as well as its global counterparts. %M 33886487 %R 10.2196/28352 %U https://publichealth.jmir.org/2021/5/e28352 %U https://doi.org/10.2196/28352 %U http://www.ncbi.nlm.nih.gov/pubmed/33886487 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 5 %P e25714 %T Using a Secure, Continually Updating, Web Source Processing Pipeline to Support the Real-Time Data Synthesis and Analysis of Scientific Literature: Development and Validation Study %A Vaghela,Uddhav %A Rabinowicz,Simon %A Bratsos,Paris %A Martin,Guy %A Fritzilas,Epameinondas %A Markar,Sheraz %A Purkayastha,Sanjay %A Stringer,Karl %A Singh,Harshdeep %A Llewellyn,Charlie %A Dutta,Debabrata %A Clarke,Jonathan M %A Howard,Matthew %A , %A Serban,Ovidiu %A Kinross,James %+ Data Science Institute, Imperial College London, William Penney Laboratory, South Kensington Campus, London, United Kingdom, o.serban@imperial.ac.uk %K structured data synthesis %K data science %K critical analysis %K web crawl data %K pipeline %K database %K literature %K research %K COVID-19 %K infodemic %K decision making %K data %K data synthesis %K misinformation %K infrastructure %K methodology %D 2021 %7 6.5.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The scale and quality of the global scientific response to the COVID-19 pandemic have unquestionably saved lives. However, the COVID-19 pandemic has also triggered an unprecedented “infodemic”; the velocity and volume of data production have overwhelmed many key stakeholders such as clinicians and policy makers, as they have been unable to process structured and unstructured data for evidence-based decision making. Solutions that aim to alleviate this data synthesis–related challenge are unable to capture heterogeneous web data in real time for the production of concomitant answers and are not based on the high-quality information in responses to a free-text query. Objective: The main objective of this project is to build a generic, real-time, continuously updating curation platform that can support the data synthesis and analysis of a scientific literature framework. Our secondary objective is to validate this platform and the curation methodology for COVID-19–related medical literature by expanding the COVID-19 Open Research Dataset via the addition of new, unstructured data. Methods: To create an infrastructure that addresses our objectives, the PanSurg Collaborative at Imperial College London has developed a unique data pipeline based on a web crawler extraction methodology. This data pipeline uses a novel curation methodology that adopts a human-in-the-loop approach for the characterization of quality, relevance, and key evidence across a range of scientific literature sources. Results: REDASA (Realtime Data Synthesis and Analysis) is now one of the world’s largest and most up-to-date sources of COVID-19–related evidence; it consists of 104,000 documents. By capturing curators’ critical appraisal methodologies through the discrete labeling and rating of information, REDASA rapidly developed a foundational, pooled, data science data set of over 1400 articles in under 2 weeks. These articles provide COVID-19–related information and represent around 10% of all papers about COVID-19. Conclusions: This data set can act as ground truth for the future implementation of a live, automated systematic review. The three benefits of REDASA’s design are as follows: (1) it adopts a user-friendly, human-in-the-loop methodology by embedding an efficient, user-friendly curation platform into a natural language processing search engine; (2) it provides a curated data set in the JavaScript Object Notation format for experienced academic reviewers’ critical appraisal choices and decision-making methodologies; and (3) due to the wide scope and depth of its web crawling method, REDASA has already captured one of the world’s largest COVID-19–related data corpora for searches and curation. %M 33835932 %R 10.2196/25714 %U https://www.jmir.org/2021/5/e25714 %U https://doi.org/10.2196/25714 %U http://www.ncbi.nlm.nih.gov/pubmed/33835932 %0 Journal Article %@ 2561-1011 %I JMIR Publications %V 5 %N 1 %P e25277 %T The Resilience of Cardiac Care Through Virtualized Services During the COVID-19 Pandemic: Case Study of a Heart Function Clinic %A Shah,Amika %A Guessi,Milena %A Wali,Sahr %A Ware,Patrick %A McDonald,Michael %A O'Sullivan,Mary %A Posada,Juan Duero %A Ross,Heather %A Seto,Emily %+ Centre for Global eHealth Innovation, Techna Institute, University Health Network, 190 Elizabeth St, Toronto, ON, M5G 2C4, Canada, 1 4163404800 ext 4765, amika.shah@mail.utoronto.ca %K telemedicine %K telehealth %K digital health %K digital medicine %K COVID-19 %K coronavirus %K SARS-CoV-2 %K public health %K surveillance %K outbreak %K pandemic %K infectious disease %K cardiology %K patient %K organizational innovation %K organizational objectives %K global health %K resilience %D 2021 %7 5.5.2021 %9 Original Paper %J JMIR Cardio %G English %X Background: Virtual care has historically faced barriers to widespread adoption. However, the COVID-19 pandemic has necessitated the rapid adoption and expansion of virtual care technologies. Although the intense and prolonged nature of the COVID-19 pandemic has renewed people’s interest in health systems resilience, which includes how services adapt or transform in response to shocks, evidence regarding the role of virtual care technologies in health systems resilience is scarce. Objective: At Toronto General Hospital in Ontario, Canada, the rapid virtualization of cardiac care began on March 9, 2020, as a response to the pandemic. The objective of this study was to understand people’s experiences with and the barriers and facilitators of the rapid virtualization and expansion of cardiac care resulting from the pandemic. Methods: A single-case study was conducted with 3 embedded units of analysis. Patients, clinicians, and staff were recruited purposively from an existing mobile, phone-based telemonitoring program at a heart function clinic in Toronto, Canada. Individual, semistructured phone interviews were conducted by two researchers and transcribed verbatim. An inductive thematic analysis at the semantic level was used to analyze transcripts and develop themes. Results: A total of 29 participants were interviewed, including patients (n=16), clinicians (n=9), and staff (n=4). The following five themes were identified: (1) patient safety as a catalyst for virtual care adoption; (2) piecemeal virtual care solutions; (3) confronting new roles and workloads; (4) missing pieces in virtual care; and (5) the inequity paradox. The motivation to protect patient safety and a piecemeal approach to virtual care adoption facilitated the absorptive and adaptive resilience of cardiac care during the COVID-19 pandemic. However, ad hoc changes to clinic roles and workflows, challenges in building relationships through remote methods, and widened inequities were barriers that threatened virtual care sustainment. Conclusions: We contend that sustaining virtual care hinges upon transformative actions (rather than adaptive actions) that strengthen health systems so that they can face the dynamic and emergent challenges associated with COVID-19 and other shocks. Based on the barriers and facilitators we identified, we present the lessons we learned and recommend transformations for sustaining virtual care during and beyond the COVID-19 pandemic. %M 33878021 %R 10.2196/25277 %U https://cardio.jmir.org/2021/1/e25277 %U https://doi.org/10.2196/25277 %U http://www.ncbi.nlm.nih.gov/pubmed/33878021 %0 Journal Article %@ 2562-0959 %I JMIR Publications %V 4 %N 1 %P e25999 %T Evaluating the Experiences of New and Existing Teledermatology Patients During the COVID-19 Pandemic: Cross-sectional Survey Study %A Hamad,Judy %A Fox,Amy %A Kammire,Maria Suzanne %A Hollis,Alison Nancy %A Khairat,Saif %+ Carolina Health Informatics Program, University of North Carolina at Chapel Hill, 428 Carrington Hall, Chapel Hill, NC, 27514, United States, 1 9198435416, saif@unc.edu %K teledermatology %K telehealth %K patient satisfaction %K patient-centered outcomes %K COVID-19 %K dermatology %K implementation %K virtual health %K digital health %K cross-sectional %D 2021 %7 5.5.2021 %9 Original Paper %J JMIR Dermatol %G English %X Background: As teledermatology has been widely adopted during the COVID-19 pandemic, it is essential to examine patients’ experiences and satisfaction with teledermatology. Objective: We aimed to assess the teledermatology experiences of new and existing clinic patients in the context of the rapid shift toward teledermatology practices during the COVID-19 pandemic. Methods: We conducted a cross-sectional study of 184 teledermatology patients who were assessed during the COVID-19 pandemic at a major southeastern medical center from May 13 to June 5, 2020. The primary outcome was patient satisfaction levels among new and existing patients. The secondary outcome was patients’ willingness to use teledermatology in the future. Results: Of the 288 teledermatology patients who were assessed during the study period, 184 (63.9%) completed the survey. Patients reported high overall satisfaction with teledermatology, with 86.4% (159/184) of participants reporting positive overall satisfaction and experiences with teledermatology. New patients had significantly higher Likert scores for overall satisfaction with teledermatology than those of follow-up patients (new patients: mean 4.70; existing patients: mean 4.43; P=.03). Overall, patients’ satisfaction with teledermatology did not significantly differ based on age (P=.36), race and ethnicity (P=.46), education level (P=.11), residence (P=.74), or insurance status (P=.74). There were no significant differences in overall satisfaction between patients with and without prior telehealth experience (P=.53), between the video and telephone visit types (P=.17), and among platform types (P=.22). Prior telehealth experience was associated with higher odds of being willing to use telehealth in the future (odds ratio 2.39, 95% CI 1.31-4.35; P=.004). Conclusions: This cross-sectional survey study demonstrates that during the rapid expansion of teledermatology, new clinic patients had significantly higher scores for overall satisfaction with their teledermatology experience compared to those of established clinic patients (P=.03). Prior telehealth experience was associated with higher odds of being willing to use teledermatology in the future. Overall, teledermatology expansion was met with high levels of patient satisfaction during the COVID-19 pandemic. %M 34028471 %R 10.2196/25999 %U https://derma.jmir.org/2021/1/e25999 %U https://doi.org/10.2196/25999 %U http://www.ncbi.nlm.nih.gov/pubmed/34028471 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 5 %P e26590 %T A Resilience-Building App to Support the Mental Health of Health Care Workers in the COVID-19 Era: Design Process, Distribution, and Evaluation %A Golden,Eddye A %A Zweig,Micol %A Danieletto,Matteo %A Landell,Kyle %A Nadkarni,Girish %A Bottinger,Erwin %A Katz,Lindsay %A Somarriba,Ricardo %A Sharma,Vansh %A Katz,Craig L %A Marin,Deborah B %A DePierro,Jonathan %A Charney,Dennis S %+ Hasso Plattner Institute for Digital Health at Mount Sinai, Icahn School of Medicine at Mount Sinai, 770 Lexington Avenue, 14th Fl, New York, NY, 10065, United States, 1 4014398798, eddye.golden@mssm.edu %K mHealth %K resilience %K mental health %K COVID-19 %K HCWs %K digital health %K health app %K mental health platform %K mobile phone %D 2021 %7 5.5.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic has resulted in increased strain on health care systems and negative psychological effects on health care workers (HCWs). This is anticipated to result in long-term negative mental health effects on the population, with HCWs representing a particularly vulnerable group. The scope of the COVID-19 pandemic necessitates the development of a scalable mental health platform to provide services to large numbers of at-risk or affected individuals. The Mount Sinai Health System in New York City was at the epicenter of the pandemic in the United States. Objective: The Center for Stress, Resilience, and Personal Growth (CSRPG) was created to address the current and anticipated psychological impact of the pandemic on the HCWs in the health system. The mission of the Center is to support the resilience and mental health of employees through educational offerings, outreach, and clinical care. Our aim was to build a mobile app to support the newly founded Center in its mission. Methods: We built the app as a standalone digital platform that hosts a suite of tools that users can interact with on a daily basis. With consideration for the Center’s aims, we determined the overall vision, initiatives, and goals for the Wellness Hub app, followed by specific milestone tasks and deliverables for development. We defined the app’s primary features based on the mental health assessment and needs of HCWs. Feature definition was informed by the results of a resilience survey widely distributed to Mount Sinai HCWs and by the resources offered at CSRPG, including workshop content. Results: We launched our app over the course of two phases, the first phase being a “soft” launch and the second being a broader launch to all of Mount Sinai. Of the 231 HCWs who downloaded the app, 173 (74.9%) completed our baseline assessment of all mental health screeners in the app. Results from the baseline assessment show that more than half of the users demonstrate a need for support in at least one psychological area. As of 3 months after the Phase 2 launch, approximately 55% of users re-entered the app after their first opening to explore additional features, with an average of 4 app openings per person. Conclusions: To address the mental health needs of HCWs during the COVID-19 pandemic, the Wellness Hub app was built and deployed throughout the Mount Sinai Health System. To our knowledge, this is the first resilience app of its kind. The Wellness Hub app is a promising proof of concept, with room to grow, for those who wish to build a secure mobile health app to support their employees, communities, or others in managing and improving mental and physical well-being. It is a novel tool offering mental health support broadly. %M 33872189 %R 10.2196/26590 %U https://formative.jmir.org/2021/5/e26590 %U https://doi.org/10.2196/26590 %U http://www.ncbi.nlm.nih.gov/pubmed/33872189 %0 Journal Article %@ 2563-6316 %I JMIR Publications %V 2 %N 2 %P e20617 %T Why We Are Losing the War Against COVID-19 on the Data Front and How to Reverse the Situation %A Prieto-Merino,David %A Bebiano Da Providencia E Costa,Rui %A Bacallao Gallestey,Jorge %A Sofat,Reecha %A Chung,Sheng-Chia %A Potts,Henry %+ Faculty of Epidemiology & Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E7HT, United Kingdom, 44 07872619981, david.prieto@lshtm.ac.uk %K COVID-19 %K learning health systems %D 2021 %7 5.5.2021 %9 Viewpoint %J JMIRx Med %G English %X With over 117 million COVID-19–positive cases declared and the death count approaching 3 million, we would expect that the highly digitalized health systems of high-income countries would have collected, processed, and analyzed large quantities of clinical data from patients with COVID-19. Those data should have served to answer important clinical questions such as: what are the risk factors for becoming infected? What are good clinical variables to predict prognosis? What kinds of patients are more likely to survive mechanical ventilation? Are there clinical subphenotypes of the disease? All these, and many more, are crucial questions to improve our clinical strategies against the epidemic and save as many lives as possible. One might assume that in the era of big data and machine learning, there would be an army of scientists crunching petabytes of clinical data to answer these questions. However, nothing could be further from the truth. Our health systems have proven to be completely unprepared to generate, in a timely manner, a flow of clinical data that could feed these analyses. Despite gigabytes of data being generated every day, the vast quantity is locked in secure hospital data servers and is not being made available for analysis. Routinely collected clinical data are, by and large, regarded as a tool to inform decisions about individual patients, and not as a key resource to answer clinical questions through statistical analysis. The initiatives to extract COVID-19 clinical data are often promoted by private groups of individuals and not by health systems, and are uncoordinated and inefficient. The consequence is that we have more clinical data on COVID-19 than on any other epidemic in history, but we have failed to analyze this information quickly enough to make a difference. In this viewpoint, we expose this situation and suggest concrete ideas that health systems could implement to dynamically analyze their routine clinical data, becoming learning health systems and reversing the current situation. %M 34042100 %R 10.2196/20617 %U https://xmed.jmir.org/2021/2/e20617 %U https://doi.org/10.2196/20617 %U http://www.ncbi.nlm.nih.gov/pubmed/34042100 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 5 %P e26932 %T Analysis of COVID-19 Transmission Sources in France by Self-Assessment Before and After the Partial Lockdown: Observational Study %A Denis,Fabrice %A Septans,Anne-Lise %A Le Goff,Florian %A Jeanneau,Stephan %A Lescure,François-Xavier %+ Inter-regional Cancer Institut Jean Bernard - ELSAN, 9 Rue Beauverger, Le Mans, , France, 33 0684190480, fabrice.denis.home@gmail.com %K COVID-19 %K web application %K digital health %K analysis %K transmission %K France %K self-assessment %K lockdown %K observational %K survey %K impact %K public health %D 2021 %7 4.5.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: We developed a questionnaire on a web application for analyzing COVID-19 contamination circumstances in France during the second wave of the pandemic. Objective: This study aims to analyze the impact on contamination characteristics before and after the second partial lockdown in France to adapt public health restrictions to further prevent pandemic surges. Methods: Between December 15 and 24, 2020, after a national media campaign, users of the sourcecovid.fr web application were asked questions about their own or a close relative’s COVID-19 contamination after August 15, 2020, in France. The data of the contamination’s circumstances were assessed and compared before and after the second partial lockdown, which occurred on October 25, 2020, during the second wave of the pandemic and was ongoing on December 24, 2020. Results: As of December 24, 2020, 441,000 connections on the web application were observed. A total of 2218 questionnaires were assessable for analysis. About 61.8% (n=1309) of the participants were sure of their contamination origin, and 38.2% (n=809) thought they knew it. The median age of users was 43.0 (IQR 32-56) years, and 50.7% (n=1073) were male. The median incubation time of the assessed cohort was 4.0 (IQR 3-5) days. Private areas (family’s or friend’s house) were the main source of contamination (1048/2090, 50.2%), followed by work colleagues (579/2090, 27.7%). The main time of day for the contamination was the evening (339/961, 35.3%) before the lockdown and was reduced to 18.2% (86/473) after the lockdown (P<.001). The person who transmitted the virus to the user before and after the lockdown was significantly different (P<.001): a friend (382/1317, 29% vs 109/773, 14.1%), a close relative (304/1317, 23.1% vs 253/773, 32.7%), or a work colleague (315/1317, 23.9% vs 264/773, 34.2%). The main location where the virus was transmitted to the users before and after the lockdown was significantly different too (P<.001): home (278/1305, 21.3% vs 194/760, 25.5%), work (293/1305, 22.5% vs 225/760, 29.6%), collective places (430/1305, 33% vs 114/760, 15%), and care centers (58/1305, 4.4% vs 74/760, 9.7%). Conclusions: Modalities of transmissions significantly changed before and after the second lockdown in France. The main sources of contamination remained the private areas and with work colleagues. Work became the main location of contamination after the lockdown, whereas contaminations in collective places were strongly reduced. Trial Registration: ClinicalTrials.gov NCT04670003; https://clinicaltrials.gov/ct2/show/NCT04670003 %M 33878018 %R 10.2196/26932 %U https://www.jmir.org/2021/5/e26932 %U https://doi.org/10.2196/26932 %U http://www.ncbi.nlm.nih.gov/pubmed/33878018 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 5 %P e22933 %T Information-Seeking Patterns During the COVID-19 Pandemic Across the United States: Longitudinal Analysis of Google Trends Data %A Mangono,Tichakunda %A Smittenaar,Peter %A Caplan,Yael %A Huang,Vincent S %A Sutermaster,Staci %A Kemp,Hannah %A Sgaier,Sema K %+ Surgo Ventures, 1701 Rhode Island Ave NW, Washington, DC, 20036, United States, 1 8579397670, tichmangono@surgoventures.org %K Google Trends %K coronavirus %K COVID-19 %K principal component analysis %K information-seeking trends %K information retrieval %K trend %K infodemiology %K infoveillance %K virus %K public health %K information seeking %K online health information %D 2021 %7 3.5.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic has impacted people’s lives at unprecedented speed and scale, including how they eat and work, what they are concerned about, how much they move, and how much they can earn. Traditional surveys in the area of public health can be expensive and time-consuming, and they can rapidly become outdated. The analysis of big data sets (such as electronic patient records and surveillance systems) is very complex. Google Trends is an alternative approach that has been used in the past to analyze health behaviors; however, most existing studies on COVID-19 using these data examine a single issue or a limited geographic area. This paper explores Google Trends as a proxy for what people are thinking, needing, and planning in real time across the United States. Objective: We aimed to use Google Trends to provide both insights into and potential indicators of important changes in information-seeking patterns during pandemics such as COVID-19. We asked four questions: (1) How has information seeking changed over time? (2) How does information seeking vary between regions and states? (3) Do states have particular and distinct patterns in information seeking? (4) Do search data correlate with—or precede—real-life events? Methods: We analyzed searches on 38 terms related to COVID-19, falling into six themes: social and travel; care seeking; government programs; health programs; news and influence; and outlook and concerns. We generated data sets at the national level (covering January 1, 2016, to April 15, 2020) and state level (covering January 1 to April 15, 2020). Methods used include trend analysis of US search data; geographic analyses of the differences in search popularity across US states from March 1 to April 15, 2020; and principal component analysis to extract search patterns across states. Results: The data showed high demand for information, corresponding with increasing searches for coronavirus linked to news sources regardless of the ideological leaning of the news source. Changes in information seeking often occurred well in advance of action by the federal government. The popularity of searches for unemployment claims predicted the actual spike in weekly claims. The increase in searches for information on COVID-19 care was paralleled by a decrease in searches related to other health behaviors, such as urgent care, doctor’s appointments, health insurance, Medicare, and Medicaid. Finally, concerns varied across the country; some search terms were more popular in some regions than in others. Conclusions: COVID-19 is unlikely to be the last pandemic faced by the United States. Our research holds important lessons for both state and federal governments in a fast-evolving situation that requires a finger on the pulse of public sentiment. We suggest strategic shifts for policy makers to improve the precision and effectiveness of non-pharmaceutical interventions and recommend the development of a real-time dashboard as a decision-making tool. %M 33878015 %R 10.2196/22933 %U https://www.jmir.org/2021/5/e22933 %U https://doi.org/10.2196/22933 %U http://www.ncbi.nlm.nih.gov/pubmed/33878015 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 4 %P e27341 %T Emotions of COVID-19: Content Analysis of Self-Reported Information Using Artificial Intelligence %A Adikari,Achini %A Nawaratne,Rashmika %A De Silva,Daswin %A Ranasinghe,Sajani %A Alahakoon,Oshadi %A Alahakoon,Damminda %+ Research Centre for Data Analytics and Cognition, La Trobe University, Kingsbury Drive, Melbourne, Australia, 61 394793109, A.Adikari@latrobe.edu.au %K COVID-19 %K pandemic %K lockdown %K human emotions %K affective computing %K human-centric artificial intelligence %K artificial intelligence %K AI %K machine learning %K natural language processing %K language modeling %K infodemiology %K infoveillance %D 2021 %7 30.4.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic has disrupted human societies around the world. This public health emergency was followed by a significant loss of human life; the ensuing social restrictions led to loss of employment, lack of interactions, and burgeoning psychological distress. As physical distancing regulations were introduced to manage outbreaks, individuals, groups, and communities engaged extensively on social media to express their thoughts and emotions. This internet-mediated communication of self-reported information encapsulates the emotional health and mental well-being of all individuals impacted by the pandemic. Objective: This research aims to investigate the human emotions related to the COVID-19 pandemic expressed on social media over time, using an artificial intelligence (AI) framework. Methods: Our study explores emotion classifications, intensities, transitions, and profiles, as well as alignment to key themes and topics, across the four stages of the pandemic: declaration of a global health crisis (ie, prepandemic), the first lockdown, easing of restrictions, and the second lockdown. This study employs an AI framework comprised of natural language processing, word embeddings, Markov models, and the growing self-organizing map algorithm, which are collectively used to investigate social media conversations. The investigation was carried out using 73,000 public Twitter conversations posted by users in Australia from January to September 2020. Results: The outcomes of this study enabled us to analyze and visualize different emotions and related concerns that were expressed and reflected on social media during the COVID-19 pandemic, which could be used to gain insights into citizens’ mental health. First, the topic analysis showed the diverse as well as common concerns people had expressed during the four stages of the pandemic. It was noted that personal-level concerns expressed on social media had escalated to broader concerns over time. Second, the emotion intensity and emotion state transitions showed that fear and sadness emotions were more prominently expressed at first; however, emotions transitioned into anger and disgust over time. Negative emotions, except for sadness, were significantly higher (P<.05) in the second lockdown, showing increased frustration. Temporal emotion analysis was conducted by modeling the emotion state changes across the four stages of the pandemic, which demonstrated how different emotions emerged and shifted over time. Third, the concerns expressed by social media users were categorized into profiles, where differences could be seen between the first and second lockdown profiles. Conclusions: This study showed that the diverse emotions and concerns that were expressed and recorded on social media during the COVID-19 pandemic reflected the mental health of the general public. While this study established the use of social media to discover informed insights during a time when physical communication was impossible, the outcomes could also contribute toward postpandemic recovery and understanding psychological impact via emotion changes, and they could potentially inform health care decision making. This study exploited AI and social media to enhance our understanding of human behaviors in global emergencies, which could lead to improved planning and policy making for future crises. %M 33819167 %R 10.2196/27341 %U https://www.jmir.org/2021/4/e27341 %U https://doi.org/10.2196/27341 %U http://www.ncbi.nlm.nih.gov/pubmed/33819167 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 7 %N 2 %P e25903 %T The United States Medical Licensing Exam Step 2 Clinical Skills Examination: Potential Alternatives During and After the COVID-19 Pandemic %A Fatima,Rawish %A Assaly,Ahmad R %A Aziz,Muhammad %A Moussa,Mohamad %A Assaly,Ragheb %+ Department of Internal Medicine, University of Toledo Medical Center, 2100 W Central Avenue, Toledo, OH, 43606, United States, 1 5674201613, rawish.f@gmail.com %K USMLE %K United States Medical Licensing Examination %K The National Resident Matching Program %K NRMP %K Step 2 Clinical Skills %K Step 2 CS %K medical school %K medical education %K test %K medical student %K United States %K online learning %K exam %K alternative %K model %K COVID-19 %D 2021 %7 30.4.2021 %9 Viewpoint %J JMIR Med Educ %G English %X We feel that the current COVID-19 crisis has created great uncertainty and anxiety among medical students. With medical school classes initially being conducted on the web and the approaching season of “the Match” (a uniform system by which residency candidates and residency programs in the United States simultaneously “match” with the aid of a computer algorithm to fill first-year and second-year postgraduate training positions accredited by the Accreditation Council for Graduate Medical Education), the situation did not seem to be improving. The National Resident Matching Program made an official announcement on May 26, 2020, that candidates would not be required to take or pass the United States Medical Licensing Examination Step 2 Clinical Skills (CS) examination to participate in the Match. On January 26, 2021, formal discontinuation of Step 2 CS was announced; for this reason, we have provided our perspective of possible alternative solutions to the Step 2 CS examination. A successful alternative model can be implemented in future residency match seasons as well. %M 33878014 %R 10.2196/25903 %U https://mededu.jmir.org/2021/2/e25903 %U https://doi.org/10.2196/25903 %U http://www.ncbi.nlm.nih.gov/pubmed/33878014 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 4 %P e24316 %T A Peer-to-Peer Live-Streaming Intervention for Children During COVID-19 Homeschooling to Promote Physical Activity and Reduce Anxiety and Eye Strain: Cluster Randomized Controlled Trial %A Zheng,Yingfeng %A Wang,Wei %A Zhong,Yuxin %A Wu,Fengchun %A Zhu,Zhuoting %A Tham,Yih-Chung %A Lamoureux,Ecosse %A Xiao,Liang %A Zhu,Erta %A Liu,Haoning %A Jin,Ling %A Liang,Linyi %A Luo,Lixia %A He,Mingguang %A Morgan,Ian %A Congdon,Nathan %A Liu,Yizhi %+ State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, No 7 Jinsui Rd, Room 509, Zhujiang New Town, Guangzhou, 510060, China, 86 13922286455, yingfeng.zheng@qq.com %K homeschooling %K children %K anxiety, digital eye strain %K peer to peer %K live streaming %K digital health %K intervention %K health information %K physical activity %K COVID-19 %K online learning %K behavior %K app %K mobile phone %D 2021 %7 30.4.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic has led to worldwide school closures, with millions of children confined to online learning at home. As a result, children may be susceptible to anxiety and digital eye strain, highlighting a need for population interventions. Objective: The objective of our study was to investigate whether a digital behavior change intervention aimed at promoting physical activity could reduce children’s anxiety and digital eye strain while undergoing prolonged homeschooling during the COVID-19 pandemic. Methods: In this cluster randomized controlled trial, homeschooled grade 7 students at 12 middle schools in southern China were recruited through local schools and randomly assigned by the school to receive (1:1 allocation): (1) health education information promoting exercise and ocular relaxation, and access to a digital behavior change intervention, with live streaming and peer sharing of promoted activities (intervention), or (2) health education information only (control). The primary outcome was change in self-reported anxiety score. Secondary outcomes included change in self-reported eye strain and sleep quality. Results: On March 16, 2020, 1009 children were evaluated, and 954 (94.5%) eligible children of consenting families were included in the intention-to-treat analysis. Children in the intervention (n=485, 6 schools) and control (n=469, 6 schools) groups were aged 13.5 (SD 0.5) years, and 52.3% (n=499) were male. The assigned interventions were completed by 896 children (intervention: n=467, 96.3%; control: n=429, 91.5%). The 2-week change in square-root–transformed self-reported anxiety scores was greater in the intervention (–0.23, 95% CI –0.27 to –0.20) vs control group (0.12, 95% CI 0.09-0.16; unadjusted difference –0.36, 95% CI –0.63 to –0.08; P=.02). There was a significant reduction in square-root–transformed eye strain in the intervention group (–0.08, 95% CI –0.10 to 0.06) compared to controls (0.07, 95% CI 0.05-0.09; difference –0.15, 95% CI –0.26 to –0.03; P=.02). Change in sleep quality was similar between the two groups. Conclusions: This digital behavior change intervention reduced children’s anxiety and eye strain during COVID-19–associated online schooling. Trial Registration: ClinicalTrials.gov NCT04309097; http://clinicaltrials.gov/ct2/show/NCT04309097 %M 33882021 %R 10.2196/24316 %U https://www.jmir.org/2021/4/e24316 %U https://doi.org/10.2196/24316 %U http://www.ncbi.nlm.nih.gov/pubmed/33882021 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 4 %P e25075 %T Use of a Telemedicine Risk Assessment Tool to Predict the Risk of Hospitalization of 496 Outpatients With COVID-19: Retrospective Analysis %A O'Keefe,James B %A Tong,Elizabeth J %A Taylor Jr,Thomas H %A O’Keefe,Ghazala A Datoo %A Tong,David C %+ Division of General Internal Medicine, Department of Medicine, Emory University School of Medicine, 1365 Clifton Rd NE, Building A, Atlanta, GA, 30322, United States, 1 4047780480, jbokeef@emory.edu %K COVID-19 %K SARS-CoV-2 %K nonhospitalized %K risk assessment %K outpatient %K outcomes %K telemedicine %D 2021 %7 30.4.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Risk assessment of patients with acute COVID-19 in a telemedicine context is not well described. In settings of large numbers of patients, a risk assessment tool may guide resource allocation not only for patient care but also for maximum health care and public health benefit. Objective: The goal of this study was to determine whether a COVID-19 telemedicine risk assessment tool accurately predicts hospitalizations. Methods: We conducted a retrospective study of a COVID-19 telemedicine home monitoring program serving health care workers and the community in Atlanta, Georgia, with enrollment from March 24 to May 26, 2020; the final call range was from March 27 to June 19, 2020. All patients were assessed by medical providers using an institutional COVID-19 risk assessment tool designating patients as Tier 1 (low risk for hospitalization), Tier 2 (intermediate risk for hospitalization), or Tier 3 (high risk for hospitalization). Patients were followed with regular telephone calls to an endpoint of improvement or hospitalization. Using survival analysis by Cox regression with days to hospitalization as the metric, we analyzed the performance of the risk tiers and explored individual patient factors associated with risk of hospitalization. Results: Providers using the risk assessment rubric assigned 496 outpatients to tiers: Tier 1, 237 out of 496 (47.8%); Tier 2, 185 out of 496 (37.3%); and Tier 3, 74 out of 496 (14.9%). Subsequent hospitalizations numbered 3 out of 237 (1.3%) for Tier 1, 15 out of 185 (8.1%) for Tier 2, and 17 out of 74 (23%) for Tier 3. From a Cox regression model with age of 60 years or older, gender, and reported obesity as covariates, the adjusted hazard ratios for hospitalization using Tier 1 as reference were 3.74 (95% CI 1.06-13.27; P=.04) for Tier 2 and 10.87 (95% CI 3.09-38.27; P<.001) for Tier 3. Conclusions: A telemedicine risk assessment tool prospectively applied to an outpatient population with COVID-19 identified populations with low, intermediate, and high risk of hospitalization. %M 33667174 %R 10.2196/25075 %U https://publichealth.jmir.org/2021/4/e25075 %U https://doi.org/10.2196/25075 %U http://www.ncbi.nlm.nih.gov/pubmed/33667174 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 4 %P e25541 %T Transitioning to Remote Clinic Visits in a Smoking Cessation Trial During the COVID-19 Pandemic: Mixed Methods Evaluation %A Mahoney,Martin Christopher %A Park,Eunhee %A Schlienz,Nicolas J %A Duerr,CeCe %A Hawk,Larry W %+ Roswell Park Cancer Institute, Elm & Carlton Streets, Buffalo, NY, 14263, United States, 1 7168453099, martin.mahoney@roswellpark.org %K smoking %K cessation %K clinical trial %K telehealth %K COVID-19 %K coronavirus %K telemedicine %K conferencing %K mixed methods %K experience %K patient %D 2021 %7 30.4.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The pandemic of SARS-CoV-2, which causes COVID-19, has caused disruptions in ongoing clinical trials and is expected to accelerate interest in conducting research studies remotely. Objective: A quasi-experimental, mixed methods approach was used to examine the rates of visit completion as well as the opinions and experiences of participants enrolled in an ongoing clinical trial of smoking cessation who were required to change from in-person clinic visits to remote visits using video or telephone conferencing due to the COVID-19 pandemic. Methods: For quantitative comparisons, we used a quasi-experimental design, comparing a cohort of participants followed during the pandemic (n=23, COVID-19 cohort) to a comparable cohort of participants followed over a similar time period in the calendar years 2018 and 2019 (n=51, pre–COVID-19 cohort) to examine the rates of completion of scheduled visits and biospecimen collection. For the qualitative component, interviews were conducted with participants who experienced the transition from in-person to remote visits. Results: Participants in the COVID-19 cohort completed an average of 83.6% of remote clinic visits (95% CI 73.1%-91.2%), which was not significantly different than the in-person completion rate of 89.8% in the pre–COVID-19 cohort. Participants in the COVID-19 cohort returned an average of 93.2% (95% CI 83.5%-98.1%) of saliva specimens for remote clinic visits completed, which was not significantly different than the in-person saliva specimen completion rate of 100% in the pre–COVID-19 cohort. Two broad themes emerged from the qualitative data: (1) the benefits of remote visits and (2) the challenges of remote counseling compared to in-person counseling. Despite limited experience with telehealth prior to this transition, most participants expressed a willingness to engage in remote visits in the future. Conclusions: Even in the context of a rapid transition from in-person to remote visits necessitated by the COVID-19 pandemic, rates of visit completion and return of biospecimens remained high. Participants were generally accepting of the transition. Further research is needed to identify the optimal mix of in-person and remote visits beyond the pandemic context and to better understand how these changes may impact study outcomes. Trial Registration: ClinicalTrials.gov NCT03262662; https://clinicaltrials.gov/ct2/show/study/NCT03262662 %M 33878020 %R 10.2196/25541 %U https://formative.jmir.org/2021/4/e25541 %U https://doi.org/10.2196/25541 %U http://www.ncbi.nlm.nih.gov/pubmed/33878020 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 4 %P e22983 %T Characterization and Comparison of the Utilization of Facebook Groups Between Public Medical Professionals and Technical Communities to Facilitate Idea Sharing and Crowdsourcing During the COVID-19 Pandemic: Cross-sectional Observational Study %A Xun,Helen %A He,Waverley %A Chen,Jonlin %A Sylvester,Scott %A Lerman,Sheera F %A Caffrey,Julie %+ Department of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine, 733 N Broadway, Baltimore, MD, 21205, United States, 1 (410) 955 5000, jcaffre5@jhmi.edu %K cognitive intelligence %K communication %K COVID-19 %K crowdsourcing %K evidence-based %K Facebook %K Facebook groups %K internet %K social media %K virtual communities %D 2021 %7 30.4.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Strict social distancing measures owing to the COVID-19 pandemic have led people to rely more heavily on social media, such as Facebook groups, as a means of communication and information sharing. Multiple Facebook groups have been formed by medical professionals, laypeople, and engineering or technical groups to discuss current issues and possible solutions to the current medical crisis. Objective: This study aimed to characterize Facebook groups formed by laypersons, medical professionals, and technical professionals, with specific focus on information dissemination and requests for crowdsourcing. Methods: Facebook was queried for user-created groups with the keywords “COVID,” “Coronavirus,” and “SARS-CoV-2” at a single time point on March 31, 2020. The characteristics of each group were recorded, including language, privacy settings, security requirements to attain membership, and membership type. For each membership type, the group with the greatest number of members was selected, and in each of these groups, the top 100 posts were identified using Facebook’s algorithm. Each post was categorized and characterized (evidence-based, crowd-sourced, and whether the poster self-identified). STATA (version 13 SE, Stata Corp) was used for statistical analysis. Results: Our search yielded 257 COVID-19–related Facebook groups. Majority of the groups (n=229, 89%) were for laypersons, 26 (10%) were for medical professionals, and only 2 (1%) were for technical professionals. The number of members was significantly greater in medical groups (21,215, SD 35,040) than in layperson groups (7623, SD 19,480) (P<.01). Medical groups were significantly more likely to require security checks to attain membership (81% vs 43%; P<.001) and less likely to be public (3 vs 123; P<.001) than layperson groups. Medical groups had the highest user engagement, averaging 502 (SD 633) reactions (P<.01) and 224 (SD 311) comments (P<.01) per post. Medical professionals were more likely to use the Facebook groups for education and information sharing, including academic posts (P<.001), idea sharing (P=.003), resource sharing (P=.02) and professional opinions (P<.001), and requesting for crowdsourcing (P=.003). Layperson groups were more likely to share news (P<.001), humor and motivation (P<.001), and layperson opinions (P<.001). There was no significant difference in the number of evidence-based posts among the groups (P=.10). Conclusions: Medical professionals utilize Facebook groups as a forum to facilitate collective intelligence (CI) and are more likely to use Facebook groups for education and information sharing, including academic posts, idea sharing, resource sharing, and professional opinions, which highlights the power of social media to facilitate CI across geographic distances. Layperson groups were more likely to share news, humor, and motivation, which suggests the utilization of Facebook groups to provide comedic relief as a coping mechanism. Further investigations are necessary to study Facebook groups’ roles in facilitating CI, crowdsourcing, education, and community-building. %M 33878013 %R 10.2196/22983 %U https://formative.jmir.org/2021/4/e22983 %U https://doi.org/10.2196/22983 %U http://www.ncbi.nlm.nih.gov/pubmed/33878013 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 4 %P e25410 %T SARS-CoV-2 Infection in Health Care Personnel and Their Household Contacts at a Tertiary Academic Medical Center: Protocol for a Longitudinal Cohort Study %A Ciccone,Emily J %A Zivich,Paul N %A Lodge,Evans K %A Zhu,Deanna %A Law,Elle %A Miller,Elyse %A Taylor,Jasmine L %A Chung,Suemin %A Xu,Jason %A Volfovsky,Alexander %A Beatty,Cherese %A Abernathy,Haley %A King,Elise %A Garrett,Haley E %A Markmann,Alena J %A Rebuli,Meghan E %A Sellers,Subhashini %A Weber,David J %A Reyes,Raquel %A Alavian,Naseem %A Juliano,Jonathan J %A Boyce,Ross M %A Aiello,Allison E %+ Division of Infectious Diseases, School of Medicine, University of North Carolina, 111 Mason Farm Road, MBRB 2341C, CB #7036, Chapel Hill, NC, 27599, United States, 1 919 445 1138, ciccone@med.unc.edu %K SARS-CoV-2 %K COVID-19 %K health personnel %K cohort studies %K Bluetooth contact tracking %K survey-based research %K occupational health %K seroprevalence %K mobile phone %D 2021 %7 30.4.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Health care personnel (HCP) are at high risk for exposure to the SARS-CoV-2 virus. While personal protective equipment (PPE) may mitigate this risk, prospective data collection on its use and other risk factors for seroconversion in this population is needed. Objective: The primary objectives of this study are to (1) determine the incidence of, and risk factors for, SARS-CoV-2 infection among HCP at a tertiary care medical center and (2) actively monitor PPE use, interactions between study participants via electronic sensors, secondary cases in households, and participant mental health and well-being. Methods: To achieve these objectives, we designed a prospective, observational study of SARS-CoV-2 infection among HCP and their household contacts at an academic tertiary care medical center in North Carolina, USA. Enrolled HCP completed frequent surveys on symptoms and work activities and provided serum and nasal samples for SARS-CoV-2 testing every 2 weeks. Additionally, interactions between participants and their movement within the clinical environment were captured with a smartphone app and Bluetooth sensors. Finally, a subset of participants’ households was randomly selected every 2 weeks for further investigation, and enrolled households provided serum and nasal samples via at-home collection kits. Results: As of December 31, 2020, 211 HCP and 53 household participants have been enrolled. Recruitment and follow-up are ongoing and expected to continue through September 2021. Conclusions: Much remains to be learned regarding the risk of SARS-CoV-2 infection among HCP and their household contacts. Through the use of a multifaceted prospective study design and a well-characterized cohort, we will collect critical information regarding SARS-CoV-2 transmission risks in the health care setting and its linkage to the community. International Registered Report Identifier (IRRID): DERR1-10.2196/25410 %M 33769944 %R 10.2196/25410 %U https://www.researchprotocols.org/2021/4/e25410 %U https://doi.org/10.2196/25410 %U http://www.ncbi.nlm.nih.gov/pubmed/33769944 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 7 %N 2 %P e29099 %T Teaching Telemedicine: The Next Frontier for Medical Educators %A Alcocer Alkureishi,Maria %A Lenti,Gena %A Choo,Zi-Yi %A Castaneda,Jason %A Weyer,George %A Oyler,Julie %A Lee,Wei Wei %+ Department of Pediatrics, University of Chicago, 5841 S Maryland Avenue, Chicago, IL, 60637, United States, 1 773 834 8927, malkureishi@peds.bsd.uchicago.edu %K telemedicine %K virtual visits %K patient-centered care %K graduate medical education %K medical education %K telehealth %K virtual health %K graduate students %K education %K COVID-19 %K pandemic %D 2021 %7 29.4.2021 %9 Viewpoint %J JMIR Med Educ %G English %X The COVID-19 pandemic has pushed telemedicine to the forefront of health care delivery, and for many clinicians, virtual visits are the new normal. Although telemedicine has allowed clinicians to safely care for patients from a distance during the current pandemic, its rapid adoption has outpaced clinician training and development of best practices. Additionally, telemedicine has pulled trainees into a new virtual education environment that finds them oftentimes physically separated from their preceptors. Medical educators are challenged with figuring out how to integrate learners into virtual workflows while teaching and providing patient-centered virtual care. In this viewpoint, we review principles of patient-centered care in the in-person setting, explore the concept of patient-centered virtual care, and advocate for the development and implementation of patient-centered telemedicine competencies. We also recommend strategies for teaching patient-centered virtual care, integrating trainees into virtual workflows, and developing telemedicine curricula for graduate medical education trainees by using our TELEMEDS framework as a model. %M 33878011 %R 10.2196/29099 %U https://mededu.jmir.org/2021/2/e29099 %U https://doi.org/10.2196/29099 %U http://www.ncbi.nlm.nih.gov/pubmed/33878011 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 4 %P e28973 %T People’s Willingness to Vaccinate Against COVID-19 Despite Their Safety Concerns: Twitter Poll Analysis %A Eibensteiner,Fabian %A Ritschl,Valentin %A Nawaz,Faisal A %A Fazel,Sajjad S %A Tsagkaris,Christos %A Kulnik,Stefan Tino %A Crutzen,Rik %A Klager,Elisabeth %A Völkl-Kernstock,Sabine %A Schaden,Eva %A Kletecka-Pulker,Maria %A Willschke,Harald %A Atanasov,Atanas G %+ Ludwig Boltzmann Institute for Digital Health and Patient Safety, Medical University of Vienna, Spitalgasse 23, Vienna, 1090, Austria, 43 6641929852, Atanas.Atanasov@dhps.lbg.ac.at %K COVID-19 %K SARS-CoV-2 %K vaccine %K vaccination %K Twitter %K survey %K vaccination willingness %K vaccination hesitancy %K coronavirus %K vaccine confidence %K willingness %K hesitancy %K social media %K safety %K concern %K public health %K opinion %K perception %D 2021 %7 29.4.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: On January 30, 2020, the World Health Organization’s Emergency Committee declared the rapid, worldwide spread of COVID-19 a global health emergency. Since then, tireless efforts have been made to mitigate the spread of the disease and its impact, and these efforts have mostly relied on nonpharmaceutical interventions. By December 2020, the safety and efficacy of the first COVID-19 vaccines were demonstrated. The large social media platform Twitter has been used by medical researchers for the analysis of important public health topics, such as the public’s perception on antibiotic use and misuse and human papillomavirus vaccination. The analysis of Twitter-generated data can be further facilitated by using Twitter’s built-in, anonymous polling tool to gain insight into public health issues and obtain rapid feedback on an international scale. During the fast-paced course of the COVID-19 pandemic, the Twitter polling system has provided a viable method for gaining rapid, large-scale, international public health insights on highly relevant and timely SARS-CoV-2–related topics. Objective: The purpose of this study was to understand the public’s perception on the safety and acceptance of COVID-19 vaccines in real time by using Twitter polls. Methods: We developed 2 Twitter polls to explore the public’s views on available COVID-19 vaccines. The surveys were pinned to the Digital Health and Patient Safety Platform Twitter timeline for 1 week in mid-February 2021, and Twitter users and influencers were asked to participate in and retweet the polls to reach the largest possible audience. Results: The adequacy of COVID-19 vaccine safety (ie, the safety of currently available vaccines; poll 1) was agreed upon by 1579 out of 3439 (45.9%) Twitter users. In contrast, almost as many Twitter users (1434/3439, 41.7%) were unsure about the safety of COVID-19 vaccines. Only 5.2% (179/3439) of Twitter users rated the available COVID-19 vaccines as generally unsafe. Poll 2, which addressed the question of whether users would undergo vaccination, was answered affirmatively by 82.8% (2862/3457) of Twitter users, and only 8% (277/3457) categorically rejected vaccination at the time of polling. Conclusions: In contrast to the perceived high level of uncertainty about the safety of the available COVID-19 vaccines, we observed an elevated willingness to undergo vaccination among our study sample. Since people's perceptions and views are strongly influenced by social media, the snapshots provided by these media platforms represent a static image of a moving target. Thus, the results of this study need to be followed up by long-term surveys to maintain their validity. This is especially relevant due to the circumstances of the fast-paced pandemic and the need to not miss sudden rises in the incidence of vaccine hesitancy, which may have detrimental effects on the pandemic’s course. %M 33872185 %R 10.2196/28973 %U https://www.jmir.org/2021/4/e28973 %U https://doi.org/10.2196/28973 %U http://www.ncbi.nlm.nih.gov/pubmed/33872185 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 9 %N 4 %P e27419 %T Returning to a Normal Life via COVID-19 Vaccines in the United States: A Large-scale Agent-Based Simulation Study %A Li,Junjiang %A Giabbanelli,Philippe %+ Department of Computer Science & Software Engineering, Miami University, 205 Benton Hall, Oxford, OH, 45056, United States, 1 513 529 0147, aqualonne@free.fr %K agent-based model %K cloud-based simulations %K COVID-19 %K large-scale simulations %K vaccine %K model %K simulation %K United States %K agent-based %K effective %K willingness %K capacity %K plan %K strategy %K outcome %K interaction %K intervention %K scenario %K impact %D 2021 %7 29.4.2021 %9 Original Paper %J JMIR Med Inform %G English %X Background: In 2020, COVID-19 has claimed more than 300,000 deaths in the United States alone. Although nonpharmaceutical interventions were implemented by federal and state governments in the United States, these efforts have failed to contain the virus. Following the Food and Drug Administration's approval of two COVID-19 vaccines, however, the hope for the return to normalcy has been renewed. This hope rests on an unprecedented nationwide vaccine campaign, which faces many logistical challenges and is also contingent on several factors whose values are currently unknown. Objective: We study the effectiveness of a nationwide vaccine campaign in response to different vaccine efficacies, the willingness of the population to be vaccinated, and the daily vaccine capacity under two different federal plans. To characterize the possible outcomes most accurately, we also account for the interactions between nonpharmaceutical interventions and vaccines through 6 scenarios that capture a range of possible impacts from nonpharmaceutical interventions. Methods: We used large-scale, cloud-based, agent-based simulations by implementing the vaccination campaign using COVASIM, an open-source agent-based model for COVID-19 that has been used in several peer-reviewed studies and accounts for individual heterogeneity and a multiplicity of contact networks. Several modifications to the parameters and simulation logic were made to better align the model with current evidence. We chose 6 nonpharmaceutical intervention scenarios and applied the vaccination intervention following both the plan proposed by Operation Warp Speed (former Trump administration) and the plan of one million vaccines per day, proposed by the Biden administration. We accounted for unknowns in vaccine efficacies and levels of population compliance by varying both parameters. For each experiment, the cumulative infection growth was fitted to a logistic growth model, and the carrying capacities and the growth rates were recorded. Results: For both vaccination plans and all nonpharmaceutical intervention scenarios, the presence of the vaccine intervention considerably lowers the total number of infections when life returns to normal, even when the population compliance to vaccines is as low as 20%. We noted an unintended consequence; given the vaccine availability estimates under both federal plans and the focus on vaccinating individuals by age categories, a significant reduction in nonpharmaceutical interventions results in a counterintuitive situation in which higher vaccine compliance then leads to more total infections. Conclusions: Although potent, vaccines alone cannot effectively end the pandemic given the current availability estimates and the adopted vaccination strategy. Nonpharmaceutical interventions need to continue and be enforced to ensure high compliance so that the rate of immunity established by vaccination outpaces that induced by infections. %M 33872188 %R 10.2196/27419 %U https://medinform.jmir.org/2021/4/e27419 %U https://doi.org/10.2196/27419 %U http://www.ncbi.nlm.nih.gov/pubmed/33872188 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 4 %P e25987 %T Evaluation of an Intrahospital Telemedicine Program for Patients Admitted With COVID-19: Mixed Methods Study %A Legler,Sean %A Diehl,Matthew %A Hilliard,Brian %A Olson,Andrew %A Markowitz,Rebecca %A Tignanelli,Christopher %A Melton,Genevieve B %A Broccard,Alain %A Kirsch,Jonathan %A Usher,Michael %+ Division of General Internal Medicine, Department of Medicine, University of Minnesota Medical School, 420 Delaware St SE, MMC 741, Minneapolis, MN, 55455, United States, 1 734 223 3450, mgusher@umn.edu %K telemedicine %K hospital medicine %K COVID-19 %K telehealth %K hospital %K mixed methods %K evaluation %K impact %K exposure %K risk %K communication %D 2021 %7 29.4.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The increasing incidence of COVID-19 infection has challenged health care systems to increase capacity while conserving personal protective equipment (PPE) supplies and minimizing nosocomial spread. Telemedicine shows promise to address these challenges but lacks comprehensive evaluation in the inpatient environment. Objective: The aim of this study is to evaluate an intrahospital telemedicine program (virtual care), along with its impact on exposure risk and communication. Methods: We conducted a natural experiment of virtual care on patients admitted for COVID-19. The primary exposure variable was documented use of virtual care. Patient characteristics, PPE use rates, and their association with virtual care use were assessed. In parallel, we conducted surveys with patients and clinicians to capture satisfaction with virtual care along the domains of communication, medical treatment, and exposure risk. Results: Of 137 total patients in our primary analysis, 43 patients used virtual care. In total, there were 82 inpatient days of use and 401 inpatient days without use. Hospital utilization and illness severity were similar in patients who opted in versus opted out. Virtual care was associated with a significant reduction in PPE use and physical exam rate. Surveys of 41 patients and clinicians showed high rates of recommendation for further use, and subjective improvements in communication. However, providers and patients expressed limitations in usability, medical assessment, and empathetic communication. Conclusions: In this pilot natural experiment, only a subset of patients used inpatient virtual care. When used, virtual care was associated with reductions in PPE use, reductions in exposure risk, and patient and provider satisfaction. %M 33872187 %R 10.2196/25987 %U https://www.jmir.org/2021/4/e25987 %U https://doi.org/10.2196/25987 %U http://www.ncbi.nlm.nih.gov/pubmed/33872187 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 4 %P e26940 %T Knowledge About COVID-19 Among Adults in China: Cross-sectional Online Survey %A Yu,Fengyun %A Geldsetzer,Pascal %A Meierkord,Anne %A Yang,Juntao %A Chen,Qiushi %A Jiao,Lirui %A Abou-Arraj,Nadeem E %A Pan,An %A Wang,Chen %A Bärnighausen,Till %A Chen,Simiao %+ Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Im Neuenheimer Feld 130.3, Heidelberg, Germany, 49 15207926273, simiao.chen@uni-heidelberg.de %K COVID-19 %K knowledge %K perception %K risk %K public health %K China %K cross-sectional %K survey %D 2021 %7 29.4.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: A detailed understanding of the public’s knowledge and perceptions of COVID-19 could inform governments’ public health actions in response to the pandemic. Objective: The aim of this study was to determine the knowledge and perceptions of COVID-19 among adults in China and its variation among provinces and by sociodemographic characteristics. Methods: Between May 8 and June 8, 2020, we conducted a cross-sectional online survey among adults in China who were registered with the private survey company KuRunData. We set a target sample size of 10,000 adults, aiming to sample 300-360 adults from each province in China. Participants were asked 25 questions that tested their knowledge about COVID-19, including measures to prevent infection, common symptoms, and recommended care-seeking behavior. We disaggregated responses by age; sex; education; province; household income; rural–urban residency; and whether or not a participant had a family member, friend, or acquaintance who they know to have been infected with SARS-CoV-2. All analyses used survey sampling weights. Results: There were 5079 men and 4921 women who completed the questionnaire and were included in the analysis. Out of 25 knowledge questions, participants answered a mean and median of 21.4 (95% CI 21.3-21.4) and 22 (IQR 20-23) questions correctly, respectively. A total of 83.4% (95% CI 82.7%-84.1%) of participants answered four-fifths or more of the questions correctly. For at least one of four ineffective prevention measures (using a hand dryer, regular nasal irrigation, gargling mouthwash, and taking antibiotics), 68.9% (95% CI 68.0%-69.8%) of participants answered that it was an effective method to prevent a SARS-CoV-2 infection. Although knowledge overall was similar across provinces, the percent of participants who answered the question on recommended care-seeking behavior correctly varied from 47.0% (95% CI 41.4%-52.7%) in Tibet to 87.5% (95% CI 84.1%-91.0%) in Beijing. Within provinces, participants who were male, were middle-aged, were residing in urban areas, and had higher household income tended to answer a higher proportion of the knowledge questions correctly. Conclusions: This online study of individuals across China suggests that the majority of the population has good knowledge of COVID-19. However, a substantial proportion still holds misconceptions or incorrect beliefs about prevention methods and recommended health care–seeking behaviors, especially in rural areas and some less wealthy provinces in Western China. This study can inform the development of tailored public health policies and promotion campaigns by identifying knowledge areas for which misconceptions are comparatively common and provinces that have relatively low knowledge. %M 33844637 %R 10.2196/26940 %U https://www.jmir.org/2021/4/e26940 %U https://doi.org/10.2196/26940 %U http://www.ncbi.nlm.nih.gov/pubmed/33844637 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 4 %P e26558 %T Impact of the COVID-19 Pandemic on Health Care Utilization in a Large Integrated Health Care System: Retrospective Cohort Study %A Xu,Stanley %A Glenn,Sungching %A Sy,Lina %A Qian,Lei %A Hong,Vennis %A Ryan,Denison S %A Jacobsen,Steven %+ Department of Research & Evaluation, Kaiser Permanente Southern California, 100 S Los Robles Ave, 5th Floor, Pasadena, CA, 91101, United States, 1 6263726807, stan.xu@kp.org %K cohort %K COVID-19 %K difference-in-difference analysis %K health care utilization %K health care worker %K impact %K knowledge %K pandemic %K policy %K retrospective %K telehealth %K telemedicine %K usage %K utilization %D 2021 %7 29.4.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic has caused an abrupt reduction in the use of in-person health care, accompanied by a corresponding surge in the use of telehealth services. However, the extent and nature of changes in health care utilization during the pandemic may differ by care setting. Knowledge of the impact of the pandemic on health care utilization is important to health care organizations and policy makers. Objective: The aims of this study are (1) to evaluate changes in in-person health care utilization and telehealth visits during the COVID-19 pandemic and (2) to assess the difference in changes in health care utilization between the pandemic year 2020 and the prepandemic year 2019. Methods: We retrospectively assembled a cohort consisting of members of a large integrated health care organization, who were enrolled between January 6 and November 2, 2019 (prepandemic year), and between January 5 and October 31, 2020 (pandemic year). The rates of visits were calculated weekly for four settings: inpatient, emergency department (ED), outpatient, and telehealth. Using Poisson models, we assessed the impact of the pandemic on health care utilization during the early days of the pandemic and conducted difference-in-deference (DID) analyses to measure the changes in health care utilization, adjusting for the trend of health care utilization in the prepandemic year. Results: In the early days of the pandemic, we observed significant reductions in inpatient, ED, and outpatient utilization (by 30.2%, 37.0%, and 80.9%, respectively). By contrast, there was a 4-fold increase in telehealth visits between weeks 8 (February 23) and 12 (March 22) in 2020. DID analyses revealed that after adjusting for prepandemic secular trends, the reductions in inpatient, ED, and outpatient visit rates in the early days of the pandemic were 1.6, 8.9, and 367.2 visits per 100 person-years (P<.001), respectively, while the increase in telehealth visits was 272.9 visits per 100 person-years (P<.001). Further analyses suggested that the increase in telehealth visits offset the reduction in outpatient visits by week 26 (June 28, 2020). Conclusions: In-person health care utilization decreased drastically during the early period of the pandemic, but there was a corresponding increase in telehealth visits during the same period. By end-June 2020, the combined outpatient and telehealth visits had recovered to prepandemic levels. %M 33882020 %R 10.2196/26558 %U https://www.jmir.org/2021/4/e26558 %U https://doi.org/10.2196/26558 %U http://www.ncbi.nlm.nih.gov/pubmed/33882020 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 9 %N 4 %P e21394 %T Application of Artificial Intelligence for Screening COVID-19 Patients Using Digital Images: Meta-analysis %A Poly,Tahmina Nasrin %A Islam,Md Mohaimenul %A Li,Yu-Chuan Jack %A Alsinglawi,Belal %A Hsu,Min-Huei %A Jian,Wen Shan %A Yang,Hsuan-Chia %+ Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, 15 Floor, No. 172-1, Section: 2, Keelung Road, Daan District, Taipei, 106, Taiwan, 886 (02)66382736 ext 1507, itpharmacist@gmail.com %K COVID-19 %K SARS-CoV-2 %K pneumonia %K artificial intelligence %K deep learning %D 2021 %7 29.4.2021 %9 Original Paper %J JMIR Med Inform %G English %X Background: The COVID-19 outbreak has spread rapidly and hospitals are overwhelmed with COVID-19 patients. While analysis of nasal and throat swabs from patients is the main way to detect COVID-19, analyzing chest images could offer an alternative method to hospitals, where health care personnel and testing kits are scarce. Deep learning (DL), in particular, has shown impressive levels of performance when analyzing medical images, including those related to COVID-19 pneumonia. Objective: The goal of this study was to perform a systematic review with a meta-analysis of relevant studies to quantify the performance of DL algorithms in the automatic stratification of COVID-19 patients using chest images. Methods: A search strategy for use in PubMed, Scopus, Google Scholar, and Web of Science was developed, where we searched for articles published between January 1 and April 25, 2020. We used the key terms “COVID-19,” or “coronavirus,” or “SARS-CoV-2,” or “novel corona,” or “2019-ncov,” and “deep learning,” or “artificial intelligence,” or “automatic detection.” Two authors independently extracted data on study characteristics, methods, risk of bias, and outcomes. Any disagreement between them was resolved by consensus. Results: A total of 16 studies were included in the meta-analysis, which included 5896 chest images from COVID-19 patients. The pooled sensitivity and specificity of the DL models in detecting COVID-19 were 0.95 (95% CI 0.94-0.95) and 0.96 (95% CI 0.96-0.97), respectively, with an area under the receiver operating characteristic curve of 0.98. The positive likelihood, negative likelihood, and diagnostic odds ratio were 19.02 (95% CI 12.83-28.19), 0.06 (95% CI 0.04-0.10), and 368.07 (95% CI 162.30-834.75), respectively. The pooled sensitivity and specificity for distinguishing other types of pneumonia from COVID-19 were 0.93 (95% CI 0.92-0.94) and 0.95 (95% CI 0.94-0.95), respectively. The performance of radiologists in detecting COVID-19 was lower than that of the DL models; however, the performance of junior radiologists was improved when they used DL-based prediction tools. Conclusions: Our study findings show that DL models have immense potential in accurately stratifying COVID-19 patients and in correctly differentiating them from patients with other types of pneumonia and normal patients. Implementation of DL-based tools can assist radiologists in correctly and quickly detecting COVID-19 and, consequently, in combating the COVID-19 pandemic. %M 33764884 %R 10.2196/21394 %U https://medinform.jmir.org/2021/4/e21394 %U https://doi.org/10.2196/21394 %U http://www.ncbi.nlm.nih.gov/pubmed/33764884 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 4 %P e27164 %T Innovative Virtual Role Play Simulations for Managing Substance Use Conversations: Pilot Study Results and Relevance During and After COVID-19 %A Albright,Glenn %A Khalid,Nikita %A Shockley,Kristen %A Robinson,Kelsey %A Hughes,Kevin %A Pace-Danley,Bethany %+ Peer Assistance Services, Inc, 2170 South Parker Road, Suite 229, Denver, CO, 80231, United States, 1 303 369 0039 ext 245, bpace-danley@peerassist.org %K simulations %K behavior change %K motivational interviewing %K virtual humans %K role play %K substance use %K prevention %K alcohol %K public awareness %K innovation %K interview %K COVID-19 %K pilot study %K simulation %K communication %K problem solving %D 2021 %7 29.4.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Substance use places a substantial burden on our communities, both economically and socially. In light of COVID-19, it is predicted that as many as 75,000 more people will die from alcohol and other substance use and suicide as a result of isolation, new mental health concerns, and various other stressors related to the pandemic. Public awareness campaigns that aim to destigmatize substance use and help individuals have meaningful conversations with friends, coworkers, or family members to address substance use concerns are a timely and cost-effective means of augmenting existing behavioral health efforts related to substance use. These types of interventions can supplement the work being done by existing public health initiatives. Objective: This pilot study examines the impact of the One Degree: Shift the Influence role play simulation, designed to teach family, friends, and coworkers to effectively manage problem-solving conversations with individuals that they are concerned about regarding substance use. Methods: Participants recruited for this mixed methods study completed a presurvey, the simulation, and a postsurvey, and were sent a 6-week follow-up survey. The simulation involves practicing a role play conversation with a virtual human coded with emotions, a memory, and a personality. A virtual coach provides feedback in using evidence-based communication strategies such as motivational interviewing. Results: A matched sample analysis of variance revealed significant increases at follow-up in composite attitudinal constructs of preparedness (P<.001) and self-efficacy (P=.01), including starting a conversation with someone regarding substance use, avoiding upsetting someone while bringing up concerns, focusing on observable facts, and problem solving. Qualitative data provided further evidence of the simulation’s positive impact on the ability to have meaningful conversations about substance use. Conclusions: This study provides preliminary evidence that conversation-based simulations like One Degree: Shift the Influence that use role play practice can teach individuals to use evidence-based communication strategies and can cost-effectively reach geographically dispersed populations to support public health initiatives for primary prevention. %M 33848972 %R 10.2196/27164 %U https://formative.jmir.org/2021/4/e27164 %U https://doi.org/10.2196/27164 %U http://www.ncbi.nlm.nih.gov/pubmed/33848972 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 4 %P e25299 %T Conducting Internet-Based Visits for Onboarding Populations With Limited Digital Literacy to an mHealth Intervention: Development of a Patient-Centered Approach %A Hernandez-Ramos,Rosa %A Aguilera,Adrian %A Garcia,Faviola %A Miramontes-Gomez,Jose %A Pathak,Laura Elizabeth %A Figueroa,Caroline Astrid %A Lyles,Courtney Rees %+ Division of General Internal Medicine, Zuckerberg San Francisco General Hospital, University of California, San Francisco, 1001 Potrero Ave, Bldg 10, Ward 13, Box 1364, San Francisco, CA, 94110, United States, 1 628 206 6483, courtney.Lyles@ucsf.edu %K digital literacy %K digital divide %K underserved %K patient-centered %K digital health %K mhealth %K intervention %K telehealth %K COVID-19 %D 2021 %7 29.4.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic has propelled patient-facing research to shift to digital and telehealth strategies. If these strategies are not adapted for minority patients of lower socioeconomic status, health inequality will further increase. Patient-centered models of care can successfully improve access and experience for minority patients. Objective: This study aims to present the development process and preliminary acceptability of altering in-person onboarding procedures into internet-based, remote procedures for a mobile health (mHealth) intervention in a population with limited digital literacy. Methods: We actively recruited safety-net patients (English- and Spanish-speaking adults with diabetes and depression who were receiving care at a public health care delivery system in San Francisco, United States) into a randomized controlled trial of text messaging support for physical activity. Because of the COVID-19 pandemic, we modified the in-person recruitment and onboarding procedures to internet-based, remote processes with human support. We conducted a preliminary evaluation of how the composition of the recruited cohort might have changed from the pre–COVID-19 period to the COVID-19 enrollment period. First, we analyzed the digital profiles of patients (n=32) who had participated in previous in-person onboarding sessions prior to the COVID-19 pandemic. Next, we documented all changes made to our onboarding processes to account for remote recruitment, especially those needed to support patients who were not very familiar with downloading apps onto their mobile phones on their own. Finally, we used the new study procedures to recruit patients (n=11) during the COVID-19 social distancing period. These patients were also asked about their experience enrolling into a fully digitized mHealth intervention. Results: Recruitment across both pre–COVID-19 and COVID-19 periods (N=43) demonstrated relatively high rates of smartphone ownership but lower self-reported digital literacy, with 32.6% (14/43) of all patients reporting they needed help with using their smartphone and installing apps. Significant changes were made to the onboarding procedures, including facilitating app download via Zoom video call and/or a standard phone call and implementing brief, one-on-one staff-patient interactions to provide technical assistance personalized to each patient’s digital literacy skills. Comparing recruitment during pre–COVID-19 and COVID-19 periods, the proportion of patients with digital literacy barriers reduced from 34.4% (11/32) in the pre–COVID-19 cohort to 27.3% (3/11) in the COVID-19 cohort. Differences in digital literacy scores between both cohorts were not significant (P=.49). Conclusions: Patients of lower socioeconomic status have high interest in using digital platforms to manage their health, but they may require additional upfront human support to gain access. One-on-one staff-patient partnerships allowed us to provide unique technical assistance personalized to each patient’s digital literacy skills, with simple strategies to troubleshoot patient barriers upfront. These additional remote onboarding strategies can mitigate but not eliminate digital barriers for patients without extensive technology experience. Trial Registration: Clinicaltrials.gov NCT0349025, https://clinicaltrials.gov/ct2/show/NCT03490253 %M 33872184 %R 10.2196/25299 %U https://formative.jmir.org/2021/4/e25299 %U https://doi.org/10.2196/25299 %U http://www.ncbi.nlm.nih.gov/pubmed/33872184 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 4 %P e23446 %T Telemanagement of Home-Isolated COVID-19 Patients Using Oxygen Therapy With Noninvasive Positive Pressure Ventilation and Physical Therapy Techniques: Randomized Clinical Trial %A Adly,Aya Sedky %A Adly,Mahmoud Sedky %A Adly,Afnan Sedky %+ Faculty of Engineering and Technology, Badr University in Cairo (BUC), Cairo Suez Road, Badr City, Cairo, Egypt, 20 1145559778, aya.sedky@gmail.com %K telemedicine %K oxygen therapy %K noninvasive positive airway pressure %K BiPAP %K osteopathic medicine %K physical therapy %K SARS-CoV-2 %K COVID-19 %K teletherapy %K telemanagement %D 2021 %7 28.4.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: With the growing stress on hospitals caused by the COVID-19 pandemic, the need for home-based solutions has become a necessity to support these overwhelmed hospitals. Objective: The goal of this study was to compare two nonpharmacological respiratory treatment methods for home-isolated COVID-19 patients using a newly developed telemanagement health care system. Methods: In this single-blinded randomized clinical trial, 60 patients with stage 1 pneumonia caused by SARS-CoV-2 infection were treated. Group A (n=30) received oxygen therapy with bilevel positive airway pressure (BiPAP) ventilation, and Group B (n=30) received osteopathic manipulative respiratory and physical therapy techniques. Arterial blood gases of PaO2 and PaCO2, pH, vital signs (ie, temperature, respiratory rate, oxygen saturation, heart rate, and blood pressure), and chest computed tomography scans were used for follow-up and for assessment of the course and duration of recovery. Results: Analysis of the results showed a significant difference between the two groups (P<.05), with Group A showing shorter recovery periods than Group B (mean 14.9, SD 1.7 days, and mean 23.9, SD 2.3 days, respectively). Significant differences were also observed between baseline and final readings in all of the outcome measures in both groups (P<.05). Regarding posttreatment satisfaction with our proposed telemanagement health care system, positive responses were given by most of the patients in both groups. Conclusions: It was found that home-based oxygen therapy with BiPAP can be a more effective prophylactic treatment approach than osteopathic manipulative respiratory and physical therapy techniques, as it can impede exacerbation of early-stage COVID-19 pneumonia. Telemanagement health care systems are promising methods to help in the pandemic-related shortage of hospital beds, as they showed reasonable effectiveness and reliability in the monitoring and management of patients with early-stage COVID-19 pneumonia. Trial Registration: ClinicalTrials.gov NCT04368923; https://clinicaltrials.gov/ct2/show/NCT04368923 %M 33819166 %R 10.2196/23446 %U https://www.jmir.org/2021/4/e23446 %U https://doi.org/10.2196/23446 %U http://www.ncbi.nlm.nih.gov/pubmed/33819166 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 4 %P e25695 %T Surveillance of the Second Wave of COVID-19 in Europe: Longitudinal Trend Analyses %A Post,Lori %A Culler,Kasen %A Moss,Charles B %A Murphy,Robert L %A Achenbach,Chad J %A Ison,Michael G %A Resnick,Danielle %A Singh,Lauren Nadya %A White,Janine %A Boctor,Michael J %A Welch,Sarah B %A Oehmke,James Francis %+ Buehler Center for Health Policy and Economics, Feinberg School of Medicine, Northwestern University, 420 E Superior, Chicago, IL, 60611, United States, 1 203 980 7107, lori.post@northwestern.edu %K SARS-CoV-2 surveillance %K wave two %K second wave %K global COVID surveillance %K Europe Public Health Surveillance %K Europe COVID %K Europe surveillance metrics %K dynamic panel data %K generalized method of the moments %K Europe econometrics %K Europe SARS-CoV-2 %K Europe COVID surveillance system %K European COVID transmission speed %K European COVID transmission acceleration %K COVID transmission deceleration %K COVID transmission jerk %K COVID 7-day lag %K SARS-CoV-2 %K Arellano-Bond estimator %K GMM %K Albania %K Andorra %K Austria %K Belarus %K Belgium %K Bosnia and Herzegovina %K Bulgaria %K Croatia %K Czech Republic %K Denmark %K Estonia %K Finland %K France %K Germany %K Greece %K Greenland %K Hungary %K Iceland %K Ireland %K Isle of Man %K Italy %K Latvia %K Liechtenstein %K Lithuania %K Luxembourg %K Moldova %K Monaco %K Montenegro %K Netherlands %K Norway %K Poland %K Portugal %K Romania %K San Marino %K Serbia %K Slovakia %K Slovenia %K Spain %K Sweden %K Switzerland %K Ukraine %K United Kingdom %K Vatican City %D 2021 %7 28.4.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The COVID-19 pandemic has severely impacted Europe, resulting in a high caseload and deaths that varied by country. The second wave of the COVID-19 pandemic has breached the borders of Europe. Public health surveillance is necessary to inform policy and guide leaders. Objective: This study aimed to provide advanced surveillance metrics for COVID-19 transmission that account for weekly shifts in the pandemic, speed, acceleration, jerk, and persistence, to better understand countries at risk for explosive growth and those that are managing the pandemic effectively. Methods: We performed a longitudinal trend analysis and extracted 62 days of COVID-19 data from public health registries. We used an empirical difference equation to measure the daily number of cases in Europe as a function of the prior number of cases, the level of testing, and weekly shift variables based on a dynamic panel model that was estimated using the generalized method of moments approach by implementing the Arellano-Bond estimator in R. Results: New COVID-19 cases slightly decreased from 158,741 (week 1, January 4-10, 2021) to 152,064 (week 2, January 11-17, 2021), and cumulative cases increased from 22,507,271 (week 1) to 23,890,761 (week 2), with a weekly increase of 1,383,490 between January 10 and January 17. France, Germany, Italy, Spain, and the United Kingdom had the largest 7-day moving averages for new cases during week 1. During week 2, the 7-day moving average for France and Spain increased. From week 1 to week 2, the speed decreased (37.72 to 33.02 per 100,000), acceleration decreased (0.39 to –0.16 per 100,000), and jerk increased (–1.30 to 1.37 per 100,000). Conclusions: The United Kingdom, Spain, and Portugal, in particular, are at risk for a rapid expansion in COVID-19 transmission. An examination of the European region suggests that there was a decrease in the COVID-19 caseload between January 4 and January 17, 2021. Unfortunately, the rates of jerk, which were negative for Europe at the beginning of the month, reversed course and became positive, despite decreases in speed and acceleration. Finally, the 7-day persistence rate was higher during week 2 than during week 1. These measures indicate that the second wave of the pandemic may be subsiding, but some countries remain at risk for new outbreaks and increased transmission in the absence of rapid policy responses. %M 33818391 %R 10.2196/25695 %U https://publichealth.jmir.org/2021/4/e25695 %U https://doi.org/10.2196/25695 %U http://www.ncbi.nlm.nih.gov/pubmed/33818391 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 4 %P e26075 %T Predictability of COVID-19 Hospitalizations, Intensive Care Unit Admissions, and Respiratory Assistance in Portugal: Longitudinal Cohort Study %A Patrício,André %A Costa,Rafael S %A Henriques,Rui %+ LAQV-REQUIMTE, NOVA School of Science and Technology, Universidade NOVA de Lisboa, Campus Caparica, 2829-516, Caparica, 2829-516, Portugal, 351 21 294 8351, rs.costa@fct.unl.pt %K COVID-19 %K machine learning %K intensive care admissions %K respiratory assistance %K predictive models %K data modeling %K clinical informatics %D 2021 %7 28.4.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: In the face of the current COVID-19 pandemic, the timely prediction of upcoming medical needs for infected individuals enables better and quicker care provision when necessary and management decisions within health care systems. Objective: This work aims to predict the medical needs (hospitalizations, intensive care unit admissions, and respiratory assistance) and survivability of individuals testing positive for SARS-CoV-2 infection in Portugal. Methods: A retrospective cohort of 38,545 infected individuals during 2020 was used. Predictions of medical needs were performed using state-of-the-art machine learning approaches at various stages of a patient’s cycle, namely, at testing (prehospitalization), at posthospitalization, and during postintensive care. A thorough optimization of state-of-the-art predictors was undertaken to assess the ability to anticipate medical needs and infection outcomes using demographic and comorbidity variables, as well as dates associated with symptom onset, testing, and hospitalization. Results: For the target cohort, 75% of hospitalization needs could be identified at the time of testing for SARS-CoV-2 infection. Over 60% of respiratory needs could be identified at the time of hospitalization. Both predictions had >50% precision. Conclusions: The conducted study pinpoints the relevance of the proposed predictive models as good candidates to support medical decisions in the Portuguese population, including both monitoring and in-hospital care decisions. A clinical decision support system is further provided to this end. %M 33835931 %R 10.2196/26075 %U https://www.jmir.org/2021/4/e26075 %U https://doi.org/10.2196/26075 %U http://www.ncbi.nlm.nih.gov/pubmed/33835931 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 4 %P e24277 %T Effects of Age, Gender, Health Status, and Political Party on COVID-19–Related Concerns and Prevention Behaviors: Results of a Large, Longitudinal Cross-sectional Survey %A Naeim,Arash %A Baxter-King,Ryan %A Wenger,Neil %A Stanton,Annette L %A Sepucha,Karen %A Vavreck,Lynn %+ Center for SMART Health, Departments of Medicine and Bioengineering, David Geffen School of Medicine at UCLA and Samueli School of Engineering and Applied Science, 10911 Weyburn Avenue, Los Angeles, CA, 90095, United States, 1 3103670148, anaeim@mednet.ucla.edu %K COVID-19 %K prevention %K behavior %K advice %K health care provider %K economy %K health information %K concern %K survey %D 2021 %7 28.4.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: With conflicting information about COVID-19, the general public may be uncertain about how to proceed in terms of precautionary behavior and decisions about whether to return to activity. Objective: The aim of this study is to determine the factors associated with COVID-19–related concerns, precautionary behaviors, and willingness to return to activity. Methods: National survey data were obtained from the Democracy Fund + UCLA Nationscape Project, an ongoing cross-sectional weekly survey. The sample was provided by Lucid, a web-based market research platform. Three outcomes were evaluated: (1) COVID-19–related concerns, (2) precautionary behaviors, and (3) willingness to return to activity. Key independent variables included age, gender, race or ethnicity, education, household income, political party support, religion, news consumption, number of medication prescriptions, perceived COVID-19 status, and timing of peak COVID-19 infections by state. Results: The data included 125,508 responses from web-based surveys conducted over 20 consecutive weeks during the COVID-19 pandemic (comprising approximately 6250 adults per week), between March 19 and August 5, 2020, approved by the University of California, Los Angeles (UCLA) Institutional Review Board for analysis. A substantial number of participants were not willing to return to activity even after the restrictions were lifted. Weighted multivariate logistic regressions indicated the following groups had different outcomes (all P<.001): individuals aged ≥65 years (COVID-19–related concerns: OR 2.05, 95% CI 1.93-2.18; precautionary behaviors: OR 2.38, 95% CI 2.02-2.80; return to activity: OR 0.41, 95% CI 0.37-0.46 vs 18-40 years); men (COVID-19–related concerns: OR 0.73, 95% CI 0.70-0.75; precautionary behaviors: OR 0.74, 95% CI 0.67-0.81; return to activity: OR 2.00, 95% CI 1.88-2.12 vs women); taking ≥4 medications (COVID-19–related concerns: OR 1.47, 95% CI 1.40-1.54; precautionary behaviors: OR 1.36, 95% CI 1.20-1.555; return to activity: OR 0.75, 95% CI 0.69-0.81 vs <3 medications); Republicans (COVID-19–related concerns: OR 0.40, 95% CI 0.38-0.42; precautionary behaviors: OR 0.45, 95% CI 0.40-0.50; return to activity: OR 2.22, 95% CI 2.09-2.36 vs Democrats); and adults who reported having COVID-19 (COVID-19–related concerns: OR 1.24, 95% CI 1.12-1.39; precautionary behaviors: OR 0.65, 95% CI 0.52-0.81; return to activity: OR 3.99, 95% CI 3.48-4.58 vs those who did not). Conclusions: Participants’ age, party affiliation, and perceived COVID-19 status were strongly associated with their COVID-19–related concerns, precautionary behaviors, and willingness to return to activity. Future studies need to develop and test targeted messaging approaches and consider political partisanship to encourage preventative behaviors and willingness to return to activities. %M 33908887 %R 10.2196/24277 %U https://publichealth.jmir.org/2021/4/e24277 %U https://doi.org/10.2196/24277 %U http://www.ncbi.nlm.nih.gov/pubmed/33908887 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 4 %P e27433 %T Coinfection With SARS-CoV-2 and Influenza A(H1N1) in a Patient Seen at an Influenza-like Illness Surveillance Site in Egypt: Case Report %A Fahim,Manal %A Ghonim,Hanaa Abu El Sood %A Roshdy,Wael H %A Naguib,Amel %A Elguindy,Nancy %A AbdelFatah,Mohamad %A Hassany,Mohamed %A Mohsen,Amira %A Afifi,Salma %A Eid,Alaa %+ Department of Surveillance and Epidemiology, Ministry of Health and Population, 3 Magles El Shab Street, Cairo, , Egypt, 20 01222598200 ext 202, fahimmanal@yahoo.com %K influenza-like Illness %K pandemic %K SARS-CoV-2 %K COVID-19 %K influenza %K virus %K case study %K Egypt %K flu %K coinfection %K infectious disease %K surveillance %K outcome %K demographic %D 2021 %7 28.4.2021 %9 Short Paper %J JMIR Public Health Surveill %G English %X Background: Sentinel surveillance of influenza-like illness (ILI) in Egypt started in 2000 at 8 sentinel sites geographically distributed all over the country. In response to the COVID-19 pandemic, SARS-CoV-2 was added to the panel of viral testing by polymerase chain reaction for the first 2 patients with ILI seen at one of the sentinel sites. We report the first SARS-CoV-2 and influenza A(H1N1) virus co-infection with mild symptoms detected through routine ILI surveillance in Egypt. Objective: This report aims to describe how the case was identified and the demographic and clinical characteristics and outcomes of the patient. Methods: The case was identified by Central Public Health Laboratory staff, who contacted the ILI sentinel surveillance officer at the Ministry of Health. The case patient was contacted through a telephone call. Detailed information about the patient’s clinical picture, course of disease, and outcome was obtained. The contacts of the patient were investigated for acute respiratory symptoms, disease confirmation, and outcomes. Results: Among 510 specimens collected from patients with ILI symptoms from October 2019 to August 2020, 61 (12.0%) were COVID-19–positive and 29 (5.7%) tested positive for influenza, including 15 (51.7%) A(H1N1), 11 (38.0%) A(H3N2), and 3 (10.3%) influenza B specimens. A 21-year-old woman was confirmed to have SARS-CoV-2 and influenza A(H1N1) virus coinfection. She had a high fever of 40.2 °C and mild respiratory symptoms that resolved within 2 days with symptomatic treatment. All five of her family contacts had mild respiratory symptoms 2-3 days after exposure to the confirmed case, and their symptoms resolved without treatment or investigation. Conclusions: This case highlights the possible occurrence of SARS-CoV-2/influenza A(H1N1) coinfection in younger and healthy people, who may resolve the infection rapidly. We emphasize the usefulness of the surveillance system for detection of viral causative agents of ILI and recommend broadening of the testing panel, especially if it can guide case management. %M 33784634 %R 10.2196/27433 %U https://publichealth.jmir.org/2021/4/e27433 %U https://doi.org/10.2196/27433 %U http://www.ncbi.nlm.nih.gov/pubmed/33784634 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 4 %P e27091 %T Association Between Smoking and SARS-CoV-2 Infection: Cross-sectional Study of the EPICOVID19 Internet-Based Survey %A Prinelli,Federica %A Bianchi,Fabrizio %A Drago,Gaspare %A Ruggieri,Silvia %A Sojic,Aleksandra %A Jesuthasan,Nithiya %A Molinaro,Sabrina %A Bastiani,Luca %A Maggi,Stefania %A Noale,Marianna %A Galli,Massimo %A Giacomelli,Andrea %A Antonelli Incalzi,Raffaele %A Adorni,Fulvio %A Cibella,Fabio %A , %+ Institute of Biomedical Technologies, National Research Council, Via Fratelli 93, Segrate (MI), 20090, Italy, 39 0226422629, federica.prinelli@cnr.it %K SARS-CoV-2 %K COVID-19 %K smoking habit %K dose-response relationship %K nasopharyngeal swab testing %K infection severity %K web-based survey %K self-reported %K cross-sectional design %D 2021 %7 28.4.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Several studies have reported a low prevalence of current smoking among hospitalized COVID-19 cases; however, no definitive conclusions can be drawn. Objective: We investigated the association of tobacco smoke exposure with nasopharyngeal swab (NPS) test results for SARS-CoV-2 infection and disease severity accounting for possible confounders. Methods: The nationwide, self-administered, cross-sectional web-based Italian National Epidemiological Survey on COVID-19 (EPICOVID19) was administered to an Italian population of 198,822 adult volunteers who filled in an online questionnaire between April 13 and June 2, 2020. For this study, we analyzed 6857 individuals with known NPS test results. The associations of smoking status and the dose-response relationship with a positive NPS test result and infection severity were calculated as odds ratios (ORs) with 95% CIs by means of logistic and multinomial regression models adjusting for sociodemographic, clinical, and behavioral characteristics. Results: Out of the 6857 individuals (mean age 47.9 years, SD 14.1; 4516/6857, 65.9% female), 63.2% (4334/6857) had never smoked, 21.3% (1463/6857) were former smokers, and 15.5% (1060/6857) were current smokers. Compared to nonsmokers, current smokers were younger, were more educated, were less affected by chronic diseases, reported COVID-19–like symptoms less frequently, were less frequently hospitalized, and less frequently tested positive for COVID-19. In multivariate analysis, current smokers had almost half the odds of a positive NPS test result (OR 0.54, 95% CI 0.45-0.65) compared to nonsmokers. We also found a dose-dependent relationship with tobacco smoke: mild smokers (adjusted OR [aOR] 0.76, 95% CI 0.55-1.05), moderate smokers (aOR 0.56, 95% CI 0.42-0.73), and heavy smokers (aOR 0.38, 95% CI 0.27-0.53). This inverse association also persisted when considering the severity of the infection. Current smokers had a statistically significantly lower probability of having asymptomatic (aOR 0.50, 95% CI 0.27-0.92), mild (aOR 0.65, 95% CI 0.53-0.81), and severe infections (aOR 0.27, 95% CI 0.17-0.42) compared to those who never smoked. Conclusions: Current smoking was negatively associated with SARS-CoV-2 infection with a dose-dependent relationship. Ad hoc experimental studies are needed to elucidate the mechanisms underlying this association. Trial Registration: ClinicalTrials.gov NCT04471701; https://clinicaltrials.gov/ct2/show/NCT04471701 %M 33668011 %R 10.2196/27091 %U https://publichealth.jmir.org/2021/4/e27091 %U https://doi.org/10.2196/27091 %U http://www.ncbi.nlm.nih.gov/pubmed/33668011 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 4 %P e25407 %T Protocol for the Pregnancy During the COVID-19 Pandemic (PdP) Study: A Longitudinal Cohort Study of Mental Health Among Pregnant Canadians During the COVID-19 Pandemic and Developmental Outcomes in Their Children %A Giesbrecht,Gerald F %A Bagshawe,Mercedes %A van Sloten,Melinda %A MacKinnon,Anna L %A Dhillon,Ashley %A van de Wouw,Marcel %A Vaghef-Mehrabany,Elnaz %A Rojas,Laura %A Cattani,Danielle %A Lebel,Catherine %A Tomfohr-Madsen,Lianne %+ Department of Pediatrics, University of Calgary, 2500 University Drive, Calgary, AB, T2N 1N4, Canada, 1 403 441 8469, ggiesbre@ucalgary.ca %K pregnancy %K anxiety %K depression %K stress %K social support %K resilience %K COVID-19 %K infant development %K pandemic %D 2021 %7 28.4.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: The COVID-19 pandemic and countermeasures implemented by governments around the world have led to dramatically increased symptoms of depression and anxiety. Pregnant individuals may be particularly vulnerable to the negative psychological effects of COVID-19 public health measures because they represent a demographic that is most affected by disasters and because pregnancy itself entails significant life changes that require major psychosocial and emotional adjustments. Objective: The PdP study was designed to investigate the associations among exposure to objective hardship caused by the pandemic, perceived stress and psychological distress in pregnant individuals, and developmental outcomes in their offspring. Methods: The PdP study comprises a prospective longitudinal cohort of individuals who were pregnant at enrollment, with repeated follow-ups during pregnancy and the postpartum period. Participants were eligible if they were pregnant, ≥17 years old, at ≤35 weeks of gestation at study enrollment, living in Canada, and able to read and write in English or French. At enrollment, participants completed an initial survey that assessed demographic and socioeconomic characteristics, previous pregnancies and births, prepregnancy health, health conditions during pregnancy, medications, psychological distress, social support, and hardships experienced because of the COVID-19 pandemic (eg, lost employment or a loved one dying). For the first three months following the initial survey, participants received a monthly email link to complete a follow-up survey that asked about their experiences since the previous survey. After three months, follow-up surveys were sent every other month to reduce participant burden. For each of these surveys, participants were first asked if they were still pregnant and then routed either to the next prenatal survey or to the delivery survey. In the postpartum period, surveys were sent at 3, 6, and 12 months of infant age to assess maternal stress, psychological distress, and infant development. Results: Participant recruitment via social media (Facebook and Instagram) began on April 5, 2020, and is ongoing. As of April 2021, more than 11,000 individuals have started the initial survey. Follow-up data collection is ongoing. Conclusions: This longitudinal investigation seeks to elucidate the associations among hardships, maternal psychological distress, child development during the COVID-19 pandemic, and risk and resilience factors that amplify or ameliorate these associations. The findings of this study are intended to generate knowledge about the psychological consequences of pandemics on pregnant individuals and point toward prevention and intervention targets. International Registered Report Identifier (IRRID): DERR1-10.2196/25407 %M 33848971 %R 10.2196/25407 %U https://www.researchprotocols.org/2021/4/e25407 %U https://doi.org/10.2196/25407 %U http://www.ncbi.nlm.nih.gov/pubmed/33848971 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 4 %P e25215 %T Patterns of Media Use, Strength of Belief in COVID-19 Conspiracy Theories, and the Prevention of COVID-19 From March to July 2020 in the United States: Survey Study %A Romer,Daniel %A Jamieson,Kathleen Hall %+ Annnenberg Public Policy Center, University of Pennsylvania, 202 S 36th St, Philadelphia, PA, 19104, United States, 1 610 202 7315, dan.romer@appc.upenn.edu %K COVID-19 %K conspiracy beliefs %K social media %K print news media %K broadcast news media %K conservative media %K vaccination %K mask wearing %K belief %K misinformation %K infodemic %K United States %K intention %K prevention %D 2021 %7 27.4.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Holding conspiracy beliefs regarding the COVID-19 pandemic in the United States has been associated with reductions in both actions to prevent the spread of the infection (eg, mask wearing) and intentions to accept a vaccine when one becomes available. Patterns of media use have also been associated with acceptance of COVID-19 conspiracy beliefs. Here we ask whether the type of media on which a person relies increased, decreased, or had no additional effect on that person’s COVID-19 conspiracy beliefs over a 4-month period. Objective: We used panel data to explore whether use of conservative and social media in the United States, which were previously found to be positively related to holding conspiracy beliefs about the origins and prevention of COVID-19, were associated with a net increase in the strength of those beliefs from March to July of 2020. We also asked whether mainstream news sources, which were previously found to be negatively related to belief in pandemic-related conspiracies, were associated with a net decrease in the strength of such beliefs over the study period. Additionally, we asked whether subsequent changes in pandemic conspiracy beliefs related to the use of media were also related to subsequent mask wearing and vaccination intentions. Methods: A survey that we conducted with a national US probability sample in March of 2020 and again in July with the same 840 respondents assessed belief in pandemic-related conspiracies, use of various types of media information sources, actions taken to prevent the spread of the disease and intentions to vaccinate, and various demographic characteristics. Change across the two waves was analyzed using path analytic techniques. Results: We found that conservative media use predicted an increase in conspiracy beliefs (β=.17, 99% CI .10-.25) and that reliance on mainstream print predicted a decrease in their belief (β=–.08, 99% CI –.14 to –.02). Although many social media platforms reported downgrading or removing false or misleading content, ongoing use of such platforms by respondents predicted growth in conspiracy beliefs as well (β=.072, 99% CI .018-.123). Importantly, conspiracy belief changes related to media use between the two waves of the study were associated with the uptake of mask wearing and changes in vaccination intentions in July. Unlike other media, use of mainstream broadcast television predicted greater mask wearing (β=.17, 99% CI .09-.26) and vaccination intention (β=.08, 95% CI .02-.14), independent of conspiracy beliefs. Conclusions: The findings point to the need for greater efforts on the part of commentators, reporters, and guests on conservative media to report verifiable information about the pandemic. The results also suggest that social media platforms need to be more aggressive in downgrading, blocking, and counteracting claims about COVID-19 vaccines, claims about mask wearing, and conspiracy beliefs that have been judged problematic by public health authorities. %M 33857008 %R 10.2196/25215 %U https://www.jmir.org/2021/4/e25215 %U https://doi.org/10.2196/25215 %U http://www.ncbi.nlm.nih.gov/pubmed/33857008 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 4 %P e25728 %T Latin America and the Caribbean SARS-CoV-2 Surveillance: Longitudinal Trend Analysis %A Post,Lori %A Ohiomoba,Ramael O %A Maras,Ashley %A Watts,Sean J %A Moss,Charles B %A Murphy,Robert Leo %A Ison,Michael G %A Achenbach,Chad J %A Resnick,Danielle %A Singh,Lauren Nadya %A White,Janine %A Chaudhury,Azraa S %A Boctor,Michael J %A Welch,Sarah B %A Oehmke,James Francis %+ Buehler Center for Health Policy and Economics, Feinberg School of Medicine, Northwestern University, 420 E Superior, Chicago, IL, 60611, United States, 1 203 980 7107, lori.post@northwestern.edu %K 7-day persistence %K acceleration %K Arellano–Bond estimator %K COVID-19 surveillance system %K COVID-19 %K dynamic panel data %K econometrics %K economic %K generalized method of moments %K global COVID-19 surveillance %K Latin America and the Caribbean %K longitudinal %K metric %K persistence %K policy %K public health surveillance %K SARS-CoV-2 %K second wave %K surveillance metrics %K transmission deceleration %K transmission jerk %K transmission speed %K trend analysis %D 2021 %7 27.4.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The COVID-19 pandemic has placed unprecedented stress on economies, food systems, and health care resources in Latin America and the Caribbean (LAC). Existing surveillance provides a proxy of the COVID-19 caseload and mortalities; however, these measures make it difficult to identify the dynamics of the pandemic and places where outbreaks are likely to occur. Moreover, existing surveillance techniques have failed to measure the dynamics of the pandemic. Objective: This study aimed to provide additional surveillance metrics for COVID-19 transmission to track changes in the speed, acceleration, jerk, and persistence in the transmission of the pandemic more accurately than existing metrics. Methods: Through a longitudinal trend analysis, we extracted COVID-19 data over 45 days from public health registries. We used an empirical difference equation to monitor the daily number of cases in the LAC as a function of the prior number of cases, the level of testing, and weekly shift variables based on a dynamic panel model that was estimated using the generalized method of moments approach by implementing the Arellano–Bond estimator in R. COVID-19 transmission rates were tracked for the LAC between September 30 and October 6, 2020, and between October 7 and 13, 2020. Results: The LAC saw a reduction in the speed, acceleration, and jerk for the week of October 13, 2020, compared to the week of October 6, 2020, accompanied by reductions in new cases and the 7-day moving average. For the week of October 6, 2020, Belize reported the highest acceleration and jerk, at 1.7 and 1.8, respectively, which is particularly concerning, given its high mortality rate. The Bahamas also had a high acceleration at 1.5. In total, 11 countries had a positive acceleration during the week of October 6, 2020, whereas only 6 countries had a positive acceleration for the week of October 13, 2020. The TAC displayed an overall positive trend, with a speed of 10.40, acceleration of 0.27, and jerk of –0.31, all of which decreased in the subsequent week to 9.04, –0.81, and –0.03, respectively. Conclusions: Metrics such as new cases, cumulative cases, deaths, and 7-day moving averages provide a static view of the pandemic but fail to identify where and the speed at which SARS-CoV-2 infects new individuals, the rate of acceleration or deceleration of the pandemic, and weekly comparison of the rate of acceleration of the pandemic indicate impending explosive growth or control of the pandemic. Enhanced surveillance will inform policymakers and leaders in the LAC about COVID-19 outbreaks. %M 33852413 %R 10.2196/25728 %U https://publichealth.jmir.org/2021/4/e25728 %U https://doi.org/10.2196/25728 %U http://www.ncbi.nlm.nih.gov/pubmed/33852413 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 4 %P e26955 %T Estimating the Proportion of COVID-19 Contacts Among Households Based on Individuals With Myocardial Infarction History: Cross-sectional Telephone Survey %A Fraticelli,Laurie %A Freyssenge,Julie %A Claustre,Clément %A Martinez,Mikaël %A Redjaline,Abdesslam %A Serre,Patrice %A Bochaton,Thomas %A El Khoury,Carlos %+ RESCUe-RESUVal, Lucien Hussel Hospital, Montée du Docteur Maurice Chapuis, Vienne, 38200, France, 33 4 37 02 10 59, l.fraticelli@resuval.fr %K COVID-19 %K survey %K myocardial infarction %K cases %K contacts %K household %K estimate %K cross-sectional %K cardiovascular %K risk %K symptom %D 2021 %7 27.4.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Adults with cardiovascular diseases were disproportionately associated with an increased risk of a severe form of COVID-19 and all-cause mortality. Objective: The aims of this study are to report the associated symptoms for COVID-19 cases, to estimate the proportion of contacts, and to describe the clinical signs and behaviors among individuals with and without myocardial infarction history among cases and contacts. Methods: A 2-week cross-sectional telephone survey was conducted during the first lockdown period in France, from May 4 to 15, 2020. A total of 668 households participated, representing 703 individuals with pre-existing cardiovascular disease in the past 2 years and 849 individuals without myocardial infarction history. Results: High rates of compliance with health measures were self-reported, regardless of age or risk factors. There were 4 confirmed COVID-19 cases that were registered from 4 different households. Based on deductive assumptions of the 1552 individuals, 9.73% (n=151) were identified as contacts, of whom 71.52% (108/151) were asymptomatic. Among individuals with a myocardial infarction history, 2 were COVID-19 cases, and the estimated proportion of contacts was 8.68% (61/703), of whom 68.85% (42/61) were asymptomatic. The cases and contacts presented different symptoms, with more respiratory signs in those with a myocardial infarction history. Conclusions: The telephone survey could be a relevant tool for reporting the number of contacts during a limited period and in a limited territory based on the presence of associated symptoms and COVID-19 cases in the households. This study advanced our knowledge to better prepare for future crises. %M 33855968 %R 10.2196/26955 %U https://formative.jmir.org/2021/4/e26955 %U https://doi.org/10.2196/26955 %U http://www.ncbi.nlm.nih.gov/pubmed/33855968 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 4 %P e24760 %T Psychological and Coping Strategies Related to Home Isolation and Social Distancing in Children and Adolescents During the COVID-19 Pandemic: Cross-sectional Study %A Zainel,Abduljaleel Abdullatif %A Qotba,Hamda %A Al-Maadeed,Alyaa %A Al-Kohji,Sadriya %A Al Mujalli,Hanan %A Ali,Atif %A Al Mannai,Lolwa %A Aladab,Aisha %A AlSaadi,Hamda %A AlKarbi,Khalid Ali %A Al-Baghdadi,Tholfakhar %+ Primary Health Care Corporation, PO Box 55772, Doha, Qatar, 974 55087676, azainel@phcc.gov.qa %K COVID-19 %K coronavirus %K pandemic %K psychological %K coping strategies %K children %K adolescents %K Qatar %D 2021 %7 27.4.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: In December 2019, a novel coronavirus called SARS-CoV-2 was identified as the cause of a cluster of pneumonia cases in Wuhan, China. It rapidly spread due to human-to-human transmission, resulting in a global pandemic. Nearly every country, including Qatar, has established guidelines and regulations to limit the spread of the virus and to preserve public health. However, these procedures have been associated with negative effects on the psychological and intellectual well-being of individuals, including children and adolescents. Objective: The objective of this study was to determine the psychological influence of home isolation and social distancing on children and adolescents during the COVID-19 pandemic in Qatar, and the strategies used to cope with these measures. Methods: This cross-sectional study was undertaken using an online questionnaire administered through SMS text messaging. All home-isolated children and adolescents registered at the Primary Health Care Corporation aged 7-18 years were invited to participate in the study. Children and adolescents with intellectual disadvantages were excluded. A P value of .05 (two-tailed) was considered statistically significant. Results: Data were collected from 6608 participants from June 23 to July 18, 2020. Nearly all participants adhered to the official regulations during the period of home isolation and social distancing; however, 69.1% (n=4568) of parents believed their children were vulnerable to the virus compared to 25% (n=1652) who expressed they were not vulnerable at all. Higher levels of anger, depression, and general anxiety were prevalent among 1.3% (n=84), 3.9% (n=260), and 1.6% (n=104) of participants, respectively. The mean score for the emotional constructs anger and depression decreased with increased compliance with regulations (P=.04 and P=.11, respectively). The differences in mean score for all psychological and coping strategies used among participants across the 3 levels of vulnerability to SARS-CoV-2 were statistically significant. The mean score varied little with increasing reported vulnerability to the virus. This mild variation can make a difference when the sample size is large, as is the case in this study. Conclusions: Screening for psychological and social disruptions is important for the development of strategies by schools and health care providers to assess and monitor behavioral changes and negative psychological impact during post–COVID-19 reintegration. Participants experiencing higher levels of anxiety should be given more attention during reintegration and transitional phases in schools. Although electronic devices and social media platforms may have lowered anxiety levels in some cases, it is important to address how they are used and how content is tailored to children and adolescents. It is also important to maintain an active lifestyle for children and young persons, and encourage them not to neglect their physical health, as this promotes a better psychological state of mind. %M 33851577 %R 10.2196/24760 %U https://formative.jmir.org/2021/4/e24760 %U https://doi.org/10.2196/24760 %U http://www.ncbi.nlm.nih.gov/pubmed/33851577 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 4 %P e27503 %T Validation of the Withings ScanWatch as a Wrist-Worn Reflective Pulse Oximeter: Prospective Interventional Clinical Study %A Kirszenblat,Romain %A Edouard,Paul %+ Withings, 2 rue Maurice Hartmann, Issy-Les-Moulineaux, 92130, France, 33 141460460, romain.kirszenblat@withings.com %K connected watch %K COPD %K COVID-19 %K neural network %K pulse oxygen saturation %K reflective pulse oximeter %K sleep apnea syndrome %K SpO2 %K Withings ScanWatch %K wearable %K respiratory %K oxygen %K respiratory disease %K oximeter %K validation %K accuracy %K safety %D 2021 %7 26.4.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: A decrease in the level of pulse oxygen saturation as measured by pulse oximetry (SpO2) is an indicator of hypoxemia that may occur in various respiratory diseases, such as chronic obstructive pulmonary disease (COPD), sleep apnea syndrome, and COVID-19. Currently, no mass-market wrist-worn SpO2 monitor meets the medical standards for pulse oximeters. Objective: The main objective of this monocentric and prospective clinical study with single-blind analysis was to test and validate the accuracy of the reflective pulse oximeter function of the Withings ScanWatch to measure SpO2 levels at different stages of hypoxia. The secondary objective was to confirm the safety of this device when used as intended. Methods: To achieve these objectives, we included 14 healthy participants aged 23-39 years in the study, and we induced several stable plateaus of arterial oxygen saturation (SaO2) ranging from 100%-70% to mimic nonhypoxic conditions and then mild, moderate, and severe hypoxic conditions. We measured the SpO2 level with a Withings ScanWatch on each participant’s wrist and the SaO2 from blood samples with a co-oximeter, the ABL90 hemoximeter (Radiometer Medical ApS). Results: After removal of the inconclusive measurements, we obtained 275 and 244 conclusive measurements with the two ScanWatches on the participants’ right and left wrists, respectively, evenly distributed among the 3 predetermined SpO2 groups: SpO2≤80%, 80%65 years) are perceived as the most physiologically susceptible population to developing COVID-19 and are at risk of secondary mental health challenges related to the social isolation that has been imposed by virus containment strategies. To mitigate concerns regarding sampling bias, we analyzed a random sample of older adults to understand the uptake and acceptance of technologies that support socialization during the pandemic. Objective: We aimed to conduct a population-based assessment of the barriers and facilitators to engaging in the use of technology for web-based socialization among older adults in the Canadian province of British Columbia during the COVID-19 pandemic. Methods: We conducted a cross-sectional, population-based, regionally representative survey by using the random-digit dialing method to reach participants aged >65 years who live in British Columbia. Data were analyzed using SPSS (IBM Corporation), and open-text responses were analyzed via thematic analysis. Results: Respondents included 400 older adults aged an average of 72 years, and 63.7% (n=255) of respondents were female. Most respondents (n=358, 89.5%) were aware of how to use technology to connect with others, and slightly more than half of the respondents (n=224, 56%) reported that, since the beginning of the pandemic, they used technology differently to connect with others during the pandemic. Additionally, 55.9% (n=223) of respondents reported that they adopted new technology since the beginning of the pandemic. Older adults reported the following key barriers to using technology: (1) a lack of access (including finance-, knowledge-, and age-related issues); (2) a lack of interest (including a preference for telephones and a general lack of interest in computers); and (3) physical barriers (resultant of cognitive impairments, stroke, and arthritis). Older adults also reported the following facilitators: (1) a knowledge of technologies (from self-teaching or external courses); (2) reliance on others (family, friends, and general internet searches); (3) technology accessibility (including appropriate environments, user-friendly technology, and clear instructions); and (4) social motivation (everyone else is doing it). Conclusions: Much data on older adults’ use of technology are limited by sampling biases, but this study, which used a random sampling method, demonstrated that older adults used technology to mitigate social isolation during the pandemic. Web-based socialization is the most promising method for mitigating potential mental health effects that are related to virus containment strategies. Providing telephone training; creating task lists; and implementing the facilitators described by participants, such as facilitated socialization activities, are important strategies for addressing barriers, and these strategies can be implemented during and beyond the pandemic to bolster the mental health needs of older adults. %M 33739929 %R 10.2196/28010 %U https://aging.jmir.org/2021/2/e28010 %U https://doi.org/10.2196/28010 %U http://www.ncbi.nlm.nih.gov/pubmed/33739929 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 9 %N 4 %P e25181 %T Machine Learning Models for Image-Based Diagnosis and Prognosis of COVID-19: Systematic Review %A Montazeri,Mahdieh %A ZahediNasab,Roxana %A Farahani,Ali %A Mohseni,Hadis %A Ghasemian,Fahimeh %+ Computer Engineering Department, Faculty of Engineering, Shahid Bahonar University of Kerman, Pajoohesh Sq, PO Box: 76169-14111, Kerman, Iran, 98 9133924837, ghasemianfahime@uk.ac.ir %K machine learning %K diagnosis %K prognosis %K COVID-19 %D 2021 %7 23.4.2021 %9 Review %J JMIR Med Inform %G English %X Background: Accurate and timely diagnosis and effective prognosis of the disease is important to provide the best possible care for patients with COVID-19 and reduce the burden on the health care system. Machine learning methods can play a vital role in the diagnosis of COVID-19 by processing chest x-ray images. Objective: The aim of this study is to summarize information on the use of intelligent models for the diagnosis and prognosis of COVID-19 to help with early and timely diagnosis, minimize prolonged diagnosis, and improve overall health care. Methods: A systematic search of databases, including PubMed, Web of Science, IEEE, ProQuest, Scopus, bioRxiv, and medRxiv, was performed for COVID-19–related studies published up to May 24, 2020. This study was performed in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines. All original research articles describing the application of image processing for the prediction and diagnosis of COVID-19 were considered in the analysis. Two reviewers independently assessed the published papers to determine eligibility for inclusion in the analysis. Risk of bias was evaluated using the Prediction Model Risk of Bias Assessment Tool. Results: Of the 629 articles retrieved, 44 articles were included. We identified 4 prognosis models for calculating prediction of disease severity and estimation of confinement time for individual patients, and 40 diagnostic models for detecting COVID-19 from normal or other pneumonias. Most included studies used deep learning methods based on convolutional neural networks, which have been widely used as a classification algorithm. The most frequently reported predictors of prognosis in patients with COVID-19 included age, computed tomography data, gender, comorbidities, symptoms, and laboratory findings. Deep convolutional neural networks obtained better results compared with non–neural network–based methods. Moreover, all of the models were found to be at high risk of bias due to the lack of information about the study population, intended groups, and inappropriate reporting. Conclusions: Machine learning models used for the diagnosis and prognosis of COVID-19 showed excellent discriminative performance. However, these models were at high risk of bias, because of various reasons such as inadequate information about study participants, randomization process, and the lack of external validation, which may have resulted in the optimistic reporting of these models. Hence, our findings do not recommend any of the current models to be used in practice for the diagnosis and prognosis of COVID-19. %M 33735095 %R 10.2196/25181 %U https://medinform.jmir.org/2021/4/e25181 %U https://doi.org/10.2196/25181 %U http://www.ncbi.nlm.nih.gov/pubmed/33735095 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 4 %N 2 %P e25106 %T Challenges and Considerations for Reducing Diabetes Distress and Fear of Hypoglycemia in Parents of Youth With Type 1 Diabetes During the COVID-19 Pandemic %A Monzon,Alexandra %A Kahhan,Nicole %A Marker,Arwen %A Patton,Susana %+ Center for Healthcare Delivery Science, Nemours Children’s Health System, 807 Children’s Way, Jacksonville, FL, 32207, United States, 1 904 697 3595, susana.patton@nemours.org %K type 1 diabetes %K parents %K children %K diabetes distress %K fear of hypoglycemia %K COVID-19 %K telehealth %K diabetes %K challenge %K youth %K young adults %D 2021 %7 23.4.2021 %9 Viewpoint %J JMIR Pediatr Parent %G English %X Type 1 diabetes management can be challenging for children and their families. To address psychosocial concerns for parents of youth with type 1 diabetes, we developed two parent-focused interventions to reduce their diabetes distress and fear of hypoglycemia. Our team conducted several of these interventions during the early stages of the COVID-19 pandemic and recognized a need to make timely adjustments to our interventions. In this viewpoint article, we describe our experience conducting these manualized treatment groups during the pandemic, the range of challenges and concerns specific to COVID-19 that parents expressed, and how we adjusted our approach to better address parents’ treatment needs. %M 33848256 %R 10.2196/25106 %U https://pediatrics.jmir.org/2021/2/e25106 %U https://doi.org/10.2196/25106 %U http://www.ncbi.nlm.nih.gov/pubmed/33848256 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 4 %P e23806 %T Consumer-Based Activity Trackers as a Tool for Physical Activity Monitoring in Epidemiological Studies During the COVID-19 Pandemic: Development and Usability Study %A Henriksen,André %A Johannessen,Erlend %A Hartvigsen,Gunnar %A Grimsgaard,Sameline %A Hopstock,Laila Arnesdatter %+ Department of Community Medicine, UiT The Arctic University of Norway, Postboks 6050 langnes, Tromsø, 9037, Norway, 47 77645214, andre.henriksen@uit.no %K COVID-19 %K energy expenditure %K steps %K smart watch %K fitness tracker %K actigraphy %K public health %K lockdown %K SARS-CoV-2 %K pandemic %K wearables %D 2021 %7 23.4.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Consumer-based physical activity trackers have increased in popularity. The widespread use of these devices and the long-term nature of the recorded data provides a valuable source of physical activity data for epidemiological research. The challenges include the large heterogeneity between activity tracker models in terms of available data types, the accuracy of recorded data, and how this data can be shared between different providers and third-party systems. Objective: The aim of this study is to develop a system to record data on physical activity from different providers of consumer-based activity trackers and to examine its usability as a tool for physical activity monitoring in epidemiological research. The longitudinal nature of the data and the concurrent pandemic outbreak allowed us to show how the system can be used for surveillance of physical activity levels before, during, and after a COVID-19 lockdown. Methods: We developed a system (mSpider) for automatic recording of data on physical activity from participants wearing activity trackers from Apple, Fitbit, Garmin, Oura, Polar, Samsung, and Withings, as well as trackers storing data in Google Fit and Apple Health. To test the system throughout development, we recruited 35 volunteers to wear a provided activity tracker from early 2019 and onward. In addition, we recruited 113 participants with privately owned activity trackers worn before, during, and after the COVID-19 lockdown in Norway. We examined monthly changes in the number of steps, minutes of moderate-to-vigorous physical activity, and activity energy expenditure between 2019 and 2020 using bar plots and two-sided paired sample t tests and Wilcoxon signed-rank tests. Results: Compared to March 2019, there was a significant reduction in mean step count and mean activity energy expenditure during the March 2020 lockdown period. The reduction in steps and activity energy expenditure was temporary, and the following monthly comparisons showed no significant change between 2019 and 2020. A small significant increase in moderate-to-vigorous physical activity was observed for several monthly comparisons after the lockdown period and when comparing March-December 2019 with March-December 2020. Conclusions: mSpider is a working prototype currently able to record physical activity data from providers of consumer-based activity trackers. The system was successfully used to examine changes in physical activity levels during the COVID-19 period. %M 33843598 %R 10.2196/23806 %U https://publichealth.jmir.org/2021/4/e23806 %U https://doi.org/10.2196/23806 %U http://www.ncbi.nlm.nih.gov/pubmed/33843598 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 8 %N 2 %P e28589 %T Patient Satisfaction and Trust in Telemedicine During the COVID-19 Pandemic: Retrospective Observational Study %A Orrange,Sharon %A Patel,Arpna %A Mack,Wendy Jean %A Cassetta,Julia %+ Keck School of Medicine of USC, University of Southern California, 1975 Zonal Avenue, Los Angeles, CA, 90033, United States, 1 323 442 5100, sharon.orrange@med.usc.edu %K telemedicine %K patient satisfaction %K COVID-19 %K health services research %K health policy %K health care delivery %K physicians %K medicine %D 2021 %7 22.4.2021 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Los Angeles County is a hub for COVID-19 cases in the United States. Academic health centers rapidly deployed and leveraged telemedicine to permit uninterrupted care of patients. Telemedicine enjoys high patient satisfaction, yet little is known about the level of satisfaction during a crisis and to what extent patient- or visit-related factors and trust play when in-person visits are eliminated. Objective: The aim of this study is to examine correlates of patients’ satisfaction with a telemedicine visit. Methods: In this retrospective observational study conducted in our single-institution, urban, academic medical center in Los Angeles, internal medicine patients aged ≥18 years who completed a telemedicine visit between March 10th and April 17th, 2020, were invited for a survey (n=1624). Measures included patient demographics, degree of interpersonal trust in patient-physician relationships (using the Trust in Physician Scale), and visit-related concerns. Statistical analysis used descriptive statistics, Spearman rank-order correlation, and linear and ordinal logistic regression. Results: Of 1624 telemedicine visits conducted during this period, 368 (22.7%) patients participated in the survey. Across the study, respondents were very satisfied (173/365, 47.4%) or satisfied (n=129, 35.3%) with their telemedicine visit. Higher physician trust was associated with higher patient satisfaction (Spearman correlation r=0.51, P<.001). Visit-related factors with statistically significant correlation with Trust in Physician score were technical issues with the telemedicine visit (r=–0.16), concerns about privacy (r=–0.19), concerns about cost (r=–0.23), satisfaction with telemedicine convenience (r=0.41), and amount of time spent (r=0.47; all P<.01). Visit-related factors associated with patients’ satisfaction included fewer technical issues (P<.001), less concern about privacy (P<.001) or cost (P=.02), and successful face-to-face video (P<.001). The only patient variable with a significant positive association was income and level of trust in physician (r=0.18, P<.001). Younger age was associated with higher satisfaction with the telemedicine visit (P=.005). Conclusions: There have been calls for redesigning primary care after the COVID-19 pandemic and for the widespread adoption of telemedicine. Patients’ satisfaction with telemedicine during the COVID-19 pandemic is high. Their satisfaction is shaped by the degree of trust in physician and visit-related factors more so than patient factors. This has widespread implications for outpatient practices and further research into visit-related factors and the patient-provider connection over telemedicine is needed. %M 33822736 %R 10.2196/28589 %U https://humanfactors.jmir.org/2021/2/e28589 %U https://doi.org/10.2196/28589 %U http://www.ncbi.nlm.nih.gov/pubmed/33822736 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 4 %P e27832 %T Communicating Scientific Uncertainty About the COVID-19 Pandemic: Online Experimental Study of an Uncertainty-Normalizing Strategy %A Han,Paul K J %A Scharnetzki,Elizabeth %A Scherer,Aaron M %A Thorpe,Alistair %A Lary,Christine %A Waterston,Leo B %A Fagerlin,Angela %A Dieckmann,Nathan F %+ Center for Outcomes Research and Evaluation, Maine Medical Center Research Institute, 509 Forest Avenue, Portland, ME, 04101, United States, 1 207 661 7619, hanp@mmc.org %K uncertainty %K communication %K ambiguity %K vaccination %K COVID-19 %D 2021 %7 22.4.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Communicating scientific uncertainty about public health threats such as COVID-19 is an ethically desirable task endorsed by expert guidelines on crisis communication. However, the communication of scientific uncertainty is challenging because of its potential to promote ambiguity aversion—a well-described syndrome of negative psychological responses consisting of heightened risk perceptions, emotional distress, and decision avoidance. Communication strategies that can inform the public about scientific uncertainty while mitigating ambiguity aversion are a critical unmet need. Objective: This study aimed to evaluate whether an “uncertainty-normalizing” communication strategy—aimed at reinforcing the expected nature of scientific uncertainty about the COVID-19 pandemic—can reduce ambiguity aversion, and to compare its effectiveness to conventional public communication strategies aimed at promoting hope and prosocial values. Methods: In an online factorial experiment conducted from May to June 2020, a national sample of 1497 US adults read one of five versions of an informational message describing the nature, transmission, prevention, and treatment of COVID-19; the versions varied in level of expressed scientific uncertainty and supplemental focus (ie, uncertainty-normalizing, hope-promoting, and prosocial). Participants then completed measures of cognitive, emotional, and behavioral manifestations of ambiguity aversion (ie, perceived likelihood of getting COVID-19, COVID-19 worry, and intentions for COVID-19 risk-reducing behaviors and vaccination). Analyses assessed (1) the extent to which communicating uncertainty produced ambiguity-averse psychological responses; (2) the comparative effectiveness of uncertainty-normalizing, hope-promoting, and prosocial communication strategies in reducing ambiguity-averse responses; and (3) potential moderators of the effects of alternative uncertainty communication strategies. Results: The communication of scientific uncertainty about the COVID-19 pandemic increased perceived likelihood of getting COVID-19 and worry about COVID-19, consistent with ambiguity aversion. However, it did not affect intentions for risk-reducing behaviors or vaccination. The uncertainty-normalizing strategy reduced these aversive effects of communicating scientific uncertainty, resulting in levels of both perceived likelihood of getting COVID-19 and worry about COVID-19 that did not differ from the control message that did not communicate uncertainty. In contrast, the hope-promoting and prosocial strategies did not decrease ambiguity-averse responses to scientific uncertainty. Age and political affiliation, respectively, moderated the effects of uncertainty communication strategies on intentions for COVID-19 risk-reducing behaviors and worry about COVID-19. Conclusions: Communicating scientific uncertainty about the COVID-19 pandemic produces ambiguity-averse cognitive and emotional, but not behavioral, responses among the general public, and an uncertainty-normalizing communication strategy reduces these responses. Normalizing uncertainty may be an effective strategy for mitigating ambiguity aversion in crisis communication efforts. More research is needed to test uncertainty-normalizing communication strategies and to elucidate the factors that moderate their effectiveness. %M 33769947 %R 10.2196/27832 %U https://www.jmir.org/2021/4/e27832 %U https://doi.org/10.2196/27832 %U http://www.ncbi.nlm.nih.gov/pubmed/33769947 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 4 %P e27214 %T Google Trends for Pain Search Terms in the World’s Most Populated Regions Before and After the First Recorded COVID-19 Case: Infodemiological Study %A Szilagyi,Istvan-Szilard %A Ullrich,Torsten %A Lang-Illievich,Kordula %A Klivinyi,Christoph %A Schittek,Gregor Alexander %A Simonis,Holger %A Bornemann-Cimenti,Helmar %+ Department of Anesthesiology and Intensive Care Medicine, Medical University of Graz, Auenbruggerplatz 5/5, Graz, 8036, Austria, 1 316 385, helmar.bornemann@medunigraz.at %K COVID-19 %K data mining %K Google Trends %K incidence %K internet %K interest %K pain %K research %K trend %D 2021 %7 22.4.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Web-based analysis of search queries has become a very useful method in various academic fields for understanding timely and regional differences in the public interest in certain terms and concepts. Particularly in health and medical research, Google Trends has been increasingly used over the last decade. Objective: This study aimed to assess the search activity of pain-related parameters on Google Trends from among the most populated regions worldwide over a 3-year period from before the report of the first confirmed COVID-19 cases in these regions (January 2018) until December 2020. Methods: Search terms from the following regions were used for the analysis: India, China, Europe, the United States, Brazil, Pakistan, and Indonesia. In total, 24 expressions of pain location were assessed. Search terms were extracted using the local language of the respective country. Python scripts were used for data mining. All statistical calculations were performed through exploratory data analysis and nonparametric Mann–Whitney U tests. Results: Although the overall search activity for pain-related terms increased, apart from pain entities such as headache, chest pain, and sore throat, we observed discordant search activity. Among the most populous regions, pain-related search parameters for shoulder, abdominal, and chest pain, headache, and toothache differed significantly before and after the first officially confirmed COVID-19 cases (for all, P<.001). In addition, we observed a heterogenous, marked increase or reduction in pain-related search parameters among the most populated regions. Conclusions: As internet searches are a surrogate for public interest, we assume that our data are indicative of an increased incidence of pain after the onset of the COVID-19 pandemic. However, as these increased incidences vary across geographical and anatomical locations, our findings could potentially facilitate the development of specific strategies to support the most affected groups. %M 33844638 %R 10.2196/27214 %U https://www.jmir.org/2021/4/e27214 %U https://doi.org/10.2196/27214 %U http://www.ncbi.nlm.nih.gov/pubmed/33844638 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 4 %P e26459 %T Loss of Smell and Taste in Patients With Suspected COVID-19: Analyses of Patients’ Reports on Social Media %A Koyama,Sachiko %A Ueha,Rumi %A Kondo,Kenji %+ Department of Chemistry, Indiana University, 800 E Kirkwood Ave, Bloomington, IN, 47405-7102, United States, 1 812 345 6155, apodemusmice@gmail.com %K COVID-19 %K anosmia %K ageusia %K free reports on social media %K symptomatic %K asymptomatic %K recovery of senses %K symptom %K social media %K smell %K taste %K senses %K patient-reported %K benefit %K limit %K diagnosis %D 2021 %7 22.4.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The year 2020 was the year of the global COVID-19 pandemic. The severity of the situation has become so substantial that many or even most of the patients with mild to moderate symptoms had to self-isolate without specific medical treatments or even without being tested for COVID-19. Many patients joined internet membership groups to exchange information and support each other. Objective: Our goal is to determine the benefits and limits of using social media to understand the symptoms of patients with suspected COVID-19 with mild to moderate symptoms and, in particular, their symptoms of anosmia (loss of the sense of smell) and ageusia (loss of the sense of taste). The voluntary reports on an internet website of a membership group will be the platform of the analyses. Methods: Posts and comments of members of an internet group known as COVID-19 Smell and Taste Loss, founded on March 24, 2020, to support patients with suspected COVID-19 were collected and analyzed daily. Demographic data were collected using the software mechanism called Group Insights on the membership group website. Results: Membership groups on social media have become rare sources of support for patients with suspected COVID-19 with mild to moderate symptoms. These groups provided mental support to their members and became resources for information on COVID-19 tests and medicines or supplements. However, the membership was voluntary, and often the members leave without notification. It is hard to be precise from the free voluntary reports. The number of women in the group (6995/9227, 75.38% as of October 12, 2020) was about three times more than men (2272/9227, 24.62% as of October 12, 2020), and the peak age of members was between 20-40 years in both men and women. Patients who were asymptomatic other than the senses comprised 14.93% (53/355) of the total patients. Recovery of the senses was higher in the patients who were asymptomatic besides having anosmia and ageusia. Most (112/123, 91.06%) patients experienced other symptoms first and then lost their senses, on average, 4.2 days later. Patients without other symptoms tended to recover earlier (P=.02). Patients with anosmia and ageusia occasionally reported distorted smell and taste (parosmia and dysgeusia) as well as experiencing or perceiving the smell and taste without the sources of the smell or taste (phantosmia and phantogeusia). Conclusions: Our analysis of the social media database of suspected COVID-19 patients’ voices demonstrated that, although accurate diagnosis of patients is not always obtained with social media–based analyses, it may be a useful tool to collect a large amount of data on symptoms and the clinical course of worldwide rapidly growing infectious diseases. %M 33788699 %R 10.2196/26459 %U https://www.jmir.org/2021/4/e26459 %U https://doi.org/10.2196/26459 %U http://www.ncbi.nlm.nih.gov/pubmed/33788699 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 4 %P e24964 %T Decline of Psychological Health Following the Designation of COVID-19 as a Pandemic: Descriptive Study %A Patel,Darpan I %A Gamez,Yazmin %A Shah,Lajja %A Patel,Jaini %+ Biobehavioral Research Laboratory, School of Nursing, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, United States, 1 210 567 0362, pateld7@uthscsa.edu %K anxiety %K COVID-19 %K descriptive study %K mental health %K pandemic %K physical health %K quality of life %K stress %D 2021 %7 22.4.2021 %9 Short Paper %J J Med Internet Res %G English %X Background: COVID-19 was declared a pandemic by the World Health Organization on March 11, 2020, and as of this writing, Texas, United States, has reported >675,000 cases with over 14,000 deaths. Many of the preventive measures implemented during the pandemic can increase sedentary lifestyles, which can lead to the development of chronic diseases, including obesity, among the general population and cause serious threats to people’s physical health and overall quality of life. Individuals with pre-existing comorbidities are at an increased risk of COVID-19 and may hence have higher levels of stress. Objective: This study aimed to investigate the relationship between physical activity levels and mental health status on an individual level and to compare them between those with and those without comorbidities in a cohort of Texas residents, before and after COVID-19 was declared a pandemic. Methods: An electronic survey was disseminated throughout various regions of Texas. In total, 160 individuals were asked questions about their demographic characteristics, time spent on daily physical activities, and daily mental health status before and after COVID-19 was declared a pandemic. Frequency distributions and descriptive statistics were analyzed. Results: Overall, 94 (58%) participants reported having ≥1 medical condition, and 31 (13.1%) had >3 medical conditions. Physical activity levels among participants with ≥1 pre-existing comorbidity drastically—but not significantly—decreased, as evident from a 10% increase in sedentary lifestyles after COVID-19 was declared a pandemic. On the contrary, we observed a 9% increase in the number of individuals without a pre-existing comorbidity who reported 30-60 min of physical activity per week. There was a 2-fold increase in the number of participants reporting more frequent feelings of nervousness, too much worry, trouble relaxing, and the fear of something awful happening after the pandemic. More specifically, individuals with pre-existing medical conditions reported, on average, a 10% higher incidence of feelings of stress, anxiety, and sadness compared to their healthy counterparts after COVID-19 was declared a pandemic. Conclusions: Stressful life conditions and chronic comorbidities are risk factors that can affect mental health and reduce the ability to perform activities of daily life. Therefore, when implementing pandemic protocols, municipalities should consider providing mental health support to their citizens to protect them from this rather inconspicuous adverse effect. %M 33793408 %R 10.2196/24964 %U https://www.jmir.org/2021/4/e24964 %U https://doi.org/10.2196/24964 %U http://www.ncbi.nlm.nih.gov/pubmed/33793408 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 4 %P e28945 %T One Year of Pandemic Learning Response: Benefits of Massive Online Delivery of the World Health Organization’s Technical Guidance %A Utunen,Heini %A Van Kerkhove,Maria D %A Tokar,Anna %A O'Connell,Gillian %A Gamhewage,Gaya M %A Fall,Ibrahima Socé %+ Health Emergencies Programme, World Health Organization, 20 Avenue Appia, Geneva, 1211, Switzerland, 41 795933476, utunenh@who.int %K COVID-19 %K e-learning %K massive open web-based courses %K OpenWHO %K pandemic %K public health %K web-based learning %K World Health Organization %D 2021 %7 21.4.2021 %9 Viewpoint %J JMIR Public Health Surveill %G English %X The World Health Organization (WHO) launched the first web-based learning course on COVID-19 on January 26, 2020, four days before the director general of the WHO declared a public health emergency of international concern. The WHO is expanding access to web-based learning for COVID-19 through its open-learning platform for health emergencies, OpenWHO. Throughout the pandemic, OpenWHO has continued to publish learning offerings based on the WHO’s emerging evidence-based knowledge for managing the COVID-19 pandemic. This study presents the various findings derived from the analysis of the performance of the OpenWHO platform during the pandemic, along with the core benefits of massive web-based learning formats. %M 33881404 %R 10.2196/28945 %U https://publichealth.jmir.org/2021/4/e28945 %U https://doi.org/10.2196/28945 %U http://www.ncbi.nlm.nih.gov/pubmed/33881404 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 4 %P e24369 %T Participation in Virtual Urology Conferences During the COVID-19 Pandemic: Cross-sectional Survey Study %A Wang,Menghua %A Liao,Banghua %A Jian,Zhongyu %A Jin,Xi %A Xiang,Liyuan %A Yuan,Chi %A Li,Hong %A Wang,Kunjie %+ Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, China, 86 189 8060 1848, wangkj@scu.edu.cn %K virtual conference %K COVID-19 %K survey %D 2021 %7 21.4.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Due to the influence of the COVID-19 pandemic, conventional face-to-face academic conferences have been restricted, and many of these conferences have moved onto the internet. Objective: The aim of this study was to investigate the virtual conferences in the field of urology during the COVID-19 pandemic and provide suggestions for better organization of such conferences. Methods: A cross-sectional survey was conducted from May 30 to June 15, 2020, in China. Our team designed a 23-item questionnaire to investigate the conferences attended by urologists during the COVID-19 pandemic. SPSS 22.0 (IBM Corporation) was applied to analyze the data collected. Results: A total of 330 Chinese urologists participated in our survey, and the response rate was 89.7% (330/368). Among the participants, 40.9% (135/330) were associate chief physicians. The proportion of participants who took part in conventional face-to-face academic conferences decreased from 92.7% (306/330) before the COVID-19 pandemic to 22.1% (73/330) during the pandemic (P<.001). In contrast, the proportion of urologists who took part in virtual conferences increased from 69.4% (229/330) to 90% (297/330) (P<.001). Most urologists (70.7%, 210/297) chose to participate in the virtual conferences at home and thought that a meeting length of 1-2 hours was most appropriate. Among the urologists, 73.7% (219/297) reported that their participation in the virtual conferences went smoothly, while the remaining respondents reported that they had experienced lags in video and audio streaming during the virtual conferences. When comparing conventional face-to-face conferences with virtual conferences, 70.7% (210/297) of the respondents thought that both conference formats were acceptable, while 17.9% (53/297) preferred virtual conferences and 11.5% (34/297) preferred conventional face-to-face meetings. Conclusions: Virtual conferences are increasing in popularity during the COVID-19 pandemic; however, many aspects of these conferences could be improved for better organization. %M 33844635 %R 10.2196/24369 %U https://www.jmir.org/2021/4/e24369 %U https://doi.org/10.2196/24369 %U http://www.ncbi.nlm.nih.gov/pubmed/33844635 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 4 %P e27069 %T A Technology Acceptance Model for Deploying Masks to Combat the COVID-19 Pandemic in Taiwan (My Health Bank): Web-Based Cross-sectional Survey Study %A Tsai,Wen-Hsun %A Wu,Yi-Syuan %A Cheng,Chia-Shiang %A Kuo,Ming-Hao %A Chang,Yu-Tien %A Hu,Fu-Kang %A Sun,Chien-An %A Chang,Chi-Wen %A Chan,Ta-Chien %A Chen,Chao-Wen %A Lee,Chia-Cheng %A Chu,Chi-Ming %+ School of Public Health, National Defense Medical Center, 4F, No161, Min-Chun E Rd, Sec 6, Neihu Dist, Taipei, Taiwan, 886 2 8792 3100 ext 18473, chuchiming@web.de %K personal health record %K electronic medical record %K my health bank %K technology acceptance model %K structural equation model %K electronic health record %K COVID-19 %K protection %K survey %K model %K intention %K usage %K literacy %K privacy %K security %D 2021 %7 21.4.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The successful completion of medical practices often relies on information collection and analysis. Government agencies and medical institutions have encouraged people to use medical information technology (MIT) to manage their conditions and promote personal health. In 2014, Taiwan established the first electronic personal health record (PHR) platform, My Health Bank (MHB), which allows people to access and manage their PHRs at any time. In the face of the COVID-19 pandemic in 2020, Taiwan has used MIT to effectively prevent the spread of COVID-19 and undertaken various prevention measures before the onset of the outbreak. Using MHB to purchase masks in an efficient and orderly way and thoroughly implementing personal protection efforts is highly important to contain disease spread. Objective: This study aims to understand people’s intention to use the electronic PHR platform MHB and to investigate the factors affecting their intention to use this platform. Methods: From March 31 to April 9, 2014, in a promotion via email and Facebook, participants were asked to fill out a structured questionnaire after watching an introductory video about MHB on YouTube. The questionnaire included seven dimensions: perceived usefulness, perceived ease of use, health literacy, privacy and security, computer self-efficacy, attitude toward use, and behavioral intention to use. Each question was measured on a 5-point Likert scale ranging from “strongly disagree” (1 point) to “strongly agree” (5 points). Descriptive statistics and structural equation analysis were performed using SPSS 21 and AMOS 21 software. Results: A total of 350 valid questionnaire responses were collected (female: 219/350, 62.6%; age: 21-30 years: 238/350, 68.0%; university-level education: 228/350, 65.1%; occupation as student: 195/350, 56.6%; average monthly income 200 physicians participating in this group. At the time of writing, the group provides a much-needed service to >58,000 people in Denmark during this crisis. %M 33835935 %R 10.2196/24586 %U https://www.jmir.org/2021/4/e24586 %U https://doi.org/10.2196/24586 %U http://www.ncbi.nlm.nih.gov/pubmed/33835935 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 4 %P e23488 %T Novel Predictors of COVID-19 Protective Behaviors Among US Adults: Cross-sectional Survey %A Resnicow,Ken %A Bacon,Elizabeth %A Yang,Penny %A Hawley,Sarah %A Van Horn,M Lee %A An,Lawrence %+ Department of Health Behavior & Health Education, School of Public Health, University of Michigan, 109 Observatory Street, Room 3867 SPH I, Ann Arbor, MI, 48109, United States, 1 734 764 9494, kresnic@umich.edu %K COVID-19 %K protective behavior %K psychological predictors %K reactance %K conspiracy beliefs %K public health %K health communication %K communication %K protection %K behavior %K psychology %D 2021 %7 20.4.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: A central component of the public health strategy to control the COVID-19 pandemic involves encouraging mask wearing and social distancing to protect individuals from acquiring and transmitting the virus. Objective: This study aims to understand the psychological factors that drive adoption or rejection of these protective behaviors, which can inform public health interventions to control the pandemic. Methods: We conducted an online survey of a representative sample of 1074 US adults and assessed three novel potential predictors of COVID-19 behaviors: trait reactance, COVID-19 conspiracy beliefs, and COVID-19 apocalypse beliefs. Key outcomes (dependent variables) included an index of COVID-19 protective behaviors, the number of trips taken from the home, and COVID-19 knowledge. Results: In bivariate analyses, all three predictors were significantly correlated in the hypothesized direction with the three COVID-19 outcomes. Specifically, each predictor was negatively (P<.01) correlated with the COVID-19 protective behaviors index and COVID-19 knowledge score, and positively correlated with trips taken from home per week (more of which was considered higher risk). COVID-19 protective behaviors and COVID-19 knowledge were significantly lower in the top median compared to the bottom median for all three predictors. In general, these findings remained significant after adjusting for all novel predictors plus age, gender, income, education, race, political party, and religiosity. Self-identified Republicans (vs other political affiliations) reported the highest values for each of the novel predictors. Conclusions: This study can inform the development of health communication interventions to encourage the adoption of COVID-19 protective behaviors. Interestingly, we found that higher scores of all three novel predictors were associated with lower COVID-19 knowledge, suggesting that lack of an accurate understanding of the virus may be driving some of these attitudes; although, it is also possible that these attributes may interfere with one’s willingness or ability to seek and absorb accurate health information. These individuals may be particularly immune to accepting new information and yielding their beliefs. Health communication professionals may apply lessons learned from countering similar beliefs around climate change and vaccine hesitancy. Messages designed for individuals prone to reactance may be more effective if they minimize controlling language and emphasize the individual’s independence in adopting these behavioral recommendations. Messaging for those who possess conspiracy beliefs should similarly not assume that providing evidence contrary to these beliefs will alone alter behavior. Other communication techniques such as rolling with resistance, a strategy used in motivational interviewing, may be helpful. Messaging for those with apocalyptic beliefs may require using religious leaders as the message source and using scripture that would support the adoption of COVID-19 protection behaviors. %M 33835930 %R 10.2196/23488 %U https://www.jmir.org/2021/4/e23488 %U https://doi.org/10.2196/23488 %U http://www.ncbi.nlm.nih.gov/pubmed/33835930 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 4 %P e23311 %T The Uncounted Casualties of a Hidden COVID-19 Epidemic in China: Cross-sectional Study on Deaths Related to Overwork %A Wang,Zhicheng %A Lin,Leesa %A Guo,Yan %A Xiong,Huayi %A Tang,Kun %+ Vanke School of Public Health, Tsinghua University, No. 30, Shuangqing Road, Haidian District, Beijing, China, 86 13671129425, tangk@mail.tsinghua.edu.cn %K nonpharmaceutical interventions %K on-duty deaths %K COVID-19 %K overwork death %K crowdsourced data %K intervention %K mortality %K casualty %K cross-sectional %K overwork %K stress %D 2021 %7 20.4.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: During the COVID-19 response, nonclinical essential workers usually worked overtime and experienced significant work stress, which subsequently increased their risk of mortality due to cardiovascular diseases, stroke, and pre-existing conditions. Deaths on duty, including deaths due to overwork, during the COVID-19 response were usually reported on web-based platforms for public recognition and solidarity. Although no official statistics are available for these casualties, a list of on-duty deaths has been made publicly available on the web by crowdsourcing. Objective: This study aims to understand the trends and characteristics of deaths related to overwork among the frontline nonclinical essential workers participating in nonpharmaceutical interventions during the first wave of COVID-19 in China. Methods: Based on a web-based crowdsourced list of deaths on duty during the first wave of the COVID-19 response in China, we manually verified all overwork-related death records against the full-text web reports from credible sources. After excluding deaths caused by COVID-19 infection and accidents, a total of 340 deaths related to overwork among nonclinical essential workers were attributed to combatting the COVID-19 crisis. We coded the key characteristics of the deceased workers, including sex, age at death, location, causes of death, date of incidence, date of death, containment duties, working area, and occupation. The temporal and spatial correlations between deaths from overwork and COVID-19 cases in China were also examined using Pearson correlation coefficient. Results: From January 20 to April 26, 2020, at least 340 nonclinical frontline workers in China were reported to have died as a result of overwork while combatting COVID-19. The weekly overwork mortality was positively correlated with weekly COVID-19 cases (r=0.79, P<.001). Two-thirds of deceased workers (230/340, 67.6%) were under 55 years old, and two major causes of deaths related to overwork were cardiovascular diseases (138/340, 40.6%) and cerebrovascular diseases (73/340, 21.5%). Outside of Hubei province, there were almost 2.5 times as many deaths caused by COVID-19–related overwork (308/340, 90.6%) than by COVID-19 itself (n=120). Conclusions: The high number of deaths related to overwork among nonclinical essential workers at the frontline of the COVID-19 epidemic is alarming. Policies for occupational health protection against work hazards should therefore be prioritized and enforced. %M 33822735 %R 10.2196/23311 %U https://www.jmir.org/2021/4/e23311 %U https://doi.org/10.2196/23311 %U http://www.ncbi.nlm.nih.gov/pubmed/33822735 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 4 %P e25097 %T Learning the Mental Health Impact of COVID-19 in the United States With Explainable Artificial Intelligence: Observational Study %A Jha,Indra Prakash %A Awasthi,Raghav %A Kumar,Ajit %A Kumar,Vibhor %A Sethi,Tavpritesh %+ Indraprastha Institute of Information Technology, Room 309, R and D Building, IIIT Campus, Okhla Phase 3, New Delhi, India, 91 01126907533, tavpriteshsethi@iiitd.ac.in %K COVID-19 %K mental health %K Bayesian network %K machine learning %K artificial intelligence %K disorder %K susceptibility %K well-being %K explainable artificial intelligence %D 2021 %7 20.4.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: The COVID-19 pandemic has affected the health, economic, and social fabric of many nations worldwide. Identification of individual-level susceptibility factors may help people in identifying and managing their emotional, psychological, and social well-being. Objective: This study is focused on learning a ranked list of factors that could indicate a predisposition to a mental disorder during the COVID-19 pandemic. Methods: In this study, we have used a survey of 17,764 adults in the United States from different age groups, genders, and socioeconomic statuses. Through initial statistical analysis and Bayesian network inference, we have identified key factors affecting mental health during the COVID-19 pandemic. Integrating Bayesian networks with classical machine learning approaches led to effective modeling of the level of mental health prevalence. Results: Overall, females were more stressed than males, and people in the age group 18-29 years were more vulnerable to anxiety than other age groups. Using the Bayesian network model, we found that people with a chronic mental illness were more prone to mental disorders during the COVID-19 pandemic. The new realities of working from home; homeschooling; and lack of communication with family, friends, and neighbors induces mental pressure. Financial assistance from social security helps in reducing mental stress during the COVID-19–generated economic crises. Finally, using supervised machine learning models, we predicted the most mentally vulnerable people with ~80% accuracy. Conclusions: Multiple factors such as social isolation, digital communication, and working and schooling from home were identified as factors of mental illness during the COVID-19 pandemic. Regular in-person communication with friends and family, a healthy social life, and social security were key factors, and taking care of people with a history of mental disease appears to be even more important during this time. %M 33877051 %R 10.2196/25097 %U https://mental.jmir.org/2021/4/e25097 %U https://doi.org/10.2196/25097 %U http://www.ncbi.nlm.nih.gov/pubmed/33877051 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 4 %P e26477 %T Pregnancy Outcomes and Child Development Effects of SARS-CoV-2 Infection (PROUDEST Trial): Protocol for a Multicenter, Prospective Cohort Study %A Fernandes,Geraldo Magela %A Motta,Felipe %A Sasaki,Lizandra Moura Paravidine %A Silva,Ângelo Pereira Da %A Miranda,Andreza Monforte %A Carvalho,Aleida Oliveira De %A Gomides,Ana Paula Monteiro %A Soares,Alexandre Anderson De Sousa Munhoz %A Santos Jr,Agenor De Castro Moreira Dos %A Alves,Caroline De Oliveira %A Gomes,Ciro Martins %A Siracusa,Clara Correia De %A Araújo Jr,David Alves De %A Mendonça-Silva,Dayde Lane %A Jesus,José Alfredo Lacerda De %A Costa,Karina Nascimento %A Castro,Maria Eduarda Canellas De %A Kurizky,Patricia Shu %A França,Paulo Sérgio %A Tristão,Rosana %A Pereira,Yacara Ribeiro %A Castro,Luiz Claudio Gonçalves De %A Zaconeta,Alberto Moreno %A Albuquerque,Cleandro Pires De %A Mota,Licia Maria Henrique Da %+ Faculty of Medicine, University of Brasília, Campus Universitário Darcy Ribeiro, UNB Área 1 - Asa Norte, Brasília - DF, 70910-900, Brazil, 55 61981070071, geraldomafer@gmail.com %K SARS-CoV-2 %K COVID-19 %K pregnancy %K neonate %K children %K outcome %K development %K prospective %K cohort %K women %K fetus %K baby %K implication %D 2021 %7 20.4.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: A growing body of evidence suggests that SARS-COV-2 infection during pregnancy may affect maternal-fetal outcomes and possibly result in implications for the long-term development of SARS-CoV-2–exposed children. Objective: The PROUDEST (Pregnancy Outcomes and Child Development Effects of SARS-CoV-2 Infection Study) is a multicenter, prospective cohort study designed to elucidate the repercussions of COVID-19 for the global health of mothers and their children. Methods: The PROUDEST trial comprises 2 prospective, sequential substudies. The PREGNANT substudy will clinically assess the effects of SARS-CoV-2 infection on pregnancy, childbirth, and puerperium from a mechanistic standpoint to elucidate the pregnancy-related inflammatory and immunological phenomena underlying COVID-19. Pregnant women aged 18-40 years who have been exposed (proven with laboratory tests) to SARS-CoV-2 (group A; n=300) will be compared to control subjects with no laboratory evidence of in-pregnancy exposure to the virus (group B; n=300). Subjects exposed to other infections during pregnancy will be excluded. The BORN substudy is a long-term follow-up study that will assess the offspring of women who enrolled in the prior substudy. It will describe the effects of SARS-CoV-2 exposure during pregnancy on children’s growth, neurodevelopment, and metabolism from birth up to 5 years of age. It includes two comparison groups; group A (exposed; n=300) comprises children born from SARS-CoV-2–exposed pregnancies, and group B (controls; n=300) comprises children born from nonexposed mothers. Results: Recruitment began in July 2020, and as of January 2021, 260 pregnant women who were infected with SARS-CoV-2 during pregnancy and 160 newborns have been included in the study. Data analysis is scheduled to start after all data are collected. Conclusions: Upon completion of the study, we expect to have comprehensive data that will provide a better understanding of the effects of SARS-CoV-2 infection and related inflammatory and immunological processes on pregnancy, puerperium, and infancy. Our findings will inform clinical decisions regarding the care of SARS-CoV-2–exposed mothers and children and support the development of evidence-based public health policies. Trial Registration: Brazilian Register of Clinical Trials RBR65QXS2; https://ensaiosclinicos.gov.br/rg/RBR-65qxs2 International Registered Report Identifier (IRRID): DERR1-10.2196/26477 %M 33793409 %R 10.2196/26477 %U https://www.researchprotocols.org/2021/4/e26477 %U https://doi.org/10.2196/26477 %U http://www.ncbi.nlm.nih.gov/pubmed/33793409 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 4 %P e24191 %T Measuring Stress in Health Professionals Over the Phone Using Automatic Speech Analysis During the COVID-19 Pandemic: Observational Pilot Study %A König,Alexandra %A Riviere,Kevin %A Linz,Nicklas %A Lindsay,Hali %A Elbaum,Julia %A Fabre,Roxane %A Derreumaux,Alexandre %A Robert,Philippe %+ Stars Team, Institut national de recherche en informatique et en automatique, 2004 Route des Lucioles, 06902, Sophia Antipolis, Valbonne, 06200, France, 33 +33652021156, alexandra.konig@inria.fr %K stress detection %K speech %K voice analysis %K COVID-19 %K phone monitoring %K computer linguistics %D 2021 %7 19.4.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: During the COVID-19 pandemic, health professionals have been directly confronted with the suffering of patients and their families. By making them main actors in the management of this health crisis, they have been exposed to various psychosocial risks (stress, trauma, fatigue, etc). Paradoxically, stress-related symptoms are often underreported in this vulnerable population but are potentially detectable through passive monitoring of changes in speech behavior. Objective: This study aims to investigate the use of rapid and remote measures of stress levels in health professionals working during the COVID-19 outbreak. This was done through the analysis of participants’ speech behavior during a short phone call conversation and, in particular, via positive, negative, and neutral storytelling tasks. Methods: Speech samples from 89 health care professionals were collected over the phone during positive, negative, and neutral storytelling tasks; various voice features were extracted and compared with classical stress measures via standard questionnaires. Additionally, a regression analysis was performed. Results: Certain speech characteristics correlated with stress levels in both genders; mainly, spectral (ie, formant) features, such as the mel-frequency cepstral coefficient, and prosodic characteristics, such as the fundamental frequency, appeared to be sensitive to stress. Overall, for both male and female participants, using vocal features from the positive tasks for regression yielded the most accurate prediction results of stress scores (mean absolute error 5.31). Conclusions: Automatic speech analysis could help with early detection of subtle signs of stress in vulnerable populations over the phone. By combining the use of this technology with timely intervention strategies, it could contribute to the prevention of burnout and the development of comorbidities, such as depression or anxiety. %M 33739930 %R 10.2196/24191 %U https://www.jmir.org/2021/4/e24191 %U https://doi.org/10.2196/24191 %U http://www.ncbi.nlm.nih.gov/pubmed/33739930 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 4 %P e27060 %T Prediction and Feature Importance Analysis for Severity of COVID-19 in South Korea Using Artificial Intelligence: Model Development and Validation %A Chung,Heewon %A Ko,Hoon %A Kang,Wu Seong %A Kim,Kyung Won %A Lee,Hooseok %A Park,Chul %A Song,Hyun-Ok %A Choi,Tae-Young %A Seo,Jae Ho %A Lee,Jinseok %+ Department of Artificial Intelligence, The Catholic University of Korea, 43 Jibong-ro, Bucheon, 14662, Republic of Korea, 82 2 2164 5523, gonasago@catholic.ac.kr %K COVID-19 %K artificial intelligence %K blood samples %K mortality prediction %D 2021 %7 19.4.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The number of deaths from COVID-19 continues to surge worldwide. In particular, if a patient’s condition is sufficiently severe to require invasive ventilation, it is more likely to lead to death than to recovery. Objective: The goal of our study was to analyze the factors related to COVID-19 severity in patients and to develop an artificial intelligence (AI) model to predict the severity of COVID-19 at an early stage. Methods: We developed an AI model that predicts severity based on data from 5601 COVID-19 patients from all national and regional hospitals across South Korea as of April 2020. The clinical severity of COVID-19 was divided into two categories: low and high severity. The condition of patients in the low-severity group corresponded to no limit of activity, oxygen support with nasal prong or facial mask, and noninvasive ventilation. The condition of patients in the high-severity group corresponded to invasive ventilation, multi-organ failure with extracorporeal membrane oxygenation required, and death. For the AI model input, we used 37 variables from the medical records, including basic patient information, a physical index, initial examination findings, clinical findings, comorbid diseases, and general blood test results at an early stage. Feature importance analysis was performed with AdaBoost, random forest, and eXtreme Gradient Boosting (XGBoost); the AI model for predicting COVID-19 severity among patients was developed with a 5-layer deep neural network (DNN) with the 20 most important features, which were selected based on ranked feature importance analysis of 37 features from the comprehensive data set. The selection procedure was performed using sensitivity, specificity, accuracy, balanced accuracy, and area under the curve (AUC). Results: We found that age was the most important factor for predicting disease severity, followed by lymphocyte level, platelet count, and shortness of breath or dyspnea. Our proposed 5-layer DNN with the 20 most important features provided high sensitivity (90.2%), specificity (90.4%), accuracy (90.4%), balanced accuracy (90.3%), and AUC (0.96). Conclusions: Our proposed AI model with the selected features was able to predict the severity of COVID-19 accurately. We also made a web application so that anyone can access the model. We believe that sharing the AI model with the public will be helpful in validating and improving its performance. %M 33764883 %R 10.2196/27060 %U https://www.jmir.org/2021/4/e27060 %U https://doi.org/10.2196/27060 %U http://www.ncbi.nlm.nih.gov/pubmed/33764883 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 4 %P e21468 %T A Recursive Model of the Spread of COVID-19: Modelling Study %A Ilyin,Sergey O %+ AV Topchiev Institute of Petrochemical Synthesis, Russian Academy of Sciences, 29 Leninsky prospekt, Moscow, 119991, Russian Federation, 7 9168276852, s.o.ilyin@gmail.com %K epidemiology %K COVID-19 %K model %K modelling %K prediction %K spread %K infection %K effective %K contagious %K transmission %D 2021 %7 19.4.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The major medical and social challenge of the 21st century is COVID-19, caused by the novel coronavirus SARS-CoV-2. Critical issues include the rate at which the coronavirus spreads and the effect of quarantine measures and population vaccination on this rate. Knowledge of the laws of the spread of COVID-19 will enable assessment of the effectiveness and reasonableness of the quarantine measures used, as well as determination of the necessary level of vaccination needed to overcome this crisis. Objective: This study aims to establish the laws of the spread of COVID-19 and to use them to develop a mathematical model to predict changes in the number of active cases over time, possible human losses, and the rate of recovery of patients, to make informed decisions about the number of necessary beds in hospitals, the introduction and type of quarantine measures, and the required threshold of vaccination of the population. Methods: This study analyzed the onset of COVID-19 spread in countries such as China, Italy, Spain, the United States, the United Kingdom, Japan, France, and Germany based on publicly available statistical data. The change in the number of COVID-19 cases, deaths, and recovered persons over time was examined, considering the possible introduction of quarantine measures and isolation of infected people in these countries. Based on the data, the virus transmissibility and the average duration of the disease at different stages were evaluated, and a model based on the principle of recursion was developed. Its key features are the separation of active (nonisolated) infected persons into a distinct category and the prediction of their number based on the average duration of the disease in the inactive phase and the concentration of these persons in the population in the preceding days. Results: Specific values for SARS-CoV-2 transmissibility and COVID-19 duration were estimated for different countries. In China, the viral transmissibility was 3.12 before quarantine measures were implemented and 0.36 after these measures were lifted. For the other countries, the viral transmissibility was 2.28-2.76 initially, and it then decreased to 0.87-1.29 as a result of quarantine measures. Therefore, it can be expected that the spread of SARS-CoV-2 will be suppressed if 56%-64% of the total population becomes vaccinated or survives COVID-19. Conclusions: The quarantine measures adopted in most countries are too weak compared to those previously used in China. Therefore, it is not expected that the spread of COVID-19 will stop and the disease will cease to exist naturally or owing to quarantine measures. Active vaccination of the population is needed to prevent the spread of COVID-19. Furthermore, the required specific percentage of vaccinated individuals depends on the magnitude of viral transmissibility, which can be evaluated using the proposed model and statistical data for the country of interest. %M 33871381 %R 10.2196/21468 %U https://publichealth.jmir.org/2021/4/e21468 %U https://doi.org/10.2196/21468 %U http://www.ncbi.nlm.nih.gov/pubmed/33871381 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 4 %P e26994 %T Rise in Use of Digital Mental Health Tools and Technologies in the United States During the COVID-19 Pandemic: Survey Study %A Sorkin,Dara H %A Janio,Emily A %A Eikey,Elizabeth V %A Schneider,Margaret %A Davis,Katelyn %A Schueller,Stephen M %A Stadnick,Nicole A %A Zheng,Kai %A Neary,Martha %A Safani,David %A Mukamel,Dana B %+ Department of Medicine, University of California, Irvine, 100 Theory, Suite 120, Irvine, CA, 92697, United States, 1 949 824 0149, dsorkin@uci.edu %K COVID-19 %K digital technologies %K mHealth %K mental health %K anxiety %K depression %K MTurk %K e-mental health %K digital health %K distress %K self-management %D 2021 %7 16.4.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Accompanying the rising rates of reported mental distress during the COVID-19 pandemic has been a reported increase in the use of digital technologies to manage health generally, and mental health more specifically. Objective: The objective of this study was to systematically examine whether there was a COVID-19 pandemic–related increase in the self-reported use of digital mental health tools and other technologies to manage mental health. Methods: We analyzed results from a survey of 5907 individuals in the United States using Amazon Mechanical Turk (MTurk); the survey was administered during 4 week-long periods in 2020 and survey respondents were from all 50 states and Washington DC. The first set of analyses employed two different logistic regression models to estimate the likelihood of having symptoms indicative of clinical depression and anxiety, respectively, as a function of the rate of COVID-19 cases per 10 people and survey time point. The second set employed seven different logistic regression models to estimate the likelihood of using seven different types of digital mental health tools and other technologies to manage one’s mental health, as a function of symptoms indicative of clinical depression and anxiety, rate of COVID-19 cases per 10 people, and survey time point. These models also examined potential interactions between symptoms of clinical depression and anxiety, respectively, and rate of COVID-19 cases. All models controlled for respondent sociodemographic characteristics and state fixed effects. Results: Higher COVID-19 case rates were associated with a significantly greater likelihood of reporting symptoms of depression (odds ratio [OR] 2.06, 95% CI 1.27-3.35), but not anxiety (OR 1.21, 95% CI 0.77-1.88). Survey time point, a proxy for time, was associated with a greater likelihood of reporting clinically meaningful symptoms of depression and anxiety (OR 1.19, 95% CI 1.12-1.27 and OR 1.12, 95% CI 1.05-1.19, respectively). Reported symptoms of depression and anxiety were associated with a greater likelihood of using each type of technology. Higher COVID-19 case rates were associated with a significantly greater likelihood of using mental health forums, websites, or apps (OR 2.70, 95% CI 1.49-4.88), and other health forums, websites, or apps (OR 2.60, 95% CI 1.55-4.34). Time was associated with increased odds of reported use of mental health forums, websites, or apps (OR 1.20, 95% CI 1.11-1.30), phone-based or text-based crisis lines (OR 1.20, 95% CI 1.10-1.31), and online, computer, or console gaming/video gaming (OR 1.12, 95% CI 1.05-1.19). Interactions between COVID-19 case rate and mental health symptoms were not significantly associated with any of the technology types. Conclusions: Findings suggested increased use of digital mental health tools and other technologies over time during the early stages of the COVID-19 pandemic. As such, additional effort is urgently needed to consider the quality of these products, either by ensuring users have access to evidence-based and evidence-informed technologies and/or by providing them with the skills to make informed decisions around their potential efficacy. %M 33822737 %R 10.2196/26994 %U https://www.jmir.org/2021/4/e26994 %U https://doi.org/10.2196/26994 %U http://www.ncbi.nlm.nih.gov/pubmed/33822737 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 4 %P e26645 %T Evolving Epidemiological Characteristics of COVID-19 in Hong Kong From January to August 2020: Retrospective Study %A Kwok,Kin On %A Wei,Wan In %A Huang,Ying %A Kam,Kai Man %A Chan,Emily Ying Yang %A Riley,Steven %A Chan,Ho Hin Henry %A Hui,David Shu Cheong %A Wong,Samuel Yeung Shan %A Yeoh,Eng Kiong %+ JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Room 419, 4/F, School of Public Health Building, Prince of Wales Hospital, Shatin, NT, Hong Kong, China (Hong Kong), 852 22528405, kkokwok@cuhk.edu.hk %K SARS-CoV-2 %K COVID-19 %K evolving epidemiology %K containment delay %K serial interval %K Hong Kong %K epidemiology %K public health %K transmission %K China %K intervention %K case study %D 2021 %7 16.4.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: COVID-19 has plagued the globe, with multiple SARS-CoV-2 clusters hinting at its evolving epidemiology. Since the disease course is governed by important epidemiological parameters, including containment delays (time between symptom onset and mandatory isolation) and serial intervals (time between symptom onsets of infector-infectee pairs), understanding their temporal changes helps to guide interventions. Objective: This study aims to characterize the epidemiology of the first two epidemic waves of COVID-19 in Hong Kong by doing the following: (1) estimating the containment delays, serial intervals, effective reproductive number (Rt), and proportion of asymptomatic cases; (2) identifying factors associated with the temporal changes of the containment delays and serial intervals; and (3) depicting COVID-19 transmission by age assortativity and types of social settings. Methods: We retrieved the official case series and the Apple mobility data of Hong Kong from January-August 2020. The empirical containment delays and serial intervals were fitted to theoretical distributions, and factors associated with their temporal changes were quantified in terms of percentage contribution (the percentage change in the predicted outcome from multivariable regression models relative to a predefined comparator). Rt was estimated with the best fitted distribution for serial intervals. Results: The two epidemic waves were characterized by imported cases and clusters of local cases, respectively. Rt peaked at 2.39 (wave 1) and 3.04 (wave 2). The proportion of asymptomatic cases decreased from 34.9% (0-9 years) to 12.9% (≥80 years). Log-normal distribution best fitted the 1574 containment delays (mean 5.18 [SD 3.04] days) and the 558 serial intervals (17 negative; mean 4.74 [SD 4.24] days). Containment delays decreased with involvement in a cluster (percentage contribution: 10.08%-20.73%) and case detection in the public health care sector (percentage contribution: 27.56%, 95% CI 22.52%-32.33%). Serial intervals decreased over time (6.70 days in wave 1 versus 4.35 days in wave 2) and with tertiary transmission or beyond (percentage contribution: –50.75% to –17.31%), but were lengthened by mobility (percentage contribution: 0.83%). Transmission within the same age band was high (18.1%). Households (69.9%) and social settings (20.3%) were where transmission commonly occurred. Conclusions: First, the factors associated with reduced containment delays suggested government-enacted interventions were useful for achieving outbreak control and should be further encouraged. Second, the shorter serial intervals associated with the composite mobility index calls for empirical surveys to disentangle the role of different contact dimensions in disease transmission. Third, the presymptomatic transmission and asymptomatic cases underscore the importance of remaining vigilant about COVID-19. Fourth, the time-varying epidemiological parameters suggest the need to incorporate their temporal variations when depicting the epidemic trajectory. Fifth, the high proportion of transmission events occurring within the same age group supports the ban on gatherings outside of households, and underscores the need for residence-centered preventive measures. %M 33750740 %R 10.2196/26645 %U https://www.jmir.org/2021/4/e26645 %U https://doi.org/10.2196/26645 %U http://www.ncbi.nlm.nih.gov/pubmed/33750740 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 4 %P e25852 %T Prediction Models for the Clinical Severity of Patients With COVID-19 in Korea: Retrospective Multicenter Cohort Study %A Oh,Bumjo %A Hwangbo,Suhyun %A Jung,Taeyeong %A Min,Kyungha %A Lee,Chanhee %A Apio,Catherine %A Lee,Hyejin %A Lee,Seungyeoun %A Moon,Min Kyong %A Kim,Shin-Woo %A Park,Taesung %+ Department of Statistics, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, 08826, Republic of Korea, 82 2 880 8924, tspark@stats.snu.ac.kr %K clinical decision support system %K clinical characteristics %K COVID-19 %K SARS-CoV-2 %K prognostic tool %K severity %D 2021 %7 16.4.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Limited information is available about the present characteristics and dynamic clinical changes that occur in patients with COVID-19 during the early phase of the illness. Objective: This study aimed to develop and validate machine learning models based on clinical features to assess the risk of severe disease and triage for COVID-19 patients upon hospital admission. Methods: This retrospective multicenter cohort study included patients with COVID-19 who were released from quarantine until April 30, 2020, in Korea. A total of 5628 patients were included in the training and testing cohorts to train and validate the models that predict clinical severity and the duration of hospitalization, and the clinical severity score was defined at four levels: mild, moderate, severe, and critical. Results: Out of a total of 5601 patients, 4455 (79.5%), 330 (5.9%), 512 (9.1%), and 301 (5.4%) were included in the mild, moderate, severe, and critical levels, respectively. As risk factors for predicting critical patients, we selected older age, shortness of breath, a high white blood cell count, low hemoglobin levels, a low lymphocyte count, and a low platelet count. We developed 3 prediction models to classify clinical severity levels. For example, the prediction model with 6 variables yielded a predictive power of >0.93 for the area under the receiver operating characteristic curve. We developed a web-based nomogram, using these models. Conclusions: Our prediction models, along with the web-based nomogram, are expected to be useful for the assessment of the onset of severe and critical illness among patients with COVID-19 and triage patients upon hospital admission. %M 33822738 %R 10.2196/25852 %U https://www.jmir.org/2021/4/e25852 %U https://doi.org/10.2196/25852 %U http://www.ncbi.nlm.nih.gov/pubmed/33822738 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 4 %P e24184 %T Gender Differences in Satisfaction With a Text Messaging Program (Text4Hope) and Anticipated Receptivity to Technology-Based Health Support During the COVID-19 Pandemic: Cross-sectional Survey Study %A Shalaby,Reham %A Vuong,Wesley %A Hrabok,Marianne %A Gusnowski,April %A Mrklas,Kelly %A Li,Daniel %A Snaterse,Mark %A Surood,Shireen %A Cao,Bo %A Li,Xin-Min %A Greiner,Russell %A Greenshaw,Andrew James %A Agyapong,Vincent Israel Opoku %+ Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, 8440 112 St NW, Edmonton, AB, T6G 2B7, Canada, 1 7807144315, agyapong@ualberta.ca %K COVID-19 %K Text4Hope %K satisfaction %K mobile phone %K text %K anxiety %K depression %K stress, pandemic %K e-mental health %K gender %D 2021 %7 15.4.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: In March 2020, Text4Hope—a community health service—was provided to Alberta residents. This free service aims to promote psychological resilience and alleviate pandemic-associated stress, anxiety, and depression symptoms during the COVID-19 pandemic. Objective: This study aimed to evaluate the feedback, satisfaction, experience, and perceptions of Text4Hope subscribers and to examine any differences based on gender after subscribers received 6 weeks of daily supportive text messages. Additionally, this study examined subscribers’ anticipated receptivity to technology-based medical services that could be offered during major crises, emergencies, or pandemics. Methods: Individuals self-subscribed to Text4Hope to receive daily supportive text messages for 3 months. Subscribers were invited to complete a web-based survey at 6 weeks postintervention to provide service satisfaction–related information. Overall satisfaction was assessed on a scale of 0-10, and satisfaction scores were analyzed using a related-measures t test. Likert scale satisfaction responses were used to assess various aspects of the Text4Hope program. Gender differences were analyzed using one-way analysis of variance (ANOVA) and Chi-square analyses. Results: A total of 2032 subscribers completed the baseline and 6-week surveys; 1788 (88%) were female, 219 (10.8%) were male, and 25 (1.2%) were other gender. The mean age of study participants was 44.58 years (SD 13.45 years). The mean overall satisfaction score was 8.55 (SD 1.78), suggesting high overall satisfaction with Text4Hope. The ANOVA analysis, which was conducted using the Welch test (n=1716), demonstrated that females had significantly higher mean satisfaction scores than males (8.65 vs 8.11, respectively; mean difference=0.546; 95% CI 0.19 to 0.91; P<.001) and nonsignificantly lower satisfaction scores than other gender respondents (mean difference=−0.938; 95% CI −0.37 to 2.25; P=.15). More than 70% of subscribers agreed that Text4Hope helped them cope with stress (1334/1731, 77.1%) and anxiety (1309/1728, 75.8%), feel connected to a support system (1400/1729, 81%), manage COVID-19–related issues (1279/1728, 74%), and improve mental well-being (1308/1731, 75.6%). Similarly, subscribers agreed that messages were positive, affirmative, and succinct. Messages were always or often read by 97.9% (1681/1716) of respondents, and more than 20% (401/1716, 23.4%) always or often returned to messages. The majority of subscribers (1471/1666, 88.3%) read the messages and either reflected upon them or took a positive action. Subscribers welcomed almost all technology-based services as part of their health care during crisis or emergency situations. Text4Hope was perceived to be effective by many female subscribers, who reported higher satisfaction and improved coping after receiving text messages for 6 weeks. Conclusions: Respondents affirmed the high quality of the text messages with their positive feedback. Technology-based services can provide remotely accessible and population-level interventions that align with the recommended physical distancing practices for pandemics. Text4Hope subscriber feedback revealed high satisfaction and acceptance at 6 weeks postintervention. International Registered Report Identifier (IRRID): RR2-10.2196/19292 %M 33750738 %R 10.2196/24184 %U https://mhealth.jmir.org/2021/4/e24184 %U https://doi.org/10.2196/24184 %U http://www.ncbi.nlm.nih.gov/pubmed/33750738 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 4 %P e26734 %T The Impact of the COVID-19 Pandemic on the Uptake of Influenza Vaccine: UK-Wide Observational Study %A Bachtiger,Patrik %A Adamson,Alexander %A Chow,Ji-Jian %A Sisodia,Rupa %A Quint,Jennifer K %A Peters,Nicholas S %+ National Heart & Lung Institute, Imperial College London, 4th Floor ICTEM Building, Hammersmith Campus, Du Cane Road, London, W12 0NN, United Kingdom, 44 020 7589 5111, n.peters@imperial.ac.uk %K COVID-19 %K influenza %K vaccination %K COVID %K Pandemic %K National Health Service %K Health Service %K flu %K virus %K vaccine %K impact %K uptake %K observational %K United Kingdom %K public health %K intention %K electronic health record %D 2021 %7 14.4.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: In the face of the COVID-19 pandemic, the UK National Health Service (NHS) extended eligibility for influenza vaccination this season to approximately 32.4 million people (48.8% of the population). Knowing the intended uptake of the vaccine will inform supply and public health messaging to maximize vaccination. Objective: The objective of this study was to measure the impact of the COVID-19 pandemic on the acceptance of influenza vaccination in the 2020-2021 season, specifically focusing on people who were previously eligible but routinely declined vaccination and newly eligible people. Methods: Intention to receive the influenza vaccine in 2020-2021 was asked of all registrants of the largest electronic personal health record in the NHS by a web-based questionnaire on July 31, 2020. Of those who were either newly or previously eligible but had not previously received an influenza vaccination, multivariable logistic regression and network diagrams were used to examine their reasons to undergo or decline vaccination. Results: Among 6641 respondents, 945 (14.2%) were previously eligible but were not vaccinated; of these, 536 (56.7%) intended to receive an influenza vaccination in 2020-2021, as did 466 (68.6%) of the newly eligible respondents. Intention to receive the influenza vaccine was associated with increased age, index of multiple deprivation quintile, and considering oneself to be at high risk from COVID-19. Among those who were eligible but not intending to be vaccinated in 2020-2021, 164/543 (30.2%) gave reasons based on misinformation. Of the previously unvaccinated health care workers, 47/96 (49%) stated they would decline vaccination in 2020-2021. Conclusions: In this sample, COVID-19 has increased acceptance of influenza vaccination in previously eligible but unvaccinated people and has motivated substantial uptake in newly eligible people. This study is essential for informing resource planning and the need for effective messaging campaigns to address negative misconceptions, which is also necessary for COVID-19 vaccination programs. %M 33651708 %R 10.2196/26734 %U https://publichealth.jmir.org/2021/4/e26734 %U https://doi.org/10.2196/26734 %U http://www.ncbi.nlm.nih.gov/pubmed/33651708 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 4 %P e26211 %T Machine Learning Applied to Clinical Laboratory Data in Spain for COVID-19 Outcome Prediction: Model Development and Validation %A Domínguez-Olmedo,Juan L %A Gragera-Martínez,Álvaro %A Mata,Jacinto %A Pachón Álvarez,Victoria %+ Higher Technical School of Engineering, University of Huelva, Fuerzas Armadas Ave, Huelva, 21007, Spain, 34 959217371, juan.dominguez@dti.uhu.es %K COVID-19 %K electronic health record %K machine learning %K mortality %K prediction %D 2021 %7 14.4.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic is probably the greatest health catastrophe of the modern era. Spain’s health care system has been exposed to uncontrollable numbers of patients over a short period, causing the system to collapse. Given that diagnosis is not immediate, and there is no effective treatment for COVID-19, other tools have had to be developed to identify patients at the risk of severe disease complications and thus optimize material and human resources in health care. There are no tools to identify patients who have a worse prognosis than others. Objective: This study aimed to process a sample of electronic health records of patients with COVID-19 in order to develop a machine learning model to predict the severity of infection and mortality from among clinical laboratory parameters. Early patient classification can help optimize material and human resources, and analysis of the most important features of the model could provide more detailed insights into the disease. Methods: After an initial performance evaluation based on a comparison with several other well-known methods, the extreme gradient boosting algorithm was selected as the predictive method for this study. In addition, Shapley Additive Explanations was used to analyze the importance of the features of the resulting model. Results: After data preprocessing, 1823 confirmed patients with COVID-19 and 32 predictor features were selected. On bootstrap validation, the extreme gradient boosting classifier yielded a value of 0.97 (95% CI 0.96-0.98) for the area under the receiver operator characteristic curve, 0.86 (95% CI 0.80-0.91) for the area under the precision-recall curve, 0.94 (95% CI 0.92-0.95) for accuracy, 0.77 (95% CI 0.72-0.83) for the F-score, 0.93 (95% CI 0.89-0.98) for sensitivity, and 0.91 (95% CI 0.86-0.96) for specificity. The 4 most relevant features for model prediction were lactate dehydrogenase activity, C-reactive protein levels, neutrophil counts, and urea levels. Conclusions: Our predictive model yielded excellent results in the differentiating among patients who died of COVID-19, primarily from among laboratory parameter values. Analysis of the resulting model identified a set of features with the most significant impact on the prediction, thus relating them to a higher risk of mortality. %M 33793407 %R 10.2196/26211 %U https://www.jmir.org/2021/4/e26211 %U https://doi.org/10.2196/26211 %U http://www.ncbi.nlm.nih.gov/pubmed/33793407 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 4 %P e24577 %T Socioeconomic Disparities in eHealth Literacy and Preventive Behaviors During the COVID-19 Pandemic in Hong Kong: Cross-sectional Study %A Guo,Ziqiu %A Zhao,Sheng Zhi %A Guo,Ningyuan %A Wu,Yongda %A Weng,Xue %A Wong,Janet Yuen-Ha %A Lam,Tai Hing %A Wang,Man Ping %+ School of Nursing, University of Hong Kong, 21 Sassoon Road, Hong Kong, China (Hong Kong), 852 3917 6636, mpwang@hku.hk %K COVID-19 %K eHealth literacy %K preventive behaviors %K socioeconomic disparities %K web-based information seeking %D 2021 %7 14.4.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: eHealth literacy can potentially facilitate web-based information seeking and taking informed measures. Objective: This study aimed to evaluate socioeconomic disparities in eHealth literacy and seeking of web-based information on COVID-19, and their associations with COVID-19 preventive behaviors. Methods: The COVID-19 Health Information Survey (CoVHIns), using telephonic (n=500) and web-based surveys (n=1001), was conducted among adults in Hong Kong in April 2020. The Chinese eHealth literacy scale (eHEALS; score range 8-40) was used to measure eHealth literacy. COVID-19 preventive behaviors included wearing surgical masks, wearing fabric masks, washing hands, social distancing, and adding water or bleach to the household drainage system. Adjusted beta coefficients and the slope indices of inequality for the eHEALS score by socioeconomic status, adjusted odds ratios (aORs) for seeking of web-based information on COVID-19 by socioeconomic status, and aORs for the high adherence to preventive behaviors by the eHEALS score and seeking of web-based information on COVID-19 were calculated. Results: The mean eHEALS score was 26.10 (SD 7.70). Age was inversely associated with the eHEALS score, but education and personal income were positively associated with the eHEALS score and seeking of web-based information on COVID-19 (for all, P for trend<.05). Participants who sought web-based information on COVID-19 showed high adherence to the practice of wearing surgical masks (aOR 1.56, 95% CI 1.15-2.13), washing hands (aOR 1.33, 95% CI 1.05-1.71), social distancing (aOR 1.48, 95% CI 1.14-1.93), and adding water or bleach to the household drainage system (aOR 1.67, 95% CI 1.28-2.18). Those with the highest eHEALS score displayed high adherence to the practice of wearing surgical masks (aOR 3.84, 95% CI 1.63-9.05), washing hands (aOR 4.14, 95% CI 2.46-6.96), social distancing (aOR 2.25, 95% CI 1.39-3.65), and adding water or bleach to the household drainage system (aOR 1.94, 95% CI 1.19-3.16), compared to those with the lowest eHEALS score. Conclusions: Chinese adults with a higher socioeconomic status had higher eHealth literacy and sought more web-based information on COVID-19; both these factors were associated with a high adherence to the guidelines for preventive behaviors during the COVID-19 pandemic. %M 33784240 %R 10.2196/24577 %U https://www.jmir.org/2021/4/e24577 %U https://doi.org/10.2196/24577 %U http://www.ncbi.nlm.nih.gov/pubmed/33784240 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 4 %P e26527 %T “Thought I’d Share First” and Other Conspiracy Theory Tweets from the COVID-19 Infodemic: Exploratory Study %A Gerts,Dax %A Shelley,Courtney D %A Parikh,Nidhi %A Pitts,Travis %A Watson Ross,Chrysm %A Fairchild,Geoffrey %A Vaquera Chavez,Nidia Yadria %A Daughton,Ashlynn R %+ Analytics, Intelligence, and Technology Division, Los Alamos National Laboratory, P.O. Box 1663, Los Alamos, NM, 87545, United States, 1 505 664 0062, adaughton@lanl.gov %K COVID-19 %K coronavirus %K social media %K misinformation %K health communication %K Twitter %K infodemic %K infodemiology %K conspiracy theories %K vaccine hesitancy %K 5G %K unsupervised learning %K random forest %K active learning %K supervised learning %K machine learning %K conspiracy %K communication %K vaccine %K public health %D 2021 %7 14.4.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The COVID-19 outbreak has left many people isolated within their homes; these people are turning to social media for news and social connection, which leaves them vulnerable to believing and sharing misinformation. Health-related misinformation threatens adherence to public health messaging, and monitoring its spread on social media is critical to understanding the evolution of ideas that have potentially negative public health impacts. Objective: The aim of this study is to use Twitter data to explore methods to characterize and classify four COVID-19 conspiracy theories and to provide context for each of these conspiracy theories through the first 5 months of the pandemic. Methods: We began with a corpus of COVID-19 tweets (approximately 120 million) spanning late January to early May 2020. We first filtered tweets using regular expressions (n=1.8 million) and used random forest classification models to identify tweets related to four conspiracy theories. Our classified data sets were then used in downstream sentiment analysis and dynamic topic modeling to characterize the linguistic features of COVID-19 conspiracy theories as they evolve over time. Results: Analysis using model-labeled data was beneficial for increasing the proportion of data matching misinformation indicators. Random forest classifier metrics varied across the four conspiracy theories considered (F1 scores between 0.347 and 0.857); this performance increased as the given conspiracy theory was more narrowly defined. We showed that misinformation tweets demonstrate more negative sentiment when compared to nonmisinformation tweets and that theories evolve over time, incorporating details from unrelated conspiracy theories as well as real-world events. Conclusions: Although we focus here on health-related misinformation, this combination of approaches is not specific to public health and is valuable for characterizing misinformation in general, which is an important first step in creating targeted messaging to counteract its spread. Initial messaging should aim to preempt generalized misinformation before it becomes widespread, while later messaging will need to target evolving conspiracy theories and the new facets of each as they become incorporated. %M 33764882 %R 10.2196/26527 %U https://publichealth.jmir.org/2021/4/e26527 %U https://doi.org/10.2196/26527 %U http://www.ncbi.nlm.nih.gov/pubmed/33764882 %0 Journal Article %@ 2561-9128 %I JMIR Publications %V 4 %N 1 %P e26316 %T An Online Calculator to Better Understand the Impact of False-Negative COVID-19 Polymerase Chain Reaction Test Results in the Context of Anesthesia Providers %A Runnels,Sean %A Pearson,John Frederick %A Samuels,Jon Dean %A Panchamia,Rohan Kirit %+ Department of Anesthesiology, Weill Cornell Medical College, 525 E 68th St, New York, NY, 10065, United States, 1 2127462755, rkp9004@med.cornell.edu %K COVID-19 %K testing %K false-negative rate %K calculator %K provider exposure %K airway management %K anesthesia %K exposure %K false negative %K risk %K transmission %K infectious disease %D 2021 %7 14.4.2021 %9 Viewpoint %J JMIR Perioper Med %G English %X What does the COVID-19 false-negative exposure problem mean in the context of a local anesthesia practice? We present a customizable online calculator designed to quantify and better understand individual and aggregate provider exposure risk. %M 33851930 %R 10.2196/26316 %U https://periop.jmir.org/2021/1/e26316 %U https://doi.org/10.2196/26316 %U http://www.ncbi.nlm.nih.gov/pubmed/33851930 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 4 %P e27045 %T Spatial-Temporal Relationship Between Population Mobility and COVID-19 Outbreaks in South Carolina: Time Series Forecasting Analysis %A Zeng,Chengbo %A Zhang,Jiajia %A Li,Zhenlong %A Sun,Xiaowen %A Olatosi,Bankole %A Weissman,Sharon %A Li,Xiaoming %+ South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, United States, 1 8034775298, czeng@email.sc.edu %K COVID-19 %K mobility %K incidence %K South Carolina %D 2021 %7 13.4.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Population mobility is closely associated with COVID-19 transmission, and it could be used as a proximal indicator to predict future outbreaks, which could inform proactive nonpharmaceutical interventions for disease control. South Carolina is one of the US states that reopened early, following which it experienced a sharp increase in COVID-19 cases. Objective: The aims of this study are to examine the spatial-temporal relationship between population mobility and COVID-19 outbreaks and use population mobility data to predict daily new cases at both the state and county level in South Carolina. Methods: This longitudinal study used disease surveillance data and Twitter-based population mobility data from March 6 to November 11, 2020, in South Carolina and its five counties with the largest number of cumulative confirmed COVID-19 cases. Population mobility was assessed based on the number of Twitter users with a travel distance greater than 0.5 miles. A Poisson count time series model was employed for COVID-19 forecasting. Results: Population mobility was positively associated with state-level daily COVID-19 incidence as well as incidence in the top five counties (ie, Charleston, Greenville, Horry, Spartanburg, and Richland). At the state level, the final model with a time window within the last 7 days had the smallest prediction error, and the prediction accuracy was as high as 98.7%, 90.9%, and 81.6% for the next 3, 7, and 14 days, respectively. Among Charleston, Greenville, Horry, Spartanburg, and Richland counties, the best predictive models were established based on their observations in the last 9, 14, 28, 20, and 9 days, respectively. The 14-day prediction accuracy ranged from 60.3%-74.5%. Conclusions: Using Twitter-based population mobility data could provide acceptable predictions of COVID-19 daily new cases at both the state and county level in South Carolina. Population mobility measured via social media data could inform proactive measures and resource relocations to curb disease outbreaks and their negative influences. %M 33784239 %R 10.2196/27045 %U https://www.jmir.org/2021/4/e27045 %U https://doi.org/10.2196/27045 %U http://www.ncbi.nlm.nih.gov/pubmed/33784239 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 4 %P e26874 %T COVID-19 Vaccine Hesitancy in Canada: Content Analysis of Tweets Using the Theoretical Domains Framework %A Griffith,Janessa %A Marani,Husayn %A Monkman,Helen %+ Women's College Hospital Institute for Health Systems Solutions and Virtual Care, Women’s College Hospital, 76 Grenville Street, Toronto, ON, M5S 1B2, Canada, 1 6479650943, janessa.griffith@wchospital.ca %K vaccine hesitancy %K vaccine %K COVID-19 %K immunization %K Twitter %K infodemiology %K infoveillance %K social media %K behavioral science %K behavior %K Canada %K content analysis %K framework %K hesitancy %D 2021 %7 13.4.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: With the approval of two COVID-19 vaccines in Canada, many people feel a sense of relief, as hope is on the horizon. However, only about 75% of people in Canada plan to receive one of the vaccines. Objective: The purpose of this study is to determine the reasons why people in Canada feel hesitant toward receiving a COVID-19 vaccine. Methods: We screened 3915 tweets from public Twitter profiles in Canada by using the search words “vaccine” and “COVID.” The tweets that met the inclusion criteria (ie, those about COVID-19 vaccine hesitancy) were coded via content analysis. Codes were then organized into themes and interpreted by using the Theoretical Domains Framework. Results: Overall, 605 tweets were identified as those about COVID-19 vaccine hesitancy. Vaccine hesitancy stemmed from the following themes: concerns over safety, suspicion about political or economic forces driving the COVID-19 pandemic or vaccine development, a lack of knowledge about the vaccine, antivaccine or confusing messages from authority figures, and a lack of legal liability from vaccine companies. This study also examined mistrust toward the medical industry not due to hesitancy, but due to the legacy of communities marginalized by health care institutions. These themes were categorized into the following five Theoretical Domains Framework constructs: knowledge, beliefs about consequences, environmental context and resources, social influence, and emotion. Conclusions: With the World Health Organization stating that one of the worst threats to global health is vaccine hesitancy, it is important to have a comprehensive understanding of the reasons behind this reluctance. By using a behavioral science framework, this study adds to the emerging knowledge about vaccine hesitancy in relation to COVID-19 vaccines by analyzing public discourse in tweets in real time. Health care leaders and clinicians may use this knowledge to develop public health interventions that are responsive to the concerns of people who are hesitant to receive vaccines. %M 33769946 %R 10.2196/26874 %U https://www.jmir.org/2021/4/e26874 %U https://doi.org/10.2196/26874 %U http://www.ncbi.nlm.nih.gov/pubmed/33769946 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 4 %P e25762 %T Assessment of the Effectiveness of Identity-Based Public Health Announcements in Increasing the Likelihood of Complying With COVID-19 Guidelines: Randomized Controlled Cross-sectional Web-Based Study %A Dennis,Alexander S %A Moravec,Patricia L %A Kim,Antino %A Dennis,Alan R %+ Kelley School of Business, Indiana University, 1309 E 10th St, Bloomington, IN, 47405, United States, 1 8128552691, ardennis@indiana.edu %K Amazon Mechanical Turk %K compliance %K COVID-19 %K custom %K effectiveness %K guideline %K identity %K public health %K public health announcement %K public service announcement %K social media %K web-based health information %D 2021 %7 13.4.2021 %9 Short Paper %J JMIR Public Health Surveill %G English %X Background: Public health campaigns aimed at curbing the spread of COVID-19 are important in reducing disease transmission, but traditional information-based campaigns have received unexpectedly extreme backlash. Objective: This study aimed to investigate whether customizing of public service announcements (PSAs) providing health guidelines to match individuals’ identities increases their compliance. Methods: We conducted a within- and between-subjects, randomized controlled cross-sectional, web-based study in July 2020. Participants viewed two PSAs: one advocating wearing a mask in public settings and one advocating staying at home. The control PSA only provided information, and the treatment PSAs were designed to appeal to the identities held by individuals; that is, either a Christian identity or an economically motivated identity. Participants were asked about their identity and then provided a control PSA and treatment PSA matching their identity, in random order. The PSAs were of approximately 100 words. Results: We recruited 300 social media users from Amazon Mechanical Turk in accordance with usual protocols to ensure data quality. In total, 8 failed the data quality checks, and the remaining 292 were included in the analysis. In the identity-based PSA, the source of the PSA was changed, and a phrase of approximately 12 words relevant to the individual’s identity was inserted. A PSA tailored for Christians, when matched with a Christian identity, increased the likelihood of compliance by 12 percentage points. A PSA that focused on economic values, when shown to individuals who identified as economically motivated, increased the likelihood of compliance by 6 points. Conclusions: Using social media to deliver COVID-19 public health announcements customized to individuals’ identities is a promising measure to increase compliance with public health guidelines. Trial Registration: ISRCTN Registry 22331899; https://www.isrctn.com/ISRCTN22331899. %M 33819910 %R 10.2196/25762 %U https://publichealth.jmir.org/2021/4/e25762 %U https://doi.org/10.2196/25762 %U http://www.ncbi.nlm.nih.gov/pubmed/33819910 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 4 %P e26330 %T Physical Activity, Nutritional Habits, and Sleeping Behavior in Students and Employees of a Swiss University During the COVID-19 Lockdown Period: Questionnaire Survey Study %A Taeymans,Jan %A Luijckx,Eefje %A Rogan,Slavko %A Haas,Karin %A Baur,Heiner %+ Department of Health Professions, Bern University of Applied Sciences, Murtenstr. 10, Bern, 3008, Switzerland, 41 31 848 35 56, slavko.rogan@bfh.ch %K COVID-19 %K healthy lifestyle %K pandemics %K public health %K universities %D 2021 %7 13.4.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The new coronavirus SARS-CoV-2 led to the COVID-19 pandemic starting in January 2020. The Swiss Federal Council prescribed a lockdown of nonessential businesses. Students and employees of higher education institutions had to install home offices and participate in online lectures. Objective: The aim of this survey study was to evaluate lifestyle habits, such as physical activity (PA), sitting time, nutritional habits (expressed as median modified Mediterranean Diet Score [mMDS]), alcohol consumption habits, and sleeping behavior during a 2-month period of confinement and social distancing due to the COVID-19 pandemic. Survey participants were students and employees of a Swiss university of applied sciences. Methods: All students and employees from Bern University of Applied Sciences, Department of Health Professions (ie, nursing, nutrition and dietetics, midwifery, and physiotherapy divisions) were invited to complete an anonymous online survey during the COVID-19 confinement period. Information on the lifestyle dimensions of PA, sitting time, nutritional and alcohol consumption habits, and sleep behavior was gathered using adaptations of validated questionnaires. Frequency analyses and nonparametric statistical methods were used for data analysis. Significance was set at 5% α level of error. Results: Prevalence of non-health-enhancing PA was 37.1%, with participants of the division of physiotherapy showing the lowest prevalence. Prevalence of long sitting time (>8 hours/day) was 36.1%. The median mMDS was 9, where the maximal score was 15, with participants of the division of nutrition and dietetics being more adherent to a Mediterranean diet as compared to the other groups. Prevalence of nonadherence to the Swiss alcohol consumption recommendations was 8.3%. Prevalence of low sleeping quality was 44.7%, while the median sleeping duration was 8 hours, which is considered healthy for adult populations. Conclusions: In the group analysis, differences in PA, sitting time, and mMDS were observed between different divisions of health professions as well as between Bachelor of Science students, Master of Science students, and employees. Therefore, public health messages regarding healthy lifestyle habits during home confinement should be more group specific. The results of this study may provide support for the implementation of group-specific health promotion interventions at universities in pandemic conditions. Trial Registration: ClinicalTrials.gov NCT04502108; https://www.clinicaltrials.gov/ct2/show/NCT04502108 %M 33630747 %R 10.2196/26330 %U https://publichealth.jmir.org/2021/4/e26330 %U https://doi.org/10.2196/26330 %U http://www.ncbi.nlm.nih.gov/pubmed/33630747 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 9 %N 4 %P e25884 %T Machine Learning Approach to Predicting COVID-19 Disease Severity Based on Clinical Blood Test Data: Statistical Analysis and Model Development %A Aktar,Sakifa %A Ahamad,Md Martuza %A Rashed-Al-Mahfuz,Md %A Azad,AKM %A Uddin,Shahadat %A Kamal,AHM %A Alyami,Salem A %A Lin,Ping-I %A Islam,Sheikh Mohammed Shariful %A Quinn,Julian MW %A Eapen,Valsamma %A Moni,Mohammad Ali %+ WHO Collaborating Centre on eHealth, UNSW Digital Health, School of Public Health and Community Medicine, Faculty of Medicine, University of New South Wales, Kensington, Sydney, NSW 2052, Australia, 61 414701759, m.moni@unsw.edu.au %K COVID-19 %K blood samples %K machine learning %K statistical analysis %K prediction %K severity %K mortality %K morbidity %K risk %K blood %K testing %K outcome %K data set %D 2021 %7 13.4.2021 %9 Original Paper %J JMIR Med Inform %G English %X Background: Accurate prediction of the disease severity of patients with COVID-19 would greatly improve care delivery and resource allocation and thereby reduce mortality risks, especially in less developed countries. Many patient-related factors, such as pre-existing comorbidities, affect disease severity and can be used to aid this prediction. Objective: Because rapid automated profiling of peripheral blood samples is widely available, we aimed to investigate how data from the peripheral blood of patients with COVID-19 can be used to predict clinical outcomes. Methods: We investigated clinical data sets of patients with COVID-19 with known outcomes by combining statistical comparison and correlation methods with machine learning algorithms; the latter included decision tree, random forest, variants of gradient boosting machine, support vector machine, k-nearest neighbor, and deep learning methods. Results: Our work revealed that several clinical parameters that are measurable in blood samples are factors that can discriminate between healthy people and COVID-19–positive patients, and we showed the value of these parameters in predicting later severity of COVID-19 symptoms. We developed a number of analytical methods that showed accuracy and precision scores >90% for disease severity prediction. Conclusions: We developed methodologies to analyze routine patient clinical data that enable more accurate prediction of COVID-19 patient outcomes. With this approach, data from standard hospital laboratory analyses of patient blood could be used to identify patients with COVID-19 who are at high risk of mortality, thus enabling optimization of hospital facilities for COVID-19 treatment. %M 33779565 %R 10.2196/25884 %U https://medinform.jmir.org/2021/4/e25884 %U https://doi.org/10.2196/25884 %U http://www.ncbi.nlm.nih.gov/pubmed/33779565 %0 Journal Article %@ 2563-6316 %I JMIR Publications %V 2 %N 2 %P e27254 %T Mass Testing With Contact Tracing Compared to Test and Trace for the Effective Suppression of COVID-19 in the United Kingdom: Systematic Review %A Mbwogge,Mathew %+ London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, United Kingdom, 44 07424409211, mathew.ngime@alumni.lshtm.ac.uk %K COVID-19 %K SARS-CoV-2 %K test and trace %K universal testing %K mass testing %K contact tracing %K infection surveillance %K prevention and control %K review %D 2021 %7 12.4.2021 %9 Review %J JMIRx Med %G English %X Background: Making testing available to everyone and tracing contacts might be the gold standard to control COVID-19. Many countries including the United Kingdom have relied on the symptom-based test and trace strategy in bringing the COVID-19 pandemic under control. The effectiveness of a test and trace strategy based on symptoms has been questionable and has failed to meet testing and tracing needs. This is further exacerbated by it not being delivered at the point of care, leading to rising cases and deaths. Increases in COVID-19 cases and deaths in the United Kingdom despite performing the highest number of tests in Europe suggest that symptom-based testing and contact tracing might not be effective as a control strategy. An alternative strategy is making testing available to all. Objective: The primary objective of this review was to compare mass testing and contact tracing with the conventional test and trace method in the suppression of SARS-CoV-2 infections. The secondary objective was to determine the proportion of asymptomatic COVID-19 cases reported during mass testing interventions. Methods: Literature in English was searched from September through December 2020 in Google Scholar, ScienceDirect, Mendeley, and PubMed. Search terms included “mass testing,” “test and trace,” “contact tracing,” “COVID-19,” “SARS-CoV-2,” “effectiveness,” “asymptomatic,” “symptomatic,” “community screening,” “UK,” and “2020.” Search results were synthesized without meta-analysis using the direction of effect as the standardized metric and vote counting as the synthesis metric. A statistical synthesis was performed using Stata 14.2. Tabular and graphical methods were used to present findings. Results: The literature search yielded 286 articles from Google Scholar, 20 from ScienceDirect, 14 from Mendeley, 27 from PubMed, and 15 through manual search. A total of 35 articles were included in the review, with a sample size of nearly 1 million participants. We found a 76.9% (10/13, 95% CI 46.2%-95.0%; P=.09) majority vote in favor of the intervention under the primary objective. The overall proportion of asymptomatic cases among those who tested positive and in the tested sample populations under the secondary objective was 40.7% (1084/2661, 95% CI 38.9%-42.6%) and 0.0% (1084/9,942,878, 95% CI 0.0%-0.0%), respectively. Conclusions: There was low-level but promising evidence that mass testing and contact tracing could be more effective in bringing the virus under control and even more effective if combined with social distancing and face coverings. The conventional test and trace method should be superseded by decentralized and regular mass rapid testing and contact tracing, championed by general practitioner surgeries and low-cost community services. %M 33857269 %R 10.2196/27254 %U https://xmed.jmir.org/2021/2/e27254 %U https://doi.org/10.2196/27254 %U http://www.ncbi.nlm.nih.gov/pubmed/33857269 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 4 %N 2 %P e26474 %T Impact of the COVID-19 Pandemic on Older Adults: Rapid Review %A Lebrasseur,Audrey %A Fortin-Bédard,Noémie %A Lettre,Josiane %A Raymond,Emilie %A Bussières,Eve-Line %A Lapierre,Nolwenn %A Faieta,Julie %A Vincent,Claude %A Duchesne,Louise %A Ouellet,Marie-Christine %A Gagnon,Eric %A Tourigny,André %A Lamontagne,Marie-Ève %A Routhier,François %+ Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, 525 Hamel est, Québec, QC, G1M 2S8, Canada, 1 4185299141 ext 6256, francois.routhier@rea.ulaval.ca %K COVID-19 %K impact %K rapid review %K older adults %K aged individuals %K review %D 2021 %7 12.4.2021 %9 Review %J JMIR Aging %G English %X Background: The COVID-19 pandemic has drastically changed the lives of countless members of the general population. Older adults are known to experience loneliness, age discrimination, and excessive worry. It is therefore reasonable to anticipate that they would experience greater negative outcomes related to the COVID-19 pandemic given their increased isolation and risk for complications than younger adults. Objective: This study aims to synthesize the existing research on the impact of the COVID-19 pandemic, and associated isolation and protective measures, on older adults. The secondary objective is to investigate the impact of the COVID-19 pandemic, and associated isolation and protective measures, on older adults with Alzheimer disease and related dementias. Methods: A rapid review of the published literature was conducted on October 6, 2020, through a search of 6 online databases to synthesize results from published original studies regarding the impact of the COVID-19 pandemic on older adults. The Human Development Model conceptual framework–Disability Creation Process was used to describe and understand interactions between personal factors, environmental factors, and life habits. Methods and results are reported following the Preferred Reporting Items for Systematic Reviews and Meta-analyses Statement. Results: A total of 135 records were included from the initial search strategy of 13,452 individual studies. Of these, 113 (83.7%) studies were determined to be of level 4 according to the levels of evidence classification by the Centre for Evidence-Based Medicine. The presence of psychological symptoms, exacerbation of ageism, and physical deterioration of aged populations were reported in the included studies. Decreased social life and fewer in-person social interactions reported during the COVID-19 pandemic were occasionally associated with reduced quality of life and increased depression. Difficulties accessing services, sleep disturbances, and a reduction of physical activity were also noted. Conclusions: Our results highlight the need for adequate isolation and protective measures. Older adults represent a heterogeneous group, which could explain the contradictory results found in the literature. Individual, organizational, and institutional strategies should be established to ensure that older adults are able to maintain social contacts, preserve family ties, and maintain the ability to give or receive help during the current pandemic. Future studies should focus on specific consequences and needs of more at-risk older adults to ensure their inclusion, both in public health recommendations and considerations made by policy makers. %M 33720839 %R 10.2196/26474 %U https://aging.jmir.org/2021/2/e26474 %U https://doi.org/10.2196/26474 %U http://www.ncbi.nlm.nih.gov/pubmed/33720839 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 4 %P e25379 %T Gender Disparity in the Authorship of Biomedical Research Publications During the COVID-19 Pandemic: Retrospective Observational Study %A Muric,Goran %A Lerman,Kristina %A Ferrara,Emilio %+ Annenberg School for Communication and Journalism, University of Southern California, 3630 Watt Way, Suite 402, Los Angeles, CA, 90089, United States, 1 3104488661, emiliofe@usc.edu %K science of science %K gender disparities %K research evaluation %K COVID-19 %D 2021 %7 12.4.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Gender imbalances in academia have been evident historically and persist today. For the past 60 years, we have witnessed the increase of participation of women in biomedical disciplines, showing that the gender gap is shrinking. However, preliminary evidence suggests that women, including female researchers, are disproportionately affected by the COVID-19 pandemic in terms of unequal distribution of childcare, elderly care, and other kinds of domestic and emotional labor. Sudden lockdowns and abrupt shifts in daily routines have had disproportionate consequences on their productivity, which is reflected by a sudden drop in research output in biomedical research, consequently affecting the number of female authors of scientific publications. Objective: The objective of this study is to test the hypothesis that the COVID-19 pandemic has had a disproportionate adverse effect on the productivity of female researchers in the biomedical field in terms of authorship of scientific publications. Methods: This is a retrospective observational bibliometric study. We investigated the proportion of male and female researchers who published scientific papers during the COVID-19 pandemic, using bibliometric data from biomedical preprint servers and selected Springer-Nature journals. We used the ordinary least squares regression model to estimate the expected proportions over time by correcting for temporal trends. We also used a set of statistical methods, such as the Kolmogorov-Smirnov test and regression discontinuity design, to test the validity of the results. Results: A total of 78,950 papers from the bioRxiv and medRxiv repositories and from 62 selected Springer-Nature journals by 346,354 unique authors were analyzed. The acquired data set consisted of papers that were published between January 1, 2019, and August 2, 2020. The proportion of female first authors publishing in the biomedical field during the pandemic dropped by 9.1%, on average, across disciplines (expected arithmetic mean yest=0.39; observed arithmetic mean y=0.35; standard error of the estimate, Sest=0.007; standard error of the observation, σx=0.004). The impact was particularly pronounced for papers related to COVID-19 research, where the proportion of female scientists in the first author position dropped by 28% (yest=0.39; y=0.28; Sest=0.007; σx=0.007). When looking at the last authors, the proportion of women dropped by 7.9%, on average (yest=0.25; y=0.23; Sest=0.005; σx=0.003), while the proportion of women writing about COVID-19 as the last author decreased by 18.8% (yest=0.25; y=0.21; Sest=0.005; σx=0.007). Further, by geocoding authors’ affiliations, we showed that the gender disparities became even more apparent when disaggregated by country, up to 35% in some cases. Conclusions: Our findings document a decrease in the number of publications by female authors in the biomedical field during the global pandemic. This effect was particularly pronounced for papers related to COVID-19, indicating that women are producing fewer publications related to COVID-19 research. This sudden increase in the gender gap was persistent across the 10 countries with the highest number of researchers. These results should be used to inform the scientific community of this worrying trend in COVID-19 research and the disproportionate effect that the pandemic has had on female academics. %M 33735097 %R 10.2196/25379 %U https://www.jmir.org/2021/4/e25379 %U https://doi.org/10.2196/25379 %U http://www.ncbi.nlm.nih.gov/pubmed/33735097 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 4 %P e26331 %T Assessing Public Interest Based on Wikipedia’s Most Visited Medical Articles During the SARS-CoV-2 Outbreak: Search Trends Analysis %A Chrzanowski,Jędrzej %A Sołek,Julia %A Fendler,Wojciech %A Jemielniak,Dariusz %+ Department of Biostatistics and Translational Medicine, Medical University of Łódź, Mazowiecka 15, Łódź, 92-215, Poland, 48 422722585, wojciech.fendler@umed.lodz.pl %K COVID-19 %K pandemic %K media %K Wikipedia %K internet %K online health information %K information seeking %K interest %K retrospective %K surveillance %K infodemiology %K infoveillance %D 2021 %7 12.4.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: In the current era of widespread access to the internet, we can monitor public interest in a topic via information-targeted web browsing. We sought to provide direct proof of the global population’s altered use of Wikipedia medical knowledge resulting from the new COVID-19 pandemic and related global restrictions. Objective: We aimed to identify temporal search trends and quantify changes in access to Wikipedia Medicine Project articles that were related to the COVID-19 pandemic. Methods: We performed a retrospective analysis of medical articles across nine language versions of Wikipedia and country-specific statistics for registered COVID-19 deaths. The observed patterns were compared to a forecast model of Wikipedia use, which was trained on data from 2015 to 2019. The model comprehensively analyzed specific articles and similarities between access count data from before (ie, several years prior) and during the COVID-19 pandemic. Wikipedia articles that were linked to those directly associated with the pandemic were evaluated in terms of degrees of separation and analyzed to identify similarities in access counts. We assessed the correlation between article access counts and the number of diagnosed COVID-19 cases and deaths to identify factors that drove interest in these articles and shifts in public interest during the subsequent phases of the pandemic. Results: We observed a significant (P<.001) increase in the number of entries on Wikipedia medical articles during the pandemic period. The increased interest in COVID-19–related articles temporally correlated with the number of global COVID-19 deaths and consistently correlated with the number of region-specific COVID-19 deaths. Articles with low degrees of separation were significantly similar (P<.001) in terms of access patterns that were indicative of information-seeking patterns. Conclusions: The analysis of Wikipedia medical article popularity could be a viable method for epidemiologic surveillance, as it provides important information about the reasons behind public attention and factors that sustain public interest in the long term. Moreover, Wikipedia users can potentially be directed to credible and valuable information sources that are linked with the most prominent articles. %M 33667176 %R 10.2196/26331 %U https://www.jmir.org/2021/4/e26331 %U https://doi.org/10.2196/26331 %U http://www.ncbi.nlm.nih.gov/pubmed/33667176 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 7 %N 2 %P e25892 %T Social Media and Medical Education in the Context of the COVID-19 Pandemic: Scoping Review %A Katz,Marc %A Nandi,Neilanjan %+ Division of Cardiology, Department of Medicine, St. Luke's University Hospital, 801 Ostrum Street, Bethlehem, PA, 18015, United States, 1 8667858537, marckatzmd@gmail.com %K social media %K medical education %K COVID-19 %K medical student %K review %K doctor %K communication %K online learning %K e-learning %K online education %K delivery %K dissemination %D 2021 %7 12.4.2021 %9 Review %J JMIR Med Educ %G English %X Background: The COVID-19 pandemic has brought virtual web-based learning to the forefront of medical education as training programs adapt to physical distancing challenges while maintaining the rigorous standards of medical training. Social media has unique and partially untapped potential to supplement formal medical education. Objective: The aim of this review is to provide a summary of the incentives, applications, challenges, and pitfalls of social media–based medical education for both trainees and educators. Methods: We performed a literature review via PubMed of medical research involving social media platforms, including Facebook, Twitter, Instagram, YouTube, WhatsApp, and podcasts. Papers were reviewed for inclusion based on the integrity and power of the study. Results: The unique characteristics of social media platforms such as Facebook, Twitter, Instagram, YouTube, WhatsApp, and podcasts endow them with unique communication capabilities that serve different educational purposes in both formal and informal education settings. However, contemporary medical education curricula lack widespread guidance on meaningful use, application, and deployment of social media in medical education. Conclusions: Clinicians and institutions must evolve to embrace the use of social media platforms for medical education. Health care professionals can approach social media engagement in the same ethical manner that they would with patients in person; however, health care institutions ultimately must enable their health care professionals to achieve this by enacting realistic social media policies. Institutions should appoint clinicians with strong social media experience to leadership roles to spearhead these generational and cultural changes. Further studies are needed to better understand how health care professionals can most effectively use social media platforms as educational tools. Ultimately, social media is here to stay, influencing lay public knowledge and trainee knowledge. Clinicians and institutions must embrace this complementary modality of trainee education and champion social media as a novel distribution platform that can also help propagate truth in a time of misinformation, such as the COVID-19 pandemic. %M 33755578 %R 10.2196/25892 %U https://mededu.jmir.org/2021/2/e25892 %U https://doi.org/10.2196/25892 %U http://www.ncbi.nlm.nih.gov/pubmed/33755578 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 4 %P e24053 %T Association of Perceived Threat, Negative Emotions, and Self-Efficacy With Mental Health and Personal Protective Behavior Among Chinese Pregnant Women During the COVID-19 Pandemic: Cross-sectional Survey Study %A Mo,Phoenix Kit Han %A Fong,Vivian Wai In %A Song,Bo %A Di,Jiangli %A Wang,Qian %A Wang,Linhong %+ National Center for Women and Children's Health, Chinese Center for Disease Control and Prevention, No 12 Dahuisi Road, Haidian District, Beijing, 100081, China, 86 010 62170970, qianawang@chinawch.org.cn %K COVID-19 %K pregnant women %K depression %K anxiety %K self-efficacy %K mental health %K survey %K threat %K emotion %D 2021 %7 12.4.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: COVID-19 is an emerging infectious disease that has created health care challenges worldwide. Pregnant women are particularly affected by this disease. Objective: The aims of this study are to assess the levels of perceived threat (susceptibility, severity, impact), negative emotions (fear, worry), and self-efficacy of pregnant women in China related to COVID-19 and to examine their associations with mental health (depression and anxiety) and personal protective behavior (wearing a face mask). Methods: A total of 4087 pregnant women from China completed a cross-sectional web-based survey between March 3 and 10, 2020. Results: The prevalence of probable depression and anxiety was 48.7% (1989/4087) and 33.0% (1347/4087), respectively; 23.8% participants (974/4087) reported always wearing a face mask when going out. Of the 4087 participants, 32.1% (1313) and 36.4% (1490) perceived themselves or their family members to be susceptible to COVID-19 infection, respectively; 3216-3518 (78.7%-86.1%) agreed the disease would have various severe consequences. Additionally, 2275 of the 4087 participants (55.7%) showed self-efficacy in protecting themselves from contracting COVID-19, and 2232 (54.6%) showed efficacy in protecting their family members; 1303 (31.9%) reported a high level of fear of the disease, and 2780-3056 (68.0%-74.8%) expressed worry about various aspects of COVID-19. The results of the multivariate multinominal logistic regression analyses showed that perceived severity, perceived impact, fear, and worry were risk factors for probable depression and anxiety, while self-efficacy was a protective factor. The results of the multivariate logistic regression analysis showed that perceived susceptibility was associated with always wearing a face mask. Conclusions: Chinese pregnant women showed high levels of mental distress but low levels of personal protective behavior during the COVID-19 pandemic. Interventions are needed to promote the mental health and health behavior of pregnant women during the pandemic. %M 33729983 %R 10.2196/24053 %U https://www.jmir.org/2021/4/e24053 %U https://doi.org/10.2196/24053 %U http://www.ncbi.nlm.nih.gov/pubmed/33729983 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 9 %N 4 %P e23238 %T A Patient Journey Map to Improve the Home Isolation Experience of Persons With Mild COVID-19: Design Research for Service Touchpoints of Artificial Intelligence in eHealth %A He,Qian %A Du,Fei %A Simonse,Lianne W L %+ Department of Design Organisation & Strategy, Faculty of Industrial Design Engineering, Delft University of Technology, Landbergstraat 15, Delft, 2628CE, Netherlands, 31 15 27 ext 89054, L.W.L.Simonse@tudelft.nl %K COVID-19 %K design %K eHealth %K artificial intelligence %K service design %K patient journey map %K user-centered design %K digital service solutions in health %K home isolation %K AI %K touchpoint %D 2021 %7 12.4.2021 %9 Original Paper %J JMIR Med Inform %G English %X Background: In the context of the COVID-19 outbreak, 80% of the persons who are infected have mild symptoms and are required to self-recover at home. They have a strong demand for remote health care that, despite the great potential of artificial intelligence (AI), is not met by the current services of eHealth. Understanding the real needs of these persons is lacking. Objective: The aim of this paper is to contribute a fine-grained understanding of the home isolation experience of persons with mild COVID-19 symptoms to enhance AI in eHealth services. Methods: A design research method with a qualitative approach was used to map the patient journey. Data on the home isolation experiences of persons with mild COVID-19 symptoms was collected from the top-viewed personal video stories on YouTube and their comment threads. For the analysis, this data was transcribed, coded, and mapped into the patient journey map. Results: The key findings on the home isolation experience of persons with mild COVID-19 symptoms concerned (1) an awareness period before testing positive, (2) less typical and more personal symptoms, (3) a negative mood experience curve, (5) inadequate home health care service support for patients, and (6) benefits and drawbacks of social media support. Conclusions: The design of the patient journey map and underlying insights on the home isolation experience of persons with mild COVID-19 symptoms serves health and information technology professionals in more effectively applying AI technology into eHealth services, for which three main service concepts are proposed: (1) trustworthy public health information to relieve stress, (2) personal COVID-19 health monitoring, and (3) community support. %M 33444156 %R 10.2196/23238 %U https://medinform.jmir.org/2021/4/e23238 %U https://doi.org/10.2196/23238 %U http://www.ncbi.nlm.nih.gov/pubmed/33444156 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 4 %P e24617 %T Effects of Participating in a Research Project During the COVID-19 Pandemic on Medical Students’ Educational Routines and Mental Health: Protocol for a Web-Based Survey Study %A Calderaro,Débora Cerqueira %A Kahlow,Barbara Stadler %A Munhoz,Gabriela Araújo %A Dias,Samuel Elias Basualto %A Lopes,João Vitor Ziroldo %A Borges,Aline Rizzo %A Mariz,Henrique De Ataíde %A Gomes,Kirla Wagner Poti %A Valadares,Lilian David De Azevedo %A Araújo,Nafice Costa %A Ribeiro,Sandra Lucia Euzébio %A Kakehasi,Adriana Maria %A Reis,Ana Paula Monteiro Gomides %A Marques,Cláudia %A Reis-Neto,Edgard Torres %A Paiva,Eduardo Dos Santos %A Pileggi,Gecilmara Salviato %A Ferreira,Gilda Aparecida %A Provenza,José Roberto %A Mota,Licia Maria Henrique %A Xavier,Ricardo Machado %A Teodoro,Maycoln Leôni Martins %A Pinheiro,Marcelo De Medeiros %A , %+ Universidade Federal de Minas Gerais, 190 Professor Alfredo Balena Avenue, Belo Horizonte, 30130-100, Brazil, 55 3134099757, dccalderaro@gmail.com %K SARS-CoV-2 %K COVID-19 %K medical education %K observational %K cross-sectional %K case-control study %K voluntary %K mental health %K rheumatic disease %K medical student %K protocol %K survey %D 2021 %7 9.4.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: The COVID-19 pandemic has resulted in social isolation, which has a potential negative impact on the educational routines (eg, the suspension of face-to-face appointments) and mental health of medical students. The Mario Pinotti II (MPII) study is a 24-week observational study that conducted scheduled telephone calls every 2 weeks to verify the occurrence of COVID-19 in patients with rheumatic diseases on chronic hydroxychloroquine therapy (from March 29, 2020, to September 30, 2020). The effects of voluntarily participating in a research project (ie, one that involves interactions via telephone contact with patients, professors, rheumatologists, and colleagues) on the daily lives and mental health of medical students requires evaluation. Objective: As medical students are professionals in training and have a high level of responsibility in terms of handling the emotional and physical aspects of several diseases, this study aims to evaluate the impacts of the COVID-19 pandemic and participation in the MPII study on the educational routines and mental health of medical students. Methods: A web-based survey was carried out to perform a cross-sectional comparative assessment of medical students who participated in the MPII study and their colleagues who were not involved in the MPII study. Participants from both groups were matched based on sex, age, and medical school. The web questionnaire was developed by a panel composed of graduate medical students, rheumatologists, medical school professors, and a psychology professor. The questionnaire included details on demographic and life habits data and evaluated participants' impressions of the MPII study and the impact of the COVID-19 pandemic on their educational routines and medical training. In addition, depression, anxiety, and stress were evaluated using the Brazilian version of the Depression, Anxiety, and Stress Scale (DASS)-21, and currently, the DASS-21 scores are grouped as those that indicate a low, moderate, or high risk of mental distress. This project was approved by the Federal University of São Paulo Ethics Committee (CAAE: 34034620.0.0000.5505). Results: Data were collected from both medical student groups from July 20 to August 31, 2020. Data extraction was completed in September 2020. The data analysis is ongoing. We expect the results to be published in the first semester of 2021. Conclusions: This study will provide insight into the effects of participating in a research project on depression, anxiety, and stress, which will be determined by applying the DASS-21 to a large sample of Brazilian undergraduate medical students. We will also evaluate the impact of the COVID-19 pandemic on medical students’ educational routines and medical training. International Registered Report Identifier (IRRID): DERR1-10.2196/24617 %M 33735094 %R 10.2196/24617 %U https://www.researchprotocols.org/2021/4/e24617 %U https://doi.org/10.2196/24617 %U http://www.ncbi.nlm.nih.gov/pubmed/33735094 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 8 %N 2 %P e24860 %T Identifying Barriers to and Opportunities for Telehealth Implementation Amidst the COVID-19 Pandemic by Using a Human Factors Approach: A Leap Into the Future of Health Care Delivery? %A Zhang,Tianyi %A Mosier,Jarrod %A Subbian,Vignesh %+ Department of Systems and Industrial Engineering, College of Engineering, The University of Arizona, 1127 E James E Rogers Way, Tucson, AZ, 85721-0020, United States, 1 6088863936, tianyi@email.arizona.edu %K telehealth %K healthcare system %K COVID-19 %K human factors %K implementation %K SEIPS %D 2021 %7 9.4.2021 %9 Viewpoint %J JMIR Hum Factors %G English %X The extensive uptake of telehealth has considerably transformed health care delivery since the beginning of the COVID-19 pandemic and has imposed tremendous challenges to its large-scale implementation and adaptation. Given the shift in paradigm from telehealth as an alternative mechanism of care delivery to telehealth as an integral part of the health system, it is imperative to take a systematic approach to identifying barriers to, opportunities for, and the overall impact of telehealth implementation amidst the current pandemic. In this work, we apply a human factors framework, the Systems Engineering Initiative for Patient Safety model, to guide our holistic analysis and discussion of telehealth implementation, encompassing the health care work system, care processes, and outcomes. %M 33779566 %R 10.2196/24860 %U https://humanfactors.jmir.org/2021/2/e24860 %U https://doi.org/10.2196/24860 %U http://www.ncbi.nlm.nih.gov/pubmed/33779566 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 9 %N 4 %P e24073 %T A Natural Language Processing–Based Virtual Patient Simulator and Intelligent Tutoring System for the Clinical Diagnostic Process: Simulator Development and Case Study %A Furlan,Raffaello %A Gatti,Mauro %A Menè,Roberto %A Shiffer,Dana %A Marchiori,Chiara %A Giaj Levra,Alessandro %A Saturnino,Vincenzo %A Brunetta,Enrico %A Dipaola,Franca %+ Department of Biomedical Sciences, Humanitas University, Via R Levi Montalcini, 4, Pieve Emanuele, Milan, 20090, Italy, 39 0282247228, raffaello.furlan@hunimed.eu %K COVID-19 %K intelligent tutoring system %K virtual patient simulator %K natural language processing %K artificial intelligence %K clinical diagnostic reasoning %D 2021 %7 9.4.2021 %9 Original Paper %J JMIR Med Inform %G English %X Background: Shortage of human resources, increasing educational costs, and the need to keep social distances in response to the COVID-19 worldwide outbreak have prompted the necessity of clinical training methods designed for distance learning. Virtual patient simulators (VPSs) may partially meet these needs. Natural language processing (NLP) and intelligent tutoring systems (ITSs) may further enhance the educational impact of these simulators. Objective: The goal of this study was to develop a VPS for clinical diagnostic reasoning that integrates interaction in natural language and an ITS. We also aimed to provide preliminary results of a short-term learning test administered on undergraduate students after use of the simulator. Methods: We trained a Siamese long short-term memory network for anamnesis and NLP algorithms combined with Systematized Nomenclature of Medicine (SNOMED) ontology for diagnostic hypothesis generation. The ITS was structured on the concepts of knowledge, assessment, and learner models. To assess short-term learning changes, 15 undergraduate medical students underwent two identical tests, composed of multiple-choice questions, before and after performing a simulation by the virtual simulator. The test was made up of 22 questions; 11 of these were core questions that were specifically designed to evaluate clinical knowledge related to the simulated case. Results: We developed a VPS called Hepius that allows students to gather clinical information from the patient’s medical history, physical exam, and investigations and allows them to formulate a differential diagnosis by using natural language. Hepius is also an ITS that provides real-time step-by-step feedback to the student and suggests specific topics the student has to review to fill in potential knowledge gaps. Results from the short-term learning test showed an increase in both mean test score (P<.001) and mean score for core questions (P<.001) when comparing presimulation and postsimulation performance. Conclusions: By combining ITS and NLP technologies, Hepius may provide medical undergraduate students with a learning tool for training them in diagnostic reasoning. This may be particularly useful in a setting where students have restricted access to clinical wards, as is happening during the COVID-19 pandemic in many countries worldwide. %M 33720840 %R 10.2196/24073 %U https://medinform.jmir.org/2021/4/e24073 %U https://doi.org/10.2196/24073 %U http://www.ncbi.nlm.nih.gov/pubmed/33720840 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 4 %P e27293 %T Classification Models for COVID-19 Test Prioritization in Brazil: Machine Learning Approach %A Viana dos Santos Santana,Íris %A CM da Silveira,Andressa %A Sobrinho,Álvaro %A Chaves e Silva,Lenardo %A Dias da Silva,Leandro %A Santos,Danilo F S %A Gurjão,Edmar C %A Perkusich,Angelo %+ Federal University of the Agreste of Pernambuco, Av. Bom Pastor, s/n - Boa Vista, Garanhuns, 55292-270, Brazil, 55 87981493955, alvaro.alvares@ufape.edu.br %K COVID-19 %K test prioritization %K classification models %K medical diagnosis %D 2021 %7 8.4.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Controlling the COVID-19 outbreak in Brazil is a challenge due to the population’s size and urban density, inefficient maintenance of social distancing and testing strategies, and limited availability of testing resources. Objective: The purpose of this study is to effectively prioritize patients who are symptomatic for testing to assist early COVID-19 detection in Brazil, addressing problems related to inefficient testing and control strategies. Methods: Raw data from 55,676 Brazilians were preprocessed, and the chi-square test was used to confirm the relevance of the following features: gender, health professional, fever, sore throat, dyspnea, olfactory disorders, cough, coryza, taste disorders, and headache. Classification models were implemented relying on preprocessed data sets; supervised learning; and the algorithms multilayer perceptron (MLP), gradient boosting machine (GBM), decision tree (DT), random forest (RF), extreme gradient boosting (XGBoost), k-nearest neighbors (KNN), support vector machine (SVM), and logistic regression (LR). The models’ performances were analyzed using 10-fold cross-validation, classification metrics, and the Friedman and Nemenyi statistical tests. The permutation feature importance method was applied for ranking the features used by the classification models with the highest performances. Results: Gender, fever, and dyspnea were among the highest-ranked features used by the classification models. The comparative analysis presents MLP, GBM, DT, RF, XGBoost, and SVM as the highest performance models with similar results. KNN and LR were outperformed by the other algorithms. Applying the easy interpretability as an additional comparison criterion, the DT was considered the most suitable model. Conclusions: The DT classification model can effectively (with a mean accuracy≥89.12%) assist COVID-19 test prioritization in Brazil. The model can be applied to recommend the prioritizing of a patient who is symptomatic for COVID-19 testing. %M 33750734 %R 10.2196/27293 %U https://www.jmir.org/2021/4/e27293 %U https://doi.org/10.2196/27293 %U http://www.ncbi.nlm.nih.gov/pubmed/33750734 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 4 %P e24389 %T Adaptive Susceptible-Infectious-Removed Model for Continuous Estimation of the COVID-19 Infection Rate and Reproduction Number in the United States: Modeling Study %A Shapiro,Mark B %A Karim,Fazle %A Muscioni,Guido %A Augustine,Abel Saju %+ Anthem, Inc, 220 Virginia Avenue, Indianapolis, IN, 46204, United States, 1 708 295 8150, mark.shapiro@anthem.com %K compartmental models %K COVID-19 %K decision-making %K estimate %K infection rate %K infectious disease %K modeling %K pandemic %K prediction %K reproduction number %K SARS-CoV-2 %K United States %D 2021 %7 7.4.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The dynamics of the COVID-19 pandemic vary owing to local population density and policy measures. During decision-making, policymakers consider an estimate of the effective reproduction number Rt, which is the expected number of secondary infections spread by a single infected individual. Objective: We propose a simple method for estimating the time-varying infection rate and the Rt. Methods: We used a sliding window approach with a Susceptible-Infectious-Removed (SIR) model. We estimated the infection rate from the reported cases over a 7-day window to obtain a continuous estimation of Rt. A proposed adaptive SIR (aSIR) model was applied to analyze the data at the state and county levels. Results: The aSIR model showed an excellent fit for the number of reported COVID-19 cases, and the 1-day forecast mean absolute prediction error was <2.6% across all states. However, the 7-day forecast mean absolute prediction error approached 16.2% and strongly overestimated the number of cases when the Rt was rapidly decreasing. The maximal Rt displayed a wide range of 2.0 to 4.5 across all states, with the highest values for New York (4.4) and Michigan (4.5). We found that the aSIR model can rapidly adapt to an increase in the number of tests and an associated increase in the reported cases of infection. Our results also suggest that intensive testing may be an effective method of reducing Rt. Conclusions: The aSIR model provides a simple and accurate computational tool for continuous Rt estimation and evaluation of the efficacy of mitigation measures. %M 33755577 %R 10.2196/24389 %U https://www.jmir.org/2021/4/e24389 %U https://doi.org/10.2196/24389 %U http://www.ncbi.nlm.nih.gov/pubmed/33755577 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 4 %P e23948 %T A Multimodality Machine Learning Approach to Differentiate Severe and Nonsevere COVID-19: Model Development and Validation %A Chen,Yuanfang %A Ouyang,Liu %A Bao,Forrest S %A Li,Qian %A Han,Lei %A Zhang,Hengdong %A Zhu,Baoli %A Ge,Yaorong %A Robinson,Patrick %A Xu,Ming %A Liu,Jie %A Chen,Shi %+ Department of Occupational Disease Prevention, Jiangsu Provincial Center for Disease Control and Prevention, 172 Jiangsu Road, Nanjing, 210009, China, 86 85393210, sosolou@126.com %K COVID-19 %K clinical type %K multimodality %K classification %K machine learning %K machine learning %K diagnosis %K prediction %K reliable %K decision support %D 2021 %7 7.4.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Effectively and efficiently diagnosing patients who have COVID-19 with the accurate clinical type of the disease is essential to achieve optimal outcomes for the patients as well as to reduce the risk of overloading the health care system. Currently, severe and nonsevere COVID-19 types are differentiated by only a few features, which do not comprehensively characterize the complicated pathological, physiological, and immunological responses to SARS-CoV-2 infection in the different disease types. In addition, these type-defining features may not be readily testable at the time of diagnosis. Objective: In this study, we aimed to use a machine learning approach to understand COVID-19 more comprehensively, accurately differentiate severe and nonsevere COVID-19 clinical types based on multiple medical features, and provide reliable predictions of the clinical type of the disease. Methods: For this study, we recruited 214 confirmed patients with nonsevere COVID-19 and 148 patients with severe COVID-19. The clinical characteristics (26 features) and laboratory test results (26 features) upon admission were acquired as two input modalities. Exploratory analyses demonstrated that these features differed substantially between two clinical types. Machine learning random forest models based on all the features in each modality as well as on the top 5 features in each modality combined were developed and validated to differentiate COVID-19 clinical types. Results: Using clinical and laboratory results independently as input, the random forest models achieved >90% and >95% predictive accuracy, respectively. The importance scores of the input features were further evaluated, and the top 5 features from each modality were identified (age, hypertension, cardiovascular disease, gender, and diabetes for the clinical features modality, and dimerized plasmin fragment D, high sensitivity troponin I, absolute neutrophil count, interleukin 6, and lactate dehydrogenase for the laboratory testing modality, in descending order). Using these top 10 multimodal features as the only input instead of all 52 features combined, the random forest model was able to achieve 97% predictive accuracy. Conclusions: Our findings shed light on how the human body reacts to SARS-CoV-2 infection as a unit and provide insights on effectively evaluating the disease severity of patients with COVID-19 based on more common medical features when gold standard features are not available. We suggest that clinical information can be used as an initial screening tool for self-evaluation and triage, while laboratory test results should be applied when accuracy is the priority. %M 33714935 %R 10.2196/23948 %U https://www.jmir.org/2021/4/e23948 %U https://doi.org/10.2196/23948 %U http://www.ncbi.nlm.nih.gov/pubmed/33714935 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 4 %P e21726 %T Addressing the Digital Inverse Care Law in the Time of COVID-19: Potential for Digital Technology to Exacerbate or Mitigate Health Inequalities %A Davies,Alisha R %A Honeyman,Matthew %A Gann,Bob %+ Research and Evaluation Division, Public Health Wales, 2 Capital Quarter, Tyndall St, Cardiff, CF10 4BZ, United Kingdom, 44 2920227744, alisha.davies@wales.nhs.uk %K COVID-19 %K digital divide %K digital exclusion %K digital health %K health inequality %K population health %D 2021 %7 7.4.2021 %9 Viewpoint %J J Med Internet Res %G English %X Digital technologies have been transforming methods of health care delivery and have been embraced within the health, social, and public response to the COVID-19 pandemic. However, this has directed attention to the “inverse information law” (also called “digital inverse care law”) and digital inequalities, as people who are most in need of support (in particular, older people and those experiencing social deprivation) are often least likely to engage with digital platforms. The response to the COVID-19 pandemic represents a sustained shift to the adoption of digital approaches to working and engaging with populations, which will continue beyond the COVID-19 pandemic. Therefore, it is important to understand the underlying factors contributing to digital inequalities and act immediately to avoid digital inequality contributing to health inequalities in the future. The response to COVID-19 represents a sustained shift to adopting digital approaches to working and engaging with populations which will continue beyond this pandemic. Therefore it is important that we understand the underlying factors contributing to digital inequalities, and act now to protect against digital inequality contributing to health inequalities in the future. %M 33735096 %R 10.2196/21726 %U https://www.jmir.org/2021/4/e21726 %U https://doi.org/10.2196/21726 %U http://www.ncbi.nlm.nih.gov/pubmed/33735096 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 4 %P e25500 %T Convalescent Plasma for the Prevention and Treatment of COVID-19: A Systematic Review and Quantitative Analysis %A Peng,Henry T %A Rhind,Shawn G %A Beckett,Andrew %+ Defence Research and Development Canada, Toronto Research Centre, 1133 Sheppard Avenue West, Toronto, ON, M3K 2C9, Canada, 1 416 635 2129, henry.peng@drdc-rddc.gc.ca %K COVID-19 %K SARS-CoV-2 %K antibodies %K convalescent plasma %K immunotherapy %K prevention %K treatment %K review %K quantitative %K therapeutic %K immunology %K research %K literature %K knowledge %K recommendation %D 2021 %7 7.4.2021 %9 Review %J JMIR Public Health Surveill %G English %X Background: The COVID-19 pandemic, caused by a novel coronavirus termed SARS-CoV-2, has spread quickly worldwide. Convalescent plasma (CP) obtained from patients following recovery from COVID-19 infection and development of antibodies against the virus is an attractive option for either prophylactic or therapeutic treatment, since antibodies may have direct or indirect antiviral activities and immunotherapy has proven effective in principle and in many clinical reports. Objective: We seek to characterize the latest advances and evidence in the use of CP for COVID-19 through a systematic review and quantitative analysis, identify knowledge gaps in this setting, and offer recommendations and directives for future research. Methods: PubMed, Web of Science, and Embase were continuously searched for studies assessing the use of CP for COVID-19, including clinical studies, commentaries, reviews, guidelines or protocols, and in vitro testing of CP antibodies. The screening process and data extraction were performed according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Quality appraisal of all clinical studies was conducted using a universal tool independent of study designs. A meta-analysis of case-control and randomized controlled trials (RCTs) was conducted using a random-effects model. Results: Substantial literature has been published covering various aspects of CP therapy for COVID-19. Of the references included in this review, a total of 243 eligible studies including 64 clinical studies, 79 commentary articles, 46 reviews, 19 guidance and protocols, and 35 in vitro testing of CP antibodies matched the criteria. Positive results have been mostly observed so far when using CP for the treatment of COVID-19. There were remarkable heterogeneities in the CP therapy with respect to patient demographics, donor antibody titers, and time and dose of CP administration. The studies assessing the safety of CP treatment reported low incidence of adverse events. Most clinical studies, in particular case reports and case series, had poor quality. Only 1 RCT was of high quality. Randomized and nonrandomized data were found in 2 and 11 studies, respectively, and were included for meta-analysis, suggesting that CP could reduce mortality and increase viral clearance. Despite promising pilot studies, the benefits of CP treatment can only be clearly established through carefully designed RCTs. Conclusions: There is developing support for CP therapy, particularly for patients who are critically ill or mechanically ventilated and resistant to antivirals and supportive care. These studies provide important lessons that should inform the planning of well-designed RCTs to generate more robust knowledge for the efficacy of CP in patients with COVID-19. Future research is necessary to fill the knowledge gap regarding prevention and treatment for patients with COVID-19 with CP while other therapeutics are being developed. %M 33825689 %R 10.2196/25500 %U https://publichealth.jmir.org/2021/4/e25500 %U https://doi.org/10.2196/25500 %U http://www.ncbi.nlm.nih.gov/pubmed/33825689 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 4 %P e24292 %T Community and Campus COVID-19 Risk Uncertainty Under University Reopening Scenarios: Model-Based Analysis %A Benneyan,James %A Gehrke,Christopher %A Ilies,Iulian %A Nehls,Nicole %+ Healthcare Systems Engineering Institute, Northeastern University, 360 Huntington Avenue 177H, Boston, MA, 02115, United States, 1 617 373 6450, j.benneyan@northeastern.edu %K COVID-19 %K university reopening %K community impact %K epidemic model %K model %K community %K university %K safety %K strategy %K risk %K infectious disease %D 2021 %7 7.4.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Significant uncertainty has existed about the safety of reopening college and university campuses before the COVID-19 pandemic is better controlled. Moreover, little is known about the effects that on-campus students may have on local higher-risk communities. Objective: We aimed to estimate the range of potential community and campus COVID-19 exposures, infections, and mortality under various university reopening plans and uncertainties. Methods: We developed campus-only, community-only, and campus × community epidemic differential equations and agent-based models, with inputs estimated via published and grey literature, expert opinion, and parameter search algorithms. Campus opening plans (spanning fully open, hybrid, and fully virtual approaches) were identified from websites and publications. Additional student and community exposures, infections, and mortality over 16-week semesters were estimated under each scenario, with 10% trimmed medians, standard deviations, and probability intervals computed to omit extreme outliers. Sensitivity analyses were conducted to inform potential effective interventions. Results: Predicted 16-week campus and additional community exposures, infections, and mortality for the base case with no precautions (or negligible compliance) varied significantly from their medians (4- to 10-fold). Over 5% of on-campus students were infected after a mean of 76 (SD 17) days, with the greatest increase (first inflection point) occurring on average on day 84 (SD 10.2 days) of the semester and with total additional community exposures, infections, and mortality ranging from 1-187, 13-820, and 1-21 per 10,000 residents, respectively. Reopening precautions reduced infections by 24%-26% and mortality by 36%-50% in both populations. Beyond campus and community reproductive numbers, sensitivity analysis indicated no dominant factors that interventions could primarily target to reduce the magnitude and variability in outcomes, suggesting the importance of comprehensive public health measures and surveillance. Conclusions: Community and campus COVID-19 exposures, infections, and mortality resulting from reopening campuses are highly unpredictable regardless of precautions. Public health implications include the need for effective surveillance and flexible campus operations. %M 33667173 %R 10.2196/24292 %U https://publichealth.jmir.org/2021/4/e24292 %U https://doi.org/10.2196/24292 %U http://www.ncbi.nlm.nih.gov/pubmed/33667173 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 4 %P e26460 %T Test, Trace, and Put on the Blockchain?: A Viewpoint Evaluating the Use of Decentralized Systems for Algorithmic Contact Tracing to Combat a Global Pandemic %A Platt,Moritz %A Hasselgren,Anton %A Román-Belmonte,Juan Manuel %A Tuler de Oliveira,Marcela %A De la Corte-Rodríguez,Hortensia %A Delgado Olabarriaga,Sílvia %A Rodríguez-Merchán,E Carlos %A Mackey,Tim Ken %+ Department of Anesthesiology, Division of Infectious Diseases and Global Public Health, School of Medicine, UC San Diego, 8950 Villa La Jolla Drive, A124, La Jolla, CA, 92037, United States, 1 951 491 4161, tmackey@ucsd.edu %K COVID-19 %K public health %K blockchain %K distributed ledger technology %K mobile apps %K pandemic mitigation %K contact tracing %K epidemiological monitoring %D 2021 %7 6.4.2021 %9 Viewpoint %J JMIR Public Health Surveill %G English %X The enormous pressure of the increasing case numbers experienced during the COVID-19 pandemic has given rise to a variety of novel digital systems designed to provide solutions to unprecedented challenges in public health. The field of algorithmic contact tracing, in particular, an area of research that had previously received limited attention, has moved into the spotlight as a crucial factor in containing the pandemic. The use of digital tools to enable more robust and expedited contact tracing and notification, while maintaining privacy and trust in the data generated, is viewed as key to identifying chains of transmission and close contacts, and, consequently, to enabling effective case investigations. Scaling these tools has never been more critical, as global case numbers have exceeded 100 million, as many asymptomatic patients remain undetected, and as COVID-19 variants begin to emerge around the world. In this context, there is increasing attention on blockchain technology as a part of systems for enhanced digital algorithmic contact tracing and reporting. By analyzing the literature that has emerged from this trend, the common characteristics of the designs proposed become apparent. An archetypal system architecture can be derived, taking these characteristics into consideration. However, assessing the utility of this architecture using a recognized evaluation framework shows that the added benefits and features of blockchain technology do not provide significant advantages over conventional centralized systems for algorithmic contact tracing and reporting. From our study, it, therefore, seems that blockchain technology may provide a more significant benefit in other areas of public health beyond contact tracing. %M 33727212 %R 10.2196/26460 %U https://publichealth.jmir.org/2021/4/e26460 %U https://doi.org/10.2196/26460 %U http://www.ncbi.nlm.nih.gov/pubmed/33727212 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 9 %N 4 %P e25035 %T Characterizing the Anticancer Treatment Trajectory and Pattern in Patients Receiving Chemotherapy for Cancer Using Harmonized Observational Databases: Retrospective Study %A Jeon,Hokyun %A You,Seng Chan %A Kang,Seok Yun %A Seo,Seung In %A Warner,Jeremy L %A Belenkaya,Rimma %A Park,Rae Woong %+ Department of Biomedical Informatics, Ajou University School of Medicine, Hong Jae Gwan, 5th Fl, 164, World cup-ro, Yeongtong-gu, Suwon, Gyeonggi-do, 16499, Republic of Korea, 82 31 219 4471, rwpark99@gmail.com %K antineoplastic combined chemotherapy protocols %K electronic health record %K cancer %K pattern %K chemotherapy %K database %K retrospective %K algorithm %K scalability %K interoperability %D 2021 %7 6.4.2021 %9 Original Paper %J JMIR Med Inform %G English %X Background: Accurate and rapid clinical decisions based on real-world evidence are essential for patients with cancer. However, the complexity of chemotherapy regimens for cancer impedes retrospective research that uses observational health databases. Objective: The aim of this study is to compare the anticancer treatment trajectories and patterns of clinical events according to regimen type using the chemotherapy episodes determined by an algorithm. Methods: We developed an algorithm to extract the regimen-level abstracted chemotherapy episodes from medication records in a conventional Observational Medical Outcomes Partnership (OMOP) common data model (CDM) database. The algorithm was validated on the Ajou University School Of Medicine (AUSOM) database by manual review of clinical notes. Using the algorithm, we extracted episodes of chemotherapy from patients in the EHR database and the claims database. We also developed an application software for visualizing the chemotherapy treatment patterns based on the treatment episodes in the OMOP-CDM database. Using this software, we generated the trends in the types of regimen used in the institutions, the patterns of the iterative chemotherapy use, and the trajectories of cancer treatment in two EHR-based OMOP-CDM databases. As a pilot study, the time of onset of chemotherapy-induced neutropenia according to regimen was measured using the AUSOM database. The anticancer treatment trajectories for patients with COVID-19 were also visualized based on the nationwide claims database. Results: We generated 178,360 treatment episodes for patients with colorectal, breast, and lung cancer for 85 different regimens. The algorithm precisely identified the type of chemotherapy regimen in 400 patients (average positive predictive value >98%). The trends in the use of routine clinical chemotherapy regimens from 2008-2018 were identified for 8236 patients. For a total of 12 regimens (those administered to the largest proportion of patients), the number of repeated treatments was concordant with the protocols for standard chemotherapy regimens for certain cases. In addition, the anticancer treatment trajectories for 8315 patients were shown, including 62 patients with COVID-19. A comparative analysis of neutropenia showed that its onset in colorectal cancer regimens tended to cluster between days 9-15, whereas it tended to cluster between days 2-8 for certain regimens for breast cancer or lung cancer. Conclusions: We propose a method for generating chemotherapy episodes for introduction into the oncology extension module of the OMOP-CDM databases. These proof-of-concept studies demonstrated the usability, scalability, and interoperability of the proposed framework through a distributed research network. %M 33720842 %R 10.2196/25035 %U https://medinform.jmir.org/2021/4/e25035 %U https://doi.org/10.2196/25035 %U http://www.ncbi.nlm.nih.gov/pubmed/33720842 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 9 %N 4 %P e24192 %T An Agent-Based Model of the Local Spread of SARS-CoV-2: Modeling Study %A Staffini,Alessio %A Svensson,Akiko Kishi %A Chung,Ung-Il %A Svensson,Thomas %+ Precision Health, Department of Bioengineering, Graduate School of Engineering, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan, 81 080 7058 1309, alessio.staffini@bocconialumni.it %K computational epidemiology %K COVID-19 %K SARS-CoV-2 %K agent-based modeling %K public health %K computational models %K modeling %K agent %K spread %K computation %K epidemiology %K policy %D 2021 %7 6.4.2021 %9 Original Paper %J JMIR Med Inform %G English %X Background: The spread of SARS-CoV-2, originating in Wuhan, China, was classified as a pandemic by the World Health Organization on March 11, 2020. The governments of affected countries have implemented various measures to limit the spread of the virus. The starting point of this paper is the different government approaches, in terms of promulgating new legislative regulations to limit the virus diffusion and to contain negative effects on the populations. Objective: This paper aims to study how the spread of SARS-CoV-2 is linked to government policies and to analyze how different policies have produced different results on public health. Methods: Considering the official data provided by 4 countries (Italy, Germany, Sweden, and Brazil) and from the measures implemented by each government, we built an agent-based model to study the effects that these measures will have over time on different variables such as the total number of COVID-19 cases, intensive care unit (ICU) bed occupancy rates, and recovery and case-fatality rates. The model we implemented provides the possibility of modifying some starting variables, and it was thus possible to study the effects that some policies (eg, keeping the national borders closed or increasing the ICU beds) would have had on the spread of the infection. Results: The 4 considered countries have adopted different containment measures for COVID-19, and the forecasts provided by the model for the considered variables have given different results. Italy and Germany seem to be able to limit the spread of the infection and any eventual second wave, while Sweden and Brazil do not seem to have the situation under control. This situation is also reflected in the forecasts of pressure on the National Health Services, which see Sweden and Brazil with a high occupancy rate of ICU beds in the coming months, with a consequent high number of deaths. Conclusions: In line with what we expected, the obtained results showed that the countries that have taken restrictive measures in terms of limiting the population mobility have managed more successfully than others to contain the spread of COVID-19. Moreover, the model demonstrated that herd immunity cannot be reached even in countries that have relied on a strategy without strict containment measures. %M 33750735 %R 10.2196/24192 %U https://medinform.jmir.org/2021/4/e24192 %U https://doi.org/10.2196/24192 %U http://www.ncbi.nlm.nih.gov/pubmed/33750735 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 4 %P e25502 %T The Healing Hearts Together Randomized Controlled Trial and the COVID-19 Pandemic: A Tutorial for Transitioning From an In-Person to a Web-Based Intervention %A Lalande,Kathleen %A Greenman,Paul S %A Bouchard,Karen %A Johnson,Susan M %A Tulloch,Heather %+ Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, 40 Ruskin St, Ottawa, ON, K1Y 4W7, Canada, 1 613 696 7000 ext 19705, hetulloch@ottawaheart.ca %K web-based intervention %K internet-based intervention %K randomized controlled trial %K COVID-19 %K research %K tutorial %K digital medicine %K behavioral medicine %K telehealth %K telemedicine %K cardiovascular rehabilitation %D 2021 %7 6.4.2021 %9 Tutorial %J J Med Internet Res %G English %X Supportive couple relationships are associated with reduced risk of chronic illness development, such as cardiovascular disease, as well as improved secondary prevention. Healing Hearts Together (HHT) is an 8-week couples-based intervention designed to improve relationship quality, mental health, quality of life, and cardiovascular health among couples in which one partner has experienced a cardiac event. A randomized controlled trial began in October 2019 to test the efficacy of the in-person, group-based HHT program as compared to usual care. In March of 2020, all recruitment, assessments, and interventions halted due to the COVID-19 pandemic. Guided by optimal virtual care principles, as well as by Hom and colleagues’ four-stage framework—consultation, adaptation, pilot-testing, and test launch—this paper is a tutorial for the step-by-step transition planning and implementation of a clinical research intervention from an in-person to a web-based format, using the HHT program as an example. Clinical and research considerations are reviewed, including (1) privacy, (2) therapeutic aspects of the intervention, (3) group cohesion, (4) research ethics, (5) participant recruitment, (6) assessment measures, (7) data collection, and (8) data analyses. This tutorial can assist clinical researchers in transitioning their research programs to a web-based format during the pandemic and beyond. %M 33729984 %R 10.2196/25502 %U https://www.jmir.org/2021/4/e25502 %U https://doi.org/10.2196/25502 %U http://www.ncbi.nlm.nih.gov/pubmed/33729984 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 4 %P e24552 %T Teleassistance for Patients With Type 1 Diabetes During the COVID-19 Pandemic: Results of a Pilot Study %A Parise,Martina %A Tartaglione,Linda %A Cutruzzolà,Antonio %A Maiorino,Maria Ida %A Esposito,Katherine %A Pitocco,Dario %A Gnasso,Agostino %A Irace,Concetta %+ Department of Health Science, University Magna Graecia Catanzaro, Viale Europa, Catanzaro, 88100, Italy, 39 3316718143, irace@unicz.it %K chronic disease %K COVID-19 %K diabetes %K effectiveness %K management %K technology %K teleassistance %K telehealth %K telemedicine %K time in range %K type 1 diabetes %D 2021 %7 6.4.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Telemedicine use in chronic disease management has markedly increased during health emergencies due to COVID-19. Diabetes and technologies supporting diabetes care, including glucose monitoring devices, software analyzing glucose data, and insulin delivering systems, would facilitate remote and structured disease management. Indeed, most of the currently available technologies to store and transfer web-based data to be shared with health care providers. Objective: During the COVID-19 pandemic, we provided our patients the opportunity to manage their diabetes remotely by implementing technology. Therefore, this study aimed to evaluate the effectiveness of 2 virtual visits on glycemic control parameters among patients with type 1 diabetes (T1D) during the lockdown period. Methods: This prospective observational study included T1D patients who completed 2 virtual visits during the lockdown period. The glucose outcomes that reflected the benefits of the virtual consultation were time in range (TIR), time above range, time below range, mean daily glucose, glucose management indicator (GMI), and glycemic variability. This metric was generated using specific computer programs that automatically upload data from the devices used to monitor blood or interstitial glucose levels. If needed, we changed the ongoing treatment at the first virtual visit. Results: Among 209 eligible patients with T1D, 166 completed 2 virtual visits, 35 failed to download glucose data, and 8 declined the visit. Among the patients not included in the study, we observed a significantly lower proportion of continuous glucose monitoring (CGM) and continuous subcutaneous insulin infusion (CSII) users (n=7/43, 16% vs n=155/166, 93.4% and n=9/43, 21% vs n=128/166, 77.1%, respectively; P<.001) compared to patients who completed the study. TIR significantly increased from the first (62%, SD 18%) to the second (65%, SD 16%) virtual visit (P=.02); this increase was more marked among patients using the traditional meter (n=11; baseline TIR=55%, SD 17% and follow-up TIR=66%, SD 13%; P=.01) than among those using CGM, and in those with a baseline GMI of ≥7.5% (n=46; baseline TIR=45%, SD 15% and follow-up TIR=53%, SD 18%; P<.001) than in those with a GMI of <7.5% (n=120; baseline TIR=68%, SD 15% and follow-up TIR=69%, SD 15%; P=.98). The only variable independently associated with TIR was the change of ongoing therapy. The unstandardized beta coefficient (B) and 95% CI were 5 (95% CI 0.7-8.0) (P=.02). The type of glucose monitoring device and insulin delivery systems did not influence glucometric parameters. Conclusions: These findings indicate that the structured virtual visits help maintain and improve glycemic control in situations where in-person visits are not feasible. %M 33769945 %R 10.2196/24552 %U https://www.jmir.org/2021/4/e24552 %U https://doi.org/10.2196/24552 %U http://www.ncbi.nlm.nih.gov/pubmed/33769945 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 4 %P e22880 %T The Causality Inference of Public Interest in Restaurants and Bars on Daily COVID-19 Cases in the United States: Google Trends Analysis %A Asgari Mehrabadi,Milad %A Dutt,Nikil %A Rahmani,Amir M %+ Department of Electrical Engineering and Computer Science, University of California Irvine, Berk Hall, 1st Floor, Irvine, CA, 92617, United States, 1 949 506 8187, masgarim@uci.edu %K bars %K coronavirus %K COVID-19 %K deep learning %K infodemiology %K infoveillance %K Google Trends %K LSTM %K machine learning %K restaurants %D 2021 %7 6.4.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The COVID-19 pandemic has affected virtually every region in the world. At the time of this study, the number of daily new cases in the United States was greater than that in any other country, and the trend was increasing in most states. Google Trends provides data regarding public interest in various topics during different periods. Analyzing these trends using data mining methods may provide useful insights and observations regarding the COVID-19 outbreak. Objective: The objective of this study is to consider the predictive ability of different search terms not directly related to COVID-19 with regard to the increase of daily cases in the United States. In particular, we are concerned with searches related to dine-in restaurants and bars. Data were obtained from the Google Trends application programming interface and the COVID-19 Tracking Project. Methods: To test the causation of one time series on another, we used the Granger causality test. We considered the causation of two different search query trends related to dine-in restaurants and bars on daily positive cases in the US states and territories with the 10 highest and 10 lowest numbers of daily new cases of COVID-19. In addition, we used Pearson correlations to measure the linear relationships between different trends. Results: Our results showed that for states and territories with higher numbers of daily cases, the historical trends in search queries related to bars and restaurants, which mainly occurred after reopening, significantly affected the number of daily new cases on average. California, for example, showed the most searches for restaurants on June 7, 2020; this affected the number of new cases within two weeks after the peak, with a P value of .004 for the Granger causality test. Conclusions: Although a limited number of search queries were considered, Google search trends for restaurants and bars showed a significant effect on daily new cases in US states and territories with higher numbers of daily new cases. We showed that these influential search trends can be used to provide additional information for prediction tasks regarding new cases in each region. These predictions can help health care leaders manage and control the impact of the COVID-19 outbreak on society and prepare for its outcomes. %M 33690143 %R 10.2196/22880 %U https://publichealth.jmir.org/2021/4/e22880 %U https://doi.org/10.2196/22880 %U http://www.ncbi.nlm.nih.gov/pubmed/33690143 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 4 %P e24288 %T Reporting and Availability of COVID-19 Demographic Data by US Health Departments (April to October 2020): Observational Study %A Ossom-Williamson,Peace %A Williams,Isaac Maximilian %A Kim,Kukhyoung %A Kindratt,Tiffany B %+ Public Health Program, Department of Kinesiology, College of Nursing and Health Innovation, University of Texas at Arlington, 500 W Nedderman Drive, Arlington, TX, 75919, United States, 1 817 272 7917, tiffany.kindratt@uta.edu %K coronavirus disease 2019 %K COVID-19 %K SARS-CoV-2 %K race %K ethnicity %K age %K sex %K health equity %K open data %K dashboards %D 2021 %7 6.4.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: There is an urgent need for consistent collection of demographic data on COVID-19 morbidity and mortality and sharing it with the public in open and accessible ways. Due to the lack of consistency in data reporting during the initial spread of COVID-19, the Equitable Data Collection and Disclosure on COVID-19 Act was introduced into the Congress that mandates collection and reporting of demographic COVID-19 data on testing, treatments, and deaths by age, sex, race and ethnicity, primary language, socioeconomic status, disability, and county. To our knowledge, no studies have evaluated how COVID-19 demographic data have been collected before and after the introduction of this legislation. Objective: This study aimed to evaluate differences in reporting and public availability of COVID-19 demographic data by US state health departments and Washington, District of Columbia (DC) before (pre-Act), immediately after (post-Act), and 6 months after (6-month follow-up) the introduction of the Equitable Data Collection and Disclosure on COVID-19 Act in the Congress on April 21, 2020. Methods: We reviewed health department websites of all 50 US states and Washington, DC (N=51). We evaluated how each state reported age, sex, and race and ethnicity data for all confirmed COVID-19 cases and deaths and how they made this data available (ie, charts and tables only or combined with dashboards and machine-actionable downloadable formats) at the three timepoints. Results: We found statistically significant increases in the number of health departments reporting age-specific data for COVID-19 cases (P=.045) and resulting deaths (P=.002), sex-specific data for COVID-19 deaths (P=.003), and race- and ethnicity-specific data for confirmed cases (P=.003) and deaths (P=.005) post-Act and at the 6-month follow-up (P<.05 for all). The largest increases were race and ethnicity state data for confirmed cases (pre-Act: 18/51, 35%; post-Act: 31/51, 61%; 6-month follow-up: 46/51, 90%) and deaths due to COVID-19 (pre-Act: 13/51, 25%; post-Act: 25/51, 49%; and 6-month follow-up: 39/51, 76%). Although more health departments reported race and ethnicity data based on federal requirements (P<.001), over half (29/51, 56.9%) still did not report all racial and ethnic groups as per the Office of Management and Budget guidelines (pre-Act: 5/51, 10%; post-Act: 21/51, 41%; and 6-month follow-up: 27/51, 53%). The number of health departments that made COVID-19 data available for download significantly increased from 7 to 23 (P<.001) from our initial data collection (April 2020) to the 6-month follow-up, (October 2020). Conclusions: Although the increased demand for disaggregation has improved public reporting of demographics across health departments, an urgent need persists for the introduced legislation to be passed by the Congress for the US states to consistently collect and make characteristics of COVID-19 cases, deaths, and vaccinations available in order to allocate resources to mitigate disease spread. %M 33821804 %R 10.2196/24288 %U https://publichealth.jmir.org/2021/4/e24288 %U https://doi.org/10.2196/24288 %U http://www.ncbi.nlm.nih.gov/pubmed/33821804 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 4 %P e23914 %T Prescribing Phones to Address Health Equity Needs in the COVID-19 Era: The PHONE-CONNECT Program %A Kazevman,Gill %A Mercado,Marck %A Hulme,Jennifer %A Somers,Andrea %+ Department of Emergency Medicine, University Health Network, 200 Elizabeth St, RFE-GS-480, Toronto, ON, M5G 2C4, Canada, 1 416 340 3856, Andrea.Somers@uhn.ca %K digital health equity %K health inequity %K digital determinants of health %K emergency medicine %K COVID-19 %K public health %K health policy %K primary care %K cell phone %D 2021 %7 6.4.2021 %9 Viewpoint %J J Med Internet Res %G English %X Vulnerable populations have been identified as having higher infection rates and poorer COVID-19–related outcomes, likely due to their inability to readily access primary care, follow public health directives, and adhere to self-isolation guidelines. As a response to the COVID-19 pandemic, many health care services have adopted new digital solutions, which rely on phone and internet connectivity. However, persons who are digitally inaccessible, such as those experiencing poverty or homelessness, are often unable to use these services. In response to this newly highlighted social disparity known as “digital health inequity,” emergency physicians at the University Health Network in Toronto, Canada, initiated a program called PHONE-CONNECT (Phones for Healthier Ontarians iN EDs – COvid NEeds met by Cellular Telephone). This novel approach attempts to improve patients’ access to health care, information, and social services, as well as improve their ability to adhere to public health directives (social isolation and contact tracing). Although similar programs addressing the same emerging issues have been recently described in the media, this is the first time phones have been provided as a health care intervention in an emergency department. This innovative emergency department point-of-care intervention may have a significant impact on improving health outcomes for vulnerable people during the COVID-19 pandemic and beyond. %M 33760753 %R 10.2196/23914 %U https://www.jmir.org/2021/4/e23914 %U https://doi.org/10.2196/23914 %U http://www.ncbi.nlm.nih.gov/pubmed/33760753 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 9 %N 4 %P e22734 %T Health, Psychosocial, and Social Issues Emanating From the COVID-19 Pandemic Based on Social Media Comments: Text Mining and Thematic Analysis Approach %A Oyebode,Oladapo %A Ndulue,Chinenye %A Adib,Ashfaq %A Mulchandani,Dinesh %A Suruliraj,Banuchitra %A Orji,Fidelia Anulika %A Chambers,Christine T %A Meier,Sandra %A Orji,Rita %+ Faculty of Computer Science, Dalhousie University, 6050 University Avenue, Halifax, NS, B3H 1W5, Canada, 1 902 494 2093, oladapo.oyebode@dal.ca %K social media %K COVID-19 %K coronavirus %K infodemiology %K infoveillance %K natural language processing %K text mining %K thematic analysis %K interventions %K health issues %K psychosocial issues %K social issues %D 2021 %7 6.4.2021 %9 Original Paper %J JMIR Med Inform %G English %X Background: The COVID-19 pandemic has caused a global health crisis that affects many aspects of human lives. In the absence of vaccines and antivirals, several behavioral change and policy initiatives such as physical distancing have been implemented to control the spread of COVID-19. Social media data can reveal public perceptions toward how governments and health agencies worldwide are handling the pandemic, and the impact of the disease on people regardless of their geographic locations in line with various factors that hinder or facilitate the efforts to control the spread of the pandemic globally. Objective: This paper aims to investigate the impact of the COVID-19 pandemic on people worldwide using social media data. Methods: We applied natural language processing (NLP) and thematic analysis to understand public opinions, experiences, and issues with respect to the COVID-19 pandemic using social media data. First, we collected over 47 million COVID-19–related comments from Twitter, Facebook, YouTube, and three online discussion forums. Second, we performed data preprocessing, which involved applying NLP techniques to clean and prepare the data for automated key phrase extraction. Third, we applied the NLP approach to extract meaningful key phrases from over 1 million randomly selected comments and computed sentiment score for each key phrase and assigned sentiment polarity (ie, positive, negative, or neutral) based on the score using a lexicon-based technique. Fourth, we grouped related negative and positive key phrases into categories or broad themes. Results: A total of 34 negative themes emerged, out of which 15 were health-related issues, psychosocial issues, and social issues related to the COVID-19 pandemic from the public perspective. Some of the health-related issues were increased mortality, health concerns, struggling health systems, and fitness issues; while some of the psychosocial issues were frustrations due to life disruptions, panic shopping, and expression of fear. Social issues were harassment, domestic violence, and wrong societal attitude. In addition, 20 positive themes emerged from our results. Some of the positive themes were public awareness, encouragement, gratitude, cleaner environment, online learning, charity, spiritual support, and innovative research. Conclusions: We uncovered various negative and positive themes representing public perceptions toward the COVID-19 pandemic and recommended interventions that can help address the health, psychosocial, and social issues based on the positive themes and other research evidence. These interventions will help governments, health professionals and agencies, institutions, and individuals in their efforts to curb the spread of COVID-19 and minimize its impact, and in reacting to any future pandemics. %M 33684052 %R 10.2196/22734 %U https://medinform.jmir.org/2021/4/e22734 %U https://doi.org/10.2196/22734 %U http://www.ncbi.nlm.nih.gov/pubmed/33684052 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 9 %N 2 %P e26216 %T How Gameful Experience Affects Public Knowledge, Attitudes, and Practices Regarding COVID-19 Among the Taiwanese Public: Cross-sectional Study %A Peng,Li-Hsun %A Bai,Ming-Han %+ Graduate School of Design, National Yunlin University of Science and Technology, 123 University Road, Section 3, Douliou, Yunlin, 640301, Taiwan, 886 961055900, minghan.bai@gmail.com %K COVID-19 %K knowledge %K attitude %K practice %K serious game %K gameful experience %D 2021 %7 6.4.2021 %9 Original Paper %J JMIR Serious Games %G English %X Background: In 2019, with the COVID-19 pandemic sweeping across the globe, public health systems worldwide faced severe challenges. Amid the pandemic, one simulation game, Plague Inc., has received substantial attention. This game has indirectly drawn greater public attention to public health issues by simulating pathogen transmission and disease symptoms. Objective: Against this backdrop, this research investigates whether the gameful experience of Plague Inc. has indirectly affected public knowledge, attitudes, and practices (KAP) regarding COVID-19. Methods: An online survey was conducted through social networking services in Taiwan from May 6-28, 2020. Results: A total of 486 subjects participated in this study, of which 276 (56.8%) had played Plague Inc. This study had several findings. First, participants who had played Plague Inc. demonstrated higher levels of knowledge (P=.03, median 7, IQR 7-8) and attitudes (P=.007, median 8, IQR 7-8) than participants who had not played Plague Inc. (knowledge: median 7, IQR 6-8; attitude: median 7, IQR 6-8). Second, there was a significant correlation between creative thinking (ρ=.127, P=.04) and dominance (ρ=.122, P=.04) in attitude. Finally, there was a significant correlation between creative thinking (ρ=.126, P<.001) and dominance (ρ=.119, P=.049) in practice. Conclusions: Serious games highlighting the theme of pathogen transmission may enhance public knowledge and attitudes regarding COVID-19. Furthermore, the creative thinking and dominance involved in gameful experiences may act as critical factors in public attitudes and practices regarding COVID-19. These findings should be further verified through experimental research in the future. %M 33737262 %R 10.2196/26216 %U https://games.jmir.org/2021/2/e26216 %U https://doi.org/10.2196/26216 %U http://www.ncbi.nlm.nih.gov/pubmed/33737262 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 4 %P e26960 %T Rural Telemedicine Use Before and During the COVID-19 Pandemic: Repeated Cross-sectional Study %A Chu,Cherry %A Cram,Peter %A Pang,Andrea %A Stamenova,Vess %A Tadrous,Mina %A Bhatia,R Sacha %+ Women's College Hospital Institute for Health System Solutions and Virtual Care, Women's College Hospital, 76 Grenville St, Toronto, ON, M5S 1B2, Canada, 1 416 312 9147, sacha.bhatia@wchospital.ca %K chronic disease %K chronic illness %K COVID-19 %K health care %K health services %K older adults %K remote %K rural %K pandemic %K population %K telemedicine %K virtual care %D 2021 %7 5.4.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic has led to a notable increase in telemedicine adoption. However, the impact of the pandemic on telemedicine use at a population level in rural and remote settings remains unclear. Objective: This study aimed to evaluate changes in the rate of telemedicine use among rural populations and identify patient characteristics associated with telemedicine use prior to and during the pandemic. Methods: We conducted a repeated cross-sectional study on all monthly and quarterly rural telemedicine visits from January 2012 to June 2020, using administrative data from Ontario, Canada. We compared the changes in telemedicine use among residents of rural and urban regions of Ontario prior to and during the pandemic. Results: Before the pandemic, telemedicine use was steadily low in 2012-2019 for both rural and urban populations but slightly higher overall for rural patients (11 visits per 1000 patients vs 7 visits per 1000 patients in December 2019, P<.001). The rate of telemedicine visits among rural patients significantly increased to 147 visits per 1000 patients in June 2020. A similar but steeper increase (P=.15) was observed among urban patients (220 visits per 1000 urban patients). Telemedicine use increased across all age groups, with the highest rates reported among older adults aged ≥65 years (77 visits per 100 patients in 2020). The proportions of patients with at least 1 telemedicine visit were similar across the adult age groups (n=82,246/290,401, 28.3% for patients aged 18-49 years, n=79,339/290,401, 27.3% for patients aged 50-64 years, and n=80,833/290,401, 27.8% for patients aged 65-79 years), but lower among younger patients <18 years (n=23,699/290,401, 8.2%) and older patients ≥80 years (n=24,284/290,401, 8.4%) in 2020 (P<.001). There were more female users than male users of telemedicine (n=158,643/290,401, 54.6% vs n=131,758/290,401, 45.4%, respectively, in 2020; P<.001). There was a significantly higher proportion of telemedicine users residing in relatively less rural than in more rural regions (n=261,814/290,401, 90.2% vs n=28,587/290,401, 9.8%, respectively, in 2020; P<.001). Conclusions: Telemedicine adoption increased in rural and remote areas during the COVID-19 pandemic, but its use increased in urban and less rural populations. Future studies should investigate the potential barriers to telemedicine use among rural patients and the impact of rural telemedicine on patient health care utilization and outcomes. %M 33769942 %R 10.2196/26960 %U https://www.jmir.org/2021/4/e26960 %U https://doi.org/10.2196/26960 %U http://www.ncbi.nlm.nih.gov/pubmed/33769942 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 4 %P e26627 %T Artificial Intelligence–Enabled Analysis of Public Attitudes on Facebook and Twitter Toward COVID-19 Vaccines in the United Kingdom and the United States: Observational Study %A Hussain,Amir %A Tahir,Ahsen %A Hussain,Zain %A Sheikh,Zakariya %A Gogate,Mandar %A Dashtipour,Kia %A Ali,Azhar %A Sheikh,Aziz %+ School of Computing, Edinburgh Napier University, 10 Colinton Road, Edinburgh, EH10 5DT, United Kingdom, 44 0845 260 6040, a.hussain@napier.ac.uk %K artificial intelligence %K COVID-19 %K deep learning %K Facebook %K health informatics %K natural language processing %K public health %K sentiment analysis %K social media %K Twitter %K infodemiology %K vaccination %D 2021 %7 5.4.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Global efforts toward the development and deployment of a vaccine for COVID-19 are rapidly advancing. To achieve herd immunity, widespread administration of vaccines is required, which necessitates significant cooperation from the general public. As such, it is crucial that governments and public health agencies understand public sentiments toward vaccines, which can help guide educational campaigns and other targeted policy interventions. Objective: The aim of this study was to develop and apply an artificial intelligence–based approach to analyze public sentiments on social media in the United Kingdom and the United States toward COVID-19 vaccines to better understand the public attitude and concerns regarding COVID-19 vaccines. Methods: Over 300,000 social media posts related to COVID-19 vaccines were extracted, including 23,571 Facebook posts from the United Kingdom and 144,864 from the United States, along with 40,268 tweets from the United Kingdom and 98,385 from the United States from March 1 to November 22, 2020. We used natural language processing and deep learning–based techniques to predict average sentiments, sentiment trends, and topics of discussion. These factors were analyzed longitudinally and geospatially, and manual reading of randomly selected posts on points of interest helped identify underlying themes and validated insights from the analysis. Results: Overall averaged positive, negative, and neutral sentiments were at 58%, 22%, and 17% in the United Kingdom, compared to 56%, 24%, and 18% in the United States, respectively. Public optimism over vaccine development, effectiveness, and trials as well as concerns over their safety, economic viability, and corporation control were identified. We compared our findings to those of nationwide surveys in both countries and found them to correlate broadly. Conclusions: Artificial intelligence–enabled social media analysis should be considered for adoption by institutions and governments alongside surveys and other conventional methods of assessing public attitude. Such analyses could enable real-time assessment, at scale, of public confidence and trust in COVID-19 vaccines, help address the concerns of vaccine sceptics, and help develop more effective policies and communication strategies to maximize uptake. %M 33724919 %R 10.2196/26627 %U https://www.jmir.org/2021/4/e26627 %U https://doi.org/10.2196/26627 %U http://www.ncbi.nlm.nih.gov/pubmed/33724919 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 4 %P e26518 %T Comparison of Public Responses to Containment Measures During the Initial Outbreak and Resurgence of COVID-19 in China: Infodemiology Study %A Zhou,Xinyu %A Song,Yi %A Jiang,Hao %A Wang,Qian %A Qu,Zhiqiang %A Zhou,Xiaoyu %A Jit,Mark %A Hou,Zhiyuan %A Lin,Leesa %+ School of Public Health, Fudan University, Mailbox 250, 138# Yixueyuan Road, Xuhui District, Shanghai, 200032, China, 86 21 33563935, zyhou@fudan.edu.cn %K COVID-19 %K engagement %K latent Dirichlet allocation %K public response %K sentiment %K social media %K topic modeling %D 2021 %7 5.4.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: COVID-19 cases resurged worldwide in the second half of 2020. Not much is known about the changes in public responses to containment measures from the initial outbreak to resurgence. Monitoring public responses is crucial to inform policy measures to prepare for COVID-19 resurgence. Objective: This study aimed to assess and compare public responses to containment measures during the initial outbreak and resurgence of COVID-19 in China. Methods: We curated all COVID-19–related posts from Sina Weibo (China’s version of Twitter) during the initial outbreak and resurgence of COVID-19 in Beijing, China. With a Python script, we constructed subsets of Weibo posts focusing on 3 containment measures: lockdown, the test-trace-isolate strategy, and suspension of gatherings. The Baidu open-source sentiment analysis model and latent Dirichlet allocation topic modeling, a widely used machine learning algorithm, were used to assess public engagement, sentiments, and frequently discussed topics on each containment measure. Results: A total of 8,985,221 Weibo posts were curated. In China, the containment measures evolved from a complete lockdown for the general population during the initial outbreak to a more targeted response strategy for high-risk populations during COVID-19 resurgence. Between the initial outbreak and resurgence, the average daily proportion of Weibo posts with negative sentiments decreased from 57% to 47% for the lockdown, 56% to 51% for the test-trace-isolate strategy, and 55% to 48% for the suspension of gatherings. Among the top 3 frequently discussed topics on lockdown measures, discussions on containment measures accounted for approximately 32% in both periods, but those on the second-most frequently discussed topic shifted from the expression of negative emotions (11%) to its impacts on daily life or work (26%). The public expressed a high level of panic (21%) during the initial outbreak but almost no panic (1%) during resurgence. The more targeted test-trace-isolate measure received the most support (60%) among all 3 containment measures in the initial outbreak, and its support rate approached 90% during resurgence. Conclusions: Compared to the initial outbreak, the public expressed less engagement and less negative sentiments on containment measures and were more supportive toward containment measures during resurgence. Targeted test-trace-isolate strategies were more acceptable to the public. Our results indicate that when COVID-19 resurges, more targeted test-trace-isolate strategies for high-risk populations should be promoted to balance pandemic control and its impact on daily life and the economy. %M 33750739 %R 10.2196/26518 %U https://www.jmir.org/2021/4/e26518 %U https://doi.org/10.2196/26518 %U http://www.ncbi.nlm.nih.gov/pubmed/33750739 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 9 %N 4 %P e21547 %T Implementation of the COVID-19 Vulnerability Index Across an International Network of Health Care Data Sets: Collaborative External Validation Study %A Reps,Jenna M %A Kim,Chungsoo %A Williams,Ross D %A Markus,Aniek F %A Yang,Cynthia %A Duarte-Salles,Talita %A Falconer,Thomas %A Jonnagaddala,Jitendra %A Williams,Andrew %A Fernández-Bertolín,Sergio %A DuVall,Scott L %A Kostka,Kristin %A Rao,Gowtham %A Shoaibi,Azza %A Ostropolets,Anna %A Spotnitz,Matthew E %A Zhang,Lin %A Casajust,Paula %A Steyerberg,Ewout W %A Nyberg,Fredrik %A Kaas-Hansen,Benjamin Skov %A Choi,Young Hwa %A Morales,Daniel %A Liaw,Siaw-Teng %A Abrahão,Maria Tereza Fernandes %A Areia,Carlos %A Matheny,Michael E %A Lynch,Kristine E %A Aragón,María %A Park,Rae Woong %A Hripcsak,George %A Reich,Christian G %A Suchard,Marc A %A You,Seng Chan %A Ryan,Patrick B %A Prieto-Alhambra,Daniel %A Rijnbeek,Peter R %+ Janssen Research & Development, 1125 Trenton Harbourton Rd, Titusville, NJ, United States, 1 732 715 6300, jreps@its.jnj.com %K external validation %K transportability %K COVID-19 %K prognostic model %K prediction %K C-19 %K modeling %K datasets %K observation %K hospitalization %K bias %K risk %K decision-making %D 2021 %7 5.4.2021 %9 Original Paper %J JMIR Med Inform %G English %X Background: SARS-CoV-2 is straining health care systems globally. The burden on hospitals during the pandemic could be reduced by implementing prediction models that can discriminate patients who require hospitalization from those who do not. The COVID-19 vulnerability (C-19) index, a model that predicts which patients will be admitted to hospital for treatment of pneumonia or pneumonia proxies, has been developed and proposed as a valuable tool for decision-making during the pandemic. However, the model is at high risk of bias according to the “prediction model risk of bias assessment” criteria, and it has not been externally validated. Objective: The aim of this study was to externally validate the C-19 index across a range of health care settings to determine how well it broadly predicts hospitalization due to pneumonia in COVID-19 cases. Methods: We followed the Observational Health Data Sciences and Informatics (OHDSI) framework for external validation to assess the reliability of the C-19 index. We evaluated the model on two different target populations, 41,381 patients who presented with SARS-CoV-2 at an outpatient or emergency department visit and 9,429,285 patients who presented with influenza or related symptoms during an outpatient or emergency department visit, to predict their risk of hospitalization with pneumonia during the following 0-30 days. In total, we validated the model across a network of 14 databases spanning the United States, Europe, Australia, and Asia. Results: The internal validation performance of the C-19 index had a C statistic of 0.73, and the calibration was not reported by the authors. When we externally validated it by transporting it to SARS-CoV-2 data, the model obtained C statistics of 0.36, 0.53 (0.473-0.584) and 0.56 (0.488-0.636) on Spanish, US, and South Korean data sets, respectively. The calibration was poor, with the model underestimating risk. When validated on 12 data sets containing influenza patients across the OHDSI network, the C statistics ranged between 0.40 and 0.68. Conclusions: Our results show that the discriminative performance of the C-19 index model is low for influenza cohorts and even worse among patients with COVID-19 in the United States, Spain, and South Korea. These results suggest that C-19 should not be used to aid decision-making during the COVID-19 pandemic. Our findings highlight the importance of performing external validation across a range of settings, especially when a prediction model is being extrapolated to a different population. In the field of prediction, extensive validation is required to create appropriate trust in a model. %M 33661754 %R 10.2196/21547 %U https://medinform.jmir.org/2021/4/e21547 %U https://doi.org/10.2196/21547 %U http://www.ncbi.nlm.nih.gov/pubmed/33661754 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 4 %P e26780 %T Public Discourse Against Masks in the COVID-19 Era: Infodemiology Study of Twitter Data %A Al-Ramahi,Mohammad %A Elnoshokaty,Ahmed %A El-Gayar,Omar %A Nasralah,Tareq %A Wahbeh,Abdullah %+ Supply Chain and Information Management Group, D’Amore-McKim School of Business, Northeastern University, 360 Huntington Ave, Boston, MA, 02115, United States, 1 617 373 4460, t.nasralah@northeastern.edu %K pandemic %K coronavirus %K masks %K social medial, opinion analysis %K COVID-19 %D 2021 %7 5.4.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Despite scientific evidence supporting the importance of wearing masks to curtail the spread of COVID-19, wearing masks has stirred up a significant debate particularly on social media. Objective: This study aimed to investigate the topics associated with the public discourse against wearing masks in the United States. We also studied the relationship between the anti-mask discourse on social media and the number of new COVID-19 cases. Methods: We collected a total of 51,170 English tweets between January 1, 2020, and October 27, 2020, by searching for hashtags against wearing masks. We used machine learning techniques to analyze the data collected. We investigated the relationship between the volume of tweets against mask-wearing and the daily volume of new COVID-19 cases using a Pearson correlation analysis between the two-time series. Results: The results and analysis showed that social media could help identify important insights related to wearing masks. The results of topic mining identified 10 categories or themes of user concerns dominated by (1) constitutional rights and freedom of choice; (2) conspiracy theory, population control, and big pharma; and (3) fake news, fake numbers, and fake pandemic. Altogether, these three categories represent almost 65% of the volume of tweets against wearing masks. The relationship between the volume of tweets against wearing masks and newly reported COVID-19 cases depicted a strong correlation wherein the rise in the volume of negative tweets led the rise in the number of new cases by 9 days. Conclusions: These findings demonstrated the potential of mining social media for understanding the public discourse about public health issues such as wearing masks during the COVID-19 pandemic. The results emphasized the relationship between the discourse on social media and the potential impact on real events such as changing the course of the pandemic. Policy makers are advised to proactively address public perception and work on shaping this perception through raising awareness, debunking negative sentiments, and prioritizing early policy intervention toward the most prevalent topics. %M 33720841 %R 10.2196/26780 %U https://publichealth.jmir.org/2021/4/e26780 %U https://doi.org/10.2196/26780 %U http://www.ncbi.nlm.nih.gov/pubmed/33720841 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 4 %P e24374 %T Shaping Workflows in Digital and Remote Diabetes Care During the COVID-19 Pandemic via Service Design: Prospective, Longitudinal, Open-label Feasibility Trial %A Braune,Katarina %A Boss,Karina %A Schmidt-Herzel,Jessica %A Gajewska,Katarzyna Anna %A Thieffry,Axel %A Schulze,Lilian %A Posern,Barbara %A Raile,Klemens %+ Charité – Universitätsmedizin Berlin, Department of Paediatric Endocrinology and Diabetes, Augustenburger Platz 1, Berlin, 13353, Germany, 49 30450616454, katarina.braune@charite.de %K telemedicine %K telehealth %K remote care %K digital care %K type 1 diabetes %K pediatric diabetes %K open source %K service design %K digital health %K COVID-19 %K diabetes %K workflow %D 2021 %7 5.4.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The COVID-19 pandemic poses new challenges to health care providers and the delivery of continuous care. Although many diabetes technologies, such as insulin pumps and continuous glucose monitors, have been established, the data from these devices are rarely assessed. Furthermore, telemedicine has not been sufficiently integrated into clinical workflows. Objective: We sought to remotely support children with type 1 diabetes and their caregivers, enhance the clinical outcomes and quality of life of children with diabetes, increase multiple stakeholders’ engagement with digital care via a participatory approach, evaluate the feasibility of using an interoperable open-source platform in a university hospital setting, and analyze the success factors and barriers of transitioning from conventional care to digital care. Methods: Service design methods were used to adapt clinical workflows. Remote consultations were performed on a monthly and on-demand basis. Diabetes device data were uploaded from patients’ homes to an open-source platform. Clinical and patient-reported outcomes were assessed before, during, and after the COVID-19 lockdown period in Germany. Results: A total of 28 children with type 1 diabetes and their caregivers enrolled in this study and completed 6 months of remote visits. Of these 28 participants, 16 (57%) also opted to attend at least one of their regular visits remotely. After 3 months of remote visits, participants’ time in range (P=.001) and time in hyperglycemia (P=.004) significantly improved, and their time in hypoglycemia did not increase. These improvements were maintained during the COVID-19 lockdown period (ie, between months 3 and 6 of this study). Participants’ psychosocial health improved after 6 months. Conclusions: Remote consultations and commonly shared data access can improve the clinical outcomes and quality of life of children with type 1 diabetes, even during challenging circumstances. A service design approach helped with the delivery of comprehensive and holistic solutions that accounted for the needs of multiple stakeholders. Our findings can inform the future integration of digital tools into clinical care during and beyond the pandemic. Trial Registration: German Clinical Trials Register DRKS00016170; https://tinyurl.com/skz4wdk5 %M 33571104 %R 10.2196/24374 %U https://mhealth.jmir.org/2021/4/e24374 %U https://doi.org/10.2196/24374 %U http://www.ncbi.nlm.nih.gov/pubmed/33571104 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 4 %P e23593 %T Concerns Discussed on Chinese and French Social Media During the COVID-19 Lockdown: Comparative Infodemiology Study Based on Topic Modeling %A Schück,Stéphane %A Foulquié,Pierre %A Mebarki,Adel %A Faviez,Carole %A Khadhar,Mickaïl %A Texier,Nathalie %A Katsahian,Sandrine %A Burgun,Anita %A Chen,Xiaoyi %+ Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, Université de Paris, 15 Rue de l'école de médecine, Paris, F-75006, France, 33 171196369, xiaoyi.chen@inserm.fr %K comparative analysis %K content analysis %K topic model %K social media %K COVID-19 %K lockdown %K China %K France %K impact %K population %D 2021 %7 5.4.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: During the COVID-19 pandemic, numerous countries, including China and France, have implemented lockdown measures that have been effective in controlling the epidemic. However, little is known about the impact of these measures on the population as expressed on social media from different cultural contexts. Objective: This study aims to assess and compare the evolution of the topics discussed on Chinese and French social media during the COVID-19 lockdown. Methods: We extracted posts containing COVID-19–related or lockdown-related keywords in the most commonly used microblogging social media platforms (ie, Weibo in China and Twitter in France) from 1 week before lockdown to the lifting of the lockdown. A topic model was applied independently for three periods (prelockdown, early lockdown, and mid to late lockdown) to assess the evolution of the topics discussed on Chinese and French social media. Results: A total of 6395; 23,422; and 141,643 Chinese Weibo messages, and 34,327; 119,919; and 282,965 French tweets were extracted in the prelockdown, early lockdown, and mid to late lockdown periods, respectively, in China and France. Four categories of topics were discussed in a continuously evolving way in all three periods: epidemic news and everyday life, scientific information, public measures, and solidarity and encouragement. The most represented category over all periods in both countries was epidemic news and everyday life. Scientific information was far more discussed on Weibo than in French tweets. Misinformation circulated through social media in both countries; however, it was more concerned with the virus and epidemic in China, whereas it was more concerned with the lockdown measures in France. Regarding public measures, more criticisms were identified in French tweets than on Weibo. Advantages and data privacy concerns regarding tracing apps were also addressed in French tweets. All these differences were explained by the different uses of social media, the different timelines of the epidemic, and the different cultural contexts in these two countries. Conclusions: This study is the first to compare the social media content in eastern and western countries during the unprecedented COVID-19 lockdown. Using general COVID-19–related social media data, our results describe common and different public reactions, behaviors, and concerns in China and France, even covering the topics identified in prior studies focusing on specific interests. We believe our study can help characterize country-specific public needs and appropriately address them during an outbreak. %M 33750736 %R 10.2196/23593 %U https://formative.jmir.org/2021/4/e23593 %U https://doi.org/10.2196/23593 %U http://www.ncbi.nlm.nih.gov/pubmed/33750736 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 4 %P e23233 %T Recommendations for Health Equity and Virtual Care Arising From the COVID-19 Pandemic: Narrative Review %A Shaw,James %A Brewer,LaPrincess C %A Veinot,Tiffany %+ Institute for Health System Solutions and Virtual Care, Women's College Hospital, 76 Grenville Street, Toronto, ON, M5S 1B2, Canada, 1 416 323 6400 ext 4224, jay.shaw@wchospital.ca %K virtual care %K health equity %K health disparities %K health informatics %K COVID-19 %K telemedicine %K telehealth %K digital health %D 2021 %7 5.4.2021 %9 Review %J JMIR Form Res %G English %X Background: The COVID-19 health crisis has disproportionately impacted populations who have been historically marginalized in health care and public health, including low-income and racial and ethnic minority groups. Members of marginalized communities experience undue barriers to accessing health care through virtual care technologies, which have become the primary mode of ambulatory health care delivery during the COVID-19 pandemic. Insights generated during the COVID-19 pandemic can inform strategies to promote health equity in virtual care now and in the future. Objective: The aim of this study is to generate insights arising from literature that was published in direct response to the widespread use of virtual care during the COVID-19 pandemic, and had a primary focus on providing recommendations for promoting health equity in the delivery of virtual care. Methods: We conducted a narrative review of literature on health equity and virtual care during the COVID-19 pandemic published in 2020, describing strategies that have been proposed in the literature at three levels: (1) policy and government, (2) organizations and health systems, and (3) communities and patients. Results: We highlight three strategies for promoting health equity through virtual care that have been underaddressed in this literature: (1) simplifying complex interfaces and workflows, (2) using supportive intermediaries, and (3) creating mechanisms through which marginalized community members can provide immediate input into the planning and delivery of virtual care. Conclusions: We conclude by outlining three areas of work that are required to ensure that virtual care is employed in ways that are equity enhancing in a post–COVID-19 reality. %M 33739931 %R 10.2196/23233 %U https://formative.jmir.org/2021/4/e23233 %U https://doi.org/10.2196/23233 %U http://www.ncbi.nlm.nih.gov/pubmed/33739931 %0 Journal Article %@ 2563-6316 %I JMIR Publications %V 2 %N 1 %P e21044 %T Forecasting the COVID-19 Pandemic in Saudi Arabia Using a Modified Singular Spectrum Analysis Approach: Model Development and Data Analysis %A Alharbi,Nader %+ King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Prince Mutib Ibn Abdullah Ibn Abdulaziz Rd, Ar Rimayah, Riyadh, Saudi Arabia, 966 114299999 ext 95590, alharbina@ksau-hs.edu.sa %K COVID-19 %K prediction %K singular spectrum analysis %K separability %K eigenvalues %K Saudi Arabia %D 2021 %7 31.3.2021 %9 Original Paper %J JMIRx Med %G English %X Background: Infectious disease is one of the main issues that threatens human health worldwide. The 2019 outbreak of the new coronavirus SARS-CoV-2, which causes the disease COVID-19, has become a serious global pandemic. Many attempts have been made to forecast the spread of the disease using various methods, including time series models. Among the attempts to model the pandemic, to the best of our knowledge, no studies have used the singular spectrum analysis (SSA) technique to forecast confirmed cases. Objective: The primary objective of this paper is to construct a reliable, robust, and interpretable model for describing, decomposing, and forecasting the number of confirmed cases of COVID-19 and predicting the peak of the pandemic in Saudi Arabia. Methods: A modified singular spectrum analysis (SSA) approach was applied for the analysis of the COVID-19 pandemic in Saudi Arabia. We proposed this approach and developed it in our previous studies regarding the separability and grouping steps in SSA, which play important roles in reconstruction and forecasting. The modified SSA approach mainly enables us to identify the number of interpretable components required for separability, signal extraction, and noise reduction. The approach was examined using different levels of simulated and real data with different structures and signal-to-noise ratios. In this study, we examined the capability of the approach to analyze COVID-19 data. We then used vector SSA to predict new data points and the peak of the pandemic in Saudi Arabia. Results: In the first stage, the confirmed daily cases on the first 42 days (March 02 to April 12, 2020) were used and analyzed to identify the value of the number of required eigenvalues (r) for separability between noise and signal. After obtaining the value of r, which was 2, and extracting the signals, vector SSA was used to predict and determine the pandemic peak. In the second stage, we updated the data and included 81 daily case values. We used the same window length and number of eigenvalues for reconstruction and forecasting of the points 90 days ahead. The results of both forecasting scenarios indicated that the peak would occur around the end of May or June 2020 and that the crisis would end between the end of June and the middle of August 2020, with a total number of infected people of approximately 330,000. Conclusions: Our results confirm the impressive performance of modified SSA in analyzing COVID-19 data and selecting the value of r for identifying the signal subspace from a noisy time series and then making a reliable prediction of daily confirmed cases using the vector SSA method. %M 34076627 %R 10.2196/21044 %U https://xmed.jmir.org/2021/1/e21044 %U https://doi.org/10.2196/21044 %U http://www.ncbi.nlm.nih.gov/pubmed/34076627 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 3 %P e22603 %T Online Tool for the Assessment of the Burden of COVID-19 in Patients: Development Study %A van Noort,Esther M J %A Claessens,Danny %A Moor,Catharina C %A Berg,Carlijn A L Van Den %A Kasteleyn,Marise J %A in 't Veen,Johannes C C M %A Van Schayck,Onno C P %A Chavannes,Niels H %+ Department of Public Health and Primary Care, Leiden University Medical Center, Albinusdreef 2, Leiden, 2333 ZA, Netherlands, 31 162520571, e.m.j.van_noort@lumc.nl %K COVID-19 %K patient-reported outcomes %K ABCoV tool %K monitoring %K patient outcome %K long-term impact %K tool %K assessment %K online patient platform %D 2021 %7 31.3.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The impact of COVID-19 has been felt worldwide, yet we are still unsure about its full impact. One of the gaps in our current knowledge relates to the long-term mental and physical impact of the infection on affected individuals. The COVID-19 pandemic hit the Netherlands at the end of February 2020, resulting in over 900,000 people testing positive for the virus, over 24,000 hospitalizations, and over 13,000 deaths by the end of January 2021. Although many patients recover from the acute phase of the disease, experience with other virus outbreaks has raised concerns regarding possible late sequelae of the infection. Objective: This study aims to develop an online tool to assess the long-term burden of COVID-19 in patients. Methods: In this paper, we describe the process of development, assessment, programming, implementation, and use of this new tool: the assessment of burden of COVID-19 (ABCoV) tool. This new tool is based on the well-validated assessment of burden of chronic obstructive pulmonary disease tool. Results: As of January 2021, the new ABCoV tool has been used in an online patient platform by more than 2100 self-registered patients and another 400 patients in a hospital setting, resulting in over 2500 patients. These patients have submitted the ABCoV questionnaire 3926 times. Among the self-registered patients who agreed to have their data analyzed (n=1898), the number of females was high (n=1153, 60.7%), many were medically diagnosed with COVID-19 (n=892, 47.0%), and many were relatively young with only 7.4% (n=141) being older than 60 years. Of all patients that actually used the tool (n=1517), almost one-quarter (n=356, 23.5%) used the tool twice, and only a small group (n=76, 5.0%) used the tool 6 times. Conclusions: This new ABCoV tool has been broadly and repeatedly used, and may provide insight into the perceived burden of disease, provide direction for personalized aftercare for people post COVID-19, and help us to be prepared for possible future recurrences. %M 33729982 %R 10.2196/22603 %U https://formative.jmir.org/2021/3/e22603 %U https://doi.org/10.2196/22603 %U http://www.ncbi.nlm.nih.gov/pubmed/33729982 %0 Journal Article %@ 2563-6316 %I JMIR Publications %V 2 %N 1 %P e25610 %T The Psychological Impact of Hypertension During COVID-19 Restrictions: Retrospective Case-Control Study %A Bonner,Carissa %A Cvejic,Erin %A Ayre,Julie %A Isautier,Jennifer %A Semsarian,Christopher %A Nickel,Brooke %A Batcup,Carys %A Pickles,Kristen %A Dodd,Rachael %A Cornell,Samuel %A Copp,Tessa %A McCaffery,Kirsten J %+ Sydney Health Literacy Lab, School of Public Health, Faculty of Medicine and Health, The University of Sydney, Edward Ford Building A27, Rm 128A, Sydney, NSW 2006, Australia, 61 2 9351 7125, carissa.bonner@sydney.edu.au %K public health %K global health %K COVID-19 %K hypertension %K risk %K strategy %K mental health %K behavior %K response %K anxiety %K vaccine %K retrospective %K perception %K prevention %K intention %D 2021 %7 30.3.2021 %9 Original Paper %J JMIRx Med %G English %X Background: It is unclear how people with hypertension are responding to the COVID-19 pandemic given their increased risk, and whether targeted public health strategies are needed. Objective: This retrospective case-control study compared people with hypertension to matched healthy controls during the COVID-19 lockdown to determine whether they have higher risk perceptions, anxiety, and vaccination intentions. Methods: Baseline data from a national survey were collected in April 2020 during the COVID-19 lockdown in Australia. People who reported hypertension with no other chronic conditions were randomly matched to healthy controls of similar age, gender, education, and health literacy level. A subset including participants with hypertension was followed up at 2 months after restrictions were eased. Risk perceptions, anxiety, and vaccination intentions were measured in April and June. Results: Of the 4362 baseline participants, 466 (10.7%) reported hypertension with no other chronic conditions. A subset of 1369 people were followed up at 2 months, which included 147 (10.7%) participants with hypertension. At baseline, perceived seriousness was high for both hypertension and control groups. The hypertension group reported greater anxiety compared to the controls and were more willing to vaccinate against influenza, but COVID-19 vaccination intentions were similar. At follow-up, these differences were no longer present in the longitudinal subsample. Perceived seriousness and anxiety had decreased, but vaccination intentions for both influenza and COVID-19 remained high across groups (>80%). Conclusions: Anxiety was above normal levels during the COVID-19 lockdown. It was higher in the hypertension group, which also had higher vaccination intentions. Groups that are more vulnerable to COVID-19 may require targeted mental health screening during periods of greater risk. Despite a decrease in perceived risk and anxiety after 2 months of lockdown restrictions, vaccination intentions remained high, which is encouraging for the future prevention of COVID-19. %M 34076628 %R 10.2196/25610 %U https://xmed.jmir.org/2021/1/e25610 %U https://doi.org/10.2196/25610 %U http://www.ncbi.nlm.nih.gov/pubmed/34076628 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e25042 %T Relationship Between Coronavirus-Related eHealth Literacy and COVID-19 Knowledge, Attitudes, and Practices among US Adults: Web-Based Survey Study %A An,Lawrence %A Bacon,Elizabeth %A Hawley,Sarah %A Yang,Penny %A Russell,Daniel %A Huffman,Scott %A Resnicow,Ken %+ Center for Health Communications Research, Rogel Cancer Center, University of Michigan, North Campus Research Complex, Building 16, 2800 Plymouth Rd, Ann Arbor, MI, 48109, United States, 1 734 763 6099, lcan@med.umich.edu %K internet %K digital health %K eHealth %K eHealth literacy %K coronavirus %K COVID-19 %K knowledge %K conspiracy beliefs %K protective behaviors %K social distancing %K survey %K health communication %K attitude %K behavior %D 2021 %7 29.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: During a global pandemic, it is critical that the public is able to rapidly acquire new and accurate health information. The internet is a major source of health information. eHealth literacy is the ability of individuals to find, assess, and use health information available on the internet. Objective: The goals of this study were to assess coronavirus-related eHealth literacy and examine the relationship between eHealth literacy and COVID-19−related knowledge, attitudes, and practices (KAPs). Methods: We conducted a web-based survey of a representative sample of 1074 US adults. We adapted the 8-item eHealth Literacy Scale to develop the Coronavirus-Related eHealth Literacy Scale (CoV-eHEALS) to measure COVID-19−related knowledge, conspiracy beliefs, and adherence to protective behaviors (eg, wearing facial masks and social distancing). Our analyses identified sociodemographic associations with the participants’ CoV-eHEALS scores and an association between the CoV-eHEALS measure and COVID-19 KAPs. Results: The internal consistency of the adapted CoV-eHEALS measure was high (Cronbach α=.92). The mean score for the CoV-eHEALS was 29.0 (SD 6.1). A total of 29% (306/1074) of the survey participants were classified as having low coronavirus-related eHealth literacy (CoV-eHEALS score <26). Independent associations were found between CoV-eHEALS scores and ethnicity (standardized β=–.083, P=.016 for Black participants) and education level (standardized β=–.151, P=.001 for participants with high-school education or lower). Controlling for demographic characteristics, CoV-eHEALS scores demonstrated positive independent associations with knowledge (standardized β=.168, P<.001) and adherence to protective behaviors (standardized β=.241, P<.001) and a negative association with conspiracy beliefs (standardized β=–.082, P=.009). Conclusions: This study provides an estimate of coronavirus-related eHealth literacy among US adults. Our findings suggest that a substantial proportion of US adults have low coronavirus-related eHealth literacy and are thus at a greater risk of lower and less-protective COVID-19 KAPs. These findings highlight the need to assess and address eHealth literacy as part of COVID-19 control efforts. Potential strategies include improving the quality of health information about COVID-19 available on the internet, assisting or simplifying web-based search for information about COVID-19, and training to improve general or coronavirus-specific search skills. %M 33626015 %R 10.2196/25042 %U https://www.jmir.org/2021/3/e25042 %U https://doi.org/10.2196/25042 %U http://www.ncbi.nlm.nih.gov/pubmed/33626015 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 3 %P e26811 %T Digital Mental Health Challenges and the Horizon Ahead for Solutions %A Balcombe,Luke %A De Leo,Diego %+ Australian Institute for Suicide Research and Prevention, Griffith University, Messines Ridge Rd, Brisbane, 4122, Australia, 61 0447505709, lukebalcombe@gmail.com %K challenges %K COVID-19 %K digital mental health implementation %K explainable artificial intelligence %K hybrid model of care %K human-computer interaction %K resilience %K technology %D 2021 %7 29.3.2021 %9 Commentary %J JMIR Ment Health %G English %X The demand outstripping supply of mental health resources during the COVID-19 pandemic presents opportunities for digital technology tools to fill this new gap and, in the process, demonstrate capabilities to increase their effectiveness and efficiency. However, technology-enabled services have faced challenges in being sustainably implemented despite showing promising outcomes in efficacy trials since the early 2000s. The ongoing failure of these implementations has been addressed in reconceptualized models and frameworks, along with various efforts to branch out among disparate developers and clinical researchers to provide them with a key for furthering evaluative research. However, the limitations of traditional research methods in dealing with the complexities of mental health care warrant a diversified approach. The crux of the challenges of digital mental health implementation is the efficacy and evaluation of existing studies. Web-based interventions are increasingly used during the pandemic, allowing for affordable access to psychological therapies. However, a lagging infrastructure and skill base has limited the application of digital solutions in mental health care. Methodologies need to be converged owing to the rapid development of digital technologies that have outpaced the evaluation of rigorous digital mental health interventions and strategies to prevent mental illness. The functions and implications of human-computer interaction require a better understanding to overcome engagement barriers, especially with predictive technologies. Explainable artificial intelligence is being incorporated into digital mental health implementation to obtain positive and responsible outcomes. Investment in digital platforms and associated apps for real-time screening, tracking, and treatment offer the promise of cost-effectiveness in vulnerable populations. Although machine learning has been limited by study conduct and reporting methods, the increasing use of unstructured data has strengthened its potential. Early evidence suggests that the advantages outweigh the disadvantages of incrementing such technology. The limitations of an evidence-based approach require better integration of decision support tools to guide policymakers with digital mental health implementation. There is a complex range of issues with effectiveness, equity, access, and ethics (eg, privacy, confidentiality, fairness, transparency, reproducibility, and accountability), which warrant resolution. Evidence-informed policies, development of eminent digital products and services, and skills to use and maintain these solutions are required. Studies need to focus on developing digital platforms with explainable artificial intelligence–based apps to enhance resilience and guide the treatment decisions of mental health practitioners. Investments in digital mental health should ensure their safety and workability. End users should encourage the use of innovative methods to encourage developers to effectively evaluate their products and services and to render them a worthwhile investment. Technology-enabled services in a hybrid model of care are most likely to be effective (eg, specialists using these services among vulnerable, at-risk populations but not severe cases of mental ill health). %M 33779570 %R 10.2196/26811 %U https://mental.jmir.org/2021/3/e26811 %U https://doi.org/10.2196/26811 %U http://www.ncbi.nlm.nih.gov/pubmed/33779570 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 3 %P e27317 %T Analyzing Cross-country Pandemic Connectedness During COVID-19 Using a Spatial-Temporal Database: Network Analysis %A Chu,Amanda MY %A Chan,Jacky NL %A Tsang,Jenny TY %A Tiwari,Agnes %A So,Mike KP %+ Department of Information Systems, Business Statistics and Operations Management, The Hong Kong University of Science and Technology, Clear Water Bay, Hong Kong, China (Hong Kong), 852 23587726, immkpso@ust.hk %K air traffic %K coronavirus %K COVID-19 %K human mobility %K network analysis %K travel restrictions %D 2021 %7 29.3.2021 %9 Rapid Surveillance Report %J JMIR Public Health Surveill %G English %X Communicable diseases including COVID-19 pose a major threat to public health worldwide. To curb the spread of communicable diseases effectively, timely surveillance and prediction of the risk of pandemics are essential. The aim of this study is to analyze free and publicly available data to construct useful travel data records for network statistics other than common descriptive statistics. This study describes analytical findings of time-series plots and spatial-temporal maps to illustrate or visualize pandemic connectedness. We analyzed data retrieved from the web-based Collaborative Arrangement for the Prevention and Management of Public Health Events in Civil Aviation dashboard, which contains up-to-date and comprehensive meta-information on civil flights from 193 national governments in accordance with the airport, country, city, latitude, and the longitude of flight origin and the destination. We used the database to visualize pandemic connectedness through the workflow of travel data collection, network construction, data aggregation, travel statistics calculation, and visualization with time-series plots and spatial-temporal maps. We observed similar patterns in the time-series plots of worldwide daily flights from January to early-March of 2019 and 2020. A sharp reduction in the number of daily flights recorded in mid-March 2020 was likely related to large-scale air travel restrictions owing to the COVID-19 pandemic. The levels of connectedness between places are strong indicators of the risk of a pandemic. Since the initial reports of COVID-19 cases worldwide, a high network density and reciprocity in early-March 2020 served as early signals of the COVID-19 pandemic and were associated with the rapid increase in COVID-19 cases in mid-March 2020. The spatial-temporal map of connectedness in Europe on March 13, 2020, shows the highest level of connectedness among European countries, which reflected severe outbreaks of COVID-19 in late March and early April of 2020. As a quality control measure, we used the aggregated numbers of international flights from April to October 2020 to compare the number of international flights officially reported by the International Civil Aviation Organization with the data collected from the Collaborative Arrangement for the Prevention and Management of Public Health Events in Civil Aviation dashboard, and we observed high consistency between the 2 data sets. The flexible design of the database provides users access to network connectedness at different periods, places, and spatial levels through various network statistics calculation methods in accordance with their needs. The analysis can facilitate early recognition of the risk of a current communicable disease pandemic and newly emerging communicable diseases in the future. %M 33711799 %R 10.2196/27317 %U https://publichealth.jmir.org/2021/3/e27317 %U https://doi.org/10.2196/27317 %U http://www.ncbi.nlm.nih.gov/pubmed/33711799 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 3 %P e26293 %T Changes in Workers’ Sedentary and Physical Activity Behaviors in Response to the COVID-19 Pandemic and Their Relationships With Fatigue: Longitudinal Online Study %A Koohsari,Mohammad Javad %A Nakaya,Tomoki %A McCormack,Gavin R %A Shibata,Ai %A Ishii,Kaori %A Oka,Koichiro %+ Faculty of Sport Sciences, Waseda University, 2-579-15 Mikajima, Tokorozawa, 359-1192, Japan, 81 4 2947 7189, javadkoohsari@aoni.waseda.jp %K COVID-19 %K physical inactivity %K sitting time %K mental health %K Japan %K prospective design %D 2021 %7 26.3.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Sedentary behaviors and physical activity are likely to be affected by the COVID-19 outbreak, and sedentary lifestyles can increase subjective fatigue. The nonpharmaceutical policies imposed as a result of the COVID-19 pandemic may also have adverse effects on fatigue. Objective: This study has two aims: to examine the changes in sedentary behaviors and physical activity of company workers in response to the COVID-19 pandemic in Japan and to examine relationships between changes in these sedentary behaviors and physical activity and changes in fatigue. Methods: Data from a nationwide prospective online survey conducted in 2019 and 2020 were used. On February 22, 2019, an email with a link to participate in the study was sent to 45,659 workers, aged 20 to 59 years, who were randomly selected from a database of approximately 1 million individuals. A total of 2466 and 1318 participants, who self-reported their occupation as company workers, answered the baseline and follow-up surveys, respectively. Surveys captured fatigue, workday and daily domain-specific sedentary behaviors and physical activity, and total sedentary behaviors and physical activity. We used multivariable linear regression models to estimate associations of changes in sedentary behaviors and physical activity with changes in fatigue. Results: Increases in public transportation sitting during workdays, other leisure sitting time during workdays, and other leisure sitting time were associated with an increase in the motivation aspect of fatigue (b=0.29, 95% CI 0-0.57, P=.048; b=0.40, 95% CI 0.18-0.62, P<.001; and b=0.26, 95% CI 0.07-0.45, P=.007, respectively). Increases in work-related sitting time during workdays, total sitting time during workdays, and total work-related sitting time were significantly associated with an increase in the physical activity aspect of fatigue (b=0.06, 95% CI 0-0.12, P=.03; b=0.05, 95% CI 0.01-0.09, P=.02; and b=0.07, 95% CI 0-0.14, P=.04, respectively). The motivation and physical activity aspects of fatigue increased by 0.06 for each 1-hour increase in total sitting time between baseline and follow-up (b=0.06, 95% CI 0-0.11, P=.045; and b=0.06, 95% CI 0.01-0.10, P=.009, respectively). Conclusions: Our findings demonstrated that sedentary and active behaviors among company workers in Japan were negatively affected during the COVID-19 outbreak. Increases in several domain-specific sedentary behaviors also contributed to unfavorable changes in workers’ fatigue. Social distancing and teleworking amid a pandemic may contribute to the sedentary lifestyle of company workers. Public health interventions are needed to mitigate the negative effects of the COVID-19 pandemic or future pandemics on sedentary and physical activity behaviors and fatigue among company workers. %M 33727211 %R 10.2196/26293 %U https://publichealth.jmir.org/2021/3/e26293 %U https://doi.org/10.2196/26293 %U http://www.ncbi.nlm.nih.gov/pubmed/33727211 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 3 %P e27232 %T Analyzing the Essential Attributes of Nationally Issued COVID-19 Contact Tracing Apps: Open-Source Intelligence Approach and Content Analysis %A Weiß,Jan-Patrick %A Esdar,Moritz %A Hübner,Ursula %+ Health Informatics Research Group, Faculty of Business Management and Social Sciences, University of Applied Sciences Osnabrueck, Caprivistraße 30a, Osnabrück, , Germany, 49 5419692012, u.huebner@hs-osnabrueck.de %K COVID-19 %K contact tracing %K app %K protocol %K privacy %K assessment %K review %K surveillance %K monitoring %K design %K framework %K feature %K usage %D 2021 %7 26.3.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Contact tracing apps are potentially useful tools for supporting national COVID-19 containment strategies. Various national apps with different technical design features have been commissioned and issued by governments worldwide. Objective: Our goal was to develop and propose an item set that was suitable for describing and monitoring nationally issued COVID-19 contact tracing apps. This item set could provide a framework for describing the key technical features of such apps and monitoring their use based on widely available information. Methods: We used an open-source intelligence approach (OSINT) to access a multitude of publicly available sources and collect data and information regarding the development and use of contact tracing apps in different countries over several months (from June 2020 to January 2021). The collected documents were then iteratively analyzed via content analysis methods. During this process, an initial set of subject areas were refined into categories for evaluation (ie, coherent topics), which were then examined for individual features. These features were paraphrased as items in the form of questions and applied to information materials from a sample of countries (ie, Brazil, China, Finland, France, Germany, Italy, Singapore, South Korea, Spain, and the United Kingdom [England and Wales]). This sample was purposefully selected; our intention was to include the apps of different countries from around the world and to propose a valid item set that can be relatively easily applied by using an OSINT approach. Results: Our OSINT approach and subsequent analysis of the collected documents resulted in the definition of the following five main categories and associated subcategories: (1) background information (open-source code, public information, and collaborators); (2) purpose and workflow (secondary data use and warning process design); (3) technical information (protocol, tracing technology, exposure notification system, and interoperability); (4) privacy protection (the entity of trust and anonymity); and (5) availability and use (release date and the number of downloads). Based on this structure, a set of items that constituted the evaluation framework were specified. The application of these items to the 10 selected countries revealed differences, especially with regard to the centralization of the entity of trust and the overall transparency of the apps’ technical makeup. Conclusions: We provide a set of criteria for monitoring and evaluating COVID-19 tracing apps that can be easily applied to publicly issued information. The application of these criteria might help governments to identify design features that promote the successful, widespread adoption of COVID-19 tracing apps among target populations and across national boundaries. %M 33724920 %R 10.2196/27232 %U https://mhealth.jmir.org/2021/3/e27232 %U https://doi.org/10.2196/27232 %U http://www.ncbi.nlm.nih.gov/pubmed/33724920 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 3 %P e24275 %T Understanding On-Campus Interactions With a Semiautomated, Barcode-Based Platform to Augment COVID-19 Contact Tracing: App Development and Usage %A Scherr,Thomas Foster %A Hardcastle,Austin N %A Moore,Carson Paige %A DeSousa,Jenna Maria %A Wright,David Wilson %+ Department of Chemistry, Vanderbilt University, 7330 Stevenson Center, Station B 351822, Nashville, TN, 37235, United States, 1 6153222861, thomas.f.scherr@vanderbilt.edu %K contact tracing %K COVID-19 %K disease surveillance %K digital health %D 2021 %7 26.3.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The COVID-19 pandemic has forced drastic changes to daily life, from the implementation of stay-at-home orders to mandating facial coverings and limiting in-person gatherings. While the relaxation of these control measures has varied geographically, it is widely agreed that contact tracing efforts will play a major role in the successful reopening of businesses and schools. As the volume of positive cases has increased in the United States, it has become clear that there is room for digital health interventions to assist in contact tracing. Objective: The goal of this study was to evaluate the use of a mobile-friendly app designed to supplement manual COVID-19 contact tracing efforts on a university campus. Here, we present the results of a development and validation study centered around the use of the MyCOVIDKey app on the Vanderbilt University campus during the summer of 2020. Methods: We performed a 6-week pilot study in the Stevenson Center Science and Engineering Complex on Vanderbilt University’s campus in Nashville, TN. Graduate students, postdoctoral fellows, faculty, and staff >18 years who worked in Stevenson Center and had access to a mobile phone were eligible to register for a MyCOVIDKey account. All users were encouraged to complete regular self-assessments of COVID-19 risk and to key in to sites by scanning a location-specific barcode. Results: Between June 17, 2020, and July 29, 2020, 45 unique participants created MyCOVIDKey accounts. These users performed 227 self-assessments and 1410 key-ins. Self-assessments were performed by 89% (n=40) of users, 71% (n=32) of users keyed in, and 48 unique locations (of 71 possible locations) were visited. Overall, 89% (202/227) of assessments were determined to be low risk (ie, asymptomatic with no known exposures), and these assessments yielded a CLEAR status. The remaining self-assessments received a status of NOT CLEAR, indicating either risk of exposure or symptoms suggestive of COVID-19 (7.5% [n=17] and 3.5% [n=8] of self-assessments indicated moderate and high risk, respectively). These 25 instances came from 8 unique users, and in 19 of these instances, the at-risk user keyed in to a location on campus. Conclusions: Digital contact tracing tools may be useful in assisting organizations to identify persons at risk of COVID-19 through contact tracing, or in locating places that may need to be cleaned or disinfected after being visited by an index case. Incentives to continue the use of such tools can improve uptake, and their continued usage increases utility to both organizational and public health efforts. Parameters of digital tools, including MyCOVIDKey, should ideally be optimized to supplement existing contact tracing efforts. These tools represent a critical addition to manual contact tracing efforts during reopening and sustained regular activity. %M 33690142 %R 10.2196/24275 %U https://mhealth.jmir.org/2021/3/e24275 %U https://doi.org/10.2196/24275 %U http://www.ncbi.nlm.nih.gov/pubmed/33690142 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 3 %P e25859 %T App Use and Usability of a Barcode-Based Digital Platform to Augment COVID-19 Contact Tracing: Postpilot Survey and Paradata Analysis %A Scherr,Thomas Foster %A DeSousa,Jenna Maria %A Moore,Carson Paige %A Hardcastle,Austin %A Wright,David Wilson %+ Department of Chemistry, Vanderbilt University, 1234 Stevenson Center Lane, Nashville, TN, 37212, United States, 1 615 322 5516, thomas.f.scherr@vanderbilt.edu %K contact tracing %K COVID-19 %K mobile health %K usability %K app %K usage %K tracking %K monitoring %K survey %K pilot %D 2021 %7 26.3.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The COVID-19 pandemic has drastically changed life in the United States, as the country has recorded over 23 million cases and 383,000 deaths to date. In the leadup to widespread vaccine deployment, testing and surveillance are critical for detecting and stopping possible routes of transmission. Contact tracing has become an important surveillance measure to control COVID-19 in the United States, and mobile health interventions have found increased prominence in this space. Objective: The aim of this study was to investigate the use and usability of MyCOVIDKey, a mobile-based web app to assist COVID-19 contact tracing efforts, during the 6-week pilot period. Methods: A 6-week study was conducted on the Vanderbilt University campus in Nashville, Tennessee. The study participants, consisting primarily of graduate students, postdoctoral researchers, and faculty in the Chemistry Department at Vanderbilt University, were asked to use the MyCOVIDKey web app during the course of the study period. Paradata were collected as users engaged with the MyCOVIDKey web app. At the end of the study, all participants were asked to report on their user experience in a survey, and the results were analyzed in the context of the user paradata. Results: During the pilot period, 45 users enrolled in MyCOVIDKey. An analysis of their enrollment suggests that initial recruiting efforts were effective; however, participant recruitment and engagement efforts at the midpoint of the study were less effective. App use paralleled the number of users, indicating that incentives were useful for recruiting new users to sign up but did not result in users attempting to artificially inflate their use as a result of prize offers. Times to completion of key tasks were low, indicating that the main features of the app could be used quickly. Of the 45 users, 30 provided feedback through a postpilot survey, with 26 (58%) completing it in its entirety. The MyCOVIDKey app as a whole was rated 70.0 on the System Usability Scale, indicating that it performed above the accepted threshold for usability. When the key-in and self-assessment features were examined on their own, it was found that they individually crossed the same thresholds for acceptable usability but that the key-in feature had a higher margin for improvement. Conclusions: The MyCOVIDKey app was found overall to be a useful tool for COVID-19 contact tracing in a university setting. Most users suggested simple-to-implement improvements, such as replacing the web app framework with a native app format or changing the placement of the scanner within the app workflow. After these updates, this tool could be readily deployed and easily adapted to other settings across the country. The need for digital contact tracing tools is becoming increasingly apparent, particularly as COVID-19 case numbers continue to increase while more businesses begin to reopen. %M 33630745 %R 10.2196/25859 %U https://publichealth.jmir.org/2021/3/e25859 %U https://doi.org/10.2196/25859 %U http://www.ncbi.nlm.nih.gov/pubmed/33630745 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 3 %P e27882 %T The Dutch COVID-19 Contact Tracing App (the CoronaMelder): Usability Study %A Bente,Britt Elise %A van 't Klooster,Jan Willem Jaap Roderick %A Schreijer,Maud Annemarie %A Berkemeier,Lea %A van Gend,Joris Elmar %A Slijkhuis,Peter Jan Hendrik %A Kelders,Saskia Marion %A van Gemert-Pijnen,Julia Elisabeth Wilhelmina Cornelia %+ Centre for eHealth and Wellbeing Research, Department of Psychology, Health and Technology, University of Twente, Drienerlolaan 5, Enschede, 7522 NB, Netherlands, 31 53 489 9660, b.e.bente@utwente.nl %K usability testing %K user evaluation %K user experience %K contact tracing apps %K CoronaMelder %K COVID-19 %K pandemic %K mobile apps %K mHealth %K public health %D 2021 %7 26.3.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Adoption and evaluation of contact tracing tools based on information and communications technology may expand the reach and efficacy of traditional contact tracing methods in fighting COVID-19. The Dutch Ministry of Health, Welfare and Sports initiated and developed CoronaMelder, a COVID-19 contact tracing app. This app is based on a Google/Apple Exposure Notification approach and aims to combat the spread of the coronavirus among individuals by notifying those who are at increased risk of infection due to proximity to someone who later tests positive for COVID-19. The app should support traditional contact tracing by faster tracing and greater reach compared to regular contact tracing procedures. Objective: The main goal of this study is to investigate whether the CoronaMelder is able to support traditional contact tracing employed by public health authorities. To achieve this, usability tests were conducted to answer the following question: is the CoronaMelder user-friendly, understandable, reliable and credible, and inclusive? Methods: Participants (N=44) of different backgrounds were recruited: youth with varying educational levels, youth with an intellectual disability, migrants, adults (aged 40-64 years), and older adults (aged >65 years) via convenience sampling in the region of Twente in the Netherlands. The app was evaluated with scenario-based, think-aloud usability tests and additional interviews. Findings were recorded via voice recordings, observation notes, and the Dutch User Experience Questionnaire, and some participants wore eye trackers to measure gaze behavior. Results: Our results showed that the app is easy to use, although problems occurred with understandability and accessibility. Older adults and youth with a lower education level did not understand why or under what circumstances they would receive notifications, why they must share their key (ie, their assigned identifier), and what happens after sharing. In particular, youth in the lower-education category did not trust or understand Bluetooth signals, or comprehend timing and follow-up activities after a risk exposure notification. Older adults had difficulties multitasking (speaking with a public health worker and simultaneously sharing the key in the app). Public health authorities appeared to be unprepared to receive support from the app during traditional contact tracing because their telephone conversation protocol lacks guidance, explanation, and empathy. Conclusions: The study indicated that the CoronaMelder app is easy to use, but participants experienced misunderstandings about its functioning. The perceived lack of clarity led to misconceptions about the app, mostly regarding its usefulness and privacy-preserving mechanisms. Tailored and targeted communication through, for example, public campaigns or social media, is necessary to provide correct information about the app to residents in the Netherlands. Additionally, the app should be presented as part of the national coronavirus measures instead of as a stand-alone app offered to the public. Public health workers should be trained to effectively and empathetically instruct users on how to use the CoronaMelder app. %M 33724198 %R 10.2196/27882 %U https://formative.jmir.org/2021/3/e27882 %U https://doi.org/10.2196/27882 %U http://www.ncbi.nlm.nih.gov/pubmed/33724198 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e27443 %T Impact of a Serious Game (Escape COVID-19) on the Intention to Change COVID-19 Control Practices Among Employees of Long-term Care Facilities: Web-Based Randomized Controlled Trial %A Suppan,Mélanie %A Abbas,Mohamed %A Catho,Gaud %A Stuby,Loric %A Regard,Simon %A Achab,Sophia %A Harbarth,Stephan %A Suppan,Laurent %+ Division of Anesthesiology, Department of Anesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, University of Geneva Hospitals and Faculty of Medicine, Rue Gabrielle-Perret-Gentil 4, Geneva, 1211, Switzerland, 41 223723311, melanie.suppan@hcuge.ch %K COVID-19 %K transmission %K serious game %K infection prevention %K health care worker %K SARS-CoV-2 %K nursing homes %K randomized controlled trial %K long-term care facilities %K impact %K game %K intention %K control %K elderly %D 2021 %7 25.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Most residents of long-term care facilities (LTCFs) are at high risk of complications and death following SARS-CoV-2 infection. In these facilities, viral transmission can be facilitated by shortages of human and material resources, which can lead to suboptimal application of infection prevention and control (IPC) procedures. To improve the dissemination of COVID-19 IPC guidelines, we developed a serious game called “Escape COVID-19” using Nicholson’s RECIPE for meaningful gamification, as engaging serious games have the potential to induce behavioral change. Objective: As the probability of executing an action is strongly linked to the intention of performing it, the objective of this study was to determine whether LTCF employees were willing to change their IPC practices after playing “Escape COVID-19.” Methods: This was a web-based, triple-blind, randomized controlled trial, which took place between November 5 and December 4, 2020. The health authorities of Geneva, Switzerland, asked the managers of all LTCFs under their jurisdiction to forward information regarding the study to all their employees, regardless of professional status. Participants were unaware that they would be randomly allocated to one of two different study paths upon registration. In the control group, participants filled in a first questionnaire designed to gather demographic data and assess baseline knowledge before accessing regular online IPC guidelines. They then answered a second questionnaire, which assessed their willingness to change their IPC practices and identified the reasons underlying their decision. They were then granted access to the serious game. Conversely, the serious game group played “Escape COVID-19” after answering the first questionnaire but before answering the second one. This group accessed the control material after answering the second set of questions. There was no time limit. The primary outcome was the proportion of LTCF employees willing to change their IPC practices. Secondary outcomes included the factors underlying participants’ decisions, the domains these changes would affect, changes in the use of protective equipment items, and attrition at each stage of the study. Results: A total of 295 answer sets were analyzed. Willingness to change behavior was higher in the serious game group (82% [119/145] versus 56% [84/150]; P<.001), with an odds ratio of 3.86 (95% CI 2.18-6.81; P<.001) after adjusting for professional category and baseline knowledge, using a mixed effects logistic regression model with LTCF as a random effect. For more than two-thirds (142/203) of the participants, the feeling of playing an important role against the epidemic was the most important factor explaining their willingness to change behavior. Most of the participants unwilling to change their behavior answered that they were already applying all the guidelines. Conclusions: The serious game “Escape COVID-19” was more successful than standard IPC material in convincing LTCF employees to adopt COVID-19–safe IPC behavior. International Registered Report Identifier (IRRID): RR2-10.2196/25595 %M 33685854 %R 10.2196/27443 %U https://www.jmir.org/2021/3/e27443 %U https://doi.org/10.2196/27443 %U http://www.ncbi.nlm.nih.gov/pubmed/33685854 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e27009 %T Echo Chamber Effect in Rumor Rebuttal Discussions About COVID-19 in China: Social Media Content and Network Analysis Study %A Wang,Dandan %A Qian,Yuxing %+ School of Information Management, Wuhan University, No.483, Bayi Road, Hongshan District, Wuhan, 430072, China, 86 13871241431, dandanw@whu.edu.cn %K rumor rebuttal %K infodemiology %K infodemic %K infoveillance %K echo chamber effect %K attitude %K COVID-19 %K Weibo %D 2021 %7 25.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The dissemination of rumor rebuttal content on social media is vital for rumor control and disease containment during public health crises. Previous research on the effectiveness of rumor rebuttal, to a certain extent, ignored or simplified the structure of dissemination networks and users’ cognition as well as decision-making and interaction behaviors. Objective: This study aimed to roughly evaluate the effectiveness of rumor rebuttal; dig deeply into the attitude-based echo chamber effect on users’ responses to rumor rebuttal under multiple topics on Weibo, a Chinese social media platform, in the early stage of the COVID-19 epidemic; and evaluate the echo chamber’s impact on the information characteristics of user interaction content. Methods: We used Sina Weibo’s application programming interface to crawl rumor rebuttal content related to COVID-19 from 10 AM on January 23, 2020, to midnight on April 8, 2020. Using content analysis, sentiment analysis, social network analysis, and statistical analysis, we first analyzed whether and to what extent there was an echo chamber effect on the shaping of individuals’ attitudes when retweeting or commenting on others’ tweets. Then, we tested the heterogeneity of attitude distribution within communities and the homophily of interactions between communities. Based on the results at user and community levels, we made comprehensive judgments. Finally, we examined users’ interaction content from three dimensions—sentiment expression, information seeking and sharing, and civility—to test the impact of the echo chamber effect. Results: Our results indicated that the retweeting mechanism played an essential role in promoting polarization, and the commenting mechanism played a role in consensus building. Our results showed that there might not be a significant echo chamber effect on community interactions and verified that, compared to like-minded interactions, cross-cutting interactions contained significantly more negative sentiment, information seeking and sharing, and incivility. We found that online users’ information-seeking behavior was accompanied by incivility, and information-sharing behavior was accompanied by more negative sentiment, which was often accompanied by incivility. Conclusions: Our findings revealed the existence and degree of an echo chamber effect from multiple dimensions, such as topic, interaction mechanism, and interaction level, and its impact on interaction content. Based on these findings, we provide several suggestions for preventing or alleviating group polarization to achieve better rumor rebuttal. %M 33690145 %R 10.2196/27009 %U https://www.jmir.org/2021/3/e27009 %U https://doi.org/10.2196/27009 %U http://www.ncbi.nlm.nih.gov/pubmed/33690145 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e25696 %T Modeling Predictive Age-Dependent and Age-Independent Symptoms and Comorbidities of Patients Seeking Treatment for COVID-19: Model Development and Validation Study %A Huang,Yingxiang %A Radenkovic,Dina %A Perez,Kevin %A Nadeau,Kari %A Verdin,Eric %A Furman,David %+ Buck Institute for Research on Aging, 8001 Redwood Blvd, Novato, CA, 94945, United States, 1 (415) 209 2000, DFurman@buckinstitute.org %K clinical informatics %K predictive modeling %K COVID-19 %K app %K model %K prediction %K symptom %K informatics %K age %K morbidity %K hospital %D 2021 %7 25.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic continues to ravage and burden hospitals around the world. The epidemic started in Wuhan, China, and was subsequently recognized by the World Health Organization as an international public health emergency and declared a pandemic in March 2020. Since then, the disruptions caused by the COVID-19 pandemic have had an unparalleled effect on all aspects of life. Objective: With increasing total hospitalization and intensive care unit admissions, a better understanding of features related to patients with COVID-19 could help health care workers stratify patients based on the risk of developing a more severe case of COVID-19. Using predictive models, we strive to select the features that are most associated with more severe cases of COVID-19. Methods: Over 3 million participants reported their potential symptoms of COVID-19, along with their comorbidities and demographic information, on a smartphone-based app. Using data from the >10,000 individuals who indicated that they had tested positive for COVID-19 in the United Kingdom, we leveraged the Elastic Net regularized binary classifier to derive the predictors that are most correlated with users having a severe enough case of COVID-19 to seek treatment in a hospital setting. We then analyzed such features in relation to age and other demographics and their longitudinal trend. Results: The most predictive features found include fever, use of immunosuppressant medication, use of a mobility aid, shortness of breath, and severe fatigue. Such features are age-related, and some are disproportionally high in minority populations. Conclusions: Predictors selected from the predictive models can be used to stratify patients into groups based on how much medical attention they are expected to require. This could help health care workers devote valuable resources to prevent the escalation of the disease in vulnerable populations. %M 33621185 %R 10.2196/25696 %U https://www.jmir.org/2021/3/e25696 %U https://doi.org/10.2196/25696 %U http://www.ncbi.nlm.nih.gov/pubmed/33621185 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 3 %P e26719 %T Automated Travel History Extraction From Clinical Notes for Informing the Detection of Emergent Infectious Disease Events: Algorithm Development and Validation %A Peterson,Kelly S %A Lewis,Julia %A Patterson,Olga V %A Chapman,Alec B %A Denhalter,Daniel W %A Lye,Patricia A %A Stevens,Vanessa W %A Gamage,Shantini D %A Roselle,Gary A %A Wallace,Katherine S %A Jones,Makoto %+ VA Salt Lake City Health Care System, US Department of Veterans Affairs, 500 Foothill Dr, Salt Lake City, UT, 84148, United States, 1 801 582 1565, kelly.peterson2@va.gov %K natural language processing %K machine learning %K travel history %K COVID-19 %K Zika %K infectious disease surveillance %K surveillance applications %K biosurveillance %K electronic health record %D 2021 %7 24.3.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Patient travel history can be crucial in evaluating evolving infectious disease events. Such information can be challenging to acquire in electronic health records, as it is often available only in unstructured text. Objective: This study aims to assess the feasibility of annotating and automatically extracting travel history mentions from unstructured clinical documents in the Department of Veterans Affairs across disparate health care facilities and among millions of patients. Information about travel exposure augments existing surveillance applications for increased preparedness in responding quickly to public health threats. Methods: Clinical documents related to arboviral disease were annotated following selection using a semiautomated bootstrapping process. Using annotated instances as training data, models were developed to extract from unstructured clinical text any mention of affirmed travel locations outside of the continental United States. Automated text processing models were evaluated, involving machine learning and neural language models for extraction accuracy. Results: Among 4584 annotated instances, 2659 (58%) contained an affirmed mention of travel history, while 347 (7.6%) were negated. Interannotator agreement resulted in a document-level Cohen kappa of 0.776. Automated text processing accuracy (F1 85.6, 95% CI 82.5-87.9) and computational burden were acceptable such that the system can provide a rapid screen for public health events. Conclusions: Automated extraction of patient travel history from clinical documents is feasible for enhanced passive surveillance public health systems. Without such a system, it would usually be necessary to manually review charts to identify recent travel or lack of travel, use an electronic health record that enforces travel history documentation, or ignore this potential source of information altogether. The development of this tool was initially motivated by emergent arboviral diseases. More recently, this system was used in the early phases of response to COVID-19 in the United States, although its utility was limited to a relatively brief window due to the rapid domestic spread of the virus. Such systems may aid future efforts to prevent and contain the spread of infectious diseases. %M 33759790 %R 10.2196/26719 %U https://publichealth.jmir.org/2021/3/e26719 %U https://doi.org/10.2196/26719 %U http://www.ncbi.nlm.nih.gov/pubmed/33759790 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e24925 %T Short-Range Forecasting of COVID-19 During Early Onset at County, Health District, and State Geographic Levels Using Seven Methods: Comparative Forecasting Study %A Lynch,Christopher J %A Gore,Ross %+ Virginia Modeling, Analysis, and Simulation Center, Old Dominion University, 1030 University Blvd, Suffolk, VA, 23435, United States, 1 7576866248, cjlynch@odu.edu %K coronavirus disease 2019 %K COVID-19 %K infectious disease %K emerging outbreak %K forecasting %K modeling and simulation %K public health %K modeling disease outbreaks %D 2021 %7 23.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Forecasting methods rely on trends and averages of prior observations to forecast COVID-19 case counts. COVID-19 forecasts have received much media attention, and numerous platforms have been created to inform the public. However, forecasting effectiveness varies by geographic scope and is affected by changing assumptions in behaviors and preventative measures in response to the pandemic. Due to time requirements for developing a COVID-19 vaccine, evidence is needed to inform short-term forecasting method selection at county, health district, and state levels. Objective: COVID-19 forecasts keep the public informed and contribute to public policy. As such, proper understanding of forecasting purposes and outcomes is needed to advance knowledge of health statistics for policy makers and the public. Using publicly available real-time data provided online, we aimed to evaluate the performance of seven forecasting methods utilized to forecast cumulative COVID-19 case counts. Forecasts were evaluated based on how well they forecast 1, 3, and 7 days forward when utilizing 1-, 3-, 7-, or all prior–day cumulative case counts during early virus onset. This study provides an objective evaluation of the forecasting methods to identify forecasting model assumptions that contribute to lower error in forecasting COVID-19 cumulative case growth. This information benefits professionals, decision makers, and the public relying on the data provided by short-term case count estimates at varied geographic levels. Methods: We created 1-, 3-, and 7-day forecasts at the county, health district, and state levels using (1) a naïve approach, (2) Holt-Winters (HW) exponential smoothing, (3) a growth rate approach, (4) a moving average (MA) approach, (5) an autoregressive (AR) approach, (6) an autoregressive moving average (ARMA) approach, and (7) an autoregressive integrated moving average (ARIMA) approach. Forecasts relied on Virginia’s 3464 historical county-level cumulative case counts from March 7 to April 22, 2020, as reported by The New York Times. Statistically significant results were identified using 95% CIs of median absolute error (MdAE) and median absolute percentage error (MdAPE) metrics of the resulting 216,698 forecasts. Results: The next-day MA forecast with 3-day look-back length obtained the lowest MdAE (median 0.67, 95% CI 0.49-0.84, P<.001) and statistically significantly differed from 39 out of 59 alternatives (66%) to 53 out of 59 alternatives (90%) at each geographic level at a significance level of .01. For short-range forecasting, methods assuming stationary means of prior days’ counts outperformed methods with assumptions of weak stationarity or nonstationarity means. MdAPE results revealed statistically significant differences across geographic levels. Conclusions: For short-range COVID-19 cumulative case count forecasting at the county, health district, and state levels during early onset, the following were found: (1) the MA method was effective for forecasting 1-, 3-, and 7-day cumulative case counts; (2) exponential growth was not the best representation of case growth during early virus onset when the public was aware of the virus; and (3) geographic resolution was a factor in the selection of forecasting methods. %M 33621186 %R 10.2196/24925 %U https://www.jmir.org/2021/3/e24925 %U https://doi.org/10.2196/24925 %U http://www.ncbi.nlm.nih.gov/pubmed/33621186 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e24593 %T Insights From the SmokeFree.gov Initiative Regarding the Use of Smoking Cessation Digital Platforms During the COVID-19 Pandemic: Cross-sectional Trends Analysis Study %A El-Toukhy,Sherine %+ Division of Intramural Research, National Institute on Minority Health & Health Disparities, National Institutes of Health, 7201 Wisconsin Ave, Bethesda, MD, 20814, United States, 1 3015944743, sherine.el-toukhy@nih.gov %K COVID-19 %K smoking %K cessation %K mHealth %K risk %K digital platform %K social distancing %K lockdown %K trend %D 2021 %7 22.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Smoking is a plausible risk factor for COVID-19 progression and complications. Smoking cessation digital platforms transcend pandemic-driven social distancing and lockdown measures in terms of assisting smokers in their quit attempts. Objective: This study aims to examine trends in the number of visitors, followers, and subscribers on smoking cessation digital platforms from January to April 2020 and to compare these traffic data to those observed during the same 4-month period in 2019. The examination of prepandemic and postpandemic trends in smoking cessation digital platform traffic can reveal whether interest in smoking cessation among smokers is attributable to the COVID-19 pandemic. Methods: We obtained cross-sectional data from daily visitors on the SmokeFree website; the followers of six SmokeFree social media accounts; and subscribers to the SmokeFree SMS text messaging and mobile app interventions of the National Cancer Institute’s SmokeFree.gov initiative platforms, which are publicly available to US smokers. Average daily percentage changes (ADPCs) were used to measure trends for the entire 2020 and 2019 study periods, whereas daily percentage changes (DPCs) were used to measure trends for each time segment of change within each 4-month period. Data analysis was conducted in May and June 2020. Results: The number of new daily visitors on the SmokeFree website (between days 39 and 44: DPC=18.79%; 95% CI 5.16% to 34.19%) and subscribers to the adult-focused interventions QuitGuide (between days 11 and 62: DPC=1.11%; 95% CI 0.80% to 1.43%) and SmokeFreeTXT (between days 11 and 89: DPC=0.23%; 95% CI 0.004% to 0.47%) increased, but this was followed by declines in traffic. No comparable peaks were observed in 2019. The number of new daily subscribers to quitSTART (ie, the teen-focused intervention) trended downward in 2020 (ADPC=−1.02%; 95% CI −1.88% to −0.15%), whereas the overall trend in the number of subscribers in 2019 was insignificant (P=.07). The number of SmokeFree social media account followers steadily increased by <0.1% over the 4-month study periods in 2019 and 2020. Conclusions: Peaks in traffic on the SmokeFree website and adult-focused intervention platforms in 2020 could be attributed to an increased interest in smoking cessation among smokers during the COVID-19 pandemic. Coordinated campaigns, especially those for adolescents, should emphasize the importance of smoking cessation as a preventive measure against SARS-CoV-2 infection and raise awareness of digital smoking cessation platforms to capitalize on smokers’ heightened interest during the pandemic. %M 33646963 %R 10.2196/24593 %U https://www.jmir.org/2021/3/e24593 %U https://doi.org/10.2196/24593 %U http://www.ncbi.nlm.nih.gov/pubmed/33646963 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 4 %N 1 %P e25779 %T Health Impacts of the Stay-at-Home Order on Community-Dwelling Older Adults and How Technologies May Help: Focus Group Study %A Daly,Jessica R %A Depp,Colin %A Graham,Sarah A %A Jeste,Dilip V %A Kim,Ho-Cheol %A Lee,Ellen E %A Nebeker,Camille %+ Research Center for Optimal Digital Ethics in Health, Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, 92093-0811, United States, 1 8585347786, nebeker@eng.ucsd.edu %K aging %K quarantine %K mental health %K physical health %K social isolation %K COVID-19 pandemic %K continued care senior housing community %K CCSHC %K qualitative research %K videoconferencing %K older adults %K gerontechnology %K loneliness %K housing for the elderly %K independent living %D 2021 %7 22.3.2021 %9 Original Paper %J JMIR Aging %G English %X Background: As of March 2021, in the USA, the COVID-19 pandemic has resulted in over 500,000 deaths, with a majority being people over 65 years of age. Since the start of the pandemic in March 2020, preventive measures, including lockdowns, social isolation, quarantine, and social distancing, have been implemented to reduce viral spread. These measures, while effective for risk prevention, may contribute to increased social isolation and loneliness among older adults and negatively impact their mental and physical health. Objective: This study aimed to assess the impact of the COVID-19 pandemic and the resulting “Stay-at-Home” order on the mental and physical health of older adults and to explore ways to safely increase social connectedness among them. Methods: This qualitative study involved older adults living in a Continued Care Senior Housing Community (CCSHC) in southern California, USA. Four 90-minute focus groups were convened using the Zoom Video Communications platform during May 2020, involving 21 CCSHC residents. Participants were asked to describe how they were managing during the “stay-at-home” mandate that was implemented in March 2020, including its impact on their physical and mental health. Transcripts of each focus group were analyzed using qualitative methods. Results: Four themes emerged from the qualitative data: (1) impact of the quarantine on health and well-being, (2) communication innovation and technology use, (3) effective ways of coping with the quarantine, and (4) improving access to technology and training. Participants reported a threat to their mental and physical health directly tied to the quarantine and exacerbated by social isolation and decreased physical activity. Technology was identified as a lifeline for many who are socially isolated from their friends and family. Conclusions: Our study findings suggest that technology access, connectivity, and literacy are potential game-changers to supporting the mental and physical health of older adults and must be prioritized for future research. %M 33690146 %R 10.2196/25779 %U https://aging.jmir.org/2021/1/e25779 %U https://doi.org/10.2196/25779 %U http://www.ncbi.nlm.nih.gov/pubmed/33690146 %0 Journal Article %@ 1947-2579 %I JMIR Publications %V 13 %N 1 %P e11072 %T Roles of Health Literacy in Relation to Social Determinants of Health and Recommendations for Informatics-Based Interventions: Systematic Review %D 2021 %7 ..2021 %9 %J Online J Public Health Inform %G English %X Objective: To develop a conceptual model and novel, comprehensive framework that encompass the myriad ways informatics and technology can support public health response to a pandemic.Method: The conceptual model and framework categorize informatics solutions that could be used by stakeholders (e.g., government, academic institutions, healthcare providers and payers, life science companies, employers, citizens) to address public health challenges across the prepare, respond, and recover phases of a pandemic, building on existing models for public health operations and response.Results: Mapping existing solutions, technology assets, and ideas to the framework helped identify public health informatics solution requirements and gaps in responding to COVID-19 in areas such as applied science, epidemiology, communications, and business continuity. Two examples of technologies used in COVID-19 illustrate novel applications of informatics encompassed by the framework. First, we examine a hub from The Weather Channel, which provides COVID-19 data via interactive maps, trend graphs, and details on case data to individuals and businesses. Second, we examine IBM Watson Assistant for Citizens, an AI-powered virtual agent implemented by healthcare providers and payers, government agencies, and employers to provide information about COVID-19 via digital and telephone-based interaction.Discussion: Early results from these novel informatics solutions have been positive, showing high levels of engagement and added value across stakeholders.Conclusion: The framework supports development, application, and evaluation of informatics approaches and technologies in support of public health preparedness, response, and recovery during a pandemic. Effective solutions are critical to success in recovery from COVID-19 and future pandemics. %M 33936521 %R 10.5210/ojphi.v13i1.11072 %U %U https://doi.org/10.5210/ojphi.v13i1.11072 %U http://www.ncbi.nlm.nih.gov/pubmed/33936521 %0 Journal Article %@ 1947-2579 %I JMIR Publications %V 13 %N 1 %P e11456 %T Roles of Health Literacy in Relation to Social Determinants of Health and Recommendations for Informatics-Based Interventions: Systematic Review %D 2021 %7 ..2021 %9 %J Online J Public Health Inform %G English %X Objective- India has seen a rapid rise in COVID-19 cases. Examine spatiotemporal variation of COVID-19 burden Tracker across Indian states and union territories using SMAART RAPID Tracker.Method: We used SMAART RAPID Tracker to visually display COVID-19 spread in space and time across various states and UTs of India. Data is gathered from publicly available government information sources. Data analysis on COVID-19 has been conducted from March 1 2020 to October 1 2020. Variables recorded include COVID-19 cases and fatality, 7-day average change, recovery rate, labs and tests. Spatial and temporal trends of COVID-19 spread across Indian states and UTs is presented.Result: The total number of COVID-19 cases were 63, 12,584 and total fatality was 86,821 (October 1 2020). More than 85,000 new cases of COVID-19 were reported. There were 1,867 total COVID-19 labs throughout India. More than half of them were Government labs. The total number of COVID-19 tests was 76,717,728 and total recovered COVID-19 cases was 5,273,201. Results show an overall decline in the 7-day average change of new COVID-19 cases and new COVID-19 fatality. States such as Maharashtra, Chandigarh, Puducherry, Goa, Karnataka and Andhra Pradesh continue to have high COVID-19 infectivity rate.Discussion: Findings highlight need for both national guidelines combined with a state specific recommendations to help manage the spread of COVD-19.Conclusion: India’s great diversity along with its vast population would help decide further actions to contain the spread of the disease, and can be crucial for the specific states only. %M 33936524 %R 10.5210/ojphi.v13i1.11456 %U %U https://doi.org/10.5210/ojphi.v13i1.11456 %U http://www.ncbi.nlm.nih.gov/pubmed/33936524 %0 Journal Article %@ 1947-2579 %I JMIR Publications %V 13 %N 1 %P e11462 %T Roles of Health Literacy in Relation to Social Determinants of Health and Recommendations for Informatics-Based Interventions: Systematic Review %D 2021 %7 ..2021 %9 %J Online J Public Health Inform %G English %X As the COVID-19 pandemic continues to unfold and states experience the impacts of reopened economies, it is critical to efficiently manage new outbreaks through widespread testing and monitoring of both new and possible cases. Existing labor-intensive public health workflows may benefit from information collection directly from individuals through patient-reported outcomes (PROs) systems. Our objective was to develop a reusable, mobile-friendly application for collecting PROs and experiences to support COVID-19 symptom self-monitoring and data sharing with appropriate public health agencies, using Fast Healthcare Interoperability Resources (FHIR) for interoperability. We conducted a needs assessment and designed and developed StayHome, a mobile PRO administration tool. FHIR serves as the primary data model and driver of business logic. Keycloak, AWS, Docker, and other technologies were used for deployment. Several FHIR modules were used to create a novel “FHIR-native” application design. By leveraging FHIR to shape not only the interface strategy but also the information architecture of the application, StayHome enables the consistent standards-based representation of data and reduces the barrier to integration with public health information systems. FHIR supported rapid application development by providing a domain-appropriate data model and tooling. FHIR modules and implementation guides were referenced in design and implementation. However, there are gaps in the FHIR specification which must be recognized and addressed appropriately. StayHome is live and accessible to the public at https://stayhome.app. The code and resources required to build and deploy the application are available from https://github.com/uwcirg/stayhome-project. %M 33936522 %R 10.5210/ojphi.v13i1.11462 %U %U https://doi.org/10.5210/ojphi.v13i1.11462 %U http://www.ncbi.nlm.nih.gov/pubmed/33936522 %0 Journal Article %@ 1947-2579 %I JMIR Publications %V 13 %N 1 %P e11621 %T Roles of Health Literacy in Relation to Social Determinants of Health and Recommendations for Informatics-Based Interventions: Systematic Review %D 2021 %7 ..2021 %9 %J Online J Public Health Inform %G English %X Considering the potential for widespread adoption of social vulnerability indices (SVI) to prioritize COVID-19 vaccinations, there is a need to carefully assess them, particularly for correspondence with outcomes (such as loss of life) in the context of the COVID-19 pandemic. The University of Illinois at Chicago School of Public Health Public Health GIS team developed a methodology for assessing and deriving vulnerability indices based on the premise that these indices are, in the final analysis, classifiers. Application of this methodology to several Midwestern states with a commonly used SVI indicates that by using only the SVI rankings there is risk of assigning a high priority to locations with the lowest mortality rates and low priority to locations with the highest mortality rates. Based on the findings, we propose using a two-dimensional approach to rationalize the distribution of vaccinations. This approach has the potential to account for areas with high vulnerability characteristics as well as to incorporate the areas that were hard hit by the pandemic. %M 33936526 %R 10.5210/ojphi.v13i1.11621 %U %U https://doi.org/10.5210/ojphi.v13i1.11621 %U http://www.ncbi.nlm.nih.gov/pubmed/33936526 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e22860 %T Revealing Opinions for COVID-19 Questions Using a Context Retriever, Opinion Aggregator, and Question-Answering Model: Model Development Study %A Lu,Zhao-Hua %A Wang,Jade Xiaoqing %A Li,Xintong %+ Department of Biostatistics, St. Jude Children’s Research Hospital, MS 768, Room R6006, 262 Danny Thomas Place, Memphis, TN, 38105-3678, United States, 1 901 595 2714, zhaohua.lu@stjude.org %K natural language processing %K question-answering systems %K language summarization %K machine learning %K life and medical sciences %K COVID-19 %K public health %K coronavirus literature %D 2021 %7 19.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: COVID-19 has challenged global public health because it is highly contagious and can be lethal. Numerous ongoing and recently published studies about the disease have emerged. However, the research regarding COVID-19 is largely ongoing and inconclusive. Objective: A potential way to accelerate COVID-19 research is to use existing information gleaned from research into other viruses that belong to the coronavirus family. Our objective is to develop a natural language processing method for answering factoid questions related to COVID-19 using published articles as knowledge sources. Methods: Given a question, first, a BM25-based context retriever model is implemented to select the most relevant passages from previously published articles. Second, for each selected context passage, an answer is obtained using a pretrained bidirectional encoder representations from transformers (BERT) question-answering model. Third, an opinion aggregator, which is a combination of a biterm topic model and k-means clustering, is applied to the task of aggregating all answers into several opinions. Results: We applied the proposed pipeline to extract answers, opinions, and the most frequent words related to six questions from the COVID-19 Open Research Dataset Challenge. By showing the longitudinal distributions of the opinions, we uncovered the trends of opinions and popular words in the articles published in the five time periods assessed: before 1990, 1990-1999, 2000-2009, 2010-2018, and since 2019. The changes in opinions and popular words agree with several distinct characteristics and challenges of COVID-19, including a higher risk for senior people and people with pre-existing medical conditions; high contagion and rapid transmission; and a more urgent need for screening and testing. The opinions and popular words also provide additional insights for the COVID-19–related questions. Conclusions: Compared with other methods of literature retrieval and answer generation, opinion aggregation using our method leads to more interpretable, robust, and comprehensive question-specific literature reviews. The results demonstrate the usefulness of the proposed method in answering COVID-19–related questions with main opinions and capturing the trends of research about COVID-19 and other relevant strains of coronavirus in recent years. %M 33739287 %R 10.2196/22860 %U https://www.jmir.org/2021/3/e22860 %U https://doi.org/10.2196/22860 %U http://www.ncbi.nlm.nih.gov/pubmed/33739287 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e27078 %T Temporal Dynamics of Public Emotions During the COVID-19 Pandemic at the Epicenter of the Outbreak: Sentiment Analysis of Weibo Posts From Wuhan %A Yu,Shaobin %A Eisenman,David %A Han,Ziqiang %+ Department of Public Administration, School of Political Science and Public Administration, Shandong University, Binhai Road 72, Jimo, Qingdao, 266237, China, 86 13210178710, ziqiang.han@sdu.edu.cn %K public health emergencies %K emotion %K infodemiology %K temporal dynamics %K sentiment analysis %K COVID-19 %D 2021 %7 18.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The ongoing COVID-19 pandemic has led to an increase in anxiety, depression, posttraumatic stress disorder, and psychological stress experienced by the general public in various degrees worldwide. However, effective, tailored mental health services and interventions cannot be achieved until we understand the patterns of mental health issues emerging after a public health crisis, especially in the context of the rapid transmission of COVID-19. Understanding the public's emotions and needs and their distribution attributes are therefore critical for creating appropriate public policies and eventually responding to the health crisis effectively, efficiently, and equitably. Objective: This study aims to detect the temporal patterns in emotional fluctuation, significant events during the COVID-19 pandemic that affected emotional changes and variations, and hourly variations of emotions within a single day by analyzing data from the Chinese social media platform Weibo. Methods: Based on a longitudinal dataset of 816,556 posts published by 27,912 Weibo users in Wuhan, China, from December 31, 2019, to April 31, 2020, we processed general sentiment inclination rating and the type of sentiments of Weibo posts by using pandas and SnowNLP Python libraries. We also grouped the publication times into 5 time groups to measure changes in netizens’ sentiments during different periods in a single day. Results: Overall, negative emotions such as surprise, fear, and anger were the most salient emotions detected on Weibo. These emotions were triggered by certain milestone events such as the confirmation of human-to-human transmission of COVID-19. Emotions varied within a day. Although all emotions were more prevalent in the afternoon and night, fear and anger were more dominant in the morning and afternoon, whereas depression was more salient during the night. Conclusions: Various milestone events during the COVID-19 pandemic were the primary events that ignited netizens’ emotions. In addition, Weibo users’ emotions varied within a day. Our findings provide insights into providing better-tailored mental health services and interventions. %M 33661755 %R 10.2196/27078 %U https://www.jmir.org/2021/3/e27078 %U https://doi.org/10.2196/27078 %U http://www.ncbi.nlm.nih.gov/pubmed/33661755 %0 Journal Article %@ 2563-6316 %I JMIR Publications %V 2 %N 1 %P e22617 %T A Framework for a Statistical Characterization of Epidemic Cycles: COVID-19 Case Study %A De Carvalho,Eduardo Atem %A De Carvalho,Rogerio Atem %+ Innovation Hub, Instituto Federal Fluminense, R Cel Walter Kramer, 357, Campos, 28080-565, Brazil, 55 22 27375692, ratem@iff.edu.br %K COVID-19 %K SARS-CoV-2 %K pandemics %K infection control %K models %K experimental %K longitudinal studies %K statistical modeling %K epidemic cycles %D 2021 %7 18.3.2021 %9 Original Paper %J JMIRx Med %G English %X Background: Since the beginning of the COVID-19 pandemic, researchers and health authorities have sought to identify the different parameters that drive its local transmission cycles to make better decisions regarding prevention and control measures. Different modeling approaches have been proposed in an attempt to predict the behavior of these local cycles. Objective: This paper presents a framework to characterize the different variables that drive the local, or epidemic, cycles of the COVID-19 pandemic, in order to provide a set of relatively simple, yet efficient, statistical tools to be used by local health authorities to support decision making. Methods: Virtually closed cycles were compared to cycles in progress from different locations that present similar patterns in the figures that describe them. With the aim to compare populations of different sizes at different periods of time and locations, the cycles were normalized, allowing an analysis based on the core behavior of the numerical series. A model for the reproduction number was derived from the experimental data, and its performance was presented, including the effect of subnotification (ie, underreporting). A variation of the logistic model was used together with an innovative inventory model to calculate the actual number of infected persons, analyze the incubation period, and determine the actual onset of local epidemic cycles. Results: The similarities among cycles were demonstrated. A pattern between the cycles studied, which took on a triangular shape, was identified and used to make predictions about the duration of future cycles. Analyses on effective reproduction number (Rt) and subnotification effects for Germany, Italy, and Sweden were presented to show the performance of the framework introduced here. After comparing data from the three countries, it was possible to determine the probable dates of the actual onset of the epidemic cycles for each country, the typical duration of the incubation period for the disease, and the total number of infected persons during each cycle. In general terms, a probable average incubation time of 5 days was found, and the method used here was able to estimate the end of the cycles up to 34 days in advance, while demonstrating that the impact of the subnotification level (ie, error) on the effective reproduction number was <5%. Conclusions: It was demonstrated that, with relatively simple mathematical tools, it is possible to obtain a reliable understanding of the behavior of COVID-19 local epidemic cycles, by introducing an integrated framework for identifying cycle patterns and calculating the variables that drive it, namely: the Rt, the subnotification effects on estimations, the most probable actual cycles start dates, the total number of infected, and the most likely incubation period for SARS-CoV-2. %M 34077489 %R 10.2196/22617 %U https://xmed.jmir.org/2021/1/e22617 %U https://doi.org/10.2196/22617 %U http://www.ncbi.nlm.nih.gov/pubmed/34077489 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 3 %P e21606 %T The Influence of Social Distancing on COVID-19 Mortality in US Counties: Cross-sectional Study %A Tran,Phoebe %A Tran,Lam %A Tran,Liem %+ Department of Geography, University of Tennessee, 1000 Phillip Fulmer Way, BGB 306, Knoxville, TN, United States, 1 865 974 6034, ltran1@utk.edu %K COVID-19 %K marginal effects %K mortality %K negative binomial model %K social distancing %D 2021 %7 18.3.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Previous studies on the impact of social distancing on COVID-19 mortality in the United States have predominantly examined this relationship at the national level and have not separated COVID-19 deaths in nursing homes from total COVID-19 deaths. This approach may obscure differences in social distancing behaviors by county in addition to the actual effectiveness of social distancing in preventing COVID-19 deaths. Objective: This study aimed to determine the influence of county-level social distancing behavior on COVID-19 mortality (deaths per 100,000 people) across US counties over the period of the implementation of stay-at-home orders in most US states (March-May 2020). Methods: Using social distancing data from tracked mobile phones in all US counties, we estimated the relationship between social distancing (average proportion of mobile phone usage outside of home between March and May 2020) and COVID-19 mortality (when the state in which the county is located reported its first confirmed case of COVID-19 and up to May 31, 2020) with a mixed-effects negative binomial model while distinguishing COVID-19 deaths in nursing homes from total COVID-19 deaths and accounting for social distancing– and COVID-19–related factors (including the period between the report of the first confirmed case of COVID-19 and May 31, 2020; population density; social vulnerability; and hospital resource availability). Results from the mixed-effects negative binomial model were then used to generate marginal effects at the mean, which helped separate the influence of social distancing on COVID-19 deaths from other covariates while calculating COVID-19 deaths per 100,000 people. Results: We observed that a 1% increase in average mobile phone usage outside of home between March and May 2020 led to a significant increase in COVID-19 mortality by a factor of 1.18 (P<.001), while every 1% increase in the average proportion of mobile phone usage outside of home in February 2020 was found to significantly decrease COVID-19 mortality by a factor of 0.90 (P<.001). Conclusions: As stay-at-home orders have been lifted in many US states, continued adherence to other social distancing measures, such as avoiding large gatherings and maintaining physical distance in public, are key to preventing additional COVID-19 deaths in counties across the country. %M 33497348 %R 10.2196/21606 %U https://publichealth.jmir.org/2021/3/e21606 %U https://doi.org/10.2196/21606 %U http://www.ncbi.nlm.nih.gov/pubmed/33497348 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e23218 %T Improving Predictions of COVID-19 Preventive Behavior: Development of a Sequential Mediation Model %A Roberts,James A %A David,Meredith E %+ Marketing Department, Hankamer School of Business, Baylor University, 1 Bear Pl Unit 98007, Waco, TX, 76798-8007, United States, 1 2547104952, jim_roberts@baylor.edu %K pandemic %K COVID-19 %K preventive behavior %K self-efficacy %K prevention %K behavior %K modeling %K student %K communication %D 2021 %7 17.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Since the beginning of the COVID-19 pandemic, social distancing, self-quarantining, wearing masks, and washing hands have become part of the new norm for many, but not all. It appears that such preventive measures are critical to “flattening the curve” of the spread of COVID-19. The public’s adoption of such behaviors is an essential component in the battle against what has been referred to as the “invisible enemy.” Objective: The primary objective of this study was to develop a model for predicting COVID-19 preventive behaviors among US college students. The Health Belief Model has a long history of use and empirical support in predicting preventive health behaviors, but it is not without its purported shortcomings. This study identifies a more optimal and defensible combination of variables to explain preventive behaviors among college students. This segment of the US population is critical in helping slow the spread of COVID-19 because of the relative reluctance of college students to perform the needed behaviors given they do not feel susceptible to or fearful of COVID-19. Methods: For this study, 415 US college students were surveyed via Qualtrics and asked to answer questions regarding their fear of COVID-19, information receptivity (seeking relevant information), perceived knowledge of the disease, self-efficacy, and performance of preventive behaviors. The PROCESS macro (Model 6) was used to test our conceptual model, including predictions involving sequential mediation. Results: Sequential mediation results show that fear of COVID-19 leads individuals to seek out information regarding the disease, which increases their perceived knowledge and fosters self-efficacy; this is key to driving preventive behaviors. Conclusions: Self-imposed preventive measures can drastically impact the rate of infection among populations. Based on this study’s newly created sequential mediation model, communication strategies for encouraging COVID-19 preventive behaviors are offered. It is clear that college students, and very possibly adults of all ages, must have a healthy fear of COVID-19 to set in motion a process where concerned individuals seek out COVID-19–related information, increasing their store of knowledge concerning the disease, their self-efficacy, and ultimately their likelihood of performing the needed preventive behaviors. %M 33651707 %R 10.2196/23218 %U https://www.jmir.org/2021/3/e23218 %U https://doi.org/10.2196/23218 %U http://www.ncbi.nlm.nih.gov/pubmed/33651707 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e27015 %T Social Media and Emotional Burnout Regulation During the COVID-19 Pandemic: Multilevel Approach %A Shao,Ruosi %A Shi,Zhen %A Zhang,Di %+ The Research Center for Journalism and Social Development, Renmin University of China, RM713 Mingde Journalism Building, 59 Zhongguancun Rd, Haidian Dist, Beijing, 100872, China, 86 13801247280, zhangdi204@gmail.com %K COVID-19 %K pandemic %K emotion regulation %K emotional exhaustion %K multilevel approach %K well-being %K emotion %K mental health %K social media %K perspective %K strategy %K effective %K modeling %K buffer %D 2021 %7 16.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: In February 2020, the Chinese government imposed a complete lockdown of Wuhan and other cities in Hubei Province to contain a spike of COVID-19 cases. Although such measures are effective in preventing the spread of the virus, medical professionals strongly voiced a caveat concerning the pandemic emotional burnout at the individual level. Although the lockdown limited individuals’ interpersonal communication with people in their social networks, it is common that individuals turn to social media to seek and share health information, exchange social support, and express pandemic-generated feelings. Objective: Based on a holistic and multilevel perspective, this study examines how pandemic-related emotional exhaustion enacts intrapersonal, interpersonal, and hyperpersonal emotional regulation strategies, and then evaluates the effectiveness of these strategies, with a particular interest in understanding the role of hyperpersonal-level regulation or social media–based regulation. Methods: Using an online panel, this study sampled 538 Chinese internet users from Hubei Province, the epicenter of the COVID-19 outbreak in China. Survey data collection lasted for 12 days from February 7-18, 2020, two weeks after Hubei Province was placed under quarantine. The sample had an average age of 35 (SD 10.65, range 18-78) years, and a majority were married (n=369, 68.6%). Results: Using structural equation modeling, this study found that intrapersonal-level (B=0.22; β=.24; P<.001) and interpersonal-level (B=0.35; β=.49; P<.001) emotional regulation strategies were positively associated with individuals’ outcome reappraisal. In contrast with intrapersonal and interpersonal regulations, hyperpersonal (social media–based) regulation strategies, such as disclosing and retweeting negative emotions, were negatively related to the outcome reappraisal (B=–1.00; β=–.80; P<.001). Conclusions: Consistent with previous literature, intrapersonal-level regulation (eg, cognitive reappraisal, mindfulness, and self-kindness) and interpersonal-level supportive interaction may generate a buffering effect on emotional exhaustion and promote individuals’ reappraisal toward the stressful situation. However, hyperpersonal-level regulation may exacerbate the experienced negative emotions and impede reappraisal of the pandemic situation. It is speculated that retweeting content that contains pandemic-related stress and anxiety may cause a digital emotion contagion. Individuals who share other people’s negative emotional expressions on social media are likely to be affected by the negative affect contagion. More importantly, the possible benefits of intrapersonal and interpersonal emotion regulations may be counteracted by social media or hyperpersonal regulation. This suggests the necessity to conduct social media–based health communication interventions to mitigate the social media–wide negative affect contagion if lockdown policies related to highly infectious diseases are initiated. %M 33661753 %R 10.2196/27015 %U https://www.jmir.org/2021/3/e27015 %U https://doi.org/10.2196/27015 %U http://www.ncbi.nlm.nih.gov/pubmed/33661753 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 9 %N 3 %P e27079 %T Emotional Attitudes of Chinese Citizens on Social Distancing During the COVID-19 Outbreak: Analysis of Social Media Data %A Shen,Lining %A Yao,Rui %A Zhang,Wenli %A Evans,Richard %A Cao,Guang %A Zhang,Zhiguo %+ School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science & Technology, No 13 Hangkong Road, Wuhan, 430030, China, 86 02783692730, sln2008@hust.edu.cn %K COVID-19 %K Sina Weibo %K social distancing measures %K emotional analysis %K machine learning %K moderating effects %K deep learning %K social media %K emotion %K attitude %K infodemiology %K infoveillance %D 2021 %7 16.3.2021 %9 Original Paper %J JMIR Med Inform %G English %X Background: Wuhan, China, the epicenter of the COVID-19 pandemic, imposed citywide lockdown measures on January 23, 2020. Neighboring cities in Hubei Province followed suit with the government enforcing social distancing measures to restrict the spread of the disease throughout the province. Few studies have examined the emotional attitudes of citizens as expressed on social media toward the imposed social distancing measures and the factors that affected their emotions. Objective: The aim of this study was twofold. First, we aimed to detect the emotional attitudes of different groups of users on Sina Weibo toward the social distancing measures imposed by the People’s Government of Hubei Province. Second, the influencing factors of their emotions, as well as the impact of the imposed measures on users’ emotions, was studied. Methods: Sina Weibo, one of China’s largest social media platforms, was chosen as the primary data source. The time span of selected data was from January 21, 2020, to March 24, 2020, while analysis was completed in late June 2020. Bi-directional long short-term memory (Bi-LSTM) was used to analyze users’ emotions, while logistic regression analysis was employed to explore the influence of explanatory variables on users’ emotions, such as age and spatial location. Further, the moderating effects of social distancing measures on the relationship between user characteristics and users’ emotions were assessed by observing the interaction effects between the measures and explanatory variables. Results: Based on the 63,169 comments obtained, we identified six topics of discussion—(1) delaying the resumption of work and school, (2) travel restrictions, (3) traffic restrictions, (4) extending the Lunar New Year holiday, (5) closing public spaces, and (6) community containment. There was no multicollinearity in the data during statistical analysis; the Hosmer-Lemeshow goodness-of-fit was 0.24 (χ28=10.34, P>.24). The main emotions shown by citizens were negative, including anger and fear. Users located in Hubei Province showed the highest amount of negative emotions in Mainland China. There are statistically significant differences in the distribution of emotional polarity between social distancing measures (χ220=19,084.73, P<.001), as well as emotional polarity between genders (χ24=1784.59, P<.001) and emotional polarity between spatial locations (χ24=1659.67, P<.001). Compared with other types of social distancing measures, the measures of delaying the resumption of work and school or travel restrictions mainly had a positive moderating effect on public emotion, while traffic restrictions or community containment had a negative moderating effect on public emotion. Conclusions: Findings provide a reference point for the adoption of epidemic prevention and control measures, and are considered helpful for government agencies to take timely actions to alleviate negative emotions during public health emergencies. %M 33724200 %R 10.2196/27079 %U https://medinform.jmir.org/2021/3/e27079 %U https://doi.org/10.2196/27079 %U http://www.ncbi.nlm.nih.gov/pubmed/33724200 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e23970 %T Public Interest in Cosmetic Surgical and Minimally Invasive Plastic Procedures During the COVID-19 Pandemic: Infodemiology Study of Twitter Data %A Liu,Wenhui %A Wei,Zhiru %A Cheng,Xu %A Pang,Ran %A Zhang,Han %A Li,Guangshuai %+ Plastic and Reconstructive Surgery, First Affiliated Hospital, Zhengzhou University, 1 Jianshe E Road, Erqi District, Zhengzhou, , China, 86 0371 66862241, liguangshuai@zzu.edu.cn %K COVID-19 %K Twitter %K Google Trends %K plastic procedure %K trend %K survey %K surgery %K social media %D 2021 %7 16.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The unprecedented COVID-19 pandemic has brought drastic changes to the field of plastic surgery. It is critical for stakeholders in this field to identify the changes in public interest in plastic procedures to be adequately prepared to meet the challenges of the pandemic. Objective: The aim of this study is to examine tweets related to the public interest in plastic procedures during the COVID-19 pandemic and to help stakeholders in the field of plastic surgery adjust their practices and sustain their operations during the current difficult situation of the pandemic. Methods: Using a web crawler, 73,963 publicly accessible tweets about the most common cosmetic surgical and minimally invasive plastic procedures were collected. The tweets were grouped into three phases, and the tweeting frequencies and Google Trends indices were examined. Tweeting frequency, sentiment, and word frequency analyses were performed with Python modules. Results: Tweeting frequency increased by 24.0% in phase 2 and decreased by 9.1% in phase 3. Tweets about breast augmentation, liposuction, and abdominoplasty (“tummy tuck”) procedures consecutively increased over the three phases of the pandemic. Interest in Botox and chemical peel procedures revived first when the lockdown was lifted. The COVID-19 pandemic was associated with a negative impact on public sentiment about plastic procedures. The word frequency pattern significantly changed after phase 1 and then remained relatively stable. Conclusions: According to Twitter data, the public maintained their interest in plastic procedures during the COVID-19 pandemic. Stakeholders should consider refocusing on breast augmentation, liposuction, and abdominoplasty procedures during the current phase of the pandemic. In the case of a second wave of COVID-19, stakeholders should prepare for a temporary surge of Botox and chemical peel procedures. %M 33608248 %R 10.2196/23970 %U https://www.jmir.org/2021/3/e23970 %U https://doi.org/10.2196/23970 %U http://www.ncbi.nlm.nih.gov/pubmed/33608248 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e23272 %T COVID-19 Discourse on Twitter in Four Asian Countries: Case Study of Risk Communication %A Park,Sungkyu %A Han,Sungwon %A Kim,Jeongwook %A Molaie,Mir Majid %A Vu,Hoang Dieu %A Singh,Karandeep %A Han,Jiyoung %A Lee,Wonjae %A Cha,Meeyoung %+ Data Science Group, Institute for Basic Science, 55, Expo-ro, Yuseong-gu, Daejeon, 34126, Republic of Korea, 82 428788114, meeyoung.cha@gmail.com %K COVID-19 %K coronavirus %K infodemic %K infodemiology %K infoveillance %K Twitter %K topic phase detection %K topic modeling %K latent Dirichlet allocation %K risk communication %D 2021 %7 16.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: COVID-19, caused by SARS-CoV-2, has led to a global pandemic. The World Health Organization has also declared an infodemic (ie, a plethora of information regarding COVID-19 containing both false and accurate information circulated on the internet). Hence, it has become critical to test the veracity of information shared online and analyze the evolution of discussed topics among citizens related to the pandemic. Objective: This research analyzes the public discourse on COVID-19. It characterizes risk communication patterns in four Asian countries with outbreaks at varying degrees of severity: South Korea, Iran, Vietnam, and India. Methods: We collected tweets on COVID-19 from four Asian countries in the early phase of the disease outbreak from January to March 2020. The data set was collected by relevant keywords in each language, as suggested by locals. We present a method to automatically extract a time–topic cohesive relationship in an unsupervised fashion based on natural language processing. The extracted topics were evaluated qualitatively based on their semantic meanings. Results: This research found that each government’s official phases of the epidemic were not well aligned with the degree of public attention represented by the daily tweet counts. Inspired by the issue-attention cycle theory, the presented natural language processing model can identify meaningful transition phases in the discussed topics among citizens. The analysis revealed an inverse relationship between the tweet count and topic diversity. Conclusions: This paper compares similarities and differences of pandemic-related social media discourse in Asian countries. We observed multiple prominent peaks in the daily tweet counts across all countries, indicating multiple issue-attention cycles. Our analysis identified which topics the public concentrated on; some of these topics were related to misinformation and hate speech. These findings and the ability to quickly identify key topics can empower global efforts to fight against an infodemic during a pandemic. %M 33684054 %R 10.2196/23272 %U https://www.jmir.org/2021/3/e23272 %U https://doi.org/10.2196/23272 %U http://www.ncbi.nlm.nih.gov/pubmed/33684054 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e25977 %T Social Media Engagement and Influenza Vaccination During the COVID-19 Pandemic: Cross-sectional Survey Study %A Benis,Arriel %A Khodos,Anna %A Ran,Sivan %A Levner,Eugene %A Ashkenazi,Shai %+ Faculty of Industrial Engineering and Technology Management, Holon Institute of Technology, Golomb St. 52, Holon, 5810201, Israel, 972 3 5026892, arrielb@hit.ac.il %K influenza %K vaccines %K vaccination %K social media %K online social networking %K health literacy %K eHealth %K information dissemination %K access to information %K COVID-19 %D 2021 %7 16.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Vaccines are one of the most important achievements of modern medicine. However, their acceptance is only partial, with vaccine hesitancy and refusal representing a major health threat. Influenza vaccines have low compliance since repeated, annual vaccination is required. Influenza vaccines stimulate discussions both in the real world and online. Social media is currently a significant source of health and medical information. Elucidating the association between social media engagement and influenza vaccination is important and may be applicable to other vaccines, including ones against COVID-19. Objective: The goal of this study is to characterize profiles of social media engagement regarding the influenza vaccine and their association with knowledge and compliance in order to support improvement of future web-associated vaccination campaigns. Methods: A weblink to an online survey in Hebrew was disseminated over social media and messaging platforms. The survey answers were collected during April 2020. Anonymous and volunteer participants aged 21 years and over answered 30 questions related to sociodemographics; social media usage; influenza- and vaccine-related knowledge and behavior; health-related information searching, its reliability, and its influence; and COVID-19-related information searching. A univariate descriptive data analysis was performed, followed by multivariate analysis via building a decision tree to define the most important attributes associated with vaccination compliance. Results: A total of 213 subjects responded to the survey, of whom 207 were included in the analysis; the majority of the respondents were female, were aged 21 to 40 years, had 1 to 2 children, lived in central Israel, were secular Israeli natives, had higher education, and had a salary close to the national average. Most respondents (128/207, 61.8%) were not vaccinated against influenza in 2019 and used social media. Participants that used social media were younger, secular, and living in high-density agglomerations and had lower influenza vaccination rates. The perceived influence and reliability of the information on social media about COVID-19 were generally similar to those perceptions about influenza. Conclusions: Using social media is negatively linked to compliance with seasonal influenza vaccination in this study. A high proportion of noncompliant individuals can lead to increased consumption of health care services and can, therefore, overload these health services. This is particularly crucial with a concomitant outbreak, such as COVID-19. Health care professionals should use improved and targeted health communication campaigns with the aid of experts in social media. Targeted communication, based on sociodemographic factors and personalized social media usage, might increase influenza vaccination rates and compliance with other vaccines as well. %M 33651709 %R 10.2196/25977 %U https://www.jmir.org/2021/3/e25977 %U https://doi.org/10.2196/25977 %U http://www.ncbi.nlm.nih.gov/pubmed/33651709 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 9 %N 3 %P e22916 %T Systematic Delineation of Media Polarity on COVID-19 Vaccines in Africa: Computational Linguistic Modeling Study %A Gbashi,Sefater %A Adebo,Oluwafemi Ayodeji %A Doorsamy,Wesley %A Njobeh,Patrick Berka %+ Faculty of Science, University of Johannesburg, 55 Beit Street, Doornfontein, Johannesburg, 2028, South Africa, 27 620402580, sefatergbashi@gmail.com %K COVID-19 %K coronavirus %K vaccine %K infodemiology %K infoveillance %K infodemic %K sentiment analysis %K natural language processing %K media %K computation %K linguistic %K model %K communication %D 2021 %7 16.3.2021 %9 Original Paper %J JMIR Med Inform %G English %X Background: The global onset of COVID-19 has resulted in substantial public health and socioeconomic impacts. An immediate medical breakthrough is needed. However, parallel to the emergence of the COVID-19 pandemic is the proliferation of information regarding the pandemic, which, if uncontrolled, cannot only mislead the public but also hinder the concerted efforts of relevant stakeholders in mitigating the effect of this pandemic. It is known that media communications can affect public perception and attitude toward medical treatment, vaccination, or subject matter, particularly when the population has limited knowledge on the subject. Objective: This study attempts to systematically scrutinize media communications (Google News headlines or snippets and Twitter posts) to understand the prevailing sentiments regarding COVID-19 vaccines in Africa. Methods: A total of 637 Twitter posts and 569 Google News headlines or descriptions, retrieved between February 2 and May 5, 2020, were analyzed using three standard computational linguistics models (ie, TextBlob, Valence Aware Dictionary and Sentiment Reasoner, and Word2Vec combined with a bidirectional long short-term memory neural network). Results: Our findings revealed that, contrary to general perceptions, Google News headlines or snippets and Twitter posts within the stated period were generally passive or positive toward COVID-19 vaccines in Africa. It was possible to understand these patterns in light of increasingly sustained efforts by various media and health actors in ensuring the availability of factual information about the pandemic. Conclusions: This type of analysis could contribute to understanding predominant polarities and associated potential attitudinal inclinations. Such knowledge could be critical in informing relevant public health and media engagement policies. %M 33667172 %R 10.2196/22916 %U https://medinform.jmir.org/2021/3/e22916 %U https://doi.org/10.2196/22916 %U http://www.ncbi.nlm.nih.gov/pubmed/33667172 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e24948 %T Using Narrative Evidence to Convey Health Information on Social Media: The Case of COVID-19 %A Gesser-Edelsburg,Anat %+ School of Public Health, University of Haifa, 199 Aba Khoushy Ave, Mount Carmel, Haifa, 3498838, Israel, 972 544243530, ageser@univ.haifa.ac.il %K health and risk communication %K social media %K narrative evidence %K crisis %K pandemic %K misinformation %K infodemic %K infodemiology %K COVID-19 %K policy %K segmentation %K barrier reduction %K role models %K empathy and support %K strengthening self/community-efficacy %K coping tools %K preventing stigmatization %K at-risk populations %K communicating uncertainty %K positive deviance %K tailor messaging %K targeted behavioral change %D 2021 %7 15.3.2021 %9 Viewpoint %J J Med Internet Res %G English %X During disease outbreaks or pandemics, policy makers must convey information to the public for informative purposes (eg, morbidity or mortality rates). They must also motivate members of the public to cooperate with the guidelines, specifically by changing their usual behavior. Policy makers have traditionally adopted a didactic and formalistic stance by conveying dry, statistics-based health information to the public. They have not yet considered the alternative of providing health information in the form of narrative evidence, using stories that address both cognitive and emotional aspects. The aim of this viewpoint paper is to introduce policy makers to the advantages of using narrative evidence to provide health information during a disease outbreak or pandemic such as COVID-19. Throughout human history, authorities have tended to employ apocalyptic narratives during disease outbreaks or pandemics. This viewpoint paper proposes an alternative coping narrative that includes the following components: segmentation; barrier reduction; role models; empathy and support; strengthening self-efficacy, community efficacy, and coping tools; preventing stigmatization of at-risk populations; and communicating uncertainty. It also discusses five conditions for using narrative evidence to produce an effective communication campaign on social media: (1) identifying narratives that reveal the needs, personal experiences, and questions of different subgroups to tailor messaging to produce targeted behavioral change; (2) providing separate and distinct treatment of each information unit or theory that arises on social networks; (3) identifying positive deviants who found creative solutions for stress during the COVID-19 crisis not found by other members of the community; (4) creating different stories of coping; and (5) maintaining a dialogue with population subgroups (eg, skeptical and hesitant groups). The paper concludes by proposing criteria for evaluating the effectiveness of a narrative. %M 33674257 %R 10.2196/24948 %U https://www.jmir.org/2021/3/e24948 %U https://doi.org/10.2196/24948 %U http://www.ncbi.nlm.nih.gov/pubmed/33674257 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 9 %N 3 %P e24497 %T Medical Morphology Training Using the Xuexi Tong Platform During the COVID-19 Pandemic: Development and Validation of a Web-Based Teaching Approach %A Liu,Qinlai %A Sun,Wenping %A Du,Changqing %A Yang,Leiying %A Yuan,Na %A Cui,Haiqing %A Song,Wengang %A Ge,Li %+ Department of Histology and Embryology, Shandong First Medical University & Shandong Academy of Medical Sciences, 2 Ying Sheng East Road, Tai’an, China, 86 0538622203, juliagl@126.com %K COVID-19 %K histology and embryology %K pathology %K web-based teaching %K Xuexi Tong platform %D 2021 %7 15.3.2021 %9 Original Paper %J JMIR Med Inform %G English %X Background: Histology and Embryology and Pathology are two important basic medical morphology courses for studying human histological structures under healthy and pathological conditions, respectively. There is a natural succession between the two courses. At the beginning of 2020, the COVID-19 pandemic suddenly swept the world. During this unusual period, to ensure that medical students would understand and master basic medical knowledge and to lay a solid foundation for future medical bridge courses and professional courses, a web-based medical morphology teaching team, mainly including teachers of courses in Histology and Embryology and Pathology, was established. Objective: This study aimed to explore a new teaching mode of Histology and Embryology and Pathology courses during the COVID-19 pandemic and to illustrate its feasibility and acceptability. Methods: From March to July 2020, our team selected clinical medicine undergraduate students who started their studies in 2018 and 2019 as recipients of web-based teaching. Meanwhile, nursing undergraduate students who started their studies in 2019 and 2020 were selected for traditional offline teaching as the control group. For the web-based teaching, our team used the Xuexi Tong platform as the major platform to realize a new “seven-in-one” teaching method (ie, videos, materials, chapter tests, interactions, homework, live broadcasts, and case analysis/discussion). This new teaching mode involved diverse web-based teaching methods and contents, including flipped classroom, screen-to-screen experimental teaching, a drawing competition, and a writing activity on the theme of “What I Know About COVID-19.” When the teaching was about to end, a questionnaire was administered to obtain feedback regarding the teaching performance. In the meantime, the final written pathology examination results of the web-based teaching and traditional offline teaching groups were compared to examine the mastery of knowledge of the students. Results: Using the Xuexi Tong platform as the major platform to conduct “seven-in-one” teaching is feasible and acceptable. With regard to the teaching performance of this new web-based teaching mode, students demonstrated a high degree of satisfaction, and the questionnaire showed that 71.3% or more of the students in different groups reported a greater degree of satisfaction or being very satisfied. In fact, more students achieved high scores (90-100) in the web-based learning group than in the offline learning control group (P=.02). Especially, the number of students with objective scores >60 in the web-based learning group was greater than that in the offline learning control group (P=.045). Conclusions: This study showed that the web-based teaching mode was not inferior to the traditional offline teaching mode for medical morphology courses, proving the feasibility and acceptability of web-based teaching during the COVID-19 pandemic. Our findings lay a solid theoretical foundation for follow-up studies of medical students. %M 33566792 %R 10.2196/24497 %U https://medinform.jmir.org/2021/3/e24497 %U https://doi.org/10.2196/24497 %U http://www.ncbi.nlm.nih.gov/pubmed/33566792 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 3 %P e21757 %T Effects of Web-Based Group Mindfulness Training on Stress and Sleep Quality in Singapore During the COVID-19 Pandemic: Retrospective Equivalence Analysis %A Lim,Julian %A Leow,Zaven %A Ong,Jason %A Pang,Ly-Shan %A Lim,Eric %+ Centre for Sleep and Cognition, Yong Loo Lin School of Medicine, National University of Singapore, Tahir Foundation Building, MD1, Level 13 South, 12 Science Drive 2, Singapore, 117549, Singapore, 65 66011956, julian.lim@nus.edu.sg %K mindfulness %K COVID-19 %K videoconference %K perceived stress %K sleep quality %K intervention %K telehealth %K mental health %K psychology %D 2021 %7 15.3.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: The COVID-19 pandemic has negatively impacted psychological health. Mindfulness training, which helps individuals attend to the present moment with a nonjudgmental attitude, improves sleep and reduces stress during regular times. Mindfulness training may also be relevant to the mitigation of harmful health consequences during acute crises. However, certain restrictions may necessitate the web-based delivery of mindfulness training (ie, rather than in-person group training settings). Objective: The objective of our study was to examine the effects of mindfulness interventions during the COVID-19 pandemic and to evaluate the effectiveness of web-based interventions. Methods: Data from an ongoing study were used for this retrospective equivalence analysis. Recruited participants were enrollees from mindfulness courses at a local charity organization that promoted mental wellness. This study had no exclusion criteria. We created three groups; two groups received their training during the COVID-19 pandemic (in-person training group: n=36; videoconferencing group: n=38), and a second control group included participants who were trained before the pandemic (n=86). Our primary outcomes were self-reported stress and sleep quality. Baseline levels and changes in these variables due to mindfulness training were compared among the groups via an analysis of covariance test and two one-tailed t tests. Results: Baseline perceived stress (P=.50) and sleep quality (P=.22) did not differ significantly among the three groups. Mindfulness training significantly reduced stress in all three groups (P<.001), and this effect was statistically significant when comparing videoconferencing to in-person training (P=.002). Sleep quality improved significantly in the prepandemic training group (P<.001). However, sleep quality did not improve in the groups that received training during the pandemic. Participants reported that they required shorter times to initiate sleep following prepandemic mindfulness training (P<.001), but this was not true for those who received training during the pandemic. Course attendance was high and equivalent across the videoconferencing and comparison groups (P=.02), and participants in the videoconferencing group engaged in marginally more daily practice than the in-person training group. Conclusions: Web-based mindfulness training via videoconferencing may be a useful intervention for reducing stress during times when traditional, in-person training is not feasible. However, it may not be useful for improving sleep quality. %M 33482627 %R 10.2196/21757 %U https://mental.jmir.org/2021/3/e21757 %U https://doi.org/10.2196/21757 %U http://www.ncbi.nlm.nih.gov/pubmed/33482627 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e22453 %T Artificial Intelligence–Aided Precision Medicine for COVID-19: Strategic Areas of Research and Development %A Santus,Enrico %A Marino,Nicola %A Cirillo,Davide %A Chersoni,Emmanuele %A Montagud,Arnau %A Santuccione Chadha,Antonella %A Valencia,Alfonso %A Hughes,Kevin %A Lindvall,Charlotta %+ Barcelona Supercomputing Center, c/Jordi Girona, 29, Barcelona, Spain, 34 934137971, davide.cirillo@bsc.es %K COVID-19 %K SARS-CoV-2 %K artificial intelligence %K personalized medicine %K precision medicine %K prevention %K monitoring %K epidemic %K literature %K public health %K pandemic %D 2021 %7 12.3.2021 %9 Viewpoint %J J Med Internet Res %G English %X Artificial intelligence (AI) technologies can play a key role in preventing, detecting, and monitoring epidemics. In this paper, we provide an overview of the recently published literature on the COVID-19 pandemic in four strategic areas: (1) triage, diagnosis, and risk prediction; (2) drug repurposing and development; (3) pharmacogenomics and vaccines; and (4) mining of the medical literature. We highlight how AI-powered health care can enable public health systems to efficiently handle future outbreaks and improve patient outcomes. %M 33560998 %R 10.2196/22453 %U https://www.jmir.org/2021/3/e22453 %U https://doi.org/10.2196/22453 %U http://www.ncbi.nlm.nih.gov/pubmed/33560998 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e21892 %T Effectiveness of Interactive Tools in Online Health Care Communities: Social Exchange Theory Perspective %A Ren,Dixuan %A Ma,Baolong %+ School of Management and Economics, Beijing Institute of Technology, Number 5, Zhongguancun Road, Haidian District, Beijing, China, 86 1068915602, dmmibb@163.com %K efforts %K income %K privacy disease %K platform %K social exchange %D 2021 %7 12.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Although the COVID-19 pandemic will have a negative effect on China’s economy in the short term, it also represents a major opportunity for internet-based medical treatment in the medium and long term. Compared with normal times, internet-based medical platforms including the Haodf website were visited by 1.11 billion people, the number of new registered users of all platforms increased by 10, and the number of new users’ daily consultations increased by 9 during the pandemic. The continuous participation of physicians is a major factor in the success of the platform, and economic return is an important reason for physicians to provide internet-based services. However, no study has provided the effectiveness of interactive tools in online health care communities to influence physicians’ returns. Objective: The effect of internet-based effort on the benefits and effectiveness of interactive effort tools in internet-based health care areas remains unclear. Thus, the goals of this study are to examine the effect of doctors’ internet-based service quality on their economic returns during COVID-19 social restrictions, to examine the effect of mutual help groups on doctors’ economic returns during COVID-19 social restrictions, and to explore the moderating effect of disease privacy on doctors’ efforts and economic returns during COVID-19 social restrictions. Methods: On the basis of the social exchange theory, this study establishes an internet-based effort exchange model for doctors. We used a crawler to download information automatically from Haodf website. From March 5 to 7, 2020, which occurred during the COVID-19 pandemic in China, cross-sectional information of 2530 doctors were collected. Results: Hierarchical linear regression showed that disease privacy (β=.481; P<.001), reputation (β=.584; P<.001), and service quality (β=.560; P<.001) had a significant positive effect on the economic returns of the physicians. The influence of mutual help groups on earnings increases with an increase in the degree of disease privacy (β=.189; P<.001), indicating that mutual help groups have a stronger effect on earnings when patients ask questions about diseases regarding which they desire privacy. Conclusions: For platform operators, the results of this study can help the platform understand how to improve doctors’ economic returns, especially regarding helping a specific doctor group improve its income to retain good doctors. For physicians on the platform, this study will help doctors spend their limited energy and time on tools that can improve internet-based consultation incomes. Patients who receive internet-based health care services extract information about a doctor based on the doctor’s internet-based efforts to understand the doctor’s level of professionalism and personality to choose the doctor they like the most. The data used in this study may be biased or not representative of all medical platforms, as they were collected from a single website. %M 33709940 %R 10.2196/21892 %U https://www.jmir.org/2021/3/e21892 %U https://doi.org/10.2196/21892 %U http://www.ncbi.nlm.nih.gov/pubmed/33709940 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e26182 %T A Self-Assessment Web-Based App to Assess Trends of the COVID-19 Pandemic in France: Observational Study %A Denis,Fabrice %A Fontanet,Arnaud %A Le Douarin,Yann-Mael %A Le Goff,Florian %A Jeanneau,Stephan %A Lescure,François-Xavier %+ Institut Inter-régional de Cancérologie Jean Bernard, 9 rue Beauverger, Le Mans, 72000, France, 33 684190480, f.denis@cjb72.org %K app %K big data %K COVID-19 %K diagnosis %K diagnostic test %K digital health %K France %K mobile phone %K observational %K participatory app %K self-assessment %K surveillance %K trend %K web-based app %D 2021 %7 12.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: We developed a self-assessment and participatory web-based triage app to assess the trends of the COVID-19 pandemic in France in March 2020. Objective: We compared daily large-scale RT–PCR test results to monitor recent reports of anosmia through a web-based app to assess the dynamics of emergency department visits, hospitalizations, and intensive care unit (ICU) admissions among individuals with COVID-19 in France. Methods: Between March 21 and November 18, 2020, users of the maladiecoronavirus.fr self-triage app were asked questions about COVID-19 symptoms. Data on daily hospitalizations, large-scale positive results on RT–PCR tests, emergency department visits, and ICU admission of individuals with COVID-19 were compared to data on daily reports of anosmia on the app. Results: As of November 18, 2020, recent anosmia was reported 575,214 times from among approximately 13,000,000 responses. Daily anosmia reports during peak engagement with the app on September 16, 2020, were spatially correlated with the peak in daily COVID-19–related hospitalizations in November 2020 (Spearman rank correlation coefficient [ρ]=0.77; P<.001). This peak in daily anosmia reports was observed primarily among young adults (age range 18-40 years), being observed 49 days before the peak of hospitalizations that corresponded to the first wave of infections among the young population, followed by a peak in hospitalizations among older individuals (aged ≥50 years) in November 2020. The reduction in the daily reports of anosmia associated with the peaks in the number of cases preceded the reduction in daily hospitalizations by 10 and 9 days during the first and the second waves of infection, respectively, although the reduction in the positivity rates on RT–PCR tests preceded the reduction in daily hospitalizations by only 2 days during the second wave of infections. Conclusions: Data on daily reports of anosmia collected through a nationwide, web-based self-assessment app can be a relevant tool to anticipate surges in outbreaks, hospitalizations, and ICU admission during the COVID-19 pandemic. Trial Registration: ClinicalTrials.gov NCT04331171; https://clinicaltrials.gov/ct2/show/NCT04331171 %M 33709945 %R 10.2196/26182 %U https://www.jmir.org/2021/3/e26182 %U https://doi.org/10.2196/26182 %U http://www.ncbi.nlm.nih.gov/pubmed/33709945 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e26718 %T Clinical Trial Data Sharing for COVID-19–Related Research %A Dron,Louis %A Dillman,Alison %A Zoratti,Michael J %A Haggstrom,Jonas %A Mills,Edward J %A Park,Jay J H %+ Department of Experimental Medicine, University of British Columbia, 802-777 West Broadway, Vancouver, BC, V5Z 1J5, Canada, 1 (604) 294 3823, jayhpark1@alumni.ubc.ca %K COVID-19 %K data-sharing %K clinical trials %K data %K research %K privacy %K security %K registry %K feasibility %K challenge %K recruitment %K error %K bias %K assessment %K interoperability %K dataset %K intervention %K cooperation %D 2021 %7 12.3.2021 %9 Viewpoint %J J Med Internet Res %G English %X This paper aims to provide a perspective on data sharing practices in the context of the COVID-19 pandemic. The scientific community has made several important inroads in the fight against COVID-19, and there are over 2500 clinical trials registered globally. Within the context of the rapidly changing pandemic, we are seeing a large number of trials conducted without results being made available. It is likely that a plethora of trials have stopped early, not for statistical reasons but due to lack of feasibility. Trials stopped early for feasibility are, by definition, statistically underpowered and thereby prone to inconclusive findings. Statistical power is not necessarily linear with the total sample size, and even small reductions in patient numbers or events can have a substantial impact on the research outcomes. Given the profusion of clinical trials investigating identical or similar treatments across different geographical and clinical contexts, one must also consider that the likelihood of a substantial number of false-positive and false-negative trials, emerging with the increasing overall number of trials, adds to public perceptions of uncertainty. This issue is complicated further by the evolving nature of the pandemic, wherein baseline assumptions on control group risk factors used to develop sample size calculations are far more challenging than those in the case of well-documented diseases. The standard answer to these challenges during nonpandemic settings is to assess each trial for statistical power and risk-of-bias and then pool the reported aggregated results using meta-analytic approaches. This solution simply will not suffice for COVID-19. Even with random-effects meta-analysis models, it will be difficult to adjust for the heterogeneity of different trials with aggregated reported data alone, especially given the absence of common data standards and outcome measures. To date, several groups have proposed structures and partnerships for data sharing. As COVID-19 has forced reconsideration of policies, processes, and interests, this is the time to advance scientific cooperation and shift the clinical research enterprise toward a data-sharing culture to maximize our response in the service of public health. %M 33684053 %R 10.2196/26718 %U https://www.jmir.org/2021/3/e26718 %U https://doi.org/10.2196/26718 %U http://www.ncbi.nlm.nih.gov/pubmed/33684053 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 3 %P e26121 %T Use of Telehealth for Domiciliary Follow-up After Hematopoietic Cell Transplantation During the COVID-19 Pandemic: Prospective Pilot Study %A Mussetti,Alberto %A Salas,Maria Queralt %A Condom,Maria %A Antonio,Maite %A Ochoa,Cristian %A Ivan,Iulia %A Jimenez Ruiz-De la Torre,David %A Sanz Linares,Gabriela %A Ansoleaga,Belen %A Patiño-Gutierrez,Beatriz %A Jimenez-Prat,Laura %A Parody,Rocio %A Sureda-Balari,Ana %+ Clinical Hematology Department, Institut Català d'Oncologia-Hospitalet, Hospital Duran i Reynals, Avinguda de la Gran Via de l'Hospitalet, 199-203, L'Hospitalet de Llobregat, Barcelona, 08908, Spain, 34 622188475, amussetti@iconcologia.net %K SARS-CoV-2 %K COVID-19 %K hematology %K hematopoietic cell transplantation %K telemedicine %K mortality %K surveillance %K monitoring %K stem cell %K transplant %K app %K medical device %D 2021 %7 12.3.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Patients who have recently received a hematopoietic cell transplant (HCT) are at higher risk of acute complications in the first weeks after discharge, especially during the COVID-19 pandemic. Objective: The aim of this study was to test the use of a telehealth platform for the follow-up of HCT patients during the first two weeks after discharge. Methods: In total, 21 patients who received autologous or allogeneic HCT for hematological malignancies were screened from April 30, 2020, to July 15, 2020. The telehealth platform assisted in the daily collection of vital signs as well as physical and psychological symptoms for two weeks after hospital discharge. The required medical devices (oximeter and blood pressure monitor) were given to patients and a dedicated smartphone app was developed to collect this data. The data were reviewed daily through web-based software by a hematologist specializing in HCT. Results: Only 12 of 21 patients were able to join and complete the study. Technological barriers were the most frequent limiting factor in this study. Among the 12 patients who completed the study, adherence to data reporting was high. The patients’ experience of using such a system was considered good. In two cases, the system enabled the early recognition of acute complications. Conclusions: This pilot study showed that telehealth systems can be applied in the early posttransplant setting, with evident advantages for physicians and patients for both medical and psychological aspects. Technological issues still represent a challenge for the applicability of such a system, especially for older adult patients. Easier-to-use technologies could help to expand the use of telehealth systems in this setting in the future. %M 33600351 %R 10.2196/26121 %U https://formative.jmir.org/2021/3/e26121 %U https://doi.org/10.2196/26121 %U http://www.ncbi.nlm.nih.gov/pubmed/33600351 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e25173 %T Guidelines for Conducting Virtual Cognitive Interviews During a Pandemic %A Shepperd,James A %A Pogge,Gabrielle %A Hunleth,Jean M %A Ruiz,Sienna %A Waters,Erika A %+ Department of Psychology, University of Florida, 945 Center Drive, Gainesville, FL, 32611, United States, 1 352 273 2165, shepperd@ufl.edu %K cognitive interview %K COVID-19 %K guidelines %K teleresearch %K pandemic %K tablet computer %K telehealth %K training %D 2021 %7 11.3.2021 %9 Viewpoint %J J Med Internet Res %G English %X The COVID-19 pandemic has challenged researchers working in physical contact with research participants. Cognitive interviews examine whether study components (most often questionnaire items) are worded or structured in a manner that allows study participants to interpret the items in a way intended by the researcher. We developed guidelines to conduct cognitive interviews virtually to accommodate interviewees who have limited access to the internet. The guidelines describe the essential communication and safety equipment requirements and outline a procedure for collecting responses while maintaining the safety of the participants and researchers. Furthermore, the guidelines provide suggestions regarding training of participants to use the technology, encouraging them to respond aloud (a potential challenge given that the researcher is not physically present with the participant), and testing and deploying the equipment prior to the interview. Finally, the guidelines emphasize the need to adapt the interview to the circumstances and anticipate potential problems that might arise. %M 33577464 %R 10.2196/25173 %U https://www.jmir.org/2021/3/e25173 %U https://doi.org/10.2196/25173 %U http://www.ncbi.nlm.nih.gov/pubmed/33577464 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e24883 %T Examining Tweet Content and Engagement of Canadian Public Health Agencies and Decision Makers During COVID-19: Mixed Methods Analysis %A Slavik,Catherine E %A Buttle,Charlotte %A Sturrock,Shelby L %A Darlington,J Connor %A Yiannakoulias,Niko %+ School of Earth, Environment and Society, McMaster University, General Science Building, 1280 Main Street West, Room 204, Hamilton, ON, L8S 4K1, Canada, 1 905 525 9140 ext 20118, yiannan@mcmaster.ca %K COVID-19 %K coronavirus %K pandemic %K public health %K Twitter %K social media %K engagement %K risk communication %K infodemiology %K content analysis %D 2021 %7 11.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Effective communication during a health crisis can ease public concerns and promote the adoption of important risk-mitigating behaviors. Public health agencies and leaders have served as the primary communicators of information related to COVID-19, and a key part of their public outreach has taken place on social media platforms. Objective: This study examined the content and engagement of COVID-19 tweets authored by Canadian public health agencies and decision makers. We propose ways for public health accounts to adjust their tweeting practices during public health crises to improve risk communication and maximize engagement. Methods: We retrieved data from tweets by Canadian public health agencies and decision makers from January 1, 2020, to June 30, 2020. The Twitter accounts were categorized as belonging to either a public health agency, regional or local health department, provincial health authority, medical health officer, or minister of health. We analyzed trends in COVID-19 tweet engagement and conducted a content analysis on a stratified random sample of 485 tweets to examine the message functions and risk communication strategies used by each account type. Results: We analyzed 32,737 tweets authored by 118 Canadian public health Twitter accounts, of which 6982 tweets were related to COVID-19. Medical health officers authored the largest percentage of COVID-19–related tweets (n=1337, 35%) relative to their total number of tweets and averaged the highest number of retweets per COVID-19 tweet (112 retweets per tweet). Public health agencies had the highest frequency of daily tweets about COVID-19 throughout the study period. Compared to tweets containing media and user mentions, hashtags and URLs were used in tweets more frequently by all account types, appearing in 69% (n=4798 tweets) and 68% (n=4781 tweets) of COVID-19–related tweets, respectively. Tweets containing hashtags also received the highest average retweets (47 retweets per tweet). Our content analysis revealed that of the three tweet message functions analyzed (information, action, community), tweets providing information were the most commonly used across most account types, constituting 39% (n=181) of all tweets; however, tweets promoting actions from users received higher than average retweets (55 retweets per tweet). When examining tweets that received one or more retweet (n=359), the difference between mean retweets across the message functions was statistically significant (P<.001). The risk communication strategies that we examined were not widely used by any account type, appearing in only 262 out of 485 tweets. However, when these strategies were used, these tweets received more retweets compared to tweets that did not use any risk communication strategies (P<.001) (61 retweets versus 13 retweets on average). Conclusions: Public health agencies and decision makers should examine what messaging best meets the needs of their Twitter audiences to maximize sharing of their communications. Public health accounts that do not currently employ risk communication strategies in their tweets may be missing an important opportunity to engage with users about the mitigation of health risks related to COVID-19. %M 33651705 %R 10.2196/24883 %U https://www.jmir.org/2021/3/e24883 %U https://doi.org/10.2196/24883 %U http://www.ncbi.nlm.nih.gov/pubmed/33651705 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e24804 %T Antecedents of Individuals’ Concerns Regarding Hospital Hygiene and Surgery Postponement During the COVID-19 Pandemic: Cross-sectional, Web-Based Survey Study %A Ostermann,Thomas %A Gampe,Julia %A Röer,Jan Philipp %A Radtke,Theda %+ Department of Psychology and Psychotherapy, Witten/Herdecke University, Alfred-Herrhausen-Str 50, Witten, 58448, Germany, 49 2302926707, thomas.ostermann@uni-wh.de %K COVID-19 %K public health %K medical investigations %K surgery %K hospitalization, medical practices %D 2021 %7 11.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic poses a major challenge to people’s everyday lives. In the context of hospitalization, the pandemic is expected to have a strong influence on affective reactions and preventive behaviors. Research is needed to develop evidence-driven strategies for coping with the challenges of the pandemic. Therefore, this survey study investigates the effects that personality traits, risk-taking behaviors, and anxiety have on medical service–related affective reactions and anticipated behaviors during the COVID-19 pandemic. Objective: The aim of this study was to identify key factors that are associated with individuals’ concerns about hygiene in hospitals and the postponement of surgeries. Methods: We conducted a cross-sectional, web-based survey of 929 residents in Germany (women: 792/929, 85.3%; age: mean 35.2 years, SD 12.9 years). Hypotheses were tested by conducting a saturated path analysis. Results: We found that anxiety had a direct effect on people’s concerns about safety (β=−.12, 95% CI −.20 to −.05) and hygiene in hospitals (β=.16, 95% CI .08 to .23). Risk-taking behaviors and personality traits were not associated with concerns about safety and hygiene in hospitals or anticipated behaviors. Conclusions: Our findings suggest that distinct interventions and information campaigns are not necessary for individuals with different personality traits or different levels of risk-taking behavior. However, we recommend that health care workers should carefully address anxiety when interacting with patients. %M 33617458 %R 10.2196/24804 %U https://www.jmir.org/2021/3/e24804 %U https://doi.org/10.2196/24804 %U http://www.ncbi.nlm.nih.gov/pubmed/33617458 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 3 %P e25542 %T Feasibility and Initial Outcomes of a Group-Based Teletherapy Psychiatric Day Program for Adults With Serious Mental Illness: Open, Nonrandomized Trial in the Context of COVID-19 %A Puspitasari,Ajeng J %A Heredia,Dagoberto %A Coombes,Brandon J %A Geske,Jennifer R %A Gentry,Melanie T %A Moore,Wendy R %A Sawchuk,Craig N %A Schak,Kathryn M %+ Department of Quantitative Health Sciences, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, United States, 1 507 538 8730, puspitasari.ajeng@mayo.edu %K COVID-19 %K teletherapy %K intensive outpatient %K serious mental illness %K mental health %K therapy %K telemedicine %K telehealth %K feasibility %K outcome %K behavioral science %K pilot %K implementation %K effective %D 2021 %7 11.3.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: In the context of the COVID-19 pandemic, many behavioral health services have transitioned to teletherapy to continue delivering care for patients with mental illness. Studies that evaluate the outcome of this rapid teletherapy adoption and implementation are pertinent. Objective: This single-arm, nonrandomized pilot study aimed to assess the feasibility and initial patient-level outcomes of a psychiatric transitional day program that switched from an in-person group to a video teletherapy group during the COVID-19 pandemic. Methods: Patients with transdiagnostic conditions who were at risk of psychiatric hospitalization were referred to the Adult Transitions Program (ATP) at a large academic medical center in the United States. ATP was a 3-week intensive outpatient program that implemented group teletherapy guided by cognitive and behavioral principles delivered daily for 3 hours per day. Feasibility was assessed via retention, attendance rate, and rate of securing aftercare appointments prior to ATP discharge. Patients completed standardized patient-reported outcome measures at admission and discharge to assess the effectiveness of the program for improving quality of mental health, depression, anxiety, and suicide risk. Results: Patients (N=76) started the program between March and August of 2020. Feasibility was established, with 70 of the 76 patients (92%) completing the program and a mean attendance of 14.43 days (SD 1.22); also, 71 patients (95%) scheduled at least one behavioral health aftercare service prior to ATP discharge. All patient-level reported outcomes demonstrated significant improvements in depression (95% CI –3.6 to –6.2; Cohen d=0.77; P<.001), anxiety (95% CI –3.0 to –4.9; Cohen d=0.74; P<.001), overall suicide risk (95% CI –0.5 to –0.1; Cohen d=0.41; P=.02), wish to live (95% CI 0.3 to 1.0; Cohen d=0.39; P<.001), wish to die (95% CI –0.2 to –1.4; Cohen d=0.52; P=.01), and overall mental health (95% CI 1.5 to 4.5; Cohen d=0.39; P<.001) from admission to discharge. Conclusions: Rapid adoption and implementation of a group-based teletherapy day program for adults at risk of psychiatric hospitalization appeared to be feasible and effective. Patients demonstrated high completion and attendance rates and reported significant improvements in psychosocial outcomes. Larger trials should be conducted to further evaluate the efficacy and effectiveness of the program through randomized controlled trials. %M 33651706 %R 10.2196/25542 %U https://mental.jmir.org/2021/3/e25542 %U https://doi.org/10.2196/25542 %U http://www.ncbi.nlm.nih.gov/pubmed/33651706 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e23097 %T Factors Affecting Public Adoption of COVID-19 Prevention and Treatment Information During an Infodemic: Cross-sectional Survey Study %A Han,Yangyang %A Jiang,Binshan %A Guo,Rui %+ School of Public Health, Capital Medical University, No.10 Youanmenwai, Xitoutiao, Beijing, China, 86 01083911573, guorui@ccmu.edu.cn %K information adoption %K infodemic %K China %K health information %K infodemiology %K COVID-19 %K public health %D 2021 %7 11.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: With the spread of COVID-19, an infodemic is also emerging. In public health emergencies, the use of information to enable disease prevention and treatment is incredibly important. Although both the information adoption model (IAM) and health belief model (HBM) have their own merits, they only focus on information or public influence factors, respectively, to explain the public’s intention to adopt online prevention and treatment information. Objective: The aim of this study was to fill this gap by using a combination of the IAM and the HBM as the framework for exploring the influencing factors and paths in public health events that affect the public’s adoption of online health information and health behaviors, focusing on both objective and subjective factors. Methods: We carried out an online survey to collect responses from participants in China (N=501). Structural equation modeling was used to evaluate items, and confirmatory factor analysis was used to calculate construct reliability and validity. The goodness of fit of the model and mediation effects were analyzed. Results: The overall fitness indices for the model developed in this study indicated an acceptable fit. Adoption intention was predicted by information characteristics (β=.266, P<.001) and perceived usefulness (β=.565, P<.001), which jointly explained nearly 67% of the adoption intention variance. Information characteristics (β=.244, P<.001), perceived drawbacks (β=–.097, P=.002), perceived benefits (β=.512, P<.001), and self-efficacy (β=.141, P<.001) jointly determined perceived usefulness and explained about 81% of the variance of perceived usefulness. However, social influence did not have a statistically significant impact on perceived usefulness, and self-efficacy did not significantly influence adoption intention directly. Conclusions: By integrating IAM and HBM, this study provided the insight and understanding that perceived usefulness and adoption intention of online health information could be influenced by information characteristics, people’s perceptions of information drawbacks and benefits, and self-efficacy. Moreover, people also exhibited proactive behavior rather than reactive behavior to adopt information. Thus, we should consider these factors when helping the informed public obtain useful information via two approaches: one is to improve the quality of government-based and other official information, and the other is to improve the public’s capacity to obtain information, in order to promote truth and fight rumors. This will, in turn, contribute to saving lives as the pandemic continues to unfold and run its course. %M 33600348 %R 10.2196/23097 %U https://www.jmir.org/2021/3/e23097 %U https://doi.org/10.2196/23097 %U http://www.ncbi.nlm.nih.gov/pubmed/33600348 %0 Journal Article %@ 2152-7202 %I JMIR Publications %V 13 %N 1 %P e24966 %T Best Practices for Virtual Engagement of Patient-Centered Outcomes Research Teams During and After the COVID-19 Pandemic: Qualitative Study %A Thayer,Erin K %A Pam,Molly %A Al Achkar,Morhaf %A Mentch,Laura %A Brown,Georgia %A Kazmerski,Traci M %A Godfrey,Emily %+ Department of Family Medicine, University of Washington, Box 354982, 4311 11th Ave NE, Suite 210, Seattle, WA, 98103, United States, 1 2066854895, godfreye@uw.edu %K attributes %K best practices %K COVID-19 %K cystic fibrosis %K engagement %K outcome %K patient %K patient-centered outcomes research %K qualitative %K research %K stakeholder engagement %K user guide %K virtual care %K virtual teams %K web-based collaboration %D 2021 %7 11.3.2021 %9 Original Paper %J J Particip Med %G English %X Background: Patient-centered outcomes research (PCOR) engages patients as partners in research and focuses on questions and outcomes that are important to patients. The COVID-19 pandemic has forced PCOR teams to engage through web-based platforms rather than in person. Similarly, virtual engagement is the only safe alternative for members of the cystic fibrosis (CF) community, who spend their lives following strict infection control guidelines and are already restricted from in-person interactions. In the absence of universal best practices, the CF community has developed its own guidelines to help PCOR teams engage through web-based platforms. Objective: This study aimed to identify the important attributes, facilitators, and barriers to teams when selecting web-based platforms. Methods: We conducted semistructured interviews with CF community members, nonprofit stakeholders, and researchers to obtain information regarding their experience with using web-based platforms, including the effectiveness and efficiency of these platforms and their satisfaction with and confidence while using each platform. Interviews conducted via Zoom were audio recorded and transcribed. We identified key themes through content analysis with an iterative, inductive, and deductive coding process. Results: In total, 15 participants reported using web-based platforms for meetings, project management, document sharing, scheduling, and communication. When selecting web-based platforms, participants valued their accessibility, ease of use, and integration with other platforms. Participants speculated that successful web-based collaboration involved platforms that emulate in-person interactions, recognized the digital literacy levels of the team members, intentionally aligned platforms with collaboration goals, and achieved team member buy-in to adopt new platforms. Conclusions: Successful web-based engagement in PCOR requires the use of multiple platforms in order to fully meet the asynchronous or synchronous goals of the project. This study identified the key attributes for the successful practice of PCOR on web-based platforms and the common challenges and solutions associated with their use. Our findings provide the best practices for selecting platforms and the lessons learned through web-based PCOR collaborations. %M 33646964 %R 10.2196/24966 %U https://jopm.jmir.org/2021/1/e24966 %U https://doi.org/10.2196/24966 %U http://www.ncbi.nlm.nih.gov/pubmed/33646964 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e23365 %T Evidence Synthesis of Digital Interventions to Mitigate the Negative Impact of the COVID-19 Pandemic on Public Mental Health: Rapid Meta-review %A Rauschenberg,Christian %A Schick,Anita %A Hirjak,Dusan %A Seidler,Andreas %A Paetzold,Isabell %A Apfelbacher,Christian %A Riedel-Heller,Steffi G %A Reininghaus,Ulrich %+ Department of Public Mental Health, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, J5, Mannheim, 68159, Germany, 49 62117031929, christian.rauschenberg@zi-mannheim.de %K COVID-19 %K mHealth %K eHealth %K telemedicine %K prevention %K mental health promotion %K intervention %K digital mental health %K digital intervention %K public mental health %D 2021 %7 10.3.2021 %9 Review %J J Med Internet Res %G English %X Background: Accumulating evidence suggests the COVID-19 pandemic has negative effects on public mental health. Digital interventions that have been developed and evaluated in recent years may be used to mitigate the negative consequences of the pandemic. However, evidence-based recommendations on the use of existing telemedicine and internet-based (eHealth) and app-based mobile health (mHealth) interventions are lacking. Objective: The aim of this study was to investigate the theoretical and empirical base, user perspective, safety, effectiveness, and cost-effectiveness of digital interventions related to public mental health provision (ie, mental health promotion, prevention, and treatment of mental disorders) that may help to reduce the consequences of the COVID-19 pandemic. Methods: A rapid meta-review was conducted. The MEDLINE, PsycINFO, and CENTRAL databases were searched on May 11, 2020. Study inclusion criteria were broad and considered systematic reviews and meta-analyses that investigated digital tools for health promotion, prevention, or treatment of mental health conditions and determinants likely affected by the COVID-19 pandemic. Results: Overall, 815 peer-reviewed systematic reviews and meta-analyses were identified, of which 83 met the inclusion criteria. Our findings suggest that there is good evidence on the usability, safety, acceptance/satisfaction, and effectiveness of eHealth interventions. Evidence on mHealth apps is promising, especially if social components (eg, blended care) and strategies to promote adherence are incorporated. Although most digital interventions focus on the prevention or treatment of mental disorders, there is some evidence on mental health promotion. However, evidence on process quality, cost-effectiveness, and long-term effects is very limited. Conclusions: There is evidence that digital interventions are particularly suited to mitigating psychosocial consequences at the population level. In times of physical distancing, quarantine, and restrictions on social contacts, decision makers should develop digital strategies for continued mental health care and invest time and efforts in the development and implementation of mental health promotion and prevention programs. %M 33606657 %R 10.2196/23365 %U https://www.jmir.org/2021/3/e23365 %U https://doi.org/10.2196/23365 %U http://www.ncbi.nlm.nih.gov/pubmed/33606657 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e19473 %T Digital Health Solutions to Control the COVID-19 Pandemic in Countries With High Disease Prevalence: Literature Review %A R Niakan Kalhori,Sharareh %A Bahaadinbeigy,Kambiz %A Deldar,Kolsoum %A Gholamzadeh,Marsa %A Hajesmaeel-Gohari,Sadrieh %A Ayyoubzadeh,Seyed Mohammad %+ Department of Health Information Management, Tehran University of Medical Sciences, 3rd Floor, School of Allied Medical Sciences, No #17, Farredanesh Alley, Ghods St, Enghelab Ave, Tehran, Iran, 98 2188983025, s.m.ayyoubzadeh@gmail.com %K COVID-19 %K digital health %K information technology %K telemedicine %K electronic health %D 2021 %7 10.3.2021 %9 Review %J J Med Internet Res %G English %X Background: COVID-19, the disease caused by the novel coronavirus SARS-CoV-2, has become a global pandemic, affecting most countries worldwide. Digital health information technologies can be applied in three aspects, namely digital patients, digital devices, and digital clinics, and could be useful in fighting the COVID-19 pandemic. Objective: Recent reviews have examined the role of digital health in controlling COVID-19 to identify the potential of digital health interventions to fight the disease. However, this study aims to review and analyze the digital technology that is being applied to control the COVID-19 pandemic in the 10 countries with the highest prevalence of the disease. Methods: For this review, the Google Scholar, PubMed, Web of Science, and Scopus databases were searched in August 2020 to retrieve publications from December 2019 to March 15, 2020. Furthermore, the Google search engine was used to identify additional applications of digital health for COVID-19 pandemic control. Results: We included 32 papers in this review that reported 37 digital health applications for COVID-19 control. The most common digital health projects to address COVID-19 were telemedicine visits (11/37, 30%). Digital learning packages for informing people about the disease, geographic information systems and quick response code applications for real-time case tracking, and cloud- or mobile-based systems for self-care and patient tracking were in the second rank of digital tool applications (all 7/37, 19%). The projects were deployed in various European countries and in the United States, Australia, and China. Conclusions: Considering the potential of available information technologies worldwide in the 21st century, particularly in developed countries, it appears that more digital health products with a higher level of intelligence capability remain to be applied for the management of pandemics and health-related crises. %M 33600344 %R 10.2196/19473 %U https://www.jmir.org/2021/3/e19473 %U https://doi.org/10.2196/19473 %U http://www.ncbi.nlm.nih.gov/pubmed/33600344 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 4 %N 1 %P e26340 %T A New Tool for Detecting COVID-19 Psychological Burden Among Postacute and Long-term Care Residents (Mood-5 Scale): Observational Study %A Mansbach,William E %A Mace,Ryan A %A Tanner,Melissa A %+ Mansbach Health Tools, LLC, PO Box 307, Simpsonville, MD, 21150, United States, 1 4438967409, wmansbach@thebcat.com %K nursing homes %K long-term care %K COVID-19 %K depression %K stress %K coping %K burden %K mental health %K elderly %K older adults %K risk %K telehealth %K self-assessment %K scale %K mood %D 2021 %7 10.3.2021 %9 Original Paper %J JMIR Aging %G English %X Background: Older adults are at high risk for developing serious somatic and psychological symptoms associated with COVID-19. Currently available instruments may not be sensitive to the concerns about COVID-19 in postacute and long-term care and their applications in telehealth remain to be clarified. Objective: We investigated the psychometric properties of the Mood-5 Scale (M5) as a rapid self-assessment of the COVID-19 psychological burden among postacute and long-term care residents. Methods: Residents (N=131), aged 50 years and above, from 20 postacute and long-term care facilities in Maryland, USA, were evaluated in-person or via telehealth (43/131, 32.8%) across a 4-week period (May 11 to June 5, 2020) during the COVID-19 pandemic. The COVID-19 psychological burden experienced by the residents was rated by geriatric psychologists who independently reviewed their clinical documentation. Psychometric analyses were performed on the M5 in relation to psychological tests, COVID-19 psychological burden, and diagnostic data collected during the evaluation. Results: The M5 demonstrated acceptable internal consistency (Cronbach α=.77). M5 scores were not confounded by demographic variables or telehealth administration (P>.08). Convergent validity for the M5 was established via positive associations with anxiety (r=0.56, P<.001) and depressive (r=0.49, P<.001) symptoms. An M5 cutoff score of 3 demonstrated strong sensitivity (0.92) and adequate specificity (0.75) for identifying COVID-19 psychological distress among postacute and long-term care residents (area under the curve of 0.89, positive predictive value=0.79, negative predictive value=0.91). Conclusions: The M5 is a reliable and valid tool for self-assessment of mood that can help identify postacute and long-term care residents with significant psychological burden associated with COVID-19. It can be completed in less than 1 minute and is appropriate for use in both in-person and virtual visits. %M 33640866 %R 10.2196/26340 %U https://aging.jmir.org/2021/1/e26340 %U https://doi.org/10.2196/26340 %U http://www.ncbi.nlm.nih.gov/pubmed/33640866 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e24673 %T Behavioral Intention to Receive a COVID-19 Vaccination Among Chinese Factory Workers: Cross-sectional Online Survey %A Zhang,Ke Chun %A Fang,Yuan %A Cao,He %A Chen,Hongbiao %A Hu,Tian %A Chen,Yaqi %A Zhou,Xiaofeng %A Wang,Zixin %+ JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Room 508, School of Public Health, Prince of Wales Hospital, Shatin, N.T., Hong Kong, 666888, China, 852 22528740, wangzx@cuhk.edu.hk %K COVID-19 %K vaccination %K behavioral intention %K perception %K social media influence %K personal preventive behaviors %K factory workers %K China %K social media %K vaccine %K behavior %K intention %K risk %D 2021 %7 9.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: COVID-19 vaccines will become available in China soon. Understanding communities’ responses to the forthcoming COVID-19 vaccines is important. We applied the theory of planned behavior as the theoretical framework. Objective: This study investigates the prevalence of and factors associated with behavioral intention to receive self-financed or free COVID-19 vaccinations among Chinese factory workers who resumed work during the pandemic. We examined the effects of factors including sociodemographics, perceptions related to COVID-19 vaccination, exposure to information about COVID-19 vaccination through social media, and COVID-19 preventive measures implemented by individuals and factories. Methods: Participants were full-time employees 18 years or older who worked in factories in Shenzhen. Factory workers in Shenzhen are required to receive a physical examination annually. Eligible workers attending six physical examination sites were invited to complete a survey on September 1-7, 2020. Out of 2653 eligible factory workers, 2053 (77.4%) completed the online survey. Multivariate two-level logistic regression models and ordinal logistic regression models were fitted. Results: The prevalence of behavioral intention to receive a COVID-19 vaccination was 66.6% (n=1368, conditional on 80% vaccine efficacy and market rate) and 80.6% (n=1655, conditional on 80% vaccine efficacy and free vaccines). After adjusting for significant background characteristics, positive attitudes toward COVID-19 vaccination (adjusted odds ratio [AOR] 1.20, 95% CI 1.15-1.25 and AOR 1.24, 95% CI 1.19-1.30), perceived support from significant others for getting a COVID-19 vaccination (AOR 1.43, 95% CI 1.32-1.55 and AOR 1.37, 95% CI 1.25-1.50), and perceived behavioral control to get a COVID-19 vaccination (AOR 1.51, 95% CI 1.32-1.73 and AOR 1.28, 95% CI 1.09-1.51) were positively associated with both dependent variables (conditional on 80% vaccine efficacy and market rate or free vaccines, respectively). Regarding social media influence, higher frequency of exposure to positive information related to COVID-19 vaccination was associated with a higher intention to receive a COVID-19 vaccination at market rate (AOR 1.53, 95% CI 1.39-1.70) or a free vaccination (AOR 1.52, 95% CI 1.35-1.71). Higher self-reported compliance with wearing a face mask in the workplace (AOR 1.27, 95% CI 1.02-1.58 and AOR 1.67, 95% CI 1.24-2.27) and other public spaces (AOR 1.80, 95% CI 1.42-2.29 and AOR 1.34, 95% CI 1.01-1.77), hand hygiene (AOR 1.21, 95% CI 1.00-1.47 and AOR 1.52, 95% CI 1.19-1.93), and avoiding social gatherings (AOR 1.22, 95% CI 1.01-1.47 and AOR 1.55, 95% CI 1.23-1.95) and crowded places (AOR 1.24, 95% CI 1.02-1.51 and AOR 1.73, 95% CI 1.37-2.18) were also positively associated with both dependent variables. The number of COVID-19 preventive measures implemented by the factory was positively associated with the intention to receive a COVID-19 vaccination under both scenarios (AOR 1.08, 95% CI 1.04-1.12 and AOR 1.06, 95% CI 1.01-1.11). Conclusions: Factory workers in China reported a high behavioral intention to receive a COVID-19 vaccination. The theory of planned behavior is a useful framework to guide the development of future campaigns promoting COVID-19 vaccination. %M 33646966 %R 10.2196/24673 %U https://www.jmir.org/2021/3/e24673 %U https://doi.org/10.2196/24673 %U http://www.ncbi.nlm.nih.gov/pubmed/33646966 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e21064 %T Virtual Health Care for Community Management of Patients With COVID-19 in Australia: Observational Cohort Study %A Hutchings,Owen Rhys %A Dearing,Cassandra %A Jagers,Dianna %A Shaw,Miranda Jane %A Raffan,Freya %A Jones,Aaron %A Taggart,Richard %A Sinclair,Tim %A Anderson,Teresa %A Ritchie,Angus Graham %+ Sydney Local Health District, Missenden Road, Camperdown, 2050, Australia, 61 2 9767 6447, angus.ritchie@health.nsw.gov.au %K COVID-19 %K digital health %K health %K informatics %K remote monitoring %K telehealth %K virtual health care %D 2021 %7 9.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Australia has successfully controlled the COVID-19 pandemic. Similar to other high-income countries, Australia has extensively used telehealth services. Virtual health care, including telemedicine in combination with remote patient monitoring, has been implemented in certain settings as part of new models of care that are aimed at managing patients with COVID-19 outside the hospital setting. Objective: This study aimed to describe the implementation of and early experience with virtual health care for community management of patients with COVID-19. Methods: This observational cohort study was conducted with patients with COVID-19 who availed of a large Australian metropolitan health service with an established virtual health care program capable of monitoring patients remotely. We included patients with COVID-19 who received the health service, could self-isolate safely, did not require immediate admission to an in-patient setting, had no major active comorbid illness, and could be managed at home or at other suitable sites. Skin temperature, pulse rate, and blood oxygen saturation were remotely monitored. The primary outcome measures were care escalation rates, including emergency department presentation, and hospital admission. Results: During March 11-29, 2020, a total of 162 of 173 (93.6%) patients with COVID-19 (median age 38 years, range 11-79 years), who were diagnosed locally, were enrolled in the virtual health care program. For 62 of 162 (38.3%) patients discharged during this period, the median length of stay was 8 (range 1-17) days. The peak of 100 prevalent patients equated to approximately 25 patients per registered nurse per shift. Patients were contacted a median of 16 (range 1-30) times during this period. Video consultations (n=1902, 66.3%) comprised most of the patient contacts, and 132 (81.5%) patients were monitored remotely. Care escalation rates were low, with an ambulance attendance rate of 3% (n=5), emergency department attendance rate of 2.5% (n=4), and hospital admission rate of 1.9% (n=3). No deaths were recorded. Conclusions: Community-based virtual health care is safe for managing most patients with COVID-19 and can be rapidly implemented in an urban Australian setting for pandemic management. Health services implementing virtual health care should anticipate challenges associated with rapid technology deployments and provide adequate support to resolve them, including strategies to support the use of health information technologies among consumers. %M 33687341 %R 10.2196/21064 %U https://www.jmir.org/2021/3/e21064 %U https://doi.org/10.2196/21064 %U http://www.ncbi.nlm.nih.gov/pubmed/33687341 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 3 %P e24843 %T Early Improvement of Acute Respiratory Distress Syndrome in Patients With COVID-19 in the Intensive Care Unit: Retrospective Analysis %A Zhan,Zhu %A Yang,Xin %A Du,Hu %A Zhang,Chuanlai %A Song,Yuyan %A Ran,Xiaoyun %A Zhang,An %A Yang,Mei %+ Department of Intensive Care Unit, The Second Affiliated Hospital of Chongqing Medical University, 76 Linjiang Rd, Yuzhong District, Chongqing, 600010, China, 86 63693449, zhangan@hospital.cqmu.edu.cn %K acute respiratory distress syndrome %K ARDS %K Chongqing %K COVID-19 %K critically ill %K intensive care unit %K outcome %K characteristic %K mortality %K epidemiology %K improvement %D 2021 %7 9.3.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Since the start of the COVID-19 pandemic, there have been over 2 million deaths globally. Acute respiratory distress syndrome (ARDS) may be the main cause of death. Objective: This study aimed to describe the clinical features, outcomes, and ARDS characteristics of patients with COVID-19 admitted to the intensive care unit (ICU) in Chongqing, China. Methods: The epidemiology of COVID-19 from January 21, 2020, to March 15, 2020, in Chongqing, China, was analyzed retrospectively, and 75 ICU patients from two hospitals were included in this study. On day 1, 56 patients with ARDS were selected for subgroup analysis, and a modified Poisson regression was performed to identify predictors for the early improvement of ARDS (eiARDS). Results: Chongqing reported a 5.3% case fatality rate for the 75 ICU patients. The median age of these patients was 57 (IQR 25-75) years, and no bias was present in the sex ratio. A total of 93% (n=70) of patients developed ARDS during ICU stay, and more than half had moderate ARDS. However, most patients (n=41, 55%) underwent high-flow nasal cannula oxygen therapy, but not mechanical ventilation. Nearly one-third of patients with ARDS improved (arterial blood oxygen partial pressure/oxygen concentration >300 mm Hg) in 1 week, which was defined as eiARDS. Patients with eiARDS had a higher survival rate and a shorter length of ICU stay than those without eiARDS. Age (<55 years) was the only variable independently associated with eiARDS, with a risk ratio of 2.67 (95% CI 1.17-6.08). Conclusions: A new subphenotype of ARDS—eiARDS—in patients with COVID-19 was identified. As clinical outcomes differ, the stratified management of patients based on eiARDS or age is highly recommended. %M 33630743 %R 10.2196/24843 %U https://publichealth.jmir.org/2021/3/e24843 %U https://doi.org/10.2196/24843 %U http://www.ncbi.nlm.nih.gov/pubmed/33630743 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 9 %N 3 %P e18933 %T Regional Resource Assessment During the COVID-19 Pandemic in Italy: Modeling Study %A Guzzi,Pietro H %A Tradigo,Giuseppe %A Veltri,Pierangelo %+ Department of Surgical and Medical Sciences, University of Catanzaro, Catanzaro, CZ, , Italy, 39 09613694148, hguzzi@unicz.it %K COVID-19 %K data analysis %K ICU %K management %K intensive care unit %K pandemic %K outbreak %K infectious disease %K resource %K planning %D 2021 %7 9.3.2021 %9 Original Paper %J JMIR Med Inform %G English %X Background: COVID-19 has been declared a worldwide emergency and a pandemic by the World Health Organization. It started in China in December 2019, and it rapidly spread throughout Italy, which was the most affected country after China. The pandemic affected all countries with similarly negative effects on the population and health care structures. Objective: The evolution of the COVID-19 infections and the way such a phenomenon can be characterized in terms of resources and planning has to be considered. One of the most critical resources has been intensive care units (ICUs) with respect to the infection trend and critical hospitalization. Methods: We propose a model to estimate the needed number of places in ICUs during the most acute phase of the infection. We also define a scalable geographic model to plan emergency and future management of patients with COVID-19 by planning their reallocation in health structures of other regions. Results: We applied and assessed the prediction method both at the national and regional levels. ICU bed prediction was tested with respect to real data provided by the Italian government. We showed that our model is able to predict, with a reliable error in terms of resource complexity, estimation parameters used in health care structures. In addition, the proposed method is scalable at different geographic levels. This is relevant for pandemics such as COVID-19, which has shown different case incidences even among northern and southern Italian regions. Conclusions: Our contribution can be useful for decision makers to plan resources to guarantee patient management, but it can also be considered as a reference model for potential upcoming waves of COVID-19 and similar emergency situations. %M 33629957 %R 10.2196/18933 %U https://medinform.jmir.org/2021/3/e18933 %U https://doi.org/10.2196/18933 %U http://www.ncbi.nlm.nih.gov/pubmed/33629957 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 3 %P e27107 %T An Acute Stress Scale for Health Care Professionals Caring for Patients With COVID-19: Validation Study %A Mira,Jose Joaquin %A Cobos,Angel %A Martínez García,Olga %A Bueno Domínguez,María José %A Astier-Peña,María Pilar %A Pérez Pérez,Pastora %A Carrillo,Irene %A Guilabert,Mercedes %A Perez-Jover,Virtudes %A Fernandez,Cesar %A Vicente,María Asuncion %A Lahera-Martin,Matilde %A Silvestre Busto,Carmen %A Lorenzo Martínez,Susana %A Sanchez Martinez,Ascension %A Martin-Delgado,Jimmy %A Mula,Aurora %A Marco-Gomez,Barbara %A Abad Bouzan,Cristina %A Aibar-Remon,Carlos %A Aranaz-Andres,Jesus %A , %+ Atenea Research Group, Foundation for the Promotion of Health and Biomedical Research, Hermanos López de Osaba, Alicante, Spain, 34 606433599, jose.mira@umh.es %K SARS-CoV-2 virus %K COVID-19 outbreak %K medical staff %K acute stress %K moral injury %K posttraumatic stress %K COVID-19 %D 2021 %7 9.3.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic has affected the response capacity of the health care workforce, and health care professionals have been experiencing acute stress reactions since the beginning of the pandemic. In Spain, the first wave was particularly severe among the population and health care professionals, many of whom were infected. These professionals required initial psychological supports that were gradual and in line with their conditions. Objective: In the early days of the pandemic in Spain (March 2020), this study aimed to design and validate a scale to measure acute stress experienced by the health care workforce during the care of patients with COVID-19: the Self-applied Acute Stress Scale (EASE). Methods: Item development, scale development, and scale evaluation were considered. Qualitative research was conducted to produce the initial pool of items, assure their legibility, and assess the validity of the content. Internal consistency was calculated using Cronbach α and McDonald ω. Confirmatory factor analysis and the Mann-Whitney-Wilcoxon test were used to assess construct validity. Linear regression was applied to assess criterion validity. Back-translation methodology was used to translate the scale into Portuguese and English. Results: A total of 228 health professionals from the Spanish public health system responded to the 10 items of the EASE scale. Internal consistency was .87 (McDonald ω). Goodness-of-fit indices confirmed a two-factor structure, explaining 55% of the variance. As expected, the highest level of stress was found among professionals working in health services where a higher number of deaths from COVID-19 occurred (P<.05). Conclusions: The EASE scale was shown to have adequate metric properties regarding consistency and construct validity. The EASE scale could be used to determine the levels of acute stress among the health care workforce in order to give them proportional support according to their needs during emergency conditions, such as the COVID-19 pandemic. %M 33687343 %R 10.2196/27107 %U https://formative.jmir.org/2021/3/e27107 %U https://doi.org/10.2196/27107 %U http://www.ncbi.nlm.nih.gov/pubmed/33687343 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 3 %P e26168 %T Rapid Design and Delivery of an Experience-Based Co-designed Mobile App to Support the Mental Health Needs of Health Care Workers Affected by the COVID-19 Pandemic: Impact Evaluation Protocol %A Lewis,Matthew %A Palmer,Victoria J %A Kotevski,Aneta %A Densley,Konstancja %A O'Donnell,Meaghan L %A Johnson,Caroline %A Wohlgezogen,Franz %A Gray,Kathleen %A Robins-Browne,Kate %A Burchill,Luke %+ Department of Medicine, The University of Melbourne, Royal Melbourne Hospital, 4th Floor, Clinical Sciences Building, Parkville, 3050, Australia, 61 3 8344 7161, blj@unimelb.edu.au %K mental health %K mobile applications %K COVID-19 %K health personnel %K experience-based co-design %K impact %K evaluation %K digital interventions %K app %K intervention %K health care worker %K design %K delivery %K support %D 2021 %7 9.3.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: The COVID-19 pandemic has highlighted the importance of health care workers’ mental health and well-being for the successful function of the health care system. Few targeted digital tools exist to support the mental health of hospital-based health care workers, and none of them appear to have been led and co-designed by health care workers. Objective: RMHive is being led and developed by health care workers using experience-based co-design (EBCD) processes as a mobile app to support the mental health challenges posed by the COVID-19 pandemic to health care workers. We present a protocol for the impact evaluation for the rapid design and delivery of the RMHive mobile app. Methods: The impact evaluation will adopt a mixed methods design. Qualitative data from photo interviews undertaken with up to 30 health care workers and semistructured interviews conducted with up to 30 governance stakeholders will be integrated with qualitative and quantitative user analytics data and user-generated demographic and mental health data entered into the app. Analyses will address three evaluation questions related to engagement with the mobile app, implementation and integration of the app, and the impact of the app on individual mental health outcomes. The design and development will be described using the Mobile Health Evidence Reporting and Assessment guidelines. Implementation of the app will be evaluated using normalization process theory to analyze qualitative data from interviews combined with text and video analysis from the semistructured interviews. Mental health impacts will be assessed using the total score of the 4-item Patient Health Questionnaire (PHQ4) and subscale scores for the 2-item Patient Health Questionnaire for depression and the 2-item Generalized Anxiety Scale for anxiety. The PHQ4 will be completed at baseline and at 14 and 28 days. Results: The anticipated average use period of the app is 30 days. The rapid design will occur over four months using EBCD to collect qualitative data and develop app content. The impact evaluation will monitor outcome data for up to 12 weeks following hospital-wide release of the minimal viable product release. The study received funding and ethics approvals in June 2020. Outcome data is expected to be available in March 2021, and the impact evaluation is expected to be published mid-2021. Conclusions: The impact evaluation will examine the rapid design, development, and implementation of the RMHive app and its impact on mental health outcomes for health care workers. Findings from the impact evaluation will provide guidance for the integration of EBCD in rapid design and implementation processes. The evaluation will also inform future development and rollout of the app to support the mental health needs of hospital-based health care workers more widely. International Registered Report Identifier (IRRID): DERR1-10.2196/26168 %M 33635823 %R 10.2196/26168 %U https://www.researchprotocols.org/2021/3/e26168 %U https://doi.org/10.2196/26168 %U http://www.ncbi.nlm.nih.gov/pubmed/33635823 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e23703 %T A Comprehensive Overview of the COVID-19 Literature: Machine Learning–Based Bibliometric Analysis %A Abd-Alrazaq,Alaa %A Schneider,Jens %A Mifsud,Borbala %A Alam,Tanvir %A Househ,Mowafa %A Hamdi,Mounir %A Shah,Zubair %+ Division of Information and Computing Technology, College of Science and Engineering, Hamad Bin Khalifa University, Qatar Foundation, P.O. Box 5825, Doha Al Luqta St, Ar-Rayyan, Doha, 00000, Qatar, 974 55708549, zshah@hbku.edu.qa %K novel coronavirus disease %K COVID-19 %K SARS-CoV-2 %K 2019-nCoV %K bibliometric analysis %K literature %K machine learning %K research %K review %D 2021 %7 8.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Shortly after the emergence of COVID-19, researchers rapidly mobilized to study numerous aspects of the disease such as its evolution, clinical manifestations, effects, treatments, and vaccinations. This led to a rapid increase in the number of COVID-19–related publications. Identifying trends and areas of interest using traditional review methods (eg, scoping and systematic reviews) for such a large domain area is challenging. Objective: We aimed to conduct an extensive bibliometric analysis to provide a comprehensive overview of the COVID-19 literature. Methods: We used the COVID-19 Open Research Dataset (CORD-19) that consists of a large number of research articles related to all coronaviruses. We used a machine learning–based method to analyze the most relevant COVID-19–related articles and extracted the most prominent topics. Specifically, we used a clustering algorithm to group published articles based on the similarity of their abstracts to identify research hotspots and current research directions. We have made our software accessible to the community via GitHub. Results: Of the 196,630 publications retrieved from the database, we included 28,904 in our analysis. The mean number of weekly publications was 990 (SD 789.3). The country that published the highest number of COVID-19–related articles was China (2950/17,270, 17.08%). The highest number of articles were published in bioRxiv. Lei Liu affiliated with the Southern University of Science and Technology in China published the highest number of articles (n=46). Based on titles and abstracts alone, we were able to identify 1515 surveys, 733 systematic reviews, 512 cohort studies, 480 meta-analyses, and 362 randomized control trials. We identified 19 different topics covered among the publications reviewed. The most dominant topic was public health response, followed by clinical care practices during the COVID-19 pandemic, clinical characteristics and risk factors, and epidemic models for its spread. Conclusions: We provide an overview of the COVID-19 literature and have identified current hotspots and research directions. Our findings can be useful for the research community to help prioritize research needs and recognize leading COVID-19 researchers, institutes, countries, and publishers. Our study shows that an AI-based bibliometric analysis has the potential to rapidly explore a large corpus of academic publications during a public health crisis. We believe that this work can be used to analyze other eHealth-related literature to help clinicians, administrators, and policy makers to obtain a holistic view of the literature and be able to categorize different topics of the existing research for further analyses. It can be further scaled (for instance, in time) to clinical summary documentation. Publishers should avoid noise in the data by developing a way to trace the evolution of individual publications and unique authors. %M 33600346 %R 10.2196/23703 %U https://www.jmir.org/2021/3/e23703 %U https://doi.org/10.2196/23703 %U http://www.ncbi.nlm.nih.gov/pubmed/33600346 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e23231 %T Comparing Public Perceptions and Preventive Behaviors During the Early Phase of the COVID-19 Pandemic in Hong Kong and the United Kingdom: Cross-sectional Survey Study %A Bowman,Leigh %A Kwok,Kin On %A Redd,Rozlyn %A Yi,Yuanyuan %A Ward,Helen %A Wei,Wan In %A Atchison,Christina %A Wong,Samuel Yeung-Shan %+ JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Room 419, 4/F, JC School of Public Health and Primary Care Building, Prince of Wales Hospital, Shatin, New Territories, Hong Kong, Hong Kong, 852 22528405, kkokwok@cuhk.edu.hk %K COVID-19 %K novel coronavirus %K pandemic %K behavioural response %K risk perceptions %K anxiety %K comparative %K Hong Kong %K United Kingdom %D 2021 %7 8.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Given the public health responses to previous respiratory disease pandemics, and in the absence of treatments and vaccines, the mitigation of the COVID-19 pandemic relies on population engagement in nonpharmaceutical interventions. This engagement is largely driven by risk perception, anxiety levels, and knowledge, as well as by historical exposure to disease outbreaks, government responses, and cultural factors. Objective: The aim of this study is to compare psychobehavioral responses in Hong Kong and the United Kingdom during the early phase of the COVID-19 pandemic. Methods: Comparable cross-sectional surveys were administered to adults in Hong Kong and the United Kingdom during the early phase of the epidemic in each setting. Explanatory variables included demographics, risk perception, knowledge of COVID-19, anxiety level, and preventive behaviors. Responses were weighted according to census data. Logistic regression models, including effect modification to quantify setting differences, were used to assess the association between the explanatory variables and the adoption of social distancing measures. Results: Data from 3431 complete responses (Hong Kong, 1663; United Kingdom, 1768) were analyzed. Perceived severity of symptoms differed by setting, with weighted percentages of 96.8% for Hong Kong (1621/1663) and 19.9% for the United Kingdom (366/1768). A large proportion of respondents were abnormally or borderline anxious (Hong Kong: 1077/1603, 60.0%; United Kingdom: 812/1768, 46.5%) and regarded direct contact with infected individuals as the transmission route of COVID-19 (Hong Kong: 94.0%-98.5%; United Kingdom: 69.2%-93.5%; all percentages weighted), with Hong Kong identifying additional routes. Hong Kong reported high levels of adoption of various social distancing measures (Hong Kong: 32.6%-93.7%; United Kingdom: 17.6%-59.0%) and mask-wearing (Hong Kong: 98.8% (1647/1663); United Kingdom: 3.1% (53/1768)). The impact of perceived severity of symptoms and perceived ease of transmission of COVID-19 on the adoption of social distancing measures varied by setting. In Hong Kong, these factors had no impact, whereas in the United Kingdom, those who perceived their symptom severity as “high” were more likely to adopt social distancing (adjusted odds ratios [aORs] 1.58-3.01), and those who perceived transmission as “easy” were prone to adopt both general social distancing (aOR 2.00, 95% CI 1.57-2.55) and contact avoidance (aOR 1.80, 95% CI 1.41-2.30). The impact of anxiety on adopting social distancing did not vary by setting. Conclusions: Our results suggest that health officials should ascertain baseline levels of risk perception and knowledge in populations, as well as prior sensitization to infectious disease outbreaks, during the development of mitigation strategies. Risk should be communicated through suitable media channels—and trust should be maintained—while early intervention remains the cornerstone of effective outbreak response. %M 33539309 %R 10.2196/23231 %U https://www.jmir.org/2021/3/e23231 %U https://doi.org/10.2196/23231 %U http://www.ncbi.nlm.nih.gov/pubmed/33539309 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 8 %N 1 %P e25724 %T Collaboration Structures in COVID-19 Critical Care: Retrospective Network Analysis Study %A Yan,Chao %A Zhang,Xinmeng %A Gao,Cheng %A Wilfong,Erin %A Casey,Jonathan %A France,Daniel %A Gong,Yang %A Patel,Mayur %A Malin,Bradley %A Chen,You %+ Department of Biomedical Informatics, Vanderbilt University Medical Center, 2525 West End Ave, Nashville, TN, 37203, United States, 1 615 343 1939, you.chen@vanderbilt.edu %K COVID-19 %K intensive care unit %K collaboration structure %K critically ill patient %K health care worker %K network analysis %K electronic health record %K collaboration %K critical care %K relationship %K safety %K teamwork %D 2021 %7 8.3.2021 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Few intensive care unit (ICU) staffing studies have examined the collaboration structures of health care workers (HCWs). Knowledge about how HCWs are connected to the care of critically ill patients with COVID-19 is important for characterizing the relationships among team structures, care quality, and patient safety. Objective: We aimed to discover differences in the teamwork structures of COVID-19 critical care by comparing HCW collaborations in the management of critically ill patients with and without COVID-19. Methods: In this retrospective study, we used network analysis methods to analyze the electronic health records (EHRs) of 76 critically ill patients (with COVID-19: n=38; without COVID-19: n=38) who were admitted to a large academic medical center, and to learn about HCW collaboration. We used the EHRs of adult patients who were admitted to the COVID-19 ICU at the Vanderbilt University Medical Center (Nashville, Tennessee, United States) between March 17, 2020, and May 31, 2020. We matched each patient according to age, gender, and their length of stay. Patients without COVID-19 were admitted to the medical ICU between December 1, 2019, and February 29, 2020. We used two sociometrics—eigencentrality and betweenness—to quantify HCWs’ statuses in networks. Eigencentrality characterizes the degree to which an HCW is a core person in collaboration structures. Betweenness centrality refers to whether an HCW lies on the path of other HCWs who are not directly connected. This sociometric was used to characterize HCWs’ broad skill sets. We measured patient staffing intensity in terms of the number of HCWs who interacted with patients’ EHRs. We assessed the statistical differences in the core and betweenness statuses of HCWs and the patient staffing intensities of COVID-19 and non–COVID-19 critical care, by using Mann-Whitney U tests and reporting 95% CIs. Results: HCWs in COVID-19 critical care were more likely to frequently work with each other (eigencentrality: median 0.096) than those in non–COVID-19 critical care (eigencentrality: median 0.057; P<.001). Internal medicine physicians in COVID-19 critical care had higher core statuses than those in non–COVID-19 critical care (P=.001). Nurse practitioners in COVID-19 care had higher betweenness statuses than those in non–COVID-19 care (P<.001). Compared to HCWs in non–COVID-19 settings, the EHRs of critically ill patients with COVID-19 were used by a larger number of internal medicine nurse practitioners (P<.001), cardiovascular nurses (P<.001), and surgical ICU nurses (P=.002) and a smaller number of resident physicians (P<.001). Conclusions: Network analysis methodologies and data on EHR use provide a novel method for learning about differences in collaboration structures between COVID-19 and non–COVID-19 critical care. Health care organizations can use this information to learn about the novel changes that the COVID-19 pandemic has imposed on collaboration structures in urgent care. %M 33621187 %R 10.2196/25724 %U https://humanfactors.jmir.org/2021/1/e25724 %U https://doi.org/10.2196/25724 %U http://www.ncbi.nlm.nih.gov/pubmed/33621187 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e26482 %T Understanding Concerns, Sentiments, and Disparities Among Population Groups During the COVID-19 Pandemic Via Twitter Data Mining: Large-scale Cross-sectional Study %A Zhang,Chunyan %A Xu,Songhua %A Li,Zongfang %A Hu,Shunxu %+ Institute of Medical Artificial Intelligence, The Second Affiliate Hospital of Xi’an Jiaotong University, No.157 Xiwu Road, Xi'an, China, 86 18710823698, songhua_xu1@163.com %K COVID-19 %K Twitter mining %K infodemiology %K infoveillance %K pandemic %K concerns %K sentiments %K population groups %K disparities %D 2021 %7 5.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Since the beginning of the COVID-19 pandemic in late 2019, its far-reaching impacts have been witnessed globally across all aspects of human life, such as health, economy, politics, and education. Such widely penetrating impacts cast significant and profound burdens on all population groups, incurring varied concerns and sentiments among them. Objective: This study aims to identify the concerns, sentiments, and disparities of various population groups during the COVID-19 pandemic through a cross-sectional study conducted via large-scale Twitter data mining infoveillance. Methods: This study consisted of three steps: first, tweets posted during the pandemic were collected and preprocessed on a large scale; second, the key population attributes, concerns, sentiments, and emotions were extracted via a collection of natural language processing procedures; third, multiple analyses were conducted to reveal concerns, sentiments, and disparities among population groups during the pandemic. Overall, this study implemented a quick, effective, and economical approach for analyzing population-level disparities during a public health event. The source code developed in this study was released for free public use at GitHub. Results: A total of 1,015,655 original English tweets posted from August 7 to 12, 2020, were acquired and analyzed to obtain the following results. Organizations were significantly more concerned about COVID-19 (odds ratio [OR] 3.48, 95% CI 3.39-3.58) and expressed more fear and depression emotions than individuals. Females were less concerned about COVID-19 (OR 0.73, 95% CI 0.71-0.75) and expressed less fear and depression emotions than males. Among all age groups (ie, ≤18, 19-29, 30-39, and ≥40 years of age), the attention ORs of COVID-19 fear and depression increased significantly with age. It is worth noting that not all females paid less attention to COVID-19 than males. In the age group of 40 years or older, females were more concerned than males, especially regarding the economic and education topics. In addition, males 40 years or older and 18 years or younger were the least positive. Lastly, in all sentiment analyses, the sentiment polarities regarding political topics were always the lowest among the five topics of concern across all population groups. Conclusions: Through large-scale Twitter data mining, this study revealed that meaningful differences regarding concerns and sentiments about COVID-19-related topics existed among population groups during the study period. Therefore, specialized and varied attention and support are needed for different population groups. In addition, the efficient analysis method implemented by our publicly released code can be utilized to dynamically track the evolution of each population group during the pandemic or any other major event for better informed public health research and interventions. %M 33617460 %R 10.2196/26482 %U https://www.jmir.org/2021/3/e26482 %U https://doi.org/10.2196/26482 %U http://www.ncbi.nlm.nih.gov/pubmed/33617460 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 3 %P e23843 %T A Patient-Initiated Digital COVID-19 Contact Notification Tool (TellYourContacts): Evaluation Study %A Okpara,Kelechi S %A Hecht,Jennifer %A Wohlfeiler,Dan %A Prior,Matthew %A Klausner,Jeffrey D %+ David Geffen School of Medicine, University of California, Los Angeles, 10833 Le Conte Ave, Los Angeles, CA, United States, 1 (310) 825 6373, kokpara@mednet.ucla.edu %K patient-led digital contact notification %K COVID-19 %K digital contact tracing %K contact notification website %D 2021 %7 5.3.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Contact notification is a method used to control the spread of infectious disease. In this process, a patient who tests positive for an infectious disease and public health officials work to identify the patient’s close contacts, notify them of their risk of possible exposure to the disease, and provide resources to facilitate the decreased spreading of disease. Contact notification can be done physically in person, via phone call, or digitally through the use of media such as SMS text messages and email. When alerts are made through the latter, it is called digital contact notification. Objective: For this study, we aim to perform a preliminary evaluation of the use of the TellYourContacts website, a digital contact notification tool for COVID-19 that can be used confidentially and anonymously. We will gather information about the number of website users and message senders, the types of messages sent, and the geographic distribution of senders. Methods: Patients who chose to get tested for COVID-19 and subsequently tested positive for the disease were alerted of their positive results through Curative Inc (a COVID-19 testing laboratory) and Healthvana (a results disclosure app). Included in the notification was a link to the TellYourContacts website and a message encouraging the person who tested positive for COVID-19 to use the website to alert their close contacts of exposure risk. Over the course of three months, from May 18, 2020, to August 17, 2020, we used Google Analytics and Microsoft Excel to record data on the number of website users and message senders, types of messages sent, and geographic distribution of the senders. Results: Over the course of three months, 9130 users accessed the website and 1474 unique senders sent a total of 1957 messages, which included 1820 (93%) SMS text messages and 137 (7%) emails. Users sent messages from 40 US states, with the majority of US senders residing in California (49%). Conclusions: We set out to determine if individuals who test positive for COVID-19 will use the TellYourContacts website to notify their close contacts of COVID-19 exposure risk. Our findings reveal that, during the observation period, each unique sender sent an average of 1.33 messages. The TellYourContacts website offers an additional method that individuals can and will use to notify their close contacts about a recent COVID-19 diagnosis. %M 33621189 %R 10.2196/23843 %U https://formative.jmir.org/2021/3/e23843 %U https://doi.org/10.2196/23843 %U http://www.ncbi.nlm.nih.gov/pubmed/33621189 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 3 %P e25220 %T Preservation of Person-Centered Care Through Videoconferencing for Patient Follow-up During the COVID-19 Pandemic: Case Study of a Multidisciplinary Care Team %A Silsand,Line %A Severinsen,Gro-Hilde %A Berntsen,Gro %+ Norwegian Centre for E-health Research, Sykehusveien 23, Tromsø, 9019, Norway, 47 91335053, line.silsand@ehealthresearch.no %K person-centered care %K rapid digitalization %K health care %K videoconferencing %K persons with complex, long-term needs %K COVID-19 %D 2021 %7 5.3.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The Patient-Centered Team (PACT) focuses on the transitional phase between hospital and primary care for older patients in Northern Norway with complex and long-term needs. PACT emphasizes a person-centered care approach whereby the sharing of power and the patient’s response to “What matters to you?” drive care decisions. However, during the COVID-19 pandemic, videoconferencing was the only option for assessing, planning, coordinating, and performing treatment and care. Objective: The aim of this study is to report the experience of the PACT multidisciplinary health care team in shifting rapidly from face-to-face care to using videoconferencing for clinical and collaborative services during the initial phase of the COVID-19 pandemic. This study explores how PACT managed to maintain person-centered care under these conditions. Methods: This case study takes a qualitative approach based on four semistructured focus group interviews carried out in May and June 2020 with 19 PACT members and leaders. Results: The case study illustrates that videoconferencing is a good solution for many persons with complex and long-term needs and generates new opportunities for interaction between patients and health care personnel. Persons with complex and long-term needs are a heterogeneous group, and for many patients with reduced cognitive capacity or hearing and vision impairment, the use of videoconferencing was challenging and required support from relatives or health care personnel. The study shows that using videoconferencing offered an opportunity to use health care personnel more efficiently, reduce travelling time for patients, and improve the information exchange between health care levels. This suggests that the integration of videoconferencing contributed to the preservation of the person-centered focus on care during the COVID-19 pandemic. There was an overall agreement in PACT that face-to-face care needed to be at the core of the person-centered care approach; the main use of videoconferencing was to support follow-up and coordination. Conclusions: The COVID-19 pandemic and the rapid adoption of digital care have generated a unique opportunity to continue developing a health service to both preserve and improve the person-centered care approach for persons with complex and long-term needs. This creates demand for overall agreements, including guidelines and procedures for how and when to use videoconferencing to supplement face-to-face treatment and care. Implementing videoconferencing in clinical practice generates a need for systematic training and familiarization with the equipment and technology as well as for an extensive support organization. Videoconferencing can then contribute to better preparing health care services for future scenarios. %M 33646965 %R 10.2196/25220 %U https://formative.jmir.org/2021/3/e25220 %U https://doi.org/10.2196/25220 %U http://www.ncbi.nlm.nih.gov/pubmed/33646965 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 3 %P e26702 %T Going Remote—Demonstration and Evaluation of Remote Technology Delivery and Usability Assessment With Older Adults: Survey Study %A Hill,Jordan R %A Harrington,Addison B %A Adeoye,Philip %A Campbell,Noll L %A Holden,Richard J %+ Department of Medicine, Indiana University School of Medicine, 1101 W 10th St, Indianapolis, IN, 46202, United States, 1 7655438559, jrh6@iu.edu %K COVID-19 %K mobile usability testing %K usability inspection %K methods %K aging %K agile %K mobile phone %D 2021 %7 4.3.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The COVID-19 pandemic necessitated “going remote” with the delivery, support, and assessment of a study intervention targeting older adults enrolled in a clinical trial. While remotely delivering and assessing technology is not new, there are few methods available in the literature that are proven to be effective with diverse populations, and none for older adults specifically. Older adults comprise a diverse population, including in terms of their experience with and access to technology, making this a challenging endeavor. Objective: Our objective was to remotely deliver and conduct usability testing for a mobile health (mHealth) technology intervention for older adult participants enrolled in a clinical trial of the technology. This paper describes the methodology used, its successes, and its limitations. Methods: We developed a conceptual model for remote operations, called the Framework for Agile and Remote Operations (FAR Ops), that combined the general requirements for spaceflight operations with Agile project management processes to quickly respond to this challenge. Using this framework, we iteratively created care packages that differed in their contents based on participant needs and were sent to study participants to deliver the study intervention—a medication management app—and assess its usability. Usability data were collected using the System Usability Scale (SUS) and a novel usability questionnaire developed to collect more in-depth data. Results: In the first 6 months of the project, we successfully delivered 21 care packages. We successfully designed and deployed a minimum viable product in less than 6 weeks, generally maintained a 2-week sprint cycle, and achieved a 40% to 50% return rate for both usability assessment instruments. We hypothesize that lack of engagement due to the pandemic and our use of asynchronous communication channels contributed to the return rate of usability assessments being lower than desired. We also provide general recommendations for performing remote usability testing with diverse populations based on the results of our work, including implementing screen sharing capabilities when possible, and determining participant preference for phone or email communications. Conclusions: The FAR Ops model allowed our team to adopt remote operations for our mHealth trial in response to interruptions from the COVID-19 pandemic. This approach can be useful for other research or practice-based projects under similar circumstances or to improve efficiency, cost, effectiveness, and participant diversity in general. In addition to offering a replicable approach, this paper tells the often-untold story of practical challenges faced by mHealth projects and practical strategies used to address them. Trial Registration: ClinicalTrials.gov NCT04121858; https://clinicaltrials.gov/ct2/show/NCT04121858 %M 33606655 %R 10.2196/26702 %U https://mhealth.jmir.org/2021/3/e26702 %U https://doi.org/10.2196/26702 %U http://www.ncbi.nlm.nih.gov/pubmed/33606655 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e25726 %T Adoption of COVID-19 Contact Tracing Apps: A Balance Between Privacy and Effectiveness %A Seto,Emily %A Challa,Priyanka %A Ware,Patrick %+ Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, 155 College Street, Suite 425, Toronto, ON, M5T 3M6, Canada, 1 416 669 9295, emily.seto@utoronto.ca %K mobile apps %K COVID-19 %K contact tracing %K exposure notification %K privacy %K effectiveness %K app %K surveillance %K tracing %K transmission %K security %K digital health %D 2021 %7 4.3.2021 %9 Viewpoint %J J Med Internet Res %G English %X With the relative ubiquity of smartphones, contact tracing and exposure notification apps have been looked to as novel methods to help reduce the transmission of COVID-19. Many countries have created apps that lie across a spectrum from privacy-first approaches to those that have very few privacy measures. The level of privacy incorporated into an app is largely based on the societal norms and values of a particular country. Digital health technologies can be highly effective and preserve privacy at the same time, but in the case of contact tracing and exposure notification apps, there is a trade-off between increased privacy measures and the effectiveness of the app. In this article, examples from various countries are used to highlight how characteristics of contract tracing and exposure notification apps contribute to the perceived levels of privacy awarded to citizens and how this impacts an app’s effectiveness. We conclude that finding the right balance between privacy and effectiveness, while critical, is challenging because it is highly context-specific. %M 33617459 %R 10.2196/25726 %U https://www.jmir.org/2021/3/e25726 %U https://doi.org/10.2196/25726 %U http://www.ncbi.nlm.nih.gov/pubmed/33617459 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 3 %P e24795 %T Bridging Learning in Medicine and Citizenship During the COVID-19 Pandemic: A Telehealth-Based Case Study %A Cerqueira-Silva,Thiago %A Carreiro,Roberto %A Nunes,Victor %A Passos,Louran %A Canedo,Bernardo F %A Andrade,Sofia %A Ramos,Pablo Ivan P %A Khouri,Ricardo %A Santos,Carolina Barbosa Souza %A Nascimento,Jedson Dos Santos %A Paste,Aurea Angélica %A Paiva Filho,Ivan De Mattos %A Santini-Oliveira,Marília %A Cruz,Álvaro %A Barral-Netto,Manoel %A Boaventura,Viviane %+ Universidade Federal da Bahia, Av. Adhemar de Barros, s/nº - Ondina, Salvador, 40170-110, Brazil, 55 (71) 3283 6017, viviane.boaventura@fiocruz.br %K medical education %K surveillance %K COVID-19 %K education %K telehealth %K training %K impact %K medical student %K triage %K epidemiology %K monitoring %D 2021 %7 4.3.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: COVID-19 presented great challenges for not only those in the field of health care but also those undergoing medical training. The burden on health care services worldwide has limited the educational opportunities available for medical students due to social distancing requirements. Objective: In this paper, we describe a strategy that combines telehealth and medical training to mitigate the adverse effects of the COVID-19 pandemic. Methods: A toll-free telescreening service, Telecoronavirus, began operations in March 2020. This service was operated remotely by supervised medical students and was offered across all 417 municipalities (14.8 million inhabitants) in the Brazilian state of Bahia. Students recorded clinical and sociodemographic data by using a web-based application that was simultaneously accessed by medical volunteers for supervision purposes, as well as by state health authorities who conducted epidemiological surveillance and health management efforts. In parallel, students received up-to-date scientific information about COVID-19 via short educational videos prepared by professors. A continuously updated triage algorithm was conceived to provide consistent service. Results: The program operated for approximately 4 months, engaging 1396 medical students and 133 physicians. In total, 111,965 individuals residing in 343 municipalities used this service. Almost 70,000 individuals were advised to stay at home, and they received guidance to avoid disease transmission, potentially contributing to localized reductions in the spread of COVID-19. Additionally, the program promoted citizenship education for medical students, who were engaged in a real-life opportunity to fight the pandemic within their own communities. The objectives of the education, organization, and assistance domains of the Telecoronavirus program were successfully achieved according to the results of a web-based post-project survey that assessed physicians’ and students’ perceptions. Conclusions: In a prolonged pandemic scenario, a combination of remote tools and medical supervision via telehealth services may constitute a useful strategy for maintaining social distancing measures while preserving some practical aspects of medical education. A low-cost tool such as the Telecoronavirus program could be especially valuable in resource-limited health care scenarios, in addition to offering support for epidemiological surveillance actions. %M 33630746 %R 10.2196/24795 %U https://publichealth.jmir.org/2021/3/e24795 %U https://doi.org/10.2196/24795 %U http://www.ncbi.nlm.nih.gov/pubmed/33630746 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 3 %P e24211 %T Molecular and Cellular Biomarkers of COVID-19 Prognosis: Protocol for the Prospective Cohort TARGET Study %A Kurizky,Patricia %A Nóbrega,Otávio T %A Soares,Alexandre Anderson De Sousa Munhoz %A Aires,Rodrigo Barbosa %A Albuquerque,Cleandro Pires De %A Nicola,André Moraes %A Albuquerque,Patrícia %A Teixeira-Carvalho,Andréa %A Naves,Luciana Ansaneli %A Fontes,Wagner %A Luz,Isabelle Souza %A Felicori,Liza %A Gomides,Ana Paulo Monteiro %A Mendonça-Silva,Dayde Lane %A Espindola,Laila Salmen %A Martins-Filho,Olindo Assis %A de Lima,Sheila Maria Barbosa %A Mota,Licia Maria Henrique %A Gomes,Ciro Martins %+ Programa de Pós-graduação em Ciências Médicas da Faculdade de Medicina, University of Brasília, Laboratório de Dermatomicologia - Faculdade de Medicina da UnB, Campus Universitário Darcy Ribeiro, Brasilia, 70910-900, Brazil, 55 61 98114 8432, patyshu79@gmail.com %K COVID-19 %K TARGET %K cytokine profile %K neutrophil function %K thromboelastometry %K neutralizing antibodies %K metabolomics %K proteomics %K biomarker %K prognosis %K design %K cohort %K virus %K immunology %K immune system %K genetics %D 2021 %7 4.3.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Since the beginning of the COVID-19 pandemic, the world’s attention has been focused on better understanding the relation between the human host and the SARS-CoV-2 virus, as its action has led to hundreds of thousands of deaths. Objective: In this context, we decided to study certain consequences of the abundant cytokine release over the innate and adaptive immune systems, inflammation, and hemostasis, comparing mild and severe forms of COVID-19. Methods: To accomplish these aims, we will analyze demographic characteristics, biochemical tests, immune biomarkers, leukocyte phenotyping, immunoglobulin profile, hormonal release (cortisol and prolactin), gene expression, thromboelastometry, neutralizing antibodies, metabolic profile, and neutrophil function (reactive oxygen species production, neutrophil extracellular trap production, phagocytosis, migration, gene expression, and proteomics). A total of 200 reverse transcription polymerase chain reaction–confirmed patients will be enrolled and divided into two groups: mild/moderate or severe/critical forms of COVID-19. Blood samples will be collected at different times: at inclusion and after 9 and 18 days, with an additional 3-day sample for severe patients. We believe that this information will provide more knowledge for future studies that will provide more robust and useful clinical information that may allow for better decisions at the front lines of health care. Results: The recruitment began in June 2020 and is still in progress. It is expected to continue until February 2021. Data analysis is scheduled to start after all data have been collected. The coagulation study branch is complete and is already in the analysis phase. Conclusions: This study is original in terms of the different parameters analyzed in the same sample of patients with COVID-19. The project, which is currently in the data collection phase, was approved by the Brazilian Committee of Ethics in Human Research (CAAE 30846920.7.0000.0008). Trial Registration: Brazilian Registry of Clinical Trials RBR-62zdkk; https://ensaiosclinicos.gov.br/rg/RBR-62zdkk International Registered Report Identifier (IRRID): DERR1-10.2196/24211 %M 33661132 %R 10.2196/24211 %U https://www.researchprotocols.org/2021/3/e24211 %U https://doi.org/10.2196/24211 %U http://www.ncbi.nlm.nih.gov/pubmed/33661132 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 3 %P e21242 %T Improving the Understanding of the Immunopathogenesis of Lymphopenia as a Correlate of SARS-CoV-2 Infection Risk and Disease Progression in African Patients: Protocol for a Cross-sectional Study %A Iwalokun,Bamidele Abiodun %A Olalekan,Adesola %A Adenipekun,Eyitayo %A Ojo,Olabisi %A Iwalokun,Senapon Olusola %A Mutiu,Bamidele %A Orija,Oluseyi %A Adegbola,Richard %A Salako,Babatunde %A Akinloye,Oluyemi %+ Nigerian Institute of Medical Research, 6 Edmund Crescent, Yaba-Lagos, PMB 2013, Lagos, 23401, Nigeria, 234 08023357646, ba.iwalokun@nimr.ov.ng %K SARS-COV-2 infection %K COVID-19 %K lymphopenia %K immunopathogenesis %K Nigeria %D 2021 %7 4.3.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: The COVID-19 pandemic, caused by SARS-CoV-2, continues to impact health systems throughout the world with serious medical challenges being imposed on many African countries like Nigeria. Although emerging studies have identified lymphopenia as a driver of cytokine storm, disease progression, and poor outcomes in infected patients, its immunopathogenesis, as well as environmental and genetic determinants, remain unclear. Understanding the interplay of these determinants in the context of lymphopenia and COVID-19 complications in patients in Africa may help with risk stratification and appropriate deployment of targeted treatment regimens with repurposed drugs to improve prognosis. Objective: This study is designed to investigate the role of vitamin D status, vasculopathy, apoptotic pathways, and vitamin D receptor (VDR) gene polymorphisms in the immunopathogenesis of lymphopenia among African people infected with SARS-CoV-2. Methods: This cross-sectional study will enroll 230 participants, categorized as “SARS-CoV-2 negative” (n=69), “COVID-19 mild” (n=32), “hospitalized” (n=92), and “recovered” (n=37), from two health facilities in Lagos, Nigeria. Sociodemographic data, travel history, and information on comorbidities will be obtained from case files and through a pretested, interview-based structured questionnaire. Venous blood samples (5 mL) collected between 8 AM and 10 AM and aliquoted into EDTA (ethylenediaminetetraacetic acid) and plain tubes will be used for complete blood count and CD4 T cell assays to determine lymphopenia (lymphocyte count <1000 cells/µL) and CD4 T lymphocyte levels, as well as to measure the concentrations of vitamin D, caspase 3, soluble vascular cell adhesion molecule-1 (sVCAM-1), and soluble Fas ligand (sFasL) using an autoanalyzer, flow cytometry, and ELISA (enzyme-linked immunosorbent assay) techniques. Genomic DNA will be extracted from the buffy coat and used as a template for the amplification of apoptosis-related genes (Bax, Bcl-2, BCL2L12) by polymerase chain reaction (PCR) and genotyping of VDR (Apa1, Fok1, and Bsm1) gene polymorphisms by the PCR restriction fragment length polymorphism method and capillary sequencing. Total RNA will also be extracted, reverse transcribed, and subsequently quantitated by reverse transcription PCR (RT-PCR) to monitor the expression of apoptosis genes in the four participant categories. Data analyses, which include a test of association between VDR gene polymorphisms and study outcomes (lymphopenia and hypovitaminosis D prevalence, mild/moderate and severe infections) will be performed using the R statistical software. Hardy-Weinberg equilibrium and linkage disequilibrium analyses for the alleles, genotypes, and haplotypes of the genotyped VDR gene will also be carried out. Results: A total of 45 participants comprising 37 SARS-CoV-2–negative and 8 COVID-19–recovered individuals have been enrolled so far. Their complete blood counts and CD4 T lymphocyte counts have been determined, and their serum samples and genomic DNA and RNA samples have been extracted and stored at –20 °C until further analyses. Other expected outcomes include the prevalence and distribution of lymphopenia and hypovitaminosis D in the control (SARS-CoV-2 negative), confirmed, hospitalized, and recovered SARS-CoV-2–positive participants; association of lymphopenia with CD4 T lymphocyte level, serum vitamin D, sVCAM-1, sFasL, and caspase 3 levels in hospitalized patients with COVID-19; expression levels of apoptosis-related genes among hospitalized participants with COVID-19, and those with lymphopenia compared to those without lymphopenia; and frequency distribution of the alleles, genotypes, and haplotypes of VDR gene polymorphisms in COVID-19–infected participants. Conclusions: This study will aid in the genotypic and phenotypic stratification of COVID-19–infected patients in Nigeria with and without lymphopenia to enable biomarker discovery and pave the way for the appropriate and timely deployment of patient-centered treatments to improve prognosis. International Registered Report Identifier (IRRID): DERR1-10.2196/21242 %M 33621190 %R 10.2196/21242 %U https://www.researchprotocols.org/2021/3/e21242 %U https://doi.org/10.2196/21242 %U http://www.ncbi.nlm.nih.gov/pubmed/33621190 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e26516 %T Cost-effectiveness of a Telemonitoring Program for Patients With Heart Failure During the COVID-19 Pandemic in Hong Kong: Model Development and Data Analysis %A Jiang,Xinchan %A Yao,Jiaqi %A You,Joyce Hoi-Sze %+ School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, 8th Floor, Lo Kwee-Seong Integrated Biomedical Sciences Building, Shatin, NT, Hong Kong, China (Hong Kong), 852 39436830, joyceyou@cuhk.edu.hk %K telemonitoring %K mobile health %K smartphone %K heart failure %K COVID-19 %K health care avoidance %K cost-effectiveness %D 2021 %7 3.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic has caused patients to avoid seeking medical care. Provision of telemonitoring programs in addition to usual care has demonstrated improved effectiveness in managing patients with heart failure (HF). Objective: We aimed to examine the potential clinical and health economic outcomes of a telemonitoring program for management of patients with HF during the COVID-19 pandemic from the perspective of health care providers in Hong Kong. Methods: A Markov model was designed to compare the outcomes of a care under COVID-19 (CUC) group and a telemonitoring plus CUC group (telemonitoring group) in a hypothetical cohort of older patients with HF in Hong Kong. The model outcome measures were direct medical cost, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratio. Sensitivity analyses were performed to examine the model assumptions and the robustness of the base-case results. Results: In the base-case analysis, the telemonitoring group showed a higher QALY gain (1.9007) at a higher cost (US $15,888) compared to the CUC group (1.8345 QALYs at US $15,603). Adopting US $48,937/QALY (1 × the gross domestic product per capita of Hong Kong) as the willingness-to-pay threshold, telemonitoring was accepted as a highly cost-effective strategy, with an incremental cost-effective ratio of US $4292/QALY. No threshold value was identified in the deterministic sensitivity analysis. In the probabilistic sensitivity analysis, telemonitoring was accepted as cost-effective in 99.22% of 10,000 Monte Carlo simulations. Conclusions: Compared to the current outpatient care alone under the COVID-19 pandemic, the addition of telemonitoring-mediated management to the current care for patients with HF appears to be a highly cost-effective strategy from the perspective of health care providers in Hong Kong. %M 33656440 %R 10.2196/26516 %U https://www.jmir.org/2021/3/e26516 %U https://doi.org/10.2196/26516 %U http://www.ncbi.nlm.nih.gov/pubmed/33656440 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e26399 %T Health Care Students’ Knowledge of and Attitudes, Beliefs, and Practices Toward the French COVID-19 App: Cross-sectional Questionnaire Study %A Montagni,Ilaria %A Roussel,Nicolas %A Thiébaut,Rodolphe %A Tzourio,Christophe %+ Bordeaux Population Health Research Center, U1219, Bordeaux University, INSERM, 146 rue Léo Saignat, Bordeaux, 33000, France, 33 05 57 57 16 5, ilaria.montagni@u-bordeaux.fr %K contact tracing %K COVID-19 %K mobile app %K students %K field survey %K app %K survey %K monitoring %K knowledge %K attitude %K belief %K practice %K communication %K use %D 2021 %7 3.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Many countries worldwide have developed mobile phone apps capable of supporting instantaneous contact tracing to control the COVID-19 pandemic. In France, a few people have downloaded and are using the StopCovid contact tracing app. Students in the health domain are of particular concern in terms of app uptake. Exploring their use and opinions about the app can inform improvements and diffusion of StopCovid among young people. Objective: The aim of this study is to investigate health care students’ knowledge of and attitudes, beliefs, and practices (KABP) toward the StopCovid app. Methods: A field survey was conducted among 318 students at the health sciences campus of the University of Bordeaux, France, between September 25 and October 16, 2020. A quota sampling method was used, and descriptive statistics and univariate analyses were performed. Results: Of the 318 respondents, 77.3% (n=246) had heard about the app, but only 11.3% (n=36) had downloaded it, and 4.7% (n=15) were still using it at the time of the survey. Among the 210 participants who had heard about the app but did not download it, the main reasons for not using the app were a belief that it was not effective given its limited diffusion (n=37, 17.6%), a lack of interest (n=37, 17.6%), and distrust in the data security and fear of being geolocated (n=33, 15.7%). Among the 72 students who had not heard of the app and were given a brief description of its functioning and confidentiality policy, 52.7% (n=38) said they would use it. Participants reported that the main solution for increasing the use of the app would be better communication about it (227/318, 71.4%). Conclusions: Even among health students, the contact tracing app was poorly used. The findings suggest that improved communication about its advantages and simplicity of use as well as clarifying false beliefs about it could help improve uptake. %M 33566793 %R 10.2196/26399 %U https://www.jmir.org/2021/3/e26399 %U https://doi.org/10.2196/26399 %U http://www.ncbi.nlm.nih.gov/pubmed/33566793 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e26799 %T Minimizing the Impact of the COVID-19 Epidemic on Oncology Clinical Trials: Retrospective Study of Beijing Cancer Hospital %A Fu,Zhiying %A Jiang,Min %A Wang,Kun %A Li,Jian %+ Beijing Institute for Cancer Research, Beijing Cancer Hospital, No 52 Fucheng Road, Haidian District, Beijing, China, 86 1088196949, LIJIAN8409@126.com %K COVID-19 %K clinical trials %K management strategy %K information technology %D 2021 %7 2.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: In view of repeated COVID-19 outbreaks in most countries, clinical trials will continue to be conducted under outbreak prevention and control measures for the next few years. It is very significant to explore an optimal clinical trial management model during the outbreak period to provide reference and insight for other clinical trial centers worldwide. Objective: The aim of this study was to explore the management strategies used to minimize the impact of the COVID-19 epidemic on oncology clinical trials. Methods: We implemented a remote management model to maintain clinical trials conducted at Beijing Cancer Hospital, which realized remote project approval, remote initiation, remote visits, remote administration and remote monitoring to get through two COVID-19 outbreaks in the capital city from February to April and June to July 2020. The effectiveness of measures was evaluated as differences in rates of protocol compliance, participants lost to follow-up, participant withdrawal, disease progression, participant mortality, and detection of monitoring problems. Results: During the late of the first outbreak, modifications were made in trial processing, participant management and quality control, which allowed the hospital to ensure the smooth conduct of 572 trials, with a protocol compliance rate of 85.24% for 3718 participants across both outbreaks. No COVID-19 infections were recorded among participants or trial staff, and no major procedural errors occurred between February and July 2020. These measures led to significantly higher rates of protocol compliance and significantly lower rates of loss to follow-up or withdrawal after the second outbreak than after the first, without affecting rates of disease progression or mortality. The hospital provided trial sponsors with a remote monitoring system in a timely manner, and 3820 trial issues were identified. Conclusions: When public health emergencies occur, an optimal clinical trial model combining on-site and remote management could guarantee the health care and treatment needs of clinical trial participants, in which remote management plays a key role. %M 33591924 %R 10.2196/26799 %U https://www.jmir.org/2021/3/e26799 %U https://doi.org/10.2196/26799 %U http://www.ncbi.nlm.nih.gov/pubmed/33591924 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e22219 %T What Every Reader Should Know About Studies Using Electronic Health Record Data but May Be Afraid to Ask %A Kohane,Isaac S %A Aronow,Bruce J %A Avillach,Paul %A Beaulieu-Jones,Brett K %A Bellazzi,Riccardo %A Bradford,Robert L %A Brat,Gabriel A %A Cannataro,Mario %A Cimino,James J %A García-Barrio,Noelia %A Gehlenborg,Nils %A Ghassemi,Marzyeh %A Gutiérrez-Sacristán,Alba %A Hanauer,David A %A Holmes,John H %A Hong,Chuan %A Klann,Jeffrey G %A Loh,Ne Hooi Will %A Luo,Yuan %A Mandl,Kenneth D %A Daniar,Mohamad %A Moore,Jason H %A Murphy,Shawn N %A Neuraz,Antoine %A Ngiam,Kee Yuan %A Omenn,Gilbert S %A Palmer,Nathan %A Patel,Lav P %A Pedrera-Jiménez,Miguel %A Sliz,Piotr %A South,Andrew M %A Tan,Amelia Li Min %A Taylor,Deanne M %A Taylor,Bradley W %A Torti,Carlo %A Vallejos,Andrew K %A Wagholikar,Kavishwar B %A , %A Weber,Griffin M %A Cai,Tianxi %+ Department of Biomedical Informatics, Harvard Medical School, 10 Shattuck Street, Boston, MA, 02115, United States, 1 617 432 3226, isaac_kohane@harvard.edu %K COVID-19 %K electronic health records %K real-world data %K literature %K publishing %K quality %K data quality %K reporting standards %K reporting checklist %K review %K statistics %D 2021 %7 2.3.2021 %9 Viewpoint %J J Med Internet Res %G English %X Coincident with the tsunami of COVID-19–related publications, there has been a surge of studies using real-world data, including those obtained from the electronic health record (EHR). Unfortunately, several of these high-profile publications were retracted because of concerns regarding the soundness and quality of the studies and the EHR data they purported to analyze. These retractions highlight that although a small community of EHR informatics experts can readily identify strengths and flaws in EHR-derived studies, many medical editorial teams and otherwise sophisticated medical readers lack the framework to fully critically appraise these studies. In addition, conventional statistical analyses cannot overcome the need for an understanding of the opportunities and limitations of EHR-derived studies. We distill here from the broader informatics literature six key considerations that are crucial for appraising studies utilizing EHR data: data completeness, data collection and handling (eg, transformation), data type (ie, codified, textual), robustness of methods against EHR variability (within and across institutions, countries, and time), transparency of data and analytic code, and the multidisciplinary approach. These considerations will inform researchers, clinicians, and other stakeholders as to the recommended best practices in reviewing manuscripts, grants, and other outputs from EHR-data derived studies, and thereby promote and foster rigor, quality, and reliability of this rapidly growing field. %M 33600347 %R 10.2196/22219 %U https://www.jmir.org/2021/3/e22219 %U https://doi.org/10.2196/22219 %U http://www.ncbi.nlm.nih.gov/pubmed/33600347 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e26997 %T Preferences for Artificial Intelligence Clinicians Before and During the COVID-19 Pandemic: Discrete Choice Experiment and Propensity Score Matching Study %A Liu,Taoran %A Tsang,Winghei %A Xie,Yifei %A Tian,Kang %A Huang,Fengqiu %A Chen,Yanhui %A Lau,Oiying %A Feng,Guanrui %A Du,Jianhao %A Chu,Bojia %A Shi,Tingyu %A Zhao,Junjie %A Cai,Yiming %A Hu,Xueyan %A Akinwunmi,Babatunde %A Huang,Jian %A Zhang,Casper J P %A Ming,Wai-Kit %+ Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, 601 Huangpu W Ave, Tianhe District, Guangzhou, 510632, China, 86 85228852, wkming@connect.hku.hk %K propensity score matching %K discrete latent traits %K patients’ preferences %K artificial intelligence %K COVID-19 %K preference %K discrete choice %K choice %K traditional medicine %K public health %K resource %K patient %K diagnosis %K accuracy %D 2021 %7 2.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Artificial intelligence (AI) methods can potentially be used to relieve the pressure that the COVID-19 pandemic has exerted on public health. In cases of medical resource shortages caused by the pandemic, changes in people’s preferences for AI clinicians and traditional clinicians are worth exploring. Objective: We aimed to quantify and compare people’s preferences for AI clinicians and traditional clinicians before and during the COVID-19 pandemic, and to assess whether people’s preferences were affected by the pressure of pandemic. Methods: We used the propensity score matching method to match two different groups of respondents with similar demographic characteristics. Respondents were recruited in 2017 and 2020. A total of 2048 respondents (2017: n=1520; 2020: n=528) completed the questionnaire and were included in the analysis. Multinomial logit models and latent class models were used to assess people’s preferences for different diagnosis methods. Results: In total, 84.7% (1115/1317) of respondents in the 2017 group and 91.3% (482/528) of respondents in the 2020 group were confident that AI diagnosis methods would outperform human clinician diagnosis methods in the future. Both groups of matched respondents believed that the most important attribute of diagnosis was accuracy, and they preferred to receive combined diagnoses from both AI and human clinicians (2017: odds ratio [OR] 1.645, 95% CI 1.535-1.763; P<.001; 2020: OR 1.513, 95% CI 1.413-1.621; P<.001; reference: clinician diagnoses). The latent class model identified three classes with different attribute priorities. In class 1, preferences for combined diagnoses and accuracy remained constant in 2017 and 2020, and high accuracy (eg, 100% accuracy in 2017: OR 1.357, 95% CI 1.164-1.581) was preferred. In class 2, the matched data from 2017 were similar to those from 2020; combined diagnoses from both AI and human clinicians (2017: OR 1.204, 95% CI 1.039-1.394; P=.011; 2020: OR 2.009, 95% CI 1.826-2.211; P<.001; reference: clinician diagnoses) and an outpatient waiting time of 20 minutes (2017: OR 1.349, 95% CI 1.065-1.708; P<.001; 2020: OR 1.488, 95% CI 1.287-1.721; P<.001; reference: 0 minutes) were consistently preferred. In class 3, the respondents in the 2017 and 2020 groups preferred different diagnosis methods; respondents in the 2017 group preferred clinician diagnoses, whereas respondents in the 2020 group preferred AI diagnoses. In the latent class, which was stratified according to sex, all male and female respondents in the 2017 and 2020 groups believed that accuracy was the most important attribute of diagnosis. Conclusions: Individuals’ preferences for receiving clinical diagnoses from AI and human clinicians were generally unaffected by the pandemic. Respondents believed that accuracy and expense were the most important attributes of diagnosis. These findings can be used to guide policies that are relevant to the development of AI-based health care. %M 33556034 %R 10.2196/26997 %U https://www.jmir.org/2021/3/e26997 %U https://doi.org/10.2196/26997 %U http://www.ncbi.nlm.nih.gov/pubmed/33556034 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 3 %P e26550 %T Digital Interventions to Support Population Mental Health in Canada During the COVID-19 Pandemic: Rapid Review %A Strudwick,Gillian %A Sockalingam,Sanjeev %A Kassam,Iman %A Sequeira,Lydia %A Bonato,Sarah %A Youssef,Alaa %A Mehta,Rohan %A Green,Nadia %A Agic,Branka %A Soklaridis,Sophie %A Impey,Danielle %A Wiljer,David %A Crawford,Allison %+ Centre for Addiction and Mental Health, 1001 Queen St W, Toronto, ON, M6J 1H4, Canada, 1 416 535 8501, gillian.strudwick@camh.ca %K digital health %K psychiatry %K mental health %K informatics %K pandemic %K COVID-19 %K telemedicine %K eHealth %K public health %K virtual care %K mobile apps %K population health %D 2021 %7 2.3.2021 %9 Review %J JMIR Ment Health %G English %X Background: The COVID-19 pandemic has resulted in a number of negative health related consequences, including impacts on mental health. More than 22% of Canadians reported that they had felt depressed in the last week, in response to a December 2020 national survey. Given the need to physically distance during the pandemic, and the increase in demand for mental health services, digital interventions that support mental health and wellness may be beneficial. Objective: The purpose of this research was to identify digital interventions that could be used to support the mental health of the Canadian general population during the COVID-19 pandemic. The objectives were to identify (1) the populations these interventions were developed for, inclusive of exploring areas of equity such as socioeconomic status, sex/gender, race/ethnicity and culture, and relevance to Indigenous peoples and communities; (2) the effect of the interventions; and (3) any barriers or facilitators to the use of the intervention. Methods: This study was completed using a Cochrane Rapid Review methodology. A search of Embase, PsycInfo, Medline, and Web of Science, along with Google, Million Short, and popular mobile app libraries, was conducted. Two screeners were involved in applying inclusion criteria using Covidence software. Academic articles and mobile apps identified were screened using the Standard Quality Assessment Criteria for Evaluating Primary Research Papers from a Variety of Fields resource, the American Psychiatric Association App Evaluation Framework, and the Mental Health Commission of Canada’s guidance on app assessment and selection. Results: A total of 31 mobile apps and 114 web-based resources (eg, telemedicine, virtual peer support groups, discussion forums, etc) that could be used to support the mental health of the Canadian population during the pandemic were identified. These resources have been listed on a publicly available website along with search tags that may help an individual make a suitable selection. Variability exists in the populations that the interventions were developed for, and little assessment has been done with regard to areas of equity. The effect of the interventions was not reported for all those identified in this synthesis; however, for those that did report the effect, it was shown that they were effective in the context that they were used. A number of barriers and facilitators to using these interventions were identified, such as access, cost, and connectivity. Conclusions: A number of digital interventions that could support population mental health in Canada during the global COVID-19 pandemic were identified, indicating that individuals have several options to choose from. These interventions vary in their purpose, approach, design, cost, and targeted user group. While some research and digital interventions addressed equity-related considerations, more research and focused attention should be given to this area. %M 33650985 %R 10.2196/26550 %U https://mental.jmir.org/2021/3/e26550 %U https://doi.org/10.2196/26550 %U http://www.ncbi.nlm.nih.gov/pubmed/33650985 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e23362 %T Barriers to the Large-Scale Adoption of a COVID-19 Contact Tracing App in Germany: Survey Study %A Blom,Annelies G %A Wenz,Alexander %A Cornesse,Carina %A Rettig,Tobias %A Fikel,Marina %A Friedel,Sabine %A Möhring,Katja %A Naumann,Elias %A Reifenscheid,Maximiliane %A Krieger,Ulrich %+ School of Social Sciences, University of Mannheim, A5, 6, Mannheim, 68131, Germany, 49 621 181 2298, a.wenz@uni-mannheim.de %K digital health %K mobile health %K smartphone %K mobile phone %K app %K digital technology %K contact tracing %K coronavirus %K COVID-19 %K survey %D 2021 %7 2.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: During the COVID-19 pandemic, one way to reduce further transmissions of SARS-CoV-2 is the widespread use of contact tracing apps. Such apps keep track of proximity contacts and warn contacts of persons who tested positive for an infection. Objective: In this study, we analyzed potential barriers to the large-scale adoption of the official contact tracing app that was introduced in Germany on June 16, 2020. Methods: Survey data were collected from 3276 adults during the week the app was introduced using an offline-recruited, probability-based online panel of the general adult population in Germany. Results: We estimate that 81% of the population aged 18 to 77 years possess the devices and ability to install the official app and that 35% are also willing to install and use it. Potential spreaders show high access to devices required to install the app (92%) and high ability to install the app (91%) but low willingness (31%) to correctly adopt the app, whereas for vulnerable groups, the main barrier is access (62%). Conclusions: The findings suggest a pessimistic view on the effectiveness of app-based contact tracing to contain the COVID-19 pandemic. We recommend targeting information campaigns at groups with a high potential to spread the virus but who are unwilling to install and correctly use the app, in particular men and those aged between 30 and 59 years. In addition, vulnerable groups, in particular older individuals and those in lower-income households, may be provided with equipment and support to overcome their barriers to app adoption. %M 33577466 %R 10.2196/23362 %U https://www.jmir.org/2021/3/e23362 %U https://doi.org/10.2196/23362 %U http://www.ncbi.nlm.nih.gov/pubmed/33577466 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 3 %P e24696 %T The Relationship Between the Global Burden of Influenza From 2017 to 2019 and COVID-19: Descriptive Epidemiological Assessment %A Baral,Stefan David %A Rucinski,Katherine Blair %A Twahirwa Rwema,Jean Olivier %A Rao,Amrita %A Prata Menezes,Neia %A Diouf,Daouda %A Kamarulzaman,Adeeba %A Phaswana-Mafuya,Nancy %A Mishra,Sharmistha %+ Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, 615 N. Wolfe Street, Baltimore, MD, 21205, United States, 1 410 502 8975, sbaral@jhu.edu %K SARS-CoV-2 %K COVID-19 %K influenza %K descriptive epidemiology %K epidemiology %K assessment %K relationship %K flu %K virus %K burden %K global health %K public health %K transmission %K pattern %D 2021 %7 2.3.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: SARS-CoV-2 and influenza are lipid-enveloped viruses with differential morbidity and mortality but shared modes of transmission. Objective: With a descriptive epidemiological framing, we assessed whether recent historical patterns of regional influenza burden are reflected in the observed heterogeneity in COVID-19 cases across regions of the world. Methods: Weekly surveillance data reported by the World Health Organization from January 2017 to December 2019 for influenza and from January 1, 2020 through October 31, 2020, for COVID-19 were used to assess seasonal and temporal trends for influenza and COVID-19 cases across the seven World Bank regions. Results: In regions with more pronounced influenza seasonality, COVID-19 epidemics have largely followed trends similar to those seen for influenza from 2017 to 2019. COVID-19 epidemics in countries across Europe, Central Asia, and North America have been marked by a first peak during the spring, followed by significant reductions in COVID-19 cases in the summer months and a second wave in the fall. In Latin America and the Caribbean, COVID-19 epidemics in several countries peaked in the summer, corresponding to months with the highest influenza activity in the region. Countries from regions with less pronounced influenza activity, including South Asia and sub-Saharan Africa, showed more heterogeneity in COVID-19 epidemics seen to date. However, similarities in COVID-19 and influenza trends were evident within select countries irrespective of region. Conclusions: Ecological consistency in COVID-19 trends seen to date with influenza trends suggests the potential for shared individual, structural, and environmental determinants of transmission. Using a descriptive epidemiological framework to assess shared regional trends for rapidly emerging respiratory pathogens with better studied respiratory infections may provide further insights into the differential impacts of nonpharmacologic interventions and intersections with environmental conditions. Ultimately, forecasting trends and informing interventions for novel respiratory pathogens like COVID-19 should leverage epidemiologic patterns in the relative burden of past respiratory pathogens as prior information. %M 33522974 %R 10.2196/24696 %U https://publichealth.jmir.org/2021/3/e24696 %U https://doi.org/10.2196/24696 %U http://www.ncbi.nlm.nih.gov/pubmed/33522974 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 3 %P e24322 %T Health Apps for Combating COVID-19: Descriptive Review and Taxonomy %A Almalki,Manal %A Giannicchi,Anna %+ Department of Health Informatics, Faculty of Public Health and Tropical Medicine, Jazan University, Gizan, Jazan, 82726, Saudi Arabia, 966 597636563, manal_almalki@hotmail.com %K app %K COVID-19 %K corona %K self-care %K personal tracking %K review %K mHealth %K track %K surveillance %K awareness %K exposure %K consumer health informatics %D 2021 %7 2.3.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile phone apps have been leveraged to combat the spread of COVID-19. However, little is known about these technologies’ characteristics, technical features, and various applications in health care when responding to this public health crisis. The lack of understanding has led developers and governments to make poor choices about apps’ designs, which resulted in creating less useful apps that are overall less appealing to consumers due to their technical flaws. Objective: This review aims to identify, analyze, and categorize health apps related to COVID-19 that are currently available for consumers in app stores; in particular, it focuses on exploring their key technical features and classifying the purposes that these apps were designed to serve. Methods: A review of health apps was conducted using the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. The Apple Store and Google Play were searched between April 20 and September 11, 2020. An app was included if it was dedicated for this disease and was listed under the health and medical categories in these app stores. The descriptions of these apps were extracted from the apps’ web pages and thematically analyzed via open coding to identify both their key technical features and overall purpose. The characteristics of the included apps were summarized and presented with descriptive statistics. Results: Of the 298 health apps that were initially retrieved, 115 met the inclusion criteria. A total of 29 technical features were found in our sample of apps, which were then categorized into five key purposes of apps related to COVID-19. A total of 77 (67%) apps were developed by governments or national authorities and for the purpose of promoting users to track their personal health (9/29, 31%). Other purposes included raising awareness on how to combat COVID-19 (8/29, 27%), managing exposure to COVID-19 (6/29, 20%), monitoring health by health care professionals (5/29, 17%), and conducting research studies (1/29, 3.5%). Conclusions: This study provides an overview and taxonomy of the health apps currently available in the market to combat COVID-19 based on their differences in basic technical features and purpose. As most of the apps were provided by governments or national authorities, it indicates the essential role these apps have as tools in public health crisis management. By involving most of the population in self-tracking their personal health and providing them with the technology to self-assess, the role of these apps is deemed to be a key driver for a participatory approach to curtail the spread of COVID-19. Further effort is required from researchers to evaluate these apps’ effectiveness and from governmental organizations to increase public awareness of these digital solutions. %M 33626017 %R 10.2196/24322 %U https://mhealth.jmir.org/2021/3/e24322 %U https://doi.org/10.2196/24322 %U http://www.ncbi.nlm.nih.gov/pubmed/33626017 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e26559 %T Exploring Usage of COVID Coach, a Public Mental Health App Designed for the COVID-19 Pandemic: Evaluation of Analytics Data %A Jaworski,Beth K %A Taylor,Katherine %A Ramsey,Kelly M %A Heinz,Adrienne %A Steinmetz,Sarah %A Pagano,Ian %A Moraja,Giovanni %A Owen,Jason E %+ National Center for PTSD, Dissemination & Training Division, US Department of Veterans Affairs, 795 Willow Road, Menlo Park, CA, 94025, United States, 1 650 308 9437, beth.jaworski@va.gov %K COVID-19 %K coronavirus %K mobile app %K mHealth %K digital health %K mental health %K public mental health %K stress %K coping %K public health %K app %D 2021 %7 1.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic has significantly impacted mental health and well-being. Mobile mental health apps can be scalable and useful tools in large-scale disaster responses and are particularly promising for reaching vulnerable populations. COVID Coach is a free, evidence-informed mobile app designed specifically to provide tools and resources for addressing COVID-19–related stress. Objective: The purpose of this study was to characterize the overall usage of COVID Coach, explore retention and return usage, and assess whether the app was reaching individuals who may benefit from mental health resources. Methods: Anonymous usage data collected from COVID Coach between May 1, 2020, through October 31, 2020, were extracted and analyzed for this study. The sample included 49,287 unique user codes and 3,368,931 in-app events. Results: Usage of interactive tools for coping and stress management comprised the majority of key app events (n=325,691, 70.4%), and the majority of app users tried a tool for managing stress (n=28,009, 58.8%). COVID Coach was utilized for ≤3 days by 80.9% (n=34,611) of the sample whose first day of app use occurred within the 6-month observation window. Usage of the key content in COVID Coach predicted returning to the app for a second day. Among those who tried at least one coping tool on their first day of app use, 57.2% (n=11,444) returned for a second visit; whereas only 46.3% (n=10,546) of those who did not try a tool returned (P<.001). Symptoms of anxiety, depression, and posttraumatic stress disorder (PTSD) were prevalent among app users. For example, among app users who completed an anxiety assessment on their first day of app use (n=4870, 11.4% of users), 55.1% (n=2680) reported levels of anxiety that were moderate to severe, and 29.9% (n=1455) of scores fell into the severe symptom range. On average, those with moderate levels of depression on their first day of app use returned to the app for a greater number of days (mean 3.72 days) than those with minimal symptoms (mean 3.08 days; t1=3.01, P=.003). Individuals with significant PTSD symptoms on their first day of app use utilized the app for a significantly greater number of days (mean 3.79 days) than those with fewer symptoms (mean 3.13 days; t1=2.29, P=.02). Conclusions: As the mental health impacts of the pandemic continue to be widespread and increasing, digital health resources, such as apps like COVID Coach, are a scalable way to provide evidence-informed tools and resources. Future research is needed to better understand for whom and under what conditions the app is most helpful and how to increase and sustain engagement. %M 33606656 %R 10.2196/26559 %U https://www.jmir.org/2021/3/e26559 %U https://doi.org/10.2196/26559 %U http://www.ncbi.nlm.nih.gov/pubmed/33606656 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 2 %P e23720 %T Influence of Health Beliefs on Adherence to COVID-19 Preventative Practices: International, Social Media–Based Survey Study %A Hsing,Julianna C %A Ma,Jasmin %A Barrero-Castillero,Alejandra %A Jani,Shilpa G %A Pulendran,Uma Palam %A Lin,Bea-Jane %A Thomas-Uribe,Monika %A Wang,C Jason %+ Center for Policy, Outcomes, and Prevention, Department of Pediatrics, Stanford University School of Medicine, 117 Encina Commons, CHP/PCOR, Stanford, CA, 94305, United States, 1 (650) 736 0403, cjwang1@stanford.edu %K COVID-19 pandemic %K health belief model %K behavior change %K preventative health behaviors %K handwashing %K social distancing %K international %K online survey %K social media %K cross-sectional study %D 2021 %7 26.2.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Health behavior is influenced by culture and social context. However, there are limited data evaluating the scope of these influences on COVID-19 response. Objective: This study aimed to compare handwashing and social distancing practices in different countries and evaluate practice predictors using the health belief model (HBM). Methods: From April 11 to May 1, 2020, we conducted an online, cross-sectional survey disseminated internationally via social media. Participants were adults aged 18 years or older from four different countries: the United States, Mexico, Hong Kong (China), and Taiwan. Primary outcomes were self-reported handwashing and social distancing practices during COVID-19. Predictors included constructs of the HBM: perceived susceptibility, perceived severity, perceived benefits, perceived barriers, self-efficacy, and cues to action. Associations of these constructs with behavioral outcomes were assessed by multivariable logistic regression. Results: We analyzed a total of 71,851 participants, with 3070 from the United States, 3946 from Mexico, 1201 from Hong Kong (China), and 63,634 from Taiwan. Of these countries, respondents from the United States adhered to the most social distancing practices (χ23=2169.7, P<.001), while respondents from Taiwan performed the most handwashing (χ23=309.8, P<.001). Multivariable logistic regression analyses indicated that self-efficacy was a positive predictor for handwashing (odds ratio [OR]United States 1.58, 95% CI 1.21-2.07; ORMexico 1.5, 95% CI 1.21-1.96; ORHong Kong 2.48, 95% CI 1.80-3.44; ORTaiwan 2.30, 95% CI 2.21-2.39) and social distancing practices (ORUnited States 1.77, 95% CI 1.24-2.49; ORMexico 1.77, 95% CI 1.40-2.25; ORHong Kong 3.25, 95% CI 2.32-4.62; ORTaiwan 2.58, 95% CI 2.47-2.68) in all countries. Handwashing was positively associated with perceived susceptibility in Mexico, Hong Kong, and Taiwan, while social distancing was positively associated with perceived severity in the United States, Mexico, and Taiwan. Conclusions: Social media recruitment strategies can be used to reach a large audience during a pandemic. Self-efficacy was the strongest predictor for handwashing and social distancing. Policies that address relevant health beliefs can facilitate adoption of necessary actions for preventing COVID-19. Our findings may be explained by the timing of government policies, the number of cases reported in each country, individual beliefs, and cultural context. %M 33571103 %R 10.2196/23720 %U https://www.jmir.org/2021/2/e23720 %U https://doi.org/10.2196/23720 %U http://www.ncbi.nlm.nih.gov/pubmed/33571103 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 2 %P e23458 %T Using Automated Machine Learning to Predict the Mortality of Patients With COVID-19: Prediction Model Development Study %A Ikemura,Kenji %A Bellin,Eran %A Yagi,Yukako %A Billett,Henny %A Saada,Mahmoud %A Simone,Katelyn %A Stahl,Lindsay %A Szymanski,James %A Goldstein,D Y %A Reyes Gil,Morayma %+ Department of Pathology, Albert Einstein College of Medicine, Montefiore Medical Center, 111 E 210th St, The Bronx, NY, 10467, United States, 1 9493703777, kikemura@montefiore.org %K automated machine learning %K COVID-19 %K biomarker %K ranking %K decision support tool %K machine learning %K decision support %K Shapley additive explanation %K partial dependence plot %K dimensionality reduction %D 2021 %7 26.2.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: During a pandemic, it is important for clinicians to stratify patients and decide who receives limited medical resources. Machine learning models have been proposed to accurately predict COVID-19 disease severity. Previous studies have typically tested only one machine learning algorithm and limited performance evaluation to area under the curve analysis. To obtain the best results possible, it may be important to test different machine learning algorithms to find the best prediction model. Objective: In this study, we aimed to use automated machine learning (autoML) to train various machine learning algorithms. We selected the model that best predicted patients’ chances of surviving a SARS-CoV-2 infection. In addition, we identified which variables (ie, vital signs, biomarkers, comorbidities, etc) were the most influential in generating an accurate model. Methods: Data were retrospectively collected from all patients who tested positive for COVID-19 at our institution between March 1 and July 3, 2020. We collected 48 variables from each patient within 36 hours before or after the index time (ie, real-time polymerase chain reaction positivity). Patients were followed for 30 days or until death. Patients’ data were used to build 20 machine learning models with various algorithms via autoML. The performance of machine learning models was measured by analyzing the area under the precision-recall curve (AUPCR). Subsequently, we established model interpretability via Shapley additive explanation and partial dependence plots to identify and rank variables that drove model predictions. Afterward, we conducted dimensionality reduction to extract the 10 most influential variables. AutoML models were retrained by only using these 10 variables, and the output models were evaluated against the model that used 48 variables. Results: Data from 4313 patients were used to develop the models. The best model that was generated by using autoML and 48 variables was the stacked ensemble model (AUPRC=0.807). The two best independent models were the gradient boost machine and extreme gradient boost models, which had an AUPRC of 0.803 and 0.793, respectively. The deep learning model (AUPRC=0.73) was substantially inferior to the other models. The 10 most influential variables for generating high-performing models were systolic and diastolic blood pressure, age, pulse oximetry level, blood urea nitrogen level, lactate dehydrogenase level, D-dimer level, troponin level, respiratory rate, and Charlson comorbidity score. After the autoML models were retrained with these 10 variables, the stacked ensemble model still had the best performance (AUPRC=0.791). Conclusions: We used autoML to develop high-performing models that predicted the survival of patients with COVID-19. In addition, we identified important variables that correlated with mortality. This is proof of concept that autoML is an efficient, effective, and informative method for generating machine learning–based clinical decision support tools. %M 33539308 %R 10.2196/23458 %U https://www.jmir.org/2021/2/e23458 %U https://doi.org/10.2196/23458 %U http://www.ncbi.nlm.nih.gov/pubmed/33539308 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 9 %N 2 %P e23427 %T An Automated Patient Self-Monitoring System to Reduce Health Care System Burden During the COVID-19 Pandemic in Malaysia: Development and Implementation Study %A Lim,Hooi Min %A Teo,Chin Hai %A Ng,Chirk Jenn %A Chiew,Thiam Kian %A Ng,Wei Leik %A Abdullah,Adina %A Abdul Hadi,Haireen %A Liew,Chee Sun %A Chan,Chee Seng %+ eHealth Unit, Faculty of Medicine, University of Malaya, Kuala Lumpur, 50603, Malaysia, 60 142204126, ngcj@um.edu.my %K COVID-19 %K coronavirus disease %K home monitoring %K symptom monitoring %K system %K teleconsultation %K development %K eHealth %K digital health %K mHealth %K health services research %K telesurveillance %K infectious disease %K app %D 2021 %7 26.2.2021 %9 Original Paper %J JMIR Med Inform %G English %X Background: During the COVID-19 pandemic, there was an urgent need to develop an automated COVID-19 symptom monitoring system to reduce the burden on the health care system and to provide better self-monitoring at home. Objective: This paper aimed to describe the development process of the COVID-19 Symptom Monitoring System (CoSMoS), which consists of a self-monitoring, algorithm-based Telegram bot and a teleconsultation system. We describe all the essential steps from the clinical perspective and our technical approach in designing, developing, and integrating the system into clinical practice during the COVID-19 pandemic as well as lessons learned from this development process. Methods: CoSMoS was developed in three phases: (1) requirement formation to identify clinical problems and to draft the clinical algorithm, (2) development testing iteration using the agile software development method, and (3) integration into clinical practice to design an effective clinical workflow using repeated simulations and role-playing. Results: We completed the development of CoSMoS in 19 days. In Phase 1 (ie, requirement formation), we identified three main functions: a daily automated reminder system for patients to self-check their symptoms, a safe patient risk assessment to guide patients in clinical decision making, and an active telemonitoring system with real-time phone consultations. The system architecture of CoSMoS involved five components: Telegram instant messaging, a clinician dashboard, system administration (ie, back end), a database, and development and operations infrastructure. The integration of CoSMoS into clinical practice involved the consideration of COVID-19 infectivity and patient safety. Conclusions: This study demonstrated that developing a COVID-19 symptom monitoring system within a short time during a pandemic is feasible using the agile development method. Time factors and communication between the technical and clinical teams were the main challenges in the development process. The development process and lessons learned from this study can guide the future development of digital monitoring systems during the next pandemic, especially in developing countries. %M 33600345 %R 10.2196/23427 %U https://medinform.jmir.org/2021/2/e23427 %U https://doi.org/10.2196/23427 %U http://www.ncbi.nlm.nih.gov/pubmed/33600345 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 9 %N 2 %P e23335 %T Utilization of Telehealth Services in Libya in Response to the COVID-19 Pandemic: Cross-sectional Analysis %A Elhadi,Muhammed %A Msherghi,Ahmed %A Elhadi,Ahmed %A Ashini,Aimen %A Alsoufi,Ahmed %A Bin Alshiteewi,Fatimah %A Elmabrouk,Amna %A Alsuyihili,Ali %A Elgherwi,Alsafa %A Elkhafeefi,Fatimah %A Abdulrazik,Sarah %A Tarek,Ahmed %+ Faculty of Medicine, University of Tripoli, Furnaj, University Road, Tripoli, 13275, Libyan Arab Jamahiriya, 218 945196407, muhammed.elhadi.uot@gmail.com %K COVID-19 %K cross-sectional study %K resource-limited countries %K SARS-CoV-2 %K telehealth %K telemedicine %K transitional countries %K usability %D 2021 %7 26.2.2021 %9 Original Paper %J JMIR Med Inform %G English %X Background: Health care systems in transitional countries have witnessed unprecedented challenges related to adequate and continuous health care provision during the COVID-19 pandemic. In many countries, including Libya, institutions and organizations have begun to implement telehealth technology for the first time. This serves to establish an alternative modality for direct physician-patient interviews to reduce the risk of COVID-19 transmission. Objective: This study aimed to assess the usability of telehealth services in Libya and to provide an overview of the current COVID-19 scenario. Methods: In this cross-sectional study, an anonymous web-based survey was administered to Libyan residents between April and May 2020. Participants were contacted through text messaging, emails, and social media. The survey items yielded information on the sociodemographic characteristics, availability and accessibility of health care services, effects of the COVID-19 pandemic on health care services, mental health status, and the feasibility and application of the telehealth system. Results: We obtained 2512 valid responses, of which 1721 (68.5%) were from females. The participants were aged 28.2 (SD 7.6) years, of whom 2333 (92.9%) were aged <40 years, and 1463 (58.2%) were single. Regarding the health care services and their accessibility, 786 (31.1%) participants reported having a poor health status in general, and 492 (19.6%) reported having a confirmed diagnosis of at least one chronic disease. Furthermore, 498 (19.9%) participants reported varying degrees of difficulty in accessing health care centers, and 1558 (62.0%) could not access their medical records. Additionally, 1546 (61.6%) participants experienced problems in covering medical costs, and 1429 (56.9%) avoided seeking medical care owing to financial concerns. Regarding the feasibility of the telehealth system, approximately half of the participants reported that telehealth services were useful during the COVID-19 pandemic, and 1545 (61.5%) reported that the system was an effective means of communication and of obtaining health care services. Furthermore, 1435 (57.1%) participants felt comfortable using the telehealth system, and 1129 (44.9%) felt that they were able to express themselves effectively. Moreover, 1389 (55.3%) participants found the system easy to understand, and 1354 (53.9%) reported having excellent communication with physicians through the telehealth system. However, only 1018 (40.5%) participants reported that communication was better with the telehealth system than with traditional methods. Conclusions: Our study revealed high levels of usability and willingness to use the telemedicine system as an alternative modality to in-person consultations among the Libyan residents in this study. This system is advantageous because it helps overcome health care costs, increases access to prompt medical care and follow-up evaluation, and reduces the risk of COVID-19 transmission. However, internet connectivity and electricity issues could be a substantial barrier for many resource-limited communities, and further studies should address such obstacles. %M 33606654 %R 10.2196/23335 %U https://medinform.jmir.org/2021/2/e23335 %U https://doi.org/10.2196/23335 %U http://www.ncbi.nlm.nih.gov/pubmed/33606654 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 2 %P e25345 %T Challenges for Nontechnical Implementation of Digital Proximity Tracing During the COVID-19 Pandemic: Media Analysis of the SwissCovid App %A von Wyl,Viktor %+ Epidemiology, Biostatistics & Prevention Institute, University of Zurich, Hirschengraben 84, Zürich, 8001, Switzerland, 41 +41446346380, viktor.vonwyl@uzh.ch %K epidemiology %K normalization process theory %K implementation %K digital health %K digital proximity tracing %K digital contact tracing %K COVID-19 %K app %K surveillance %K implementation %K tracking %K tracing %K framework %D 2021 %7 26.2.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Several countries have released digital proximity tracing (DPT) apps to complement manual contact tracing for combatting the SARS-CoV-2 pandemic. DPT aims to notify app users about proximity exposures to persons infected with SARS-CoV-2 so that they can self-quarantine. The success of DPT apps depends on user acceptance and the embedding of DPT into the pandemic mitigation strategy. Objective: By searching for media articles published during the first 3 months after DPT launch, the implementation of DPT in Switzerland was evaluated to inform similar undertakings in other countries. The second aim of the study was to create a link between reported DPT implementation challenges and normalization process theory for planning and optimizing complex digital health interventions, which can provide useful guidance for decision-making in DPT design and implementation. Methods: A Swiss media database was searched for articles on the Swiss DPT app (SwissCovid) published in German or French between July 4 and October 3, 2020. In a structured process, topics were extracted and clustered manually from articles that were deemed pertinent. Extracted topics were mapped to four NPT constructs, which reflected the flow of intervention development from planning, stakeholder onboarding, and execution to critical appraisal. Coherence constructs describe sense-making by stakeholders, cognitive participation constructs reflect participants’ efforts to create engagement with the intervention, collective actions refer to intervention execution and joint stakeholder efforts to make the intervention work, and reflexive monitoring refers to collective risk-benefit appraisals to create improvements. Results: Out of 94 articles deemed pertinent and selected for closer inspection, 38 provided unique information on implementation challenges. Five challenge areas were identified: communication challenges, challenges for DPT to interface with other processes, fear of resource competition with established pandemic mitigation measures, unclear DPT effectiveness, and obstacles to greater user coverage and compliance. Specifically, several articles mentioned unclear DPT benefits to affect commitment and to raise fears among different health system actors regarding resource competition. Moreover, media reports indicated process interface challenges such as delays or unclear responsibilities in the notification cascade, as well as misunderstandings and unmet communication needs from health system actors. Finally, reports suggested misaligned incentives, not only for app usage by the public but also for process engagement by other actors in the app notification cascade. NPT provided a well-fitting framework to contextualize the different DPT implementation challenges and to highlight improvement strategies, namely a better alignment of stakeholder incentives, or stakeholder-specific communication to address their concerns about DPT. Conclusions: Early experiences from one of the first adopters of DPT indicate that nontechnical implementation challenges may affect the effectiveness of DPT. The NPT analysis provides a novel perspective on DPT implementation and stresses the need for stakeholder inclusion in development and operationalization. %M 33606658 %R 10.2196/25345 %U https://mhealth.jmir.org/2021/2/e25345 %U https://doi.org/10.2196/25345 %U http://www.ncbi.nlm.nih.gov/pubmed/33606658 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 2 %P e22483 %T Expert Opinions on the Most Promising Treatments and Vaccine Candidates for COVID-19: Global Cross-sectional Survey of Virus Researchers in the Early Months of the Pandemic %A Cabral,Bernardo Pereira %A Braga,Luiza %A Mota,Fabio %+ Center for Strategic Studies, Oswaldo Cruz Foundation, Avenida Brasil, 4036, Manguinhos, Rio de Janeiro, 21040-361, Brazil, 55 2138829133, fabio.mota@fiocruz.br %K COVID-19 %K SARS-CoV-2 %K vaccine %K treatment %K survey %K public health %K drug %K clinical trial %D 2021 %7 26.2.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The COVID-19 pandemic presents a great public health challenge worldwide, especially given the urgent need to identify effective drugs and develop a vaccine in a short period of time. Globally, several drugs and vaccine candidates are in clinical trials. However, because these drugs and vaccines are still being tested, there is still no definition of which ones will succeed. Objective: This study aimed to assess the opinions of over 1000 virus researchers with knowledge on the prevention and treatment of coronavirus-related human diseases to determine the most promising drug and vaccine candidates to address COVID-19. Methods: We mapped the clinical trials related to COVID-19 registered at ClinicalTrials.gov. These data were used to prepare a survey questionnaire about treatments and vaccine candidates for COVID-19. In May 2020, a global survey was conducted with authors of recent scientific publications indexed in the Web of Science Core Collection related to viruses, severe acute respiratory syndrome coronavirus, coronaviruses, and COVID-19. Results: Remdesivir, immunoglobulin from cured patients, and plasma were considered to be the most promising treatments in May 2020, while ChAdOx1 and mRNA-1273 were considered to be the most promising vaccine candidates. Almost two-thirds of the respondents (766/1219, 62.8%) believed that vaccines for COVID-19 were likely to be available in the next 18 months. Slightly fewer than 25% (289/1219, 23.7%) believed that a vaccine was feasible, but probably not within 18 months. Conclusions: The issues addressed in this study are constantly evolving; therefore, the current state of knowledge has changed since the survey was conducted. However, for several months after the survey, the respondents’ expectations were in line with recent results related to treatments and vaccine candidates for COVID-19. %M 33635275 %R 10.2196/22483 %U https://publichealth.jmir.org/2021/2/e22483 %U https://doi.org/10.2196/22483 %U http://www.ncbi.nlm.nih.gov/pubmed/33635275 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 2 %P e22197 %T Infection Control Behavior at Home During the COVID-19 Pandemic: Observational Study of a Web-Based Behavioral Intervention (Germ Defence) %A Ainsworth,Ben %A Miller,Sascha %A Denison-Day,James %A Stuart,Beth %A Groot,Julia %A Rice,Cathy %A Bostock,Jennifer %A Hu,Xiao-Yang %A Morton,Katherine %A Towler,Lauren %A Moore,Michael %A Willcox,Merlin %A Chadborn,Tim %A Gold,Natalie %A Amlôt,Richard %A Little,Paul %A Yardley,Lucy %+ Department of Psychology, University of Bath, Claverton Down, Bath, BA27AY, United Kingdom, 44 01225388388, ba548@bath.ac.uk %K COVID-19 %K novel coronavirus %K behavior change %K digital medicine %K infection control %K infectious disease %K protection %K digital health %D 2021 %7 25.2.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: To control the COVID-19 pandemic, people should adopt protective behaviors at home (self-isolation, social distancing, putting shopping and packages aside, wearing face coverings, cleaning and disinfecting, and handwashing). There is currently limited support to help individuals conduct these behaviors. Objective: This study aims to report current household infection control behaviors in the United Kingdom and examine how they might be improved. Methods: This was a pragmatic cross-sectional observational study of anonymous participant data from Germ Defence between May 6-24, 2020. Germ Defence is an open-access fully automated website providing behavioral advice for infection control within households. A total of 28,285 users sought advice from four website pathways based on household status (advice to protect themselves generally, to protect others if the user was showing symptoms, to protect themselves if household members were showing symptoms, and to protect a household member who is at high risk). Users reported current infection control behaviors within the home and intentions to change these behaviors. Results: Current behaviors varied across all infection control measures but were between sometimes (face covering: mean 1.61, SD 1.19; social distancing: mean 2.40, SD 1.22; isolating: mean 2.78, SD 1.29; putting packages and shopping aside: mean 2.75, SD 1.55) and quite often (cleaning and disinfecting: mean 3.17, SD 1.18), except for handwashing (very often: mean 4.00, SD 1.03). Behaviors were similar regardless of the website pathway used. After using Germ Defence, users recorded intentions to improve infection control behavior across all website pathways and for all behaviors (overall average infection control score mean difference 0.30, 95% CI 0.29-0.31). Conclusions: Self-reported infection control behaviors other than handwashing are lower than is optimal for infection prevention, although handwashing is much higher. Advice using behavior change techniques in Germ Defence led to intentions to improve these behaviors. Promoting Germ Defence within national and local public health and primary care guidance could reduce COVID-19 transmission. %M 33566791 %R 10.2196/22197 %U https://www.jmir.org/2021/2/e22197 %U https://doi.org/10.2196/22197 %U http://www.ncbi.nlm.nih.gov/pubmed/33566791 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 2 %P e24165 %T Effects of COVID-19 Emergency Alert Text Messages on Practicing Preventive Behaviors: Cross-sectional Web-Based Survey in South Korea %A Lee,Minjung %A You,Myoungsoon %+ Department of Public Health Sciences, Graduate School of Public Health, Seoul National University, Gwanak-ro 1, Gwanak-gu, Seoul, 08826, Republic of Korea, 82 880 2773, msyou@snu.ac.kr %K COVID-19 %K coronavirus %K preventive behaviors %K text message %K mobile phone %K alert %K prevention %K behavior %K public health %K survey %D 2021 %7 25.2.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Sending emergency messages via mobile phone text messaging can be a promising communication tool to rapidly disseminate information and promote preventive behavior among the public during epidemic outbreaks. The battle to overcome COVID-19 is not yet over; thus, it is essential that the public practices preventive measures to prevent the spread of COVID-19. Objective: This study aimed to investigate the effectiveness of reading and obtaining information via emergency alert SMS text messages and their effects on the individual's practice of preventive behaviors during the early stages of the COVID-19 outbreak in South Korea. Methods: A cross-sectional web-based survey comprising 990 participants was conducted over 3 days (March 25-27, 2020). A multivariable logistic regression analysis revealed the sociodemographic factors that might influence the behavior of reading emergency alert text messages. A hierarchical linear regression model estimated the associations between reading emergency alert text messages for each precautionary behavior practiced against COVID-19. Additionally, the indirect effects of reading the text messages on each precautionary behavior via psychological factors (ie, perceived risk and response efficacy) were calculated. All data were weighted according to the 2019 Korea census data. Results: Overall, 49.2% (487/990) of the participants reported that they always read emergency alert text messages and visited the linked website to obtain more information. Factors such as female sex (odds ratio [OR] 1.68, 95% CI 1.28-2.21) and older age (30-39 years: OR 2.02, 95% CI 1.25-3.28; 40-49 years: OR 2.84, 95% CI 1.80-4.47; 50-59 years: OR 3.19, 95% CI 2.01-5.06; 60 years and above: OR 3.12, 95% CI 2.00-4.86 versus 18-29 years) were identified to be associated with a higher frequency of reading the text messages. Participants who always read the text messages practiced wearing facial masks (β=.074, P=.01) more frequently than those who did not. In terms of social distancing, participants who reported they always read the text messages avoided crowded places (β=.078, P=.01) and canceled or postponed social gatherings (β=.103, P<.001) more frequently than those who did not read the text messages. Furthermore, reading text messages directly and indirectly affected practicing precautionary behaviors, as the mediation effect of response efficacy between reading text messages and practicing preventive behaviors was significant. Conclusions: Our findings suggest that emergency alert text messages sent to individuals' mobile phones are timely and effective strategies for encouraging preventive behavior in public. Sending emergency alert text messages to provide the public with accurate and reliable information could be positively considered by the health authorities, which might reduce the negative impact of infodemics. %M 33544691 %R 10.2196/24165 %U https://www.jmir.org/2021/2/e24165 %U https://doi.org/10.2196/24165 %U http://www.ncbi.nlm.nih.gov/pubmed/33544691 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 2 %P e23441 %T Health Care Workers’ Reasons for Choosing Between Two Different COVID-19 Prophylaxis Trials in an Acute Pandemic Context: Single-Center Questionnaire Study %A Borobia,Alberto M %A García-García,Irene %A Díaz-García,Lucía %A Rodríguez-Mariblanca,Amelia %A Martínez de Soto,Lucía %A Monserrat Villatoro,Jaime %A Seco Meseguer,Enrique %A González,Juan J %A Frías Iniesta,Jesús %A Ramírez García,Elena %A Arribas,Jose Ramón %A Carcas-Sansuán,Antonio J %+ Clinical Pharmacology Department, La Paz University Hospital (IdiPAZ), School of Medicine, Universidad Autónoma de Madrid, Paseo Castellana, 261, Madrid, 28046, Spain, 34 912071466, alberto.borobia@idipaz.es %K clinical trials %K COVID-19 %K health care worker %K motivation %K personnel %K pre-exposure %K professional practice %K prophylaxis %K SARS-CoV-2 %K volunteers, web-based survey %K workplace safety %D 2021 %7 25.2.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: In April 2020, two independent clinical trials to assess SARS-CoV-2 prophylaxis strategies among health care workers were initiated at our hospital: MeCOVID (melatonin vs placebo) and EPICOS (tenofovir disoproxil/emtricitabine vs hydroxychloroquine vs combination therapy vs placebo). Objective: This study aimed to evaluate the reasons why health care workers chose to participate in the MeCOVID and EPICOS trials, as well as why they chose one over the other. Methods: Both trials were offered to health care workers through an internal news bulletin. After an initial screening visit, all subjects were asked to respond to a web-based survey. Results: In the first month, 206 health care workers were screened and 160 were randomized. The survey participation was high at 73.3%. Health care workers cited “to contribute to scientific knowledge” (n=80, 53.0%), followed by “to avoid SARS-CoV-2 infection” (n=33, 21.9%) and “the interest to be tested for SARS-CoV-2” (n=28, 18.5%), as their primary reasons to participate in the trials. We observed significant differences in the expected personal benefits across physicians and nurses (P=.01). The vast majority of volunteers (n=202, 98.0%) selected the MeCOVID trial, their primary reason being their concern regarding adverse reactions to treatments in the EPICOS trial (n=102, 69.4%). Conclusions: Health care workers’ reasons to participate in prophylaxis trials in an acute pandemic context appear to be driven largely by their desire to contribute to science and to gain health benefits. Safety outweighed efficacy when choosing between the two clinical trials. %M 33556032 %R 10.2196/23441 %U https://www.jmir.org/2021/2/e23441 %U https://doi.org/10.2196/23441 %U http://www.ncbi.nlm.nih.gov/pubmed/33556032 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 2 %P e25651 %T The Influence of Media Coverage and Governmental Policies on Google Queries Related to COVID-19 Cutaneous Symptoms: Infodemiology Study %A Huynh Dagher,Solene %A Lamé,Guillaume %A Hubiche,Thomas %A Ezzedine,Khaled %A Duong,Tu Anh %+ Assistance Publique des Hôpitaux de Paris (AP-HP), Département de dermatologie, Hôpital Henri Mondor, 51 avenue du Maréchal de Lattre de Tassigny, Créteil, 94000, France, 33 149812512, tu-anh.duong@aphp.fr %K chilblains %K COVID-19 %K dermatology %K Google Trends %K infodemiology %K lesion %K media %K media coverage %K online health information %K skin lesions %K trend %D 2021 %7 25.2.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: During COVID-19, studies have reported the appearance of internet searches for disease symptoms before their validation by the World Health Organization. This suggested that monitoring of these searches with tools including Google Trends may help monitor the pandemic itself. In Europe and North America, dermatologists reported an unexpected outbreak of cutaneous acral lesions (eg, chilblain-like lesions) in April 2020. However, external factors such as public communications may also hinder the use of Google Trends as an infodemiology tool. Objective: The study aimed to assess the impact of media announcements and lockdown enforcement on internet searches related to cutaneous acral lesions during the COVID-19 outbreak in 2020. Methods: Two searches on Google Trends, including daily relative search volumes for (1) “toe” or “chilblains” and (2) “coronavirus,” were performed from January 1 to May 16, 2020, with the United States, the United Kingdom, France, Italy, Spain, and Germany as the countries of choice. The ratio of interest over time in “chilblains” and “coronavirus” was plotted. To assess the impact of lockdown enforcement and media coverage on these internet searches, we performed an interrupted time-series analysis for each country. Results: The ratio of interest over time in “chilblains” to “coronavirus” showed a constant upward trend. In France, Italy, and the United Kingdom, lockdown enforcement was associated with a significant slope change for “chilblain” searches with a variation coefficient of 1.06 (SE 0.42) (P=0.01), 1.04 (SE 0.28) (P<.01), and 1.21 (SE 0.44) (P=0.01), respectively. After media announcements, these ratios significantly increased in France, Spain, Italy, and the United States with variation coefficients of 18.95 (SE 5.77) (P=.001), 31.31 (SE 6.31) (P<.001), 14.57 (SE 6.33) (P=.02), and 11.24 (SE 4.93) (P=.02), respectively, followed by a significant downward trend in France (–1.82 [SE 0.45]), Spain (–1.10 [SE 0.38]), and Italy (–0.93 [SE 0.33]) (P<.001, P=0.004, and P<.001, respectively). The adjusted R2 values were 0.311, 0.351, 0.325, and 0.305 for France, Spain, Italy, and the United States, respectively, suggesting an average correlation between time and the search volume; however, this correlation was weak for Germany and the United Kingdom. Conclusions: To date, the association between chilblain-like lesions and COVID-19 remains controversial; however, our results indicate that Google queries of “chilblain” were highly influenced by media coverage and government policies, indicating that caution should be exercised when using Google Trends as a monitoring tool for emerging diseases. %M 33513563 %R 10.2196/25651 %U https://publichealth.jmir.org/2021/2/e25651 %U https://doi.org/10.2196/25651 %U http://www.ncbi.nlm.nih.gov/pubmed/33513563 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 2 %P e23658 %T Impact of Remote and Virtual Care Models on the Sustainability of Small Health Care Businesses: Perceptual Analysis of Small Clinics, Physician Offices, and Pharmacies in Colorado %A Parthasarathy,Madhavan %A Khuntia,Jiban %A Stacey,Rulon %+ University of Colorado-Denver, 1475 Lawrence Street, Denver, CO 80202, Denver, CO, United States, 1 303 315 8445, madhavan.parthasarathy@ucdenver.edu %K clinics %K Colorado %K COVID-19 %K electronic physician visits %K entrepreneur %K pharmacies %K physician offices %K small business %K telehealth %K telemedicine %D 2021 %7 25.2.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Lockdowns and shelter-in-place orders during COVID-19 have accelerated the adoption of remote and virtual care (RVC) models, potentially including telehealth, telemedicine, and internet-based electronic physician visits (e-visits) for remote consultation, diagnosis, and care, deterring small health care businesses including clinics, physician offices, and pharmacies from aligning resources and operations to new RVC realities. Current perceptions of small health care businesses toward remote care, particularly perceptions of whether RVC adoption will synergistically improve business sustainability, would highlight the pros and cons of rapidly adopting RVC technology among policy makers. Objective: This study aimed to assess the perceptions of small health care businesses regarding the impact of RVC on their business sustainability during COVID-19, gauge their perceptions of their current levels of adoption of and satisfaction with RVC models and analyze how well that aligns with their perceptions of the current business scenario (SCBS), and determine whether these perceptions influence their view of their midterm sustainability (SUST). Methods: We randomly sampled small clinics, physician offices, and pharmacies across Colorado and sought assistance from a consulting firm to collect survey data in July 2020. Focal estimated study effects were compared across the three groups of small businesses to draw several insights. Results: In total, 270 respondents, including 82 clinics, 99 small physician offices, and 89 pharmacies, across Colorado were included. SRVC and SCBS had direct, significant, and positive effects on SUST. However, we investigated the effect of the interaction between SRVC and SCBS to determine whether RVC adoption aligns with their perceptions of the current business scenario and whether this interaction impacts their perception of business sustainability. Effects differed among the three groups. The interaction term SRVC×SCBS was significant and positive for clinics (P=.02), significant and negative for physician offices (P=.05), and not significant for pharmacies (P=.76). These variations indicate that while clinics positively perceived RVC alignment with the current business scenario, the opposite held true for small physician offices. Conclusions: As COVID-19 continues to spread worldwide and RVC adoption progresses rapidly, it is critical to understand the impact of RVC on small health care businesses and their perceptions of long-term survival. Small physician practices cannot harness RVC developments and, in contrast with clinics, consider it incompatible with business survival during and after COVID-19. If small health care firms cannot compete with RVC (or synergistically integrate RVC platforms into their current business practices) and eventually become nonoperational, the resulting damage to traditional health care services may be severe, particularly for critical care delivery and other important services that RVC cannot effectively replace. Our results have implications for public policy decisions such as incentive-aligned models, policy-initiated incentives, and payer-based strategies for improved alignment between RVC and existing models. %M 33539306 %R 10.2196/23658 %U https://www.jmir.org/2021/2/e23658 %U https://doi.org/10.2196/23658 %U http://www.ncbi.nlm.nih.gov/pubmed/33539306 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 2 %P e21103 %T Perception of COVID-19 Physical Distancing Effectiveness and Contagiousness of Asymptomatic Individuals: Cross-sectional Survey of Deaf and Hard of Hearing Adults in the United States %A Paludneviciene,Raylene %A Knight,Tracy %A Firl,Gideon %A Luttrell,Kaela %A Takayama,Kota %A Kushalnagar,Poorna %+ Department of Psychology, Gallaudet University, 800 Florida Ave NE, Washington, DC, 20002, United States, 1 585 666 0818, poorna.kushalnagar@gallaudet.edu %K COVID-19 %K coronavirus %K physical distancing %K asymptomatic individual %K social media %K deaf %K hard of hearing %K sign language %K perception %K misinformation %D 2021 %7 25.2.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: During the COVID-19 pandemic, there has been a rapid increase in the amount of information about the disease and SARS-CoV-2 on the internet. If the language used in video messages is not clear or understandable to deaf and hard of hearing (DHH) people with a high school degree or less, this can cause confusion and result in information gaps among DHH people during a health emergency. Objective: The aim of this study is to investigate the relationship between DHH people's perception of the effectiveness of physical distancing and contagiousness of an asymptomatic person. Methods: This is a cross-sectional survey study on DHH people's perceptions about COVID-19 (N=475). Items pertaining to COVID-19 knowledge were administered to US deaf adults from April 17, 2020, to May 1, 2020, via a bilingual American Sign Language/English online survey platform. Results: The sample consisted of 475 DHH adults aged 18-88 years old, with 74% (n=352) identifying as White and 54% (n=256) as female. About 88% (n=418) of the sample felt they knew most things or a lot about physical distancing. This figure dropped to 72% (n=342) for the question about the effectiveness of physical distancing in reducing the spread of COVID-19 and 70% (n=333) for the question about the contagiousness of an infected person without symptoms. Education and a knowledge of the effectiveness of physical distancing significantly predicted knowledge about the contagiousness of an asymptomatic individual. Race, gender, and age did not emerge as significant predictors. Conclusions: This results of this study point to the strong connection between education and coronavirus-related knowledge. Education-related disparities can be remedied by making information fully accessible and easily understood during emergencies and pandemics. %M 33560996 %R 10.2196/21103 %U https://www.jmir.org/2021/2/e21103 %U https://doi.org/10.2196/21103 %U http://www.ncbi.nlm.nih.gov/pubmed/33560996 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 2 %P e20812 %T Telemedicine Awareness, Knowledge, Attitude, and Skills of Health Care Workers in a Low-Resource Country During the COVID-19 Pandemic: Cross-sectional Study %A Elhadi,Muhammed %A Elhadi,Ahmed %A Bouhuwaish,Ahmad %A Bin Alshiteewi,Fatimah %A Elmabrouk,Amna %A Alsuyihili,Ali %A Alhashimi,Ayiman %A Khel,Samer %A Elgherwi,Alsafa %A Alsoufi,Ahmed %A Albakoush,Ahmed %A Abdulmalik,Abdulmuez %+ Faculty of Medicine, University of Tripoli, University Road, Furnaj, Tripoli, 13275, Libyan Arab Jamahiriya, 218 945196407, muhammed.elhadi.uot@gmail.com %K attitude %K awareness %K coronavirus %K COVID-19 %K knowledge %K pandemic %K skills %K telemedicine %D 2021 %7 25.2.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Since the onset of the COVID-19 pandemic, several health care programs intended to provide telemedicine services have been introduced in Libya. Many physicians have used these services to provide care and advice to their patients remotely. Objective: This study aimed to provide an overview of physicians’ awareness, knowledge, attitude, and skill in using telehealth services in Libya. Methods: In this cross-sectional study, we administered a web-based survey to health care workers in Libya in May 2020. The questionnaire collected information on physicians’ general demographic characteristics, ability to use a computer, and telemedicine awareness, knowledge, attitude, and skills. Results: Among 673 health care workers who responded to the survey, 377 (56%) and 248 (36.8%) reported high awareness and high computer skill scores, respectively, for telemedicine. Furthermore, 582 (86.5%) and 566 (82.6%) health care workers reported high knowledge and high attitude scores, respectively. We observed no significant differences in awareness, knowledge, attitude, and skill scores among physicians employed at public, private, or both types of hospitals. We observed significant differences in the mean awareness (P<.001), attitude (P=.001), and computer skill scores (P<.001) , where the score distribution of the groups based on the ability to use computers was not similar. Knowledge scores did not significantly differ among the three groups (P=.37). Respondents with professional computer skills had significantly higher awareness (χ23=14.5; P<.001) and attitude (χ23=13.5; P=.001) scores than those without professional computer skills. We observed significant differences in the mean computer skill scores of the groups (χ23=199.6; P<.001). Conclusions: The consequences of the COVID-19 pandemic are expected to persist for a long time. Hence, policy programs such as telemedicine services, which aim to address the obstacles to medical treatment owing to physical distancing measures, will likely continue for a long time. Therefore, there is a need to train and support health care workers and initiate government programs that provide adequate and supportive health care services to patients in transitional countries. %M 33600350 %R 10.2196/20812 %U https://www.jmir.org/2021/2/e20812 %U https://doi.org/10.2196/20812 %U http://www.ncbi.nlm.nih.gov/pubmed/33600350 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 2 %P e25682 %T Features Constituting Actionable COVID-19 Dashboards: Descriptive Assessment and Expert Appraisal of 158 Public Web-Based COVID-19 Dashboards %A Ivanković,Damir %A Barbazza,Erica %A Bos,Véronique %A Brito Fernandes,Óscar %A Jamieson Gilmore,Kendall %A Jansen,Tessa %A Kara,Pinar %A Larrain,Nicolas %A Lu,Shan %A Meza-Torres,Bernardo %A Mulyanto,Joko %A Poldrugovac,Mircha %A Rotar,Alexandru %A Wang,Sophie %A Willmington,Claire %A Yang,Yuanhang %A Yelgezekova,Zhamin %A Allin,Sara %A Klazinga,Niek %A Kringos,Dionne %+ Department of Public and Occupational Health, Amsterdam UMC, Amsterdam Public Health Research Institute, University of Amsterdam, Meibergdreef 9, Amsterdam, 1105AZ, Netherlands, 31 981801700, d.ivankovic@amsterdamumc.nl %K COVID-19 %K pandemic %K internet %K performance measures %K public reporting of health care data %K public health %K surveillance %K health information management %K dashboard %K accessibility %K online tool %K communication %K feature %K expert %D 2021 %7 24.2.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Since the outbreak of COVID-19, the development of dashboards as dynamic, visual tools for communicating COVID-19 data has surged worldwide. Dashboards can inform decision-making and support behavior change. To do so, they must be actionable. The features that constitute an actionable dashboard in the context of the COVID-19 pandemic have not been rigorously assessed. Objective: The aim of this study is to explore the characteristics of public web-based COVID-19 dashboards by assessing their purpose and users (“why”), content and data (“what”), and analyses and displays (“how” they communicate COVID-19 data), and ultimately to appraise the common features of highly actionable dashboards. Methods: We conducted a descriptive assessment and scoring using nominal group technique with an international panel of experts (n=17) on a global sample of COVID-19 dashboards in July 2020. The sequence of steps included multimethod sampling of dashboards; development and piloting of an assessment tool; data extraction and an initial round of actionability scoring; a workshop based on a preliminary analysis of the results; and reconsideration of actionability scores followed by joint determination of common features of highly actionable dashboards. We used descriptive statistics and thematic analysis to explore the findings by research question. Results: A total of 158 dashboards from 53 countries were assessed. Dashboards were predominately developed by government authorities (100/158, 63.0%) and were national (93/158, 58.9%) in scope. We found that only 20 of the 158 dashboards (12.7%) stated both their primary purpose and intended audience. Nearly all dashboards reported epidemiological indicators (155/158, 98.1%), followed by health system management indicators (85/158, 53.8%), whereas indicators on social and economic impact and behavioral insights were the least reported (7/158, 4.4% and 2/158, 1.3%, respectively). Approximately a quarter of the dashboards (39/158, 24.7%) did not report their data sources. The dashboards predominately reported time trends and disaggregated data by two geographic levels and by age and sex. The dashboards used an average of 2.2 types of displays (SD 0.86); these were mostly graphs and maps, followed by tables. To support data interpretation, color-coding was common (93/158, 89.4%), although only one-fifth of the dashboards (31/158, 19.6%) included text explaining the quality and meaning of the data. In total, 20/158 dashboards (12.7%) were appraised as highly actionable, and seven common features were identified between them. Actionable COVID-19 dashboards (1) know their audience and information needs; (2) manage the type, volume, and flow of displayed information; (3) report data sources and methods clearly; (4) link time trends to policy decisions; (5) provide data that are “close to home”; (6) break down the population into relevant subgroups; and (7) use storytelling and visual cues. Conclusions: COVID-19 dashboards are diverse in the why, what, and how by which they communicate insights on the pandemic and support data-driven decision-making. To leverage their full potential, dashboard developers should consider adopting the seven actionability features identified. %M 33577467 %R 10.2196/25682 %U https://www.jmir.org/2021/2/e25682 %U https://doi.org/10.2196/25682 %U http://www.ncbi.nlm.nih.gov/pubmed/33577467 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 4 %N 1 %P e22696 %T Telemedicine in Pediatrics: Systematic Review of Randomized Controlled Trials %A Shah,Aashaka C %A Badawy,Sherif M %+ Division of Hematology, Oncology, Neuro-Oncology and Stem Cell Transplant, Ann & Robert H Lurie Children's Hospital of Chicago, 225 E Chicago Avenue, Chicago, IL, 60611, United States, 1 3122274000 ext 74836, sbadawy@luriechildrens.org %K telemedicine %K telehealth %K pediatrics %K COVID-19 %K coronavirus %K pandemic %K digital %K eHealth %K mHealth %K mobile health %D 2021 %7 24.2.2021 %9 Review %J JMIR Pediatr Parent %G English %X Background: Telemedicine modalities, such as videoconferencing, are used by health care providers to remotely deliver health care to patients. Telemedicine use in pediatrics has increased in recent years. This has resulted in improved health care access, optimized disease management, progress in the monitoring of health conditions, and fewer exposures to patients with illnesses during pandemics (eg, the COVID-19 pandemic). Objective: We aimed to systematically evaluate the most recent evidence on the feasibility and accessibility of telemedicine services, patients’ and care providers’ satisfaction with these services, and treatment outcomes related to telemedicine service use among pediatric populations with different health conditions. Methods: Studies were obtained from the PubMed database on May 10, 2020. We followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. In this review, we included randomized controlled trials from the last 10 years that used a telemedicine approach as a study intervention or assessed telemedicine as a subspecialty of pediatric care. Titles and abstracts were independently screened based on the eligibility criteria. Afterward, full texts were retrieved and independently screened based on the eligibility criteria. A standardized form was used to extract the following data: publication title, first author’s name, publication year, participants’ characteristics, study design, the technology-based approach that was used, intervention characteristics, study goals, and study findings. Results: In total, 11 articles met the inclusion criteria and were included in this review. All studies were categorized as randomized controlled trials (8/11, 73%) or cluster randomized trials (3/11, 27%). The number of participants in each study ranged from 22 to 400. The health conditions that were assessed included obesity (3/11, 27%), asthma (2/11, 18%), mental health conditions (1/11, 9%), otitis media (1/11, 9%), skin conditions (1/11, 9%), type 1 diabetes (1/11, 9%), attention deficit hyperactivity disorder (1/11, 9%), and cystic fibrosis–related pancreatic insufficiency (1/11). The telemedicine approaches that were used included patient and doctor videoconferencing visits (5/11, 45%), smartphone-based interventions (3/11, 27%), telephone counseling (2/11, 18%), and telemedicine-based screening visits (1/11, 9%). The telemedicine interventions in all included studies resulted in outcomes that were comparable to or better than the outcomes of control groups. These outcomes were related to symptom management, quality of life, satisfaction, medication adherence, visit completion rates, and disease progression. Conclusions: Although more research is needed, the evidence from this review suggests that telemedicine services for the general public and pediatric care are comparable to or better than in-person services. Patients, health care professionals, and caregivers may benefit from using both telemedicine services and traditional, in-person health care services. To maximize the potential of telemedicine, future research should focus on improving patients’ access to care, increasing the cost-effectiveness of telemedicine services, and eliminating barriers to telemedicine use. %M 33556030 %R 10.2196/22696 %U https://pediatrics.jmir.org/2021/1/e22696 %U https://doi.org/10.2196/22696 %U http://www.ncbi.nlm.nih.gov/pubmed/33556030 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 2 %P e23957 %T Public Opinions and Concerns Regarding the Canadian Prime Minister’s Daily COVID-19 Briefing: Longitudinal Study of YouTube Comments Using Machine Learning Techniques %A Zheng,Chengda %A Xue,Jia %A Sun,Yumin %A Zhu,Tingshao %+ Key Laboratory of Behavioral Science, Institute of Psychology, Chinese Academy of Sciences, 16 Lincui Road, Chaoyang district, Beijing, 100101, China, 86 1064871661, tszhu@psych.ac.cn %K Canada %K PM Trudeau %K YouTube %K machine learning %K big data %K infodemiology %K infodemic %K public concerns %K communication %K concern %K social media %K video %D 2021 %7 23.2.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: During the COVID-19 pandemic in Canada, Prime Minister Justin Trudeau provided updates on the novel coronavirus and the government’s responses to the pandemic in his daily briefings from March 13 to May 22, 2020, delivered on the official Canadian Broadcasting Corporation (CBC) YouTube channel. Objective: The aim of this study was to examine comments on Canadian Prime Minister Trudeau’s COVID-19 daily briefings by YouTube users and track these comments to extract the changing dynamics of the opinions and concerns of the public over time. Methods: We used machine learning techniques to longitudinally analyze a total of 46,732 English YouTube comments that were retrieved from 57 videos of Prime Minister Trudeau’s COVID-19 daily briefings from March 13 to May 22, 2020. A natural language processing model, latent Dirichlet allocation, was used to choose salient topics among the sampled comments for each of the 57 videos. Thematic analysis was used to classify and summarize these salient topics into different prominent themes. Results: We found 11 prominent themes, including strict border measures, public responses to Prime Minister Trudeau’s policies, essential work and frontline workers, individuals’ financial challenges, rental and mortgage subsidies, quarantine, government financial aid for enterprises and individuals, personal protective equipment, Canada and China’s relationship, vaccines, and reopening. Conclusions: This study is the first to longitudinally investigate public discourse and concerns related to Prime Minister Trudeau’s daily COVID-19 briefings in Canada. This study contributes to establishing a real-time feedback loop between the public and public health officials on social media. Hearing and reacting to real concerns from the public can enhance trust between the government and the public to prepare for future health emergencies. %M 33544690 %R 10.2196/23957 %U https://www.jmir.org/2021/2/e23957 %U https://doi.org/10.2196/23957 %U http://www.ncbi.nlm.nih.gov/pubmed/33544690 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 2 %P e24452 %T A Mobile App to Facilitate Socially Distanced Hospital Communication During COVID-19: Implementation Experience %A Anyanwu,Emeka C %A Ward,R Parker %A Shah,Atman %A Arora,Vineet %A Umscheid,Craig A %+ Section of Cardiology, University of Chicago, 5841 S Maryland Avenue, Chicago, IL, 60637, United States, 1 (773) 834 0343, emeka@emeka.ca %K adoption %K communication %K COVID-19 %K hospital %K inpatient %K mHealth %K mobile app %K telemedicine %D 2021 %7 23.2.2021 %9 Short Paper %J JMIR Mhealth Uhealth %G English %X Background: COVID-19 has significantly altered health care delivery, requiring clinicians and hospitals to adapt to rapidly changing hospital policies and social distancing guidelines. At our large academic medical center, clinicians reported that existing information on distribution channels, including emails and hospital intranet posts, was inadequate to keep everyone abreast with these changes. To address these challenges, we adapted a mobile app developed in-house to communicate critical changes in hospital policies and enable direct telephonic communication between clinical team members and hospitalized patients, to support social distancing guidelines and remote rounding. Objective: This study aimed to describe the unique benefits and challenges of adapting an app developed in-house to facilitate communication and remote rounding during COVID-19. Methods: We adapted moblMD, a mobile app available on the iOS and Android platforms. In conjunction with our Hospital Incident Command System, resident advisory council, and health system innovation center, we identified critical, time-sensitive policies for app usage. A shared collaborative document was used to align app-based communication with more traditional communication channels. To minimize synchronization efforts, we particularly focused on high-yield policies, and the time of last review and the corresponding reviewer were noted for each protocol. To facilitate social distancing and remote patient rounding, the app was also populated with a searchable directory of numbers to patient bedside phones and hospital locations. We monitored anonymized user activity from February 1 to July 31, 2020. Results: On its first release, 1104 clinicians downloaded moblMD during the observation period, of which 46% (n=508) of downloads occurred within 72 hours of initial release. COVID-19 policies in the app were reviewed most commonly during the first week (801 views). Users made sustained use of hospital phone dialing features, including weekly peaks of 2242 phone number dials, 1874 directory searches, and 277 patient room phone number searches through the last 2 weeks of the observation period. Furthermore, clinicians submitted 56 content- and phone number–related suggestions through moblMD. Conclusions: We rapidly developed and deployed a communication-focused mobile app early during COVID-19, which has demonstrated initial and sustained value among clinicians in communicating with in-patients and each other during social distancing. Our internal innovation benefited from our team’s familiarity with institutional structures, short feedback loops, limited security and privacy implications, and a path toward sustainability provided by our innovation center. Challenges in content management were overcome through synchronization efforts and timestamping review. As COVID-19 continues to alter health care delivery, user activity metrics suggest that our solution will remain important in our efforts to continue providing safe and up-to-date clinical care. %M 33513562 %R 10.2196/24452 %U https://mhealth.jmir.org/2021/2/e24452 %U https://doi.org/10.2196/24452 %U http://www.ncbi.nlm.nih.gov/pubmed/33513562 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 2 %P e21415 %T Public Knowledge, Attitudes, and Practices Related to COVID-19 in Iran: Questionnaire Study %A Abbasi-Kangevari,Mohsen %A Kolahi,Ali-Asghar %A Ghamari,Seyyed-Hadi %A Hassanian-Moghaddam,Hossein %+ Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Koodakyar Ave and Daneshju Blvd, Tehran, Iran, 98 2122220980, a.kolahi@sbmu.ac.ir %K COVID-19 %K SARS-CoV-2 %K attitudes %K coronavirus %K knowledge %K perceptions %K practices %K Iran %D 2021 %7 23.2.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The COVID-19 pandemic is a rapidly growing outbreak, the future course of which is strongly determined by people’s adherence to social distancing measures. Objective: The objective of this study was to determine the knowledge level, attitudes, and practices of the Iranian population in the context of COVID-19. Methods: A nationwide study was conducted from March 24 to April 3, 2020, whereby data were collected via an online self-administered questionnaire. Results: Responses from 12,332 participants were analyzed. Participants’ mean knowledge score was 23.2 (SD 4.3) out of 30. Most participants recognized the cause of COVID-19, its routes of transmission, its symptoms and signs, predisposing factors, and prevention measures. Social media was the leading source of information. Participants recognized the dangers of the situation and felt responsible for following social distancing protocols, as well as isolating themselves upon symptom presentation. Participants’ mean practice score was 20.7 (SD 2.2) out of 24. Nearly none of the respondents went on a trip, and 92% (n=11,342) washed their hands before touching their faces. Conclusions: Knowledge of COVID-19 among people in Iran was nearly sufficient, their attitudes were mainly positive, and their practices were satisfactory. There is still room for improvement in correcting misinformation and protecting people from deception. Iranians appear to support government actions like social distancing and care for their and others’ safety. %M 33620326 %R 10.2196/21415 %U https://publichealth.jmir.org/2021/2/e21415 %U https://doi.org/10.2196/21415 %U http://www.ncbi.nlm.nih.gov/pubmed/33620326 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 9 %N 2 %P e26773 %T Rapid Response to Drive COVID-19 Research in a Learning Health Care System: Rationale and Design of the Houston Methodist COVID-19 Surveillance and Outcomes Registry (CURATOR) %A Vahidy,Farhaan %A Jones,Stephen L %A Tano,Mauricio E %A Nicolas,Juan Carlos %A Khan,Osman A %A Meeks,Jennifer R %A Pan,Alan P %A Menser,Terri %A Sasangohar,Farzan %A Naufal,George %A Sostman,Dirk %A Nasir,Khurram %A Kash,Bita A %+ Houston Methodist, 7550 Greenbriar Drive, Houston, TX, 77030, United States, 1 3463561479, fvahidy@houstonmethodist.org %K COVID-19 %K SARS-CoV-2 %K data science %K data curation %K electronic health records %K learning health system %K databases, factual %D 2021 %7 23.2.2021 %9 Original Paper %J JMIR Med Inform %G English %X Background: The COVID-19 pandemic has exacerbated the challenges of meaningful health care digitization. The need for rapid yet validated decision-making requires robust data infrastructure. Organizations with a focus on learning health care (LHC) systems tend to adapt better to rapidly evolving data needs. Few studies have demonstrated a successful implementation of data digitization principles in an LHC context across health care systems during the COVID-19 pandemic. Objective: We share our experience and provide a framework for assembling and organizing multidisciplinary resources, structuring and regulating research needs, and developing a single source of truth (SSoT) for COVID-19 research by applying fundamental principles of health care digitization, in the context of LHC systems across a complex health care organization. Methods: Houston Methodist (HM) comprises eight tertiary care hospitals and an expansive primary care network across Greater Houston, Texas. During the early phase of the pandemic, institutional leadership envisioned the need to streamline COVID-19 research and established the retrospective research task force (RRTF). We describe an account of the structure, functioning, and productivity of the RRTF. We further elucidate the technical and structural details of a comprehensive data repository—the HM COVID-19 Surveillance and Outcomes Registry (CURATOR). We particularly highlight how CURATOR conforms to standard health care digitization principles in the LHC context. Results: The HM COVID-19 RRTF comprises expertise in epidemiology, health systems, clinical domains, data sciences, information technology, and research regulation. The RRTF initially convened in March 2020 to prioritize and streamline COVID-19 observational research; to date, it has reviewed over 60 protocols and made recommendations to the institutional review board (IRB). The RRTF also established the charter for CURATOR, which in itself was IRB-approved in April 2020. CURATOR is a relational structured query language database that is directly populated with data from electronic health records, via largely automated extract, transform, and load procedures. The CURATOR design enables longitudinal tracking of COVID-19 cases and controls before and after COVID-19 testing. CURATOR has been set up following the SSoT principle and is harmonized across other COVID-19 data sources. CURATOR eliminates data silos by leveraging unique and disparate big data sources for COVID-19 research and provides a platform to capitalize on institutional investment in cloud computing. It currently hosts deeply phenotyped sociodemographic, clinical, and outcomes data of approximately 200,000 individuals tested for COVID-19. It supports more than 30 IRB-approved protocols across several clinical domains and has generated numerous publications from its core and associated data sources. Conclusions: A data-driven decision-making strategy is paramount to the success of health care organizations. Investment in cross-disciplinary expertise, health care technology, and leadership commitment are key ingredients to foster an LHC system. Such systems can mitigate the effects of ongoing and future health care catastrophes by providing timely and validated decision support. %M 33544692 %R 10.2196/26773 %U https://medinform.jmir.org/2021/2/e26773 %U https://doi.org/10.2196/26773 %U http://www.ncbi.nlm.nih.gov/pubmed/33544692 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 2 %P e22841 %T Patients’ Preferences for Artificial Intelligence Applications Versus Clinicians in Disease Diagnosis During the SARS-CoV-2 Pandemic in China: Discrete Choice Experiment %A Liu,Taoran %A Tsang,Winghei %A Huang,Fengqiu %A Lau,Oi Ying %A Chen,Yanhui %A Sheng,Jie %A Guo,Yiwei %A Akinwunmi,Babatunde %A Zhang,Casper JP %A Ming,Wai-Kit %+ Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, West Huangpu Road 601, Guangzhou, 510000, China, 86 14715485116, wkming@connect.hku.hk %K discrete choice experiment %K artificial intelligence %K patient preference %K multinomial logit analysis %K questionnaire %K latent-class conditional logit %K app %K human clinicians %K diagnosis %K COVID-19 %K China %D 2021 %7 23.2.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Misdiagnosis, arbitrary charges, annoying queues, and clinic waiting times among others are long-standing phenomena in the medical industry across the world. These factors can contribute to patient anxiety about misdiagnosis by clinicians. However, with the increasing growth in use of big data in biomedical and health care communities, the performance of artificial intelligence (Al) techniques of diagnosis is improving and can help avoid medical practice errors, including under the current circumstance of COVID-19. Objective: This study aims to visualize and measure patients’ heterogeneous preferences from various angles of AI diagnosis versus clinicians in the context of the COVID-19 epidemic in China. We also aim to illustrate the different decision-making factors of the latent class of a discrete choice experiment (DCE) and prospects for the application of AI techniques in judgment and management during the pandemic of SARS-CoV-2 and in the future. Methods: A DCE approach was the main analysis method applied in this paper. Attributes from different dimensions were hypothesized: diagnostic method, outpatient waiting time, diagnosis time, accuracy, follow-up after diagnosis, and diagnostic expense. After that, a questionnaire is formed. With collected data from the DCE questionnaire, we apply Sawtooth software to construct a generalized multinomial logit (GMNL) model, mixed logit model, and latent class model with the data sets. Moreover, we calculate the variables’ coefficients, standard error, P value, and odds ratio (OR) and form a utility report to present the importance and weighted percentage of attributes. Results: A total of 55.8% of the respondents (428 out of 767) opted for AI diagnosis regardless of the description of the clinicians. In the GMNL model, we found that people prefer the 100% accuracy level the most (OR 4.548, 95% CI 4.048-5.110, P<.001). For the latent class model, the most acceptable model consists of 3 latent classes of respondents. The attributes with the most substantial effects and highest percentage weights are the accuracy (39.29% in general) and expense of diagnosis (21.69% in general), especially the preferences for the diagnosis “accuracy” attribute, which is constant across classes. For class 1 and class 3, people prefer the AI + clinicians method (class 1: OR 1.247, 95% CI 1.036-1.463, P<.001; class 3: OR 1.958, 95% CI 1.769-2.167, P<.001). For class 2, people prefer the AI method (OR 1.546, 95% CI 0.883-2.707, P=.37). The OR of levels of attributes increases with the increase of accuracy across all classes. Conclusions: Latent class analysis was prominent and useful in quantifying preferences for attributes of diagnosis choice. People’s preferences for the “accuracy” and “diagnostic expenses” attributes are palpable. AI will have a potential market. However, accuracy and diagnosis expenses need to be taken into consideration. %M 33493130 %R 10.2196/22841 %U https://www.jmir.org/2021/2/e22841 %U https://doi.org/10.2196/22841 %U http://www.ncbi.nlm.nih.gov/pubmed/33493130 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 2 %P e23026 %T Learning From Past Respiratory Infections to Predict COVID-19 Outcomes: Retrospective Study %A Sang,Shengtian %A Sun,Ran %A Coquet,Jean %A Carmichael,Harris %A Seto,Tina %A Hernandez-Boussard,Tina %+ Department of Medicine, Biomedical Informatics, Stanford University, 1265 Welch Rd, 245, Stanford, CA, 94305-5479, United States, 1 650 725 5507, boussard@stanford.edu %K COVID-19 %K invasive mechanical ventilation %K all-cause mortality %K machine learning %K artificial intelligence %K respiratory %K infection %K outcome %K data %K feasibility %K framework %D 2021 %7 22.2.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: For the clinical care of patients with well-established diseases, randomized trials, literature, and research are supplemented with clinical judgment to understand disease prognosis and inform treatment choices. In the void created by a lack of clinical experience with COVID-19, artificial intelligence (AI) may be an important tool to bolster clinical judgment and decision making. However, a lack of clinical data restricts the design and development of such AI tools, particularly in preparation for an impending crisis or pandemic. Objective: This study aimed to develop and test the feasibility of a “patients-like-me” framework to predict the deterioration of patients with COVID-19 using a retrospective cohort of patients with similar respiratory diseases. Methods: Our framework used COVID-19–like cohorts to design and train AI models that were then validated on the COVID-19 population. The COVID-19–like cohorts included patients diagnosed with bacterial pneumonia, viral pneumonia, unspecified pneumonia, influenza, and acute respiratory distress syndrome (ARDS) at an academic medical center from 2008 to 2019. In total, 15 training cohorts were created using different combinations of the COVID-19–like cohorts with the ARDS cohort for exploratory purposes. In this study, two machine learning models were developed: one to predict invasive mechanical ventilation (IMV) within 48 hours for each hospitalized day, and one to predict all-cause mortality at the time of admission. Model performance was assessed using the area under the receiver operating characteristic curve (AUROC), sensitivity, specificity, positive predictive value, and negative predictive value. We established model interpretability by calculating SHapley Additive exPlanations (SHAP) scores to identify important features. Results: Compared to the COVID-19–like cohorts (n=16,509), the patients hospitalized with COVID-19 (n=159) were significantly younger, with a higher proportion of patients of Hispanic ethnicity, a lower proportion of patients with smoking history, and fewer patients with comorbidities (P<.001). Patients with COVID-19 had a lower IMV rate (15.1 versus 23.2, P=.02) and shorter time to IMV (2.9 versus 4.1 days, P<.001) compared to the COVID-19–like patients. In the COVID-19–like training data, the top models achieved excellent performance (AUROC>0.90). Validating in the COVID-19 cohort, the top-performing model for predicting IMV was the XGBoost model (AUROC=0.826) trained on the viral pneumonia cohort. Similarly, the XGBoost model trained on all 4 COVID-19–like cohorts without ARDS achieved the best performance (AUROC=0.928) in predicting mortality. Important predictors included demographic information (age), vital signs (oxygen saturation), and laboratory values (white blood cell count, cardiac troponin, albumin, etc). Our models had class imbalance, which resulted in high negative predictive values and low positive predictive values. Conclusions: We provided a feasible framework for modeling patient deterioration using existing data and AI technology to address data limitations during the onset of a novel, rapidly changing pandemic. %M 33534724 %R 10.2196/23026 %U https://www.jmir.org/2021/2/e23026 %U https://doi.org/10.2196/23026 %U http://www.ncbi.nlm.nih.gov/pubmed/33534724 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 9 %N 2 %P e21679 %T Lexicon Development for COVID-19-related Concepts Using Open-source Word Embedding Sources: An Intrinsic and Extrinsic Evaluation %A Parikh,Soham %A Davoudi,Anahita %A Yu,Shun %A Giraldo,Carolina %A Schriver,Emily %A Mowery,Danielle %+ Department of Biostatistics, Epidemiology, & Informatics, Institute for Biomedical Informatics, University of Pennsylvania, A206 Richards Hall,, 3700 Hamilton Walk, Philadelphia, PA, 19104-6021, United States, 1 215 746 6677, dlmowery@pennmedicine.upenn.edu %K natural language processing %K word embedding %K COVID-19 %K intrinsic %K open-source %K computation %K model %K prediction %K semantic %K syntactic %K pattern %D 2021 %7 22.2.2021 %9 Original Paper %J JMIR Med Inform %G English %X Background: Scientists are developing new computational methods and prediction models to better clinically understand COVID-19 prevalence, treatment efficacy, and patient outcomes. These efforts could be improved by leveraging documented COVID-19–related symptoms, findings, and disorders from clinical text sources in an electronic health record. Word embeddings can identify terms related to these clinical concepts from both the biomedical and nonbiomedical domains, and are being shared with the open-source community at large. However, it’s unclear how useful openly available word embeddings are for developing lexicons for COVID-19–related concepts. Objective: Given an initial lexicon of COVID-19–related terms, this study aims to characterize the returned terms by similarity across various open-source word embeddings and determine common semantic and syntactic patterns between the COVID-19 queried terms and returned terms specific to the word embedding source. Methods: We compared seven openly available word embedding sources. Using a series of COVID-19–related terms for associated symptoms, findings, and disorders, we conducted an interannotator agreement study to determine how accurately the most similar returned terms could be classified according to semantic types by three annotators. We conducted a qualitative study of COVID-19 queried terms and their returned terms to detect informative patterns for constructing lexicons. We demonstrated the utility of applying such learned synonyms to discharge summaries by reporting the proportion of patients identified by concept among three patient cohorts: pneumonia (n=6410), acute respiratory distress syndrome (n=8647), and COVID-19 (n=2397). Results: We observed high pairwise interannotator agreement (Cohen kappa) for symptoms (0.86-0.99), findings (0.93-0.99), and disorders (0.93-0.99). Word embedding sources generated based on characters tend to return more synonyms (mean count of 7.2 synonyms) compared to token-based embedding sources (mean counts range from 2.0 to 3.4). Word embedding sources queried using a qualifier term (eg, dry cough or muscle pain) more often returned qualifiers of the similar semantic type (eg, “dry” returns consistency qualifiers like “wet” and “runny”) compared to a single term (eg, cough or pain) queries. A higher proportion of patients had documented fever (0.61-0.84), cough (0.41-0.55), shortness of breath (0.40-0.59), and hypoxia (0.51-0.56) retrieved than other clinical features. Terms for dry cough returned a higher proportion of patients with COVID-19 (0.07) than the pneumonia (0.05) and acute respiratory distress syndrome (0.03) populations. Conclusions: Word embeddings are valuable technology for learning related terms, including synonyms. When leveraging openly available word embedding sources, choices made for the construction of the word embeddings can significantly influence the words learned. %M 33544689 %R 10.2196/21679 %U https://medinform.jmir.org/2021/2/e21679 %U https://doi.org/10.2196/21679 %U http://www.ncbi.nlm.nih.gov/pubmed/33544689 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 2 %P e24266 %T Digital Pathology During the COVID-19 Outbreak in Italy: Survey Study %A Giaretto,Simone %A Renne,Salvatore Lorenzo %A Rahal,Daoud %A Bossi,Paola %A Colombo,Piergiuseppe %A Spaggiari,Paola %A Manara,Sofia %A Sollai,Mauro %A Fiamengo,Barbara %A Brambilla,Tatiana %A Fernandes,Bethania %A Rao,Stefania %A Elamin,Abubaker %A Valeri,Marina %A De Carlo,Camilla %A Belsito,Vincenzo %A Lancellotti,Cesare %A Cieri,Miriam %A Cagini,Angelo %A Terracciano,Luigi %A Roncalli,Massimo %A Di Tommaso,Luca %+ Department of Pathology, Humanitas Clinical and Research Center – IRCCS, via Manzoni 56, Rozzano (MI), 20089, Italy, 39 0282244787, salvatore.renne@hunimed.eu %K COVID19 %K digital pathology %K Bayesian data analysis %K probabilistic modeling %D 2021 %7 22.2.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Transition to digital pathology usually takes months or years to be completed. We were familiarizing ourselves with digital pathology solutions at the time when the COVID-19 outbreak forced us to embark on an abrupt transition to digital pathology. Objective: The aim of this study was to quantitatively describe how the abrupt transition to digital pathology might affect the quality of diagnoses, model possible causes by probabilistic modeling, and qualitatively gauge the perception of this abrupt transition. Methods: A total of 17 pathologists and residents participated in this study; these participants reviewed 25 additional test cases from the archives and completed a final psychologic survey. For each case, participants performed several different diagnostic tasks, and their results were recorded and compared with the original diagnoses performed using the gold standard method (ie, conventional microscopy). We performed Bayesian data analysis with probabilistic modeling. Results: The overall analysis, comprising 1345 different items, resulted in a 9% (117/1345) error rate in using digital slides. The task of differentiating a neoplastic process from a nonneoplastic one accounted for an error rate of 10.7% (42/392), whereas the distinction of a malignant process from a benign one accounted for an error rate of 4.2% (11/258). Apart from residents, senior pathologists generated most discrepancies (7.9%, 13/164). Our model showed that these differences among career levels persisted even after adjusting for other factors. Conclusions: Our findings are in line with previous findings, emphasizing that the duration of transition (ie, lengthy or abrupt) might not influence the diagnostic performance. Moreover, our findings highlight that senior pathologists may be limited by a digital gap, which may negatively affect their performance with digital pathology. These results can guide the process of digital transition in the field of pathology. %M 33503002 %R 10.2196/24266 %U https://www.jmir.org/2021/2/e24266 %U https://doi.org/10.2196/24266 %U http://www.ncbi.nlm.nih.gov/pubmed/33503002 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 2 %P e23390 %T Establishing Classifiers With Clinical Laboratory Indicators to Distinguish COVID-19 From Community-Acquired Pneumonia: Retrospective Cohort Study %A Dai,Wanfa %A Ke,Pei-Feng %A Li,Zhen-Zhen %A Zhuang,Qi-Zhen %A Huang,Wei %A Wang,Yi %A Xiong,Yujuan %A Huang,Xian-Zhang %+ Department of Laboratory Medicine, The Second Affiliated Hospital, Guangzhou University of Chinese Medicine, 111 Dade Rd, Guangzhou, 510210, China, 86 020 81887233 ext 35362, huangxz020@gzucm.edu.cn %K COVID-19 %K clinical laboratory indicators %K community-acquired pneumonia %K classifier %K classification algorithm %D 2021 %7 22.2.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The initial symptoms of patients with COVID-19 are very much like those of patients with community-acquired pneumonia (CAP); it is difficult to distinguish COVID-19 from CAP with clinical symptoms and imaging examination. Objective: The objective of our study was to construct an effective model for the early identification of COVID-19 that would also distinguish it from CAP. Methods: The clinical laboratory indicators (CLIs) of 61 COVID-19 patients and 60 CAP patients were analyzed retrospectively. Random combinations of various CLIs (ie, CLI combinations) were utilized to establish COVID-19 versus CAP classifiers with machine learning algorithms, including random forest classifier (RFC), logistic regression classifier, and gradient boosting classifier (GBC). The performance of the classifiers was assessed by calculating the area under the receiver operating characteristic curve (AUROC) and recall rate in COVID-19 prediction using the test data set. Results: The classifiers that were constructed with three algorithms from 43 CLI combinations showed high performance (recall rate >0.9 and AUROC >0.85) in COVID-19 prediction for the test data set. Among the high-performance classifiers, several CLIs showed a high usage rate; these included procalcitonin (PCT), mean corpuscular hemoglobin concentration (MCHC), uric acid, albumin, albumin to globulin ratio (AGR), neutrophil count, red blood cell (RBC) count, monocyte count, basophil count, and white blood cell (WBC) count. They also had high feature importance except for basophil count. The feature combination (FC) of PCT, AGR, uric acid, WBC count, neutrophil count, basophil count, RBC count, and MCHC was the representative one among the nine FCs used to construct the classifiers with an AUROC equal to 1.0 when using the RFC or GBC algorithms. Replacing any CLI in these FCs would lead to a significant reduction in the performance of the classifiers that were built with them. Conclusions: The classifiers constructed with only a few specific CLIs could efficiently distinguish COVID-19 from CAP, which could help clinicians perform early isolation and centralized management of COVID-19 patients. %M 33534722 %R 10.2196/23390 %U https://www.jmir.org/2021/2/e23390 %U https://doi.org/10.2196/23390 %U http://www.ncbi.nlm.nih.gov/pubmed/33534722 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 2 %P e26302 %T Using Tweets to Understand How COVID-19–Related Health Beliefs Are Affected in the Age of Social Media: Twitter Data Analysis Study %A Wang,Hanyin %A Li,Yikuan %A Hutch,Meghan %A Naidech,Andrew %A Luo,Yuan %+ Department of Preventive Medicine, Northwestern University, 750 N Lakeshore Dr, Chicago, IL, 60611, United States, 1 312 503 5742, yuan.luo@northwestern.edu %K COVID-19 %K social media %K health belief %K Twitter %K infodemic %K infodemiology %K machine learning %K natural language processing %D 2021 %7 22.2.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The emergence of SARS-CoV-2 (ie, COVID-19) has given rise to a global pandemic affecting 215 countries and over 40 million people as of October 2020. Meanwhile, we are also experiencing an infodemic induced by the overabundance of information, some accurate and some inaccurate, spreading rapidly across social media platforms. Social media has arguably shifted the information acquisition and dissemination of a considerably large population of internet users toward higher interactivities. Objective: This study aimed to investigate COVID-19-related health beliefs on one of the mainstream social media platforms, Twitter, as well as potential impacting factors associated with fluctuations in health beliefs on social media. Methods: We used COVID-19-related posts from the mainstream social media platform Twitter to monitor health beliefs. A total of 92,687,660 tweets corresponding to 8,967,986 unique users from January 6 to June 21, 2020, were retrieved. To quantify health beliefs, we employed the health belief model (HBM) with four core constructs: perceived susceptibility, perceived severity, perceived benefits, and perceived barriers. We utilized natural language processing and machine learning techniques to automate the process of judging the conformity of each tweet with each of the four HBM constructs. A total of 5000 tweets were manually annotated for training the machine learning architectures. Results: The machine learning classifiers yielded areas under the receiver operating characteristic curves over 0.86 for the classification of all four HBM constructs. Our analyses revealed a basic reproduction number R0 of 7.62 for trends in the number of Twitter users posting health belief–related content over the study period. The fluctuations in the number of health belief–related tweets could reflect dynamics in case and death statistics, systematic interventions, and public events. Specifically, we observed that scientific events, such as scientific publications, and nonscientific events, such as politicians’ speeches, were comparable in their ability to influence health belief trends on social media through a Kruskal-Wallis test (P=.78 and P=.92 for perceived benefits and perceived barriers, respectively). Conclusions: As an analogy of the classic epidemiology model where an infection is considered to be spreading in a population with an R0 greater than 1, we found that the number of users tweeting about COVID-19 health beliefs was amplifying in an epidemic manner and could partially intensify the infodemic. It is “unhealthy” that both scientific and nonscientific events constitute no disparity in impacting the health belief trends on Twitter, since nonscientific events, such as politicians’ speeches, might not be endorsed by substantial evidence and could sometimes be misleading. %M 33529155 %R 10.2196/26302 %U https://www.jmir.org/2021/2/e26302 %U https://doi.org/10.2196/26302 %U http://www.ncbi.nlm.nih.gov/pubmed/33529155 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 2 %P e26257 %T Prognosis Score System to Predict Survival for COVID-19 Cases: a Korean Nationwide Cohort Study %A Cho,Sung-Yeon %A Park,Sung-Soo %A Song,Min-Kyu %A Bae,Young Yi %A Lee,Dong-Gun %A Kim,Dong-Wook %+ Catholic Hematology Hospital, College of Medicine, The Catholic University of Korea, Seoul St. Mary's Hospital, 222 Banpo-daero, Seocho-Gu, Seoul, 06591, Republic of Korea, 82 222586003, symonlee@catholic.ac.kr %K COVID-19 %K length of stay %K mortality %K prognosis %K triage %K digital health %K prediction %K cohort %K risk %K allocation %K disease management %K intensive care %K decision making %D 2021 %7 22.2.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: As the COVID-19 pandemic continues, an initial risk-adapted allocation is crucial for managing medical resources and providing intensive care. Objective: In this study, we aimed to identify factors that predict the overall survival rate for COVID-19 cases and develop a COVID-19 prognosis score (COPS) system based on these factors. In addition, disease severity and the length of hospital stay for patients with COVID-19 were analyzed. Methods: We retrospectively analyzed a nationwide cohort of laboratory-confirmed COVID-19 cases between January and April 2020 in Korea. The cohort was split randomly into a development cohort and a validation cohort with a 2:1 ratio. In the development cohort (n=3729), we tried to identify factors associated with overall survival and develop a scoring system to predict the overall survival rate by using parameters identified by the Cox proportional hazard regression model with bootstrapping methods. In the validation cohort (n=1865), we evaluated the prediction accuracy using the area under the receiver operating characteristic curve. The score of each variable in the COPS system was rounded off following the log-scaled conversion of the adjusted hazard ratio. Results: Among the 5594 patients included in this analysis, 234 (4.2%) died after receiving a COVID-19 diagnosis. In the development cohort, six parameters were significantly related to poor overall survival: older age, dementia, chronic renal failure, dyspnea, mental disturbance, and absolute lymphocyte count <1000/mm3. The following risk groups were formed: low-risk (score 0-2), intermediate-risk (score 3), high-risk (score 4), and very high-risk (score 5-7) groups. The COPS system yielded an area under the curve value of 0.918 for predicting the 14-day survival rate and 0.896 for predicting the 28-day survival rate in the validation cohort. Using the COPS system, 28-day survival rates were discriminatively estimated at 99.8%, 95.4%, 82.3%, and 55.1% in the low-risk, intermediate-risk, high-risk, and very high-risk groups, respectively, of the total cohort (P<.001). The length of hospital stay and disease severity were directly associated with overall survival (P<.001), and the hospital stay duration was significantly longer among survivors (mean 26.1, SD 10.7 days) than among nonsurvivors (mean 15.6, SD 13.3 days). Conclusions: The newly developed predictive COPS system may assist in making risk-adapted decisions for the allocation of medical resources, including intensive care, during the COVID-19 pandemic. %M 33539312 %R 10.2196/26257 %U https://www.jmir.org/2021/2/e26257 %U https://doi.org/10.2196/26257 %U http://www.ncbi.nlm.nih.gov/pubmed/33539312 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 2 %P e22705 %T Factors Influencing Depression and Mental Distress Related to COVID-19 Among University Students in China: Online Cross-sectional Mediation Study %A Yu,Yanqiu %A She,Rui %A Luo,Sitong %A Xin,Meiqi %A Li,Lijuan %A Wang,Suhua %A Ma,Le %A Tao,Fangbiao %A Zhang,Jianxin %A Zhao,Junfeng %A Li,Liping %A Hu,Dongsheng %A Zhang,Guohua %A Gu,Jing %A Lin,Danhua %A Wang,Hongmei %A Cai,Yong %A Wang,Zhaofen %A You,Hua %A Hu,Guoqing %A Lau,Joseph Tak-Fai %+ Centre for Health Behaviours Research, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Prince Whales Hospital, Sha Tin, Hong Kong, Hong Kong, 852 22528727, jlau@cuhk.edu.hk %K COVID-19 %K depression %K mental distress %K psychological responses %K mediation %K China %K online survey %D 2021 %7 22.2.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: The COVID-19 epidemic may elevate mental distress and depressive symptoms in various populations in China. Objective: This study investigates the levels of depression and mental distress due to COVID-19, and the associations between cognitive, behavioral, and psychosocial factors, and depression and mental distress due to COVID-19 among university students in China. Methods: A large-scale online cross-sectional study (16 cities in 13 provinces) was conducted among university students from February 1 to 10, 2020, in China; 23,863 valid questionnaires were returned. The Patient Health Questionnaire-9 was used to assess depression. Structural equation modeling was performed to test mediation and suppression effects. Results: Of the 23,863 participants, 47.1% (n=11,235) reported high or very high levels of one or more types of mental distress due to COVID-19; 39.1% (n=9326) showed mild to severe depression. Mental distress due to COVID-19 was positively associated with depression. All but one factor (perceived infection risks, perceived chance of controlling the epidemic, staying at home, contacted people from Wuhan, and perceived discrimination) were significantly associated with mental distress due to COVID-19 and depression. Mental distress due to COVID-19 partially mediated and suppressed the associations between some of the studied factors and depression (effect size of 6.0%-79.5%). Conclusions: Both mental distress due to COVID-19 and depression were prevalent among university students in China; the former may have increased the prevalence of the latter. The studied cognitive, behavioral, and psychosocial factors related to COVID-19 may directly or indirectly (via mental distress due to COVID-19) affect depression. Interventions to modify such factors may reduce mental distress and depressive symptoms during the COVID-19 epidemic. %M 33616541 %R 10.2196/22705 %U https://mental.jmir.org/2021/2/e22705 %U https://doi.org/10.2196/22705 %U http://www.ncbi.nlm.nih.gov/pubmed/33616541 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 2 %P e26107 %T Use of Physiological Data From a Wearable Device to Identify SARS-CoV-2 Infection and Symptoms and Predict COVID-19 Diagnosis: Observational Study %A Hirten,Robert P %A Danieletto,Matteo %A Tomalin,Lewis %A Choi,Katie Hyewon %A Zweig,Micol %A Golden,Eddye %A Kaur,Sparshdeep %A Helmus,Drew %A Biello,Anthony %A Pyzik,Renata %A Charney,Alexander %A Miotto,Riccardo %A Glicksberg,Benjamin S %A Levin,Matthew %A Nabeel,Ismail %A Aberg,Judith %A Reich,David %A Charney,Dennis %A Bottinger,Erwin P %A Keefer,Laurie %A Suarez-Farinas,Mayte %A Nadkarni,Girish N %A Fayad,Zahi A %+ The Dr Henry D Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, 1468 Madison Avenue, Annenberg Building RM 5-12, New York, NY, 10029, United States, 1 212 241 0150, robert.hirten@mountsinai.org %K wearable device %K COVID-19 %K identification %K prediction %K heart rate variability %K physiological %K wearable %K app %K data %K infectious disease %K symptom %K prediction %K diagnosis %K observational %D 2021 %7 22.2.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Changes in autonomic nervous system function, characterized by heart rate variability (HRV), have been associated with infection and observed prior to its clinical identification. Objective: We performed an evaluation of HRV collected by a wearable device to identify and predict COVID-19 and its related symptoms. Methods: Health care workers in the Mount Sinai Health System were prospectively followed in an ongoing observational study using the custom Warrior Watch Study app, which was downloaded to their smartphones. Participants wore an Apple Watch for the duration of the study, measuring HRV throughout the follow-up period. Surveys assessing infection and symptom-related questions were obtained daily. Results: Using a mixed-effect cosinor model, the mean amplitude of the circadian pattern of the standard deviation of the interbeat interval of normal sinus beats (SDNN), an HRV metric, differed between subjects with and without COVID-19 (P=.006). The mean amplitude of this circadian pattern differed between individuals during the 7 days before and the 7 days after a COVID-19 diagnosis compared to this metric during uninfected time periods (P=.01). Significant changes in the mean and amplitude of the circadian pattern of the SDNN was observed between the first day of reporting a COVID-19–related symptom compared to all other symptom-free days (P=.01). Conclusions: Longitudinally collected HRV metrics from a commonly worn commercial wearable device (Apple Watch) can predict the diagnosis of COVID-19 and identify COVID-19–related symptoms. Prior to the diagnosis of COVID-19 by nasal swab polymerase chain reaction testing, significant changes in HRV were observed, demonstrating the predictive ability of this metric to identify COVID-19 infection. %M 33529156 %R 10.2196/26107 %U https://www.jmir.org/2021/2/e26107 %U https://doi.org/10.2196/26107 %U http://www.ncbi.nlm.nih.gov/pubmed/33529156 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 2 %P e24445 %T Telehealth Demand Trends During the COVID-19 Pandemic in the Top 50 Most Affected Countries: Infodemiological Evaluation %A Wong,Mark Yu Zheng %A Gunasekeran,Dinesh Visva %A Nusinovici,Simon %A Sabanayagam,Charumathi %A Yeo,Khung Keong %A Cheng,Ching-Yu %A Tham,Yih-Chung %+ Singapore Eye Research Institute, Singapore National Eye Centre, 20 College Road Discovery Tower, Level 6, The Academia, Singapore, 169856, Singapore, 65 6576 7200, tham.yih.chung@seri.com.sg %K COVID-19 %K infodemiology %K telehealth %K telemedicine %K internet %D 2021 %7 19.2.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The COVID-19 pandemic has led to urgent calls for the adoption of telehealth solutions. However, public interest and demand for telehealth during the pandemic remain unknown. Objective: We used an infodemiological approach to estimate the worldwide demand for telehealth services during COVID-19, focusing on the 50 most affected countries and comparing the demand for such services with the level of information and communications technology (ICT) infrastructure available. Methods: We used Google Trends, the Baidu Index (China), and Yandex Keyword Statistics (Russia) to extract data on worldwide and individual countries’ telehealth-related internet searches from January 1 to July 7, 2020, presented as relative search volumes (RSV; range 0-100). Daily COVID-19 cases and deaths were retrieved from the World Health Organization. Individual countries’ ICT infrastructure profiles were retrieved from the World Economic Forum Report. Results: Across the 50 countries, the mean RSV was 18.5 (SD 23.2), and the mean ICT index was 62.1 (SD 15.0). An overall spike in worldwide telehealth-related RSVs was observed from March 11, 2020 (RSV peaked to 76.0), which then tailed off in June-July 2020 (mean RSV for the period was 25.8), but remained higher than pre-March RSVs (mean 7.29). By country, 42 (84%) manifested increased RSVs over the evaluation period, with the highest observed in Canada (RSV=100) and the United States (RSV=96). When evaluating associations between RSV and the ICT index, both the United States and Canada demonstrated high RSVs and ICT scores (≥70.3). In contrast, European countries had relatively lower RSVs (range 3.4-19.5) despite high ICT index scores (mean 70.3). Several Latin American (Brazil, Chile, Colombia) and South Asian (India, Bangladesh, Pakistan) countries demonstrated relatively higher RSVs (range 13.8-73.3) but low ICT index scores (mean 44.6), indicating that the telehealth demand outstrips the current ICT infrastructure. Conclusions: There is generally increased interest and demand for telehealth services across the 50 countries most affected by COVID-19, highlighting the need to scale up telehealth capabilities, during and beyond the pandemic. %M 33605883 %R 10.2196/24445 %U http://publichealth.jmir.org/2021/2/e24445/ %U https://doi.org/10.2196/24445 %U http://www.ncbi.nlm.nih.gov/pubmed/33605883 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 2 %P e22790 %T Mobile Remote Monitoring of Intimate Partner Violence Among Pregnant Patients During the COVID-19 Shelter-In-Place Order: Quality Improvement Pilot Study %A Krishnamurti,Tamar %A Davis,Alexander L %A Quinn,Beth %A Castillo,Anabel F %A Martin,Kelly L %A Simhan,Hyagriv N %+ Department of General Internal Medicine, University of Pittsburgh School of Medicine, 200 Meyran Avenue, Parkvale Building Suite 200, Pittsburgh, PA, 15213, United States, 1 4126924855, tamark@pitt.edu %K COVID-19 %K social isolation, sheltering-in-place %K intimate partner violence %K domestic violence %K pregnancy %K telemedicine %K telehealth %D 2021 %7 19.2.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Intimate partner violence (IPV) is one of the leading causes of pregnancy-related death. Prenatal health care providers can offer critical screening and support to pregnant people who experience IPV. During the COVID-19 shelter-in-place order, mobile apps may offer such people the opportunity to continue receiving screening and support services. Objective: We aimed to examine cases of IPV that were reported on a prenatal care app before and during the implementation of COVID-19 shelter-in-place mandates. Methods: The number of patients who underwent voluntary IPV screening and the incidence rate of IPV were determined by using a prenatal care app that was disseminated to patients from a single, large health care system. We compared the IPV screening frequencies and IPV incidence rates of patients who started using the app before the COVID-19 shelter-in-place order, to those of patients who started using the app during the shelter-in-place order. Results: We found 552 patients who started using the app within 60 days prior to the enforcement of the shelter-in-place order, and 407 patients who used the app at the start of shelter-in-place enforcement until the order was lifted. The incidence rates of voluntary IPV screening for new app users during the two time periods were similar (before sheltering in place: 252/552, 46%; during sheltering in place: 163/407, 40%). The overall use of the IPV screening tool increased during the shelter-in-place order. A slight, nonsignificant increase in the incidence of physical, sexual, and psychological violence during the shelter-in-place order was found across all app users (P=.56). Notably, none of the patients who screened positively for IPV had mentions of IPV in their medical charts. Conclusions: App-based screening for IPV is feasible during times when in-person access to health care providers is limited. Our results suggest that the incidence of IPV slightly increased during the shelter-in-place order. App-based screening may also address the needs of those who are unwilling or unable to share their IPV experiences with their health care provider. %M 33605898 %R 10.2196/22790 %U http://www.jmir.org/2021/2/e22790/ %U https://doi.org/10.2196/22790 %U http://www.ncbi.nlm.nih.gov/pubmed/33605898 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 2 %P e20545 %T Precision Assessment of COVID-19 Phenotypes Using Large-Scale Clinic Visit Audio Recordings: Harnessing the Power of Patient Voice %A Barr,Paul J %A Ryan,James %A Jacobson,Nicholas C %+ The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth College, 46 Centerra Parkway, Lebanon, NH, 03766, United States, 1 603 653 0863, paul.j.barr@dartmouth.edu %K communication %K coronavirus %K COVID-19 %K Machine Learning %K natural language processing %K patient-physician communication %K patient records %K recording %D 2021 %7 19.2.2021 %9 Viewpoint %J J Med Internet Res %G English %X COVID-19 cases are exponentially increasing worldwide; however, its clinical phenotype remains unclear. Natural language processing (NLP) and machine learning approaches may yield key methods to rapidly identify individuals at a high risk of COVID-19 and to understand key symptoms upon clinical manifestation and presentation. Data on such symptoms may not be accurately synthesized into patient records owing to the pressing need to treat patients in overburdened health care settings. In this scenario, clinicians may focus on documenting widely reported symptoms that indicate a confirmed diagnosis of COVID-19, albeit at the expense of infrequently reported symptoms. While NLP solutions can play a key role in generating clinical phenotypes of COVID-19, they are limited by the resulting limitations in data from electronic health records (EHRs). A comprehensive record of clinic visits is required—audio recordings may be the answer. A recording of clinic visits represents a more comprehensive record of patient-reported symptoms. If done at scale, a combination of data from the EHR and recordings of clinic visits can be used to power NLP and machine learning models, thus rapidly generating a clinical phenotype of COVID-19. We propose the generation of a pipeline extending from audio or video recordings of clinic visits to establish a model that factors in clinical symptoms and predict COVID-19 incidence. With vast amounts of available data, we believe that a prediction model can be rapidly developed to promote the accurate screening of individuals at a high risk of COVID-19 and to identify patient characteristics that predict a greater risk of a more severe infection. If clinical encounters are recorded and our NLP model is adequately refined, benchtop virologic findings would be better informed. While clinic visit recordings are not the panacea for this pandemic, they are a low-cost option with many potential benefits, which have recently begun to be explored. %M 33556031 %R 10.2196/20545 %U http://www.jmir.org/2021/2/e20545/ %U https://doi.org/10.2196/20545 %U http://www.ncbi.nlm.nih.gov/pubmed/33556031 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 2 %P e24341 %T Influenza and Respiratory Virus Surveillance, Vaccine Uptake, and Effectiveness at a Time of Cocirculating COVID-19: Protocol for the English Primary Care Sentinel System for 2020-2021 %A de Lusignan,Simon %A Lopez Bernal,Jamie %A Byford,Rachel %A Amirthalingam,Gayatri %A Ferreira,Filipa %A Akinyemi,Oluwafunmi %A Andrews,Nick %A Campbell,Helen %A Dabrera,Gavin %A Deeks,Alexandra %A Elliot,Alex J %A Krajenbrink,Else %A Liyanage,Harshana %A McGagh,Dylan %A Okusi,Cecilia %A Parimalanathan,Vaishnavi %A Ramsay,Mary %A Smith,Gillian %A Tripathy,Manasa %A Williams,John %A Victor,William %A Zambon,Maria %A Howsam,Gary %A Nicholson,Brian David %A Tzortziou Brown,Victoria %A Butler,Christopher C %A Joy,Mark %A Hobbs,FD Richard %+ Nuffield Department of Primary Care Health Sciences, University of Oxford, Eagle House, 7 Walton Well Road, Oxford, OX2 6ED, United Kingdom, 44 1865617975, simon.delusignan@phc.ox.ac.uk %K COVID-19 %K general practice %K influenza %K computerized medical record systems %K sentinel surveillance %K coronavirus infections %K records as topic %K serology %K virology %D 2021 %7 19.2.2021 %9 Protocol %J JMIR Public Health Surveill %G English %X Background: The Oxford–Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC) and Public Health England (PHE) are commencing their 54th season of collaboration at a time when SARS-CoV-2 infections are likely to be cocirculating with the usual winter infections. Objective: The aim of this study is to conduct surveillance of influenza and other monitored respiratory conditions and to report on vaccine uptake and effectiveness using nationally representative surveillance data extracted from primary care computerized medical records systems. We also aim to have general practices collect virology and serology specimens and to participate in trials and other interventional research. Methods: The RCGP RSC network comprises over 1700 general practices in England and Wales. We will extract pseudonymized data twice weekly and are migrating to a system of daily extracts. First, we will collect pseudonymized, routine, coded clinical data for the surveillance of monitored and unexpected conditions; data on vaccine exposure and adverse events of interest; and data on approved research study outcomes. Second, we will provide dashboards to give general practices feedback about levels of care and data quality, as compared to other network practices. We will focus on collecting data on influenza-like illness, upper and lower respiratory tract infections, and suspected COVID-19. Third, approximately 300 practices will participate in the 2020-2021 virology and serology surveillance; this will include responsive surveillance and long-term follow-up of previous SARS-CoV-2 infections. Fourth, member practices will be able to recruit volunteer patients to trials, including early interventions to improve COVID-19 outcomes and point-of-care testing. Lastly, the legal basis for our surveillance with PHE is Regulation 3 of the Health Service (Control of Patient Information) Regulations 2002; other studies require appropriate ethical approval. Results: The RCGP RSC network has tripled in size; there were previously 100 virology practices and 500 practices overall in the network and we now have 322 and 1724, respectively. The Oxford–RCGP Clinical Informatics Digital Hub (ORCHID) secure networks enable the daily analysis of the extended network; currently, 1076 practices are uploaded. We are implementing a central swab distribution system for patients self-swabbing at home in addition to in-practice sampling. We have converted all our primary care coding to Systematized Nomenclature of Medicine Clinical Terms (SNOMED CT) coding. Throughout spring and summer 2020, the network has continued to collect specimens in preparation for the winter or for any second wave of COVID-19 cases. We have collected 5404 swabs and detected 623 cases of COVID-19 through extended virological sampling, and 19,341 samples have been collected for serology. This shows our preparedness for the winter season. Conclusions: The COVID-19 pandemic has been associated with a groundswell of general practices joining our network. It has also created a permissive environment in which we have developed the capacity and capability of the national primary care surveillance systems and our unique public health institute, the RCGP and University of Oxford collaboration. %M 33605892 %R 10.2196/24341 %U http://publichealth.jmir.org/2021/2/e24341/ %U https://doi.org/10.2196/24341 %U http://www.ncbi.nlm.nih.gov/pubmed/33605892 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 2 %P e25232 %T Impact of the COVID-19 Pandemic on the Psychological Distress of Medical Students in Japan: Cross-sectional Survey Study %A Nishimura,Yoshito %A Ochi,Kanako %A Tokumasu,Kazuki %A Obika,Mikako %A Hagiya,Hideharu %A Kataoka,Hitomi %A Otsuka,Fumio %+ Department of General Medicine, Okayama University Hospital, 2-5-1 Shikata-Cho, Kita-Ku, Okayama, Japan, 81 86 235 7342, nishimura-yoshito@okayama-u.ac.jp %K COVID-19 %K online education %K depression %K pandemic %K anxiety %K medical student %D 2021 %7 18.2.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic has negatively affected medical education. However, little data are available about medical students’ distress during the pandemic. Objective: This study aimed to provide details on how medical students have been affected by the pandemic. Methods: A cross-sectional study was conducted. A total of 717 medical students participated in the web-based survey. The survey included questions about how the participants’ mental status had changed from before to after the Japanese nationwide state of emergency (SOE). Results: Out of 717 medical students, 473 (66.0%) participated in the study. In total, 29.8% (141/473) of the students reported concerns about the shift toward online education, mostly because they thought online education would be ineffective compared with in-person learning. The participants’ subjective mental health status significantly worsened after the SOE was lifted (P<.001). Those who had concerns about a shift toward online education had higher odds of having generalized anxiety and being depressed (odds ratio [OR] 1.97, 95% CI 1.19-3.28) as did those who said they would request food aid (OR 1.99, 95% CI 1.16-3.44) and mental health care resources (OR 3.56, 95% CI 2.07-6.15). Conclusions: Given our findings, the sudden shift to online education might have overwhelmed medical students. Thus, we recommend that educators inform learners that online learning is not inferior to in-person learning, which could attenuate potential depression and anxiety. %M 33556033 %R 10.2196/25232 %U http://www.jmir.org/2021/2/e25232/ %U https://doi.org/10.2196/25232 %U http://www.ncbi.nlm.nih.gov/pubmed/33556033 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 2 %P e23870 %T Evaluating Closures of Fresh Fruit and Vegetable Vendors During the COVID-19 Pandemic: Methodology and Preliminary Results Using Omnidirectional Street View Imagery %A Ali,Shahmir H %A Imbruce,Valerie M %A Russo,Rienna G %A Kaplan,Samuel %A Stevenson,Kaye %A Mezzacca,Tamar Adjoian %A Foster,Victoria %A Radee,Ashley %A Chong,Stella %A Tsui,Felice %A Kranick,Julie %A Yi,Stella S %+ Department of Population Health, NYU Grossman School of Medicine, 8th Floor, Room 8-13, 180 Madison Avenue, New York, NY, United States, 1 646 501 3477, Stella.Yi@nyulangone.org %K built environment %K Google Street View %K food retail environment %K COVID-19 %K geographic surveillance %K food %K longitudinal %K supply chain %K economy %K demand %K service %K vendor %K surveillance %D 2021 %7 18.2.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic has significantly disrupted the food retail environment. However, its impact on fresh fruit and vegetable vendors remains unclear; these are often smaller, more community centered, and may lack the financial infrastructure to withstand supply and demand changes induced by such crises. Objective: This study documents the methodology used to assess fresh fruit and vegetable vendor closures in New York City (NYC) following the start of the COVID-19 pandemic by using Google Street View, the new Apple Look Around database, and in-person checks. Methods: In total, 6 NYC neighborhoods (in Manhattan and Brooklyn) were selected for analysis; these included two socioeconomically advantaged neighborhoods (Upper East Side, Park Slope), two socioeconomically disadvantaged neighborhoods (East Harlem, Brownsville), and two Chinese ethnic neighborhoods (Chinatown, Sunset Park). For each neighborhood, Google Street View was used to virtually walk down each street and identify vendors (stores, storefronts, street vendors, or wholesalers) that were open and active in 2019 (ie, both produce and vendor personnel were present at a location). Past vendor surveillance (when available) was used to guide these virtual walks. Each identified vendor was geotagged as a Google Maps pinpoint that research assistants then physically visited. Using the “notes” feature of Google Maps as a data collection tool, notes were made on which of three categories best described each vendor: (1) open, (2) open with a more limited setup (eg, certain sections of the vendor unit that were open and active in 2019 were missing or closed during in-person checks), or (3) closed/absent. Results: Of the 135 open vendors identified in 2019 imagery data, 35% (n=47) were absent/closed and 10% (n=13) were open with more limited setups following the beginning of the COVID-19 pandemic. When comparing boroughs, 35% (28/80) of vendors in Manhattan were absent/closed, as were 35% (19/55) of vendors in Brooklyn. Although Google Street View was able to provide 2019 street view imagery data for most neighborhoods, Apple Look Around was required for 2019 imagery data for some areas of Park Slope. Past surveillance data helped to identify 3 additional established vendors in Chinatown that had been missed in street view imagery. The Google Maps “notes” feature was used by multiple research assistants simultaneously to rapidly collect observational data on mobile devices. Conclusions: The methodology employed enabled the identification of closures in the fresh fruit and vegetable retail environment and can be used to assess closures in other contexts. The use of past baseline surveillance data to aid vendor identification was valuable for identifying vendors that may have been absent or visually obstructed in the street view imagery data. Data collection using Google Maps likewise has the potential to enhance the efficiency of fieldwork in future studies. %M 33539310 %R 10.2196/23870 %U http://formative.jmir.org/2021/2/e23870/ %U https://doi.org/10.2196/23870 %U http://www.ncbi.nlm.nih.gov/pubmed/33539310 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 2 %P e23795 %T Telemedicine Use and Health-Related Concerns of Patients With Chronic Conditions During COVID-19: Survey of Members of Online Health Communities %A Horrell,Lindsey Nicole %A Hayes,Sara %A Herbert,Leslie Beth %A MacTurk,Katie %A Lawhon,Lauren %A Valle,Carmina G %A Bhowmick,Amrita %+ William F Connell School of Nursing, Boston College, Maloney Hall 378B, 140 Commonwealth Avenue, Chestnut Hill, MA, 02467, United States, 1 617 552 4886, lindsey.horrell@bc.edu %K telehealth %K telemedicine %K coronavirus %K COVID-19 %K chronic disease %D 2021 %7 18.2.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: It has been widely communicated that individuals with underlying health conditions are at higher risk of severe disease due to COVID-19 than healthy peers. As social distancing measures continue during the COVID-19 pandemic, experts encourage individuals with underlying conditions to engage in telehealth appointments to maintain continuity of care while minimizing risk exposure. To date, however, little information has been provided regarding telehealth uptake among this high-risk population. Objective: The aim of this study is to describe the telehealth use, resource needs, and information sources of individuals with chronic conditions during the COVID-19 pandemic. Secondary objectives include exploring differences in telehealth use by sociodemographic characteristics. Methods: Data for this study were collected through an electronic survey distributed between May 12-14, 2020, to members of 26 online health communities for individuals with chronic disease. Descriptive statistics were run to explore telehealth use, support needs, and information sources, and z tests were run to assess differences in sociodemographic factors and information and support needs among those who did and did not use telehealth services. Results: Among the 2210 respondents, 1073 (49%) reported engaging in telehealth in the past 4 months. Higher proportions of women engaged in telehealth than men (890/1781, 50% vs 181/424, 43%; P=.007), and a higher proportion of those earning household incomes of more than US $100,000 engaged in telehealth than those earning less than US $30,000 (195/370, 53% vs 241/530 45%; P=.003). Although 59% (133/244) of those younger than 40 years and 54% (263/486) of those aged 40-55 years used telehealth, aging populations were less likely to do so, with only 45% (677/1500) of individuals 56 years or older reporting telehealth use (P<.001 and P=.001, respectively). Patients with cystic fibrosis, lupus, and ankylosing spondylitis recorded the highest proportions of individuals using telehealth when compared to those with other diagnoses. Of the 2210 participants, 1333 (60%) participants either looked up information about the virus online or planned to in the future, and when asked what information or support would be most helpful right now, over half (1151/2210, 52%) responded “understanding how COVID-19 affects people with my health condition.” Conclusions: Nearly half of the study sample reported participating in telehealth in the past 4 months. Future efforts to engage individuals with underlying medical conditions in telehealth should focus on outreach to men, members of lower-income households, and aging populations. These results may help inform and refine future health communications to further engage this at-risk population in telehealth as the pandemic continues. %M 33539307 %R 10.2196/23795 %U http://www.jmir.org/2021/2/e23795/ %U https://doi.org/10.2196/23795 %U http://www.ncbi.nlm.nih.gov/pubmed/33539307 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 2 %P e26715 %T Impact of the COVID-19 Pandemic on Online Obsessive-Compulsive Disorder Support Community Members: Survey Study %A Kaveladze,Benjamin %A Chang,Katherine %A Siev,Jedidiah %A Schueller,Stephen M %+ Department of Psychological Science, University of California, Irvine, School of Social Ecology (Attn: Irice Castro), 5315 Social and Behavioral Sciences Gateway, Irvine, CA, 92697-7050, United States, 1 (949) 342 6253, bkavelad@uci.edu %K obsessive-compulsive disorder %K COVID-19 pandemic %K online support communities %K mental health %D 2021 %7 17.2.2021 %9 Short Paper %J JMIR Ment Health %G English %X Background: People with obsessive-compulsive disorder (OCD) have faced unique challenges during the COVID-19 pandemic. Research from the first two months of the pandemic suggests that a small proportion of people with OCD experienced worsening in their OCD symptoms since the pandemic began, whereas the rest experienced either no change or an improvement in their symptoms. However, as society-level factors relating to the pandemic have evolved, the effects of the pandemic on people with OCD have likely changed as well, in complex and population-specific ways. Therefore, this study contributes to a growing body of knowledge on the impact of the COVID-19 pandemic on people and demonstrates how differences across studies might emerge when studying specific populations at specific timepoints. Objective: This study aimed to assess how members of online OCD support communities felt the COVID-19 pandemic had affected their OCD symptoms, around 3 months after the pandemic began. Methods: We recruited participants from online OCD support communities for our brief survey. Participants indicated how much they felt their OCD symptoms had changed since the pandemic began and how much they felt that having OCD was making it harder to deal with the pandemic. Results: We collected survey data from June through August 2020 and received a total of 196 responses, some of which were partial responses. Among the nonmissing data, 65.9% (108/164) of the participants were from the United States and 90.5% (152/168) had been subjected to a stay-at-home order. In all, 92.9% (182/196) of the participants said they experienced worsening of their OCD symptoms since the pandemic began, although the extent to which their symptoms worsened differed across dimensions of OCD; notably, symmetry and completeness symptoms were less likely to have worsened than others. Moreover, 95.5% (171/179) of the participants felt that having OCD made it difficult to deal with the pandemic. Conclusions: Our study of online OCD support community members found a much higher rate of OCD symptom worsening than did other studies on people with OCD conducted during the current COVID-19 pandemic. Factors such as quarantine length, location, overlapping society-level challenges, and differing measurement and sampling choices may help to explain this difference across studies. %M 33595449 %R 10.2196/26715 %U http://mental.jmir.org/2021/2/e26715/ %U https://doi.org/10.2196/26715 %U http://www.ncbi.nlm.nih.gov/pubmed/33595449 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 2 %P e25484 %T Distance Management of Spinal Disorders During the COVID-19 Pandemic and Beyond: Evidence-Based Patient and Clinician Guides From the Global Spine Care Initiative %A Haldeman,Scott %A Nordin,Margareta %A Tavares,Patricia %A Mullerpatan,Rajani %A Kopansky-Giles,Deborah %A Setlhare,Vincent %A Chou,Roger %A Hurwitz,Eric %A Treanor,Caroline %A Hartvigsen,Jan %A Schneider,Michael %A Gay,Ralph %A Moss,Jean %A Haldeman,Joan %A Gryfe,David %A Wilkey,Adam %A Brown,Richard %A Outerbridge,Geoff %A Eberspaecher,Stefan %A Carroll,Linda %A Engelbrecht,Reginald %A Graham,Kait %A Cashion,Nathan %A Ince,Stefanie %A Moon,Erin %+ World Spine Care, 10131 Brier Lane, Santa Ana, CA, 92705, United States, 1 714 651 2949, shaldema@uci.edu %K COVID-19 %K spinal disorders %K evidence-based care %K physical distancing care %K clinical guides %K low- and middle-income communities %K telehealth %K telemedicine %K evidence-based %K spine %K guide %K management %D 2021 %7 17.2.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The COVID-19 pandemic has greatly limited patients' access to care for spine-related symptoms and disorders. However, physical distancing between clinicians and patients with spine-related symptoms is not solely limited to restrictions imposed by pandemic-related lockdowns. In most low- and middle-income countries, as well as many underserved marginalized communities in high-income countries, there is little to no access to clinicians trained in evidence-based care for people experiencing spinal pain. Objective: The aim of this study is to describe the development and present the components of evidence-based patient and clinician guides for the management of spinal disorders where in-person care is not available. Methods: Ultimately, two sets of guides were developed (one for patients and one for clinicians) by extracting information from the published Global Spine Care Initiative (GSCI) papers. An international, interprofessional team of 29 participants from 10 countries on 4 continents participated. The team included practitioners in family medicine, neurology, physiatry, rheumatology, psychology, chiropractic, physical therapy, and yoga, as well as epidemiologists, research methodologists, and laypeople. The participants were invited to review, edit, and comment on the guides in an open iterative consensus process. Results: The Patient Guide is a simple 2-step process. The first step describes the nature of the symptoms or concerns. The second step provides information that a patient can use when considering self-care, determining whether to contact a clinician, or considering seeking emergency care. The Clinician Guide is a 5-step process: (1) Obtain and document patient demographics, location of primary clinical symptoms, and psychosocial information. (2) Review the symptoms noted in the patient guide. (3) Determine the GSCI classification of the patient’s spine-related complaints. (4) Ask additional questions to determine the GSCI subclassification of the symptom pattern. (5) Consider appropriate treatment interventions. Conclusions: The Patient and Clinician Guides are designed to be sufficiently clear to be useful to all patients and clinicians, irrespective of their location, education, professional qualifications, and experience. However, they are comprehensive enough to provide guidance on the management of all spine-related symptoms or disorders, including triage for serious and specific diseases. They are consistent with widely accepted evidence-based clinical practice guidelines. They also allow for adequate documentation and medical record keeping. These guides should be of value during periods of government-mandated physical or social distancing due to infectious diseases, such as during the COVID-19 pandemic. They should also be of value in underserved communities in high-, middle-, and low-income countries where there is a dearth of accessible trained spine care clinicians. These guides have the potential to reduce the overutilization of unnecessary and expensive interventions while empowering patients to self-manage uncomplicated spinal pain with the assistance of their clinician, either through direct in-person consultation or via telehealth communication. %M 33471778 %R 10.2196/25484 %U http://publichealth.jmir.org/2021/2/e25484/ %U https://doi.org/10.2196/25484 %U http://www.ncbi.nlm.nih.gov/pubmed/33471778 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 2 %P e23363 %T Defining Telemedicine and Engaging Future Medical Practitioners. Comment on “Telemedicine in Germany During the COVID-19 Pandemic: Multi-Professional National Survey” %A Sadik,Neha %A Salman,Reem %+ Barts and the London School of Medicine and Dentistry, Queen Mary University of London, Garrod Building, Turner St, Whitechapel, London, E1 2AD, United Kingdom, 44 7444321677, ha17302@qmul.ac.uk %K telemedicine %K coronavirus %K COVID-19 %K medical education %D 2021 %7 17.2.2021 %9 Letter to the Editor %J J Med Internet Res %G English %X %M 33595454 %R 10.2196/23363 %U https://www.jmir.org/2021/2/e23363 %U https://doi.org/10.2196/23363 %U http://www.ncbi.nlm.nih.gov/pubmed/33595454 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 2 %P e23295 %T Remote Examination and Screening for Domestic Abuse. Comment on “Online Antenatal Care During the COVID-19 Pandemic: Opportunities and Challenges” %A Grimes,Hannah Lee %A Uppal,Ramnik %+ University of Cambridge Clinical School, Hills Road, Cambridge, United Kingdom, 44 01223 336700, hlg42@cam.ac.uk %K spouse abuse %K domestic abuse %K apps %K patient information %K antenatal care %K COVID-19 %D 2021 %7 17.2.2021 %9 Letter to the Editor %J J Med Internet Res %G English %X %M 33595438 %R 10.2196/23295 %U https://www.jmir.org/2021/2/e23295 %U https://doi.org/10.2196/23295 %U http://www.ncbi.nlm.nih.gov/pubmed/33595438 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 2 %P e22427 %T Dissemination and Refutation of Rumors During the COVID-19 Outbreak in China: Infodemiology Study %A Chen,Bin %A Chen,Xinyi %A Pan,Jin %A Liu,Kui %A Xie,Bo %A Wang,Wei %A Peng,Ying %A Wang,Fei %A Li,Na %A Jiang,Jianmin %+ Department of Tuberculosis Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Binsheng Road 3399, Binjiang District, Hangzhou, 310051, China, 86 571 87115009, jmjiang@cdc.zj.cn %K rumor %K Internet %K COVID-19 %K epidemic %K misinformation %K infodemiology %K infodemic %K social media %K communication %K public health %D 2021 %7 15.2.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: During the outbreak of COVID-19, numerous rumors emerged on the internet in China and caused confusion among the public. However, the characteristics of these rumors in different phases of the epidemic have not been studied in depth, and the official responses to the rumors have not been systematically evaluated. Objective: The aims of this study were to evaluate the rumor epidemic and official responses during the COVID-19 outbreak in China and to provide a scientific basis for effective information communication in future public health crises. Methods: Data on internet rumors related to COVID-19 were collected via the Sina Weibo Official Account to Refute Rumors between January 20 and April 8, 2020, extracted, and analyzed. The data were divided into five periods according to the key events and disease epidemic. Different classifications of rumors were described and compared over the five periods. The trends of the epidemic and the focus of the public at different stages were plotted, and correlation analysis between the number of rumors and the number of COVID-19 cases was performed. The geographic distributions of the sources and refuters of the rumors were graphed, and analyses of the most frequently appearing words in the rumors were applied to reveal hotspots of the rumors. Results: A total of 1943 rumors were retrieved. The median of the response interval between publication and debunking of the rumors was 1 day (IQR 1-2). Rumors in text format accounted for the majority of the 1943 rumors (n=1241, 63.9%); chat tools, particularly WeChat (n=1386, 71.3%), were the most common platform for initial publishing of the rumors (n=1412, 72.7%). In addition to text rumors, Weibo and web pages were more likely to be platforms for rumors released in multimedia formats or in a combination of formats, respectively. Local agencies played a large role in dispelling rumors among social media platforms (1537/1943, 79.1%). There were significant differences in the formats and origins of rumors over the five periods (P<.001). Hubei Province accounted for most of the country’s confirmed rumors. Beijing and Wuhan City were the main centers for debunking of disinformation. The words most frequently included in the core messages of the rumors varied by period, indicating shifting in the public’s concern. Conclusions: Chat tools, particularly WeChat, became the major sources of rumors during the COVID-19 outbreak in China, indicating a requirement to establish rumor monitoring and refuting mechanisms on these platforms. Moreover, targeted policy adjustments and timely release of official information are needed in different phases of the outbreak. %M 33493124 %R 10.2196/22427 %U http://www.jmir.org/2021/2/e22427/ %U https://doi.org/10.2196/22427 %U http://www.ncbi.nlm.nih.gov/pubmed/33493124 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 2 %P e20335 %T Evaluating Apple Inc Mobility Trend Data Related to the COVID-19 Outbreak in Japan: Statistical Analysis %A Kurita,Junko %A Sugishita,Yoshiyuki %A Sugawara,Tamie %A Ohkusa,Yasushi %+ Department of Nursing, Tokiwa University, 1-430-1 Miwa, Mito, Ibraki, 3108585, Japan, 81 29 232 2511, kuritaj@tokiwa.ac.jp %K peak %K COVID-19 %K effective reproduction number %K mobility trend data %K Apple %K countermeasure %D 2021 %7 15.2.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: In Japan, as a countermeasure against the COVID-19 outbreak, both the national and local governments issued voluntary restrictions against going out from residences at the end of March 2020 in preference to the lockdowns instituted in European and North American countries. The effect of such measures can be studied with mobility data, such as data which is generated by counting the number of requests made to Apple Maps for directions in select countries/regions, sub-regions, and cities. Objective: We investigate the associations of mobility data provided by Apple Inc and an estimate an an effective reproduction number R(t). Methods: We regressed R(t) on a polynomial function of daily Apple data, estimated using the whole period, and analyzed subperiods delimited by March 10, 2020. Results: In the estimation results, R(t) was 1.72 when voluntary restrictions against going out ceased and mobility reverted to a normal level. However, the critical level of reducing R(t) to <1 was obtained at 89.3% of normal mobility. Conclusions: We demonstrated that Apple mobility data are useful for short-term prediction of R(t). The results indicate that the number of trips should decrease by 10% until herd immunity is achieved and that higher voluntary restrictions against going out might not be necessary for avoiding a re-emergence of the outbreak. %M 33481755 %R 10.2196/20335 %U http://publichealth.jmir.org/2021/2/e20335/ %U https://doi.org/10.2196/20335 %U http://www.ncbi.nlm.nih.gov/pubmed/33481755 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 2 %P e26392 %T Promoting Mask Use on TikTok: Descriptive, Cross-sectional Study %A Basch,Corey H %A Fera,Joseph %A Pierce,Isabela %A Basch,Charles E %+ Department of Public Health, William Paterson University, 300 Pompton Rd, University Hall, Wayne, NJ, 07470, United States, 1 9737202603, baschc@wpunj.edu %K TikTok %K COVID-19 %K social media %K infodemiology %K infoveillance %K mask use %K prevention %K promotion %K communication %K public health %K cross-sectional %K content analysis %K transmission %D 2021 %7 12.2.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Over the past decade, there has been an increasing secular trend in the number of studies on social media and health. Objective: The purpose of this cross-sectional study was to examine the content and characteristics of TikTok videos that are related to an important aspect of community mitigation—the use of masks as a method for interrupting the transmission of SARS-CoV-2. Methods: In total, 100 trending videos with the hashtag #WearAMask (ie, a campaign on TikTok), along with 32 videos that were posted by the World Health Organization (WHO) and involved masks in any way (ie, all related WHO videos at the time of this study), were included in our sample. We collected the metadata of each post, and created content categories based on fact sheets that were provided by the WHO and the US Centers for Disease Control and Prevention. We used these fact sheets to code the characteristics of mask use. Results: Videos that were posted on TikTok and had the hashtag #WearAMask garnered almost 500 million views, and videos that were posted by the WHO garnered almost 57 million views. Although the ratio of the number of trending #WearAMask videos to the number of WHO videos was around 3:1, the #WearAMask videos received almost 10 times as many cumulative views as the WHO videos. In total, 68% (68/100) of the trending #WearAMask videos involved humor and garnered over 355 million cumulative views. However, only 9% (3/32) of the WHO videos involved humor. Furthermore, 27% (27/100) of the trending #WearAMask videos involved dance and garnered over 130 million cumulative views, whereas none of the WHO videos involved dance. Conclusions: This study is one of the first to describe how TikTok is being used to mitigate the community spread of COVID-19 by promoting mask use. Due to the platform’s incredible reach, TikTok has great potential in conveying important public health messages to various segments of the population. %M 33523823 %R 10.2196/26392 %U http://publichealth.jmir.org/2021/2/e26392/ %U https://doi.org/10.2196/26392 %U http://www.ncbi.nlm.nih.gov/pubmed/33523823 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 2 %P e25734 %T Quantifying the Influence of Delay in Opinion Transmission of COVID-19 Information Propagation: Modeling Study %A Yin,Fulian %A Shao,Xueying %A Ji,Meiqi %A Wu,Jianhong %+ Fields-CQAM Laboratory of Mathematics for Public Health, Laboratory for Industrial and Applied Mathematics, York University, 4700 Keele St, Toronto, ON, M3J1P3, Canada, 1 416 736 5243, wujhhida@hotmail.com %K COVID-19 %K delay transmission %K dynamic model %K Sina Microblog %K social media %K communication %K online health information %K health information %K public health %K opinion %K strategy %K model %K information transmission %K delay %K infodemiology %K infoveillance %D 2021 %7 12.2.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: In a fast-evolving public health crisis such as the COVID-19 pandemic, multiple pieces of relevant information can be posted sequentially on a social media platform. The interval between subsequent posting times may have a different impact on the transmission and cross-propagation of the old and new information that results in a different peak value and a final size of forwarding users of the new information, depending on the content correlation and whether the new information is posted during the outbreak or quasi–steady-state phase of the old information. Objective: This study aims to help in designing effective communication strategies to ensure information is delivered to the maximal number of users. Methods: We developed and analyzed two classes of susceptible-forwarding-immune information propagation models with delay in transmission to describe the cross-propagation process of relevant information. A total of 28,661 retweets of typical information were posted frequently by each opinion leader related to COVID-19 with high influence (data acquisition up to February 19, 2020). The information was processed into discrete points with a frequency of 10 minutes, and the real data were fitted by the model numerical simulation. Furthermore, the influence of parameters on information dissemination and the design of a publishing strategy were analyzed. Results: The current epidemic outbreak situation, epidemic prevention, and other related authoritative information cannot be timely and effectively browsed by the public. The ingenious use of information release intervals can effectively enhance the interaction between information and realize the effective diffusion of information. We parameterized our models using real data from Sina Microblog and used the parameterized models to define and evaluate mutual attractiveness indexes, and we used these indexes and parameter sensitivity analyses to inform optimal strategies for new information to be effectively propagated in the microblog. The results of the parameter analysis showed that using different attractiveness indexes as the key parameters can control the information transmission with different release intervals, so it is considered as a key link in the design of an information communication strategy. At the same time, the dynamic process of information was analyzed through index evaluation. Conclusions: Our model can carry out an accurate numerical simulation of information at different release intervals and achieve a dynamic evaluation of information transmission by constructing an indicator system so as to provide theoretical support and strategic suggestions for government decision making. This study optimizes information posting strategies to maximize communication efforts for delivering key public health messages to the public for better outcomes of public health emergency management. %M 33529153 %R 10.2196/25734 %U http://www.jmir.org/2021/2/e25734/ %U https://doi.org/10.2196/25734 %U http://www.ncbi.nlm.nih.gov/pubmed/33529153 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 2 %P e25363 %T Exposure to COVID-19-Related Information and its Association With Mental Health Problems in Thailand: Nationwide, Cross-sectional Survey Study %A Mongkhon,Pajaree %A Ruengorn,Chidchanok %A Awiphan,Ratanaporn %A Thavorn,Kednapa %A Hutton,Brian %A Wongpakaran,Nahathai %A Wongpakaran,Tinakon %A Nochaiwong,Surapon %+ Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, 239, Suthep Road, Chiang Mai, 50200, Thailand, 66 899973365, surapon.nochaiwong@gmail.com %K coronavirus %K COVID-19 %K insomnia %K mental health %K social media %K depression %K anxiety %K stress %K psychosocial problem %D 2021 %7 12.2.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic has had a negative impact on both the physical and mental health of individuals worldwide. Evidence regarding the association between mental health problems and information exposure among Thai citizens during the COVID-19 outbreak is limited. Objective: This study aimed to explore the relationship between information exposure and mental health problems during the COVID-19 pandemic in Thailand. Methods: Between April 21 and May 4, 2020, we conducted a cross-sectional, nationwide online survey of the general population in Thailand. We categorized the duration of exposure to COVID-19-related information as follows: <1 h/day (reference group), 1-2 h/day, and ≥3 h/day. Mental health outcomes were assessed using the Patient Health Questionnaire-9, the Generalized Anxiety Disorder-7 scale, the Perceived Stress Scale-10, and the Insomnia Severity Index for symptoms of depression, anxiety, perceived stress, and insomnia, respectively. Multivariable logistic regression models were used to evaluate the relationship between information exposure and the risk of developing the aforementioned symptoms. An ancillary analysis using multivariable multinomial logistic regression models was also conducted to assess the possible dose-response relationship across the severity strata of mental health problems. Results: Of the 4322 eligible participants, 4004 (92.6%) completed the online survey. Of them, 1481 (37.0%), 1644 (41.1%), and 879 (22.0%) participants were exposed to COVID-19-related information for less than 1 hour per day, 1 to 2 hours per day, or 3 or more hours per day, respectively. The major source of information related to the COVID-19 pandemic was social media (95.3%), followed by traditional media (68.7%) and family members (34.9%). Those exposed to information for 3 or more hours per day had a higher risk of developing symptoms of depression (adjusted odds ratio [OR] 1.35, 95% CI 1.03-1.76; P=.03), anxiety (adjusted OR 1.88, 95% CI 1.43-2.46; P<.001), and insomnia (adjusted OR 1.52, 95% CI 1.17-1.97; P=.001) than people exposed to information for less than 1 hour per day. Meanwhile, people exposed to information for 1 to 2 hours per day were only at risk of developing symptoms of anxiety (adjusted OR 1.35, 95% CI 1.08-1.69; P=.008). However, no association was found between information exposure and the risk of perceived stress. In the ancillary analysis, a dose-response relationship was observed between information exposure of 3 or more hours per day and the severity of mental health problems. Conclusions: These findings suggest that social media is the main source of COVID-19-related information. Moreover, people who are exposed to information for 3 or more hours per day are more likely to develop psychological problems, including depression, anxiety, and insomnia. Longitudinal studies investigating the long-term effects of COVID-19-related information exposure on mental health are warranted. %M 33523828 %R 10.2196/25363 %U http://www.jmir.org/2021/2/e25363/ %U https://doi.org/10.2196/25363 %U http://www.ncbi.nlm.nih.gov/pubmed/33523828 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 2 %P e26683 %T Efficacy of a Six-Week-Long Therapist-Guided Online Therapy Versus Self-help Internet-Based Therapy for COVID-19–Induced Anxiety and Depression: Open-label, Pragmatic, Randomized Controlled Trial %A Al-Alawi,Mohammed %A McCall,Roopa K %A Sultan,Alya %A Al Balushi,Naser %A Al-Mahrouqi,Tamadhir %A Al Ghailani,Abdullah %A Al Sabti,Hilal %A Al-Maniri,Abdullah %A Panchatcharam,Sathiya M %A Al Sinawi,Hamed %+ Department of Behavioral Medicine, Sultan Qaboos University Hospital, Al Khoud, Muscat, 123, Oman, 968 92281145, alalawim@squ.edu.om %K COVID-19 %K depression %K anxiety %K Oman %K online therapy %K randomized controlled trial %K telehealth %K therapy %K mental health %K e-mental health %K self-help %K distress %D 2021 %7 12.2.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: The COVID-19 pandemic has led to a notable increase in psychological distress, globally. Oman is no exception to this, with several studies indicating high levels of anxiety and depression among the Omani public. There is a need for adaptive and effective interventions that aim to improve the elevated levels of psychological distress due to the COVID-19 pandemic. Objective: This study aimed to comparatively assess the efficacy of therapist-guided online therapy with that of self-help, internet-based therapy focusing on COVID-19–induced symptoms of anxiety and depression among individuals living in Oman during the COVID-19 pandemic. Methods: This was a 6-week-long pragmatic randomized controlled trial involving 60 participants who were recruited from a study sample surveyed for symptoms of anxiety or depression among the Omani public amid the COVID-19 pandemic. Participants in the intervention group were allocated to receive 1 online session per week for 6 weeks from certified psychotherapists in Oman; these sessions were conducted in Arabic or English. The psychotherapists utilized cognitive behavioral therapy and acceptance and commitment therapy interventions. Participants in the control group received an automatic weekly newsletter via email containing self-help information and tips to cope with distress associated with COVID-19. The information mainly consisted of behavioral tips revolving around the principles of cognitive behavioral therapy and acceptance and commitment therapy. The primary outcome was measured by comparing the change in the mean scores of Patient Health Questionnaire-9 (PHQ-9) and General Anxiety Disorder-7 (GAD-7) scale from the baseline to the end of the study (ie, after 6 sessions) between the two groups. The secondary outcome was to compare the proportions of participants with depression and anxiety between the two groups. Results: Data from 46 participants were analyzed (intervention group n=22, control group n=24). There was no statistical difference in the baseline characteristics between both groups. Analysis of covariance indicated a significant reduction in the GAD-7 scores (F1,43=7.307; P=.01) between the two groups after adjusting for baseline scores. GAD-7 scores of participants in the intervention group were considerably more reduced than those of participants in the control group (β=−3.27; P=.01). Moreover, a greater reduction in mean PHQ-9 scores was observed among participants in the intervention group (F1,43=8.298; P=.006) than those in the control group (β=−4.311; P=.006). Although the levels of anxiety and depression reduced in both study groups, the reduction was higher in the intervention group (P=.049) than in the control group (P=.02). Conclusions: This study provides preliminary evidence to support the efficacy of online therapy for improving the symptoms of anxiety and depression during the COVID-19 crisis in Oman. Therapist-guided online therapy was found to be superior to self-help, internet-based therapy; however, both therapies could be considered as viable options. Trial Registration: ClinicalTrials.gov NCT04378257; https://clinicaltrials.gov/ct2/show/NCT04378257 %M 33512323 %R 10.2196/26683 %U http://mental.jmir.org/2021/2/e26683/ %U https://doi.org/10.2196/26683 %U http://www.ncbi.nlm.nih.gov/pubmed/33512323 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 2 %P e26570 %T Consuming Information Related to COVID-19 on Social Media Among Older Adults and Its Association With Anxiety, Social Trust in Information, and COVID-Safe Behaviors: Cross-sectional Telephone Survey %A Wong,Frankie Ho Chun %A Liu,Tianyin %A Leung,Dara Kiu Yi %A Zhang,Anna Y %A Au,Walker Siu Hong %A Kwok,Wai Wai %A Shum,Angie K Y %A Wong,Gloria Hoi Yan %A Lum,Terry Yat-Sang %+ Department of Social Work and Social Administration, The University of Hong Kong, CJT-514, The University of Hong Kong, Pokfulam, Hong Kong, 852 39178569, tlum@hku.hk %K COVID-19 %K anxiety %K social media %K infodemic %K Hong Kong %D 2021 %7 11.2.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: COVID-19-related information on social media is overabundant and sometimes questionable, resulting in an “infodemic” during the pandemic. While previous studies suggest social media usage increases the risk of developing anxiety symptoms, how induced anxiety affects attitudes and behaviors is less discussed, let alone during a global pandemic. Little is known about the relationship between older adults using social media during a pandemic and their anxiety, their attitudes toward social trust in information, and behaviors to avoid contracting COVID-19. Objective: The goal of this study was to investigate the associations between using social media for COVID-19-related information and anxiety symptoms as well as the mediation effect of anxiety symptoms on social trust in information and COVID-safe behaviors among older adults. Methods: A cross-sectional telephone survey was conducted in Hong Kong between May and August 2020. A rapid warm-call protocol was developed to train social workers and volunteers from participant nongovernmental organizations to conduct the telephone surveys. Questions related to COVID-safe behaviors, social trust in information, social media use, anxiety and depressive symptoms, and sociodemographic information were asked. The number of confirmed COVID-19 cases at the community level was used to account for the risk of contracting COVID-19. Ordinary least squares regressions examined the associations between social media use and anxiety symptoms, and how they were associated with social trust in information and COVID-safe behaviors. Structural equation modeling further mapped out these relationships to identify the mediation effects of anxiety symptoms. Results: This study collected information regarding 3421 adults aged 60 years and older. Use of social media for COVID-19-related information was associated with more anxiety symptoms and lower social trust in information but had no significant relationship with COVID-safe behaviors. Anxiety symptoms predicted lower social trust in information and higher COVID-safe behaviors. Lower social trust in information was predicted by using social media for COVID-19 information, mediated by anxiety symptoms, while no mediation effect was found for COVID-safe behaviors. Conclusions: Older adults who rely on social media for COVID-19-related information exhibited more anxiety symptoms, while showing mixed effects on attitudes and behaviors. Social trust in information may be challenged by unverified and contradictory information online. The negligible impact on COVID-safe behaviors suggested that social media may have caused more confusion than consolidating a consistent effort against the pandemic. Media literacy education is recommended to promote critical evaluation of COVID-19-related information and responsible sharing among older adults. %M 33523825 %R 10.2196/26570 %U http://www.jmir.org/2021/2/e26570/ %U https://doi.org/10.2196/26570 %U http://www.ncbi.nlm.nih.gov/pubmed/33523825 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 9 %N 2 %P e24572 %T Development and Validation of a Machine Learning Approach for Automated Severity Assessment of COVID-19 Based on Clinical and Imaging Data: Retrospective Study %A Quiroz,Juan Carlos %A Feng,You-Zhen %A Cheng,Zhong-Yuan %A Rezazadegan,Dana %A Chen,Ping-Kang %A Lin,Qi-Ting %A Qian,Long %A Liu,Xiao-Fang %A Berkovsky,Shlomo %A Coiera,Enrico %A Song,Lei %A Qiu,Xiaoming %A Liu,Sidong %A Cai,Xiang-Ran %+ Centre for Health Informatics, Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, 75 Talvera Road, Macquarie Park, 2113, Australia, 61 29852729, sidong.liu@mq.edu.au %K algorithm %K clinical data %K clinical features %K COVID-19 %K CT scans %K development %K imaging %K imbalanced data %K machine learning %K oversampling %K severity assessment %K validation %D 2021 %7 11.2.2021 %9 Original Paper %J JMIR Med Inform %G English %X Background: COVID-19 has overwhelmed health systems worldwide. It is important to identify severe cases as early as possible, such that resources can be mobilized and treatment can be escalated. Objective: This study aims to develop a machine learning approach for automated severity assessment of COVID-19 based on clinical and imaging data. Methods: Clinical data—including demographics, signs, symptoms, comorbidities, and blood test results—and chest computed tomography scans of 346 patients from 2 hospitals in the Hubei Province, China, were used to develop machine learning models for automated severity assessment in diagnosed COVID-19 cases. We compared the predictive power of the clinical and imaging data from multiple machine learning models and further explored the use of four oversampling methods to address the imbalanced classification issue. Features with the highest predictive power were identified using the Shapley Additive Explanations framework. Results: Imaging features had the strongest impact on the model output, while a combination of clinical and imaging features yielded the best performance overall. The identified predictive features were consistent with those reported previously. Although oversampling yielded mixed results, it achieved the best model performance in our study. Logistic regression models differentiating between mild and severe cases achieved the best performance for clinical features (area under the curve [AUC] 0.848; sensitivity 0.455; specificity 0.906), imaging features (AUC 0.926; sensitivity 0.818; specificity 0.901), and a combination of clinical and imaging features (AUC 0.950; sensitivity 0.764; specificity 0.919). The synthetic minority oversampling method further improved the performance of the model using combined features (AUC 0.960; sensitivity 0.845; specificity 0.929). Conclusions: Clinical and imaging features can be used for automated severity assessment of COVID-19 and can potentially help triage patients with COVID-19 and prioritize care delivery to those at a higher risk of severe disease. %M 33534723 %R 10.2196/24572 %U http://medinform.jmir.org/2021/2/e24572/ %U https://doi.org/10.2196/24572 %U http://www.ncbi.nlm.nih.gov/pubmed/33534723 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 2 %P e24162 %T Intentions to Seek Mental Health Services During the COVID-19 Pandemic Among Chinese Pregnant Women With Probable Depression or Anxiety: Cross-sectional, Web-Based Survey Study %A Wang,Qian %A Song,Bo %A Di,Jiangli %A Yang,Xue %A Wu,Anise %A Lau,Joseph %A Xin,Meiqi %A Wang,Linhong %A Mo,Phoenix Kit-Han %+ Center for Health Behaviours Research, School of Public Health and Primary Care, The Chinese University of Hong Kong, JC School of Public Health and Primary Care, Room 508, 30-32 Ngan Shing St, Hong Kong, Hong Kong, 852 22528765, phoenix.mo@cuhk.edu.hk %K pregnant women %K COVID-19 %K depression %K anxiety %K help-seeking %K mental health services %K social support %K trust %K intention %K mental health %K pregnancy %K survey %D 2021 %7 11.2.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: Mental health problems are prevalent among pregnant women, and it is expected that their mental health will worsen during the COVID-19 pandemic. Furthermore, the underutilization of mental health services among pregnant women has been widely documented. Objective: We aimed to identify factors that are associated with pregnant women’s intentions to seek mental health services. We specifically assessed pregnant women who were at risk of mental health problems in mainland China. Methods: A web-based survey was conducted from February to March, 2020 among 19,515 pregnant women who were recruited from maternal health care centers across various regions of China. A subsample of 6248 pregnant women with probable depression (ie, those with a score of ≥10 on the 9-item Patient Health Questionnaire) or anxiety (ie, those with a score of ≥5 on the 7-item General Anxiety Disorder Scale) was included in our analysis. Results: More than half (3292/6248, 52.7%) of the participants reported that they did not need mental health services. Furthermore, 28.3% (1770/6248) of participants felt that they needed mental health services, but had no intentions of seeking help, and only 19% (1186/6248) felt that they needed mental health services and had intentions of seek help. The results from our multivariate logistic regression analysis showed that age, education level, and gestational age were factors of not seeking help. However, COVID-19–related lockdowns in participants’ cities of residence, social support during the COVID-19 pandemic, and trust in health care providers were protective factors of participants’ intentions to seek help from mental health services. Conclusions: Interventions that promote seeking help for mental health problems among pregnant women should also promote social support from health care providers and trust between pregnant women and their care providers. %M 33570500 %R 10.2196/24162 %U http://mental.jmir.org/2021/2/e24162/ %U https://doi.org/10.2196/24162 %U http://www.ncbi.nlm.nih.gov/pubmed/33570500 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 2 %P e24246 %T A Machine Learning Prediction Model of Respiratory Failure Within 48 Hours of Patient Admission for COVID-19: Model Development and Validation %A Bolourani,Siavash %A Brenner,Max %A Wang,Ping %A McGinn,Thomas %A Hirsch,Jamie S %A Barnaby,Douglas %A Zanos,Theodoros P %A , %+ Feinstein Institutes for Medical Research, Northwell Health, 350 Community Dr, Room 1257, Manhasset, NY, 11030, United States, 1 5165620484, tzanos@northwell.edu %K artificial intelligence %K prognostic %K model %K pandemic %K severe acute respiratory syndrome coronavirus 2 %K modeling %K development %K validation %K COVID-19 %K machine learning %D 2021 %7 10.2.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Predicting early respiratory failure due to COVID-19 can help triage patients to higher levels of care, allocate scarce resources, and reduce morbidity and mortality by appropriately monitoring and treating the patients at greatest risk for deterioration. Given the complexity of COVID-19, machine learning approaches may support clinical decision making for patients with this disease. Objective: Our objective is to derive a machine learning model that predicts respiratory failure within 48 hours of admission based on data from the emergency department. Methods: Data were collected from patients with COVID-19 who were admitted to Northwell Health acute care hospitals and were discharged, died, or spent a minimum of 48 hours in the hospital between March 1 and May 11, 2020. Of 11,525 patients, 933 (8.1%) were placed on invasive mechanical ventilation within 48 hours of admission. Variables used by the models included clinical and laboratory data commonly collected in the emergency department. We trained and validated three predictive models (two based on XGBoost and one that used logistic regression) using cross-hospital validation. We compared model performance among all three models as well as an established early warning score (Modified Early Warning Score) using receiver operating characteristic curves, precision-recall curves, and other metrics. Results: The XGBoost model had the highest mean accuracy (0.919; area under the curve=0.77), outperforming the other two models as well as the Modified Early Warning Score. Important predictor variables included the type of oxygen delivery used in the emergency department, patient age, Emergency Severity Index level, respiratory rate, serum lactate, and demographic characteristics. Conclusions: The XGBoost model had high predictive accuracy, outperforming other early warning scores. The clinical plausibility and predictive ability of XGBoost suggest that the model could be used to predict 48-hour respiratory failure in admitted patients with COVID-19. %M 33476281 %R 10.2196/24246 %U http://www.jmir.org/2021/2/e24246/ %U https://doi.org/10.2196/24246 %U http://www.ncbi.nlm.nih.gov/pubmed/33476281 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 2 %P e23917 %T The Efficacy of WeChat-Based Parenting Training on the Psychological Well-being of Mothers With Children With Autism During the COVID-19 Pandemic: Quasi-Experimental Study %A Liu,Guihua %A Wang,Shuo %A Liao,Jinhua %A Ou,Ping %A Huang,Longsheng %A Xie,Namei %A He,Yingshuang %A Lin,Jinling %A He,Hong-Gu %A Hu,Rongfang %+ The School of Nursing, Fujian Medical University, 1 Xuefu Road, Shangjie Zhen, Minhou County, Fuzhou, 350000, China, 86 13509366729, hulu2886@sina.com %K coronavirus disease 2019 %K autism spectrum disorder %K parenting training %K psychological well-being %K social media %K WeChat %K COVID-19 %K autism %K parenting %K mental health %K well-being %K anxiety %K depression %K stress %D 2021 %7 10.2.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: During the COVID-19 pandemic, special education schools for children in most areas of China were closed between the end of January and the beginning of June in 2020. The sudden interruption in schooling and the pandemic itself caused parents to be anxious and even to panic. Mobile-based parenting skills education has been demonstrated to be an effective method for improving the psychological well-being of mothers with children with autism. However, whether it can improve the psychological states of mothers in the context of the COVID-19 pandemic is a subject that should be urgently investigated. Objective: The aim of this study is to evaluate the efficacy of WeChat-based parenting training on anxiety, depression, parenting stress, and hope in mothers with children with autism, as well as the feasibility of the program during the COVID-19 pandemic. Methods: This was a quasi-experimental trial. A total of 125 mothers with preschool children with autism were recruited in January 2020. The participants were assigned to the control group (n=60), in which they received routine care, or the intervention group (n=65), in which they received the 12-week WeChat-based parenting training plus routine care, according to their preferences. Anxiety, depression, parenting stress, hope, satisfaction, and adherence to the intervention were measured at three timepoints: baseline (T0), postintervention (T1), and a 20-week follow-up (T2). Results: In total, 109 mothers completed the T1 assessment and 104 mothers completed the T2 assessment. The results of the linear mixed model analysis showed statistically significant group × time interaction effects for the intervention on anxiety (F=14.219, P<.001), depression (F=26.563, P<.001), parenting stress (F=68.572, P<.001), and hope (F=197.608, P<.001). Of all mothers in the intervention group, 90.4% (48.8/54) reported that they were extremely satisfied with the WeChat-based parenting training. In total, 40.0% (26/65) logged their progress in home training each week and 61.5% (40/65) logged their progress more than 80% of the time for all 20 weeks. Conclusions: The WeChat-based parenting training is acceptable and appears to be an effective approach for reducing anxiety, depression, and parenting stress, as well as increasing hope in mothers with children with autism during the global COVID-19 pandemic. Future studies with rigorous designs and longer follow-up periods are needed to further detect the effectiveness of the WeChat-based parenting training. Trial Registration: Chinese Clinical Trial Registry ChiCTR2000031772; http://www.chictr.org.cn/showproj.aspx?proj=52165 %M 33481751 %R 10.2196/23917 %U https://mental.jmir.org/2021/2/e23917 %U https://doi.org/10.2196/23917 %U http://www.ncbi.nlm.nih.gov/pubmed/33481751 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 2 %P e23693 %T Fast and Accurate Detection of COVID-19 Along With 14 Other Chest Pathologies Using a Multi-Level Classification: Algorithm Development and Validation Study %A Albahli,Saleh %A Yar,Ghulam Nabi Ahmad Hassan %+ Department of Information Technology, College of Computer, Qassim University, Buraydah, 51452, Saudi Arabia, 966 163012604, salbahli@qu.edu.sa %K COVID-19 %K chest x-ray %K convolutional neural network %K data augmentation %K biomedical imaging %K automatic detection %D 2021 %7 10.2.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: COVID-19 has spread very rapidly, and it is important to build a system that can detect it in order to help an overwhelmed health care system. Many research studies on chest diseases rely on the strengths of deep learning techniques. Although some of these studies used state-of-the-art techniques and were able to deliver promising results, these techniques are not very useful if they can detect only one type of disease without detecting the others. Objective: The main objective of this study was to achieve a fast and more accurate diagnosis of COVID-19. This study proposes a diagnostic technique that classifies COVID-19 x-ray images from normal x-ray images and those specific to 14 other chest diseases. Methods: In this paper, we propose a novel, multilevel pipeline, based on deep learning models, to detect COVID-19 along with other chest diseases based on x-ray images. This pipeline reduces the burden of a single network to classify a large number of classes. The deep learning models used in this study were pretrained on the ImageNet dataset, and transfer learning was used for fast training. The lungs and heart were segmented from the whole x-ray images and passed onto the first classifier that checks whether the x-ray is normal, COVID-19 affected, or characteristic of another chest disease. If it is neither a COVID-19 x-ray image nor a normal one, then the second classifier comes into action and classifies the image as one of the other 14 diseases. Results: We show how our model uses state-of-the-art deep neural networks to achieve classification accuracy for COVID-19 along with 14 other chest diseases and normal cases based on x-ray images, which is competitive with currently used state-of-the-art models. Due to the lack of data in some classes such as COVID-19, we applied 10-fold cross-validation through the ResNet50 model. Our classification technique thus achieved an average training accuracy of 96.04% and test accuracy of 92.52% for the first level of classification (ie, 3 classes). For the second level of classification (ie, 14 classes), our technique achieved a maximum training accuracy of 88.52% and test accuracy of 66.634% by using ResNet50. We also found that when all the 16 classes were classified at once, the overall accuracy for COVID-19 detection decreased, which in the case of ResNet50 was 88.92% for training data and 71.905% for test data. Conclusions: Our proposed pipeline can detect COVID-19 with a higher accuracy along with detecting 14 other chest diseases based on x-ray images. This is achieved by dividing the classification task into multiple steps rather than classifying them collectively. %M 33529154 %R 10.2196/23693 %U http://www.jmir.org/2021/2/e23693/ %U https://doi.org/10.2196/23693 %U http://www.ncbi.nlm.nih.gov/pubmed/33529154 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 2 %P e25518 %T A Virtual Ward Model of Care for Patients With COVID-19: Retrospective Single-Center Clinical Study %A Ferry,Olivia R %A Moloney,Emma C %A Spratt,Owen T %A Whiting,Gerald F M %A Bennett,Cameron J %+ Metro North Hospital and Health Service, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, Brisbane, 4006, Australia, 61 36468111, cameron.bennett@health.qld.gov.au %K COVID-19 %K efficacy %K hospital %K innovation %K model %K remote care %K safety %K telemedicine %K virtual health care %K virtual ward %D 2021 %7 10.2.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: COVID-19 has necessitated the implementation of innovative health care models in preparation for an influx of patients. A virtual ward model delivers clinical care remotely to patients in isolation. We report on an Australian cohort of patients with COVID-19 treated in a virtual ward. Objective: The aim of this study was to describe and evaluate the safety and efficacy of a virtual ward model of care for an Australian cohort of patients with COVID-19. Methods: Retrospective clinical assessment was performed for 223 patients with confirmed COVID-19 treated in a virtual ward in Brisbane, Australia, from March 25 to May 15, 2020. Statistical analysis was performed for variables associated with the length of stay and hospitalization. Results: Of 223 patients, 205 (92%) recovered without the need for escalation to hospital care. The median length of stay in the virtual ward was 8 days (range 1-44 days). In total, 18 (8%) patients were referred to hospital, of which 6 (33.3%) were discharged after assessment at the emergency department. Furthermore, 12 (5.4%) patients were admitted to hospital, of which 4 (33.3%) required supplemental oxygen and 2 (16.7%) required mechanical ventilation. No deaths were recorded. Factors associated with escalation to hospital care were the following: hypertension (odds ratio [OR] 3.6, 95% CI 1.28-9.87; P=.01), sputum production (OR 5.2, 95% CI 1.74-15.49; P=.001), and arthralgia (OR 3.8, 95% CI 1.21-11.71; P=.02) at illness onset and a polymerase chain reaction cycle threshold of ≤20 on a diagnostic nasopharyngeal swab (OR 5.0, 95% CI 1.25-19.63; P=.02). Conclusions: Our results suggest that a virtual ward model of care to treat patients with COVID-19 is safe and efficacious, and only a small number of patients would potentially require escalation to hospital care. Further studies are required to validate this model of care. %M 33529157 %R 10.2196/25518 %U http://www.jmir.org/2021/2/e25518/ %U https://doi.org/10.2196/25518 %U http://www.ncbi.nlm.nih.gov/pubmed/33529157 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 9 %N 2 %P e25457 %T Classification of the Disposition of Patients Hospitalized with COVID-19: Reading Discharge Summaries Using Natural Language Processing %A Fernandes,Marta %A Sun,Haoqi %A Jain,Aayushee %A Alabsi,Haitham S %A Brenner,Laura N %A Ye,Elissa %A Ge,Wendong %A Collens,Sarah I %A Leone,Michael J %A Das,Sudeshna %A Robbins,Gregory K %A Mukerji,Shibani S %A Westover,M Brandon %+ Department of Neurology, Massachusetts General Hospital, 50 Staniford St, Boston, MA, 02114, United States, 1 6508621154, mbentofernandes@mgh.harvard.edu %K ICU %K coronavirus %K electronic health record %K unstructured text %K natural language processing %K BoW %K LASSO %K feature selection %K machine learning %K intensive care unit %K COVID-19 %K EHR %D 2021 %7 10.2.2021 %9 Original Paper %J JMIR Med Inform %G English %X Background: Medical notes are a rich source of patient data; however, the nature of unstructured text has largely precluded the use of these data for large retrospective analyses. Transforming clinical text into structured data can enable large-scale research studies with electronic health records (EHR) data. Natural language processing (NLP) can be used for text information retrieval, reducing the need for labor-intensive chart review. Here we present an application of NLP to large-scale analysis of medical records at 2 large hospitals for patients hospitalized with COVID-19. Objective: Our study goal was to develop an NLP pipeline to classify the discharge disposition (home, inpatient rehabilitation, skilled nursing inpatient facility [SNIF], and death) of patients hospitalized with COVID-19 based on hospital discharge summary notes. Methods: Text mining and feature engineering were applied to unstructured text from hospital discharge summaries. The study included patients with COVID-19 discharged from 2 hospitals in the Boston, Massachusetts area (Massachusetts General Hospital and Brigham and Women’s Hospital) between March 10, 2020, and June 30, 2020. The data were divided into a training set (70%) and hold-out test set (30%). Discharge summaries were represented as bags-of-words consisting of single words (unigrams), bigrams, and trigrams. The number of features was reduced during training by excluding n-grams that occurred in fewer than 10% of discharge summaries, and further reduced using least absolute shrinkage and selection operator (LASSO) regularization while training a multiclass logistic regression model. Model performance was evaluated using the hold-out test set. Results: The study cohort included 1737 adult patients (median age 61 [SD 18] years; 55% men; 45% White and 16% Black; 14% nonsurvivors and 61% discharged home). The model selected 179 from a vocabulary of 1056 engineered features, consisting of combinations of unigrams, bigrams, and trigrams. The top features contributing most to the classification by the model (for each outcome) were the following: “appointments specialty,” “home health,” and “home care” (home); “intubate” and “ARDS” (inpatient rehabilitation); “service” (SNIF); “brief assessment” and “covid” (death). The model achieved a micro-average area under the receiver operating characteristic curve value of 0.98 (95% CI 0.97-0.98) and average precision of 0.81 (95% CI 0.75-0.84) in the testing set for prediction of discharge disposition. Conclusions: A supervised learning–based NLP approach is able to classify the discharge disposition of patients hospitalized with COVID-19. This approach has the potential to accelerate and increase the scale of research on patients’ discharge disposition that is possible with EHR data. %M 33449908 %R 10.2196/25457 %U https://medinform.jmir.org/2021/2/e25457 %U https://doi.org/10.2196/25457 %U http://www.ncbi.nlm.nih.gov/pubmed/33449908 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 2 %P e25431 %T Tracking COVID-19 Discourse on Twitter in North America: Infodemiology Study Using Topic Modeling and Aspect-Based Sentiment Analysis %A Jang,Hyeju %A Rempel,Emily %A Roth,David %A Carenini,Giuseppe %A Janjua,Naveed Zafar %+ British Columbia Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC, V5Z 4R4, Canada, 1 604 707 2514, naveed.janjua@bccdc.ca %K COVID-19 %K Twitter %K topic modeling %K aspect-based sentiment analysis %K racism %K anti-Asians %K Canada %K North America %K sentiment analysis %K social media %K discourse %K reaction %K public health %D 2021 %7 10.2.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Social media is a rich source where we can learn about people’s reactions to social issues. As COVID-19 has impacted people’s lives, it is essential to capture how people react to public health interventions and understand their concerns. Objective: We aim to investigate people’s reactions and concerns about COVID-19 in North America, especially in Canada. Methods: We analyzed COVID-19–related tweets using topic modeling and aspect-based sentiment analysis (ABSA), and interpreted the results with public health experts. To generate insights on the effectiveness of specific public health interventions for COVID-19, we compared timelines of topics discussed with the timing of implementation of interventions, synergistically including information on people’s sentiment about COVID-19–related aspects in our analysis. In addition, to further investigate anti-Asian racism, we compared timelines of sentiments for Asians and Canadians. Results: Topic modeling identified 20 topics, and public health experts provided interpretations of the topics based on top-ranked words and representative tweets for each topic. The interpretation and timeline analysis showed that the discovered topics and their trend are highly related to public health promotions and interventions such as physical distancing, border restrictions, handwashing, staying home, and face coverings. After training the data using ABSA with human-in-the-loop, we obtained 545 aspect terms (eg, “vaccines,” “economy,” and “masks”) and 60 opinion terms such as “infectious” (negative) and “professional” (positive), which were used for inference of sentiments of 20 key aspects selected by public health experts. The results showed negative sentiments related to the overall outbreak, misinformation and Asians, and positive sentiments related to physical distancing. Conclusions: Analyses using natural language processing techniques with domain expert involvement can produce useful information for public health. This study is the first to analyze COVID-19–related tweets in Canada in comparison with tweets in the United States by using topic modeling and human-in-the-loop domain-specific ABSA. This kind of information could help public health agencies to understand public concerns as well as what public health messages are resonating in our populations who use Twitter, which can be helpful for public health agencies when designing a policy for new interventions. %M 33497352 %R 10.2196/25431 %U http://www.jmir.org/2021/2/e25431/ %U https://doi.org/10.2196/25431 %U http://www.ncbi.nlm.nih.gov/pubmed/33497352 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 2 %P e25118 %T Efficiency and Quality of Data Collection Among Public Mental Health Surveys Conducted During the COVID-19 Pandemic: Systematic Review %A Lin,Yu-Hsuan %A Chen,Chung-Yen %A Wu,Shiow-Ing %+ Institute of Population Health Sciences, National Health Research Institutes, 35 Keyan Road, Zhunan, Miaoli County, 35053, Taiwan, 886 37 206166 ext 36383, yuhsuanlin@nhri.edu.tw %K COVID-19 %K mental health %K Newcastle-Ottawa Scale %K review %K data collection %K survey %K surveillance %K literature %K research %D 2021 %7 10.2.2021 %9 Review %J J Med Internet Res %G English %X Background: The World Health Organization has recognized the importance of assessing population-level mental health during the COVID-19 pandemic. During a global crisis such as the COVID-19 pandemic, a timely surveillance method is urgently needed to track the impact on public mental health. Objective: This brief systematic review focused on the efficiency and quality of data collection of studies conducted during the COVID-19 pandemic. Methods: We searched the PubMed database using the following search strings: ((COVID-19) OR (SARS-CoV-2)) AND ((Mental health) OR (psychological) OR (psychiatry)). We screened the titles, abstracts, and texts of the published papers to exclude irrelevant studies. We used the Newcastle-Ottawa Scale to evaluate the quality of each research paper. Results: Our search yielded 37 relevant mental health surveys of the general public that were conducted during the COVID-19 pandemic, as of July 10, 2020. All these public mental health surveys were cross-sectional in design, and the journals efficiently made these articles available online in an average of 18.7 (range 1-64) days from the date they were received. The average duration of recruitment periods was 9.2 (range 2-35) days, and the average sample size was 5137 (range 100-56,679). However, 73% (27/37) of the selected studies had Newcastle-Ottawa Scale scores of <3 points, which suggests that these studies are of very low quality for inclusion in a meta-analysis. Conclusions: The studies examined in this systematic review used an efficient data collection method, but there was a high risk of bias, in general, among the existing public mental health surveys. Therefore, following recommendations to avoid selection bias, or employing novel methodologies considering both a longitudinal design and high temporal resolution, would help provide a strong basis for the formation of national mental health policies. %M 33481754 %R 10.2196/25118 %U http://www.jmir.org/2021/2/e25118/ %U https://doi.org/10.2196/25118 %U http://www.ncbi.nlm.nih.gov/pubmed/33481754 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 2 %P e24585 %T Comparing News Articles and Tweets About COVID-19 in Brazil: Sentiment Analysis and Topic Modeling Approach %A de Melo,Tiago %A Figueiredo,Carlos M S %+ Intelligent Systems Laboratory, Superior School of Technology, Amazonas State University, Av Darcy Vargas, 1200, Manaus, Brazil, 55 9233487601, tmelo@uea.edu.br %K COVID-19 %K Twitter %K infodemiology %K news %K sentiment analysis %K social media %K Brazil %K monitoring %K topic modeling %K entity recognition %K text analysis %D 2021 %7 10.2.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The COVID-19 pandemic is severely affecting people worldwide. Currently, an important approach to understand this phenomenon and its impact on the lives of people consists of monitoring social networks and news on the internet. Objective: The purpose of this study is to present a methodology to capture the main subjects and themes under discussion in news media and social media and to apply this methodology to analyze the impact of the COVID-19 pandemic in Brazil. Methods: This work proposes a methodology based on topic modeling, namely entity recognition, and sentiment analysis of texts to compare Twitter posts and news, followed by visualization of the evolution and impact of the COVID-19 pandemic. We focused our analysis on Brazil, an important epicenter of the pandemic; therefore, we faced the challenge of addressing Brazilian Portuguese texts. Results: In this work, we collected and analyzed 18,413 articles from news media and 1,597,934 tweets posted by 1,299,084 users in Brazil. The results show that the proposed methodology improved the topic sentiment analysis over time, enabling better monitoring of internet media. Additionally, with this tool, we extracted some interesting insights about the evolution of the COVID-19 pandemic in Brazil. For instance, we found that Twitter presented similar topic coverage to news media; the main entities were similar, but they differed in theme distribution and entity diversity. Moreover, some aspects represented negative sentiment toward political themes in both media, and a high incidence of mentions of a specific drug denoted high political polarization during the pandemic. Conclusions: This study identified the main themes under discussion in both news and social media and how their sentiments evolved over time. It is possible to understand the major concerns of the public during the pandemic, and all the obtained information is thus useful for decision-making by authorities. %M 33480853 %R 10.2196/24585 %U http://publichealth.jmir.org/2021/2/e24585/ %U https://doi.org/10.2196/24585 %U http://www.ncbi.nlm.nih.gov/pubmed/33480853 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 2 %P e25108 %T Understanding the Public Discussion About the Centers for Disease Control and Prevention During the COVID-19 Pandemic Using Twitter Data: Text Mining Analysis Study %A Lyu,Joanne Chen %A Luli,Garving K %+ Center for Tobacco Control Research and Education, University of California, San Francisco, 530 Parnassus Avenue, San Francisco, CA, 94143-1390, United States, 1 415 502 4181, chenjoanne.lyu@ucsf.edu %K COVID-19 %K CDC %K Twitter %K public discussion %K public opinion %K social media %K data mining %D 2021 %7 9.2.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The Centers for Disease Control and Prevention (CDC) is a national public health protection agency in the United States. With the escalating impact of the COVID-19 pandemic on society in the United States and around the world, the CDC has become one of the focal points of public discussion. Objective: This study aims to identify the topics and their overarching themes emerging from the public COVID-19-related discussion about the CDC on Twitter and to further provide insight into public's concerns, focus of attention, perception of the CDC's current performance, and expectations from the CDC. Methods: Tweets were downloaded from a large-scale COVID-19 Twitter chatter data set from March 11, 2020, when the World Health Organization declared COVID-19 a pandemic, to August 14, 2020. We used R (The R Foundation) to clean the tweets and retain tweets that contained any of five specific keywords—cdc, CDC, centers for disease control and prevention, CDCgov, and cdcgov—while eliminating all 91 tweets posted by the CDC itself. The final data set included in the analysis consisted of 290,764 unique tweets from 152,314 different users. We used R to perform the latent Dirichlet allocation algorithm for topic modeling. Results: The Twitter data generated 16 topics that the public linked to the CDC when they talked about COVID-19. Among the topics, the most discussed was COVID-19 death counts, accounting for 12.16% (n=35,347) of the total 290,764 tweets in the analysis, followed by general opinions about the credibility of the CDC and other authorities and the CDC's COVID-19 guidelines, with over 20,000 tweets for each. The 16 topics fell into four overarching themes: knowing the virus and the situation, policy and government actions, response guidelines, and general opinion about credibility. Conclusions: Social media platforms, such as Twitter, provide valuable databases for public opinion. In a protracted pandemic, such as COVID-19, quickly and efficiently identifying the topics within the public discussion on Twitter would help public health agencies improve the next-round communication with the public. %M 33497351 %R 10.2196/25108 %U http://www.jmir.org/2021/2/e25108/ %U https://doi.org/10.2196/25108 %U http://www.ncbi.nlm.nih.gov/pubmed/33497351 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 2 %P e26081 %T Dynamic Panel Data Modeling and Surveillance of COVID-19 in Metropolitan Areas in the United States: Longitudinal Trend Analysis %A Oehmke,Theresa B %A Post,Lori A %A Moss,Charles B %A Issa,Tariq Z %A Boctor,Michael J %A Welch,Sarah B %A Oehmke,James F %+ Department of Civil and Environmental Engineering, University of California, Berkeley, 202 O'Brien Hall, Berkeley, CA, 94720, United States, 1 5108986406, toehmke@berkeley.edu %K COVID-19 %K SARS-CoV-2 %K SARS-CoV-2 surveillance %K second wave %K wave two %K wave 2 %K global COVID-19 surveillance %K COVID-19 metropolitan areas %K COVID-19 cities %K US public health surveillance %K US COVID-19 %K US surveillance metrics %K dynamic panel data %K generalized method of the moments %K US econometrics %K US SARS-CoV-2 %K US COVID-19 surveillance system %K US COVID-19 transmission speed %K US COVID-19 transmission acceleration %K COVID-19 transmission deceleration %K COVID-19 transmission jerk %K COVID-19 7-day lag %K Arellano-Bond estimator %K generalized method of moments %K GMM %K New York City %K Los Angeles %K Chicago %K Dallas %K Houston %K Washington, DC %K Miami %K Philadelphia %K Atlanta %K Phoenix %K Boston %K San Francisco %K Riverside %K Detroit %K Seattle %K Minneapolis %K San Diego %K Tampa %K Denver %K St Louis %K Baltimore %K Charlotte %K Orlando %K San Antonio %K Portland %D 2021 %7 9.2.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic has had profound and differential impacts on metropolitan areas across the United States and around the world. Within the United States, metropolitan areas that were hit earliest with the pandemic and reacted with scientifically based health policy were able to contain the virus by late spring. For other areas that kept businesses open, the first wave in the United States hit in mid-summer. As the weather turns colder, universities resume classes, and people tire of lockdowns, a second wave is ascending in both metropolitan and rural areas. It becomes more obvious that additional SARS-CoV-2 surveillance is needed at the local level to track recent shifts in the pandemic, rates of increase, and persistence. Objective: The goal of this study is to provide advanced surveillance metrics for COVID-19 transmission that account for speed, acceleration, jerk and persistence, and weekly shifts, to better understand and manage risk in metropolitan areas. Existing surveillance measures coupled with our dynamic metrics of transmission will inform health policy to control the COVID-19 pandemic until, and after, an effective vaccine is developed. Here, we provide values for novel indicators to measure COVID-19 transmission at the metropolitan area level. Methods: Using a longitudinal trend analysis study design, we extracted 260 days of COVID-19 data from public health registries. We used an empirical difference equation to measure the daily number of cases in the 25 largest US metropolitan areas as a function of the prior number of cases and weekly shift variables based on a dynamic panel data model that was estimated using the generalized method of moments approach by implementing the Arellano-Bond estimator in R. Results: Minneapolis and Chicago have the greatest average number of daily new positive results per standardized 100,000 population (which we refer to as speed). Extreme behavior in Minneapolis showed an increase in speed from 17 to 30 (67%) in 1 week. The jerk and acceleration calculated for these areas also showed extreme behavior. The dynamic panel data model shows that Minneapolis, Chicago, and Detroit have the largest persistence effects, meaning that new cases pertaining to a specific week are statistically attributable to new cases from the prior week. Conclusions: Three of the metropolitan areas with historically early and harsh winters have the highest persistence effects out of the top 25 most populous metropolitan areas in the United States at the beginning of their cold weather season. With these persistence effects, and with indoor activities becoming more popular as the weather gets colder, stringent COVID-19 regulations will be more important than ever to flatten the second wave of the pandemic. As colder weather grips more of the nation, southern metropolitan areas may also see large spikes in the number of cases. %M 33481757 %R 10.2196/26081 %U https://www.jmir.org/2021/2/e26081 %U https://doi.org/10.2196/26081 %U http://www.ncbi.nlm.nih.gov/pubmed/33481757 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 2 %P e25429 %T Early Crowdfunding Response to the COVID-19 Pandemic: Cross-sectional Study %A Saleh,Sameh Nagui %A Lehmann,Christoph U %A Medford,Richard J %+ Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, United States, 1 5713383680, sameh.n.saleh@gmail.com %K crowdfunding %K fundraising %K GoFundMe %K COVID-19 %K coronavirus %K pandemic %K natural disasters %K disaster relief %K fundraise %K disaster %K cross-sectional %K crowdfund %K crowdsource %K economy %K social media %K community %K distress %D 2021 %7 9.2.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: As the number of COVID-19 cases increased precipitously in the United States, policy makers and health officials marshalled their pandemic responses. As the economic impacts multiplied, anecdotal reports noted the increased use of web-based crowdfunding to defray these costs. Objective: We examined the web-based crowdfunding response in the early stage of the COVID-19 pandemic in the United States to understand the incidence of initiation of COVID-19–related campaigns and compare them to non–COVID-19–related campaigns. Methods: On May 16, 2020, we extracted all available data available on US campaigns that contained narratives and were created between January 1 and May 10, 2020, on GoFundMe. We identified the subset of COVID-19–related campaigns using keywords relevant to the COVID-19 pandemic. We explored the incidence of COVID-19–related campaigns by geography, by category, and over time, and we compared the characteristics of the campaigns to those of non–COVID-19–related campaigns after March 11, when the pandemic was declared. We then used a natural language processing algorithm to cluster campaigns by narrative content using overlapping keywords. Results: We found that there was a substantial increase in overall GoFundMe web-based crowdfunding campaigns in March, largely attributable to COVID-19–related campaigns. However, as the COVID-19 pandemic persisted and progressed, the number of campaigns per COVID-19 case declined more than tenfold across all states. The states with the earliest disease burden had the fewest campaigns per case, indicating a lack of a case-dependent response. COVID-19–related campaigns raised more money, had a longer narrative description, and were more likely to be shared on Facebook than other campaigns in the study period. Conclusions: Web-based crowdfunding appears to be a stopgap for only a minority of campaigners. The novelty of an emergency likely impacts both campaign initiation and crowdfunding success, as it reflects the affective response of a community. Crowdfunding activity likely serves as an early signal for emerging needs and societal sentiment for communities in acute distress that could be used by governments and aid organizations to guide disaster relief and policy. %M 33523826 %R 10.2196/25429 %U http://www.jmir.org/2021/2/e25429/ %U https://doi.org/10.2196/25429 %U http://www.ncbi.nlm.nih.gov/pubmed/33523826 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 9 %N 2 %P e25245 %T Blockchain-Based Digital Contact Tracing Apps for COVID-19 Pandemic Management: Issues, Challenges, Solutions, and Future Directions %A Idrees,Sheikh Mohammad %A Nowostawski,Mariusz %A Jameel,Roshan %+ Department of Computer Science, Norwegian University of Science and Technology, Teknologivegen 22, Gjovik, 2815, Norway, 47 46248610, sheikh.idrees99@gmail.com %K COVID-19 %K digital contact tracing %K privacy preservation %K security %K blockchain technology %K blockchain %K privacy %K contact tracing %K app %K surveillance %K security %D 2021 %7 9.2.2021 %9 Viewpoint %J JMIR Med Inform %G English %X The COVID-19 pandemic has caused substantial global disturbance by affecting more than 42 million people (as of the end of October 2020). Since there is no medication or vaccine available, the only way to combat it is to minimize transmission. Digital contact tracing is an effective technique that can be utilized for this purpose, as it eliminates the manual contact tracing process and could help in identifying and isolating affected people. However, users are reluctant to share their location and contact details due to concerns related to the privacy and security of their personal information, which affects its implementation and extensive adoption. Blockchain technology has been applied in various domains and has been proven to be an effective approach for handling data transactions securely, which makes it an ideal choice for digital contact tracing apps. The properties of blockchain such as time stamping and immutability of data may facilitate the retrieval of accurate information on the trail of the virus in a transparent manner, while data encryption assures the integrity of the information being provided. Furthermore, the anonymity of the user’s identity alleviates some of the risks related to privacy and confidentiality concerns. In this paper, we provide readers with a detailed discussion on the digital contact tracing mechanism and outline the apps developed so far to combat the COVID-19 pandemic. Moreover, we present the possible risks, issues, and challenges associated with the available contact tracing apps and analyze how the adoption of a blockchain-based decentralized network for handling the app could provide users with privacy-preserving contact tracing without compromising performance and efficiency. %M 33400677 %R 10.2196/25245 %U https://medinform.jmir.org/2021/2/e25245 %U https://doi.org/10.2196/25245 %U http://www.ncbi.nlm.nih.gov/pubmed/33400677 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 2 %P e23467 %T Technology, Privacy, and User Opinions of COVID-19 Mobile Apps for Contact Tracing: Systematic Search and Content Analysis %A Elkhodr,Mahmoud %A Mubin,Omar %A Iftikhar,Zainab %A Masood,Maleeha %A Alsinglawi,Belal %A Shahid,Suleman %A Alnajjar,Fady %+ Department of Computer Science and Software Engineering, College of Information Technology, United Arab Emirates University, Alain 15551, Alain, , United Arab Emirates, 971 037135538, fady.alnajjar@uaeu.ac.ae %K contact tracing %K COVID-19 %K digital contact tracing apps %D 2021 %7 9.2.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Many countries across the globe have released their own COVID-19 contact tracing apps. This has resulted in the proliferation of several apps that used a variety of technologies. With the absence of a standardized approach used by the authorities, policy makers, and developers, many of these apps were unique. Therefore, they varied by function and the underlying technology used for contact tracing and infection reporting. Objective: The goal of this study was to analyze most of the COVID-19 contact tracing apps in use today. Beyond investigating the privacy features, design, and implications of these apps, this research examined the underlying technologies used in contact tracing apps. It also attempted to provide some insights into their level of penetration and to gauge their public reception. This research also investigated the data collection, reporting, retention, and destruction procedures used by each of the apps under review. Methods: This research study evaluated 13 apps corresponding to 10 countries based on the underlying technology used. The inclusion criteria ensured that most COVID-19-declared epicenters (ie, countries) were included in the sample, such as Italy. The evaluated apps also included countries that did relatively well in controlling the outbreak of COVID-19, such as Singapore. Informational and unofficial contact tracing apps were excluded from this study. A total of 30,000 reviews corresponding to the 13 apps were scraped from app store webpages and analyzed. Results: This study identified seven distinct technologies used by COVID-19 tracing apps and 13 distinct apps. The United States was reported to have released the most contact tracing apps, followed by Italy. Bluetooth was the most frequently used underlying technology, employed by seven apps, whereas three apps used GPS. The Norwegian, Singaporean, Georgian, and New Zealand apps were among those that collected the most personal information from users, whereas some apps, such as the Swiss app and the Italian (Immuni) app, did not collect any user information. The observed minimum amount of time implemented for most of the apps with regard to data destruction was 14 days, while the Georgian app retained records for 3 years. No significant battery drainage issue was reported for most of the apps. Interestingly, only about 2% of the reviewers expressed concerns about their privacy across all apps. The number and frequency of technical issues reported on the Apple App Store were significantly more than those reported on Google Play; the highest was with the New Zealand app, with 27% of the reviewers reporting technical difficulties (ie, 10% out of 27% scraped reviews reported that the app did not work). The Norwegian, Swiss, and US (PathCheck) apps had the least reported technical issues, sitting at just below 10%. In terms of usability, many apps, such as those from Singapore, Australia, and Switzerland, did not provide the users with an option to sign out from their apps. Conclusions: This article highlighted the fact that COVID-19 contact tracing apps are still facing many obstacles toward their widespread and public acceptance. The main challenges are related to the technical, usability, and privacy issues or to the requirements reported by some users. %M 33493125 %R 10.2196/23467 %U http://www.jmir.org/2021/2/e23467/ %U https://doi.org/10.2196/23467 %U http://www.ncbi.nlm.nih.gov/pubmed/33493125 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 2 %P e25935 %T Collaborating in the Time of COVID-19: The Scope and Scale of Innovative Responses to a Global Pandemic %A Bernardo,Theresa %A Sobkowich,Kurtis Edward %A Forrest,Russell Othmer %A Stewart,Luke Silva %A D'Agostino,Marcelo %A Perez Gutierrez,Enrique %A Gillis,Daniel %+ Department of Population Medicine, University of Guelph, 50 Stone Rd E, Guelph, ON, N1G 2W1, Canada, 1 519 824 4120 ext 54184, theresabernardo@gmail.com %K crowdsourcing %K artificial intelligence %K collaboration %K personal protective equipment %K big data %K AI %K COVID-19 %K innovation %K information sharing %K communication %K teamwork %K knowledge %K dissemination %D 2021 %7 9.2.2021 %9 Viewpoint %J JMIR Public Health Surveill %G English %X The emergence of COVID-19 spurred the formation of myriad teams to tackle every conceivable aspect of the virus and thwart its spread. Enabled by global digital connectedness, collaboration has become a constant theme throughout the pandemic, resulting in the expedition of the scientific process (including vaccine development), rapid consolidation of global outbreak data and statistics, and experimentation with novel partnerships. To document the evolution of these collaborative efforts, the authors collected illustrative examples as the pandemic unfolded, supplemented with publications from the JMIR COVID-19 Special Issue. Over 60 projects rooted in collaboration are categorized into five main themes: knowledge dissemination, data propagation, crowdsourcing, artificial intelligence, and hardware design and development. They highlight the numerous ways that citizens, industry professionals, researchers, and academics have come together worldwide to consolidate information and produce products to combat the COVID-19 pandemic. Initially, researchers and citizen scientists scrambled to access quality data within an overwhelming quantity of information. As global curated data sets emerged, derivative works such as visualizations or models were developed that depended on consistent data and would fail when there were unanticipated changes. Crowdsourcing was used to collect and analyze data, aid in contact tracing, and produce personal protective equipment by sharing open designs for 3D printing. An international consortium of entrepreneurs and researchers created a ventilator based on an open-source design. A coalition of nongovernmental organizations and governmental organizations, led by the White House Office of Science and Technology Policy, created a shared open resource of over 200,000 research publications about COVID-19 and subsequently offered cash prizes for the best solutions to 17 key questions involving artificial intelligence. A thread of collaboration weaved throughout the pandemic response, which will shape future efforts. Novel partnerships will cross boundaries to create better processes, products, and solutions to consequential societal challenges. %M 33503001 %R 10.2196/25935 %U http://publichealth.jmir.org/2021/2/e25935/ %U https://doi.org/10.2196/25935 %U http://www.ncbi.nlm.nih.gov/pubmed/33503001 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 2 %P e26190 %T Analyzing Digital Evidence From a Telemental Health Platform to Assess Complex Psychological Responses to the COVID-19 Pandemic: Content Analysis of Text Messages %A Hull,Thomas D %A Levine,Jacob %A Bantilan,Niels %A Desai,Angel N %A Majumder,Maimuna S %+ Talkspace, 2578 Broadway #607, New York, NY, 10025, United States, 1 4802548815, tdh732@mail.harvard.edu %K digital phenotyping %K COVID-19 %K telehealth %K digital mental health %K natural language processing %K machine learning %K mental health %K phenotyping %K burden %K treatment %K symptom %D 2021 %7 9.2.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The novel COVID-19 disease has negatively impacted mortality, economic conditions, and mental health. These impacts are likely to continue after the COVID-19 pandemic ends. There are no methods for characterizing the mental health burden of the COVID-19 pandemic, and differentiating this burden from that of the prepandemic era. Accurate illness detection methods are critical for facilitating pandemic-related treatment and preventing the worsening of symptoms. Objective: We aimed to identify major themes and symptom clusters in the SMS text messages that patients send to therapists. We assessed patients who were seeking treatment for pandemic-related distress on Talkspace, which is a popular telemental health platform. Methods: We used a machine learning algorithm to identify patients’ pandemic-related concerns, based on their SMS text messages in a large, digital mental health service platform (ie, Talkspace). This platform uses natural language processing methods to analyze unstructured therapy transcript data, in parallel with brief clinical assessment methods for analyzing depression and anxiety symptoms. Results: Our results show a significant increase in the incidence of COVID-19–related intake anxiety symptoms (P<.001), but no significant differences in the incidence of intake depression symptoms (P=.79). During our transcript analyses, we identified terms that were related to 24 symptoms outside of those included in the diagnostic criteria for anxiety and depression. Conclusions: Our findings for Talkspace suggest that people who seek treatment during the pandemic experience more severe intake anxiety than they did before the COVID-19 outbreak. It is important to monitor the symptoms that we identified in this study and the symptoms of anxiety and depression, to fully understand the effects of the COVID-19 pandemic on mental health. %M 33502999 %R 10.2196/26190 %U http://formative.jmir.org/2021/2/e26190/ %U https://doi.org/10.2196/26190 %U http://www.ncbi.nlm.nih.gov/pubmed/33502999 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 2 %P e26617 %T The Impact of a Digital Intervention (Happify) on Loneliness During COVID-19: Qualitative Focus Group %A Boucher,Eliane M %A McNaughton,Emily C %A Harake,Nicole %A Stafford,Julia L %A Parks,Acacia C %+ Happify Health, 51 East 12th Street, New York, NY, 10003, United States, 1 432 258 5233, eliane@happify.com %K loneliness %K digital interventions %K COVID-19 %K qualitative research %K perspective %K impact %K intervention %K lonely %K mental health %K e-mental health %K digital health %K focus group %D 2021 %7 8.2.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: Loneliness is a growing area of concern, attracting attention as a public health concern due to its association with a variety of psychological and physical health problems. However, interventions targeting loneliness are less common than interventions for other mental health problems, such as depression and anxiety, and existing interventions focus primarily on building social skills and increasing opportunities for social interaction despite research suggesting these techniques are not the most effective. Furthermore, although there is an increasing need for scalable and convenient interventions, digital interventions for loneliness are even less common. Objective: Using a qualitative approach, we explore how adults (18-64 years of age) who express wanting to be more connected to others experience loneliness and react to a digital mental health intervention targeting loneliness. Methods: A total of 11 participants were recruited from a pilot randomized controlled trial exploring the impact of a digital mental health intervention, Happify Health, on loneliness among adults aged 18-64 years who indicated wanting to feel more connected to others when signing up for the platform. Participants were invited to participate in a 3-day asynchronous focus group about their experiences with loneliness, with Happify Health, and with social distancing during the COVID-19 pandemic. All 11 participants completed the focus group in May 2020. Results: Participants’ responses were coded using thematic analysis, which led to identifying five themes, each with separate subthemes, that could be applied across the 3-day focus group: loneliness, relationships, social distancing, skill acquisition, and coping. Overall, we observed variability across participants in terms of the source of their loneliness, their perceptions of their social connections, and their motivation to reduce feelings of loneliness; however, participants commonly referred to negative self-perceptions as a cause or consequence of loneliness. Participants also varied in the extent to which they felt social distancing increased or decreased feelings of loneliness. In regard to the intervention, participants showed evidence of adopting skills they used to address their loneliness, particularly mindfulness and gratitude, and then using these skills to shift toward more active coping strategies following the intervention, including during the COVID-19 pandemic. Conclusions: The heterogeneity in participants’ experiences with loneliness described during this focus group emphasizes the subjective and complex nature of loneliness. This highlights the importance of developing loneliness interventions that use a variety of strategies, including both direct and indirect strategies for reducing loneliness. However, based on our data, a key component to loneliness interventions is incorporating strategies for addressing underlying negative self-perceptions that stem from, but also contribute to, loneliness. This data also provides preliminary evidence that digital platforms may be an effective tool for disseminating loneliness interventions while providing the added benefit of offering a productive distraction when feeling lonely. %M 33498011 %R 10.2196/26617 %U http://mental.jmir.org/2021/2/e26617/ %U https://doi.org/10.2196/26617 %U http://www.ncbi.nlm.nih.gov/pubmed/33498011 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 2 %P e26433 %T Suitability of Video Consultations During the COVID-19 Pandemic Lockdown: Cross-sectional Survey Among Norwegian General Practitioners %A Johnsen,Tor Magne %A Norberg,Børge Lønnebakke %A Kristiansen,Eli %A Zanaboni,Paolo %A Austad,Bjarne %A Krogh,Frode Helgetun %A Getz,Linn %+ Norwegian Centre for E-health Research, Sykehusveien 23, Tromsø, 9019, Norway, 47 97162311, eli.kristiansen@ehealthresearch.no %K video consultations %K digital consultations %K eHealth %K general practice %K primary health care %K continuity of care %K physician-patient relationship %K patient safety %K COVID-19 %K pandemic %K telehealth %K telemedicine %K consultation %K safety %K cross-sectional %K online survey %D 2021 %7 8.2.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic imposed an acute, sharp rise in the use of video consultations (VCs) by general practitioners (GPs) in Norway. Objective: This study aims to document GPs’ experiences with the large-scale uptake of VCs in the natural experiment context of the pandemic. Methods: A nationwide, cross-sectional online survey was conducted among Norwegian GPs during the pandemic lockdown (April 14-May 3, 2020). Each respondent was asked to evaluate up to 10 VCs. Basic demographic characteristics of the GPs and their practices were collected. The associations between GPs’ perceived suitability of the VCs, the nature of the patients’ main problems, prior knowledge of the patients (relational continuity), and follow-up of previously presented problems (episodic continuity) were explored using descriptive statistics, diagrams, and chi-square tests. Results: In total, 1237 GPs (26% of the target group) responded to the survey. Among these, 1000 GPs offered VCs, and 855 GPs evaluated a total of 3484 VCs. Most GPs who offered VCs (1000/1237; 81%) had no experience with VCs before the pandemic. Overall, 51% (1766/3476) of the evaluated VCs were considered to have similar or even better suitability to assess the main reason for contact, compared to face-to-face consultations. In the presence of relational continuity, VCs were considered equal to or better than face-to-face consultations in 57% (1011/1785) of cases, as opposed to 32% (87/274) when the patient was unknown. The suitability rate for follow-up consultations (episodic continuity) was 61% (1165/1919), compared to 35% (544/1556) for new patient problems. Suitability varied considerably across clinical contact reasons. VCs were found most suitable for anxiety and life stress, depression, and administrative purposes, as well as for longstanding or complex problems that normally require multiple follow-up consultations. The GPs estimate that they will conduct about 20% of their consultations by video in a future, nonpandemic setting. Conclusions: Our study of VCs performed in general practice during the pandemic lockdown indicates a clear future role for VCs in nonpandemic settings. The strong and consistent association between continuity of care and GPs’ perceptions of the suitability of VCs is a new and important finding with considerable relevance for future primary health care planning. %M 33465037 %R 10.2196/26433 %U http://www.jmir.org/2021/2/e26433/ %U https://doi.org/10.2196/26433 %U http://www.ncbi.nlm.nih.gov/pubmed/33465037 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 2 %P e25893 %T The Role of Transparency, Trust, and Social Influence on Uncertainty Reduction in Times of Pandemics: Empirical Study on the Adoption of COVID-19 Tracing Apps %A Oldeweme,Andreas %A Märtins,Julian %A Westmattelmann,Daniel %A Schewe,Gerhard %+ University of Muenster, Universitaetsstrasse 14-16, Muenster, 48143, Germany, 49 251 83 22991, andreas.oldeweme@wiwi.uni-muenster.de %K Uncertainty Reduction Theory %K URT %K COVID-19 %K tracing app %K mobile health care adoption %K DCA-transparency %K social influence %K initial trust %K public health %K eHealth %K communication %K trust %K surveillance %K monitoring %K app %K empirical %K risk %K use %D 2021 %7 8.2.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Contact tracing apps are an essential component of an effective COVID-19 testing strategy to counteract the spread of the pandemic and thereby avoid overburdening the health care system. As the adoption rates in several regions are undesirable, governments must increase the acceptance of COVID-19 tracing apps in these times of uncertainty. Objective: Building on the Uncertainty Reduction Theory (URT), this study aims to investigate how uncertainty reduction measures foster the adoption of COVID-19 tracing apps and how their use affects the perception of different risks. Methods: Representative survey data were gathered at two measurement points (before and after the app’s release) and analyzed by performing covariance-based structural equation modeling (n=1003). Results: We found that uncertainty reduction measures in the form of the transparency dimensions disclosure and accuracy, as well as social influence and trust in government, foster the adoption process. The use of the COVID-19 tracing app in turn reduced the perceived privacy and performance risks but did not reduce social risks and health-related COVID-19 concerns. Conclusions: This study contributes to the mass adoption of health care technology and URT research by integrating interactive communication measures and transparency as a multidimensional concept to reduce different types of uncertainty over time. Furthermore, our results help to derive communication strategies to promote the mass adoption of COVID-19 tracing apps, thus detecting infection chains and allowing intelligent COVID-19 testing. %M 33465036 %R 10.2196/25893 %U https://www.jmir.org/2021/2/e25893 %U https://doi.org/10.2196/25893 %U http://www.ncbi.nlm.nih.gov/pubmed/33465036 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 2 %P e25525 %T Early Perceptions of COVID-19 Contact Tracing Apps in German-Speaking Countries: Comparative Mixed Methods Study %A Zimmermann,Bettina Maria %A Fiske,Amelia %A Prainsack,Barbara %A Hangel,Nora %A McLennan,Stuart %A Buyx,Alena %+ Institute of History and Ethics in Medicine, Technical University Munich, Ismaninger Straße 22, Munich, , Germany, 49 89 4140 4042, bettina.zimmermann@tum.de %K COVID-19 %K contact tracing %K app %K interview study %K newspaper content analysis %K privacy paradox %K digital surveillance %K trust %K content analysis %K surveillance %K privacy %K interview %D 2021 %7 8.2.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The main German-speaking countries (Germany, Austria, and Switzerland) have implemented digital contact tracing apps to assist the authorities with COVID-19 containment strategies. Low user rates for these apps can affect contact tracing and, thus, its usefulness in controlling the spread of the novel coronavirus. Objective: This study aimed to assess the early perceptions of people living in the German-speaking countries and compare them with the frames portrayed in the newspapers during the first wave of the COVID-19 pandemic. Methods: We conducted qualitative interviews with 159 participants of the SolPan project. Of those, 110 participants discussed contact tracing apps and were included in this study. We analyzed articles regarding contact tracing apps from 12 newspapers in the German-speaking countries. Results: Study participants perceived and newspaper coverage in all German-speaking countries framed contact tracing apps as governmental surveillance tools and embedded them in a broader context of technological surveillance. Participants identified trust in authorities, respect of individual privacy, voluntariness, and temporary use of contact tracing apps as prerequisites for democratic compatibility. Newspapers commonly referenced the use of such apps in Asian countries, emphasizing the differences in privacy regulation among these countries. Conclusions: The uptake of digital contact tracing apps in German-speaking countries may be undermined due to privacy risks that are not compensated by potential benefits and are rooted in a deeper skepticism towards digital tools. When authorities plan to implement new digital tools and practices in the future, they should be very transparent and proactive in communicating their objectives and the role of the technology—and how it differs from other, possibly similar, tools. It is also important to publicly address ethical, legal, and social issues related to such technologies prior to their launch. %M 33503000 %R 10.2196/25525 %U http://www.jmir.org/2021/2/e25525/ %U https://doi.org/10.2196/25525 %U http://www.ncbi.nlm.nih.gov/pubmed/33503000 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 2 %P e25283 %T Interdisciplinary Online Hackathons as an Approach to Combat the COVID-19 Pandemic: Case Study %A Braune,Katarina %A Rojas,Pablo-David %A Hofferbert,Joscha %A Valera Sosa,Alvaro %A Lebedev,Anastasiya %A Balzer,Felix %A Thun,Sylvia %A Lieber,Sascha %A Kirchberger,Valerie %A Poncette,Akira-Sebastian %+ Department of Paediatric Endocrinology and Diabetes, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, Berlin, 13353, Germany, 49 30450616454, katarina.braune@charite.de %K hackathon %K COVID-19 %K digital health %K mentoring %K interdisciplinarity %K interoperability %K SARS-CoV-2 %K public health %K innovation %K collaboration %K hack %K mentor %K case study %K online health care %K challenge %K implementation %K plan %K collaboration %D 2021 %7 8.2.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 outbreak has affected the lives of millions of people by causing a dramatic impact on many health care systems and the global economy. This devastating pandemic has brought together communities across the globe to work on this issue in an unprecedented manner. Objective: This case study describes the steps and methods employed in the conduction of a remote online health hackathon centered on challenges posed by the COVID-19 pandemic. It aims to deliver a clear implementation road map for other organizations to follow. Methods: This 4-day hackathon was conducted in April 2020, based on six COVID-19–related challenges defined by frontline clinicians and researchers from various disciplines. An online survey was structured to assess: (1) individual experience satisfaction, (2) level of interprofessional skills exchange, (3) maturity of the projects realized, and (4) overall quality of the event. At the end of the event, participants were invited to take part in an online survey with 17 (+5 optional) items, including multiple-choice and open-ended questions that assessed their experience regarding the remote nature of the event and their individual project, interprofessional skills exchange, and their confidence in working on a digital health project before and after the hackathon. Mentors, who guided the participants through the event, also provided feedback to the organizers through an online survey. Results: A total of 48 participants and 52 mentors based in 8 different countries participated and developed 14 projects. A total of 75 mentorship video sessions were held. Participants reported increased confidence in starting a digital health venture or a research project after successfully participating in the hackathon, and stated that they were likely to continue working on their projects. Of the participants who provided feedback, 60% (n=18) would not have started their project without this particular hackathon and indicated that the hackathon encouraged and enabled them to progress faster, for example, by building interdisciplinary teams, gaining new insights and feedback provided by their mentors, and creating a functional prototype. Conclusions: This study provides insights into how online hackathons can contribute to solving the challenges and effects of a pandemic in several regions of the world. The online format fosters team diversity, increases cross-regional collaboration, and can be executed much faster and at lower costs compared to in-person events. Results on preparation, organization, and evaluation of this online hackathon are useful for other institutions and initiatives that are willing to introduce similar event formats in the fight against COVID-19. %M 33497350 %R 10.2196/25283 %U http://www.jmir.org/2021/2/e25283/ %U https://doi.org/10.2196/25283 %U http://www.ncbi.nlm.nih.gov/pubmed/33497350 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 2 %P e25452 %T Clinical Characterization of Patients With COVID-19 in Primary Care in Catalonia: Retrospective Observational Study %A Mayer,Miguel Angel %A Vidal-Alaball,Josep %A Puigdellívol-Sánchez,Anna %A Marín Gomez,Francesc X %A Leis,Angela %A Mendioroz Peña,Jacobo %+ Health Promotion in Rural Areas Research Group, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, Carrer Pica d'Estats, 13-15, Sant Fruitós de Bages, 08272, Spain, 34 936930040, jvidal.cc.ics@gencat.cat %K COVID-19 %K risk factors %K primary health care %K angiotensin-converting enzyme inhibitors %K angiotensin II type 2 receptor blockers %K risk %K characteristic %K retrospective %K observational %K Spain %K mortality %D 2021 %7 8.2.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The country of Spain has one of the highest incidences of COVID-19, with more than 1,000,000 cases as of the end of October 2020. Patients with a history of chronic conditions, obesity, and cancer are at greater risk from COVID-19; moreover, concerns surrounding the use of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin type II receptor blockers (ARBs) and its relationship to COVID-19 susceptibility have increased since the beginning of the pandemic. Objective: The objectives of this study were to compare the characteristics of patients diagnosed with COVID-19 to those of patients without COVID-19 in primary care; to determine the risk factors associated with the outcome of mortality; and to determine the potential influence of certain medications, such as ACEIs and ARBs, on the mortality of patients with COVID-19. Methods: An observational retrospective study of patients diagnosed with COVID-19 in the Catalan Central Region of Spain between March 1 and August 17, 2020, was conducted. The data were obtained from the Primary Care Services Information Technologies System of the Catalan Institute of Health in Barcelona, Spain. Results: The study population included 348,596 patients (aged >15 years) registered in the Primary Care Services Information Technologies System of the Catalan Central Region. The mean age of the patients was 49.53 years (SD 19.42), and 31.17% of the patients were aged ≥60 years. 175,484/348,596 patients (50.34%) were women. A total of 23,844/348,596 patients (6.84%) in the population studied were diagnosed with COVID-19 during the study period, and the most common clinical conditions of these patients were hypertension (5267 patients, 22.1%) and obesity (5181 patients, 21.7%). Overall, 2680/348,596 patients in the study population (0.77%) died during the study period. The number of deaths among patients without COVID-19 was 1825/324,752 (0.56%; mean age 80.6 years, SD 13.3), while among patients diagnosed with COVID-19, the number of deaths was 855/23,844 (3.58%; mean age 83.0 years, SD 10.80) with an OR of 6.58 (95% CI 6.06-7.15). Conclusions: We observed that women were more likely to contract COVID-19 than men. In addition, our study did not show that hypertension, obesity, or being treated with ACEIs or ARBs was linked to an increase in mortality in patients with COVID-19. Age is the main factor associated with mortality in patients infected with SARS-CoV-2. %M 33496668 %R 10.2196/25452 %U http://publichealth.jmir.org/2021/2/e25452/ %U https://doi.org/10.2196/25452 %U http://www.ncbi.nlm.nih.gov/pubmed/33496668 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 2 %P e23400 %T The US Public’s Perception of the Threat of COVID-19 During the Rapid Spread of the COVID-19 Outbreak: Cross-Sectional Survey Study %A Xiu,Xiaolei %A Wang,Anran %A Qian,Qing %A Wu,Sizhu %+ Department of Medical Data Sharing, Institute of Medical Information & Library, Chinese Academy of Medical Sciences & Peking Union Medical College, 3 Yabao Road, Chaoyang District, Beijing, 100020, China, 86 10 5232 8760, wu.sizhu@imicams.ac.cn %K COVID-19 %K perceived threat of disease %K environment %K behavior %K America %D 2021 %7 8.2.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The rapid spread of the COVID-19 pandemic in the United States has made people uncertain about their perceptions of the threat of COVID-19 and COVID-19 response measures. To mount an effective response to this epidemic, it is necessary to understand the public's perceptions, behaviors, and attitudes. Objective: We aimed to test the hypothesis that people’s perceptions of the threat of COVID-19 influence their attitudes and behaviors. Methods: This study used an open dataset of web-based questionnaires about COVID-19. The questionnaires were provided by Nexoid United Kingdom. We selected the results of a questionnaire on COVID-19–related behaviors, attitudes, and perceptions among the US public. The questionnaire was conducted from March 29 to April 20, 2020. A total of 24,547 people who lived in the United States took part in the survey. Results: In this study, the average self-assessed probability of contracting COVID-19 was 33.2%, and 49.9% (12,244/24,547) of the respondents thought that their chances of contracting COVID-19 were less than 30%. The self-assessed probability of contracting COVID-19 among women was 1.35 times that of males. A 5% increase in perceived infection risk was significantly associated with being 1.02 times (OR 1.02, 95% CI 1.02-1.02; P<.001) more likely to report having close contact with >10 people, and being 1.01 times (OR 1.01, 95% CI 1.01-1.01; P<.001) more likely to report that cohabitants disagreed with taking steps to reduce the risk of contracting COVID-19. However, there was no significant association between participants who lived with more than 5 cohabitants or less than 5 cohabitants (P=.85). Generally, participants who lived in states with 1001-10,000 COVID-19 cases, were aged 20-40 years, were obese, smoked, drank alcohol, never used drugs, and had no underlying medical conditions were more likely to be in close contact with >10 people. Most participants (21,017/24,547, 85.6%) agreed with washing their hands and maintaining social distancing, but only 20.2% (4958/24,547) of participants often wore masks. Additionally, male participants and participants aged <20 years typically disagreed with washing their hands, maintaining social distancing, and wearing masks. Conclusions: This survey is the first attempt to describe the determinants of the US public’s perception of the threat of COVID-19 on a large scale. The self-assessed probability of contracting COVID-19 differed significantly based on the respondents’ genders, states of residence, ages, body mass indices, smoking habits, alcohol consumption habits, drug use habits, underlying medical conditions, environments, and behaviors. These findings can be used as references by public health policy makers and health care workers who want to identify populations that need to be educated on COVID-19 prevention and health. %M 33481753 %R 10.2196/23400 %U http://www.jmir.org/2021/2/e23400/ %U https://doi.org/10.2196/23400 %U http://www.ncbi.nlm.nih.gov/pubmed/33481753 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 2 %P e25835 %T Use of Telehealth in Substance Use Disorder Services During and After COVID-19: Online Survey Study %A Molfenter,Todd %A Roget,Nancy %A Chaple,Michael %A Behlman,Stephanie %A Cody,Olivia %A Hartzler,Bryan %A Johnson,Edward %A Nichols,Maureen %A Stilen,Patricia %A Becker,Sara %+ Center for Health Enhancement System Studies, University of Wisconsin-Madison, 1513 University Avenue, Madison, WI, 53706, United States, 1 16082203556, todd.molfenter@chess.wisc.edu %K COVID-19 %K substance use disorders %K technology acceptance model %K telehealth %D 2021 %7 8.2.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: Social distancing guidelines for COVID-19 have caused a rapid transition to telephone and video technologies for delivering treatment for substance use disorders (SUDs). Objective: This study examined the adoption of these technologies across the SUD service continuum, acceptance of these technologies among service providers, and intent of providers to use these technologies after the pandemic. Additional analysis using the validated technology acceptance model (TAM) was performed to test the potential applications of these technologies after the pandemic. The study objectives were as follows: (1) to assess the use of telehealth (telephone and video technologies) for different SUD services during COVID-19 in May-June 2020, (2) to assess the intended applications of telehealth for SUD services beyond COVID-19, (3) to evaluate the perceived ease of use and value of telehealth for delivering SUD services, and (4) to assess organizational readiness for the sustained use of telehealth services. Methods: An online survey on the use of telephonic and video services was distributed between May and August 2020 to measure the current use of these services, perceived organizational readiness to use these services, and the intent to use these services after COVID-19. In total, 8 of 10 regional Addiction Technology Transfer Centers representing 43 states distributed the survey. Individual organizations were the unit of analysis. Results: In total, 457 organizations responded to the survey. Overall, the technology was widely used; >70% (n>335) of organizations reported using telephone or video platforms for most services. The odds of the intent of organizations to use these technologies to deliver services post COVID-19 were significantly greater for all but two services (ie, telephonic residential counseling and buprenorphine therapy; mean odds ratio 3.79, range 1.87-6.98). Clinical users preferred video technologies to telephone technologies for virtually all services. Readiness to use telephone and video technologies was high across numerous factors, though telephonic services were considered more accessible. Consistent with the TAM, perceived usefulness and ease of use influenced the intent to use both telephone and video technologies. Conclusions: The overall perceived ease of use and usefulness of telephonic and video services suggest promising post–COVID-19 applications of these services. Survey participants consistently preferred video services to telephonic services; however, the availability of telephonic services to those lacking easy access to video technology is an important characteristic of these services. Future studies should review the acceptance of telehealth services and their comparative impact on SUD care outcomes. %M 33481760 %R 10.2196/25835 %U http://mental.jmir.org/2021/2/e25835/ %U https://doi.org/10.2196/25835 %U http://www.ncbi.nlm.nih.gov/pubmed/33481760 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 2 %P e26090 %T Characterizing the COVID-19 Infodemic on Chinese Social Media: Exploratory Study %A Zhang,Shuai %A Pian,Wenjing %A Ma,Feicheng %A Ni,Zhenni %A Liu,Yunmei %+ School of Information Management, Wuhan University, No 299 Bayi Road, Wuchang District, Wuhan, , China, 86 13507119710, fchma@whu.edu.cn %K COVID-19 %K infodemic %K infodemiology %K epidemic %K misinformation %K spread characteristics %K social media %K China %K exploratory %K dissemination %D 2021 %7 5.2.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The COVID-19 infodemic has been disseminating rapidly on social media and posing a significant threat to people’s health and governance systems. Objective: This study aimed to investigate and analyze posts related to COVID-19 misinformation on major Chinese social media platforms in order to characterize the COVID-19 infodemic. Methods: We collected posts related to COVID-19 misinformation published on major Chinese social media platforms from January 20 to May 28, 2020, by using PythonToolkit. We used content analysis to identify the quantity and source of prevalent posts and topic modeling to cluster themes related to the COVID-19 infodemic. Furthermore, we explored the quantity, sources, and theme characteristics of the COVID-19 infodemic over time. Results: The daily number of social media posts related to the COVID-19 infodemic was positively correlated with the daily number of newly confirmed (r=0.672, P<.01) and newly suspected (r=0.497, P<.01) COVID-19 cases. The COVID-19 infodemic showed a characteristic of gradual progress, which can be divided into 5 stages: incubation, outbreak, stalemate, control, and recovery. The sources of the COVID-19 infodemic can be divided into 5 types: chat platforms (1100/2745, 40.07%), video-sharing platforms (642/2745, 23.39%), news-sharing platforms (607/2745, 22.11%), health care platforms (239/2745, 8.71%), and Q&A platforms (157/2745, 5.72%), which slightly differed at each stage. The themes related to the COVID-19 infodemic were clustered into 8 categories: “conspiracy theories” (648/2745, 23.61%), “government response” (544/2745, 19.82%), “prevention action” (411/2745, 14.97%), “new cases” (365/2745, 13.30%), “transmission routes” (244/2745, 8.89%), “origin and nomenclature” (228/2745, 8.30%), “vaccines and medicines” (154/2745, 5.61%), and “symptoms and detection” (151/2745, 5.50%), which were prominently diverse at different stages. Additionally, the COVID-19 infodemic showed the characteristic of repeated fluctuations. Conclusions: Our study found that the COVID-19 infodemic on Chinese social media was characterized by gradual progress, videoization, and repeated fluctuations. Furthermore, our findings suggest that the COVID-19 infodemic is paralleled to the propagation of the COVID-19 epidemic. We have tracked the COVID-19 infodemic across Chinese social media, providing critical new insights into the characteristics of the infodemic and pointing out opportunities for preventing and controlling the COVID-19 infodemic. %M 33460391 %R 10.2196/26090 %U http://publichealth.jmir.org/2021/2/e26090/ %U https://doi.org/10.2196/26090 %U http://www.ncbi.nlm.nih.gov/pubmed/33460391 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 2 %P e25960 %T Implementation of Online Hospitals and Factors Influencing the Adoption of Mobile Medical Services in China: Cross-Sectional Survey Study %A Wang,Huanlin %A Liang,LanYu %A Du,ChunLin %A Wu,YongKang %+ West China Hospital, Sichuan University, No. 37 Guoxue Lane, Wuhou District, Sichuan, China, 86 2885423265, vipwyk@163.com %K COVID-19 %K online hospital %K mobile medical service %K Unified Theory of Acceptance and Use of Technology %K UTAUT %D 2021 %7 5.2.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Online hospitals are part of an innovative model that allows China to explore telemedicine services based on national conditions with large populations, uneven distribution of medical resources, and lack of quality medical resources, especially among residents needing to be protected from COVID-19 infection. Objective: In this study, we built a hypothesis model based on the Unified Theory of Acceptance and Use of Technology (UTAUT) in order to analyze the factors that may influence patients’ willingness to use mobile medical services. This research was designed to assist in the development of mobile medical services. Residents who do not live in urban areas and cannot access medical assistance would greatly benefit from this research, as they could immediately go to the online hospital when needed. Methods: A cross-sectional study based at the West China Hospital, Sichuan University, was conducted in July 2020. A total of 407 respondents, 18 to 59 years old, in Western China were recruited by convenience sampling. We also conducted an empirical test for the hypothesis model and applied structural equation modeling to estimate the significance of path coefficients so that we could better understand the influencing factors. Results: Out of 407 respondents, 95 (23.3%) were aware of online hospitals, while 312 (76.7%) indicated that they have never heard of online hospitals before. Gender (P=.048) and education level (P=.04) affected people’s willingness to use online hospitals, and both of these factors promoted the use of online hospitals (odds ratio [OR] 2.844, 95% CI 1.010-8.003, and OR 2.187, 95% CI 1.031-4.636, respectively). According to structural equation modeling, the results of the path coefficient analysis indicated that performance expectancy, effort expectancy, and facilitating conditions have positive effects on patients’ willingness to use online hospitals. Conclusions: The goal of our research was to determine the factors that influence patients’ awareness and willingness to use online hospitals. Currently, the public’s awareness and usage of online hospitals is low. In fact, effort expectancy was the most important factor that influenced the use of online hospitals; being female and having a high education also played positive roles toward the use of mobile medical services. %M 33444155 %R 10.2196/25960 %U http://mhealth.jmir.org/2021/2/e25960/ %U https://doi.org/10.2196/25960 %U http://www.ncbi.nlm.nih.gov/pubmed/33444155 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 2 %P e21463 %T Factors Driving Citizen Engagement With Government TikTok Accounts During the COVID-19 Pandemic: Model Development and Analysis %A Chen,Qiang %A Min,Chen %A Zhang,Wei %A Ma,Xiaoyue %A Evans,Richard %+ School of Medicine and Health Management, Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan, 430074, China, 86 13397110378, weizhanghust@hust.edu.cn %K government social media %K citizen engagement %K public health crisis %K TikTok %K emotion valence %K dialogic loop %K COVID-19 %D 2021 %7 4.2.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: During the COVID-19 pandemic, growth in citizen engagement with social media platforms has enabled public health departments to accelerate and improve health information dissemination, developing transparency and trust between governments and citizens. In light of these benefits, it is imperative to learn the antecedents and underlying mechanisms for this to maintain and enhance engagement. Objective: The aim of this study is to determine the factors and influencing mechanisms related to citizen engagement with the TikTok account of the National Health Commission of China during the COVID-19 pandemic. Methods: Using a web crawler, 355 short videos were collected from the Healthy China account on TikTok (with more than 3 million followers throughout China), covering the period from January 21, 2020, to April 25, 2020. The title and video length, as well as the number of likes, shares, and comments were collected for each video. After classifying them using content analysis, a series of negative binomial regression analyses were completed. Results: Among the 355 videos, 154 (43.4%) related to guidance for clinicians, patients, and ordinary citizens, followed by information concerning the government’s handling of the pandemic (n=100, 28.2%), the latest news about COVID-19 (n=61, 17.2%), and appreciation toward frontline emergency services (n=40, 11.3%). Video length, titles, dialogic loop, and content type all influenced the level of citizen engagement. Specifically, video length was negatively associated with the number of likes (incidence rate ratio [IRR]=0.19, P<.001) and comments (IRR=0.39, P<.001). Title length was positively related to the number of shares (IRR=24.25, P=.01), likes (IRR=8.50, P=.03), and comments (IRR=7.85, P=.02). Dialogic loop negatively predicted the number of shares (IRR=0.56, P=.03). In comparison to appreciative information, information about the government’s handling of the situation (IRR=5.16, P<.001) and guidelines information (IRR=7.31, P<.001) were positively correlated with the number of shares, while the latest news was negatively related to the number of likes received (IRR=0.46, P=.004). More importantly, the relationship between predictors and citizen engagement was moderated by the emotional valence of video titles. Longer videos with positive titles received a higher number of likes (IRR=21.72, P=.04) and comments (IRR=10.14, P=.047). Furthermore, for short videos related to government handling of the pandemic (IRR=14.48, P=.04) and guidance for stakeholders (IRR=7.59, P=.04), positive titles received a greater number of shares. Videos related to the latest news (IRR=66.69, P=.04) received more likes if the video title displayed higher levels of positive emotion. Conclusions: During the COVID-19 pandemic, videos were frequently published on government social media platforms. Video length, title, dialogic loop, and content type significantly influenced the level of citizen engagement. These relationships were moderated by the emotional valence of the video’s title. Our findings have implications for maintaining and enhancing citizen engagement via government social media. %M 33481756 %R 10.2196/21463 %U http://www.jmir.org/2021/2/e21463/ %U https://doi.org/10.2196/21463 %U http://www.ncbi.nlm.nih.gov/pubmed/33481756 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 7 %N 1 %P e24032 %T Using Machine Learning Algorithms to Predict People’s Intention to Use Mobile Learning Platforms During the COVID-19 Pandemic: Machine Learning Approach %A Akour,Iman %A Alshurideh,Muhammad %A Al Kurdi,Barween %A Al Ali,Amel %A Salloum,Said %+ Research Institute of Sciences & Engineering, University of Sharjah, Academic City, Sharjah, United Arab Emirates, 971 507679647, salloum78@live.com %K COVID-19 %K pandemic %K mobile learning %K fear %K technology acceptance model %K theory of planned behavior %K prediction %K intent %K online learning %K machine learning %K behavior %D 2021 %7 4.2.2021 %9 Original Paper %J JMIR Med Educ %G English %X Background: Mobile learning has become an essential instruction platform in many schools, colleges, universities, and various other educational institutions across the globe, as a result of the COVID-19 pandemic crisis. The resulting severe, pandemic-related circumstances have disrupted physical and face-to-face contact teaching practices, thereby requiring many students to actively use mobile technologies for learning. Mobile learning technologies offer viable web-based teaching and learning platforms that are accessible to teachers and learners worldwide. Objective: This study investigated the use of mobile learning platforms for instruction purposes in United Arab Emirates higher education institutions. Methods: An extended technology acceptance model and theory of planned behavior model were proposed to analyze university students’ adoption of mobile learning platforms for accessing course materials, searching the web for information related to their disciplines, sharing knowledge, and submitting assignments during the COVID-19 pandemic. We collected a total of 1880 questionnaires from different universities in the United Arab Emirates. Partial least squares-structural equation modeling and machine learning algorithms were used to assess the research model, which was based on the data gathered from a student survey. Results: Based on our results, each hypothesized relationship within the research model was supported by our data analysis results. It should also be noted that the J48 classifier (89.37% accuracy) typically performed better than the other classifiers when it came to the prediction of the dependent variable. Conclusions: Our study revealed that teaching and learning could considerably benefit from adopting remote learning systems as educational tools during the COVID-19 pandemic. However, the value of such systems could be lessened because of the emotions that students experience, including a fear of poor grades, stress resulting from family circumstances, and sadness resulting from a loss of friends. Accordingly, these issues can only be resolved by evaluating the emotions of students during the pandemic. %M 33444154 %R 10.2196/24032 %U http://mededu.jmir.org/2021/1/e24032/ %U https://doi.org/10.2196/24032 %U http://www.ncbi.nlm.nih.gov/pubmed/33444154 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 2 %P e26254 %T Using Twitter to Understand the COVID-19 Experiences of People With Dementia: Infodemiology Study %A Bacsu,Juanita-Dawne %A O'Connell,Megan E %A Cammer,Allison %A Azizi,Mahsa %A Grewal,Karl %A Poole,Lisa %A Green,Shoshana %A Sivananthan,Saskia %A Spiteri,Raymond J %+ Department of Psychology, University of Saskatchewan, 9 Campus Drive, Saskatoon, SK, S7N 5A5, Canada, 1 306 966 2496, megan.oconnell@usask.ca %K Twitter %K social media %K dementia %K COVID-19 %K health policy %K experience %K support %K disorder %K theme %K collaborate %K quality of life %D 2021 %7 3.2.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic is affecting people with dementia in numerous ways. Nevertheless, there is a paucity of research on the COVID-19 impact on people with dementia and their care partners. Objective: Using Twitter, the purpose of this study is to understand the experiences of COVID-19 for people with dementia and their care partners. Methods: We collected tweets on COVID-19 and dementia using the GetOldTweets application in Python from February 15 to September 7, 2020. Thematic analysis was used to analyze the tweets. Results: From the 5063 tweets analyzed with line-by-line coding, we identified 4 main themes including (1) separation and loss; (2) COVID-19 confusion, despair, and abandonment; (3) stress and exhaustion exacerbation; and (4) unpaid sacrifices by formal care providers. Conclusions: There is an imminent need for governments to rethink using a one-size-fits-all response to COVID-19 policy and use a collaborative approach to support people with dementia. Collaboration and more evidence-informed research are essential to reducing COVID-19 mortality and improving the quality of life for people with dementia and their care partners. %M 33468449 %R 10.2196/26254 %U https://www.jmir.org/2021/2/e26254 %U https://doi.org/10.2196/26254 %U http://www.ncbi.nlm.nih.gov/pubmed/33468449 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 2 %P e25799 %T Surveillance Metrics of SARS-CoV-2 Transmission in Central Asia: Longitudinal Trend Analysis %A Post,Lori Ann %A Benishay,Elana T %A Moss,Charles B %A Murphy,Robert Leo %A Achenbach,Chad J %A Ison,Michael G %A Resnick,Danielle %A Singh,Lauren Nadya %A White,Janine %A Chaudhury,Azraa S %A Boctor,Michael J %A Welch,Sarah B %A Oehmke,James Francis %+ Buehler Center for Health Policy and Economics, Feinberg School of Medicine, Northwestern University, 420 E Superior, Chicago, IL, 60611, United States, 1 203 980 7107, lori.post@northwestern.edu %K SARS-CoV-2 surveillance %K second wave %K wave two %K global COVID-19 surveillance %K Central Asia public health surveillance %K Central Asia COVID-19 %K Central Asia surveillance metrics %K dynamic panel data %K generalized method of moments %K Central Asia econometrics %K Central Asia SARS-CoV-2 %K Central Asia COVID-19 surveillance system %K Central Asia COVID-19 transmission speed %K Central Asia COVID transmission acceleration %K COVID-19 transmission deceleration %K COVID-19 transmission jerk %K COVID-19 7-day lag %K SARS-CoV-2 %K Arellano-Bond estimator, generalized method of moments %K GMM %K Armenia %K Azerbaijan %K Cyprus %K Faeroe Islands %K Georgia %K Gibraltar %K Kazakhstan %K Kosovo %K Kyrgyzstan %K Macedonia %K Russia %K Tajikistan Turkey %K Turkmenistan %K Uzbekistan %K COVID-19 %K surveillance %K longitudinal %K trend %K trend analysis %K monitoring %K public health %K infectious disease %K transmission %K risk %K management %K policy %K prevention %D 2021 %7 3.2.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: SARS-CoV-2, the virus that caused the global COVID-19 pandemic, has severely impacted Central Asia; in spring 2020, high numbers of cases and deaths were reported in this region. The second wave of the COVID-19 pandemic is currently breaching the borders of Central Asia. Public health surveillance is necessary to inform policy and guide leaders; however, existing surveillance explains past transmissions while obscuring shifts in the pandemic, increases in infection rates, and the persistence of the transmission of COVID-19. Objective: The goal of this study is to provide enhanced surveillance metrics for SARS-CoV-2 transmission that account for weekly shifts in the pandemic, including speed, acceleration, jerk, and persistence, to better understand the risk of explosive growth in each country and which countries are managing the pandemic successfully. Methods: Using a longitudinal trend analysis study design, we extracted 60 days of COVID-19–related data from public health registries. We used an empirical difference equation to measure the daily number of cases in the Central Asia region as a function of the prior number of cases, level of testing, and weekly shift variables based on a dynamic panel model that was estimated using the generalized method of moments approach by implementing the Arellano-Bond estimator in R. Results: COVID-19 transmission rates were tracked for the weeks of September 30 to October 6 and October 7-13, 2020, in Central Asia. The region averaged 11,730 new cases per day for the first week and 14,514 for the second week. Infection rates increased across the region from 4.74 per 100,000 persons to 5.66. Russia and Turkey had the highest 7-day moving averages in the region, with 9836 and 1469, respectively, for the week of October 6 and 12,501 and 1603, respectively, for the week of October 13. Russia has the fourth highest speed in the region and continues to have positive acceleration, driving the negative trend for the entire region as the largest country by population. Armenia is experiencing explosive growth of COVID-19; its infection rate of 13.73 for the week of October 6 quickly jumped to 25.19, the highest in the region, the following week. The region overall is experiencing increases in its 7-day moving average of new cases, infection, rate, and speed, with continued positive acceleration and no sign of a reversal in sight. Conclusions: The rapidly evolving COVID-19 pandemic requires novel dynamic surveillance metrics in addition to static metrics to effectively analyze the pandemic trajectory and control spread. Policy makers need to know the magnitude of transmission rates, how quickly they are accelerating, and how previous cases are impacting current caseload due to a lag effect. These metrics applied to Central Asia suggest that the region is trending negatively, primarily due to minimal restrictions in Russia. %M 33475513 %R 10.2196/25799 %U https://www.jmir.org/2021/2/e25799 %U https://doi.org/10.2196/25799 %U http://www.ncbi.nlm.nih.gov/pubmed/33475513 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 2 %P e24730 %T Predicting Public Uptake of Digital Contact Tracing During the COVID-19 Pandemic: Results From a Nationwide Survey in Singapore %A Saw,Young Ern %A Tan,Edina Yi-Qin %A Liu,Jessica Shijia %A Liu,Jean CJ %+ Division of Social Sciences, Yale-NUS College, 28 College Avenue West #01-501, Singapore, 138533, Singapore, 65 6601 3694, jeanliu@yale-nus.edu.sg %K contact tracing %K COVID-19 %K mobile app %K digital health %K epidemiology %D 2021 %7 3.2.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: During the COVID-19 pandemic, new digital solutions have been developed for infection control. In particular, contact tracing mobile apps provide a means for governments to manage both health and economic concerns. However, public reception of these apps is paramount to their success, and global uptake rates have been low. Objective: In this study, we sought to identify the characteristics of individuals or factors potentially associated with voluntary downloads of a contact tracing mobile app in Singapore. Methods: A cohort of 505 adults from the general community completed an online survey. As the primary outcome measure, participants were asked to indicate whether they had downloaded the contact tracing app TraceTogether introduced at the national level. The following were assessed as predictor variables: (1) participant demographics, (2) behavioral modifications on account of the pandemic, and (3) pandemic severity (the number of cases and lockdown status). Results: Within our data set, the strongest predictor of the uptake of TraceTogether was the extent to which individuals had already adjusted their lifestyles because of the pandemic (z=13.56; P<.001). Network analyses revealed that uptake was most related to the following: using hand sanitizers, avoiding public transport, and preferring outdoor over indoor venues during the pandemic. However, demographic and situational characteristics were not significantly associated with app downloads. Conclusions: Efforts to introduce contact tracing apps could capitalize on pandemic-related behavioral adjustments among individuals. Given that a large number of individuals is required to download contact tracing apps for contact tracing to be effective, further studies are required to understand how citizens respond to contact tracing apps. Trial Registration: ClinicalTrials.gov NCT04468581, https://clinicaltrials.gov/ct2/show/NCT04468581 %M 33465034 %R 10.2196/24730 %U https://www.jmir.org/2021/2/e24730 %U https://doi.org/10.2196/24730 %U http://www.ncbi.nlm.nih.gov/pubmed/33465034 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 2 %P e23701 %T Physical Activity Behavior Before, During, and After COVID-19 Restrictions: Longitudinal Smartphone-Tracking Study of Adults in the United Kingdom %A McCarthy,Hannah %A Potts,Henry W W %A Fisher,Abigail %+ Institute of Health Informatics, University College London, 222 Euston Road, London, NW1 2DA, United Kingdom, 44 020 3549 5969, h.potts@ucl.ac.uk %K physical activity %K mobile apps %K apps %K fitness trackers %K mHealth %K COVID-19 %K behavior %K tracking %K smartphone %K pattern %D 2021 %7 3.2.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic led to the implementation of worldwide restrictive measures to reduce social contact and viral spread. These measures have been reported to have a negative effect on physical activity (PA). Studies of PA during the pandemic have primarily used self-reported data. The single academic study that used tracked data did not report on demographics. Objective: This study aimed to explore patterns of smartphone-tracked activity before, during, and immediately after lockdown in the United Kingdom, and examine differences by sociodemographic characteristics and prior levels of PA. Methods: Tracked longitudinal weekly minutes of PA were captured using the BetterPoints smartphone app between January and June 2020. Data were plotted by week, demographics, and activity levels at baseline. Nonparametric tests of difference were used to assess mean and median weekly minutes of activity at significant points before and during the lockdown, and as the lockdown was eased. Changes over time by demographics (age, gender, Index of Multiple Deprivation, baseline activity levels) were examined using generalized estimating equations (GEEs). Results: There were 5395 users with a mean age of 41 years (SD 12) and 61% (n=3274) were female. At baseline, 26% (n=1422) of users were inactive, 23% (n=1240) were fairly active, and 51% (n=2733) were active. There was a relatively even spread across deprivation deciles (31% [n=1693] in the least deprived deciles and 23% in the most [n=1261]). We found significant changes in PA from the week before the first case of COVID-19 was announced (baseline) to the week that social distancing restrictions were relaxed (Friedman test: χ22=2331, P<.001). By the first full week of lockdown, the median change in PA was 57 minutes less than baseline. This represents a 37% reduction in weekly minutes of PA. Overall, 63% of people decreased their level of activity between baseline and the first week of COVID-19 restrictions. Younger people showed more PA before lockdown but the least PA after lockdown. In contrast, those aged >65 years appeared to remain more active throughout and increased their activity levels as soon as lockdown was eased. Levels of PA among those classed as active at baseline showed a larger drop compared with those considered to be fairly active or inactive. Socioeconomic group and gender did not appear to be associated with changes in PA. Conclusions: Our tracked PA data suggests a significant drop in PA during the United Kingdom’s COVID-19 lockdown. Significant differences by age group and prior PA levels suggests that the government’s response to COVID-19 needs to be sensitive to these individual differences and the government should react accordingly. Specifically, it should consider the impact on younger age groups, encourage everyone to increase their PA, and not assume that people will recover prior levels of PA on their own. %M 33347421 %R 10.2196/23701 %U https://www.jmir.org/2021/2/e23701 %U https://doi.org/10.2196/23701 %U http://www.ncbi.nlm.nih.gov/pubmed/33347421 %0 Journal Article %@ 2563-6316 %I JMIR Publications %V 2 %N 1 %P e22195 %T Evaluating Population Density as a Parameter for Optimizing COVID-19 Testing: Statistical Analysis %A Budhwani,Karim I %A Budhwani,Henna %A Podbielski,Ben %+ CerFlux Inc, 2140 11th Avenue South, Suite 308, Birmingham, AL, 35205, United States, 1 8555000040, ironman@cerflux.com %K infectious diseases %K testing %K per capita %K population density %K policy %K coronavirus %K SARS-CoV-2 %K COVID-19 %D 2021 %7 3.2.2021 %9 Short Paper %J JMIRx Med %G English %X Background: SARS-CoV-2 transmission risk generally increases with the proximity of those shedding the virus to those susceptible to infection. Thus, this risk is a function of both the number of people and the area they occupy. However, the latter continues to evade the COVID-19 testing policy. Objective: The aim of this study is to analyze per capita COVID-19 testing data reported for Alabama to evaluate whether testing realignment along population density, rather than density agnostic per capita, would be more effective. Methods: Descriptive statistical analyses were performed for population, density, COVID-19 tests administered, and positive cases for all 67 Alabama counties. Results: Tests reported per capita appeared to suggest widespread statewide testing. However, there was little correlation (r=0.28, P=.02) between tests per capita and the number of cases. In terms of population density, new cases were higher in areas with a higher population density, despite relatively lower test rates as a function of density. Conclusions: Increased testing in areas with lower population density has the potential to induce a false sense of security even as cases continue to rise sharply overall. %M 33725028 %R 10.2196/22195 %U https://med.jmirx.org/2021/1/e22195/ %U https://doi.org/10.2196/22195 %U http://www.ncbi.nlm.nih.gov/pubmed/33725028 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 7 %N 1 %P e25317 %T Physical Activity, Mental Health, and Technology Preferences to Support Cancer Survivors During the COVID-19 Pandemic: Cross-sectional Study %A Faro,Jamie M %A Mattocks,Kristin M %A Nagawa,Catherine S %A Lemon,Stephenie C %A Wang,Bo %A Cutrona,Sarah L %A Sadasivam,Rajani S %+ Division of Health Informatics and Implementation Science, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation St, Worcester, MA, 01605, United States, 1 617 828 8093, Jamie.faro@umassmed.edu %K cancer %K COVID-19 %K digital %K physical activity %K support %K technology %D 2021 %7 3.2.2021 %9 Original Paper %J JMIR Cancer %G English %X Background: COVID-19 has had significant health-related and behavioral impacts worldwide. Cancer survivors (hereafter referred to as “survivors”) are particularly prone to behavioral changes and are encouraged to be more vigilant and observe stricter social distancing measures. Objective: We explored (1) changes in physical activity and sedentary behaviors since the onset of COVID-19, along with changes in mental health status, and (2) alternative strategies to support survivors’ physical activity and social health during and after COVID-19, along with the role of digital health in such strategies. Methods: A questionnaire was distributed among survivors participating (currently or previously) in the community-based physical activity program LIVESTRONG at the Young Men’s Christian Association (YMCA), from 3 sites outside an urban area in Massachusetts. Questions addressed pre–COVID-19 vs current changes in physical activity and sedentary behavior. Anxiety and depression were assessed using the 2-item Generalized Anxiety Disorder scale (GAD-2) and 2-item Patient Health Questionnaire (PHQ-2), and scores ≥3 indicated a clinical diagnosis of anxiety or depression, respectively. Digital health preferences were assessed through closed-ended questions. Open-ended responses addressing other preferences for physical activity programs and social support were analyzed, coded, and categorized into themes. Results: Among 61 participants (mean age 62 [SD 10.4] years; females: 51/61 [83.6%]), 67.2% (n=41) reported decreased physical activity and 67.2% (n=41) reported prolonged sitting times since the onset of COVID-19. Further, 24.6% (n=15) and 26.2% (n=16) met the GAD-2 and PHQ-2 criteria for clinical anxiety and depression, respectively. All participants owned a cellphone; 90% (n=54) owned a smartphone. Preferences for physical activity programs (n=28) included three themes: (1) use of digital or remote platforms (Zoom, other online platforms, and video platforms), (2) specific activities and locations (eg, outdoor activities, walking, gardening, biking, and physical activities at the YMCA and at senior centers), and (3) importance of social support regardless of activity type (eg, time spent with family, friends, peers, or coaches). The survey revealed a mean score of 71.8 (SD 21.4; scale 0-100) for the importance of social support during physical activity programs. Social support preferences (n=15) revealed three themes: (1) support through remote platforms (eg, texting, Zoom, phone calls, emails, and Facebook), (2) tangible in-person support (YMCA and senior centers), and (3) social support with no specific platform (eg, small gatherings and family or friend visits). Conclusions: Physical activity and mental health are critical factors for the quality of life of survivors, and interventions tailored to their activity preferences are necessary. Digital or remote physical activity programs with added social support may help address the ongoing needs of survivors during and after the pandemic. %M 33471776 %R 10.2196/25317 %U http://cancer.jmir.org/2021/1/e25317/ %U https://doi.org/10.2196/25317 %U http://www.ncbi.nlm.nih.gov/pubmed/33471776 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 2 %P e21156 %T COVID-19–Induced Fear in Infoveillance Studies: Pilot Meta-analysis Study of Preliminary Results %A Geronikolou,Styliani %A Chrousos,George %+ University Research Institute of Maternal and Child Health and Precision Medicine, National and Kapodistrian University of Athens, Levadias 1, Athens, Greece, 30 2132013362, sgeronik@gmail.com %K COVID-19 %K social media %K misinformation %K infodemics %K infodemiology %K infoveillance %K fear %K meta-analysis %D 2021 %7 3.2.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The World Health Organization named the phenomenon of misinformation spread through social media as an “infodemic” and recognized the need to curb it. Misinformation infodemics undermine not only population safety but also compliance to the suggestions and prophylactic measures recommended during pandemics. Objective: The aim of this pilot study is to review the impact of social media on general population fear in “infoveillance” studies during the COVID-19 pandemic. Methods: The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) protocol was followed, and 6 out of 20 studies were retrieved, meta-analyzed, and had their findings presented in the form of a forest plot. Results: The summary random and significant event rate was 0.298 (95% CI 0.213-0.400), suggesting that social media–circulated misinformation related to COVID-19 triggered public fear and other psychological manifestations. These findings merit special attention by public health authorities. Conclusions: Infodemiology and infoveillance are valid tools in the hands of epidemiologists to help prevent dissemination of false information, which has potentially damaging effects. %M 33400681 %R 10.2196/21156 %U https://formative.jmir.org/2021/2/e21156 %U https://doi.org/10.2196/21156 %U http://www.ncbi.nlm.nih.gov/pubmed/33400681 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 2 %P e20546 %T Estimated Sleep Duration Before and During the COVID-19 Pandemic in Major Metropolitan Areas on Different Continents: Observational Study of Smartphone App Data %A Robbins,Rebecca %A Affouf,Mahmoud %A Weaver,Matthew D %A Czeisler,Mark É %A Barger,Laura K %A Quan,Stuart F %A Czeisler,Charles A %+ Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, 221 Longwood Avenue, Boston, MA, 02115, United States, 1 2039792338, rrobbins4@bwh.harvard.edu %K sleep health %K mobile health %K sleep tracking %K COVID-19 %K sleep %K observational study %K app %D 2021 %7 2.2.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Amid the COVID-19 pandemic, public health policies to curb the spread of SARS-CoV-2 and its associated disease, COVID-19, have resulted in significant alterations to daily routines (eg, work-from-home policies) that may have enabled longer sleep duration among the general population. Objective: We aimed to examine changes in estimated sleep duration in 5 major metropolitan areas before and after the start of the COVID-19 pandemic. Methods: We conducted a prospective observational study using estimated sleep duration data obtained from a smartphone app. The data were obtained from regular users of the smartphone app before and after the World Health Organization declared COVID-19 a pandemic in March 2020. We compared within-subject estimated sleep duration before and during the COVID-19 pandemic using generalized linear mixed models. Results: Among the 2,871,037 observations, 957,022 (33.3%) were from users in London; 549,151 (19.1%) were from users in Los Angeles; 846,527 (29.5%) were from users in New York City; 251,113 (8.7%) were from users in Seoul; and 267,224 (9.3%) were from users in Stockholm. The average age of the users in the sample was 35 years (SE 11 years). Prior to the COVID-19 pandemic, people residing in Seoul had the shortest estimated sleep duration (mean 6 hours 28 minutes, SE 11.6 minutes) and those residing in Stockholm had the longest estimated sleep duration (mean 7 hours 34 minutes, SE 9.9 minutes). The onset of the COVID-19 pandemic was associated with a 13.7 minute increase in estimated sleep duration when comparing March 2019 and March 2020 (95% CI 13.1-14.3, P<.001) and an increase of 22.3 minutes when comparing April 2019 and April 2020 (95% CI 21.5-23.1, P<.001). Conclusions: The average estimated sleep duration increased sharply in the months after the onset of the COVID-19 pandemic. This finding suggests that the implementation of COVID-19 mitigation strategies has provided people worldwide with increased opportunities to sleep, which may enhance the response of the immune system to viral pathogens. %M 33493126 %R 10.2196/20546 %U https://www.jmir.org/2021/2/e20546 %U https://doi.org/10.2196/20546 %U http://www.ncbi.nlm.nih.gov/pubmed/33493126 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 2 %P e23316 %T Clinical and Epidemiological Characteristics of Postdischarge Patients With COVID-19 in Tehran, Iran: Protocol for a Prospective Cohort Study (Tele-COVID-19 Study) %A Jalilian Khave,Laya %A Vahidi,Mohammad %A Shirini,Dorsa %A Sanadgol,Ghazal %A Ashrafi,Farzad %A Arab-Ahmadi,Mehran %A Fatemi,Alireza %A Shabani Barzegar,Minoosh %A Hassanzadeh,Taha %A Rezaei,Behandokht %A Zali,Alireza %A Ommi,Davood %A Nohesara,Shabnam %A Jalili Khoshnood,Reza %A Abdi,Saeed %A Pirsalehi,Ali %A Masarat,Ehsan %A Shokoohi,Mostafa %A Karamouzian,Mohammad %+ Faculty of Medicine, School of Population and Public Health, University of British Columbia, 2206 E Mall, Vancouver, BC, Canada, 1 6048222772, karamouzian.m@alumni.ubc.ca %K cohort studies %K COVID-19 %K health care delivery %K Iran %K medical education %K telemedicine %D 2021 %7 2.2.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: COVID-19 was declared a pandemic on March 11, 2020. Given that the severe shortage of hospital beds has led to early discharge and insufficient patient education on home care routines and isolation protocols, the close follow-up of patients and their immediate relatives is an integral part of transitioning from hospital care to home care for patients with COVID-19. Objective: We designed the Tele-COVID-19 prospective cohort to follow-up with COVID-19 patients in Tehran, Iran, and improve health care delivery and the recording of postdischarge patients’ clinical profiles. Methods: All adult patients who were admitted to the COVID-19 wards of teaching hospitals in Tehran, Iran were eligible to participate in this cohort study. At baseline, patients were recruited from 4 major hospitals from March 9, 2020 to May 20, 2020. Telephone follow-ups, which were led by volunteer medical students, were conducted on postdischarge days 1-3, 5, 7, 10, and 14. We collected data on a range of sociodemographic, epidemiological, and clinical characteristics by using a standard questionnaire. Results: Of the 950 patients with confirmed COVID-19 who were approached, 823 (response rate: 86.6%) consented and were enrolled into the cohort. Of the 823 participants, 449 (54.5%) were male. The mean age of participants was 50.1 years (SD 12.6 years). During the initial data collection phase, more than 5000 phone calls were made and over 577 reports of critical patients who were in need of urgent medical attention were recorded. Conclusions: The Tele-COVID-19 cohort will provide patients with sufficient education on home care and isolation, and medical advice on care and the proper use of drugs. In addition, by preventing unnecessary hospital returns and providing information on household SARS-CoV-2 transmission as early as possible, this cohort will help with effective disease management in resource-limited settings. International Registered Report Identifier (IRRID): DERR1-10.2196/23316 %M 33471777 %R 10.2196/23316 %U https://www.researchprotocols.org/2021/2/e23316 %U https://doi.org/10.2196/23316 %U http://www.ncbi.nlm.nih.gov/pubmed/33471777 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 2 %P e25454 %T SARS-CoV-2 Wave Two Surveillance in East Asia and the Pacific: Longitudinal Trend Analysis %A Post,Lori Ann %A Lin,Jasmine S %A Moss,Charles B %A Murphy,Robert Leo %A Ison,Michael G %A Achenbach,Chad J %A Resnick,Danielle %A Singh,Lauren Nadya %A White,Janine %A Boctor,Michael J %A Welch,Sarah B %A Oehmke,James Francis %+ Buehler Center for Health Policy and Economics, Feinberg School of Medicine, Northwestern University, 420 E Superior St, Chicago, IL, 60611, United States, 1 2039807108, lori.post@northwestern.edu %K COVID-19 %K SARS-CoV-2 %K SARS-CoV-2 surveillance %K second wave %K wave two %K wave 2 %K global COVID-19 surveillance %K Asia Pacific public health surveillance %K Asia Pacific COVID-19 %K Asian Pacific SARS-CoV-2 %K Asia Pacific surveillance metrics %K dynamic panel data %K generalized method of the moments %K Asian Pacific econometrics %K East Asian Pacific COVID-19 surveillance system %K Pacific Asian COVID-19 transmission speed %K Asian Pacific COVID-19 transmission acceleration %K COVID-19 transmission deceleration %K COVID-19 transmission jerk %K COVID-19 7-day lag %K Arellano-Bond estimator %K generalized method of moments %K GMM %K Australia %K Brunei %K Cambodia %K China %K Fiji %K French Polynesia %K Guam %K Indonesia %K Japan %K Kiribati %K Laos %K Malaysia %K Mongolia %K Myanmar %K New Caledonia %K Philippines %D 2021 %7 1.2.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic has had a profound global impact on governments, health care systems, economies, and populations around the world. Within the East Asia and Pacific region, some countries have mitigated the spread of the novel coronavirus effectively and largely avoided severe negative consequences, while others still struggle with containment. As the second wave reaches East Asia and the Pacific, it becomes more evident that additional SARS-CoV-2 surveillance is needed to track recent shifts, rates of increase, and persistence associated with the pandemic. Objective: The goal of this study is to provide advanced surveillance metrics for COVID-19 transmission that account for speed, acceleration, jerk, persistence, and weekly shifts, to better understand country risk for explosive growth and those countries who are managing the pandemic successfully. Existing surveillance coupled with our dynamic metrics of transmission will inform health policy to control the COVID-19 pandemic until an effective vaccine is developed. We provide novel indicators to measure disease transmission. Methods: Using a longitudinal trend analysis study design, we extracted 330 days of COVID-19 data from public health registries. We used an empirical difference equation to measure the daily number of cases in East Asia and the Pacific as a function of the prior number of cases, the level of testing, and weekly shift variables based on a dynamic panel model that was estimated using the generalized method of moments approach by implementing the Arellano-Bond estimator in R. Results: The standard surveillance metrics for Indonesia, the Philippines, and Myanmar were concerning as they had the largest new caseloads at 4301, 2588, and 1387, respectively. When looking at the acceleration of new COVID-19 infections, we found that French Polynesia, Malaysia, and the Philippines had rates at 3.17, 0.22, and 0.06 per 100,000. These three countries also ranked highest in terms of jerk at 15.45, 0.10, and 0.04, respectively. Conclusions: Two of the most populous countries in East Asia and the Pacific, Indonesia and the Philippines, have alarming surveillance metrics. These two countries rank highest in new infections in the region. The highest rates of speed, acceleration, and positive upwards jerk belong to French Polynesia, Malaysia, and the Philippines, and may result in explosive growth. While all countries in East Asia and the Pacific need to be cautious about reopening their countries since outbreaks are likely to occur in the second wave of COVID-19, the country of greatest concern is the Philippines. Based on standard and enhanced surveillance, the Philippines has not gained control of the COVID-19 epidemic, which is particularly troubling because the country ranks 4th in population in the region. Without extreme and rigid social distancing, quarantines, hygiene, and masking to reverse trends, the Philippines will remain on the global top 5 list of worst COVID-19 outbreaks resulting in high morbidity and mortality. The second wave will only exacerbate existing conditions and increase COVID-19 transmissions. %M 33464207 %R 10.2196/25454 %U https://www.jmir.org/2021/2/e25454 %U https://doi.org/10.2196/25454 %U http://www.ncbi.nlm.nih.gov/pubmed/33464207 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 2 %P e23389 %T The Use of Digital Platforms for Adults’ and Adolescents’ Physical Activity During the COVID-19 Pandemic (Our Life at Home): Survey Study %A Parker,Kate %A Uddin,Riaz %A Ridgers,Nicola D %A Brown,Helen %A Veitch,Jenny %A Salmon,Jo %A Timperio,Anna %A Sahlqvist,Shannon %A Cassar,Samuel %A Toffoletti,Kim %A Maddison,Ralph %A Arundell,Lauren %+ Institute for Physical Activity and Nutrition, Deakin University, 75 Pigdons Rd, Geelong, Australia, 61 92468094, k.parker@deakin.edu.au %K digital health %K moderate- to vigorous-intensity physical activity %K muscle-strengthening exercise %K online platforms %K COVID-19 %D 2021 %7 1.2.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Government responses to managing the COVID-19 pandemic may have impacted the way individuals were able to engage in physical activity. Digital platforms are a promising way to support physical activity levels and may have provided an alternative for people to maintain their activity while at home. Objective: This study aimed to examine associations between the use of digital platforms and adherence to the physical activity guidelines among Australian adults and adolescents during the COVID-19 stay-at-home restrictions in April and May 2020. Methods: A national online survey was distributed in May 2020. Participants included 1188 adults (mean age 37.4 years, SD 15.1; 980/1188, 82.5% female) and 963 adolescents (mean age 16.2 years, SD 1.2; 685/963, 71.1% female). Participants reported demographic characteristics, use of digital platforms for physical activity over the previous month, and adherence to moderate- to vigorous-intensity physical activity (MVPA) and muscle-strengthening exercise (MSE) guidelines. Multilevel logistic regression models examined differences in guideline adherence between those who used digital platforms (ie, users) to support their physical activity compared to those who did not (ie, nonusers). Results: Digital platforms include streaming services for exercise (eg, YouTube, Instagram, and Facebook); subscriber fitness programs, via an app or online (eg, Centr and MyFitnessPal); facilitated online live or recorded classes, via platforms such as Zoom (eg, dance, sport training, and fitness class); sport- or activity-specific apps designed by sporting organizations for participants to keep up their skills (eg, TeamBuildr); active electronic games (eg, Xbox Kinect); and/or online or digital training or racing platforms (eg, Zwift, FullGaz, and Rouvy). Overall, 39.5% (469/1188) of adults and 26.5% (255/963) of adolescents reported using digital platforms for physical activity. Among adults, MVPA (odds ratio [OR] 2.0, 95% CI 1.5-2.7), MSE (OR 3.3, 95% CI 2.5-4.5), and combined (OR 2.7, 95% CI 2.0-3.8) guideline adherence were higher among digital platform users relative to nonusers. Adolescents’ MVPA (OR 2.4, 95% CI 1.3-4.3), MSE (OR 3.1, 95% CI 2.1-4.4), and combined (OR 4.3, 95% CI 2.1-9.0) guideline adherence were also higher among users of digital platforms relative to nonusers. Conclusions: Digital platform users were more likely than nonusers to meet MVPA and MSE guidelines during the COVID-19 stay-at-home restrictions in April and May 2020. Digital platforms may play a critical role in helping to support physical activity engagement when access to facilities or opportunities for physical activity outside the home are restricted. %M 33481759 %R 10.2196/23389 %U https://www.jmir.org/2021/2/e23389 %U https://doi.org/10.2196/23389 %U http://www.ncbi.nlm.nih.gov/pubmed/33481759 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 9 %N 2 %P e25183 %T Driving Digital Transformation During a Pandemic: Case Study of Virtual Collaboration in a German Hospital %A Frick,Nicholas R J %A Möllmann,Henriette L %A Mirbabaie,Milad %A Stieglitz,Stefan %+ Department of IT-Strategy, MAINGAU Energie GmbH, Ringstraße 4, Obertshausen, 63179, Germany, 49 1711904454, nicholas.frick@maingau-energie.de %K digital transformation %K virtual collaboration %K digital health %K health care %K COVID-19 %K pandemic %K hospital %K collaboration %K virtual heath %K crisis %K case study %D 2021 %7 1.2.2021 %9 Original Paper %J JMIR Med Inform %G English %X Background: The COVID-19 pandemic has not only changed the private lives of millions of people but has significantly affected the collaboration of medical specialists throughout health care systems worldwide. Hospitals are making changes to their regular operations to slow the spread of SARS-CoV-2 while ensuring the treatment of emergency patients. These substantial changes affect the typical work setting of clinicians and require the implementation of organizational arrangements. Objective: In this study, we aim to increase our understanding of how digital transformation drives virtual collaboration among clinicians in hospitals in times of crisis, such as the COVID-19 pandemic. Methods: We present the lessons learned from an exploratory case study in which we observed the introduction of an information technology (IT) system for enhancing collaboration among clinicians in a German hospital. The results are based on 16 semistructured interviews with physicians from various departments and disciplines; the interviews were generalized to better understand and interpret the meaning of the statements. Results: Three key lessons and recommendations explain how digital transformation ensures goal-driven collaboration among clinicians. First, we found that implementing a disruptive change requires alignment of the mindsets of the stakeholders. Second, IT-enabled collaboration presupposes behavioral rules that must be followed. Third, transforming antiquated processes demands a suitable technological infrastructure. Conclusions: Digital transformation is being driven by the COVID-19 pandemic. However, the rapid introduction of IT-enabled collaboration reveals grievances concerning the digital dissemination of medical information along the patient treatment path. To avoid being caught unprepared by future crises, digital transformation must be further driven to ensure collaboration, and the diagnostic and therapeutic process must be opened to disruptive strategies. %M 33449905 %R 10.2196/25183 %U https://medinform.jmir.org/2021/2/e25183 %U https://doi.org/10.2196/25183 %U http://www.ncbi.nlm.nih.gov/pubmed/33449905 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 2 %P e24785 %T Telehealth in the COVID-19 Era: A Balancing Act to Avoid Harm %A Reeves,J Jeffery %A Ayers,John W %A Longhurst,Christopher A %+ Department of Surgery, University of California San Diego, 9300 Campus Point Drive, MC7400, La Jolla, CA, 92037-7400, United States, 1 505 515 9844, jreeves@ucsd.edu %K telehealth %K patient safety %K COVID-19 %K coronavirus %K informatics %K safety %K harm %K risk %K access %K efficiency %K virtual care %D 2021 %7 1.2.2021 %9 Viewpoint %J J Med Internet Res %G English %X The telehealth revolution in response to COVID-19 has increased essential health care access during an unprecedented public health crisis. However, virtual patient care can also limit the patient-provider relationship, quality of examination, efficiency of health care delivery, and overall quality of care. As we witness the most rapidly adopted medical trend in modern history, clinicians are beginning to comprehend the many possibilities of telehealth, but its limitations also need to be understood. As outcomes are studied and federal regulations reconsidered, it is important to be precise in the virtual patient encounter approach. Herein, we offer some simple guidelines that could assist health care providers and clinic schedulers in determining the appropriateness of a telehealth visit by considering visit types, patient characteristics, and chief complaint or disease states. %M 33477104 %R 10.2196/24785 %U https://www.jmir.org/2021/2/e24785 %U https://doi.org/10.2196/24785 %U http://www.ncbi.nlm.nih.gov/pubmed/33477104 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 2 %P e22581 %T COVID-19 and Black, Asian, and Minority Ethnic Communities: A Complex Relationship Without Just Cause %A Phiri,Peter %A Delanerolle,Gayathri %A Al-Sudani,Ayaat %A Rathod,Shanaya %+ Research & Development Department, Tom Rudd Unit, Moorgreen Hospital, Southern Health NHS Foundation Trust, Research & Development Dept., Clinical Trials Facility, Tom Rudd Unit,, Southampton, SO30 3JB, United Kingdom, 44 02380475112, peter.phiri@southernhealth.nhs.uk %K BAME %K COVID-19 %K ethnicity %K health care professionals %K health care worker %K impact %K inequalities %K minority %K risk %D 2021 %7 1.2.2021 %9 Viewpoint %J JMIR Public Health Surveill %G English %X Emerging evidence has indicated a negative and disproportionate impact of COVID-19 on Black, Asian, and minority ethnic (BAME) communities. Previous studies have already reported that biological and social risk factors increase disease susceptibility, particularly in BAME communities. Despite frontline workers in ethnic minority communities in the United Kingdom’s National Health Service attempting to quell the pandemic, disproportionate numbers of BAME physicians and other health care workers have died of COVID-19. This unprecedented situation highlights ethical and moral implications, which could further augment the impact of the pandemic on their mental health. While the government attempts to mitigate the rate of virus transmission, certain key factors inadvertently augment the negative impact of the pandemic on the mental health and general well-being of BAME communities. This study examined the available literature to explore the association between, and the wider impact of, COVID-19 on BAME communities. Furthermore, this study aims to raise awareness and provide a deeper insight into current scientific discussions. %M 33481752 %R 10.2196/22581 %U https://publichealth.jmir.org/2021/2/e22581 %U https://doi.org/10.2196/22581 %U http://www.ncbi.nlm.nih.gov/pubmed/33481752 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 1 %P e25652 %T Digital Health Tools for Managing Noncommunicable Diseases During and After the COVID-19 Pandemic: Perspectives of Patients and Caregivers %A Monaco,Alessandro %A Palmer,Katie %A Holm Ravn Faber,Nicolaj %A Kohler,Irene %A Silva,Mitchell %A Vatland,Anita %A van Griensven,Joop %A Votta,Mariano %A Walsh,Donna %A Clay,Vincent %A Yazicioglu,Mehmet Cuneyt %A Ducinskiene,Danute %A Donde,Shaantanu %+ École des hautes études commerciales de Paris (HEC Paris), Rue de la Libération 1, Jouy-en-Josas, 78350, France, 33 0692948312, alessandro.monaco@hec.edu %K digital health %K information and communication technologies %K health technologies %K telemedicine %K noncommunicable diseases %K COVID-19 %K SARS-CoV-2 %K patient advocacy %K caregivers %K ageing %K patient empowerment %K digital tool %K perspective %K patient perspective %D 2021 %7 29.1.2021 %9 Viewpoint %J J Med Internet Res %G English %X Background: A reduction in the number of face-to-face medical examinations conducted for patients with noncommunicable diseases (NCDs) during the first wave of the COVID-19 pandemic has led to health care professionals quickly adopting different strategies to communicate with and monitor their patients. Such strategies include the increased use of digital health tools. However, patient preferences, privacy concerns, a lack of regulations, overregulation, and insufficient evidence on the efficacy of digital health tools may have hampered the potential positive benefits of using such tools to manage NCDs. Objective: This viewpoint aims to discuss the views of an advisory board of patient and caregiver association members. Specifically, we aim to present this advisory board’s view on the role of digital health tools in managing patients with NCDs during and after the COVID-19 pandemic, and to identify future directions based on patients’ perspectives. Methods: As an initiative under the NCD Partnership (PARTners in Ncds Engage foR building Strategies to improve Healthy ageing In Patients) model of Upjohn, a web-based advisory board of patient and caregiver advocates was held on July 28, 2020, to bring together key stakeholders from public and private sectors. Results: The following key themes emerged: (1) technology developers should understand that the goals of patients may differ from those of health care professionals and other stakeholders; (2) patients, health care professionals, caregivers, and other end users need to be involved in the development of digital health tools at the earliest phase possible, to guarantee usability, efficacy, and adoption; (3) digital health tools must be better tailored to people with complex conditions, such as multimorbidity, older age, and cognitive or sensory impairment; and (4) some patients do not want or are unable to use digital health care tools, so adequate alternatives should always be available. Conclusions: There was consensus that public-private partnership models, such as the Upjohn NCD Partnership, can be effective models that foster innovation by integrating multiple perspectives (eg, patients’ perspectives) into the design, development, and implementation of digital and nondigital health tools, with the main overall objective of improving the life of patients with NCDs. %M 33464206 %R 10.2196/25652 %U http://www.jmir.org/2021/1/e25652/ %U https://doi.org/10.2196/25652 %U http://www.ncbi.nlm.nih.gov/pubmed/33464206 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 1 %P e23126 %T Geographic Distribution of Mental Health Problems Among Chinese College Students During the COVID-19 Pandemic: Nationwide, Web-Based Survey Study %A Wu,Xiaoyan %A Tao,Shuman %A Zhang,Yi %A Li,Shiyue %A Ma,Le %A Yu,Yizhen %A Sun,Guilong %A Li,Tingting %A Tao,Fangbiao %+ Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No. 81 Meishan Road, Anhui, China, 86 055165161169, fbtao@ahmu.edu.cn %K COVID-19 pandemic %K college students %K mental health problems %K geographic location %D 2021 %7 29.1.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Since the COVID-19 outbreak was first reported, considerable attention has been drawn to mental health problems among college students. Objective: We aimed to estimate the prevalence of anxiety and depressive symptoms among college students in different geographical areas of China during the early stage of the COVID-19 outbreak. Methods: A nationwide cross-sectional survey was conducted among Chinese college students of 16 provinces or municipalities from February 4 to 12, 2020. A web-based survey was adopted to collect information from these college students, including demographics, perceived risk of infection, attitudes toward the epidemic and its control, and mental health status. Anxiety symptoms were assessed using the Generalized Anxiety Disorder scale, and depressive symptoms were assessed using the Patient Health Questionnaire. Chi-square test was used to compare the percentage of perceived risk of infection and attitude toward COVID-19 among college students in different geographic locations. Binary logistic models were used to identify associations between geographic locations and mental health problems after controlling for covariates. Results: A total of 11,787 participants were analyzed in this study (response rate: 79.7%). The prevalence of anxiety and depressive symptoms among college students was 17.8% (95% CI 17.1%-18.5%) and 25.9% (95% CI 25.1%-26.7%), respectively. After controlling for covariates, current residence area in Wuhan city was found to have a positive association with anxiety symptoms (odds ratio [OR] 1.37, 95% CI 1.11-1.68) and depressive symptoms (OR 1.32, 95% CI 1.09-1.59). Similarly, college location in Wuhan city was found to have a positive association with anxiety symptoms (OR 1.20, 95% CI 1.07-1.35) and depressive symptoms (OR 1.22, 95% CI 1.10-1.36). History of residence in or travel to Wuhan city in the past month was also positively associated with anxiety symptoms (OR 1.62, 95% CI 1.46-1.80) and depressive symptoms (OR 1.48, 95% CI 1.35-1.63). Furthermore, the perceived risk of COVID-19 was higher among students whose college location and current residence area were in Wuhan city, and it was positively associated with anxiety and depressive symptoms. Conclusions: During the COVID-19 pandemic, mental health problems among Chinese college students were widespread and geographically diverse. Our study results provide further insight for policymakers to develop targeted intervention strategies. %M 33439853 %R 10.2196/23126 %U http://www.jmir.org/2021/1/e23126/ %U https://doi.org/10.2196/23126 %U http://www.ncbi.nlm.nih.gov/pubmed/33439853 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 4 %N 1 %P e25675 %T Parents’ and Students’ Perceptions of Telepractice Services for Speech-Language Therapy During the COVID-19 Pandemic: Survey Study %A Lam,Joseph Hin Yan %A Lee,Stephen Man Kit %A Tong,Xiuli %+ Human Communication, Development, and Information Sciences, Faculty of Education, The University of Hong Kong, Room 804C, Meng Wah Complex, Pokfulam, Hong Kong, 852 22415982, xltong@hku.hk %K eHealth %K telepractice %K speech and language pathology %K user satisfaction %K COVID-19 %K school-based service %D 2021 %7 28.1.2021 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: The ongoing COVID-19 pandemic has resulted in the suspension of face-to-face classes and a considerable increase in the use of telepractice services in speech-language pathology. However, little is known about parents’ and students’ satisfaction with telepractice services and their preferences for different service delivery modes. These factors may affect therapy effectiveness and the future adoption of telepractice. Objective: We evaluated students’ and parents’ perceptions of telepractice efficacy and their preferences for different service delivery modes (ie, on-site practice vs telepractice). We also identified factors that affect parents’ and students’ preferences for different service delivery modes during the COVID-19 pandemic. Methods: A 19-question survey on telepractice satisfaction and preferences was administered to 41 Hong Kong Chinese students and 85 parents who received telepractice services from school-based speech-language pathologists during the COVID-19 class suspension period. In addition to providing demographic information and data on the implementation of telepractice services, all participants were asked to rate their perceptions of the efficacy of telepractice services and compare on-site practices to telepractice on a 5-point Likert scale (ie, 1=strongly disagree/prefer the use of on-site speech-language therapy services and 5=strongly agree/prefer the use of telepractice services). Results: Despite the fact that telepractice efficacy was highly rated by parents (95% CI 3.30-3.66) and students (95% CI 3.21-3.76), both groups believed that telepractice was less effective than on-site practices (parents: 95% CI 2.14-2.52; students: 95% CI 2.08-2.65). Moreover, parents preferred on-site practices over telepractice (95% CI 2.04-2.43), whereas students did not prefer one mode of practice over the other (95% CI 2.74-3.41). A significant association between telepractice efficacy and a preference for telepractice services was found only among the students (τ=.43, P<.001), not the parents (τ=.07; P=.44). Conclusions: Although telepractice is an acceptable alternative service delivery option for providing speech and language therapy services to school-aged individuals, speech-language therapists and parents must play a more proactive role in telepractice services to facilitate effective communication between clinicians and parents. %M 33449909 %R 10.2196/25675 %U http://pediatrics.jmir.org/2021/1/e25675/ %U https://doi.org/10.2196/25675 %U http://www.ncbi.nlm.nih.gov/pubmed/33449909 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 1 %P e19858 %T Demographic Factors Influencing the Impact of Coronavirus-Related Misinformation on WhatsApp: Cross-sectional Questionnaire Study %A Bapaye,Jay Amol %A Bapaye,Harsh Amol %+ Department Of Internal Medicine, Rochester General Hospital, 1425 Portland Avenue, Rochester, NY, 14621, United States, 1 5855370133, jaybapaye@gmail.com %K coronavirus %K COVID-19 %K SARS–CoV–2 %K WhatsApp %K social media %K misinformation %K infodemiology %K infodemic %K pandemic %K medical informatics %D 2021 %7 30.1.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The risks of misinformation on social networking sites is a global issue, especially in light of the COVID-19 infodemic. WhatsApp is being used as an important source of COVID-19–related information during the current pandemic. Unlike Facebook and Twitter, limited studies have investigated the role of WhatsApp as a source of communication, information, or misinformation during crisis situations. Objective: Our study aimed to evaluate the vulnerability of demographic cohorts in a developing country toward COVID-19–related misinformation shared via WhatsApp. We also aimed to identify characteristics of WhatsApp messages associated with increased credibility of misinformation. Methods: We conducted a web-based questionnaire survey and designed a scoring system based on theories supported by the existing literature. Vulnerability (K) was measured as a ratio of the respondent’s score to the maximum score. Respondents were stratified according to age and occupation, and Kmean was calculated and compared among each subgroup using single-factor analysis of variance and Hochberg GT2 tests. The questionnaire evaluated the respondents’ opinion of the veracity of coronavirus-related WhatsApp messages. The responses to the false-proven messages were compared using z test between the 2 groups: coronavirus-related WhatsApp messages with an attached link and/or source and those without. Results: We analyzed 1137 responses from WhatsApp users in India. Users aged over 65 years had the highest vulnerability (Kmean=0.38, 95% CI 0.341-0.419) to misinformation. Respondents in the age group 19-25 years had significantly lower vulnerability (Kmean=0.31, 95% CI 0.301-0.319) than those aged over 25 years (P<.05). The vulnerability of users employed in elementary occupations was the highest (Kmean=0.38, 95% CI 0.356-0.404), and it was significantly higher than that of professionals and students (P<.05). Interestingly, the vulnerability of healthcare workers was not significantly different from that of other occupation groups (P>.05). We found that false CRWMs with an attached link and/or source were marked true 6 times more often than false CRWMs without an attached link or source (P<.001). Conclusions: Our study demonstrates that in a developing country, WhatsApp users aged over 65 years and those involved in elementary occupations were found to be the most vulnerable to false information disseminated via WhatsApp. Health care workers, who are otherwise considered as experts with regard to this global health care crisis, also shared this vulnerability to misinformation with other occupation groups. Our findings also indicated that the presence of an attached link and/or source falsely validating an incorrect message adds significant false credibility, making it appear true. These results indicate an emergent need to address and rectify the current usage patterns of WhatsApp users. This study also provides metrics that can be used by health care organizations and government authorities of developing countries to formulate guidelines to contain the spread of WhatsApp-related misinformation. %M 33444152 %R 10.2196/19858 %U http://publichealth.jmir.org/2021/1/e19858/ %U https://doi.org/10.2196/19858 %U http://www.ncbi.nlm.nih.gov/pubmed/33444152 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 9 %N 1 %P e24973 %T Deep Learning Models for Predicting Severe Progression in COVID-19-Infected Patients: Retrospective Study %A Ho,Thao Thi %A Park,Jongmin %A Kim,Taewoo %A Park,Byunggeon %A Lee,Jaehee %A Kim,Jin Young %A Kim,Ki Beom %A Choi,Sooyoung %A Kim,Young Hwan %A Lim,Jae-Kwang %A Choi,Sanghun %+ School of Mechanical Engineering, Kyungpook National University, 80 Daehak-ro, Buk-gu, Daegu, 41566, Republic of Korea, 82 53 950 5578, s-choi@knu.ac.kr %K COVID-19 %K deep learning %K artificial neural network %K convolutional neural network %K lung CT %D 2021 %7 28.1.2021 %9 Original Paper %J JMIR Med Inform %G English %X Background: Many COVID-19 patients rapidly progress to respiratory failure with a broad range of severities. Identification of high-risk cases is critical for early intervention. Objective: The aim of this study is to develop deep learning models that can rapidly identify high-risk COVID-19 patients based on computed tomography (CT) images and clinical data. Methods: We analyzed 297 COVID-19 patients from five hospitals in Daegu, South Korea. A mixed artificial convolutional neural network (ACNN) model, combining an artificial neural network for clinical data and a convolutional neural network for 3D CT imaging data, was developed to classify these cases as either high risk of severe progression (ie, event) or low risk (ie, event-free). Results: Using the mixed ACNN model, we were able to obtain high classification performance using novel coronavirus pneumonia lesion images (ie, 93.9% accuracy, 80.8% sensitivity, 96.9% specificity, and 0.916 area under the curve [AUC] score) and lung segmentation images (ie, 94.3% accuracy, 74.7% sensitivity, 95.9% specificity, and 0.928 AUC score) for event versus event-free groups. Conclusions: Our study successfully differentiated high-risk cases among COVID-19 patients using imaging and clinical features. The developed model can be used as a predictive tool for interventions in aggressive therapies. %M 33455900 %R 10.2196/24973 %U http://medinform.jmir.org/2021/1/e24973/ %U https://doi.org/10.2196/24973 %U http://www.ncbi.nlm.nih.gov/pubmed/33455900 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 1 %P e26011 %T Impact of the COVID-19 Pandemic on Disordered Eating Behavior: Qualitative Analysis of Social Media Posts %A Nutley,Sara K %A Falise,Alyssa M %A Henderson,Rebecca %A Apostolou,Vasiliki %A Mathews,Carol A %A Striley,Catherine W %+ Department of Epidemiology, University of Florida, Room 4240, 2004 Mowry Road, Gainesville, FL, 32610, United States, 1 7086921336, snutley@ufl.edu %K eating disorders %K anorexia nervosa %K binge eating disorder %K COVID-19 %K coronavirus %K Reddit %K social media %K disorder %K eating %K qualitative %K experience %K mental health %K theme %D 2021 %7 27.1.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: A growing body of evidence is suggesting a significant association between the COVID-19 pandemic and population-level mental health. Study findings suggest that individuals with a lifetime history of disordered eating behavior may be negatively affected by COVID-19–related anxiety, and prevention measures may disrupt daily functioning and limit access to treatment. However, data describing the influence of the COVID-19 pandemic on disordered eating behaviors are limited, and most findings focus on individuals in treatment settings. Objective: The aim of this study is to characterize the experiences of Reddit users worldwide who post in eating disorder (ED)–related discussion forums describing the influence of the COVID-19 pandemic on their overall mental health and disordered eating behavior. Methods: Data were collected from popular subreddits acknowledging EDs as their primary discussion topic. Unique discussion posts dated from January 1 to May 31, 2020 that referenced the COVID-19 pandemic were extracted and evaluated using inductive, thematic data analysis. Results: Six primary themes were identified: change in ED symptoms, change in exercise routine, impact of quarantine on daily life, emotional well-being, help-seeking behavior, and associated risks and health outcomes. The majority of users reported that the COVID-19 pandemic and associated public health prevention measures negatively impacted their psychiatric health and contributed to increased disordered eating behaviors. Feelings of isolation, frustration, and anxiety were common. Many individuals used Reddit forums to share personal experiences, seek advice, and offer shared accountability. Conclusions: Reddit discussion forums have provided a therapeutic community for individuals to share experiences and provide support for peers with ED during a period of increased psychiatric distress. Future research is needed to assess the impact of the COVID-19 pandemic on disordered eating behavior and to evaluate the role of social media discussion forums in mental health treatment, especially during periods of limited treatment access. %M 33465035 %R 10.2196/26011 %U http://mental.jmir.org/2021/1/e26011/ %U https://doi.org/10.2196/26011 %U http://www.ncbi.nlm.nih.gov/pubmed/33465035 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 9 %N 1 %P e24207 %T Federated Learning of Electronic Health Records to Improve Mortality Prediction in Hospitalized Patients With COVID-19: Machine Learning Approach %A Vaid,Akhil %A Jaladanki,Suraj K %A Xu,Jie %A Teng,Shelly %A Kumar,Arvind %A Lee,Samuel %A Somani,Sulaiman %A Paranjpe,Ishan %A De Freitas,Jessica K %A Wanyan,Tingyi %A Johnson,Kipp W %A Bicak,Mesude %A Klang,Eyal %A Kwon,Young Joon %A Costa,Anthony %A Zhao,Shan %A Miotto,Riccardo %A Charney,Alexander W %A Böttinger,Erwin %A Fayad,Zahi A %A Nadkarni,Girish N %A Wang,Fei %A Glicksberg,Benjamin S %+ The Hasso Plattner Institute for Digital Health at Mount Sinai, Icahn School of Medicine at Mount Sinai, 770 Lexington Avenue, 14th Floor, New York, NY, 10065, United States, 1 (212) 731 7078, benjamin.glicksberg@mssm.edu %K federated learning %K COVID-19 %K machine learning %K electronic health records %D 2021 %7 27.1.2021 %9 Original Paper %J JMIR Med Inform %G English %X Background: Machine learning models require large datasets that may be siloed across different health care institutions. Machine learning studies that focus on COVID-19 have been limited to single-hospital data, which limits model generalizability. Objective: We aimed to use federated learning, a machine learning technique that avoids locally aggregating raw clinical data across multiple institutions, to predict mortality in hospitalized patients with COVID-19 within 7 days. Methods: Patient data were collected from the electronic health records of 5 hospitals within the Mount Sinai Health System. Logistic regression with L1 regularization/least absolute shrinkage and selection operator (LASSO) and multilayer perceptron (MLP) models were trained by using local data at each site. We developed a pooled model with combined data from all 5 sites, and a federated model that only shared parameters with a central aggregator. Results: The LASSOfederated model outperformed the LASSOlocal model at 3 hospitals, and the MLPfederated model performed better than the MLPlocal model at all 5 hospitals, as determined by the area under the receiver operating characteristic curve. The LASSOpooled model outperformed the LASSOfederated model at all hospitals, and the MLPfederated model outperformed the MLPpooled model at 2 hospitals. Conclusions: The federated learning of COVID-19 electronic health record data shows promise in developing robust predictive models without compromising patient privacy. %M 33400679 %R 10.2196/24207 %U http://medinform.jmir.org/2021/1/e24207/ %U https://doi.org/10.2196/24207 %U http://www.ncbi.nlm.nih.gov/pubmed/33400679 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 1 %P e24098 %T Going From Zero to 100 in Remote Dementia Research: A Practical Guide %A O'Connell,Megan E %A Vellani,Shirin %A Robertson,Sheryl %A O'Rourke,Hannah M %A McGilton,Kathy S %+ University of Saskatchewan, Department of Psychology, 9 Campus Drive, Saskatoon, SK, S7N 5A5, Canada, 1 3069662496, megan.oconnell@usask.ca %K COVID-19 %K telehealth %K videoconferencing %K dementia %K information communications technology %D 2021 %7 27.1.2021 %9 Viewpoint %J J Med Internet Res %G English %X Remote approaches for dementia research are required in the era of COVID-19, but moving a research program from in person to remote involves additional considerations. We recommend using outcome measures that have psychometric properties for remote delivery, and we recommend against adapting in-person scales for remote delivery without evidence for psychometric equivalency. We suggest remote research designs that maximize benefit for participants, which could have implications for control groups. Researchers should plan for flexibility in their methods for remote research and must not assume all participants will be able to videoconference; telephone-only research is possible. We recommend performing an assessment of information communication technology infrastructure and prior exposure to this technology with each participant before making a final choice on remote methods for research. In general, researchers should adapt their methods for remote research to each participant rather than requesting participants to adapt to the researchers. Screening for sensory loss should be conducted, and the impact of this on the use of technology for remote research should be considered. In this viewpoint, we detail how individualized training is required prior to engaging in remote research, how training plans interact with cognitive impairments and, finally, the steps involved in facilitating technology-based remote data collection. %M 33468448 %R 10.2196/24098 %U http://www.jmir.org/2021/1/e24098/ %U https://doi.org/10.2196/24098 %U http://www.ncbi.nlm.nih.gov/pubmed/33468448 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 1 %P e23155 %T Willingness to Adopt mHealth Among Chinese Parents During the COVID-19 Outbreak: Cross-sectional Questionnaire Study %A Yang,Siyu %A Chen,Yijing %A Zhou,Leshan %A Huang,Yuting %A Dai,Jiahui %+ Xiangya Nursing School, Central South University, No172 Tongzipo Road, Yuelu District, Changsha, China, 86 1897516606, leshanzhou@csu.edu.cn %K mHealth %K parents %K child health at home %K COVID-19 %D 2021 %7 27.1.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Parental involvement in mobile health (mHealth) to consult with medical professionals appears to be prevalent in China with the rapid development of the internet. More parents with busy jobs have chosen to use mHealth. During the ongoing COVID-19 outbreak, mHealth can assist with health promotion, directions for medication use, and disease diagnosis via online chat and video consultation without contacting others. To our knowledge, no studies have been performed to explore the role of mHealth in parents’ attitudes toward child health care at home during the COVID-19 outbreak. Objective: This study aims to identify the associated factors of willingness to adopt mHealth among Chinese parents during the COVID-19 outbreak and to explore the correlation between the frequency of adopting mHealth and parents’ attitudes toward child health care at home. Methods: Chinese parents were asked to complete an online survey from January 25 to February 15, 2020. The questionnaire comprised of two parts with a total of 16 items, including parents’ demographic variables and attitudes toward child health care at home. By multivariate logistic regression, we explored factors associated with parents’ willingness to adopt mHealth during the COVID-19 outbreak. Pearson chi-square tests were used to reveal the correlation between the frequency of adopting mHealth and parents’ attitudes toward child health care at home. Results: A total of 254 parents enrolled, and 202 (79.5%) parents were willing to adopt mHealth during the COVID-19 outbreak. Parents’ age (26-35 years: adjusted odds ratio [AOR] 8.114, 95% CI 1.471-44.764), parents’ interest in the COVID-19 pandemic (moderate: AOR 8.753, 95% CI 2.009-38.127; high: AOR 22.194, 95% CI 5.509-89.411), the source that recommended mHealth (medical health providers: AOR 4.257, 95% CI 1.439-12.596), the presence of chronic disease in their children (yes: AOR 20.844, 95% CI 4.600-94.443), parents’ duration of daily internet use (4-6 hours: AOR 6.487, 95% CI 1.870-22.495; >6 hours: AOR 8.766, 95% CI 1.883-40.804), and adoption of mHealth before the COVID-19 outbreak (yes: AOR 3.413, 95% CI 1.234-9.444) were significantly correlated with the parents’ willingness to adopt mHealth during the COVID-19 outbreak. The frequency of mHealth use among parents was correlated with their behaviors in regard to handwashing (χ26=18.967, P=.004), mask wearing (χ26=45.364, P<.001), frequency of leaving the home (χ26=16.767, P=.01), room disinfection and ventilation (χ26=19.515, P=.003), temperature checking (χ26=17.47, P=.007), and mental health care of children (χ26=63.810, P<.001) during the COVID-19 pandemic. Conclusions: We found various objective factors that were associated with parents’ willingness to adopt mHealth during the COVID-19 outbreak. Overall, parents’ willingness to adopt mHealth was high. The frequency of mHealth use among parents was correlated with their attitudes toward child health care at home. The option of mHealth to patients at home during the COVID-19 outbreak would be beneficial for education and improvement in self-management of child health care at home. %M 33406052 %R 10.2196/23155 %U http://mhealth.jmir.org/2021/1/e23155/ %U https://doi.org/10.2196/23155 %U http://www.ncbi.nlm.nih.gov/pubmed/33406052 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 1 %P e23034 %T Using the Novel Mortality-Prevalence Ratio to Evaluate Potentially Undocumented SARS-CoV-2 Infection: Correlational Study %A Lin,Sheng-Hsuan %A Fu,Shih-Chen %A Kao,Chu-Lan Michael %+ Institute of Statistics, National Chiao Tung University, Assembly Building I, 4th Floor, 1001 University Road, Hsinchu, 30010, Taiwan, 886 35712121 ext 56822, chulankao@gmail.com %K COVID-19 %K prevalence %K mortality %K undocumented infection %K mortality-prevalence ratio %K China %D 2021 %7 27.1.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The high prevalence of COVID-19 has resulted in 200,000 deaths as of early 2020. The corresponding mortality rate among different countries and times varies. Objective: This study aims to investigate the relationship between the mortality rate and prevalence of COVID-19 within a country. Methods: We collected data from the Johns Hopkins Coronavirus Resource Center. These data included the daily cumulative death count, recovered count, and confirmed count for each country. This study focused on a total of 36 countries with over 10,000 confirmed COVID-19 cases. Mortality was the main outcome and dependent variable, and it was computed by dividing the number of COVID-19 deaths by the number of confirmed cases. Results: The results of our global panel regression analysis showed that there was a highly significant correlation between prevalence and mortality (ρ=0.8304; P<.001). We found that every increment of 1 confirmed COVID-19 case per 1000 individuals led to a 1.29268% increase in mortality, after controlling for country-specific baseline mortality and time-fixed effects. Over 70% of excess mortality could be attributed to prevalence, and the heterogeneity among countries’ mortality-prevalence ratio was significant (P<.001). Further, our results showed that China had an abnormally high and significant mortality-prevalence ratio compared to other countries (P<.001). This unusual deviation in the mortality-prevalence ratio disappeared with the removal of the data that was collected from China after February 17, 2020. It is worth noting that the prevalence of a disease relies on accurate diagnoses and comprehensive surveillance, which can be difficult to achieve due to practical or political concerns. Conclusions: The association between COVID-19 mortality and prevalence was observed and quantified as the mortality-prevalence ratio. Our results highlight the importance of constraining disease transmission to decrease mortality rates. The comparison of mortality-prevalence ratios between countries can be a powerful method for detecting, or even quantifying, the proportion of individuals with undocumented SARS-CoV-2 infection. %M 33332282 %R 10.2196/23034 %U http://publichealth.jmir.org/2021/1/e23034/ %U https://doi.org/10.2196/23034 %U http://www.ncbi.nlm.nih.gov/pubmed/33332282 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 9 %N 1 %P e21712 %T Giving Your Electronic Health Record a Checkup After COVID-19: A Practical Framework for Reviewing Clinical Decision Support in Light of the Telemedicine Expansion %A Feldman,Jonah %A Szerencsy,Adam %A Mann,Devin %A Austrian,Jonathan %A Kothari,Ulka %A Heo,Hye %A Barzideh,Sam %A Hickey,Maureen %A Snapp,Catherine %A Aminian,Rod %A Jones,Lauren %A Testa,Paul %+ Medical Center Information Technology, NYU Langone Health, 360 Park Ave South, 18th Floor, New York, NY, 10010, United States, 1 646 524 0300, jonah.feldman@nyulangone.org %K COVID-19 %K EHR %K clinical decision support %K telemedicine %K ambulatory care %K electronic health record %K framework %K implementation %D 2021 %7 27.1.2021 %9 Original Paper %J JMIR Med Inform %G English %X Background: The transformation of health care during COVID-19, with the rapid expansion of telemedicine visits, presents new challenges to chronic care and preventive health providers. Clinical decision support (CDS) is critically important to chronic care providers, and CDS malfunction is common during times of change. It is essential to regularly reassess an organization's ambulatory CDS program to maintain care quality. This is especially true after an immense change, like the COVID-19 telemedicine expansion. Objective: Our objective is to reassess the ambulatory CDS program at a large academic medical center in light of telemedicine's expansion in response to the COVID-19 pandemic. Methods: Our clinical informatics team devised a practical framework for an intrapandemic ambulatory CDS assessment focused on the impact of the telemedicine expansion. This assessment began with a quantitative analysis comparing CDS alert performance in the context of in-person and telemedicine visits. Board-certified physician informaticists then completed a formal workflow review of alerts with inferior performance in telemedicine visits. Informaticists then reported on themes and optimization opportunities through the existing CDS governance structure. Results: Our assessment revealed that 10 of our top 40 alerts by volume were not firing as expected in telemedicine visits. In 3 of the top 5 alerts, providers were significantly less likely to take action in telemedicine when compared to office visits. Cumulatively, alerts in telemedicine encounters had an action taken rate of 5.3% (3257/64,938) compared to 8.3% (19,427/233,636) for office visits. Observations from a clinical informaticist workflow review included the following: (1) Telemedicine visits have different workflows than office visits. Some alerts developed for the office were not appearing at the optimal time in the telemedicine workflow. (2) Missing clinical data is a common reason for the decreased alert firing seen in telemedicine visits. (3) Remote patient monitoring and patient-reported clinical data entered through the portal could replace data collection usually completed in the office by a medical assistant or registered nurse. Conclusions: In a large academic medical center at the pandemic epicenter, an intrapandemic ambulatory CDS assessment revealed clinically significant CDS malfunctions that highlight the importance of reassessing ambulatory CDS performance after the telemedicine expansion. %M 33400683 %R 10.2196/21712 %U http://medinform.jmir.org/2021/1/e21712/ %U https://doi.org/10.2196/21712 %U http://www.ncbi.nlm.nih.gov/pubmed/33400683 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 1 %P e25265 %T Assessing COVID-19–Related Knowledge, Attitudes, and Practices Among Hispanic Primary Care Patients: Protocol for a Cross-sectional Survey Study %A Burger,Zoe C %A Mehta,Shivani N %A Ortiz,Dayanna %A Sor,Sekboppa %A Kothari,Jigna %A Lam,Yvonne %A Meka,Meena %A Meka,Ajay %A Rodwell,Timothy %+ School of Medicine, University of California San Diego, 9500 Gilman Dr #0039, La Jolla, CA, 92093, United States, 1 7146790080, s1mehta@ucsd.edu %K COVID-19 %K knowledge %K attitude %K practices %K Hispanic %K California %K protocol %K cross-sectional %K survey %D 2021 %7 27.1.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Recent epidemiological data indicate that minority groups, especially Hispanic communities, experience higher rates of infection, hospitalization, and death due to COVID-19. It is important to understand the nature of this health disparity and the socioeconomic or behavioral factors that are placing Hispanic communities and other minority populations at higher risk for morbidity and mortality. Objective: The purpose of this project is to assess current COVID-19–related knowledge, attitudes, and practices (KAP) among a predominantly Hispanic population from Orange County, California, and identify risk factors that may contribute to increased susceptibility and vulnerability to contracting SARS-CoV-2. Methods: Our Orange County–wide community survey consists of quantitative survey questions in four domains: demographic information, COVID-19 knowledge questions, COVID-19 attitude questions, and COVID-19 practices questions. The survey questions are adapted from recent global KAP studies. Participants are being recruited from Amistad Medical Clinic, a private primary health clinic group in Orange County that treats a predominantly Hispanic population. Patients recruited during telehealth visits are surveyed remotely by telephone, and those recruited during in-person clinic visits are surveyed in person. Surveys are conducted by trained members of the study team who are native to the community setting. Results: As of October 12, 2020, we had recruited and enrolled 327 participants. Data collection occurred June 26th to October 30th. Data analysis is ongoing. Conclusions: Very few current COVID-19 studies focus on the perspective and experience of minority populations. Because Hispanic communities are disproportionately affected by COVID-19, it is important to understand the factors the contribute to this disparity and the next steps that should be taken to reduce the COVID-19 burden in this population. We believe that our study model of partnering with a local clinic system that serves our study population can be expanded to other settings to compare COVID-19 KAP and associated factors within different minority communities. International Registered Report Identifier (IRRID): DERR1-10.2196/25265 %M 33406051 %R 10.2196/25265 %U http://www.researchprotocols.org/2021/1/e25265/ %U https://doi.org/10.2196/25265 %U http://www.ncbi.nlm.nih.gov/pubmed/33406051 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 1 %P e23775 %T Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework %A James,Hannah M %A Papoutsi,Chrysanthi %A Wherton,Joseph %A Greenhalgh,Trisha %A Shaw,Sara E %+ Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Oxford, , United Kingdom, 44 1865617873, sara.shaw@phc.ox.ac.uk %K delivery of health care %K remote consultation %K telemedicine %K videoconferencing %K spread and scale-up %K sustainability %K mobile phone %K COVID-19 %K remote care %K consultation %K review %D 2021 %7 26.1.2021 %9 Review %J J Med Internet Res %G English %X Background: COVID-19 has thrust video consulting into the limelight, as health care practitioners worldwide shift to delivering care remotely. Evidence suggests that video consulting is acceptable, safe, and effective in selected conditions and settings. However, research to date has mostly focused on initial adoption, with limited consideration of how video consulting can be mainstreamed and sustained. Objective: This study sought to do the following: (1) review and synthesize reported opportunities, challenges, and lessons learned in the scale-up, spread, and sustainability of video consultations, and (2) identify transferable insights that can inform policy and practice. Methods: We identified papers through systematic searches in PubMed, CINAHL, and Web of Science. Included articles reported on synchronous, video-based consultations that had spread to more than one setting beyond an initial pilot or feasibility stage, and were published since 2010. We used the Nonadoption, Abandonment, and challenges to the Scale-up, Spread, and Sustainability (NASSS) framework to synthesize findings relating to 7 domains: an understanding of the health condition(s) for which video consultations were being used, the material properties of the technological platform and relevant peripherals, the value proposition for patients and developers, the role of the adopter system, organizational factors, wider macro-level considerations, and emergence over time. Results: We identified 13 papers describing 10 different video consultation services in 6 regions, covering the following: (1) video-to-home services, connecting providers directly to the patient; (2) hub-and-spoke models, connecting a provider at a central hub to a patient at a rural center; and (3) large-scale top-down evaluations scaled up or spread across a national health administration. Services covered rehabilitation, geriatrics, cancer surgery, diabetes, and mental health, as well as general specialist care and primary care. Potential enablers of spread and scale-up included embedded leadership and the presence of a telehealth champion, appropriate reimbursement mechanisms, user-friendly technology, pre-existing staff relationships, and adaptation (of technology and services) over time. Challenges tended to be related to service development, such as the absence of a long-term strategic plan, resistance to change, cost and reimbursement issues, and the technical experience of staff. There was limited articulation of the challenges to scale-up and spread of video consultations. This was combined with a lack of theorization, with papers tending to view spread and scale-up as the sum of multiple technical implementations, rather than theorizing the distinct processes required to achieve widespread adoption. Conclusions: There remains a significant lack of evidence that can support the spread and scale-up of video consulting. Given the recent pace of change due to COVID-19, a more definitive evidence base is urgently needed to support global efforts and match enthusiasm for extending use. %M 33434141 %R 10.2196/23775 %U http://www.jmir.org/2021/1/e23775/ %U https://doi.org/10.2196/23775 %U http://www.ncbi.nlm.nih.gov/pubmed/33434141 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 1 %P e25456 %T It Is Time to REACT: Opportunities for Digital Mental Health Apps to Reduce Mental Health Disparities in Racially and Ethnically Minoritized Groups %A Friis-Healy,Elsa A %A Nagy,Gabriela A %A Kollins,Scott H %+ Department of Psychiatry and Behavioral Services, Duke University School of Medicine, 2608 Erwin Road, Durham, NC, 27705, United States, 1 919 681 0014, eaf23@duke.edu %K digital health %K app %K public mental health %K health disparities %K COVID-19 %K pandemic %K mental health %K disparity %K behavior %D 2021 %7 26.1.2021 %9 Viewpoint %J JMIR Ment Health %G English %X The behavioral health toll of the COVID-19 pandemic and systemic racism has directed increased attention to the potential of digital health as a way of improving access to and quality of behavioral health care. However, as the pandemic continues to widen health disparities in racially and ethnically minoritized groups, concerns arise around an increased reliance on digital health technologies exacerbating the digital divide and reinforcing rather than mitigating systemic health inequities in communities of color. As funding for digital mental health continues to surge, we offer five key recommendations on how the field can “REACT” to ensure the development of approaches that increase health equity by increasing real-world evidence, educating consumers and providers, utilizing adaptive interventions to optimize care, creating for diverse populations, and building trust. Recommendations highlight the need to take a strengths-based view when designing for racially and ethnically diverse populations and embracing the potential of digital approaches to address complex challenges. %M 33406050 %R 10.2196/25456 %U http://mental.jmir.org/2021/1/e25456/ %U https://doi.org/10.2196/25456 %U http://www.ncbi.nlm.nih.gov/pubmed/33406050 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 1 %P e22717 %T Diet, Nutrition, Obesity, and Their Implications for COVID-19 Mortality: Development of a Marginalized Two-Part Model for Semicontinuous Data %A Kamyari,Naser %A Soltanian,Ali Reza %A Mahjub,Hossein %A Moghimbeigi,Abbas %+ Modeling of Noncommunicable Diseases Research Center, Hamadan University of Medical Sciences, Daneshgah-e-Bu Ali Sina, Hamadan, Iran, 98 81 38380025, soltanian@umsha.ac.ir %K COVID-19 %K diet %K nutrition %K obesity %K marginalized two-part model %K semicontinuous data %D 2021 %7 26.1.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Nutrition is not a treatment for COVID-19, but it is a modifiable contributor to the development of chronic disease, which is highly associated with COVID-19 severe illness and deaths. A well-balanced diet and healthy patterns of eating strengthen the immune system, improve immunometabolism, and reduce the risk of chronic disease and infectious diseases. Objective: This study aims to assess the effect of diet, nutrition, obesity, and their implications for COVID-19 mortality among 188 countries by using new statistical marginalized two-part models. Methods: We globally evaluated the distribution of diet and nutrition at the national level while considering the variations between different World Health Organization regions. The effects of food supply categories and obesity on (as well as associations with) the number of deaths and the number of recoveries were reported globally by estimating coefficients and conducting color maps. Results: The findings show that a 1% increase in supplementation of pulses reduced the odds of having a zero death by 4-fold (OR 4.12, 95% CI 11.97-1.42). In addition, a 1% increase in supplementation of animal products and meat increased the odds of having a zero death by 1.076-fold (OR 1.076, 95% CI 1.01-1.15) and 1.13-fold (OR 1.13, 95% CI 1.0-1.28), respectively. Tree nuts reduced the odds of having a zero death, and vegetables increased the number of deaths. Globally, the results also showed that populations (countries) who consume more eggs, cereals excluding beer, spices, and stimulants had the greatest impact on the recovery of patients with COVID-19. In addition, populations that consume more meat, vegetal products, sugar and sweeteners, sugar crops, animal fats, and animal products were associated with more death and less recoveries in patients. The effect of consuming sugar products on mortality was considerable, and obesity has affected increased death rates and reduced recovery rates. Conclusions: Although there are differences in dietary patterns, overall, unbalanced diets are a health threat across the world and not only affect death rates but also the quality of life. To achieve the best results in preventing nutrition-related pandemic diseases, strategies and policies should fully recognize the essential role of both diet and obesity in determining good nutrition and optimal health. Policies and programs must address the need for change at the individual level and make modifications in society and the environment to make healthier choices accessible and preferable. %M 33439850 %R 10.2196/22717 %U http://publichealth.jmir.org/2021/1/e22717/ %U https://doi.org/10.2196/22717 %U http://www.ncbi.nlm.nih.gov/pubmed/33439850 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 1 %P e23946 %T Impact of COVID-19 on Physical Activity Among 10,000 Steps Members and Engagement With the Program in Australia: Prospective Study %A To,Quyen G %A Duncan,Mitch J %A Van Itallie,Anetta %A Vandelanotte,Corneel %+ Appleton Institute, School of Health, Medical and Applied Sciences, Central Queensland University, 554-700 Yaamba Rd, Rockhampton, 4701, Australia, 61 7 4930 6456, q.to@cqu.edu.au %K exercise %K pandemic %K lockdown %K eHealth %K physical activity %K COVID-19 %K engagement %K behavior %D 2021 %7 25.1.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Physical activity is an important health behavior, due to its association with many physical and mental health conditions. During distressing events, such as the COVID-19 pandemic, there is a concern that physical activity levels may be negatively impacted. However, recent studies have shown inconsistent results. Additionally, there is a lack of studies in Australia on this topic. Objective: The aim of this study is to investigate changes in physical activity reported through the 10,000 Steps program and changes in engagement with the program during the COVID-19 pandemic. Methods: Data between January 1, 2018, and June 30, 2020, from registered members of the 10,000 Steps program, which included 3,548,825 days with step data, were used. The number of daily steps were logged manually by the members or synced automatically from their activity trackers connected to the program. Measures on program usage were the number of new registered members per day, the number of newly registered organizations per day, the number of steps logged per day, and the number of step entries per day. Key dates used for comparison were as follows: the first case with symptoms in Wuhan, China; the first case reported in Australia; the implementation of a 14-day ban for noncitizens arriving in Australia from China; the start of the lockdown in Australia; and the relaxing of restrictions by the Australian Government. Wilcoxon signed-rank tests were used to test for significant differences in number of steps between subgroups, between engagement measures in 2019 versus 2020, and before and after an event. Results: A decrease in steps was observed after the first case in Australia was reported (1.5%; P=.02) and after the start of the lockdown (3.4%; P<.001). At the time that the relaxing of restrictions started, the steps had already recovered from the lockdown. Additionally, the trends were consistent across genders and age groups. New South Wales, Australian Capital Territory, and Victoria had the greatest step reductions, with decreases of 7.0% (P<.001), 6.2% (P=.02), and 4.7% (P<.001), respectively. During the lockdown, the use of the program increased steeply. On the peak day, there were more than 9000 step entries per day, with nearly 100 million steps logged per day; in addition, more than 450 new users and more than 15 new organizations registered per day, although the numbers decreased quickly when restrictions were relaxed. On average per day, there were about 55 new registered users (P<.001), 2 new organizations (P<.001), 25.6 million steps (P<.001), and 2672 log entries (P<.001) more in 2020 compared to the same period in 2019. Conclusions: The pandemic has had negative effects on steps among Australians across age groups and genders. However, the effect was relatively small, with steps recovering quickly after the lockdown. There was a large increase in program usage during the pandemic, which might help minimize the health impact of the lockdown and confirms the important role of physical activity programs during times of distress and lockdowns. %M 33449907 %R 10.2196/23946 %U http://www.jmir.org/2021/1/e23946/ %U https://doi.org/10.2196/23946 %U http://www.ncbi.nlm.nih.gov/pubmed/33449907 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 1 %P e22273 %T Predictors of COVID-19 Information Sources and Their Perceived Accuracy in Nigeria: Online Cross-sectional Study %A Erinoso,Olufemi %A Wright,Kikelomo Ololade %A Anya,Samuel %A Kuyinu,Yetunde %A Abdur-Razzaq,Hussein %A Adewuya,Abiodun %+ Department of Oral and Maxillofacial Surgery, Lagos State University Teaching Hospital, 1-5b Oba Akinjobi Road, GRA Ikeja, Lagos, 23401, Nigeria, 234 1 8950825, olufemierinoso@gmail.com %K COVID-19 %K communication %K health information %K public health %K infodemiology %K infodemic %K accuracy %K cross-sectional %K risk %K information source %K predictor %K Nigeria %D 2021 %7 25.1.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Effective communication is critical for mitigating the public health risks associated with the COVID-19 pandemic. Objective: This study assesses the source(s) of COVID-19 information among people in Nigeria, as well as the predictors and the perceived accuracy of information from these sources. Methods: We conducted an online survey of consenting adults residing in Nigeria between April and May 2020 during the lockdown and first wave of COVID-19. The major sources of information about COVID-19 were distilled from 7 potential sources (family and friends, places of worship, health care providers, internet, workplace, traditional media, and public posters/banners). An open-ended question was asked to explore how respondents determined accuracy of information. Statistical analysis was conducted using STATA 15.0 software (StataCorp Texas) with significance placed at P<.05. Approval to conduct this study was obtained from the Lagos State University Teaching Hospital Health Research Ethics Committee. Results: A total of 719 respondents completed the survey. Most respondents (n=642, 89.3%) obtained COVID-19–related information from the internet. The majority (n=617, 85.8%) considered their source(s) of information to be accurate, and 32.6% (n=234) depended on only 1 out of the 7 potential sources of COVID-19 information. Respondents earning a monthly income between NGN 70,000-120,000 had lower odds of obtaining COVID-19 information from the internet compared to respondents earning less than NGN 20,000 (odds ratio [OR] 0.49, 95% CI 0.24-0.98). In addition, a significant proportion of respondents sought accurate information from recognized health organizations, such as the Nigeria Centre for Disease Control and the World Health Organization. Conclusions: The internet was the most common source of COVID-19 information, and the population sampled had a relatively high level of perceived accuracy for the COVID-19 information received. Effective communication requires dissemination of information via credible communication channels, as identified from this study. This can be potentially beneficial for risk communication to control the pandemic. %M 33428580 %R 10.2196/22273 %U http://publichealth.jmir.org/2021/1/e22273/ %U https://doi.org/10.2196/22273 %U http://www.ncbi.nlm.nih.gov/pubmed/33428580 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 1 %P e20495 %T The Influence of Average Temperature and Relative Humidity on New Cases of COVID-19: Time-Series Analysis %A He,Zonglin %A Chin,Yiqiao %A Yu,Shinning %A Huang,Jian %A Zhang,Casper J P %A Zhu,Ke %A Azarakhsh,Nima %A Sheng,Jie %A He,Yi %A Jayavanth,Pallavi %A Liu,Qian %A Akinwunmi,Babatunde O %A Ming,Wai-Kit %+ School of Medicine, Jinan University, 601 West Huangpu Avenue, Guangzhou, China, 86 14715485116, wkming@connect.hku.hk %K COVID-19 %K coronavirus %K meteorological factors %K temperature %K humidity %K weather %K transmission %K virus %K Asia %K time-series %K analysis %K public health %D 2021 %7 25.1.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The influence of meteorological factors on the transmission and spread of COVID-19 is of interest and has not been investigated. Objective: This study aimed to investigate the associations between meteorological factors and the daily number of new cases of COVID-19 in 9 Asian cities. Methods: Pearson correlation and generalized additive modeling (GAM) were performed to assess the relationships between daily new COVID-19 cases and meteorological factors (daily average temperature and relative humidity) with the most updated data currently available. Results: The Pearson correlation showed that daily new confirmed cases of COVID-19 were more correlated with the average temperature than with relative humidity. Daily new confirmed cases were negatively correlated with the average temperature in Beijing (r=–0.565, P<.001), Shanghai (r=–0.47, P<.001), and Guangzhou (r=–0.53, P<.001). In Japan, however, a positive correlation was observed (r=0.416, P<.001). In most of the cities (Shanghai, Guangzhou, Hong Kong, Seoul, Tokyo, and Kuala Lumpur), GAM analysis showed the number of daily new confirmed cases to be positively associated with both average temperature and relative humidity, especially using lagged 3D modeling where the positive influence of temperature on daily new confirmed cases was discerned in 5 cities (exceptions: Beijing, Wuhan, Korea, and Malaysia). Moreover, the sensitivity analysis showed, by incorporating the city grade and public health measures into the model, that higher temperatures can increase daily new case numbers (beta=0.073, Z=11.594, P<.001) in the lagged 3-day model. Conclusions: The findings suggest that increased temperature yield increases in daily new cases of COVID-19. Hence, large-scale public health measures and expanded regional research are still required until a vaccine becomes widely available and herd immunity is established. %M 33232262 %R 10.2196/20495 %U https://publichealth.jmir.org/2021/1/e20495 %U https://doi.org/10.2196/20495 %U http://www.ncbi.nlm.nih.gov/pubmed/33232262 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 1 %P e21220 %T COVID-19–Related Knowledge and Practices Among Health Care Workers in Saudi Arabia: Cross-sectional Questionnaire Study %A Shaikhain,Talal Ahmad %A Al-Husayni,Faisal Abdulmohsen %A Alhejaili,Essam Awadh %A Al-Harbi,Maha Nawaf %A Bogari,Anas Abdullah %A Baghlaf,Bayan Abdulaziz %A Alzahrani,Mohammed Saeed %+ Department of Infectious Disease, National Guard Hospital, Old Makkah Road, Jeddah, 22384, Saudi Arabia, 966 556655712, mzahrani@gmail.com %K COVID-19 %K health care workers %K infection control %K attitude %K knowledge %K Saudi Arabia %D 2021 %7 25.1.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Health care workers are at the front line against COVID-19. The risk of transmission decreases with adequate knowledge of infection prevention methods. However, health care workers reportedly lack a proper attitude and knowledge of different viral outbreaks. Objective: This study aimed to assess the knowledge and attitude of health care workers in Saudi Arabia toward COVID-19. Assessment of these parameters may help researchers focus on areas that require improvement. Methods: A cross-sectional questionnaire study was conducted among 563 participants recruited from multiple cities in Saudi Arabia. An online questionnaire was shared via social media applications, which contained questions to health care workers about general information regarding COVID-19 and standard practices. Results: The mean age of the study population was 30.7 (SD 8) years. Approximately 8.3% (47/563) of the health care workers were isolated as suspected cases of COVID-19, and 0.9% (n=5) were found positive. The majority agreed that social distancing, face masks, and hand washing are effective methods for preventing disease transmission. However, only 63.7% (n=359) knew the correct duration of hand washing. Almost 70% (n=394) strictly adhered to hand hygiene practices, but less than half complied with the practice of wearing a face mask. Significant differences in health care workers' attitudes were observed on the basis of their city of residence, their adherence to COVID-19 practices, and their compliance with the use of a face mask. Among the health care workers, 27.2% (n=153) declared that they will isolate themselves at home and take influenza medication if they experience COVID-19 symptoms. Conclusions: The majority of health care workers in Saudi Arabia presented acceptable levels of general knowledge on COVID-19, but they lack awareness in some crucial details that may prevent disease spread. Intense courses and competency assessments are highly recommended. Prevention of disease progression is the only option for the time being. %M 33460390 %R 10.2196/21220 %U http://formative.jmir.org/2021/1/e21220/ %U https://doi.org/10.2196/21220 %U http://www.ncbi.nlm.nih.gov/pubmed/33460390 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 1 %P e26165 %T Expanding Telemonitoring in a Virtual World: A Case Study of the Expansion of a Heart Failure Telemonitoring Program During the COVID-19 Pandemic %A Wali,Sahr %A Guessi Margarido,Milena %A Shah,Amika %A Ware,Patrick %A McDonald,Michael %A O'Sullivan,Mary %A Duero Posada,Juan %A Ross,Heather %A Seto,Emily %+ Centre for Global eHealth Innovation, Techna Institute, University Health Network, TGH/RFE Building, 4th Floor, 190 Elizabeth Street, Toronto, ON, M5G 2C4, Canada, 1 416 340 4800 ext 4765, sahr.wali@mail.utoronto.ca %K telemedicine %K telehealth %K digital health %K digital medicine %K virtual care %K COVID-19 %K coronavirus %K SARS-CoV-2 %K public health %K surveillance %K outbreak %K pandemic %K infectious disease %K cardiology %K patient %D 2021 %7 22.1.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: To minimize the spread and risk of a COVID-19 outbreak, societal norms have been challenged with respect to how essential services are delivered. With pressures to reduce the number of in-person ambulatory visits, innovative models of telemonitoring have been used during the pandemic as a necessary alternative to support access to care for patients with chronic conditions. The pandemic has led health care organizations to consider the adoption of telemonitoring interventions for the first time, while others have seen existing programs rapidly expand. Objective: At the Toronto General Hospital in Ontario, Canada, the rapid expansion of a telemonitoring program began on March 9, 2020, in response to COVID-19. The objective of this study was to understand the experiences related to the expanded role of a telemonitoring program under the changing conditions of the pandemic. Methods: A single-case qualitative study was conducted with 3 embedded units of analysis. Semistructured interviews probed the experiences of patients, clinicians, and program staff from the Medly telemonitoring program at a heart function clinic in Toronto, Canada. Data were analyzed using inductive thematic analysis as well as Eakin and Gladstone’s value-adding approach to enhance the analytic interpretation of the study findings. Results: A total of 29 participants were interviewed, including patients (n=16), clinicians (n=9), and operational staff (n=4). Four themes were identified: (1) providing care continuity through telemonitoring; (2) adapting telemonitoring operations for a more virtual health care system; (3) confronting virtual workflow challenges; and (4) fostering a meaningful patient-provider relationship. Beyond supporting virtual visits, the program’s ability to provide a more comprehensive picture of the patient’s health was valued. However, issues relating to the lack of system integration and alert-driven interactions jeopardized the perceived sustainability of the program. Conclusions: With the reduction of in-person visits during the pandemic, virtual services such as telemonitoring have demonstrated significant value. Based on our study findings, we offer recommendations to proactively adapt and scale telemonitoring programs under the changing conditions of an increasingly virtual health care system. These include revisiting the scope and expectations of telemedicine interventions, streamlining virtual patient onboarding processes, and personalizing the collection of patient information to build a stronger virtual relationship and a more holistic assessment of patient well-being. %M 33444153 %R 10.2196/26165 %U http://www.jmir.org/2021/1/e26165/ %U https://doi.org/10.2196/26165 %U http://www.ncbi.nlm.nih.gov/pubmed/33444153 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 1 %P e25848 %T Adequacy of Web-Based Activities as a Substitute for In-Person Activities for Older Persons During the COVID-19 Pandemic: Survey Study %A Cohen-Mansfield,Jiska %A Muff,Aline %A Meschiany,Guy %A Lev-Ari,Shahar %+ Department of Health Promotion, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, POB 39040, Tel Aviv, Israel, 972 03 6407576, jiska@tauex.tau.ac.il %K web-based venues for older adults %K social engagement %K activities %K boredom %K technology barriers for seniors %K COVID-19 %K pandemic %K senior %K elderly %K older adult %K online activity %K engagement %K activity %K loneliness %K isolation %K effectiveness %D 2021 %7 22.1.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Senior centers and other types of clubs provide activities for older adults to address boredom, social isolation, and loneliness. Due to the COVID-19 pandemic, most of these activities have been cancelled. A limited range of web-based activities have been offered as alternatives. However, the effectiveness of these web-based group activities for older adults has scarcely been researched. Objective: We aimed to understand the extent to which web-based activities for older adults provide an adequate substitute for in-person activities. Methods: In this telephone survey, we interviewed 105 older adults in Israel who had been offered the opportunity to participate in web-based activities after routine activities closed due to the COVID-19 pandemic. Of the total sample, 49/105 (46.7%) participated in the activities and 56/105 (53.3%) did not. We inquired about the respondents’ background characteristics, satisfaction with the activities, and reasons for participation or nonparticipation. Results: The respondents who participated in the web-based activities tended to be highly satisfied with at least some of them. They rated the enjoyment derived from the content of the activity as the most important motivator, followed by maintaining a routine and by enjoying the group and the presence of others. Over 50% of the participants (28/49, 57%) wished to continue with the exercise programming after the end of the COVID-19 pandemic, and 41% (20/49) wished to continue with the web-based lectures. Participants were more likely to report partaking in alternative activities than nonparticipants (P=.04). The most common reasons cited by nonparticipants were being unaware of the web-based program (24/56, 43%) despite a notification having been sent to the entire sample, lack of interest in the content (18/56, 32%), and technical issues (13/56, 23%), such as not owning or being able to fully use a computer. Both participants and nonparticipants were interested in a wide range of topics, with many being very particular about the topics they wished to access. Approximately half expressed willingness to pay for access; those who were willing to pay tended to have more years of education (P=.03). Conclusions: Our findings suggest a need for web-based activities for countering boredom and feelings of isolation. The main factors that influence the use, efficacy, and sustainability of online activities are access, motivational and need-fulfilling factors, and whether the activities are sufficiently tailored to individuals’ preferences and abilities. Challenges in substituting in-person services are promoting social relationships that are currently not sufficiently incorporated into most web-based programs, accommodating a wider range of topics, and increasing the accessibility of current programs to older adults, especially those who are homebound, both during and after the COVID-19 pandemic. %M 33439851 %R 10.2196/25848 %U http://www.jmir.org/2021/1/e25848/ %U https://doi.org/10.2196/25848 %U http://www.ncbi.nlm.nih.gov/pubmed/33439851 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 1 %P e25314 %T Toward Using Twitter for Tracking COVID-19: A Natural Language Processing Pipeline and Exploratory Data Set %A Klein,Ari Z %A Magge,Arjun %A O'Connor,Karen %A Flores Amaro,Jesus Ivan %A Weissenbacher,Davy %A Gonzalez Hernandez,Graciela %+ Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, 421A Blockley Hall, 423 Guardian Dr, Philadelphia, PA, 19104, United States, 1 215 746 1101, ariklein@pennmedicine.upenn.edu %K natural language processing %K social media %K data mining %K COVID-19 %K coronavirus %K pandemics %K epidemiology %K infodemiology %D 2021 %7 22.1.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: In the United States, the rapidly evolving COVID-19 outbreak, the shortage of available testing, and the delay of test results present challenges for actively monitoring its spread based on testing alone. Objective: The objective of this study was to develop, evaluate, and deploy an automatic natural language processing pipeline to collect user-generated Twitter data as a complementary resource for identifying potential cases of COVID-19 in the United States that are not based on testing and, thus, may not have been reported to the Centers for Disease Control and Prevention. Methods: Beginning January 23, 2020, we collected English tweets from the Twitter Streaming application programming interface that mention keywords related to COVID-19. We applied handwritten regular expressions to identify tweets indicating that the user potentially has been exposed to COVID-19. We automatically filtered out “reported speech” (eg, quotations, news headlines) from the tweets that matched the regular expressions, and two annotators annotated a random sample of 8976 tweets that are geo-tagged or have profile location metadata, distinguishing tweets that self-report potential cases of COVID-19 from those that do not. We used the annotated tweets to train and evaluate deep neural network classifiers based on bidirectional encoder representations from transformers (BERT). Finally, we deployed the automatic pipeline on more than 85 million unlabeled tweets that were continuously collected between March 1 and August 21, 2020. Results: Interannotator agreement, based on dual annotations for 3644 (41%) of the 8976 tweets, was 0.77 (Cohen κ). A deep neural network classifier, based on a BERT model that was pretrained on tweets related to COVID-19, achieved an F1-score of 0.76 (precision=0.76, recall=0.76) for detecting tweets that self-report potential cases of COVID-19. Upon deploying our automatic pipeline, we identified 13,714 tweets that self-report potential cases of COVID-19 and have US state–level geolocations. Conclusions: We have made the 13,714 tweets identified in this study, along with each tweet’s time stamp and US state–level geolocation, publicly available to download. This data set presents the opportunity for future work to assess the utility of Twitter data as a complementary resource for tracking the spread of COVID-19. %M 33449904 %R 10.2196/25314 %U http://www.jmir.org/2021/1/e25314/ %U https://doi.org/10.2196/25314 %U http://www.ncbi.nlm.nih.gov/pubmed/33449904 %0 Journal Article %@ 2561-1011 %I JMIR Publications %V 5 %N 1 %P e25074 %T Patient Perspectives With Telehealth Visits in Cardiology During COVID-19: Online Patient Survey Study %A Singh,Aniruddha %A Mountjoy,Natalie %A McElroy,Doug %A Mittal,Shilpi %A Al Hemyari,Bashar %A Coffey,Nicholas %A Miller,Kristen %A Gaines,Kenneth %+ Western Kentucky Heart and Lung Research Foundation, 421 US31W By-pass, Bowling Green, KY, 42101, United States, 1 2707820151, Aniruddha.Singh@uky.edu %K COVID-19 %K telehealth %K cardiology %K internet %K broadband %K patient satisfaction %K restriction %K survey %D 2021 %7 22.1.2021 %9 Original Paper %J JMIR Cardio %G English %X Background: The rise of COVID-19 and the issue of a mandatory stay-at-home order in March 2020 led to the use of a direct-to-consumer model for cardiology telehealth in Kentucky. Kentucky has poor health outcomes and limited broadband connectivity. Given these and other practice-specific constraints, the region serves as a unique context to explore the efficacy of telehealth in cardiology. Objective: This study aims to determine the limitations of telehealth accessibility, patient satisfaction with telehealth relative to in-person visits, and the perceived advantages and disadvantages to telehealth. Our intent was two-fold. First, we wanted to conduct a rapid postassessment of the mandated overhaul of the health care delivery system, focusing on a representative specialty field, and how it was affecting patients. Second, we intend to use our findings to make suggestions about the future application of a telehealth model in specialty fields such as cardiology. Methods: We constructed an online survey in Qualtrics following the Patient Assessment of Communication During Telemedicine, a patient self-report questionnaire that has been previously developed and validated. We invited all patients who had a visit scheduled during the COVID-19 telehealth-only time frame to participate. Questions included factors for declining telehealth, patient satisfaction ratings of telehealth and in-person visits, and perceived advantages and disadvantages associated with telehealth. We also used electronic medical records to collect no-show data for in-person versus telehealth visits to check for nonresponse bias. Results: A total of 224 respondents began our survey (11% of our sample of 2019 patients). Our recruitment rate was 86% (n=193) and our completion rate was 62% (n=120). The no-show rate for telehealth visits (345/2019, 17%) was nearly identical to the typical no-show rate for in-person appointments. Among the 32 respondents who declined a telehealth visit, 20 (63%) cited not being aware of their appointment as a primary factor, and 15 (47%) respondents cited their opinion that a telehealth appointment was not medically necessary as at least somewhat of a factor in their decision. Both in-person and telehealth were viewed favorably, but in-person was rated higher across all domains of patient satisfaction. The only significantly lower mean score for telehealth (3.7 vs 4.2, P=.007) was in the clinical competence domain. Reduced travel time, lower visit wait time, and cost savings were seen as big advantages. Poor internet connectivity was rated as at least somewhat of a factor by 33.0% (35/106) of respondents. Conclusions: This study takes advantage of the natural experiment provided by the COVID-19 pandemic to assess the efficacy of telehealth in cardiology. Patterns of satisfaction are consistent across modalities and show that telehealth appears to be a viable alternative to in-person appointments. However, we found evidence that scheduling of telehealth visits may be problematic and needs additional attention. Additionally, we include a note of caution that patient satisfaction with telehealth may be artificially inflated during COVID-19 due to external health concerns connected with in-person visits. %M 33385234 %R 10.2196/25074 %U http://cardio.jmir.org/2021/1/e25074/ %U https://doi.org/10.2196/25074 %U http://www.ncbi.nlm.nih.gov/pubmed/33385234 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 1 %P e24591 %T Socioeconomic Disparities in Social Distancing During the COVID-19 Pandemic in the United States: Observational Study %A Garnier,Romain %A Benetka,Jan R %A Kraemer,John %A Bansal,Shweta %+ Department of Biology, Georgetown University, Reiss Science Building, 37th and O Streets, Washington, DC, 20057, United States, 1 2026879256, sb753@georgetown.edu %K COVID-19 %K SARS-CoV-2 %K disease ecology %K nonpharmaceutical interventions %K mobility data %K economic %K disparity %K social distancing %K equity %K access %K socioeconomic %K infectious disease %K mobility %D 2021 %7 22.1.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Eliminating disparities in the burden of COVID-19 requires equitable access to control measures across socio-economic groups. Limited research on socio-economic differences in mobility hampers our ability to understand whether inequalities in social distancing are occurring during the SARS-CoV-2 pandemic. Objective: We aimed to assess how mobility patterns have varied across the United States during the COVID-19 pandemic and to identify associations with socioeconomic factors of populations. Methods: We used anonymized mobility data from tens of millions of devices to measure the speed and depth of social distancing at the county level in the United States between February and May 2020, the period during which social distancing was widespread in this country. Using linear mixed models, we assessed the associations between social distancing and socioeconomic variables, including the proportion of people in the population below the poverty level, the proportion of Black people, the proportion of essential workers, and the population density. Results: We found that the speed, depth, and duration of social distancing in the United States are heterogeneous. We particularly show that social distancing is slower and less intense in counties with higher proportions of people below the poverty level and essential workers; in contrast, we show that social distancing is intensely adopted in counties with higher population densities and larger Black populations. Conclusions: Socioeconomic inequalities appear to be associated with the levels of adoption of social distancing, potentially resulting in wide-ranging differences in the impact of the COVID-19 pandemic in communities across the United States. These inequalities are likely to amplify existing health disparities and must be addressed to ensure the success of ongoing pandemic mitigation efforts. %M 33351774 %R 10.2196/24591 %U http://www.jmir.org/2021/1/e24591/ %U https://doi.org/10.2196/24591 %U http://www.ncbi.nlm.nih.gov/pubmed/33351774 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 1 %P e24495 %T Social, Cognitive, and eHealth Mechanisms of COVID-19–Related Lockdown and Mandatory Quarantine That Potentially Affect the Mental Health of Pregnant Women in China: Cross-Sectional Survey Study %A Yang,Xue %A Song,Bo %A Wu,Anise %A Mo,Phoenix K H %A Di,Jiangli %A Wang,Qian %A Lau,Joseph T F %A Wang,Linhong %+ National Center for Women and Children's Health, Chinese Center for Disease Control and Prevention, No 12 Dahuisi Road, Haidan District, Beijing, 100081, China, 86 01062170871, qianawang@chinawch.org.cn %K eHealth %K lockdown %K quarantine %K depression %K anxiety %K pregnant women %D 2021 %7 22.1.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Although lockdown and mandatory quarantine measures have played crucial roles in the sharp decrease of the number of newly confirmed/suspected COVID-19 cases, concerns have been raised over the threat that these measures pose to mental health, especially the mental health of vulnerable groups, including pregnant women. Few empirical studies have assessed whether and how these control measures may affect mental health, and no study has investigated the prevalence and impacts of the use of eHealth resources among pregnant women during the COVID-19 outbreak. Objective: This study investigated (1) the effects of lockdown and mandatory quarantine on mental health problems (ie, anxiety and depressive symptoms), (2) the potential mediation effects of perceived social support and maladaptive cognition, and (3) the moderation effects of eHealth-related factors (ie, using social media to obtain health information and using prenatal care services during the COVID-19 pandemic) on pregnant women in China. Methods: An online cross-sectional survey was conducted among 19,515 pregnant women from all 34 Chinese provincial-level administrative regions from February 25 to March 10, 2020. Results: Of the 19,515 participants, 12,209 (62.6%) were subjected to lockdown in their areas of residence, 737 (3.8%) were subjected to mandatory quarantine, 8712 (44.6%) had probable mild to severe depression, 5696 (29.2%) had probable mild to severe anxiety, and 1442 (7.4%) had suicidal ideations. Only 640 (3.3%) participants reported that they used online prenatal care services during the outbreak. Significant sociodemographic/maternal factors of anxiety/depressive symptoms included age, education, occupation, the area of residence, gestational duration, the number of children born, complication during pregnancy, the means of using prenatal care services, and social media use for obtaining health information. Multiple indicators multiple causes modeling (χ214=495.21; P<.05; comparative fit index=.99; nonnormed fit index=.98; root mean square error of approximation=.04, 90% CI 0.038-0.045) showed that quarantine was directly and indirectly strongly associated with poor mental health through decreased perceived social support and increased maladaptive cognition (B=.04; β=.02, 95% CI 0.01-0.02; P=.001), while lockdown was indirectly associated with mental health through increased social support and maladaptive cognition among pregnant women (B=.03; β=.03, 95% CI 0.02-0.03; P=.001). Multigroup analyses revealed that the use of social media for obtaining health information and the means of using prenatal care services were significant moderators of the model paths. Conclusions: Our findings provide epidemiological evidence for the importance of integrating mental health care and eHealth into the planning and implementation of control measure policies. The observed social and cognitive mechanisms and moderators in this study are modifiable, and they can inform the design of evidence-based mental health promotion among pregnant women. %M 33302251 %R 10.2196/24495 %U http://www.jmir.org/2021/1/e24495/ %U https://doi.org/10.2196/24495 %U http://www.ncbi.nlm.nih.gov/pubmed/33302251 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 1 %P e24502 %T COVID-19–Related Hospitalization Rates and Severe Outcomes Among Veterans From 5 Veterans Affairs Medical Centers: Hospital-Based Surveillance Study %A Cardemil,Cristina V %A Dahl,Rebecca %A Prill,Mila M %A Cates,Jordan %A Brown,Sheldon %A Perea,Adrienne %A Marconi,Vincent %A Bell,LaSara %A Rodriguez-Barradas,Maria C %A Rivera-Dominguez,Gilberto %A Beenhouwer,David %A Poteshkina,Aleksandra %A Holodniy,Mark %A Lucero-Obusan,Cynthia %A Balachandran,Neha %A Hall,Aron J %A Kim,Lindsay %A Langley,Gayle %+ Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA, 30329, United States, 1 404 639 8241, cristina.cardemil@nih.gov %K veteran %K COVID-19 %K hospitalization %K outcome %K fatality %K mortality %K prevention %K at-risk %D 2021 %7 22.1.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: COVID-19 has disproportionately affected older adults and certain racial and ethnic groups in the United States. Data quantifying the disease burden, as well as describing clinical outcomes during hospitalization among these groups, are needed. Objective: We aimed to describe interim COVID-19 hospitalization rates and severe clinical outcomes by age group and race and ethnicity among US veterans by using a multisite surveillance network. Methods: We implemented a multisite COVID-19 surveillance platform in 5 Veterans Affairs Medical Centers located in Atlanta, Bronx, Houston, Palo Alto, and Los Angeles, collectively serving more than 396,000 patients annually. From February 27 to July 17, 2020, we actively identified inpatient cases with COVID-19 by screening admitted patients and reviewing their laboratory test results. We then manually abstracted the patients' medical charts for demographics, underlying medical conditions, and clinical outcomes. Furthermore, we calculated hospitalization incidence and incidence rate ratios, as well as relative risk for invasive mechanical ventilation, intensive care unit admission, and case fatality rate after adjusting for age, race and ethnicity, and underlying medical conditions. Results: We identified 621 laboratory-confirmed, hospitalized COVID-19 cases. The median age of the patients was 70 years, with 65.7% (408/621) aged ≥65 years and 94% (584/621) male. Most COVID-19 diagnoses were among non-Hispanic Black (325/621, 52.3%) veterans, followed by non-Hispanic White (153/621, 24.6%) and Hispanic or Latino (112/621, 18%) veterans. Hospitalization rates were the highest among veterans who were ≥85 years old, Hispanic or Latino, and non-Hispanic Black (430, 317, and 298 per 100,000, respectively). Veterans aged ≥85 years had a 14-fold increased rate of hospitalization compared with those aged 18-29 years (95% CI: 5.7-34.6), whereas Hispanic or Latino and Black veterans had a 4.6- and 4.2-fold increased rate of hospitalization, respectively, compared with non-Hispanic White veterans (95% CI: 3.6-5.9). Overall, 11.6% (72/621) of the patients required invasive mechanical ventilation, 26.6% (165/621) were admitted to the intensive care unit, and 16.9% (105/621) died in the hospital. The adjusted relative risk for invasive mechanical ventilation and admission to the intensive care unit did not differ by age group or race and ethnicity, but veterans aged ≥65 years had a 4.5-fold increased risk of death while hospitalized with COVID-19 compared with those aged <65 years (95% CI: 2.4-8.6). Conclusions: COVID-19 surveillance at the 5 Veterans Affairs Medical Centers across the United States demonstrated higher hospitalization rates and severe outcomes among older veterans, as well as higher hospitalization rates among Hispanic or Latino and non-Hispanic Black veterans than among non-Hispanic White veterans. These findings highlight the need for targeted prevention and timely treatment for veterans, with special attention to older aged, Hispanic or Latino, and non-Hispanic Black veterans. %M 33338028 %R 10.2196/24502 %U http://publichealth.jmir.org/2021/1/e24502/ %U https://doi.org/10.2196/24502 %U http://www.ncbi.nlm.nih.gov/pubmed/33338028 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 1 %P e26836 %T Digital Contact Tracing Based on a Graph Database Algorithm for Emergency Management During the COVID-19 Epidemic: Case Study %A Mao,Zijun %A Yao,Hong %A Zou,Qi %A Zhang,Weiting %A Dong,Ying %+ College of Public Administration, Huazhong University of Science and Technology, 1037 Luoyu Road, Wuhan, 430074, China, 86 15871410683, maozijun@hust.edu.cn %K COVID-19 %K digital contact tracing %K emergency management %K graph database %K big data %K visualization %K China %D 2021 %7 22.1.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The COVID-19 epidemic is still spreading globally. Contact tracing is a vital strategy in epidemic emergency management; however, traditional contact tracing faces many limitations in practice. The application of digital technology provides an opportunity for local governments to trace the contacts of individuals with COVID-19 more comprehensively, efficiently, and precisely. Objective: Our research aimed to provide new solutions to overcome the limitations of traditional contact tracing by introducing the organizational process, technical process, and main achievements of digital contact tracing in Hainan Province. Methods: A graph database algorithm, which can efficiently process complex relational networks, was applied in Hainan Province; this algorithm relies on a governmental big data platform to analyze multisource COVID-19 epidemic data and build networks of relationships among high-risk infected individuals, the general population, vehicles, and public places to identify and trace contacts. We summarized the organizational and technical process of digital contact tracing in Hainan Province based on interviews and data analyses. Results: An integrated emergency management command system and a multi-agency coordination mechanism were formed during the emergency management of the COVID-19 epidemic in Hainan Province. The collection, storage, analysis, and application of multisource epidemic data were realized based on the government’s big data platform using a centralized model. The graph database algorithm is compatible with this platform and can analyze multisource and heterogeneous big data related to the epidemic. These practices were used to quickly and accurately identify and trace 10,871 contacts among hundreds of thousands of epidemic data records; 378 closest contacts and a number of public places with high risk of infection were identified. A confirmed patient was found after quarantine measures were implemented by all contacts. Conclusions: During the emergency management of the COVID-19 epidemic, Hainan Province used a graph database algorithm to trace contacts in a centralized model, which can identify infected individuals and high-risk public places more quickly and accurately. This practice can provide support to government agencies to implement precise, agile, and evidence-based emergency management measures and improve the responsiveness of the public health emergency response system. Strengthening data security, improving tracing accuracy, enabling intelligent data collection, and improving data-sharing mechanisms and technologies are directions for optimizing digital contact tracing. %M 33460389 %R 10.2196/26836 %U http://mhealth.jmir.org/2021/1/e26836/ %U https://doi.org/10.2196/26836 %U http://www.ncbi.nlm.nih.gov/pubmed/33460389 %0 Journal Article %@ 2563-3570 %I JMIR Publications %V 2 %N 1 %P e25995 %T Isolating SARS-CoV-2 Strains From Countries in the Same Meridian: Genome Evolutionary Analysis %A Mastriani,Emilio %A Rakov,Alexey V %A Liu,Shu-Lin %+ HMU-UCCSM Centre for Infection and Genomics, Harbin Medical University, No 157, Baojian Road, Harbin, 150081, China, 86 13664502721 ext 64502721, emiliomastriani@icloud.com %K SARS-CoV-2 %K evolutionary analysis %K episodic selective pressure %K virus evolution %K codon mutation %K binding probability %K evolution %K genome %K genetics %K COVID-19 %K virus %K strain %K codon %K pressure %K mutation %K structure %K prediction %K protein %D 2021 %7 22.1.2021 %9 Original Paper %J JMIR Bioinformatics Biotechnol %G English %X Background: COVID-19, caused by the novel SARS-CoV-2, is considered the most threatening respiratory infection in the world, with over 40 million people infected and over 0.934 million related deaths reported worldwide. It is speculated that epidemiological and clinical features of COVID-19 may differ across countries or continents. Genomic comparison of 48,635 SARS-CoV-2 genomes has shown that the average number of mutations per sample was 7.23, and most SARS-CoV-2 strains belong to one of 3 clades characterized by geographic and genomic specificity: Europe, Asia, and North America. Objective: The aim of this study was to compare the genomes of SARS-CoV-2 strains isolated from Italy, Sweden, and Congo, that is, 3 different countries in the same meridian (longitude) but with different climate conditions, and from Brazil (as an outgroup country), to analyze similarities or differences in patterns of possible evolutionary pressure signatures in their genomes. Methods: We obtained data from the Global Initiative on Sharing All Influenza Data repository by sampling all genomes available on that date. Using HyPhy, we achieved the recombination analysis by genetic algorithm recombination detection method, trimming, removal of the stop codons, and phylogenetic tree and mixed effects model of evolution analyses. We also performed secondary structure prediction analysis for both sequences (mutated and wild-type) and “disorder” and “transmembrane” analyses of the protein. We analyzed both protein structures with an ab initio approach to predict their ontologies and 3D structures. Results: Evolutionary analysis revealed that codon 9628 is under episodic selective pressure for all SARS-CoV-2 strains isolated from the 4 countries, suggesting it is a key site for virus evolution. Codon 9628 encodes the P0DTD3 (Y14_SARS2) uncharacterized protein 14. Further investigation showed that the codon mutation was responsible for helical modification in the secondary structure. The codon was positioned in the more ordered region of the gene (41-59) and near to the area acting as the transmembrane (54-67), suggesting its involvement in the attachment phase of the virus. The predicted protein structures of both wild-type and mutated P0DTD3 confirmed the importance of the codon to define the protein structure. Moreover, ontological analysis of the protein emphasized that the mutation enhances the binding probability. Conclusions: Our results suggest that RNA secondary structure may be affected and, consequently, the protein product changes T (threonine) to G (glycine) in position 50 of the protein. This position is located close to the predicted transmembrane region. Mutation analysis revealed that the change from G (glycine) to D (aspartic acid) may confer a new function to the protein—binding activity, which in turn may be responsible for attaching the virus to human eukaryotic cells. These findings can help design in vitro experiments and possibly facilitate a vaccine design and successful antiviral strategies. %M 33497425 %R 10.2196/25995 %U http://bioinform.jmir.org/2021/1/e25995/ %U https://doi.org/10.2196/25995 %U http://www.ncbi.nlm.nih.gov/pubmed/33497425 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 1 %P e21409 %T The Effect of a Name-Based Mask Rationing Plan in Taiwan on Public Anxiety Regarding a Mask Shortage During the COVID-19 Pandemic: Observational Study %A Tai,Yu-Lin %A Chi,Hsin %A Chiu,Nan-Chang %A Tseng,Cheng-Yin %A Huang,Ya-Ning %A Lin,Chien-Yu %+ Hsinchu MacKay Memorial Hospital, Department of Pediatrics and Infectious Disease, 690 Guanfu Rd, East District, Hsinchu, 300, Taiwan, 886 6119595 ext 2582, mmhped.lin@gmail.com %K coronavirus %K COVID-19 %K novel coronavirus %K SARS-CoV-2 %K mask %K rationing %K Taiwan %K anxiety %K mental health %K observational %K crisis %K plan %D 2021 %7 22.1.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic is a severe global health crisis. Wearing a mask is a straightforward action that can be taken, but shortage of stock and equity of allocation were important issues in Taiwan. Furthermore, increased anxiety leading to the stockpiling of masks has been common during the pandemic. Objective: We aim to summarize the name-based mask rationing plan implemented in Taiwan and explore the public’s perceived anxiety about mask shortages. Methods: The government of Taiwan took action to control the supply and allocation of face masks. We summarize the timeline and important components of the mask rationing plan. A survey that aimed to investigate the overall response to the mask rationing plan was answered by 44 participants. Results: The mask rationing plan was implemented in late January 2020. Daily production capacity was increased from 2 million masks to 16 million masks in April 2020. People could buy 9 masks in 14 days by verification via their National Health Insurance card. Digital face mask availability maps were created. Moreover, the mask plan safeguarded the purchase of masks and resulted in decreased anxiety about a mask shortage (4.05 [SD 1.15] points; 72.7% [n=32] of participants answered “agree” or “strongly agree”). The majority of people felt that the mask plan was satisfactory (4.2 [SD 0.92] points; 79.5% [n=35] of participants answered “agree” or “strongly agree”). Conclusions: We found that the unique name-based mask rationing plan allowed for control of the production and supply of masks, and contributed to the appropriate allocation of masks. The mask rationing plan not only provided the public with physical protection, but also resulted in reduced anxiety about mask shortages during the pandemic. %M 33400678 %R 10.2196/21409 %U http://formative.jmir.org/2021/1/e21409/ %U https://doi.org/10.2196/21409 %U http://www.ncbi.nlm.nih.gov/pubmed/33400678 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 1 %P e24756 %T Knowledge About COVID-19 in Brazil: Cross-Sectional Web-Based Study %A Guimarães,Vinícius Henrique Almeida %A de Oliveira-Leandro,Maísa %A Cassiano,Carolina %A Marques,Anna Laura Piantino %A Motta,Clara %A Freitas-Silva,Ana Letícia %A de Sousa,Marlos Aureliano Dias %A Silveira,Luciano Alves Matias %A Pardi,Thiago César %A Gazotto,Fernanda Castro %A Silva,Marcos Vinícius %A Rodrigues Jr,Virmondes %A Rodrigues,Wellington Francisco %A Oliveira,Carlo Jose Freire %+ Laboratory of Immunology and Bioinformatics, Institute of Biological and Natural Sciences, Federal University of Triangulo Mineiro, Uberaba, Brazil, 55 34988567251, carlo.oliveira@uftm.edu.br %K COVID-19 %K coronavirus %K perception %K knowledge %K Brazil %K cross-sectional %K online survey %K health information %D 2021 %7 21.1.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: COVID-19 is a highly transmissible illness caused by SARS-CoV-2. The disease has affected more than 200 countries, and the measures that have been implemented to combat its spread, as there is still no vaccine or definitive medication, have been based on supportive interventions and drug repositioning. Brazil, the largest country in South America, has had more than 140,000 recorded deaths and is one of the most affected countries. Despite the extensive quantity of scientifically recognized information, there are still conflicting discussions on how best to face the disease and the virus, especially with regard to social distancing, preventive methods, and the use of medications. Objective: The main purpose of this study is to evaluate the Brazilian population’s basic knowledge about COVID-19 to demonstrate how Brazilians are managing to identify scientifically proven information. Methods: A cross-sectional study design was used. An original online questionnaire survey was administered from June 16 to August 21, 2020, across all five different geopolitical regions of the country (ie, the North, Northeast, Center-West, Southeast, and South). The questionnaire was comprised of questions about basic aspects of COVID-19, such as the related symptoms, conduct that should be followed when suspected of infection, risk groups, prevention, transmission, and social distancing. The wrong questionnaire response alternatives were taken from the fake news combat website of the Brazilian Ministry of Health. Participants (aged ≥18 years) were recruited through social networking platforms, including Facebook, WhatsApp, and Twitter. The mean distributions, frequencies, and similarities or dissimilarities between the responses for the different variables of the study were evaluated. The significance level for all statistical tests was less than .05. Results: A total of 4180 valid responses representative of all the states and regions of Brazil were recorded. Most respondents had good knowledge about COVID-19, getting an average of 86.59% of the total score with regard to the basic aspects of the disease. The region, education level, age, sex, and social condition had a significant association (P<.001) with knowledge about the disease, which meant that women, the young, those with higher education levels, nonrecipients of social assistance, and more economically and socially developed regions had more correct answers. Conclusions: Overall, Brazilians with social media access have a good level of basic knowledge about COVID-19 but with differences depending on the analyzed subgroup. Due to the limitation of the platform used in carrying out the study, care should be taken when generalizing the study findings to populations with less education or who are not used to accessing social networking platforms. %M 33400684 %R 10.2196/24756 %U http://publichealth.jmir.org/2021/1/e24756/ %U https://doi.org/10.2196/24756 %U http://www.ncbi.nlm.nih.gov/pubmed/33400684 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 1 %P e20621 %T Patient Care During the COVID-19 Pandemic: Use of Virtual Care %A Wong,Andy %A Bhyat,Rashaad %A Srivastava,Siddhartha %A Boissé Lomax,Lysa %A Appireddy,Ramana %+ Division of Neurology, Queen's University, 76 Stuart Street, Connell 7, Kingston, ON, K7L 2V7, Canada, 1 6135482472, mrra@queensu.ca %K virtual care %K teleneurology %K telemedicine %K medical informatics %K internet %K patient-physician relationship %K email %K digital health %D 2021 %7 21.1.2021 %9 Viewpoint %J J Med Internet Res %G English %X Virtual care, the use of videoconferencing technology to connect with patients, has become critical in providing continuing care for patients during the current COVID-19 pandemic. Virtual care has now been adopted by health care providers across the spectrum, including physicians, residents, nurse practitioners, nurses, and allied health care professionals. Virtual care is novel and nuanced compared to in-person care. Most of the health care providers who are delivering or expected to deliver virtual care have little to no prior experience with it. The nuances of virtual care involve regulatory standards, platforms, technology and troubleshooting, patient selection, etiquette, and workflow, all of which comprise critical points in the provision of health care. It is important to consistently deliver high-quality, equitable, and professional virtual care to inspire patients with the trust they need to continue follow-up of their care in these difficult times. We have been adopting virtual care in our clinical practice for over two years. In partnership with Canada Health Infoway, we have assembled a primer for virtual care that can serve as a guide for any health care provider in Canada and globally, with the goal of providing seamless transitions between in-person and virtual care. %M 33326410 %R 10.2196/20621 %U https://www.jmir.org/2021/1/e20621 %U https://doi.org/10.2196/20621 %U http://www.ncbi.nlm.nih.gov/pubmed/33326410 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 1 %P e24619 %T Use of a Remote Oncology Pharmacy Service Platform for Patients With Cancer During the COVID-19 Pandemic: Implementation and User Acceptance Evaluation %A Chen,Zhuo-Jia %A Liang,Wei-Ting %A Liu,Qing %A He,Rong %A Chen,Qian-Chao %A Li,Qiu-Feng %A Zhang,Yao %A Du,Xiao-Dong %A Pan,Ying %A Liu,Shu %A Li,Xiao-Yan %A Wei,Xue %A Huang,He %A Huang,Hong-Bing %A Liu,Tao %+ Department of Pharmacy, Sun Yat-sen University Cancer Center, Guangzhou, China, huanghb@sysucc.org.cn %K COVID-19 %K cancer patients %K remote pharmacy %K service platform %K implementation %K oncology %K pharmacy %K online platform %K cancer %K health management %K app %K online hospital %K acceptance %K impact %D 2021 %7 21.1.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 outbreak has increased challenges associated with health management, especially cancer management. In an effort to provide continuous pharmaceutical care to cancer patients, Sun Yat-sen University Cancer Center (SYSUCC) implemented a remote pharmacy service platform based on its already existing web-based hospital app known as Cloud SYSUCC. Objective: The aim of this study was to investigate the characteristics, acceptance, and initial impact of the Cloud SYSUCC app during a COVID-19 outbreak in a tertiary cancer hospital in China. Methods: The total number of online prescriptions and detailed information on the service were obtained during the first 6 months after the remote service platform was successfully set up. The patients’ gender, age, residence, primary diagnosis, drug classification, weekly number of prescriptions, and prescribed drugs were analyzed. In addition, a follow-up telephonic survey was conducted to evaluate patients’ satisfaction in using the remote prescription service. Results: A total of 1718 prescriptions, including 2022 drugs for 1212 patients, were delivered to 24 provinces and municipalities directly under the Central Government of China between February 12, 2020, and August 11, 2020. The majority of patients were female (841/1212, 69.39%), and 90.18% (1093/1212) of them were aged 31-70 years old. The top 3 primary diagnoses for which remote medical prescriptions were made included breast cancer (599/1212, 49.42%), liver cancer (249/1212, 20.54%), and thyroid cancer (125/1212, 10.31%). Of the 1718 prescriptions delivered, 1435 (83.5%) were sent to Guangdong Province and 283 (16.5%) were sent to other provinces in China. Of the 2022 drugs delivered, 1012 (50.05%) were hormonal drugs. The general trend in the use of the remote prescription service declined since the 10th week. A follow-up telephonic survey found that 88% (88/100) of the patients were very satisfied, and 12% (12/100) of the patients were somewhat satisfied with the remote pharmacy service platform. Conclusions: The remote pharmacy platform Cloud SYSUCC is efficient and convenient for providing continuous pharmaceutical care to patients with cancer during the COVID-19 crisis. The widespread use of this platform can help to reduce person-to-person transmission as well as infection risk for these patients. Further efforts are needed to improve the quality and acceptance of the Cloud SYSUCC platform, as well as to regulate and standardize the management of this novel service. %M 33395398 %R 10.2196/24619 %U http://www.jmir.org/2021/1/e24619/ %U https://doi.org/10.2196/24619 %U http://www.ncbi.nlm.nih.gov/pubmed/33395398 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 1 %P e21825 %T Assessment of Internet Hospitals in China During the COVID-19 Pandemic: National Cross-Sectional Data Analysis Study %A Xu,Xingyan %A Cai,Yingying %A Wu,Siying %A Guo,Jianhui %A Yang,Le %A Lan,Jieli %A Sun,Yi %A Wang,Bingbing %A Wu,Jieyu %A Wang,Tinggui %A Huang,Shuna %A Lin,Yawen %A Hu,Yuduan %A Chen,Mingjun %A Gao,Xuecai %A Xie,Xiaoxu %+ Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, No. 1 Xuefu North Road, Minhou County, Fuzhou, 350122, China, 86 059122862023, xiexiaoxu@aliyun.com %K internet hospital %K COVID-19 %K prevention %K control %K health care %K China %K cross-sectional %K digital health %K accessibility %D 2021 %7 20.1.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Internet hospitals in China are being rapidly developed as an innovative approach to providing health services. The ongoing COVID-19 pandemic has triggered the development of internet hospitals that promote outpatient service delivery to the public via internet technologies. To date, no studies have assessed China's internet hospitals during the COVID-19 pandemic. Objective: This study aimed to elucidate the characteristics of China's internet hospitals and assess the health service capacity of these hospitals. Methods: Data on 711 internet hospitals were collected from official websites, the WeChat (Tencent Inc) platform, smartphone apps, and the Baidu search engine until July 16, 2020. Results: As of July 16, 2020, 711 internet hospitals were developed in mainland China. More than half of these internet hospitals (421/711, 59.2%) were established during 2019 (206/711, 29%) and 2020 (215/711, 30.2%). Furthermore, about one-third (215/711, 30.2%) of internet hospitals were established at the beginning of 2020 as an emergency response to the COVID-19 epidemic. The 711 internet hospitals consisted of the following 3 types of hospitals: government-oriented (42/711, 5.91%), hospital-oriented (143/711, 20.11%), and enterprise-oriented internet hospitals (526/711, 73.98%). The vast majority of internet hospitals were traditional hospitals (526/711, 74%). Nearly 46.1% (221/711) of internet hospitals requested doctors to provide health services at a specific web clinic. Most patients (224/639, 35.1%) accessed outpatient services via WeChat. Internet hospitals’ consulting methods included SMS text messaging consultations involving the use of graphics (552/570, 96.8%), video consultations (248/570, 43.5%), and telephone consultations (238/570, 41.8%). The median number of available web-based doctors was 43, and the median consultation fees of fever clinics and other outpatient clinics were ¥0 (US $0) per consultation and ¥6 (US $0.93) per consultation, respectively. Internet hospitals have provided various services during the COVID-19 pandemic, including medical prescription, drug delivery, and medical insurance services. Conclusions: The dramatic increase of internet hospitals in China has played an important role in the prevention and control of COVID-19. Internet hospitals provide different and convenient medical services for people in need. %M 33417586 %R 10.2196/21825 %U http://www.jmir.org/2021/1/e21825/ %U https://doi.org/10.2196/21825 %U http://www.ncbi.nlm.nih.gov/pubmed/33417586 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 1 %P e22619 %T Implementation of Telehealth Services to Assess, Monitor, and Treat Neurodevelopmental Disorders: Systematic Review %A Valentine,Althea Z %A Hall,Sophie S %A Young,Emma %A Brown,Beverley J %A Groom,Madeleine J %A Hollis,Chris %A Hall,Charlotte L %+ Institute of Mental Health, School of Medicine, Division of Psychiatry and Applied Psychology, University of Nottingham, Triumph Road, Nottingham, NG7 2TU, United Kingdom, 44 01157484249, althea.valentine@nottingham.ac.uk %K neurodevelopmental disorders %K technology %K telehealth %K review %K COVID-19 %K implement %K effective %K mental health %D 2021 %7 20.1.2021 %9 Review %J J Med Internet Res %G English %X Background: In response to COVID-19, there has been increasing momentum in telehealth development and delivery. To assess the anticipated exponential growth in telehealth, it is important to accurately capture how telehealth has been used in specific mental health fields prior to the pandemic. Objective: This systematic review aimed to highlight how telehealth has been used with clinical samples in the neurodevelopmental field, including patients with neurodevelopmental disorders (NDDs), their families, and health care professionals. To identify which technologies show the greatest potential for implementation into health services, we evaluated technologies for effectiveness, economic impact, and readiness for clinical adoption. Methods: A systematic search of literature was undertaken in April 2018 and updated until December 2019, by using the Medline, Web of Science, Scopus, CINAHL Plus, EMBASE, and PsycInfo databases. Extracted data included the type of technology, how the technology was used (ie, assessment, treatment, and monitoring), participant characteristics, reported outcomes and authors’ views on clinical effectiveness, user impact (ie, feasibility and acceptability), economic impact, and readiness for clinic adoption. A quality review of the research was performed in accordance with the Oxford Centre for Evidence-Based Medicine Levels of Evidence. Results: A total of 42 studies met the inclusion criteria. These studies included participants and family members with autism spectrum disorders (21/42, 50%), attention deficit hyperactivity disorders (8/42, 19%), attention deficit hyperactivity or autism spectrum disorders (3/42, 7%), communication disorders (7/42, 17%), and tic disorders (2/42, 5%). The focus of most studies (33/42, 79%) was on treatment, rather than assessment (4/42, 10%) or monitoring (5/42, 12%). Telehealth services demonstrated promise for being clinically effective, predominantly in relation to diagnosing and monitoring NDDs. In terms of NDD treatment, telehealth services were usually equivalent to control groups. There was some evidence of positive user and economic impacts, including increased service delivery efficiency (eg, increased treatment availability and decreased waiting times). However, these factors were not widely recorded across the studies. Telehealth was demonstrated to be cost-effective in the few studies that considered cost-effectiveness. Study quality varied, as many studies had small sample sizes and inadequate control groups. Of the 42 studies, only 11 (26%) were randomized controlled trials, 12 (29%) were case studies or case series, 6 (14%) were qualitative studies, and 5 (12%) were noncomparative trials. Conclusions: Telehealth has the potential to increase treatment availability, decrease diagnosis waiting times, and aid in NDD monitoring. Further research with more robust and adequately powered study designs that consider cost-effectiveness and increased efficiency is needed. This systematic review highlights the extent of telehealth technology use prior to the COVID-19 pandemic and the movement for investing in remote access to treatments. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42018091156; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42018091156 %M 33326409 %R 10.2196/22619 %U http://www.jmir.org/2021/1/e22619/ %U https://doi.org/10.2196/22619 %U http://www.ncbi.nlm.nih.gov/pubmed/33326409 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 9 %N 1 %P e25149 %T Interoperable Platform to Report Polymerase Chain Reaction SARS-CoV-2 Tests From Laboratories to the Chilean Government: Development and Implementation Study %A Guinez-Molinos,Sergio %A Andrade,José María %A Medina Negrete,Alejandro %A Espinoza Vidal,Sonia %A Rios,Elvis %+ Laboratory of Biomedical Informatics, School of Medicine, Universidad de Talca, Campus San Miguel, Avda. San Miguel S/N, Talca, 3460000, Chile, 56 71 2418820, sguinez@utalca.cl %K COVID-19 %K SARS-CoV-2 %K interoperability %K laboratory information system %K HL7 FHIR %K PCR %D 2021 %7 20.1.2021 %9 Original Paper %J JMIR Med Inform %G English %X Background: Testing, traceability, and isolation actions are a central strategy defined by the World Health Organization to contain the COVID-19 pandemic. In this sense, the countries have had difficulties in counting the number of people infected with SARS-CoV-2. Errors in reporting results are a common factor, as well as the lack of interoperability between laboratories and governments. Approaches aimed at sending spreadsheets via email expose patients’ privacy and have increased the probability of errors due to retyping, which generates a delay in the notification of results. Objective: This study aims to design and develop an interoperable platform to report polymerase chain reaction (PCR) SARS-CoV-2 tests from laboratories to the Chilean government. Methods: The methodology to design and develop the interoperable platform was comprised of six well-structured stages: (1) creation of a minimum data set for PCR SARS-CoV-2 tests, (2) modeling processes and end points where institutions interchange information, (3) standards and interoperability design, (4) software development, (5) software testing, and (6) software implementation. Results: The interoperable Fast Healthcare Interoperability Resources (FHIR) platform to report PCR SARS-CoV-2 tests from laboratories to the Chilean government was successfully implemented. The platform was designed, developed, tested, and implemented following a structured methodology. The platform’s performance to 1000 requests resulted in a response time of 240 milliseconds, throughput of 28.3 requests per second, and process management time of 131 milliseconds. The security was assured through a private network exclusive to the Ministry of Health to ensure confidentiality and integrity. The authorization and authentication of laboratories were implemented with a JavaScript Object Notation Web Token. All the PCR SARS-CoV-2 tests were accessible through an application programming interface gateway with valid credentials and the right access control list. Conclusions: The platform was implemented and is currently being used by UC Christus Laboratory. The platform is secure. It was tested adequately for confidentiality, secure authorization, authentication, and message integrity. This platform simplifies the reporting of PCR SARS-CoV-2 tests and reduces the time and probability of mistakes in counting positive cases. The interoperable solution with FHIR is working successfully and is open for the community, laboratories, and any institution that needs to report PCR SARS-CoV-2 tests. %M 33417587 %R 10.2196/25149 %U http://medinform.jmir.org/2021/1/e25149/ %U https://doi.org/10.2196/25149 %U http://www.ncbi.nlm.nih.gov/pubmed/33417587 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 1 %P e23125 %T Psychological Impact of the COVID-19 Pandemic on Chinese Health Care Workers: Cross-Sectional Survey Study %A Ni,Jie %A Wang,Fang %A Liu,Yihai %A Wu,Mingyue %A Jiang,Yan %A Zhou,Yujie %A Sha,Dujuan %+ General Medical Department, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Zhongshan Road 321, Nanjing, 210000, China, 86 13951980866, tbwen0912@126.com %K 2019-nCoV %K COVID-19 %K frontline clinician %K medical students %K psychology %D 2021 %7 20.1.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: The outbreak of COVID-19 has dominated headlines worldwide. The number of infections has continued to rise and had reached 30,000 worldwide at the time this paper was written. Because of the high risk of nosocomial transmission, medical health care workers may be experiencing substantial psychological stress. This descriptive study aimed to identify psychosocial effects on hospital staff associated with working in a hospital environment during the COVID-19 outbreak. Objective: Our survey participants included 57 frontline clinicians working at Wuhan First Hospital and 157 medical students working at Jiangsu Provincial People’s Hospital during the COVID-19 outbreak. The questionnaire we adopted included questions regarding the participants’ personal well-being, sociodemographic characteristics, and psychological status. Methods: 57 frontline clinicians working in Wuhan First Hospital and 157 medical training students working in Jiangsu Provincial Peoples Hospital during this outbreak participated in our survey. The questionnaire we adopted included questions regarding the participants’ personal well-being, sociodemographic characteristics and the psychological status. Results: The COVID-19 outbreak had psychological impacts both on formal workers and medical students. The psychological effects included sleep disorders, anxiety, and depression. There was no significant difference between the group of formal workers and medical students (P=.85), and more than 50% (30/54, 56%, vs. 83/157, 52.9%) of the respondents reported pandemic-related mental disorders. Conclusions: Our study indicates that the high risk of SARS-CoV-2 exposure caused substantial psychological stress among health care workers. This finding emphasizes the need to promote psychological crisis intervention for medical personnel during this epidemic. %M 33341754 %R 10.2196/23125 %U http://mental.jmir.org/2021/1/e23125/ %U https://doi.org/10.2196/23125 %U http://www.ncbi.nlm.nih.gov/pubmed/33341754 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 9 %N 1 %P e22753 %T A Low-Cost, Ear-Contactless Electronic Stethoscope Powered by Raspberry Pi for Auscultation of Patients With COVID-19: Prototype Development and Feasibility Study %A Yang,Chuan %A Zhang,Wei %A Pang,Zhixuan %A Zhang,Jing %A Zou,Deling %A Zhang,Xinzhong %A Guo,Sicong %A Wan,Jiye %A Wang,Ke %A Pang,Wenyue %+ Department of Cardiology, Shengjing Hospital of China Medical University, 36 Sanhao Street, Shenyang, 110004, China, 86 18940258063, pangwy@sj-hospital.org %K stethoscope %K auscultation %K COVID-19 %K Raspberry Pi %K Python %K ear-contactless %K low-cost %K phonocardiogram %K digital health %D 2021 %7 19.1.2021 %9 Original Paper %J JMIR Med Inform %G English %X Background: Chest examination by auscultation is essential in patients with COVID-19, especially those with poor respiratory conditions, such as severe pneumonia and respiratory dysfunction, and intensive cases who are intubated and whose breathing is assisted with a ventilator. However, proper auscultation of these patients is difficult when medical workers wear personal protective equipment and when it is necessary to minimize contact with patients. Objective: The objective of our study was to design and develop a low-cost electronic stethoscope enabling ear-contactless auscultation and digital storage of data for further analysis. The clinical feasibility of our device was assessed in comparison to a standard electronic stethoscope. Methods: We developed a prototype of the ear-contactless electronic stethoscope, called Auscul Pi, powered by Raspberry Pi and Python. Our device enables real-time capture of auscultation sounds with a microspeaker instead of an earpiece, and it can store data files for later analysis. We assessed the feasibility of using this stethoscope by detecting abnormal heart and respiratory sounds from 8 patients with heart failure or structural heart diseases and from 2 healthy volunteers and by comparing the results with those from a 3M Littmann electronic stethoscope. Results: We were able to conveniently operate Auscul Pi and precisely record the patients’ auscultation sounds. Auscul Pi showed similar real-time recording and playback performance to the Littmann stethoscope. The phonocardiograms of data obtained with the two stethoscopes were consistent and could be aligned with the cardiac cycles of the corresponding electrocardiograms. Pearson correlation analysis of amplitude data from the two types of phonocardiograms showed that Auscul Pi was correlated with the Littmann stethoscope with coefficients of 0.3245-0.5570 for healthy participants (P<.001) and of 0.3449-0.5138 among 4 patients (P<.001). Conclusions: Auscul Pi can be used for auscultation in clinical practice by applying real-time ear-contactless playback followed by quantitative analysis. Auscul Pi may allow accurate auscultation when medical workers are wearing protective suits and have difficulties in examining patients with COVID-19. Trial Registration: ChiCTR.org.cn ChiCTR2000033830; http://www.chictr.org.cn/showproj.aspx?proj=54971. %M 33436354 %R 10.2196/22753 %U https://medinform.jmir.org/2021/1/e22753 %U https://doi.org/10.2196/22753 %U http://www.ncbi.nlm.nih.gov/pubmed/33436354 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 1 %P e20236 %T Telemedicine and the Use of Korean Medicine for Patients With COVID-19 in South Korea: Observational Study %A Jang,Soobin %A Kim,Dongsu %A Yi,Eunhee %A Choi,Gunhee %A Song,Mideok %A Lee,Eun-Kyoung %+ Research Institute of Korean Medicine Policy, The Association of Korean Medicine, 91 Heojun-ro, Gangseo-go, Seoul, 07525, Republic of Korea, 82 2 5657 5000, eundust@hotmail.com %K telemedicine %K telehealth %K herbal medicine %K Korean medicine %K COVID-19 %K Korea %K pandemic %K guideline %K infectious disease %D 2021 %7 19.1.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: COVID-19 was first reported in Wuhan, China, in December 2019, and it has since spread worldwide. The Association of Korean Medicine (AKOM) established the COVID-19 telemedicine center of Korean medicine (KM telemedicine center) in Daegu and Seoul. Objective: The aim of this study was to describe the results of the KM telemedicine center and the clinical possibility of using herbal medicines for COVID-19. Methods: All procedures were conducted by voice call following standardized guidelines. The students in the reception group obtained informed consent from participants and they collected basic information. Subsequently, Korean Medicine doctors assessed COVID-19–related symptoms and prescribed the appropriate herbal medicine according to the KM telemedicine guidelines. The data of patients who completed the program by June 30, 2020, were analyzed. Results: From March 9 to June 30, 2020, 2324 patients participated in and completed the KM telemedicine program. Kyung-Ok-Ko (n=2285) was the most prescribed herbal medicine, and Qingfei Paidu decoction (I and II, n=2053) was the second most prescribed. All COVID-19–related symptoms (headache, chills, sputum, dry cough, sore throat, fatigue, muscle pain, rhinorrhea, nasal congestion, dyspnea, chest tightness, diarrhea, and loss of appetite) improved after treatment (P<.001). Conclusions: The KM telemedicine center has provided medical service to 10.8% of all patients with COVID-19 in South Korea (as of June 30, 2020), and it is still in operation. We hope that this study will help to establish a better health care system to overcome COVID-19. %M 33342765 %R 10.2196/20236 %U http://publichealth.jmir.org/2021/1/e20236/ %U https://doi.org/10.2196/20236 %U http://www.ncbi.nlm.nih.gov/pubmed/33342765 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 1 %P e24298 %T Mental Health and Burnout Syndrome Among Postgraduate Students in Medical and Multidisciplinary Residencies During the COVID-19 Pandemic in Brazil: Protocol for a Prospective Cohort Study %A Pinho,Rebeca Da Nóbrega Lucena %A Costa,Thais Ferreira %A Silva,Nayane Miranda %A Barros-Areal,Adriana F %A Salles,André De Mattos %A Oliveira,Andrea Pedrosa %A Rassi,Carlos %A Valero,Caroline Elizabeth Brero %A Gomes,Ciro Martins %A Mendonça-Silva,Dayde %A Oliveira,Fernando %A Jochims,Isadora %A Ranulfo,Ivan %A Neves,Juliana De Brito Seixas %A Oliveira,Lucas %A Dantas,Maria Nogueira %A Rosal,Marta %A Soares,Mayra %A Kurizky,Patrícia %A Peterle,Viviane Uliana %A Faro,Yasmin Furtado %A Gomides,Ana Paula %A da Mota,Licia %A Albuquerque,Cleandro %A Simaan,Cezar Kozak %A Amado,Veronica M %+ Programa de Pós-Graduação em Ciências Médicas FM-UnB, SGAN 605, Av. L2 Norte, Brasília, Brazil, 55 61 98343 6834, nlp.rebeca@gmail.com %K burnout syndrome %K medical residency %K multidisciplinary residency %K COVID-19 %K mental health %K burnout %K stress %K anxiety %K prospective %K cohort %K health care professional %K medical student %D 2021 %7 19.1.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: The COVID-19 pandemic has led to high levels of physical, psychological, and social stress among health care professionals, including postgraduate students in medical and multidisciplinary residencies. This stress is associated with the intense fear of occupational exposure to SARS-CoV-2, the virus known to cause COVID-19. These professionals are at risk of developing physical and mental illnesses not only due to the infection but also due to prolonged exposure to multidimensional stress and continued work overload. Objective: This study aims to evaluate the prevalence of symptoms suggestive of mental disorders and burnout syndrome and determine the risk factors for burnout among postgraduate students in medical and multidisciplinary residencies in Brazil during the COVID-19 pandemic. Methods: For this prospective cohort study with parallel groups, participants were recruited between July and September 2020 to achieve a sample size of at least 1144 participants. Research instruments such as Depression, Anxiety, and Stress Scale; Patient Health Questionnaire; Brief Resilient Coping Scale; and Oldenburg Burnout Inventory will be used to collect data. Data will be collected in 2 waves: the first wave will include data related to sample characterization and psychosocial evaluation, and the second wave will be launched 12 weeks later and will include an evaluation of the incidence of burnout as well as correlations with the potential predictive factors collected in the first wave. Additionally, we will collect data regarding participants’ withdrawal from work. Results: The recruitment took place from July 29 to September 5, 2020. Data analyses for this phase is already in progress. The second phase of the study is also in progress. The final data collection began on December 1, 2020, and it will be completed by December 31, 2020. Conclusions: We believe the findings of this study will help evaluate the impact of the COVID-19 pandemic on the mental health conditions of health professionals in Brazil as well as contribute to the planning and implementation of appropriate measures that can alleviate these mental health challenges. International Registered Report Identifier (IRRID): DERR1-10.2196/24298 %M 33290246 %R 10.2196/24298 %U https://www.researchprotocols.org/2021/1/e24298 %U https://doi.org/10.2196/24298 %U http://www.ncbi.nlm.nih.gov/pubmed/33290246 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 1 %P e24983 %T Mental Health Among Medical Professionals During the COVID-19 Pandemic in Eight European Countries: Cross-sectional Survey Study %A Hummel,Svenja %A Oetjen,Neele %A Du,Junfeng %A Posenato,Elisabetta %A Resende de Almeida,Rosa Maria %A Losada,Raquel %A Ribeiro,Oscar %A Frisardi,Vincenza %A Hopper,Louise %A Rashid,Asarnusch %A Nasser,Habib %A König,Alexandra %A Rudofsky,Gottfried %A Weidt,Steffi %A Zafar,Ali %A Gronewold,Nadine %A Mayer,Gwendolyn %A Schultz,Jobst-Hendrik %+ Department of General Internal and Psychosomatic Medicine, Heidelberg University Hospital, Im Neuenheimer Feld 410, Heidelberg, 69120, Germany, 49 62215632408, Neele.Oetjen@med.uni-heidelberg.de %K mental health %K COVID-19 %K Europe %K medical professionals %K stress %K depression %K anxiety %K coping %K stressors %D 2021 %7 18.1.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The death toll of COVID-19 topped 170,000 in Europe by the end of May 2020. COVID-19 has caused an immense psychological burden on the population, especially among doctors and nurses who are faced with high infection risks and increased workload. Objective: The aim of this study was to compare the mental health of medical professionals with nonmedical professionals in different European countries during the COVID-19 pandemic. We hypothesized that medical professionals, particularly those exposed to COVID-19 at work, would have higher levels of depression, anxiety, and stress. We also aimed to determine their main stressors and most frequently used coping strategies during the crisis. Methods: A cross-sectional online survey was conducted during peak COVID-19 months in 8 European countries. The questionnaire included demographic data and inquired whether the participants were exposed to COVID-19 at work or not. Mental health was assessed via the Depression Anxiety Stress Scales32 (23.53)–21 (DASS-21). A 12-item checklist on preferred coping strategies and another 23-item questionnaire on major stressors were completed by medical professionals. Results: The sample (N=609) consisted of 189 doctors, 165 nurses, and 255 nonmedical professionals. Participants from France and the United Kingdom reported experiencing severe/extremely severe depression, anxiety, and stress more often compared to those from the other countries. Nonmedical professionals had significantly higher scores for depression and anxiety. Among medical professionals, no significant link was reported between direct contact with patients with COVID-19 at work and anxiety, depression, or stress. “Uncertainty about when the epidemic will be under control” caused the most amount of stress for health care professionals while “taking protective measures” was the most frequently used coping strategy among all participants. Conclusions: COVID-19 poses a major challenge to the mental health of working professionals as a considerable proportion of our participants showed high values for depression, anxiety, and stress. Even though medical professionals exhibited less mental stress than nonmedical professionals, sufficient help should be offered to all occupational groups with an emphasis on effective coping strategies. %M 33411670 %R 10.2196/24983 %U http://www.jmir.org/2021/1/e24983/ %U https://doi.org/10.2196/24983 %U http://www.ncbi.nlm.nih.gov/pubmed/33411670 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 1 %P e18722 %T Maternal Mental Health Status and Approaches for Accessing Antenatal Care Information During the COVID-19 Epidemic in China: Cross-Sectional Study %A Jiang,Hong %A Jin,Longmei %A Qian,Xu %A Xiong,Xu %A La,Xuena %A Chen,Weiyi %A Yang,Xiaoguang %A Yang,Fengyun %A Zhang,Xinwen %A Abudukelimu,Nazhakaiti %A Li,Xingying %A Xie,Zhenyu %A Zhu,Xiaoling %A Zhang,Xiaohua %A Zhang,Lifeng %A Wang,Li %A Li,Lingling %A Li,Mu %+ School of Public Health, Fudan University, Mailbox 175, 138 Yixueyuan Road, Shanghai, 200032, China, 86 2154237267, h_jiang@fudan.edu.cn %K COVID-19 %K mental health %K perceived stress %K anxiety %K depression %K antenatal care information %K social media platform %K pregnancy %K women %D 2021 %7 18.1.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: China was the first country in the world to experience a large-scale COVID-19 outbreak. The rapid spread of the disease and enforcement of public health measures has caused distress among vulnerable populations such as pregnant women. With a limited understanding of the novel, emerging infectious disease, pregnant women have sought ways to access timely and trusted health care information. The mental health status of pregnant women during this public health emergency, as well as how they responded to the situation and where and how they obtained antenatal care information, remain to be understood. Objective: This study aimed to evaluate the mental health status of pregnant women during the COVID-19 epidemic in China by measuring their perceived stress, anxiety, and depression levels; explore the approaches used by them to access antenatal health care information; and determine their associations with maternal mental health status. Methods: We conducted a web-based, cross-sectional survey to assess the mental health status of Chinese pregnant women by using the validated, Chinese version of Perceived Stress Scale, Self-Rating Anxiety Scale, and Edinburgh Depression Scale. We also collected information on the various approaches these women used to access antenatal care information during the early stage of the COVID-19 epidemic, from February 5 to 28, 2020. Results: A total of 1873 pregnant women from 22 provinces or regions of China participated in the survey. The prevalence of perceived stress, anxiety, and depression among these participants was 89.1% (1668/1873; 95% CI 87.6%, 90.4%), 18.1% (339/1873; 95% CI 16.4%, 19.9%), and 45.9% (859/1873; 95% CI 43.6%, 48.1%), respectively. Hospitals’ official accounts on the Chinese social media platforms WeChat and Weibo were the most popular channels among these pregnant women to obtain antenatal care information during the COVID-19 outbreak. Access to antenatal care information via the hospitals’ official social media accounts was found to be associated with a significantly lower risk of perceived stress (adjusted odds ratio [aOR] 0.46, 95% CI 0.30-0.72; P=.001), anxiety (aOR 0.53, 95% CI 0.41-0.68; P<.001), and depression (aOR 0.73, 95% CI 0.59-0.91; P=.005). Access to health care information via hospital hotlines or SMS was found to be significantly associated with a lower risk of anxiety only (OR 0.77, 95% CI 0.60-0.98; P=.04). Conclusions: During the COVID-19 outbreak in China, pregnant women experienced high levels of perceived stress, anxiety, and depression. During such public health emergencies, mental health care services should be strengthened to reassure and support pregnant women. Specific information targeted at pregnant women, including information on how to cope in an emergency or major disease outbreak, developed and disseminated by health care institutions via social media platforms could be an effective way to mitigate mental health challenges and ensure epidemic preparedness and response in the future. %M 33347423 %R 10.2196/18722 %U http://www.jmir.org/2021/1/e18722/ %U https://doi.org/10.2196/18722 %U http://www.ncbi.nlm.nih.gov/pubmed/33347423 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 1 %P e26089 %T Unfolding the Determinants of COVID-19 Vaccine Acceptance in China %A Yin,Fulian %A Wu,Zhaoliang %A Xia,Xinyu %A Ji,Meiqi %A Wang,Yanyan %A Hu,Zhiwen %+ Zhejiang Gongshang University, No 18 Xuezheng Street, Higher Education Zone, Hangzhou, China, 86 13676458899, huzhiwen@zjgsu.edu.cn %K COVID-19 vaccines %K COVID-19 vaccination %K affordability %K efficacy %K risk communication %K evidence communication %K social media %K COVID-19 %K vaccine %K communication %K risk %K acceptance %K China %K opinion %K strategy %K promotion %D 2021 %7 15.1.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: China is at the forefront of global efforts to develop COVID-19 vaccines and has five fast-tracked candidates at the final-stage, large-scale human clinical trials testing phase. Vaccine-promoting policymaking for public engagement is a prerequisite for social mobilization. However, making an informed and judicious choice is a dilemma for the Chinese government in the vaccine promotion context. Objective: In this study, public opinions in China were analyzed via dialogues on Chinese social media, based on which Chinese netizens’ views on COVID-19 vaccines and vaccination were investigated. We also aimed to develop strategies for promoting vaccination programs in China based on an in-depth understanding of the challenges in risk communication and social mobilization. Methods: We proposed a novel behavioral dynamics model, SRS/I (susceptible-reading-susceptible/immune), to analyze opinion transmission paradigms on Chinese social media. Coupled with a meta-analysis and natural language processing techniques, the emotion polarity of individual opinions was examined in their given context. Results: We collected more than 1.75 million Weibo messages about COVID-19 vaccines from January to October 2020. According to the public opinion reproduction ratio (R0), the dynamic propagation of those messages can be classified into three periods: the ferment period (R01=1.1360), the revolution period (R02=2.8278), and the transmission period (R03=3.0729). Topics on COVID-19 vaccine acceptance in China include price and side effects. From September to October, Weibo users claimed that the vaccine was overpriced, making up 18.3% (n=899) of messages; 38.1% (n=81,909) of relevant topics on Weibo received likes. On the contrary, the number of messages that considered the vaccine to be reasonably priced was twice as high but received fewer likes, accounting for 25.0% (n=53,693). In addition, we obtained 441 (47.7%) positive and 295 (31.9%) negative Weibo messages about side effects. Interestingly, inactivated vaccines instigated more heated discussions than any other vaccine type. The discussions, forwards, comments, and likes associated with topics related to inactivated vaccines accounted for 53% (n=588), 42% (n=3072), 56% (n=3671), and 49% (n=17,940), respectively, of the total activity associated with the five types of vaccines in China. Conclusions: Most Chinese netizens believe that the vaccine is less expensive than previously thought, while some claim they cannot afford it for their entire family. The findings demonstrate that Chinese individuals are inclined to be positive about side effects over time and are proud of China’s involvement with vaccine development. Nevertheless, they have a collective misunderstanding about inactivated vaccines, insisting that inactivated vaccines are safer than other vaccines. Reflecting on netizens’ collective responses, the unfolding determinants of COVID-19 vaccine acceptance provide illuminating benchmarks for vaccine-promoting policies. %M 33400682 %R 10.2196/26089 %U http://www.jmir.org/2021/1/e26089/ %U https://doi.org/10.2196/26089 %U http://www.ncbi.nlm.nih.gov/pubmed/33400682 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 1 %P e25538 %T Nowcasting for Real-Time COVID-19 Tracking in New York City: An Evaluation Using Reportable Disease Data From Early in the Pandemic %A Greene,Sharon K %A McGough,Sarah F %A Culp,Gretchen M %A Graf,Laura E %A Lipsitch,Marc %A Menzies,Nicolas A %A Kahn,Rebecca %+ Bureau of Communicable Disease, New York City Department of Health and Mental Hygiene, 42-09 28th Street, CN 22A, WS 06-154, Long Island City, NY, 11101, United States, 1 347 396 2679, sgreene4@health.nyc.gov %K COVID-19 %K data quality %K epidemiology %K forecasting %K infectious disease %K morbidity and mortality trends %K public health practice %K surveillance %D 2021 %7 15.1.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Nowcasting approaches enhance the utility of reportable disease data for trend monitoring by correcting for delays, but implementation details affect accuracy. Objective: To support real-time COVID-19 situational awareness, the New York City Department of Health and Mental Hygiene used nowcasting to account for testing and reporting delays. We conducted an evaluation to determine which implementation details would yield the most accurate estimated case counts. Methods: A time-correlated Bayesian approach called Nowcasting by Bayesian Smoothing (NobBS) was applied in real time to line lists of reportable disease surveillance data, accounting for the delay from diagnosis to reporting and the shape of the epidemic curve. We retrospectively evaluated nowcasting performance for confirmed case counts among residents diagnosed during the period from March to May 2020, a period when the median reporting delay was 2 days. Results: Nowcasts with a 2-week moving window and a negative binomial distribution had lower mean absolute error, lower relative root mean square error, and higher 95% prediction interval coverage than nowcasts conducted with a 3-week moving window or with a Poisson distribution. Nowcasts conducted toward the end of the week outperformed nowcasts performed earlier in the week, given fewer patients diagnosed on weekends and lack of day-of-week adjustments. When estimating case counts for weekdays only, metrics were similar across days when the nowcasts were conducted, with Mondays having the lowest mean absolute error of 183 cases in the context of an average daily weekday case count of 2914. Conclusions: Nowcasting using NobBS can effectively support COVID-19 trend monitoring. Accounting for overdispersion, shortening the moving window, and suppressing diagnoses on weekends—when fewer patients submitted specimens for testing—improved the accuracy of estimated case counts. Nowcasting ensured that recent decreases in observed case counts were not overinterpreted as true declines and supported officials in anticipating the magnitude and timing of hospitalizations and deaths and allocating resources geographically. %M 33406053 %R 10.2196/25538 %U http://publichealth.jmir.org/2021/1/e25538/ %U https://doi.org/10.2196/25538 %U http://www.ncbi.nlm.nih.gov/pubmed/33406053 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 1 %P e25830 %T SARS-CoV-2 Surveillance in the Middle East and North Africa: Longitudinal Trend Analysis %A Post,Lori %A Marogi,Emily %A Moss,Charles B %A Murphy,Robert Leo %A Ison,Michael G %A Achenbach,Chad J %A Resnick,Danielle %A Singh,Lauren %A White,Janine %A Boctor,Michael J %A Welch,Sarah B %A Oehmke,James Francis %+ Buehler Center for Health Policy and Economics, Feinberg School of Medicine, Northwestern University, 420 E Superior, Chicago, IL, 60611, United States, 1 203 980 7107, lori.post@northwestern.edu %K COVID-19 %K SARS-CoV-2 surveillance %K wave two %K second wave %K global COVID-19 surveillance %K MENA public health surveillance %K MENA COVID-19 %K Middle East and North Africa surveillance metrics %K dynamic panel data %K MENA econometrics %K MENA SARS-CoV-2 %K Middle East and North Africa COVID-19 surveillance system %K MENA COVID-19 transmission speed %K MENA COVID-19 transmission acceleration %K COVID-19 transmission deceleration %K COVID-19 transmission jerk %K COVID-19 7-day lag %K SARS-CoV-2 %K Arellano-Bond estimator %K generalized method of moments %K GMM %K Bahrain %K Iran %K Iraq %K Israel %K Jordan %K Kuwait %K Lebanon %K Oman %K Qatar %K Saudi Arabia %K Syria %K United Arab Emirates %K Yemen %K Algeria %K Djibouti %K Egypt %K Libya %K Morocco %K Tunisia %D 2021 %7 15.1.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic has disrupted the lives of millions and forced countries to devise public health policies to reduce the pace of transmission. In the Middle East and North Africa (MENA), falling oil prices, disparities in wealth and public health infrastructure, and large refugee populations have significantly increased the disease burden of COVID-19. In light of these exacerbating factors, public health surveillance is particularly necessary to help leaders understand and implement effective disease control policies to reduce SARS-CoV-2 persistence and transmission. Objective: The goal of this study is to provide advanced surveillance metrics, in combination with traditional surveillance, for COVID-19 transmission that account for weekly shifts in the pandemic speed, acceleration, jerk, and persistence to better understand a country’s risk for explosive growth and to better inform those who are managing the pandemic. Existing surveillance coupled with our dynamic metrics of transmission will inform health policy to control the COVID-19 pandemic until an effective vaccine is developed. Methods: Using a longitudinal trend analysis study design, we extracted 30 days of COVID-19 data from public health registries. We used an empirical difference equation to measure the daily number of cases in MENA as a function of the prior number of cases, the level of testing, and weekly shift variables based on a dynamic panel data model that was estimated using the generalized method of moments approach by implementing the Arellano-Bond estimator in R. Results: The regression Wald statistic was significant (χ25=859.5, P<.001). The Sargan test was not significant, failing to reject the validity of overidentifying restrictions (χ2294=16, P=.99). Countries with the highest cumulative caseload of the novel coronavirus include Iran, Iraq, Saudi Arabia, and Israel with 530,380, 426,634, 342,202, and 303,109 cases, respectively. Many of the smaller countries in MENA have higher infection rates than those countries with the highest caseloads. Oman has 33.3 new infections per 100,000 population while Bahrain has 12.1, Libya has 14, and Lebanon has 14.6 per 100,000 people. In order of largest to smallest number of cumulative deaths since January 2020, Iran, Iraq, Egypt, and Saudi Arabia have 30,375, 10,254, 6120, and 5185, respectively. Israel, Bahrain, Lebanon, and Oman had the highest rates of COVID-19 persistence, which is the number of new infections statistically related to new infections in the prior week. Bahrain had positive speed, acceleration, and jerk, signaling the potential for explosive growth. Conclusions: Static and dynamic public health surveillance metrics provide a more complete picture of pandemic progression across countries in MENA. Static measures capture data at a given point in time such as infection rates and death rates. By including speed, acceleration, jerk, and 7-day persistence, public health officials may design policies with an eye to the future. Iran, Iraq, Saudi Arabia, and Israel all demonstrated the highest rate of infections, acceleration, jerk, and 7-day persistence, prompting public health leaders to increase prevention efforts. %M 33302252 %R 10.2196/25830 %U http://www.jmir.org/2021/1/e25830/ %U https://doi.org/10.2196/25830 %U http://www.ncbi.nlm.nih.gov/pubmed/33302252 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 1 %P e23594 %T Asynchronous Distance Learning of the National Institutes of Health Stroke Scale During the COVID-19 Pandemic (E-Learning vs Video): Randomized Controlled Trial %A Suppan,Mélanie %A Stuby,Loric %A Carrera,Emmanuel %A Cottet,Philippe %A Koka,Avinash %A Assal,Frédéric %A Savoldelli,Georges Louis %A Suppan,Laurent %+ Division of Emergency Medicine, Department of Anaesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals and Faculty of Medicine, Rue Gabrielle-Perret-Gentil 4, Geneva, 1211, Switzerland, 41 795532579, laurent.suppan@hcuge.ch %K stroke %K COVID-19 %K e-learning %K medical student %K medical education %K online learning %K randomized controlled trial %K video %D 2021 %7 15.1.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic has considerably altered the regular medical education curriculum while increasing the need for health care professionals. Senior medical students are being incrementally deployed to the front line to address the shortage of certified physicians. These students, some of whom will be fast-tracked as physicians, may lack knowledge regarding the initial management of time-critical emergencies such as stroke. Objective: Our aim was to determine whether an e-learning module could improve asynchronous distance knowledge acquisition of the National Institutes of Health Stroke Scale (NIHSS) in senior medical students compared to the traditional didactic video. Methods: A randomized, data analyst–blinded web-based trial was conducted at the University of Geneva Faculty of Medicine between April and June 2020. Fifth year medical students followed a distance learning path designed to teach the NIHSS. The control group followed the traditional didactic video created by Patrick Lyden, while the e-learning group followed the updated version of a previously tested, highly interactive e-learning module. The main outcome was the score on a 50-question quiz displayed upon completion of the learning material. The difference in the proportion of correct answers for each specific NIHSS item was also assessed. Results: Out of 158 potential participants, 88 started their allocated learning path and 75 completed the trial. Participants who followed the e-learning module performed better than those who followed the video (38 correct answers, 95% CI 37-39, vs 35 correct answers, 95% CI 34-36, P<.001). Participants in the e-learning group scored better on five elements than the video group: key NIHSS concepts (P=.02), the consciousness – global item (P<.001), the facial palsy item (P=.04), the ataxia item (P=.03), and the sensory item (P=.04). Conclusions: Compared to the traditional didactic video, a highly interactive e-learning module enhances asynchronous distance learning and NIHSS knowledge acquisition in senior medical students. %M 33428581 %R 10.2196/23594 %U http://www.jmir.org/2021/1/e23594/ %U https://doi.org/10.2196/23594 %U http://www.ncbi.nlm.nih.gov/pubmed/33428581 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 1 %P e24097 %T Digital Health Literacy and Web-Based Information-Seeking Behaviors of University Students in Germany During the COVID-19 Pandemic: Cross-sectional Survey Study %A Dadaczynski,Kevin %A Okan,Orkan %A Messer,Melanie %A Leung,Angela Y M %A Rosário,Rafaela %A Darlington,Emily %A Rathmann,Katharina %+ Department of Nursing and Health Sciences, Fulda University of Applied Sciences, Leipziger Sraße 123, Fulda, 36037, Germany, 49 661 9640 6073, kevin.dadaczynski@pg.hs-fulda.de %K digital health %K literacy %K infodemic %K health information %K behaviour %K coronavirus %K COVID-19 %K university student %K student %K infodemiology %D 2021 %7 15.1.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Digital communication technologies are playing an important role in the health communication strategies of governments and public health authorities during the COVID-19 pandemic. The internet and social media have become important sources of health-related information on COVID-19 and on protective behaviors. In addition, the COVID-19 infodemic is spreading faster than the coronavirus itself, which interferes with governmental health-related communication efforts. This jeopardizes national public health containment strategies. Therefore, digital health literacy is a key competence to navigate web-based COVID-19–related information and service environments. Objective: This study aimed to investigate university students’ digital health literacy and web-based information-seeking behaviors during the early stages of the COVID-19 pandemic in Germany. Methods: A cross-sectional study among 14,916 university students aged ≥18 years from 130 universities across all 16 federal states of Germany was conducted using a web-based survey. Along with sociodemographic characteristics (sex, age, subjective social status), the measures included five subscales from the Digital Health Literacy Instrument (DHLI), which was adapted to the specific context of the COVID-19 pandemic. Web-based information-seeking behavior was investigated by examining the web-based sources used by university students and the topics that the students searched for in connection with COVID-19. Data were analyzed using univariate and bivariate analyses. Results: Across digital health literacy dimensions, the greatest difficulties could be found for assessing the reliability of health-related information (5964/14,103, 42.3%) and the ability to determine whether the information was written with a commercial interest (5489/14,097, 38.9%). Moreover, the respondents indicated that they most frequently have problems finding the information they are looking for (4282/14,098, 30.4%). When stratified according to sociodemographic characteristics, significant differences were found, with female university students reporting a lower DHLI for the dimensions of “information searching” and “evaluating reliability.” Search engines, news portals, and websites of public bodies were most often used by the respondents as sources to search for information on COVID-19 and related issues. Female students were found to use social media and health portals more frequently, while male students used Wikipedia and other web-based encyclopedias as well as YouTube more often. The use of social media was associated with a low ability to critically evaluate information, while the opposite was observed for the use of public websites. Conclusions: Although digital health literacy is well developed in university students, a significant proportion of students still face difficulties with certain abilities to evaluate information. There is a need to strengthen the digital health literacy capacities of university students using tailored interventions. Improving the quality of health-related information on the internet is also key. %M 33395396 %R 10.2196/24097 %U http://www.jmir.org/2021/1/e24097/ %U https://doi.org/10.2196/24097 %U http://www.ncbi.nlm.nih.gov/pubmed/33395396 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 1 %P e23190 %T Mobile App–Based Remote Patient Monitoring in Acute Medical Conditions: Prospective Feasibility Study Exploring Digital Health Solutions on Clinical Workload During the COVID Crisis %A Shah,Sachin Shailendra %A Gvozdanovic,Andrew %A Knight,Matthew %A Gagnon,Julien %+ Huma Therapeutics, 13th Floor Millbank Tower, 21-24 Millbank, London, SW1P 4QP, United Kingdom, 44 7875210783, sachsshah@gmail.com %K mHealth %K remote patient monitoring %K digital health %K COVID-19 %K service improvement %K cost-effectiveness %K monitoring %D 2021 %7 15.1.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital remote patient monitoring can add value to virtual wards; this has become more apparent in the context of the COVID-19 pandemic. Health care providers are overwhelmed, resulting in clinical teams spread more thinly. We aimed to assess the impact of introducing an app-based remote patient monitoring system (Huma Therapeutics) on a clinician’s workload in the context of a COVID-19–specific virtual ward. Objective: This prospective feasibility study aimed to evaluate the health economic effects (in terms of clinical workload) of a mobile app on a telephone-based virtual ward used in the monitoring of patients with COVID-19 who are clinically ready for discharge from the hospital. Methods: A prospective feasibility study was carried out over 1 month where clinician workload was monitored, and full-time equivalents savings were determined. An NHS hospital repurposed a telephone-based respiratory virtual ward for COVID-19. Patients with COVID-19 in the amber zone (according to the National Health Service definition) were monitored for 14 days postdischarge to help identify deteriorating patients earlier. A smartphone-based app was introduced to monitor data points submitted by the patients via communication over telephone calls. We then comparatively evaluated the clinical workload between patients monitored by telephone only (cohort 1) with those monitored via mobile app and telephone (cohort 2). Results: In all, 56 patients were enrolled in the app-based virtual ward (cohort 2). Digital remote patient monitoring resulted in a reduction in the number of phone calls from a mean total of 9 calls to 4 calls over the monitoring period. There was no change in the mean duration of phone calls (8.5 minutes) and no reports of readmission or mortality. These results equate to a mean saving of 47.60 working hours. Moreover, it translates to 3.30 fewer full-time equivalents (raw phone call data), resulting in 1.1 fewer full-time equivalents required to monitor 100 patients when adjusted for time spent reviewing app data. Individual clinicians spent an average of 10.9 minutes per day reviewing data. Conclusions: Smartphone-based remote patient monitoring technologies may offer tangible reductions in clinician workload at a time when service is severely strained. In this small-scale pilot study, we demonstrated the economic and operational impact that digital remote patient monitoring technology can have in improving working efficiency and reducing operational costs. Although this particular RPM solution was deployed for the COVID-19 pandemic, it may set a precedent for wider utilization of digital, remote patient monitoring solutions in other clinical scenarios where increased care delivery efficiency is sought. %M 33400675 %R 10.2196/23190 %U http://formative.jmir.org/2021/1/e23190/ %U https://doi.org/10.2196/23190 %U http://www.ncbi.nlm.nih.gov/pubmed/33400675 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 1 %P e24220 %T YouTube Videos Demonstrating the Nasopharyngeal Swab Technique for SARS-CoV-2 Specimen Collection: Content Analysis %A Itamura,Kyohei %A Wu,Arthur %A Illing,Elisa %A Ting,Jonathan %A Higgins,Thomas %+ Department of Otolaryngology - Head and Neck Surgery and Communicative Disorders, University of Louisville, 6420 Dutchman's Parkway, STE 380, Louisville, KY, 40205, United States, 1 502 894 8441, thomas.higgins@louisville.edu %K COVID-19 %K coronavirus %K SARS-coV-2 %K nasopharyngeal swab %K viral testing %K PCR %K YouTube %K infodemiology %K digital epidemiology %K testing %K diagnostic %K content analysis %K video %K error %D 2021 %7 14.1.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Real-time polymerase chain reaction using nasopharyngeal swabs is currently the most widely used diagnostic test for SARS-CoV-2 detection. However, false negatives and the sensitivity of this mode of testing have posed challenges in the accurate estimation of the prevalence of SARS-CoV-2 infection rates. Objective: The purpose of this study was to evaluate whether technical and, therefore, correctable errors were being made with regard to nasopharyngeal swab procedures. Methods: We searched a web-based video database (YouTube) for videos demonstrating SARS-CoV-2 nasopharyngeal swab tests, posted from January 1 to May 15, 2020. Videos were rated by 3 blinded rhinologists for accuracy of swab angle and depth. The overall score for swab angle and swab depth for each nasopharyngeal swab demonstration video was determined based on the majority score with agreement between at least 2 of the 3 reviewers. We then comparatively evaluated video data collected from YouTube videos demonstrating the correct nasopharyngeal swab technique with data from videos demonstrating an incorrect nasopharyngeal swab technique. Multiple linear regression analysis with statistical significance set at P=.05 was performed to determine video data variables associated with the correct nasopharyngeal swab technique. Results: In all, 126 videos met the study inclusion and exclusion criteria. Of these, 52.3% (66/126) of all videos demonstrated the correct swab angle, and 46% (58/126) of the videos demonstrated an appropriate swab depth. Moreover, 45.2% (57/126) of the videos demonstrated both correct nasopharyngeal swab angle and appropriate depth, whereas 46.8% (59/126) of the videos demonstrated both incorrect nasopharyngeal swab angle and inappropriate depth. Videos with correct nasopharyngeal swab technique were associated with the swab operators identifying themselves as a medical professional or as an Ear, Nose, Throat–related medical professional. We also found an association between correct nasopharyngeal swab techniques and recency of video publication date (relative to May 15, 2020). Conclusions: Our findings show that over half of the videos documenting the nasopharyngeal swab test showed an incorrect technique, which could elevate false-negative test rates. Therefore, greater attention needs to be provided toward educating frontline health care workers who routinely perform nasopharyngeal swab procedures. %M 33406478 %R 10.2196/24220 %U http://publichealth.jmir.org/2021/1/e24220/ %U https://doi.org/10.2196/24220 %U http://www.ncbi.nlm.nih.gov/pubmed/33406478 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 10 %N 1 %P e23443 %T COVID-19 #StayAtHome Restrictions and Deep Vein Thrombosis: Case Report %A Blum,Edna %A Abdelwahed,Youssef S %A Spiess,Eileen %A Mueller-Werdan,Ursula %A Leistner,David M %A Rosada,Adrian %+ Department of Geriatrics, Charité Universitätsmedizin Berlin, Hindenburgdamm 30, Berlin, , Germany, 49 30450514494, adrian.rosada@charite.de %K thrombosis %K public health %K social distancing %K physical inactivity %K pandemic management %K COVID-19 %K case study %K vein %K adverse effect %K physical activity %D 2021 %7 14.1.2021 %9 Short Paper %J Interact J Med Res %G English %X Background: The COVID-19 pandemic triggered countermeasures like #StayAtHome initiatives, which have changed the whole world. Despite the success of such initiatives in limiting the spread of COVID-19 to #FlattenTheCurve, physicians are now confronted with the adverse effects of the current restrictive pandemic management strategies and social distancing measures. Objective: We aim to draw attention to the particular importance and magnitude of what may be the adverse effects of COVID-19–related policies. Methods: We herein report a case of an otherwise healthy 84-year-old woman with deep vein thrombosis (DVT) due to COVID-19–related directives. #StayAtHome policies and consequential social isolation have diminished our patient’s social life and reduced her healthy movement behaviors. The patient spent long hours in a seated position while focusing on the intensive flow of media information regarding the pandemic. Results: Reduced mobility due to preventive social isolation during the COVID-19 pandemic was the only identified cause of the DVT. Conclusions: While evaluating the effect of the COVID-19 pandemic and governmentally implemented containment measures, including social isolation and mobility reduction, adverse events should be considered. Digital approaches might play a crucial role in supporting public health. %M 33400676 %R 10.2196/23443 %U http://www.i-jmr.org/2021/1/e23443/ %U https://doi.org/10.2196/23443 %U http://www.ncbi.nlm.nih.gov/pubmed/33400676 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 1 %P e21408 %T Retracted: "Assessing the Dissemination of COVID-19 Articles Across Social Media With Altmetric and PlumX Metrics: Correlational Study" %A Tornberg,Haley N %A Moezinia,Carine %A Wei,Chapman %A Bernstein,Simone A %A Wei,Chaplin %A Al-Beyati,Refka %A Quan,Theodore %A Diemert,David J %+ Department of Medicine, David Geffen School of Medicine at University of California, 10833 Le Conte Ave, Los Angeles, CA, United States, 1 3133102931, Ralbeyat@gmail.com %K Altmetric %K PlumX %K social media %K impact factor %K COVID-19 %K information %K dissemination %K citation %D 2021 %7 14.1.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The use of social media assists in the distribution of COVID-19 information to the general public and health professionals. Alternative-level metrics (ie, altmetrics) and PlumX metrics are new bibliometrics that can assess how many times a scientific article has been shared and how much a scientific article has spread within social media platforms. Objective: Our objective was to characterize and compare the traditional bibliometrics (ie, citation count and impact factors) and new bibliometrics (ie, Altmetric Attention Score [AAS] and PlumX score) of the top 100 COVID-19 articles with the highest AASs. Methods: The top 100 articles with highest AASs were identified with Altmetric Explorer in May 2020. The AASs, journal names, and the number of mentions in various social media databases of each article were collected. Citation counts and PlumX Field-Weighted Citation Impact scores were collected from the Scopus database. Additionally, AASs, PlumX scores, and citation counts were log-transformed and adjusted by +1 for linear regression, and Spearman correlation coefficients were used to determine correlations. Results: The median AAS, PlumX score, and citation count were 4922.50, 37.92, and 24.00, respectively. The New England Journal of Medicine published the most articles (18/100, 18%). The highest number of mentions (985,429/1,022,975, 96.3%) were found on Twitter, making it the most frequently used social media platform. A positive correlation was observed between AAS and citation count (r2=0.0973; P=.002), and between PlumX score and citation count (r2=0.8911; P<.001). Conclusions: Our study demonstrated that citation count weakly correlated with AASs and strongly correlated with PlumX scores, with regard to COVID-19 articles at this point in time. Altmetric and PlumX metrics should be used to complement traditional citation counts when assessing the dissemination and impact of a COVID-19 article. %M 33406049 %R 10.2196/21408 %U http://www.jmir.org/2021/1/e21408/ %U https://doi.org/10.2196/21408 %U http://www.ncbi.nlm.nih.gov/pubmed/33406049 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 1 %P e23592 %T A Text Messaging Intervention for Coping With Social Distancing During COVID-19 (StayWell at Home): Protocol for a Randomized Controlled Trial %A Figueroa,Caroline Astrid %A Hernandez-Ramos,Rosa %A Boone,Claire Elizabeth %A Gómez-Pathak,Laura %A Yip,Vivian %A Luo,Tiffany %A Sierra,Valentín %A Xu,Jing %A Chakraborty,Bibhas %A Darrow,Sabrina %A Aguilera,Adrian %+ School of Social Welfare, University of California Berkeley, 105 Havilland Hall, Berkeley, CA, 94709, United States, 1 5106436669, c.a.figueroa@berkeley.edu %K COVID-19 %K mental health %K depression %K reinforcement learning %K microrandomized trial %D 2021 %7 14.1.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Social distancing is a crucial intervention to slow down person-to-person transmission of COVID-19. However, social distancing has negative consequences, including increases in depression and anxiety. Digital interventions, such as text messaging, can provide accessible support on a population-wide scale. We developed text messages in English and Spanish to help individuals manage their depressive mood and anxiety during the COVID-19 pandemic. Objective: In a two-arm randomized controlled trial, we aim to examine the effect of our 60-day text messaging intervention. Additionally, we aim to assess whether the use of machine learning to adapt the messaging frequency and content improves the effectiveness of the intervention. Finally, we will examine the differences in daily mood ratings between the message categories and time windows. Methods: The messages were designed within two different categories: behavioral activation and coping skills. Participants will be randomized into (1) a random messaging arm, where message category and timing will be chosen with equal probabilities, and (2) a reinforcement learning arm, with a learned decision mechanism for choosing the messages. Participants in both arms will receive one message per day within three different time windows and will be asked to provide their mood rating 3 hours later. We will compare self-reported daily mood ratings; self-reported depression, using the 8-item Patient Health Questionnaire; and self-reported anxiety, using the 7-item Generalized Anxiety Disorder scale at baseline and at intervention completion. Results: The Committee for the Protection of Human Subjects at the University of California Berkeley approved this study in April 2020 (No. 2020-04-13162). Data collection began in April 2020 and will run to April 2021. As of August 24, 2020, we have enrolled 229 participants. We plan to submit manuscripts describing the main results of the trial and results from the microrandomized trial for publication in peer-reviewed journals and for presentations at national and international scientific meetings. Conclusions: Results will contribute to our knowledge of effective psychological tools to alleviate the negative effects of social distancing and the benefit of using machine learning to personalize digital mental health interventions. Trial Registration: ClinicalTrials.gov NCT04473599; https://clinicaltrials.gov/ct2/show/NCT04473599 International Registered Report Identifier (IRRID): DERR1-10.2196/23592 %M 33370721 %R 10.2196/23592 %U http://www.researchprotocols.org/2021/1/e23592/ %U https://doi.org/10.2196/23592 %U http://www.ncbi.nlm.nih.gov/pubmed/33370721 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 1 %P e25507 %T Building Health Services in a Rapidly Changing Landscape: Lessons in Adaptive Leadership and Pivots in a COVID-19 Remote Monitoring Program %A Laur,Celia Violet %A Agarwal,Payal %A Mukerji,Geetha %A Goulbourne,Elaine %A Baranek,Hayley %A Pus,Laura %A Bhatia,R Sacha %A Martin,Danielle %A Bhattacharyya,Onil %+ Women's College Hospital Institute for Health System Solutions and Virtual Care, 76 Grenville Street, Toronto, ON, M5S 1B2, Canada, 1 (416) 323 6400, onil.bhattacharyya@wchospital.ca %K adaptive leadership %K pivots %K acute care %K COVID-19 %K leadership %K remote monitoring %K monitoring %K health service %K framework %D 2021 %7 13.1.2021 %9 Viewpoint %J J Med Internet Res %G English %X Adaptive leadership has become an essential skill for leaders in health systems to respond to the COVID-19 pandemic as new knowledge emerges and case counts rise, fall, and rise again. This leadership approach has been described as an iterative process of taking a wide view of the situation, interpreting the meaning of incoming data from multiple directions, and taking real-time action. This process is also common in start-ups, which attempt to create new products or services of uncertain value for consumer markets that may not yet exist. Start-ups manage uncertainty through “pivots,” which can include changes in the target group, need, features, or intended benefit of a product or service. Pivots are large changes that account for the high likelihood of getting something wrong during development, and they are distinct from the “tweaks” or small tests of change that define quality improvement methodology. This case study describes three pivots in the launch of a remote monitoring program for COVID-19. Adaptive leadership helped inform strategic decisions, with pivots providing a framework for internal and external stakeholders to articulate options for changes to address shifting needs. There is considerable uncertainty in the appropriate design and implementation of health services, and although this case example focuses on the use of adaptive leadership and pivots during a pandemic, these strategies are relevant for health care leaders at any time. %M 33417588 %R 10.2196/25507 %U http://www.jmir.org/2021/1/e25507/ %U https://doi.org/10.2196/25507 %U http://www.ncbi.nlm.nih.gov/pubmed/33417588 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 1 %P e22794 %T The Association Between Chronic Disease and Serious COVID-19 Outcomes and Its Influence on Risk Perception: Survey Study and Database Analysis %A Laires,Pedro Almeida %A Dias,Sónia %A Gama,Ana %A Moniz,Marta %A Pedro,Ana R %A Soares,Patricia %A Aguiar,Pedro %A Nunes,Carla %+ Public Health Research Centre, NOVA National School of Public Health, Universidade NOVA de Lisboa, Av Padre Cruz, Lisbon, Portugal, 351 919783234, pedro.laires@ensp.unl.pt %K COVID-19 %K risk factors %K morbidity %K chronic disease %K risk %K perception %K outcome %K association %D 2021 %7 12.1.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: COVID-19, a viral respiratory disease first reported in December 2019, quickly became a threat to global public health. Further understanding of the epidemiology of the SARS-CoV-2 virus and the risk perception of the community may better inform targeted interventions to reduce the impact and spread of COVID-19. Objective: In this study, we aimed to examine the association between chronic diseases and serious outcomes following COVID-19 infection, and to explore its influence on people’s self-perception of risk for worse COVID-19 outcomes. Methods: This study draws data from two databases: (1) the nationwide database of all confirmed COVID-19 cases in Portugal, extracted on April 28, 2020 (n=20,293); and (2) the community-based COVID-19 Barometer survey, which contains data on health status, perceptions, and behaviors during the first wave of COVID-19 (n=171,087). We assessed the association between relevant chronic diseases (ie, respiratory, cardiovascular, and renal diseases; diabetes; and cancer) and death and intensive care unit (ICU) admission following COVID-19 infection. We identified determinants of self-perception of risk for severe COVID-19 outcomes using logistic regression models. Results: Respiratory, cardiovascular, and renal diseases were associated with mortality and ICU admission among patients hospitalized due to COVID-19 infection (odds ratio [OR] 1.48, 95% CI 1.11-1.98; OR 3.39, 95% CI 1.80-6.40; and OR 2.25, 95% CI 1.66-3.06, respectively). Diabetes and cancer were associated with serious outcomes only when considering the full sample of COVID-19–infected cases in the country (OR 1.30, 95% CI 1.03-1.64; and OR 1.40, 95% CI 1.03-1.89, respectively). Older age and male sex were both associated with mortality and ICU admission. The perception of risk for severe COVID-19 disease in the study population was 23.9% (n=40,890). This was markedly higher for older adults (n=5235, 46.4%), those with at least one chronic disease (n=17,647, 51.6%), or those in both of these categories (n=3212, 67.7%). All included diseases were associated with self-perceptions of high risk in this population. Conclusions: Our results demonstrate the association between some prevalent chronic diseases and increased risk of worse COVID-19 outcomes. It also brings forth a greater understanding of the community’s risk perceptions of serious COVID-19 disease. Hence, this study may aid health authorities to better adapt measures to the real needs of the population and to identify vulnerable individuals requiring further education and awareness of preventive measures. %M 33433397 %R 10.2196/22794 %U http://publichealth.jmir.org/2021/1/e22794/ %U https://doi.org/10.2196/22794 %U http://www.ncbi.nlm.nih.gov/pubmed/33433397 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 1 %P e24069 %T Investigating and Improving the Accuracy of US Citizens’ Beliefs About the COVID-19 Pandemic: Longitudinal Survey Study %A van Stekelenburg,Aart %A Schaap,Gabi %A Veling,Harm %A Buijzen,Moniek %+ Behavioural Science Institute, Radboud University, Montessorilaan 3, Nijmegen, 6525 HR, Netherlands, 31 024 3615723, a.vanstekelenburg@bsi.ru.nl %K infodemic %K infodemiology %K misinformation %K COVID-19 pandemic %K belief accuracy %K boosting %K trust in scientists %K political orientation %K media use %D 2021 %7 12.1.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 infodemic, a surge of information and misinformation, has sparked worry about the public’s perception of the coronavirus pandemic. Excessive information and misinformation can lead to belief in false information as well as reduce the accurate interpretation of true information. Such incorrect beliefs about the COVID-19 pandemic might lead to behavior that puts people at risk of both contracting and spreading the virus. Objective: The objective of this study was two-fold. First, we attempted to gain insight into public beliefs about the novel coronavirus and COVID-19 in one of the worst hit countries: the United States. Second, we aimed to test whether a short intervention could improve people’s belief accuracy by empowering them to consider scientific consensus when evaluating claims related to the pandemic. Methods: We conducted a 4-week longitudinal study among US citizens, starting on April 27, 2020, just after daily COVID-19 deaths in the United States had peaked. Each week, we measured participants’ belief accuracy related to the coronavirus and COVID-19 by asking them to indicate to what extent they believed a number of true and false statements (split 50/50). Furthermore, each new survey wave included both the original statements and four new statements: two false and two true statements. Half of the participants were exposed to an intervention aimed at increasing belief accuracy. The intervention consisted of a short infographic that set out three steps to verify information by searching for and verifying a scientific consensus. Results: A total of 1202 US citizens, balanced regarding age, gender, and ethnicity to approximate the US general public, completed the baseline (T0) wave survey. Retention rate for the follow-up waves— first follow-up wave (T1), second follow-up wave (T2), and final wave (T3)—was high (≥85%). Mean scores of belief accuracy were high for all waves, with scores reflecting low belief in false statements and high belief in true statements; the belief accuracy scale ranged from –1, indicating completely inaccurate beliefs, to 1, indicating completely accurate beliefs (T0 mean 0.75, T1 mean 0.78, T2 mean 0.77, and T3 mean 0.75). Accurate beliefs were correlated with self-reported behavior aimed at preventing the coronavirus from spreading (eg, social distancing) (r at all waves was between 0.26 and 0.29 and all P values were less than .001) and were associated with trust in scientists (ie, higher trust was associated with more accurate beliefs), political orientation (ie, liberal, Democratic participants held more accurate beliefs than conservative, Republican participants), and the primary news source (ie, participants reporting CNN or Fox News as the main news source held less accurate beliefs than others). The intervention did not significantly improve belief accuracy. Conclusions: The supposed infodemic was not reflected in US citizens’ beliefs about the COVID-19 pandemic. Most people were quite able to figure out the facts in these relatively early days of the crisis, calling into question the prevalence of misinformation and the public’s susceptibility to misinformation. %M 33351776 %R 10.2196/24069 %U http://www.jmir.org/2021/1/e24069/ %U https://doi.org/10.2196/24069 %U http://www.ncbi.nlm.nih.gov/pubmed/33351776 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 1 %P e23699 %T The Effects of Downloading a Government-Issued COVID-19 Contact Tracing App on Psychological Distress During the Pandemic Among Employed Adults: Prospective Study %A Kawakami,Norito %A Sasaki,Natsu %A Kuroda,Reiko %A Tsuno,Kanami %A Imamura,Kotaro %+ Department of Mental Health, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 1130033, Japan, 81 358413521, nkawakami@m.u-tokyo.ac.jp %K coronavirus disease %K digital contact tracing %K mental health %K working population %K longitudinal study %K COVID-19 %K contact tracing %K surveillance %K tracking %K anxiety %K distress %D 2021 %7 12.1.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: Downloading a COVID-19 contact tracing app may be effective in reducing users’ worry about COVID-19 and psychological distress. Objective: This 2.5-month prospective study aimed to investigate the association of downloading a COVID-19 contact tracing app, the COVID-19 Contact Confirming Application (COCOA), released by the Japanese government, with worry about COVID-19 and psychological distress in a sample of employed adults in Japan. Methods: A total of 996 full-time employed respondents to an online survey conducted May 22-26, 2020 (baseline), were invited to participate in a follow-up survey August 7-12, 2020 (follow-up). A high level of worrying about COVID-19 and high psychological distress were defined by baseline and follow-up scores on a single-item scale and the Kessler 6 (K6) scale, respectively. The app was released between the two surveys, on June 17. Participants were asked at follow-up if they downloaded the app. Results: A total of 902 (90.6%) of 996 baseline participants responded to the follow-up survey. Among them, 184 (20.4%) reported that they downloaded the app. Downloading of the contact tracing app was significantly negatively associated with psychological distress at follow-up after controlling for baseline variables, but not with worry about COVID-19. Conclusions: This study provides the first evidence that using a government-issued COVID-19 contact tracing app may be beneficial for the mental health of employed adults during the COVID-19 pandemic. %M 33347424 %R 10.2196/23699 %U http://mental.jmir.org/2021/1/e23699/ %U https://doi.org/10.2196/23699 %U http://www.ncbi.nlm.nih.gov/pubmed/33347424 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 8 %N 1 %P e23232 %T Information Sources, Risk Perception, and Efficacy Appraisal’s Prediction of Engagement in Protective Behaviors Against COVID-19 in China: Repeated Cross-sectional Survey %A Rui,Jian Raymond %A Yang,Keqing %A Chen,Juan %+ College of Journalism and Communication, South China University of Technology, 382 Waihuan East Rd, Guangzhou, 510006, China, 86 17819720631, jckqyang@scut.edu.cn %K information source %K perceived severity %K perceived susceptibility %K response efficacy %K self-efficacy %K health information %K protective behavior %K COVID-19 %K protection %K behavior %K risk %K perception %K prediction %D 2021 %7 12.1.2021 %9 Original Paper %J JMIR Hum Factors %G English %X Background: As the COVID-19 pandemic has become a major public health threat worldwide, it is critical to understand what factors affect individual engagement in protective actions. Because of its authoritarian political system and state-owned media system, how Chinese individuals engaged in protective actions against COVID-19 might be different compared to other countries. Objective: The purpose of this study is to examine how the source of information about COVID-19, Chinese individuals’ risk perception of COVID-19 (ie, perceived severity and perceived susceptibility), and their efficacy appraisal in controlling COVID-19 (ie, response efficacy and self-efficacy) affected their engagement in protective actions. Additionally, this study aims to investigate whether there is any difference in these relationships throughout the duration of this pandemic. Methods: A six-wave repeated cross-sectional survey (N=1942) was conducted in six major cities in China between February 7 and April 23, 2020. Participants’ reliance on expert versus inexpert sources for information about COVID-19, their perceived severity of and susceptibility to COVID-19, their response efficacy and self-efficacy, and their engagement in protective actions (staying at home, wearing a face mask, and washing hands) were measured. Demographic variables (sex, age, income, education, and city of residence), knowledge of COVID-19, and self-rated health condition were controlled. Results: Reliance on expert sources did not become the major factor that motivated these actions until wave 3, and the negative effect of inexpert sources on these actions was limited to wave 2. Perceived severity encouraged some protective behaviors but its effect varied depending on the specific behavior. In addition, perceived severity exhibited a stronger effect on these behaviors compared to perceived susceptibility. The positive effect of response efficacy was only significant at waves 1 and 2, and limited to certain behaviors. Conclusions: Chinese individuals’ engagement in protective behaviors might not entirely be their autonomous decision but a result of compliance with executive orders. After the early outbreak, expert sources started to facilitate protective behaviors, suggesting that it might take time to develop trust in these sources. The facilitating effect of perceived severity lasted throughout the duration of the pandemic, but that of response efficacy was limited to the early stage. %M 33338027 %R 10.2196/23232 %U http://humanfactors.jmir.org/2021/1/e23232/ %U https://doi.org/10.2196/23232 %U http://www.ncbi.nlm.nih.gov/pubmed/33338027 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 9 %N 1 %P e23811 %T Role of Machine Learning Techniques to Tackle the COVID-19 Crisis: Systematic Review %A Syeda,Hafsa Bareen %A Syed,Mahanazuddin %A Sexton,Kevin Wayne %A Syed,Shorabuddin %A Begum,Salma %A Syed,Farhanuddin %A Prior,Fred %A Yu Jr,Feliciano %+ Department of Biomedical Informatics, University of Arkansas for Medical Sciences, 4301 W Markham #469, Little Rock, AR, 72205, United States, 1 5016131443, ssyed@uams.edu %K COVID-19 %K coronavirus %K SARS-CoV-2 %K artificial intelligence %K machine learning %K deep learning %K systematic review %K epidemiology %K pandemic %K neural network %D 2021 %7 11.1.2021 %9 Review %J JMIR Med Inform %G English %X Background: SARS-CoV-2, the novel coronavirus responsible for COVID-19, has caused havoc worldwide, with patients presenting a spectrum of complications that have pushed health care experts to explore new technological solutions and treatment plans. Artificial Intelligence (AI)–based technologies have played a substantial role in solving complex problems, and several organizations have been swift to adopt and customize these technologies in response to the challenges posed by the COVID-19 pandemic. Objective: The objective of this study was to conduct a systematic review of the literature on the role of AI as a comprehensive and decisive technology to fight the COVID-19 crisis in the fields of epidemiology, diagnosis, and disease progression. Methods: A systematic search of PubMed, Web of Science, and CINAHL databases was performed according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines to identify all potentially relevant studies published and made available online between December 1, 2019, and June 27, 2020. The search syntax was built using keywords specific to COVID-19 and AI. Results: The search strategy resulted in 419 articles published and made available online during the aforementioned period. Of these, 130 publications were selected for further analyses. These publications were classified into 3 themes based on AI applications employed to combat the COVID-19 crisis: Computational Epidemiology, Early Detection and Diagnosis, and Disease Progression. Of the 130 studies, 71 (54.6%) focused on predicting the COVID-19 outbreak, the impact of containment policies, and potential drug discoveries, which were classified under the Computational Epidemiology theme. Next, 40 of 130 (30.8%) studies that applied AI techniques to detect COVID-19 by using patients’ radiological images or laboratory test results were classified under the Early Detection and Diagnosis theme. Finally, 19 of the 130 studies (14.6%) that focused on predicting disease progression, outcomes (ie, recovery and mortality), length of hospital stay, and number of days spent in the intensive care unit for patients with COVID-19 were classified under the Disease Progression theme. Conclusions: In this systematic review, we assembled studies in the current COVID-19 literature that utilized AI-based methods to provide insights into different COVID-19 themes. Our findings highlight important variables, data types, and available COVID-19 resources that can assist in facilitating clinical and translational research. %M 33326405 %R 10.2196/23811 %U http://medinform.jmir.org/2021/1/e23811/ %U https://doi.org/10.2196/23811 %U http://www.ncbi.nlm.nih.gov/pubmed/33326405 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 1 %P e24320 %T Jobs, Housing, and Mask Wearing: Cross-Sectional Study of Risk Factors for COVID-19 %A van den Broek-Altenburg,Eline M %A Atherly,Adam J %A Diehl,Sean A %A Gleason,Kelsey M %A Hart,Victoria C %A MacLean,Charles D %A Barkhuff,Daniel A %A Levine,Mark A %A Carney,Jan K %+ Department of Radiology, Larner College of Medicine, University of Vermont, 89 Beaumont Avenue, Burlington, VT, 05405, United States, 1 8024613951, eline.altenburg@med.uvm.edu %K COVID-19 %K risk of infection %K community exposure %K self-protecting behavior %K mask wearing %K infection fatality rate %K infection %K self-protecting %K mask %K fatality rate %K exposure %K virus %K SARS-CoV-2 %D 2021 %7 11.1.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Many studies have focused on the characteristics of symptomatic patients with COVID-19 and clinical risk factors. This study reports the prevalence of COVID-19 in an asymptomatic population of a hospital service area (HSA) and identifies factors that affect exposure to the virus. Objective: The aim of this study is to measure the prevalence of COVID-19 in an HSA, identify factors that may increase or decrease the risk of infection, and analyze factors that increase the number of daily contacts. Methods: This study surveyed 1694 patients between April 30 and May 13, 2020, about their work and living situations, income, behavior, sociodemographic characteristics, and prepandemic health characteristics. This data was linked to testing data for 454 of these patients, including polymerase chain reaction test results and two different serologic assays. Positivity rate was used to calculate approximate prevalence, hospitalization rate, and infection fatality rate (IFR). Survey data was used to analyze risk factors, including the number of contacts reported by study participants. The data was also used to identify factors increasing the number of daily contacts, such as mask wearing and living environment. Results: We found a positivity rate of 2.2%, a hospitalization rate of 1.2%, and an adjusted IFR of 0.55%. A higher number of daily contacts with adults and older adults increases the probability of becoming infected. Occupation, living in an apartment versus a house, and wearing a face mask outside work increased the number of daily contacts. Conclusions: Studying prevalence in an asymptomatic population revealed estimates of unreported COVID-19 cases. Occupational, living situation, and behavioral data about COVID-19–protective behaviors such as wearing a mask may aid in the identification of nonclinical factors affecting the number of daily contacts, which may increase SARS-CoV-2 exposure. %M 33315576 %R 10.2196/24320 %U http://publichealth.jmir.org/2021/1/e24320/ %U https://doi.org/10.2196/24320 %U http://www.ncbi.nlm.nih.gov/pubmed/33315576 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 1 %P e21327 %T Implementation of Telemedicine in a Tertiary Hospital–Based Ambulatory Practice in Detroit During the COVID-19 Pandemic: Observational Study %A Garg,Alpana %A Goyal,Sachin %A Thati,Rohit %A Thati,Neelima %+ Wayne State University, University Health Center, 4201 St. Antoine, Detroit, MI, 48201, United States, 1 708 501 2938, alpanagarg24@yahoo.com %K telemedicine %K telehealth %K COVID-19 %K Detroit %K ambulatory care %K primary care %K internal medicine %K pandemic %D 2021 %7 8.1.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The COVID-19 pandemic, caused by SARS-CoV-2, has forced the health care delivery structure to change rapidly. The pandemic has further widened the disparities in health care and exposed vulnerable populations. Health care services caring for such populations must not only continue to operate but create innovative methods of care delivery without compromising safety. We present our experience of incorporating telemedicine in our university hospital–based outpatient clinic in one of the worst-hit areas in the world. Objective: Our goal is to assess the adoption of a telemedicine service in the first month of its implementation in outpatient practice during the COVID-19 pandemic. We also want to assess the need for transitioning to telemedicine, the benefits and challenges in doing so, and ongoing solutions during the initial phase of the implementation of telemedicine services for our patients. Methods: We conducted a prospective review of clinic operations data from the first month of a telemedicine rollout in the outpatient adult ambulatory clinic from April 1, 2020, to April 30, 2020. A telemedicine visit was defined as synchronous audio-video communication between the provider and patient for clinical care longer than 5 minutes or if the video visit converted to a telephone visit after 5 minutes due to technical problems. We recorded the number of telemedicine visits scheduled, visits completed, and the time for each visit. We also noted the most frequent billing codes used based on the time spent in the patient care and the number of clinical tasks (eg, activity suggested through diagnosis or procedural code) that were addressed remotely by the physicians. Results: During the study period, we had 110 telemedicine visits scheduled, of which 94 (85.4%) visits were completed. The average duration of the video visit was 35 minutes, with the most prolonged visit lasting 120 minutes. Of 94 patients, 24 (25.54%) patients were recently discharged from the hospital, and 70 (74.46%) patients were seen for urgent care needs. There was a 50% increase from the baseline in the number of clinical tasks that were addressed by the physicians during the pandemic. Conclusions: There was a high acceptance of telemedicine services by the patients, which was evident by a high show rate during the COVID-19 pandemic in Detroit. With limited staffing, restricted outpatient work hours, a shortage of providers, and increased outpatient needs, telemedicine was successfully implemented in our practice. %M 33400680 %R 10.2196/21327 %U http://publichealth.jmir.org/2021/1/e21327/ %U https://doi.org/10.2196/21327 %U http://www.ncbi.nlm.nih.gov/pubmed/33400680 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 9 %N 1 %P e25435 %T Using an Extended Technology Acceptance Model to Understand the Factors Influencing Telehealth Utilization After Flattening the COVID-19 Curve in South Korea: Cross-sectional Survey Study %A An,Min Ho %A You,Seng Chan %A Park,Rae Woong %A Lee,Seongwon %+ Department of Biomedical Informatics, Ajou University School of Medicine, 164, World cup-ro, Yeongtong-gu, Suwon, 16499, Republic of Korea, 82 31 219 4471, seongwon.lee.16@gmail.com %K telemedicine %K telehealth %K COVID-19 %K pandemic %K model %K South Korea %K acceptance %K anxiety %K cross-sectional %D 2021 %7 8.1.2021 %9 Original Paper %J JMIR Med Inform %G English %X Background: Although telehealth is considered a key component in combating the worldwide crisis caused by COVID-19, the factors that influence its acceptance by the general population after the flattening of the COVID-19 curve remain unclear. Objective: We aimed to identify factors affecting telehealth acceptance, including anxiety related to COVID-19, after the initial rapid spread of the disease in South Korea. Methods: We proposed an extended technology acceptance model (TAM) and performed a cross-sectional survey of individuals aged ≥30 years. In total, 471 usable responses were collected. Confirmatory factor analysis was used to examine the validity of measurements, and the partial least squares (PLS) method was used to investigate factors influencing telehealth acceptance and the impacts of COVID-19. Results: PLS analysis showed that increased accessibility, enhanced care, and ease of telehealth use had positive effects on its perceived usefulness (P=.002, P<.001, and P<.001, respectively). Furthermore, perceived usefulness, ease, and privacy/discomfort significantly impacted the acceptance of telehealth (P<.001, P<.001, and P<.001, respectively). However, anxiety toward COVID-19 was not associated with telehealth acceptance (P=.112), and this insignificant relationship was consistent in the cluster (n=216, 46%) of respondents with chronic diseases (P=.185). Conclusions: Increased accessibility, enhanced care, usefulness, ease of use, and privacy/discomfort are decisive variables affecting telehealth acceptance in the Korean general population, whereas anxiety about COVID-19 is not. This study may lead to a tailored promotion of telehealth after the pandemic subsides. %M 33395397 %R 10.2196/25435 %U http://medinform.jmir.org/2021/1/e25435/ %U https://doi.org/10.2196/25435 %U http://www.ncbi.nlm.nih.gov/pubmed/33395397 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 1 %P e23000 %T Attitudes and Perceptions Toward COVID-19 Digital Surveillance: Survey of Young Adults in the United States %A Maytin,Lauren %A Maytin,Jason %A Agarwal,Priya %A Krenitsky,Anna %A Krenitsky,JoAnn %A Epstein,Robert S %+ Epstein Health LLC, 50 Tice Blvd, Suite 340, Woodcliff Lake, NJ, 07677, United States, 1 201 285 5800, repstein@epsteinhealth.com %K attitude %K perception %K young adult %K COVID-19 %K digital surveillance %K population health technologies %K surveillance %K population %K survey %K adolescent %D 2021 %7 8.1.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: COVID-19 is an international health crisis of particular concern in the United States, which saw surges of infections with the lifting of lockdowns and relaxed social distancing. Young adults have proven to be a critical factor for COVID-19 transmission and are an important target of the efforts to contain the pandemic. Scalable digital public health technologies could be deployed to reduce COVID-19 transmission, but their use depends on the willingness of young adults to participate in surveillance. Objective: The aim of this study is to determine the attitudes of young adults regarding COVID-19 digital surveillance, including which aspects they would accept and which they would not, as well as to determine factors that may be associated with their willingness to participate in digital surveillance. Methods: We conducted an anonymous online survey of young adults aged 18-24 years throughout the United States in June 2020. The questionnaire contained predominantly closed-ended response options with one open-ended question. Descriptive statistics were applied to the data. Results: Of 513 young adult respondents, 383 (74.7%) agreed that COVID-19 represents a public health crisis. However, only 231 (45.1%) agreed to actively share their COVID-19 status or symptoms for monitoring and only 171 (33.4%) reported a willingness to allow access to their cell phone for passive location tracking or contact tracing. Conclusions: Despite largely agreeing that COVID-19 represents a serious public health risk, the majority of young adults sampled were reluctant to participate in digital monitoring to manage the pandemic. This was true for both commonly used methods of public health surveillance (such as contact tracing) and novel methods designed to facilitate a return to normal (such as frequent symptom checking through digital apps). This is a potential obstacle to ongoing containment measures (many of which rely on widespread surveillance) and may reflect a need for greater education on the benefits of public health digital surveillance for young adults. %M 33347420 %R 10.2196/23000 %U http://formative.jmir.org/2021/1/e23000/ %U https://doi.org/10.2196/23000 %U http://www.ncbi.nlm.nih.gov/pubmed/33347420 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 1 %P e23805 %T COVID-19 Misinformation Trends in Australia: Prospective Longitudinal National Survey %A Pickles,Kristen %A Cvejic,Erin %A Nickel,Brooke %A Copp,Tessa %A Bonner,Carissa %A Leask,Julie %A Ayre,Julie %A Batcup,Carys %A Cornell,Samuel %A Dakin,Thomas %A Dodd,Rachael H %A Isautier,Jennifer M J %A McCaffery,Kirsten J %+ The University of Sydney, Rm 127A Edward Ford Building, Sydney, 2006, Australia, 61 93512064, kristen.pickles@sydney.edu.au %K COVID-19 %K coronavirus %K misinformation %K infodemic %K myths %K conspiracy %K digital health %K literacy %K social media %K trust %D 2021 %7 7.1.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Misinformation about COVID-19 is common and has been spreading rapidly across the globe through social media platforms and other information systems. Understanding what the public knows about COVID-19 and identifying beliefs based on misinformation can help shape effective public health communications to ensure efforts to reduce viral transmission are not undermined. Objective: This study aimed to investigate the prevalence and factors associated with COVID-19 misinformation in Australia and their changes over time. Methods: This prospective, longitudinal national survey was completed by adults (18 years and above) across April (n=4362), May (n=1882), and June (n=1369) 2020. Results: Stronger agreement with misinformation was associated with younger age, male gender, lower education level, and language other than English spoken at home (P<.01 for all). After controlling for these variables, misinformation beliefs were significantly associated (P<.001) with lower levels of digital health literacy, perceived threat of COVID-19, confidence in government, and trust in scientific institutions. Analyses of specific government-identified misinformation revealed 3 clusters: prevention (associated with male gender and younger age), causation (associated with lower education level and greater social disadvantage), and cure (associated with younger age). Lower institutional trust and greater rejection of official government accounts were associated with stronger agreement with COVID-19 misinformation. Conclusions: The findings of this study highlight important gaps in communication effectiveness, which must be addressed to ensure effective COVID-19 prevention. %M 33302250 %R 10.2196/23805 %U https://www.jmir.org/2021/1/e23805 %U https://doi.org/10.2196/23805 %U http://www.ncbi.nlm.nih.gov/pubmed/33302250 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 1 %P e24889 %T A Novel Machine Learning Framework for Comparison of Viral COVID-19–Related Sina Weibo and Twitter Posts: Workflow Development and Content Analysis %A Chen,Shi %A Zhou,Lina %A Song,Yunya %A Xu,Qian %A Wang,Ping %A Wang,Kanlun %A Ge,Yaorong %A Janies,Daniel %+ Department of Public Health Sciences, University of North Carolina at Charlotte, 9021 University City Blvd, Charlotte, NC, 28223-0001, United States, 1 8148800738, schen56@uncc.edu %K COVID-19 %K Twitter %K Sina Weibo %K content feature extraction %K cross-cultural comparison %K machine learning %K social media %K infodemiology %K infoveillance %K content analysis %K workflow %K communication %K framework %D 2021 %7 6.1.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Social media plays a critical role in health communications, especially during global health emergencies such as the current COVID-19 pandemic. However, there is a lack of a universal analytical framework to extract, quantify, and compare content features in public discourse of emerging health issues on different social media platforms across a broad sociocultural spectrum. Objective: We aimed to develop a novel and universal content feature extraction and analytical framework and contrast how content features differ with sociocultural background in discussions of the emerging COVID-19 global health crisis on major social media platforms. Methods: We sampled the 1000 most shared viral Twitter and Sina Weibo posts regarding COVID-19, developed a comprehensive coding scheme to identify 77 potential features across six major categories (eg, clinical and epidemiological, countermeasures, politics and policy, responses), quantified feature values (0 or 1, indicating whether or not the content feature is mentioned in the post) in each viral post across social media platforms, and performed subsequent comparative analyses. Machine learning dimension reduction and clustering analysis were then applied to harness the power of social media data and provide more unbiased characterization of web-based health communications. Results: There were substantially different distributions, prevalence, and associations of content features in public discourse about the COVID-19 pandemic on the two social media platforms. Weibo users were more likely to focus on the disease itself and health aspects, while Twitter users engaged more about policy, politics, and other societal issues. Conclusions: We extracted a rich set of content features from social media data to accurately characterize public discourse related to COVID-19 in different sociocultural backgrounds. In addition, this universal framework can be adopted to analyze social media discussions of other emerging health issues beyond the COVID-19 pandemic. %M 33326408 %R 10.2196/24889 %U https://www.jmir.org/2021/1/e24889 %U https://doi.org/10.2196/24889 %U http://www.ncbi.nlm.nih.gov/pubmed/33326408 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 1 %P e25701 %T Drivers of Acceptance of COVID-19 Proximity Tracing Apps in Switzerland: Panel Survey Analysis %A von Wyl,Viktor %A Höglinger,Marc %A Sieber,Chloé %A Kaufmann,Marco %A Moser,André %A Serra-Burriel,Miquel %A Ballouz,Tala %A Menges,Dominik %A Frei,Anja %A Puhan,Milo Alan %+ Epdemiology, Biostatistics & Prevention Institute, University of Zurich, Hirschengraben 84, Zürich, 8001, Switzerland, 41 446346380, viktor.vonwyl@uzh.ch %K COVID-19 %K SARS-CoV-2 %K digital proximity tracing %K digital contact tracing %K mHealth %K tracing %K compliance %K acceptance %K uptake %K usability %K communication %D 2021 %7 6.1.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Digital proximity tracing apps have been released to mitigate the transmission of SARS-CoV-2, the virus known to cause COVID-19. However, it remains unclear how the acceptance and uptake of these apps can be improved. Objective: This study aimed to investigate the coverage of the SwissCovid app and the reasons for its nonuse in Switzerland during a period of increasing incidence of COVID-19 cases. Methods: We collected data between September 28 and October 8, 2020, via a nationwide online panel survey (COVID-19 Social Monitor, N=1511). We examined sociodemographic and behavioral factors associated with app use by using multivariable logistic regression, whereas reasons for app nonuse were analyzed descriptively. Results: Overall, 46.5% (703/1511) of the survey participants reported they used the SwissCovid app, which was an increase from 43.9% (662/1508) reported in the previous study wave conducted in July 2020. A higher monthly household income (ie, income >CHF 10,000 or >US $11,000 vs income ≤CHF 6000 or 3 hours on reading COVID-19 news per day. Women with excessive media use (>3 hours) were more likely to be previously pregnant (P=.03), have no physical activity (P=.003), have inadequate dietary diversity (P=.03), and have poor sleep quality (P<.001). The prevalence of miscarriage was 16.0% (n=73; 95% CI 12.6%-19.4%). Compared with women who spent 0.5-2 hours (25/247, 10.1%) on reading COVID-19 news per day, miscarriage prevalence in women who spent <0.5 hours (5/23, 21.7%), 2-3 hours (26/132, 19.7%), and >3 hours (17/54, 31.5%) was higher (P<.001). Miscarriage prevalence was also higher in pregnant women with poor sleep quality (39/174, 22.4% vs 34/282, 12.1%; P=.003) and a high education level (66/368, 17.9% vs 7/88, 8.0%; P=.02). In the multivariable model, poor sleep quality (adjusted RR 2.06, 95% CI 1.24-3.44; P=.006), 2-3 hours of media use daily (adjusted RR 1.74, 95% CI 1.02-2.97; P=.04), and >3 hours of media use daily (adjusted RR 2.56, 95% CI 1.43-4.59; P=.002) were associated with miscarriage. In the sensitivity analysis, results were still stable. Conclusions: Pregnant women with excessive media use were more likely to have no physical activity, inadequate dietary diversity, and poor sleep quality. Excessive media use and poor sleep quality were associated with a higher risk of miscarriage. Our findings highlight the importance of healthy lifestyles during the COVID-19 pandemic. %M 33293263 %R 10.2196/25241 %U https://publichealth.jmir.org/2021/1/e25241 %U https://doi.org/10.2196/25241 %U http://www.ncbi.nlm.nih.gov/pubmed/33293263 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 1 %P e24859 %T Electronic Cigarette Users' Perspective on the COVID-19 Pandemic: Observational Study Using Twitter Data %A Gao,Yankun %A Xie,Zidian %A Li,Dongmei %+ Department of Clinical & Translational Research, University of Rochester Medical Center, Saunders Research Building 1.303J, 265 Crittenden Boulevard CU 420708, Rochester, NY, 14642-0708, United States, 1 5852767285, Dongmei_Li@urmc.rochester.edu %K COVID-19 %K Twitter %K infodemiology %K Electronic cigarette %K perspective %K observational %K social media %K vulnerable %K sentiment analysis %K topic modeling %K concern %D 2021 %7 5.1.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Previous studies have shown that electronic cigarette (e-cigarette) users might be more vulnerable to COVID-19 infection and could develop more severe symptoms if they contract the disease owing to their impaired immune responses to viral infections. Social media platforms such as Twitter have been widely used by individuals worldwide to express their responses to the current COVID-19 pandemic. Objective: In this study, we aimed to examine the longitudinal changes in the attitudes of Twitter users who used e-cigarettes toward the COVID-19 pandemic, as well as compare differences in attitudes between e-cigarette users and nonusers based on Twitter data. Methods: The study dataset containing COVID-19–related Twitter posts (tweets) posted between March 5 and April 3, 2020, was collected using a Twitter streaming application programming interface with COVID-19–related keywords. Twitter users were classified into two groups: Ecig group, including users who did not have commercial accounts but posted e-cigarette–related tweets between May 2019 and August 2019, and non-Ecig group, including users who did not post any e-cigarette–related tweets. Sentiment analysis was performed to compare sentiment scores towards the COVID-19 pandemic between both groups and determine whether the sentiment expressed was positive, negative, or neutral. Topic modeling was performed to compare the main topics discussed between the groups. Results: The US COVID-19 dataset consisted of 4,500,248 COVID-19–related tweets collected from 187,399 unique Twitter users in the Ecig group and 11,479,773 COVID-19–related tweets collected from 2,511,659 unique Twitter users in the non-Ecig group. Sentiment analysis showed that Ecig group users had more negative sentiment scores than non-Ecig group users. Results from topic modeling indicated that Ecig group users had more concerns about deaths due to COVID-19, whereas non-Ecig group users cared more about the government’s responses to the COVID-19 pandemic. Conclusions: Our findings show that Twitter users who tweeted about e-cigarettes had more concerns about the COVID-19 pandemic. These findings can inform public health practitioners to use social media platforms such as Twitter for timely monitoring of public responses to the COVID-19 pandemic and educating and encouraging current e-cigarette users to quit vaping to minimize the risks associated with COVID-19. %M 33347422 %R 10.2196/24859 %U http://publichealth.jmir.org/2021/1/e24859/ %U https://doi.org/10.2196/24859 %U http://www.ncbi.nlm.nih.gov/pubmed/33347422 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 1 %P e25372 %T A Novel Artificial Intelligence-Powered Emotional Intelligence and Mindfulness App (Ajivar) for the College Student Population During the COVID-19 Pandemic: Quantitative Questionnaire Study %A Sturgill,Ronda %A Martinasek,Mary %A Schmidt,Trine %A Goyal,Raj %+ Department of Health Sciences and Human Performance, The University of Tampa, 401 West Kennedy Blvd, Box 30F, Tampa, FL, 33606, United States, 1 8132573445, rsturgill@ut.edu %K mindfulness %K COVID-19 %K college students %K emotional intelligence %D 2021 %7 5.1.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Emotional intelligence (EI) and mindfulness can impact the level of anxiety and depression that an individual experiences. These symptoms have been exacerbated among college students during the COVID-19 pandemic. Ajivar is an app that utilizes artificial intelligence (AI) and machine learning to deliver personalized mindfulness and EI training. Objective: The main objective of this research study was to determine the effectiveness of delivering an EI curriculum and mindfulness techniques using an AI conversation platform, Ajivar, to improve symptoms of anxiety and depression during this pandemic. Methods: A total of 99 subjects, aged 18 to 29 years, were recruited from a second-semester group of freshmen students. All participants completed the online TestWell Wellness Inventory at the start and end of the 14-week semester. The comparison group members (49/99, 49%) were given routine mental wellness instruction. The intervention group members (50/99, 51%) were required to complete Ajivar activities in addition to routine mental wellness instruction during the semester, which coincided with the onset of the COVID-19 pandemic. This group also completed assessments to evaluate for anxiety, using the 7-item Generalized Anxiety Disorder (GAD-7) scale, and depression, using the 9-item Patient Health Questionnaire (PHQ-9). Results: Study participants reported a mean age of 19.9 (SD 1.94) years; 27% (27/99) of the group were male and 60% (59/99) identified as Caucasian. No significant demographic differences existed between the comparison and intervention groups. Subjects in the intervention group interacted with Ajivar for a mean time of 1424 (SD 1168) minutes. There was a significant decrease in anxiety, as measured by the GAD-7: the mean score was 11.47 (SD 1.85) at the start of the study compared to 6.27 (SD 1.44) at the end (P<.001). There was a significant reduction in the symptoms of depression measured by the PHQ-9: the mean score was 10.69 (SD 2.04) at the start of the study compared to 6.69 (SD 2.41) at the end (P=.001). Both the intervention and comparison groups independently had significant improvements in the TestWell Wellness Inventory from pretest to posttest. The subgroups in the social awareness and spirituality inventories showed significant improvement in the intervention group. In a subgroup of participants (11/49, 22%) where the GAD-7 was available during the onset of the COVID-19 pandemic, there was an increase in anxiety from the start of the study (mean score 11.63, SD 2.16) to mid-March (ie, onset of the pandemic) (mean score 13.03, SD 1.48; P=.23), followed by a significant decrease at the end of the study period (mean score 5.9, SD 1.44; P=.001). Conclusions: It is possible to deliver EI and mindfulness training in a scalable way using the Ajivar app during the COVID-19 pandemic, resulting in improvements in anxiety, depression, and EI in the college student population. %M 33320822 %R 10.2196/25372 %U http://formative.jmir.org/2021/1/e25372/ %U https://doi.org/10.2196/25372 %U http://www.ncbi.nlm.nih.gov/pubmed/33320822 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 12 %P e23696 %T Association of Social Media Use With Mental Health Conditions of Nonpatients During the COVID-19 Outbreak: Insights from a National Survey Study %A Zhong,Bu %A Jiang,Zhibin %A Xie,Wenjing %A Qin,Xuebing %+ School of Communication, East China Normal University, 500 Dongchuan Road, Minhang District, Shanghai, 200062, China, 86 13818950148, xbqin@comm.ecnu.edu.cn %K COVID-19 %K mental health %K social media %K health information support %K secondary traumatic stress %K vicarious trauma %K social support %D 2020 %7 31.12.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Considerable research has been devoted to examining the mental health conditions of patients with COVID-19 and medical staff attending to these patients during the COVID-19 pandemic. However, there are few insights concerning how the pandemic may take a toll on the mental health of the general population, and especially of nonpatients (ie, individuals who have not contracted COVID-19). Objective: This study aimed to investigate the association between social media use and mental health conditions in the general population based on a national representative sample during the peak of the COVID-19 outbreak in China. Methods: We formed a national representative sample (N=2185) comprising participants from 30 provinces across China, who were the first to experience the COVID-19 outbreak in the world. We administered a web-based survey to these participants to analyze social media use, health information support received via social media, and possible psychiatric disorders, including secondary traumatic stress (STS) and vicarious trauma (VT). Results: Social media use did not cause mental health issues, but it mediated the levels of traumatic emotions among nonpatients. Participants received health information support via social media, but excessive social media use led to elevated levels of stress (β=.175; P<.001), anxiety (β=.224; P<.001), depression (β=.201; P<.001), STS (β=.307; P<.001), and VT (β=.688; P<.001). Geographic location (or geolocation) and lockdown conditions also contributed to more instances of traumatic disorders. Participants living in big cities were more stressed than those living in rural areas (P=.02). Furthermore, participants from small cities or towns were more anxious (P=.01), stressed (P<.001), and depressed (P=.008) than those from rural areas. Obtaining more informational support (β=.165; P<.001) and emotional support (β=.144; P<.001) via social media increased their VT levels. Peer support received via social media increased both VT (β=.332; P<.001) and STS (β=.130; P<.001) levels. Moreover, geolocation moderated the relationships between emotional support on social media and VT (F2=3.549; P=.029) and the association between peer support and STS (F2=5.059; P=.006). Geolocation also interacted with health information support in predicting STS (F2=5.093; P=.006). Conclusions: COVID-19 has taken a severe toll on the mental health of the general population, including individuals who have no history of psychiatric disorders or coronavirus infection. This study contributes to the literature by establishing the association between social media use and psychiatric disorders among the general public during the COVID-19 outbreak. The study findings suggest that the causes of such psychiatric disorders are complex and multifactorial, and social media use is a potential factor. The findings also highlight the experiences of people in China and can help global citizens and health policymakers to mitigate the effects of psychiatric disorders during this and other public health crises, which should be regarded as a key component of a global pandemic response. %M 33302256 %R 10.2196/23696 %U https://www.jmir.org/2020/12/e23696 %U https://doi.org/10.2196/23696 %U http://www.ncbi.nlm.nih.gov/pubmed/33302256 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 12 %P e23729 %T Knowledge, Perceived Beliefs, and Preventive Behaviors Related to COVID-19 Among Chinese Older Adults: Cross-Sectional Web-Based Survey %A Chen,Ying %A Zhou,Rui %A Chen,Boyan %A Chen,Hao %A Li,Ying %A Chen,Zhi %A Zhu,Haihong %A Wang,Hongmei %+ Department of Social Medicine of School of Public Health, and Department of Pharmacy of the First Affiliated Hospital, Zhejiang University School of Medicine, 866 Yuhangtang Road, Xihu District, Hangzhou, Zhejiang Province, 310058, China, 86 571 88208222, rosa@zju.edu.cn %K COVID-19 %K knowledge %K perceived beliefs %K behaviors %K elderly %K China %D 2020 %7 31.12.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic continues to pose an international public health threat. Prevention is of paramount importance to protect the high-risk group of older adults until specific treatments for COVID-19 become available; however, little work has been done to explore factors that promote preventive behaviors among this population. Objective: This study aims to investigate the knowledge, perceived beliefs, and preventive behaviors towards COVID-19 of older adults in China and determine the factors that influence their practice of preventive behaviors. Methods: From February 19 to March 19, 2020, a cross-sectional, web-based survey was administered to Chinese older adults in all 31 provinces of mainland China using a convenience sampling method to assess the respondents’ knowledge, perceived beliefs, and preventive behaviors towards COVID-19. Standard descriptive statistics and hierarchical linear regression analyses were conducted to analyze the data. Results: A total of 1501 participants responded to the survey, and 1263 valid responses (84.1%) were obtained for further analysis. The overall correct rate on the knowledge questionnaire was 87%, overall positive beliefs regarding COVID-19 were found, and the mean behavior score was 13.73/15 (SD 1.62, range 5-15). The hierarchical linear regression showed that respondents who were married or cohabitating and who lived in areas with community-level control measures were more likely to practice preventive behaviors (P<.01). Knowledge (β=0.198, P<.001), perceived susceptibility (β=0.263, P=.03), perceived benefits (β=0.643, P<.001), and self-efficacy in preventing COVID-19 (β=0.468, P<.001) were also found to be significantly associated with preventive behaviors. Conclusions: Most older residents had adequate knowledge and positive beliefs regarding COVID-19 and engaged in proactive behaviors to prevent the disease. Knowledge and beliefs were confirmed to be significantly associated with behavior responses. Our findings have significant implications in enhancing the effectiveness of COVID-19 prevention programs targeting the older population; these programs must be continued and strengthened as the epidemic continues. %M 33293262 %R 10.2196/23729 %U https://www.jmir.org/2020/12/e23729 %U https://doi.org/10.2196/23729 %U http://www.ncbi.nlm.nih.gov/pubmed/33293262 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 4 %P e25546 %T SARS-CoV-2 Testing Service Preferences of Adults in the United States: Discrete Choice Experiment %A Zimba,Rebecca %A Kulkarni,Sarah %A Berry,Amanda %A You,William %A Mirzayi,Chloe %A Westmoreland,Drew %A Parcesepe,Angela %A Waldron,Levi %A Rane,Madhura %A Kochhar,Shivani %A Robertson,McKaylee %A Maroko,Andrew %A Grov,Christian %A Nash,Denis %+ Institute for Implementation Science in Population Health, City University of New York, 55 W 125th St, 6th Floor, New York, NY, 10027, United States, 1 646 364 9618, rebecca.zimba@sph.cuny.edu %K COVID-19 %K SARS-CoV-2 %K discrete choice experiment %K implementation science %K engagement %K testing %K cohort study %K stated preference study %K pandemic %D 2020 %7 31.12.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Ascertaining preferences for SARS-CoV-2 testing and incorporating findings into the design and implementation of strategies for delivering testing services may enhance testing uptake and engagement, a prerequisite to reducing onward transmission. Objective: This study aims to determine important drivers of decisions to obtain a SARS-CoV-2 test in the context of increasing community transmission. Methods: We used a discrete choice experiment to assess preferences for SARS-CoV-2 test type, specimen type, testing venue, and results turnaround time. Participants (n=4793) from the US national longitudinal Communities, Households and SARS-CoV-2 Epidemiology (CHASING) COVID Cohort Study completed our online survey from July 30 to September 8, 2020. We estimated the relative importance of testing method attributes and part-worth utilities of attribute levels, and simulated the uptake of an optimized testing scenario relative to the current typical testing scenario of polymerase chain reaction (PCR) via nasopharyngeal swab in a provider’s office or urgent care clinic with results in >5 days. Results: Test result turnaround time had the highest relative importance (30.4%), followed by test type (28.3%), specimen type (26.2%), and venue (15.0%). In simulations, immediate or same-day test results, both PCR and serology, or oral specimens substantially increased testing uptake over the current typical testing option. Simulated uptake of a hypothetical testing scenario of PCR and serology via a saliva sample at a pharmacy with same-day results was 97.7%, compared to 0.6% for the current typical testing scenario, with 1.8% opting for no test. Conclusions: Testing strategies that offer both PCR and serology with noninvasive methods and rapid turnaround time would likely have the most uptake and engagement among residents in communities with increasing community transmission of SARS-CoV-2. %M 33315584 %R 10.2196/25546 %U http://publichealth.jmir.org/2020/4/e25546/ %U https://doi.org/10.2196/25546 %U http://www.ncbi.nlm.nih.gov/pubmed/33315584 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 12 %P e24797 %T Evaluating the Onset, Severity, and Recovery of Changes to Smell and Taste Associated With COVID-19 Infection in a Singaporean Population (the COVOSMIA-19 Trial): Protocol for a Prospective Case-Control Study %A Sheen,Florence %A Tan,Vicki %A Haldar,Sumanto %A Sengupta,Sharmila %A Allen,David %A Somani,Jyoti %A Chen,Hui Yee %A Tambyah,Paul %A Forde,Ciaran G %+ Singapore Institute of Food and Biotechnology Innovation, Agency of Science and Research, 14 Medical Drive #07-02, MD 6 Building, Yong Loo Lin School of Medicine, Singapore, 117599, Singapore, 65 6407 0104, Ciaran_Forde@sifbi.a-star.edu.sg %K SARS-CoV-2 %K COVID-19 %K olfactory dysfunction %K gustatory dysfunction %K anosmia %K ageusia %K onset %K severity %K symptom %K infectious disease %K dysfunction %K protocol %K marker %K recovery %K monitoring %K taste %K smell %D 2020 %7 31.12.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: Sudden loss of smell and/or taste has been suggested to be an early marker of COVID-19 infection, with most findings based on self-reporting of sensory changes at a single time point. Objective: To understand the onset, severity, and recovery of sensory changes associated with COVID-19 infection, this study will longitudinally track changes in chemosensory acuity among people with suspected COVID-19 infection using standardized test stimuli that are self-administered over 28 days. Methods: In a prospective, case-controlled observational study, volunteers will be recruited when they present for COVID-19 screening by respiratory tract polymerase chain reaction test (“swab test”). The volunteers will initially complete a series of questionnaires to record their recent changes in smell and taste ability, followed by a brief standardized smell and taste test. Participants will receive a home-use smell and taste test kit to prospectively complete daily self-assessments of their smell and taste acuity at their place of residence for up to 4 weeks, with all data submitted for collection through web-based software. Results: This study has been approved by the Domain Specific Review Board of the National Healthcare Group, Singapore, and is funded by the Biomedical Research Council Singapore COVID-19 Research Fund. Recruitment began on July 23, 2020, and will continue through to March 31, 2021. As of October 2, 2020, 69 participants had been recruited. Conclusions: To our knowledge, this study will be the first to collect longitudinal data on changes to smell and taste sensitivity related to clinically diagnosed COVID-19 infection, confirmed by PCR swab test, in a population-based cohort. The findings will provide temporal insights on the onset, severity, and recovery of sensory changes with COVID-19 infection, the consistency of symptoms, and the frequency of full smell recovery among patients with COVID-19. This self-administered and cost-effective approach has many advantages over self-report questionnaire–based methods and provides a more objective measure of smell and taste changes associated with COVID-19 infection; this will encourage otherwise asymptomatic individuals who are potential spreaders of the virus to self-isolate and seek formal medical diagnosis if they experience a sudden change in sensory acuity. This broadened case finding can potentially help control the COVID-19 pandemic and reduce the emergence of clusters of infections. Trial Registration: ClinicalTrials.gov NCT04492904; https://clinicaltrials.gov/ct2/show/NCT04492904. International Registered Report Identifier (IRRID): DERR1-10.2196/24797 %M 33351775 %R 10.2196/24797 %U http://www.researchprotocols.org/2020/12/e24797/ %U https://doi.org/10.2196/24797 %U http://www.ncbi.nlm.nih.gov/pubmed/33351775 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 12 %P e23830 %T Efficacy and Safety of Inhaled Ciclesonide in Treating Patients With Asymptomatic or Mild COVID-19 in the RACCO Trial: Protocol for a Multicenter, Open-label, Randomized Controlled Trial %A Terada-Hirashima,Junko %A Suzuki,Manabu %A Uemura,Yukari %A Hojo,Masayuki %A Mikami,Ayako %A Sugiura,Wataru %A Ohmagari,Norio %A Sugiyama,Haruhito %+ Department of Pulmonary Medicine, Center Hospital of the National Center for Global Health and Medicine, 1-21-1 Toyama Shinjuku-ku, Tokyo, Japan, 81 332027181, jterada@hosp.ncgm.go.jp %K COVID-19 %K SARS-CoV-2 %K proposed therapy %K therapy %K drug %K treatment %K protocol %K randomized controlled trial %K intervention %D 2020 %7 31.12.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: Currently, there are no specific effective treatments for SARS-CoV-2 infection; however, various COVID-19 treatment options are under investigation. It is vital to continue investigating the landscape of SARS-CoV-2–induced pneumonia and therapeutic interventions. Objective: This paper presents the protocol for a randomized controlled trial that aims to compare the pneumonia exacerbation rate between ciclesonide (ALVESCO; Teijin Pharma Limited) administration and symptomatic treatment in patients with COVID-19 and to determine the efficacy of ciclesonide. The secondary objectives are to investigate the safety of ciclesonide administration, changes in clinical and laboratory findings, and the number of viral genome copies of SARS-CoV-2 over time between the 2 groups. Methods: In this investigator-initiated, exploratory, prospective, multicenter, parallel-group, open-label, randomized controlled trial, a total of 90 patients diagnosed with COVID-19 will be recruited from 21 hospitals in Japan based on specific inclusion and exclusion criteria. Participants will be randomized either to the ciclesonide group, which will receive a 400-µg dose of ciclesonide 3 times per day over a 7-day period, or to the symptomatic treatment group. Both groups will receive antitussives and antipyretics as required. Data collection for various parameters will be conducted on days 1, 2, 4, 8, 22, and 29 to record baseline assessments and the findings over an extended period. Computed tomography images taken prior to drug administration and 1 week following treatment will be compared, and efficacy will be confirmed by checking for pneumonia exacerbation. Primary endpoint analysis will be performed using the Fisher exact test to determine statistically significant differences in the pneumonia exacerbation rate between the ciclesonide and symptomatic treatment groups. Results: The first trial participant was enrolled on April 3, 2020. Recruitment is expected to be completed on September 30, 2020, while follow-up assessments of all participants are expected to be completed by October 31, 2020. The study results will be published in a peer-reviewed scientific journal. Conclusions: The RACCO (Randomized Ciclesonid COVID-19) study will provide definitive comparative effectiveness data and important clinical outcomes data between the ciclesonide and symptomatic treatment groups. If the hypotheses that pneumonia exacerbation rate reduction is more significant in the ciclesonide treatment group than in the symptomatic treatment group and that ciclesonide is safe for use are valid, ciclesonide will serve as an important therapeutic option for patients with COVID-19. Trial Registration: Japan Registry of Clinical Trials jRCTs031190269; https://jrct.niph.go.jp/en-latest-detail/jRCTs031190269 International Registered Report Identifier (IRRID): DERR1-10.2196/23830 %M 33206053 %R 10.2196/23830 %U http://www.researchprotocols.org/2020/12/e23830/ %U https://doi.org/10.2196/23830 %U http://www.ncbi.nlm.nih.gov/pubmed/33206053 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 12 %P e21815 %T Harnessing Digital Health Technologies During and After the COVID-19 Pandemic: Context Matters %A Petracca,Francesco %A Ciani,Oriana %A Cucciniello,Maria %A Tarricone,Rosanna %+ Centre for Research in Health and Social Care Management (CERGAS), Government, Health and Non Profit Division, SDA Bocconi, Via Roentgen 1, 20136, Milan, Italy, 39 02 58365257, francesco.petracca@unibocconi.it %K mobile apps %K coronavirus %K COVID-19 %K digital health %K mHealth %K organizational context %K public health %K telemedicine %D 2020 %7 30.12.2020 %9 Viewpoint %J J Med Internet Res %G English %X A common development observed during the COVID-19 pandemic is the renewed reliance on digital health technologies. Prior to the pandemic, the uptake of digital health technologies to directly strengthen public health systems had been unsatisfactory; however, a relentless acceleration took place within health care systems during the COVID-19 pandemic. Therefore, digital health technologies could not be prescinded from the organizational and institutional merits of the systems in which they were introduced. The Italian National Health Service is strongly decentralized, with the national government exercising general stewardship and regions responsible for the delivery of health care services. Together with the substantial lack of digital efforts previously, these institutional characteristics resulted in delays in the uptake of appropriate solutions, territorial differences, and issues in engaging the appropriate health care professionals during the pandemic. An in-depth analysis of the organizational context is instrumental in fully interpreting the contribution of digital health during the pandemic and providing the foundation for the digital reconstruction of what is to come after. %M 33351777 %R 10.2196/21815 %U http://www.jmir.org/2020/12/e21815/ %U https://doi.org/10.2196/21815 %U http://www.ncbi.nlm.nih.gov/pubmed/33351777 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 12 %P e24868 %T Use of Asynchronous Virtual Mental Health Resources for COVID-19 Pandemic–Related Stress Among the General Population in Canada: Cross-Sectional Survey Study %A Richardson,Chris G %A Slemon,Allie %A Gadermann,Anne %A McAuliffe,Corey %A Thomson,Kimberly %A Daly,Zachary %A Salway,Travis %A Currie,Leanne M %A David,Anita %A Jenkins,Emily %+ School of Nursing, University of British Columbia, T201-2211 Wesbrook Mall, Vancouver, BC, V6B 2B5, Canada, 1 604 822 4980, emily.jenkins@ubc.ca %K virtual health %K digital health %K virtual mental health %K mental health %K public health %K COVID-19 %K coping %K stress %K implementation %K utilization %D 2020 %7 30.12.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic has resulted in profound mental health impacts among the general population worldwide. As many in-person mental health support services have been suspended or transitioned online to facilitate physical distancing, there have been numerous calls for the rapid expansion of asynchronous virtual mental health (AVMH) resources. These AVMH resources have great potential to provide support for people coping with negative mental health impacts associated with the pandemic; however, literature examining use prior to COVID-19 illustrates that the uptake of these resources is consistently low. Objective: The aim of this paper is to examine the use of AVMH resources in Canada during the COVID-19 pandemic among the general population and among a participant subgroup classified as experiencing an adverse mental health impact related to the pandemic. Methods: Data from this study were drawn from the first wave of a large multiwave cross-sectional monitoring survey, distributed from May 14 to 29, 2020. Participants (N=3000) were adults living in Canada. Descriptive statistics were used to characterize the sample, and bivariate cross-tabulations were used to examine the relationships between the use of AVMH resources and self-reported indicators of mental health that included a range of emotional and coping-related responses to the pandemic. Univariate and fully adjusted multivariate logistic regression models were used to examine associations between sociodemographic and health-related characteristics and use of AVMH resources in the subgroup of participants who reported experiencing one or more adverse mental health impacts identified in the set of self-reported mental health indicators. Results: Among the total sample, 2.0% (n=59) of participants reported accessing AVMH resources in the prior 2 weeks to cope with stress related to the COVID-19 pandemic, with the highest rates of use among individuals who reported self-harm (n=5, 10.4%) and those who reported coping “not well” with COVID-19–related stress (n=22, 5.5%). Within the subgroup of 1954 participants (65.1% of the total sample) who reported an adverse mental health impact related to COVID-19, 54 (2.8%) reported use of AVMH resources. Individuals were more likely to have used AVMH resources if they had reported receiving in-person mental health supports, were connecting virtually with a mental health worker or counselor, or belonged to a visible minority group. Conclusions: Despite substantial government investment into AVMH resources, uptake is low among both the general population and individuals who may benefit from the use of these resources as a means of coping with the adverse mental health impacts of the COVID-19 pandemic. Further research is needed to improve our understanding of the barriers to use. %M 33315583 %R 10.2196/24868 %U http://www.jmir.org/2020/12/e24868/ %U https://doi.org/10.2196/24868 %U http://www.ncbi.nlm.nih.gov/pubmed/33315583 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 4 %P e24694 %T Time Trends of the Public’s Attention Toward Suicide During the COVID-19 Pandemic: Retrospective, Longitudinal Time-Series Study %A Burnett,Dayle %A Eapen,Valsamma %A Lin,Ping-I %+ School of Psychiatry, University of New South Wales, Level 1, Australian Graduate School of Management Building Gate, 11 Botany St, Kensington, 2052, Australia, 61 421315320, pingi.lin@gmail.com %K COVID-19 %K suicide %K infodemiology %K infoveillance %K Google Trends %K time trend %K school closure %K attention %K mental health %K crisis %K time series %D 2020 %7 30.12.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The COVID-19 pandemic has overwhelmed health care systems around the world. Emerging evidence has suggested that substantially few patients seek help for suicidality at clinical settings during the COVID-19 pandemic, which has elicited concerns of an imminent mental health crisis as the course of the pandemic continues to unfold. Clarifying the relationship between the public’s attention to knowledge about suicide and the public’s attention to knowledge about the COVID-19 pandemic may provide insight into developing prevention strategies for a putative surge of suicide in relation to the impact of the COVID-19 pandemic. Objective: The goal of this retrospective, longitudinal time-series study is to understand the relationship between temporal trends of interest for the search term “suicide” and those of COVID-19–related terms, such as “social distancing,” “school closure,” and “lockdown.” Methods: We used the Google Trends platform to collect data on daily interest levels for search terms related to suicide, several other mental health-related issues, and COVID-19 over the period between February 14, 2020 and May 13, 2020. A correlational analysis was performed to determine the association between the search term ‘‘suicide’’ and COVID-19–related search terms in 16 countries. The Mann-Kendall test was used to examine significant differences between interest levels for the search term “suicide” before and after school closure. Results: We found that interest levels for the search term “suicide” statistically significantly inversely correlated with interest levels for the search terms “COVID-19” or “coronavirus” in nearly all countries between February 14, 2020 and May 13, 2020. Additionally, search interest for the term ‘‘suicide’’ significantly and negatively correlated with that of many COVID-19–related search terms, and search interest varied between countries. The Mann-Kendall test was used to examine significant differences between search interest levels for the term “suicide” before and after school closure. The Netherlands (P=.19), New Zealand (P=.003), the United Kingdom (P=.006), and the United States (P=.049) showed significant negative trends in interest levels for suicide in the 2-week period preceding school closures. In contrast, interest levels for suicide had a significant positive trend in Canada (P<.001) and the United States (P=.002) after school closures. Conclusions: The public’s attention to suicide might inversely correlate with the public’s attention to COVID-19–related issues. Additionally, several anticontagion policies, such as school closure, might have led to a turning point for mental health crises, because the attention to suicidality increased after restrictions were implemented. Our results suggest that an increased risk of suicidal ideation may ensue due to the ongoing anticontagion policies. Timely intervention strategies for suicides should therefore be an integral part of efforts to flatten the epidemic curve. %M 33326407 %R 10.2196/24694 %U http://publichealth.jmir.org/2020/4/e24694/ %U https://doi.org/10.2196/24694 %U http://www.ncbi.nlm.nih.gov/pubmed/33326407 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 12 %P e20642 %T COVID-19–Related Disruptions and Increased mHealth Emergency Use Intention: Experience Sampling Method Study %A Zhang,Zhenduo %A Zhang,Li %A Zheng,Junwei %A Xiao,Huan %A Li,Zhigang %+ School of Economics and Management, Beijing Polytechnic, No 9, Liangshuihe 1st Street, Beijing Economic and Technological Development Zone, Beijing, China, 86 13651205747, lizhigang@bpi.edu.cn %K mobile health services %K emergency use intention %K event disruption %K COVID-19–induced strain %K promotion regulatory focus %K mHealth %K COVID-19 %D 2020 %7 30.12.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The COVID-19 pandemic has become a global public health event, which has raised concerns regarding individuals’ health. Individuals need to cope with the COVID-19 pandemic with guidelines on symptom recognition, home isolation, and maintain mental health. Besides routine use of mobile health (mHealth) such as accessing information to keep healthy, individuals can use mHealth services in situations requiring urgent medical care, which is defined as mHealth emergency use. It is not known whether individuals have increased their daily mHealth services emergency use as a result of disruptions caused by the COVID-19 pandemic. Objective: The purpose of this diary analysis study is to assess the influences of daily disruptions related to the COVID-19 pandemic on individuals’ mHealth emergency use. The secondary purpose of this study is to explore the mediating role of COVID-19–induced strain and the moderating role of promotion regulatory focus in the relationship between daily disruptions of COVID-19 and mHealth emergency use. Drawing from the cognitive activation theory of stress, we investigated the underlying mechanism and boundary condition of the influence of COVID-19–related disruptions on daily mHealth emergency use. Methods: To test the proposed model, this study adopts the experience sampling method to collect daily data. The experience sampling method helps researchers to capture participants’ fluctuations in emotions, mental engagement in an activity, and experienced stress. This study collected 550 cases nested in 110 samples in mainland China to test the conceptual model. In addition, we employed hierarchical linear modeling analysis to test the effect of COVID-19–related disruptions on mHealth emergency use. Results: We found that COVID-19–related disruptions increased COVID-19–induced strain (γ=0.24, P<.001) and mHealth emergency use on a daily basis (γ=0.28, P<.001). COVID-19–induced daily strain mediated this relationship (effect=0.09, 95% CI 0.05-0.14). Promotion regulatory focus moderated the relationship between COVID-19–induced strain and mHealth emergency use (γ=0.35, P=.02). In addition, the indirect relationship between disruptions and mHealth emergency use intentions through COVID-19–induced strain is contingent upon promotion regulatory focus: this relationship was stronger in those with high promotion regulatory focus (effect=0.12, 95% CI 0.06-0.19) than in those with low promotion regulatory focus (effect=0.06, 95% CI 0.02-0.11). Conclusions: Event disruption of the COVID-19 pandemic induced mHealth emergency use intention through increased psychological strain. Furthermore, individuals’ promotion regulatory focus amplified this indirect relationship. Our findings extend our understanding of the factors underlying mHealth emergency use intention and illustrate the potential contingent role of promotion regulatory focus in the cognitive activation theory of stress. This study also opens avenues for future research on mHealth emergency use intention in other countries and cultural settings. %M 33315579 %R 10.2196/20642 %U http://mhealth.jmir.org/2020/12/e20642/ %U https://doi.org/10.2196/20642 %U http://www.ncbi.nlm.nih.gov/pubmed/33315579 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 3 %N 2 %P e24827 %T Parental Acceptability of COVID-19 Vaccination for Children Under the Age of 18 Years: Cross-Sectional Online Survey %A Zhang,Ke Chun %A Fang,Yuan %A Cao,He %A Chen,Hongbiao %A Hu,Tian %A Chen,Ya Qi %A Zhou,Xiaofeng %A Wang,Zixin %+ JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Room 508, School of Public Health, Prince of Wales Hospital, Shatin, NT, Hong Kong, 666888, China, 852 22528740, wangzx@cuhk.edu.hk %K parental acceptability %K COVID-19 vaccination %K children under the age of 18 years %K theory of planned behavior %K social media influence %K China %D 2020 %7 30.12.2020 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: It is expected that COVID-19 vaccines will become available in China by the end of 2020. Vaccinating children against COVID-19 would contribute to the control of the pandemic and the recovery of the global economy. For children under the age of 18 years, parents are usually the decision makers regarding their children’s vaccination. Objective: The goal of this study was to investigate parental acceptability of free COVID-19 vaccination for children under the age of 18 years in China. Methods: This is a secondary analysis of a cross-sectional, closed online survey among 2053 factory workers in Shenzhen, China, implemented from September 1 to 7, 2020. Participants of the online survey were full-time employees aged 18 years or over who had resumed work in factories in Shenzhen. Factory workers in Shenzhen are required to receive physical examinations once a year. Eligible workers attending six designated physical examination sites were invited to complete an online survey. This study was based on a subsample of those who had at least one child under the age of 18 years (N=1052). After being briefed that COVID-19 vaccines developed by China are likely to be available by the end of 2020, participants were asked about their likelihood of having their children under the age of 18 years take up free COVID-19 vaccination provided by the government, if it existed. Multivariate logistic regression models were fitted to examine the associations of perceptions related to COVID-19 vaccination based on the theory of planned behavior (TPB) and exposure to information related to COVID-19 through social media with parental acceptability, after controlling for significant background characteristics. Results: The prevalence of parents’ acceptability of COVID-19 vaccination for their children was 72.6% (764/1052). After adjusting for significant background characteristics, positive attitudes toward COVID-19 vaccination (adjusted odds ratio [AOR] 1.70, 95% CI 1.50-1.91), the perception that a family member would support them in having their children take up COVID-19 vaccination (ie, perceived subjective norm) (AOR 4.18, 95% CI 3.21-5.43), and perceived behavioral control to have the children take up COVID-19 vaccination (AOR 1.84, 95% CI 1.49-2.26) were associated with higher parental acceptability of COVID-19 vaccination. Regarding social media influence, higher exposure to positive information related to COVID-19 vaccination was associated with higher parental acceptability of COVID-19 vaccination (AOR 1.35, 95% CI 1.17-1.56). Higher exposure to negative information related to COVID-19 vaccination was negatively associated with the dependent variable (AOR 0.85, 95% CI 0.74-0.99). Conclusions: Parents’ acceptability of COVID-19 vaccination for their children under 18 years of age was high in China. The TPB is a useful framework to guide the development of future campaigns promoting COVID-19 vaccination targeting parents. Transparency in communicating about the vaccine development process and vaccine safety testing is important. Public health authorities should also address misinformation in a timely manner. %M 33326406 %R 10.2196/24827 %U http://pediatrics.jmir.org/2020/2/e24827/ %U https://doi.org/10.2196/24827 %U http://www.ncbi.nlm.nih.gov/pubmed/33326406 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 12 %P e20064 %T Implications of the COVID-19 Pandemic for the Development and Update of Clinical Practice Guidelines: Viewpoint %A Steeb,Theresa %A Follmann,Markus %A Hagen,Ralf Matthias %A Berking,Carola %A Heppt,Markus Vincent %+ Department of Dermatology, Universitätsklinikum Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Ulmenweg 18, Erlangen, 91054, Germany, 49 091318545852, Theresa.Steeb@uk-erlangen.de %K practice guideline %K consensus development conference %K guideline %K videoconferencing %K clinical practice %K COVID-19 %K pandemic %K public health %K policy %K decision making %K online conference %D 2020 %7 29.12.2020 %9 Viewpoint %J J Med Internet Res %G English %X Following the rapid spread of a new type of coronavirus (SARS-CoV-2), nearly all countries have introduced temporary restrictions affecting daily life, with “social distancing” as a key intervention for slowing the spread of the virus. Despite the pandemic, the development or actualization of medical guidelines, especially in the rapidly changing field of oncology, needs to be continued to provide up-to-date evidence- and consensus-based recommendations for shared decision making and maintaining the treatment quality for patients. In this viewpoint, we describe the potential strengths and limitations of online conferences for medical guideline development. This viewpoint will assist guideline developers in evaluating whether online conferences are an appropriate tool for their guideline conference and audience. %M 33347419 %R 10.2196/20064 %U http://www.jmir.org/2020/12/e20064/ %U https://doi.org/10.2196/20064 %U http://www.ncbi.nlm.nih.gov/pubmed/33347419 %0 Journal Article %@ 2561-3278 %I JMIR Publications %V 5 %N 1 %P e24388 %T Personalized Monitoring Model for Electrocardiogram Signals: Diagnostic Accuracy Study %A Kotorov,Rado %A Chi,Lianhua %A Shen,Min %+ La Trobe University, Thomas Cherry Bldg, 3rd Fl, La Trobe University, Bundoora, 3086, Australia, 61 3 94792454, l.chi@latrobe.edu.au %K COVID-19 %K personalized monitoring model %K ECG %K time series %K motif discovery %K monitoring %K heart disease %K electrocardiogram %D 2020 %7 29.12.2020 %9 Original Paper %J JMIR Biomed Eng %G English %X Background: Due to the COVID-19 pandemic, the demand for remote electrocardiogram (ECG) monitoring has increased drastically in an attempt to prevent the spread of the virus and keep vulnerable individuals with less severe cases out of hospitals. Enabling clinicians to set up remote patient ECG monitoring easily and determining how to classify the ECG signals accurately so relevant alerts are sent in a timely fashion is an urgent problem to be addressed for remote patient monitoring (RPM) to be adopted widely. Hence, a new technique is required to enable routine and widespread use of RPM, as is needed due to COVID-19. Objective: The primary aim of this research is to create a robust and easy-to-use solution for personalized ECG monitoring in real-world settings that is precise, easily configurable, and understandable by clinicians. Methods: In this paper, we propose a Personalized Monitoring Model (PMM) for ECG data based on motif discovery. Motif discovery finds meaningful or frequently recurring patterns in patient ECG readings. The main strategy is to use motif discovery to extract a small sample of personalized motifs for each individual patient and then use these motifs to predict abnormalities in real-time readings of that patient using an artificial logical network configured by a physician. Results: Our approach was tested on 30 minutes of ECG readings from 32 patients. The average diagnostic accuracy of the PMM was always above 90% and reached 100% for some parameters, compared to 80% accuracy for the Generalized Monitoring Models (GMM). Regardless of parameter settings, PMM training models were generated within 3-4 minutes, compared to 1 hour (or longer, with increasing amounts of training data) for the GMM. Conclusions: Our proposed PMM almost eliminates many of the training and small sample issues associated with GMMs. It also addresses accuracy and computational cost issues of the GMM, caused by the uniqueness of heartbeats and training issues. In addition, it addresses the fact that doctors and nurses typically do not have data science training and the skills needed to configure, understand, and even trust existing black box machine learning models. %M 33529270 %R 10.2196/24388 %U https://biomedeng.jmir.org/2020/1/e24388 %U https://doi.org/10.2196/24388 %U http://www.ncbi.nlm.nih.gov/pubmed/33529270 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 9 %N 4 %P e24371 %T Dental Treatments During the COVID-19 Pandemic in Three Hospitals in Jordan: Retrospective Study %A Obeidat,Lina %A Masarwa,Nader %A AlWarawreh,Amjad %A El-Naji,Waddah %+ Dental Department, Royal Medical Services of Jordan Armed Forces, 230 King Abdulla II Street, Amman, 11733, Jordan, 962 5840840, lina_obeidat@yahoo.com %K COVID-19 %K dental treatments %K Jordan %K lockdown %K pandemic %D 2020 %7 29.12.2020 %9 Original Paper %J Interact J Med Res %G English %X Background: Cases of COVID-19 first emerged in December 2019. Since then, the virus has spread rapidly worldwide, with daily increases in the numbers of infections and deaths. COVID-19 spreads via airborne transmission, which renders dental treatment a potential source of virus transmission. Dental treatments require the use of handpieces, ultrasonic devices, or air–water syringes, which generate considerable amounts of aerosols. Jordan, being one of the affected countries, instituted preventive lockdown measures on March 17, 2020. Emergency dental treatments were only allowed in dental clinics of the Royal Medical Services of Jordan Armed Forces and Ministry of Health, and were prohibited in other sectors such as private clinics and universities. Objective: The aim of this study is to investigate the dental treatments performed in three military hospitals during the 44-day lockdown period in Jordan. The investigation explores the impact of COVID-19 on the number of patients and types of performed dental treatments. Methods: Data such as number of patients, patients’ age and gender, and performed dental treatments were collected retrospectively from the hospital records and were analyzed. Results: Our results showed a 90% (17,591 to 1689) decrease in patient visits during the lockdown period compared to regular days. The total number of treatments (n=1689) during the lockdown period varied between endodontic cases (n=877, 51.9%), extraction and other surgical cases (n=374, 22.1%), restorative cases (n=142, 8.4%), orthodontic treatments (n=4, 0.2%), and other procedures (n=292, 17.3%). The differences in gender and age group among all clinics were statistically significant (P<.001 and P=.02, respectively). Conclusions: The COVID-19 pandemic had a significant effect on the number of patients seeking dental treatments. It also affected the types of treatments performed. Endodontic treatment accounted for almost 50% of patient load during the lockdown compared to approximately 20% during regular days. %M 33325372 %R 10.2196/24371 %U http://www.i-jmr.org/2020/4/e24371/ %U https://doi.org/10.2196/24371 %U http://www.ncbi.nlm.nih.gov/pubmed/33325372 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 12 %P e24487 %T Anxiety and Suicidal Thoughts During the COVID-19 Pandemic: Cross-Country Comparative Study Among Indonesian, Taiwanese, and Thai University Students %A Pramukti,Iqbal %A Strong,Carol %A Sitthimongkol,Yajai %A Setiawan,Agus %A Pandin,Moses Glorino Rumambo %A Yen,Cheng-Fang %A Lin,Chung-Ying %A Griffiths,Mark D %A Ko,Nai-Ying %+ Institute of Allied Health Sciences, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 1 University Road, Tainan, 701, Taiwan, 886 6 2353535 ext 5720, cylin36933@gmail.com %K anxiety %K COVID-19 %K cross-country %K suicidal thoughts %K university students %D 2020 %7 24.12.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic has negatively affected the mental health of university students. Objective: This study examined the psychological responses toward COVID-19 among university students from 3 countries—Indonesia, Taiwan, and Thailand. Methods: We used a web-based, cross-sectional survey to recruit 1985 university students from 5 public universities (2 in Indonesia, 1 in Thailand, and 1 in Taiwan) via popular social media platforms such as Facebook, LINE, WhatsApp, and broadcast. All students (n=938 in Indonesia, n=734 in Thailand, and n=313 in Taiwan) answered questions concerning their anxiety, suicidal thoughts (or sadness), confidence in pandemic control, risk perception of susceptibility to infection, perceived support, resources for fighting infection, and sources of information in the context of the COVID-19 pandemic. Results: Among the 3 student groups, Thai students had the highest levels of anxiety but the lowest levels of confidence in pandemic control and available resources for fighting COVID-19. Factors associated with higher anxiety differed across countries. Less perceived satisfactory support was associated with more suicidal thoughts among Indonesian students. On the other hand, Taiwanese students were more negatively affected by information gathered from the internet and from medical staff than were Indonesian or Thai students. Conclusions: Our findings suggest that health care providers in Thailand may need to pay special attention to Thai university students given that high levels of anxiety were observed in this study population. In addition, health care providers should establish a good support system for university students, as the results of this study indicate a negative association between support and suicidal thoughts. %M 33296867 %R 10.2196/24487 %U http://www.jmir.org/2020/12/e24487/ %U https://doi.org/10.2196/24487 %U http://www.ncbi.nlm.nih.gov/pubmed/33296867 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 12 %P e22740 %T Social Capital–Accrual, Escape-From-Self, and Time-Displacement Effects of Internet Use During the COVID-19 Stay-at-Home Period: Prospective, Quantitative Survey Study %A Cheng,Cecilia %A Lau,Yan-Ching %A Luk,Jeremy W %+ Social and Health Psychology Laboratory, Department of Psychology, The University of Hong Kong, Centennial Campus, Pokfulam Road, Hong Kong, Hong Kong, 852 39174224, ceci-cheng@hku.hk %K coping %K coronavirus %K COVID-19 %K cyberaggression %K cybervictimization %K epidemic %K gaming %K mental health %K psychological well-being %K social networking %K social support %D 2020 %7 24.12.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: COVID-19 has spread like wildfire across the globe, prompting many governments to impose unprecedented stay-at-home orders to limit its transmission. During an extended stay-at-home period, individuals may engage in more online leisure activities. Internet use is a double-edged sword that may have both desirable and undesirable effects on psychological well-being, and this study sought to disentangle adaptive from maladaptive internet use amidst this unusual health crisis. Objective: The objectives of this study were to assess the prevalence of probable depression during the COVID-19 stay-at-home period and to test three hypothesized risk reduction or risk elevation mechanisms, namely social capital–accrual, escape-from-self, and time-displacement effects. Methods: This study took place from March to May 2020 at the early stage of the pandemic. The study adopted a prospective design, with an online survey administered to 573 UK and 474 US adult residents at two assessment points 2 months apart. Results: The prevalence of moderate to severe depression was 36% (bootstrap bias-corrected and accelerated [BCa] 95% CI 33%-39%) at Time 1 (ie, initial time point) and 27% (bootstrap BCa 95% CI 25%-30%) at Time 2 (ie, follow-up time point). The results supported the social capital–accrual hypothesis by showing that the approach coping style was inversely associated with Time 2 depression through its positive associations with both social networking and perceived family support. The results also supported the escape-from-self hypothesis by revealing that the avoidant coping style was positively associated with Time 2 depression through its positive associations with both gaming and cyberbullying victimization, but the serial mediation model was no longer significant after Time 1 depression and some demographic risk factors had been controlled for. Finally, the results supported the time-displacement hypothesis by showing that gaming was positively associated with Time 2 depression through its inverse associations with social networking and perceived family support. Conclusions: During the extended stay-at-home period in the early stages of the COVID-19 pandemic, the prevalence of probable depression during the 2-month study period was high among the UK and US residents. Individuals with distinct coping styles may engage in different types of online leisure activities and perceive varying levels of social support, which are associated with risks of probable depression. %M 33320824 %R 10.2196/22740 %U http://www.jmir.org/2020/12/e22740/ %U https://doi.org/10.2196/22740 %U http://www.ncbi.nlm.nih.gov/pubmed/33320824 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 4 %P e25174 %T Public Health Interventions’ Effect on Hospital Use in Patients With COVID-19: Comparative Study %A Wang,Xiaofeng %A Ren,Rui %A Kattan,Michael W %A Jehi,Lara %A Cheng,Zhenshun %A Fang,Kuangnan %+ Department of Quantitative Health Sciences, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, United States, 1 216 445 7737, wangx6@ccf.org %K COVID-19 %K public health %K intervention %K hospital %K use %K prediction %K comparative %K United States %K China %K implementation %K observational %D 2020 %7 23.12.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Different states in the United States had different nonpharmaceutical public health interventions during the COVID-19 pandemic. The effects of those interventions on hospital use have not been systematically evaluated. The investigation could provide data-driven evidence to potentially improve the implementation of public health interventions in the future. Objective: We aim to study two representative areas in the United States and one area in China (New York State, Ohio State, and Hubei Province), and investigate the effects of their public health interventions by time periods according to key interventions. Methods: This observational study evaluated the numbers of infected, hospitalized, and death cases in New York and Ohio from March 16 through September 14, 2020, and Hubei from January 26 to March 31, 2020. We developed novel Bayesian generalized compartmental models. The clinical stages of COVID-19 were stratified in the models, and the effects of public health interventions were modeled through piecewise exponential functions. Time-dependent transmission rates and effective reproduction numbers were estimated. The associations of interventions and the numbers of required hospital and intensive care unit beds were studied. Results: The interventions of social distancing, home confinement, and wearing masks significantly decreased (in a Bayesian sense) the case incidence and reduced the demand for beds in all areas. Ohio’s transmission rates declined before the state’s “stay at home” order, which provided evidence that early intervention is important. Wearing masks was significantly associated with reducing the transmission rates after reopening, when comparing New York and Ohio. The centralized quarantine intervention in Hubei played a significant role in further preventing and controlling the disease in that area. The estimated rates that cured patients become susceptible in all areas were small (<0.0001), which indicates that they have little chance to get the infection again. Conclusions: The series of public health interventions in three areas were temporally associated with the burden of COVID-19–attributed hospital use. Social distancing and the use of face masks should continue to prevent the next peak of the pandemic. %M 33315585 %R 10.2196/25174 %U http://publichealth.jmir.org/2020/4/e25174/ %U https://doi.org/10.2196/25174 %U http://www.ncbi.nlm.nih.gov/pubmed/33315585 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 4 %P e24598 %T The Use of Digital Tools to Mitigate the COVID-19 Pandemic: Comparative Retrospective Study of Six Countries %A Zeng,Kylie %A Bernardo,Stephanie N %A Havins,Weldon E %+ College of Osteopathic Medicine, Touro University Nevada, 874 American Pacific Dr #8801, Henderson, NV, 89014, United States, 1 702 777 8687, kzeng2@student.touro.edu %K COVID-19 %K digital tool %K policy %K proposal %K digital health %K precaution %K spread %K contact tracing %K public health %D 2020 %7 23.12.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Since the COVID-19 outbreak began in Wuhan, China, countries worldwide have been forced to take unprecedented measures to combat it. While some countries are still grappling with the COVID-19 pandemic, others have fared better and have re-established relative normalcy quickly. The rapid transmission rate of the virus has shown a greater need for efficient and technologically modern containment measures. The use of digital tools to facilitate strict containment measures in countries that have fared well against the COVID-19 pandemic has sparked both interest and controversy. Objective: In this study, we compare the precautions taken against the spread of COVID-19 in the United States, Spain, and Italy, with Taiwan, South Korea, and Singapore, particularly related to the use of digital tools for contact tracing, and propose policies that could be used in the United States for future COVID-19 waves or pandemics. Methods: COVID-19 death rate data were obtained from the European Center for Disease Prevention and Control (ECDC), accessed through the Our World in Data database, and were evaluated based on population size per 100,000 people from December 31, 2019, to September 6, 2020. All policies and measures enacted were obtained from their respective governmental websites. Results: We found a strong association between lower death rates per capita and countries that implemented early mask use and strict border control measures that included mandatory quarantine using digital tools. There is a significant difference in the number of deaths per 100,000 when comparing Taiwan, South Korea, and Singapore with the United States, Spain, and Italy. Conclusions: Based on our research, it is evident that early intervention with the use of digital tools had a strong correlation with the successful containment of COVID-19. Infection rates and subsequent deaths in Italy, Spain, and the United States could have been much lower with early mask use and, more importantly, timely border control measures using modern digital tools. Thus, we propose that the United States execute the following national policies should a public health emergency be declared: (1) immediately establish a National Command responsible for enacting strict mandatory guidelines enforced by federal and state governments, including national mask use; (2) mandate civilian cooperation with health officials in contact tracing and quarantine orders; and (3) require incoming travelers to the United States and those quarantined to download a contact tracing app. We acknowledge the countries we studied differ in their cultures, political systems, and reporting criteria for COVID-19 deaths. Further research may need to be conducted to address these limitations; however, we believe that the proposed policies could protect the American public. %M 33302255 %R 10.2196/24598 %U http://publichealth.jmir.org/2020/4/e24598/ %U https://doi.org/10.2196/24598 %U http://www.ncbi.nlm.nih.gov/pubmed/33302255 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 4 %P e23902 %T County-Level Social Distancing and Policy Impact in the United States: A Dynamical Systems Model %A McKee,Kevin L %A Crandell,Ian C %A Hanlon,Alexandra L %+ Center for Biostatistics and Health Data Science, Virginia Tech, One Riverside Circle, Suite 104, Roanoke, VA, 24016, United States, 1 703 593 1690, klmckee@vt.edu %K pandemic %K SARS-CoV-2 %K infection control %K COVID-19 %K social distancing %K lockdown %K nonpharmaceutical interventions %K public health %K intervention %K model %K infectious disease %K policy %D 2020 %7 23.12.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Social distancing and public policy have been crucial for minimizing the spread of SARS-CoV-2 in the United States. Publicly available, county-level time series data on mobility are derived from individual devices with global positioning systems, providing a variety of indices of social distancing behavior per day. Such indices allow a fine-grained approach to modeling public behavior during the pandemic. Previous studies of social distancing and policy have not accounted for the occurrence of pre-policy social distancing and other dynamics reflected in the long-term trajectories of public mobility data. Objective: We propose a differential equation state-space model of county-level social distancing that accounts for distancing behavior leading up to the first official policies, equilibrium dynamics reflected in the long-term trajectories of mobility, and the specific impacts of four kinds of policy. The model is fit to each US county individually, producing a nationwide data set of novel estimated mobility indices. Methods: A differential equation model was fit to three indicators of mobility for each of 3054 counties, with T=100 occasions per county of the following: distance traveled, visitations to key sites, and the log number of interpersonal encounters. The indicators were highly correlated and assumed to share common underlying latent trajectory, dynamics, and responses to policy. Maximum likelihood estimation with the Kalman-Bucy filter was used to estimate the model parameters. Bivariate distributional plots and descriptive statistics were used to examine the resulting county-level parameter estimates. The association of chronology with policy impact was also considered. Results: Mobility dynamics show moderate correlations with two census covariates: population density (Spearman r ranging from 0.11 to 0.31) and median household income (Spearman r ranging from –0.03 to 0.39). Stay-at-home order effects were negatively correlated with both (r=–0.37 and r=–0.38, respectively), while the effects of the ban on all gatherings were positively correlated with both (r=0.51, r=0.39). Chronological ordering of policies was a moderate to strong determinant of their effect per county (Spearman r ranging from –0.12 to –0.56), with earlier policies accounting for most of the change in mobility, and later policies having little or no additional effect. Conclusions: Chronological ordering, population density, and median household income were all associated with policy impact. The stay-at-home order and the ban on gatherings had the largest impacts on mobility on average. The model is implemented in a graphical online app for exploring county-level statistics and running counterfactual simulations. Future studies can incorporate the model-derived indices of social distancing and policy impacts as important social determinants of COVID-19 health outcomes. %M 33296866 %R 10.2196/23902 %U http://publichealth.jmir.org/2020/4/e23902/ %U https://doi.org/10.2196/23902 %U http://www.ncbi.nlm.nih.gov/pubmed/33296866 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 12 %P e25442 %T An Artificial Intelligence Model to Predict the Mortality of COVID-19 Patients at Hospital Admission Time Using Routine Blood Samples: Development and Validation of an Ensemble Model %A Ko,Hoon %A Chung,Heewon %A Kang,Wu Seong %A Park,Chul %A Kim,Do Wan %A Kim,Seong Eun %A Chung,Chi Ryang %A Ko,Ryoung Eun %A Lee,Hooseok %A Seo,Jae Ho %A Choi,Tae-Young %A Jaimes,Rafael %A Kim,Kyung Won %A Lee,Jinseok %+ Biomedical Engineering, Wonkwang University, Iksan Daero, Iksan, 54538, Republic of Korea, 82 1638506970, gonasago@gmail.com %K COVID-19 %K artificial intelligence %K blood samples %K mortality prediction %D 2020 %7 23.12.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: COVID-19, which is accompanied by acute respiratory distress, multiple organ failure, and death, has spread worldwide much faster than previously thought. However, at present, it has limited treatments. Objective: To overcome this issue, we developed an artificial intelligence (AI) model of COVID-19, named EDRnet (ensemble learning model based on deep neural network and random forest models), to predict in-hospital mortality using a routine blood sample at the time of hospital admission. Methods: We selected 28 blood biomarkers and used the age and gender information of patients as model inputs. To improve the mortality prediction, we adopted an ensemble approach combining deep neural network and random forest models. We trained our model with a database of blood samples from 361 COVID-19 patients in Wuhan, China, and applied it to 106 COVID-19 patients in three Korean medical institutions. Results: In the testing data sets, EDRnet provided high sensitivity (100%), specificity (91%), and accuracy (92%). To extend the number of patient data points, we developed a web application (BeatCOVID19) where anyone can access the model to predict mortality and can register his or her own blood laboratory results. Conclusions: Our new AI model, EDRnet, accurately predicts the mortality rate for COVID-19. It is publicly available and aims to help health care providers fight COVID-19 and improve patients’ outcomes. %M 33301414 %R 10.2196/25442 %U http://www.jmir.org/2020/12/e25442/ %U https://doi.org/10.2196/25442 %U http://www.ncbi.nlm.nih.gov/pubmed/33301414 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 4 %P e20343 %T Canada’s Decentralized “Human-Driven” Approach During the Early COVID-19 Pandemic %A Hansen,Gregory %A Cyr,Amelie %+ Jim Pattison Children's Hospital, 103 Hospital Drive, Pediatric Intensive Care Unit, Saskatoon, SK, S7N 0W8, Canada, 1 306 655 1000, gregory.hansen@usask.ca %K COVID-19 %K coronavirus infection %K public health %D 2020 %7 23.12.2020 %9 Viewpoint %J JMIR Public Health Surveill %G English %X A country’s early response to a pandemic is critical for controlling the disease outbreak. During the COVID-19 pandemic, a number of southeast Asian countries adopted centralized, coordinated, rapid, and comprehensive approaches that involved smart technology (the “techno-driven” approach). In comparison, Canada’s approach appeared to be decentralized, uncoordinated, and slow, and it focused on educating citizens and enhancing social and human capital (the “human-driven” approach). We propose that in future pandemics, early and coordinated “techno-driven” approaches should receive more careful consideration to curtail outbreaks; however, these approaches must be balanced with protecting individuals’ freedoms. %M 33315582 %R 10.2196/20343 %U http://publichealth.jmir.org/2020/4/e20343/ %U https://doi.org/10.2196/20343 %U http://www.ncbi.nlm.nih.gov/pubmed/33315582 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 12 %P e25117 %T COVID-19 as ‘Game Changer’ for the Physical Activity and Mental Well-Being of Augmented Reality Game Players During the Pandemic: Mixed Methods Survey Study %A Ellis,Louise A %A Lee,Matthew D %A Ijaz,Kiran %A Smith,James %A Braithwaite,Jeffrey %A Yin,Kathleen %+ Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Level 6, Talavera Road, North Ryde, 2109, Australia, 61 298502484, louise.ellis@mq.edu.au %K COVID-19 %K Pokémon GO %K Harry Potter: Wizards Unite %K augmented reality games %K physical activity %K mental health %K well-being %D 2020 %7 22.12.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Location-based augmented reality (AR) games, such as Pokémon GO and Harry Potter: Wizards Unite, have been shown to have a beneficial impact on the physical activity, social connectedness, and mental health of their players. In March 2020, global social distancing measures related to the COVID-19 pandemic prompted the AR games developer Niantic Inc to implement several changes to ensure continued player engagement with Pokémon GO and Harry Potter: Wizards Unite. We sought to examine how the physical and mental well-being of players of these games were affected during the unprecedented COVID-19 restriction period as well as how their video game engagement was affected. Objective: The aims of this study were to examine the impact of COVID-19–related social restrictions on the physical and mental well-being of AR game players; to examine the impact of COVID-19–related social restrictions on the use of video games and motivations for their use; and to explore the potential role of AR games (and video games in general) in supporting well-being during COVID-19–related social restrictions. Methods: A mixed methods web-based self-reported survey was conducted in May 2020, during which COVID-19–related social restrictions were enforced in many countries. Participants were recruited on the web via four subreddits dedicated to Pokémon GO or Harry Potter: Wizards Unite. Data collected included quantitative data on demographics, time spent playing video games, physical activity, and mental health; qualitative data included motivations to play and the impact of video games on mental health during COVID-19 lockdown. Results: We report results for 2004 participants (1153/1960 male, 58.8%, average age 30.5 years). Self-reported physical activity during COVID-19–related social restrictions significantly decreased from 7.50 hours per week on average (SD 11.12) to 6.50 hours (SD 7.81) (P<.001). More than half of the participants reported poor mental health (925/1766, 52.4%; raw World Health Organization–5 Well-Being Index score <13). Female gender, younger age, and reduced exercise were significant predictors of poor mental health. Participants reported a significant increase in video game play time from 16.38 hours per week on average (SD 19.12) to 20.82 hours (SD 17.49) (P<.001). Approximately three quarters of the participants (n=1102/1427, 77.2%) reported that playing video games had been beneficial to their mental health. The changes made to Pokémon GO and Harry Potter: Wizards Unite were very well received by players, and the players continued to use these games while exercising and to maintain social connection. In addition to seeking an escape during the pandemic and as a form of entertainment, participants reported that they used video games for emotional coping and to lower stress, relax, and alleviate mental health conditions. Conclusions: AR games have the potential to promote physical and mental health during the COVID-19 pandemic. Used by populations under isolation and distress, these games can improve physical and mental health by providing virtual socialization, sustained exercise, temporal routine, and mental structure. Further research is needed to explore the potential of AR games as digital behavioral interventions to maintain human well-being in the wider population. %M 33284781 %R 10.2196/25117 %U http://www.jmir.org/2020/12/e25117/ %U https://doi.org/10.2196/25117 %U http://www.ncbi.nlm.nih.gov/pubmed/33284781 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 3 %N 2 %P e25607 %T Secondary Prevention of Hip Fragility Fractures During the COVID-19 Pandemic: Service Evaluation of “MRS BAD BONES” %A Stephens,Alastair %A Rudd,Hannah %A Stephens,Emilia %A Ward,Jayne %+ Trauma and Orthopaedic Department, University Hospital Coventry and Warwickshire, Clifford Bridge Road, Coventry, CV2 2DX, United Kingdom, 44 7805909974, alastair.stephens@nhs.net %K osteoporosis %K fragility fracture %K guideline %K mnemonic %K acronym %K COVID-19 %K bone %K morbidity %K mortality %K fracture %K elderly %K older adults %K geriatrics %K audit %K prevention %D 2020 %7 22.12.2020 %9 Original Paper %J JMIR Aging %G English %X Background: Management of osteoporosis is an important consideration for patients with femoral neck fractures due to the morbidity and mortality it poses. The input of orthogeriatric teams is invaluable in coordinating secondary fragility fracture prevention. The COVID-19 pandemic resulted in the rapid restructuring of health care teams and led to the redeployment of orthogeriatricians. Objective: This study aimed to determine the impact COVID-19 had on the secondary prevention of fragility fractures among patients with femoral neck fractures, and to optimize management in this population. Methods: A retrospective audit was conducted of patients with femoral neck fractures before and after the lockdown in response to the COVID-19 pandemic in the United Kingdom. A reaudit was conducted following the development of our new mnemonic, “MRS BAD BONES,” which addressed key factors in the assessment and management of osteoporosis: medication review, rheumatology/renal advice, smoking cessation; blood tests, alcohol limits, DEXA (dual energy X-ray absorptiometry) scan; bone-sparing medications, orthogeriatric review, nutrition, exercise, supplements. The Fisher exact test was used for comparison analyses between each phase. Results: Data for 50 patients were available in each phase. The orthogeriatric team reviewed 88% (n=44) of patients prelockdown, which fell to 0% due to redeployment, before recovering to 38% (n=19) in the postintervention period. The lockdown brought a significant drop in the prescription of vitamin D/calcium supplements from 81.6% (n=40) to 58.0% (n=29) (P=.02); of bone-sparing medications from 60.7% (n=17) to 18.2% (n=4) (P=.004), and DEXA scan requests from 40.1% (n=9) to 3.6% (n=1) (P=.003). Following the implementation of our mnemonic, there was a significant increase in the prescription of vitamin D/calcium supplements to 85.7% (n=42) (P=.003), bone-sparing medications to 72.4% (n=21) (P<.001), and DEXA scan requests to 60% (n=12) (P<.001). Conclusions: The redeployment of the orthogeriatric team, due to the COVID-19 pandemic, impacted the secondary prevention of fragility fractures in the study population. The “MRS BAD BONES” mnemonic significantly improved management and could be used in a wider setting. %M 33326412 %R 10.2196/25607 %U https://aging.jmir.org/2020/2/e25607 %U https://doi.org/10.2196/25607 %U http://www.ncbi.nlm.nih.gov/pubmed/33326412 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 8 %N 4 %P e25226 %T A Mobile Serious Game About the Pandemic (COVID-19 - Did You Know?): Design and Evaluation Study %A Gaspar,Juliano De Souza %A Lage,Eura Martins %A Silva,Fernando José Da %A Mineiro,Érico %A Oliveira,Isaias José Ramos De %A Oliveira,Igor %A Souza,Rayner Guilherme De %A Gusmão,Juan Rodrigues Oliveira %A De Souza,Camila Fernanda Donadoni %A Reis,Zilma Silveira Nogueira %+ Faculdade de Medicina, Universidade Federal de Minas Gerais, Rua Alfredo Balena, 190, Belo Horizonte, 30130-100, Brazil, 55 313409 0000, julianogaspar@gmail.com %K coronavirus %K COVID-19 %K e-learning %K mHealth %K digital health %K gamification %K serious game %K mobile apps %K public health %K informatics %D 2020 %7 22.12.2020 %9 Original Paper %J JMIR Serious Games %G English %X Background: No treatment for COVID-19 is yet available; therefore, providing access to information about SARS-CoV-2, the transmission route of the virus, and ways to prevent the spread of infection is a critical sanitary measure worldwide. Serious games have advantages in the dissemination of reliable information during the pandemic; they can provide qualified content while offering interactivity to the user, and they have great reach over the internet. Objective: This study aimed to develop a serious game with the purpose of providing science-based information on the prevention of COVID-19 and personal care during the pandemic while assessing players’ knowledge about COVID-19–related topics. Methods: The study was conducted with the interdisciplinary collaboration of specialists in health sciences, computing, and design at the Federal University of Minas Gerais, Brazil. The health recommendations were grouped into six thematic blocks, presented in a quiz format. The software languages were based on the progressive web app development methodology with the Ionic framework, JavaScript, HTML5, cascading style sheets, and TypeScript (Angular). Open data reports of how users interact with the serious game were obtained using the Google Analytics application programming interface. The visual identity, logo, infographics, and icons were carefully developed by considering a selection of colors, typography, sounds, and images that are suitable for young audiences. Cards with cartoon characters were introduced at the end of each thematic topic to interact with the player, reinforcing their correct answers or alerting them to the need to learn more about the disease. The players’ performance was assessed by the rate of incorrect and correct answers and analyzed by linear correlation coefficient over 7 weeks. The agile SCRUM development methodology enabled quick and daily interactions of developers through a webchat and sequential team meetings. Results: The game “COVID-19–Did You Know?” was made available for free on a public university website on April 1, 2020. The game had been accessed 17,571 times as of September 2020. Dissemination actions such as reports on social media and television showed a temporal correspondence with the access number. The players’ error rate in the topic “Mask” showed a negative trend (r=–.83; P=.01) over the weeks of follow-up. The other topics showed no significant trend over the weeks. Conclusions: The gamification strategy for health education content on the theme of COVID-19 reached a young audience, which is considered to be a priority in the strategy of orientation toward social distancing. Specific educational reinforcement measures were proposed and implemented based on the players’ performance. The improvement in the users’ performance on the topic about the use of masks may reflect an increase in information about or adherence to mask use over time. %M 33301416 %R 10.2196/25226 %U http://games.jmir.org/2020/4/e25226/ %U https://doi.org/10.2196/25226 %U http://www.ncbi.nlm.nih.gov/pubmed/33301416 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 12 %P e25137 %T Wearables in the SARS-CoV-2 Pandemic: What Are They Good for? %A Bent,Brinnae %A Dunn,Jessilyn P %+ Department of Biomedical Engineering, Duke University, 2424 Erwin Road, Durham, NC, 27705, United States, 1 9196689798, jessilyn.dunn@duke.edu %K digital medicine %K digital health %K mHealth %K wearables %K sensors %K validation %K pandemic %K COVID-19 %D 2020 %7 22.12.2020 %9 Viewpoint %J JMIR Mhealth Uhealth %G English %X Recently, companies such as Apple Inc, Fitbit Inc, and Garmin Ltd have released new wearable blood oxygenation measurement technologies. Although the release of these technologies has great potential for generating health-related information, it is important to acknowledge the repercussions of consumer-targeted biometric monitoring technologies (BioMeTs), which in practice, are often used for medical decision making. BioMeTs are bodily connected digital medicine products that process data captured by mobile sensors that use algorithms to generate measures of behavioral and physiological function. These BioMeTs span both general wellness products and medical devices, and consumer-targeted BioMeTs intended for general wellness purposes are not required to undergo a standardized and transparent evaluation process for ensuring their quality and accuracy. The combination of product functionality, marketing, and the circumstances of the global SARS-CoV-2 pandemic have inevitably led to the use of consumer-targeted BioMeTs for reporting health-related measurements to drive medical decision making. In this viewpoint, we urge consumer-targeted BioMeT manufacturers to go beyond the bare minimum requirements described in US Food and Drug Administration guidance when releasing information on wellness BioMeTs. We also explore new methods and incentive systems that may result in a clearer public understanding of the performance and intended use of consumer-targeted BioMeTs. %M 33315580 %R 10.2196/25137 %U http://mhealth.jmir.org/2020/12/e25137/ %U https://doi.org/10.2196/25137 %U http://www.ncbi.nlm.nih.gov/pubmed/33315580 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 7 %N 12 %P e24761 %T Patient Attitudes Toward Telepsychiatry During the COVID-19 Pandemic: A Nationwide, Multisite Survey %A Guinart,Daniel %A Marcy,Patricia %A Hauser,Marta %A Dwyer,Michael %A Kane,John M %+ Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, 7559 263rd St, New York, NY, United States, 1 7184704139, daniguinart@gmail.com %K telehealth %K telepsychiatry %K telemedicine %K attitude %K patients %K survey %K COVID-19 %K mental health %D 2020 %7 22.12.2020 %9 Original Paper %J JMIR Ment Health %G English %X Background: The COVID-19 pandemic and its associated movement restrictions forced a rapid and massive transition to telepsychiatry to successfully maintain care continuity. Objective: The aim of this study is to examine a large number of patients’ experiences of, use of, and attitudes toward telepsychiatry. Methods: An anonymous 11-question survey was delivered electronically to 14,000 patients receiving telepsychiatry care at 18 participating centers across 11 US states between the months of April and June 2020, including questions about their age and length of service use, as well as experience and satisfaction with telepsychiatry on a 5-point Likert scale. Descriptive statistics were used to analyze and report data. Results: In total, 3070 patients with different age ranges participated. The overall experience using telepsychiatry was either excellent or good for 1189 (82.2%) participants using video and 2312 (81.5%) using telephone. In addition, 1922 (63.6%) patients either agreed or strongly agreed that remote treatment sessions (telephone or video) have been just as helpful as in-person treatment. Lack of commute (n=1406, 46.1%) and flexible scheduling/rescheduling (n=1389, 45.5%) were frequently reported advantages of telepsychiatry, whereas missing the clinic/hospital (n=936, 30.7%) and not feeling as connected to their doctor/nurse/therapist (n=752, 24.6%) were the most frequently reported challenges. After the current pandemic resolves, 1937 (64.2%) respondents either agreed or strongly agreed that they would consider using remote treatment sessions in the future. Conclusions: Telepsychiatry is very well perceived among a large sample of patients. After the current pandemic resolves, some patients may benefit from continued telepsychiatry, but longitudinal studies are needed to assess impact on clinical outcomes and determine whether patients’ perceptions change over time. %M 33302254 %R 10.2196/24761 %U http://mental.jmir.org/2020/12/e24761/ %U https://doi.org/10.2196/24761 %U http://www.ncbi.nlm.nih.gov/pubmed/33302254 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 4 %P e24206 %T Anxiety and Sleep Disturbances Among Health Care Workers During the COVID-19 Pandemic in India: Cross-Sectional Online Survey %A Gupta,Bhawna %A Sharma,Vyom %A Kumar,Narinder %A Mahajan,Akanksha %+ Torrens University, Public Health, 196 Flinders street, Melbourne, Australia, 61 1300 575 803, bhawna.gupta@laureate.edu.au %K occupational epidemiology %K anxiety %K GAD-7 %K sleep quality %K health care worker %K pandemic %K COVID-19 %K online survey %K sleep %K mental health, personal protective equipment %D 2020 %7 22.12.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The COVID-19 pandemic caused by SARS-CoV-2 has become a serious concern among the global medical community and has resulted in an unprecedented psychological impact on health care workers, who were already working under stressful conditions. Objective: In this study, we aimed to evaluate and measure the effects of the COVID-19 pandemic on the anxiety levels and sleep quality among health care workers in India, as well as to determine how the unavailability of personal protective equipment affects their willingness to provide patient-related care. Methods: We conducted an online cross-sectional study using piloted, structured questionnaires with self-reported responses from 368 volunteer male and female health care workers in India. Study participants were identified through social networking platforms such as Facebook and WhatsApp. The survey evaluated the participants’ degree of signs and symptoms of anxiety and sleep quality based on the 7-item Generalized Anxiety Disorder (GAD-7) scale and single-item Sleep Quality Scale, respectively. Information on the availability of personal protective equipment was collected based on responses to relevant survey questions. Results: The majority of health care workers (126/368, 34.2%) were in the age group 45-60 years, and 52.2% (192/368) were doctors. Severe anxiety (ie, GAD-7 score >10) was observed among 7.3% (27/368) health care workers, whereas moderate, mild, and minimal anxiety was observed among 12.5% (46/368), 29.3% (108/368), and 50.8% (187/368) health care workers, respectively. Moreover, 31.5% (116/368) of the health care workers had poor-to-fair sleep quality (ie, scores <6). Univariate analysis showed female gender and inadequate availability of personal protective equipment was significantly associated with higher anxiety levels (P=.01 for both). Sleep disturbance was significantly associated with age <30 years (P=.04) and inadequate personal protective equipment (P<.001). Multivariable analysis showed that poorer quality of sleep was associated with higher anxiety levels (P<.001). Conclusions: The COVID-19 pandemic has potentially caused significant levels of anxiety and sleep disturbances among health care workers, particularly associated with the female gender, younger age group, and inadequate availability of personal protective equipment. These factors put health care workers at constant risk of contracting the infection themselves or transmitting it to their families. Early identification of at-risk health care workers and implementation of situation-tailored mitigation measures could help alleviate the risk of long-term, serious psychological sequelae as well as reduce current anxiety levels among health care workers. %M 33284784 %R 10.2196/24206 %U https://publichealth.jmir.org/2020/4/e24206 %U https://doi.org/10.2196/24206 %U http://www.ncbi.nlm.nih.gov/pubmed/33284784 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 8 %N 12 %P e20567 %T Global Infectious Disease Surveillance and Case Tracking System for COVID-19: Development Study %A Lee,Hsiu-An %A Kung,Hsin-Hua %A Lee,Yuarn-Jang %A Chao,Jane C-J %A Udayasankaran,Jai Ganesh %A Fan,Hueng-Chuen %A Ng,Kwok-Keung %A Chang,Yu-Kang %A Kijsanayotin,Boonchai %A Marcelo,Alvin B %A Hsu,Chien-Yeh %+ Department of Information Management, National Taipei University of Nursing and Health Sciences, 365 Ming-te Road, Peitou District, Taipei, 11219, Taiwan, 886 28227101, cyhsu@ntunhs.edu.tw %K blockchain %K infectious disease surveillance %K international collaboration %K HL7 FHIR %K COVID-19 defense %K COVID-19 %D 2020 %7 22.12.2020 %9 Original Paper %J JMIR Med Inform %G English %X Background: COVID-19 has affected more than 180 countries and is the first known pandemic to be caused by a new virus. COVID-19’s emergence and rapid spread is a global public health and economic crisis. However, investigations into the disease, patient-tracking mechanisms, and case report transmissions are both labor-intensive and slow. Objective: The pandemic has overwhelmed health care systems, forcing hospitals and medical facilities to find effective ways to share data. This study aims to design a global infectious disease surveillance and case tracking system that can facilitate the detection and control of COVID-19. Methods: The International Patient Summary (IPS; an electronic health record that contains essential health care information about a patient) was used. The IPS was designed to support the used case scenario for unplanned cross-border care. The design, scope, utility, and potential for reuse of the IPS for unplanned cross-border care make it suitable for situations like COVID-19. The Fast Healthcare Interoperability Resources confirmed that IPS data, which includes symptoms, therapies, medications, and laboratory data, can be efficiently transferred and exchanged on the system for easy access by physicians. To protect privacy, patient data are deidentified. All systems are protected by blockchain architecture, including data encryption, validation, and exchange of records. Results: To achieve worldwide COVID-19 surveillance, a global infectious disease information exchange must be enacted. The COVID-19 surveillance system was designed based on blockchain architecture. The IPS was used to exchange case study information among physicians. After being verified, physicians can upload IPS files and receive IPS data from other global cases. The system includes a daily IPS uploading and enhancement plan, which covers real-time uploading through the interoperation of the clinic system, with the module based on the Open Application Programming Interface architecture. Through the treatment of different cases, drug treatments, and the exchange of treatment results, the disease spread can be controlled, and treatment methods can be funded. In the Infectious Disease Case Tracking module, we can track the moving paths of infectious disease cases. The location information recorded in the blockchain is used to check the locations of different cases. The Case Tracking module was established for the Centers for Disease Control and Prevention to track cases and prevent disease spread. Conclusions: We created the IPS of infectious diseases for physicians treating patients with COVID-19. Our system can help health authorities respond quickly to the transmission and spread of unknown diseases, and provides a system for information retrieval on disease transmission. In addition, this system can help researchers form trials and analyze data from different countries. A common forum to facilitate the mutual sharing of experiences, best practices, therapies, useful medications, and clinical intervention outcomes from research in various countries could help control an unknown virus. This system could be an effective tool for global collaboration in evidence-based efforts to fight COVID-19. %M 33320826 %R 10.2196/20567 %U http://medinform.jmir.org/2020/12/e20567/ %U https://doi.org/10.2196/20567 %U http://www.ncbi.nlm.nih.gov/pubmed/33320826 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 7 %N 12 %P e23776 %T Ethics of Digital Mental Health During COVID-19: Crisis and Opportunities %A Martinez-Martin,Nicole %A Dasgupta,Ishan %A Carter,Adrian %A Chandler,Jennifer A %A Kellmeyer,Philipp %A Kreitmair,Karola %A Weiss,Anthony %A Cabrera,Laura Y %+ Department of Pediatrics, Center for Biomedical Ethics, School of Medicine, Stanford University, 1215 Welch Road, Modular A, Stanford, CA, 94305, United States, 1 6507235760, nicolemz@stanford.edu %K ethics %K digital mental health %K neuroethics %K mental health %K COVID-19 %K crisis %K opportunity %K implementation %K online tool %K telehealth %D 2020 %7 22.12.2020 %9 Viewpoint %J JMIR Ment Health %G English %X Social distancing measures due to the COVID-19 pandemic have accelerated the adoption and implementation of digital mental health tools. Psychiatry and therapy sessions are being conducted via videoconferencing platforms, and the use of digital mental health tools for monitoring and treatment has grown. This rapid shift to telehealth during the pandemic has given added urgency to the ethical challenges presented by digital mental health tools. Regulatory standards have been relaxed to allow this shift to socially distanced mental health care. It is imperative to ensure that the implementation of digital mental health tools, especially in the context of this crisis, is guided by ethical principles and abides by professional codes of conduct. This paper examines key areas for an ethical path forward in this digital mental health revolution: privacy and data protection, safety and accountability, and access and fairness. %M 33156811 %R 10.2196/23776 %U https://mental.jmir.org/2020/12/e23776 %U https://doi.org/10.2196/23776 %U http://www.ncbi.nlm.nih.gov/pubmed/33156811 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 12 %P e25051 %T Physical Activity, Nutritional Habits, and Sleep Behavior Among Health Profession Students and Employees of a Swiss University During and After COVID-19 Confinement: Protocol for a Longitudinal Observational Study %A Rogan,Slavko %A Luijckx,Eefje %A Taeymans,Jan %A Haas,Karin %A Baur,Heiner %+ Department of Health Professions, Bern University of Applied Sciences, Murtenstr. 10, Bern, 3008, Switzerland, 41 31 848 35 56, slavko.rogan@bfh.ch %K healthy lifestyle %K pandemic %K public health %K universities %K COVID-19 %K SARS-CoV-2 %D 2020 %7 22.12.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: SARS-CoV-2, a novel coronavirus strain, has resulted in the COVID-19 pandemic since early 2020. To contain the transmission of this virus, the Swiss Federal Council ordered a nationwide lockdown of all nonessential businesses. Accordingly, students and employees of institutions for higher education were informed to continue their academic programs through home-office settings and online lectures. Objective: This longitudinal survey aims to evaluate various lifestyle habits such as physical activity, nutritional habits, and sleep behavior among students and employees of a Swiss University of Applied Sciences during a 2-month period of confinement and social distancing due to the COVID-19 pandemic and 1 year thereafter. Methods: This paper describes a protocol for a retrospective and prospective observational cohort study. Students and employees of Bern University of Applied Sciences, Department of Health Professions, were invited to anonymously complete a web-based survey during the COVID-19 confinement period. This will be followed by a second survey, scheduled 1 year after the lockdown. Information on various lifestyle aspects, including physical activity, nutritional habits, and sleep behavior, will be collected using adaptations of existing validated questionnaires. Results: This longitudinal study started during the government-ordered confinement period in Switzerland in mid-April 2020 and will end in mid-2021. Conclusions: The findings of this survey will provide information about the impact of confinement during the COVID-19 crisis on the physical activity, nutritional habits, and sleep behavior of students and employees of a Swiss institute. Trial Registration: ClinicalTrials.gov NCT04502108; https://www.clinicaltrials.gov/ct2/show/NCT04502108 International Registered Report Identifier (IRRID): DERR1-10.2196/25051 %M 33296868 %R 10.2196/25051 %U http://www.researchprotocols.org/2020/12/e25051/ %U https://doi.org/10.2196/25051 %U http://www.ncbi.nlm.nih.gov/pubmed/33296868 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 12 %P e25469 %T Factors Influencing Patients’ Initial Decisions Regarding Telepsychiatry Participation During the COVID-19 Pandemic: Telephone-Based Survey %A Severe,Jennifer %A Tang,Ruiqi %A Horbatch,Faith %A Onishchenko,Regina %A Naini,Vidisha %A Blazek,Mary Carol %+ Department of Psychiatry, University of Michigan, 4250 Plymouth Road, Rachel Upjohn Building, Floor 1, Door 1, Ann Arbor, MI, 48109, United States, 1 617 416 8275, severej@med.umich.edu %K telepsychiatry %K COVID-19 %K video visit %K telephone visit %K telehealth %K mental health %K United States %K decision making %K virtual care %D 2020 %7 22.12.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Telepsychiatry enables patients to establish or maintain psychiatric care during the COVID-19 pandemic. Little is known about the factors influencing patients’ initial decisions to participate in telepsychiatry in the midst of a public health crisis. Objective: This paper seeks to examine factors influencing patients’ initial decisions to accept or decline telepsychiatry immediately after the stay-at-home order in Michigan, their initial choice of virtual care modality (video or telephone), and their anticipated participation in telepsychiatry once clinics reopen for in-person visits. Methods: Between June and August 2020, we conducted a telephone-based survey using a questionnaire comprising 14 quantitative and two qualitative items as part of a quality improvement initiative. We targeted patients who had an in-person appointment date that fell in the first few weeks following the Michigan governor’s stay-at-home order, necessitating conversion to virtual visits or deferment of in-person care. We used descriptive statistics to report individual survey responses and assess the association between chosen visit type and patient characteristics and future participation in telepsychiatry using multivariable logistic regression. Results: A total of 244 patients whose original in-person appointments were scheduled within the first 3 weeks of the stay-at-home order in Michigan completed the telephone survey. The majority of the 244 respondents (n=202, 82.8%) initially chose to receive psychiatric care through video visits, while 13.5% (n=33) chose telephone visits and 1.2% (n=3) decided to postpone care until in-person visit availability. Patient age correlated with chosen visit type (P<.001; 95% CI 0.02-0.06). Patients aged ≥44 years were more likely than patients aged 0-44 years to opt for telephone visits (relative risk reduction [RRR] 1.2; 95% CI 1.06-1.35). Patient sex (P=.99), race (P=.06), type of insurance (P=.08), and number of previous visits to the clinic (P=.63) were not statistically relevant. Half of the respondents (132/244, 54.1%) stated theywere likely to continue with telepsychiatry even after in-person visits were made available. Telephone visit users were less likely than video visit users to anticipate future participation in telepsychiatry (RRR 1.08; 95% CI 0.97-1.2). Overall, virtual visits met or exceeded expectations for the majority of users. Conclusions: In this cohort, patient age correlates with the choice of virtual visit type, with older adults more likely to choose telephone visits over video visits. Understanding challenges to patient-facing technologies can help advance health equity and guide best practices for engaging patients and families through telehealth. %M 33320823 %R 10.2196/25469 %U https://formative.jmir.org/2020/12/e25469 %U https://doi.org/10.2196/25469 %U http://www.ncbi.nlm.nih.gov/pubmed/33320823 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 12 %P e24614 %T Reduction of COVID-19 Incidence and Nonpharmacologic Interventions: Analysis Using a US County–Level Policy Data Set %A Ebrahim,Senan %A Ashworth,Henry %A Noah,Cray %A Kadambi,Adesh %A Toumi,Asmae %A Chhatwal,Jagpreet %+ Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, United States, 1 617 432 1000, senan@hikmahealth.org %K communicable diseases %K COVID-19 %K data set %K pandemic %K policy %K public health %K data %K intervention %K effectiveness %K incidence %K time series %D 2020 %7 21.12.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Worldwide, nonpharmacologic interventions (NPIs) have been the main tool used to mitigate the COVID-19 pandemic. This includes social distancing measures (closing businesses, closing schools, and quarantining symptomatic persons) and contact tracing (tracking and following exposed individuals). While preliminary research across the globe has shown these policies to be effective, there is currently a lack of information on the effectiveness of NPIs in the United States. Objective: The purpose of this study was to create a granular NPI data set at the county level and then analyze the relationship between NPI policies and changes in reported COVID-19 cases. Methods: Using a standardized crowdsourcing methodology, we collected time-series data on 7 key NPIs for 1320 US counties. Results: This open-source data set is the largest and most comprehensive collection of county NPI policy data and meets the need for higher-resolution COVID-19 policy data. Our analysis revealed a wide variation in county-level policies both within and among states (P<.001). We identified a correlation between workplace closures and lower growth rates of COVID-19 cases (P=.004). We found weak correlations between shelter-in-place enforcement and measures of Democratic local voter proportion (R=0.21) and elected leadership (R=0.22). Conclusions: This study is the first large-scale NPI analysis at the county level demonstrating a correlation between NPIs and decreased rates of COVID-19. Future work using this data set will explore the relationship between county-level policies and COVID-19 transmission to optimize real-time policy formulation. %M 33302253 %R 10.2196/24614 %U http://www.jmir.org/2020/12/e24614/ %U https://doi.org/10.2196/24614 %U http://www.ncbi.nlm.nih.gov/pubmed/33302253 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 12 %P e24268 %T Smartphone-Based Virtual Agents to Help Individuals With Sleep Concerns During COVID-19 Confinement: Feasibility Study %A Philip,Pierre %A Dupuy,Lucile %A Morin,Charles M %A de Sevin,Etienne %A Bioulac,Stéphanie %A Taillard,Jacques %A Serre,Fuschia %A Auriacombe,Marc %A Micoulaud-Franchi,Jean-Arthur %+ USR 3413 SANPSY, University of Bordeaux, Bordeaux, France, 33 557571100, lucile.dupuy@u-bordeaux.fr %K COVID-19 %K virtual agent %K sleep disorders %K technology acceptance %K agent %K sleep %K smartphone %K mobile phone %K eHealth %K feasibility %K stress %K app %K intervention %K behavior %D 2020 %7 18.12.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 crisis and consequent confinement restrictions have caused significant psychosocial stress and reports of sleep complaints, which require early management, have increased during recent months. To help individuals concerned about their sleep, we developed a smartphone-based app called KANOPEE that allows users to interact with a virtual agent dedicated to autonomous screening and delivering digital behavioral interventions. Objective: Our objective was to assess the feasibility of this app, in terms of inclusion rate, follow-up rate, perceived trust and acceptance of the virtual agent, and effects of the intervention program, in the context of COVID-19 confinement in France. Methods: The virtual agent is an artificial intelligence program using decision tree architecture and interacting through natural body motion and natural voice. A total of 2069 users aged 18 years and above downloaded the free app during the study period (April 22 to May 5, 2020). These users first completed a screening interview based on the Insomnia Severity Index (ISI) conducted by the virtual agent. If the users were positive for insomnia complaints (ISI score >14), they were eligible to join the 2-stage intervention program: (1) complete an electronic sleep diary for 1 week and (2) follow personalized sleep recommendations for 10 days. We collected and analyzed the following measures: sociodemographic information, ISI scores and sleep/wake schedules, and acceptance and trust of the agent. Results: Approximately 76% (1574/2069) of the app users completed the screening interview with the virtual agent. The virtual agent was well accepted by 27.4% (431/1574) of the users who answered the acceptance and trust questionnaires on its usability, satisfaction, benevolence, and credibility. Of the 773 screened users who reported sleep complaints (ISI score >14), 166 (21.5%) followed Step 1 of the intervention, and only 47 of those (28.3%) followed Step 2. Users who completed Step 1 found that their insomnia complaints (baseline mean ISI score 18.56, mean ISI score after Step 1 15.99; P<.001) and nocturnal sleep quality improved significantly after 1 week. Users who completed Step 2 also showed an improvement compared to the initial measures (baseline mean ISI score 18.87, mean ISI score after Step 2 14.68; P<.001). Users that were most severely affected (ISI score >21) did not respond to either intervention. Conclusions: These preliminary results suggest that the KANOPEE app is a promising solution to screen populations for sleep complaints and that it provides acceptable and practical behavioral advice for individuals reporting moderately severe insomnia. %M 33264099 %R 10.2196/24268 %U http://www.jmir.org/2020/12/e24268/ %U https://doi.org/10.2196/24268 %U http://www.ncbi.nlm.nih.gov/pubmed/33264099 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 12 %P e23518 %T COVID-19 Symptom-Related Google Searches and Local COVID-19 Incidence in Spain: Correlational Study %A Jimenez,Alberto Jimenez %A Estevez-Reboredo,Rosa M %A Santed,Miguel A %A Ramos,Victoria %+ Faculty of Psychology, Universidad Nacional de Educación a Distancia, Calle de Juan del Rosal 10, Madrid, 28040, Spain, 34 646517577, msanted@psi.uned.es %K behavioral epidemiology %K big data %K smart data %K tracking %K nowcasting %K forecast %K predict %K infosurveillance %K infodemiology %K COVID-19 %D 2020 %7 18.12.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: COVID-19 is one of the biggest pandemics in human history, along with other disease pandemics, such as the H1N1 influenza A, bubonic plague, and smallpox pandemics. This study is a small contribution that tries to find contrasted formulas to alleviate global suffering and guarantee a more manageable future. Objective: In this study, a statistical approach was proposed to study the correlation between the incidence of COVID-19 in Spain and search data provided by Google Trends. Methods: We assessed the linear correlation between Google Trends search data and the data provided by the National Center of Epidemiology in Spain—which is dependent on the Instituto de Salud Carlos III—regarding the number of COVID-19 cases reported with a certain time lag. These data enabled the identification of anticipatory patterns. Results: In response to the ongoing outbreak, our results demonstrate that by using our correlation test, the evolution of the COVID-19 pandemic can be predicted in Spain up to 11 days in advance. Conclusions: During the epidemic, Google Trends offers the possibility to preempt health care decisions in real time by tracking people's concerns through their search patterns. This can be of great help given the critical, if not dramatic need for complementary monitoring approaches that work on a population level and inform public health decisions in real time. This study of Google search patterns, which was motivated by the fears of individuals in the face of a pandemic, can be useful in anticipating the development of the pandemic. %M 33156803 %R 10.2196/23518 %U http://www.jmir.org/2020/12/e23518/ %U https://doi.org/10.2196/23518 %U http://www.ncbi.nlm.nih.gov/pubmed/33156803 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 7 %N 12 %P e22423 %T Changes in Stress, Anxiety, and Depression Levels of Subscribers to a Daily Supportive Text Message Program (Text4Hope) During the COVID-19 Pandemic: Cross-Sectional Survey Study %A Agyapong,Vincent Israel Ouoku %A Hrabok,Marianne %A Vuong,Wesley %A Shalaby,Reham %A Noble,Jasmine Marie %A Gusnowski,April %A Mrklas,Kelly J %A Li,Daniel %A Urichuk,Liana %A Snaterse,Mark %A Surood,Shireen %A Cao,Bo %A Li,Xin-Min %A Greiner,Russell %A Greenshaw,Andrew James %+ Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, 1E1 Walter Mackenzie Health Sciences Centre, 8440 112 St NW, Edmonton, AB, T6G 2B7, Canada, 1 780 215 7771, agyapong@ualberta.ca %K COVID-19 %K mobile technology %K text %K anxiety %K depression %K stress %K outbreak %K pandemic %K mental health %K outreach %D 2020 %7 18.12.2020 %9 Original Paper %J JMIR Ment Health %G English %X Background: In addition to the obvious physical medical impact of COVID-19, the disease poses evident threats to people’s mental health, psychological safety, and well-being. Provision of support for these challenges is complicated by the high number of people requiring support and the need to maintain physical distancing. Text4Hope, a daily supportive SMS text messaging program, was launched in Canada to mitigate the negative mental health impacts of the pandemic among Canadians. Objective: This paper describes the changes in the stress, anxiety, and depression levels of subscribers to the Text4Hope program after 6 weeks of exposure to daily supportive SMS text messages. Methods: We used self-administered, empirically supported web-based questionnaires to assess the demographic and clinical characteristics of Text4Hope subscribers. Perceived stress, anxiety, and depression were measured with the 10-Item Perceived Stress Scale (PSS-10), the Generalized Anxiety Disorder–7 (GAD-7) scale, and the Patient Health Questionnaire–9 (PHQ-9) scale at baseline and sixth week time points. Moderate or high perceived stress, likely generalized anxiety disorder, and likely major depressive disorder were assessed using cutoff scores of ≥14 for the PSS-10, ≥10 for the GAD-7, and ≥10 for the PHQ-9, respectively. At 6 weeks into the program, 766 participants had completed the questionnaires at both time points. Results: At the 6-week time point, there were statistically significant reductions in mean scores on the PSS-10 and GAD-7 scales but not on the PHQ-9 scale. Effect sizes were small overall. There were statistically significant reductions in the prevalence rates of moderate or high stress and likely generalized anxiety disorder but not likely major depressive disorder for the group that completed both the baseline and 6-week assessments. The largest reductions in mean scores and prevalence rates were for anxiety (18.7% and 13.5%, respectively). Conclusions: Text4Hope is a convenient, cost-effective, and accessible means of implementing a population-level psychological intervention. This service demonstrated significant reductions in anxiety and stress levels during the COVID-19 pandemic and could be used as a population-level mental health intervention during natural disasters and other emergencies. International Registered Report Identifier (IRRID): RR2-10.2196/19292 %M 33296330 %R 10.2196/22423 %U http://mental.jmir.org/2020/12/e22423/ %U https://doi.org/10.2196/22423 %U http://www.ncbi.nlm.nih.gov/pubmed/33296330 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 12 %P e24913 %T Using the Online Psychotherapy Tool to Address Mental Health Problems in the Context of the COVID-19 Pandemic: Protocol for an Electronically Delivered Cognitive Behavioral Therapy Program %A Alavi,Nazanin %A Yang,Megan %A Stephenson,Callum %A Nikjoo,Niloofar %A Malakouti,Niloufar %A Layzell,Gina %A Jagayat,Jasleen %A Shirazi,Amirhossein %A Groll,Dianne %A Omrani,Mohsen %A O'Riordan,Anne %A Khalid-Khan,Sarosh %A Freire,Rafael %A Brietzke,Elisa %A Gomes,Fabiano Alves %A Milev,Roumen %A Soares,Claudio N %+ Department of Psychiatry, Faculty of Health Sciences, Queen's University, Providence Care Hospital, 752 King Street W, Kingston, ON, K7L 7X3, Canada, 1 6135444900 ext 73002, nazanin.alavitabari@kingstonhsc.ca %K mental health %K COVID-19 %K depression %K anxiety %K psychotherapy %K cognitive behavioural therapy %K online %K internet %K electronic %K mental health care %D 2020 %7 18.12.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: The considerable rise of mental health challenges during the COVID-19 pandemic has had detrimental effects on the public health sector and economy. To meet the overwhelming and growing demand for mental health care, innovative approaches must be employed to significantly expand mental health care delivery capacity. Although it is not feasible to increase the number of mental health care providers or hours they work in the short term, improving their time efficiency may be a viable solution. Virtually and digitally delivering psychotherapy, which has been shown to be efficient and clinically effective, might be a good method for addressing this growing demand. Objective: This research protocol aims to evaluate the feasibility and efficacy of using an online, digital, asynchronous care model to treat mental health issues that are started or aggravated by stressors associated with the COVID-19 pandemic. Methods: This nonrandomized controlled trial intervention will be delivered through the Online Psychotherapy Tool, a secure, cloud-based, digital mental health platform. Participants will be offered a 9-week electronically delivered cognitive behavioral therapy program that is tailored to address mental health problems in the context of the COVID-19 pandemic. This program will involve weekly self-guided educational material that provides an overview of behavioral skills and weekly homework. Participants (N=80) will receive personalized feedback from and weekly interaction with a therapist throughout the course of the program. The efficacy of the program will be evaluated using clinically validated symptomology questionnaires, which are to be completed by participants at baseline, week 5, and posttreatment. Inclusion criteria includes the capacity to consent; a primary diagnosis of generalized anxiety disorder or major depressive disorder, with symptoms that started or worsened during the COVID-19 pandemic; the ability to speak and read English; and consistent and reliable access to the internet. Exclusion criteria includes active psychosis, acute mania, severe alcohol or substance use disorder, and active suicidal or homicidal ideation. Results: This study received funding in May 2020. Ethics approval was received in June 2020. The recruitment of participants began in June 2020. Participant recruitment is being conducted via social media, web-based communities, and physician referrals. To date, 58 participants have been recruited (intervention group: n=35; control group: n=23). Data collection is expected to conclude by the end of 2020. Analyses (ie, linear regression analysis for continuous outcomes and binomial regression analysis for categorical outcomes) are expected to be completed by February 2021. Conclusions: If proven feasible, this care delivery method could increase care capacity by up to fourfold. The findings from this study can potentially influence clinical practices and policies and increase accessibility to care during the COVID-19 pandemic, without sacrificing the quality of care. Trial Registration: ClinicalTrials.gov NCT04476667; https://clinicaltrials.gov/ct2/show/NCT04476667 International Registered Report Identifier (IRRID): DERR1-10.2196/24913 %M 33290245 %R 10.2196/24913 %U http://www.researchprotocols.org/2020/12/e24913/ %U https://doi.org/10.2196/24913 %U http://www.ncbi.nlm.nih.gov/pubmed/33290245 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 12 %P e24432 %T Monitoring the Spatial Spread of COVID-19 and Effectiveness of Control Measures Through Human Movement Data: Proposal for a Predictive Model Using Big Data Analytics %A Li,Zhenlong %A Li,Xiaoming %A Porter,Dwayne %A Zhang,Jiajia %A Jiang,Yuqin %A Olatosi,Bankole %A Weissman,Sharon %+ Geoinformation and Big Data Research Laboratory, Department of Geography, University of South Carolina, 709 Bull Street, Columbia, SC, United States, 1 8037774590, zhenlong@sc.edu %K big data %K human movement %K spatial computing %K COVID-19 %K artificial intelligence %D 2020 %7 18.12.2020 %9 Proposal %J JMIR Res Protoc %G English %X Background: Human movement is one of the forces that drive the spatial spread of infectious diseases. To date, reducing and tracking human movement during the COVID-19 pandemic has proven effective in limiting the spread of the virus. Existing methods for monitoring and modeling the spatial spread of infectious diseases rely on various data sources as proxies of human movement, such as airline travel data, mobile phone data, and banknote tracking. However, intrinsic limitations of these data sources prevent us from systematic monitoring and analyses of human movement on different spatial scales (from local to global). Objective: Big data from social media such as geotagged tweets have been widely used in human mobility studies, yet more research is needed to validate the capabilities and limitations of using such data for studying human movement at different geographic scales (eg, from local to global) in the context of global infectious disease transmission. This study aims to develop a novel data-driven public health approach using big data from Twitter coupled with other human mobility data sources and artificial intelligence to monitor and analyze human movement at different spatial scales (from global to regional to local). Methods: We will first develop a database with optimized spatiotemporal indexing to store and manage the multisource data sets collected in this project. This database will be connected to our in-house Hadoop computing cluster for efficient big data computing and analytics. We will then develop innovative data models, predictive models, and computing algorithms to effectively extract and analyze human movement patterns using geotagged big data from Twitter and other human mobility data sources, with the goal of enhancing situational awareness and risk prediction in public health emergency response and disease surveillance systems. Results: This project was funded as of May 2020. We have started the data collection, processing, and analysis for the project. Conclusions: Research findings can help government officials, public health managers, emergency responders, and researchers answer critical questions during the pandemic regarding the current and future infectious risk of a state, county, or community and the effectiveness of social/physical distancing practices in curtailing the spread of the virus. International Registered Report Identifier (IRRID): DERR1-10.2196/24432 %M 33301418 %R 10.2196/24432 %U http://www.researchprotocols.org/2020/12/e24432/ %U https://doi.org/10.2196/24432 %U http://www.ncbi.nlm.nih.gov/pubmed/33301418 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 12 %P e22500 %T Online and Recovery-Oriented Support Groups Facilitated by Peer Support Workers in Times of COVID-19: Protocol for a Feasibility Pre-Post Study %A Pelletier,Jean-Francois %A Houle,Janie %A Goulet,Marie-Hélène %A Juster,Robert-Paul %A Giguère,Charles-Édouard %A Bordet,Jonathan %A Hénault,Isabelle %A Lesage,Alain %A De Benedictis,Luigi %A Denis,Frédéric %A Ng,Roger %+ Department of Psychiatry and Addictology, Montreal Mental Health University Institute – Research Centre, University of Montreal, 7401 Hochelaga Street, Montreal, QC, H1N 3M5, Canada, 1 1 514 574 5879, jean-francois.pelletier@yale.edu %K peer support workers %K internet-based peer support groups %K personal-civic recovery %K clinical recovery %K COVID-19 Stress Scales %K peer support %K feasibility %K mental health %K COVID-19 %K intervention %K recovery %D 2020 %7 18.12.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: In times of pandemics, social distancing, isolation, and quarantine have precipitated depression, anxiety, and substance misuse. Scientific literature suggests that patients living with mental health problems or illnesses (MHPIs) who interact with peer support workers (PSWs) experience not only the empathy and connectedness that comes from similar life experiences but also feel hope in the possibility of recovery. So far, it is the effect of mental health teams or programs with PSWs that has been evaluated. Objective: This paper presents the protocol for a web-based intervention facilitated by PSWs. The five principal research questions are whether this intervention will have an impact in terms of (Q1) personal-civic recovery and (Q2) clinical recovery, (Q3) how these recovery potentials can be impacted by the COVID-19 pandemic, (Q4) how the lived experience of persons in recovery can be mobilized to cope with such a situation, and (Q5) how sex and gender considerations can be taken into account for the pairing of PSWs with service users beyond considerations based solely on psychiatric diagnoses or specific MHPIs. This will help us assess the impact of PSWs in this setting. Methods: PSWs will lead a typical informal peer support group within the larger context of online peer support groups, focusing on personal-civic recovery. They will be scripted with a fixed, predetermined duration (a series of 10 weekly 90-minute online workshops). There will be 2 experimental subgroups—patients diagnosed with (1) psychotic disorders (n=10) and (2) anxiety or mood disorders (n=10)—compared to a control group (n=10). Random assignment to the intervention and control arms will be conducted using a 2:1 ratio. Several instruments will be used to assess clinical recovery (eg, the Recovery Assessment Scale, the Citizenship Measure questionnaire). The COVID-19 Stress Scales will be used to assess effects in terms of clinical recovery and stress- or anxiety-related responses to COVID-19. Changes will be compared between groups from baseline to endpoint in the intervention and control groups using the Student paired sample t test. Results: This pilot study was funded in March 2020. The protocol was approved on June 16, 2020, by the Research Ethics Committees of the Montreal Mental Health University Institute. Recruitment took place during the months of July and August, and results are expected in December 2020. Conclusions: Study results will provide reliable evidence on the effectiveness of a web-based intervention provided by PSWs. The investigators, alongside key decision makers and patient partners, will ensure knowledge translation throughout, and our massive open online course (MOOC), The Fundamentals of Recovery, will be updated with the evidence and new knowledge generated by this feasibility study. Trial Registration: ClinicalTrials.gov NCT04445324; https://clinicaltrials.gov/ct2/show/NCT04445324 International Registered Report Identifier (IRRID): PRR1-10.2196/22500 %M 33259326 %R 10.2196/22500 %U http://www.researchprotocols.org/2020/12/e22500/ %U https://doi.org/10.2196/22500 %U http://www.ncbi.nlm.nih.gov/pubmed/33259326 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 12 %P e24775 %T Subjective Well-Being of Chinese Sina Weibo Users in Residential Lockdown During the COVID-19 Pandemic: Machine Learning Analysis %A Wang,Yilin %A Wu,Peijing %A Liu,Xiaoqian %A Li,Sijia %A Zhu,Tingshao %A Zhao,Nan %+ Key Laboratory of Behavioral Science, Institute of Psychology, Chinese Academy of Sciences, 16 Lincui Road, Chaoyang District, Beijing, , China, 86 010 64101377, zhaonan@psych.ac.cn %K COVID-19 %K residential lockdown %K subjective well-being %K online ecological recognition %D 2020 %7 17.12.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: During the COVID-19 pandemic, residential lockdowns were implemented in numerous cities in China to contain the rapid spread of the disease. Although these stringent regulations effectively slowed the spread of COVID-19, they may have posed challenges to the well-being of residents. Objective: This study aims to explore the effects of residential lockdown on the subjective well-being (SWB) of individuals in China during the COVID-19 pandemic. Methods: The sample consisted of 1790 Sina Weibo users who were residents of cities that imposed residential lockdowns, of which 1310 users (73.18%) were female, and 3580 users who were residents of cities that were not locked down (gender-matched with the 1790 lockdown residents). In both the lockdown and nonlockdown groups, we calculated SWB indicators during the 2 weeks before and after the enforcement date of the residential lockdown using individuals’ original posts on Sina Weibo. SWB was calculated via online ecological recognition, which is based on established machine learning predictive models. Results: The interactions of time (before the residential lockdown or after the residential lockdown) × area (lockdown or nonlockdown) in the integral analysis (N=5370) showed that after the residential lockdown, compared with the nonlockdown group, the lockdown group scored lower in some negative SWB indicators, including somatization (F1,5368=13.593, P<.001) and paranoid ideation (F1,5368=14.333, P<.001). The interactions of time (before the residential lockdown or after the residential lockdown) × area (developed or underdeveloped) in the comparison of residential lockdown areas with different levels of economic development (N=1790) indicated that the SWB of residents in underdeveloped areas showed no significant change after the residential lockdown (P>.05), while that of residents in developed areas changed. Conclusions: These findings increase our understanding of the psychological impact and cost of residential lockdown during an epidemic. The more negative changes in the SWB of residents in developed areas imply a greater need for psychological intervention under residential lockdown in such areas. %M 33290247 %R 10.2196/24775 %U http://www.jmir.org/2020/12/e24775/ %U https://doi.org/10.2196/24775 %U http://www.ncbi.nlm.nih.gov/pubmed/33290247 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 12 %P e24693 %T Attitudes Toward Using COVID-19 mHealth Tools Among Adults With Chronic Health Conditions: Secondary Data Analysis of the COVID-19 Impact Survey %A Camacho-Rivera,Marlene %A Islam,Jessica Yasmine %A Rivera,Argelis %A Vidot,Denise Christina %+ Department of Community Health Sciences, State University of New York Downstate Health Sciences University, 450 Clarkson Avenue, MSC 43, Brooklyn, NY, 11203, United States, 1 7182704386, marlene.camacho-rivera@downstate.edu %K smartphone %K mHealth %K COVID-19 %K chronic health conditions %K health disparities %K chronic disease %K attitude %K perception %K data analysis %K contact tracing %K mobile app %K disparity %D 2020 %7 17.12.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Adults with chronic conditions are disproportionately burdened by COVID-19 morbidity and mortality. Although COVID-19 mobile health (mHealth) apps have emerged, research on attitudes toward using COVID-19 mHealth tools among those with chronic conditions is scarce. Objective: This study aimed to examine attitudes toward COVID-19, identify determinants of COVID-19 mHealth tool use across demographic and health-related characteristics, and evaluate associations between chronic health conditions and attitudes toward using COVID-19 mHealth tools (eg, mHealth or web-based methods for tracking COVID-19 exposures, symptoms, and recommendations). Methods: We used nationally representative data from the COVID-19 Impact Survey collected from April to June 2020 (n=10,760). Primary exposure was a history of chronic conditions, which were defined as self-reported diagnoses of cardiometabolic, respiratory, immune-related, and mental health conditions and overweight/obesity. Primary outcomes were attitudes toward COVID-19 mHealth tools, including the likelihood of using (1) a mobile phone app to track COVID-19 symptoms and receive recommendations; (2) a website to track COVID-19 symptoms, track location, and receive recommendations; and (3) an app using location data to track potential COVID-19 exposure. Outcome response options for COVID-19 mHealth tool use were extremely/very likely, moderately likely, or not too likely/not likely at all. Multinomial logistic regression was used to compare the likelihood of COVID-19 mHealth tool use between people with different chronic health conditions, with not too likely/not likely at all responses used as the reference category for each outcome. We evaluated the determinants of each COVID-19 mHealth intervention using Poisson regression. Results: Of the 10,760 respondents, 21.8% of respondents were extremely/very likely to use a mobile phone app or a website to track their COVID-19 symptoms and receive recommendations. Additionally, 24.1% of respondents were extremely/very likely to use a mobile phone app to track their location and receive push notifications about whether they have been exposed to COVID-19. After adjusting for age, race/ethnicity, sex, socioeconomic status, and residence, adults with mental health conditions were the most likely to report being extremely/very or moderately likely to use each mHealth intervention compared to those without such conditions. Adults with respiratory-related chronic diseases were extremely/very (conditional odds ratio 1.16, 95% CI 1.00-1.35) and moderately likely (conditional odds ratio 1.23, 95% CI 1.04-1.45) to use a mobile phone app to track their location and receive push notifications about whether they have been exposed to COVID-19. Conclusions: Our study demonstrates that attitudes toward using COVID-19 mHealth tools vary widely across modalities (eg, web-based method vs app) and chronic health conditions. These findings may inform the adoption of long-term engagement with COVID-19 apps, which is crucial for determining their potential in reducing disparities in COVID-19 morbidity and mortality among individuals with chronic health conditions. %M 33301415 %R 10.2196/24693 %U http://mhealth.jmir.org/2020/12/e24693/ %U https://doi.org/10.2196/24693 %U http://www.ncbi.nlm.nih.gov/pubmed/33301415 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 12 %P e24478 %T Computing SARS-CoV-2 Infection Risk From Symptoms, Imaging, and Test Data: Diagnostic Model Development %A D'Ambrosia,Christopher %A Christensen,Henrik %A Aronoff-Spencer,Eliah %+ Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, 9500 Gilman Drive 0711, San Diego, CA, 92101, United States, 1 6462348153, earonoffspencer@health.ucsd.edu %K health %K informatics %K computation %K COVID-19 %K infection %K risk %K symptom %K imaging %K diagnostic %K probability %K machine learning %K Bayesian %K model %D 2020 %7 16.12.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Assigning meaningful probabilities of SARS-CoV-2 infection risk presents a diagnostic challenge across the continuum of care. Objective: The aim of this study was to develop and clinically validate an adaptable, personalized diagnostic model to assist clinicians in ruling in and ruling out COVID-19 in potential patients. We compared the diagnostic performance of probabilistic, graphical, and machine learning models against a previously published benchmark model. Methods: We integrated patient symptoms and test data using machine learning and Bayesian inference to quantify individual patient risk of SARS-CoV-2 infection. We trained models with 100,000 simulated patient profiles based on 13 symptoms and estimated local prevalence, imaging, and molecular diagnostic performance from published reports. We tested these models with consecutive patients who presented with a COVID-19–compatible illness at the University of California San Diego Medical Center over the course of 14 days starting in March 2020. Results: We included 55 consecutive patients with fever (n=43, 78%) or cough (n=42, 77%) presenting for ambulatory (n=11, 20%) or hospital care (n=44, 80%). In total, 51% (n=28) were female and 49% (n=27) were aged <60 years. Common comorbidities included diabetes (n=12, 22%), hypertension (n=15, 27%), cancer (n=9, 16%), and cardiovascular disease (n=7, 13%). Of these, 69% (n=38) were confirmed via reverse transcription-polymerase chain reaction (RT-PCR) to be positive for SARS-CoV-2 infection, and 20% (n=11) had repeated negative nucleic acid testing and an alternate diagnosis. Bayesian inference network, distance metric learning, and ensemble models discriminated between patients with SARS-CoV-2 infection and alternate diagnoses with sensitivities of 81.6%-84.2%, specificities of 58.8%-70.6%, and accuracies of 61.4%-71.8%. After integrating imaging and laboratory test statistics with the predictions of the Bayesian inference network, changes in diagnostic uncertainty at each step in the simulated clinical evaluation process were highly sensitive to location, symptom, and diagnostic test choices. Conclusions: Decision support models that incorporate symptoms and available test results can help providers diagnose SARS-CoV-2 infection in real-world settings. %M 33301417 %R 10.2196/24478 %U http://www.jmir.org/2020/12/e24478/ %U https://doi.org/10.2196/24478 %U http://www.ncbi.nlm.nih.gov/pubmed/33301417 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 4 %P e23624 %T An Epidemiological Model Considering Isolation to Predict COVID-19 Trends in Tokyo, Japan: Numerical Analysis %A Utamura,Motoaki %A Koizumi,Makoto %A Kirikami,Seiichi %+ Research Laboratory for Nuclear Reactors, Tokyo Institute of Technology, Ookayama 2-12-1, Meguro-ku, Tokyo, 1528550, Japan, 81 3 5477 3464, titech02715@gmail.com %K coronavirus %K COVID-19 %K epidemiological model %K prediction %K Tokyo %K delay differential equation %K SIR model %K model %K epidemiology %K isolation %K trend %D 2020 %7 16.12.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: COVID-19 currently poses a global public health threat. Although Tokyo, Japan, is no exception to this, it was initially affected by only a small-level epidemic. Nevertheless, medical collapse nearly happened since no predictive methods were available to assess infection counts. A standard susceptible-infectious-removed (SIR) epidemiological model has been widely used, but its applicability is limited often to the early phase of an epidemic in the case of a large collective population. A full numerical simulation of the entire period from beginning until end would be helpful for understanding COVID-19 trends in (separate) counts of inpatient and infectious cases and can also aid the preparation of hospital beds and development of quarantine strategies. Objective: This study aimed to develop an epidemiological model that considers the isolation period to simulate a comprehensive trend of the initial epidemic in Tokyo that yields separate counts of inpatient and infectious cases. It was also intended to induce important corollaries of governing equations (ie, effective reproductive number) and equations for the final count. Methods: Time-series data related to SARS-CoV-2 from February 28 to May 23, 2020, from Tokyo and antibody testing conducted by the Japanese government were adopted for this study. A novel epidemiological model based on a discrete delay differential equation (apparent time-lag model [ATLM]) was introduced. The model can predict trends in inpatient and infectious cases in the field. Various data such as daily new confirmed cases, cumulative infections, inpatients, and PCR (polymerase chain reaction) test positivity ratios were used to verify the model. This approach also derived an alternative formulation equivalent to the standard SIR model. Results: In a typical parameter setting, the present ATLM provided 20% less infectious cases in the field compared to the standard SIR model prediction owing to isolation. The basic reproductive number was inferred as 2.30 under the condition that the time lag T from infection to detection and isolation is 14 days. Based on this, an adequate vaccine ratio to avoid an outbreak was evaluated for 57% of the population. We assessed the date (May 23) that the government declared a rescission of the state of emergency. Taking into consideration the number of infectious cases in the field, a date of 1 week later (May 30) would have been most effective. Furthermore, simulation results with a shorter time lag of T=7 and a larger transmission rate of α=1.43α0 suggest that infections at large should reduce by half and inpatient numbers should be similar to those of the first wave of COVID-19. Conclusions: A novel mathematical model was proposed and examined using SARS-CoV-2 data for Tokyo. The simulation agreed with data from the beginning of the pandemic. Shortening the period from infection to hospitalization is effective against outbreaks without rigorous public health interventions and control. %M 33259325 %R 10.2196/23624 %U http://publichealth.jmir.org/2020/4/e23624/ %U https://doi.org/10.2196/23624 %U http://www.ncbi.nlm.nih.gov/pubmed/33259325 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 12 %P e25595 %T Impact of a Serious Game on the Intention to Change Infection Prevention and Control Practices in Nursing Homes During the COVID-19 Pandemic: Protocol for a Web-Based Randomized Controlled Trial %A Suppan,Laurent %A Abbas,Mohamed %A Catho,Gaud %A Stuby,Loric %A Regard,Simon %A Harbarth,Stephan %A Achab,Sophia %A Suppan,Mélanie %+ Division of Emergency Medicine, Department of Anesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, University of Geneva Hospitals and Faculty of Medicine, Rue Gabrielle-Perret-Gentil 4, Geneva, 1211, Switzerland, 41 223723311, laurent.suppan@hcuge.ch %K COVID-19 %K transmission %K serious game %K infection prevention %K health care worker %K SARS-COV-2 %K nursing home %K randomized controlled trial %K elderly %K older adult %K infection control %K infectious disease %D 2020 %7 15.12.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: Nursing home residents are at high risk of complications and death due to COVID-19. Lack of resources, both human and material, amplifies the likelihood of contamination in these facilities where a single employee can contaminate dozens of residents and colleagues. Improving the dissemination of and adhesion to infection prevention and control (IPC) guidelines is therefore essential. Serious games have been shown to be effective in developing knowledge and in increasing engagement, and could motivate nursing home employees to change their IPC practices. Objective: Our aim is to assess the impact of “Escape COVID-19,” a serious game designed to enhance knowledge and application of IPC procedures, on the intention of nursing home employees to change their IPC practices. Methods: We will carry out a web-based randomized controlled trial following the CONSORT-EHEALTH (Consolidated Standards of Reporting Trials of Electronic and Mobile Health Applications and Online Telehealth) guidelines and incorporating relevant elements of CHERRIES (Checklist for Reporting Results of Internet E-Surveys). Participants will be randomized to either the control or the serious game (intervention) group. First, both groups will be asked to answer a questionnaire designed to gather demographic data and assess baseline knowledge. The control group will then receive a quick reminder of the current national guidelines and links to IPC guidelines for health care professionals, while the other group will play the game. Both groups will then have to answer a second questionnaire designed to assess their willingness to change their IPC practices after having followed their respective material. After completing this questionnaire, they will be granted access to the material presented to the group they were not assigned to and receive a course completion certificate. The primary outcome will be the proportion of participants willing to change their IPC practices according to group. Secondary outcomes will include the analysis of specific questions detailing the exact changes considered by the participants. Factors associated with participant willingness or reluctance to change behavior will also be assessed. Attrition will also be assessed at each stage of the study. Results: The study protocol has been presented to our regional ethics committee (Req-2020-01262), which issued a declaration of no objection as such projects do not fall within the scope of the Swiss federal law on human research. Data collection began on November 5, 2020, and should be completed by December 4, 2020. Conclusions: This study should determine whether “Escape COVID-19,” a serious game designed to improve compliance with COVID-19 safe practices, modifies the intention to follow IPC guidelines among nursing home employees. International Registered Report Identifier (IRRID): DERR1-10.2196/25595 %M 33296329 %R 10.2196/25595 %U http://www.researchprotocols.org/2020/12/e25595/ %U https://doi.org/10.2196/25595 %U http://www.ncbi.nlm.nih.gov/pubmed/33296329 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 12 %P e25501 %T Impact of Telemedicine Use by Oncology Physicians on the Patient and Informal Caregiver Experience of Receiving Care: Protocol for a Scoping Review in the Context of COVID-19 %A Thiessen,Maclean %A Soriano,Andrea Michelle %A Loewen,Hal John %A Decker,Kathleen Margaret %+ Research Institute of Oncology and Hematology, CancerCare Manitoba, 675 McDermot Ave, Winnipeg, MB, R3E 0V9, Canada, 1 204 787 4249, macthiessen@gmail.com %K cancer %K experience %K information needs %K telemedicine %K telehealth %K COVID-19 %K patient satisfaction %D 2020 %7 15.12.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: During the COVID-19 pandemic, the use of telemedicine by oncology physicians in Manitoba, Canada, has increased to limit the risk of exposure to the virus for both patients and health care providers. It is not clear how telemedicine impacts the information needs of patients or the experience of receiving cancer care. Objective: The objective of this study is to describe how the use of telemedicine impacts the information needs and experience of patients with cancer and their informal caregivers (ie, family and friends) and identify directions for future research. Methods: This review will include all studies addressing telemedicine in the cancer context including those using quantitative, qualitative, and mixed methods approaches. This scoping review will be conducted using the methodology described by the Joanna Briggs Institute. In collaboration with a librarian scientist specializing in health sciences, a comprehensive search will be undertaken to identify and retrieve relevant reports published in English from 1990 to the present. Databases searched will include MEDLINE, CINAHL, EMBASE, Scopus, Cochrane Library, and PsycINFO. Data will be extracted by two independent reviewers, synthesized, and reported in a summary table and in a narrative format describing what has been reported regarding the impact of telemedicine by physicians in oncology on the experience of patients and their informal caregivers and their receipt of information. Results: The results from this scoping review are expected to be available by late spring 2021. Conclusions: The results from this scoping review will be useful for informing practice as well as directing future research, both in the context of COVID-19 and beyond. International Registered Report Identifier (IRRID): PRR1-10.2196/25501 %M 33290243 %R 10.2196/25501 %U http://www.researchprotocols.org/2020/12/e25501/ %U https://doi.org/10.2196/25501 %U http://www.ncbi.nlm.nih.gov/pubmed/33290243 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 7 %N 12 %P e24815 %T Real-time Mental Health Impact of the COVID-19 Pandemic on College Students: Ecological Momentary Assessment Study %A Kleiman,Evan M %A Yeager,April L %A Grove,Jeremy L %A Kellerman,John K %A Kim,Joanne S %+ Rutgers, The State University of New Jersey, 53 Avenue E, Tillett Hall Room 627, Piscataway, NJ, 08854, United States, 1 2153596148, evan.kleiman@rutgers.edu %K ecological momentary assessment %K college students %K COVID-19, anxiety %K real-time %K mental health %K impact %K student %D 2020 %7 15.12.2020 %9 Original Paper %J JMIR Ment Health %G English %X Background: College students’ mental health may be disproportionally affected by the COVID-19 pandemic because of the abrupt shift off campus and subsequent loss of a social network and potential long-term impact on job prospects. Objective: We sought to assess the nature of COVID-19’s mental health impact among a sample of undergraduates who were experiencing the pandemic as it occurred in real time. Methods: In total, 140 college students completed smartphone-based ecological momentary assessments of anxiety and optimism related to COVID-19 and other generic mental health variables 6 times daily. Results: Participants completed >23,750 surveys. Overall, >75% of these surveys indicated at least some level of anxiety about COVID-19. On average, the proportion of responses each day at the highest levels of anxiety about COVID-19 was 7 times greater than the proportion of responses at the highest levels of non–COVID-19–specific anxiety. Structural change analyses indicated a significant downward trend in COVID-19 anxiety after the first week of June, but even at the lowest point, >15% of the participants in the sample still reported high levels of COVID-19 anxiety each day. Participants felt more anxious about COVID-19 on days when the number of new cases and deaths due to COVID-19 were higher. When participants felt anxious about COVID-19, they also felt sad, anxious (in general), and had a greater desire to drink and use drugs. Participants felt more optimistic about COVID-19 when they received more support from others and from their university. Conclusions: This study demonstrated the widespread mental health impact that COVID-19 has had on college students. %M 33207308 %R 10.2196/24815 %U http://mental.jmir.org/2020/12/e24815/ %U https://doi.org/10.2196/24815 %U http://www.ncbi.nlm.nih.gov/pubmed/33207308 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 12 %P e24776 %T Psychological Impacts of COVID-19 During the First Nationwide Lockdown in Vietnam: Web-Based, Cross-Sectional Survey Study %A Ngoc Cong Duong,Khanh %A Nguyen Le Bao,Tien %A Thi Lan Nguyen,Phuong %A Vo Van,Thanh %A Phung Lam,Toi %A Pham Gia,Anh %A Anuratpanich,Luerat %A Vo Van,Bay %+ Department of Pharmacy, Thong Nhat Hospital, 1 Ly Thuong Kiet Street, Ward 7, Tan Binh District, Ho Chi Minh City, 70000, Vietnam, 84 988889315, vovanbay2005@yahoo.com.vn %K COVID-19 %K mental health %K psychological distress %K depression %K anxiety %K Vietnam %K psychology %K distress %K lockdown %K survey %D 2020 %7 15.12.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: The first nationwide lockdown due to the COVID-19 pandemic was implemented in Vietnam from April 1 to 15, 2020. Nevertheless, there has been limited information on the impact of COVID-19 on the psychological health of the public. Objective: This study aimed to estimate the prevalence of psychological issues and identify the factors associated with the psychological impact of COVID-19 during the first nationwide lockdown among the general population in Vietnam. Methods: We employed a cross-sectional study design with convenience sampling. A self-administered, online survey was used to collect data and assess psychological distress, depression, anxiety, and stress of participants from April 10 to 15, 2020. The Impact of Event Scale-Revised (IES-R) and the Depression, Anxiety, and Stress Scale-21 (DASS-21) were utilized to assess psychological distress, depression, anxiety, and stress of participants during social distancing due to COVID-19. Associations across factors were explored using regression analysis. Results: A total of 1385 respondents completed the survey. Of this, 35.9% (n=497) experienced psychological distress, as well as depression (n=325, 23.5%), anxiety (n=195, 14.1%), and stress (n=309, 22.3%). Respondents who evaluated their physical health as average had a higher IES-R score (beta coefficient [B]=9.16, 95% CI 6.43 to 11.89), as well as higher depression (B=5.85, 95% CI 4.49 to 7.21), anxiety (B=3.64, 95% CI 2.64 to 4.63), and stress (B=5.19, 95% CI 3.83 to 6.56) scores for DASS-21 than those who rated their health as good or very good. Those who self-reported their health as bad or very bad experienced more severe depression (B=9.57, 95% CI 4.54 to 14.59), anxiety (B=7.24, 95% CI 3.55 to 10.9), and stress (B=10.60, 95% CI 5.56 to 15.65). Unemployment was more likely to be associated with depression (B=3.34, 95% CI 1.68 to 5.01) and stress (B=2.34, 95% CI 0.84 to 3.85). Regarding worries about COVID-19, more than half (n=755, 54.5%) expressed concern for their children aged <18 years, which increased their IES-R score (B=7.81, 95% CI 4.98 to 10.64) and DASS-21 stress score (B=1.75, 95% CI 0.27 to 3.24). The majority of respondents (n=1335, 96.4%) were confident about their doctor’s expertise in terms of COVID-19 diagnosis and treatment, which was positively associated with less distress caused by the outbreak (B=–7.84, 95% CI –14.58 to –1.11). Conclusions: The findings highlight the effect of COVID-19 on mental health during the nationwide lockdown among the general population in Vietnam. The study provides useful evidence for policy decision makers to develop and implement interventions to mitigate these impacts. %M 33284778 %R 10.2196/24776 %U http://formative.jmir.org/2020/12/e24776/ %U https://doi.org/10.2196/24776 %U http://www.ncbi.nlm.nih.gov/pubmed/33284778 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 12 %P e24430 %T Psychological Effects of the COVID-19 Imposed Lockdown on Adults with Attention Deficit/Hyperactivity Disorder: Cross-Sectional Survey Study %A Adamou,Marios %A Fullen,Tim %A Galab,Nazmeen %A Mackintosh,Isobel %A Abbott,Karl %A Lowe,Deborah %A Smith,Claire %+ School of Human and Health Sciences, University of Huddersfield, Queensgate, Huddersfield, HD1 3DH, United Kingdom, 44 1924316492, m.adamou@hud.ac.uk %K adult ADHD %K pandemic %K lockdown %K COVID-19 %K well-being %K psychological %K intervention %K ADHD %D 2020 %7 15.12.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: The psychological effects of the COVID-19 government-imposed lockdown have been studied in several populations. These effects however have not been studied in adult populations with attention deficit/hyperactivity disorder (ADHD). Objective: We wanted to investigate the psychological effects of the COVID-19 imposed lockdown on an adult population with ADHD. Methods: We conducted a cross-sectional survey by administering the Patient Health Questionnaire-9, Generalized Anxiety Disorder Scale-7, Brief Adjustment Scale-6, Perceived Stress Scale, and Multidimensional Scale of Perceived Social Support to a pragmatic sample of adults with ADHD. Results: In total, 24 individuals (male: n=18, 75%; female: n=6, 25%; age: mean 21.75 years, SD 1.85 years) were included in this study. The adults with ADHD we surveyed had significant levels of emotional distress during the COVID-19 pandemic period. However, there was no evidence of significant deterioration to the mental health of our sample during the COVID-19 pandemic. Conclusions: When treatment for ADHD is maintained, the effects of the COVID-19 pandemic on the mental health of adults with ADHD are mild. Targeted psychological interventions may be useful in such circumstances. %M 33108312 %R 10.2196/24430 %U https://formative.jmir.org/2020/12/e24430 %U https://doi.org/10.2196/24430 %U http://www.ncbi.nlm.nih.gov/pubmed/33108312 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 12 %P e24425 %T COVID-19 Misinformation Spread in Eight Countries: Exponential Growth Modeling Study %A Nsoesie,Elaine Okanyene %A Cesare,Nina %A Müller,Martin %A Ozonoff,Al %+ Department of Global Health, School of Public Health, Boston University, 801 Massachusetts Ave, Third floor, Boston, MA, 02118, United States, 1 617 638 5234, onelaine@bu.edu %K misinformation %K internet %K COVID-19 %K social media %K rumors %D 2020 %7 15.12.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The epidemic of misinformation about COVID-19 transmission, prevention, and treatment has been going on since the start of the pandemic. However, data on the exposure and impact of misinformation is not readily available. Objective: We aim to characterize and compare the start, peak, and doubling time of COVID-19 misinformation topics across 8 countries using an exponential growth model usually employed to study infectious disease epidemics. Methods: COVID-19 misinformation topics were selected from the World Health Organization Mythbusters website. Data representing exposure was obtained from the Google Trends application programming interface for 8 English-speaking countries. Exponential growth models were used in modeling trends for each country. Results: Searches for “coronavirus AND 5G” started at different times but peaked in the same week for 6 countries. Searches for 5G also had the shortest doubling time across all misinformation topics, with the shortest time in Nigeria and South Africa (approximately 4-5 days). Searches for “coronavirus AND ginger” started at the same time (the week of January 19, 2020) for several countries, but peaks were incongruent, and searches did not always grow exponentially after the initial week. Searches for “coronavirus AND sun” had different start times across countries but peaked at the same time for multiple countries. Conclusions: Patterns in the start, peak, and doubling time for “coronavirus AND 5G” were different from the other misinformation topics and were mostly consistent across countries assessed, which might be attributable to a lack of public understanding of 5G technology. Understanding the spread of misinformation, similarities and differences across different contexts can help in the development of appropriate interventions for limiting its impact similar to how we address infectious disease epidemics. Furthermore, the rapid proliferation of misinformation that discourages adherence to public health interventions could be predictive of future increases in disease cases. %M 33264102 %R 10.2196/24425 %U http://www.jmir.org/2020/12/e24425/ %U https://doi.org/10.2196/24425 %U http://www.ncbi.nlm.nih.gov/pubmed/33264102 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 12 %P e24357 %T A Brazilian Cohort of Patients With Immuno-Mediated Chronic Inflammatory Diseases Infected by SARS-CoV-2 (ReumaCoV-Brasil Registry): Protocol for a Prospective, Observational Study %A Marques,Claudia %A Kakehasi,Adriana Maria %A Gomides,Ana Paula Monteiro %A Paiva,Eduardo Dos Santos %A dos Reis Neto,Edgard Torres %A Pileggi,Gecilmara Cristina Salviato %A Provenza,José Roberto %A Mota,Licia %A Xavier,Ricardo Machado %A Ferreira,Gilda Aparecida %A Pinheiro,Marcelo Medeiros %+ Hospital das Clínicas, Universidade Federal de Minas Gerais, Av Prof Alfredo Balena, 110 - Santa Efigênia, Belo Horizonte, 30130-100, Brazil, 55 31 996174211, gildaferreira9@gmail.com %K COVID-19 %K SARS-CoV-2 %K prospective study %K immune-mediated rheumatic diseases %K registry %K Brazil %K inflammatory %K chronic disease %K cohort %K immunology %K infection rate %K mortality %K morbidity %D 2020 %7 15.12.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: Patients with immune-mediated rheumatic diseases (IMRD) are at increased risk of infections, including significant morbidity and high mortality. Considering the potential for unfavorable outcomes of SARS-CoV-2 infection in patients with IMRD, several questions were raised regarding the impact of COVID-19 at the start of the pandemic. Objective: This paper presents the protocol of a study that aims to prospectively evaluate patients with IMRD and a confirmed COVID-19 diagnosis (using criteria provided by the Brazilian Ministry of Health). Methods: The study comprised a prospective, observational cohort (patients with IMRD and COVID-19) and a comparison group (patients with only IMRD), with a follow-up time of 6 months to evaluate differences in health outcomes. The primary outcomes will be changes in IMRD disease activity after SARS-CoV-2 infection at 4 time points: (1) at baseline, (2) within 4-6 weeks after infection, (3) at 3 months after the second assessment (±15 days), and (4) at 6 months (±15 days). The secondary outcomes will be the progression rate to moderate or severe forms of COVID-19, need for intensive care unit admission and mechanical ventilation, death, and therapeutic changes related to IMRD. Two outcomes—pulmonary and thromboembolic events in patients with both IMRD and SARS-CoV-2 infection—are of particular interest and will be monitored with close attention (clinical, laboratory, and function tests as well as imaging). Results: Recruitment opened in May 2020, with 1300 participants recruited from 43 sites as of November 2020. Patient recruitment will conclude by the end of December 2020, with follow-up occurring until April 2021. Data analysis is scheduled to start after all inclusion data have been collected, with an aim to publish a peer-reviewed paper in December 2020. Conclusions: We believe this study will provide clinically relevant data on the general impact of COVID-19 on patients with IMRD. Trial Registration: Brazilian Registry of Clinical Trials RBR-33YTQC; http://www.ensaiosclinicos.gov.br/rg/RBR-33ytqc/ International Registered Report Identifier (IRRID): DERR1-10.2196/24357 %M 33156812 %R 10.2196/24357 %U https://www.researchprotocols.org/2020/12/e24357 %U https://doi.org/10.2196/24357 %U http://www.ncbi.nlm.nih.gov/pubmed/33156812 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 12 %P e22727 %T Where Virtual Care Was Already a Reality: Experiences of a Nationwide Telehealth Service Provider During the COVID-19 Pandemic %A Uscher-Pines,Lori %A Thompson,James %A Taylor,Prentiss %A Dean,Kristin %A Yuan,Tony %A Tong,Ian %A Mehrotra,Ateev %+ RAND Corporation, Health Care Division, 1200 S Hayes St, Arlington, VA, 22202, United States, 1 7034131100, luscherp@rand.org %K telehealth %K telemedicine %K COVID-19 %K pandemic %K infectious disease %K virus %K United States %D 2020 %7 15.12.2020 %9 Viewpoint %J J Med Internet Res %G English %X Background: The COVID-19 pandemic has led to an increase in the use of and demand for telehealth services. Objective: Here, we describe the utilization of telehealth services provided by Doctor On Demand, Inc., a well-known telehealth company in the United States, before and during the COVID-19 pandemic. We also explore how the number of virtual visits, reasons for visits, and patients served changed over time. Methods: We reported data as a percentage change from the baseline week during 2 distinct time periods: February-June 2019 and February-June 2020 based on 4 categories of visits: respiratory illness, unscheduled behavioral health, scheduled behavioral health, and chronic illness. Results: In 2020, the total visit volume increased considerably from March through April 7, 2020 (59% above the baseline) and then declined through the week of June 2 (15% above the baseline). Visits for respiratory illnesses increased through the week of March 24 (30% above the baseline) and then steadily declined through the week of June 2 (65% below the baseline). Higher relative increases were observed for unscheduled behavioral health and chronic illness visits through April (109% and 131% above the baseline, respectively) before a decline through the week of June 2 (69% and 37% above the baseline, respectively). Increases in visit volume among rural residents were slightly higher than those among urban residents (peak at 64% vs 58% above the baseline, respectively). Conclusions: Although this telehealth service provider observed a substantial increase in the volume of visits during the COVID-19 pandemic, it is interesting to note that this growth was not fueled by COVID-19 concerns but by visits for behavioral health and chronic illness. Telehealth services may play a role as a “safety valve” for patients who have difficulty accessing care during a public health emergency. %M 33112761 %R 10.2196/22727 %U https://www.jmir.org/2020/12/e22727 %U https://doi.org/10.2196/22727 %U http://www.ncbi.nlm.nih.gov/pubmed/33112761 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 12 %P e20756 %T Artificial Intelligence in the Fight Against COVID-19: Scoping Review %A Abd-Alrazaq,Alaa %A Alajlani,Mohannad %A Alhuwail,Dari %A Schneider,Jens %A Al-Kuwari,Saif %A Shah,Zubair %A Hamdi,Mounir %A Househ,Mowafa %+ Division of Information and Computing Technology, College of Science and Engineering, Hamad Bin Khalifa University, Qatar Foundation, PO Box 5825, Doha Al Luqta St, Ar-Rayyan, Doha, , Qatar, 974 55708549, mhouseh@hbku.edu.qa %K artificial intelligence %K machine learning %K deep learning %K natural language processing %K coronavirus %K COVID-19 %K 2019-nCoV %K SARS-CoV-2 %D 2020 %7 15.12.2020 %9 Review %J J Med Internet Res %G English %X Background: In December 2019, COVID-19 broke out in Wuhan, China, leading to national and international disruptions in health care, business, education, transportation, and nearly every aspect of our daily lives. Artificial intelligence (AI) has been leveraged amid the COVID-19 pandemic; however, little is known about its use for supporting public health efforts. Objective: This scoping review aims to explore how AI technology is being used during the COVID-19 pandemic, as reported in the literature. Thus, it is the first review that describes and summarizes features of the identified AI techniques and data sets used for their development and validation. Methods: A scoping review was conducted following the guidelines of PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews). We searched the most commonly used electronic databases (eg, MEDLINE, EMBASE, and PsycInfo) between April 10 and 12, 2020. These terms were selected based on the target intervention (ie, AI) and the target disease (ie, COVID-19). Two reviewers independently conducted study selection and data extraction. A narrative approach was used to synthesize the extracted data. Results: We considered 82 studies out of the 435 retrieved studies. The most common use of AI was diagnosing COVID-19 cases based on various indicators. AI was also employed in drug and vaccine discovery or repurposing and for assessing their safety. Further, the included studies used AI for forecasting the epidemic development of COVID-19 and predicting its potential hosts and reservoirs. Researchers used AI for patient outcome–related tasks such as assessing the severity of COVID-19, predicting mortality risk, its associated factors, and the length of hospital stay. AI was used for infodemiology to raise awareness to use water, sanitation, and hygiene. The most prominent AI technique used was convolutional neural network, followed by support vector machine. Conclusions: The included studies showed that AI has the potential to fight against COVID-19. However, many of the proposed methods are not yet clinically accepted. Thus, the most rewarding research will be on methods promising value beyond COVID-19. More efforts are needed for developing standardized reporting protocols or guidelines for studies on AI. %M 33284779 %R 10.2196/20756 %U http://www.jmir.org/2020/12/e20756/ %U https://doi.org/10.2196/20756 %U http://www.ncbi.nlm.nih.gov/pubmed/33284779 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 7 %N 12 %P e24578 %T Flip the Clinic: A Digital Health Approach to Youth Mental Health Service Delivery During the COVID-19 Pandemic and Beyond %A Davenport,Tracey A %A Cheng,Vanessa Wan Sze %A Iorfino,Frank %A Hamilton,Blake %A Castaldi,Eva %A Burton,Amy %A Scott,Elizabeth M %A Hickie,Ian B %+ Brain and Mind Centre, The University of Sydney, 94 Mallett Street, Sydney, 2050, Australia, 61 404 83 9897, tracey.davenport@sydney.edu.au %K health information technologies %K clinical staging %K youth %K mental health %K transdiagnostic %K eHealth %K routine outcome monitoring %K adolescent %K mental health services %K health services %K telemedicine %K monitoring %K outcome %K young adult %K COVID-19 %D 2020 %7 15.12.2020 %9 Viewpoint %J JMIR Ment Health %G English %X The demand for mental health services is projected to rapidly increase as a direct and indirect result of the COVID-19 pandemic. Given that young people are disproportionately disadvantaged by mental illness and will face further challenges related to the COVID-19 pandemic, it is crucial to deliver appropriate mental health care to young people as early as possible. Integrating digital health solutions into mental health service delivery pathways has the potential to greatly increase efficiencies, enabling the provision of “right care, first time.” We propose an innovative digital health solution for demand management intended for use by primary youth mental health services, comprised of (1) a youth mental health model of care (ie, the Brain and Mind Centre Youth Model) and (2) a health information technology specifically designed to deliver this model of care (eg, the InnoWell Platform). We also propose an operational protocol of how this solution could be applied to primary youth mental health service delivery processes. By “flipping” the conventional service delivery models of majority in-clinic and minority web-delivered care to a model where web-delivered care is the default, this digital health solution offers a scalable way of delivering quality youth mental health care both in response to public health crises (such as the COVID-19 pandemic) and on an ongoing basis in the future. %M 33206051 %R 10.2196/24578 %U http://mental.jmir.org/2020/12/e24578/ %U https://doi.org/10.2196/24578 %U http://www.ncbi.nlm.nih.gov/pubmed/33206051 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 4 %P e22521 %T Associations of Medications With Lower Odds of Typical COVID-19 Symptoms: Cross-Sectional Symptom Surveillance Study %A Urbach,Dietmar %A Awiszus,Friedemann %A Leiß,Sven %A Venton,Tamsin %A Specht,Alexander Vincent De %A Apfelbacher,Christian %+ Department of Orthopaedic Surgery, Otto von Guericke University, Leipziger Str. 44, 39122, Magdeburg, 39122, Germany, 49 537187 ext 3353, dietmar.urbach@med.ovgu.de %K COVID-19 %K SARS-CoV-2 %K statins %K antihypertensives %K surveillance %K hydroxymethyl-glutaryl-coenzyme A reductase inhibitors %K online survey %D 2020 %7 14.12.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: As the COVID-19 pandemic continues to spread across the globe, the search for an effective medication to treat the symptoms of COVID-19 continues as well. It would be desirable to identify a medication that is already in use for another condition and whose side effect profile and safety data are already known and approved. Objective: The objective of this study was to evaluate the effect of different medications on typical COVID-19 symptoms by using data from an online surveillance survey. Methods: Between early April and late-July 2020, a total of 3654 individuals in Lower Saxony, Germany, participated in an online symptom-tracking survey conducted through the app covid-nein-danke.de. The questionnaire comprised items on typical COVID-19 symptoms, age range, gender, employment in patient-facing healthcare, housing status, postal code, previous illnesses, permanent medication, vaccination status, results of reverse transcription polymerase chain reaction (RT-PCR) and antibody tests for COVID-19 diagnosis, and consequent COVID-19 treatment if applicable. Odds ratio estimates with corresponding 95% CIs were computed for each medication and symptom by using logistic regression models. Results: Data analysis suggested a statistically significant inverse relationship between typical COVID-19 symptoms self-reported by the participants and self-reported statin therapy and, to a lesser extent, antihypertensive therapy. When COVID-19 diagnosis was based on restrictive symptom criteria (ie, presence of 4 out of 7 symptoms) or a positive RT-PCR test, a statistically significant association was found solely for statins (odds ratio 0.28, 95% CI 0.1-0.78). Conclusions: Individuals taking statin medication are more likely to have asymptomatic COVID-19, in which case they may be at an increased risk of transmitting the disease unknowingly. We suggest that the results of this study be incorporated into symptoms-based surveillance and decision-making protocols in regard to COVID-19 management. Whether statin therapy has a beneficial effect in combating COVID-19 cannot be deduced based on our findings and should be investigated by further study. Trial Registration: German Clinical Trials Register DRKS00022185; https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00022185; World Health Organization International Clinical Trials Registry Platform U1111-1252-6946 %M 33197879 %R 10.2196/22521 %U http://publichealth.jmir.org/2020/4/e22521/ %U https://doi.org/10.2196/22521 %U http://www.ncbi.nlm.nih.gov/pubmed/33197879 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 12 %P e21418 %T Social Media Insights Into US Mental Health During the COVID-19 Pandemic: Longitudinal Analysis of Twitter Data %A Valdez,Danny %A ten Thij,Marijn %A Bathina,Krishna %A Rutter,Lauren A %A Bollen,Johan %+ Department of Applied Health Science, School of Public Health, Indiana University, 1033 E 3rd Street, Office 143, Bloomington, IN, United States, 1 812 855 1561, danvald@iu.edu %K social media %K analytics %K infodemiology %K infoveillance %K COVID-19 %K United States %K mental health %K informatics %K sentiment analysis %K Twitter %D 2020 %7 14.12.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic led to unprecedented mitigation efforts that disrupted the daily lives of millions. Beyond the general health repercussions of the pandemic itself, these measures also present a challenge to the world’s mental health and health care systems. Considering that traditional survey methods are time-consuming and expensive, we need timely and proactive data sources to respond to the rapidly evolving effects of health policy on our population’s mental health. Many people in the United States now use social media platforms such as Twitter to express the most minute details of their daily lives and social relations. This behavior is expected to increase during the COVID-19 pandemic, rendering social media data a rich field to understand personal well-being. Objective: This study aims to answer three research questions: (1) What themes emerge from a corpus of US tweets about COVID-19? (2) To what extent did social media use increase during the onset of the COVID-19 pandemic? and (3) Does sentiment change in response to the COVID-19 pandemic? Methods: We analyzed 86,581,237 public domain English language US tweets collected from an open-access public repository in three steps. First, we characterized the evolution of hashtags over time using latent Dirichlet allocation (LDA) topic modeling. Second, we increased the granularity of this analysis by downloading Twitter timelines of a large cohort of individuals (n=354,738) in 20 major US cities to assess changes in social media use. Finally, using this timeline data, we examined collective shifts in public mood in relation to evolving pandemic news cycles by analyzing the average daily sentiment of all timeline tweets with the Valence Aware Dictionary and Sentiment Reasoner (VADER) tool. Results: LDA topics generated in the early months of the data set corresponded to major COVID-19–specific events. However, as state and municipal governments began issuing stay-at-home orders, latent themes shifted toward US-related lifestyle changes rather than global pandemic-related events. Social media volume also increased significantly, peaking during stay-at-home mandates. Finally, VADER sentiment analysis scores of user timelines were initially high and stable but decreased significantly, and continuously, by late March. Conclusions: Our findings underscore the negative effects of the pandemic on overall population sentiment. Increased use rates suggest that, for some, social media may be a coping mechanism to combat feelings of isolation related to long-term social distancing. However, in light of the documented negative effect of heavy social media use on mental health, social media may further exacerbate negative feelings in the long-term for many individuals. Thus, considering the overburdened US mental health care structure, these findings have important implications for ongoing mitigation efforts. %M 33284783 %R 10.2196/21418 %U http://www.jmir.org/2020/12/e21418/ %U https://doi.org/10.2196/21418 %U http://www.ncbi.nlm.nih.gov/pubmed/33284783 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 12 %P e20653 %T Addressing Public Health Emergencies via Facebook Surveys: Advantages, Challenges, and Practical Considerations %A Grow,André %A Perrotta,Daniela %A Del Fava,Emanuele %A Cimentada,Jorge %A Rampazzo,Francesco %A Gil-Clavel,Sofia %A Zagheni,Emilio %+ Laboratory of Digital and Computational Demography, Max Planck Institute for Demographic Research, Konrad-Zuse-Str 1, Rostock, 18057, Germany, 49 3812081142, grow@demogr.mpg.de %K Facebook %K web-based surveys %K public health emergency %K COVID-19 %D 2020 %7 14.12.2020 %9 Viewpoint %J J Med Internet Res %G English %X Surveys of the general population can provide crucial information for designing effective nonpharmaceutical interventions to tackle public health emergencies, such as the COVID-19 pandemic. Yet, conducting such surveys can be difficult, especially when timely data collection is required. In this viewpoint paper, we discuss our experiences with using targeted Facebook advertising campaigns to address these difficulties in relation to the COVID-19 pandemic. We describe central advantages, challenges, and practical considerations. This includes a discussion of potential sources of bias and how they can be addressed. %M 33284782 %R 10.2196/20653 %U http://www.jmir.org/2020/12/e20653/ %U https://doi.org/10.2196/20653 %U http://www.ncbi.nlm.nih.gov/pubmed/33284782 %0 Journal Article %@ 2152-7202 %I JMIR Publications %V 12 %N 4 %P e23860 %T Does a Pandemic Preempt Participatory Medicine? %A Millenson,Michael Louis %+ Health Quality Advisors LLC, Highland Park, IL, United States, michael@healthqualityadvisors.com %K participatory medicine %K COVID-19 %K pandemic %K Fitbit %K DETECT study, Body Politic %K wearables %K sensors %K patient-generated health data %K shared decision making %D 2020 %7 14.12.2020 %9 Patient Perspectives %J J Participat Med %G English %X For those of us who believe deeply in a collaborative relationship between patients and doctors, the chaos created by the COVID-19 pandemic has brought an uncomfortable question to the fore: Is participatory medicine still relevant during a pandemic? Drawing liberally upon the Jewish tradition of Talmudic reasoning, I would like to offer 3 considered replies: “Yes,” “no,” and “it depends.” Sometimes, patients may have no choice but to cede control to medical professionals, even though patients are still the experts on their own lives. Other times, the shared control of participatory medicine is both an ethical and clinical imperative. However, as the worldwide toll exacted by COVID-19 has made us grimly aware, no one is really in control. That is why, in these uncertain times, the path forward requires maintaining mutual trust between health care providers and patients, whatever the circumstances. After all, it is our bodies and our selves at stake. %M 33157521 %R 10.2196/23860 %U http://jopm.jmir.org/2020/4/e23860/ %U https://doi.org/10.2196/23860 %U http://www.ncbi.nlm.nih.gov/pubmed/33157521 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 12 %P e21273 %T An Educational Network for Surgical Education Supported by Gamification Elements: Protocol for a Randomized Controlled Trial %A Guérard-Poirier,Natasha %A Beniey,Michèle %A Meloche-Dumas,Léamarie %A Lebel-Guay,Florence %A Misheva,Bojana %A Abbas,Myriam %A Dhane,Malek %A Elraheb,Myriam %A Dubrowski,Adam %A Patocskai,Erica %+ Department of General Surgery, Université de Montréal, Pavillon Roger-Gaudry, Local: S-749, CP 6128, succursale Centre-ville, Montreal, QC, H3C 3J7, Canada, 1 514 343 6111, michele.beniey@umontreal.ca %K distance learning %K COVID-19 %K surgical pedagogy %K learning platform %K subcuticular sutures %K advanced sutures %K medical education %K peer learning %K surgery %K medical student %K web-based learning %K web-based tool %K gamification %K video %D 2020 %7 14.12.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: Traditionally, medical students have learned surgical skills by observing a resident physician or surgeon who is performing the technique. Due to inconsistent practice opportunities in the clinical setting, a disparity of skill levels among students has been observed. In addition, the poor availability of faculty professors is a limiting factor in teaching and adequately preparing medical students for their clerkship years. With the ongoing COVID-19 pandemic, medical students do not have access to traditional suturing learning opportunities. Didactic courses are available on videoconferencing platforms; however, these courses do not include technical training. Objective: Our overarching goal is to evaluate the efficacy and usability of web-based peer-learning for advanced suturing techniques (ie, running subcuticular sutures). We will use the Gamified Educational Network (GEN), a newly developed web-based learning tool. We will assess students’ ability to identify and perform the correct technique. We will also assess the students’ satisfaction with regard to GEN. Methods: We will conduct a prospective randomized controlled trial with blinding of expert examiners. First-year medical students in the Faculty of Medicine of Université de Montréal will be randomized into four groups: (1) control, (2) self-learning, (3) peer-learning, and (4) peer-learning with expert feedback. Each arm will have 15 participants who will learn how to perform running subcuticular sutures through videos on GEN. For our primary outcome, the students’ ability to identify the correct technique will be evaluated before and after the intervention on GEN. The students will view eight videos and rate the surgical techniques using the Objective Structured Assessment of Technical Skills Global Rating Scale and the Subcuticular Suture Checklist as evaluation criteria. For our secondary outcomes, students will anonymously record themselves performing a running subcuticular suture and will be evaluated using the same scales. Then, a survey will be sent to assess the students’ acceptance of the intervention. Results: The study will be conducted in accordance with the Declaration of Helsinki and has been approved by our institutional review board (CERSES 20-068-D). No participants have been recruited yet. Conclusions: Peer learning through GEN has the potential to overcome significant limitations related to the COVID-19 pandemic and the lack of availability of faculty professors. Further, a decrease of the anxiety related to traditional suturing classes can be expected. We aim to create an innovative and sustainable method of teaching surgical skills to improve the efficiency and quality of surgical training in medical faculties. In the context of the COVID-19 pandemic, the need for such tools is imperative. Trial Registration: ClinicalTrials.gov NCT04425499; https://clinicaltrials.gov/ct2/show/NCT04425499 International Registered Report Identifier (IRRID): PRR1-10.2196/21273 %M 33284780 %R 10.2196/21273 %U http://www.researchprotocols.org/2020/12/e21273/ %U https://doi.org/10.2196/21273 %U http://www.ncbi.nlm.nih.gov/pubmed/33284780 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 12 %P e24514 %T Research Output and International Cooperation Among Countries During the COVID-19 Pandemic: Scientometric Analysis %A Grammes,Nadja %A Millenaar,Dominic %A Fehlmann,Tobias %A Kern,Fabian %A Böhm,Michael %A Mahfoud,Felix %A Keller,Andreas %+ University Hospital of Saarland, Department of Internal Medicine III, Kirrberger Str, Homburg, 66421, Germany, 49 68411615000, dominic.millenaar@uks.eu %K scientometric analysis %K COVID-19 %K SARS-CoV-2 %K citation analysis %K research %K literature %K citation %D 2020 %7 11.12.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic, caused by the novel coronavirus SARS-CoV-2, has instigated immediate and massive worldwide research efforts. Rapid publication of research data may be desirable but also carries the risk of quality loss. Objective: This analysis aimed to correlate the severity of the COVID-19 outbreak with its related scientific output per country. Methods: All articles related to the COVID-19 pandemic were retrieved from Web of Science and analyzed using the web application SciPE (science performance evaluation), allowing for large data scientometric analyses of the global geographical distribution of scientific output. Results: A total of 7185 publications, including 2592 articles, 2091 editorial materials, 2528 early access papers, 1479 letters, 633 reviews, and other contributions were extracted. The top 3 countries involved in COVID-19 research were the United States, China, and Italy. The confirmed COVID-19 cases or deaths per region correlated with scientific research output. The United States was most active in terms of collaborative efforts, sharing a significant amount of manuscript authorships with the United Kingdom, China, and Italy. The United States was China’s most frequent collaborative partner, followed by the United Kingdom. Conclusions: The COVID-19 research landscape is rapidly developing and is driven by countries with a generally strong prepandemic research output but is also significantly affected by countries with a high prevalence of COVID-19 cases. Our findings indicate that the United States is leading international collaborative efforts. %M 33237878 %R 10.2196/24514 %U http://www.jmir.org/2020/12/e24514/ %U https://doi.org/10.2196/24514 %U http://www.ncbi.nlm.nih.gov/pubmed/33237878 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 12 %P e22874 %T Use of WhatsApp for Polyclinic Consultation of Suspected Patients With COVID-19: Retrospective Case Control Study %A Sabırlı,Ramazan %A Karsli,Emre %A Canacik,Omer %A Ercin,Dogan %A Çiftçi,Handan %A Sahin,Levent %A Dolanbay,Turgut %A Tutuncu,Emin Ediz %+ Kafkas University Faculty of Medicine, Department of Emergency Medicine, Kafkas University Hospital, Kars, 36000, Turkey, 90 5387344298, ramazan_sabirli@hotmail.com %K telemedicine %K WhatsApp %K ED crowding %K COVID-19 %K emergency department %K messaging %K communication %K consultation %K clinic %K infectious disease %D 2020 %7 11.12.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Telephones, internet-connected devices (phablets, personal computers), chat platforms, and mobile apps (eg, Skype, Facebook Messenger, WhatsApp) can be exploited for telemedicine applications. WhatsApp and similar apps are also widely used to facilitate clinical communication between physicians. Moreover, WhatsApp is used by emergency department (ED) physicians and consulting physicians to exchange medical information during ED consultations. This platform is regarded as a useful app in the consultation of dermatological and orthopedic cases. Preventing overcrowding in the ED is key to reducing the risk of disease transmission, and teleconsulting practice is thought to be effective in the diagnosis, treatment, and reduction of transmission risk of disease, most notably during the COVID-19 pandemic. Video consultation is highly recommended in some countries on the grounds that it is likely to reduce the risk of transmission. WhatsApp-like apps are among the video consultation platforms that are assumed to reduce the risk of contamination by minimizing patient-physician contact. Objective: The aim of this study was to investigate the effects of WhatsApp video consultation on patient admission and discharge times in comparison to bedside consultation in the evaluation of potential patients with COVID-19 visiting a COVID-19 outpatient clinic during the pandemic. Methods: Patients who presented to the ED COVID-19 outpatient clinic between March 11 and May 31, 2020, and for whom an infectious disease specialist was consulted (via WhatsApp or at bedside) were included in the study in accordance with the inclusion and exclusion criteria. Eventually, 54 patients whose consultations were performed via WhatsApp and 90 patients whose consultations were performed at bedside were included in our study. Results: The median length of stay in the ED of discharged patients amounted to 103 minutes (IQR 85-147.75) in the WhatsApp group and 196 minutes (IQR 141-215) in the bedside group. In this regard, the length of stay in the ED was found to be significantly shorter in the WhatsApp group than in the bedside group (P<.001). Among the consulted and discharged patients, 1 patient in each group tested positive for SARS-CoV-2 by polymerase chain reaction test and thus was readmitted and hospitalized (P=.62). The median length of stay of the inpatients in the ED was found to be 116.5 minutes (IQR 85.5-145.5) in the WhatsApp group and 132 minutes (IQR 102-168) in the bedside group. The statistical analysis of this time difference revealed that the length of stay in the ED was significantly shorter for patients in the WhatsApp group than in the bedside group (P=.04). Conclusions: Consultation via WhatsApp reduces both contact time with patients with COVID-19 and the number of medical staff contacting the patients, which contributes greatly to reducing the risk of COVID-19 transmission. WhatsApp consultation may prove useful in clinical decision making as well as in shortening process times. Moreover, it does not result in a decreased accuracy rate. The shortened discharge and hospitalization timespans also decreased the length of stay in the ED, which can have an impact on minimizing ED crowding. Trial Registration: ClinicalTrials.gov NCT04645563; https://clinicaltrials.gov/ct2/show/NCT04645563. %M 33276318 %R 10.2196/22874 %U http://mhealth.jmir.org/2020/12/e22874/ %U https://doi.org/10.2196/22874 %U http://www.ncbi.nlm.nih.gov/pubmed/33276318 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 12 %P e22703 %T Use and Cost-Effectiveness of a Telehealth Service at a Centralized COVID-19 Quarantine Center in Taiwan: Cohort Study %A Yen,Yung-Feng %A Tsai,Yi-Fan %A Su,Vincent Yi-Fong %A Chan,Shang-Yih %A Yu,Wen-Ruey %A Ho,Hsuan %A Hou,Chun-Mei %A Chen,Chu-Chieh %A Woung,Lin-Chung %A Huang,Sheng-Jean %+ Department of Internal Medicine, Taipei City Hospital Yangming Branch, No.145 Zhengzhou Road, Datong District, Taipei, 103, Taiwan, 886 2 2555 3000, dad89@tpech.gov.tw %K COVID-19 %K international travelers %K quarantine %K telehealth %K cost-effectiveness %K cohort %K monitoring %K telemedicine %D 2020 %7 11.12.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Telehealth is a recommended method for monitoring the progression of nonsevere infections in patients with COVID-19. However, telehealth has not been widely implemented to monitor SARS-CoV-2 infection in quarantined individuals. Moreover, studies on the cost-effectiveness of quarantine measures during the COVID-19 pandemic are scarce. Objective: In this cohort study, we aimed to use telehealth to monitor COVID-19 infections in 217 quarantined Taiwanese travelers and to analyze the cost-effectiveness of the quarantine program. Methods: Travelers were quarantined for 14 days at the Taiwan Yangmingshan quarantine center and monitored until they were discharged. The travelers’ clinical symptoms were evaluated twice daily. A multidisciplinary medical team used the telehealth system to provide timely assistance for ill travelers. The cost of the mandatory quarantine was calculated according to data from the Ministry of Health and Welfare of Taiwan. Results: All 217 quarantined travelers tested negative for SARS-CoV-2 upon admission to the quarantine center. During the quarantine, 28/217 travelers (12.9%) became ill and were evaluated via telehealth. Three travelers with fever were hospitalized after telehealth assessment, and subsequent tests for COVID-19 were negative for all three patients. The total cost incurred during the quarantine was US $193,938, which equated to US $894 per individual. Conclusions: Telehealth is an effective instrument for monitoring COVID-19 infection in quarantined travelers and could help provide timely disease management for people who are ill. It is imperative to screen and quarantine international travelers for SARS-CoV-2 infection to reduce the nationwide spread of COVID-19. %M 33259324 %R 10.2196/22703 %U http://www.jmir.org/2020/12/e22703/ %U https://doi.org/10.2196/22703 %U http://www.ncbi.nlm.nih.gov/pubmed/33259324 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 12 %P e24531 %T People’s Experiences and Satisfaction With Telehealth During the COVID-19 Pandemic in Australia: Cross-Sectional Survey Study %A Isautier,Jennifer MJ %A Copp,Tessa %A Ayre,Julie %A Cvejic,Erin %A Meyerowitz-Katz,Gideon %A Batcup,Carys %A Bonner,Carissa %A Dodd,Rachael %A Nickel,Brooke %A Pickles,Kristen %A Cornell,Samuel %A Dakin,Thomas %A McCaffery,Kirsten J %+ Faculty of Medicine and Health, Sydney Health Literacy Lab, School of Public Health, The University of Sydney, Edward Ford Building, A27 Fisher Rd, Sydney, 2006, Australia, 61 02 9114 2199, jennifer.isautier@sydney.edu.au %K COVID-19 %K patient experience %K telehealth %K experience %K satisfaction %K telemedicine %K Australia %K usability %K cross-sectional %K survey %D 2020 %7 10.12.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: In response to the COVID-19 pandemic, telehealth has rapidly been adopted to deliver health care services around the world. To date, studies have not compared people’s experiences with telehealth services during the pandemic in Australia to their experiences with traditional in-person visits. Objective: This study aimed to compare participants’ perceptions of telehealth consults to their perceptions of traditional in-person visits and investigate whether people believe that telehealth services would be useful after the pandemic. Methods: A national, cross-sectional, community survey was conducted between June 5 and June 12, 2020 in Australia. In total, 1369 participants who were aged ≥18 years and lived in Australia were recruited via targeted advertisements on social media (ie, Facebook and Instagram). Participants responded to survey questions about their telehealth experience, which included a free-text response option. A generalized linear model was used to estimate the adjusted relative risks of having a poorer telehealth experience than a traditional in-person visit experience. Content analysis was performed to determine the reasons why telehealth experiences were worse than traditional in-person visit experiences. Results: Of the 596 telehealth users, the majority of respondents (n=369, 61.9%) stated that their telehealth experience was “just as good as” or “better than” their traditional in-person medical appointment experience. On average, respondents perceived that telehealth would be moderately useful to very useful for medical appointments after the COVID-19 pandemic ends (mean 3.67, SD 1.1). Being male (P=.007), having a history of both depression and anxiety (P=.016), and lower patient activation scores (ie, individuals’ willingness to take on the role of managing their health/health care) (P=.036) were significantly associated with a poor telehealth experience. In total, 6 overarching themes were identified from free-text responses for why participants’ telehealth experiences were poorer than their traditional in-person medical appointment experiences, as follows: communication is not as effective, limitations with technology, issues with obtaining prescriptions and pathology results, reduced confidence in their doctor, additional burden for complex care, and inability to be physically examined. Conclusions: Based on our sample’s responses, telehealth appointment experiences were comparable to traditional in-person medical appointment experiences. Telehealth may be worthwhile as a mode of health care delivery while the pandemic continues, and it may continue to be worthwhile after the pandemic. %M 33156806 %R 10.2196/24531 %U http://www.jmir.org/2020/12/e24531/ %U https://doi.org/10.2196/24531 %U http://www.ncbi.nlm.nih.gov/pubmed/33156806 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 12 %P e22103 %T Effective Control of COVID-19 in South Korea: Cross-Sectional Study of Epidemiological Data %A Jeong,Gwang Hun %A Lee,Hyo Jeong %A Lee,Jinhee %A Lee,Jun Young %A Lee,Keum Hwa %A Han,Young Joo %A Yoon,Sojung %A Ryu,Seohyun %A Kim,Da Kyung %A Park,Myung Bae %A Yang,Jae Won %A Effenberger,Maria %A Eisenhut,Michael %A Hong,Sung Hwi %A Kronbichler,Andreas %A Ghayda,Ramy Abou %A Shin,Jae Il %+ Department of Pediatrics, Yonsei University College of Medicine, Yonsei-ro 50, Seodaemun-gu, CPO Box 8044, Seoul, 03722, Republic of Korea, 82 222282050, shinji@yuhs.ac %K COVID-19 %K Korea %K strategies %K epidemiological characteristics %D 2020 %7 10.12.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: South Korea is one of the few countries that has succeeded in flattening the curve of new COVID-19 cases and avoiding a second outbreak by implementing multiple strategies, ranging from an individual level to the population level. Objective: We aim to discuss the unique strategies and epidemiological characteristics of COVID-19 in South Korea and present a summary of policies implemented by the Korean government during the COVID-19 pandemic. Methods: We designed a cross-sectional study of epidemiological data published by the Korea Centers for Disease Control and Prevention on October 1, 2020. We analyzed detailed epidemiological information of COVID-19 cases, including the number of confirmed cases and resulting deaths. Results: As of October 1, 2020, a total of 23,889 confirmed COVID-19 cases and 415 deaths were reported in South Korea. In this paper, we present data on the epidemiological characteristics and transmission of the disease and discuss how the South Korean government, health care providers, and society responded to the COVID-19 outbreak. Conclusions: Understanding the epidemiological characteristics of COVID-19 in South Korea and the government’s successful efforts in managing the spread of the disease can provide important insights to other countries dealing with the ongoing pandemic. %M 33151893 %R 10.2196/22103 %U http://www.jmir.org/2020/12/e22103/ %U https://doi.org/10.2196/22103 %U http://www.ncbi.nlm.nih.gov/pubmed/33151893 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 7 %N 2 %P e24960 %T An Affordable, User-friendly Telerehabilitation System Assembled Using Existing Technologies for Individuals Isolated With COVID-19: Development and Feasibility Study %A Mukaino,Masahiko %A Tatemoto,Tsuyoshi %A Kumazawa,Nobuhiro %A Tanabe,Shigeo %A Katoh,Masaki %A Saitoh,Eiichi %A Otaka,Yohei %+ Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, 4701192, Japan, 81 562 93 2167, otaka119@mac.com %K telerehabilitation %K COVID-19 %K telemedicine %K isolation %K user-friendly %K feasibility %K rehabilitation %K eHealth %D 2020 %7 10.12.2020 %9 Original Paper %J JMIR Rehabil Assist Technol %G English %X Background: Isolation due to a COVID-19 infection can limit activities and cause physical and mental decline, especially in older adults and people with disabilities. However, due to limited contact, adequate rehabilitation is difficult to provide for quarantined patients. Telerehabilitation technology could be a solution; however, issues specific to COVID-19 should be taken into consideration, such as strict quarantine and respiratory symptoms, as well as accessibility to deal with rapid increases in need due to the pandemic. Objective: This study aims to develop and to investigate the feasibility of a telerehabilitation system for patients who are quarantined due to COVID-19 by combining existing commercial devices and computer applications. Methods: A multidisciplinary team has identified the requirements for a telerehabilitation system for COVID-19 and developed the system to satisfy those requirements. In the subsequent feasibility study, patients diagnosed with COVID-19 (N=10; mean age 60 years, SD 18 years) were included. A single session of telerehabilitation consisted of stretching exercises, a 15-minute exercise program, and a video exercise program conducted under real-time guidance by a physical therapist through a video call. The system included a tablet computer, a pulse oximeter, videoconferencing software, and remote control software. The feasibility of the system was evaluated using the Telemedicine Satisfaction Questionnaire (TSQ; 14 items) and an additional questionnaire on the telerehabilitation system (5 items). Each item was rated from “1 = strongly disagree” to “5 = strongly agree.” Results: The telerehabilitation system was developed by combining existing devices and applications, including a pulse oximeter and remote control mechanism, to achieve user-friendliness, affordability, and safety, which were determined as the system requirements. In the feasibility study, 9 out of 10 patients were able to use the telerehabilitation system without any on-site help. On the TSQ, the mean score for each item was 4.7 (SD 0.7), and in the additional items regarding telerehabilitation, the mean score for each item was 4.3 (SD 1.0). Conclusions: These findings support the feasibility of this simple telerehabilitation system in quarantined patients with COVID-19, encouraging further investigation on the merit of the system’s use in clinical practice. %M 33279877 %R 10.2196/24960 %U http://rehab.jmir.org/2020/2/e24960/ %U https://doi.org/10.2196/24960 %U http://www.ncbi.nlm.nih.gov/pubmed/33279877 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 12 %P e23170 %T COVID-19 Mobile Apps: A Systematic Review of the Literature %A Kondylakis,Haridimos %A Katehakis,Dimitrios G %A Kouroubali,Angelina %A Logothetidis,Fokion %A Triantafyllidis,Andreas %A Kalamaras,Ilias %A Votis,Konstantinos %A Tzovaras,Dimitrios %+ Computational Biomedicine Laboratory, Foundation for Research and Technology - Hellas–Institute of Computer Science, N. Plastira 100, Heraklion, 70013, Greece, 30 2810391449, kondylak@ics.forth.gr %K mobile apps %K systematic survey %K COVID-19 %K mobile health %K eHealth %D 2020 %7 9.12.2020 %9 Review %J J Med Internet Res %G English %X Background: A vast amount of mobile apps have been developed during the past few months in an attempt to “flatten the curve” of the increasing number of COVID-19 cases. Objective: This systematic review aims to shed light into studies found in the scientific literature that have used and evaluated mobile apps for the prevention, management, treatment, or follow-up of COVID-19. Methods: We searched the bibliographic databases Global Literature on Coronavirus Disease, PubMed, and Scopus to identify papers focusing on mobile apps for COVID-19 that show evidence of their real-life use and have been developed involving clinical professionals in their design or validation. Results: Mobile apps have been implemented for training, information sharing, risk assessment, self-management of symptoms, contact tracing, home monitoring, and decision making, rapidly offering effective and usable tools for managing the COVID-19 pandemic. Conclusions: Mobile apps are considered to be a valuable tool for citizens, health professionals, and decision makers in facing critical challenges imposed by the pandemic, such as reducing the burden on hospitals, providing access to credible information, tracking the symptoms and mental health of individuals, and discovering new predictors. %M 33197234 %R 10.2196/23170 %U http://www.jmir.org/2020/12/e23170/ %U https://doi.org/10.2196/23170 %U http://www.ncbi.nlm.nih.gov/pubmed/33197234 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 12 %P e24328 %T Rapid Implementation of Video Visits in Neurology During COVID-19: Mixed Methods Evaluation %A Saliba-Gustafsson,Erika A %A Miller-Kuhlmann,Rebecca %A Kling,Samantha M R %A Garvert,Donn W %A Brown-Johnson,Cati G %A Lestoquoy,Anna Sophia %A Verano,Mae-Richelle %A Yang,Laurice %A Falco-Walter,Jessica %A Shaw,Jonathan G %A Asch,Steven M %A Gold,Carl A %A Winget,Marcy %+ Primary Care and Population Health, Stanford University School of Medicine, Stanford University, Stanford MSOB, 1265 Welch Rd, Mail Code 5475, Palo Alto, CA, 94305, United States, 1 650 723 1146, esalgus@stanford.edu %K teleneurology %K telemedicine %K telehealth %K ambulatory neurology %K video visits %K COVID-19 %K implementation %K outcomes %K video %K neurology %K mixed methods %K acceptability %K sustainability %D 2020 %7 9.12.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Telemedicine has been used for decades. Despite its many advantages, its uptake and rigorous evaluation of feasibility across neurology’s ambulatory subspecialties has been sparse. However, the COVID-19 pandemic prompted health care systems worldwide to reconsider traditional health care delivery. To safeguard health care workers and patients, many health care systems quickly transitioned to telemedicine, including across neurology subspecialties, providing a new opportunity to evaluate this modality of care. Objective: To evaluate the accelerated implementation of video visits in ambulatory neurology during the COVID-19 pandemic, we used mixed methods to assess adoption, acceptability, appropriateness, and perceptions of potential sustainability. Methods: Video visits were launched rapidly in ambulatory neurology clinics of a large academic medical center. To assess adoption, we analyzed clinician-level scheduling data collected between March 22 and May 16, 2020. We assessed acceptability, appropriateness, and sustainability via a clinician survey (n=48) and semistructured interviews with providers (n=30) completed between March and May 2020. Results: Video visits were adopted rapidly; overall, 65 (98%) clinicians integrated video visits into their workflow within the first 6 implementation weeks and 92% of all visits were conducted via video. Video visits were largely considered acceptable by clinicians, although various technological issues impacted their satisfaction. Video visits were reported to be more convenient for patients, families, and caregivers than in-person visits; however, access to technology, the patient’s technological capacity, and language difficulties were considered barriers. Many clinicians expressed optimism about future utilization of video visits in neurology. They believed that video visits promote continuity of care and can be incorporated into their practice long-term, although several insisted that they can never replace the in-person examination. Conclusions: Video visits are an important addition to clinical care in ambulatory neurology and are anticipated to remain a permanent supplement to in-person visits, promoting patient care continuity, and flexibility for patients and clinicians alike. %M 33245699 %R 10.2196/24328 %U http://www.jmir.org/2020/12/e24328/ %U https://doi.org/10.2196/24328 %U http://www.ncbi.nlm.nih.gov/pubmed/33245699 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 12 %P e23157 %T Experiences, Attitudes, and Needs of Users of a Pregnancy and Parenting App (Baby Buddy) During the COVID-19 Pandemic: Mixed Methods Study %A Rhodes,Alexandra %A Kheireddine,Sara %A Smith,Andrea D %+ Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London, Gower Street, London, WC1E 6BT, United Kingdom, 44 20 7679 2000, alexandra.rhodes.15@ucl.ac.uk %K pregnancy %K parenting %K app %K COVID-19 %K pregnancy support %K postnatal support %K perinatal %K mental well-being %K physical well-being %K support %K well-being %K experience %K attitude %K needs %D 2020 %7 9.12.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The COVID-19 pandemic has impacted the lives of expectant parents and parents of young babies, with disruptions in health care provision and loss of social support. Objective: This study investigated the impact of the COVID-19 pandemic and its associated lockdown on this population through the lens of users of the UK National Health Service–approved pregnancy and parenting smartphone app, Baby Buddy. The study aims were threefold: to gain insights into the attitudes and experiences of expectant and recent parents (with babies under 24 weeks of age) during the COVID-19 pandemic; to investigate whether Baby Buddy is meeting users’ needs during this time; and to identify ways to revise the content of Baby Buddy to better support its users now and in future. Methods: A mixed methods study design combining a web-based survey with semistructured telephone interviews among Baby Buddy users in the United Kingdom was applied. Data were collected from April 15 to mid-June 2020, corresponding to weeks 4-13 of the lockdown in the United Kingdom. Results: A total of 436 expectant (n=244, 56.0%) and recent (n=192, 44.0%) parents responded to the web-based survey, of which 79.1% (n=345) were aged 25-39 years and 17.2% (n=75) spoke English as their second language. Of the 436 respondents, 88.5% (386/436) reported increased levels of anxiety around pregnancy, birth, and being a new parent, and 58.0% (253/436) were concerned about their emotional and mental health. Of the 244 pregnant respondents, 43.4% (n=106) were concerned about their physical health. Telephone interviews with 13 pregnant women and 19 recent parents revealed similarly increased levels of anxiety due to reduced health care provision and loss of support from friends and family. Although a minority of respondents identified some positive outcomes of lockdown, such as family bonding, many telephone interviewees reported feeling isolated, disregarded, and overwhelmed. Recent parents were particularly anxious about the impact of the lockdown on their baby’s development and socialization. Many interviewees were also concerned about their physical health as a consequence of both limited access to face-to-face medical appointments and their own poorer dietary and physical activity behaviors. Across both samples, 97.0% (423/436) of respondents reported that Baby Buddy was currently helping them, with many commenting that its role was even more important given the lack of face-to-face support from health care and parenting organizations. Greater speed in updating digital content to reflect changes due to the pandemic was suggested. Conclusions: The COVID-19 pandemic has created heightened anxiety and stress among expectant parents and those with a young baby, and for many, lockdown has had an adverse impact on their physical and mental well-being. With reductions in health care and social support, expectant and new parents are increasingly relying on web-based resources. As a free, evidence-based app, Baby Buddy is well positioned to meet this need. The app could support its users even more by actively directing them to the wealth of existing content relevant to their concerns and by adding content to give users the knowledge and confidence to meet new challenges. %M 33264100 %R 10.2196/23157 %U http://mhealth.jmir.org/2020/12/e23157/ %U https://doi.org/10.2196/23157 %U http://www.ncbi.nlm.nih.gov/pubmed/33264100 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 12 %P e22609 %T Detection of Hate Speech in COVID-19–Related Tweets in the Arab Region: Deep Learning and Topic Modeling Approach %A Alshalan,Raghad %A Al-Khalifa,Hend %A Alsaeed,Duaa %A Al-Baity,Heyam %A Alshalan,Shahad %+ King Saud University, Riyadh 11451, Riyadh, , Saudi Arabia, 966 504426816, hend.alkhalifa@gmail.com %K COVID-19 %K coronavirus %K Twitter %K hate speech %K social network analysis %K social media %K public health %K pandemic %K deep learning %K non-negative matrix factorization %K NMF %K convolutional neural network %K CNN %D 2020 %7 8.12.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The massive scale of social media platforms requires an automatic solution for detecting hate speech. These automatic solutions will help reduce the need for manual analysis of content. Most previous literature has cast the hate speech detection problem as a supervised text classification task using classical machine learning methods or, more recently, deep learning methods. However, work investigating this problem in Arabic cyberspace is still limited compared to the published work on English text. Objective: This study aims to identify hate speech related to the COVID-19 pandemic posted by Twitter users in the Arab region and to discover the main issues discussed in tweets containing hate speech. Methods: We used the ArCOV-19 dataset, an ongoing collection of Arabic tweets related to COVID-19, starting from January 27, 2020. Tweets were analyzed for hate speech using a pretrained convolutional neural network (CNN) model; each tweet was given a score between 0 and 1, with 1 being the most hateful text. We also used nonnegative matrix factorization to discover the main issues and topics discussed in hate tweets. Results: The analysis of hate speech in Twitter data in the Arab region identified that the number of non–hate tweets greatly exceeded the number of hate tweets, where the percentage of hate tweets among COVID-19 related tweets was 3.2% (11,743/547,554). The analysis also revealed that the majority of hate tweets (8385/11,743, 71.4%) contained a low level of hate based on the score provided by the CNN. This study identified Saudi Arabia as the Arab country from which the most COVID-19 hate tweets originated during the pandemic. Furthermore, we showed that the largest number of hate tweets appeared during the time period of March 1-30, 2020, representing 51.9% of all hate tweets (6095/11,743). Contrary to what was anticipated, in the Arab region, it was found that the spread of COVID-19–related hate speech on Twitter was weakly related with the dissemination of the pandemic based on the Pearson correlation coefficient (r=0.1982, P=.50). The study also identified the commonly discussed topics in hate tweets during the pandemic. Analysis of the 7 extracted topics showed that 6 of the 7 identified topics were related to hate speech against China and Iran. Arab users also discussed topics related to political conflicts in the Arab region during the COVID-19 pandemic. Conclusions: The COVID-19 pandemic poses serious public health challenges to nations worldwide. During the COVID-19 pandemic, frequent use of social media can contribute to the spread of hate speech. Hate speech on the web can have a negative impact on society, and hate speech may have a direct correlation with real hate crimes, which increases the threat associated with being targeted by hate speech and abusive language. This study is the first to analyze hate speech in the context of Arabic COVID-19–related tweets in the Arab region. %M 33207310 %R 10.2196/22609 %U http://www.jmir.org/2020/12/e22609/ %U https://doi.org/10.2196/22609 %U http://www.ncbi.nlm.nih.gov/pubmed/33207310 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 7 %N 12 %P e24021 %T Videoconferencing-Based Telemental Health: Important Questions for the COVID-19 Era From Clinical and Patient-Centered Perspectives %A Chiauzzi,Emil %A Clayton,Ashley %A Huh-Yoo,Jina %+ Department of Information Science, College of Computing and Informatics, Drexel University, 3675 Market St, Philadelphia, PA, 19104, United States, 1 7346453664, jh3767@drexel.edu %K telehealth %K telemental health %K COVID-19 %K videoconferencing %K ethics %K privacy %K mental health %K psychotherapy %K patient-centered %K lived experience %D 2020 %7 8.12.2020 %9 Viewpoint %J JMIR Ment Health %G English %X The COVID-19 pandemic has intensified the search for digital approaches in mental health treatment, particularly due to patients and clinicians practicing social distancing. This has resulted in the dramatic growth of videoconferencing-based telemental health (V-TMH) services. It is critical for behavioral health providers and those in the mental health field to understand the implications of V-TMH expansion on the stakeholders who use such services, such as patients and clinicians, to provide the service that addresses both patient and clinical needs. Several key questions arise as a result, such as the following: (1) in what ways does V-TMH affect the practice of psychotherapy (ie, clinical needs), (2) to what extent are ethical and patient-centered concerns warranted in terms of V-TMH services (ie, patient needs), and (3) how do factors related to user experience affect treatment dynamics for both the patient and therapist (ie, patient and clinical needs)? We discuss how behavioral health providers can consider the future delivery of mental health care services based on these questions, which pose strong implications for technological innovation, the adaptation of treatments to new technologies, and training professionals in the delivery of V-TMH services and other digital health interventions. %M 33180739 %R 10.2196/24021 %U http://mental.jmir.org/2020/12/e24021/ %U https://doi.org/10.2196/24021 %U http://www.ncbi.nlm.nih.gov/pubmed/33180739 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 4 %P e24125 %T Characterizing Weibo Social Media Posts From Wuhan, China During the Early Stages of the COVID-19 Pandemic: Qualitative Content Analysis %A Xu,Qing %A Shen,Ziyi %A Shah,Neal %A Cuomo,Raphael %A Cai,Mingxiang %A Brown,Matthew %A Li,Jiawei %A Mackey,Tim %+ Department of Anesthesiology and Division of Infectious Diseases and Global Public Health, School of Medicine, University of California, San Diego, 8950 Villa La Jolla Drive, A124, La Jolla, CA, 92037, United States, 1 951 491 4161, tmackey@ucsd.edu %K COVID-19 %K infodemiology %K infoveillance %K infodemic %K Weibo %K social media %K content analysis %K China %K data mining %K knowledge %K attitude %K behavior %D 2020 %7 7.12.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The COVID-19 pandemic has reached 40 million confirmed cases worldwide. Given its rapid progression, it is important to examine its origins to better understand how people’s knowledge, attitudes, and reactions have evolved over time. One method is to use data mining of social media conversations related to information exposure and self-reported user experiences. Objective: This study aims to characterize the knowledge, attitudes, and behaviors of social media users located at the initial epicenter of the outbreak by analyzing data from the Sina Weibo platform in Chinese. Methods: We used web scraping to collect public Weibo posts from December 31, 2019, to January 20, 2020, from users located in Wuhan City that contained COVID-19–related keywords. We then manually annotated all posts using an inductive content coding approach to identify specific information sources and key themes including news and knowledge about the outbreak, public sentiment, and public reaction to control and response measures. Results: We identified 10,159 COVID-19 posts from 8703 unique Weibo users. Among our three parent classification areas, 67.22% (n=6829) included news and knowledge posts, 69.72% (n=7083) included public sentiment, and 47.87% (n=4863) included public reaction and self-reported behavior. Many of these themes were expressed concurrently in the same Weibo post. Subtopics for news and knowledge posts followed four distinct timelines and evidenced an escalation of the outbreak’s seriousness as more information became available. Public sentiment primarily focused on expressions of anxiety, though some expressions of anger and even positive sentiment were also detected. Public reaction included both protective and elevated health risk behavior. Conclusions: Between the announcement of pneumonia and respiratory illness of unknown origin in late December 2019 and the discovery of human-to-human transmission on January 20, 2020, we observed a high volume of public anxiety and confusion about COVID-19, including different reactions to the news by users, negative sentiment after being exposed to information, and public reaction that translated to self-reported behavior. These findings provide early insight into changing knowledge, attitudes, and behaviors about COVID-19, and have the potential to inform future outbreak communication, response, and policy making in China and beyond. %M 33175693 %R 10.2196/24125 %U http://publichealth.jmir.org/2020/4/e24125/ %U https://doi.org/10.2196/24125 %U http://www.ncbi.nlm.nih.gov/pubmed/33175693 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 4 %P e22471 %T Clinical Characteristics and Outcomes of Patients With Diabetes Admitted for COVID-19 Treatment in Dubai: Single-Centre Cross-Sectional Study %A Bhatti,Rahila %A Khamis,Amar Hassan %A Khatib,Samara %A Shiraz,Seemin %A Matfin,Glenn %+ Department of Endocrinology, Mediclinic Parkview Hospital, 3 Umm Suqeim, Al Barsha South 1, Dubai, United Arab Emirates, 971 505290575, rsbhatti91@hotmail.com %K Diabetes %K COVID-19 %K characteristic %K outcome %K chronic condition %K cross-sectional %D 2020 %7 7.12.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Recent studies have shown that diabetes is a major risk factor that contributes to the severity of COVID-19 and resulting mortality. Poor glycemic control is also associated with poor patient outcomes (eg, hospitalization and death). Objective: This study aimed to describe the clinical characteristics and outcomes of patients with diabetes who were admitted to our hospital for COVID-19 treatment. Methods: This cross-sectional, observational study comprised patients with diabetes admitted with COVID-19 to Mediclinic Parkview Hospital in Dubai, United Arab Emirates, from March 30 to June 7, 2020. We studied the differences among characteristics, length of hospital stay, diabetes status, comorbidities, treatments, and outcomes among these patients. Results: Of the cohort patients, 25.1% (103/410) had coexistent diabetes or prediabetes. These patients represented 17 different ethnicities, with 59.2% (61/103) from Asian countries and 35% (36/103) from Arab countries. Mean patient age was 54 (SD 12.5) years, and 66.9% (69/103) of patients were male. Moreover, 85.4% (88/103) of patients were known to have diabetes prior to admission, and 14.6% (15/103) were newly diagnosed with either diabetes or prediabetes at admission. Most cohort patients had type 2 diabetes or prediabetes, and only 2.9% (3/103) of all patients had type 1 diabetes. Furthermore, 44.6% (46/103) of patients demonstrated evidence suggesting good glycemic control during the 4-12 weeks prior to admission, as defined arbitrarily by admission hemoglobin A1c level <7.5%, and 73.8% (76/103) of patients had other comorbidities, including hypertension, ischemic heart disease, and dyslipidemia. Laboratory data (mean and SD values) at admission for patients who needed ward-based care versus those who needed intensive care were as follows: fibrinogen, 462.8 (SD 125.1) mg/dL vs 660.0 (SD 187.6) mg/dL; D-dimer, 0.7 (SD 0.5) µg/mL vs 2.3 (SD 3.5) µg/mL; ferritin, 358.0 (SD 442.0) mg/dL vs 1762.4 (SD 2586.4) mg/dL; and C-reactive protein, 33.9 (SD 38.6) mg/L vs 137.0 (SD 111.7) mg/L. Laboratory data were all significantly higher for patients in the intensive care unit subcohort (P<.05). The average length of hospital stay was 14.55 days for all patients, with 28.2% (29/103) of patients requiring intensive care. In all, 4.9% (5/103) died during hospitalization—all of whom were in the intensive care unit. Conclusions: Majority of patients with diabetes or prediabetes and COVID-19 had other notable comorbidities. Only 4 patients tested negative for COVID-19 RT-PCR but showed pathognomonic changes of COVID-19 radiologically. Laboratory analyses revealed distinct abnormal patterns of biomarkers that were associated with a poor prognosis: fibrinogen, D-dimer, ferritin, and C-reactive protein levels were all significantly higher at admission in patients who subsequently needed intensive care than in those who needed ward-based care. More studies with larger sample sizes are needed to compare data of COVID-19 patients admitted with and without diabetes within the UAE region. %M 33284130 %R 10.2196/22471 %U http://publichealth.jmir.org/2020/4/e22471/ %U https://doi.org/10.2196/22471 %U http://www.ncbi.nlm.nih.gov/pubmed/33284130 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 12 %P e24383 %T COVID-19 Misinformation Prophylaxis: Protocol for a Randomized Trial of a Brief Informational Intervention %A Agley,Jon %A Xiao,Yunyu %A Thompson,Esi E %A Golzarri-Arroyo,Lilian %+ Prevention Insights, Department of Applied Health Science, School of Public Health Bloomington, Indiana University Bloomington, 501 N Morton St, Suite 110, Bloomington, IN, 47404, United States, 1 812 855 3123, jagley@indiana.edu %K COVID-19 %K misinformation %K infodemic %K infodemiology %K trust %K trust in science %K protocol %K intervention %K health information %K prevention %K behavior %D 2020 %7 7.12.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: As the COVID-19 pandemic continues to affect life in the United States, the important role of nonpharmaceutical preventive behaviors (such as wearing a face mask) in reducing the risk of infection has become clear. During the pandemic, researchers have observed the rapid proliferation of misinformed or inconsistent narratives about COVID-19. There is growing evidence that such misinformed narratives are associated with various forms of undesirable behavior (eg, burning down cell towers). Furthermore, individuals’ adherence to recommended COVID-19 preventive guidelines has been inconsistent, and such mandates have engendered opposition and controversy. Recent research suggests the possibility that trust in science and scientists may be an important thread to weave throughout these seemingly disparate components of the modern public health landscape. Thus, this paper describes the protocol for a randomized trial of a brief, digital intervention designed to increase trust in science. Objective: The objective of this study is to examine whether exposure to a curated infographic can increase trust in science, reduce the believability of misinformed narratives, and increase the likelihood to engage in preventive behaviors. Methods: This is a randomized, placebo-controlled, superiority trial comprising 2 parallel groups. A sample of 1000 adults aged ≥18 years who are representative of the population of the United States by gender, race and ethnicity, and age will be randomly assigned (via a 1:1 allocation) to an intervention or a placebo-control arm. The intervention will be a digital infographic with content based on principles of trust in science, developed by a health communications expert. The intervention will then be both pretested and pilot-tested to determine its viability. Study outcomes will include trust in science, a COVID-19 narrative belief latent profile membership, and the likelihood to engage in preventive behaviors, which will be controlled by 8 theoretically selected covariates. Results: This study was funded in August 2020, approved by the Indiana University Institutional Review Board on September 15, 2020, and prospectively registered with ClinicalTrials.gov. Conclusions: COVID-19 misinformation prophylaxis is crucial. This proposed experiment investigates the impact of a brief yet actionable intervention that can be easily disseminated to increase individuals’ trust in science, with the intention of affecting misinformation believability and, consequently, preventive behavioral intentions. Trial Registration: ClinicalTrials.gov NCT04557241; https://clinicaltrials.gov/ct2/show/NCT04557241 International Registered Report Identifier (IRRID): PRR1-10.2196/24383 %M 33175694 %R 10.2196/24383 %U http://www.researchprotocols.org/2020/12/e24383/ %U https://doi.org/10.2196/24383 %U http://www.ncbi.nlm.nih.gov/pubmed/33175694 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 8 %N 12 %P e24544 %T Growth of Ambulatory Virtual Visits and Differential Use by Patient Sociodemographics at One Urban Academic Medical Center During the COVID-19 Pandemic: Retrospective Analysis %A Gilson,Sarah F %A Umscheid,Craig A %A Laiteerapong,Neda %A Ossey,Graeme %A Nunes,Kenneth J %A Shah,Sachin D %+ Department of Medicine, University of Chicago, 5841 S Maryland Ave, MC 3051, Chicago, IL, 60637, United States, 1 773 834 8455, sdshah@uchicago.edu %K telemedicine %K telehealth %K video visit %K telephone visit %K virtual visit %K COVID-19 %K age %K sex %K race %K insurance %K demographic %K retrospective %D 2020 %7 4.12.2020 %9 Original Paper %J JMIR Med Inform %G English %X Background: Despite widespread interest in the use of virtual (ie, telephone and video) visits for ambulatory patient care during the COVID-19 pandemic, studies examining their adoption during the pandemic by race, sex, age, or insurance are lacking. Moreover, there have been limited evaluations to date of the impact of these sociodemographic factors on the use of telephone versus video visits. Such assessments are crucial to identify, understand, and address differences in care delivery across patient populations, particularly those that could affect access to or quality of care. Objective: The aim of this study was to examine changes in ambulatory visit volume and type (ie, in-person vs virtual and telephone vs video visits) by patient sociodemographics during the COVID-19 pandemic at one urban academic medical center. Methods: We compared volumes and patient sociodemographics (age, sex, race, insurance) for visits during the first 11 weeks following the COVID-19 national emergency declaration (March 15 to May 31, 2020) to visits in the corresponding weeks in 2019. Additionally, for visits during the COVID-19 study period, we examined differences in visit type (ie, in-person versus virtual, and telephone versus video visits) by sociodemographics using multivariate logistic regression. Results: Total visit volumes in the COVID-19 study period comprised 51.4% of the corresponding weeks in 2019 (n=80,081 vs n=155,884 visits). Although patient sociodemographics between the COVID-19 study period in 2020 and the corresponding weeks in 2019 were similar, 60.5% (n=48,475) of the visits were virtual, compared to 0% in 2019. Of the virtual visits, 61.2% (n=29,661) were video based, and 38.8% (n=18,814) were telephone based. In the COVID-19 study period, virtual (vs in-person) visits were more likely among patients with race categorized as other (vs White) and patients with Medicare (vs commercial) insurance and less likely for men, patients aged 0-17 years, 65-74 years, or ≥75 years (compared to patients aged 18-45 years), and patients with Medicaid insurance or insurance categorized as other. Among virtual visits, compared to telephone visits, video visits were more likely to be adopted by patients aged 0-17 years (vs 18-45 years), but less likely for all other age groups, men, Black (vs White) patients, and patients with Medicare or Medicaid (vs commercial) insurance. Conclusions: Virtual visits comprised the majority of ambulatory visits during the COVID-19 study period, of which a majority were by video. Sociodemographic differences existed in the use of virtual versus in-person and video versus telephone visits. To ensure equitable care delivery, we present five policy recommendations to inform the further development of virtual visit programs and their reimbursement. %M 33191247 %R 10.2196/24544 %U https://medinform.jmir.org/2020/12/e24544 %U https://doi.org/10.2196/24544 %U http://www.ncbi.nlm.nih.gov/pubmed/33191247 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 12 %P e24264 %T A Digital Program (Hope) for People Living With Cancer During the COVID-19 Pandemic: Protocol for a Feasibility Randomized Controlled Trial %A Wright,Hayley %A Martin,Faith %A Clyne,Wendy %A Clark,Cain C T %A McGillion,Michael %A Matouskova,Gabriela %A Turner,Andrew %+ Centre for Intelligent Healthcare, Faculty of Health and Life Sciences, Coventry University, Richard Crossman Building, Jordan Well, Coventry, CV1 5DE, United Kingdom, 44 2477657498, hsx116@coventry.ac.uk %K self-management %K survivorship %K cancer %K feasibility %K randomized controlled trial %K COVID-19 %K protocol %K digital health %K intervention %D 2020 %7 4.12.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: During the COVID-19 lockdown period in the United Kingdom that began on March 23, 2020, more than a quarter of a million people with cancer reported worsening mental health. Help to Overcome Problems Effectively (Hope) is a self-management program for people with cancer, designed to provide support for distress, unmet needs, and poor psychological health. In light of social distancing during the COVID-19 pandemic, digital delivery of the Hope Programme has become ever more vital for people with cancer. Previous pre-post studies of the digital Hope Programme have found reduced anxiety and depression and improved well-being for people with cancer. However, evaluation of this evidence has been limited by the lack of a control group in these previous studies. Objective: We now present a protocol for a feasibility randomized controlled trial of the digital Hope Programme for people with cancer during the COVID-19 pandemic. Primary outcomes will be recruitment, dropout, and adherence rates, and estimations of sample and effect size. To detect signals of efficacy, secondary outcomes will be participant mental health and well-being. Methods: Participants will be recruited by Macmillan Cancer Support (MCS) through their social media networks. The study will employ a feasibility wait-list randomized controlled trial (RCT) design, with people with cancer being randomized to join the digital Hope Programme immediately (intervention group [IG]) or join a 6-week waiting list (wait-list control group [WLCG]) with a 1:1 allocation ratio. Participants will complete digital measures of depression, anxiety, mental well-being, and confidence in managing their own health. Online questionnaires will be administered preprogram and 6 weeks postprogram. Results: All people who had requested access to the Hope Programme from MCS (N=61) will be invited to participate in the trial. Baseline data collection commenced in April 2020, and the Hope Programme began for the IG in May 2020 and for the WLCG in June 2020. Postprogram data collection was completed by the end of August 2020. Conclusions: This feasibility study will provide data to inform the design of a future definitive trial. Wider-scale provision of the digital Hope Programme has potential to improve the lives of thousands of people with cancer and reduce the burden on health care providers during these unprecedented times. Trial Registration: ISRCTN Registry ISRCTN79623250; http://www.isrctn.com/ISRCTN79623250 International Registered Report Identifier (IRRID): DERR1-10.2196/24264 %M 33237877 %R 10.2196/24264 %U https://www.researchprotocols.org/2020/12/e24264 %U https://doi.org/10.2196/24264 %U http://www.ncbi.nlm.nih.gov/pubmed/33237877 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 7 %N 12 %P e24507 %T Measuring COVID-19 Related Anxiety in Parents: Psychometric Comparison of Four Different Inventories %A Kubb,Christian %A Foran,Heather M %+ Health Psychology Unit, Institute of Psychology, Universität Klagenfurt, Universitätsstr 65-67, Klagenfurt, 9020, Austria, 43 463 2700 1631, christian.kubb@aau.at %K COVID-19 %K coronavirus %K anxiety %K parents %K parenting %K scale %K inventory %K well-being %K mental health %K stress %D 2020 %7 3.12.2020 %9 Original Paper %J JMIR Ment Health %G English %X Background: The COVID-19 outbreak and the measures to contain the global pandemic can have an impact on the well-being and mental health status of individuals. Parents of young children are particularly at risk for high levels of parental stress due to the current public health crisis, which can impact parenting behaviors and children’s well-being. Although different initial scales have been developed to measure COVID-19–related anxiety, they have not yet been tested sufficiently in parent samples. A brief measure of COVID-19–related anxiety is necessary for both quick assessment in practice and in larger epidemiological studies of parents. Objective: The purpose of this study is to compare the distributions, validities, and reliabilities of four different COVID-19 anxiety scales: Fear of COVID-19 Scale, Coronavirus Anxiety Scale, Pandemic Anxiety Scale, and one subscale of the COVID Stress Scales. Based on the psychometric properties of these scales, we aim to provide recommendations for a brief unidimensional inventory to assess COVID-19–related anxiety among parents. Methods: A cross-sectional web-based survey of 515 German-speaking parents (465 mothers, 90.3%) with at least one child aged 0-6 years was conducted during a 6-week period (June 29 to August 9, 2020). Half of the parents were recruited via Facebook parenting groups, while the other half were recruited through childcare centers. We psychometrically tested 25 items on COVID-19–related anxiety using the framework of classical test theory, including item analysis, correlational analysis of family variables, and exploratory factor analysis. Moreover, an item response theory approach was applied to estimate item discriminations and item difficulties. Results: Based on the psychometric properties, three items of the Pandemic Anxiety Scale were identified as a single unidimensional factor. The adapted scale demonstrated acceptable internal consistency (α=.79), moderate to high item discrimination, strong positive intercorrelation with two other COVID-19 anxiety scales, and a small positive association with parenting stress. Mothers and fathers did not differ in total scores (t513=−0.79, P=.42). Conclusions: Factor analysis suggests that existing COVID-19–related anxiety scales measure different latent constructs of anxiety. Furthermore, all scales showed only small to moderate correlations with trait health anxiety, suggesting that COVID-19–related anxiety is distinct from general health anxiety. The adapted “disease anxiety” subscale of the Pandemic Anxiety Scale is an economical measure for assessing COVID-19–related anxiety in parents. Directions for future research are outlined. %M 33197233 %R 10.2196/24507 %U https://mental.jmir.org/2020/12/e24507 %U https://doi.org/10.2196/24507 %U http://www.ncbi.nlm.nih.gov/pubmed/33197233 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 12 %P e24286 %T Dynamic Public Health Surveillance to Track and Mitigate the US COVID-19 Epidemic: Longitudinal Trend Analysis Study %A Post,Lori Ann %A Issa,Tariq Ziad %A Boctor,Michael J %A Moss,Charles B %A Murphy,Robert L %A Ison,Michael G %A Achenbach,Chad J %A Resnick,Danielle %A Singh,Lauren Nadya %A White,Janine %A Faber,Joshua Marco Mitchell %A Culler,Kasen %A Brandt,Cynthia A %A Oehmke,James Francis %+ Buehler Center for Health Policy & Economics and Departments of Emergency Medicine, Feinberg School of Medicine, Northwestern University, 750 N Lake Shore Dr, 9th Floor, Suite 9-9035 Rubloff Building, Chicago, IL, 60611, United States, 1 203 980 7107, lori.post@northwestern.edu %K global COVID-19 surveillance %K United States public health surveillance %K US COVID-19 %K surveillance metrics %K dynamic panel data %K generalized method of the moments %K United States econometrics %K US SARS-CoV-2 %K US COVID-19 surveillance system %K US COVID-19 transmission speed %K COVID-19 transmission acceleration %K COVID-19 speed %K COVID-19 acceleration %K COVID-19 jerk %K COVID-19 persistence %K Arellano-Bond estimator %K COVID-19 %D 2020 %7 3.12.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The emergence of SARS-CoV-2, the virus that causes COVID-19, has led to a global pandemic. The United States has been severely affected, accounting for the most COVID-19 cases and deaths worldwide. Without a coordinated national public health plan informed by surveillance with actionable metrics, the United States has been ineffective at preventing and mitigating the escalating COVID-19 pandemic. Existing surveillance has incomplete ascertainment and is limited by the use of standard surveillance metrics. Although many COVID-19 data sources track infection rates, informing prevention requires capturing the relevant dynamics of the pandemic. Objective: The aim of this study is to develop dynamic metrics for public health surveillance that can inform worldwide COVID-19 prevention efforts. Advanced surveillance techniques are essential to inform public health decision making and to identify where and when corrective action is required to prevent outbreaks. Methods: Using a longitudinal trend analysis study design, we extracted COVID-19 data from global public health registries. We used an empirical difference equation to measure daily case numbers for our use case in 50 US states and the District of Colombia as a function of the prior number of cases, the level of testing, and weekly shift variables based on a dynamic panel model that was estimated using the generalized method of moments approach by implementing the Arellano-Bond estimator in R. Results: Examination of the United States and state data demonstrated that most US states are experiencing outbreaks as measured by these new metrics of speed, acceleration, jerk, and persistence. Larger US states have high COVID-19 caseloads as a function of population size, density, and deficits in adherence to public health guidelines early in the epidemic, and other states have alarming rates of speed, acceleration, jerk, and 7-day persistence in novel infections. North and South Dakota have had the highest rates of COVID-19 transmission combined with positive acceleration, jerk, and 7-day persistence. Wisconsin and Illinois also have alarming indicators and already lead the nation in daily new COVID-19 infections. As the United States enters its third wave of COVID-19, all 50 states and the District of Colombia have positive rates of speed between 7.58 (Hawaii) and 175.01 (North Dakota), and persistence, ranging from 4.44 (Vermont) to 195.35 (North Dakota) new infections per 100,000 people. Conclusions: Standard surveillance techniques such as daily and cumulative infections and deaths are helpful but only provide a static view of what has already occurred in the pandemic and are less helpful in prevention. Public health policy that is informed by dynamic surveillance can shift the country from reacting to COVID-19 transmissions to being proactive and taking corrective action when indicators of speed, acceleration, jerk, and persistence remain positive week over week. Implicit within our dynamic surveillance is an early warning system that indicates when there is problematic growth in COVID-19 transmissions as well as signals when growth will become explosive without action. A public health approach that focuses on prevention can prevent major outbreaks in addition to endorsing effective public health policies. Moreover, subnational analyses on the dynamics of the pandemic allow us to zero in on where transmissions are increasing, meaning corrective action can be applied with precision in problematic areas. Dynamic public health surveillance can inform specific geographies where quarantines are necessary while preserving the economy in other US areas. %M 33216726 %R 10.2196/24286 %U https://www.jmir.org/2020/12/e24286 %U https://doi.org/10.2196/24286 %U http://www.ncbi.nlm.nih.gov/pubmed/33216726 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 8 %N 4 %P e24986 %T A Serious Game Designed to Promote Safe Behaviors Among Health Care Workers During the COVID-19 Pandemic: Development of “Escape COVID-19” %A Suppan,Mélanie %A Catho,Gaud %A Robalo Nunes,Tomás %A Sauvan,Valérie %A Perez,Monique %A Graf,Christophe %A Pittet,Didier %A Harbarth,Stephan %A Abbas,Mohamed %A Suppan,Laurent %+ Division of Anesthesiology, Department of Anesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, University of Geneva Hospitals and Faculty of Medicine, Rue Gabrielle-Perret-Gentil 4, Geneva, 1211, Switzerland, 41 223723311, melanie.bochet@hcuge.ch %K COVID-19 %K transmission %K serious games %K infection prevention %K health care workers %K SARS-COV-2 %K infectious disease %K safety %K behavior %K hospital %D 2020 %7 3.12.2020 %9 Original Paper %J JMIR Serious Games %G English %X Background: As many countries fear and even experience the emergence of a second wave of COVID-19, reminding health care workers (HCWs) and other hospital employees of the critical role they play in preventing SARS-CoV-2 transmission is more important than ever. Building and strengthening the intrinsic motivation of HCWs to apply infection prevention and control (IPC) guidelines to avoid contaminating their colleagues, patients, friends, and relatives is a goal that must be energetically pursued. A high rate of nosocomial infections during the first COVID-19 wave was detected by IPC specialists and further cemented their belief in the need for an engaging intervention that could improve compliance with COVID-19 safe behaviors. Objective: Our aim was to develop a serious game that would promote IPC practices with a specific focus on COVID-19 among HCWs and other hospital employees. Methods: The first 3 stages of the SERES framework were used to develop this serious game. A brainswarming session between developers and IPC specialists was used to identify the target audience and acquisition objectives. Nicholson’s RECIPE mnemonic (reflection, engagement, choice, information, play, exposition) for meaningful gamification was used to guide the general design. A common and simple terminology was used to suit the broad target audience. The game was tested on various platforms (smartphones, tablets, laptops, desktop computers) by different users during each development loop and before its final release. Results: The game was designed to target all hospital staff who could be in direct contact with patients within the Geneva University Hospitals. In total, 10 acquisition objectives were defined by IPC specialists and implemented into the game according to the principles of meaningful gamification. A simple storyboard was first created using Microsoft PowerPoint and was progressively refined through multiple iteration loops. Articulate Storyline was then used to create two successive versions of the actual game. In the final version, a unique graphic atmosphere was created with help from a professional graphic designer. Feedback mechanisms were used extensively throughout the game to strengthen key IPC messages. Conclusions: The SERES framework was successfully used to create “Escape COVID-19,” a serious game designed to promote safe IPC practices among HCWs and other hospital employees during the COVID-19 pandemic. This game can be obtained free of charge for research and educational purposes. A SCORM (shareable content object reference model) package is available to facilitate results and completion tracking on most current learning management systems. %M 33242312 %R 10.2196/24986 %U http://games.jmir.org/2020/4/e24986/ %U https://doi.org/10.2196/24986 %U http://www.ncbi.nlm.nih.gov/pubmed/33242312 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 12 %P e24550 %T Tweets by People With Arthritis During the COVID-19 Pandemic: Content and Sentiment Analysis %A Berkovic,Danielle %A Ackerman,Ilana N %A Briggs,Andrew M %A Ayton,Darshini %+ School of Public Health and Preventive Medicine, Monash University, , Melbourne, , Australia, 61 425 705 130, darshini.ayton@monash.edu %K COVID-19 %K SARS-CoV-2 %K novel coronavirus %K social media %K Twitter %K content analysis %K sentiment analysis %K microblogging %K arthritis %D 2020 %7 3.12.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Emerging evidence suggests that people with arthritis are reporting increased physical pain and psychological distress during the COVID-19 pandemic. At the same time, Twitter’s daily usage has surged by 23% throughout the pandemic period, presenting a unique opportunity to assess the content and sentiment of tweets. Individuals with arthritis use Twitter to communicate with peers, and to receive up-to-date information from health professionals and services about novel therapies and management techniques. Objective: The aim of this research was to identify proxy topics of importance for individuals with arthritis during the COVID-19 pandemic, and to explore the emotional context of tweets by people with arthritis during the early phase of the pandemic. Methods: From March 20 to April 20, 2020, publicly available tweets posted in English and with hashtag combinations related to arthritis and COVID-19 were extracted retrospectively from Twitter. Content analysis was used to identify common themes within tweets, and sentiment analysis was used to examine positive and negative emotions in themes to understand the COVID-19 experiences of people with arthritis. Results: In total, 149 tweets were analyzed. The majority of tweeters were female and were from the United States. Tweeters reported a range of arthritis conditions, including rheumatoid arthritis, systemic lupus erythematosus, and psoriatic arthritis. Seven themes were identified: health care experiences, personal stories, links to relevant blogs, discussion of arthritis-related symptoms, advice sharing, messages of positivity, and stay-at-home messaging. Sentiment analysis demonstrated marked anxiety around medication shortages, increased physical symptom burden, and strong desire for trustworthy information and emotional connection. Conclusions: Tweets by people with arthritis highlight the multitude of concurrent concerns during the COVID-19 pandemic. Understanding these concerns, which include heightened physical and psychological symptoms in the context of treatment misinformation, may assist clinicians to provide person-centered care during this time of great health uncertainty. %M 33170802 %R 10.2196/24550 %U https://www.jmir.org/2020/12/e24550 %U https://doi.org/10.2196/24550 %U http://www.ncbi.nlm.nih.gov/pubmed/33170802 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 7 %N 12 %P e22757 %T Web-Based Relaxation Intervention for Stress During Social Isolation: Randomized Controlled Trial %A Pizzoli,Silvia Francesca Maria %A Marzorati,Chiara %A Mazzoni,Davide %A Pravettoni,Gabriella %+ University of Milan, Department of Oncology and Hematology-Oncology, Via Festa del Perdono 7, Milan, 20122, Italy, 39 0294372099, silviafrancescamaria.pizzoli@ieo.it %K relaxation %K guided meditation %K web-based intervention %K social isolation %K intervention %K COVID-19 %K anxiety %K stress %K internet %D 2020 %7 3.12.2020 %9 Original Paper %J JMIR Ment Health %G English %X Background: Relaxation practices might be helpful exercises for coping with anxiety and stressful sensations. They may be of particular utility when used in web-based interventions during periods of social isolation. Objective: This randomized study aimed to test whether web-based relaxation practices like natural sounds, deep respiration, and body scans can promote relaxation and a positive emotional state, and reduce psychomotor activation and preoccupation related to the COVID-19 pandemic. Methods: Participants were randomly assigned to one of three experimental conditions. Each condition was characterized by a single online session of a guided square breathing exercise, a guided body scan exercise, or natural sounds. The participants listened to one of the fully automated audio clips for 7 minutes and pre-post completed self-assessed scales on perceived relaxation, psychomotor activation, level of preoccupation associated with COVID-19, and emotional state. At the end of the session, qualitative reports on subjective experience were also collected. Results: Overall, 294 participants completed 75% of the survey and 240 completed the entire survey as well as one of three randomly assigned interventions. Perceived relaxation, psychomotor activation/stress, and preoccupation related to COVID-19 showed a positive improvement after participants listened to the audio clips. The same pattern was observed for the valence and perceived dominance of the emotional state. The square breathing and body scan exercises yielded superior results compared to natural sounds in lowering perceived stress. Conclusions: This study provides a novel insight that can guide the development of future low-cost web-based interventions to reduce preoccupation and stress in the general population. International Registered Report Identifier (IRRID): RR2-10.2196/19236 %M 33200990 %R 10.2196/22757 %U https://mental.jmir.org/2020/12/e22757 %U https://doi.org/10.2196/22757 %U http://www.ncbi.nlm.nih.gov/pubmed/33200990 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 12 %P e21572 %T COVID-19 Contact-Tracing Apps: Analysis of the Readability of Privacy Policies %A Zhang,Melvyn %A Chow,Aloysius %A Smith,Helen %+ Family Medicine and Primary Care, Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, 11 Mandalay Road Level 18, Clinical Sciences Building, Singapore, 308322, Singapore, 65 63892504, melvynzhangweibin@gmail.com %K COVID-19 %K smartphone apps %K contact tracing %K privacy policy %K readability %K app %K privacy %K surveillance %D 2020 %7 3.12.2020 %9 Viewpoint %J J Med Internet Res %G English %X Apps that enable contact-tracing are instrumental in mitigating the transmission of COVID-19, but there have been concerns among users about the data collected by these apps and their management. Contact tracing is of paramount importance when dealing with a pandemic, as it allows for rapid identification of cases based on the information collected from infected individuals about other individuals they may have had recent contact with. Advances in digital technology have enabled devices such as mobile phones to be used in the contract-tracing process. However, there is a potential risk of users’ personal information and sensitive data being stolen should hackers be in the near vicinity of these devices. Thus, there is a need to develop privacy-preserving apps. Meanwhile, privacy policies that outline the risk associated with the use of contact-tracing apps are needed, in formats that are easily readable and comprehensible by the public. To our knowledge, no previous study has examined the readability of privacy policies of contact-tracings apps. Therefore, we performed a readability analysis to evaluate the comprehensibility of privacy policies of 7 contact-tracing apps currently in use. The contents of the privacy policies of these apps were assessed for readability using Readability Test Tool, a free web-based reliability calculator, which computes scores based on a number of statistics (ie, word count and the number of complex words) and indices (ie, Flesch Reading Ease, Flesch-Kincaid Reading Grade Level, Gunning Fog Index, and Simplified Measure of Gobbledygook index). Our analysis revealed that explanations used in the privacy policies of these apps require a reading grade between 7 and 14, which is considerably higher than the reading ability of the average individual. We believe that improving the readability of privacy policies of apps could be potentially reassuring for users and may help facilitate the increased use of such apps. %M 33170798 %R 10.2196/21572 %U https://www.jmir.org/2020/12/e21572 %U https://doi.org/10.2196/21572 %U http://www.ncbi.nlm.nih.gov/pubmed/33170798 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 12 %P e21499 %T The Twitter Social Mobility Index: Measuring Social Distancing Practices With Geolocated Tweets %A Xu,Paiheng %A Dredze,Mark %A Broniatowski,David A %+ Malone Center for Engineering in Healthcare, Center for Language and Speech Processing, Department of Computer Science, Johns Hopkins University, Malone 339, 3400 N Charles St, Baltimore, MD, 21218, United States, 1 4105166786, mdredze@cs.jhu.edu %K COVID-19 %K social distancing %K mobility %K Twitter %K social media %K surveillance %K tracking %K travel %K index %D 2020 %7 3.12.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Social distancing is an important component of the response to the COVID-19 pandemic. Minimizing social interactions and travel reduces the rate at which the infection spreads and “flattens the curve” so that the medical system is better equipped to treat infected individuals. However, it remains unclear how the public will respond to these policies as the pandemic continues. Objective: The aim of this study is to present the Twitter Social Mobility Index, a measure of social distancing and travel derived from Twitter data. We used public geolocated Twitter data to measure how much users travel in a given week. Methods: We collected 469,669,925 tweets geotagged in the United States from January 1, 2019, to April 27, 2020. We analyzed the aggregated mobility variance of a total of 3,768,959 Twitter users at the city and state level from the start of the COVID-19 pandemic. Results: We found a large reduction (61.83%) in travel in the United States after the implementation of social distancing policies. However, the variance by state was high, ranging from 38.54% to 76.80%. The eight states that had not issued statewide social distancing orders as of the start of April ranked poorly in terms of travel reduction: Arkansas (45), Iowa (37), Nebraska (35), North Dakota (22), South Carolina (38), South Dakota (46), Oklahoma (50), Utah (14), and Wyoming (53). We are presenting our findings on the internet and will continue to update our analysis during the pandemic. Conclusions: We observed larger travel reductions in states that were early adopters of social distancing policies and smaller changes in states without such policies. The results were also consistent with those based on other mobility data to a certain extent. Therefore, geolocated tweets are an effective way to track social distancing practices using a public resource, and this tracking may be useful as part of ongoing pandemic response planning. %M 33048823 %R 10.2196/21499 %U https://www.jmir.org/2020/12/e21499 %U https://doi.org/10.2196/21499 %U http://www.ncbi.nlm.nih.gov/pubmed/33048823 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 12 %P e20871 %T Citizen Responses to Government Restrictions in Switzerland During the COVID-19 Pandemic: Cross-Sectional Survey %A Selby,Kevin %A Durand,Marie-Anne %A Gouveia,Alexandre %A Bosisio,Francesca %A Barazzetti,Gaia %A Hostettler,Maxime %A D'Acremont,Valérie %A Kaufmann,Alain %A von Plessen,Christian %+ Center for Primary Care and Public Health (Unisanté), University of Lausanne, Rue de Bugnon 44, Lausanne, 1011, Switzerland, 41 0798940957, kevin.selby@unisante.ch %K COVID-19 %K coronavirus %K Switzerland %K mitigation strategies %K citizen knowledge %D 2020 %7 3.12.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: The success of government-recommended mitigation measures during the COVID-19 pandemic depends largely on information uptake and implementation by individual citizens. Objective: Our aim was to assess citizens’ knowledge and perceptions about COVID-19 recommendations in the Canton of Vaud, Switzerland. Methods: A cross-sectional electronic survey with open and closed questions was disseminated by community-based partners prior to the relaxation of government restrictions. Outcomes included citizen knowledge (9-question measure) and worry about the virus, perception of government measures, and recommendations for improvements. Comparisons used linear regression, controlling for age, sex, education, and health literacy. Free-text answers were analyzed thematically. Results: Of 807 people who accessed the survey, 684 (85%) completed all questions and 479 (60%) gave free-text recommendations. Overall, 75% were female, the mean age was 48 years, and 93% had high health literacy. Knowledge scores were high, with a median score of 8 out of 9. Mean levels of worry about the COVID-19 pandemic were higher in women than men (55/100 versus 44/100, P<.001), and in respondents with lower health literacy (57/100 versus 52/100, P=.03). Self-reported adherence to recommendations was high (85%) and increased with age and worry (both P<.001). Respondents rated their own adherence higher than others (85% versus 61%, P<.001). Moreover, 34% of respondents reported having self-quarantined; this rose to 52% for those aged ≥75 years. Those who had self-quarantined reported higher levels of fear. Nearly half (49%) of respondents felt the government response had been adequate, though younger age and higher levels of worry were associated with considering the response to be insufficient (both P<.001). Analysis of open-text answers revealed 4 major themes: access to and use of masks, gloves, and hand sanitizer; government messaging; lockdown and lockdown exit plan communication; and testing for COVID-19. Conclusions: Knowledge, adherence, and satisfaction regarding government recommendations and response were high in this sample, but many desired greater access to personal protective equipment. Those with lower health literacy and those who have been in self-isolation reported greater concerns about the pandemic. %M 33156809 %R 10.2196/20871 %U https://formative.jmir.org/2020/12/e20871 %U https://doi.org/10.2196/20871 %U http://www.ncbi.nlm.nih.gov/pubmed/33156809 %0 Journal Article %@ 2563-6316 %I JMIR Publications %V 1 %N 1 %P e22470 %T Predicting Health Disparities in Regions at Risk of Severe Illness to Inform Health Care Resource Allocation During Pandemics: Observational Study %A Fusillo,Tara %+ John F Kennedy High School, 3000 Bellmore Ave, Bellmore, NY, 11710, United States, 1 516 992 1400, ifusil@optonline.net %K coronavirus %K SARS-CoV-2 %K COVID-19 %K pandemic %K socioeconomic status %K predictive model %K health care resource allocation %D 2020 %7 2.12.2020 %9 Original Paper %J JMIRx Med %G English %X Background: Pandemics including COVID-19 have disproportionately affected socioeconomically vulnerable populations. Objective: Our objective was to create a repeatable modeling process to identify regional population centers with pandemic vulnerability. Methods: Using readily available COVID-19 and socioeconomic variable data sets, we used stepwise linear regression techniques to build predictive models during the early days of the COVID-19 pandemic. The models were validated later in the pandemic timeline using actual COVID-19 mortality rates in high population density states. The mean sample size was 43 and ranged from 8 (Connecticut) to 82 (Michigan). Results: The New York, New Jersey, Connecticut, Massachusetts, Louisiana, Michigan, and Pennsylvania models provided the strongest predictions of top counties in densely populated states with a high likelihood of disproportionate COVID-19 mortality rates. For all of these models, P values were less than .05. Conclusions: The models have been shared with the Department of Health Commissioners of each of these states with strong model predictions as input into a much needed “pandemic playbook” for local health care agencies in allocating medical testing and treatment resources. We have also confirmed the utility of our models with pharmaceutical companies for use in decisions pertaining to vaccine trial and distribution locations. %M 33711085 %R 10.2196/22470 %U https://med.jmirx.org/2020/1/e22470/ %U https://doi.org/10.2196/22470 %U http://www.ncbi.nlm.nih.gov/pubmed/33711085 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 12 %P e24240 %T Mental Health Burden in Different Professions During the Final Stage of the COVID-19 Lockdown in China: Cross-sectional Survey Study %A Du,Junfeng %A Mayer,Gwendolyn %A Hummel,Svenja %A Oetjen,Neele %A Gronewold,Nadine %A Zafar,Ali %A Schultz,Jobst-Hendrik %+ Department of General Internal Medicine and Psychosomatics, Heidelberg University Hospital, Im Neuenheimer Feld 130.3, Heidelberg, 69120, Germany, 49 62215635685, gwendolyn.mayer@med.uni-heidelberg.de %K mental health %K COVID-19 %K China %K depression %K anxiety %K lockdown %K coping strategies %K stressors %K stress %K doctors %K nurses %K students %K media consumption %K WeChat %D 2020 %7 2.12.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: COVID-19 resulted in considerable mental health burden in the Chinese general population and among health care workers at the beginning and peak of the pandemic. However, little is known about potentially vulnerable groups during the final stage of the lockdown. Objective: The aim of this survey study was to assess the mental health burden of different professions in China in order to find vulnerable groups, possible influencing factors, and successful ways of coping during the last 4 weeks of the lockdown in Hubei Province. Methods: A cross-sectional online survey asked participants about current residence, daily working hours, exposure to COVID-19 at work, and media preferences. We used a shortened version of the Depression, Anxiety and Stress Scale (DASS-21) to assess mental health. Further assessments included perceived stress (Simplified Chinese version of the 14-item Perceived Stress Scale), coping strategies for all participants, and specific stressors for health care workers. We followed the reporting guidelines of the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) statement for observational studies. Results: The sample (N=687) consisted of 158 doctors, 221 nurses, 24 other medical staff, 43 students, 60 teachers/government staff, 135 economy staff, 26 workers/farmers, and 20 professions designated under the “other” category. We found increased depression (n=123, 17.9%), anxiety (n=208, 30.3%), and stress (n=94, 13.7%) in our sample. Professions that were vulnerable to depression were other medical staff and students. Doctors, nurses, and students were vulnerable to anxiety; and other medical staff, students, and economy staff were vulnerable to stress. Coping strategies were reduced to three factors: active, mental, and emotional. Being female and emotional coping were independently associated with depression, anxiety, or stress. Applying active coping strategies showed lower odds for anxiety while mental coping strategies showed lower odds for depression, anxiety, and stress. Age, being inside a lockdown area, exposure to COVID-19 at work, and having a high workload (8-12 hours per day) were not associated with depression, anxiety, or stress. WeChat was the preferred way of staying informed across all groups. Conclusions: By the end of the lockdown, a considerable part of the Chinese population showed increased levels of depression and anxiety. Students and other medical staff were the most affected, while economy staff were highly stressed. Doctors and nurses need support regarding potential anxiety disorders. Future work should focus on longitudinal results of the pandemic and develop targeted preventive measures. %M 33197231 %R 10.2196/24240 %U https://www.jmir.org/2020/12/e24240 %U https://doi.org/10.2196/24240 %U http://www.ncbi.nlm.nih.gov/pubmed/33197231 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 12 %P e24048 %T Development and External Validation of a Machine Learning Tool to Rule Out COVID-19 Among Adults in the Emergency Department Using Routine Blood Tests: A Large, Multicenter, Real-World Study %A Plante,Timothy B %A Blau,Aaron M %A Berg,Adrian N %A Weinberg,Aaron S %A Jun,Ik C %A Tapson,Victor F %A Kanigan,Tanya S %A Adib,Artur B %+ Larner College of Medicine at the University of Vermont, 360 S Park Drive, Suite 206B, Colchester, VT, 05446, United States, 1 802 656 3688, timothy.plante@uvm.edu %K COVID-19 %K SARS-CoV-2 %K machine learning %K artificial intelligence %K electronic medical records %K laboratory results %K development %K validation %K testing %K model %K emergency department %D 2020 %7 2.12.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Conventional diagnosis of COVID-19 with reverse transcription polymerase chain reaction (RT-PCR) testing (hereafter, PCR) is associated with prolonged time to diagnosis and significant costs to run the test. The SARS-CoV-2 virus might lead to characteristic patterns in the results of widely available, routine blood tests that could be identified with machine learning methodologies. Machine learning modalities integrating findings from these common laboratory test results might accelerate ruling out COVID-19 in emergency department patients. Objective: We sought to develop (ie, train and internally validate with cross-validation techniques) and externally validate a machine learning model to rule out COVID 19 using only routine blood tests among adults in emergency departments. Methods: Using clinical data from emergency departments (EDs) from 66 US hospitals before the pandemic (before the end of December 2019) or during the pandemic (March-July 2020), we included patients aged ≥20 years in the study time frame. We excluded those with missing laboratory results. Model training used 2183 PCR-confirmed cases from 43 hospitals during the pandemic; negative controls were 10,000 prepandemic patients from the same hospitals. External validation used 23 hospitals with 1020 PCR-confirmed cases and 171,734 prepandemic negative controls. The main outcome was COVID 19 status predicted using same-day routine laboratory results. Model performance was assessed with area under the receiver operating characteristic (AUROC) curve as well as sensitivity, specificity, and negative predictive value (NPV). Results: Of 192,779 patients included in the training, external validation, and sensitivity data sets (median age decile 50 [IQR 30-60] years, 40.5% male [78,249/192,779]), AUROC for training and external validation was 0.91 (95% CI 0.90-0.92). Using a risk score cutoff of 1.0 (out of 100) in the external validation data set, the model achieved sensitivity of 95.9% and specificity of 41.7%; with a cutoff of 2.0, sensitivity was 92.6% and specificity was 59.9%. At the cutoff of 2.0, the NPVs at a prevalence of 1%, 10%, and 20% were 99.9%, 98.6%, and 97%, respectively. Conclusions: A machine learning model developed with multicenter clinical data integrating commonly collected ED laboratory data demonstrated high rule-out accuracy for COVID-19 status, and might inform selective use of PCR-based testing. %M 33226957 %R 10.2196/24048 %U https://www.jmir.org/2020/12/e24048 %U https://doi.org/10.2196/24048 %U http://www.ncbi.nlm.nih.gov/pubmed/33226957 %0 Journal Article %@ 2562-7600 %I JMIR Publications %V 3 %N 1 %P e24521 %T Academic Nurse-Managed Community Clinics Transitioning to Telehealth: Case Report on the Rapid Response to COVID-19 %A Sutter,Rebecca %A Cuellar,Alison E %A Harvey,Megan %A Hong,Y Alicia %+ Department of Health Administration and Policy, College of Health and Human Services, George Mason University, 4400 University Dr, MS 1J3, Fairfax, VA, 22030, United States, 1 7039931929, yhong22@gmu.edu %K telehealth %K telemedicine %K COVID-19, nurse practitioners %K safety net clinics %K community clinics %K nurse %K clinic %K transition %D 2020 %7 1.12.2020 %9 Original Paper %J JMIR Nursing %G English %X Background: In response to the COVID-19 pandemic, many health care organizations have adopted telehealth. The current literature on transitioning to telehealth has mostly been from large health care or specialty care organizations, with limited data from safety net or community clinics. Objective: This is a case report on the rapid implementation of a telehealth hub at an academic nurse-managed community clinic in response to the national COVID-19 emergency. We also identify factors of success and challenges associated with the transition to telehealth. Methods: This study was conducted at the George Mason University Mason and Partners clinic, which serves the dual mission of caring for community clinic patients and providing health professional education. We interviewed the leadership team of Mason and Partners clinics and summarized our findings. Results: Mason and Partners clinics reacted quickly to the COVID-19 crisis and transitioned to telehealth within 2 weeks of the statewide lockdown. Protocols were developed for a coordination hub, a main patient triage and appointment telephone line, a step-by-step flowchart of clinical procedure, and a team structure with clearly defined work roles and backups. The clinics were able to maintain most of its clinical service and health education functions while adapting to new clinic duties that arose during the pandemic. Conclusions: The experiences learned from the Mason and Partners clinics are transferable to other safety net clinics and academic nurse-led community clinics. The changes arising from the pandemic have resulted in sustainable procedures, and these changes will have a long-term impact on health care delivery and training. %M 33496682 %R 10.2196/24521 %U https://nursing.jmir.org/2020/1/e24521/ %U https://doi.org/10.2196/24521 %U http://www.ncbi.nlm.nih.gov/pubmed/33496682 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 12 %P e24087 %T Use of Telehealth During the COVID-19 Pandemic: Scoping Review %A Doraiswamy,Sathyanarayanan %A Abraham,Amit %A Mamtani,Ravinder %A Cheema,Sohaila %+ Institute for Population Health, Weill Cornell Medicine, Education City, Al Luqta St, Ar-Rayyan, Doha, PO 24144, Qatar, 974 50422860, sdo4003@qatar-med.cornell.edu %K COVID-19 %K telehealth %K telemedicine %K scoping review %D 2020 %7 1.12.2020 %9 Review %J J Med Internet Res %G English %X Background: With over 37.8 million cases and over 1 million deaths worldwide, the COVID-19 pandemic has created a societal and economic upheaval of unparalleled magnitude. A positive transformation has been brought about by innovative solutions in the health care sector that aim to mitigate the impact of COVID-19 on human health. For instance, the use of telehealth has been on the rise amidst this public health emergency. Objective: Given the unprecedented scale of the pandemic with no definitive endpoint, we aimed to scope the existing telehealth-related literature during a defined period of the ongoing pandemic (ie, January to June 2020). Methods: Our scoping review was guided by the Joanna Briggs Institute Reviewer Manual. We systematically searched PubMed and Embase databases with specific eligibility criteria. Data extracted from the shortlisted articles included first author and affiliation, journal title, publication type, terminologies used to describe telehealth and their accompanying definitions, health discipline or medical specialties and subspecialties wherein telehealth had been applied, the purpose of telehealth use, and the authors’ overall sentiment on telehealth use. We collated the available information and used descriptive statistics to analyze the synthesized data. Results: In all, 543 articles published across 331 different journals were included in this scoping review. The Journal of Medical Internet Research and its sister journals featured the highest number of articles (25/543, 4.6%). Nearly all (533/543, 98.2%) articles were in English. The majority of the articles were opinions, commentaries, and perspectives (333/543, 61.3%). Most authors of the articles reviewed were from high-income countries (470/543, 86.6%), especially from the United States of America (237/543, 43.6%). In all, 39 different definitions were used to describe terms equivalent to telehealth. A small percentage (42/543, 7.7%) of the articles focused on the provision of COVID-19–related care. Moreover, 49.7% (270/543) of the articles primarily focused on the provision of multiple components of clinical care, and 23% (125/543) of the articles focused on various specialties and subspecialties of internal medicine. For a vast majority (461/543, 84.9%) of the articles, the authors expressed a celebratory sentiment about the use of telehealth. Conclusions: This review identified considerable emerging literature on telehealth during the first six months of the COVID-19 pandemic, albeit mostly from high-income countries. There is compelling evidence to suggest that telehealth may have a significant effect on advancing health care in the future. However, the feasibility and application of telehealth in resource-limited settings and low- and middle-income countries must be established to avail its potential and transform health care for the world’s population. Given the rapidity with which telehealth is advancing, a global consensus on definitions, boundaries, protocols, monitoring, evaluation, and data privacy is urgently needed. %M 33147166 %R 10.2196/24087 %U https://www.jmir.org/2020/12/e24087 %U https://doi.org/10.2196/24087 %U http://www.ncbi.nlm.nih.gov/pubmed/33147166 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 12 %P e22098 %T Evaluation of the Design and Implementation of a Peer-To-Peer COVID-19 Contact Tracing Mobile App (COCOA) in Japan %A Nakamoto,Ichiro %A Jiang,Ming %A Zhang,Jilin %A Zhuang,Weiqing %A Guo,Yan %A Jin,Ming-Hui %A Huang,Yi %A Tang,Kuotai %+ School of Internet Economics and Business, Fujian University of Technology, 999 Dongsanhuang Road, JinAn District, Fuzhou, China, 86 059183503931, ichiro2019@163.com %K COVID-19 %K contact tracing %K mobile app %K peer-to-peer %K Bluetooth-based %K telehealth %K privacy protection %K load balancing %K close contact %K decentralized %D 2020 %7 1.12.2020 %9 Viewpoint %J JMIR Mhealth Uhealth %G English %X We evaluate a Bluetooth-based mobile contact-confirming app, COVID-19 Contact-Confirming Application (COCOA), which is being used in Japan to contain the spread of COVID-19, the disease caused by the novel virus termed SARS-COV-2. The app prioritizes the protection of users’ privacy from a variety of parties (eg, other users, potential attackers, and public authorities), enhances the capacity to balance the current load of excessive pressure on health care systems (eg, local triage of exposure risk and reduction of in-person hospital visits), increases the speed of responses to the pandemic (eg, automated recording of close contact based on proximity), and reduces operation errors and population mobility. The peer-to-peer framework of COCOA is intended to provide the public with dynamic and credible updates on the COVID-19 pandemic without sacrificing the privacy of their information. However, cautions must be exercised to address critical concerns, such as the rate of participation and delays in data sharing. The results of a simulation imply that the participation rate in Japan needs to be close 90% to effectively control the spread of COVID-19. %M 33170801 %R 10.2196/22098 %U https://mhealth.jmir.org/2020/12/e22098 %U https://doi.org/10.2196/22098 %U http://www.ncbi.nlm.nih.gov/pubmed/33170801 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 12 %P e21886 %T Real-Time Communication: Creating a Path to COVID-19 Public Health Activism in Adolescents Using Social Media %A Sobowale,Kunmi %A Hilliard,Heather %A Ignaszewski,Martha J %A Chokroverty,Linda %+ Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, 760 Westwood Plaza, Suite 37-384, Los Angeles, CA, 90024, United States, 1 310 794 7035, osobowale@mednet.ucla.edu %K social media %K digital health %K COVID-19 %K adolescent %K public health %K disaster %K communication %K affordances %D 2020 %7 1.12.2020 %9 Viewpoint %J J Med Internet Res %G English %X The COVID-19 pandemic and related public health efforts limiting in-person social interactions present unique challenges to adolescents. Social media, which is widely used by adolescents, presents an opportunity to counteract these challenges and promote adolescent health and public health activism. However, public health organizations and officials underuse social media to communicate with adolescents. Using well-established risk communication strategies and insights from adolescent development and human-computer interaction literature, we identify current efforts and gaps, and propose recommendations to advance the use of social media risk communication for adolescents during the COVID-19 pandemic and future disasters. %M 33226956 %R 10.2196/21886 %U https://www.jmir.org/2020/12/e21886 %U https://doi.org/10.2196/21886 %U http://www.ncbi.nlm.nih.gov/pubmed/33226956 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 11 %P e20144 %T Novel Indicator to Ascertain the Status and Trend of COVID-19 Spread: Modeling Study %A Nakano,Takashi %A Ikeda,Yoichi %+ Research Center for Nuclear Physics, Osaka University, 10-1 Mihogaoka, Ibaraki, Osaka, 567-0047, Japan, 81 6 6879 8900, nakano@rcnp.osaka-u.ac.jp %K communicable diseases %K COVID-19 %K SARS-CoV-2 %K model %K modeling %K virus %K infectious disease %K spread %D 2020 %7 30.11.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: In the fight against the pandemic of COVID-19, it is important to ascertain the status and trend of the infection spread quickly and accurately. Objective: The purpose of our study is to formulate a new and simple indicator that represents the COVID-19 spread rate by using publicly available data. Methods: The new indicator K is a backward difference approximation of the logarithmic derivative of the cumulative number of cases with a time interval of 7 days. It is calculated as a ratio of the number of newly confirmed cases in a week to the total number of cases. Results: The analysis of the current status of COVID-19 spreading over countries showed an approximate linear decrease in the time evolution of the K value. The slope of the linear decrease differed from country to country. In addition, it was steeper for East and Southeast Asian countries than for European countries. The regional difference in the slope seems to reflect both social and immunological circumstances for each country. Conclusions: The approximate linear decrease of the K value indicates that the COVID-19 spread does not grow exponentially but starts to attenuate from the early stage. The K trajectory in a wide range was successfully reproduced by a phenomenological model with the constant attenuation assumption, indicating that the total number of the infected people follows the Gompertz curve. Focusing on the change in the value of K will help to improve and refine epidemiological models of COVID-19. %M 33180742 %R 10.2196/20144 %U http://www.jmir.org/2020/11/e20144/ %U https://doi.org/10.2196/20144 %U http://www.ncbi.nlm.nih.gov/pubmed/33180742 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 11 %P e23194 %T COVID-19 Contact Tracing Apps: A Technologic Tower of Babel and the Gap for International Pandemic Control %A Du,Li %A Raposo,Vera Lúcia %A Wang,Meng %+ Faculty of Law, University of Macau, Avenida da Universidade, Taipa, Macau, SAR, 999078, China, 853 88224733, stephendu@um.edu.mo %K COVID-19 %K contact tracing apps %K privacy %K public health %K global health %D 2020 %7 27.11.2020 %9 Viewpoint %J JMIR Mhealth Uhealth %G English %X As the world struggles with the new COVID-19 pandemic, contact tracing apps of various types have been adopted in many jurisdictions for combating the spread of the SARS-CoV-2 virus. However, even if they are successful in containing the virus within national borders, these apps are becoming ineffective as international travel is gradually resumed. The problem rests in the plurality of apps and their inability to operate in a synchronized manner, as well as the absence of an international entity with the power to coordinate and analyze the information collected by the disparate apps. The risk of creating a useless Tower of Babel of COVID-19 contact tracing apps is very real, endangering global health. This paper analyzes legal barriers for realizing the interoperability of contact tracing apps and emphasizes the need for developing coordinated solutions to promote safe international travel and global pandemic control. %M 33156804 %R 10.2196/23194 %U http://mhealth.jmir.org/2020/11/e23194/ %U https://doi.org/10.2196/23194 %U http://www.ncbi.nlm.nih.gov/pubmed/33156804 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 11 %P e20246 %T Experiences of Psychotherapists With Remote Psychotherapy During the COVID-19 Pandemic: Cross-sectional Web-Based Survey Study %A Humer,Elke %A Stippl,Peter %A Pieh,Christoph %A Pryss,Rüdiger %A Probst,Thomas %+ Department for Psychotherapy and Biopsychosocial Health, Danube University Krems, Dr-Karl-Dorrek-Straße 30, Krems, 3500, Austria, 43 27328932676, thomas.probst@donau-uni.ac.at %K psychotherapists %K remote psychotherapy %K telephone %K internet %K experiences %K expectations %K COVID-19 %K telehealth %K therapy %K psychology %D 2020 %7 27.11.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The current situation around the COVID-19 pandemic and the measures necessary to fight it are creating challenges for psychotherapists, who usually treat patients face-to-face with personal contact. The pandemic is accelerating the use of remote psychotherapy (ie, psychotherapy provided via telephone or the internet). However, some psychotherapists have expressed reservations regarding remote psychotherapy. As psychotherapists are the individuals who determine the frequency of use of remote psychotherapy, the potential of enabling mental health care during the COVID-19 pandemic in line with the protective measures to fight COVID-19 can be realized only if psychotherapists are willing to use remote psychotherapy. Objective: This study aimed to investigate the experiences of psychotherapists with remote psychotherapy in the first weeks of the COVID-19 lockdown in Austria (between March 24 and April 1, 2020). Methods: Austrian psychotherapists were invited to take part in a web-based survey. The therapeutic orientations of the psychotherapists (behavioral, humanistic, psychodynamic, or systemic), their rating of the comparability of remote psychotherapy (web- or telephone-based) with face-to-face psychotherapy involving personal contact, and potential discrepancies between their actual experiences and previous expectations with remote psychotherapy were assessed. Data from 1162 psychotherapists practicing before and during the COVID-19 lockdown were analyzed. Results: Psychotherapy conducted via telephone or the internet was reported to not be totally comparable to psychotherapy with personal contact (P<.001). Psychodynamic (P=.001) and humanistic (P=.005) therapists reported a higher comparability of telephone-based psychotherapy to in-person psychotherapy than behavioral therapists. Experiences with remote therapy (both web- and telephone-based) were more positive than previously expected (P<.001). Psychodynamic therapists reported more positive experiences with telephone-based psychotherapy than expected compared to behavioral (P=.03) and systemic (P=.002) therapists. In general, web-based psychotherapy was rated more positively (regarding comparability to psychotherapy with personal contact and experiences vs expectations) than telephone-based psychotherapy (P<.001); however, psychodynamic therapists reported their previous expectations to be equal to their actual experiences for both telephone- and web-based psychotherapy. Conclusions: Psychotherapists found their experiences with remote psychotherapy (ie, web- or telephone-based psychotherapy) to be better than expected but found that this mode was not totally comparable to face-to-face psychotherapy with personal contact. Especially, behavioral therapists were found to rate telephone-based psychotherapy less favorably than therapists with other theoretical backgrounds. %M 33151896 %R 10.2196/20246 %U http://www.jmir.org/2020/11/e20246/ %U https://doi.org/10.2196/20246 %U http://www.ncbi.nlm.nih.gov/pubmed/33151896 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 11 %P e24718 %T Comparison of Mobile Health Technology Use for Self-Tracking Between Older Adults and the General Adult Population in Canada: Cross-Sectional Survey %A Jaana,Mirou %A Paré,Guy %+ Telfer School of Management, University of Ottawa, 55 Laurier Ave East, Ottawa, ON, K1N 6N5, Canada, 1 16135625800 ext 3400, jaana@telfer.uottawa.ca %K mobile health %K older adults %K self-tracking %K wearable technology %K smart devices %K mobile apps %K survey %K mobile phone %K seniors %K elderly %D 2020 %7 27.11.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The burden of population aging and chronic conditions has been reported worldwide. Older adults, especially those with high needs, experience social isolation and have high rates of emergency visits and limited satisfaction with the care they receive. Mobile health (mHealth) technologies present opportunities to address these challenges. To date, limited information is available on Canadian older adults’ attitudes toward and use of mHealth technologies for self-tracking purposes—an area that is increasingly important and relevant during the COVID-19 era. Objective: This study presents contributions to an underresearched area on older adults and mHealth technology use. The aim of this study was to compare older adults’ use of mHealth technologies to that of the general adult population in Canada and to investigate the factors that affect their use. Methods: A cross-sectional survey on mHealth and digital self-tracking was conducted. A web-based questionnaire was administered to a national sample of 4109 Canadian residents who spoke either English or French. The survey instrument consisted of 3 sections assessing the following items: (1) demographic characteristics, health status, and comorbidities; (2) familiarity with and use of mHealth technologies (ie, mobile apps, consumer smart devices/wearables such as vital signs monitors, bathroom scales, fitness trackers, intelligent clothing); and (3) factors influencing the continued use of mHealth technologies. Results: Significant differences were observed between the older adults and the general adult population in the use of smart technologies and internet (P<.001). Approximately 47.4% (323/682) of the older adults in the community reported using smartphones and 49.8% (340/682) indicated using digital tablets. Only 19.6% (91/463) of the older adults using smartphones/digital tablets reported downloading mobile apps, and 12.3% (47/383) of the older adults who heard of smart devices/wearables indicated using them. The majority of the mobile apps downloaded by older adults was health-related; interestingly, their use was sustained over a longer period of time (P=.007) by the older adults compared to that by the general population. Approximately 62.7% (428/682) of the older adults reported tracking their health measures, but the majority did so manually. Older adults with one or more chronic conditions were mostly nontrackers (odds ratio 0.439 and 0.431 for traditional trackers and digital trackers, respectively). No significant differences were observed between the older adults and the general adult population with regard to satisfaction with mHealth technologies and their intention to continue using them. Conclusions: Leveraging mHealth technologies in partnership with health care providers and sharing of health/well-being data with health care professionals and family members remain very limited. A culture shift in the provision of care to older adults is deemed necessary to keep up with the development of mHealth technologies and the changing demographics and expectations of patients and their caregivers. %M 33104517 %R 10.2196/24718 %U http://mhealth.jmir.org/2020/11/e24718/ %U https://doi.org/10.2196/24718 %U http://www.ncbi.nlm.nih.gov/pubmed/33104517 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 4 %P e23083 %T The Relationship Between Demographic, Socioeconomic, and Health-Related Parameters and the Impact of COVID-19 on 24 Regions in India: Exploratory Cross-Sectional Study %A Rajkumar,Ravi Philip %+ Jawaharlal Institute of Postgraduate Medical Education and Research, Dhanvantari Nagar Post, Pondicherry, 605006, India, 91 4132296280, ravi.psych@gmail.com %K burden of disease %K COVID-19 %K diarrheal disease %K ischemic heart disease %K population size %K sex ratio %D 2020 %7 27.11.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The impact of the COVID-19 pandemic has varied widely across nations and even in different regions of the same nation. Some of this variability may be due to the interplay of pre-existing demographic, socioeconomic, and health-related factors in a given population. Objective: The aim of this study was to examine the statistical associations between the statewise prevalence, mortality rate, and case fatality rate of COVID-19 in 24 regions in India (23 states and Delhi), as well as key demographic, socioeconomic, and health-related indices. Methods: Data on disease prevalence, crude mortality, and case fatality were obtained from statistics provided by the Government of India for 24 regions, as of June 30, 2020. The relationship between these parameters and the demographic, socioeconomic, and health-related indices of the regions under study was examined using both bivariate and multivariate analyses. Results: COVID-19 prevalence was negatively associated with male-to-female sex ratio (defined as the number of females per 1000 male population) and positively associated with the presence of an international airport in a particular state. The crude mortality rate for COVID-19 was negatively associated with sex ratio and the statewise burden of diarrheal disease, and positively associated with the statewise burden of ischemic heart disease. Multivariate analyses demonstrated that the COVID-19 crude mortality rate was significantly and negatively associated with sex ratio. Conclusions: These results suggest that the transmission and impact of COVID-19 in a given population may be influenced by a number of variables, with demographic factors showing the most consistent association. %M 33147164 %R 10.2196/23083 %U http://publichealth.jmir.org/2020/4/e23083/ %U https://doi.org/10.2196/23083 %U http://www.ncbi.nlm.nih.gov/pubmed/33147164 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 6 %N 2 %P e24989 %T Medical Students’ Corner: Barriers to Communication During the COVID-19 Pandemic %A Ogunbiyi,M Olabisi %A Obiri-Darko,Emma %+ University College London Medical School, 74 Huntley Street, London, United Kingdom, 44 7483126613, zchamoo@ucl.ac.uk %K COVID-19 %K medical education %K education %K student %K communication %K perspective %K medical student %K barrier %K culture %D 2020 %7 27.11.2020 %9 Viewpoint %J JMIR Med Educ %G English %X The COVID-19 pandemic has inspired us, as medical students, to reflect upon the communication training we have received in medical school and the obstacles we have faced in the clinic due to COVID-19. We hold the view that our communication training is inadequate; this view is driven by our limited exposure to patients, a situation that is currently being exacerbated by the pandemic. The medical curriculum must be inclusive of all groups and take into account the new challenges arising during the COVID-19 pandemic. %M 33197232 %R 10.2196/24989 %U http://mededu.jmir.org/2020/2/e24989/ %U https://doi.org/10.2196/24989 %U http://www.ncbi.nlm.nih.gov/pubmed/33197232 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 11 %P e23449 %T Searching PubMed to Retrieve Publications on the COVID-19 Pandemic: Comparative Analysis of Search Strings %A Lazarus,Jeffrey V %A Palayew,Adam %A Rasmussen,Lauge Neimann %A Andersen,Tue Helms %A Nicholson,Joey %A Norgaard,Ole %+ Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Carrer del Rosselló, 132, Barcelona, Spain, 34 608703573, jeffrey.lazarus@isglobal.org %K coronavirus %K COVID-19 %K pandemic %K scientific publishing %K PubMed %K literature searching %K research %K literature %K search %K performance %D 2020 %7 26.11.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Since it was declared a pandemic on March 11, 2020, COVID-19 has dominated headlines around the world and researchers have generated thousands of scientific articles about the disease. The fast speed of publication has challenged researchers and other stakeholders to keep up with the volume of published articles. To search the literature effectively, researchers use databases such as PubMed. Objective: The aim of this study is to evaluate the performance of different searches for COVID-19 records in PubMed and to assess the complexity of searches required. Methods: We tested PubMed searches for COVID-19 to identify which search string performed best according to standard metrics (sensitivity, precision, and F-score). We evaluated the performance of 8 different searches in PubMed during the first 10 weeks of the COVID-19 pandemic to investigate how complex a search string is needed. We also tested omitting hyphens and space characters as well as applying quotation marks. Results: The two most comprehensive search strings combining several free-text and indexed search terms performed best in terms of sensitivity (98.4%/98.7%) and F-score (96.5%/95.7%), but the single-term search COVID-19 performed best in terms of precision (95.3%) and well in terms of sensitivity (94.4%) and F-score (94.8%). The term Wuhan virus performed the worst: 7.7% for sensitivity, 78.1% for precision, and 14.0% for F-score. We found that deleting a hyphen or space character could omit a substantial number of records, especially when searching with SARS-CoV-2 as a single term. Conclusions: Comprehensive search strings combining free-text and indexed search terms performed better than single-term searches in PubMed, but not by a large margin compared to the single term COVID-19. For everyday searches, certain single-term searches that are entered correctly are probably sufficient, whereas more comprehensive searches should be used for systematic reviews. Still, we suggest additional measures that the US National Library of Medicine could take to support all PubMed users in searching the COVID-19 literature. %M 33197230 %R 10.2196/23449 %U http://www.jmir.org/2020/11/e23449/ %U https://doi.org/10.2196/23449 %U http://www.ncbi.nlm.nih.gov/pubmed/33197230 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 8 %N 11 %P e19524 %T Applying eHealth for Pandemic Management in Saudi Arabia in the Context of COVID-19: Survey Study and Framework Proposal %A Alsharif,Abdullah %+ Department of Management Information Systems, College of Business Administration-Yanbu, Taibah University, 14 Khlaf Alkhfigee Street 8314, Iskan, Medinah, PO Box 344, Saudi Arabia, 966 542578585, alsharifa@taibahu.edu.sa %K COVID-19 %K eHealth framework %K infectious disease %K pandemic %K eHealth %K public health %D 2020 %7 26.11.2020 %9 Original Paper %J JMIR Med Inform %G English %X Background: The increased frequency of epidemics such as Middle East respiratory syndrome, severe acute respiratory syndrome, Ebola virus, and Zika virus has created stress on health care management and operations as well as on relevant stakeholders. In addition, the recent COVID-19 outbreak has been creating challenges for various countries and their respective health care organizations in managing and controlling the pandemic. One of the most important observations during the recent outbreak is the lack of effective eHealth frameworks for managing and controlling pandemics. Objective: The aims of this study are to review the current National eHealth Strategy of Saudi Arabia and to propose an integrated eHealth framework that can be effective for managing health care operations and services during pandemics. Methods: A questionnaire-based survey was administered to 316 health care professionals to review the current national eHealth framework of Saudi Arabia and identify the objectives, factors, and components that are key for managing and controlling pandemics. Purposive sampling was used to collect responses from diverse experts, including physicians, technical experts, nurses, administrative experts, and pharmacists. The survey was administered at five hospitals in Saudi Arabia by forwarding the survey link using a web-based portal. A sample population of 350 was achieved, which was filtered to exclude incomplete and ineligible samples, giving a sample of 316 participants. Results: Of the 316 participants, 187 (59.2%) found the current eHealth framework to be ineffective, and more than 50% of the total participants stated that the framework lacked some essential components and objectives. Additional components and objectives focusing on using eHealth for managing information, creating awareness, increasing accessibility and reachability, promoting self-management and self-collaboration, promoting electronic services, and extensive stakeholder engagement were considered to be the most important factors by more than 80% of the total participants. Conclusions: Managing pandemics requires an effective and efficient eHealth framework that can be used to manage various health care services by integrating different eHealth components and collaborating with all stakeholders. %M 33035174 %R 10.2196/19524 %U http://medinform.jmir.org/2020/11/e19524/ %U https://doi.org/10.2196/19524 %U http://www.ncbi.nlm.nih.gov/pubmed/33035174 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 11 %P e22152 %T Concerns Expressed by Chinese Social Media Users During the COVID-19 Pandemic: Content Analysis of Sina Weibo Microblogging Data %A Wang,Junze %A Zhou,Ying %A Zhang,Wei %A Evans,Richard %A Zhu,Chengyan %+ School of Medicine and Health Management, Huazhong University of Science and Technology, 13# Hangkong Road, Qiaokou District, Wuhan, 430074, China, 86 13397110378, weizhanghust@hust.edu.cn %K coronavirus %K COVID-19 %K social media %K public health %K Sina Weibo %K public opinion %K citizen concerns %D 2020 %7 26.11.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic has created a global health crisis that is affecting economies and societies worldwide. During times of uncertainty and unexpected change, people have turned to social media platforms as communication tools and primary information sources. Platforms such as Twitter and Sina Weibo have allowed communities to share discussion and emotional support; they also play important roles for individuals, governments, and organizations in exchanging information and expressing opinions. However, research that studies the main concerns expressed by social media users during the pandemic is limited. Objective: The aim of this study was to examine the main concerns raised and discussed by citizens on Sina Weibo, the largest social media platform in China, during the COVID-19 pandemic. Methods: We used a web crawler tool and a set of predefined search terms (New Coronavirus Pneumonia, New Coronavirus, and COVID-19) to investigate concerns raised by Sina Weibo users. Textual information and metadata (number of likes, comments, retweets, publishing time, and publishing location) of microblog posts published between December 1, 2019, and July 32, 2020, were collected. After segmenting the words of the collected text, we used a topic modeling technique, latent Dirichlet allocation (LDA), to identify the most common topics posted by users. We analyzed the emotional tendencies of the topics, calculated the proportional distribution of the topics, performed user behavior analysis on the topics using data collected from the number of likes, comments, and retweets, and studied the changes in user concerns and differences in participation between citizens living in different regions of mainland China. Results: Based on the 203,191 eligible microblog posts collected, we identified 17 topics and grouped them into 8 themes. These topics were pandemic statistics, domestic epidemic, epidemics in other countries worldwide, COVID-19 treatments, medical resources, economic shock, quarantine and investigation, patients’ outcry for help, work and production resumption, psychological influence, joint prevention and control, material donation, epidemics in neighboring countries, vaccine development, fueling and saluting antiepidemic action, detection, and study resumption. The mean sentiment was positive for 11 topics and negative for 6 topics. The topic with the highest mean of retweets was domestic epidemic, while the topic with the highest mean of likes was quarantine and investigation. Conclusions: Concerns expressed by social media users are highly correlated with the evolution of the global pandemic. During the COVID-19 pandemic, social media has provided a platform for Chinese government departments and organizations to better understand public concerns and demands. Similarly, social media has provided channels to disseminate information about epidemic prevention and has influenced public attitudes and behaviors. Government departments, especially those related to health, can create appropriate policies in a timely manner through monitoring social media platforms to guide public opinion and behavior during epidemics. %M 33151894 %R 10.2196/22152 %U http://www.jmir.org/2020/11/e22152/ %U https://doi.org/10.2196/22152 %U http://www.ncbi.nlm.nih.gov/pubmed/33151894 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 11 %P e19768 %T The Public’s Perception of the Severity and Global Impact at the Start of the SARS-CoV-2 Pandemic: A Crowdsourcing-Based Cross-Sectional Analysis %A Shauly,Orr %A Stone,Gregory %A Gould,Daniel %+ Keck School of Medicine, University of Southern California, 1450 San Pablo Street, Suite 415, Los Angeles, CA, United States, 1 323 442 7920, dr.danjgould@gmail.com %K Amazon Mechanical Turk %K crowdsourcing %K COVID-19, SARS-CoV-2 %K pandemic %K perception %K public opinion %K survey %K severity %K impact %K behavior %K education %D 2020 %7 26.11.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: COVID-19 is a rapidly developing threat to most people in the United States and abroad. The behaviors of the public are important to understand, as they may have a tremendous impact on the course of this novel coronavirus pandemic. Objective: This study intends to assess the US population’s perception and knowledge of the virus as a threat and the behaviors of the general population in response. Methods: A prospective cross-sectional study was conducted with random volunteers recruited through Amazon Mechanical Turk, an internet crowdsourcing service, on March 24, 2020. Results: A total of 969 participants met the inclusion criteria. It was found that the perceived severity of the COVID-19 pandemic significantly differed between age groups (P<.001) and men and women (P<.001). A majority of study participants were actively adhering to the Centers for Disease Control and Prevention guidelines. Conclusions: Though many participants identified COVID-19 as a threat, many failed to place themselves appropriately in the correct categories with respect to risk. This may indicate a need for additional public education for appropriately defining the risk of this novel pandemic. %M 33108314 %R 10.2196/19768 %U http://www.jmir.org/2020/11/e19768/ %U https://doi.org/10.2196/19768 %U http://www.ncbi.nlm.nih.gov/pubmed/33108314 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 11 %P e23748 %T A Mental Health Surveillance System for the General Population During the COVID-19 Pandemic: Protocol for a Multiwave Cross-sectional Survey Study %A BinDhim,Nasser F %A Althumiri,Nora A %A Basyouni,Mada H %A Alageel,Asem A %A Alghnam,Suliman %A Al-Qunaibet,Ada M %A Almubark,Rasha A %A Aldhukair,Shahla %A Ad-Dab'bagh,Yasser %+ Sharik Association for Health Research, 4 Ans Ibn Malik St, Riyadh, , Saudi Arabia, 966 580033299, nd@nasserdhim.com %K mental health %K depression %K anxiety %K screening %K surveillance %K COVID-19 %D 2020 %7 26.11.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: The COVID-19 outbreak can potentially be categorized as a traumatic event. Public health surveillance is one of the cornerstones of public health practice, and it empowers decision makers to lead and manage public health crises and programs more effectively by providing timely and useful evidence. Objective: This paper presents the protocol for a study that aims to identify, track, and monitor trends in the population in Saudi Arabia at risk of major depressive disorders and anxiety during the COVID-19 pandemic. Methods: This study utilizes continuous, cross-sectional, national-level mental health screening via computer-assisted phone interviews, conducted in four waves on a monthly basis (between May and August 2020). Arabic-speaking adults, aged ≥18 years, and living in Saudi Arabia were recruited via a random phone list. This surveillance system used the proportional quota sampling technique to achieve an equal distribution of participants, stratified by age and gender, and region, within and across the 13 administrative regions of Saudi Arabia. A sample size of 4056 participants per wave was calculated to achieve enough power to detect changes in mental health status. The questionnaire includes the Arabic version of the Patient Health Questionnaire-9 (PHQ-9) to measure depressive symptoms and the General Anxiety Disorder-7 (GAD-7) to measure anxiety. In addition, it will collect data on sociodemographic variables and potential risk factors. Results: Study recruitment began in May 2020. The data analysis was completed in October 2020, and the final report is expected to be published by the end of December 2020. Conclusions: Monitoring the population’s mental health status during the COVID-19 pandemic will inform decision makers of any potential deterioration in mental health on a national level and among subgroups, including across regions, age groups, and gender groups. It will allow decision makers to recognize issues and intervene sooner. It will also provide valuable scientific data to help understand the effects of epidemics and pandemics on mental health. As far as we know, this is the only study that attempts to monitor the mental health status of the general population on a monthly basis. International Registered Report Identifier (IRRID): DERR1-10.2196/23748 %M 33156802 %R 10.2196/23748 %U http://www.researchprotocols.org/2020/11/e23748/ %U https://doi.org/10.2196/23748 %U http://www.ncbi.nlm.nih.gov/pubmed/33156802 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 11 %P e21933 %T Public Emotions and Rumors Spread During the COVID-19 Epidemic in China: Web-Based Correlation Study %A Dong,Wei %A Tao,Jinhu %A Xia,Xiaolin %A Ye,Lin %A Xu,Hanli %A Jiang,Peiye %A Liu,Yangyang %+ School of Education, Tianjin University, 135 Yaguan Road, Tianjin, 300350, China, 86 18118849345, liuyangyang661@sina.com %K public emotions %K rumor %K infodemic %K infodemiology %K infoveillance %K China %K COVID-19 %D 2020 %7 25.11.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Various online rumors have led to inappropriate behaviors among the public in response to the COVID-19 epidemic in China. These rumors adversely affect people’s physical and mental health. Therefore, a better understanding of the relationship between public emotions and rumors during the epidemic may help generate useful strategies for guiding public emotions and dispelling rumors. Objective: This study aimed to explore whether public emotions are related to the dissemination of online rumors in the context of COVID-19. Methods: We used the web-crawling tool Scrapy to gather data published by People’s Daily on Sina Weibo, a popular social media platform in China, after January 8, 2020. Netizens’ comments under each Weibo post were collected. Nearly 1 million comments thus collected were divided into 5 categories: happiness, sadness, anger, fear, and neutral, based on the underlying emotional information identified and extracted from the comments by using a manual identification process. Data on rumors spread online were collected through Tencent’s Jiaozhen platform. Time-lagged cross-correlation analyses were performed to examine the relationship between public emotions and rumors. Results: Our results indicated that the angrier the public felt, the more rumors there would likely be (r=0.48, P<.001). Similar results were observed for the relationship between fear and rumors (r=0.51, P<.001) and between sadness and rumors (r=0.47, P<.001). Furthermore, we found a positive correlation between happiness and rumors, with happiness lagging the emergence of rumors by 1 day (r=0.56, P<.001). In addition, our data showed a significant positive correlation between fear and fearful rumors (r=0.34, P=.02). Conclusions: Our findings confirm that public emotions are related to the rumors spread online in the context of COVID-19 in China. Moreover, these findings provide several suggestions, such as the use of web-based monitoring methods, for relevant authorities and policy makers to guide public emotions and behavior during this public health emergency. %M 33112757 %R 10.2196/21933 %U http://www.jmir.org/2020/11/e21933/ %U https://doi.org/10.2196/21933 %U http://www.ncbi.nlm.nih.gov/pubmed/33112757 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 11 %P e21672 %T Chinese Residents’ Perceptions of COVID-19 During the Pandemic: Online Cross-sectional Survey Study %A Cui,Tingting %A Yang,Guoping %A Ji,Lili %A Zhu,Lin %A Zhen,Shiqi %A Shi,Naiyang %A Xu,Yan %A Jin,Hui %+ Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, No. 87 Dingjiaqiao, Nanjing, , China, 86 025 8327 2572, jinhuihld@seu.edu.cn %K COVID-19 %K perception %K China %K cross-sectional survey %K health education %K time-varying reproduction number %K knowledge %K skill %K behavior %K work resumption %K study resumption %D 2020 %7 25.11.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: COVID-19 has posed a global threat due to substantial morbidity and mortality, and health education strategies need to be adjusted accordingly to prevent a possible epidemic rebound. Objective: This study aimed to evaluate the perceptions of COVID-19 among individuals coming to, returning to, or living in Jiangsu Province, China, and determine the impact of the pandemic on the perceptions of the public. Methods: In this study, an online questionnaire was distributed to participants between February 15 and April 21, 2020. The questionnaire comprised items on personal information (eg, sex, age, educational level, and occupation); protection knowledge, skills, and behaviors related to COVID-19; access to COVID-19–related information; and current information needs. Factors influencing the knowledge score, skill score, behavior score, and total score for COVID-19 were evaluated using univariate and multivariate analyses. The time-varying reproduction number (Rt) and its 95% credible interval were calculated and compared with the daily participation number and protection scores. Results: In total, 52,066 participants were included in the study; their average knowledge score, skill score, behavior score, and total score were 25.58 (SD 4.22), 24.05 (SD 4.02), 31.51 (SD 2.84), and 90.02 (SD 8.87), respectively, and 65.91% (34,315/52,066) had a total protection score above 90 points. For the knowledge and skill sections, correct rates of answers to questions on medical observation days, infectiousness of asymptomatic individuals, cough or sneeze treatment, and precautions were higher than 95%, while those of questions on initial symptoms (32,286/52,066, 62.01%), transmission routes (37,134/52,066, 71.32%), selection of disinfection products (37,390/52,066, 71.81%), and measures of home quarantine (40,037/52,066, 76.90%) were relatively low. For the actual behavior section, 97.93% (50,989/52,066) of participants could wear masks properly when going out. However, 19.76% (10,290/52,066) could not disinfect their homes each week, and 18.42% (9589/52,066) could not distinguish differences in initial symptoms between the common cold and COVID-19. The regression analyses showed that the knowledge score, skill score, behavior score, and total score were influenced by sex, age, educational level, occupation, and place of residence at different degrees (P<.001). The government, television shows, and news outlets were the main sources of protection knowledge, and the information released by the government and authoritative medical experts was considered the most reliable. The current information needs included the latest epidemic developments, disease treatment progress, and daily protection knowledge. The Rt in the Jiangsu Province and mainland China dropped below 1, while the global Rt remained at around 1. The maximal information coefficients ranged from 0.76 to 1.00, which indicated that the public’s perceptions were significantly associated with the epidemic. Conclusions: A high proportion of the participants had sufficient COVID-19 protection knowledge and skills and were able to avoid risky behaviors. Thus, it is necessary to apply different health education measures tailored to work and study resumption for specific populations to improve their self-protection and, ultimately, to prevent a possible rebound of COVID-19. %M 33152684 %R 10.2196/21672 %U http://www.jmir.org/2020/11/e21672/ %U https://doi.org/10.2196/21672 %U http://www.ncbi.nlm.nih.gov/pubmed/33152684 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 11 %P e21504 %T Communicative Blame in Online Communication of the COVID-19 Pandemic: Computational Approach of Stigmatizing Cues and Negative Sentiment Gauged With Automated Analytic Techniques %A Chang,Angela %A Schulz,Peter Johannes %A Tu,ShengTsung %A Liu,Matthew Tingchi %+ Department of Communication, Faculty of Social Sciences, University of Macau, E21-2056, Avenida da Universidade, Taipa, Macao, 100, China, 853 88228991, wychang@um.edu.mo %K placing blame %K culprits %K sentiment analysis %K infodemic analysis %K political grievances %K COVID-19 %K communication %K pandemic %K social media %K negativity %K infodemic %K infodemiology %K infoveillance %K blame %K stigma %D 2020 %7 25.11.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Information about a new coronavirus emerged in 2019 and rapidly spread around the world, gaining significant public attention and attracting negative bias. The use of stigmatizing language for the purpose of blaming sparked a debate. Objective: This study aims to identify social stigma and negative sentiment toward the blameworthy agents in social communities. Methods: We enabled a tailored text-mining platform to identify data in their natural settings by retrieving and filtering online sources, and constructed vocabularies and learning word representations from natural language processing for deductive analysis along with the research theme. The data sources comprised of ten news websites, eleven discussion forums, one social network, and two principal media sharing networks in Taiwan. A synthesis of news and social networking analytics was present from December 30, 2019, to March 31, 2020. Results: We collated over 1.07 million Chinese texts. Almost two-thirds of the texts on COVID-19 came from news services (n=683,887, 63.68%), followed by Facebook (n=297,823, 27.73%), discussion forums (n=62,119, 5.78%), and Instagram and YouTube (n=30,154, 2.81%). Our data showed that online news served as a hotbed for negativity and for driving emotional social posts. Online information regarding COVID-19 associated it with China—and a specific city within China through references to the “Wuhan pneumonia”—potentially encouraging xenophobia. The adoption of this problematic moniker had a high frequency, despite the World Health Organization guideline to avoid biased perceptions and ethnic discrimination. Social stigma is disclosed through negatively valenced responses, which are associated with the most blamed targets. Conclusions: Our sample is sufficiently representative of a community because it contains a broad range of mainstream online media. Stigmatizing language linked to the COVID-19 pandemic shows a lack of civic responsibility that encourages bias, hostility, and discrimination. Frequently used stigmatizing terms were deemed offensive, and they might have contributed to recent backlashes against China by directing blame and encouraging xenophobia. The implications ranging from health risk communication to stigma mitigation and xenophobia concerns amid the COVID-19 outbreak are emphasized. Understanding the nomenclature and biased terms employed in relation to the COVID-19 outbreak is paramount. We propose solidarity with communication professionals in combating the COVID-19 outbreak and the infodemic. Finding solutions to curb the spread of virus bias, stigma, and discrimination is imperative. %M 33108306 %R 10.2196/21504 %U http://www.jmir.org/2020/11/e21504/ %U https://doi.org/10.2196/21504 %U http://www.ncbi.nlm.nih.gov/pubmed/33108306 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 11 %P e20550 %T Twitter Discussions and Emotions About the COVID-19 Pandemic: Machine Learning Approach %A Xue,Jia %A Chen,Junxiang %A Hu,Ran %A Chen,Chen %A Zheng,Chengda %A Su,Yue %A Zhu,Tingshao %+ CAS Key Laboratory of Behavioral Science, Institute of Psychology, Chinese Academy of Sciences, 16 Lincui Road, Chaoyang District, Beijing, 100101, China, 86 0106485166, tszhu@psych.ac.cn %K machine learning %K Twitter data %K COVID-19 %K infodemic %K infodemiology %K infoveillance %K public discussion %K public sentiment %K Twitter %K social media %K virus %D 2020 %7 25.11.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: It is important to measure the public response to the COVID-19 pandemic. Twitter is an important data source for infodemiology studies involving public response monitoring. Objective: The objective of this study is to examine COVID-19–related discussions, concerns, and sentiments using tweets posted by Twitter users. Methods: We analyzed 4 million Twitter messages related to the COVID-19 pandemic using a list of 20 hashtags (eg, “coronavirus,” “COVID-19,” “quarantine”) from March 7 to April 21, 2020. We used a machine learning approach, Latent Dirichlet Allocation (LDA), to identify popular unigrams and bigrams, salient topics and themes, and sentiments in the collected tweets. Results: Popular unigrams included “virus,” “lockdown,” and “quarantine.” Popular bigrams included “COVID-19,” “stay home,” “corona virus,” “social distancing,” and “new cases.” We identified 13 discussion topics and categorized them into 5 different themes: (1) public health measures to slow the spread of COVID-19, (2) social stigma associated with COVID-19, (3) COVID-19 news, cases, and deaths, (4) COVID-19 in the United States, and (5) COVID-19 in the rest of the world. Across all identified topics, the dominant sentiments for the spread of COVID-19 were anticipation that measures can be taken, followed by mixed feelings of trust, anger, and fear related to different topics. The public tweets revealed a significant feeling of fear when people discussed new COVID-19 cases and deaths compared to other topics. Conclusions: This study showed that Twitter data and machine learning approaches can be leveraged for an infodemiology study, enabling research into evolving public discussions and sentiments during the COVID-19 pandemic. As the situation rapidly evolves, several topics are consistently dominant on Twitter, such as confirmed cases and death rates, preventive measures, health authorities and government policies, COVID-19 stigma, and negative psychological reactions (eg, fear). Real-time monitoring and assessment of Twitter discussions and concerns could provide useful data for public health emergency responses and planning. Pandemic-related fear, stigma, and mental health concerns are already evident and may continue to influence public trust when a second wave of COVID-19 occurs or there is a new surge of the current pandemic. %M 33119535 %R 10.2196/20550 %U http://www.jmir.org/2020/11/e20550/ %U https://doi.org/10.2196/20550 %U http://www.ncbi.nlm.nih.gov/pubmed/33119535 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 11 %P e24505 %T Digital Health Technologies Respond to the COVID-19 Pandemic In a Tertiary Hospital in China: Development and Usability Study %A Lian,Wanmin %A Wen,Li %A Zhou,Qiru %A Zhu,Weijie %A Duan,Wenzhou %A Xiao,Xiongzhi %A Mhungu,Florence %A Huang,Wenchen %A Li,Chongchong %A Cheng,Weibin %A Tian,Junzhang %+ Institute for Healthcare Artificial Intelligence Application, Guangdong Second Provincial General Hospital, No 466 Xingangzhong Road, Haizhu District, Guangzhou, 510317, China, 86 13929587509, chwb817@gmail.com %K Internet hospital %K COVID-19 %K automated screening %K symptom %K monitoring %K web-based consultation %K psychological support %K emergency %K digital health %K hospital %K China %K screening %D 2020 %7 24.11.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The outbreak of COVID-19 has caused a continuing global pandemic. Hospitals are integral to the control and prevention of COVID-19; however, they are facing numerous challenges during the epidemic. Objective: Our study aimed to introduce the practical experience of the design and implementation of a web-based COVID-19 service platform at a tertiary hospital in China as well as the preliminary results of the implementation. Methods: The web-based COVID-19 service platform was deployed within the health care system of the Guangdong Second Provincial General Hospital and Internet Hospital; the function of the platform was to provide web-based medical services for both members of the public and lay health care workers. The focal functions of this system included automated COVID-19 screening, related symptom monitoring, web-based consultation, and psychological support; it also served as a COVID-19 knowledge hub. The design and process of each function are introduced. The usage data for the platform service were collected and are represented by three periods: the pre-epidemic period (December 22, 2019, to January 22, 2020, 32 days), the controlled period (January 23 to March 31, 2020, 69 days), and the postepidemic period (April 1 to June 30, 2020, 91 days). Results: By the end of June 2020, 96,642 people had used the automated COVID-19 screening and symptom monitoring systems 161,884 and 7,795,194 times, respectively. The number of general web-based consultation services per day increased from 30 visits in the pre-epidemic period to 122 visits during the controlled period, then dropped to 73 visits in the postepidemic period. The psychological counseling program served 636 clients during the epidemic period. For people who used the automated COVID-19 screening service, 160,916 (99.40%) of the total users were classified in the no risk category. 464 (0.29%) of the people were categorized as medium to high risk, and 12 people (0.01%) were recommended for further COVID-19 testing and treatment. Among the 96,642 individuals who used the COVID-19 related symptoms monitoring service, 6696 (6.93%) were symptomatic at some point during the monitoring period. Fever was the most frequently reported symptom, with 2684/6696 symptomatic people (40.1%) having had this symptom. Cough and sore throat were also relatively frequently reported by the 6696 symptomatic users (1657 people, 24.7%, and 1622 people, 24.2%, respectively). Conclusions: The web-based COVID-19 service platform implemented at a tertiary hospital in China is exhibited to be a role model for using digital health technologies to respond to the COVID-19 pandemic. The digital solutions of automated COVID-19 screening, daily symptom monitoring, web-based care, and knowledge propagation have plausible acceptability and feasibility for complementing offline hospital services and facilitating disease control and prevention. %M 33141679 %R 10.2196/24505 %U http://www.jmir.org/2020/11/e24505/ %U https://doi.org/10.2196/24505 %U http://www.ncbi.nlm.nih.gov/pubmed/33141679 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 6 %N 2 %P e24222 %T Virtual Cancer Care During the COVID-19 Pandemic and Beyond: A Call for Evaluation %A Levine,Oren Hannun %A McGillion,Michael %A Levine,Mark %+ Department of Oncology, McMaster University, Room 104, G Wing, 711 Concession Street, Hamilton, ON, L8V 1C3, Canada, 1 905 527 2299 ext 42176, mlevine@mcmaster.ca %K care %K patient-physician relationship %K patient-centered care %K oncology care delivery %K virtual visits %K telehealth %K virtual care %K cancer %K oncology %K evaluation %K COVID-19 %D 2020 %7 24.11.2020 %9 Viewpoint %J JMIR Cancer %G English %X The interplay of virtual care and cancer care in the context of the COVID-19 pandemic is unique and unprecedented. Patients with cancer are at increased risk of SARS-CoV-2 infection and have worse outcomes than patients with COVID-19 who do not have cancer. Virtual care has been introduced quickly and extemporaneously in cancer treatment centers worldwide to maintain COVID-19–free zones. The outbreak of COVID-19 in a cancer center could have devastating consequences. The virtual care intervention that was first used in our cancer center, as well as many others, was a landline telephone in an office or clinic that connected a clinician with a patient. There is a lack of virtual care evaluation from the perspectives of patients and oncology health care providers. A number of factors for assessing oncology care delivered through a virtual care intervention have been described, including patient rapport, frailty, delicate conversations, team-based care, resident education, patient safety, technical effectiveness, privacy, operational effectiveness, and resource utilization. These factors are organized according to the National Quality Forum framework for the assessment of telehealth in oncology. This includes the following 4 domains of assessing outcomes: experience, access to care, effectiveness, and financial impact or cost. In terms of virtual care and oncology, the pandemic has opened the door to change. The lessons learned during the initial period of the pandemic have given rise to opportunities for the evolution of long-term virtual care. The opportunity to evaluate and improve virtual care should be seized upon. %M 33180741 %R 10.2196/24222 %U http://cancer.jmir.org/2020/2/e24222/ %U https://doi.org/10.2196/24222 %U http://www.ncbi.nlm.nih.gov/pubmed/33180741 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 11 %P e20839 %T Telemedicine in the United States: An Introduction for Students and Residents %A Hyder,Maryam A %A Razzak,Junaid %+ Department of Emergency Medicine, Johns Hopkins School of Medicine, 5801 Smith Ave, Suite 3220, Baltimore, MD, 21209, United States, 1 410 735 6450, junaid.razzak@jhu.edu %K telemedicine %K telehealth %K eHealth %K biomedical technology %K mHealth %K mobile health %K COVID-19 %D 2020 %7 24.11.2020 %9 Viewpoint %J J Med Internet Res %G English %X Telemedicine refers to the delivery of medical care and provision of general health services from a distance. Telemedicine has been practiced for decades with increasing evidence proving its potential for enhanced quality of care for patients, reduction in hospital readmissions, and increase in savings for both patients and providers. The COVID-19 pandemic has resulted in a significant increase in the reliance on telemedicine and telehealth for provision of health care services. Developments in telemedicine should be structured as complements to current health care procedures, not with the goal of completely digitizing the entire health care system, but rather to use the power of technology to enhance areas that may not be working at their full potential. At the same time, it is also clear that further research is needed on the effectiveness of telemedicine in terms of both financial and patient benefits. We discuss the current and rapidly increasing knowledge about the use of telemedicine in the United States, and identify the gaps in knowledge and opportunities for further research. Beginning with telemedicine’s origins in the United States to its widespread use during the COVID-19 pandemic, we highlight recent developments in legislation, accessibility, and acceptance of telemedicine. %M 33215999 %R 10.2196/20839 %U http://www.jmir.org/2020/11/e20839/ %U https://doi.org/10.2196/20839 %U http://www.ncbi.nlm.nih.gov/pubmed/33215999 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 6 %N 2 %P e20288 %T Telehealth and Palliative Care for Patients With Cancer: Implications of the COVID-19 Pandemic %A Grewal,Udhayvir Singh %A Terauchi,Stephanie %A Beg,Muhammad Shaalan %+ Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, , United States, 1 5136416314, muhammad.beg@utsouthwestern.edu %K COVID-19 %K telehealth %K palliative care %K telepalliative care %K patients with cancer %K telemedicine %D 2020 %7 24.11.2020 %9 Viewpoint %J JMIR Cancer %G English %X It has been reported that the incidence of SARS-CoV-2 infection is higher in patients with cancer than in the general population and that patients with cancer are at an increased risk of developing severe life-threatening complications from COVID-19. Increased transmission and poor outcomes noted in emerging data on patients with cancer and COVID-19 call for aggressive isolation and minimization of nosocomial exposure. Palliative care and oncology providers are posed with unique challenges due to the ongoing COVID-19 pandemic. Telepalliative care is the use of telehealth services for remotely delivering palliative care to patients through videoconferencing, telephonic communication, or remote symptom monitoring. It offers great promise in addressing the palliative and supportive care needs of patients with advanced cancer during the ongoing pandemic. We discuss the case of a 75-year-old woman who was initiated on second-line chemotherapy, to highlight how innovations in technology and telehealth-based interventions can be used to address patients’ palliative and supportive care needs in the ongoing epidemic. %M 33049695 %R 10.2196/20288 %U http://cancer.jmir.org/2020/2/e20288/ %U https://doi.org/10.2196/20288 %U http://www.ncbi.nlm.nih.gov/pubmed/33049695 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 11 %P e22600 %T Psychosocial Effects of the COVID-19 Pandemic: Large-scale Quasi-Experimental Study on Social Media %A Saha,Koustuv %A Torous,John %A Caine,Eric D %A De Choudhury,Munmun %+ School of Interactive Computing, Georgia Institute of Technology, North Ave NW, Atlanta, GA, 30332, United States, 1 4046929496, koustuv.saha@gatech.edu %K social media %K Twitter %K language %K psychosocial effects %K mental health %K transfer learning %K depression %K anxiety %K stress %K social support %K emotions %K COVID-19 %K coronavirus %K crisis %D 2020 %7 24.11.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic has caused several disruptions in personal and collective lives worldwide. The uncertainties surrounding the pandemic have also led to multifaceted mental health concerns, which can be exacerbated with precautionary measures such as social distancing and self-quarantining, as well as societal impacts such as economic downturn and job loss. Despite noting this as a “mental health tsunami”, the psychological effects of the COVID-19 crisis remain unexplored at scale. Consequently, public health stakeholders are currently limited in identifying ways to provide timely and tailored support during these circumstances. Objective: Our study aims to provide insights regarding people’s psychosocial concerns during the COVID-19 pandemic by leveraging social media data. We aim to study the temporal and linguistic changes in symptomatic mental health and support expressions in the pandemic context. Methods: We obtained about 60 million Twitter streaming posts originating from the United States from March 24 to May 24, 2020, and compared these with about 40 million posts from a comparable period in 2019 to attribute the effect of COVID-19 on people’s social media self-disclosure. Using these data sets, we studied people’s self-disclosure on social media in terms of symptomatic mental health concerns and expressions of support. We employed transfer learning classifiers that identified the social media language indicative of mental health outcomes (anxiety, depression, stress, and suicidal ideation) and support (emotional and informational support). We then examined the changes in psychosocial expressions over time and language, comparing the 2020 and 2019 data sets. Results: We found that all of the examined psychosocial expressions have significantly increased during the COVID-19 crisis—mental health symptomatic expressions have increased by about 14%, and support expressions have increased by about 5%, both thematically related to COVID-19. We also observed a steady decline and eventual plateauing in these expressions during the COVID-19 pandemic, which may have been due to habituation or due to supportive policy measures enacted during this period. Our language analyses highlighted that people express concerns that are specific to and contextually related to the COVID-19 crisis. Conclusions: We studied the psychosocial effects of the COVID-19 crisis by using social media data from 2020, finding that people’s mental health symptomatic and support expressions significantly increased during the COVID-19 period as compared to similar data from 2019. However, this effect gradually lessened over time, suggesting that people adapted to the circumstances and their “new normal.” Our linguistic analyses revealed that people expressed mental health concerns regarding personal and professional challenges, health care and precautionary measures, and pandemic-related awareness. This study shows the potential to provide insights to mental health care and stakeholders and policy makers in planning and implementing measures to mitigate mental health risks amid the health crisis. %M 33156805 %R 10.2196/22600 %U http://www.jmir.org/2020/11/e22600/ %U https://doi.org/10.2196/22600 %U http://www.ncbi.nlm.nih.gov/pubmed/33156805 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 11 %P e22407 %T COVID-19–Related Internet Search Patterns Among People in the United States: Exploratory Analysis %A Shen,Tony S %A Chen,Aaron Z %A Bovonratwet,Patawut %A Shen,Carol L %A Su,Edwin P %+ Weill Cornell Medical College, 1300 York Avenue, New York, NY, 10065, United States, 1 8605196413, azc2001@med.cornell.edu %K COVID-19 %K pandemic %K internet %K infodemic %K infodemiology %K infoveillance %K natural language processing %K NLP %K health information %K information seeking %D 2020 %7 23.11.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The internet is a well-known source of information that patients use to better inform their opinions and to guide their conversations with physicians during clinic visits. The novelty of the recent COVID-19 outbreak has led patients to turn more frequently to the internet to gather more information and to alleviate their concerns about the virus. Objective: The aims of the study were to (1) determine the most commonly searched phrases related to COVID-19 in the United States and (2) identify the sources of information for these web searches. Methods: Search terms related to COVID-19 were entered into Google. Questions and websites from Google web search were extracted to a database using customized software. Each question was categorized into one of 6 topics: clinical signs and symptoms, treatment, transmission, cleaning methods, activity modification, and policy. Additionally, the websites were categorized according to source: World Health Organization (WHO), Centers for Disease Control and Prevention (CDC), non-CDC government, academic, news, and other media. Results: In total, 200 questions and websites were extracted. The most common question topic was transmission (n=63, 31.5%), followed by clinical signs and symptoms (n=54, 27.0%) and activity modification (n=31, 15.5%). Notably, the clinical signs and symptoms category captured questions about myths associated with the disease, such as whether consuming alcohol stops the coronavirus. The most common websites provided were maintained by the CDC, the WHO, and academic medical organizations. Collectively, these three sources accounted for 84.0% (n=168) of the websites in our sample. Conclusions: In the United States, the most commonly searched topics related to COVID-19 were transmission, clinical signs and symptoms, and activity modification. Reassuringly, a sizable majority of internet sources provided were from major health organizations or from academic medical institutions. %M 33147163 %R 10.2196/22407 %U http://www.jmir.org/2020/11/e22407/ %U https://doi.org/10.2196/22407 %U http://www.ncbi.nlm.nih.gov/pubmed/33147163 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 11 %P e20044 %T Impact of Trump's Promotion of Unproven COVID-19 Treatments and Subsequent Internet Trends: Observational Study %A Niburski,Kacper %A Niburski,Oskar %+ McGill University, 3655 Promenade Sir William Osler, Montreal, QC, H3G 0B1, Canada, 1 9055162020, kacperniburski@gmail.com %K COVID-19 %K behavioral economics %K public health %K behavior %K economics %K media %K influence %K infodemic %K infodemiology %K infoveillance %K Twitter %K analysis %K trend %D 2020 %7 20.11.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Individuals with large followings can influence public opinions and behaviors, especially during a pandemic. In the early days of the pandemic, US president Donald J Trump has endorsed the use of unproven therapies. Subsequently, a death attributed to the wrongful ingestion of a chloroquine-containing compound occurred. Objective: We investigated Donald J Trump’s speeches and Twitter posts, as well as Google searches and Amazon purchases, and television airtime for mentions of hydroxychloroquine, chloroquine, azithromycin, and remdesivir. Methods: Twitter sourcing was catalogued with Factba.se, and analytics data, both past and present, were analyzed with Tweet Binder to assess average analytics data on key metrics. Donald J Trump’s time spent discussing unverified treatments on the United States’ 5 largest TV stations was catalogued with the Global Database of Events, Language, and Tone, and his speech transcripts were obtained from White House briefings. Google searches and shopping trends were analyzed with Google Trends. Amazon purchases were assessed using Helium 10 software. Results: From March 1 to April 30, 2020, Donald J Trump made 11 tweets about unproven therapies and mentioned these therapies 65 times in White House briefings, especially touting hydroxychloroquine and chloroquine. These tweets had an impression reach of 300% above Donald J Trump’s average. Following these tweets, at least 2% of airtime on conservative networks for treatment modalities like azithromycin and continuous mentions of such treatments were observed on stations like Fox News. Google searches and purchases increased following his first press conference on March 19, 2020, and increased again following his tweets on March 21, 2020. The same is true for medications on Amazon, with purchases for medicine substitutes, such as hydroxychloroquine, increasing by 200%. Conclusions: Individuals in positions of power can sway public purchasing, resulting in undesired effects when the individuals’ claims are unverified. Public health officials must work to dissuade the use of unproven treatments for COVID-19. %M 33151895 %R 10.2196/20044 %U http://www.jmir.org/2020/11/e20044/ %U https://doi.org/10.2196/20044 %U http://www.ncbi.nlm.nih.gov/pubmed/33151895 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 7 %N 11 %P e24012 %T The Relationships of Deteriorating Depression and Anxiety With Longitudinal Behavioral Changes in Google and YouTube Use During COVID-19: Observational Study %A Zhang,Boyu %A Zaman,Anis %A Silenzio,Vincent %A Kautz,Henry %A Hoque,Ehsan %+ Department of Computer Science, University of Rochester, 2513 Wegmans Hall, Rochester, NY, 14627, United States, 1 6262981861, azaman2@cs.rochester.edu %K mental health %K anxiety %K depression %K Google Search %K YouTube %K pandemic %K COVID-19 %D 2020 %7 23.11.2020 %9 Original Paper %J JMIR Ment Health %G English %X Background: Depression and anxiety disorders among the global population have worsened during the COVID-19 pandemic. Yet, current methods for screening these two issues rely on in-person interviews, which can be expensive, time-consuming, and blocked by social stigma and quarantines. Meanwhile, how individuals engage with online platforms such as Google Search and YouTube has undergone drastic shifts due to COVID-19 and subsequent lockdowns. Such ubiquitous daily behaviors on online platforms have the potential to capture and correlate with clinically alarming deteriorations in depression and anxiety profiles of users in a noninvasive manner. Objective: The goal of this study is to examine, among college students in the United States, the relationships of deteriorating depression and anxiety conditions with the changes in user behaviors when engaging with Google Search and YouTube during COVID-19. Methods: This study recruited a cohort of undergraduate students (N=49) from a US college campus during January 2020 (prior to the pandemic) and measured the anxiety and depression levels of each participant. The anxiety level was assessed via the General Anxiety Disorder-7 (GAD-7). The depression level was assessed via the Patient Health Questionnaire-9 (PHQ-9). This study followed up with the same cohort during May 2020 (during the pandemic), and the anxiety and depression levels were assessed again. The longitudinal Google Search and YouTube history data of all participants were anonymized and collected. From individual-level Google Search and YouTube histories, we developed 5 features that can quantify shifts in online behaviors during the pandemic. We then assessed the correlations of deteriorating depression and anxiety profiles with each of these features. We finally demonstrated the feasibility of using the proposed features to build predictive machine learning models. Results: Of the 49 participants, 49% (n=24) of them reported an increase in the PHQ-9 depression scores; 53% (n=26) of them reported an increase in the GAD-7 anxiety scores. The results showed that a number of online behavior features were significantly correlated with deteriorations in the PHQ-9 scores (r ranging between –0.37 and 0.75, all P values less than or equal to .03) and the GAD-7 scores (r ranging between –0.47 and 0.74, all P values less than or equal to .03). Simple machine learning models were shown to be useful in predicting the change in anxiety and depression scores (mean squared error ranging between 2.37 and 4.22, R2 ranging between 0.68 and 0.84) with the proposed features. Conclusions: The results suggested that deteriorating depression and anxiety conditions have strong correlations with behavioral changes in Google Search and YouTube use during the COVID-19 pandemic. Though further studies are required, our results demonstrate the feasibility of using pervasive online data to establish noninvasive surveillance systems for mental health conditions that bypasses many disadvantages of existing screening methods. %M 33180743 %R 10.2196/24012 %U http://mental.jmir.org/2020/11/e24012/ %U https://doi.org/10.2196/24012 %U http://www.ncbi.nlm.nih.gov/pubmed/33180743 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 4 %P e21939 %T Leveraging a Cloud-Based Critical Care Registry for COVID-19 Pandemic Surveillance and Research in Low- and Middle-Income Countries %A , %A Hashmi,Madiha %A Beane,Abi %A Murthy,Srinivas %A Dondorp,Arjen M %A Haniffa,Rashan %+ Collaboration for Research, Improvement and Training in Critical Care in Asia, Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand, 66 07841131252, abi@nicslk.com %K critical care %K registry %K informatics %K COVID-19 %K severe acute respiratory infection %K pandemic %K surveillance %K cloud-based %K research %K low-and-middle-income countries %D 2020 %7 23.11.2020 %9 Viewpoint %J JMIR Public Health Surveill %G English %X The COVID-19 pandemic has revealed limitations in real-time surveillance needed for responsive health care action in low- and middle-income countries (LMICs). The Pakistan Registry for Intensive CarE (PRICE) was adapted to enable International Severe Acute Respiratory and emerging Infections Consortium (ISARIC)–compliant real-time reporting of severe acute respiratory infection (SARI). The cloud-based common data model and standardized nomenclature of the registry platform ensure interoperability of data and reporting between regional and global stakeholders. Inbuilt analytics enable stakeholders to visualize individual and aggregate epidemiological, clinical, and operational data in real time. The PRICE system operates in 5 of 7 administrative regions of Pakistan. The same platform supports acute and critical care registries in eleven countries in South Asia and sub-Saharan Africa. ISARIC-compliant SARI reporting was successfully implemented by leveraging the existing PRICE infrastructure in all 49 member intensive care units (ICUs), enabling clinicians, operational leads, and established stakeholders with responsibilities for coordinating the pandemic response to access real-time information on suspected and confirmed COVID-19 cases (N=592 as of May 2020) via secure registry portals. ICU occupancy rates, use of ICU resources, mechanical ventilation, renal replacement therapy, and ICU outcomes were reported through registry dashboards. This information has facilitated coordination of critical care resources, health care worker training, and discussions on treatment strategies. The PRICE network is now being recruited to international multicenter clinical trials regarding COVID-19 management, leveraging the registry platform. Systematic and standardized reporting of SARI is feasible in LMICs. Existing registry platforms can be adapted for pandemic research, surveillance, and resource planning. %M 33147162 %R 10.2196/21939 %U http://publichealth.jmir.org/2020/4/e21939/ %U https://doi.org/10.2196/21939 %U http://www.ncbi.nlm.nih.gov/pubmed/33147162 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 11 %P e22924 %T Implementation of a Self-Triage Web Application for Suspected COVID-19 and Its Impact on Emergency Call Centers: Observational Study %A Galmiche,Simon %A Rahbe,Eve %A Fontanet,Arnaud %A Dinh,Aurélien %A Bénézit,François %A Lescure,François-Xavier %A Denis,Fabrice %+ Institut Inter-régional de Cancérologie Jean Bernard, 9 Rue Beauverger, Le Mans, 72100, France, 33 243475810, f.denis@cjb72.org %K COVID-19 %K emergency medical services %K emergency call center %K questionnaires %K application %K website %K self-triage %K digital health %K smartphone %K mobile phone %D 2020 %7 23.11.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: We developed a self-triage web application for COVID-19 symptoms, which was launched in France in March 2020, when French health authorities recommended all patients with suspected COVID-19 call an emergency phone number. Objective: Our objective was to determine if a self-triage tool could reduce the burden on emergency call centers and help predict increasing burden on hospitals. Methods: Users were asked questions about their underlying conditions, sociodemographic status, postal code, and main COVID-19 symptoms. Participants were advised to call an emergency call center if they reported dyspnea or complete loss of appetite for over 24 hours. Data on COVID-19–related calls were collected from 6 emergency call centers and data on COVID-19 hospitalizations were collected from Santé Publique France and the French Ministry of Health. We examined the change in the number of emergency calls before and after the launch of the web application. Results: From March 17 to April 2, 2020, 735,419 questionnaires were registered in the study area. Of these, 121,370 (16.5%) led to a recommendation to call an emergency center. The peak number of overall questionnaires and of questionnaires leading to a recommendation to call an emergency center were observed on March 22, 2020. In the 17 days preceding the launch of the web application, emergency call centers in the study area registered 66,925 COVID-19–related calls and local hospitals admitted 639 patients for COVID-19; the ratio of emergency calls to hospitalizations for COVID-19 was 104.7 to 1. In the 17 days following the launch of the web application, there were 82,347 emergency calls and 6009 new hospitalizations for COVID-19, a ratio of 13.7 calls to 1 hospitalization (chi-square test: P<.001). Conclusions: The self-triage web application launch was followed by a nearly 10-fold increase in COVID-19–related hospitalizations with only a 23% increase in emergency calls. The peak of questionnaire completions preceded the peak of COVID-19–related hospitalizations by 5 days. Although the design of this study does not allow us to conclude that the self-triage tool alone contributed to the alleviation of calls to the emergency call centers, it does suggest that it played a role, and may be used for predicting increasing burden on hospitals. Trial Registration: ClinicalTrials.gov NCT04331171; https://clinicaltrials.gov/ct2/show/NCT04331171 %M 33147165 %R 10.2196/22924 %U https://www.jmir.org/2020/11/e22924 %U https://doi.org/10.2196/22924 %U http://www.ncbi.nlm.nih.gov/pubmed/33147165 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 11 %P e21501 %T Use of Facebook by Academic Medical Centers in Taiwan During the COVID-19 Pandemic: Observational Study %A Chu,Wei-Min %A Shieh,Gow-Jen %A Wu,Shi-Liang %A Sheu,Wayne Huey-Herng %+ Department of Top Hospital Administration, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Section 4, Taichung, 40705, Taiwan, 886 23592525 ext 2005, whhsheu@vghtc.gov.tw %K COVID-19 %K social media %K Facebook %K medical centers %K Taiwan %K communication %K video post %K survey %K health promotion %K engagement %D 2020 %7 20.11.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The battle against COVID-19 remains ongoing, and social media has played an important role during the crisis for both communication and health promotion, particularly for health care organizations. Taiwan’s success during the COVID-19 outbreak is well known and the use of social media is one of the key contributing factors to that success. Objective: This nationwide observational study in Taiwan aimed to explore the use of Facebook by academic medical centers during the COVID-19 pandemic. Methods: We conducted a nationwide observational study of all Facebook fan page posts culled from the official accounts of all medical centers in Taiwan from December 2019 to April 2020. All Facebook posts were categorized into either COVID-19–related posts or non–COVID-19–related posts. COVID-19–related posts were split into 4 categories: policy of Taiwan’s Center for Disease Control (TCDC), gratitude notes, news and regulations from hospitals, and education. Data from each post was also recorded as follows: date of post, headline, number of “likes,” number of messages left, number of shares, video or non-video post, and date of search. Results: The Facebook fan pages of 13 academic medical centers, with a total of 1816 posts, were analyzed. From January 2020, the percentage of COVID-19 posts increased rapidly, from 21% (January 2020) to 56.3% (April 2020). The trends of cumulative COVID-19 posts and reported confirmed cases were significantly related (Pearson correlation coefficient=0.93, P<.001). Pages from private hospitals had more COVID-19 posts (362 versus 289), as well as more video posts (72 posts, 19.9% versus 36 posts, 12.5%, P=.011), when compared to public hospitals. However, Facebook pages from public hospitals had significantly more “likes,” comments, and shares per post (314, 5, 14, respectively, P<.001). Additionally, medical centers from different regions displayed different strategies for using video posts on Facebook. Conclusions: Social media has been a useful tool for communication during the COVID-19 pandemic. This nationwide observational study has helped demonstrate the value of Facebook for academic medical centers in Taiwan, along with its engagement efficacy. We believe that the experience of Taiwan and the knowledge it can share will be helpful to health care organizations worldwide during our global battle against COVID-19. %M 33119536 %R 10.2196/21501 %U http://www.jmir.org/2020/11/e21501/ %U https://doi.org/10.2196/21501 %U http://www.ncbi.nlm.nih.gov/pubmed/33119536 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 11 %P e24248 %T A SARS-CoV-2 Surveillance System in Sub-Saharan Africa: Modeling Study for Persistence and Transmission to Inform Policy %A Post,Lori Ann %A Argaw,Salem T %A Jones,Cameron %A Moss,Charles B %A Resnick,Danielle %A Singh,Lauren Nadya %A Murphy,Robert Leo %A Achenbach,Chad J %A White,Janine %A Issa,Tariq Ziad %A Boctor,Michael J %A Oehmke,James Francis %+ Buehler Center for Health Policy & Economics and Departments of Emergency Medicine, Feinberg School of Medicine, Northwestern University, 750 N Lake Shore Dr, 9th Floor, Suite 9-9035 Rubloff Building, Chicago, IL, 60611, United States, 1 203 980 7107, lori.post@northwestern.edu %K global COVID-19 surveillance %K African public health surveillance %K sub-Saharan African COVID-19 %K African surveillance metrics %K dynamic panel data %K generalized method of the moments %K African econometrics %K African SARS-CoV-2 %K African COVID-19 surveillance system %K African COVID-19 transmission speed %K African COVID-19 transmission acceleration %K COVID-19 transmission deceleration %K COVID-19 transmission jerk %K COVID-19 7-day persistence %K Sao Tome and Principe %K Senegal %K Seychelles %K Sierra Leone %K Somalia %K South Africa %K South Sudan %K Sudan %K Suriname %K Swaziland %K Tanzania %K Togo %K Uganda %K Zambia %K Zimbabwe %K Gambia %K Ghana %K Guinea %K Guinea-Bissau %K Kenya %K Lesotho %K Liberia %K Madagascar %K Malawi %K Mali %K Mauritania %K Mauritius %K Mozambique %K Namibia %K Niger %K Nigeria %K Rwanda %K Angola %K Benin %K Botswana %K Burkina Faso %K Burundi %K Cameroon %K Central African Republic %K Chad %K Comoros %K Congo %K Cote d'Ivoire %K Democratic Republic of Congo %K Equatorial Guinea %K Eritrea %K Ethiopia %K Gabon %D 2020 %7 19.11.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Since the novel coronavirus emerged in late 2019, the scientific and public health community around the world have sought to better understand, surveil, treat, and prevent the disease, COVID-19. In sub-Saharan Africa (SSA), many countries responded aggressively and decisively with lockdown measures and border closures. Such actions may have helped prevent large outbreaks throughout much of the region, though there is substantial variation in caseloads and mortality between nations. Additionally, the health system infrastructure remains a concern throughout much of SSA, and the lockdown measures threaten to increase poverty and food insecurity for the subcontinent’s poorest residents. The lack of sufficient testing, asymptomatic infections, and poor reporting practices in many countries limit our understanding of the virus’s impact, creating a need for better and more accurate surveillance metrics that account for underreporting and data contamination. Objective: The goal of this study is to improve infectious disease surveillance by complementing standardized metrics with new and decomposable surveillance metrics of COVID-19 that overcome data limitations and contamination inherent in public health surveillance systems. In addition to prevalence of observed daily and cumulative testing, testing positivity rates, morbidity, and mortality, we derived COVID-19 transmission in terms of speed, acceleration or deceleration, change in acceleration or deceleration (jerk), and 7-day transmission rate persistence, which explains where and how rapidly COVID-19 is transmitting and quantifies shifts in the rate of acceleration or deceleration to inform policies to mitigate and prevent COVID-19 and food insecurity in SSA. Methods: We extracted 60 days of COVID-19 data from public health registries and employed an empirical difference equation to measure daily case numbers in 47 sub-Saharan countries as a function of the prior number of cases, the level of testing, and weekly shift variables based on a dynamic panel model that was estimated using the generalized method of moments approach by implementing the Arellano-Bond estimator in R. Results: Kenya, Ghana, Nigeria, Ethiopia, and South Africa have the most observed cases of COVID-19, and the Seychelles, Eritrea, Mauritius, Comoros, and Burundi have the fewest. In contrast, the speed, acceleration, jerk, and 7-day persistence indicate rates of COVID-19 transmissions differ from observed cases. In September 2020, Cape Verde, Namibia, Eswatini, and South Africa had the highest speed of COVID-19 transmissions at 13.1, 7.1, 3.6, and 3 infections per 100,0000, respectively; Zimbabwe had an acceleration rate of transmission, while Zambia had the largest rate of deceleration this week compared to last week, referred to as a jerk. Finally, the 7-day persistence rate indicates the number of cases on September 15, 2020, which are a function of new infections from September 8, 2020, decreased in South Africa from 216.7 to 173.2 and Ethiopia from 136.7 to 106.3 per 100,000. The statistical approach was validated based on the regression results; they determined recent changes in the pattern of infection, and during the weeks of September 1-8 and September 9-15, there were substantial country differences in the evolution of the SSA pandemic. This change represents a decrease in the transmission model R value for that week and is consistent with a de-escalation in the pandemic for the sub-Saharan African continent in general. Conclusions: Standard surveillance metrics such as daily observed new COVID-19 cases or deaths are necessary but insufficient to mitigate and prevent COVID-19 transmission. Public health leaders also need to know where COVID-19 transmission rates are accelerating or decelerating, whether those rates increase or decrease over short time frames because the pandemic can quickly escalate, and how many cases today are a function of new infections 7 days ago. Even though SSA is home to some of the poorest countries in the world, development and population size are not necessarily predictive of COVID-19 transmission, meaning higher income countries like the United States can learn from African countries on how best to implement mitigation and prevention efforts. International Registered Report Identifier (IRRID): RR2-10.2196/21955 %M 33211026 %R 10.2196/24248 %U https://www.jmir.org/2020/11/e24248 %U https://doi.org/10.2196/24248 %U http://www.ncbi.nlm.nih.gov/pubmed/33211026 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 11 %P e22302 %T Status of Institutional Review Board Meetings Conducted Through Web Conference Systems in Japanese National University Hospitals During the COVID-19 Pandemic: Questionnaire Study %A Yagi,Kenta %A Maeda,Kazuki %A Sakaguchi,Satoshi %A Chuma,Masayuki %A Sato,Yasutaka %A Kane,Chikako %A Akaishi,Akiyo %A Ishizawa,Keisuke %A Yanagawa,Hiroaki %+ Clinical Research Center for Developmental Therapeutics, Tokushima University Hospital, 2-50-1 Kuramoto-cho, Tokushima, 770-8503, Japan, 81 88 615 8512, yagi.kenta@tokushima-u.ac.jp %K COVID-19 %K IRB %K Institutional Review Board %K REB %K Research Ethics Board %K web conference %K survey %K drug development %K teleconference %K clinical trial %K Japan %K hospital %D 2020 %7 19.11.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: With the global proliferation of the novel COVID-19 disease, conventionally conducting institutional review board (IRB) meetings has become a difficult task. Amid concerns about the suspension of drug development due to delays within IRBs, it has been suggested that IRB meetings should be temporarily conducted via the internet. Objective: This study aimed to elucidate the current status of IRB meetings conducted through web conference systems. Methods: A survey on conducting IRB meetings through web conference systems was administered to Japanese national university hospitals. Respondents were in charge of operating IRB offices at different universities. This study was not a randomized controlled trial. Results: The survey was performed at 42 facilities between the end of May and early June, 2020, immediately after the state of emergency was lifted in Japan. The survey yielded a response rate of 74% (31/42). Additionally, while 68% (21/31) of facilities introduced web conference systems for IRB meetings, 13% (4/31) of the surveyed facilities postponed IRB meetings. Therefore, we conducted a further survey of 21 facilities that implemented web conference systems for IRB meetings. According to 71% (15/21) of the respondents, there was no financial burden for implementing these systems, as they were free of charge. In 90% (19/21) of the facilities, IRB meetings through web conference systems were already being conducted with personal electronic devices. Furthermore, in 48% (10/21) of facilities, a web conference system was used in conjunction with face-to-face meetings. Conclusions: Due to the COVID-19 pandemic, the number of reviews in clinical trial core hospitals has decreased. This suggests that the development of pharmaceuticals has stagnated because of COVID-19. According to 71% (15/21) of the respondents who conducted IRB meetings through web conference systems, the cost of introducing such meetings was US $0, showing a negligible financial burden. Moreover, it was shown that online deliberations could be carried out in the same manner as face-to-face meetings, as 86% (18/21) of facilities stated that the number of comments made by board members did not change. To improve the quality of IRB meetings conducted through web conference systems, it is necessary to further examine camera use and the content displayed on members’ screens during meetings. Further examination of all members who use web conference systems is required. Our measures for addressing the requests and problems identified in our study could potentially be considered protocols for future IRB meetings, when the COVID-19 pandemic has passed and face-to-face meetings are possible again. This study also highlights the importance of developing web conference systems for IRB meetings to respond to future unforeseen pandemics. %M 33112758 %R 10.2196/22302 %U http://www.jmir.org/2020/11/e22302/ %U https://doi.org/10.2196/22302 %U http://www.ncbi.nlm.nih.gov/pubmed/33112758 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 11 %P e23019 %T Threat, Coping, and Social Distance Adherence During COVID-19: Cross-Continental Comparison Using an Online Cross-Sectional Survey %A Al-Hasan,Abrar %A Khuntia,Jiban %A Yim,Dobin %+ Kuwait University, College of Business Administration, AlShadadiya University City, 13055, Kuwait, 965 51165005, abrar.alhasan@ku.edu.kw %K COVID-19 %K adherence %K coping appraisal %K threat appraisal %K protection motivation theory %K social distancing %K information sources %K social media %K knowledge %K coping %K threat %K protection %K motivation %K cross-sectional %K survey %D 2020 %7 18.11.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Social distancing is an effective preventative policy for COVID-19 that is enforced by governments worldwide. However, significant variations are observed in adherence to social distancing across individuals and countries. Due to the lack of treatment, rapid spread, and prevalence of COVID-19, panic and fear associated with the disease causes great stress. Subsequent effects will be a variation around the coping and mitigation strategies for different individuals following different paths to manage the situation. Objective: This study aims to explore how threat and coping appraisal processes work as mechanisms between information and citizens’ adherence to COVID-19–related recommendations (ie, how the information sources and social media influence threat and coping appraisal processes with COVID-19 and how the threat and coping appraisal processes influence adherence to policy guidelines). In addition, this study aims to explore how citizens in three different countries (the United States, Kuwait, and South Korea), randomly sampled, are effectively using the mechanisms. Methods: Randomly sampled online survey data collected by a global firm in May 2020 from 162 citizens of the United States, 185 of Kuwait, and 71 of South Korea were analyzed, resulting in a total sample size of 418. A seemingly unrelated regression model, controlling for several counterfactuals, was used for analysis. The study’s focal estimated effects were compared across the three countries using the weighted distance between the parameter estimates. Results: The seemingly unrelated regression model estimation results suggested that, overall, the intensity of information source use for the COVID-19 pandemic positively influenced the threat appraisal for the disease (P<.001). Furthermore, the intensity of social media use for the COVID-19 pandemic positively influenced the coping appraisal for the disease (P<.001). Higher COVID-19 threat appraisal had a positive effect on social distancing adherence (P<.001). Higher COVID-19 coping appraisal had a positive effect on social distancing adherence (P<.001). Higher intensity of COVID-19 knowledge positively influenced social distancing adherence (P<.001). There were country-level variations. Broadly, we found that the United States had better results than South Korea and Kuwait in leveraging the information to threat and coping appraisal to the adherence process, indicating that individuals in countries like the United States and South Korea may be more pragmatic to appraise the situation before making any decisions. Conclusions: This study’s findings suggest that the mediation of threat and coping strategies are essential, in varying effects, to shape the information and social media strategies for adherence outcomes. Accordingly, coordinating public service announcements along with information source outlets such as mainstream media (eg, TV and newspaper) as well as social media (eg, Facebook and Twitter) to inform citizens and, at the same time, deliver balanced messages about the threat and coping appraisal is critical in implementing a staggered social distancing and sheltering strategy. %M 33119538 %R 10.2196/23019 %U http://www.jmir.org/2020/11/e23019/ %U https://doi.org/10.2196/23019 %U http://www.ncbi.nlm.nih.gov/pubmed/33119538 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 6 %N 2 %P e22926 %T Integration of Technology in Medical Education on Primary Care During the COVID-19 Pandemic: Students’ Viewpoint %A Paul,Nadine %A Kohara,Sae %A Khera,Gursharan Kaur %A Gunawardena,Ramith %+ King's College London, Faculty of Life Sciences & Medicine, King’s College London School of Medical Education, London, SE1 1UL, United Kingdom, 44 7871593154, nadine.paul@kcl.ac.uk %K clinical education %K curriculum development %K personal characteristics %K physician/patient relationship %K professional development %K education %K medical student %K telemedicine %K simulation %K COVID-19 %D 2020 %7 18.11.2020 %9 Viewpoint %J JMIR Med Educ %G English %X The COVID-19 pandemic has forced medical schools and clinicians to transition swiftly to working online, where possible. During this time, final-year medical students at King’s College London, England, have received some of their general practice teachings in the form of virtual tutor groups. The predominant feature of such groups is online patient simulations, which provide students a valuable experience to help gain insight into current clinical practice amid the pandemic and inform how their practices as incoming junior doctors would continue. Even in the absence of face-to-face teaching and clinical placements, students have been able to hone their medical knowledge and soft skills through these virtual, simulated consultations. They have been exposed to a new consultation style while in a safe and collaborative learning space. Here, we explore how medical students have benefited from these virtual tutor groups and how similar small-group online teaching opportunities can add value to the medical curriculum in the future. %M 33112760 %R 10.2196/22926 %U http://mededu.jmir.org/2020/2/e22926/ %U https://doi.org/10.2196/22926 %U http://www.ncbi.nlm.nih.gov/pubmed/33112760 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 11 %P e21329 %T Identifying and Ranking Common COVID-19 Symptoms From Tweets in Arabic: Content Analysis %A Alanazi,Eisa %A Alashaikh,Abdulaziz %A Alqurashi,Sarah %A Alanazi,Aued %+ Center of Innovation and Development in Artificial Intelligence, Umm Al-Qura University, Prince Sultan Road, Makkah, 11343, Saudi Arabia, 966 55 601 4171, eaanazi@uqu.edu.sa %K health %K informatics %K social networks %K Twitter %K anosmia %K Arabic %K COVID-19 %K symptom %D 2020 %7 18.11.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: A substantial amount of COVID-19–related data is generated by Twitter users every day. Self-reports of COVID-19 symptoms on Twitter can reveal a great deal about the disease and its prevalence in the community. In particular, self-reports can be used as a valuable resource to learn more about common symptoms and whether their order of appearance differs among different groups in the community. These data may be used to develop a COVID-19 risk assessment system that is tailored toward a specific group of people. Objective: The aim of this study was to identify the most common symptoms reported by patients with COVID-19, as well as the order of symptom appearance, by examining tweets in Arabic. Methods: We searched Twitter posts in Arabic for personal reports of COVID-19 symptoms from March 1 to May 27, 2020. We identified 463 Arabic users who had tweeted about testing positive for COVID-19 and extracted the symptoms they associated with the disease. Furthermore, we asked them directly via personal messaging to rank the appearance of the first 3 symptoms they had experienced immediately before (or after) their COVID-19 diagnosis. Finally, we tracked their Twitter timeline to identify additional symptoms that were mentioned within ±5 days from the day of the first tweet on their COVID-19 diagnosis. In total, 270 COVID-19 self-reports were collected, and symptoms were (at least partially) ranked. Results: The collected self-reports contained 893 symptoms from 201 (74%) male and 69 (26%) female Twitter users. The majority (n=270, 82%) of the tracked users were living in Saudi Arabia (n=125, 46%) and Kuwait (n=98, 36%). Furthermore, 13% (n=36) of the collected reports were from asymptomatic individuals. Of the 234 users with symptoms, 66% (n=180) provided a chronological order of appearance for at least 3 symptoms. Fever (n=139, 59%), headache (n=101, 43%), and anosmia (n=91, 39%) were the top 3 symptoms mentioned in the self-reports. Additionally, 28% (n=65) reported that their COVID-19 experience started with a fever, 15% (n=34) with a headache, and 12% (n=28) with anosmia. Of the 110 symptomatic cases from Saudi Arabia, the most common 3 symptoms were fever (n=65, 59%), anosmia (n=46, 42%), and headache (n=42, 38%). Conclusions: This study identified the most common symptoms of COVID-19 from tweets in Arabic. These symptoms can be further analyzed in clinical settings and may be incorporated into a real-time COVID-19 risk estimator. %M 33119539 %R 10.2196/21329 %U http://www.jmir.org/2020/11/e21329/ %U https://doi.org/10.2196/21329 %U http://www.ncbi.nlm.nih.gov/pubmed/33119539 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 6 %N 2 %P e20963 %T Effectiveness of Virtual Medical Teaching During the COVID-19 Crisis: Systematic Review %A Wilcha,Robyn-Jenia %+ Faculty of Biology, Medicine and Health, University of Manchester, Oxford Road, Manchester, M13 9PL, United Kingdom, 44 (0)161 306 0211, robynwilcha05@gmail.com %K virtual teaching %K medical student %K medical education %K COVID-19 %K review %K virus %K pandemic %K quarantine %D 2020 %7 18.11.2020 %9 Review %J JMIR Med Educ %G English %X Background: In December 2019, COVID-19 emerged and rapidly spread worldwide. Transmission of SARS-CoV-2, the virus that causes COVID-19, is high; as a result, countries worldwide have imposed rigorous public health measures, such as quarantine. This has involved the suspension of medical school classes globally. Medical school attachments are vital to aid the progression of students’ confidence and competencies as future physicians. Since the outbreak of COVID-19, medical schools have sought ways to replace medical placements with virtual clinical teaching. Objective: The objective of this study was to review the advantages and disadvantages of virtual medical teaching for medical students during the COVID-19 pandemic based on the current emerging literature. Methods: A brief qualitative review based on the application and effectiveness of virtual teaching during the COVID-19 pandemic was conducted by referencing keywords, including medical student virtual teaching COVID-19, virtual undergraduate medical education, and virtual medical education COVID-19, in the electronic databases of PubMed and Google Scholar. A total of 201 articles were found, of which 34 were included in the study. Manual searches of the reference lists of the included articles yielded 5 additional articles. The findings were tabulated and assessed under the following headings: summary of virtual teaching offered, strengths of virtual teaching, and weaknesses of virtual teaching. Results: The strengths of virtual teaching included the variety of web-based resources available. New interactive forms of virtual teaching are being developed to enable students to interact with patients from their homes. Open-access teaching with medical experts has enabled students to remain abreast of the latest medical advancements and to reclaim knowledge lost by the suspension of university classes and clinical attachments. Peer mentoring has been proven to be a valuable tool for medical students with aims of increasing knowledge and providing psychological support. Weaknesses of virtual teaching included technical challenges, confidentiality issues, reduced student engagement, and loss of assessments. The mental well-being of students was found to be negatively affected during the pandemic. Inequalities of virtual teaching services worldwide were also noted to cause differences in medical education. Conclusions: In the unprecedented times of the COVID-19 pandemic, medical schools have a duty to provide ongoing education to medical students. The continuation of teaching is crucial to enable the graduation of future physicians into society. The evidence suggests that virtual teaching is effective, and institutions are working to further develop these resources to improve student engagement and interactivity. Moving forward, medical faculties must adopt a more holistic approach to student education and consider the mental impact of COVID-19 on students as well as improve the security and technology of virtual platforms. %M 33106227 %R 10.2196/20963 %U http://mededu.jmir.org/2020/2/e20963/ %U https://doi.org/10.2196/20963 %U http://www.ncbi.nlm.nih.gov/pubmed/33106227 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 11 %P e20656 %T Psychological Impact of Health Risk Communication and Social Media on College Students During the COVID-19 Pandemic: Cross-Sectional Study %A Li,Mengyao %A Liu,Li %A Yang,Yilong %A Wang,Yang %A Yang,Xiaoshi %A Wu,Hui %+ China Medical University, No 77 Puhe Road, Shenyang North New Area, Shenyang, 110122, China, 86 18900910568, hwu@cmu.edu.cn %K COVID-19 %K anxiety %K panic %K health risk %K communication %K social media %D 2020 %7 18.11.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The outbreak of COVID-19 began in 2019 and is expected to impact the psychological health of college students. Few studies have investigated the associations among health risk communication, social media, and psychological symptoms during a major pandemic. Objective: The aim of this research was to assess the prevalence of psychological symptoms among college students and explore their associations with health risk communication and social media. Methods: A web-based survey was distributed through the Wenjuanxing platform among Chinese college students from March 3-15, 2020. In addition to demographics, information on health risk communication and social media was collected, and the Symptom Checklist 90 Phobia and Health Anxiety Inventory subscale was used to assess psychological symptoms among 1676 college students in China. Multivariable logistic regression was performed to examine these independent risk factors. Results: The prevalence of panic and health anxiety was 17.2% (288/1676) and 24.3% (408/1676), respectively. Regarding risk communication, understanding the risk of COVID-19 (odds ratio [OR] 0.480, 95% CI 0.367-0.627) was a protective factor against panic. Knowledge of prognosis (OR 0.708, 95% CI 0.551-0.910), preventive measures (OR 0.380, 95% CI 0.195-0.742), and wearing face masks (OR 0.445, 95% CI 0.230-0.862) were shown to be protective factors in predicting health anxiety. Perceived lethality (OR 1.860, 95% CI 1.408-2.459), being affected by the global spread (OR 1.936, 95% CI 1.405-2.669), and impact on social contacts (OR 1.420, 95% CI 1.118-1.802) were identified as significant risk factors associated with health anxiety. In terms of social media, trust in mainstream media (OR 0.613, 95% CI 0.461-0.816) was considered to be a protective factor against health anxiety. Conclusions: There was a high prevalence of psychological symptoms among college students. Health risk communication and social media use were important in predicting psychological symptoms, especially health anxiety. Scientific and evidence-based information should be reported by social media platforms. Web-based consultation and intervention measures should be the focus of future studies. %M 33108308 %R 10.2196/20656 %U http://www.jmir.org/2020/11/e20656/ %U https://doi.org/10.2196/20656 %U http://www.ncbi.nlm.nih.gov/pubmed/33108308 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 11 %P e24136 %T The Effect of the COVID-19 Pandemic on Health Care Workers’ Anxiety Levels: Protocol for a Meta-Analysis %A Zhang,Lunbo %A Yan,Ming %A Takashima,Kaito %A Guo,Wenru %A Yamada,Yuki %+ Graduate School of Human–Environment Studies, Kyushu University, 744 Motooka, Nishi-ku, Fukuoka, 819-0395, Japan, 81 092 802 5251, zhanglunbo014@gmail.com %K COVID-19 %K health care worker %K anxiety %K meta-analysis %K review %K protocol %K mental health %K literature %K bias %D 2020 %7 18.11.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: The COVID-19 pandemic has been declared a public health emergency of international concern; this has caused excessive anxiety among health care workers. In addition, publication bias and low-quality publications have become widespread, which can result in the dissemination of unreliable findings. Objective: This paper presents the protocol for a meta-analysis with the following two aims: (1) to examine the prevalence of anxiety among health care workers and determine whether it has increased due to the COVID-19 pandemic, and (2) to investigate whether there has been an increase in publication bias. Methods: All related studies that were published/released from 2015 to 2020 will be searched in electronic databases (Web of Science, PubMed, PsyArXiv, and medRxiv). The risk of bias in individual studies will be assessed using the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) checklist. The heterogeneity of the studies will be assessed using the I2 statistic. The effect size (prevalence rates of anxiety) and a 95% CI for each paper will also be calculated. We will use a moderator analysis to test for the effect of COVID-19 on health care workers’ anxiety levels and detect publication bias in COVID-19 studies. We will also assess publication bias using the funnel plot and Egger regression. In case of publication bias, if studies have no homogeneity, the trim-and-fill procedure will be applied to adjust for missing studies. Results: Database searches will commence in November 2020. The meta-analysis will be completed within 2 months of the start date. Conclusions: This meta-analysis aims to provide comprehensive evidence about whether COVID-19 increases the prevalence of anxiety among health care workers and whether there has been an increase in publication bias and a deterioration in the quality of publications due to the pandemic. The results of this meta-analysis can provide evidence to help health managers to make informed decisions related to anxiety prevention in health care workers. International Registered Report Identifier (IRRID): PRR1-10.2196/24136 %M 33170800 %R 10.2196/24136 %U http://www.researchprotocols.org/2020/11/e24136/ %U https://doi.org/10.2196/24136 %U http://www.ncbi.nlm.nih.gov/pubmed/33170800 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 4 %P e21434 %T COVID-19 Surveillance in a Primary Care Sentinel Network: In-Pandemic Development of an Application Ontology %A de Lusignan,Simon %A Liyanage,Harshana %A McGagh,Dylan %A Jani,Bhautesh Dinesh %A Bauwens,Jorgen %A Byford,Rachel %A Evans,Dai %A Fahey,Tom %A Greenhalgh,Trisha %A Jones,Nicholas %A Mair,Frances S %A Okusi,Cecilia %A Parimalanathan,Vaishnavi %A Pell,Jill P %A Sherlock,Julian %A Tamburis,Oscar %A Tripathy,Manasa %A Ferreira,Filipa %A Williams,John %A Hobbs,F D Richard %+ Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Rd, Oxford, OX2 6GG, United Kingdom, 44 1865617283, simon.delusignan@phc.ox.ac.uk %K COVID-19 %K medical informatics %K sentinel surveillance %D 2020 %7 17.11.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Creating an ontology for COVID-19 surveillance should help ensure transparency and consistency. Ontologies formalize conceptualizations at either the domain or application level. Application ontologies cross domains and are specified through testable use cases. Our use case was an extension of the role of the Oxford Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC) to monitor the current pandemic and become an in-pandemic research platform. Objective: This study aimed to develop an application ontology for COVID-19 that can be deployed across the various use-case domains of the RCGP RSC research and surveillance activities. Methods: We described our domain-specific use case. The actor was the RCGP RSC sentinel network, the system was the course of the COVID-19 pandemic, and the outcomes were the spread and effect of mitigation measures. We used our established 3-step method to develop the ontology, separating ontological concept development from code mapping and data extract validation. We developed a coding system–independent COVID-19 case identification algorithm. As there were no gold-standard pandemic surveillance ontologies, we conducted a rapid Delphi consensus exercise through the International Medical Informatics Association Primary Health Care Informatics working group and extended networks. Results: Our use-case domains included primary care, public health, virology, clinical research, and clinical informatics. Our ontology supported (1) case identification, microbiological sampling, and health outcomes at an individual practice and at the national level; (2) feedback through a dashboard; (3) a national observatory; (4) regular updates for Public Health England; and (5) transformation of a sentinel network into a trial platform. We have identified a total of 19,115 people with a definite COVID-19 status, 5226 probable cases, and 74,293 people with possible COVID-19, within the RCGP RSC network (N=5,370,225). Conclusions: The underpinning structure of our ontological approach has coped with multiple clinical coding challenges. At a time when there is uncertainty about international comparisons, clarity about the basis on which case definitions and outcomes are made from routine data is essential. %M 33112762 %R 10.2196/21434 %U http://publichealth.jmir.org/2020/4/e21434/ %U https://doi.org/10.2196/21434 %U http://www.ncbi.nlm.nih.gov/pubmed/33112762 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 6 %N 2 %P e22045 %T Impact of the COVID-19 Pandemic on the Education of Plastic Surgery Trainees in the United States %A Hamidian Jahromi,Alireza %A Arnautovic,Alisa %A Konofaos,Petros %+ Department of Plastic Surgery, University of Tennessee Health Science Center, 910 Madison Ave, Room 315, Memphis, TN, 38163, United States, 1 3185184600, alirezahamidian@yahoo.com %K COVID-19 %K coronavirus %K education %K plastic surgery residency %K plastic surgery fellowship %K surgery residency %K impact %K trainee %D 2020 %7 17.11.2020 %9 Viewpoint %J JMIR Med Educ %G English %X The current COVID-19 pandemic has vastly impacted the health care system in the United States, and it is continuing to dictate its unprecedented influence on the education systems, especially the residency and fellowship training programs. The impact of COVID-19 on these training programs has not been uniform across the board, with plastic surgery residency and fellowship programs among the hardest hit specialties. Implementation of social distancing regulations has affected departmental educational activities, including preoperative, morbidity and mortality conferences and journal clubs; operating room educational activities; as well as the overall education of plastic surgery trainees in the United States. Almost all elective and semielective surgeries across the United States were suspended for a few months during the COVID-19 pandemic; this constitutes a significant portion of plastic surgery cases. Considering the current staged reopening policies, it may be a long time, if ever, before restrictions are completely lifted. In this paper, we review the multidimensional impact of the current COVID-19 pandemic on the training programs of plastic surgery residents and fellows in the United States and worldwide, along with some potential solutions on how to address existing challenges. %M 33119537 %R 10.2196/22045 %U http://mededu.jmir.org/2020/2/e22045/ %U https://doi.org/10.2196/22045 %U http://www.ncbi.nlm.nih.gov/pubmed/33119537 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 8 %N 11 %P e21604 %T Prediction of COVID-19 Severity Using Chest Computed Tomography and Laboratory Measurements: Evaluation Using a Machine Learning Approach %A Li,Daowei %A Zhang,Qiang %A Tan,Yue %A Feng,Xinghuo %A Yue,Yuanyi %A Bai,Yuhan %A Li,Jimeng %A Li,Jiahang %A Xu,Youjun %A Chen,Shiyu %A Xiao,Si-Yu %A Sun,Muyan %A Li,Xiaona %A Zhu,Fang %+ Department of Cardiovascular Ultrasound, The People's Hospital of China Medical University & The People's Hospital of Liaoning Province, No 33, Wenyi Road, Shenhe District, Shenyang, 110016, China, 86 2483283333, zfmoon024@163.com %K COVID-19 %K severe case prediction %K computerized tomography %K machine learning %K CT %K scan %K detection %K prediction %K model %D 2020 %7 17.11.2020 %9 Original Paper %J JMIR Med Inform %G English %X Background: Most of the mortality resulting from COVID-19 has been associated with severe disease. Effective treatment of severe cases remains a challenge due to the lack of early detection of the infection. Objective: This study aimed to develop an effective prediction model for COVID-19 severity by combining radiological outcome with clinical biochemical indexes. Methods: A total of 46 patients with COVID-19 (10 severe, 36 nonsevere) were examined. To build the prediction model, a set of 27 severe and 151 nonsevere clinical laboratory records and computerized tomography (CT) records were collected from these patients. We managed to extract specific features from the patients’ CT images by using a recently published convolutional neural network. We also trained a machine learning model combining these features with clinical laboratory results. Results: We present a prediction model combining patients’ radiological outcomes with their clinical biochemical indexes to identify severe COVID-19 cases. The prediction model yielded a cross-validated area under the receiver operating characteristic (AUROC) score of 0.93 and an F1 score of 0.89, which showed a 6% and 15% improvement, respectively, compared to the models based on laboratory test features only. In addition, we developed a statistical model for forecasting COVID-19 severity based on the results of patients’ laboratory tests performed before they were classified as severe cases; this model yielded an AUROC score of 0.81. Conclusions: To our knowledge, this is the first report predicting the clinical progression of COVID-19, as well as forecasting severity, based on a combined analysis using laboratory tests and CT images. %M 33038076 %R 10.2196/21604 %U http://medinform.jmir.org/2020/11/e21604/ %U https://doi.org/10.2196/21604 %U http://www.ncbi.nlm.nih.gov/pubmed/33038076 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 11 %P e22639 %T The COVID-19 Infodemic: Infodemiology Study Analyzing Stigmatizing Search Terms %A Hu,Zhiwen %A Yang,Zhongliang %A Li,Qi %A Zhang,An %+ School of Computer and Information Engineering, Zhejiang Gongshang University, No 18 Xuezheng Street, Higher Education Zone, Hangzhou, 310018, China, 86 0571 28008316, huzhiwen@zjgsu.edu.cn %K infodemiology %K COVID-19 %K infodemic %K social contagion %K collective perceptual biases %K collective behavioral propensities %K social mobilization %D 2020 %7 16.11.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: In the context of the COVID-19 infodemic, the global profusion of monikers and hashtags for COVID-19 have found their way into daily communication and contributed to a backlash against China and the Chinese people. Objective: This study examines public engagement in crisis communication about COVID-19 during the early epidemic stage and the practical strategy of social mobilization to mitigate the infodemic. Methods: We retrieved the unbiased values of the top-ranked search phrases between December 30, 2019, and July 15, 2020, which normalized the anonymized, categorized, and aggregated samples from Google Search data. This study illustrates the most-searched terms, including the official COVID-19 terms, the stigmatized terms, and other controls, to measure the collective behavioral propensities to stigmatized terms and to explore the global reaction to the COVID-19 epidemic in the real world. We calculated the ratio of the cumulative number of COVID-19 cases to the regional population as the cumulative rate (R) of a specific country or territory and calculated the Gini coefficient (G) to measure the collective heterogeneity of crowd behavior. Results: People around the world are using stigmatizing terms on Google Search, and these terms were used earlier than the official names. Many stigmatized monikers against China (eg, “Wuhan pneumonia,” G=0.73; “Wuhan coronavirus,” G=0.60; “China pneumonia,” G=0.59; “China coronavirus,” G=0.52; “Chinese coronavirus,” G=0.50) had high collective heterogeneity of crowd behavior between December 30, 2019, and July 15, 2020, while the official terms “COVID-19” (G=0.44) and “SARS-CoV-2” (G=0.42) have not become de facto standard usages. Moreover, the pattern of high consistent usage was observed in 13 territories with low cumulative rates (R) between January 16 and July 15, 2020, out of 58 countries and territories that have reported confirmed cases of COVID-19. In the scientific literature, multifarious naming practices may have provoked unintended negative impacts by stigmatizing Chinese people. The World Health Organization; the United Nations Educational, Scientific and Cultural Organization; and the media initiated campaigns for fighting back against the COVID-19 infodemic with the same mission but in diverse voices. Conclusions: Infodemiological analysis can articulate the collective propensities to stigmatized monikers across search behaviors, which may reflect the collective sentiment of backlash against China and Chinese people in the real world. The full-fledged official terms are expected to fight back against the resilience of negative perceptual bias amid the COVID-19 epidemic. Such official naming efforts against the infodemic should be met with a fair share of identification in scientific conventions and sociocultural paradigms. As an integral component of preparedness, appropriate nomenclatures should be duly assigned to the newly identified coronavirus, and social mobilization in a uniform voice is a priority for combating the next infodemic. %M 33156807 %R 10.2196/22639 %U http://www.jmir.org/2020/11/e22639/ %U https://doi.org/10.2196/22639 %U http://www.ncbi.nlm.nih.gov/pubmed/33156807 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 11 %P e23117 %T A Self-Administered Multicomponent Web-Based Mental Health Intervention for the Mexican Population During the COVID-19 Pandemic: Protocol for a Randomized Controlled Trial %A Dominguez-Rodriguez,Alejandro %A De La Rosa-Gómez,Anabel %A Hernández Jiménez,M Jesús %A Arenas-Landgrave,Paulina %A Martínez-Luna,Sofía Cristina %A Alvarez Silva,Joabian %A García Hernández,José Ernesto %A Arzola-Sánchez,Carlos %A Acosta Guzmán,Victoria %+ Valencian International University, Carrer del Pintor Sorolla, 21, Valencia, 46002, Spain, 34 961 92 49 50, alejandro.dominguez.r@campusviu.es %K e-health %K positive psychology %K cognitive behavioral therapy, behavioral activation therapy, COVID-19 %K internet %K intervention %K telepsychology, Mexican sample %D 2020 %7 16.11.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: The COVID-19 pandemic has become a public health emergency of international concern; it has not only threatened people's physical health but has also affected their mental health and psychological well-being. It is necessary to develop and offer strategies to reduce the psychological impact of the outbreak and promote adaptive coping. Objective: This study protocol aims to describe a self-administered web-based intervention (Mental Health COVID-19) based on the principles of positive psychology supported by elements of cognitive behavioral therapy and behavioral activation therapy to reduce the symptoms of anxiety and depression and increase positive emotions and sleep quality during and after the COVID-19 outbreak through a telepsychology system. Methods: A randomized controlled clinical superiority trial with two independent groups will be performed, with intrasubject measures at four evaluation periods: pretest, posttest, 3-month follow-up, and 6-month follow-up. Participants will be randomly assigned to one of two groups: self-administered intervention with assistance via chat or self-administered intervention without assistance via chat. The total required sample size will be 166 participants (83 per group). Results: The clinical trial is ongoing. This protocol was approved by the Research Ethics Board of the Free School of Psychology-University of Behavioral Sciences (Escuela libre de Psicología-Universidad de Ciencias del Comportamiento). The aim is to publish the preliminary results in December 2020. A conservative approach will be adopted, and the size effect will be estimated using the Cohen d index with a significance level (α) of .05 (95% reliability) and a conventional 80% power statistic. Conclusions: The central mechanism of action will be to investigate the effectiveness of an intervention based on positive psychology through a web platform that can be delivered through computers and tablets, with content that has been rigorously contextualized to the Mexican culture to provide functional strategies to help the target users cope with the COVID-19 pandemic. Trial Registration: ClinicalTrials.gov NCT04468893; https://clinicaltrials.gov/ct2/show/NCT04468893 International Registered Report Identifier (IRRID): DERR1-10.2196/23117 %M 33196449 %R 10.2196/23117 %U http://www.researchprotocols.org/2020/11/e23117/ %U https://doi.org/10.2196/23117 %U http://www.ncbi.nlm.nih.gov/pubmed/33196449 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 11 %P e22205 %T Associations Between COVID-19 Misinformation Exposure and Belief With COVID-19 Knowledge and Preventive Behaviors: Cross-Sectional Online Study %A Lee,Jung Jae %A Kang,Kyung-Ah %A Wang,Man Ping %A Zhao,Sheng Zhi %A Wong,Janet Yuen Ha %A O'Connor,Siobhan %A Yang,Sook Ching %A Shin,Sunhwa %+ College of Nursing, Sahmyook University, 815 Hwarang-ro, Nowon-gu, Seoul, 01795, Republic of Korea, 82 2 3399 1595, shinsh@syu.ac.kr %K COVID-19 %K misinformation %K infodemic %K infodemiology %K anxiety %K depression %K PTSD %K knowledge %K preventive behaviors %K prevention %K behavior %D 2020 %7 13.11.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Online misinformation proliferation during the COVID-19 pandemic has become a major public health concern. Objective: We aimed to assess the prevalence of COVID-19 misinformation exposure and beliefs, associated factors including psychological distress with misinformation exposure, and the associations between COVID-19 knowledge and number of preventive behaviors. Methods: A cross-sectional online survey was conducted with 1049 South Korean adults in April 2020. Respondents were asked about receiving COVID-19 misinformation using 12 items identified by the World Health Organization. Logistic regression was used to compute adjusted odds ratios (aORs) for the association of receiving misinformation with sociodemographic characteristics, source of information, COVID-19 misinformation belief, and psychological distress, as well as the associations of COVID-19 misinformation belief with COVID-19 knowledge and the number of COVID-19 preventive behaviors among those who received the misinformation. All data were weighted according to the Korea census data in 2018. Results: Overall, 67.78% (n=711) of respondents reported exposure to at least one COVID-19 misinformation item. Misinformation exposure was associated with younger age, higher education levels, and lower income. Sources of information associated with misinformation exposure were social networking services (aOR 1.67, 95% CI 1.20-2.32) and instant messaging (aOR 1.79, 1.27-2.51). Misinformation exposure was also associated with psychological distress including anxiety (aOR 1.80, 1.24-2.61), depressive (aOR 1.47, 1.09-2.00), and posttraumatic stress disorder symptoms (aOR 1.97, 1.42-2.73), as well as misinformation belief (aOR 7.33, 5.17-10.38). Misinformation belief was associated with poorer COVID-19 knowledge (high: aOR 0.62, 0.45-0.84) and fewer preventive behaviors (≥7 behaviors: aOR 0.54, 0.39-0.74). Conclusions: COVID-19 misinformation exposure was associated with misinformation belief, while misinformation belief was associated with fewer preventive behaviors. Given the potential of misinformation to undermine global efforts in COVID-19 disease control, up-to-date public health strategies are required to counter the proliferation of misinformation. %M 33048825 %R 10.2196/22205 %U http://www.jmir.org/2020/11/e22205/ %U https://doi.org/10.2196/22205 %U http://www.ncbi.nlm.nih.gov/pubmed/33048825 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 11 %P e21372 %T Relationship Between COVID-19 Infection and Risk Perception, Knowledge, Attitude, and Four Nonpharmaceutical Interventions During the Late Period of the COVID-19 Epidemic in China: Online Cross-Sectional Survey of 8158 Adults %A Xu,Hong %A Gan,Yong %A Zheng,Daikun %A Wu,Bo %A Zhu,Xian %A Xu,Chang %A Liu,Chenglu %A Tao,Zhou %A Hu,Yaoyue %A Chen,Min %A Li,Mingjing %A Lu,Zuxun %A Chen,Jack %+ School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Hubei, PRC, Wuhai, 430030, China, 86 27 8754 2101, zuxunlu@yahoo.com %K COVID-19 %K nonpharmaceutical personal interventions %K NPI %K public health %K mask wearing %K intervention %K infection %K risk perception %K knowledge %K attitude %K online survey %K China %D 2020 %7 13.11.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: So far, there have been no published population studies on the relationship between a COVID-19 infection and public risk perception, information source, knowledge, attitude, and behaviors during the COVID-19 outbreak in China. Objective: This study aims to understand the relationships between COVID-19 infection; four personal nonpharmaceutical interventions (NPIs; handwashing, proper coughing habits, social distancing, and mask wearing); and public risk perception, knowledge, attitude, and other social demographic variables. Methods: An online survey of 8158 Chinese adults between February 22 and March 5, 2020, was conducted. Bivariate associations between categorical variables were examined using Fisher exact test. We also explored the determinants of four NPIs as well as their association with COVID-19 infection using logistic regression. Results: Of 8158 adults included, 57 (0.73%) were infected with COVID-19. The overwhelming majority of respondents showed a positive attitude (n=8094, 99.2%), positive risk perception (n=8146, 99.9%), and high knowledge levels that were among the strongest predictors of the four adopted NPIs (handwashing: n=7895, 96.8%; proper coughing: 5997/6444, 93.1%; social distancing: n=7104/8158, 87.1%; and mask wearing: 5011/5120, 97.9%). There was an increased risk of COVID-19 infection for those who did not wash their hands (2.28% vs 0.65%; risk ratio [RR] 3.53, 95% CI 1.53-8.15; P=.009), did not practice proper coughing (1.79% vs 0.73%; RR 2.44, 95% CI 1.15-5.15; P=.03), did not practice social distancing (1.52% vs 0.58%; RR 2.63, 95% CI 1.48-4.67; P=.002), and did not wear a mask (7.41% vs 0.6%; RR 12.38, 95% CI 5.81-26.36; P<.001). For those who did practice all other three NPIs, wearing a mask was associated with a significantly reduced risk of infection compared to those who did not wear a mask (0.6% vs 16.7%; P=.04). Similarly, for those who did not practice all or part of the other three NPIs, wearing a mask was also associated with a significantly reduced risk of infection. In a penalized logistic regression model including all four NPIs, wearing a mask was the only significant predictor of COVID-19 infection among the four NPIs (odds ratio 7.20, 95% CI 2.24-23.11; P<.001). Conclusions: We found high levels of risk perception, positive attitude, desirable knowledge, as well as a high level of adopting the four NPIs. The relevant knowledge, risk perception, and attitude were strong predictors of adapting the four NPIs. Mask wearing, among the four personal NPIs, was the most effective protective measure against COVID-19 infection, with added preventive effect among those who practiced all or part of the other three NPIs. %M 33108317 %R 10.2196/21372 %U http://www.jmir.org/2020/11/e21372/ %U https://doi.org/10.2196/21372 %U http://www.ncbi.nlm.nih.gov/pubmed/33108317 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 4 %P e24291 %T Analysis of the COVID-19 Epidemic Transmission Network in Mainland China: K-Core Decomposition Study %A Qin,Lei %A Wang,Yidan %A Sun,Qiang %A Zhang,Xiaomei %A Shia,Ben-Chang %A Liu,Chengcheng %+ School of Statistics, Capital University of Economics and Business, No 121 Huaxiang Zhangjia Road, Fengtai District, Beijing, 100070, China, 86 188 1152 1258, ccliu@cueb.edu.cn %K COVID-19 %K epidemic network %K prevention and control %K k-core decomposition %D 2020 %7 13.11.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Since the outbreak of COVID-19 in December 2019 in Wuhan, Hubei Province, China, frequent interregional contacts and the high rate of infection spread have catalyzed the formation of an epidemic network. Objective: The aim of this study was to identify influential nodes and highlight the hidden structural properties of the COVID-19 epidemic network, which we believe is central to prevention and control of the epidemic. Methods: We first constructed a network of the COVID-19 epidemic among 31 provinces in mainland China; after some basic characteristics were revealed by the degree distribution, the k-core decomposition method was employed to provide static and dynamic evidence to determine the influential nodes and hierarchical structure. We then exhibited the influence power of the above nodes and the evolution of this power. Results: Only a small fraction of the provinces studied showed relatively strong outward or inward epidemic transmission effects. The three provinces of Hubei, Beijing, and Guangzhou showed the highest out-degrees, and the three highest in-degrees were observed for the provinces of Beijing, Henan, and Liaoning. In terms of the hierarchical structure of the COVID-19 epidemic network over the whole period, more than half of the 31 provinces were located in the innermost core. Considering the correlation of the characteristics and coreness of each province, we identified some significant negative and positive factors. Specific to the dynamic transmission process of the COVID-19 epidemic, three provinces of Anhui, Beijing, and Guangdong always showed the highest coreness from the third to the sixth week; meanwhile, Hubei Province maintained the highest coreness until the fifth week and then suddenly dropped to the lowest in the sixth week. We also found that the out-strengths of the innermost nodes were greater than their in-strengths before January 27, 2020, at which point a reversal occurred. Conclusions: Increasing our understanding of how epidemic networks form and function may help reduce the damaging effects of COVID-19 in China as well as in other countries and territories worldwide. %M 33108309 %R 10.2196/24291 %U http://publichealth.jmir.org/2020/4/e24291/ %U https://doi.org/10.2196/24291 %U http://www.ncbi.nlm.nih.gov/pubmed/33108309 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 11 %P e22894 %T Health Literacy, eHealth Literacy, Adherence to Infection Prevention and Control Procedures, Lifestyle Changes, and Suspected COVID-19 Symptoms Among Health Care Workers During Lockdown: Online Survey %A Do,Binh N %A Tran,Tien V %A Phan,Dung T %A Nguyen,Hoang C %A Nguyen,Thao T P %A Nguyen,Huu C %A Ha,Tung H %A Dao,Hung K %A Trinh,Manh V %A Do,Thinh V %A Nguyen,Hung Q %A Vo,Tam T %A Nguyen,Nhan P T %A Tran,Cuong Q %A Tran,Khanh V %A Duong,Trang T %A Pham,Hai X %A Nguyen,Lam V %A Nguyen,Kien T %A Chang,Peter W S %A Duong,Tuyen Van %+ School of Nutrition and Health Sciences, Taipei Medical University, 250 Wuxing St, Taipei, 11031, Taiwan, 886 2 2736 1661 ext 6545, tvduong@tmu.edu.tw %K COVID-19 %K health literacy %K eHealth literacy %K health care workers %K personal protective equipment %K handwashing %K masks %K disposing %K lifestyle %K Vietnam %K eHealth %K adherence %K infection prevention %K control %D 2020 %7 12.11.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic has imposed a heavy burden on health care systems and governments. Health literacy (HL) and eHealth literacy (as measured by the eHealth Literacy Scale [eHEALS]) are recognized as strategic public health elements but they have been underestimated during the pandemic. HL, eHEALS score, practices, lifestyles, and the health status of health care workers (HCWs) play crucial roles in containing the COVID-19 pandemic. Objective: The aim of this study is to evaluate the psychometric properties of the eHEALS and examine associations of HL and eHEALS scores with adherence to infection prevention and control (IPC) procedures, lifestyle changes, and suspected COVID-19 symptoms among HCWs during lockdown. Methods: We conducted an online survey of 5209 HCWs from 15 hospitals and health centers across Vietnam from April 6 to April 19, 2020. Participants answered questions related to sociodemographics, HL, eHEALS, adherence to IPC procedures, behavior changes in eating, smoking, drinking, and physical activity, and suspected COVID-19 symptoms. Principal component analysis, correlation analysis, and bivariate and multivariate linear and logistic regression models were used to validate the eHEALS and examine associations. Results: The eHEALS had a satisfactory construct validity with 8 items highly loaded on one component, with factor loadings ranked from 0.78 to 0.92 explaining 76.34% of variance; satisfactory criterion validity as correlated with HL (ρ=0.42); satisfactory convergent validity with high item-scale correlations (ρ=0.80-0.84); and high internal consistency (Cronbach α=.95). HL and eHEALS scores were significantly higher in men (unstandardized coefficient [B]=1.01, 95% CI 0.57-1.45, P<.001; B=0.72, 95% CI 0.43-1.00, P<.001), those with a better ability to pay for medication (B=1.65, 95% CI 1.25-2.05, P<.001; B=0.60, 95% CI 0.34-0.86, P<.001), doctors (B=1.29, 95% CI 0.73-1.84, P<.001; B 0.56, 95% CI 0.20-0.93, P=.003), and those with epidemic containment experience (B=1.96, 95% CI 1.56-2.37, P<.001; B=0.64, 95% CI 0.38-0.91, P<.001), as compared to their counterparts, respectively. HCWs with higher HL or eHEALS scores had better adherence to IPC procedures (B=0.13, 95% CI 0.10-0.15, P<.001; B=0.22, 95% CI 0.19-0.26, P<.001), had a higher likelihood of healthy eating (odds ratio [OR] 1.04, 95% CI 1.01-1.06, P=.001; OR 1.04, 95% CI 1.02-1.07, P=.002), were more physically active (OR 1.03, 95% CI 1.02-1.03, P<.001; OR 1.04, 95% CI 1.03-1.05, P<.001), and had a lower likelihood of suspected COVID-19 symptoms (OR 0.97, 95% CI 0.96-0.98, P<.001; OR 0.96, 95% CI 0.95-0.98, P<.001), respectively. Conclusions: The eHEALS is a valid and reliable survey tool. Gender, ability to pay for medication, profession, and epidemic containment experience were independent predictors of HL and eHEALS scores. HCWs with higher HL or eHEALS scores had better adherence to IPC procedures, healthier lifestyles, and a lower likelihood of suspected COVID-19 symptoms. Efforts to improve HCWs’ HL and eHEALS scores can help to contain the COVID-19 pandemic and minimize its consequences. %M 33122164 %R 10.2196/22894 %U https://www.jmir.org/2020/11/e22894 %U https://doi.org/10.2196/22894 %U http://www.ncbi.nlm.nih.gov/pubmed/33122164 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 11 %P e23922 %T Relationship Between COVID-19 Information Sources and Attitudes in Battling the Pandemic Among the Malaysian Public: Cross-Sectional Survey Study %A Mohamad,Emma %A Tham,Jen Sern %A Ayub,Suffian Hadi %A Hamzah,Mohammad Rezal %A Hashim,Hasrul %A Azlan,Arina Anis %+ Centre for Research in Media and Communication, Faculty of Social Sciences and Humanities, Universiti Kebangsaan Malaysia, 43600 UKM, Bangi, Selangor, 43600, Malaysia, 60 389215456, arina@ukm.edu.my %K COVID-19 %K information source %K confidence %K media %K social media %K government %K Malaysia %K online information %K survey %D 2020 %7 12.11.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: There are multiple media platforms and various resources available for information on COVID-19. Identifying people’s preferences is key to building public confidence and planning for successful national health intervention strategies. Objective: This study examines the sources of information for COVID-19 used by the Malaysian public and identifies those that are associated with building public confidence and positive perceptions toward the Malaysian government. Methods: A cross-sectional online survey of 4850 Malaysian residents was conducted. Participant demographics, media use, information sources, and attitudes surrounding COVID-19 were assessed. Descriptive statistics and multiple logistic regression analyses were conducted to gauge the relationship between demographics, information sources, and attitudes toward COVID-19. Results: Malaysians primarily used television and internet news portals to access information on COVID-19. The Malaysian Ministry of Health was the most preferred source of COVID-19 information. Respondents who referred to the Ministry of Health, television, and the Malaysian National Security Council for information were more likely to believe that the country could win the battle against COVID-19 and that the government was handling the health crisis well compared to those who referred to other information sources. Those who used the World Health Organization, friends, YouTube, family, and radio as sources of information were less likely to harbor confidence and positive belief toward combating COVID-19. Conclusions: Managing information and sustaining public confidence is important during a pandemic. Health authorities should pay considerable attention to the use of appropriate media channels and sources to allow for more effective dissemination of critical information to the public. %M 33151897 %R 10.2196/23922 %U http://www.jmir.org/2020/11/e23922/ %U https://doi.org/10.2196/23922 %U http://www.ncbi.nlm.nih.gov/pubmed/33151897 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 11 %P e23853 %T Impact of Systematic Factors on the Outbreak Outcomes of the Novel COVID-19 Disease in China: Factor Analysis Study %A Cao,Zicheng %A Tang,Feng %A Chen,Cai %A Zhang,Chi %A Guo,Yichen %A Lin,Ruizhen %A Huang,Zhihong %A Teng,Yi %A Xie,Ting %A Xu,Yutian %A Song,Yanxin %A Wu,Feng %A Dong,Peipei %A Luo,Ganfeng %A Jiang,Yawen %A Zou,Huachun %A Chen,Yao-Qing %A Sun,Litao %A Shu,Yuelong %A Du,Xiangjun %+ School of Public Health (Shenzhen), Sun Yat-sen University, 135 Xingang Xi Road, Guangzhou, 510275, China, 86 020 83226383, duxj9@mail.sysu.edu.cn %K COVID-19 %K new cases %K growth rate %K multidimensional factors %K statistical machine learning %D 2020 %7 11.11.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The novel COVID-19 disease has spread worldwide, resulting in a new pandemic. The Chinese government implemented strong intervention measures in the early stage of the epidemic, including strict travel bans and social distancing policies. Prioritizing the analysis of different contributing factors to outbreak outcomes is important for the precise prevention and control of infectious diseases. We proposed a novel framework for resolving this issue and applied it to data from China. Objective: This study aimed to systematically identify national-level and city-level contributing factors to the control of COVID-19 in China. Methods: Daily COVID-19 case data and related multidimensional data, including travel-related, medical, socioeconomic, environmental, and influenza-like illness factors, from 343 cities in China were collected. A correlation analysis and interpretable machine learning algorithm were used to evaluate the quantitative contribution of factors to new cases and COVID-19 growth rates during the epidemic period (ie, January 17 to February 29, 2020). Results: Many factors correlated with the spread of COVID-19 in China. Travel-related population movement was the main contributing factor for new cases and COVID-19 growth rates in China, and its contributions were as high as 77% and 41%, respectively. There was a clear lag effect for travel-related factors (previous vs current week: new cases, 45% vs 32%; COVID-19 growth rates, 21% vs 20%). Travel from non-Wuhan regions was the single factor with the most significant impact on COVID-19 growth rates (contribution: new cases, 12%; COVID-19 growth rate, 26%), and its contribution could not be ignored. City flow, a measure of outbreak control strength, contributed 16% and 7% to new cases and COVID-19 growth rates, respectively. Socioeconomic factors also played important roles in COVID-19 growth rates in China (contribution, 28%). Other factors, including medical, environmental, and influenza-like illness factors, also contributed to new cases and COVID-19 growth rates in China. Based on our analysis of individual cities, compared to Beijing, population flow from Wuhan and internal flow within Wenzhou were driving factors for increasing the number of new cases in Wenzhou. For Chongqing, the main contributing factor for new cases was population flow from Hubei, beyond Wuhan. The high COVID-19 growth rates in Wenzhou were driven by population-related factors. Conclusions: Many factors contributed to the COVID-19 outbreak outcomes in China. The differential effects of various factors, including specific city-level factors, emphasize the importance of precise, targeted strategies for controlling the COVID-19 outbreak and future infectious disease outbreaks. %M 33098287 %R 10.2196/23853 %U http://www.jmir.org/2020/11/e23853/ %U https://doi.org/10.2196/23853 %U http://www.ncbi.nlm.nih.gov/pubmed/33098287 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 11 %P e23128 %T Prognostic Assessment of COVID-19 in the Intensive Care Unit by Machine Learning Methods: Model Development and Validation %A Pan,Pan %A Li,Yichao %A Xiao,Yongjiu %A Han,Bingchao %A Su,Longxiang %A Su,Mingliang %A Li,Yansheng %A Zhang,Siqi %A Jiang,Dapeng %A Chen,Xia %A Zhou,Fuquan %A Ma,Ling %A Bao,Pengtao %A Xie,Lixin %+ College of Pulmonary and Critical Care Medicine, Chinese PLA General Hospital, No.28 Fuxing Road, Haidian District, Beijing, Beijing, China, 86 55499128, xielx301@126.com %K COVID-19 %K ICU %K machine learning %K death prediction model %K factor analysis %K SHAP %K LIME %D 2020 %7 11.11.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Patients with COVID-19 in the intensive care unit (ICU) have a high mortality rate, and methods to assess patients’ prognosis early and administer precise treatment are of great significance. Objective: The aim of this study was to use machine learning to construct a model for the analysis of risk factors and prediction of mortality among ICU patients with COVID-19. Methods: In this study, 123 patients with COVID-19 in the ICU of Vulcan Hill Hospital were retrospectively selected from the database, and the data were randomly divided into a training data set (n=98) and test data set (n=25) with a 4:1 ratio. Significance tests, correlation analysis, and factor analysis were used to screen 100 potential risk factors individually. Conventional logistic regression methods and four machine learning algorithms were used to construct the risk prediction model for the prognosis of patients with COVID-19 in the ICU. The performance of these machine learning models was measured by the area under the receiver operating characteristic curve (AUC). Interpretation and evaluation of the risk prediction model were performed using calibration curves, SHapley Additive exPlanations (SHAP), Local Interpretable Model-Agnostic Explanations (LIME), etc, to ensure its stability and reliability. The outcome was based on the ICU deaths recorded from the database. Results: Layer-by-layer screening of 100 potential risk factors finally revealed 8 important risk factors that were included in the risk prediction model: lymphocyte percentage, prothrombin time, lactate dehydrogenase, total bilirubin, eosinophil percentage, creatinine, neutrophil percentage, and albumin level. Finally, an eXtreme Gradient Boosting (XGBoost) model established with the 8 important risk factors showed the best recognition ability in the training set of 5-fold cross validation (AUC=0.86) and the verification queue (AUC=0.92). The calibration curve showed that the risk predicted by the model was in good agreement with the actual risk. In addition, using the SHAP and LIME algorithms, feature interpretation and sample prediction interpretation algorithms of the XGBoost black box model were implemented. Additionally, the model was translated into a web-based risk calculator that is freely available for public usage. Conclusions: The 8-factor XGBoost model predicts risk of death in ICU patients with COVID-19 well; it initially demonstrates stability and can be used effectively to predict COVID-19 prognosis in ICU patients. %M 33035175 %R 10.2196/23128 %U https://www.jmir.org/2020/11/e23128 %U https://doi.org/10.2196/23128 %U http://www.ncbi.nlm.nih.gov/pubmed/33035175 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 4 %P e21978 %T Public Perception of the COVID-19 Pandemic on Twitter: Sentiment Analysis and Topic Modeling Study %A Boon-Itt,Sakun %A Skunkan,Yukolpat %+ Department of Operations Management, Center of Excellence in Operations and Information Management, Thammasat Business School, Thammasat University, 2 Prachan Road, Pranakorn, Bangkok, 10240, Thailand, 66 26132200, sboonitt@tu.ac.th %K COVID-19 %K Twitter %K social media %K infoveillance %K infodemiology %K infodemic %K data %K health informatics %K mining %K perception %K topic modeling %D 2020 %7 11.11.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: COVID-19 is a scientifically and medically novel disease that is not fully understood because it has yet to be consistently and deeply studied. Among the gaps in research on the COVID-19 outbreak, there is a lack of sufficient infoveillance data. Objective: The aim of this study was to increase understanding of public awareness of COVID-19 pandemic trends and uncover meaningful themes of concern posted by Twitter users in the English language during the pandemic. Methods: Data mining was conducted on Twitter to collect a total of 107,990 tweets related to COVID-19 between December 13 and March 9, 2020. The analyses included frequency of keywords, sentiment analysis, and topic modeling to identify and explore discussion topics over time. A natural language processing approach and the latent Dirichlet allocation algorithm were used to identify the most common tweet topics as well as to categorize clusters and identify themes based on the keyword analysis. Results: The results indicate three main aspects of public awareness and concern regarding the COVID-19 pandemic. First, the trend of the spread and symptoms of COVID-19 can be divided into three stages. Second, the results of the sentiment analysis showed that people have a negative outlook toward COVID-19. Third, based on topic modeling, the themes relating to COVID-19 and the outbreak were divided into three categories: the COVID-19 pandemic emergency, how to control COVID-19, and reports on COVID-19. Conclusions: Sentiment analysis and topic modeling can produce useful information about the trends in the discussion of the COVID-19 pandemic on social media as well as alternative perspectives to investigate the COVID-19 crisis, which has created considerable public awareness. This study shows that Twitter is a good communication channel for understanding both public concern and public awareness about COVID-19. These findings can help health departments communicate information to alleviate specific public concerns about the disease. %M 33108310 %R 10.2196/21978 %U http://publichealth.jmir.org/2020/4/e21978/ %U https://doi.org/10.2196/21978 %U http://www.ncbi.nlm.nih.gov/pubmed/33108310 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 11 %P e21559 %T Analysis of Scientific Publications During the Early Phase of the COVID-19 Pandemic: Topic Modeling Study %A Älgå,Andreas %A Eriksson,Oskar %A Nordberg,Martin %+ Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Sjukhusbacken 10, Stockholm, 118 83, Sweden, 46 8 616 10 00, andreas.alga@ki.se %K COVID-19 %K SARS-CoV-2 %K coronavirus %K pandemic %K topic modeling %K research %K literature %D 2020 %7 10.11.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic has spread at an alarming speed, and effective treatment for the disease is still lacking. The body of evidence on COVID-19 has been increasing at an impressive pace, creating the need for a method to rapidly assess the current knowledge and identify key information. Gold standard methods such as systematic reviews and meta-analyses are regarded unsuitable because they have a narrow scope and are very time consuming. Objective: This study aimed to explore the published scientific literature on COVID-19 and map the research evolution during the early phase of the COVID-19 pandemic. Methods: We performed a PubMed search to analyze the titles, keywords, and abstracts of published papers on COVID-19. We used latent Dirichlet allocation modeling to extract topics and conducted a trend analysis to understand the temporal changes in research for each topic, journal impact factor (JIF), and geographic origin. Results: Based on our search, we identified 16,670 relevant articles dated between February 14, 2020, and June 1, 2020. Of these, 6 articles were reports from peer-reviewed randomized trials on patients with COVID-19. We identified 14 main research topics, of which the most common topics were health care responses (2812/16,670, 16.86%) and clinical manifestations (1828/16,670, 10.91%). We found an increasing trend for research on clinical manifestations and protective measures and a decreasing trend for research on disease transmission, epidemiology, health care response, and radiology. Publications on protective measures, immunology, and clinical manifestations were associated with the highest JIF. The overall median JIF was 3.7 (IQR 2.6-5.9), and we found that the JIF for these publications declined over time. The top countries producing research were the United States, China, Italy, and the United Kingdom. Conclusions: In less than 6 months since the novel coronavirus was first detected, a remarkably high number of research articles on COVID-19 have been published. Here, we discuss and present the temporal changes in the available COVID-19 research during the early phase of the pandemic. Our findings may aid researchers and policy makers to form a structured view of the current COVID-19 evidence base and provide further research directions. %M 33031049 %R 10.2196/21559 %U http://www.jmir.org/2020/11/e21559/ %U https://doi.org/10.2196/21559 %U http://www.ncbi.nlm.nih.gov/pubmed/33031049 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 8 %N 11 %P e21648 %T Toward Preparing a Knowledge Base to Explore Potential Drugs and Biomedical Entities Related to COVID-19: Automated Computational Approach %A Khan,Junaed Younus %A Khondaker,Md Tawkat Islam %A Hoque,Iram Tazim %A Al-Absi,Hamada R H %A Rahman,Mohammad Saifur %A Guler,Reto %A Alam,Tanvir %A Rahman,M Sohel %+ College of Science and Engineering, Hamad Bin Khalifa University, PO Box 34110, Education City, Doha, Qatar, 974 44542277, talam@hbku.edu.qa %K COVID-19 %K 2019-nCoV %K coronavirus %K SARS-CoV-2 %K SARS %K remdesivir %K statin %K statins %K dexamethasone %K ivermectin %K hydroxychloroquine %D 2020 %7 10.11.2020 %9 Original Paper %J JMIR Med Inform %G English %X Background: Novel coronavirus disease 2019 (COVID-19) is taking a huge toll on public health. Along with the non-therapeutic preventive measurements, scientific efforts are currently focused, mainly, on the development of vaccines and pharmacological treatment with existing drugs. Summarizing evidences from scientific literatures on the discovery of treatment plan of COVID-19 under a platform would help the scientific community to explore the opportunities in a systematic fashion. Objective: The aim of this study is to explore the potential drugs and biomedical entities related to coronavirus related diseases, including COVID-19, that are mentioned on scientific literature through an automated computational approach. Methods: We mined the information from publicly available scientific literature and related public resources. Six topic-specific dictionaries, including human genes, human miRNAs, diseases, Protein Databank, drugs, and drug side effects, were integrated to mine all scientific evidence related to COVID-19. We employed an automated literature mining and labeling system through a novel approach to measure the effectiveness of drugs against diseases based on natural language processing, sentiment analysis, and deep learning. We also applied the concept of cosine similarity to confidently infer the associations between diseases and genes. Results: Based on the literature mining, we identified 1805 diseases, 2454 drugs, 1910 genes that are related to coronavirus related diseases including COVID-19. Integrating the extracted information, we developed the first knowledgebase platform dedicated to COVID-19, which highlights potential list of drugs and related biomedical entities. For COVID-19, we highlighted multiple case studies on existing drugs along with a confidence score for their applicability in the treatment plan. Based on our computational method, we found Remdesivir, Statins, Dexamethasone, and Ivermectin could be considered as potential effective drugs to improve clinical status and lower mortality in patients hospitalized with COVID-19. We also found that Hydroxychloroquine could not be considered as an effective drug for COVID-19. The resulting knowledgebase is made available as an open source tool, named COVID-19Base. Conclusions: Proper investigation of the mined biomedical entities along with the identified interactions among those would help the research community to discover possible ways for the therapeutic treatment of COVID-19. %M 33055059 %R 10.2196/21648 %U http://medinform.jmir.org/2020/11/e21648/ %U https://doi.org/10.2196/21648 %U http://www.ncbi.nlm.nih.gov/pubmed/33055059 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 3 %N 2 %P e23176 %T Disparities in Video and Telephone Visits Among Older Adults During the COVID-19 Pandemic: Cross-Sectional Analysis %A Schifeling,Christopher H %A Shanbhag,Prajakta %A Johnson,Angene %A Atwater,Riannon C %A Koljack,Claire %A Parnes,Bennett L %A Vejar,Maria M %A Farro,Samantha A %A Phimphasone-Brady,Phoutdavone %A Lum,Hillary D %+ Division of Geriatric Medicine, University of Colorado School of Medicine, Mail Stop B179, 12631 E 17th Avenue, Room 8119, Aurora, CO, 80045, United States, 1 303 724 1911, hillary.lum@cuanschutz.edu %K telemedicine %K telehealth %K telephone %K videoconferencing %K health care disparities %K older adults %K geriatrics %K advance care planning %K advanced directives %K COVID-19 %K coronavirus pandemic %K SARS-CoV-2 %K primary care %D 2020 %7 10.11.2020 %9 Original Paper %J JMIR Aging %G English %X Background: Telephone and video telemedicine appointments have been a crucial service delivery method during the COVID-19 pandemic for maintaining access to health care without increasing the risk of exposure. Although studies conducted prior to the pandemic have suggested that telemedicine is an acceptable format for older adults, there is a paucity of data on the practical implementation of telemedicine visits. Due to prior lack of reimbursement for telemedicine visits involving nonrural patients, no studies have compared telephone visits to video visits in geriatric primary care. Objective: This study aimed to determine (1) whether video visits had longer durations, more visit diagnoses, and more advance care planning discussions than telephone visits during the rapid implementation of telemedicine in the COVID-19 pandemic, and (2) whether disparities in visit type existed based on patient characteristics. Methods: We conducted a retrospective, cross-sectional analysis of patients seen at two geriatric clinics from April 23 to May 22, 2020. Approximately 25% of patients who had telephone and video appointments during this time underwent chart review. We analyzed patient characteristics, visit characteristics, duration of visits, number of visit diagnoses, and the presence of advance care planning discussion in clinical documentation. Results: Of the 190 appointments reviewed, 47.4% (n=90) were video visits. Compared to telephone appointments, videoconferencing was, on average, 7 minutes longer (mean 37.3 minutes, SD 10 minutes; P<.001) and had, on average, 1.2 more visit diagnoses (mean 5.7, SD 3; P=.001). Video and telephone visits had similar rates of advance care planning. Furthermore, hearing, vision, and cognitive impairment did not result in different rates of video or telephone appointments. Non-White patients, patients who needed interpreter services, and patients who received Medicaid were less likely to have video visits than White patients, patients who did not need an interpreter, and patients who did not receive Medicaid, respectively (P=.003, P=.01, P<.001, respectively). Conclusions: Although clinicians spent more time on video visits than telephone visits, more than half of this study’s older patients did not use video visits, especially if they were from racial or ethnic minority backgrounds or Medicaid beneficiaries. This potential health care disparity merits greater attention. %M 33048821 %R 10.2196/23176 %U http://aging.jmir.org/2020/2/e23176/ %U https://doi.org/10.2196/23176 %U http://www.ncbi.nlm.nih.gov/pubmed/33048821 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 11 %P e24225 %T An Easy-to-Use Machine Learning Model to Predict the Prognosis of Patients With COVID-19: Retrospective Cohort Study %A Kim,Hyung-Jun %A Han,Deokjae %A Kim,Jeong-Han %A Kim,Daehyun %A Ha,Beomman %A Seog,Woong %A Lee,Yeon-Kyeng %A Lim,Dosang %A Hong,Sung Ok %A Park,Mi-Jin %A Heo,JoonNyung %+ The Armed Forces Medical Command, 81 Saemaeul-ro 177beon-gil, Bundang-gu, Seongnam, , Republic of Korea, 82 31 725 5490, jnheo@jnheo.com %K COVID-19 %K machine learning %K prognosis %K SARS-CoV-2 %K severe acute respiratory syndrome coronavirus 2 %D 2020 %7 9.11.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Prioritizing patients in need of intensive care is necessary to reduce the mortality rate during the COVID-19 pandemic. Although several scoring methods have been introduced, many require laboratory or radiographic findings that are not always easily available. Objective: The purpose of this study was to develop a machine learning model that predicts the need for intensive care for patients with COVID-19 using easily obtainable characteristics—baseline demographics, comorbidities, and symptoms. Methods: A retrospective study was performed using a nationwide cohort in South Korea. Patients admitted to 100 hospitals from January 25, 2020, to June 3, 2020, were included. Patient information was collected retrospectively by the attending physicians in each hospital and uploaded to an online case report form. Variables that could be easily provided were extracted. The variables were age, sex, smoking history, body temperature, comorbidities, activities of daily living, and symptoms. The primary outcome was the need for intensive care, defined as admission to the intensive care unit, use of extracorporeal life support, mechanical ventilation, vasopressors, or death within 30 days of hospitalization. Patients admitted until March 20, 2020, were included in the derivation group to develop prediction models using an automated machine learning technique. The models were externally validated in patients admitted after March 21, 2020. The machine learning model with the best discrimination performance was selected and compared against the CURB-65 (confusion, urea, respiratory rate, blood pressure, and 65 years of age or older) score using the area under the receiver operating characteristic curve (AUC). Results: A total of 4787 patients were included in the analysis, of which 3294 were assigned to the derivation group and 1493 to the validation group. Among the 4787 patients, 460 (9.6%) patients needed intensive care. Of the 55 machine learning models developed, the XGBoost model revealed the highest discrimination performance. The AUC of the XGBoost model was 0.897 (95% CI 0.877-0.917) for the derivation group and 0.885 (95% CI 0.855-0.915) for the validation group. Both the AUCs were superior to those of CURB-65, which were 0.836 (95% CI 0.825-0.847) and 0.843 (95% CI 0.829-0.857), respectively. Conclusions: We developed a machine learning model comprising simple patient-provided characteristics, which can efficiently predict the need for intensive care among patients with COVID-19. %M 33108316 %R 10.2196/24225 %U http://www.jmir.org/2020/11/e24225/ %U https://doi.org/10.2196/24225 %U http://www.ncbi.nlm.nih.gov/pubmed/33108316 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 11 %P e20487 %T Concerns About Information Regarding COVID-19 on the Internet: Cross-Sectional Study %A Zhao,Yusui %A Xu,Shuiyang %A Wang,Lei %A Huang,Yu %A Xu,Yue %A Xu,Yan %A Lv,Qiaohong %A Wang,Zhen %A Wu,Qingqing %+ Zhejiang Provincial Center for Disease Control and Prevention, 3399 Binsheng Road, Hangzhou, 310051, China, 86 571 87115239, qqwu@cdc.zj.cn %K coronavirus %K COVID-19 %K disease prevention %K internet %K knowledge %D 2020 %7 9.11.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Since the outbreak of COVID-19, the Chinese government and the Chinese Center for Disease Control and Prevention have released COVID-19–related information to the public through various channels to raise their concern level of the pandemic, increase their knowledge of disease prevention, and ensure the uptake of proper preventive practices. Objective: Our objectives were to determine Chinese netizens’ concerns related to COVID-19 and the relationship between their concerns and information on the internet. We also aimed to elucidate the association between individuals’ levels of concern, knowledge, and behaviors related to COVID-19. Methods: The questionnaire, which consisted of 15 closed-ended questions, was designed to investigate Chinese netizens’ knowledge about COVID-19. The self-selection online survey method of nonprobability sampling was used to recruit participants through Dingxiangyisheng WeChat (a public, medical, and health service platform in China) accounts. Standard descriptive statistics and multivariate logistic regression analyses were conducted to analyze the data. Results: In total, 10,304 respondents were surveyed on the internet (response rate=1.75%; 10,304/590,000). Nearly all (n=9803, 95.30%) participants were concerned about “confirmed cases” of COVID-19, and 87.70% (n=9036) received information about the outbreak through social media websites. There were significant differences in participants’ concerns by sex (P=.02), age (P<.001), educational attainment (P=.001), and occupation (P<.001). All knowledge questions and preventive practices were associated with concerns about COVID-19. The results of the multivariate logistic regression indicated that participants’ sex, educational attainment, occupation and employment status, knowledge acquisition, and concern level were significantly associated with the practice of proper preventive behaviors. Conclusions: This study elucidated Chinese netizens’ concerns, information sources, and preventive behaviors related to the COVID-19 pandemic. Sex, educational attainment, occupation and employment status, knowledge acquisition, and level of concern were key factors associated with proper preventive behaviors. This offers a theoretical basis for the government to provide targeted disease prevention and control information to the public. %M 33095740 %R 10.2196/20487 %U http://www.jmir.org/2020/11/e20487/ %U https://doi.org/10.2196/20487 %U http://www.ncbi.nlm.nih.gov/pubmed/33095740 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 7 %N 11 %P e22984 %T Behavior of Callers to a Crisis Helpline Before and During the COVID-19 Pandemic: Quantitative Data Analysis %A Turkington,Robin %A Mulvenna,Maurice %A Bond,Raymond %A Ennis,Edel %A Potts,Courtney %A Moore,Ciaran %A Hamra,Louise %A Morrissey,Jacqui %A Isaksen,Mette %A Scowcroft,Elizabeth %A O'Neill,Siobhan %+ School of Computing, Ulster University, Shore Road, Newtownabbey, United Kingdom, 44 28 9036 6129, Turkington-R@ulster.ac.uk %K COVID-19 %K coronavirus %K pandemic %K mental health %K crisis helplines %K machine learning %K clustering %K caller behavior %D 2020 %7 6.11.2020 %9 Original Paper %J JMIR Ment Health %G English %X Background: The World Health Organization declared the outbreak of COVID-19 to be an international pandemic in March 2020. While numbers of new confirmed cases of the disease and death tolls are rising at an alarming rate on a daily basis, there is concern that the pandemic and the measures taken to counteract it could cause an increase in distress among the public. Hence, there could be an increase in need for emotional support within the population, which is complicated further by the reduction of existing face-to-face mental health services as a result of measures taken to limit the spread of the virus. Objective: The objective of this study was to determine whether the COVID-19 pandemic has had any influence on the calls made to Samaritans Ireland, a national crisis helpline within the Republic of Ireland. Methods: This study presents an analysis of calls made to Samaritans Ireland in a four-week period before the first confirmed case of COVID-19 (calls=41,648, callers=3752) and calls made to the service within a four-week period after a restrictive lockdown was imposed by the government of the Republic of Ireland (calls=46,043, callers=3147). Statistical analysis was conducted to explore any differences between the duration of calls in the two periods at a global level and at an hourly level. We performed k-means clustering to determine the types of callers who used the helpline based on their helpline call usage behavior and to assess the impact of the pandemic on the caller type usage patterns. Results: The analysis revealed that calls were of a longer duration in the postlockdown period in comparison with the pre–COVID-19 period. There were changes in the behavior of individuals in the cluster types defined by caller behavior, where some caller types tended to make longer calls to the service in the postlockdown period. There were also changes in caller behavior patterns with regard to the time of day of the call; variations were observed in the duration of calls at particular times of day, where average call durations increased in the early hours of the morning. Conclusions: The results of this study highlight the impact of COVID-19 on a national crisis helpline service. Statistical differences were observed in caller behavior between the prelockdown and active lockdown periods. The findings suggest that service users relied on crisis helpline services more during the lockdown period due to an increased sense of isolation, worsening of underlying mental illness due to the pandemic, and reduction or overall removal of access to other support resources. Practical implications and limitations are discussed. %M 33112759 %R 10.2196/22984 %U http://mental.jmir.org/2020/11/e22984/ %U https://doi.org/10.2196/22984 %U http://www.ncbi.nlm.nih.gov/pubmed/33112759 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 11 %P e24018 %T Machine Learning to Predict Mortality and Critical Events in a Cohort of Patients With COVID-19 in New York City: Model Development and Validation %A Vaid,Akhil %A Somani,Sulaiman %A Russak,Adam J %A De Freitas,Jessica K %A Chaudhry,Fayzan F %A Paranjpe,Ishan %A Johnson,Kipp W %A Lee,Samuel J %A Miotto,Riccardo %A Richter,Felix %A Zhao,Shan %A Beckmann,Noam D %A Naik,Nidhi %A Kia,Arash %A Timsina,Prem %A Lala,Anuradha %A Paranjpe,Manish %A Golden,Eddye %A Danieletto,Matteo %A Singh,Manbir %A Meyer,Dara %A O'Reilly,Paul F %A Huckins,Laura %A Kovatch,Patricia %A Finkelstein,Joseph %A Freeman,Robert M. %A Argulian,Edgar %A Kasarskis,Andrew %A Percha,Bethany %A Aberg,Judith A %A Bagiella,Emilia %A Horowitz,Carol R %A Murphy,Barbara %A Nestler,Eric J %A Schadt,Eric E %A Cho,Judy H %A Cordon-Cardo,Carlos %A Fuster,Valentin %A Charney,Dennis S %A Reich,David L %A Bottinger,Erwin P %A Levin,Matthew A %A Narula,Jagat %A Fayad,Zahi A %A Just,Allan C %A Charney,Alexander W %A Nadkarni,Girish N %A Glicksberg,Benjamin S %+ The Hasso Plattner Institute for Digital Health at Mount Sinai, Icahn School of Medicine at Mount Sinai, 770 Lexington St., New York, NY, United States, 1 212 731 7078, benjamin.glicksberg@mssm.edu %K machine learning %K COVID-19 %K electronic health record %K TRIPOD %K clinical informatics %K prediction %K mortality %K EHR %K cohort %K hospital %K performance %D 2020 %7 6.11.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: COVID-19 has infected millions of people worldwide and is responsible for several hundred thousand fatalities. The COVID-19 pandemic has necessitated thoughtful resource allocation and early identification of high-risk patients. However, effective methods to meet these needs are lacking. Objective: The aims of this study were to analyze the electronic health records (EHRs) of patients who tested positive for COVID-19 and were admitted to hospitals in the Mount Sinai Health System in New York City; to develop machine learning models for making predictions about the hospital course of the patients over clinically meaningful time horizons based on patient characteristics at admission; and to assess the performance of these models at multiple hospitals and time points. Methods: We used Extreme Gradient Boosting (XGBoost) and baseline comparator models to predict in-hospital mortality and critical events at time windows of 3, 5, 7, and 10 days from admission. Our study population included harmonized EHR data from five hospitals in New York City for 4098 COVID-19–positive patients admitted from March 15 to May 22, 2020. The models were first trained on patients from a single hospital (n=1514) before or on May 1, externally validated on patients from four other hospitals (n=2201) before or on May 1, and prospectively validated on all patients after May 1 (n=383). Finally, we established model interpretability to identify and rank variables that drive model predictions. Results: Upon cross-validation, the XGBoost classifier outperformed baseline models, with an area under the receiver operating characteristic curve (AUC-ROC) for mortality of 0.89 at 3 days, 0.85 at 5 and 7 days, and 0.84 at 10 days. XGBoost also performed well for critical event prediction, with an AUC-ROC of 0.80 at 3 days, 0.79 at 5 days, 0.80 at 7 days, and 0.81 at 10 days. In external validation, XGBoost achieved an AUC-ROC of 0.88 at 3 days, 0.86 at 5 days, 0.86 at 7 days, and 0.84 at 10 days for mortality prediction. Similarly, the unimputed XGBoost model achieved an AUC-ROC of 0.78 at 3 days, 0.79 at 5 days, 0.80 at 7 days, and 0.81 at 10 days. Trends in performance on prospective validation sets were similar. At 7 days, acute kidney injury on admission, elevated LDH, tachypnea, and hyperglycemia were the strongest drivers of critical event prediction, while higher age, anion gap, and C-reactive protein were the strongest drivers of mortality prediction. Conclusions: We externally and prospectively trained and validated machine learning models for mortality and critical events for patients with COVID-19 at different time horizons. These models identified at-risk patients and uncovered underlying relationships that predicted outcomes. %M 33027032 %R 10.2196/24018 %U https://www.jmir.org/2020/11/e24018 %U https://doi.org/10.2196/24018 %U http://www.ncbi.nlm.nih.gov/pubmed/33027032 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 11 %P e24361 %T The Hidden Pandemic of Family Violence During COVID-19: Unsupervised Learning of Tweets %A Xue,Jia %A Chen,Junxiang %A Chen,Chen %A Hu,Ran %A Zhu,Tingshao %+ Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor St W, Toronto, ON, M5S 1V4, Canada, 1 416 946 5429, jia.xue@utoronto.ca %K Twitter %K family violence %K COVID-19 %K machine learning %K big data %K infodemiology %K infoveillance %D 2020 %7 6.11.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Family violence (including intimate partner violence/domestic violence, child abuse, and elder abuse) is a hidden pandemic happening alongside COVID-19. The rates of family violence are rising fast, and women and children are disproportionately affected and vulnerable during this time. Objective: This study aims to provide a large-scale analysis of public discourse on family violence and the COVID-19 pandemic on Twitter. Methods: We analyzed over 1 million tweets related to family violence and COVID-19 from April 12 to July 16, 2020. We used the machine learning approach Latent Dirichlet Allocation and identified salient themes, topics, and representative tweets. Results: We extracted 9 themes from 1,015,874 tweets on family violence and the COVID-19 pandemic: (1) increased vulnerability: COVID-19 and family violence (eg, rising rates, increases in hotline calls, homicide); (2) types of family violence (eg, child abuse, domestic violence, sexual abuse); (3) forms of family violence (eg, physical aggression, coercive control); (4) risk factors linked to family violence (eg, alcohol abuse, financial constraints, guns, quarantine); (5) victims of family violence (eg, the LGBTQ [lesbian, gay, bisexual, transgender, and queer or questioning] community, women, women of color, children); (6) social services for family violence (eg, hotlines, social workers, confidential services, shelters, funding); (7) law enforcement response (eg, 911 calls, police arrest, protective orders, abuse reports); (8) social movements and awareness (eg, support victims, raise awareness); and (9) domestic violence–related news (eg, Tara Reade, Melissa DeRosa). Conclusions: This study overcomes limitations in the existing scholarship where data on the consequences of COVID-19 on family violence are lacking. We contribute to understanding family violence during the pandemic by providing surveillance via tweets. This is essential for identifying potentially useful policy programs that can offer targeted support for victims and survivors as we prepare for future outbreaks. %M 33108315 %R 10.2196/24361 %U http://www.jmir.org/2020/11/e24361/ %U https://doi.org/10.2196/24361 %U http://www.ncbi.nlm.nih.gov/pubmed/33108315 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 11 %P e22280 %T Adoption of Digital Technologies in Health Care During the COVID-19 Pandemic: Systematic Review of Early Scientific Literature %A Golinelli,Davide %A Boetto,Erik %A Carullo,Gherardo %A Nuzzolese,Andrea Giovanni %A Landini,Maria Paola %A Fantini,Maria Pia %+ Department of Biomedical and Neuromotor Sciences, University of Bologna, via San Giacomo 12, Bologna, 40126, Italy, 39 0512094830, erik.boetto@gmail.com %K COVID-19 %K SARS-CoV-2 %K pandemic %K digital heath %K review %K literature %K mitigate %K impact %K eHealth %D 2020 %7 6.11.2020 %9 Review %J J Med Internet Res %G English %X Background: The COVID-19 pandemic is favoring digital transitions in many industries and in society as a whole. Health care organizations have responded to the first phase of the pandemic by rapidly adopting digital solutions and advanced technology tools. Objective: The aim of this review is to describe the digital solutions that have been reported in the early scientific literature to mitigate the impact of COVID-19 on individuals and health systems. Methods: We conducted a systematic review of early COVID-19–related literature (from January 1 to April 30, 2020) by searching MEDLINE and medRxiv with appropriate terms to find relevant literature on the use of digital technologies in response to the pandemic. We extracted study characteristics such as the paper title, journal, and publication date, and we categorized the retrieved papers by the type of technology and patient needs addressed. We built a scoring rubric by cross-classifying the patient needs with the type of technology. We also extracted information and classified each technology reported by the selected articles according to health care system target, grade of innovation, and scalability to other geographical areas. Results: The search identified 269 articles, of which 124 full-text articles were assessed and included in the review after screening. Most of the selected articles addressed the use of digital technologies for diagnosis, surveillance, and prevention. We report that most of these digital solutions and innovative technologies have been proposed for the diagnosis of COVID-19. In particular, within the reviewed articles, we identified numerous suggestions on the use of artificial intelligence (AI)–powered tools for the diagnosis and screening of COVID-19. Digital technologies are also useful for prevention and surveillance measures, such as contact-tracing apps and monitoring of internet searches and social media usage. Fewer scientific contributions address the use of digital technologies for lifestyle empowerment or patient engagement. Conclusions: In the field of diagnosis, digital solutions that integrate with traditional methods, such as AI-based diagnostic algorithms based both on imaging and clinical data, appear to be promising. For surveillance, digital apps have already proven their effectiveness; however, problems related to privacy and usability remain. For other patient needs, several solutions have been proposed, such as telemedicine or telehealth tools. These tools have long been available, but this historical moment may actually be favoring their definitive large-scale adoption. It is worth taking advantage of the impetus provided by the crisis; it is also important to keep track of the digital solutions currently being proposed to implement best practices and models of care in future and to adopt at least some of the solutions proposed in the scientific literature, especially in national health systems, which have proved to be particularly resistant to the digital transition in recent years. %M 33079693 %R 10.2196/22280 %U http://www.jmir.org/2020/11/e22280/ %U https://doi.org/10.2196/22280 %U http://www.ncbi.nlm.nih.gov/pubmed/33079693 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 11 %P e21684 %T Exploring the Role of Media Sources on COVID-19–Related Discrimination Experiences and Concerns Among Asian People in the United States: Cross-Sectional Survey Study %A Yu,Nan %A Pan,Shuya %A Yang,Chia-chen %A Tsai,Jiun-Yi %+ School of Journalism and Communication, Renmin University of China, 59 Zhongguancun St, Beijing, 100082, China, 86 1082500855, shuya@ruc.edu.cn %K COVID-19 %K discrimination %K Asians %K Asian Americans %K media source %K social media %K prejudice  %D 2020 %7 6.11.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Media coverage and scholarly research have reported that Asian people who reside in the United States have been the targets of racially motivated incidents during the COVID-19 pandemic. Objective: This study aimed to examine the types of discrimination and worries experienced by Asians and Asian Americans living in the United States during the pandemic, as well as factors that were associated with everyday discrimination experience and concerns about future discrimination that the Asian community may face. Methods: A cross-sectional online survey was conducted. A total of 235 people who identified themselves as Asian or Asian American and resided in the United States completed the questionnaire. Results: Our study suggested that up to a third of Asians surveyed had experienced some type of discrimination. Pooling the responses “very often,” “often,” and “sometimes,” the percentages for each experienced discrimination type ranged between 14%-34%. In total, 49%-58% of respondents expressed concerns about discrimination in the future. The most frequently experienced discrimination types, as indicated by responses “very often” and “often,” were “people act as if they think you are dangerous” (25/235, 11%) and “being treated with less courtesy or respect” (24/235, 10%). About 14% (32/235) of individuals reported very often, often, or sometimes being threatened or harassed. In addition, social media use was significantly associated with a higher likelihood of experiencing discrimination (β=.18, P=.01) and having concerns about future episodes of discrimination the community may face (β=.20, P=.005). Use of print media was also positively associated with experiencing discrimination (β=.31, P<.001). Conclusions: Our study provided important empirical evidence regarding the various types of discrimination Asians residing in the United States experienced or worried about during the COVID-19 pandemic. The relationship between media sources and the perception of racial biases in this group was also identified. We noted the role of social media in reinforcing the perception of discrimination experience and concerns about future discrimination among Asians during this outbreak. Our results indicate several practical implications for public health agencies. To reduce discrimination against Asians during the pandemic, official sources and public health professionals should be cognizant of the possible impacts of stigmatizing cues in media reports on activating racial biases. Furthermore, Asians or Asian Americans could also be informed that using social media to obtain COVID-19 information is associated with an increase in concerns about future discrimination, and thus they may consider approaching this media source with caution. %M 33108307 %R 10.2196/21684 %U http://www.jmir.org/2020/11/e21684/ %U https://doi.org/10.2196/21684 %U http://www.ncbi.nlm.nih.gov/pubmed/33108307 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 11 %P e19665 %T A Patient Self-Checkup App for COVID-19: Development and Usage Pattern Analysis %A Heo,JoonNyung %A Sung,MinDong %A Yoon,Sangchul %A Jang,Jinkyu %A Lee,Wonwoo %A Han,Deokjae %A Kim,Hyung-Jun %A Kim,Han-Kyeol %A Han,Ji Hyuk %A Seog,Woong %A Ha,Beomman %A Park,Yu Rang %+ Department of Biomedical Systems Informatics, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea, 82 222282493, yurangpark@yuhs.ac %K COVID-19 %K mobile app %K smartphone %K mobile phone %K self-checkup %D 2020 %7 6.11.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Clear guidelines for a patient with suspected COVID-19 infection are unavailable. Many countries rely on assessments through a national hotline or telecommunications, but this only adds to the burden of an already overwhelmed health care system. In this study, we developed an algorithm and a web application to help patients get screened. Objective: This study aims to aid the general public by developing a web-based application that helps patients decide when to seek medical care during a novel disease outbreak. Methods: The algorithm was developed via consultations with 6 physicians who directly screened, diagnosed, and/or treated patients with COVID-19. The algorithm mainly focused on when to test a patient in order to allocate limited resources more efficiently. The application was designed to be mobile-friendly and deployed on the web. We collected the application usage pattern data from March 1 to March 27, 2020. We evaluated the association between the usage pattern and the numbers of COVID-19 confirmed, screened, and mortality cases by access location and digital literacy by age group. Results: The algorithm used epidemiological factors, presence of fever, and other symptoms. In total, 83,460 users accessed the application 105,508 times. Despite the lack of advertisement, almost half of the users accessed the application from outside of Korea. Even though the digital literacy of the 60+ years age group is half of that of individuals in their 50s, the number of users in both groups was similar for our application. Conclusions: We developed an expert-opinion–based algorithm and web-based application for screening patients. This innovation can be helpful in circumstances where information on a novel disease is insufficient and may facilitate efficient medical resource allocation. %M 33079692 %R 10.2196/19665 %U https://www.jmir.org/2020/11/e19665 %U https://doi.org/10.2196/19665 %U http://www.ncbi.nlm.nih.gov/pubmed/33079692 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 11 %P e22287 %T The COVID-19 Pandemic: A Pandemic of Lockdown Loneliness and the Role of Digital Technology %A Shah,Syed Ghulam Sarwar %A Nogueras,David %A van Woerden,Hugo Cornelis %A Kiparoglou,Vasiliki %+ NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, OX3 9DU, United Kingdom, 44 10865 221262, sarwar.shah@ouh.nhs.uk %K COVID-19 %K coronavirus %K pandemic %K social isolation %K loneliness %K lockdown %K social distancing %K digital technology %K social connectedness %K social networking %K online digital tools %D 2020 %7 5.11.2020 %9 Viewpoint %J J Med Internet Res %G English %X The focus of this perspective is on lockdown loneliness, which we define as loneliness resulting from social disconnection as a result of enforced social distancing and lockdowns during the COVID-19 pandemic. We also explore the role of digital technology in tackling lockdown loneliness amid the pandemic. In this regard, we highlight and discuss a number of the key relevant issues: a description of lockdown loneliness, the burden of lockdown loneliness during the COVID-19 pandemic, characteristics of people who are more likely to be affected by lockdown loneliness, factors that could increase the risk of loneliness, lockdown loneliness as an important public health issue, tackling loneliness during the pandemic, digital technology tools for social connection and networking during the pandemic, assessment of digital technology tools from the end users’ perspectives, and access to and use of digital technology for tackling lockdown loneliness during the COVID-19 pandemic. We suggest that the most disadvantaged and vulnerable people who are more prone to lockdown loneliness are provided with access to digital technology so that they can connect socially with their loved ones and others; this could reduce loneliness resulting from social distancing and lockdowns during the COVID-19 crisis. Nonetheless, some key issues such as access to and knowledge of digital technology tools must be considered. In addition, the involvement of all key stakeholders (family and friends, social care providers, and clinicians and health allied professionals) should be ensured. %M 33108313 %R 10.2196/22287 %U http://www.jmir.org/2020/11/e22287/ %U https://doi.org/10.2196/22287 %U http://www.ncbi.nlm.nih.gov/pubmed/33108313 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 11 %P e21875 %T Telemedicine Usage Among Urologists During the COVID-19 Pandemic: Cross-Sectional Study %A Dubin,Justin M %A Wyant,W Austin %A Balaji,Navin C %A Ong,William LK %A Kettache,Reda H %A Haffaf,Malik %A Zouari,Skander %A Santillan,Diego %A Autrán Gómez,Ana Maria %A Sadeghi-Nejad,Hossein %A Loeb,Stacy %A Borin,James F %A Gomez Rivas,Juan %A Grummet,Jeremy %A Ramasamy,Ranjith %A Teoh,Jeremy Y C %+ Department of Urology, University of Miami Miller School of Medicine, 1120 NW 14th Street, Miami, FL, 33136, United States, 1 973 634 8677, jdubin50@gmail.com %K coronavirus %K COVID-19 %K technology %K telemedicine %K telehealth %K urology %K cross-sectional %K perception %K usability %K barrier %K implementation %D 2020 %7 5.11.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Prior to the COVID-19 pandemic, urology was one of the specialties with the lowest rates of telemedicine and videoconferencing use. Common barriers to the implementation of telemedicine included a lack of technological literacy, concerns with reimbursement, and resistance to changes in the workplace. In response to the COVID-19 pandemic declared in March 2020, the delivery of urological services globally has quickly shifted to telemedicine to account for the mass clinical, procedural, and operative cancellations, inadequate personal protective equipment, and shortage of personnel. Objective: The aim of this study was to investigate current telemedicine usage by urologists, urologists’ perceptions on the necessity of in-person clinic appointments, the usability of telemedicine, and the current barriers to its implementation. Methods: We conducted a global, cross-sectional, web-based survey to investigate the use of telemedicine before and after the COVID-19 pandemic. Urologists’ perceived usability of telemedicine was assessed using a modified Delphi approach to create questions based on a modified version of the validated Telehealth Usability Questionnaire (TUQ). For the purposes of this study, telemedicine was defined as video calls only. Results: A total of 620 urologists from 58 different countries and 6 continents participated in the survey. Prior to COVID-19, 15.8% (n=98) of urologists surveyed were using telemedicine in their clinical practices; during the pandemic, that proportion increased to 46.1% (n=283). Of the urologists without telemedicine experience, interest in telemedicine usage increased from 43.7% (n=139) to 80.8% (n=257) during the COVID-19 pandemic. Among urologists that used telemedicine during the pandemic, 80.9% (n=244) were interested in continuing to use it in their practice. The three most commonly used platforms were Zoom, Doxy.me, and Epic, and the top three barriers to implementing telemedicine were patients’ lack of technological comprehension, patients’ lack of access to the required technology, and reimbursement concerns. Conclusions: This is the first study to quantify the use, usability, and pervading interest in telemedicine among urologists during the COVID-19 pandemic. In the face of this pandemic, urologists’ usage of telemedicine nearly tripled, demonstrating their ability to adopt and adapt telemedicine into their practices, but barriers involving the technology itself are still preventing many from utilizing it despite increasing interest. %M 33031047 %R 10.2196/21875 %U https://www.jmir.org/2020/11/e21875 %U https://doi.org/10.2196/21875 %U http://www.ncbi.nlm.nih.gov/pubmed/33031047 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 11 %P e21646 %T COVID-19 and the Gendered Use of Emojis on Twitter: Infodemiology Study %A Al-Rawi,Ahmed %A Siddiqi,Maliha %A Morgan,Rosemary %A Vandan,Nimisha %A Smith,Julia %A Wenham,Clare %+ Simon Fraser University, Schrum Science Centre-K 9653, Burnaby, BC, V5A 1S6, Canada, 1 7787824419, aalrawi@sfu.ca %K emojis %K social media %K Twitter %K gender %K COVID-19 %K sentiment %K meaning %D 2020 %7 5.11.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The online discussion around the COVID-19 pandemic is multifaceted, and it is important to examine the different ways by which online users express themselves. Since emojis are used as effective vehicles to convey ideas and sentiments, they can offer important insight into the public’s gendered discourses about the pandemic. Objective: This study aims at exploring how people of different genders (eg, men, women, and sex and gender minorities) are discussed in relation to COVID-19 through the study of Twitter emojis. Methods: We collected over 50 million tweets referencing the hashtags #Covid-19 and #Covid19 for a period of more than 2 months in early 2020. Using a mixed method, we extracted three data sets containing tweets that reference men, women, and sexual and gender minorities, and we then analyzed emoji use along each gender category. We identified five major themes in our analysis including morbidity fears, health concerns, employment and financial issues, praise for frontline workers, and unique gendered emoji use. The top 600 emojis were manually classified based on their sentiment, indicating how positive, negative, or neutral each emoji is and studying their use frequencies. Results: The findings indicate that the majority of emojis are overwhelmingly positive in nature along the different genders, but sexual and gender minorities, and to a lesser extent women, are discussed more negatively than men. There were also many differences alongside discourses of men, women, and gender minorities when certain topics were discussed, such as death, financial and employment matters, gratitude, and health care, and several unique gendered emojis were used to express specific issues like community support. Conclusions: Emoji research can shed light on the gendered impacts of COVID-19, offering researchers an important source of information on health crises as they happen in real time. %M 33052871 %R 10.2196/21646 %U http://www.jmir.org/2020/11/e21646/ %U https://doi.org/10.2196/21646 %U http://www.ncbi.nlm.nih.gov/pubmed/33052871 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 7 %N 2 %P e23827 %T Leveraging Digital Technology to Overcome Barriers in the Prosthetic and Orthotic Industry: Evaluation of its Applicability and Use During the COVID-19 Pandemic %A Binedell,Trevor %A Subburaj,Karupppasamy %A Wong,Yoko %A Blessing,Lucienne T M %+ SUTD-MIT International Design Centre, Engineering Product Development, Singapore University of Technology and Design, 8 Somapah Rd, Singapore, 65 6303 6600, trevor_binedell@ttsh.com.sg %K rehabilitation %K telehealth %K telemedicine %K 3D printing %K additive manufacturing %K prosthetics %K orthotics %K assistive technologies %K amputee %K stroke %K virtual %K COVID-19 %D 2020 %7 5.11.2020 %9 Original Paper %J JMIR Rehabil Assist Technol %G English %X Background: The prosthetic and orthotic industry typically provides an artisan “hands-on” approach to the assessment and fitting of orthopedic devices. Despite growing interest in digital technology for prosthetic and orthotic service provision, little is known of the quantum of use and the extent to which the current pandemic has accelerated the adoption. Objective: This study’s aim is to assess the use of digital technology in prosthetics and orthotics, and whether its use can help overcome challenges posed by the current COVID-19 pandemic. Methods: A web-based survey of working prosthetists, orthotists, and lower limb patients was conducted between June and July 2020 and divided into three sections: lower limb amputees, prosthetist and orthotist (P&O) currently using digital technologies in their practice, and P&O not using any digital technology. Input was sought from industry and academia experts for the development of the survey. Descriptive analyses were performed for both qualitative (open-ended questions) and quantitative data. Results: In total, 113 individuals responded to the web-based survey. There were 83 surveys included in the analysis (patients: n=13, 15%; prosthetists and orthotists: n=70, 85%). There were 30 surveys excluded because less than 10% of the questions were answered. Out of 70 P&Os, 31 (44%) used digital technologies. Three dimensional scanning and digital imaging were the leading technologies being used (27/31, 88%), primarily for footwear (18/31, 58%), ankle-foot orthoses, and transtibial and transfemoral sockets (14/31, 45%). Digital technology enables safer care during COVID-19 with 24 out of 31 (77%) respondents stating it improves patient outcomes. Singapore was significantly less certain that the industry's future is digital (P=.04). The use of virtual care was reported by the P&O to be beneficial for consultations, education, patient monitoring, or triaging purposes. However, the technology could not overcome inherent barriers such as the lack of details normally obtained during a physical assessment. Conclusions: Digital technology is transforming health care. The current pandemic highlights its usefulness in providing safer care, but digital technology must be implemented thoughtfully and designed to address issues that are barriers to current adoption. Technology advancements using virtual platforms, digitalization methods, and improved connectivity will continue to change the future of health care delivery. The prosthetic and orthotic industry should keep an open mind and move toward creating the required infrastructure to support this digital transformation, even if the world returns to pre–COVID-19 days. %M 33006946 %R 10.2196/23827 %U http://rehab.jmir.org/2020/2/e23827/ %U https://doi.org/10.2196/23827 %U http://www.ncbi.nlm.nih.gov/pubmed/33006946 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 4 %P e23081 %T Concerns and Misconceptions About the Australian Government’s COVIDSafe App: Cross-Sectional Survey Study %A Thomas,Rae %A Michaleff,Zoe A %A Greenwood,Hannah %A Abukmail,Eman %A Glasziou,Paul %+ Institute for Evidence-Based Healthcare, Bond University, University Drive, Robina, 4229, Australia, 61 5595 5521, rthomas@bond.edu.au %K health %K policy %K COVID-19 %K digital tracing app %K COVIDSafe %D 2020 %7 4.11.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Timely and effective contact tracing is an essential public health measure for curbing the transmission of COVID-19. App-based contact tracing has the potential to optimize the resources of overstretched public health departments. However, its efficiency is dependent on widespread adoption. Objective: This study aimed to investigate the uptake of the Australian Government’s COVIDSafe app among Australians and examine the reasons why some Australians have not downloaded the app. Methods: An online national survey, with representative quotas for age and gender, was conducted between May 8 and May 11, 2020. Participants were excluded if they were a health care professional or had been tested for COVID-19. Results: Of the 1802 potential participants contacted, 289 (16.0%) were excluded prior to completing the survey, 13 (0.7%) declined, and 1500 (83.2%) participated in the survey. Of the 1500 survey participants, 37.3% (n=560) had downloaded the COVIDSafe app, 18.7% (n=280) intended to do so, 27.7% (n=416) refused to do so, and 16.3% (n=244) were undecided. Equally proportioned reasons for not downloading the app included privacy (165/660, 25.0%) and technical concerns (159/660, 24.1%). Other reasons included the belief that social distancing was sufficient and the app was unnecessary (111/660, 16.8%), distrust in the government (73/660, 11.1%), and other miscellaneous responses (eg, apathy and following the decisions of others) (73/660, 11.1%). In addition, knowledge about COVIDSafe varied among participants, as some were confused about its purpose and capabilities. Conclusions: For the COVIDSafe app to be accepted by the public and used correctly, public health messages need to address the concerns of citizens, specifically privacy, data storage, and technical capabilities. Understanding the specific barriers preventing the uptake of contact tracing apps provides the opportunity to design targeted communication strategies aimed at strengthening public health initiatives, such as downloading and correctly using contact tracing apps. %M 33048826 %R 10.2196/23081 %U http://publichealth.jmir.org/2020/4/e23081/ %U https://doi.org/10.2196/23081 %U http://www.ncbi.nlm.nih.gov/pubmed/33048826 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 11 %P e22131 %T COVID-19 Outcome Prediction and Monitoring Solution for Military Hospitals in South Korea: Development and Evaluation of an Application %A Heo,JoonNyung %A Park,Ji Ae %A Han,Deokjae %A Kim,Hyung-Jun %A Ahn,Daeun %A Ha,Beomman %A Seog,Woong %A Park,Yu Rang %+ Department of Biomedical Systems Informatics, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea, 82 2 2228 2493, yurangpark@yuhs.ac %K COVID-19 %K patient management %K prediction model %K military medicine %K proportional hazards models %K outcome %K prediction %K monitoring %K app %K usability %K prediction %K modeling %D 2020 %7 4.11.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: COVID-19 has officially been declared as a pandemic, and the spread of the virus is placing sustained demands on public health systems. There are speculations that the COVID-19 mortality differences between regions are due to the disparities in the availability of medical resources. Therefore, the selection of patients for diagnosis and treatment is essential in this situation. Military personnel are especially at risk for infectious diseases; thus, patient selection with an evidence-based prognostic model is critical for them. Objective: This study aims to assess the usability of a novel platform used in the military hospitals in Korea to gather data and deploy patient selection solutions for COVID-19. Methods: The platform’s structure was developed to provide users with prediction results and to use the data to enhance the prediction models. Two applications were developed: a patient’s application and a physician’s application. The primary outcome was requiring an oxygen supplement. The outcome prediction model was developed with patients from four centers. A Cox proportional hazards model was developed. The outcome of the model for the patient’s application was the length of time from the date of hospitalization to the date of the first oxygen supplement use. The demographic characteristics, past history, patient symptoms, social history, and body temperature were considered as risk factors. A usability study with the Post-Study System Usability Questionnaire (PSSUQ) was conducted on the physician’s application on 50 physicians. Results: The patient’s application and physician’s application were deployed on the web for wider availability. A total of 246 patients from four centers were used to develop the outcome prediction model. A small percentage (n=18, 7.32%) of the patients needed professional care. The variables included in the developed prediction model were age; body temperature; predisease physical status; history of cardiovascular disease; hypertension; visit to a region with an outbreak; and symptoms of chills, feverishness, dyspnea, and lethargy. The overall C statistic was 0.963 (95% CI 0.936-0.99), and the time-dependent area under the receiver operating characteristic curve ranged from 0.976 at day 3 to 0.979 at day 9. The usability of the physician’s application was good, with an overall average of the responses to the PSSUQ being 2.2 (SD 1.1). Conclusions: The platform introduced in this study enables evidence-based patient selection in an effortless and timely manner, which is critical in the military. With a well-designed user experience and an accurate prediction model, this platform may help save lives and contain the spread of the novel virus, COVID-19. %M 33048824 %R 10.2196/22131 %U https://www.jmir.org/2020/11/e22131 %U https://doi.org/10.2196/22131 %U http://www.ncbi.nlm.nih.gov/pubmed/33048824 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 11 %P e21099 %T Health Perceptions and Misconceptions Regarding COVID-19 in China: Online Survey Study %A Zhou,Jiawei %A Ghose,Bishwajit %A Wang,Ruoxi %A Wu,Ruijun %A Li,Zhifei %A Huang,Rui %A Feng,Da %A Feng,Zhanchun %A Tang,Shangfeng %+ School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan, China, 86 13349895639, sftang2018@hust.edu.cn %K COVID-19 %K perceptions %K knowledge %K coronavirus %K SARS-CoV-2 %K pandemic %K rapid %K online %K surveys %K public health %D 2020 %7 2.11.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Great efforts have been made to prevent the spread of COVID-19, including national initiatives to promote the change of personal behaviors. The lessons learned from the 2003 SARS outbreak indicate that knowledge and attitudes about infectious diseases are related to panic among the population, which may further complicate efforts to prevent the spread of infectious diseases. Misunderstandings may result in behaviors such as underestimation, panic, and taking ineffective measures to avoid infection; these behaviors are likely to cause the epidemic to spread further. Objective: The purpose of this study is to assess public health perceptions and misunderstandings about COVID-19 in China, and to propose targeted response measures based on the findings to control the development of the epidemic. Methods: The study was conducted in April 2020 through an online survey, with participants in 8 provinces in Eastern, Central, and Western China. We designed a questionnaire with a health knowledge section consisting of 5 questions (4 conventional questions and 1 misleading question) on clinical features of and preventive measures against COVID-19. Descriptive statistics, chi-square analysis, binary logistic regression, and Mantel-Haenszel hierarchical analysis were used for statistical analysis. Results: In total, 4788 participants completed the survey and the mean knowledge score was 4.63 (SD 0.67), gained mainly through experts (76.1%), television (60.0%), newspapers (57.9%), and opinions (46.6%) and videos (42.9%) from social media. Compared to those who obtained information from only 1 or 2 channels, people who obtained information from >3 channels had increased health perception and a better ability to identify misleading information. Suggestions from experts were the most positive information source (χ2=41.61), while information on social media was the most misleading. Those aged >60 years (OR 1.52, 95% CI 1.10-2.11), those with a lower or middle income (OR 1.36, 95% CI 1.00-1.83), those not working and not able to work (OR 1.83, 95% CI 1.04-3.21), those with a household income <100,000 RMB (2 suspected symptoms (OR 2.95, 95% CI 1.50-5.80) were more likely to be misled by videos on social media, but the error correction effect of expert advice was limited in these groups. Conclusions: Multiple information channels can improve public health perception and the identification of misleading information during the COVID-19 pandemic. Videos on social media increased the risk of rumor propagation among vulnerable groups. We suggest the government should strengthen social media regulation and increase experts’ influence on the targeted vulnerable populations to reduce the risk of rumors spreading. %M 33027037 %R 10.2196/21099 %U https://www.jmir.org/2020/11/e21099 %U https://doi.org/10.2196/21099 %U http://www.ncbi.nlm.nih.gov/pubmed/33027037 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 11 %P e19574 %T Perception of the COVID-19 Pandemic Among Patients With Inflammatory Bowel Disease in the Time of Telemedicine: Cross-Sectional Questionnaire Study %A Zingone,Fabiana %A Siniscalchi,Monica %A Savarino,Edoardo Vincenzo %A Barberio,Brigida %A Cingolani,Linda %A D'Incà,Renata %A De Filippo,Francesca Romana %A Camera,Silvia %A Ciacci,Carolina %+ Inflammatory Bowel Disease Center, Department of Medicine, Surgery, Dentistry, Scuola Medica Salernitana, University of Salerno, University Hospital San Giovanni di Dio e Ruggi d’Aragona, Via San Leonardo 1, Salerno, 84131, Italy, 39 089672635, cciacci@unisa.it %K COVID-19 %K IBD %K ulcerative colitis %K Crohn disease %K telemedicine %K biologic agents %K perception %K survey %D 2020 %7 2.11.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: After the COVID-19 outbreak, the Italian Government stopped most regular health care activity. As a result, patients with inflammatory bowel disease (IBD) had limited access to outpatient clinics and hospitals. Objective: This study aimed to analyze the perception of the COVID-19 emergency among patients with IBD during the early weeks of the lockdown. Methods: We invited adult patients with IBD from the University of Salerno (Campania, South Italy) and the University of Padua (Veneto, North Italy) by email to answer an ad hoc anonymous survey about COVID-19. We also collected data on demographic and disease characteristics. Results: In total, 167 patients with IBD from Padua and 83 patients from Salerno answered the survey (age: mean 39.7 years, SD 13.9 years; female: n=116, 46.4%). We found that patients with IBD were particularly worried about the COVID-19 pandemic (enough: 77/250, 30.8%; much/very much: 140/250, 56.0%), as they felt more vulnerable to COVID-19 due to their condition (enough: 70/250, 28.0%; much/very much: 109/250, 43.6%). Patients with IBD from the red zone of Veneto were more worried than patients from Campania (P=.001), and men felt more susceptible to the virus than women (P=.05). Additionally, remote medicine was appreciated more by younger patients than older patients (P=.04). Conclusions: The results of our survey demonstrate that the lockdown had a significant impact on the psychological aspects of patients with IBD and suggest the need for increasing communication with patients with IBD (eg, through telemedicine) to ensure patients receive adequate health care, correct information, and proper psychological support. %M 33006945 %R 10.2196/19574 %U https://www.jmir.org/2020/11/e19574 %U https://doi.org/10.2196/19574 %U http://www.ncbi.nlm.nih.gov/pubmed/33006945 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 11 %P e23361 %T openEHR Archetype Use and Reuse Within Multilingual Clinical Data Sets: Case Study %A Leslie,Heather %+ Atomica Informatics, Fitzroy, Australia, 61 418966670, heather.leslie@atomicainformatics.com %K openEHR %K archetype %K template %K reuse %K clinical informatics %K COVID-19 %K standard %K crowd sourced %K data set %K data quality %K multilingual %K EHR %K electronic health record %K SARS-CoV-2 %D 2020 %7 2.11.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Despite electronic health records being in existence for over 50 years, our ability to exchange health data remains frustratingly limited. Commonly used clinical content standards, and the information models that underpin them, are primarily related to health data exchange, and so are usually document- or message-focused. In contrast, over the past 12 years, the Clinical Models program at openEHR International has gradually established a governed, coordinated, and coherent ecosystem of clinical information models, known as openEHR archetypes. Each archetype is designed as a maximal data set for a universal use-case, intended for reuse across various health data sets, known as openEHR templates. To date, only anecdotal evidence has been available to indicate if the hypothesis of archetype reuse across templates is feasible and scalable. As a response to the COVID-19 pandemic, between February and July 2020, 7 openEHR templates were independently created to represent COVID-19–related data sets for symptom screening, confirmed infection reporting, clinical decision support, and research. Each of the templates prioritized reuse of existing use-case agnostic archetypes found in openEHR International's online Clinical Knowledge Manager tool as much as possible. This study is the first opportunity to investigate archetype reuse within a range of diverse, multilingual openEHR templates. Objective: This study aims to investigate the use and reuse of openEHR archetypes across the 7 openEHR templates as an initial investigation about the reuse of information models across data sets used for a variety of clinical purposes. Methods: Analysis of both the number of occurrences of archetypes and patterns of occurrence within 7 discrete templates was carried out at the archetype or clinical concept level. Results: Across all 7 templates collectively, 203 instances of 58 unique archetypes were used. The most frequently used archetype occurred 24 times across 4 of the 7 templates. Total data points per template ranged from 40 to 179. Archetype instances per template ranged from 10 to 62. Unique archetype occurrences ranged from 10 to 28. Existing archetype reuse of use-case agnostic archetypes ranged from 40% to 90%. Total reuse of use-case agnostic archetypes ranged from 40% to 100%. Conclusions: Investigation of the amount of archetype reuse across the 7 openEHR templates in this initial study has demonstrated significant reuse of archetypes, even across unanticipated, novel modeling challenges and multilingual deployments. While the trigger for the development of each of these templates was the COVID-19 pandemic, the templates represented a variety of types of data sets: symptom screening, infection report, clinical decision support for diagnosis and treatment, and secondary use or research. The findings support the openEHR hypothesis that it is possible to create a shared, public library of standards-based, vendor-neutral clinical information models that can be reused across a diverse range of health data sets. %M 33035176 %R 10.2196/23361 %U https://www.jmir.org/2020/11/e23361 %U https://doi.org/10.2196/23361 %U http://www.ncbi.nlm.nih.gov/pubmed/33035176 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 10 %P e22835 %T Depression, Anxiety, and Lifestyle Among Essential Workers: A Web Survey From Brazil and Spain During the COVID-19 Pandemic %A De Boni,Raquel Brandini %A Balanzá-Martínez,Vicent %A Mota,Jurema Correa %A Cardoso,Taiane De Azevedo %A Ballester,Pedro %A Atienza-Carbonell,Beatriz %A Bastos,Francisco I %A Kapczinski,Flavio %+ Institute of Scientific and Technological Communication and Information in Health, Oswaldo Cruz Foundation, Av Brasil 4365 Pavilhao Haity Moussatche, Room 229, Rio de Janeiro, 21040-360, Brazil, 55 21 3865 3231, raqueldeboni@gmail.com %K COVID-19 %K depression %K anxiety %K lifestyle %K Brazil %K Spain %D 2020 %7 30.10.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Essential workers have been shown to present a higher prevalence of positive screenings for anxiety and depression during the COVID-19 pandemic. Individuals from countries with socioeconomic inequalities may be at increased risk for mental health disorders. Objective: We aimed to assess the prevalence and predictors of depression, anxiety, and their comorbidity among essential workers in Brazil and Spain during the COVID-19 pandemic. Methods: A web survey was conducted between April and May 2020 in both countries. The main outcome was a positive screening for depression only, anxiety only, or both. Lifestyle was measured using a lifestyle multidimensional scale adapted for the COVID-19 pandemic (Short Multidimensional Inventory Lifestyle Evaluation–Confinement). A multinomial logistic regression model was performed to evaluate the factors associated with depression, anxiety, and the presence of both conditions. Results: From the 22,786 individuals included in the web survey, 3745 self-reported to be essential workers. Overall, 8.3% (n=311), 11.6% (n=434), and 27.4% (n=1027) presented positive screenings for depression, anxiety, and both, respectively. After adjusting for confounding factors, the multinomial model showed that an unhealthy lifestyle increased the likelihood of depression (adjusted odds ratio [AOR] 4.00, 95% CI 2.72-5.87), anxiety (AOR 2.39, 95% CI 1.80-3.20), and both anxiety and depression (AOR 8.30, 95% CI 5.90-11.7). Living in Brazil was associated with increased odds of depression (AOR 2.89, 95% CI 2.07-4.06), anxiety (AOR 2.81, 95%CI 2.11-3.74), and both conditions (AOR 5.99, 95% CI 4.53-7.91). Conclusions: Interventions addressing lifestyle may be useful in dealing with symptoms of common mental disorders during the strain imposed among essential workers by the COVID-19 pandemic. Essential workers who live in middle-income countries with higher rates of inequality may face additional challenges. Ensuring equitable treatment and support may be an important challenge ahead, considering the possible syndemic effect of the social determinants of health. %M 33038075 %R 10.2196/22835 %U http://www.jmir.org/2020/10/e22835/ %U https://doi.org/10.2196/22835 %U http://www.ncbi.nlm.nih.gov/pubmed/33038075 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 10 %P e21743 %T Intersection of the Web-Based Vaping Narrative With COVID-19: Topic Modeling Study %A Janmohamed,Kamila %A Soale,Abdul-Nasah %A Forastiere,Laura %A Tang,Weiming %A Sha,Yongjie %A Demant,Jakob %A Airoldi,Edoardo %A Kumar,Navin %+ Human Nature Lab, Department of Sociology, Yale University, 17 Hillhouse Ave, New Haven, CT, 06511, United States, 1 4754148375, navin.kumar@yale.edu %K vaping %K COVID-19 %K topic modeling %K web-based narrative %K modeling %K trend %K narrative %K social media %K internet %K web-based health information %D 2020 %7 30.10.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 outbreak was designated a global pandemic on March 11, 2020. The relationship between vaping and contracting COVID-19 is unclear, and information on the internet is conflicting. There is some scientific evidence that vaping cannabidiol (CBD), an active ingredient in cannabis that is obtained from the hemp plant, or other substances is associated with more severe manifestations of COVID-19. However, there is also inaccurate information that vaping can aid COVID-19 treatment, as well as expert opinion that CBD, possibly administered through vaping, can mitigate COVID-19 symptoms. Thus, it is necessary to study the spread of inaccurate information to better understand how to promote scientific knowledge and curb inaccurate information, which is critical to the health of vapers. Inaccurate information about vaping and COVID-19 may affect COVID-19 treatment outcomes. Objective: Using structural topic modeling, we aimed to map temporal trends in the web-based vaping narrative (a large data set comprising web-based vaping chatter from several sources) to indicate how the narrative changed from before to during the COVID-19 pandemic. Methods: We obtained data using a textual query that scanned a data pool of approximately 200,000 different domains (4,027,172 documents and 361,100,284 words) such as public internet forums, blogs, and social media, from August 1, 2019, to April 21, 2020. We then used structural topic modeling to understand changes in word prevalence and semantic structures within topics around vaping before and after December 31, 2019, when COVID-19 was reported to the World Health Organization. Results: Broadly, the web-based vaping narrative can be organized into the following groups or archetypes: harms from vaping; Vaping Regulation; Vaping as Harm Reduction or Treatment; and Vaping Lifestyle. Three archetypes were observed prior to the emergence of COVID-19; however, four archetypes were identified post–COVID-19 (Vaping as Harm Reduction or Treatment was the additional archetype). A topic related to CBD product preference emerged after COVID-19 was first reported, which may be related to the use of CBD by vapers as a COVID-19 treatment. Conclusions: Our main finding is the emergence of a vape-administered CBD treatment narrative around COVID-19 when comparing the web-based vaping narratives before and during the COVID-19 pandemic. These results are key to understanding how vapers respond to inaccurate information about COVID-19, optimizing treatment of vapers who contract COVID-19, and possibly minimizing instances of inaccurate information. The findings have implications for the management of COVID-19 among vapers and the monitoring of web-based content pertinent to tobacco to develop targeted interventions to manage COVID-19 among vapers. %M 33001829 %R 10.2196/21743 %U http://www.jmir.org/2020/10/e21743/ %U https://doi.org/10.2196/21743 %U http://www.ncbi.nlm.nih.gov/pubmed/33001829 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 10 %P e19152 %T Rapid Serological Assays and SARS-CoV-2 Real-Time Polymerase Chain Reaction Assays for the Detection of SARS-CoV-2: Comparative Study %A Paradiso,Angelo Virgilio %A De Summa,Simona %A Loconsole,Daniela %A Procacci,Vito %A Sallustio,Anna %A Centrone,Francesca %A Silvestris,Nicola %A Cafagna,Vito %A De Palma,Giuseppe %A Tufaro,Antonio %A Garrisi,Vito Michele %A Chironna,Maria %+ Science Direction, IRCCS Istituto Tumori Giovanni Paolo II, Viale Orazio Flacco 65, Bari, 70124, Italy, 39 805555900, a.paradiso@oncologico.bari.it %K SARS-CoV-2 %K COVID-19 %K serological test %K RT-PCR %D 2020 %7 30.10.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Real-time polymerase chain reaction (RT-PCR) testing for the identification of viral nucleic acid is the current standard for the diagnosis of SARS-CoV-2 infection, but technical issues limit its utilization for large-scale screening. Serological immunoglobulin M (IgM)/IgG testing has been proposed as a useful tool for detecting SARS-CoV-2 exposure. Objective: The objective of our study was to compare the results of the rapid serological VivaDiag test for SARS-CoV-2–related IgM/IgG detection with those of the standard RT-PCR laboratory test for identifying SARS-CoV-2 nucleic acid. Methods: We simultaneously performed both serological and molecular tests with a consecutive series of 191 symptomatic patients. The results provided by a new rapid serological colorimetric test for analyzing IgM/IgG expression were compared with those of RT-PCR testing for SARS-CoV-2 detection. Results: Of the 191 subjects, 70 (36.6%) tested positive for SARS-CoV-2 based on RT-PCR results, while 34 (17.3%) tested positive based on serological IgM/IgG expression. Additionally, 13 (6.8%) subjects tested positive based on serological test results, but also tested negative based on RT-PCR results. The rapid serological test had a sensitivity of 30% and a specificity of 89% compared to the standard RT-PCR assay. Interestingly, the performance of both assays improved 8 days after symptom appearance. After 10 days had passed since symptom appearance, the predictive value of the rapid serological test was higher than that of the standard molecular assay (proportion of positive results: 40% vs 20%). Multivariate analysis showed that age >58 years (P<.01) and period of >15 days after symptom onset (P<.02) were significant and independent factors associated with serological test positivity. Conclusions: The rapid serological test analyzed in this study seems limited in terms of usefulness when diagnosing SARS-CoV-2 infection. However, it may be useful for providing relevant information on people’s immunoreaction to COVID-19 exposure. %M 33031048 %R 10.2196/19152 %U http://www.jmir.org/2020/10/e19152/ %U https://doi.org/10.2196/19152 %U http://www.ncbi.nlm.nih.gov/pubmed/33031048 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 10 %P e23148 %T Performance of Digital Contact Tracing Tools for COVID-19 Response in Singapore: Cross-Sectional Study %A Huang,Zhilian %A Guo,Huiling %A Lee,Yee-Mun %A Ho,Eu Chin %A Ang,Hou %A Chow,Angela %+ Department of Clinical Epidemiology, Office of Clinical Epidemiology, Analytics, and Knowledge, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore, 65 63577477, angela_chow@ttsh.com.sg %K infectious disease %K real-time locating systems %K electronic medical records %K COVID-19 %K contact tracing %K public health %D 2020 %7 29.10.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Effective contact tracing is labor intensive and time sensitive during the COVID-19 pandemic, but also essential in the absence of effective treatment and vaccines. Singapore launched the first Bluetooth-based contact tracing app—TraceTogether—in March 2020 to augment Singapore’s contact tracing capabilities. Objective: This study aims to compare the performance of the contact tracing app—TraceTogether—with that of a wearable tag-based real-time locating system (RTLS) and to validate them against the electronic medical records at the National Centre for Infectious Diseases (NCID), the national referral center for COVID-19 screening. Methods: All patients and physicians in the NCID screening center were issued RTLS tags (CADI Scientific) for contact tracing. In total, 18 physicians were deployed to the NCID screening center from May 10 to May 20, 2020. The physicians activated the TraceTogether app (version 1.6; GovTech) on their smartphones during shifts and urged their patients to use the app. We compared patient contacts identified by TraceTogether and those identified by RTLS tags within the NCID vicinity during physicians’ 10-day posting. We also validated both digital contact tracing tools by verifying the physician-patient contacts with the electronic medical records of 156 patients who attended the NCID screening center over a 24-hour time frame within the study period. Results: RTLS tags had a high sensitivity of 95.3% for detecting patient contacts identified either by the system or TraceTogether while TraceTogether had an overall sensitivity of 6.5% and performed significantly better on Android phones than iPhones (Android: 9.7%, iPhone: 2.7%; P<.001). When validated against the electronic medical records, RTLS tags had a sensitivity of 96.9% and specificity of 83.1%, while TraceTogether only detected 2 patient contacts with physicians who did not attend to them. Conclusions: TraceTogether had a much lower sensitivity than RTLS tags for identifying patient contacts in a clinical setting. Although the tag-based RTLS performed well for contact tracing in a clinical setting, its implementation in the community would be more challenging than TraceTogether. Given the uncertainty of the adoption and capabilities of contact tracing apps, policy makers should be cautioned against overreliance on such apps for contact tracing. Nonetheless, leveraging technology to augment conventional manual contact tracing is a necessary move for returning some normalcy to life during the long haul of the COVID-19 pandemic. %M 33006944 %R 10.2196/23148 %U http://mhealth.jmir.org/2020/10/e23148/ %U https://doi.org/10.2196/23148 %U http://www.ncbi.nlm.nih.gov/pubmed/33006944 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 10 %P e22716 %T Determinants of Patients’ Intention to Use the Online Inquiry Services Provided by Internet Hospitals: Empirical Evidence From China %A Li,Dehe %A Hu,Yinhuan %A Pfaff,Holger %A Wang,Liuming %A Deng,Lu %A Lu,Chuntao %A Xia,Shixiao %A Cheng,Siyu %A Zhu,Ximin %A Wu,Xiaoyue %+ School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, No. 13, Hangkong Road, Wuhan, Hubei, , China, 86 13554285879, hyh288@hotmail.com %K internet hospital %K health care–seeking intention %K online inquiry %K theory of planned behavior %K chronic disease %K structural equation modeling %K China %K COVID-19 %K intention %K online service %K eHealth %K behavior %K modeling %D 2020 %7 29.10.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Internet hospitals show great potential for adequately fulfilling people’s demands for high-quality outpatient services, and with the normalization of the epidemic prevention and control of COVID-19, internet hospitals play an increasingly important role in delivering health services to the public. However, the factors that influence patients’ intention to use the online inquiry services provided by internet hospitals remain unclear. Understanding the patients’ behavioral intention is necessary to support the development of internet hospitals in China and promote patients’ intention to use online inquiry services provided by internet hospitals during the prevention and control of the COVID-19 epidemic. Objective: The purpose of this study is to identify the determinants of patients’ intention to use the online inquiry services provided by internet hospitals based on the theory of planned behavior (TPB). Methods: The hypotheses of our research model were developed based on the TPB. A questionnaire was developed through patient interviews, verified using a presurvey, and used for data collection for this study. The cluster sampling technique was used to include respondents with chronic diseases. Structural equation modeling was used to test the research hypotheses. Results: A total of 638 valid responses were received from patients with chronic diseases. The goodness-of-fit indexes corroborated that the research model was a good fit for the collected data. The model explained 45.9% of the variance in attitude toward the behavior and 60.5% of the variance in behavioral intention. Perceived behavioral control and perceived severity of disease had the strongest total effects on behavioral intention (β=.624, P=.004 and β=.544, P=.003, respectively). Moreover, perceived convenience, perceived information risk, emotional preference, and health consciousness had indirect effects on behavioral intention, and these effects were mediated by attitude toward the behavior. Among the four constructs, perceived convenience had the highest indirect effect on behavioral intention (β=.207; P=.001). Conclusions: Perceived behavioral control and perceived severity of disease are the most important determinants of patients’ intention to use the online inquiry services provided by internet hospitals. Therefore, internet hospitals should further optimize the design of online service delivery and ensure a reasonable assembly of high-quality experts, which will benefit the promotion of patients’ adoption intention toward online inquiry services for health purposes. Perceived convenience, emotional preference, and perceived risks also have effects on behavioral intention. Therefore, the relevant quality control standards and regulations for internet hospitals should be further developed and improved, and the measures to protect personal information should be strengthened to ensure the patient safety. Our study supports the use of the TPB in explaining patients’ intention to use online inquiry services provided by internet hospitals. %M 33006941 %R 10.2196/22716 %U http://www.jmir.org/2020/10/e22716/ %U https://doi.org/10.2196/22716 %U http://www.ncbi.nlm.nih.gov/pubmed/33006941 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 6 %N 2 %P e21697 %T The Impact of COVID-19 on Cancer Screening: Challenges and Opportunities %A Cancino,Ramon S %A Su,Zhaohui %A Mesa,Ruben %A Tomlinson,Gail E %A Wang,Jing %+ Department of Family & Community Medicine, Joe R & Teresa Lozano Long School of Medicine, UT Health San Antonio, 7703 Floyd Curl Dr, San Antonio, TX, 78229, United States, 1 2165710888, cancinor@uthscsa.edu %K cancer %K screening %K COVID-19 %K coronavirus %K telemedicine %K social determinants %K health %K education %K training %K social media %K campaign %K branding %K cobranding %D 2020 %7 29.10.2020 %9 Viewpoint %J JMIR Cancer %G English %X Cancer is a leading cause of death in the United States and across the globe. Cancer screening is an effective preventive measure that can reduce cancer incidence and mortality. While cancer screening is integral to cancer control and prevention, due to the COVID-19 outbreak many screenings have either been canceled or postponed, leaving a vast number of patients without access to recommended health care services. This disruption to cancer screening services may have a significant impact on patients, health care practitioners, and health systems. In this paper, we aim to offer a comprehensive view of the impact of COVID-19 on cancer screening. We present the challenges COVID-19 has exerted on patients, health care practitioners, and health systems as well as potential opportunities that could help address these challenges. %M 33027039 %R 10.2196/21697 %U http://cancer.jmir.org/2020/2/e21697/ %U https://doi.org/10.2196/21697 %U http://www.ncbi.nlm.nih.gov/pubmed/33027039 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 10 %P e22069 %T Smartphone-Enabled, Telehealth-Based Family Conferences in Palliative Care During the COVID-19 Pandemic: Pilot Observational Study %A Wu,Yu-Rui %A Chou,Tzu-Jung %A Wang,Yi-Jen %A Tsai,Jaw-Shiun %A Cheng,Shao-Yi %A Yao,Chien-An %A Peng,Jen-Kuei %A Hu,Wen-Yu %A Chiu,Tai-Yuan %A Huang,Hsien-Liang %+ Department of Family Medicine, National Taiwan University Hospital, 7 Chung-Shan South Road, Taipei City, 100, Taiwan, 886 2 23123456 ext 66832, tennishuang@gmail.com %K smartphone %K mobile phone %K telehealth %K family conference %K shared decision making %K COVID-19 %K palliative care %K end-of-life care %D 2020 %7 28.10.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: In the palliative care setting, infection control measures implemented due to COVID-19 have become barriers to end-of-life care discussions (eg, discharge planning and withdrawal of life-sustaining treatments) between patients, their families, and multidisciplinary medical teams. Strict restrictions in terms of visiting hours and the number of visitors have made it difficult to arrange in-person family conferences. Phone-based telehealth consultations may be a solution, but the lack of nonverbal cues may diminish the clinician-patient relationship. In this context, video-based, smartphone-enabled family conferences have become important. Objective: We aimed to establish a smartphone-enabled telehealth model for palliative care family conferences. Our model integrates principles from the concept of shared decision making (SDM) and the value, acknowledge, listen, understand, and elicit (VALUE) approach. Methods: Family conferences comprised three phases designed according to telehealth implementation guidelines—the previsit, during-visit, and postvisit phases. We incorporated the following SDM elements into the model: “team talk,” “option talk,” and “decision talk.” The model has been implemented at a national cancer treatment center in Taiwan since February 2020. Results: From February to April 2020, 14 telehealth family conferences in the palliative care unit were analyzed. The patients’ mean age was 73 (SD 10.1) years; 6 out of 14 patients (43%) were female and 12 (86%) were married. The primary caregiver joining the conference virtually comprised mostly of spouses and children (n=10, 71%). The majority of participants were terminally ill patients with cancer (n=13, 93%), with the exception of 1 patient with stroke. Consensus on care goals related to discharge planning and withdrawal of life-sustaining treatments was reached in 93% (n=13) of cases during the family conferences. In total, 5 families rated the family conferences as good or very good (36%), whereas 9 were neutral (64%). Conclusions: Smartphone-enabled telehealth for palliative care family conferences with SDM and VALUE integration demonstrated high satisfaction for families. In most cases, it was effective in reaching consensus on care decisions. The model may be applied to other countries to promote quality in end-of-life care in the midst of the COVID-19 pandemic. %M 33021483 %R 10.2196/22069 %U http://mhealth.jmir.org/2020/10/e22069/ %U https://doi.org/10.2196/22069 %U http://www.ncbi.nlm.nih.gov/pubmed/33021483 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 10 %P e21801 %T Clinical Characteristics and Prognostic Factors for Intensive Care Unit Admission of Patients With COVID-19: Retrospective Study Using Machine Learning and Natural Language Processing %A Izquierdo,Jose Luis %A Ancochea,Julio %A , %A Soriano,Joan B %+ Hospital Universitario de La Princesa, Diego de León 62, Madrid, 28005, Spain, 34 618867769, jbsoriano2@gmail.com %K artificial intelligence %K big data %K COVID-19 %K electronic health records %K tachypnea %K SARS-CoV-2 %K predictive model %D 2020 %7 28.10.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Many factors involved in the onset and clinical course of the ongoing COVID-19 pandemic are still unknown. Although big data analytics and artificial intelligence are widely used in the realms of health and medicine, researchers are only beginning to use these tools to explore the clinical characteristics and predictive factors of patients with COVID-19. Objective: Our primary objectives are to describe the clinical characteristics and determine the factors that predict intensive care unit (ICU) admission of patients with COVID-19. Determining these factors using a well-defined population can increase our understanding of the real-world epidemiology of the disease. Methods: We used a combination of classic epidemiological methods, natural language processing (NLP), and machine learning (for predictive modeling) to analyze the electronic health records (EHRs) of patients with COVID-19. We explored the unstructured free text in the EHRs within the Servicio de Salud de Castilla-La Mancha (SESCAM) Health Care Network (Castilla-La Mancha, Spain) from the entire population with available EHRs (1,364,924 patients) from January 1 to March 29, 2020. We extracted related clinical information regarding diagnosis, progression, and outcome for all COVID-19 cases. Results: A total of 10,504 patients with a clinical or polymerase chain reaction–confirmed diagnosis of COVID-19 were identified; 5519 (52.5%) were male, with a mean age of 58.2 years (SD 19.7). Upon admission, the most common symptoms were cough, fever, and dyspnea; however, all three symptoms occurred in fewer than half of the cases. Overall, 6.1% (83/1353) of hospitalized patients required ICU admission. Using a machine-learning, data-driven algorithm, we identified that a combination of age, fever, and tachypnea was the most parsimonious predictor of ICU admission; patients younger than 56 years, without tachypnea, and temperature <39 degrees Celsius (or >39 ºC without respiratory crackles) were not admitted to the ICU. In contrast, patients with COVID-19 aged 40 to 79 years were likely to be admitted to the ICU if they had tachypnea and delayed their visit to the emergency department after being seen in primary care. Conclusions: Our results show that a combination of easily obtainable clinical variables (age, fever, and tachypnea with or without respiratory crackles) predicts whether patients with COVID-19 will require ICU admission. %M 33090964 %R 10.2196/21801 %U http://www.jmir.org/2020/10/e21801/ %U https://doi.org/10.2196/21801 %U http://www.ncbi.nlm.nih.gov/pubmed/33090964 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 10 %P e21476 %T Artificial Intelligence for COVID-19: Rapid Review %A Chen,Jiayang %A See,Kay Choong %+ Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore, 117597, Singapore, 65 84369198, jiayang_chen1997@live.com %K coronavirus %K deep learning %K machine learning %K medical informatics %K computing %K SARS virus %K COVID-19 %K artificial intelligence %K review %D 2020 %7 27.10.2020 %9 Review %J J Med Internet Res %G English %X Background: COVID-19 was first discovered in December 2019 and has since evolved into a pandemic. Objective: To address this global health crisis, artificial intelligence (AI) has been deployed at various levels of the health care system. However, AI has both potential benefits and limitations. We therefore conducted a review of AI applications for COVID-19. Methods: We performed an extensive search of the PubMed and EMBASE databases for COVID-19–related English-language studies published between December 1, 2019, and March 31, 2020. We supplemented the database search with reference list checks. A thematic analysis and narrative review of AI applications for COVID-19 was conducted. Results: In total, 11 papers were included for review. AI was applied to COVID-19 in four areas: diagnosis, public health, clinical decision making, and therapeutics. We identified several limitations including insufficient data, omission of multimodal methods of AI-based assessment, delay in realization of benefits, poor internal/external validation, inability to be used by laypersons, inability to be used in resource-poor settings, presence of ethical pitfalls, and presence of legal barriers. AI could potentially be explored in four other areas: surveillance, combination with big data, operation of other core clinical services, and management of patients with COVID-19. Conclusions: In view of the continuing increase in the number of cases, and given that multiple waves of infections may occur, there is a need for effective methods to help control the COVID-19 pandemic. Despite its shortcomings, AI holds the potential to greatly augment existing human efforts, which may otherwise be overwhelmed by high patient numbers. %M 32946413 %R 10.2196/21476 %U http://www.jmir.org/2020/10/e21476/ %U https://doi.org/10.2196/21476 %U http://www.ncbi.nlm.nih.gov/pubmed/32946413 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 10 %P e19791 %T Investigating the Prevalence of Reactive Online Searching in the COVID-19 Pandemic: Infoveillance Study %A Badell-Grau,Rafael A %A Cuff,Jordan Patrick %A Kelly,Brendan P %A Waller-Evans,Helen %A Lloyd-Evans,Emyr %+ School of Biosciences, Cardiff University, Sir Martin Evans Building, Museum Avenue, Cardiff, CF10 3AX, United Kingdom, 44 (0)29 2087 4304, lloyd-evanse@cardiff.ac.uk %K chloroquine %K coronavirus %K COVID-19 %K fake news %K Google Trends %K ibuprofen %K infodemiology %K misinformation %D 2020 %7 27.10.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The ongoing pandemic has placed an unprecedented strain on global society, health care, governments, and mass media. Public dissemination of government policies, medical interventions, and misinformation has been remarkably rapid and largely unregulated during the COVID-19 pandemic, resulting in increased misinterpretations, miscommunication, and public panic. Being the first full-scale global pandemic of the digital age, COVID-19 has presented novel challenges pertinent to government advice, the spread of news and misinformation, and the trade-off between the accessibility of science and the premature public use of unproven medical interventions.  Objective: This study aims to assess the use of internet search terms relating to COVID-19 information and misinformation during the global pandemic, identify which were most used in six affected countries, investigate any temporal trends and the likely propagators of key search terms, and determine any correlation between the per capita cases and deaths with the adoption of these search terms in each of the six countries. Methods: This study uses relative search volume data extracted from Google Trends for search terms linked to the COVID-19 pandemic alongside per capita case and mortality data extracted from the European Open Data Portal to identify the temporal dynamics of the spread of news and misinformation during the global pandemic in six affected countries (Australia, Germany, Italy, Spain, the United Kingdom, and the United States). A correlation analysis was carried out to ascertain any correlation between the temporal trends of search term use and the rise of per capita mortality and disease cases. Results: Of the selected search terms, most were searched immediately following promotion by governments, public figures, or viral circulation of information, but also in relation to the publication of scientific resources, which were sometimes misinterpreted before further dissemination. Strong correlations were identified between the volume of these COVID-19–related search terms (overall mean Spearman rho 0.753, SD 0.158), and per capita mortality (mean per capita deaths Spearman rho 0.690, SD 0.168) and cases (mean per capita cases Spearman rho 0.800, SD 0.112). Conclusions: These findings illustrate the increased rate and volume of the public consumption of novel information during a global health care crisis. The positive correlation between mortality and online searching, particularly in countries with lower COVID-19 testing rates, may demonstrate the imperative to safeguard official communications and dispel misinformation in these countries. Online news, government briefings, and social media provide a powerful tool for the dissemination of important information to the public during pandemics, but their misuse and the presentation of misrepresented medical information should be monitored, minimized, and addressed to safeguard public safety. Ultimately, governments, public health authorities, and scientists have a moral imperative to safeguard the truth and maintain an accessible discourse with the public to limit fear. %M 32915763 %R 10.2196/19791 %U https://www.jmir.org/2020/10/e19791 %U https://doi.org/10.2196/19791 %U http://www.ncbi.nlm.nih.gov/pubmed/32915763 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 10 %P e21632 %T Physical Distancing Measures and Walking Activity in Middle-aged and Older Residents in Changsha, China, During the COVID-19 Epidemic Period: Longitudinal Observational Study %A Wang,Yilun %A Zhang,Yuqing %A Bennell,Kim %A White,Daniel Kenta %A Wei,Jie %A Wu,Ziying %A He,Hongyi %A Liu,Shaohui %A Luo,Xianghang %A Hu,Shuo %A Zeng,Chao %A Lei,Guanghua %+ Department of Orthopaedics, Xiangya Hospital, Central South University, Xiangya Road 87, Changsha, 410008, China, 86 0731 89753006, lei_guanghua@csu.edu.cn %K COVID-19 %K pandemic %K physical distancing %K steps %K walking activity %D 2020 %7 26.10.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Physical distancing measures taken to contain COVID-19 transmission may substantially reduce physical activity levels and cause individuals to adopt a more sedentary lifestyle. Objective: The objective of this study is to determine if there was any change in daily steps, an important component of daily physical activity, and examine risk factors for frequent low daily steps during the COVID-19 epidemic. Methods: We used data collected from the Step Study, a population-based longitudinal study of walking activity among residents aged ≥40 years in Changsha, China. Daily steps were collected via a smartphone linked to WeChat, a social networking platform. We plotted mean daily steps and the prevalence of low daily steps (≤1500 steps/day) 30 days before (reference period) and 30 days after (epidemic period) January 21, 2020 (date of the first COVID-19 case diagnosed in Changsha), and compared it with the same corresponding period from 2019. We examined the association of risk factors with the prevalence of frequent low daily steps (≤1500 steps/day for ≥14 days) using logistic regression. Results: Among 3544 participants (mean age 51.6 years; n=1226 females, 34.6%), mean daily steps dropped from 8097 to 5440 and the prevalence of low daily steps increased from 3% (2287/76,136 person-day) to 18.5% (12,951/70,183 person-day) during the reference and epidemic periods, respectively. No such phenomenon was observed during the corresponding period in 2019. Older age (P for interaction=.001) and female sex (P for interaction<.001) were both associated with a higher prevalence of frequent low daily steps and were more pronounced during the epidemic period. More education was associated with a lower prevalence of frequent low daily steps during the reference period but not the epidemic period (P for interaction=.34). Body mass index or comorbidity were not associated with frequent low daily steps during either period. Conclusions: Daily steps of Changsha residents aged ≥40 years dropped significantly during the COVID-19 period, especially among older adults and females. Although successful physical distancing, measured by the rapid downward trend in daily step counts of residents, played a critical role in the containment of the COVID-19 epidemic, our findings of an increase in the prevalence of frequent low daily steps raise concerns about unintended effects on physical activity. %M 33027035 %R 10.2196/21632 %U http://www.jmir.org/2020/10/e21632/ %U https://doi.org/10.2196/21632 %U http://www.ncbi.nlm.nih.gov/pubmed/33027035 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 7 %N 10 %P e21814 %T Digital Phenotyping to Enhance Substance Use Treatment During the COVID-19 Pandemic %A Hsu,Michael %A Ahern,David K %A Suzuki,Joji %+ Department of Psychiatry, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, United States, 1 617 732 5000, mhsu7@partners.org %K digital phenotyping %K digital psychiatry %K addiction %K psychiatry %K coronavirus %K COVID-19 %K digital health %K treatment %K drugs %K substance use disorder %D 2020 %7 26.10.2020 %9 Viewpoint %J JMIR Ment Health %G English %X Due to the COVID-19 pandemic, many clinical addiction treatment programs have been required to transition to telephonic or virtual visits. Novel solutions are needed to enhance substance use treatment during a time when many patients are disconnected from clinical care and social support. Digital phenotyping, which leverages the unique functionality of smartphone sensors (GPS, social behavior, and typing patterns), can buttress clinical treatment in a remote, scalable fashion. Specifically, digital phenotyping has the potential to improve relapse prediction and intervention, relapse detection, and overdose intervention. Digital phenotyping may enhance relapse prediction through coupling machine learning algorithms with the enormous amount of collected behavioral data. Activity-based analysis in real time can potentially be used to prevent relapse by warning substance users when they approach locational triggers such as bars or liquor stores. Wearable devices detect when a person has relapsed to substances through measuring physiological changes such as electrodermal activity and locomotion. Despite the initial promise of this approach, privacy, security, and barriers to access are important issues to address. %M 33031044 %R 10.2196/21814 %U http://mental.jmir.org/2020/10/e21814/ %U https://doi.org/10.2196/21814 %U http://www.ncbi.nlm.nih.gov/pubmed/33031044 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 10 %P e22679 %T Video Consultations for Older Adults With Multimorbidity During the COVID-19 Pandemic: Protocol for an Exploratory Qualitative Study %A Lee,Eng Sing %A Lee,Poay Sian Sabrina %A Chew,Evelyn Ai Ling %A Muthulingam,Gayathri %A Koh,Hui Li %A Tan,Shu Yun %A Ding,Yew Yoong %+ Clinical Research Unit, National Healthcare Group Polyclinics, 3 Fusionopolis Link, Nexus@one-north, Singapore, 138543, Singapore, 65 64966215, eng_sing_lee@nhgp.com.sg %K COVID-19 %K multimorbidity %K older adults %K telemedicine %K video consultation %K elderly %K telehealth %K morbidity %K protocol %K chronic disease %K high risk %K qualitative %D 2020 %7 26.10.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: Multimorbidity, the coexistence of multiple chronic conditions in an individual, is a growing public health challenge. Amidst the COVID-19 pandemic, physical distancing remains an indispensable measure to limit the spread of the virus. This pertains especially to those belonging to high-risk groups, namely older adults with multimorbidity. In-person visits are discouraged for this cohort; hence, there is a need for an alternative form of consultation such as video consultations to continue the provision of care. Objective: The potential of video consultations has been explored in several studies. However, the emergence of COVID-19 presents us with an unprecedented opportunity to explore the use of this technological innovation in a time when physical distancing is imperative. This study will evaluate the sustainability of video consultations on a micro-, meso-, and macro-level by assessing the views of patients, physicians, and organizational and national policymakers, respectively. Methods: The NASSS (nonadoption, abandonment, scale-up, spread, and sustainability) framework was designed as a guide for the development of health care technologies. In this study, the implementation of and experiences related to video consultations will be studied using the NASSS framework. Individual in-depth interviews or focus group discussions will be conducted with participants using the Zoom platform. Data will be analyzed by at least two investigators trained in qualitative methodology, organized thematically, and coded in two phases—an initial phase and a focused selective phase. All disagreements will be resolved by consulting the larger research team until consensus is reached. Results: This study was approved for funding from the Geriatric Education and Research Institute. Ethics approval was obtained from the National Healthcare Group Domain Specific Review Board (reference #2020/00760). Study recruitment commenced in July 2020. The results of the data analysis are expected to be available by the end of the year. Conclusions: This study aims to evaluate the adoption and sustainability of video consultations for older adults with multimorbidity during the pandemic as well as post COVID-19. The study will yield knowledge that will challenge the current paradigm on how care is being delivered for community-dwelling older adults with multimorbidity. Findings will be shared with administrators in the health care sector in order to enhance the safety and quality of these video consultations to improve patient care for this group of population. International Registered Report Identifier (IRRID): DERR1-10.2196/22679 %M 33027034 %R 10.2196/22679 %U http://www.researchprotocols.org/2020/10/e22679/ %U https://doi.org/10.2196/22679 %U http://www.ncbi.nlm.nih.gov/pubmed/33027034 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 10 %P e22624 %T Topics, Trends, and Sentiments of Tweets About the COVID-19 Pandemic: Temporal Infoveillance Study %A Chandrasekaran,Ranganathan %A Mehta,Vikalp %A Valkunde,Tejali %A Moustakas,Evangelos %+ Department of Information and Decision Sciences, University of Illinois at Chicago, 601 S Morgan St, Chicago, IL, 60607, United States, 1 3129962847, ranga@uic.edu %K coronavirus %K infodemiology %K infoveillance %K infodemic %K twitter %K COVID-19 %K social media %K sentiment analysis %K trends %K topic modeling %K disease surveillance %D 2020 %7 23.10.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: With restrictions on movement and stay-at-home orders in place due to the COVID-19 pandemic, social media platforms such as Twitter have become an outlet for users to express their concerns, opinions, and feelings about the pandemic. Individuals, health agencies, and governments are using Twitter to communicate about COVID-19. Objective: The aims of this study were to examine key themes and topics of English-language COVID-19–related tweets posted by individuals and to explore the trends and variations in how the COVID-19–related tweets, key topics, and associated sentiments changed over a period of time from before to after the disease was declared a pandemic. Methods: Building on the emergent stream of studies examining COVID-19–related tweets in English, we performed a temporal assessment covering the time period from January 1 to May 9, 2020, and examined variations in tweet topics and sentiment scores to uncover key trends. Combining data from two publicly available COVID-19 tweet data sets with those obtained in our own search, we compiled a data set of 13.9 million English-language COVID-19–related tweets posted by individuals. We use guided latent Dirichlet allocation (LDA) to infer themes and topics underlying the tweets, and we used VADER (Valence Aware Dictionary and sEntiment Reasoner) sentiment analysis to compute sentiment scores and examine weekly trends for 17 weeks. Results: Topic modeling yielded 26 topics, which were grouped into 10 broader themes underlying the COVID-19–related tweets. Of the 13,937,906 examined tweets, 2,858,316 (20.51%) were about the impact of COVID-19 on the economy and markets, followed by spread and growth in cases (2,154,065, 15.45%), treatment and recovery (1,831,339, 13.14%), impact on the health care sector (1,588,499, 11.40%), and governments response (1,559,591, 11.19%). Average compound sentiment scores were found to be negative throughout the examined time period for the topics of spread and growth of cases, symptoms, racism, source of the outbreak, and political impact of COVID-19. In contrast, we saw a reversal of sentiments from negative to positive for prevention, impact on the economy and markets, government response, impact on the health care industry, and treatment and recovery. Conclusions: Identification of dominant themes, topics, sentiments, and changing trends in tweets about the COVID-19 pandemic can help governments, health care agencies, and policy makers frame appropriate responses to prevent and control the spread of the pandemic. %M 33006937 %R 10.2196/22624 %U http://www.jmir.org/2020/10/e22624/ %U https://doi.org/10.2196/22624 %U http://www.ncbi.nlm.nih.gov/pubmed/33006937 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 10 %P e22043 %T Mental Health During the COVID-19 Pandemic in the United States: Online Survey %A Jewell,Jennifer S %A Farewell,Charlotte V %A Welton-Mitchell,Courtney %A Lee-Winn,Angela %A Walls,Jessica %A Leiferman,Jenn A %+ Colorado School of Public Health, Building 500, 13001 E 17th Place, Aurora, CO , United States, 1 303 519 6620, jennifer.jewell@cuanschutz.edu %K COVID-19 %K mental health %K pandemic %K depression %K anxiety %K well-being %K stress %D 2020 %7 23.10.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic has had numerous worldwide effects. In the United States, there have been 8.3 million cases and nearly 222,000 deaths as of October 21, 2020. Based on previous studies of mental health during outbreaks, the mental health of the population will be negatively affected in the aftermath of this pandemic. The long-term nature of this pandemic may lead to unforeseen mental health outcomes and/or unexpected relationships between demographic factors and mental health outcomes. Objective: This research focused on assessing the mental health status of adults in the United States during the early weeks of an unfolding pandemic. Methods: Data was collected from English-speaking adults from early April to early June 2020 using an online survey. The final convenience sample included 1083 US residents. The 71-item survey consisted of demographic questions, mental health and well-being measures, a coping mechanisms checklist, and questions about COVID-19–specific concerns. Hierarchical multivariable logistic regression was used to explore associations among demographic variables and mental health outcomes. Hierarchical linear regression was conducted to examine associations among demographic variables, COVID-19–specific concerns, and mental health and well-being outcomes. Results: Approximately 50% (536/1076) of the US sample was aged ≥45 years. Most of the sample was White (1013/1054, 96%), non-Hispanic (985/1058, 93%), and female (884/1073, 82%). Participants reported high rates of depression (295/1034, 29%), anxiety (342/1007, 34%), and stress (773/1058, 73%). Older individuals were less likely to report depressive symptomology (OR 0.78, P<.001) and anxiety symptomology (OR 0.72, P<.001); in addition, they had lower stress scores (–0.15 points, SE 0.01, P<.001) and increased well-being scores (1.86 points, SE 0.22, P<.001). Individuals who were no longer working due to COVID-19 were 2.25 times more likely to report symptoms of depression (P=.02), had a 0.51-point increase in stress (SE 0.17, P=.02), and a 3.9-point decrease in well-being scores (SE 1.49, P=.009) compared to individuals who were working remotely before and after COVID-19. Individuals who had partial or no insurance coverage were 2-3 times more likely to report depressive symptomology compared to individuals with full coverage (P=.02 and P=.01, respectively). Individuals who were on Medicare/Medicaid and individuals with no coverage were 1.97 and 4.48 times more likely to report moderate or severe anxiety, respectively (P=.03 and P=.01, respectively). Financial and food access concerns were significantly and positively related to depression, anxiety, and stress (all P<.05), and significantly negatively related to well-being (both P<.001). Economy, illness, and death concerns were significantly positively related to overall stress scores (all P<.05). Conclusions: Our findings suggest that many US residents are experiencing high stress, depressive, and anxiety symptomatology, especially those who are underinsured, uninsured, or unemployed. Longitudinal investigation of these variables is recommended. Health practitioners may provide opportunities to allay concerns or offer coping techniques to individuals in need of mental health care. These messages should be shared in person and through practice websites and social media. %M 33006939 %R 10.2196/22043 %U http://formative.jmir.org/2020/10/e22043/ %U https://doi.org/10.2196/22043 %U http://www.ncbi.nlm.nih.gov/pubmed/33006939 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 10 %P e23297 %T COVID-19 Self-Reported Symptom Tracking Programs in the United States: Framework Synthesis %A Koehlmoos,Tracey Pérez %A Janvrin,Miranda Lynn %A Korona-Bailey,Jessica %A Madsen,Cathaleen %A Sturdivant,Rodney %+ Health Services Research Program, Henry M Jackson Foundation for the Advancement of Military Medicine, 6720B Rockledge Dr, Suite 605, Bethesda, MD, United States, 1 6035403059, miranda.janvrin.ctr@usuhs.edu %K COVID-19 %K coronavirus %K framework analysis %K information resources %K patient-reported outcome measures %K self-reported %K surveillance %K monitoring %K symptom tracking %K synthesis %D 2020 %7 22.10.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: With the continued spread of COVID-19 in the United States, identifying potential outbreaks before infected individuals cross the clinical threshold is key to allowing public health officials time to ensure local health care institutions are adequately prepared. In response to this need, researchers have developed participatory surveillance technologies that allow individuals to report emerging symptoms daily so that their data can be extrapolated and disseminated to local health care authorities. Objective: This study uses a framework synthesis to evaluate existing self-reported symptom tracking programs in the United States for COVID-19 as an early-warning tool for probable clusters of infection. This in turn will inform decision makers and health care planners about these technologies and the usefulness of their information to aid in federal, state, and local efforts to mobilize effective current and future pandemic responses. Methods: Programs were identified through keyword searches and snowball sampling, then screened for inclusion. A best fit framework was constructed for all programs that met the inclusion criteria by collating information collected from each into a table for easy comparison. Results: We screened 8 programs; 6 were included in our final framework synthesis. We identified multiple common data elements, including demographic information like race, age, gender, and affiliation (all were associated with universities, medical schools, or schools of public health). Dissimilarities included collection of data regarding smoking status, mental well-being, and suspected exposure to COVID-19. Conclusions: Several programs currently exist that track COVID-19 symptoms from participants on a semiregular basis. Coordination between symptom tracking program research teams and local and state authorities is currently lacking, presenting an opportunity for collaboration to avoid duplication of efforts and more comprehensive knowledge dissemination. %M 33006943 %R 10.2196/23297 %U http://www.jmir.org/2020/10/e23297/ %U https://doi.org/10.2196/23297 %U http://www.ncbi.nlm.nih.gov/pubmed/33006943 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 10 %P e20748 %T Covidom, a Telesurveillance Solution for Home Monitoring Patients With COVID-19 %A Yordanov,Youri %A Dechartres,Agnes %A Lescure,Xavier %A Apra,Caroline %A Villie,Pascaline %A Marchand-Arvier,Jerome %A Debuc,Erwan %A Dinh,Aurélien %A Jourdain,Patrick %A , %+ Sorbonne Université, AP-HP, Hôpital Saint Antoine, Service d'Accueil des Urgences, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, UMR-S 1136, 34 rue Crozatier, Paris, France, 33 171970869, youri.yordanov@aphp.fr %K COVID-19 %K coronavirus disease %K home monitoring %K telesurveillance %K monitoring %K patient %K infectious disease %K app %D 2020 %7 22.10.2020 %9 Viewpoint %J J Med Internet Res %G English %X In a matter of months, COVID-19 has escalated from a cluster of cases in Wuhan, China, to a global pandemic. As the number of patients with COVID-19 grew, solutions for the home monitoring of infected patients became critical. This viewpoint presents a telesurveillance solution—Covidom—deployed in the greater Paris area to monitor patients with COVID-19 in their homes. The system was rapidly developed and is being used on a large scale with more than 65,000 registered patients to date. The Covidom solution combines an easy-to-use and free web application for patients (through which patients fill out short questionnaires on their health status) with a regional control center that monitors and manages alerts (triggered by questionnaire responses) from patients whose health may be deteriorating. This innovative solution could alleviate the burden of health care professionals and systems while allowing for rapid response when patients trigger an alert. %M 33006938 %R 10.2196/20748 %U http://www.jmir.org/2020/10/e20748/ %U https://doi.org/10.2196/20748 %U http://www.ncbi.nlm.nih.gov/pubmed/33006938 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 4 %P e23098 %T Online Public Attention During the Early Days of the COVID-19 Pandemic: Infoveillance Study Based on Baidu Index %A Gong,Xue %A Han,Yangyang %A Hou,Mengchi %A Guo,Rui %+ School of Public Health, Capital Medical University, No 10 Youanmenwai, Xitoutiao, Beijing, China, 86 01083911573, guorui@ccmu.edu.cn %K Baidu Index %K public attention %K time lag cross-correlation analysis %K COVID-19 %D 2020 %7 22.10.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The COVID-19 pandemic has become a global public health event, attracting worldwide attention. As a tool to monitor public awareness, internet search engines have been widely used in public health emergencies. Objective: This study aims to use online search data (Baidu Index) to monitor the public’s attention and verify internet search engines’ function in public attention monitoring of public health emergencies. Methods: We collected the Baidu Index and the case monitoring data from January 20, 2020, to April 20, 2020. We combined the Baidu Index of keywords related to COVID-19 to describe the public attention’s temporal trend and spatial distribution, and conducted the time lag cross-correlation analysis. Results: The Baidu Index temporal trend indicated that the changes of the Baidu Index had a clear correspondence with the development time node of the pandemic. The Baidu Index spatial distribution showed that in the regions of central and eastern China, with denser populations, larger internet user bases, and higher economic development levels, the public was more concerned about COVID-19. In addition, the Baidu Index was significantly correlated with six case indicators of new confirmed cases, new death cases, new cured discharge cases, cumulative confirmed cases, cumulative death cases, and cumulative cured discharge cases. Moreover, the Baidu Index was 0-4 days earlier than new confirmed and new death cases, and about 20 days earlier than new cured and discharged cases while 3-5 days later than the change of cumulative cases. Conclusions: The national public’s demand for epidemic information is urgent regardless of whether it is located in the hardest hit area. The public was more sensitive to the daily new case data that represents the progress of the epidemic, but the public’s attention to the epidemic situation in other areas may lag behind. We could set the Baidu Index as the sentinel and the database in the online infoveillance system for infectious disease and public health emergencies. According to the monitoring data, the government needs to prevent and control the possible outbreak in advance and communicate the risks to the public so as to ensure the physical and psychological health of the public in the epidemic. %M 32960177 %R 10.2196/23098 %U http://publichealth.jmir.org/2020/4/e23098/ %U https://doi.org/10.2196/23098 %U http://www.ncbi.nlm.nih.gov/pubmed/32960177 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 3 %N 2 %P e21608 %T Decrease in Stroke Diagnoses During the COVID-19 Pandemic: Where Did All Our Stroke Patients Go? %A Dula,Adrienne Nicole %A Gealogo Brown,Gretchel %A Aggarwal,Aarushi %A Clark,Kal L %+ Department of Neurology, Dell Medical School, The University of Texas at Austin, 1601 Trinity Street Building B, Austin, TX, 78712, United States, 1 512 495 5922, adrienne.dula@austin.utexas.edu %K stroke %K ischemic stroke %K COVID-19 %K SARS-CoV-2 %K emergency medicine %K cerebrovascular %D 2020 %7 21.10.2020 %9 Viewpoint %J JMIR Aging %G English %X Despite the evidence suggesting a high rate of cerebrovascular complications in patients with SARS-CoV-2, reports have indicated decreasing rates of new ischemic stroke diagnoses during the COVID-19 pandemic. The observed decrease in emergency department (ED) visits is unsurprising during this major crisis, as patients are likely to prioritize avoiding exposure to SARS-CoV-2 over addressing what they may perceive as mild symptoms of headache, lethargy, difficulty speaking, and numbness. In the central and south Texas regions where we practice, we suspect that patient admission, treatment, and discharge volumes for acute stroke treatment have decreased significantly since COVID-19–related shelter-at-home orders were issued. Symptoms of stroke are frequently noticed by a family member, friend, or community member before they are recognized by the patients themselves, and these symptoms may be going unnoticed due to limited face-to-face encounters. This possibility emphasizes the importance of patient education regarding stroke warning signs and symptoms during the current period of isolation and social-distancing. The south Texas population, already saddled with above-average rates of cardiovascular and cerebrovascular disease, has a higher stroke mortality rate compared to Texas and U.S. averages; however, the number of patients presenting to EDs with acute ischemic stroke diagnoses is lower than average. In our viewpoint, we aim to present the relative literature to date and outline our ongoing analyses of the highly affected and diverse stroke populations in San Antonio and Austin, Texas, to answer a simple question: where did all our stroke patients go? %M 33006936 %R 10.2196/21608 %U http://aging.jmir.org/2020/2/e21608/ %U https://doi.org/10.2196/21608 %U http://www.ncbi.nlm.nih.gov/pubmed/33006936 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 10 %P e23197 %T Characteristics and Symptoms of App Users Seeking COVID-19–Related Digital Health Information and Remote Services: Retrospective Cohort Study %A Perlman,Amichai %A Vodonos Zilberg,Alina %A Bak,Peter %A Dreyfuss,Michael %A Leventer-Roberts,Maya %A Vurembrand,Yael %A Jeffries,Howard E %A Fisher,Eyal %A Steuerman,Yael %A Namir,Yinat %A Goldschmidt,Yaara %A Souroujon,Daniel %+ K Health Inc, 298 Fifth Avenue, 7th Floor, New York, NY, 10001, United States, 1 616 304 4654, daniel@khealth.ai %K digital health %K remote care %K symptom checker %K telemedicine %K COVID-19 %K symptom %K cohort study %K self-reported %K online tool %D 2020 %7 20.10.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Patient-facing digital health tools have been promoted to help patients manage concerns related to COVID-19 and to enable remote care and self-care during the COVID-19 pandemic. It has also been suggested that these tools can help further our understanding of the clinical characteristics of this new disease. However, there is limited information on the characteristics and use patterns of these tools in practice. Objective: The aims of this study are to describe the characteristics of people who use digital health tools to address COVID-19–related concerns; explore their self-reported symptoms and characterize the association of these symptoms with COVID-19; and characterize the recommendations provided by digital health tools. Methods: This study used data from three digital health tools on the K Health app: a protocol-based COVID-19 self-assessment, an artificial intelligence (AI)–driven symptom checker, and communication with remote physicians. Deidentified data were extracted on the demographic and clinical characteristics of adults seeking COVID-19–related health information between April 8 and June 20, 2020. Analyses included exploring features associated with COVID-19 positivity and features associated with the choice to communicate with a remote physician. Results: During the period assessed, 71,619 individuals completed the COVID-19 self-assessment, 41,425 also used the AI-driven symptom checker, and 2523 consulted with remote physicians. Individuals who used the COVID-19 self-assessment were predominantly female (51,845/71,619, 72.4%), with a mean age of 34.5 years (SD 13.9). Testing for COVID-19 was reported by 2901 users, of whom 433 (14.9%) reported testing positive. Users who tested positive for COVID-19 were more likely to have reported loss of smell or taste (relative rate [RR] 6.66, 95% CI 5.53-7.94) and other established COVID-19 symptoms as well as ocular symptoms. Users communicating with a remote physician were more likely to have been recommended by the self-assessment to undergo immediate medical evaluation due to the presence of severe symptoms (RR 1.19, 95% CI 1.02-1.32). Most consultations with remote physicians (1940/2523, 76.9%) were resolved without need for referral to an in-person visit or to the emergency department. Conclusions: Our results suggest that digital health tools can help support remote care and self-management of COVID-19 and that self-reported symptoms from digital interactions can extend our understanding of the symptoms associated with COVID-19. %M 32961527 %R 10.2196/23197 %U http://www.jmir.org/2020/10/e23197/ %U https://doi.org/10.2196/23197 %U http://www.ncbi.nlm.nih.gov/pubmed/32961527 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 10 %P e19876 %T Investigating the Impact of COVID-19 Lockdown on the Psychological Health of University Students and Their Attitudes Toward Mobile Mental Health Solutions: Two-Part Questionnaire Study %A Drissi,Nidal %A Alhmoudi,Ayat %A Al Nuaimi,Hana %A Alkhyeli,Mahra %A Alsalami,Shaikha %A Ouhbi,Sofia %+ United Arab Emirates University, , Al Ain, United Arab Emirates, 971 37135568, sofia.ouhbi@uaeu.ac.ae %K COVID-19 %K GHQ-12 %K mobile %K apps %K m-health %K m-mental health %K UAE %K attitudes %K university students %K questionnaire %D 2020 %7 20.10.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 outbreak was first reported to the World Health Organization on December 31, 2019, and it was officially declared a public health emergency of international concern on January 30, 2020. The COVID-19 outbreak and the safety measures taken to control it caused many psychological issues in populations worldwide, such as depression, anxiety, and stress. Objective: The objectives of this study were to assess the psychological effects of the lockdown due to the COVID-19 outbreak on university students in the United Arab Emirates (UAE) and to investigate the students’ awareness of mobile mental health care apps as well as their attitudes toward the use of these apps. Methods: A two-part self-administered web-based questionnaire was delivered to students at United Arab Emirates University. The first part of the questionnaire assessed the mental state of the participants using the 12-item General Health Questionnaire (GHQ-12), while the second part contained questions investigating the participants’ awareness of and attitudes toward mental health care apps. Students were invited to fill out the web-based questionnaire via social media and mailing lists. Results: A total of 154 students participated in the survey, and the majority were female. The results of the GHQ-12 analysis showed that the students were experiencing psychological issues related to depression and anxiety as well as social dysfunction. The results also revealed a lack of awareness of mental health care apps and uncertainty regarding the use of such apps. Approximately one-third of the participants (44/154, 28.6%) suggested preferred functionalities and characteristics of mobile mental health care apps, such as affordable price, simple design, ease of use, web-based therapy, communication with others experiencing the same issues, and tracking of mental status. Conclusions: Like many groups of people worldwide, university students in the UAE were psychologically affected by the lockdown due to the COVID-19 outbreak. Although apps can be useful tools for mental health care delivery, especially in circumstances such as those produced by the outbreak, the students in this study showed a lack of awareness of these apps and mixed attitudes toward them. Improving the digital health literacy of university students in the UAE by increasing their awareness of mental health care apps and the treatment methods and benefits of the apps, as well as involving students in the app creation process, may encourage students to use these tools for mental health care. %M 32969340 %R 10.2196/19876 %U http://formative.jmir.org/2020/10/e19876/ %U https://doi.org/10.2196/19876 %U http://www.ncbi.nlm.nih.gov/pubmed/32969340 %0 Journal Article %@ 2563-6316 %I JMIR Publications %V 1 %N 1 %P e23582 %T A Machine Learning Explanation of the Pathogen-Immune Relationship of SARS-CoV-2 (COVID-19), and a Model to Predict Immunity and Therapeutic Opportunity: A Comparative Effectiveness Research Study %A Luellen,Eric %+ Bioinformatix, Faculty Lane, Box 3628, Interlochen, MI, 49643, United States, 1 4129157468, eluellen@bioinformatix.io %K infectious disease %K SARS-CoV-2 %K COVID-19 %K public health %K immunity %K mass vaccinations %K therapeutics %K stem-cell growth factor-beta %D 2020 %7 19.10.2020 %9 Original Paper %J JMIRx Med %G English %X Background: Approximately 80% of those infected with COVID-19 are immune. They are asymptomatic unknown carriers who can still infect those with whom they come into contact. Understanding what makes them immune could inform public health policies as to who needs to be protected and why, and possibly lead to a novel treatment for those who cannot, or will not, be vaccinated once a vaccine is available. Objective: The primary objectives of this study were to learn if machine learning could identify patterns in the pathogen-host immune relationship that differentiate or predict COVID-19 symptom immunity and, if so, which ones and at what levels. The secondary objective was to learn if machine learning could take such differentiators to build a model that could predict COVID-19 immunity with clinical accuracy. The tertiary purpose was to learn about the relevance of other immune factors. Methods: This was a comparative effectiveness research study on 53 common immunological factors using machine learning on clinical data from 74 similarly grouped Chinese COVID-19–positive patients, 37 of whom were symptomatic and 37 asymptomatic. The setting was a single-center primary care hospital in the Wanzhou District of China. Immunological factors were measured in patients who were diagnosed as SARS-CoV-2 positive by reverse transcriptase-polymerase chain reaction (RT-PCR) in the 14 days before observations were recorded. The median age of the 37 asymptomatic patients was 41 years (range 8-75 years); 22 were female, 15 were male. For comparison, 37 RT-PCR test–positive patients were selected and matched to the asymptomatic group by age, comorbidities, and sex. Machine learning models were trained and compared to understand the pathogen-immune relationship and predict who was immune to COVID-19 and why, using the statistical programming language R. Results: When stem cell growth factor-beta (SCGF-β) was included in the machine learning analysis, a decision tree and extreme gradient boosting algorithms classified and predicted COVID-19 symptom immunity with 100% accuracy. When SCGF-β was excluded, a random-forest algorithm classified and predicted asymptomatic and symptomatic cases of COVID-19 with 94.8% AUROC (area under the receiver operating characteristic) curve accuracy (95% CI 90.17%-100%). In total, 34 common immune factors have statistically significant associations with COVID-19 symptoms (all c<.05), and 19 immune factors appear to have no statistically significant association. Conclusions: The primary outcome was that asymptomatic patients with COVID-19 could be identified by three distinct immunological factors and levels: SCGF-β (>127,637), interleukin-16 (IL-16) (>45), and macrophage colony-stimulating factor (M-CSF) (>57). The secondary study outcome was the suggestion that stem-cell therapy with SCGF-β may be a novel treatment for COVID-19. Individuals with an SCGF-β level >127,637, or an IL-16 level >45 and an M-CSF level >57, appear to be predictively immune to COVID-19 100% and 94.8% (AUROC) of the time, respectively. Testing levels of these three immunological factors may be a valuable tool at the point of care for managing and preventing outbreaks. Further, stem-cell therapy via SCGF-β and M-CSF appear to be promising novel therapeutics for patients with COVID-19. %M 33711083 %R 10.2196/23582 %U https://med.jmirx.org/2020/1/e23582/ %U https://doi.org/10.2196/23582 %U http://www.ncbi.nlm.nih.gov/pubmed/33711083 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 4 %P e22305 %T Deployment of a Smart Handwashing Station in a School Setting During the COVID-19 Pandemic: Field Study %A Herbert,Jeremy %A Horsham,Caitlin %A Ford,Helen %A Wall,Alexander %A Hacker,Elke %+ School of Public Health and Social Work, Queensland University of Technology, 60 Musk Avenue, Brisbane, 4059, Australia, 61 0731389674, elke.hacker@qut.edu.au %K COVID-19 %K hand hygiene %K health promotion %K public health %K preventive medicine %K digital health technology %D 2020 %7 19.10.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Hand hygiene is one of the most effective ways to remove germs, prevent the spread of infectious pathogens, and avoid getting sick. Since the COVID-19 pandemic began, health authorities have been advocating good hand hygiene practices. Objective: The primary aim of this study is to field test a prototype smart handwashing station deployed in a school setting during the COVID-19 pandemic. Methods: We deployed a smart handwashing station and examined key technological considerations including connectivity, security, and data management systems, as well as the health and safety of users. Results: The smart handwashing station was deployed for 10 days in a school setting in Australia during the COVID-19 pandemic. The smart handwashing station’s electrical components remained operational during field testing and underwent robust cleaning protocols each day. The handwashing station was used 1138 times during the field test and there was no COVID-19 transmission at the school during the testing. Conclusions: This study demonstrates that a personalized feedback approach using technology can successfully be implemented at a school and can provide a platform to improve hand hygiene among school-aged children. %M 33006559 %R 10.2196/22305 %U http://publichealth.jmir.org/2020/4/e22305/ %U https://doi.org/10.2196/22305 %U http://www.ncbi.nlm.nih.gov/pubmed/33006559 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 10 %P e20419 %T Solving Community SARS-CoV-2 Testing With Telehealth: Development and Implementation for Screening, Evaluation and Testing %A Joshi,Aditi U %A Lewiss,Resa E %A Aini,Maria %A Babula,Bracken %A Henwood,Patricia C %+ Thomas Jefferson University Hospital, 1020 Samson Street, 239 Thompson, Philadelphia, PA, 19103, United States, 1 2159556844, aditi.joshi@jefferson.edu %K telehealth %K telemedicine %K disaster planning %K pandemic %K COVID-19 %K SARS-CoV-2 %K emergency medicine %K testing %D 2020 %7 16.10.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Telehealth has emerged as a crucial component of the SARS-CoV-2 pandemic emergency response. Simply stated, telehealth is a tool to provide health care from a distance. Jefferson Health has leveraged its acute care telehealth platform to screen, order testing, and manage patients with COVID-19–related concerns. Objective: This study aims to describe the expansion and results of using a telehealth program to increase access to care while minimizing additional potential exposures during the early period of the COVID-19 pandemic. Methods: Screening algorithms for patients with SARS-CoV-2–related complaints were created, and 150 new clinicians were trained within 72 hours to address increased patient demand. Simultaneously, Jefferson Health created mobile testing sites throughout eastern Pennsylvania and the southern New Jersey region. Visit volume, the number of SARS-CoV-2 tests ordered, and the number of positive tests were evaluated, and the volume was compared with preceding time periods. Results: From March 8, 2020, to April 11, 2020, 4663 patients were screened using telehealth, representing a surge in visit volume. There were 1521 patients sent to mobile testing sites, and they received a telephone call from a centralized call center for results. Of the patients who were tested, nearly 20% (n=301) had a positive result. Conclusions: Our model demonstrates how using telehealth for a referral to central testing sites can increase access to community-based care, decrease clinician exposure, and minimize the demand for personal protective equipment. The scaling of this innovation may allow health care systems to focus on preparing for and delivering hospital-based care needs. %M 33006942 %R 10.2196/20419 %U http://mhealth.jmir.org/2020/10/e20419/ %U https://doi.org/10.2196/20419 %U http://www.ncbi.nlm.nih.gov/pubmed/33006942 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 4 %P e19833 %T The Resurgence of Cyber Racism During the COVID-19 Pandemic and its Aftereffects: Analysis of Sentiments and Emotions in Tweets %A Dubey,Akash Dutt %+ Jaipuria Institute of Management, Pratap Nagar, Sanganer, Jaipur, 302017, India, +91 7510099112, drakashddubey@gmail.com %K COVID-19 %K pandemic %K China %K racism %K WHO %K Twitter %K infodemiology %K infodemic %D 2020 %7 15.10.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: With increasing numbers of patients with COVID-19 globally, China and the World Health Organization have been blamed by some for the spread of this disease. Consequently, instances of racism and hateful acts have been reported around the world. When US President Donald Trump used the term “Chinese Virus,” this issue gained momentum, and ethnic Asians are now being targeted. The online situation looks similar, with increases in hateful comments and posts. Objective: The aim of this paper is to analyze the increasing instances of cyber racism during the COVID-19 pandemic, by assessing emotions and sentiments associated with tweets on Twitter. Methods: In total, 16,000 tweets from April 11-16, 2020, were analyzed to determine their associated sentiments and emotions. Statistical analysis was carried out using R. Twitter API and the sentimentr package were used to collect tweets and then evaluate their sentiments, respectively. This research analyzed the emotions and sentiments associated with terms like “Chinese Virus,” “Wuhan Virus,” and “Chinese Corona Virus.” Results: The results suggest that the majority of the analyzed tweets were of negative sentiment and carried emotions of fear, sadness, anger, and disgust. There was a high usage of slurs and profane words. In addition, terms like “China Lied People Died,” “Wuhan Health Organization,” “Kung Flu,” “China Must Pay,” and “CCP is Terrorist” were frequently used in these tweets. Conclusions: This study provides insight into the rise in cyber racism seen on Twitter. Based on the findings, it can be concluded that a substantial number of users are tweeting with mostly negative sentiments toward ethnic Asians, China, and the World Health Organization. %M 32936772 %R 10.2196/19833 %U http://publichealth.jmir.org/2020/4/e19833/ %U https://doi.org/10.2196/19833 %U http://www.ncbi.nlm.nih.gov/pubmed/32936772 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 4 %P e22678 %T Transmission Dynamics of the COVID-19 Epidemic at the District Level in India: Prospective Observational Study %A Saurabh,Suman %A Verma,Mahendra Kumar %A Gautam,Vaishali %A Kumar,Nitesh %A Goel,Akhil Dhanesh %A Gupta,Manoj Kumar %A Bhardwaj,Pankaj %A Misra,Sanjeev %+ Department of Community Medicine and Family Medicine, All India Institute of Medical Sciences, 2nd Floor, Academic Building, 342005, Jodhpur, India, 91 7766906623, drsumansaurabh@gmail.com %K Epidemiology %K SARS-CoV-2 %K COVID-19 %K serial interval %K basic reproduction number %K projection %K outbreak response %K India %K mathematical modeling %K infectious disease %D 2020 %7 15.10.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: On March 9, 2020, the first COVID-19 case was reported in Jodhpur, Rajasthan, in the northwestern part of India. Understanding the epidemiology of COVID-19 at a local level is becoming increasingly important to guide measures to control the pandemic. Objective: The aim of this study was to estimate the serial interval and basic reproduction number (R0) to understand the transmission dynamics of the COVID-19 outbreak at a district level. We used standard mathematical modeling approaches to assess the utility of these factors in determining the effectiveness of COVID-19 responses and projecting the size of the epidemic. Methods: Contact tracing of individuals infected with SARS-CoV-2 was performed to obtain the serial intervals. The median and 95th percentile values of the SARS-CoV-2 serial interval were obtained from the best fits with the weibull, log-normal, log-logistic, gamma, and generalized gamma distributions. Aggregate and instantaneous R0 values were derived with different methods using the EarlyR and EpiEstim packages in R software. Results: The median and 95th percentile values of the serial interval were 5.23 days (95% CI 4.72-5.79) and 13.20 days (95% CI 10.90-18.18), respectively. R0 during the first 30 days of the outbreak was 1.62 (95% CI 1.07-2.17), which subsequently decreased to 1.15 (95% CI 1.09-1.21). The peak instantaneous R0 values obtained using a Poisson process developed by Jombert et al were 6.53 (95% CI 2.12-13.38) and 3.43 (95% CI 1.71-5.74) for sliding time windows of 7 and 14 days, respectively. The peak R0 values obtained using the method by Wallinga and Teunis were 2.96 (95% CI 2.52-3.36) and 2.92 (95% CI 2.65-3.22) for sliding time windows of 7 and 14 days, respectively. R0 values of 1.21 (95% CI 1.09-1.34) and 1.12 (95% CI 1.03-1.21) for the 7- and 14-day sliding time windows, respectively, were obtained on July 6, 2020, using method by Jombert et al. Using the method by Wallinga and Teunis, values of 0.32 (95% CI 0.27-0.36) and 0.61 (95% CI 0.58-0.63) were obtained for the 7- and 14-day sliding time windows, respectively. The projection of cases over the next month was 2131 (95% CI 1799-2462). Reductions of transmission by 25% and 50% corresponding to reasonable and aggressive control measures could lead to 58.7% and 84.0% reductions in epidemic size, respectively. Conclusions: The projected transmission reductions indicate that strengthening control measures could lead to proportionate reductions of the size of the COVID-19 epidemic. Time-dependent instantaneous R0 estimation based on the process by Jombart et al was found to be better suited for guiding COVID-19 response at the district level than overall R0 or instantaneous R0 estimation by the Wallinga and Teunis method. A data-driven approach at the local level is proposed to be useful in guiding public health strategy and surge capacity planning. %M 33001839 %R 10.2196/22678 %U http://publichealth.jmir.org/2020/4/e22678/ %U https://doi.org/10.2196/22678 %U http://www.ncbi.nlm.nih.gov/pubmed/33001839 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 10 %P e22628 %T Knowledge, Awareness, and Attitudes Relating to the COVID-19 Pandemic Among Different Populations in Central China: Cross-Sectional Survey %A Xu,Huifang %A Gonzalez Mendez,Maria Jose %A Guo,Lanwei %A Chen,Qiong %A Zheng,Liyang %A Chen,Peipei %A Cao,Xiaoqin %A Liu,Shuzheng %A Sun,Xibin %A Zhang,Shaokai %A Qiao,Youlin %+ Department of Cancer Epidemiology, Affiliated Cancer Hospital of Zhengzhou University/Henan Cancer Hospital, 127 Dongming Rd, Jinshui District, Zhengzhou, China, 86 037165587346, shaokaizhang@126.com %K COVID-19 %K knowledge %K awareness %K attitude %D 2020 %7 15.10.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic has threatened the health systems of many countries worldwide. Several studies have suggested that the pandemic affects not only physical health but also all aspects of society. A lot of information has been reported about the disease since the beginning of the outbreak. For that reason, it is essential to investigate the attitudes and level of knowledge and awareness that different populations had regarding COVID-19 during the critical period of the outbreak. Objective: This study aimed to assess the knowledge and awareness of and attitudes toward the COVID-19 pandemic among different populations in Central China during the critical period of the outbreak. Methods: A cross-sectional web-based survey was conducted in Central China from February to March 2020. The study participants included three different populations: medical workers, students, and those with other occupations. In this study, a questionnaire was designed to collect information on the following four aspects: sociodemographic information, knowledge related to COVID-19, awareness of COVID-19, and attitude toward COVID-19. The chi-square test and Fisher test were used for comparison among groups. The level of significance was set at P<.05. Results: This study enrolled a total of 508 participants. Among them, there were 380 students (74.8%), 39 medical workers (7.7%), and 89 people with other occupations (17.5%). Most of the participants were female (n=272, 53.5%), lived in rural areas (n=258, 50.8%), and were single (n=423, 86.9%). The majority of the respondents had attended college (n=454, 89.4%). Most of the participants said they had heard about COVID-19 by January, and most of them looked for information on social media (Sina Weibo, 84.7%), and WeChat and QQ groups (74.2%). The participants showed an adequate level of knowledge about COVID-19 with no significant differences among the groups. However, medical workers demonstrated a slightly advanced knowledge in their responses to professional questions such as the potential susceptible population, possible host, treatment of COVID-19, and disease category. A higher proportion of medical workers (71.8%) and those in the other occupations group (52.8%) were highly concerned about the COVID-19 pandemic. More than 43% of the participants stated that the lockdown of their village/city had a significant impact on their lives. Nevertheless, the majority of respondents had an overall optimistic attitude toward the control of the disease (92.1% of students [n=350], 94.9% of medical workers [n=37], and 92.3% of those in other occupations [n=83]). Conclusions: All three groups reported an adequate background knowledge about COVID-19 but medical workers showed a slightly advanced knowledge in their responses to professional questions. Most of the participants were highly concerned about COVID-19 during the critical period of the outbreak. The majority of respondents declared that the village/city lockdown policy had a significant impact on their daily life but most of them held an optimistic attitude toward the control of COVID-19. %M 32886623 %R 10.2196/22628 %U https://www.jmir.org/2020/10/e22628 %U https://doi.org/10.2196/22628 %U http://www.ncbi.nlm.nih.gov/pubmed/32886623 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 10 %P e19589 %T Using WeChat, a Chinese Social Media App, for Early Detection of the COVID-19 Outbreak in December 2019: Retrospective Study %A Wang,Wenjun %A Wang,Yikai %A Zhang,Xin %A Jia,Xiaoli %A Li,Yaping %A Dang,Shuangsuo %+ Second Affiliated Hospital of Xi'an Jiaotong University, 157 Xiwu Road, Xi'an, 710004, China, 86 02987679688, dangshuangsuo123@xjtu.edu.cn %K novel coronavirus %K SARS %K SARS-CoV-2 %K COVID-19 %K social media %K WeChat %K early detection %K surveillance %K infodemiology %K infoveillance %D 2020 %7 5.10.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: A novel coronavirus, SARS-CoV-2, was identified in December 2019, when the first cases were reported in Wuhan, China. The once-localized outbreak has since been declared a pandemic. As of April 24, 2020, there have been 2.7 million confirmed cases and nearly 200,000 deaths. Early warning systems using new technologies should be established to prevent or mitigate such events in the future. Objective: This study aimed to explore the possibility of detecting the SARS-CoV-2 outbreak in 2019 using social media. Methods: WeChat Index is a data service that shows how frequently a specific keyword appears in posts, subscriptions, and search over the last 90 days on WeChat, the most popular Chinese social media app. We plotted daily WeChat Index results for keywords related to SARS-CoV-2 from November 17, 2019, to February 14, 2020. Results: WeChat Index hits for “Feidian” (which means severe acute respiratory syndrome in Chinese) stayed at low levels until 16 days ahead of the local authority’s outbreak announcement on December 31, 2019, when the index increased significantly. The WeChat Index values persisted at relatively high levels from December 15 to 29, 2019, and rose rapidly on December 30, 2019, the day before the announcement. The WeChat Index hits also spiked for the keywords “SARS,” “coronavirus,” “novel coronavirus,” “shortness of breath,” “dyspnea,” and “diarrhea,” but these terms were not as meaningful for the early detection of the outbreak as the term “Feidian”. Conclusions: By using retrospective infoveillance data from the WeChat Index, the SARS-CoV-2 outbreak in December 2019 could have been detected about two weeks before the outbreak announcement. WeChat may offer a new approach for the early detection of disease outbreaks. %M 32931439 %R 10.2196/19589 %U https://mhealth.jmir.org/2020/10/e19589 %U https://doi.org/10.2196/19589 %U http://www.ncbi.nlm.nih.gov/pubmed/32931439 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 8 %N 10 %P e21788 %T Predictive Models of Mortality for Hospitalized Patients With COVID-19: Retrospective Cohort Study %A Wang,Taiyao %A Paschalidis,Aris %A Liu,Quanying %A Liu,Yingxia %A Yuan,Ye %A Paschalidis,Ioannis Ch %+ Department of Electrical and Computer Engineering, Boston University, 8 Saint Mary's St, Boston, MA, 02215, United States, 1 6173530434, yannisp@bu.edu %K coronavirus %K COVID-19 %K mortality %K Wuhan %K China %K machine learning %K logistic regression %K support vector machine %K predictive modeling %D 2020 %7 15.10.2020 %9 Original Paper %J JMIR Med Inform %G English %X Background: The novel coronavirus SARS-CoV-2 and its associated disease, COVID-19, have caused worldwide disruption, leading countries to take drastic measures to address the progression of the disease. As SARS-CoV-2 continues to spread, hospitals are struggling to allocate resources to patients who are most at risk. In this context, it has become important to develop models that can accurately predict the severity of infection of hospitalized patients to help guide triage, planning, and resource allocation. Objective: The aim of this study was to develop accurate models to predict the mortality of hospitalized patients with COVID-19 using basic demographics and easily obtainable laboratory data. Methods: We performed a retrospective study of 375 hospitalized patients with COVID-19 in Wuhan, China. The patients were randomly split into derivation and validation cohorts. Regularized logistic regression and support vector machine classifiers were trained on the derivation cohort, and accuracy metrics (F1 scores) were computed on the validation cohort. Two types of models were developed: the first type used laboratory findings from the entire length of the patient’s hospital stay, and the second type used laboratory findings that were obtained no later than 12 hours after admission. The models were further validated on a multicenter external cohort of 542 patients. Results: Of the 375 patients with COVID-19, 174 (46.4%) died of the infection. The study cohort was composed of 224/375 men (59.7%) and 151/375 women (40.3%), with a mean age of 58.83 years (SD 16.46). The models developed using data from throughout the patients’ length of stay demonstrated accuracies as high as 97%, whereas the models with admission laboratory variables possessed accuracies of up to 93%. The latter models predicted patient outcomes an average of 11.5 days in advance. Key variables such as lactate dehydrogenase, high-sensitivity C-reactive protein, and percentage of lymphocytes in the blood were indicated by the models. In line with previous studies, age was also found to be an important variable in predicting mortality. In particular, the mean age of patients who survived COVID-19 infection (50.23 years, SD 15.02) was significantly lower than the mean age of patients who died of the infection (68.75 years, SD 11.83; P<.001). Conclusions: Machine learning models can be successfully employed to accurately predict outcomes of patients with COVID-19. Our models achieved high accuracies and could predict outcomes more than one week in advance; this promising result suggests that these models can be highly useful for resource allocation in hospitals. %M 33055061 %R 10.2196/21788 %U http://medinform.jmir.org/2020/10/e21788/ %U https://doi.org/10.2196/21788 %U http://www.ncbi.nlm.nih.gov/pubmed/33055061 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 10 %P e22910 %T Online Health Information Seeking Using “#COVID-19 Patient Seeking Help” on Weibo in Wuhan, China: Descriptive Study %A Zhao,Xiaoman %A Fan,Ju %A Basnyat,Iccha %A Hu,Baijing %+ School of Journalism and Communication, Renmin University of China, 59 Zhongguancun Street, Beijing, China, 86 01062514835, hubaijing@vip.sina.com %K COVID-19 %K coronavirus %K information seeking %K social media %K Wuhan %D 2020 %7 15.10.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: First detected in Wuhan, China in December 2019, the COVID-19 pandemic stretched the medical system in Wuhan and posed a challenge to the state’s risk communication efforts. Timely access to quality health care information during outbreaks of infectious diseases can be effective to curtail the spread of disease and feelings of anxiety. Although existing studies have extended our knowledge about online health information–seeking behavior, processes, and motivations, rarely have the findings been applied to an outbreak. Moreover, there is relatively little recent research on how people in China are using the internet for seeking health information during a pandemic. Objective: The aim of this study is to explore how people in China are using the internet for seeking health information during a pandemic. Drawing on previous research of online health information seeking, this study asks the following research questions: how was the “#COVID-19 Patient Seeking Help” hashtag being used by patients in Wuhan seeking health information on Weibo at the peak of the outbreak? and what kinds of health information were patients in Wuhan seeking on Weibo at the peak of the outbreak? Methods: Using entity identification and textual analysis on 10,908 posts on Weibo, we identified 1496 patients with COVID-19 using “#COVID-19 Patient Seeking Help” and explored their online health information–seeking behavior. Results: The curve of the hashtag posting provided a dynamic picture of public attention to the COVID-19 pandemic. Many patients faced difficulties accessing offline health care services. In general, our findings confirmed that the internet is used by the Chinese public as an important source of health information. The lockdown policy was found to cut off the patients’ social support network, preventing them from seeking help from family members. The ability to seek information and help online, especially for those with young children or older adult members during the pandemic. A high proportion of female users were seeking health information and help for their parents or for older adults at home. The most searched information included accessing medical treatment, managing self-quarantine, and offline to online support. Conclusions: Overall, the findings contribute to our understanding of health information–seeking behaviors during an outbreak and highlight the importance of paying attention to the information needs of vulnerable groups and the role social media may play. %M 33001838 %R 10.2196/22910 %U http://www.jmir.org/2020/10/e22910/ %U https://doi.org/10.2196/22910 %U http://www.ncbi.nlm.nih.gov/pubmed/33001838 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 10 %P e21081 %T How Data Analytics and Big Data Can Help Scientists in Managing COVID-19 Diffusion: Modeling Study to Predict the COVID-19 Diffusion in Italy and the Lombardy Region %A Tosi,Davide %A Campi,Alessandro %+ Politecnico di Milano, Piazza Leonardo da Vinci 32, Milano, Italy, 39 0223993644, alessandro.campi@polimi.it %K COVID-19 %K SARS-CoV-2 %K big data %K data analytics %K predictive models %K prediction %K modeling %K Italy %K diffusion %D 2020 %7 14.10.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: COVID-19 is the most widely discussed topic worldwide in 2020, and at the beginning of the Italian epidemic, scientists tried to understand the virus diffusion and the epidemic curve of positive cases with controversial findings and numbers. Objective: In this paper, a data analytics study on the diffusion of COVID-19 in Italy and the Lombardy Region is developed to define a predictive model tailored to forecast the evolution of the diffusion over time. Methods: Starting with all available official data collected worldwide about the diffusion of COVID-19, we defined a predictive model at the beginning of March 2020 for the Italian country. Results: This paper aims at showing how this predictive model was able to forecast the behavior of the COVID-19 diffusion and how it predicted the total number of positive cases in Italy over time. The predictive model forecasted, for the Italian country, the end of the COVID-19 first wave by the beginning of June. Conclusions: This paper shows that big data and data analytics can help medical experts and epidemiologists in promptly designing accurate and generalized models to predict the different COVID-19 evolutionary phases in other countries and regions, and for second and third possible epidemic waves. %M 33027038 %R 10.2196/21081 %U http://www.jmir.org/2020/10/e21081/ %U https://doi.org/10.2196/21081 %U http://www.ncbi.nlm.nih.gov/pubmed/33027038 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 10 %P e19878 %T Application of an Artificial Intelligence Trilogy to Accelerate Processing of Suspected Patients With SARS-CoV-2 at a Smart Quarantine Station: Observational Study %A Liu,Ping-Yen %A Tsai,Yi-Shan %A Chen,Po-Lin %A Tsai,Huey-Pin %A Hsu,Ling-Wei %A Wang,Chi-Shiang %A Lee,Nan-Yao %A Huang,Mu-Shiang %A Wu,Yun-Chiao %A Ko,Wen-Chien %A Yang,Yi-Ching %A Chiang,Jung-Hsien %A Shen,Meng-Ru %+ Department of Obstetrics and Gynecology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 138 Sheng-Li Rd, Tainan, 70401, Taiwan, 886 6 2353535 ext 5505, mrshen@mail.ncku.edu.tw %K SARS-CoV-2 %K COVID-19 %K artificial intelligence %K smart device assisted decision making %K quarantine station %D 2020 %7 14.10.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: As the COVID-19 epidemic increases in severity, the burden of quarantine stations outside emergency departments (EDs) at hospitals is increasing daily. To address the high screening workload at quarantine stations, all staff members with medical licenses are required to work shifts in these stations. Therefore, it is necessary to simplify the workflow and decision-making process for physicians and surgeons from all subspecialties. Objective: The aim of this paper is to demonstrate how the National Cheng Kung University Hospital artificial intelligence (AI) trilogy of diversion to a smart quarantine station, AI-assisted image interpretation, and a built-in clinical decision-making algorithm improves medical care and reduces quarantine processing times. Methods: This observational study on the emerging COVID-19 pandemic included 643 patients. An “AI trilogy” of diversion to a smart quarantine station, AI-assisted image interpretation, and a built-in clinical decision-making algorithm on a tablet computer was applied to shorten the quarantine survey process and reduce processing time during the COVID-19 pandemic. Results: The use of the AI trilogy facilitated the processing of suspected cases of COVID-19 with or without symptoms; also, travel, occupation, contact, and clustering histories were obtained with the tablet computer device. A separate AI-mode function that could quickly recognize pulmonary infiltrates on chest x-rays was merged into the smart clinical assisting system (SCAS), and this model was subsequently trained with COVID-19 pneumonia cases from the GitHub open source data set. The detection rates for posteroanterior and anteroposterior chest x-rays were 55/59 (93%) and 5/11 (45%), respectively. The SCAS algorithm was continuously adjusted based on updates to the Taiwan Centers for Disease Control public safety guidelines for faster clinical decision making. Our ex vivo study demonstrated the efficiency of disinfecting the tablet computer surface by wiping it twice with 75% alcohol sanitizer. To further analyze the impact of the AI application in the quarantine station, we subdivided the station group into groups with or without AI. Compared with the conventional ED (n=281), the survey time at the quarantine station (n=1520) was significantly shortened; the median survey time at the ED was 153 minutes (95% CI 108.5-205.0), vs 35 minutes at the quarantine station (95% CI 24-56; P<.001). Furthermore, the use of the AI application in the quarantine station reduced the survey time in the quarantine station; the median survey time without AI was 101 minutes (95% CI 40-153), vs 34 minutes (95% CI 24-53) with AI in the quarantine station (P<.001). Conclusions: The AI trilogy improved our medical care workflow by shortening the quarantine survey process and reducing the processing time, which is especially important during an emerging infectious disease epidemic. %M 33001832 %R 10.2196/19878 %U http://www.jmir.org/2020/10/e19878/ %U https://doi.org/10.2196/19878 %U http://www.ncbi.nlm.nih.gov/pubmed/33001832 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 4 %P e20355 %T Novel Approach to Support Rapid Data Collection, Management, and Visualization During the COVID-19 Outbreak Response in the World Health Organization African Region: Development of a Data Summarization and Visualization Tool %A Ahmed,Kamran %A Bukhari,Muhammad Arish %A Mlanda,Tamayi %A Kimenyi,Jean Paul %A Wallace,Polly %A Okot Lukoya,Charles %A Hamblion,Esther L %A Impouma,Benido %+ Regional Office for Africa, World Health Organization, Cite du Djoue, PO Box 06, Brazzaville, Congo, 242 770 02 02, drkamranrajput@gmail.com %K COVID-19 %K health information management %K data collection %K visualization %K EWARS %K WHO African region %K Go.Data %K outbreak %K pandemic %K health emergencies %D 2020 %7 14.10.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The COVID-19 pandemic has created unprecedented challenges to the systematic and timely sharing of COVID-19 field data collection and management. The World Health Organization (WHO) is working with health partners on the rollout and implementation of a robust electronic field data collection platform. The delay in the deployment and rollout of this electronic platform in the WHO African Region, as a consequence of the application of large-scale public health and social measures including movement restrictions and geographical area quarantine, left a gap between data collection and management. This lead to the need to develop interim data management solutions to accurately monitor the evolution of the pandemic and support the deployment of appropriate public health interventions. Objective: The aim of this study is to review the design, development, and implementation of the COVID-19 Data Summarization and Visualization (DSV) tool as a rapidly deployable solution to fill this critical data collection gap as an interim solution. Methods: This paper reviews the processes undertaken to research and develop a tool to bridge the data collection gap between the onset of a COVID-19 outbreak and the start of data collection using a prioritized electronic platform such as Go.Data in the WHO African Region. Results: In anticipation of the implementation of a prioritized tool for field data collection, the DSV tool was deployed in 18 member states for COVID-19 outbreak data management. We highlight preliminary findings and lessons learned from the DSV tool deployment in the WHO African Region. Conclusions: We developed a rapidly deployable tool for COVID-19 data collection and visualization in the WHO African Region. The lessons drawn on this experience offer an opportunity to learn and apply these to improve future similar public health informatics initiatives in an outbreak or similar humanitarian setting, particularly in low- and middle-income countries. %M 32997641 %R 10.2196/20355 %U http://publichealth.jmir.org/2020/4/e20355/ %U https://doi.org/10.2196/20355 %U http://www.ncbi.nlm.nih.gov/pubmed/32997641 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 10 %P e23532 %T Impact of Chronic Use of Antimalarials on SARS-CoV-2 Infection in Patients With Immune-Mediated Rheumatic Diseases: Protocol for a Multicentric Observational Cohort Study %A Gomides,Ana %A Ferreira,Gilda %A Kakehasi,Adriana %A Lacerda,Marcus %A Marques,Cláudia %A Mota,Licia %A Paiva,Eduardo %A Pileggi,Gecilmara %A Provenza,José %A Reis-Neto,Edgard %A Sampaio,Vanderson %A Xavier,Ricardo %A Pinheiro,Marcelo %+ Federal University of São Paulo, Hospital São Paulo, São Paulo, , Brazil, 55 6135480162, mpinheiro@uol.com.br %K COVID-19 %K SARS-CoV-2 %K coronavirus %K antimalarial %K rheumatic diseases %K mortality %K immune system %K immunology %K protocol %K observational %K pharmacological %K drug %D 2020 %7 14.10.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: COVID-19, caused by the virus SARS-CoV-2, has brought extensive challenges to the scientific community in recent months. Several studies have been undertaken in an attempt to minimize the impact of the disease worldwide. Although new knowledge has been quickly disseminated, including viral mechanisms, pathophysiology, and clinical findings, there is a lack of information on the effective pharmacological management of this disease. In vitro studies have shown some benefits related to the use of antimalarials (chloroquine and hydroxychloroquine) for inhibiting SARS-CoV-2. However, the data from open clinical trials on COVID-19 patients are controversial. Objective: We present the protocol for a research project that compares the potential protective effect of antimalarials in preventing moderate-to-severe forms of COVID-19 in two groups: (1) patients treated chronically with antimalarials for rheumatic diseases and (2) other members of the patients’ household who have not been diagnosed with rheumatic diseases and are not taking antimalarials. Methods: This is a 24-week, prospective, observational cohort study comprising patients from public and private health services across Brazil, who chronically use antimalarials for the treatment of immune-mediated rheumatic diseases, osteoarthritis, or chikungunya-related arthropathy. A total of six sequential phone interviews were scheduled during the COVID-19 outbreak in five different regions of Brazil. Information regarding social, epidemiological, and demographic data, as well as details about rheumatic diseases, antimalarials, comorbidities, and concomitant medication, is being recorded using a specific online form in the REDCap database. Symptoms suggestive of COVID-19, including fever, cough, dyspnea, anosmia, and dysgeusia, are being self-reported and collected via phone interviews. Our main outcomes are hospitalization, need of intensive care unit, and death. Results: Recruitment began at the end of March 2020, and the inclusion was done during an 8-week period (from March 29 to May 17) with a total of 10,443 individuals enrolled at baseline, 5166 of whom have rheumatic diseases, from 23 tertiary rheumatology centers across 97 Brazilian cities. Data analysis is scheduled to begin after all inclusion data have been collected. Conclusions: This study, which includes a large sample of chronic antimalarial users, will allow us to explore whether SARS-CoV-2 infection may be associated with immune-mediated rheumatic diseases and long-term antimalarial usage. Trial Registration: Brazilian Registry of Clinical Trials RBR–9KTWX6; http://www.ensaiosclinicos.gov.br/rg/RBR-9ktwx6/ International Registered Report Identifier (IRRID): DERR1-10.2196/23532 %M 32924956 %R 10.2196/23532 %U http://www.researchprotocols.org/2020/10/e23532/ %U https://doi.org/10.2196/23532 %U http://www.ncbi.nlm.nih.gov/pubmed/32924956 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 10 %P e22635 %T Natural Language Processing Reveals Vulnerable Mental Health Support Groups and Heightened Health Anxiety on Reddit During COVID-19: Observational Study %A Low,Daniel M %A Rumker,Laurie %A Talkar,Tanya %A Torous,John %A Cecchi,Guillermo %A Ghosh,Satrajit S %+ Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, 43 Vassar St, Cambridge, MA, 02139, United States, 1 6176317230, dlow@mit.edu %K COVID-19 %K mental health %K psychiatry %K infodemiology %K infoveillance %K infodemic %K social media %K Reddit %K natural language processing %K ADHD %K eating disorders %K anxiety %K suicidality %D 2020 %7 12.10.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic is impacting mental health, but it is not clear how people with different types of mental health problems were differentially impacted as the initial wave of cases hit. Objective: The aim of this study is to leverage natural language processing (NLP) with the goal of characterizing changes in 15 of the world’s largest mental health support groups (eg, r/schizophrenia, r/SuicideWatch, r/Depression) found on the website Reddit, along with 11 non–mental health groups (eg, r/PersonalFinance, r/conspiracy) during the initial stage of the pandemic. Methods: We created and released the Reddit Mental Health Dataset including posts from 826,961 unique users from 2018 to 2020. Using regression, we analyzed trends from 90 text-derived features such as sentiment analysis, personal pronouns, and semantic categories. Using supervised machine learning, we classified posts into their respective support groups and interpreted important features to understand how different problems manifest in language. We applied unsupervised methods such as topic modeling and unsupervised clustering to uncover concerns throughout Reddit before and during the pandemic. Results: We found that the r/HealthAnxiety forum showed spikes in posts about COVID-19 early on in January, approximately 2 months before other support groups started posting about the pandemic. There were many features that significantly increased during COVID-19 for specific groups including the categories “economic stress,” “isolation,” and “home,” while others such as “motion” significantly decreased. We found that support groups related to attention-deficit/hyperactivity disorder, eating disorders, and anxiety showed the most negative semantic change during the pandemic out of all mental health groups. Health anxiety emerged as a general theme across Reddit through independent supervised and unsupervised machine learning analyses. For instance, we provide evidence that the concerns of a diverse set of individuals are converging in this unique moment of history; we discovered that the more users posted about COVID-19, the more linguistically similar (less distant) the mental health support groups became to r/HealthAnxiety (ρ=–0.96, P<.001). Using unsupervised clustering, we found the suicidality and loneliness clusters more than doubled in the number of posts during the pandemic. Specifically, the support groups for borderline personality disorder and posttraumatic stress disorder became significantly associated with the suicidality cluster. Furthermore, clusters surrounding self-harm and entertainment emerged. Conclusions: By using a broad set of NLP techniques and analyzing a baseline of prepandemic posts, we uncovered patterns of how specific mental health problems manifest in language, identified at-risk users, and revealed the distribution of concerns across Reddit, which could help provide better resources to its millions of users. We then demonstrated that textual analysis is sensitive to uncover mental health complaints as they appear in real time, identifying vulnerable groups and alarming themes during COVID-19, and thus may have utility during the ongoing pandemic and other world-changing events such as elections and protests. %M 32936777 %R 10.2196/22635 %U http://www.jmir.org/2020/10/e22635/ %U https://doi.org/10.2196/22635 %U http://www.ncbi.nlm.nih.gov/pubmed/32936777 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 10 %P e21597 %T Collective Response to Media Coverage of the COVID-19 Pandemic on Reddit and Wikipedia: Mixed-Methods Analysis %A Gozzi,Nicolò %A Tizzani,Michele %A Starnini,Michele %A Ciulla,Fabio %A Paolotti,Daniela %A Panisson,André %A Perra,Nicola %+ University of Greenwich, Old Royal Naval College, Park Row, London, SE10 9LS, United Kingdom, 44 020 8331 8000, n.gozzi@gre.ac.uk %K social media %K news coverage %K digital epidemiology %K infodemiology %K infoveillance %K infodemic %K digital epidemiology %K data science %K topic modeling %K pandemic %K COVID-19 %K Reddit %K Wikipedia %K information %K response %K risk perception %K behavior %D 2020 %7 12.10.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The exposure and consumption of information during epidemic outbreaks may alter people’s risk perception and trigger behavioral changes, which can ultimately affect the evolution of the disease. It is thus of utmost importance to map the dissemination of information by mainstream media outlets and the public response to this information. However, our understanding of this exposure-response dynamic during the COVID-19 pandemic is still limited. Objective: The goal of this study is to characterize the media coverage and collective internet response to the COVID-19 pandemic in four countries: Italy, the United Kingdom, the United States, and Canada. Methods: We collected a heterogeneous data set including 227,768 web-based news articles and 13,448 YouTube videos published by mainstream media outlets, 107,898 user posts and 3,829,309 comments on the social media platform Reddit, and 278,456,892 views of COVID-19–related Wikipedia pages. To analyze the relationship between media coverage, epidemic progression, and users’ collective web-based response, we considered a linear regression model that predicts the public response for each country given the amount of news exposure. We also applied topic modelling to the data set using nonnegative matrix factorization. Results: Our results show that public attention, quantified as user activity on Reddit and active searches on Wikipedia pages, is mainly driven by media coverage; meanwhile, this activity declines rapidly while news exposure and COVID-19 incidence remain high. Furthermore, using an unsupervised, dynamic topic modeling approach, we show that while the levels of attention dedicated to different topics by media outlets and internet users are in good accordance, interesting deviations emerge in their temporal patterns. Conclusions: Overall, our findings offer an additional key to interpret public perception and response to the current global health emergency and raise questions about the effects of attention saturation on people’s collective awareness and risk perception and thus on their tendencies toward behavioral change. %M 32960775 %R 10.2196/21597 %U http://www.jmir.org/2020/10/e21597/ %U https://doi.org/10.2196/21597 %U http://www.ncbi.nlm.nih.gov/pubmed/32960775 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 10 %P e19994 %T Epidemiological Parameters of COVID-19: Case Series Study %A Ma,Shujuan %A Zhang,Jiayue %A Zeng,Minyan %A Yun,Qingping %A Guo,Wei %A Zheng,Yixiang %A Zhao,Shi %A Wang,Maggie H %A Yang,Zuyao %+ JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, 852 2252 8739, zyang@cuhk.edu.hk %K coronavirus disease 2019 %K COVID-19 %K incubation period %K serial interval %K basic reproduction number %K presymptomatic transmission %D 2020 %7 12.10.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The estimates of several key epidemiological parameters of the COVID-19 pandemic are often based on small sample sizes or are inaccurate for various reasons. Objective: The aim of this study is to obtain more robust estimates of the incubation period, serial interval, frequency of presymptomatic transmission, and basic reproduction number (R0) of COVID-19 based on a large case series. Methods: We systematically retrieved and screened 20,658 reports of laboratory-confirmed COVID-19 cases released by the health authorities of China, Japan, and Singapore. In addition, 9942 publications were retrieved from PubMed and China National Knowledge Infrastructure (CNKI) through April 8, 2020. To be eligible, a report had to contain individual data that allowed for accurate estimation of at least one parameter. Widely used models such as gamma distributions were fitted to the data sets and the results with the best-fitting values were presented. Results: In total, 1591 cases were included for the final analysis. The mean incubation period (n=687) and mean serial interval (n=1015 pairs) were estimated to be 7.04 (SD 4.27) days and 6.49 (SD 4.90) days, respectively. In 40 cases (5.82%), the incubation period was longer than 14 days. In 32 infector-infectee pairs (3.15%), infectees’ symptom onsets occurred before those of infectors. Presymptomatic transmission occurred in 129 of 296 infector-infectee pairs (43.58%). R0 was estimated to be 1.85 (95% CI 1.37-2.60). Conclusions: This study provides robust estimates of several epidemiological parameters of COVID-19. The findings support the current practice of 14-day quarantine of persons with potential exposure, but also suggest the need for additional measures. Presymptomatic transmission together with the asymptomatic transmission reported by previous studies highlight the importance of adequate testing, strict quarantine, and social distancing. %M 33001833 %R 10.2196/19994 %U http://www.jmir.org/2020/10/e19994/ %U https://doi.org/10.2196/19994 %U http://www.ncbi.nlm.nih.gov/pubmed/33001833 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 10 %P e21980 %T Application of Big Data Technology for COVID-19 Prevention and Control in China: Lessons and Recommendations %A Wu,Jun %A Wang,Jian %A Nicholas,Stephen %A Maitland,Elizabeth %A Fan,Qiuyan %+ Dong Fureng Institute of Economic and Social Development, Wuhan University, No.54 Dongsi Lishi Hutong, Dongcheng District, Beijing, 100010, China, 86 13864157135, 00032954@whu.edu.cn %K big data %K COVID-19 %K disease prevention and control %D 2020 %7 9.10.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: In the prevention and control of infectious diseases, previous research on the application of big data technology has mainly focused on the early warning and early monitoring of infectious diseases. Although the application of big data technology for COVID-19 warning and monitoring remain important tasks, prevention of the disease’s rapid spread and reduction of its impact on society are currently the most pressing challenges for the application of big data technology during the COVID-19 pandemic. After the outbreak of COVID-19 in Wuhan, the Chinese government and nongovernmental organizations actively used big data technology to prevent, contain, and control the spread of COVID-19. Objective: The aim of this study is to discuss the application of big data technology to prevent, contain, and control COVID-19 in China; draw lessons; and make recommendations. Methods: We discuss the data collection methods and key data information that existed in China before the outbreak of COVID-19 and how these data contributed to the prevention and control of COVID-19. Next, we discuss China’s new data collection methods and new information assembled after the outbreak of COVID-19. Based on the data and information collected in China, we analyzed the application of big data technology from the perspectives of data sources, data application logic, data application level, and application results. In addition, we analyzed the issues, challenges, and responses encountered by China in the application of big data technology from four perspectives: data access, data use, data sharing, and data protection. Suggestions for improvements are made for data collection, data circulation, data innovation, and data security to help understand China’s response to the epidemic and to provide lessons for other countries’ prevention and control of COVID-19. Results: In the process of the prevention and control of COVID-19 in China, big data technology has played an important role in personal tracking, surveillance and early warning, tracking of the virus’s sources, drug screening, medical treatment, resource allocation, and production recovery. The data used included location and travel data, medical and health data, news media data, government data, online consumption data, data collected by intelligent equipment, and epidemic prevention data. We identified a number of big data problems including low efficiency of data collection, difficulty in guaranteeing data quality, low efficiency of data use, lack of timely data sharing, and data privacy protection issues. To address these problems, we suggest unified data collection standards, innovative use of data, accelerated exchange and circulation of data, and a detailed and rigorous data protection system. Conclusions: China has used big data technology to prevent and control COVID-19 in a timely manner. To prevent and control infectious diseases, countries must collect, clean, and integrate data from a wide range of sources; use big data technology to analyze a wide range of big data; create platforms for data analyses and sharing; and address privacy issues in the collection and use of big data. %M 33001836 %R 10.2196/21980 %U http://www.jmir.org/2020/10/e21980/ %U https://doi.org/10.2196/21980 %U http://www.ncbi.nlm.nih.gov/pubmed/33001836 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 6 %N 2 %P e23604 %T Medical Students' Corner: Lessons From COVID-19 in Equity, Adaptability, and Community for the Future of Medical Education %A Mann,Simran %A Novintan,Shonnelly %A Hazemi-Jebelli,Yasmin %A Faehndrich,Daniel %+ School of Medicine, Imperial College London, Kensington, London, United Kingdom, 44 7964965972, sm6015@ic.ac.uk %K medical education %K COVID-19 %K student equity %K community %K adaptability %K medical student %D 2020 %7 9.10.2020 %9 Viewpoint %J JMIR Med Educ %G English %X As UK medical students, we recently completed 3 months of remote learning due to the COVID-19 pandemic, before taking online end-of-the-year exams. We are now entering our final year of medical school. Based on our experiences and our understanding of others’ experiences, we believe that three key lessons have been universal for medical students around the world. The lessons learned throughout this process address the need for a fair system for medical students, the importance of adaptability in all aspects of medical education, and the value of a strong medical school community. These lessons can be applied in the years to come to improve medical education as we know it. %M 32936774 %R 10.2196/23604 %U http://mededu.jmir.org/2020/2/e23604/ %U https://doi.org/10.2196/23604 %U http://www.ncbi.nlm.nih.gov/pubmed/32936774 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 10 %P e19684 %T Social Media Use, eHealth Literacy, Disease Knowledge, and Preventive Behaviors in the COVID-19 Pandemic: Cross-Sectional Study on Chinese Netizens %A Li,Xiaojing %A Liu,Qinliang %+ Center for Health and Medical Communication, School of Media & Communication, Shanghai Jiao Tong University, 800 Dongchuan Rd, Shanghai, 200240, China, 86 13918611103, lixiaojing@sjtu.edu.cn %K social media %K media use %K COVID-19 %K pandemic %K disease knowledge %K eHealth literacy %K public health %K preventive behaviors %D 2020 %7 9.10.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Since its outbreak in January 2020, COVID-19 has quickly spread worldwide and has become a global pandemic. Social media platforms have been recognized as important tools for health-promoting practices in public health, and the use of social media is widespread among the public. However, little is known about the effects of social media use on health promotion during a pandemic such as COVID-19. Objective: In this study, we aimed to explore the predictive role of social media use on public preventive behaviors in China during the COVID-19 pandemic and how disease knowledge and eHealth literacy moderated the relationship between social media use and preventive behaviors. Methods: A national web-based cross-sectional survey was conducted by a proportionate probability sampling among 802 Chinese internet users (“netizens”) in February 2020. Descriptive statistics, Pearson correlations, and hierarchical multiple regressions were employed to examine and explore the relationships among all the variables. Results: Almost half the 802 study participants were male (416, 51.9%), and the average age of the participants was 32.65 years. Most of the 802 participants had high education levels (624, 77.7%), had high income >¥5000 (US $736.29) (525, 65.3%), were married (496, 61.8%), and were in good health (486, 60.6%). The average time of social media use was approximately 2 to 3 hours per day (mean 2.34 hours, SD 1.11), and the most frequently used media types were public social media (mean score 4.49/5, SD 0.78) and aggregated social media (mean score 4.07/5, SD 1.07). Social media use frequency (β=.20, P<.001) rather than time significantly predicted preventive behaviors for COVID-19. Respondents were also equipped with high levels of disease knowledge (mean score 8.15/10, SD 1.43) and eHealth literacy (mean score 3.79/5, SD 0.59). Disease knowledge (β=.11, P=.001) and eHealth literacy (β=.27, P<.001) were also significant predictors of preventive behaviors. Furthermore, eHealth literacy (P=.038) and disease knowledge (P=.03) positively moderated the relationship between social media use frequency and preventive behaviors, while eHealth literacy (β=.07) affected this relationship positively and disease knowledge (β=–.07) affected it negatively. Different social media types differed in predicting an individual’s preventive behaviors for COVID-19. Aggregated social media (β=.22, P<.001) was the best predictor, followed by public social media (β=.14, P<.001) and professional social media (β=.11, P=.002). However, official social media (β=.02, P=.597) was an insignificant predictor. Conclusions: Social media is an effective tool to promote behaviors to prevent COVID-19 among the public. Health literacy is essential for promotion of individual health and influences the extent to which the public engages in preventive behaviors during a pandemic. Our results not only enrich the theoretical paradigm of public health management and health communication but also have practical implications in pandemic control for China and other countries. %M 33006940 %R 10.2196/19684 %U http://www.jmir.org/2020/10/e19684/ %U https://doi.org/10.2196/19684 %U http://www.ncbi.nlm.nih.gov/pubmed/33006940 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 3 %N 2 %P e23463 %T Patient and Clinician Perspectives on Adolescent Opioid Use Disorder Treatment During a Pandemic: One Step Back, but Two Forward? %A Stull,Samuel W %A McKnight,Erin R %A Bonny,Andrea E %+ Department of Biobehavioral Health, The Pennsylvania State University, Biobehavioral Health Building, University Park, PA, 16802, United States, 1 6145518640, sws6084@psu.edu %K adolescent %K opioid use disorder %K treatment %K telehealth %K drug %K perspective %K opioid %K COVID-19 %K young adult %D 2020 %7 9.10.2020 %9 Viewpoint %J JMIR Pediatr Parent %G English %X Opioid use disorder (OUD) is one of the most pressing public health problems in the United States and is highly prevalent among adolescents and young adults (AYAs). However, only a small percentage of AYAs with OUD ever receive treatment. Further, among those that do receive treatment, a substantial proportion of patients continue to struggle with OUD, and many prematurely drop out of treatment. These challenges have only been heightened in the face of the COVID-19 pandemic, but greater utilization of telehealth and mobile technologies by OUD patients may help counter these barriers, which ultimately may improve AYA OUD treatment in the postpandemic period. This viewpoint presents the perspective of a person in OUD recovery using online and mobile technology to support his own OUD recovery combined with thoughts from two clinicians supporting AYAs with OUD. Their perspectives may provide insights to help counter COVID-19–related consequences and offer clues to improving AYA OUD treatment in the long term. %M 33016885 %R 10.2196/23463 %U http://pediatrics.jmir.org/2020/2/e23463/ %U https://doi.org/10.2196/23463 %U http://www.ncbi.nlm.nih.gov/pubmed/33016885 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 10 %P e21364 %T Syndromic Surveillance Insights from a Symptom Assessment App Before and During COVID-19 Measures in Germany and the United Kingdom: Results From Repeated Cross-Sectional Analyses %A Mehl,Alicia %A Bergey,Francois %A Cawley,Caoimhe %A Gilsdorf,Andreas %+ Department of Epidemiology & Public Health, Ada Health GmbH, Karl-Liebknecht-Str 1, Berlin, 10178, Germany, 49 30 403 67 390, alicia.mehl@ada.com %K epidemiology %K participatory epidemiology %K participatory surveillance %K COVID-19 symptom assessment apps %K symptom checker apps %K syndromic surveillance %K COVID-19 measures %K COVID-19 lockdown %K digital public health %K health effects of COVID-19 measures, infoveillance %D 2020 %7 9.10.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Unprecedented lockdown measures have been introduced in countries worldwide to mitigate the spread and consequences of COVID-19. Although attention has been focused on the effects of these measures on epidemiological indicators relating directly to the infection, there is increased recognition of their broader health implications. However, assessing these implications in real time is a challenge, due to the limitations of existing syndromic surveillance data and tools. Objective: The aim of this study is to explore the added value of mobile phone app–based symptom assessment tools as real-time health insight providers to inform public health policy makers. Methods: A comparative and descriptive analysis of the proportion of all self-reported symptoms entered by users during an assessment within the Ada app in Germany and the United Kingdom was conducted between two periods, namely before and after the implementation of “Phase One” COVID-19 measures. Additional analyses were performed to explore the association between symptom trends and seasonality, and symptom trends and weather. Differences in the proportion of unique symptoms between the periods were analyzed using a Pearson chi-square test and reported as log2 fold changes. Results: Overall, 48,300-54,900 symptomatic users reported 140,500-170,400 symptoms during the Baseline and Measures periods in Germany. Overall, 34,200-37,400 symptomatic users in the United Kingdom reported 112,100-131,900 symptoms during the Baseline and Measures periods. The majority of symptomatic users were female (Germany: 68,600/103,200, 66.52%; United Kingdom: 51,200/71,600, 72.74%). The majority were aged 10-29 years (Germany: 68,500/100,000, 68.45%; United Kingdom: 50,900/68,800, 73.91%), and about one-quarter were aged 30-59 years (Germany: 26,200/100,000, 26.15%; United Kingdom: 14,900/68,800, 21.65%). Overall, 103 symptoms were reported either more or less frequently (with statistically significant differences) during the Measures period as compared to the Baseline period, and 34 of these were reported in both countries. The following mental health symptoms (log2 fold change, P value) were reported less often during the Measures period: inability to manage constant stress and demands at work (–1.07, P<.001), memory difficulty (–0.56, P<.001), depressed mood (–0.42, P<.001), and impaired concentration (–0.46, P<.001). Diminished sense of taste (2.26, P<.001) and hyposmia (2.20, P<.001) were reported more frequently during the Measures period. None of the 34 symptoms were found to be different between the same dates in 2019. In total, 14 of the 34 symptoms had statistically significant associations with weather variables. Conclusions: Symptom assessment apps have an important role to play in facilitating improved understanding of the implications of public health policies such as COVID-19 lockdown measures. Not only do they provide the means to complement and cross-validate hypotheses based on data collected through more traditional channels, they can also generate novel insights through a real-time syndromic surveillance system. %M 32997640 %R 10.2196/21364 %U http://mhealth.jmir.org/2020/10/e21364/ %U https://doi.org/10.2196/21364 %U http://www.ncbi.nlm.nih.gov/pubmed/32997640 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 10 %P e20741 %T COVID-19 Contact Tracing Apps: Predicted Uptake in the Netherlands Based on a Discrete Choice Experiment %A Jonker,Marcel %A de Bekker-Grob,Esther %A Veldwijk,Jorien %A Goossens,Lucas %A Bour,Sterre %A Rutten-Van Mölken,Maureen %+ Erasmus School of Health Policy & Management, Erasmus University Rotterdam, , Rotterdam, Netherlands, 31 10 408 8555, marcel@mfjonker.com %K COVID-19 %K discrete choice experiment %K contact tracing %K participatory epidemiology %K participatory surveillance %K app %K uptake %K prediction %K smartphone %K transmission %K privacy %K mobile phone %D 2020 %7 9.10.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Smartphone-based contact tracing apps can contribute to reducing COVID-19 transmission rates and thereby support countries emerging from lockdowns as restrictions are gradually eased. Objective: The primary objective of our study is to determine the potential uptake of a contact tracing app in the Dutch population, depending on the characteristics of the app. Methods: A discrete choice experiment was conducted in a nationally representative sample of 900 Dutch respondents. Simulated maximum likelihood methods were used to estimate population average and individual-level preferences using a mixed logit model specification. Individual-level uptake probabilities were calculated based on the individual-level preference estimates and subsequently aggregated into the sample as well as subgroup-specific contact tracing app adoption rates. Results: The predicted app adoption rates ranged from 59.3% to 65.7% for the worst and best possible contact tracing app, respectively. The most realistic contact tracing app had a predicted adoption of 64.1%. The predicted adoption rates strongly varied by age group. For example, the adoption rates of the most realistic app ranged from 45.6% to 79.4% for people in the oldest and youngest age groups (ie, ≥75 years vs 15-34 years), respectively. Educational attainment, the presence of serious underlying health conditions, and the respondents’ stance on COVID-19 infection risks were also correlated with the predicted adoption rates but to a lesser extent. Conclusions: A secure and privacy-respecting contact tracing app with the most realistic characteristics can obtain an adoption rate as high as 64% in the Netherlands. This exceeds the target uptake of 60% that has been formulated by the Dutch government. The main challenge will be to increase the uptake among older adults, who are least inclined to install and use a COVID-19 contact tracing app. %M 32795998 %R 10.2196/20741 %U https://mhealth.jmir.org/2020/10/e20741 %U https://doi.org/10.2196/20741 %U http://www.ncbi.nlm.nih.gov/pubmed/32795998 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 10 %P e22596 %T Associations of Mental Health and Personal Preventive Measure Compliance With Exposure to COVID-19 Information During Work Resumption Following the COVID-19 Outbreak in China: Cross-Sectional Survey Study %A Pan,Yihang %A Xin,Meiqi %A Zhang,Changhua %A Dong,Willa %A Fang,Yuan %A Wu,Wenhui %A Li,Mingzhe %A Pang,Jun %A Zheng,Zilong %A Wang,Zixin %A Yuan,Jinqiu %A He,Yulong %+ JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Room 508, School of Public Health, Prince of Wales Hospital, Shatin, NT, 666888, Hong Kong, 852 22528740, wangzx@cuhk.edu.hk %K COVID-19 %K information exposure %K risk %K communication %K mental health %K personal preventive measures %K China %K cross-sectional %K public health %K prevention %D 2020 %7 8.10.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Risk and crisis communication plays an essential role in public health emergency responses. The COVID-19 pandemic has triggered spontaneous and intensive media attention, which has affected people’s adoption of personal preventive measures and their mental health. Objective: The aim of this study was to investigate the associations between exposure to COVID-19–specific information and mental health (depression and sleep quality) and self-reported compliance with personal preventive measures (face mask wearing and hand sanitizing). We also tested whether these associations were moderated by thoughtful consideration of the veracity of the information to which people were exposed. Methods: A cross-sectional, closed web-based survey was conducted among a sample of 3035 factory workers at the beginning of work resumption following the COVID-19 outbreak in Shenzhen, China. A stratified two-stage cluster sampling design was used for recruitment. Multivariate linear and logistic regression models were used for the analyses. Results: The prevalence of probable moderate-to-severe depression was 170/3035 (5.6%), while that of good or excellent sleep quality was 2110/3035 (69.5%). The prevalence of self-reported consistent face mask wearing in public places was 2903/3035 (95.7%), while that of sanitizing hands every time after returning from public spaces or touching public installations was 2151/3035 (70.9%). Of the 3035 respondents, 1013 to 1638 (33.3% to 54.0%) reported >1 hour of daily exposure to COVID-19–specific information through web-based media and television. After controlling for significant background variables, higher information exposure via television and via newspapers and magazines was associated with better sleep quality and higher compliance with hand sanitizing. Higher exposure via unofficial web-based media was associated with higher compliance with hand sanitizing but was also associated with higher depressive symptoms. In contrast, higher exposure through face-to-face communication was associated with higher depressive symptoms, worse sleep quality, and lower compliance with hand sanitizing. Exposure to information about positive outcomes for patients with COVID-19, development of vaccines and effective treatments, and heroic stories about frontline health care workers were associated with both better mental health and higher compliance with preventive measures. Higher overall information exposure was associated with higher depressive symptoms among participants who were less likely to carefully consider the veracity of the information to which they were exposed; it was also associated with better sleep quality among people who reported more thoughtful consideration of information veracity. Conclusions: This study provides empirical evidence of how the amount, sources, and contents of information to which people were exposed influenced their mental health and compliance with personal preventive measures at the initial phase of work resumption in China. Thoughtful consideration of information quality was found to play an important moderating role. Our findings may inform strategic risk communication by government and public health authorities during the COVID-19 pandemic. %M 32936776 %R 10.2196/22596 %U http://www.jmir.org/2020/10/e22596/ %U https://doi.org/10.2196/22596 %U http://www.ncbi.nlm.nih.gov/pubmed/32936776 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 10 %P e22068 %T Topics, Delivery Modes, and Social-Epistemological Dimensions of Web-Based Information for Patients Undergoing Renal Transplant and Living Donors During the COVID-19 Pandemic: Content Analysis %A van Klaveren,Charlotte W %A de Jong,Peter G M %A Hendriks,Renée A %A Luk,Franka %A de Vries,Aiko P J %A van der Boog,Paul J M %A Reinders,Marlies E J %+ Division of Nephrology and Transplant Center, Department of Internal Medicine, Leiden University Medical Center, Albinusdreef 2, Leiden, 2333 ZA, Netherlands, 31 (0)71 526512, c.w.van_klaveren@lumc.nl %K web-based information %K internet %K websites %K patient education %K COVID-19 %K renal transplantation %K eHealth %K constructivism %K social-epistemological dimensions %K teaching modes %K health communication %D 2020 %7 8.10.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic has markedly affected renal transplant care. During this time of social distancing, limited in-person visits, and uncertainty, patients and donors are relying more than ever on telemedicine and web-based information. Several factors can influence patients’ understanding of web-based information, such as delivery modes (instruction, interaction, and assessment) and social-epistemological dimensions (choices in interactive knowledge building). Objective: The aim of this study was to systemically evaluate the content, delivery modes, and social-epistemological dimensions of web-based information on COVID-19 and renal transplantation at time of the pandemic. Methods: Multiple keyword combinations were used to retrieve websites on COVID-19 and renal transplantation using the search engines Google.com and Google.nl. From 14 different websites, 30 webpages were examined to determine their organizational sources, topics, delivery modes, and social-epistemological dimensions. Results: The variety of topics and delivery modes was limited. A total of 13 different delivery modes were encountered, of which 8 (62%) were instructional and 5 (38%) were interactional; no assessment delivery modes were observed. No website offered all available delivery modes. The majority of delivery modes (8/13, 62%) focused on individual and passive learning, whereas group learning and active construction of knowledge were rarely encountered. Conclusions: By taking interactive knowledge transfer into account, the educational quality of eHealth for transplant care could increase, especially in times of crisis when rapid knowledge transfer is needed. %M 32946412 %R 10.2196/22068 %U http://www.jmir.org/2020/10/e22068/ %U https://doi.org/10.2196/22068 %U http://www.ncbi.nlm.nih.gov/pubmed/32946412 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 4 %P e21071 %T Trends and Predictors of COVID-19 Information Sources and Their Relationship With Knowledge and Beliefs Related to the Pandemic: Nationwide Cross-Sectional Study %A Ali,Shahmir H %A Foreman,Joshua %A Tozan,Yesim %A Capasso,Ariadna %A Jones,Abbey M %A DiClemente,Ralph J %+ Department of Social & Behavioral Sciences, School of Global Public Health, New York University, 715 Broadway, New York, NY, 10003, United States, 1 (212) 992 3709, rjd438@nyu.edu %K COVID-19 %K coronavirus %K pandemic %K outbreak %K infectious disease %K social media %K information seeking behaviors %K surveillance %D 2020 %7 8.10.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: During the COVID-19 pandemic, there is a heightened need to understand health information seeking behaviors to address disparities in knowledge and beliefs about the crisis. Objective: This study assessed sociodemographic predictors of the use and trust of different COVID-19 information sources, as well as the association between information sources and knowledge and beliefs about the pandemic. Methods: An online survey was conducted among US adults in two rounds during March and April 2020 using advertisement-based recruitment on social media. Participants were asked about their use of 11 different COVID-19 information sources as well as their most trusted source of information. The selection of COVID-related knowledge and belief questions was based on past empirical literature and salient concerns at the time of survey implementation. Results: The sample consisted of 11,242 participants. When combined, traditional media sources (television, radio, podcasts, or newspapers) were the largest sources of COVID-19 information (91.2%). Among those using mainstream media sources for COVID-19 information (n=7811, 69.5%), popular outlets included CNN (24.0%), Fox News (19.3%), and other local or national networks (35.2%). The largest individual information source was government websites (87.6%). They were also the most trusted source of information (43.3%), although the odds of trusting government websites were lower among males (adjusted odds ratio [AOR] 0.58, 95% CI 0.53-0.63) and those aged 40-59 years and ≥60 years compared to those aged 18-39 years (AOR 0.83, 95% CI 0.74-0.92; AOR 0.62, 95% CI 0.54-0.71). Participants used an average of 6.1 sources (SD 2.3). Participants who were male, aged 40-59 years or ≥60 years; not working, unemployed, or retired; or Republican were likely to use fewer sources while those with children and higher educational attainment were likely to use more sources. Participants surveyed in April were markedly less likely to use (AOR 0.41, 95% CI 0.35-0.46) and trust (AOR 0.51, 95% CI 0.47-0.56) government sources. The association between information source and COVID-19 knowledge was mixed, while many COVID-19 beliefs were significantly predicted by information source; similar trends were observed with reliance on different types of mainstream media outlets. Conclusions: COVID-19 information source was significantly determined by participant sociodemographic characteristics and was also associated with both knowledge and beliefs about the pandemic. Study findings can help inform COVID-19 health communication campaigns and highlight the impact of using a variety of different and trusted information sources. %M 32936775 %R 10.2196/21071 %U http://publichealth.jmir.org/2020/4/e21071/ %U https://doi.org/10.2196/21071 %U http://www.ncbi.nlm.nih.gov/pubmed/32936775 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 10 %P e19533 %T A Web-Based, Mobile-Responsive Application to Screen Health Care Workers for COVID-19 Symptoms: Rapid Design, Deployment, and Usage %A Zhang,Haipeng %A Dimitrov,Dimitar %A Simpson,Lynn %A Plaks,Nina %A Singh,Balaji %A Penney,Stephen %A Charles,Jo %A Sheehan,Rosemary %A Flammini,Steven %A Murphy,Shawn %A Landman,Adam %+ Digital Innovation Hub, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, United States, 1 6174591650, hzhang37@partners.org %K public health %K clinical informatics %K digital health %K coronavirus %K COVID-19 %K SARS-CoV-2 %K 2019-nCov %K app %K eHealth %D 2020 %7 8.10.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: As of July 17, 2020, the COVID-19 pandemic has affected over 14 million people worldwide, with over 3.68 million cases in the United States. As the number of COVID-19 cases increased in Massachusetts, the Massachusetts Department of Public Health mandated that all health care workers be screened for symptoms daily prior to entering any hospital or health care facility. We rapidly created a digital COVID-19 symptom screening tool to enable this screening for a large, academic, integrated health care delivery system, Partners HealthCare, in Boston, Massachusetts. Objective: The aim of this study is to describe the design and development of the COVID Pass COVID-19 symptom screening application and report aggregate usage data from the first three months of its use across the organization. Methods: Using agile principles, we designed, tested, and implemented a solution over the span of one week using progressively customized development approaches as the requirements and use case become more solidified. We developed the minimum viable product (MVP) of a mobile-responsive, web-based, self-service application using research electronic data capture (REDCap). For employees without access to a computer or mobile device to use the self-service application, we established a manual process where in-person, socially distanced screeners asked employees entering the site if they have symptoms and then manually recorded the responses in an Office 365 Form. A custom .NET Framework application solution was developed as COVID Pass was scaled. We collected log data from the .NET application, REDCap, and Microsoft Office 365 from the first three months of enterprise deployment (March 30 to June 30, 2020). Aggregate descriptive statistics, including overall employee attestations by day and site, employee attestations by application method (COVID Pass automatic screening vs manual screening), employee attestations by time of day, and percentage of employees reporting COVID-19 symptoms, were obtained. Results: We rapidly created the MVP and gradually deployed it across the hospitals in our organization. By the end of the first week, the screening application was being used by over 25,000 employees each weekday. After three months, 2,169,406 attestations were recorded with COVID Pass. Over this period, 1865/160,159 employees (1.2%) reported positive symptoms. 1,976,379 of the 2,169,406 attestations (91.1%) were generated from the self-service screening application. The remainder were generated either from manual attestation processes (174,865/2,169,406, 8.1%) or COVID Pass kiosks (25,133/2,169,406, 1.2%). Hospital staff continued to work 24 hours per day, with staff attestations peaking around shift changes between 7 and 8 AM, 2 and 3 PM, 4 and 6 PM, and 11 PM and midnight. Conclusions: Using rapid, agile development, we quickly created and deployed a dedicated employee attestation application that gained widespread adoption and use within our health system. Further, we identified 1865 symptomatic employees who otherwise may have come to work, potentially putting others at risk. We share the story of our implementation, lessons learned, and source code (via GitHub) for other institutions who may want to implement similar solutions. %M 32877348 %R 10.2196/19533 %U https://formative.jmir.org/2020/10/e19533 %U https://doi.org/10.2196/19533 %U http://www.ncbi.nlm.nih.gov/pubmed/32877348 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 10 %P e23716 %T Coping Skills Mobile App to Support the Emotional Well-Being of Young People During the COVID-19 Pandemic: Protocol for a Mixed Methods Study %A Serlachius,Anna %A Schache,Kiralee %A Boggiss,Anna %A Lim,David %A Wallace-Boyd,Kate %A Brenton-Peters,Jennifer %A Buttenshaw,Elise %A Chadd,Stephanie %A Cavadino,Alana %A Cao,Nicholas %A Morunga,Eva %A Thabrew,Hiran %+ Department of Psychological Medicine, University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand, 64 09 923 3073, a.serlachius@auckland.ac.nz %K COVID-19 %K pandemic %K mental health %K mobile applications %K apps %K mHealth %K coping skills %K wellbeing %K adolescent %K young adult %K coping %D 2020 %7 8.10.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: The COVID-19 pandemic is likely to increase anxiety and distress in young people worldwide. It is important to prioritize mental health during crisis events to mitigate the negative and often long-term effects of the crises on young people, families, and society. Mental health and well-being apps represent a scalable approach for improving psychological outcomes in young people and have potential to improve the equity of service access. Objective: The Whitu: 7 Ways in 7 Days well-being app was recently developed by our group to address the urgent need for innovative approaches to reach young New Zealanders who are struggling to cope with the COVID-19 pandemic. The aim of this study is twofold: to evaluate the acceptability of the prototype app and to examine the effectiveness of the refined app at improving mental and emotional well-being and reducing depression, anxiety, and stress in young people in New Zealand. Methods: A two-phase mixed methods study will be undertaken to achieve these aims. During the first phase, 20 young people aged 16-30 years (including those of Māori and Pacific ethnicity) will participate in a qualitative study to help refine the prototype app. During the second phase, 90 young people aged 16-30 years will participate in a randomized waitlist-controlled trial (RCT) to evaluate the efficacy of the refined Whitu app at 4 weeks and 3 months after baseline. Outcomes will be evaluated using validated web-based questionnaires at baseline, 4 weeks, and 3 months. Results: The study received ethics approval in May 2020, and recruitment for the focus groups commenced in June 2020. Recruitment for the RCT is expected to commence in October 2020. Participants for both study phases will be recruited via social media and web-based communities. Data collection for the RCT is expected to be completed by January 2021, and analyses are expected to be completed by March 2021. Linear mixed modelling will be used to determine between-group differences in psychological outcomes. Conclusions: There is an urgent need to develop culturally appropriate, scalable mental health interventions to address the psychological consequences of the COVID-19 pandemic. In this study, we will develop and test an evidence-based well-being app that, if effective, can be made available to all young people in New Zealand and internationally. Trial Registration: Australian New Zealand Clinical Trials Registry (ACTRN12620000516987); https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=379597. International Registered Report Identifier (IRRID): PRR1-10.2196/23716 %M 32991303 %R 10.2196/23716 %U https://www.researchprotocols.org/2020/10/e23716 %U https://doi.org/10.2196/23716 %U http://www.ncbi.nlm.nih.gov/pubmed/32991303 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 4 %P e22117 %T Human-Animal Interaction and the Emergence of SARS-CoV-2 %A Hassani,Asma %A Khan,Gulfaraz %+ Department of Medical Microbiology and Immunology, College of Medicine and Health Sciences, United Arab Emirates University, Tawam Hospital Campus, Al Ain, United Arab Emirates, 971 3 7137482, g_khan@uaeu.ac.ae %K zoonosis %K human-animal interface %K COVID-19 %K SARS-CoV-1 %K outbreak %K virus %K transmission %K pathogen %K emergence %K reservoir %D 2020 %7 7.10.2020 %9 Viewpoint %J JMIR Public Health Surveill %G English %X The COVID-19 pandemic has affected all sectors of society, from health and economics to socialization and travel. The level and extent of this impact are unprecedented. Although the cause of COVID-19 was quickly identified to be a new coronavirus (SARS-CoV-2), the world was poorly prepared for preventing its spread. One important pillar of preparedness is surveillance of the sources of emerging pathogens and responding appropriately to prevent their spread in the human population. The ever-increasing interaction between humans and animals is one leading factor in facilitating the emergence of new pathogens. In this viewpoint, we discuss the possibility of the zoonotic origin of SARS-CoV-2, highlight the importance of understanding human-animal interaction to improve preparedness for future outbreaks, and outline recommendations for prevention. %M 33001837 %R 10.2196/22117 %U http://publichealth.jmir.org/2020/4/e22117/ %U https://doi.org/10.2196/22117 %U http://www.ncbi.nlm.nih.gov/pubmed/33001837 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 6 %N 2 %P e21701 %T Confronting the Challenges of Anatomy Education in a Competency-Based Medical Curriculum During Normal and Unprecedented Times (COVID-19 Pandemic): Pedagogical Framework Development and Implementation %A Naidoo,Nerissa %A Akhras,Aya %A Banerjee,Yajnavalka %+ College of Medicine and Health Sciences, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai Health Care City, Dubai, 505055, United Arab Emirates, 971 568345125, yaj.banerjee@gmail.com %K undergraduate medical education %K anatomy education %K Gagne’s 9 events of instruction %K Peyton’s 4-step approach %K Mento’s 12-step change management model %K Bourdieu’s Theory of Practice %K social media application %K interactome %K COVID-19 %K framework %D 2020 %7 7.10.2020 %9 Original Paper %J JMIR Med Educ %G English %X Background: Anatomy is considered to be one of the keystones of undergraduate medical education. However, recently, there has been drastic reduction, both in gross anatomy teaching hours and its context. Additionally, a decrease in the number of trained anatomists and an increase in the costs associated with procuring human cadavers have been noted, causing a diminution of cadaveric dissections in anatomy education. Objective: To address these challenges, there is an ardent need for a pedagogical framework such that anatomy education can be disseminated through active learning principles, within a fixed time frame, using a small team of anatomists and a small number of cadaveric specimens (for live on-site sessions) as well as collaborative learning principles. The latter is particularly important when anatomy education is delivered through distance learning, as is the case currently during the COVID-19 pandemic. Methods: Here, we have blueprinted a pedagogical framework blending the instructional design models of Gagne’s 9 events of instruction with Peyton’s 4-step approach. The framework’s applicability was validated through the delivery of anatomical concepts, using an exemplar from the structure-function course Head and Neck during the normal and COVID-19–mandated lockdown periods, employing the archetype of Frey syndrome. Preliminary evaluation of the framework was pursued using student feedback and end-of-course feedback responses. The efficiency of the framework in knowledge transfer was also appraised. Results: The blueprinted instructional plan designed to implement the pedagogical framework was successfully executed in the dissemination of anatomy education, employing a limited number of cadaveric specimens (during normal times) and a social media application (SMA)–integrated “interactome” strategy (during the COVID-19 lockdown). Students’ response to the framework was positive. However, reluctance was expressed by a majority of the faculty in adopting the framework for anatomy education. To address this aspect, a strategy has been designed using Mento’s 12-step change management model. The long-term benefits for any medical school to adopt the blended pedagogical framework have also been explicated by applying Bourdieu’s Theory of Practice. Additionally, through the design of an SMA interactome model, the framework’s applicability to the delivery of anatomy education and content during the ongoing COVID-19 pandemic was realized. Conclusions: In conclusion, the study effectively tackles some of the contemporary key challenges associated with the delivery of anatomy content in medical education during normal and unprecedented times. %M 32873536 %R 10.2196/21701 %U http://mededu.jmir.org/2020/2/e21701/ %U https://doi.org/10.2196/21701 %U http://www.ncbi.nlm.nih.gov/pubmed/32873536 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 10 %P e22146 %T System-Wide Accelerated Implementation of Telemedicine in Response to COVID-19: Mixed Methods Evaluation %A Garcia-Huidobro,Diego %A Rivera,Solange %A Valderrama Chang,Sebastián %A Bravo,Paula %A Capurro,Daniel %+ Department of Family Medicine, Pontificia Universidad Catolica de Chile, Vicuna Mackenna 4686, Macul, Santiago, , Chile, 56 930233407, dngarcih@uc.cl %K telemedicine %K telehealth %K virtual medicine %K health services evaluation %K COVID-19 %D 2020 %7 6.10.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: As the COVID-19 pandemic disrupted medical practice, telemedicine emerged as an alternative to outpatient visits. However, it is not known how patients and physicians responded to an accelerated implementation of this model of medical care. Objective: The aim of this study is to report the system-wide accelerated implementation of telemedicine, compare patient satisfaction between telemedicine and in-person visits, and report provider perceptions. Methods: This study was conducted at the UC Christus Health Network, a large private academic health network in Santiago, Chile. The satisfaction of patients receiving telemedicine care in March and April 2020 was compared to those receiving in-person care during the same period (concurrent control group) as well as in March and April 2019 (retrospective control group). Patient satisfaction with in-person care was measured using the Net Promoter Score (NPS) survey. Patient satisfaction with telemedicine was assessed with an online survey assessing similar domains. Providers rated their satisfaction and responded to open-ended questions assessing challenges, strategies used to address challenges, the diagnostic process, treatment, and the patient-provider relationship. Results: A total of 3962 patients receiving telemedicine, 1187 patients from the concurrent control group, and 1848 patients from the retrospective control group completed the surveys. Satisfaction was very high with both telemedicine and in-person services. Overall, 263 physicians from over 41 specialties responded to the survey. During telemedicine visits, most providers felt their clinical skills were challenged (61.8%). Female providers felt more challenged than male providers (70.7% versus 50.9%, P=.002). Surgeons, obstetricians, and gynecologists felt their clinical skills were challenged the least, compared to providers from nonsurgical specialties (P<.001). Challenges related to the delivery modality, diagnostic process, and patient-provider relationship differed by provider specialty (P=.046, P<.001, and P=.02, respectively). Conclusions: Telemedicine implemented in response to the COVID-19 pandemic produced high patient and provider satisfaction. Specialty groups perceived the impact of this new mode of clinical practice differently. %M 32903195 %R 10.2196/22146 %U https://www.jmir.org/2020/10/e22146 %U https://doi.org/10.2196/22146 %U http://www.ncbi.nlm.nih.gov/pubmed/32903195 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 10 %P e21439 %T Clinical Predictive Models for COVID-19: Systematic Study %A Schwab,Patrick %A DuMont Schütte,August %A Dietz,Benedikt %A Bauer,Stefan %+ F Hoffmann-La Roche Ltd, Grenzacherstrasse 124, Basel, 4070, Switzerland, 41 793093361, patrick.schwab@icloud.com %K SARS-CoV-2 %K COVID-19 %K machine learning %K clinical prediction %K prediction %K infectious disease %K clinical data %K testing %K hospitalization %K intensive care %D 2020 %7 6.10.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: COVID-19 is a rapidly emerging respiratory disease caused by SARS-CoV-2. Due to the rapid human-to-human transmission of SARS-CoV-2, many health care systems are at risk of exceeding their health care capacities, in particular in terms of SARS-CoV-2 tests, hospital and intensive care unit (ICU) beds, and mechanical ventilators. Predictive algorithms could potentially ease the strain on health care systems by identifying those who are most likely to receive a positive SARS-CoV-2 test, be hospitalized, or admitted to the ICU. Objective: The aim of this study is to develop, study, and evaluate clinical predictive models that estimate, using machine learning and based on routinely collected clinical data, which patients are likely to receive a positive SARS-CoV-2 test or require hospitalization or intensive care. Methods: Using a systematic approach to model development and optimization, we trained and compared various types of machine learning models, including logistic regression, neural networks, support vector machines, random forests, and gradient boosting. To evaluate the developed models, we performed a retrospective evaluation on demographic, clinical, and blood analysis data from a cohort of 5644 patients. In addition, we determined which clinical features were predictive to what degree for each of the aforementioned clinical tasks using causal explanations. Results: Our experimental results indicate that our predictive models identified patients that test positive for SARS-CoV-2 a priori at a sensitivity of 75% (95% CI 67%-81%) and a specificity of 49% (95% CI 46%-51%), patients who are SARS-CoV-2 positive that require hospitalization with 0.92 area under the receiver operator characteristic curve (AUC; 95% CI 0.81-0.98), and patients who are SARS-CoV-2 positive that require critical care with 0.98 AUC (95% CI 0.95-1.00). Conclusions: Our results indicate that predictive models trained on routinely collected clinical data could be used to predict clinical pathways for COVID-19 and, therefore, help inform care and prioritize resources. %M 32976111 %R 10.2196/21439 %U http://www.jmir.org/2020/10/e21439/ %U https://doi.org/10.2196/21439 %U http://www.ncbi.nlm.nih.gov/pubmed/32976111 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 10 %P e21299 %T Diagnostic Accuracy of Web-Based COVID-19 Symptom Checkers: Comparison Study %A Munsch,Nicolas %A Martin,Alistair %A Gruarin,Stefanie %A Nateqi,Jama %A Abdarahmane,Isselmou %A Weingartner-Ortner,Rafael %A Knapp,Bernhard %+ Data Science Department, Symptoma, Landstraßer Gürtel 3, Vienna, 1030, Austria, 43 662458206, science@symptoma.com %K COVID-19 %K symptom checkers %K benchmark %K digital health %K symptom %K chatbot %K accuracy %D 2020 %7 6.10.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: A large number of web-based COVID-19 symptom checkers and chatbots have been developed; however, anecdotal evidence suggests that their conclusions are highly variable. To our knowledge, no study has evaluated the accuracy of COVID-19 symptom checkers in a statistically rigorous manner. Objective: The aim of this study is to evaluate and compare the diagnostic accuracies of web-based COVID-19 symptom checkers. Methods: We identified 10 web-based COVID-19 symptom checkers, all of which were included in the study. We evaluated the COVID-19 symptom checkers by assessing 50 COVID-19 case reports alongside 410 non–COVID-19 control cases. A bootstrapping method was used to counter the unbalanced sample sizes and obtain confidence intervals (CIs). Results are reported as sensitivity, specificity, F1 score, and Matthews correlation coefficient (MCC). Results: The classification task between COVID-19–positive and COVID-19–negative for “high risk” cases among the 460 test cases yielded (sorted by F1 score): Symptoma (F1=0.92, MCC=0.85), Infermedica (F1=0.80, MCC=0.61), US Centers for Disease Control and Prevention (CDC) (F1=0.71, MCC=0.30), Babylon (F1=0.70, MCC=0.29), Cleveland Clinic (F1=0.40, MCC=0.07), Providence (F1=0.40, MCC=0.05), Apple (F1=0.29, MCC=-0.10), Docyet (F1=0.27, MCC=0.29), Ada (F1=0.24, MCC=0.27) and Your.MD (F1=0.24, MCC=0.27). For “high risk” and “medium risk” combined the performance was: Symptoma (F1=0.91, MCC=0.83) Infermedica (F1=0.80, MCC=0.61), Cleveland Clinic (F1=0.76, MCC=0.47), Providence (F1=0.75, MCC=0.45), Your.MD (F1=0.72, MCC=0.33), CDC (F1=0.71, MCC=0.30), Babylon (F1=0.70, MCC=0.29), Apple (F1=0.70, MCC=0.25), Ada (F1=0.42, MCC=0.03), and Docyet (F1=0.27, MCC=0.29). Conclusions: We found that the number of correctly assessed COVID-19 and control cases varies considerably between symptom checkers, with different symptom checkers showing different strengths with respect to sensitivity and specificity. A good balance between sensitivity and specificity was only achieved by two symptom checkers. %M 33001828 %R 10.2196/21299 %U http://www.jmir.org/2020/10/e21299/ %U https://doi.org/10.2196/21299 %U http://www.ncbi.nlm.nih.gov/pubmed/33001828 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 10 %P e22374 %T COVID-19 and the “Film Your Hospital” Conspiracy Theory: Social Network Analysis of Twitter Data %A Ahmed,Wasim %A López Seguí,Francesc %A Vidal-Alaball,Josep %A Katz,Matthew S %+ Department of Marketing, Operations and Systems, Newcastle University Business School, Newcastle University, 5 Barrack Rd, Newcastle Upon Tyne, NE1 4SE, United Kingdom, 44 1912081704, wasim.ahmed@newcastle.ac.uk %K COVID-19 %K coronavirus %K Twitter %K misinformation %K fake news %K social network analysis %K public health %K social media %D 2020 %7 5.10.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: During the COVID-19 pandemic, a number of conspiracy theories have emerged. A popular theory posits that the pandemic is a hoax and suggests that certain hospitals are “empty.” Research has shown that accepting conspiracy theories increases the likelihood that an individual may ignore government advice about social distancing and other public health interventions. Due to the possibility of a second wave and future pandemics, it is important to gain an understanding of the drivers of misinformation and strategies to mitigate it. Objective: This study set out to evaluate the #FilmYourHospital conspiracy theory on Twitter, attempting to understand the drivers behind it. More specifically, the objectives were to determine which online sources of information were used as evidence to support the theory, the ratio of automated to organic accounts in the network, and what lessons can be learned to mitigate the spread of such a conspiracy theory in the future. Methods: Twitter data related to the #FilmYourHospital hashtag were retrieved and analyzed using social network analysis across a 7-day period from April 13-20, 2020. The data set consisted of 22,785 tweets and 11,333 Twitter users. The Botometer tool was used to identify accounts with a higher probability of being bots. Results: The most important drivers of the conspiracy theory are ordinary citizens; one of the most influential accounts is a Brexit supporter. We found that YouTube was the information source most linked to by users. The most retweeted post belonged to a verified Twitter user, indicating that the user may have had more influence on the platform. There was a small number of automated accounts (bots) and deleted accounts within the network. Conclusions: Hashtags using and sharing conspiracy theories can be targeted in an effort to delegitimize content containing misinformation. Social media organizations need to bolster their efforts to label or remove content that contains misinformation. Public health authorities could enlist the assistance of influencers in spreading antinarrative content. %M 32936771 %R 10.2196/22374 %U http://www.jmir.org/2020/10/e22374/ %U https://doi.org/10.2196/22374 %U http://www.ncbi.nlm.nih.gov/pubmed/32936771 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 10 %P e21955 %T Dynamic Panel Surveillance of COVID-19 Transmission in the United States to Inform Health Policy: Observational Statistical Study %A Oehmke,James Francis %A Moss,Charles B %A Singh,Lauren Nadya %A Oehmke,Theresa Bristol %A Post,Lori Ann %+ Buehler Center for Health Policy and Economics, Feinberg School of Medicine, Northwestern University, 420 E Superior St, Chicago, IL, , United States, 1 203 980 7107, lori.post@northwestern.edu %K COVID-19 %K models %K surveillance %K reopening America %K contagion %K metrics %K surveillance %K health policy %K public health %D 2020 %7 5.10.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The Great COVID-19 Shutdown aimed to eliminate or slow the spread of SARS-CoV-2, the virus that causes COVID-19. The United States has no national policy, leaving states to independently implement public health guidelines that are predicated on a sustained decline in COVID-19 cases. Operationalization of “sustained decline” varies by state and county. Existing models of COVID-19 transmission rely on parameters such as case estimates or R0 and are dependent on intensive data collection efforts. Static statistical models do not capture all of the relevant dynamics required to measure sustained declines. Moreover, existing COVID-19 models use data that are subject to significant measurement error and contamination. Objective: This study will generate novel metrics of speed, acceleration, jerk, and 7-day lag in the speed of COVID-19 transmission using state government tallies of SARS-CoV-2 infections, including state-level dynamics of SARS-CoV-2 infections. This study provides the prototype for a global surveillance system to inform public health practice, including novel standardized metrics of COVID-19 transmission, for use in combination with traditional surveillance tools. Methods: Dynamic panel data models were estimated with the Arellano-Bond estimator using the generalized method of moments. This statistical technique allows for the control of a variety of deficiencies in the existing data. Tests of the validity of the model and statistical techniques were applied. Results: The statistical approach was validated based on the regression results, which determined recent changes in the pattern of infection. During the weeks of August 17-23 and August 24-30, 2020, there were substantial regional differences in the evolution of the US pandemic. Census regions 1 and 2 were relatively quiet with a small but significant persistence effect that remained relatively unchanged from the prior 2 weeks. Census region 3 was sensitive to the number of tests administered, with a high constant rate of cases. A weekly special analysis showed that these results were driven by states with a high number of positive test reports from universities. Census region 4 had a high constant number of cases and a significantly increased persistence effect during the week of August 24-30. This change represents an increase in the transmission model R value for that week and is consistent with a re-emergence of the pandemic. Conclusions: Reopening the United States comes with three certainties: (1) the “social” end of the pandemic and reopening are going to occur before the “medical” end even while the pandemic is growing. We need improved standardized surveillance techniques to inform leaders when it is safe to open sections of the country; (2) varying public health policies and guidelines unnecessarily result in varying degrees of transmission and outbreaks; and (3) even those states most successful in containing the pandemic continue to see a small but constant stream of new cases daily. %M 32924962 %R 10.2196/21955 %U https://www.jmir.org/2020/10/e21955 %U https://doi.org/10.2196/21955 %U http://www.ncbi.nlm.nih.gov/pubmed/32924962 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 10 %P e21692 %T Preventing and Addressing the Stress Reactions of Health Care Workers Caring for Patients With COVID-19: Development of a Digital Platform (Be + Against COVID) %A Mira,José Joaquín %A Vicente,María Asunción %A Lopez-Pineda,Adriana %A Carrillo,Irene %A Guilabert,Mercedes %A Fernández,César %A Pérez-Jover,Virtudes %A Martin Delgado,Jimmy %A Pérez-Pérez,Pastora %A Cobos Vargas,Angel %A Astier-Peña,María Pilar %A Martínez-García,Olga Beatriz %A Marco-Gómez,Bárbara %A Abad Bouzán,Cristina %+ Telematics Engineering Area, Miguel Hernández University, Edificio Innova, Elche, 03202, Spain, 34 966658423, c.fernandez@umh.es %K COVID-19 %K pandemic %K internet %K social media %K mobile app %K psychosocial %K support system %K health personnel %K app %D 2020 %7 5.10.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: COVID-19 became a major public health concern in March 2020. Due to the high rate of hospitalizations for COVID-19 in a short time, health care workers and other involved staff are subjected to a large workload and high emotional distress. Objective: The objective of this study is to develop a digital tool to provide support resources that might prevent and consider acute stress reactions in health care workers and other support staff due to the COVID-19 pandemic. Methods: The contents of the digital platform were created through an evidence-based review and consensus conference. The website was built using the Google Blogger tool. The Android version of the app was developed in the Java and XML languages using Android Studio version 3.6, and the iOS version was developed in the Swift language using Xcode version 11.5. The app was evaluated externally by the Andalusian Agency for Healthcare Quality. Results: We detected the needs and pressing situations of frontline health care workers, and then, we proposed a serial of recommendations and support resources to address them. These resources were redesigned using the feedback received. A website in three different languages (Spanish, English, and Portuguese) and a mobile app were developed with these contents, and the AppSaludable Quality Seal was granted to the app. A specific self-report scale to measure acute stress and additional tools were included to support the health care workforce. This instrument has been used in several Latin American countries and has been adapted considering cultural differences. The resources section of the website was the most visited with 18,516 out of 68,913 (26.9%) visits, and the “Self-Report Acute Stress Scale” was the most visited resource with 6468 out of 18,516 (34.9%) visits. Conclusions: The Be + against COVID platform (website and app) was developed and launched to offer a pool of recommendations and support resources, which were specifically designed to protect the psychological well-being and the work morale of health care workers. This is an original initiative different from the usual psychological assistance hotlines. %M 32936769 %R 10.2196/21692 %U https://mhealth.jmir.org/2020/10/e21692 %U https://doi.org/10.2196/21692 %U http://www.ncbi.nlm.nih.gov/pubmed/32936769 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 10 %P e21301 %T Association of Web-Based Physical Education With Mental Health of College Students in Wuhan During the COVID-19 Outbreak: Cross-Sectional Survey Study %A Deng,Cheng-Hu %A Wang,Jing-Qiang %A Zhu,Li-Ming %A Liu,He-Wang %A Guo,Yu %A Peng,Xue-Hua %A Shao,Jian-Bo %A Xia,Wei %+ Department of Imaging Center, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Hubei, Wuhan 430015, China, 86 1 338 755 3260, 176778380@qq.com %K COVID-19 %K college students %K mental status %K physical education %K young adults %K web-based education %K global health %K web-based survey %K physical activity %K mental health %D 2020 %7 5.10.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 outbreak has affected people’s health worldwide. For college students, web-based physical education is a challenge, as these course are normally offered outdoors. Objective: The aim of this study was to use data from a web-based survey to evaluate the relationship between the mental health status of college students and their sports-related lifestyles. Problems related to web-based physical education were also examined. Methods: A web-based survey was conducted by snowball sampling from May 8 to 11, 2020. Demographic data, mental health status, and sports-related lifestyles of college students in Wuhan as well as issues related to web-based physical education were collected. Mental health status was assessed by the Depression, Anxiety, and Stress Scale (DASS-21). Results: The study included 1607 respondents from 267 cities. The average scores of the DASS-21 subscales (2.46 for depression, 1.48 for anxiety, and 2.59 for stress) were significantly lower in our study than in a previous study (P<.05). Lower DASS-21 scores were significantly correlated with regular exercise, maintaining exercise habits during the outbreak of COVID-19, exercising more than 1 to 2 times a week, exercise duration >1 hour, and >2000 pedometer steps (all P<.05). None of the three forms of web-based physical education was preferred by more than 50% of respondents. Frequent technical problems were confronted by 1087/1607 students (67.6%). Shape-up exercises (846/1607, 52.6%), a designed combination of exercises (710/1607, 44.2%), and Chinese kung fu (559/1607, 34.8%) were suggested sports for web-based physical education. Conclusions: Mental status was significantly correlated with regular exercise and sufficient exercise duration. Professional physical guidance is needed for college students in selected sports. Exercises not meeting students’ preferences, frequent technical problems, and the distant interaction involved in web-based physical education were the main problems that should be solved in future. %M 32997639 %R 10.2196/21301 %U http://www.jmir.org/2020/10/e21301/ %U https://doi.org/10.2196/21301 %U http://www.ncbi.nlm.nih.gov/pubmed/32997639 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 10 %P e21211 %T The Need for Sustainable Teleconsultation Systems in the Aftermath of the First COVID-19 Wave %A Giunti,Guido %A Goossens,Richard %A De Bont,Antoinette %A Visser,Jacob J %A Mulder,Mark %A Schuit,Stephanie C E %+ University of Oulu, Pentti Kaiteran katu 1, Oulu, 90014, Finland, 358 294480000, drguidogiunti@gmail.com %K telemedicine %K COVID-19 %K telehealth %K teleconsultation %K exposure %K software %K digital health %K organization %D 2020 %7 5.10.2020 %9 Viewpoint %J J Med Internet Res %G English %X The physical and social distancing measures that have been adopted worldwide because of COVID-19 will probably remain in place for a long time, especially for senior adults, people with chronic conditions, and other at-risk populations. Teleconsultations can be useful in ensuring that patients continue to receive clinical care while reducing physical crowding and avoiding unnecessary exposure of health care staff. Implementation processes that typically take months of planning, budgeting, pilot testing, and education were compressed into days. However, in the urgency to deal with the present crisis, we may be forgetting that the introduction of digital health is not exclusively a technological issue, but part of a complex organizational change problem. This viewpoint offers insight regarding issues that rapidly adopted teleconsultation systems may face in a post–COVID-19 world. %M 32997642 %R 10.2196/21211 %U http://www.jmir.org/2020/10/e21211/ %U https://doi.org/10.2196/21211 %U http://www.ncbi.nlm.nih.gov/pubmed/32997642 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 10 %P e20509 %T Identification of Risk Factors and Symptoms of COVID-19: Analysis of Biomedical Literature and Social Media Data %A Jeon,Jouhyun %A Baruah,Gaurav %A Sarabadani,Sarah %A Palanica,Adam %+ Klick Labs, Klick Applied Sciences, 175 Bloor Street East, Suite 300, Toronto, ON, M4W 3R8, Canada, 1 416 214 4977, cjeon@klick.com %K SARS-CoV-2 %K COVID-19 %K risk factor %K symptom %K diagnosis %K treatment %K biomedical literature %K social media %K Twitter %K tweets %D 2020 %7 2.10.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: In December 2019, the COVID-19 outbreak started in China and rapidly spread around the world. Lack of a vaccine or optimized intervention raised the importance of characterizing risk factors and symptoms for the early identification and successful treatment of patients with COVID-19. Objective: This study aims to investigate and analyze biomedical literature and public social media data to understand the association of risk factors and symptoms with the various outcomes observed in patients with COVID-19. Methods: Through semantic analysis, we collected 45 retrospective cohort studies, which evaluated 303 clinical and demographic variables across 13 different outcomes of patients with COVID-19, and 84,140 Twitter posts from 1036 COVID-19–positive users. Machine learning tools to extract biomedical information were introduced to identify mentions of uncommon or novel symptoms in tweets. We then examined and compared two data sets to expand our landscape of risk factors and symptoms related to COVID-19. Results: From the biomedical literature, approximately 90% of clinical and demographic variables showed inconsistent associations with COVID-19 outcomes. Consensus analysis identified 72 risk factors that were specifically associated with individual outcomes. From the social media data, 51 symptoms were characterized and analyzed. By comparing social media data with biomedical literature, we identified 25 novel symptoms that were specifically mentioned in tweets but have been not previously well characterized. Furthermore, there were certain combinations of symptoms that were frequently mentioned together in social media. Conclusions: Identified outcome-specific risk factors, symptoms, and combinations of symptoms may serve as surrogate indicators to identify patients with COVID-19 and predict their clinical outcomes in order to provide appropriate treatments. %M 32936770 %R 10.2196/20509 %U https://www.jmir.org/2020/10/e20509 %U https://doi.org/10.2196/20509 %U http://www.ncbi.nlm.nih.gov/pubmed/32936770 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 10 %P e22299 %T CoV-Seq, a New Tool for SARS-CoV-2 Genome Analysis and Visualization: Development and Usability Study %A Liu,Boxiang %A Liu,Kaibo %A Zhang,He %A Zhang,Liang %A Bian,Yuchen %A Huang,Liang %+ Baidu Research, 1195 Bordeaux Drive, Sunnyvale, CA, 94089, United States, 1 3093108265, jollier.liu@gmail.com %K COVID-19 %K SARS-CoV-2 %K bioinformatics %K genetics %K genome %K virus %K sequence %K data sets %K programming %K web server %D 2020 %7 2.10.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: COVID-19 became a global pandemic not long after its identification in late 2019. The genomes of SARS-CoV-2 are being rapidly sequenced and shared on public repositories. To keep up with these updates, scientists need to frequently refresh and reclean data sets, which is an ad hoc and labor-intensive process. Further, scientists with limited bioinformatics or programming knowledge may find it difficult to analyze SARS-CoV-2 genomes. Objective: To address these challenges, we developed CoV-Seq, an integrated web server that enables simple and rapid analysis of SARS-CoV-2 genomes. Methods: CoV-Seq is implemented in Python and JavaScript. The web server and source code URLs are provided in this article. Results: Given a new sequence, CoV-Seq automatically predicts gene boundaries and identifies genetic variants, which are displayed in an interactive genome visualizer and are downloadable for further analysis. A command-line interface is available for high-throughput processing. In addition, we aggregated all publicly available SARS-CoV-2 sequences from the Global Initiative on Sharing Avian Influenza Data (GISAID), National Center for Biotechnology Information (NCBI), European Nucleotide Archive (ENA), and China National GeneBank (CNGB), and extracted genetic variants from these sequences for download and downstream analysis. The CoV-Seq database is updated weekly. Conclusions: We have developed CoV-Seq, an integrated web service for fast and easy analysis of custom SARS-CoV-2 sequences. The web server provides an interactive module for the analysis of custom sequences and a weekly updated database of genetic variants of all publicly accessible SARS-CoV-2 sequences. We believe CoV-Seq will help improve our understanding of the genetic underpinnings of COVID-19. %M 32931441 %R 10.2196/22299 %U https://www.jmir.org/2020/10/e22299 %U https://doi.org/10.2196/22299 %U http://www.ncbi.nlm.nih.gov/pubmed/32931441 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 10 %P e23543 %T Safety and Efficacy of Convalescent Plasma to Treat Severe COVID-19: Protocol for the Saudi Collaborative Multicenter Phase II Study %A Albalawi,Mohammed %A Zaidi,Syed Ziauddin Ahmed %A AlShehry,Nawal %A AlAskar,Ahmed %A Zaidi,Abdul Rehman Zia %A Abdallah,Rania Nagib Mohammed %A Salam,Abdul %A AlSagheir,Ahmed %A AlMozain,Nour %A Elgohary,Ghada %A Batarfi,Khalid %A Alfaraedi,Alia %A Khojah,Osamah %A Al-Ansari,Rehab %A Alfaraj,Mona %A Dayel,Afra %A Al Bahrani,Ahmed %A Abdelhameed,Arwa Nabhan %A Alhumaidan,Hind %A Al-Otaibi,Jawaher M %A Radwi,Ghazala %A Raizah,Abdulrahman %A Shatry,Hind %A Alsaleh,Sara %A AlZahrani,Hazzaa %A Al-Hashmi,Hani %+ Adult Hematology & Stem Cell Transplantation Department, Oncology Centre, King Fahad Specialist Hospital, Amr Bin Thabet, P.O. Box 15373, Dammam, 31444, Saudi Arabia, 966 564773377, hashmih@yahoo.com %K coronaviruses %K SARS-CoV-2 %K COVID-19 %K antibodies %K convalescent plasma %K treatment %K immunology %K feasibility %K safety %K efficacy %K infectious disease %D 2020 %7 2.10.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: The COVID-19 pandemic is expected to cause significant morbidity and mortality. The development of an effective vaccine will take several months to become available, and its affordability is unpredictable. Transfusion of convalescent plasma (CP) may provide passive immunity. Based on initial data from China, a group of hematologists, infectious disease specialists, and intensivists drafted this protocol in March 2020. Objective: The aim of this study is to test the feasibility, safety, and efficacy of CP in treating patients with COVID-19 across Saudi Arabia. Methods: Eligible patients with COVID-19 will be recruited for CP infusion according to the inclusion criteria. As COVID-19 has proven to be a moving target as far as its management is concerned, we will use current definitions according to the Ministry of Health (MOH) guidelines for diagnosis, treatment, and recovery. All CP recipients will receive supportive management including all available recommended therapies according to the available MOH guidelines. Eligible CP donors will be patients with COVID-19 who have fully recovered from their disease according to MOH recovery criteria as detailed in the inclusion criteria. CP donors have to qualify as blood donors according to MOH regulations except for the history of COVID-19 in the recent past. We will also test the CP donors for the presence of SARS-CoV-2 antibodies by a rapid test, and aliquots will be archived for future antibody titration. Due to the perceived benefit of CP, randomization was not considered. However, we will compare the outcome of the cohort treated with CP with those who did not receive CP due to a lack of consent or lack of availability. In this national collaborative study, there is a likelihood of not finding exactly matched control group patients. Hence, we plan to perform a propensity score matching of the CP recipients with the comparator group patients for the major characteristics. We plan to collect demographic, clinical, and laboratory characteristics of both groups and compare the outcomes. A total sample size of 575 patients, 115 CP recipients and 460 matched controls (1:4 ratio), will be sufficient to detect a clinically important hospital stay and 30-day mortality difference between the two groups with 80% power and a 5% level of significance. Results: At present, patient recruitment is still ongoing, and the interim analysis of the first 40 patients will be shared soon. Conclusions: In this paper, we present a protocol for a national collaborative multicenter phase II study in Saudi Arabia for assessing the feasibility, safety, and potential efficacy of CP in treating patients with severe COVID-19. We plan to publish an interim report of the first 40 CP recipients and their matched comparators soon. Trial Registration: ClinicalTrials.gov NCT04347681; https://clinicaltrials.gov/ct2/show/NCT04347681 International Registered Report Identifier (IRRID): PRR1-10.2196/23543 %M 32903199 %R 10.2196/23543 %U https://www.researchprotocols.org/2020/10/e23543 %U https://doi.org/10.2196/23543 %U http://www.ncbi.nlm.nih.gov/pubmed/32903199 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 10 %P e22523 %T Adapting an Outpatient Psychiatric Clinic to Telehealth During the COVID-19 Pandemic: A Practice Perspective %A Sasangohar,Farzan %A Bradshaw,Major R %A Carlson,Marianne Millen %A Flack,James N %A Fowler,James C %A Freeland,Diana %A Head,John %A Marder,Kate %A Orme,William %A Weinstein,Benjamin %A Kolman,Jacob M %A Kash,Bita %A Madan,Alok %+ Center for Outcomes Research, Houston Methodist Hospital, 6565 Fannin St, Houston, TX, United States, 1 979 458 2337, sasangohar@tamu.edu %K telemedicine %K psychiatry %K preventive psychiatry %K SARS virus %K pandemic %K prevention %K COVID-19 %K telehealth %K perspective %D 2020 %7 1.10.2020 %9 Viewpoint %J J Med Internet Res %G English %X As the demand for telepsychiatry increases during the COVID-19 pandemic, the strengths and challenges of telepsychiatry implementation must be articulated to improve clinical practices in the long term. Currently, observations within US contexts are lacking; therefore, we report on the rapid implementation of telepsychiatry and workflow experiences in a psychiatric practice based within a large health care system in southeast Texas with a national catchment area. We discuss the logistics of the implementation, including modes of communication, scheduling, coordination, and capacity; the psychological effects of web-based services, including both the loss of the physical therapeutic environment and the unique interpersonal dynamics experienced in the virtual environment; and postadoption patterns of engagement with our services and with other clinical functions affected by the rapid adaptation to telemedicine. Our art therapy group programming serves as an applied case study, demonstrating the value of a well-managed web-based program (eg, patients were receptive and well-engaged, and they appreciated the continuity of accessible service) as well as the challenges (eg, the need for backup plans and technological fallbacks, managing interruptions and telecommunication learning curves, and working around the difference in resources for art and music therapy between a well-stocked clinical setting versus clients’ home spaces). We conclude from our experience that the overall strengths of telepsychiatry include receptive and well-engaged responses from patients as well as the expansion of boundaries, which provides a directly contextualized view into patients’ home lives. Challenges and corresponding recommendations include the need for more careful safety planning for high-risk patients; maintaining professional boundaries in the newly informal virtual setting; designing the physical space to both frame the patient encounter and maintain work-life balance for the therapist; allowing for delays and interruptions (including an initial acclimation session); and preserving interprofessional care team collaboration when the physical locations that normally facilitate such encounters are not accessible. We believe that careful observations of the strengths and challenges of telepsychiatry during this pandemic will better inform practices that are considering telepsychiatry adoption both within pandemic contexts and more broadly thereafter. %M 32936768 %R 10.2196/22523 %U https://www.jmir.org/2020/10/e22523 %U https://doi.org/10.2196/22523 %U http://www.ncbi.nlm.nih.gov/pubmed/32936768 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 8 %N 10 %P e21628 %T A Computer-Interpretable Guideline for COVID-19: Rapid Development and Dissemination %A Nan,Shan %A Tang,Tianhua %A Feng,Hongshuo %A Wang,Yijie %A Li,Mengyang %A Lu,Xudong %A Duan,Huilong %+ College of Biomedical Engineering and Instrumental Science, Zhejiang University, Zhouyiqing Building, 512, 38 Zheda Road, Hangzhou, Hangzhou, 310027, China, 86 13957118891, lvxd@zju.edu.cn %K COVID-19 %K guideline %K CDSS %K openEHR %K Guideline Definition Language %K development %K dissemination %K electronic health record %K algorithm %D 2020 %7 1.10.2020 %9 Original Paper %J JMIR Med Inform %G English %X Background: COVID-19 is a global pandemic that is affecting more than 200 countries worldwide. Efficient diagnosis and treatment are crucial to combat the disease. Computer-interpretable guidelines (CIGs) can aid the broad global adoption of evidence-based diagnosis and treatment knowledge. However, currently, no internationally shareable CIG exists. Objective: The aim of this study was to establish a rapid CIG development and dissemination approach and apply it to develop a shareable CIG for COVID-19. Methods: A 6-step rapid CIG development and dissemination approach was designed and applied. Processes, roles, and deliverable artifacts were specified in this approach to eliminate ambiguities during development of the CIG. The Guideline Definition Language (GDL) was used to capture the clinical rules. A CIG for COVID-19 was developed by translating, interpreting, annotating, extracting, and formalizing the Chinese COVID-19 diagnosis and treatment guideline. A prototype application was implemented to validate the CIG. Results: We used 27 archetypes for the COVID-19 guideline. We developed 18 GDL rules to cover the diagnosis and treatment suggestion algorithms in the narrative guideline. The CIG was further translated to object data model and Drools rules to facilitate its use by people who do not employ the non-openEHR archetype. The prototype application validated the correctness of the CIG with a public data set. Both the GDL rules and Drools rules have been disseminated on GitHub. Conclusions: Our rapid CIG development and dissemination approach accelerated the pace of COVID-19 CIG development. A validated COVID-19 CIG is now available to the public. %M 32931443 %R 10.2196/21628 %U https://medinform.jmir.org/2020/10/e21628 %U https://doi.org/10.2196/21628 %U http://www.ncbi.nlm.nih.gov/pubmed/32931443 %0 Journal Article %@ 2563-6316 %I JMIR Publications %V 1 %N 1 %P e19583 %T No Time to Waste: Real-World Repurposing of Generic Drugs as a Multifaceted Strategy Against COVID-19 %A Rogosnitzky,Moshe %A Berkowitz,Esther %A Jadad,Alejandro R %+ Medinsight Research Institute, Pekeris 4, Weizmann Science Park, Rehovot, 7670204, Israel, 972 522945520, moshe@medinsight.org %K COVID-19 %K drug repurposing %K fibrates %K histamine type-2 receptor antagonists %K cimetidine %K famotidine %K fenofibrate %K bezafibrate %K dipyridamole %K sildenafil %D 2020 %7 30.9.2020 %9 Viewpoint %J JMIRx Med %G English %X Real-world drug repurposing—the immediate “off-label” prescribing of drugs to address urgent clinical needs—is an indispensable strategy gaining rapid traction in the current COVID-19 crisis. Although off-label prescribing (ie, for a nonapproved indication) is legal in most countries, it tends to shift the burden of liability and cost to physicians and patients, respectively. Nevertheless, in urgent public health crises, it is often the only realistic source of a meaningful potential solution. To be considered for real-world repurposing, drug candidates should ideally have a track record of safety, affordability, and wide accessibility. Although thousands of such drugs are already available, the absence of a central repository of off-label uses presents a barrier to the immediate identification and selection of the safest, potentially useful interventions. Using the current COVID-19 pandemic as an example, we provide a glimpse at the extensive literature that supports the rationale behind six generic drugs, in four classes, all of which are affordable, supported by decades of safety data, and pleiotropically target the underlying pathophysiology that makes COVID-19 so dangerous. Having previously fast-tracked this paper to publication in summary form, we now expand on why cimetidine/famotidine (histamine type-2 receptor antagonists), dipyridamole (antiplatelet agent), fenofibrate/bezafibrate (cholesterol/triglyceride-lowering agents), and sildenafil (phosphodiesterase-5 inhibitor) are worth considering for patients with COVID-19 based on their antiviral, anti-inflammatory, renoprotective, cardioprotective, and anticoagulation properties. These examples also reveal the unlimited opportunity to future-proof public health by proactively mining, synthesizing, and cataloging the off-label treatment opportunities of thousands of safe, well-established, and affordable generic drugs. %M 33724265 %R 10.2196/19583 %U https://med.jmirx.org/2020/1/e19583/ %U https://doi.org/10.2196/19583 %U http://www.ncbi.nlm.nih.gov/pubmed/33724265 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 9 %P e21915 %T Effects of the COVID-19 Pandemic on Obsessive-Compulsive Symptoms Among University Students: Prospective Cohort Survey Study %A Ji,Guangjun %A Wei,Wenjun %A Yue,Kai-Chen %A Li,Heng %A Shi,Li-Jing %A Ma,Jian-Dong %A He,Chen-Yang %A Zhou,Sheng-Sheng %A Zhao,Zongya %A Lou,Tao %A Cheng,Jie %A Yang,Shi-Chang %A Hu,Xian-Zhang %+ The Second Affiliated Hospital of Xinxiang Medical University, No 388, Jianshe Road, Muye District, Xinxiang City, 453002, China, 86 13938744850, huxianzhang@xxmu.edu.cn %K COVID-19 %K fear %K anxiety %K obsessive-compulsive disorder %K OCD %K Yale-Brown Obsessive-Compulsive Scale %K university student %K mental health %D 2020 %7 30.9.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic is associated with common mental health problems. However, evidence for the association between fear of COVID-19 and obsessive-compulsive disorder (OCD) is limited. Objective: This study aimed to examine if fear of negative events affects Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) scores in the context of a COVID-19–fear-invoking environment. Methods: All participants were medical university students and voluntarily completed three surveys via smartphone or computer. Survey 1 was conducted on February 8, 2020, following a 2-week-long quarantine period without classes; survey 2 was conducted on March 25, 2020, when participants had been taking online courses for 2 weeks; and survey 3 was conducted on April 28, 2020, when no new cases had been reported for 2 weeks. The surveys comprised the Y-BOCS and the Zung Self-Rating Anxiety Scale (SAS); additional items included questions on demographics (age, gender, only child vs siblings, enrollment year, major), knowledge of COVID-19, and level of fear pertaining to COVID-19. Results: In survey 1, 11.3% of participants (1519/13,478) scored ≥16 on the Y-BOCS (defined as possible OCD). In surveys 2 and 3, 3.6% (305/8162) and 3.5% (305/8511) of participants had scores indicative of possible OCD, respectively. The Y-BOCS score, anxiety level, quarantine level, and intensity of fear were significantly lower at surveys 2 and 3 than at survey 1 (P<.001 for all). Compared to those with a lower Y-BOCS score (<16), participants with possible OCD expressed greater intensity of fear and had higher SAS standard scores (P<.001). The regression linear analysis indicated that intensity of fear was positively correlated to the rate of possible OCD and the average total scores for the Y-BOCS in each survey (P<.001 for all). Multiple regressions showed that those with a higher intensity of fear, a higher anxiety level, of male gender, with sibling(s), and majoring in a nonmedicine discipline had a greater chance of having a higher Y-BOCS score in all surveys. These results were redemonstrated in the 5827 participants who completed both surveys 1 and 2 and in the 4006 participants who completed all three surveys. Furthermore, in matched participants, the Y-BOCS score was negatively correlated to changes in intensity of fear (r=0.74 for survey 2, P<.001; r=0.63 for survey 3, P=.006). Conclusions: Our findings indicate that fear of COVID-19 was associated with a greater Y-BOCS score, suggesting that an environment (COVID-19 pandemic) × psychology (fear and/or anxiety) interaction might be involved in OCD and that a fear of negative events might play a role in the etiology of OCD. %M 32931444 %R 10.2196/21915 %U http://www.jmir.org/2020/9/e21915/ %U https://doi.org/10.2196/21915 %U http://www.ncbi.nlm.nih.gov/pubmed/32931444 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 9 %P e21561 %T VA Video Connect for Clinical Care in Older Adults in a Rural State During the COVID-19 Pandemic: Cross-Sectional Study %A Padala,Kalpana P %A Wilson,Kerrie B %A Gauss,C Heath %A Stovall,Jessica D %A Padala,Prasad R %+ Central Arkansas Veterans Healthcare System, 2200 Fort Roots Drive, North Little Rock, AR, 72114, United States, 1 501 257 2044, kalpana.padala@va.gov %K VA Video Connect %K older adults %K rural %K COVID-19 %K veterans %K telehealth %K elderly %K disparity %K veteran affairs %K capabillity %K cross-sectional %D 2020 %7 30.9.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic has accelerated the need for telehealth at home. Although the Department of Veterans Affairs is a leading provider of telehealth, disparities may exist in reaching older veterans living in rural areas. VA Video Connect (VVC) is a video conferencing app that enables veterans to connect with their health care provider via a secure and private session. Objective: The aim of this study was to examine the capability and willingness of older veterans to participate in a VVC visit during the COVID-19 pandemic. Methods: A cross-sectional study was conducted on older veterans (N=118) at the Central Arkansas Veterans Healthcare System. Participants were interviewed over the phone and responses to the following items were recorded: availability of internet, email, and an electronic device with a camera; veterans’ willingness to complete an appointment via a VVC visit; and availability of assistance from a caregiver for those who were unable to participate in a VVC visit alone. Results: Participants’ mean age was 72.6 (SD 8.3) years, 92% (n=108) were male, 69% (n=81) were Caucasian, 30% (n=35) were African Americans, and 36% (n=42) lived in a rural location. The majority reported having access to the internet (n=93, 77%) and email service (n=83, 70%), but only 56% (n=67) had a camera-equipped device. Overall, 53% (n=63) were willing and capable of participating in a VVC visit. The availability of internet access was significantly lower in rural compared to nonrural participants (P=.045) and in those with or less than a high school education compared to those who pursued higher education (P=.02). Willingness to participate in the VVC visit was significantly lower in rural compared to nonrural participants (P=.03). Of the participants who reported they were able and willing to partake in a VVC visit (n=54), 65% (n=35) opted for VVC and 35% (n=19) preferred a phone visit. In total, 77% (n=27) of the scheduled VVC visits were successful. Conclusions: Despite advances in technology, and willingness on the part of health care systems, there are some lingering issues with capability and willingness to participate in video telehealth visits, particularly among older adults residing in rural areas. %M 32936773 %R 10.2196/21561 %U http://www.jmir.org/2020/9/e21561/ %U https://doi.org/10.2196/21561 %U http://www.ncbi.nlm.nih.gov/pubmed/32936773 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 9 %P e22457 %T Self-Reported Compliance With Personal Preventive Measures Among Chinese Factory Workers at the Beginning of Work Resumption Following the COVID-19 Outbreak: Cross-Sectional Survey Study %A Pan,Yihang %A Fang,Yuan %A Xin,Meiqi %A Dong,Willa %A Zhou,Liemin %A Hou,Qinghua %A Li,Fanping %A Sun,Gang %A Zheng,Zilong %A Yuan,Jinqiu %A Wang,Zixin %A He,Yulong %+ Center for Digestive Disease, The Seventh Affiliated Hospital, Sun Yat-sen University, No. 628 Zhenyuan Road, Guangming (New) District, Shenzhen, 518107, China, 86 755 81206988, heyulong@mail.sysu.edu.cn %K COVID-19 %K work resumption, factory workers %K facemask wearing %K hand hygiene %K physical distancing %K prevention %K cross-sectional %K online %K survey %K compliance %D 2020 %7 29.9.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Maintaining compliance with personal preventive measures is important to achieve a balance of COVID-19 pandemic control and work resumption. Objective: The aim of this study was to investigate self-reported compliance with four personal measures to prevent COVID-19 among a sample of factory workers in Shenzhen, China, at the beginning of work resumption in China following the COVID-19 outbreak. These preventive measures included consistent wearing of face masks in public spaces (the workplace and other public settings); sanitizing hands using soap, liquid soap, or alcohol-based hand sanitizer after returning from public spaces or touching public installations and equipment; avoiding social and meal gatherings; and avoiding crowded places. Methods: The participants were adult factory workers who had resumed work in Shenzhen, China. A stratified two-stage cluster sampling design was used. We randomly selected 14 factories that had resumed work. All full-time employees aged ≥18 years who had resumed work in these factories were invited to complete a web-based survey. Out of 4158 workers who had resumed work in these factories, 3035 (73.0%) completed the web-based survey from March 1 to 14, 2020. Multilevel logistic regression models were fitted. Results: Among the 3035 participants, 2938 (96.8%) and 2996 (98.7%) reported always wearing a face mask in the workplace and in other public settings, respectively, in the past month. However, frequencies of self-reported sanitizing hands (2152/3035, 70.9%), avoiding social and meal gatherings (2225/3035, 73.3%), and avoiding crowded places (1997/3035, 65.8%) were relatively low. At the individual level, knowledge about COVID-19 (adjusted odds ratios [AORs] from 1.16, CI 1.10-1.24, to 1.29, CI 1.21-1.37), perceived risk (AORs from 0.58, CI 0.50-0.68, to 0.85, CI 0.72-0.99) and severity (AOR 1.05, CI 1.01-1.09, and AOR 1.07, CI 1.03-1.11) of COVID-19, perceived effectiveness of preventive measures by the individual (AORs from 1.05, CI 1.00-1.10, to 1.09, CI 1.04-1.13), organization (AOR 1.30, CI 1.20-1.41), and government (AORs from 1.14, CI 1.04-1.25, to 1.21, CI 1.02-1.42), perceived preparedness for a potential outbreak after work resumption (AORs from 1.10, CI 1.00-1.21, to 1.50, CI 1.36-1.64), and depressive symptoms (AORs from 0.93, CI 0.91-0.94, to 0.96, CI 0.92-0.99) were associated with self-reported compliance with at least one personal preventive measure. At the interpersonal level, exposure to COVID-19–specific information through official media channels (AOR 1.08, CI 1.04-1.11) and face-to-face communication (AOR 0.90, CI 0.83-0.98) were associated with self-reported sanitizing of hands. The number of preventive measures implemented in the workplace was positively associated with self-reported compliance with all four preventive measures (AORs from 1.30, CI 1.08-1.57, to 1.63, CI 1.45-1.84). Conclusions: Measures are needed to strengthen hand hygiene and physical distancing among factory workers to reduce transmission following work resumption. Future programs in workplaces should address these factors at multiple levels. %M 32924947 %R 10.2196/22457 %U http://www.jmir.org/2020/9/e22457/ %U https://doi.org/10.2196/22457 %U http://www.ncbi.nlm.nih.gov/pubmed/32924947 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 9 %P e19788 %T Understanding the Community Risk Perceptions of the COVID-19 Outbreak in South Korea: Infodemiology Study %A Husnayain,Atina %A Shim,Eunha %A Fuad,Anis %A Su,Emily Chia-Yu %+ Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, 172-1 Keelung Rd, Sec 2, Taipei, 106, Taiwan, 886 2 66382736 ext 1515, emilysu@tmu.edu.tw %K Google Trends %K risk %K perception %K communication %K COVID-19 %K South Korea %K outbreak %K infodemiology %D 2020 %7 29.9.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: South Korea is among the best-performing countries in tackling the coronavirus pandemic by using mass drive-through testing, face mask use, and extensive social distancing. However, understanding the patterns of risk perception could also facilitate effective risk communication to minimize the impacts of disease spread during this crisis. Objective: We attempt to explore patterns of community health risk perceptions of COVID-19 in South Korea using internet search data. Methods: Google Trends (GT) and NAVER relative search volumes (RSVs) data were collected using COVID-19–related terms in the Korean language and were retrieved according to time, gender, age groups, types of device, and location. Online queries were compared to the number of daily new COVID-19 cases and tests reported in the Kaggle open-access data set for the time period of December 5, 2019, to May 31, 2020. Time-lag correlations calculated by Spearman rank correlation coefficients were employed to assess whether correlations between new COVID-19 cases and internet searches were affected by time. We also constructed a prediction model of new COVID-19 cases using the number of COVID-19 cases, tests, and GT and NAVER RSVs in lag periods (of 1-3 days). Single and multiple regressions were employed using backward elimination and a variance inflation factor of <5. Results: The numbers of COVID-19–related queries in South Korea increased during local events including local transmission, approval of coronavirus test kits, implementation of coronavirus drive-through tests, a face mask shortage, and a widespread campaign for social distancing as well as during international events such as the announcement of a Public Health Emergency of International Concern by the World Health Organization. Online queries were also stronger in women (r=0.763-0.823; P<.001) and age groups ≤29 years (r=0.726-0.821; P<.001), 30-44 years (r=0.701-0.826; P<.001), and ≥50 years (r=0.706-0.725; P<.001). In terms of spatial distribution, internet search data were higher in affected areas. Moreover, greater correlations were found in mobile searches (r=0.704-0.804; P<.001) compared to those of desktop searches (r=0.705-0.717; P<.001), indicating changing behaviors in searching for online health information during the outbreak. These varied internet searches related to COVID-19 represented community health risk perceptions. In addition, as a country with a high number of coronavirus tests, results showed that adults perceived coronavirus test–related information as being more important than disease-related knowledge. Meanwhile, younger, and older age groups had different perceptions. Moreover, NAVER RSVs can potentially be used for health risk perception assessments and disease predictions. Adding COVID-19–related searches provided by NAVER could increase the performance of the model compared to that of the COVID-19 case–based model and potentially be used to predict epidemic curves. Conclusions: The use of both GT and NAVER RSVs to explore patterns of community health risk perceptions could be beneficial for targeting risk communication from several perspectives, including time, population characteristics, and location. %M 32931446 %R 10.2196/19788 %U http://www.jmir.org/2020/9/e19788/ %U https://doi.org/10.2196/19788 %U http://www.ncbi.nlm.nih.gov/pubmed/32931446 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 9 %P e23565 %T Clinical Mortality in a Large COVID-19 Cohort: Observational Study %A Jarrett,Mark %A Schultz,Susanne %A Lyall,Julie %A Wang,Jason %A Stier,Lori %A De Geronimo,Marcella %A Nelson,Karen %+ Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hofstra University, 500 Hofstra University, Hempstead, NY, 11549, United States, 1 5163216044, MJarrett@northwell.edu %K COVID-19 %K mortality %K respiratory failure %K hypoxemia %K observational %K review %K cohort %K ICU %K intensive care unit %D 2020 %7 25.9.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Northwell Health, an integrated health system in New York, has treated more than 15,000 inpatients with COVID-19 at the US epicenter of the SARS-CoV-2 pandemic. Objective: We describe the demographic characteristics of patients who died of COVID-19, observation of frequent rapid response team/cardiac arrest (RRT/CA) calls for non–intensive care unit (ICU) patients, and factors that contributed to RRT/CA calls. Methods: A team of registered nurses reviewed the medical records of inpatients who tested positive for SARS-CoV-2 via polymerase chain reaction before or on admission and who died between March 13 (first Northwell Health inpatient expiration) and April 30, 2020, at 15 Northwell Health hospitals. The findings for these patients were abstracted into a database and statistically analyzed. Results: Of 2634 patients who died of COVID-19, 1478 (56.1%) had oxygen saturation levels ≥90% on presentation and required no respiratory support. At least one RRT/CA was called on 1112/2634 patients (42.2%) at a non-ICU level of care. Before the RRT/CA call, the most recent oxygen saturation levels for 852/1112 (76.6%) of these non-ICU patients were at least 90%. At the time the RRT/CA was called, 479/1112 patients (43.1%) had an oxygen saturation of <80%. Conclusions: This study represents one of the largest reviewed cohorts of mortality that also captures data in nonstructured fields. Approximately 50% of deaths occurred at a non-ICU level of care despite admission to the appropriate care setting with normal staffing. The data imply a sudden, unexpected deterioration in respiratory status requiring RRT/CA in a large number of non-ICU patients. Patients admitted at a non-ICU level of care suffered rapid clinical deterioration, often with a sudden decrease in oxygen saturation. These patients could benefit from additional monitoring (eg, continuous central oxygenation saturation), although this approach warrants further study. %M 32930099 %R 10.2196/23565 %U http://www.jmir.org/2020/9/e23565/ %U https://doi.org/10.2196/23565 %U http://www.ncbi.nlm.nih.gov/pubmed/32930099 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 9 %P e22767 %T Intergroup Contact, COVID-19 News Consumption, and the Moderating Role of Digital Media Trust on Prejudice Toward Asians in the United States: Cross-Sectional Study %A Tsai,Jiun-Yi %A Phua,Joe %A Pan,Shuya %A Yang,Chia-chen %+ School of Journalism and Communication, Renmin University of China, No. 59 Zhongguancun Street, Haidian District, Beijing, 100872, China, 86 10 62511081, shuya@ruc.edu.cn %K COVID-19 %K prejudice %K news exposure %K news trust %K infodemic %K media bias %K racism %K social media use %K intergroup contact %K regression %K moderation analysis %K cross-sectional survey %D 2020 %7 25.9.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The perceived threat of a contagious virus may lead people to be distrustful of immigrants and out-groups. Since the COVID-19 outbreak, the salient politicized discourses of blaming Chinese people for spreading the virus have fueled over 2000 reports of anti-Asian racial incidents and hate crimes in the United States. Objective: The study aims to investigate the relationships between news consumption, trust, intergroup contact, and prejudicial attitudes toward Asians and Asian Americans residing in the United States during the COVID-19 pandemic. We compare how traditional news, social media use, and biased news exposure cultivate racial attitudes, and the moderating role of media use and trust on prejudice against Asians is examined. Methods: A cross-sectional study was completed in May 2020. A total of 430 US adults (mean age 36.75, SD 11.49 years; n=258, 60% male) participated in an online survey through Amazon’s Mechanical Turk platform. Respondents answered questions related to traditional news exposure, social media use, perceived trust, and their top three news channels for staying informed about the novel coronavirus. In addition, intergroup contact and racial attitudes toward Asians were assessed. We performed hierarchical regression analyses to test the associations. Moderation effects were estimated using simple slopes testing with a 95% bootstrap confidence interval approach. Results: Participants who identified as conservatives (β=.08, P=.02), had a personal infection history (β=.10, P=.004), and interacted with Asian people frequently in their daily lives (β=.46, P<.001) reported more negative attitudes toward Asians after controlling for sociodemographic variables. Relying more on traditional news media (β=.08, P=.04) and higher levels of trust in social media (β=.13, P=.007) were positively associated with prejudice against Asians. In contrast, consuming news from left-leaning outlets (β=–.15, P=.001) and neutral outlets (β=–.13, P=.003) was linked to less prejudicial attitudes toward Asians. Among those who had high trust in social media, exposure had a negative relationship with prejudice. At high levels of trust in digital websites and apps, frequent use was related to less unfavorable attitudes toward Asians. Conclusions: Experiencing racial prejudice among the Asian population during a challenging pandemic can cause poor psychological outcomes and exacerbate health disparities. The results suggest that conservative ideology, personal infection history, frequency of intergroup contact, traditional news exposure, and trust in social media emerge as positive predictors of prejudice against Asians and Asian Americans, whereas people who get COVID-19 news from left-leaning and balanced outlets show less prejudice. For those who have more trust in social media and digital news, frequent use of these two sources is associated with lower levels of prejudice. Our findings highlight the need to reshape traditional news discourses and use social media and mobile news apps to develop credible messages for combating racial prejudice against Asians. %M 32924948 %R 10.2196/22767 %U http://www.jmir.org/2020/9/e22767/ %U https://doi.org/10.2196/22767 %U http://www.ncbi.nlm.nih.gov/pubmed/32924948 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 9 %P e22142 %T The Relation Between Official WhatsApp-Distributed COVID-19 News Exposure and Psychological Symptoms: Cross-Sectional Survey Study %A Liu,Jean C J %A Tong,Eddie M W %+ Yale-NUS College, 02-221, 16 College Avenue West, Singapore, 138527, Singapore, 65 66013694, jeanliu@yale-nus.edu.sg %K mental health %K social media %K pandemic %K depression %K anxiety %K stress %K COVID-19 %K app %K risk factor %K psychology %D 2020 %7 25.9.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: In a global pandemic, digital technology offers innovative methods to disseminate public health messages. As an example, the messenger app WhatsApp was adopted by both the World Health Organization and government agencies to provide updates on the coronavirus disease (COVID-19). During a time when rumors and excessive news threaten psychological well-being, these services allow for rapid transmission of information and may boost resilience. Objective: In this study, we sought to accomplish the following: (1) assess well-being during the pandemic; (2) replicate prior findings linking exposure to COVID-19 news with psychological distress; and (3) examine whether subscription to an official WhatsApp channel can mitigate this risk. Methods: Across 8 weeks of the COVID-19 outbreak (March 7 to April 21, 2020), we conducted a survey of 1145 adults in Singapore. As the primary outcome measure, participants completed the Depression, Anxiety, and Stress Scale (DASS-21). As predictor variables, participants also answered questions pertaining to the following: (1) their exposure to COVID-19 news; (2) their use of the Singapore government’s WhatsApp channel; and (3) their demographics. Results: Within the sample, 7.9% of participants had severe or extremely severe symptoms on at least one DASS-21 subscale. Depression scores were associated with increased time spent receiving COVID-19 updates, whereas use of the official WhatsApp channel emerged as a protective factor (b=–0.07, t[863]=–2.04, P=.04). Similarly, increased anxiety scores were associated with increased exposure to both updates and rumors, but this risk was mitigated by trust in the government’s WhatsApp messages (b=–0.05, t[863]=–2.13, P=.03). Finally, although stress symptoms increased with the amount of time spent receiving updates, these symptoms were not significantly related to WhatsApp use. Conclusions: Our findings suggest that messenger apps may be an effective medium for disseminating pandemic-related information, allowing official agencies to reach a broad sector of the population rapidly. In turn, this use may promote public well-being amid an “infodemic.” Trial Registration: ClinicalTrials.gov NCT04305574; https://clinicaltrials.gov/ct2/show/NCT04305574 %M 32877349 %R 10.2196/22142 %U http://www.jmir.org/2020/9/e22142/ %U https://doi.org/10.2196/22142 %U http://www.ncbi.nlm.nih.gov/pubmed/32877349 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 9 %P e19992 %T Using Smartphones and Wearable Devices to Monitor Behavioral Changes During COVID-19 %A Sun,Shaoxiong %A Folarin,Amos A %A Ranjan,Yatharth %A Rashid,Zulqarnain %A Conde,Pauline %A Stewart,Callum %A Cummins,Nicholas %A Matcham,Faith %A Dalla Costa,Gloria %A Simblett,Sara %A Leocani,Letizia %A Lamers,Femke %A Sørensen,Per Soelberg %A Buron,Mathias %A Zabalza,Ana %A Guerrero Pérez,Ana Isabel %A Penninx,Brenda WJH %A Siddi,Sara %A Haro,Josep Maria %A Myin-Germeys,Inez %A Rintala,Aki %A Wykes,Til %A Narayan,Vaibhav A %A Comi,Giancarlo %A Hotopf,Matthew %A Dobson,Richard JB %A , %+ The Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, Social Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, PO Box 80 De Crespigny Park, Denmark Hill, London, SE58AF, United Kingdom, 44 02078480951, shaoxiong.sun@kcl.ac.uk %K mobile health %K COVID-19 %K behavioral monitoring %K smartphones %K wearable devices %K mobility %K phone use %D 2020 %7 25.9.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: In the absence of a vaccine or effective treatment for COVID-19, countries have adopted nonpharmaceutical interventions (NPIs) such as social distancing and full lockdown. An objective and quantitative means of passively monitoring the impact and response of these interventions at a local level is needed. Objective: We aim to explore the utility of the recently developed open-source mobile health platform Remote Assessment of Disease and Relapse (RADAR)–base as a toolbox to rapidly test the effect and response to NPIs intended to limit the spread of COVID-19. Methods: We analyzed data extracted from smartphone and wearable devices, and managed by the RADAR-base from 1062 participants recruited in Italy, Spain, Denmark, the United Kingdom, and the Netherlands. We derived nine features on a daily basis including time spent at home, maximum distance travelled from home, the maximum number of Bluetooth-enabled nearby devices (as a proxy for physical distancing), step count, average heart rate, sleep duration, bedtime, phone unlock duration, and social app use duration. We performed Kruskal-Wallis tests followed by post hoc Dunn tests to assess differences in these features among baseline, prelockdown, and during lockdown periods. We also studied behavioral differences by age, gender, BMI, and educational background. Results: We were able to quantify expected changes in time spent at home, distance travelled, and the number of nearby Bluetooth-enabled devices between prelockdown and during lockdown periods (P<.001 for all five countries). We saw reduced sociality as measured through mobility features and increased virtual sociality through phone use. People were more active on their phones (P<.001 for Italy, Spain, and the United Kingdom), spending more time using social media apps (P<.001 for Italy, Spain, the United Kingdom, and the Netherlands), particularly around major news events. Furthermore, participants had a lower heart rate (P<.001 for Italy and Spain; P=.02 for Denmark), went to bed later (P<.001 for Italy, Spain, the United Kingdom, and the Netherlands), and slept more (P<.001 for Italy, Spain, and the United Kingdom). We also found that young people had longer homestay than older people during the lockdown and fewer daily steps. Although there was no significant difference between the high and low BMI groups in time spent at home, the low BMI group walked more. Conclusions: RADAR-base, a freely deployable data collection platform leveraging data from wearables and mobile technologies, can be used to rapidly quantify and provide a holistic view of behavioral changes in response to public health interventions as a result of infectious outbreaks such as COVID-19. RADAR-base may be a viable approach to implementing an early warning system for passively assessing the local compliance to interventions in epidemics and pandemics, and could help countries ease out of lockdown. %M 32877352 %R 10.2196/19992 %U https://www.jmir.org/2020/9/e19992 %U https://doi.org/10.2196/19992 %U http://www.ncbi.nlm.nih.gov/pubmed/32877352 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 7 %N 9 %P e22408 %T Prevalence of Perceived Stress, Anxiety, Depression, and Obsessive-Compulsive Symptoms in Health Care Workers and Other Workers in Alberta During the COVID-19 Pandemic: Cross-Sectional Survey %A Mrklas,Kelly %A Shalaby,Reham %A Hrabok,Marianne %A Gusnowski,April %A Vuong,Wesley %A Surood,Shireen %A Urichuk,Liana %A Li,Daniel %A Li,Xin-Min %A Greenshaw,Andrew James %A Agyapong,Vincent Israel Opoku %+ Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, 2047 Hilliard Place NW, Edmonton, AB, T6R 3P5, Canada, 1 7807144315, agyapong@ualberta.ca %K health care worker %K COVID-19 %K pandemic %K mental health %K depression %K anxiety %K stress %K obsessive compulsive %D 2020 %7 25.9.2020 %9 Original Paper %J JMIR Ment Health %G English %X Background: During pandemics, effective containment and mitigation measures may also negatively influence psychological stability. As knowledge about COVID-19 rapidly evolves, global implementation of containment and mitigation measures has varied greatly, with impacts to mental wellness. Assessing the impact of COVID-19 on the mental health needs of health care workers and other workers may help mitigate mental health impacts and secure sustained delivery of health care and other essential goods and services. Objective: This study assessed the self-reported prevalence of stress, anxiety, depression, and obsessive-compulsive symptoms in health care workers and other workers seeking support through Text4Hope, an evidence-based SMS text messaging service supporting the mental health of residents of Alberta, Canada, during the COVID-19 pandemic. Methods: An online cross-sectional survey gathered demographic (age, gender, ethnicity, education, relationship, housing and employment status, employment type, and isolation status) and clinical characteristics using validated tools (self-reported stress, anxiety, depression, and contamination/hand hygiene obsessive-compulsive symptoms). Descriptive statistics and chi-square analysis were used to compare the clinical characteristics of health care workers and other workers. Post hoc analysis was conducted on variables with >3 response categories using adjusted residuals. Logistic regression determined associations between worker type and likelihood of self-reported symptoms of moderate or high stress, generalized anxiety disorder, and major depressive disorder, while controlling for other variables. Results: Overall, 8267 surveys were submitted by 44,992 Text4Hope subscribers (19.39%). Of these, 5990 respondents were employed (72.5%), 958 (11.6%) were unemployed, 454 (5.5%) were students, 559 (6.8%) were retired, 234 (2.8%) selected “other,” and 72 (0.9%) did not indicate their employment status. Most employed survey respondents were female (n=4621, 86.2%). In the general sample, the 6-week prevalence rates for moderate or high stress, anxiety, and depression symptoms were 85.6%, 47.0%, and 44.0%, respectively. Self-reported symptoms of moderate or high stress, anxiety, and depression were all statistically significantly higher in other workers than in health care workers (P<.001). Other workers reported higher obsessive-compulsive symptoms (worry about contamination and compulsive handwashing behavior) after the onset of the pandemic (P<.001), while health care worker symptoms were statistically significantly higher before and during the COVID-19 pandemic (P<.001). This finding should be interpreted with caution, as it is unclear the extent to which the adaptive behavior of health care workers or the other workers might be misclassified by validated tools during a pandemic. Conclusions: Assessing symptoms of prevalent stress, anxiety, depression, and obsessive-compulsive behavior in health care workers and other workers may enhance our understanding of COVID-19 mental health needs. Research is needed to understand more fully the relationship between worker type, outbreak phase, and mental health changes over time, as well as the utility of validated tools in health care workers and other workers during pandemics. Our findings underscore the importance of anticipating and mitigating the mental health effects of pandemics using integrated implementation strategies. Finally, we demonstrate the ease of safely and rapidly assessing mental health needs using an SMS text messaging platform during a pandemic. International Registered Report Identifier (IRRID): RR2-10.2196/19292 %M 32915764 %R 10.2196/22408 %U http://mental.jmir.org/2020/9/e22408/ %U https://doi.org/10.2196/22408 %U http://www.ncbi.nlm.nih.gov/pubmed/32915764 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 9 %P e23153 %T Association of Social Network Use With Increased Anxiety Related to the COVID-19 Pandemic in Anesthesiology, Intensive Care, and Emergency Medicine Teams: Cross-Sectional Web-Based Survey Study %A Clavier,Thomas %A Popoff,Benjamin %A Selim,Jean %A Beuzelin,Marion %A Roussel,Melanie %A Compere,Vincent %A Veber,Benoit %A Besnier,Emmanuel %+ Department of Anesthesiology and Critical Care, Rouen University Hospital, 1 rue de Germont, Rouen, 76000, France, 33 685656293, thomasclavier76@gmail.com %K social network %K nurse %K physician %K anxiety %K emergency medicine, anesthesiology, critical care medicine %K coronavirus disease 2019 %K mental health %K COVID-19 %D 2020 %7 24.9.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Critical care teams are on the front line of managing the COVID-19 pandemic, which is stressful for members of these teams. Objective: Our objective was to assess whether the use of social networks is associated with increased anxiety related to the COVID-19 pandemic among members of critical care teams. Methods: We distributed a web-based survey to physicians, residents, registered and auxiliary nurses, and nurse anesthetists providing critical care (anesthesiology, intensive care, or emergency medicine) in several French hospitals. The survey evaluated the respondents’ use of social networks, their sources of information on COVID-19, and their levels of anxiety and information regarding COVID-19 on analog scales from 0 to 10. Results: We included 641 respondents in the final analysis; 553 (86.3%) used social networks, spending a median time of 60 minutes (IQR 30-90) per day on these networks. COVID-19–related anxiety was higher in social network users than in health care workers who did not use these networks (median 6, IQR 5-8 vs median 5, IQR 3-7) in univariate (P=.02) and multivariate (P<.001) analyses, with an average anxiety increase of 10% in social network users. Anxiety was higher among health care workers using social networks to obtain information on COVID-19 than among those using other sources (median 6, IQR 5-8 vs median 6, IQR 4-7; P=.04). Social network users considered that they were less informed about COVID-19 than those who did not use social networks (median 8, IQR 7-9 vs median 7, IQR 6-8; P<.01). Conclusions: Our results suggest that social networks contribute to increased anxiety in critical care teams. To protect their mental health, critical care professionals should consider limiting their use of these networks during the COVID-19 pandemic. %M 32924946 %R 10.2196/23153 %U http://mhealth.jmir.org/2020/9/e23153/ %U https://doi.org/10.2196/23153 %U http://www.ncbi.nlm.nih.gov/pubmed/32924946 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 9 %P e20924 %T Dynamic Panel Estimate–Based Health Surveillance of SARS-CoV-2 Infection Rates to Inform Public Health Policy: Model Development and Validation %A Oehmke,James Francis %A Oehmke,Theresa B %A Singh,Lauren Nadya %A Post,Lori Ann %+ Department of Emergency Medicine, Feinberg School of Medicine, Northwestern University, 420 E. Superior St, Chicago, IL, 60611, United States, 1 203 980 7107, lori.post@northwestern.edu %K COVID-19 %K models %K surveillance %K COVID-19 surveillance system %K dynamic panel data %K infectious disease modeling %K reopening America %K COVID-19 guidelines %K COVID-19 health policy %D 2020 %7 22.9.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: SARS-CoV-2, the novel coronavirus that causes COVID-19, is a global pandemic with higher mortality and morbidity than any other virus in the last 100 years. Without public health surveillance, policy makers cannot know where and how the disease is accelerating, decelerating, and shifting. Unfortunately, existing models of COVID-19 contagion rely on parameters such as the basic reproduction number and use static statistical methods that do not capture all the relevant dynamics needed for surveillance. Existing surveillance methods use data that are subject to significant measurement error and other contaminants. Objective: The aim of this study is to provide a proof of concept of the creation of surveillance metrics that correct for measurement error and data contamination to determine when it is safe to ease pandemic restrictions. We applied state-of-the-art statistical modeling to existing internet data to derive the best available estimates of the state-level dynamics of COVID-19 infection in the United States. Methods: Dynamic panel data (DPD) models were estimated with the Arellano-Bond estimator using the generalized method of moments. This statistical technique enables control of various deficiencies in a data set. The validity of the model and statistical technique was tested. Results: A Wald chi-square test of the explanatory power of the statistical approach indicated that it is valid (χ210=1489.84, P<.001), and a Sargan chi-square test indicated that the model identification is valid (χ2946=935.52, P=.59). The 7-day persistence rate for the week of June 27 to July 3 was 0.5188 (P<.001), meaning that every 10,000 new cases in the prior week were associated with 5188 cases 7 days later. For the week of July 4 to 10, the 7-day persistence rate increased by 0.2691 (P=.003), indicating that every 10,000 new cases in the prior week were associated with 7879 new cases 7 days later. Applied to the reported number of cases, these results indicate an increase of almost 100 additional new cases per day per state for the week of July 4-10. This signifies an increase in the reproduction parameter in the contagion models and corroborates the hypothesis that economic reopening without applying best public health practices is associated with a resurgence of the pandemic. Conclusions: DPD models successfully correct for measurement error and data contamination and are useful to derive surveillance metrics. The opening of America involves two certainties: the country will be COVID-19–free only when there is an effective vaccine, and the “social” end of the pandemic will occur before the “medical” end. Therefore, improved surveillance metrics are needed to inform leaders of how to open sections of the United States more safely. DPD models can inform this reopening in combination with the extraction of COVID-19 data from existing websites. %M 32915762 %R 10.2196/20924 %U http://www.jmir.org/2020/9/e20924/ %U https://doi.org/10.2196/20924 %U http://www.ncbi.nlm.nih.gov/pubmed/32915762 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 8 %N 9 %P e20477 %T Applying Blockchain Technology to Address the Crisis of Trust During the COVID-19 Pandemic %A Khurshid,Anjum %+ The University of Texas at Austin, 1701 Trinity Street, Austin, TX, 78712, United States, 1 5124955225, anjum.khurshid@austin.utexas.edu %K blockchain %K privacy %K trust %K contact tracing %K COVID-19 %K coronavirus %D 2020 %7 22.9.2020 %9 Viewpoint %J JMIR Med Inform %G English %X Background: The widespread death and disruption caused by the COVID-19 pandemic has revealed deficiencies of existing institutions regarding the protection of human health and well-being. Both a lack of accurate and timely data and pervasive misinformation are causing increasing harm and growing tension between data privacy and public health concerns. Objective: This aim of this paper is to describe how blockchain, with its distributed trust networks and cryptography-based security, can provide solutions to data-related trust problems. Methods: Blockchain is being applied in innovative ways that are relevant to the current COVID-19 crisis. We describe examples of the challenges faced by existing technologies to track medical supplies and infected patients and how blockchain technology applications may help in these situations. Results: This exploration of existing and potential applications of blockchain technology for medical care shows how the distributed governance structure and privacy-preserving features of blockchain can be used to create “trustless” systems that can help resolve the tension between maintaining privacy and addressing public health needs in the fight against COVID-19. Conclusions: Blockchain relies on a distributed, robust, secure, privacy-preserving, and immutable record framework that can positively transform the nature of trust, value sharing, and transactions. A nationally coordinated effort to explore blockchain to address the deficiencies of existing systems and a partnership of academia, researchers, business, and industry are suggested to expedite the adoption of blockchain in health care. %M 32903197 %R 10.2196/20477 %U http://medinform.jmir.org/2020/9/e20477/ %U https://doi.org/10.2196/20477 %U http://www.ncbi.nlm.nih.gov/pubmed/32903197 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 9 %P e22181 %T Increased Internet Searches for Insomnia as an Indicator of Global Mental Health During the COVID-19 Pandemic: Multinational Longitudinal Study %A Lin,Yu-Hsuan %A Chiang,Ting-Wei %A Lin,Yu-Lun %+ Institute of Population Health Sciences, National Health Research Institutes, Room A3234, No 35 Keyan Road, Zhunan Town, Miaoli County, 35053, Taiwan, 1 886 37206166 ext 36383, yuhsuanlin@nhri.edu.tw %K internet search %K Google Trends %K infodemiology %K infoveillance %K COVID-19 %K insomnia %K mental health %D 2020 %7 21.9.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Real-time global mental health surveillance is urgently needed for tracking the long-term impact of the COVID-19 pandemic. Objective: This study aimed to use Google Trends data to investigate the impact of the pandemic on global mental health by analyzing three keywords indicative of mental distress: “insomnia,” “depression,” and “suicide.” Methods: We examined increases in search queries for 19 countries. Significant increases were defined as the actual daily search value (from March 20 to April 19, 2020) being higher than the 95% CIs of the forecast from the 3-month baseline via ARIMA (autoregressive integrated moving average) modeling. We examined the correlation between increases in COVID-19–related deaths and the number of days with significant increases in search volumes for insomnia, depression, and suicide across multiple nations. Results: The countries with the greatest increases in searches for insomnia were Iran, Spain, the United States, and Italy; these countries exhibited a significant increase in insomnia searches on more than 10 of the 31 days observed. The number of COVID-19–related deaths was positively correlated to the number of days with an increase in searches for insomnia in the 19 countries (ρ=0.64, P=.003). By contrast, there was no significant correlation between the number of deaths and increases in searches for depression (ρ=–0.12, P=.63) or suicide (ρ=–0.07, P=.79). Conclusions: Our analysis suggests that insomnia could be a part of routine mental health screening during the COVID-19 pandemic. %M 32924951 %R 10.2196/22181 %U http://www.jmir.org/2020/9/e22181/ %U https://doi.org/10.2196/22181 %U http://www.ncbi.nlm.nih.gov/pubmed/32924951 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 9 %P e22079 %T Virtual Trauma-Focused Therapy for Military Members, Veterans, and Public Safety Personnel With Posttraumatic Stress Injury: Systematic Scoping Review %A Jones,Chelsea %A Miguel-Cruz,Antonio %A Smith-MacDonald,Lorraine %A Cruikshank,Emily %A Baghoori,Delaram %A Kaur Chohan,Avneet %A Laidlaw,Alexa %A White,Allison %A Cao,Bo %A Agyapong,Vincent %A Burback,Lisa %A Winkler,Olga %A Sevigny,Phillip R %A Dennett,Liz %A Ferguson-Pell,Martin %A Greenshaw,Andrew %A Brémault-Phillips,Suzette %+ Heroes in Mind Advocacy and Research Consortium, Faculty of Rehabilitation Medicine, University of Alberta, 1-94 Corbett Hall, 8205 - 114 Street, Edmonton, AB, T6G 2G4, Canada, 1 780 492 0404, cweiman@ualberta.ca %K trauma %K mental health %K telemedicine %K therapy %K rehabilitation %K digital health %K psychotherapy %K military %K veteran %K first responder %K public safety personnel %K teletherapy %K psychotherapy %K telepsychiatry %K mobile phone %D 2020 %7 21.9.2020 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: A necessary shift from in-person to remote delivery of psychotherapy (eg, teletherapy, eHealth, videoconferencing) has occurred because of the COVID-19 pandemic. A corollary benefit is a potential fit in terms of the need for equitable and timely access to mental health services in remote and rural locations. Owing to COVID-19, there may be an increase in the demand for timely, virtual delivery of services among trauma-affected populations, including public safety personnel (PSP; eg, paramedics, police, fire, correctional officers), military members, and veterans. There is a lack of evidence on the question of whether digital delivery of trauma-therapies for military members, veterans, and PSP leads to similar outcomes to in-person delivery. Information on barriers and facilitators and recommendations regarding digital-delivery is also scarce. Objective: This study aims to evaluate the scope and quality of peer-reviewed literature on psychotherapeutic digital health interventions delivered remotely to military members, veterans, and PSP and synthesize the knowledge of needs, gaps, barriers to, and facilitators for virtual assessment of and virtual interventions for posttraumatic stress injury. Methods: Relevant studies were identified using MEDLINE (Medical Literature Analysis and Retrieval System Online), EMBASE (Excerpta Medica dataBASE), APA (American Psychological Association) PsycINFO, CINAHL (Cumulative Index of Nursing and Allied Health Literature) Plus with Full Text, and Military & Government Collection. For collation, analysis, summarizing, and reporting of results, we used the CASP (Critical Skills Appraisal Program) qualitative checklist, PEDro (Physiotherapy Evidence Database) scale, level of evidence hierarchy, PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews), and narrative synthesis. Results: A total of 38 studies were included in this review. Evidence for the effectiveness of digital delivery of prolonged exposure therapy, cognitive processing therapy, behavioral activation treatment with therapeutic exposure to military members, veterans, and PSP was rated level 1a, whereas evidence for cognitive behavioral therapy was conflicting. The narrative synthesis indicated that virtual delivery of these therapies can be as effective as in-person delivery but may reduce stigma and cost while increasing access to therapy. Issues of risk, safety, potential harm (ie, suicidality, enabling avoidance), privacy, security, and the match among the therapist, modality, and patient warrant further consideration. There is a lack of studies on the influences of gender, racial, and cultural factors that may result in differential outcomes, preferences, and/or needs. An investigation into other therapies that may be suitable for digital delivery is needed. Conclusions: Digital delivery of trauma therapies for military members, veterans, and PSP is a critical area for further research. Although promising evidence exists regarding the effectiveness of digital health within these populations, many questions remain, and a cautious approach to more widespread implementation is warranted. %M 32955456 %R 10.2196/22079 %U http://mhealth.jmir.org/2020/9/e22079/ %U https://doi.org/10.2196/22079 %U http://www.ncbi.nlm.nih.gov/pubmed/32955456 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 9 %P e20874 %T Use of Telemedicine for Chronic Liver Disease at a Single Care Center During the COVID-19 Pandemic: Prospective Observational Study %A Guarino,Maria %A Cossiga,Valentina %A Fiorentino,Andrea %A Pontillo,Giuseppina %A Morisco,Filomena %+ Gastroenterology Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Sergio Pansini, Naples, Italy, 39 0817464746, maria.guarino86@gmail.com %K telemedicine %K COVID-19 %K hepatology %K telehealth %K liver disease %K Italy %K hospital %K chronic disease %K liver %D 2020 %7 21.9.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 outbreak has overwhelmed and altered health care systems worldwide, with a substantial impact on patients with chronic diseases. The response strategy has involved implementing measures like social distancing, and care delivery modalities like telemedicine have been promoted to reduce the risk of transmission. Objective: The aim of this study was to analyze the benefits of using telemedicine services for patients with chronic liver disease (CLD) at a tertiary care center in Italy during the COVID-19–mandated lockdown. Methods: From March 9 to May 3, 2020, a prospective observational study was conducted in the Liver Unit of the University Hospital of Naples Federico II to evaluate the impact of (1) a fully implemented telemedicine program, partially restructured in response to COVID-19 to include video consultations; (2) extended hours of operation for helpline services; and (3) smart-working from home to facilitate follow-up visits for patients with CLD while adhering to social distancing regulations. Results: During the lockdown in Italy, almost 400 visits were conducted using telemedicine; only patients requiring urgent care were admitted to a non–COVID-19 ward of our hospital. Telemedicine services were implemented not only for follow-up visits but also to screen patients prior to hospital admission and to provide urgent evaluations during complications. Of the nearly 1700 patients with CLD who attended a follow-up visit at our Liver Unit, none contracted COVID-19, and there was no need to alter treatment schedules. Conclusions: Telemedicine was a useful tool for following up patients with CLD and for reducing the impact of the COVID-19 pandemic. This system of health care delivery was appreciated by patients since it gave them the opportunity to be in contact with physicians while respecting social distancing rules. %M 32896833 %R 10.2196/20874 %U http://www.jmir.org/2020/9/e20874/ %U https://doi.org/10.2196/20874 %U http://www.ncbi.nlm.nih.gov/pubmed/32896833 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 3 %P e21653 %T Hospital Epidemics Tracker (HEpiTracker): Description and Pilot Study of a Mobile App to Track COVID-19 in Hospital Workers %A Soriano,Joan B %A Fernández,Esteve %A de Astorza,Álvaro %A Pérez de Llano,Luis A %A Fernández-Villar,Alberto %A Carnicer-Pont,Dolors %A Alcázar-Navarrete,Bernardino %A García,Arturo %A Morales,Aurelio %A Lobo,María %A Maroto,Marcos %A Ferreras,Eloy %A Soriano,Cecilia %A Del Rio-Bermudez,Carlos %A Vega-Piris,Lorena %A Basagaña,Xavier %A Muncunill,Josep %A Cosio,Borja G %A Lumbreras,Sara %A Catalina,Carlos %A Alzaga,José María %A Gómez Quilón,David %A Valdivia,Carlos Alberto %A de Lara,Celia %A Ancochea,Julio %+ Hospital Universitario La Princesa, Universidad Autónoma de Madrid, Planta 6, Servicio de Neumología, Diego de León 62, Madrid, 28006, Spain, +34 915202200, jbsoriano2@gmail.com %K app %K COVID-19 %K coronavirus %K e-medicine %K monitoring %K symptoms %K surveillance %D 2020 %7 21.9.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Hospital workers have been the most frequently and severely affected professional group during the COVID-19 pandemic, and have a big impact on transmission. In this context, innovative tools are required to measure the symptoms compatible with COVID-19, the spread of infection, and testing capabilities within hospitals in real time. Objective: We aimed to develop and test an effective and user-friendly tool to identify and track symptoms compatible with COVID-19 in hospital workers. Methods: We developed and pilot tested Hospital Epidemics Tracker (HEpiTracker), a newly designed app to track the spread of COVID-19 among hospital workers. Hospital staff in 9 hospital centers across 5 Spanish regions (Andalusia, Balearics, Catalonia, Galicia, and Madrid) were invited to download the app on their phones and to register their daily body temperature, COVID-19–compatible symptoms, and general health score, as well as any polymerase chain reaction and serological test results. Results: A total of 477 hospital staff participated in the study between April 8 and June 2, 2020. Of note, both health-related (n=329) and non–health-related (n=148) professionals participated in the study; over two-thirds of participants (68.8%) were health workers (43.4% physicians and 25.4% nurses), while the proportion of non–health-related workers by center ranged from 40% to 85%. Most participants were female (n=323, 67.5%), with a mean age of 45.4 years (SD 10.6). Regarding smoking habits, 13.0% and 34.2% of participants were current or former smokers, respectively. The daily reporting of symptoms was highly variable across participating hospitals; although we observed a decline in adherence after an initial participation peak in some hospitals, other sites were characterized by low participation rates throughout the study period. Conclusions: HEpiTracker is an already available tool to monitor COVID-19 and other infectious diseases in hospital workers. This tool has already been tested in real conditions. HEpiTracker is available in Spanish, Portuguese, and English. It has the potential to become a customized asset to be used in future COVID-19 pandemic waves and other environments. Trial Registration: ClinicalTrials.gov NCT04326400; https://clinicaltrials.gov/ct2/show/NCT04326400 %M 32845852 %R 10.2196/21653 %U http://publichealth.jmir.org/2020/3/e21653/ %U https://doi.org/10.2196/21653 %U http://www.ncbi.nlm.nih.gov/pubmed/32845852 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 3 %P e21866 %T Self-Reported Symptoms of SARS-CoV-2 Infection in a Nonhospitalized Population in Italy: Cross-Sectional Study of the EPICOVID19 Web-Based Survey %A Adorni,Fulvio %A Prinelli,Federica %A Bianchi,Fabrizio %A Giacomelli,Andrea %A Pagani,Gabriele %A Bernacchia,Dario %A Rusconi,Stefano %A Maggi,Stefania %A Trevisan,Caterina %A Noale,Marianna %A Molinaro,Sabrina %A Bastiani,Luca %A Fortunato,Loredana %A Jesuthasan,Nithiya %A Sojic,Aleksandra %A Pettenati,Carla %A Tavio,Marcello %A Andreoni,Massimo %A Mastroianni,Claudio %A Antonelli Incalzi,Raffaele %A Galli,Massimo %+ Infectious Diseases Unit, Department of Biomedical and Clinical Sciences L. Sacco, University of Milan, Via G.B. Grassi 74, Milan, 20157, Italy, 39 02 50319761, massimo.galli@unimi.it %K SARS-CoV-2 %K COVID-19 %K voluntary respondents %K web-based survey %K self-reported symptom %K nasopharyngeal swab testing %K cross-sectional %D 2020 %7 18.9.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Understanding the occurrence of symptoms resembling those of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in a large nonhospitalized population at the peak of the epidemic in Italy is of paramount importance; however, data are currently scarce. Objective: The aims of this study were to evaluate the association of self-reported symptoms with SARS-CoV-2 nasopharyngeal swab (NPS) test results in nonhospitalized individuals and to estimate the occurrence of symptoms associated with coronavirus disease (COVID-19) in a larger nontested population. Methods: EPICOVID19 is a self-administered cross-sectional voluntary web-based survey of adults throughout Italy who completed an anonymous questionnaire in the period of April 13 to 21, 2020. The associations between symptoms potentially related to SARS-CoV-2 infection and NPS results were calculated as adjusted odds ratios (aORs) with 95% CIs by multiple logistic regression analysis controlling for age, sex, education, smoking habits, and number of comorbidities. Thereafter, for each symptom and for combinations of the symptoms, we calculated the sensitivity, specificity, accuracy, and areas under the curve (AUCs) in a receiver operating characteristic (ROC) analysis to estimate the occurrence of COVID-19–like infection in the nontested population. Results: A total of 171,310 people responded to the survey, of whom 102,543 (59.9%) were women; mean age 47.4 years. Out of the 4785 respondents with known NPS test results, 4392 were not hospitalized. Among the 4392 nonhospitalized respondents, those with positive NPS tests (856, 19.5%) most frequently reported myalgia (527, 61.6%), olfactory and taste disorders (507, 59.2%), cough (466, 54.4%), and fever (444, 51.9%), whereas 7.7% were asymptomatic. Multiple regression analysis showed that olfactory and taste disorders (aOR 10.3, 95% CI 8.4-12.7), fever (aOR 2.5, 95% CI 2.0-3.1), myalgia (aOR 1.5, 95% CI 1.2-1.8), and cough (aOR 1.3, 95% CI 1.0-1.6) were associated with NPS positivity. Having two to four of these symptoms increased the aOR from 7.4 (95% CI 5.6-9.7) to 35.5 (95% CI 24.6-52.2). The combination of the four symptoms showed an AUC of 0.810 (95% CI 0.795-0.825) in classifying positive NPS test results and then was applied to the nonhospitalized and nontested sample (n=165,782). We found that 7739 to 20,103 of these 165,782 respondents (4.4% to 12.1%) had experienced symptoms suggestive of COVID-19 infection. Conclusions: Our results suggest that self-reported symptoms are reliable indicators of SARS-CoV-2 infection in a pandemic context. A nonnegligible number of symptomatic respondents (up to 12.1%) were undiagnosed and potentially contributed to the spread of the infection. Trial Registration: ClinicalTrials.gov NCT04471701; https://clinicaltrials.gov/ct2/show/NCT04471701 %M 32650305 %R 10.2196/21866 %U http://publichealth.jmir.org/2020/3/e21866/ %U https://doi.org/10.2196/21866 %U http://www.ncbi.nlm.nih.gov/pubmed/32650305 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 3 %P e21152 %T Prediction of the Transition From Subexponential to the Exponential Transmission of SARS-CoV-2 in Chennai, India: Epidemic Nowcasting %A Krishnamurthy,Kamalanand %A Ambikapathy,Bakiya %A Kumar,Ashwani %A Britto,Lourduraj De %+ Vector Control Research Centre, Indian Council for Medical Research, Indra Nagar, Puducherry, 605006, India, 91 4132272841, rljbritto@gmail.com %K COVID-19 %K epidemic %K mathematical modeling %K probabilistic models %K public transport %K exponential transmission %D 2020 %7 18.9.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Several countries adopted lockdown to slowdown the exponential transmission of the coronavirus disease (COVID-19) epidemic. Disease transmission models and the epidemic forecasts at the national level steer the policy to implement appropriate intervention strategies and budgeting. However, it is critical to design a data-driven reliable model for nowcasting for smaller populations, in particular metro cities. Objective: The aim of this study is to analyze the transition of the epidemic from subexponential to exponential transmission in the Chennai metro zone and to analyze the probability of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) secondary infections while availing the public transport systems in the city. Methods: A single geographical zone “Chennai-Metro-Merge” was constructed by combining Chennai District with three bordering districts. Subexponential and exponential models were developed to analyze and predict the progression of the COVID-19 epidemic. Probabilistic models were applied to assess the probability of secondary infections while availing public transport after the release of the lockdown. Results: The model predicted that transition from subexponential to exponential transmission occurs around the eighth week after the reporting of a cluster of cases. The probability of secondary infections with a single index case in an enclosure of the city bus, the suburban train general coach, and the ladies coach was found to be 0.192, 0.074, and 0.114, respectively. Conclusions: Nowcasting at the early stage of the epidemic predicts the probable time point of the exponential transmission and alerts the public health system. After the lockdown release, public transportation will be the major source of SARS-CoV-2 transmission in metro cities, and appropriate strategies based on nowcasting are needed. %M 32609621 %R 10.2196/21152 %U https://publichealth.jmir.org/2020/3/e21152 %U https://doi.org/10.2196/21152 %U http://www.ncbi.nlm.nih.gov/pubmed/32609621 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 9 %P e20606 %T Knowledge and Psychological Stress Related to COVID-19 Among Nursing Staff in a Hospital in China: Cross-Sectional Survey Study %A Huang,Huaping %A Zhao,Wen-Jun %A Li,Gui-Rong %+ Department of Nursing, Mianyang Central Hospital, No.12, Changjia Alley, Jingzhogn Street, Fucheng District, Mianyang, 621000, China, 86 0816 2239671, 384895848@qq.com %K COVID-19 %K nursing staff %K knowledge %K psychological stress %D 2020 %7 18.9.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Since December 2019, coronavirus disease (COVID-19) has been rapidly spreading worldwide. Nurses play a key role in fighting this disease and are at risk of COVID-19 infection. Therefore, there is an urgent need to assess the mental health condition of nurses and establish appropriate interventions to reduce the negative psychiatric outcomes of the pandemic. Objective: The objectives of this study were to evaluate the knowledge and psychological stress related to COVID-19 among nursing staff and to provide evidence of the need for targeted training and psychological intervention. Methods: This cross-sectional web-based survey study was performed in a class 3 grade A general hospital in a southwest province of China from March 1 to March 15, 2020. A self-designed questionnaire with questions about COVID-19–related prevention and control knowledge and the Triage Assessment Form (TAF) were used to assess nursing staff’s knowledge of COVID-19 and their degree of psychological stress, respectively. SPSS 23.0 was applied for statistical analysis of the collected data. Results: A total of 979 nurses completed the questionnaire. The results showed that the nursing staff provided the fewest correct answers to questions about continuous viral nucleic acid testing specifications (379/979 correct answers, 38.7%), isolation/discharge criteria (539/979 correct answers, 55.1%), and management measures for patients with suspected symptoms (713/979 correct answers, 72.8%). The median total score of the TAF was 7.0 (IQR 5.0-12.0), and there were statistically significant differences in scores between different nursing roles, years of work experience, and hospital departments (P<.05). Conclusions: This study indicated that nursing staff have insufficient knowledge about COVID-19. Meanwhile, although the psychological damage to nurses during the pandemic was found to be low, nurse managers must continue to monitor the mental health of nursing staff and perform timely interventions. %M 32640419 %R 10.2196/20606 %U https://formative.jmir.org/2020/9/e20606 %U https://doi.org/10.2196/20606 %U http://www.ncbi.nlm.nih.gov/pubmed/32640419 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 9 %P e20156 %T Digital Media’s Role in the COVID-19 Pandemic %A Bao,Huanyu %A Cao,Bolin %A Xiong,Yuan %A Tang,Weiming %+ UNC Project-China, No. 2 Lujing Road, Guangzhou, 510095, China, 86 15920567132, weimingtangscience@gmail.com %K COVID-19 %K digital health %K media %K pandemic %K public health %K social media %K dissemination %K health information %K mobile health %D 2020 %7 18.9.2020 %9 Viewpoint %J JMIR Mhealth Uhealth %G English %X The severe acute respiratory syndrome coronavirus 2 outbreak has had a significant impact on global health, the economy, and society as a whole. Various measures are being taken to respond to the pandemic, with digital media playing a pivotal role, especially in the use of visual data to disseminate information, mobile health to coordinate medical resources, social media to promote public health campaigns, and digital tools to assist population management and disease tracing. However, digital media also faces some challenges like misinformation, lack of guidance, and information leakage. We encourage the increased use of digital media with a focus on improving trust, building social solidarity, reducing chaos, educating the public on prevention measures, and reducing the medical burden in facility-based sites. %M 32530817 %R 10.2196/20156 %U https://mhealth.jmir.org/2020/9/e20156 %U https://doi.org/10.2196/20156 %U http://www.ncbi.nlm.nih.gov/pubmed/32530817 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 3 %P e19630 %T Global Changes and Factors of Increase in Caloric/Salty Food Intake, Screen Use, and Substance Use During the Early COVID-19 Containment Phase in the General Population in France: Survey Study %A Rolland,Benjamin %A Haesebaert,Frédéric %A Zante,Elodie %A Benyamina,Amine %A Haesebaert,Julie %A Franck,Nicolas %+ Service Universitaire d'Addictologie de Lyon, CH Le Vinatier, Hospices Civils de Lyon, Bâtiment 502, Bron, 69500, France, 33 0437915075, benjrolland@gmail.com %K COVID-19 %K containment %K eating behaviors %K screen use %K internet use %K substance use %K public health %K mental health %K pandemic %K lifestyle %K online survey %K addiction %D 2020 %7 18.9.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The international outbreak of coronavirus disease (COVID-19) has led many countries to enforce drastic containment measures. It has been suggested that this abrupt lockdown of populations will foster addiction-related habits such as caloric/salty food intake, screen use, and substance use. Objective: Our aim was to assess the global changes and factors of increase in addiction-related habits during the early COVID-19 containment phase in France. Methods: A web-based survey was provided from day 8 to day 13 of the containment and was completed by 11,391 participants. The questions explored sociodemographic features, psychiatric/addiction history, material conditions of lockdown, general stress, mental well-being, and reported changes in several addiction-related behaviors. Global changes were described and factors of increase were explored using population-weighted and adjusted logistic regression models, providing adjusted odds ratios (aORs) and their 95% confidence intervals. Results: Overall, the respondents reported more increases in addiction-related habits than decreases, specifically 28.4% (caloric/salty food intake), 64.6% (screen use), 35.6% (tobacco use), 24.8% (alcohol use), and 31.2% (cannabis use). Reduced well-being scores and increased stress scores were general factors of increase in addiction-related habits (P<.001 for all habits). Factors of increase in caloric/salty food intake (n=10,771) were female gender (aOR 1.62, 95% CI 1.48-1.77), age less than 29 years (P<.001), having a partner (aOR 1.19, 95% CI 1.06-1.35), being locked down in a more confined space (per 1 square meter/person decrease: aOR 1.02, 95% CI 1.01-1.03), being locked down alone (aOR 1.29, 95% CI 1.11-1.49), and reporting current (aOR 1.94, 95% CI 1.62-2.31) or past (aOR 1.27, 95% CI 1.09-1.47) psychiatric treatment. Factors of increase in screen use (n=11,267) were female gender (aOR 1.31, 95% CI 1.21-1.43), age less than 29 years (P<.001), having no partner (aOR 1.18, 95% CI 1.06-1.32), being employed (P<.001), intermediate/high education level (P<.001), being locked down with no access to an outdoor space (aOR 1.16, 95% CI 1.05-1.29), being locked down alone (aOR 1.15, 95% CI 1.01-1.32), living in an urban environment (P<.01), and not working (P<.001). Factors of increase in tobacco use (n=2787) were female gender (aOR 1.31, 95% CI 1.11-1.55), having no partner (aOR 1.30, 95% CI 1.06-1.59), intermediate/low education level (P<.01), and still working in the workplace (aOR 1.47, 95% CI 1.17-1.86). Factors of increase in alcohol use (n=7108) were age 30-49 years (P<.05), a high level of education (P<.001), and current psychiatric treatment (aOR 1.44, 95% CI 1.10-1.88). The only significant factor of increase in cannabis use (n=620) was intermediate/low level of education (P<.001). Conclusions: The early phase of COVID-19 containment in France led to widespread increases in addiction-related habits in the general population. Reduced well-being and increased stress were universal factors of increase. More specific factors were associated with increases in each of the explored habits. %M 32589149 %R 10.2196/19630 %U http://publichealth.jmir.org/2020/3/e19630/ %U https://doi.org/10.2196/19630 %U http://www.ncbi.nlm.nih.gov/pubmed/32589149 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 6 %N 1 %P e19047 %T Awareness and Preparedness of Field Epidemiology Training Program Graduates to Respond to COVID-19 in the Eastern Mediterranean Region: Cross-Sectional Study %A Al Nsour,Mohannad %A Khader,Yousef %A Al Serouri,Abdulwahed %A Bashier,Haitham %A Osman,Shahd %+ Jordan University of Science and Technology, Alramtha-Amman Street, Irbid, 22110, Jordan, 962 796802040, yskhader@just.edu.jo %K COVID-19 %K infection %K preparedness %K awareness %K Jordan %K Yemen %K Sudan %D 2020 %7 18.9.2020 %9 Original Paper %J JMIR Med Educ %G English %X Background: The Field Epidemiology Training Program (FETP) is a 2-year training program in applied epidemiology. FETP graduates have contributed significantly to improvements in surveillance systems, control of infectious diseases, and outbreak investigations in the Eastern Mediterranean Region (EMR). Objective: Considering the instrumental roles of FETP graduates during the coronavirus disease (COVID-19) crisis, this study aimed to assess their awareness and preparedness to respond to the COVID-19 pandemic in three EMR countries. Methods: An online survey was sent to FETP graduates in the EMR in March 2020. The FETP graduates were contacted by email and requested to fill out an online survey. Sufficient number of responses were received from only three countries—Jordan, Sudan, and Yemen. A few responses were received from other countries, and therefore, they were excluded from the analysis. The questionnaire comprised a series of questions pertaining to sociodemographic characteristics, knowledge of the epidemiology of COVID-19, and preparedness to respond to COVID-19. Results: This study included a total of 57 FETP graduates (20 from Jordan, 13 from Sudan, and 24 from Yemen). A total of 31 (54%) graduates had attended training on COVID-19, 29 (51%) were members of a rapid response team against COVID-19, and 54 (95%) had previous experience in response to disease outbreaks or health emergencies. The vast majority were aware of the main symptoms, mode of transmission, high-risk groups, and how to use personal protective equipment. A total of 46 (81%) respondents considered themselves well prepared for the COVID-19 outbreak, and 40 (70%) reported that they currently have a role in supporting the country’s efforts in the management of COVID-19 outbreak. Conclusions: The FETP graduates in Jordan, Sudan, and Yemen were fully aware of the epidemiology of COVID-19 and the safety measures required, and they are well positioned to investigate and respond to the COVID-19 pandemic. Therefore, they should be properly and efficiently utilized by the Ministries of Health to investigate and respond to the current COVID-19 crisis where the needs are vastly growing and access to outside experts is becoming limited. %M 32406852 %R 10.2196/19047 %U http://mededu.jmir.org/2020/1/e19047/ %U https://doi.org/10.2196/19047 %U http://www.ncbi.nlm.nih.gov/pubmed/32406852 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 3 %P e18965 %T Flexible, Freely Available Stochastic Individual Contact Model for Exploring COVID-19 Intervention and Control Strategies: Development and Simulation %A Churches,Timothy %A Jorm,Louisa %+ Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, Faculty of Medicine, University of New South Wales Sydney, 1 Campbell St, Liverpool, 2071, Australia, 61 468819609, timothy.churches@unsw.edu.au %K COVID-19 %K epidemic curve %K infection dynamics %K public health interventions %D 2020 %7 18.9.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Throughout March 2020, leaders in countries across the world were making crucial decisions about how and when to implement public health interventions to combat the coronavirus disease (COVID-19). They urgently needed tools to help them to explore what will work best in their specific circumstances of epidemic size and spread, and feasible intervention scenarios. Objective: We sought to rapidly develop a flexible, freely available simulation model for use by modelers and researchers to allow investigation of how various public health interventions implemented at various time points might change the shape of the COVID-19 epidemic curve. Methods: “COVOID” (COVID-19 Open-Source Infection Dynamics) is a stochastic individual contact model (ICM), which extends the ICMs provided by the open-source EpiModel package for the R statistical computing environment. To demonstrate its use and inform urgent decisions on March 30, 2020, we modeled similar intervention scenarios to those reported by other investigators using various model types, as well as novel scenarios. The scenarios involved isolation of cases, moderate social distancing, and stricter population “lockdowns” enacted over varying time periods in a hypothetical population of 100,000 people. On April 30, 2020, we simulated the epidemic curve for the three contiguous local areas (population 287,344) in eastern Sydney, Australia that recorded 5.3% of Australian cases of COVID-19 through to April 30, 2020, under five different intervention scenarios and compared the modeled predictions with the observed epidemic curve for these areas. Results: COVOID allocates each member of a population to one of seven compartments. The number of times individuals in the various compartments interact with each other and their probability of transmitting infection at each interaction can be varied to simulate the effects of interventions. Using COVOID on March 30, 2020, we were able to replicate the epidemic response patterns to specific social distancing intervention scenarios reported by others. The simulated curve for three local areas of Sydney from March 1 to April 30, 2020, was similar to the observed epidemic curve in terms of peak numbers of cases, total numbers of cases, and duration under a scenario representing the public health measures that were actually enacted, including case isolation and ramp-up of testing and social distancing measures. Conclusions: COVOID allows rapid modeling of many potential intervention scenarios, can be tailored to diverse settings, and requires only standard computing infrastructure. It replicates the epidemic curves produced by other models that require highly detailed population-level data, and its predicted epidemic curve, using parameters simulating the public health measures that were enacted, was similar in form to that actually observed in Sydney, Australia. Our team and collaborators are currently developing an extended open-source COVOID package comprising of a suite of tools to explore intervention scenarios using several categories of models. %M 32568729 %R 10.2196/18965 %U https://publichealth.jmir.org/2020/3/e18965 %U https://doi.org/10.2196/18965 %U http://www.ncbi.nlm.nih.gov/pubmed/32568729 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 3 %P e18939 %T Using Open-Source Intelligence to Detect Early Signals of COVID-19 in China: Descriptive Study %A Kpozehouen,Elizabeth Benedict %A Chen,Xin %A Zhu,Mengyao %A Macintyre,C Raina %+ Biosecurity Program, The Kirby Institute for Infection and Immunity, University of New South Wales, Level 6 Wallace Wurth Building, University of New South Wales, Sydney, 2052, Australia, 61 93850082, bettysanga@protonmail.com %K COVID-19 %K infectious disease %K surveillance %K epidemiology %K biosecurity %D 2020 %7 18.9.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The coronavirus disease (COVID-19) outbreak in China was first reported to the World Health Organization (WHO) on December 31, 2019, and the first cases were officially identified around December 8, 2019. Although the origin of COVID-19 has not been confirmed, approximately half of the early cases were linked to a seafood market in Wuhan. However, the first two documented patients did not visit the seafood market. News reports, social media, and informal sources may provide information about outbreaks prior to formal notification. Objective: The aim of this study was to identify early signals of pneumonia or severe acute respiratory illness (SARI) in China prior to official recognition of the COVID-19 outbreak in December 2019 using open-source data. Methods: To capture early reports, we searched an open source epidemic observatory, EpiWatch, for SARI or pneumonia-related illnesses in China from October 1, 2019. The searches were conducted using Google and the Chinese search engine Baidu. Results: There was an increase in reports following the official notification of COVID-19 to the WHO on December 31, 2019, and a report that appeared on December 26, 2019 was retracted. A report of severe pneumonia on November 22, 2019, in Xiangyang was identified, and a potential index patient was retrospectively identified on November 17. Conclusions: The lack of reports of SARI outbreaks prior to December 31, 2019, with a retracted report on December 26, suggests media censorship, given that formal reports indicate that cases began appearing on December 8. However, the findings also support a relatively recent origin of COVID-19 in November 2019. The case reported on November 22 was transferred to Wuhan approximately one incubation period before the first identified cases on December 8; this case should be further investigated, as only half of the early cases were exposed to the seafood market in Wuhan. Another case of COVID-19 has since been retrospectively identified in Hubei on November 17, 2019, suggesting that the infection was present prior to December. %M 32598290 %R 10.2196/18939 %U http://publichealth.jmir.org/2020/3/e18939/ %U https://doi.org/10.2196/18939 %U http://www.ncbi.nlm.nih.gov/pubmed/32598290 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 9 %P e21845 %T Communication Technology Preferences of Hospitalized and Institutionalized Frail Older Adults During COVID-19 Confinement: Cross-Sectional Survey Study %A Sacco,Guillaume %A Lléonart,Sébastien %A Simon,Romain %A Noublanche,Frédéric %A Annweiler,Cédric %A , %+ Department of Geriatric Medicine and Memory Clinic, University Hospital of Angers, 4 Rue Larey, Angers , France, 33 609733254, yogisacco@gmail.com %K video communication %K telephone %K older adults %K nursing home %K hospital %K confinement %K elderly %K COVID-19 %K communication %K technology %K social isolation %K loneliness %D 2020 %7 18.9.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Technological communication methods such as telephone calls and video calls can help prevent social isolation and loneliness in frail older adults during confinement. Objective: Our objectives were to determine which virtual communication method (ie, telephone call or video call) was preferred by confined older hospital patients and nursing home residents and the variables influencing this preference. Methods: The TOVID (Telephony Or Videophony for Isolated elDerly) study was a cross-sectional study that was designed to examine the preference between telephone calls and video calls among frail older adults who were either hospitalized in a geriatric acute care unit or institutionalized in a long-term care and nursing home during the COVID-19 confinement period. Results: A total of 132 older people were surveyed between March 25 and May 11, 2020 (mean age 88.2 years, SD 6.2); 79 (59.8%) were women. Patients hospitalized in the geriatric acute care unit were more able to establish communication independently than residents institutionalized in the long-term care and nursing home (P=.03) and were more satisfied with their communication experiences (P=.02). Overall, older people tended to favor telephone calls (73/132, 55.3%) over video calls (59/132, 44.7%); however, their satisfaction degree was similar regardless of the chosen method (P=.1), with no effect of age (P=.97) or gender (P=.2). In the geriatric acute care unit, the satisfaction degrees were similar for telephone calls (40/41, 98%) and video calls (33/38, 87%) in older patients (P=.10). Conversely, in the long-term care and nursing home, residents were more satisfied with the use of video calls to communicate with their relatives (14/15, 93%) versus the use of telephone calls (6/12, 50%; P=.02). Conclusions: Older people confined to health care settings were able to complete telephone calls more independently than video calls, and they tended to use telephone calls more often than video calls. The satisfaction degrees were similar with both modalities and even greater with video calls among long-term care and nursing home residents when they were given assistance to establish communication. Trial Registration: ClinicalTrials.gov NCT04333849: https://www.clinicaltrials.gov/ct2/show/NCT04333849. %M 32896832 %R 10.2196/21845 %U http://mhealth.jmir.org/2020/9/e21845/ %U https://doi.org/10.2196/21845 %U http://www.ncbi.nlm.nih.gov/pubmed/32896832 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 9 %P e20548 %T New York Inner City Hospital COVID-19 Experience and Current Data: Retrospective Analysis at the Epicenter of the American Coronavirus Outbreak %A Mani,Vishnu R %A Kalabin,Aleksandr %A Valdivieso,Sebastian C %A Murray-Ramcharan,Max %A Donaldson,Brian %+ Columbia University College of Physicians and Surgeons at Harlem Hospital, 506 Lenox Avenue, New York, NY, , United States, 1 2129391000 ext 1641, vishnu.mani@duke.edu %K SARS-CoV-2 %K COVID-19 %K pandemic %K New York City %K coronavirus outbreak %K American minority %K outbreak %K minority %K mortality %K patient %K characteristic %K mechanical ventilation %D 2020 %7 18.9.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: In the midst of the coronavirus disease pandemic, emerging clinical data across the world has equipped frontline health care workers, policy makers, and researchers to better understand and combat the illness. Objective: The aim of this study is to report the correlation of clinical and laboratory parameters with patients requiring mechanical ventilation and the mortality in patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Methods: We did a review of patients with SARS-CoV-2 confirmed infection admitted and managed by our institution during the last month. Patients were grouped into intubated and nonintubated, and subgrouped to alive and deceased. A comprehensive analysis using the following parameters were performed: age, sex, ethnicity, BMI, comorbidities, inflammatory markers, laboratory values, cardiac and renal function, electrocardiogram (EKG), chest x-ray findings, temperature, treatment groups, and hospital-acquired patients with SARS-CoV-2. Results: A total of 184 patients were included in our study with ages ranging from 28-97 years (mean 64.72 years) and including 73 females (39.67%) and 111 males (60.33%) with a mean BMI of 29.10. We had 114 African Americans (61.96%), 58 Hispanics (31.52%), 11 Asians (5.98%), and 1 Caucasian (0.54%), with a mean of 1.70 comorbidities. Overall, the mortality rate was 17.39% (n=32), 16.30% (n=30) of our patients required mechanical ventilation, and 11.41% (n=21) had hospital-acquired SARS-CoV-2 infection. Pertinent and statistically significant results were found in the intubated versus nonintubated patients with confirmed SARS-CoV-2 for the following parameters: age (P=.01), BMI (P=.07), African American ethnicity (P<.001), Hispanic ethnicity (P=.02), diabetes mellitus (P=.001), creatinine (P=.29), blood urea nitrogen (BUN; P=.001), procalcitonin (P=.03), C-reactive protein (CRP; P=.007), lactate dehydrogenase (LDH; P=.001), glucose (P=.01), temperature (P=.004), bilateral pulmonary infiltrates in chest x-rays (P<.001), and bilateral patchy opacity (P=.02). The results between the living and deceased subgroups of patients with confirmed SARS-CoV-2 (linking to or against mortality) were BMI (P=.04), length of stay (P<.001), hypertension (P=.02), multiple comorbidity (P=.045), BUN (P=.04), and EKG findings with arrhythmias or blocks (P=.02). Conclusions: We arrived at the following conclusions based on a comprehensive review of our study group, data collection, and statistical analysis. Parameters that were strongly correlated with the need for mechanical ventilation were younger age group, overweight, Hispanic ethnicity, higher core body temperature, EKG findings with sinus tachycardia, and bilateral diffuse pulmonary infiltrates on the chest x-rays. Those intubated exhibited increased disease severity with significantly elevated levels of serum procalcitonin, CRP, LDH, mean glucose, creatinine, and BUN. Mortality was strongly correlated with BMI, African American ethnicity, hypertension, presence of multiple comorbidities (with a mean of 2.32), worsening renal function with acute kidney injury or acute chronic kidney injury, and EKG findings of arrhythmias and heart blocks. %M 32540837 %R 10.2196/20548 %U https://www.jmir.org/2020/9/e20548 %U https://doi.org/10.2196/20548 %U http://www.ncbi.nlm.nih.gov/pubmed/32540837 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 7 %N 9 %P e20157 %T Pediatric Telebehavioral Health: A Transformational Shift in Care Delivery in the Era of COVID-19 %A Ramtekkar,Ujjwal %A Bridge,Jeffrey A %A Thomas,Glenn %A Butter,Eric %A Reese,Jennifer %A Logan,Erica %A Lin,Simon %A Axelson,David %+ Department of Psychiatry, Nationwide Children's Hospital, The Ohio State University College of Medicine, 700 Children's Drive, Columbus, OH, 43205, United States, 1 614 722 6811, ujjwal.ramtekkar@nationwidechildrens.org %K telepsychiatry %K telebehavioral health %K child and adolescent psychiatry %K COVID-19 %D 2020 %7 18.9.2020 %9 Viewpoint %J JMIR Ment Health %G English %X The use of telebehavioral health has been expanding in the past decade to improve access to psychiatric care and address critical shortages in the psychiatric workforce. The coronavirus (COVID-19) pandemic forced a sudden shift from traditional in-person visits to alternative modalities. There are key factors associated with successful transitional and large-scale implementation of telehealth with existing resources. We describe the experience of a large health care system using telehealth technology, and we identify strategies and discuss considerations for long-term sustainability after the pandemic. %M 32525485 %R 10.2196/20157 %U https://mental.jmir.org/2020/9/e20157 %U https://doi.org/10.2196/20157 %U http://www.ncbi.nlm.nih.gov/pubmed/32525485 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 9 %P e22817 %T Investigating Mental Health of US College Students During the COVID-19 Pandemic: Cross-Sectional Survey Study %A Wang,Xiaomei %A Hegde,Sudeep %A Son,Changwon %A Keller,Bruce %A Smith,Alec %A Sasangohar,Farzan %+ Industrial and Systems Engineering, Texas A&M University, Emerging Technologies Building, 3131 TAMU, 101 Bizzell Street, College Station, TX, 77843, United States, 1 9794582337, sasangohar@tamu.edu %K mental health %K online survey %K COVID-19 %K coronavirus %K college student %K student %K stress %K depression %K university %D 2020 %7 17.9.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Evidence suggests that the COVID-19 pandemic has generally increased levels of stress and depression among the public. However, the impact on college students in the United States has not been well-documented. Objective: This paper surveys the mental health status and severity of depression and anxiety of college students in a large university system in the United States during the COVID-19 pandemic. Methods: An online survey was conducted among undergraduate and graduate students recruited from Texas A&M University via email. The survey consisted of two standardized scales—the Patient Health Questionnaire-9 and the General Anxiety Disorder-7—for depression and anxiety, and additional multiple-choice and open-ended questions regarding stressors and coping mechanisms specific to COVID-19. Results: Among the 2031 participants, 48.14% (n=960) showed a moderate-to-severe level of depression, 38.48% (n=775) showed a moderate-to-severe level of anxiety, and 18.04% (n=366) had suicidal thoughts. A majority of participants (n=1443, 71.26%) indicated that their stress/anxiety levels had increased during the pandemic. Less than half of the participants (n=882, 43.25%) indicated that they were able to cope adequately with the stress related to the current situation. Conclusions: The proportion of respondents showing depression, anxiety, and/or suicidal thoughts is alarming. Respondents reported academic-, health-, and lifestyle-related concerns caused by the pandemic. Given the unexpected length and severity of the outbreak, these concerns need to be further understood and addressed. %M 32897868 %R 10.2196/22817 %U http://www.jmir.org/2020/9/e22817/ %U https://doi.org/10.2196/22817 %U http://www.ncbi.nlm.nih.gov/pubmed/32897868 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 9 %P e22469 %T An Index for Lifting Social Distancing During the COVID-19 Pandemic: Algorithm Recommendation for Lifting Social Distancing %A Chen,Sam Li-Sheng %A Yen,Amy Ming-Fang %A Lai,Chao-Chih %A Hsu,Chen-Yang %A Chan,Chang-Chuan %A Chen,Tony Hsiu-Hsi %+ Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Room 533, No 17, Xu-Zhou Road, Taipei, 100, Taiwan, 886 233668033, chenlin@ntu.edu.tw %K COVID-19 %K pandemic %K social distancing %K index %K algorithm %K data analysis %K decision making %K global health %K public health %D 2020 %7 17.9.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Implementing and lifting social distancing (LSD) is an urgent global issue during the COVID-19 pandemic, particularly when the travel ban is lifted to revive international businesses and economies. However, when and whether LSD can be considered is subject to the spread of SARS-CoV-2, the recovery rate, and the case-fatality rate. It is imperative to provide real-time assessment of three factors to guide LSD. Objective: A simple LSD index was developed for health decision makers to do real-time assessment of COVID-19 at the global, country, region, and community level. Methods: Data on the retrospective cohort of 186 countries with three factors were retrieved from a publicly available repository from January to early July. A simple index for guiding LSD was measured by the cumulative number of COVID-19 cases and recoveries, and the case-fatality rate was envisaged. If the LSD index was less than 1, LSD can be considered. The dynamic changes of the COVID-19 pandemic were evaluated to assess whether and when health decision makers allowed for LSD and when to reimplement social distancing after resurgences of the epidemic. Results: After large-scale outbreaks in a few countries before mid-March (prepandemic phase), the global weekly LSD index peaked at 4.27 in March and lasted until mid-June (pandemic phase), during which most countries were affected and needed to take various social distancing measures. Since, the value of LSD has gradually declined to 0.99 on July 5 (postpandemic phase), at which 64.7% (120/186) of countries and regions had an LSD<1 with the decile between 0 and 1 to refine risk stratification by countries. The LSD index decreased to 1 in about 115 days. In addition, we present the results of dynamic changes of the LSD index for the world and for each country and region with different time windows from January to July 5. The results of the LSD index on the resurgence of the COVID-19 epidemic in certain regions and validation by other emerging infectious diseases are presented. Conclusions: This simple LSD index provides a quantitative assessment of whether and when to ease or implement social distancing to provide advice for health decision makers and travelers. %M 32886622 %R 10.2196/22469 %U http://www.jmir.org/2020/9/e22469/ %U https://doi.org/10.2196/22469 %U http://www.ncbi.nlm.nih.gov/pubmed/32886622 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 9 %P e21685 %T A New Era of Epidemiology: Digital Epidemiology for Investigating the COVID-19 Outbreak in China %A He,Zonglin %A Zhang,Casper J P %A Huang,Jian %A Zhai,Jingyan %A Zhou,Shuang %A Chiu,Joyce Wai-Ting %A Sheng,Jie %A Tsang,Winghei %A Akinwunmi,Babatunde O %A Ming,Wai-Kit %+ Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, 601 Huangpu W Ave, Guangzhou, , China, 86 14715485116, wkming@connect.hku.hk %K digital epidemiology %K COVID-19 %K risk %K control %K public health %K epidemiology %K China %K outbreak %K case study %D 2020 %7 17.9.2020 %9 Viewpoint %J J Med Internet Res %G English %X A novel pneumonia-like coronavirus disease (COVID-19) caused by a novel coronavirus named SARS-CoV-2 has swept across China and the world. Public health measures that were effective in previous infection outbreaks (eg, wearing a face mask, quarantining) were implemented in this outbreak. Available multidimensional social network data that take advantage of the recent rapid development of information and communication technologies allow for an exploration of disease spread and control via a modernized epidemiological approach. By using spatiotemporal data and real-time information, we can provide more accurate estimates of disease spread patterns related to human activities and enable more efficient responses to the outbreak. Two real cases during the COVID-19 outbreak demonstrated the application of emerging technologies and digital data in monitoring human movements related to disease spread. Although the ethical issues related to using digital epidemiology are still under debate, the cases reported in this article may enable the identification of more effective public health measures, as well as future applications of such digitally directed epidemiological approaches in controlling infectious disease outbreaks, which offer an alternative and modern outlook on addressing the long-standing challenges in population health. %M 32805703 %R 10.2196/21685 %U https://www.jmir.org/2020/9/e21685 %U https://doi.org/10.2196/21685 %U http://www.ncbi.nlm.nih.gov/pubmed/32805703 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 9 %P e19796 %T Mobile Health Apps on COVID-19 Launched in the Early Days of the Pandemic: Content Analysis and Review %A Ming,Long Chiau %A Untong,Noorazrina %A Aliudin,Nur Amalina %A Osili,Norliza %A Kifli,Nurolaini %A Tan,Ching Siang %A Goh,Khang Wen %A Ng,Pit Wei %A Al-Worafi,Yaser Mohammed %A Lee,Kah Seng %A Goh,Hui Poh %+ Pengiran Anak Puteri Rashidah Sa’adatul Bolkiah Institute of Health Sciences, Universiti Brunei Darussalam, Tungku Link Rd, Gadong, BE1410, Brunei Darussalam, 673 2460922 ext 2202, longchiauming@gmail.com %K coronavirus %K mobile medical app %K self-care %K mHealth %K health education %K app %K COVID-19 %K content analysis %D 2020 %7 16.9.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile health (mHealth) app use is a major concern because of the possible dissemination of misinformation that could harm the users. Particularly, it can be difficult for health care professionals to recommend a suitable app for coronavirus disease (COVID-19) education and self-monitoring purposes. Objective: This study aims to analyze and evaluate the contents as well as features of COVID-19 mobile apps. The findings are instrumental in helping health care professionals to identify suitable mobile apps for COVID-19 self-monitoring and education. The results of the mobile apps’ assessment could potentially help mobile app developers improve or modify their existing mobile app designs to achieve optimal outcomes. Methods: The search for the mHealth apps available in the android-based Play Store and the iOS-based App Store was conducted between April 18 and May 5, 2020. The region of the App Store where we performed the search was the United States, and a virtual private network app was used to locate and access COVID-19 mobile apps from all countries on the Google Play Store. The inclusion criteria were apps that are related to COVID-19 with no restriction in language type. The basic features assessment criteria used for comparison were the requirement for free subscription, internet connection, education or advisory content, size of the app, ability to export data, and automated data entry. The functionality of the apps was assessed according to knowledge (information on COVID-19), tracing or mapping of COVID-19 cases, home monitoring surveillance, online consultation with a health authority, and official apps run by health authorities. Results: Of the 223 COVID-19–related mobile apps, only 30 (19.9%) found in the App Store and 28 (44.4%) in the Play Store matched the inclusion criteria. In the basic features assessment, most App Store (10/30, 33.3%) and Play Store (10/28, 35.7%) apps scored 4 out of 7 points. Meanwhile, the outcome of the functionality assessment for most App Store apps (13/30, 43.3%) was a score of 3 compared to android-based apps (10/28, 35.7%), which scored 2 (out of the maximum 5 points). Evaluation of the basic functions showed that 75.0% (n=36) of the 48 included mobile apps do not require a subscription, 56.3% (n=27) provide symptom advice, and 41.7% (n=20) have educational content. In terms of the specific functions, more than half of the included mobile apps are official mobile apps maintained by a health authority for COVID-19 information provision. Around 37.5% (n=18) and 31.3% (n=15) of the mobile apps have tracing or mapping and home monitoring surveillance functions, respectively, with only 17% (n=8) of the mobile apps equipped with an online consultation function. Conclusions: Most iOS-based apps incorporate infographic mapping of COVID-19 cases, while most android-based apps incorporate home monitoring surveillance features instead of providing focused educational content on COVID-19. It is important to evaluate the contents and features of COVID-19 mobile apps to guide users in choosing a suitable mobile app based on their requirements. %M 32609622 %R 10.2196/19796 %U https://mhealth.jmir.org/2020/9/e19796 %U https://doi.org/10.2196/19796 %U http://www.ncbi.nlm.nih.gov/pubmed/32609622 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 9 %P e20896 %T Can Disinfection Robots Reduce the Risk of Transmission of SARS-CoV-2 in Health Care and Educational Settings? %A Cresswell,Kathrin %A Sheikh,Aziz %+ Usher Institute, The University of Edinburgh, Teviot Place, Edinburgh, United Kingdom, 44 131 650 8102, kathrin.cresswell@ed.ac.uk %K robotics %K disinfection %K SARS-CoV-2 %K COVID-19 %K risk %K transmission %K virus %D 2020 %7 15.9.2020 %9 Viewpoint %J J Med Internet Res %G English %X We explore the opportunities and challenges surrounding the use of disinfection robots to reduce the risk of SARS-CoV-2 transmission in health care and educational settings. Although there is some potential for deploying robots to help with manual cleaning, the evidence base is mixed, and we highlight that there needs to be work to establish and enhance the effectiveness of these robots in inactivating the virus. %M 32903196 %R 10.2196/20896 %U http://www.jmir.org/2020/9/e20896/ %U https://doi.org/10.2196/20896 %U http://www.ncbi.nlm.nih.gov/pubmed/32903196 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 3 %P e21607 %T Consumer Reported Care Deferrals Due to the COVID-19 Pandemic, and the Role and Potential of Telemedicine: Cross-Sectional Analysis %A Atherly,Adam %A Van Den Broek-Altenburg,Eline %A Hart,Victoria %A Gleason,Kelsey %A Carney,Jan %+ Center for Health Services Research, Larner College of Medicine, University of Vermont, 89 Beaumont Avenue, Burlington, VT, 05404, United States, 1 8026563555, adam.atherly@med.uvm.edu %K COVID-19 %K telemedicine %K deferred care %K mental health %K alternative %K health effect %K viability %D 2020 %7 14.9.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The COVID-19 pandemic forced many health systems to proactively reduce care delivery to prepare for an expected surge in hospitalizations. There have been concerns that care deferral may have negative health effects, but it is hoped that telemedicine can provide a viable alternative. Objective: This study aimed to understand what type of health care services were being deferred during the COVID-19 pandemic lockdown, the role played by telemedicine to fill in care gaps, and changes in attitudes toward telemedicine. Methods: We conducted a cross-sectional analysis of survey responses from 1694 primary care patients in a mid-sized northeastern city. Our main outcomes were use of telemedicine and reports of care deferral during the shutdown. Results: Deferred care was widespread—48% (n=812) of respondents deferred care—but it was largely for preventive services, particularly dental and primary care, and did not cause concerns about negative health effects. In total, 30.2% (n=242) of those who delayed care were concerned about health effects, with needs centered around orthopedics and surgery. Telemedicine was viewed more positively than prior to the pandemic; it was seen as a viable option to deliver deferred care, particularly by respondents who were over 65 years of age, female, and college educated. Mental health services stood out for having high levels of deferred care. Conclusions: Temporary health system shutdowns will give rise to deferred care. However, much of the deferrals will be for preventive services. The effect of this on patient health can be moderated by prioritizing surgical and orthopedic services and delivering other services through telemedicine. Having telemedicine as an option is particularly crucial for mental health services. %M 32833661 %R 10.2196/21607 %U http://publichealth.jmir.org/2020/3/e21607/ %U https://doi.org/10.2196/21607 %U http://www.ncbi.nlm.nih.gov/pubmed/32833661 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 9 %P e20955 %T Excessive Media Consumption About COVID-19 is Associated With Increased State Anxiety: Outcomes of a Large Online Survey in Russia %A Nekliudov,Nikita A %A Blyuss,Oleg %A Cheung,Ka Yan %A Petrou,Loukia %A Genuneit,Jon %A Sushentsev,Nikita %A Levadnaya,Anna %A Comberiati,Pasquale %A Warner,John O %A Tudor-Williams,Gareth %A Teufel,Martin %A Greenhawt,Matthew %A DunnGalvin,Audrey %A Munblit,Daniel %+ Department of Infectious Disease, Faculty of Medicine, Imperial College London, Wright Fleming Building, Norfolk Place, Paddington, London, W2 1PG, United Kingdom, 44 (0) 7898257151, daniel.munblit08@imperial.ac.uk %K anxiety %K COVID-19 %K media consumption %K SARS-CoV-2 %K STAI %K state anxiety %K trait anxiety %K trust to government %K trust %K mental health %K social media %K survey %D 2020 %7 11.9.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic has potentially had a negative impact on the mental health and well-being of individuals and families. Anxiety levels and risk factors within particular populations are poorly described. Objective: This study aims to evaluate confidence, understanding, trust, concerns, and levels of anxiety during the COVID-19 pandemic in the general population and assess risk factors for increased anxiety. Methods: We launched a cross-sectional online survey of a large Russian population between April 6 and 15, 2020, using multiple social media platforms. A set of questions targeted confidence, understanding, trust, and concerns in respondents. The State-Trait Anxiety Inventory was used to measure anxiety. Multiple linear regressions were used to model predictors of COVID-19–related anxiety. Results: The survey was completed by 23,756 out of 53,966 (44.0% response rate) unique visitors; of which, 21,364 were residing in 62 areas of Russia. State Anxiety Scale (S-Anxiety) scores were higher than Trait Anxiety Scale scores across all regions of Russia (median S-Anxiety score 52, IQR 44-60), exceeding published norms. Time spent following news on COVID-19 was strongly associated with an increased S-Anxiety adjusted for baseline anxiety level. One to two hours spent reading COVID-19 news was associated with a 5.46 (95% CI 5.03-5.90) point difference, 2-3 hours with a 7.06 (95% CI 6.37-7.74) point difference, and more than three hours with an 8.65 (95% CI 7.82-9.47) point difference, all compared to less than 30 minutes per day. Job loss during the pandemic was another important factor associated with higher S-Anxiety scores (3.95, 95% CI 3.31-4.58). Despite survey respondents reporting high confidence in information regarding COVID-19 as well as an understanding of health care guidance, they reported low overall trust in state and local authorities, and perception of country readiness. Conclusions: Among Russian respondents from multiple social media platforms, there was evidence of higher levels of state anxiety associated with recent job loss and increased news consumption, as well as lower than expected trust in government agencies. These findings can help inform the development of key public health messages to help reduce anxiety and raise perceived trust in governmental response to this current national emergency. Using a similar methodology, comparative surveys are ongoing in other national populations. %M 32788143 %R 10.2196/20955 %U https://www.jmir.org/2020/9/e20955 %U https://doi.org/10.2196/20955 %U http://www.ncbi.nlm.nih.gov/pubmed/32788143 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 9 %P e22288 %T Association of Socioeconomic Changes due to the COVID-19 Pandemic With Health Outcomes in Patients With Skin Diseases: Cross-Sectional Survey Study %A Guo,Yeye %A Shen,Minxue %A Zhang,Xu %A Xiao,Yi %A Zhao,Shuang %A Yin,Mingzhu %A Bu,Wenbo %A Wang,Yan %A Chen,Xiang %A Su,Juan %+ Department of Dermatology, Xiangya Hospital, Central South University, Xiangya Road #87, Changsha, 410008, China, 86 731 84327377, sujuanderm@csu.edu.cn %K skin diseases %K coronavirus disease 2019 %K unemployment %K quality of life %K web-based %K survey %K dermatology %K COVID-19 %K lifestyle %K impact %K outcome %K isolation %D 2020 %7 11.9.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The outbreak of COVID-19 has profoundly influenced people’s lifestyles; these impacts have varied across subgroups of people. The pandemic-related impacts on the health outcomes of people with dermatological conditions are unknown. Objective: The aim of this paper was to study the association of COVID-19 pandemic–related impacts with health-related quality of life in patients with skin diseases. Methods: This was a cross-sectional study among Chinese patients with skin diseases. A self-administered web-based questionnaire was distributed through social media. Demographic and clinical data and pandemic-related impacts (isolation status, income changes, and employment status) were collected. The main outcomes included perceived stress (Visual Analog Scale), symptoms of anxiety (Generalized Anxiety Disorder-7) and depression (9-Item Patient Health Questionnaire), quality of life (Dermatology Life Quality Index), and health utility mapping based on the EQ-5D-3L descriptive system. Multivariable logistic regression was used to investigate the associations. Results: A total of 506 patients with skin diseases completed the survey. The mean age of the patients was 33.5 years (SD 14.0), and 217/506 patients (42.9%) were male. Among the 506 respondents, 128 (25.3%) were quarantined, 102 (20.2%) reported unemployment, and 317 (62.6%) reported decrease or loss of income since the pandemic. The pandemic-related impacts were significantly associated with impaired mental well-being and quality of life with different effects. Unemployment and complete loss of income were associated with the highest risks of adverse outcomes, with increases of 110% to 162% in the prevalence of anxiety, depression, and impaired quality of life. Conclusions: Isolation, income loss, and unemployment are associated with impaired health-related quality of life in patients with skin diseases during the COVID-19 pandemic. %M 32845850 %R 10.2196/22288 %U http://www.jmir.org/2020/9/e22288/ %U https://doi.org/10.2196/22288 %U http://www.ncbi.nlm.nih.gov/pubmed/32845850 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 3 %P e19446 %T Early Stage Machine Learning–Based Prediction of US County Vulnerability to the COVID-19 Pandemic: Machine Learning Approach %A Mehta,Mihir %A Julaiti,Juxihong %A Griffin,Paul %A Kumara,Soundar %+ Purdue University, Regenstrief Center for Healthcare Engineering, West Lafayette, IN, 47907, United States, 1 765 496 7395, paulgriffin@purdue.edu %K COVID-19 %K coronavirus %K prediction model %K county-level vulnerability %K machine learning %K XGBoost %D 2020 %7 11.9.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The rapid spread of COVID-19 means that government and health services providers have little time to plan and design effective response policies. It is therefore important to quickly provide accurate predictions of how vulnerable geographic regions such as counties are to the spread of this virus. Objective: The aim of this study is to develop county-level prediction around near future disease movement for COVID-19 occurrences using publicly available data. Methods: We estimated county-level COVID-19 occurrences for the period March 14 to 31, 2020, based on data fused from multiple publicly available sources inclusive of health statistics, demographics, and geographical features. We developed a three-stage model using XGBoost, a machine learning algorithm, to quantify the probability of COVID-19 occurrence and estimate the number of potential occurrences for unaffected counties. Finally, these results were combined to predict the county-level risk. This risk was then used as an estimated after-five-day-vulnerability of the county. Results: The model predictions showed a sensitivity over 71% and specificity over 94% for models built using data from March 14 to 31, 2020. We found that population, population density, percentage of people aged >70 years, and prevalence of comorbidities play an important role in predicting COVID-19 occurrences. We observed a positive association at the county level between urbanicity and vulnerability to COVID-19. Conclusions: The developed model can be used for identification of vulnerable counties and potential data discrepancies. Limited testing facilities and delayed results introduce significant variation in reported cases, which produces a bias in the model. %M 32784193 %R 10.2196/19446 %U http://publichealth.jmir.org/2020/3/e19446/ %U https://doi.org/10.2196/19446 %U http://www.ncbi.nlm.nih.gov/pubmed/32784193 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 9 %P e21562 %T Excess Patient Visits for Cough and Pulmonary Disease at a Large US Health System in the Months Prior to the COVID-19 Pandemic: Time-Series Analysis %A Elmore,Joann G %A Wang,Pin-Chieh %A Kerr,Kathleen F %A Schriger,David L %A Morrison,Douglas E %A Brookmeyer,Ron %A Pfeffer,Michael A %A Payne,Thomas H %A Currier,Judith S %+ Department of Medicine, David Geffen School of Medicine, UCLA, 1100 Glendon Ave, Suite 900, Los Angeles, CA, 90024, United States, 1 310 794 9505, jelmore@mednet.ucla.edu %K COVID-19 %K pandemic %K electronic health record %K time-series analysis %K prediction %K forecast %D 2020 %7 10.9.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Accurately assessing the regional activity of diseases such as COVID-19 is important in guiding public health interventions. Leveraging electronic health records (EHRs) to monitor outpatient clinical encounters may lead to the identification of emerging outbreaks. Objective: The aim of this study is to investigate whether excess visits where the word “cough” was present in the EHR reason for visit, and hospitalizations with acute respiratory failure were more frequent from December 2019 to February 2020 compared with the preceding 5 years. Methods: A retrospective observational cohort was identified from a large US health system with 3 hospitals, over 180 clinics, and 2.5 million patient encounters annually. Data from patient encounters from July 1, 2014, to February 29, 2020, were included. Seasonal autoregressive integrated moving average (SARIMA) time-series models were used to evaluate if the observed winter 2019/2020 rates were higher than the forecast 95% prediction intervals. The estimated excess number of visits and hospitalizations in winter 2019/2020 were calculated compared to previous seasons. Results: The percentage of patients presenting with an EHR reason for visit containing the word “cough” to clinics exceeded the 95% prediction interval the week of December 22, 2019, and was consistently above the 95% prediction interval all 10 weeks through the end of February 2020. Similar trends were noted for emergency department visits and hospitalizations starting December 22, 2019, where observed data exceeded the 95% prediction interval in 6 and 7 of the 10 weeks, respectively. The estimated excess over the 3-month 2019/2020 winter season, obtained by either subtracting the maximum or subtracting the average of the five previous seasons from the current season, was 1.6 or 2.0 excess visits for cough per 1000 outpatient visits, 11.0 or 19.2 excess visits for cough per 1000 emergency department visits, and 21.4 or 39.1 excess visits per 1000 hospitalizations with acute respiratory failure, respectively. The total numbers of excess cases above the 95% predicted forecast interval were 168 cases in the outpatient clinics, 56 cases for the emergency department, and 18 hospitalized with acute respiratory failure. Conclusions: A significantly higher number of patients with respiratory complaints and diseases starting in late December 2019 and continuing through February 2020 suggests community spread of SARS-CoV-2 prior to established clinical awareness and testing capabilities. This provides a case example of how health system analytics combined with EHR data can provide powerful and agile tools for identifying when future trends in patient populations are outside of the expected ranges. %M 32791492 %R 10.2196/21562 %U https://www.jmir.org/2020/9/e21562 %U https://doi.org/10.2196/21562 %U http://www.ncbi.nlm.nih.gov/pubmed/32791492 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 9 %P e21490 %T Association Between Generalized Anxiety Disorder Scores and Online Activity Among US Adults During the COVID-19 Pandemic: Cross-Sectional Analysis %A Singh,Parvati %A Cumberland,William G %A Ugarte,Dominic %A Bruckner,Tim-Allen %A Young,Sean D %+ University of California Institute for Prediction Technology, University of California, Irvine, Irvine, CA, United States, 1 310 794 8530, parvatis@uci.edu %K online activity %K COVID-19 %K anxiety %K generalized anxiety disorder %K GAD %K scores %K stress %K anxiety %K internet %K survey %K cross-sectional %D 2020 %7 10.9.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Evidence from past pandemics suggests that fear, uncertainty, and loss of control during large-scale public health crises may lead to increased pandemic-related information seeking, particularly among persons predisposed to high anxiety. In such groups, a greater consumption of information pertaining to the COVID-19 pandemic may increase anxiety. Objective: In this study, we examine the association between online activity and Generalized Anxiety Disorder 7 (GAD-7) scores in the United States. Methods: We recruited participants for an online survey through advertisements on various platforms such as Google, Facebook, and Reddit. A total of 406 adult US participants with moderate to severe (≥10) GAD-7 scores met the inclusion criteria and completed the survey. Anxiety levels measured using the GAD-7 scale formed our primary outcome. Our key independent variables were average daily time spent online and average daily time spent online searching about COVID-19 within the past 14 days. We used as controls potential confounders of the relation between our key independent variables and GAD-7 scores, namely, sleep quality, the COVID-19 Fear Inventory scale, binge drinking, substance use, prescription drug abuse, and sociodemographic attributes. Results: Linear multivariate regression analyses showed that GAD-7 scores were higher among those who spent >4 hours online (per day) searching for information about COVID-19 (coefficient 1.29, P=.002), controlling for all other covariates. The total time spent online was not statistically associated with GAD-7 scores. Conclusions: Results from this study indicate that limiting pandemic-related online information seeking may aid anxiety management in our study population. %M 32841152 %R 10.2196/21490 %U http://www.jmir.org/2020/9/e21490/ %U https://doi.org/10.2196/21490 %U http://www.ncbi.nlm.nih.gov/pubmed/32841152 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 9 %P e21319 %T Assessing the Impact of the COVID-19 Pandemic in Spain: Large-Scale, Online, Self-Reported Population Survey %A Oliver,Nuria %A Barber,Xavier %A Roomp,Kirsten %A Roomp,Kristof %+ The Institute for Human(ity)-Centric Artificial Intelligence, ELLIS Unit Alicante Foundation, Avenida Universidad, Alicante, 03690, Spain, 34 630726085, nuria@alum.mit.edu %K COVID-19 %K SARS-CoV-2 %K public health authorities %K large-scale online surveys %K infectious disease %K outbreak %K public engagement %K disease prevalence %K impact %K survey %K spain %K public health %K perception %D 2020 %7 10.9.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Spain has been one of the countries most impacted by the COVID-19 pandemic. Since the first confirmed case was reported on January 31, 2020, there have been over 405,000 cases and 28,000 deaths in Spain. The economic and social impact is without precedent. Thus, it is important to quickly assess the situation and perception of the population. Large-scale online surveys have been shown to be an effective tool for this purpose. Objective: We aim to assess the situation and perception of the Spanish population in four key areas related to the COVID-19 pandemic: social contact behavior during confinement, personal economic impact, labor situation, and health status. Methods: We obtained a large sample using an online survey with 24 questions related to COVID-19 in the week of March 28-April 2, 2020, during the peak of the first wave of COVID-19 in Spain. The self-selection online survey method of nonprobability sampling was used to recruit 156,614 participants via social media posts that targeted the general adult population (age >18 years). Given such a large sample, the 95% CI was ±0.843 for all reported proportions. Results: Regarding social behavior during confinement, participants mainly left their homes to satisfy basic needs. We found several statistically significant differences in social behavior across genders and age groups. The population’s willingness to comply with the confinement measures is evident. From the survey answers, we identified a significant adverse economic impact of the pandemic on those working in small businesses and a negative correlation between economic damage and willingness to stay in confinement. The survey revealed that close contacts play an important role in the transmission of the disease, and 28% of the participants lacked the necessary resources to properly isolate themselves. We also identified a significant lack of testing, with only 1% of the population tested and 6% of respondents unable to be tested despite their doctor’s recommendation. We developed a generalized linear model to identify the variables that were correlated with a positive SARS-CoV-2 test result. Using this model, we estimated an average of 5% for SARS-CoV-2 prevalence in the Spanish population during the time of the study. A seroprevalence study carried out later by the Spanish Ministry of Health reported a similar level of disease prevalence (5%). Conclusions: Large-scale online population surveys, distributed via social media and online messaging platforms, can be an effective, cheap, and fast tool to assess the impact and prevalence of an infectious disease in the context of a pandemic, particularly when there is a scarcity of official data and limited testing capacity. %M 32870159 %R 10.2196/21319 %U http://www.jmir.org/2020/9/e21319/ %U https://doi.org/10.2196/21319 %U http://www.ncbi.nlm.nih.gov/pubmed/32870159 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 9 %P e21956 %T App-Based Tracking of Self-Reported COVID-19 Symptoms: Analysis of Questionnaire Data %A Zens,Martin %A Brammertz,Arne %A Herpich,Juliane %A Südkamp,Norbert %A Hinterseer,Martin %+ Department of Medicine, Kliniken Ostallgaeu-Kaufbeuren, Stadtbleiche 1, Fuessen, 87629, Germany, 49 8362 500 726, martin.zens@me.com %K COVID-19 %K self-reporting %K symptom %K tracking %K app %K surveillance %K distribution %K digital tool %K screening %D 2020 %7 9.9.2020 %9 Short Paper %J J Med Internet Res %G English %X Background: COVID-19 is an infectious disease characterized by various clinical presentations. Knowledge of possible symptoms and their distribution allows for the early identification of infected patients. Objective: To determine the distribution pattern of COVID-19 symptoms as well as possible unreported symptoms, we created an app-based self-reporting tool. Methods: The COVID-19 Symptom Tracker is an app-based daily self-reporting tool. Between April 8 and May 15, 2020, a total of 22,327 individuals installed this app on their mobile device. An initial questionnaire asked for demographic information (age, gender, postal code) and past medical history comprising relevant chronic diseases. The participants were reminded daily to report whether they were experiencing any symptoms and if they had been tested for SARS-CoV-2 infection. Participants who sought health care services were asked additional questions regarding diagnostics and treatment. Participation was open to all adults (≥18 years). The study was completely anonymous. Results: In total, 11,829 (52.98%) participants completed the symptom questionnaire at least once. Of these, 291 (2.46%) participants stated that they had undergone an RT-PCR (reverse transcription-polymerase chain reaction) test for SARS-CoV-2; 65 (0.55%) reported a positive test result and 226 (1.91%) a negative one. The mean number of reported symptoms among untested participants was 0.81 (SD 1.85). Participants with a positive test result had, on average, 5.63 symptoms (SD 2.82). The most significant risk factors were diabetes (odds ratio [OR] 8.95, 95% CI 3.30-22.37) and chronic heart disease (OR 2.85, 95% CI 1.43-5.69). We identified chills, fever, loss of smell, nausea and vomiting, and shortness of breath as the top five strongest predictors for a COVID-19 infection. The odds ratio for loss of smell was 3.13 (95% CI 1.76-5.58). Nausea and vomiting (OR 2.84, 95% CI 1.61-5.00) had been reported as an uncommon symptom previously; however, our data suggest a significant predictive value. Conclusions: Self-reported symptom tracking helps to identify novel symptoms of COVID-19 and to estimate the predictive value of certain symptoms. This aids in the development of reliable screening tools. Clinical screening with a high pretest probability allows for the rapid identification of infections and the cost-effective use of testing resources. Based on our results, we suggest that loss of smell and taste be considered cardinal symptoms; we also stress that diabetes is a risk factor for a highly symptomatic course of COVID-19 infection. %M 32791493 %R 10.2196/21956 %U http://www.jmir.org/2020/9/e21956/ %U https://doi.org/10.2196/21956 %U http://www.ncbi.nlm.nih.gov/pubmed/32791493 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 9 %P e20786 %T Patient Satisfaction With Telemedicine During the COVID-19 Pandemic: Retrospective Cohort Study %A Ramaswamy,Ashwin %A Yu,Miko %A Drangsholt,Siri %A Ng,Eric %A Culligan,Patrick J %A Schlegel,Peter N %A Hu,Jim C %+ Department of Urology, Weill Cornell Medicine, 525 East 68th Street, New York, NY, 10065, United States, 1 646 962 9600, asr9066@nyp.org %K telemedicine %K medicine %K pandemics %K patient satisfaction %K remote consultation %K disruptive technology %K medical informatics %K health care delivery %K practice patterns %K physicians %K health policy %K health services research %K health care reform %K COVID-19 %D 2020 %7 9.9.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: New York City was the international epicenter of the COVID-19 pandemic. Health care providers responded by rapidly transitioning from in-person to video consultations. Telemedicine (ie, video visits) is a potentially disruptive innovation; however, little is known about patient satisfaction with this emerging alternative to the traditional clinical encounter. Objective: This study aimed to determine if patient satisfaction differs between video and in-person visits. Methods: In this retrospective observational cohort study, we analyzed 38,609 Press Ganey patient satisfaction survey outcomes from clinic encounters (620 video visits vs 37,989 in-person visits) at a single-institution, urban, quaternary academic medical center in New York City for patients aged 18 years, from April 1, 2019, to March 31, 2020. Time was categorized as pre–COVID-19 and COVID-19 (before vs after March 4, 2020). Wilcoxon-Mann-Whitney tests and multivariable linear regression were used for hypothesis testing and statistical modeling, respectively. Results: We experienced an 8729% increase in video visit utilization during the COVID-19 pandemic compared to the same period last year. Video visit Press Ganey scores were significantly higher than in-person visits (94.9% vs 92.5%; P<.001). In adjusted analyses, video visits (parameter estimate [PE] 2.18; 95% CI 1.20-3.16) and the COVID-19 period (PE 0.55; 95% CI 0.04-1.06) were associated with higher patient satisfaction. Younger age (PE –2.05; 95% CI –2.66 to –1.22), female gender (PE –0.73; 95% CI –0.96 to –0.50), and new visit type (PE –0.75; 95% CI –1.00 to –0.49) were associated with lower patient satisfaction. Conclusions: Patient satisfaction with video visits is high and is not a barrier toward a paradigm shift away from traditional in-person clinic visits. Future research comparing other clinic visit quality indicators is needed to guide and implement the widespread adoption of telemedicine. %M 32810841 %R 10.2196/20786 %U http://www.jmir.org/2020/9/e20786/ %U https://doi.org/10.2196/20786 %U http://www.ncbi.nlm.nih.gov/pubmed/32810841 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 9 %P e19907 %T Real-World Implications of a Rapidly Responsive COVID-19 Spread Model with Time-Dependent Parameters via Deep Learning: Model Development and Validation %A Jung,Se Young %A Jo,Hyeontae %A Son,Hwijae %A Hwang,Hyung Ju %+ Department of Mathematics, Pohang University of Science and Technology, 77, Cheongam-ro, Nam-gu, Pohang-si, Gyeongsangbuk-do, Pohang, 37673, Republic of Korea, 82 542792056, hjhwang@postech.ac.kr %K epidemic models %K SIR models %K time-dependent parameters %K neural networks %K deep learning %K COVID-19 %K modeling %K spread %K outbreak %D 2020 %7 9.9.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic has caused major disruptions worldwide since March 2020. The experience of the 1918 influenza pandemic demonstrated that decreases in the infection rates of COVID-19 do not guarantee continuity of the trend. Objective: The aim of this study was to develop a precise spread model of COVID-19 with time-dependent parameters via deep learning to respond promptly to the dynamic situation of the outbreak and proactively minimize damage. Methods: In this study, we investigated a mathematical model with time-dependent parameters via deep learning based on forward-inverse problems. We used data from the Korea Centers for Disease Control and Prevention (KCDC) and the Center for Systems Science and Engineering (CSSE) at Johns Hopkins University for Korea and the other countries, respectively. Because the data consist of confirmed, recovered, and deceased cases, we selected the susceptible-infected-recovered (SIR) model and found approximated solutions as well as model parameters. Specifically, we applied fully connected neural networks to the solutions and parameters and designed suitable loss functions. Results: We developed an entirely new SIR model with time-dependent parameters via deep learning methods. Furthermore, we validated the model with the conventional Runge-Kutta fourth order model to confirm its convergent nature. In addition, we evaluated our model based on the real-world situation reported from the KCDC, the Korean government, and news media. We also crossvalidated our model using data from the CSSE for Italy, Sweden, and the United States. Conclusions: The methodology and new model of this study could be employed for short-term prediction of COVID-19, which could help the government prepare for a new outbreak. In addition, from the perspective of measuring medical resources, our model has powerful strength because it assumes all the parameters as time-dependent, which reflects the exact status of viral spread. %M 32877350 %R 10.2196/19907 %U http://www.jmir.org/2020/9/e19907/ %U https://doi.org/10.2196/19907 %U http://www.ncbi.nlm.nih.gov/pubmed/32877350 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 9 %P e19913 %T Perceptions, Knowledge, and Behaviors Related to COVID-19 Among Social Media Users: Cross-Sectional Study %A Ali,Khawla F %A Whitebridge,Simon %A Jamal,Mohammad H %A Alsafy,Mohammad %A Atkin,Stephen L %+ Royal College of Surgeons in Ireland-Medical University of Bahrain, PO Box 15503, Adliya, Bahrain, 974 973 34611722, khawlafouad@hotmail.com %K COVID-19 %K social media %K public health %K perception %K knowledge %K health information %K health education %K virus %D 2020 %7 8.9.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Social media is one of the most rapid and impactful ways of obtaining and delivering information in the modern era. Objective: The aim of this study was to rapidly obtain information on public perceptions, knowledge, and behaviors related to COVID-19 in order to identify deficiencies in key areas of public education. Methods: Using a cross-sectional study design, a survey web link was posted on the social media and messaging platforms Instagram, Twitter, and WhatsApp by the study investigators. Participants, aged ≥18 years, filled out the survey on a voluntary basis. The main outcomes measured were knowledge of COVID-19 symptoms, protective measures against COVID-19, and source(s) of information about COVID-19. Subgroup analyses were conducted to determine the effects of age, gender, underlying illness, and working or studying in the health care industry on the perceived likelihood of acquiring COVID-19 and getting vaccinated. Results: A total of 5677 subjects completed the survey over the course of 1 week. “Fever or chills” (n=4973, 87.6%) and “shortness of breath” (n=4695, 82.7%) were identified as the main symptoms of COVID-19. Washing and sanitizing hands (n=4990, 87.9%) and avoiding public places and crowds (n=4865, 85.7%) were identified as the protective measures most frequently used against COVID-19. Social media was the most utilized source for information on the disease (n=4740, 83.5%), followed by the World Health Organization (n=2844, 50.1%). Subgroup analysis revealed that younger subjects (<35 years), males, and those working or studying in health care reported a higher perceived likelihood of acquiring COVID-19, whereas older subjects, females, and those working or studying in non–health care areas reported a lower perceived likelihood of acquiring COVID-19. Similar trends were observed for vaccination against COVID-19, with older subjects, females, and those working or studying in non–health care sectors reporting a lower likelihood of vaccinating against COVID-19. Conclusions: Our results are indicative of a relatively well-informed cohort implementing appropriate protective measures. However, key knowledge deficiencies exist with regards to vaccination against COVID-19, which future efforts should aim at correcting. %M 32841153 %R 10.2196/19913 %U http://www.jmir.org/2020/9/e19913/ %U https://doi.org/10.2196/19913 %U http://www.ncbi.nlm.nih.gov/pubmed/32841153 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 8 %N 9 %P e19588 %T Nomogram for Predicting COVID-19 Disease Progression Based on Single-Center Data: Observational Study and Model Development %A Fan,Tao %A Hao,Bo %A Yang,Shuo %A Shen,Bo %A Huang,Zhixin %A Lu,Zilong %A Xiong,Rui %A Shen,Xiaokang %A Jiang,Wenyang %A Zhang,Lin %A Li,Donghang %A He,Ruyuan %A Meng,Heng %A Lin,Weichen %A Feng,Haojie %A Geng,Qing %+ Renmin Hospital, Wuhan University, 238 Jiefang Road, Wuhan, 430060, China, 27 88041911 880419, gengqingwhu@whu.edu.cn %K coronavirus disease 2019 %K COVID-19 %K risk factors %K nomogram %D 2020 %7 8.9.2020 %9 Original Paper %J JMIR Med Inform %G English %X Background: In late December 2019, a pneumonia caused by SARS-CoV-2 was first reported in Wuhan and spread worldwide rapidly. Currently, no specific medicine is available to treat infection with COVID-19. Objective: The aims of this study were to summarize the epidemiological and clinical characteristics of 175 patients with SARS-CoV-2 infection who were hospitalized in Renmin Hospital of Wuhan University from January 1 to January 31, 2020, and to establish a tool to identify potential critical patients with COVID-19 and help clinical physicians prevent progression of this disease. Methods: In this retrospective study, clinical characteristics of 175 confirmed COVID-19 cases were collected and analyzed. Univariate analysis and least absolute shrinkage and selection operator (LASSO) regression were used to select variables. Multivariate analysis was applied to identify independent risk factors in COVID-19 progression. We established a nomogram to evaluate the probability of progression of the condition of a patient with COVID-19 to severe within three weeks of disease onset. The nomogram was verified using calibration curves and receiver operating characteristic curves. Results: A total of 18 variables were considered to be risk factors after the univariate regression analysis of the laboratory parameters (P<.05), and LASSO regression analysis screened out 10 risk factors for further study. The six independent risk factors revealed by multivariate Cox regression were age (OR 1.035, 95% CI 1.017-1.054; P<.001), CK level (OR 1.002, 95% CI 1.0003-1.0039; P=.02), CD4 count (OR 0.995, 95% CI 0.992-0.998; P=.002), CD8 % (OR 1.007, 95% CI 1.004-1.012, P<.001), CD8 count (OR 0.881, 95% CI 0.835-0.931; P<.001), and C3 count (OR 6.93, 95% CI 1.945-24.691; P=.003). The areas under the curve of the prediction model for 0.5-week, 1-week, 2-week and 3-week nonsevere probability were 0.721, 0.742, 0.87, and 0.832, respectively. The calibration curves showed that the model had good prediction ability within three weeks of disease onset. Conclusions: This study presents a predictive nomogram of critical patients with COVID-19 based on LASSO and Cox regression analysis. Clinical use of the nomogram may enable timely detection of potential critical patients with COVID-19 and instruct clinicians to administer early intervention to these patients to prevent the disease from worsening. %M 32866109 %R 10.2196/19588 %U http://medinform.jmir.org/2020/9/e19588/ %U https://doi.org/10.2196/19588 %U http://www.ncbi.nlm.nih.gov/pubmed/32866109 %0 Journal Article %@ 2561-3278 %I JMIR Publications %V 5 %N 1 %P e19623 %T Fingerprint Biometric System Hygiene and the Risk of COVID-19 Transmission %A Okereafor,Kenneth %A Ekong,Iniobong %A Okon Markson,Ini %A Enwere,Kingsley %+ Department of Information & Communications Technology, National Health Insurance Scheme, NHIS Data Centre, Abuja, Nigeria, 234 8023148494, nitelken@yahoo.com %K biometric %K contact %K contaminate %K coronavirus %K COVID-19 %K cybersecurity %K disease %K fingerprint %K hygienic %K infectious %K pathogen %K scanner %K surface %K verification %D 2020 %7 8.9.2020 %9 Viewpoint %J JMIR Biomed Eng %G English %X Biometric systems use scanners to verify the identity of human beings by measuring the patterns of their behavioral or physiological characteristics. Some biometric systems are contactless and do not require direct touch to perform these measurements; others, such as fingerprint verification systems, require the user to make direct physical contact with the scanner for a specified duration for the biometric pattern of the user to be properly read and measured. This may increase the possibility of contamination with harmful microbial pathogens or of cross-contamination of food and water by subsequent users. Physical contact also increases the likelihood of inoculation of harmful microbial pathogens into the respiratory tract, thereby triggering infectious diseases. In this viewpoint, we establish the likelihood of infectious disease transmission through touch-based fingerprint biometric devices and discuss control measures to curb the spread of infectious diseases, including COVID-19. %R 10.2196/19623 %U http://biomedeng.jmir.org/2020/1/e19623/ %U https://doi.org/10.2196/19623 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 9 %P e22321 %T A QR Code–Based Contact Tracing Framework for Sustainable Containment of COVID-19: Evaluation of an Approach to Assist the Return to Normal Activity %A Nakamoto,Ichiro %A Wang,Sheng %A Guo,Yan %A Zhuang,Weiqing %+ School of Internet Economics and Business, Fujian University of Technology, 999 Dongsanhuang Road, JinAn District, Fuzhou , China, 86 132 550 66365, fw107@foxmail.com %K COVID-19 %K coronavirus %K symptom-based %K quick response %K eHealth %K digital health %K telesurveillance %K pandemic %K epidemic %K interoperability %D 2020 %7 7.9.2020 %9 Viewpoint %J JMIR Mhealth Uhealth %G English %X We discuss a pandemic management framework using symptom-based quick response (QR) codes to contain the spread of COVID-19. In this approach, symptom-based QR health codes are issued by public health authorities. The codes do not retrieve the location data of the users; instead, two different colors are displayed to differentiate the health status of individuals. The QR codes are officially regarded as electronic certificates of individuals’ health status, and can be used for contact tracing, exposure risk self-triage, self-update of health status, health care appointments, and contact-free psychiatric consultations. This approach can be effectively deployed as a uniform platform interconnecting a variety of responders (eg, individuals, institutions, and public authorities) who are affected by the pandemic, which minimizes the errors of manual operation and the costs of fragmented coordination. At the same time, this approach enhances the promptness, interoperability, credibility, and traceability of containment measures. The proposed approach not only provides a supplemental mechanism for manual control measures but also addresses the partial failures of pandemic management tools in the abovementioned facets. The QR tool has been formally deployed in Fujian, a province located in southeast China that has a population of nearly 40 million people. All individuals aged ≥3 years were officially requested to present their QR code during daily public activities, such as when using public transportation systems, working at institutions, and entering or exiting schools. The deployment of this approach has achieved sizeable containment effects and played remarkable roles in shifting the negative gross domestic product (–6.8%) to a positive value by July 2020. The number of cumulative patients with COVID-19 in this setting was confined to 363, of whom 361 had recovered (recovery rate 99.4%) as of July 12, 2020. A simulation showed that if only partial measures of the framework were followed, the number of cumulative cases of COVID-19 could potentially increase ten-fold. This approach can serve as a reliable solution to counteract the emergency of a public health crisis; as a routine tool to enhance the level of public health; to accelerate the recovery of social activities; to assist decision making for policy makers; and as a sustainable measure that enables scalability. %M 32841151 %R 10.2196/22321 %U http://mhealth.jmir.org/2020/9/e22321/ %U https://doi.org/10.2196/22321 %U http://www.ncbi.nlm.nih.gov/pubmed/32841151 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 9 %P e22002 %T Perinatal Distress During COVID-19: Thematic Analysis of an Online Parenting Forum %A Chivers,Bonnie R %A Garad,Rhonda M %A Boyle,Jacqueline A %A Skouteris,Helen %A Teede,Helena J %A Harrison,Cheryce L %+ Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Wellington Rd, Clayton, Australia, 61 3 8572 2662, cheryce.harrison@monash.edu %K pregnancy %K perinatal %K maternal %K COVID-19 %K communication %K social support %K qualitative research %K mental health %K health information %K online support %K thematic analysis %K sentiment analysis %K word frequency %D 2020 %7 7.9.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 global pandemic has impacted the whole of society, requiring rapid implementation of individual-, population-, and system-level public health responses to contain and reduce the spread of infection. Women in the perinatal period (pregnant, birthing, and postpartum) have unique and timely needs for directives on health, safety, and risk aversion during periods of isolation and physical distancing for themselves, their child or children, and other family members. In addition, they are a vulnerable group at increased risk of psychological distress that may be exacerbated in the context of social support deprivation and a high-risk external environment. Objective: The aim of this study is to examine the public discourse of a perinatal cohort to understand unmet health information and support needs, and the impacts on mothering identity and social dynamics in the context of COVID-19. Methods: A leading Australian online support forum for women pre- through to postbirth was used to interrogate all posts related to COVID-19 from January 27 to May 12, 2020, inclusive. Key search terms included “COVID,” “corona,” and “pandemic.” A three-phase analysis was conducted, including thematic analysis, sentiment analysis, and word frequency calculations. Results: The search yielded 960 posts, of which 831 were included in our analysis. The qualitative thematic analysis demonstrated reasonable understanding, interpretation, and application of relevant restrictions in place, with five emerging themes identified. These were (1) heightened distress related to a high-risk external environment; (2) despair and anticipatory grief due to deprivation of social and family support, and bonding rituals; (3) altered family and support relationships; (4) guilt-tampered happiness; and (5) family future postponed. Sentiment analysis revealed that the content was predominantly negative (very negative: n=537 and moderately negative: n=443 compared to very positive: n=236 and moderately positive: n=340). Negative words were frequently used in the 831 posts with associated derivatives including “worried” (n=165, 19.9%), “risk” (n=143, 17.2%), “anxiety” (n=98, 11.8%), “concerns” (n=74, 8.8%), and “stress” (n=69, 8.3%). Conclusions: Women in the perinatal period are uniquely impacted by the current pandemic. General information on COVID-19 safe behaviors did not meet the particular needs of this cohort. The lack of nuanced and timely information may exacerbate the risk of psychological and psychosocial distress in this vulnerable, high-risk group. State and federal public health departments need to provide a central repository of information that is targeted, consistent, accessible, timely, and reassuring. Compensatory social and emotional support should be considered, using alternative measures to mitigate the risk of mental health disorders in this cohort. %M 32857707 %R 10.2196/22002 %U http://www.jmir.org/2020/9/e22002/ %U https://doi.org/10.2196/22002 %U http://www.ncbi.nlm.nih.gov/pubmed/32857707 %0 Journal Article %@ 2563-3570 %I JMIR Publications %V 1 %N 1 %P e20735 %T The Novel Coronavirus Enigma: Phylogeny and Analyses of Coevolving Mutations Among the SARS-CoV-2 Viruses Circulating in India %A Banerjee,Anindita %A Sarkar,Rakesh %A Mitra,Suvrotoa %A Lo,Mahadeb %A Dutta,Shanta %A Chawla-Sarkar,Mamta %+ Indian Council of Medical Research-National Institute of Cholera and Enteric Diseases, P-33, CIT Road, Scheme-XM, Beliaghata,, Kolkata, 700010, India, 91 9830660999, chawlam70@gmail.com %K SARS-CoV-2 %K Indian isolates %K phylogeny %K nucleotide homology %K novel coevolving mutations %K NSP12/RdRP secondary structure %K genetics %K virus %K evolution %K mutation %K COVID-19 %K genome %K epidemiology %K infectious disease %D 2020 %7 7.9.2020 %9 Original Paper %J JMIR Bioinformatics Biotechnol %G English %X Background: The RNA genome of the emerging novel coronavirus is rapidly mutating, and its human-to-human transmission rate is increasing. Hence, temporal dissection of their evolutionary dynamics, the nature of variations among different strains, and understanding the single nucleotide polymorphisms in the endemic settings are crucial. Delineating the heterogeneous genomic constellations of this novel virus will help us understand its complex behavior in a particular geographical region. Objective: This is a comprehensive analysis of 95 Indian SARS-CoV-2 genome sequences available from the Global Initiative on Sharing All Influenza Data (GISAID) repository during the first 6 months of 2020 (January through June). Evolutionary dynamics, gene-specific phylogeny, and the emergence of the novel coevolving mutations in 9 structural and nonstructural genes among circulating SARS-CoV-2 strains across 12 different Indian states were analyzed. Methods: A total of 95 SARS-CoV-2 nucleotide sequences submitted from India were downloaded from the GISAID database. Molecular Evolutionary Genetics Analysis, version X software was used to construct the 9 phylogenetic dendrograms based on nucleotide sequences of the SARS-CoV-2 genes. Analyses of the coevolving mutations were done in comparison to the prototype SARS-CoV-2 from Wuhan, China. The secondary structure of the RNA-dependent RNA polymerase/nonstructural protein NSP12 was predicted with respect to the novel A97V mutation. Results: Phylogenetic analyses revealed the evolution of “genome-type clusters” and adaptive selection of “L”-type SARS-CoV-2 strains with genetic closeness to the bat severe acute respiratory syndrome–like coronaviruses. These strains were distant to pangolin or Middle East respiratory syndrome–related coronavirus strains. With regard to the novel coevolving mutations, 2 groups have been seen circulating in India at present, the “major group” (66/95, 69.4%) and the “minor group” (21/95, 22.1%) , harboring 4 and 5 coexisting mutations, respectively. The “major group” mutations fall in the A2a clade. All the minor group mutations, except 11083G>T (L37F, NSP6 gene), were unique to the Indian isolates. Conclusions: This study highlights the rapidly evolving SARS-CoV-2 virus and the cocirculation of multiple clades and subclades. This comprehensive study is a potential resource for monitoring the novel mutations in the viral genome, interpreting changes in viral pathogenesis, and designing vaccines or other therapeutics. %M 33496683 %R 10.2196/20735 %U http://bioinform.jmir.org/2020/1/e20735/ %U https://doi.org/10.2196/20735 %U http://www.ncbi.nlm.nih.gov/pubmed/33496683 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 9 %P e22227 %T Depression and Psychological-Behavioral Responses Among the General Public in China During the Early Stages of the COVID-19 Pandemic: Survey Study %A Zhang,Weiyu %A Yang,Xiaoting %A Zhao,Jinfeng %A Yang,Fengzhi %A Jia,Yajing %A Cui,Can %A Yang,Xiaoshi %+ Department of Social Medicine, School of Public Health, China Medical University, No 77 Puhe Road, Shenyang North New Area, Shenyang, 110122, China, 86 18900910796, xsyang@cmu.edu.cn %K depression %K COVID-19 %K social support %K the general public %D 2020 %7 4.9.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic has recently spread dramatically worldwide, raising considerable concerns and resulting in detrimental effects on the psychological health of people who are vulnerable to the disease. Therefore, assessment of depression in members of the general public and their psychological and behavioral responses is essential for the maintenance of health. Objective: This study aimed to assess the prevalence of depression and the associated factors among the general public during the early stages of the COVID-19 pandemic in China. Methods: A cross-sectional survey with convenience sampling was conducted from February 11 to 16, 2020, in the early stages of the COVID-19 outbreak in China. A self-administrated smartphone questionnaire based on the Patient Health Questionnaire-9 (PHQ-9) and psychological and behavioral responses was distributed to the general public. Hierarchical multiple regression analysis and multivariate logistic regression analysis were conducted to explore the associated factors of depression.aA cross-sectional survey with convenience sampling was conducted from February 11 to 16, 2020, in the early stages of the COVID-19 outbreak in China. A self-administrated smartphone questionnaire based on the Patient Health Questionnaire-9 (PHQ-9) and psychological and behavioral responses was distributed to the general public. Hierarchical multiple regression analysis and multivariate logistic regression analysis were conducted to explore the associated factors of depression. Results: The prevalence of depression (PHQ-9 score ≥10) among the general public during the COVID-19 pandemic was 182/1342 (13.6%). Regression analysis indicated that feeling stressed, feeling helpless, persistently being worried even with support, never feeling clean after disinfecting, scrubbing hands and items repeatedly, hoarding food, medicine, or daily supplies, and being distracted from work or study were positively associated with depression, while social support and being calm were negatively associated with depression. Conclusions: The general public suffered from high levels of depression during the early stages of the COVID-19 pandemic. Thus, COVID-19–related mood management and social support should be provided to attenuate depression in the general public. %M 32886066 %R 10.2196/22227 %U https://www.jmir.org/2020/9/e22227 %U https://doi.org/10.2196/22227 %U http://www.ncbi.nlm.nih.gov/pubmed/32886066 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 3 %P e19578 %T COVID-19 and Slums: A Pandemic Highlights Gaps in Knowledge About Urban Poverty %A Friesen,John %A Pelz,Peter F %+ Chair of Fluid Systems, Technical University of Darmstadt, Otto-Berndt-Str 2, Darmstadt, 64287, Germany, 49 06151 1627100, john.friesen@fst.tu-darmstadt.de %K slums %K informal settlements %K COVID-19, pandemic %K infectious disease %K living conditions %K lifestyle %K risk %K risk group %K health information %D 2020 %7 4.9.2020 %9 Viewpoint %J JMIR Public Health Surveill %G English %X According to the United Nations, about 1 billion persons live in so-called slums. Numerous studies have shown that this population is particularly vulnerable to infectious diseases. The current COVID-19 pandemic, caused by the novel coronavirus SARS-CoV-2, emphatically underlines this problem. The often high-density living quarters coupled with a large number of persons per dwelling and the lack of adequate sanitation are reasons why measures to contain the pandemic only work to a limited extent in slums. Furthermore, assignment to risk groups for severe courses of COVID-19 caused by noncommunicable diseases (eg, cardiovascular diseases) is not possible due to inadequate data availability. Information on people living in slums and their health status is either unavailable or only exists for specific regions (eg, Nairobi). We argue that one of the greatest problems with regard to the COVID-19 pandemic in the context of slums in the Global South is the lack of data on the number of people, their living conditions, and their health status. %M 32877347 %R 10.2196/19578 %U http://publichealth.jmir.org/2020/3/e19578/ %U https://doi.org/10.2196/19578 %U http://www.ncbi.nlm.nih.gov/pubmed/32877347 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 9 %P e20143 %T Rapid Implementation and Innovative Applications of a Virtual Intensive Care Unit During the COVID-19 Pandemic: Case Study %A Dhala,Atiya %A Sasangohar,Farzan %A Kash,Bita %A Ahmadi,Nima %A Masud,Faisal %+ Department of Industrial and Systems Engineering, Texas A&M University, 3131 TAMU, College Station, TX, 77843, United States, 1 9794582337, sasangohar@tamu.edu %K intensive care units %K critical care %K pandemics %K SARS-CoV-2 %K telemedicine %K infection control %K COVID-19 %D 2020 %7 3.9.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic has necessitated a rapid increase of space in highly infectious disease intensive care units (ICUs). At Houston Methodist Hospital (HMH), a virtual intensive care unit (vICU) was used amid the COVID-19 outbreak. Objective: The aim of this paper was to detail the novel adaptations and rapid expansion of the vICU that were applied to achieve patient-centric solutions while protecting staff and patients’ families during the pandemic. Methods: The planned vICU implementation was redirected to meet the emerging needs of conversion of COVID-19 ICUs, including alterations to staged rollout timing, virtual and in-person staffing, and scope of application. With the majority of the hospital critical care physician workforce redirected to rapidly expanded COVID-19 ICUs, the non–COVID-19 ICUs were managed by cardiovascular surgeons, cardiologists, neurosurgeons, and acute care surgeons. HMH expanded the vICU program to fill the newly depleted critical care expertise in the non–COVID-19 units to provide urgent, emergent, and code blue support to all ICUs. Results: Virtual family visitation via the Consultant Bridge application, palliative care delivery, and specialist consultation for patients with COVID-19 exemplify the successful adaptation of the vICU implementation. Patients with COVID-19, who were isolated and separated from their families to prevent the spread of infection, were able to virtually see and hear their loved ones, which bolstered the mental and emotional status of those patients. Many families expressed gratitude for the ability to see and speak with their loved ones. The vICU also protected medical staff and specialists assigned to COVID-19 units, reducing exposure and conserving personal protective equipment. Conclusions: Telecritical care has been established as an advantageous mechanism for the delivery of critical care expertise during the expedited rollout of the vICU at Houston Methodist Hospital. Overall responses from patients, families, and physicians are in favor of continued vICU care; however, further research is required to examine the impact of innovative applications of telecritical care in the treatment of critically ill patients. %M 32795997 %R 10.2196/20143 %U http://www.jmir.org/2020/9/e20143/ %U https://doi.org/10.2196/20143 %U http://www.ncbi.nlm.nih.gov/pubmed/32795997 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 9 %P e21279 %T Effects of COVID-19 on College Students’ Mental Health in the United States: Interview Survey Study %A Son,Changwon %A Hegde,Sudeep %A Smith,Alec %A Wang,Xiaomei %A Sasangohar,Farzan %+ Department of Industrial and Systems Engineering, Texas A&M University, 3131 TAMU, College Station, TX, 77843, United States, 1 979 458 2337, sasangohar@tamu.edu %K COVID-19 %K pandemic %K college student %K mental health %K stress %K anxiety %K self-management %D 2020 %7 3.9.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Student mental health in higher education has been an increasing concern. The COVID-19 pandemic situation has brought this vulnerable population into renewed focus. Objective: Our study aims to conduct a timely assessment of the effects of the COVID-19 pandemic on the mental health of college students. Methods: We conducted interview surveys with 195 students at a large public university in the United States to understand the effects of the pandemic on their mental health and well-being. The data were analyzed through quantitative and qualitative methods. Results: Of the 195 students, 138 (71%) indicated increased stress and anxiety due to the COVID-19 outbreak. Multiple stressors were identified that contributed to the increased levels of stress, anxiety, and depressive thoughts among students. These included fear and worry about their own health and of their loved ones (177/195, 91% reported negative impacts of the pandemic), difficulty in concentrating (173/195, 89%), disruptions to sleeping patterns (168/195, 86%), decreased social interactions due to physical distancing (167/195, 86%), and increased concerns on academic performance (159/195, 82%). To cope with stress and anxiety, participants have sought support from others and helped themselves by adopting either negative or positive coping mechanisms. Conclusions: Due to the long-lasting pandemic situation and onerous measures such as lockdown and stay-at-home orders, the COVID-19 pandemic brings negative impacts on higher education. The findings of our study highlight the urgent need to develop interventions and preventive strategies to address the mental health of college students. %M 32805704 %R 10.2196/21279 %U https://www.jmir.org/2020/9/e21279 %U https://doi.org/10.2196/21279 %U http://www.ncbi.nlm.nih.gov/pubmed/32805704 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 9 %P e19471 %T Willingness to Use Home Collection Methods to Provide Specimens for SARS-CoV-2/COVID-19 Research: Survey Study %A Hall,Eric William %A Luisi,Nicole %A Zlotorzynska,Maria %A Wilde,Gretchen %A Sullivan,Patrick %A Sanchez,Travis %A Bradley,Heather %A Siegler,Aaron J %+ Department of Behavioral, Social and Health Education Sciences, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA, 30322, United States, 1 404 712 9733, asiegle@emory.edu %K COVID-19 %K SARS-CoV-2 %K specimen collection %K survey %K research %K public health %K infectious disease %K virus %K test %D 2020 %7 3.9.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Innovative laboratory testing approaches for SARS-CoV-2 infection and immune response are needed to conduct research to establish estimates of prevalence and incidence. Self-specimen collection methods have been successfully used in HIV and sexually transmitted infection research and can provide a feasible opportunity to scale up SARS-CoV-2 testing for research purposes. Objective: The aim of this study was to assess the willingness of adults to use different specimen collection modalities for themselves and children as part of a COVID-19 research study. Methods: Between March 27 and April 1, 2020, we recruited 1435 adults aged 18 years or older though social media advertisements. Participants completed a survey that included 5-point Likert scale items stating how willing they were to use the following specimen collection testing modalities as part of a research study: home collection of a saliva sample, home collection of a throat swab, home finger-prick blood collection, drive-through site throat swab, clinic throat swab, and clinic blood collection. Additionally, participants indicated how the availability of home-based collection methods would impact their willingness to participate compared to drive-through and clinic-based specimen collection. We used Kruskal-Wallis tests and Spearman rank correlations to assess if willingness to use each testing modality differed by demographic variables and characteristics of interest. We compared the overall willingness to use each testing modality and estimated effect sizes with Cohen d. Results: We analyzed responses from 1435 participants with a median age of 40.0 (SD=18.2) years and over half of which were female (761/1435, 53.0%). Most participants agreed or strongly agreed that they would be willing to use specimens self-collected at home to participate in research, including willingness to collect a saliva sample (1259/1435, 87.7%) or a throat swab (1191/1435, 83.1%). Willingness to collect a throat swab sample was lower in both a drive-through setting (64%) and clinic setting (53%). Overall, 69.0% (990/1435) of participants said they would be more likely to participate in a research study if they could provide a saliva sample or throat swab at home compared to going to a drive-through site; only 4.4% (63/1435) of participants said they would be less likely to participate using self-collected samples. For each specimen collection modality, willingness to collect specimens from children for research was lower than willingness to use on oneself, but the ranked order of modalities was similar. Conclusions: Most participants were willing to participate in a COVID-19 research study that involves laboratory testing; however, there was a strong preference for home specimen collection procedures over drive-through or clinic-based testing. To increase participation and minimize bias, epidemiologic research studies of SARS-CoV-2 infection and immune response should consider home specimen collection methods. %M 32790639 %R 10.2196/19471 %U https://www.jmir.org/2020/9/e19471 %U https://doi.org/10.2196/19471 %U http://www.ncbi.nlm.nih.gov/pubmed/32790639 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 9 %P e20953 %T Telemonitoring for Patients With COVID-19: Recommendations for Design and Implementation %A Silven,Anna V %A Petrus,Annelieke H J %A Villalobos-Quesada,María %A Dirikgil,Ebru %A Oerlemans,Carlijn R %A Landstra,Cyril P %A Boosman,Hileen %A van Os,Hendrikus J A %A Blanker,Marco H %A Treskes,Roderick W %A Bonten,Tobias N %A Chavannes,Niels H %A Atsma,Douwe E %A Teng,Y K Onno %+ Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, Leiden, 2333 ZA, Netherlands, 31 715262038, d.e.atsma@lumc.nl %K telemonitoring %K telemedicine %K eHealth %K digital health %K COVID-19 %D 2020 %7 2.9.2020 %9 Viewpoint %J J Med Internet Res %G English %X Despite significant efforts, the COVID-19 pandemic has put enormous pressure on health care systems around the world, threatening the quality of patient care. Telemonitoring offers the opportunity to carefully monitor patients with a confirmed or suspected case of COVID-19 from home and allows for the timely identification of worsening symptoms. Additionally, it may decrease the number of hospital visits and admissions, thereby reducing the use of scarce resources, optimizing health care capacity, and minimizing the risk of viral transmission. In this paper, we present a COVID-19 telemonitoring care pathway developed at a tertiary care hospital in the Netherlands, which combined the monitoring of vital parameters with video consultations for adequate clinical assessment. Additionally, we report a series of medical, scientific, organizational, and ethical recommendations that may be used as a guide for the design and implementation of telemonitoring pathways for COVID-19 and other diseases worldwide. %M 32833660 %R 10.2196/20953 %U https://www.jmir.org/2020/9/e20953 %U https://doi.org/10.2196/20953 %U http://www.ncbi.nlm.nih.gov/pubmed/32833660 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 9 %P e21419 %T Public Perceptions and Attitudes Toward COVID-19 Nonpharmaceutical Interventions Across Six Countries: A Topic Modeling Analysis of Twitter Data %A Doogan,Caitlin %A Buntine,Wray %A Linger,Henry %A Brunt,Samantha %+ Department of Data Science and AI, Faculty of Information Technology, Monash University, Wellington Rd, Clayton, 3800, Australia, 61 3 9903 1004, caitlin.doogan@monash.edu %K COVID-19 %K SARS-CoV-2 %K topic modeling %K nonpharmaceutical interventions %K social media %K public health %K machine learning %K social distancing %K lockdown %K face masks %K infodemiology %D 2020 %7 3.9.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Nonpharmaceutical interventions (NPIs) (such as wearing masks and social distancing) have been implemented by governments around the world to slow the spread of COVID-19. To promote public adherence to these regimes, governments need to understand the public perceptions and attitudes toward NPI regimes and the factors that influence them. Twitter data offer a means to capture these insights. Objective: The objective of this study is to identify tweets about COVID-19 NPIs in six countries and compare the trends in public perceptions and attitudes toward NPIs across these countries. The aim is to identify factors that influenced public perceptions and attitudes about NPI regimes during the early phases of the COVID-19 pandemic. Methods: We analyzed 777,869 English language tweets about COVID-19 NPIs in six countries (Australia, Canada, New Zealand, Ireland, the United Kingdom, and the United States). The relationship between tweet frequencies and case numbers was assessed using a Pearson correlation analysis. Topic modeling was used to isolate tweets about NPIs. A comparative analysis of NPIs between countries was conducted. Results: The proportion of NPI-related topics, relative to all topics, varied between countries. The New Zealand data set displayed the greatest attention to NPIs, and the US data set showed the lowest. The relationship between tweet frequencies and case numbers was statistically significant only for Australia (r=0.837, P<.001) and New Zealand (r=0.747, P<.001). Topic modeling produced 131 topics related to one of 22 NPIs, grouped into seven NPI categories: Personal Protection (n=15), Social Distancing (n=9), Testing and Tracing (n=10), Gathering Restrictions (n=18), Lockdown (n=42), Travel Restrictions (n=14), and Workplace Closures (n=23). While less restrictive NPIs gained widespread support, more restrictive NPIs were perceived differently across countries. Four characteristics of these regimes were seen to influence public adherence to NPIs: timeliness of implementation, NPI campaign strategies, inconsistent information, and enforcement strategies. Conclusions: Twitter offers a means to obtain timely feedback about the public response to COVID-19 NPI regimes. Insights gained from this analysis can support government decision making, implementation, and communication strategies about NPI regimes, as well as encourage further discussion about the management of NPI programs for global health events, such as the COVID-19 pandemic. %M 32784190 %R 10.2196/21419 %U https://www.jmir.org/2020/9/e21419 %U https://doi.org/10.2196/21419 %U http://www.ncbi.nlm.nih.gov/pubmed/32784190 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 9 %P e21758 %T Efficacy of Hydroxychloroquine and Tocilizumab in Patients With COVID-19: Single-Center Retrospective Chart Review %A Roomi,Sohaib %A Ullah,Waqas %A Ahmed,Faizan %A Farooq,Soban %A Sadiq,Usama %A Chohan,Asad %A Jafar,Munnam %A Saddique,Maryum %A Khanal,Shristi %A Watson,Robert %A Boigon,Margot %+ Jefferson Health Abington, 1200 Old York Rd, Abington, PA, United States, 1 2674666985, roomigujjar251@gmail.com %K COVID-19 %K hydroxychloroquine %K tocilizumab %D 2020 %7 1.9.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: During the initial phases of the COVID-19 pandemic, there was an unfounded fervor surrounding the use of hydroxychloroquine (HCQ) and tocilizumab (TCZ); however, evidence on their efficacy and safety have been controversial. Objective: The purpose of this study is to evaluate the overall clinical effectiveness of HCQ and TCZ in patients with COVID-19. We hypothesize that HCQ and TCZ use in these patients will be associated with a reduction in in-hospital mortality, upgrade to intensive medical care, invasive mechanical ventilation, or acute renal failure needing dialysis. Methods: A retrospective cohort study was performed to determine the impact of HCQ and TCZ use on hard clinical outcomes during hospitalization. A total of 176 hospitalized patients with a confirmed COVID-19 diagnosis was included. Patients were divided into two comparison groups: (1) HCQ (n=144) vs no-HCQ (n=32) and (2) TCZ (n=32) vs no-TCZ (n=144). The mean age, baseline comorbidities, and other medications used during hospitalization were uniformly distributed among all the groups. Independent t tests and multivariate logistic regression analysis were performed to calculate mean differences and adjusted odds ratios with 95% CIs, respectively. Results: The unadjusted odds ratio for patients upgraded to a higher level of care (ie, intensive care unit) (OR 2.6, 95% CI 1.19-5.69; P=.003) and reductions in C-reactive protein (CRP) level on day 7 of hospitalization (21% vs 56%, OR 0.21, 95% CI 0.08-0.55; P=.002) were significantly higher in the TCZ group compared to the control group. There was no significant difference in the odds of in-hospital mortality, upgrade to intensive medical care, need for invasive mechanical ventilation, acute kidney failure necessitating dialysis, or discharge from the hospital after recovery in both the HCQ and TCZ groups compared to their respective control groups. Adjusted odds ratios controlled for baseline comorbidities and medications closely followed the unadjusted estimates. Conclusions: In this cohort of patients with COVID-19, neither HCQ nor TCZ offered a significant reduction in in-hospital mortality, upgrade to intensive medical care, invasive mechanical ventilation, or acute renal failure needing dialysis. These results are similar to the recently published preliminary results of the HCQ arm of the Recovery trial, which showed no clinical benefit from the use of HCQ in hospitalized patients with COVID-19 (the TCZ arm is ongoing). Double-blinded randomized controlled trials are needed to further evaluate the impact of these drugs in larger patient samples so that data-driven guidelines can be deduced to combat this global pandemic. %M 32784192 %R 10.2196/21758 %U https://www.jmir.org/2020/9/e21758 %U https://doi.org/10.2196/21758 %U http://www.ncbi.nlm.nih.gov/pubmed/32784192 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 9 %P e19338 %T Digital Response During the COVID-19 Pandemic in Saudi Arabia %A Hassounah,Marwah %A Raheel,Hafsa %A Alhefzi,Mohammed %+ Prince Sattam Chair for Epidemiology and Public Health Research, Department of Family and Community Medicine, College of Medicine, King Saud University, Room No. 321/27, Third Floor, Medical Education Department, Riyadh, , Saudi Arabia, 966 556942926, hafsaraheel@yahoo.com %K digital response %K COVID-19 %K Saudi Arabia %K digital health %K containment %K public health %K pandemic %K prevention %D 2020 %7 1.9.2020 %9 Viewpoint %J J Med Internet Res %G English %X Background: The first case of COVID-19 in Saudi Arabia was confirmed on March 3, 2020. Saudi Arabia, like many other countries worldwide, implemented lockdown of most public and private services in response to the pandemic and established population movement restrictions nationwide. With the implementation of these strict mitigation regulations, technology and digital solutions have enabled the provision of essential services. Objective: The aim of this paper is to highlight how Saudi Arabia has used digital technology during the COVID-19 pandemic in the domains of public health, health care services, education, telecommunication, commerce, and risk communication. Methods: We documented the use of digital technology in Saudi Arabia during the pandemic using publicly available official announcements, press briefings and releases, news clips, published data, peer-reviewed literature, and professional discussions. Results: Saudi Arabia’s government and private sectors combined developed and launched approximately 19 apps and platforms that serve public health functions and provide health care services. A detailed account of each is provided. Education processes continued using an established electronic learning infrastructure with a promising direction toward wider adoption in the future. Telecommunication companies exhibited smooth collaboration as well as innovative initiatives to support ongoing efforts. Risk communication activities using social media, websites, and SMS text messaging followed best practice guides. Conclusions: The Saudi Vision 2030 framework, released in 2017, has paved the path for digital transformation. COVID-19 enabled the promotion and testing of this transition. In Saudi Arabia, the use of artificial intelligence in integrating different data sources during future outbreaks could be further explored. Also, decreasing the number of mobile apps and merging their functions could increase and facilitate their use. %M 32790642 %R 10.2196/19338 %U https://www.jmir.org/2020/9/e19338 %U https://doi.org/10.2196/19338 %U http://www.ncbi.nlm.nih.gov/pubmed/32790642 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 3 %P e20572 %T Adoption of a Contact Tracing App for Containing COVID-19: A Health Belief Model Approach %A Walrave,Michel %A Waeterloos,Cato %A Ponnet,Koen %+ Research Group MIOS, Department of Communication Studies, Faculty of Social Sciences, University of Antwerp, Sint-Jacobstraat 2, Antwerp, 2000, Belgium, 32 475459785, michel.walrave@uantwerp.be %K COVID-19 %K SARS-CoV-2 %K health belief model %K contact tracing %K proximity tracing %K privacy %D 2020 %7 1.9.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: To track and reduce the spread of COVID-19, apps have been developed to identify contact with individuals infected with SARS-CoV-2 and warn those who are at risk of having contracted the virus. However, the effectiveness of these apps depends highly on their uptake by the general population. Objective: The present study investigated factors influencing app use intention, based on the health belief model. In addition, associations with respondents’ level of news consumption and their health condition were investigated. Methods: A survey was administered in Flanders, Belgium, to 1500 respondents, aged 18 to 64 years. Structural equation modeling was used to investigate relationships across the model’s constructs. Results: In total, 48.70% (n=730) of respondents indicated that they intend to use a COVID-19 tracing app. The most important predictor was the perceived benefits of the app, followed by self-efficacy and perceived barriers. Perceived severity and perceived susceptibility were not related to app uptake intention. Moreover, cues to action (ie, individuals’ exposure to [digital] media content) were positively associated with app use intention. As the respondents’ age increased, their perceived benefits and self-efficacy for app usage decreased. Conclusions: Initiatives to stimulate the uptake of contact tracing apps should enhance perceived benefits and self-efficacy. A perceived barrier for some potential users is privacy concerns. Therefore, when developing and launching an app, clarification on how individuals’ privacy will be protected is needed. To sustain perceived benefits in the long run, supplementary options could be integrated to inform and assist users. %M 32755882 %R 10.2196/20572 %U http://publichealth.jmir.org/2020/3/e20572/ %U https://doi.org/10.2196/20572 %U http://www.ncbi.nlm.nih.gov/pubmed/32755882 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 9 %N 3 %P e22768 %T Venous Thromboembolism in Hospitalized COVID-19 Patients: Systematic Review %A Birkeland,Kade %A Zimmer,Raymond %A Kimchi,Asher %A Kedan,Ilan %+ Smidt Cedars-Sinai Heart Institute, 8501 Wilshire Blvd Suite 200, Beverly Hills, CA, 90211, United States, 1 3103853496, kedani@cshs.org %K VTE %K COVID-19 %K anticoagulation %K SARS-CoV-2 %K review %K heart %K morbidity %K hospital %K incidence %K treatment %K incidence %D 2020 %7 1.9.2020 %9 Review %J Interact J Med Res %G English %X Background: Coagulopathy associated with COVID-19 infection and venous thromboembolism (VTE) have emerged as significant contributors to morbidity among patients infected with SARS-CoV-2. Objective: We performed a systematic review to estimate VTE incidence in hospitalized patients and to analyze characteristic factors in the VTE cohort. Methods: We searched PubMed and Google Scholar using specified title search terms “SARS-CoV-2” or “COVID-19” and “venous thromboembolism” and “anticoagulation” among others to identify peer-reviewed journal articles published between June 22, 2019, and June 22, 2020. Data were systematically extracted and synthesized using Microsoft Excel for analysis. The main outcome was VTE incidence, and measures included patient characteristics, anticoagulation, and clinical outcomes with assessment for associations. Results: In total, 14 studies were included comprising 1677 patients. Most patients (n=1306, 82.4%) received anticoagulation (either VTE prophylaxis or treatment). VTE incidence was 26.9% (SE 3.1; 95% CI 20.8-33.1) and was correlated with systematic screening (r2=0.34, P=.03) and study duration (r2=–0.33, P=.03). D-dimer was higher for the VTE cohort (5.62 [SD 0.9] vs 1.43 [SD 0.6]; P<.001). Odds of VTE were higher at the intensive care unit (odds ratio [OR] 6.38, 95% CI 3.67-11.11; P<.001) but lower with anticoagulation (OR 0.58, 95% CI 0.36-0.92; P=.02). Conclusions: Despite the utilization of background anticoagulation, VTE incidence was historically high. Future studies are needed to provide additional data to guide optimal VTE prophylaxis and diagnostic strategies. %M 32805702 %R 10.2196/22768 %U http://www.i-jmr.org/2020/3/e22768/ %U https://doi.org/10.2196/22768 %U http://www.ncbi.nlm.nih.gov/pubmed/32805702 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 8 %P e21609 %T Virtual Consultations and the Role of Technology During the COVID-19 Pandemic for People With Type 2 Diabetes: The UK Perspective %A Quinn,Lauren M %A Davies,Melanie J %A Hadjiconstantinou,Michelle %+ Leicester Diabetes Centre, University of Leicester, Leicester General Hospital, Gwendolen Rd, Leicester, LE5 4PW, United Kingdom, 44 0116 258 4322, lauren.quinn3@nhs.net %K diabetes %K virtual clinic %K technology %K COVID-19 %K United Kingdom %K pandemic %K feasibility %K effective %K telehealth %D 2020 %7 28.8.2020 %9 Viewpoint %J J Med Internet Res %G English %X The coronavirus disease (COVID-19) pandemic has presented unique challenges for people with diabetes, in addition to their high-risk stratification for infection. Supporting people with diabetes to self-care has been critical to reduce their risk of severe infection. This global pandemic has presented an opportunity to digitalize diabetes care and rapidly implement virtual diabetes clinics, with the aim of optimizing diabetes management and well-being, while keeping patients safe. We performed a rapid review of the literature to evaluate the feasibility and effectiveness of virtual clinics in diabetes care before and during the COVID-19 pandemic and have combined these findings with our own reflections in practice. We identified examples demonstrating safety and feasibility of virtual diabetes clinics, which aligns with our own clinical experience during the pandemic. The advantages of virtual clinics include reduced treatment burden, improved therapeutic alliances, societal and psychological benefits, and in our experience, innovative solutions to overcome the challenges presented by the transition from in-person to virtual care. We have provided three infographics to illustrate lessons learned and key recommendations, including steps to establish a virtual diabetes clinic, a checklist guide for health care professionals conducting virtual clinics, and a patient guide for making the most out of the virtual clinic. It is important to continue adapting to this pandemic and to make technology a sustainable option for the future of diabetes care. %M 32716898 %R 10.2196/21609 %U http://www.jmir.org/2020/8/e21609/ %U https://doi.org/10.2196/21609 %U http://www.ncbi.nlm.nih.gov/pubmed/32716898 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 7 %N 8 %P e21108 %T COVID-19 and Telepsychiatry: Development of Evidence-Based Guidance for Clinicians %A Smith,Katharine %A Ostinelli,Edoardo %A Macdonald,Orla %A Cipriani,Andrea %+ Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, United Kingdom, 44 01865618228, andrea.cipriani@psych.ox.ac.uk %K digital mental health %K telepsychiatry %K evidence-based guidance %K systematic review %K mental health %K COVID-19 %D 2020 %7 28.8.2020 %9 Original Paper %J JMIR Ment Health %G English %X Background: The coronavirus disease (COVID-19) presents unique challenges in health care, including mental health care provision. Telepsychiatry can provide an alternative to face-to-face assessment and can also be used creatively with other technologies to enhance care, but clinicians and patients may feel underconfident about embracing this new way of working. Objective: The aim of this paper is to produce an open-access, easy-to-consult, and reliable source of information and guidance about telepsychiatry and COVID-19 using an evidence-based approach. Methods: We systematically searched existing English language guidelines and websites for information on telepsychiatry in the context of COVID-19 up to and including May 2020. We used broad search criteria and included pre–COVID-19 guidelines and other digital mental health topics where relevant. We summarized the data we extracted as answers to specific clinical questions. Results: Findings from this study are presented as both a short practical checklist for clinicians and detailed textboxes with a full summary of all the guidelines. The summary textboxes are also available on an open-access webpage, which is regularly updated. These findings reflected the strong evidence base for the use of telepsychiatry and included guidelines for many of the common concerns expressed by clinicians about practical implementation, technology, information governance, and safety. Guidelines across countries differ significantly, with UK guidelines more conservative and focused on practical implementation and US guidelines more expansive and detailed. Guidelines on possible combinations with other digital technologies such as apps (eg, from the US Food and Drug Administration, the National Health Service Apps Library, and the National Institute for Health and Care Excellence) are less detailed. Several key areas were not represented. Although some special populations such as child and adolescent, and older adult, and cultural issues are specifically included, important populations such as learning disabilities, psychosis, personality disorder, and eating disorders, which may present particular challenges for telepsychiatry, are not. In addition, the initial consultation and follow-up sessions are not clearly distinguished. Finally, a hybrid model of care (combining telepsychiatry with other technologies and in-person care) is not explicitly covered by the existing guidelines. Conclusions: We produced a comprehensive synthesis of guidance answering a wide range of clinical questions in telepsychiatry. This meets the urgent need for practical information for both clinicians and health care organizations who are rapidly adapting to the pandemic and implementing remote consultation. It reflects variations across countries and can be used as a basis for organizational change in the short- and long-term. Providing easily accessible guidance is a first step but will need cultural change to implement as clinicians start to view telepsychiatry not just as a replacement but as a parallel and complementary form of delivering therapy with its own advantages and benefits as well as restrictions. A combination or hybrid approach can be the most successful approach in the new world of mental health post–COVID-19, and guidance will need to expand to encompass the use of telepsychiatry in conjunction with other in-person and digital technologies, and its use across all psychiatric disorders, not just those who are the first to access and engage with remote treatment. %M 32658857 %R 10.2196/21108 %U https://mental.jmir.org/2020/8/e21108 %U https://doi.org/10.2196/21108 %U http://www.ncbi.nlm.nih.gov/pubmed/32658857 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 8 %P e19857 %T Acceptability of App-Based Contact Tracing for COVID-19: Cross-Country Survey Study %A Altmann,Samuel %A Milsom,Luke %A Zillessen,Hannah %A Blasone,Raffaele %A Gerdon,Frederic %A Bach,Ruben %A Kreuter,Frauke %A Nosenzo,Daniele %A Toussaert,Séverine %A Abeler,Johannes %+ University of Oxford, Manor Road, Oxford, OX1 3UQ, United Kingdom, 44 1865 281440, johannes.abeler@economics.ox.ac.uk %K COVID-19 %K contact tracing %K proximity tracing %K app %K digital %K user acceptability %K mHealth %K epidemiology %D 2020 %7 28.8.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The COVID-19 pandemic is the greatest public health crisis of the last 100 years. Countries have responded with various levels of lockdown to save lives and stop health systems from being overwhelmed. At the same time, lockdowns entail large socioeconomic costs. One exit strategy under consideration is a mobile phone app that traces the close contacts of those infected with COVID-19. Recent research has demonstrated the theoretical effectiveness of this solution in different disease settings. However, concerns have been raised about such apps because of the potential privacy implications. This could limit the acceptability of app-based contact tracing in the general population. As the effectiveness of this approach increases strongly with app uptake, it is crucial to understand public support for this intervention. Objective: The objective of this study is to investigate the user acceptability of a contact-tracing app in five countries hit by the pandemic. Methods: We conducted a largescale, multicountry study (N=5995) to measure public support for the digital contact tracing of COVID-19 infections. We ran anonymous online surveys in France, Germany, Italy, the United Kingdom, and the United States. We measured intentions to use a contact-tracing app across different installation regimes (voluntary installation vs automatic installation by mobile phone providers) and studied how these intentions vary across individuals and countries. Results: We found strong support for the app under both regimes, in all countries, across all subgroups of the population, and irrespective of regional-level COVID-19 mortality rates. We investigated the main factors that may hinder or facilitate uptake and found that concerns about cybersecurity and privacy, together with a lack of trust in the government, are the main barriers to adoption. Conclusions: Epidemiological evidence shows that app-based contact tracing can suppress the spread of COVID-19 if a high enough proportion of the population uses the app and that it can still reduce the number of infections if uptake is moderate. Our findings show that the willingness to install the app is very high. The available evidence suggests that app-based contact tracing may be a viable approach to control the diffusion of COVID-19. %M 32759102 %R 10.2196/19857 %U http://mhealth.jmir.org/2020/8/e19857/ %U https://doi.org/10.2196/19857 %U http://www.ncbi.nlm.nih.gov/pubmed/32759102 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 8 %P e19629 %T Temporal and Location Variations, and Link Categories for the Dissemination of COVID-19–Related Information on Twitter During the SARS-CoV-2 Outbreak in Europe: Infoveillance Study %A Pobiruchin,Monika %A Zowalla,Richard %A Wiesner,Martin %+ GECKO Institute for Medicine, Informatics & Economics, Heilbronn University, Max-Planck-Str 39, Heilbronn, 74081, Germany, 49 7131504633, monika.pobiruchin@hs-heilbronn.de %K COVID-19 %K SARS-CoV-2 %K social media %K public health %K Twitter %K infoveillance %K infodemiology %K infodemic %K health informatics %K disease surveillance %D 2020 %7 28.8.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The spread of the 2019 novel coronavirus disease, COVID-19, across Asia and Europe sparked a significant increase in public interest and media coverage, including on social media platforms such as Twitter. In this context, the origin of information plays a central role in the dissemination of evidence-based information about the SARS-CoV-2 virus and COVID-19. On February 2, 2020, the World Health Organization (WHO) constituted a “massive infodemic” and argued that this situation “makes it hard for people to find trustworthy sources and reliable guidance when they need it.” Objective: This infoveillance study, conducted during the early phase of the COVID-19 pandemic, focuses on the social media platform Twitter. It allows monitoring of the dynamic pandemic situation on a global scale for different aspects and topics, languages, as well as regions and even whole countries. Of particular interest are temporal and geographical variations of COVID-19–related tweets, the situation in Europe, and the categories and origin of shared external resources. Methods: Twitter’s Streaming application programming interface was used to filter tweets based on 16 prevalent hashtags related to the COVID-19 outbreak. Each tweet’s text and corresponding metadata as well as the user’s profile information were extracted and stored into a database. Metadata included links to external resources. A link categorization scheme—introduced in a study by Chew and Eysenbach in 2009—was applied onto the top 250 shared resources to analyze the relative proportion for each category. Moreover, temporal variations of global tweet volumes were analyzed and a specific analysis was conducted for the European region. Results: Between February 9 and April 11, 2020, a total of 21,755,802 distinct tweets were collected, posted by 4,809,842 distinct Twitter accounts. The volume of #covid19-related tweets increased after the WHO announced the name of the new disease on February 11, 2020, and stabilized at the end of March at a high level. For the regional analysis, a higher tweet volume was observed in the vicinity of major European capitals or in densely populated areas. The most frequently shared resources originated from various social media platforms (ranks 1-7). The most prevalent category in the top 50 was “Mainstream or Local News.” For the category “Government or Public Health,” only two information sources were found in the top 50: US Centers for Disease Control and Prevention at rank 25 and the WHO at rank 27. The first occurrence of a prevalent scientific source was Nature (rank 116). Conclusions: The naming of the disease by the WHO was a major signal to address the public audience with public health response via social media platforms such as Twitter. Future studies should focus on the origin and trustworthiness of shared resources, as monitoring the spread of fake news during a pandemic situation is of particular importance. In addition, it would be beneficial to analyze and uncover bot networks spreading COVID-19–related misinformation. %M 32790641 %R 10.2196/19629 %U http://www.jmir.org/2020/8/e19629/ %U https://doi.org/10.2196/19629 %U http://www.ncbi.nlm.nih.gov/pubmed/32790641 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 8 %P e21613 %T Motivations for Social Distancing and App Use as Complementary Measures to Combat the COVID-19 Pandemic: Quantitative Survey Study %A Kaspar,Kai %+ Department of Psychology, University of Cologne, Richard-Strauss-Str. 2, Cologne, 50931, Germany, 49 221 470 2347, kkaspar@uni-koeln.de %K COVID-19 %K protection motivation theory %K social distancing %K contact tracing app %K data donation app %K social trust %K data security %D 2020 %7 27.8.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The current COVID-19 pandemic is showing negative effects on human health as well as on social and economic life. It is a critical and challenging task to revive public life while minimizing the risk of infection. Reducing interactions between people by social distancing is an effective and prevalent measure to reduce the risk of infection and spread of the virus within a community. Current developments in several countries show that this measure can be technologically accompanied by mobile apps; meanwhile, privacy concerns are being intensively discussed. Objective: The aim of this study was to examine central cognitive variables that may constitute people’s motivations for social distancing, using an app, and providing health-related data requested by two apps that differ in their direct utility for the individual user. The results may increase our understanding of people’s concerns and convictions, which can then be specifically addressed by public-oriented communication strategies and appropriate political decisions. Methods: This study refers to the protection motivation theory, which is adaptable to both health-related and technology-related motivations. The concept of social trust was added. The quantitative survey included answers from 406 German-speaking participants who provided assessments of data security issues, trust components, and the processes of threat and coping appraisal related to the prevention of SARS-CoV-2 infection by social distancing. With respect to apps, one central focus was on the difference between a contact tracing app and a data donation app. Results: Multiple regression analyses showed that the present model could explain 55% of the interindividual variance in the participants’ motivation for social distancing, 46% for using a contact tracing app, 42% for providing their own infection status to a contact tracing app, and 34% for using a data donation app. Several cognitive components of threat and coping appraisal were related to motivation measurements. Trust in other people’s social distancing behavior and general trust in official app providers also played important roles; however, the participants’ age and gender did not. Motivations for using and accepting a contact tracing app were higher than those for using and accepting a data donation app. Conclusions: This study revealed some important cognitive factors that constitute people’s motivation for social distancing and using apps to combat the COVID-19 pandemic. Concrete implications for future research, public-oriented communication strategies, and appropriate political decisions were identified and are discussed. %M 32759100 %R 10.2196/21613 %U http://www.jmir.org/2020/8/e21613/ %U https://doi.org/10.2196/21613 %U http://www.ncbi.nlm.nih.gov/pubmed/32759100 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 8 %P e19799 %T COVID-19 Research: Navigating the European General Data Protection Regulation %A Becker,Regina %A Thorogood,Adrian %A Ordish,Johan %A Beauvais,Michael J.S. %+ ELIXIR-Luxembourg, Luxembourg Centre for Systems Biomedicine (LCSB), University of Luxembourg, Campus Belval, 7, avenue des Hauts-Fourneaux, L-4362, Esch-sur-Alzette, Luxembourg, 352 46 66 44 61 50, regina.becker@uni.lu %K COVID-19 %K GDPR %K health research %K pandemic %K data privacy %K data protection %K regulation %D 2020 %7 27.8.2020 %9 Viewpoint %J J Med Internet Res %G English %X Researchers must collaborate globally to rapidly respond to the COVID-19 pandemic. In Europe, the General Data Protection Regulation (GDPR) regulates the processing of personal data, including health data of value to researchers. Even during a pandemic, research still requires a legal basis for the processing of sensitive data, additional justification for its processing, and a basis for any transfer of data outside Europe. The GDPR does provide legal grounds and derogations that can support research addressing a pandemic, if the data processing activities are proportionate to the aim pursued and accompanied by suitable safeguards. During a pandemic, a public interest basis may be more promising for research than a consent basis, given the high standards set out in the GDPR. However, the GDPR leaves many aspects of the public interest basis to be determined by individual Member States, which have not fully or uniformly made use of all options. The consequence is an inconsistent legal patchwork that displays insufficient clarity and impedes joint approaches. The COVID-19 experience provides lessons for national legislatures. Responsiveness to pandemics requires clear and harmonized laws that consider the related practical challenges and support collaborative global research in the public interest. %M 32784191 %R 10.2196/19799 %U http://www.jmir.org/2020/8/e19799/ %U https://doi.org/10.2196/19799 %U http://www.ncbi.nlm.nih.gov/pubmed/32784191 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 8 %P e19572 %T Information Disclosure During the COVID-19 Epidemic in China: City-Level Observational Study %A Hu,Guangyu %A Li,Peiyi %A Yuan,Changzheng %A Tao,Chenglin %A Wen,Hai %A Liu,Qiannan %A Qiu,Wuqi %+ Institute of Medical Information/Center for Health Policy and Management, Chinese Academy of Medical Sciences and Peking Union Medical College, No 3 Bldg 3th Fl, Yabao Road, Chaoyang District, Beijing, 100020, China, 86 01052328735, hu.guangyu@imicams.ac.cn %K information disclosure %K COVID-19 %K website %K risk %K communication %K China %K disclosure %K pandemic %K health information %K public health %D 2020 %7 27.8.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Information disclosure is a top priority for official responses to the COVID-19 pandemic. The timely and standardized information published by authorities as a response to the crisis can better inform the public and enable better preparations for the pandemic; however, there is limited evidence of any systematic analyses of the disclosed epidemic information. This in turn has important implications for risk communication. Objective: This study aimed to describe and compare the officially released content regarding local epidemic situations as well as analyze the characteristics of information disclosure through local communication in major cities in China. Methods: The 31 capital cities in mainland China were included in this city-level observational study. Data were retrieved from local municipalities and health commission websites as of March 18, 2020. A checklist was employed as a rapid qualitative assessment tool to analyze the information disclosure performance of each city. Descriptive analyses and data visualizations were produced to present and compare the comparative performances of the cities. Results: In total, 29 of 31 cities (93.5%) established specific COVID-19 webpages to disclose information. Among them, 12 of the city webpages were added to their corresponding municipal websites. A majority of the cities (21/31, 67.7%) published their first cases of infection in a timely manner on the actual day of confirmation. Regarding the information disclosures highlighted on the websites, news updates from local media or press briefings were the most prevalent (28/29, 96.6%), followed by epidemic surveillance (25/29, 86.2%), and advice for the public (25/29, 86.2%). Clarifications of misinformation and frequently asked questions were largely overlooked as only 2 cities provided this valuable information. The median daily update frequency of epidemic surveillance summaries was 1.2 times per day (IQR 1.0-1.3 times), and the majority of these summaries (18/25, 72.0%) also provided detailed information regarding confirmed cases. The reporting of key indicators in the epidemic surveillance summaries, as well as critical facts included in the confirmed case reports, varied substantially between cities. In general, the best performance in terms of timely reporting and the transparency of information disclosures were observed in the municipalities directly administered by the central government compared to the other cities. Conclusions: Timely and effective efforts to disclose information related to the COVID-19 epidemic have been made in major cities in China. Continued improvements to local authority reporting will contribute to more effective public communication and efficient public health research responses. The development of protocols and the standardization of epidemic message templates—as well as the use of uniform operating procedures to provide regular information updates—should be prioritized to ensure a coordinated national response. %M 32790640 %R 10.2196/19572 %U http://www.jmir.org/2020/8/e19572/ %U https://doi.org/10.2196/19572 %U http://www.ncbi.nlm.nih.gov/pubmed/32790640 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 8 %P e20673 %T Global Infodemiology of COVID-19: Analysis of Google Web Searches and Instagram Hashtags %A Rovetta,Alessandro %A Bhagavathula,Akshaya Srikanth %+ Research and Disclosure Division, Mensana srls, Via Moro Aldo 5, Brescia, 25124, Italy, 39 3927112808, rovetta.mresearch@gmail.com %K COVID-19 %K coronavirus %K Google %K Instagram %K infodemiology %K infodemic %K social media %D 2020 %7 25.8.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Although “infodemiological” methods have been used in research on coronavirus disease (COVID-19), an examination of the extent of infodemic moniker (misinformation) use on the internet remains limited. Objective: The aim of this paper is to investigate internet search behaviors related to COVID-19 and examine the circulation of infodemic monikers through two platforms—Google and Instagram—during the current global pandemic. Methods: We have defined infodemic moniker as a term, query, hashtag, or phrase that generates or feeds fake news, misinterpretations, or discriminatory phenomena. Using Google Trends and Instagram hashtags, we explored internet search activities and behaviors related to the COVID-19 pandemic from February 20, 2020, to May 6, 2020. We investigated the names used to identify the virus, health and risk perception, life during the lockdown, and information related to the adoption of COVID-19 infodemic monikers. We computed the average peak volume with a 95% CI for the monikers. Results: The top six COVID-19–related terms searched in Google were “coronavirus,” “corona,” “COVID,” “virus,” “corona virus,” and “COVID-19.” Countries with a higher number of COVID-19 cases had a higher number of COVID-19 queries on Google. The monikers “coronavirus ozone,” “coronavirus laboratory,” “coronavirus 5G,” “coronavirus conspiracy,” and “coronavirus bill gates” were widely circulated on the internet. Searches on “tips and cures” for COVID-19 spiked in relation to the US president speculating about a “miracle cure” and suggesting an injection of disinfectant to treat the virus. Around two thirds (n=48,700,000, 66.1%) of Instagram users used the hashtags “COVID-19” and “coronavirus” to disperse virus-related information. Conclusions: Globally, there is a growing interest in COVID-19, and numerous infodemic monikers continue to circulate on the internet. Based on our findings, we hope to encourage mass media regulators and health organizers to be vigilant and diminish the use and circulation of these infodemic monikers to decrease the spread of misinformation. %M 32748790 %R 10.2196/20673 %U http://www.jmir.org/2020/8/e20673/ %U https://doi.org/10.2196/20673 %U http://www.ncbi.nlm.nih.gov/pubmed/32748790 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 8 %P e21366 %T Work-Related and Personal Factors Associated With Mental Well-Being During the COVID-19 Response: Survey of Health Care and Other Workers %A Evanoff,Bradley A %A Strickland,Jaime R %A Dale,Ann Marie %A Hayibor,Lisa %A Page,Emily %A Duncan,Jennifer G %A Kannampallil,Thomas %A Gray,Diana L %+ Washington University School of Medicine, 4523 Clayton Avenue, Box 8005, St. Louis, MO, 63110, United States, 1 3144548340, bevanoff@wustl.edu %K COVID-19 %K coronavirus %K pandemic %K mental health %K health care workers %K remote work %K worker well-being %K occupational health %D 2020 %7 25.8.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The response to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has created an unprecedented disruption in work conditions. This study describes the mental health and well-being of workers both with and without clinical exposure to patients with coronavirus disease (COVID-19). Objective: The aim of this study is to measure the prevalence of stress, anxiety, depression, work exhaustion, burnout, and decreased well-being among faculty and staff at a university and academic medical center during the SARS-CoV-2 pandemic and describe work-related and personal factors associated with their mental health and well-being. Methods: All faculty, staff, and postdoctoral fellows of a university, including its medical school, were invited in April 2020 to complete an online questionnaire measuring stress, anxiety, depression, work exhaustion, burnout, and decreased well-being. We examined associations between these outcomes and factors including work in high-risk clinical settings and family/home stressors. Results: There were 5550 respondents (overall response rate of 34.3%). Overall, 34% of faculty and 14% of staff (n=915) were providing clinical care, while 61% of faculty and 77% of staff were working from home. Among all workers, anxiety (prevalence ratio 1.37, 95% CI 1.09-1.73), depression (prevalence ratio 1.28, 95% CI 1.03-1.59), and high work exhaustion (prevalence ratio 1.24, 95% CI 1.13-1.36) were independently associated with community or clinical exposure to COVID-19. Poor family-supportive behaviors by supervisors were also associated with these outcomes (prevalence ratio 1.40, 95% CI 1.21-1.62; prevalence ratio 1.69, 95% CI 1.48-1.92; and prevalence ratio 1.54, 95% CI 1.44-1.64, respectively). Age <40 years and a greater number of family/home stressors were also associated with these poorer outcomes. Among the subset of clinicians, caring for patients with COVID-19 and working in high-risk clinical settings were additional risk factors. Conclusions: Our findings suggest that the pandemic has had negative effects on the mental health and well-being of both clinical and nonclinical employees. Mitigating exposure to COVID-19 and increasing supervisor support are modifiable risk factors that may protect mental health and well-being for all workers. %M 32763891 %R 10.2196/21366 %U http://www.jmir.org/2020/8/e21366/ %U https://doi.org/10.2196/21366 %U http://www.ncbi.nlm.nih.gov/pubmed/32763891 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 8 %N 8 %P e20992 %T Nationwide Results of COVID-19 Contact Tracing in South Korea: Individual Participant Data From an Epidemiological Survey %A Lee,Seung Won %A Yuh,Woon Tak %A Yang,Jee Myung %A Cho,Yoon-Sik %A Yoo,In Kyung %A Koh,Hyun Yong %A Marshall,Dominic %A Oh,Donghwan %A Ha,Eun Kyo %A Han,Man Yong %A Yon,Dong Keon %+ Armed Force Medical Command, Republic of Korea Armed Forces, 81 Saemaeul-ro 177, Seongnam, 463-040, Republic of Korea, 82 2 6935 2476, yonkkang@gmail.com %K COVID-19 %K contact tracing %K coronavirus %K South Korea %K survey %K health data %K epidemiology %K transmission %D 2020 %7 25.8.2020 %9 Original Paper %J JMIR Med Inform %G English %X Background: Evidence regarding the effectiveness of contact tracing of COVID-19 and the related social distancing is limited and inconclusive. Objective: This study aims to investigate the epidemiological characteristics of SARS-CoV-2 transmission in South Korea and evaluate whether a social distancing campaign is effective in mitigating the spread of COVID-19. Methods: We used contract tracing data to investigate the epidemic characteristics of SARS-CoV-2 transmission in South Korea and evaluate whether a social distancing campaign was effective in mitigating the spread of COVID-19. We calculated the mortality rate for COVID-19 by infection type (cluster vs noncluster) and tested whether new confirmed COVID-19 trends changed after a social distancing campaign. Results: There were 2537 patients with confirmed COVID-19 who completed the epidemiologic survey: 1305 (51.4%) cluster cases and 1232 (48.6%) noncluster cases. The mortality rate was significantly higher in cluster cases linked to medical facilities (11/143, 7.70% vs 5/1232, 0.41%; adjusted percentage difference 7.99%; 95% CI 5.83 to 10.14) and long-term care facilities (19/221, 8.60% vs 5/1232, 0.41%; adjusted percentage difference 7.56%; 95% CI 5.66 to 9.47) than in noncluster cases. The change in trends of newly confirmed COVID-19 cases before and after the social distancing campaign was significantly negative in the entire cohort (adjusted trend difference –2.28; 95% CI –3.88 to –0.68) and the cluster infection group (adjusted trend difference –0.96; 95% CI –1.83 to –0.09). Conclusions: In a nationwide contact tracing study in South Korea, COVID-19 linked to medical and long-term care facilities significantly increased the risk of mortality compared to noncluster COVID-19. A social distancing campaign decreased the spread of COVID-19 in South Korea and differentially affected cluster infections of SARS-CoV-2. %M 32784189 %R 10.2196/20992 %U http://medinform.jmir.org/2020/8/e20992/ %U https://doi.org/10.2196/20992 %U http://www.ncbi.nlm.nih.gov/pubmed/32784189 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 8 %P e20334 %T Features and Functionalities of Smartphone Apps Related to COVID-19: Systematic Search in App Stores and Content Analysis %A Collado-Borrell,Roberto %A Escudero-Vilaplana,Vicente %A Villanueva-Bueno,Cristina %A Herranz-Alonso,Ana %A Sanjurjo-Saez,Maria %+ Hospital General Universitario Gregorio Marañón, C/del Dr. Esquerdo, 46, Madrid, 28007, Spain, 34 678239017, vicente.escudero@salud.madrid.org %K COVID-19 %K mobile apps %K contact tracing %K monitoring %K telemedicine %K smartphone %D 2020 %7 25.8.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Knowledge of the quantity and quality of apps related to coronavirus disease (COVID-19) is lacking. In addition, no directory has been established listing all the apps developed to address the COVID-19 pandemic. Objective: The aim of this study was to identify smartphone apps designed to address the COVID-19 pandemic and to analyze their characteristics. Methods: We performed an observational, cross-sectional, descriptive study of all smartphone apps associated with COVID-19. Between April 27 and May 2, 2020, we searched the App Store (iOS) and Google Play Store (Android) for COVID-19 apps. The search terms used were coronavirus, COVID-19, and SARS-COV-2. The apps were downloaded and evaluated. The variables analyzed were name, platform, country, language, category, cost, update date, size, version, number of downloads, developer, and purpose. Purpose was further classified into the following categories: news, general information, self-diagnosis, contact tracing, notices to contacts, notification of close cases, awareness, helplines, monitoring of clinical parameters, recording of symptoms and treatment, and messaging with health care professionals. Results: We identified 114 apps on the investigated platforms. Of these, 62/114 (54.4%) were on Android and 52/114 (45.6%) were on iOS. Of the 114 apps, 37 (32.5%) were developed in Europe, 32 (28.1%) in Asia, and 30 (26.3%) in North America. The most frequent languages were English (65/114, 57.0%), Spanish (34/114, 29.8%), and Chinese (14/114, 12.3%). The most common categories were health and well-being/fitness apps (41/114, 41.2%) and medicine apps (43/114, 37.7%). Of the 114 apps, 113 (99.1%) were free. The mean time between the date of the analysis and the date of the last update was 11.1 days (SD 11.0). Overall, 95 of the 114 apps (83.3%) were intended for the general population, 99 apps (7.9%) were intended for health professionals, and 3 apps (2.6%) were intended for both. Regarding the type of developer, 64/114 apps (56.1%) were developed by governments; 42/114 (64.1%) were developed by national governments, and 23/114 (35.9%) were developed by regional governments. The apps with the highest number of downloads (100,000+) were developed by governments (P=.13), except for the World Health Organization app (500,000+). The purposes of the apps available in Western languages (107/114, 93.9%) were determined; the most common purposes were general information about COVID-19 (66, 64.0%), COVID-19 news (53, 51.0%), recording of symptoms (53, 51.0%), and contact tracing (51, 47.7%). More than one purpose was identified for 99/107 apps (92.5%). Conclusions: This paper offers a comprehensive and unique review of all available COVID-19 apps. Governments have adopted these tools during the pandemic, and more than half of the apps were developed by government agencies. The most common purposes of the apps are providing information on the numbers of infected, recovered, and deceased patients, recording of symptoms, and contact tracing. %M 32614777 %R 10.2196/20334 %U https://www.jmir.org/2020/8/e20334 %U https://doi.org/10.2196/20334 %U http://www.ncbi.nlm.nih.gov/pubmed/32614777 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 8 %P e21176 %T Impact of the COVID-19 Epidemic on Lifestyle Behaviors and Their Association With Subjective Well-Being Among the General Population in Mainland China: Cross-Sectional Study %A Hu,Zhao %A Lin,Xuhui %A Chiwanda Kaminga,Atipatsa %A Xu,Huilan %+ Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, 238 Shangmayuanling, Changsha, 410078, China, 86 073184135459, xhl6363@sina.com %K COVID-19 %K coronavirus disease %K subjective well-being %K lifestyle behaviors %D 2020 %7 25.8.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The world is experiencing an unprecedented challenge due to the coronavirus disease (COVID-19) pandemic. However, it is unclear whether people’s lifestyles will change as a result. Objective: The aim of this study is to explore perceived lifestyle changes after the outbreak of COVID-19 and their association with subjective well-being (SWB) among the general population in Mainland China. Methods: An online survey was conducted in May 2020. Lifestyle behaviors including leisure-time physical exercise, leisure-time screen time, and dietary intake were self-reported. SWB was measured using the General Wellbeing Schedule (GWS). Other covariates including sociodemographic factors, self-rated physical health, perceived social support, and loneliness were also assessed by a structured questionnaire. A multivariate ordinal regression method was used to analyze the association between SWB and lifestyle behaviors as well as perceived lifestyle changes. Results: A total of 1033 participants aged between 18 and 60 years were included in this study. The mean GWS score was 71.7 points. About 70% of the respondents reported spending more time looking at screens, whereas about 30% reported an increased frequency of vegetable and fruit intake after the outbreak of COVID-19. Inactive physical exercise (odds ratio [OR] 1.16, 95% CI 1.02-1.48), infrequent vegetable intake (OR 1.45, 95% CI 1.10-1.90), infrequent fruit intake (OR 1.31, 95% CI 1.01-1.70), and often skipping breakfast (OR 1.43, 95% CI 1.08-1.91) were associated with lower SWB after adjusting for sociodemographic factors, self-rated physical health, perceived social support, and loneliness. Moreover, participants who perceived a decrease in the frequency of vegetable, fruit, and breakfast intake were more likely to report lower SWB. Conclusions: The COVID-19 pandemic may have positive and negative impacts on different aspects of lifestyle behaviors. Both unhealthy lifestyle behaviors and negative lifestyle changes were associated with lower SWB. These findings provide scientific evidence that can inform lifestyle guidelines and public mental health interventions during the COVID-19 outbreak. %M 32759103 %R 10.2196/21176 %U http://www.jmir.org/2020/8/e21176/ %U https://doi.org/10.2196/21176 %U http://www.ncbi.nlm.nih.gov/pubmed/32759103 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 8 %P e20259 %T Prognostic Modeling of COVID-19 Using Artificial Intelligence in the United Kingdom: Model Development and Validation %A Abdulaal,Ahmed %A Patel,Aatish %A Charani,Esmita %A Denny,Sarah %A Mughal,Nabeela %A Moore,Luke %+ NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, Exhibition Rd, South Kensington, London, SW7 2AZ, United Kingdom, 44 783 436 6302, l.moore@imperial.ac.uk %K COVID-19 %K coronavirus %K machine learning %K deep learning %K modeling %K artificial intelligence %K neural network %K prediction %D 2020 %7 25.8.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The current severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreak is a public health emergency and the case fatality rate in the United Kingdom is significant. Although there appear to be several early predictors of outcome, there are no currently validated prognostic models or scoring systems applicable specifically to patients with confirmed SARS-CoV-2. Objective: We aim to create a point-of-admission mortality risk scoring system using an artificial neural network (ANN). Methods: We present an ANN that can provide a patient-specific, point-of-admission mortality risk prediction to inform clinical management decisions at the earliest opportunity. The ANN analyzes a set of patient features including demographics, comorbidities, smoking history, and presenting symptoms and predicts patient-specific mortality risk during the current hospital admission. The model was trained and validated on data extracted from 398 patients admitted to hospital with a positive real-time reverse transcription polymerase chain reaction (RT-PCR) test for SARS-CoV-2. Results: Patient-specific mortality was predicted with 86.25% accuracy, with a sensitivity of 87.50% (95% CI 61.65%-98.45%) and specificity of 85.94% (95% CI 74.98%-93.36%). The positive predictive value was 60.87% (95% CI 45.23%-74.56%), and the negative predictive value was 96.49% (95% CI 88.23%-99.02%). The area under the receiver operating characteristic curve was 90.12%. Conclusions: This analysis demonstrates an adaptive ANN trained on data at a single site, which demonstrates the early utility of deep learning approaches in a rapidly evolving pandemic with no established or validated prognostic scoring systems. %M 32735549 %R 10.2196/20259 %U http://www.jmir.org/2020/8/e20259/ %U https://doi.org/10.2196/20259 %U http://www.ncbi.nlm.nih.gov/pubmed/32735549 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 8 %P e22033 %T Managing COVID-19 With a Clinical Decision Support Tool in a Community Health Network: Algorithm Development and Validation %A McRae,Michael P %A Dapkins,Isaac P %A Sharif,Iman %A Anderman,Judd %A Fenyo,David %A Sinokrot,Odai %A Kang,Stella K %A Christodoulides,Nicolaos J %A Vurmaz,Deniz %A Simmons,Glennon W %A Alcorn,Timothy M %A Daoura,Marco J %A Gisburne,Stu %A Zar,David %A McDevitt,John T %+ Department of Biomaterials, Bioengineering Institute, New York University College of Dentistry, 433 First Avenue, Room 820, New York, NY, 10010, United States, 1 (212) 998-9204, mcdevitt@nyu.edu %K COVID-19 %K coronavirus %K clinical decision support system %K point of care %K mobile app %K disease severity %K biomarkers %K artificial intelligence %K app %K family health center %D 2020 %7 24.8.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The coronavirus disease (COVID-19) pandemic has resulted in significant morbidity and mortality; large numbers of patients require intensive care, which is placing strain on health care systems worldwide. There is an urgent need for a COVID-19 disease severity assessment that can assist in patient triage and resource allocation for patients at risk for severe disease. Objective: The goal of this study was to develop, validate, and scale a clinical decision support system and mobile app to assist in COVID-19 severity assessment, management, and care. Methods: Model training data from 701 patients with COVID-19 were collected across practices within the Family Health Centers network at New York University Langone Health. A two-tiered model was developed. Tier 1 uses easily available, nonlaboratory data to help determine whether biomarker-based testing and/or hospitalization is necessary. Tier 2 predicts the probability of mortality using biomarker measurements (C-reactive protein, procalcitonin, D-dimer) and age. Both the Tier 1 and Tier 2 models were validated using two external datasets from hospitals in Wuhan, China, comprising 160 and 375 patients, respectively. Results: All biomarkers were measured at significantly higher levels in patients who died vs those who were not hospitalized or discharged (P<.001). The Tier 1 and Tier 2 internal validations had areas under the curve (AUCs) of 0.79 (95% CI 0.74-0.84) and 0.95 (95% CI 0.92-0.98), respectively. The Tier 1 and Tier 2 external validations had AUCs of 0.79 (95% CI 0.74-0.84) and 0.97 (95% CI 0.95-0.99), respectively. Conclusions: Our results demonstrate the validity of the clinical decision support system and mobile app, which are now ready to assist health care providers in making evidence-based decisions when managing COVID-19 patient care. The deployment of these new capabilities has potential for immediate impact in community clinics and sites, where application of these tools could lead to improvements in patient outcomes and cost containment. %M 32750010 %R 10.2196/22033 %U http://www.jmir.org/2020/8/e22033/ %U https://doi.org/10.2196/22033 %U http://www.ncbi.nlm.nih.gov/pubmed/32750010 %0 Journal Article %@ 2561-1011 %I JMIR Publications %V 4 %N 1 %P e20426 %T Google Trends Insights Into Reduced Acute Coronary Syndrome Admissions During the COVID-19 Pandemic: Infodemiology Study %A Senecal,Conor %A Gulati,Rajiv %A Lerman,Amir %+ Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, United States, 1 507 255 1622, Lerman.amir@mayo.edu %K Google Trends %K acute coronary syndrome %K coronary heart disease %K online search %K internet %K trend %K COVID-19 %K heart %K cardiovascular %D 2020 %7 24.8.2020 %9 Original Paper %J JMIR Cardio %G English %X Background: During the coronavirus disease (COVID-19) pandemic, a reduction in the presentation of acute coronary syndrome (ACS) has been noted in several countries. However, whether these trends reflect a reduction in ACS incidence or a decrease in emergency room visits is unknown. Using Google Trends, queries for chest pain that have previously been shown to closely correlate with coronary heart disease were compared with searches for myocardial infarction and COVID-19 symptoms. Objective: The current study evaluates if search terms (or topics) pertaining to chest pain symptoms correlate with the reported decrease in presentations of ACS. Methods: Google Trends data for search terms “chest pain,” “myocardial infarction,” “cough,” and “fever” were obtained from June 1, 2019, to May 31, 2020. Related queries were evaluated for a relationship to coronary heart disease. Results: Following the onset of the COVID-19 pandemic, chest pain searches increased in all countries studied by at least 34% (USA P=.003, Spain P=.007, UK P=.001, Italy P=.002), while searches for myocardial infarction dropped or remained unchanged. Rising searches for chest pain included “coronavirus chest pain,” “home remedies for chest pain,” and “natural remedies for chest pain.” Searches on COVID-19 symptoms (eg, cough, fever) rose initially but returned to baseline while chest pain–related searches remained elevated throughout May. Conclusions: Search engine queries for chest pain have risen during the pandemic as have related searches with alternative attribution for chest pain or home care for chest pain, suggesting that recent drops in ACS presentations may be due to patients avoiding the emergency room and potential treatment in the midst of the COVID-19 pandemic. %M 32831186 %R 10.2196/20426 %U http://cardio.jmir.org/2020/1/e20426/ %U https://doi.org/10.2196/20426 %U http://www.ncbi.nlm.nih.gov/pubmed/32831186 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 8 %P e21360 %T Grappling With the COVID-19 Health Crisis: Content Analysis of Communication Strategies and Their Effects on Public Engagement on Social Media %A Ngai,Cindy Sing Bik %A Singh,Rita Gill %A Lu,Wenze %A Koon,Alex Chun %+ School of Biomedical Sciences, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 21 Sassoon Road, Laboratory Block, Pok Fu Lam, Hong Kong, Hong Kong (China), 852 39179500, alexkoon@hku.hk %K COVID-19 %K communication %K public engagement %K social media %K infodemiology %K infodemic %K message style %K health content frames %K interactive features %K framework %K content analysis %D 2020 %7 24.8.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The coronavirus disease (COVID-19) has posed an unprecedented challenge to governments worldwide. Effective government communication of COVID-19 information with the public is of crucial importance. Objective: We investigate how the most-read state-owned newspaper in China, People’s Daily, used an online social networking site, Sina Weibo, to communicate about COVID-19 and whether this could engage the public. The objective of this study is to develop an integrated framework to examine the content, message style, and interactive features of COVID-19–related posts and determine their effects on public engagement in the largest social media network in China. Methods: Content analysis was employed to scrutinize 608 COVID-19 posts, and coding was performed on three main dimensions: content, message style, and interactive features. The content dimension was coded into six subdimensions: action, new evidence, reassurance, disease prevention, health care services, and uncertainty, and the style dimension was coded into the subdimensions of narrative and nonnarrative. As for interactive features, they were coded into links to external sources, use of hashtags, use of questions to solicit feedback, and use of multimedia. Public engagement was measured in the form of the number of shares, comments, and likes on the People’s Daily’s Sina Weibo account from January 20, 2020, to March 11, 2020, to reveal the association between different levels of public engagement and communication strategies. A one-way analysis of variance followed by a post-hoc Tukey test and negative binomial regression analysis were employed to generate the results. Results: We found that although the content frames of action, new evidence, and reassurance delivered in a nonnarrative style were predominant in COVID-19 communication by the government, posts related to new evidence and a nonnarrative style were strong negative predictors of the number of shares. In terms of generating a high number of shares, it was found that disease prevention posts delivered in a narrative style were able to achieve this purpose. Additionally, an interaction effect was found between content and style. The use of a narrative style in disease prevention posts had a significant positive effect on generating comments and likes by the Chinese public, while links to external sources fostered sharing. Conclusions: These results have implications for governments, health organizations, medical professionals, the media, and researchers on their epidemic communication to engage the public. Selecting suitable communication strategies may foster active liking and sharing of posts on social media, which in turn, might raise the public’s awareness of COVID-19 and motivate them to take preventive measures. The sharing of COVID-19 posts is particularly important because this action can reach out to a large audience, potentially helping to contain the spread of the virus. %M 32750013 %R 10.2196/21360 %U http://www.jmir.org/2020/8/e21360/ %U https://doi.org/10.2196/21360 %U http://www.ncbi.nlm.nih.gov/pubmed/32750013 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 8 %P e19642 %T Clinical Characteristics and Outcomes of Childbearing-Age Women With COVID-19 in Wuhan: Retrospective, Single-Center Study %A Wei,Lijie %A Gao,Xuan %A Chen,Suhua %A Zeng,Wanjiang %A Wu,Jianli %A Lin,Xingguang %A Zhang,Huiting %A Mwamaka Sharifu,Lali %A Chen,Ling %A Feng,Ling %A Wang,Shaoshuai %+ Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095, Jiefang Avenue, Wuhan, Hubei 430030, China, 86 83663812, colombo2008@sina.com %K COVID-19 %K SARS-CoV-2 %K childbearing age %K pregnancy %K clinical characteristics %K outcomes %K women %K health information %K epidemiology %K diagnosis %K symptom %D 2020 %7 24.8.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Since December 2019, an outbreak of the coronavirus disease (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread rapidly in Wuhan and worldwide. However, previous studies on pregnant patients were limited. Objective: The aim of this study is to evaluate the clinical characteristics and outcomes of pregnant and nonpregnant women with COVID-19. Methods: This study retrospectively collected epidemiological, clinical, laboratory, imaging, management, and outcome data of 43 childbearing-age women patients (including 17 pregnant and 26 nonpregnant patients) who presented with laboratory-confirmed COVID-19 in Tongji Hospital, Wuhan, China from January 19 to March 2, 2020. Clinical outcomes were followed up to March 28, 2020. Results: Of the 43 childbearing-age women in this study, none developed a severe adverse illness or died. The median ages of pregnant and nonpregnant women were 33.0 and 33.5 years, respectively. Pregnant women had a markedly higher proportion of history exposure to hospitals within 2 weeks before onset compared to nonpregnant women (9/17, 53% vs 5/26, 19%, P=.02) and a lower proportion of other family members affected (4/17, 24% vs 19/26, 73%, P=.004). Fever (8/17, 47% vs 18/26, 69%) and cough (9/17, 53% vs 12/26, 46%) were common onsets of symptoms for the two groups. Abdominal pain (n=4, 24%), vaginal bleeding (n=1, 6%), reduced fetal movement (n=1, 6%), and increased fetal movement (n=2, 13%) were observed at onset in the 17 pregnant patients. Higher neutrophil and lower lymphocyte percent were observed in the pregnant group compared to the nonpregnant group (79% vs 56%, P<.001; 15% vs 33%, P<.001, respectively). In both groups, we observed an elevated concentration of high-sensitivity C-reactive protein, erythrocyte sedimentation rate, aminotransferase, and lactate dehydrogenase. Concentrations of alkaline phosphatase and D-dimer in the pregnant group were significantly higher than those of the nonpregnant group (119.0 vs 48.0 U/L, P<.001; 2.1 vs 0.3μg/mL, P<.001, respectively). Both pregnant (4/10, 40%) and nonpregnant (8/15, 53%) women tested positive for influenza A virus. A majority of pregnant and nonpregnant groups received antiviral (13/17, 76% vs 25/26, 96%) and antibiotic (13/17, 76% vs 23/26, 88%) therapy. Additionally, both pregnant (2/11, 18%) and nonpregnant (2/19, 11%) recovered women redetected positive for SARS-CoV-2 after discharge. Conclusions: The epidemiology and clinical and laboratory features of pregnant women with COVID-19 were diverse and atypical, which increased the difficulty of diagnosis. Most pregnant women with COVID-19 were mild and moderate, and rarely developed severe pneumonia or severe adverse outcomes. %M 32750000 %R 10.2196/19642 %U http://www.jmir.org/2020/8/e19642/ %U https://doi.org/10.2196/19642 %U http://www.ncbi.nlm.nih.gov/pubmed/32750000 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 8 %P e21265 %T Effect of an E-Learning Module on Personal Protective Equipment Proficiency Among Prehospital Personnel: Web-Based Randomized Controlled Trial %A Suppan,Laurent %A Abbas,Mohamed %A Stuby,Loric %A Cottet,Philippe %A Larribau,Robert %A Golay,Eric %A Iten,Anne %A Harbarth,Stephan %A Gartner,Birgit %A Suppan,Mélanie %+ Division of Emergency Medicine, Department of Anesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, University of Geneva Hospitals and Faculty of Medicine, Rue Gabrielle-Perret-Gentil 4, Geneva, 1211, Switzerland, 41 789151845, laurent.suppan@hcuge.ch %K personal protective equipment %K COVID-19 %K electronic learning %K prehospital %K randomized controlled trial %K protection %K equipment %K safety %K gamified %K online learning %K communication %D 2020 %7 21.8.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: To avoid misuse of personal protective equipment (PPE), ensure health care workers’ safety, and avoid shortages, effective communication of up-to-date infection control guidelines is essential. As prehospital teams are particularly at risk of contamination given their challenging work environment, a specific gamified electronic learning (e-learning) module targeting this audience might provide significant advantages as it requires neither the presence of learners nor the repetitive use of equipment for demonstration. Objective: The aim of this study was to evaluate whether a gamified e-learning module could improve the rate of adequate PPE choice by prehospital personnel in the context of the coronavirus disease (COVID-19) pandemic. Methods: This was an individual-level randomized, controlled, quadruple-blind (investigators, participants, outcome assessors, and data analysts) closed web-based trial. All emergency prehospital personnel working in Geneva, Switzerland, were eligible for inclusion, and were invited to participate by email in April 2020. Participants were informed that the study aim was to assess their knowledge regarding PPE, and that they would be presented with both the guidelines and the e-learning module, though they were unaware that there were two different study paths. All participants first answered a preintervention quiz designed to establish their profile and baseline knowledge. The control group then accessed the guidelines before answering a second set of questions, and were then granted access to the e-learning module. The e-learning group was shown the e-learning module right after the guidelines and before answering the second set of questions. Results: Of the 291 randomized participants, 176 (60.5%) completed the trial. There was no significant difference in baseline knowledge between groups. Though the baseline proportion of adequate PPE choice was high (75%, IQR 50%-75%), participants’ description of the donning sequence was in most cases incorrect. After either intervention, adequate choice of PPE increased significantly in both groups (P<.001). Though the median of the difference in the proportion of correct answers was slightly higher in the e-learning group (17%, IQR 8%-33% versus 8%, IQR 8%-33%), the difference was not statistically significant (P=.27). Confidence in the ability to use PPE was maintained in the e-learning group (P=.27) but significantly decreased in the control group (P=.04). Conclusions: Among prehospital personnel with an already relatively high knowledge of and experience with PPE use, both web-based study paths increased the rate of adequate choice of PPE. There was no major added value of the gamified e-learning module apart from preserving participants' confidence in their ability to correctly use PPE. %M 32747329 %R 10.2196/21265 %U http://www.jmir.org/2020/8/e21265/ %U https://doi.org/10.2196/21265 %U http://www.ncbi.nlm.nih.gov/pubmed/32747329 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 8 %P e21173 %T Dynamics and Development of the COVID-19 Epidemic in the United States: A Compartmental Model Enhanced With Deep Learning Techniques %A Deng,Qi %+ College of Economics and Management, China-Africa International Business School, Zhejiang Normal University, 688 Yingbin Avenue, Jinhua, China, 86 13811402549, qi.deng@zjnu.edu.cn %K epidemiology %K COVID-19 %K compartmental models %K deep learning %K model %K modeling %K transmission %K estimation %K virus %K simulate %D 2020 %7 21.8.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Compartmental models dominate epidemic modeling. Transmission parameters between compartments are typically estimated through stochastic parameterization processes that depends on detailed statistics of transmission characteristics, which are economically and resource-wise expensive to collect. Objective: We aim to apply deep learning techniques as a lower data dependency alternative to estimate transmission parameters of a customized compartmental model, for the purpose of simulating the dynamics of the US coronavirus disease (COVID-19) epidemic and projecting its further development. Methods: We constructed a compartmental model and developed a multistep deep learning methodology to estimate the model’s transmission parameters. We then fed the estimated transmission parameters to the model to predict development of the US COVID-19 epidemic for 35 and 42 days. Epidemics are considered suppressed when the basic reproduction number (R0) is less than 1. Results: The deep learning–enhanced compartmental model predicts that R0 will fall to <1 around August 17-19, 2020, at which point the epidemic will effectively start to die out, and that the US “infected” population will peak around August 16-18, 2020, at 3,228,574 to 3,308,911 individual cases. The model also predicted that the number of accumulative confirmed cases will cross the 5 million mark around August 7, 2020. Conclusions: Current compartmental models require stochastic parameterization to estimate the transmission parameters. These models’ effectiveness depends upon detailed statistics on transmission characteristics. As an alternative, deep learning techniques are effective in estimating these stochastic parameters with greatly reduced dependency on data particularity. %M 32763892 %R 10.2196/21173 %U http://www.jmir.org/2020/8/e21173/ %U https://doi.org/10.2196/21173 %U http://www.ncbi.nlm.nih.gov/pubmed/32763892 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 8 %P e21169 %T The Anatomy of the SARS-CoV-2 Biomedical Literature: Introducing the CovidX Network Algorithm for Drug Repurposing Recommendation %A Gates,Lyndsey Elaine %A Hamed,Ahmed Abdeen %+ School of Cybersecurity, Data Science, and Computing, Norwich University, 158 Harmon Drive, Northfield, VT, 05663, United States, 1 802 485 2276, ahamed@norwich.edu %K health %K informatics %K COVID-19 treatment %K drug repurposing %K network algorithm %K ranking %K drug %K biomedical %K antiviral %K COVID-19 %D 2020 %7 20.8.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Driven by the COVID-19 pandemic and the dire need to discover an antiviral drug, we explored the landscape of the SARS-CoV-2 biomedical publications to identify potential treatments. Objective: The aims of this study are to identify off-label drugs that may have benefits for the coronavirus disease pandemic, present a novel ranking algorithm called CovidX to recommend existing drugs for potential repurposing, and validate the literature-based outcome with drug knowledge available in clinical trials. Methods: To achieve such objectives, we applied natural language processing techniques to identify drugs and linked entities (eg, disease, gene, protein, chemical compounds). When such entities are linked, they form a map that can be further explored using network science tools. The CovidX algorithm was based upon a notion that we called “diversity.” A diversity score for a given drug was calculated by measuring how “diverse” a drug is calculated using various biological entities (regardless of the cardinality of actual instances in each category). The algorithm validates the ranking and awards those drugs that are currently being investigated in open clinical trials. The rationale behind the open clinical trial is to provide a validating mechanism of the PubMed results. This ensures providing up to date evidence of the fast development of this disease. Results: From the analyzed biomedical literature, the algorithm identified 30 possible drug candidates for repurposing, ranked them accordingly, and validated the ranking outcomes against evidence from clinical trials. The top 10 candidates according to our algorithm are hydroxychloroquine, azithromycin, chloroquine, ritonavir, losartan, remdesivir, favipiravir, methylprednisolone, rapamycin, and tilorone dihydrochloride. Conclusions: The ranking shows both consistency and promise in identifying drugs that can be repurposed. We believe, however, the full treatment to be a multifaceted, adjuvant approach where multiple drugs may need to be taken at the same time. %M 32735546 %R 10.2196/21169 %U http://www.jmir.org/2020/8/e21169/ %U https://doi.org/10.2196/21169 %U http://www.ncbi.nlm.nih.gov/pubmed/32735546 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 8 %P e19995 %T Chinese Public’s Engagement in Preventive and Intervening Health Behaviors During the Early Breakout of COVID-19: Cross-Sectional Study %A Niu,Zhaomeng %A Wang,Tingting %A Hu,Pengwei %A Mei,Jing %A Tang,Zhihan %+ Hengyang Medical College, University of South China, 28 West Changsheng Road, Hengyang, 421001, China, 86 135 7478 0245, tangzhihan98@163.com %K COVID-19 %K China %K preventive health behaviors %K intervening health behaviors %K psychosocial %K health literacy %K behavior %K prevention %K cross-sectional %D 2020 %7 21.8.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Since January 2020, the coronavirus disease (COVID-19) swept over China and then the world, causing a global public health crisis. People’s adoption of preventive and intervening behaviors is critical in curbing the spread of the virus. Objective: The aim of this study is to evaluate Chinese people’s adoption of health behaviors in responding to COVID-19 and to identify key determinants for their engagement. Methods: An anonymous online questionnaire was distributed in early February 2020 among Mainland Chinese (18 years or older) to examine their engagement in preventive behaviors (eg, frequent handwashing, wearing masks, staying at home) and intervening behaviors (eg, advising family to wash hands frequently), and to explore potential determinants for their adoption of these health behaviors. Results: Out of 2949 participants, 55.3% (n=1629) reported frequent engagement in preventive health behaviors, and over 84% (n=2493) performed at least one intervening health behavior. Greater engagement in preventive behaviors was found among participants who received higher education, were married, reported fewer barriers and greater benefits of engagement, reported greater self-efficacy and emotional support, had greater patient-centered communication before, had a greater media literacy level, and had greater new media and traditional media use for COVID-19 news. Greater engagement in intervening behaviors was observed among participants who were married, had lower income, reported greater benefits of health behaviors, had greater patient-centered communication before, had a lower media literacy level, and had a greater new media and traditional media use for COVID-19 news. Conclusions: Participants’ engagement in coronavirus-related preventive and intervening behaviors was overall high, and the associations varied across demographic and psychosocial variables. Hence, customized health interventions that address the determinants for health behaviors are needed to improve people’s adherence to coronavirus-related behavior guidelines. %M 32716897 %R 10.2196/19995 %U http://www.jmir.org/2020/8/e19995/ %U https://doi.org/10.2196/19995 %U http://www.ncbi.nlm.nih.gov/pubmed/32716897 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 8 %P e19706 %T Digital Tools to Ameliorate Psychological Symptoms Associated With COVID-19: Scoping Review %A Zhang,Melvyn %A Smith,Helen Elizabeth %+ Family Medicine and Primary Care, Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, 11 Mandalay Road, Level 11, Family Medicine and Primary Care, 308322, Singapore, 65 98556631, melvynzhangweibin@gmail.com %K COVID-19 %K digital tool %K psychiatry %K mental health %K digital health %K psychology %K distress %K stress %K anxiety %K depression %D 2020 %7 21.8.2020 %9 Review %J J Med Internet Res %G English %X Background: In the four months after the discovery of the index case of coronavirus disease (COVID-19), several studies highlighted the psychological impact of COVID-19 on frontline health care workers and on members of the general public. It is evident from these studies that individuals experienced elevated levels of anxiety and depression in the acute phase, when they first became aware of the pandemic, and that the psychological distress persisted into subsequent weeks. It is becoming apparent that technological tools such as SMS text messages, web-based interventions, mobile interventions, and conversational agents can help ameliorate psychological distress in the workplace and in society. To our knowledge, there are few publications describing how digital tools have been used to ameliorate psychological symptoms among individuals. Objective: The aim of this review was to identify existing SMS text message, web-based, mobile, and conversational agents that the general public can access to ameliorate the psychological symptoms they are experiencing during the COVID-19 pandemic. Methods: To identify digital tools that were published specifically for COVID-19, a search was performed in the PubMed and MEDLINE databases from the inception of the databases through June 17, 2020. The following search strings were used: “NCOV OR 2019-nCoV OR SARS-CoV-2 OR Coronavirus OR COVID19 OR COVID” and “mHealth OR eHealth OR text”. Another search was conducted in PubMed and MEDLINE to identify existing digital tools for depression and anxiety disorders. A web-based search engine (Google) was used to identify if the cited web-based interventions could be accessed. A mobile app search engine, App Annie, was used to determine if the identified mobile apps were commercially available. Results: A total of 6 studies were identified. Of the 6 identified web-based interventions, 5 websites (83%) could be accessed. Of the 32 identified mobile interventions, 7 apps (22%) could be accessed. Of the 7 identified conversational agents, only 2 (29%) could be accessed. Results: A total of 6 studies were identified. Of the 6 identified web-based interventions, 5 websites (83%) could be accessed. Of the 32 identified mobile interventions, 7 apps (22%) could be accessed. Of the 7 identified conversational agents, only 2 (29%) could be accessed. Conclusions: The COVID-19 pandemic has caused significant psychological distress. Digital tools that are commercially available may be useful for at-risk individuals or individuals with pre-existing psychiatric symptoms. %M 32721922 %R 10.2196/19706 %U http://www.jmir.org/2020/8/e19706/ %U https://doi.org/10.2196/19706 %U http://www.ncbi.nlm.nih.gov/pubmed/32721922 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 8 %P e20073 %T Digital Inequality During a Pandemic: Quantitative Study of Differences in COVID-19–Related Internet Uses and Outcomes Among the General Population %A van Deursen,Alexander JAM %+ University of Twente, Drienerlolaan 5, Enschede, 7500AE, Netherlands, 31 622942142, a.j.a.m.vandeursen@utwente.nl %K COVID-19 %K digital inequality %K internet use %K survey %K personality %K literacy %K internet skills %K information %K communication %D 2020 %7 20.8.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The World Health Organization considers coronavirus disease (COVID-19) to be a public emergency threatening global health. During the crisis, the public’s need for web-based information and communication is a subject of focus. Digital inequality research has shown that internet access is not evenly distributed among the general population. Objective: The aim of this study was to provide a timely understanding of how different people use the internet to meet their information and communication needs and the outcomes they gain from their internet use in relation to the COVID-19 pandemic. We also sought to reveal the extent to which gender, age, personality, health, literacy, education, economic and social resources, internet attitude, material access, internet access, and internet skills remain important factors in obtaining internet outcomes after people engage in the corresponding uses. Methods: We used a web-based survey to draw upon a sample collected in the Netherlands. We obtained a dataset with 1733 respondents older than 18 years. Results: Men are more likely to engage in COVID-19–related communication uses. Age is positively related to COVID-19–related information uses and negatively related to information and communication outcomes. Agreeableness is negatively related to both outcomes and to information uses. Neuroticism is positively related to both uses and to communication outcomes. Conscientiousness is not related to any of the uses or outcomes. Introversion is negatively related to communication outcomes. Finally, openness relates positively to all information uses and to both outcomes. Physical health has negative relationships with both outcomes. Health perception contributes positively to information uses and both outcomes. Traditional literacy has a positive relationship with information uses and both outcomes. Education has a positive relationship with information and communication uses. Economic and social resources played no roles. Internet attitude is positively related to information uses and outcomes but negatively related to communication uses and outcomes. Material access and internet access contributed to all uses and outcomes. Finally, several of the indicators and outcomes became insignificant after accounting for engagement in internet uses. Conclusions: Digital inequality is a major concern among national and international scholars and policy makers. This contribution aimed to provide a broader understanding in the case of a major health pandemic by using the ongoing COVID-19 crisis as a context for empirical work. Several groups of people were identified as vulnerable, such as older people, less educated people, and people with physical health problems, low literacy levels, or low levels of internet skills. Generally, people who are already relatively advantaged are more likely to use the information and communication opportunities provided by the internet to their benefit in a health pandemic, while less advantaged individuals are less likely to benefit. Therefore, the COVID-19 crisis is also enforcing existing inequalities. %M 32750005 %R 10.2196/20073 %U http://www.jmir.org/2020/8/e20073/ %U https://doi.org/10.2196/20073 %U http://www.ncbi.nlm.nih.gov/pubmed/32750005 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 8 %P e21257 %T Impact of Wearing Masks, Hand Hygiene, and Social Distancing on Influenza, Enterovirus, and All-Cause Pneumonia During the Coronavirus Pandemic: Retrospective National Epidemiological Surveillance Study %A Chiu,Nan-Chang %A Chi,Hsin %A Tai,Yu-Lin %A Peng,Chun-Chih %A Tseng,Cheng-Yin %A Chen,Chung-Chu %A Tan,Boon Fatt %A Lin,Chien-Yu %+ Hsinchu MacKay Memorial Hospital, 690 Guanfu Road, East District, Hsinchu, 300, Taiwan, 886 36119595 ext 2582, mmhped.lin@gmail.com %K novel coronavirus %K COVID-19 %K SARS-CoV-2 %K pandemic %K influenza %K pneumonia %K hygiene %K social distancing %K prevention %K incidence %K surveillance %D 2020 %7 20.8.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The coronavirus disease (COVID-19) pandemic is an important health crisis worldwide. Several strategies were implemented to combat COVID-19, including wearing masks, hand hygiene, and social distancing. The impact of these strategies on COVID-19 and other viral infections remains largely unclear. Objective: We aim to investigate the impact of implemented infectious control strategies on the incidences of influenza, enterovirus infection, and all-cause pneumonia during the COVID-19 pandemic. Methods: We utilized the electronic database of the Taiwan National Infectious Disease Statistics System and extracted incidences of COVID-19, influenza virus, enterovirus, and all-cause pneumonia. We compared the incidences of these diseases from week 45 of 2016 to week 21 of 2020 and performed linear regression analyses. Results: The first case of COVID-19 in Taiwan was reported in late January 2020 (week 4). Infectious control strategies have been promoted since late January. The influenza virus usually peaks in winter and decreases around week 14. However, a significant decrease in influenza was observed after week 6 of 2020. Regression analyses produced the following results: 2017, R2=0.037; 2018, R2=0.021; 2019, R2=0.046; and 2020, R2=0.599. A dramatic decrease in all-cause pneumonia was also reported (R2 values for 2017-2020 were 0.435, 0.098, 0.352, and 0.82, respectively). Enterovirus had increased by week 18 in 2017-2019, but this was not observed in 2020. Conclusions: Using this national epidemiological database, we found a significant decrease in cases of influenza, enterovirus, and all-cause pneumonia during the COVID-19 pandemic. Wearing masks, hand hygiene, and social distancing may contribute not only to the prevention of COVID-19 but also to the decline of other respiratory infectious diseases. Further studies are warranted to elucidate the causal relationship. %M 32750008 %R 10.2196/21257 %U http://www.jmir.org/2020/8/e21257/ %U https://doi.org/10.2196/21257 %U http://www.ncbi.nlm.nih.gov/pubmed/32750008 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 8 %P e19996 %T Influence of Social Media Platforms on Public Health Protection Against the COVID-19 Pandemic via the Mediating Effects of Public Health Awareness and Behavioral Changes: Integrated Model %A Al-Dmour,Hani %A Masa’deh,Ra’ed %A Salman,Amer %A Abuhashesh,Mohammad %A Al-Dmour,Rand %+ The University of Jordan, Amman-Jordan, Amman, 11962, Jordan, 962 795666979, dmourh@ju.edu.jo %K social media platforms %K Interventions %K public health %K awareness %K public health protection %K coronavirus %K COVID-19 %K pandemic %K behavioral change %K Jordan %K behavior %K social media %D 2020 %7 19.8.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Despite the growing body of literature examining social media in health contexts, including public health communication, promotion, and surveillance, limited insight has been provided into how the utility of social media may vary depending on the particular public health objectives governing an intervention. For example, the extent to which social media platforms contribute to enhancing public health awareness and prevention during epidemic disease transmission is currently unknown. Doubtlessly, coronavirus disease (COVID-19) represents a great challenge at the global level, aggressively affecting large cities and public gatherings and thereby having substantial impacts on many health care systems worldwide as a result of its rapid spread. Each country has its capacity and reacts according to its perception of threat, economy, health care policy, and the health care system structure. Furthermore, we noted a lack of research focusing on the role of social media campaigns in public health awareness and public protection against the COVID-19 pandemic in Jordan as a developing country. Objective: The purpose of this study was to examine the influence of social media platforms on public health protection against the COVID-19 pandemic via public health awareness and public health behavioral changes as mediating factors in Jordan. Methods: A quantitative approach and several social media platforms were used to collect data via web questionnaires in Jordan, and a total of 2555 social media users were sampled. This study used structural equation modeling to analyze and verify the study variables. Results: The main findings revealed that the use of social media platforms had a significant positive influence on public health protection against COVID-19 as a pandemic. Public health awareness and public health behavioral changes significantly acted as partial mediators in this relationship. Therefore, a better understanding of the effects of the use of social media interventions on public health protection against COVID-19 while taking public health awareness and behavioral changes into account as mediators should be helpful when developing any health promotion strategy plan. Conclusions: Our findings suggest that the use of social media platforms can positively influence awareness of public health behavioral changes and public protection against COVID-19. Public health authorities may use social media platforms as an effective tool to increase public health awareness through dissemination of brief messages to targeted populations. However, more research is needed to validate how social media channels can be used to improve health knowledge and adoption of healthy behaviors in a cross-cultural context. %M 32750004 %R 10.2196/19996 %U http://www.jmir.org/2020/8/e19996/ %U https://doi.org/10.2196/19996 %U http://www.ncbi.nlm.nih.gov/pubmed/32750004 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 8 %P e19673 %T Diagnostic Value of Imaging Modalities for COVID-19: Scoping Review %A Aljondi,Rowa %A Alghamdi,Salem %+ Department of Applied Radiologic Technology, College of Applied Medical Sciences, University of Jeddah, Al Sharafeyah, Jeddah, 23218, Saudi Arabia, 966 530550559, rowaaljondi@gmail.com %K diagnostic imaging %K radiology %K COVID-19 %K respiratory infection %K pneumonia %K imaging %K CT %K infectious disease %K diagnosis %K review %D 2020 %7 19.8.2020 %9 Review %J J Med Internet Res %G English %X Background: Coronavirus disease (COVID-19) is a serious infectious disease that causes severe respiratory illness. This pandemic represents a serious public health risk. Therefore, early and accurate diagnosis is essential to control disease progression. Radiological examination plays a crucial role in the early identification and management of infected patients. Objective: The aim of this review was to identify the diagnostic value of different imaging modalities used for diagnosis of COVID-19. Methods: A comprehensive literature search was conducted using the PubMed, Scopus, Web of Science, and Google Scholar databases. The keywords diagnostic imaging, radiology, respiratory infection, pneumonia, coronavirus infection and COVID-19 were used to identify radiology articles focusing on the diagnosis of COVID-19 and to determine the diagnostic value of various imaging modalities, including x-ray, computed tomography (CT), ultrasound, and nuclear medicine for identification and management of infected patients. Results: We identified 50 articles in the literature search. Studies that investigated the diagnostic roles and imaging features of patients with COVID-19, using either chest CT, lung ultrasound, chest x-ray, or positron emission topography/computed tomography (PET/CT) scan, were discussed. Of these imaging modalities, chest x-ray and CT scan are the most commonly used for diagnosis and management of COVID-19 patients, with chest CT scan being more accurate and sensitive in identifying COVID-19 at early stages. Only a few studies have investigated the roles of ultrasound and PET/CT scan in diagnosing COVID-19. Conclusions: Chest CT scan remains the most sensitive imaging modality in initial diagnosis and management of suspected and confirmed patients with COVID-19. Other diagnostic imaging modalities could add value in evaluating disease progression and monitoring critically ill patients with COVID-19. %M 32716893 %R 10.2196/19673 %U http://www.jmir.org/2020/8/e19673/ %U https://doi.org/10.2196/19673 %U http://www.ncbi.nlm.nih.gov/pubmed/32716893 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 8 %P e22590 %T Social Network Analysis of COVID-19 Sentiments: Application of Artificial Intelligence %A Hung,Man %A Lauren,Evelyn %A Hon,Eric S %A Birmingham,Wendy C %A Xu,Julie %A Su,Sharon %A Hon,Shirley D %A Park,Jungweon %A Dang,Peter %A Lipsky,Martin S %+ College of Dental Medicine, Roseman University of Health Sciences, 10894 South River Front Parkway, South Jordan, UT, 84095-3538, United States, 1 801 878 1270, mhung@roseman.edu %K COVID-19 %K coronavirus %K sentiment %K social network %K Twitter %K infodemiology %K infodemic %K pandemic %K crisis %K public health %K business economy %K artificial intelligence %D 2020 %7 18.8.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The coronavirus disease (COVID-19) pandemic led to substantial public discussion. Understanding these discussions can help institutions, governments, and individuals navigate the pandemic. Objective: The aim of this study is to analyze discussions on Twitter related to COVID-19 and to investigate the sentiments toward COVID-19. Methods: This study applied machine learning methods in the field of artificial intelligence to analyze data collected from Twitter. Using tweets originating exclusively in the United States and written in English during the 1-month period from March 20 to April 19, 2020, the study examined COVID-19–related discussions. Social network and sentiment analyses were also conducted to determine the social network of dominant topics and whether the tweets expressed positive, neutral, or negative sentiments. Geographic analysis of the tweets was also conducted. Results: There were a total of 14,180,603 likes, 863,411 replies, 3,087,812 retweets, and 641,381 mentions in tweets during the study timeframe. Out of 902,138 tweets analyzed, sentiment analysis classified 434,254 (48.2%) tweets as having a positive sentiment, 187,042 (20.7%) as neutral, and 280,842 (31.1%) as negative. The study identified 5 dominant themes among COVID-19–related tweets: health care environment, emotional support, business economy, social change, and psychological stress. Alaska, Wyoming, New Mexico, Pennsylvania, and Florida were the states expressing the most negative sentiment while Vermont, North Dakota, Utah, Colorado, Tennessee, and North Carolina conveyed the most positive sentiment. Conclusions: This study identified 5 prevalent themes of COVID-19 discussion with sentiments ranging from positive to negative. These themes and sentiments can clarify the public’s response to COVID-19 and help officials navigate the pandemic. %M 32750001 %R 10.2196/22590 %U http://www.jmir.org/2020/8/e22590/ %U https://doi.org/10.2196/22590 %U http://www.ncbi.nlm.nih.gov/pubmed/32750001 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 8 %P e21413 %T COVID-19 Mortality Underreporting in Brazil: Analysis of Data From Government Internet Portals %A Veiga e Silva,Lena %A de Andrade Abi Harb,Maria Da Penha %A Teixeira Barbosa dos Santos,Aurea Milene %A de Mattos Teixeira,Carlos André %A Macedo Gomes,Vitor Hugo %A Silva Cardoso,Evelin Helena %A S da Silva,Marcelino %A Vijaykumar,N L %A Venâncio Carvalho,Solon %A Ponce de Leon Ferreira de Carvalho,André %A Lisboa Frances,Carlos Renato %+ Federal University of Pará, R Augusto Corrêa, 01, Guamá, Belém, 66073-040, Brazil, 55 91 3201 7634, lenaveiga@gmail.com %K Brazil %K COVID-19 %K mortality %K underreporting %K respiratory system diseases %K public health %K pandemic %K time series %K forecasting %D 2020 %7 18.8.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: In Brazil, a substantial number of coronavirus disease (COVID-19) cases and deaths have been reported. It has become the second most affected country worldwide, as of June 9, 2020. Official Brazilian government sources present contradictory data on the impact of the disease; thus, it is possible that the actual number of infected individuals and deaths in Brazil is far larger than those officially reported. It is very likely that the actual spread of the disease has been underestimated. Objective: This study investigates the underreporting of cases and deaths related to COVID-19 in the most affected cities in Brazil, based on public data available from official Brazilian government internet portals, to identify the actual impact of the pandemic. Methods: We used data from historical deaths due to respiratory problems and other natural causes from two public portals: DATASUS (Department of Informatics of the Unified Healthcare System) (2010-2018) and the Brazilian Transparency Portal of Civil Registry (2019-2020). These data were used to build time-series models (modular regressions) to predict the expected mortality patterns for 2020. The forecasts were used to estimate the possible number of deaths that were incorrectly registered during the pandemic and posted on government internet portals in the most affected cities in the country. Results: Our model found a significant difference between the real and expected values. The number of deaths due to severe acute respiratory syndrome (SARS) was considerably higher in all cities, with increases between 493% and 5820%. This sudden increase may be associated with errors in reporting. An average underreporting of 40.68% (range 25.9%-62.7%) is estimated for COVID-19–related deaths. Conclusions: The significant rates of underreporting of deaths analyzed in our study demonstrate that officially released numbers are much lower than actual numbers, making it impossible for the authorities to implement a more effective pandemic response. Based on analyses carried out using different fatality rates, it can be inferred that Brazil’s epidemic is worsening, and the actual number of infectees could already be between 1 to 5.4 million. %M 32730219 %R 10.2196/21413 %U http://www.jmir.org/2020/8/e21413/ %U https://doi.org/10.2196/21413 %U http://www.ncbi.nlm.nih.gov/pubmed/32730219 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 8 %P e20285 %T Real-Time Forecasting of the COVID-19 Outbreak in Chinese Provinces: Machine Learning Approach Using Novel Digital Data and Estimates From Mechanistic Models %A Liu,Dianbo %A Clemente,Leonardo %A Poirier,Canelle %A Ding,Xiyu %A Chinazzi,Matteo %A Davis,Jessica %A Vespignani,Alessandro %A Santillana,Mauricio %+ Computational Health Informatics Program, Boston Children’s Hospital, 300 Longwood Avenue, Landmark 5th Floor East, Boston, MA, 02215, United States, 1 (617) 919 1795, msantill@g.harvard.edu %K COVID-19 %K coronavirus %K digital epidemiology %K modeling %K modeling disease outbreaks %K emerging outbreak %K machine learning %K precision public health %K machine learning in public health %K forecasting %K digital data %K mechanistic model %K hybrid simulation %K hybrid model %K simulation %D 2020 %7 17.8.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The inherent difficulty of identifying and monitoring emerging outbreaks caused by novel pathogens can lead to their rapid spread; and if left unchecked, they may become major public health threats to the planet. The ongoing coronavirus disease (COVID-19) outbreak, which has infected over 2,300,000 individuals and caused over 150,000 deaths, is an example of one of these catastrophic events. Objective: We present a timely and novel methodology that combines disease estimates from mechanistic models and digital traces, via interpretable machine learning methodologies, to reliably forecast COVID-19 activity in Chinese provinces in real time. Methods: Our method uses the following as inputs: (a) official health reports, (b) COVID-19–related internet search activity, (c) news media activity, and (d) daily forecasts of COVID-19 activity from a metapopulation mechanistic model. Our machine learning methodology uses a clustering technique that enables the exploitation of geospatial synchronicities of COVID-19 activity across Chinese provinces and a data augmentation technique to deal with the small number of historical disease observations characteristic of emerging outbreaks. Results: Our model is able to produce stable and accurate forecasts 2 days ahead of the current time and outperforms a collection of baseline models in 27 out of 32 Chinese provinces. Conclusions: Our methodology could be easily extended to other geographies currently affected by COVID-19 to aid decision makers with monitoring and possibly prevention. %M 32730217 %R 10.2196/20285 %U http://www.jmir.org/2020/8/e20285/ %U https://doi.org/10.2196/20285 %U http://www.ncbi.nlm.nih.gov/pubmed/32730217 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 8 %P e20007 %T Artificial Intelligence for Rapid Meta-Analysis: Case Study on Ocular Toxicity of Hydroxychloroquine %A Michelson,Matthew %A Chow,Tiffany %A Martin,Neil A %A Ross,Mike %A Tee Qiao Ying,Amelia %A Minton,Steven %+ Evid Science, 2361 Rosencrans Ave Ste 348, El Segundo, CA, 90245-4929, United States, 1 626 765 1903, mmichelson@evidscience.com %K meta-analysis %K rapid meta-analysis %K artificial intelligence %K drug %K analysis %K hydroxychloroquine %K toxic %K COVID-19 %K treatment %K side effect %K ocular %K eye %D 2020 %7 17.8.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Rapid access to evidence is crucial in times of an evolving clinical crisis. To that end, we propose a novel approach to answer clinical queries, termed rapid meta-analysis (RMA). Unlike traditional meta-analysis, RMA balances a quick time to production with reasonable data quality assurances, leveraging artificial intelligence (AI) to strike this balance. Objective: We aimed to evaluate whether RMA can generate meaningful clinical insights, but crucially, in a much faster processing time than traditional meta-analysis, using a relevant, real-world example. Methods: The development of our RMA approach was motivated by a currently relevant clinical question: is ocular toxicity and vision compromise a side effect of hydroxychloroquine therapy? At the time of designing this study, hydroxychloroquine was a leading candidate in the treatment of coronavirus disease (COVID-19). We then leveraged AI to pull and screen articles, automatically extract their results, review the studies, and analyze the data with standard statistical methods. Results: By combining AI with human analysis in our RMA, we generated a meaningful, clinical result in less than 30 minutes. The RMA identified 11 studies considering ocular toxicity as a side effect of hydroxychloroquine and estimated the incidence to be 3.4% (95% CI 1.11%-9.96%). The heterogeneity across individual study findings was high, which should be taken into account in interpretation of the result. Conclusions: We demonstrate that a novel approach to meta-analysis using AI can generate meaningful clinical insights in a much shorter time period than traditional meta-analysis. %M 32804086 %R 10.2196/20007 %U http://www.jmir.org/2020/8/e20007/ %U https://doi.org/10.2196/20007 %U http://www.ncbi.nlm.nih.gov/pubmed/32804086 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 8 %P e21486 %T Use of the HoloLens2 Mixed Reality Headset for Protecting Health Care Workers During the COVID-19 Pandemic: Prospective, Observational Evaluation %A Martin,Guy %A Koizia,Louis %A Kooner,Angad %A Cafferkey,John %A Ross,Clare %A Purkayastha,Sanjay %A Sivananthan,Arun %A Tanna,Anisha %A Pratt,Philip %A Kinross,James %A , %+ Department of Surgery and Cancer, Imperial College London, 10th Floor, QEQM Building, St Mary’s Hospital, London, W2 1NY, United Kingdom, 44 0203 312 6072, guy.martin@imperial.ac.uk %K COVID-19 %K mixed reality %K telemedicine %K protection %K acceptability %K feasibility %K impact %K headset %K virtual reality %K augmented reality %K pilot %D 2020 %7 14.8.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The coronavirus disease (COVID-19) pandemic has led to rapid acceleration in the deployment of new digital technologies to improve both accessibility to and quality of care, and to protect staff. Mixed-reality (MR) technology is the latest iteration of telemedicine innovation; it is a logical next step in the move toward the provision of digitally supported clinical care and medical education. This technology has the potential to revolutionize care both during and after the COVID-19 pandemic. Objective: This pilot project sought to deploy the HoloLens2 MR device to support the delivery of remote care in COVID-19 hospital environments. Methods: A prospective, observational, nested cohort evaluation of the HoloLens2 was undertaken across three distinct clinical clusters in a teaching hospital in the United Kingdom. Data pertaining to staff exposure to high-risk COVID-19 environments and personal protective equipment (PPE) use by clinical staff (N=28) were collected, and assessments of acceptability and feasibility were conducted. Results: The deployment of the HoloLens2 led to a 51.5% reduction in time exposed to harm for staff looking after COVID-19 patients (3.32 vs 1.63 hours/day/staff member; P=.002), and an 83.1% reduction in the amount of PPE used (178 vs 30 items/round/day; P=.02). This represents 222.98 hours of reduced staff exposure to COVID-19, and 3100 fewer PPE items used each week across the three clusters evaluated. The majority of staff using the device agreed it was easy to set up and comfortable to wear, improved the quality of care and decision making, and led to better teamwork and communication. In total, 89.3% (25/28) of users felt that their clinical team was safer when using the HoloLens2. Conclusions: New technologies have a role in minimizing exposure to nosocomial infection, optimizing the use of PPE, and enhancing aspects of care. Deploying such technologies at pace requires context-specific information security, infection control, user experience, and workflow integration to be addressed at the outset and led by clinical end-users. The deployment of new telemedicine technology must be supported with objective evidence for its safety and effectiveness to ensure maximum impact. %M 32730222 %R 10.2196/21486 %U http://www.jmir.org/2020/8/e21486/ %U https://doi.org/10.2196/21486 %U http://www.ncbi.nlm.nih.gov/pubmed/32730222 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 8 %P e20914 %T The Infection Rate of COVID-19 in Wuhan, China: Combined Analysis of Population Samples %A Qu,Hui-Qi %A Cheng,Zhangkai Jason %A Duan,Zhifeng %A Tian,Lifeng %A Hakonarson,Hakon %+ Center for Applied Genomics, The Children’s Hospital of Philadelphia, 3615 Civic Center Boulevard, Philadelphia, PA, United States, 1 267 426 0088, Hakonarson@email.chop.edu %K infectious disease %K COVID-19 %K infection rate %K China %K Wuhan %K fatality %K public health %K diagnosis %D 2020 %7 14.8.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The coronavirus disease (COVID-19) pandemic began in Wuhan, China, in December 2019. Wuhan had a much higher mortality rate than the rest of China. However, a large number of asymptomatic infections in Wuhan may have never been diagnosed, contributing to an overestimated mortality rate. Objective: This study aims to obtain an accurate estimate of infections in Wuhan using internet data. Methods: In this study, we performed a combined analysis of the infection rate among evacuated foreign citizens to estimate the infection rate in Wuhan in late January and early February. Results: Based on our analysis, the combined infection rate of the foreign evacuees was 0.013 (95% CI 0.008-0.022). Therefore, we estimate the number of infected people in Wuhan to be 143,000 (range 88,000-242,000), which is significantly higher than previous estimates. Our study indicates that a large number of infections in Wuhan were not diagnosed, which has resulted in an overestimated case fatality rate. Conclusions: Increased awareness of the original infection rate of Wuhan is critical for proper public health measures at all levels, as well as to eliminate panic caused by overestimated mortality rates that may bias health policy actions by the authorities. %M 32707538 %R 10.2196/20914 %U https://www.jmir.org/2020/8/e20914 %U https://doi.org/10.2196/20914 %U http://www.ncbi.nlm.nih.gov/pubmed/32707538 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 8 %P e20773 %T Natural Language Processing for Rapid Response to Emergent Diseases: Case Study of Calcium Channel Blockers and Hypertension in the COVID-19 Pandemic %A Neuraz,Antoine %A Lerner,Ivan %A Digan,William %A Paris,Nicolas %A Tsopra,Rosy %A Rogier,Alice %A Baudoin,David %A Cohen,Kevin Bretonnel %A Burgun,Anita %A Garcelon,Nicolas %A Rance,Bastien %A , %+ Department of Biomedical Informatics, Necker-Enfant Malades Hospital, Assistance Publique – Hôpitaux de Paris (AP-HP), Bat Imagine, Bureau 145, 149 rue de Sèvres, Paris, 75015, France, 33 0624622355, antoine.neuraz@aphp.fr %K medication information %K natural language processing %K electronic health records %K COVID-19 %K public health %K response %K emergent disease %K informatics %D 2020 %7 14.8.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: A novel disease poses special challenges for informatics solutions. Biomedical informatics relies for the most part on structured data, which require a preexisting data or knowledge model; however, novel diseases do not have preexisting knowledge models. In an emergent epidemic, language processing can enable rapid conversion of unstructured text to a novel knowledge model. However, although this idea has often been suggested, no opportunity has arisen to actually test it in real time. The current coronavirus disease (COVID-19) pandemic presents such an opportunity. Objective: The aim of this study was to evaluate the added value of information from clinical text in response to emergent diseases using natural language processing (NLP). Methods: We explored the effects of long-term treatment by calcium channel blockers on the outcomes of COVID-19 infection in patients with high blood pressure during in-patient hospital stays using two sources of information: data available strictly from structured electronic health records (EHRs) and data available through structured EHRs and text mining. Results: In this multicenter study involving 39 hospitals, text mining increased the statistical power sufficiently to change a negative result for an adjusted hazard ratio to a positive one. Compared to the baseline structured data, the number of patients available for inclusion in the study increased by 2.95 times, the amount of available information on medications increased by 7.2 times, and the amount of additional phenotypic information increased by 11.9 times. Conclusions: In our study, use of calcium channel blockers was associated with decreased in-hospital mortality in patients with COVID-19 infection. This finding was obtained by quickly adapting an NLP pipeline to the domain of the novel disease; the adapted pipeline still performed sufficiently to extract useful information. When that information was used to supplement existing structured data, the sample size could be increased sufficiently to see treatment effects that were not previously statistically detectable. %M 32759101 %R 10.2196/20773 %U http://www.jmir.org/2020/8/e20773/ %U https://doi.org/10.2196/20773 %U http://www.ncbi.nlm.nih.gov/pubmed/32759101 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 8 %P e20193 %T Hazards of the Cytokine Storm and Cytokine-Targeted Therapy in Patients With COVID-19: Review %A Quirch,Miguel %A Lee,Jeannie %A Rehman,Shabnam %+ Texas Tech University Health Sciences Center, 3601 4th St, Lubbock, TX, 79430, United States, 1 806 743 3543, miguel.quirch@ttuhsc.edu %K coronavirus %K COVID-19 %K convalescent plasma therapy %K cytokine storm %K SARS-CoV-2 %K cytokine %K immunology %K review %K mortality %K inflammation %K therapy %D 2020 %7 13.8.2020 %9 Review %J J Med Internet Res %G English %X Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has challenged medicine and health care on a global scale. Its impact and frightening mortality rate are in large part attributable to the fact that there is a lack of available treatments. It has been shown that in patients who are severely ill, SARS-CoV-2 can lead to an inflammatory response known as cytokine storm, which involves activation and release of inflammatory cytokines in a positive feedback loop of pathogen-triggered inflammation. Currently, cytokine storm is one of the leading causes of morbidity and mortality in SARS-CoV-2, but there is no proven treatment to combat this systemic response. Objective: The aim of this paper is to study the cytokine storm response in SARS-CoV-2 and to explore the early treatment options for patients who are critically ill with the coronavirus disease (COVID-19) in the early stages of the pandemic by reviewing the literature. Methods: A literature review was performed from December 1, 2000, to April 4, 2020, to explore and compare therapies that target cytokine storm among SARS-CoV-2 and prior coronavirus cases. Results: A total of 38 eligible studies including 24 systematic reviews, 5 meta-analyses, 5 experimental model studies, 7 cohort studies, and 4 case reports matched the criteria. Conclusions: The severity of the cytokine storm, measured by elevated levels of interleukin-1B, interferon-γ, interferon-inducible protein 10, and monocyte chemoattractant protein 1, was associated with COVID-19 disease severity. Many treatment options with different targets have been proposed during the early stages of the COVID-19 pandemic, ranging from targeting the virus itself to managing the systemic inflammation caused by the virus and the excessive cytokine response. Among the different agents to manage cytokine storm in patients with COVID-19, there is developing support for convalescent plasma therapy particularly for patients who are critically ill or mechanically ventilated and resistant to antivirals and supportive care. Treatment options that were proposed in the beginning phases of the pandemic were multidimensional, and further research is needed to develop a more established treatment guideline. %M 32707537 %R 10.2196/20193 %U http://www.jmir.org/2020/8/e20193/ %U https://doi.org/10.2196/20193 %U http://www.ncbi.nlm.nih.gov/pubmed/32707537 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 8 %P e20108 %T Characteristics and Outcomes of a Sample of Patients With COVID-19 Identified Through Social Media in Wuhan, China: Observational Study %A Liu,Dong %A Wang,Yuyan %A Wang,Juan %A Liu,Jue %A Yue,Yongjie %A Liu,Wenjun %A Zhang,Fuhai %A Wang,Ziping %+ Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Thoracic Medical Oncology, Peking University Cancer Hospital & Institute, No 52 Fucheng Road, Haidian District, Beijing , China, 86 13301212676, wangzp2007@126.com %K COVID-19 %K risk factors %K web-based data %K outcome %K infectious disease %K clinical characteristic %K mortality %K social media %K prognosis, China %K coronavirus %D 2020 %7 13.8.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The number of deaths worldwide caused by coronavirus disease (COVID-19) is increasing rapidly. Information about the clinical characteristics of patients with COVID-19 who were not admitted to hospital is limited. Some risk factors of mortality associated with COVID-19 are controversial (eg, smoking). Moreover, the impact of city closure on mortality and admission rates is unknown. Objective: The aim of this study was to explore the risk factors of mortality associated with COVID-19 infection among a sample of patients in Wuhan whose conditions were reported on social media. Methods: We enrolled 599 patients with COVID-19 from 67 hospitals in Wuhan in the study; 117 of the participants (19.5%) were not admitted to hospital. The demographic, epidemiological, clinical, and radiological features of the patients were extracted from their social media posts and coded. Telephone follow-up was conducted 1 month later (between March 15 and 23, 2020) to check the clinical outcomes of the patients and acquire other relevant information. Results: The median age of patients with COVID-19 who died (72 years, IQR 66.5-82.0) was significantly higher than that of patients who recovered (61 years, IQR 53-69, P<.001). We found that lack of admission to hospital (odds ratio [OR] 5.82, 95% CI 3.36-10.1; P<.001), older age (OR 1.08, 95% CI 1.06-1.1; P<.001), diffuse distribution (OR 11.09, 95% CI 0.93-132.9; P=.058), and hypoxemia (odds ratio 2.94, 95% CI 1.32-6.6; P=.009) were associated with increasing odds of death. Smoking was not significantly associated with mortality risk (OR 0.9, 95% CI 0.44-1.85; P=.78). Conclusions: Older age, diffuse distribution, and hypoxemia are factors that can help clinicians identify patients with COVID-19 who have poor prognosis. Our study suggests that aggregated data from social media can also be comprehensive, immediate, and informative in disease prognosis. %M 32716901 %R 10.2196/20108 %U http://www.jmir.org/2020/8/e20108/ %U https://doi.org/10.2196/20108 %U http://www.ncbi.nlm.nih.gov/pubmed/32716901 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 3 %P e19399 %T Rapid Deployment of a Free, Privacy-Assured COVID-19 Symptom Tracker for Public Safety During Reopening: System Development and Feasibility Study %A Kassaye,Seble G %A Spence,Amanda Blair %A Lau,Edwin %A Bridgeland,David M %A Cederholm,John %A Dimolitsas,Spiros %A Smart,JC %+ Department of Medicine, Georgetown University, 2115 Wisconsin Ave, Washington, DC, 20007, United States, 1 2026878114, sgk23@georgetown.edu %K COVID-19 %K SARS-CoV-2 %K home isolation %K quarantine %K symptom monitoring %K information systems %K privacy %K contact tracing %K virus %K transmission %K public health %K eHealth %D 2020 %7 13.8.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Since the emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the number of cases of coronavirus disease (COVID-19) in the United States has exponentially increased. Identifying and monitoring individuals with COVID-19 and individuals who have been exposed to the disease is critical to prevent transmission. Traditional contact tracing mechanisms are not structured on the scale needed to address this pandemic. As businesses reopen, institutions and agencies not traditionally engaged in disease prevention are being tasked with ensuring public safety. Systems to support organizations facing these new challenges are critically needed. Most currently available symptom trackers use a direct-to-consumer approach and use personal identifiers, which raises privacy concerns. Objective: Our aim was to develop a monitoring and reporting system for COVID-19 to support institutions conducting monitoring activities without compromising privacy. Methods: Our multidisciplinary team designed a symptom tracking system after consultation with experts. The system was designed in the Georgetown University AvesTerra knowledge management environment, which supports data integration and synthesis to identify actionable events and maintain privacy. We conducted a beta test for functionality among consenting Georgetown University medical students. Results: The symptom tracker system was designed based on guiding principles developed during peer consultations. Institutions are provided access to the system through an efficient onboarding process that uses clickwrap technology to document agreement to limited terms of use to rapidly enable free access. Institutions provide their constituents with a unique identifier to enter data through a web-based user interface to collect vetted symptoms as well as clinical and epidemiologic data. The website also provides individuals with educational information through links to the COVID-19 prevention recommendations from the US Centers for Disease Control and Prevention. Safety features include instructions for people with new or worsening symptoms to seek care. No personal identifiers are collected in the system. The reporter mechanism safeguards data access so that institutions can only access their own data, and it provides institutions with on-demand access to the data entered by their constituents, organized in summary reports that highlight actionable data. Development of the system began on March 15, 2020, and it was launched on March 20, 2020. In the beta test, 48 Georgetown University School of Medicine students or their social contacts entered data into the system from March 31 to April 5, 2020. One of the 48 users (2%) reported active COVID-19 infection and had no symptoms by the end of the monitoring period. No other participants reported symptoms. Only data with the unique entity identifier for our beta test were generated in our summary reports. Conclusions: This system harnesses insights into privacy and data sharing to avoid regulatory and legal hurdles to rapid adaption by entities tasked with maintaining public safety. Our pilot study demonstrated feasibility and ease of use. Refinements based on feedback from early adapters included release of a Spanish language version. These systems provide technological advances to complement the traditional contact tracing and digital tracing applications being implemented to limit SARS-CoV-2 transmission during reopening. %M 32788148 %R 10.2196/19399 %U http://publichealth.jmir.org/2020/3/e19399/ %U https://doi.org/10.2196/19399 %U http://www.ncbi.nlm.nih.gov/pubmed/32788148 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 8 %P e20775 %T Evaluation of Korean-Language COVID-19–Related Medical Information on YouTube: Cross-Sectional Infodemiology Study %A Moon,Hana %A Lee,Geon Ho %+ Department of Family Medicine, School of Medicine, Daegu Catholic University, 33, Duryugongwon-ro 17-gil, Nam-gu, Daegu, 42472, Republic of Korea, 82 53 650 4696, totoslee@cu.ac.kr %K COVID-19 %K YouTube %K social media %K misinformation %K public health surveillance %K health communication %K consumer health information %K health education %K infectious disease outbreaks %K infodemiology %K infoveillance %K infodemic %K internet %K multimedia %D 2020 %7 12.8.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: In South Korea, the number of coronavirus disease (COVID-19) cases has declined rapidly and much sooner than in other countries. South Korea is one of the most digitalized countries in the world, and YouTube may have served as a rapid delivery mechanism for increasing public awareness of COVID-19. Thus, the platform may have helped the South Korean public fight the spread of the disease. Objective: The aim of this study is to compare the reliability, overall quality, title–content consistency, and content coverage of Korean-language YouTube videos on COVID-19, which have been uploaded by different sources. Methods: A total of 200 of the most viewed YouTube videos from January 1, 2020, to April 30, 2020, were screened, searching in Korean for the terms “Coronavirus,” “COVID,” “Corona,” “Wuhan virus,” and “Wuhan pneumonia.” Non-Korean videos and videos that were duplicated, irrelevant, or livestreamed were excluded. Source and video metrics were collected. The videos were scored based on the following criteria: modified DISCERN index, Journal of the American Medical Association Score (JAMAS) benchmark criteria, global quality score (GQS), title–content consistency index (TCCI), and medical information and content index (MICI). Results: Of the 105 total videos, 37.14% (39/105) contained misleading information; independent user–generated videos showed the highest proportion of misleading information at 68.09% (32/47), while all of the government-generated videos were useful. Government agency–generated videos achieved the highest median score of DISCERN (5.0, IQR 5.0-5.0), JAMAS (4.0, IQR 4.0-4.0), GQS (4.0, IQR 3.0-4.5), and TCCI (5.0, IQR 5.0-5.0), while independent user–generated videos achieved the lowest median score of DISCERN (2.0, IQR 1.0-3.0), JAMAS (2.0, IQR 1.5-2.0), GQS (2.0, IQR 1.5-2.0), and TCCI (3.0, IQR 3.0-4.0). However, the total MICI was not significantly different among sources. “Transmission and precautionary measures” were the most commonly covered content by government agencies, news agencies, and independent users. In contrast, the most mentioned content by news agencies was “prevalence,” followed by “transmission and precautionary measures.” Conclusions: Misleading videos had more likes, fewer comments, and longer running times than useful videos. Korean-language YouTube videos on COVID-19 uploaded by different sources varied significantly in terms of reliability, overall quality, and title–content consistency, but the content coverage was not significantly different. Government-generated videos had higher reliability, overall quality, and title–content consistency than independent user–generated videos. %M 32730221 %R 10.2196/20775 %U http://www.jmir.org/2020/8/e20775/ %U https://doi.org/10.2196/20775 %U http://www.ncbi.nlm.nih.gov/pubmed/32730221 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 3 %P e20341 %T COVID-19 in India: Statewise Analysis and Prediction %A Ghosh,Palash %A Ghosh,Rik %A Chakraborty,Bibhas %+ Centre for Quantitative Medicine & Programme in Health Services and Systems Research, Duke-National University of Singapore Medical School, 8 College Road, Singapore, 169857, Singapore, 65 6576 7377, bibhas.chakraborty@duke-nus.edu.sg %K COVID-19 %K disease modeling %K 30-day prediction %K logistic model %K exponential model %K SIS model %K daily infection rate %D 2020 %7 12.8.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The highly infectious coronavirus disease (COVID-19) was first detected in Wuhan, China in December 2019 and subsequently spread to 212 countries and territories around the world, infecting millions of people. In India, a large country of about 1.3 billion people, the disease was first detected on January 30, 2020, in a student returning from Wuhan. The total number of confirmed infections in India as of May 3, 2020, is more than 37,000 and is currently growing fast. Objective: Most of the prior research and media coverage focused on the number of infections in the entire country. However, given the size and diversity of India, it is important to look at the spread of the disease in each state separately, wherein the situations are quite different. In this paper, we aim to analyze data on the number of infected people in each Indian state (restricted to only those states with enough data for prediction) and predict the number of infections for that state in the next 30 days. We hope that such statewise predictions would help the state governments better channelize their limited health care resources. Methods: Since predictions from any one model can potentially be misleading, we considered three growth models, namely, the logistic, the exponential, and the susceptible-infectious-susceptible models, and finally developed a data-driven ensemble of predictions from the logistic and the exponential models using functions of the model-free maximum daily infection rate (DIR) over the last 2 weeks (a measure of recent trend) as weights. The DIR is used to measure the success of the nationwide lockdown. We jointly interpreted the results from all models along with the recent DIR values for each state and categorized the states as severe, moderate, or controlled. Results: We found that 7 states, namely, Maharashtra, Delhi, Gujarat, Madhya Pradesh, Andhra Pradesh, Uttar Pradesh, and West Bengal are in the severe category. Among the remaining states, Tamil Nadu, Rajasthan, Punjab, and Bihar are in the moderate category, whereas Kerala, Haryana, Jammu and Kashmir, Karnataka, and Telangana are in the controlled category. We also tabulated actual predicted numbers from various models for each state. All the R2 values corresponding to the logistic and the exponential models are above 0.90, indicating a reasonable goodness of fit. We also provide a web application to see the forecast based on recent data that is updated regularly. Conclusions: States with nondecreasing DIR values need to immediately ramp up the preventive measures to combat the COVID-19 pandemic. On the other hand, the states with decreasing DIR can maintain the same status to see the DIR slowly become zero or negative for a consecutive 14 days to be able to declare the end of the pandemic. %M 32763888 %R 10.2196/20341 %U http://publichealth.jmir.org/2020/3/e20341/ %U https://doi.org/10.2196/20341 %U http://www.ncbi.nlm.nih.gov/pubmed/32763888 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 8 %P e20169 %T Can Robots Improve Testing Capacity for SARS-CoV-2? %A Cresswell,Kathrin %A Ramalingam,Sandeep %A Sheikh,Aziz %+ The University of Edinburgh, Teviot Place, Edinburgh, United Kingdom, 44 131 651 4151, kathrin.beyer@ed.ac.uk %K robotics %K testing %K SARS-CoV-2 %K COVID-19 %K pandemic %K virus %K infectious disease %D 2020 %7 12.8.2020 %9 Viewpoint %J J Med Internet Res %G English %X There is currently increasing interest internationally in deploying robotic applications for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) testing, as these can help to reduce the risk of transmission of the virus to health care staff and patients. We provide an overview of key recent developments in this area. We argue that, although there is some potential for deploying robots to help with SARS-CoV-2 testing, the potential of patient-facing applications is likely to be limited. This is due to the high costs associated with patient-facing functionality, and risks of potentially adverse impacts on health care staff work practices and patient interactions. In contrast, back-end laboratory-based robots dealing with sample extraction and amplification, that effectively integrate with established processes, software, and interfaces to process samples, are much more likely to result in safety and efficiency gains. Consideration should therefore be given to deploying these at scale. %M 32735547 %R 10.2196/20169 %U http://www.jmir.org/2020/8/e20169/ %U https://doi.org/10.2196/20169 %U http://www.ncbi.nlm.nih.gov/pubmed/32735547 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 8 %P e20240 %T Closing the COVID-19 Psychological Treatment Gap for Cancer Patients in Alberta: Protocol for the Implementation and Evaluation of Text4Hope-Cancer Care %A Agyapong,Vincent Israel Opoku %A Hrabok,Marianne %A Shalaby,Reham %A Mrklas,Kelly %A Vuong,Wesley %A Gusnowski,April %A Surood,Shireen %A Greenshaw,Andrew James %A Nkire,Nnamdi %+ Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, 1E1 Walter Mackenzie Health Sciences Centre, 8440 112 St NW, Edmonton, AB, T6G 2B7, Canada, 1 7807144315, agyapong@ualberta.ca %K cancer care %K COVID-19 %K pandemic %K mobile phones %K text messaging %K anxiety %K depression %K e-mental health %D 2020 %7 12.8.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: Cancer diagnoses and treatments usually engender significant anxiety and depressive symptoms in patients, close relatives, and caregivers. Providing psychological support during the coronavirus disease (COVID-19) pandemic presents additional challenges due to self-isolation and social or physical distancing measures in place to limit viral spread. This protocol describes the use of text messaging (Text4Hope-Cancer Care) as a convenient, cost-effective, and accessible population-level mental health intervention. As demonstrated in previous research, this evidence-based program supports good outcomes and high user satisfaction. Objective: We will implement daily supportive text messaging as a way of reducing and managing anxiety and depression related to cancer diagnosis and treatment in Alberta, Canada. Prevalence of anxiety and depressive symptoms, their demographic correlates, and Text4Hope-Cancer Care–induced changes in anxiety and depression will be evaluated. Methods: Alberta residents with a cancer diagnosis and the close relatives of those dealing with a cancer diagnosis can self-subscribe to the Text4Hope-Cancer Care program by texting “CancerCare” to a dedicated text number. Self-administered, anonymous, online questionnaires will be used to assess anxiety and depressive symptoms using the Hospital Anxiety and Depression Scale (HADS). Data will be collected at onset from individuals receiving text messages, and at the mid- and endpoints of the program (ie, at 6 and 12 weeks, respectively). Data will be analyzed with parametric and nonparametric statistics for primary outcomes (ie, anxiety and depressive symptoms) and usage metrics, including the number of subscribers and user satisfaction. In addition, data mining and machine learning analysis will focus on determining subscriber characteristics that predict high levels of symptoms of mental disorders, and may subsequently predict changes in those measures in response to the Text4Hope-Cancer Care program. Results: The first research stage, which was completed in April 2020, involved the creation and review of the supportive text messages and uploading of messages into a web-based text messaging service. The second stage, involving the launch of the Text4Hope-Cancer Care program, occurred in May 2020. Conclusions: Text4Hope-Cancer Care has the potential to provide key information regarding the prevalence rates of anxiety and depressive symptoms in patients diagnosed or receiving care for cancer and their caregivers. The study will generate demographic correlates of anxiety and depression, and outcome data related to this scalable, population-level intervention. Information from this study will be valuable for health care practitioners working in cancer care and may help inform policy and decision making regarding psychological interventions for cancer care. International Registered Report Identifier (IRRID): PRR1-10.2196/20240 %M 32750012 %R 10.2196/20240 %U http://www.researchprotocols.org/2020/8/e20240/ %U https://doi.org/10.2196/20240 %U http://www.ncbi.nlm.nih.gov/pubmed/32750012 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 8 %P e21385 %T Advance Care Planning Among Users of a Patient Portal During the COVID-19 Pandemic: Retrospective Observational Study %A Portz,Jennifer D %A Brungardt,Adreanne %A Shanbhag,Prajakta %A Staton,Elizabeth W %A Bose-Brill,Seuli %A Lin,Chen-Tan %A Kutner,Jean S %A Lum,Hillary D %+ Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine, 12631 East 17th Avenue, Aurora, CO, 80045, United States, 1 303 724 4438, jennifer.portz@cuanschutz.edu %K advance care planning %K electronic health records %K pandemic %K COVID-19 %K advance directives %K patient portal %K planning %K web-based tool %K health system %D 2020 %7 11.8.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Advance care planning is the process of discussing health care treatment preferences based on patients’ personal values, and it often involves the completion of advance directives. In the first months of 2020, a novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), began circulating widely in the American state of Colorado, leading to widespread diagnosis of coronavirus disease (COVID-19), hospitalizations, and deaths. In this context, the importance of technology-based, non–face-to-face methods to conduct advance care planning via patient portals has increased. Objective: The aim of this study was to determine the rates of use of a web-based advance care planning tool through a health system–based electronic patient portal both before and in the early months of the COVID-19 pandemic. Methods: In 2017, we implemented web-based tools through the patient portal of UCHealth’s electronic health record (EHR) for patients to learn about advance care planning and complete an electronically signed medical durable power of attorney (MDPOA) to legally appoint a medical decision maker. Patients accessing the portal can complete and submit a legally valid MDPOA, which becomes part of their medical record. We collected data on the patients’ date of MDPOA completion, use of advance care planning messaging, age, sex, and geographic location during the early phase of the COVID-19 pandemic (December 29, 2019, to May 30, 2020). Results: Over a 5-month period that includes the early phase of the COVID-19 pandemic in Colorado, total monthly use of the advance care planning portal tool increased from 418 users in January to 1037 users in April and then decreased slightly to 815 users in May. The number of MDPOA forms submitted per week increased 2.4-fold after the stay-at-home order was issued in Colorado on March 26, 2020 (P<.001). The mean age of the advance care planning portal users was 47.7 years (SD 16.1), and 2206/3292 (67.0%) were female. Women were more likely than men to complete an MDPOA, particularly in younger age groups (P<.001). The primary use of the advance care planning portal tools was the completion of an MDPOA (3138/3292, 95.3%), compared to sending an electronic message (148/3292, 4.5%). Over 50% of patients who completed an MDPOA did not have a prior agent in the EHR. Conclusions: Use of a web-based patient portal to complete an MDPOA increased substantially during the first months of the COVID-19 pandemic in Colorado. There was an increase in advance care planning that corresponded with state government shelter-in-place orders as well as public health reports of increased numbers of COVID-19 cases and deaths. Patient portals are an important tool for providing advance care planning resources and documenting medical decision makers during the pandemic to ensure that medical treatment aligns with patient goals and values. %M 32716900 %R 10.2196/21385 %U http://www.jmir.org/2020/8/e21385/ %U https://doi.org/10.2196/21385 %U http://www.ncbi.nlm.nih.gov/pubmed/32716900 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 8 %P e20634 %T Citizens’ Adherence to COVID-19 Mitigation Recommendations by the Government: A 3-Country Comparative Evaluation Using Web-Based Cross-Sectional Survey Data %A Al-Hasan,Abrar %A Yim,Dobin %A Khuntia,Jiban %+ College of Business Administration, Kuwait University, Information Systems and Operation Management Department, AlShadadiya University City, 13055, Kuwait, 965 51165005, abrar.alhasan@ku.edu.kw %K COVID-19 %K adherence %K social distancing %K government perception %K information sources %K social media %K knowledge %D 2020 %7 11.8.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Social distancing is an effective preventative policy for the coronavirus disease (COVID-19) that is enforced by governments worldwide. However, significant variations are observed in following the policy across individuals and countries. Arguably, differences in citizens’ adherence actions will be influenced by their perceptions about government’s plans and the information available to guide their behaviors—more so in the digital age in the realm of mass influence of social media on citizens. Insights into the underlying factors and dynamics involved with citizens’ adherence process will inform the policy makers to follow appropriate communication and messaging approaches to influence citizens’ willingness to adhere to the recommendations. Objective: The aim of this study is a comparative evaluation of citizens’ adherence process to COVID-19–relevant recommendations by the government. The focus is on how three different countries’ (United States, Kuwait, and South Korea) citizens, randomly sampled, respond to governments’ pandemic guidance efforts. We draw insights into two categories of perceived government roles in managing the pandemic: (1) citizens’ perceptions of government’s role in responding to the pandemic and (2) citizens’ perceptions of government’s business reopening efforts. Undoubtedly, the internet and social media have burgeoned, with differing effects on shaping individuals’ views and assessments of the COVID-19 situation; we argue and test for the effects of information sources, social media use, and knowledge on the adherence actions. Methods: We randomly sampled web-based survey data collected by a global firm in May 2020 from citizens of the United States, Kuwait, and South Korea. A nonlinear ordered probit regression, controlling for several counterfactuals, was used for analysis. The focal estimated effects of the study were compared across countries using the weighted distance between the parameter estimates. Results: The total sample size was 482 respondents, of which 207 (43%) lived in the United States, 181 (38%) lived in Kuwait, and 94 (20%) lived in South Korea. The ordered probit estimation results suggest that overall, perception of government response efforts positively influenced self-adherence (P<.001) and others’ adherence (P<.001) to social distancing and sheltering. Perception of government business reopening efforts positively influenced others’ adherence (P<.001). A higher intensity of general health information source for COVID-19 had a positive effect on self-adherence (P=.003). A higher intensity of social media source use for COVID-19 positively influenced others’ adherence (P=.002). A higher intensity of knowledge on COVID-19 positively influenced self-adherence (P=.008) and negatively influenced others’ adherence (P<.001). There were country-level variations—broadly, the United States and Kuwait had better effects than South Korea. Conclusions: As the COVID-19 global pandemic continues to grow and governmental restrictions are ongoing, it is critical to understand people’s frustration to reduce panic and promote social distancing to facilitate the control of the pandemic. This study finds that the government plays a central role in terms of adherence to restrictions. Governments need to enhance their efforts on publicizing information on the pandemic, as well as employ strategies for improved communication management to citizens through social media as well as mainstream information sources. %M 32716896 %R 10.2196/20634 %U http://www.jmir.org/2020/8/e20634/ %U https://doi.org/10.2196/20634 %U http://www.ncbi.nlm.nih.gov/pubmed/32716896 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 8 %P e19615 %T Global Research on Coronaviruses: An R Package %A Warin,Thierry %+ HEC Montreal, 3000, chemin de la Côte-Sainte-Catherine, Montreal, QC, H3T 2A7, Canada, 1 514 340 6185, thierry.warin@hec.ca %K COVID-19 %K SARS-CoV-2 %K coronavirus %K R package %K bibliometric %K virus %K infectious disease %K reference %K informatics %D 2020 %7 11.8.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: In these trying times, we developed an R package about bibliographic references on coronaviruses. Working with reproducible research principles based on open science, disseminating scientific information, providing easy access to scientific production on this particular issue, and offering a rapid integration in researchers’ workflows may help save time in this race against the virus, notably in terms of public health. Objective: The goal is to simplify the workflow of interested researchers, with multidisciplinary research in mind. With more than 60,500 medical bibliographic references at the time of publication, this package is among the largest about coronaviruses. Methods: This package could be of interest to epidemiologists, researchers in scientometrics, biostatisticians, as well as data scientists broadly defined. This package collects references from PubMed and organizes the data in a data frame. We then built functions to sort through this collection of references. Researchers can also integrate the data into their pipeline and implement them in R within their code libraries. Results: We provide a short use case in this paper based on a bibliometric analysis of the references made available by this package. Classification techniques can also be used to go through the large volume of references and allow researchers to save time on this part of their research. Network analysis can be used to filter the data set. Text mining techniques can also help researchers calculate similarity indices and help them focus on the parts of the literature that are relevant for their research. Conclusions: This package aims at accelerating research on coronaviruses. Epidemiologists can integrate this package into their workflow. It is also possible to add a machine learning layer on top of this package to model the latest advances in research about coronaviruses, as we update this package daily. It is also the only one of this size, to the best of our knowledge, to be built in the R language. %M 32730218 %R 10.2196/19615 %U http://www.jmir.org/2020/8/e19615/ %U https://doi.org/10.2196/19615 %U http://www.ncbi.nlm.nih.gov/pubmed/32730218 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 8 %P e19529 %T Mobile Fotonovelas Within a Text Message Outreach: An Innovative Tool to Build Health Literacy and Influence Behaviors in Response to the COVID-19 Pandemic %A Brar Prayaga,Rena %A Prayaga,Ram S %+ mPulse Mobile, Inc, 16530 Ventura Blvd, Suite 500, Encino, CA, 91436, United States, 1 888 678 5735, rena@mpulsemobile.com %K text messaging %K SMS %K mobile fotonovelas %K COVID-19 %K social isolation %K social support %K health behaviors %K health literacy %K health plans %D 2020 %7 10.8.2020 %9 Viewpoint %J JMIR Mhealth Uhealth %G English %X With all 50 US states reporting cases of coronavirus disease (COVID-19), people around the country are adapting and stepping up to the challenges of the pandemic; however, they are also frightened, anxious, and confused about what they can do to avoid exposure to the disease. Usual habits have been interrupted as a result of the crisis, and consumers are open to suggestions and strategies to help them change long-standing attitudes and behaviors. In response, a novel and innovative mobile communication capability was developed to present health messages in English and Spanish with links to fotonovelas (visual stories) that are accessible, easy to understand across literacy levels, and compelling to a diverse audience. While SMS text message outreach has been used to build health literacy and provide social support, few studies have explored the benefits of SMS text messaging combined with visual stories to influence health behaviors and build knowledge and self-efficacy. In particular, this approach can be used to provide vital information, resources, empathy, and support to the most vulnerable populations. This also allows providers and health plans to quickly reach out to their patients and members without any additional resource demands at a time when the health care system is severely overburdened. %M 32716894 %R 10.2196/19529 %U http://mhealth.jmir.org/2020/8/e19529/ %U https://doi.org/10.2196/19529 %U http://www.ncbi.nlm.nih.gov/pubmed/32716894 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 8 %P e19611 %T Assessment of the Impact of Media Coverage on COVID-19–Related Google Trends Data: Infodemiology Study %A Sousa-Pinto,Bernardo %A Anto,Aram %A Czarlewski,Wienia %A Anto,Josep M %A Fonseca,João Almeida %A Bousquet,Jean %+ Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Rua Plácido Costa s/n, Porto, 4400, Portugal, 351 912362153, bernardosousapinto@protonmail.com %K COVID-19 %K infodemiology %K infodemic %K Google Trends %K media coverage %K media %K coronavirus %K symptom %K monitoring %K trend %K pandemic %D 2020 %7 10.8.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The influence of media coverage on web-based searches may hinder the role of Google Trends (GT) in monitoring coronavirus disease (COVID-19). Objective: The aim of this study was to assess whether COVID-19–related GT data, particularly those related to ageusia and anosmia, were primarily related to media coverage or to epidemic trends. Methods: We retrieved GT query data for searches on coronavirus, cough, anosmia, and ageusia and plotted them over a period of 5 years. In addition, we analyzed the trends of those queries for 17 countries throughout the year 2020 with a particular focus on the rises and peaks of the searches. For anosmia and ageusia, we assessed whether the respective GT data correlated with COVID-19 cases and deaths both throughout 2020 and specifically before March 16, 2020 (ie, the date when the media started reporting that these symptoms can be associated with COVID-19). Results: Over the last five years, peaks for coronavirus searches in GT were only observed during the winter of 2020. Rises and peaks in coronavirus searches appeared at similar times in the 17 different assessed countries irrespective of their epidemic situations. In 15 of these countries, rises in anosmia and ageusia searches occurred in the same week or 1 week after they were identified in the media as symptoms of COVID-19. When data prior to March 16, 2020 were analyzed, anosmia and ageusia GT data were found to have variable correlations with COVID-19 cases and deaths in the different countries. Conclusions: Our results indicate that COVID-19–related GT data are more closely related to media coverage than to epidemic trends. %M 32530816 %R 10.2196/19611 %U https://www.jmir.org/2020/8/e19611 %U https://doi.org/10.2196/19611 %U http://www.ncbi.nlm.nih.gov/pubmed/32530816 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 8 %P e19104 %T Approaches Based on Artificial Intelligence and the Internet of Intelligent Things to Prevent the Spread of COVID-19: Scoping Review %A Adly,Aya Sedky %A Adly,Afnan Sedky %A Adly,Mahmoud Sedky %+ Faculty of Oral and Dental Medicine, Cairo University, Cairo University Road, Cairo, , Egypt, 20 1145559778, dr.mahmoud.sedky@gmail.com %K SARS-CoV-2 %K COVID-19 %K novel coronavirus %K artificial intelligence %K internet of things %K telemedicine %K machine learning %K modeling %K simulation %K robotics %D 2020 %7 10.8.2020 %9 Review %J J Med Internet Res %G English %X Background: Artificial intelligence (AI) and the Internet of Intelligent Things (IIoT) are promising technologies to prevent the concerningly rapid spread of coronavirus disease (COVID-19) and to maximize safety during the pandemic. With the exponential increase in the number of COVID-19 patients, it is highly possible that physicians and health care workers will not be able to treat all cases. Thus, computer scientists can contribute to the fight against COVID-19 by introducing more intelligent solutions to achieve rapid control of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes the disease. Objective: The objectives of this review were to analyze the current literature, discuss the applicability of reported ideas for using AI to prevent and control COVID-19, and build a comprehensive view of how current systems may be useful in particular areas. This may be of great help to many health care administrators, computer scientists, and policy makers worldwide. Methods: We conducted an electronic search of articles in the MEDLINE, Google Scholar, Embase, and Web of Knowledge databases to formulate a comprehensive review that summarizes different categories of the most recently reported AI-based approaches to prevent and control the spread of COVID-19. Results: Our search identified the 10 most recent AI approaches that were suggested to provide the best solutions for maximizing safety and preventing the spread of COVID-19. These approaches included detection of suspected cases, large-scale screening, monitoring, interactions with experimental therapies, pneumonia screening, use of the IIoT for data and information gathering and integration, resource allocation, predictions, modeling and simulation, and robotics for medical quarantine. Conclusions: We found few or almost no studies regarding the use of AI to examine COVID-19 interactions with experimental therapies, the use of AI for resource allocation to COVID-19 patients, or the use of AI and the IIoT for COVID-19 data and information gathering/integration. Moreover, the adoption of other approaches, including use of AI for COVID-19 prediction, use of AI for COVID-19 modeling and simulation, and use of AI robotics for medical quarantine, should be further emphasized by researchers because these important approaches lack sufficient numbers of studies. Therefore, we recommend that computer scientists focus on these approaches, which are still not being adequately addressed. %M 32584780 %R 10.2196/19104 %U https://www.jmir.org/2020/8/e19104 %U https://doi.org/10.2196/19104 %U http://www.ncbi.nlm.nih.gov/pubmed/32584780 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 8 %P e19493 %T Telehealth for Noncritical Patients With Chronic Diseases During the COVID-19 Pandemic %A Liu,Na %A Huang,Robin %A Baldacchino,Tanya %A Sud,Archana %A Sud,Kamal %A Khadra,Mohamed %A Kim,Jinman %+ The University of Sydney Business School, Abercrombie Building (H70), Sydney, 2006, Australia, 61 2 86274277, liu.na@sydney.edu.au %K telehealth %K chronic diseases %K COVID-19 %K coronavirus %K pandemic %K remote monitoring %K copresence %D 2020 %7 7.8.2020 %9 Viewpoint %J J Med Internet Res %G English %X During the recent coronavirus disease (COVID-19) pandemic, telehealth has received greater attention due to its role in reducing hospital visits from patients with COVID-19 or other conditions, while supporting home isolation in patients with mild symptoms. The needs of patients with chronic diseases tend to be overlooked during the pandemic. With reduced opportunities for routine clinic visits, these patients are adopting various telehealth services such as video consultation and remote monitoring. We advocate for more innovative designs to be considered to enhance patients’ feelings of “copresence”—a sense of connection with another interactant via digital technology—with their health care providers during this time. The copresence-enhanced design has been shown to reduce patients’ anxiety and increase their confidence in managing their chronic disease condition. It has the potential to reduce the patient’s need to reach out to their health care provider during a time when health care resources are being stretched. %M 32721925 %R 10.2196/19493 %U http://www.jmir.org/2020/8/e19493/ %U https://doi.org/10.2196/19493 %U http://www.ncbi.nlm.nih.gov/pubmed/32721925 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 8 %P e20961 %T Impact of the COVID-19 Pandemic on Partner Relationships and Sexual and Reproductive Health: Cross-Sectional, Online Survey Study %A Li,Guanjian %A Tang,Dongdong %A Song,Bing %A Wang,Chao %A Qunshan,Shen %A Xu,Chuan %A Geng,Hao %A Wu,Huan %A He,Xiaojin %A Cao,Yunxia %+ Reproductive Medicine Center, Department of Obstetrics and Gynecology, The First Affiliated Hospital of Anhui Medical University, National Health Commission Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, 81 Meishan Road, Hefei, 230000, China, 86 15395104659, caoyunxia6@126.com %K COVID-19 %K survey %K novel coronavirus %K sexual behavior %K sexual health %K reproductive health %K young adults %K youth %K China %D 2020 %7 6.8.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: In the past few months, the coronavirus disease (COVID-19) pandemic has caused extensive economic and social damage. Objective: The purpose of this study was to assess the impact of COVID-19–related measures on partner relationships and sexual and reproductive health in China. Methods: From May 1 to 5, 2020, 3500 young Chinese individuals were recruited through WeChat or Weibo to participate in a survey to obtain information on sexual and reproductive health (eg, sexual desire, frequency of sexual intercourse, sexual satisfaction, etc). The questionnaire also collected demographic data (eg, age, race, education, current financial status, sexual orientation, relationship status, etc). Results: In total, 967 participants were included in the sexual health analysis. Due to the COVID-19 pandemic and related containment measures, 22% of participants (n=212) reported a decrease in sexual desire; 41% (n=396) experienced a decrease in the sexual intercourse frequency; 30% (n=291) reported an increase in the frequency of masturbation; 20% (n=192) reported a decrease in alcohol consumption before or during sexual activities, and 31% (n=298) reported a deterioration in partner relationships during the pandemic. The logistic regression analysis indicated that the following influenced partner relationships: accommodations during the pandemic (P=.046; odds ratio [OR] 0.59; 95% CI 0.30-0.86); exclusive relationship status (yes or no) (P<.001; OR 0.44; 95 % CI 0.27-0.73); sexual desire (P=.02; OR 2.01; 95% CI 1.38-2.97); and sexual satisfaction (P<.001; OR 1.92; 95% CI 1.54-2.50). COVID-19 also caused disruptions in reproductive health services such as prenatal and postnatal care, childbirth and abortion services, contraception availability, and the management of sexually transmitted infections. Conclusions: Our results show that many young people have wide-ranging issues affecting their sexual and reproductive health due to the COVID-19 pandemic and related containment measures. Strategies and guidelines are needed to safeguard the sexual and reproductive health of young people during this pandemic. %M 32716895 %R 10.2196/20961 %U https://www.jmir.org/2020/8/e20961 %U https://doi.org/10.2196/20961 %U http://www.ncbi.nlm.nih.gov/pubmed/32716895 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 8 %P e20328 %T Mental Health Disorders and Associated Risk Factors in Quarantined Adults During the COVID-19 Outbreak in China: Cross-Sectional Study %A Guo,Yan %A Cheng,Chao %A Zeng,Yu %A Li,Yiran %A Zhu,Mengting %A Yang,Weixiong %A Xu,He %A Li,Xiaohua %A Leng,Jinhang %A Monroe-Wise,Aliza %A Wu,Shaomin %+ Department of Thoracic Surgery, The First Affiliated Hospital of Sun Yat-sen University, No 58 2nd Zhongshan Road, Guangzhou, 510080, China, 86 87755766, drchengchao@163.com %K COVID-19 %K anxiety or depressive symptoms %K quarantine %K risk and protective factors %D 2020 %7 6.8.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: People undergoing mass home- and community-based quarantine are vulnerable to mental health disorders during outbreaks of coronavirus disease (COVID-19), but few studies have evaluated the associated psychosocial factors. Objective: This study aimed to estimate the prevalence of anxiety and depressive symptoms and identify associated demographic and psychosocial factors in the general Chinese population during the COVID-19 pandemic quarantine period. Methods: Participants aged 18 years or above were recruited in a cross-sectional online survey using snowball sampling from February 26-29, 2020. The survey included questions on demographics, family relationships, chronic diseases, quarantine conditions, lifestyle, COVID-19 infection, and anxiety and depressive symptoms. Logistic regression analyses were conducted to identify factors associated with elevated anxiety or depressive symptoms. Results: Out of 2331 participants, 762 (32.7%) experienced elevated anxiety or depressive symptoms. Nine risk factors associated with anxiety or depressive symptoms included younger age, reduced income, having cancer or other chronic diseases, having family members living with cancer, concerns related to COVID-19 infection for themselves or family members, living alone, having family conflicts, having <3 or >8 hours of sedentary time per day, and worsened sleep quality. Conclusions: The findings highlight an urgent need for psychological support for populations at high risk for elevated anxiety or depressive symptoms during the COVID-19 pandemic. %M 32716899 %R 10.2196/20328 %U http://www.jmir.org/2020/8/e20328/ %U https://doi.org/10.2196/20328 %U http://www.ncbi.nlm.nih.gov/pubmed/32716899 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 8 %P e20186 %T What Media Helps, What Media Hurts: A Mixed Methods Survey Study of Coping with COVID-19 Using the Media Repertoire Framework and the Appraisal Theory of Stress %A Pahayahay,Amber %A Khalili-Mahani,Najmeh %+ PERFORM Centre, Concordia University, PC 2.207 PERFORM Centre, 7200 Rue Sherbrooke O, Montreal, QC, H4B 1R6, Canada, 1 514 848 2424 ext 5370, najmeh.khalili-mahani@concordia.ca %K Netflix %K social network %K stress %K COVID-19 %K information and communication technologies %K survey %K media %K coping %K infodemic %K infodemiology %D 2020 %7 6.8.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Social and physical distancing in response to the coronavirus disease (COVID-19) pandemic has made screen-mediated information and communication technologies (media) indispensable. Whether an increase in screen use is a source of or a relief for stress remains to be seen. Objective: In the immediate aftermath of the COVID-19 lockdowns, we investigated the relation between subjective stress and changes in the pattern of media use. Based on Lazarus’s transactional model of appraisal and coping, and building on an earlier similar survey, we hypothesize that individual differences in the appraisal of media predict variations in approach or avoidance of media for coping with COVID-19 stress. Methods: Between March 20 and April 20, 2020, a brief snowball survey entitled: “What media helps, what media hurts: coping with COVID19 through screens” was distributed via Concordia University’s mailing lists and social media (PERFORM Centre, EngAGE Centre, and Media Health Lab). Using a media repertoire method, we asked questions about preferences, changes in use, and personal appraisal of media experiences (approach, avoid, and ignore) as a result of the COVID-19 pandemic and investigated interindividual differences in media use by factors such as subjective stress, age, gender, and self-reported mental health. Results: More than 90% of the survey respondents were in Canada and the east coast of the United States. From 685 completed responses, 169 respondents were “very stressed” and 452 were “slightly worried” about the pandemic. COVID-19 stress led to increased use of Facebook (χ23=11.76, P=.008), television (χ23=12.40, P=.006), YouTube (χ23=8.577, P=.04), and streaming services such as Netflix (χ23=10.71, P=.01). Respondents who considered their mental health “not good” were twice as likely to prefer streaming services as a coping tool for self-isolation. Women and nonbinary respondents were twice as likely than men to pick social media for coping. Individuals younger than 35 years were 3 times more likely to pick computer games, and individuals older than 55 years were more likely to pick network television or print media. Gender affected the appraisal of media (less in men than others) in terms of avoid (F1,637=5.84, P=.02) and approach scores (F1,637=14.31, P<.001). Subjective mental health affected the ignore score (less in those who said “good” than others; F1,637=13.88, P<.001). The appraisal score and use increase explained variations in worrying about physical and mental health stress due to increased screen time. A qualitative analysis of open-ended questions revealed that media (especially social networks) were important for coping if they provided support and connection through the dissemination of factual and positive information while avoiding the overflow of sensational and false news. Conclusions: The relationship between appraisal of media’s positive and negative facets vary with demographic differences in mental health resiliency. The media repertoire approach is an important tool in studies that focus on assessing the benefits and harms of screen overuse in different populations, especially in the context of the COVID-19 pandemic. %M 32701459 %R 10.2196/20186 %U https://www.jmir.org/2020/8/e20186 %U https://doi.org/10.2196/20186 %U http://www.ncbi.nlm.nih.gov/pubmed/32701459 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 8 %P e19678 %T The Internet Hospital Plus Drug Delivery Platform for Health Management During the COVID-19 Pandemic: Observational Study %A Ding,Liang %A She,Qiuru %A Chen,Fengxian %A Chen,Zitong %A Jiang,Meifang %A Huang,Huasi %A Li,Yujin %A Liao,Chaofeng %+ Department of Pharmacy, People’s Hospital of Baoan Shenzhen, 118 Longjing 2nd Road, Shenzhen, 518101, China, 86 18926480093, bayylcf@126.com %K internet hospital %K drug delivery %K internet hospital plus drug delivery %K IHDD %K health management %K COVID-19 %D 2020 %7 6.8.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Widespread access to the internet has boosted the emergence of online hospitals. A new outpatient service called “internet hospital plus drug delivery” (IHDD) has been developed in China, but little is known about this platform. Objective: The aim of this study is to investigate the characteristics, acceptance, and initial impact of IHDD during the outbreak of COVID-19 in a tertiary hospital in South China Methods: The total number of and detailed information on online prescriptions during the first 2 months after work resumption were obtained. Patients’ gender, age, residence, associated prescription department, time of prescription, payment, and drug delivery region were included in the analysis. Results: A total of 1380 prescriptions were picked up or delivered between March 2 and April 20, 2020. The largest group of patients were 36-59 years old (n=680, 49.3%), followed by the 18-35 years age category (n=573, 41.5%). In total, 39.4% (n=544) of the patients chose to get their medicine by self-pickup, while 60.6% (n=836) preferred to receive their medicine via drug delivery service. The top five online prescription departments were infectious diseases (n=572, 41.4%), nephrology (n=264, 19.1%), endocrinology (n=145, 10.5%), angiocardiopathy (n=107, 7.8%), and neurology (n=42, 3%). Of the 836 delivered prescriptions, 440 (52.6%) were sent to Guangdong Province (including 363 [43.4%] to Shenzhen), and 396 (47.4%) were sent to other provinces in China. Conclusions: The IHDD platform is efficient and convenient for various types of patients during the COVID-19 crisis. Although offline visits are essential for patients with severe conditions, IHDD can help to relieve pressure on hospitals by reducing an influx of patients with mild symptoms. Further efforts need to be made to improve the quality and acceptance of IHDD, as well as to regulate and standardize the management of this novel service. %M 32716892 %R 10.2196/19678 %U http://www.jmir.org/2020/8/e19678/ %U https://doi.org/10.2196/19678 %U http://www.ncbi.nlm.nih.gov/pubmed/32716892 %0 Journal Article %@ 2562-7600 %I JMIR Publications %V 3 %N 1 %P e20596 %T Mobile Health Apps That Help With COVID-19 Management: Scoping Review %A John Leon Singh,Hanson %A Couch,Danielle %A Yap,Kevin %+ Department of Public Health, School of Psychology and Public Health, La Trobe University, Health Sciences 2 Building, Melbourne, 3086, Australia, 61 3 9479 6068, kevinyap.ehealth@gmail.com %K COVID-19 %K mobile apps %K mHealth %K contact tracing %K symptom monitoring %K information provision %K mobile health %D 2020 %7 6.8.2020 %9 Review %J JMIR Nursing %G English %X Background: Mobile health (mHealth) apps have played an important role in mitigating the coronavirus disease (COVID-19) response. However, there is no resource that provides a holistic picture of the available mHealth apps that have been developed to combat this pandemic. Objective: Our aim is to scope the evidence base on apps that were developed in response to COVID-19. Methods: Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines for scoping reviews, literature searches were conducted on Google Search, Google Scholar, and PubMed using the country’s name as keywords and “coronavirus,” “COVID-19,” “nCOV19,” “contact tracing,” “information providing apps,” “symptom tracking,” “mobile apps,” “mobile applications,” “smartphone,” “mobile phone,” and “mHealth.” Countries most affected by COVID-19 and those that first rolled out COVID-19–related apps were included. Results: A total of 46 articles were reviewed from 19 countries, resulting in a total of 29 apps. Among them, 15 (52%) apps were on contact tracing, 7 (24%) apps on quarantine, 7 (24%) on symptom monitoring, and 1 (3%) on information provision. More than half (n=20, 69%) were from governmental sources, only 3 (10%) were from private organizations, and 3 (10%) from universities. There were 6 (21%) apps available on either Android or iOS, and 10 (34%) were available on both platforms. Bluetooth was used in 10 (34%) apps for collecting data, 12 (41%) apps used GPS, and 12 (41%) used other forms of data collection. Conclusions: This review identifies that the majority of COVID-19 apps were for contact tracing and symptom monitoring. However, these apps are effective only if taken up by the community. The sharing of good practices across different countries can enable governments to learn from each other and develop effective strategies to combat and manage this pandemic. %M 32897271 %R 10.2196/20596 %U https://nursing.jmir.org/2020/1/e20596/ %U https://doi.org/10.2196/20596 %U http://www.ncbi.nlm.nih.gov/pubmed/32897271 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 8 %P e19745 %T Telemedicine in Germany During the COVID-19 Pandemic: Multi-Professional National Survey %A Peine,Arne %A Paffenholz,Pia %A Martin,Lukas %A Dohmen,Sandra %A Marx,Gernot %A Loosen,Sven H %+ Department of Intensive Care and Intermediate Care, University Hospital Rheinisch Westfaelische Technische Hochschule Aachen, Pauwelsstraße 30, Aachen, 52072, Germany, 49 2418038009, apeine@ukaachen.de %K telemedicine %K coronavirus %K COVID-19 %K telehealth %K SARS-CoV-2 %K pandemic %K survey %K medical professional %K availability %K acceptance %K burden %D 2020 %7 5.8.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: In an effort to contain the effects of the coronavirus disease (COVID-19) pandemic, health care systems worldwide implemented telemedical solutions to overcome staffing, technical, and infrastructural limitations. In Germany, a multitude of telemedical systems are already being used, while new approaches are rapidly being developed in response to the crisis. However, the extent of the current implementation within different health care settings, the user’s acceptance and perception, as well as the hindering technical and regulatory obstacles remain unclear. Objective: The aim of this paper is to assess the current status quo of the availability and routine use of telemedical solutions, user acceptance, and the subjectively perceived burdens on telemedical approaches. Furthermore, we seek to assess the perception of public information quality among professional groups and their preferred communication channels. Methods: A national online survey was conducted on 14 consecutive days in March and April 2020, and distributed to doctors, nurses, and other medical professionals in the German language. Results: A total of 2827 medical professionals participated in the study. Doctors accounted for 65.6% (n=1855) of the professionals, 29.5% (n=833) were nursing staff, and 4.9% (n=139) were identified as others such as therapeutic staff. A majority of participants rated the significance of telemedicine within the crisis as high (1065/2730, 39%) or neutral (n=720, 26.4%); however, there were significant differences between doctors and nurses (P=.01) as well as between the stationary sector compared to the ambulatory sector (P<.001). Telemedicine was already in routine use for 19.6% (532/2711) of German health care providers and in partial use for 40.2% (n=1090). Participants working in private practices (239/594, 40.2%) or private clinics (23/59, 39.0%) experienced less regulatory or technical obstacles compared to university hospitals (586/1190, 49.2%). A majority of doctors rated the public information quality on COVID-19 as good (942/1855, 50.8%) or very good (213/1855, 11.5%); nurses rated the quality of public information significantly lower (P<.001). Participant’s age negatively correlated with the perception of telemedicine’s significance (ρ=–0.23; P<.001). Conclusions: Telemedicine has a broad acceptance among German medical professionals. However, to establish telemedical structures within routine care, technical and regulatory burdens must be overcome. %M 32568724 %R 10.2196/19745 %U https://www.jmir.org/2020/8/e19745 %U https://doi.org/10.2196/19745 %U http://www.ncbi.nlm.nih.gov/pubmed/32568724 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 8 %P e19551 %T Effects of Internet Hospital Consultations on Psychological Burdens and Disease Knowledge During the Early Outbreak of COVID-19 in China: Cross-Sectional Survey Study %A Li,Lin %A Liu,Gang %A Xu,Weiguo %A Zhang,Yun %A He,Mei %+ Department of President’s Office, Mianyang Central Hospital, 12# Changjia Lane, Jingzhong Street, Fucheng District, Mianyang, 621000, China, 1 13981110800, hemeimy@163.com %K internet hospital %K telemedicine %K novel coronavirus disease %K pandemic %K psychological burden %K disease cognition %K coronavirus %K COVID-19 %K public health %K infectious disease %D 2020 %7 4.8.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Coronavirus disease (COVID-19) has become a global threat to human health. Internet hospitals have emerged as a critical technology to bring epidemic-related web-based services and medical support to the public. However, only a few very recent scientific literature reports have explored the effects of internet hospitals on psychological burden and disease knowledge in major public health emergencies such as the COVID-19 pandemic. Objective: The aim of this study was to explore the role of internet hospitals in relieving psychological burden and increasing disease knowledge during the early outbreak of the COVID-19 pandemic. Methods: This survey was conducted from January 26 to February 1, 2020, during the early outbreak of COVID-19 in China. The platform used for the consultation was the WeChat public account of our hospital. To participate in the study, the patient was required to answer a list of questions to exclude the possibility of COVID-19 infection and confirm their willingness to participate voluntarily. Next, the participant was directed to complete the self-report questionnaire. After the internet consultation, the participant was directed to complete the self-report questionnaire again. The questionnaire included sections on general information, the General Health Questionnaire-28 (GHQ-28), and the participant’s worries, disease knowledge, and need for hospital treatment. Results: The total number of internet consultations was 4120. The consultation topics mainly included respiratory symptoms such as cough, expectoration, and fever (2489/4120, 60.4%) and disease knowledge, anxiety, and fear (1023/4120, 24.8%). A total of 1530 people filled out the questionnaires before and after the internet consultation. Of these people, 1398/1530 (91.4%) experienced psychological stress before the internet consultation, which significantly decreased after consultation (260/1530, 17.0%) (χ21=1704.8, P<.001). There was no significant difference in the number of people who expressed concern about the COVID-19 pandemic before and after the internet consultation (χ21=0.7, P=.43). However, the degree of concern after the internet consultation was significantly alleviated (t2699=90.638, P<.001). The main worries before and after consultation were the dangers posed by the disease and the risk of infection of family members. The scores of the self-assessment risk after the internet consultation were significantly lower than those before consultation (t3058=95.694, P<.001). After the consultation, the participants’ knowledge of the symptoms, transmission routes, and preventive measures of COVID-19 was significantly higher than before the consultation (t3058=–106.105, –80.456, and –152.605, respectively; all P<.001). The hospital treatment need score after the internet consultation decreased from 3.3 (SD 1.2) to 1.6 (SD 0.8), and the difference was statistically significant (t3058=45.765, P<.001). Conclusions: During the early outbreak of COVID-19, internet hospitals could help relieve psychological burdens and increase disease awareness through timely and rapid spread of knowledge regarding COVID-19 prevention and control. Internet hospitals should be an important aspect of a new medical model in public health emergency systems. %M 32687061 %R 10.2196/19551 %U https://www.jmir.org/2020/8/e19551 %U https://doi.org/10.2196/19551 %U http://www.ncbi.nlm.nih.gov/pubmed/32687061 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 8 %P e21143 %T Cross-Country Comparison of Public Awareness, Rumors, and Behavioral Responses to the COVID-19 Epidemic: Infodemiology Study %A Hou,Zhiyuan %A Du,Fanxing %A Zhou,Xinyu %A Jiang,Hao %A Martin,Sam %A Larson,Heidi %A Lin,Leesa %+ School of Public Health, Fudan University, Mailbox 250, 138# Yixueyuan Road, Xuhui District, Shanghai, China, 86 21 33563935, zyhou@fudan.edu.cn %K COVID-19 %K internet %K surveillance %K infodemic %K infodemiology %K infoveillance %K Google Trends %K public response %K behavior %K rumor %K trend %D 2020 %7 3.8.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Understanding public behavioral responses to the coronavirus disease (COVID-19) epidemic and the accompanying infodemic is crucial to controlling the epidemic. Objective: The aim of this study was to assess real-time public awareness and behavioral responses to the COVID-19 epidemic across 12 selected countries. Methods: Internet surveillance was used to collect real-time data from the general public to assess public awareness and rumors (China: Baidu; worldwide: Google Trends) and behavior responses (China: Ali Index; worldwide: Google Shopping). These indices measured the daily number of searches or purchases and were compared with the numbers of daily COVID-19 cases. The trend comparisons across selected countries were observed from December 1, 2019 (prepandemic baseline) to April 11, 2020 (at least one month after the governments of selected countries took actions for the pandemic). Results: We identified missed windows of opportunity for early epidemic control in 12 countries, when public awareness was very low despite the emerging epidemic. China's epidemic and the declaration of a public health emergency of international concern did not prompt a worldwide public reaction to adopt health-protective measures; instead, most countries and regions only responded to the epidemic after their own case counts increased. Rumors and misinformation led to a surge of sales in herbal remedies in China and antimalarial drugs worldwide, and timely clarification of rumors mitigated the rush to purchase unproven remedies. Conclusions: Our comparative study highlights the urgent need for international coordination to promote mutual learning about epidemic characteristics and effective control measures as well as to trigger early and timely responses in individual countries. Early release of official guidelines and timely clarification of rumors led by governments are necessary to guide the public to take rational action. %M 32701460 %R 10.2196/21143 %U https://www.jmir.org/2020/8/e21143 %U https://doi.org/10.2196/21143 %U http://www.ncbi.nlm.nih.gov/pubmed/32701460 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 8 %P e19311 %T Public Health in the Information Age: Recognizing the Infosphere as a Social Determinant of Health %A Morley,Jessica %A Cowls,Josh %A Taddeo,Mariarosaria %A Floridi,Luciano %+ Oxford Internet Institute, University of Oxford, 1 St Giles',, Oxford, OX1 3JS, United Kingdom, 44 01865 287210, jessica.morley@phc.ox.ac.uk %K COVID-19 %K public health %K misinformation %K disinformation %K infodemic %K infodemiology %K infosphere %K social determinants of health %K information ethics %D 2020 %7 3.8.2020 %9 Proposal %J J Med Internet Res %G English %X Since 2016, social media companies and news providers have come under pressure to tackle the spread of political mis- and disinformation (MDI) online. However, despite evidence that online health MDI (on the web, on social media, and within mobile apps) also has negative real-world effects, there has been a lack of comparable action by either online service providers or state-sponsored public health bodies. We argue that this is problematic and seek to answer three questions: why has so little been done to control the flow of, and exposure to, health MDI online; how might more robust action be justified; and what specific, newly justified actions are needed to curb the flow of, and exposure to, online health MDI? In answering these questions, we show that four ethical concerns—related to paternalism, autonomy, freedom of speech, and pluralism—are partly responsible for the lack of intervention. We then suggest that these concerns can be overcome by relying on four arguments: (1) education is necessary but insufficient to curb the circulation of health MDI, (2) there is precedent for state control of internet content in other domains, (3) network dynamics adversely affect the spread of accurate health information, and (4) justice is best served by protecting those susceptible to inaccurate health information. These arguments provide a strong case for classifying the quality of the infosphere as a social determinant of health, thus making its protection a public health responsibility. In addition, they offer a strong justification for working to overcome the ethical concerns associated with state-led intervention in the infosphere to protect public health. %M 32648850 %R 10.2196/19311 %U https://www.jmir.org/2020/8/e19311 %U https://doi.org/10.2196/19311 %U http://www.ncbi.nlm.nih.gov/pubmed/32648850 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 3 %P e22331 %T Notes From the Field: Use of Emergency Medical Service Data to Augment COVID-19 Public Health Surveillance in Montgomery County, Maryland, From March to June 2020 %A Sayers,David R %A Hulse,Scott T %A Webber,Bryant J %A Burns,Timothy A %A Denicoff,Anne L %+ Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD, 20814, United States, 1 2704038911, david.sayers@usuhs.edu %K SARS-CoV-2 %K COVID-19 %K public health %K surveillance %K prediction %K emergency medical service %K EMS %K pulse oximetry %K testing %D 2020 %7 31.7.2020 %9 Viewpoint %J JMIR Public Health Surveill %G English %X Epidemiologic and syndromic surveillance metrics traditionally used by public health departments can be enhanced to better predict hospitalization for coronavirus disease (COVID-19). In Montgomery County, Maryland, measurements of oxygen saturation (SpO2) by pulse oximetry obtained by the emergency medical service (EMS) were added to these traditional metrics to enhance the public health picture for decision makers. During a 78-day period, the rolling 7-day average of the percentage of EMS patients with SpO2 <94% had a stronger correlation with next-day hospital bed occupancy (Spearman ρ=0.58, 95% CI 0.40-0.71) than either the rolling 7-day average of the percentage of positive tests (ρ=0.55, 95% CI: 0.37-0.69) or the rolling 7-day average of the percentage of emergency department visits for COVID-19–like illness (ρ=0.49, 95% CI: 0.30-0.64). Health departments should consider adding EMS data to augment COVID-19 surveillance and thus improve resource allocation. %M 32678799 %R 10.2196/22331 %U http://publichealth.jmir.org/2020/3/e22331/ %U https://doi.org/10.2196/22331 %U http://www.ncbi.nlm.nih.gov/pubmed/32678799 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 7 %P e20912 %T Multiple Epidemic Wave Model of the COVID-19 Pandemic: Modeling Study %A Kaxiras,Efthimios %A Neofotistos,Georgios %+ Department of Physics, Harvard University, Lyman Lab 339, 17 Oxford Street, Cambridge, MA, 02138, United States, 1 617 495 7977, kaxiras@physics.harvard.edu %K COVID-19 %K multiple waves %K transmission %K intervention measures %K simulations %K modeling %K pandemic response index %K pandemic %K virus %K intervention %D 2020 %7 30.7.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Intervention measures have been implemented around the world to mitigate the spread of the coronavirus disease (COVID-19) pandemic. Understanding the dynamics of the disease spread and the effectiveness of the interventions is essential in predicting its future evolution. Objective: The aim of this study is to simulate the effect of different social distancing interventions and investigate whether their timing and stringency can lead to multiple waves (subepidemics), which can provide a better fit to the wavy behavior observed in the infected population curve in the majority of countries. Methods: We have designed and run agent-based simulations and a multiple wave model to fit the infected population data for many countries. We have also developed a novel Pandemic Response Index to provide a quantitative and objective way of ranking countries according to their COVID-19 response performance. Results: We have analyzed data from 18 countries based on the multiple wave (subepidemics) hypothesis and present the relevant parameters. Multiple waves have been identified and were found to describe the data better. The effectiveness of intervention measures can be inferred by the peak intensities of the waves. Countries imposing fast and stringent interventions exhibit multiple waves with declining peak intensities. This result strongly corroborated with agent-based simulations outcomes. We also provided an estimate of how much lower the number of infections could have been if early and strict intervention measures had been taken to stop the spread at the first wave, as actually happened for a handful of countries. A novel index, the Pandemic Response Index, was constructed, and based on the model’s results, an index value was assigned to each country, quantifying in an objective manner the country’s response to the pandemic. Conclusions: Our results support the hypothesis that the COVID-19 pandemic can be successfully modeled as a series of epidemic waves (subepidemics) and that it is possible to infer to what extent the imposition of early intervention measures can slow the spread of the disease. %M 32692690 %R 10.2196/20912 %U http://www.jmir.org/2020/7/e20912/ %U https://doi.org/10.2196/20912 %U http://www.ncbi.nlm.nih.gov/pubmed/32692690 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 7 %P e19483 %T Regional Infoveillance of COVID-19 Case Rates: Analysis of Search-Engine Query Patterns %A Cousins,Henry C %A Cousins,Clara C %A Harris,Alon %A Pasquale,Louis R %+ Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, One Gustave L Levy Place, Box 1183, New York, NY, 10029, United States, 1 212 241 6752, louis.pasquale@mssm.edu %K epidemiology %K infoveillance %K COVID-19 %K internet activity %K Google Trends %K infectious disease %K surveillance %K public health %D 2020 %7 30.7.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Timely allocation of medical resources for coronavirus disease (COVID-19) requires early detection of regional outbreaks. Internet browsing data may predict case outbreaks in local populations that are yet to be confirmed. Objective: We investigated whether search-engine query patterns can help to predict COVID-19 case rates at the state and metropolitan area levels in the United States. Methods: We used regional confirmed case data from the New York Times and Google Trends results from 50 states and 166 county-based designated market areas (DMA). We identified search terms whose activity precedes and correlates with confirmed case rates at the national level. We used univariate regression to construct a composite explanatory variable based on best-fitting search queries offset by temporal lags. We measured the raw and z-transformed Pearson correlation and root-mean-square error (RMSE) of the explanatory variable with out-of-sample case rate data at the state and DMA levels. Results: Predictions were highly correlated with confirmed case rates at the state (mean r=0.69, 95% CI 0.51-0.81; median RMSE 1.27, IQR 1.48) and DMA levels (mean r=0.51, 95% CI 0.39-0.61; median RMSE 4.38, IQR 1.80), using search data available up to 10 days prior to confirmed case rates. They fit case-rate activity in 49 of 50 states and in 103 of 166 DMA at a significance level of .05. Conclusions: Identifiable patterns in search query activity may help to predict emerging regional outbreaks of COVID-19, although they remain vulnerable to stochastic changes in search intensity. %M 32692691 %R 10.2196/19483 %U http://www.jmir.org/2020/7/e19483/ %U https://doi.org/10.2196/19483 %U http://www.ncbi.nlm.nih.gov/pubmed/32692691 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 3 %P e19831 %T Digital or Digitally Delivered Responses to Domestic and Intimate Partner Violence During COVID-19 %A Emezue,Chuka %+ Sinclair School of Nursing, University of Missouri-Columbia, S235 School of Nursing, Columbia, MO, 65211, United States, 1 573 999 2594, chukanestor@gmail.com %K COVID-19 %K pandemic %K mental health %K digital interventions %K technology %K coronavirus %K domestic violence %K prevention %K abuse %K intimate partner violence %D 2020 %7 30.7.2020 %9 Viewpoint %J JMIR Public Health Surveill %G English %X Before the coronavirus disease (COVID-19), 1 in 3 women and girls, globally, were victimized by an abusive partner in intimate relationships. However, the current pandemic has amplified cases of domestic violence (DV) against women and girls, with up to thrice the prevalence in DV cases compared to the same time last year. Evidence of the adverse effects of the pandemic on DV is still emerging, even as violence prevention strategies are iteratively being refined by service providers, advocacy agencies, and survivors to meet stay-at-home mandates. Emotional and material support for survivors is a critical resource increasingly delivered using digital and technology-based modalities, which offer several advantages and challenges. This paper rapidly describes current DV mitigation approaches using digital solutions, signaling emerging best practices to support survivors, their children, and abusers during stay-at-home advisories. Some examples of technology-based strategies and solutions are presented. An immediate priority is mapping out current digital solutions in response to COVID-19–related DV and outlining issues with uptake, coverage, and meaningful use of digital solutions. %M 32678797 %R 10.2196/19831 %U http://publichealth.jmir.org/2020/3/e19831/ %U https://doi.org/10.2196/19831 %U http://www.ncbi.nlm.nih.gov/pubmed/32678797 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 3 %N 2 %P e19867 %T Pediatric Mental and Behavioral Health in the Period of Quarantine and Social Distancing With COVID-19 %A Ye,Jiancheng %+ Feinberg School of Medicine, Northwestern University, 633 N Saint Clair St, Chicago, IL, , United States, 1 312 503 3690, jiancheng.ye@u.northwestern.edu %K pediatrics %K mental health %K stay-at-home orders %K health technology %K digital interventions %K social distancing %K COVID-19 %D 2020 %7 28.7.2020 %9 Viewpoint %J JMIR Pediatr Parent %G English %X The coronavirus disease (COVID-19) pandemic has spread rapidly throughout the world and has had a long-term impact. The pandemic has caused great harm to society and caused serious psychological trauma to many people. Children are a vulnerable group in this global public health emergency, as their nervous systems, endocrine systems, and hypothalamic-pituitary-adrenal axes are not well developed. Psychological crises often cause children to produce feelings of abandonment, despair, incapacity, and exhaustion, and even raise the risk of suicide. Children with mental illnesses are especially vulnerable during the quarantine and social distancing period. The inclusion of psychosocial support for children and their families are part of the health responses to disaster and disaster recovery. Based on the biopsychosocial model, some children may have catastrophic thoughts and be prone to experience despair, numbness, flashbacks, and other serious emotional and behavioral reactions. In severe cases, there may be symptoms of psychosis or posttraumatic stress disorder. Timely and appropriate protections are needed to prevent the occurrence of psychological and behavioral problems. The emerging digital applications and health services such as telehealth, social media, mobile health, and remote interactive online education are able to bridge the social distance and support mental and behavioral health for children. Based on the psychological development characteristics of children, this study also illustrates interventions on the psychological impact from the COVID-19 pandemic. Even though the world has been struggling to curb the influences of the pandemic, the quarantine and social distancing policies will have long-term impacts on children. Innovative digital solutions and informatics tools are needed more than ever to mitigate the negative consequences on children. Health care delivery and services should envision and implement innovative paradigms to meet broad well-being needs and child health as the quarantine and social distancing over a longer term becomes a new reality. Future research on children's mental and behavioral health should pay more attention to novel solutions that incorporate cutting edge interactive technologies and digital approaches, leveraging considerable advances in pervasive and ubiquitous computing, human-computer interaction, and health informatics among many others. Digital approaches, health technologies, and informatics are supposed to be designed and implemented to support public health surveillance and critical responses to children’s growth and development. For instance, human-computer interactions, augmented reality, and virtual reality could be incorporated to remote psychological supporting service for children’s health; mobile technologies could be used to monitor children’s mental and behavioral health while protecting their individual privacy; big data and artificial intelligence could be used to support decision making on whether children should go out for physical activities and whether schools should be reopened. Implications to clinical practices, psychological therapeutic practices, and future research directions to address current effort gaps are highlighted in this study. %M 32634105 %R 10.2196/19867 %U http://pediatrics.jmir.org/2020/2/e19867/ %U https://doi.org/10.2196/19867 %U http://www.ncbi.nlm.nih.gov/pubmed/32634105 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 7 %N 7 %P e20429 %T Strategies to Increase Peer Support Specialists’ Capacity to Use Digital Technology in the Era of COVID-19: Pre-Post Study %A Fortuna,Karen L %A Myers,Amanda L %A Walsh,Danielle %A Walker,Robert %A Mois,George %A Brooks,Jessica M %+ Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Suite 401, 2 Pillsbury Street, Concord, NH, 03301, United States, 1 6037225727, karen.l.fortuna@dartmouth.edu %K COVID-19 %K peer support %K telemental health %K mental health %K training %D 2020 %7 23.7.2020 %9 Original Paper %J JMIR Ment Health %G English %X Background: Prior to the outbreak of coronavirus disease (COVID-19), telemental health to support mental health services was primarily designed for individuals with professional clinical degrees, such as psychologists, psychiatrists, registered nurses, and licensed clinical social workers. For the first the time in history, peer support specialists are offering Medicaid-reimbursable telemental health services during the COVID-19 crisis; however, little effort has been made to train peer support specialists on telehealth practice and delivery. Objective: The aim of this study was to explore the impact of the Digital Peer Support Certification on peer support specialists’ capacity to use digital peer support technology. Methods: The Digital Peer Support Certification was co-produced with peer support specialists and included an education and simulation training session, synchronous and asynchronous support services, and audit and feedback. Participants included 9 certified peer support specialists between the ages of 25 and 54 years (mean 39 years) who were employed as peer support specialists for 1 to 11 years (mean 4.25 years) and had access to a work-funded smartphone device and data plan. A pre-post design was implemented to examine the impact of the Digital Peer Support Certification on peer support specialists’ capacity to use technology over a 3-month timeframe. Data were collected at baseline, 1 month, 2 months, and 3 months. Results: Overall, an upward trend in peer support specialists’ capacity to offer digital peer support occurred during the 3-month certification period. Conclusions: The Digital Peer Support Certification shows promising evidence of increasing the capacity of peer support specialists to use specific digital peer support technology features. Our findings also highlighted that this capacity was less likely to increase with training alone and that a combinational knowledge translation approach that includes both training and management will be more successful. %M 32629424 %R 10.2196/20429 %U http://mental.jmir.org/2020/7/e20429/ %U https://doi.org/10.2196/20429 %U http://www.ncbi.nlm.nih.gov/pubmed/32629424 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 7 %N 7 %P e21718 %T An Integrated Blueprint for Digital Mental Health Services Amidst COVID-19 %A Balcombe,Luke %A De Leo,Diego %+ Australian Institute for Suicide Research and Prevention, Griffith University, Messines Ridge Rd, Brisbane, Australia, 61 447505709, lukebalcombe@gmail.com %K digital mental health %K mental well-being online assessments %K machine learning %K automation %K COVID-19 %K well-being services %D 2020 %7 22.7.2020 %9 Commentary %J JMIR Ment Health %G English %X In-person traditional approaches to mental health care services are facing difficulties amidst the coronavirus disease (COVID-19) crisis. The recent implementation of social distancing has redirected attention to nontraditional mental health care delivery to overcome hindrances to essential services. Telehealth has been established for several decades but has only been able to play a small role in health service delivery. Mobile and teledigital health solutions for mental health are well poised to respond to the upsurge in COVID-19 cases. Screening and tracking with real-time automation and machine learning are useful for both assisting psychological first-aid resources and targeting interventions. However, rigorous evaluation of these new opportunities is needed in terms of quality of interventions, effectiveness, and confidentiality. Service delivery could be broadened to include trained, unlicensed professionals, who may help health care services in delivering evidence-based strategies. Digital mental health services emerged during the pandemic as complementary ways of assisting community members with stress and transitioning to new ways of living and working. As part of a hybrid model of care, technologies (mobile and online platforms) require consolidated and consistent guidelines as well as consensus, expert, and position statements on the screening and tracking (with real-time automation and machine learning) of mental health in general populations as well as considerations and initiatives for underserved and vulnerable subpopulations. %M 32668402 %R 10.2196/21718 %U https://mental.jmir.org/2020/7/e21718 %U https://doi.org/10.2196/21718 %U http://www.ncbi.nlm.nih.gov/pubmed/32668402 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 7 %P e19916 %T Online Antenatal Care During the COVID-19 Pandemic: Opportunities and Challenges %A Wu,Huailiang %A Sun,Weiwei %A Huang,Xinyu %A Yu,Shinning %A Wang,Hao %A Bi,Xiaoyu %A Sheng,Jie %A Chen,Sihan %A Akinwunmi,Babatunde %A Zhang,Casper J P %A Ming,Wai-Kit %+ Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, No 602 Huangpu Avenue West, Tianhe District, Guangzhou, 510000, China, 86 14715485116, wkming@connect.hku.hk %K coronavirus disease %K COVID-19 %K SARS-CoV-2 %K online prenatal education %K pregnancy %K online education %K antenatal %K telehealth %K convenience %K inequality %D 2020 %7 22.7.2020 %9 Viewpoint %J J Med Internet Res %G English %X People across the world have been greatly affected by the ongoing coronavirus disease (COVID-19) pandemic. The high infection risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in hospitals is particularly problematic for recently delivered mothers and currently pregnant women who require professional antenatal care. Online antenatal care would be a preferable alternative for these women since it can provide pregnancy-related information and remote clinic consultations. In addition, online antenatal care may help to provide relatively economical medical services and diminish health care inequality due to its convenience and cost-effectiveness, especially in developing countries or regions. However, some pregnant women will doubt the reliability of such online information. Therefore, it is important to ensure the quality and safety of online services and establish a stable, mutual trust between the pregnant women, the obstetric care providers and the technology vis-a-vis the online programs. Here, we report how the COVID-19 pandemic brings not only opportunities for the development and popularization of online antenatal care programs but also challenges. %M 32658860 %R 10.2196/19916 %U http://www.jmir.org/2020/7/e19916/ %U https://doi.org/10.2196/19916 %U http://www.ncbi.nlm.nih.gov/pubmed/32658860 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 7 %P e19904 %T Impact of National Containment Measures on Decelerating the Increase in Daily New Cases of COVID-19 in 54 Countries and 4 Epicenters of the Pandemic: Comparative Observational Study %A Wong,Carlos K H %A Wong,Janet Y H %A Tang,Eric H M %A Au,Chi Ho %A Lau,Kristy T K %A Wai,Abraham K C %+ Emergency Medicine Unit, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Room 514, William MW Mong Block, Faculty of Medicine Building, 21 Sassoon Road, Pokfulam, Hong Kong, , China (Hong Kong), 852 3917 9859, awai@hku.hk %K COVID-19 %K national containment %K lockdown %K curfew %K stay-at-home %K epidemic curve %D 2020 %7 22.7.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Coronavirus disease (COVID-19) is a worldwide epidemic, and various countries have responded with different containment measures to reduce disease transmission, including stay-at-home orders, curfews, and lockdowns. Comparative studies have not yet been conducted to investigate the impact of these containment measures; these studies are needed to facilitate public health policy-making across countries. Objective: The aim of this study was to describe and evaluate the impact of national containment measures and policies (stay-at-home orders, curfews, and lockdowns) on decelerating the increase in daily new cases of COVID-19 in 54 countries and 4 epicenters of the pandemic in different jurisdictions worldwide. Methods: We reviewed the effective dates of the national containment measures (stay-at-home order, curfew, or lockdown) of 54 countries and 4 epicenters of the COVID-19 pandemic (Wuhan, New York State, Lombardy, and Madrid), and we searched cumulative numbers of confirmed COVID-19 cases and daily new cases provided by health authorities. Data were drawn from an open, crowdsourced, daily-updated COVID-19 data set provided by Our World in Data. We examined the trends in the percent increase in daily new cases from 7 days before to 30 days after the dates on which containment measures went into effect by continent, World Bank income classification, type of containment measures, effective date of containment measures, and number of confirmed cases on the effective date of the containment measures. Results: We included 122,366 patients with confirmed COVID-19 infection from 54 countries and 24,071 patients from 4 epicenters on the effective dates on which stay-at-home orders, curfews, or lockdowns were implemented between January 23 and April 11, 2020. Stay-at-home, curfew, and lockdown measures commonly commenced in countries with approximately 30%, 20%, or 10% increases in daily new cases. All three measures were found to lower the percent increase in daily new cases to <5 within one month. Among the countries studied, 20% had an average percent increase in daily new cases of 30-49 over the seven days prior to the commencement of containment measures; the percent increase in daily new cases in these countries was curbed to 10 and 5 a maximum of 15 days and 23 days after the implementation of containment measures, respectively. Conclusions: Different national containment measures were associated with a decrease in daily new cases of confirmed COVID-19 infection. Stay-at-home orders, curfews, and lockdowns curbed the percent increase in daily new cases to <5 within a month. Resurgence in cases within one month was observed in some South American countries. %M 32658858 %R 10.2196/19904 %U http://www.jmir.org/2020/7/e19904/ %U https://doi.org/10.2196/19904 %U http://www.ncbi.nlm.nih.gov/pubmed/32658858 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 3 %P e20040 %T Emergency Center Curbside Screening During the COVID-19 Pandemic: Retrospective Cohort Study %A Halalau,Alexandra %A Ditkoff,Jeffrey %A Hamilton,Jessica %A Sharrak,Aryana %A Vanood,Aimen %A Abbas,Amr %A Ziadeh,James %+ Beaumont Health, 3601 W 13 Mile Rd, Royal Oak, MI, 48073, United States, 1 248 551 3481, alexandra.halalau@beaumont.edu %K COVID-19 %K emergency center %K curbside testing %K drive-through testing %K pandemic %K public health %D 2020 %7 21.7.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Coronavirus disease (COVID-19) is a global pandemic that has placed a significant burden on health care systems in the United States. Michigan has been one of the top states affected by COVID-19. Objective: We describe the emergency center curbside testing procedure implemented at Beaumont Hospital, a large hospital in Royal Oak, MI, and aim to evaluate its safety and efficiency. Methods: Anticipating a surge in patients requiring testing, Beaumont Health implemented curbside testing, operated by a multidisciplinary team of health care workers, including physicians, advanced practice providers, residents, nurses, technicians, and registration staff. We report on the following outcomes over a period of 26 days (March 12, 2020, to April 6, 2020): time to medical decision, time spent documenting electronic medical records, overall screening time, and emergency center return evaluations. Results: In total, 2782 patients received curbside services. A nasopharyngeal swab was performed on 1176 patients (41%), out of whom 348 (29.6%) tested positive. The median time for the entire process (from registration to discharge) was 28 minutes (IQR 17-44). The median time to final medical decision was 15 minutes (IQR 8-27). The median time from medical decision to discharge was 9 minutes (IQR 5-16). Only 257 patients (9.2%) returned to the emergency center for an evaluation within 7 or more days, of whom 64 were admitted to the hospital, 11 remained admitted, and 4 expired. Conclusions: Our curbside testing model encourages the incorporation of this model at other high-volume facilities during an infectious disease pandemic. %M 32619184 %R 10.2196/20040 %U http://publichealth.jmir.org/2020/3/e20040/ %U https://doi.org/10.2196/20040 %U http://www.ncbi.nlm.nih.gov/pubmed/32619184 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 3 %P e20737 %T Belief in a COVID-19 Conspiracy Theory as a Predictor of Mental Health and Well-Being of Health Care Workers in Ecuador: Cross-Sectional Survey Study %A Chen,Xi %A Zhang,Stephen X %A Jahanshahi,Asghar Afshar %A Alvarez-Risco,Aldo %A Dai,Huiyang %A Li,Jizhen %A Ibarra,Verónica García %+ Faculty of Professions, University of Adelaide, Nexus10 Tower, 10 Pulteney St, Adelaide, 5000, Australia, 61 8 8313 9310, stephen.x.zhang@gmail.com %K coronavirus %K 2019-nCoV %K mental health %K psychiatric identification %K Latin America %K COVID-19 %K conspiracy %K well-being %K health care worker %K social media %K prediction %D 2020 %7 21.7.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: During the coronavirus disease (COVID-19) pandemic, social media platforms have become active sites for the dissemination of conspiracy theories that provide alternative explanations of the cause of the pandemic, such as secret plots by powerful and malicious groups. However, the association of individuals’ beliefs in conspiracy theories about COVID-19 with mental health and well-being issues has not been investigated. This association creates an assessable channel to identify and provide assistance to people with mental health and well-being issues during the pandemic. Objective: Our aim was to provide the first evidence that belief in conspiracy theories regarding the COVID-19 pandemic is a predictor of the mental health and well-being of health care workers. Methods: We conducted a survey of 252 health care workers in Ecuador from April 10 to May 2, 2020. We analyzed the data regarding distress and anxiety caseness with logistic regression and the data regarding life and job satisfaction with linear regression. Results: Among the 252 sampled health care workers in Ecuador, 61 (24.2%) believed that the virus was developed intentionally in a lab; 82 (32.5%) experienced psychological distress, and 71 (28.2%) had anxiety disorder. Compared to health care workers who were not sure where the virus originated, those who believed the virus was developed intentionally in a lab were more likely to report psychological distress and anxiety disorder and to have lower levels of job satisfaction and life satisfaction. Conclusions: This paper identifies belief in COVID-19 conspiracy theories as an important predictor of distress, anxiety, and job and life satisfaction among health care workers. This finding will enable mental health services to better target and provide help to mentally vulnerable health care workers during the ongoing COVID-19 pandemic. %M 32658859 %R 10.2196/20737 %U http://publichealth.jmir.org/2020/3/e20737/ %U https://doi.org/10.2196/20737 %U http://www.ncbi.nlm.nih.gov/pubmed/32658859 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 7 %P e20469 %T The Story of #GetMePPE and GetUsPPE.org to Mobilize Health Care Response to COVID-19 : Rapidly Deploying Digital Tools for Better Health Care %A He,Shuhan %A Ojo,Ayotomiwa %A Beckman,Adam L %A Gondi,Suhas %A Ranney,Megan %A Betz,Marian %A Faust,Jeremy S %A Choo,Esther %A Kass,Dara %A Raja,Ali S %+ Center for Innovation in Digital HealthCare, Massachusetts General Hospital, 50 Staniford street, suite 750, Boston, MA, 02114, United States, 1 8477074695, She8@partners.org %K digital health %K getusppe %K getmeppe %K COVID-19 %K personal protective equipment %K protection %K Twitter %K pandemic %K health care worker %D 2020 %7 20.7.2020 %9 Viewpoint %J J Med Internet Res %G English %X Physicians, nurses, and other health care providers initiated the #GetMePPE movement on Twitter to spread awareness of the shortage of personal protective equipment (PPE) during the coronavirus disease (COVID-19) pandemic. Dwindling supplies, such as face masks, gowns and goggles, and inadequate production to meet increasing demand have placed health care workers and patients at risk. The momentum of the #GetMePPE Twitter hashtag resulted in the creation of a petition to urge public officials to address the PPE shortage through increased funding and production. Simultaneously, the GetUsPPE.org website was launched through the collaboration of physicians and software engineers to develop a digital platform for the donation, request, and distribution of multi-modal sources of PPE. GetUsPPE.org and #GetMePPE were merged in an attempt to combine public engagement and advocacy on social media with the coordination of PPE donation and distribution. Within 10 days, over 1800 hospitals and PPE suppliers were registered in a database that enabled the rapid coordination and distribution of scarce and in-demand materials. One month after its launch, the organization had distributed hundreds of thousands of PPE items and had built a database of over 6000 PPE requesters. The call for action on social media and the rapid development of this digital tool created a productive channel for the public to contribute to the health care response to COVID-19 in meaningful ways. #GetMePPE and GetUsPPE.org were able to mobilize individuals and organizations outside of the health care system to address the unmet needs of the medical community. The success of GetUsPPE.org demonstrates the potential of digital tools as a platform for larger health care institutions to rapidly address urgent issues in health care. In this paper, we outline this process and discuss key factors determining success. %M 32530813 %R 10.2196/20469 %U https://www.jmir.org/2020/7/e20469 %U https://doi.org/10.2196/20469 %U http://www.ncbi.nlm.nih.gov/pubmed/32530813 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 7 %P e19982 %T Influence of Mass and Social Media on Psychobehavioral Responses Among Medical Students During the Downward Trend of COVID-19 in Fujian, China: Cross-Sectional Study %A Lin,Yulan %A Hu,Zhijian %A Alias,Haridah %A Wong,Li Ping %+ Department of Epidemiology and Health Statistics, Fujian Provincial Key Laboratory of Environment Factors and Cancer, School of Public Health, Fujian Medical University, 1 Xue Yuan Road, University Town, Fuzhou, 350122, China, 86 (0)591 2286 ext 2573, huzhijian@fjmu.edu.cn %K psychobehavioral %K COVID-19 %K mass media %K social media %K medical students %K China %D 2020 %7 20.7.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: An extensive amount of information related to the novel coronavirus (COVID-19) pandemic was disseminated by mass and social media in China. To date, there is limited evidence on how this infodemic may influence psychobehavioral responses to the crisis. Objective: The aim of this study is to assess the psychobehavioral responses to the COVID-19 outbreak and examine their associations with mass and social media exposure. Methods: A cross-sectional study among medical and health sciences students from the Fujian Medical University in Fuzhou, China, was conducted between April 6-22, 2020. Results: A total of 2086 completed responses were received. Multivariable analyses demonstrated that four constructs of the Health Belief Model (HBM)—higher perception of susceptibility (odds ratio [OR] 1.44; 95% CI 1.07-1.94), severity (OR 1.32; 95% CI 1.10-1.59), self-efficacy (OR 1.61; 95% CI 1.21-2.15), and perceived control or intention to carry out prevention measures (OR 1.32; 95% CI 1.09-1.59)—were significantly associated with a higher mass media exposure score, whereas only three constructs—higher perception of severity (OR 1.43; 95% CI 1.19-1.72), self-efficacy (OR 1.85; 95% CI 1.38-2.48), and perceived control or intention to carry out prevention measures (OR 1.32; 95% CI 1.08-1.58)—were significantly associated with a higher social media exposure score. Lower emotional consequences and barriers to carry out prevention measures were also significantly associated with greater mass and social media exposure. Our findings on anxiety levels revealed that 38.1% (n=795; 95% CI 36.0-40.2) of respondents reported moderate-to-severe anxiety. A lower anxiety level was significantly associated with higher mass and social media exposure in the univariable analyses; however, the associations were not significant in the multivariable analyses. Conclusions: In essence, both mass and social media are useful means of disseminating health messages and contribute to the betterment of psychobehavioral responses to COVID-19. Our findings stress the importance of the credibility of information shared through mass and social media outlets and viable strategies to counter misinformation during a pandemic. %M 32584779 %R 10.2196/19982 %U https://www.jmir.org/2020/7/e19982 %U https://doi.org/10.2196/19982 %U http://www.ncbi.nlm.nih.gov/pubmed/32584779 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 7 %P e19667 %T Unmuting Medical Students’ Education: Utilizing Telemedicine During the COVID-19 Pandemic and Beyond %A Iancu,Ariella Magen %A Kemp,Michael Thomas %A Alam,Hasan Badre %+ Department of Surgery, University of Michigan, 2920 Taubman Center, 1500 E Medical Center Dr, Ann Arbor, MI, 48109, United States, 1 734 936 5823, alamh@med.umich.edu %K telemedicine %K medical education %K medical school %K COVID-19 %K education, medical, undergraduate %K curriculum %D 2020 %7 20.7.2020 %9 Viewpoint %J J Med Internet Res %G English %X Due to the coronavirus disease (COVID-19) pandemic, medical schools have paused traditional clerkships, eliminating direct patient encounters from medical students’ education for the immediate future. Telemedicine offers opportunities in a variety of specialties that can augment student education during this time. The projected growth of telemedicine necessitates that students learn new skills to be effective providers. In this viewpoint, we delineate specific telehealth opportunities that teach core competencies for patient care, while also teaching telemedicine-specific skills. Schools can further augment student education through a variety of telemedicine initiatives across multiple medical fields. The explosion of telemedicine programs due to the pandemic can be a catalyst for schools to integrate telemedicine into their current curricula. The depth and variety of telemedicine opportunities allow schools to continue providing high-quality medical education while maintaining social distancing policies. %M 32614776 %R 10.2196/19667 %U http://www.jmir.org/2020/7/e19667/ %U https://doi.org/10.2196/19667 %U http://www.ncbi.nlm.nih.gov/pubmed/32614776 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 3 %P e21163 %T COVIDApp as an Innovative Strategy for the Management and Follow-Up of COVID-19 Cases in Long-Term Care Facilities in Catalonia: Implementation Study %A Echeverría,Patricia %A Mas Bergas,Miquel Angel %A Puig,Jordi %A Isnard,Mar %A Massot,Mireia %A Vedia,Cristina %A Peiró,Ricardo %A Ordorica,Yolanda %A Pablo,Sara %A Ulldemolins,María %A Iruela,Mercé %A Balart,Dolors %A Ruiz,José María %A Herms,Jordi %A Clotet Sala,Bonaventura %A Negredo,Eugenia %+ Infectious Diseases Department, Hospital Universitari Germans Trias i Pujol, Carretera de Canyet s/n, Badalona, Spain, 34 934978887 ext 3417, pecheverria@flsida.org %K COVID-19 %K mobile health %K app %K COVIDApp %K long-term care facilities %K institutionalized individuals %K mHealth %K elderly %K long-term %K care %K public health %K management %K surveillance %D 2020 %7 17.7.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The coronavirus disease (COVID-19) pandemic has caused an unprecedented worldwide public health crisis that requires new management approaches. COVIDApp is a mobile app that was adapted for the management of institutionalized individuals in long-term care facilities. Objective: The aim of this paper is to report the implementation of this innovative tool for the management of long-term care facility residents as a high-risk population, specifically for early identification and self-isolation of suspected cases, remote monitoring of mild cases, and real-time monitoring of the progression of the infection. Methods: COVIDApp was implemented in 196 care centers in collaboration with 64 primary care teams. The following parameters of COVID-19 were reported daily: signs/symptoms; diagnosis by reverse transcriptase–polymerase chain reaction; absence of symptoms for ≥14 days; total deaths; and number of health care workers isolated with suspected COVID-19. The number of at-risk centers was also described. Results: Data were recorded from 10,347 institutionalized individuals and up to 4000 health care workers between April 1 and 30, 2020. A rapid increase in suspected cases was seen until day 6 but decreased during the last two weeks (from 1084 to 282 cases). The number of confirmed cases increased from 419 (day 6) to 1293 (day 22) and remained stable during the last week. Of the 10,347 institutionalized individuals, 5,090 (49,2%) remained asymptomatic for ≥14 days. A total of 854/10,347 deaths (8.3%) were reported; 383 of these deaths (44.8%) were suspected/confirmed cases. The number of isolated health care workers remained high over the 30 days, while the number of suspected cases decreased during the last 2 weeks. The number of high-risk long-term care facilities decreased from 19/196 (9.5%) to 3/196 (1.5%). Conclusions: COVIDApp can help clinicians rapidly detect and remotely monitor suspected and confirmed cases of COVID-19 among institutionalized individuals, thus limiting the risk of spreading the virus. The platform shows the progression of infection in real time and can aid in designing new monitoring strategies. %M 32629425 %R 10.2196/21163 %U http://publichealth.jmir.org/2020/3/e21163/ %U https://doi.org/10.2196/21163 %U http://www.ncbi.nlm.nih.gov/pubmed/32629425 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 6 %N 2 %P e20190 %T The Present and Future Applications of Technology in Adapting Medical Education Amidst the COVID-19 Pandemic %A Remtulla,Ridhaa %+ Birmingham Medical School, College of Medical and Dental Sciences, University of Birmingham, Birmingham Medical School, College of Medical and Dental Sciences, Edgbaston, Birmingham, B15 2TT, United Kingdom, 44 7436 719660, rxr529@student.bham.ac.uk %K medical education %K technology %K coronavirus %K medical students %K COVID-19 %K pandemic %K online lecture %K virtual reality %D 2020 %7 17.7.2020 %9 Viewpoint %J JMIR Med Educ %G English %X The coronavirus disease (COVID-19) pandemic has not only been catastrophic toward patient health but has also proven to be incredibly disruptive to several industries and sectors, including medical education. However, many medical schools have employed various technological solutions in order to minimize the disruption to medical education during this unpredictable time. This viewpoint reviews the various current and potential applications of technology in order to adapt medical education amidst a global pandemic. %M 32634107 %R 10.2196/20190 %U http://mededu.jmir.org/2020/2/e20190/ %U https://doi.org/10.2196/20190 %U http://www.ncbi.nlm.nih.gov/pubmed/32634107 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 3 %P e19354 %T Association of Search Query Interest in Gastrointestinal Symptoms With COVID-19 Diagnosis in the United States: Infodemiology Study %A Rajan,Anjana %A Sharaf,Ravi %A Brown,Robert S %A Sharaiha,Reem Z %A Lebwohl,Benjamin %A Mahadev,SriHari %+ Department of Gastroenterology and Hepatology, Weill Cornell Medicine, 1305 York Ave, 4th Floor, New York, NY, 10065, United States, 1 646 962 2382, srm9005@med.cornell.edu %K COVID-19 %K diarrhea %K internet search queries %K Google Trends %K gastrointestinal %K symptom %K health information %K pandemic %K infectious disease %K virus %D 2020 %7 17.7.2020 %9 Short Paper %J JMIR Public Health Surveill %G English %X Background: Coronavirus disease (COVID-19) is a novel viral illness that has rapidly spread worldwide. While the disease primarily presents as a respiratory illness, gastrointestinal symptoms such as diarrhea have been reported in up to one-third of confirmed cases, and patients may have mild symptoms that do not prompt them to seek medical attention. Internet-based infodemiology offers an approach to studying symptoms at a population level, even in individuals who do not seek medical care. Objective: This study aimed to determine if a correlation exists between internet searches for gastrointestinal symptoms and the confirmed case count of COVID-19 in the United States. Methods: The search terms chosen for analysis in this study included common gastrointestinal symptoms such as diarrhea, nausea, vomiting, and abdominal pain. Furthermore, the search terms fever and cough were used as positive controls, and constipation was used as a negative control. Daily query shares for the selected symptoms were obtained from Google Trends between October 1, 2019 and June 15, 2020 for all US states. These shares were divided into two time periods: pre–COVID-19 (prior to March 1) and post–COVID-19 (March 1-June 15). Confirmed COVID-19 case numbers were obtained from the Johns Hopkins University Center for Systems Science and Engineering data repository. Moving averages of the daily query shares (normalized to baseline pre–COVID-19) were then analyzed against the confirmed disease case count and daily new cases to establish a temporal relationship. Results: The relative search query shares of many symptoms, including nausea, vomiting, abdominal pain, and constipation, remained near or below baseline throughout the time period studied; however, there were notable increases in searches for the positive control symptoms of fever and cough as well as for diarrhea. These increases in daily search queries for fever, cough, and diarrhea preceded the rapid rise in number of cases by approximately 10 to 14 days. The search volumes for these terms began declining after mid-March despite the continued rises in cumulative cases and daily new case counts. Conclusions: Google searches for symptoms may precede the actual rises in cases and hospitalizations during pandemics. During the current COVID-19 pandemic, this study demonstrates that internet search queries for fever, cough, and diarrhea increased prior to the increased confirmed case count by available testing during the early weeks of the pandemic in the United States. While the search volumes eventually decreased significantly as the number of cases continued to rise, internet query search data may still be a useful tool at a population level to identify areas of active disease transmission at the cusp of new outbreaks. %M 32640418 %R 10.2196/19354 %U http://publichealth.jmir.org/2020/3/e19354/ %U https://doi.org/10.2196/19354 %U http://www.ncbi.nlm.nih.gov/pubmed/32640418 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 8 %N 7 %P e19866 %T The Role of Health Technology and Informatics in a Global Public Health Emergency: Practices and Implications From the COVID-19 Pandemic %A Ye,Jiancheng %+ Feinberg School of Medicine, Northwestern University, 633 N Saint Clair St, Chicago, IL, United States, 1 312 503 3690, jiancheng.ye@u.northwestern.edu %K health technology %K health information system %K COVID-19 %K artificial intelligence %K telemedicine %K big data %K privacy %D 2020 %7 14.7.2020 %9 Viewpoint %J JMIR Med Inform %G English %X At present, the coronavirus disease (COVID-19) is spreading around the world. It is a critical and important task to take thorough efforts to prevent and control the pandemic. Compared with severe acute respiratory syndrome and Middle East Respiratory Syndrome, COVID-19 spreads more rapidly owing to increased globalization, a longer incubation period, and unobvious symptoms. As the coronavirus has the characteristics of strong transmission and weak lethality, and since the large-scale increase of infected people may overwhelm health care systems, efforts are needed to treat critical patients, track and manage the health status of residents, and isolate suspected patients. The application of emerging health technologies and digital practices in health care, such as artificial intelligence, telemedicine or telehealth, mobile health, big data, 5G, and the Internet of Things, have become powerful “weapons” to fight against the pandemic and provide strong support in pandemic prevention and control. Applications and evaluations of all of these technologies, practices, and health delivery services are highlighted in this study. %M 32568725 %R 10.2196/19866 %U http://medinform.jmir.org/2020/7/e19866/ %U https://doi.org/10.2196/19866 %U http://www.ncbi.nlm.nih.gov/pubmed/32568725 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 7 %P e20001 %T Similarities and Differences in COVID-19 Awareness, Concern, and Symptoms by Race and Ethnicity in the United States: Cross-Sectional Survey %A Jones,Jeb %A Sullivan,Patrick S %A Sanchez,Travis H %A Guest,Jodie L %A Hall,Eric W %A Luisi,Nicole %A Zlotorzynska,Maria %A Wilde,Gretchen %A Bradley,Heather %A Siegler,Aaron J %+ Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA, 30322, United States, 1 4047122275, jeb.jones@emory.edu %K COVID-19 %K SARS-CoV-2 %K race %K ethnicity %K awareness %K concern %K symptom %K cross-sectional %K knowledge %K health disparity %K inequality %D 2020 %7 10.7.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Existing health disparities based on race and ethnicity in the United States are contributing to disparities in morbidity and mortality during the coronavirus disease (COVID-19) pandemic. We conducted an online survey of American adults to assess similarities and differences by race and ethnicity with respect to COVID-19 symptoms, estimates of the extent of the pandemic, knowledge of control measures, and stigma. Objective: The aim of this study was to describe similarities and differences in COVID-19 symptoms, knowledge, and beliefs by race and ethnicity among adults in the United States. Methods: We conducted a cross-sectional survey from March 27, 2020 through April 1, 2020. Participants were recruited on social media platforms and completed the survey on a secure web-based survey platform. We used chi-square tests to compare characteristics related to COVID-19 by race and ethnicity. Statistical tests were corrected using the Holm Bonferroni correction to account for multiple comparisons. Results: A total of 1435 participants completed the survey; 52 (3.6%) were Asian, 158 (11.0%) were non-Hispanic Black, 548 (38.2%) were Hispanic, 587 (40.9%) were non-Hispanic White, and 90 (6.3%) identified as other or multiple races. Only one symptom (sore throat) was found to be different based on race and ethnicity (P=.003); this symptom was less frequently reported by Asian (3/52, 5.8%), non-Hispanic Black (9/158, 5.7%), and other/multiple race (8/90, 8.9%) participants compared to those who were Hispanic (99/548, 18.1%) or non-Hispanic White (95/587, 16.2%). Non-Hispanic White and Asian participants were more likely to estimate that the number of current cases was at least 100,000 (P=.004) and were more likely to answer all 14 COVID-19 knowledge scale questions correctly (Asian participants, 13/52, 25.0%; non-Hispanic White participants, 180/587, 30.7%) compared to Hispanic (108/548, 19.7%) and non-Hispanic Black (25/158, 15.8%) participants. Conclusions: We observed differences with respect to knowledge of appropriate methods to prevent infection by the novel coronavirus that causes COVID-19. Deficits in knowledge of proper control methods may further exacerbate existing race/ethnicity disparities. Additional research is needed to identify trusted sources of information in Hispanic and non-Hispanic Black communities and create effective messaging to disseminate correct COVID-19 prevention and treatment information. %M 32614778 %R 10.2196/20001 %U http://www.jmir.org/2020/7/e20001/ %U https://doi.org/10.2196/20001 %U http://www.ncbi.nlm.nih.gov/pubmed/32614778 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 3 %P e19538 %T Statistical Issues and Lessons Learned From COVID-19 Clinical Trials With Lopinavir-Ritonavir and Remdesivir %A Yin,Guosheng %A Zhang,Chenyang %A Jin,Huaqing %+ Department of Statistics and Actuarial Science, The University of Hong Kong, Run Run Shaw Building, Pokfulam Road, Hong Kong, China (Hong Kong), 852 39178313, gyin@hku.hk %K coronavirus %K COVID-19 %K cure rate model %K sample size adjustment %K terminal event %K type I error rate %K restricted mean survival time %D 2020 %7 10.7.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Recently, three randomized clinical trials on coronavirus disease (COVID-19) treatments were completed: one for lopinavir-ritonavir and two for remdesivir. One trial reported that remdesivir was superior to placebo in shortening the time to recovery, while the other two showed no benefit of the treatment under investigation. Objective: The aim of this paper is to, from a statistical perspective, identify several key issues in the design and analysis of three COVID-19 trials and reanalyze the data from the cumulative incidence curves in the three trials using more appropriate statistical methods. Methods: The lopinavir-ritonavir trial enrolled 39 additional patients due to insignificant results after the sample size reached the planned number, which led to inflation of the type I error rate. The remdesivir trial of Wang et al failed to reach the planned sample size due to a lack of eligible patients, and the bootstrap method was used to predict the quantity of clinical interest conditionally and unconditionally if the trial had continued to reach the originally planned sample size. Moreover, we used a terminal (or cure) rate model and a model-free metric known as the restricted mean survival time or the restricted mean time to improvement (RMTI) to analyze the reconstructed data. The remdesivir trial of Beigel et al reported the median recovery time of the remdesivir and placebo groups, and the rate ratio for recovery, while both quantities depend on a particular time point representing local information. We use the restricted mean time to recovery (RMTR) as a global and robust measure for efficacy. Results: For the lopinavir-ritonavir trial, with the increase of sample size from 160 to 199, the type I error rate was inflated from 0.05 to 0.071. The difference of RMTIs between the two groups evaluated at day 28 was –1.67 days (95% CI –3.62 to 0.28; P=.09) in favor of lopinavir-ritonavir but not statistically significant. For the remdesivir trial of Wang et al, the difference of RMTIs at day 28 was –0.89 days (95% CI –2.84 to 1.06; P=.37). The planned sample size was 453, yet only 236 patients were enrolled. The conditional prediction shows that the hazard ratio estimates would reach statistical significance if the target sample size had been maintained. For the remdesivir trial of Beigel et al, the difference of RMTRs between the remdesivir and placebo groups at day 30 was –2.7 days (95% CI –4.0 to –1.2; P<.001), confirming the superiority of remdesivir. The difference in the recovery time at the 25th percentile (95% CI –3 to 0; P=.65) was insignificant, while the differences became more statistically significant at larger percentiles. Conclusions: Based on the statistical issues and lessons learned from the recent three clinical trials on COVID-19 treatments, we suggest more appropriate approaches for the design and analysis of ongoing and future COVID-19 trials. %M 32589146 %R 10.2196/19538 %U https://publichealth.jmir.org/2020/3/e19538 %U https://doi.org/10.2196/19538 %U http://www.ncbi.nlm.nih.gov/pubmed/32589146 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 3 %P e19332 %T COVID-19 Crisis in Jordan: Response, Scenarios, Strategies, and Recommendations %A Alqutob,Raeda %A Al Nsour,Mohannad %A Tarawneh,Mohammed Rasoul %A Ajlouni,Musa %A Khader,Yousef %A Aqel,Ibrahim %A Kharabsheh,Saad %A Obeidat,Nathir %+ Department of Public Health, Jordan University of Science and Technology, Alramtha-Irbid street, Irbid, 22110, Jordan, 962 796802040, yskhader@just.edu.jo %K infection %K prevention %K public health %K pandemic %K Jordan %K virus %K COVID-19 %D 2020 %7 7.7.2020 %9 Viewpoint %J JMIR Public Health Surveill %G English %X As of April 12, 2020, a total of 389 cases of coronavirus disease were confirmed in Jordan. To control this imminent threat, Jordan has enforced public health infection prevention and control measures, called for social distancing, seized all forms of inbound and outbound movement and international travel, and enacted the Defence Law that transferred the authority to the Minister of Defence to work and formulate orders according to the situation. In an effort to support the government in anticipating the requirements of the health system in the upcoming period, an in-depth reflection and examination of different scenarios of the disease spread were developed. This viewpoint suggests different strategies and measures for case detection and contact tracing, clinical management of cases, public health system functioning, and civil society organizations’ contribution. It is necessary to accelerate containment of the disease to protect the economy and to maintain the continuity of some activities to mitigate the subsequent social, economic, and financial impacts. This requires finding a coping mechanism for a period that may be prolonged until laboratories develop a vaccine. Specifically, it is strongly recommended to promote community health awareness toward public health prevention and control measures, increase the efficiency and comprehensiveness of the epidemiological investigation and active and passive surveillance, and employ technology and digital health solutions to track cases and contacts. It is also recommended to increase and expand resources of intensive care units including respirators, increase the capacity and the number of trained health staff in the area of public health and epidemiology, ensure continued provision of essential public health programs, and mobilize the resources of nongovernmental sectors and donors to provide services for refugees and vulnerable populations. %M 32407289 %R 10.2196/19332 %U https://publichealth.jmir.org/2020/3/e19332 %U https://doi.org/10.2196/19332 %U http://www.ncbi.nlm.nih.gov/pubmed/32407289 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 7 %P e19322 %T Rapid Utilization of Telehealth in a Comprehensive Cancer Center as a Response to COVID-19: Cross-Sectional Analysis %A Lonergan,Peter E %A Washington III,Samuel L %A Branagan,Linda %A Gleason,Nathaniel %A Pruthi,Raj S %A Carroll,Peter R %A Odisho,Anobel Y %+ Department of Urology, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, 550 16th Street, San Francisco, CA, 94143, United States, 1 (415) 353 2200, anobel.odisho@ucsf.edu %K health informatics %K telehealth %K video visits %K COVID-19 %K video consultation %K pandemic %K electronic health record %K EHR %D 2020 %7 6.7.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The emergence of the coronavirus disease (COVID-19) pandemic in March 2020 created unprecedented challenges in the provision of scheduled ambulatory cancer care. As a result, there has been a renewed focus on video-based telehealth consultations as a means to continue ambulatory care. Objective: The aim of this study is to analyze the change in video visit volume at the University of California, San Francisco (UCSF) Comprehensive Cancer Center in response to COVID-19 and compare patient demographics and appointment data from January 1, 2020, and in the 11 weeks after the transition to video visits. Methods: Patient demographics and appointment data (dates, visit types, and departments) were extracted from the electronic health record reporting database. Video visits were performed using a HIPAA (Health Insurance Portability and Accountability Act)-compliant video conferencing platform with a pre-existing workflow. Results: In 17 departments and divisions at the UCSF Cancer Center, 2284 video visits were performed in the 11 weeks before COVID-19 changes were implemented (mean 208, SD 75 per week) and 12,946 video visits were performed in the 11-week post–COVID-19 period (mean 1177, SD 120 per week). The proportion of video visits increased from 7%-18% to 54%-72%, between the pre– and post–COVID-19 periods without any disparity based on race/ethnicity, primary language, or payor. Conclusions: In a remarkably brief period of time, we rapidly scaled the utilization of telehealth in response to COVID-19 and maintained access to complex oncologic care at a time of social distancing. %M 32568721 %R 10.2196/19322 %U https://www.jmir.org/2020/7/e19322 %U https://doi.org/10.2196/19322 %U http://www.ncbi.nlm.nih.gov/pubmed/32568721 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 7 %P e19902 %T Health Observation App for COVID-19 Symptom Tracking Integrated With Personal Health Records: Proof of Concept and Practical Use Study %A Yamamoto,Keiichi %A Takahashi,Tsubasa %A Urasaki,Miwa %A Nagayasu,Yoichi %A Shimamoto,Tomonari %A Tateyama,Yukiko %A Matsuzaki,Keiichi %A Kobayashi,Daisuke %A Kubo,Satoshi %A Mito,Shigeyuki %A Abe,Tatsuya %A Matsuura,Hideo %A Iwami,Taku %+ Information Technology Center, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8509, Japan, 81 73 441 0901, kyamamo@wakayama-med.ac.jp %K public health informatics %K public health administration %K emerging infectious disease %K preventive medicine %K mobile apps %K contact tracing %D 2020 %7 6.7.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: As a counter-cluster measure to prevent the spread of the infectious novel coronavirus disease (COVID-19), an efficient system for health observation outside the hospital is urgently required. Personal health records (PHRs) are suitable for the daily management of physical conditions. Importantly, there are no major differences between the items collected by daily health observation via PHR and the observation of items related to COVID-19. Until now, observations related to COVID-19 have been performed exclusively based on disease-specific items. Therefore, we hypothesize that PHRs would be suitable as a symptom-tracking tool for COVID-19. To this end, we integrated health observation items specific to COVID-19 with an existing PHR-based app. Objective: This study is conducted as a proof-of-concept study in a real-world setting to develop a PHR-based COVID-19 symptom-tracking app and to demonstrate the practical use of health observations for COVID-19 using a smartphone or tablet app integrated with PHRs. Methods: We applied the PHR-based health observation app within an active epidemiological investigation conducted by Wakayama City Public Health Center. At the public health center, a list is made of individuals who have been in close contact with known infected cases (health observers). Email addresses are used by the app when a health observer sends data to the public health center. Each health observer downloads the app and installs it on their smartphone. Self-observed health data are entered daily into the app. These data are then sent via the app by email at a designated time. Localized epidemiological officers can visualize the collected data using a spreadsheet macro and, thus, monitor the health condition of all health observers. Results: We used the app as part of an active epidemiological investigation executed at a public health center. During the investigation, 72 close contacts were discovered. Among them, 57 had adopted the use of the health observation app. Before the introduction of the app, all health observers would have been interviewed by telephone, a slow process that took four epidemiological officers more than 2 hours. After the introduction of the app, a single epidemiological officer can carry out health observations. The app was distributed for free beginning in early March, and by mid-May, it had been used by more than 20,280 users and 400 facilities and organizations across Japan. Currently, health observation of COVID-19 is socially recognized and has become one of the requirements for resuming social activities. Conclusions: Health observation by PHRs for the purpose of improving health management can also be effectively applied as a measure against large-scale infectious diseases. Individual habits of improving awareness of personal health and the use of PHRs for daily health management are powerful armaments against the rapid spread of infectious diseases. Ultimately, similar actions may help to prevent the spread of COVID-19. %M 32568728 %R 10.2196/19902 %U https://mhealth.jmir.org/2020/7/e19902 %U https://doi.org/10.2196/19902 %U http://www.ncbi.nlm.nih.gov/pubmed/32568728 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 7 %P e20472 %T Racial and Ethnic Digital Divides in Posting COVID-19 Content on Social Media Among US Adults: Secondary Survey Analysis %A Campos-Castillo,Celeste %A Laestadius,Linnea I %+ Department of Sociology, University of Wisconsin-Milwaukee, 3210 N Maryland Ave, Milwaukee, WI, 53201, United States, 1 414 229 1113, camposca@uwm.edu %K COVID-19 %K digital divides %K user characteristics %K race %K ethnicity %K algorithm bias %K social media %K bias %K surveillance %K public health %D 2020 %7 3.7.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Public health surveillance experts are leveraging user-generated content on social media to track the spread and effects of COVID-19. However, racial and ethnic digital divides, which are disparities among people who have internet access and post on social media, can bias inferences. This bias is particularly problematic in the context of the COVID-19 pandemic because due to structural inequalities, members of racial and ethnic minority groups are disproportionately vulnerable to contracting the virus and to the deleterious economic and social effects from mitigation efforts. Further, important demographic intersections with race and ethnicity, such as gender and age, are rarely investigated in work characterizing social media users; however, they reflect additional axes of inequality shaping differential exposure to COVID-19 and its effects. Objective: The aim of this study was to characterize how the race and ethnicity of US adults are associated with their odds of posting COVID-19 content on social media and how gender and age modify these odds. Methods: We performed a secondary analysis of a survey conducted by the Pew Research Center from March 19 to 24, 2020, using a national probability sample (N=10,510). Respondents were recruited from an online panel, where panelists without an internet-enabled device were given one to keep at no cost. The binary dependent variable was responses to an item asking whether respondents “used social media to share or post information about the coronavirus.” We used survey-weighted logistic regressions to estimate the odds of responding in the affirmative based on the race and ethnicity of respondents (white, black, Latino, other race/ethnicity), adjusted for covariates measuring sociodemographic background and COVID-19 experiences. We examined how gender (female, male) and age (18 to 30 years, 31 to 50 years, 51 to 64 years, and 65 years and older) intersected with race and ethnicity by estimating interactions. Results: Respondents who identified as black (odds ratio [OR] 1.29, 95% CI 1.02-1.64; P=.03), Latino (OR 1.66, 95% CI 1.36-2.04; P<.001), or other races/ethnicities (OR 1.33, 95% CI 1.02-1.72; P=.03) had higher odds than respondents who identified as white of reporting that they posted COVID-19 content on social media. Women had higher odds of posting than men regardless of race and ethnicity (OR 1.58, 95% CI 1.39-1.80; P<.001). Among men, respondents who identified as black, Latino, or members of other races/ethnicities were significantly more likely to post than respondents who identified as white. Older adults (65 years or older) had significantly lower odds (OR 0.73, 95% CI 0.57-0.94; P=.01) of posting compared to younger adults (18-29 years), particularly among those identifying as other races/ethnicities. Latino respondents were the most likely to report posting across all age groups. Conclusions: In the United States, members of racial and ethnic minority groups are most likely to contribute to COVID-19 content on social media, particularly among groups traditionally less likely to use social media (older adults and men). The next step is to ensure that data collection procedures capture this diversity by encompassing a breadth of search criteria and social media platforms. %M 32568726 %R 10.2196/20472 %U https://www.jmir.org/2020/7/e20472 %U https://doi.org/10.2196/20472 %U http://www.ncbi.nlm.nih.gov/pubmed/32568726 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 7 %P e19417 %T Application and Preliminary Outcomes of Remote Diagnosis and Treatment During the COVID-19 Outbreak: Retrospective Cohort Study %A Liu,Luwen %A Gu,Jianqin %A Shao,Fengmin %A Liang,Xinliang %A Yue,Lixia %A Cheng,Qiaomei %A Zhang,Lianzhong %+ Zhengzhou University People's Hospital, Henan Provincial People's Hospital, No. 7 Weiwu Road, Zhengzhou, China, 86 13598896699, llw0624@gs.zzu.edu.cn %K coronavirus disease %K COVID-19 %K remote diagnosis and treatment %K telemedicine %K online outpatient visit %K offline drug delivery %K pandemic management %K China %K Henan Province %D 2020 %7 3.7.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The coronavirus disease (COVID-19) pandemic, caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has resulted in the self-quarantine of countless people due to possible infection. This situation makes telemedicine necessary as it can overcome geographical barriers, increase the number of people served, and provide online clinical support for patients. However, the outcomes of telemedicine have not yet been evaluated. Objective: The aim of our study is to describe the epidemiological features and clinical symptoms of patients receiving remote diagnosis and treatment at the online outpatient clinic of our hospital, as well as to analyze the outcomes and advantages of telemedicine, during the COVID-19 pandemic. Methods: Data from patients receiving remote diagnosis and treatment via consultation services for COVID-19 concerns at the online outpatient clinic of Henan Provincial People's Hospital from January 24 to February 17, 2020, were collected. A retrospective analysis was performed on epidemiological features, clinical symptoms, and preliminary outcomes. Results: Online inquiry, consultation, and suggestions were provided for patient concerns related to COVID-19. Our hospital also offered offline noncontact drug delivery services following online ordering and payment. A total of 4589 patients receiving remote diagnosis and treatment were recruited. The daily number of online outpatient visits initially increased and then decreased, reaching its peak on January 28 when the daily number of online outpatient visits totaled 612. Of 4589 patients, 1940 (42.3%) were males and 2649 (57.7%) were females (age range: 78 days to 85 years). Most patients were aged 20-39 years (n=3714, 80.9%) and came from Henan Province (n=3898, 84.9%). The number of patients from other provinces was 691 (15.1%). During the online consultations, patients discussed the following symptoms: fever (n=2383), cough (n=1740), nasal obstruction (n=794), fatigue (n=503), and diarrhea (n=276). A total of 873 orders of noncontact drug delivery following online payment was completed. The daily number of such orders gradually stabilized after the initial, steady increase. For offline drug delivery orders, the median (IQR) was 36 (58). An online satisfaction survey was filled out postconsultation by patients; of the 985 responses received, 98.1% (n=966) of respondents were satisfied with the service they received. Conclusions: Remote diagnosis and treatment offered via online outpatient consultations effectively reduced the burden on hospitals, prevented overcrowding, reduced the risk of cross-infection, and relieved patients' anxiety during the COVID-19 outbreak. This plays an essential role in pandemic management. %M 32568722 %R 10.2196/19417 %U https://mhealth.jmir.org/2020/7/e19417 %U https://doi.org/10.2196/19417 %U http://www.ncbi.nlm.nih.gov/pubmed/32568722 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 7 %P e18415 %T COVID-19 Modifications for Remote Teleassessment and Teletraining of a Complementary Alternative Medicine Intervention for People With Multiple Sclerosis: Protocol for a Randomized Controlled Trial %A Lai,Byron %A Chiu,Chia-Ying %A Pounds,Emily %A Tracy,Tracy %A Mehta,Tapan %A Young,Hui-Ju %A Riser,Emily %A Rimmer,James %+ Division of Pediatric Rehabilitation Medicine, School of Medicine, University of Alabama at Birmingham, 1720 University Blvd, Birmingham, AL, 35294, United States, 1 205 638 9790 ext 8, byronlai@uab.edu %K multiple sclerosis %K telerehabilitation %K teletraining %K physical activity %K disability %K tele-exercise %K telehealth %K COVID-19 %D 2020 %7 3.7.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: Access to comprehensive exercise and rehabilitation services for people with multiple sclerosis (MS) remains a major challenge, especially in rural, low-income areas. Hence, the Tele-Exercise and Multiple Sclerosis (TEAMS) study aims to provide patient-centered, coordinated care by implementing a 12-week complementary and alternative medicine (CAM) intervention for adults with MS. However, due to the societal impact of coronavirus disease (COVID-19) in mid-March 2020, the University of Alabama at Birmingham announced a limited business model halting all nonessential research requiring on-site visits, which includes the TEAMS study. Objective: In compliance with the shelter-in-place policy and quarantine guidance, a modified testing and training protocol was developed to allow participants to continue the study. Methods: The modified protocol, which replaces on-site data collection and training procedures, includes a teleassessment package (computer tablet, blood pressure cuff, hand dynamometer, mini disc cone, measuring tape, an 8” step, and a large-print 8” × 11” paper with ruler metrics and wall-safe tape) and a virtual meeting platform for synchronous interactive training between the therapist and the participant. The teleassessment measures include resting blood pressure and heart rate, grip strength, Five Times Sit to Stand, Timed Up & Go, and the Berg Balance Scale. The teletraining component includes 20 sessions of synchronous training sessions of dual tasking, yoga, and Pilates exercises designed and customized for a range of functional levels. Teletraining lasts 12 weeks and participants are instructed to continue exercising for a posttraining period of 9 months. Results: The protocol modifications were supported with supplemental funding (from the Patient-Centered Outcomes Research Institute) and approved by the University Institutional Review Board for Human Use. At the time nonessential research visits were halted by the university, there were 759 people enrolled and baseline tested, accounting for 92.5% of our baseline testing completion target (N=820). Specifically, 325 participants completed the 12-week intervention and follow-up testing visits, and 289 participants needed to complete either the intervention or follow-up assessments. A modified analysis plan will include sensitivity analyses to ensure the robustness of the study results in the presence of uncertainty and protocol deviations. Study results are projected to be published in 2021. Conclusions: This modified remote teleassessment/teletraining protocol will impact a large number of participants with MS who would otherwise have been discontinued from the study. Trial Registration: ClinicalTrials.gov NCT03117881; https://clinicaltrials.gov/ct2/show/NCT03117881 International Registered Report Identifier (IRRID): DERR1-10.2196/18415 %M 32540838 %R 10.2196/18415 %U https://www.researchprotocols.org/2020/7/e18415 %U https://doi.org/10.2196/18415 %U http://www.ncbi.nlm.nih.gov/pubmed/32540838 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 3 %P e18880 %T General Model for COVID-19 Spreading With Consideration of Intercity Migration, Insufficient Testing, and Active Intervention: Modeling Study of Pandemic Progression in Japan and the United States %A Zhan,Choujun %A Tse,Chi Kong %A Lai,Zhikang %A Chen,Xiaoyun %A Mo,Mingshen %+ City University of Hong Kong, Tat Chee Avenue, Kowloon, Hong Kong, 0000, Hong Kong, 852 92701816, cktse@ieee.org %K pandemic spreading %K SEICR model %K COVID-19 %K prediction %K effect of intervention %D 2020 %7 3.7.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The coronavirus disease (COVID-19) began to spread in mid-December 2019 from Wuhan, China, to most provinces in China and over 200 other countries through an active travel network. Limited by the ability of the country or city to perform tests, the officially reported number of confirmed cases is expected to be much smaller than the true number of infected cases. Objective: This study aims to develop a new susceptible-exposed-infected-confirmed-removed (SEICR) model for predicting the spreading progression of COVID-19 with consideration of intercity travel and the difference between the number of confirmed cases and actual infected cases, and to apply the model to provide a realistic prediction for the United States and Japan under different scenarios of active intervention. Methods: The model introduces a new state variable corresponding to the actual number of infected cases, integrates intercity travel data to track the movement of exposed and infected individuals among cities, and allows different levels of active intervention to be considered so that a realistic prediction of the number of infected individuals can be performed. Moreover, the model generates future progression profiles for different levels of intervention by setting the parameters relative to the values found from the data fitting. Results: By fitting the model with the data of the COVID-19 infection cases and the intercity travel data for Japan (January 15 to March 20, 2020) and the United States (February 20 to March 20, 2020), model parameters were found and then used to predict the pandemic progression in 47 regions of Japan and 50 states (plus a federal district) in the United States. The model revealed that, as of March 19, 2020, the number of infected individuals in Japan and the United States could be 20-fold and 5-fold as many as the number of confirmed cases, respectively. The results showed that, without tightening the implementation of active intervention, Japan and the United States will see about 6.55% and 18.2% of the population eventually infected, respectively, and with a drastic 10-fold elevated active intervention, the number of people eventually infected can be reduced by up to 95% in Japan and 70% in the United States. Conclusions: The new SEICR model has revealed the effectiveness of active intervention for controlling the spread of COVID-19. Stepping up active intervention would be more effective for Japan, and raising the level of public vigilance in maintaining personal hygiene and social distancing is comparatively more important for the United States. %M 32589145 %R 10.2196/18880 %U https://publichealth.jmir.org/2020/3/e18880 %U https://doi.org/10.2196/18880 %U http://www.ncbi.nlm.nih.gov/pubmed/32589145 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 3 %P e19773 %T The Oxford Royal College of General Practitioners Clinical Informatics Digital Hub: Protocol to Develop Extended COVID-19 Surveillance and Trial Platforms %A de Lusignan,Simon %A Jones,Nicholas %A Dorward,Jienchi %A Byford,Rachel %A Liyanage,Harshana %A Briggs,John %A Ferreira,Filipa %A Akinyemi,Oluwafunmi %A Amirthalingam,Gayatri %A Bates,Chris %A Lopez Bernal,Jamie %A Dabrera,Gavin %A Eavis,Alex %A Elliot,Alex J %A Feher,Michael %A Krajenbrink,Else %A Hoang,Uy %A Howsam,Gary %A Leach,Jonathan %A Okusi,Cecilia %A Nicholson,Brian %A Nieri,Philip %A Sherlock,Julian %A Smith,Gillian %A Thomas,Mark %A Thomas,Nicholas %A Tripathy,Manasa %A Victor,William %A Williams,John %A Wood,Ian %A Zambon,Maria %A Parry,John %A O’Hanlon,Shaun %A Joy,Mark %A Butler,Chris %A Marshall,Martin %A Hobbs,FD Richard %+ Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Woodstock Road, Oxford, OX26GG, United Kingdom, 44 1865617283, simon.delusignan@phc.ox.ac.uk %K primary health care %K general practice %K medical record systems, computerized %K sentinel surveillance %K public health surveillance %K clinical trials as a topic %K adaptive clinical trials %K severe acute respiratory syndrome coronavirus 2 %K COVID-19 %D 2020 %7 2.7.2020 %9 Protocol %J JMIR Public Health Surveill %G English %X Background: Routinely recorded primary care data have been used for many years by sentinel networks for surveillance. More recently, real world data have been used for a wider range of research projects to support rapid, inexpensive clinical trials. Because the partial national lockdown in the United Kingdom due to the coronavirus disease (COVID-19) pandemic has resulted in decreasing community disease incidence, much larger numbers of general practices are needed to deliver effective COVID-19 surveillance and contribute to in-pandemic clinical trials. Objective: The aim of this protocol is to describe the rapid design and development of the Oxford Royal College of General Practitioners Clinical Informatics Digital Hub (ORCHID) and its first two platforms. The Surveillance Platform will provide extended primary care surveillance, while the Trials Platform is a streamlined clinical trials platform that will be integrated into routine primary care practice. Methods: We will apply the FAIR (Findable, Accessible, Interoperable, and Reusable) metadata principles to a new, integrated digital health hub that will extract routinely collected general practice electronic health data for use in clinical trials and provide enhanced communicable disease surveillance. The hub will be findable through membership in Health Data Research UK and European metadata repositories. Accessibility through an online application system will provide access to study-ready data sets or developed custom data sets. Interoperability will be facilitated by fixed linkage to other key sources such as Hospital Episodes Statistics and the Office of National Statistics using pseudonymized data. All semantic descriptors (ie, ontologies) and code used for analysis will be made available to accelerate analyses. We will also make data available using common data models, starting with the US Food and Drug Administration Sentinel and Observational Medical Outcomes Partnership approaches, to facilitate international studies. The Surveillance Platform will provide access to data for health protection and promotion work as authorized through agreements between Oxford, the Royal College of General Practitioners, and Public Health England. All studies using the Trials Platform will go through appropriate ethical and other regulatory approval processes. Results: The hub will be a bottom-up, professionally led network that will provide benefits for member practices, our health service, and the population served. Data will only be used for SQUIRE (surveillance, quality improvement, research, and education) purposes. We have already received positive responses from practices, and the number of practices in the network has doubled to over 1150 since February 2020. COVID-19 surveillance has resulted in tripling of the number of virology sites to 293 (target 300), which has aided the collection of the largest ever weekly total of surveillance swabs in the United Kingdom as well as over 3000 severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) serology samples. Practices are recruiting to the PRINCIPLE (Platform Randomised trial of INterventions against COVID-19 In older PeopLE) trial, and these participants will be followed up through ORCHID. These initial outputs demonstrate the feasibility of ORCHID to provide an extended national digital health hub. Conclusions: ORCHID will provide equitable and innovative use of big data through a professionally led national primary care network and the application of FAIR principles. The secure data hub will host routinely collected general practice data linked to other key health care repositories for clinical trials and support enhanced in situ surveillance without always requiring large volume data extracts. ORCHID will support rapid data extraction, analysis, and dissemination with the aim of improving future research and development in general practice to positively impact patient care. International Registered Report Identifier (IRRID): DERR1-10.2196/19773 %M 32484782 %R 10.2196/19773 %U https://publichealth.jmir.org/2020/3/e19773 %U https://doi.org/10.2196/19773 %U http://www.ncbi.nlm.nih.gov/pubmed/32484782 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 7 %P e19514 %T Monitoring and Management of Home-Quarantined Patients With COVID-19 Using a WeChat-Based Telemedicine System: Retrospective Cohort Study %A Xu,Hui %A Huang,Sufang %A Qiu,Chun %A Liu,Shangkun %A Deng,Juan %A Jiao,Bo %A Tan,Xi %A Ai,Ling %A Xiao,Yaru %A Belliato,Mirko %A Yan,Li %+ Department of Emergency Medicine, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, 1095 Jie Fang Avenue, Qiaokou District, Wuhan, 430030, China, 86 13607124420, yanli008@163.com %K telemedicine system %K home quarantine %K quarantine management assessment %K progressive COVID-19 patients %K COVID-19 %D 2020 %7 2.7.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Most patients with coronavirus disease (COVID-19) who show mild symptoms are sent home by physicians to recover. However, the condition of some of these patients becomes severe or critical as the disease progresses. Objective: The aim of this study was to evaluate a telemedicine model that was developed to address the challenges of treating patients with progressive COVID-19 who are home-quarantined and shortages in the medical workforce. Methods: A telemedicine system was developed to continuously monitor the progression of home-quarantined patients with COVID-19. The system was built based on a popular social media smartphone app called WeChat; the app was used to establish two-way communication between a multidisciplinary team consisting of 7 medical workers and 188 home-quarantined individuals (including 74 confirmed patients with COVID-19). The system helped patients self-assess their conditions and update the multidisciplinary team through a telemedicine form stored on a cloud service, based on which the multidisciplinary team made treatment decisions. We evaluated this telemedicine system via a single-center retrospective study conducted at Tongji Hospital in Wuhan, China, in January 2020. Results: Among 188 individuals using the telemedicine system, 114 (60.6%) were not infected with COVID-19 and were dismissed. Of the 74 confirmed patients with COVID-19, 26 (35%) recovered during the study period and voluntarily stopped using the system. The remaining 48/76 confirmed patients with COVID-19 (63%) used the system until the end of the study, including 6 patients whose conditions progressed to severe or critical. These 6 patients were admitted to hospital and were stabilized (one received extracorporeal membrane oxygenation support for 17 days). All 74 patients with COVID-19 eventually recovered. Through a comparison of the monitored symptoms between hospitalized and nonhospitalized patients, we found prolonged persistence and deterioration of fever, dyspnea, lack of strength, and muscle soreness to be diagnostic of need for hospitalization. Conclusions: By continuously monitoring the changes in several key symptoms, the telemedicine system reduces the risks of delayed hospitalization due to disease progression for patients with COVID-19 quarantined at home. The system uses a set of scales for quarantine management assessment that enables patients to self-assess their conditions. The results are useful for medical staff to identify disease progression and, hence, make appropriate and timely treatment decisions. The system requires few staff to manage a large cohort of patients. In addition, the system can solicit help from recovered but self-quarantined medical workers to alleviate shortages in the medical workforce and free healthy medical workers to fight COVID-19 on the front line. Thus, it optimizes the usage of local medical resources and prevents cross-infections among medical workers and patients. %M 32568727 %R 10.2196/19514 %U https://www.jmir.org/2020/7/e19514 %U https://doi.org/10.2196/19514 %U http://www.ncbi.nlm.nih.gov/pubmed/32568727 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 7 %P e18831 %T Mapping of Health Literacy and Social Panic Via Web Search Data During the COVID-19 Public Health Emergency: Infodemiological Study %A Xu,Chenjie %A Zhang,Xinyu %A Wang,Yaogang %+ School of Public Health, Tianjin Medical University, No 22, Qixiangtai Road, Heping District, Tianjin, 300070, China, 86 13820046130, wangyg@tmu.edu.cn %K COVID-19 %K China %K Baidu %K infodemiology %K web search %K internet %K public health %K emergency %K outbreak %K infectious disease %K pandemic %K health literacy %D 2020 %7 2.7.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Coronavirus disease (COVID-19) is a type of pneumonia caused by a novel coronavirus that was discovered in 2019. As of May 6, 2020, 84,407 cases and 4643 deaths have been confirmed in China. The Chinese population has expressed great concern since the COVID-19 outbreak. Meanwhile, an average of 1 billion people per day are using the Baidu search engine to find COVID-19–related health information. Objective: The aim of this paper is to analyze web search data volumes related to COVID-19 in China. Methods: We conducted an infodemiological study to analyze web search data volumes related to COVID-19. Using Baidu Index data, we assessed the search frequencies of specific search terms in Baidu to describe the impact of COVID-19 on public health, psychology, behaviors, lifestyles, and social policies (from February 11, 2020, to March 17, 2020). Results: The search frequency related to COVID-19 has increased significantly since February 11th. Our heat maps demonstrate that citizens in Wuhan, Hubei Province, express more concern about COVID-19 than citizens from other cities since the outbreak first occurred in Wuhan. Wuhan citizens frequently searched for content related to “medical help,” “protective materials,” and “pandemic progress.” Web searches for “return to work” and “go back to school” have increased eight-fold compared to the previous month. Searches for content related to “closed community and remote office” have continued to rise, and searches for “remote office demand” have risen by 663% from the previous quarter. Employees who have returned to work have mainly engaged in the following web searches: “return to work and prevention measures,” “return to work guarantee policy,” and “time to return to work.” Provinces with large, educated populations (eg, Henan, Hebei, and Shandong) have been focusing on “online education” whereas medium-sized cities have been paying more attention to “online medical care.” Conclusions: Our findings suggest that web search data may reflect changes in health literacy, social panic, and prevention and control policies in response to COVID-19. %M 32540844 %R 10.2196/18831 %U https://www.jmir.org/2020/7/e18831 %U https://doi.org/10.2196/18831 %U http://www.ncbi.nlm.nih.gov/pubmed/32540844 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 6 %P e19636 %T Identification of Symptoms Prognostic of COVID-19 Severity: Multivariate Data Analysis of a Case Series in Henan Province %A Li,Jitian %A Chen,Zhe %A Nie,Yifei %A Ma,Yan %A Guo,Qiaoyun %A Dai,Xiaofeng %+ Wuxi School of Medicine, Jiangnan University, Lihu Avenue 1800, Wuxi, 214122, China, 86 18168870169, 1281423490@qq.com %K prognostic symptoms %K COVID-19 %K severity %K CVD %K Henan Province %D 2020 %7 30.6.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes coronavirus disease (COVID-19), has been declared a global pandemic. Identifying individuals whose infection can potentially become severe is critical to control the case fatality rate of COVID-19. However, knowledge of symptoms that are prognostic of COVID-19 severity is lacking. Objective: The objective of our study was to identify symptoms prognostic of COVID-19 infection severity. Methods: We analyzed documented symptoms, including fever, cough, fatigue, expectoration, sore throat, chest distress, headache, diarrhea, rhinorrhea, stuffed nose, nausea, vomiting, muscle or joint ache, shortness of breath, and their associations with disease severity using a case series, including 655 confirmed cases from January 23 to February 5, 2020 in Henan Province, China. We also analyzed the influence of individual characteristics, including age, gender, and comorbidities, on symptoms with prognostic value. Results: Fatigue (95% CI 0.141 to 0.334, P<.001), expectoration (95% CI 0.107 to 0.305, P<.001) and stuffed nose (95% CI –0.499 to –0.082, P=.006) were identified as the prognostic symptoms of COVID-19 patients from the multivariate analysis. Fever occurred in 603/655 (92.1%) of the patients but was not associated with disease severity. Fatigue accounted for 184/655 (28.1%) of the patients and was linearly associated with infection severity with statistical significance. Expectoration occurred in 169/655 (25.8%) patients in the cohort and was the sole prognostic factor for patients with cardiovascular complications, including hypertension. Shortness of breath, chest distress, muscle or joint ache, and dry cough, which occurred in 33 (5%), 83 (12.7%), 78 (11.9%), and 276 (42.1%) of the 655 patients, respectively, were significantly enriched among patients classified as severe. Stuffed nose and nausea were associated with favorable disease severity, especially among male patients. More female than male patients were documented as having muscle or joint ache. Headache was most enriched in patents aged 15 to 39 years, followed by those aged 40 to 64 years, with statistical significance. Conclusions: Fatigue and expectoration are signs of severe COVID-19 infection. Shortness of breath, chest distress, muscle or joint ache, and dry cough are prevalent in severe patients. Expectoration is commonly present in older individuals and patients with cardiovascular disorders, including hypertension. Shortness of breath is prognostic of severe infection in male patients. Stuffed nose and nausea are favorable prognostic factors of severe infection, especially among male patients. %M 32544071 %R 10.2196/19636 %U https://www.jmir.org/2020/6/e19636 %U https://doi.org/10.2196/19636 %U http://www.ncbi.nlm.nih.gov/pubmed/32544071 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 6 %P e19786 %T A COVID-19 Risk Assessment Decision Support System for General Practitioners: Design and Development Study %A Liu,Ying %A Wang,Zhixiao %A Ren,Jingjing %A Tian,Yu %A Zhou,Min %A Zhou,Tianshu %A Ye,Kangli %A Zhao,Yinghao %A Qiu,Yunqing %A Li,Jingsong %+ Engineering Research Center of EMR and Intelligent Expert System, Ministry of Education, College of Biomedical Engineering and Instrument Science, Zhejiang University, 38 Zheda Road, Hangzhou, 310027, China, 86 57187951564, ljs@zju.edu.cn %K COVID-19 %K dynamic risk stratification %K decision support system %K telemedicine triage system %K multiclass logistic regression %D 2020 %7 29.6.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The coronavirus disease (COVID-19) has become an urgent and serious global public health crisis. Community engagement is the first line of defense in the fight against infectious diseases, and general practitioners (GPs) play an important role in it. GPs are facing unique challenges from disasters and pandemics in delivering health care. However, there is still no suitable mobile management system that can help GPs collect data, dynamically assess risks, and effectively triage or follow-up with patients with COVID-19. Objective: The aim of this study is to design, develop, and deploy a mobile-based decision support system for COVID-19 (DDC19) to assist GPs in collecting data, assessing risk, triaging, managing, and following up with patients during the COVID-19 outbreak. Methods: Based on the actual scenarios and the process of patients using health care, we analyzed the key issues that need to be solved and designed the main business flowchart of DDC19. We then constructed a COVID-19 dynamic risk stratification model with high recall and clinical interpretability, which was based on a multiclass logistic regression algorithm. Finally, through a 10-fold cross-validation to quantitatively evaluate the risk stratification ability of the model, a total of 2243 clinical data consisting of 36 dimension clinical features from fever clinics were used for training and evaluation of the model. Results: DDC19 is composed of three parts: mobile terminal apps for the patient-end and GP-end, and the database system. All mobile terminal devices were wirelessly connected to the back end data center to implement request sending and data transmission. We used low risk, moderate risk, and high risk as labels, and adopted a 10-fold cross-validation method to evaluate and test the COVID-19 dynamic risk stratification model in different scenarios (different dimensions of personal clinical data accessible at an earlier stage). The data set dimensions were (2243, 15) when only using the data of patients’ demographic information, clinical symptoms, and contact history; (2243, 35) when the results of blood tests were added; and (2243, 36) after obtaining the computed tomography imaging results of the patient. The average value of the three classification results of the macro–area under the curve were all above 0.71 in each scenario. Conclusions: DCC19 is a mobile decision support system designed and developed to assist GPs in providing dynamic risk assessments for patients with suspected COVID-19 during the outbreak, and the model had a good ability to predict risk levels in any scenario it covered. %M 32540845 %R 10.2196/19786 %U http://www.jmir.org/2020/6/e19786/ %U https://doi.org/10.2196/19786 %U http://www.ncbi.nlm.nih.gov/pubmed/32540845 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 6 %P e19569 %T COVID-19 Pneumonia Diagnosis Using a Simple 2D Deep Learning Framework With a Single Chest CT Image: Model Development and Validation %A Ko,Hoon %A Chung,Heewon %A Kang,Wu Seong %A Kim,Kyung Won %A Shin,Youngbin %A Kang,Seung Ji %A Lee,Jae Hoon %A Kim,Young Jun %A Kim,Nan Yeol %A Jung,Hyunseok %A Lee,Jinseok %+ Department of Biomedical Engineering, Wonkwang University College of Medicine, 460 Iksan-daero, Iksan-si, 54538, Republic of Korea, 82 63 850 5114, gonasago@wku.ac.kr %K COVID-19 %K deep learning %K convolutional neural networks, transfer learning %K chest CT %K CT %K neural network %K pneumonia %K artificial intelligence %K diagnosis %K pneumonia %K scan %D 2020 %7 29.6.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Coronavirus disease (COVID-19) has spread explosively worldwide since the beginning of 2020. According to a multinational consensus statement from the Fleischner Society, computed tomography (CT) is a relevant screening tool due to its higher sensitivity for detecting early pneumonic changes. However, physicians are extremely occupied fighting COVID-19 in this era of worldwide crisis. Thus, it is crucial to accelerate the development of an artificial intelligence (AI) diagnostic tool to support physicians. Objective: We aimed to rapidly develop an AI technique to diagnose COVID-19 pneumonia in CT images and differentiate it from non–COVID-19 pneumonia and nonpneumonia diseases. Methods: A simple 2D deep learning framework, named the fast-track COVID-19 classification network (FCONet), was developed to diagnose COVID-19 pneumonia based on a single chest CT image. FCONet was developed by transfer learning using one of four state-of-the-art pretrained deep learning models (VGG16, ResNet-50, Inception-v3, or Xception) as a backbone. For training and testing of FCONet, we collected 3993 chest CT images of patients with COVID-19 pneumonia, other pneumonia, and nonpneumonia diseases from Wonkwang University Hospital, Chonnam National University Hospital, and the Italian Society of Medical and Interventional Radiology public database. These CT images were split into a training set and a testing set at a ratio of 8:2. For the testing data set, the diagnostic performance of the four pretrained FCONet models to diagnose COVID-19 pneumonia was compared. In addition, we tested the FCONet models on an external testing data set extracted from embedded low-quality chest CT images of COVID-19 pneumonia in recently published papers. Results: Among the four pretrained models of FCONet, ResNet-50 showed excellent diagnostic performance (sensitivity 99.58%, specificity 100.00%, and accuracy 99.87%) and outperformed the other three pretrained models in the testing data set. In the additional external testing data set using low-quality CT images, the detection accuracy of the ResNet-50 model was the highest (96.97%), followed by Xception, Inception-v3, and VGG16 (90.71%, 89.38%, and 87.12%, respectively). Conclusions: FCONet, a simple 2D deep learning framework based on a single chest CT image, provides excellent diagnostic performance in detecting COVID-19 pneumonia. Based on our testing data set, the FCONet model based on ResNet-50 appears to be the best model, as it outperformed other FCONet models based on VGG16, Xception, and Inception-v3. %M 32568730 %R 10.2196/19569 %U http://www.jmir.org/2020/6/e19569/ %U https://doi.org/10.2196/19569 %U http://www.ncbi.nlm.nih.gov/pubmed/32568730 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 6 %P e21820 %T How to Fight an Infodemic: The Four Pillars of Infodemic Management %A Eysenbach,Gunther %+ JMIR Publications, 130 Queens Quay East, Suite 1100, Toronto, ON, , Canada, 1 416 583 2040, editor@jmir.org %K infodemiology %K infodemic %K COVID-19 %K infoveillance %K pandemic %K epidemics %K emergency management %K public health %D 2020 %7 29.6.2020 %9 Commentary %J J Med Internet Res %G English %X In this issue of the Journal of Medical Internet Research, the World Health Organization (WHO) is presenting a framework for managing the coronavirus disease (COVID-19) infodemic. Infodemiology is now acknowledged by public health organizations and the WHO as an important emerging scientific field and critical area of practice during a pandemic. From the perspective of being the first “infodemiologist” who originally coined the term almost two decades ago, I am positing four pillars of infodemic management: (1) information monitoring (infoveillance); (2) building eHealth Literacy and science literacy capacity; (3) encouraging knowledge refinement and quality improvement processes such as fact checking and peer-review; and (4) accurate and timely knowledge translation, minimizing distorting factors such as political or commercial influences. In the current COVID-19 pandemic, the United Nations has advocated that facts and science should be promoted and that these constitute the antidote to the current infodemic. This is in stark contrast to the realities of infodemic mismanagement and misguided upstream filtering, where social media platforms such as Twitter have advertising policies that sideline science organizations and science publishers, treating peer-reviewed science as “inappropriate content.” %M 32589589 %R 10.2196/21820 %U http://www.jmir.org/2020/6/e21820/ %U https://doi.org/10.2196/21820 %U http://www.ncbi.nlm.nih.gov/pubmed/32589589 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 6 %P e19659 %T Framework for Managing the COVID-19 Infodemic: Methods and Results of an Online, Crowdsourced WHO Technical Consultation %A Tangcharoensathien,Viroj %A Calleja,Neville %A Nguyen,Tim %A Purnat,Tina %A D’Agostino,Marcelo %A Garcia-Saiso,Sebastian %A Landry,Mark %A Rashidian,Arash %A Hamilton,Clayton %A AbdAllah,Abdelhalim %A Ghiga,Ioana %A Hill,Alexandra %A Hougendobler,Daniel %A van Andel,Judith %A Nunn,Mark %A Brooks,Ian %A Sacco,Pier Luigi %A De Domenico,Manlio %A Mai,Philip %A Gruzd,Anatoliy %A Alaphilippe,Alexandre %A Briand,Sylvie %+ Department of Digital Health and Innovation, Science Division, World Health Organization, 20 Avenue Appia, Geneva, 1211, Switzerland, 41 22 791 2476, purnatt@who.int %K COVID-19 %K infodemic %K knowledge translation %K message amplification %K misinformation %K information-seeking behavior %K access to information %K information literacy %K communications media %K internet %K risk communication %K evidence synthesis %D 2020 %7 26.6.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: An infodemic is an overabundance of information—some accurate and some not—that occurs during an epidemic. In a similar manner to an epidemic, it spreads between humans via digital and physical information systems. It makes it hard for people to find trustworthy sources and reliable guidance when they need it. Objective: A World Health Organization (WHO) technical consultation on responding to the infodemic related to the coronavirus disease (COVID-19) pandemic was held, entirely online, to crowdsource suggested actions for a framework for infodemic management. Methods: A group of policy makers, public health professionals, researchers, students, and other concerned stakeholders was joined by representatives of the media, social media platforms, various private sector organizations, and civil society to suggest and discuss actions for all parts of society, and multiple related professional and scientific disciplines, methods, and technologies. A total of 594 ideas for actions were crowdsourced online during the discussions and consolidated into suggestions for an infodemic management framework. Results: The analysis team distilled the suggestions into a set of 50 proposed actions for a framework for managing infodemics in health emergencies. The consultation revealed six policy implications to consider. First, interventions and messages must be based on science and evidence, and must reach citizens and enable them to make informed decisions on how to protect themselves and their communities in a health emergency. Second, knowledge should be translated into actionable behavior-change messages, presented in ways that are understood by and accessible to all individuals in all parts of all societies. Third, governments should reach out to key communities to ensure their concerns and information needs are understood, tailoring advice and messages to address the audiences they represent. Fourth, to strengthen the analysis and amplification of information impact, strategic partnerships should be formed across all sectors, including but not limited to the social media and technology sectors, academia, and civil society. Fifth, health authorities should ensure that these actions are informed by reliable information that helps them understand the circulating narratives and changes in the flow of information, questions, and misinformation in communities. Sixth, following experiences to date in responding to the COVID-19 infodemic and the lessons from other disease outbreaks, infodemic management approaches should be further developed to support preparedness and response, and to inform risk mitigation, and be enhanced through data science and sociobehavioral and other research. Conclusions: The first version of this framework proposes five action areas in which WHO Member States and actors within society can apply, according to their mandate, an infodemic management approach adapted to national contexts and practices. Responses to the COVID-19 pandemic and the related infodemic require swift, regular, systematic, and coordinated action from multiple sectors of society and government. It remains crucial that we promote trusted information and fight misinformation, thereby helping save lives. %M 32558655 %R 10.2196/19659 %U http://www.jmir.org/2020/6/e19659/ %U https://doi.org/10.2196/19659 %U http://www.ncbi.nlm.nih.gov/pubmed/32558655 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 3 %N 1 %P e20049 %T Digital Approaches to Remote Pediatric Health Care Delivery During the COVID-19 Pandemic: Existing Evidence and a Call for Further Research %A Badawy,Sherif M %A Radovic,Ana %+ Department of Pediatrics, Northwestern University Feinberg School of Medicine, 225 E Chicago Avenue, Box #30, Chicago, IL, 60654, United States, 1 312 227 4000 ext 74836, sbadawy@luriechildrens.org %K coronavirus %K COVID-19 %K SARS-CoV-2 %K pandemic %K outbreak %K public health %K pediatric %K children %K adolescents %K telehealth %K telemedicine %K digital %K interventions %K digital health %K digital medicine %K mobile health %K mHealth %K eHealth %K health care delivery %D 2020 %7 25.6.2020 %9 Viewpoint %J JMIR Pediatr Parent %G English %X The global spread of the coronavirus disease (COVID-19) outbreak poses a public health threat and has affected people worldwide in various unprecedented ways, both personally and professionally. There is no question that the current global COVID-19 crisis, now more than ever, is underscoring the importance of leveraging digital approaches to optimize pediatric health care delivery in the era of this pandemic. In this perspective piece, we highlight some of the available digital approaches that have been and can continue to be used to streamline remote pediatric patient care in the era of the COVID-19 pandemic, including but not limited to telemedicine. JMIR Pediatrics and Parenting is currently publishing a COVID-19 special theme issue in which investigators can share their interim and final research data related to digital approaches to remote pediatric health care delivery in different settings. The COVID-19 pandemic has rapidly transformed health care systems worldwide, with significant variations and innovations in adaptation. There has been rapid expansion of the leveraging and optimization of digital approaches to health care delivery, particularly integrated telemedicine and virtual health. Digital approaches have played and will play major roles as invaluable and reliable resources to overcome restrictions and challenges imposed during the COVID-19 pandemic and to increase access to effective, accessible, and consumer-friendly care for more patients and families. However, a number of challenges remain to be addressed, and further research is needed. Optimizing digital approaches to health care delivery and integrating them into the public health response will be an ongoing process during the current COVID-19 outbreak and during other possible future pandemics. Regulatory changes are essential to support the safe and wide adoption of these approaches. Involving all relevant stakeholders in addressing current and future challenges as well as logistical, technological, and financial barriers will be key for success. Future studies should consider evaluating the following research areas related to telemedicine and other digital approaches: cost-effectiveness and return on investment; impact on quality of care; balance in use and number of visits needed for the management of both acute illness and chronic health conditions; system readiness for further adoption in other settings, such as inpatient services, subspecialist consultations, and rural areas; ongoing user-centered evaluations, with feedback from patients, families, and health care providers; strategies to optimize health equity and address disparities in access to care related to race and ethnicity, socioeconomic status, immigration status, and rural communities; privacy and security concerns for protected health information with Health Insurance Portability and Accountability Act (HIPAA)–secured programs; confidentiality issues for some specific populations, especially adolescents and those in need of mental health services; early detection of exposure to violence and child neglect; and integration of training into undergraduate and graduate medical education and subspecialty fellowships. Addressing these research areas is essential to understanding the benefits, sustainability, safety, and optimization strategies of telemedicine and other digital approaches as key parts of modern health care delivery. These efforts will inform long-term adoption of these approaches with expanded dissemination and implementation efforts. %M 32540841 %R 10.2196/20049 %U http://pediatrics.jmir.org/2020/1/e20049/ %U https://doi.org/10.2196/20049 %U http://www.ncbi.nlm.nih.gov/pubmed/32540841 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 6 %P e19771 %T Leveraging User Experience to Improve Video Consultations in a Cardiology Practice During the COVID-19 Pandemic: Initial Insights %A Vandekerckhove,Pieter %A Vandekerckhove,Yves %A Tavernier,Rene %A De Jaegher,Kelly %A de Mul,Marleen %+ Erasmus School of Health Policy and Management, Erasmus University, Burgemeester Oudlaan 50, Rotterdam, 3000 DR, Netherlands, 31 10 408 8555, vandekerckhove@eshpm.eur.nl %K telemedicine %K design thinking %K cardiology %K patient %K COVID-19 %K user experience %D 2020 %7 25.6.2020 %9 Viewpoint %J J Med Internet Res %G English %X During the coronavirus disease (COVID-19) pandemic, cardiologists have attempted to minimize risks to their patients by using telehealth to provide continuing care. Rapid implementation of video consultations in outpatient clinics for patients with heart disease can be challenging. We employed a design thinking tool called a customer journey to explore challenges and opportunities when using video communication software in the cardiology department of a regional hospital. Interviews were conducted with 5 patients with implanted devices, a nurse, an information technology manager and two cardiologists. Three lessons were identified based on these challenges and opportunities. Attention should be given to the ease of use of the technology, the meeting features, and the establishment of the connection between the cardiologist and the patient. Further, facilitating the role of an assistant (or virtual assistant) with the video consultation software who can manage the telehealth process may improve the success of video consultations. Employing design thinking to implement video consultations in cardiology and to further implement telehealth is crucial to build a resilient health care system that can address urgent needs beyond the COVID-19 pandemic. %M 32519964 %R 10.2196/19771 %U http://www.jmir.org/2020/6/e19771/ %U https://doi.org/10.2196/19771 %U http://www.ncbi.nlm.nih.gov/pubmed/32519964 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e19731 %T Suitability and Sufficiency of Telehealth Clinician-Observed, Participant-Collected Samples for SARS-CoV-2 Testing: The iCollect Cohort Pilot Study %A Guest,Jodie L %A Sullivan,Patrick S %A Valentine-Graves,Mariah %A Valencia,Rachel %A Adam,Elizabeth %A Luisi,Nicole %A Nakano,Mariko %A Guarner,Jeannette %A del Rio,Carlos %A Sailey,Charles %A Goedecke,Zoe %A Siegler,Aaron J %A Sanchez,Travis H %+ Rollins School of Public Health, Emory University, 1518 Clifton Rd, Atlanta, GA, 30322, United States, 1 4046802450, Jodie.Guest@emory.edu %K COVID-19 %K testing %K home testing %K telehealth %K pilot study %K diagnostic %K diagnosis %D 2020 %7 25.6.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The severe acute respiratory coronavirus 2 (SARS-CoV-2) pandemic calls for expanded opportunities for testing, including novel testing strategies such as home-collected specimens. Objective: We aimed to understand whether oropharyngeal swab (OPS), saliva, and dried blood spot (DBS) specimens collected by participants at home and mailed to a laboratory were sufficient for use in diagnostic and serology tests of SARS-CoV-2. Methods: Eligible participants consented online and were mailed a participant-collection kit to support collection of three specimens for SARS-CoV-2 testing: saliva, OPS, and DBS. Participants performed the specimen collection procedures during a telehealth video appointment while clinical observers watched and documented the suitability of the collection. The biological sufficiency of the specimens for detection of SARS-CoV-2 by reverse transcriptase–polymerase chain reaction and serology testing was assessed by laboratorians using visual inspection and quantification of the nucleic acid contents of the samples by ribonuclease P (RNase P) measurements. Results: Of the enrolled participants,153/159 (96.2%) returned their kits, which were included in this analysis. All these participants attended their video appointments. Clinical observers assessed that of the samples collected, 147/153 (96.1%) of the saliva samples, 146/151 (96.7%) of the oropharyngeal samples, and 135/145 (93.1%) of the DBS samples were of sufficient quality for submission for laboratory testing; 100% of the OPS samples and 98% of the saliva samples had cycle threshold values for RNase P <30, indicating that the samples contained sufficient nucleic acid for RNA-PCR testing for SARS-CoV-2. Conclusions: These pilot data indicate that most participant-collected OPS, saliva, and DBS specimens are suitable and sufficient for testing for SARS-CoV-2 RNA and serology. Clinical observers rated the collection of specimens as suitable for testing, and visual and quantitative laboratory assessment indicated that the specimens were biologically sufficient. These data support the utility of participant-collected and mailed-in specimens for SARS-CoV-2 testing. International Registered Report Identifier (IRRID): RR2-10.2196/19054 %M 32479412 %R 10.2196/19731 %U http://publichealth.jmir.org/2020/2/e19731/ %U https://doi.org/10.2196/19731 %U http://www.ncbi.nlm.nih.gov/pubmed/32479412 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e19045 %T Telehealth as a Bright Spot of the COVID-19 Pandemic: Recommendations From the Virtual Frontlines ("Frontweb") %A Olayiwola,J Nwando %A Magaña,Candy %A Harmon,Ashley %A Nair,Shalina %A Esposito,Erica %A Harsh,Christine %A Forrest,L Arick %A Wexler,Randy %+ Department of Family Medicine, The Ohio State University Wexner Medical Center, 2231 N High Street, Suite 250, Columbus, OH, 43210, United States, 1 6142932652, nwando.olayiwola@osumc.edu %K telehealth %K telemedicine %K primary care %K COVID-19 %K pandemic %K outbreak %K public health %K infectious disease %D 2020 %7 25.6.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X The coronavirus disease (COVID-19) pandemic has accelerated the telehealth tipping point in the practice of family medicine and primary care in the United States, making telehealth not just a novel approach to care but also a necessary one for public health safety. Social distancing requirements and stay-at-home orders have shifted patient care from face-to-face consultations in primary care offices to virtual care from clinicians’ homes or offices, moving to a new frontline, which we call the “frontweb.” Our telehealth workgroup employed the Clinical Transformation in Technology implementation framework to accelerate telehealth expansion and to develop a consensus document for clinician recommendations in providing remote virtual care during the pandemic. In a few weeks, telehealth went from under 5% of patient visits to almost 93%, while maintaining high levels of patient satisfaction. In this paper, we share clinician recommendations and guidance gleaned from this transition to the frontweb and offer a systematic approach for ensuring “webside” success. %M 32479413 %R 10.2196/19045 %U http://publichealth.jmir.org/2020/2/e19045/ %U https://doi.org/10.2196/19045 %U http://www.ncbi.nlm.nih.gov/pubmed/32479413 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 6 %P e19691 %T Virtual Management of Patients With Cancer During the COVID-19 Pandemic: Web-Based Questionnaire Study %A Tashkandi,Emad %A Zeeneldin,Ahmed %A AlAbdulwahab,Amal %A Elemam,Omima %A Elsamany,Shereef %A Jastaniah,Wasil %A Abdullah,Shaker %A Alfayez,Mohammad %A Jazieh,Abdul Rahman %A Al-Shamsi,Humaid O %+ Department of Medical Oncology, Oncology Center, King Abdullah Medical City, PO box 715, Makkah, 21955, Saudi Arabia, 966 555290061, Tashkandi.e@kamc.med.sa %K teleoncology %K telemedicine %K eHealth %K cancer %K COVID-19 %K public health %D 2020 %7 24.6.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: During the coronavirus disease (COVID-19) pandemic, patients with cancer in rural settings and distant geographical areas will be affected the most by curfews. Virtual management (telemedicine) has been shown to reduce health costs and improve access to care. Objective: The aim of this survey is to understand oncologists’ awareness of and views on virtual management, challenges, and preferences, as well as their priorities regarding the prescribing of anticancer treatments during the COVID-19 pandemic. Methods: We created a self-administrated electronic survey about the virtual management of patients with cancer during the COVID-19 pandemic. We evaluated its clinical sensibility and pilot tested the instrument. We surveyed practicing oncologists in Gulf and Arab countries using snowball sampling via emails and social media networks. Reminders were sent 1 and 2 weeks later using SurveyMonkey. Results: We received 222 responses from validated oncologists from April 2-22, 2020. An awareness of virtual clinics, virtual multidisciplinary teams, and virtual prescriptions was reported by 182 (82%), 175 (79%), and 166 (75%) respondents, respectively. Reported challenges associated with virtual management were the lack of physical exam (n=134, 60%), patients’ awareness and access (n=131, 59%), the lack of physical attendance of patients (n=93, 42%), information technology (IT) support (n=82, 37%), and the safety of virtual management (n=78, 35%). Overall, 111 (50%) and 107 (48%) oncologists did not prefer the virtual prescription of chemotherapy and novel immunotherapy, respectively. However, 188 (85%), 165 (74%), and 127 (57%) oncologists preferred the virtual prescription of hormonal therapy, bone modifying agents, and targeted therapy, respectively. In total, 184 (83%), 183 (83%), and 176 (80%) oncologists preferred to continue neoadjuvant, adjuvant, and perioperative treatments, respectively. Overall, 118 (53%) respondents preferred to continue first-line palliative treatment, in contrast to 68 (30%) and 47 (21%) respondents indicating a preference to interrupt second- and third-line palliative treatment, respectively. For administration of virtual prescriptions, all respondents preferred the oral route and 118 (53%) preferred the subcutaneous route. In contrast, 193 (87%) did not prefer the intravenous route for virtual prescriptions. Overall, 102 (46%) oncologists responded that they would “definitely” prefer to manage patients with cancer virtually. Conclusions: Oncologists have a high level of awareness of virtual management. Although their survey responses indicated that second- and third-line palliative treatments should be interrupted, they stated that neoadjuvant, adjuvant, perioperative, and first-line palliative treatments should continue. Our results confirm that oncologists’ views on the priority of anticancer treatments are consistent with the evolving literature during the COVID-19 pandemic. Challenges to virtual management should be addressed to improve the care of patients with cancer. %M 32501807 %R 10.2196/19691 %U http://www.jmir.org/2020/6/e19691/ %U https://doi.org/10.2196/19691 %U http://www.ncbi.nlm.nih.gov/pubmed/32501807 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 6 %P e20586 %T A Double Triage and Telemedicine Protocol to Optimize Infection Control in an Emergency Department in Taiwan During the COVID-19 Pandemic: Retrospective Feasibility Study %A Lin,Chien-Hao %A Tseng,Wen-Pin %A Wu,Jhong-Lin %A Tay,Joyce %A Cheng,Ming-Tai %A Ong,Hooi-Nee %A Lin,Hao-Yang %A Chen,Yi-Ying %A Wu,Chih-Hsien %A Chen,Jiun-Wei %A Chen,Shey-Ying %A Chan,Chang-Chuan %A Huang,Chien-Hua %A Chen,Shyr-Chyr %+ Department of Emergency Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, No 7, Zhongshan S Road, Zhongzheng District, Taipei, 100, Taiwan, 886 2 233123456 ext 62831, chhuang5940@ntu.edu.tw %K COVID-19 %K triage %K emergency department %K health care workers %K infection control %K telemedicine %D 2020 %7 23.6.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Frontline health care workers, including physicians, are at high risk of contracting coronavirus disease (COVID-19) owing to their exposure to patients suspected of having COVID-19. Objective: The aim of this study was to evaluate the benefits and feasibility of a double triage and telemedicine protocol in improving infection control in the emergency department (ED). Methods: In this retrospective study, we recruited patients aged ≥20 years referred to the ED of the National Taiwan University Hospital between March 1 and April 30, 2020. A double triage and telemedicine protocol was developed to triage suggested COVID-19 cases and minimize health workers’ exposure to this disease. We categorized patients attending video interviews into a telemedicine group and patients experiencing face-to-face interviews into a conventional group. A questionnaire was used to assess how patients perceived the quality of the interviews and their communication with physicians as well as perceptions of stress, discrimination, and privacy. Each question was evaluated using a 5-point Likert scale. Physicians’ total exposure time and total evaluation time were treated as primary outcomes, and the mean scores of the questions were treated as secondary outcomes. Results: The final sample included 198 patients, including 93 cases (47.0%) in the telemedicine group and 105 cases (53.0%) in the conventional group. The total exposure time in the telemedicine group was significantly shorter than that in the conventional group (4.7 minutes vs 8.9 minutes, P<.001), whereas the total evaluation time in the telemedicine group was significantly longer than that in the conventional group (12.2 minutes vs 8.9 minutes, P<.001). After controlling for potential confounders, the total exposure time in the telemedicine group was 4.6 minutes shorter than that in the conventional group (95% CI −5.7 to −3.5, P<.001), whereas the total evaluation time in the telemedicine group was 2.8 minutes longer than that in the conventional group (95% CI −1.6 to −4.0, P<.001). The mean scores of the patient questionnaire were high in both groups (4.5/5 to 4.7/5 points). Conclusions: The implementation of the double triage and telemedicine protocol in the ED during the COVID-19 pandemic has high potential to improve infection control. %M 32544072 %R 10.2196/20586 %U http://www.jmir.org/2020/6/e20586/ %U https://doi.org/10.2196/20586 %U http://www.ncbi.nlm.nih.gov/pubmed/32544072 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e18928 %T COVID-19 and Laparoscopic Surgery: Scoping Review of Current Literature and Local Expertise %A de Leeuw,Robert Adrianus %A Burger,Nicole Birgit %A Ceccaroni,Marcello %A Zhang,Jian %A Tuynman,Jurriaan %A Mabrouk,Mohamed %A Barri Soldevila,Pere %A Bonjer,Hendrik Jaap %A Ankum,Pim %A Huirne,Judith %+ Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, 1081HV, Netherlands, 31 618390269, r.a.deleeuw@amsterdamumc.nl %K laparoscopy %K COVID-19 %K surgical procedures, operative %K corona 2019 %K surgery %K pandemic %K outbreak %K infectious disease %K health care provider %K physician %D 2020 %7 23.6.2020 %9 Review %J JMIR Public Health Surveill %G English %X Background: The current coronavirus disease (COVID-19) pandemic is holding the world in its grip. Epidemiologists have shown that the mortality risks are higher when the health care system is subjected to pressure from COVID-19. It is therefore of great importance to maintain the health of health care providers and prevent contamination. An important group who will be required to treat patients with COVID-19 are health care providers during semiacute surgery. There are concerns that laparoscopic surgery increases the risk of contamination more than open surgery; therefore, balancing the safety of health care providers with the benefit of laparoscopic surgery for the patient is vital. Objective: We aimed to provide an overview of potential contamination routes and possible risks for health care providers; we also aimed to propose research questions based on current literature and expert opinions about performing laparoscopic surgery on patients with COVID-19. Methods: We performed a scoping review, adding five additional questions concerning possible contaminating routes. A systematic search was performed on the PubMed, CINAHL, and Embase databases, adding results from gray literature as well. The search not only included COVID-19 but was extended to virus contamination in general. We excluded society and professional association statements about COVID-19 if they did not add new insights to the available literature. Results: The initial search provided 2007 records, after which 267 full-text papers were considered. Finally, we used 84 papers, of which 14 discussed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Eight papers discussed the added value of performing intubation in a low-pressure operating room, mainly based on the SARS outbreak experience in 2003. Thirteen papers elaborated on the risks of intubation for health care providers and SARS-CoV-2, and 19 papers discussed this situation with other viruses. They conclude that there is significant evidence that intubation and extubation is a high-risk aerosol-producing procedure. No papers were found on the risk of SARS-CoV-2 and surgical smoke, although 25 papers did provide conflicting evidence on the infection risk of human papillomavirus, hepatitis B, polio, and rabies. No papers were found discussing tissue extraction or the deflation risk of the pneumoperitoneum after laparoscopic surgery. Conclusions: There seems to be consensus in the literature that intubation and extubation are high-risk procedures for health care providers and that maximum protective equipment is needed. On the other hand, minimal evidence is available of the actual risk of contamination of health care providers during laparoscopy itself, nor of operating room pressure, surgical smoke, tissue extraction, or CO2 deflation. However, new studies are being published daily from current experiences, and society statements are continuously updated. There seems to be no reason to abandon laparoscopic surgery in favor of open surgery. However, the risks should not be underestimated, surgery should be performed on patients with COVID-19 only when necessary, and health care providers should use logic and common sense to protect themselves and others by performing surgery in a safe and protected environment. %M 32406853 %R 10.2196/18928 %U http://publichealth.jmir.org/2020/2/e18928/ %U https://doi.org/10.2196/18928 %U http://www.ncbi.nlm.nih.gov/pubmed/32406853 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 6 %P e20369 %T Case-Initiated COVID-19 Contact Tracing Using Anonymous Notifications %A Cheng,Weibin %A Hao,Chun %+ Institute for Healthcare Artificial Intelligence Application, Guangdong Second Provincial General Hospital, 466 Xingangzhong Road, Guangzhou, 510317, China, 86 20 89168139, chwb817@gmail.com %K COVID-19 %K surveillance %K contact tracing %K digital contact tracing %K notification %K anonymous %K labor-saving %K stigma %K privacy protection %D 2020 %7 22.6.2020 %9 Viewpoint %J JMIR Mhealth Uhealth %G English %X We discuss the concept of a participatory digital contact notification approach to assist tracing of contacts who are exposed to confirmed cases of coronavirus disease (COVID-19); the approach is simple and affordable for countries with limited access to health care resources and advanced technology. The proposed tool serves as a supplemental contract tracing approach to counteract the shortage of health care staff while providing privacy protection for both cases and contacts. This tool can be deployed on the internet or as a plugin for a smartphone app. Confirmed cases with COVID-19 can use this tool to provide contact information (either email addresses or mobile phone numbers) of close contacts. The system will then automatically send a message to the contacts informing them of their contact status, what this status means, the actions that should follow (eg, self-quarantine, respiratory hygiene/cough etiquette), and advice for receiving early care if they develop symptoms. The name of the sender of the notification message by email or mobile phone can be anonymous or not. The message received by the contact contains no disease information but contains a security code for the contact to log on the platform to retrieve the information. %M 32501802 %R 10.2196/20369 %U http://mhealth.jmir.org/2020/6/e20369/ %U https://doi.org/10.2196/20369 %U http://www.ncbi.nlm.nih.gov/pubmed/32501802 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 6 %P e19292 %T Closing the Psychological Treatment Gap During the COVID-19 Pandemic With a Supportive Text Messaging Program: Protocol for Implementation and Evaluation %A Agyapong,Vincent Israel Opoku %A Hrabok,Marianne %A Vuong,Wesley %A Gusnowski,April %A Shalaby,Reham %A Mrklas,Kelly %A Li,Daniel %A Urichuk,Liana %A Snaterse,Mark %A Surood,Shireen %A Cao,Bo %A Li,Xin-Min %A Greiner,Russ %A Greenshaw,Andrew James %+ Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, 1E1 Walter Mackenzie Health Sciences Centre, 8440 112 St NW, Edmonton, AB, T6G 2B7, Canada, 1 7807144315, agyapong@ualberta.ca %K COVID-19 %K Text4Hope %K mobile phones %K text %K anxiety %K depression %K stress %K pandemic %K e-mental health %D 2020 %7 22.6.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: Coronavirus disease (COVID-19) has spread globally with far-reaching, significant, and unprecedented impacts on health and everyday life. Threats to mental health, psychological safety, and well-being are now emerging, increasing the impact of this virus on world health. Providing support for these challenges is difficult because of the high number of people requiring support in the context of a need to maintain physical distancing. This protocol describes the use of SMS text messaging (Text4Hope) as a convenient, cost-effective, and accessible population-level mental health intervention. This program is evidence-based, with prior research supporting good outcomes and high user satisfaction. Objective: The project goal is to implement a program of daily supportive SMS text messaging (Text4Hope) to reduce distress related to the COVID-19 crisis, initially among Canadians. The prevalence of stress, anxiety, and depressive symptoms; the demographic correlates of the same; and the outcomes of the Text4Hope intervention in mitigating distress will be evaluated. Methods: Self-administered anonymous online questionnaires will be used to assess stress (Perceived Stress Scale), anxiety (Generalized Anxiety Disorder-7 scale [GAD-7]), and depressive symptoms (Patient Health Questionnaire-9 [PHQ-9]). Data will be collected at baseline (onset of SMS text messaging), the program midpoint (6 weeks), and the program endpoint (12 weeks). Results: Data analysis will include parametric and nonparametric techniques, focusing on primary outcomes (ie, stress, anxiety, and depressive symptoms) and metrics of use, including the number of subscribers and user satisfaction. Given the large size of the data set, machine learning and data mining methods will also be used. Conclusions: This COVID-19 project will provide key information regarding prevalence rates of stress, anxiety, and depressive symptoms during the pandemic; demographic correlates of distress; and outcome data related to this scalable population-level intervention. Information from this study will be valuable for practitioners and useful for informing policy and decision making regarding psychological interventions during the pandemic. International Registered Report Identifier (IRRID): DERR1-10.2196/19292 %M 32501805 %R 10.2196/19292 %U http://www.researchprotocols.org/2020/6/e19292/ %U https://doi.org/10.2196/19292 %U http://www.ncbi.nlm.nih.gov/pubmed/32501805 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e19847 %T Perspective of Medical Students on the COVID-19 Pandemic: Survey of Nine Medical Schools in Uganda %A Olum,Ronald %A Kajjimu,Jonathan %A Kanyike,Andrew Marvin %A Chekwech,Gaudencia %A Wekha,Godfrey %A Nassozi,Dianah Rhoda %A Kemigisa,Juliet %A Mulyamboga,Paul %A Muhoozi,Oscar Kabagambe %A Nsenga,Lauryn %A Lyavala,Musilim %A Asiimwe,Asaph %A Bongomin,Felix %+ School of Medicine, College of Health Sciences, Makerere University, Mulago Hospital Complex, Kampala, , Uganda, +256 775 512 540, olum.ronald@gmail.com %K knowledge %K attitude %K practices %K COVID-19 %K medical students %K Uganda %K medical education %K perspective %D 2020 %7 19.6.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The coronavirus disease (COVID-19) pandemic is a global public health concern affecting over 5 million people and posing a great burden on health care systems worldwide. Objective: The aim of this study is to determine the knowledge, attitude, and practices of medical students in Uganda on the COVID-19 pandemic. Methods: We conducted an online, descriptive cross-sectional study in mid-April 2020, using WhatsApp Messenger. Medical students in 9 of the 10 medical schools in Uganda were approached through convenience sampling. Bloom’s cut-off of 80% was used to determine good knowledge (≥12 out of 15), positive attitude (≥20 out of 25), and good practice (≥12 out of 15). Results: The data of 741 first- to fifth-year medical students, consisting of 468 (63%) males with a mean age of 24 (SD 4) years, were analyzed. The majority (n=626, 84%) were pursuing Bachelor of Medicine and Bachelor of Surgery degrees. Overall, 671 (91%) had good knowledge, 550 (74%) had a positive attitude, and 426 (57%) had good practices. Knowledge was associated with the 4th year of study (adjusted odds ratio [aOR] 4.1, 95% CI 1.6-10.3; P<.001). Attitude was associated with the female sex (aOR 0.7, 95% CI 0.5-1; P=.04) and TV or radio shows (aOR 1.1, 95% CI 0.6-2.1; P=.01). Practices were associated with the ≥24 years age category (aOR 1.5, 95% CI 1.1-2.1; P=.02) and online courses (aOR 1.8, 95% CI 1.1-3.2; P=.03). In total, 592 (80%) medical students were willing to participate in frontline care if called upon. Conclusions: Medical students in Uganda have sufficient knowledge of COVID-19 and will be a large reservoir for health care response when the need arises. %M 32530815 %R 10.2196/19847 %U http://publichealth.jmir.org/2020/2/e19847/ %U https://doi.org/10.2196/19847 %U http://www.ncbi.nlm.nih.gov/pubmed/32530815 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 6 %P e19787 %T Wearable Activity Trackers for Monitoring Adherence to Home Confinement During the COVID-19 Pandemic Worldwide: Data Aggregation and Analysis %A Pépin,Jean Louis %A Bruno,Rosa Maria %A Yang,Rui-Yi %A Vercamer,Vincent %A Jouhaud,Paul %A Escourrou,Pierre %A Boutouyrie,Pierre %+ HP2 (Hypoxia and Physio-Pathologies) Laboratory, Inserm (French National Institute of Health and Medical Research) U1042, University Grenoble Alpes, CHU (University Hospital) Michallon, Grenoble, 38043, France, 33 476768473, JPepin@chu-grenoble.fr %K wearable activity trackers %K pandemic %K COVID-19 %K home confinement %K lockdown %K monitoring %K wearables %K tracking %D 2020 %7 19.6.2020 %9 Short Paper %J J Med Internet Res %G English %X Background: In the context of home confinement during the coronavirus disease (COVID-19) pandemic, objective, real-time data are needed to assess populations’ adherence to home confinement to adapt policies and control measures accordingly. Objective: The aim of this study was to determine whether wearable activity trackers could provide information regarding users' adherence to home confinement policies because of their capacity for seamless and continuous monitoring of individuals’ natural activity patterns regardless of their location. Methods: We analyzed big data from individuals using activity trackers (Withings) that count the wearer’s average daily number of steps in a number of representative nations that adopted different modalities of restriction of citizens’ activities. Results: Data on the number of steps per day from over 740,000 individuals around the world were analyzed. We demonstrate the physical activity patterns in several representative countries with total, partial, or no home confinement. The decrease in steps per day in regions with strict total home confinement ranged from 25% to 54%. Partial lockdown (characterized by social distancing measures such as school closures, bar and restaurant closures, and cancellation of public meetings but without strict home confinement) does not appear to have a significant impact on people’s activity compared to the pre-pandemic period. The absolute level of physical activity under total home confinement in European countries is around twofold that in China. In some countries, such as France and Spain, physical activity started to gradually decrease even before official commitment to lockdown as a result of initial less stringent restriction orders or self-quarantine. However, physical activity began to increase again in the last 2 weeks, suggesting a decrease in compliance with confinement orders. Conclusions: Aggregate analysis of activity tracker data with the potential for daily updates can provide information regarding adherence to home confinement policies. %M 32501803 %R 10.2196/19787 %U http://www.jmir.org/2020/6/e19787/ %U https://doi.org/10.2196/19787 %U http://www.ncbi.nlm.nih.gov/pubmed/32501803 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e19353 %T Modeling COVID-19 Latent Prevalence to Assess a Public Health Intervention at a State and Regional Scale: Retrospective Cohort Study %A Turk,Philip J %A Chou,Shih-Hsiung %A Kowalkowski,Marc A %A Palmer,Pooja P %A Priem,Jennifer S %A Spencer,Melanie D %A Taylor,Yhenneko J %A McWilliams,Andrew D %+ Center for Outcomes Research and Evaluation, Atrium Health, 1300 Scott Ave, Office 124, Charlotte, NC, 28203, United States, 1 304 376 5377, Philip.Turk@atriumhealth.org %K COVID-19 %K public health surveillance %K novel coronavirus 2019 %K pandemic %K forecasting %K SIR model %K detection probability %K latent prevalence %D 2020 %7 19.6.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Emergence of the coronavirus disease (COVID-19) caught the world off guard and unprepared, initiating a global pandemic. In the absence of evidence, individual communities had to take timely action to reduce the rate of disease spread and avoid overburdening their health care systems. Although a few predictive models have been published to guide these decisions, most have not taken into account spatial differences and have included assumptions that do not match the local realities. Access to reliable information that is adapted to local context is critical for policy makers to make informed decisions during a rapidly evolving pandemic. Objective: The goal of this study was to develop an adapted susceptible-infected-removed (SIR) model to predict the trajectory of the COVID-19 pandemic in North Carolina and the Charlotte Metropolitan Region, and to incorporate the effect of a public health intervention to reduce disease spread while accounting for unique regional features and imperfect detection. Methods: Three SIR models were fit to infection prevalence data from North Carolina and the greater Charlotte Region and then rigorously compared. One of these models (SIR-int) accounted for a stay-at-home intervention and imperfect detection of COVID-19 cases. We computed longitudinal total estimates of the susceptible, infected, and removed compartments of both populations, along with other pandemic characteristics such as the basic reproduction number. Results: Prior to March 26, disease spread was rapid at the pandemic onset with the Charlotte Region doubling time of 2.56 days (95% CI 2.11-3.25) and in North Carolina 2.94 days (95% CI 2.33-4.00). Subsequently, disease spread significantly slowed with doubling times increased in the Charlotte Region to 4.70 days (95% CI 3.77-6.22) and in North Carolina to 4.01 days (95% CI 3.43-4.83). Reflecting spatial differences, this deceleration favored the greater Charlotte Region compared to North Carolina as a whole. A comparison of the efficacy of intervention, defined as 1 – the hazard ratio of infection, gave 0.25 for North Carolina and 0.43 for the Charlotte Region. In addition, early in the pandemic, the initial basic SIR model had good fit to the data; however, as the pandemic and local conditions evolved, the SIR-int model emerged as the model with better fit. Conclusions: Using local data and continuous attention to model adaptation, our findings have enabled policy makers, public health officials, and health systems to proactively plan capacity and evaluate the impact of a public health intervention. Our SIR-int model for estimated latent prevalence was reasonably flexible, highly accurate, and demonstrated efficacy of a stay-at-home order at both the state and regional level. Our results highlight the importance of incorporating local context into pandemic forecast modeling, as well as the need to remain vigilant and informed by the data as we enter into a critical period of the outbreak. %M 32427104 %R 10.2196/19353 %U http://publichealth.jmir.org/2020/2/e19353/ %U https://doi.org/10.2196/19353 %U http://www.ncbi.nlm.nih.gov/pubmed/32427104 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e19606 %T Distribution of Patients at Risk for Complications Related to COVID-19 in the United States: Model Development Study %A Smith-Ray,Renae %A Roberts,Erin E %A Littleton,Devonee E %A Singh,Tanya %A Sandberg,Thomas %A Taitel,Michael %+ Walgreens Center for Health and Wellbeing Research, Health Analytics, Research, and Reporting, Walgreen Co, 102 Wilmot Rd, MS 125D, Deerfield, IL, 60015, United States, 1 8472268552, renae.smith-ray@walgreens.com %K COVID-19 %K modeling %K chronic conditions %K older adults %D 2020 %7 18.6.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Coronavirus disease (COVID-19) has spread exponentially across the United States. Older adults with underlying health conditions are at an especially high risk of developing life-threatening complications if infected. Most intensive care unit (ICU) admissions and non-ICU hospitalizations have been among patients with at least one underlying health condition. Objective: The aim of this study was to develop a model to estimate the risk status of the patients of a nationwide pharmacy chain in the United States, and to identify the geographic distribution of patients who have the highest risk of severe COVID-19 complications. Methods: A risk model was developed using a training test split approach to identify patients who are at high risk of developing serious complications from COVID-19. Adult patients (aged ≥18 years) were identified from the Walgreens pharmacy electronic data warehouse. Patients were considered eligible to contribute data to the model if they had at least one prescription filled at a Walgreens location between October 27, 2019, and March 25, 2020. Risk parameters included age, whether the patient is being treated for a serious or chronic condition, and urban density classification. Parameters were differentially weighted based on their association with severe complications, as reported in earlier cases. An at-risk rate per 1000 people was calculated at the county level, and ArcMap was used to depict the rate of patients at high risk for severe complications from COVID-19. Real-time COVID-19 cases captured by the Johns Hopkins University Center for Systems Science and Engineering (CSSE) were layered in the risk map to show where cases exist relative to the high-risk populations. Results: Of the 30,100,826 adults included in this study, the average age is 50 years, 15% have at least one specialty medication, and the average patient has 2 to 3 comorbidities. Nearly 28% of patients have the greatest risk score, and an additional 34.64% of patients are considered high-risk, with scores ranging from 8 to 10. Age accounts for 53% of a patient’s total risk, followed by the number of comorbidities (29%); inferred chronic obstructive pulmonary disease, hypertension, or diabetes (15%); and urban density classification (5%). Conclusions: This risk model utilizes data from approximately 10% of the US population. Currently, this is the most comprehensive US model to estimate and depict the county-level prognosis of COVID-19 infection. This study shows that there are counties across the United States whose residents are at high risk of developing severe complications from COVID-19. Our county-level risk estimates may be used alongside other data sets to improve the accuracy of anticipated health care resource needs. The interactive map can also aid in proactive planning and preparations among employers that are deemed critical, such as pharmacies and grocery stores, to prevent the spread of COVID-19 within their facilities. %M 32511100 %R 10.2196/19606 %U https://publichealth.jmir.org/2020/2/e19606 %U https://doi.org/10.2196/19606 %U http://www.ncbi.nlm.nih.gov/pubmed/32511100 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e19276 %T Mining Physicians’ Opinions on Social Media to Obtain Insights Into COVID-19: Mixed Methods Analysis %A Wahbeh,Abdullah %A Nasralah,Tareq %A Al-Ramahi,Mohammad %A El-Gayar,Omar %+ Supply Chain and Information Management Group, D’Amore-McKim School of Business, Northeastern University, 360 Huntington Ave, Boston, MA, 02115, United States, 1 617 373 4460, t.nasralah@northeastern.edu %K pandemic %K coronavirus %K COVID-19 %K social media %K infodemiology %K infoveillance %K medical professionals %K opinion analysis %D 2020 %7 18.6.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The coronavirus disease (COVID-19) pandemic is considered to be the most daunting public health challenge in decades. With no effective treatments and with time needed to develop a vaccine, alternative approaches are being used to control this pandemic. Objective: The objective of this paper was to identify topics, opinions, and recommendations about the COVID-19 pandemic discussed by medical professionals on the Twitter social medial platform. Methods: Using a mixed methods approach blending the capabilities of social media analytics and qualitative analysis, we analyzed COVID-19–related tweets posted by medical professionals and examined their content. We used qualitative analysis to explore the collected data to identify relevant tweets and uncover important concepts about the pandemic using qualitative coding. Unsupervised and supervised machine learning techniques and text analysis were used to identify topics and opinions. Results: Data were collected from 119 medical professionals on Twitter about the coronavirus pandemic. A total of 10,096 English tweets were collected from the identified medical professionals between December 1, 2019 and April 1, 2020. We identified eight topics, namely actions and recommendations, fighting misinformation, information and knowledge, the health care system, symptoms and illness, immunity, testing, and infection and transmission. The tweets mainly focused on needed actions and recommendations (2827/10,096, 28%) to control the pandemic. Many tweets warned about misleading information (2019/10,096, 20%) that could lead to infection of more people with the virus. Other tweets discussed general knowledge and information (911/10,096, 9%) about the virus as well as concerns about the health care systems and workers (909/10,096, 9%). The remaining tweets discussed information about symptoms associated with COVID-19 (810/10,096, 8%), immunity (707/10,096, 7%), testing (605/10,096, 6%), and virus infection and transmission (503/10,096, 5%). Conclusions: Our findings indicate that Twitter and social media platforms can help identify important and useful knowledge shared by medical professionals during a pandemic. %M 32421686 %R 10.2196/19276 %U http://publichealth.jmir.org/2020/2/e19276/ %U https://doi.org/10.2196/19276 %U http://www.ncbi.nlm.nih.gov/pubmed/32421686 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 6 %P e20185 %T Mental Health and Behavior of College Students During the Early Phases of the COVID-19 Pandemic: Longitudinal Smartphone and Ecological Momentary Assessment Study %A Huckins,Jeremy F %A daSilva,Alex W %A Wang,Weichen %A Hedlund,Elin %A Rogers,Courtney %A Nepal,Subigya K %A Wu,Jialing %A Obuchi,Mikio %A Murphy,Eilis I %A Meyer,Meghan L %A Wagner,Dylan D %A Holtzheimer,Paul E %A Campbell,Andrew T %+ Department of Psychological and Brain Science, Dartmouth College, HB6207, Hanover, NH, 03755, United States, 1 508 657 4825, jeremy.f.huckins@dartmouth.edu %K COVID-19 %K depression %K anxiety %K mobile sensing %K sedentary %K phone usage %K mental health %K behavior %K pandemic %K app %D 2020 %7 17.6.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The vast majority of people worldwide have been impacted by coronavirus disease (COVID-19). In addition to the millions of individuals who have been infected with the disease, billions of individuals have been asked or required by local and national governments to change their behavioral patterns. Previous research on epidemics or traumatic events suggests that this can lead to profound behavioral and mental health changes; however, researchers are rarely able to track these changes with frequent, near-real-time sampling or compare their findings to previous years of data for the same individuals. Objective: By combining mobile phone sensing and self-reported mental health data among college students who have been participating in a longitudinal study for the past 2 years, we sought to answer two overarching questions. First, have the behaviors and mental health of the participants changed in response to the COVID-19 pandemic compared to previous time periods? Second, are these behavior and mental health changes associated with the relative news coverage of COVID-19 in the US media? Methods: Behaviors such as the number of locations visited, distance traveled, duration of phone usage, number of phone unlocks, sleep duration, and sedentary time were measured using the StudentLife smartphone sensing app. Depression and anxiety were assessed using weekly self-reported ecological momentary assessments of the Patient Health Questionnaire-4. The participants were 217 undergraduate students, with 178 (82.0%) students providing data during the Winter 2020 term. Differences in behaviors and self-reported mental health collected during the Winter 2020 term compared to previous terms in the same cohort were modeled using mixed linear models. Results: During the first academic term impacted by COVID-19 (Winter 2020), individuals were more sedentary and reported increased anxiety and depression symptoms (P<.001) relative to previous academic terms and subsequent academic breaks. Interactions between the Winter 2020 term and the week of the academic term (linear and quadratic) were significant. In a mixed linear model, phone usage, number of locations visited, and week of the term were strongly associated with increased amount of COVID-19–related news. When mental health metrics (eg, depression and anxiety) were added to the previous measures (week of term, number of locations visited, and phone usage), both anxiety (P<.001) and depression (P=.03) were significantly associated with COVID-19–related news. Conclusions: Compared with prior academic terms, individuals in the Winter 2020 term were more sedentary, anxious, and depressed. A wide variety of behaviors, including increased phone usage, decreased physical activity, and fewer locations visited, were associated with fluctuations in COVID-19 news reporting. While this large-scale shift in mental health and behavior is unsurprising, its characterization is particularly important to help guide the development of methods to reduce the impact of future catastrophic events on the mental health of the population. %M 32519963 %R 10.2196/20185 %U http://www.jmir.org/2020/6/e20185/ %U https://doi.org/10.2196/20185 %U http://www.ncbi.nlm.nih.gov/pubmed/32519963 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 6 %P e19947 %T Human Factor Considerations in Using Personal Protective Equipment in the COVID-19 Pandemic Context: Binational Survey Study %A Parush,Avi %A Wacht,Oren %A Gomes,Ricardo %A Frenkel,Amit %+ Israel Institute of Technology, Technion City, Haifa, 3200003, Israel, 972 0502301857, aparush@technion.ac.il %K COVID-19 %K personal protective equipment %K PPE %K human factors %K cognitive functioning %K multinational survey %K pandemic %K protection %K infectious disease %K infection %K survey %D 2020 %7 17.6.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Full level 1 personal protective equipment (PPE) is used in various domains and contexts. Prior research has shown influences of such equipment on performance, comfort, and contamination levels. The coronavirus disease (COVID-19) pandemic forced a pervasive requirement of PPE, with little preparation, rushed deployment, inadequate time for training, and massive use by personnel who are inexperienced or not qualified in its effective use. Objective: This study aims to examine the key human factors (physical and ergonomic, perceptual and cognitive) that influence the use of level 1 PPE when attending to patients with suspected or confirmed COVID-19. Methods: The research approach consisted of a short survey disseminated to health care professionals in two countries, Israel and Portugal, with similar demographics and health care systems. The survey included 10 items with a 5-point Likert scale regarding the key human factors involved in level 1 PPE, as identified in prior research. Results: A total of 722 respondents from Israel and 301 respondents from Portugal were included in the analysis. All the respondents reported using level 1 PPE with patients with COVID-19 in the range of several hours daily to several hours weekly. The Cronbach α was .73 for Israel and .75 for Portugal. Responses showed high levels of difficulty, with medians of 4 for items related to discomfort (n=539/688, 78% in Israel; n=328/377, 87% in Portugal), hearing (n=236/370, 64% in Portugal; n=321/642, 50% in Israel), seeing (n=697/763, 89% in Israel; n=317/376, 84% in Portugal), and doffing (n=290/374, 77% in Portugal; n=315/713, 44% in Israel). A factor analysis showed a set of strongly related variables consisting of hearing, understanding speech, and understanding the situation. This suggests that degradation in communication was strongly associated with degradation in situational awareness. A subsequent mediation analysis showed a direct effect of PPE discomfort on situational awareness (P<.001); this was also influenced (mediated) by difficulties in communicating, namely in hearing and understanding speech. Conclusions: In 2020, the COVID-19 pandemic is paving the way for updating PPE design. The use of already deployed technology affords ample opportunities to improve, adapt, and overcome caveats. The findings here suggest that the use of level 1 PPE with patients with COVID-19 has perceptual and cognitive effects, in addition to physical and ergonomic influences. Efforts should be taken to mitigate the harmful effects of such influences, both regarding the performance of medical actions and the risk of contamination to health care workers. Such efforts involve the design of PPE; the introduction of technologies to enhance vision, hearing, and communicating during the use of PPE; and training staff in using the equipment and in effective communication and teamwork protocols. %M 32511099 %R 10.2196/19947 %U http://www.jmir.org/2020/6/e19947/ %U https://doi.org/10.2196/19947 %U http://www.ncbi.nlm.nih.gov/pubmed/32511099 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 6 %P e19825 %T Clarification of Misleading Perceptions of COVID-19 Fatality and Testing Rates in Italy: Data Analysis %A Tosi,Davide %A Verde,Alessandro %A Verde,Manuela %+ Department of Theoretical and Applied Science, University of Insubria, Jean Henry Dunant, 3, Varese, 21100, Italy, 39 0332 42138, davide.tosi@uninsubria.it %K COVID-19 %K SARS-CoV-2 %K fatality rate %K swab tests %K Italy %K Lombardy region %D 2020 %7 17.6.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The fatality rate of coronavirus disease (COVID-19) in Italy is controversial and is greatly affecting discussion on the impact of containment measures that are straining the world’s social and economic fabric, such as instigating large-scale isolation and quarantine, closing borders, imposing limits on public gatherings, and implementing nationwide lockdowns. Objective: The scientific community, citizens, politicians, and mass media are expressing concerns regarding data suggesting that the number of COVID-19–related deaths in Italy is significantly higher than in the rest of the world. Moreover, Italian citizens have misleading perceptions related to the number of swab tests that have actually been performed. Citizens and mass media are denouncing the coverage of COVID-19 swab testing in Italy, claiming that it is not in line with that in other countries worldwide. Methods: In this paper, we attempt to clarify the aspects of COVID-19 fatalities and testing in Italy by performing a set of statistical analyses that highlight the actual numbers in Italy and compare them with official worldwide data. Results: The analysis clearly shows that the Italian COVID-19 fatality and mortality rates are in line with the official world scenario, as are the numbers of COVID-19 tests performed in Italy and in the Lombardy region. Conclusions: This up-to-date analysis may elucidate the evolution of the COVID-19 pandemic in Italy. %M 32490842 %R 10.2196/19825 %U http://www.jmir.org/2020/6/e19825/ %U https://doi.org/10.2196/19825 %U http://www.ncbi.nlm.nih.gov/pubmed/32490842 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 6 %P e19236 %T An Internet-Based Intervention to Alleviate Stress During Social Isolation With Guided Relaxation and Meditation: Protocol for a Randomized Controlled Trial %A Pizzoli,Silvia Maria Francesca %A Marzorati,Chiara %A Mazzoni,Davide %A Pravettoni,Gabriella %+ Department of Oncology and Hemato-Oncology, University of Milan, Via Festa del Perdono 7, Milan, 20122, Italy, 39 0294372099, silviafrancescamaria.pizzoli@ieo.it %K relaxation %K guided meditation %K internet-based intervention %K social isolation %K stress %K COVID-19 %K mental health %K public health %D 2020 %7 17.6.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: Psychophysiological stress and decreased well-being are relevant issues during prolonged social isolation periods. Relaxation practices may represent helpful exercises to cope with anxiety and stressful sensations. Objective: The aim of this research protocol is to test whether remote relaxation practices such as natural sounds, deep respiration, and body scan meditation promote relaxation and improved emotional state and reduce psychomotor activation and the preoccupation related to the coronavirus disease (COVID-19) pandemic. Methods: The study population will consist of 3 experimental groups that will randomly receive one of 3 internet-based audio clips containing a single session of guided breathing exercise, guided body scan exercise, or natural sounds. The participants will listen to the fully automated audio clip for 7 minutes and complete pre-post self-assessment scales on their perceived relaxation, psychomotor activation, level of worry associated with COVID-19, and emotional state. At the end of the session, the participants will also be asked to provide qualitative reports on their subjective experiences. Results: Analyses will be performed to test the differences in the efficacy of the different audio clips in an internet-based intervention on 252 participants (84 per group), investigating whether natural sounds or remote guided practices such as deep respiration and body scan meditation positively enhance the participants’ perceived psychological state. Conclusions: The study will provide information on if and to what extent guided practices can help in reducing psychological side effects related to social isolation during the COVID-19 pandemic. International Registered Report Identifier (IRRID): PRR1-10.2196/19236 %M 32530814 %R 10.2196/19236 %U http://www.researchprotocols.org/2020/6/e19236/ %U https://doi.org/10.2196/19236 %U http://www.ncbi.nlm.nih.gov/pubmed/32530814 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 6 %P e19284 %T Digital Health Strategies to Fight COVID-19 Worldwide: Challenges, Recommendations, and a Call for Papers %A Fagherazzi,Guy %A Goetzinger,Catherine %A Rashid,Mohammed Ally %A Aguayo,Gloria A %A Huiart,Laetitia %+ Luxembourg Institute of Health, 1 A-B Rue Thomas Edison, Strassen, 1445, Luxembourg, 352 33669396334, guy.fagherazzi@lih.lu %K coronavirus %K COVID-19 %K digital health %K eHealth %K digital technology %K health care %K surveillance %K communication %K review %K epidemiology %K infodemiology %K public health %D 2020 %7 16.6.2020 %9 Viewpoint %J J Med Internet Res %G English %X The coronavirus disease (COVID-19) pandemic has created an urgent need for coordinated mechanisms to respond to the outbreak across health sectors, and digital health solutions have been identified as promising approaches to address this challenge. This editorial discusses the current situation regarding digital health solutions to fight COVID-19 as well as the challenges and ethical hurdles to broad and long-term implementation of these solutions. To decrease the risk of infection, telemedicine has been used as a successful health care model in both emergency and primary care. Official communication plans should promote facile and diverse channels to inform people about the pandemic and to avoid rumors and reduce threats to public health. Social media platforms such as Twitter and Google Trends analyses are highly beneficial to model pandemic trends as well as to monitor the evolution of patients’ symptoms or public reaction to the pandemic over time. However, acceptability of digital solutions may face challenges due to potential conflicts with users’ cultural, moral, and religious backgrounds. Digital tools can provide collective public health benefits; however, they may be intrusive and can erode individual freedoms or leave vulnerable populations behind. The COVID-19 pandemic has demonstrated the strong potential of various digital health solutions that have been tested during the crisis. More concerted measures should be implemented to ensure that future digital health initiatives will have a greater impact on the epidemic and meet the most strategic needs to ease the life of people who are at the forefront of the crisis. %M 32501804 %R 10.2196/19284 %U http://www.jmir.org/2020/6/e19284/ %U https://doi.org/10.2196/19284 %U http://www.ncbi.nlm.nih.gov/pubmed/32501804 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 6 %P e19782 %T Internet Use, Risk Awareness, and Demographic Characteristics Associated With Engagement in Preventive Behaviors and Testing: Cross-Sectional Survey on COVID-19 in the United States %A Li,Siyue %A Feng,Bo %A Liao,Wang %A Pan,Wenjing %+ School of Journalism and Communication, Renmin University of China, 507, School of Journalism and Communication, 59 Zhongguancun St, Haidian District, Beijing, 100872, China, 86 010 82500855, wenjingpan@ruc.edu.cn %K COVID-19 %K coronavirus %K preventive behaviors %K testing %K online health information %K risk awareness %D 2020 %7 16.6.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: During the coronavirus disease (COVID-19) pandemic, engagement in preventive behaviors and getting tested for the virus play a crucial role in protecting people from contracting the new coronavirus. Objective: This study aims to examine how internet use, risk awareness, and demographic characteristics are associated with engagement in preventative behaviors and testing during the COVID-19 pandemic in the United States. Methods: A cross-sectional survey was conducted on Amazon Mechanical Turk from April 10, 2020, to April 14, 2020. Participants’ internet use (in terms of the extent of receiving information pertaining to COVID-19), risk awareness (whether any immediate family members, close friends or relatives, or people in local communities tested positive for COVID-19), demographics (sex, age, ethnicity, income, education level, marital status, and employment status), as well as their engagement in preventative behaviors and testing were assessed. Results: Our data included 979 valid responses from the United States. Participants who received more COVID-19–related health information online reported more frequent effort to engage in all types of preventive behaviors: wearing a facemask in public (odds ratio [OR] 1.55, 95% CI 1.34-1.79, P<.001), washing hands (OR 1.58, 95% CI 1.35-1.85, P<.001), covering nose and mouth when sneezing and coughing (OR 1.78, 95% CI 1.52-2.10, P<.001), keeping social distance with others (OR 1.41, 95% CI 1.21-1.65, P<.001), staying home (OR 1.40, 95% CI 1.20-1.62, P<.001), avoiding using public transportation (OR 1.57, 95% CI 1.32-1.88, P<.001), and cleaning frequently used surfaces (OR 1.55, 95% CI 1.34-1.79, P<.001). Compared with participants who did not have positive cases in their social circles, those who had immediate family members (OR 1.48, 95% CI 8.28-26.44, P<.001) or close friends and relatives (OR 2.52, 95% CI 1.58-4.03, P<.001) who tested positive were more likely to get tested. Participants’ sex, age, ethnicity, marital status, and employment status were also associated with preventive behaviors and testing. Conclusions: Our findings revealed that the extent of receiving COVID-19–related information online, risk awareness, and demographic characteristics including sex, ethnicity, age, marital status, and employment status are key factors associated with US residents’ engagement in various preventive behaviors and testing for COVID-19. %M 32501801 %R 10.2196/19782 %U http://www.jmir.org/2020/6/e19782/ %U https://doi.org/10.2196/19782 %U http://www.ncbi.nlm.nih.gov/pubmed/32501801 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 6 %P e19981 %T Nature and Diffusion of COVID-19–related Oral Health Information on Chinese Social Media: Analysis of Tweets on Weibo %A Tao,Zhuo-Ying %A Chu,Guang %A McGrath,Colman %A Hua,Fang %A Leung,Yiu Yan %A Yang,Wei-Fa %A Su,Yu-Xiong %+ Division of Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, 34 Hospital Road, Hong Kong, , China (Hong Kong), 852 28590267, richsu@hku.hk %K COVID-19 %K dentistry %K oral health %K online health %K social media %K tweet %K Weibo %K China %K health information %D 2020 %7 15.6.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Social media has become increasingly important as a source of information for the public and is widely used for health-related information. The outbreak of the coronavirus disease (COVID-19) has exerted a negative impact on dental practices. Objective: The aim of this study is to analyze the nature and diffusion of COVID-19–related oral health information on the Chinese social media site Weibo. Methods: A total of 15,900 tweets related to oral health and dentistry information from Weibo during the COVID-19 outbreak in China (December 31, 2019, to March 16, 2020) were included in our study. Two researchers coded 1000 of the total tweets in advance, and two main thematic categories with eight subtypes were refined. The included tweets were analyzed over time and geographic region, and coded into eight thematic categories. Additionally, the time distributions of tweets containing information about dental services, needs of dental treatment, and home oral care during the COVID-19 epidemic were further analyzed. Results: People reacted rapidly to the emerging severe acute respiratory syndrome coronavirus 2 threat to dental services, and a large amount of COVID-19–related oral health information was tweeted on Weibo. The time and geographic distribution of tweets shared similarities with epidemiological data of the COVID-19 outbreak in China. Tweets containing home oral care and dental services content were the most frequently exchanged information (n=4803/15,900, 30.20% and n=4478, 28.16%, respectively). Significant differences of public attention were found between various types of bloggers in dental services–related tweets (P<.001), and the tweets from the government and media engaged the most public attention. The distributions of tweets containing information about dental services, needs of dental treatment, and home oral care information dynamically changed with time. Conclusions: Our study overviewed and analyzed social media data on the dental services and oral health information during the COVID-19 epidemic, thus, providing insights for government organizations, media, and dental professionals to better facilitate oral health communication and efficiently shape public concern through social media when routine dental services are unavailable during an unprecedented event. The study of the nature and distribution of social media can serve as a useful adjunct tool to help make public health policies. %M 32501808 %R 10.2196/19981 %U http://www.jmir.org/2020/6/e19981/ %U https://doi.org/10.2196/19981 %U http://www.ncbi.nlm.nih.gov/pubmed/32501808 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 6 %N 1 %P e19725 %T COVID-19 Can Catalyze the Modernization of Medical Education %A Chen,Cathy Hsi %A Mullen,Alexander Joseph %+ Department of Medicine, University of Mississippi Medical Center, 2500 N State St, Jackson, MS, 39216, United States, 1 6019841000, ajmullen7@gmail.com %K medical education %K health professions education %K medical school %K curriculum design %K flipped classroom %K preclinical education %K COVID-19 %K coronavirus %K medical student %D 2020 %7 12.6.2020 %9 Viewpoint %J JMIR Med Educ %G English %X Amid the coronavirus disease (COVID-19) crisis, we have witnessed true physicianship as our frontline doctors apply clinical problem-solving to an illness without a textbook algorithm. Yet, for over a century, medical education in the United States has plowed ahead with a system that prioritizes content delivery over problem-solving. As resident trainees, we are acutely aware that memorizing content is not enough. We need a preclinical system designed to steer early learners from “know” to “know how.” Education leaders have long advocated for such changes to the medical school structure. For what may be the first time, we have a real chance to effect change. In response to the COVID-19 pandemic, medical educators have scrambled to conform curricula to social distancing mandates. The resulting online infrastructures are a rare chance for risk-averse medical institutions to modernize how we train our future physicians—starting by eliminating the traditional classroom lecture. Institutions should capitalize on new digital infrastructures and curricular flexibility to facilitate the eventual rollout of flipped classrooms—a system designed to cultivate not only knowledge acquisition but problem-solving skills and creativity. These skills are more vital than ever for modern physicians. %M 32501809 %R 10.2196/19725 %U http://mededu.jmir.org/2020/1/e19725/ %U https://doi.org/10.2196/19725 %U http://www.ncbi.nlm.nih.gov/pubmed/32501809 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 6 %P e19934 %T Why African Americans Are a Potential Target for COVID-19 Infection in the United States %A Hamidian Jahromi,Alireza %A Hamidianjahromi,Anahid %+ Department of Plastic Surgery, The University of Tennessee Health Science Center, 910 Madison Avenue, Suite 315, Memphis, TN, 38103, United States, 1 318 518 4600, alirezahamidian@yahoo.com %K coronavirus %K COVID-19 %K African American %K mortality %K race %K virus %K minority %K infectious disease %D 2020 %7 12.6.2020 %9 Viewpoint %J J Med Internet Res %G English %X Since the World Health Organization declared the coronavirus disease (COVID-19) outbreak a pandemic, significant changes have occurred in the United States as the infection spread reached and passed its exponential phase. A stringent analysis of COVID-19 epidemiologic data requires time and would generally be expected to happen with significant delay after the exponential phase of the disease is over and when the focus of the health care system is diverted away from crisis management. Although much has been said about high-risk groups and the vulnerability of the elderly and patients with underlying comorbidities, the impact of race on the susceptibility of ethnic minorities living in indigent communities has not been discussed in detail worldwide and specifically in the United States. There are currently some data on disparities between African American and Caucasian populations for COVID-19 infection and mortality. While health care authorities are reorganizing resources and infrastructure to provide care for symptomatic COVID-19 patients, they should not shy away from protecting the general public as a whole and specifically the most vulnerable members of society, such as the elderly, ethnic minorities, and people with underlying comorbidities. %M 32496205 %R 10.2196/19934 %U http://www.jmir.org/2020/6/e19934/ %U https://doi.org/10.2196/19934 %U http://www.ncbi.nlm.nih.gov/pubmed/32496205 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 6 %P e19938 %T Information Technology–Based Management of Clinically Healthy COVID-19 Patients: Lessons From a Living and Treatment Support Center Operated by Seoul National University Hospital %A Bae,Ye Seul %A Kim,Kyung Hwan %A Choi,Sae Won %A Ko,Taehoon %A Jeong,Chang Wook %A Cho,BeLong %A Kim,Min Sun %A Kang,EunKyo %+ Office of Hospital Information, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea, 82 2 2072 7600, kkh726@snu.ac.kr %K COVID-19 %K clinical informatics %K mobile app %K telemedicine %K hospital information system %K app %K health information technology %D 2020 %7 12.6.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: South Korea took preemptive action against coronavirus disease (COVID-19) by implementing extensive testing, thorough epidemiological investigation, strict social distancing, and rapid treatment of patients according to disease severity. The Korean government entrusted large-scale hospitals with the operation of living and treatment support centers (LTSCs) for the management for clinically healthy COVID-19 patients. Objective: The aim of this paper is to introduce our experience implementing information and communications technology (ICT)-based remote patient management systems at a COVID-19 LTSC. Methods: We adopted new electronic health record templates, hospital information system (HIS) dashboards, cloud-based medical image sharing, a mobile app, and smart vital sign monitoring devices. Results: Enhancements were made to the HIS to assist in the workflow and care of patients in the LTSC. A dashboard was created for the medical staff to view the vital signs and symptoms of all patients. Patients used a mobile app to consult with their physician or nurse, answer questionnaires, and input self-measured vital signs; the results were uploaded to the hospital information system in real time. Cloud-based image sharing enabled interoperability between medical institutions. Korea’s strategy of aggressive mitigation has “flattened the curve” of the rate of infection. A multidisciplinary approach was integral to develop systems supporting patient care and management at the living and treatment support center as quickly as possible. Conclusions: Faced with a novel infectious disease, we describe the implementation and experience of applying an ICT-based patient management system in the LTSC affiliated with Seoul National University Hospital. ICT-based tools and applications are increasingly important in health care, and we hope that our experience will provide insight into future technology-based infectious disease responses. %M 32490843 %R 10.2196/19938 %U http://www.jmir.org/2020/6/e19938/ %U https://doi.org/10.2196/19938 %U http://www.ncbi.nlm.nih.gov/pubmed/32490843 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 8 %N 2 %P e20173 %T Teaching Adequate Prehospital Use of Personal Protective Equipment During the COVID-19 Pandemic: Development of a Gamified e-Learning Module %A Suppan,Mélanie %A Gartner,Birgit %A Golay,Eric %A Stuby,Loric %A White,Marion %A Cottet,Philippe %A Abbas,Mohamed %A Iten,Anne %A Harbarth,Stephan %A Suppan,Laurent %+ Division of Anesthesiology, Department of Anesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, University of Geneva Hospitals and Faculty of Medicine, Rue Gabrielle-Perret-Gentil 4, Geneva, 1211, Switzerland, 41 223723311, melanie.bochet@hcuge.ch %K personal protective equipment %K electronic learning %K gamification %K prehospital %K COVID-19 %D 2020 %7 12.6.2020 %9 Original Paper %J JMIR Serious Games %G English %X Background: The coronavirus disease (COVID-19) pandemic has led to increased use of personal protective equipment (PPE). Adequate use of this equipment is more critical than ever because the risk of shortages must be balanced against the need to effectively protect health care workers, including prehospital personnel. Specific training is therefore necessary; however, the need for social distancing has markedly disrupted the delivery of continuing education courses. Electronic learning (e-learning) may provide significant advantages because it requires neither the physical presence of learners nor the repetitive use of equipment for demonstration. Objective: Inclusion of game mechanics, or “gamification,” has been shown to increase knowledge and skill acquisition. The objective of this research was to develop a gamified e-learning module to interactively deliver concepts and information regarding the correct choice and handling of PPE. Methods: The SERES framework was used to define and describe the development process, including scientific and design foundations. After we defined the target audience and learning objectives by interviewing the stakeholders, we searched the scientific literature to establish relevant theoretical bases. The learning contents were validated by infection control and prehospital experts. Learning mechanics were then determined according to the learning objectives, and the content that could benefit from the inclusion of game mechanics was identified. Results: The literature search resulted in the selection and inclusion of 12 articles. In addition to gamification, pretesting, feedback, avoiding content skipping, and demonstrations using embedded videos were used as learning mechanics. Gamification was used to enhance the interactivity of the PPE donning and doffing sequences, which presented the greatest learning challenges. The module was developed with Articulate Storyline 3 to ensure that it would be compatible with a wide array of devices, as this software generates HTML5-compatible output that can be accessed on smartphones, tablets, and regular computers as long as a recent browser is available. Conclusions: A gamified e-learning module designed to promote better knowledge and understanding of PPE use among prehospital health care workers was created by following the SERES framework. The impact of this module should now be assessed by means of a randomized controlled trial. %M 32516115 %R 10.2196/20173 %U http://games.jmir.org/2020/2/e20173/ %U https://doi.org/10.2196/20173 %U http://www.ncbi.nlm.nih.gov/pubmed/32516115 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 6 %P e19855 %T Epidemiological Observations on the Association Between Anosmia and COVID-19 Infection: Analysis of Data From a Self-Assessment Web Application %A Denis,Fabrice %A Galmiche,Simon %A Dinh,Aurélien %A Fontanet,Arnaud %A Scherpereel,Arnaud %A Benezit,Francois %A Lescure,François-Xavier %+ Inter-regional Cancer Institut Jean Bernard, 9, rue Beauverger, Le Mans, 72100, France, 33 243475810, f.denis@cjb72.org %K COVID-19 %K anosmia %K epidemiological surveillance %K self-assessment %K web application %K outbreak %K symptoms %K self-assessment %K surveillance %K epidemiology %D 2020 %7 11.6.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: We developed a self-assessment and participatory surveillance web application for coronavirus disease (COVID-19), which was launched in France in March 2020. Objective: Our objective was to determine if self-reported symptoms could help monitor the dynamics of the COVID-19 outbreak in France. Methods: Users were asked questions about underlying conditions, sociodemographic status, zip code, and COVID-19 symptoms. Depending on the symptoms reported and the presence of coexisting disorders, users were told to either stay at home, contact a general practitioner (GP), or call an emergency phone number. Data regarding COVID-19–related hospitalizations were retrieved from the Ministry of Health. Results: As of March 29, 2020, the application was opened 4,126,789 times; 3,799,535 electronic questionnaires were filled out; and 2,477,174 users had at least one symptom. In total, 34.8% (n=1,322,361) reported no symptoms. The remaining users were directed to self-monitoring (n=858,878, 22.6%), GP visit or teleconsultation (n=1,033,922, 27.2%), or an emergency phone call (n=584,374, 15.4%). Emergency warning signs were reported by 39.1% of participants with anosmia, a loss of the sense of smell (n=127,586) versus 22.7% of participants without anosmia (n=1,597,289). Anosmia and fever and/or cough were correlated with hospitalizations for COVID-19 (Spearman correlation coefficients=0.87 and 0.82, respectively; P<.001 for both). Conclusions: This study suggests that anosmia may be strongly associated with COVID-19 and its severity. Despite a lack of medical assessment and virological confirmation, self-checking application data could be a relevant tool to monitor outbreak trends. Trial Registration: ClinicalTrials.gov NCT04331171; https://clinicaltrials.gov/ct2/show/NCT04331171 %M 32496206 %R 10.2196/19855 %U http://www.jmir.org/2020/6/e19855/ %U https://doi.org/10.2196/19855 %U http://www.ncbi.nlm.nih.gov/pubmed/32496206 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 6 %P e19494 %T Influence of the SARS-CoV-2 Outbreak on the Uptake of a Popular Smoking Cessation App in UK Smokers: Interrupted Time Series Analysis %A Perski,Olga %A Herbeć,Aleksandra %A Shahab,Lion %A Brown,Jamie %+ Department of Behavioural Science and Health, University College London, 1-19 Torrington Place, London, WC1E 7HB, United Kingdom, 44 020 7679 1258, olga.perski@ucl.ac.uk %K SARS-CoV-2 %K COVID-19 %K smoking cessation %K mobile health %K smartphone app %K time series analysis %K smoking %K public health %K app %D 2020 %7 11.6.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreak may motivate smokers to attempt to stop in greater numbers. However, given the temporary closure of UK stop smoking services and vape shops, smokers attempting to quit may instead seek out mobile health support, such as smartphone apps. Objective: We examined, using an interrupted time series approach, whether the SARS-CoV-2 outbreak has been associated with a step change or increasing trend in UK downloads of an otherwise popular smoking cessation app, Smoke Free. Methods: Data were from daily and nondaily adult smokers in the United Kingdom who had downloaded the Smoke Free app between January 1, 2020, and March 31, 2020 (primary analysis), and January 1, 2019, and March 31, 2020 (secondary analysis). The outcome variable was the number of downloads aggregated at the 12-hourly (primary analysis) or daily level (secondary analysis). The explanatory variable was the start of the SARS-CoV-2 outbreak, operationalized as March 1, 2020 (primary analysis), and January 15, 2020 (secondary analysis). Generalized additive mixed models adjusted for relevant covariates were fitted. Results: Data were collected on 45,105 (primary analysis) and 119,881 (secondary analysis) users. In both analyses, there was no evidence for a step change or increasing trend in downloads attributable to the start of the SARS-CoV-2 outbreak. Calculation of Bayes factors (BFs) indicated that the data for the primary analysis favored the null hypothesis compared with large associations (for level, BF=0.25; for slope, BF=0.26) but were insensitive to the detection of small associations (for level, BF=0.78; for slope, BF=1.35). Conclusions: In the United Kingdom, between January 1, 2020, and March 31, 2020, and between January 1, 2019, and March 31, 2020, there was no evidence that the SARS-CoV-2 outbreak has been associated with a large step change or increasing trend in downloads of a popular smoking cessation app. Findings on the association of the SARS-CoV-2 outbreak with a small step change or increasing trend were inconclusive. %M 32463375 %R 10.2196/19494 %U http://mhealth.jmir.org/2020/6/e19494/ %U https://doi.org/10.2196/19494 %U http://www.ncbi.nlm.nih.gov/pubmed/32463375 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 7 %N 6 %P e20696 %T Using Internet-Based Psychological Measurement to Capture the Deteriorating Community Mental Health Profile During COVID-19: Observational Study %A van Agteren,Joep %A Bartholomaeus,Jonathan %A Fassnacht,Daniel B %A Iasiello,Matthew %A Ali,Kathina %A Lo,Laura %A Kyrios,Michael %+ Wellbeing and Resilience Centre, Lifelong Health Theme, South Australian Health and Medical Research Institute, North Terrace, Adelaide, 5000, Australia, 61 81284944, joep.vanagteren@sahmri.com %K psychological measurement %K positive mental health %K resilience %K mental health %K psychological distress %K internet %K COVID-19 %K pandemic %D 2020 %7 11.6.2020 %9 Original Paper %J JMIR Ment Health %G English %X Background: The coronavirus disease (COVID-19) is expected to have widespread and pervasive implications for mental health in terms of deteriorating outcomes and increased health service use, leading to calls for empirical research on mental health during the pandemic. Internet-based psychological measurement can play an important role in collecting imperative data, assisting to guide evidence-based decision making in practice and policy, and subsequently facilitating immediate reporting of measurement results to participants. Objective: The aim of this study is to use an internet-based mental health measurement platform to compare the mental health profile of community members during COVID-19 with community members assessed before the pandemic. Methods: This study uses an internet-based self-assessment tool to collect data on psychological distress, mental well-being, and resilience in community cohorts during (n=673) and prior to the pandemic (two cohorts, n=1264 and n=340). Results: Our findings demonstrate significantly worse outcomes on all mental health measures for participants measured during COVID-19 compared to those measured before (P<.001 for all outcomes, effect sizes ranging between Cohen d=0.32 to Cohen d=0.81. Participants who demonstrated problematic scores for at least one of the mental health outcomes increased from 58% (n=197/340) before COVID-19 to 79% (n=532/673) during COVID-19, leading to only 21% (n=141) of measured participants displaying good mental health during the pandemic. Conclusions: The results clearly demonstrate deterioration in mental health outcomes during COVID-19. Although further research is needed, our findings support the serious mental health implications of the pandemic and highlight the utility of internet-based data collection tools in providing evidence to innovate and strengthen practice and policy during and after the pandemic. %M 32490845 %R 10.2196/20696 %U http://mental.jmir.org/2020/6/e20696/ %U https://doi.org/10.2196/20696 %U http://www.ncbi.nlm.nih.gov/pubmed/32490845 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 6 %P e20239 %T Development of an openEHR Template for COVID-19 Based on Clinical Guidelines %A Li,Mengyang %A Leslie,Heather %A Qi,Bin %A Nan,Shan %A Feng,Hongshuo %A Cai,Hailing %A Lu,Xudong %A Duan,Huilong %+ College of Biomedical Engineering and Instrument Science, Zhejiang University, Room 512, Zhouyiqing Building, 38 Zheda Road, Hangzhou, Zhejiang, 310007, China, 86 13957118891, lvxd@zju.edu.cn %K coronavirus disease %K COVID-19 %K openEHR %K archetype %K template %K knowledge modeling %K clinical guidelines %D 2020 %7 10.6.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The coronavirus disease (COVID-19) was discovered in China in December 2019. It has developed into a threatening international public health emergency. With the exception of China, the number of cases continues to increase worldwide. A number of studies about disease diagnosis and treatment have been carried out, and many clinically proven effective results have been achieved. Although information technology can improve the transferring of such knowledge to clinical practice rapidly, data interoperability is still a challenge due to the heterogeneous nature of hospital information systems. This issue becomes even more serious if the knowledge for diagnosis and treatment is updated rapidly as is the case for COVID-19. An open, semantic-sharing, and collaborative-information modeling framework is needed to rapidly develop a shared data model for exchanging data among systems. openEHR is such a framework and is supported by many open software packages that help to promote information sharing and interoperability. Objective: This study aims to develop a shared data model based on the openEHR modeling approach to improve the interoperability among systems for the diagnosis and treatment of COVID-19. Methods: The latest Guideline of COVID-19 Diagnosis and Treatment in China was selected as the knowledge source for modeling. First, the guideline was analyzed and the data items used for diagnosis and treatment, and management were extracted. Second, the data items were classified and further organized into domain concepts with a mind map. Third, searching was executed in the international openEHR Clinical Knowledge Manager (CKM) to find the existing archetypes that could represent the concepts. New archetypes were developed for those concepts that could not be found. Fourth, these archetypes were further organized into a template using Ocean Template Editor. Fifth, a test case of data exchanging between the clinical data repository and clinical decision support system based on the template was conducted to verify the feasibility of the study. Results: A total of 203 data items were extracted from the guideline in China, and 16 domain concepts (16 leaf nodes in the mind map) were organized. There were 22 archetypes used to develop the template for all data items extracted from the guideline. All of them could be found in the CKM and reused directly. The archetypes and templates were reviewed and finally released in a public project within the CKM. The test case showed that the template can facilitate the data exchange and meet the requirements of decision support. Conclusions: This study has developed the openEHR template for COVID-19 based on the latest guideline from China using openEHR modeling methodology. It represented the capability of the methodology for rapidly modeling and sharing knowledge through reusing the existing archetypes, which is especially useful in a new and fast-changing area such as with COVID-19. %M 32496207 %R 10.2196/20239 %U http://www.jmir.org/2020/6/e20239/ %U https://doi.org/10.2196/20239 %U http://www.ncbi.nlm.nih.gov/pubmed/32496207 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 6 %P e19457 %T A New System for Surveillance and Digital Contact Tracing for COVID-19: Spatiotemporal Reporting Over Network and GPS %A Wang,Shaoxiong %A Ding,Shuizi %A Xiong,Li %+ Department of General Surgery, Second Xiangya Hospital, Central South University, No. 139 Renmin Middle Road, Furong District, Changsha, China, 86 13787782059, lixionghn@163.com %K COVID-19 %K China %K mobile health %K mobile phones %K smartphones %K contact tracing %K social media %K spatiotemporal data %K GPS %K disease tracking %K public health %K infectious disease %K virus %D 2020 %7 10.6.2020 %9 Viewpoint %J JMIR Mhealth Uhealth %G English %X The current pandemic of the coronavirus disease (COVID-19) has highlighted the importance of rapid control of the transmission of infectious diseases. This is particularly important for COVID-19, where many individuals are asymptomatic or have only mild symptoms but can still spread the disease. Current systems for controlling transmission rely on patients to report their symptoms to medical professionals and be able to recall and trace all their contacts from the previous few days. This is unrealistic in the modern world. However, existing smartphone-based GPS and social media technology may provide a suitable alternative. We, therefore, developed a mini-program within the app WeChat. This analyzes data from all users and traces close contacts of all patients. This permits early tracing and quarantine of potential sources of infection. Data from the mini-program can also be merged with other data to predict epidemic trends, calculate individual and population risks, and provide recommendations for individual and population protection action. It may also improve our understanding of how the disease spreads. However, there are a number of unresolved questions about the use of smartphone data for health surveillance, including how to protect individual privacy and provide safeguards against data breaches. %M 32499212 %R 10.2196/19457 %U http://mhealth.jmir.org/2020/6/e19457/ %U https://doi.org/10.2196/19457 %U http://www.ncbi.nlm.nih.gov/pubmed/32499212 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 6 %P e19264 %T Telehealth in the Context of COVID-19: Changing Perspectives in Australia, the United Kingdom, and the United States %A Fisk,Malcolm %A Livingstone,Anne %A Pit,Sabrina Winona %+ De Montfort University, The Gateway, Leicester, LE1 9BH, United Kingdom, 44 116 257 7723, malcolm.fisk@dmu.ac.uk %K telehealth %K COVID-19 %K SARS-CoV-2 %K public health %K older people %K resource allocation %K aged care %K innovation %K pandemic %K telemedicine %D 2020 %7 9.6.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: On March 12, 2020, the World Health Organization declared the coronavirus disease (COVID-19) outbreak a pandemic. On that date, there were 134,576 reported cases and 4981 deaths worldwide. By March 26, 2020, just 2 weeks later, reported cases had increased four-fold to 531,865, and deaths increased five-fold to 24,073. Older people are both major users of telehealth services and are more likely to die as a result of COVID-19. Objective: This paper examines the extent that Australia, the United Kingdom, and the United States, during the 2 weeks following the pandemic announcement, sought to promote telehealth as a tool that could help identify COVID-19 among older people who may live alone, be frail, or be self-isolating, and give support to or facilitate the treatment of people who are or may be infected. Methods: This paper reports, for the 2-week period previously mentioned and immediately prior, on activities and initiatives in the three countries taken by governments or their agencies (at national or state levels) together with publications or guidance issued by professional, trade, and charitable bodies. Different sources of information are drawn upon that point to the perceived likely benefits of telehealth in fighting the pandemic. It is not the purpose of this paper to draw together or analyze information that reflects growing knowledge about COVID-19, except where telehealth is seen as a component. Results: The picture that emerges for the three countries, based on the sources identified, shows a number of differences. These differences center on the nature of their health services, the extent of attention given to older people (and the circumstances that can relate to them), the different geographies (notably concerned with rurality), and the changes to funding frameworks that could impact these. Common to all three countries is the value attributed to maintaining quality safeguards in the wider context of their health services but where such services are noted as sometimes having precluded significant telehealth use. Conclusions: The COVID-19 pandemic is forcing changes and may help to establish telehealth more firmly in its aftermath. Some of the changes may not be long-lasting. However, the momentum is such that telehealth will almost certainly find a stronger place within health service frameworks for each of the three countries and is likely to have increased acceptance among both patients and health care providers. %M 32463377 %R 10.2196/19264 %U http://www.jmir.org/2020/6/e19264/ %U https://doi.org/10.2196/19264 %U http://www.ncbi.nlm.nih.gov/pubmed/32463377 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 8 %N 6 %P e19515 %T Using Information Technology to Manage the COVID-19 Pandemic: Development of a Technical Framework Based on Practical Experience in China %A Ye,Qing %A Zhou,Jin %A Wu,Hong %+ School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Qiaokou District, Wuhan, 430030, China, 86 13277942186, wuhong634214924@163.com %K COVID-19 %K pandemic %K health informatics %K health information technology %K technical framework %K privacy protection %D 2020 %7 8.6.2020 %9 Original Paper %J JMIR Med Inform %G English %X Background: The coronavirus disease (COVID-19) epidemic poses an enormous challenge to the global health system, and governments have taken active preventive and control measures. The health informatics community in China has actively taken action to leverage health information technologies for epidemic monitoring, detection, early warning, prevention and control, and other tasks. Objective: The aim of this study was to develop a technical framework to respond to the COVID-19 epidemic from a health informatics perspective. Methods: In this study, we collected health information technology–related information to understand the actions taken by the health informatics community in China during the COVID-19 outbreak and developed a health information technology framework for epidemic response based on health information technology–related measures and methods. Results: Based on the framework, we review specific health information technology practices for managing the outbreak in China, describe the highlights of their application in detail, and discuss critical issues to consider when using health information technology. Technologies employed include mobile and web-based services such as Internet hospitals and Wechat, big data analyses (including digital contact tracing through QR codes or epidemic prediction), cloud computing, Internet of things, Artificial Intelligence (including the use of drones, robots, and intelligent diagnoses), 5G telemedicine, and clinical information systems to facilitate clinical management for COVID-19. Conclusions: Practical experience in China shows that health information technologies play a pivotal role in responding to the COVID-19 epidemic. %M 32479411 %R 10.2196/19515 %U http://medinform.jmir.org/2020/6/e19515/ %U https://doi.org/10.2196/19515 %U http://www.ncbi.nlm.nih.gov/pubmed/32479411 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e19509 %T Machine Learning to Detect Self-Reporting of Symptoms, Testing Access, and Recovery Associated With COVID-19 on Twitter: Retrospective Big Data Infoveillance Study %A Mackey,Tim %A Purushothaman,Vidya %A Li,Jiawei %A Shah,Neal %A Nali,Matthew %A Bardier,Cortni %A Liang,Bryan %A Cai,Mingxiang %A Cuomo,Raphael %+ Department of Anesthesiology and Division of Global Public Health and Infectious Diseases, School of Medicine, University of California San Diego, 8950 Villa La Jolla Drive, A124, La Jolla, CA, 92037, United States, 1 9514914161, tmackey@ucsd.edu %K infoveillance %K COVID-19 %K Twitter %K machine learning %K surveillance %D 2020 %7 8.6.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The coronavirus disease (COVID-19) pandemic is a global health emergency with over 6 million cases worldwide as of the beginning of June 2020. The pandemic is historic in scope and precedent given its emergence in an increasingly digital era. Importantly, there have been concerns about the accuracy of COVID-19 case counts due to issues such as lack of access to testing and difficulty in measuring recoveries. Objective: The aims of this study were to detect and characterize user-generated conversations that could be associated with COVID-19-related symptoms, experiences with access to testing, and mentions of disease recovery using an unsupervised machine learning approach. Methods: Tweets were collected from the Twitter public streaming application programming interface from March 3-20, 2020, filtered for general COVID-19-related keywords and then further filtered for terms that could be related to COVID-19 symptoms as self-reported by users. Tweets were analyzed using an unsupervised machine learning approach called the biterm topic model (BTM), where groups of tweets containing the same word-related themes were separated into topic clusters that included conversations about symptoms, testing, and recovery. Tweets in these clusters were then extracted and manually annotated for content analysis and assessed for their statistical and geographic characteristics. Results: A total of 4,492,954 tweets were collected that contained terms that could be related to COVID-19 symptoms. After using BTM to identify relevant topic clusters and removing duplicate tweets, we identified a total of 3465 (<1%) tweets that included user-generated conversations about experiences that users associated with possible COVID-19 symptoms and other disease experiences. These tweets were grouped into five main categories including first- and secondhand reports of symptoms, symptom reporting concurrent with lack of testing, discussion of recovery, confirmation of negative COVID-19 diagnosis after receiving testing, and users recalling symptoms and questioning whether they might have been previously infected with COVID-19. The co-occurrence of tweets for these themes was statistically significant for users reporting symptoms with a lack of testing and with a discussion of recovery. A total of 63% (n=1112) of the geotagged tweets were located in the United States. Conclusions: This study used unsupervised machine learning for the purposes of characterizing self-reporting of symptoms, experiences with testing, and mentions of recovery related to COVID-19. Many users reported symptoms they thought were related to COVID-19, but they were not able to get tested to confirm their concerns. In the absence of testing availability and confirmation, accurate case estimations for this period of the outbreak may never be known. Future studies should continue to explore the utility of infoveillance approaches to estimate COVID-19 disease severity. %M 32490846 %R 10.2196/19509 %U http://publichealth.jmir.org/2020/2/e19509/ %U https://doi.org/10.2196/19509 %U http://www.ncbi.nlm.nih.gov/pubmed/32490846 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 6 %P e20021 %T COVID-19-Related Information Sources and the Relationship With Confidence in People Coping with COVID-19: Facebook Survey Study in Taiwan %A Wang,Peng-Wei %A Lu,Wei-Hsin %A Ko,Nai-Ying %A Chen,Yi-Lung %A Li,Dian-Jeng %A Chang,Yu-Ping %A Yen,Cheng-Fang %+ Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung Medical University, 100 Tzyou 1st Road, Kaohsiung, 807, Taiwan, 886 7 3121101 ext 6822, chfaye@cc.kmu.edu.tw %K COVID-19 %K information %K internet %K coping %K confidence %K mental health %K social media %K Facebook %K survey %K online health information %D 2020 %7 5.6.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: People obtain information on the coronavirus disease (COVID-19) from the internet and other sources. Understanding the factors related to such information sources aids health professionals in educating individuals. Objective: This study used data collected from the online survey study on COVID-19 in Taiwan to examine what major COVID-19 information sources are available and which sources are significantly related to the self-confidence of people in coping with COVID-19 in Taiwan. Methods: A total of 1904 participants (1270 non–health-care workers and 634 health care workers) were recruited from the Facebook advertisement. Their major sources of information about COVID-19, the relationships between the sources and demographic factors, and the relationships between the sources and the self-confidence in coping with COVID-19 were surveyed. Results: Most Taiwanese people relied on the internet for COVID-19 information. Many respondents also used a variety of sources of information on COVID-19; such variety was associated with sex, age, and the level of worry toward COVID-19, as well as if one was a health care worker. For health care workers, the use of formal lessons as an information source was significantly associated with better self-confidence in coping with COVID-19. The significant association between receiving information from more sources and greater self-confidence was found only in health care workers but not in non–health-care workers. Conclusions: Medical professionals should consider subgroups of the population when establishing various means to deliver information on COVID-19. %M 32490839 %R 10.2196/20021 %U http://www.jmir.org/2020/6/e20021/ %U https://doi.org/10.2196/20021 %U http://www.ncbi.nlm.nih.gov/pubmed/32490839 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 6 %P e19930 %T Considerations for an Individual-Level Population Notification System for Pandemic Response: A Review and Prototype %A Sakib,Mohammad Nazmus %A Butt,Zahid A %A Morita,Plinio Pelegrini %A Oremus,Mark %A Fong,Geoffrey T %A Hall,Peter A %+ School of Public Health and Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada, 1 519 888 4567 ext 38110, pahall@uwaterloo.ca %K pandemic %K epidemic %K notification system %K hygiene %K physical distancing %K lockdown %K mobile technology %K COVID-19 %K coronavirus %D 2020 %7 5.6.2020 %9 Viewpoint %J J Med Internet Res %G English %X The outbreak of the coronavirus disease (COVID-19), caused by severe acute respiratory syndrome coronavirus 2, spread worldwide after its emergence in China. Whether rich or poor, all nations are struggling to cope with this new global health crisis. The speed of the threat’s emergence and the quick response required from public health authorities and the public itself makes evident the need for a major reform in pandemic surveillance and notification systems. The development and implementation of a graded, individual-level pandemic notification system could be an effective tool to combat future threats of epidemics. This paper describes a prototype model of such a notification system and its potential advantages and challenges for implementation. Similar to other emergency alerts, this system would include a number of threat levels (level 1-5) with a higher level indicating increasing severity and intensity of safety measures (eg, level 1: general hygiene, level 2: enhanced hygiene, level 3: physical distancing, level 4: shelter in place, and level 5: lockdown). The notifications would be transmitted to cellular devices via text message (for lower threat levels) or push notification (for higher threat levels). The notification system would allow the public to be informed about the threat level in real time and act accordingly in an organized manner. New Zealand and the United Kingdom have recently launched similar alert systems designed to coordinate the ongoing COVID-19 pandemic response more efficiently. Implementing such a system, however, faces multiple challenges. Extensive preparation and coordination among all levels of government and relevant sectors are required. Additionally, such systems may be effective primarily in countries where there exists at least moderate trust in government. Advance and ongoing public education about the nature of the system and its steps would be an essential part of the system, such that all members of the public understand the meaning of each step in advance, similar to what has been established in systems for other emergency responses. This educational component is of utmost importance to minimize adverse public reaction and unintended consequences. The use of mass media and local communities could be considered where mobile phone penetration is low. The implementation of such a notification system would be more challenging in developing countries for several reasons, including inadequate technology, limited use of data plans, high population density, poverty, mistrust in government, and tendency to ignore or failure to understand the warning messages. Despite the challenges, an individual-level pandemic notification system could provide added benefits by giving an additional route for notification that would be complementary to existing platforms. %M 32484443 %R 10.2196/19930 %U http://www.jmir.org/2020/6/e19930/ %U https://doi.org/10.2196/19930 %U http://www.ncbi.nlm.nih.gov/pubmed/32484443 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 6 %P e19455 %T Online Information Exchange and Anxiety Spread in the Early Stage of the Novel Coronavirus (COVID-19) Outbreak in South Korea: Structural Topic Model and Network Analysis %A Jo,Wonkwang %A Lee,Jaeho %A Park,Junli %A Kim,Yeol %+ National Cancer Control Institute, National Cancer Center, 323, Ilsan-ro, Ilsandong-gu, Goyang, 10408, Republic of Korea, 82 31 920 1753, drheat@ncc.re.kr %K coronavirus %K anxiety %K pandemic %K online %K health information exchange %K topic modeling %D 2020 %7 2.6.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: In case of a population-wide infectious disease outbreak, such as the novel coronavirus disease (COVID-19), people’s online activities could significantly affect public concerns and health behaviors due to difficulty in accessing credible information from reliable sources, which in turn causes people to seek necessary information on the web. Therefore, measuring and analyzing online health communication and public sentiment is essential for establishing effective and efficient disease control policies, especially in the early stage of an outbreak. Objective: This study aimed to investigate the trends of online health communication, analyze the focus of people’s anxiety in the early stages of COVID-19, and evaluate the appropriateness of online information. Methods: We collected 13,148 questions and 29,040 answers related to COVID-19 from Naver, the most popular Korean web portal (January 20, 2020, to March 2, 2020). Three main methods were used in this study: (1) the structural topic model was used to examine the topics in the online questions; (2) word network analysis was conducted to analyze the focus of people’s anxiety and worry in the questions; and (3) two medical doctors assessed the appropriateness of the answers to the questions, which were primarily related to people’s anxiety. Results: A total of 50 topics and 6 cohesive topic communities were identified from the questions. Among them, topic community 4 (suspecting COVID-19 infection after developing a particular symptom) accounted for the largest portion of the questions. As the number of confirmed patients increased, the proportion of topics belonging to topic community 4 also increased. Additionally, the prolonged situation led to a slight increase in the proportion of topics related to job issues. People’s anxieties and worries were closely related with physical symptoms and self-protection methods. Although relatively appropriate to suspect physical symptoms, a high proportion of answers related to self-protection methods were assessed as misinformation or advertisements. Conclusions: Search activity for online information regarding the COVID-19 outbreak has been active. Many of the online questions were related to people’s anxieties and worries. A considerable portion of corresponding answers had false information or were advertisements. The study results could contribute reference information to various countries that need to monitor public anxiety and provide appropriate information in the early stage of an infectious disease outbreak, including COVID-19. Our research also contributes to developing methods for measuring public opinion and sentiment in an epidemic situation based on natural language data on the internet. %M 32463367 %R 10.2196/19455 %U https://www.jmir.org/2020/6/e19455 %U https://doi.org/10.2196/19455 %U http://www.ncbi.nlm.nih.gov/pubmed/32463367 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 6 %P e19361 %T Digital Health Equity and COVID-19: The Innovation Curve Cannot Reinforce the Social Gradient of Health %A Crawford,Allison %A Serhal,Eva %+ Virtual Mental Health and Outreach, Centre for Addiction and Mental Health, 250 College St, Room 825, Toronto, ON, M5T1R8, Canada, 1 416 659 5591, allison.crawford@utoronto.ca %K virtual health %K digital determinants of health %K digital health equity %K digital health %K equity %K COVID-19 %K public health %K eHealth %K social %D 2020 %7 2.6.2020 %9 Viewpoint %J J Med Internet Res %G English %X Digital health innovations have been rapidly implemented and scaled to provide solutions to health delivery challenges posed by the coronavirus disease (COVID-19) pandemic. This has provided people with ongoing access to vital health services while minimizing their potential exposure to infection and allowing them to maintain social distancing. However, these solutions may have unintended consequences for health equity. Poverty, lack of access to digital health, poor engagement with digital health for some communities, and barriers to digital health literacy are some factors that can contribute to poor health outcomes. We present the Digital Health Equity Framework, which can be used to consider health equity factors. Along with person-centered care, digital health equity should be incorporated into health provider training and should be championed at the individual, institutional, and social levels. Important future directions will be to develop measurement-based approaches to digital health equity and to use these findings to further validate and refine this model. %M 32452816 %R 10.2196/19361 %U https://www.jmir.org/2020/6/e19361 %U https://doi.org/10.2196/19361 %U http://www.ncbi.nlm.nih.gov/pubmed/32452816 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e19927 %T Primary Health Care Facility Preparedness for Outpatient Service Provision During the COVID-19 Pandemic in India: Cross-Sectional Study %A Garg,Suneela %A Basu,Saurav %A Rustagi,Ruchir %A Borle,Amod %+ Department of Community Medicine, Maulana Azad Medical College, 2 BSZ Marg, New Delhi, 110002, India, 91 8447527452, saurav.basu1983@gmail.com %K primary health care %K COVID-19 %K pandemic %K health systems %K India %D 2020 %7 1.6.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Primary health centers (PHCs) represent the first tier of the Indian health care system, providing a range of essential outpatient services to people living in the rural, suburban, and hard-to-reach areas. Diversion of health care resources for containing the coronavirus disease (COVID-19) pandemic has significantly undermined the accessibility and availability of essential health services. Under these circumstances, the preparedness of PHCs in providing safe patient-centered care and meeting the current health needs of the population while preventing further transmission of the severe acute respiratory syndrome coronavirus 2 infection is crucial. Objective: The aim of this study was to determine the primary health care facility preparedness toward the provision of safe outpatient services during the COVID-19 pandemic in India. Methods: We conducted a cross-sectional study among supervisors and managers of primary health care facilities attached to medical colleges and institutions in India. A list of 60 faculties involved in the management and supervision of PHCs affiliated with the community medicine departments of medical colleges and institutes across India was compiled from an accessible private organization member database. We collected the data through a rapid survey from April 24 to 30, 2020, using a Google Forms online digital questionnaire that evaluated preparedness parameters based on self-assessment by the participants. The preparedness domains assessed were infrastructure availability, health worker safety, and patient care. Results: A total of 51 faculties responded to the survey. Each medical college and institution had on average a total of 2.94 (SD 1.7) PHCs under its jurisdiction. Infrastructural and infection control deficits at the PHC were reported in terms of limited physical space and queuing capacity, lack of separate entry and exit gates (n=25, 49%), inadequate ventilation (n=29, 57%), and negligible airborne infection control measures (n=38, 75.5%). N95 masks were available at 26 (50.9%) sites. Infection prevention and control measures were also suboptimal with inadequate facilities for handwashing and hand hygiene reported in 23.5% (n=12) and 27.4% (n=14) of sites, respectively. The operation of outpatient services, particularly related to maternal and child health, was significantly disrupted (P<.001) during the COVID-19 pandemic. Conclusions: Existing PHC facilities in India providing outpatient services are constrained in their functioning during the COVID-19 pandemic due to weak infrastructure contributing to suboptimal patient safety and infection control measures. Furthermore, there is a need for effective planning, communication, and coordination between the centralized health policy makers and health managers working at primary health care facilities to ensure overall preparedness during public health emergencies. %M 32452819 %R 10.2196/19927 %U http://publichealth.jmir.org/2020/2/e19927/ %U https://doi.org/10.2196/19927 %U http://www.ncbi.nlm.nih.gov/pubmed/32452819 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e19170 %T A Snapshot of SARS-CoV-2 Genome Availability up to April 2020 and its Implications: Data Analysis %A Mavian,Carla %A Marini,Simone %A Prosperi,Mattia %A Salemi,Marco %+ Emerging Pathogens Institute, University of Florida, Mowry Rd 2055, Gainesville, FL, United States, 1 352 273 9567, salemi@pathology.ufl.edu %K covid-19 %K sars-cov-2 %K phylogenetics %K genome %K evolution %K genetics %K pandemic %K infectious disease %K virus %K sequence %K transmission %K tracing %K tracking %D 2020 %7 1.6.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has been growing exponentially, affecting over 4 million people and causing enormous distress to economies and societies worldwide. A plethora of analyses based on viral sequences has already been published both in scientific journals and through non–peer-reviewed channels to investigate the genetic heterogeneity and spatiotemporal dissemination of SARS-CoV-2. However, a systematic investigation of phylogenetic information and sampling bias in the available data is lacking. Although the number of available genome sequences of SARS-CoV-2 is growing daily and the sequences show increasing phylogenetic information, country-specific data still present severe limitations and should be interpreted with caution. Objective: The objective of this study was to determine the quality of the currently available SARS-CoV-2 full genome data in terms of sampling bias as well as phylogenetic and temporal signals to inform and guide the scientific community. Methods: We used maximum likelihood–based methods to assess the presence of sufficient information for robust phylogenetic and phylogeographic studies in several SARS-CoV-2 sequence alignments assembled from GISAID (Global Initiative on Sharing All Influenza Data) data released between March and April 2020. Results: Although the number of high-quality full genomes is growing daily, and sequence data released in April 2020 contain sufficient phylogenetic information to allow reliable inference of phylogenetic relationships, country-specific SARS-CoV-2 data sets still present severe limitations. Conclusions: At the present time, studies assessing within-country spread or transmission clusters should be considered preliminary or hypothesis-generating at best. Hence, current reports should be interpreted with caution, and concerted efforts should continue to increase the number and quality of sequences required for robust tracing of the epidemic. %M 32412415 %R 10.2196/19170 %U http://publichealth.jmir.org/2020/2/e19170/ %U https://doi.org/10.2196/19170 %U http://www.ncbi.nlm.nih.gov/pubmed/32412415 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e19033 %T A Web- and App-Based Connected Care Solution for COVID-19 In- and Outpatient Care: Qualitative Study and Application Development %A Schinköthe,Timo %A Gabri,Mariano Rolando %A Mitterer,Manfred %A Gouveia,Pedro %A Heinemann,Volker %A Harbeck,Nadia %A Subklewe,Marion %+ CANKADO, Eupener Sraße 165, Cologne, 50933, Germany, 49 221 429 153 00, t.schinkoethe@cankado.com %K COVID-19 %K eHealth %K connected care %K telecare %K cloud solution %K telehealth %K public health %K infectious disease %K pandemic %K outbreak %D 2020 %7 1.6.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: From the perspective of health care professionals, coronavirus disease (COVID-19) brings many challenges as well as opportunities for digital health care. One challenge is that health care professionals are at high risk of infection themselves. Therefore, in-person visits need to be reduced to an absolute minimum. Connected care solutions, including telehealth, remote patient monitoring, and secure communications between clinicians and their patients, may rapidly become the first choice in such public health emergencies. Objective: The aim of the COVID-19 Caregiver Cockpit (C19CC) was to implement a free-of-charge, web- and app-based tool for patient assessment to assist health care professionals working in the COVID-19 environment. Methods: Physicians in Argentina, Germany, Iran, Italy, Portugal, Switzerland, and the United States explained their challenges with COVID-19 patient care through unstructured interviews. Based on the collected feedback, the first version of the C19CC was built. In the second round of interviews, the application was presented to physicians, and more feedback was obtained. Results: Physicians identified a number of different scenarios where telemedicine or connected care solutions could rapidly improve patient care. These scenarios included outpatient care, discharge management, remote tracking of patients with chronic diseases, as well as incorporating infected physicians under quarantine into telehealth services. Conclusions: The C19CC is the result of an agile and iterative development process that complements the work of physicians. It aims to improve the care and safety of people who are infected by COVID-19. %M 32406855 %R 10.2196/19033 %U http://publichealth.jmir.org/2020/2/e19033/ %U https://doi.org/10.2196/19033 %U http://www.ncbi.nlm.nih.gov/pubmed/32406855 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 7 %N 6 %P e19347 %T Flattening the Mental Health Curve: COVID-19 Stay-at-Home Orders Are Associated With Alterations in Mental Health Search Behavior in the United States %A Jacobson,Nicholas C %A Lekkas,Damien %A Price,George %A Heinz,Michael V %A Song,Minkeun %A O’Malley,A James %A Barr,Paul J %+ Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, 46 Centerra Parkway, Suite 300, Office #333S, Lebanon, NH, 03766, United States, 1 6036467037, Nicholas.C.Jacobson@dartmouth.edu %K COVID-19 %K coronavirus %K stay-at-home orders %K mental health %K suicide %K anxiety %K infodemiology %K infoveillance %K search trends %K health information needs %D 2020 %7 1.6.2020 %9 Original Paper %J JMIR Ment Health %G English %X Background: The coronavirus disease (COVID-19) has led to dramatic changes worldwide in people’s everyday lives. To combat the pandemic, many governments have implemented social distancing, quarantine, and stay-at-home orders. There is limited research on the impact of such extreme measures on mental health. Objective: The goal of this study was to examine whether stay-at-home orders produced differential changes in mental health symptoms using internet search queries on a national scale. Methods: In the United States, individual states vary in their adoption of measures to reduce the spread of COVID-19; as of March 23, 2020, 11 of the 50 states had issued stay-at-home orders. The staggered rollout of stay-at-home measures across the United States allows us to investigate whether these measures impact mental health by exploring variations in mental health search queries across the states. This paper examines the changes in mental health search queries on Google between March 16-23, 2020, across each state and Washington, DC. Specifically, this paper examines differential changes in mental health searches based on patterns of search activity following issuance of stay-at-home orders in these states compared to all other states. The participants were all the people who searched mental health terms in Google between March 16-23. Between March 16-23, 11 states underwent stay-at-home orders to prevent the transmission of COVID-19. Outcomes included search terms measuring anxiety, depression, obsessive-compulsive, negative thoughts, irritability, fatigue, anhedonia, concentration, insomnia, and suicidal ideation. Results: Analyzing over 10 million search queries using generalized additive mixed models, the results suggested that the implementation of stay-at-home orders are associated with a significant flattening of the curve for searches for suicidal ideation, anxiety, negative thoughts, and sleep disturbances, with the most prominent flattening associated with suicidal ideation and anxiety. Conclusions: These results suggest that, despite decreased social contact, mental health search queries increased rapidly prior to the issuance of stay-at-home orders, and these changes dissipated following the announcement and enactment of these orders. Although more research is needed to examine sustained effects, these results suggest mental health symptoms were associated with an immediate leveling off following the issuance of stay-at-home orders. %M 32459186 %R 10.2196/19347 %U https://mental.jmir.org/2020/6/e19347 %U https://doi.org/10.2196/19347 %U http://www.ncbi.nlm.nih.gov/pubmed/32459186 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e19273 %T Tracking Social Media Discourse About the COVID-19 Pandemic: Development of a Public Coronavirus Twitter Data Set %A Chen,Emily %A Lerman,Kristina %A Ferrara,Emilio %+ Information Sciences Institute, University of Southern California, 4676 Admiralty Way, #1001, Marina del Rey, CA, 90292, United States, 1 310 448 8661, emiliofe@usc.edu %K COVID-19 %K SARS-CoV-2 %K social media %K network analysis %K computational social sciences %D 2020 %7 29.5.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: At the time of this writing, the coronavirus disease (COVID-19) pandemic outbreak has already put tremendous strain on many countries' citizens, resources, and economies around the world. Social distancing measures, travel bans, self-quarantines, and business closures are changing the very fabric of societies worldwide. With people forced out of public spaces, much of the conversation about these phenomena now occurs online on social media platforms like Twitter. Objective: In this paper, we describe a multilingual COVID-19 Twitter data set that we are making available to the research community via our COVID-19-TweetIDs GitHub repository. Methods: We started this ongoing data collection on January 28, 2020, leveraging Twitter’s streaming application programming interface (API) and Tweepy to follow certain keywords and accounts that were trending at the time data collection began. We used Twitter’s search API to query for past tweets, resulting in the earliest tweets in our collection dating back to January 21, 2020. Results: Since the inception of our collection, we have actively maintained and updated our GitHub repository on a weekly basis. We have published over 123 million tweets, with over 60% of the tweets in English. This paper also presents basic statistics that show that Twitter activity responds and reacts to COVID-19-related events. Conclusions: It is our hope that our contribution will enable the study of online conversation dynamics in the context of a planetary-scale epidemic outbreak of unprecedented proportions and implications. This data set could also help track COVID-19-related misinformation and unverified rumors or enable the understanding of fear and panic—and undoubtedly more. %M 32427106 %R 10.2196/19273 %U http://publichealth.jmir.org/2020/2/e19273/ %U https://doi.org/10.2196/19273 %U http://www.ncbi.nlm.nih.gov/pubmed/32427106 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e19279 %T COVID-19: Putting the General Data Protection Regulation to the Test %A McLennan,Stuart %A Celi,Leo Anthony %A Buyx,Alena %+ Institute of History and Ethics in Medicine, Technical University of Munich, Ismaninger Straße 22, Munich, 81675, Germany, 49 089 4140 4041, stuart.mclennan@tum.de %K COVID-19 %K data sharing %K GDPR %K research exemption %K global health %K public health %K research %K digital health %K electronic health records %K EHR %D 2020 %7 29.5.2020 %9 Viewpoint %J JMIR Public Health Surveill %G English %X The coronavirus disease (COVID-19) pandemic is very much a global health issue and requires collaborative, international health research efforts to address it. A valuable source of information for researchers is the large amount of digital health data that are continuously collected by electronic health record systems at health care organizations. The European Union’s General Data Protection Regulation (GDPR) will be the key legal framework with regard to using and sharing European digital health data for research purposes. However, concerns persist that the GDPR has made many organizations very risk-averse in terms of data sharing, even if the regulation permits such sharing. Health care organizations focusing on individual risk minimization threaten to undermine COVID-19 research efforts. In our opinion, there is an ethical obligation to use the research exemption clause of the GDPR during the COVID-19 pandemic to support global collaborative health research efforts. Solidarity is a European value, and here is a chance to exemplify it by using the GDPR regulatory framework in a way that does not hinder but actually fosters solidarity during the COVID-19 pandemic. %M 32449686 %R 10.2196/19279 %U http://publichealth.jmir.org/2020/2/e19279/ %U https://doi.org/10.2196/19279 %U http://www.ncbi.nlm.nih.gov/pubmed/32449686 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e19862 %T No Place Like Home: Cross-National Data Analysis of the Efficacy of Social Distancing During the COVID-19 Pandemic %A Delen,Dursun %A Eryarsoy,Enes %A Davazdahemami,Behrooz %+ Center for Health Systems Innovation, Department of Management Science and Information Systems, Oklahoma State University, 700 N Greenwood Ave, NH302, Tulsa, OK, 74106, United States, 1 9185948283, dursun.delen@okstate.edu %K COVID-19 %K public health %K social distancing %K machine learning %K pandemic %D 2020 %7 28.5.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: In the absence of a cure in the time of a pandemic, social distancing measures seem to be the most effective intervention to slow the spread of disease. Various simulation-based studies have been conducted to investigate the effectiveness of these measures. While those studies unanimously confirm the mitigating effect of social distancing on disease spread, the reported effectiveness varies from 10% to more than 90% reduction in the number of infections. This level of uncertainty is mostly due to the complex dynamics of epidemics and their time-variant parameters. However, real transactional data can reduce uncertainty and provide a less noisy picture of the effectiveness of social distancing. Objective: The aim of this paper was to integrate multiple transactional data sets (GPS mobility data from Google and Apple as well as disease statistics from the European Centre for Disease Prevention and Control) to study the role of social distancing policies in 26 countries and analyze the transmission rate of the coronavirus disease (COVID-19) pandemic over the course of 5 weeks. Methods: Relying on the susceptible-infected-recovered (SIR) model and official COVID-19 reports, we first calculated the weekly transmission rate (β) of COVID-19 in 26 countries for 5 consecutive weeks. Then, we integrated these data with the Google and Apple mobility data sets for the same time frame and used a machine learning approach to investigate the relationship between the mobility factors and β values. Results: Gradient boosted trees regression analysis showed that changes in mobility patterns resulting from social distancing policies explain approximately 47% of the variation in the disease transmission rates. Conclusions: Consistent with simulation-based studies, real cross-national transactional data confirms the effectiveness of social distancing interventions in slowing the spread of COVID-19. In addition to providing less noisy and more generalizable support for the idea of social distancing, we provide specific insights for public health policy makers regarding locations that should be given higher priority for enforcing social distancing measures. %M 32434145 %R 10.2196/19862 %U http://publichealth.jmir.org/2020/2/e19862/ %U https://doi.org/10.2196/19862 %U http://www.ncbi.nlm.nih.gov/pubmed/32434145 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e19464 %T Comparison of Transmissibility of Coronavirus Between Symptomatic and Asymptomatic Patients: Reanalysis of the Ningbo COVID-19 Data %A Yin,Guosheng %A Jin,Huaqing %+ Department of Statistics and Actuarial Science, The University of Hong Kong, Pokfulam Road, Hong Kong, China, 852 3917 8313, gyin@hku.hk %K asymptomatic case %K close contact %K coronavirus %K COVID-19 %K Fisher exact test %K transmission rate %K transmission %K virus %K immunology %K analysis %D 2020 %7 28.5.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Since the outbreak of the novel coronavirus disease (COVID-19) in December 2019, the coronavirus has spread all over the world at an unprecedented rate. The transmissibility of the coronavirus from asymptomatic patients to healthy individuals has received enormous attention. An important study using COVID-19 data from the city of Ningbo, China, was carried out to estimate and compare the transmission rates of the coronavirus by the symptomatic and asymptomatic patients. However, in the original analysis, the usual chi-square tests were unduly used for some contingency tables with small cell counts including zero, which may violate the assumptions for the chi-square test. Objective: We reanalyze the data from the city of Ningbo with more appropriate statistical methods to draw more reliable and sound conclusions on the transmission rates of the coronavirus by the symptomatic and asymptomatic patients. Methods: We excluded the cases associated with the super-spreader and adopted a more appropriate statistical method, including the permutation test and the Fisher exact test, to reanalyze the COVID-19 data from the city of Ningbo. Results: After excluding the cases related to the super-spreader, the Fisher exact test yields a P value of .84, which indicates stronger evidence of no difference in the transmission rates compared with the original analysis. The odds ratio of the coronavirus transmission rates between the symptomatic and asymptomatic patients is 1.2 with a 95% confidence interval 0.5-2.8. Conclusions: Through a more in-depth and comprehensive statistical analysis of the Ningbo data, we concluded that there is no difference in the transmission rates of coronavirus between symptomatic and asymptomatic patients. %M 32442131 %R 10.2196/19464 %U http://publichealth.jmir.org/2020/2/e19464/ %U https://doi.org/10.2196/19464 %U http://www.ncbi.nlm.nih.gov/pubmed/32442131 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 5 %P e19421 %T Using Reports of Symptoms and Diagnoses on Social Media to Predict COVID-19 Case Counts in Mainland China: Observational Infoveillance Study %A Shen,Cuihua %A Chen,Anfan %A Luo,Chen %A Zhang,Jingwen %A Feng,Bo %A Liao,Wang %+ Department of Communication, University of California, Davis, One Shields Ave, Davis, CA, , United States, 1 5307520966, wngliao@ucdavis.edu %K COVID-19 %K SARS-CoV-2 %K novel coronavirus %K infectious disease %K social media %K Weibo %K China %K disease surveillance %K surveillance %K infoveillance %K infodemiology %D 2020 %7 28.5.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Coronavirus disease (COVID-19) has affected more than 200 countries and territories worldwide. This disease poses an extraordinary challenge for public health systems because screening and surveillance capacity is often severely limited, especially during the beginning of the outbreak; this can fuel the outbreak, as many patients can unknowingly infect other people. Objective: The aim of this study was to collect and analyze posts related to COVID-19 on Weibo, a popular Twitter-like social media site in China. To our knowledge, this infoveillance study employs the largest, most comprehensive, and most fine-grained social media data to date to predict COVID-19 case counts in mainland China. Methods: We built a Weibo user pool of 250 million people, approximately half the entire monthly active Weibo user population. Using a comprehensive list of 167 keywords, we retrieved and analyzed around 15 million COVID-19–related posts from our user pool from November 1, 2019 to March 31, 2020. We developed a machine learning classifier to identify “sick posts,” in which users report their own or other people’s symptoms and diagnoses related to COVID-19. Using officially reported case counts as the outcome, we then estimated the Granger causality of sick posts and other COVID-19 posts on daily case counts. For a subset of geotagged posts (3.10% of all retrieved posts), we also ran separate predictive models for Hubei province, the epicenter of the initial outbreak, and the rest of mainland China. Results: We found that reports of symptoms and diagnosis of COVID-19 significantly predicted daily case counts up to 14 days ahead of official statistics, whereas other COVID-19 posts did not have similar predictive power. For the subset of geotagged posts, we found that the predictive pattern held true for both Hubei province and the rest of mainland China regardless of the unequal distribution of health care resources and the outbreak timeline. Conclusions: Public social media data can be usefully harnessed to predict infection cases and inform timely responses. Researchers and disease control agencies should pay close attention to the social media infosphere regarding COVID-19. In addition to monitoring overall search and posting activities, leveraging machine learning approaches and theoretical understanding of information sharing behaviors is a promising approach to identify true disease signals and improve the effectiveness of infoveillance. %M 32452804 %R 10.2196/19421 %U http://www.jmir.org/2020/5/e19421/ %U https://doi.org/10.2196/19421 %U http://www.ncbi.nlm.nih.gov/pubmed/32452804 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 5 %P e18707 %T Agile Health Care Analytics: Enabling Real-Time Disease Surveillance With a Computational Health Platform %A Schulz,Wade L %A Durant,Thomas J S %A Torre Jr,Charles J %A Hsiao,Allen L %A Krumholz,Harlan M %+ Department of Laboratory Medicine, Yale School of Medicine, 55 Park St, PS215, New Haven, CT, 06511, United States, 1 (203) 688 2286, wade.schulz@yale.edu %K real-time analytics %K real-world data %K disease surveillance %K computational health %K surveillance %K public health %K COVID-19 %K outbreak %K health information technology %K HIT %K interface %K monitoring %K pandemic %D 2020 %7 28.5.2020 %9 Viewpoint %J J Med Internet Res %G English %X The ongoing coronavirus disease outbreak demonstrates the need for novel applications of real-time data to produce timely information about incident cases. Using health information technology (HIT) and real-world data, we sought to produce an interface that could, in near real time, identify patients presenting with suspected respiratory tract infection and enable monitoring of test results related to specific pathogens, including severe acute respiratory syndrome coronavirus 2. This tool was built upon our computational health platform, which provides access to near real-time data from disparate HIT sources across our health system. This combination of technology allowed us to rapidly prototype, iterate, and deploy a platform to support a cohesive organizational response to a rapidly evolving outbreak. Platforms that allow for agile analytics are needed to keep pace with evolving needs within the health care system. %M 32442130 %R 10.2196/18707 %U http://www.jmir.org/2020/5/e18707/ %U https://doi.org/10.2196/18707 %U http://www.ncbi.nlm.nih.gov/pubmed/32442130 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 5 %P e19367 %T Complex Reporting of the COVID-19 Epidemic in the Czech Republic: Use of an Interactive Web-Based App in Practice %A Komenda,Martin %A Bulhart,Vojtěch %A Karolyi,Matěj %A Jarkovský,Jiří %A Mužík,Jan %A Májek,Ondřej %A Šnajdrová,Lenka %A Růžičková,Petra %A Rážová,Jarmila %A Prymula,Roman %A Macková,Barbora %A Březovský,Pavel %A Marounek,Jan %A Černý,Vladimír %A Dušek,Ladislav %+ Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Kamenice 3, Brno, Czech Republic, 420 725174940, komenda@iba.muni.cz %K coronavirus disease %K COVID-19 %K Czech Republic %K web app %K interactive reporting %K epidemiological overview %K CRISP-DM %K public health %K app %K epidemiology %K virus %K health data %K data mining %K modeling %D 2020 %7 27.5.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The beginning of the coronavirus disease (COVID-19) epidemic dates back to December 31, 2019, when the first cases were reported in the People’s Republic of China. In the Czech Republic, the first three cases of infection with the novel coronavirus were confirmed on March 1, 2020. The joint effort of state authorities and researchers gave rise to a unique team, which combines methodical knowledge of real-world processes with the know-how needed for effective processing, analysis, and online visualization of data. Objective: Due to an urgent need for a tool that presents important reports based on valid data sources, a team of government experts and researchers focused on the design and development of a web app intended to provide a regularly updated overview of COVID-19 epidemiology in the Czech Republic to the general population. Methods: The cross-industry standard process for data mining model was chosen for the complex solution of analytical processing and visualization of data that provides validated information on the COVID-19 epidemic across the Czech Republic. Great emphasis was put on the understanding and a correct implementation of all six steps (business understanding, data understanding, data preparation, modelling, evaluation, and deployment) needed in the process, including the infrastructure of a nationwide information system; the methodological setting of communication channels between all involved stakeholders; and data collection, processing, analysis, validation, and visualization. Results: The web-based overview of the current spread of COVID-19 in the Czech Republic has been developed as an online platform providing a set of outputs in the form of tables, graphs, and maps intended for the general public. On March 12, 2020, the first version of the web portal, containing fourteen overviews divided into five topical sections, was released. The web portal’s primary objective is to publish a well-arranged visualization and clear explanation of basic information consisting of the overall numbers of performed tests, confirmed cases of COVID-19, COVID-19-related deaths, the daily and cumulative overviews of people with a positive COVID-19 case, performed tests, location and country of infection of people with a positive COVID-19 case, hospitalizations of patients with COVID-19, and distribution of personal protective equipment. Conclusions: The online interactive overview of the current spread of COVID-19 in the Czech Republic was launched on March 11, 2020, and has immediately become the primary communication channel employed by the health care sector to present the current situation regarding the COVID-19 epidemic. This complex reporting of the COVID-19 epidemic in the Czech Republic also shows an effective way to interconnect knowledge held by various specialists, such as regional and national methodology experts (who report positive cases of the disease on a daily basis), with knowledge held by developers of central registries, analysts, developers of web apps, and leaders in the health care sector. %M 32412422 %R 10.2196/19367 %U http://www.jmir.org/2020/5/e19367/ %U https://doi.org/10.2196/19367 %U http://www.ncbi.nlm.nih.gov/pubmed/32412422 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 5 %P e18796 %T Public Engagement and Government Responsiveness in the Communications About COVID-19 During the Early Epidemic Stage in China: Infodemiology Study on Social Media Data %A Liao,Qiuyan %A Yuan,Jiehu %A Dong,Meihong %A Yang,Lin %A Fielding,Richard %A Lam,Wendy Wing Tak %+ School of Public Health, The University of Hong Kong, 2/F, Patrick Manson Building (North Wing), 7 Sassoon Road, Pokfulam, Hong Kong, 852 39179289, qyliao11@hku.hk %K risk communication %K social media %K epidemic %K COVID-19 %K pandemic %K outbreak %K infectious disease %K content analysis %D 2020 %7 26.5.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Effective risk communication about the outbreak of a newly emerging infectious disease in the early stage is critical for managing public anxiety and promoting behavioral compliance. China has experienced the unprecedented epidemic of the coronavirus disease (COVID-19) in an era when social media has fundamentally transformed information production and consumption patterns. Objective: This study examined public engagement and government responsiveness in the communications about COVID-19 during the early epidemic stage based on an analysis of data from Sina Weibo, a major social media platform in China. Methods: Weibo data relevant to COVID-19 from December 1, 2019, to January 31, 2020, were retrieved. Engagement data (likes, comments, shares, and followers) of posts from government agency accounts were extracted to evaluate public engagement with government posts online. Content analyses were conducted for a random subset of 644 posts from personal accounts of individuals, and 273 posts from 10 relatively more active government agency accounts and the National Health Commission of China to identify major thematic contents in online discussions. Latent class analysis further explored main content patterns, and chi-square for trend examined how proportions of main content patterns changed by time within the study time frame. Results: The public response to COVID-19 seemed to follow the spread of the disease and government actions but was earlier for Weibo than the government. Online users generally had low engagement with posts relevant to COVID-19 from government agency accounts. The common content patterns identified in personal and government posts included sharing epidemic situations; general knowledge of the new disease; and policies, guidelines, and official actions. However, personal posts were more likely to show empathy to affected people (χ21=13.3, P<.001), attribute blame to other individuals or government (χ21=28.9, P<.001), and express worry about the epidemic (χ21=32.1, P<.001), while government posts were more likely to share instrumental support (χ21=32.5, P<.001) and praise people or organizations (χ21=8.7, P=.003). As the epidemic evolved, sharing situation updates (for trend, χ21=19.7, P<.001) and policies, guidelines, and official actions (for trend, χ21=15.3, P<.001) became less frequent in personal posts but remained stable or increased significantly in government posts. Moreover, as the epidemic evolved, showing empathy and attributing blame (for trend, χ21=25.3, P<.001) became more frequent in personal posts, corresponding to a slight increase in sharing instrumental support, praising, and empathizing in government posts (for trend, χ21=9.0, P=.003). Conclusions: The government should closely monitor social media data to improve the timing of communications about an epidemic. As the epidemic evolves, merely sharing situation updates and policies may be insufficient to capture public interest in the messages. The government may adopt a more empathic communication style as more people are affected by the disease to address public concerns. %M 32412414 %R 10.2196/18796 %U http://www.jmir.org/2020/5/e18796/ %U https://doi.org/10.2196/18796 %U http://www.ncbi.nlm.nih.gov/pubmed/32412414 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e19501 %T Online National Health Agency Mask Guidance for the Public in Light of COVID-19: Content Analysis %A Laestadius,Linnea %A Wang,Yang %A Ben Taleb,Ziyad %A Kalan,Mohammad Ebrahimi %A Cho,Young %A Manganello,Jennifer %+ Zilber School of Public Health, University of Wisconsin Milwaukee, PO Box 413, Milwaukee, WI, 53201, United States, 1 414 227 4512, llaestad@uwm.edu %K public health policy %K infectious disease %K personal protective equipment %K public health %K COVID-19 %K pandemic %K online health information %K content analysis %D 2020 %7 26.5.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The rapid global spread of the coronavirus disease (COVID-19) has compelled national governments to issue guidance on the use of face masks for members of the general public. To date, no work has assessed how this guidance differs across governments. Objective: This study seeks to contribute to a rational and consistent global response to infectious disease by determining how guidelines differ across nations and regions. Methods: A content analysis of health agency mask guidelines on agency websites was performed in late March 2020 among 25 countries and regions with large numbers of COVID-19 cases. Countries and regions were assigned across the coding team by language proficiency, with Google Translate used as needed. When available, both the original and English language version of guidance were reviewed. Results: All examined countries and regions had some form of guidance online, although detail and clarity differed. Although 9 countries and regions recommended surgical, medical, or unspecified masks in public and poorly ventilated places, 16 recommended against people wearing masks in public. There were 2 countries that explicitly recommended against fabric masks. In addition, 12 failed to outline the minimum basic World Health Organization guidance for masks. Conclusions: Online guidelines for face mask use to prevent COVID-19 in the general public are currently inconsistent across nations and regions, and have been changing often. Efforts to create greater standardization and clarity should be explored in light of the status of COVID-19 as a global pandemic. %M 32427103 %R 10.2196/19501 %U http://publichealth.jmir.org/2020/2/e19501/ %U https://doi.org/10.2196/19501 %U http://www.ncbi.nlm.nih.gov/pubmed/32427103 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 5 %P e19357 %T A Global Digital Citizen Science Policy to Tackle Pandemics Like COVID-19 %A Katapally,Tarun R %+ University of Regina, 2155 College Ave, Johnson Shoyama Graduate School of Public Policy, Regina, SK, S4P4V5, Canada, 1 3065854544, tarun.katapally@uregina.ca %K COVID-19 %K pandemic %K citizen science %K smartphones %K population health %K mHealth %K eHealth %K big data %K virus %K infectious diseases %K public health %K digital epidemiology %D 2020 %7 26.5.2020 %9 Proposal %J J Med Internet Res %G English %X The coronavirus disease (COVID-19) pandemic is an extremely complex existential threat that requires cohesive societal effort to address health system inefficiencies. When our society has faced existential crises in the past, we have banded together by using the technology at hand to overcome them. The COVID-19 pandemic is one such threat that requires not only a cohesive effort, but also enormous trust to follow public health guidelines, maintain social distance, and share necessities. However, are democratic societies with civil liberties capable of doing this? Mobile technology has immense potential for addressing pandemics like COVID-19, as it gives us access to big data in terms of volume, velocity, veracity, and variety. These data are particularly relevant to understand and mitigate the spread of pandemics such as COVID-19. In order for such intensive and potentially intrusive data collection measures to succeed, we need a cohesive societal effort with full buy-in from citizens and their representatives. This article outlines an evidence-based global digital citizen science policy that provides the theoretical and methodological foundation for ethically sourcing big data from citizens to tackle pandemics such as COVID-19. %M 32408267 %R 10.2196/19357 %U http://www.jmir.org/2020/5/e19357/ %U https://doi.org/10.2196/19357 %U http://www.ncbi.nlm.nih.gov/pubmed/32408267 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 5 %P e19437 %T Use of a Real-Time Locating System for Contact Tracing of Health Care Workers During the COVID-19 Pandemic at an Infectious Disease Center in Singapore: Validation Study %A Ho,Hanley J %A Zhang,Zoe Xiaozhu %A Huang,Zhilian %A Aung,Aung Hein %A Lim,Wei-Yen %A Chow,Angela %+ Department of Clinical Epidemiology, Office of Clinical Epidemiology, Analytics, and Knowledge (OCEAN), Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, 308433, Singapore, 65 6511 5054, hanley_ho@ttsh.com.sg %K infectious disease %K real-time locating systems %K electronic medical records %K COVID-19 %K contact tracing %K health care workers %K RFID %D 2020 %7 26.5.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: In early 2020, coronavirus disease (COVID-19) emerged and spread by community and nosocomial transmission. Effective contact tracing of potentially exposed health care workers is crucial for the prevention and control of infectious disease outbreaks in the health care setting. Objective: This study aimed to evaluate the comparative effectiveness of contact tracing during the COVID-19 pandemic through the real-time locating system (RTLS) and review of the electronic medical record (EMR) at the designated hospital for COVID-19 response in Singapore. Methods: Over a 2-day study period, all admitted patients with COVID-19, their ward locations, and the health care workers rostered to each ward were identified to determine the total number of potential contacts between patients with COVID-19 and health care workers. The numbers of staff-patient contacts determined by EMR reviews, RTLS-based contact tracing, and a combination of both methods were evaluated. The use of EMR-based and RTLS-based contact tracing methods was further validated by comparing their sensitivity and specificity against self-reported staff-patient contacts by health care workers. Results: Of 796 potential staff-patient contacts (between 17 patients and 162 staff members), 104 (13.1%) were identified by both the RTLS and EMR, 54 (6.8%) by the RTLS alone, and 99 (12.4%) by the EMR alone; 539 (67.7%) were not identified through either method. Compared to self-reported contacts, EMR reviews had a sensitivity of 47.2% and a specificity of 77.9%, while the RTLS had a sensitivity of 72.2% and a specificity of 87.7%. The highest sensitivity was obtained by including all contacts identified by either the RTLS or the EMR (sensitivity 77.8%, specificity 73.4%). Conclusions: RTLS-based contact tracing showed higher sensitivity and specificity than EMR review. Integration of both methods provided the best performance for rapid contact tracing, although technical adjustments to the RTLS and increasing user compliance with wearing of RTLS tags remain necessary. %M 32412416 %R 10.2196/19437 %U http://www.jmir.org/2020/5/e19437/ %U https://doi.org/10.2196/19437 %U http://www.ncbi.nlm.nih.gov/pubmed/32412416 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e18638 %T Mathematical Modeling of COVID-19 Control and Prevention Based on Immigration Population Data in China: Model Development and Validation %A Huang,Qiangsheng %A Kang,Yu Sunny %+ Ping An Technology (Shenzhen) Co, Ltd, Ping An Wealth Building, 1088 Yuanshen Road, Pudong New District, Shanghai, 200135, China, 86 13761879218, hqsh@live.cn %K COVID-19 %K 2019-ncov %K epidemic control and prevention %K epidemic risk time series model %K incoming immigration population %K new diagnoses per day %D 2020 %7 25.5.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: At the end of February 2020, the spread of coronavirus disease (COVID-19) in China had drastically slowed and appeared to be under control compared to the peak data in early February of that year. However, the outcomes of COVID-19 control and prevention measures varied between regions (ie, provinces and municipalities) in China; moreover, COVID-19 has become a global pandemic, and the spread of the disease has accelerated in countries outside China. Objective: This study aimed to establish valid models to evaluate the effectiveness of COVID-19 control and prevention among various regions in China. These models also targeted regions with control and prevention problems by issuing immediate warnings. Methods: We built a mathematical model, the Epidemic Risk Time Series Model, and used it to analyze two sets of data, including the daily COVID-19 incidence (ie, newly diagnosed cases) as well as the daily immigration population size. Results: Based on the results of the model evaluation, some regions, such as Shanghai and Zhejiang, were successful in COVID-19 control and prevention, whereas other regions, such as Heilongjiang, yielded poor performance. The evaluation result was highly correlated with the basic reproduction number (R0) value, and the result was evaluated in a timely manner at the beginning of the disease outbreak. Conclusions: The Epidemic Risk Time Series Model was designed to evaluate the effectiveness of COVID-19 control and prevention in different regions in China based on analysis of immigration population data. Compared to other methods, such as R0, this model enabled more prompt issue of early warnings. This model can be generalized and applied to other countries to evaluate their COVID-19 control and prevention. %M 32396132 %R 10.2196/18638 %U http://publichealth.jmir.org/2020/2/e18638/ %U https://doi.org/10.2196/18638 %U http://www.ncbi.nlm.nih.gov/pubmed/32396132 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e19447 %T Global Sentiments Surrounding the COVID-19 Pandemic on Twitter: Analysis of Twitter Trends %A Lwin,May Oo %A Lu,Jiahui %A Sheldenkar,Anita %A Schulz,Peter Johannes %A Shin,Wonsun %A Gupta,Raj %A Yang,Yinping %+ Wee Kim Wee School of Communication and Information, Nanyang Technological University, 31 Nanyang Link, Singapore, 637718, Singapore, 65 69083444, anitas@ntu.edu.sg %K COVID-19 %K Twitter %K pandemic %K social sentiments %K emotions %K infodemic %D 2020 %7 22.5.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: With the World Health Organization’s pandemic declaration and government-initiated actions against coronavirus disease (COVID-19), sentiments surrounding COVID-19 have evolved rapidly. Objective: This study aimed to examine worldwide trends of four emotions—fear, anger, sadness, and joy—and the narratives underlying those emotions during the COVID-19 pandemic. Methods: Over 20 million social media twitter posts made during the early phases of the COVID-19 outbreak from January 28 to April 9, 2020, were collected using “wuhan,” “corona,” “nCov,” and “covid” as search keywords. Results: Public emotions shifted strongly from fear to anger over the course of the pandemic, while sadness and joy also surfaced. Findings from word clouds suggest that fears around shortages of COVID-19 tests and medical supplies became increasingly widespread discussion points. Anger shifted from xenophobia at the beginning of the pandemic to discourse around the stay-at-home notices. Sadness was highlighted by the topics of losing friends and family members, while topics related to joy included words of gratitude and good health. Conclusions: Overall, global COVID-19 sentiments have shown rapid evolutions within just the span of a few weeks. Findings suggest that emotion-driven collective issues around shared public distress experiences of the COVID-19 pandemic are developing and include large-scale social isolation and the loss of human lives. The steady rise of societal concerns indicated by negative emotions needs to be monitored and controlled by complementing regular crisis communication with strategic public health communication that aims to balance public psychological wellbeing. %M 32412418 %R 10.2196/19447 %U http://publichealth.jmir.org/2020/2/e19447/ %U https://doi.org/10.2196/19447 %U http://www.ncbi.nlm.nih.gov/pubmed/32412418 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 5 %P e19434 %T Telehealth Home Support During COVID-19 Confinement for Community-Dwelling Older Adults With Mild Cognitive Impairment or Mild Dementia: Survey Study %A Goodman-Casanova,Jessica Marian %A Dura-Perez,Elena %A Guzman-Parra,Jose %A Cuesta-Vargas,Antonio %A Mayoral-Cleries,Fermin %+ Department of Mental Health, Regional University Hospital of Málaga, Biomedical Research Institute of Malaga (IBIMA), Plaza del Hospital Civil s/n, Málaga, 29009, Spain, 34 660901966, jmariangoodman@gmail.com %K telehealth %K confinement %K coronavirus %K COVID-19 %K well-being %K emergency response %K public health %K mental health %K physical health %K elderly %K older adults %K cognitive impairment %K dementia %D 2020 %7 22.5.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The public health emergency of coronavirus disease (COVID-19) is rapidly evolving worldwide; some countries, including Spain, have implemented restrictive measures. Populations that are vulnerable to this outbreak and its physical and mental health effects include community-dwelling older adults with mild cognitive impairment or mild dementia. Telehealth is a potential tool to deliver health care and decrease exposure risk. Objective: The aims of this study were to explore the impact of confinement on the health and well-being of community-dwelling older adults with mild cognitive impairment or mild dementia, to provide television-based and telephone-based health and social support, and to study the effects of a television-based assistive integrated technology, TV-AssistDem (TeleVision-based ASSistive Integrated Service to supporT European adults living with mild DEMentia or mild cognitive impairment). Methods: A telephone-based survey was administered in Spain to 93 participants in the TV-AssistDem clinical trial from March 25 to April 6, 2020. Results: Of the respondents, 60/93 (65%) were women. The mean age was 73.34 (SD 6.07), and 69/93 (74%) lived accompanied. Lockdown measures forced 17/93 respondents (18%) to change their living arrangements. Health status was found to be optimal in 89/93 respondents (96%), with no COVID-19 symptoms. Grocery and pharmacy outings were performed by family members of 68/93 participants (73%); 57 (61%) reported overall well-being, and 65 (70%) maintained their sleep quality. However, participants living alone reported greater negative feelings and more sleeping problems. Regarding leisure activities, 53/93 respondents (57%) took walks, 32 (35%) played memory games, 55 (60%) watched television, and 91 (98%) telephoned relatives. 58/93 (64%) respondents reported accessing moderate or too much COVID-19 information, 89 (97%) received it from television, and 56 (62%) stated that their understanding of the information was extreme. 39/93 (39%) respondents had contacted health and social services, while 29 (31%) requested information regarding these services during the telephone call. There were no significant differences in health and well-being between the intervention and control groups. Respondents with TV-AssistDem performed more memory exercises (24/93, 52% vs 8/93, 17.4%; P<.001) than control respondents. Conclusions: Our findings suggest that during COVID-19 confinement, the physical and mental health and well-being was optimal for the majority of our vulnerable population. However, those living alone reported greater negative psychological effects and sleeping problems. Measures adopted to address the negative experiences of confinement included keeping informed about the situation, accessing health and social services, having a support network that prevents risk of exposure to COVID-19 and guarantees food and medical supplies, a daily routine with maintained sleeping habits and leisure activities, staying physically and mentally active with cognitive stimulation exercises, and ensuring social connectedness using technology. Television sets were preferred technological devices to access COVID-19 information, watch television as a recreational activity, and perform memory exercises as an intellectual activity. Television-based telehealth support using TV-AssistDem demonstrated potential for cognitive stimulation. Trial Registration: ClinicalTrials.gov NCT03653234; https://clinicaltrials.gov/ct2/show/NCT03653234 %M 32401215 %R 10.2196/19434 %U http://www.jmir.org/2020/5/e19434/ %U https://doi.org/10.2196/19434 %U http://www.ncbi.nlm.nih.gov/pubmed/32401215 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e19702 %T Correlations of Online Search Engine Trends With Coronavirus Disease (COVID-19) Incidence: Infodemiology Study %A Higgins,Thomas S %A Wu,Arthur W %A Sharma,Dhruv %A Illing,Elisa A %A Rubel,Kolin %A Ting,Jonathan Y %A , %+ Rhinology, Sinus & Skull Base, Kentuckiana Ear Nose Throat, 6420 Dutchman's Parkway, STE 380, Louisville, KY, 40205, United States, 1 502 894 8441, thomas.higgins@louisville.edu %K COVID-19 %K coronavirus %K big data %K infodemiology %K infoveillance %K Baidu %K SARS-CoV-2 %K Google Trends %K digital health %K epidemiology %K China %K Italy %K Spain %K New York %K Washington %D 2020 %7 21.5.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The coronavirus disease (COVID-19) is the latest pandemic of the digital age. With the internet harvesting large amounts of data from the general population in real time, public databases such as Google Trends (GT) and the Baidu Index (BI) can be an expedient tool to assist public health efforts. Objective: The aim of this study is to apply digital epidemiology to the current COVID-19 pandemic to determine the utility of providing adjunctive epidemiologic information on outbreaks of this disease and evaluate this methodology in the case of future pandemics. Methods: An epidemiologic time series analysis of online search trends relating to the COVID-19 pandemic was performed from January 9, 2020, to April 6, 2020. BI was used to obtain online search data for China, while GT was used for worldwide data, the countries of Italy and Spain, and the US states of New York and Washington. These data were compared to real-world confirmed cases and deaths of COVID-19. Chronologic patterns were assessed in relation to disease patterns, significant events, and media reports. Results: Worldwide search terms for shortness of breath, anosmia, dysgeusia and ageusia, headache, chest pain, and sneezing had strong correlations (r>0.60, P<.001) to both new daily confirmed cases and deaths from COVID-19. GT COVID-19 (search term) and GT coronavirus (virus) searches predated real-world confirmed cases by 12 days (r=0.85, SD 0.10 and r=0.76, SD 0.09, respectively, P<.001). Searches for symptoms of diarrhea, fever, shortness of breath, cough, nasal obstruction, and rhinorrhea all had a negative lag greater than 1 week compared to new daily cases, while searches for anosmia and dysgeusia peaked worldwide and in China with positive lags of 5 days and 6 weeks, respectively, corresponding with widespread media coverage of these symptoms in COVID-19. Conclusions: This study demonstrates the utility of digital epidemiology in providing helpful surveillance data of disease outbreaks like COVID-19. Although certain online search trends for this disease were influenced by media coverage, many search terms reflected clinical manifestations of the disease and showed strong correlations with real-world cases and deaths. %M 32401211 %R 10.2196/19702 %U https://publichealth.jmir.org/2020/2/e19702 %U https://doi.org/10.2196/19702 %U http://www.ncbi.nlm.nih.gov/pubmed/32401211 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 5 %P e19334 %T Measuring the Outreach Efforts of Public Health Authorities and the Public Response on Facebook During the COVID-19 Pandemic in Early 2020: Cross-Country Comparison %A Sesagiri Raamkumar,Aravind %A Tan,Soon Guan %A Wee,Hwee Lin %+ Saw Swee Hock School of Public Health, National University of Singapore, MD1 #10-01, 12 Science Drive 2, National University of Singapore, Singapore, 117549, Singapore, 65 65164975, ephwhl@nus.edu.sg %K COVID-19 %K sentiment analysis %K emotion analysis %K public health authorities %K infectious disease %K outbreak %K public engagement %K social media %K public health %K virus %D 2020 %7 19.5.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The coronavirus disease (COVID-19) pandemic presents one of the most challenging global crises at the dawn of a new decade. Public health authorities (PHAs) are increasingly adopting the use of social media such as Facebook to rapidly communicate and disseminate pandemic response measures to the public. Understanding of communication strategies across different PHAs and examining the public response on the social media landscapes can help improve practices for disseminating information to the public. Objective: This study aims to examine COVID-19-related outreach efforts of PHAs in Singapore, the United States, and England, and the corresponding public response to these outreach efforts on Facebook. Methods: Posts and comments from the Facebook pages of the Ministry of Health (MOH) in Singapore, the Centers for Disease Control and Prevention (CDC) in the United States, and Public Health England (PHE) in England were extracted from January 1, 2019, to March 18, 2020. Posts published before January 1, 2020, were categorized as pre-COVID-19, while the remaining posts were categorized as peri-COVID-19 posts. COVID-19-related posts were identified and classified into themes. Metrics used for measuring outreach and engagement were frequency, mean posts per day (PPD), mean reactions per post, mean shares per post, and mean comments per post. Responses to the COVID-19 posts were measured using frequency, mean sentiment polarity, positive to negative sentiments ratio (PNSR), and positive to negative emotions ratio (PNER). Toxicity in comments were identified and analyzed using frequency, mean likes per toxic comment, and mean replies per toxic comment. Trend analysis was performed to examine how the metrics varied with key events such as when COVID-19 was declared a pandemic. Results: The MOH published more COVID-19 posts (n=271; mean PPD 5.0) compared to the CDC (n=94; mean PPD 2.2) and PHE (n=45; mean PPD 1.4). The mean number of comments per COVID-19 post was highest for the CDC (mean CPP 255.3) compared to the MOH (mean CPP 15.6) and PHE (mean CPP 12.5). Six major themes were identified, with posts about prevention and safety measures and situation updates being prevalent across the three PHAs. The themes of the MOH’s posts were diverse, while the CDC and PHE posts focused on a few themes. Overall, response sentiments for the MOH posts (PNSR 0.94) were more favorable compared to response sentiments for the CDC (PNSR 0.57) and PHE (PNSR 0.55) posts. Toxic comments were rare (0.01%) across all PHAs. Conclusions: PHAs’ extent of Facebook use for outreach purposes during the COVID-19 pandemic varied among the three PHAs, highlighting the strategies and approaches that other PHAs can potentially adopt. Our study showed that social media analysis was capable of providing insights about the communication strategies of PHAs during disease outbreaks. %M 32401219 %R 10.2196/19334 %U http://www.jmir.org/2020/5/e19334/ %U https://doi.org/10.2196/19334 %U http://www.ncbi.nlm.nih.gov/pubmed/32401219 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 5 %P e19556 %T The Impact of Social Media on Panic During the COVID-19 Pandemic in Iraqi Kurdistan: Online Questionnaire Study %A Ahmad,Araz Ramazan %A Murad,Hersh Rasool %+ Department of Administration, College of Humanities, University of Raparin, Main Road, Ranya - Al Sulaimaniyah, 46012, Iraq, 964 7701573122, araz.ahmad85@uor.edu.krd %K social media %K COVID-19 %K infodemic %K panic %K mental health %K fake news %K misinformation %K impact %K Kurdistan region %K Iraq %D 2020 %7 19.5.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: In the first few months of 2020, information and news reports about the coronavirus disease (COVID-19) were rapidly published and shared on social media and social networking sites. While the field of infodemiology has studied information patterns on the Web and in social media for at least 18 years, the COVID-19 pandemic has been referred to as the first social media infodemic. However, there is limited evidence about whether and how the social media infodemic has spread panic and affected the mental health of social media users. Objective: The aim of this study is to determine how social media affects self-reported mental health and the spread of panic about COVID-19 in the Kurdistan Region of Iraq. Methods: To carry out this study, an online questionnaire was prepared and conducted in Iraqi Kurdistan, and a total of 516 social media users were sampled. This study deployed a content analysis method for data analysis. Correspondingly, data were analyzed using SPSS software. Results: Participants reported that social media has a significant impact on spreading fear and panic related to the COVID-19 outbreak in Iraqi Kurdistan, with a potential negative influence on people’s mental health and psychological well-being. Facebook was the most used social media network for spreading panic about the COVID-19 outbreak in Iraq. We found a significant positive statistical correlation between self-reported social media use and the spread of panic related to COVID-19 (R=.8701). Our results showed that the majority of youths aged 18-35 years are facing psychological anxiety. Conclusions: During lockdown, people are using social media platforms to gain information about COVID-19. The nature of the impact of social media panic among people varies depending on an individual's gender, age, and level of education. Social media has played a key role in spreading anxiety about the COVID-19 outbreak in Iraqi Kurdistan. %M 32369026 %R 10.2196/19556 %U http://www.jmir.org/2020/5/e19556/ %U https://doi.org/10.2196/19556 %U http://www.ncbi.nlm.nih.gov/pubmed/32369026 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 5 %P e19087 %T Mining the Characteristics of COVID-19 Patients in China: Analysis of Social Media Posts %A Huang,Chunmei %A Xu,Xinjie %A Cai,Yuyang %A Ge,Qinmin %A Zeng,Guangwang %A Li,Xiaopan %A Zhang,Weide %A Ji,Chen %A Yang,Ling %+ Department of Geriatrics, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, 1665 Kongjiang Road, Shanghai, China, 86 13651608005, yangling01@xinhuamed.com.cn %K SARS-CoV-2 %K COVID-19 %K coronavirus disease %K social media %K Sina Weibo %K help %D 2020 %7 17.5.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: In December 2019, pneumonia cases of unknown origin were reported in Wuhan City, Hubei Province, China. Identified as the coronavirus disease (COVID-19), the number of cases grew rapidly by human-to-human transmission in Wuhan. Social media, especially Sina Weibo (a major Chinese microblogging social media site), has become an important platform for the public to obtain information and seek help. Objective: This study aims to analyze the characteristics of suspected or laboratory-confirmed COVID-19 patients who asked for help on Sina Weibo. Methods: We conducted data mining on Sina Weibo and extracted the data of 485 patients who presented with clinical symptoms and imaging descriptions of suspected or laboratory-confirmed cases of COVID-19. In total, 9878 posts seeking help on Sina Weibo from February 3 to 20, 2020 were analyzed. We used a descriptive research methodology to describe the distribution and other epidemiological characteristics of patients with suspected or laboratory-confirmed SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) infection. The distance between patients’ home and the nearest designated hospital was calculated using the geographic information system ArcGIS. Results: All patients included in this study who sought help on Sina Weibo lived in Wuhan, with a median age of 63.0 years (IQR 55.0-71.0). Fever (408/485, 84.12%) was the most common symptom. Ground-glass opacity (237/314, 75.48%) was the most common pattern on chest computed tomography; 39.67% (167/421) of families had suspected and/or laboratory-confirmed family members; 36.58% (154/421) of families had 1 or 2 suspected and/or laboratory-confirmed members; and 70.52% (232/329) of patients needed to rely on their relatives for help. The median time from illness onset to real-time reverse transcription-polymerase chain reaction (RT-PCR) testing was 8 days (IQR 5.0-10.0), and the median time from illness onset to online help was 10 days (IQR 6.0-12.0). Of 481 patients, 32.22% (n=155) lived more than 3 kilometers away from the nearest designated hospital. Conclusions: Our findings show that patients seeking help on Sina Weibo lived in Wuhan and most were elderly. Most patients had fever symptoms, and ground-glass opacities were noted in chest computed tomography. The onset of the disease was characterized by family clustering and most families lived far from the designated hospital. Therefore, we recommend the following: (1) the most stringent centralized medical observation measures should be taken to avoid transmission in family clusters; and (2) social media can help these patients get early attention during Wuhan’s lockdown. These findings can help the government and the health department identify high-risk patients and accelerate emergency responses following public demands for help. %M 32401210 %R 10.2196/19087 %U http://www.jmir.org/2020/5/e19087/ %U https://doi.org/10.2196/19087 %U http://www.ncbi.nlm.nih.gov/pubmed/32401210 %0 Journal Article %@ 2371-4379 %I JMIR Publications %V 5 %N 2 %P e19581 %T The Challenges of COVID-19 for People Living With Diabetes: Considerations for Digital Health %A Gamble,Anissa %A Pham,Quynh %A Goyal,Shivani %A Cafazzo,Joseph A %+ Centre for Global eHealth Innovation, Techna Institute, University Health Network, 190 Elizabeth Street, 4th Floor R Fraser Elliot Building, Toronto, ON, M5G2C4, Canada, 1 (416) 340 4800 ext 4765, anissa.gamble@uhn.ca %K diabetes %K digital health %K COVID-19 %K pandemic %D 2020 %7 15.5.2020 %9 Viewpoint %J JMIR Diabetes %G English %X The coronavirus disease (COVID-19) is a global pandemic that significantly impacts people living with diabetes. Diabetes-related factors of glycemic control, medication pharmacodynamics, and insulin access can impact the severity of a COVID-19 infection. In this commentary, we explore how digital health can support the diabetes community through the pandemic. For those living with diabetes, digital health presents the opportunity to access care with greater convenience while not having to expose themselves to infection in an in-person clinic. Digital diabetes apps can increase agency in self-care and produce clinically significant improvement in glycemic control through facilitating the capture of diabetes device data. However, the ability to share these data back to the clinic to inform virtual care and enhance diabetes coaching and guidance remains a challenge. In the end, it requires an unnecessarily high level of technical sophistication on the clinic’s part and on those living with diabetes to routinely use their diabetes device data in clinic visits, virtual or otherwise. As the world comes together to fight the COVID-19 pandemic, close collaboration among the global diabetes community is critical to understand and manage the sustained impact of the pandemic on people living with diabetes. %M 32392473 %R 10.2196/19581 %U http://diabetes.jmir.org/2020/2/e19581/ %U https://doi.org/10.2196/19581 %U http://www.ncbi.nlm.nih.gov/pubmed/32392473 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e18995 %T Emergency Response to COVID-19 in Canada: Platform Development and Implementation for eHealth in Crisis Management %A Krausz,Michael %A Westenberg,Jean Nicolas %A Vigo,Daniel %A Spence,Richard Trafford %A Ramsey,Damon %+ Department of Psychiatry, University of British Columbia, 5950 University Boulevard, Room 430, Vancouver, BC, V6T 1Z3, Canada, 1 604 827 4381, jean.westenberg@alumni.ubc.ca %K eHealth %K digital health %K web-based intervention %K crisis management %K COVID-19 %K public health %K health care system %D 2020 %7 15.5.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Public health emergencies like epidemics put enormous pressure on health care systems while revealing deep structural and functional problems in the organization of care. The current coronavirus disease (COVID-19) pandemic illustrates this at a global level. The sudden increased demand on delivery systems puts unique pressures on pre-established care pathways. These extraordinary times require efficient tools for smart governance and resource allocation. Objective: The aim of this study is to develop an innovative web-based solution addressing the seemingly insurmountable challenges of triaging, monitoring, and delivering nonhospital services unleashed by the COVID-19 pandemic. Methods: An adaptable crisis management digital platform was envisioned and designed with the goal of improving the system’s response on the basis of the literature; an existing shared health record platform; and discussions between health care providers, decision makers, academia, and the private sector in response to the COVID 19 epidemic. Results: The Crisis Management Platform was developed and offered to health authorities in Ontario on a nonprofit basis. It has the capability to dramatically streamline patient intake, triage, monitoring, referral, and delivery of nonhospital services. It decentralizes the provision of services (by moving them online) and centralizes data gathering and analysis, maximizing the use of existing human resources, facilitating evidence-based decision making, and minimizing the risk to both users and providers. It has unlimited scale-up possibilities (only constrained by human health risk resource availability) with minimal marginal cost. Similar web-based solutions have the potential to fill an urgent gap in resource allocation, becoming a unique asset for health systems governance and management during critical times. They highlight the potential effectiveness of web-based solutions if built on an outcome-driven architecture. Conclusions: Data and web-based approaches in response to a public health crisis are key to evidence-driven oversight and management of public health emergencies. %M 32401218 %R 10.2196/18995 %U http://publichealth.jmir.org/2020/2/e18995/ %U https://doi.org/10.2196/18995 %U http://www.ncbi.nlm.nih.gov/pubmed/32401218 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 5 %P e19370 %T Analysis of Public Perception of the Israeli Government’s Early Emergency Instructions Regarding COVID-19: Online Survey Study %A Gesser-Edelsburg,Anat %A Cohen,Ricky %A Hijazi,Rana %A Abed Elhadi Shahbari,Nour %+ School of Public Health, University of Haifa, 199 Aba Khoushy Ave Mount Carmel, Haifa, 3498838, Israel, 972 544243530, ageser@univ.haifa.ac.il %K covid-19 %K risk %K perception %K crisis management %K economical threat %K compliance to guidelines %K spokesperson credibility %K source of information credibility %K online survey %K public health %K pandemic %D 2020 %7 15.5.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: On March 11, 2020, the World Health Organization (WHO) officially declared coronavirus disease (COVID-19) to be a pandemic. This posed challenges to many countries, prominent among which is communication with the public to gain their cooperation. Israel faces different challenges from other countries in its management of the COVID-19 crisis because it is in the midst of a deep constitutional crisis. Objective: The objective of this paper was to examine the response of the Israeli public to the government’s emergency instructions regarding the pandemic in terms of correlations between overall risk perception and crisis management; overall risk perception and economic threat perception; crisis management and compliance with behavioral guidelines; and crisis management and economic threat perception. We also made comparisons between crisis management and spokesperson credibility and between crisis management and the credibility of information sources. Methods: The sample was established using an online survey that enabled rapid and effective distribution of an online questionnaire during the COVID-19 crisis. The self-selection online survey method of nonprobability sampling was used to recruit participants (N=1056) through social network posts asking the general public (aged ≥18 years) to answer the survey. Results: Participants aged ≥65 years perceived higher personal risk compared to those aged 18-30 years (mean difference 0.33, 95% CI 0.04-0.61) and those aged 46-64 years (mean difference 0.38, 95% CI 0.12-0.64). Significant correlations were found between overall risk perception and attitudes toward crisis management (r=0.19, P<.001), overall risk perception and economic threat perception (r=0.22, P<.001), attitudes toward crisis management and compliance with behavioral guidelines (r=0.15, P<.001), and attitudes toward crisis management and economic threat perception (r=–0.15, P<.001). Participants who perceived that the prime minister was the most credible spokesperson evaluated the crisis management significantly higher than all other groups. The crisis management was evaluated significantly lower by participants who stated that infectious disease specialists were the most credible spokespersons. Participants for whom the Ministry of Health website was the most credible source of information evaluated the crisis management higher than all other groups. Participants for whom scientific articles were the most credible source of information evaluated the crisis management lower than those who perceived that the WHO/Centers for Disease Control and Prevention websites or Ministry of Health/hospital websites and health care workers were the most credible. Conclusions: The higher the public trust and evaluation of crisis management, the greater the compliance of the public with guidelines. It was also found that crisis management and information cannot be approached in the same way for the overall public. Furthermore, unlike other epidemics, the COVID-19 crisis has widespread economic and social consequences; therefore, it is impossible to focus only on health risks without communicating economic and social risks as well. %M 32392172 %R 10.2196/19370 %U http://www.jmir.org/2020/5/e19370/ %U https://doi.org/10.2196/19370 %U http://www.ncbi.nlm.nih.gov/pubmed/32392172 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e19097 %T Estimation of the Probability of Reinfection With COVID-19 by the Susceptible-Exposed-Infectious-Removed-Undetectable-Susceptible Model %A Victor Okhuese,Alexander %+ Department of Mathematics, Nasarawa State University Keffi, Nasarawa State, Lafiya, Keffi, 234, Nigeria, 234 8060273138, alexandervictor16@yahoo.com %K infectious %K disease %K reinfection %K model %K math %K COVID-19 %K coronavirus %K pandemic %K outbreak %K SEIRUS %D 2020 %7 13.5.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: With the sensitivity of the polymerase chain reaction test used to detect the presence of the virus in the human host, the worldwide health community has been able to record a large number of the recovered population. Objective: The aim of this study was to evaluate the probability of reinfection in the recovered class and the model equations, which exhibits the disease-free equilibrium state for the coronavirus disease. Methods: The model differential equation was evaluated for the disease-free equilibrium for the case of reinfection as well as the existence and stability criteria for the disease, using the model proportions. This evaluation shows that the criteria for a local or worldwide asymptotic stability with a basic reproductive number (R0=0) were satisfied. Hence, there is a chance of no secondary reinfections from the recovered population, as the rate of incidence of the recovered population vanishes (ie, B=0). Results: With a total of about 900,000 infected cases worldwide, numerical simulations for this study were carried out to complement the analytical results and investigate the effect that the implementation of quarantine and observation procedures has on the projection of further virus spread. Conclusions: As shown by the results, the proportion of the infected population, in the absence of a curative vaccination, will continue to grow worldwide; meanwhile, the recovery rate will continue slowly, which means that the ratio of infection rate to recovery rate will determine the death rate that is recorded. Most significant for this study is the rate of reinfection by the recovered population, which will decline to zero over time as the virus is cleared clinically from the system of the recovered class. %M 32369029 %R 10.2196/19097 %U http://publichealth.jmir.org/2020/2/e19097/ %U https://doi.org/10.2196/19097 %U http://www.ncbi.nlm.nih.gov/pubmed/32369029 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e19199 %T Delivering Benefits at Speed Through Real-World Repurposing of Off-Patent Drugs: The COVID-19 Pandemic as a Case in Point %A Rogosnitzky,Moshe %A Berkowitz,Esther %A Jadad,Alejandro R %+ MedInsight Research Institute, Pekeris 4,, Weizmann Science Park,, Rehovot, 7670204, Israel, 972 86220942, moshe@medinsight.org %K COVID-19 %K drug costs %K drug repositioning %K drugs, generic %K off-label use %K public health %K severe acute respiratory syndrome coronavirus 2 %K pandemic %K crisis %D 2020 %7 13.5.2020 %9 Viewpoint %J JMIR Public Health Surveill %G English %X Real-world drug repurposing—the immediate “off-label” prescribing of drugs to address urgent clinical needs—is a widely overlooked opportunity. Off-label prescribing (ie, for a nonapproved indication) is legal in most countries and tends to shift the burden of liability and cost to physicians and patients, respectively. Nevertheless, health crises may mean that real-world repurposing is the only realistic source for solutions. Optimal real-world repurposing requires a track record of safety, affordability, and access for drug candidates. Although thousands of such drugs are already available, there is no central repository of off-label uses to facilitate immediate identification and selection of potentially useful interventions during public health crises. Using the current coronavirus disease (COVID-19) pandemic as an example, we provide a glimpse of the extensive literature that supports the rationale behind six generic drugs, in four classes, all of which are affordable, supported by decades of safety data, and targeted toward the underlying pathophysiology that makes COVID-19 so deadly. This paper briefly summarizes why cimetidine or famotidine, dipyridamole, fenofibrate or bezafibrate, and sildenafil citrate are worth considering for patients with COVID-19. Clinical trials to assess efficacy are already underway for famotidine, dipyridamole, and sildenafil, and further trials of all these agents will be important in due course. These examples also reveal the unlimited opportunity to future-proof our health care systems by proactively mining, synthesizing, cataloging, and evaluating the off-label treatment opportunities of thousands of safe, well-established, and affordable generic drugs. %M 32374264 %R 10.2196/19199 %U http://publichealth.jmir.org/2020/2/e19199/ %U https://doi.org/10.2196/19199 %U http://www.ncbi.nlm.nih.gov/pubmed/32374264 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 5 %P e18718 %T Measures Undertaken in China to Avoid COVID-19 Infection: Internet-Based, Cross-Sectional Survey Study %A Huang,Yu %A Wu,Qingqing %A Wang,Ping %A Xu,Yan %A Wang,Lei %A Zhao,Yusui %A Yao,Dingming %A Xu,Yue %A Lv,Qiaohong %A Xu,Shuiyang %+ Zhejiang Provincial Center for Disease Control and Prevention, 3399 Binsheng Road, Binjiang District, Hangzhou, 310051, China, 86 87115118, 417286592@qq.com %K COVID-19 %K coronavirus disease %K response %K strategy %K preventive measures %K internet-based research %K health QR code %K outbreak %K infectious disease %K health education %D 2020 %7 12.5.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: In early 2020, over 80,000 cases of coronavirus disease (COVID-19) were confirmed in China. Public prevention and control measures, along with efforts from all sectors of society, were undertaken to control and eliminate disease transmission. Objective: This paper describes Chinese citizens’ response to the epidemic, the preventive measures they implemented to avoid being infected, and the public strategies that were carried out by the government, health workers, etc. We also discuss the efficacy of these measures in controlling the epidemic in China. Methods: Information on the responses and behaviors of Chinese citizens were collected through a cross-sectional, internet-based survey using Dingxiang Doctor’s public account on WeChat. Information on public strategies implemented by all sectors of society to control the epidemic and data on new COVID-19 cases were collected from the internet, mainly from government websites. Standard descriptive statistics and multivariate logistic regression analyses were conducted to analyze the data. Results: A total of 10,304 participants responded to the survey, with 10,198 valid responses; 74.1% (n=7557) were female and 25.9% (n=2641) were male. Overall, 98.2% (n=10,013) of participants paid high or very high attention to the epidemic, with WeChat being their main information source (n=9400, 92.2%). Over half the participants (n=5878, 57.7%) were confident that the epidemic could be curbed in China; 92.4% (n=9427) opened windows for ventilation more frequently than usual; 97.9% (n=9986) used masks in public; 95.7% (n=9759) avoided large crowds and stayed at home as much as possible; and 97.9% (n=9988) washed their hands more often than usual. Women were more likely to practice these behaviors than men (P<.001). With a series of strict public control measures, like nationwide health education campaigns, holiday extensions, the Examine and Approve Policy on the resumption of work, close management of working and living quarters, a health QR (Quick Response) code system, community screening, and social distancing policies, the number of new cases have decreased dramatically since February 12, 2020. Conclusions: The methods employed by Chinese citizens and authorities have effectively curtailed the spread of COVID-19, demonstrating that this pandemic can be brought under control as long as the right measures are taken. %M 32396516 %R 10.2196/18718 %U http://www.jmir.org/2020/5/e18718/ %U https://doi.org/10.2196/18718 %U http://www.ncbi.nlm.nih.gov/pubmed/32396516 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 7 %N 5 %P e19009 %T Mental Health, Risk Factors, and Social Media Use During the COVID-19 Epidemic and Cordon Sanitaire Among the Community and Health Professionals in Wuhan, China: Cross-Sectional Survey %A Ni,Michael Y %A Yang,Lin %A Leung,Candi M C %A Li,Na %A Yao,Xiaoxin I %A Wang,Yishan %A Leung,Gabriel M %A Cowling,Benjamin J %A Liao,Qiuyan %+ School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, 7 Sassoon Road, Pokfulam, Hong Kong, China (Hong Kong), 852 39179280, nimy@hku.hk %K COVID-19 %K nonpharmaceutical interventions %K population mental health %K depression %K anxiety %K community %K health professionals %K social media %K WeChat %K pandemic %K outbreak %K public health %K mental health %K intervention %D 2020 %7 12.5.2020 %9 Original Paper %J JMIR Ment Health %G English %X Background: The mental health consequences of the coronavirus disease (COVID-19) pandemic, community-wide interventions, and social media use during a pandemic are unclear. The first and most draconian interventions have been implemented in Wuhan, China, and these countermeasures have been increasingly deployed by countries around the world. Objective: The aim of this study was to examine risk factors, including the use of social media, for probable anxiety and depression in the community and among health professionals in the epicenter, Wuhan, China. Methods: We conducted an online survey via WeChat, the most widely used social media platform in China, which was administered to 1577 community-based adults and 214 health professionals in Wuhan. Probable anxiety and probable depression were assessed by the validated Generalized Anxiety Disorder-2 (cutoff ≥3) and Patient Health Questionnaire-2 (cutoff ≥3), respectively. A multivariable logistic regression analysis was used to examine factors associated with probable anxiety and probable depression. Results: Of the 1577 community-based adults, about one-fifth of respondents reported probable anxiety (n=376, 23.84%, 95% CI 21.8-26.0) and probable depression (n=303, 19.21%, 95% CI 17.3-21.2). Similarly, of the 214 health professionals, about one-fifth of surveyed health professionals reported probable anxiety (n=47, 22.0%, 95% CI 16.6-28.1) or probable depression (n=41, 19.2%, 95% CI 14.1-25.1). Around one-third of community-based adults and health professionals spent ≥2 hours daily on COVID-19 news via social media. Close contact with individuals with COVID-19 and spending ≥2 hours daily on COVID-19 news via social media were associated with probable anxiety and depression in community-based adults. Social support was associated with less probable anxiety and depression in both health professionals and community-based adults. Conclusions: The internet could be harnessed for telemedicine and restoring daily routines, yet caution is warranted toward spending excessive time searching for COVID-19 news on social media given the infodemic and emotional contagion through online social networks. Online platforms may be used to monitor the toll of the pandemic on mental health. %M 32365044 %R 10.2196/19009 %U https://mental.jmir.org/2020/5/e19009 %U https://doi.org/10.2196/19009 %U http://www.ncbi.nlm.nih.gov/pubmed/32365044 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e18821 %T Preparation for Quarantine on the Cruise Ship Diamond Princess in Japan due to COVID-19 %A Yamahata,Yoshihiro %A Shibata,Ayako %+ Obstetrics & Gynecology, Yodogawa Christian Hospital, 1-7-50, Kunijima, Higashiyodogawa-ku, Osaka, 533-0024, Japan, 81 6 6322 2250, sibata700@gmail.com %K SARS-CoV-2 %K COVID-19 %K infectious control %K cruise ship quarantine %K pandemic %K outbreak %K surveillance %K preparation %K infectious disease %K public health %K quarantine %D 2020 %7 11.5.2020 %9 Viewpoint %J JMIR Public Health Surveill %G English %X Background: Japan implemented a large-scale quarantine on the Diamond Princess cruise ship in an attempt to control the spread of the novel coronavirus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in February 2020. Objective: We aim to describe the medical activities initiated and difficulties in implementing quarantine on a cruise ship. Methods: Reverse transcription–polymerase chain reaction (RT-PCR) tests for SARS-CoV-2 were performed for all 3711 people (2666 passengers and 1045 crew) on board. Results: Of those tested, 696 (18.8%) tested positive for coronavirus disease (COVID-19), of which 410 (58.9%) were asymptomatic. We also confirmed that 54% of the asymptomatic patients with a positive RT-PCR result had lung opacities on chest computed tomography. There were many difficulties in implementing quarantine, such as creating a dividing traffic line between infectious and noninfectious passengers, finding hospitals and transportation providers willing to accept these patients, transporting individuals, language barriers, and supporting daily life. As of March 8, 2020, 31 patients (4.5% of patients with positive RT-PCR results) were hospitalized and required ventilator support or intensive care, and 7 patients (1.0% of patients with positive RT-PCR results) had died. Conclusions: There were several difficulties in implementing large-scale quarantine and obtaining medical support on the cruise ship. In the future, we need to prepare for patients’ transfer and the admitting hospitals when disembarking the passengers. We recommend treating the crew the same way as the passengers to control the infection. We must also draw a plan for the future, to protect travelers and passengers from emerging infectious diseases on cruise ships. %M 32365046 %R 10.2196/18821 %U http://publichealth.jmir.org/2020/2/e18821/ %U https://doi.org/10.2196/18821 %U http://www.ncbi.nlm.nih.gov/pubmed/32365046 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e19161 %T Knowledge and Behaviors Toward COVID-19 Among US Residents During the Early Days of the Pandemic: Cross-Sectional Online Questionnaire %A Clements,John M %+ Master of Public Health Program, Division of Public Health, College of Human Medicine, Michigan State University, 130 E 2nd Street, Suite 202, Flint, MI, 48502, United States, 1 989 708 6338, clemen69@msu.edu %K public health %K surveillance %K COVID-19 %K knowledge %K behavior %K outbreak %K infectious disease %K health information %D 2020 %7 8.5.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The early days of the coronavirus disease (COVID-19) pandemic in the United States brought uncertainty in the knowledge about COVID-19 and what to do about it. It is necessary to understand public knowledge and behaviors if we are to effectively address the pandemic. Objective: The aim of this study is to test the hypothesis that knowledge about COVID-19 influences participation in different behaviors including self-reports of purchasing more goods than usual, attending large gatherings, and using medical masks. Methods: This study was funded and approved by the Institutional Review Board on March 17, 2020. The cross-sectional online survey of 1034 US residents aged 18 years or older was conducted on March 17, 2020. Results: For every point increase in knowledge, the odds of participation in purchasing more goods (odds ratio [OR] 0.88, 95% CI 0.81-0.95), attending large gatherings (OR 0.87, 95% CI 0.81-0.93), and using medical masks (OR 0.56, 95% CI 0.50-0.62) decreased by 12%, 13%, and 44%, respectively. Gen X and millennial participants had 56% and 76% higher odds, respectively, of increased purchasing behavior compared to baby boomers. The results suggest that there is a politicization of response recommendations. Democrats had 30% lower odds of attending large gatherings (OR 0.70, 95% CI 0.50-0.97) and 48% lower odds of using medical masks (OR 0.52, 95% CI 0.34-0.78) compared to Republicans. Conclusions: This survey is one of the first attempts to study determinants of knowledge and behaviors in response to the COVID-19 pandemic in the United States. A national, coordinated effort toward a pandemic response may ensure better compliance with behavioral recommendations to address this public health emergency. %M 32369759 %R 10.2196/19161 %U http://publichealth.jmir.org/2020/2/e19161/ %U https://doi.org/10.2196/19161 %U http://www.ncbi.nlm.nih.gov/pubmed/32369759 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e19462 %T Considerations for Postacute Rehabilitation for Survivors of COVID-19 %A Sheehy,Lisa Mary %+ Bruyère Research Institute, 43 Bruyère St, Ottawa, ON, K1N5C8, Canada, 1 6135626262 ext 1593, lsheehy@bruyere.org %K covid-19 %K rehabilitation %K subacute care %K inpatient rehabilitation %K public health %K infectious disease %K virus %K patient outcome %K geriatric %K treatment %K recovery %D 2020 %7 8.5.2020 %9 Viewpoint %J JMIR Public Health Surveill %G English %X Coronavirus disease (COVID-19), the infection caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was first reported on December 31, 2019. Because it has only been studied for just over three months, our understanding of this disease is still incomplete, particularly regarding its sequelae and long-term outcomes. Moreover, very little has been written about the rehabilitation needs of patients with COVID-19 after discharge from acute care. The objective of this report is to answer the question “What rehabilitation services do survivors of COVID-19 require?” The question was asked within the context of a subacute hospital delivering geriatric inpatient and outpatient rehabilitation services. Three areas relevant to rehabilitation after COVID-19 were identified. First, details of how patients may present have been summarized, including comorbidities, complications from an intensive care unit stay with or without intubation, and the effects of the virus on multiple body systems, including those pertaining to cardiac, neurological, cognitive, and mental health. Second, I have suggested procedures regarding the design of inpatient rehabilitation units for COVID-19 survivors, staffing issues, and considerations for outpatient rehabilitation. Third, guidelines for rehabilitation (physiotherapy, occupational therapy, speech-language pathology) following COVID-19 have been proposed with respect to recovery of the respiratory system as well as recovery of mobility and function. A thorough assessment and an individualized, progressive treatment plan which focuses on function, disability, and return to participation in society will help each patient to maximize their function and quality of life. Careful consideration of the rehabilitation environment will ensure that all patients recover as completely as possible. %M 32369030 %R 10.2196/19462 %U http://publichealth.jmir.org/2020/2/e19462/ %U https://doi.org/10.2196/19462 %U http://www.ncbi.nlm.nih.gov/pubmed/32369030 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 5 %P e19577 %T Telemedicine During the COVID-19 Pandemic: Experiences From Western China %A Hong,Zhen %A Li,Nian %A Li,Dajiang %A Li,Junhua %A Li,Bing %A Xiong,Weixi %A Lu,Lu %A Li,Weimin %A Zhou,Dong %+ Department of Neurology, West China Hospital, Sichuan University, No. 37 Guoxue Road, Chengdu, 610041, China, 86 28 8542 2893, zhoudong66@yahoo.de %K COVID-19 %K coronavirus disease %K medical education %K pandemics %K teleteaching %K tele-education %K telemedicine %D 2020 %7 8.5.2020 %9 Viewpoint %J J Med Internet Res %G English %X Disasters and pandemics pose unique challenges to health care delivery. As health care resources continue to be stretched due to the increasing burden of the coronavirus disease (COVID-19) pandemic, telemedicine, including tele-education, may be an effective way to rationally allocate medical resources. During the COVID-19 pandemic, a multimodal telemedicine network in Sichuan Province in Western China was activated immediately after the first outbreak in January 2020. The network synergizes a newly established 5G service, a smartphone app, and an existing telemedicine system. Telemedicine was demonstrated to be feasible, acceptable, and effective in Western China, and allowed for significant improvements in health care outcomes. The success of telemedicine here may be a useful reference for other parts of the world. %M 32349962 %R 10.2196/19577 %U http://www.jmir.org/2020/5/e19577/ %U https://doi.org/10.2196/19577 %U http://www.ncbi.nlm.nih.gov/pubmed/32349962 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e19368 %T Mathematical Modelling to Assess the Impact of Lockdown on COVID-19 Transmission in India: Model Development and Validation %A Ambikapathy,Bakiya %A Krishnamurthy,Kamalanand %+ Department of Instrumentation Engineering, Madras Institute of Technology Campus, Anna University, Chromepet, Chennai, Tamil Nadu, 600044, India, 91 9884948410, bakiya88@gmail.com %K covid-19 %K coronavirus %K epidemic %K mathematical modelling %K pandemic %K sars %D 2020 %7 7.5.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The World Health Organization has declared the novel coronavirus disease (COVID-19) to be a public health emergency; at present, India is facing a major threat of community spread. We developed a mathematical model for investigating and predicting the effects of lockdown on future COVID-19 cases with a specific focus on India. Objective: The objective of this work was to develop and validate a mathematical model and to assess the impact of various lockdown scenarios on COVID-19 transmission in India. Methods: A model consisting of a framework of ordinary differential equations was developed by incorporating the actual reported cases in 14 countries. After validation, the model was applied to predict COVID-19 transmission in India for different intervention scenarios in terms of lockdown for 4, 14, 21, 42, and 60 days. We also assessed the situations of enhanced exposure due to aggregation of individuals in transit stations and shopping malls before the lockdown. Results: The developed model is efficient in predicting the number of COVID-19 cases compared to the actual reported cases in 14 countries. For India, the model predicted marked reductions in cases for the intervention periods of 14 and 21 days of lockdown and significant reduction for 42 days of lockdown. Such intervention exceeding 42 days does not result in measurable improvement. Finally, for the scenario of “panic shopping” or situations where there is a sudden increase in the factors leading to higher exposure to infection, the model predicted an exponential transmission, resulting in failure of the considered intervention strategy. Conclusions: Implementation of a strict lockdown for a period of at least 21 days is expected to reduce the transmission of COVID-19. However, a further extension of up to 42 days is required to significantly reduce the transmission of COVID-19 in India. Any relaxation in the lockdown may lead to exponential transmission, resulting in a heavy burden on the health care system in the country. %M 32365045 %R 10.2196/19368 %U http://publichealth.jmir.org/2020/2/e19368/ %U https://doi.org/10.2196/19368 %U http://www.ncbi.nlm.nih.gov/pubmed/32365045 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 3 %N 1 %P e19007 %T Impact of Home Quarantine on Physical Activity Among Older Adults Living at Home During the COVID-19 Pandemic: Qualitative Interview Study %A Goethals,Luc %A Barth,Nathalie %A Guyot,Jessica %A Hupin,David %A Celarier,Thomas %A Bongue,Bienvenu %+ Autonomic Nervous System Research Laboratory, University of Jean Monnet, 10 Rue Tréfilerie, Saint-Etienne, France, 33 0699222119, luc.goethals@univ-st-etienne.fr %K older adults %K physical activity %K COVID-19 %K social marketing %D 2020 %7 7.5.2020 %9 Short Paper %J JMIR Aging %G English %X Background: Older adults and those with pre-existing medical conditions are at risk of death from severe acute respiratory syndrome coronavirus 2 (SARS CoV-2). In this period of quarantine, one of the reasons for going out is physical activity. This issue is important, as the impact of a sedentary lifestyle might be lower for children and young adults, but is far more severe for older adults. Although older adults need to stay at home because they have a higher risk of coronavirus disease (COVID-19), they need to avoid a sedentary lifestyle. Physical activity is important for older adults, especially to maintain their level of independence, mental health, and well-being. Maintaining mobility in old age is necessary, as it may predict loss of independence in older adults. Objective: Our first objective was to evaluate the impact of this quarantine period on physical activity programs and on the physical and mental health of older adults. Our second objective was to discuss alternatives to physical activity programs that could be suggested for this population to avoid a sedentary lifestyle. Methods: We conducted a qualitative survey using semistructured interviews with professionals (managers in charge of physical activity programs for older adults and sports trainers who run these physical activity programs) from the French Federation of Physical Education and Voluntary Gymnastics (FFPEVG) and older adults participating in a physical activity program of the FFPEVG. We followed a common interview guide. For analysis, we carried out a thematic analysis of the interviews. Results: This study suggests that the COVID-19 epidemic has affected, before quarantine measures, the number of seniors attending group physical activity programs in the two study territories. In addition, despite the decline in their participation in group physical activities before the quarantine, older adults expressed the need to perform physical activity at home. There is a need to help older adults integrate simple and safe ways to stay physically active in a limited space. A national policy to support older adults for physical activity at home appears essential in this context. Conclusions: Given the results of our study, it seems necessary to globally communicate how important it is for older adults to maintain physical activity at home. We are concerned about the level of independence and mental health state of older adults after the end of quarantine if there is no appropriate campaign to promote physical activity among them at home. %M 32356777 %R 10.2196/19007 %U http://aging.jmir.org/2020/1/e19007/ %U https://doi.org/10.2196/19007 %U http://www.ncbi.nlm.nih.gov/pubmed/32356777 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 5 %P e19458 %T COVID-19 and the 5G Conspiracy Theory: Social Network Analysis of Twitter Data %A Ahmed,Wasim %A Vidal-Alaball,Josep %A Downing,Joseph %A López Seguí,Francesc %+ Newcastle University, 5 Barrack Rd, Newcastle upon Tyne, NE1 4SE, United Kingdom, 44 (0) 191 208 150, Wasim.Ahmed@Newcastle.ac.uk %K COVID-19 %K coronavirus %K twitter %K misinformation %K fake news %K 5G %K social network analysis %K social media %K public health %K pandemic %D 2020 %7 6.5.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Since the beginning of December 2019, the coronavirus disease (COVID-19) has spread rapidly around the world, which has led to increased discussions across online platforms. These conversations have also included various conspiracies shared by social media users. Amongst them, a popular theory has linked 5G to the spread of COVID-19, leading to misinformation and the burning of 5G towers in the United Kingdom. The understanding of the drivers of fake news and quick policies oriented to isolate and rebate misinformation are keys to combating it. Objective: The aim of this study is to develop an understanding of the drivers of the 5G COVID-19 conspiracy theory and strategies to deal with such misinformation. Methods: This paper performs a social network analysis and content analysis of Twitter data from a 7-day period (Friday, March 27, 2020, to Saturday, April 4, 2020) in which the #5GCoronavirus hashtag was trending on Twitter in the United Kingdom. Influential users were analyzed through social network graph clusters. The size of the nodes were ranked by their betweenness centrality score, and the graph’s vertices were grouped by cluster using the Clauset-Newman-Moore algorithm. The topics and web sources used were also examined. Results: Social network analysis identified that the two largest network structures consisted of an isolates group and a broadcast group. The analysis also revealed that there was a lack of an authority figure who was actively combating such misinformation. Content analysis revealed that, of 233 sample tweets, 34.8% (n=81) contained views that 5G and COVID-19 were linked, 32.2% (n=75) denounced the conspiracy theory, and 33.0% (n=77) were general tweets not expressing any personal views or opinions. Thus, 65.2% (n=152) of tweets derived from nonconspiracy theory supporters, which suggests that, although the topic attracted high volume, only a handful of users genuinely believed the conspiracy. This paper also shows that fake news websites were the most popular web source shared by users; although, YouTube videos were also shared. The study also identified an account whose sole aim was to spread the conspiracy theory on Twitter. Conclusions: The combination of quick and targeted interventions oriented to delegitimize the sources of fake information is key to reducing their impact. Those users voicing their views against the conspiracy theory, link baiting, or sharing humorous tweets inadvertently raised the profile of the topic, suggesting that policymakers should insist in the efforts of isolating opinions that are based on fake news. Many social media platforms provide users with the ability to report inappropriate content, which should be used. This study is the first to analyze the 5G conspiracy theory in the context of COVID-19 on Twitter offering practical guidance to health authorities in how, in the context of a pandemic, rumors may be combated in the future. %M 32352383 %R 10.2196/19458 %U http://www.jmir.org/2020/5/e19458/ %U https://doi.org/10.2196/19458 %U http://www.ncbi.nlm.nih.gov/pubmed/32352383 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e19297 %T Agile Requirements Engineering and Software Planning for a Digital Health Platform to Engage the Effects of Isolation Caused by Social Distancing: Case Study %A Meinert,Edward %A Milne-Ives,Madison %A Surodina,Svitlana %A Lam,Ching %+ Digitally Enabled PrevenTative Health Research Group, Department of Paediatrics, University of Oxford, Level 2, Children's Hospital, John Radcliffe Hospital, Oxford, OX3 9DU, United Kingdom, 44 7824446808, e.meinert14@imperial.ac.uk %K telemedicine %K information science %K data science %K COVID-19 %K coronavirus %K public reporting of healthcare data %K health care quality, access and evaluation %K aged %K mental health %K exercise %K cellphone %K artificial intelligence %K agile %K requirements engineering %K social distancing %K digital health %K app %D 2020 %7 6.5.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Social distancing and shielding measures have been put in place to reduce social interaction and slow the transmission of the coronavirus disease (COVID-19). For older people, self-isolation presents particular challenges for mental health and social relationships. As time progresses, continued social distancing could have a compounding impact on these concerns. Objective: This project aims to provide a tool for older people and their families and peers to improve their well-being and health during and after regulated social distancing. First, we will evaluate the tool’s feasibility, acceptability, and usability to encourage positive nutrition, enhance physical activity, and enable virtual interaction while social distancing. Second, we will be implementing the app to provide an online community to assist families and peer groups in maintaining contact with older people using goal setting. Anonymized data from the app will be aggregated with other real-world data sources to develop a machine learning algorithm to improve the identification of patients with COVID-19 and track for real time use by health systems. Methods: Development of this project is occurring at the time of publication, and therefore, a case study design was selected to provide a systematic means of capturing software engineering in progress. The app development framework for software design was based on agile methods. The evaluation of the app’s feasibility, acceptability and usability shall be conducted using Public Health England's guidance on evaluating digital health products, Bandura’s model of health promotion, the Reach Effectiveness Adoption Implementation Maintenance (RE-AIM) framework and the Nonadoption, Abandonment and Challenges to the Scale-up, Spread and Suitability (NASSS) framework. Results: Making use of a pre-existing software framework for health behavior change, a proof of concept was developed, and a multistage app development and deployment for the solution was created. Grant submissions to fund the project and study execution have been sought at the time of publication, and prediscovery iteration of the solution has begun. Ethical approval for a feasibility study design is being sought. Conclusions: This case study lays the foundations for future app development to combat mental and societal issues arising from social distancing measures. The app will be tested and evaluated in future studies to allow continuous improvement of the app. This novel contribution will provide an evidence-based exemplar for future app development in the space of social isolation and loneliness. %M 32348293 %R 10.2196/19297 %U http://publichealth.jmir.org/2020/2/e19297/ %U https://doi.org/10.2196/19297 %U http://www.ncbi.nlm.nih.gov/pubmed/32348293 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 5 %P e19128 %T Impact of Online Information on Self-Isolation Intention During the COVID-19 Pandemic: Cross-Sectional Study %A Farooq,Ali %A Laato,Samuli %A Islam,A K M Najmul %+ Department of Future Technologies, University of Turku, Vesilinnantie 3, Turku, 20500, Finland, 358 402180131, alifar@utu.fi %K COVID-19 %K pandemic %K self-isolation %K behavior %K protection motivation theory %K cyberchondria %K information overload %D 2020 %7 6.5.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: During the coronavirus disease (COVID-19) pandemic, governments issued movement restrictions and placed areas into quarantine to combat the spread of the disease. In addition, individuals were encouraged to adopt personal health measures such as social isolation. Information regarding the disease and recommended avoidance measures were distributed through a variety of channels including social media, news websites, and emails. Previous research suggests that the vast amount of available information can be confusing, potentially resulting in overconcern and information overload. Objective: This study investigates the impact of online information on the individual-level intention to voluntarily self-isolate during the pandemic. Using the protection-motivation theory as a framework, we propose a model outlining the effects of cyberchondria and information overload on individuals’ perceptions and motivations. Methods: To test the proposed model, we collected data with an online survey (N=225) and analyzed it using partial least square-structural equation modeling. The effects of social media and living situation were tested through multigroup analysis. Results: Cyberchondria and information overload had a significant impact on individuals’ threat and coping perceptions, and through them on self-isolation intention. Among the appraisal constructs, perceived severity (P=.002) and self-efficacy (P=.003) positively impacted self-isolation intention, while response cost (P<.001) affected the intention negatively. Cyberchondria (P=.003) and information overload (P=.003) indirectly affected self-isolation intention through the aforementioned perceptions. Using social media as an information source increased both cyberchondria and information overload. No differences in perceptions were found between people living alone and those living with their families. Conclusions: During COVID-19, frequent use of social media contributed to information overload and overconcern among individuals. To boost individuals’ motivation to adopt preventive measures such as self-isolation, actions should focus on lowering individuals’ perceived response costs in addition to informing them about the severity of the situation. %M 32330115 %R 10.2196/19128 %U http://www.jmir.org/2020/5/e19128/ %U https://doi.org/10.2196/19128 %U http://www.ncbi.nlm.nih.gov/pubmed/32330115 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 5 %P e19301 %T Creating COVID-19 Stigma by Referencing the Novel Coronavirus as the “Chinese virus” on Twitter: Quantitative Analysis of Social Media Data %A Budhwani,Henna %A Sun,Ruoyan %+ Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, 1720 University Blvd, RPHB #330C, Birmingham, AL, 35294, United States, 1 2059757613, budhwani@uab.edu %K COVID-19 %K coronavirus %K Twitter %K stigma %K social media %K public health %D 2020 %7 6.5.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Stigma is the deleterious, structural force that devalues members of groups that hold undesirable characteristics. Since stigma is created and reinforced by society—through in-person and online social interactions—referencing the novel coronavirus as the “Chinese virus” or “China virus” has the potential to create and perpetuate stigma. Objective: The aim of this study was to assess if there was an increase in the prevalence and frequency of the phrases “Chinese virus” and “China virus” on Twitter after the March 16, 2020, US presidential reference of this term. Methods: Using the Sysomos software (Sysomos, Inc), we extracted tweets from the United States using a list of keywords that were derivatives of “Chinese virus.” We compared tweets at the national and state levels posted between March 9 and March 15 (preperiod) with those posted between March 19 and March 25 (postperiod). We used Stata 16 (StataCorp) for quantitative analysis, and Python (Python Software Foundation) to plot a state-level heat map. Results: A total of 16,535 “Chinese virus” or “China virus” tweets were identified in the preperiod, and 177,327 tweets were identified in the postperiod, illustrating a nearly ten-fold increase at the national level. All 50 states witnessed an increase in the number of tweets exclusively mentioning “Chinese virus” or “China virus” instead of coronavirus disease (COVID-19) or coronavirus. On average, 0.38 tweets referencing “Chinese virus” or “China virus” were posted per 10,000 people at the state level in the preperiod, and 4.08 of these stigmatizing tweets were posted in the postperiod, also indicating a ten-fold increase. The 5 states with the highest number of postperiod “Chinese virus” tweets were Pennsylvania (n=5249), New York (n=11,754), Florida (n=13,070), Texas (n=14,861), and California (n=19,442). Adjusting for population size, the 5 states with the highest prevalence of postperiod “Chinese virus” tweets were Arizona (5.85), New York (6.04), Florida (6.09), Nevada (7.72), and Wyoming (8.76). The 5 states with the largest increase in pre- to postperiod “Chinese virus” tweets were Kansas (n=697/58, 1202%), South Dakota (n=185/15, 1233%), Mississippi (n=749/54, 1387%), New Hampshire (n=582/41, 1420%), and Idaho (n=670/46, 1457%). Conclusions: The rise in tweets referencing “Chinese virus” or “China virus,” along with the content of these tweets, indicate that knowledge translation may be occurring online and COVID-19 stigma is likely being perpetuated on Twitter. %M 32343669 %R 10.2196/19301 %U http://www.jmir.org/2020/5/e19301/ %U https://doi.org/10.2196/19301 %U http://www.ncbi.nlm.nih.gov/pubmed/32343669 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 5 %P e19540 %T Containing COVID-19 Among 627,386 Persons in Contact With the Diamond Princess Cruise Ship Passengers Who Disembarked in Taiwan: Big Data Analytics %A Chen,Chi-Mai %A Jyan,Hong-Wei %A Chien,Shih-Chieh %A Jen,Hsiao-Hsuan %A Hsu,Chen-Yang %A Lee,Po-Chang %A Lee,Chun-Fu %A Yang,Yi-Ting %A Chen,Meng-Yu %A Chen,Li-Sheng %A Chen,Hsiu-Hsi %A Chan,Chang-Chuan %+ Institute of Environmental and Occupational Health Sciences, College of Public Health, National Taiwan University, No.17, Xuzhou Road, Taipei, 100, Taiwan, 886 233668082, ccchan@ntu.edu.tw %K COVID-19 %K mobile geopositioning %K contact tracing %K proximity tracing %K digital contact tracking %K big data %K public health %K precision public health %K surveillance %K virus %D 2020 %7 5.5.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Low infection and case-fatality rates have been thus far observed in Taiwan. One of the reasons for this major success is better use of big data analytics in efficient contact tracing and management and surveillance of those who require quarantine and isolation. Objective: We present here a unique application of big data analytics among Taiwanese people who had contact with more than 3000 passengers that disembarked at Keelung harbor in Taiwan for a 1-day tour on January 31, 2020, 5 days before the outbreak of coronavirus disease (COVID-19) on the Diamond Princess cruise ship on February 5, 2020, after an index case was identified on January 20, 2020. Methods: The smart contact tracing–based mobile sensor data, cross-validated by other big sensor surveillance data, were analyzed by the mobile geopositioning method and rapid analysis to identify 627,386 potential contact-persons. Information on self-monitoring and self-quarantine was provided via SMS, and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) tests were offered for symptomatic contacts. National Health Insurance claims big data were linked, to follow-up on the outcome related to COVID-19 among those who were hospitalized due to pneumonia and advised to undergo screening for SARS-CoV-2. Results: As of February 29, a total of 67 contacts who were tested by reverse transcription–polymerase chain reaction were all negative and no confirmed COVID-19 cases were found. Less cases of respiratory syndrome and pneumonia were found after the follow-up of the contact population compared with the general population until March 10, 2020. Conclusions: Big data analytics with smart contact tracing, automated alert messaging for self-restriction, and follow-up of the outcome related to COVID-19 using health insurance data could curtail the resources required for conventional epidemiological contact tracing. %M 32353827 %R 10.2196/19540 %U http://www.jmir.org/2020/5/e19540/ %U https://doi.org/10.2196/19540 %U http://www.ncbi.nlm.nih.gov/pubmed/32353827 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e19374 %T COVID-19-Related Web Search Behaviors and Infodemic Attitudes in Italy: Infodemiological Study %A Rovetta,Alessandro %A Bhagavathula,Akshaya Srikanth %+ Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, Abu Dhabi, 17666, United Arab Emirates, 971 54322 ext 6187, akshaypharmd@gmail.com %K novel coronavirus, COVID-19, Google search %K Google Trends %K infodemiology, infodemic monikers, Italy %K behavior %K public health %K communication %K digital health %K online search %D 2020 %7 5.5.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Since the beginning of the novel coronavirus disease (COVID-19) outbreak, fake news and misleading information have circulated worldwide, which can profoundly affect public health communication. Objective: We investigated online search behavior related to the COVID-19 outbreak and the attitudes of “infodemic monikers” (ie, erroneous information that gives rise to interpretative mistakes, fake news, episodes of racism, etc) circulating in Italy. Methods: By using Google Trends to explore the internet search activity related to COVID-19 from January to March 2020, article titles from the most read newspapers and government websites were mined to investigate the attitudes of infodemic monikers circulating across various regions and cities in Italy. Search volume values and average peak comparison (APC) values were used to analyze the results. Results: Keywords such as “novel coronavirus,” “China coronavirus,” “COVID-19,” “2019-nCOV,” and “SARS-COV-2” were the top infodemic and scientific COVID-19 terms trending in Italy. The top five searches related to health were “face masks,” “amuchina” (disinfectant), “symptoms of the novel coronavirus,” “health bulletin,” and “vaccines for coronavirus.” The regions of Umbria and Basilicata recorded a high number of infodemic monikers (APC weighted total >140). Misinformation was widely circulated in the Campania region, and racism-related information was widespread in Umbria and Basilicata. These monikers were frequently searched (APC weighted total >100) in more than 10 major cities in Italy, including Rome. Conclusions: We identified a growing regional and population-level interest in COVID-19 in Italy. The majority of searches were related to amuchina, face masks, health bulletins, and COVID-19 symptoms. Since a large number of infodemic monikers were observed across Italy, we recommend that health agencies use Google Trends to predict human behavior as well as to manage misinformation circulation in Italy. %M 32338613 %R 10.2196/19374 %U http://publichealth.jmir.org/2020/2/e19374/ %U https://doi.org/10.2196/19374 %U http://www.ncbi.nlm.nih.gov/pubmed/32338613 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 5 %P e18897 %T Conversations and Medical News Frames on Twitter: Infodemiological Study on COVID-19 in South Korea %A Park,Han Woo %A Park,Sejung %A Chong,Miyoung %+ Tim Russert Department of Communication, John Carroll University, 1 John Carroll Blvd, University Heights, Cleveland Heights, OH, 44118, United States, 1 216 397 4722, sjpark@jcu.edu %K infodemiology %K COVID-19 %K SARS-CoV-2 %K coronavirus %K Twitter %K South Korea %K medical news %K social media %K pandemic %K outbreak %K infectious disease %K public health %D 2020 %7 5.5.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: SARS-CoV-2 (severe acute respiratory coronavirus 2) was spreading rapidly in South Korea at the end of February 2020 following its initial outbreak in China, making Korea the new center of global attention. The role of social media amid the current coronavirus disease (COVID-19) pandemic has often been criticized, but little systematic research has been conducted on this issue. Social media functions as a convenient source of information in pandemic situations. Objective: Few infodemiology studies have applied network analysis in conjunction with content analysis. This study investigates information transmission networks and news-sharing behaviors regarding COVID-19 on Twitter in Korea. The real time aggregation of social media data can serve as a starting point for designing strategic messages for health campaigns and establishing an effective communication system during this outbreak. Methods: Korean COVID-19-related Twitter data were collected on February 29, 2020. Our final sample comprised of 43,832 users and 78,233 relationships on Twitter. We generated four networks in terms of key issues regarding COVID-19 in Korea. This study comparatively investigates how COVID-19-related issues have circulated on Twitter through network analysis. Next, we classified top news channels shared via tweets. Lastly, we conducted a content analysis of news frames used in the top-shared sources. Results: The network analysis suggests that the spread of information was faster in the Coronavirus network than in the other networks (Corona19, Shincheon, and Daegu). People who used the word “Coronavirus” communicated more frequently with each other. The spread of information was faster, and the diameter value was lower than for those who used other terms. Many of the news items highlighted the positive roles being played by individuals and groups, directing readers’ attention to the crisis. Ethical issues such as deviant behavior among the population and an entertainment frame highlighting celebrity donations also emerged often. There was a significant difference in the use of nonportal (n=14) and portal news (n=26) sites between the four network types. The news frames used in the top sources were similar across the networks (P=.89, 95% CI 0.004-0.006). Tweets containing medically framed news articles (mean 7.571, SD 1.988) were found to be more popular than tweets that included news articles adopting nonmedical frames (mean 5.060, SD 2.904; N=40, P=.03, 95% CI 0.169-4.852). Conclusions: Most of the popular news on Twitter had nonmedical frames. Nevertheless, the spillover effect of the news articles that delivered medical information about COVID-19 was greater than that of news with nonmedical frames. Social media network analytics cannot replace the work of public health officials; however, monitoring public conversations and media news that propagates rapidly can assist public health professionals in their complex and fast-paced decision-making processes. %M 32325426 %R 10.2196/18897 %U http://www.jmir.org/2020/5/e18897/ %U https://doi.org/10.2196/18897 %U http://www.ncbi.nlm.nih.gov/pubmed/32325426 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e19106 %T Turning the Crisis Into an Opportunity: Digital Health Strategies Deployed During the COVID-19 Outbreak %A Pérez Sust,Pol %A Solans,Oscar %A Fajardo,Joan Carles %A Medina Peralta,Manuel %A Rodenas,Pepi %A Gabaldà,Jordi %A Garcia Eroles,Luis %A Comella,Adrià %A Velasco Muñoz,César %A Sallent Ribes,Josuè %A Roma Monfa,Rosa %A Piera-Jimenez,Jordi %+ Open Evidence Research Group, Universitat Oberta de Catalunya, Av del Tibidabo 39, Barcelona, 08035, Spain, 34 651041515, jpiera@bsa.cat %K digital health %K eHealth %K telemedicine %K COVID-19 %K coronavirus %K SARS-CoV-2 %K public health %K policymaking %D 2020 %7 4.5.2020 %9 Viewpoint %J JMIR Public Health Surveill %G English %X Digital health technologies offer significant opportunities to reshape current health care systems. From the adoption of electronic medical records to mobile health apps and other disruptive technologies, digital health solutions have promised a better quality of care at a more sustainable cost. However, the widescale adoption of these solutions is lagging behind. The most adverse scenarios often provide an opportunity to develop and test the capacity of digital health technologies to increase the efficiency of health care systems. Catalonia (Northeast Spain) is one of the most advanced regions in terms of digital health adoption across Europe. The region has a long tradition of health information exchange in the public health care sector and is currently implementing an ambitious digital health strategy. In this viewpoint, we discuss the crucial role digital health solutions play during the coronavirus disease (COVID-19) pandemic to support public health policies. We also report on the strategies currently deployed at scale during the outbreak in Catalonia. %M 32339998 %R 10.2196/19106 %U http://publichealth.jmir.org/2020/2/e19106/ %U https://doi.org/10.2196/19106 %U http://www.ncbi.nlm.nih.gov/pubmed/32339998 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 5 %P e18825 %T Chinese Public's Attention to the COVID-19 Epidemic on Social Media: Observational Descriptive Study %A Zhao,Yuxin %A Cheng,Sixiang %A Yu,Xiaoyan %A Xu,Huilan %+ Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Xiangya School of Public Health, Central South University, Changsha, 410078, China, 86 13637480958, xhl_csu@163.com %K COVID-19 %K Sina Microblog %K public attention %K social media %K China %K public health emergency %K infodemic %D 2020 %7 4.5.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Since the coronavirus disease (COVID-19) epidemic in China in December 2019, information and discussions about COVID-19 have spread rapidly on the internet and have quickly become the focus of worldwide attention, especially on social media. Objective: This study aims to investigate and analyze the public’s attention to events related to COVID-19 in China at the beginning of the COVID-19 epidemic (December 31, 2019, to February 20, 2020) through the Sina Microblog hot search list. Methods: We collected topics related to the COVID-19 epidemic on the Sina Microblog hot search list from December 31, 2019, to February 20, 2020, and described the trend of public attention on COVID-19 epidemic-related topics. ROST Content Mining System version 6.0 was used to analyze the collected text for word segmentation, word frequency, and sentiment analysis. We further described the hot topic keywords and sentiment trends of public attention. We used VOSviewer to implement a visual cluster analysis of hot keywords and build a social network of public opinion content. Results: The study has four main findings. First, we analyzed the changing trend of the public’s attention to the COVID-19 epidemic, which can be divided into three stages. Second, the hot topic keywords of public attention at each stage were slightly different. Third, the emotional tendency of the public toward the COVID-19 epidemic-related hot topics changed from negative to neutral, with negative emotions weakening and positive emotions increasing as a whole. Fourth, we divided the COVID-19 topics with the most public concern into five categories: the situation of the new cases of COVID-19 and its impact, frontline reporting of the epidemic and the measures of prevention and control, expert interpretation and discussion on the source of infection, medical services on the frontline of the epidemic, and focus on the worldwide epidemic and the search for suspected cases. Conclusions: Our study found that social media (eg, Sina Microblog) can be used to measure public attention toward public health emergencies. During the epidemic of the novel coronavirus, a large amount of information about the COVID-19 epidemic was disseminated on Sina Microblog and received widespread public attention. We have learned about the hotspots of public concern regarding the COVID-19 epidemic. These findings can help the government and health departments better communicate with the public on health and translate public health needs into practice to create targeted measures to prevent and control the spread of COVID-19. %M 32314976 %R 10.2196/18825 %U https://www.jmir.org/2020/5/e18825 %U https://doi.org/10.2196/18825 %U http://www.ncbi.nlm.nih.gov/pubmed/32314976 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e19160 %T Knowledge and Perceptions of COVID-19 Among Health Care Workers: Cross-Sectional Study %A Bhagavathula,Akshaya Srikanth %A Aldhaleei,Wafa Ali %A Rahmani,Jamal %A Mahabadi,Mohammadjavad Ashrafi %A Bandari,Deepak Kumar %+ Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, Abu Dhabi, 17666, United Arab Emirates, 971 543226187, akshaypharmd@gmail.com %K coronavirus %K outbreak %K COVID-19 %K knowledge %K perception %K health care %K questionnaire %K health care worker %D 2020 %7 30.4.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: During the first week of March, the coronavirus disease 2019 (COVID-19) outbreak reached more than 100 countries with over 100,000 cases. Health care authorities have already initiated awareness and preparedness activities worldwide. A poor understanding of the disease among health care workers (HCWs) may result in delayed treatment and result in the rapid spread of the infection. Objective: This study aimed to investigate the knowledge and perceptions of HCWs about COVID-19. Methods: A cross-sectional, web-based study was conducted among HCWs about COVID-19 during the first week of March 2020. A 23-item survey instrument was developed and distributed randomly to HCWs using social media; it required 5 minutes to complete. A chi-square test was used to investigate the level of association among variables, with significance set to P<.05. Results: Of 529 participants, a total of 453 HCWs completed the survey (response rate: 85.6%); 51.6% (n=234) were male, 32.1% (n=147) were aged 25-34 years, and most were doctors (n=137, 30.2%) and medical students (n=134, 29.6%). Most participants (n=276, 61.0%) used social media to obtain information on COVID-19. A significant proportion of HCWs had poor knowledge of its transmission (n=276, 61.0%) and symptom onset (n=288, 63.6%) and showed positive perceptions of COVID-19. Factors such as age and profession were associated with inadequate knowledge and a poor perception of COVID-19. Conclusions: As the global threat of COVID-19 continues to emerge, it is critical to improve the knowledge and perceptions of HCWs. Educational interventions are urgently needed to reach HCWs worldwide, and further studies are warranted. %M 32320381 %R 10.2196/19160 %U http://publichealth.jmir.org/2020/2/e19160/ %U https://doi.org/10.2196/19160 %U http://www.ncbi.nlm.nih.gov/pubmed/32320381 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e18808 %T A Guide to Chatbots for COVID-19 Screening at Pediatric Health Care Facilities %A Espinoza,Juan %A Crown,Kelly %A Kulkarni,Omkar %+ Department of Pediatrics, Children's Hospital Los Angeles, 4650 W Sunset Blvd, Mailstop #76, Los Angeles, CA, 90027, United States, 1 3233612721, jespinoza@chla.usc.edu %K chatbots %K COVID-19: pediatrics %K digital health %K screening %D 2020 %7 30.4.2020 %9 Tutorial %J JMIR Public Health Surveill %G English %X The coronavirus disease 2019 (COVID-19) outbreak has required institutions to rapidly adapt to changing public health circumstances. The Centers for Disease Control and Prevention has encouraged health care facilities to explore novel health care delivery modes. However, many institutions may not be prepared to begin offering digital health and telehealth services. Chatbots are one digital health tool that can help evolve triage and screening processes in a scalable manner. Here, we present a decision-making and implementation framework for deploying COVID-19 screening chatbots at pediatric health care facilities. %M 32325425 %R 10.2196/18808 %U http://publichealth.jmir.org/2020/2/e18808/ %U https://doi.org/10.2196/18808 %U http://www.ncbi.nlm.nih.gov/pubmed/32325425 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 7 %N 4 %P e19547 %T Comment on “Digital Mental Health and COVID-19: Using Technology Today to Accelerate the Curve on Access and Quality Tomorrow”: A UK Perspective %A Whelan,Pauline %A Stockton-Powdrell,Charlotte %A Jardine,Jenni %A Sainsbury,John %+ Centre for Health Informatics, University of Manchester, Vaughan House, Manchester, M13 9PL, United Kingdom, 44 7554227474, pauline.whelan@manchester.ac.uk %K digital mental health %K digital psychiatry %K COVID-19 %K mhealth %K mobile apps %K learning health system %D 2020 %7 27.4.2020 %9 Letter to the Editor %J JMIR Ment Health %G English %X %M 32330113 %R 10.2196/19547 %U http://mental.jmir.org/2020/4/e19547/ %U https://doi.org/10.2196/19547 %U http://www.ncbi.nlm.nih.gov/pubmed/32330113 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 4 %P e19139 %T COVID-19 Mobile Positioning Data Contact Tracing and Patient Privacy Regulations: Exploratory Search of Global Response Strategies and the Use of Digital Tools in Nigeria %A Ekong,Iniobong %A Chukwu,Emeka %A Chukwu,Martha %+ Department of Computer Information System, Faculty of Information & Communication Technology, University of Malta, PG room A24, Level 0, Msida, MSD 2080, Malta, 356 99330888, nnaemeka_ec@hotmail.com %K COVID-19 %K contact tracing %K Nigeria’s National Data Protection Regulation %K General Data Protection Regulation %K GDPR %K coronavirus %K surveillance %K mHealth %K eHealth %K digital health %D 2020 %7 27.4.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The coronavirus disease (COVID-19) pandemic is the biggest global economic and health challenge of the century. Its effect and impact are still evolving, with deaths estimated to reach 40 million if unchecked. One effective and complementary strategy to slow the spread and reduce the impact is to trace the primary and secondary contacts of confirmed COVID-19 cases using contact tracing technology. Objective: The objective of this paper is to survey strategies for digital contact tracing for the COVID-19 pandemic and to present how using mobile positioning data conforms with Nigeria’s data privacy regulations. Methods: We conducted an exploratory review of current measures for COVID-19 contact tracing implemented around the world. We then analyzed how countries are using mobile positioning data technology to reduce the spread of COVID-19. We made recommendations on how Nigeria can adopt this approach while adhering to the guidelines provided by the National Data Protection Regulation (NDPR). Results: Despite the potential of digital contact tracing, it always conflicts with patient data privacy regulations. We found that Nigeria’s response complies with the NDPR, and that it is possible to leverage call detail records to complement current strategies within the NDPR. Conclusions: Our study shows that mobile position data contact tracing is important for epidemic control as long as it conforms to relevant data privacy regulations. Implementation guidelines will limit data misuse. %M 32310817 %R 10.2196/19139 %U http://mhealth.jmir.org/2020/4/e19139/ %U https://doi.org/10.2196/19139 %U http://www.ncbi.nlm.nih.gov/pubmed/32310817 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 4 %P e19076 %T Global Reach of an Online COVID-19 Course in Multiple Languages on OpenWHO in the First Quarter of 2020: Analysis of Platform Use Data %A Utunen,Heini %A Ndiaye,Ngouille %A Piroux,Corentin %A George,Richelle %A Attias,Melissa %A Gamhewage,Gaya %+ Learning and Capacity Development Unit, World Health Organization Health Emergencies Programme, World Health Organization, 20 Avenue Appia, Geneva, 1211, Switzerland, 41 795933476, utunenh@who.int %K online learning %K OpenWHO %K novel coronavirus %K COVID-19 %K coronavirus %K pandemic %K WHO %K e-learning %K MOOC %K public health %D 2020 %7 27.4.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: At the onset of the coronavirus outbreak, the World Health Organization’s (WHO) Health Emergencies Learning and Capacity Development Unit, together with the WHO’s health technical lead on coronaviruses, developed a massive open online course within 3 weeks as part of the global response to the emergency. The introductory coronavirus disease (COVID‑19) course was launched on January 26, 2020, on the health emergencies learning platform OpenWHO.org. Objective: The aim of this paper is to investigate the geographic reach of different language courses accessed by a worldwide audience seeking information on COVID-19. Users’ professional identities and backgrounds were explored to inform course owners on the use case. The course was developed and delivered via the open-access learning platform OpenWHO.org. The self-paced resources are available in a total of 13 languages and were produced between January 26 and March 25, 2020. Methods: Data were collected from the online courses’ statistical data and metrics reporting system on the OpenWHO platform. User patterns and locations were analyzed based on Google Analytics and the platform’s own statistics capabilities, and data sets were overlaid. This analysis was conducted based on user location, with the data disaggregated according to the six WHO regions, the top 10 countries, and the proportion of use for each language version. Data included affiliation, gender, age, and other parameters for 32.43% (52,214/161,007) of the users who indicated their background. Results: As of March 25, 2020, the introductory COVID-19 course totaled 232,890 enrollments across all languages. The Spanish language course was comprised of more than half (n=118,754, 50.99%) of all course enrollments, and the English language course was comprised of 38.21% (n=88,988) of enrollments. The WHO’s Region of the Americas accounted for most of the course enrollments, with more than 72.47% (138,503/191,130) enrollment across all languages. Other regions were more evenly distributed with less than 10% enrollment for each. A total of 32.43% (52,214/161,007) of users specified a professional affiliation by choosing from the 12 most common backgrounds in the OpenWHO user profiles. Before the COVID-19 pandemic, users were spread over the 11 distinct affiliations, with a small fraction of users identifying themselves as “Other.” With the COVID-19 introductory course, the largest number of users selected “Other” (16,527/52,214, 31.65%), suggesting a large number of users who were not health professionals or academics. The top 10 countries with the most users across all languages were Argentina, Chile, Colombia, Ecuador, India, Mexico, Peru, Spain, the United Kingdom, and the United States. Conclusions: The online course has addressed a worldwide learning need by providing WHO’s technical guidance packaged in simple formats for access and use. The learning material development was expedited to meet the onset of the epidemic. Initial data suggest that the various language versions of the course, in particular Spanish, have reached new user groups, fulfilling the platform’s aim of providing learning everywhere to anyone that is interested. User surveys will be carried out to measure the real impact. %M 32293580 %R 10.2196/19076 %U https://www.jmir.org/2020/4/e19076 %U https://doi.org/10.2196/19076 %U http://www.ncbi.nlm.nih.gov/pubmed/32293580 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e18576 %T Surveillance of COVID-19 in the General Population Using an Online Questionnaire: Report From 18,161 Respondents in China %A Luo,Hongxing %A Lie,Yongchan %A Prinzen,Frits W %+ Department of Physiology, Cardiovascular Research Institute Maastricht, Maastricht University, Welsdaal 150 C, Maastricht, 6228JG, Netherlands, 31 685704703, h.luo@maastrichtuniversity.nl %K coronavirus %K surveillance %K syndromic surveillance %K participatory surveillance %K online questionnaire %K Wuhan %K COVID-19 %D 2020 %7 27.4.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The recent outbreak of the coronavirus disease (COVID-19) has become an international pandemic. So far, little is known about the role of an internet approach in COVID-19 participatory surveillance. Objective: The aim of this study is to investigate whether an online survey can provide population-level information for observing prevalence trends during the early phase of an outbreak and identifying potential risk factors of COVID-19 infection. Methods: A 10-item online questionnaire was developed according to medical guidelines and relevant publications. It was distributed between January 24 and February 17, 2020. The characteristics of respondents and temporal changes of various questionnaire-derived indicators were analyzed. Results: A total of 18,161 questionnaires were returned, including 6.45% (n=1171) from Wuhan City. Geographical distributions of the respondents were consistent with the population per province (R2=0.61, P<.001). History of contact significantly decreased with time, both outside Wuhan City (R2=0.35, P=.002) and outside Hubei Province (R2=0.42, P<.001). The percentage of respondents reporting a fever peaked around February 8 (R2=0.57, P<.001) and increased with a history of contact in the areas outside Wuhan City (risk ratio 1.31, 95% CI 1.13-1.52, P<.001). Male sex, advanced age, and lung diseases were associated with a higher risk of fever in the general population with a history of contact. Conclusions: This study shows the usefulness of an online questionnaire for the surveillance of outbreaks like COVID-19 by providing information about trends of the disease and aiding the identification of potential risk factors. %M 32319956 %R 10.2196/18576 %U http://publichealth.jmir.org/2020/2/e18576/ %U https://doi.org/10.2196/18576 %U http://www.ncbi.nlm.nih.gov/pubmed/32319956 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e19054 %T Detection of SARS-CoV-2 RNA and Antibodies in Diverse Samples: Protocol to Validate the Sufficiency of Provider-Observed, Home-Collected Blood, Saliva, and Oropharyngeal Samples %A Sullivan,Patrick Sean %A Sailey,Charles %A Guest,Jodie Lynn %A Guarner,Jeannette %A Kelley,Colleen %A Siegler,Aaron Julius %A Valentine-Graves,Mariah %A Gravens,Laura %A del Rio,Carlos %A Sanchez,Travis Howard %+ Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA, 30322, United States, 1 4047272038, pssulli@emory.edu %K SARS-CoV-2 %K RNA-PCR %K serology %K COVID-19 %K PCR %K public health %K outbreak %K infectious disease %K diagnostic %K telemedicine %K testing %D 2020 %7 24.4.2020 %9 Protocol %J JMIR Public Health Surveill %G English %X Background: The response in the United States to the coronavirus disease (COVID-19) pandemic has been hampered by a lack of aggressive testing for the infection. Testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the cornerstone of an effective public health response. However, efforts to test have been hampered by limited reagents, limitations in the availability of swabs used for the collection of nasopharyngeal swab (NPS) specimens, limitations in personal protective equipment (PPE) for health care providers collecting the NPS specimens, and limitations in viral transport media for transporting the specimens. Therefore, more flexible options for screening for SARS-CoV-2 RNA and serologic responses are critical to inform clinical and public health responses. Objective: We aim to document the ability of patients to self-collect sufficient specimens for SARS-CoV-2 viral detection and serology. Methods: Patient self-collection of samples will be done with observation by a health care provider during a telemedicine session. Participants will be mailed a specimen collection kit, engage in a telehealth session with a provider through a HIPPA (Health Insurance Portability and Accountability Act of 1996)-compliant video meeting, and collect specimens while being observed by the provider. Providers will record whether they are confident in the suitability of the specimen for laboratory testing that would inform clinical decision making. We will objectively assess the sufficiency of biological material in the mailed-in specimens. Results: The protocol was approved by the Emory University Institutional Review Board (IRB) on March 30, 2020 (Protocol number 371). To date, we have enrolled 159 participants. Conclusions: Defining a conceptual framework for assessing the sufficiency of patient-collected samples for the detection of SARS-CoV-2 RNA and serologic responses to infection is critical for facilitating public health responses and providing PPE-sparing options to increase testing. Validation of alternative methods of specimen collection should include objective measures of the sufficiency of specimens for testing. A strong evidence base for diversifying testing modalities will improve tools to guide public health responses to the COVID-19 pandemic. %M 32310815 %R 10.2196/19054 %U http://publichealth.jmir.org/2020/2/e19054/ %U https://doi.org/10.2196/19054 %U http://www.ncbi.nlm.nih.gov/pubmed/32310815 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e19218 %T Regulation and Trust: 3-Month Follow-up Study on COVID-19 Mortality in 25 European Countries %A Oksanen,Atte %A Kaakinen,Markus %A Latikka,Rita %A Savolainen,Iina %A Savela,Nina %A Koivula,Aki %+ Tampere University, Kalevantie 5, Faculty of Social Sciences, Tampere, 33014, Finland, 358 503187279, atte.oksanen@tuni.fi %K mortality %K infectious diseases %K sociability %K trust %K prevention %K Europe %D 2020 %7 24.4.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The outbreak of the coronavirus disease (COVID-19) has dramatically changed societies in 2020. Since the end of February, Europe has been hit particularly hard by COVID-19, but there are major country differences in both the spread of the virus and measures taken to stop the virus. Social psychological factors such as institutional trust could be important in understanding the development of the epidemic. Objective: The aim of this study was to examine country variations of COVID-19 mortality in Europe by analyzing social risk factors explaining the spread of the disease, restrictions and control measures, and institutional trust. Methods: The present study was based on a background analysis of European Social Survey data on 25 European countries (N=47,802). Multilevel mixed effects linear regression models focused on 84 days of the COVID-19 epidemic (January 22 to April 14, 2020) and modelled the daily COVID-19 mortality. Analysis focused on the impact of social relations, restrictions, and institutional trust within each country. Results: The spread of the COVID-19 epidemic has been fast everywhere, but the findings revealed significant differences between countries in COVID-19 mortality. Perceived sociability predicted higher COVID-19 mortality. Major differences between the 25 countries were found in reaction times to the crisis. Late reaction to the crisis predicted later mortality figures. Institutional trust was associated with lower COVID-19 mortality. Conclusions: The analyses demonstrated the importance of societal and social psychological factors in the spread of the COVID-19 epidemic. By considering multiple perspectives, this study showed that country differences in Europe are major, and this will have an impact on how countries will cope with the ongoing crisis in the following months. The results indicated the importance of timely restrictions and cooperation with people. %M 32301734 %R 10.2196/19218 %U http://publichealth.jmir.org/2020/2/e19218/ %U https://doi.org/10.2196/19218 %U http://www.ncbi.nlm.nih.gov/pubmed/32301734 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 4 %P e18948 %T Cloud-Based System for Effective Surveillance and Control of COVID-19: Useful Experiences From Hubei, China %A Gong,Mengchun %A Liu,Li %A Sun,Xin %A Yang,Yue %A Wang,Shuang %A Zhu,Hong %+ Nanfang Hospital, Southern Medical University, North 1838, Guangzhou Ave, Baiyun District, Guangzhou, China, 86 130 7687 721, zhnfyy@yeah.net %K COVID-19 %K cloud system %K syndromic surveillance %K clinical decision support %K stakeholders involvement %K pandemic %K medical informatics %D 2020 %7 22.4.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Coronavirus disease (COVID-19) has been an unprecedented challenge to the global health care system. Tools that can improve the focus of surveillance efforts and clinical decision support are of paramount importance. Objective: The aim of this study was to illustrate how new medical informatics technologies may enable effective control of the pandemic through the development and successful 72-hour deployment of the Honghu Hybrid System (HHS) for COVID-19 in the city of Honghu in Hubei, China. Methods: The HHS was designed for the collection, integration, standardization, and analysis of COVID-19-related data from multiple sources, which includes a case reporting system, diagnostic labs, electronic medical records, and social media on mobile devices. Results: HHS supports four main features: syndromic surveillance on mobile devices, policy-making decision support, clinical decision support and prioritization of resources, and follow-up of discharged patients. The syndromic surveillance component in HHS covered over 95% of the population of over 900,000 people and provided near real time evidence for the control of epidemic emergencies. The clinical decision support component in HHS was also provided to improve patient care and prioritize the limited medical resources. However, the statistical methods still require further evaluations to confirm clinical effectiveness and appropriateness of disposition assigned in this study, which warrants further investigation. Conclusions: The facilitating factors and challenges are discussed to provide useful insights to other cities to build suitable solutions based on cloud technologies. The HHS for COVID-19 was shown to be feasible and effective in this real-world field study, and has the potential to be migrated. %M 32287040 %R 10.2196/18948 %U http://www.jmir.org/2020/4/e18948/ %U https://doi.org/10.2196/18948 %U http://www.ncbi.nlm.nih.gov/pubmed/32287040 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e18700 %T Data Mining and Content Analysis of the Chinese Social Media Platform Weibo During the Early COVID-19 Outbreak: Retrospective Observational Infoveillance Study %A Li,Jiawei %A Xu,Qing %A Cuomo,Raphael %A Purushothaman,Vidya %A Mackey,Tim %+ Department of Anesthesiology and Division of Infectious Diseases and Global Public Health, University of California San Diego School of Medicine, 8950 Villa La Jolla Drive, A124, La Jolla, CA, 92037, United States, 1 9514914161, tmackey@ucsd.edu %K COVID-19 %K coronavirus %K infectious disease %K social media, surveillance %K infoveillance %K infodemiology %D 2020 %7 21.4.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The coronavirus disease (COVID-19) pandemic, which began in Wuhan, China in December 2019, is rapidly spreading worldwide with over 1.9 million cases as of mid-April 2020. Infoveillance approaches using social media can help characterize disease distribution and public knowledge, attitudes, and behaviors critical to the early stages of an outbreak. Objective: The aim of this study is to conduct a quantitative and qualitative assessment of Chinese social media posts originating in Wuhan City on the Chinese microblogging platform Weibo during the early stages of the COVID-19 outbreak. Methods: Chinese-language messages from Wuhan were collected for 39 days between December 23, 2019, and January 30, 2020, on Weibo. For quantitative analysis, the total daily cases of COVID-19 in Wuhan were obtained from the Chinese National Health Commission, and a linear regression model was used to determine if Weibo COVID-19 posts were predictive of the number of cases reported. Qualitative content analysis and an inductive manual coding approach were used to identify parent classifications of news and user-generated COVID-19 topics. Results: A total of 115,299 Weibo posts were collected during the study time frame consisting of an average of 2956 posts per day (minimum 0, maximum 13,587). Quantitative analysis found a positive correlation between the number of Weibo posts and the number of reported cases from Wuhan, with approximately 10 more COVID-19 cases per 40 social media posts (P<.001). This effect size was also larger than what was observed for the rest of China excluding Hubei Province (where Wuhan is the capital city) and held when comparing the number of Weibo posts to the incidence proportion of cases in Hubei Province. Qualitative analysis of 11,893 posts during the first 21 days of the study period with COVID-19-related posts uncovered four parent classifications including Weibo discussions about the causative agent of the disease, changing epidemiological characteristics of the outbreak, public reaction to outbreak control and response measures, and other topics. Generally, these themes also exhibited public uncertainty and changing knowledge and attitudes about COVID-19, including posts exhibiting both protective and higher-risk behaviors. Conclusions: The results of this study provide initial insight into the origins of the COVID-19 outbreak based on quantitative and qualitative analysis of Chinese social media data at the initial epicenter in Wuhan City. Future studies should continue to explore the utility of social media data to predict COVID-19 disease severity, measure public reaction and behavior, and evaluate effectiveness of outbreak communication. %M 32293582 %R 10.2196/18700 %U http://publichealth.jmir.org/2020/2/e18700/ %U https://doi.org/10.2196/18700 %U http://www.ncbi.nlm.nih.gov/pubmed/32293582 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e19145 %T The Role of YouTube and the Entertainment Industry in Saving Lives by Educating and Mobilizing the Public to Adopt Behaviors for Community Mitigation of COVID-19: Successive Sampling Design Study %A Basch,Charles E %A Basch,Corey H %A Hillyer,Grace C %A Jaime,Christie %+ Teachers College, Columbia University, 525 W 120th St, New York, NY, 10027, United States, 1 212 678 3983, ceb35@columbia.edu %K YouTube %K COVID-19 %K social media %K pandemic %K outbreak %K infectious disease %K public health %K prevention %D 2020 %7 21.4.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Effective community mitigation through voluntary behavior change is currently the best way to reduce mortality caused by coronavirus disease (COVID-19). This study builds on our prior study based on the scientific premise that YouTube is one of the most effective ways to communicate and mobilize the public in community mitigation to reduce exposure to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Objective: Because of the rapidly changing nature of YouTube in the context of the COVID-19 pandemic, we conducted a follow-up study to document how coverage of preventive behaviors for effective community mitigation has changed. Methods: A successive sampling design was used to compare coverage of behaviors to mitigate community transmission of COVID-19 in the 100 most widely viewed YouTube videos in January 2020 and March 2020. Results: Videos in the January and March samples were viewed >125 million times and >355 million times, respectively. Fewer than half of the videos in either sample covered any of the prevention behaviors recommended by the US Centers for Disease Control and Prevention, but many covered key prevention behaviors and were very widely viewed. There were no videos uploaded by entertainment television in the January sample, but this source comprised the majority of videos and garnered the majority of cumulative views in the March sample. Conclusions: This study demonstrates the incredible reach of YouTube and the potential value of partnership with the entertainment industry for communicating and mobilizing the public about community mitigation to reduce mortality from the COVID-19 viral pandemic. %M 32297593 %R 10.2196/19145 %U http://publichealth.jmir.org/2020/2/e19145/ %U https://doi.org/10.2196/19145 %U http://www.ncbi.nlm.nih.gov/pubmed/32297593 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 4 %P e19016 %T Top Concerns of Tweeters During the COVID-19 Pandemic: Infoveillance Study %A Abd-Alrazaq,Alaa %A Alhuwail,Dari %A Househ,Mowafa %A Hamdi,Mounir %A Shah,Zubair %+ College of Science and Engineering, Hamad Bin Khalifa University, Doha Al Luqta St, Ar- Rayyan, Doha, Qatar, 974 50744851, ZShah@hbku.edu.qa %K coronavirus, COVID-19 %K SARS-CoV-2 %K 2019-nCov %K social media %K public health %K Twitter %K infoveillance %K infodemiology %K health informatics %K disease surveillance %D 2020 %7 21.4.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The recent coronavirus disease (COVID-19) pandemic is taking a toll on the world’s health care infrastructure as well as the social, economic, and psychological well-being of humanity. Individuals, organizations, and governments are using social media to communicate with each other on a number of issues relating to the COVID-19 pandemic. Not much is known about the topics being shared on social media platforms relating to COVID-19. Analyzing such information can help policy makers and health care organizations assess the needs of their stakeholders and address them appropriately. Objective: This study aims to identify the main topics posted by Twitter users related to the COVID-19 pandemic. Methods: Leveraging a set of tools (Twitter’s search application programming interface (API), Tweepy Python library, and PostgreSQL database) and using a set of predefined search terms (“corona,” “2019-nCov,” and “COVID-19”), we extracted the text and metadata (number of likes and retweets, and user profile information including the number of followers) of public English language tweets from February 2, 2020, to March 15, 2020. We analyzed the collected tweets using word frequencies of single (unigrams) and double words (bigrams). We leveraged latent Dirichlet allocation for topic modeling to identify topics discussed in the tweets. We also performed sentiment analysis and extracted the mean number of retweets, likes, and followers for each topic and calculated the interaction rate per topic. Results: Out of approximately 2.8 million tweets included, 167,073 unique tweets from 160,829 unique users met the inclusion criteria. Our analysis identified 12 topics, which were grouped into four main themes: origin of the virus; its sources; its impact on people, countries, and the economy; and ways of mitigating the risk of infection. The mean sentiment was positive for 10 topics and negative for 2 topics (deaths caused by COVID-19 and increased racism). The mean for tweet topics of account followers ranged from 2722 (increased racism) to 13,413 (economic losses). The highest mean of likes for the tweets was 15.4 (economic loss), while the lowest was 3.94 (travel bans and warnings). Conclusions: Public health crisis response activities on the ground and online are becoming increasingly simultaneous and intertwined. Social media provides an opportunity to directly communicate health information to the public. Health systems should work on building national and international disease detection and surveillance systems through monitoring social media. There is also a need for a more proactive and agile public health presence on social media to combat the spread of fake news. %M 32287039 %R 10.2196/19016 %U http://www.jmir.org/2020/4/e19016/ %U https://doi.org/10.2196/19016 %U http://www.ncbi.nlm.nih.gov/pubmed/32287039 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 4 %P e19359 %T COVID-19 Contact Tracing and Data Protection Can Go Together %A Abeler,Johannes %A Bäcker,Matthias %A Buermeyer,Ulf %A Zillessen,Hannah %+ Department of Economics, University of Oxford, Manor Road, Oxford, United Kingdom, 44 1865281440, johannes.abeler@economics.ox.ac.uk %K COVID-19 %K app %K contact tracing %K proximity tracing %K privacy %K data protection %K Bluetooth %D 2020 %7 20.4.2020 %9 Guest Editorial %J JMIR Mhealth Uhealth %G English %X We discuss the implementation of app-based contact tracing to control the coronavirus disease (COVID-19) pandemic and discuss its data protection and user acceptability aspects. %M 32294052 %R 10.2196/19359 %U http://mhealth.jmir.org/2020/4/e19359/ %U https://doi.org/10.2196/19359 %U http://www.ncbi.nlm.nih.gov/pubmed/32294052 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e18941 %T Tracking COVID-19 in Europe: Infodemiology Approach %A Mavragani,Amaryllis %+ Department of Computing Science and Mathematics, Faculty of Natural Sciences, University of Stirling, University Campus, Stirling, FK94LA, United Kingdom, 44 7523782711, amaryllis.mavragani1@stir.ac.uk %K big data %K coronavirus %K COVID-19 %K infodemiology %K infoveillance %K Google Trends %D 2020 %7 20.4.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Infodemiology (ie, information epidemiology) uses web-based data to inform public health and policy. Infodemiology metrics have been widely and successfully used to assess and forecast epidemics and outbreaks. Objective: In light of the recent coronavirus disease (COVID-19) pandemic that started in Wuhan, China in 2019, online search traffic data from Google are used to track the spread of the new coronavirus disease in Europe. Methods: Time series from Google Trends from January to March 2020 on the Topic (Virus) of “Coronavirus” were retrieved and correlated with official data on COVID-19 cases and deaths worldwide and in the European countries that have been affected the most: Italy (at national and regional level), Spain, France, Germany, and the United Kingdom. Results: Statistically significant correlations are observed between online interest and COVID-19 cases and deaths. Furthermore, a critical point, after which the Pearson correlation coefficient starts declining (even if it is still statistically significant) was identified, indicating that this method is most efficient in regions or countries that have not yet peaked in COVID-19 cases. Conclusions: In the past, infodemiology metrics in general and data from Google Trends in particular have been shown to be useful in tracking and forecasting outbreaks, epidemics, and pandemics as, for example, in the cases of the Middle East respiratory syndrome, Ebola, measles, and Zika. With the COVID-19 pandemic still in the beginning stages, it is essential to explore and combine new methods of disease surveillance to assist with the preparedness of health care systems at the regional level. %M 32250957 %R 10.2196/18941 %U http://publichealth.jmir.org/2020/2/e18941/ %U https://doi.org/10.2196/18941 %U http://www.ncbi.nlm.nih.gov/pubmed/32250957 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e18980 %T Global Preparedness Against COVID-19: We Must Leverage the Power of Digital Health %A Mahmood,Sultan %A Hasan,Khaled %A Colder Carras,Michelle %A Labrique,Alain %+ International Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St., W 5501, Baltimore, MD, 21205, United States, 1 443 287 4744, alabriq1@jhu.edu %K informatics %K global health %K developing countries %K internet %K infection %K control %K COVID-19 %K pandemic %D 2020 %7 16.4.2020 %9 Viewpoint %J JMIR Public Health Surveill %G English %X The coronavirus disease (COVID-19) pandemic has revealed many areas of public health preparedness that are lacking, especially in lower- and middle-income countries. Digital interventions provide many opportunities for strengthening health systems and could be vital resources in the current public health emergency. We provide several use cases for infection control, home-based diagnosis and screening, empowerment through information, public health surveillance and epidemiology, and leveraging crowd-sourced data. A thoughtful, concerted effort—leveraging existing experience and robust enterprise-grade technologies—can have a substantive impact on the immediate and distal consequences of COVID-19. %M 32297868 %R 10.2196/18980 %U http://publichealth.jmir.org/2020/2/e18980/ %U https://doi.org/10.2196/18980 %U http://www.ncbi.nlm.nih.gov/pubmed/32297868 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e18795 %T A Case for Participatory Disease Surveillance of the COVID-19 Pandemic in India %A Garg,Suneela %A Bhatnagar,Nidhi %A Gangadharan,Navya %+ Maulana Azad Medical College, Delhi University, Bahadur Shah Zafar Marg-02, Delhi, 110002, India, 91 08750647995, bhatnagarnidhi.mamc@gmail.com %K participatory %K surveillance %K COVID-19 %K pandemic %K outbreak %K public health %K infectious disease %K India %D 2020 %7 16.4.2020 %9 Viewpoint %J JMIR Public Health Surveill %G English %X The coronavirus disease pandemic requires the deployment of novel surveillance strategies to curtail further spread of the disease in the community. Participatory disease surveillance mechanisms have already been adopted in countries for the current pandemic. India, with scarce resources, good telecom support, and a not-so-robust heath care system, makes a strong case for introducing participatory disease surveillance for the prevention and control of the pandemic. India has just launched Aarogya Setu, which is a first-of-its-kind participatory disease surveillance initiative in India. This will supplement the existing Integrated Disease Surveillance Programme in India by finding missing cases and having faster aggregation, analysis of data, and prompt response measures. This newly created platform empowers communities with the right information and guidance, enabling protection from infection and reducing unnecessary contact with the overburdened health care system. However, caution needs to be exercised to address participation from digitally isolated populations, ensure the reliability of data, and consider ethical concerns such as maintaining individual privacy. %M 32287038 %R 10.2196/18795 %U http://publichealth.jmir.org/2020/2/e18795/ %U https://doi.org/10.2196/18795 %U http://www.ncbi.nlm.nih.gov/pubmed/32287038 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e18811 %T Interpreting COVID-19 and Virtual Care Trends: Cohort Study %A Khairat,Saif %A Meng,Chenlu %A Xu,Yuxuan %A Edson,Barbara %A Gianforcaro,Robert %+ School or Nursing, University of North Carolina at Chapel Hill, 428 Carrington Hall, NC, NC, 27514, United States, 1 9198435416, saif@unc.edu %K virtual care %K COVID-19 %K trends %K patterns %K pandemic %K outbreak %K infectious disease %K public health %D 2020 %7 15.4.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The coronavirus disease (COVID-19) pandemic is rapidly spreading across the world. As of March 26, 2020, there are more than 500,000 cases and more than 25,000 deaths related to COVID-19, and the numbers are increasing by the hour. Objective: The aim of this study was to explore the trends in confirmed COVID-19 cases in North Carolina, and to understand patterns in virtual visits related to symptoms of COVID-19. Methods: We conducted a cohort study of confirmed COVID-19 cases and patients using an on-demand, statewide virtual urgent care center. We collected data from February 1, 2020, to March 15, 2020. Institutional Review Board exemption was obtained prior to the study. Results: As of March, 18 2020, there were 92 confirmed COVID-19 cases and 733 total virtual visits. Of the total visits, 257 (35.1%) were related to COVID-19-like symptoms. Of the COVID-19-like visits, the number of females was 178 (69.2%). People in the age groups of 30-39 years (n=67, 26.1%) and 40-49 years (n=64, 24.9%) were half of the total patients. Additionally, approximately 96.9% (n=249) of the COVID-like encounters came from within the state of North Carolina. Our study shows that virtual care can provide efficient triaging in the counties with the highest number of COVID-19 cases. We also confirmed that the largest spread of the disease occurs in areas with a high population density as well as in areas with major airports. Conclusions: The use of virtual care presents promising potential in the fight against COVID-19. Virtual care is capable of reducing emergency room visits, conserving health care resources, and avoiding the spread of COVID-19 by treating patients remotely. We call for further adoption of virtual care by health systems across the United States and the world during the COVID-19 pandemic. %M 32252023 %R 10.2196/18811 %U http://publichealth.jmir.org/2020/2/e18811/ %U https://doi.org/10.2196/18811 %U http://www.ncbi.nlm.nih.gov/pubmed/32252023 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 4 %P e18908 %T Internet Hospitals Help Prevent and Control the Epidemic of COVID-19 in China: Multicenter User Profiling Study %A Gong,Kai %A Xu,Zhong %A Cai,Zhefeng %A Chen,Yuxiu %A Wang,Zhanxiang %+ The Internet Hospital of the First Affiliated Hospital of Xia'men University, 10 Shanggu Road, Siming District, Xia'men City, 361003, China, 86 13063035888, 493834266@qq.com %K internet hospital %K telemedicine %K novel coronavirus disease %K pandemic %K prevention %K control %K coronavirus %K COVID-19 %K public health %K infectious disease %D 2020 %7 14.4.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: During the spread of the novel coronavirus disease (COVID-19), internet hospitals in China were engaged with epidemic prevention and control, offering epidemic-related online services and medical support to the public. Objective: The aim of this study is to explore the role of internet hospitals during the prevention and control of the COVID-19 outbreak in China. Methods: Online epidemic-related consultations from multicenter internet hospitals in China during the COVID-19 epidemic were collected. The counselees were described and classified into seven type groups. Symptoms were recorded and compared with reported patients with COVID-19. Hypochondriacal suspicion and offline visit motivation were detected within each counselees’ group to evaluate the social panic of the epidemic along with the consequent medical-seeking behaviors. The counselees’ motivation and the doctors’ recommendation for an offline visit were compared. Risk factors affecting the counselees’ tendency of hypochondriacal suspicion and offline visit motivation were explored by logistic regression models. The epidemic prevention and control measures based on internet hospitals were listed, and the corresponding effects were discussed. Results: A total of 4913 consultations were enrolled for analysis with the median age of the counselees at 28 years (IQR 22-33 years). There were 104 (2.12%) healthy counselees, 147 (2.99%) hypochondriacal counselees, 34 (0.69%) exposed counselees, 853 (17.36%) mildly suspicious counselees, 42 (0.85%) moderately suspicious counselees, 3550 (72.26%) highly suspicious counselees, and 183 (3.72%) severely suspicious counselees. A total of 94.20% (n=4628) of counselees had epidemic-related symptoms with a distribution similar to those of COVID-19. The hypochondriacal suspicion (n=2167, 44.11%) was common. The counselees’ motivation and the doctors’ recommendation for offline visits were inconsistent (P<.001) with a Cohen kappa score of 0.039, indicating improper medical-seeking behaviors. Adult counselees (odds ratio [OR]=1.816, P<.001) with epidemiological exposure (OR 7.568, P<.001), shortness of breath (OR 1.440, P=.001), diarrhea (OR 1.272, P=.04), and unrelated symptoms (OR 1.509, P<.001) were more likely to have hypochondriacal suspicion. Counselees with severe illnesses (OR 2.303, P<.001), fever (OR 1.660, P<.001), epidemiological exposure history (OR 1.440, P=.01), and hypochondriacal suspicion (OR 4.826, P<.001) were more likely to attempt an offline visit. Reattending counselees (OR 0.545, P=.002) were less motivated to go to the offline clinic. Conclusions: Internet hospitals can serve different types of epidemic counselees, offer essential medical supports to the public during the COVID-19 outbreak, reduce the social panic, promote social distancing, enhance the public’s ability of self-protection, correct improper medical-seeking behaviors, reduce the chance of nosocomial cross-infection, and facilitate epidemiological screening, thus, playing an important role on preventing and controlling COVID-19. %M 32250962 %R 10.2196/18908 %U http://www.jmir.org/2020/4/e18908/ %U https://doi.org/10.2196/18908 %U http://www.ncbi.nlm.nih.gov/pubmed/32250962 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e18668 %T A Mobile Health Platform to Disseminate Validated Institutional Measurements During the COVID-19 Outbreak: Utilization-Focused Evaluation Study %A Zamberg,Ido %A Manzano,Sergio %A Posfay-Barbe,Klara %A Windisch,Olivier %A Agoritsas,Thomas %A Schiffer,Eduardo %+ Division of General Internal Medicine, Department of Medicine, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil 4, Geneva, 1205, Switzerland, 41 022 372 33 11, idozamberg@gmail.com %K covid-19 %K novel coronavirus %K smartphone %K SARS-COV-2 %K mHealth %K knowledge %K information %K dissemination %K health policy %K infectious disease %K outbreak %K public health %K preparation %D 2020 %7 14.4.2020 %9 Short Paper %J JMIR Public Health Surveill %G English %X Background: As part of the response plans for the current outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), authorities are drafting and implementing containment measures across jurisdictions worldwide in the effort to slow down transmission and reduce the infection rate. A solid communication strategy is needed to increase the reach of valid information to health professionals, reduce misinformation, and efficiently implement recommended measures. Objective: The aim of this paper is to describe the utilization of a dedicated mobile health (mHealth) platform to disseminate up-to-date and validated information about SARS-CoV-2 to all medical staff of the Children’s Hospital at the University Hospitals of Geneva. Methods: Three documents containing institutional information concerning screening, local containment procedures, and frequently asked questions and answers for parents were made available to the staff through a mobile app developed in the University of Geneva, Switzerland. Using a third-party statistics tool, we anonymously monitored user activity as well as content utilization patterns since the diagnosis of the first case of SARS-CoV-2 in Switzerland on February 25, 2020. Results: From February 25, 2020, to March 13, 2020 (18 days), information documents on SARS-CoV-2 were viewed 859 times, which accounted for 35.6% of the total content views (total views=332). User activity increased significantly with 50.8 (SD 14.4) users per day in this period as compared to the previous weeks (mean 26.4, SD 9.8; P<.001). In addition, session numbers per day more than doubled during the aforementioned period (P<.001). In a survey, medical staff found the information easy to find within the app. On a 10-point Likert scale, the ability of the app to reassure staff in clinical practice was rated as 7.6 (SD 2.1), time-saving ability was rated as 8.5 (SD 2.1), and the need to look for information from other sources was rated as 5.9 (SD 3.3). Conclusions: The use of an mHealth solution to disseminate novel coronavirus–related information seemed to be an effective and time-saving communication channel within our institution during the SARS-CoV-2 outbreak. Medical staff felt reassured and informed in daily practice. More research should be done on the clinical impact and outcomes of the integration of mHealth solutions as a communication channel of validated information within health institutions. %M 32250958 %R 10.2196/18668 %U http://publichealth.jmir.org/2020/2/e18668/ %U https://doi.org/10.2196/18668 %U http://www.ncbi.nlm.nih.gov/pubmed/32250958 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e18873 %T Urban Intelligence for Pandemic Response: Viewpoint %A Lai,Yuan %A Yeung,Wesley %A Celi,Leo Anthony %+ Laboratory for Computational Physiology, Massachusetts Institute of Technology, 77 Massachusetts Ave, Cambridge, MA, 02139, United States, 1 (617) 253 1000, wesleyyeung123@gmail.com %K urban informatics %K urban science %K data science %K health emergency %K medical informatics %K COVID-19 %K pandemic %K outbreak %K public health %K infectious disease %D 2020 %7 14.4.2020 %9 Viewpoint %J JMIR Public Health Surveill %G English %X Previous epidemic management research proves the importance of city-level information, but also highlights limited expertise in urban data applications during a pandemic outbreak. In this paper, we provide an overview of city-level information, in combination with analytical and operational capacity, that define urban intelligence for supporting response to disease outbreaks. We present five components (movement, facilities, people, information, and engagement) that have been previously investigated but remain siloed to successfully orchestrate an integrated pandemic response. Reflecting on the coronavirus disease (COVID-19) outbreak that was first identified in Wuhan, China, we discuss the opportunities, technical challenges, and foreseeable controversies for deploying urban intelligence during a pandemic. Finally, we emphasize the urgency of building urban intelligence through cross-disciplinary research and collaborative practice on a global scale. %M 32248145 %R 10.2196/18873 %U http://publichealth.jmir.org/2020/2/e18873/ %U https://doi.org/10.2196/18873 %U http://www.ncbi.nlm.nih.gov/pubmed/32248145 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e18828 %T Predicting COVID-19 Incidence Through Analysis of Google Trends Data in Iran: Data Mining and Deep Learning Pilot Study %A Ayyoubzadeh,Seyed Mohammad %A Ayyoubzadeh,Seyed Mehdi %A Zahedi,Hoda %A Ahmadi,Mahnaz %A R Niakan Kalhori,Sharareh %+ Department of Health Information Management, School of Allied Medical Sciences, Tehran University of Medical Sciences, 3rd Floor, No 17, Farredanesh Alley, Ghods St, Enghelab Ave, Tehran, Iran, 98 21 88983025, niakan2@gmail.com %K coronavirus %K COVID-19 %K prediction %K incidence %K Google Trends %K linear regression %K LSTM %K pandemic %K outbreak %K public health %D 2020 %7 14.4.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The recent global outbreak of coronavirus disease (COVID-19) is affecting many countries worldwide. Iran is one of the top 10 most affected countries. Search engines provide useful data from populations, and these data might be useful to analyze epidemics. Utilizing data mining methods on electronic resources’ data might provide a better insight into the COVID-19 outbreak to manage the health crisis in each country and worldwide. Objective: This study aimed to predict the incidence of COVID-19 in Iran. Methods: Data were obtained from the Google Trends website. Linear regression and long short-term memory (LSTM) models were used to estimate the number of positive COVID-19 cases. All models were evaluated using 10-fold cross-validation, and root mean square error (RMSE) was used as the performance metric. Results: The linear regression model predicted the incidence with an RMSE of 7.562 (SD 6.492). The most effective factors besides previous day incidence included the search frequency of handwashing, hand sanitizer, and antiseptic topics. The RMSE of the LSTM model was 27.187 (SD 20.705). Conclusions: Data mining algorithms can be employed to predict trends of outbreaks. This prediction might support policymakers and health care managers to plan and allocate health care resources accordingly. %M 32234709 %R 10.2196/18828 %U http://publichealth.jmir.org/2020/2/e18828/ %U https://doi.org/10.2196/18828 %U http://www.ncbi.nlm.nih.gov/pubmed/32234709 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e18798 %T Dentists’ Awareness, Perception, and Attitude Regarding COVID-19 and Infection Control: Cross-Sectional Study Among Jordanian Dentists %A Khader,Yousef %A Al Nsour,Mohannad %A Al-Batayneh,Ola Barakat %A Saadeh,Rami %A Bashier,Haitham %A Alfaqih,Mahmoud %A Al-Azzam,Sayer %A AlShurman,Bara’ Abdallah %+ Jordan University of Science and Technology, Alramtha-Amman Street, Irbid, 22110, Jordan, 962 796802040, yskhader@just.edu.jo %K COVID-19 %K infection %K dentist %K infection control %D 2020 %7 9.4.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Despite the availability of prevention guidelines and recommendations on infection control, many dental practices lack the minimum requirements for infection control. Objective: This study aimed to assess the level of awareness, perception, and attitude regarding the coronavirus disease (COVID-19) and infection control among Jordanian dentists. Methods: The study population consisted of dentists who worked in private clinics, hospitals, and health centers in Jordan. An online questionnaire was sent to a sample of Jordanian dentists in March 2020. The questionnaire was comprised of a series of questions about dentists’ demographic characteristics; their awareness of the incubation period, the symptoms of the disease, mode of transmission of COVID-19 and infection control measures for preventing COVID-19; and their attitude toward treating patients with COVID-19. Results: This study included a total of 368 dentists aged 22-73 years (mean 32.9 years, SD 10.6 years). A total of 112 (30.4%) dentists had completed a master or residency program in dentistry, 195 (53.0%) had received training in infection control in dentistry, and 28 (7.6%) had attended training or lectures regarding COVID-19. A total of 133 (36.1%) dentists reported that the incubation period is 1-14 days. The majority of dentists were aware of COVID-19 symptoms and ways of identifying patients at risk of having COVID-19, were able to correctly report known modes of transmission, and were aware of measures for preventing COVID-19 transmission in dental clinics. A total of 275 (74.7%) believed that it was necessary to ask patients to sit far from each other, wear masks while in the waiting room, and wash hands before getting in the dental chair to decrease disease transmission. Conclusions: Jordanian dentists were aware of COVID-19 symptoms, mode of transmission, and infection controls and measures in dental clinics. However, dentists had limited comprehension of the extra precautionary measures that protect the dental staff and other patients from COVID-19. National and international guidelines should be sent by the regional and national dental associations to all registered dentists during a crisis, including the COVID-19 pandemic, to make sure that dentists are well informed and aware of best practices and recommended disease management approaches. %M 32250959 %R 10.2196/18798 %U http://publichealth.jmir.org/2020/2/e18798/ %U https://doi.org/10.2196/18798 %U http://www.ncbi.nlm.nih.gov/pubmed/32250959 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e18444 %T Misinformation of COVID-19 on the Internet: Infodemiology Study %A Cuan-Baltazar,Jose Yunam %A Muñoz-Perez,Maria José %A Robledo-Vega,Carolina %A Pérez-Zepeda,Maria Fernanda %A Soto-Vega,Elena %+ Medicine School, Universidad Anáhuac Puebla, Av Orion sn. Colonia Country Club, San Andres Cholula, 72810, Mexico, 52 2225415200, elenasoto_74@hotmail.com %K HONcode %K JAMA benchmarks %K DISCERN instrument %K Wuhan coronavirus %K COVID-19 %K nCoV %K epidemiology %K health information seeking %K information quality %K misinformation %K public health %D 2020 %7 9.4.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The internet has become an important source of health information for users worldwide. The novel coronavirus caused a pandemic search for information with broad dissemination of false or misleading health information. Objective: The aim of this study was to evaluate the quality and readability of online information about the coronavirus disease (COVID-19), which was a trending topic on the internet, using validated instruments and relating the quality of information to its readability. Methods: The search was based on the term “Wuhan Coronavirus” on the Google website (February 6, 2020). At the search time, the terms “COVID-19” or “SARS-CoV-2” (severe acute respiratory syndrome coronavirus 2) did not exist. Critical analysis was performed on the first 110 hits using the Health on the Net Foundation Code of Conduct (HONcode), the Journal of the American Medical Association (JAMA) benchmark, the DISCERN instrument, and Google ranking. Results: The first 110 websites were critically analyzed, and only 1.8% (n=2) of the websites had the HONcode seal. The JAMA benchmark showed that 39.1% (n=43) of the websites did not have any of the categories required by this tool, and only 10.0% (11/110) of the websites had the four quality criteria required by JAMA. The DISCERN score showed that 70.0% (n=77) of the websites were evaluated as having a low score and none were rated as having a high score. Conclusions: Nonhealth personnel and the scientific community need to be aware about the quality of the information they read and produce, respectively. The Wuhan coronavirus health crisis misinformation was produced by the media, and the misinformation was obtained by users from the internet. The use of the internet has a risk to public health, and, in cases like this, the governments should be developing strategies to regulate health information on the internet without censuring the population. By February 6, 2020, no quality information was available on the internet about COVID-19. %M 32250960 %R 10.2196/18444 %U http://publichealth.jmir.org/2020/2/e18444/ %U https://doi.org/10.2196/18444 %U http://www.ncbi.nlm.nih.gov/pubmed/32250960 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 4 %P e18936 %T Peer-to-Peer Contact Tracing: Development of a Privacy-Preserving Smartphone App %A Yasaka,Tyler M %A Lehrich,Brandon M %A Sahyouni,Ronald %+ Department of Otolaryngology – Head and Neck Surgery, University of California, Irvine, 1001 Health Sciences Rd, Irvine, CA, 92617, United States, 1 949 824 5011, yasaka.tyler@gmail.com %K COVID-19 %K smartphone %K privacy %K contact tracing %K peer-to-peer %K epidemic %K personal data %K mobile phone %K coronavirus %K pandemic %D 2020 %7 7.4.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The novel coronavirus disease 2019 (COVID-19) pandemic is an urgent public health crisis, with epidemiologic models predicting severe consequences, including high death rates, if the virus is permitted to run its course without any intervention or response. Contact tracing using smartphone technology is a powerful tool that may be employed to limit disease transmission during an epidemic or pandemic; yet, contact tracing apps present significant privacy concerns regarding the collection of personal data such as location. Objective: The aim of this study is to develop an effective contact tracing smartphone app that respects user privacy by not collecting location information or other personal data. Methods: We propose the use of an anonymized graph of interpersonal interactions to conduct a novel form of contact tracing and have developed a proof-of-concept smartphone app that implements this approach. Additionally, we developed a computer simulation model that demonstrates the impact of our proposal on epidemic or pandemic outbreak trajectories across multiple rates of adoption. Results: Our proof-of-concept smartphone app allows users to create “checkpoints” for contact tracing, check their risk level based on their past interactions, and anonymously self-report a positive status to their peer network. Our simulation results suggest that higher adoption rates of such an app may result in a better controlled epidemic or pandemic outbreak. Conclusions: Our proposed smartphone-based contact tracing method presents a novel solution that preserves privacy while demonstrating the potential to suppress an epidemic or pandemic outbreak. This app could potentially be applied to the current COVID-19 pandemic as well as other epidemics or pandemics in the future to achieve a middle ground between drastic isolation measures and unmitigated disease spread. %M 32240973 %R 10.2196/18936 %U https://mhealth.jmir.org/2020/4/e18936 %U https://doi.org/10.2196/18936 %U http://www.ncbi.nlm.nih.gov/pubmed/32240973 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e18961 %T Population-Level Interest and Telehealth Capacity of US Hospitals in Response to COVID-19: Cross-Sectional Analysis of Google Search and National Hospital Survey Data %A Hong,Young-Rock %A Lawrence,John %A Williams Jr,Dunc %A Mainous III,Arch %+ Department of Health Services Research, Management and Policy, College of Public Health and Health Professions, University of Florida, PO Box 100195, Gainesville, FL, 32610, United States, 1 3522735335, youngrock.h@phhp.ufl.edu %K COVID-19 %K telehealth %K telemedicine %K screening %K pandemic %K outbreak %K infectious disease %K public health %D 2020 %7 7.4.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: As the novel coronavirus disease (COVID-19) is widely spreading across the United States, there is a concern about the overloading of the nation’s health care capacity. The expansion of telehealth services is expected to deliver timely care for the initial screening of symptomatic patients while minimizing exposure in health care facilities, to protect health care providers and other patients. However, it is currently unknown whether US hospitals have the telehealth capacity to meet the increasing demand and needs of patients during this pandemic. Objective: We investigated the population-level internet search volume for telehealth (as a proxy of population interest and demand) with the number of new COVID-19 cases and the proportion of hospitals that adopted a telehealth system in all US states. Methods: We used internet search volume data from Google Trends to measure population-level interest in telehealth and telemedicine between January 21, 2020 (when the first COVID-19 case was reported), and March 18, 2020. Data on COVID-19 cases in the United States were obtained from the Johns Hopkins Coronavirus Resources Center. We also used data from the 2018 American Hospital Association Annual Survey to estimate the proportion of hospitals that adopted telehealth (including telemedicine and electronic visits) and those with the capability of telemedicine intensive care unit (tele-ICU). Pearson correlation was used to examine the relations of population search volume for telehealth and telemedicine (composite score) with the cumulative numbers of COVID-19 cases in the United States during the study period and the proportion of hospitals with telehealth and tele-ICU capabilities. Results: We found that US population–level interest in telehealth increased as the number of COVID-19 cases increased, with a strong correlation (r=0.948, P<.001). We observed a higher population-level interest in telehealth in the Northeast and West census region, whereas the proportion of hospitals that adopted telehealth was higher in the Midwest region. There was no significant association between population interest and the proportion of hospitals that adopted telehealth (r=0.055, P=.70) nor hospitals having tele-ICU capability (r=–0.073, P=.61). Conclusions: As the number of COVID-19 cases increases, so does the US population’s interest in telehealth. However, the level of population interest did not correlate with the proportion of hospitals providing telehealth services in the United States, suggesting that increased population demand may not be met with the current telehealth capacity. Telecommunication infrastructures in US hospitals may lack the capability to address the ongoing health care needs of patients with other health conditions. More practical investment is needed to deploy the telehealth system rapidly against the impending patient surge. %M 32250963 %R 10.2196/18961 %U http://publichealth.jmir.org/2020/2/e18961/ %U https://doi.org/10.2196/18961 %U http://www.ncbi.nlm.nih.gov/pubmed/32250963 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e18844 %T Novel Coronavirus in Cape Town Informal Settlements: Feasibility of Using Informal Dwelling Outlines to Identify High Risk Areas for COVID-19 Transmission From A Social Distancing Perspective %A Gibson,Lesley %A Rush,David %+ School of Engineering, University of Edinburgh, Kings Buildings, University of Edinburgh, Edinburgh, EH9 3FB, United Kingdom, 44 01316501000, lesley.gibson@ed.ac.uk %K COVID-19 %K Cape Town %K informal settlements %K social distancing %K GIS %K pandemic %K outbreak %K infectious disease %K public health %K geographic data %K risk %D 2020 %7 6.4.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The challenges faced by the Global South during the coronavirus disease (COVID-19) pandemic are compounded by the presence of informal settlements, which are typically densely populated and lacking in formalized sanitation infrastructure. Social distancing measures in informal settlements may be difficult to implement due to the density and layout of settlements. This study measures the distance between dwellings in informal settlements in Cape Town to identify the risk of COVID-19 transmission. Objective: The aim of this paper is to determine if social distancing measures are achievable in informal settlements in Cape Town, using two settlements as an example. We will first examine the distance between dwellings and their first, second, and third nearest neighbors and then identify clusters of dwellings in which residents would be unable to effectively practice social isolation due to the close proximity of their homes. Methods: Dwellings in the settlements of Masiphumelele and Klipfontein Glebe were extracted from a geographic information system data set of outlines of all informal dwellings in Cape Town. The distance to each dwelling’s first, second, and third nearest neighbors was calculated for each settlement. A social distance measure of 2 m was used (buffer of 1 m, as dwellings less than 2 m apart are joined) to identify clusters of dwellings that are unable to effectively practice social distancing in each settlement. Results: The distance to each dwelling’s first 3 nearest neighbors illustrates that the settlement of Masiphumelele is constructed in a denser fashion as compared to the Klipfontein Glebe settlement. This implies that implementing social distancing will likely be more challenging in Masiphumelele than in Klipfontein Glebe. However, using a 2-m social distancing measure, it was demonstrated that large portions of Klipfontein Glebe would also be unable to effectively implement social distancing. Conclusions: Effectively implementing social distancing may be a challenge in informal settlements due to their density. This paper uses dwelling outlines for informal settlements in the city of Cape Town to demonstrate that with a 2 m measure, effective social distancing will be challenging. %M 32250283 %R 10.2196/18844 %U http://publichealth.jmir.org/2020/2/e18844/ %U https://doi.org/10.2196/18844 %U http://www.ncbi.nlm.nih.gov/pubmed/32250283 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e18887 %T Conducting Clinical Research During the COVID-19 Pandemic: Investigator and Participant Perspectives %A Padala,Prasad R %A Jendro,Ashlyn M %A Padala,Kalpana P %+ Geriatric Research Education and Clinical Center, Eugene J Towbin Healthcare Center, Central Arkansas Veterans Healthcare System, 2200 Fort Roots Drive, North Little Rock, AR, 72114-1706, United States, 1 501 257 2537, prasad.padala@va.gov %K clinical research %K COVID-19 %K pandemic %K outbreak %K infectious disease %K public health %K ethics %D 2020 %7 6.4.2020 %9 Viewpoint %J JMIR Public Health Surveill %G English %X As the medical landscape changes daily with the coronavirus disease (COVID-19) pandemic, clinical researchers are caught off-guard and are forced to make decisions on research visits in their ongoing clinical trials. Although there is some guidance from local and national organizations, the principal investigator (PI) is ultimately responsible for determining the risk-benefit ratio of conducting, rescheduling, or cancelling each research visit. The PI should take into consideration the ethical principles of research, local/national guidance, the community risk of the pandemic in their locale, staffing strain, and the risk involved to each participant, to ultimately decide on the course of action. While balancing the rights and protection of the human subject, we seldom examine patients’ views and opinions about their scheduled research visit(s). This article discusses the ethical principles of beneficence and autonomy in helping the decision-making process. We discuss ways to weigh-in local and national guidance, staffing strain, and institutional support into the decision-making process and outline potential changes needed for regulatory bodies depending on the decision. Further, we discuss the need to weigh-in the individual risk-benefit ratio for each participant and present a decision tree to navigate this complex process. Finally, we examine participant and caregiver perspectives on their fears, sense of preparedness, and factors that they consider before deciding whether to keep or postpone the research appointments. This entry also provides PIs ways to support their research participants in both scenarios, including provision of psychological support. %M 32250281 %R 10.2196/18887 %U http://publichealth.jmir.org/2020/2/e18887/ %U https://doi.org/10.2196/18887 %U http://www.ncbi.nlm.nih.gov/pubmed/32250281 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e19043 %T The Three Steps Needed to End the COVID-19 Pandemic: Bold Public Health Leadership, Rapid Innovations, and Courageous Political Will %A Guest,Jodie L %A del Rio,Carlos %A Sanchez,Travis %+ Rollins School of Public Health at Emory University, 1518 Clifton Road NE, Atlanta, GA, 30322, United States, 1 404 727 8403, Travis.Sanchez@emory.edu %K COVID-19 %K coronavirus %K SARS-CoV-2 %D 2020 %7 6.4.2020 %9 Editorial %J JMIR Public Health Surveill %G English %X The world is experiencing the expansive spread of severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) in a global pandemic that is placing strain on health care, economic, and social systems. Commitment to implementing proven public health strategies will require bold public health leadership and courageous acts by politicians. Developing new innovative communication, mitigation, and health care approaches, particularly in the era of social media, is also clearly warranted. We believe that the best public health evidence must inform activities in three priority areas to stop this pandemic: (1) coordinated and consistent stay-at-home orders across multiple jurisdictions, including potential nationwide mandates; (2) rapid scale-up of SARS-CoV-2 testing; and (3) improved health care capacity to respond. This editorial outlines those areas, the rationale behind them, and the call for innovation and engagement of bold public health leadership to empower courageous political action to reduce the number of deaths during this pandemic. %M 32240972 %R 10.2196/19043 %U https://publichealth.jmir.org/2020/2/e19043 %U https://doi.org/10.2196/19043 %U http://www.ncbi.nlm.nih.gov/pubmed/32240972 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 4 %P e18790 %T Use of Rapid Online Surveys to Assess People's Perceptions During Infectious Disease Outbreaks: A Cross-sectional Survey on COVID-19 %A Geldsetzer,Pascal %+ Division of Primary Care and Population Health, Department of Medicine, Stanford University, 1265 Welch Road, Stanford, CA, 94035, United States, 1 6507238596, pgeldsetzer@stanford.edu %K rapid online surveys %K perceptions %K knowledge %K coronavirus %K SARS-CoV-2 %K pandemic %K infectious disease %K outbreak %K survey %K COVID-19 %K public health %D 2020 %7 2.4.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Given the extensive time needed to conduct a nationally representative household survey and the commonly low response rate of phone surveys, rapid online surveys may be a promising method to assess and track knowledge and perceptions among the general public during fast-moving infectious disease outbreaks. Objective: This study aimed to apply rapid online surveying to determine knowledge and perceptions of coronavirus disease 2019 (COVID-19) among the general public in the United States and the United Kingdom. Methods: An online questionnaire was administered to 3000 adults residing in the United States and 3000 adults residing in the United Kingdom who had registered with Prolific Academic to participate in online research. Prolific Academic established strata by age (18-27, 28-37, 38-47, 48-57, or ≥58 years), sex (male or female), and ethnicity (white, black or African American, Asian or Asian Indian, mixed, or “other”), as well as all permutations of these strata. The number of participants who could enroll in each of these strata was calculated to reflect the distribution in the US and UK general population. Enrollment into the survey within each stratum was on a first-come, first-served basis. Participants completed the questionnaire between February 23 and March 2, 2020. Results: A total of 2986 and 2988 adults residing in the United States and the United Kingdom, respectively, completed the questionnaire. Of those, 64.4% (1924/2986) of US participants and 51.5% (1540/2988) of UK participants had a tertiary education degree, 67.5% (2015/2986) of US participants had a total household income between US $20,000 and US $99,999, and 74.4% (2223/2988) of UK participants had a total household income between £15,000 and £74,999. US and UK participants’ median estimate for the probability of a fatal disease course among those infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was 5.0% (IQR 2.0%-15.0%) and 3.0% (IQR 2.0%-10.0%), respectively. Participants generally had good knowledge of the main mode of disease transmission and common symptoms of COVID-19. However, a substantial proportion of participants had misconceptions about how to prevent an infection and the recommended care-seeking behavior. For instance, 37.8% (95% CI 36.1%-39.6%) of US participants and 29.7% (95% CI 28.1%-31.4%) of UK participants thought that wearing a common surgical mask was “highly effective” in protecting them from acquiring COVID-19, and 25.6% (95% CI 24.1%-27.2%) of US participants and 29.6% (95% CI 28.0%-31.3%) of UK participants thought it was prudent to refrain from eating at Chinese restaurants. Around half (53.8%, 95% CI 52.1%-55.6%) of US participants and 39.1% (95% CI 37.4%-40.9%) of UK participants thought that children were at an especially high risk of death when infected with SARS-CoV-2. Conclusions: The distribution of participants by total household income and education followed approximately that of the US and UK general population. The findings from this online survey could guide information campaigns by public health authorities, clinicians, and the media. More broadly, rapid online surveys could be an important tool in tracking the public’s knowledge and misperceptions during rapidly moving infectious disease outbreaks. %M 32240094 %R 10.2196/18790 %U http://www.jmir.org/2020/4/e18790/ %U https://doi.org/10.2196/18790 %U http://www.ncbi.nlm.nih.gov/pubmed/32240094 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e18807 %T Preventive Behaviors Conveyed on YouTube to Mitigate Transmission of COVID-19: Cross-Sectional Study %A Basch,Corey H %A Hillyer,Grace C %A Meleo-Erwin,Zoe C %A Jaime,Christie %A Mohlman,Jan %A Basch,Charles E %+ William Paterson University, University Hall, Wayne, NJ, 07470, United States, 1 9737202603, baschc@wpunj.edu %K YouTube %K COVID-19 %K social media %K pandemic %K outbreak %K infectious disease %K public health %K prevention %D 2020 %7 2.4.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Accurate information and guidance about personal behaviors that can reduce exposure to severe acute respiratory syndrome coronavirus 2 are among the most important elements in mitigating the spread of coronavirus disease 2019 (COVID-19). With over 2 billion users, YouTube is a media channel that millions turn to when seeking information. Objective: At the time of this study, there were no published studies investigating the content of YouTube videos related to COVID-19. This study aims to address this gap in the current knowledge. Methods: The 100 most widely viewed YouTube videos uploaded throughout the month of January 2020 were reviewed and the content covered was described. Collectively, these videos were viewed over 125 million times. Results: Fewer than one-third of the videos covered any of the seven key prevention behaviors listed on the US Centers for Disease Control and Prevention website. Conclusions: These results represent an important missed opportunity for disease prevention. %M 32240096 %R 10.2196/18807 %U http://publichealth.jmir.org/2020/2/e18807/ %U https://doi.org/10.2196/18807 %U http://www.ncbi.nlm.nih.gov/pubmed/32240096 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e18606 %T Emergence of a Novel Coronavirus (COVID-19): Protocol for Extending Surveillance Used by the Royal College of General Practitioners Research and Surveillance Centre and Public Health England %A de Lusignan,Simon %A Lopez Bernal,Jamie %A Zambon,Maria %A Akinyemi,Oluwafunmi %A Amirthalingam,Gayatri %A Andrews,Nick %A Borrow,Ray %A Byford,Rachel %A Charlett,André %A Dabrera,Gavin %A Ellis,Joanna %A Elliot,Alex J %A Feher,Michael %A Ferreira,Filipa %A Krajenbrink,Else %A Leach,Jonathan %A Linley,Ezra %A Liyanage,Harshana %A Okusi,Cecilia %A Ramsay,Mary %A Smith,Gillian %A Sherlock,Julian %A Thomas,Nicholas %A Tripathy,Manasa %A Williams,John %A Howsam,Gary %A Joy,Mark %A Hobbs,Richard %+ Nuffield Department of Primary Care Health Sciences, University of Oxford, Eagle House,Walton Well Road, Oxford, OX2 6ED, United Kingdom, 44 01865289344, simon.delusignan@phc.ox.ac.uk %K general practice %K medical record systems %K computerized %K sentinel surveillance %K coronavirus %K COVID-19 %K SARS-CoV-2 %K surveillance %K infections %K pandemic %K records as topic %K serology %D 2020 %7 2.4.2020 %9 Protocol %J JMIR Public Health Surveill %G English %X Background: The Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC) and Public Health England (PHE) have successfully worked together on the surveillance of influenza and other infectious diseases for over 50 years, including three previous pandemics. With the emergence of the international outbreak of the coronavirus infection (COVID-19), a UK national approach to containment has been established to test people suspected of exposure to COVID-19. At the same time and separately, the RCGP RSC’s surveillance has been extended to monitor the temporal and geographical distribution of COVID-19 infection in the community as well as assess the effectiveness of the containment strategy. Objectives: The aims of this study are to surveil COVID-19 in both asymptomatic populations and ambulatory cases with respiratory infections, ascertain both the rate and pattern of COVID-19 spread, and assess the effectiveness of the containment policy. Methods: The RCGP RSC, a network of over 500 general practices in England, extract pseudonymized data weekly. This extended surveillance comprises of five components: (1) Recording in medical records of anyone suspected to have or who has been exposed to COVID-19. Computerized medical records suppliers have within a week of request created new codes to support this. (2) Extension of current virological surveillance and testing people with influenza-like illness or lower respiratory tract infections (LRTI)—with the caveat that people suspected to have or who have been exposed to COVID-19 should be referred to the national containment pathway and not seen in primary care. (3) Serology sample collection across all age groups. This will be an extra blood sample taken from people who are attending their general practice for a scheduled blood test. The 100 general practices currently undertaking annual influenza virology surveillance will be involved in the extended virological and serological surveillance. (4) Collecting convalescent serum samples. (5) Data curation. We have the opportunity to escalate the data extraction to twice weekly if needed. Swabs and sera will be analyzed in PHE reference laboratories. Results: General practice clinical system providers have introduced an emergency new set of clinical codes to support COVID-19 surveillance. Additionally, practices participating in current virology surveillance are now taking samples for COVID-19 surveillance from low-risk patients presenting with LRTIs. Within the first 2 weeks of setup of this surveillance, we have identified 3 cases: 1 through the new coding system, the other 2 through the extended virology sampling. Conclusions: We have rapidly converted the established national RCGP RSC influenza surveillance system into one that can test the effectiveness of the COVID-19 containment policy. The extended surveillance has already seen the use of new codes with 3 cases reported. Rapid sharing of this protocol should enable scientific critique and shared learning. International Registered Report Identifier (IRRID): DERR1-10.2196/18606 %M 32240095 %R 10.2196/18606 %U https://publichealth.jmir.org/2020/2/e18606 %U https://doi.org/10.2196/18606 %U http://www.ncbi.nlm.nih.gov/pubmed/32240095 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e18810 %T Global Telemedicine Implementation and Integration Within Health Systems to Fight the COVID-19 Pandemic: A Call to Action %A Ohannessian,Robin %A Duong,Tu Anh %A Odone,Anna %+ Télémédecine 360, TLM360, 55 Avenue Marceau, Paris, 75116, France, 33 647814410, robin.ohannessian@telemedecine-360.com %K telemedicine %K telehealth %K digital health %K digital medicine %K COVID-19 %K coronavirus %K SARS-CoV-2 %K public health %K surveillance %K outbreak %K pandemic %D 2020 %7 2.4.2020 %9 Viewpoint %J JMIR Public Health Surveill %G English %X On March 11, 2020, the World Health Organization declared the coronavirus disease 2019 (COVID-19) outbreak as a pandemic, with over 720,000 cases reported in more than 203 countries as of 31 March. The response strategy included early diagnosis, patient isolation, symptomatic monitoring of contacts as well as suspected and confirmed cases, and public health quarantine. In this context, telemedicine, particularly video consultations, has been promoted and scaled up to reduce the risk of transmission, especially in the United Kingdom and the United States of America. Based on a literature review, the first conceptual framework for telemedicine implementation during outbreaks was published in 2015. An updated framework for telemedicine in the COVID-19 pandemic has been defined. This framework could be applied at a large scale to improve the national public health response. Most countries, however, lack a regulatory framework to authorize, integrate, and reimburse telemedicine services, including in emergency and outbreak situations. In this context, Italy does not include telemedicine in the essential levels of care granted to all citizens within the National Health Service, while France authorized, reimbursed, and actively promoted the use of telemedicine. Several challenges remain for the global use and integration of telemedicine into the public health response to COVID-19 and future outbreaks. All stakeholders are encouraged to address the challenges and collaborate to promote the safe and evidence-based use of telemedicine during the current pandemic and future outbreaks. For countries without integrated telemedicine in their national health care system, the COVID-19 pandemic is a call to adopt the necessary regulatory frameworks for supporting wide adoption of telemedicine. %M 32238336 %R 10.2196/18810 %U https://publichealth.jmir.org/2020/2/e18810 %U https://doi.org/10.2196/18810 %U http://www.ncbi.nlm.nih.gov/pubmed/32238336 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e18717 %T Assessment of Health Information About COVID-19 Prevention on the Internet: Infodemiological Study %A Hernández-García,Ignacio %A Giménez-Júlvez,Teresa %+ Department of Preventive Medicine, Lozano Blesa University Clinical Hospital of Zaragoza, Avda San Juan Bosco 15, Zaragoza, 50009, Spain, 34 976 76 57 00 ext 162414, ignaciohernandez79@yahoo.es %K COVID-19 %K coronavirus %K prevention %K internet %K information %K evaluation %K authorship %K World Health Organization %K official public health organizations %K digital media %K infodemic %K infodemiology %D 2020 %7 1.4.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The internet is a large source of health information and has the capacity to influence its users. However, the information found on the internet often lacks scientific rigor, as anyone may upload content. This factor is a cause of great concern to scientific societies, governments, and users. Objective: The objective of our study was to investigate the information about the prevention of coronavirus disease 2019 (COVID-19) on the internet. Methods: On February 29, 2020, we performed a Google search with the terms “Prevention coronavirus,” “Prevention COVID-19,” “Prevención coronavirus,” and “Prevención COVID-19”. A univariate analysis was performed to study the association between the type of authorship, country of publication, and recommendations to avoid COVID-19 according to the World Health Organization (WHO). Results: In total, 80 weblinks were reviewed. Most of them were produced in the United States and Spain (n=58, 73%) by digital media sources and official public health organizations (n=60, 75%). The most mentioned WHO preventive measure was “wash your hands frequently” (n=65, 81%). A less frequent recommendation was to “stay home if you feel unwell” (n=26, 33%). The analysis by type of author (official public health organizations versus digital media) revealed significant differences regarding the recommendation to wear a mask when you are healthy only if caring for a person with suspected COVID-19 (odds ratio [OR] 4.39). According to the country of publication (Spain versus the United States), significant differences were detected regarding some recommendations such as “wash your hands frequently” (OR 9.82), “cover your mouth and nose with your bent elbow or tissue when you cough or sneeze” (OR 4.59), or “stay home if you feel unwell” (OR 0.31). Conclusions: It is necessary to urge and promote the use of the websites of official public health organizations when seeking information on COVID-19 preventive measures on the internet. In this way, users will be able to obtain high-quality information more frequently, and such websites may improve their accessibility and positioning, given that search engines justify the positioning of links obtained in a search based on the frequency of access to them. %M 32217507 %R 10.2196/18717 %U https://publichealth.jmir.org/2020/2/e18717 %U https://doi.org/10.2196/18717 %U http://www.ncbi.nlm.nih.gov/pubmed/32217507 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 1 %P e18503 %T The Role of the Global Health Development/Eastern Mediterranean Public Health Network and the Eastern Mediterranean Field Epidemiology Training Programs in Preparedness for COVID-19 %A Al Nsour,Mohannad %A Bashier,Haitham %A Al Serouri,Abulwahed %A Malik,Elfatih %A Khader,Yousef %A Saeed,Khwaja %A Ikram,Aamer %A Abdalla,Abdalla Mohammed %A Belalia,Abdelmounim %A Assarag,Bouchra %A Baig,Mirza Amir %A Almudarra,Sami %A Arqoub,Kamal %A Osman,Shahd %A Abu-Khader,Ilham %A Shalabi,Dana %A Majeed,Yasir %+ Jordan University of Science and Technology, Ar Ramtha 3030, Irbid, 22110, Jordan, 962 796802040, yskhader@just.edu.jo %K COVID-19 %K outbreak %K preparedness %K response %K public health %D 2020 %7 27.3.2020 %9 Editorial %J JMIR Public Health Surveill %G English %X The World Health Organization (WHO) declared the current COVID-19 a public health emergency of international concern on January 30, 2020. Countries in the Eastern Mediterranean Region (EMR) have a high vulnerability and variable capacity to respond to outbreaks. Many of these countries addressed the need for increasing capacity in the areas of surveillance and rapid response to public health threats. Moreover, countries addressed the need for communication strategies that direct the public to actions for self- and community protection. This viewpoint article aims to highlight the contribution of the Global Health Development (GHD)/Eastern Mediterranean Public Health Network (EMPHNET) and the EMR’s Field Epidemiology Training Program (FETPs) to prepare for and respond to the current COVID-19 threat. GHD/EMPHNET has the scientific expertise to contribute to elevating the level of country alert and preparedness in the EMR and to provide technical support through health promotion, training and training materials, guidelines, coordination, and communication. The FETPs are currently actively participating in surveillance and screening at the ports of entry, development of communication materials and guidelines, and sharing information to health professionals and the public. However, some countries remain ill-equipped, have poor diagnostic capacity, and are in need of further capacity development in response to public health threats. It is essential that GHD/EMPHNET and FETPs continue building the capacity to respond to COVID-19 and intensify support for preparedness and response to public health emergencies. %M 32217506 %R 10.2196/18503 %U http://publichealth.jmir.org/2020/1/e18503/ %U https://doi.org/10.2196/18503 %U http://www.ncbi.nlm.nih.gov/pubmed/32217506 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 7 %N 3 %P e18848 %T Digital Mental Health and COVID-19: Using Technology Today to Accelerate the Curve on Access and Quality Tomorrow %A Torous,John %A Jän Myrick,Keris %A Rauseo-Ricupero,Natali %A Firth,Joseph %+ Division of Digital Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Rabb 2, 330 Brookline Ave, Boston, MA, 02215, United States, 1 61766700, jtorous@bidmc.harvard.edu %K digital health %K emergency response %K telehealth %K apps %D 2020 %7 26.3.2020 %9 Editorial %J JMIR Ment Health %G English %X As interest in and use of telehealth during the COVID-19 global pandemic increase, the potential of digital health to increase access and quality of mental health is becoming clear. Although the world today must “flatten the curve” of spread of the virus, we argue that now is the time to “accelerate and bend the curve” on digital health. Increased investments in digital health today will yield unprecedented access to high-quality mental health care. Focusing on personal experiences and projects from our diverse authorship team, we share selected examples of digital health innovations while acknowledging that no single piece can discuss all the impressive global efforts past and present. Exploring the success of telehealth during the present crisis and how technologies like apps can soon play a larger role, we discuss the need for workforce training, high-quality evidence, and digital equity among other factors critical for bending the curve further. %M 32213476 %R 10.2196/18848 %U http://mental.jmir.org/2020/3/e18848/ %U https://doi.org/10.2196/18848 %U http://www.ncbi.nlm.nih.gov/pubmed/32213476