%0 Journal Article %@ 14388871 %I JMIR Publications Inc. %V 15 %N 4 %P e84 %T Multilevel Growth Curve Analyses of Treatment Effects of a Web-Based Intervention for Stress Reduction: Randomized Controlled Trial %A Drozd,Filip %A Raeder,Sabine %A Kraft,Pål %A Bjørkli,Cato Alexander %+ Research and Development, Changetech AS, Changetech AS, Gaustadalléen 21, Oslo, N-0349, Norway, 47 97516188, fd@changetech.no %K stress, multilevel modeling, randomized controlled trial, mindfulness, procrastination, multiple mediation, multiple moderation, Web %D 2013 %7 22.04.2013 %9 Original Paper %J J Med Internet Res %G English %X Background: Stress is commonly experienced by many people and it is a contributing factor to many mental and physical health conditions, However, few efforts have been made to develop and test the effects of interventions for stress. Objective: The aim of this study was to examine the effects of a Web-based stress-reduction intervention on stress, investigate mindfulness and procrastination as potential mediators of any treatment effects, and test whether the intervention is equally effective for females as males, all ages, and all levels of education. Methods: We employed a randomized controlled trial in this study. Participants were recruited online via Facebook and randomly assigned to either the stress intervention or a control condition. The Web-based stress intervention was fully automated and consisted of 13 sessions over 1 month. The controls were informed that they would get access to the intervention after the final data collection. Data were collected at baseline and at 1, 2, and 6 months after intervention onset by means of online questionnaires. Outcomes were stress, mindfulness, and procrastination, which were all measured at every measurement occasion. Results: A total of 259 participants were included and were allocated to either the stress intervention (n=126) or the control condition (n=133). Participants in the intervention and control group were comparable at baseline; however, results revealed that participants in the stress intervention followed a statistically different (ie, cubic) developmental trajectory in stress levels over time compared to the controls. A growth curve analysis showed that participants in the stress intervention (unstandardized beta coefficient [B]=–3.45, P=.008) recovered more quickly compared to the control group (B=–0.81, P=.34) from baseline to 1 month. Although participants in the stress intervention did show increases in stress levels during the study period (B=2.23, P=.008), long-term stress levels did decrease again toward study end at 6 months (B=–0.28, P=.009). Stress levels in the control group, however, remained largely unchanged after 1 month (B=0.29, P=.61) and toward 6 months (B=–0.03, P=.67). Mediation analyses showed nonlinear (ie, cubic) specific indirect effects of mindfulness and a linear specific indirect effect of procrastination on stress. In simple terms, the intervention increased mindfulness and decreased procrastination, which was related to lower stress levels. Finally, the effect of the stress intervention was independent of participants’ gender, age, or education. Conclusions: The results from this randomized controlled trial suggest that a Web-based intervention can reduce levels of stress in a normal population and that both mindfulness and procrastination may be important components included in future eHealth interventions for stress. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN): 25619675; http://controlled-trials.com/ISRCTN25619675 (Archived by Webcite at http://www.webcitation.org/6FxB1gOKY) %M 23607962 %R 10.2196/jmir.2570 %U http://www.jmir.org/2013/4/e84/ %U https://doi.org/10.2196/jmir.2570 %U http://www.ncbi.nlm.nih.gov/pubmed/23607962 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 15 %N 4 %P e68 %T Use of a Text Message-Based Pharmacovigilance Tool in Cambodia: Pilot Study %A Baron,Sophie %A Goutard,Flavie %A Nguon,Kunthy %A Tarantola,Arnaud %+ Epidemiology and Public Health Unit (epi@ipc), Institut Pasteur du Cambodge, 5, Bvd Monivong, Phnom Penh, BP983, Cambodia, 855 12 333 650, atarantola@pasteur-kh.org %K cellular phone %K text messages %K texting %K short message service %K vaccines %K adverse events %K surveillance %K adverse drug reaction reporting systems %K pharmacovigilance %D 2013 %7 16.04.2013 %9 Original Paper %J J Med Internet Res %G English %X Background: There is no functional pharmacovigilance system in Cambodia to our knowledge. Mobile phone–based tools, such as short message service (SMS) text messages, are increasingly used for surveillance purposes. Objective: To pilot-test the FrontlineSMS mobile phone–based tool for notification of adverse events, using Cambodia’s only International Vaccination Center at the Institut Pasteur du Cambodge as a field site. Methods: People receiving vaccinations, aged over 18 years, and who owned a cell phone were recruited in the study following informed consent. The names and mobile phone numbers of the participants interviewed were entered each day into the FrontlineSMS software. Two days after being vaccinated, participants received an automatically generated SMS text message asking whether any adverse events had occurred. Their SMS reply was number-coded and exported from the software daily to an Excel spreadsheet and examined before being saved. If the participant replied with a code for a severe adverse event (8 or 9), they were automatically advised to consult the nearest doctor. Results: The active surveillance study was conducted over 72 days in the spring of 2012. Patients agreed to be asked by SMS text message whether unwanted events had occurred after vaccination. Of 1331 persons aged over 18 years referred to the vaccination unit, 184 (13.8%) were asked and agreed to participate. When texted for clinical status 48 hours after vaccination, 52 (28.3%) participants did not reply, 101 (54.9%) sent an immediate SMS reply, and 31 (16.8%) sent an SMS reply after additional prompting. Of the initial 184 participants, 132 (71.7%) replied. These 132 participants received 135 vaccine doses and 109 (82.6%) reported no adverse events, whereas 23 (17.4%) reported adverse events, all benign. Conclusions: Notification using an SMS-based text message system is already used in Cambodia for syndromic surveillance in health centers and reporting by health care workers. Our results show that such tools can also be useful for notification by patients or health users in Cambodia, especially in an urban setting. %M 23591700 %R 10.2196/jmir.2477 %U http://www.jmir.org/2013/4/e68/ %U https://doi.org/10.2196/jmir.2477 %U http://www.ncbi.nlm.nih.gov/pubmed/23591700 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 15 %N 4 %P e60 %T A Comparison of Two Delivery Modalities of a Mobile Phone-Based Assessment for Serious Mental Illness: Native Smartphone Application vs Text-Messaging Only Implementations %A Ainsworth,John %A Palmier-Claus,Jasper E %A Machin,Matthew %A Barrowclough,Christine %A Dunn,Graham %A Rogers,Anne %A Buchan,Iain %A Barkus,Emma %A Kapur,Shitij %A Wykes,Til %A Hopkins,Richard S %A Lewis,Shôn %+ NIBHI Manchester Health e-Research Centre, Institue of Population Health, University of Manchester, Oxford Road, Manchester, M13 9PL, United Kingdom, 44 1612751129, John.Ainsworth@manchester.ac.uk %K mobile phone %K psychosis %K assessment %K schizophrenia %K text-messages %D 2013 %7 05.04.2013 %9 Original Paper %J J Med Internet Res %G English %X Background: Mobile phone–based assessment may represent a cost-effective and clinically effective method of monitoring psychotic symptoms in real-time. There are several software options, including the use of native smartphone applications and text messages (short message service, SMS). Little is known about the strengths and limitations of these two approaches in monitoring symptoms in individuals with serious mental illness. Objective: The objective of this study was to compare two different delivery modalities of the same diagnostic assessment for individuals with non-affective psychosis—a native smartphone application employing a graphical, touch user interface against an SMS text-only implementation. The overall hypothesis of the study was that patient participants with sewrious mental illness would find both delivery modalities feasible and acceptable to use, measured by the quantitative post-assessment feedback questionnaire scores, the number of data points completed, and the time taken to complete the assessment. It was also predicted that a native smartphone application would (1) yield a greater number of data points, (2) take less time, and (3) be more positively appraised by patient participant users than the text-based system. Methods: A randomized repeated measures crossover design was employed. Participants with currently treated Diagnostic and Statistical Manual (Fourth Edition) schizophrenia or related disorders (n=24) were randomly allocated to completing 6 days of assessment (four sets of questions per day) with a native smartphone application or the SMS text-only implementation. There was then a 1-week break before completing a further 6 days with the alternative delivery modality. Quantitative feedback questionnaires were administered at the end of each period of sampling. Results: A greater proportion of data points were completed with the native smartphone application in comparison to the SMS text-only implementation (β = -.25, SE=.11, P=.02), which also took significantly less time to complete (β =.78, SE= .09, P<.001). Although there were no significant differences in participants’ quantitative feedback for the two delivery modalities, most participants reported preferring the native smartphone application (67%; n=16) and found it easier to use (71%; n=16). 33% of participants reported that they would be willing to complete mobile phone assessment for 5 weeks or longer. Conclusions: Native smartphone applications and SMS text are both valuable methods of delivering real-time assessment in individuals with schizophrenia. However, a more streamlined graphical user interface may lead to better compliance and shorter entry times. Further research is needed to test the efficacy of this technology within clinical services, to assess validity over longer periods of time and when delivered on patients’ own phones. %M 23563184 %R 10.2196/jmir.2328 %U http://www.jmir.org/2013/4/e60/ %U https://doi.org/10.2196/jmir.2328 %U http://www.ncbi.nlm.nih.gov/pubmed/23563184 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 15 %N 4 %P e32 %T Adherence to a Smartphone Application for Weight Loss Compared to Website and Paper Diary: Pilot Randomized Controlled Trial %A Carter,Michelle Clare %A Burley,Victoria Jane %A Nykjaer,Camilla %A Cade,Janet Elizabeth %+ Nutritional Epidemiology Group, School of Food Science and Nutrition, University of Leeds, Food Science Building, Leeds, LS2 9JT, United Kingdom, 44 113 343 ext 8908, m.carter@leeds.ac.uk %K smartphone %K obesity %K text message %K app %D 2013 %7 15.04.2013 %9 Original Paper %J J Med Internet Res %G English %X Background: There is growing interest in the use of information communication technologies to treat obesity. An intervention delivered by smartphone could be a convenient, potentially cost-effective, and wide-reaching weight management strategy. Although there have been studies of texting-based interventions and smartphone applications (apps) used as adjuncts to other treatments, there are currently no randomized controlled trials (RCT) of a stand-alone smartphone application for weight loss that focuses primarily on self-monitoring of diet and physical activity. Objective: The aim of this pilot study was to collect acceptability and feasibility outcomes of a self-monitoring weight management intervention delivered by a smartphone app, compared to a website and paper diary. Methods: A sample of 128 overweight volunteers were randomized to receive a weight management intervention delivered by smartphone app, website, or paper diary. The smartphone app intervention, My Meal Mate (MMM), was developed by the research team using an evidence-based behavioral approach. The app incorporates goal setting, self-monitoring of diet and activity, and feedback via weekly text message. The website group used an existing commercially available slimming website from a company called Weight Loss Resources who also provided the paper diaries. The comparator groups delivered a similar self-monitoring intervention to the app, but by different modes of delivery. Participants were recruited by email, intranet, newsletters, and posters from large local employers. Trial duration was 6 months. The intervention and comparator groups were self-directed with no ongoing human input from the research team. The only face-to-face components were at baseline enrollment and brief follow-up sessions at 6 weeks and 6 months to take anthropometric measures and administer questionnaires. Results: Trial retention was 40/43 (93%) in the smartphone group, 19/42 (55%) in the website group, and 20/43 (53%) in the diary group at 6 months. Adherence was statistically significantly higher in the smartphone group with a mean of 92 days (SD 67) of dietary recording compared with 35 days (SD 44) in the website group and 29 days (SD 39) in the diary group (P<.001). Self-monitoring declined over time in all groups. In an intention-to-treat analysis using baseline observation carried forward for missing data, mean weight change at 6 months was -4.6 kg (95% CI –6.2 to –3.0) in the smartphone app group, –2.9 kg (95% CI –4.7 to –1.1) in the diary group, and –1.3 kg (95% CI –2.7 to 0.1) in the website group. BMI change at 6 months was –1.6 kg/m2 (95% CI –2.2 to –1.1) in the smartphone group, –1.0 kg/m2 (95% CI –1.6 to –0.4) in the diary group, and –0.5 kg/m2 (95% CI –0.9 to 0.0) in the website group. Change in body fat was –1.3% (95% CI –1.7 to –0.8) in the smartphone group, –0.9% (95% CI –1.5 to –0.4) in the diary group, and –0.5% (95% CI –0.9 to 0.0) in the website group. Conclusions: The MMM app is an acceptable and feasible weight loss intervention and a full RCT of this approach is warranted. Trial Registration: ClinicalTrials.gov NCT01744535; http://clinicaltrials.gov/ct2/show/NCT01744535 (Archived by WebCite at http://www.webcitation.org/6FEtc3PVB) %M 23587561 %R 10.2196/jmir.2283 %U http://www.jmir.org/2013/4/e32/ %U https://doi.org/10.2196/jmir.2283 %U http://www.ncbi.nlm.nih.gov/pubmed/23587561 %0 Journal Article %@ 14388871 %I JMIR Publications Inc. %V 15 %N 4 %P e86 %T Opportunities and Challenges for Smartphone Applications in Supporting Health Behavior Change: Qualitative Study %A Dennison,Laura %A Morrison,Leanne %A Conway,Gemma %A Yardley,Lucy %+ Academic Unit of Psychology, University of Southampton, Shackleton Building, Highfield Campus, Highfield, Southampton, SO171BJ, United Kingdom, 44 02380 ext 597657, l.k.dennison@soton.ac.uk %K mobile phone %K cellular phone %K behavior %K health %K qualitative research %K focus groups %D 2013 %7 18.04.2013 %9 Original Paper %J J Med Internet Res %G English %X Background: There is increasing interest from academics and clinicians in harnessing smartphone applications (apps) as a means of delivering behavioral interventions for health. Despite the growing availability of a range of health-related apps on the market, academic research on the development and evaluation of such apps is in the relatively early stages. A few existing studies have explored the views of various populations on using mobile phones for health-related issues and some studies are beginning to report user feedback on specific apps. However, there remains little in depth research on users’ (and potential users’) experiences and views on a wide range of features and technologies that apps are, or will soon be, capable of. In particular, research on young adults is lacking, which is an unfortunate omission considering that this group comprises of a good number of mobile technology adoptors. Objective: The current study sought to explore young adults’ perspectives on apps related to health behavior change. It sought their experiences and views of features that might support health behavior change and issues that contribute to interest in and willingness to use such apps. Methods: Four focus groups were conducted with 19 students and staff at a University in the United Kingdom. Participants included 13 females and 6 males with a mean age of 23.79 (SD 7.89). The focus group discussions centred on participants’ experiences of using smartphone apps to support a healthy lifestyle, and their interest in and feelings about features and capabilities of such apps. The focus groups were recorded, transcribed, and analyzed using inductive thematic analysis. Results: Study findings suggested that young, currently healthy adults have some interest in apps that attempt to support health-related behavior change. Accuracy and legitimacy, security, effort required, and immediate effects on mood emerged as important influences on app usage. The ability to record and track behavior and goals and the ability to acquire advice and information “on the go” were valued. Context-sensing capabilities and social media features tended to be considered unnecessary and off-putting. Conclusions: This study provided insight into the opportunities and challenges involved in delivering health-related behavioral interventions through smartphone apps. The findings suggested a number of valued features and characteristics that app developers may wish to consider when creating health behavior apps. Findings also highlighted several major challenges that appeared to need further consideration and research to ensure the development of effective and well-accepted behavior change apps. %M 23598614 %R 10.2196/jmir.2583 %U http://www.jmir.org/2013/4/e86/ %U https://doi.org/10.2196/jmir.2583 %U http://www.ncbi.nlm.nih.gov/pubmed/23598614 %0 Journal Article %@ 14388871 %I JMIR Publications Inc. %V 15 %N 4 %P e76 %T Hispanic Migrant Farm Workers' Attitudes Toward Mobile Phone-Based Telehealth for Management of Chronic Health Conditions %A Price,Matthew %A Williamson,Deborah %A McCandless,Romina %A Mueller,Martina %A Gregoski,Mathew %A Brunner-Jackson,Brenda %A Treiber,Eveline %A Davidson,Lydia %A Treiber,Frank %+ Technology Applications Center for Healthy Lifestyles, College of Nursing, Medical University of South Carolina, 19 Hagood Avenue, Suite 1002, Charleston, SC, 29425, United States, 1 843 792 8852, treiberf@musc.edu %K mobile phone %K hypertension %K health care disparities %K rural health %D 2013 %7 26.04.2013 %9 Original Paper %J J Med Internet Res %G English %X Background: Mobile phone–based interventions present a means of providing high quality health care to hard-to-reach underserved populations. Migrant farm workers (MFWs) are among the most underserved populations in the United States due to a high prevalence of chronic diseases yet limited access to health care. However, it is unknown if MFWs have access to mobile phone devices used in mobile health (mHealth) interventions, or if they are willing to use such technologies. Objective: Determine rates of ownership of mobile devices and willingness to use mHealth strategies in MFWs. Methods: A demonstration of mHealth devices and a survey were individually administered to 80 Hispanic MFWs to evaluate use of mobile phones and mHealth devices and willingness to use such technologies. Results: Of the 80 participants, 81% (65/80) owned cell phones capable of sending and receiving health-related messages. Most participants (65/80, 81%) were receptive to using mHealth technology and felt it would be helpful in enhancing medication adherence, self-monitoring health conditions, and receiving quicker medication changes from their doctors (median scores ≥4 on 5-point Likert scales). Relations between age and attitudes toward using mHealth were not statistically significant. Conclusions: Hispanic MFWs have access to mobile phones and are willing to use mHealth devices. Future work is needed to comprehensively evaluate the degree to which these devices could be used. %M 23624105 %R 10.2196/jmir.2500 %U http://www.jmir.org/2013/4/e76/ %U https://doi.org/10.2196/jmir.2500 %U http://www.ncbi.nlm.nih.gov/pubmed/23624105 %0 Journal Article %@ 14388871 %I JMIR Publications Inc. %V 15 %N 4 %P e73 %T Web 2.0-Based Crowdsourcing for High-Quality Gold Standard Development in Clinical Natural Language Processing %A Zhai,Haijun %A Lingren,Todd %A Deleger,Louise %A Li,Qi %A Kaiser,Megan %A Stoutenborough,Laura %A Solti,Imre %+ Division of Biomedical Informatics, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45229, United States, 1 513 636 1020, imre.solti@cchmc.org %K clinical informatics %K natural language processing %K named entity %K reference standards %K crowdsourcing %K user computer interface %K quality control %D 2013 %7 02.04.2013 %9 Original Paper %J J Med Internet Res %G English %X Background: A high-quality gold standard is vital for supervised, machine learning-based, clinical natural language processing (NLP) systems. In clinical NLP projects, expert annotators traditionally create the gold standard. However, traditional annotation is expensive and time-consuming. To reduce the cost of annotation, general NLP projects have turned to crowdsourcing based on Web 2.0 technology, which involves submitting smaller subtasks to a coordinated marketplace of workers on the Internet. Many studies have been conducted in the area of crowdsourcing, but only a few have focused on tasks in the general NLP field and only a handful in the biomedical domain, usually based upon very small pilot sample sizes. In addition, the quality of the crowdsourced biomedical NLP corpora were never exceptional when compared to traditionally-developed gold standards. The previously reported results on medical named entity annotation task showed a 0.68 F-measure based agreement between crowdsourced and traditionally-developed corpora. Objective: Building upon previous work from the general crowdsourcing research, this study investigated the usability of crowdsourcing in the clinical NLP domain with special emphasis on achieving high agreement between crowdsourced and traditionally-developed corpora. Methods: To build the gold standard for evaluating the crowdsourcing workers’ performance, 1042 clinical trial announcements (CTAs) from the ClinicalTrials.gov website were randomly selected and double annotated for medication names, medication types, and linked attributes. For the experiments, we used CrowdFlower, an Amazon Mechanical Turk-based crowdsourcing platform. We calculated sensitivity, precision, and F-measure to evaluate the quality of the crowd’s work and tested the statistical significance (P<.001, chi-square test) to detect differences between the crowdsourced and traditionally-developed annotations. Results: The agreement between the crowd’s annotations and the traditionally-generated corpora was high for: (1) annotations (0.87, F-measure for medication names; 0.73, medication types), (2) correction of previous annotations (0.90, medication names; 0.76, medication types), and excellent for (3) linking medications with their attributes (0.96). Simple voting provided the best judgment aggregation approach. There was no statistically significant difference between the crowd and traditionally-generated corpora. Our results showed a 27.9% improvement over previously reported results on medication named entity annotation task. Conclusions: This study offers three contributions. First, we proved that crowdsourcing is a feasible, inexpensive, fast, and practical approach to collect high-quality annotations for clinical text (when protected health information was excluded). We believe that well-designed user interfaces and rigorous quality control strategy for entity annotation and linking were critical to the success of this work. Second, as a further contribution to the Internet-based crowdsourcing field, we will publicly release the JavaScript and CrowdFlower Markup Language infrastructure code that is necessary to utilize CrowdFlower’s quality control and crowdsourcing interfaces for named entity annotations. Finally, to spur future research, we will release the CTA annotations that were generated by traditional and crowdsourced approaches. %M 23548263 %R 10.2196/jmir.2426 %U http://www.jmir.org/2013/4/e73/ %U https://doi.org/10.2196/jmir.2426 %U http://www.ncbi.nlm.nih.gov/pubmed/23548263 %0 Journal Article %@ 14388871 %I JMIR Publications Inc. %V 15 %N 4 %P e85 %T A New Dimension of Health Care: Systematic Review of the Uses, Benefits, and Limitations of Social Media for Health Communication %A Moorhead,S Anne %A Hazlett,Diane E %A Harrison,Laura %A Carroll,Jennifer K %A Irwin,Anthea %A Hoving,Ciska %+ School of Communication, University of Ulster, Shore Road, Newtownabbey, Northern Ireland, BT37 OQB, United Kingdom, 44 28 90368905, a.moorhead@ulster.ac.uk %K health communication %K social media %K review %D 2013 %7 23.04.2013 %9 Review %J J Med Internet Res %G English %X Background: There is currently a lack of information about the uses, benefits, and limitations of social media for health communication among the general public, patients, and health professionals from primary research. Objective: To review the current published literature to identify the uses, benefits, and limitations of social media for health communication among the general public, patients, and health professionals, and identify current gaps in the literature to provide recommendations for future health communication research. Methods: This paper is a review using a systematic approach. A systematic search of the literature was conducted using nine electronic databases and manual searches to locate peer-reviewed studies published between January 2002 and February 2012. Results: The search identified 98 original research studies that included the uses, benefits, and/or limitations of social media for health communication among the general public, patients, and health professionals. The methodological quality of the studies assessed using the Downs and Black instrument was low; this was mainly due to the fact that the vast majority of the studies in this review included limited methodologies and was mainly exploratory and descriptive in nature. Seven main uses of social media for health communication were identified, including focusing on increasing interactions with others, and facilitating, sharing, and obtaining health messages. The six key overarching benefits were identified as (1) increased interactions with others, (2) more available, shared, and tailored information, (3) increased accessibility and widening access to health information, (4) peer/social/emotional support, (5) public health surveillance, and (6) potential to influence health policy. Twelve limitations were identified, primarily consisting of quality concerns and lack of reliability, confidentiality, and privacy. Conclusions: Social media brings a new dimension to health care as it offers a medium to be used by the public, patients, and health professionals to communicate about health issues with the possibility of potentially improving health outcomes. Social media is a powerful tool, which offers collaboration between users and is a social interaction mechanism for a range of individuals. Although there are several benefits to the use of social media for health communication, the information exchanged needs to be monitored for quality and reliability, and the users’ confidentiality and privacy need to be maintained. Eight gaps in the literature and key recommendations for future health communication research were provided. Examples of these recommendations include the need to determine the relative effectiveness of different types of social media for health communication using randomized control trials and to explore potential mechanisms for monitoring and enhancing the quality and reliability of health communication using social media. Further robust and comprehensive evaluation and review, using a range of methodologies, are required to establish whether social media improves health communication practice both in the short and long terms. %M 23615206 %R 10.2196/jmir.1933 %U http://www.jmir.org/2013/4/e85/ %U https://doi.org/10.2196/jmir.1933 %U http://www.ncbi.nlm.nih.gov/pubmed/23615206 %0 Journal Article %@ 1438-8871 %I Gunther Eysenbach %V 15 %N 4 %P e62 %T Tweaking and Tweeting: Exploring Twitter for Nonmedical Use of a Psychostimulant Drug (Adderall) Among College Students %A Hanson,Carl L %A Burton,Scott H %A Giraud-Carrier,Christophe %A West,Josh H %A Barnes,Michael D %A Hansen,Bret %+ Computational Health Science Research Group, Department of Health Science, Brigham Young University, 213 Richards Building, Provo, UT, 84602, United States, 1 (801) 422 9103, Carl_Hanson@byu.edu %K Adderall %K Twitter %K social media %K prescription drug abuse %D 2013 %7 17.04.2013 %9 Original Paper %J J Med Internet Res %G English %X Background: Adderall is the most commonly abused prescription stimulant among college students. Social media provides a real-time avenue for monitoring public health, specifically for this population. Objective: This study explores discussion of Adderall on Twitter to identify variations in volume around college exam periods, differences across sets of colleges and universities, and commonly mentioned side effects and co-ingested substances. Methods: Public-facing Twitter status messages containing the term “Adderall” were monitored from November 2011 to May 2012. Tweets were examined for mention of side effects and other commonly abused substances. Tweets from likely students containing GPS data were identified with clusters of nearby colleges and universities for regional comparison. Results: 213,633 tweets from 132,099 unique user accounts mentioned “Adderall.” The number of Adderall tweets peaked during traditional college and university final exam periods. Rates of Adderall tweeters were highest among college and university clusters in the northeast and south regions of the United States. 27,473 (12.9%) mentioned an alternative motive (eg, study aid) in the same tweet. The most common substances mentioned with Adderall were alcohol (4.8%) and stimulants (4.7%), and the most common side effects were sleep deprivation (5.0%) and loss of appetite (2.6%). Conclusions: Twitter posts confirm the use of Adderall as a study aid among college students. Adderall discussions through social media such as Twitter may contribute to normative behavior regarding its abuse. %M 23594933 %R 10.2196/jmir.2503 %U http://www.jmir.org/2013/4/e62/ %U https://doi.org/10.2196/jmir.2503 %U http://www.ncbi.nlm.nih.gov/pubmed/23594933 %0 Journal Article %@ 1438-8871 %I Gunther Eysenbach %V 15 %N 4 %P e58 %T Tailored System to Deliver Behavioral Intervention and Manage Data in Randomized Trials %A Zheng,Hua %A Rosal,Milagros C %A Oatis,Carol A %A Li,Wenjun %A Franklin,Patricia D %+ Department of Orthopedics and Physical Rehabilitation, University of Massachusetts Medical School, ACC Building, AC-7037, 55 Lake Ave North, Worcester, MA, 01655, United States, 1 508 856 5748, Patricia.Franklin@umassmed.edu %K structured behavioral intervention %K intervention fidelity %K clinical translational research %K intervention delivery support system %D 2013 %7 11.04.2013 %9 Original Paper %J J Med Internet Res %G English %X Background: The integrity of behavioral intervention trials depends on consistent intervention delivery, and uniform, comprehensive process data collection. It can be challenging in practice due to complex human interactions involved. Objective: We sought to design a system to support the fidelity of intervention delivery and efficient capture of qualitative and quantitative process data for a telephone-delivered behavioral counseling intervention to increase physical activity and function after total knee replacement surgery. Methods: A tailored system was designed to prompt the intervention coach in the delivery of a 5 step counseling protocol to support intervention fidelity across patients. System features included structured data components, automated data exchange functions, user-friendly data capture screens, and real-time surveillance reporting. The system structured the capture of patient goals and open-ended conversation. Results: The system recorded intervention process data from each of 12 sessions held with the 92 intervention patients. During the trial, 992 telephone sessions were conducted, and more than 97% (4816/4960) of intervention process data fields were completed in the system. The coach spent 5-10 minutes preparing for each counseling call using system-generated summaries of historical data and 10-15 minutes entering intervention process data following each telephone session. Conclusions: This intervention delivery system successfully supported the delivery of a structured behavioral counseling intervention and collection of intervention process data. It addressed the unique needs of clinical behavioral intervention trials, and had promising potential to facilitate high-fidelity translation of the intervention to broad clinical practice and Web-based multicenter clinical trials in the future. %M 23579207 %R 10.2196/jmir.2375 %U http://www.jmir.org/2013/4/e58/ %U https://doi.org/10.2196/jmir.2375 %U http://www.ncbi.nlm.nih.gov/pubmed/23579207 %0 Journal Article %@ 14388871 %I JMIR Publications Inc. %V 15 %N 4 %P e87 %T Clinical Outcome and Cost-Effectiveness of a Synchronous Telehealth Service for Seniors and Nonseniors with Cardiovascular Diseases: Quasi-Experimental Study %A Chen,Ying-Hsien %A Lin,Yen-Hung %A Hung,Chi-Sheng %A Huang,Ching-Chang %A Yeih,Deng-Feng %A Chuang,Pao-Yu %A Ho,Yi-Lwun %A Chen,Ming-Fong %+ National Taiwan University Hospital, Departments of Internal Medicine, #7, Chung-Shan South Road, Taipei, 100, Taiwan, 886 2 2312 3456 ext 6552, ylho@ntu.edu.tw %K age factors %K telehealth %K cost-benefit analysis %K cardiovascular diseases %D 2013 %7 24.04.2013 %9 Original Paper %J J Med Internet Res %G English %X Background: Telehealth based on advanced information technology is an emerging health care strategy for managing chronic diseases. However, the cost-effectiveness and clinical effect of synchronous telehealth services in older patients with cardiovascular diseases has not yet been studied. Since 2009, the Telehealth Center at the National Taiwan University Hospital has provided a range of telehealth services (led by a cardiologist and staffed by cardiovascular nursing specialists) for cardiovascular disease patients including (1) instant transmission of blood pressure, pulse rate, electrocardiography, oximetry, and glucometry for analysis, (2) mutual telephone communication and health promotion, and (3) continuous analytical and decision-making support. Objective: To evaluate the impact of a synchronous telehealth service on older patients with cardiovascular diseases. Methods: Between November 2009 and April 2010, patients with cardiovascular disease who received telehealth services at the National Taiwan University Hospital were recruited. We collected data on hospital visits and health expenditures for the 6-month period before and the 6-month period after the opening of the Telehealth Center to assess the clinical impact and cost-effectiveness of telehealth services on cardiovascular patients. Results: A total of 141 consecutive cardiovascular disease patients were recruited, including 93 aged ≥65 years (senior group) and 48 aged <65 years (nonsenior group). The telehealth intervention significantly reduced the all-cause admission rate per month per person in the nonsenior group (pretelehealth: median 0.09, IQR 0-0.14; posttelehealth: median 0, IQR 0-0; P=.002) and the duration (days per month per person) of all-cause hospital stay (pretelehealth: median 0.70, IQR 0-1.96; posttelehealth: median 0, IQR 0-0; P<.001) with increased all-cause outpatient visits per month per person (pretelehealth: median 0.77, IQR 0.20-1.64; posttelehealth: mean 1.60, IQR 1.06-2.57; P=.002). In the senior group, the telehealth intervention also significantly reduced the all-cause admission rate per month per person (pretelehealth: median 0.10, IQR 0-0.18; posttelehealth: median 0, IQR 0-0; P<.001) and the duration (days per month per person) of all-cause hospital stay (pretelehealth: median 0.59, IQR 0-2.24; posttelehealth: median 0, IQR 0-0; P<.001) with increased all-cause outpatient visits per month per person (pretelehealth: median 1.40, IQR 0.52-2.63; posttelehealth: median 1.76, IQR 1.12-2.75; P=.02). In addition, telehealth intervention reduced the inpatient cost in the nonsenior group from $814.93 (SD 1000.40) to US $217.39 (SD 771.01, P=.001) and the total cost per month from US $954.78 (SD 998.70) to US $485.06 (SD 952.47, P<.001). In the senior group, the inpatient cost per month was reduced from US $768.27 (SD 1148.20) to US $301.14 (SD 926.92, P<.001) and the total cost per month from US $928.20 (SD 1194.11) to US $494.87 (SD 1047.08, P<.001). Conclusions: Synchronous telehealth intervention may reduce costs, decrease all-cause admission rates, and decrease durations of all-cause hospital stays in cardiovascular disease patients, regardless of age. %M 23615318 %R 10.2196/jmir.2091 %U http://www.jmir.org/2013/4/e87/ %U https://doi.org/10.2196/jmir.2091 %U http://www.ncbi.nlm.nih.gov/pubmed/23615318 %0 Journal Article %@ 1438-8871 %I Gunther Eysenbach %V 15 %N 4 %P e52 %T How Valid are Web-Based Self-Reports of Weight? %A Bonn,Stephanie Erika %A Trolle Lagerros,Ylva %A Bälter,Katarina %+ Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Nobels väg 12a, Stockholm, SE-17177, Sweden, 46 852482298, stephanie.bonn@ki.se %K body weight %K Internet %K validity %D 2013 %7 09.04.2013 %9 Original Paper %J J Med Internet Res %G English %X Background: Many studies rely on self-reported anthropometric data. While paper-based self-reports have been the standard collection mode, the number of studies collecting self-reported data via the Web is increasing rapidly. Although numerous studies have shown good agreement between self-reported and measured weight using paper-based questionnaires, the validity of using the Web to inquire about weight is unknown. Objective: The objective of this study was to validate Web-based self-reports of bodyweight compared to weight measured at the study center. Methods: The validity of weight self-reported via the Web was assessed by comparing self-reports against measurements of weight in a convenience sample of 149 individuals (77.2% women, 115/149), aged 20-65 years. Study participants self-reported their weight via a Web-based questionnaire and thereafter had their weight measured in the research center. Results: The Spearman correlation coefficient between self-reported and measured weight was 0.98 (P<.001). The mean difference between self-reported and measured weight was -1.2 (SD 2.6) kg. There was a statistically significant difference between self-reported and measured weight with the self-reported being lower (P<.001). Subjects with a body mass index (BMI) ≥25 kg/m2, and subjects ≥30 years of age, under-reported their weight statistically significantly more than subjects with a BMI <25 kg/m2, and subjects <30 years of age, respectively. Conclusions: Our results show that self-reported weight via the Web can be a valid method of data collection. %M 23570956 %R 10.2196/jmir.2393 %U http://www.jmir.org/2013/4/e52/ %U https://doi.org/10.2196/jmir.2393 %U http://www.ncbi.nlm.nih.gov/pubmed/23570956 %0 Journal Article %@ 14388871 %I JMIR Publications Inc. %V 15 %N 4 %P e71 %T Self-Test Web-Based Pure-Tone Audiometry: Validity Evaluation and Measurement Error Analysis %A Masalski,Marcin %A Kręcicki,Tomasz %+ Department and Clinic of Otolaryngology, Head and Neck Surgery, Wroclaw Medical University, Borowska 213, Wrocław, 50-556, Poland, 48 71 734 3700, marcin.masalski@pwr.wroc.pl %K pure tone audiometry %K computer-assisted instruction %K self-examination %D 2013 %7 12.04.2013 %9 Original Paper %J J Med Internet Res %G English %X Background: Potential methods of application of self-administered Web-based pure-tone audiometry conducted at home on a PC with a sound card and ordinary headphones depend on the value of measurement error in such tests. Objective: The aim of this research was to determine the measurement error of the hearing threshold determined in the way described above and to identify and analyze factors influencing its value. Methods: The evaluation of the hearing threshold was made in three series: (1) tests on a clinical audiometer, (2) self-tests done on a specially calibrated computer under the supervision of an audiologist, and (3) self-tests conducted at home. The research was carried out on the group of 51 participants selected from patients of an audiology outpatient clinic. From the group of 51 patients examined in the first two series, the third series was self-administered at home by 37 subjects (73%). Results: The average difference between the value of the hearing threshold determined in series 1 and in series 2 was -1.54dB with standard deviation of 7.88dB and a Pearson correlation coefficient of .90. Between the first and third series, these values were -1.35dB±10.66dB and .84, respectively. In series 3, the standard deviation was most influenced by the error connected with the procedure of hearing threshold identification (6.64dB), calibration error (6.19dB), and additionally at the frequency of 250Hz by frequency nonlinearity error (7.28dB). Conclusions: The obtained results confirm the possibility of applying Web-based pure-tone audiometry in screening tests. In the future, modifications of the method leading to the decrease in measurement error can broaden the scope of Web-based pure-tone audiometry application. %M 23583917 %R 10.2196/jmir.2222 %U http://www.jmir.org/2013/4/e71/ %U https://doi.org/10.2196/jmir.2222 %U http://www.ncbi.nlm.nih.gov/pubmed/23583917 %0 Journal Article %@ 1438-8871 %I Gunther Eysenbach %V 15 %N 4 %P e55 %T Attitudes of Patients Toward Adoption of 3D Technology in Pain Assessment: Qualitative Perspective %A Spyridonis,Fotios %A Ghinea,Gheorghita %A Frank,Andrew O %+ Brunel University, Department of Information Systems and Computing, Kingston Lane, Uxbridge, UB8 3PH, United Kingdom, 44 1895265503, fotios.spyridonis@brunel.ac.uk %K pain assessment %K 3-dimensional image %K health care systems %K health care delivery %K patient acceptance of health care %K qualitative research %D 2013 %7 10.04.2013 %9 Original Paper %J J Med Internet Res %G English %X Background: Past research has revealed that insufficient pain assessment could, and often, has negative implications on the provision of quality health care. While current available clinical approaches have proven to be valid interventions, they are expensive and can often fail in providing efficient pain measurements. The increase in the prevalence of pain calls for more intuitive pain assessment solutions. Computerized alternatives have already been proposed both in the literature and in commerce, but may lack essential qualities such as accuracy of the collected clinical information and effective patient-clinician interaction. In response to this concern, 3-dimensional (3D) technology could become the innovative intervention needed to support and improve the pain assessment process. Objective: The purpose of this analysis was to describe qualitative findings from a study which was designed to explore patients’ perceptions of adopting 3D technology in the assessment of their pain experience related to important themes that might positively or negatively influence the quality of the pain assessment process. Methods: The perceptions of 60 individuals with some form of pain in the area of Greater London were collected through semi-structured interviews. Of the 60 respondents, 24 (43%) produced usable responses and were analyzed for content using principles of the grounded theory approach and thematic analysis, in order to gain insight into the participants’ beliefs and attitudes towards adopting 3D technology in pain assessment. Results: The analysis identified 4 high-level core themes that were representative of the participants’ responses. These themes indicated that most respondents valued “the potential of 3D technology to facilitate better assessment of pain” as the most useful outcome of adopting a 3D approach. Respondents also expressed their opinions on the usability of the 3D approach, with no important concerns reported about its perceived ease of use. Our findings finally, showed that respondents appreciated the perceived clinical utility of the proposed approach, which could further have an influence on their intention to use it. Conclusions: These findings highlighted factors that are seen as essential for improving the assessment of pain, and demonstrated the need for a strong focus on patient-clinician communication. The participants of this analysis believed that the introduction of 3D technology in the process might be a useful mechanism for such a positive health care outcome. The study’s findings could also be used to make recommendations concerning the potential for inclusion of 3D technology in current clinical pain tools for the purpose of improving the quality of health care. %M 23575479 %R 10.2196/jmir.2427 %U http://www.jmir.org/2013/4/e55/ %U https://doi.org/10.2196/jmir.2427 %U http://www.ncbi.nlm.nih.gov/pubmed/23575479 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 15 %N 4 %P e67 %T Preferred Sources of Health Information in Persons With Multiple Sclerosis: Degree of Trust and Information Sought %A Marrie,Ruth Ann %A Salter,Amber R %A Tyry,Tuula %A Fox,Robert J %A Cutter,Gary R %+ University of Manitoba, Departments of Internal Medicine & Community Health Sciences, GF 543 - Health Sciences Centre, 820 Sherbrook Street, Winnipeg, MB, R3A 1R9, Canada, 1 204 787 4951, rmarrie@hsc.mb.ca %K multiple sclerosis %K Internet %K social media %K trust %K health information %D 2013 %7 30.04.2013 %9 Original Paper %J J Med Internet Res %G English %X Background: Effective health communication is important for informed decision-making, yet little is known about the range of information sources used by persons with multiple sclerosis (MS), the perceived trust in those information sources, or how this might vary according to patient characteristics. Objective: We aimed to investigate the sources of health information used by persons with MS, their preferences for the source of health information, and levels of trust in those information sources. We also aimed to evaluate how these findings varied according to participant characteristics. Methods: In 2011, participants in the North American Research Committee on Multiple Sclerosis (NARCOMS) Registry were asked about their sources of health information using selected questions adapted from the 2007 Health Information National Trends (HINTS) survey. Results: Of 12,974 eligible participants, 66.18% (8586/12,974) completed the questionnaire. Mass media sources, rather than interpersonal information sources, were the first sources used by 83.22% (5953/7153) of participants for general health topics and by 68.31% (5026/7357) of participants for MS concerns. Specifically, the Internet was the first source of health information for general health issues (5332/7267, 73.40%) and MS (4369/7376, 59.23%). In a logistic regression model, younger age, less disability, and higher annual income were independently associated with increased odds of use of mass media rather than interpersonal sources of information first. The most trusted information source was a physician, with 97.94% (8318/8493) reporting that they trusted a physician some or a lot. Information sought included treatment for MS (4470/5663, 78.93%), general information about MS (3378/5405, 62.50%), paying for medical care (1096/4282, 25.59%), where to get medical care (787/4282, 18.38%), and supports for coping with MS (2775/5031, 55.16%). Nearly 40% (2998/7521) of participants had concerns about the quality of the information they gathered. Conclusions: Although physicians remain the most trusted source of health information for people with MS, the Internet is the first source of health information for most of them. This has important implications for the dissemination of health information. %M 23635393 %R 10.2196/jmir.2466 %U http://www.jmir.org/2013/4/e67/ %U https://doi.org/10.2196/jmir.2466 %U http://www.ncbi.nlm.nih.gov/pubmed/23635393 %0 Journal Article %@ 1438-8871 %I Gunther Eysenbach %V 15 %N 4 %P e66 %T A Data Encryption Solution for Mobile Health Apps in Cooperation Environments %A Silva,Bruno M %A Rodrigues,Joel JPC %A Canelo,Fábio %A Lopes,Ivo C %A Zhou,Liang %+ Instituto de Telecomunicações, University of Beira Interior, Rua Marques D'Avila e Bolama, Covilhã, 6201-001, Portugal, 351 275242081, joeljr@ieee.org %K mobile health %K mHealth %K mobile computing %K eHealth %K cooperation %K encryption %K security %D 2013 %7 25.04.2013 %9 Original Paper %J J Med Internet Res %G English %X Background: Mobile Health (mHealth) proposes health care delivering anytime and anywhere. It aims to answer several emerging problems in health services, including the increasing number of chronic diseases, high costs on national health services, and the need to provide direct access to health services, regardless of time and place. mHealth systems include the use of mobile devices and apps that interact with patients and caretakers. However, mobile devices present several constraints, such as processor, energy, and storage resource limitations. The constant mobility and often-required Internet connectivity also exposes and compromises the privacy and confidentiality of health information. Objective: This paper presents a proposal, construction, performance evaluation, and validation of a data encryption solution for mobile health apps (DE4MHA), considering a novel and early-proposed cooperation strategy. The goal was to present a robust solution based on encryption algorithms that guarantee the best confidentiality, integrity, and authenticity of users health information. In this paper, we presented, explained, evaluated the performance, and discussed the cooperation mechanisms and the proposed encryption solution for mHealth apps. Methods: First, we designed and deployed the DE4MHA. Then two studies were performed: (1) study and comparison of symmetric and asymmetric encryption/decryption algorithms in an mHealth app under a cooperation environment, and (2) performance evaluation of the DE4MHA. Its performance was evaluated through a prototype using an mHealth app for obesity prevention and cares, called SapoFit. We then conducted an evaluation study of the mHealth app with cooperation mechanisms and the DE4MHA using real users and a real cooperation scenario. In 5 days, 5 different groups of 7 students selected randomly agreed to use and experiment the SapoFit app using the 7 devices available for trials. Results: There were 35 users of SapoFit that participated in this study. The performance evaluation of the app was done using 7 real mobile devices in 5 different days. The results showed that confidentiality and protection of the users’ health information was guaranteed and SapoFit users were able to use the mHealth app with satisfactory quality. Results also showed that the app with the DE4MHA presented nearly the same results as the app without the DE4MHA. The performance evaluation results considered the probability that a request was successfully answered as a function of the number of uncooperative nodes in the network. The service delivery probability decreased with the increase of uncooperative mobile nodes. Using DE4MHA, it was observed that performance presented a slightly worse result. The service average was also slightly worse but practically insignificantly different than with DE4MHA, being considered negligible. Conclusions: This paper proposed a data encryption solution for mobile health apps, called DE4MHA. The data encryption algorithm DE4MHA with cooperation mechanisms in mobile health allow users to safely obtain health information with the data being carried securely. These security mechanisms did not deteriorate the overall network performance and the app, maintaining similar performance levels as without the encryption. More importantly, it offers a robust and reliable increase of privacy, confidentiality, integrity, and authenticity of their health information. Although it was experimented on a specific mHealth app, SapoFit, both DE4MHA and the cooperation strategy can be deployed in other mHealth apps. %M 23624056 %R 10.2196/jmir.2498 %U http://www.jmir.org/2013/4/e66/ %U https://doi.org/10.2196/jmir.2498 %U http://www.ncbi.nlm.nih.gov/pubmed/23624056 %0 Journal Article %@ 14388871 %I JMIR Publications Inc. %V 15 %N 4 %P e90 %T Examining the Differences in Format and Characteristics of Zoonotic Virus Surveillance Data on State Agency Websites %A Scotch,Matthew %A Baarson,Brittany %A Beard,Rachel %A Lauder,Robert %A Varman,Aarthi %A Halden,Rolf U %+ Center for Environmental Security, Biodesign Institute and Security and Defense Systems Initiative, Arizona State University, P.O. Box 875904, Tempe, AZ, 85287-5904, United States, 1 480 727 2985, matthew.scotch@asu.edu %K public health %K zoonoses %K World Wide Web %K epidemiology %K data analysis %D 2013 %7 29.04.2013 %9 Original Paper %J J Med Internet Res %G English %X Background: Zoonotic viruses are infectious organisms transmittable between animals and humans. Agencies of public health, agriculture, and wildlife conduct surveillance of zoonotic viruses and often report data on their websites. However, the format and characteristics of these data are not known. Objective: To describe and compare the format and characteristics of statistics of zoonotic viruses on state public health, agriculture, and wildlife agency websites. Methods: For each state, we considered the websites of that state’s public health, agriculture, and wildlife agency. For each website, we noted the presence of any statistics for zoonotic viruses from 2000-2012. We analyzed the data using numerous categories including type of statistic, temporal and geographic level of detail, and format. We prioritized our analysis within each category based on assumptions of individuals’ preferences for extracting and analyzing data from websites. Thus, if two types of data (such as city and state-level) were present for a given virus in a given year, we counted the one with higher priority (city). External links from agency sites to other websites were not considered. Results: From 2000-2012, state health departments had the most extensive virus data, followed by agriculture, and then wildlife. We focused on the seven viruses that were common across the three agencies. These included rabies, West Nile virus, eastern equine encephalitis, St. Louis encephalitis, western equine encephalitis, influenza, and dengue fever. Simple numerical totals were most often used to report the data (89% for public health, 81% for agriculture, and 82% for wildlife), and proportions were not different (chi-square P=.15). Public health data were most often presented yearly (66%), while agriculture and wildlife agencies often described cases as they occurred (Fisher’s Exact test P<.001). Regarding format, public health agencies had more downloadable PDF files (68%), while agriculture (61%) and wildlife agencies (46%) presented data directly in the text of the HTML webpage (Fisher’s Exact test P<.001). Demographics and other information including age, gender, and host were limited. Finally, a Fisher’s Exact test showed no association between geography data and agency type (P=.08). However, it was noted that agriculture department data was often at the county level (63%), while public health was mixed between county (38%) and state (35%). Conclusions: This study focused on the format and characteristics of statistics of zoonotic viruses on websites of state public health, wildlife, and agriculture agencies in the context of population health surveillance. Data on zoonotic viruses varied across agencies presenting challenges for researchers needing to integrate animal and human data from different websites. %M 23628771 %R 10.2196/jmir.2487 %U http://www.jmir.org/2013/4/e90/ %U https://doi.org/10.2196/jmir.2487 %U http://www.ncbi.nlm.nih.gov/pubmed/23628771 %0 Journal Article %@ 1438-8871 %I Gunther Eysenbach %V 15 %N 4 %P e59 %T Health-Related Effects Reported by Electronic Cigarette Users in Online Forums %A Hua,My %A Alfi,Mina %A Talbot,Prue %+ University of California, Department of Cell Biology and Neuroscience, University of California, 900 Univeristy Avenue, Riverside, CA, 92521, United States, 1 950 827 3768, talbot@ucr.edu %K Electronic cigarettes %K e-cigarettes %K electronic nicotine delivery devices %K ENDS %K health effects %K nicotine %K harm reduction %K symptoms %K Internet %D 2013 %7 08.04.2013 %9 Original Paper %J J Med Internet Res %G English %X Background: The health effects caused by electronic cigarette (e-cigarette) use are not well understood. Objective: Our purpose was to document the positive and negative short-term health effects produced by e-cigarette use through an analysis of original posts from three online e-cigarettes forums. Methods: Data were collected into Microsoft Access databases and analyzed using Cytoscape association graphics, frequency distributions, and interactomes to determine the number and type of health effects reported, the organ systems affected the frequency of specific effects, and systems interactions. Results: A total of 405 different symptoms due to e-cigarette use were reported from three forums. Of these, 78 were positive, 326 were negative, and one was neutral. While the reported health effects were similar in all three forums, the forum with the most posts was analyzed in detail. Effects, which were reported for 12 organ systems/anatomical regions, occurred most often in the mouth and throat and in the respiratory, neurological, sensory, and digestive systems. Users with negative symptoms often reported more than one symptom, and in these cases interactions were often seen between systems, such as the circulatory and neurological systems. Positive effects usually occurred singly and most frequently affected the respiratory system. Conclusions: This is the first compilation and analysis of the health effects reported by e-cigarette users in online forums. These data show that e-cigarette use can have wide ranging positive and negative effects and that online forums provide a useful resource for examining how e-cigarette use affects health. %M 23567935 %R 10.2196/jmir.2324 %U http://www.jmir.org/2013/4/e59/ %U https://doi.org/10.2196/jmir.2324 %U http://www.ncbi.nlm.nih.gov/pubmed/23567935 %0 Journal Article %@ 14388871 %I JMIR Publications Inc. %V 15 %N 4 %P e75 %T Computing Health Quality Measures Using Informatics for Integrating Biology and the Bedside %A Klann,Jeffrey G %A Murphy,Shawn N %+ Laboratory of Computer Science, Massachusetts General Hospital, One Constitution Center, Boston, MA, 02129, United States, 1 6176435879, jklann@partners.org %K medical informatics %K healthcare quality assessment %K reimbursement %K incentive %K systems integration %K database management systems %D 2013 %7 19.04.2013 %9 Original Paper %J J Med Internet Res %G English %X Background: The Health Quality Measures Format (HQMF) is a Health Level 7 (HL7) standard for expressing computable Clinical Quality Measures (CQMs). Creating tools to process HQMF queries in clinical databases will become increasingly important as the United States moves forward with its Health Information Technology Strategic Plan to Stages 2 and 3 of the Meaningful Use incentive program (MU2 and MU3). Informatics for Integrating Biology and the Bedside (i2b2) is one of the analytical databases used as part of the Office of the National Coordinator (ONC)’s Query Health platform to move toward this goal. Objective: Our goal is to integrate i2b2 with the Query Health HQMF architecture, to prepare for other HQMF use-cases (such as MU2 and MU3), and to articulate the functional overlap between i2b2 and HQMF. Therefore, we analyze the structure of HQMF, and then we apply this understanding to HQMF computation on the i2b2 clinical analytical database platform. Specifically, we develop a translator between two query languages, HQMF and i2b2, so that the i2b2 platform can compute HQMF queries. Methods: We use the HQMF structure of queries for aggregate reporting, which define clinical data elements and the temporal and logical relationships between them. We use the i2b2 XML format, which allows flexible querying of a complex clinical data repository in an easy-to-understand domain-specific language. Results: The translator can represent nearly any i2b2-XML query as HQMF and execute in i2b2 nearly any HQMF query expressible in i2b2-XML. This translator is part of the freely available reference implementation of the QueryHealth initiative. We analyze limitations of the conversion and find it covers many, but not all, of the complex temporal and logical operators required by quality measures. Conclusions: HQMF is an expressive language for defining quality measures, and it will be important to understand and implement for CQM computation, in both meaningful use and population health. However, its current form might allow complexity that is intractable for current database systems (both in terms of implementation and computation). Our translator, which supports the subset of HQMF currently expressible in i2b2-XML, may represent the beginnings of a practical compromise. It is being pilot-tested in two Query Health demonstration projects, and it can be further expanded to balance computational tractability with the advanced features needed by measure developers. %M 23603227 %R 10.2196/jmir.2493 %U http://www.jmir.org/2013/4/e75/ %U https://doi.org/10.2196/jmir.2493 %U http://www.ncbi.nlm.nih.gov/pubmed/23603227 %0 Journal Article %@ 14388871 %I JMIR Publications Inc. %V 15 %N 4 %P e74 %T Using Social Networking to Understand Social Networks: Analysis of a Mobile Phone Closed User Group Used by a Ghanaian Health Team %A Kaonga,Nadi Nina %A Labrique,Alain %A Mechael,Patricia %A Akosah,Eric %A Ohemeng-Dapaah,Seth %A Sakyi Baah,Joseph %A Kodie,Richmond %A Kanter,Andrew S %A Levine,Orin %+ Earth Institute, Center on Globalization and Sustainable Development, Columbia University, Suite 401, 475 Riverside Drive, New York, NY, , United States, 1 6039694883, nkaonga@gmail.com %K mobile health %K electronic health %K telehealth %K sociology %K social network analysis %K rural health %K global health %K evaluation research %K Ghana %D 2013 %7 03.04.2013 %9 Original Paper %J J Med Internet Res %G English %X Background: The network structure of an organization influences how well or poorly an organization communicates and manages its resources. In the Millennium Villages Project site in Bonsaaso, Ghana, a mobile phone closed user group has been introduced for use by the Bonsaaso Millennium Villages Project Health Team and other key individuals. No assessment on the benefits or barriers of the use of the closed user group had been carried out. Objective: The purpose of this research was to make the case for the use of social network analysis methods to be applied in health systems research—specifically related to mobile health. Methods: This study used mobile phone voice records of, conducted interviews with, and reviewed call journals kept by a mobile phone closed user group consisting of the Bonsaaso Millennium Villages Project Health Team. Social network analysis methodology complemented by a qualitative component was used. Monthly voice data of the closed user group from Airtel Bharti Ghana were analyzed using UCINET and visual depictions of the network were created using NetDraw. Interviews and call journals kept by informants were analyzed using NVivo. Results: The methodology was successful in helping identify effective organizational structure. Members of the Health Management Team were the more central players in the network, rather than the Community Health Nurses (who might have been expected to be central). Conclusions: Social network analysis methodology can be used to determine the most productive structure for an organization or team, identify gaps in communication, identify key actors with greatest influence, and more. In conclusion, this methodology can be a useful analytical tool, especially in the context of mobile health, health services, and operational and managerial research. %M 23552721 %R 10.2196/jmir.2332 %U http://www.jmir.org/2013/4/e74/ %U https://doi.org/10.2196/jmir.2332 %U http://www.ncbi.nlm.nih.gov/pubmed/23552721 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 15 %N 4 %P e70 %T The Personal Health Record Paradox: Health Care Professionals’ Perspectives and the Information Ecology of Personal Health Record Systems in Organizational and Clinical Settings %A Nazi,Kim M %+ Veterans and Consumers Health Informatics Office, Veterans Health Administration, Department of Veterans Affairs, c/o Stratton VA Medical Center, 113 Holland Avenue, Albany, NY, 12208, United States, 1 449 0621, kim.nazi@va.gov %K personal health record (PHR) %K health professionals %K attitudes %K eHealth %K electronic health records (EHRs) %K secure messaging %K qualitative analysis %D 2013 %7 04.04.2013 %9 Original Paper %J J Med Internet Res %G English %X Background: Despite significant consumer interest and anticipated benefits, overall adoption of personal health records (PHRs) remains relatively low. Understanding the consumer perspective is necessary, but insufficient by itself. Consumer PHR use also has broad implications for health care professionals and organizational delivery systems; however, these have received less attention. An exclusive focus on the PHR as a tool for consumer empowerment does not adequately take into account the social and organizational context of health care delivery, and the reciprocal nature of patient engagement. Objective: The purpose of this study was to examine the experiences of physicians, nurses, and pharmacists at the Department of Veterans Affairs (VA) using an organizationally sponsored PHR to develop insights into the interaction of technology and processes of health care delivery. The conceptual framework for the study draws on an information ecology perspective, which recognizes that a vibrant dynamic exists among technologies, people, practices, and values, accounting for both the values and norms of the participants and the practices of the local setting. The study explores the experiences and perspectives of VA health care professionals related to patient use of the My HealtheVet PHR portal and secure messaging systems. Methods: In-depth interviews were conducted with 30 VA health care professionals engaged in providing direct patient care who self-reported that they had experiences with at least 1 of 4 PHR features. Interviews were transcribed, coded, and analyzed to identify inductive themes. Organizational documents and artifacts were reviewed and analyzed to trace the trajectory of secure messaging implementation as part of the VA Patient Aligned Care Team (PACT) model. Results: Study findings revealed a variety of factors that have facilitated or inhibited PHR adoption, use, and endorsement of patient use by health care professionals. Health care professionals’ accounts and analysis of organizational documents revealed a multidimensional dynamic between the trajectory of secure messaging implementation and its impact on organizational actors and their use of technology, influencing workflow, practices, and the flow of information. In effect, secure messaging was the missing element of complex information ecology and its implementation acted as a catalyst for change. Secure messaging was found to have important consequences for access, communication, patient self-report, and patient/provider relationships. Conclusions: Study findings have direct implications for the development and implementation of PHR systems to ensure adequate training and support for health care professionals, alignment with clinical workflow, and features that enable information sharing and communication. Study findings highlight the importance of clinician endorsement and engagement, and the need to further examine both intended and unintended consequences of use. This research provides an integral step toward better understanding the social and organizational context and impact of PHR and secure messaging use in clinical practice settings. %M 23557596 %R 10.2196/jmir.2443 %U http://www.jmir.org/2013/4/e70/ %U https://doi.org/10.2196/jmir.2443 %U http://www.ncbi.nlm.nih.gov/pubmed/23557596 %0 Journal Article %@ 14388871 %I JMIR Publications Inc. %V 15 %N 4 %P e89 %T A Systematic Self-Certification Model for Mobile Medical Apps %A Lewis,Thomas Lorchan %+ Warwick Medical School, University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL, United Kingdom, 44 7876453511, t.lewis@warwick.ac.uk %K smartphone %K technology %K education %K medicine %K app %K health care %K Android %K iPhone %K BlackBerry %K mobile phone %K standards %D 2013 %7 24.04.2013 %9 Letter to the Editor %J J Med Internet Res %G English %X %M 23615332 %R 10.2196/jmir.2446 %U http://www.jmir.org/2013/4/e89/ %U https://doi.org/10.2196/jmir.2446 %U http://www.ncbi.nlm.nih.gov/pubmed/23615332