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JMIR - JOURNAL OF MEDICAL INTERNET RESEARCHJMIR MENTAL HEALTHCURRENT ISSUEJMIR SERIOUS GAMESAUTHORSJMIR MHEALTH UHEALTH The Journal of Medical Internet Research (JMIR) (founded in 1999, now in its' 22nd year!), is the pioneer open access eHealth journal and is the flagship journal of JMIR Publications.It is the leading digital health journal globally in terms of quality/visibility (Impact Factor 2019: 5.03), ranking Q1 in the medical informatics category, and is also the largest journal in the field. JOURNAL OF MEDICAL INTERNET RESEARCH Background: Since late 2019, the lives of people across the globe have been disrupted by COVID-19. Millions of people have become infected with the disease, while billions of people have been continually asked or required by local and national governments to change their behavioral patterns. Previous research on the COVID-19 pandemic suggests that it is associated with large-scale JOURNAL OF MEDICAL INTERNET RESEARCH Background: The COVID-19 pandemic has negatively affected medical education. However, little data are available about medical students’ distress during the pandemic. Objective: This study aimed to provide details on how medical students have been affected by the pandemic. Methods: A cross-sectional study was conducted. A total of 717 medical students participated in the web-based survey. JOURNAL OF MEDICAL INTERNET RESEARCH Background: As the use of technology to deliver health services is increasing rapidly and has further intensified during the COVID-19 pandemic, these initiatives may fail if ethical impacts are not fully identified and acted upon by practitioners. Ignoring the ethical impacts of information and communication technology health service delivery creates an unintended risk for patients and can JOURNAL OF MEDICAL INTERNET RESEARCH Background: Loneliness is a serious public health issue, and its burden is increasing in many countries. Loneliness affects social, physical, and mental health, and it is associated with multimorbidity and premature mortality. In addition to social interventions, a range of digital technology interventions (DTIs) are being used to tackle

loneliness.

JOURNAL OF MEDICAL INTERNET RESEARCH Background: Hypertension (HTN) is a major modifiable risk factor and the leading cause of premature deaths globally. The lack of awareness and knowledge have been identified as risk factors in low- and middle-income countries including Bangladesh. Recently, the use of mobile phone SMS text messaging is found to have an important positive impact on HTN management. JOURNAL OF MEDICAL INTERNET RESEARCH One Digital Health is a proposed unified structure. The conceptual framework of the One Digital Health Steering Wheel is built around two keys (ie, One Health and digital health), three perspectives (ie, individual health and well-being, population and society, and ecosystem), and five dimensions (ie, citizens’ engagement, education, environment, human and veterinary health care, and JOURNAL OF MEDICAL INTERNET RESEARCH Background: Over the recent decades, Vietnam has attained remarkable achievements in all areas of health care. However, shortcomings including health disparities persist particularly with a rapidly aging population. This has resulted in a shift in the disease burden from communicable to noncommunicable diseases such as dementia, cancer, and

diabetes.

JMIR PEDIATRICS AND PARENTING JMIR Pediatrics and Parenting (JPP) is an open access journal. JPP has a unique focus on technologies, medical devices, apps, engineering, informatics applications for patient/parent education, training, counselling, behavioral interventions, preventative interventions and clinical care for pediatric and adolescent populations or child-parent

dyads.

JMIR NURSING

loneliness.

diabetes.

dyads.

JMIR NURSING

Background: Mobile health (mHealth) apps have played an important role in mitigating the coronavirus disease (COVID-19) response. However, there is no resource that provides a holistic picture of the available mHealth apps that have been developed to combat this pandemic. Objective: Our aim is to scope the evidence base on apps that were developed in response to COVID-19. JOURNAL OF MEDICAL INTERNET RESEARCH Background: The COVID-19 pandemic has negatively affected medical education. However, little data are available about medical students’ distress during the pandemic. Objective: This study aimed to provide details on how medical students have been affected by the pandemic. Methods: A cross-sectional study was conducted. A total of 717 medical students participated in the web-based survey. JOURNAL OF MEDICAL INTERNET RESEARCH Background: Government responses to managing the COVID-19 pandemic may have impacted the way individuals were able to engage in physical activity. Digital platforms are a promising way to support physical activity levels and may have provided an alternative for people to maintain their activity while at home. Objective: This study aimed to examine associations between the use of digital JOURNAL OF MEDICAL INTERNET RESEARCH Background: Media coverage and scholarly research have reported that Asian people who reside in the United States have been the targets of racially motivated incidents during the COVID-19 pandemic. Objective: This study aimed to examine the types of discrimination and worries experienced by Asians and Asian Americans living in the United States during the pandemic, as well as factors that JOURNAL OF MEDICAL INTERNET RESEARCH Background: Simulation study results suggest that COVID-19 contact tracing apps have the potential to achieve pandemic control. Concordantly, high app adoption rates were a stipulated prerequisite for success. Early studies on potential adoption were encouraging. Several factors predicting adoption rates were investigated, especially pertaining to user characteristics. JOURNAL OF MEDICAL INTERNET RESEARCH Background: The adoption rate of electronic health records (EHRs) in hospitals has become a main index to measure digitalization in medicine in each country. Objective: This study summarizes and shares the experiences with EHR adoption in China and in the United States. Methods: Using the 2007-2018 annual hospital survey data from the Chinese Health Information Management Association JOURNAL OF MEDICAL INTERNET RESEARCH One Digital Health is a proposed unified structure. The conceptual framework of the One Digital Health Steering Wheel is built around two keys (ie, One Health and digital health), three perspectives (ie, individual health and well-being, population and society, and ecosystem), and five dimensions (ie, citizens’ engagement, education, environment, human and veterinary health care, and JOURNAL OF MEDICAL INTERNET RESEARCH Background: During the COVID-19 pandemic, growth in citizen engagement with social media platforms has enabled public health departments to accelerate and improve health information dissemination, developing transparency and trust between governments and citizens. In light of these benefits, it is imperative to learn the antecedents and underlying mechanisms for this to maintain and JOURNAL OF MEDICAL INTERNET RESEARCH Background: Digital food registration via online platforms that are coupled to large food databases obviates the need for manual processing of dietary data. The reliability of such platforms depends on the quality of the associated food database. Objective: In this study, we validate the database of MyFitnessPal versus the Belgian food composition database, Nubel. JOURNAL OF MEDICAL INTERNET RESEARCH Background: With advances in science and technology, biotechnology is becoming more accessible to people of all demographics. These advances inevitably hold the promise to improve personal and population well-being and welfare substantially. It is paradoxical that while greater access to biotechnology on a population level has many advantages, it may also increase the likelihood and JMIR PERIOPERATIVE MEDICINE JMIR Perioperative Medicine (JPOP, Editor-in-chief: John F. Pearson MD, University of Utah School of Medicine) is an open access journal focusing on technologies, medical devices, apps, engineering, informatics and patient education for perioperative medicine and nursing, including pre- and post-operative education, preventative interventions and clinical care for surgery and anaesthesiology JMIR - JOURNAL OF MEDICAL INTERNET RESEARCHJMIR MENTAL HEALTHCURRENT ISSUEJMIR SERIOUS GAMESAUTHORSJMIR MHEALTH UHEALTH The Journal of Medical Internet Research (JMIR) (founded in 1999, now in its' 22nd year!), is the pioneer open access eHealth journal and is the flagship journal of JMIR Publications.It is the leading digital health journal globally in terms of quality/visibility (Impact Factor 2019: 5.03), ranking Q1 in the medical informatics category, and is also the largest journal in the field. JOURNAL OF MEDICAL INTERNET RESEARCH Background: As the use of technology to deliver health services is increasing rapidly and has further intensified during the COVID-19 pandemic, these initiatives may fail if ethical impacts are not fully identified and acted upon by practitioners. Ignoring the ethical impacts of information and communication technology health service delivery creates an unintended risk for patients and can JOURNAL OF MEDICAL INTERNET RESEARCH Background: The vast majority of people worldwide have been impacted by coronavirus disease (COVID-19). In addition to the millions of individuals who have been infected with the disease, billions of individuals have been asked or required by local and national governments to change their behavioral patterns. Previous research on epidemics or traumatic events suggests that this can lead to JMIR PEDIATRICS AND PARENTING JMIR Pediatrics and Parenting (JPP) is an open access journal. JPP has a unique focus on technologies, medical devices, apps, engineering, informatics applications for patient/parent education, training, counselling, behavioral interventions, preventative interventions and clinical care for pediatric and adolescent populations or child-parent

dyads.

JOURNAL OF MEDICAL INTERNET RESEARCH Background: Although the COVID-19 pandemic will have a negative effect on China’s economy in the short term, it also represents a major opportunity for internet-based medical treatment in the medium and long term. Compared with normal times, internet-based medical platforms including the Haodf website were visited by 1.11 billion people, the number of new registered users of all platforms JOURNAL OF MEDICAL INTERNET RESEARCH Background: Social distancing is an effective preventative policy for the coronavirus disease (COVID-19) that is enforced by governments worldwide. However, significant variations are observed in following the policy across individuals and countries. Arguably, differences in citizens’ adherence actions will be influenced by their perceptions about government’s plans and the information JOURNAL OF MEDICAL INTERNET RESEARCH One Digital Health is a proposed unified structure. The conceptual framework of the One Digital Health Steering Wheel is built around two keys (ie, One Health and digital health), three perspectives (ie, individual health and well-being, population and society, and ecosystem), and five dimensions (ie, citizens’ engagement, education, environment, human and veterinary health care, and JOURNAL OF MEDICAL INTERNET RESEARCH Background: Patient falls are a major problem in hospitals. The development of a Patient-Centered Fall Prevention Toolkit, Fall TIPS (Tailoring Interventions for Patient Safety), reduced falls by 25% in acute care hospitals by leveraging health information technology to complete the 3-step fall prevention process—(1) conduct fall risk assessments; (2) develop tailored fall prevention plans JOURNAL OF MEDICAL INTERNET RESEARCH Background: The ability to perform vape tricks (ie, blowing large vapor clouds or shapes like rings) using e-cigarettes appeals to youth. Vape tricks are promoted on social media, but the promotion of vape tricks on social media is not well understood. Objective: The aim of this study was to examine how vape tricks were promoted on YouTube

to youth.

dyads.

to youth.

JOURNAL OF MEDICAL INTERNET RESEARCH Background: Depression and anxiety are common mental health difficulties experienced by university students and can impair academic and social functioning. Students are limited in seeking help from professionals. As university students are highly connected to digital technologies, Web-based and computer-delivered interventions could be used to improve students’ mental health. JOURNAL OF MEDICAL INTERNET RESEARCH Background: The COVID-19 pandemic has negatively affected medical education. However, little data are available about medical students’ distress during the pandemic. Objective: This study aimed to provide details on how medical students have been affected by the pandemic. Methods: A cross-sectional study was conducted. A total of 717 medical students participated in the web-based survey. JOURNAL OF MEDICAL INTERNET RESEARCH The telehealth revolution in response to COVID-19 has increased essential health care access during an unprecedented public health crisis. However, virtual patient care can also limit the patient-provider relationship, quality of examination, efficiency of health care delivery, and overall quality of care. As we witness the most rapidly adopted medical trend in modern history, clinicians are JOURNAL OF MEDICAL INTERNET RESEARCH The coronavirus disease (COVID-19) pandemic has presented unique challenges for people with diabetes, in addition to their high-risk stratification for infection. Supporting people with diabetes to self-care has been critical to reduce their risk of severe infection. This global pandemic has presented an opportunity to digitalize diabetes care and rapidly implement virtual diabetes clinics JOURNAL OF MEDICAL INTERNET RESEARCH Background: COVID-19 resulted in considerable mental health burden in the Chinese general population and among health care workers at the beginning and peak of the pandemic. However, little is known about potentially vulnerable groups during the final stage of the lockdown. Objective: The aim of this survey study was to assess the mental health burden of different professions in China in order JOURNAL OF MEDICAL INTERNET RESEARCH Background: Hypertension (HTN) is a major modifiable risk factor and the leading cause of premature deaths globally. The lack of awareness and knowledge have been identified as risk factors in low- and middle-income countries including Bangladesh. Recently, the use of mobile phone SMS text messaging is found to have an important positive impact on HTN management. JOURNAL OF MEDICAL INTERNET RESEARCH Background: During the COVID-19 pandemic, growth in citizen engagement with social media platforms has enabled public health departments to accelerate and improve health information dissemination, developing transparency and trust between governments and citizens. In light of these benefits, it is imperative to learn the antecedents and underlying mechanisms for this to maintain and JOURNAL OF MEDICAL INTERNET RESEARCH Background: Since the coronavirus disease (COVID-19) epidemic in China in December 2019, information and discussions about COVID-19 have spread rapidly on the internet and have quickly become the focus of worldwide attention, especially on social media. Objective: This study aims to investigate and analyze the public’s attention to events related to COVID-19 in China at the beginning JOURNAL OF MEDICAL INTERNET RESEARCH Background: Loneliness is a serious public health issue, and its burden is increasing in many countries. Loneliness affects social, physical, and mental health, and it is associated with multimorbidity and premature mortality. In addition to social interventions, a range of digital technology interventions (DTIs) are being used to tackle

loneliness.

JOURNAL OF MEDICAL INTERNET RESEARCH Background: Digital food registration via online platforms that are coupled to large food databases obviates the need for manual processing of dietary data. The reliability of such platforms depends on the quality of the associated food database. Objective: In this study, we validate the database of MyFitnessPal versus the Belgian food composition database, Nubel. JOURNAL OF MEDICAL INTERNET RESEARCH Background: Patient falls are a major problem in hospitals. The development of a Patient-Centered Fall Prevention Toolkit, Fall TIPS (Tailoring Interventions for Patient Safety), reduced falls by 25% in acute care hospitals by leveraging health information technology to complete the 3-step fall prevention process—(1) conduct fall risk assessments; (2) develop tailored fall prevention plans JMIR - JOURNAL OF MEDICAL INTERNET RESEARCHJMIR MENTAL HEALTHJMIR SERIOUS GAMESAUTHORSJMIR MHEALTH UHEALTHJMI-JMIR MEDICAL INFORMATICS The Journal of Medical Internet Research (JMIR) (founded in 1999, now in its' 22nd year!), is the pioneer open access eHealth journal and is the flagship journal of JMIR Publications.It is the leading digital health journal globally in terms of quality/visibility (Impact Factor 2019: 5.03), ranking Q1 in the medical informatics category, and is also the largest journal in the field. JOURNAL OF MEDICAL INTERNET RESEARCH Background: As the use of technology to deliver health services is increasing rapidly and has further intensified during the COVID-19 pandemic, these initiatives may fail if ethical impacts are not fully identified and acted upon by practitioners. Ignoring the ethical impacts of information and communication technology health service delivery creates an unintended risk for patients and can JMIR PEDIATRICS AND PARENTING JMIR Pediatrics and Parenting (JPP) is an open access journal. JPP has a unique focus on technologies, medical devices, apps, engineering, informatics applications for patient/parent education, training, counselling, behavioral interventions, preventative interventions and clinical care for pediatric and adolescent populations or child-parent

dyads.

JOURNAL OF MEDICAL INTERNET RESEARCH Background: Social distancing is an effective preventative policy for the coronavirus disease (COVID-19) that is enforced by governments worldwide. However, significant variations are observed in following the policy across individuals and countries. Arguably, differences in citizens’ adherence actions will be influenced by their perceptions about government’s plans and the information JOURNAL OF MEDICAL INTERNET RESEARCH Background: Hypertension (HTN) is a major modifiable risk factor and the leading cause of premature deaths globally. The lack of awareness and knowledge have been identified as risk factors in low- and middle-income countries including Bangladesh. Recently, the use of mobile phone SMS text messaging is found to have an important positive impact on HTN management. JMIR MHEALTH AND UHEALTH JMIR mHealth and uHealth (JMU, ISSN 2291-5222; Impact Factor 4.31) is a sister journal of JMIR, the leading eHealth journal. JMIR mHealth and uHealth is indexed in PubMed, PubMed Central, Scopus, MEDLINE and Science Citation Index Expanded (SCIE), and in June 2020 received an Impact Factor of 4.31, ranking the journal Q1 in the medical

JMIR AGING

JMIR Aging (JA, Founding Editor-in-chief: Jing Wang, Professor and Vice Dean for Research, Hugh Roy Cullen Professor, UT Health San Antonio School of Nursing, San Antonio, TX, USA) is an open access journal, focusing on technologies, medical devices, apps, engineering, informatics applications and patient education for medicine and nursing, education, preventative interventions and clinical JOURNAL OF MEDICAL INTERNET RESEARCH Background: Depression and anxiety are common mental health difficulties experienced by university students and can impair academic and social functioning. Students are limited in seeking help from professionals. As university students are highly connected to digital technologies, Web-based and computer-delivered interventions could be used to improve students’ mental health. JOURNAL OF MEDICAL INTERNET RESEARCH Background: The ability to perform vape tricks (ie, blowing large vapor clouds or shapes like rings) using e-cigarettes appeals to youth. Vape tricks are promoted on social media, but the promotion of vape tricks on social media is not well understood. Objective: The aim of this study was to examine how vape tricks were promoted on YouTube

to youth.

JOURNAL OF MEDICAL INTERNET RESEARCH Background: Internet technology can provide a diverse array of online resources for low-income disabled and homebound older adults to manage their health and mental health problems and maintain social connections. Despite many previous studies of older adults’ Internet use, none focused on these most vulnerable older adults. Objective: This study examined Internet use patterns, reasons for JMIR - JOURNAL OF MEDICAL INTERNET RESEARCHJMIR MENTAL HEALTHJMIR SERIOUS GAMESAUTHORSJMIR MHEALTH UHEALTHJMI-JMIR MEDICAL INFORMATICS The Journal of Medical Internet Research (JMIR) (founded in 1999, now in its' 22nd year!), is the pioneer open access eHealth journal and is the flagship journal of JMIR Publications.It is the leading digital health journal globally in terms of quality/visibility (Impact Factor 2019: 5.03), ranking Q1 in the medical informatics category, and is also the largest journal in the field. JOURNAL OF MEDICAL INTERNET RESEARCH Background: As the use of technology to deliver health services is increasing rapidly and has further intensified during the COVID-19 pandemic, these initiatives may fail if ethical impacts are not fully identified and acted upon by practitioners. Ignoring the ethical impacts of information and communication technology health service delivery creates an unintended risk for patients and can JMIR PEDIATRICS AND PARENTING JMIR Pediatrics and Parenting (JPP) is an open access journal. JPP has a unique focus on technologies, medical devices, apps, engineering, informatics applications for patient/parent education, training, counselling, behavioral interventions, preventative interventions and clinical care for pediatric and adolescent populations or child-parent

dyads.

JOURNAL OF MEDICAL INTERNET RESEARCH Background: Social distancing is an effective preventative policy for the coronavirus disease (COVID-19) that is enforced by governments worldwide. However, significant variations are observed in following the policy across individuals and countries. Arguably, differences in citizens’ adherence actions will be influenced by their perceptions about government’s plans and the information JMIR MHEALTH AND UHEALTH JMIR mHealth and uHealth (JMU, ISSN 2291-5222; Impact Factor 4.31) is a sister journal of JMIR, the leading eHealth journal. JMIR mHealth and uHealth is indexed in PubMed, PubMed Central, Scopus, MEDLINE and Science Citation Index Expanded (SCIE), and in June 2020 received an Impact Factor of 4.31, ranking the journal Q1 in the medical JOURNAL OF MEDICAL INTERNET RESEARCH Background: Hypertension (HTN) is a major modifiable risk factor and the leading cause of premature deaths globally. The lack of awareness and knowledge have been identified as risk factors in low- and middle-income countries including Bangladesh. Recently, the use of mobile phone SMS text messaging is found to have an important positive impact on HTN management.

JMIR AGING

to youth.

JOURNAL OF MEDICAL INTERNET RESEARCH Background: Internet technology can provide a diverse array of online resources for low-income disabled and homebound older adults to manage their health and mental health problems and maintain social connections. Despite many previous studies of older adults’ Internet use, none focused on these most vulnerable older adults. Objective: This study examined Internet use patterns, reasons for JOURNAL OF MEDICAL INTERNET RESEARCH Background: Although the COVID-19 pandemic will have a negative effect on China’s economy in the short term, it also represents a major opportunity for internet-based medical treatment in the medium and long term. Compared with normal times, internet-based medical platforms including the Haodf website were visited by 1.11 billion people, the number of new registered users of all platforms JOURNAL OF MEDICAL INTERNET RESEARCH Background: Since the coronavirus disease (COVID-19) epidemic in China in December 2019, information and discussions about COVID-19 have spread rapidly on the internet and have quickly become the focus of worldwide attention, especially on social media. Objective: This study aims to investigate and analyze the public’s attention to events related to COVID-19 in China at the beginning JOURNAL OF MEDICAL INTERNET RESEARCH Background: Digital food registration via online platforms that are coupled to large food databases obviates the need for manual processing of dietary data. The reliability of such platforms depends on the quality of the associated food database. Objective: In this study, we validate the database of MyFitnessPal versus the Belgian food composition database, Nubel. JOURNAL OF MEDICAL INTERNET RESEARCH Background: Although there is evidence for the efficacy of internet-based cognitive behavioral therapy (iCBT), the generalizability of results to routine care is limited. Objective: This study systematically reviews effectiveness studies of guided iCBT interventions for the treatment of depression or anxiety. Methods: The acceptability (uptake, participants’ characteristics, adherence, and

JMIR NURSING

JMIR Nursing (JN, Editor-in-Chief: Elizabeth Borycki, RN PhD, FIAHIS, FACMI, FCAHS) is a peer-reviewed journal for nursing in the 21st century. The focus of this journal is original research related to the paradigm change in nursing due to information technology and the shift towards preventative, predictive, personal medicine: JOURNAL OF MEDICAL INTERNET RESEARCH Background: Internet technology can provide a diverse array of online resources for low-income disabled and homebound older adults to manage their health and mental health problems and maintain social connections. Despite many previous studies of older adults’ Internet use, none focused on these most vulnerable older adults. Objective: This study examined Internet use patterns, reasons for JMIR PERIOPERATIVE MEDICINE JMIR Perioperative Medicine (JPOP, Editor-in-chief: John F. Pearson MD, University of Utah School of Medicine) is an open access journal focusing on technologies, medical devices, apps, engineering, informatics and patient education for perioperative medicine and nursing, including pre- and post-operative education, preventative interventions and clinical care for surgery and anaesthesiology

JMIR DIABETES

JMIR Diabetes (JD, Editor-in-Chief: Caroline Richardson) is a PubMed-indexed journal of JMIR, the leading open-access journal in health informatics.JMIR Diabetes focuses on technologies, medical devices, apps, engineering, informatics and patient education for diabetes prevention, self-management, care, and cure, to help people

with diabetes.

GUIDELINES FOR REPORTING STATISTICS Percentages Within a Sentence. Preferred JMIR style is to always make clear what the numerators and the denominators are. Of note, do not add a 0 after the decimal if the percentage value is a whole number, (ie, 64/100=64%, not 64.0%). There are no exceptions to this

guideline.

VIEWPOINT - FORMATIVE.JMIR.ORG Articles published in 2021-viewpoint in this theme: 3 (scroll down to load remaining articles) JMIR - JOURNAL OF MEDICAL INTERNET RESEARCHJMIR MENTAL HEALTHJMIR SERIOUS GAMESAUTHORSJMIR MHEALTH UHEALTHJMI-JMIR MEDICAL INFORMATICS The Journal of Medical Internet Research (JMIR) (founded in 1999, now in its' 22nd year!), is the pioneer open access eHealth journal and is the flagship journal of JMIR Publications.It is the leading digital health journal globally in terms of quality/visibility (Impact Factor 2019: 5.03), ranking Q1 in the medical informatics category, and is also the largest journal in the field. JOURNAL OF MEDICAL INTERNET RESEARCH Background: As the use of technology to deliver health services is increasing rapidly and has further intensified during the COVID-19 pandemic, these initiatives may fail if ethical impacts are not fully identified and acted upon by practitioners. Ignoring the ethical impacts of information and communication technology health service delivery creates an unintended risk for patients and can JMIR PEDIATRICS AND PARENTING JMIR Pediatrics and Parenting (JPP) is an open access journal. JPP has a unique focus on technologies, medical devices, apps, engineering, informatics applications for patient/parent education, training, counselling, behavioral interventions, preventative interventions and clinical care for pediatric and adolescent populations or child-parent

dyads.

JMIR AGING

to youth.

dyads.

JMIR AGING

to youth.

JOURNAL OF MEDICAL INTERNET RESEARCH Background: Internet technology can provide a diverse array of online resources for low-income disabled and homebound older adults to manage their health and mental health problems and maintain social connections. Despite many previous studies of older adults’ Internet use, none focused on these most vulnerable older adults. Objective: This study examined Internet use patterns, reasons for JOURNAL OF MEDICAL INTERNET RESEARCH Background: Although the COVID-19 pandemic will have a negative effect on China’s economy in the short term, it also represents a major opportunity for internet-based medical treatment in the medium and long term. Compared with normal times, internet-based medical platforms including the Haodf website were visited by 1.11 billion people, the number of new registered users of all platforms JOURNAL OF MEDICAL INTERNET RESEARCH Background: Since the coronavirus disease (COVID-19) epidemic in China in December 2019, information and discussions about COVID-19 have spread rapidly on the internet and have quickly become the focus of worldwide attention, especially on social media. Objective: This study aims to investigate and analyze the public’s attention to events related to COVID-19 in China at the beginning JOURNAL OF MEDICAL INTERNET RESEARCH Background: Digital food registration via online platforms that are coupled to large food databases obviates the need for manual processing of dietary data. The reliability of such platforms depends on the quality of the associated food database. Objective: In this study, we validate the database of MyFitnessPal versus the Belgian food composition database, Nubel. JOURNAL OF MEDICAL INTERNET RESEARCH Background: Although there is evidence for the efficacy of internet-based cognitive behavioral therapy (iCBT), the generalizability of results to routine care is limited. Objective: This study systematically reviews effectiveness studies of guided iCBT interventions for the treatment of depression or anxiety. Methods: The acceptability (uptake, participants’ characteristics, adherence, and

JMIR NURSING

JMIR DIABETES

with diabetes.

guideline.

dyads.

JMIR AGING

to youth.

dyads.

JMIR AGING

to youth.

JOURNAL OF MEDICAL INTERNET RESEARCH Background: Internet technology can provide a diverse array of online resources for low-income disabled and homebound older adults to manage their health and mental health problems and maintain social connections. Despite many previous studies of older adults’ Internet use, none focused on these most vulnerable older adults. Objective: This study examined Internet use patterns, reasons for JOURNAL OF MEDICAL INTERNET RESEARCH Background: Although the COVID-19 pandemic will have a negative effect on China’s economy in the short term, it also represents a major opportunity for internet-based medical treatment in the medium and long term. Compared with normal times, internet-based medical platforms including the Haodf website were visited by 1.11 billion people, the number of new registered users of all platforms JOURNAL OF MEDICAL INTERNET RESEARCH Background: Since the coronavirus disease (COVID-19) epidemic in China in December 2019, information and discussions about COVID-19 have spread rapidly on the internet and have quickly become the focus of worldwide attention, especially on social media. Objective: This study aims to investigate and analyze the public’s attention to events related to COVID-19 in China at the beginning JOURNAL OF MEDICAL INTERNET RESEARCH Background: Digital food registration via online platforms that are coupled to large food databases obviates the need for manual processing of dietary data. The reliability of such platforms depends on the quality of the associated food database. Objective: In this study, we validate the database of MyFitnessPal versus the Belgian food composition database, Nubel. JOURNAL OF MEDICAL INTERNET RESEARCH Background: Although there is evidence for the efficacy of internet-based cognitive behavioral therapy (iCBT), the generalizability of results to routine care is limited. Objective: This study systematically reviews effectiveness studies of guided iCBT interventions for the treatment of depression or anxiety. Methods: The acceptability (uptake, participants’ characteristics, adherence, and

JMIR NURSING

JMIR DIABETES

with diabetes.

guideline.

VIEWPOINT - FORMATIVE.JMIR.ORG Articles published in 2021-viewpoint in this theme: 3 (scroll down to load remaining articles) Sorry, you need to enable javascript for this page to function

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This Theme's Latest Article2020-04-09 10:47:03 ONLINE HEALTH INFORMATION–SEEKING AMONG OLDER WOMEN WITH CHRONIC ILLNESS: ANALYSIS OF THE WOMEN’S HEALTH INITIATIVE BACKGROUND: Understanding how older patients with chronic illnesses use the internet to obtain health information is relevant for the design of digital interventions aimed at improving the health and well-being of adults aged 65 years and older; this cohort represents the sickest, most expensive, and fastest-growing segment of the US population. OBJECTIVE: The objective of our study was to describe online health information–seeking behavior among older patients with chronic illnesses and to compare the characteristics of patients who report using the internet to obtain health information with those who do not. METHODS: The study population included 72,806 women aged 65 years and older enrolled in the Women’s Health Initiative (WHI), a national cohort study, who completed a 2014 supplemental questionnaire assessing everyday technology use and internet use for researching health conditions. Comparisons were made between participants with and without a history of chronic illness and between users and nonusers of online sources for health information. Multivariate logistic regression was used to estimate odds ratios (ORs) and 95% CIs. RESULTS: Of the total, 59% (42,887/72,806) of older women used the internet for health information. Compared with women who did not use the internet to obtain health information, those who used the internet were younger (median age: 76 vs 81 years), more likely to be non-Hispanic white (90% vs 87% ), earned a higher income (over $US 50,000: 55% vs 33% ), achieved a higher educational level (more than high school: 87% vs 75% ), and were more likely to live with a partner (52% vs 36% ) (all _P_<.001). Women with Alzheimer disease were least likely to report online health information–seeking compared to those without the disease (OR 0.41, 95% CI 0.38-0.43). In contrast, women with a recent diagnosis of cancer, within the previous 2 years (OR 1.23, 95% CI 1.11-1.36) or 2-5 years ago (OR 1.09, 95% CI 1.00-1.19), were most likely to use the internet for health information. CONCLUSIONS: Nearly 6 in 10 older women participating in the WHI reported using the internet to obtain health information. Patients recently diagnosed with cancer are more likely to be looking for health information online, even after adjustment for age, suggesting that these patients may have a greater need for digital

health resources.

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This Theme's Latest Article2020-03-31 10:45:03 IMPROVING PATIENT PREFERENCE ELICITATION BY APPLYING CONCEPTS FROM THE CONSUMER RESEARCH FIELD: NARRATIVE LITERATURE REVIEW BACKGROUND: Although preference research finds its origins in consumer research, preference elicitation methods have increasingly attracted attention in different decision-making contexts in health care. Simulating real-life decision making is believed to be important during consumer preference elicitation. OBJECTIVE: The aims of this study were to compare the process of decision making between patients and consumers and to identify methods from the consumer research field that could be applied in patient preference elicitation. METHODS: A narrative literature review was performed to identify preference elicitation concepts from a consumer context that could offer improvements in health care. RESULTS: The process of decision making between patients and consumers was highly comparable. The following five concepts from the consumer research field that could effectively simulate a real-life decision-making process for applications in health care were identified: simulating alternatives, self-reflection, feedback-driven exploration, separated (adaptive) dual response, and arranging profiles in blocks. CONCLUSIONS: Owing to similarities in the decision-making process, patients could be considered as a subgroup of consumers, suggesting that preference elicitation concepts from the consumer field may be relevant in health care. Five concepts that help to simulate real-life decision making have the potential to improve patient preference elicitation. However, the extent to which real decision-making contexts can be mimicked in health care remains

unknown.

LATEST SUBMISSION OPEN FOR PEER-REVIEW IMPROVEMENTS IN PATIENT MONITORING FOR THE INTENSIVE CARE UNIT: SURVEY

STUDY

Background: Due to demographic change and, more recently, the Coronavirus Disease 2019 (COVID-19), the importance of modern intensive care units (ICU) is becoming apparent. One of the key components of an ICU is the continuous monitoring of patients' vital parameters. However, existing advances in informatics, signal processing, or engineering that could alleviate the burden on ICUs have not yet been applied. This could be related to the lack of user involvement in research and development. Objective: This study focused on satisfaction of ICU staff with the current patient monitoring and their suggestions for future improvements. We aimed to identify aspects disturbing patient care, remote monitoring display devices, use cases for artificial intelligence (AI), and whether ICU staff is willing to improve their digital literacy or contribute to the improvement of patient monitoring. We further desired to uncover differences between the answers of the professional groups. Methods: This survey study was realized with ICU staff from four ICUs of a German university hospital between November 2019 and January 2020. We developed a web-based 36-item survey questionnaire by analyzing a preceding qualitative interview study with ICU staff about clinical requirements of future patient monitoring. Statistical analyses of questionnaire results included median values with their bootstrapped 95% confidence intervals, and Chi-square tests to compare the distributions of item responses of the professional groups. Results: Eighty-six of the 270 ICU staff members completed the survey questionnaire. The majority stated to feel confident using the patient monitoring, but high rates of false positive alarms and the many sensor cables were considered to disturb patient care. Wireless sensors, reduction of false positive alarms and hospital standard operating procedures (SOP) for alarm management were demanded. Responses to the display devices proposed for remote patient monitoring were split. Regarding its use, most respondents indicated responsibility for multiple wards or earlier alerting. AI for ICUs would be useful for early detection of complications, increased risk of mortality, and to have guidelines for therapy and diagnostics proposed. Transparency, interoperability, usability, and staff training were essential to promote usage of an AI. The majority wanted to learn more about new technologies for ICU and desired more time for it. Physicians had fewer reservations than nurses about using mobile phones for remote monitoring, and AI-based intelligent alarm management. Conclusions: This survey study among ICU staff revealed key improvements for patient monitoring in intensive care medicine. Hospital providers and medical device manufacturers should focus on reducing false alarms, implementing hospital alarm SOPs, introducing wireless sensors, preparing for the use of AI, and enhancing digital literacy of ICU staff. Our results may contribute to the user-centered transfer of digital technologies into practice to alleviate challenges in intensive care medicine. Clinical Trial: ClinicalTrials.gov NCT03514173; https://clinicaltrials.gov/ct2/show/NCT03514173 Date Submitted: Apr 13, 2020 Open Peer Review Period: Apr 13, 2020 -

Jun 8, 2020

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ANNOUNCEMENT

PREREVIEW + JMIR PUBLICATIONS VIRTUAL COVID-19 PREPRINT JOURNAL CLUB:

APRIL 14TH, 2020

2020-04-06

PREREVIEW + JMIR PUBLICATIONS VIRTUAL COVID-19 PREPRINT JOURNAL CLUB (Toronto/Portland, 27 March 2020) In addition to its' previous Call for COVID19 Papers , JMIR Publications has joined forces with PREreview to bring together scientists from across the globe for a virtual discussion and collaborative review of a recent preprint covering new research related to coronavirus SARS-COV-2 leading to the disease referred to as COVID-19. After our previous call for preprint nominations (archived here

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discussed at the journal club has now been selected: “KNOWLEDGE AND BEHAVIORS TOWARD COVID-19 AMONG U.S. RESIDENTS DURING THE EARLY DAYS OF THE PANDEMIC” REGISTRATION NOW OPEN: The online journal club will be hosted by two facilitators who will guide participants through a constructive discussion of the preprint following a curated template. The moderators will be joined by an invited expert, the author of the preprint and researchers from all over the world including you! WHEN: April 14th, 2020, 12noon ET

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Get ready to spend one hour with your fellows colleagues diving straight into the preprint and resurfacing with constructive feedback for the authors. A short version of the review will then be posted on Outbreak Science Rapid PREreview while the longer report will be posted on PREreview and receive a digital object identifier (DOI).

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JOURNAL DESCRIPTION

The Journal of Medical Internet Research (JMIR), now in its 21st year, is the pioneer open access eHealth journal and is the flagship journal of JMIR Publications. It is the leading digital health journal globally in terms of quality/visibility (Impact Factor 2018: 4.945 , ranked #1 out of 26 journals in the medical informatics category) and in terms of size (number of papers published). The journal focuses on emerging technologies, medical devices, apps, engineering, and informatics applications for patient education, prevention, population health and clinical care. As a leading high-impact journal in its disciplines (health informatics and health services research), it is selective, but it is now complemented by almost 30 specialty JMIR sister journals

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which have a broader scope. Peer-review reports are portable across JMIR journals and papers can be transferred, so authors save time by not having to resubmit a paper to different journals. As an open access journal, we are read by clinicians, allied health professionals, informal caregivers, and patients alike, and have (as with all JMIR journals) a focus on readable and applied science reporting the design and evaluation of health innovations and emerging technologies. We publish original research, viewpoints, and reviews (both literature reviews and medical device/technology/app reviews). We are also a leader in participatory and open science approaches, and offer the option to publish new submissions immediately as preprints , which receive DOIs for immediate citation (eg, in grant proposals), and for open peer-review purposes. We also invite patients to participate (eg, as peer-reviewers) and have patient representatives on editorial boards. Be a widely cited leader in the digitial health revolution and submit

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Review

APR 13, 2020

EDUCATING PATIENTS BY PROVIDING TIMELY INFORMATION USING SMARTPHONE AND TABLET APPS: SYSTEMATIC REVIEW View Authors View Abstract

AUTHORS LIST:

* Thomas Timmers

* Loes Janssen

* Rudolf B Kool

* Jan AM Kremer

ABSTRACT:

BACKGROUND: Patient education is a crucial element within health care. It is a known predictor for increased engagement in shared decision making, improved medication and treatment adherence, higher levels of satisfaction, and even better treatment outcomes. Unfortunately, often patients only remember a very limited amount of medical information. An important reason is that most patients are simply not capable of processing large amounts of new medical information in a short time. Apps for smartphones and tablets have the potential to actively educate patients by providing them with timely information through the use of push notifications. OBJECTIVE: The objective of this systematic review is to provide an overview of the effects of using smartphone and tablet apps to educate patients with timely education. Within this review, we focused on patients that receive their care in a hospital setting. We assessed the effects of the interventions on outcomes, such as patients’ knowledge about their illness and treatment, adherence to treatment instructions and to medication usage, and satisfaction with the care they received. METHODS: A comprehensive search of MEDLINE (Medical Literature Analysis and Retrieval System Online), Embase, CINAHL (Cumulative Index to Nursing and Allied Health Literature), and Web of Science was conducted. Randomized controlled trials (RCTs) published between January 2015 and November 2019 were eligible for inclusion. Two reviewers independently searched and screened articles, assessed study quality and risk of bias, and extracted the data. Due to the heterogeneity of populations, interventions, and outcomes, a meta-analysis was not deemed appropriate. Instead, a narrative synthesis is presented. RESULTS: A total of 21 RCTs with 4106 participants were included. Compared to usual care, overall effectiveness of the interventions was demonstrated in 69% of the outcomes. Effectiveness increased to 82% when the intervention had a duration shorter than one month and increased to 78% when the intervention provided at least one push notification per week. The interventions showed the highest effects on satisfaction with information, adherence to treatment instructions and to medication usage, clinical outcomes, and knowledge. CONCLUSIONS: This review demonstrates that educating patients with timely medical information through their smartphones or tablets improves their levels of knowledge, medication or treatment adherence, satisfaction, and clinical outcomes, as well as having a positive effect on health care economics. These effects are most pronounced in interventions with a short duration (ie, less than a month) and with a high frequency of messages to patients (ie, once per week or more). With the knowledge that patient education is a predictor for improved outcomes and the fact that patients have obvious difficulties processing large amounts of new medical information, we suggest incorporating the delivery of timely information through smartphone and tablet apps within current

medical practices.

* J Med Internet Res 2020

;22(4) :e17342

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Review

APR 13, 2020

MOBILE HEALTH FOR PERINATAL DEPRESSION AND ANXIETY: SCOPING REVIEW View Authors View Abstract

AUTHORS LIST:

* Neesha Hussain-Shamsy

* Amika Shah

* Simone N Vigod

* Juveria Zaheer

* Emily Seto

ABSTRACT:

BACKGROUND: The perinatal period is a vulnerable time during which depression and anxiety commonly occur. If left untreated or undertreated, there may be significant adverse effects; therefore, access to rapid, effective treatment is essential. Treatments for mild-to-moderate symptoms according to a stepped-care approach involve psychoeducation, peer support, and psychological therapy, all of which have been shown to be efficaciously delivered through digital means. Women experience significant barriers to care because of system- and individual-level factors, such as cost, accessibility, and availability of childcare. The use of mobile phones is widespread in this population, and the delivery of mental health services via mobile phones has been suggested as a means of reducing barriers. OBJECTIVE: This study aimed to understand the extent, range, and nature of mobile health (mHealth) tools for prevention, screening, and treatment of perinatal depression and anxiety in order to identify gaps and inform opportunities for future work. METHODS: Using a scoping review framework, 4 databases were searched for terms related to mobile phones, perinatal period, and either depression or anxiety. A total of 477 unique records were retrieved, 81 of which were reviewed by full text. Peer-reviewed publications were included if they described the population as women pregnant or up to 1 year postpartum and a tool explicitly delivered via a mobile phone for preventing, screening, or treating depression or anxiety. Studies published in 2007 or earlier, not in English, or as case reports were excluded. RESULTS: A total of 26 publications describing 22 unique studies were included (77% published after 2017). mHealth apps were slightly more common than texting-based interventions (12/22, 54% vs 10/22, 45%). Most tools were for either depression (12/22, 54%) or anxiety and depression (9/22, 41%); 1 tool was for anxiety only (1/22, 4%). Interventions starting in pregnancy and continuing into the postpartum period were rare (2/22, 9%). Tools were for prevention (10/22, 45%), screening (6/22, 27%), and treatment (6/22, 27%). Interventions delivered included psychoeducation (16/22, 73%), peer support (4/22, 18%), and psychological therapy (4/22, 18%). Cost was measured in 14% (3/22) studies. CONCLUSIONS: Future work in this growing area should incorporate active psychological treatment, address continuity of care across the perinatal period, and consider clinical sustainability to realize the potential of mHealth. TRIAL REGISTRATION: * J Med Internet Res 2020

;22(4) :e17011

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Information Retrieval

APR 13, 2020

COMPARING MEDICAL TERM USAGE PATTERNS OF PROFESSIONALS AND SEARCH ENGINE AND COMMUNITY QUESTION ANSWERING SERVICE USERS IN JAPAN: LOG

ANALYSIS

View Authors View Abstract

AUTHORS LIST:

* Kazuya Taira

* Taichi Murayama

* Sumio Fujita

* Mikiko Ito

* Kei Kamide

* Eiji Aramaki

ABSTRACT:

BACKGROUND: Despite increasing opportunities for acquiring health information online, discussion of the specific words used in searches has been limited. OBJECTIVE: The aim of this study was to clarify the medical information gap between medical professionals and the general public in Japan through health information–seeking activities on the internet. METHODS: Search and posting data were analyzed from one of the most popular domestic search engines in Japan (Yahoo! JAPAN Search) and the most popular Japanese community question answering service (Yahoo! Chiebukuro). We compared the frequency of 100 clinical words appearing in the clinical case reports of medical professionals (clinical frequency) with their frequency in Yahoo! JAPAN Search (search frequency) logs and questions posted to Yahoo! Chiebukuro (question frequency). The Spearman correlation coefficient was used to quantify association patterns among the three information sources. Additionally, user information (gender and age) in the search frequency associated with each registered user was extracted. RESULTS: Significant correlations were observed between clinical and search frequencies (_r_=0.29, _P_=.003), clinical and question frequencies (_r_=0.34, _P_=.001), and search and question frequencies (_r_=0.57, _P_<.001). Low-frequency words in clinical frequency (eg, “hypothyroidism,” “ulcerative colitis”) highly ranked in search frequency. Similarly, “pain,” “slight fever,” and “numbness” were highly ranked only in question frequency. The weighted average of ages was 34.5 (SD 2.7) years, and the weighted average of gender (man –1, woman +1) was 0.1 (SD 0.1) in search frequency. Some words were specifically extracted from the search frequency of certain age groups, including “abdominal pain” (10-20 years), “plasma cells” and “inflammatory findings” (20-30 years), “DM” (diabetes mellitus; 30-40 years), “abnormal shadow” and “inflammatory findings” (40-50 years), “hypertension” and “abnormal shadow” (50-60 years), and “lung cancer” and “gastric cancer” (60-70 years). CONCLUSIONS: Search and question frequencies showed similar tendencies, whereas search and clinical frequencies showed discrepancy. Low-clinical frequency words related to diseases such as “hypothyroidism” and “ulcerative colitis” had high search frequencies, whereas those related to symptoms such as “pain,” “slight fever,” and “numbness” had high question frequencies. Moreover, high search frequency words included designated intractable diseases such as “ulcerative colitis,” which has an incidence of less than 0.1% in the Japanese population. Therefore, it is generally worthwhile to pay attention not only to major diseases but also to minor diseases that users frequently seek information on, and more words will need to be analyzed in the future. Some characteristic words for certain age groups were observed (eg, 20-40 years: “cancer”; 40-60 years: diagnoses and diseases identified in health examinations; 60-70 years: diseases with late adulthood onset and “death”). Overall, this analysis demonstrates that medical professionals as information providers should be aware of clinical frequency, and medical information gaps between professionals and the general public should

be bridged.

* J Med Internet Res 2020

;22(4) :e13369

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Review

APR 9, 2020

HOW BEHAVIOR CHANGE STRATEGIES ARE USED TO DESIGN DIGITAL INTERVENTIONS TO IMPROVE MEDICATION ADHERENCE AND BLOOD PRESSURE AMONG PATIENTS WITH HYPERTENSION:... View Authors View Abstract

AUTHORS LIST:

* Kobra Etminani

* Arianna Tao Engström

* Carina Göransson

* Anita Sant’Anna

* Sławomir Nowaczyk

ABSTRACT:

BACKGROUND: Information on how behavior change strategies have been used to design digital interventions (DIs) to improve blood pressure (BP) control or medication adherence (MA) for patients with hypertension is currently limited. OBJECTIVE: Hypertension is a major modifiable risk factor for cardiovascular diseases and can be controlled with appropriate medication. Many interventions that target MA to improve BP are increasingly using modern digital technologies. This systematic review was conducted to discover how DIs have been designed to improve MA and BP control among patients with hypertension in the recent 10 years. Results were mapped into a matrix of change objectives using the Intervention Mapping framework to guide future development of technologies to improve MA and BP control. METHODS: We included all the studies regarding DI development to improve MA or BP control for patients with hypertension published in PubMed from 2008 to 2018. All the DI components were mapped into a matrix of change objectives using the Intervention Mapping technique by eliciting the key determinant factors (from patient and health care team and system levels) and targeted patient behaviors. RESULTS: The analysis included 54 eligible studies. The determinants were considered at two levels: patient and health care team and system. The most commonly described determinants at the patient level were lack of education, lack of self-awareness, lack of self-efficacy, and forgetfulness. Clinical inertia and an inadequate health workforce were the most commonly targeted determinants at the health care team and system level. Taking medication, interactive patient-provider communication, self-measurement, and lifestyle management were the most cited patient behaviors at both levels. Most of the DIs did not include support from peers or family members, despite its reported effectiveness and the rate of social media penetration. CONCLUSIONS: This review highlights the need to design a multifaceted DI that can be personalized according to patient behavior(s) that need to be changed to overcome the key determinant(s) of low adherence to medication or uncontrolled BP among patients with hypertension, considering different levels including patient and healthcare team and system involvement. * J Med Internet Res 2020

;22(4) :e17201

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Telehealth and Telemonitoring

APR 9, 2020

PARENT PERSPECTIVES ON FAMILY-CENTERED PEDIATRIC ELECTRONIC CONSULTATIONS: QUALITATIVE STUDY View Authors View Abstract

AUTHORS LIST:

* Rhea Verma

* Tamar Krishnamurti

* Kristin N Ray

ABSTRACT:

BACKGROUND: Electronic consultations, which use store-and-forward transfer of clinical information between a primary care physician and a specialist, improve access to specialty care. Adoption of electronic consultations is beginning in pediatric health care systems, but little is known about parent perspectives, informational needs, and preferences for interaction with this new model of care. OBJECTIVE: This study aimed to examine parent perspectives about electronic consultations, including perceived benefits and risks, anticipated informational needs, and preferences for parent engagement with electronic consultations. METHODS: We recruited caregivers of pediatric patients (aged 0-21 years) attending visits at an academic primary care center. Caregivers were eligible if their child had ever been referred for in-person specialty care. Caregivers participated in a semistructured interview about electronic consultations, including general perspectives, desired information, and preferences for parental engagement. Interviews were transcribed and qualitatively analyzed to identify parent perspectives on electronic consultations in general, information parents would like to receive about electronic consultations, and perspectives on opportunities to enhance parent engagement with electronic consultations. RESULTS: Interviewees (n=20) anticipated that electronic consultations would reduce the time burden of specialty care on families and that these had the potential to improve the integrity and availability of clinical information, but interviewees also expressed concern about data confidentiality. The most detailed information desired by interviewees about electronic consultations related to data security, including data confidentiality, availability, and integrity. Interviewees expressed concern that electronic consultations could exclude parents from their child’s health care decisions. Interviewees saw value in the potential ability to track the consultation status or to participate in the consultation dialogue, but they were more ambivalent about the idea of read-only access to consultation documentation. CONCLUSIONS: Parents identified the potential risks and benefits of pediatric electronic consultations, with implications for communication with families about electronic consultations and for incorporation of features to enhance parent engagement. * J Med Internet Res 2020

;22(4) :e16954

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Information Retrieval

APR 9, 2020

ONLINE HEALTH INFORMATION–SEEKING AMONG OLDER WOMEN WITH CHRONIC ILLNESS: ANALYSIS OF THE WOMEN’S HEALTH INITIATIVE View Authors View Abstract

AUTHORS LIST:

* Mina S Sedrak

* Enrique Soto-Perez-De-Celis

* Rebecca A Nelson

* Jennifer Liu

* Molly E Waring

* Dorothy S Lane

* Electra D Paskett

* Rowan T Chlebowski

ABSTRACT:

BACKGROUND: Understanding how older patients with chronic illnesses use the internet to obtain health information is relevant for the design of digital interventions aimed at improving the health and well-being of adults aged 65 years and older; this cohort represents the sickest, most expensive, and fastest-growing segment of the US population. OBJECTIVE: The objective of our study was to describe online health information–seeking behavior among older patients with chronic illnesses and to compare the characteristics of patients who report using the internet to obtain health information with those who do not. METHODS: The study population included 72,806 women aged 65 years and older enrolled in the Women’s Health Initiative (WHI), a national cohort study, who completed a 2014 supplemental questionnaire assessing everyday technology use and internet use for researching health conditions. Comparisons were made between participants with and without a history of chronic illness and between users and nonusers of online sources for health information. Multivariate logistic regression was used to estimate odds ratios (ORs) and 95% CIs. RESULTS: Of the total, 59% (42,887/72,806) of older women used the internet for health information. Compared with women who did not use the internet to obtain health information, those who used the internet were younger (median age: 76 vs 81 years), more likely to be non-Hispanic white (90% vs 87% ), earned a higher income (over $US 50,000: 55% vs 33% ), achieved a higher educational level (more than high school: 87% vs 75% ), and were more likely to live with a partner (52% vs 36% ) (all _P_<.001). Women with Alzheimer disease were least likely to report online health information–seeking compared to those without the disease (OR 0.41, 95% CI 0.38-0.43). In contrast, women with a recent diagnosis of cancer, within the previous 2 years (OR 1.23, 95% CI 1.11-1.36) or 2-5 years ago (OR 1.09, 95% CI 1.00-1.19), were most likely to use the internet for health information. CONCLUSIONS: Nearly 6 in 10 older women participating in the WHI reported using the internet to obtain health information. Patients recently diagnosed with cancer are more likely to be looking for health information online, even after adjustment for age, suggesting that these patients may have a greater need for digital

health resources.

* J Med Internet Res 2020

;22(4) :e15906

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Clinical Informatics

APR 9, 2020

EPIDEMIOLOGICAL CHARACTERIZATION OF A DIRECTED AND WEIGHTED DISEASE NETWORK USING DATA FROM A COHORT OF ONE MILLION PATIENTS: NETWORK

ANALYSIS

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AUTHORS LIST:

* Kyungmin Ko

* Chae Won Lee

* Sangmin Nam

* Song Vogue Ahn

* Jung Ho Bae

* Chi Yong Ban

* Jongman Yoo

* Jungmin Park

* Hyun Wook Han

ABSTRACT:

BACKGROUND: In the past 20 years, various methods have been introduced to construct disease networks. However, established disease networks have not been clinically useful to date because of differences among demographic factors, as well as the temporal order and intensity among disease-disease associations. OBJECTIVE: This study sought to investigate the overall patterns of the associations among diseases; network properties, such as clustering, degree, and strength; and the relationship between the structure of disease networks and demographic factors. METHODS: We used National Health Insurance Service-National Sample Cohort (NHIS-NSC) data from the Republic of Korea, which included the time series insurance information of 1 million out of 50 million Korean (approximately 2%) patients obtained between 2002 and 2013. After setting the observation and outcome periods, we selected only 520 common Korean Classification of Disease, sixth revision codes that were the most prevalent diagnoses, making up approximately 80% of the cases, for statistical validity. Using these data, we constructed a directional and weighted temporal network that considered both demographic factors and network properties. RESULTS: Our disease network contained 294 nodes and 3085 edges, a relative risk value of more than 4, and a false discovery rate-adjusted _P_ value of <.001. Interestingly, our network presented four large clusters. Analysis of the network topology revealed a stronger correlation between in-strength and out-strength than between in-degree and out-degree. Further, the mean age of each disease population was related to the position along the regression line of the out/in-strength plot. Conversely, clustering analysis suggested that our network boasted four large clusters with different sex, age, and disease categories. CONCLUSIONS: We constructed a directional and weighted disease network visualizing demographic factors. Our proposed disease network model is expected to be a valuable tool for use by early clinical researchers seeking to explore the relationships among diseases in the future. * J Med Internet Res 2020

;22(4) :e15196

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Patient-Reported Outcome Measures...

APR 9, 2020

PATIENT-REPORTED OUTCOMES DURING IMMUNOTHERAPY FOR METASTATIC MELANOMA: MIXED METHODS STUDY OF PATIENTS’ AND CLINICIANS’

EXPERIENCES

View Authors View Abstract

AUTHORS LIST:

* Lærke K Tolstrup

* Helle Pappot

* Lars Bastholt

* Ann-Dorthe Zwisler

* Karin B Dieperink

ABSTRACT:

Background: The benefits of electronic patient reported outcomes (PRO) questionnaires have been demonstrated in many settings, including in hospitals and patient homes. However, it remains to be investigated how melanoma patients and their treating clinicians experience the electronic self-reporting of side effects and the derived communication. Objective: The primary objective of this study was to examine patients’ and clinicians’ experiences with an eHealth intervention for weekly monitoring of side effects during treatment with immunotherapy. Methods: An eHealth intervention based on questions from the PRO-Common Terminology Criteria for Adverse Events (CTCAE) library was used and tested in a randomized clinical trial with patients receiving immunotherapy for malignant melanoma and clinicians at a university hospital in Denmark. On a weekly basis, patients reported their symptoms from home during the treatment via a provided tablet. The electronic patient reports were available to clinicians in the outpatient clinic. A mixed methods approach was applied to investigate the patients’ and clinicians’ experiences with the intervention. Data from patient experiences were collected in a short survey, the Patient Feedback Form. Moreover, a subset of the patients participating in the survey was interviewed about their experience. Furthermore, one focus group interview with clinicians was carried out to elucidate their views. Results: A total of 57 patients completed the Patient Feedback Form, and 14 patients were interviewed. The focus group interview included 5 clinicians. Overall, patients and clinicians were satisfied with the tool. They believed it enhanced patients’ awareness of side effects and increased their feeling of involvement. The patients reported that it was easy to fill out the questionnaire and that it made sense to do so. However, a minority of the patients expressed in the interviews that they did not believe that the health care professionals had seen their reports when they came to the clinic, and that the reporting did not lead to increased contact with the department. Conclusions: Overall, satisfaction with the eHealth intervention was high among patients and their treating clinicians. The tool was easy to use and contributed to greater symptom awareness and patient involvement. Thus, in terms of patient and clinician satisfaction with the tool, it makes sense to continue using the tool beyond the project period. Clinical Trial: ClinicalTrials.gov NCT03073031; https://tinyurl.com/tjx3gtu * J Med Internet Res 2020

;22(4) :e14896

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Virtual Reality and Virtual Worlds

APR 8, 2020

NURSE-PHYSICIAN COMMUNICATION TEAM TRAINING IN VIRTUAL REALITY VERSUS LIVE SIMULATIONS: RANDOMIZED CONTROLLED TRIAL ON TEAM COMMUNICATION AND TEAMWORK ATTITUDES View Authors View Abstract

AUTHORS LIST:

* Sok Ying Liaw

* Sim Win Ooi

* Khairul Dzakirin Bin Rusli

* Tang Ching Lau

* Wilson Wai San Tam

* Wei Ling Chua

ABSTRACT:

BACKGROUND: Interprofessional team training is needed to improve nurse-physician communication skills that are lacking in clinical practice. Using simulations has proven to be an effective learning approach for team training. Yet, it has logistical constraints that call for the exploration of virtual environments in delivering team training. OBJECTIVE: This study aimed to evaluate a team training program using virtual reality vs conventional live simulations on medical and nursing students’ communication skill performances and teamwork attitudes. METHODS: In June 2018, the authors implemented nurse-physician communication team training using communication tools. A randomized controlled trial study was conducted with 120 undergraduate medical and nursing students who were randomly assigned to undertake team training using virtual reality or live simulations. The participants from both groups were tested on their communication performances through team-based simulation assessments. Their teamwork attitudes were evaluated using interprofessional attitude surveys that were administered before, immediately after, and 2 months after the study interventions. RESULTS: The team-based simulation assessment revealed no significant differences in the communication performance posttest scores (_P_=.29) between the virtual and simulation groups. Both groups reported significant increases in the interprofessional attitudes posttest scores from the baseline scores, with no significant differences found between the groups over the 3 time points. CONCLUSIONS: Our study outcomes did not show an inferiority of team training using virtual reality when compared with live simulations, which supports the potential use of virtual reality to substitute conventional simulations for communication team training. Future studies can leverage the use of artificial intelligence technology in virtual reality to replace costly human-controlled facilitators to achieve better scalability and sustainability of team-based training in interprofessional education. TRIAL REGISTRATION: ClinicalTrials.gov NCT04330924; https://clinicaltrials.gov/ct2/show/NCT04330924 * J Med Internet Res 2020

;22(4) :e17279

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Information Retrieval

APR 8, 2020

INFORMATION NEEDS AND INFORMATION-SEEKING BEHAVIOR OF ITALIAN NEUROLOGISTS: EXPLORATORY MIXED METHODS STUDY View Authors View Abstract

AUTHORS LIST:

* Silvia Demergazzi

* Luca Pastore

* Giada Bassani

* Marco Arosio

* Caterina Lonati

ABSTRACT:

BACKGROUND: Current medical professions involve an extensive knowledge of the latest validated scientific data to implement disease diagnosis, therapeutic strategies, and patient care. Although clinicians can refer to a growing number and type of information sources to keep current with new scientific achievements, there are still various concerns about medical information validity, quality, and applicability into clinical practice. Novel strategies are required to identify physicians’ real-life needs with the final aim to improve modern medical information delivery. OBJECTIVE: Our research used an innovative tool to collect real-time physician queries in order to investigate information needs and seeking behavior of Italian neurologists treating patients with multiple sclerosis (MS) and migraine. METHODS: The study was designed as an exploratory mixed methods (ie, qualitative and quantitative) study involving 15 consecutive days of observation. A total of 50 neurologists (n=25 MS and n=25 migraine specialists) were recruited. Data were collected using an instant messaging mobile app designed for this research. At each information-seeking event, moderators triggered a computer-assisted personal interview including both semistructured interview and close-ended questions. Interactions and physician queries collected using the mobile app were coded into emerging themes by content analysis. RESULTS: Neurologist queries were relevant to the following major themes: therapy management (36/50, 71%) and drug-related information (34/50, 67%), followed by diagnostic strategies and procedures (21/50, 42%). Quantitative analysis indicated online resources were preferentially used by clinicians (48/50, 96%) compared with offline sources (24/50, 47%). A multichannel approach, in which both online and offline sources were consulted to meet the same need, was adopted in 33% (65/198) of information-seeking events. Neurologists more likely retrieved information from online relative to offline channels (F=1.7; _P_=.01). MS specialists were 53% more likely to engage in one information-seeking event compared with migraine neurologists (risk ratio 1.54; 95% CI 1.16-2.05). MS specialists tended to be more interested in patient-related content than migraine clinicians (28% vs 10% , _P_=.06), who conversely more likely sought information concerning therapy management (85% vs 60% , _P_=.05). Compared with MS clinicians, migraine specialists had a harder time finding the required information, either looking at online or offline channels (F=12.5; _P_=.01) and less frequently used offline channels (30% vs 60% of information-seeking events, _P_=.02). When multiple sources needed to be consulted to retrieve an information item, a reduced satisfaction rate was observed both among migraine and MS specialists (single source vs multiple sources _P_=.003). CONCLUSIONS: This study provides a detailed description of real-life seeking behavior, educational needs, and information sources adopted by Italian MS and migraine neurologists. Neurologist information needs and seeking behavior reflect the specific characteristics of the specialty area in which they operate. These findings suggest identification of time- and context-specific needs of clinicians is required to design an effective medical information

strategy.

* J Med Internet Res 2020

;22(4) :e14979

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Web-based and Mobile Health...

APR 7, 2020

FIBROMYALGIA IMPACT REDUCTION USING ONLINE PERSONAL HEALTH INFORMATICS: LONGITUDINAL OBSERVATIONAL STUDY View Authors View Abstract

AUTHORS LIST:

* William Collinge

* Robert Soltysik

* Paul Yarnold

ABSTRACT:

BACKGROUND: Personal health informatics have the potential to help patients discover personalized health management strategies that influence outcomes. Fibromyalgia (FM) is a complex chronic illness requiring individualized strategies that may be informed by analysis of personal health informatics data. An online health diary program with dynamic feedback was developed to assist patients with FM in identifying symptom management strategies that predict their personal outcomes, and found reduced symptom levels associated with program use. OBJECTIVE: The aim of this study was to determine longitudinal associations between program use and functional impact of FM as measured by scores on a standardized assessment instrument, the Fibromyalgia Impact Questionnaire (FIQ). METHODS: Participants were self-identified as diagnosed with FM and recruited via online FM advocacy websites. Participants used an online health diary program (“SMARTLog”) to report symptom ratings, behaviors, and management strategies used. Based on single-subject analysis of the accumulated data over time, individualized recommendations (“SMARTProfile”) were then provided by the automated feedback program. Indices of program use comprised of cumulative numbers of SMARTLogs completed and SMARTProfiles received. Participants included in this analysis met a priori criteria of sufficient program use to generate SMARTProfiles (ie, ≥22 SMARTLogs completed). Users completed the FIQ at baseline and again each subsequent month of program use as follow-up data for analysis. Kendall tau-b, a nonparametric statistic that measures both the strength and direction of an ordinal association between two repeated measured variables, was computed between all included FIQ scores and both indices of program use for each subject at the time of each completed FIQ. RESULTS: A total of 76 users met the a priori use criteria. The mean baseline FIQ score was 61.6 (SD 14.7). There were 342 FIQ scores generated for longitudinal analysis via Kendall tau-b. Statistically significant inverse associations were found over time between FIQ scores and (1) the cumulative number of SMARTLogs completed (tau-b=–0.135, _P_<.001); and (2) the cumulative number of SMARTProfiles received (tau-b=–0.133, _P_<.001). Users who completed 61 or more SMARTLogs had mean follow-up scores of 49.9 (n=25, 33% of the sample), an 18.9% drop in FM impact. Users who generated 11 or more new SMARTProfiles had mean follow-up scores of 51.8 (n=23, 30% of the sample), a 15.9% drop. CONCLUSIONS: Significant inverse associations were found between FIQ scores and both indices of program use, with FIQ scores declining as use increased. Based on established criteria for rating FM severity, the top one-third of users in terms of use had clinically significant reductions from “severe” to “moderate” FM impact. These findings underscore the value of self-management interventions with low burden, high usability, and high perceived relevance to the user. TRIAL REGISTRATION: ClinicalTrials.gov NCT02515552; https://clinicaltrials.gov/ct2/show/NCT02515552 * J Med Internet Res 2020

;22(4) :e15819

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Demographics of Users, Social &...

APR 6, 2020

THE USE OF TECHNOLOGY FOR COMMUNICATING WITH CLINICIANS OR SEEKING HEALTH INFORMATION IN A MULTILINGUAL URBAN COHORT: CROSS-SECTIONAL

SURVEY

View Authors View Abstract

AUTHORS LIST:

* Elaine C Khoong

* Natalie A Rivadeneira

* Robert A Hiatt

* Urmimala Sarkar

ABSTRACT:

BACKGROUND: Technology is being increasingly used to communicate health information, but there is limited knowledge on whether these strategies are effective for vulnerable populations, including non–English speaking or low-income individuals. OBJECTIVE: This study assessed how language preferences (eg, English, Spanish, or Chinese), smartphone ownership, and the type of clinic for usual source of care (eg, no usual source of care, nonintegrated safety net, integrated safety net, private or community clinic, academic tertiary medical center, or integrated payer-provider) affect technology use for health-related communication. METHODS: From May to September 2017, we administered a nonrandom, targeted survey to 1027 English-, Spanish-, and Chinese-speaking San Francisco residents and used weighted multivariable logistic regression analyses to assess predictors of five technology use outcomes. The three primary predictors of interest—language preference, smartphone ownership, and type of clinic for usual care—were adjusted for age, gender, race or ethnicity, limited English proficiency, educational attainment, health literacy, and health status. Three outcomes focused on use of email, SMS text message, or phone apps to communicate with clinicians. The two other outcomes were use of Web-based health videos or online health support groups. RESULTS: Nearly one-third of participants watched Web-based health videos (367/1027, 35.74%) or used emails to communicate with their clinician (318/1027, 30.96%). In adjusted analyses, individuals without smartphones had significantly lower odds of texting their clinician (adjusted odds ratio 0.27, 95% CI 0.13-0.56), using online health support groups (aOR 0.14, 95% CI 0.04-0.55), or watching Web-based health videos (aOR 0.31, 95% CI 0.15-0.64). Relative to English-speaking survey respondents, individuals who preferred Chinese had lower odds of texting their clinician (aOR 0.25, 95% CI 0.08-0.79), whereas Spanish-speaking survey respondents had lower odds of using apps to communicate with clinicians (aOR 0.34, 95% CI 0.16-0.75) or joining an online support group (aOR 0.30, 95% CI 0.10-0.92). Respondents who received care from a clinic affiliated with the integrated safety net, academic tertiary medical center, or integrated payer-provider systems had higher odds than individuals without a usual source of care at using emails, SMS text messages, or apps to communicate with clinicians. CONCLUSIONS: In vulnerable populations, smartphone ownership increases the use of many forms of technology for health purposes, but device ownership itself is not sufficient to increase the use of all technologies for communicating with clinicians. Language preference impacts the use of technology for health purposes even after considering English proficiency. Health system factors impact patients’ use of technology-enabled approaches for communicating with clinicians. No single factor was associated with higher odds of using technology for all health purposes; therefore, existing disparities in the use of digital health tools among diverse and vulnerable populations can only be addressed using a multipronged approach. * J Med Internet Res 2020

;22(4) :e16951

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Right click to copy or hit: ctrl+c (cmd+c on mac) LATEST SUBMISSIONS OPEN FOR PEER-REVIEW: View All Open Peer Review Articles

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IMPROVEMENTS IN PATIENT MONITORING FOR THE INTENSIVE CARE UNIT: SURVEY

STUDY

DATE SUBMITTED: APR 13, 2020 OPEN PEER REVIEW PERIOD: APR 13, 2020 - JUN 8, 2020

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AddThis Sharing Buttons Share to FacebookFacebook3Share to TwitterTwitterShare to LinkedInLinkedInShare to PinterestPinterest Background: Due to demographic change and, more recently, the Coronavirus Disease 2019 (COVID-19), the importance of modern intensive care units (ICU) is becoming apparent. One of the key

components o...

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APPLICATION AND INVESTIGATION OF WEARABLE DEVICES IN THE FIELD OF

HEALTH CARE

DATE SUBMITTED: MAR 26, 2020 OPEN PEER REVIEW PERIOD: APR 10, 2020 - JUN 10, 2020

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AddThis Sharing Buttons Share to FacebookFacebook3Share to TwitterTwitterShare to LinkedInLinkedInShare to PinterestPinterest With the development of science and technology, wearable devices have been widely used in the field of health care. In this article, we summarize the characteristics, key technologies, and classificat...

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With the development of science and technology, wearable devices have been widely used in the field of health care. In this article, we summarize the characteristics, key technologies, and classification of wearable devices, as well as their application in health and safety monitoring, chronic disease management, diagnosis and treatment of diseases, and rehabilitation. We analyze the shortcomings of wearable devices to highlight development trends and provide a useful reference for the development of wearable devices by collecting data on the application and investigation of wearable devices in the medical

field.

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COVID-19: HOME QUARANTINE IS NOT RECOMMENDED FOR CONFIRMED AND

SUSPECTED PATIENTS

DATE SUBMITTED: APR 10, 2020 OPEN PEER REVIEW PERIOD: APR 10, 2020 - JUN 10, 2020

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AddThis Sharing Buttons Share to FacebookFacebook3Share to TwitterTwitterShare to LinkedInLinkedInShare to PinterestPinterest The outbreak of the 2019 novel coronavirus (COVID-19) cause huge pressure on health care infrastructure. We recommend that those diagnosed, suspected and in close contact with diagnosed patients

shoul...

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The outbreak of the 2019 novel coronavirus (COVID-19) cause huge pressure on health care infrastructure. We recommend that those diagnosed, suspected and in close contact with diagnosed patients should be separately collected and treated in a centralized manner. According to the progress of the disease in the course of treatment, the patients will be further shunted. With standardized procedures in test and treatment, treatment capacity can be improved rapidly with the lowest social costs. We hope that the recommendations we delineate can provide guidance for the future global anti-epidemic.

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TELECONSULTATION BETWEEN PATIENTS AND HEALTHCARE PROFESSIONALS IN THE CATALAN PRIMARY CARE SERVICE: DESCRIPTIVE ANALYSIS THROUGH MESSAGE ANNOTATION IN A RETROSPECTIVE CROSS-SECTIONAL STUDY DATE SUBMITTED: APR 6, 2020 OPEN PEER REVIEW PERIOD: APR 6, 2020 - JUN 1, 2020

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AddThis Sharing Buttons Share to FacebookFacebook3Share to TwitterTwitterShare to LinkedInLinkedInShare to PinterestPinterest Background: Over the last decade telemedicine services have been introduced in the public healthcare systems of industrialized countries. In Catalonia, the use of eConsulta, an asynchronous

teleconsul...

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Background: Over the last decade telemedicine services have been introduced in the public healthcare systems of industrialized countries. In Catalonia, the use of eConsulta, an asynchronous teleconsultation between primary care professionals and citizens in the public healthcare system has already reached 400,000 cases and is growing at a monthly rate of 7%. Despite its widespread usage, there is little qualitative evidence describing how this tool is used. Objective: To annotate a random sample of these teleconsultations and to evaluate the level of agreement between healthcare professionals with respect to the annotation. Methods: 20 GPs retrospectively annotated a random sample of 5,382 cases managed with eConsulta according to 3 variables: the type of interaction according to 6 author-proposed categories, whether the practitioners believed a face-to-face visit was avoided, and whether they believed the patient would have requested a face-to-face visit had eConsulta not been available. 1,217 cases were classified three times, by three different professionals, to assess the degree of consensus among them. Results: In response to the question “Has the online consultation avoided a face-to-face visit?”, GPs answered Yes for 79,6% (4,284/5,382) of the teleconsultations, while to the question “In the absence of a service like eConsulta, would the patient have made a face-to-face visit?” GPs answered Yes 65% (3,496/5,382) of the time. The most frequent uses were for management of test results (26.8%, 1,433/5,354), the management of repeat prescriptions (24.3%, 1,301/5,354) and medical enquiries (14.2%, 762/5,354). The degree of agreement among professionals as to the annotations is mixed, with the highest consensus being for the variable “Has the online consultation avoided a face-to-face visit?” (3/3 professionals agreed 68% of the time (827/1,217), and the lowest for the type of use of the teleconsultation (3/3 professionals agreed 57.6% of the time, 701/1,217). Conclusions: This study shows eConsulta’s ability to reduce the number of face-to-face visit stands at between 55% (79% x 65%) and 79% of cases. In comparison to previous research, these results are a bit more pessimistic while figures are still high and in line with administrative data’ proxies, which show 84% of teleconsultations do not register an in-person appointment in the following 3 months. With respect to the type of consultation performed, results are similar to previous literature, thus giving robust support to the eConsulta’s usage. The mixed degree of consensus among professionals implies that results derived from AI applications such as message classification algorithms should be understood in light of these shortcomings.

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ASSOCIATION BETWEEN STANDING ELECTRIC SCOOTER INJURIES AND HUMAN BEHAVIORS ON INSTAGRAM: #ELECTRICSCOOTER DATE SUBMITTED: APR 5, 2020 OPEN PEER REVIEW PERIOD: APR 5, 2020 - MAY 31, 2020

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AddThis Sharing Buttons Share to FacebookFacebook3Share to TwitterTwitterShare to LinkedInLinkedInShare to PinterestPinterest Background: With the recent rise in popularity of standing electric scooters, there have been an increase in related injuries seen in the emergency departments. Social media, especially Instagram, is...

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Background: With the recent rise in popularity of standing electric scooters, there have been an increase in related injuries seen in the emergency departments. Social media, especially Instagram, is used by a significant number of young people as a platform of socialization and information sharing. Objective: The aim of this study is to examine the association between standing electric scooter related injuries seen in the emergency room and human behaviors on Instagram. Methods: We searched “#electricscooter” on Instagram and reviewed the first 1000 posts. To be included in the study, the image must include at least one standing electric scooter. Based on image characteristics, we categorized the posts non-exclusively, meaning that a post can be assigned to more than one category. The categories include: 1. no humans, 2. human using the standing electric scooter or is posing next to the vehicle, 3. more than one rider on one scooter, 4. include children, 5. include helmet, 6. advertisement, 7. advertisement that depicts helmet. Results: As of 1/30/2020, there are 278,054 posts related to #electricscooter on Instagram. 563 posts are included in the study. These posts are categorized non-exclusively as follow: 231 (40.1%) posts depict electric scooter(s) in the image without any human interactions. 248 (44.0%) posts illustrate humans using the scooter or is posting next to the scooter. 5 (0.9%) posts depict more than one rider on one vehicle at a time. 5 (0.9%) posts include children. 59 (10.5%) posts depicted helmets within the image. 73 (13.0%) posts are advertisements for electric scooters. 2 (0.4%) of the advertisement posts include helmet(s). Conclusions: Our study shows that human behaviors regarding standing electric scooters on Instagram are reflexive of human behaviors in real life. We suspect that human behaviors and advertisement patterns on Instagram may contribute to the normalization of unsafe standing electric scooter riding practices. Instagram and other social media platforms may be cost-effective places for patient outreach regarding electric scooter

safety.

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HOW PHYSICIANS’ SERVICE QUALITY AFFECTS PATIENT CONSULTATION IN ONLINE HEALTH COMMUNITIES: A LONGITUDINAL STUDY DATE SUBMITTED: APR 4, 2020 OPEN PEER REVIEW PERIOD: APR 4, 2020 - MAY 30, 2020

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AddThis Sharing Buttons Share to FacebookFacebook3Share to TwitterTwitterShare to LinkedInLinkedInShare to PinterestPinterest Background: With the dramatic development of Web 2.0, an increasing number of patients and physicians are active in online health communities (OHCs). While extant literature has primarily discussed

fa...

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Background: With the dramatic development of Web 2.0, an increasing number of patients and physicians are active in online health communities (OHCs). While extant literature has primarily discussed factors that influence patient consultation in OHCs, there is a lack of a thorough examination of the impact of two dimensions of physicians’ service quality on patients’ choices of physicians for their consulting services. Objective: This study aimed to explore the impact of the service delivery process (i.e., physicians’ login behavior) and service outcomes (i.e., online reputation) on patient consultation. Methods: A longitudinal study is conducted to examine the effects of login behavior and online reputation on patient consultation by analyzing short panel data from 779 physicians over five time periods in a Chinese OHC. Results: The results indicate that physicians’ service delivery process positively affects patient consultation, specifically with respect to login behavior. The maximum number of days of physicians’ no-login should be 20 days. Two online signals (login behavior and online reputation) are not complementary to each other. In addition, the moderating effects of offline signals (i.e., offline status) on two online signals are different, with the relationship between online reputation and patient consultation being positively moderated by offline status. Conclusions: This study contributes to online service quality and e-health literature by investigating the effects of two dimensions of physicians’ service quality on patient consultation and making a clear distinction between the online and offline signals. This study also provides practical implications, indicating that the service delivery process can affect patient consultation alone, rather than a complementary effect with the service outcomes.

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