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Comparative Analysis of Diagnostic Performance: Differential Diagnosis Lists by LLaMA3 Versus LLaMA2 for Case Reports. 诊断性能比较分析:LLaMA3 与 LLaMA2 的病例报告鉴别诊断列表。
IF 2 Q3 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-11-19 DOI: 10.2196/64844
Takanobu Hirosawa, Yukinori Harada, Kazuki Tokumasu, Tatsuya Shiraishi, Tomoharu Suzuki, Taro Shimizu

Background: Generative artificial intelligence (AI), particularly in the form of large language models, has rapidly developed. The LLaMA series are popular and recently updated from LLaMA2 to LLaMA3. However, the impacts of the update on diagnostic performance have not been well documented.

Objective: We conducted a comparative evaluation of the diagnostic performance in differential diagnosis lists generated by LLaMA3 and LLaMA2 for case reports.

Methods: We analyzed case reports published in the American Journal of Case Reports from 2022 to 2023. After excluding nondiagnostic and pediatric cases, we input the remaining cases into LLaMA3 and LLaMA2 using the same prompt and the same adjustable parameters. Diagnostic performance was defined by whether the differential diagnosis lists included the final diagnosis. Multiple physicians independently evaluated whether the final diagnosis was included in the top 10 differentials generated by LLaMA3 and LLaMA2.

Results: In our comparative evaluation of the diagnostic performance between LLaMA3 and LLaMA2, we analyzed differential diagnosis lists for 392 case reports. The final diagnosis was included in the top 10 differentials generated by LLaMA3 in 79.6% (312/392) of the cases, compared to 49.7% (195/392) for LLaMA2, indicating a statistically significant improvement (P<.001). Additionally, LLaMA3 showed higher performance in including the final diagnosis in the top 5 differentials, observed in 63% (247/392) of cases, compared to LLaMA2's 38% (149/392, P<.001). Furthermore, the top diagnosis was accurately identified by LLaMA3 in 33.9% (133/392) of cases, significantly higher than the 22.7% (89/392) achieved by LLaMA2 (P<.001). The analysis across various medical specialties revealed variations in diagnostic performance with LLaMA3 consistently outperforming LLaMA2.

Conclusions: The results reveal that the LLaMA3 model significantly outperforms LLaMA2 per diagnostic performance, with a higher percentage of case reports having the final diagnosis listed within the top 10, top 5, and as the top diagnosis. Overall diagnostic performance improved almost 1.5 times from LLaMA2 to LLaMA3. These findings support the rapid development and continuous refinement of generative AI systems to enhance diagnostic processes in medicine. However, these findings should be carefully interpreted for clinical application, as generative AI, including the LLaMA series, has not been approved for medical applications such as AI-enhanced diagnostics.

背景:生成式人工智能(AI),尤其是以大型语言模型为形式的生成式人工智能发展迅速。LLaMA 系列很受欢迎,最近已从 LLaMA2 升级到 LLaMA3。然而,更新对诊断性能的影响还没有得到很好的记录:我们对 LLaMA3 和 LLaMA2 生成的病例报告鉴别诊断列表的诊断性能进行了比较评估:我们分析了 2022 年至 2023 年发表在《美国病例报告杂志》(American Journal of Case Reports)上的病例报告。在排除非诊断性病例和儿科病例后,我们使用相同的提示和可调参数将剩余病例输入 LLaMA3 和 LLaMA2。诊断性能以鉴别诊断列表是否包含最终诊断来定义。多名医生独立评估最终诊断是否包含在 LLaMA3 和 LLaMA2 生成的前 10 个鉴别诊断中:在对 LLaMA3 和 LLaMA2 的诊断性能进行比较评估时,我们分析了 392 份病例报告的鉴别诊断列表。有 79.6% 的病例(312/392 例)的最终诊断被列入 LLaMA3 生成的前 10 个鉴别诊断中,而 LLaMA2 只有 49.7% 的病例(195/392 例)被列入前 10 个鉴别诊断中,这表明 LLaMA3 和 LLaMA2 的诊断性能在统计学上有显著提高(结论:结果显示,LLaMA3 和 LLaMA2 在诊断性能上有显著差异:结果表明,LLaMA3 模型的诊断性能明显优于 LLaMA2,有更高比例的病例报告的最终诊断被列入前 10 名、前 5 名和最高诊断。从 LLaMA2 到 LLaMA3,整体诊断性能提高了近 1.5 倍。这些发现支持了生成式人工智能系统的快速发展和不断完善,以提高医学诊断过程。不过,在临床应用中应谨慎解读这些发现,因为生成式人工智能(包括 LLaMA 系列)尚未获准用于人工智能增强诊断等医疗应用。
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引用次数: 0
Factors Influencing Poststroke Cognitive Dysfunction: Cross-Sectional Analysis. 影响脑卒中后认知功能障碍的因素:横断面分析
IF 2 Q3 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-11-19 DOI: 10.2196/59572
Wu Zhou, HaiXia Feng, Hua Tao, Hui Sun, TianTian Zhang, QingXia Wang, Li Zhang
<p><strong>Background: </strong>Poststroke cognitive impairment (PSCI) is a common and debilitating complication that affects stroke survivors, impacting memory, attention, and executive function. Despite its prevalence, the factors contributing to PSCI remain unclear, with limited insights into how demographic and clinical variables influence cognitive outcomes.</p><p><strong>Objective: </strong>This study investigates the incidence of cognitive impairment in patients with stroke and examines key demographic and clinical factors, such as age, gender, and education level, which contribute to cognitive decline. The aim is to provide a deeper understanding of PSCI to inform early intervention strategies for improving patient outcomes.</p><p><strong>Methods: </strong>A cross-sectional study was conducted on 305 patients with ischemic stroke admitted to Zhongda Hospital, Southeast University, from January 2019 to September 2022. Cognitive function was assessed using the Mini-Mental State Examination (MMSE) within 72 hours of hospital admission. Demographic information, including age, gender, and education level, were collected. Statistical analyses were performed using chi-square tests, independent t tests, and multivariate regression to assess the relationship between cognitive function and key variables. Pearson correlation analysis explored associations among age, education, and MMSE scores.</p><p><strong>Results: </strong>Among the 305 patients with stroke, 16.7% (n=51) were diagnosed with cognitive impairment based on MMSE scores. The prevalence of cognitive impairment was slightly higher in males (17.6%, n=159) than females (15.8%, n=146), but this difference was not statistically significant. A strong negative correlation was found between MMSE scores and age (r=-0.32; P<.01), indicating that older patients had lower cognitive function. Education level showed a positive correlation with MMSE scores (r=0.41; P<.01), with patients with higher educational attainment demonstrating better cognitive outcomes. Cognitive function showed a marked decline in patients older than 60 years, particularly in domains such as memory, attention, and language skills.</p><p><strong>Conclusions: </strong>This study confirms that age and education are significant factors in determining cognitive outcomes after stroke. The results align with existing literature showing that cognitive function declines with age, while higher educational attainment serves as a protective factor. The findings suggest that individuals with greater cognitive reserve, often linked to higher education, are better equipped to cope with the impact of brain injury. However, the study's reliance on MMSE may have limited its ability to detect domain-specific impairments. Future studies should consider using more sensitive cognitive tools, such as the Montreal Cognitive Assessment (MoCA), to provide a more comprehensive evaluation of PSCI. Cognitive impairment is prevalent among stroke survivors
背景:脑卒中后认知障碍(PSCI)是影响脑卒中幸存者的一种常见且使人衰弱的并发症,会影响记忆力、注意力和执行功能。尽管它很普遍,但导致 PSCI 的因素仍不清楚,对人口统计学和临床变量如何影响认知结果的了解也很有限:本研究调查了脑卒中患者认知功能障碍的发生率,并研究了导致认知功能下降的关键人口统计学和临床因素,如年龄、性别和教育水平。目的是加深对 PSCI 的了解,为改善患者预后的早期干预策略提供依据:方法:对2019年1月至2022年9月东南大学附属中大医院收治的305名缺血性脑卒中患者进行横断面研究。在入院 72 小时内使用迷你精神状态检查(MMSE)评估认知功能。此外,还收集了包括年龄、性别和受教育程度在内的人口统计学信息。采用卡方检验、独立 t 检验和多变量回归进行统计分析,以评估认知功能与关键变量之间的关系。皮尔逊相关分析探讨了年龄、教育程度和 MMSE 评分之间的关系:在 305 名脑卒中患者中,16.7%(n=51)根据 MMSE 评分被诊断为认知功能障碍。男性的认知障碍发生率(17.6%,n=159)略高于女性(15.8%,n=146),但差异无统计学意义。MMSE评分与年龄之间存在很强的负相关(r=-0.32;PC结论:本研究证实,年龄和教育程度是决定中风后认知结果的重要因素。研究结果与现有文献一致,表明认知功能会随着年龄的增长而下降,而较高的教育程度则是一个保护因素。研究结果表明,认知储备较强的人通常与受教育程度较高有关,他们更有能力应对脑损伤的影响。然而,该研究对 MMSE 的依赖可能限制了其检测特定领域损伤的能力。未来的研究应考虑使用更敏感的认知工具,如蒙特利尔认知评估(MoCA),以提供更全面的 PSCI 评估。认知障碍在中风幸存者中很普遍,年龄和教育水平是影响结果的关键因素。这些发现强调了早期检测和针对性干预对缓解认知功能衰退的重要性。要全面了解 PSCI 并改进中风患者的康复策略,还需要对更大的样本和更敏感的认知评估进行进一步研究。
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引用次数: 0
An Investigation of the Feasibility and Acceptability of Using a Commercial DASH (Dietary Approaches to Stop Hypertension) App in People With High Blood Pressure: Mixed Methods Study. 高血压患者使用商用 DASH(饮食疗法止高血压)应用程序的可行性和可接受性调查:混合方法研究。
IF 2 Q3 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-11-19 DOI: 10.2196/60037
Ghadah Alnooh, Jozaa Z AlTamimi, Elizabeth A Williams, Mark S Hawley
<p><strong>Background: </strong>The use of smartphone apps for dietary self-management among patients with high blood pressure is becoming increasingly common. Few commercially available DASH (Dietary Approaches to Stop Hypertension) diet apps have the potential to be effective, and only a few of these have adequate security and privacy measures. In previous studies, we identified 2 high-quality apps that are likely effective and safe. One of these, the Noom app, was selected as the most suitable app for use in the Saudi Arabian context based on health care professionals' and patients' preferences.</p><p><strong>Objective: </strong>This study aims to determine the feasibility and acceptability of using the Noom app to support DASH diet self-management among people with high blood pressure in Saudi Arabia.</p><p><strong>Methods: </strong>This mixed methods study evaluated the feasibility and acceptability of using the Noom app among people with high blood pressure in Riyadh, Saudi Arabia. Fourteen participants with high blood pressure were recruited and asked to use the app for 8 weeks. The quantitative outcome measures were DASH diet adherence and self-efficacy. Feasibility and acceptability were assessed during and after the intervention via the Noom diet-tracking engagement questionnaire, the System Usability Scale, and semistructured interviews.</p><p><strong>Results: </strong>Most participants (8/13, 62%) logged their meals for 3 to 5 days a week; the frequency of logging increased over time. Snacks were the foods they most often forgot to log. The interviews revealed four main themes: (1) acceptance, (2) app usability, (3) technical issues, and (4) suggestions for improvement. Most participants found the Noom app acceptable, and most had no difficulties integrating it into their daily routines. The results of this feasibility study provided insights into the app's educational content, some of which was deemed unsuitable for Saudi Arabian users. App usability was identified as a critical theme: the app and its database were easy to use, convenient, and valuable to most of the participants. Despite this, some of the participants reported difficulties in identifying some foods because of a lack of local options on the app. Technical issues included the app freezing or responding slowly. Most participants also suggested developing an Arabic version of the app and simplifying the method of food logging. The participants showed some improvement in self-efficacy and adherence to the DASH diet, although these improvements were not statistically significant. The mean self-efficacy score increased from 18 (SD 4.7) to 20 (SD 6.3), and the mean DASH diet score increased from 3.4 (SD 1.4) to 4.3 (SD 1.1).</p><p><strong>Conclusions: </strong>The app was feasible and acceptable among the participants who completed the study. Further studies are needed to examine the potential of smartphone apps in promoting adherence to the DASH diet and their impact on bl
背景:高血压患者使用智能手机应用程序进行饮食自我管理正变得越来越普遍。目前市售的 DASH(膳食疗法止高血压)饮食应用程序很少有可能有效,其中只有少数几个具有足够的安全和隐私措施。在之前的研究中,我们发现了两款可能有效且安全的高质量应用程序。根据医护人员和患者的偏好,我们选择了其中的 Noom 应用程序作为最适合在沙特阿拉伯使用的应用程序:本研究旨在确定沙特阿拉伯高血压患者使用 Noom 应用支持 DASH 饮食自我管理的可行性和可接受性:这项混合方法研究评估了沙特阿拉伯利雅得高血压患者使用 Noom 应用程序的可行性和可接受性。研究人员招募了 14 名高血压患者,要求他们使用该应用程序 8 周。定量结果测量指标为 DASH 饮食坚持率和自我效能感。在干预期间和之后,通过 Noom 饮食跟踪参与问卷、系统可用性量表和半结构化访谈对可行性和可接受性进行了评估:大多数参与者(8/13,62%)每周记录 3 到 5 天的膳食;随着时间的推移,记录频率也在增加。零食是他们最常忘记记录的食物。访谈显示了四大主题:(1)接受度;(2)应用程序可用性;(3)技术问题;(4)改进建议。大多数参与者认为 Noom 应用程序是可以接受的,而且大多数人在将其融入日常生活方面没有遇到困难。这项可行性研究的结果提供了对应用程序教育内容的见解,其中一些内容被认为不适合沙特阿拉伯用户。应用程序的可用性被确定为一个关键主题:应用程序及其数据库对于大多数参与者来说都易于使用、方便且有价值。尽管如此,一些参与者表示,由于应用程序上缺乏本地选项,他们在识别某些食品时遇到了困难。技术问题包括应用程序冻结或响应缓慢。大多数参与者还建议开发一个阿拉伯语版本的应用程序,并简化食物记录方法。参与者在自我效能感和坚持 DASH 饮食方面有了一些改善,尽管这些改善在统计学上并不显著。自我效能感的平均得分从 18 分(标准差 4.7 分)上升到 20 分(标准差 6.3 分),DASH 饮食的平均得分从 3.4 分(标准差 1.4 分)上升到 4.3 分(标准差 1.1 分):结论:该应用程序在完成研究的参与者中是可行且可接受的。需要进一步研究智能手机应用程序在促进沙特阿拉伯高血压患者坚持 DASH 饮食方面的潜力及其对血压的影响。
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引用次数: 0
Measuring Technology-Facilitated Sexual Violence and Abuse in the Chinese Context: Development Study and Content Validity Analysis. 在中国背景下测量技术促成的性暴力和性虐待:开发研究与内容有效性分析》。
IF 2 Q3 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-11-19 DOI: 10.2196/65199
Sharon Hoi Lam Pak, Chanchan Wu, Kitty Wai Ying Choi, Edmond Pui Hang Choi
<p><strong>Background: </strong>Technology-facilitated sexual violence and abuse (TFSVA) encompasses a range of behaviors where digital technologies are used to enable both virtual and in-person sexual violence. Given that TFSVA is an emerging and continually evolving form of sexual abuse, it has been challenging to establish a universally accepted definition or to develop standardized measures for its assessment.</p><p><strong>Objective: </strong>This study aimed to address the significant gap in research on TFSVA within the Chinese context. Specifically, it sought to develop a TFSVA measurement tool with robust content validity, tailored for use in subsequent epidemiological studies within the Chinese context.</p><p><strong>Methods: </strong>The first step in developing the measurement approach for TFSVA victimization and perpetration was to conduct a thorough literature review of existing empirical research on TFSVA and relevant measurement tools. After the initial generation of items, all the items were reviewed by an expert panel to assess the face validity. The measurement items were further reviewed by potential research participants, who were recruited through snowball sampling via online platforms. The assessment results were quantified by computing the content validity index (CVI). The participants were asked to rate each scale item in terms of its relevance, appropriateness, and clarity regarding the topic.</p><p><strong>Results: </strong>The questionnaire was reviewed by 24 lay experts, with a mean age of 27.96 years. They represented different genders and sexual orientations. The final questionnaire contained a total of 89 items. Three key domains were identified to construct the questionnaire, which included image-based sexual abuse, nonimage-based TFSVA, and online-initiated physical sexual violence. The overall scale CVI values of relevance, appropriateness, and clarity for the scale were 0.90, 0.96, and 0.97, respectively, which indicated high content validity for all the instrument items. To ensure the measurement accurately reflects the experiences of diverse demographic groups, the content validity was further analyzed by gender and sexual orientation. This analysis revealed variations in item validity among participants from different genders and sexual orientations. For instance, heterosexual male respondents showed a particularly low CVI for relevance of 0.20 in the items related to nudity, including "male's chest/nipples are visible" and "the person is sexually suggestive." This underscored the importance of an inclusive approach when developing a measurement for TFSVA.</p><p><strong>Conclusions: </strong>This study greatly advances the assessment of TFSVA by examining the content validity of our newly developed measurement. The findings revealed that our measurement tool demonstrated adequate content validity, thereby providing a strong foundation for assessing TFSVA within the Chinese context. Implementing this tool is a
背景:技术协助下的性暴力和性虐待(TFSVA)包括一系列利用数字技术实施虚拟和亲身性暴力的行为。鉴于技术协助下的性暴力和性虐待是一种新兴且不断演变的性虐待形式,建立一个普遍接受的定义或制定标准化的评估措施一直是一项挑战:本研究旨在填补中国在 TFSVA 研究方面的空白。具体而言,本研究旨在开发一种具有可靠内容效度的 TFSVA 测量工具,以便在中国的后续流行病学研究中使用:开发 TFSVA 受害和施暴测量方法的第一步是对现有的 TFSVA 实证研究和相关测量工具进行全面的文献回顾。在初步生成项目后,所有项目均由专家小组进行审核,以评估其表面效度。通过网络平台以滚雪球方式招募的潜在研究参与者对测量项目进行了进一步审查。评估结果通过计算内容效度指数(CVI)进行量化。参与者被要求对每个量表项目的相关性、适当性和主题清晰度进行评分:24 名平均年龄为 27.96 岁的非专业专家对问卷进行了审查。他们代表了不同的性别和性取向。最终问卷共包含 89 个项目。问卷的编制确定了三个关键领域,包括图像性虐待、非图像性 TFSVA 和网络引发的身体性暴力。该量表的相关性、适当性和清晰度的总体量表 CVI 值分别为 0.90、0.96 和 0.97,这表明该量表的所有项目都具有较高的内容效度。为确保量表能准确反映不同人口群体的经历,我们按性别和性取向对内容效度进行了进一步分析。分析结果显示,不同性别和性取向的参与者在项目效度上存在差异。例如,在与裸体有关的项目中,包括 "男性胸部/乳头可见 "和 "此人有性暗示",异性恋男性受访者的相关性 CVI 值特别低,仅为 0.20。这强调了在制定 TFSVA 测量方法时采用包容性方法的重要性:本研究通过检验我们新开发的测量工具的内容效度,极大地推动了对 TFSVA 的评估。研究结果表明,我们的测量工具具有充分的内容效度,从而为在中国环境下评估 TFSVA 奠定了坚实的基础。预计这一工具的实施将加深我们对 TFSVA 的了解,并有助于制定有效的干预措施来打击这种形式的虐待。
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引用次数: 0
Exploring the Perspectives of Older Adults on a Digital Brain Health Platform Using Natural Language Processing: Cohort Study. 利用自然语言处理技术探索老年人对数字脑健康平台的看法:队列研究。
IF 2 Q3 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-11-18 DOI: 10.2196/60453
Huitong Ding, Katherine Gifford, Ludy C Shih, Kristi Ho, Salman Rahman, Akwaugo Igwe, Spencer Low, Zachary Popp, Edward Searls, Zexu Li, Sanskruti Madan, Alexa Burk, Phillip H Hwang, Ileana De Anda-Duran, Vijaya B Kolachalama, Rhoda Au, Honghuang Lin

Background: Although digital technology represents a growing field aiming to revolutionize early Alzheimer disease risk prediction and monitoring, the perspectives of older adults on an integrated digital brain health platform have not been investigated.

Objective: This study aims to understand the perspectives of older adults on a digital brain health platform by conducting semistructured interviews and analyzing their transcriptions by natural language processing.

Methods: The study included 28 participants from the Boston University Alzheimer's Disease Research Center, all of whom engaged with a digital brain health platform over an initial assessment period of 14 days. Semistructured interviews were conducted to collect data on participants' experiences with the digital brain health platform. The transcripts generated from these interviews were analyzed using natural language processing techniques. The frequency of positive and negative terms was evaluated through word count analysis. A sentiment analysis was used to measure the emotional tone and subjective perceptions of the participants toward the digital platform.

Results: Word count analysis revealed a generally positive sentiment toward the digital platform, with "like," "well," and "good" being the most frequently mentioned positive terms. However, terms such as "problem" and "hard" indicated certain challenges faced by participants. Sentiment analysis showed a slightly positive attitude with a median polarity score of 0.13 (IQR 0.08-0.15), ranging from -1 (completely negative) to 1 (completely positive), and a median subjectivity score of 0.51 (IQR 0.47-0.53), ranging from 0 (completely objective) to 1 (completely subjective). These results suggested an overall positive attitude among the study cohort.

Conclusions: The study highlights the importance of understanding older adults' attitudes toward digital health platforms amid the comprehensive evolution of the digitalization era. Future research should focus on refining digital solutions to meet the specific needs of older adults, fostering a more personalized approach to brain health.

背景:尽管数字技术是一个不断发展的领域,旨在彻底改变早期阿尔茨海默病的风险预测和监测,但尚未对老年人对综合数字脑健康平台的看法进行调查:本研究旨在通过半结构式访谈和自然语言处理分析转录,了解老年人对数字脑健康平台的看法:研究对象包括波士顿大学阿尔茨海默病研究中心的 28 名参与者,他们都在 14 天的初始评估期内使用了数字脑健康平台。研究人员进行了半结构化访谈,以收集参与者使用数字脑健康平台的体验数据。我们使用自然语言处理技术对访谈记录进行了分析。通过字数分析评估了正面和负面词汇的频率。情感分析用于衡量参与者对数字平台的情感基调和主观看法:字数分析表明,人们对数字平台普遍持积极态度,"喜欢"、"很好 "和 "不错 "是最常被提及的积极词汇。然而,"问题 "和 "困难 "等词语表明了参与者面临的某些挑战。情感分析表明,参与者的态度略微积极,极性得分中位数为 0.13(IQR 0.08-0.15),从-1(完全消极)到 1(完全积极)不等,主观性得分中位数为 0.51(IQR 0.47-0.53),从 0(完全客观)到 1(完全主观)不等。这些结果表明,研究对象总体上持积极态度:这项研究强调了在数字化时代全面发展的背景下,了解老年人对数字健康平台态度的重要性。未来的研究应侧重于改进数字解决方案,以满足老年人的特殊需求,促进更加个性化的大脑健康方法。
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引用次数: 0
Effectiveness of Game-Based Training of Selective Voluntary Motor Control in Children With Upper Motor Neuron Lesions: Randomized Multiple Baseline Design Study. 基于游戏的选择性自主运动控制训练对上运动神经元受损儿童的效果:随机多基线设计研究》。
IF 2 Q3 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-11-18 DOI: 10.2196/47754
Annina Fahr, Andrina Kläy, Larissa S Coka, Hubertus J A van Hedel
<p><strong>Background: </strong>Selective voluntary motor control (SVMC) is the ability to control joint movements independently. Impairments in SVMC can affect functional activities, but only a few interventions directly target SVMC. Therefore, we developed a game-based intervention for children with upper motor neuron lesions to improve SVMC. The intervention trained selective activation of a muscle or joint movement while providing immediate feedback about involuntarily occurring muscle activations or movements in another joint. The intervention was provided in a playful manner with a custom-made game environment and a technology-based interface to capture muscle activation or joint movements.</p><p><strong>Objective: </strong>This study aimed to investigate the effectiveness of this game-based intervention and explore treatment response-related factors in children with impaired SVMC undergoing inpatient neurorehabilitation.</p><p><strong>Methods: </strong>We conducted a single-case research study with a randomized, nonconcurrent, multiple baseline design. The study consisted of a random-length baseline phase where no SVMC-specific intervention was provided and an intervention phase with additional SVMC training. Concurrently in both phases, children attended their individual multimodal rehabilitation program at our clinic, Swiss Children's Rehab. During the intervention phase, participants completed ten 45-minute sessions with our game-based SVMC training. SVMC was measured repeatedly throughout both phases and at the 3-month follow-up with a short custom-made assessment.</p><p><strong>Results: </strong>Eighteen children with reduced SVMC from upper motor neuron lesions participated in the study. The mean age of the children was 12.7 (SD 2.9) years, and they mostly had spastic cerebral palsy. A linear mixed-effects model revealed a significant trend (P<.001) for improved SVMC already in the baseline phase. This trend did not change significantly (P=.15) when the game-based SVMC training was introduced in the intervention phase, suggesting no additional improvements due to the SVMC training. Although we could not find an overall treatment effect, we could explain 89.4% of the total random variation of the treatment effect by patient and therapy characteristics. Children with spasticity in the trained movement (20.1%), and those who trained the more affected side (23.5%) benefited most from the intervention. At the 3-month follow-up, SVMC had deteriorated compared to the end of the intervention but was still better than at the beginning of the study.</p><p><strong>Conclusions: </strong>The regular concomitant rehabilitation program already yielded improvements in SVMC, while the game-based SVMC training showed no additional effects. Although the intervention did not show a group effect, we could identify patient and therapy characteristics that determine who is likely to profit from the intervention.</p><p><strong>Trial registration: </strong>G
背景:选择性自主运动控制(SVMC)是指独立控制关节运动的能力。SVMC 的损伤会影响功能活动,但只有少数干预措施直接针对 SVMC。因此,我们为上运动神经元受损的儿童开发了一种基于游戏的干预方法,以改善 SVMC。该干预措施训练选择性激活肌肉或关节运动,同时提供有关非自主发生的肌肉激活或另一关节运动的即时反馈。干预以游戏的方式进行,通过定制的游戏环境和基于技术的界面来捕捉肌肉激活或关节运动:本研究旨在对接受住院神经康复治疗的 SVMC 受损儿童进行游戏式干预的有效性研究,并探讨与治疗反应相关的因素:我们采用随机、非同期、多基线设计进行了单例研究。研究包括一个随机长度的基线阶段和一个干预阶段,前者不提供针对 SVMC 的干预,后者则提供额外的 SVMC 训练。在这两个阶段中,孩子们同时在我们的诊所瑞士儿童康复中心参加个人多模式康复计划。在干预阶段,参与者完成了 10 次 45 分钟的基于游戏的 SVMC 训练。在这两个阶段以及为期 3 个月的随访中,我们通过定制的简短评估对 SVMC 进行了反复测量:结果:18 名因上运动神经元病变导致 SVMC 下降的儿童参与了研究。这些儿童的平均年龄为 12.7 岁(标准差为 2.9 岁),大部分患有痉挛性脑瘫。线性混合效应模型显示了一个显著的趋势(PC结论:常规的同步康复计划已经改善了SVMC,而基于游戏的SVMC训练则没有显示出额外的效果。虽然干预措施没有显示出群体效应,但我们可以确定患者和治疗方法的特征,这些特征决定了谁有可能从干预措施中获益:试验注册:德国临床试验注册中心 DRKS00025184;https://tinyurl.com/msnkek9b。
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引用次数: 0
Understanding Patients' Preferences for a Digital Intervention to Prevent Posttreatment Deterioration for Bulimia-Spectrum Eating Disorders: User-Centered Design Study. 了解患者对数字干预的偏好,预防贪食症系列进食障碍治疗后恶化:以用户为中心的设计研究。
IF 2 Q3 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-11-18 DOI: 10.2196/60865
Jianyi Liu, Alyssa Giannone, Hailing Wang, Lucy Wetherall, Adrienne Juarascio
<p><strong>Background: </strong>Deterioration rates after enhanced cognitive behavioral therapy (CBT-E) for patients with bulimia-spectrum eating disorders (BN-EDs) remain high, and decreased posttreatment skill use might be a particularly relevant contributor. Digital interventions could be an ideal option to improve skill use after treatment ends but they have yet to be investigated for BN-EDs.</p><p><strong>Objective: </strong>This study used a user-centered design approach to explore patients' interest in a digital intervention to prevent deterioration after CBT-E and their desired features.</p><p><strong>Methods: </strong>A total of 12 participants who previously received CBT-E for BN-EDs and experienced at least a partial response to treatment completed a qualitative interview asking about their interests and needs for an app designed to prevent deterioration after treatment ended. Participants were also presented with features commonly used in digital interventions for EDs and were asked to provide feedback.</p><p><strong>Results: </strong>All 12 participants expressed interest in using an app to prevent deterioration after treatment ended. In total, 11 participants thought the proposed feature of setting a goal focusing on skill use weekly would help improve self-accountability for skill use, and 6 participants supported the idea of setting goals related to specific triggers because they would know what skills to use in high-risk situations. A total of 10 participants supported the self-monitoring ED behaviors feature because it could increase their awareness levels. Participants also reported wanting to track mood (n=6) and food intake (n=5) besides the proposed tracking feature. A total of 10 participants reported wanting knowledge-based content in the app, including instructions on skill practice (n=6), general mental health strategies outside of EDs (n=4), guided mindfulness exercises (n=3), and nutrition recommendations (n=3). Eight participants reported a desire for the app to send targeted push notifications, including reminders of skill use (n=7) and inspirational quotes for encouragement (n=3). Finally, 8 participants reported wanting a human connection in the app, 6 participants wishing to interact with other users to support and learn from each other, and 4 participants wanting to connect with professionals as needed. Overall, participants thought that having an app targeting skill use could provide continued support and improve self-accountability, thus lowering the risk of decreased skill use after treatment ended.</p><p><strong>Conclusions: </strong>Insights from participants highlighted the perceived importance of continued support for continued skill use after treatment ended. This study also provided valuable design implications regarding potential features focusing on facilitating posttreatment skill use to include in digital deterioration prevention programs. Future research should examine the optimal approaches to deli
背景:暴食症系列饮食失调症(BN-EDs)患者在接受强化认知行为疗法(CBT-E)治疗后的病情恶化率仍然很高,而治疗后技能使用的减少可能是一个特别相关的因素。数字干预可能是治疗结束后提高技能使用率的理想选择,但目前尚未对 BN-EDs 进行研究:本研究采用以用户为中心的设计方法,探索患者对数字干预的兴趣,以防止 CBT-E 治疗后病情恶化,以及他们所希望的功能:共有12名曾接受过CBT-E治疗BN-ED并对治疗至少有部分反应的参与者完成了定性访谈,询问了他们对旨在防止治疗结束后病情恶化的应用程序的兴趣和需求。此外,还向参与者介绍了针对ED的数字干预措施中常用的功能,并要求他们提供反馈意见:结果:所有 12 位参与者都表示有兴趣使用一款应用程序来防止治疗结束后病情恶化。共有 11 名参与者认为,建议中提出的每周设定技能使用目标的功能将有助于提高技能使用的自我责任感,6 名参与者支持设定与特定触发因素相关的目标,因为他们知道在高风险情况下应该使用哪些技能。共有 10 名参与者支持自我监控 ED 行为的功能,因为这可以提高他们的认知水平。除了建议的跟踪功能外,参与者还表示希望跟踪情绪(6 人)和食物摄入量(5 人)。共有 10 名参与者表示希望在应用程序中加入知识性内容,包括技能练习指导(6 人)、ED 以外的一般心理健康策略(4 人)、正念练习指导(3 人)和营养建议(3 人)。有 8 名参与者表示希望该应用程序能够发送有针对性的推送通知,包括技能使用提醒(7 人)和励志名言鼓励(3 人)。最后,8 名参与者表示希望在应用程序中建立人际联系,6 名参与者希望与其他用户互动,相互支持和学习,4 名参与者希望在需要时与专业人士联系。总体而言,参与者认为,针对技能使用的应用程序可以提供持续支持并提高自我责任感,从而降低治疗结束后技能使用减少的风险:参与者的观点强调了持续支持对治疗结束后继续使用技能的重要性。这项研究还提供了有价值的设计启示,即在数字衰退预防计划中加入促进治疗后技能使用的潜在功能。未来的研究应探讨提供本研究中确定的核心功能的最佳方法,这些核心功能可提高技能的持续使用率,并降低长期恶化的风险。
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引用次数: 0
Cultural Adaptation and User Satisfaction of an Internet-Delivered Cognitive Behavioral Program for Depression and Anxiety Among College Students in Two Latin American Countries: Focus Group Study With Potential Users and a Cross-Sectional Questionnaire Study With Actual Users. 两个拉丁美洲国家的大学生对通过互联网传播的抑郁和焦虑认知行为项目的文化适应性和用户满意度:针对潜在用户的焦点小组研究和针对实际用户的横断面问卷调查。
IF 2 Q3 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-11-15 DOI: 10.2196/63298
Yesica Albor, Noé González, Corina Benjet, Alicia Salamanca-Sanabria, Cristiny Hernández-de la Rosa, Viridiana Eslava-Torres, María Carolina García-Alfaro, Andrés Melchor-Audirac, Laura Itzel Montoya-Montero, Karla Suárez
<p><strong>Background: </strong>To scale up mental health care in low-resource settings, digital interventions must consider cultural fit. Despite the findings that culturally adapted digital interventions have greater effectiveness, there is a lack of empirical evidence of interventions that have been culturally adapted or their adaptation documented.</p><p><strong>Objective: </strong>This study aimed to document the cultural adaptation of the SilverCloud Health Space from Depression and Anxiety program for university students in Colombia and Mexico and evaluate user satisfaction with the adapted program.</p><p><strong>Methods: </strong>A mixed methods process was based on Cultural Sensitivity and Ecological Validity frameworks. In phase 1, the research team added culturally relevant content (eg, expressions, personal stories, photos) for the target population to the intervention. In phase 2, potential users (9 university students) first evaluated the vignettes and photos used throughout the program. We calculated median and modal responses. They then participated in focus groups to evaluate and assess the cultural appropriateness of the materials. Their comments were coded into the 8 dimensions of the Ecological Validity Framework. Phase 3 consisted of choosing the vignettes most highly rated by the potential users and making modifications to the materials based on the student feedback. In the final phase, 765 actual users then engaged with the culturally adapted program and rated their satisfaction with the program. We calculated the percentage of users who agreed or strongly agreed that the modules were interesting, relevant, useful, and helped them attain their goals.</p><p><strong>Results: </strong>The potential users perceived the original vignettes as moderately genuine, or true, which were given median scores between 2.5 and 3 (out of a possible 4) and somewhat identified with the situations presented in the vignettes given median scores between 1.5 and 3. The majority of comments or suggestions for modification concerned language (126/218, 57.5%), followed by concepts (50/218, 22.8%). Much less concerned methods (22/218, 10%), persons (9/218, 4.1%), context (5/218, 2.3%), or content (2/218, 0.9%). There were no comments about metaphors or goals. Intervention materials were modified based on these results. Of the actual users who engaged with the adapted version of the program, 87.7%-96.2% of them agreed or strongly agreed that the modules were interesting, relevant, useful, and helped them to attain their goals.</p><p><strong>Conclusions: </strong>We conclude that the adapted version is satisfactory for this population based on the focus group discussions and the satisfaction scores. Conducting and documenting such cultural adaptations and involving the users in the cultural adaptation process will likely improve the effectiveness of digital mental health interventions in low- and middle-income countries and culturally diverse contexts.
背景:要在资源匮乏的环境中推广心理健康护理,数字干预措施必须考虑文化适应性。尽管研究结果表明,经过文化适应性调整的数字化干预措施具有更高的有效性,但目前缺乏经过文化适应性调整的干预措施的实证证据,也缺乏对其适应性的记录:本研究旨在记录针对哥伦比亚和墨西哥大学生的银云健康空间(SilverCloud Health Space from Depression and Anxiety)项目的文化适应性,并评估用户对适应性项目的满意度:方法:根据文化敏感性和生态有效性框架,采用混合方法进行研究。在第一阶段,研究小组为干预措施添加了与目标人群文化相关的内容(如表达方式、个人故事、照片)。在第 2 阶段,潜在用户(9 名大学生)首先对整个程序中使用的小故事和照片进行了评估。我们计算了回答的中位数和模数。然后,他们参加了焦点小组,对材料的文化适宜性进行评价和评估。他们的意见被编入生态有效性框架的 8 个维度。第三阶段包括选择潜在用户评价最高的小故事,并根据学生的反馈意见对教材进行修改。在最后阶段,765 名实际用户参与了经过文化调整的程序,并对程序的满意度进行了评分。我们计算了同意或非常同意这些模块有趣、相关、有用并能帮助他们实现目标的用户百分比:潜在用户认为原版小故事的真实性一般,中位数在 2.5 到 3 分之间(满分 4 分),对小故事中的情境有一定认同感,中位数在 1.5 到 3 分之间。大多数意见或修改建议涉及语言(126/218,57.5%),其次是概念(50/218,22.8%)。与方法(22/218,10%)、人物(9/218,4.1%)、语境(5/218,2.3%)或内容(2/218,0.9%)有关的意见或建议要少得多。没有人对隐喻或目标提出意见。根据这些结果对干预材料进行了修改。在参与改编版项目的实际使用者中,87.7%-96.2%的人同意或非常同意这些模块有趣、相关、有用,并有助于他们实现目标:根据焦点小组讨论和满意度评分,我们得出结论,改编版课程对这一人群来说是令人满意的。在中低收入国家和多元文化背景下,进行此类文化适应性调整并将其记录在案,让用户参与到文化适应性调整过程中,将有可能提高数字心理健康干预措施的有效性。
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引用次数: 0
Exploring the Qualitative Experiences of Administering and Participating in Remote Research via Telephone Using the Montreal Cognitive Assessment-Blind: Cross-Sectional Study of Older Adults. 探索通过电话使用蒙特利尔认知评估-盲法进行和参与远程研究的定性体验:老年人横断面研究》。
IF 2 Q3 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-11-15 DOI: 10.2196/58537
Shirley Dumassais, Karl Singh Grewal, Gabrielle Aubin, Megan O'Connell, Natalie A Phillips, Walter Wittich

Background: The COVID-19 pandemic caused a drastic shift in the practice of research and clinical services. It has been noted that cognition measured via in-person versus remote methods differ substantially, and it is possible that subjective and experiential differences exist between modalities.

Objective: The aim of the study is to explore the perceptions of both researchers and older adult participants on the experience of remotely conducted research using a cognitive screener.

Methods: We conducted a thematic analysis of the experience of engaging in remote research from both the participant (n=10) and researcher (n=4) perspectives. The research interaction was framed through teleadministration of the Montreal Cognitive Assessment-Blind (suitable for telephone administration) and administration of a subsequent semistructured debriefing interview. Participant perspectives were garnered during debriefing interviews, while researcher insights were collected via self-reported qualitative field notes completed following each research session.

Results: Data aggregated into themes of barriers and facilitators from the lenses of both participants and researchers. Participants noted facilitators including short instrument length, convenience, and presession contact; barriers included the length of the interaction, some tasks being more challenging on the phone, and the potential for participant dishonesty. Research assistants noted several facilitators: instrument length, rapport building, ability to prepare for and record sessions, and comfort with the protocol; barriers were items with too many response options, telephone issues (eg, response delays), and concerns about participant comprehension.

Conclusions: These results suggest remote telephone-delivered cognitive screening tools as a feasible and acceptable method of research inquiry. The findings provide a starting point for the inclusion of diverse populations in research to capture underrepresented groups whose input would immensely benefit our understanding of remotely delivered cognitive screening measures. Further, we offer materials (eg, checklists), which can be used in future investigations to promote future inclusive research and increase generalizability.

背景:COVID-19 大流行导致了研究和临床服务实践的急剧转变。人们注意到,通过亲临现场和远程方法测量的认知能力有很大不同,而且不同方式之间可能存在主观和经验上的差异:本研究旨在探讨研究人员和老年参与者对使用认知筛选器进行远程研究的体验的看法:我们从参与者(10 人)和研究者(4 人)的角度对参与远程研究的体验进行了专题分析。研究互动是通过远程管理蒙特利尔认知评估盲法(适合电话管理)和随后的半结构化汇报访谈来实现的。参与者的观点是在汇报访谈中收集的,而研究人员的见解则是通过在每个研究环节后完成的自我报告定性现场笔记收集的:结果:从参与者和研究人员的视角出发,数据汇聚成障碍和促进因素的主题。参与者注意到的促进因素包括工具长度短、方便和会前联系;障碍包括互动时间长、某些任务在电话中更具挑战性以及参与者可能不诚实。研究助理注意到了几个有利因素:问卷长度、建立融洽关系、准备和记录会议的能力以及对协议的适应性;障碍是项目中的回答选项过多、电话问题(如回答延迟)以及对被试理解能力的担忧:这些结果表明,远程电话认知筛查工具是一种可行且可接受的研究调查方法。研究结果为将不同人群纳入研究提供了一个起点,以捕捉代表人数不足的群体,他们的意见将极大地促进我们对远程认知筛查措施的理解。此外,我们还提供了可用于未来调查的材料(如核对表),以促进未来的包容性研究并提高可推广性。
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引用次数: 0
Association of Drugs for Sale on the Internet and Official Health Indicators: Darknet Parsing and Correlational Study. 互联网销售药物与官方健康指标的关联:暗网解析与相关性研究》。
IF 2 Q3 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-11-15 DOI: 10.2196/56006
Sergey Soshnikov, Svetlana Bekker, Bulat Idrisov, Vasiliy Vlassov
<p><strong>Background: </strong>Studying illicit drug circulation and its effects on population health is complicated due to the criminalization of trade and consumption. Illicit drug markets have evolved with IT, moving digital to the "darknet." Previous research has analyzed darknet market listings and customer reviews. Research tools include public health surveys and medical reports but lack neutral data on drugs' spread and impact. This study fills this gap with an analysis of the volume of drugs traded on the darknet market.</p><p><strong>Objective: </strong>We aimed to use the dark web data and officially published indicators to identify the most vulnerable regions of Russia and the correlations between the pairs of variables to measure how illicit drug trade can affect population well-being.</p><p><strong>Methods: </strong>We web-parsed the Hydra darknet drug marketplace using Python code. The dataset encompassed 3045 individual sellers marketing 6721 unique products via 58,563 distinct postings, each representing specific quantities sold in different Russian regions during 2019. In the second stage, we collected 31 variables from official sources to compare officially collected data with darknet data about amounts and types of selling drugs in every 85 regions of Russia. The health-related data were obtained from official published sources-statistical yearbooks. Maps, diagrams, correlation matrixes, and applied observational statistical methods were used.</p><p><strong>Results: </strong>In 2019, a minimum of 124 kilograms of drugs circulated daily in small batches on the Russian darknet. Cannabis dominated the market, being 10 times more prevalent than opiates, and cannabis products' higher availability in the region is correlated with a lower incidence of opiate overdoses. The "grams of opiates in the region" variable is significantly correlated with drug overdose deaths (r=.41; P=.003), HIV-positive cases due to drug use (r=.51; P=.002), and drug court convictions in Russia (r=.39; P=.004). The study identified significant correlations between opiate sales on the darknet and higher rates of HIV among injection drug users (r=.47; P=.003). Conversely, regions with higher cannabis sales exhibited significant negative correlations with indicators of harmful drug use (r=-.52; P=.002) and its prevalence (r=-.49; P=.001). These findings suggest regional variations in drug sales on the darknet may be associated with differing public health outcomes. These indicators accurately reflect regional drug issues, though some official statistics may be incomplete or biased.</p><p><strong>Conclusions: </strong>Our findings point to varying levels of risk associated with different types of drugs sold on the darknet, but further research is needed to explore these relationships in greater depth. The study's findings highlight the importance of considering regional variations in darknet drug sales when developing public health strategies. The significant c
背景:由于交易和消费被定为犯罪,研究非法药物流通及其对人口健康的影响变得十分复杂。随着信息技术的发展,非法毒品市场也在向数字化的 "暗网 "发展。以往的研究分析了暗网市场列表和客户评论。研究工具包括公共卫生调查和医疗报告,但缺乏有关毒品传播和影响的中立数据。本研究通过分析暗网市场的毒品交易量填补了这一空白:我们旨在利用暗网数据和官方公布的指标来确定俄罗斯最脆弱的地区,并利用成对变量之间的相关性来衡量非法毒品交易如何影响人口福祉:我们使用 Python 代码对 Hydra 暗网毒品市场进行了网络解析。数据集包括 3045 个卖家,他们通过 58563 个不同的帖子销售 6721 种独特的产品,每个帖子都代表了 2019 年期间在俄罗斯不同地区销售的具体数量。在第二阶段,我们从官方来源收集了 31 个变量,以便将官方收集的数据与暗网数据进行比较,了解俄罗斯每 85 个地区的药品销售数量和类型。与健康相关的数据来自官方公布的来源--统计年鉴。研究使用了地图、图表、相关矩阵和应用观察统计方法:2019 年,每天至少有 124 公斤毒品在俄罗斯暗网上小批量流通。大麻在市场上占据主导地位,其流行程度是鸦片制剂的 10 倍,大麻产品在该地区的高供应量与鸦片制剂过量的低发生率相关。该地区鸦片制剂的克数 "变量与吸毒过量死亡人数(r=.41;P=.003)、因吸毒导致的艾滋病毒阳性病例(r=.51;P=.002)以及俄罗斯毒品法庭的定罪(r=.39;P=.004)显著相关。研究发现,暗网上的鸦片剂销售与注射吸毒者中较高的艾滋病毒感染率之间存在明显的相关性(r=.47;P=.003)。相反,大麻销量较高的地区则与有害药物使用指标(r=-.52;P=.002)及其流行率(r=-.49;P=.001)呈显著负相关。这些发现表明,暗网上毒品销售的地区差异可能与不同的公共卫生结果有关。这些指标准确地反映了地区毒品问题,尽管一些官方统计数据可能不完整或存在偏差:我们的研究结果表明,不同类型的毒品在暗网上销售会带来不同程度的风险,但要更深入地探讨这些关系,还需要进一步的研究。研究结果强调了在制定公共卫生战略时考虑暗网毒品销售地区差异的重要性。毒品销售数据与公共健康指标之间的重要相关性表明,针对特定地区的干预措施可以更有效地应对非法药物使用带来的各种挑战。
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JMIR Formative Research
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