Background: Internet gaming disorder (IGD) is an emerging behavioral addiction with mental health implications among adolescents. Low self-control is an established risk factor of IGD. Few studies have, however, examined the moderating role of meaning in life (MIL) on the relationships between low self-control and IGD symptoms and functioning.
Objective: This study aimed to examine the effects of low self-control and MIL and their interaction effects on IGD symptoms and family and school functioning in a structural equation model.
Methods: A sample of 2064 adolescents (967, 46.9% male; mean age 14.6 years) was recruited by multistage cluster random sampling from 5 middle schools in Sichuan, China, in 2022. The participants completed a self-report questionnaire with validated measures on low self-control, presence of MIL, search for MIL, IGD symptoms, school commitment, and family functioning. Construct validity, measurement invariance, and structural invariance of the measures were evaluated by confirmatory factor analysis across sex. Structural equation modeling was conducted to examine the indirect effects of low self-control and MIL on family and school functioning through IGD symptoms. Latent moderated structural equation modeling was performed to examine the interaction effects between low self-control and MIL on IGD symptoms, school commitment, and family functioning.
Results: All scales showed satisfactory model fit and scalar measurement invariance by sex. Males showed significantly greater IGD symptoms and lower levels of self-control (Cohen d=0.25-1.20, P<.001) than females. IGD symptoms were significantly and positively associated with impulsivity (β=.20, P=.01), temper (β=.25, P<.001), and search for meaning (β=.11, P=.048) and significantly and negatively associated with presence of meaning (β=-.21, P<.001). Presence of MIL and impulsivity showed a significant and negative interaction effect (β=-.11, SE .05; P=.03) on IGD symptoms. The positive effect of impulsivity on IGD symptoms was stronger among adolescents with low presence of MIL than those with high presence of MIL. Temper showed significant and positive interaction effects with presence of MIL (β=.08, SE .04; P=.03) and search for MIL (β=.08, SE .04; P=.04) on family functioning. The negative effects of temper on family functioning were stronger among adolescents with low levels of MIL than among those with high levels of MIL.
Conclusions: This study provides the first findings on the interaction effects between low self-control and presence of MIL and search for MIL on IGD symptoms and functioning among a large sample of adolescents in rural China. The results have implications for targeted interventions to help male adolescents with lower self-control and presence of meaning.
{"title":"Interaction Effects Between Low Self-Control and Meaning in Life on Internet Gaming Disorder Symptoms and Functioning in Chinese Adolescents: Cross-Sectional Latent Moderated Structural Equation Modeling Study.","authors":"Ted Ct Fong, Kunjie Cui, Paul Sf Yip","doi":"10.2196/59490","DOIUrl":"10.2196/59490","url":null,"abstract":"<p><strong>Background: </strong>Internet gaming disorder (IGD) is an emerging behavioral addiction with mental health implications among adolescents. Low self-control is an established risk factor of IGD. Few studies have, however, examined the moderating role of meaning in life (MIL) on the relationships between low self-control and IGD symptoms and functioning.</p><p><strong>Objective: </strong>This study aimed to examine the effects of low self-control and MIL and their interaction effects on IGD symptoms and family and school functioning in a structural equation model.</p><p><strong>Methods: </strong>A sample of 2064 adolescents (967, 46.9% male; mean age 14.6 years) was recruited by multistage cluster random sampling from 5 middle schools in Sichuan, China, in 2022. The participants completed a self-report questionnaire with validated measures on low self-control, presence of MIL, search for MIL, IGD symptoms, school commitment, and family functioning. Construct validity, measurement invariance, and structural invariance of the measures were evaluated by confirmatory factor analysis across sex. Structural equation modeling was conducted to examine the indirect effects of low self-control and MIL on family and school functioning through IGD symptoms. Latent moderated structural equation modeling was performed to examine the interaction effects between low self-control and MIL on IGD symptoms, school commitment, and family functioning.</p><p><strong>Results: </strong>All scales showed satisfactory model fit and scalar measurement invariance by sex. Males showed significantly greater IGD symptoms and lower levels of self-control (Cohen d=0.25-1.20, P<.001) than females. IGD symptoms were significantly and positively associated with impulsivity (β=.20, P=.01), temper (β=.25, P<.001), and search for meaning (β=.11, P=.048) and significantly and negatively associated with presence of meaning (β=-.21, P<.001). Presence of MIL and impulsivity showed a significant and negative interaction effect (β=-.11, SE .05; P=.03) on IGD symptoms. The positive effect of impulsivity on IGD symptoms was stronger among adolescents with low presence of MIL than those with high presence of MIL. Temper showed significant and positive interaction effects with presence of MIL (β=.08, SE .04; P=.03) and search for MIL (β=.08, SE .04; P=.04) on family functioning. The negative effects of temper on family functioning were stronger among adolescents with low levels of MIL than among those with high levels of MIL.</p><p><strong>Conclusions: </strong>This study provides the first findings on the interaction effects between low self-control and presence of MIL and search for MIL on IGD symptoms and functioning among a large sample of adolescents in rural China. The results have implications for targeted interventions to help male adolescents with lower self-control and presence of meaning.</p>","PeriodicalId":16337,"journal":{"name":"Journal of Medical Internet Research","volume":"26 ","pages":"e59490"},"PeriodicalIF":5.8,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11574502/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142575785","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Advancing the United Nations Sustainable Development Goals Through Digital Health Research: 25 Years of Contributions From the Journal of Medical Internet Research.","authors":"Raghu Raman, Monica Singhania, Prema Nedungadi","doi":"10.2196/60025","DOIUrl":"10.2196/60025","url":null,"abstract":"","PeriodicalId":16337,"journal":{"name":"Journal of Medical Internet Research","volume":"26 ","pages":"e60025"},"PeriodicalIF":5.8,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11574500/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142575780","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jonathan Yi-Shin Yau, Soheil Saadat, Edmund Hsu, Linda Suk-Ling Murphy, Jennifer S Roh, Jeffrey Suchard, Antonio Tapia, Warren Wiechmann, Mark I Langdorf
<p><strong>Background: </strong>Recent surveys indicate that 48% of consumers actively use generative artificial intelligence (AI) for health-related inquiries. Despite widespread adoption and the potential to improve health care access, scant research examines the performance of AI chatbot responses regarding emergency care advice.</p><p><strong>Objective: </strong>We assessed the quality of AI chatbot responses to common emergency care questions. We sought to determine qualitative differences in responses from 4 free-access AI chatbots, for 10 different serious and benign emergency conditions.</p><p><strong>Methods: </strong>We created 10 emergency care questions that we fed into the free-access versions of ChatGPT 3.5 (OpenAI), Google Bard, Bing AI Chat (Microsoft), and Claude AI (Anthropic) on November 26, 2023. Each response was graded by 5 board-certified emergency medicine (EM) faculty for 8 domains of percentage accuracy, presence of dangerous information, factual accuracy, clarity, completeness, understandability, source reliability, and source relevancy. We determined the correct, complete response to the 10 questions from reputable and scholarly emergency medical references. These were compiled by an EM resident physician. For the readability of the chatbot responses, we used the Flesch-Kincaid Grade Level of each response from readability statistics embedded in Microsoft Word. Differences between chatbots were determined by the chi-square test.</p><p><strong>Results: </strong>Each of the 4 chatbots' responses to the 10 clinical questions were scored across 8 domains by 5 EM faculty, for 400 assessments for each chatbot. Together, the 4 chatbots had the best performance in clarity and understandability (both 85%), intermediate performance in accuracy and completeness (both 50%), and poor performance (10%) for source relevance and reliability (mostly unreported). Chatbots contained dangerous information in 5% to 35% of responses, with no statistical difference between chatbots on this metric (P=.24). ChatGPT, Google Bard, and Claud AI had similar performances across 6 out of 8 domains. Only Bing AI performed better with more identified or relevant sources (40%; the others had 0%-10%). Flesch-Kincaid Reading level was 7.7-8.9 grade for all chatbots, except ChatGPT at 10.8, which were all too advanced for average emergency patients. Responses included both dangerous (eg, starting cardiopulmonary resuscitation with no pulse check) and generally inappropriate advice (eg, loosening the collar to improve breathing without evidence of airway compromise).</p><p><strong>Conclusions: </strong>AI chatbots, though ubiquitous, have significant deficiencies in EM patient advice, despite relatively consistent performance. Information for when to seek urgent or emergent care is frequently incomplete and inaccurate, and patients may be unaware of misinformation. Sources are not generally provided. Patients who use AI to guide health care decisions assum
{"title":"Accuracy of Prospective Assessments of 4 Large Language Model Chatbot Responses to Patient Questions About Emergency Care: Experimental Comparative Study.","authors":"Jonathan Yi-Shin Yau, Soheil Saadat, Edmund Hsu, Linda Suk-Ling Murphy, Jennifer S Roh, Jeffrey Suchard, Antonio Tapia, Warren Wiechmann, Mark I Langdorf","doi":"10.2196/60291","DOIUrl":"10.2196/60291","url":null,"abstract":"<p><strong>Background: </strong>Recent surveys indicate that 48% of consumers actively use generative artificial intelligence (AI) for health-related inquiries. Despite widespread adoption and the potential to improve health care access, scant research examines the performance of AI chatbot responses regarding emergency care advice.</p><p><strong>Objective: </strong>We assessed the quality of AI chatbot responses to common emergency care questions. We sought to determine qualitative differences in responses from 4 free-access AI chatbots, for 10 different serious and benign emergency conditions.</p><p><strong>Methods: </strong>We created 10 emergency care questions that we fed into the free-access versions of ChatGPT 3.5 (OpenAI), Google Bard, Bing AI Chat (Microsoft), and Claude AI (Anthropic) on November 26, 2023. Each response was graded by 5 board-certified emergency medicine (EM) faculty for 8 domains of percentage accuracy, presence of dangerous information, factual accuracy, clarity, completeness, understandability, source reliability, and source relevancy. We determined the correct, complete response to the 10 questions from reputable and scholarly emergency medical references. These were compiled by an EM resident physician. For the readability of the chatbot responses, we used the Flesch-Kincaid Grade Level of each response from readability statistics embedded in Microsoft Word. Differences between chatbots were determined by the chi-square test.</p><p><strong>Results: </strong>Each of the 4 chatbots' responses to the 10 clinical questions were scored across 8 domains by 5 EM faculty, for 400 assessments for each chatbot. Together, the 4 chatbots had the best performance in clarity and understandability (both 85%), intermediate performance in accuracy and completeness (both 50%), and poor performance (10%) for source relevance and reliability (mostly unreported). Chatbots contained dangerous information in 5% to 35% of responses, with no statistical difference between chatbots on this metric (P=.24). ChatGPT, Google Bard, and Claud AI had similar performances across 6 out of 8 domains. Only Bing AI performed better with more identified or relevant sources (40%; the others had 0%-10%). Flesch-Kincaid Reading level was 7.7-8.9 grade for all chatbots, except ChatGPT at 10.8, which were all too advanced for average emergency patients. Responses included both dangerous (eg, starting cardiopulmonary resuscitation with no pulse check) and generally inappropriate advice (eg, loosening the collar to improve breathing without evidence of airway compromise).</p><p><strong>Conclusions: </strong>AI chatbots, though ubiquitous, have significant deficiencies in EM patient advice, despite relatively consistent performance. Information for when to seek urgent or emergent care is frequently incomplete and inaccurate, and patients may be unaware of misinformation. Sources are not generally provided. Patients who use AI to guide health care decisions assum","PeriodicalId":16337,"journal":{"name":"Journal of Medical Internet Research","volume":"26 ","pages":"e60291"},"PeriodicalIF":5.8,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11574488/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142575764","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: eHealth literacy is critical for evaluating abilities in locating, accessing, and applying digital health information to enhance one's understanding, skills, and attitudes toward a healthy lifestyle. Prior research indicates that enhancing eHealth literacy can improve health behaviors such as physical activity (PA). Physical literacy (PL) refers to the ability to develop sustainable PA habits, taking into account various aspects of an individual. Notably, university students have shown a decline in PA and possess low PL levels. However, the connection between eHealth literacy and PL in this demographic has not been extensively studied, and it remains uncertain whether PA acts as a mediator between eHealth literacy and PL.
Objective: This study examines the extent to which PA mediates the link between eHealth literacy and PL in Chinese university students and explores gender differences in these variables.
Methods: In February 2022, a cross-sectional survey was administered to 1210 students across 3 universities in China. The instruments used were the Perceived PL Instrument, the International Physical Activity Questionnaire, and the Chinese version of the eHealth Literacy Scale. Correlations between eHealth literacy, PA, and PL were analyzed using Pearson product-moment correlation and multiple linear regression, while mediation models helped elucidate the interactions among the 3 variables.
Results: The response rate for the study was 92.9% (1124/1210). In the mediation analysis, eHealth literacy showed a significant direct effect on PL, with a coefficient of 0.78 (β .75, SE 0.02; P<.001). Moderate to vigorous physical activity (MVPA) accounted for 2.16% of the total effect, suggesting that MVPA partially mediates the relationship between eHealth literacy and PL. Additionally, male students outperformed female students in terms of MVPA (t636=4.94; P<.001) and PL (t636=3.18; P<.001), but no significant differences were found in eHealth literacy (t636=1.23; P=.22).
Conclusions: The findings indicate that MVPA serves as a mediator in the link between eHealth literacy and PL among university students. Students with low eHealth literacy or limited PA are less likely to be physically literate. Thus, eHealth literacy plays a crucial role in enhancing PL and PA, especially when interventions targeting PL are implemented. Our results also suggest a need for targeted health education interventions aimed at improving MVPA and PL among female students, while also recognizing that eHealth literacy is comparable across genders at universities.
{"title":"Relationships Among eHealth Literacy, Physical Literacy, and Physical Activity in Chinese University Students: Cross-Sectional Study.","authors":"Shan Jiang, Johan Y Y Ng, Siu Ming Choi, Amy S Ha","doi":"10.2196/56386","DOIUrl":"10.2196/56386","url":null,"abstract":"<p><strong>Background: </strong>eHealth literacy is critical for evaluating abilities in locating, accessing, and applying digital health information to enhance one's understanding, skills, and attitudes toward a healthy lifestyle. Prior research indicates that enhancing eHealth literacy can improve health behaviors such as physical activity (PA). Physical literacy (PL) refers to the ability to develop sustainable PA habits, taking into account various aspects of an individual. Notably, university students have shown a decline in PA and possess low PL levels. However, the connection between eHealth literacy and PL in this demographic has not been extensively studied, and it remains uncertain whether PA acts as a mediator between eHealth literacy and PL.</p><p><strong>Objective: </strong>This study examines the extent to which PA mediates the link between eHealth literacy and PL in Chinese university students and explores gender differences in these variables.</p><p><strong>Methods: </strong>In February 2022, a cross-sectional survey was administered to 1210 students across 3 universities in China. The instruments used were the Perceived PL Instrument, the International Physical Activity Questionnaire, and the Chinese version of the eHealth Literacy Scale. Correlations between eHealth literacy, PA, and PL were analyzed using Pearson product-moment correlation and multiple linear regression, while mediation models helped elucidate the interactions among the 3 variables.</p><p><strong>Results: </strong>The response rate for the study was 92.9% (1124/1210). In the mediation analysis, eHealth literacy showed a significant direct effect on PL, with a coefficient of 0.78 (β .75, SE 0.02; P<.001). Moderate to vigorous physical activity (MVPA) accounted for 2.16% of the total effect, suggesting that MVPA partially mediates the relationship between eHealth literacy and PL. Additionally, male students outperformed female students in terms of MVPA (t<sub>636</sub>=4.94; P<.001) and PL (t<sub>636</sub>=3.18; P<.001), but no significant differences were found in eHealth literacy (t<sub>636</sub>=1.23; P=.22).</p><p><strong>Conclusions: </strong>The findings indicate that MVPA serves as a mediator in the link between eHealth literacy and PL among university students. Students with low eHealth literacy or limited PA are less likely to be physically literate. Thus, eHealth literacy plays a crucial role in enhancing PL and PA, especially when interventions targeting PL are implemented. Our results also suggest a need for targeted health education interventions aimed at improving MVPA and PL among female students, while also recognizing that eHealth literacy is comparable across genders at universities.</p>","PeriodicalId":16337,"journal":{"name":"Journal of Medical Internet Research","volume":"26 ","pages":"e56386"},"PeriodicalIF":5.8,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11574492/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142575704","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p><strong>Background: </strong>Telemedicine, or online medical care, has gained considerable attention worldwide. However, it has not been widely adopted in Japan, and the detailed status of received and provided online medical care and the reasons for its lack of popularity remain unknown.</p><p><strong>Objective: </strong>This study aims to investigate the current status of online medical care in Japan and the factors limiting its adoption from the perspective of both patients receiving and medical professionals providing online medical care.</p><p><strong>Methods: </strong>In total, 2 nationwide questionnaire surveys were conducted. The first survey, targeting both patients and healthy individuals, screened approximately 40,000 participants among 13 million people. The participants were selected to match the age distribution of the Japanese population based on government data, and their online medical care experience and medical visit status were recorded. To further investigate online medical care use and satisfaction, a web-based survey was conducted with 15% (6000/40,000) of the screened participants. The second survey, targeting medical professionals, was administered to a physician, a nurse, and a member of the administrative staff in each of 4900 randomly selected medical facilities to inquire about their online medical care practices and impressions. In addition, both surveys investigated the factors limiting online medical care expansion in Japan.</p><p><strong>Results: </strong>The response rates among patients and healthy individuals targeted for the screening and main surveys were 92.5% (36,998/40,000) and ˃80% (1312/1478, 88.77%; 1281/1522, 84.17%; 404/478, 84.5%; and 2226/2522, 88.26% in 4 survey groups), respectively. The survey of medical professionals yielded 1552 responses (n=618, 39.82% physicians; n=428, 27.58% nurses; n=506, 32.6% administrative staff). Although the facility-level response rate was low (794/4900, 16.2%), some facility categories had relatively high response rates. Only 5.29% (1956/36,998) of the patients and healthy individuals had online medical care experience. When there were more hospitals nearby and they felt it was more work to see a physician in person, they were more likely to use online medical care (more nearby hospitals: adjusted odds ratio [aOR] 1.33, 95% CI 1.18-1.50; more work: aOR 1.48, 95% CI 1.35-1.63 per survey response point in the patient group). Similarly, these factors were substantially associated with satisfaction (more nearby hospitals: aOR 1.40, 95% CI 1.14-1.73; more work: aOR 1.50, 95% CI 1.27-1.76 per survey response point in the patient group). In both surveys, the most frequently selected factor preventing the widespread use of online medical care was patients' need to switch to face-to-face medical care for mandatory tests and procedures. Inadequate awareness of and education on online medical care were also frequently selected.</p><p><strong>Conclusions: </strong>Our nation
背景：远程医疗或在线医疗已在全球范围内受到广泛关注。然而，它在日本尚未被广泛采用，接受和提供在线医疗服务的详细情况及其不受欢迎的原因仍不得而知：本研究旨在从接受在线医疗服务的患者和提供在线医疗服务的医务人员的角度，调查日本在线医疗服务的现状以及限制其采用的因素：方法：总共进行了两次全国范围的问卷调查。第一项调查以患者和健康人为对象，从 1300 万人口中筛选出约 4 万名参与者。根据政府数据，按照日本人口的年龄分布选择参与者，并记录他们的在线医疗经验和就医状况。为了进一步调查在线医疗的使用情况和满意度，我们对筛选出的参与者中的 15%（6000/40000）进行了网络调查。第二项调查的对象是医疗专业人员，在随机抽取的 4900 家医疗机构中，每家医疗机构都有一名医生、一名护士和一名行政人员参与调查，以了解他们的在线医疗护理实践和印象。此外，这两项调查还调查了限制日本扩大在线医疗服务的因素：在筛选调查和主要调查中，患者和健康人的回复率分别为 92.5%（36998/40000）和 80%（4 个调查组分别为 1312/1478，88.77%；1281/1522，84.17%；404/478，84.5%；2226/2522，88.26%）。对医疗专业人员的调查共收到 1552 份回复（其中医生 618 份，占 39.82%；护士 428 份，占 27.58%；行政人员 506 份，占 32.6%）。虽然机构层面的回复率较低（794/4900，16.2%），但某些机构类别的回复率相对较高。只有 5.29%（1956/36998）的患者和健康人有过在线医疗护理经验。如果附近有更多的医院，并且他们认为亲自去看医生更费事，那么他们就更有可能使用在线医疗（附近有更多的医院：调整后的几率比 [aOR] 1.33，95% CI 1.18-1.50；更费事：患者组中每个调查回复点的几率比 1.48，95% CI 1.35-1.63）。同样，这些因素与满意度也有很大关系（附近医院较多：aOR 1.40，95% CI 1.14-1.73；工作较多：aOR 1.50，95% CI 1.27-1.76，患者组中每个调查回复点）。在这两项调查中，最常被选中的阻碍广泛使用在线医疗服务的因素是患者在进行强制性检查和程序时需要改用面对面的医疗服务。对在线医疗的认识和教育不足也是经常被选中的因素：我们在全国范围内开展的调查有助于了解日本在线医疗的现状，同时也发现了与之相关的一些问题，这些问题将有助于促进在线医疗的广泛应用。
{"title":"Issues in the Adoption of Online Medical Care: Cross-Sectional Questionnaire Survey.","authors":"Yuka Sugawara, Yosuke Hirakawa, Masao Iwagami, Haruo Kuroki, Shuhei Mitani, Ataru Inagaki, Hiroki Ohashi, Mitsuru Kubota, Soichi Koike, Rie Wakimizu, Masaomi Nangaku","doi":"10.2196/64159","DOIUrl":"10.2196/64159","url":null,"abstract":"<p><strong>Background: </strong>Telemedicine, or online medical care, has gained considerable attention worldwide. However, it has not been widely adopted in Japan, and the detailed status of received and provided online medical care and the reasons for its lack of popularity remain unknown.</p><p><strong>Objective: </strong>This study aims to investigate the current status of online medical care in Japan and the factors limiting its adoption from the perspective of both patients receiving and medical professionals providing online medical care.</p><p><strong>Methods: </strong>In total, 2 nationwide questionnaire surveys were conducted. The first survey, targeting both patients and healthy individuals, screened approximately 40,000 participants among 13 million people. The participants were selected to match the age distribution of the Japanese population based on government data, and their online medical care experience and medical visit status were recorded. To further investigate online medical care use and satisfaction, a web-based survey was conducted with 15% (6000/40,000) of the screened participants. The second survey, targeting medical professionals, was administered to a physician, a nurse, and a member of the administrative staff in each of 4900 randomly selected medical facilities to inquire about their online medical care practices and impressions. In addition, both surveys investigated the factors limiting online medical care expansion in Japan.</p><p><strong>Results: </strong>The response rates among patients and healthy individuals targeted for the screening and main surveys were 92.5% (36,998/40,000) and ˃80% (1312/1478, 88.77%; 1281/1522, 84.17%; 404/478, 84.5%; and 2226/2522, 88.26% in 4 survey groups), respectively. The survey of medical professionals yielded 1552 responses (n=618, 39.82% physicians; n=428, 27.58% nurses; n=506, 32.6% administrative staff). Although the facility-level response rate was low (794/4900, 16.2%), some facility categories had relatively high response rates. Only 5.29% (1956/36,998) of the patients and healthy individuals had online medical care experience. When there were more hospitals nearby and they felt it was more work to see a physician in person, they were more likely to use online medical care (more nearby hospitals: adjusted odds ratio [aOR] 1.33, 95% CI 1.18-1.50; more work: aOR 1.48, 95% CI 1.35-1.63 per survey response point in the patient group). Similarly, these factors were substantially associated with satisfaction (more nearby hospitals: aOR 1.40, 95% CI 1.14-1.73; more work: aOR 1.50, 95% CI 1.27-1.76 per survey response point in the patient group). In both surveys, the most frequently selected factor preventing the widespread use of online medical care was patients' need to switch to face-to-face medical care for mandatory tests and procedures. Inadequate awareness of and education on online medical care were also frequently selected.</p><p><strong>Conclusions: </strong>Our nation","PeriodicalId":16337,"journal":{"name":"Journal of Medical Internet Research","volume":"26 ","pages":"e64159"},"PeriodicalIF":8.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11568393/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142562495","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Scoliosis is a spinal deformity in which one or more spinal segments bend to the side or show vertebral rotation. Some artificial intelligence (AI) apps have already been developed for measuring the Cobb angle in patients with scoliosis. These apps still require doctors to perform certain measurements, which can lead to interobserver variability. The AI app (cobbAngle pro) in this study will eliminate the need for doctor measurements, achieving complete automation.
Objective: We aimed to evaluate the reliability and accuracy of our new AI app that is based on deep learning to automatically measure the Cobb angle in patients with scoliosis.
Methods: A retrospective analysis was conducted on the clinical data of children with scoliosis who were treated at the Pediatric Orthopedics Department of the Children's Hospital affiliated with Fudan University from July 2019 to July 2022. Three measurers used the Picture Archiving and Communication System (PACS) to measure the coronal main curve Cobb angle in 802 full-length anteroposterior and lateral spine X-rays of 601 children with scoliosis, and recorded the results of each measurement. After an interval of 2 weeks, the mobile AI app was used to remeasure the Cobb angle once. The Cobb angle measurements from the PACS were used as the reference standard, and the accuracy of the Cobb angle measurements by the app was analyzed through the Bland-Altman test. The intraclass correlation coefficient (ICC) was used to compare the repeatability within measurers and the consistency between measurers.
Results: Among 601 children with scoliosis, 89 were male and 512 were female (age range: 10-17 years), and 802 full-length spinal X-rays were analyzed. Two functionalities of the app (photography and photo upload) were compared with the PACS for measuring the Cobb angle. The consistency was found to be excellent. The average absolute errors of the Cobb angle measured by the photography and upload methods were 2.00 and 2.08, respectively. Using a clinical allowance maximum error of 5°, the 95% limits of agreement (LoAs) for Cobb angle measurements by the photography and upload methods were -4.7° to 4.9° and -4.9° to 4.9°, respectively. For the photography and upload methods, the 95% LoAs for measuring Cobb angles were -4.3° to 4.6° and -4.4° to 4.7°, respectively, in mild scoliosis patients; -4.9° to 5.2° and -5.1° to 5.1°, respectively, in moderate scoliosis patients; and -5.2° to 5.0° and -6.0° to 4.8°, respectively, in severe scoliosis patients. The Cobb angle measured by the 3 observers twice before and after using the photography method had good repeatability (P<.001). The consistency between the observers was excellent (P<.001).
Conclusions: The new AI platform is accurate and repeatable in the automatic measurement of the Cobb angle of the main curvature in patients with scoliosis.
{"title":"Use of Artificial Intelligence in Cobb Angle Measurement for Scoliosis: Retrospective Reliability and Accuracy Study of a Mobile App.","authors":"Haodong Li, Chuang Qian, Weili Yan, Dong Fu, Yiming Zheng, Zhiqiang Zhang, Junrong Meng, Dahui Wang","doi":"10.2196/50631","DOIUrl":"10.2196/50631","url":null,"abstract":"<p><strong>Background: </strong>Scoliosis is a spinal deformity in which one or more spinal segments bend to the side or show vertebral rotation. Some artificial intelligence (AI) apps have already been developed for measuring the Cobb angle in patients with scoliosis. These apps still require doctors to perform certain measurements, which can lead to interobserver variability. The AI app (cobbAngle pro) in this study will eliminate the need for doctor measurements, achieving complete automation.</p><p><strong>Objective: </strong>We aimed to evaluate the reliability and accuracy of our new AI app that is based on deep learning to automatically measure the Cobb angle in patients with scoliosis.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on the clinical data of children with scoliosis who were treated at the Pediatric Orthopedics Department of the Children's Hospital affiliated with Fudan University from July 2019 to July 2022. Three measurers used the Picture Archiving and Communication System (PACS) to measure the coronal main curve Cobb angle in 802 full-length anteroposterior and lateral spine X-rays of 601 children with scoliosis, and recorded the results of each measurement. After an interval of 2 weeks, the mobile AI app was used to remeasure the Cobb angle once. The Cobb angle measurements from the PACS were used as the reference standard, and the accuracy of the Cobb angle measurements by the app was analyzed through the Bland-Altman test. The intraclass correlation coefficient (ICC) was used to compare the repeatability within measurers and the consistency between measurers.</p><p><strong>Results: </strong>Among 601 children with scoliosis, 89 were male and 512 were female (age range: 10-17 years), and 802 full-length spinal X-rays were analyzed. Two functionalities of the app (photography and photo upload) were compared with the PACS for measuring the Cobb angle. The consistency was found to be excellent. The average absolute errors of the Cobb angle measured by the photography and upload methods were 2.00 and 2.08, respectively. Using a clinical allowance maximum error of 5°, the 95% limits of agreement (LoAs) for Cobb angle measurements by the photography and upload methods were -4.7° to 4.9° and -4.9° to 4.9°, respectively. For the photography and upload methods, the 95% LoAs for measuring Cobb angles were -4.3° to 4.6° and -4.4° to 4.7°, respectively, in mild scoliosis patients; -4.9° to 5.2° and -5.1° to 5.1°, respectively, in moderate scoliosis patients; and -5.2° to 5.0° and -6.0° to 4.8°, respectively, in severe scoliosis patients. The Cobb angle measured by the 3 observers twice before and after using the photography method had good repeatability (P<.001). The consistency between the observers was excellent (P<.001).</p><p><strong>Conclusions: </strong>The new AI platform is accurate and repeatable in the automatic measurement of the Cobb angle of the main curvature in patients with scoliosis.</p>","PeriodicalId":16337,"journal":{"name":"Journal of Medical Internet Research","volume":"26 ","pages":"e50631"},"PeriodicalIF":8.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11568394/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142562439","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Yannik Terhorst, Johannes Knauer, Paula Philippi, Harald Baumeister
<p><strong>Background: </strong>The objective, unobtrusively collected GPS features (eg, homestay and distance) from everyday devices like smartphones may offer a promising augmentation to current assessment tools for depression. However, to date, there is no systematic and meta-analytical evidence on the associations between GPS features and depression.</p><p><strong>Objective: </strong>This study aimed to investigate the between-person and within-person correlations between GPS mobility and activity features and depressive symptoms, and to critically review the quality and potential publication bias in the field.</p><p><strong>Methods: </strong>We searched MEDLINE, PsycINFO, Embase, CENTRAL, ACM, IEEE Xplore, PubMed, and Web of Science to identify eligible articles focusing on the correlations between GPS features and depression from December 6, 2022, to March 24, 2023. Inclusion and exclusion criteria were applied in a 2-stage inclusion process conducted by 2 independent reviewers (YT and JK). To be eligible, studies needed to report correlations between wearable-based GPS variables (eg, total distance) and depression symptoms measured with a validated questionnaire. Studies with underage persons and other mental health disorders were excluded. Between- and within-person correlations were analyzed using random effects models. Study quality was determined by comparing studies against the STROBE (Strengthening the Reporting of Observational studies in Epidemiology) guidelines. Publication bias was investigated using Egger test and funnel plots.</p><p><strong>Results: </strong>A total of k=19 studies involving N=2930 participants were included in the analysis. The mean age was 38.42 (SD 18.96) years with 59.64% (SD 22.99%) of participants being female. Significant between-person correlations between GPS features and depression were identified: distance (r=-0.25, 95% CI -0.29 to -0.21), normalized entropy (r-0.17, 95% CI -0.29 to -0.04), location variance (r-0.17, 95% CI -0.26 to -0.04), entropy (r=-0.13, 95% CI -0.23 to -0.04), number of clusters (r=-0.11, 95% CI -0.18 to -0.03), and homestay (r=0.10, 95% CI 0.00 to 0.19). Studies reporting within-correlations (k=3) were too heterogeneous to conduct meta-analysis. A deficiency in study quality and research standards was identified: all studies followed exploratory observational designs, but no study referenced or fully adhered to the international guidelines for reporting observational studies (STROBE). A total of 79% (k=15) of the studies were underpowered to detect a small correlation (r=.20). Results showed evidence for potential publication bias.</p><p><strong>Conclusions: </strong>Our results provide meta-analytical evidence for between-person correlations of GPS mobility and activity features and depression. Hence, depression diagnostics may benefit from adding GPS mobility and activity features as an integral part of future assessment and expert tools. However, confirmatory studies for bet
背景：从智能手机等日常设备中客观、不显眼地收集 GPS 特征（如寄宿家庭和距离），可能会对目前的抑郁症评估工具起到很好的辅助作用。然而，迄今为止，还没有关于 GPS 特征与抑郁症之间关系的系统性荟萃分析证据：本研究旨在调查 GPS 移动性和活动特征与抑郁症状之间的人际相关性和人内相关性，并对该领域的研究质量和潜在的发表偏差进行严格审查：我们检索了MEDLINE、PsycINFO、Embase、CENTRAL、ACM、IEEE Xplore、PubMed和Web of Science，以确定从2022年12月6日至2023年3月24日期间关注GPS特征与抑郁症之间相关性的合格文章。纳入和排除标准由两名独立审稿人（YT 和 JK）分两阶段进行。符合条件的研究需要报告可穿戴式 GPS 变量（如总距离）与通过有效问卷测量的抑郁症状之间的相关性。涉及未成年人和其他心理健康疾病的研究除外。采用随机效应模型分析了人与人之间和人与人之间的相关性。根据 STROBE（加强流行病学观察性研究的报告）指南对研究进行比较，以确定研究质量。使用Egger检验和漏斗图调查发表偏倚：共有 19 项研究（涉及 2930 名参与者）被纳入分析。平均年龄为 38.42 岁（标准差为 18.96 岁），59.64%（标准差为 22.99%）的参与者为女性。GPS特征与抑郁之间存在显著的人际相关性：距离（r=-0.25，95% CI -0.29至-0.21）、归一化熵（r-0.17，95% CI -0.29至-0.04）、位置方差（r=-0.25，95% CI -0.29至-0.21）、熵（r=-0.17，95% CI -0.29至-0.04）、熵（r=-0.25，95% CI -0.29至-0.21）。04）、位置方差（r-0.17，95% CI -0.26至-0.04）、熵（r=-0.13，95% CI -0.23至-0.04）、聚类数（r=-0.11，95% CI -0.18至-0.03）和寄宿家庭（r=0.10，95% CI 0.00至0.19）。报告内部相关性（k=3）的研究过于分散，无法进行荟萃分析。研究质量和研究标准方面存在不足：所有研究都采用了探索性观察设计，但没有一项研究参考或完全遵守了国际观察性研究报告指南（STROBE）。共有 79% 的研究（k=15）检测到的相关性较小（r=.20）。结果显示存在潜在的发表偏倚：我们的研究结果为 GPS 移动性和活动特征与抑郁症的人际相关性提供了元分析证据。因此，将 GPS 移动性和活动特征作为未来评估和专家工具的一个组成部分，可能对抑郁症诊断有益。不过，还需要对人与人之间的相关性进行确证研究，并对人与人之间的相关性进行进一步研究。此外，证据的方法学质量也有待提高：OSF Registeries cwder; https://osf.io/cwder.
{"title":"The Relation Between Passively Collected GPS Mobility Metrics and Depressive Symptoms: Systematic Review and Meta-Analysis.","authors":"Yannik Terhorst, Johannes Knauer, Paula Philippi, Harald Baumeister","doi":"10.2196/51875","DOIUrl":"10.2196/51875","url":null,"abstract":"<p><strong>Background: </strong>The objective, unobtrusively collected GPS features (eg, homestay and distance) from everyday devices like smartphones may offer a promising augmentation to current assessment tools for depression. However, to date, there is no systematic and meta-analytical evidence on the associations between GPS features and depression.</p><p><strong>Objective: </strong>This study aimed to investigate the between-person and within-person correlations between GPS mobility and activity features and depressive symptoms, and to critically review the quality and potential publication bias in the field.</p><p><strong>Methods: </strong>We searched MEDLINE, PsycINFO, Embase, CENTRAL, ACM, IEEE Xplore, PubMed, and Web of Science to identify eligible articles focusing on the correlations between GPS features and depression from December 6, 2022, to March 24, 2023. Inclusion and exclusion criteria were applied in a 2-stage inclusion process conducted by 2 independent reviewers (YT and JK). To be eligible, studies needed to report correlations between wearable-based GPS variables (eg, total distance) and depression symptoms measured with a validated questionnaire. Studies with underage persons and other mental health disorders were excluded. Between- and within-person correlations were analyzed using random effects models. Study quality was determined by comparing studies against the STROBE (Strengthening the Reporting of Observational studies in Epidemiology) guidelines. Publication bias was investigated using Egger test and funnel plots.</p><p><strong>Results: </strong>A total of k=19 studies involving N=2930 participants were included in the analysis. The mean age was 38.42 (SD 18.96) years with 59.64% (SD 22.99%) of participants being female. Significant between-person correlations between GPS features and depression were identified: distance (r=-0.25, 95% CI -0.29 to -0.21), normalized entropy (r-0.17, 95% CI -0.29 to -0.04), location variance (r-0.17, 95% CI -0.26 to -0.04), entropy (r=-0.13, 95% CI -0.23 to -0.04), number of clusters (r=-0.11, 95% CI -0.18 to -0.03), and homestay (r=0.10, 95% CI 0.00 to 0.19). Studies reporting within-correlations (k=3) were too heterogeneous to conduct meta-analysis. A deficiency in study quality and research standards was identified: all studies followed exploratory observational designs, but no study referenced or fully adhered to the international guidelines for reporting observational studies (STROBE). A total of 79% (k=15) of the studies were underpowered to detect a small correlation (r=.20). Results showed evidence for potential publication bias.</p><p><strong>Conclusions: </strong>Our results provide meta-analytical evidence for between-person correlations of GPS mobility and activity features and depression. Hence, depression diagnostics may benefit from adding GPS mobility and activity features as an integral part of future assessment and expert tools. However, confirmatory studies for bet","PeriodicalId":16337,"journal":{"name":"Journal of Medical Internet Research","volume":"26 ","pages":"e51875"},"PeriodicalIF":8.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11568401/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142562437","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mu-Hsing Ho, Chi-Yuan Peng, Yung Liao, Hsin-Yen Yen
Background: Smart wearable technology has potential benefits for promoting physical activity and preventing sarcopenia.
Objective: The purpose of this study was to explore the efficacy of a wearable activity tracker with 2-stage goal-setting for daily steps on older adults' physical activity and sarcopenia indicators.
Methods: The study used a clustered trial design and was conducted in March to June 2022. Participants were community-dwelling adults older than 60 years who were recruited from 4 community centers in Taipei City. The intervention was designed with 2-stage goals set to 5000 steps/day in the first 4 weeks and 7500 steps/day in the final 4 weeks while wearing a commercial wearable activity tracker. Data were collected by self-reported questionnaires, a body composition analyzer, a handle grip tester, and 5 sit-to-stand tests.
Results: All 27 participants in the experimental group and 31 participants in the control group completed the 8-week intervention. Total and light-intensity physical activities, skeletal muscle index, and muscle strength increased, while sedentary time, BMI, and the waist circumference of participants decreased in the experimental group, with significant group-by-time interactions compared to the control group.
Conclusions: A wearable activity tracker with gradual goal-setting is an efficient approach to improve older adults' physical activity and sarcopenia indicators. Smart wearable products with behavioral change techniques are recommended to prevent sarcopenia in older adult populations.
{"title":"Efficacy of a Wearable Activity Tracker With Step-by-Step Goal-Setting on Older Adults' Physical Activity and Sarcopenia Indicators: Clustered Trial.","authors":"Mu-Hsing Ho, Chi-Yuan Peng, Yung Liao, Hsin-Yen Yen","doi":"10.2196/60183","DOIUrl":"10.2196/60183","url":null,"abstract":"<p><strong>Background: </strong>Smart wearable technology has potential benefits for promoting physical activity and preventing sarcopenia.</p><p><strong>Objective: </strong>The purpose of this study was to explore the efficacy of a wearable activity tracker with 2-stage goal-setting for daily steps on older adults' physical activity and sarcopenia indicators.</p><p><strong>Methods: </strong>The study used a clustered trial design and was conducted in March to June 2022. Participants were community-dwelling adults older than 60 years who were recruited from 4 community centers in Taipei City. The intervention was designed with 2-stage goals set to 5000 steps/day in the first 4 weeks and 7500 steps/day in the final 4 weeks while wearing a commercial wearable activity tracker. Data were collected by self-reported questionnaires, a body composition analyzer, a handle grip tester, and 5 sit-to-stand tests.</p><p><strong>Results: </strong>All 27 participants in the experimental group and 31 participants in the control group completed the 8-week intervention. Total and light-intensity physical activities, skeletal muscle index, and muscle strength increased, while sedentary time, BMI, and the waist circumference of participants decreased in the experimental group, with significant group-by-time interactions compared to the control group.</p><p><strong>Conclusions: </strong>A wearable activity tracker with gradual goal-setting is an efficient approach to improve older adults' physical activity and sarcopenia indicators. Smart wearable products with behavioral change techniques are recommended to prevent sarcopenia in older adult populations.</p>","PeriodicalId":16337,"journal":{"name":"Journal of Medical Internet Research","volume":"26 ","pages":"e60183"},"PeriodicalIF":8.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11568398/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142562491","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Xiaoxia Liu, Lianzhen Ning, Wenqi Fan, Chanyi Jia, Lina Ge
<p><strong>Background: </strong>Cervical cancer is a significant cause of mortality in women. Although screening has reduced cervical cancer mortality, screening rates remain suboptimal. Electronic health interventions emerge as promising strategies to effectively tackle this issue.</p><p><strong>Objective: </strong>This systematic review and meta-analysis aimed to determine the effectiveness of electronic health interventions in cervical cancer screening.</p><p><strong>Methods: </strong>On December 29, 2023, we performed an extensive search for randomized controlled trials evaluating electronic health interventions to promote cervical cancer screening in adults. The search covered multiple databases, including MEDLINE, the Cochrane Central Registry of Controlled Trials, Embase, PsycINFO, PubMed, Scopus, Web of Science, and the Cumulative Index to Nursing and Allied Health Literature. These studies examined the effectiveness of electronic health interventions on cervical cancer screening. Studies published between 2013 and 2022 were included. Two independent reviewers evaluated the titles, abstracts, and full-text publications, also assessing the risk of bias using the Cochrane Risk of Bias 2 tool. Subgroup analysis was conducted based on subjects, intervention type, and economic level. The Mantel-Haenszel method was used within a random-effects model to pool the relative risk of participation in cervical cancer screening.</p><p><strong>Results: </strong>A screening of 713 records identified 14 articles (15 studies) with 23,102 participants, which were included in the final analysis. The intervention strategies used in these studies included short messaging services (4/14), multimode interventions (4/14), phone calls (2/14), web videos (3/14), and internet-based booking (1/14). The results indicated that electronic health interventions were more effective than control interventions for improving cervical cancer screening rates (relative risk [RR] 1.464, 95% CI 1.285-1.667; P<.001; I<sup>2</sup>=84%), cervical cancer screening (intention-to-treat) (RR 1.382, 95% CI 1.214-1.574; P<.001; I<sup>2</sup>=82%), and cervical cancer screening (per-protocol; RR 1.565, 95% CI 1.381-1.772; P<.001; I<sup>2</sup>=74%). Subgroup analysis revealed that phone calls (RR 1.82, 95% CI 1.40-2.38), multimode (RR 1.62, 95% CI 1.26-2.08), SMS (RR 1.41, 95% CI 1.14-1.73), and video- and internet-based booking (RR 1.25, 95% CI 1.03-1.51) interventions were superior to usual care. In addition, electronic health interventions did not show a statistically significant improvement in cervical cancer screening rates among women with HPV (RR 1.17, 95% CI 0.95-1.45). Electronic health interventions had a greater impact on improving cervical cancer screening rates among women in low- and middle-income areas (RR 1.51, 95% CI 1.27-1.79). There were no indications of small study effects or publication bias.</p><p><strong>Conclusions: </strong>Electronic health interventions are recom
背景：宫颈癌是导致妇女死亡的一个重要原因。尽管宫颈癌筛查降低了宫颈癌死亡率，但筛查率仍不理想。电子健康干预是有希望有效解决这一问题的策略：本系统综述和荟萃分析旨在确定电子健康干预在宫颈癌筛查中的有效性：2023 年 12 月 29 日，我们对评估电子健康干预措施促进成人宫颈癌筛查的随机对照试验进行了广泛检索。该检索涵盖多个数据库，包括MEDLINE、Cochrane对照试验中央登记处、Embase、PsycINFO、PubMed、Scopus、Web of Science以及《护理与专职医疗文献累积索引》（Cumulative Index to Nursing and Allied Health Literature）。这些研究考察了电子健康干预对宫颈癌筛查的有效性。研究发表于 2013 年至 2022 年之间。两位独立审稿人评估了研究的标题、摘要和全文，并使用 Cochrane Risk of Bias 2 工具评估了偏倚风险。根据受试者、干预类型和经济水平进行了分组分析。在随机效应模型中使用 Mantel-Haenszel 方法对参与宫颈癌筛查的相对风险进行汇总：对 713 条记录进行筛选后，共发现 14 篇文章（15 项研究），23102 名参与者，这些文章被纳入最终分析。这些研究采用的干预策略包括短信服务（4/14）、多模式干预（4/14）、电话（2/14）、网络视频（3/14）和网络预约（1/14）。结果表明，在提高宫颈癌筛查率（相对风险 [RR] 1.464，95% CI 1.285-1.667；P2=84%）、宫颈癌筛查（意向治疗）（RR 1.382，95% CI 1.214-1.574；P2=82%）和宫颈癌筛查（按协议；RR 1.565，95% CI 1.381-1.772；P2=74%）方面，电子健康干预比对照干预更有效。亚组分析显示，电话（RR 1.82，95% CI 1.40-2.38）、多模式（RR 1.62，95% CI 1.26-2.08）、短信（RR 1.41，95% CI 1.14-1.73）以及视频和互联网预约（RR 1.25，95% CI 1.03-1.51）干预优于常规护理。此外，电子健康干预并未显示出对感染 HPV 妇女的宫颈癌筛查率有显著的统计学改善（RR 1.17，95% CI 0.95-1.45）。电子健康干预对提高中低收入地区妇女的宫颈癌筛查率影响更大（RR 1.51，95% CI 1.27-1.79）。没有迹象表明存在小规模研究效应或发表偏差：结论：建议在宫颈癌筛查项目中采用电子健康干预措施，因为它们有可能提高参与率。然而，这项荟萃分析仍存在明显的异质性。研究人员应开展大规模研究，重点关注这些干预措施的成本效益：CRD42024502884; https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=502884.
{"title":"Electronic Health Interventions and Cervical Cancer Screening: Systematic Review and Meta-Analysis.","authors":"Xiaoxia Liu, Lianzhen Ning, Wenqi Fan, Chanyi Jia, Lina Ge","doi":"10.2196/58066","DOIUrl":"10.2196/58066","url":null,"abstract":"<p><strong>Background: </strong>Cervical cancer is a significant cause of mortality in women. Although screening has reduced cervical cancer mortality, screening rates remain suboptimal. Electronic health interventions emerge as promising strategies to effectively tackle this issue.</p><p><strong>Objective: </strong>This systematic review and meta-analysis aimed to determine the effectiveness of electronic health interventions in cervical cancer screening.</p><p><strong>Methods: </strong>On December 29, 2023, we performed an extensive search for randomized controlled trials evaluating electronic health interventions to promote cervical cancer screening in adults. The search covered multiple databases, including MEDLINE, the Cochrane Central Registry of Controlled Trials, Embase, PsycINFO, PubMed, Scopus, Web of Science, and the Cumulative Index to Nursing and Allied Health Literature. These studies examined the effectiveness of electronic health interventions on cervical cancer screening. Studies published between 2013 and 2022 were included. Two independent reviewers evaluated the titles, abstracts, and full-text publications, also assessing the risk of bias using the Cochrane Risk of Bias 2 tool. Subgroup analysis was conducted based on subjects, intervention type, and economic level. The Mantel-Haenszel method was used within a random-effects model to pool the relative risk of participation in cervical cancer screening.</p><p><strong>Results: </strong>A screening of 713 records identified 14 articles (15 studies) with 23,102 participants, which were included in the final analysis. The intervention strategies used in these studies included short messaging services (4/14), multimode interventions (4/14), phone calls (2/14), web videos (3/14), and internet-based booking (1/14). The results indicated that electronic health interventions were more effective than control interventions for improving cervical cancer screening rates (relative risk [RR] 1.464, 95% CI 1.285-1.667; P<.001; I<sup>2</sup>=84%), cervical cancer screening (intention-to-treat) (RR 1.382, 95% CI 1.214-1.574; P<.001; I<sup>2</sup>=82%), and cervical cancer screening (per-protocol; RR 1.565, 95% CI 1.381-1.772; P<.001; I<sup>2</sup>=74%). Subgroup analysis revealed that phone calls (RR 1.82, 95% CI 1.40-2.38), multimode (RR 1.62, 95% CI 1.26-2.08), SMS (RR 1.41, 95% CI 1.14-1.73), and video- and internet-based booking (RR 1.25, 95% CI 1.03-1.51) interventions were superior to usual care. In addition, electronic health interventions did not show a statistically significant improvement in cervical cancer screening rates among women with HPV (RR 1.17, 95% CI 0.95-1.45). Electronic health interventions had a greater impact on improving cervical cancer screening rates among women in low- and middle-income areas (RR 1.51, 95% CI 1.27-1.79). There were no indications of small study effects or publication bias.</p><p><strong>Conclusions: </strong>Electronic health interventions are recom","PeriodicalId":16337,"journal":{"name":"Journal of Medical Internet Research","volume":"26 ","pages":"e58066"},"PeriodicalIF":8.3,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11565089/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142558058","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jiaqi Zeng, Xiaoyi Zou, Shirong Li, Yao Tang, Sisi Teng, Huanhuan Li, Changyu Wang, Yuxuan Wu, Luyao Zhang, Yunheng Zhong, Jialin Liu, Siru Liu
<p><strong>Background: </strong>Alzheimer's disease (AD) is a progressive neurodegenerative disorder posing challenges to patients, caregivers, and society. Accessible and accurate information is crucial for effective AD management.</p><p><strong>Objective: </strong>This study aimed to evaluate the accuracy, comprehensibility, clarity, and usefulness of the Generative Pretrained Transformer's (GPT) answers concerning the management and caregiving of patients with AD.</p><p><strong>Methods: </strong>In total, 14 questions related to the prevention, treatment, and care of AD were identified and posed to GPT-3.5 and GPT-4 in Chinese and English, respectively, and 4 respondent neurologists were asked to answer them. We generated 8 sets of responses (total 112) and randomly coded them in answer sheets. Next, 5 evaluator neurologists and 5 family members of patients were asked to rate the 112 responses using separate 5-point Likert scales. We evaluated the quality of the responses using a set of 8 questions rated on a 5-point Likert scale. To gauge comprehensibility and participant satisfaction, we included 3 questions dedicated to each aspect within the same set of 8 questions.</p><p><strong>Results: </strong>As of April 10, 2023, the 5 evaluator neurologists and 5 family members of patients with AD rated the 112 responses: GPT-3.5: n=28, 25%, responses; GPT-4: n=28, 25%, responses; respondent neurologists: 56 (50%) responses. The top 5 (4.5%) responses rated by evaluator neurologists had 4 (80%) GPT (GPT-3.5+GPT-4) responses and 1 (20%) respondent neurologist's response. For the top 5 (4.5%) responses rated by patients' family members, all but the third response were GPT responses. Based on the evaluation by neurologists, the neurologist-generated responses achieved a mean score of 3.9 (SD 0.7), while the GPT-generated responses scored significantly higher (mean 4.4, SD 0.6; P<.001). Language and model analyses revealed no significant differences in response quality between the GPT-3.5 and GPT-4 models (GPT-3.5: mean 4.3, SD 0.7; GPT-4: mean 4.4, SD 0.5; P=.51). However, English responses outperformed Chinese responses in terms of comprehensibility (Chinese responses: mean 4.1, SD 0.7; English responses: mean 4.6, SD 0.5; P=.005) and participant satisfaction (Chinese responses: mean 4.2, SD 0.8; English responses: mean 4.5, SD 0.5; P=.04). According to the evaluator neurologists' review, Chinese responses had a mean score of 4.4 (SD 0.6), whereas English responses had a mean score of 4.5 (SD 0.5; P=.002). As for the family members of patients with AD, no significant differences were observed between GPT and neurologists, GPT-3.5 and GPT-4, or Chinese and English responses.</p><p><strong>Conclusions: </strong>GPT can provide patient education materials on AD for patients, their families and caregivers, nurses, and neurologists. This capability can contribute to the effective health care management of patients with AD, leading to enhanced patient outco
{"title":"Assessing the Role of the Generative Pretrained Transformer (GPT) in Alzheimer's Disease Management: Comparative Study of Neurologist- and Artificial Intelligence-Generated Responses.","authors":"Jiaqi Zeng, Xiaoyi Zou, Shirong Li, Yao Tang, Sisi Teng, Huanhuan Li, Changyu Wang, Yuxuan Wu, Luyao Zhang, Yunheng Zhong, Jialin Liu, Siru Liu","doi":"10.2196/51095","DOIUrl":"10.2196/51095","url":null,"abstract":"<p><strong>Background: </strong>Alzheimer's disease (AD) is a progressive neurodegenerative disorder posing challenges to patients, caregivers, and society. Accessible and accurate information is crucial for effective AD management.</p><p><strong>Objective: </strong>This study aimed to evaluate the accuracy, comprehensibility, clarity, and usefulness of the Generative Pretrained Transformer's (GPT) answers concerning the management and caregiving of patients with AD.</p><p><strong>Methods: </strong>In total, 14 questions related to the prevention, treatment, and care of AD were identified and posed to GPT-3.5 and GPT-4 in Chinese and English, respectively, and 4 respondent neurologists were asked to answer them. We generated 8 sets of responses (total 112) and randomly coded them in answer sheets. Next, 5 evaluator neurologists and 5 family members of patients were asked to rate the 112 responses using separate 5-point Likert scales. We evaluated the quality of the responses using a set of 8 questions rated on a 5-point Likert scale. To gauge comprehensibility and participant satisfaction, we included 3 questions dedicated to each aspect within the same set of 8 questions.</p><p><strong>Results: </strong>As of April 10, 2023, the 5 evaluator neurologists and 5 family members of patients with AD rated the 112 responses: GPT-3.5: n=28, 25%, responses; GPT-4: n=28, 25%, responses; respondent neurologists: 56 (50%) responses. The top 5 (4.5%) responses rated by evaluator neurologists had 4 (80%) GPT (GPT-3.5+GPT-4) responses and 1 (20%) respondent neurologist's response. For the top 5 (4.5%) responses rated by patients' family members, all but the third response were GPT responses. Based on the evaluation by neurologists, the neurologist-generated responses achieved a mean score of 3.9 (SD 0.7), while the GPT-generated responses scored significantly higher (mean 4.4, SD 0.6; P<.001). Language and model analyses revealed no significant differences in response quality between the GPT-3.5 and GPT-4 models (GPT-3.5: mean 4.3, SD 0.7; GPT-4: mean 4.4, SD 0.5; P=.51). However, English responses outperformed Chinese responses in terms of comprehensibility (Chinese responses: mean 4.1, SD 0.7; English responses: mean 4.6, SD 0.5; P=.005) and participant satisfaction (Chinese responses: mean 4.2, SD 0.8; English responses: mean 4.5, SD 0.5; P=.04). According to the evaluator neurologists' review, Chinese responses had a mean score of 4.4 (SD 0.6), whereas English responses had a mean score of 4.5 (SD 0.5; P=.002). As for the family members of patients with AD, no significant differences were observed between GPT and neurologists, GPT-3.5 and GPT-4, or Chinese and English responses.</p><p><strong>Conclusions: </strong>GPT can provide patient education materials on AD for patients, their families and caregivers, nurses, and neurologists. This capability can contribute to the effective health care management of patients with AD, leading to enhanced patient outco","PeriodicalId":16337,"journal":{"name":"Journal of Medical Internet Research","volume":"26 ","pages":"e51095"},"PeriodicalIF":8.3,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11565080/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142558056","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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