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The demand for better health services has resulted in the advancement of remote monitoring health, i.e., virtual nursing systems, to watch and support the elderly with innovative concepts such as being patient-centric, easier to use, and having smarter interactions and more accurate conclusions. While virtual nursing services attempt to provide consumers and medical practitioners with continuous medical and health monitoring services, access to allied healthcare experts such as nurses remains a challenge. In this research, we present Virtual Nursing Using Deep Belief Networks for Elderly People (DBN-EP), a new framework that provides a virtual nurse agent deployed on a senior citizen's home, workplace, or care centre to help manage their health condition on a continuous basis. Using this method, healthcare providers can assign various jobs to nurses by utilizing a general task definition mechanism, in which a task is defined as a combination of medical workflow, operational guidelines, and data gathered from a remotely monitored virtual nursing system. Practitioners are in charge of DBN-EP and make treatment decisions for patients. This allows a DBN-EP to act as a personalized full-time nurse for a client by carrying out practitioner support activities based on information gathered about the client's health. An electronic Personal Health Record (ePHR) system, such as a specialized web portal and mobile apps, could provide such patient information to elderly person family members and care centres. We created a prototype system using a DBN-EP system that allows traditional client applications and healthcare provider systems to collaborate. Finally, we demonstrate how this system may benefit the elderly through a result and debate. [ABSTRACT FROM AUTHOR]

Highlights • Constructing question-disease bipartite network from online health forums. • A link prediction method to identify the connections between questions and diseases. • Performance comparison for five different methods. • Testing accuracy of the answers given by health professionals to questions of the users in online health forums. • Medical histories of a set of similar patients are important for prediction. Abstract The Internet has become an indispensable part of human life in today. People can now easily find answers to questions they are curious about via the internet. The short, effortless and free way that the Internet provides is extremely attractive for people to have an idea in subjects they wonder related to their health. There are many online health forums where people can ask questions answered by health professionals. Every day, people ask thousands of questions on these sites and get answers about which diseases their complaints may be related to. The frequent use of online forum sites by people has led to the selection of these forums as data source for this study, and analysis of reliability. Firstly, in this study, link prediction in bipartite social networks, where intensive works have been done and it is applied on many areas nowadays, is tried to be carried out on question-disease bipartite network constructed with data obtained from analysis of online health forums whose use rate increase substantially. For this purpose, a novel link prediction method called as intensive link prediction is proposed, and prediction success of this method is compared with five of similarity-based link prediction methods. Better results have been obtained with the proposed method than the other methods. Then, the accuracy of the answers given to the users on online health forums which received intense interest are tested. The reliability of online health forums is measured by the accuracy analysis performed. [ABSTRACT FROM AUTHOR]

With the digitisation of society, e-health technology increasingly supports new design situations that extend those traditional to Information Systems, and therefore need to be better understood. In design for complex, new and sensitive design situations, it is not possible to apply known methods and solutions without a deeper situational understanding. These design situations are fraught with wicked problems that are contradictory and complex. This paper intends to answer how the wickedness of the design situation when designing e-health technology for people diagnosed with schizophrenia can be understood and what consequences the design situation has for the design process. The paper presents a grounded theory analysis of stakeholder interviews and focus group interviews with people diagnosed with schizophrenia. Four wicked problems are identified: struggle of dependence, contradiction of social interaction, contradiction of trust and counteracting improvement behaviour. The problems are interrelated and have consequences for the design, acceptance, use and user involvement in design of e-health technology for people diagnosed with schizophrenia. The paper also shows the viability of using grounded theory for studying and describing situational wickedness. [ABSTRACT FROM AUTHOR]

Three-way decision models and their relative applications have received a great deal of research attention. Most of these models were constructed on the basis of decision-theoretic rough sets (DTRSs) and Bayesian decision theory, both of which ignore the risk preferences of decision-makers. To address this shortcoming, this paper constructs a novel TODIM method-based three-way decision model and demonstrates its use in the context of online diagnosis and medical treatment selection. This model combines information systems and DTRSs together to construct a hybrid information system. And it solves the problems in aggregating cost-loss information with different levels of importance by utilizing the power average operator. Furthermore, an extension of the TODIM method is proposed based on the novel possibility degree measurement considering the probability distribution of loss functions. To validate the reasonableness and effectiveness of our model, we give a series of simulation experiments related to treatment selection for a Good Doctor Online user infected with the common cold. [ABSTRACT FROM AUTHOR]

Offering breast cancer patients treatment choice has become a priority as the involvement of patients in the decision-making process is associated with improved physical and psychological outcomes. As the Internet is increasingly being used by patients as a source of medical information, it is important to evaluate the quality of information relating to breast cancer on the Internet. We analysed 200 websites returned by google.co.uk searching “breast cancer treatment options” in terms of their typology and treatment options described. These were related to standard measures of health information quality such as the JAMA score and the presence of quality certifications, as well as readability. We found that health portals were of higher quality whilst commercial and professional websites were of poorer quality in terms of JAMA criteria. Overall, readability was higher than previously reported for other conditions, and Google ranked websites with better readability higher. Most websites discussed surgical and medical treatments. Few websites, with a large proportion being of commercial typology, discussed complementary and alternative medicine. Google ranked professional websites low whilst websites from non-profit organizations were promoted in the ranking. [ABSTRACT FROM AUTHOR]

This work details developments made in a system for hand rehabilitation, that aims to improve recovery of fine motor control, mostly for those recovering from stroke. The system consists of an instrumented device that is used to interact with a variety of games designed to improve fine motor control, enhancing rehabilitation practices. These games were tested with actual disabled individuals and therapists, having received overall positive feedback. [ABSTRACT FROM AUTHOR]

Alongside teleconsulting platforms, existing digital-based healthcare services propose automated solutions such as medical chatbots to interact with patients. Nevertheless, previous research stress their lack of human-like interactions delaying implementation. The advent of Metaverse may fill this gap by "catapulting" patients and doctors into a parallel virtual reality made up of avatars where interactions are as similar as those in the real world. By leveraging on a sample of 689 participants to an international experimental study, this paper investigates the effect of the human-like interactions (manipulated as low in case of medical chatbots vs high in case of doctors' avatars in the Metaverse) on the individuals' intention to use such digital-based healthcare services. We analyze the relationship through the perceived anthropomorphism mediating the two options. Moreover, by considering the peculiarities of the doctor-patient relationship resulting not only from professionalism but also from social interactions, we analyze the moderating effect of emotional receptivity. Results show that higher level human-like interactions (i.e., doctors' avatars in the Metaverse) positively influences individuals' intention to use such healthcare service via the effect of perceived anthropomorphism. Moreover, such effect is significant only among individuals who exhibit higher level of emotional receptivity. • The level of human-like interactions positively influences individuals' intention to use digital-based healthcare service • Perceived anthropomorphism explains the direct effect of the human-like interactions on intention to use • Emotional receptivity moderates the intention to use digital-based healthcare service • Avatars (vs chatbot) may be better perceived by final patients because of their human-like interactivity and anthropomorphism • Metaverse avatars may be a new crucial tool to boost digital-based healthcare service [ABSTRACT FROM AUTHOR]

This study examines the relationship between internet use and health outcomes (i.e. infant mortality, under-five mortality, life expectancy) using generalized quantile regression approach. We used annual unbalanced panel data for 48 sub-Saharan Africa countries from 2000 to 2020. The findings show that internet use has a positive and statistically significant impact on improving health outcomes in sub-Saharan Africa to almost all quantiles (10th to 90th). This implies that internet use among individuals increases longevity (i.e. life expectancy) and lowers both infant and under-five mortality from 2000 to 2020. The findings still holds the same after checking robustness analysis. Moreover, the findings reveal the heterogeneous effect of income, health spending, carbon dioxide emissions and trade on health outcomes across different quantiles. These imply that at a certain quantile there are a diminishing returns or increases of health outcomes. Overall, the findings support the idea that increasing internet use and penetration will likely contribute to improving longevity (i.e. life expectancy) and lowering infant and under-five mortality in sub-Saharan Africa. The mechanism of internet use and adoption in influencing health outcomes is also discussed. We suggest sub-Saharan Africa countries to give priority to internet use and adoption strategies, policies or laws that ensure the availability of digital tools (such as smartphones and computers) for online searching and use of health-related information. • We assess if internet access and adoption improves health outcomes in sub-Saharan Africa. • The study employs health promotion theory to explain internet access and health outcomes nexus. • The evidence is based on generalized quantile regression developed by Powell (2020). • Internet use improves health outcomes (i.e., reduce infant and under-five mortality, and increases life expectancy) in Sub-Saharan Africa countries. [ABSTRACT FROM AUTHOR]

Objectives: To identify which states currently have substance use disorder (SUD) programs to facilitate the return of pharmacy professionals (including technicians, interns, and student pharmacists) to active practice, to identify the operational structures used by the states in providing these services and compare them with those reported previously, and to compile the most current and accurate contact information for each state SUD program.Methods: Information specific to each state program was identified from Internet resources including state pharmacy associations, licensing boards, and professional associations. Each state's site was evaluated for currency within 2016-2017. Direct contact by e-mail or telephone using the program information, or association, or licensing board contacts was pursued to identify the current program status.Results: Five states with no program in 1990 have since developed programs, and 2 states with programs in 1990 have closed their programs. Overall, 4 states do not currently have a program, 2 of which have never had one. One of the 2 states has recent authorization from their legislature to develop a program. Three other programs are currently in transition from 1 model to another, resulting in website inaccuracies. The operational models have undergone significant shifts with a decrease in the association (± [with or without] Foundation) model toward a group health care association or organization model including other health- or all state-licensed professionals.Conclusion: Currently, 46 states have programs for assisting pharmacy professionals. Information presented in this article provides the most current contact information and model structure used by states with programs. Frequent updating of program information is critical for those who might decide to seek assistance. Expansion to include a central database that enables rigorous evaluation of outcomes and specific features is viewed as desirable. [ABSTRACT FROM AUTHOR]

Framing of causal interdependencies and uncertainties is important due to factors bringing change to healthcare, such as increasing access to healthcare information via the Internet and increasing self-care. In this paper, it is explained how critical realism can provide a basis for framing causal interdependencies and causal uncertainties within healthcare. The need for critical realist framing of causal interdependencies and uncertainties in healthcare is explained from the perspectives of human to human communication and human to AI communication. An example is provided of critical realist framing for causal interdependencies. Also, an example is provided of critical realist framing for causal uncertainties. Implications are discussed for human to human communication and human to AI communication. Critical realism can provide framing that is easy to grasp and recall. Importantly, critical realist framing can encompass both causal specificity and holistic overview when integrating diverse healthcare options. Moreover, critical realist framing can encompass uncertainties across the “why”, “how”, and “what” of healthcare. These characteristics of critical realist framing are important as end-users become increasingly aware of healthcare diversity and uncertainty. [ABSTRACT FROM AUTHOR]

With the rapidly growing popularity of the delivery of health services through the Internet, it is timely to examine online health service (OHS) diffusion from the human decision process perspective for its development and diffusion. The health service possesses an offline-to-online nature; that is, its online service is an extension of its offline service. Therefore, we develop a research model to bridge offline healthcare and the OHS-decision, which is contingent on different levels of offline healthcare habits, drawing on user satisfaction literature, the Innovation Diffusion Theory, and the habit literature. Data were collected from 323 Internet users, and our empirical results show that high satisfaction on offline healthcare hinders the awareness of OHS and subsequently influences adoption intention. On the other hand, offline healthcare habits weaken the effects of offline health satisfaction on the OHS awareness. Discussions and implications are also proposed in the concluding sections of this research. [ABSTRACT FROM AUTHOR]

Objective: Despite advances in supported treatments for early onset obsessive-compulsive disorder (OCD), progress has been constrained by regionally limited expertise in pediatric OCD. Videoteleconferencing (VTC) methods have proved useful for extending the reach of services for older individuals, but no randomized clinical trials (RCTs) have evaluated VTC for treating early onset OCD. Method: RCT comparing VTC-delivered family based cognitive-behavioral therapy (FB-CBT) versus clinicbased FB-CBT in the treatment of children ages 4-8 with OCD (N = 22). Pretreatment, posttreatment, and 6-month follow-up assessments included mother-/therapist-reports and independent evaluations masked to treatment condition. Primary analyses focused on treatment retention, engagement and satisfaction. Hierarchical linear modeling preliminarily evaluated the effects of time, treatment condition, and their interactions. "Excellent response" was defined as a 1 or 2 on the Clinical Global Impressions-Improvement Scale. Results: Treatment retention, engagement, alliance and satisfaction were high across conditions. Symptom trajectories and family accommodation across both conditions showed outcomes improving from baseline to posttreatment, and continuing through follow-up. At posttreatment, 72.7% of Internet cases and 60% of Clinic cases showed "excellent response," and at follow-up 80% of Internet cases and 66.7% of Clinic cases showed "excellent response." Significant condition differences were not found across outcomes. Conclusions: VTC methods may offer solutions to overcoming traditional barriers to care for early onset OCD by extending the reach of real-time expert services regardless of children's geographic proximity to quality care. [ABSTRACT FROM AUTHOR]

Objective: Psychological treatments can relieve mental distress and improve well-being, and the dissemination of evidence-based methods can help patients gain access to the right type of aid. Meanwhile, Internet-based cognitive-behavioral therapy (ICBT) has shown promising results for many psychiatric disorders. However, research on the potential for negative effects of psychological treatments has been lacking. Method: An individual patient data meta-analysis of 29 clinical trials of ICBT (N = 2,866) was performed using the Reliable Change Index for each primary outcome measures to distinguish deterioration rates among patients in treatment and control conditions. Statistical analyses of predictors were conducted using generalized linear mixed models. Missing data was handled by multiple imputation. Results: Deterioration rates were 122 (5.8%) in treatment and 130 (17.4%) in control conditions. Relative to receiving treatment, patients in a control condition had higher odds of deteriorating, odds ratios {ORs) = 3.10, 95% confidence interval (Cl) [2.21, 4.34], Clinical severity at pretreatment was related to lower odds, OR = 0.62,95% Cl [0.50, 0.77], and OR = 0.51, 95% Cl [0.51,0.80], for treatment and control conditions. In terms of sociodemographic variables, being in a relationship, OR = 0.58, 95% Cl [0.35, 0.95], having at least a university degree, OR = 0.54, 95% Cl [0.33, 0.88], and being older, OR = 0.78, 95% Cl, [0.62, 0.98], were also associated with lower odds of deterioration, but only for patients assigned to a treatment condition. Conclusion: Deterioration among patients receiving ICBT or being in a control condition can occur and should be monitored by researchers to reverse and prevent a negative treatment trend. [ABSTRACT FROM AUTHOR]

Patients increasingly search the Internet for information about health and potential treatments, but the content and accuracy of some websites are questionable. To evaluate the quality of information on maxillofacial trauma, we searched for the terms “jaw fracture” and “cheekbone fracture” on Google, Yahoo, and Bing. We assessed the first 10 results of each search and excluded duplicates or those that were unrelated. We then used the DISCERN tool and the JAMA (Journal of the American Medical Association) benchmarks to assess those that remained. Of the original 60 found, 38 were excluded (29 duplicates, 9 unrelated). The mean (range) DISCERN score for each search was 38.5 (27–57) for jaw fracture and 41.9 (26–61) for cheekbone fracture. No website achieved an excellent score (more than 63), and over three-quarters were categorised as poor (27–38) or fair (39–50). None met all the JAMA benchmarks, but most adhered to at least two. The standard of online information on maxillofacial trauma varies, but is generally of poor quality. Patients should therefore be advised to be cautious of online sources and should be directed towards higher-quality websites. [ABSTRACT FROM AUTHOR]

This paper presents the main results of a study about the influence of the web on decision-making processes of women during pregnancy. It aims to understand how search practices, peer influence and opinion sharing are carried out and specifically focusing on the decisions concerning “prenatal screening” and “type of birth”. Data was collected using a questionnaire filled by 178 Portuguese pregnant women that focused on baseline demographics, Internet use and its comparison to traditional forms of information (medical personnel and family). The results are mainly descriptive and show that, although internet information was often sought and used, face to face contact, especially with the medical doctor, is most influential in decision making. Contact with other pregnant women, relatives and friends were relevant but less influential. The main conclusions point out that currently the physician's opinion is still the primary factor in decision making. The importance of Internet data is secondary when compared to direct interaction with the physicians and care givers. [ABSTRACT FROM AUTHOR]

Background: Regular physical activity (PA) is recommended for persons with chronic obstructive pulmonary disease (COPD). Interventions that promote PA and sustain long-term adherence to PA are needed.Objective: We examined the effects of an Internet-mediated, pedometer-based walking intervention, called Taking Healthy Steps, at 12 months.Methods: Veterans with COPD (N=239) were randomized in a 2:1 ratio to the intervention or wait-list control. During the first 4 months, participants in the intervention group were instructed to wear the pedometer every day, upload daily step counts at least once a week, and were provided access to a website with four key components: individualized goal setting, iterative feedback, educational and motivational content, and an online community forum. The subsequent 8-month maintenance phase was the same except that participants no longer received new educational content. Participants randomized to the wait-list control group were instructed to wear the pedometer, but they did not receive step-count goals or instructions to increase PA. The primary outcome was health-related quality of life (HRQL) assessed by the St George's Respiratory Questionnaire Total Score (SGRQ-TS); the secondary outcome was daily step count. Linear mixed-effect models assessed the effect of intervention over time. One participant was excluded from the analysis because he was an outlier. Within the intervention group, we assessed pedometer adherence and website engagement by examining percent of days with valid step-count data, number of log-ins to the website each month, use of the online community forum, and responses to a structured survey.Results: Participants were 93.7% male (223/238) with a mean age of 67 (SD 9) years. At 12 months, there were no significant between-group differences in SGRQ-TS or daily step count. Between-group difference in daily step count was maximal and statistically significant at month 4 (P<.001), but approached zero in months 8-12. Within the intervention group, mean 76.7% (SD 29.5) of 366 days had valid step-count data, which decreased over the months of study (P<.001). Mean number of log-ins to the website each month also significantly decreased over the months of study (P<.001). The online community forum was used at least once during the study by 83.8% (129/154) of participants. Responses to questions assessing participants' goal commitment and intervention engagement were not significantly different at 12 months compared to 4 months.Conclusions: An Internet-mediated, pedometer-based PA intervention, although efficacious at 4 months, does not maintain improvements in HRQL and daily step counts at 12 months. Waning pedometer adherence and website engagement by the intervention group were observed. Future efforts should focus on improving features of PA interventions to promote long-term behavior change and sustain engagement in PA.Clinicaltrial: Clinicaltrials.gov NCT01102777; https://clinicaltrials.gov/ct2/show/NCT01102777 (Archived by WebCite at http://www.webcitation.org/6iyNP9KUC). [ABSTRACT FROM AUTHOR]

Background: Integrating stakeholder involvement in complex health intervention design maximizes acceptability and potential effectiveness. However, there is little methodological guidance about how to integrate evidence systematically from various sources in this process. Scientific evidence derived from different approaches can be difficult to integrate and the problem is compounded when attempting to include diverse, subjective input from stakeholders.Objective: The intent of the study was to describe and appraise a systematic, sequential approach to integrate scientific evidence, expert knowledge and experience, and stakeholder involvement in the co-design and development of a complex health intervention. The development of a Web-based lifestyle intervention for people in retirement is used as an example.Methods: Evidence from three systematic reviews, qualitative research findings, and expert knowledge was compiled to produce evidence statements (stage 1). Face validity of these statements was assessed by key stakeholders in a co-design workshop resulting in a set of intervention principles (stage 2). These principles were assessed for face validity in a second workshop, resulting in core intervention concepts and hand-drawn prototypes (stage 3). The outputs from stages 1-3 were translated into a design brief and specification (stage 4), which guided the building of a functioning prototype, Web-based intervention (stage 5). This prototype was de-risked resulting in an optimized functioning prototype (stage 6), which was subject to iterative testing and optimization (stage 7), prior to formal pilot evaluation.Results: The evidence statements (stage 1) highlighted the effectiveness of physical activity, dietary and social role interventions in retirement; the idiosyncratic nature of retirement and well-being; the value of using specific behavior change techniques including those derived from the Health Action Process Approach; and the need for signposting to local resources. The intervention principles (stage 2) included the need to facilitate self-reflection on available resources, personalization, and promotion of links between key lifestyle behaviors. The core concepts and hand-drawn prototypes (stage 3) had embedded in them the importance of time use and work exit planning, personalized goal setting, and acceptance of a Web-based intervention. The design brief detailed the features and modules required (stage 4), guiding the development of wireframes, module content and functionality, virtual mentors, and intervention branding (stage 5). Following an iterative process of intervention testing and optimization (stage 6), the final Web-based intervention prototype of LEAP (Living, Eating, Activity, and Planning in retirement) was produced (stage 7). The approach was resource intensive and required a multidisciplinary team. The design expert made an invaluable contribution throughout the process.Conclusions: Our sequential approach fills an important methodological gap in the literature, describing the stages and techniques useful in developing an evidence-based complex health intervention. The systematic and rigorous integration of scientific evidence, expert knowledge and experience, and stakeholder input has resulted in an intervention likely to be acceptable and feasible. [ABSTRACT FROM AUTHOR]

With the expanding availability of Internet capabilities in the recent two decades, many Americans have used these services to search about medical information for multiple purposes. Americans are using the Internet for acquiring information and alternate treatments regarding their health care issues; including the selection of a physician based off of online physician ratings. Many questions derive from societal changes that come about when technology advances such as the development of the Internet. Medical sociologists have a long history of concentrating on the doctor-patient relationship. This study focuses on the determinations that influence the trust between the patient and their doctor. Millions of people now have access to the World Wide Web, allowing medical advice to be just a click away. A closed-ended questionnaire on the above topics was administered at the end of 2014 to a random sample size of 240 people. The age of the participants were 18 years and older and they resided in the Greater Cincinnati area during the time of data collection. The purpose of the questionnaire was to examine data from various age groups and study those respondents' attitudes concerning any changes in the trust between patients and their physicians due to technological advancements. The results of the study revealed that the respondents continue to retain a high level of trust with their physicians and still prefer face-to-face consultations. This is even though they have access to massive amounts of information right at their fingertips. The respondents also showed high levels of maturity and rationality when using online medical information in their decision-making regarding their healthcare needs and choices. [ABSTRACT FROM AUTHOR]

The main aim of study was to identify the primary source of health information seeking among high school students and the characteristics of quality consumer health information from their perspective. A cross sectional descriptive survey was used to conduct the study utilizing a valid questionnaire. The first source of health information seeking for most of the high school student (79%) was the Internet rather than books, journals or family members. Majority of boys (87%) go to the Internet for pathology and definition of diseases, but the girls (82%) usually search for life style, exercise, nutrition, mental health, maturity and then general health information such as physiology, anatomy, and calculations. All of the student recognize content accuracy, and believe that involvements of information specialists in management of websites may guarantee the quality criteria of website. It is concluded that development of a quality consumer health information website is essential to meet the health information needs of students and promotion of health literacy among high school students and adolescents in Iran. [ABSTRACT FROM AUTHOR]

Scientific advances in medicine and related fields demand an informed and participating public. However many established venues for public communication, such as the internet or news talk shows, become conflicted in their messaging, inserting doubt about the very processes of scientific progress and discovery. Museums have managed to rise above such conflicts, vetting discussion to provide an unbiased, safe, and balanced platform to facilitate the public's understanding of issues, paving a road to policy debate and decision. [ABSTRACT FROM PUBLISHER]

The internet is frequently used by patients for researching information regarding breast cancer. This study aims to assess the quality of these websites using validated tools. The term 'breast cancer' was searched for in 3 search engines. The top 20 results were selected, and duplicates and irrelevant websites were excluded. 26/34 websites were analysed using the DISCERN Plus tool, HONcode and the JAMA benchmarks. 46% of the websites were classed as ‘excellent’ when assessed with the DISCERN tool. The range of DISCERN scores was wide (range: 25–74). Nine websites were found to be HONcode certified. Seven websites complied with all four JAMA benchmarks. This study shows the quality of breast cancer information on the internet is on the whole good; however the range of quality is wide. We recommend healthcare professionals use all 3 tools together to establish which websites are best to advise which websites patients should trust. [ABSTRACT FROM AUTHOR]

The development of online counseling services has followed the advent on information and communication technologies. The present study assessed mental health professionals' perspectives of online counseling by using an extended version of the technology acceptance model. Participants completed anonymous structured questionnaires assessing technology acceptance-related variables, including perceived usefulness and ease of use, usage intentions, job relevance, social norms, attitudes, computer anxiety, and past experience with online counseling. Linear regression and mediation analyses respectively showed that the model predicted 72.9% of usage intentions, and that perceived usefulness significantly predicted usage intentions and mediated the effect of perceived relevance. Interventions to promote online counseling should consider educating counselors and mental health professionals about the relevance and the expected benefits of online counseling to counseling practice. [ABSTRACT FROM AUTHOR]

eHealth initiatives are constantly evolving, supporting consumers to take active control of their health and well-being through access to health information via the Internet. Although particularly elderly people could benefit from eHealth, they often pose resistance and anxiety towards new technologies. Since modern technologies become increasingly complex, elderly's mental models on how technology works might be not supported. Today's technologies are often designed without paying attention to the circumstances of elderly people, thereby limiting the technologies’ intended effectiveness. As such it becomes apparent to understand who these ‘elderly people’ actually are and how individual characteristics shape elderly's perceptions and behavior in using eHealth. Consequently, we seek to investigate how broad personality traits (i.e. the ‘big five’) affect perceptions of elderly of being generally able to use the Internet (i.e. self-efficacy) in order to use the Internet for health-related purposes. By conducting a quantitative study among elderly people, we aim to contribute to the knowledge on relationships between personality traits and self-efficacy. We further expect to provide new insights on elderly's personality in order to design effective systems for the growing segment of older adults. [ABSTRACT FROM AUTHOR]

This paper examines the home monitoring system used in our Department of Cardiology in the Future Internet Social Technological Alignment in Healthcare (FISTAR) project - a project focused on secondary prevention in cardiology (www.fi-star.eu). The system used is composed of bluetooth capable medical devices that collect vital parameters though CardioStar application (an application that was developed in collaboration with computer engineers. The collected data are transmitted in real time to a central server in our hospital, where there is a continuous supervision of the parameters. We evaluated this system in order to prove its use in reducing the cardiovascular risk and increasing the adherence to the life-style changes. This paper presents the analysis of the MAST (Model for Assessment of Telemedicine) evaluation - which is the best way of evaluation for the telemedicine solutions - from the professional point of view. The questionnaires of evaluation were performed anonymous on a online platform. The application passed successfully the MAST evaluation, demonstrating that the developed telemedicine system designed for our cardiac patients fulfills its purpose in the secondary prevention. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the effect of dental crowding and lip protrusion on self-esteem and quality of life (QOL) in female orthodontic patients with Class I malocclusion. Materials and Methods: The study sample consisted of 201 patients (mean age 22.6 ± 3.0 years) who sought orthodontic treatment. All the patients were evaluated before treatment in terms of their degree of dental crowding and lip protrusion. Rosenberg's Self-Esteem Scale and the Orthognathic Quality of Life Questionnaire (OQLQ) were used to determine self-esteem and QOL and to evaluate whether these values were related to malocclusion severity. Results: The results indicated that severe crowding and severe protrusion can result in lower self-esteem and poorer QOL (P < .05) than mild crowding and protrusion in Class I malocclusion. In the oral function component of the OQLQ, the severity of protrusion did not have significant effect. Conclusions: In Class I malocclusion, patients with mild crowding or protrusion had significantly better self-esteem and QOL scores than severe crowding or protrusion patients. [ABSTRACT FROM AUTHOR]

The effectiveness of both emergency services and response planning functions in humanitarian response and public health crises are significantly enhanced by the availability of location services in mobile networks. Here we describe how eHealth Africa and Netfuse Telecom are working together to use mobile network location services to improve the operational effectiveness of the 117 Ebola response call centre and support decision making and resource allocation at the National Ebola Response Centre, which is coordinating the response to the Ebola epidemic in Sierra Leone. [ABSTRACT FROM AUTHOR]

Objective: To characterize the literature on social media applications used to deliver patient care. Data Sources: A search of the literature was conducted on June 11, 2014, using PubMed, MEDLINE, CINAHL, and Communication Abstracts databases for clinical studies between 2004 and 2014. A combination of the search terms "social media" or "Web 2.0" or "online social networking" or "Facebook" or "Twitter" AND "patient care" or "health care" was used. In addition, 42 additional abstracts were retrieved from www.patientslikeme. com for review. Study selection: Only published, peer-reviewed journal articles were considered and only publications in English were included. The abstracts from this search were reviewed for relevance to Web-based social media platforms being used in patient care activities. Data synthesis: A total of 35 articles were included in the review. A majority of the studies published on social media and patient care used cross-sectional designs and were conducted in the United States. Multiple social media applications were studied, but Facebook was the predominant social media tool found. Pa bent care opportunities for various diseases with social media have been studied. Recurring themes included overcoming barriers, engaging and empowering patients, enhancing research, providing information for health promotion, scratching the surface, and potential pitfalls. Conclusion: Social media have the potential to help patients and practitioners overcome multiple barriers in the delivery of health care. Maintaining patient privacy, security of information shared in the platform, and integrity of information shared are all concerns when using this type of Web application. [ABSTRACT FROM AUTHOR]

Objective: To date, no research has evaluated the efficacy of a stand-alone, smartphone-based intervention for individuals with an alcohol use disorder. The current pilot study evaluated the short-term outcomes of a smartphone-based intervention for alcohol use disorders compared with an Internet-based brief motivational intervention plus bibliotherapy. Method: Adults (IB to 45 years old) with an alcohol use disorder received either the Location-Based Monitoring and Intervention for Alcohol Use Disorders (LBMI-A; n = 28), a smartphone-based intervention, or the online Drinker's Check-up plus bibliotherapy (DCU + bib; n = 26). These groups were compared using the Timeline Followback interview for percent days abstinent (PDA), percent heavy drinking days (PHDD), and drinks per week (DPW) from baseline to 6 weeks after the introduction of the interventions. Results: Multilevel models revealed that the LBMI-A resulted in a significant increase in PDA over the course of the study, whereas the DCU + bib did not. Effect sizes for change from baseline for PDA suggest that the DCU + bib resulted in moderate a decrease, whereas the LBMI-A resulted in a large increase in PDA. Both interventions resulted in significant decreases in PHDD and DPW. The LBMI-A produced larger reductions in the first 3 to 4 weeks after the intervention was introduced than the DCU + bib. On weeks with greater LBMI-A usage, participants reported less DPW and PHDD. Conclusions: Both interventions resulted in significant decreases in alcohol use over the 6-week trial, which is promising for stand-alone technology-based intervention systems aimed at individuals with an alcohol use disorder. [ABSTRACT FROM AUTHOR]

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Objective: To examine the benefit of adding an Internet-delivered behavior therapy to a buprenorphine medication program and voucher-based motivational incentives. Method: A block-randomized, unblinded, parallel, 12-week treatment trial was conducted with 170 opioid-dependent adult patients (mean age = 34.3 years; 54.1% male; 95.3% White). Participants received an Internet-based community reinforcement approach intervention plus contingency management (CRA+) and buprenorphine or contingency management alone (CM-alone) plus buprenorphine. The primary outcomes, measured over the course of treatment, were longest continuous abstinence, total abstinence, and days retained in treatment. Results: Compared to those receiving CM-alone, CRA+ recipients exhibited, on average, 9.7 total days more of abstinence (95% confidence interval [CI = 2.3, 17.2]) and had a reduced hazard of dropping out of treatment (hazard ratio = 0.47; 95% CI [0.26, 0.85]). Prior treatment for opioid dependence significantly moderated the additional improvement of CRA+ for longest continuous days of abstinence. Conclusions: These results provide further evidence that an Internet-based CRA+ treatment is efficacious and adds clinical benefits to a contingency management/medication based program for opioid dependence. [ABSTRACT FROM AUTHOR]

Summary Background Internet-based interventions for smoking cessation could help millions of people stop smoking at very low unit costs; however, long-term biochemically verified evidence is scarce and such interventions might be less effective for smokers with low socioeconomic status than for those with high status because of lower online literacy to engage with websites. We aimed to assess a new interactive internet-based intervention (StopAdvisor) for smoking cessation that was designed with particular attention directed to people with low socioeconomic status. Methods We did this online randomised controlled trial between Dec 6, 2011, and Oct 11, 2013, in the UK. Participants aged 18 years and older who smoked every day were randomly assigned (1:1) to receive treatment with StopAdvisor or an information-only website. Randomisation was automated with an unseen random number function embedded in the website to establish which treatment was revealed after the online baseline assessment. Recruitment continued until the required sample size had been achieved from both high and low socioeconomic status subpopulations. Participants, and researchers who obtained data and did laboratory analyses, were masked to treatment allocation. The primary outcome was 6 month sustained, biochemically verified abstinence. The main secondary outcome was 6 month, 7 day biochemically verified point prevalence. Analysis was by intention to treat. Homogeneity of intervention effect across the socioeconomic subsamples was first assessed to establish whether overall or separate subsample analyses were appropriate. The study is registered as an International Standard Randomised Controlled Trial, number ISRCTN99820519. Findings We randomly assigned 4613 participants to the StopAdvisor group (n=2321) or the control group (n=2292); 2142 participants were of low socioeconomic status and 2471 participants were of high status. The overall rate of smoking cessation was similar between participants in the StopAdvisor and control groups for the primary (237 [10%] vs 220 [10%] participants; relative risk [RR] 1·06, 95% CI 0·89–1·27; p=0·49) and the secondary (358 [15%] vs 332 [15%] participants; 1·06, 0·93–1·22; p=0·37) outcomes; however, the intervention effect differed across socioeconomic status subsamples (1·44, 0·99–2·09; p=0·0562 and 1·37, 1·02–1·84; p=0·0360, respectively). StopAdvisor helped participants with low socioeconomic status stop smoking compared with the information-only website (primary outcome: 90 [8%] of 1088 vs 64 [6%] of 1054 participants; RR 1·36, 95% CI 1·00–1·86; p=0·0499; secondary outcome: 136 [13%] vs 100 [10%] participants; 1·32, 1·03–1·68, p=0·0267), but did not improve cessation rates in those with high socioeconomic status (147 [12%] of 1233 vs 156 [13%] of 1238 participants; 0·95, 0·77–1·17; p=0·61 and 222 [18%] vs 232 [19%] participants; 0·96, 0·81–1·13, p=0·64, respectively). Interpretation StopAdvisor was more effective than an information-only website in smokers of low, but not high, socioeconomic status. StopAdvisor could be implemented easily and made freely available, which would probably improve the success rates of smokers with low socioeconomic status who are seeking online support. Funding National Prevention Research Initiative. [ABSTRACT FROM AUTHOR]

The success of clinical decision-making depends on providing the right information at the right time to key clinicians such as physicians. The Internet has tremendously enabled medical information provision for clinical decision-making. However, key factors that influence the use of the Internet for medical information provisioning are not widely known. This research synthesizes the clinical and general decision-making, and information processing literature streams to build a research model and empirically validate the moderating role of uncertainty and equivocality in the use of the Internet for provisioning information for clinical decision-making. [ABSTRACT FROM AUTHOR]

Abstract: Breast cancer patient's expectation and choice of reconstruction is increasing and patients often satisfy their information needs outside clinic time by searching the world wide web. The aim of our study was to analyse the quality of content and extent of information regarding breast reconstruction available on YouTube videos and whether this is an appropriate additional source of information for patients. A snapshot qualitative and quantitative analysis of the first 100 videos was performed after the term ‘breast reconstruction’ was input into the search window of the video sharing website www.youtube.com on the 1st of September 2011. Qualitative categorical analysis included patient, oncological and reconstruction factors. It was concluded that although videos uploaded onto YouTube do not provide comprehensive information, it is a useful resource that can be utilised in patient education provided comprehensive and validated videos are made available. [Copyright &y& Elsevier]

Objective: College represents a window of opportunity to reach the sizeable number of cigarette smokers who are vulnerable to lifelong smoking. The underutilization of typical cessation programs suggests the need for novel and more engaging approaches for reaching college smokers. The aim of the present study was to test the efficacy of a dissonance-enhancing, Web-based experiential intervention for increasing smoking cessation motivation and behavior. Method: We used a 4-arm, randomized design to examine the efficacy of a Web-based, experiential smoking intervention (Web-Smoke). The control conditions included a didactic smoking intervention (Didactic), a group-based experiential intervention (Group), and a Web-based nutrition experiential intervention (Web-Nutrition). We recruited 341 college smokers. Primary outcomes were motivation to quit, assessed immediately postintervention, and smoking abstinence at 1 and 6 months following the intervention. Results: As hypothesized, the Web-Smoke intervention was more effective than control groups in increasing motivation to quit. At 6-month follow-up, the Web-Smoke intervention produced higher rates of smoking cessation than the Web-Nutrition control intervention. Daily smoking moderated intervention outcomes. Among daily smokers, the Web-Smoke intervention produced greater abstinence rates than both the Web-Nutrition and Didactic control conditions. Conclusion: Findings demonstrate the efficacy of a theory-based intervention delivered over the Internet for increasing motivation to quit and smoking abstinence among college smokers. The intervention has potential for translation and implementation as a secondary prevention strategy for college-aged smokers. [ABSTRACT FROM AUTHOR]

Objective: Computerized cognitive-bias modification (CBM) protocols are rapidly evolving in experimental medicine yet might best be combined with Internet-based cognitive behavioral therapy (iCBT). No research to date has evaluated the combined approach in depression. The current randomized controlled trial aimed to evaluate both the independent effects of a CBM protocol targeting imagery and interpretation bias (CBM-I) and the combined effects of CBM-I followed by iCBT. Method: Patients diagnosed with a major depressive episode were randomized to an 11-week intervention (1 week/CBM-I + 10 weeks/iCBT; n = 38) that was delivered via the Internet with no face-to-face patient contact or to a wait-list control (WLC; n = 31). Results: Intent-to-treat marginal models using restricted maximum likelihood estimation demonstrated significant reductions in primary measures of depressive symptoms and distress corresponding to medium-large effect sizes (Cohen's d = 0.62-2.40) following CBM-I and the combined (CBM-I + iCBT) intervention. Analyses demonstrated that the change in interpretation bias at least partially mediated the reduction in depression symptoms following CBM-I. Treatment superiority over the WLC was also evident on all outcome measures at both time points (Hedges gs = .59-.98). Significant reductions were also observed following the combined intervention on secondary measures associated with depression: disability, anxiety, and repetitive negative thinking (Cohen's d = 1.51-2.23). Twenty-seven percent of patients evidenced clinically significant change following CBM-I, and this proportion increased to 65% following the combined intervention. Conclusions: The current study provides encouraging results of the integration of Internet-based technologies into an efficacious and acceptable form of treatment delivery. [ABSTRACT FROM AUTHOR]

With the Internet facilitating access to vast amounts of free information, dental practitioners face providing treatment for an increasingly informed public. However, the available content is not filtered, and it can be difficult for patients to discriminate between research-informed evidence and "glamorised" material of dubious origin. Patients reasonably expect a return for their investment and want to know how long their treatment will last. Clinicians have an obligation to inform their patients so that they can make reasoned decisions about treatment options. Longevity data are also informative for health agencies setting service schedules for publicly funded treatment, and for determining settlements by insurers such as ACC. Historically, much of the prosthodontic treatment performed in practice has relied heavily on dogma, low-level anecdotal evidence, and clinical case reports. This paper considers the literature on fixed and removable prosthodontic restorations and provides a critical review which can be used practically as the basis for informing patients, and to assist decision-makers in making fair and appropriate judgements. [ABSTRACT FROM AUTHOR]

Introduction. Tissue engineering and biomaterials science currently offer the technology needed to replace the urinary tract wall. This review addresses current achievements and barriers for the regeneration of the urinary blad- der based on tissue engineering methods. Materials and methods. Medline was search for urinary bladder tissue engineering regenerative medicine and stem cells. Results. Numerous studies to develop a substitute for the native urinary bladder wall us- ing the tissue engineering approach are ongoing. Stem cells combined with biomaterials open new treatment methods, including even de novo urinary bladder construction. However, there are still many issues before advances in tissue engineering can be introduced for clinical application. Conclusions. Before tissue engineering techniques could be recognize as effective and safe for patients, more research stud- ies performed on large animal models and with long follow-up are needed to carry on in the future. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: Many patients and their parents utilize the Internet for health-related information, but quality is largely uncontrolled and unregulated. The Health on the Net Foundation Code (HONcode) and DISCERN Plus were used to evaluate the pediatric urological search terms ‘circumcision,’ ‘vesicoureteral reflux’ and ‘posterior urethral valves’. Materials and methods: A google.com search was performed to identify the top 20 websites for each term. The HONcode toolbar was utilized to determine whether each website was HONcode accredited and report the overall frequency of accreditation for each term. The DISCERN Plus instrument was used to score each website in accordance with the DISCERN Handbook. High and low scoring criteria were then compared. Results: A total of 60 websites were identified. For the search terms ‘circumcision’, ‘posterior urethral valves’ and ‘vesicoureteral reflux’, 25–30% of the websites were HONcode certified. Out of the maximum score of 80, the average DISCERN Plus score was 60 (SD = 12, range 38–78), 40 (SD = 12, range 22–69) and 45 (SD = 19, range 16–78), respectively. The lowest scoring DISCERN criteria included: ‘Does it describe how the treatment choices affect overall quality of life?’, ‘Does it describe the risks of each treatment?’ and ‘Does it provide details of additional sources of support and information?’ (1.35, 1.83 and 1.95 out of 5, respectively). Conclusions: These findings demonstrate the poor quality of information that patients and their parents may use in decision-making and treatment choices. The two lowest scoring DISCERN Plus criteria involved education on quality of life issues and risks of treatment. Physicians should know how to best use these tools to help guide patients and their parents to websites with valid information. [Copyright &y& Elsevier]

Telecommunications technology is making its way into operating rooms by new developments in e-health. However, conflicts arise with existing legal principles regarding data protection. This paper deals with key elements of the interactions between data protection and evolution in e-health. The scope will be the digital operating room, where different health services and activities converge through networked technology, raising a number of privacy-related issues. For instance, the patient's health records and tools for recording surgical procedures could be integrated within the same platform, potentially leading to sensitive personal data linkage. Also the possible duration and reason of storage of surgical recordings, is a matter that remains largely unresolved in current practice. First, this paper will analyze the data exchanges of the digital operating room. As these will include personal patient data, it must be assessed whether and how the European framework on data protection can apply. Second, the regulatory regime of the manufacturers of the devices of the digital operating room will be analyzed. Can the current legal framework relating to e-health provide for suitable regulation for such devices? Drawing from experience gained in research projects, this paper aims to provide practical answers to often theoretical questions. [ABSTRACT FROM AUTHOR]

Abstract: Objective: Breast cancer is the cancer most commonly searched for on the internet. Our aim was to assess daily new breast cancer related posting on the internet. Methods: We analyzed numbers of new daily posts for common cancers for one month and subsequently analyzed content of 1426 breast cancer related posts. We also assessed use of online discussion forums for breast cancer related dialogue. Results: Breast related topics had significantly more posts per day compared to others (mean 66.7, p < 0.01). Most posts were on media sites (65.8%). Accuracy levels were high (87.5%) but significantly lower where posted on blogs and discussion forums (p < 0.001). Anonymous posts were common (55%) and less likely to be accurate (p < 0.001). Use of discussion forums has exponentially increased over the last five years (p < 0.001). Conclusions: The internet has become a primary forum within which health information, particularly relating to breast cancer, is both sought and shared. Increasingly information is provided by patients themselves. [Copyright &y& Elsevier]

The article evaluates the therapy options for patients with stress urinary incontinence (SUI) using a Medline search. Findings revealed that midurethral slings (MUS) and open colposuspension have better results than a conservative treatment approach of SUI. Between the two, MUS showed better subjective and objective cure rates. The researchers add that it is less invasive and more cost-effective. Open colposuspension, on the other hand, has been an effective treatment possibility for recurrent stress urinary incontinence after failed MU.