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BackgroundMethodsResultsConclusionTechnological advancement has added new dimensions to the communication between physicians and their patients in healthcare settings worldwide. This study aimed to measure patients’ views about physicians’ interpersonal communication during telemedicine consultations by cultural adaptation and validation of the communication assessment tool (CAT) in Bangladesh.A cross-sectional phone survey was conducted among 400 patients who received healthcare services from a telemedicine centre in Bangladesh. Both exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were performed to test the dimensionality of the CAT-Bangla scale. The goodness of fit of the CFA was assessed using the comparative fit index (CFI), Tucker–Lewis index (TLI), Chi-square values, root-mean-square error of approximation (RMSEA) and standardized root mean squared residual (SRMR). The internal consistency reliability of the CAT-Bangla scale was assessed using Cronbach's alpha.Factor analysis findings suggest that the CAT-Bangla scale is unidimensional with good internal consistency (Cronbach's α = 0.876). The individual item analysis findings suggest that most of the patients felt that the physicians treated them with respect (81% rated ‘excellent’) and allowed them to talk without interruption (73.5% rated ‘excellent’). Overall, the level of satisfaction among patients regarding physicians’ communication skills was high with a mean score of 4.36 (SD = 0.30) across all the 14 items. However, the patients were not satisfied with the amount of time that physicians spent with them as none of them reported ‘excellent’ in that domain.The CAT-Bangla scale is feasible, valid, and internally consistent for measuring physicians’ communication skills in the telemedicine environment. This study can contribute to policymakers regarding the integration of learning communication skills of future physicians to competently deliver healthcare in the telemedicine environment. It would also help to understand various aspects of doctor-patient communication in a telemedicine context. [ABSTRACT FROM AUTHOR]

Objective: Digital technology has become increasingly relevant in physiotherapy, but little is known about communication and interaction in video-based physiotherapy. Therefore, this study aimed to explore the experiences among patients and physiotherapists, of communication and interaction in digital, video-based physiotherapy. Methods: A qualitative interview study with a phenomenological approach was conducted. Participants were purposively recruited from primary health care clinics. Semi-structured, in-depth interviews were conducted with 10 physiotherapists and 6 patients. Interviews were recorded, transcribed, and analyzed using a phenomenological approach. Results: The analysis resulted in the overall theme Reaching for connection, which captured the central meaning of the participants' experiences. Four categories emerged from the analysis: 1) Closeness at a distance; 2) Overcoming limited bodily communication; 3) The technology as part of the meeting; and 4) Challenging the physical meeting as a norm. The results suggest that communication and interaction in digital settings differ from physical settings, but there is an ongoing adaptation process to this new paradigm. Conclusions: The results of this study show that video-based physiotherapy, while having several benefits according to both patients and physiotherapists, affects the communication in several ways. Physiotherapists need to acknowledge these limitations and seek strategies to adapt and to compensate for the reduced non-verbal elements and lack of touch. Attention to the physical room and shifting between positions (face/full figure) are suggested practical strategies, but also to practice awareness and embodied communication to improve receptivity in the interaction. [ABSTRACT FROM AUTHOR]

AbstractBackgroundAimsMethodsResultsConclusionDepression is a very common disorder and comorbidity. Primary care providers are the first medical contacts to diagnose and treat depression. Video calls are emerging communication tools to deliver psychological interventions.To examine the effectiveness of videocall delivered psychological interventions to treat depressive symptoms in adult patients in primary care, as well as a systematic assessment of implementation factors.We conducted a systematic literature search in PubMed Central, Embase, PsycInfo, Cochrane Library and the WHO COVID-19 database and included randomized controlled trials only. Two authors screened the studies and assessed the risk of bias independently (Cochrane RoB tool). We followed the PRISMA guidelines. The study protocol was published in PROSPERO (CRD42022295238). The results were synthesized narratively.Of 6.971 identified studies, we included six publications. Studies powered to detect clinically significant changes in primary outcomes, identified video calls to be effective for delivering complex psychological interventions in an integrated primary care setting.Further research is needed to consolidate the findings on a larger scale and evaluate the effectiveness in comparison with alternatives such as telephone-delivered care. Results are promising and indicate the need for replication in larger studies as well as different health care settings. [ABSTRACT FROM AUTHOR]

AbstractAimMethodsResultsConclusionWe aimed to describe telehealth used to detect infants at risk of neurodevelopmental delay and assess the assessors’ and caregivers’ perceptions and costs.This was an observational study in which five physical therapists applied the General Movement Assessment, the neurological exam based on the Hammersmith Infant Neurological Examination, and the Alberta Infant Motor Scale via telehealth in 65 infants at risk of neurologic delay during the COVID-19 pandemic. The perceptions of assessors and caregivers were assessed using a questionnaire. We tabulated the family’s costs (internet access) and the therapist’s expenses (internet access and professional fees).In general, assessors felt comfortable and reported good quality of teleassessment. They highlighted the significant effort they and caregivers required for synchronous methods, challenges in clearly guiding caregivers on infant positioning, difficulties in adjusting the camera’s position, and unstable internet connections. Most assessors expressed a willingness to continue using telehealth. Caregivers displayed high satisfaction, and the costs were minimal.Teleassessment during the COVID-19 pandemic was feasible, although implementing this method of health service in general clinical practice still requires further scrutiny. [ABSTRACT FROM AUTHOR]

Background: Substance use amongst young people poses developmental and clinical challenges, necessitating early detection and treatment. Considering the widespread use of technology in young people, delivering interventions digitally may help to reduce and monitor their substance use. Aims: We conducted a systematic review and two meta-analyses to assess the effectiveness of digital interventions for reducing substance use (alcohol, smoking, and other substances) among young people aged 10 to 24 years old. Method: Embase, Global Health, Medline, PsychINFO, Web of Science and reference lists of relevant papers were searched in November 2020. Studies were included if they quantitatively evaluated the effectiveness of digital health technologies for treating substance use. A narrative synthesis and meta-analysis were conducted. Results: Forty-two studies were included in the systematic review and 18 in the meta-analyses. Digital interventions showed small, but statistically significant reductions in weekly alcohol consumption compared to controls (SMD= −0.12, 95% CI= −0.17 to −0.06, I2=0%), but no overall effect was seen on 30-day smoking abstinence (OR = 1.12, 95% CI = 0.70 to 1.80, I2=81%). The effectiveness of digital interventions for reducing substance use is generally weak, however, promising results such as reducing alcohol use were seen. Large-scale studies should investigate the viability of digital interventions, collect user feedback, and determine cost-effectiveness. Prisma/Prospero: This systematic review was conducted following Cochrane methodology PRISMA guidelines. The review was registered with PROSPERO in November 2020 (CRD42020218442). [ABSTRACT FROM AUTHOR]

Purpose: The aim of this qualitative study was to utilise the recent Theoretical Framework of Acceptability (TFA) to explore participants' acceptability of the mindfulness and exercise interventions in the MOVE-Online pain management programme (PMP) and the programmes' online delivery method. Methods: Online focus groups were carried out following the completion of the PMP. The data were analysed using template analysis in terms of the seven TFA constructs of acceptability [(i) Perceived Effectiveness, (ii) Affective Attitude, (iii) Self-Efficacy, (iv) Ethicality, (v) Burden, (vi) Opportunity Costs and (vii) Intervention Coherence]. Results: Twenty-one participants took part in the focus groups. Five of the seven TFA constructs of acceptability were identified in the analysis. The participants perceived the intervention to have been effective at achieving the goals of the PMP (TFA construct: (i) Perceived Effectiveness), to have supported their emotional management ((ii) Affective Attitude), promoted long term self-directed engagement ((iii) Self-Efficacy), fostered a valued group environment ((iv) Ethicality) and the online delivery of the programme reduced the physical burden associated with participation at an in-person PMP ((v) Burden). Conclusion: The results of the study supports the utility of the TFA as a tool to explore the multi-dimensional construct of acceptability for the participants in the MOVE-Online programme. IMPLICATIONS FOR REHABILITATION: This investigation contributes to the understanding of acceptability as a complex multidimensional construct and emphasises the importance of considering the multiple dimensions when evaluating participants interpretations of novel complex interventions. Results suggest that participants found a pain management programme delivered in a live, online, interactive format to be acceptable, and it may be useful for rehabilitation professionals as an option for chronic pain management. [ABSTRACT FROM AUTHOR]

AbstractPurposeMethodsResultsConclusions\nIMPLICATIONS FOR REHABILITATIONIn the BigMove intervention, people with physical and mental health conditions assess their functioning, set goals, and define action plans to achieve their goals recorded in an e-health application using all categories of the International Classification of Functioning, Disability, and Health (ICF). This study investigates whether data from this application can provide insight into participants’ self-perceived functioning, goals and action plans and observe changes over time.Data from 446 participants were analysed with descriptive statistics to describe self-perceived functioning and the ICF categories related to the 15 most frequently chosen goals. Action plans were analysed using inductive analysis. Changes over time were investigated by comparing assessments before and after at least 4 months in the intervention.The data provided insight into the self-perceived functioning, goals and action plans. Also, changes over time were observed. Self-perceived functioning changed from being mainly negative before, to mainly positive after the intervention. While goals were mostly related to the same ICF categories, the action plans changed from more specific short-term to more general long-term plans.Our study demonstrates that all categories of the ICF can be used to record self-perceived functioning, goals and action plans and monitor changes over time.The complete International Classification of Functioning, Disability, and Health (ICF) can provide a useful tool to record self-perceived functioning, goals, and action plans.Setting goals by using all ICF categories shows what is relevant to people themselves and can stimulate activities that foster functioning according to what people value.Assessments of self-perceived functioning, related goals, and action plans offer a novel approach to assessing health and comparing healthcare outcomes.The complete International Classification of Functioning, Disability, and Health (ICF) can provide a useful tool to record self-perceived functioning, goals, and action plans.Setting goals by using all ICF categories shows what is relevant to people themselves and can stimulate activities that foster functioning according to what people value.Assessments of self-perceived functioning, related goals, and action plans offer a novel approach to assessing health and comparing healthcare outcomes. [ABSTRACT FROM AUTHOR]

Abstract\nIMPLICATIONS FOR REHABILITATIONObjectives: Digital interventions can offer accessible and scalable treatment for chronic conditions, though often focus separately on physical or mental health. People accessing digital health services may live with multiple conditions or experience overlapping symptoms. This study aimed to describe the breadth and characteristics of chronic health conditions and self-reported disability among routine users of a digital mental health service, and to examine related motivations to engage with digital mental health interventions.Methods: A cross-sectional survey of adults registered with a digital mental health service in the Australian community (THIS WAY UP) was conducted. Participant demography, chronic health conditions, self-reported disability and motivations for accessing digital treatment were collected and analyzed descriptively.Results: 366 participants responded (77% female, mean age 50 ± 15 years). 71.6% of participants (242/338) reported ≥1 chronic health condition and one-third reported multimorbidity (112/338, 33.1%). Chronic pain, musculoskeletal and connective tissue disorders were most common. 26.9% of respondents (90/334) reported a disability, most commonly physical disabilities. 95% of those with chronic conditions reported negative mental health effects and 46% reported heightened interest in digital mental health treatments because of their condition. Primary motivations for digital service use were receiving a recommendation from a health professional and service accessibility.Discussion: People who access digital mental health services in routine care report high rates of heterogenous chronic illness and related disability. There is interest in accessible digital treatments to support mental health at scale among people who live with varied chronic conditions and disabilities.Heterogenous chronic health conditions and disability are prevalent among people who engage with digital mental health interventions in the community.Approximately three-quarters of people (72%) who access digital mental health interventions have at least one chronic condition, and approx. one quarter (27%) have a disability.The accessibility of digital mental health treatments appealed to people with chronic conditions and/or disabilities.Digital mental health services may have a role to play in supporting mental health and wellbeing at scale among people with varied, disabling chronic conditions.Heterogenous chronic health conditions and disability are prevalent among people who engage with digital mental health interventions in the community.Approximately three-quarters of people (72%) who access digital mental health interventions have at least one chronic condition, and approx. one quarter (27%) have a disability.The accessibility of digital mental health treatments appealed to people with chronic conditions and/or disabilities.Digital mental health services may have a role to play in supporting mental health and wellbeing at scale among people with varied, disabling chronic conditions. [ABSTRACT FROM AUTHOR]

IntroductionObjectiveMethodResultsConclusionDigital options for osteoarthritis (OA) treatment are increasingly available with high patient satisfaction and acceptability. Little is, however, known about physical therapists’ (PT) perception of this treatment modality.To investigate PT’s experience of delivering digital treatment for hip and knee OA using a smart-phone application.Nine PTs (mean age 36 years, women n = 5) with 3–24 months experience of delivering digital OA treatment were interviewed using a semi-structured interview guide. The interviews were transcribed verbatim and analyzed using content analysis.Four main categories arose; 1) A feeling of being part of the future, 2) Making an osteoarthritis diagnosis in a digital setting, 3) Facilitators and barriers of digital OA management and 4) Where to go from here? PTs were in general positive for digital treatment delivery but felt that a lack of visual assessments and physical examinations to enhance exercise evaluations and diagnosis accuracy was sometimes a disadvantage.Digital treatment delivery was in general perceived as a time-efficient way of providing high-quality care that may increase patient motivation and adherence without violating the therapeutic alliance. Future implementations of digital OA treatment programs should consider the possibility of including real-time video calls for visual assessment. [ABSTRACT FROM AUTHOR]

Healthy ageing is a global priority due to a growing older population, which increases the need for preventive measures and tailored technology. In health technology development, co-design is emphasised as a valuable strategy to support a person-centred approach. Co-design, a value-driven and collaborative approach, involves end users in development processes to overcome barriers connected to capability, opportunity, and motivation. While a growing number of older adults are involved in design processes, there is a deficit of suitable methodologies for achieving active involvement. Additionally, the COVID-19 pandemic necessitated a shift to developing methodological skills and tools to facilitate co-design remotely in a digital setting. Here, we draw on experiences of conducting iterative co-design workshops with a Canadian and a Swedish cohort of older adults about technology development to support mobility, balance, and confidence in daily movement. We describe and discuss methodological and ethical challenges and opportunities to provide recommendations for conducting co-design research in a digital setting with older adults (+65 years). Our recommendations include the use of live mind mapping to facilitate participation involvement, and we address the issue of ‘homework’ in co-design and the importance of setting expectations. [ABSTRACT FROM AUTHOR]

AbstractBackgroundAimsMethodsResultsConclusionsUniversity students with a family history of mental illness may have an increased risk of developing mental health problems.The aim of the study was to assess differences in mental health help seeking among students with a family history of mental illness compared to those without a family history.A total of 1127 university students, aged 18 to 30 years, completed an online survey with questions about mental illness, family history of mental illness, help seeking, and psychological symptoms.Students with a family history of mental illness were more likely to report clinically significant symptoms and more likely to use social media and online support programs. They reported similar rates of in-person help seeking. Those with more than one family member with a mental illness reported greater symptom severity, more use of online programs, and increased likelihood of prescription drug use than those with only one family member.More research is needed to understand how to increase access to mental health care and to address barriers to help-seeking considering family history of mental illness. University students may not be accessing appropriate treatment and care as required, with the rates of in-person help-seeking being low overall. [ABSTRACT FROM AUTHOR]

We present a systematic literature review of dialogue agents for Artificial Intelligence (AI) and agent-based conversational systems dealing with cognitive disability of aged and impaired people including dementia and Parkinson's disease. We analyze current applications, gaps, and challenges in the existing research body, and provide guidelines and recommendations for their future development and use. We perform this study by applying Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria. We performed a systematic search using relevant databases (ACM Digital Library, Google Scholar, IEEE Xplore, PubMed, and Scopus). This study identified 468 articles on the use of conversational agents in healthcare. We finally selected 124 articles based on their objectives and content as directly related to our main topic. We identified the main challenges in the field and analyzed the typical examples of the application of conversational agents in the healthcare domain, the desired characteristics of conversational agents, and chatbot support for aged people and people with cognitive disabilities. Our results contribute to a discussion on conversational health agents and emphasize current knowledge gaps and challenges for future research. A systematic literature review of dialogue agents for artificial intelligence and agent-based conversational systems dealing with cognitive disability of aged and impaired people. Main challenges and desired characteristics of the conversational agents, and chatbot support for aged people and people with cognitive disability. Current knowledge gaps and challenges for remote healthcare and rehabilitation. Guidelines and recommendations for future development and use of conversational systems. [ABSTRACT FROM AUTHOR]

To estimate the effects of an interactive web-based support system via mobile phone on preference-based patient participation in patients with hypertension treated in primary care (compared with standard hypertensive care only). A parallel group, non-blinded, randomized controlled trial, conducted October 2018–February 2021. Besides standard hypertensive care, the intervention group received eight weeks of support via mobile phone to facilitate self-monitoring and self-management, tentatively providing for augmented patient engagement. 31 primary healthcare centers in Sweden. 949 patients treated for hypertension. The effects on preference-based patient participation, that is, the match between a patient's preferences for and experiences of patient participation in their health and healthcare. This was measured with the 4Ps (Patient Preferences for Patient Participation) tool at baseline, after 8 weeks, and at 12 months. Data were registered electronically and analyzed with multilevel ordinal regression. At baseline, 43–51% had a complete match between their preferences for and experiences of patient participation. There was an indication of a positive effect by a higher match for 'managing treatment myself' at 8-weeks in the intervention group. Such preference-based participation in their health and healthcare was reversed at 12 months, and no further effects of the intervention on preference-based patient participation persisted after 12 months. The interactive web-based support system via mobile phone had a wavering effect on preference-based patient participation. There is a prevailing need to better understand how person-centered patient participation can be facilitated in primary care. Although patient participation is essential when having a long-term condition, interventions optimizing individuals' engagement have not been fully identified. About half of the patients with hypertension in this study did not experience participation in the manner and extent they preferred. A web-based support system via mobile phone improved some aspects of patient participation in the short- but not long term. Strategies to better identify patients' preferences for patient participation are needed, to evaluate and improve the outcome of care. [ABSTRACT FROM AUTHOR]

To explore Norwegian GPs' experiences with and perceived suitability of issuing sickness certifications in remote consultations during the COVID-19 pandemic. We used a mixed methods research design. An online survey with 301 respondents was combined with qualitative interviews with ten GPs. Norwegian general practice. Most GPs agreed it was difficult to assess a patient's ability to work without physical attendance for a first-time certification in remote consultations. However, extending a certification was considered less problematic. If physical examinations were required, the GPs would ask the patient to come to the office. The most suitable diagnoses for remote certification were respiratory infections and COVID-19-related diagnoses, as well as known chronic and long-term diseases. The GPs emphasized the importance of knowing both the patient and the medical problem. The GP-patient relationship could be affected by remote consultations, and there were mixed views on the impact. Many GPs found it easier to deny a request for a sickness certification in remote consultations. The GPs expressed concern about the societal costs and an increased number of certifications if remote consultations were too easily accessible. The study was conducted during the COVID-19 pandemic, and the findings should be interpreted in that context. Our study shows that issuing sickness certifications in remote consultations were viewed to be suitable for COVID-19 related problems, for patients the GP has met before, for the follow-up of known medical problems, and the extension of sickness certifications. Not meeting the patient face-to-face may affect the GP-patient relationship as well as make the GPs' dual role more challenging. The GPs perceived issuing sickness certifications in remote consultations as suitable when patient and health problem are known, and when the certification is an extension. Issuing sickness certifications in remote consultations can both harm and strengthen the GP-patient relationship. The GPs were aware of their social responsibility and were concerned that issuing sickness certificates in remote consultations can change their sick-listing practice. [ABSTRACT FROM AUTHOR]

To assess the experience and perceived added value of an e-Health application during the physical therapy treatment of patients with temporomandibular disorders (TMD). A mixed-methods study including semi-structured interviews was performed with orofacial physical therapists (OPTs) and with TMD patients regarding their experience using an e-Health application, Physitrack. The modified telemedicine satisfaction and usefulness questionnaire and pain intensity score before and after treatment were collected from the patients. Ten OPTs, of which nine actively used Physitrack, described that the e-Health application can help to provide personalised care to patients with TMD, due to the satisfying content, user-friendliness, accessibility, efficiency, and ability to motivate patients. Ten patients, of which nine ended up using Physitrack, felt that shared decision-making was very important. These patients were positive towards the application as it was clear, convenient, and efficient, it helped with reassurance and adherence to the exercises and overall increased self-efficacy. This was mostly built on their experience with exercise videos, as this feature was most used. None of the OPTs or patients used all features of Physitrack. The overall satisfaction of Physitrack based on the telemedicine satisfaction and usefulness questionnaire (TSUQ) was 20.5 ± 4.0 and all patients (100%) showed a clinically relevant reduction of TMD pain (more than 2 points and minimally 30% difference). OPTs and patients with TMD shared the idea that exercise videos are of added value on top of usual physical therapy care for TMD complaints, which could be delivered through e-Health. Physical therapists and patients with temporomandibular disorders do not use all features of the e-Health application Physitrack in a clinical setting. Exercise videos were the most often used feature and seen as most valuable by physical therapists and patients. Based on a small number of participants, e-Health applications such as Physitrack may be perceived as a valuable addition to the usual care, though this would need verification by a study designed to evaluate the therapeutic effect (e.g., a randomised clinical trial). [ABSTRACT FROM AUTHOR]

To identify facilitators, barriers, and formulate recommendations for the implementation of exergames for people with dementia (PWD) in day-care centers (DCCs). Within a randomized controlled trial into the effectiveness of exergaming, 73 PWD with their informal caregivers (IC) from 11 DCCs in the Netherlands and two exergame providers participated in a process evaluation. This was a mixed-methods study using focus groups, semi-structured interviews, the Measurement Instrument for Determinants of Innovations, forms for DCC staff, and a short satisfaction questionnaire. We used descriptive statistics for the quantitative outcomes, and thematic analysis for qualitative data. The Medical Research Council guidance for process evaluation was used to identify facilitators and barriers to the implementation, mechanisms of impact, and context. Implementation-related facilitators and barriers were the availability of budget, staff, equipment, instructions, location, and supervision. Mechanisms of impact-related facilitators were experienced positive effects on physical functioning and mobility, cognitive, emotional, and social functioning, and quality of life. Barriers were mainly linked to the need to customize the intervention for each participant. Contextual facilitators were support and enthusiasm from others; barriers were costs and planning. Recommendations by DCC staff involved technical support, instructions, responsibility, location, supervision, planning, and exergaming as a group or individually. Users, IC, and staff positively valued exergaming. We found various facilitators and barriers leading to recommendations for successful implementation. We recommend further research into tailoring exergaming to specific users and contexts, and into usability and cost-effectiveness. This may contribute to further dissemination and implementation of exergaming for PWD. [ABSTRACT FROM AUTHOR]

The purpose of this study was to explore the validity of evidence for self-efficacy to regulate physical activity scale (SERPA) measurement using an exploratory latent variable approach. The objectives were to explore the dimensionality, temporal invariance, and external validity of scores produced by the SERPA, a modified version of the barriers self-efficacy scale. Data (Nbaseline= 461 and N30 days post-baseline = 427) from the Well-Being and Physical Activity Study (ClinicalTrials.gov, identifier: NCT03194854), which deployed the Fun For Wellness intervention, were analyzed. A two-dimensional factor structure explained responses to the SERPA at baseline. There was evidence for at least partial strict temporal measurement invariance for this two-dimensional structure. There was evidence for external validity of the SERPA measurement as evidenced by group assignment (i.e. the intervention) exerting a direct effect on the proposed two-dimensional structure of latent self-efficacy to regulate physical activity in adults with obesity at 30 days post-baseline. [ABSTRACT FROM AUTHOR]

This paper focuses on exploring and comparing different machine learning algorithms in the context of diabetes management. The aim is to understand their characteristics, mathematical foundations, and practical implications specifically for predicting blood glucose levels. The study provides an overview of the algorithms, with a particular emphasis on deep learning techniques such as Long Short-Term Memory Networks. Efficiency is a crucial factor in practical machine learning applications, especially in the context of diabetes management. Therefore, the paper investigates the trade-off between accuracy, resource utilisation, time consumption, and computational power requirements, aiming to identify the optimal balance. By analysing these algorithms, the research uncovers their distinct behaviours and highlights their dissimilarities, even when their analytical underpinnings may appear similar. [ABSTRACT FROM AUTHOR]

Hypertension is a major global health concern. Despite of efficient antihypertensive medications a low percentage of patients reach a blood pressure (BP) of <140/90. Nonadherence is a great concern in hypertension treatment and patients' beliefs about medications has been shown to have a strong impact on adherence. The objective of this study is to examine beliefs about medications and its impact on BP treatment in a group of Swedish primary healthcare patients treated for hypertension with or without an E-health platform. In a randomised unblinded controlled trial, 949 patients with hypertension from Swedish primary health care centres were included. The intervention group used a web-based system to support self-management of hypertension for eight weeks. Beliefs about medication questionnaire (BMQ) were administered to all patients at inclusion, 8-week follow up and 1-year follow up. Data were collected from the 862 patients who completed the trial. No statistically significant difference was found in BMQ-scores between the intervention and the control group. An association between lower scores in the BMQ subsection 'General-Harm' and achieving target BP of <140/90 mmHg were noted (p = 0.021). This study shows a significant association between beliefs about medication and BP levels, on hypertensive patients in the Swedish primary care setting, in only one out of four subsections of the BMQ. The intervention did not have a significant effect on changing patients' beliefs about medication. Further emphasis on patients' beliefs about medications could be useful in the clinical setting. What is the context? Insufficient treatment effect of high blood pressure is a major global health concern, even though there are several different effective medications. Patients not taking their medications, as they have been prescribed, is a well-known contributing factor. There are associations between underlying beliefs about medications and how strict patients adhere to their prescriptions. What is new? In this study data was collected from 862 patients with high blood pressure. The participants were randomised into two groups, one group got treatment as usual and the other group used a web-based interactive information technology system for 8 weeks, in addition to their medications. All participants answered questionnaires about their beliefs about medications. It was shown that the beliefs about medications had limited significant associations to blood pressure levels. Furthermore, the intervention seemed to have no effect upon patients' beliefs about medications. What is the impact? This study provides further evidence that patients' beliefs about medications might be a possible factor to take into consideration when aiming to treat high blood pressure. The intervention used in this study had no impact on patients' beliefs about medications. [ABSTRACT FROM AUTHOR]

To systematically review the literature on effectiveness of remote physiotherapeutic e-Health interventions on pain in patients with musculoskeletal disorders. Using online data sources PubMed, Embase, and Cochrane in adults with musculoskeletal disorders with a pain-related complaint. Remote physiotherapeutic e-Health interventions were analysed. Control interventions were not specified. Outcomes on effect of remote e-Health interventions in terms of pain intensity. From 11,811 studies identified, 27 studies were included. There is limited evidence for the effectiveness for remote e-Health for patients with back pain based on five articles. Twelve articles studied chronic pain and the effectiveness was dependent on the control group and involvement of healthcare providers. In patients with osteoarthritis (five articles), total knee surgery (two articles), and knee pain (three articles) no significant effects were found for remote e-Health compared to control groups. There is limited evidence for the effectiveness of remote physiotherapeutic e-Health interventions to decrease pain intensity in patients with back pain. There is some evidence for effectiveness of remote e-Health in patients with chronic pain. For patients with osteoarthritis, after total knee surgery and knee pain, there appears to be no effect of e-Health when solely looking at reduction of pain. This review shows that e-Health can be an effective way of reducing pain in some populations. Remote physiotherapeutic e-Health interventions may decrease pain intensity in patients with back pain. Autonomous e-Health is more effective than no treatment in patients with chronic pain. There is no effect of e-Health in reduction of pain for patients with osteoarthritis, after total knee surgery and knee pain. [ABSTRACT FROM AUTHOR]

Abstract Background Aims/Objectives Material and Methods Results Conclusion Information and communication technology (ICT) provides one solution to meet increasing demands for occupational therapy for older adults.To examine if and how municipality-based occupational therapists (OTs) include ICT in their work, and which factors are associated with use of occupational therapy at a distance.Survey study including 167 OTs. Data were presented descriptively. Associations were analysed by Chi2 test and logistic regression models.Forty-eight percent of OTs used ICT once a month or more. OTs belief on possibilites to use ICT is associated with replacement of physical home visits. Managers expectations and support also seem to be important factors.ICT solutions are frequently used by OTs in home health care and can be considered complementing rather than replacing physical home visits. More knowledge is needed on when and how ICT solutions can be used by OTs and how factors that impact the use of ICT can be managed. [ABSTRACT FROM AUTHOR]

Abstract Background Aim Material and methods Result Conclusion Research is limited about how the introduction of new ways of delivering and conducting occupational therapy, in accordance with expected changes in health care, is experienced by occupational therapists (OTs).To explore how OTs experienced use of a new internet-based intervention, ‘Strategies for Empowering activities in Everyday life’ (SEE), focusing on supporting client resources to manage an active everyday life after stroke.A focus group study with periodical repeated discussion was designed. Four sessions during a period of 22 months were conducted with a total of four OTs.Overall, the results reflected that the OTs experienced that the use of SEE for persons with stroke was a valuable complement to existing rehabilitation. The process of introducing SEE included a multifaceted transition involving context, intervention process and delivery that renewed occupational therapy.These results indicate how the use of new internet-based interventions such as SEE can influence and support renewal of occupational therapy that extends beyond the particular intervention. Continued research is needed to explore more aspects of SEE feasibility. [ABSTRACT FROM AUTHOR]

Over the past two decades, healthcare systems have shifted to adopt a more holistic, patient-centered care system. However, operationalization in practice remains challenging. Two frameworks have contributed substantially to the transformation toward more holistic and patient-centered care: the International Classification of Functioning, Disability and Health (ICF) and the capability approach (CA). Using these frameworks jointly can contribute to improved patient-centered care in clinical practice. This article explores the strengths and weaknesses of the use of the two frameworks in care and investigates whether using them jointly might contribute to more appropriate and patient-centered care. We will present a practical example of this integration in the form of a novel e-health application. The exploration indicated that if the frameworks are used jointly, the individual weaknesses can be overcome. The application, used to exemplify the joint use of the frameworks, contains all categories of the ICF. It offers a unique tool that allows a person to self-assess, record, and evaluate their functioning and capabilities and formulate related goals. Using the ICF jointly with the CA can foster holistic, patient-centered care. The e-health application provides a concrete example of how the frameworks can be used jointly. Using the International Classification of Functioning, Disability and Health jointly with the capability approach can foster holistic, patient-centered care. The joint use of the frameworks is demonstrated by an e-health application which enables users to evaluate their functioning in relation to their own goals, provides them with the opportunity to increase control over their health and have a more active role in their care. Tools to record both functioning and goals from a patient's perspective can support professionals in offering patient-centered care in daily practice. Individual recording, monitoring and evaluation of functioning, capabilities and goals regarding functioning can provide a basis for research and quality improvement. [ABSTRACT FROM AUTHOR]

The successful operation of Telemedicine significantly depends on whether or not healthcare professionals are ready to accept and use the system. Relying on the unified theory of acceptance and use of technology (UTAUT) model, this research examines the use behavior of healthcare professionals towards telemedicine with information quality as moderator. A total of 352 health workers (including nurses, pharmacist, laboratory technicians, accountants, and administrators of health institutions) were conveniently sampled for the study. The structural equation modeling (SEM) method was used to test the hypothesized paths in the framework. The results indicate that Performance Expectancy, Habit, and Hedonic Motivation have an influence on healthcare professional's behavioral intention to adopt and use telemedicine systems. This implies that users will accept and use the system if they perceive that the system will positively affect their performance. The study validates the use of UTAUT in the context of telemedicine. It also informs stakeholders in the health sector to take into consideration compatibility and system quality issues in the development of new systems. This paper provides researchers with a contemporary perspective towards understanding the adoption and use of Telemedicine especially, in the Sub-Saharan Africa context. [ABSTRACT FROM AUTHOR]

eHealth applications are increasingly being used in services for people with intellectual disabilities (ID). DigiContact is an online support service that uses videoconferencing techniques to enable people with ID to contact a team of specially trained support workers 24/7. In this qualitative and participatory study we aimed to explore the experiences of independently living people with ID with what it is like to be supported online. Five online support users were each interviewed twice and the transcripts were analysed using a phenomenological hermeneutic method. Choice and control played a central role in their shared experiences, as well as the relationship with online support staff. The results indicate that the suitability of online support depends on the needs, capabilities and preferences of each individual support user. This underlines the importance of a personalised approach to the planning and delivery of online support. In this research we interviewed five persons from the Netherlands about what it is like for them to be supported by the online service DigiContact. They felt that DigiContact helped them to have access to sufficient professional support. Without DigiContact this would have been impossible, because of a reorganisation of the national long-term care system and cuts in care budgets. They also felt that DigiContact gave them control over their support and stimulated them to take on an active role towards solving their problems. Online support felt relatively impersonal, because they had contacts with different support workers. We conclude that online support seems not to be equally suitable for everybody. Whether online support is suitable, and in what form, depends on someone's personal needs, wishes and preferences in support. Service organisations should look carefully at each individual person when planning the use of online support. [ABSTRACT FROM AUTHOR]

Chronic heart failure (HF) is characterized by high hospital admission rates. The CardioMEMSTM HF System is a pulmonary artery pressure sensor developed for remote hemodynamic monitoring to reduce HF hospitalizations. The device is FDA approved and CE marked, but clinical evidence for the CardioMEMS system is mainly based upon U.S. studies. Because of structural differences in HF care between the U.S. and Europe, it is important to study CardioMEMS efficacy in European setting on top of usual HF care and contemporary therapy. Several observational studies have been performed in Europe, but there is an unmet need for randomized clinical trials. This review focuses on safety and efficacy data for CardioMEMS remote hemodynamic monitoring in European HF setting, and discusses important upcoming studies. For safety, data from European studies are in line with U.S. studies. Efficacy with regard to reduction of HF hospitalizations seems promising, but is merely based upon observational studies comparing pre- and post-implantation event rates. The first European randomized clinical trial (MONITOR HF) will provide efficacy data compared to actual standard care in a high-quality healthcare system with contemporary HF treatment and will provide important generalizable information to other European countries. [ABSTRACT FROM AUTHOR]

The objective of this study was to provide initial validity evidence for responses to the newly developed Well-Being Actions Self-Efficacy (WBASE) scale from adults with obesity under an exploratory latent variable approach. Longitudinal data (Nbaseline = 667 and N30 days post-baseline = 550) from the Well-Being and Physical Activity study (ClinicalTrials.gov, identifier: NCT03194854), which deployed the Fun For Wellness (FFW) intervention, were analyzed. The a priori measurement model exhibited close fit to baseline data within an exploratory framework. Similarly, there was strong evidence for at least partial temporal measurement invariance for the a priori WBASE scale measurement model. Convergent (and divergent) correlations between concordant (and discordant) pairs of well-being actions scores at baseline and latent well-being actions self-efficacy factors at 30 days post-baseline were observed. There was mixed evidence for the effectiveness of the FFW intervention to exert a direct effect on latent well-being actions self-efficacy at 30 days post-baseline. [ABSTRACT FROM AUTHOR]

The goal of this paper is to argue for the concept of social communication that we identified with the idea of innovation and almost always to technological innovation. The starting point is the hypothesis that innovation is a valuable tool in the service of the greater good. The paper has four sections. First, it briefly reviews concepts and methods in Actor Network Theory, a social theory that is useful in framing the (theoretical) approach and implications of e-service (e-care, e-health, etc ...). Second, it examines the implication of social innovation and e-service and discusses the prime agents involved in its creation. Third, it assesses the role of social communication and initiative's benefits and risks to society. Finally, the paper concludes by exploring the broad implications of e-service for evolution of national-state conventional communication. [ABSTRACT FROM AUTHOR]

To explore older patients' experiences with accessing and using e-consultations to send text-based clinical inquiries to the general practitioner (GP) online. Qualitative study based on semi-structured interviews. Results were analysed through a six-phase thematic analysis and interpreted through Levesque's framework of patient-centred access to health care. General practice in Norway. Patients aged over 65 years (n = 16) with experience in using e-consultations. Respondents considered e-consultations as an integrated part of general practice which helped them achieve better access to health care. We identified four themes describing older patients' access to and use of e-consultations: 1) the importance of digital health literacy to learn about and use the service – and the fear of losing it, 2) the high availability of the service as the main advantage, due to the perceived unavailability of physical GP services, 3) the importance of voluntary use of e-consultations, 4) the importance of a trusting relationship with the GP. Information about e-consultations and guidelines for suitable use are recommended to ensure equal access to all patients, regardless of their digital health literacy. Availability problems and high work burdens for the GPs could affect the patients' choice for using e-consultations. If e-consultations are used for triage purposes, caution should be taken to avoid a shift in workload from the health secretary to the GP. The extended use of e-consultations with the general practitioner has raised concerns that the service may not be accessible and suitable for older patients. For older users, e-consultations can represent a positive addition to physical consultation forms due to the high availability of the service in a general practice setting characterised by long waiting times. Digital health literacy is essential to learn about and use the service. Information about the service and how to use it should be available to all patients to ensure equal access. A trusting relationship with the GP is described as essential for older patients to perceive the outcome of e-consultations as appropriate and safe. [ABSTRACT FROM AUTHOR]

The purpose of this article is to explore the Sustainable Development Goal of reduced inequalities (SDG 10) in relation to the experiences of people with communication disability with lived experiences and their access to self-determined healthcare. As such, the article also informs the goal of good health and well-being (SDG 3). In preparing this article the authors reviewed recent literature on digital health records and digital autonomy as a means to improving equity of access and explored the experiences of two of the authors as people with severe communication disability who use a wide range of digital health technologies in pursuing safe and quality health care. The literature and their experiences highlight a need for improved co-design and usage across disability and health service systems management if e-health records are to be used to reduce inequalities in accessing healthcare. Recent research and the lived experiences of the first two authors reflect that e-health information systems, designed to improve the consumer's ability to access and share their own health information, are not used to full advantage in disability and healthcare environments. Increased access to multimodal communication strategies and communication technologies, along with user-centred co-design that enables digital health autonomy will further progress towards reduced inequalities (SDG 10) and good health and well-being (SDG 3) and for people with communication or swallowing disability. [ABSTRACT FROM AUTHOR]

Background: Information and communication technology (ICT) has been proven to have effect in terms of providing alternative ways to deliver rehabilitation services. The intention with this paper is to serve as a foundation for discussions regarding the future development, design, and delivery of home-based rehabilitation, including ICT. Aim: To reflect on and discuss the possibilities and challenges of using ICT in home-based rehabilitation services. Method and material: We use experiences and results from various projects to reflect on and discuss possibilities and challenges related to the use of ICT in home-based rehabilitation. Findings and discussion: We exemplify how ICT present new possibilities that can increase the quality of the rehabilitation process and improve access to services. We reflect on some challenges in the use of ICT, related to non-user-friendly solutions, to the specific rehabilitation situation, and a lack of technical support. At an organisational level, readiness to use ICT can impact the extent to which new solutions are integrated into practice. Conclusion: We emphasise that ICT has the potential to develop and improve service delivery and contribute to increased quality and accessibility of home-based rehabilitation. [ABSTRACT FROM AUTHOR]

There is a lack of robust information for research assessing the association of various socio-demographic factors and digital technology use in the e-Health context in Turkey among the general population. The aim of the study was thus to examine the sociodemographic determinants of e-Health literacy in the general population in Istanbul, Turkey. The study sample consisted of 806 individuals aged 15 and over who participated in a cross-sectional survey conducted between October 2019 and February 2020. Abstracted data included age, gender, education level, income, occupation type, Internet use, self-perceived health status, regular medication usage, and visits to healthcare professionals. The e-Health Literacy Scale was used to measure e-Health literacy. This study indicated that the e-Health literacy of the general population was at a medium level and most variables reflecting the sociodemographic and economic status of the individuals were significantly associated with e-Health scores. [ABSTRACT FROM AUTHOR]

Objective: Adolescents are at risk for substance use, sexual assault, and sexual risk behaviours; however, to date no integrated prevention programmes address all three risk behaviours. The goal of this study was to evaluate the usability and acceptability of Teen Well Check, an e-health prevention programme targeting substance use, sexual assault, and sexual risk among adolescents in primary care settings. Methods: The current study included content analysis of interviews with adolescents in primary care (aged 14–18; n = 25) in the intervention development process, followed by usability and acceptability testing with qualitative interviews among adolescents in primary care (aged 14–18; n = 10) and pediatric primary care providers (n = 11) in the intervention refinement process. All data were collected in the Southeastern U.S. Results: Feedback on Teen Well Check addressed content, engagement and interaction, language and tone, aesthetics, logistics, inclusivity, parent/guardian-related topics, and the application of personal stories. Overall, providers reported they would be likely to use this intervention (5.1 out of 7.0) and recommend it to adolescents (5.4 out of 7.0). Conclusions: These findings suggest preliminary usability and acceptability of Teen Well Check. A randomized clinical trial is needed to assess efficacy. Adolescents are at risk for substance use, sexual assault, and sexual risk behaviours. The goal of this study was to evaluate the usability and acceptability of Teen Well Check, an e-health prevention programme targeting substance use, sexual assault, and sexual risk among adolescents in primary care settings. Providers and adolescents rated Teen Well Check as usable and acceptable, and providers indicated that they would recommend it to their adolescent patients. [ABSTRACT FROM AUTHOR]

Remote patient monitoring (RPM) system is an efficient technology that allows reducing healthcare costs and contamination risks, especially in the context of a pandemic. However, security and data privacy are the major challenges that hinder the development of such technology. A secure RPM system should satisfy several security requirements such as authentication, confidentiality, and access control. Public Key Infrastructure (PKI) is one of the main widely-used key management schemes. Unfortunately, in an e-Health system supporting constrained devices, PKI suffers from some issues related to the burden of certificate management (e.g., revocation, storage, and distribution) and the computational cost of certification verification. In this paper, we present our contribution to the development of a secure RPM system. Our security solution is based on Certificate-less Public Key Cryptography (CL-PKC) which ensures a dynamic solution for securing communications between patient devices and the e-Health services core. The proposed solution provides secure authentication and key agreement protocol to establish secret session keys. These keys are used for secure exchanging real-time electronic health records (EHR). To evaluate our approach, we conducted both simulation and real experiments. The security and performance analysis show that our approach is secure and effective while being easy to implement on resource-constrained devices with a low computational cost. [ABSTRACT FROM AUTHOR]

Internet-delivered cognitive behavioral therapy (ICBT) provides critical remote access to mental health care to at-risk populations. However, to our knowledge, no investigation has been conducted to understand complex pathways through which barriers to care (i.e. structural, attitudinal and technological) correlate with patient interest in ICBT. The objective of this study is to develop and test a pathway analysis framework using structural equation modeling to understand direct and mediating associations of barriers to care with interest in ICBT. This cross-sectional observational study was conducted among adult (>18 years) urban and rural residents (n = 200) in Saskatchewan, Canada. An online survey assessed interest in ICBT, barriers to ICBT, demographics, and depression and anxiety symptoms. Utilizing structural equation modeling, a path analysis framework was developed. Path analysis results showed how associations between complex barriers and demographic variables correlate with interest in ICBT. For instance, the negative association of perceived financial concerns and life chaos on interest in ICBT was mediated by perceived access to care. The findings identify specific barriers that could be addressed through targeted population health interventions to improve uptake of ICBT. [ABSTRACT FROM AUTHOR]

The purpose of the research were to describe eHealth literacy and identify factors affecting the eHealth literacy of early adolescents. This descriptive and correlational study was conducted in a government secondary school in the west of Turkey. The research sample consisted of 1347 adolescents in the sixth, seventh, and eighth grades in the academic year 2016–2017. An adolescents' description form and the eHealth Literacy Scale (eHEALS) were used to collect the data. The mean score on eHEALS was 23.81 ± 6.94. Multiple regression analysis showed that being in the 11–12 year age group (β = 0.528, p < 0.001), having a father with a high school or university level education (β = 0.055, p = 0.038), and carrying out research in the internet on health related topics (β = 0.118, p < 0.001) were determinant at 32% (F = 56.901, p < 0.001, R2 = 0.32) on the adolescents' eHealth literacy. The mean eHEALS score in the study demonstrated that the e-health literacy of the adolescents was rather low and inadequate, and that there were gaps in the adolescents' knowledge and skills about how and where to find quality eHealth information. Nurses are expected to provide eHealth literacy training that will help to find information on the internet and interpret and assess it, and this will develop eHealth literacy of adolescents. Integrating online health information sources into the school health education curriculum in line with developed strategies can be suggested because it is an attempt to improve the eHealth literacy of adolescents. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic promoted hitherto unseen uptake of telemedicine by ophthalmologists. We performed a mixed methods study to explore patters of utilization during the pandemic and perceived future utility. Ophthalmologists practicing in Canada between March and July 2020 were invited to complete an online questionnaire assessing demographics, clinical practice characteristics and telemedicine utilization prior to and during the pandemic. Descriptive and bivariate statistics were used to analyze the data. Agglomerative hierarchical cluster analysis was used to identify groups who varied on the types of visits offered using telemedicine. Ten one-on-one interviews were conducted and analyzed using thematic content analysis to explain trends observed in the survey data. Seventy-three ophthalmologists completed the survey. Six percent reported using telemedicine prior to the pandemic compared to 80% during the pandemic. A significant majority (81%) primarily used the telephone for telemedicine visits. Overall, visit volumes during the pandemic declined to 40% of pre-pandemic levels, with a smaller decline for ophthalmologists who used telemedicine than those who did not. Those who used telemedicine for all visit types were more likely to use telemedicine software and to anticipate a modest-to-large role for telemedicine in their future practice. For many ophthalmologists, integrating telemedicine into clinical practice may have partially offset the disruption to normal clinical activities during the pandemic. While the majority saw telemedicine as a temporary solution, a sizeable minority appear to have made considerable use of the technology and see an ongoing role for it once regular clinical activities resume. [ABSTRACT FROM AUTHOR]

The objective of the study was to explore the experiences of healthcare staff working with and being part of the implementation of a digital platform for patient-provider consultation across quality dimensions of access, efficiency, and patient safety. The study uses qualitative design to investigate experiences and the views of healthcare professionals. Data collection combined semi-structured individual and focus-group interviews. Content analysis was used to identify categories within the content areas 'access', 'efficiency', and 'patient safety'. The basis for the study was an e-consultation platform introduced in three primary healthcare centres in the County of Kalmar in southeast Sweden in 2019. Healthcare staff experienced that the platform offered an open channel for communication with patients in need of frequent contact. This reduced anxiety and therefore the frequency of follow-up appointments. Healthcare staff also noted that the platform offered flexibility in contact benefitting patients with mental health problems. These patients were found to make contact through the platform after closing hours when problems were more acute or intense. However, the risk of digitally illiterate groups being excluded was also noted. Efficiency gains were identified among patients with simple cases which were handled more quickly through the platform. However, low uptake and the experience that the platform did not replace, rather was added on top of other already existing functions and procedures, negatively affected the overall efficiency. Standardized questions in automated medical history-taking contributed to patient safety. The findings suggest that text-based e-consultation platforms may bring important quality improvements to primary healthcare service in terms of access, efficiency, and patient safety. Yet, areas where e-consultation does not contribute to quality improvements puts important quality gains at risk. Text based digital consultation improved access for patients in need of frequent appointments and for patients with mental health problems. Efficiency gains among patients with simple cases, and in dealing with patients with mental health problems were noted. However, lack of confidence in platform functions due to low uptake, and limited control over work situation, were perceived as negatively affecting overall efficiency. Health care staff experienced improved patient safety through a standardized set of questions in automated medical history-taking. [ABSTRACT FROM AUTHOR]

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Globally, the use of e-health has accelerated dramatically during the coronavirus pandemic. Based on both quantitative and qualitative data collected in China's Hubei province (i.e. the first epicentre of COVID-19), this research explores how the pandemic influences the practices of e-health from the perspective of users. Through analysis of 1,033 surveys and 14 in-depth interviews, we find that e-health has played a crucial role in residents' healthcare during the COVID-19 pandemic. Certain external factors influence the choice of digital health, including the high risk of infection outdoors, the shutting down of transport systems, and dysfunctional healthcare facilities that neglect non-COVID-19 patients' clinical demands. Against this backdrop, we argue digital health acts as a functional equivalent to traditional medical treatment and has largely satisfied patients and users in the crisis period. Additionally, the COVID-19 pandemic has unintentionally sped up the diffusion of digital medicine over the long term as respondents expressed their willingness to continue use of e-health in the post-COVID-19 phase. However, we assert that despite the increasing use of e-health, it cannot fully substitute traditional offline treatment. Thus, we suggest a combination of online and offline healthcare will be more commonly practiced in the future. [ABSTRACT FROM AUTHOR]

Parents of children with special healthcare needs search the Internet to learn about and share health-related information. Indeed, online communities (OCs) often increase knowledge and skills, decreasing feelings of isolation and distress. The current study explored the content and functioning of an Italian OC comprising parents of children with Down Syndrome. Following a netnographic method, data were analysed through the Latent Thematic Analysis. Five main themes emerged: the e-group, the child, prescriptive knowhow, being a parent, and personal experience across time. The findings illustrated the complex relationship between parents and children with Down Syndrome within the OC, exploring psychological themes recurring in parents of children with Down Syndrome. Within the e-group, special children and parental challenges can be described, sharing concerns, conflicting emotions, and experience-based information, countering Down Syndrome difficulties and social isolation. Clinicians and healthcare professionals should consider the OCs-related advantages to enhance the healthcare of parents and children with Down Syndrome. [ABSTRACT FROM AUTHOR]

Avoidable appointments and increasing incidence of inflammatory bowel disease (IBD) call for alternative ways of organizing outpatient visits. In controlled studies, telemedicine including patient reported outcome (PRO) has shown to improve outcomes in IBD and reduce health care utilization. However, we lack studies of telemedicine implemented in everyday practice. We therefore described use of a PRO-based telemedicine follow-up (AmbuIBD) in a real-life setting and investigated the effect on outpatient visits and hospital admissions. We conducted a cohort study including patients with IBD in an outpatient clinic at a Danish regional hospital August 2018. Data included extracts from the Patient Administration System and the AmbuFlex system between 2017 and August 2018, plus questionnaire data from clinicians. Descriptive statistics were used to describe use of AmbuIBD and differences between before and after results were tested with Wilcoxon's signed-rank test. Of 848 patients in outpatient care, 77% were included in AmbuIBD. Most patients were set to answer a PRO questionnaire once a year (n = 407, 62%), and 66% of 1913 answered questionnaires were handled with no further contact. AmbuIBD was well accepted by clinicians. Outpatient visits the year after AmbuIBD compared to the year before were reduced with 14% (p ≤.001). The largest reduction was for patients with mild or no disease activity (45%, p ≤.001). No difference was found for hospital admissions. AmbuIBD is feasible and well accepted when implemented in an outpatient clinic. More than half of patients are only followed by questionnaire, and we found a reduction in outpatient visits. [ABSTRACT FROM AUTHOR]

MOOCs can also be useful tools when facing emergencies and addressing sensitive topics and vulnerable populations, particularly in low-income countries. This points to the relevance of implementing MOOCs for addressing violence during the COVID-19 pandemic. This article shows the process of designing, developing, and assessing a distance learning MOOC for addressing violence during the COVID-19 pandemic in Brazil. The MOOC about Violence and Violence Reporting in the Brazilian National Health System launched in May 2020 and, by July 2020, had 3,673 active students with a completion rate of approximately 32%. This MOOC was a powerful instrument to address violence in Brazil during the COVID-19 pandemic. Despite their preliminary nature, the results are encouraging in what concerns the use of MOOCs as a strategy to address the infodemic, to promote professional training and to support other e-health and telemedicine techniques. [ABSTRACT FROM AUTHOR]

(1) To investigate the remote check test battery, designed for self-administration by cochlear implant (CI) recipients, parents/caregivers, to determine if the results give adequate information for clinicians to decide the necessity of an appointment and to capture suggestions for improvement. (2) To gauge acceptance of remote monitoring by CI-recipients and their parents/caregivers. Prospective, multicentre, un-blinded, non-randomized, single-subject, repeated-measures evaluation. The test battery includes an implant-site photograph, impedance measurements, datalogs, questionnaires, speech perception and aided threshold tests. Clinicians reviewed test battery results, followed by a clinical appointment with each CI-recipient, and reported if the battery identified all the issues. Study sample: n = 93 CI-recipients (73 adults, 20 children) and 28 clinicians. The test battery identified 94% (615/656) of all issues. The test battery and clinician observations agreed in 99% (92/93) of cases on the need for a clinic visit. For 68% (63/93) of cases, the test battery identified all clinician observed issues. The majority (77%, 72/93) of recipients would be satisfied if clinic visits were based on their test battery results. A significantly high proportion agreed that remote monitoring was more convenient than clinic visits and could result in travel, time and cost reductions. This is the first comprehensive test battery designed for CI-recipient remote monitoring. [ABSTRACT FROM AUTHOR]

The aim of the present work was to investigate the effect of a novel therapy based on pleoptic exercises combined with standard occlusion in patients with meridional amblyopia. The exercising system itself, termed focal ambient visual acuity stimulation (FAVAS), consists of sinusoidally modulated circular gratings, which were implemented as a background pattern in computer games binding the children's attention. For the assessment of therapeutic effects, we tested for the development of best-corrected visual acuity (BCVA) in patients trained with a gaming field background of moving gratings (Moving) compared to patients treated with stationary gratings (Stationary). Patients with amblyopia (caused by strabismus, refraction, or both) and astigmatism were randomly allocated to two groups, all of whom received a standard occlusion regimen. In combination with occlusion, using a crossover design, the first group (Moving-Stationary group) was alternately exercised for 10 days with a series of Moving followed by 10 days with Stationary and the second group (Stationary-Moving group) vice versa. The treatment-dependent training effect on BCVA was measured with respect to the alignment of the least vs. the most ametropic meridian in both groups. BCVA was examined using a meridionally direction-sensitive visual test inventory, and we estimated the monocular BCVA in all patients along four meridians: 0°, 45°, 90°, and 135° before and after Moving as compared to Stationary treatments. The Moving-Stationary group consisted of 17 children (34 eyes) aged 10 to 13 (average 11.6 ± 0.3) years. The Stationary-Moving group consisted of 20 children (40 eyes) aged 9 to 14 (average 12.5 ± 0.4). In both groups, visual acuity increased significantly only with Moving combined with occlusion. Thereby, the visual acuity (logMAR) along different meridians showed a statistically significant improvement induced by Moving if testing was coincident with alignment of the directional optical characters close to the most ametropic meridian in the Moving-Stationary group (0.73 ± 0.32 to 0.41 ± 0.22, p < 0.01) and also in the Stationary-Moving group (0.48 ± 0.27 to 0.33 ± 0.18, p < 0.01). Significant improvement was also induced by Moving if tested in alignment with the perpendicular orientation close to the least ametropic meridian, although with a smaller amount, in the Moving-Stationary group (0.49 ± 0.23 to 0.37 ± 0.21, p < 0.01) as well as in the Stationary-Moving group (0.33 ± 0.18 to 0.28 ± 0.16, p < 0.01). After Stationary combined with occlusion, however, there was no statistically significant improvement, regardless of the meridian. Visual training of patients with meridional amblyopia by a series of online exercises using attention-binding computer games which contained moving gratings as a background stimulus (Moving) resulted in a statistically significant improvement in visual acuity in the most refractive meridian, and to a lesser extent, in the least refractive meridian. No statistically significant improvement was achieved after the respective exercising series in the sham condition with stationary gratings (Stationary). [ABSTRACT FROM AUTHOR]

By examining the health needs of the general population and utilising the potential of digitalisation as a driving force, new internet-based services need to be developed in occupational therapy. However, existing guidelines for the development of complex interventions provide scant information on how to develop internet-based interventions. The aim of this paper is to share experiences and illustrate important key actions and new perspectives to consider during the innovation process of developing and designing an internet-based occupational therapy intervention. International guidelines for intervention development was reviewed to add important perspectives in the innovation process. The illustration focuses on five key actions in the development phase to highlight new perspectives and questions important to consider when designing new internet-based occupational therapy interventions. The new perspectives can complement existing guidelines to enhance the development of more effective and sustainable internet-based interventions. The illustration provided has potential to improve the sustainability in innovation processes of new internet-based occupational therapy interventions. [ABSTRACT FROM AUTHOR]

Recent technological advancements in health care delivery have paved the way for collaborative monitoring, diagnosis, and treatment of patients, which involve real-time monitoring of patients and remote storage of their health information in the cloud. However, controlling access to the stored health information in the cloud is not only difficult but also susceptible to different privacy- and security-related attacks. Besides, existing access control schemes for e-health do not support delegation of responsibilities, a common phenomenon in health care delivery, making complete adoption of e-health impracticable. In this paper, we propose a security scheme that provides fine-grained expressive access control on patients' health information for secure data and responsibilities delegation among health officers in collaborative e-health systems. The scheme takes care of the key distribution and attribute or user revocation problems of CP-ABE and supports secure delegation of responsibilities. With this scheme, a health officer can treat patients and securely delegate responsibilities to other health officers within the team without jeopardizing the security and privacy of the patients. Security and performance analysis show that our proposed scheme is efficient, secure, and expressive. [ABSTRACT FROM AUTHOR]

The Help2Care e-Health platform was developed in order to capacitate informal caregivers with digital, multimedia training materials. Health professionals select these materials according to the needs of the homebound patients under the supervision of these caregivers. In turn, caregiver can then use their smartphones to consult and apply the care procedures illustrated by these materials. In this paper, we present the results of performed usability tests for both web and mobile software applications of the Help2Care platform. These indicate an overall positive outcome, revealing less usable aspects such as the navigation flow in the web application and some design elements in the mobile application. Important written feedback was also collected, which we took into consideration to improve the software features of the platform. [ABSTRACT FROM AUTHOR]

Falls and related injuries are known to be the major health problem leading to disability and mortality among older adults. Identification and management of fall risks aimed to prevent falling is considered to be essential. The aim of this study was to develop a mobile application for screening and management of fall risks based for older adults. First, we determined product features based on literature reviews. Then we asked 10 experts to assess the importance of capabilities. The application was designed in Android environment based on the STEADI toolkit. Finally, the usability and satisfaction of the application were assessed among 30 older adults by means of a usability questionnaire, and the final version was modified. The experts rated the majority of feasibility features to be important. The application consisted of falls risk self-assessment, and the Timed Up and Go (TUG) test to measure individual fall risks, fall prevention education, and suggestions for training based on the individuals' level of fall risk among older adults. The results of the usability assessment showed that the users were satisfied with the application, 8.83 out of 10. The mobile application can be used to screen and manage fall risks in older adults. It may help health providers to identify older adults at low, moderate, and high risks of falls provide education and training to minimise falls and fall-related injuries. Falls are a major health problem in older people. A great proportion of falls and falls related injuries are preventable. Given the availability and accessibility of various mobile health application and the increasing mobile device usage among older adults, mobile application can be used as a platform for delivering fall prevention programmes such as education and exercise training. The mobile application may be a valuable tool in the fall prevention and their consequences either in old adult. [ABSTRACT FROM AUTHOR]

Treatment of temporomandibular disorder (TMD) currently consists of a combination of noninvasive therapies and may be supported by e-Health. It is, however, unclear if physical therapists and patients are positive towards the use of e-Health. To assess the needs, facilitators and barriers of the use of an e-Health application from the perspective of both orofacial physical therapists and patients with TMD. A descriptive qualitative study was performed. Eleven physical therapists and nine patients with TMD were interviewed using a topic guide. Thematic analysis was applied, and findings were ordered according to four themes: acceptance of e-Health, expected utility, usability and convenience. Physical therapists identified the need for e-Health as a supporting application to send questionnaires, animated exercises and evaluation tools. Key facilitators for both physical therapists and patients for implementing e-Health included the increase in self-efficacy, support of data collection and personalization of the application. Key barriers are the increase of screen time, the loss of personal contact, not up-to-date information and poor design of the application. Physical therapists and patients with TMD are positive towards the use of e-Health, in a blended form with the usual rehabilitation care process for TMD complaints. The rehabilitation process of temporomandibular complaints may be supported by the use of e-Health applications. Physical therapists and patients with temporomandibular disorders are positive towards the use of e-Health as an addition to the usual care. Especially during the treatment process, there is a need for clear animated videos and reminders for the patients. [ABSTRACT FROM AUTHOR]