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BACKGROUND Digital innovations in the mental health care field provide an opportunity to mitigate the global burden of mental disorders such as depression by facilitating timely, accessible, scalable, and affordable interventions. However, there is little evidence on how much these interventions rely on novel automated approaches, such as conversational agents (CAS), just-in-time adaptive interventions (JITAIs), or low-burden sensing technologies. OBJECTIVE Our objectives were: (i) to identify the top-funded companies offering digital health interventions for the prevention and treatment of depression (DHID), (ii) to review DHIDs’ scientific evidence, (iii) to identify which psychotherapy approaches are being used, and (iv) to examine the degree to which these DHIDs include novel automated approaches such as CAs, JITAIs, and low-burden sensing technologies. METHODS A systematic search was conducted using two venture capital databases (Crunchbase and Pitchbook) to identify the top 30 funded companies offering DHIDs. In addition, studies related to the DHIDs were identified via scientific databases (PubMed, Cochrane Library, and APA Psych-info) and hand-searching (companies’ websites). RESULTS The top-30 funded companies offering DHIDs received total funding of 2’592 billion USD up to February 2022. A total of 83 studies were identified by fewer than half of the companies (n=14; 46.6%), of which only 8 (n= 26.6%) employed a randomized controlled trial design. Cognitive-behavioural therapy is the most commonly used psychotherapy approach (n=25, 83.3%), whereas behavioural activation and/or interpersonal therapy (the most effective interventions for depression) were used by only 8 companies (26.6%). Regarding novel technologies, only a few companies incorporated the use of CAs (n=8, 26.6%), or low-burden sensing technologies such as biofeedback-based breathing training with heart rate measurements (n=3, 10%), and only one used a biomarker for depression based on voice features (3.33%). CONCLUSIONS Findings suggest that the amount of funding is not related to the evidence. There is a strong variation in the quantity of evidence provided and an overall need for more rigorous effectiveness trials. Few DHIDs use automated approaches such as CAs and JITAIs, limiting their scalability and delivery of actionable support at the most opportune moments. CLINICALTRIAL N/A

The Singapore Preconception Study of Long-Term Maternal and Child Outcomes (S-PRESTO) is a preconception, longitudinal cohort study that aims to study the effects of nutrition, lifestyle, and maternal mood prior to and during pregnancy on the epigenome of the offspring and clinically important outcomes including duration of gestation, fetal growth, metabolic and neural phenotypes in the offspring. Between February 2015 and October 2017, the S-PRESTO study recruited 1039 Chinese, Malay or Indian (or any combinations thereof) women aged 18 to 45 years and who intended to get pregnant and deliver in Singapore, resulting in 1032 unique participants and 373 children born in the cohort. The participants were followed up for 3 visits during the preconception phase and censored at 12 months of follow up if pregnancy was not achieved (N=557 censored). Women who successfully conceived (N=475) were characterised at gestational weeks 6-8, 11-13, 18-21, 24-26, 27-28 and 34-36. Follow up of their index offspring (N=373 singletons) is on-going at birth, 1, 3 and 6 weeks, 3, 6, 12, 18, 24 and 36 months and beyond. Women are also being followed up post-delivery. Data is collected via interviewer-administered questionnaires, metabolic imaging (magnetic resonance imaging), standardized anthropometric measurements and collection of diverse specimens, i.e. blood, urine, buccal smear, stool, skin tapes, epithelial swabs at numerous timepoints. S-PRESTO has extensive repeated phenotypic data collected which include genetic and epigenetic sampling from preconception which is unique in mother-offspring epidemiological cohorts This enables prospective assessment of a wide array of potential determinants of future health outcomes in women from preconception to post-delivery and in their offspring across the earliest development from embryonic stages into early childhood. In addition the S-PRESTO study, draws from the three major Asian ethnic groups that represent 50% of the global population, increasing the relevance of its findings to global efforts to address non-communicable diseases.

Background : Elevated plasma lactate dehydrogenase (LDH) concentration may reflect hemolysis due to mechanical heart valve dysfunction. Thus, knowledge of LDH levels in patients with properly working prostheses is required. Because hemolysis parameters for the SJM Hemodynamic Plus® (HP®) and Regent® series are currently not available, the purpose of our study was to determine these data. Methods : At 12–19 months follow-up after isolated aortic valve replacement with SJM HP® or Regent® prostheses, we examined 102 patients by transthoracic echocardiography and determined plasma LDH, haptoglobin, bilirubin and hemoglobin. Results : Five patients with properly working prostheses were excluded because of increased LDH due to non-cardiac reasons. In four patients with paravalvular leakage, LDH was 244, 307, 446 and 628 U/l, respectively. In patients with properly working prostheses, LDH was 287±52 (range: 163–374) U/l for HP® ( n =33) and 274±48 (151–386) U/l for Regent® valves ( n =60, p =0.2). Haptoglobin was r =−0.02) or valve size ( r =0.25). Conclusions : In patients with SJM HP® or Regent® valves in aortic position, LDH values >400 U/l indicate valvular dysfunction or leakage if non-cardiac causes for hemolysis are excluded. However, paravalvular leakage can be present without substantially increased LDH. Haptoglobin has no diagnostic value as it is almost always markedly reduced. Hemolysis does not correlate with transvalvular gradient or prosthesis size.

Objective Sedentary behavior such as television viewing may be an independent risk factor for coronary heart disease. However, few studies have assessed the impact of television viewing time on coronary artery calcification and it remains unclear how body fat contributes to this relationship. The aim of this study is to evaluate the association between television viewing time and subclinical atherosclerosis and whether effects on visceral or subcutaneous fat may mediate any associations observed. Methods This was a cross-sectional study of 398 Chinese participants (192 men and 206 women) from Singapore prospective study. Participants were free from known cardiovascular diseases and underwent interview, health screening, computed tomography scans of coronary arteries and abdomen. Spearman’s correlation was used to test the correlation between television viewing time, physical activity, body composition and abdominal fat distribution. The association between television viewing time and subclinical atherosclerosis was assessed by multiple logistic regression analysis. Results In men, television viewing time was significantly correlated with higher body fat mass index, percent body fat, subcutaneous and visceral fat. These associations were in the same direction, but weaker and not statistically significant in women. Television viewing time (hours/day) was associated with subclinical atherosclerosis in men (odds ratio: 1.41, 95% CI: 1.03-1.93) but no significant association was observed in women (odds ratio: 0.88, 95% CI: 0.59-1.31) after adjusting for potential socio- demographic and lifestyle confounders. Further adjustments for biological factors did not affect these associations. Conclusions Television viewing time was associated with greater adiposity and higher subcutaneous and visceral fat in men. TV viewing time was also associated with subclinical atherosclerosis in men and the potential mechanisms underlying this association require further investigation.

Background: It has been proposed that the declining stroke mortality trends will stop due to high and increasing levels of stroke risk factors. Accordingly, it has been reported that the declining mortality from coronary heart diseases, whose aetiology is comparable to that of stroke, has already started to level off in major population groups in western countries. However, there are no recent data on the development and possible change in stroke mortality trends. Aim: The objective of this study was to investigate overall as well as age- and sex-specific stroke mortality trends between 1980 and 2009 in Germany and to identify changes in these trends. Methods: Data of the German Federal Statistical Office were used to calculate age-standardized and age-specific mortality trends for women and men between 1980 and 2009. Joinpoint software was used to calculate annual percentage changes and detect changes in the direction of mortality trends. Additionally, sensitivity analyses were conducted separately for West Germany and East Germany to analyse the stroke mortality trends in the two parts of Germany. Trends of ischaemic and haemorrhagic stroke were analysed separately. Results: Between 1980 and 2009, the overall stroke mortality has decreased by 68.4% in women and 70.6% in men. The decrease was relatively constant throughout the whole period and trends were comparable across age groups and sexes. The overall percent decline was less pronounced in the younger age groups compared with the older ones. Additionally, the analyses showed that between 1990 and 1991, following the reunification of Germany, the stroke mortality in Germany as a whole increased in most of the population subgroups. After 2000, a flattening in the mortality trends could be detected in the age-standardized mortality of women as well as in the subgroups of women aged ≥55 and men aged 65–84. Conclusion: Between 1980 and 2009, stroke mortality decreased substantially in the entire population. The increase in stroke mortality after the reunification was possibly caused by changes in the coding practice in former East Germany. During the whole period, a flattening of the decrease was observed in some population subgroups, which may be the result of relatively high levels of important risk factors. The decreasing stroke mortality rate may flatten in the entire population in the future. The results may aid in designing and improving preventive strategies.

Elevated plasma lactate dehydrogenase (LDH) concentration may reflect hemolysis due to mechanical heart valve dysfunction. Thus, knowledge of LDH levels in patients with properly working prostheses is required. Because hemolysis parameters for the SJM Hemodynamic Plus (HP) and Regent series are currently not available, the purpose of our study was to determine these data.At 12-19 months follow-up after isolated aortic valve replacement with SJM HP(R) or Regent prostheses, we examined 102 patients by transthoracic echocardiography and determined plasma LDH, haptoglobin, bilirubin and hemoglobin.Five patients with properly working prostheses were excluded because of increased LDH due to non-cardiac reasons. In four patients with paravalvular leakage, LDH was 244, 307, 446 and 628 U/l, respectively. In patients with properly working prostheses, LDH was 287+/-52 (range: 163-374) U/l for HP(R) (n=33) and 274+/-48 (151-386) U/l for Regent valves (n=60, p=0.2). Haptoglobin was1g/l in all patients; in 91% of HP and 75% of Regent valves, haptoglobin was below detection limit. Bilirubin and hemoglobin as well as red blood cell count (RBC) were normal in all patients except for five patients with renal anemia, two patients with paravalvular leakage and four patients with macrocytosis due to alcohol abuse. There was no correlation between LDH and transvalvular gradient (r=-0.02) or valve size (r=0.25).In patients with SJM HP(R) or Regent valves in aortic position, LDH values400 U/l indicate valvular dysfunction or leakage if non-cardiac causes for hemolysis are excluded. However, paravalvular leakage can be present without substantially increased LDH. Haptoglobin has no diagnostic value as it is almost always markedly reduced. Hemolysis does not correlate with transvalvular gradient or prosthesis size.

Background Few studies have investigated patterns of physical activity in a multi-ethnic Asian urban population. Even less is known about sedentary behaviors in these populations. The present study examined the prevalence of physical activity, exercise and sedentary behavior. In addition, it investigated socio-demographic correlates and the contribution of different domains towards overall physical activity. Methods Data of 2319 participants from the population-based cross-sectional Singapore Health 2012 study were analyzed. Physical activity, exercise and sedentary behavior were assessed using the Global Physical Activity Questionnaires. A modified Cox regression model was used to estimate the relative prevalence rates (PR) for overall physical activity, leisure-time exercise and high level of sedentary behavior by socio-demographic factors. Results Overall, 73.8% of participants met physical activity guidelines, 24.3% did regular leisure-time exercise and 37.0% reported high levels of sedentary behavior. Travel-related activities contributed about half of the total physical activity. There was a consistent association between age of participants with physical activity and exercise. Older participants were less likely to meet the guidelines (PR = 0.74, 95% C I = 0.61 – 0.91) than younger participants. The prevalence of regular exercise was lowest among 30 to 39 years aged participants (PR = 0.62, 95% CI = 0.45 – 0.86). Females exercised less regularly (PR = 0.63, 95% C I = 0.51 – 0.76) than males. Participants with higher education exercised regularly (PR = 2.08, 95% CI = 1.45 – 2.99) than participants with lower education. Employment status was consistently associated with exercise and high levels of sedentary behavior. Participants who were not in full-time employment exercised more regularly (PR = 1.45, 95% CI = 1.1 – 1.92) and were less likely to report high levels of sedentary behavior (PR = 0.65, 95% CI = 0.44 – 0.97) than those in full-time employment. Conclusions Our population-based study suggests a need to encourage overall physical activity but, particularly regular leisure-time exercise, especially among middle-aged, females and those with lower levels of education and full-time employment. Strategies targeting workplaces may be important to reduce high levels of sedentary behavior.