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BackgroundThe mobile health (mHealth) app trustworthiness (mHAT) checklist was created to identify end users’ opinions on the characteristics of trustworthy mHealth apps and to communicate this information to app developers. To ensure that the checklist is suited for all relevant stakeholders, it is necessary to validate its contents. ObjectiveThe purpose of this study was to assess the feasibility of the mHAT checklist by modifying its contents according to ratings and suggestions from stakeholders familiar with the process of developing, managing, or curating mHealth apps. MethodsA 44-item online survey was administered to relevant stakeholders. The survey was largely comprised of the mHAT checklist items, which respondents rated on a 5-point Likert scale, ranging from completely disagree (1) to completely agree (5). ResultsIn total, seven professional backgrounds were represented in the survey: administrators (n=6), health professionals (n=7), information technology personnel (n=6), managers (n=2), marketing personnel (n=3), researchers (n=5), and user experience researchers (n=8). Aside from one checklist item—“the app can inform end users about errors in measurements”—the combined positive ratings (ie, completely agree and agree) of the checklist items overwhelmingly exceeded the combined negative ratings (ie, completely disagree and disagree). Meanwhile, two additional items were included in the checklist: (1) business or funding model of the app and (2) details on app uninstallation statistics. ConclusionsOur results indicate that the mHAT checklist is a valuable resource for a broad range of stakeholders to develop trustworthy mHealth apps. Future studies should examine if the checklist works best for certain mHealth apps or in specific settings.

BackgroundMany people are accessing digital self-help for mental health problems, often with little evidence of effectiveness. Social anxiety is one of the most common sources of mental distress in the population, and many people with symptoms do not seek help for what represents a significant public health problem. ObjectiveThis study aimed to evaluate the effectiveness of a self-guided cognitive behavioral internet intervention for people with social anxiety symptoms in the general population. MethodsWe conducted a two-group randomized controlled trial in England between May 11, 2016, and June 27, 2018. Adults with social anxiety symptoms who were not receiving treatment for social anxiety were recruited using online advertisements. All participants had unrestricted access to usual care and were randomized in a 1:1 ratio to either a Web-based unguided self-help intervention based on cognitive behavioral principles or a waiting list control group. All outcomes were collected through self-report online questionnaires. The primary outcome was the change in 17-item Social Phobia Inventory (SPIN-17) score from baseline to 6 weeks using a linear mixed-effect model that used data from all time points (6 weeks, 3 months, 6 months, and 12 months). ResultsA total of 2122 participants were randomized, and 6 were excluded from analyses because they were ineligible. Of the 2116 eligible randomized participants (mean age 37 years; 80.24%, 1698/2116 women), 70.13% (1484/2116) had follow-up data available for analysis, and 56.95% (1205/2116) had data on the primary outcome, although attrition was higher in the intervention arm. At 6 weeks, the mean (95% CI) adjusted difference in change in SPIN-17 score in the intervention group compared with control was −1.94 (−3.13 to −0.75; P=.001), a standardized mean difference effect size of 0.2. The improvement was maintained at 12 months. Given the high dropout rate, sensitivity analyses explored missing data assumptions, with results that were consistent with those of the primary analysis. The economic evaluation demonstrated cost-effectiveness with a small health status benefit and a reduction in health service utilization. ConclusionsFor people with social anxiety symptoms who are not receiving other forms of help, this study suggests that the use of an online self-help tool based on cognitive behavioral principles can provide a small improvement in social anxiety symptoms compared with no intervention, although dropout rates were high. Trial RegistrationClinicalTrials.gov NCT02451878; https://clinicaltrials.gov/ct2/show/NCT02451878

Over the next decade, one issue which will dominate sociotechnical studies in health informatics is the extent to which the promise of artificial intelligence in health care will be realized, along with the social and ethical issues which accompany it. A useful thought experiment is the application of the Turing test to user-facing artificial intelligence systems in health care (such as chatbots or conversational agents). In this paper I argue that many medical decisions require value judgements and the doctor-patient relationship requires empathy and understanding to arrive at a shared decision, often handling large areas of uncertainty and balancing competing risks. Arguably, medicine requires wisdom more than intelligence, artificial or otherwise. Artificial intelligence therefore needs to supplement rather than replace medical professionals, and identifying the complementary positioning of artificial intelligence in medical consultation is a key challenge for the future. In health care, artificial intelligence needs to pass the implementation game, not the imitation game.

BackgroundSocial network technologies have become part of health education and wider health promotion—either by design or happenstance. Social support, peer pressure, and information sharing in online communities may affect health behaviors. If there are positive and sustained effects, then social network technologies could increase the effectiveness and efficiency of many public health campaigns. Social media alone, however, may be insufficient to promote health. Furthermore, there may be unintended and potentially harmful consequences of inaccurate or misleading health information. Given these uncertainties, there is a need to understand and synthesize the evidence base for the use of online social networking as part of health promoting interventions to inform future research and practice. ObjectiveOur aim was to review the research on the integration of expert-led health promotion interventions with online social networking in order to determine the extent to which the complementary benefits of each are understood and used. We asked, in particular, (1) How is effectiveness being measured and what are the specific problems in effecting health behavior change?, and (2) To what extent is the designated role of social networking grounded in theory? MethodsThe narrative synthesis approach to literature review was used to analyze the existing evidence. We searched the indexed scientific literature using keywords associated with health promotion and social networking. The papers included were only those making substantial study of both social networking and health promotion—either reporting the results of the intervention or detailing evidence-based plans. General papers about social networking and health were not included. ResultsThe search identified 162 potentially relevant documents after review of titles and abstracts. Of these, 42 satisfied the inclusion criteria after full-text review. Six studies described randomized controlled trials (RCTs) evaluating the effectiveness of online social networking within health promotion interventions. Most of the trials investigated the value of a “social networking condition” in general and did not identify specific features that might play a role in effectiveness. Issues about the usability and level of uptake of interventions were more common among pilot studies, while observational studies showed positive evidence about the role of social support. A total of 20 papers showed the use of theory in the design of interventions, but authors evaluated effectiveness in only 10 papers. ConclusionsMore research is needed in this area to understand the actual effect of social network technologies on health promotion. More RCTs of greater length need to be conducted taking into account contextual factors such as patient characteristics and types of a social network technology. Also, more evidence is needed regarding the actual usability of online social networking and how different interface design elements may help or hinder behavior change and engagement. Moreover, it is crucial to investigate further the effect of theory on the effectiveness of this type of technology for health promotion. Research is needed linking theoretical grounding with observation and analysis of health promotion in online networks.

BackgroundAngina affects more than 50 million people worldwide. Secondary prevention interventions such as cardiac rehabilitation are not widely available for this population. An Internet-based version could offer a feasible alternative. ObjectiveOur aim was to examine the effectiveness of a Web-based cardiac rehabilitation program for those with angina. MethodsWe conducted a randomized controlled trial, recruiting those diagnosed with angina from general practitioners (GPs) in primary care to an intervention or control group. Intervention group participants were offered a 6-week Web-based rehabilitation program (“ActivateYourHeart”). The program was introduced during a face-to-face appointment and then delivered via the Internet (no further face-to-face contact). The program contained information about the secondary prevention of coronary heart disease (CHD) and set each user goals around physical activity, diet, managing emotions, and smoking. Performance against goals was reviewed throughout the program and goals were then reset/modified. Participants completed an online exercise diary and communicated with rehabilitation specialists through an email link/synchronized chat room. Participants in the control group continued with GP treatment as usual, which consisted of being placed on a CHD register and attending an annual review. Outcomes were measured at 6-week and 6-month follow-ups during face-to-face assessments. The primary outcome measure was change in daily steps at 6 weeks, measured using an accelerometer. Secondary outcome measures were energy expenditure (EE), duration of sedentary activity (DSA), duration of moderate activity (DMA), weight, diastolic/systolic blood pressure, and body fat percentage. Self-assessed questionnaire outcomes included fat/fiber intake, anxiety/depression, self-efficacy, and quality of life (QOL). ResultsA total of 94 participants were recruited and randomized to the intervention (n=48) or the usual care (n=46) group; 84 and 73 participants completed the 6-week and 6-month follow-ups, respectively. The mean number of log-ins to the program was 18.68 (SD 13.13, range 1-51), an average of 3 log-ins per week per participant. Change in daily steps walked at the 6-week follow-up was +497 (SD 2171) in the intervention group and –861 (SD 2534) in the control group (95% CI 263-2451, P=.02). Significant intervention effects were observed at the 6-week follow-up in EE (+43.94 kcal, 95% CI 43.93-309.98, P=.01), DSA (–7.79 minutes, 95% CI –55.01 to –7.01, P=.01), DMA (+6.31 minutes, 95% CI 6.01-51.20, P=.01), weight (–0.56 kg, 95% CI –1.78 to –0.15, P=.02), self-efficacy (95% CI 0.30-4.79, P=.03), emotional QOL score (95% CI 0.01-0.54, P=.04), and angina frequency (95% CI 8.57-35.05, P=.002). Significant benefits in angina frequency (95% CI 1.89-29.41, P=.02) and social QOL score (95% CI 0.05-0.54, P=.02) were also observed at the 6-month follow-up. ConclusionsAn Internet-based secondary prevention intervention could be offered to those with angina. A larger pragmatic trial is required to provide definitive evidence of effectiveness and cost-effectiveness. Trial RegistrationInternational Standard Randomized Controlled Trial Number (ISRCTN): 90110503; http://www.controlled-trials.com/ISRCTN90110503/ISRCTN90110503 (Archived by WebCite at http://www.webcitation.org/6RYVOQFKM).

BackgroundThe ALS Online Genetics Database (ALSoD) website holds mutation, geographical, and phenotype data on genes implicated in amyotrophic lateral sclerosis (ALS) and links to bioinformatics resources, publications, and tools for analysis. On average, there are 300 unique visits per day, suggesting a high demand from the research community. To enable wider access, we developed a mobile-friendly version of the website and a smartphone app. ObjectiveWe sought to compare data traffic before and after implementation of a mobile version of the website to assess utility. MethodsWe identified the most frequently viewed pages using Google Analytics and our in-house analytic monitoring. For these, we optimized the content layout of the screen, reduced image sizes, and summarized available information. We used the Microsoft .NET framework mobile detection property (HttpRequest.IsMobileDevice in the Request.Browser object in conjunction with HttpRequest.UserAgent), which returns a true value if the browser is a recognized mobile device. For app development, we used the Eclipse integrated development environment with Android plug-ins. We wrapped the mobile website version with the WebView object in Android. Simulators were downloaded to test and debug the applications. ResultsThe website automatically detects access from a mobile phone and redirects pages to fit the smaller screen. Because the amount of data stored on ALSoD is very large, the available information for display using smartphone access is deliberately restricted to improve usability. Visits to the website increased from 2231 to 2820, yielding a 26% increase from the pre-mobile to post-mobile period and an increase from 103 to 340 visits (230%) using mobile devices (including tablets). The smartphone app is currently available on BlackBerry and Android devices and will be available shortly on iOS as well. ConclusionsFurther development of the ALSoD website has allowed access through smartphones and tablets, either through the website or directly through a mobile app, making genetic data stored on the database readily accessible to researchers and patients across multiple devices.

BackgroundInterventions to promote mental well-being can bring benefits to the individual and to society. The Internet can facilitate the large-scale and low-cost delivery of individually targeted health promoting interventions. ObjectiveTo evaluate the effectiveness of a self-directed Internet-delivered cognitive-behavioral skills training tool in improving mental well-being in a population sample. MethodsThis was a randomized trial with a waiting-list control. Using advertisements on a national health portal and through its mailing list, we recruited 3070 participants aged 18 or over, resident in England, and willing to give their email address and access a fully automated Web-based intervention. The intervention (MoodGYM) consisted of 5 interactive modules that teach cognitive-behavioral principles. Participants in the intervention arm received weekly email reminders to access the intervention. The control group received access to the intervention after the trial was completed and received no specific intervention or email reminders. Outcomes were assessed by using self-completion questionnaires. The primary outcome was mental well-being measured with the Warwick-Edinburgh Mental Well-being Scale (WEMWBS). Secondary outcomes were Center for Epidemiologic Studies Depression scale (CES-D) depression scores, Generalized Anxiety Disorder 7-item scale (GAD-7) anxiety scores, EuroQol Group 5-Dimension Self-Report Questionnaire (EQ-5D) quality of life scores, physical activity, and health service use. All outcomes were measured at baseline, and at 6- and 12-week follow-ups. ResultsA total of 1529 (49.80%) participants completed final follow-up at 12 weeks. Retention was 73.11% (1123/1536) in the control arm and 26.47% (406/1534) in the intervention arm. No relationship between baseline measures and withdrawal could be established. The analysis of WEMWBS mental well-being scores using a linear mixed model for repeated measures showed no difference between intervention and control group at baseline (difference –0.124 points, 95% CI –0.814 to 0.566), and significant improvements for the intervention group at 6 weeks (2.542 points, 95% CI 1.693-3.390) and at 12 weeks (2.876 points, 95% CI 1.933-3.819). The model showed a highly significant (P

BackgroundInformation technology can help individuals to change their health behaviors. This is due to its potential for dynamic and unbiased information processing enabling users to monitor their own progress and be informed about risks and opportunities specific to evolving contexts and motivations. However, in many behavior change interventions, information technology is underused by treating it as a passive medium focused on efficient transmission of information and a positive user experience. ObjectiveTo conduct an interdisciplinary literature review to determine the extent to which the active technological capabilities of dynamic and adaptive information processing are being applied in behavior change interventions and to identify their role in these interventions. MethodsWe defined key categories of active technology such as semantic information processing, pattern recognition, and adaptation. We conducted the literature search using keywords derived from the categories and included studies that indicated a significant role for an active technology in health-related behavior change. In the data extraction, we looked specifically for the following technology roles: (1) dynamic adaptive tailoring of messages depending on context, (2) interactive education, (3) support for client self-monitoring of behavior change progress, and (4) novel ways in which interventions are grounded in behavior change theories using active technology. ResultsThe search returned 228 potentially relevant articles, of which 41 satisfied the inclusion criteria. We found that significant research was focused on dialog systems, embodied conversational agents, and activity recognition. The most covered health topic was physical activity. The majority of the studies were early-stage research. Only 6 were randomized controlled trials, of which 4 were positive for behavior change and 5 were positive for acceptability. Empathy and relational behavior were significant research themes in dialog systems for behavior change, with many pilot studies showing a preference for those features. We found few studies that focused on interactive education (3 studies) and self-monitoring (2 studies). Some recent research is emerging in dynamic tailoring (15 studies) and theoretically grounded ontologies for automated semantic processing (4 studies). ConclusionsThe potential capabilities and risks of active assistance technologies are not being fully explored in most current behavior change research. Designers of health behavior interventions need to consider the relevant informatics methods and algorithms more fully. There is also a need to analyze the possibilities that can result from interaction between different technology components. This requires deep interdisciplinary collaboration, for example, between health psychology, computer science, health informatics, cognitive science, and educational methodology.

BackgroundMost households in the United Kingdom have Internet access, and health-related Internet use is increasing. The National Health Service (NHS) Direct website is the major UK provider of online health information. ObjectiveOur objective was to identify the characteristics and motivations of online health information seekers accessing the NHS Direct website, and to examine the benefits and challenges of the health Internet. Methods We undertook an online questionnaire survey, offered to users of the NHS Direct website. A subsample of survey respondents participated in in-depth, semistructured, qualitative interviews by telephone or instant messaging/email. Questionnaire results were analyzed using chi-square statistics. Thematic coding with constant comparison was used for interview transcript analysis. ResultsIn total 792 respondents completed some or all of the survey: 71.2% (534/750 with data available) were aged under 45 years, 67.4% (511/758) were female, and 37.7% (286/759) had university-level qualifications. They sought information for themselves (545/781, 69.8%), someone else (172/781, 22.0%), or both (64/781, 8.2%). Women were more likely than men to seek help for someone else or both themselves and someone else (168/509 vs 61/242, χ22 = 6.35, P = .04). Prior consultation with a health professional was reported by 44.9% (346/770), although this was less common in younger age groups (

Background Internet-based interventions to assist in diabetes management have the potential to provide patients with the information and support they need to become effective self-managers. Objective To assess the feasibility, acceptability, and effectiveness of an Internet-based virtual clinic designed to facilitate self-management in patients who used insulin pumps to manage their diabetes. Methods For a period of 6 months, 17 patients joined the virtual clinic. The system allowed patients to communicate with health professionals, interact with peers and access information. HbA1c, quality of life, and self-efficacy were monitored at baseline and after 6 months. Questionnaires and qualitative interviews examined patient experiences. Results Participants found the virtual clinic easy to use and positively rated its design. Peer support was the most valued aspect and the discussion boards the most used component. All participants highly rated the virtual clinic in terms of improving communication with peers, but few agreed it had improved communication with health care professionals. No significant improvements in physiological and psychological measurements were found. Regarding HbA1c measurements, there was no significant difference found between the pre- and post-test results (P = .53). Mean ADDQoL scores at baseline were -2.1 (SD 1.1, range -3.4 to -0.5) compared to -2.0 (SD 1.2, range, -4.6 to -0.4) post-test (n = 12), (P = .62). Surprisingly, patients’ confidence in their ability to perform self-care tasks was found to be significantly reduced from baseline to follow up (P = .045). Conclusions An Internet-based system to aid the management of diabetes appears feasible and well accepted by patients. The pilot study did not identify evidence of an impact on improving quality of life or self-efficacy in patients who used insulin pump therapy.

Background The development of the Internet has created new opportunities for health care provision, including its use as a tool to aid the self-management of chronic conditions. We studied stakeholder reactions to an Internet-based “virtual clinic,” which would allow people with diabetes to communicate with their health care providers, find information about their condition, and share information and support with other users. Objective The aim of the study was to present the results of a detailed consultation with a variety of stakeholder groups in order to identify what they regard as the desirable, important, and feasible characteristics of an Internet-based intervention to aid diabetes self-management. Methods Three focus groups were conducted with 12 people with type 1 diabetes who used insulin pumps. Participants were recruited through a local diabetes clinic. One-on-one interviews were conducted with 5 health care professionals from the same clinic (2 doctors, 2 nurses, 1 dietitian) and with 1 representative of an insulin pump company. We gathered patient consensus via email on the important and useful features of Internet-based systems used for other chronic conditions (asthma, epilepsy, myalgic encephalopathy, mental health problems). A workshop to gather expert consensus on the use of information technology to improve the care of young people with diabetes was organized. Results Stakeholder groups identified the following important characteristics of an Internet-based virtual clinic: being grounded on personal needs rather than only providing general information; having the facility to communicate with, and learn from, peers; providing information on the latest developments and news in diabetes; being quick and easy to use. This paper discusses these characteristics in light of a review of the relevant literature. The development of a virtual clinic for diabetes that embodies these principles, and that is based on self-efficacy theory, is described. Conclusions Involvement of stakeholders is vital early in the development of a complex intervention. Stakeholders have clear and relevant views on what a virtual clinic system should provide, and these views can be captured and synthesized with relative ease. This work has led to the design of a system that is able to meet user needs and is currently being evaluated in a pilot study.

This article outlines the Mamalilikulla Nation's journey to develop and declare an Indigenous Protected and Conserved Area in November 2021. It speaks to the initiation and inspiration behind the IPCA, including the role of its guardians, and the Nation's inventory and knowledge collection that spoke to the need to manage the area in accordance with its law ofAweena'kola. It speaks to the strategy of leveraging Crown commitments to UNDRIP and reconciliation, and the development of a Marine Protected Areas Network. The importance of planning in advance to outline the Nation's direction is explored, as well as the value of managing for the inter-connection of watersheds with marine areas. The IPCA Declaration ceremony is outlined as a significant way of reconnecting dispersed Nation members and leaders to each other and to the territory. The paper speaks to the long journey ahead.

The burden of large and rare copy number genetic variants (CNVs) as well as certain specific CNVs increase the risk of developing schizophrenia. Several cognitive measures are purported schizophrenia endophenotypes and may represent an intermediate point between genetics and the illness. This paper investigates the influence of CNVs on cognition. We conducted a systematic review and meta-analysis of the literature exploring the effect of CNV burden on general intelligence. We included ten primary studies with a total of 18,847 participants and found no evidence of association. In a new psychosis family study, we investigated the effects of CNVs on specific cognitive abilities. We examined the burden of large and rare CNVs (>200 kb,

In recent years Bournemouth University (BU) has witnessed a growth in undergraduate projects aimed at resolving problems in low-resource communities, with an emphasis on sustainability through the use of locally-available resources and production methods. BU academics have also been involved in helping the Royal National Lifeboat Institute (RNLI) to develop product solutions to help prevent global drowning, with an initial focus on the Bangladeshi context. Alongside the potential to enrich or even save lives in the target communities, such projects can offer considerable benefits to a range of domestic stakeholders: from the students and staff themselves to local businesses and non-government organisations (NGO's). But they can also offer considerable challenges--educationally, ethically and practically--including issues with design validation, the reliability and availability of information, and the barriers of differing cultures and languages. How can educators support low-resource projects successfully? Can students truly gain sufficient understanding of all the relevant issues to design products for an unfamiliar culture, no matter how diverse? And why are low-resource communities looking to designers from the other side of the world to provide low-tech solutions to local problems? Bournemouth University's low-resource projects have achieved varying degrees of success. By examining some of these--including the RNLI's Bottle Buoy, which has recently gained international acclaim--the authors explore the complex issues relating to the use of such projects in an educational context, and present a proposal for future success using jugaad strategies and greater collaboration.

This paper looks at an array of case studies around bridging as a response to the profound othering we witness today. Through the examples explored in this memo, we seek to understand what is required, from an individual to an institutional level, to strengthen practices and principles that offer a path forward toward a world where all belong.

This report discerns between actions that can instigate more suffering through breaking, and those that can lead to compassion, cohesion, and inclusion through bridging. Breaking causes fractures; bridging creates solidarity. Through the lens of bridging and the examples explored in this paper, we can understand what is required, from an individual to an institutional level, to strengthen practices and principles that offer a path forward to help us realize a world where all belong.

Many common illnesses, for reasons that have not been identified, differentially affect men and women. For instance, the autoimmune diseases systemic lupus erythematosus (SLE) and Sjögren's syndrome affect nine times more women than men1, whereas schizophrenia affects men with greater frequency and severity relative to women2. All three illnesses have their strongest common genetic associations in the major histocompatibility complex (MHC) locus, an association that in SLE and Sjögren's syndrome has long been thought to arise from alleles of the human leukocyte antigen (HLA) genes at that locus3-6. Here we show that variation of the complement component 4 (C4) genes C4A and C4B, which are also at the MHC locus and have been linked to increased risk for schizophrenia7, generates 7-fold variation in risk for SLE and 16-fold variation in risk for Sjögren's syndrome among individuals with common C4 genotypes, with C4A protecting more strongly than C4B in both illnesses. The same alleles that increase risk for schizophrenia greatly reduce risk for SLE and Sjögren's syndrome. In all three illnesses, C4 alleles act more strongly in men than in women: common combinations of C4A and C4B generated 14-fold variation in risk for SLE, 31-fold variation in risk for Sjögren's syndrome, and 1.7-fold variation in schizophrenia risk among men (versus 6-fold, 15-fold and 1.26-fold variation in risk among women, respectively). At a protein level, both C4 and its effector C3 were present at higher levels in cerebrospinal fluid and plasma8,9 in men than in women among adults aged between 20 and 50 years, corresponding to the ages of differential disease vulnerability. Sex differences in complement protein levels may help to explain the more potent effects of C4 alleles in men, women's greater risk of SLE and Sjögren's syndrome and men's greater vulnerability to schizophrenia. These results implicate the complement system as a source of sexual dimorphism in vulnerability to diverse illnesses.