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Depression is a growing health and societal problem that has become increasingly prevalent and burdensome. The detection or diagnosis of depression has been very challenging, especially for patients with other comorbidities. Digital phenotyping has emerged as a promising tool for automatic depression detection from user behavior data collected by sensors. However, existing digital phenotyping-based detection of depression has not considered the diagnostic uncertainty caused by similar symptoms shared between depression and other comorbidities, which may negatively affect detection accuracy. We propose a novel deep learning model that processes and fuses data from multiple sensors and addresses the diagnostic uncertainty based on evidence theory. We evaluate the proposed model against state-of-the-art models using sensor data. Our work makes significant contributions to design science research by proposing new artificial intelligence (AI)-based artifacts to deal with uncertainty and to mental health research by improving the accuracy of depression detection in the presence of comorbidity. [ABSTRACT FROM AUTHOR]

BACKGROUND: Sleep is influenced by the environments that we experience while awake and while asleep. Neighborhood walkability has been linked with chronic disease and lifestyle factors, such as physical activity; however, evidence for the association between walkability and sleep is mixed. Extant studies assign walkability based on residential addresses, which does not account for mobility. We examined the association between walkability and sleep in the Nurses Health Study 3 (NHS3) Mobile Health Substudy (MHS). METHODS: From 2018 to 2020, individuals in the United States-based NHS3 prospective cohort participated in the MHS, in which minute-level global positioning systems (GPS) data and objective sleep duration and efficiency measures were collected via a custom smartphone application and Fitbit, respectively, for four 7-day periods across a year to capture seasonal variability. Census tract walkability was calculated by summing z-scores of population density (2015-2019 American Community Survey), business density (2018 Infogroup), and intersection density (2018 TIGER/Line road shapefiles). We ran generalized additive mixed models with penalized splines to estimate the association between walkability and sleep, adjusting for individual-level covariates as well as GPS-based exposure to environmental and contextual factors. RESULTS: The average main sleep period duration was 7.9 hours and the mean sleep efficiency was 93%. For both sleep duration and sleep efficiency, we did not observe an association with daily average walkability exposure. CONCLUSION: In this study of women across the United States, we found that daily GPS-based neighborhood walkability exposure during wake time was not associated with objective wearable-derived sleep duration or sleep efficiency.

BackgroundDual use of both e-cigarettes and cigarettes is popular among young adults and may lead to greater nicotine dependence and additive adverse health effects than single-product use. However, existing cessation programs target quitting either e-cigarettes or cigarettes, highlighting a need for interventions to help young adults quit both products (ie, dual tobacco cessation).ObjectiveThis formative study is part of a larger project to develop a smartphone intervention for dual tobacco cessation among young adults. This study aimed to (1) explore desires for and experiences with quitting both e-cigarettes and cigarettes and (2) identify needs and preferences for dual tobacco cessation intervention programming.MethodsSemistructured interviews were conducted to elicit the need for and experience with dual tobacco cessation among 14 young adults (18-29 years old) recruited through Instagram (Meta) advertisements in 2023. We conducted a thematic analysis to identify common themes related to quitting experiences and cessation needs.ResultsParticipants expressed a strong desire for dual tobacco cessation and had attempted to quit both tobacco products, mostly "cold turkey." The priority product for quitting first varied by the individual's perceived harm or level of consumption. Targets for dual tobacco cessation interventions included (1) highlighting the health effects of dual tobacco use compared with single product use, (2) providing cessation support to quit one prioritized product while cutting down the other product with the explicit goal to quit both, (3) emphasizing unique facilitators and barriers to quitting each product (eg, unpleasant smell of cigarettes facilitating smoking cessation and accessibility and flavors of e-cigarettes hindering vaping cessation), and (4) addressing co-use of tobacco with alcohol or cannabis. Participants wanted personalized interventions through smartphone apps that would tailor support to their tobacco use patterns and unique quitting goals and needs. They also suggested presenting intervention content in multimedia (eg, videos, graphic pictures, quizzes, and games) to increase engagement.ConclusionsThis study provides important insights into young adults' experiences, needs, and preferences for dual tobacco product cessation. We highlight important targets for future smartphone apps to deliver personalized and tailored support to meet the heterogeneous needs and preferences of young people who want to quit using both e-cigarettes and cigarettes.

Background: Few mobile health resistance-based physical activity interventions have targeted community-dwelling adults. "Ecofit" is a multicomponent intervention that promotes resistance and aerobic activities using smartphone technology, outdoor gyms, and social support. This study evaluated process evaluation outcomes of the ecofit randomized controlled trial: (1) the acceptability and usability of the ecofit smartphone app and app user workouts; (2) perceptions of factors influencing outdoor gym use; and (3) the fidelity, reach, recruitment, and dose received of the ecofit program. Methods: Process data were collected through program evaluation surveys at 3 months, and app usage data were collected via the intervention platform for up to 3 months. Data were analyzed using descriptive statistics. Results: The survey was completed by 57% (n = 69) of eligible participants. The majority (93%) believed the app provided them with sufficient information to perform muscle-strengthening activities. Approximately half (51%) agreed that the goal-setting function encouraged them to complete their workouts, and 42% agreed that the self-assessment helped them monitor progress. "Proximity" to outdoor gyms emerged as the most important factor for choosing locations to workout (mean = 5.5, SD = 1.1). Participants logged a median of 5.5 (interquartile range = 19) workouts and 1 (interquartile range = 1) upper- and lower-body muscular fitness self-assessment. Conclusions: The ecofit app provided participants with sufficient skills to perform unsupervised resistance training exercises using mobile health. Only half of the participants regarded self-assessments and goal setting as useful, suggesting a need for modifications to how these are implemented. Mobile health remains a promising delivery platform to promote unsupervised resistance training, although more research is needed to improve uptake. [ABSTRACT FROM AUTHOR]

BACKGROUND: More people who smoke and are living with HIV now die from tobacco-related diseases than HIV itself. Most people are ambivalent about quitting smoking and want to quit someday but not yet. Scalable, effective interventions are needed to motivate and support smoking cessation among people ambivalent about quitting smoking (PAQS) who are living with HIV. OBJECTIVE: This study aims to develop an app-based intervention for PAQS who are living with HIV and assess its feasibility, acceptability, and potential impact. Results of this study will inform plans for future research and development. METHODS: In phase 1, PAQS living with HIV (n=8) participated in user-centered design interviews to inform the final intervention app design and recruitment plan for a subsequent randomized pilot study. In phase 2, PAQS living with HIV were randomized to either a standard care control app or a similar experimental app with additional content tailored for PAQS and those with HIV. Participants were followed for 3 months. Feasibility focused on recruitment, retention, and participants willingness to install the app. The study was not powered for statistical significance. Indices of acceptability (satisfaction and use) and impact (smoking behavior change and treatment uptake) were assessed via automated data and self-report among those who installed and used the app (n=19). RESULTS: Recruitment for both study phases was a challenge, particularly via web-based and social media platforms. Enrollment success was greater among people living with HIV recruited from a health care provider and research registry. Once enrolled, retention for the phase 2 randomized study was good; 74% (14/19) of the participants completed the 3-month follow-up. Phase 1 findings suggested that PAQS living with HIV were receptive to using an app-based intervention to help them decide whether, when, and how to stop smoking, despite not being ready to quit smoking. Phase 2 findings further supported this conclusion based on feedback from people who agreed to use an app, but group differences were observed. Indices of acceptability favored the experimental arm, including a descriptively higher mean number of sessions and utilization badges. Similarly, indices of potential impact were descriptively higher in the experimental arm (proportion reducing smoking, making a quit attempt, or calling free tobacco quitline). No participants in either arm quit smoking at the 3-month follow-up. CONCLUSIONS: On the basis of this formative work, PAQS living with HIV may be receptive to using a mobile health-based app intervention to help them decide whether, when, or how to stop using tobacco. Indices of acceptability and impact indicate that additional research and development are warranted. TRIAL REGISTRATION: ClinicalTrials.gov NCT05339659; https://clinicaltrials.gov/study/NCT05339659.

BACKGROUND: Physical inactivity is associated with adverse health outcomes among Asian Americans, who exhibit the least adherence to physical activity guidelines compared with other racial and ethnic groups. Mobile app-based interventions are a promising approach to promote healthy behaviors. However, there is a lack of app-based interventions focused on improving physical activity among Asian Americans whose primary language is not English. OBJECTIVE: This pilot study aimed to assess the feasibility and acceptability of a 5-week intervention using a culturally and linguistically adapted, evidence-based mobile phone app with an accelerometer program, to promote physical activity among Chinese-, Tagalog-, or Vietnamese-speaking Americans. METHODS: Participants were recruited through collaborations with community-based organizations. The intervention was adapted from a 12-month physical activity randomized controlled trial involving the app and accelerometer for English-speaking adults. Sociodemographic characteristics, lifestyle factors, and physical measurements were collected at the baseline visit. A 7-day run-in period was conducted to screen for the participants who could wear a Fitbit One (Fitbit LLC) accelerometer and complete the apps daily step diary. During the 4-week intervention period, participants wore the accelerometer and reported their daily steps in the app. Participants also received daily messages to reinforce key contents taught during an in-person educational session, remind them to input steps, and provide tailored feedback. Feasibility measures were the percentage of eligible participants completing the run-in period and the percentage of participants who used the app diary for at least 5 out of 7 days during the intervention period. We conducted poststudy participant interviews to explore overall intervention acceptability. RESULTS: A total of 19 participants were enrolled at the beginning of the study with a mean age of 47 (SD 13.3; range 29-70) years, and 58% (n=11) of them were female. Of the participants, 26% (n=5) were Chinese, 32% (n=6) were Vietnamese, and 42% (n=8) were Filipino. All participants met the run-in criteria to proceed with the intervention. Adherence to the app diary ranged from 74% (n=14) in week 2 to 95% (n=18) in week 4. The daily average steps per week from accelerometers increased each week from 8451 (SD 3378) steps during the run-in period to 10,930 (SD 4213) steps in week 4. Participants reported positive experiences including an increased motivation to walk and the enjoyment of being able to monitor their physical activity. CONCLUSIONS: This is the first pilot study of a multicomponent intervention and evidence-based mobile phone app to promote physical activity among Asian Americans who use apps in traditional Chinese, Tagalog, or Vietnamese, which demonstrated high feasibility and acceptability. Future work focused on multilingual mobile apps to address disparities in physical inactivity among Asian Americans should be considered.

AbstractBackgroundMethodsResultsConclusionIn this article, we describe an institutional ethnographic investigation of the housing and homelessness response in one municipality in Ontario, Canada.Drawing on 42 interviews with social service professionals and municipal government employees and 49 interviews with people who are or have been using municipal housing and homeless services (e.g. emergency shelters, mobile healthcare, outreach services, transitional housing), we bring into view some of the inter-institutional and organizational processes that shape housing precarity among people who use drugs.Our research pinpoints specific institutionally-organized processes – i.e. structural vulnerabilities – that expose people who use drugs to housing loss, unsheltered homelessness, and difficulties in re-housing (or homeless chronicity). In many cases, the processes also make people more vulnerable to harms associated with substance use.The specificity of our analysis points toward policy, legislative and institutional reforms that could improve access to justice, health, and housing for people who use drugs. [ABSTRACT FROM AUTHOR]

The purpose of this study was to improve measurement of physical activity self-efficacy (PASE) in adults with obesity by evaluating relationships between responses to a new battery of PASE Scales and physical activity (PA). Specifically, relationships between a recently proposed two-dimensional (shorter and longer durations) latent PASE conceptualization and PA was evaluated across intensities (moderate, vigorous) and domains (work, transport, domestic, leisure) measured by the PASE Scales. Longitudinal secondary data (N = 461) from the Well-Being and Physical Activity (ClinicalTrials.gov, identifier: NCT03194854) study, which deployed the Fun For Wellness (FFW) intervention, were analyzed. A positive direct effect (latent PASE→PA) was observed for the shorter (but not the longer) duration in each domain at both intensities. A positive indirect effect (FFW→latent PASE→PA) was observed for the shorter (but not the longer) duration in each domain at a moderate (but not vigorous) intensity. These results have implications for PA-promotion in this at-risk population. [ABSTRACT FROM AUTHOR]

Straight: What is Your Secret?, a Mexican gay comedy-drama directed by Marcelo Tobar, premiered in November 2024 adapted from its theatrical version. The film explores themes of sexuality, relationships, and identity through the story of Roberto (Alejandro Speitzer), a banker in a six-year heterosexual relationship with Elia (Bárbara López). Roberto’s life takes a turn when he begins a sexual relationship with Cris (Franco Masini), a young man he meets through an app. This affair forces him to confront his happiness and question his true identity. While the movie incorporates humor and situational comedy, it delves into profound issues like self-discovery, acceptance, and the struggles faced by LGBTQ+ individuals, particularly in regions dominated by machismo and heteronormative norms. Franco Masini’s portrayal of Cris adds depth, as his character becomes Roberto’s guide to authenticity and self-respect. The film sheds light on societal pressures, internalized homophobia, and the challenges of coming out in developing countries. The films balances humor with meaningful discourse, challenging stereotypes and offering representation to LGBTQ+ experiences. It invites audiences to reflect on their assumptions about sexuality while promoting empathy and awareness, making it a significant contribution to LGBTQ+ cinema. [ABSTRACT FROM AUTHOR]

Background: This study aimed to compare the effectiveness of exercise therapy delivered via a smartphone mobile app, using asynchronous video-based tools, with synchronous telerehabilitation models using videoconferencing for individuals with fibromyalgia syndrome (FMS). Methods: The research, utilizing a randomized clinical study design, involves sixty-six FMS patients in an 8-week exercise program. Participants are divided into synchronous (n: 33) and asynchronous (n: 33) groups. Assessments, pain intensity (VAS), functional limitations (FIQr), health-related quality of life (SF 12), catastrophizing (PCS), anxiety and depression (HADS), functional capacity (6MWT), muscle strength (Arm curl test), and joint position sense (LI-RATT), are conducted at baseline, mid-treatment (week 4), end of treatment (week 8). Results: No significant group-time interaction was found for total VAS, FIQ, SF 12, PCS, HADS, 6MWT, Arm curl tests, LI-RATT extension, LI-RATT flexion, LI-RATT right rotation scores (p > 0.05). Significant effects of time and interactions between groups and time were observed in the neck (p = 0.010, ES = 0.19) and back region (p = 0.039, ES = 0.19) of the Visual Analog Scale, left rotation score of the LI-RATT (p = 0.008, ES = 0.36), and HADS Anxiety Score (p = 0.029, ES = 0.31). Group differences were significant at all-time points for the outcomes (p < 0.001), except for the right rotation of LI-RATT (p = 0.633). Conclusion: The study suggests that asynchronous telerehabilitation is comparable to synchronous methods in addressing pain, quality of life, and other factors in FMS patients. The asynchronous approach may offer advantages in reducing the burden on healthcare professionals and being cost-effective. Future research should explore diverse telerehabilitation protocols and their impact on overall care burdens. Trial registration: NCT06299527 (01/03/2024). [ABSTRACT FROM AUTHOR]

Background: Mobile health (mHealth) tools have gained prominence in global healthcare in recent years, with demonstrated impacts on managing service users' health. While many systematic reviews have assessed the effectiveness of mHealth on health outcomes, the role of health professions in promoting mHealth adoption and leading to improved outcomes is less clear. This systematic review of systematic reviews (SR of SRs) critically appraises and synthesises evidence to examine both the impact of mHealth interventions on service users' outcomes and the role of health professions in facilitating their adoption. Methods: Five electronic databases—EMBASE, CINAHL Plus, Medline, Web of Science, and the Cochrane Library—were searched for systematic reviews published between 1 January 2015 and 8 June 2024. Reviews focused on the impact of mHealth interventions on service users' outcomes and the role of health professions in promoting adoption were included. Screening, data extraction, and quality assessment were conducted by four independent reviewers. Results: Fourteen systematic reviews, covering 393 primary studies, were included. mHealth interventions showed positive impacts on clinical outcomes, such as reductions in blood pressure, HbA1c, and cholesterol. Behavioural improvements were also reported, including better medication adherence and physical activity. Psychological benefits, such as reduced anxiety and enhanced patient satisfaction, were noted. The involvement of health professions significantly enhanced mHealth outcomes. However, challenges such as sustainability, accessibility, and usability remain. Discussion: This SR of SRs provides critical insights into the effectiveness of mHealth interventions on health outcomes and highlights the important role of health professions in promoting their adoption. While the findings are promising, concerns about training, sustainability, accessibility, and user acceptance need to be addressed to improve the broader adoption of mHealth interventions. Further research is recommended to address these challenges and enhance the long-term success of mHealth tools in healthcare. Trial registration: PROSPERO CRD 42023414435. DOI: https://doi.org/10.1186/s13643-024-02624-y [ABSTRACT FROM AUTHOR]

Background: Telemedicine interventions, while promising for enhancing healthcare access, require an evaluation of feasibility and acceptability to inform field implementation. This qualitative study explored the acceptability of a telemedicine intervention in which surgical incision photos taken by community health workers (CHWs) were sent to hospital-based general practitioners to diagnose surgical site infections (SSIs) following cesarean section in rural Rwanda. As the study timeline coincided with the beginning of the COVID-19 pandemic we additionally asked about their perceptions of telemedicine in this context. Methods: We conducted qualitative, semi-structured in-depth interviews in Kinyarwanda among 26 individuals (14 women and 12 CHWs) who participated in the telemedicine intervention. The interviews were transcribed verbatim and translated into English. Thematic analysis was applied and parallel inductive coding was used to develop English and Kinyarwanda codebooks. These were consolidated into a master codebook for final coding. Results: All women and CHWs found the photo-based telemedicine program acceptable, though some concerns were raised. One woman voiced concerns about the reliability of photos in detecting SSIs compared to in-person visits. Women and CHWs reported perceived faster healing associated with the intervention, enhanced access to postoperative care from home, and cost savings as notable benefits of the telemedicine program. Trust in CHWs emerged as a critical factor for community acceptance. While one CHW expressed reservations about implementing the intervention during COVID-19, the majority of CHWs and patients indicated strong acceptance, with some even preferring it. Conclusion: These findings highlight the acceptance - from both caregivers and patients - of the photo-based telemedicine intervention in a resource-limited context, even amid crises like the COVID-19 pandemic. This acceptance was reinforced with recognized benefits, with trust in CHWs serving as a crucial factor. These insights can inform the development of telemedicine interventions in similar settings. [ABSTRACT FROM AUTHOR]

Objective: This study delineated the unmet mental health needs of peripartum mothers with symptoms of depression, ascertained their willingness to engage in psychotherapy via text message, and identified potential determinants of that willingness (e.g., demographics, preferred communication methods) to inform improvement to service delivery. Method: This was a cross-sectional national survey of 897 adults who had given birth in the previous 24 months, had at least one lifetime symptom of depression, had internet access, and could read English. Univariate analysis was followed by multivariable Firth's logistic regression. Results: Peripartum participants with at least one symptom of depression wanted mental health care the most within 2 years of giving birth (64.4%) and had less access to mental health care during pregnancy and postpartum (35.1% and 38.1%, compared with 23.9%). Fifty-three percent of participants were willing to engage in psychotherapy via text message. Determinants of willingness to engage in text message therapy for all periods (pregnancy, postpartum, and not peripartum) included wanting mental health treatment but not having access and previous experience with psychotherapy via text message. During pregnancy and not peripartum, more depressive symptoms were associated with willingness to engage in psychotherapy via text message. Conclusion: The peripartum period is an especially high-risk time for mothers to experience depressive symptoms. In general, most wanted therapy but were unable to access it. Most participants were willing to engage in text message therapy. [ABSTRACT FROM AUTHOR]

Nowadays, most of the medical records are maintained in a digital format known as Electronic Health Records Sharing (EHRS) framework. Patients have individual login credentials for accessing these medical records. In the BCT, the information about the owner of the block and its dependency over other blocks is maintained in itself. Moreover, each block is linked with its nearby blocks, leading to a network controlled by patients responsible for storing and sharing the information. In healthcare, BCT can help with mobile health apps, monitoring equipment, sharing and keeping of clinical trial data, electronic medical records, and insurance information storage. This study proposes a secure Patient Login Credential System (PLCS) for EHRS. The proposed scheme has been included for block encryption with the symmetric and asymmetric cryptography algorithms with respect to the hospital server and patients. Additionally, the Quantum Secure Trust Protocol (QSTP) is integrated to enhance trust and security between the patient-side and hospital-side, maintaining data integrity and confidentiality. Similarly, the Tune Swarm Optimization (TSO) algorithm is utilized to optimize performance metrics. The security analysis for the proposed scheme has been evaluated with basic security assumptions for information systems like, availability, access control, maintaining forward secrecy, and maintaining data integrity. The proposed scheme demonstrated enhanced security and performance, with IDEA achieving encryption in 58 ms and decryption in 278 ms for a 512-bit block, offering the best performance in terms of encryption speed. [ABSTRACT FROM AUTHOR]

Mental health apps (MHAs) are increasingly popular in India due to rising mental health awareness and app accessibility. Despite their benefits, like mood tracking, sleep tools and virtual therapy, MHAs lack regulatory oversight. India's framework, including the Central Drugs Standard Control Organization (CDSCO) and Medical Device Rules 2017, does not cover standalone health apps, raising concerns about data privacy and accuracy. Establishing a centralised regulatory body with guidelines for MHAs is essential for user safety and efficacy. This paper examines the current regulatory landscape, compares international approaches and proposes a tiered regulatory framework to foster responsible innovation while safeguarding user interests in digital mental health services. [ABSTRACT FROM AUTHOR]

Eating disorders are becoming an increasingly severe public health issue in China, with an urgent need to update intervention approaches. This paper introduces the role of various forms of mobile health in the prevention and treatment of eating disorders. Online psychotherapy has demonstrated efficacy comparable to face-to- face therapy. Mobile applications provide multiple functions, including psychotherapy, self-monitoring, and instant intervention, and their effectiveness has been widely validated. Wearable sensors, as monitoring tools, bring new possibilities for tracking eating behaviors and detecting risk signals. Looking forward, future efforts should prioritize the development of data-driven personalized treatment plans and explore the full potential of mobile health technologies in managing eating disorders across their entire course. [ABSTRACT FROM AUTHOR]

Objective: Mobile health (mHealth), defined as the use of mobile phones or applications in healthcare, has been developed to enhance asthma care; yet implementation is inconsistent, and few studies have focused on provider perspectives on use in daily practice. The purpose of this study was to explore primary care pediatric provider perspectives regarding mHealth use in clinical practice for children with asthma. Methods: A qualitative, descriptive approach was utilized to perform semi-structured interviews on asthma mHealth use with providers caring for children with asthma. Interview transcripts were coded by two independent investigators and any differences were reconciled. Interviews continued until thematic saturation was achieved. Results and Conclusions: Seventeen pediatric providers were recruited and interviewed. Three themes identified included implementation benefits, implementation barriers, and reporting desires, with 11 subthemes. Many subthemes were consistent across providers (e.g. self-management benefits and electronic medical record integration), while others such as provider clinical burden and approach to integrating mHealth data reports into daily workflow demonstrated variability. Provider perspectives highlight the potential of mHealth applications in asthma self-management while offering challenges related to clinical burden and suggestions for reporting and workflow integration. These results provide valuable perspectives on mHealth use and reporting to ensure provider efficiency and technology-enhanced asthma care. This study investigates pediatric provider perspectives on asthma mobile health use and reporting in daily practice, a topic that has not sufficiently been explored within the literature. Results can guide best practices, encourage more consistent use, and maximize the benefits of asthma mHealth tools by providers. [ABSTRACT FROM AUTHOR]

Background: The Enhanced Recovery After Surgery (ERAS) protocol improved perioperative colorectal care. Although the protocol is firmly implemented across hospital settings, there are benefits to gain by actively involving patients in their recovery. The main objective of this study was to investigate whether compliance with selected items in the ERAS protocol could further improve by using a patient-centred mobile application. Method: This multicentre, randomised controlled trial was conducted between October 2019 and September 2022. Patients aged 18 years or older who underwent elective colorectal surgery, and in possession of a smartphone were included. The intervention group used a mobile application combined with an activity tracker to be guided and supported through the ERAS pathway. The control group received standard care and wore an activity tracker to monitor their daily activities. The primary outcome was overall compliance with selected active elements of the ERAS protocol. Results: In total, 140 participants were randomised to either the intervention (n = 72) or control group (n = 68). The use of the ERAS App demonstrated a significant improvement in overall compliance by 10%, particularly in early solid food intake by 42% and early mobilization by 27%. Postoperative or patient reported outcomes did not differ between groups. Conclusion: The smartphone application 'ERAS App' is able to improve adherence to the active elements of the ERAS protocol for colorectal surgery. This is an important step towards optimizing perioperative care for colorectal surgery patients and enabling patients to optimize being in control of their own recovery. Trial registration: ERAS APPtimize, NTR7314 (https://trialsearch.who.int/Trial2.aspx?TrialID=NL-OMON29410). [ABSTRACT FROM AUTHOR]

Objective To determine the efficacy of the mLab App, a mobile-delivered HIV prevention intervention to increase HIV self-testing in MSM and TGW. Materials and methods This was a randomized (2:2:1) clinical trial of the efficacy the mLab App as compared to standard of care vs mailed home HIV test arm among 525 MSM and TGW aged 18-29 years to increase HIV testing. Results The mLab App arm participants demonstrated an increase from 35.1% reporting HIV testing in the prior 6 months compared to 88.5% at 6 months. In contrast, 28.8% of control participants reported an HIV test at baseline, which only increased to 65.1% at 6 months. In a generalized linear mixed model estimating this change and controlling for multiple observations of participants, this equated to control participants reporting a 61.2% smaller increase in HIV testing relative to mLab participants (P  = .001) at 6 months. This difference was maintained at 12 months with control participants reporting an 82.6% smaller increase relative to mLab App participants (P  < .001) from baseline to 12 months. Discussion and conclusion Findings suggest that the mLab App is well-supported, evidence-based, behavioral risk-reduction intervention for increasing HIV testing rates as compared to the standard of care, suggesting that this may be a useful behavioral risk-reduction intervention for increasing HIV testing among young MSM. Trial registration This trial was registered with Clinicaltrials.gov NCT03803683. [ABSTRACT FROM AUTHOR]

Given the growing global burden of non-communicable diseases (NCDs) alongside the widespread use of mobile phones, efforts have emerged to collect NCD risk factor surveillance data in low- and middle-income countries using mobile phones, increasingly so with the involvement of “outside” commercial actors. In this paper, we consider multiple potential ways to realize and support the distribution of benefits, traditional and non-traditional, from such digital public health surveillance activities, acknowledging the need for careful considerations of likely implementation risks and challenges. We put forward the concept of “digital benefit sharing”: the provision of resources or services of value commensurate with the digital data contributed or collected from mobile phone users, in recognition of their contribution to the advancement of public health. These benefits can be directed towards individuals and the communities, professionals, and governments where the data collection activity occurred. We ground digital benefit sharing in global health justice, as it makes visible the obligations of data collectors and commercial actors towards data contributors. We also consider financial, logistical, data privacy, and data quality-related challenges associated with digital benefit sharing and call for additional governance and stakeholder engagement to facilitate a transition from concept to practice. [ABSTRACT FROM AUTHOR]

By consistently taking medication, people with HIV (PWH) can attain viral suppression, improving their health and reducing transmission risk. PositiveLinks (PL) is a clinic-deployed mobile platform designed to improve engagement in care for PWH by enabling them to track their medications, connect with peers, and communicate with providers. This project investigated the experience of PL users who had recent periods of viral non-suppression to understand how these high-risk episodes can be predicted and prevented. Fifteen participants completed mental health measures and in-depth interviews. Two members of the study team independently coded interview transcripts and resolved any discrepancies. The codebook was developed iteratively until thematic saturation and intercoder reliability were achieved. Participants revealed mental health and substance use concerns. Frequent stressors highlighted were relationship challenges, financial difficulties, and unstable living situations. Relationship challenges were a common barrier to care, along with competing priorities, transportation and finances. In contrast, positive relationships, motivation, positive interactions with clinic staff, and social programs facilitated regaining viral suppression. Participants highlighted the importance of strong patient-provider relationships and social support in overcoming barriers to care. We identified factors that impact medication adherence, which will inform efforts to mitigate and prevent viral non-suppression and thus improve health outcomes. [ABSTRACT FROM AUTHOR]

Background: Prevention of (suicidal) crisis starts with appreciating its dynamics. However, crisis is a complex multidimensional phenomenon and how it evolves over time is still poorly understood. This study aims to clarify crisis dynamics by clustering fluctuations in the interplay of cognitive, affective, and behavioral (CAB) crisis factors within persons over time into latent states. Methods: To allow for fine grained information on CAB factors over a prolonged period of time, ecological momentary assessment data comprised of self-report questionnaires (3 × daily) on five CAB symptoms (self-control, negative affect, contact avoidance, contact desire and suicidal ideation) was collected in twenty-six patients (60 measurements per patient). Empirically-derived crisis states and personalized state dynamics were isolated utilizing multilevel hidden Markov models. Results: In this proof-of-concept study, four distinct and ascending CAB-based crisis states were derived. At the sample level, remaining within the current CAB crisis state from one five-hour interval to the next was most likely, with staying likeliness decreasing with ascending states. When residing in CAB crisis state 2 or higher, it was least likely to transition back to CAB crisis state 1. However, large patient heterogeneity was observed both in the tendency to remain within a certain CAB crisis state and transitioning between crisis states. Conclusion: The uncovered crisis states using multilevel HMM quantify and visualize the pattern of crisis trajectories at the patient individual level. The observed differences between patients underlines the need for future innovation in personalized crisis prevention, and statistical models that facilitate such a personalized approach. [ABSTRACT FROM AUTHOR]

Background: Early pregnancy loss (EPL) occurs in 10%–15% of all pregnancies but remains an underrecognized and undertreated condition. In Canada, resources to support individuals and their partners facing EPL remain scarce despite a high burden of psychosocial sequelae. Digital health tools hold the potential to fill important gaps in reproductive healthcare. Objectives: We sought to better understand the perspectives of individuals who experienced pregnancy loss and explore how digital health tools could offer support. Design: We conducted a qualitative study with grounded theory methodology to address our objectives. Methods: The study was conducted between September 2021 and April 2022 in Ottawa, Canada. Participants between 18 and 45 years of age who resided in Canada and experienced EPL up to 12 + 6 week gestation within the last 2 years were included. Enrolled participants who provided informed consent completed a single in-depth interview. Data were analyzed iteratively by two trained research team members with thematic techniques supported by NVivo software. Results: Interviews were conducted with 14 participants who had experienced EPL. All participants identified as female and resided in Canada, with 28.6% (n = 4) between 26 and 30 years of age, and the remaining 71.4% (n = 10) between 31 and 40. Qualitative analysis identified three primary themes centered around participants' experiences of miscarriage, access to information and support for EPL in Canada, and desires and preferences for a digital miscarriage tool. Conclusion: Miscarriage is an emotionally difficult experience for women and their loved ones, who often do not receive timely and compassionate care within the healthcare system. Participants were highly motivated to co-develop a digital intervention for EPL that is designed to fill gaps in care. The digital companion would assist individuals through their miscarriage journey by providing evidence-based and locally relevant medical information as well as avenues to access both professional and informal forms of psychosocial support. [ABSTRACT FROM AUTHOR]