@Article{info:doi/10.2196/72124,
author="Lee, Loy Teddy Tai
and Lyu, Chang-Hao Alex
and Jiang, Ting Ting
and Chan, Long Sunny Ching
and Chan, Ying Crystal
and Yip, Fung Edmond Tsz
and Luk, Fung Luke Yik
and Ho, Kei Joshua Wing
and So, Leong Kevin Wang
and Tsui, Kiu Omar Wai
and Lam, Lok Man
and Lee, Yeow Shi
and Yamamoto, Tafu
and Tong, Kwan Chak
and Wong, Sing Man
and Wong, Yi Eliza Lai
and Wai, Chung Abraham Ka
and Rainer, Hudson Timothy",
title="Effectiveness of Antivirals Nirmatrelvir-Ritonavir and Molnupiravir in Viral Sepsis: Retrospective Cohort Study",
journal="JMIR Public Health Surveill",
year="2025",
month="Sep",
day="18",
volume="11",
pages="e72124",
keywords="organ dysfunction",
keywords="viral infection",
keywords="sepsis",
keywords="antivirals",
keywords="COVID-19",
abstract="Background: Viral infections, including those leading to sepsis, are common but often overlooked in clinical practice, yet the treatment strategies for viral sepsis remain inadequately defined. Objective: This study aims to investigate the effectiveness of antivirals nirmatrelvir-ritonavir and molnupiravir in the treatment of culture-negative sepsis. Methods: This retrospective cohort study was conducted across public hospitals in Hong Kong. We included patients diagnosed with COVID-19 between February 22, 2022, and June 30, 2023, who had no secondary bacterial or fungal infections. Propensity score matching was used to assess the efficacy of the antivirals nirmatrelvir-ritonavir and molnupiravir in patient subgroups with or without organ dysfunction at hospital admission, including circulatory shock, respiratory failure, acute kidney injury, coagulopathy, acute liver impairment, a composite of all organ dysfunctions, or no organ dysfunction. Key outcomes were in-hospital mortality and length of stay, reported as hazard ratios (HR) and mean differences, respectively. Results: The study included 15,599 COVID-19 patients with a mean age of 75.1 (SD 15.9) years. Molnupiravir treatment was associated with a significantly lower risk of mortality in patients in both the presence of any organ dysfunction (HR 0.75, 95\% CI 0.58 to 0.96) and without organ dysfunction (HR 0.29, 95\% CI 0.15-0.56). Nirmatrelvir-ritonavir was associated with decreased mortality with respiratory failure (absolute risk difference: 9.5\%, 95\% CI 6.26-12.72) and without organ dysfunction (HR 0.17, 95\% CI 0.05-0.56). Antivirals also reduced the length of hospital stay; nirmatrelvir-ritonavir reduced length of stay in respiratory failure by an average of 3.37 (95\% CI 2.32-4.42) days, acute kidney injury by 7.25 (95\% CI 2.97-11.52) days, and coagulopathy by 7.04 (95\% CI 2.99-4.05) days. Molnupiravir reduced the length of stay in acute kidney injury by an average of 6.7 (95\% CI 2.39-11.08) days and coagulopathy by 5.68 (95\% CI 1.20-10.16) days. Conclusions: Antivirals reduced mortality among hospitalized COVID patients, with the greatest reduction observed in patients without organ dysfunction. Antivirals were also effective in reducing the length of hospital stay. ",
doi="10.2196/72124",
url="https://publichealth.jmir.org/2025/1/e72124"
}


@Article{info:doi/10.2196/66829,
author="Ren, Shaotong
and Li, Tiantian
and Zhang, Yongzhong
and Bai, Song
and Zhou, Zichen
and Li, Shengxin",
title="Preparing for Potential Health and Safety Risks at the Olympic Games: Scoping Review",
journal="JMIR Public Health Surveill",
year="2025",
month="Sep",
day="3",
volume="11",
pages="e66829",
keywords="Olympic Games",
keywords="illness",
keywords="injury",
keywords="terrorism",
keywords="surveillance",
keywords="PRISMA",
abstract="Background: The Olympic Games are an example of a mass gathering that involves a complex and large crowd composition, with a large number of illnesses and injuries occurring at previous Olympic Games, and the Olympic Games also becoming a target for terrorist attacks. Objective: With the help of mass-gathering medicine as a guide, this study aims to critically summarize and analyze the state of illness, injury, and terrorism during the Olympic Games in order to reduce the incidence of illnesses and injuries in crowds and to offer lessons for the organization of major international sporting events such as the Olympics. Methods: The procedure for this scoping review followed the 5-step methodological framework of Arksey and O'Malley. We searched electronic databases such as PubMed, Web of Science, and Scopus. We extracted, summarized, and categorized general information on each study, game characteristics, illness and injury profiles, terrorism characteristics, preventive measures, and surveillance paradigms. Results: We conducted a database search and retrieved a total of 9587 studies on 2 occasions. After removing duplicates and screening, we included 120 studies. Only 12 studies on the Summer, Winter, and Paralympic Games published before 2000, and 108 studies from 2000 onward, comprise the 120 studies, marking an unprecedented number of studies in this field of research, particularly in recent times. Of the 120 studies, 80 were illness-related, 81 were injury-related, and 2 were terrorism-related. Nine studies explicitly assessed body parts, including shoulders, feet, and dentistry; 26 studies specifically investigated certain illnesses and injuries, such as COVID-19 disease, heat-related illnesses, and concussions. Of the 120 research studies, 18 specifically analyzed sports such as gymnastics and weight lifting, with 11 studies focusing especially on COVID-19 disease. The most studied games were the Tokyo 2021 Olympic or Paralympic Games, the London 2012 Olympic or Paralympic Games, and the Rio 2016 Olympic or Paralympic Games. The system of injury and illness surveillance in the Olympic Games goes through 3 stages of development: the first trial of information technology, the construction of networks, and the enhancement of intelligence. Conclusions: A critical summary of studies of illness, injury, and terrorist attacks at previous Olympic Games is important for injury and terrorism prevention at major sporting events such as the Olympic Games. Surveillance methods require improvements in surveillance technology, data sharing, and privacy protection. ",
doi="10.2196/66829",
url="https://publichealth.jmir.org/2025/1/e66829"
}


@Article{info:doi/10.2196/65116,
author="Bautista-Gomez, Milena Martha
and Zuluaga Gutierrez, Sofia Laura",
title="Developing a Health Education Program for the Prevention and Control of Infectious Diseases Culturally Adapted to Ethnic and Rural Communities: Co-Design Study Using Participatory Audiovisual Methods",
journal="J Particip Med",
year="2025",
month="Aug",
day="29",
volume="17",
pages="e65116",
keywords="co-design of health interventions",
keywords="participatory audiovisual methods",
keywords="cultural adaptation",
keywords="infectious diseases",
keywords="health education program",
keywords="ethnic communities",
abstract="Background: Infectious diseases disproportionately affect rural and ethnic communities in Colombia, where structural inequalities such as limited access to health care, poor sanitation, and scarce health education worsen their effects. Education is essential for preventing and controlling infectious diseases, fostering awareness of healthy behaviors, and empowering communities with the knowledge and skills to manage their health. Participatory and co-design methods strengthen educational programs by ensuring cultural relevance, enhancing knowledge retention, and promoting sustainable community interventions. Objective: This study aims to describe the co-design process and evaluate the capacity building of an education program for the prevention and control of infectious diseases using participatory audiovisual methods culturally adapted to ethnic communities and rural contexts in Colombia. Methods: A qualitative case study approach was used. 15 community leaders contributed to the program's design, implementation, and evaluation. Nominal groups and a participatory social diagnosis identified key topics, while theoretical-practical sessions with visual methods guided the cocreation of workshops and audiovisual materials. Evaluation combined qualitative analysis of participants' perceptions and quantitative assessment of knowledge acquisition. Qualitative data were coded through content analysis, while multiple-choice questionnaires (initial and final) categorized knowledge acquisition into 3 levels (low, medium, and high), with percentage distributions used for comparative analysis. Results: The co-design process resulted in 12 theoretical and practical workshops in infectious diseases and 3 audiovisual products: an animation about malaria, a comic book about cutaneous leishmaniasis, and a puppet show about tuberculosis. The quantitative evaluation applied to the 15 participants revealed substantial improvements, with the proportion that achieved excellent scores in pedagogy increasing from 40\% (6/15) to 93\% (14/15), in leadership from 13\% (2/15) to 27\% (4/15). In terms of health knowledge, excellent scores increased from 40\% for leishmaniasis, 60\% for malaria, and 13\% for tuberculosis, reaching 80\% for all three diseases. The qualitative evaluation showed positive results in terms of the participants' perceptions of both the methodology and the co-design process outcomes. Conclusions: The co-design process was driven by 3 key factors: (1) active community participation at every stage; (2) knowledge exchange between multidisciplinary technical expertise and practical local knowledge; and (3) the use of innovative, culturally adapted pedagogical tools tailored to the rural context and population. This co-design process proved to be an effective method for meaningful capacity building among populations experiencing vulnerability in complex settings, and has the potential to contribute significantly to the improvement of infectious disease prevention and control. ",
doi="10.2196/65116",
url="https://jopm.jmir.org/2025/1/e65116"
}


@Article{info:doi/10.2196/67544,
author="Boakye Okyere, Portia
and Twumasi-Ankrah, Sampson
and Newton, Sam
and Nkansah Darko, Samuel
and Owusu Ansah, Michael
and Darko, Eric
and Agyapong, Francis
and Jeon, Jin Hyon
and Adu-Sarkodie, Yaw
and Marks, Florian
and Owusu-Dabo, Ellis",
title="Risk Factors for Typhoid Fever: Systematic Review",
journal="JMIR Public Health Surveill",
year="2025",
month="Aug",
day="28",
volume="11",
pages="e67544",
keywords="typhoid fever",
keywords="risk factors",
keywords="foodborne",
keywords="waterborne",
keywords="systematic review",
abstract="Background: Typhoid fever, a significant global health problem, demonstrates a multifaceted transmission pattern. Knowledge of the factors driving its transmission is critical for developing effective control strategies and optimizing resource allocation. Objective: This review aimed to comprehensively synthesize evidence on risk factors associated with typhoid fever transmission from 1928 to 2024. Methods: We searched PubMed, Scopus, Google Scholar, and Semantic Scholar databases using keywords related to risk, contributors, determinants, and causes of typhoid fever. We followed a registered protocol to support our search and triangulated the results. Results: Overall, we retrieved 1614 articles, of which 219 were reviewed. Of these, 109 addressed multiple, non--mutually exclusive typhoid fever risk factors. Unsurprisingly, of the total articles reviewed on risk factors, approximately 70.6\% (77/109) originated from the Asian continent (51/109, 46.8\%) and the African continent (26/109, 23.9\%). Half of the articles (55/109, 50.5\%) focused on risk factors related to demographic and socioeconomic transmission, while 44\% (48/109) of the articles examined foodborne transmission. Additional risk factors included water, sanitation, and hygiene practices: waterborne transmissions (45/109, 41.3\%) and sanitation and hygiene practices (34/109, 31.2\%), travel-related risk (19/109, 17.4\%), antimicrobial use (14/109, 12.8\%), climate-related factors (15/109, 13.8\%), environment-related factors (9/109, 8.3\%), typhoid carriers (11/109, 10.1\%), and host-related risk factors (6/109, 5.5\%). Conclusions: This review identifies demographic and socioeconomic factors as key drivers of typhoid transmission, underscoring the need for targeted interventions. Strengthening street food regulation in urban Asia and investing in water infrastructure in rural Africa can significantly mitigate risk. Integrating water, sanitation, and hygiene interventions with typhoid vaccines can reduce immediate exposure while enhancing long-term immunity. Prioritizing these strategies in schools and high-risk communities is essential for sustainable typhoid control. Future research should focus on longitudinal studies to assess risk factor causality and vaccine impact, guiding more effective public health interventions. ",
doi="10.2196/67544",
url="https://publichealth.jmir.org/2025/1/e67544",
url="http://www.ncbi.nlm.nih.gov/pubmed/40875987"
}


@Article{info:doi/10.2196/73953,
author="van Deursen, Babette
and Raven, Stijn
and van den Bosch, Wolfer
and van Jaarsveld, M. Cornelia H.
and Timen, Aura",
title="A ``Pandemic-Proof'' Methodology for Outbreak Detection Adapted From COVID-19's Impact on Notifications of Infectious Diseases in the Netherlands: Surveillance Study",
journal="JMIR Public Health Surveill",
year="2025",
month="Aug",
day="26",
volume="11",
pages="e73953",
keywords="public health surveillance",
keywords="COVID-19 pandemic",
keywords="infectious diseases",
keywords="epidemiology",
keywords="outbreak detection",
keywords="routine surveillance data",
abstract="Background: Reporting of notifiable infectious diseases was overall impacted by the COVID-19 pandemic. This could affect disease surveillance and thus, outbreak detection, as it is based on historical data. For effective outbreak detection, it is crucial that communicable disease control professionals can rely on accurate and valuable alarm thresholds to ensure timely and adequate response to potential outbreaks. Objective: In this study, we take the first steps in the development of a methodology that adjusts for the impact of the COVID-19 pandemic on the number of notifications of notifiable infectious diseases and provides corrected alarm thresholds for outbreak detection. We identify which infectious diseases were affected by the COVID-19 pandemic, assess the duration of these effects, and explore potential correction methods to improve outbreak detection. Methods: We analyzed cases of 25 notifiable infectious diseases reported from 2015?2023 in the Netherlands. Negative binomial regression was used to calculate the incidence rate ratios for each period: pre-COVID-19 pandemic, COVID 2020, COVID 2021, COVID 2022, and post-COVID-19 pandemic. To address the decrease in notifications during the COVID-19 pandemic, we tested 3 correction methods: (1) recoding COVID-19 years as missing; (2) imputing with the last pre-COVID-19 pandemic observation; and (3) imputing the historical moving average. Results: Between 2015?2023, a total of 74,990 notifications were reported in the Netherlands, of which 9,836 notifications (13\%) occurred during the COVID-19 pandemic. Malaria, typhoid fever, hepatitis A, meningococcal infection, paratyphoid fever, Q-fever, shigellosis, measles, mumps, and pertussis had significantly lower notifications during the COVID-19 pandemic, but the duration and magnitude of the effect differed among the infections. The effect of the COVID-19 pandemic on the notifications of malaria (incidence rate ratio [IRR] 0.17, 95\% CI 0.08?0.36) and typhoid fever (IRR 0.12, 95\% CI 0.02?0.55) was only seen in 2020, while the notifications for measles (IRR 0.34, 95\% CI 0.15?0.75) and pertussis (IRR 0.34, 95\% CI 0.20?0.60) were still significantly lower in the post-COVID-19 pandemic period. In addition, the newly calculated alarm thresholds showed a noticeable difference compared with the original unadjusted alarm thresholds. However, the variation among the 3 different corrected alarm thresholds was not substantial. Conclusions: During the COVID-19 pandemic, notifications of 10 infectious diseases declined significantly. The duration of this decline varied among infections, highlighting the need for pattern-specific adjustments. Our study demonstrates that accounting for the reduced notifications impacts alarm threshold calculations for outbreak detection. We therefore recommend amending the alarm thresholds to account for this impact to ensure reliable outbreak detection, so that communicable disease control professionals can act in a timely and data-driven manner. The next step in the development of the ``pandemic-proof'' methodology is to determine which correction method is most suitable. Further validation by communicable disease control professionals is essential to assess the applicability of the adjusted alarm thresholds for outbreak detection. ",
doi="10.2196/73953",
url="https://publichealth.jmir.org/2025/1/e73953"
}


@Article{info:doi/10.2196/64214,
author="Farah, Mohamed Alinoor
and Nour, Yousuf Tahir
and Roble, Kedir Abdurahman
and Obsiye, Muse
and Aden, Akil Mowlid
and Abdi, Siraj Abdulahi
and Getnet, Fentabil",
title="Food Handling Practices Among Food Businesses in Jigjiga, Eastern Ethiopia, During the COVID-19 Pandemic: Cross-Sectional Study",
journal="JMIR Form Res",
year="2025",
month="Aug",
day="20",
volume="9",
pages="e64214",
keywords="COVID-19",
keywords="knowledge",
keywords="practice",
keywords="Ethiopia",
keywords="food safety",
keywords="food",
keywords="food supply",
keywords="good hygiene practices",
keywords="proper hygiene",
keywords="hygiene",
keywords="cross-sectional study",
keywords="data collection",
keywords="employee",
keywords="food handler",
keywords="food safety training",
keywords="food handling",
abstract="Background: The COVID-19 pandemic has posed significant challenges to food safety practices globally, profoundly affecting the knowledge, attitudes, and practices  of both food handlers and consumers. Objective: This study aimed to investigate food safety knowledge and practices of food handlers in the context of COVID-19. Methods: A cross-sectional study was conducted in Jigjiga during the pandemic. A total of 384 food handlers were surveyed using a structured questionnaire and an observational checklist. The questionnaire assessed knowledge of COVID-19 symptoms, transmission, and prevention measures, and the checklist evaluated food safety practices and the implementation of COVID-19 prevention measures in food businesses. Categorical variables (eg, sufficient vs insufficient COVID-19 knowledge and good vs poor food-safety practice) were summarized as frequencies and percentages. Pearson chi?square test was used to assess differences in these binary outcomes across demographic and other categorical subgroups (eg, sex, age category, education level, and source of COVID-19 information). A P value <.05 was considered statistically significant. Results: A total of 384 food handlers were approached, and all responded (response rate=100\%). The majority of participants (276/384, 71.9\%) had received food hygiene training, and the main source of COVID-19 information was government news media (170/384, 44.3\%). The majority of respondents  (264/384, 68.8\%) correctly identified the key COVID?19 symptoms, and 52.1\% (200/384) accurately understood that respiratory droplets from coughs or sneezes drive transmission. However, less than 50\%  of participants consistently practiced preventive measures such as avoiding handshaking, frequently sanitizing food contact surfaces, and reminding customers to follow physical distancing. Participants who obtained information from government sites and the media had sufficient knowledge compared to other participants (P=.07). Females (P=.03), younger adults (P=.03), married individuals (P=.04), those with secondary education (P=.014), and those who had received previous food safety training (P=.004) demonstrated better food handling practices than their counterparts. Furthermore, 61.4\% (236/384) of food businesses had handwashing facilities at the entrance, 70.2\% (270/384) implemented crowd control measures, and 56.1\% (215/384) used floor markings to facilitate physical distancing. However, only 57.7\% (221/384) of food establishments routinely cleaned and disinfected their work surfaces and touch points. Conclusions: These findings highlight the need for targeted education and training interventions to improve food handlers' knowledge and practices, particularly during the COVID-19 pandemic. ",
doi="10.2196/64214",
url="https://formative.jmir.org/2025/1/e64214"
}


@Article{info:doi/10.2196/74403,
author="Wahyuni, Siti
and Wanda, Dessie
and Hayati, Happy",
title="Understanding the Implementation of Family-Centered Care in COVID-19 Isolation Rooms Through Pediatric Nurses' Experiences: Qualitative Descriptive Study",
journal="Asian Pac Isl Nurs J",
year="2025",
month="Jul",
day="24",
volume="9",
pages="e74403",
keywords="child",
keywords="COVID-19",
keywords="family-centered care",
keywords="nurses",
keywords="isolation room",
abstract="Background: Even though the COVID-19 pandemic has passed, the implementation of regulations in pediatric isolation rooms during the COVID-19 pandemic put enormous pressure on the practice of family-centered care (FCC). For nurses in isolation rooms for children with COVID-19, it was a challenge to implement FCC, which is an approach to child health care that supports the strengths of families and increases the involvement of parents to provide the best care outcomes. Objective: This study aimed to explore nurses' experiences in implementing FCC in isolation rooms caring for children with COVID-19. Methods: A qualitative descriptive design was used based on semistructured interviews with 11 nurses who met the inclusion criteria and worked in 1 of 3 isolation rooms caring for children with COVID-19 in a tertiary hospital in Indonesia. Interviews were recorded and transcribed, then analyzed using thematic analysis. Results: Three themes were generated, including improving psychological well-being, encouraging family involvement, and making arrangements for communication. Conclusions: Communication was key to the implementation of FCC in pediatric isolation rooms, and it provided positive results, so it should continue to be implemented even after the pandemic has passed. ",
doi="10.2196/74403",
url="https://apinj.jmir.org/2025/1/e74403"
}


@Article{info:doi/10.2196/68058,
author="Park, Minah
and Choi, Suk Won
and Cowling, J. Benjamin",
title="Shifts in Influenza and Respiratory Syncytial Virus Infection Patterns in Korea After the COVID-19 Pandemic Resulting From Immunity Debt: Retrospective Observational Study",
journal="JMIR Public Health Surveill",
year="2025",
month="Jul",
day="23",
volume="11",
pages="e68058",
keywords="influenza",
keywords="RSV",
keywords="immunity debt",
keywords="epidemiology",
keywords="public health",
abstract="Background: Nonpharmaceutical interventions (NPIs) such as mask-wearing and social distancing during the COVID-19 pandemic significantly reduced the transmission of common respiratory viruses, including influenza virus and respiratory syncytial virus (RSV). As NPIs were stopped, concerns emerged about ``immunity debt,'' which suggests that limited natural exposure to pathogens may have increased susceptibility and severity, particularly among young children. However, despite growing attention, the postpandemic impact of NPIs on epidemiologic patterns and shifts in age-specific disease burden remains underexplored. Objective: This study aims to investigate, using national surveillance data, the repercussions of the COVID-19 pandemic on the epidemiology and clinical burden of influenza virus and RSV infections in Korea, with an emphasis on the influence of NPIs on the incidence and clinical severity of these infections, particularly among young children. Methods: We analyzed weekly virologic, outpatient, and inpatient surveillance data on influenza virus and RSV infections from the Korea Disease Control and Prevention Agency from 2017 to 2024, covering the prepandemic, pandemic, and postpandemic periods. Time-series analyses were conducted to examine changes in seasonality and to estimate age-specific incidence and clinical severity of influenza virus and RSV infections before and after the COVID-19 pandemic. Results: In the postpandemic seasons, both RSV and influenza virus infections showed disrupted seasonality with delayed and prolonged epidemics. While the overall burden of both viruses was comparable to that for prepandemic periods, there was a notable shift in the age distribution of severe cases. Among influenza--associated hospital admissions, the proportion of school-aged children (7?18 years) doubled, rising from 14\% (1,814/12,660) in 2019/20 to 28\% (2,176/7,755) in 2022/23. Hospitalization rates in this age group also increased significantly, from 46.8 to 64.4 per 100,000 among children aged 7?12 years, and from 16.4 to 30.0 per 100,000 among those aged 13?18 years. For RSV infections, the burden shifted most prominently to young children aged 1?6 years, whose share of hospital admissions rose from 48\% (5,789/11,969) to 61\% (7,316/12,011) over the same period. This age group also experienced the largest rise in RSV-associated hospitalization rates, increasing from 230.8 to 357.5 per 100,000 between the 2019/20 and 2022/23 seasons. Conclusions: The patterns of influenza virus and RSV infections in Korea following the COVID-19 pandemic reveal distinct shifts in timing, severity, and the age groups that were most affected. Postpandemic influenza and RSV activity in Korea showed delayed and prolonged epidemics, with shifts in age-specific disease burden rather than an overall increase. Substantial increases in susceptibility and severity among young children for RSV infections and older children for influenza virus infections suggest lingering immunity gaps from reduced exposures during the pandemic. These effects may be further compounded by declining influenza vaccine uptake among children following the pandemic. Our findings underscore the importance of ongoing surveillance and targeted public health measures to manage respiratory viruses in the postpandemic era. ",
doi="10.2196/68058",
url="https://publichealth.jmir.org/2025/1/e68058"
}


@Article{info:doi/10.2196/66535,
author="Wang, Xingmin
and Yan, Hongli
and Shi, Lushaobo
and Li, Ting
and Xia, Yi
and Wang, Dong",
title="Factors Influencing the Maintenance of Public Health Behaviors After an Epidemic: Cross-Sectional Study",
journal="JMIR Public Health Surveill",
year="2025",
month="Jul",
day="23",
volume="11",
pages="e66535",
keywords="health behaviors",
keywords="maintenance",
keywords="Multi-Theory Model",
keywords="Protective Action Decision Model",
keywords="influencing factors",
abstract="Background: The maintenance of public health behaviors stands as a critical issue within the realm of public health. COVID-19, a major global emergency, has profoundly impacted the sustainability of public health behaviors. However, there is currently a gap of empirical studies examining the status and influencing mechanisms of public health behavior maintenance after the pandemic, especially those adopting a multifactorial and integrated approach. Objective: This study aims to investigate the current status of public health behavior maintenance in China after the COVID-19 pandemic. It integrates the complementary advantages of the Multi-Theory Model (MTM) and the Protective Action Decision Model (PADM) to conduct a comprehensive analysis of the multi-factorial mechanisms influencing the maintenance of public health behaviors. The findings are expected to provide empirical evidence and strategic recommendations for the formulation of public health policies and the promotion of national health. Methods: An integrated model was developed based on the MTM and the PADM. Data were collected from the Chinese public between October and November 2023 via the online survey panel Sojump (Changsha Ranxing Information Technology Co., Ltd.). The questionnaire included items on health behavior maintenance, variables from the MTM and the PADM, sociodemographic and personal disease, and health characteristics. Univariate analysis, correlation analysis, multivariate regression analysis, and structural equation modeling were performed to explore the determinants of health behavior maintenance. Results: This study collected 1216 valid samples, including 726 females and 490 males, with an average age of 27.38 (SD 8.52) years, and most of them had been infected with COVID-19 at least once (1054/1216, 86.68\%). The public maintenance of health behaviors was at a fairly low level (Mean 2.88, SD 0.45). Multivariate regression analysis revealed that those with high monthly incomes, married individuals, and who were more concerned about their health after the COVID-19 pandemic had higher levels of health behavior maintenance. These variables, along with others from the MTM and the PADM, accounted for 45.5\% of the variance in health behavior maintenance. Structural equation modeling indicated that efficacy perception had the most significant positive influence on health behavior maintenance ($\beta$=.386, P<.001), followed by emotional transformation and practical changes (both $\beta$=.213, P<.001). Risk perception had a slightly negative effect on health behavior maintenance ($\beta$=?.099, P=.013). Variables such as social cues, warning messages, and information sources also indirectly influenced the public maintenance of health behaviors. Conclusions: This study indicates a slight decline in public health behavior maintenance following the COVID-19 pandemic, and our analysis has explored some of its influencing factors. Attention should be given to broadening information channels and appropriately explaining the risks of unhealthy behaviors. In addition, integrating external support and bolstering the public's efficacy in maintaining health behaviors can promote sustainable healthy practices. ",
doi="10.2196/66535",
url="https://publichealth.jmir.org/2025/1/e66535"
}


@Article{info:doi/10.2196/65253,
author="Armijos Briones, Marcelo
and Aguila Gaibor, Mariuxi
and Berm{\'u}dez Vel{\'a}squez, Andrea",
title="Kissing as a Protective Factor Against Decreased Salivary pH: Protocol for a Randomized Clinical Trial",
journal="JMIR Res Protoc",
year="2025",
month="Jul",
day="17",
volume="14",
pages="e65253",
keywords="Saliva",
keywords="oral health",
keywords="sugar-sweetened beverages",
keywords="dental caries prevention",
keywords="kissing",
keywords="protective",
keywords="social behavior",
keywords="stress",
keywords="relationship",
keywords="pH",
keywords="fermented drinks",
keywords="randomized controlled trial",
abstract="Background: Kissing is a common social behavior that may influence physiological responses and impact oral health. Prior research has shown that affectionate behaviors like kissing can reduce stress and improve relationship satisfaction. However, the effects of kissing on salivary pH, particularly after consuming sugary or fermented beverages, have not been thoroughly investigated. Objective: This study aims to determine whether kissing accelerates salivary pH recovery following the consumption of sugary or fermented beverages. Methods: A randomized controlled trial will be conducted with 60 couples aged 18-30 years. Participants will be divided into 3 groups: a control group (no kissing), an experimental group where one partner consumes a beverage, and another experimental group where both partners consume a beverage. The study will measure salivary pH at baseline, after beverage consumption, and following a 40-second kiss or control period, with measurements taken every 5 minutes until the pH returns to neutral levels. The data will be analyzed using SPSS software (IBM Corporation). ANOVA will be used to compare salivary pH recovery between groups, and if assumptions of normality or sphericity are not met, alternative models such as generalized linear models or nonparametric tests will be considered. Results: The study is ongoing, with participant recruitment already initiated and preliminary data collection in progress. The study was funded by the Catholic University of Santiago de Guayaquil from June 2024 to June 2025. Ethics approval was obtained in June 2023. The results are expected to be published in the last quarter of 2025. Conclusions: This study will provide insights into the relationship between kissing, salivary pH, and oral health, potentially offering new strategies for the prevention of dental caries. The results may challenge existing assumptions about the role of kissing in oral health. Trial Registration: ClinicalTrials.gov NCT06501729; https://clinicaltrials.gov/study/NCT06501729 International Registered Report Identifier (IRRID): DERR1-10.2196/65253 ",
doi="10.2196/65253",
url="https://www.researchprotocols.org/2025/1/e65253"
}


@Article{info:doi/10.2196/68854,
author="Talal, H. Andrew
and Dharia, Arpan
and Markatou, Marianthi
and Brown Jr, S. Lawrence
and Bossert, E. Kenneth
and Grubbs, Zakiya
and Mukhopadhyay, Raktim
and Ntiri-Reid, Boatemaa
and Houtsmuller, J. Elisabeth",
title="Facilitated Telemedicine as a Patient-Centered, Sociotechnical Intervention to Integrate Hepatitis C Treatment Into Opioid Treatment Programs and Overcome the Digital Divide Among Underserved Populations: Qualitative Study",
journal="JMIR Public Health Surveill",
year="2025",
month="Jul",
day="16",
volume="11",
pages="e68854",
keywords="telemedicine",
keywords="patient-centered",
keywords="sociotechnical",
keywords="hepatitis",
keywords="opioid",
keywords="health equity",
keywords="digital divide",
keywords="underserved",
keywords="pragmatic.",
abstract="Background: People with opioid use disorder (OUD) have the highest rates of hepatitis C virus (HCV) infection. Despite the availability of curative HCV medication, people with OUD have limited health care access largely due to stigma. In a recent, pragmatic, randomized controlled trial (RCT), we compared a facilitated telemedicine intervention for HCV treatment integrated into opioid treatment programs (OTPs) with off-site referral. Facilitated telemedicine is bidirectional videoconferencing between a remote provider and a patient, supported by a case manager who facilitates the telemedicine encounter. The case manager schedules telemedicine visits, provides appointment reminders, and operates the digital equipment. Among 602 participants in the RCT, 90\% (n=262) were cured through facilitated telemedicine and 39\% (n=123) were cured through off-site referral. In this work, a multidisciplinary group of investigators, who directed the RCT, conducted a workshop, ``Advancing Viral Hepatitis Screening and Treatment in Opioid Treatment Settings -- Models \& Resources,'' at the American Association for Treatment of Opioid Dependence Conference in May 2024 to disseminate knowledge of facilitated telemedicine, including implementation considerations. We highlighted facilitated telemedicine as a patient-centered, sociotechnical, pragmatic health care delivery model for underserved populations. Objective: This study aimed to identify lessons learned to successfully overcome challenges of facilitated telemedicine implementation for HCV treatment integrated into OTPs. Methods: We partnered with the National Alliance of State and Territorial AIDS Directors in planning the workshop. The workshop consisted of 7 presentations on topics related to facilitated telemedicine implementation. The workshop was recorded and transcribed by Zoom (Zoom Communications). The transcripts served as data for the thematic analysis. The transcripts were interpreted to elucidate patterns of meanings and nuances derived from each presentation. In an iterative process, preliminary findings were compared and coalesced into themes. Verbatim quotes from the workshop were highlighted to support the themes. Results: We developed 3 themes. First, patient-centered care promotes HCV treatment for underserved populations through facilitated telemedicine. Case managers leveraged the destigmatizing environment of the OTP to build trust with patients, promoting an HCV cure through facilitated telemedicine. Second, sociotechnical approaches expand health care access for people with OUD. To be effective, facilitated telemedicine integrates 2 necessary components, a social aspect and a technical aspect. Third, facilitated telemedicine supports pragmatic research emphasizing people with OUD. Pragmatic research of facilitated telemedicine is needed to assess sustainability and scaling considerations beyond OTPs. Overall, we found that facilitated telemedicine overcame the digital divide, promoting access to digital technology, internet provision, and digital literacy. Conclusions: Facilitated telemedicine incorporates both a technical and a social component. The technical component largely addresses geographical challenges, while the social component addresses temporal (ie, care coordination) issues, promotes trust, and largely assuages patients' concerns related to HCV treatment. The patient-centered, sociotechnical intervention can address the digital divide, thereby increasing health care access. Trial Registration: ClinicalTrials.gov NCT02933970; https://clinicaltrials.gov/study/NCT02933970 ",
doi="10.2196/68854",
url="https://publichealth.jmir.org/2025/1/e68854"
}


@Article{info:doi/10.2196/72322,
author="Hoang, Uy
and Smylie, Jessica
and Button, Elizabeth
and Macartney, Jack
and Okusi, Cecilia
and Byford, Rachel
and Ferreira, Filipa
and Xie, Charis
and Joy, Mark
and Clark, Tristan
and de Lusignan, Simon",
title="The Impact of Point-of-Care Testing for Influenza on Antimicrobial Stewardship in UK Primary Care: Nested Cohort Study",
journal="JMIR Public Health Surveill",
year="2025",
month="Jul",
day="15",
volume="11",
pages="e72322",
keywords="medical records systems",
keywords="computerized",
keywords="influenza",
keywords="point of care systems",
keywords="primary care",
keywords="implementation",
keywords="outcome assessment",
keywords="health care",
abstract="Background: Influenza and respiratory syncytial virus (RSV) predominantly circulate during the winter season and cause acute respiratory illness (ARI). Deploying molecular point-of-care testing (POCT) in primary care can inform whether a patient presenting with an ARI has influenza or RSV. An early virological diagnosis could facilitate appropriate use of antivirals and enable better antimicrobial stewardship. Objective: This study aimed to report the impact of POCT for influenza and RSV on antimicrobial prescribing, including antiviral therapy in primary care. Methods: The impact of POCT for influenza on antimicrobial stewardship (PIAMS) in UK primary care was a nested cohort study undertaken from January 20 to May 31, 2023, after the period of peak virus circulation, within practices that contribute data to the English sentinel network. People presenting with ARI had a nasopharyngeal swab performed and were tested for influenza and RSV with a molecular POCT analyzer located within the practice. Data on antimicrobial prescribing and other study outcomes were collected by linking information from the analyzer to coded data from the patient's computerized medical record. Results: In total, 323 swabs were collected from 10 PIAMS study practices. In total, 59.7\% (197/323) of swabbed patients were female, and the mean age was 37.28 (SD 25.05) years. Furthermore, 2.9\% (9/323) of all swabs were positive, with 0.3\% (1/323) positive for influenza A, 1.6\% (5/323) positive for influenza B, and 0.9\% (3/323) positive for RSV. In total, 80 patients were prescribed antibiotics 7 days following POCT testing. There were no instances of antiviral prescribing in the 7 days post testing. A statistically significant difference in antibiotic prescribing given a positive POCT result compared with a negative test was not found with an unadjusted odds ratio (OR) of 7 days post testing. A statistically significant difference in antibiotic prescribing given a positive POCT result compared with a negative test was not found with an unadjusted OR of 1.54 (95\% CI 0.38?6.30; P=.55) and adjusted OR of 1.21 (95\% CI 0.00?1.78). Conclusions: This study illustrates the risk of having a narrow study window; our observation period was not aligned with when influenza was circulating. The peak of weekly incidence of influenza in the sentinel network was in the last week of 2022, and RSV was circulating before this. Further evidence is needed to assess the impact of POCT on antimicrobial prescribing. The viruses tested for using POCT could be aligned with the circulating viruses identified by the sentinel network. International Registered Report Identifier (IRRID): RR2-10.2196/46938 ",
doi="10.2196/72322",
url="https://publichealth.jmir.org/2025/1/e72322"
}


@Article{info:doi/10.2196/60658,
author="de la C{\'a}mara, {\'A}ngel Miguel
and Fern{\'a}ndez de Larrea-Baz, Nerea
and Pastor-Barriuso, Roberto
and Larrauri, Amparo
and Fern{\'a}ndez-Navarro, Pablo
and Poll{\'a}n, Marina
and P{\'e}rez-G{\'o}mez, Beatriz
and ",
title="Influenza Vaccination Coverage and Determinants of New Vaccinations During the COVID-19 Pandemic in Spain (ENE-COVID): Nationwide Population-Based Study",
journal="JMIR Public Health Surveill",
year="2025",
month="Jul",
day="1",
volume="11",
pages="e60658",
keywords="influenza prevention",
keywords="influenza vaccination",
keywords="vaccination coverage",
keywords="vaccination determinants",
keywords="COVID-19 pandemic",
keywords="influenza",
keywords="vaccination",
keywords="influenza vaccine",
keywords="Spain",
keywords="population-based study",
keywords="health information",
keywords="adult",
keywords="ENE-COVID",
keywords="epidemiology",
keywords="sociodemographic",
keywords="infection prevention",
keywords="public health",
abstract="Background: Influenza vaccination coverage is commonly suboptimal. However, the COVID-19 pandemic and consequent high exposure to health information may have changed population attitudes toward this vaccination. Objective: The aim of this study is to describe influenza vaccine uptake in Spain during the first influenza season following the start of the COVID-19 pandemic compared to the previous one and identify characteristics associated with vaccination among those previously unvaccinated. Methods: This was a population-based study of 28,987 adults included in influenza vaccination target groups (?65 years old, with risk conditions, living with someone with risk conditions, health care workers, security or emergency workers) who were participants in the nationwide Seroepidemiological Survey of SARS-CoV-2 Infection in Spain (ENE-COVID) study. Information on vaccination and sociodemographic, health, and COVID-19--related factors was collected by interview. Coverage change from 2019 to 2020 and standardized prevalences of vaccination in 2020 among the population unvaccinated in 2019 were estimated using logistic model--based methods. Results: Coverage rose from 31.4\% (95\% CI 30.5\%?32.2\%) to 46.8\% (95\% CI 45.8\%?47.8\%). People ?65 years old showed the highest uptake in both periods (58.3\%, 95\% CI 56.8\%?59.8\% and 74.8\%, 95\% CI 73.5\%?76.1\%), while health care workers had the greatest increase (22\%, 95\% CI 17.8\%?26.2\%). Among people unvaccinated in 2019, factors associated with vaccination in 2020 were age, female sex, higher education, Spanish nationality, multimorbidity, being a former smoker, obesity, contact with COVID-19 cases, living with older adults, living in provinces with low COVID-19 incidence, wearing a face mask during family meetings, and using surgical/FFP2 masks. Conclusions: This study provides nationwide representative estimates of influenza vaccination coverage, which clearly increased between 2019 and 2020 in the 5 target groups. However, coverage goals were attained only in the ?65 year old group, highlighting the importance of reinforcing influenza vaccination. Our detailed results on determinants of vaccination provide some clues to tailor vaccination strategies. ",
doi="10.2196/60658",
url="https://publichealth.jmir.org/2025/1/e60658"
}


@Article{info:doi/10.2196/66379,
author="Zimmermann, M. Bettina
and Willem, Theresa
and Rost, Michael
and Matthes, Nina
and Buyx, Alena",
title="Perceptions of Stigma Among Patients With Hepatitis B in Germany: Cross-Sectional Survey",
journal="JMIR Form Res",
year="2025",
month="Jun",
day="13",
volume="9",
pages="e66379",
keywords="infectious diseases",
keywords="infection",
keywords="contaminate",
keywords="septic shock",
keywords="hepatitis B",
keywords="social stigma",
keywords="stigmatize",
keywords="discrimination",
keywords="prejudice",
keywords="social factor",
keywords="social disparity",
keywords="social inequality",
keywords="social inequity",
keywords="Germany",
abstract="Background: Many studies find associations between hepatitis B and stigma, but studies from the Western European context are lacking. Based on available studies, we hypothesized that younger age, higher education, male gender, higher privacy needs, and non-German mother tongue were positively associated with perceived hepatitis B--related stigma. Objective: This study aims to describe the prevalence of perceived social stigma among patients with hepatitis B in Germany and to assess what factors are associated with perceptions of hepatitis B--related stigma. Methods: Applying the short version of the Berger stigma scale, we surveyed 195 patients with hepatitis B about their perceptions of hepatitis B--related stigma, privacy needs, and demographic variables through a paper-based questionnaire. Venue-based recruitment of adult patients diagnosed with acute or chronic hepatitis B was implemented at 3 clinical centers in Germany. Patients who could not read German were excluded from the study. Results: From the 195 valid questionnaires, 45.1\% (88/195) of participants identified as female, 36.6\% (71/195) had a high school diploma, and 56.9\% (111/195) reported a mother tongue other than German. The mean (SD) stigma score throughout the sample was 5.52 (6.02; range 0-24) and the median was 3.50 (IQR=9.75). Regression analysis revealed that non-German mother tongue, individual data privacy needs, and participants' secrecy regarding their hepatitis B diagnosis independently predicted perceived hepatitis B-related stigma. More precisely, the higher the data privacy need and the more secret the hepatitis B diagnosis, the higher the perceived stigma, and perceived stigma was higher for patients with a non-German mother tongue. Age, gender, and education were no predictors of perceived stigma. Conclusions: The surveyed patients with hepatitis B in Germany reported lower levels of hepatitis B--related stigma than found in other studies conducted in Asian countries. The association with non-German mother tongue indicates an important cultural and social component in the perception of stigma. Community-based interventions and the sensibilization of health care professionals might help overcome perceptions of stigma among hepatitis B--affected populations. ",
doi="10.2196/66379",
url="https://formative.jmir.org/2025/1/e66379"
}


@Article{info:doi/10.2196/68280,
author="Chidziwisano, Kondwani
and Panulo, Mindy
and MacLeod, Clara
and Vigneri, Marcella
and White, Blessings
and Wells, Joseph
and Ross, Ian
and Morse, Tracy
and Dreibelbis, Robert",
title="Water, Sanitation, and Hygiene for Everyone Intervention Study: Protocol for a Controlled Before-and-After Trial",
journal="JMIR Res Protoc",
year="2025",
month="May",
day="15",
volume="14",
pages="e68280",
keywords="community-led total sanitation",
keywords="care group model",
keywords="WASH for everyone",
keywords="Malawi",
keywords="sanitation intervention trial",
abstract="Background: Community-based behavior change interventions are a common approach to Water, Sanitation, and Hygiene (WASH). Yet, published evaluations of how these interventions work in district-wide approaches are rare. Objective: This study reports the baseline characteristics and study design for a trial assessing the effectiveness of a district-level Community-led Total Sanitation (CLTS) intervention compared to the additional integration of local care groups (CG) on sanitation coverage and use and hygiene behaviors in Chiradzulu District, Malawi. Methods: This study is a controlled before-and-after trial with 2 treatment arms and a control group. Clusters are rural villages in 3 traditional authorities (TAs). One arm will receive CLTS and the CG model (CLTS+CG group), one arm CLTS only (CLTS group), and one group will serve as the control. The trial is part of the wider WASH for Everyone (W4E) project, led by World Vision Malawi that aims to expand access to WASH services across the entire district by 2025. Study participants were selected from the 3 TAs. Systematic sampling procedures were used to select 20 households per cluster with a total of 1400 households at both baseline and end line. The primary outcome is sanitation coverage. Secondary outcome measures include sanitation use, safe disposal of child feces, observed handwashing facility, and Sanitation-related Quality of Life Index (SanQoL-5). Results: The baseline observations indicate a balanced distribution of potential demographic confounders in the trial arms with a slight variation on some WASH proxy measures. We noted the low coverage of handwashing facilities with soap and water in all 3 arms: 8\% in the CLTS group, 4\% in the CLTS+CG group, and 4\% in the control group. There was a marginal variation in handwashing practices among the study arms with 3\% of individuals handwashing with soap and water in the CLTS group, 5\% in the CLTS+CG group, and 2\% in the control group. Sanitation coverage also varied among the study arms at baseline as 83\% of households had access to unimproved sanitation in the CLTS group, 70\% in the CLTS+CG group, and 81\% in the control group. Conclusions: Results from this trial will provide evidence on whether the CLTS+CG approach is effective at improving sanitation and hygiene practices in the W4E program area compared to CLTS alone and no intervention, as well as inform implementing partners on future interventions in Chiradzulu District, Malawi. The results are expected to be published in 2025. Trial Registration: ClinicalTrials.gov NCT05808218; https://clinicaltrials.gov/study/NCT05808218 International Registered Report Identifier (IRRID): RR1-10.2196/68280 ",
doi="10.2196/68280",
url="https://www.researchprotocols.org/2025/1/e68280"
}


@Article{info:doi/10.2196/66781,
author="Tundjungsari, Vitri
and Putranto, Dwi Bambang Purnomosidi
and Ulum, Bahrul Muhamad
and Anwar, Nizirwan",
title="An Integrated Model for Circular Waste Management Using the Internet of Things, Semantic Web, and Gamification (Circonomy): Case Study in Indonesia",
journal="JMIR Serious Games",
year="2025",
month="May",
day="6",
volume="13",
pages="e66781",
keywords="IoT",
keywords="gamification",
keywords="semantic web",
keywords="waste management",
keywords="circular economy",
keywords="smart bin",
keywords="Circonomy",
keywords="semantic",
keywords="game",
keywords="gamified",
keywords="Indonesia",
keywords="reuse",
keywords="reduce",
keywords="recycle",
keywords="3Rs",
keywords="prototype",
keywords="circular waste",
keywords="Internet of Things",
keywords="DSRM",
abstract="Background: The problem of how to deal with waste is a global issue all countries face. Like many developing countries, Indonesia has inadequate infrastructure to process\enspacethe extremely high volume of waste produced throughout the country and minimal public participation in proper waste management. Although the Indonesian government regulates waste banks as a community-based waste management solution, there is a lack of integrated technological innovations to support waste banks. This study fills the gap by developing Circonomy, a model combining Internet of Things, gamification, and semantic web technologies to advance community-based circular waste management. Objective: The aim of this study is to develop Circonomy as a circular waste model that integrates an Internet of Things--based smart bin, semantic web, and gamification as an innovative technological solution. Methods: We identified the problem by observing Indonesian waste banks at 3 locations in Jakarta and Yogyakarta to define and design Circonomy. The Circonomy prototype was developed using the Design Science Research Methodology and evaluated based on technical performance and user experience. The technical performance has three indicators: bin capacity accuracy with a minimum of 80\% precision, bin lid response time <5 seconds for a minimum of 80\% of trials, and data transmission success rate of at least 80\%. The user experience metric has two indicators: a minimum of 80\% reporting high usability and ease of use, and at least 80\% of users reporting that they feel more motivated using the prototype than the traditional waste bank. We selected 10 random participants aged 18-60 years to perform a user experience evaluation of our prototype. Results: The Circonomy prototype demonstrated sound and stable performances related to technical performance and user experience. Circonomy achieved at least 80\% technical performance accuracy, comparable to industry standards. The accuracy problem lies in the placement of the ultrasonic sensor. The waste should be placed directly under the ultrasonic sensor to ensure the bin's capacity measurement accuracy. The user experience testing results from 10 participants indicated that Circonomy has excellent user engagement, and 100\% felt motivated by gamification and 80\% found the mobile app easy to use. Conclusions: The testing results showed that Circonomy has acceptable performances for early-stage prototyping, with at least an 80\% accuracy rate in technical performance and user experience. This ensures that Circonomy operates effectively in real-world conditions while remaining cost-efficient and scalable. For future development, Circonomy will prioritize enhancing the accuracy and reliability of sensor-based occupancy detection through improved sensor placement, the integration of multiple sensors, and an exploration of alternative technologies for regions with limited IT resources. In addition, more gamification features such as challenges and quizzes should be added to improve user experience and motivation. ",
doi="10.2196/66781",
url="https://games.jmir.org/2025/1/e66781"
}


@Article{info:doi/10.2196/60450,
author="Aprile, Antonio
and Morlino, Giustino
and Mosconi, Claudia
and Guarente, Luca
and Messina, Alessandra
and Carestia, Mariachiara
and De Filippis, Patrizia
and Pica, Francesca
and Maurici, Massimo
and Palombi, Leonardo",
title="Survey of Hand Hygiene, High-Touch Device Use, and Proper Habits of Health Care Workers for Infection Risk Prevention: Protocol for a Cross-Sectional Study",
journal="JMIR Res Protoc",
year="2025",
month="Apr",
day="29",
volume="14",
pages="e60450",
keywords="health care--associated infection",
keywords="nosocomial infection",
keywords="fomite",
keywords="hand hygiene",
keywords="universal precautions",
keywords="infection prevention",
keywords="infectious disease",
keywords="handwashing",
keywords="decontamination",
abstract="Background: Care-related infections are infectious diseases that occur in a care setting. The most important prevention methods are hand hygiene and the proper use of gloves and gowns. Recent literature points out that hand contact with mobile devices or potentially contaminated environments can promote an increased occurrence of health care--associated infections (HAIs). Objective: This study aims to analyze the correlation between the microbial population present on the hands of health care professionals in the wards of the Tor Vergata Hospital in Rome and the microorganisms present on the surfaces of their smartphones and tablets by searching for the main agents responsible for HAIs. Methods: Sterile swabs will be used to collect samples from hands and smartphones, which will then be plated on nutrient agar and other selective media for microbial count. Colonies showing growth and morphological characteristics suggestive of potential pathogens will be isolated and subjected to further analysis for identification at the species level and for antimicrobial resistance profiling (using a proprietary automated analytical profile index system). Sampling will be conducted quarterly (first 2 weeks of each quarter) to assess any changes in microbial flora. In parallel, an Italian version of the World Health Organization questionnaire on health care workers' knowledge of hand hygiene and a questionnaire on the use of high-touch devices will be administered to participants. Each quarter, 30 health workers will be selected, resulting in a total of 120 health workers and 240 samples collected by the end of the study. For each sample, the analysis will focus on quantifying the total bacterial load at 37 {\textdegree}C and 22 {\textdegree}C, along with detecting coliforms or Escherichia coli, Enterococci, Staphylococci, Acinetobacter, Klebsiella, Pseudomonas, and any associated antimicrobial resistance. Results: The study aims to begin sample collection by June 2025. The protocol was properly evaluated and approved by the territorial ethics committee ``Lazio Area 2'' on March 21, 2024, with the code 76.24 CET2 utv\_ptv. Conclusions: The findings of this study will be crucial in highlighting the need for targeted education and training of health care practitioners involved in the study, with a focus on the prevention of HAIs. International Registered Report Identifier (IRRID): PRR1-10.2196/60450 ",
doi="10.2196/60450",
url="https://www.researchprotocols.org/2025/1/e60450"
}


@Article{info:doi/10.2196/70997,
author="Green, Andrew
and Wu, Shishi
and Di Pasquale, Alberta
and Pang, Tikki",
title="The Role of Digital Opinion Leaders in Dengue Prevention Through Health Promotion and Public Health Collaboration: Qualitative Semistructured Interview Study",
journal="J Med Internet Res",
year="2025",
month="Apr",
day="25",
volume="27",
pages="e70997",
keywords="digital opinion leaders",
keywords="dengue prevention",
keywords="vaccine hesitancy",
keywords="public health promotion",
keywords="social media",
keywords="health care providers",
abstract="Background: Dengue fever is a significant public health concern. The advent of social media has introduced digital opinion leaders (DOLs), health care professionals with substantial online followings who play a pivotal role in disseminating health information and combating misinformation. Objective: We aimed to investigate the role of DOLs in dengue prevention and explore their preferences for collaboration with health sector entities to strengthen dengue prevention initiatives. Methods: A qualitative study was conducted using semistructured interviews with 37 purposively selected DOLs from 8 countries in Latin America and Southeast Asia. They were selected based on their active online presence, dissemination of dengue-related content, and substantial social media followings. Interviews took place either in person or online, according to the participants' chosen languages. Each session, lasting approximately 60 minutes, was audio recorded, transcribed verbatim, and subjected to thematic analysis to identify recurring themes. Results: The thematic analysis led to several key findings. First, DOLs used social media to enhance public health communication, focusing on raising awareness (16/37, 43\%), correcting misconceptions (17/37, 46\%), and modeling preventive behaviors (8/37, 22\%) for infectious diseases. They educated audiences on disease symptoms and prevention, addressed vaccine hesitancy, and shared personal practices to encourage similar actions among followers. Second, 35\% (13/37) of the DOLs reported a widespread lack of public knowledge about dengue and its prevention, with even less awareness of vaccine availability. In addition, 27\% (10/37) of them identified challenges due to antivaccination sentiments and misinformation, while 8\% (3/37) noted obstacles from perceived inadequate government leadership in dengue prevention. In response, DOLs leveraged their social media influence to educate the public. A significant number (22/37, 59\%) of the DOLs emphasized the importance of regular promotion of vector control measures as the cornerstone of dengue prevention and 68\% (25/37) highlighted the critical role of vaccines, particularly among vulnerable groups. Finally, collaboration was essential for expanding DOLs' reach and credibility, with 54\% (20/37) of them partnering with pharmaceutical companies, 43\% (16/37) with government agencies, and 27\% (10/37) with nongovernmental organizations. In these collaborations, 38\% (14/37) of the DOLs emphasized the importance of adhering to ethical standards, and 57\% (21/37) prioritized projects aligning with their personal values and professional standards, avoiding producing content that contradicted their beliefs or goals. Conclusions: DOLs are essential in disseminating dengue prevention information. They recognize their responsibility to raise awareness about dengue vaccines and dispel related misconceptions to combat vaccine hesitancy. Unlike nonmedical social media influencers, whose content may lack medical accuracy and be driven by monetization, DOLs provide evidence-based information, enhancing their credibility. Collaborations between DOLs and health sector stakeholders, although currently limited, hold significant potential for effective dengue prevention, provided they adhere to ethical standards and are supported by credible scientific evidence. ",
doi="10.2196/70997",
url="https://www.jmir.org/2025/1/e70997"
}


@Article{info:doi/10.2196/68355,
author="Faccin, Mauro
and Geenen, Caspar
and Happaerts, Michiel
and Ombelet, Sien
and Migambi, Patrick
and Andr{\'e}, Emmanuel",
title="Analyzing Satellite Imagery to Target Tuberculosis Control Interventions in Densely Urbanized Areas of Kigali, Rwanda: Cross-Sectional Pilot Study",
journal="JMIR Public Health Surveill",
year="2025",
month="Apr",
day="24",
volume="11",
pages="e68355",
keywords="tuberculosis",
keywords="Rwanda",
keywords="satellite image",
keywords="TB",
keywords="PCR testing",
keywords="PCR",
keywords="questionnaire",
keywords="satellite",
keywords="active case-finding",
keywords="diagnostic",
keywords="urban",
keywords="Africa",
keywords="TB screening",
keywords="ACF",
keywords="polymerase chain reaction",
abstract="Background: Early diagnosis and treatment initiation for tuberculosis (TB) not only improve individual patient outcomes but also reduce circulation within communities. Active case-finding (ACF), a cornerstone of TB control programs, aims to achieve this by targeting symptom screening and laboratory testing for individuals at high risk of infection. However, its efficiency is dependent on the ability to accurately identify such high-risk individuals and communities. The socioeconomic determinants of TB include difficulties in accessing health care and high within-household contact rates. These two determinants are common in the poorest neighborhoods of many sub-Saharan cities, where household crowding and lack of health-care access often coincide with malnutrition and HIV infection, further contributing to the TB burden. Objective: In this study, we propose a new approach to enhance the efficacy of ACF with focused interventions that target subpopulations at high risk. In particular, we focus on densely inhabited urban areas, where the proximity of individuals represents a proxy for poorer neighborhoods with enhanced contact rates. Methods: To this end, we used satellite imagery of the city of Kigali, Rwanda, and computer-vision algorithms to identify areas with a high density of small residential buildings. We subsequently screened 10,423 people living in these areas for TB exposure and symptoms and referred patients with a higher risk score for polymerase chain reaction testing. Results: We found autocorrelation in questionnaire scores for adjacent areas up to 782 meters. We removed the effects of this autocorrelation by aggregating the results based on H3 hexagons with a long diagonal of 1062 meters. Out of 324 people with high questionnaire scores, 202 underwent polymerase chain reaction testing, and 9 people had positive test results. We observed a weak but statistically significant correlation (r=0.28; P=.04) between the mean questionnaire score and the mean urban density of each hexagonal area. Conclusions: Nine previously undiagnosed individuals had positive test results through this screening program. This limited number may be due to low TB incidence in Kigali, Rwanda, during the study period. However, our results suggest that analyzing satellite imagery may allow the identification of urban areas where inhabitants are at higher risk of TB. These findings could be used to efficiently guide targeted ACF interventions. ",
doi="10.2196/68355",
url="https://publichealth.jmir.org/2025/1/e68355"
}


@Article{info:doi/10.2196/66872,
author="Wang, Qiang
and Bolio, Ana
and Lin, Leesa",
title="The Association Between Cultural Tightness and COVID-19 Vaccine Confidence From 28 Countries: Cross-Sectional Study",
journal="JMIR Public Health Surveill",
year="2025",
month="Apr",
day="24",
volume="11",
pages="e66872",
keywords="COVID-19",
keywords="vaccine confidence",
keywords="social norms",
keywords="global",
keywords="cultural tightness",
abstract="Background: Social norms provided a framework for understanding a variety of behaviors. Cultural tightness was introduced to measure the level of adherence to social norms and tolerance of deviant behavior. Objective: We aimed to explore the association between cultural tightness and COVID-19 vaccine hesitancy. Methods: A total of 44,339 participants aged 18 years and older were enrolled from 28 different countries between 2020 and 2022. We used the Vaccine Confidence Index (3 items related to evaluation of importance, effectiveness, and safety) with a 5-point Likert scale to collect COVID-19 vaccine confidence. Demographic information at the individual-level was obtained through the survey, while national-level data were sourced from the World Bank and Hofstede insights. Multilevel linear regressions with random effects for country were used to examine the association between cultural tightness and COVID-19 vaccine confidence. Results: Of the participants, 21,968 (50.2\%) were male and 18,957 (43.3\%) had an education level of university or above. Vietnam exhibited the highest level of confidence (mean 13.31, SD 1.71) on COVID-19 vaccine and Slovakia had the lowest level (mean 9.52, SD 0.14). The higher levels of cultural tightness were positively linked to greater vaccine confidence ($\beta$=1.94, 95\% CI 1.72-2.15; P<.001) after controlling individual- and national- level variables. Individuals who were younger in age, female, had lower levels of educational level, or belonged to minority religious groups demonstrated a positive association with lower vaccine confidence. Hofstede's 5 cultural dimensions were not significantly associated with vaccine confidence. The level of vaccine confidence in 2021 ($\beta$=?0.54, 95\% CI ?0.67 to ?0.37; P<.001) and 2022 ($\beta$=?0.23, 95\% CI ?0.34 to ?0.10; P<.001) was lower than that observed in 2020. Conclusions: Lower level of cultural tightness might be positively associated with low vaccine confidence. Our findings offered the insight for designing tailor interventions to vaccine hesitancy in different cultural tightness context. ",
doi="10.2196/66872",
url="https://publichealth.jmir.org/2025/1/e66872"
}


@Article{info:doi/10.2196/57191,
author="Baretta, Dario
and R{\"u}ttimann, Lynn Carole
and Amrein, Alexandra Melanie
and Inauen, Jennifer",
title="Promoting Hand Hygiene During the COVID-19 Pandemic: Randomized Controlled Trial of the Optimized Soapp+ App",
journal="JMIR Mhealth Uhealth",
year="2025",
month="Apr",
day="24",
volume="13",
pages="e57191",
keywords="COVID-19",
keywords="hand hygiene",
keywords="behavior change technique",
keywords="Multiphase Optimization Strategy",
keywords="randomized controlled trial",
keywords="smartphone apps",
keywords="mobile phones",
abstract="Background: The adoption of protective behaviors represents a crucial measure to counter the spread of infectious diseases. The development of effective behavior change techniques therefore emerged as a public health priority during the COVID-19 pandemic, but randomized controlled trials (RCTs) testing such interventions during the pandemic were scarce. We conducted a Multiphase Optimization Strategy to develop, optimize, and evaluate a smartphone app, Soapp+, to promote hand hygiene during the COVID-19 pandemic. Objective: This RCT aims to evaluate the efficacy of the Soapp+ app (intervention group) targeting motivation and habit compared to a simplified version of the app mainly delivering hand hygiene information (active control group). We hypothesize that, compared to the control group, the intervention group will show greater improvements in hand hygiene behavior and behavioral determinants post intervention and at a 6-month follow-up. Methods: We conducted an RCT from March 2022 to April 2023, recruiting 193 adults living in Switzerland online. Following baseline assessment, the intervention lasted 32 days, followed by a postintervention assessment and a 6-month follow-up. The primary outcome was the change in hand hygiene behavior from pre- to postintervention and preintervention to follow-up. Hand hygiene was assessed with electronic diaries. The intervention group received content incorporating various behavior change techniques designed to address key motivational and volitional determinants of hand hygiene behavior (eg, skills, knowledge, intention, attitudes toward hand hygiene, risk perception, outcome expectancies, self-efficacy, action planning, coping planning, action control, habit). In contrast, the active control group was exposed to behavior change techniques targeting only a subset of these determinants (ie, skills, knowledge, and intention). The delivery of the intervention content was fully automated. Group differences were tested using an intention-to-treat approach with the nonparametric Wilcoxon rank sum test. Results: Of the 193 randomized participants, 146 completed the first hand hygiene diary preintervention and were included in the main analysis. The mean age was 41 (SD 17) years, and 69.2\% (n=101) were women. The main analysis revealed significant superiority of the intervention compared to controls in the change in hand hygiene pre-post intervention (W=2034; P<.04; effect size r=0.17) and between preintervention and follow-up (W=2005; P<.03; effect size r=0.18). Regarding behavioral determinants, the change in coping planning pre-post intervention (W=3840; P=.03, effect size r=0.16) was significantly greater in the intervention group using Soapp+ compared to controls. Conclusions: Soapp+ was developed through a rigorous experimental method during the ongoing COVID-19 pandemic. The RCT provided evidence for the efficacy of Soapp+ to promote hand hygiene in the context of a pandemic. Trial Registration: ClinicalTrials.gov NCT04830761; https://clinicaltrials.gov/study/NCT04830761 ",
doi="10.2196/57191",
url="https://mhealth.jmir.org/2025/1/e57191"
}


@Article{info:doi/10.2196/65844,
author="Cheong, Ling Yoon
and Mohd Ghazali, Sumarni
and Mat Hashim, Hazilas Mohd
and Che Ibrahim, Khairuddin Mohd
and Amran, Afzufira
and Tiunh, Yih Tsye
and Lim, Li Hui
and Cheah, Kang Yong
and Gill, Singh Balvinder
and Lim, Hock Kuang",
title="Exploring 97 Years of Aedes aegypti as the Vector for Dengue, Yellow Fever, Zika, and Chikungunya (Diptera: Culicidae): Scientometric Analysis",
journal="Interact J Med Res",
year="2025",
month="Apr",
day="23",
volume="14",
pages="e65844",
keywords="relative growth rate",
keywords="vector control",
keywords="collaboration index",
keywords="bibliometric",
keywords="Aedes aegypti",
keywords="Scopus",
keywords="co-occurrence",
keywords="author",
keywords="dengue",
keywords="Zika",
abstract="Background: Aedes aegypti is an important vector that transmits dengue, Zika, chikungunya, and yellow fever viruses. Although research on Aedes aegypti has been conducted for decades, scientometric studies on Aedes aegypti are scarce, are limited to regions, and cover short periods. Thus, there is still a knowledge gap in the current trend, research focuses and directions, leading authors and collaboration, journal and citation impacts, countries, and worldwide collaborations. Objective: The objectives of the study are to investigate the research trend, focus and directions, citation impact, leading authors and collaboration, journals, and countries of the published works on Aedes aegypti to inform the current knowledge gaps and future direction of the control of the vector. Methods: In this study, we searched the Scopus database for articles on Aedes aegypti published from the year 1927 until April 5th, 2024, and included articles, reviews, books, and book chapters that were written in English. A total of 16,247 articles in 160 journals with 481,479 citations were included. Inconsistencies in authors' names were checked and cleaned using OpenRefine. The data were grouped into 4 periods; years 1927-1999, 2000-2009, 2010-2019, and 2020-2023. The relative growth rate and doubling time of publications were calculated. The analysis was conducted using VOSviewer, R bibliometrics, and citeSpace. Results: The overall RGR was 0.1. Doubling time increased from 9.3 in 1978-1998 to 12.1 in 2000-2009. The main research clusters were ``using Wolbachia,'' ``Dengue Zika,'' ``worldwide diversity,'' ``community support,'' ``larvicidal activity,'' ``mosquito genotype-dependent,'' and ``sterile insect technique.'' Journal of Medical Entomology was the leading journal (758/16,247, 4.7\%). The most cited articles were authored by Halstead SB and team in Science (N=1355) and Kraemer MU and team in eLife (N=1324). The United States (5806/23,538, 24.7\%) and Brazil (2035/23,538, 8.6\%) were the top countries. Gubler DJ was the top co-cited author (n=2892) from 2000 to 2019. The co-cited author cluster patterns informed the significant specialty research on Aedes aegypti across time. Authors from various specialized research fields tended to collaborate across countries, especially neighboring countries. Countries with more research funding on the study of Aedes aegypti published more papers. Conclusions: Researchers or entomologists could understand the current knowledge gap on Aedes aegypti and plan for future research pathways. This study contributed to the public health stakeholders in improving the vector control interventions and elucidated the extent of research subject areas. ",
doi="10.2196/65844",
url="https://www.i-jmr.org/2025/1/e65844"
}


@Article{info:doi/10.2196/69113,
author="M, Premikha
and Goh, Khong Jit
and Ng, Qiang Jing
and Mutalib, Adeliza
and Lim, Yang Huai",
title="Impact of Acute Respiratory Infections on Medical Absenteeism Among Military Personnel: Retrospective Cohort Study",
journal="JMIR Form Res",
year="2025",
month="Apr",
day="18",
volume="9",
pages="e69113",
keywords="respiratory infections",
keywords="military",
keywords="epidemiology",
keywords="public health",
keywords="surveillance",
abstract="Background: Acute respiratory infections (ARI) are a significant challenge in military settings due to close communal living, which facilitates the rapid transmission of pathogens. A variety of respiratory pathogens contribute to ARI, each varying in prevalence, severity, and impact on organizational productivity. Understanding and mitigating the impact of ARI is critical for optimizing the health of military personnel and maintaining organizational productivity. Objective: This retrospective study of surveillance data aims to identify pathogens causing ARI among servicemen and determine which pathogens contribute most to medical absenteeism, defined as the combined duration of the issued medical certificate and light duty. Methods: From September 2023 to August 2024, anonymous nasopharyngeal swabs (BioFire FilmArray Respiratory Panel) were collected from Singapore Armed Forces servicemen presenting with ARI symptoms after a doctor's consultation at a local military camp's medical centre. The presence of fever and duration of medical certificate and light duty were self-reported by Singapore Armed Forces servicemen. Results: A total of 1095 nasopharyngeal swabs were collected, of which 608 (55.5\%) tested positive. The most common respiratory pathogen was human rhinovirus/enterovirus (HRV/HEV) in 303 (27.7\%) individuals. The highest proportions of fever were observed in servicemen with influenza (62.8\%, 27/43), SARS-CoV-2 (34.3\%, 12/35), and parainfluenza (31.6\%, 12/38). The odds of patients with influenza that have fever was 5.8 times higher than those of patients infected with HRV/HEV (95\% CI 2.95?11.40, P<.001). The median duration of medical certificate, light duty, and medical absenteeism were 0 (IQR 0), 2 (IQR 2) and 2 (IQR 0) days, respectively. The odds of patients with influenza having a medical certificate with duration ?1 day was 5.34 times higher than those in patients with HRV/HEV (95\% CI 2.63?10.88, P<.001). No significant differences in the duration of medical absenteeism were found between HRV/HEV and other pathogens. Conclusions: Compared to HRV/HEV, influenza infections were significantly associated with longer medical certificate duration. Nonetheless, there were no significant differences in the overall duration of medical absenteeism across pathogens, as servicemen infected with other pathogens were given light duty instead. These findings emphasize the need for pathogen-agnostic ARI measures. While influenza vaccinations are already mandatory for servicemen in local military camps, encouraging additional public health measures (eg, mask-wearing among symptomatic servicemen, COVID-19 vaccinations, therapeutics) can further reduce ARI incidence, minimize the duration of medical absenteeism, and mitigate the impact on organizational productivity. ",
doi="10.2196/69113",
url="https://formative.jmir.org/2025/1/e69113"
}


@Article{info:doi/10.2196/50929,
author="Liebst, Suonper{\"a} Lasse
and Bernasco, Wim
and Ejbye-Ernst, Peter
and van Herwijnen, Nigel
and van der Veen, Thomas
and Koelma, Dennis
and Snoek, M. Cees G.
and Lindegaard, Rosenkrantz Marie",
title="Association Between Social Distancing Compliance and Public Place Crowding During the COVID-19 Pandemic: Cross-Sectional Observational Study Using Computer Vision to Analyze Surveillance Footage",
journal="JMIR Public Health Surveill",
year="2025",
month="Apr",
day="17",
volume="11",
pages="e50929",
keywords="social distancing",
keywords="compliance",
keywords="crowding",
keywords="urban public spaces",
keywords="computer vision",
keywords="surveillance footage",
keywords="COVID-19 pandemic",
abstract="Background: Social distancing behavior has been a critical nonpharmaceutical measure for mitigating the COVID-19 pandemic. For this reason, there has been widespread interest in the factors determining social distancing violations, with a particular focus on individual-based factors. Objective: In this paper, we examine an alternative and less appreciated indicator of social distancing violations: the situational opportunity for maintaining interpersonal distance in crowded settings. This focus on situational opportunities is borrowed from criminology, where it offers an alternative to individual-based explanations of crime and rule violations. We extend this approach to the COVID-19 pandemic context, suggesting its relevance in understanding distancing compliance behavior. Methods: Our data comprise a large collection of video clips (n=56,429) from public places in Amsterdam, the Netherlands, captured by municipal surveillance cameras throughout the first year of the pandemic. We automatized the analysis of this footage using a computer vision algorithm designed for pedestrian detection and estimation of metric distances between individuals in the video still frames. This method allowed us to record social distancing violations of over half a million individuals (n=539,127) across more and less crowded street contexts. Results: The data revealed a clear positive association between crowding and social distancing violations, evident both at the individual level and when aggregated per still frame. At the individual level, the analysis estimated that each additional 10 people present increased the likelihood of a distancing violation by 9 percentage points for a given pedestrian. At the aggregated level, there was an estimated increase of approximately 6 additional violations for every 10 additional individuals present, with a very large R{\texttwosuperior} of 0.80. Additionally, a comparison with simulation data indicated that street spaces should, in principle, provide sufficient room for people to pass each other while maintaining a 1.5-meter distance. This suggests that pedestrians tend to gravitate toward others, even when ample space exists to maintain distance. Conclusions: The direct positive relationship between crowding and distancing violations suggests that potential transmission encounters can be identified by simply counting the number of people present in a location. Our findings thus provide a reliable and scalable proxy measure of distancing noncompliance that offers epidemiologists a tool to easily incorporate real-life behavior into predictive models of airborne contagious diseases. Furthermore, our results highlight the need for scholars and public health agencies to consider the situational factors influencing social distancing violations, especially those related to crowding in public settings. ",
doi="10.2196/50929",
url="https://publichealth.jmir.org/2025/1/e50929"
}


@Article{info:doi/10.2196/64663,
author="Sugarman, Jeremy
and Bollinger, Juli
and Agostini, Jose
and Weinfurt, Kevin
and Geller, Gail
and Jose, Sheethal
and Hannah, Marissa
and Edwards, Winslow O.
and Henry, Meltzer Leslie
and Sanchez, Travis",
title="Impact of Disclosing to Patients the Use of Antiretroviral Resistance Testing Results for Molecular HIV Surveillance: A Randomized Experiment in 2 National Surveys",
journal="JMIR Public Health Surveill",
year="2025",
month="Apr",
day="11",
volume="11",
pages="e64663",
keywords="HIV",
keywords="disclosure",
keywords="consent",
keywords="antiretroviral",
keywords="HIV gene",
keywords="ARVRT",
keywords="molecular HIV surveillance",
keywords="antiretroviral resistance",
keywords="antiretroviral resistance testing",
keywords="molecular HIV",
keywords="HIV surveillance",
keywords="public health",
keywords="people living with HIV",
keywords="web-based survey",
keywords="United States",
keywords="AMIS",
keywords="TWIST",
keywords="prevention and care",
keywords="American Men's Internet Survey",
keywords="Transgender Women's Internet Survey and Testing",
abstract="Background: Molecular HIV surveillance (MHS) can be used to help identify and respond to emerging clusters of rapidly spreading HIV transmissions, a practice known as cluster detection and response (CDR). In the United States, MHS relies on HIV gene sequences obtained from routine clinical antiretroviral resistance testing (ARVRT). By law, ARVRT results are reported to public health agencies for MHS and individuals are not asked for their specific consent to do so. This practice has raised ethical concerns, including the lack of consent for, and transparency surrounding, public health uses of these clinical data. Such concerns have spurred debate and could have a chilling effect on the willingness of people living with HIV to agree to ARVRT when recommended clinically and jeopardize the utility of MHS-informed HIV prevention efforts. In response to the lack of routine disclosure of use of ARVRT results for MHS, in 2022, the Presidential Advisory Council on HIV/AIDS (PACHA) issued a resolution calling on the US Centers for Disease Control to ``require that providers explain MHS/CDR and the laboratory test results that are collected and used in these surveillance activities to their patients.'' Objective: This study aimed to examine the effect of clinician disclosure of the public health uses of ARVRT results for MHS versus clinician nondisclosure on patient willingness to undergo recommended ARVRT. Methods: We conducted a randomized survey experiment examining the effect of clinician disclosure of the public health uses of ARVRT results for MHS versus clinician nondisclosure (the current standard of care) and subsequent discovery of such uses through a ``trusted media source'' on patient willingness to undergo recommended ARVRT. Study participants were respondents to 1 of 2 national web-based surveys conducted annually in the United States: the American Men's Internet Survey (AMIS) and the Transgender Women's Internet Survey and Testing (TWIST). Results: Overall, 4348 AMIS participants (n=2151 disclosure; n=2197 nondisclosure) and 3314 TWIST participants (n=1670 disclosure; n=1644 nondisclosure) completed survey items regarding the randomly assigned vignettes. The majority were willing to undergo ARVRT regardless of which vignette they saw (1670/2151, 82.7\% [AMIS] and 1326/1670, 80.8\% [TWIST] in the disclosure group; and 1399/2197, 68\% [AMIS] and 1101/1674, 68.45\% [TWIST] in the nondisclosure group) after later learning about public health uses of ARVRT results. Conclusions: The majority of respondents expressed willingness to undergo ARVRT even with disclosure of public health uses of these data, but willingness markedly decreased when learning about these uses after the fact, highlighting the importance of transparency in MHS programs. Accordingly, in line with the ethical principle of respect for autonomy and the likelihood that the potential public health benefits of MHS programs will not be compromised, consideration should be given to encouraging clinicians to disclose public health uses of ARVRT at the time ARVRT is recommended. ",
doi="10.2196/64663",
url="https://publichealth.jmir.org/2025/1/e64663"
}


@Article{info:doi/10.2196/69542,
author="Abbasi, Ebrahim",
title="Assessing the Influence of Seasonal and Climatic Variations on Livestock Tick Incidence in Tehran Province, Iran: Cross-Sectional Study",
journal="JMIRx Bio",
year="2025",
month="Mar",
day="31",
volume="3",
pages="e69542",
keywords="impact of climate",
keywords="seasonal change",
keywords="frequency",
keywords="livestock",
keywords="ticks",
keywords="Tehran",
abstract="Background: Ticks are well-known ectoparasites of domestic animals, causing significant economic losses and playing a crucial role in the transmission of pathogens within the livestock industry worldwide, including in Iran. Understanding the distribution and diversity of ticks is essential for effective control strategies, especially in regions like Tehran province, where livestock plays a vital role in the economy. Objective: This study aimed to determine the frequency and distribution of livestock ticks across different seasons and climatic zones in Tehran province. Methods: In 2019, a total of 1623 domestic animals infested with ticks were examined, including chickens, sheep, camels, cows, pigeons, and dogs. A total of 806 ticks were collected, comprising 121 (15\%) soft ticks and 685 (85\%) hard ticks. Tick species were identified and categorized based on their occurrence in mountainous and plain climate regions. Results: Out of the 806 collected ticks, 44.8\% (n=361) were found in the mountainous region and 55.2\% (n=445) were found in the plain region. The most abundant species was Rhipicephalus sanguineus (n=307, 38.1\%), while Rhipicephalus (Boophilus) annulatus was the least common (n=3, 0.4\%). Seasonal variation indicated peak infestation in the spring (n=486, 60.3\%) and the lowest infestation in the winter (n=77, 9.6\%). Conclusions: The study highlights the significant diversity and abundance of both soft and hard ticks in livestock across various regions of Tehran province. These findings emphasize the need for targeted tick control measures, considering the differences in tick distribution between mountainous and plain climate regions. ",
doi="10.2196/69542",
url="https://bio.jmirx.org/2025/1/e69542"
}


@Article{info:doi/10.2196/64667,
author="Biliotti, Carolina
and Fraccaroli, Nicol{\`o}
and Puliga, Michelangelo
and Bargagli-Stoffi, J. Falco
and Riccaboni, Massimo",
title="The Impact of Stay-At-Home Mandates on Uncertainty and Sentiments: Quasi-Experimental Study",
journal="J Med Internet Res",
year="2025",
month="Mar",
day="4",
volume="27",
pages="e64667",
keywords="lockdown policy",
keywords="sentiment analysis",
keywords="uncertainty",
keywords="social media",
keywords="quasi-experiment",
abstract="Background: As the spread of the SARS-CoV-2 virus coincided with lockdown measures, it is challenging to distinguish public reactions to lockdowns from responses to COVID-19 itself. Beyond the direct impact on health, lockdowns may have worsened public sentiment toward politics and the economy or even heightened dissatisfaction with health care, imposing a significant cost on both the public and policy makers. Objective: This study aims to analyze the causal effect of COVID-19 lockdown policies on various dimensions of sentiment and uncertainty, using the Italian lockdown of February 2020 as a quasi-experiment. At the time of implementation, communities inside and just outside the lockdown area were equally exposed to COVID-19, enabling a quasi-random distribution of the lockdown. Additionally, both areas had similar socioeconomic and demographic characteristics before the lockdown, suggesting that the delineation of the strict lockdown zone approximates a randomized experiment. This approach allows us to isolate the causal effects of the lockdown on public emotions, distinguishing the impact of the policy itself from changes driven by the virus's spread. Methods: We used Twitter data (N=24,261), natural language models, and a difference-in-differences approach to compare changes in sentiment and uncertainty inside (n=1567) and outside (n=22,694) the lockdown areas before and after the lockdown began. By fine-tuning the AlBERTo (Italian BERT optimized) pretrained model, we analyzed emotions expressed in tweets from 1124 unique users. Additionally, we applied dictionary-based methods to categorize tweets into 4 dimensions---economy, health, politics, and lockdown policy---to assess the corresponding emotional reactions. This approach enabled us to measure the direct impact of local policies on public sentiment using geo-referenced social media and can be easily adapted for other policy impact analyses. Results: Our analysis shows that the lockdown had no significant effect on economic uncertainty (b=0.005, SE 0.007, t125=0.70; P=.48) or negative economic sentiment (b=--0.011, SE 0.0089, t125=--1.32; P=.19). However, it increased uncertainty about health (b=0.036, SE 0.0065, t125=5.55; P<.001) and lockdown policy (b=0.026, SE 0.006, t125=4.47; P<.001), as well as negative sentiment toward politics (b=0.025, SE 0.011, t125=2.33; P=.02), indicating that lockdowns have broad externalities beyond health. Our key findings are confirmed through a series of robustness checks. Conclusions: Our findings reveal that lockdowns have broad externalities extending beyond health. By heightening health concerns and negative political sentiment, policy makers have struggled to secure explicit public support for government measures, which may discourage future leaders from implementing timely stay-at-home policies. These results highlight the need for authorities to leverage such insights to enhance future policies and communication strategies, reducing uncertainty and mitigating social panic. ",
doi="10.2196/64667",
url="https://www.jmir.org/2025/1/e64667",
url="http://www.ncbi.nlm.nih.gov/pubmed/40053818"
}


@Article{info:doi/10.2196/66706,
author="Hall, Alex
and Aguilera-Mu{\~n}oz, Johanna
and McGarrigle, Lisa
and Eost-Telling, Charlotte
and Denison-Day, James
and Cabral, Christie
and Willcox, Merlin
and Todd, Chris",
title="Adapting the Germ Defence Web-Based Intervention to Improve Infection Prevention and Control in Care Homes: Interview Study Among Care Home Staff",
journal="JMIR Form Res",
year="2025",
month="Feb",
day="19",
volume="9",
pages="e66706",
keywords="care homes",
keywords="long-term care",
keywords="nursing homes",
keywords="infection prevention and control",
keywords="behavioral intervention development",
keywords="person-based approach",
keywords="qualitative",
abstract="Background: Infection prevention and control (IPC) is vital in care homes as it can reduce morbidity and mortality by 30\%. Ensuring good IPC practice is a perennial challenge in the varied and complex context of care homes. Behavior change interventions delivered via digital technology may be effective in improving IPC among care home staff. Objective: This study aimed to evaluate how an evidence-based, digital behavior change intervention called Germ Defence can be rapidly adapted to meet the needs of care homes. Methods: This study applied the person-based approach, which emphasizes iterative approaches to optimizing interventions via individual user feedback. Phase 1 involved initial edits to the website by the research team to create Germ Defence for Care Homes (GDCH) version 1. Phase 2 consisted of stakeholder consultation on GDCH version 1 followed by edits to create GDCH version 2. The formal research (phases 3 and 4) involved individual think-aloud interviews with 21 staff members from management, care, and ancillary positions in 4 care homes providing real-time feedback as they worked through GDCH. Edits were made to create GDCH version 3 between phases 3 and 4. During the development of GDCH versions 2 and 3, it became clear that the intervention would need more fundamental changes beyond the pragmatic, incremental changes that would be possible within the scope of this study. Analysis was completed via a rapid, qualitative descriptive approach to develop a high-level summary of key findings from the interview data. Results: There were mixed results about the attractiveness of GDCH and its suitability to the care home context. Participants felt that the images needed to be aligned much more closely with the meaning of adjacent text. Many participants felt that they would not have time to read a text-based website, and some suggested that more engaging content, including audio and video, may be preferable. Most participants felt that the overall concept of Germ Defence was clearly relevant to their context. Some felt that it might be a useful introduction for new staff members or a refresher for current staff, but others felt that it did not add anything to their existing IPC training. There were mixed opinions about the level of detail provided in the information offered by the site. While the goal-setting behavior change mechanism may have potential, the findings suggested that it may be unsuitable for care homes and more work is needed to refine it. Conclusions: Much more work needs to be done to make Germ Defence more engaging, accessible, and relevant to the care home workforce. Our study highlights the challenges of rapidly adapting an existing intervention to a new context. Future research in this area will require a pragmatic methodological approach with a focus on implementation. ",
doi="10.2196/66706",
url="https://formative.jmir.org/2025/1/e66706"
}


@Article{info:doi/10.2196/62802,
author="Zhang, Kehe
and Hunyadi, V. Jocelyn
and de Oliveira Otto, C. Marcia
and Lee, Miryoung
and Zhang, Zitong
and Ramphul, Ryan
and Yamal, Jose-Miguel
and Yaseen, Ashraf
and Morrison, C. Alanna
and Sharma, Shreela
and Rahbar, Hossein Mohammad
and Zhang, Xu
and Linder, Stephen
and Marko, Dritana
and Roy, White Rachel
and Banerjee, Deborah
and Guajardo, Esmeralda
and Crum, Michelle
and Reininger, Belinda
and Fernandez, E. Maria
and Bauer, Cici",
title="Increasing COVID-19 Testing and Vaccination Uptake in the Take Care Texas Community-Based Randomized Trial: Adaptive Geospatial Analysis",
journal="JMIR Form Res",
year="2025",
month="Feb",
day="11",
volume="9",
pages="e62802",
keywords="COVID-19 testing",
keywords="COVID-19 vaccination",
keywords="study design",
keywords="community-based interventions",
keywords="geospatial analysis",
keywords="public health",
keywords="social determinants of health",
keywords="data dashboard",
abstract="Background: Geospatial data science can be a powerful tool to aid the design, reach, efficiency, and impact of community-based intervention trials. The project titled Take Care Texas aims to develop and test an adaptive, multilevel, community-based intervention to increase COVID-19 testing and vaccination uptake among vulnerable populations in 3 Texas regions: Harris County, Cameron County, and Northeast Texas. Objective: We aimed to develop a novel procedure for adaptive selections of census block groups (CBGs) to include in the community-based randomized trial for the Take Care Texas project. Methods: CBG selection was conducted across 3 Texas regions over a 17-month period (May 2021 to October 2022). We developed persistent and recent COVID-19 burden metrics, using real-time SARS-CoV-2 monitoring data to capture dynamic infection patterns. To identify vulnerable populations, we also developed a CBG-level community disparity index, using 12 contextual social determinants of health (SDOH) measures from US census data. In each adaptive round, we determined the priority CBGs based on their COVID-19 burden and disparity index, ensuring geographic separation to minimize intervention ``spillover.'' Community input and feedback from local partners and health workers further refined the selection. The selected CBGs were then randomized into 2 intervention arms---multilevel intervention and just-in-time adaptive intervention---and 1 control arm, using covariate adaptive randomization, at a 1:1:1 ratio. We developed interactive data dashboards, which included maps displaying the locations of selected CBGs and community-level information, to inform the selection process and guide intervention delivery. Selection and randomization occurred across 10 adaptive rounds. Results: A total of 120 CBGs were selected and followed the stepped planning and interventions, with 60 in Harris County, 30 in Cameron County, and 30 in Northeast Texas counties. COVID-19 burden presented substantial temporal changes and local variations across CBGs. COVID-19 burden and community disparity exhibited some common geographical patterns but also displayed distinct variations, particularly at different time points throughout this study. This underscores the importance of incorporating both real-time monitoring data and contextual SDOH in the selection process. Conclusions: The novel procedure integrated real-time monitoring data and geospatial data science to enhance the design and adaptive delivery of a community-based randomized trial. Adaptive selection effectively prioritized the most in-need communities and allowed for a rigorous evaluation of community-based interventions in a multilevel trial. This methodology has broad applicability and can be adapted to other public health intervention and prevention programs, providing a powerful tool for improving population health and addressing health disparities. ",
doi="10.2196/62802",
url="https://formative.jmir.org/2025/1/e62802"
}


@Article{info:doi/10.2196/64780,
author="Chang, Wen
and Lin, Chun-Chih
and Crilly, Julia
and Lee, Hui-Ling
and Chen, Li-Chin
and Han, Chin-Yen",
title="Virtual Reality Simulation for Undergraduate Nursing Students for Care of Patients With Infectious Diseases: Mixed Methods Study",
journal="JMIR Med Educ",
year="2025",
month="Feb",
day="11",
volume="11",
pages="e64780",
keywords="virtual reality",
keywords="infection control",
keywords="learning motivation",
keywords="learning attitudes",
keywords="nursing education",
abstract="Background: Virtual reality simulation (VRS) teaching offers nursing students a safe, immersive learning environment with immediate feedback, enhancing learning outcomes. Before the COVID-19 pandemic, nursing students had limited training and opportunities to care for patients in isolation units with infectious diseases. However, the pandemic highlighted the ongoing global priority of providing care for patients with infectious diseases. Objective: This study aims to (1) examine the effectiveness of VRS in preparing nursing students to care for patients with infectious diseases by assessing its impact on their theoretical knowledge, learning motivation, and attitudes; and (2) evaluate their experiences with VRS. Methods: This 2-phased mixed methods study recruited third-year undergraduate nursing students enrolled in the Integrated Emergency and Critical Care course at a university in Taiwan. Phase 1 used a quasi-experimental design to address objective 1 by comparing the learning outcomes of students in the VRS teaching program (experimental group) with those in the traditional teaching program (control group). Tools included an infection control written test, the Instructional Materials Motivation Survey, and a learning attitude questionnaire. The experimental group participated in a VRS lesson titled ``Caring for a Patient with COVID-19 in the Negative Pressure Unit'' as part of the infection control unit. In phase 2, semistructured interviews were conducted to address objective 2, exploring students' learning experiences. Results: A total of 107 students participated in phase 1, and 18 students participated in phase 2. Both the VRS and control groups showed significant improvements in theoretical knowledge scores (for the VRS group t46=--7.47; P<.001, for the control group t59=--4.04; P<.001). However, compared with the control group, the VRS group achieved significantly higher theoretical knowledge scores (t98.13=2.70; P=.008) and greater learning attention (t105=2.30; P=.02) at T1. Additionally, the VRS group demonstrated a statistically significant higher regression coefficient for learning confidence compared with the control group ($\beta$=.29; P=.03). The students' learning experiences in the VRS group were categorized into 4 themes: Applying Professional Knowledge to Patient Care, Enhancing Infection Control Skills, Demonstrating Patient Care Confidence, and Engaging in Real Clinical Cases. The core theme identified was Strengthening Clinical Patient Care Competencies. Conclusions: The findings suggest that VRS teaching significantly enhanced undergraduate nursing students' infection control knowledge, learning attention, and confidence. Qualitative insights reinforced the quantitative results, highlighting the holistic benefits of VRS teaching in nursing education, including improved learning outcomes. The positive impact on student motivation and attitudes indicates a potentially transformative approach to nursing education, particularly in the post--COVID-19 era, where digital and remote learning tools play an increasingly vital role. ",
doi="10.2196/64780",
url="https://mededu.jmir.org/2025/1/e64780"
}


@Article{info:doi/10.2196/60467,
author="Kinoshita, Ryo
and Miyamoto, Sho
and Suzuki, Tadaki
and Suzuki, Motoi
and Yoneoka, Daisuke",
title="Interpreting the Influence of Using Blood Donor Residual Samples for SARS-CoV-2 Seroprevalence Studies in Japan: Cross-Sectional Survey Study",
journal="JMIR Public Health Surveill",
year="2025",
month="Feb",
day="10",
volume="11",
pages="e60467",
keywords="SARS-CoV-2",
keywords="COVID-19",
keywords="seroprevalence",
keywords="blood donor",
keywords="selection bias",
keywords="healthy donor effect",
keywords="coronavirus",
keywords="pandemic",
keywords="Japan",
keywords="cross-sectional study",
keywords="residual blood",
keywords="epidemiology",
keywords="blood donation",
keywords="web-based",
keywords="logistic regression",
keywords="social economic",
keywords="comorbidity",
keywords="COVID-19 vaccination",
keywords="public health",
doi="10.2196/60467",
url="https://publichealth.jmir.org/2025/1/e60467"
}


@Article{info:doi/10.2196/59845,
author="Sood, Akshay
and ``Cotton'' Jarrell, William
and Shore, W. Xin
and Sosa, Nestor
and Parada, Alisha
and Edwardson, Nicholas
and Yingling, V. Alexandra
and Amirkabirian, Teah
and Cheng, Qiuying
and Hurwitz, Ivy
and Cook, S. Linda
and Leng, Shuguang
and Myers, B. Orrin
and Perkins, J. Douglas",
title="Effectiveness of Frequent Point-of-Care Molecular COVID-19 Surveillance in a Rural Workplace: Nonrandomized Controlled Clinical Trial Among Miners",
journal="JMIR Public Health Surveill",
year="2025",
month="Jan",
day="27",
volume="11",
pages="e59845",
keywords="point-of-care",
keywords="seroprevalence",
keywords="SARS-CoV-2",
keywords="coronavirus",
keywords="COVID-19",
keywords="surveillance",
keywords="rural workplace",
keywords="miners",
keywords="infectious disease",
keywords="pandemic",
keywords="antigen testing",
keywords="midnasal swabs",
keywords="public health",
abstract="Background: Numerous studies have assessed the risk of SARS-CoV-2 exposure and infection among health care workers during the pandemic. However, far fewer studies have investigated the impact of SARS-CoV-2 on essential workers in other sectors. Moreover, guidance for maintaining a safely operating workplace in sectors outside of health care remains limited. Workplace surveillance has been recommended by the Centers for Disease Control and Prevention, but few studies have examined the feasibility or effectiveness of this approach. Objective: The objective of this study was to investigate the feasibility and effectiveness of using frequent point-of-care molecular workplace surveillance as an intervention strategy to prevent the spread of SARS-CoV-2 at essential rural workplaces (mining sites) where physical distancing, remote work, and flexible schedules are not possible. Methods: In this nonrandomized controlled clinical trial conducted from February 2021, to March 2022, 169 miners in New Mexico (intervention cohort) and 61 miners in Wyoming (control cohort) were enrolled. Investigators performed point-of-care rapid antigen testing on midnasal swabs (NSs) self-collected by intervention miners. Our first outcome was the intervention acceptance rate in the intervention cohort. Our second outcome was the rate of cumulative postbaseline seropositivity to SARS-CoV-2 nucleocapsid protein, which was analyzed in the intervention cohort and compared to the control cohort between baseline and 12 months. The diagnostic accuracy of detecting SARS-CoV-2 using rapid antigen testing on NSs was compared to laboratory-based reverse transcriptase polymerase chain reaction (RT-PCR) on nasopharyngeal swabs (NPSs) in a subset of 68 samples. Results: Our intervention had a mean acceptance rate of 96.4\% (11,413/11,842). The intervention miners exhibited a lower cumulative postbaseline incident seropositivity at 12 months compared to control miners (14/97, 14\% vs 17/45, 38\%; P=.002). Analysis of SARS-CoV-2 antigen detection in self-administered NSs revealed 100\% sensitivity and specificity compared to laboratory-based RT-PCR testing on NPSs. Conclusions: Our findings establish frequent point-of-care molecular workplace COVID-19 surveillance as a feasible option for keeping essential rural workplaces open and preventing SARS-CoV-2 spread. These findings extend beyond this study, providing valuable insights for designing interventions to maintain employees' safety at other essential workplaces during an infectious disease outbreak. Trial Registration: ClinicalTrials.gov NCT04977050; https://clinicaltrials.gov/study/NCT04977050 ",
doi="10.2196/59845",
url="https://publichealth.jmir.org/2025/1/e59845"
}


@Article{info:doi/10.2196/59606,
author="Dini, Guglielmo
and Curti, Stefania
and Rahmani, Alborz
and Durando, Paolo
and Mattioli, Stefano",
title="Occupational Infections Among Workers in Europe: Protocol for a Scoping Review",
journal="JMIR Res Protoc",
year="2025",
month="Jan",
day="24",
volume="14",
pages="e59606",
keywords="infection",
keywords="work-related",
keywords="biological hazard",
keywords="narrative synthesis",
keywords="Europe",
keywords="occupational infection",
keywords="worker",
keywords="scoping review",
keywords="infectious",
keywords="prevention and control",
keywords="occupational health",
keywords="epidemiology",
keywords="burden of disease",
keywords="phenomenon",
abstract="Background: Workers may be exposed to different infectious agents, putting them at risk of developing occupational diseases. This can occur in many ways, through deliberate use of speci?c microorganisms or through potential exposure from close contact with biological material. Infection prevention and control measures against biohazards can reduce the risk of infection among workers. During the last few decades, an increasing proportion of workers in Europe have been exposed to infectious biological agents in their workplace. Knowledge gaps on this topic in Europe have limited our understanding of the overall phenomenon in occupational settings. Objective: This study aims to understand the extent and type of evidence on the epidemiology of occupational or work-related infections caused by bacterial, viral, fungal, and parasitical agents in European countries, the factors affecting their occurrence among workers, and the burden of disease among workers due to occupational risk. Methods: The review will be conducted following the Joanna Briggs Institute methodology for scoping reviews and the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. This review will consider studies that include data on the epidemiology of occupational infections, risk factors and determinants, and burden of disease among workers employed in specific occupational sectors in European countries in the period 2010-2023. The search will include MEDLINE, Web of Science, and Scopus databases. Independent reviewers (including GD, SC, AR, PD, and SM) will screen the titles, abstracts, and full texts of the selected studies. Data extraction will be performed using a tool developed by the researchers. The data will be mapped and analyzed according to the type of extracted data. Results: The literature search through different scientific databases started in April 2024 and is expected to be completed by December 2024. The findings will be extracted using an ad hoc data extraction tool, and relevant results will be presented in narrative and tabular form. Conclusions: This scoping review aims to provide rigorous evidence to fill the knowledge gap in the epidemiology of occupational or work-related infections in European countries, the factors affecting their occurrence, and the burden of disease in different professional settings. Such findings could improve the understanding of this complex occupational phenomenon in the European context, enabling more accurate and up-to-date surveillance of infections incurred in the workplace. International Registered Report Identifier (IRRID): PRR1-10.2196/59606 ",
doi="10.2196/59606",
url="https://www.researchprotocols.org/2025/1/e59606"
}


@Article{info:doi/10.2196/66179,
author="Cintora-Sanz, Mar{\'i}a Ana
and Horrillo-Garc{\'i}a, Cristina
and Quesada-Cubo, V{\'i}ctor
and P{\'e}rez-Alonso, Mar{\'i}a Ana
and Guti{\'e}rrez-Misis, Alicia",
title="Prevalence and Economic Impact of Acute Respiratory Failure in the Prehospital Emergency Medical Service of the Madrid Community: Retrospective Cohort Study",
journal="JMIR Public Health Surveill",
year="2025",
month="Jan",
day="16",
volume="11",
pages="e66179",
keywords="acute respiratory failure",
keywords="COVID-19",
keywords="chronic obstructive respiratory insufficiency",
keywords="congestive heart failure",
keywords="bronchospasm",
keywords="emergency medical services costs",
keywords="ambulances",
keywords="SARS-CoV-2",
keywords="coronavirus",
keywords="respiratory",
keywords="pulmonary",
keywords="pandemic",
keywords="economic impact",
keywords="observational",
keywords="Madrid",
keywords="community",
keywords="medical records",
keywords="health records",
keywords="medical advanced life support",
keywords="ALS",
keywords="acute pulmonary edema",
keywords="chronic obstructive pulmonary disease",
keywords="COPD",
keywords="prevalence",
abstract="Background: Chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF), and acute pulmonary edema (APE) are serious illnesses that often require acute care from prehospital emergency medical services (EMSs). These respiratory diseases that cause acute respiratory failure (ARF) are one of the main reasons for hospitalization and death, generating high health care costs. The prevalence of the main respiratory diseases treated in a prehospital environment in the prepandemic period and during the COVID-19 pandemic in Spain is unknown. The Madrid Community EMS is a public service that serves all types of populations and represents an epidemiological reference for supporting a population of 6.4 million inhabitants. The high volume of patients treated by Madrid's medical advanced life supports (ALSs) allows us to analyze this little-studied problem. Objectives: Our goal was to lay the groundwork for comprehensive data collection and surveillance of respiratory failure, with an emphasis on the most prevalent diseases that cause it, an aspect that has been largely overlooked in previous initiatives. By achieving these objectives, we hope to inform efforts to address respiratory failure and establish a standardized methodology and framework that can facilitate expansion to a continuous community-wide registry in Madrid, driving advances in emergency care and care practices in these pathologies. The aim of this retrospective observational study was to determine the pathologies that have mainly caused respiratory failure in patients and required medicalized ALS and to evaluate the cost of care for these pathologies collected through this pilot registry. Methods: A multicenter descriptive study was carried out in the Madrid Community EMS. The anonymized medical records of patients treated with medical ALS, who received any of the following medical diagnoses, were extracted: ARF not related to chronic respiratory disease, ARF in chronic respiratory failure, exacerbations of COPD, APE, CHF, and bronchospasm (not from asthma or COPD). The prevalence of each pathology, its evolution from 2014 to 2020, and the economic impact of the Medical ALSs were calculated. Results: The study included 96,221 patients. The most common pathology was exacerbation of COPD, with a prevalence of 0.07\% in 2014; it decreased to 0.03\% in 2020. CHF followed at 0.06\% in 2014 and 0.03\% in 2020. APE had a prevalence of 0.01\% in 2014, decreasing to 0.005\% in 2020 with the pandemic. The greatest economic impact was on exacerbation of COPD in 2015, with an annual cost of {\texteuro}2,726,893 (which equals to US \$2,864,628). Conclusions: COPD exacerbations had the higher prevalence in the Madrid region among the respiratory diseases studied. With the COVID-19 pandemic, the prevalence and costs of almost all these diseases decreased, except for ARF not related to chronic disease. The cost of these pathologies over 5 years was {\texteuro}58,791,031 (US \$61,832,879). ",
doi="10.2196/66179",
url="https://publichealth.jmir.org/2025/1/e66179"
}


@Article{info:doi/10.2196/58862,
author="Ocagli, Honoria
and Zambito, Marco
and Da Re, Filippo
and Groppi, Vanessa
and Zampini, Marco
and Terrini, Alessia
and Rigoli, Franco
and Amoruso, Irene
and Baldovin, Tatjana
and Baldo, Vincenzo
and Russo, Francesca
and Gregori, Dario",
title="Wastewater Monitoring During the COVID-19 Pandemic in the Veneto Region, Italy: Longitudinal Observational Study",
journal="JMIR Public Health Surveill",
year="2025",
month="Jan",
day="14",
volume="11",
pages="e58862",
keywords="wastewater-based epidemiology",
keywords="SARS-CoV-2",
keywords="COVID-19",
keywords="CUSUM",
keywords="WBE",
keywords="cumulative sum chart",
abstract="Background: As the COVID-19 pandemic has affected populations around the world, there has been substantial interest in wastewater-based epidemiology (WBE) as a tool to monitor the spread of SARS-CoV-2. This study investigates the use of WBE to anticipate COVID-19 trends by analyzing the correlation between viral RNA concentrations in wastewater and reported COVID-19 cases in the Veneto region of Italy. Objective: We aimed to evaluate the effectiveness of the cumulative sum (CUSUM) control chart method in detecting changes in SARS-CoV-2 concentrations in wastewater and its potential as an early warning system for COVID-19 outbreaks. Additionally, we aimed to validate these findings over different time periods to ensure robustness. Methods: This study analyzed the temporal correlation between SARS-CoV-2 RNA concentrations in wastewater and COVID-19 clinical outcomes, including confirmed cases, hospitalizations, and intensive care unit (ICU) admissions, from October 2021 to August 2022 in the Veneto region, Italy. Wastewater samples were collected weekly from 10 wastewater treatment plants and analyzed using a reverse transcription--quantitative polymerase chain reaction. The CUSUM method was used to detect significant shifts in the data, with an initial analysis conducted from October 2021 to February 2022, followed by validation in a second period from February 2022 to August 2022. Results: The study found that peaks in SARS-CoV-2 RNA concentrations in wastewater consistently preceded peaks in reported COVID-19 cases by 5.2 days. Hospitalizations followed with a delay of 4.25 days, while ICU admissions exhibited a lead time of approximately 6 days. Notably, certain health care districts exhibited stronger correlations, with notable values in wastewater anticipating ICU admissions by an average of 13.5 and 9.5 days in 2 specific districts. The CUSUM charts effectively identified early changes in viral load, indicating potential outbreaks before clinical cases increased. Validation during the second period confirmed the consistency of these findings, reinforcing the robustness of the CUSUM method in this context. Conclusions: WBE, combined with the CUSUM method, offers valuable insight into the level of COVID-19 outbreaks in a community, including asymptomatic cases, thus acting as a precious early warning tool for infectious disease outbreaks with pandemic potential. ",
doi="10.2196/58862",
url="https://publichealth.jmir.org/2025/1/e58862"
}


@Article{info:doi/10.2196/59230,
author="Sasaki, Kenji
and Ikeda, Yoichi
and Nakano, Takashi",
title="Quantifying the Regional Disproportionality of COVID-19 Spread: Modeling Study",
journal="JMIR Form Res",
year="2025",
month="Jan",
day="3",
volume="9",
pages="e59230",
keywords="infectious disease",
keywords="COVID-19",
keywords="epidemiology",
keywords="public health",
keywords="SARS-CoV-2",
keywords="pandemic",
keywords="inequality measure",
keywords="information theory",
keywords="Kullback-Leibler divergence",
abstract="Background: The COVID-19 pandemic has caused serious health, economic, and social consequences worldwide. Understanding how infectious diseases spread can help mitigate these impacts. The Theil index, a measure of inequality rooted in information theory, is useful for identifying geographic disproportionality in COVID-19 incidence across regions. Objective: This study focused on capturing the degrees of regional disproportionality in incidence rates of infectious diseases over time. Using the Theil index, we aim to assess regional disproportionality in the spread of COVID-19 and detect epicenters where the number of infected individuals was disproportionately concentrated. Methods: To quantify the degree of disproportionality in the incidence rates, we applied the Theil index to the publicly available data of daily confirmed COVID-19 cases in the United States over a 1100-day period. This index measures relative disproportionality by comparing daily regional case distributions with population proportions, thereby identifying regions where infections are disproportionately concentrated. Results: Our analysis revealed a dynamic pattern of regional disproportionality in the confirmed cases by monitoring variations in regional contributions to the Theil index as the pandemic progressed. Over time, the index reflected a transition from localized outbreaks to widespread transmission, with high values corresponding to concentrated cases in some regions. We also found that the peaks in the Theil index often preceded surges in confirmed cases, suggesting its potential utility as an early warning signal. Conclusions: This study demonstrated that the Theil index is one of the effective indices for quantifying regional disproportionality in COVID-19 incidence rates. Although the Theil index alone cannot fully capture all aspects of pandemic dynamics, it serves as a valuable tool when used alongside other indicators such as infection and hospitalization rates. This approach allows policy makers to monitor regional disproportionality efficiently, offering insights for early intervention and targeted resource allocation. ",
doi="10.2196/59230",
url="https://formative.jmir.org/2025/1/e59230"
}


@Article{info:doi/10.2196/60136,
author="Wang, Yen-Chun
and Jiesisibieke, Liduzi Zhu
and Yang, Yu-Pei
and Wang, Bing-Long
and Hsiung, Ming-Chon
and Tung, Tao-Hsin",
title="Disparities in the Prevalence of Urinary Diseases Among Prisoners in Taiwan: Population-Based Cross-Sectional Study",
journal="JMIR Public Health Surveill",
year="2024",
month="Dec",
day="24",
volume="10",
pages="e60136",
keywords="prisoners",
keywords="Taiwan",
keywords="health care",
keywords="urinary disease",
keywords="urinary tract infection",
keywords="prison health",
abstract="Background: Prisoner health is a major global concern, with prisoners often facing limited access to health care and enduring chronic diseases, infectious diseases, and poor mental health due to unsafe prison environments, unhygienic living conditions, and inadequate medical resources. In Taiwan, prison health is increasingly an issue, particularly concerning urinary diseases such as urinary tract infections. Limited access to health care and unsanitary conditions exacerbate these problems. Urinary disease epidemiology varies by sex and age, yet studies in Asia are scarce, and comprehensive data on urinary diseases in Taiwanese prisons remain limited. Objective: This study aimed to investigate the prevalence of urinary diseases among Taiwanese prisoners and explore the differences in disease prevalence between men and women, as well as across different age groups. Methods: This study used data on prisoners from the National Health Insurance Research Database covering the period from January 1 to December 31, 2013. Prisoners covered by National Health Insurance who were diagnosed with urinary diseases, identified by ICD-9-CM (International Classification of Diseases, Ninth Revision, Clinical Modification) codes 580?599 based on their medical records, and had more than one medical visit to ambulatory care or inpatient services were included. Sex- and age-stratified analyses were conducted to determine the differences in the prevalence of urinary diseases. Results: We examined 83,048 prisoners, including 2998 with urinary diseases. The overall prevalence of urinary system diseases among prisoners was 3.61\% (n=2998; n=574, 6.64\% in men and n=2424, 3.26\% in women). The prevalence rate in men was significantly lower than that in women (prevalence ratio: 0.46, P<.001). In age-stratified analysis, the prevalence rate among prisoners aged >40 years was 4.5\% (n=1815), compared to 2.77\% (n=1183) in prisoners aged ?40 years. Prisoners aged >40 years had a higher prevalence (prevalence ratio: 1.69, P<.001). Other disorders of the urethra and urinary tract (ICD-9-CM: 599), including urinary tract infection, urinary obstruction, and hematuria, were the most prevalent diseases of the urethra and urinary tract across age and sex groups. Women and older prisoners had a higher prevalence of most urinary tract diseases. There were no significant sex-specific differences in adjusted prevalence ratios for acute glomerulonephritis, nephrotic syndrome, kidney infections, urethritis (nonsexually transmitted), or urethral syndrome. However, based on the age-specific adjusted prevalence ratio analysis, cystitis was more prevalent among younger prisoners (prevalence ratio: 0.69, P=.004). Conclusions: Urinary system infections and inflammation are common in prisons. Our findings advocate for policy reforms aimed at improving health care accessibility in prisons, with a particular focus on the needs of high-risk groups such as women and older prisoners. Further research linking claims data with prisoner information is crucial to providing more comprehensive medical services and achieving health equity. ",
doi="10.2196/60136",
url="https://publichealth.jmir.org/2024/1/e60136"
}


@Article{info:doi/10.2196/63146,
author="Nie, Jia
and Huang, Tian
and Sun, Yuhong
and Peng, Zutong
and Dong, Wenlong
and Chen, Jiancheng
and Zheng, Di
and Guo, Fuyin
and Shi, Wenhui
and Ling, Yuewei
and Zhao, Weijia
and Yang, Haijun
and Shui, Tiejun
and Yan, Xiangyu",
title="Influence of the Enterovirus 71 Vaccine and the COVID-19 Pandemic on Hand, Foot, and Mouth Disease in China Based on Counterfactual Models: Observational Study",
journal="JMIR Public Health Surveill",
year="2024",
month="Dec",
day="17",
volume="10",
pages="e63146",
keywords="hand, foot, and mouth disease",
keywords="vaccination",
keywords="enterovirus 71",
keywords="COVID-19",
keywords="epidemical trend",
keywords="HFMD",
keywords="EV71",
abstract="Background: Hand, foot, and mouth disease (HFMD) is a highly contagious viral illness. Understanding the long-term trends of HFMD incidence and its epidemic characteristics under the circumstances of the enterovirus 71 (EV71) vaccination program and the outbreak of COVID-19 is crucial for effective disease surveillance and control. Objective: We aim to give an overview of the trends of HFMD over the past decades and evaluate the impact of the EV71 vaccination program and the COVID-19 pandemic on the epidemic trends of HFMD. Methods: Using official surveillance data from the Yunnan Province, China, we described long-term incidence trends and severity rates of HFMD as well as the variation of enterovirus proportions among cases. We conducted the autoregressive integrated moving average (ARIMA) of time series analyses to predict monthly incidences based on given subsets. The difference between the actual incidences and their counterfactual predictions was compared using absolute percentage errors (APEs) for periods after the EV71 vaccination program and the COVID-19 pandemic, respectively. Results: The annual incidence of HFMD fluctuated between 25.62 cases per 100,000 people in 2008 and 221.52 cases per 100,000 people in 2018. The incidence for men ranged from 30 to 250 cases per 100,000 people from 2008 to 2021, which was constantly higher than that for women. The annual incidence for children aged 1 to 2 years old ranged from 54.54 to 630.06 cases per 100,000 people, which was persistently higher than that for other age groups. For monthly incidences, semiannual peaks were observed for each year. All actual monthly incidences of 2014 to 2015 fell within the predicted 95\% CI by the ARIMA(1,0,1)(1,1,0)[12] model. The average APE was 19\% for a 2-year prediction. After the EV71 vaccination program, the actual monthly incidence of HFMD was consistently lower than the counterfactual predictions by ARIMA(1,0,1)(1,1,0)[12], with negative APEs ranging from ?11\% to ?229\% from January 2017 to April 2018. In the meantime, the proportion of EV71 among the enteroviruses causing HFMD decreased significantly, and the proportion was highly correlated (r=0.73, P=.004) with the severity rate. After the onset of the COVID-19 pandemic in 2020, the actual monthly incidence of HFMD consistently maintained a lower magnitude compared to the counterfactual predictions---ARIMA(1,0,1)(0,1,0)[12]---from February to September 2020, with considerable negative APEs (ranging from ?31\% to ?2248\%). Conclusions: EV71 vaccination alleviated severe HFMD cases and altered epidemiological trends. The HFMD may also benefit from nonpharmaceutical interventions during outbreaks such as the COVID-19 pandemic. Further development of a multivalent virus vaccine is crucial for effectively controlling HFMD outbreaks. Policymakers should implement nonpharmaceutical interventions and emphasize personal hygiene for routine prevention when appropriate. ",
doi="10.2196/63146",
url="https://publichealth.jmir.org/2024/1/e63146"
}


@Article{info:doi/10.2196/60140,
author="Poncet, R{\'e}my
and Gargominy, Olivier",
title="In the Shadow of Medicine: The Glaring Absence of Occurrence Records of Human-Hosted Biodiversity",
journal="Online J Public Health Inform",
year="2024",
month="Dec",
day="9",
volume="16",
pages="e60140",
keywords="human microbiome",
keywords="bacterial occurrence data",
keywords="public health",
keywords="one health",
keywords="biodiversity data gap",
keywords="medical data integration",
keywords="medical data",
keywords="microbiome",
keywords="bacterial",
keywords="bacteria",
keywords="biodiversity",
keywords="disease prevention",
keywords="pathogens",
keywords="user-friendly",
keywords="bacterial pathogens",
doi="10.2196/60140",
url="https://ojphi.jmir.org/2024/1/e60140"
}


@Article{info:doi/10.2196/57718,
author="Jagomast, Tobias
and Finck, Jule
and Tangemann-M{\"u}nstedt, Imke
and Auth, Katharina
and Dr{\"o}mann, Daniel
and Franzen, F. Klaas",
title="Google Trends Assessment of Keywords Related to Smoking and Smoking Cessation During the COVID-19 Pandemic in 4 European Countries: Retrospective Analysis",
journal="Online J Public Health Inform",
year="2024",
month="Dec",
day="3",
volume="16",
pages="e57718",
keywords="internet",
keywords="coronavirus",
keywords="COVID-19",
keywords="SARS-CoV-2",
keywords="pandemics",
keywords="public health",
keywords="smoking cessation",
keywords="tobacco products",
keywords="Google Trends",
keywords="relative search volume",
keywords="Europe",
keywords="online",
keywords="search",
keywords="smoking",
keywords="addiction",
keywords="quit",
keywords="cessation",
keywords="trend",
keywords="cluster",
keywords="public interest",
keywords="lockdown",
keywords="vaccination",
keywords="spread",
keywords="incidence",
abstract="Background: Smoking is a modifiable risk factor for SARS-CoV-2 infection. Evidence of smoking behavior during the pandemic is ambiguous. Most investigations report an increase in smoking. In this context, Google Trends data monitor real-time public information--seeking behavior and are therefore useful to characterize smoking-related interest over the trajectory of the pandemic. Objective: This study aimed to use Google Trends data to evaluate the effect of the pandemic on public interest in smoking-related topics with a focus on lockdowns, vaccination campaigns, and incidence. Methods: The weekly relative search volume was retrieved from Google Trends for England, Germany, Italy, and Spain from December 31, 2017, to April 18, 2021. Data were collected for keywords concerning consumption, cessation, and treatment. The relative search volume before and during the pandemic was compared, and general trends were evaluated using the Wilcoxon rank-sum test. Short-term changes and hereby temporal clusters linked to lockdowns or vaccination campaigns were addressed by the flexible spatial scan statistics proposed by Takahashi and colleagues. Subsequently, the numbers of clusters after the onset of the pandemic were compared by chi-square test. Results: Country-wise minor differences were observed while 3 overarching trends prevailed. First, regarding cessation, the statistical comparison revealed a significant decline in interest for 58\% (7/12) of related keywords, and fewer clusters were present during the pandemic. Second, concerning consumption, significantly reduced relative search volume was observed for 58\% (7/12) of keywords, while treatment-related keywords exhibited heterogeneous trends. Third, substantial clusters of increased interest were sparsely linked to lockdowns, vaccination campaigns, or incidence. Conclusions: This study reports a substantial decline in overall relative search volume and clusters for cessation interest. These results underline the importance of intensifying cessation aid during times of crisis. Lockdowns, vaccination, and incidence had less impact on information-seeking behavior. Other public measures that positively affect smoking behavior remain to be determined. ",
doi="10.2196/57718",
url="https://ojphi.jmir.org/2024/1/e57718",
url="http://www.ncbi.nlm.nih.gov/pubmed/39626237"
}


@Article{info:doi/10.2196/51877,
author="Ma, Chunxuan
and Adler, H. Rachel
and Neidre, B. Daria
and Chen, C. Ronald
and Northouse, L. Laurel
and Rini, Christine
and Tan, Xianming
and Song, Lixin",
title="Challenges and Approaches to Recruitment for and Retention in a Dyad-Focused eHealth Intervention During COVID-19: Randomized Controlled Trial",
journal="J Med Internet Res",
year="2024",
month="Dec",
day="3",
volume="26",
pages="e51877",
keywords="randomized controlled trials",
keywords="RCT",
keywords="prostate cancer",
keywords="accrual",
keywords="retention",
keywords="COVID-19 pandemic",
keywords="family-based research",
abstract="Background: Family-based randomized controlled trials (RCTs) encounter recruitment and retention challenges. Cancer-focused RCTs typically recruit convenience samples from local cancer centers and hospitals. Objective: This study aimed to examine the recruitment and retention of a population-based, patient-partner dyad cohort in an RCT testing a dyadic eHealth intervention to improve the quality of life in patients with prostate cancer and their partners. Methods: In this 2-arm, parallel-group RCT, men who recently completed treatment for localized prostate cancer statewide were recruited through North Carolina Central Cancer Registry rapid case ascertainment between April 2018 and April 2021, coinciding with the COVID-19 pandemic. Patient-partner dyads underwent baseline assessments and were randomly assigned to either the intervention or control groups. Follow-up surveys were conducted at 4, 8, and 12 months after baseline. Descriptive and logistic regression analyses were used to achieve the study's aims. Results: Of the 3078 patients referred from rapid case ascertainment, 2899 were screened. A total of 357 partners were approached after obtaining the eligible patients' permission, 280 dyads completed baseline assessments and were randomized (dyad enrollment rate: 85.11\%, 95\% CI 81.3\%-88.9\%), and 221 dyads completed the 12-month follow-up (retention rate: 78.93\%, 95\% CI 74.2\%-83.7\%). Regarding the factors associated with retention, compared with White participants, people self-reporting as ``other races'' (including American Indian, Asian, and multiracial) were more likely to drop out of the study (odds ratio 2.78, 95\% CI 1.10-7.04), and older participants were less likely to withdraw (odds ratio 0.96, 95\% CI 0.92-0.99). Conclusions: Despite the negative impact of the pandemic, we successfully recruited enough patient-partner dyads to test our RCT hypotheses. Our recruitment and retention rates were equivalent to or higher than those in most dyadic intervention studies. A well-functioning research team and specific strategies (eg, eHealth intervention, internet phone, and online surveys) facilitated the recruitment and retention of patients with prostate cancer and their partners during the unprecedented pandemic. Trial Registration: ClinicalTrials.gov NCT03489057; https://clinicaltrials.gov/study/NCT03489057 International Registered Report Identifier (IRRID): RR2-https://doi.org/10.1186/s13063-021-05948-5 ",
doi="10.2196/51877",
url="https://www.jmir.org/2024/1/e51877",
url="http://www.ncbi.nlm.nih.gov/pubmed/39625741"
}


@Article{info:doi/10.2196/47856,
author="Baxter-King, Ryan
and Naeim, Arash
and Huang, Q. Tina
and Sepucha, Karen
and Stanton, Annette
and Rudkin, Aaron
and Ryu, Rita
and Sabacan, Leah
and Vavreck, Lynn
and Esserman, Laura
and Stover Fiscalini, Allison
and Wenger, S. Neil",
title="Relationship Between Perceived COVID-19 Risk and Change in Perceived Breast Cancer Risk: Prospective Observational Study",
journal="JMIR Cancer",
year="2024",
month="Dec",
day="2",
volume="10",
pages="e47856",
keywords="breast cancer",
keywords="COVID-19 risk perception",
keywords="cancer screening",
keywords="anxiety",
keywords="cancer",
keywords="COVID-19",
keywords="prevention",
keywords="medical care",
keywords="screening",
keywords="survey",
abstract="Background: Whether COVID-19 is associated with a change in risk perception about other health conditions is unknown. Because COVID-19 occurred during a breast cancer study, we evaluated the effect of COVID-19 risk perception on women's breast cancer risk perception. Objective: This study aims to evaluate the relationship between perceived risk of COVID-19 and change in perceived breast cancer risk. We hypothesized that women who perceived greater COVID-19 risk would evidence increased perceived breast cancer risk and this risk would relate to increased anxiety and missed cancer screening. Methods: Women aged 40-74 years with no breast cancer history were enrolled in a US breast cancer prevention trial in outpatient settings. They had provided breast cancer risk perception and general anxiety before COVID-19. We performed a prospective observational study of the relationship between the perceived risk of COVID-19 and the change in perceived breast cancer risk compared to before the pandemic. Each woman was surveyed up to 4 times about COVID-19 and breast cancer risk perception, general anxiety, and missed medical care early in COVID-19 (May to December 2020). Results: Among 13,002 women who completed a survey, compared to before COVID-19, anxiety was higher during COVID-19 (mean T score 53.5 vs 49.7 before COVID-19; difference 3.8, 95\% CI 3.6-4.0; P<.001) and directly related to perceived COVID-19 risk. In survey wave 1, anxiety increased by 2.3 T score points for women with very low perceived COVID-19 risk and 5.2 points for those with moderately or very high perceived COVID-19 risk. Despite no overall difference in breast cancer risk perception (mean 32.5\% vs 32.5\% before COVID-19; difference 0.24, 95\% CI --0.47 to 0.52; P=.93), there was a direct relationship between change in perceived breast cancer risk with COVID-19 risk perception, ranging in survey wave 4 from a 2.4\% decrease in breast cancer risk perception for those with very low COVID-19 risk perception to a 3.4\% increase for women with moderately to very high COVID-19 risk perception. This was not explained by the change in anxiety or missed cancer screening. After adjustment for age, race, education, and survey wave, compared to women with very low perceived COVID-19 risk, perceived breast cancer risk increased by 1.54\% (95\% CI 0.75\%-2.33\%; P<.001), 4.28\% (95\% CI 3.30\%-5.25\%; P<.001), and 3.67\% (95\% CI 1.94\%-5.40\%; P<.001) for women with moderately low, neither high nor low, and moderately or very high perceived COVID-19 risk, respectively. Conclusions: Low perceived COVID-19 risk was associated with reduced perceived breast cancer risk, and higher levels of perceived COVID-19 risk were associated with increased perceived breast cancer risk. This natural experiment suggests that a threat such as COVID-19 may have implications beyond the pandemic. Preventive health behaviors related to perceived risk may need attention as COVID-19 becomes endemic. ",
doi="10.2196/47856",
url="https://cancer.jmir.org/2024/1/e47856"
}


@Article{info:doi/10.2196/63415,
author="Brugger, Curdin
and Dietler, Dominik
and Abu Hamad, A. Bassam
and van Gastel, Tammo
and Sittaro, Federico
and Rossi, Rodolfo
and Owen, Nia Branwen
and Probst-Hensch, Nicole
and Winkler, S. Mirko",
title="Assessment of Health and Well-Being Effects Associated With the Challenging Drinking Water Situation in the Gaza Strip: Protocol for a Cross-Sectional Household Survey Study",
journal="JMIR Res Protoc",
year="2024",
month="Nov",
day="29",
volume="13",
pages="e63415",
keywords="drinking water",
keywords="water quality",
keywords="households survey",
keywords="noncommunicable diseases",
keywords="protracted conflict",
keywords="humanitarian crisis",
keywords="Gaza Strip",
keywords="well-being",
abstract="Background: The water supply in the Gaza Strip, Palestine, has been unstable and under strain for decades, resulting in major issues with drinking water quality, reliability, and acceptability. In 2018, between 25\% and 30\% of Gazans did not have regular access to running water. The progressive deterioration of water infrastructure and concerns over the quality of piped water have resulted in a complex mix of drinking water sources used in the Gaza Strip. The challenges of safe water provision in the Gaza Strip could potentially have severe adverse effects on the population's health and well-being. Objective: The main objectives of this survey are to determine the quality of drinking water at the household level and to investigate the association of various health outcomes with water quality at the household level in the Gaza Strip. Methods: We conducted a cross-sectional household survey in the North Gaza, Gaza, and Rafah governorates between January and March 2023. We selected a subsample of households from a representative cross-sectional survey conducted in the Gaza Strip in 2020 with persons aged 40 years and older. From each household in the 2023 survey, we invited 3 individuals (2 older than 40 years and 1 between 18 and 30 years) to participate. The face-to-face interview included questions on drinking water, mental health and well-being, self-reported diagnoses for selected diseases, use of antibiotics, and knowledge about antimicrobial resistance. Additionally, we measured each participant's blood pressure. We sampled drinking water from each household and analyzed the samples for microbial contamination, nitrate, sodium, and mineral content. Results: In total, we visited 905 households and interviewed 2291 participants. In both age groups, more female participants were interviewed. A total of 56.60\% (914/1615) were aged ?40 years, and 58.9\% (398/676) were aged between 18 and 30 years. We obtained water samples from nearly all households (902/905, 99.8\%). The results are expected to be published in several papers in 2025. Conclusions: The extensive survey components, coupled with drinking water testing and building on an existing survey, allowed us to identify a broad set of potential impacts on health and well-being and to track changes over time. This study intends to identify humanitarian and development interventions that could impact the population served most. However, we completed data collection before the escalation of violence in October 2023. Given the impact of the still ongoing conflict, the initial intent of this work is no longer valid. However, the results emerging from the survey may still serve as a valuable baseline to assess the impacts of the current escalations on physical and mental health and on drinking water quality. In addition, our findings could provide important information for rebuilding the Gaza Strip in a more health-promoting way. International Registered Report Identifier (IRRID): DERR1-10.2196/63415 ",
doi="10.2196/63415",
url="https://www.researchprotocols.org/2024/1/e63415",
url="http://www.ncbi.nlm.nih.gov/pubmed/39612204"
}


@Article{info:doi/10.2196/62747,
author="Campbell, Marie Amy
and Hauton, Chris
and van Aerle, Ronny
and Martinez-Urtaza, Jaime",
title="Eco-Evolutionary Drivers of Vibrio parahaemolyticus Sequence Type 3 Expansion: Retrospective Machine Learning Approach",
journal="JMIR Bioinform Biotech",
year="2024",
month="Nov",
day="28",
volume="5",
pages="e62747",
keywords="pathogen expansion",
keywords="climate change",
keywords="machine learning",
keywords="ecology",
keywords="evolution",
keywords="vibrio parahaemolyticus",
keywords="sequencing",
keywords="sequence type 3",
keywords="VpST3",
keywords="genomics",
abstract="Background: Environmentally sensitive pathogens exhibit ecological and evolutionary responses to climate change that result in the emergence and global expansion of well-adapted variants. It is imperative to understand the mechanisms that facilitate pathogen emergence and expansion, as well as the drivers behind the mechanisms, to understand and prepare for future pandemic expansions. Objective: The unique, rapid, global expansion of a clonal complex of Vibrio parahaemolyticus (a marine bacterium causing gastroenteritis infections) named Vibrio parahaemolyticus sequence type 3 (VpST3) provides an opportunity to explore the eco-evolutionary drivers of pathogen expansion. Methods: The global expansion of VpST3 was reconstructed using VpST3 genomes, which were then classified into metrics characterizing the stages of this expansion process, indicative of the stages of emergence and establishment. We used machine learning, specifically a random forest classifier, to test a range of ecological and evolutionary drivers for their potential in predicting VpST3 expansion dynamics. Results: We identified a range of evolutionary features, including mutations in the core genome and accessory gene presence, associated with expansion dynamics. A range of random forest classifier approaches were tested to predict expansion classification metrics for each genome. The highest predictive accuracies (ranging from 0.722 to 0.967) were achieved for models using a combined eco-evolutionary approach. While population structure and the difference between introduced and established isolates could be predicted to a high accuracy, our model reported multiple false positives when predicting the success of an introduced isolate, suggesting potential limiting factors not represented in our eco-evolutionary features. Regional models produced for 2 countries reporting the most VpST3 genomes had varying success, reflecting the impacts of class imbalance. Conclusions: These novel insights into evolutionary features and ecological conditions related to the stages of VpST3 expansion showcase the potential of machine learning models using genomic data and will contribute to the future understanding of the eco-evolutionary pathways of climate-sensitive pathogens. ",
doi="10.2196/62747",
url="https://bioinform.jmir.org/2024/1/e62747",
url="http://www.ncbi.nlm.nih.gov/pubmed/39607996"
}


@Article{info:doi/10.2196/57486,
author="Mai, Haiyan
and Lu, Yaxin
and Fu, Yu
and Luo, Tongsen
and Li, Xiaoyue
and Zhang, Yihan
and Liu, Zifeng
and Zhang, Yuenong
and Zhou, Shaoli
and Chen, Chaojin",
title="Identification of a Susceptible and High-Risk Population for Postoperative Systemic Inflammatory Response Syndrome in Older Adults: Machine Learning--Based Predictive Model",
journal="J Med Internet Res",
year="2024",
month="Nov",
day="22",
volume="26",
pages="e57486",
keywords="older adult patients",
keywords="postoperative SIRS",
keywords="sepsis",
keywords="machine learning",
keywords="prediction model",
abstract="Background: Systemic inflammatory response syndrome (SIRS) is a serious postoperative complication among older adult surgical patients that frequently develops into sepsis or even death. Notably, the incidences of SIRS and sepsis steadily increase with age. It is important to identify the risk of postoperative SIRS for older adult patients at a sufficiently early stage, which would allow preemptive individualized enhanced therapy to be conducted to improve the prognosis of older adult patients. In recent years, machine learning (ML) models have been deployed by researchers for many tasks, including disease prediction and risk stratification, exhibiting good application potential. Objective: We aimed to develop and validate an individualized predictive model to identify susceptible and high-risk populations for SIRS in older adult patients to instruct appropriate early interventions. Methods: Data for surgical patients aged ?65 years from September 2015 to September 2020 in 3 independent medical centers were retrieved and analyzed. The eligible patient cohort in the Third Affiliated Hospital of Sun Yat-sen University was randomly separated into an 80\% training set (2882 patients) and a 20\% internal validation set (720 patients).  We developed 4 ML models to predict postoperative SIRS. The area under the receiver operating curve (AUC), F1 score, Brier score, and calibration curve were used to evaluate the model performance. The model with the best performance was further validated in the other 2 independent data sets involving 844 and 307 cases, respectively. Results: The incidences of SIRS in the 3 medical centers were 24.3\% (876/3602), 29.6\% (250/844), and 6.5\% (20/307), respectively. We identified 15 variables that were significantly associated with postoperative SIRS and used in 4 ML models to predict postoperative SIRS. A balanced cutoff between sensitivity and specificity was chosen to ensure as high a true positive as possible. The random forest classifier (RF) model showed the best overall performance to predict postoperative SIRS, with an AUC of 0.751 (95\% CI 0.709-0.793), sensitivity of 0.682, specificity of 0.681, and F1 score of 0.508 in the internal validation set and higher AUCs in the external validation-1 set (0.759, 95\% CI 0.723-0.795) and external validation-2 set (0.804, 95\% CI 0.746-0.863). Conclusions: We developed and validated a generalizable RF model to predict postoperative SIRS in older adult patients, enabling clinicians to screen susceptible and high-risk patients and implement early individualized interventions. An online risk calculator to make the RF model accessible to anesthesiologists and peers around the world was developed. ",
doi="10.2196/57486",
url="https://www.jmir.org/2024/1/e57486"
}


@Article{info:doi/10.2196/59138,
author="Kang, Ye Ji
and Jung, Weon
and Kim, Ji Hyun
and An, Hyun Ji
and Yoon, Hee
and Kim, Taerim
and Chang, Hansol
and Hwang, Yeon Sung
and Park, Eun Jong
and Lee, Tak Gun
and Cha, Chul Won
and Heo, Sejin
and Lee, Uk Se",
title="Temporary Telemedicine Policy and Chronic Disease Management in South Korea: Retrospective Analysis Using National Claims Data",
journal="JMIR Public Health Surveill",
year="2024",
month="Nov",
day="20",
volume="10",
pages="e59138",
keywords="telemedicine",
keywords="public health",
keywords="medication adherence",
keywords="COVID-19",
keywords="chronic diseases",
abstract="Background: Since its introduction, telemedicine for patients with chronic diseases has been studied in various clinical settings. However, there is limited evidence of the effectiveness and medical safety of the nationwide adoption of telemedicine. Objective: This study aimed to analyze the effects of telemedicine on chronic diseases during the COVID-19 pandemic under a temporary telemedicine policy in South Korea using national claims data. Methods: Health insurance claims data were extracted over 2 years: 1 year before (from February 24, 2019, to February 23, 2020) and 1 year after the policy was implemented (from February 24, 2020, to February 23, 2021). We included all patients who used telemedicine at least once in the first year after the policy was implemented and compared them with a control group of patients who never used telemedicine. The comparison focused on health care use; the medication possession ratio (MPR); and admission rates to general wards (GWs), emergency departments (EDs), and intensive care units (ICUs) using difference-in-differences analysis. A total of 4 chronic diseases were targeted: hypertension, diabetes mellitus (DM), chronic obstructive pulmonary disease (COPD), and common mental disorders. Results: A total of 1,773,454 patients with hypertension; 795,869 patients with DM; 37,460 patients with COPD; and 167,084 patients with common mental disorders were analyzed in this study. Patients diagnosed with hypertension or DM showed increased MPRs without an increase in GW, ED, or ICU admission rates during the policy year. Moreover, patients in the DM group who did not use telemedicine had higher rates of ED, GW, and ICU admissions, and patients in the hypertension group had higher rates of GW or ICU admissions after 1 year of policy implementation. This trend was not evident in COPD and common mental disorders. Conclusions: The temporary telemedicine policy was effective in increasing medication adherence and reducing admission rates for patients with hypertension and DM; however, the efficacy of the policy was limited for patients with COPD and common mental disorders. Future studies are required to demonstrate the long-term effects of telemedicine policies with various outcome measures reflecting disease characteristics. ",
doi="10.2196/59138",
url="https://publichealth.jmir.org/2024/1/e59138"
}


@Article{info:doi/10.2196/44580,
author="Cornelis, Justien
and Christiaens, Wendy
and de Meester, Christophe
and Mistiaen, Patriek",
title="Remote Patient Monitoring at Home in Patients With COVID-19: Narrative Review",
journal="JMIR Nursing",
year="2024",
month="Nov",
day="19",
volume="7",
pages="e44580",
keywords="COVID-19",
keywords="coronavirus disease",
keywords="telemonitoring",
keywords="remote patient monitoring",
keywords="review",
keywords="pandemic",
keywords="at-home monitoring",
keywords="implementation",
keywords="health care",
keywords="patient care",
abstract="Background: During the pandemic, health care providers implemented remote patient monitoring (RPM) for patients experiencing COVID-19. RPM is an interaction between health care professionals and patients who are in different locations, in which certain patient functioning parameters are assessed and followed up for a certain duration of time. The implementation of RPM in these patients aimed to reduce the strain on hospitals and primary care. Objective: With this literature review, we aim to describe the characteristics of RPM interventions, report on patients with COVID-19 receiving RPM, and provide an overview of outcome variables such as length of stay (LOS), hospital readmission, and mortality. Methods: A combination of different searches in several database types (traditional databases, trial registers, daily [Google] searches, and daily PubMed alerts) was run daily from March 2020 to December 2021. A search update for randomized controlled trials (RCTs) was performed in April 2022. Results: The initial search yielded more than 4448 articles (not including daily searches). After deduplication and assessment for eligibility, 241 articles were retained describing 164 telemonitoring studies from 160 centers. None of the 164 studies covering 248,431 patients reported on the presence of a randomized control group. Studies described a ``prehosp'' group (96 studies) with patients who had a suspected or confirmed COVID-19 diagnosis and who were not hospitalized but closely monitored at home or a ``posthosp'' group (32 studies) with patients who were monitored at home after hospitalization for COVID-19. Moreover, 34 studies described both groups, and in 2 studies, the description was unclear. In the prehosp and posthosp groups, there were large variations in the number of emergency department (ED) visits (0\%-36\% and 0\%-16\%, respectively) and no convincing evidence that RPM leads to less or more ED visits or hospital readmissions (0\%-30\% and 0\%-22\%, respectively). Mortality was generally low, and there was weak to no evidence that RPM is associated with lower mortality. Moreover, there was no evidence that RPM shortens previous LOS. A literature update identified 3 small-scale RCTs, which could not demonstrate statistically significant differences in these outcomes. Most papers claimed savings; however, the scientific base for these claims was doubtful. The overall patient experiences with RPM were positive, as patients felt more reassured, although many patients declined RPM for several reasons (eg, technological embarrassment, digital literacy). Conclusions: Based on these results, there is no convincing evidence that RPM in COVID-19 patients avoids ED visits or hospital readmissions and shortens LOS or reduces mortality. On the other hand, there is no evidence that RPM has adverse outcomes. Further research should focus on developing, implementing, and evaluating an RPM framework. ",
doi="10.2196/44580",
url="https://nursing.jmir.org/2024/1/e44580",
url="http://www.ncbi.nlm.nih.gov/pubmed/39287362"
}


@Article{info:doi/10.2196/58873,
author="Jing, Shu
and Wu, Yijin
and Dai, Zhenwei
and Tang, Shenglan
and Su, Xiaoyou
and Qiao, Youlin",
title="The Effect of Interventions Based on the Information-Motivation-Behavioral Skills Model on the Human Papillomavirus Vaccination Rate Among 11-13-Year-Old Girls in Central and Western China: Protocol for a Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2024",
month="Nov",
day="19",
volume="13",
pages="e58873",
keywords="human papillomavirus",
keywords="HPV",
keywords="HPV vaccine",
keywords="vaccine hesitancy",
keywords="information-motivation-behavioral skills model",
keywords="HPV vaccination rate",
keywords="randomized controlled trial",
keywords="vaccination rate",
keywords="China",
abstract="Background: Persistent infection of high-risk human papillomavirus (HPV) can lead to cervical intraepithelial neoplasia, cervical cancer, and even death. HPV vaccination for girls aged 9-14 years can effectively prevent the occurrence of cervical cancer. Some Chinese provinces and cities have launched free HPV vaccination programs for school-age girls; however, due to the lack of supportive government policies, the high price and supply shortage of HPV vaccines, and vaccine hesitancy, some parents refuse to vaccinate their daughters. Objective: This protocol reports the design of a randomized controlled trial (RCT) aiming to explore the efficacy of a digital HPV vaccination education intervention based on the information-motivation-behavioral skills (IMB) model in improving the HPV vaccination rate among 11-13-year-old girls in central and western China. Methods: A multicenter intervention study based on an online applet will be conducted in December 2024, and about 750 eligible parents of 11-13-year-old girls will be assigned in a 1:1 ratio to an intervention group receiving 7-day digital HPV vaccination education based on the IMB model or a control group using non-HPV publicity materials. Free HPV vaccination pilot projects will be carried out among this population by our research team in central and western China (some parents might refuse to vaccinate their daughters). All participants will be asked to complete online questionnaires at baseline; postintervention; and 1 week, 1 month, and 3 months after the intervention. Results: The primary outcome of this study will be receipt of the first HPV vaccination within 3 months. Data will be analyzed based on an intention-to-treat approach, and Stata 16.0 will be used for statistical analysis. Conclusions: This study aims to improve the HPV vaccination rate among 11-13-year-old girls and will examine the impact of a digital HPV vaccination education intervention based on the IMB model. The findings of this study may offer promising intervention measures for HPV vaccine hesitancy in low-health-resource areas in the future. Trial Registration: Chinese Clinical Trial Registry, ChiCTR2300067402; https://tinyurl.com/v5zt4hc9 International Registered Report Identifier (IRRID): PRR1-10.2196/58873 ",
doi="10.2196/58873",
url="https://www.researchprotocols.org/2024/1/e58873"
}


@Article{info:doi/10.2196/49708,
author="Phadnis, Rachael
and Perera, Udara
and Lea, Veronica
and Davlin, Stacy
and Lee, Juliette
and Siesel, Casey
and Abeygunathilaka, Dhanushka
and Wickramasinghe, C. S.",
title="Designing and Validating a Survey for National-Level Data During the COVID-19 Pandemic in Sri Lanka: Cross-Sectional Mobile Phone Surveys",
journal="JMIR Form Res",
year="2024",
month="Nov",
day="8",
volume="8",
pages="e49708",
keywords="pilot study",
keywords="mobile phone survey",
keywords="survey methodology",
keywords="COVID-19",
keywords="data collection",
keywords="national survey",
keywords="pandemic",
keywords="population-based study",
keywords="Sri Lanka",
keywords="middle-income countries",
keywords="low-income countries",
keywords="vaccine acceptability",
keywords="vaccine",
keywords="COVID-19 vaccination",
abstract="Background: The COVID-19 pandemic has generated a demand for timely data, resulting in a surge of mobile phone surveys for tracking the impacts of and responses to the pandemic. Mobile phone surveys have become a preferred mode of data collection across low- and middle-income countries. Objective: This study piloted 2 population-based, cross-sectional mobile phone surveys among Sri Lankan residents in 2020 and 2021 during the COVID-19 pandemic. The surveys aimed to gather data on knowledge, attitudes, and practices, vaccine acceptability, availability, and barriers to COVID-19 testing, and use of a medicine distribution service. Methods: The study used Surveda, an open-source survey tool developed by the NCD (noncommunicable disease) Mobile Phone Survey Data 4 Health Initiative, for data collection and management. The surveys were conducted through interactive voice response using automated, prerecorded messages in Sinhala, Tamil, and English. The sample design involved random sampling of mobile phone numbers, stratified by sex, proportional to the general population. Eligibility criteria varied between surveys, targeting adults aged 35 years and older with any noncommunicable disease for the first survey and all adults for the second survey. The data were adjusted to population estimates, and statistical analysis was conducted using SAS (SAS Institute) and R software (R Core Team). Descriptive statistics, Rao-Scott chi-square tests, and z tests were used to analyze the data. Response rates, cooperation rates, and productivity of the sampling approach were calculated. Results: In the first survey, n=5001, the overall response rate was 7.5\%, with a completion rate of 85.6\%. In the second survey, n=1250, the overall response rate was 10.9\%, with a completion rate of 61.9\%. Approximately 3 out of 4 adults reported that they avoided public places (888/1175, 75.6\%), more than two-thirds avoided public transportation (808/1173, 68.9\%), and 9 out of 10 practiced physical distancing (1046/1167, 89.7\%). Approximately 1 out of 10 Sri Lankan persons reported being tested for COVID-19, and the majority of those received a polymerase chain reaction test (112/161, 70\%). Significantly more males than females reported being tested for COVID-19 (98/554, 17.8\% vs 61/578, 10.6\%, respectively; P<.001). Finally, the majority of adult Sri Lankan people reported that they definitely or probably would get the COVID-19 vaccination (781/1190, 65.7\%). Conclusions: The surveys revealed that, overall, the adult Sri Lankan population adhered to COVID-19 mitigation strategies. These findings underscore the use of mobile phone surveys in swiftly and easily providing essential data to inform a country's response during the COVID-19 pandemic, obviating the need for face-to-face data collection. ",
doi="10.2196/49708",
url="https://formative.jmir.org/2024/1/e49708"
}


@Article{info:doi/10.2196/58413,
author="Chung, young Wou
and Yoon, Jinsik
and Yoon, Dukyong
and Kim, Songsoo
and Kim, Yujeong
and Park, Eun Ji
and Kang, Ae Young",
title="Development and Validation of Deep Learning--Based Infectivity Prediction in Pulmonary Tuberculosis Through Chest Radiography: Retrospective Study",
journal="J Med Internet Res",
year="2024",
month="Nov",
day="7",
volume="26",
pages="e58413",
keywords="pulmonary tuberculosis",
keywords="chest radiography",
keywords="artificial intelligence",
keywords="tuberculosis",
keywords="TB",
keywords="smear",
keywords="smear test",
keywords="culture test",
keywords="diagnosis",
keywords="treatment",
keywords="deep learning",
keywords="CXR",
keywords="PTB",
keywords="management",
keywords="cost effective",
keywords="asymptomatic infection",
keywords="diagnostic tools",
keywords="infectivity",
keywords="AI tool",
keywords="cohort",
abstract="Background: Pulmonary tuberculosis (PTB) poses a global health challenge owing to the time-intensive nature of traditional diagnostic tests such as smear and culture tests, which can require hours to weeks to yield results. Objective: This study aimed to use artificial intelligence (AI)--based chest radiography (CXR) to evaluate the infectivity of patients with PTB more quickly and accurately compared with traditional methods such as smear and culture tests. Methods: We used DenseNet121 and visualization techniques such as gradient-weighted class activation mapping and local interpretable model-agnostic explanations to demonstrate the decision-making process of the model. We analyzed 36,142 CXR images of 4492 patients with PTB obtained from Severance Hospital, focusing specifically on the lung region through segmentation and cropping with TransUNet. We used data from 2004 to 2020 to train the model, data from 2021 for testing, and data from 2022 to 2023 for internal validation. In addition, we used 1978 CXR images of 299 patients with PTB obtained from Yongin Severance Hospital for external validation. Results: In the internal validation, the model achieved an accuracy of 73.27\%, an area under the receiver operating characteristic curve of 0.79, and an area under the precision-recall curve of 0.77. In the external validation, it exhibited an accuracy of 70.29\%, an area under the receiver operating characteristic curve of 0.77, and an area under the precision-recall curve of 0.8. In addition, gradient-weighted class activation mapping and local interpretable model-agnostic explanations provided insights into the decision-making process of the AI model. Conclusions: This proposed AI tool offers a rapid and accurate alternative for evaluating PTB infectivity through CXR, with significant implications for enhancing screening efficiency by evaluating infectivity before sputum test results in clinical settings, compared with traditional smear and culture tests. ",
doi="10.2196/58413",
url="https://www.jmir.org/2024/1/e58413"
}


@Article{info:doi/10.2196/56989,
author="Hong, Seohyun
and Son, Yejun
and Lee, Myeongcheol
and Lee, Hyuk Jun
and Park, Jaeyu
and Lee, Hayeon
and Dragioti, Elena
and Fond, Guillaume
and Boyer, Laurent
and L{\'o}pez S{\'a}nchez, Felipe Guillermo
and Smith, Lee
and Tully, A. Mark
and Rahmati, Masoud
and Choi, Sung Yong
and Lee, Joo Young
and Yeo, Geun Seung
and Woo, Selin
and Yon, Keon Dong",
title="Association Between Sociodemographic Factors and Vaccine Acceptance for Influenza and SARS-CoV-2 in South Korea: Nationwide Cross-Sectional Study",
journal="JMIR Public Health Surveill",
year="2024",
month="Nov",
day="1",
volume="10",
pages="e56989",
keywords="COVID-19",
keywords="influenza",
keywords="South Korea",
keywords="vaccination",
keywords="vaccinations",
keywords="COVID-19 vaccine",
keywords="COVID-19 vaccination",
keywords="SARS-CoV-2",
keywords="SARS-CoV-2 vaccine",
keywords="pandemic",
keywords="SARS-CoV-2 vaccination",
keywords="vaccine",
keywords="vaccine hesitancy",
abstract="Background: The imperative arises to study the impact of socioeconomic factors on the acceptance of SARS-CoV-2 and influenza vaccines amid changes in immunization policies during the COVID-19 pandemic. Objective: To enhance targeted public health strategies and improve age-specific policies based on identified risk factors, this study investigated the associations between sociodemographic factors and vaccination behaviors during the COVID-19 pandemic, with emphasis on age-specific vaccine cost policies. Methods: This study analyzed data from the Korean Community Health Survey 2019?2022 with 507,964 participants to investigate the impact of age-specific policies on vaccination behaviors during the pandemic period. Cohorts aged 19?64 years and 65 years or older were stratified based on age (years), sociodemographic factors, and health indicators. The cohorts were investigated to assess the influence of relevant risk factors on vaccine acceptance under the pandemic by using weighted odds ratio and ratio of odds ratio (ROR). Results: Among 507,964 participants, the acceptance of the SARS-CoV-2 vaccine (COVID-19 vaccine) was higher among individuals with factors possibly indicating higher socioeconomic status, such as higher education level (age 19?64 years: ROR 1.34; 95\% CI 1.27?1.40 and age ?65 years: ROR 1.19; 95\% CI 1.01?1.41) and higher income (age 19?64 years: ROR 1.67; 95\% CI 1.58?1.76 and age ?65 years: ROR 1.21; 95\% CI 1.06?1.38) for both age cohorts compared to influenza vaccine acceptance before the pandemic. In the context of influenza vaccination during the pandemic, the older cohort exhibited vaccine hesitancy associated with health care mobility factors such as lower general health status (ROR 0.89; 95\% CI 0.81?0.97). Conclusions: SARS-CoV-2 vaccination strategies should focus on reducing hesitancy among individuals with lower social participation. To improve influenza vaccine acceptance during the pandemic, strategies for the younger cohort should focus on individuals with lower social participation, while efforts for the older cohort should prioritize individuals with limited access to health care services. ",
doi="10.2196/56989",
url="https://publichealth.jmir.org/2024/1/e56989"
}


@Article{info:doi/10.2196/56943,
author="Helms, Bernd Yannick
and van der Meer, Akke
and Crutzen, Rik
and Ferreira, Ant{\'o}nio Jos{\'e}
and Kretzschmar, E. Mirjam E.
and Timen, Aura
and Hamdiui, Nora
and Stein, L. Mart",
title="Determinants of Citizens' Intention to Participate in Self-Led Contact Tracing: Cross-Sectional Online Questionnaire Study",
journal="JMIR Public Health Surveill",
year="2024",
month="Oct",
day="30",
volume="10",
pages="e56943",
keywords="contact tracing",
keywords="telemedicine",
keywords="health services research",
keywords="intention",
keywords="public health surveillance",
keywords="machine learning",
keywords="cross-sectional study",
keywords="online questionnaire",
keywords="disease outbreaks",
keywords="task shifting",
abstract="Background: Contact tracing (CT) is a key intervention to contain outbreaks of communicable diseases. During large-scale outbreaks, public health services may lack the resources required to perform CT effectively. One way of mitigating this issue is to shift some of the tasks in CT normally performed by public health services to cases and their contacts, supported by digital tools. We refer to this as ``self-led CT.'' However, while the effectiveness of the self-led CT inherently depends on the willingness and skills of citizens to participate, the determinants of citizens' intention to participate in self-led CT are not yet fully understood. Objective: We aimed to identify determinants of Dutch citizens' intention to participate in self-led CT and assess their potential for behavioral change, so as to identify ``behavior change targets,'' which may be used in the development and implementation of self-led CT to increase citizens' intention to participate. Methods: In March 2022, we performed an online cross-sectional questionnaire study. The questionnaire was developed based on findings from a previous exploratory semistructured interview study and distributed among a Dutch consumer panel. Using all questionnaire items as potential predictors, we performed a random forest analysis to identify determinants of citizens' intention to participate in self-led CT. We then performed an Agglomerative Hierarchical Cluster Analysis to identify groups of related determinants that may be considered overarching behavior change targets. Finally, we used Confidence Interval-Based Estimation of Relevance and calculated the Potential for Change Indices to compare the potential for behavioral change of the selected individual determinants and determinant clusters. Results: The questionnaire was completed by 3019 respondents. Our sample is representative of the Dutch population in terms of age, gender, educational level, and area of residence. Out of 3019 respondents, 2295 (76\%) had a positive intention to participate in self-led CT. We identified 20 determinants of citizens' intention that we grouped into 9 clusters. In general, increasing citizens' trust in the digital tools developed for self-led CT has the highest potential to increase citizens' intention, followed by increasing the belief that using digital tools makes participating in self-led CT easier, reducing privacy-related concerns, and increasing citizens' willingness---and sense of responsibility---to cooperate in CT in general. Conclusions: Overall, Dutch citizens are positive toward participating in self-led CT. Our results provide directions for the development and implementation of self-led CT, which may be particularly useful in preparing for future, large-scale outbreaks. ",
doi="10.2196/56943",
url="https://publichealth.jmir.org/2024/1/e56943"
}


@Article{info:doi/10.2196/60000,
author="Chen, En-ling
and Bai, Chyi-Huey
and Kocis, T. Paul
and Hwang, Wenke",
title="The Perspectives of Community Pharmacists Toward the Name-Based Rationing System During the COVID-19 Pandemic in Taiwan: Cross-Sectional Survey Study",
journal="JMIR Form Res",
year="2024",
month="Oct",
day="24",
volume="8",
pages="e60000",
keywords="name-based rationing system",
keywords="NBRS",
keywords="community pharmacy",
keywords="community pharmacist",
keywords="COVID-19",
keywords="SARS-CoV-2",
keywords="KAP",
keywords="knowledge, attitude, and practices",
keywords="public health",
keywords="health emergencies",
keywords="government strategy",
keywords="mobile phone",
abstract="Background: In Taiwan's public health system, community-based pharmacists are key first-line health care providers due to their high accessibility. During the COVID-19 pandemic, the pharmacists played a central role in the distribution of these supplies through the Name-Based Rationing System (NBRS), during an acute shortage of masks and testing kits, that helped reduce the spread of the disease. The NBRS, an innovative government-guided strategy developed after the COVID-19 outbreak, provided equitable and convenient access to masks and COVID-19 test kits. Objective: This study aimed to investigate (1) Taiwanese pharmacists' knowledge, attitude, and practices (KAPs) of COVID-19, with the intention to assess their preparedness for public health emergencies and their capabilities to implement COVID-19--related policies effectively; (2) their perspectives toward the NBRS; and (3) the association between individual's KAP and corresponding perspectives toward the NBRS. Methods: A cross-sectional, web-based survey was conducted in 2 major cities in Taiwan, from June 18 to September 11, 2022, during the peak of the COVID-19 pandemic. To gauge community pharmacists' KAP, a 66-question instrument was developed using guidelines from the Taiwanese Centers for Disease Control, the International Pharmaceutical Federation, and the Taiwanese Pharmacist Association. The instrument's internal consistency reliability was ascertained using Cronbach $\alpha$ (0.819), and its content validity was verified by field experts. Results: Overall, 343 Taiwanese community pharmacists were recruited in the study. Among them, 88\% (303/343) scored high on knowledge domain questions related to SARS-CoV-2; 58\% (201/343) and 39\% (136/343) held positive and neutral attitudes toward COVID-19--related policies, respectively; and 77\% (266/343) practiced infectious disease prevention measures in compliance with official guidelines. The results demonstrated a high level of competency in pharmacists in a public health crisis. It revealed that factors including age, pharmacy characteristics, and the number of customers were associated with their perceptions and willingness to continuously participate in the NBRS. Overall, the community pharmacists showed greater support for the COVID-19--testing NBRS compared with the mask NBRS, because of the more favorable influence on the revenue and workforce of the pharmacies and the well-being of the pharmacists. Responses also highlighted concerns about rapid government policy changes and supply dynamics, underscoring the importance of effective communication and considering supply availability in facilitating a successful NBRS. Conclusions: The strong KAP of the community pharmacists justified the government leveraging their expertise in Taiwan's COVID-19 response. While community pharmacies have proven to be essential distribution centers through the NBRS, improving community connections, communication with the government, and supply management are recommended to strengthen the system. These potential approaches aim to ensure successful NBRS implementation and better preparedness for future public health emergencies. Overall, pharmacists have demonstrated their integral role in achieving equitable outcomes and their dedication to public health efforts during crises. ",
doi="10.2196/60000",
url="https://formative.jmir.org/2024/1/e60000"
}


@Article{info:doi/10.2196/55706,
author="Li, Lan
and Wood, E. Caroline
and Kostkova, Patty",
title="Evaluating a WeChat-Based Intervention to Enhance Influenza Vaccination Knowledge, Attitude, and Behavior Among Chinese University Students Residing in the United Kingdom: Controlled, Quasi-Experimental, Mixed Methods Study",
journal="JMIR Form Res",
year="2024",
month="Oct",
day="24",
volume="8",
pages="e55706",
keywords="influenza vaccination",
keywords="intervention study",
keywords="social media",
keywords="students",
keywords="health promotion",
keywords="mixed methods",
abstract="Background: University students, who often live in close quarters and engage in frequent social interaction, face a heightened risk of influenza morbidity. Still, vaccination rates among this group, particularly Chinese students, remain consistently low due to limited awareness and insufficient access to vaccinations. Objective: This study examines the effectiveness of a cocreated WeChat-based intervention that targets mainland Chinese university students in the United Kingdom, aiming to improve their knowledge, attitude, and behavior (KAB) toward seasonal influenza vaccination. Methods: A quasi-experimental mixed methods design was used, incorporating an intervention and comparison group, with baseline and follow-up self-reported surveys. The study was conducted from December 19, 2022, to January 16, 2023. The primary outcome is the KAB score, which was measured before and after the intervention phases. System-recorded data and user feedback were included in the analysis as secondary outcomes. A series of hypothesis testing methods were applied to test the primary outcomes, and path analysis was used to explore the relationships. Results: Our study included 596 students, of which 303 (50.8\%) were in the intervention group and 293 (49.2\%) were in the control group. The intervention group showed significant improvements in knowledge, attitude, and intended behavior scores over time, whereas the control group had only a slight increase in intended behavior scores. When comparing changes between the 2 groups, the intervention group displayed significant differences in knowledge and attitude scores compared to the control group, while intended behavior scores did not significantly differ. After the intervention, the actual vaccination rate was slightly higher in the intervention group (63/303, 20.8\%) compared to the control group (54/293, 18.4\%). Path analysis found that the intervention had a significant direct impact on knowledge but not on attitudes; knowledge strongly influenced attitudes, and both knowledge and attitudes significantly influenced intended behavior; and there was a strong correlation between intended and actual behavior. In the intervention group, participants expressed a high level of satisfaction and positive review of the content and its use. Conclusions: This study demonstrates how a WeChat intervention effectively improves KAB related to seasonal influenza vaccination among Chinese students, highlighting the potential of social media interventions to drive vaccination behavior change. It contributes to the broader research on digital health intervention effectiveness and lays the groundwork for tailoring similar interventions to different health contexts and populations. ",
doi="10.2196/55706",
url="https://formative.jmir.org/2024/1/e55706"
}


@Article{info:doi/10.2196/50846,
author="Qin, Rundong
and Feng, Yan
and Zhang, Huanping
and Zhao, Beibei
and Lei, Wei
and Sun, Hongying
and Zhi, Lili
and Zheng, Zhongsheng
and Wang, Siqin
and Yu, Yafeng
and Jiang, Shengxue
and Liu, Changshan
and Ma, Xingkai
and Ma, Hui
and Wang, Huiying
and Lin, Hang
and He, Qiaojie
and Wu, Lingying
and Zhai, Yingying
and Lu, Honglue
and Chen, Shi
and Ma, Yan
and Jin, Xiaohong
and Deng, Shan
and Zhong, Nanshan
and Chen, Ruchong
and Li, Jing",
title="Protective Effect of Allergen Immunotherapy in Patients With Allergic Rhinitis and Asthma Against COVID-19 Infection: Observational, Nationwide, and Multicenter Study",
journal="JMIR Public Health Surveill",
year="2024",
month="Oct",
day="16",
volume="10",
pages="e50846",
keywords="allergen immunotherapy",
keywords="COVID-19",
keywords="antiviral effect",
keywords="allergic rhinitis",
keywords="asthma",
keywords="viral infection",
keywords="allergic disease",
keywords="trajectory",
keywords="questionnaire-based survey",
keywords="clinical evidence",
abstract="Background: Allergic diseases are associated with an increased susceptibility to respiratory tract infections. Although allergen immunotherapy (AIT) alters the course of allergies, there is limited evidence from clinical practice demonstrating its ability to enhance the host defense against pathogens. Objective: The aim of this study was to investigate the protective effect of AIT against viral infection in patients with allergic rhinitis (AR) and allergic asthma (AS) based on clinical evidence. Methods: A multicenter, questionnaire-based survey was conducted during a tremendous surge in COVID-19 cases between February 10, 2023, and March 15, 2023, in 81 centers across China recruiting healthy volunteers and patients with AR and AS to investigate the clinical outcomes of COVID-19 infection. Results: Of 10,151 participants recruited in the survey, 3654 patients and 2192 healthy volunteers who tested positive for COVID-19 were included in this analysis after screening. Overall, no significant differences in COVID-19 outcomes were observed between patients and healthy volunteers. An additional 451 patients were excluded due to their use of biologics as the sole add-on treatment, leaving 3203 patients in the further analysis. Of them, 1752 were undergoing routine medication treatment (RMT; the RMT group), whereas 1057 and 394 were receiving AIT and a combination of AIT and omalizumab (OMA) as adjunct therapies to RMT, respectively (AIT+RMT and AIT+OMA+RMT groups). The AIT group showed milder COVID-19 symptoms, shorter recovery periods, and a lower likelihood of hospitalization or emergency department visits than the RMT group (all P<.05). After adjusting for confounding factors, including demographic characteristics and COVID-19 vaccination, AIT remained a significant protective factor associated with shorter recovery time (adjusted odds ratio [OR] 0.62, 95\% CI 0.52?0.75; adjusted P<.001) and a lower incidence of hospitalization or emergency department visits (adjusted OR 0.73, 95\% CI 0.54?0.98; adjusted P=.03). Furthermore, the AIT+OMA+RMT group showed greater protection with a shorter recovery time (adjusted OR 0.51, 95\% CI 0.34?0.74; adjusted P<.001) than the AIT+RMT group. Conclusions: Our multicenter observational study provides valuable clinical evidence supporting the protective effect of AIT against COVID-19 infection in patients with AR and AS. ",
doi="10.2196/50846",
url="https://publichealth.jmir.org/2024/1/e50846"
}


@Article{info:doi/10.2196/53368,
author="Rahmon, Imme
and Bosmans, Mark
and Baliatsas, Christos
and Hooiveld, Mariette
and Marra, Elske
and D{\"u}ckers, Michel",
title="COVID-19 Health Impact: A Use Case for Syndromic Surveillance System Monitoring Based on Primary Care Patient Registries in the Netherlands",
journal="JMIR Public Health Surveill",
year="2024",
month="Sep",
day="26",
volume="10",
pages="e53368",
keywords="SARS-CoV-2",
keywords="epidemic surveillance",
keywords="public health",
keywords="general practice",
keywords="disaster health research",
abstract="Background: The COVID-19 pandemic challenged societies worldwide. The implementation of mitigation measures to limit the number of SARS-CoV-2 infections resulted in unintended health effects. Objective: The objective of this study is to demonstrate the use of an existing syndromic surveillance system in primary care during a first series of quarterly cross-sectional monitoring cycles, targeting health problems presented in primary care among Dutch youth since August 2021. Methods: Aggregated data from the surveillance system of Nivel Primary Care Database were analyzed quarterly to monitor 20 health problems often reported in the aftermath of disasters and environmental incidents. Results were stratified by age (ie, 0?4, 5?14, and 15?24 years), sex, and region (province). Weekly prevalence rates were calculated as the number of persons consulting their general practitioner in a particular week, using the number of enlisted persons as the denominator. Findings were compared to quarterly survey panel data, collected in the context of the Integrated Health Monitor COVID-19, and the Dutch stringency index values, indicative of the intensity of COVID-19 mitigation measures. Results: Over time, weekly rates pointed to an increased number of consultations for depressive feelings and suicide (attempts) among youth, during and after periods with intensified domestic restrictions. Conclusions: The results illustrate how, from a disaster health research perspective based on the COVID-19 pandemic, health consequences of pandemics could be successfully followed over time using an existing infrastructure for syndromic surveillance and monitoring. Particular areas of health concern can be defined beforehand, and may be modified or expanded during the monitoring activities to track relevant developments. Although an association between patterns and changes in the strictness of mitigation measures might seem probable, claims about causality should be made with caution. ",
doi="10.2196/53368",
url="https://publichealth.jmir.org/2024/1/e53368"
}


@Article{info:doi/10.2196/60099,
author="Garc{\'i}a-Sangen{\'i}s, Ana
and Modena, Daniela
and Jensen, Nygaard Jette
and Chalkidou, Athina
and Antsupova, S. Valeria
and Marloth, Tina
and Theut, Marie Anna
and Gonz{\'a}lez L{\'o}pez-Valc{\'a}rcel, Beatriz
and Raynal, Fabiana
and Vallejo-Torres, Laura
and Lykkegaard, Jesper
and Hansen, Plejdrup Malene
and S{\o}ndergaard, Jens
and Olsen, Kanstrup Jonas
and Munck, Anders
and Balint, Andr{\'a}s
and Benko, Ria
and Petek, Davorina
and Sodja, Nina
and Kowalczyk, Anna
and Godycki-Cwirko, Maciej
and Glasov{\'a}, Helena
and Glasa, Jozef
and Radzeviciene Jurgute, Ruta
and Jaruseviciene, Lina
and Lionis, Christos
and Anastasaki, Marilena
and Angelaki, Agapi
and Petelos, Elena
and Alvarez, Laura
and Ricart, Marta
and Briones, Sergi
and Ruppe, Georg
and Monf{\`a}, Ramon
and Bjerrum, Anders
and Llor, Carl",
title="Improving Antibiotic Use in Nursing Homes by Infection Prevention and Control and Antibiotic Stewardship (IMAGINE): Protocol for a Before-and-After Intervention and Implementation Study",
journal="JMIR Res Protoc",
year="2024",
month="Sep",
day="16",
volume="13",
pages="e60099",
keywords="antimicrobial stewardship",
keywords="medical audit",
keywords="hygiene",
keywords="antibacterial agents",
keywords="quality improvement",
keywords="nursing homes",
keywords="health personnel",
keywords="drug resistance, microbial",
keywords="frail elderly",
abstract="Background: Despite the extensive use of antibiotics and the growing challenge of antimicrobial resistance, there has been a lack of substantial initiatives aimed at diminishing the prevalence of infections in nursing homes and enhancing the detection of urinary tract infections (UTIs). Objective: This study aims to systematize and enhance efforts to prevent health care--associated infections, mainly UTIs and reduce antibiotic inappropriateness by implementing a multifaceted intervention targeting health care professionals in nursing homes. Methods: A before-and-after intervention study carried out in a minimum of 10 nursing homes in each of the 8 European participating countries (Denmark, Greece, Hungary, Lithuania, Poland, Slovakia, Slovenia, and Spain). A team of 4 professionals consisting of nurses, doctors, health care assistants, or health care helpers are actively involved in each nursing home. Over the initial 3-month period, professionals in each nursing home are registering information on UTIs as well as infection and prevention control measures by means of the Audit Project Odense method. The audit will be repeated after implementing a multifaceted intervention. The intervention will consist of feedback and discussion of the results from the first registration, training on the implementation of infection and prevention control techniques provided by experts, appropriateness of the diagnostic approach and antibiotic prescribing for UTIs, and provision of information materials on infection control and antimicrobial stewardship targeted to staff, residents, and relatives. We will compare the pre- and postintervention audit results using chi-square test for prescription appropriateness and Student t test for implemented hygiene elements. Results: A total of 109 nursing homes have participated in the pilot study and the first registration audit. The results of the first audit registration are expected to be published in autumn of 2024. The final results will be published by the end of 2025. Conclusions: This is a European Union--funded project aimed at contributing to the battle against antimicrobial resistance through improvement of the quality of management of common infections based on evidence-based interventions tailored to the nursing home setting and a diverse range of professionals. We expect the intervention to result in a significant increase in the number of hygiene activities implemented by health care providers and residents. Additionally, we anticipate a marked reduction in the number of inappropriately managed UTIs, as well as a substantial decrease in the overall incidence of infections following the intervention. International Registered Report Identifier (IRRID): DERR1-10.2196/60099 ",
doi="10.2196/60099",
url="https://www.researchprotocols.org/2024/1/e60099",
url="http://www.ncbi.nlm.nih.gov/pubmed/39284176"
}


@Article{info:doi/10.2196/55290,
author="O'Connor, Y. Suji
and Mationg, Lorraine Mary
and Kelly, J. Matthew
and Williams, M. Gail
and Clements, CA Archie
and Sripa, Banchob
and Sayasone, Somphou
and Khieu, Virak
and Wangdi, Kinley
and Stewart, E. Donald
and Tangkawattana, Sirikachorn
and Suwannatrai, T. Apiporn
and Savathdy, Vanthanom
and Khieu, Visal
and Odermatt, Peter
and Gordon, A. Catherine
and Wannachart, Sangduan
and McManus, P. Donald
and Gray, J. Darren",
title="Examining the Acceptability of Helminth Education Packages ``Magic Glasses Lower Mekong'' and ``Magic Glasses Opisthorchiasis'' and Their Impact on Knowledge, Attitudes, and Practices Among Schoolchildren in the Lower Mekong Basin: Protocol for a Cluster Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2024",
month="Sep",
day="16",
volume="13",
pages="e55290",
keywords="attitude",
keywords="child",
keywords="health education",
keywords="helminths",
keywords="knowledge",
keywords="practices",
keywords="Opisthorchis viverrini",
keywords="randomized controlled trial",
keywords="schools",
keywords="Ascaris lumbricoides",
keywords="Trichuris trichiura",
keywords="hookworm",
keywords="Magic Glasses",
abstract="Background: Helminths are a major global health issue, impacting health, educational, and socioeconomic outcomes. Infections, often starting in childhood, are linked to anemia, malnutrition, cognitive deficit, and in chronic cases of Opisthorchis viverrini (OV), cholangiocarcinoma. The main control strategy for helminth infection is mass drug administration; however, this does not prevent reinfection. As such, prevention strategies are needed. The ``Magic Glasses'' is a school-based cartoon health education package that has demonstrated success in improving knowledge, attitudes, and practices (KAP) surrounding soil-transmitted helminths (STH) in China and the Philippines. This study is designed to assess the acceptability and impact of the 2 new versions of the Magic Glasses targeting STH and OV designed for the Lower Mekong audience in Cambodia, Lao People's Democratic Republic (PDR), and Thailand. Objective: The objective of this study is to evaluate the acceptability of the ``Magic Glasses Lower Mekong'' and ``Magic Glasses Opisthorchiasis'' education packages among schoolchildren in the Lower Mekong Basin, and the impact of these education packages on students' KAP surrounding STH and OV, respectively. Methods: Schoolchildren will be recruited into a cluster randomized controlled trial with intervention and control arms in rural schools in Cambodia, Lao PDR, and Thailand. Schoolchildren's initial acceptability of the intervention will be evaluated using an adapted questionnaire. Sustained acceptability will be assessed at 9-month follow-up through focus group discussions with students and interviews with teachers. Impact will be evaluated by KAP questionnaires on STH and OV. KAP questionnaires will be administered to children at baseline and at follow-up. Indirect impact on parents' KAP of OV and STH will be assessed through focus group discussions at follow-up. Results: The trial is in progress in Lao PDR and Thailand and is expected to commence in Cambodia in January 2024. The results of the study are expected to be available 18 months from the start of recruitment. We hypothesize that participants enrolled in the intervention arm of the study will have higher KAP scores for STH and OV, compared with the participants in the control arm at follow-up. We expect that students will have initial and sustained acceptability of these intervention packages. Conclusions: This trial will examine the acceptability of the ``Magic Glasses Opisthorchiasis'' and ``Magic Glasses Lower Mekong'' interventions and provide evidence on the effectiveness of the ``Magic Glasses'' on KAP related to OV and STH among schoolchildren in the Lower Mekong Basin. Study results will provide insight on acceptability and impact indicators and inform a scaling up protocol for the ``Magic Glasses'' education packages in Cambodia, Lao PDR, and Thailand. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12623000271606; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=385315\&isReview=true International Registered Report Identifier (IRRID): DERR1-10.2196/55290 ",
doi="10.2196/55290",
url="https://www.researchprotocols.org/2024/1/e55290"
}


@Article{info:doi/10.2196/56044,
author="Luchman, Joseph
and Bennett, Morgane
and Kranzler, Elissa
and Tuskeviciute, Rugile
and Vega, Ronald
and Denison, Benjamin
and Trigger, Sarah
and Nighbor, Tyler
and Vines, Monica
and Hoffman, Leah",
title="Identifying Population Segments by Differing Levels of COVID-19 Vaccine Confidence and Evaluating Subsequent Uptake of COVID-19 Prevention Behaviors: Web-Based, Longitudinal, Probability-Based Panel Survey",
journal="JMIR Public Health Surveill",
year="2024",
month="Sep",
day="10",
volume="10",
pages="e56044",
keywords="COVID-19",
keywords="COVID-19 vaccination",
keywords="vaccine",
keywords="United States",
keywords="segmentation",
keywords="latent class cluster analysis",
keywords="vaccines",
keywords="vaccination",
keywords="segmentation analysis",
keywords="estimation",
keywords="validation",
keywords="attitude",
keywords="attitudes",
keywords="belief",
keywords="beliefs",
keywords="behavior",
keywords="behaviors",
keywords="sociodemographic",
keywords="nonintender",
keywords="nonintenders",
keywords="waiter",
keywords="waiters",
keywords="confident",
keywords="confidents",
keywords="social distancing",
keywords="bivariate",
keywords="regression analysis",
keywords="survey",
keywords="respondent",
keywords="respondents",
abstract="Background: The COVID-19 pandemic prompted the launch of the US Department of Health and Human Services' COVID-19 Public Education Campaign to boost vaccine confidence and uptake among adults, as vaccines are key to preventing severe illness and death. Objective: Past segmentation research relevant to COVID-19 behavior has found important differences in attitudes, sociodemographics, and subsequent COVID-19 prevention behaviors across population segments. This study extends prior work by incorporating a more comprehensive set of attitudes, behaviors, and sociodemographic variables to identify population segments by differing levels of COVID-19 vaccine confidence and evaluate differences in their subsequent uptake of COVID-19 prevention behaviors. Methods: Data were obtained from 5 waves (January 2021 to June 2022) of a web-based longitudinal, probability-based panel survey of US adults (N=4398) administered in English and in Spanish. Participants were recruited from NORC at the University of Chicago's national AmeriSpeak panel and were invited to participate across multiple waves. Latent class cluster analysis estimated segments of respondents based on over 40 COVID-19 attitudes, beliefs, behaviors, and sociodemographics as reported in wave 1. Survey-weighted cross-tabulations and bivariate regression analyses assessed differences in COVID-19 vaccine uptake, booster uptake, mask use, and social distancing in all segments across all 5 survey waves. Results: A total of 6 segments (hardline nonintenders, prevention-compliant nonintenders, burned-out waiters, anxious waiters, skeptical confidents, and ready confidents) were identified, which differed by their COVID-19 vaccine confidence, prevention-related attitudes and behaviors, and sociodemographics. Cross-tabulations and regression results indicated significant segment membership differences in COVID-19 vaccine and booster timing, mask use, and social distancing. Results from survey-weighted cross-tabulations comparing COVID-19 vaccine and booster uptake across segments indicate statistically significant differences in these outcomes across the 6 segments (P<.001). Results were statistically significant for each segment (P<.01 for booster uptake among burned-out waiters; P<.001 for all other coefficients), indicating that, on average, respondents in segments with lower intentions to vaccinate reported later receipt of COVID-19 vaccines and boosters relative to the timing of vaccine and booster uptake among ready confidents. Conclusions: Results extend previous research by showing that initial beliefs and behaviors relevant to COVID-19 vaccination, mask use, and social distancing are important for understanding differences in subsequent compliance with recommended COVID-19 prevention measures. Specifically, we found that across respondent segments, the probability of vaccine and booster uptake corresponded with both COVID-19 vaccine confidence and mask use and social distancing compliance; more compliant segments were more likely to get vaccinated or boosted than less compliant segments given similar levels of vaccine confidence. These findings help identify appropriate audiences for campaigns. Results highlight the use of a comprehensive list of attitudes, behaviors, and other individual-level characteristics that can serve as a basis for future segmentation efforts relevant to COVID-19 and other infectious diseases. ",
doi="10.2196/56044",
url="https://publichealth.jmir.org/2024/1/e56044",
url="http://www.ncbi.nlm.nih.gov/pubmed/39255032"
}


@Article{info:doi/10.2196/52643,
author="Williams, Paul
and Herring, A. Timothy
and Yokota, C. Renata T.
and Maia, Tiago
and Venkatesan, Sudhir
and Marcus, C. James
and Settergren, Gabriella
and Arnetorp, Sofie
and Lloyd, Andrew
and Severens, L. Johan
and Varni, W. James
and Dixon, Sharon
and Hamusankwa, Lweendo
and Powell, A. Philip
and Taylor, Sylvia
and Ware Jr, E. John
and Krol, Marieke",
title="The Association Between Physical Distancing Behaviors to Avoid COVID-19 and Health-Related Quality of Life in Immunocompromised and Nonimmunocompromised Individuals: Patient-Informed Protocol for the Observational, Cross-Sectional EAGLE Study",
journal="JMIR Res Protoc",
year="2024",
month="Aug",
day="13",
volume="13",
pages="e52643",
keywords="SARS-CoV-2",
keywords="social isolation",
keywords="patient participation",
keywords="patient-reported outcome measures",
keywords="quality of life",
keywords="immunosuppression",
keywords="respiratory tract infection",
keywords="cost of illness",
keywords="surveys and questionnaires",
keywords="protocol",
abstract="Background: Immunocompromised individuals are known to respond inadequately to SARS-CoV-2 vaccines, placing them at high risk of severe or fatal COVID-19. Thus, immunocompromised individuals and their caregivers may still practice varying degrees of social or physical distancing to avoid COVID-19. However, the association between physical distancing to avoid COVID-19 and quality of life has not been comprehensively evaluated in any study. Objective: We aim to measure physical distancing behaviors among immunocompromised individuals and the association between those behaviors and person-centric outcomes, including health-related quality of life (HRQoL) measures, health state utilities, anxiety and depression, and work and school productivity impairment. Methods: A patient-informed protocol was developed to conduct the EAGLE Study, a large cross-sectional, observational study, and this paper describes that protocol. EAGLE is designed to measure distancing behaviors and outcomes in immunocompromised individuals, including children (aged ?6 mo) and their caregivers, and nonimmunocompromised adults in the United States and United Kingdom who report no receipt of passive immunization against COVID-19. We previously developed a novel self- and observer-reported instrument, the Physical Distancing Scale for COVID-19 Avoidance (PDS-C19), to measure physical distancing behavior levels cross-sectionally and retrospectively. Using an interim or a randomly selected subset of the study population, the PDS-C19 psychometric properties will be assessed, including structural validity, internal consistency, known-group validity, and convergent validity. Associations (correlations) will be assessed between the PDS-C19 and validated HRQoL-related measures and utilities. Structural equation modeling and regression will be used to assess these associations, adjusting for potential confounders. Participant recruitment and data collection took place from December 2022 to June 2023 using direct-to-patient channels, including panels, clinician referral, patient advocacy groups, and social media, with immunocompromising diagnosis confirmation collected and assessed for a randomly selected 25\% of immunocompromised participants. The planned total sample size is 3718 participants and participant-caregiver pairs. Results will be reported by immunocompromised status, immunocompromising condition category, country, age group, and other subgroups. Results: All data analyses and reporting were planned to be completed by December 2023. Results are planned to be submitted for publication in peer-reviewed journals in 2024-2025. Conclusions: This study will quantify immunocompromised individuals' physical distancing behaviors to avoid COVID-19 and their association with HRQoL as well as health state utilities. International Registered Report Identifier (IRRID): RR1-10.2196/52643 ",
doi="10.2196/52643",
url="https://www.researchprotocols.org/2024/1/e52643",
url="http://www.ncbi.nlm.nih.gov/pubmed/39137022"
}


@Article{info:doi/10.2196/51325,
author="Denis-Robichaud, Jos{\'e}
and Rees, E. Erin
and Daley, Patrick
and Zarowsky, Christina
and Diouf, Assane
and Nasri, R. Bouchra
and de Montigny, Simon
and Carabin, H{\'e}l{\`e}ne",
title="Linking Opinions Shared on Social Media About COVID-19 Public Health Measures to Adherence: Repeated Cross-Sectional Surveys of Twitter Use in Canada",
journal="J Med Internet Res",
year="2024",
month="Aug",
day="13",
volume="26",
pages="e51325",
keywords="adherence to mask wearing",
keywords="adherence to vaccination",
keywords="social media",
keywords="sociodemographic characteristics",
keywords="Twitter",
keywords="COVID-19",
keywords="survey data",
abstract="Background: The effectiveness of public health measures (PHMs) depends on population adherence. Social media were suggested as a tool to assess adherence, but representativeness and accuracy issues have been raised. Objective: The objectives of this repeated cross-sectional study were to compare self-reported PHM adherence and sociodemographic characteristics between people who used Twitter (subsequently rebranded X) and people who did not use Twitter. Methods: Repeated Canada-wide web-based surveys were conducted every 14 days from September 2020 to March 2022. Weighted proportions were calculated for descriptive variables. Using Bayesian logistic regression models, we investigated associations between Twitter use, as well as opinions in tweets, and self-reported adherence with mask wearing and vaccination. Results: Data from 40,230 respondents were analyzed. As self-reported, Twitter was used by 20.6\% (95\% CI 20.1\%-21.2\%) of Canadians, of whom 29.9\% (95\% CI 28.6\%-31.3\%) tweeted about COVID-19. The sociodemographic characteristics differed across categories of Twitter use and opinions. Overall, 11\% (95\% CI 10.6\%-11.3\%) of Canadians reported poor adherence to mask-wearing, and 10.8\% (95\% CI 10.4\%-11.2\%) to vaccination. Twitter users who tweeted about COVID-19 reported poorer adherence to mask wearing than nonusers, which was modified by the age of the respondents and their geographical region (odds ratio [OR] 0.79, 95\% Bayesian credibility interval [BCI] 0.18-1.69 to OR 4.83, 95\% BCI 3.13-6.86). The odds of poor adherence to vaccination of Twitter users who tweeted about COVID-19 were greater than those of nonusers (OR 1.76, 95\% BCI 1.48-2.07). English- and French-speaking Twitter users who tweeted critically of PHMs were more likely (OR 4.07, 95\% BCI 3.38-4.80 and OR 7.31, 95\% BCI 4.26-11.03, respectively) to report poor adherence to mask wearing than non--Twitter users, and those who tweeted in support were less likely (OR 0.47, 95\% BCI 0.31-0.64 and OR 0.96, 95\% BCI 0.18-2.33, respectively) to report poor adherence to mask wearing than non--Twitter users. The OR of poor adherence to vaccination for those tweeting critically about PHMs and for those tweeting in support of PHMs were 4.10 (95\% BCI 3.40-4.85) and 0.20 (95\% BCI 0.10-0.32), respectively, compared to non--Twitter users. Conclusions: Opinions shared on Twitter can be useful to public health authorities, as they are associated with adherence to PHMs. However, the sociodemographics of social media users do not represent the general population, calling for caution when using tweets to assess general population-level behaviors. ",
doi="10.2196/51325",
url="https://www.jmir.org/2024/1/e51325",
url="http://www.ncbi.nlm.nih.gov/pubmed/39137009"
}


@Article{info:doi/10.2196/54383,
author="Pongutta, Suladda
and Tangcharoensathien, Viroj
and Leung, Kathy
and Larson, J. Heidi
and Lin, Leesa",
title="Social Vulnerability and Compliance With World Health Organization Advice on Protective Behaviors Against COVID-19 in African and Asia Pacific Countries: Factor Analysis to Develop a Social Vulnerability Index",
journal="JMIR Public Health Surveill",
year="2024",
month="Aug",
day="13",
volume="10",
pages="e54383",
keywords="social vulnerability Index",
keywords="COVID-19",
keywords="protective behavior",
keywords="Africa",
keywords="Western Pacific",
keywords="social vulnerability",
keywords="African countries",
keywords="Western countries",
keywords="predict",
keywords="predicts",
keywords="prediction",
keywords="propensity",
keywords="baseline data",
keywords="Factor analysis",
keywords="polychoric",
keywords="varimax rotation",
keywords="protective",
keywords="behaviour",
keywords="behaviours",
keywords="preventive",
keywords="precautionary",
keywords="linear regression",
keywords="predictability",
keywords="Omicron",
keywords="sociodemographic",
keywords="media use",
keywords="communication",
keywords="health risk perception",
keywords="socioeconomic",
abstract="Background: COVID-19 protective behaviors are key interventions advised by the World Health Organization (WHO) to prevent COVID-19 transmission. However, achieving compliance with this advice is often challenging, particularly among socially vulnerable groups. Objective: We developed a social vulnerability index (SVI) to predict individuals' propensity to adhere to the WHO advice on protective behaviors against COVID-19 and identify changes in social vulnerability as Omicron evolved in African countries between January 2022 and August 2022 and Asia Pacific countries between August 2021 and June 2022. Methods: In African countries, baseline data were collected from 14 countries (n=15,375) during the first Omicron wave, and follow-up data were collected from 7 countries (n=7179) after the wave. In Asia Pacific countries, baseline data were collected from 14 countries (n=12,866) before the first Omicron wave, and follow-up data were collected from 9 countries (n=8737) after the wave. Countries' socioeconomic and health profiles were retrieved from relevant databases. To construct the SVI for each of the 4 data sets, variables associated with COVID-19 protective behaviors were included in a factor analysis using polychoric correlation with varimax rotation. Influential factors were adjusted for cardinality, summed, and min-max normalized from 0 to 1 (most to least vulnerable). Scores for compliance with the WHO advice were calculated using individuals' self-reported protective behaviors against COVID-19. Multiple linear regression analyses were used to assess the associations between the SVI and scores for compliance to WHO advice to validate the index. Results: In Africa, factors contributing to social vulnerability included literacy and media use, trust in health care workers and government, and country income and infrastructure. In Asia Pacific, social vulnerability was determined by literacy, country income and infrastructure, and population density. The index was associated with compliance with the WHO advice in both time points in African countries but only during the follow-up period in Asia Pacific countries. At baseline, the index values in African countries ranged from 0.00 to 0.31 in 13 countries, with 1 country having an index value of 1.00. The index values in Asia Pacific countries ranged from 0.00 to 0.23 in 12 countries, with 2 countries having index values of 0.79 and 1.00. During the follow-up phase, the index values decreased in 6 of 7 African countries and the 2 most vulnerable Asia Pacific countries. The index values of the least vulnerable countries remained unchanged in both regions. Conclusions: In both regions, significant inequalities in social vulnerability to compliance with WHO advice were observed at baseline, and the gaps became larger after the first Omicron wave. Understanding the dimensions that influence social vulnerability to protective behaviors against COVID-19 may underpin targeted interventions to enhance compliance with WHO recommendations and mitigate the impact of future pandemics among vulnerable groups. ",
doi="10.2196/54383",
url="https://publichealth.jmir.org/2024/1/e54383",
url="http://www.ncbi.nlm.nih.gov/pubmed/39137034"
}


@Article{info:doi/10.2196/58821,
author="Liu, Jiaojiao
and Wang, Hui
and Zhong, Siyi
and Zhang, Xiao
and Wu, Qilin
and Luo, Haipeng
and Luo, Lei
and Zhang, Zhoubin",
title="Spatiotemporal Changes and Influencing Factors of Hand, Foot, and Mouth Disease in Guangzhou, China, From 2013 to 2022: Retrospective Analysis",
journal="JMIR Public Health Surveill",
year="2024",
month="Aug",
day="2",
volume="10",
pages="e58821",
keywords="hand, foot, and mouth disease",
keywords="spatial analysis",
keywords="space-time scan statistics",
keywords="geographically and temporally weighted regression",
keywords="infectious disease",
abstract="Background: In the past 10 years, the number of hand, foot, and mouth disease (HFMD) cases reported in Guangzhou, China, has averaged about 60,000 per year. It is necessary to conduct an in-depth analysis to understand the epidemiological pattern and related influencing factors of HFMD in this region. Objective: This study aims to describe the epidemiological characteristics and spatiotemporal distribution of HFMD cases in Guangzhou from 2013 to 2022 and explore the relationship between sociodemographic factors and HFMD incidence. Methods: The data of HFMD cases in Guangzhou come from the Infectious Disease Information Management System of the Guangzhou Center for Disease Control and Prevention. Spatial analysis and space-time scan statistics were used to visualize the spatiotemporal distribution of HFMD cases. Multifactor ordinary minimum regression model, geographically weighted regression, and geographically and temporally weighted regression were used to analyze the influencing factors, including population, economy, education, and medical care. Results: From 2013 to 2022, a total of 599,353 HFMD cases were reported in Guangzhou, with an average annual incidence rate of 403.62/100,000. Children aged 5 years and younger accounted for 93.64\% (561,218/599,353) of all cases. HFMD cases showed obvious bimodal distribution characteristics, with the peak period from May to July and the secondary peak period from August to October. HFMDs in Guangzhou exhibited a spatial aggregation trend, with the central urban area showing a pattern of low-low aggregation and the peripheral urban area demonstrating high-high aggregation. High-risk areas showed a dynamic trend of shifting from the west to the east of peripheral urban areas, with coverage first increasing and then decreasing. The geographically and temporally weighted regression model results indicated that population density ($\beta$=?0.016) and average annual income of employees ($\beta$=?0.007) were protective factors for HFMD incidence, while the average number of students in each primary school ($\beta$=1.416) and kindergarten ($\beta$=0.412) was a risk factor. Conclusions: HFMD cases in Guangzhou were mainly infants and young children, and there were obvious differences in time and space. HFMD is highly prevalent in summer and autumn, and peripheral urban areas were identified as high-risk areas. Improving the economic level of peripheral urban areas and reducing the number of students in preschool education institutions are key strategies to controlling HFMD. ",
doi="10.2196/58821",
url="https://publichealth.jmir.org/2024/1/e58821"
}


@Article{info:doi/10.2196/49648,
author="Sawires, Rana
and Clothier, J. Hazel
and Burgner, David
and Fahey, Collingwood Michael
and Buttery, Jim",
title="Kawasaki Disease and Respiratory Viruses: Ecological Spatiotemporal Analysis",
journal="JMIR Public Health Surveill",
year="2024",
month="Jul",
day="25",
volume="10",
pages="e49648",
keywords="Kawasaki disease",
keywords="pediatric",
keywords="infection",
keywords="RSV",
keywords="human metapneumovirus",
keywords="respiratory virus",
keywords="virology",
keywords="community",
keywords="viral infection",
keywords="respiratory disease",
keywords="respiratory diseases",
keywords="children",
keywords="epidemiology",
keywords="respiratory syncytial virus",
abstract="Background: Kawasaki disease is an uncommon vasculitis affecting young children. Its etiology is not completely understood, although infections have been frequently postulated as the triggers. Respiratory viruses, specifically, have often been implicated as causative agents for Kawasaki disease presentations. Objective: We aimed to conduct an ecological spatiotemporal analysis to determine whether Kawasaki disease incidence was related to community respiratory virus circulation in a shared region and population, and to describe viral associations before and during the COVID-19 pandemic. Methods: We obtained independent statewide data sets of hospital admissions of Kawasaki disease and respiratory multiplex polymerase chain reaction tests performed at two large hospital networks in Victoria, Australia, from July 2011 to November 2021. We studied spatiotemporal relationships by negative binomial regression analysis of the monthly incidence of Kawasaki disease and the rate of positive respiratory polymerase chain reaction tests in different regions of Victoria. Peak viral seasons (95th percentile incidence) were compared to median viral circulation (50th percentile incidence) to calculate peak season increased rate ratios. Results: While no seasonal trend in Kawasaki disease incidence was identified throughout the study period, we found a 1.52 (99\% CI 1.27?1.82) and a 1.43 (99\% CI 1.17?1.73) increased rate ratio of Kawasaki disease presentations in association with human metapneumovirus and respiratory syncytial virus circulation, respectively, before the COVID-19 pandemic. No respiratory viral associations with Kawasaki disease were observed during the COVID-19 pandemic. Conclusions: Our large ecological analysis demonstrates novel spatiotemporal relationships between human metapneumovirus and respiratory syncytial virus circulation with Kawasaki disease. The disappearance of these associations in the COVID-19 pandemic may reflect the reduced circulation of non--SARS-CoV-2 viruses during this period, supporting the prepandemic associations identified in this study. The roles of human metapneumovirus and respiratory syncytial virus in Kawasaki disease etiology warrant further investigation. ",
doi="10.2196/49648",
url="https://publichealth.jmir.org/2024/1/e49648"
}


@Article{info:doi/10.2196/50595,
author="Dong, Wenyong
and Miao, Yudong
and Shen, Zhanlei
and Zhang, Wanliang
and Bai, Junwen
and Zhu, Dongfang
and Ren, Ruizhe
and Zhang, Jingbao
and Wu, Jian
and Tarimo, Silver Clifford
and Ojangba, Theodora
and Li, Yi",
title="Quantifying Disparities in COVID-19 Vaccination Rates by Rural and Urban Areas: Cross-Sectional Observational Study",
journal="JMIR Public Health Surveill",
year="2024",
month="Jul",
day="19",
volume="10",
pages="e50595",
keywords="COVID-19 vaccination",
keywords="urban and rural",
keywords="the fourth COVID-19 (second booster) vaccine",
keywords="disparities",
keywords="China",
keywords="COVID-19",
abstract="Background: Vaccination plays an important role in preventing COVID-19 infection and reducing the severity of the disease. There are usually differences in vaccination rates between urban and rural areas. Measuring these differences can aid in developing more coordinated and sustainable solutions. This information also serves as a reference for the prevention and control of emerging infectious diseases in the future. Objective: This study aims to assess the current coverage rate and influencing factors of COVID-19 (second booster) vaccination among Chinese residents, as well as the disparities between urban and rural areas in China. Methods: This cross-sectional study used a stratified random sampling approach to select representative samples from 11 communities and 10 villages in eastern (Changzhou), central (Zhengzhou), western (Xining), and northeast (Mudanjiang) Mainland China from February 1 to February 18, 2023. The questionnaires were developed by experienced epidemiologists and contained the following: sociodemographic information, health conditions, vaccine-related information, information related to the Protective Motivation Theory (PMT), and the level of trust in the health care system. Vaccination rates among the participants were evaluated based on self-reported information provided. Binary logistic regression models were performed to explore influencing factors of vaccination among urban and rural participants. Urban-rural disparities in the vaccination rate were assessed using propensity score matching (PSM). Results: A total of 5780 participants were included, with 53.04\% (3066/5780) being female. The vaccination rate was 12.18\% (704/5780; 95\% CI 11.34-13.02) in the total sample, 13.76\% (341/2478; 95\% CI 12.40-15.12) among the rural participants, and 10.99\% (363/3302; 95\% CI 9.93-12.06) among the urban participants. For rural participants, self-reported health condition, self-efficacy, educational level, vaccine knowledge, susceptibility, benefits, and trust in the health care system were independent factors associated with vaccination (all P?.05). For urban participants, chronic conditions, COVID-19 infection, subjective community level, vaccine knowledge, self-efficacy, and trust in the health care system were independent factors associated with vaccination (all P?.05). PSM analysis uncovered a 3.42\% difference in vaccination rates between urban and rural participants. Conclusions: The fourth COVID-19 vaccination coverage rate (second booster) among the Chinese population was extremely low, significantly lower than the previous vaccine coverage rate. Given that COVID-19 infection is still prevalent at low levels, efforts should focus on enhancing self-efficacy to expand the vaccine coverage rate among the Chinese population. For rural residents, building awareness of the vaccine's benefits and improving their overall health status should be prioritized. In urban areas, a larger proportion of people with COVID-19 and patients with chronic illness should be vaccinated. ",
doi="10.2196/50595",
url="https://publichealth.jmir.org/2024/1/e50595",
url="http://www.ncbi.nlm.nih.gov/pubmed/39028548"
}


@Article{info:doi/10.2196/49812,
author="Du, Zhanwei
and Liu, Caifen
and Bai, Yuan
and Wang, Lin
and Lim, Wen Wey
and Lau, Y. Eric H.
and Cowling, J. Benjamin",
title="Predicting Efficacies of Fractional Doses of Vaccines by Using Neutralizing Antibody Levels: Systematic Review and Meta-Analysis",
journal="JMIR Public Health Surveill",
year="2024",
month="Jul",
day="12",
volume="10",
pages="e49812",
keywords="COVID-19",
keywords="SARS-CoV-2",
keywords="dose fractionation",
keywords="neutralizing antibody level",
keywords="vaccination",
keywords="review",
keywords="vaccine",
abstract="Background: With the emergence of SARS-CoV-2 variants that have eluded immunity from vaccines and prior infections, vaccine shortages and vaccine effectiveness pose unprecedented challenges for governments in expanding booster vaccination programs. The fractionation of vaccine doses might be an effective strategy for helping society to face these challenges, as fractional doses may have efficacies comparable with those of the standard doses. Objective: This study aims to investigate the relationship between vaccine immunogenicity and protection and to project efficacies of fractional doses of vaccines for COVID-19 by using neutralizing antibody levels. Methods: In this study, we analyzed the relationship between in vitro neutralization levels and the observed efficacies against both asymptomatic infection and symptomatic infection, using data from 13 studies of 10 COVID-19 vaccines and from convalescent cohorts. We further projected efficacies for fractional doses, using neutralization as an intermediate variable, based on immunogenicity data from 51 studies included in our systematic review. Results: In comparisons with the convalescent level, vaccine efficacy against asymptomatic infection and symptomatic infection increased from 8.8\% (95\% CI 1.4\%-16.1\%) to 71.8\% (95\% CI 63\%-80.7\%) and from 33.6\% (95\% CI 23.6\%-43.6\%) to 98.6\% (95\% CI 97.6\%-99.7\%), respectively, as the mean neutralization level increased from 0.1 to 10 folds of the convalescent level. Additionally, mRNA vaccines provided the strongest protection, which decreased slowly for fractional dosing with dosages between 50\% and 100\% of the standard dose. We also observed that although vaccine efficacy increased with the mean neutralization level, the rate of this increase was slower for vaccine efficacy against asymptomatic infection than for vaccine efficacy against symptomatic infection. Conclusions: Our results are consistent with studies on immune protection from SARS-CoV-2 infection. Based on our study, we expect that fractional-dose vaccination could provide partial immunity against SARS-CoV-2 and its variants. Our findings provide a theoretical basis for the efficacy of fractional-dose vaccines, serving as reference evidence for implementing fractional dosing vaccine policies in areas facing vaccine shortages and thereby mitigating disease burden. Fractional-dose vaccination could be a viable vaccination strategy comparable to full-dose vaccination and deserves further exploration. ",
doi="10.2196/49812",
url="https://publichealth.jmir.org/2024/1/e49812"
}


@Article{info:doi/10.2196/54551,
author="Wass, Minh Lily
and O'Keeffe Hoare, Derek
and Smits, Elena Georgia
and Osman, Marwan
and Zhang, Ning
and Klepack, William
and Parrilla, Lara
and Busche, M. Jefferson
and Clarkberg, E. Marin
and Basu, Sumanta
and Cazer, L. Casey",
title="Syndromic Surveillance Tracks COVID-19 Cases in University and County Settings: Retrospective Observational Study",
journal="JMIR Public Health Surveill",
year="2024",
month="Jun",
day="27",
volume="10",
pages="e54551",
keywords="COVID-19",
keywords="epidemiology",
keywords="epidemiological",
keywords="SARS-CoV-2",
keywords="syndromic surveillance",
keywords="surveillance system",
keywords="syndromic",
keywords="surveillance",
keywords="coronavirus",
keywords="pandemic",
keywords="epidemic",
keywords="respiratory",
keywords="infectious",
keywords="predict",
keywords="predictive",
keywords="prediction",
keywords="predictions",
abstract="Background: Syndromic surveillance represents a potentially inexpensive supplement to test-based COVID-19 surveillance. By strengthening surveillance of COVID-19--like illness (CLI), targeted and rapid interventions can be facilitated that prevent COVID-19 outbreaks without primary reliance on testing. Objective: This study aims to assess the temporal relationship between confirmed SARS-CoV-2 infections and self-reported and health care provider--reported CLI in university and county settings, respectively. Methods: We collected aggregated COVID-19 testing and symptom reporting surveillance data from Cornell University (2020?2021) and Tompkins County Health Department (2020?2022). We used negative binomial and linear regression models to correlate confirmed COVID-19 case counts and positive test rates with CLI rate time series, lagged COVID-19 cases or rates, and day of the week as independent variables. Optimal lag periods were identified using Granger causality and likelihood ratio tests. Results: In modeling undergraduate student cases, the CLI rate (P=.003) and rate of exposure to CLI (P<.001) were significantly correlated with the COVID-19 test positivity rate with no lag in the linear models. At the county level, the health care provider--reported CLI rate was significantly correlated with SARS-CoV-2 test positivity with a 3-day lag in both the linear (P<.001) and negative binomial model (P=.005). Conclusions: The real-time correlation between syndromic surveillance and COVID-19 cases on a university campus suggests symptom reporting is a viable alternative or supplement to COVID-19 surveillance testing. At the county level, syndromic surveillance is also a leading indicator of COVID-19 cases, enabling quick action to reduce transmission. Further research should investigate COVID-19 risk using syndromic surveillance in other settings, such as low-resource settings like low- and middle-income countries. ",
doi="10.2196/54551",
url="https://publichealth.jmir.org/2024/1/e54551"
}


@Article{info:doi/10.2196/47446,
author="Hartvigsen, Benedikte
and Jakobsen, Kronberg Kathrine
and Benfield, Thomas
and Gredal, Tobias Niels
and Ersb{\o}ll, Kj{\ae}r Annette
and Gr{\o}nlund, Waldemar Mathias
and Bundgaard, Henning
and Andersen, Porsborg Mikkel
and Steenhard, Nina
and von Buchwald, Christian
and Todsen, Tobias",
title="Molecular Detection of SARS-CoV-2 From Throat Swabs Performed With or Without Specimen Collection From the Tonsils: Protocol for a Multicenter Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2024",
month="Jun",
day="12",
volume="13",
pages="e47446",
keywords="SARS-CoV-2",
keywords="COVID-19",
keywords="pandemic",
keywords="oropharyngeal sampling",
keywords="diagnostic accuracy",
keywords="PCR",
keywords="polymerase chain reaction",
keywords="PCR analysis",
keywords="swab",
keywords="diagnostic",
keywords="oropharyngeal",
keywords="virology",
keywords="testing",
keywords="detection",
keywords="molecular biology",
keywords="microbiology",
keywords="laboratory",
keywords="palatine tonsil",
keywords="COVID-19 detection",
keywords="COVID-19 testing",
keywords="tonsil",
keywords="swabs",
keywords="oropharyngeal swabs",
keywords="oropharyngeal swab",
keywords="nasal swab",
keywords="nasal swabs",
keywords="molecular detection",
keywords="tool",
keywords="diagnostic technique",
keywords="diagnostic procedure",
keywords="clinical laboratory techniques",
abstract="Background: Testing for SARS-CoV-2 is essential to provide early COVID-19 treatment for people at high risk of severe illness and to limit the spread of infection in society. Proper upper respiratory specimen collection is the most critical step in the diagnosis of the SARS-CoV-2 virus in public settings, and throat swabs were the preferred specimens used for mass testing in many countries during the COVID-19 pandemic. However, there is still a discussion about whether throat swabs have a high enough sensitivity for SARS-CoV-2 diagnostic testing, as previous studies have reported a large variability in the sensitivity from 52\% to 100\%. Many previous studies exploring the diagnostic accuracy of throat swabs lack a detailed description of the sampling technique, which makes it difficult to compare the different diagnostic accuracy results. Some studies perform a throat swab by only collecting specimens from the posterior oropharyngeal wall, while others also include a swab of the palatine tonsils for SARS-CoV-2 testing. However, studies suggest that the palatine tonsils could have a tissue tropism for SARS-CoV-2 that may improve the SARS-CoV-2 detection during sampling. This may explain the variation of sensitivity reported, but no clinical studies have yet explored the differences in sensitivity and patient discomfort whether the palatine tonsils are included during the throat swab or not. Objective: The objective of this study is to examine the sensitivity and patient discomfort of a throat swab including the palatine tonsils compared to only swabbing the posterior oropharyngeal wall in molecular testing for SARS-CoV-2. Methods: We will conduct a randomized controlled study to compare the molecular detection rate of SARS-CoV-2 by a throat swab performed from the posterior oropharyngeal wall and the palatine tonsils (intervention group) or the posterior oropharyngeal wall only (control group). Participants will be randomized in a 1:1 ratio. All participants fill out a baseline questionnaire upon enrollment in the trial, examining their reason for being tested, symptoms, and previous tonsillectomy. A follow-up questionnaire will be sent to participants to explore the development of symptoms after testing. Results: A total of 2315 participants were enrolled in this study between November 10, 2022, and December 22, 2022. The results from the follow-up questionnaire are expected to be completed at the beginning of 2024. Conclusions: This randomized clinical trial will provide us with information about whether throat swabs including specimens from the palatine tonsils will improve the diagnostic sensitivity for SARS-CoV-2 molecular detection. These results can, therefore, be used to improve future testing recommendations and provide additional information about tissue tropism for SARS-CoV-2. Trial Registration: ClinicalTrials.gov NCT05611203; https://clinicaltrials.gov/study/NCT05611203 International Registered Report Identifier (IRRID): DERR1-10.2196/47446 ",
doi="10.2196/47446",
url="https://www.researchprotocols.org/2024/1/e47446",
url="http://www.ncbi.nlm.nih.gov/pubmed/38865190"
}


@Article{info:doi/10.2196/49562,
author="Azizi, Mehrnoosh
and Jamali, Akbar Ali
and Spiteri, J. Raymond",
title="Identifying X (Formerly Twitter) Posts Relevant to Dementia and COVID-19: Machine Learning Approach",
journal="JMIR Form Res",
year="2024",
month="Jun",
day="4",
volume="8",
pages="e49562",
keywords="machine learning",
keywords="dementia",
keywords="Alzheimer disease",
keywords="COVID-19",
keywords="X (Twitter)",
keywords="natural language processing",
abstract="Background: During the pandemic, patients with dementia were identified as a vulnerable population. X (formerly Twitter) became an important source of information for people seeking updates on COVID-19, and, therefore, identifying posts (formerly tweets) relevant to dementia can be an important support for patients with dementia and their caregivers. However, mining and coding relevant posts can be daunting due to the sheer volume and high percentage of irrelevant posts. Objective: The objective of this study was to automate the identification of posts relevant to dementia and COVID-19 using natural language processing and machine learning (ML) algorithms. Methods: We used a combination of natural language processing and ML algorithms with manually annotated posts to identify posts relevant to dementia and COVID-19. We used 3 data sets containing more than 100,000 posts and assessed the capability of various algorithms in correctly identifying relevant posts. Results: Our results showed that (pretrained) transfer learning algorithms outperformed traditional ML algorithms in identifying posts relevant to dementia and COVID-19. Among the algorithms tested, the transfer learning algorithm A Lite Bidirectional Encoder Representations from Transformers (ALBERT) achieved an accuracy of 82.92\% and an area under the curve of 83.53\%. ALBERT substantially outperformed the other algorithms tested, further emphasizing the superior performance of transfer learning algorithms in the classification of posts. Conclusions: Transfer learning algorithms such as ALBERT are highly effective in identifying topic-specific posts, even when trained with limited or adjacent data, highlighting their superiority over other ML algorithms and applicability to other studies involving analysis of social media posts. Such an automated approach reduces the workload of manual coding of posts and facilitates their analysis for researchers and policy makers to support patients with dementia and their caregivers and other vulnerable populations. ",
doi="10.2196/49562",
url="https://formative.jmir.org/2024/1/e49562",
url="http://www.ncbi.nlm.nih.gov/pubmed/38833288"
}


@Article{info:doi/10.2196/56593,
author="He, Yan
and Tang, Ying
and Hua, Qun
and Li, Xin
and Ge, You
and Liu, Yangyang
and Tang, Rong
and Tian, Ye
and Li, Wei",
title="Exploring Dynamic Changes in HIV-1 Molecular Transmission Networks and Key Influencing Factors: Cross-Sectional Study",
journal="JMIR Public Health Surveill",
year="2024",
month="May",
day="29",
volume="10",
pages="e56593",
keywords="HIV",
keywords="dynamic",
keywords="molecular transmission network",
keywords="influence factors",
keywords="HIV-1",
keywords="molecular network",
keywords="real-time analysis",
keywords="transmission",
keywords="Nanjing",
keywords="infection",
keywords="gene distance",
keywords="heterosexual",
keywords="homosexual",
keywords="dynamic alteration",
keywords="dynamic alterations",
keywords="risk factor",
abstract="Background: The HIV-1 molecular network is an innovative tool, using gene sequences to understand transmission attributes and complementing social and sexual network studies. While previous research focused on static network characteristics, recent studies' emphasis on dynamic features enhances our understanding of real-time changes, offering insights for targeted interventions and efficient allocation of public health resources. Objective: This study aims to identify the dynamic changes occurring in HIV-1 molecular transmission networks and analyze the primary influencing factors driving the dynamics of HIV-1 molecular networks. Methods: We analyzed and compared the dynamic changes in the molecular network over a specific time period between the baseline and observed end point. The primary factors influencing the dynamic changes in the HIV-1 molecular network were identified through univariate analysis and multivariate analysis. Results: A total of 955 HIV-1 polymerase fragments were successfully amplified from 1013 specimens; CRF01\_AE and CRF07\_BC were the predominant subtypes, accounting for 40.8\% (n=390) and 33.6\% (n=321) of the specimens, respectively. Through the analysis and comparison of the basic and terminal molecular networks, it was discovered that 144 sequences constituted static molecular networks, and 487 sequences contributed to the formation of dynamic molecular networks. The findings of the multivariate analysis indicated that the factors occupation as a student, floating population, Han ethnicity, engagement in occasional or multiple sexual partnerships, participation in anal sex, and being single were independent risk factors for the dynamic changes observed in the HIV-1 molecular network, and the odds ratio (OR; 95\% CIs) values were 2.63 (1.54-4.47), 1.83 (1.17-2.84), 2.91 (1.09-7.79), 1.75 (1.06-2.90), 4.12 (2.48-6.87), 5.58 (2.43-12.80), and 2.10 (1.25-3.54), respectively. Heterosexuality and homosexuality seem to exhibit protective effects when compared to bisexuality, with OR values of 0.12 (95\% CI 0.05-0.32) and 0.26 (95\% CI 0.11-0.64), respectively. Additionally, the National Eight-Item score and sex education experience were also identified as protective factors against dynamic changes in the HIV-1 molecular network, with OR values of 0.12 (95\% CI 0.05-0.32) and 0.26 (95\% CI 0.11-0.64), respectively. Conclusions: The HIV-1 molecular network analysis showed 144 sequences in static networks and 487 in dynamic networks. Multivariate analysis revealed that occupation as a student, floating population, Han ethnicity, and risky sexual behavior were independent risk factors for dynamic changes, while heterosexuality and homosexuality were protective compared to bisexuality. A higher National Eight-Item score and sex education experience were also protective factors. The identification of HIV dynamic molecular networks has provided valuable insights into the characteristics of individuals undergoing dynamic alterations. These findings contribute to a better understanding of HIV-1 transmission dynamics and could inform targeted prevention strategies. ",
doi="10.2196/56593",
url="https://publichealth.jmir.org/2024/1/e56593",
url="http://www.ncbi.nlm.nih.gov/pubmed/38810253"
}


@Article{info:doi/10.2196/39297,
author="Hoang, Uy
and Delanerolle, Gayathri
and Fan, Xuejuan
and Aspden, Carole
and Byford, Rachel
and Ashraf, Mansoor
and Haag, Mendel
and Elson, William
and Leston, Meredith
and Anand, Sneha
and Ferreira, Filipa
and Joy, Mark
and Hobbs, Richard
and de Lusignan, Simon",
title="A Profile of Influenza Vaccine Coverage for 2019-2020: Database Study of the English Primary Care Sentinel Cohort",
journal="JMIR Public Health Surveill",
year="2024",
month="May",
day="24",
volume="10",
pages="e39297",
keywords="medical records systems",
keywords="computerize",
keywords="influenza",
keywords="influenza vaccines",
keywords="sentinel surveillance",
keywords="vocabulary controlled",
keywords="general practitioners",
keywords="general practice",
keywords="primary health care",
keywords="vaccine",
keywords="public health",
keywords="surveillance",
keywords="uptake",
abstract="Background: Innovation in seasonal influenza vaccine development has resulted in a wider range of formulations becoming available. Understanding vaccine coverage across populations including the timing of administration is important when evaluating vaccine benefits and risks. Objective: This study aims to report the representativeness, uptake of influenza vaccines, different formulations of influenza vaccines, and timing of administration within the English Primary Care Sentinel Cohort (PCSC). Methods: We used the PCSC of the Oxford-Royal College of General Practitioners Research and Surveillance Centre. We included patients of all ages registered with PCSC member general practices, reporting influenza vaccine coverage between September 1, 2019, and January 29, 2020. We identified influenza vaccination recipients and characterized them by age, clinical risk groups, and vaccine type. We reported the date of influenza vaccination within the PCSC by International Standard Organization (ISO) week. The representativeness of the PCSC population was compared with population data provided by the Office for National Statistics. PCSC influenza vaccine coverage was compared with published UK Health Security Agency's national data. We used paired t tests to compare populations, reported with 95\% CI. Results: The PCSC comprised 7,010,627 people from 693 general practices. The study population included a greater proportion of people aged 18-49 years (2,982,390/7,010,627, 42.5\%; 95\% CI 42.5\%-42.6\%) compared with the Office for National Statistics 2019 midyear population estimates (23,219,730/56,286,961, 41.3\%; 95\% CI 4.12\%-41.3\%; P<.001). People who are more deprived were underrepresented and those in the least deprived quintile were overrepresented. Within the study population, 24.7\% (1,731,062/7,010,627; 95\% CI 24.7\%-24.7\%) of people of all ages received an influenza vaccine compared with 24.2\% (14,468,665/59,764,928; 95\% CI 24.2\%-24.2\%; P<.001) in national data. The highest coverage was in people aged ?65 years (913,695/1,264,700, 72.3\%; 95\% CI 72.2\%-72.3\%). The proportion of people in risk groups who received an influenza vaccine was also higher; for example, 69.8\% (284,280/407,228; 95\% CI 69.7\%-70\%) of people with diabetes in the PCSC received an influenza vaccine compared with 61.2\% (983,727/1,607,996; 95\% CI 61.1\%-61.3\%; P<.001) in national data. In the PCSC, vaccine type and brand information were available for 71.8\% (358,365/498,923; 95\% CI 71.7\%-72\%) of people aged 16-64 years and 81.9\% (748,312/913,695; 95\% CI 81.8\%-82\%) of people aged ?65 years, compared with 23.6\% (696,880/2,900,000) and 17.8\% (1,385,888/7,700,000), respectively, of the same age groups in national data. Vaccination commenced during ISO week 35, continued until ISO week 3, and peaked during ISO week 41. The in-week peak in vaccination administration was on Saturdays. Conclusions: The PCSC's sociodemographic profile was similar to the national population and captured more data about risk groups, vaccine brands, and batches. This may reflect higher data quality. Its capabilities included reporting precise dates of administration. The PCSC is suitable for undertaking studies of influenza vaccine coverage. ",
doi="10.2196/39297",
url="https://publichealth.jmir.org/2024/1/e39297",
url="http://www.ncbi.nlm.nih.gov/pubmed/38787605"
}


@Article{info:doi/10.2196/47626,
author="Chen, Li
and Wang, Liping
and Xing, Yi
and Xie, Junqing
and Su, Binbin
and Geng, Mengjie
and Ren, Xiang
and Zhang, Yi
and Liu, Jieyu
and Ma, Tao
and Chen, Manman
and Miller, E. Jessica
and Dong, Yanhui
and Song, Yi
and Ma, Jun
and Sawyer, Susan",
title="Persistence and Variation of the Indirect Effects of COVID-19 Restrictions on the Spectrum of Notifiable Infectious Diseases in China: Analysis of National Surveillance Among Children and Adolescents From 2018 to 2021",
journal="JMIR Public Health Surveill",
year="2024",
month="May",
day="15",
volume="10",
pages="e47626",
keywords="children and adolescents",
keywords="COVID-19",
keywords="notifiable infectious diseases",
abstract="Background: Beyond the direct effect of COVID-19 infection on young people, the wider impact of the pandemic on other infectious diseases remains unknown. Objective: This study aims to assess changes in the incidence and mortality of 42 notifiable infectious diseases during the pandemic among children and adolescents in China, compared with prepandemic levels. Methods: The Notifiable Infectious Disease Surveillance System of China was used to detect new cases and fatalities among individuals aged 5-22 years across 42 notifiable infectious diseases spanning from 2018 to 2021. These infectious diseases were categorized into 5 groups: respiratory, gastrointestinal and enterovirus, sexually transmitted and blood-borne, zoonotic, and vector-borne diseases. Each year (2018-2021) was segmented into 4 phases: phase 1 (January 1-22), phase 2 (January 23-April 7), phase 3 (April 8-August 31), and phase 4 (September 1-December 31) according to the varying intensities of pandemic restrictive measures in 2020. Generalized linear models were applied to assess the change in the incidence and mortality within each disease category, using 2018 and 2019 as the reference. Results: A total of 4,898,260 incident cases and 3701 deaths were included. The overall incidence of notifiable infectious diseases decreased sharply during the first year of the COVID-19 pandemic (2020) compared with prepandemic levels (2018 and 2019), and then rebounded in 2021, particularly in South China. Across the past 4 years, the number of deaths steadily decreased. The incidence of diseases rebounded differentially by the pandemic phase. For instance, although seasonal influenza dominated respiratory diseases in 2019, it showed a substantial decline during the pandemic (percent change in phase 2 2020: 0.21, 95\% CI 0.09-0.50), which persisted until 2021 (percent change in phase 4 2021: 1.02, 95\% CI 0.74-1.41). The incidence of gastrointestinal and enterovirus diseases decreased by 33.6\% during 2020 but rebounded by 56.9\% in 2021, mainly driven by hand, foot, and mouth disease (percent change in phase 3 2021: 1.28, 95\% CI 1.17-1.41) and infectious diarrhea (percent change in phase 3 2020: 1.22, 95\% CI 1.17-1.28). Sexually transmitted and blood-borne diseases were restrained during the first year of 2021 but rebounded quickly in 2021, mainly driven by syphilis (percent change in phase 3 2020: 1.31, 95\% CI 1.23-1.40) and gonorrhea (percent change in phase 3 2020: 1.10, 95\% CI 1.05-1.16). Zoonotic diseases were not dampened by the pandemic but continued to increase across the study period, mainly due to brucellosis (percent change in phase 2 2020: 0.94, 95\% CI 0.75-1.16). Vector-borne diseases showed a continuous decline during 2020, dominated by hemorrhagic fever (percent change in phase 2 2020: 0.68, 95\% CI 0.53-0.87), but rebounded in 2021. Conclusions: The COVID-19 pandemic was associated with a marked decline in notifiable infectious diseases in Chinese children and adolescents. These effects were not sustained, with evidence of a rebound to prepandemic levels by late 2021. To effectively address the postpandemic resurgence of infectious diseases in children and adolescents, it will be essential to maintain disease surveillance and strengthen the implementation of various initiatives. These include extending immunization programs, prioritizing the management of sexually transmitted infections, continuing feasible nonpharmaceutical intervention projects, and effectively managing imported infections. ",
doi="10.2196/47626",
url="https://publichealth.jmir.org/2024/1/e47626",
url="http://www.ncbi.nlm.nih.gov/pubmed/38748469"
}


@Article{info:doi/10.2196/38761,
author="Chadwick, L. Verity
and Saich, Freya
and Freeman, Joseph
and Martiniuk, Alexandra",
title="Media Discourse Regarding COVID-19 Vaccinations for Children Aged 5 to 11 Years in Australia, Canada, the United Kingdom, and the United States: Comparative Analysis Using the Narrative Policy Framework",
journal="JMIR Form Res",
year="2024",
month="Apr",
day="29",
volume="8",
pages="e38761",
keywords="COVID-19",
keywords="SARS-CoV-2",
keywords="vaccine",
keywords="mRNA",
keywords="Pfizer-BioNTech",
keywords="pediatric",
keywords="children",
keywords="media",
keywords="news",
keywords="web-based",
keywords="infodemic",
keywords="disinformation",
abstract="Background: Media narratives can shape public opinion and actions, influencing the uptake of pediatric COVID-19 vaccines. The COVID-19 pandemic has occurred at a time where infodemics, misinformation, and disinformation are present, impacting the COVID-19 response. Objective: This study aims to investigate how narratives about pediatric COVID-19 vaccines in the media of 4 English-speaking countries: the United States, Australia, Canada, and the United Kingdom. Methods: The Narrative Policy Framework was used to guide the comparative analyses of the major print and web-based news agencies' media regarding COVID-19 vaccines for children aged 5 to 11 years. Data were sought using systematic searching on Factiva (Dow Jones) of 4 key phases of pediatric vaccine approval and rollout. Results: A total of 400 articles (n=287, 71.8\% in the United States, n=40, 10\% in Australia, n=60, 15\% in Canada, and n=13, 3\% in the United Kingdom) met the search criteria and were included. Using the Narrative Policy Framework, the following were identified in each article: hero, villain, survivor, and plot. The United States was the earliest country to vaccinate children, and other countries' media often lauded the United States for this. Australian and Canadian media narratives about vaccines for children aged 5 to 11 years were commonly about protecting susceptible people in society, whereas the US and the UK narratives focused more on the vaccine helping children return to school. All 4 countries focused on the vaccines for children aged 5 to 11 years as being key to ``ending'' the pandemic. Australian and Canadian narratives frequently compared vaccine rollouts across states or provinces and bemoaned local progress in vaccine delivery compared with other countries globally. Canadian and US narratives highlighted the ``infodemic'' about the COVID-19 pandemic and disinformation regarding child vaccines as impeding uptake. All 4 countries---the United States, Australia, the United Kingdom, and Canada---used war imagery in reporting about COVID-19 vaccines for children. The advent of the Omicron variant demonstrated that populations were fatigued by the COVID-19 pandemic, and the media reporting increasingly blamed the unvaccinated. The UK media narrative was unique in describing vaccinating children as a distraction from adult COVID-19 vaccination efforts. The United States and Canada had narratives expressing anger about potential vaccine passports for children. In Australia, general practitioners were labelled as heroes. Finally, the Canadian narrative suggested altruistic forgoing of COVID-19 vaccine ``boosters'' as well as pediatric COVID-19 vaccines to benefit those in poorer nations. Conclusions: Public health emergencies require clear; compelling and accurate communication. The stories told during this pandemic are compelling because they contain the classic elements of a narrative; however, they can be reductive and inaccurate. ",
doi="10.2196/38761",
url="https://formative.jmir.org/2024/1/e38761",
url="http://www.ncbi.nlm.nih.gov/pubmed/36383344"
}


@Article{info:doi/10.2196/44931,
author="Kurita, Junko
and Iwasaki, Yoshitaro",
title="Effect of Long-Distance Domestic Travel Ban Policies in Japan on COVID-19 Outbreak Dynamics During Dominance of the Ancestral Strain: Ex Post Facto Retrospective Observation Study",
journal="Online J Public Health Inform",
year="2024",
month="Apr",
day="22",
volume="16",
pages="e44931",
keywords="airport users",
keywords="COVID-19",
keywords="effective reproduction number",
keywords="Go To Travel campaign",
keywords="hotel visitors",
keywords="mobility",
keywords="long-distance travel",
keywords="infection control",
keywords="lockdown",
keywords="travelling",
keywords="travel",
keywords="pandemic",
abstract="Background: In Japan, long-distance domestic travel was banned while the ancestral SARS-CoV-2 strain was dominant under the first declared state of emergency from March 2020 until the end of May 2020. Subsequently, the ``Go To Travel'' campaign travel subsidy policy was activated, allowing long-distance domestic travel, until the second state of emergency as of January 7, 2021. The effects of this long-distance domestic travel ban on SARS-CoV-2 infectivity have not been adequately evaluated. Objective: We evaluated the effects of the long-distance domestic travel ban in Japan on SARS-CoV-2 infectivity, considering climate conditions, mobility, and countermeasures such as the ``Go To Travel'' campaign and emergency status. Methods: We calculated the effective reproduction number R(t), representing infectivity, using the epidemic curve in Kagoshima prefecture based on the empirical distribution of the incubation period and procedurally delayed reporting from an earlier study. Kagoshima prefecture, in southern Japan, has several resorts, with an airport commonly used for transportation to Tokyo or Osaka. We regressed R(t) on the number of long-distance domestic travelers (based on the number of airport limousine bus users provided by the operating company), temperature, humidity, mobility, and countermeasures such as state of emergency declarations and the ``Go To Travel'' campaign in Kagoshima. The study period was June 20, 2020, through February 2021, before variant strains became dominant. A second state of emergency was not declared in Kagoshima prefecture but was declared in major cities such as Tokyo and Osaka. Results: Estimation results indicated a pattern of declining infectivity with reduced long-distance domestic travel volumes as measured by the number of airport limousine bus users. Moreover, infectivity was lower during the ``Go To Travel'' campaign and the second state of emergency. Regarding mobility, going to restaurants, shopping malls, and amusement venues was associated with increased infectivity. However, going to grocery stores and pharmacies was associated with decreased infectivity. Climate conditions showed no significant association with infectivity patterns. Conclusions: The results of this retrospective analysis suggest that the volume of long-distance domestic travel might reduce SARS-CoV-2 infectivity. Infectivity was lower during the ``Go To Travel'' campaign period, during which long-distance domestic travel was promoted, compared to that outside this campaign period. These findings suggest that policies banning long-distance domestic travel had little legitimacy or rationale. Long-distance domestic travel with appropriate infection control measures might not increase SARS-CoV-2 infectivity in tourist areas. Even though this analysis was performed much later than the study period, if we had performed this study focusing on the period of April or May 2021, it would likely yield the same results. These findings might be helpful for government decision-making in considering restarting a ``Go To Travel'' campaign in light of evidence-based policy. ",
doi="10.2196/44931",
url="https://ojphi.jmir.org/2024/1/e44931",
url="http://www.ncbi.nlm.nih.gov/pubmed/38648635"
}


@Article{info:doi/10.2196/50958,
author="Liao, Qiuyan
and Yuan, Jiehu
and Wong, Ling Irene Oi
and Ni, Yuxuan Michael
and Cowling, John Benjamin
and Lam, Tak Wendy Wing",
title="Motivators and Demotivators for COVID-19 Vaccination Based on Co-Occurrence Networks of Verbal Reasons for Vaccination Acceptance and Resistance: Repetitive Cross-Sectional Surveys and Network Analysis",
journal="JMIR Public Health Surveill",
year="2024",
month="Apr",
day="22",
volume="10",
pages="e50958",
keywords="COVID-19",
keywords="vaccination acceptance",
keywords="vaccine hesitancy",
keywords="motivators",
keywords="co-occurrence network analysis",
abstract="Background: Vaccine hesitancy is complex and multifaced. People may accept or reject a vaccine due to multiple and interconnected reasons, with some reasons being more salient in influencing vaccine acceptance or resistance and hence the most important intervention targets for addressing vaccine hesitancy. Objective: This study was aimed at assessing the connections and relative importance of motivators and demotivators for COVID-19 vaccination in Hong Kong based on co-occurrence networks of verbal reasons for vaccination acceptance and resistance from repetitive cross-sectional surveys. Methods: We conducted a series of random digit dialing telephone surveys to examine COVID-19 vaccine hesitancy among general Hong Kong adults between March 2021 and July 2022. A total of 5559 and 982 participants provided verbal reasons for accepting and resisting (rejecting or hesitating) a COVID-19 vaccine, respectively. The verbal reasons were initially coded to generate categories of motivators and demotivators for COVID-19 vaccination using a bottom-up approach. Then, all the generated codes were mapped onto the 5C model of vaccine hesitancy. On the basis of the identified reasons, we conducted a co-occurrence network analysis to understand how motivating or demotivating reasons were comentioned to shape people's vaccination decisions. Each reason's eigenvector centrality was calculated to quantify their relative importance in the network. Analyses were also stratified by age group. Results: The co-occurrence network analysis found that the perception of personal risk to the disease (egicentrality=0.80) and the social responsibility to protect others (egicentrality=0.58) were the most important comentioned reasons that motivate COVID-19 vaccination, while lack of vaccine confidence (egicentrality=0.89) and complacency (perceived low disease risk and low importance of vaccination; egicentrality=0.45) were the most important comentioned reasons that demotivate COVID-19 vaccination. For older people aged ?65 years, protecting others was a more important motivator (egicentrality=0.57), while the concern about poor health status was a more important demotivator (egicentrality=0.42); for young people aged 18 to 24 years, recovering life normalcy (egicentrality=0.20) and vaccine mandates (egicentrality=0.26) were the more important motivators, while complacency (egicentrality=0.77) was a more important demotivator for COVID-19 vaccination uptake. Conclusions: When disease risk is perceived to be high, promoting social responsibility to protect others is more important for boosting vaccination acceptance. However, when disease risk is perceived to be low and complacency exists, fostering confidence in vaccines to address vaccine hesitancy becomes more important. Interventions for promoting vaccination acceptance and reducing vaccine hesitancy should be tailored by age. ",
doi="10.2196/50958",
url="https://publichealth.jmir.org/2024/1/e50958",
url="http://www.ncbi.nlm.nih.gov/pubmed/38648099"
}


@Article{info:doi/10.2196/48784,
author="Garc{\'i}a, E. Yury
and Schmidt, J. Alec
and Solis, Leslie
and Daza-Torres, L. Mar{\'i}a
and Montesinos-L{\'o}pez, Cricelio J.
and Pollock, H. Brad
and Nu{\~n}o, Miriam",
title="Assessing SARS-CoV-2 Testing Adherence in a University Town: Recurrent Event Modeling Analysis",
journal="JMIR Public Health Surveill",
year="2024",
month="Apr",
day="17",
volume="10",
pages="e48784",
keywords="Healthy Davis Together",
keywords="COVID-19",
keywords="COVID-19 surveillance program",
keywords="community surveillance",
keywords="HDT: HYT",
keywords="Healthy Yolo Together",
keywords="SARS-CoV-2",
keywords="severe acute respiratory syndrome coronavirus 2",
keywords="coronavirus",
keywords="demographic",
keywords="demographics",
keywords="testing",
keywords="adherence",
keywords="compliance",
keywords="USA",
keywords="United States",
keywords="response program",
keywords="response programs",
keywords="engagement",
keywords="participation",
keywords="infectious",
keywords="trend",
keywords="trends",
keywords="community based",
keywords="surveillance",
keywords="public health",
keywords="infection control",
keywords="PCR",
keywords="polymerase chain reaction",
keywords="RT-qPCR",
keywords="reverse transcription quantitative polymerase chain reaction",
keywords="viral",
keywords="virus",
keywords="viruses",
abstract="Background: Healthy Davis Together was a program launched in September 2020 in the city of Davis, California, to mitigate the spread of COVID-19 and facilitate the return to normalcy. The program involved multiple interventions, including free saliva-based asymptomatic testing, targeted communication campaigns, education efforts, and distribution of personal protective equipment, community partnerships, and investments in the local economy. Objective: This study identified demographic characteristics of individuals that underwent testing and assessed adherence to testing over time in a community pandemic-response program launched in a college town in California, United States. Methods: This study outlines overall testing engagement, identifies demographic characteristics of participants, and evaluates testing participation changes over 4 periods of the COVID-19 pandemic, distinguished by the dominant variants Delta and Omicron. Additionally, a recurrent model is employed to explore testing patterns based on the participants' frequency, timing, and demographic characteristics. Results: A total of 770,165 tests were performed between November 18, 2020, and June 30, 2022, among 89,924 (41.1\% of total population) residents of Yolo County, with significant participation from racially or ethnically diverse participants and across age groups. Most positive cases (6351 of total) and highest daily participation (895 per 100,000 population) were during the Omicron period. There were some gender and age-related differences in the pattern of recurrent COVID-19 testing. Men were slightly less likely (hazard ratio [HR] 0.969, 95\% CI 0.943-0.996) to be retested and more likely (HR 1.104, 95\% CI 1.075-1.134) to stop testing altogether than women. People aged between 20 and 34 years were less likely to be retested (HR 0.861, 95\% CI 0.828-0.895) and more likely to stop testing altogether (HR 2.617, 95\% CI 2.538-2.699). However, older age groups were less likely to stop testing, especially those aged between 65-74 years and 75-84 years, than those aged between 0 and 19 years. The likelihood of stopping testing was lower (HR 0.93, 95\% CI 0.889-0.976) for the Asian group and higher for the Hispanic or Latino (HR 1.185, 95\% CI 1.148-1.223) and Black or African American (HR 1.198, 95\% CI 1.054-1.350) groups than the White group. Conclusions: The unique features of a pandemic response program that supported community-wide access to free asymptomatic testing provide a unique opportunity to evaluate adherence to testing recommendations and testing trends over time. Identification of individual and group-level factors associated with testing behaviors can provide insights for identifying potential areas of improvement in future testing initiatives. ",
doi="10.2196/48784",
url="https://publichealth.jmir.org/2024/1/e48784",
url="http://www.ncbi.nlm.nih.gov/pubmed/38631033"
}


@Article{info:doi/10.2196/51449,
author="Cheng, Wei
and Xu, Yun
and Jiang, Haibo
and Li, Jun
and Hou, Zhigang
and Meng, Haibin
and Wang, Wei
and Chai, Chengliang
and Jiang, Jianmin",
title="SARS-CoV-2 Infection, Hospitalization, and Associated Factors Among People Living With HIV in Southeastern China From December 2022 to February 2023: Cross-Sectional Survey",
journal="JMIR Public Health Surveill",
year="2024",
month="Apr",
day="17",
volume="10",
pages="e51449",
keywords="associated factors",
keywords="COVID-19",
keywords="hospitalization",
keywords="infection",
keywords="people living with HIV",
keywords="SARS-CoV-2 Omicron variant",
abstract="Background: Limited studies have explored the impact of the Omicron variant on SARS-CoV-2 infection, hospitalization, and associated factors among people living with HIV, particularly in China. The adjustment of preventive policies since December 2022 in China presents an opportunity to evaluate the real-world factors influencing SARS-CoV-2 infection and related hospitalization among people living with HIV. Objective: This study aimed to investigate SARS-CoV-2 infection, hospitalization rates, and associated factors among people living with HIV following the adjustment of preventive policies from December 2022 to February 2023 in southeastern China. Methods: A cross-sectional telephone or web-based survey was conducted among people living with HIV in 5 cities in southeastern China from December 2022 to February 2023. Demographic information, SARS-CoV-2 infection and related hospitalization, and HIV-specific characteristics were collected from existing databases and special investigations. Multivariate logistic regression analyses were conducted to determine the associated factors for infection and hospitalization rates of SARS-CoV-2. Additionally, subgroup analyses were conducted for the association between vaccination and infection across different vaccination statuses and time since the last vaccination. Results: Among people living with HIV with a COVID-19 testing history, the SARS-CoV-2 infection rate was 67.13\% (95\% CI 65.81\%-68.13\%), whereas the hospitalization rate was 0.71\% (95\% CI 0.46\%-0.97\%). Factors such as age, latest CD4 cell count, latest HIV viral load, and transmission route were found to be associated with SARS-CoV-2 infection, while age, cancer, latest CD4 cell count, and latest HIV viral load were associated with SARS-CoV-2 hospitalization. In terms of SARS-CoV-2 vaccination, compared to unvaccinated people living with HIV, there was a lower infection rate among those who had been vaccinated for <3 months in the booster vaccination group (adjusted odds ratio [aOR] 0.72, 95\% CI 0.53-0.98; P=.04); and there was also a lower risk of hospitalization among people living with HIV who had received vaccination in the past 6-12 months (aOR 0.33, 95\% CI 0.14-0.81; P=.02) and more than 12 months ago (aOR 0.22, 95\% CI 0.07-0.72; P=.01). Conclusions: After the ease of prevention and control measures in China, we observed a high SARS-CoV-2 infection rate but a low hospitalization rate. General risk factors, such as higher age and vaccination status, and HIV-related parameters, such as the latest CD4 cell count and HIV viral load, were associated with SARS-CoV-2 infection and hospitalization. A booster vaccination campaign for booster doses should be considered among people living with HIV in confronting possible COVID-19 epidemic emergencies in the near future. ",
doi="10.2196/51449",
url="https://publichealth.jmir.org/2024/1/e51449",
url="http://www.ncbi.nlm.nih.gov/pubmed/38630534"
}


@Article{info:doi/10.2196/53608,
author="Guan, Huixin
and Wang, Wei",
title="Factors Impacting Chinese Older Adults' Intention to Prevent COVID-19 in the Post--COVID-19 Pandemic Era: Survey Study",
journal="JMIR Form Res",
year="2024",
month="Apr",
day="17",
volume="8",
pages="e53608",
keywords="COVID-19",
keywords="SARS-CoV-2",
keywords="health protection",
keywords="social capital",
keywords="media exposure",
keywords="negative emotions",
keywords="structural influence model of communication",
keywords="SIM",
keywords="protect",
keywords="protection",
keywords="protective",
keywords="intent",
keywords="intention",
keywords="prevention",
keywords="preventative",
keywords="restriction",
keywords="restrictions",
keywords="public health measures",
keywords="safety",
keywords="news",
keywords="newspaper",
keywords="media",
keywords="radio",
keywords="health communication",
keywords="influence",
keywords="influencing",
keywords="infectious",
keywords="infection control",
keywords="pandemic",
keywords="gerontology",
keywords="geriatric",
keywords="geriatrics",
keywords="older adult",
keywords="older adults",
keywords="older person",
keywords="older people",
keywords="aging",
abstract="Background: Understanding the factors influencing individuals' health decisions is a dynamic research question. Particularly, after China announced the deregulation of the COVID-19 epidemic, health risks escalated rapidly. The convergence of ``no longer controlled'' viruses and the infodemic has created a distinctive social period during which multiple factors may have influenced people's decision-making. Among these factors, the precautionary intentions of older individuals, as a susceptible health group, deserve special attention. Objective: This study aims to examine the intention of older adults to engage in preventive behaviors and the influencing factors, including social, media, and individual factors, within the context of the postepidemic era. Drawing upon the structural influence model of communication, this study tests the potential mediating roles of 3 different types of media exposure between cognitive and structural social capital and protective behavior intention, as well as the moderating role of negative emotions between social capital and media exposure. Methods: In this study, a web survey was used to collect self-reported quantitative data on social capital, media exposure, negative emotions, and the intention to prevent COVID-19 among older adults aged ?60 years (N=399) in China. Results: The results indicate that cognitive social capital significantly influenced protective behavior intention (P<.001), with cell phone exposure playing an additional impactful role (P<.001). By contrast, newspaper and radio exposure and television exposure mediated the influence of structural social capital on protective behavior intention (P<.001). Furthermore, negative emotions played a moderating role in the relationship between cognitive social capital and cell phone exposure (P<.001). Conclusions: This study suggests that using tailored communication strategies across various media channels can effectively raise health awareness among older adults dealing with major pandemics in China, considering their diverse social capital characteristics and emotional states. ",
doi="10.2196/53608",
url="https://formative.jmir.org/2024/1/e53608",
url="http://www.ncbi.nlm.nih.gov/pubmed/38630517"
}


@Article{info:doi/10.2196/47170,
author="Verot, Elise
and Chaux, Robin
and Gagnaire, Julie
and Bonjean, Paul
and Gagneux-Brunon, Amandine
and Berthelot, Philippe
and Pelissier, Carole
and Boulamail, Billal
and Chauvin, Franck
and Pozzetto, Bruno
and Botelho-Nevers, Elisabeth",
title="Evaluating the Knowledge of and Behavior Toward COVID-19 and the Possibility of Isolating at a City Level: Survey Study",
journal="JMIR Public Health Surveill",
year="2024",
month="Apr",
day="11",
volume="10",
pages="e47170",
keywords="SARS-CoV-2",
keywords="COVID-19",
keywords="health literacy",
keywords="knowledge, attitude, and perception/practices (KAP)",
keywords="public health",
keywords="population",
keywords="mass testing",
keywords="screening",
keywords="pandemic",
keywords="sociological trends",
keywords="COVID-19 screening",
abstract="Background: Mass testing campaigns were proposed in France during the first wave of the COVID-19 pandemic to detect and isolate asymptomatic individuals infected by SARS-CoV-2. During mass testing in Saint-{\'E}tienne (February 2021), we performed a survey of the general population. Objective: We evaluated, on the scale of a city's population, the literacy level about SARS-CoV-2 transmission, barrier gesture respect, and isolation acceptability or possibility in case of SARS-CoV-2 infection. Methods: We used the validated CovQuest-CC questionnaire. Data were analyzed and correlated with volunteer characteristics and their SARS-CoV-2 screening results using multivariate analysis. Results: In total, 4707 participants completed the CovQuest-CC questionnaire. Multivariate analysis revealed that female sex was a determinant of a higher score of knowledge about SARS-CoV-2 transmission (adjusted $\beta$ coefficient=0.14, 95\% CI 0.04-0.23; corrected P=.02). Older ages of 50-59 years (adjusted $\beta$ coefficient=0.25, 95\% CI 0.19-0.31; corrected P<.001) and ?60 years (adjusted $\beta$ coefficient=0.25, 95\% CI 0.15-0.34; corrected P<.001) were determinants of a higher score on barrier gesture respect compared to ages 20-49 years considered as reference. Female sex was also a determinant of a higher score on barrier gesture respect (adjusted $\beta$ coefficient=0.10, 95\% CI 0.02-4.63; corrected P<.001). The knowledge score was correlated with the score on barrier gesture respect measures (adjusted $\beta$ coefficient=0.03, 95\% CI 0.001-0.004; corrected P=.001). Older ages of 50-59 years (adjusted $\beta$ coefficient=0.21, 95\% CI 0.13-0.29; corrected P<.001) and ?60 years (adjusted $\beta$ coefficient=0.25, 95\% CI 0.1-0.38; corrected P<.001) were determinants of a higher score on isolation acceptability or possibility compared to the age of 20-49 years considered as reference. Finally, the knowledge score regarding SARS-CoV-2 transmission was significantly associated with a lower risk of RT-PCR (reverse transcriptase--polymerase chain reaction) positivity (adjusted odds ratio 0.80,?95\% CI 0.69-0.94; corrected?P<.03), implying that a 1-point increase in the knowledge score lowers the risk of positivity by 20\% on average. Conclusions: This study identified factors associated with health literacy regarding SARS-CoV-2 infection in asymptomatic individuals in a large French city's population. We can confirm that in the context of the COVID-19 pandemic, the determinants of better health literacy are not the same as those in other contexts. It seems critical to obtain a more detailed understanding of the determinants of individual citizens' behavior, as part of a strategy to combat the large-scale spread of the virus. The harsh experience of this pandemic should teach us how to nurture research to structure customized interventions to encourage the adoption of ad hoc behaviors to engage citizens in adapting behaviors more favorable to their health. ",
doi="10.2196/47170",
url="https://publichealth.jmir.org/2024/1/e47170",
url="http://www.ncbi.nlm.nih.gov/pubmed/38602767"
}


@Article{info:doi/10.2196/52959,
author="Galli, Ana{\"i}s
and Ma'ani Abuzahra, Yaman
and B{\"a}nziger, Carola
and Ballo, Aboubacar
and Friedrich, D. Max N.
and Gross, Karin
and Harter, Miriam
and Hattendorf, Jan
and Peter, Maryna
and Tamas, Andrea
and Owen, N. Branwen
and Winkler, S. Mirko",
title="Assessing the Effectiveness of a Multicomponent Intervention on Hand Hygiene and Well-Being in Primary Health Care Centers and Schools Lacking Functional Water Supply in Protracted Conflict Settings: Protocol for a Cluster Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2024",
month="Apr",
day="3",
volume="13",
pages="e52959",
keywords="water, sanitation, and hygiene",
keywords="WASH",
keywords="hand hygiene",
keywords="impact evaluation",
keywords="conflict settings",
keywords="behavior change",
keywords="handwashing",
keywords="students",
keywords="handwashing stations",
keywords="primary schools, primary health care facilities",
keywords="humanitarian crisis",
keywords="mobile phone",
abstract="Background: Hand hygiene is crucial in health care centers and schools to avoid disease transmission. Currently, little is known about hand hygiene in such facilities in protracted conflict settings. Objective: This protocol aims to assess the effectiveness of a multicomponent hand hygiene intervention on handwashing behavior, underlying behavioral factors, and the well-being of health care workers and students. Moreover, we report our methodology and statistical analysis plan transparently. Methods: This is a cluster randomized controlled trial with 2 parallel arms taking place in 4 countries for 1 year. In Burkina Faso and Mali, we worked in 24 primary health care centers per country, whereas in Nigeria and Palestine, we focused on 26 primary schools per country. Facilities were eligible if they were not connected to a functioning water source but were deemed accessible to the implementation partners. Moreover, health care centers were eligible if they had a maternity ward and ?5 employees, and schools if they had ?7000 students studying in grades 5 to 7. We used covariate-constrained randomization to assign intervention facilities that received a hardware, management and monitoring support, and behavior change. Control facilities will receive the same or improved intervention after endline data collection. To evaluate the intervention, at baseline and endline, we used a self-reported survey, structured handwashing observations, and hand-rinse samples. At follow-up, hand-rinse samples were dropped. Starting from the intervention implementation, we collected longitudinal data on hygiene-related health conditions and absenteeism. We also collected qualitative data with focus group discussions and interviews. Data were analyzed descriptively and with random effect regression models with the random effect at a cluster level. The primary outcome for health centers is the handwashing rate, defined as the number of times health care workers performed good handwashing practice with soap or alcohol-based handrub at one of the World Health Organization 5 moments for hand hygiene, divided by the number of moments for hand hygiene that presented themselves during the patient interaction within an hour of observation. For schools, the primary outcome is the number of students who washed their hands before eating. Results: The baseline data collection across all countries lasted from February to June 2023. We collected data from 135 and 174 health care workers in Burkina Faso and Mali, respectively. In Nigeria, we collected data from 1300 students and in Palestine from 1127 students. The endline data collection began in February 2024. Conclusions: This is one of the first studies investigating hand hygiene in primary health care centers and schools in protracted conflict settings. With our strong study design, we expect to support local policy makers and humanitarian organizations in developing sustainable agendas for hygiene promotion. Trial Registration: ClinicalTrials.gov NCT05946980 (Burkina Faso and Mali); https://www.clinicaltrials.gov/study/NCT05946980 and NCT05964478 (Nigeria and Palestine); https://www.clinicaltrials.gov/study/NCT05964478 International Registered Report Identifier (IRRID): DERR1-10.2196/52959 ",
doi="10.2196/52959",
url="https://www.researchprotocols.org/2024/1/e52959",
url="http://www.ncbi.nlm.nih.gov/pubmed/38569182"
}


@Article{info:doi/10.2196/51113,
author="Xian, Xuechang
and Neuwirth, J. Rostam
and Chang, Angela",
title="Government-Nongovernmental Organization (NGO) Collaboration in Macao's COVID-19 Vaccine Promotion: Social Media Case Study",
journal="JMIR Infodemiology",
year="2024",
month="Mar",
day="19",
volume="4",
pages="e51113",
keywords="COVID-19",
keywords="government",
keywords="vaccine",
keywords="automated content analysis",
keywords="Granger causality test",
keywords="network agenda setting",
keywords="QAP",
keywords="social media",
abstract="Background: The COVID-19 pandemic triggered unprecedented global vaccination efforts, with social media being a popular tool for vaccine promotion. Objective: This study probes into Macao's COVID-19 vaccine communication dynamics, with a focus on the multifaceted impacts of government agendas on social media. Methods: We scrutinized 22,986 vaccine-related Facebook posts from January 2020 to August 2022 in Macao. Using automated content analysis and advanced statistical methods, we unveiled intricate agenda dynamics between government and nongovernment entities. Results: ``Vaccine importance'' and ``COVID-19 risk'' were the most prominent topics co-occurring in the overall vaccine communication. The government tended to emphasize ``COVID-19 risk'' and ``vaccine effectiveness,'' while regular users prioritized vaccine safety and distribution, indicating a discrepancy in these agendas. Nonetheless, the government has limited impact on regular users in the aspects of vaccine importance, accessibility, affordability, and trust in experts. The agendas of government and nongovernment users intertwined, illustrating complex interactions. Conclusions: This study reveals the influence of government agendas on public discourse, impacting environmental awareness, public health education, and the social dynamics of inclusive communication during health crises. Inclusive strategies, accommodating public concerns, and involving diverse stakeholders are paramount for effective social media communication during health crises. ",
doi="10.2196/51113",
url="https://infodemiology.jmir.org/2024/1/e51113",
url="http://www.ncbi.nlm.nih.gov/pubmed/38502184"
}


@Article{info:doi/10.2196/50181,
author="Blazek, Susanne E.
and Bucher, Amy",
title="Barriers to COVID-19 Vaccination in a Troop of Fleet Antiterrorism Security Team Marines: Observational Study",
journal="JMIR Form Res",
year="2024",
month="Mar",
day="19",
volume="8",
pages="e50181",
keywords="behavioral barriers",
keywords="benefits",
keywords="COVID-19",
keywords="Marine Corps",
keywords="military",
keywords="vaccine reluctance",
abstract="Background: In 2019, the World Health Organization declared the reluctance to vaccinate despite the availability of vaccination services as one of the top 10 threats to global health. In early 2021, self-reported reluctance to vaccinate among military personnel might have been considered a significant threat to national security. Having a choice architecture that made COVID-19 vaccination optional rather than required for military personnel could have inadvertently undermined military readiness if vaccination uptake did not reach an acceptable threshold. Objective: The purpose of this observational study was to examine Marines' self-reported reasons for planning to decline the COVID-19 vaccine to understand their barriers to vaccination. Methods: As the vaccination became available to 1 company of Fleet Antiterrorism Security Team (FAST) Marines in early 2021, company command required those planning to decline vaccination to write an essay with up to 5 reasons for their choice. These essays provided the data for this study. Qualitative descriptive analysis with elements from grounded theory was used to thematically categorize FAST Marines' written reasons for planning to decline the COVID-19 vaccine into a codebook describing 8 key behavioral determinants. Interrater agreement among 2 qualitatively trained researchers was very good ($\kappa$=0.81). Results: A troop of 47 Marines provided 235 reasons why they planned to decline the COVID-19 vaccine. The most frequent reasons were difficulty understanding health information (105/235, 45\%), low estimates of risk (33/235, 14\%), and fear of physical discomfort (29/235, 12\%). Resulting interventions directly targeted Marines' self-reported reasons by reducing barriers (eg, normalized getting the vaccine), increasing vaccine benefits (eg, improved access to base gyms and recreational facilities), and increasing nonvaccine friction (eg, required in writing 5 reasons for declining the vaccine). Conclusions: Understanding the barriers military personnel experience toward COVID-19 vaccination remains critical as vaccine acquisition and availability continue to protect military personnel. Insights from subpopulations like FAST Marines can enhance our ability to identify barriers and appropriate intervention techniques to influence COVID-19 vaccination behaviors. ",
doi="10.2196/50181",
url="https://formative.jmir.org/2024/1/e50181",
url="http://www.ncbi.nlm.nih.gov/pubmed/38502179"
}


@Article{info:doi/10.2196/50743,
author="Tuyishime, Elysee
and Remera, Eric
and Kayitesi, Catherine
and Malamba, Samuel
and Sangwayire, Beata
and Habimana Kabano, Ignace
and Ruisenor-Escudero, Horacio
and Oluoch, Tom
and Unna Chukwu, Angela",
title="Estimation of the Population Size of Street- and Venue-Based Female Sex Workers and Sexually Exploited Minors in Rwanda in 2022: 3-Source Capture-Recapture",
journal="JMIR Public Health Surveill",
year="2024",
month="Mar",
day="15",
volume="10",
pages="e50743",
keywords="population size",
keywords="female sex workers",
keywords="capture-recapture",
keywords="3-source",
keywords="Rwanda",
keywords="HIV",
keywords="surveillance",
keywords="population",
keywords="epidemiology",
keywords="prevention",
keywords="AIDS",
keywords="sexually transmitted disease",
keywords="STD",
keywords="minor",
keywords="young adult",
keywords="sexually exploited minor",
keywords="children",
abstract="Background: HIV surveillance among key populations is a priority in all epidemic settings. Female sex workers (FSWs) globally as well as in Rwanda are disproportionately affected by the HIV epidemic; hence, the Rwanda HIV and AIDS National Strategic Plan (2018-2024) has adopted regular surveillance of population size estimation (PSE) of FSWs every 2-3 years. Objective: We aimed at estimating, for the fourth time, the population size of street- and venue-based FSWs and sexually exploited minors aged ?15 years in Rwanda. Methods: In August 2022, the 3-source capture-recapture method was used to estimate the population size of FSWs and sexually exploited minors in Rwanda. The field work took 3 weeks to complete, with each capture occasion lasting for a week. The sample size for each capture was calculated using shinyrecap with inputs drawn from previously conducted estimation exercises. In each capture round, a stratified multistage sampling process was used, with administrative provinces as strata and FSW hotspots as the primary sampling unit. Different unique objects were distributed to FSWs in each capture round; acceptance of the unique object was marked as successful capture. Sampled FSWs for the subsequent capture occasions were asked if they had received the previously distributed unique object in order to determine recaptures. Statistical analysis was performed in R (version 4.0.5), and Bayesian Model Averaging was performed to produce the final PSE with a 95\% credibility set (CS). Results: We sampled 1766, 1848, and 1865 FSWs and sexually exploited minors in each capture round. There were 169 recaptures strictly between captures 1 and 2, 210 recaptures exclusively between captures 2 and 3, and 65 recaptures between captures 1 and 3 only. In all 3 captures, 61 FSWs were captured. The median PSE of street- and venue-based FSWs and sexually exploited minors in Rwanda was 37,647 (95\% CS 31,873-43,354), corresponding to 1.1\% (95\% CI 0.9\%-1.3\%) of the total adult females in the general population. Relative to the adult females in the general population, the western and northern provinces ranked first and second with a higher concentration of FSWs, respectively. The cities of Kigali and eastern province ranked third and fourth, respectively. The southern province was identified as having a low concentration of FSWs. Conclusions: We provide, for the first time, both the national and provincial level population size estimate of street- and venue-based FSWs in Rwanda. Compared with the previous 2 rounds of FSW PSEs at the national level, we observed differences in the street- and venue-based FSW population size in Rwanda. Our study might not have considered FSWs who do not want anyone to know they are FSWs due to several reasons, leading to a possible underestimation of the true PSE. ",
doi="10.2196/50743",
url="https://publichealth.jmir.org/2024/1/e50743",
url="http://www.ncbi.nlm.nih.gov/pubmed/38488847"
}


@Article{info:doi/10.2196/49307,
author="N{\"a}her, Anatol-Fiete
and Schulte-Althoff, Matthias
and Kopka, Marvin
and Balzer, Felix
and Pozo-Martin, Francisco",
title="Effects of Face Mask Mandates on COVID-19 Transmission in 51 Countries: Retrospective Event Study",
journal="JMIR Public Health Surveill",
year="2024",
month="Mar",
day="8",
volume="10",
pages="e49307",
keywords="nonpharmacological interventions",
keywords="face masks",
keywords="infectious diseases",
keywords="acute respiratory infections",
keywords="COVID-19",
keywords="real-world evidence",
abstract="Background: The question of the utility of face masks in preventing acute respiratory infections has received renewed attention during the COVID-19 pandemic. However, given the inconclusive evidence from existing randomized controlled trials, evidence based on real-world data with high external validity is missing. Objective: To add real-world evidence, this study aims to examine whether mask mandates in 51 countries and mask recommendations in 10 countries increased self-reported face mask use and reduced SARS-CoV-2 reproduction numbers and COVID-19 case growth rates. Methods: We applied an event study approach to data pooled from four sources: (1) country-level information on self-reported mask use was obtained from the COVID-19 Trends and Impact Survey, (2) data from the Oxford COVID-19 Government Response Tracker provided information on face mask mandates and recommendations and any other nonpharmacological interventions implemented, (3) mobility indicators from Google's Community Mobility Reports were also included, and (4) SARS-CoV-2 reproduction numbers and COVID-19 case growth rates were retrieved from the Our World in Data---COVID-19 data set. Results: Mandates increased mask use by 8.81 percentage points (P=.006) on average, and SARS-CoV-2 reproduction numbers declined on average by ?0.31 units (P=.008). Although no significant average effect of mask mandates was observed for growth rates of COVID-19 cases (?0.98 percentage points; P=.56), the results indicate incremental effects on days 26 (?1.76 percentage points; P=.04), 27 (?1.89 percentage points; P=.05), 29 (?1.78 percentage points; P=.04), and 30 (?2.14 percentage points; P=.02) after mandate implementation. For self-reported face mask use and reproduction numbers, incremental effects are seen 6 and 13 days after mandate implementation. Both incremental effects persist for >30 days. Furthermore, mask recommendations increased self-reported mask use on average (5.84 percentage points; P<.001). However, there were no effects of recommendations on SARS-CoV-2 reproduction numbers or COVID-19 case growth rates (?0.06 units; P=.70 and ?2.45 percentage points; P=.59). Single incremental effects on self-reported mask use were observed on days 11 (3.96 percentage points; P=.04), 13 (3.77 percentage points; P=.04) and 25 to 27 (4.20 percentage points; P=.048 and 5.91 percentage points; P=.01) after recommendation. Recommendations also affected reproduction numbers on days 0 (?0.07 units; P=.03) and 1 (?0.07 units; P=.03) and between days 21 (?0.09 units; P=.04) and 28 (?0.11 units; P=.05) and case growth rates between days 1 and 4 (?1.60 percentage points; P=.03 and ?2.19 percentage points; P=.03) and on day 23 (?2.83 percentage points; P=.05) after publication. Conclusions: Contrary to recommendations, mask mandates can be used as an effective measure to reduce SARS-CoV-2 reproduction numbers. However, mandates alone are not sufficient to reduce growth rates of COVID-19 cases. Our study adds external validity to the existing randomized controlled trials on the effectiveness of face masks to reduce the spread of SARS-CoV-2. ",
doi="10.2196/49307",
url="https://publichealth.jmir.org/2024/1/e49307",
url="http://www.ncbi.nlm.nih.gov/pubmed/38457225"
}


@Article{info:doi/10.2196/48255,
author="Kumwichar, Ponlagrit
and Poonsiri, Chittawan
and Botwright, Siobhan
and Sirichumroonwit, Natchalaikorn
and Loharjun, Bootsakorn
and Thawillarp, Supharerk
and Cheewaruangroj, Nontawit
and Chokchaisiripakdee, Amorn
and Teerawattananon, Yot
and Chongsuvivatwong, Virasakdi",
title="Durability of the Effectiveness of Heterologous COVID-19 Vaccine Regimens in Thailand: Retrospective Cohort Study Using National Registration Data",
journal="JMIR Public Health Surveill",
year="2024",
month="Mar",
day="5",
volume="10",
pages="e48255",
keywords="COVID-19",
keywords="heterologous vaccine",
keywords="vaccine",
keywords="vaccine effectiveness",
keywords="durability",
keywords="time",
keywords="waning",
keywords="real-world",
keywords="public health",
keywords="vaccination strategy",
keywords="health outcome",
keywords="vaccines",
keywords="vaccination",
keywords="unvaccinated",
keywords="big data",
keywords="registry",
keywords="registries",
keywords="health outcomes",
keywords="effectiveness",
keywords="SARS-CoV-2",
keywords="cohort",
keywords="database",
keywords="databases",
keywords="vaccinated",
keywords="Cochran-Mantel-Haenszel",
keywords="Mantel-Haenszel",
keywords="regression",
keywords="risk",
keywords="risks",
keywords="association",
keywords="associations",
keywords="odds ratio",
keywords="odds ratios",
abstract="Background: The durability of heterologous COVID-19 vaccine effectiveness (VE) has been primarily studied in high-income countries, while evaluation of heterologous vaccine policies in low- and middle-income countries remains limited. Objective: We aimed to evaluate the duration during which the VE of heterologous COVID-19 vaccine regimens in mitigating serious outcomes, specifically severe COVID-19 and death following hospitalization with COVID-19, remains over 50\%. Methods: We formed a dynamic cohort by linking records of Thai citizens aged ?18 years from citizen vital, COVID-19 vaccine, and COVID-19 cases registry databases between May 2021 and July 2022. Encrypted citizen identification numbers were used to merge the data between the databases. This study focuses on 8 common heterologous vaccine sequences: CoronaVac/ChAdOx1, ChAdOx1/BNT162b2, CoronaVac/CoronaVac/ChAdOx1, CoronaVac/ChAdOx1/ChAdOx1, CoronaVac/ChAdOx1/BNT162b2, BBIBP-CorV/BBIBP-CorV/BNT162b2, ChAdOx1/ChAdOx1/BNT162b2, and ChAdOx1/ChAdOx1/mRNA-1273. Nonimmunized individuals were considered for comparisons. The cohort was stratified according to the vaccination status, age, sex, province location, month of vaccination, and outcome. Data analysis employed logistic regression to determine the VE, accounting for potential confounders and durability over time, with data observed over a follow-up period of 7 months. Results: This study includes 52,580,841 individuals, with approximately 17,907,215 and 17,190,975 receiving 2- and 3-dose common heterologous vaccines (not mutually exclusive), respectively. The 2-dose heterologous vaccinations offered approximately 50\% VE against severe COVID-19 and death following hospitalization with COVID-19 for 2 months; however, the protection significantly declined over time. The 3-dose heterologous vaccinations sustained over 50\% VE against both outcomes for at least 8 months, as determined by logistic regression with durability time-interaction modeling. The vaccine sequence consisting of CoronaVac/CoronaVac/ChAdOx1 demonstrated >80\% VE against both outcomes, with no evidence of VE waning. The final monthly measured VE of CoronaVac/CoronaVac/ChAdOx1 against severe COVID-19 and death following hospitalization at 7 months after the last dose was 82\% (95\% CI 80.3\%-84\%) and 86.3\% (95\% CI 83.6\%-84\%), respectively. Conclusions: In Thailand, within a 7-month observation period, the 2-dose regimens could not maintain a 50\% VE against severe and fatal COVID-19 for over 2 months, but all of the 3-dose regimens did. The CoronaVac/CoronaVac/ChAdOx1 regimen showed the best protective effect against severe and fatal COVID-19. The estimated durability of 50\% VE for at least 8 months across all 3-dose heterologous COVID-19 vaccine regimens supports the adoption of heterologous prime-boost vaccination strategies, with a primary series of inactivated virus vaccine and boosting with either a viral vector or an mRNA vaccine, to prevent similar pandemics in low- and middle-income countries. ",
doi="10.2196/48255",
url="https://publichealth.jmir.org/2024/1/e48255",
url="http://www.ncbi.nlm.nih.gov/pubmed/38441923"
}


@Article{info:doi/10.2196/44349,
author="Liu, Yuanhua
and Yin, Yun
and Ward, P. Michael
and Li, Ke
and Chen, Yue
and Duan, Mengwei
and Wong, Y. Paulina P.
and Hong, Jie
and Huang, Jiaqi
and Shi, Jin
and Zhou, Xuan
and Chen, Xi
and Xu, Jiayao
and Yuan, Rui
and Kong, Lingcai
and Zhang, Zhijie",
title="Optimization of Screening Strategies for COVID-19: Scoping Review",
journal="JMIR Public Health Surveill",
year="2024",
month="Feb",
day="27",
volume="10",
pages="e44349",
keywords="COVID-19",
keywords="screening strategy",
keywords="optimization",
keywords="polymerase chain reaction test",
keywords="antigen test",
abstract="Background: COVID-19 screening is an effective nonpharmaceutical intervention for identifying infected individuals and interrupting viral transmission. However, questions have been raised regarding its effectiveness in controlling the spread of novel variants and its high socioeconomic costs. Therefore, the optimization of COVID-19 screening strategies has attracted great attention. Objective: This review aims to summarize the evidence and provide a reference basis for the optimization of screening strategies for the prevention and control of COVID-19. Methods: We applied a methodological framework for scoping reviews and the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) checklist. We conducted a scoping review of the present publications on the optimization of COVID-19 screening strategies. We searched the PubMed, Web of Science, and Elsevier ScienceDirect databases for publications up to December 31, 2022. English publications related to screening and testing strategies for COVID-19 were included. A data-charting form, jointly developed by 2 reviewers, was used for data extraction according to the optimization directions of the screening strategies. Results: A total of 2770 unique publications were retrieved from the database search, and 95 abstracts were retained for full-text review. There were 62 studies included in the final review. We summarized the results in 4 major aspects: the screening population (people at various risk conditions such as different regions and occupations; 12/62, 19\%), the timing of screening (when the target population is tested before travel or during an outbreak; 12/62, 19\%), the frequency of screening (appropriate frequencies for outbreak prevention, outbreak response, or community transmission control; 6/62, 10\%), and the screening and detection procedure (the choice of individual or pooled detection and optimization of the pooling approach; 35/62, 56\%). Conclusions: This review reveals gaps in the optimization of COVID-19 screening strategies and suggests that a number of factors such as prevalence, screening accuracy, effective allocation of resources, and feasibility of strategies should be carefully considered in the development of future screening strategies. ",
doi="10.2196/44349",
url="https://publichealth.jmir.org/2024/1/e44349",
url="http://www.ncbi.nlm.nih.gov/pubmed/38412011"
}


@Article{info:doi/10.2196/44258,
author="Kopila{\vs}, Vanja
and Nasadiuk, Khrystyna
and Martinelli, Lucia
and Lhotska, Lenka
and Todorovic, Zoran
and Vidmar, Matjaz
and Machado, Helena
and Svalastog, Lydia Anna
and Gajovi{\'c}, Sre{\'c}ko",
title="Perspectives on the COVID-19 Vaccination Rollout in 17 Countries: Reflexive Thematic and Frequency Analysis Based on the Strengths, Weaknesses, Opportunities, and Threats (SWOT) Framework",
journal="JMIR Hum Factors",
year="2024",
month="Feb",
day="19",
volume="11",
pages="e44258",
keywords="SARS-CoV-2 virus",
keywords="COVID-19 vaccination",
keywords="pandemic",
keywords="hesitancy",
keywords="safety",
keywords="vaccination",
keywords="COVID-19",
keywords="tool",
keywords="implementation",
keywords="vaccine hesitancy",
keywords="effectiveness",
keywords="sociocultural",
keywords="communication",
keywords="disinformation",
abstract="Background: As the SARS-CoV-2 virus created a global pandemic and rapidly became an imminent threat to the health and lives of people worldwide, the need for a vaccine and its quick distribution among the population was evident. Due to the urgency, and on the back of international collaboration, vaccines were developed rapidly. However, vaccination rollouts showed different success rates in different countries and some also led to increased vaccine hesitancy. Objective: The aim of this study was to identify the role of information sharing and context sensitivity in various vaccination programs throughout the initial COVID-19 vaccination rollout in different countries. Moreover, we aimed to identify factors in national vaccination programs related to COVID-19 vaccine hesitancy, safety, and effectiveness. Toward this end, multidisciplinary and multinational opinions from members of the Navigating Knowledge Landscape (NKL) network were analyzed. Methods: From May to July 2021, 25 completed questionnaires from 27 NKL network members were collected. These contributors were from 17 different countries. The responses reflected the contributors' subjective viewpoints on the status and details of the COVID-19 vaccination rollout in their countries. Contributors were asked to identify strengths, weaknesses, opportunities, and threats (ie, SWOT) of the respective vaccination programs. The responses were analyzed using reflexive thematic analysis, followed by frequency analysis of identified themes according to the represented countries. Results: The perspectives of NKL network members showed a link between organizational elements of the vaccination rollout and the accompanying societal response, both of which were related to strengths and weaknesses of the process. External sociocultural variables, improved public communication around vaccination-related issues, ethical controversies, and the spread of disinformation were the dominant themes related to opportunities and challenges. In the SWOT 2{\texttimes}2 matrix, Availability and Barriers emerged as internal categories, whereas Transparent communication and promotion and Societal divide emerged as key external categories. Conclusions: Inventory of themes and categories inspired by elements of the SWOT framework provides an informative multidisciplinary perspective for effective implementation of public health strategies in the battle against COVID-19 or any future pandemics of a similar nature. ",
doi="10.2196/44258",
url="https://humanfactors.jmir.org/2024/1/e44258",
url="http://www.ncbi.nlm.nih.gov/pubmed/38373020"
}


@Article{info:doi/10.2196/48430,
author="Macaluso, Maurizio
and Rothenberg, E. Marc
and Ferkol, Thomas
and Kuhnell, Pierce
and Kaminski, J. Henry
and Kimberlin, W. David
and Benatar, Michael
and Chehade, Mirna
and ",
title="Impact of the COVID-19 Pandemic on People Living With Rare Diseases and Their Families: Results of a National Survey",
journal="JMIR Public Health Surveill",
year="2024",
month="Feb",
day="14",
volume="10",
pages="e48430",
keywords="rare diseases",
keywords="rare",
keywords="chronic",
keywords="COVID-19 infection",
keywords="cross-sectional survey",
keywords="access to care",
keywords="changes in symptoms and use of medications",
keywords="psychological impact on self and family",
keywords="access",
keywords="accessibility",
keywords="cross-sectional",
keywords="national",
keywords="nationwide",
keywords="survey",
keywords="surveys",
keywords="COVID-19",
keywords="SARS-CoV-2",
keywords="coronavirus",
keywords="comorbid",
keywords="comorbidity",
keywords="vulnerable",
abstract="Background: With more than 103 million cases and 1.1 million deaths, the COVID-19 pandemic has had devastating consequences for the health system and the well-being of the entire US population. The Rare Diseases Clinical Research Network funded by the National Institutes of Health was strategically positioned to study the impact of the pandemic on the large, vulnerable population of people living with rare diseases (RDs). Objective: This study was designed to describe the characteristics of COVID-19 in the RD population, determine whether patient subgroups experienced increased occurrence or severity of infection and whether the pandemic changed RD symptoms and treatment, and understand the broader impact on respondents and their families. Methods: US residents who had an RD and were <90 years old completed a web-based survey investigating self-reported COVID-19 infection, pandemic-related changes in RD symptoms and medications, access to care, and psychological impact on self and family. We estimated the incidence of self-reported COVID-19 and compared it with that in the US population; evaluated the frequency of COVID-19 symptoms according to self-reported infection; assessed infection duration, complications and need for hospitalization; assessed the influence of the COVID-19 pandemic on RD symptoms and treatment, and whether the pandemic influenced access to care, special food and nutrition, or demand for professional psychological assistance. Results: Between May 2, 2020, and December 15, 2020, in total, 3413 individuals completed the survey. Most were female (2212/3413, 64.81\%), White (3038/3413, 89.01\%), and aged ?25 years (2646/3413, 77.53\%). Overall, 80.6\% (2751/3413) did not acquire COVID-19, 2.08\% (71/3413) acquired it, and 16.58\% (566/3413) did not know. Self-reported cases represented an annual incidence rate of 2.2\% (95\% CI 1.7\%-2.8\%). COVID-19 cases were more than twice the expected (71 vs 30.3; P<.001). COVID-19 was associated with specific symptoms (loss of taste: odds ratio [OR] 38.9, 95\% CI 22.4-67.6, loss of smell: OR 30.6, 95\% CI 17.7-53.1) and multiple symptoms (>9 symptoms vs none: OR 82.5, 95\% CI 29-234 and 5-9: OR 44.8, 95\% CI 18.7-107). Median symptom duration was 16 (IQR 9-30) days. Hospitalization (7/71, 10\%) and ventilator support (4/71, 6\%) were uncommon. Respondents who acquired COVID-19 reported increased occurrence and severity of RD symptoms and use or dosage of select medications; those who did not acquire COVID-19 reported decreased occurrence and severity of RD symptoms and use of medications; those who did not know had an intermediate pattern. The pandemic made it difficult to access care, receive treatment, get hospitalized, and caused mood changes for respondents and their families. Conclusions: Self-reported COVID-19 was more frequent than expected and was associated with increased prevalence and severity of RD symptoms and greater use of medications. The pandemic negatively affected access to care and caused mood changes in the respondents and family members. Continued surveillance is necessary. ",
doi="10.2196/48430",
url="https://publichealth.jmir.org/2024/1/e48430",
url="http://www.ncbi.nlm.nih.gov/pubmed/38354030"
}


@Article{info:doi/10.2196/50572,
author="Sharma, Pravesh
and Kamath, Celia
and Brockman, A. Tabetha
and Roche, Anne
and Sinicrope, Pamela
and Jiang, Ruoxiang
and Decker, A. Paul
and Pazdernik, Vanessa
and Patten, Christi",
title="Demographics and Social Factors Associated With Persistent Nonuse of Video Appointments at a Multisite Health Care Institution: Cross-Sectional Study",
journal="JMIR Form Res",
year="2024",
month="Jan",
day="24",
volume="8",
pages="e50572",
keywords="digital health",
keywords="telemedicine",
keywords="telehealth",
keywords="video visits",
keywords="appointments",
keywords="SDoH, social determinants of health",
keywords="social determinants",
keywords="appointment",
keywords="users",
keywords="sociodemographic",
keywords="prevention",
keywords="discomfort",
keywords="video communication",
keywords="communication",
keywords="willingness",
keywords="mobile phone",
abstract="Background: During the COVID-19 outbreak, video appointments became a popular method for health care delivery, particularly in the early stages of the pandemic. Although Mayo Clinic aimed to reduce face-to-face (F2F) appointments to prevent the spread of the virus, some patients continued seeing their health care providers in person. In the later stages of the pandemic, many patients became comfortable with video appointments, even if they were initially hesitant. However, a subset of patients continued to avoid video appointments. It is not yet clear what sociodemographic factors may be associated with this group of patients. Objective: This cross-sectional study aimed to examine demographic and social determinant of health (SDoH) factors associated with persistent nonusers of video appointments among a sample of patients within a multistate health care organization. We also explored patient beliefs about the use of video for health care appointments. Methods: We conducted a 1-time cross-sectional paper survey, mailed between July and December 2022, of patients matching the eligibility criteria: (1) aged ?18 years as of April 2020, (2) Mayo Clinic Midwest, Florida, or Arizona patient, (3) did not use video appointment services during April-December 2020 but attended F2F appointments in the departments of primary care and psychiatry/psychology. The survey asked patients, ``Have you ever had a video appointment with a healthcare provider?'' ``Yes'' respondents were defined as ``users'' (adapted to video appointments), and ``no'' respondents were defined as ``persistent nonusers'' of video appointments. We analyzed demographics, SDoH, and patient beliefs toward video appointments in 2 groups: persistent nonusers of video appointments and users. We used chi-square and 2-tailed t tests for analysis. Results: Our findings indicate that patients who were older, lived in rural areas, sought care at Mayo Clinic Midwest, and did not have access to the patient portal system were likely to be persistent nonusers of video appointments. Only 1 SDoH factor (not having a disability, handicap, or chronic disease) was associated with persistent nonuse of video appointments. Persistent nonusers of video appointments held personal beliefs such as discomfort with video communication, difficulty interpreting nonverbal cues, and personal preference for F2F appointments over video. Conclusions: Our study identified demographic (older age and rural residence), sociodemographic factors (not having a disability, handicap, or chronic disease), and personal beliefs associated with patients' decisions to choose between video versus F2F appointments for health care delivery. Health care institutions should assess patients' negative attitudes toward technology prior to introducing them to digital health care services. Failing to do so may result in its restricted usage, negative patient experience, and wasted resources. For patients who hold negative beliefs about technology but are willing to learn, a ``digital health coordinator'' could be assigned to assist with various digital health solutions. ",
doi="10.2196/50572",
url="https://formative.jmir.org/2024/1/e50572",
url="http://www.ncbi.nlm.nih.gov/pubmed/38265855"
}


@Article{info:doi/10.2196/47308,
author="Rutter, Sophie
and Sanger, Sally
and Madden, D. Andrew
and Ehdeed, Sukaina
and Stones, Catherine",
title="Office Workers' Views About the Uses, Concerns, and Acceptance of Hand Hygiene Data Collected From Smart Sanitizers: Exploratory Qualitative Interview Study",
journal="JMIR Form Res",
year="2024",
month="Jan",
day="11",
volume="8",
pages="e47308",
keywords="hand hygiene",
keywords="smart sanitizers",
keywords="Internet of Things",
keywords="IoT",
keywords="offices",
keywords="workplaces",
keywords="smart systems",
abstract="Background: COVID-19 and the prospect of future pandemics have emphasized the need to reduce disease transmission in workplaces. Despite the well-established link between good hand hygiene (HH) and employee health, HH in nonclinical workplaces has received little attention. Smart sanitizers have been deployed in clinical settings to motivate and enforce HH. This study is part of a large project that explores the potential of smart sanitizers in office settings. Objective: Our previous study found that for office workers to accept the deployment of smart sanitizers, they would need to find the data generated as useful and actionable. The objectives of this study were to identify (1) the potential uses and actions that could be taken from HH data collected by smart sanitizers (2) the concerns of office workers for the identified uses and actions and (3) the circumstances in which office workers accept HH monitoring. Methods: An interview study was conducted with 18 office workers from various professions. Interview questions were developed using a framework from personal informatics. Transcripts were analyzed thematically. Results: A wide range of uses of smart sanitizer data was identified including managing hygiene resources and workflows, finding operating sanitizers, communicating the (high) standard of organizational hygiene, promoting and enforcing organizational hygiene policies, improving workers' own hygiene practices, executing more effective interventions, and identifying the causes of outbreaks. However, hygiene is mostly considered as a private matter, and it is also possible that no action would be taken. Office workers were also concerned about bullying, coercion, and use of hygiene data for unintended purposes. They were also worried that the data could be inaccurate or incomplete, leading to misrepresentation of hygiene practices. Office workers suggested that they would be more likely to accept monitoring in situations where hygiene is considered important, when there are clear benefits to data collection, if their privacy is respected, if they have some control over how their data are collected, and if the ways in which the data will be used are clearly communicated. Conclusions: Smart sanitizers could have a valuable role in improving hygiene practices in offices and reducing disease transmission. Many actionable uses for data collected from smart systems were identified. However, office workers consider HH as a personal matter, and acceptance of smart systems is likely to be dynamic and will depend on the broad situation. Except when there are disease outbreaks, smart systems may need to be restricted to uses that do not require the sharing of personal data. Should organizations wish to implement smart sanitizers in offices, it would be advisable to consult widely with staff and develop systems that are customizable and personalizable. ",
doi="10.2196/47308",
url="https://formative.jmir.org/2024/1/e47308",
url="http://www.ncbi.nlm.nih.gov/pubmed/38206674"
}


@Article{info:doi/10.2196/47673,
author="Ramos, P. Pablo Ivan
and Marcilio, Izabel
and Bento, I. Ana
and Penna, O. Gerson
and de Oliveira, F. Juliane
and Khouri, Ricardo
and Andrade, S. Roberto F.
and Carreiro, P. Roberto
and Oliveira, A. Vinicius de
and Galv{\~a}o, C. Luiz Augusto
and Landau, Luiz
and Barreto, L. Mauricio
and van der Horst, Kay
and Barral-Netto, Manoel
and ",
title="Combining Digital and Molecular Approaches Using Health and Alternate Data Sources in a Next-Generation Surveillance System for Anticipating Outbreaks of Pandemic Potential",
journal="JMIR Public Health Surveill",
year="2024",
month="Jan",
day="9",
volume="10",
pages="e47673",
keywords="data integration",
keywords="digital public health",
keywords="infectious disease surveillance",
keywords="pandemic preparedness",
keywords="prevention",
keywords="response",
doi="10.2196/47673",
url="https://publichealth.jmir.org/2024/1/e47673",
url="http://www.ncbi.nlm.nih.gov/pubmed/38194263"
}


@Article{info:doi/10.2196/47099,
author="Apio, Catherine
and Han, Kyulhee
and Lee, Doeun
and Lee, Bogyeom
and Park, Taesung",
title="Development of New Stringency Indices for Nonpharmacological Social Distancing Policies Implemented in Korea During the COVID-19 Pandemic: Random Forest Approach",
journal="JMIR Public Health Surveill",
year="2024",
month="Jan",
day="8",
volume="10",
pages="e47099",
keywords="COVID-19",
keywords="restriction policy",
keywords="Stringency Index",
keywords="Korea Stringency Index",
keywords="social distancing",
keywords="physical distancing",
keywords="pandemic",
keywords="government",
keywords="restriction",
keywords="effectiveness",
keywords="policy",
abstract="Background: In the absence of an effective treatment method or vaccine, the outbreak of the COVID-19 pandemic elicited a wide range of unprecedented restriction policies aimed at mitigating and suppressing the spread of the SARS-CoV-2 virus. These policies and their Stringency Index (SI) of more than 160 countries were systematically recorded in the Oxford COVID-19 Government Response Tracker (OxCGRT) data set. The SI is a summary measure of the overall strictness of these policies. However, the OxCGRT SI may not fully reflect the stringency levels of the restriction policies implemented in Korea. Korea implemented 33 COVID-19 restriction policies targeting 4 areas: public facilities, public events, social gatherings, and religious gatherings. Objective: This study aims to develop new Korea Stringency Indices (KSIs) that reflect the stringency levels of Korea's restriction policies better and to determine which government-implemented policies were most effective in managing the COVID-19 pandemic in Korea. Methods: The random forest method was used to calculate the new KSIs using feature importance values and determine their effectiveness in managing daily COVID-19 confirmed cases. Five analysis periods were considered, including November 01, 2020, to January 20, 2021 (Period 1), January 20, 2021, to June 27, 2021 (Period 2), November 01, 2020, to June 27, 2021 (Period 3), June 27, 2021, to November 01, 2021 (Period 4), and November 01, 2021, to April 24, 2022 (Period 5). Results: Among the KSIs, public facilities in period 4, public events in period 2, religious gatherings in periods 1 and 3, and social gatherings in period 5 had the highest importance. Among the public facilities, policies associated with operation hour restrictions in cinemas, restaurants, PC rooms, indoor sports facilities, karaoke, coffee shops, night entertainment facilities, and baths or saunas had the highest importance across all analysis periods. Strong positive correlations were observed between daily confirmed cases and public facilities, religious gatherings, and public events in period 1 of the pandemic. From then, weaker and negative correlations were observed in the remaining analysis periods. The comparison with the OxCGRT SI showed that the SI had a relatively lower feature importance and correlation with daily confirmed cases than the proposed KSIs, making KSIs more effective than SI. Conclusions: Restriction policies targeting public facilities were the most effective among the policies analyzed. In addition, different periods call for the enforcement of different policies given their effectiveness varies during the pandemic. ",
doi="10.2196/47099",
url="https://publichealth.jmir.org/2024/1/e47099",
url="http://www.ncbi.nlm.nih.gov/pubmed/38190233"
}


@Article{info:doi/10.2196/47981,
author="De La Cerda, Isela
and Bauer, X. Cici
and Zhang, Kehe
and Lee, Miryoung
and Jones, Michelle
and Rodriguez, Arturo
and McCormick, B. Joseph
and Fisher-Hoch, P. Susan",
title="Evaluation of a Targeted COVID-19 Community Outreach Intervention: Case Report for Precision Public Health",
journal="JMIR Public Health Surveill",
year="2023",
month="Dec",
day="20",
volume="9",
pages="e47981",
keywords="community interventions",
keywords="emergency preparedness",
keywords="health disparities",
keywords="intervention evaluation",
keywords="precision public health",
keywords="public health informatics",
keywords="public health intervention",
keywords="public health",
keywords="spatial epidemiology",
keywords="surveillance",
abstract="Background: Cameron County, a low-income south Texas-Mexico border county marked by severe health disparities, was consistently among the top counties with the highest COVID-19 mortality in Texas at the onset of the pandemic. The disparity in COVID-19 burden within Texas counties revealed the need for effective interventions to address the specific needs of local health departments and their communities. Publicly available COVID-19 surveillance data were not sufficiently timely or granular to deliver such targeted interventions. An agency-academic collaboration in Cameron used novel geographic information science methods to produce granular COVID-19 surveillance data. These data were used to strategically target an educational outreach intervention named ``Boots on the Ground'' (BOG) in the City of Brownsville (COB). Objective: This study aimed to evaluate the impact of a spatially targeted community intervention on daily COVID-19 test counts. Methods: The agency-academic collaboration between the COB and UTHealth Houston led to the creation of weekly COVID-19 epidemiological reports at the census tract level. These reports guided the selection of census tracts to deliver targeted BOG between April 21 and June 8, 2020. Recordkeeping of the targeted BOG tracts and the intervention dates, along with COVID-19 daily testing counts per census tract, provided data for intervention evaluation. An interrupted time series design was used to evaluate the impact on COVID-19 test counts 2 weeks before and after targeted BOG. A piecewise Poisson regression analysis was used to quantify the slope (sustained) and intercept (immediate) change between pre- and post-BOG COVID-19 daily test count trends. Additional analysis of COB tracts that did not receive targeted BOG was conducted for comparison purposes. Results: During the intervention period, 18 of the 48 COB census tracts received targeted BOG. Among these, a significant change in the slope between pre- and post-BOG daily test counts was observed in 5 tracts, 80\% (n=4) of which had a positive slope change. A positive slope change implied a significant increase in daily COVID-19 test counts 2 weeks after targeted BOG compared to the testing trend observed 2 weeks before intervention. In an additional analysis of the 30 census tracts that did not receive targeted BOG, significant slope changes were observed in 10 tracts, of which positive slope changes were only observed in 20\% (n=2). In summary, we found that BOG-targeted tracts had mostly positive daily COVID-19 test count slope changes, whereas untargeted tracts had mostly negative daily COVID-19 test count slope changes. Conclusions: Evaluation of spatially targeted community interventions is necessary to strengthen the evidence base of this important approach for local emergency preparedness. This report highlights how an academic-agency collaboration established and evaluated the impact of a real-time, targeted intervention delivering precision public health to a small community. ",
doi="10.2196/47981",
url="https://publichealth.jmir.org/2023/1/e47981",
url="http://www.ncbi.nlm.nih.gov/pubmed/38117549"
}


@Article{info:doi/10.2196/43743,
author="Isigi, Shivuli Sharon
and Parsa, Davod Ali
and Alasqah, Ibrahim
and Mahmud, Ilias
and Kabir, Russell",
title="Predisposing Factors of Nosocomial Infections in Hospitalized Patients in the United Kingdom: Systematic Review",
journal="JMIR Public Health Surveill",
year="2023",
month="Dec",
day="19",
volume="9",
pages="e43743",
keywords="hospital-acquired infections",
keywords="nosocomial infections",
keywords="infection risk",
keywords="systematic review",
keywords="hospitalized patients",
keywords="public health",
abstract="Background: Nosocomial infections are infections incubating or not present at the time of admission to a hospital and manifest 48 hours after hospital admission. The specific factors contributing to the risk of infection during hospitalization remain unclear, particularly for the hospitalized population of the United Kingdom. Objective: The aim of this systematic literature review was to explore the risk factors of nosocomial infections in hospitalized adult patients in the United Kingdom. Methods: A comprehensive keyword search was conducted through the PubMed, Medline, and EBSCO CINAHL Plus databases. The keywords included ``risk factors'' or ``contributing factors'' or ``predisposing factors'' or ``cause'' or ``vulnerability factors'' and ``nosocomial infections'' or ``hospital-acquired infections'' and ``hospitalized patients'' or ``inpatients'' or ``patients'' or ``hospitalized.'' Additional articles were obtained through reference harvesting of selected articles. The search was limited to the United Kingdom with papers written in English, without limiting for age and gender to minimize bias. The above process retrieved 377 articles, which were further screened using inclusion and exclusion criteria following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The retained 9 studies were subjected to critical appraisal using the Critical Appraisal Skills Programme (cohort and case-control studies) and Appraisal Tool for Cross-Sectional Studies (cross-sectional studies) checklists. Finally, 6 eligible publications were identified and used to collect the study findings. A thematic analysis technique was used to analyze data extracted on risk factors of nosocomial infections in hospitalized patients in the United Kingdom. Results: The risk factors for nosocomial infections that emerged from the reviewed studies included older age, intrahospital transfers, cross-infection, longer hospital stay, readmissions, prior colonization with opportunistic organisms, comorbidities, and prior intake of antibiotics and urinary catheters. Nosocomial infections were associated with more extended hospital stays, presenting with increased morbidity and mortality. Measures for controlling nosocomial infections included the use of single-patient rooms, well-equipped wards, prior screening of staff and patients, adequate sick leave for staff, improved swallowing techniques and nutritional intake for patients, improved oral hygiene, avoiding unnecessary indwelling plastics, use of suprapubic catheters, aseptic techniques during patient care, and prophylactic use. Conclusions: There is a need for further studies to aid in implementing nosocomial infection prevention and control. ",
doi="10.2196/43743",
url="https://publichealth.jmir.org/2023/1/e43743",
url="http://www.ncbi.nlm.nih.gov/pubmed/38113098"
}


@Article{info:doi/10.2196/49687,
author="Tang, Chia-Chun
and Chen, Hsi
and Tsai, Shao-Yu
and Wu, Wei-Wen",
title="Factors Associated With Levels of Public Engagement in Protective Behaviors During the Early COVID-19 Pandemic: Causal-Comparative Study Based on the Health Belief Model",
journal="JMIR Hum Factors",
year="2023",
month="Dec",
day="19",
volume="10",
pages="e49687",
keywords="infectious disease",
keywords="protective behavior",
keywords="COVID",
keywords="health belief model",
keywords="causal comparative",
keywords="causal",
keywords="protective",
keywords="prevention",
keywords="opinion",
keywords="opinions",
keywords="attitude",
keywords="attitudes",
keywords="COVID-19",
keywords="pandemic",
keywords="infection control",
keywords="public safety",
keywords="public health",
keywords="survey",
keywords="surveys",
abstract="Background: While the challenges of COVID-19 are still unfolding, the enhancement of protective behavior remains a top priority in global health care. However, current behavior-promoting strategies may be inefficient without first identifying the individuals with lower engagement in protective behavior and the associating factors. Objective: This study aimed to identify individuals with and potential contributing factors to low engagement in protective behavior during the COVID-19 pandemic. Methods: This is a causal-comparative study. A theory-based web-based survey was used to investigate individuals' protective behavior and potential associating factors. During June 2020, the distribution of the survey was targeted to 3 areas: Taiwan, Japan, and North America. Based on the theory of the health belief model (HBM), the survey collected participants' various perceptions toward COVID-19 and a collection of protective behaviors. In addition to the descriptive analysis, cluster analysis, ANOVA, and Fisher exact and chi-square tests were used. Results: A total of 384 responses were analyzed. More than half of the respondents lived in Taiwan, followed by Japan, then North America. The respondents were grouped into 3 clusters according to their engagement level in all protective behaviors. These 3 clusters were significantly different from each other in terms of the participants' sex, residency, perceived barriers, self-efficacy, and cues of action. Conclusions: This study used an HBM-based questionnaire to assess protective behaviors against COVID-19 and the associated factors across multiple countries. The findings indicate significant differences in various HBM concepts among individuals with varying levels of behavioral engagement. ",
doi="10.2196/49687",
url="https://humanfactors.jmir.org/2023/1/e49687"
}


@Article{info:doi/10.2196/48511,
author="Li, Guanjian
and Zhang, Rongqiu
and Song, Bing
and Wang, Chao
and Shen, Qunshan
and He, Xiaojin
and Cao, Yunxia",
title="Effects of SARS-CoV-2 Vaccines on Sperm Quality: Systematic Review",
journal="JMIR Public Health Surveill",
year="2023",
month="Dec",
day="6",
volume="9",
pages="e48511",
keywords="COVID-19 vaccine",
keywords="SARS-CoV-2",
keywords="reproductive system",
keywords="fertility",
keywords="sperm quality",
abstract="Background: The COVID-19 pandemic, caused by SARS-CoV-2, has triggered a global public health crisis of unprecedented proportions. SARS-CoV-2 vaccination is a highly effective strategy for preventing infections and severe COVID-19 outcomes. Although several studies have concluded that COVID-19 vaccines are unlikely to affect fertility, concerns have arisen regarding adverse events, including the potential impact on fertility; these concerns are plagued by limited and inconsistent evidence. Objective: This review aims to provide a recent assessment of the literature on the impact of COVID-19 vaccines on male sperm quality. The possible impact of COVID-19 vaccines on fertility potential was also examined to draw a clearer picture and to evaluate the effects of COVID-19 on male reproductive health. Methods: PubMed, Scopus, Web of Science, Embase, and Cochrane databases were searched from their inception to October 2023. Eligible studies included articles reporting SARS-CoV-2 vaccination and human semen quality and fertility, as well as the impact of vaccination on assisted reproductive technology treatment outcomes. The quality of cohort studies was assessed using the Newcastle-Ottawa Scale, and the quality of cross-sectional studies was assessed using the quality evaluation criteria recommended by the Agency for Healthcare Research and Quality. The systematic review followed PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Results: The initial literature search yielded 4691 records by searching 5 peer-reviewed databases (PubMed, Scopus, Web of Science, Embase, and Cochrane). Finally, 24 relevant studies were selected for our study. There were evident research inequalities at the regional level, with the United States and Western European countries contributing 38\% (9/24) of the studies, Middle Eastern countries contributing 38\% (9/24), China accounting for 21\% (5/24), and Africa and South America accounting for none. Nonetheless, the overall quality of the included studies was generally good. Our results demonstrated that serious side effects of the COVID-19 vaccine are extremely rare, and men experience few problems with sperm parameters or reproductive potential after vaccination. Conclusions: On the basis of the studies published so far, the COVID-19 vaccine is safe for male reproductive health. Obviously, vaccination is a wise option rather than experience serious adverse symptoms of viral infections. These instances of evidence may help reduce vaccine hesitancy and increase vaccination coverage, particularly among reproductive-age couples. As new controlled trials and prospective cohort studies with larger sample sizes emerge, the possibility of a negative effect of the COVID-19 vaccine on sperm quality must be further clarified. ",
doi="10.2196/48511",
url="https://publichealth.jmir.org/2023/1/e48511",
url="http://www.ncbi.nlm.nih.gov/pubmed/37976132"
}


@Article{info:doi/10.2196/37102,
author="Sanchez, Travis
and Hall, Eric
and Siegler, J. Aaron
and Prakash-Asrani, Radhika
and Bradley, Heather
and Fahimi, Mansour
and Lopman, Benjamin
and Luisi, Nicole
and Nelson, N. Kristin
and Sailey, Charles
and Shioda, Kayoko
and Valentine-Graves, Mariah
and Sullivan, S. Patrick",
title="Prevalence of COVID-19 Mitigation Behaviors in US Adults (August-December 2020): Nationwide Household Probability Survey",
journal="JMIR Public Health Surveill",
year="2023",
month="Dec",
day="6",
volume="9",
pages="e37102",
keywords="COVID-19",
keywords="mask",
keywords="social distancing",
keywords="handwashing",
keywords="hand sanitizer",
keywords="public health",
keywords="pandemic",
keywords="mitigation behavior",
keywords="risk factor",
keywords="disease prevention",
keywords="health policy",
keywords="latent class analysis",
keywords="hygiene",
abstract="Background: COVID-19 mitigation behaviors, such as wearing masks, maintaining social distancing, and practicing hand hygiene, have been and will remain vital to slowing the pandemic. Objective: This study aims to describe the period prevalence of consistent mask-wearing, social distancing, and hand hygiene practices during the peak of COVID-19 incidence (August-December 2020) and just before COVID-19 vaccine availability, overall and in demographic subgroups. Methods: We used baseline survey data from a nationwide household probability sample to generate weighted estimates of mitigation behaviors: wearing masks, maintaining social distancing, and practicing hand hygiene. Weighted logistic regression explored differences in mitigation behaviors by demographics. Latent class analysis (LCA) identified patterns in mitigation behaviors. Results: Among 4654 participants, most (n=2727, 58.6\%) were female, were non-Hispanic White (n=3063, 65.8\%), were aged 55 years or older (n=2099, 45.1\%), lived in the South (n=2275, 48.9\%), lived in metropolitan areas (n=4186, 89.9\%), had at least a bachelor's degree (n=2547, 54.7\%), had an income of US \$50,000-\$99,000 (n=1445, 31\%), and were privately insured (n=2734, 58.7\%). The period prevalence of consistent mask wearing was 71.1\% (sample-weighted 95\% CI 68.8-73.3); consistent social distancing, 42.9\% (95\% CI 40.5-45.3); frequent handwashing, 55.0\% (95\% CI 52.3-57.7); and frequent hand sanitizing, 21.5\% (95\% CI 19.4-23.8). Mitigation behaviors were more prevalent among women, older persons, Black or Hispanic persons, those who were not college graduates, and service-oriented workers. LCA identified an optimal-mitigation class that consistently practiced all behaviors (n=2656, 67\% of US adults), a low-mitigation class that inconsistently practiced all behaviors (n=771, 20.6\%), and a class that had optimal masking and social distancing but a high frequency of hand hygiene (n=463, 12.4\%). Conclusions: Despite a high prevalence of COVID-19 mitigation behaviors, there were likely millions who did not consistently practice these behaviors during the time of the highest COVID-19 incidence. In future infectious disease outbreak responses, public health authorities should also consider addressing disparities in mitigation practices through more targeted prevention messaging. ",
doi="10.2196/37102",
url="https://publichealth.jmir.org/2023/1/e37102",
url="http://www.ncbi.nlm.nih.gov/pubmed/38055314"
}


@Article{info:doi/10.2196/48107,
author="Zhu, Dandan
and Huang, Jing
and Hu, Bei
and Cao, Donglin
and Chen, Dingqiang
and Song, Xinqiang
and Chen, Jialing
and Zhou, Hao
and Cen, Aiqun
and Hou, Tieying",
title="Trial of the Pluslife SARS-CoV-2 Nucleic Acid Rapid Test Kit: Prospective Cohort Study",
journal="JMIR Public Health Surveill",
year="2023",
month="Nov",
day="14",
volume="9",
pages="e48107",
keywords="SARS-CoV-2",
keywords="COVID-19",
keywords="RHAM",
keywords="RNase hybridization-assisted amplification",
keywords="field trial",
keywords="diagnosis",
keywords="screening",
keywords="rapid test",
keywords="cohort study",
keywords="detection",
keywords="recruitment",
keywords="infection",
keywords="Pluslife",
abstract="Background: In response to the SARS-CoV-2 epidemic, a convenient, rapid, and sensitive diagnostic method for detecting COVID-19 is crucial for patient control and timely treatment. Objective: This study aimed to validate the detection of SARS-CoV-2 with the Pluslife SARS-CoV-2 rapid test kit developed based on a novel thermostatic amplification technique called RNase hybridization-assisted amplification. Methods: From November 25 to December 8, 2022, patients with suspected or confirmed COVID-19, close contacts, and health care workers at high risk of exposure were recruited from 3 hospitals and 1 university. Respiratory specimens were collected for testing with the Pluslife SARS-CoV-2 rapid test kit and compared with reverse transcription-quantitative polymerase chain reaction (RT-qPCR) and a commercial antigen assay kit. Samples from 1447 cases were obtained from 3 ``ready-to-test'' scenarios in which samples were collected on site and tested immediately, and samples from 503 cases were obtained from a ``freeze-thaw test'' scenario in which samples were collected, frozen, and thawed for testing. Results: Pluslife SARS-CoV-2 rapid testing of samples from the ``ready-to-test'' scenario was found to be accurate (overall sensitivity and specificity of 98.3\% and 99.3\%, respectively) and diagnostically useful (positive and negative likelihood ratios of 145.45 and 0.02, respectively). Pluslife SARS-CoV-2 rapid testing of samples from the ``freeze-thaw test'' scenario was also found to be accurate (overall sensitivity and specificity of 71.2\% and 98.6\%, respectively) and diagnostically useful (positive and negative likelihood ratios of 51.01 and 0.67, respectively). Our findings demonstrated that the time efficiency and accuracy of the results in a ``ready-to-test'' scenario were better. The time required from sample preparation to the seeing the result of the Pluslife SARS-CoV-2 rapid test was 10 to 38 minutes, which was substantially shorter than that of RT-qPCR (at least 90 minutes). In addition, the diagnostic efficacy of the Pluslife SARS-CoV-2 rapid test was better than that of a commercial antigen assay kit. Conclusions: The developed RNase hybridization-assisted amplification assay provided rapid, sensitive, and convenient detection of SARS-CoV-2 infection and may be useful for enhanced detection of COVID-19 in homes, high-risk industries, and hospitals. ",
doi="10.2196/48107",
url="https://publichealth.jmir.org/2023/1/e48107",
url="http://www.ncbi.nlm.nih.gov/pubmed/37962934"
}


@Article{info:doi/10.2196/47563,
author="De Gaetano, Alessandro
and Bajardi, Paolo
and Gozzi, Nicol{\`o}
and Perra, Nicola
and Perrotta, Daniela
and Paolotti, Daniela",
title="Behavioral Changes Associated With COVID-19 Vaccination: Cross-National Online Survey",
journal="J Med Internet Res",
year="2023",
month="Oct",
day="31",
volume="25",
pages="e47563",
keywords="COVID-19",
keywords="vaccines",
keywords="social behaviors",
keywords="online surveys",
keywords="nonpharmaceutical interventions",
keywords="survey",
keywords="vaccination",
keywords="behavior",
keywords="NPIs",
keywords="prevention",
abstract="Background: During the initial phases of the vaccination campaign worldwide, nonpharmaceutical interventions (NPIs) remained pivotal in the fight against the COVID-19 pandemic. In this context, it is important to understand how the arrival of vaccines affected the adoption of NPIs. Indeed, some individuals might have seen the start of mass vaccination campaigns as the end of the emergency and, as a result, relaxed their COVID-safe behaviors, facilitating the spread of the virus in a delicate epidemic phase such as the initial rollout. Objective: The aim of this study was to collect information about the possible relaxation of protective behaviors following key events of the vaccination campaign in four countries and to analyze possible associations of these behavioral tendencies with the sociodemographic characteristics of participants. Methods: We developed an online survey named ``COVID-19 Prevention and Behavior Survey'' that was conducted between November 26 and December 22, 2021. Participants were recruited using targeted ads on Facebook in four different countries: Brazil, Italy, South Africa, and the United Kingdom. We measured the onset of relaxation of protective measures in response to key events of the vaccination campaign, namely personal vaccination and vaccination of the most vulnerable population. Through calculation of odds ratios (ORs) and regression analysis, we assessed the strength of association between compliance with NPIs and sociodemographic characteristics of participants. Results: We received 2263 questionnaires from the four countries. Participants reported the most significant changes in social activities such as going to a restaurant or the cinema and visiting relatives and friends. This is in good agreement with validated psychological models of health-related behavioral change such as the Health Belief Model, according to which activities with higher costs and perceived barriers (eg, social activities) are more prone to early relaxation. Multivariate analysis using a generalized linear model showed that the two main determinants of the drop of social NPIs were (1) having previously tested positive for COVID-19 (after the second vaccine dose: OR 2.46, 95\% CI 1.73-3.49) and (2) living with people at risk (after the second vaccine dose: OR 1.57, 95\% CI 1.22-2.03). Conclusions: This work shows that particular caution has to be taken during vaccination campaigns. Indeed, people might relax their safe behaviors regardless of the dynamics of the epidemic. For this reason, it is crucial to maintain high compliance with NPIs to avoid hindering the beneficial effects of the vaccine. ",
doi="10.2196/47563",
url="https://www.jmir.org/2023/1/e47563",
url="http://www.ncbi.nlm.nih.gov/pubmed/37906219"
}


@Article{info:doi/10.2196/50967,
author="Mgbere, Osaro
and Iloanusi, Sorochi
and Yunusa, Ismaeel
and Iloanusi, R. Nchebe-Jah
and Gohil, Shrey
and Essien, James Ekere",
title="Intersection of Perceived COVID-19 Risk, Preparedness, and Preventive Health Behaviors: Latent Class Segmentation Analysis",
journal="Online J Public Health Inform",
year="2023",
month="Oct",
day="24",
volume="15",
pages="e50967",
keywords="COVID-19",
keywords="latent class analysis",
keywords="risk perception",
keywords="preparedness",
keywords="preventive health behaviors",
keywords="Nigeria",
abstract="Background: COVID-19 risk perception is a factor that influences the pandemic spread. Understanding the potential behavioral responses to COVID-19, including preparedness and adoption of preventive measures, can inform interventions to curtail its spread. Objective: We assessed self-perceived and latent class analysis (LCA)--based risks of COVID-19 and their associations with preparedness, misconception, information gap, and preventive practices among residents of a densely populated city in Nigeria. Methods: We used data from a cross-sectional survey conducted among residents (N=140) of Onitsha, Nigeria, in March 2020, before the government-mandated lockdown. Using an iterative expectation-maximization algorithm, we applied LCA to systematically segment participants into the most likely distinct risk clusters. Furthermore, we used bivariate and multivariable logistic regression models to determine the associations among knowledge, attitude, preventive practice, perceived preparedness, misconception, COVID-19 information gap, and self-perceived and LCA-based COVID-19 risks. Results: Most participants (85/140, 60.7\%) had good knowledge and did not perceive themselves as at risk of contracting COVID-19. Three-quarters of the participants (102/137, 74.6\%; P<.001) experienced COVID-19--related information gaps, while 62.9\% (88/140; P=.04) of the participants had some misconceptions about the disease. Conversely, most participants (93/140, 66.4\%; P<.001) indicated that they were prepared for the COVID-19 pandemic. The majority of the participants (94/138, 68.1\%; P<.001) self-perceived that they were not at risk of contracting COVID-19 compared to 31.9\% (44/138) who professed to be at risk of contracting COVID-19. Using the LCA, we identified 3 distinct risk clusters (P<.001), namely, prudent or low-risk takers, skeptics or high-risk takers, and carefree or very high-risk takers with prevalence rates (probabilities of cluster membership that represent the prevalence rate [$\gamma$c]) of 47.5\% (95\% CI 40\%-55\%), 16.2\% (95\% CI 11.4\%-20.9\%), and 36.4\% (95\% CI 28.8\%-43.9\%), respectively. We recorded a significantly negative agreement between self-perceived risk and LCA-based segmentation of COVID-19 risk ($\kappa$=--0.218, SD 0.067; P=.01). Knowledge, attitude, and perceived need for COVID-19 information were significant predictors of COVID-19 preventive practices among the Onitsha city residents. Conclusions: The clustering patterns highlight the impact of modifiable risk behaviors on COVID-19 preventive practices, which can provide strong empirical support for health prevention policies. Consequently, clusters with individuals at high risk of contracting COVID-19 would benefit from multicomponent interventions delivered in diverse settings to improve the population-based response to the pandemic. ",
doi="10.2196/50967",
url="https://ojphi.jmir.org/2023/1/e50967",
url="http://www.ncbi.nlm.nih.gov/pubmed/38046563"
}


@Article{info:doi/10.2196/39919,
author="Bagasra, Anisah
and Allen, T. Christopher
and Doan, Sara",
title="Perceived Effectiveness of COVID-19 Preventive Practices and Behavioral Intention: Survey of a Representative Adult Sample in the United States",
journal="JMIR Hum Factors",
year="2023",
month="Oct",
day="10",
volume="10",
pages="e39919",
keywords="health promotion",
keywords="health communication",
keywords="health risk behavior",
keywords="behavioral intention",
keywords="public health",
keywords="COVID-19",
keywords="vaccination",
keywords="prevention",
keywords="health education",
abstract="Background: Using existing models of behavioral health promotion, specifically the Extended Parallel Process Model, previous research has identified factors that may impact engagement in preventive health behaviors during the COVID-19 pandemic such as perceived threat, perceived susceptibility to the threat, perceived severity, and perceived efficacy. Objective: This study aims to examine the role of perceived effectiveness of COVID-19 preventive behaviors, perceived susceptibility, perceived threat, and perceived severity of COVID-19 in participants' intentions to engage in Centers for Disease Control (CDC)--recommended individual health behaviors in the first year of the pandemic. Methods: In October 2020, a representative sample of 506 US adults completed a web-based survey through the RAND American Life Panel. Results: The study primarily found that participants who perceived that CDC-recommended health practices were effective had stronger intentions to engage in those practices. The second strongest correlate was participants' perceived severity of COVID-19 across the United States. Perceived effectiveness of recommended practices accounted for the largest variance in behavioral intention. However, analysis of individual behaviors indicated a mismatch in the behaviors perceived to be the most effective (avoiding sick people and mask-wearing) and those participants indicated intention to engage in (throwing away used tissues, avoiding sick people, and coughing into their elbows) in the next 30 days. Conclusions: The authors recommend tailoring public health messaging to address the perceived threat of COVID-19 and self-efficacy. Thus, health promotion efforts should emphasize the effectiveness of CDC-recommended practices while highlighting the pandemic's severity. Additionally, rebuilding trust in public health messaging and messengers is necessary to increase perceived self-efficacy. As the COVID-19 pandemic continues, health messaging must continue to promote and build trust in CDC-recommended health practices and educate regarding the efficacy of vaccination and other preventive behaviors. ",
doi="10.2196/39919",
url="https://humanfactors.jmir.org/2023/1/e39919",
url="http://www.ncbi.nlm.nih.gov/pubmed/37815862"
}


@Article{info:doi/10.2196/46318,
author="Xu, Stanley
and Hong, Vennis
and Sy, S. Lina
and Bruxvoort, J. Katia
and Lewin, Bruno
and Han, Bing
and Holmquist, J. Kimberly
and Qian, Lei",
title="Risk Factors for Not Completing a 2-Dose Primary Series of Messenger RNA COVID-19 Vaccination in a Large Health Care System in Southern California: Retrospective Cohort Study",
journal="JMIR Public Health Surveill",
year="2023",
month="Oct",
day="4",
volume="9",
pages="e46318",
keywords="mRNA COVID-19 vaccines",
keywords="2-dose primary series",
keywords="vaccines",
keywords="SARS-CoV-2",
keywords="coronavirus",
keywords="respiratory",
keywords="infectious",
keywords="communicable",
keywords="immunization",
keywords="immunize",
keywords="noncompletion",
keywords="risk factors",
keywords="multiple Poisson regression model",
keywords="COVID-19",
keywords="vaccination",
keywords="vaccine",
keywords="dose",
keywords="dosing",
keywords="regression",
keywords="risk",
keywords="risks",
keywords="health outcome",
keywords="health outcomes",
keywords="retrospective",
keywords="cohort",
keywords="dosage",
keywords="United States",
keywords="community",
keywords="inoculation",
abstract="Background: COVID-19 vaccination is crucial in combating the COVID-19 pandemic. Messenger RNA COVID-19 vaccines were initially authorized as a 2-dose primary series and have been widely used in the United States; completing the 2-dose primary series offers protection against infection, severe illness, and death. Understanding the risk factors for not completing the 2-dose primary series is critical to evaluate COVID-19 vaccination programs and promote completion of the 2-dose primary series. Objective: This study examined potential risk factors for not completing a 2-dose primary series of mRNA COVID-19 vaccination. Methods: We conducted a retrospective cohort study among members aged ?18 years from a large integrated health care system, Kaiser Permanente Southern California, from December 14, 2020, to June 30, 2022. Noncompletion of the 2-dose primary series was defined as not completing the second dose within 6 months after receipt of the first dose. Crude noncompletion rates were estimated overall and by demographic characteristics, health care use patterns, comorbidity, and community-level socioeconomic factors. A Poisson regression model was fit to examine associations of individual-level and community-level risk factors with noncompletion of the 2-dose primary series. Results: Among 2.5 million recipients of ?1 dose of mRNA COVID-19 vaccines, 3.3\% (n=81,202) did not complete the second dose within 6 months. Members aged 25-44 years, 65-74 years, and ?75 years were less likely to not complete the 2-dose primary series than those aged 18-24 years, while members aged 45-64 years were more likely to not complete the 2-dose primary series (adjusted risk ratio [aRR] 1.13, 95\% CI 1.10-1.15). Male sex was associated with a higher risk of noncompletion (aRR 1.17, 95\% CI 1.15-1.19). Hispanic and non-Hispanic Black race/ethnicity were associated with a lower risk of noncompletion (range aRR 0.78-0.91). Having Medicaid and prior influenza vaccination were associated with a higher risk of noncompletion. Having SARS-CoV-2 infection, experiencing an adverse event, or having an inpatient and emergency department visit during the minimum recommended dose intervals were associated with a higher risk of not completing the 2-dose primary series (aRR 1.98, 95\% CI 1.85-2.12; 1.99, 95\% CI 1.43-2.76; and 1.85, 95\% CI 1.77-1.93, respectively). Those who received the first dose after June 30, 2021, were more likely to not complete the 2-dose primary series within 6 months of receipt of the first dose. Conclusions: Despite limitations such as being a single-site study and the inability to consider social factors such as employment and vaccine attitudes, our study identified several risk factors for not completing a 2-dose primary series of mRNA vaccination, including being male; having Medicaid coverage; and experiencing SARS-CoV-2 infection, adverse events, or inpatient and emergency department visits during the minimum recommended dose intervals. These findings can inform future efforts in developing effective strategies to enhance vaccination coverage and improve the completion rate of necessary doses. ",
doi="10.2196/46318",
url="https://publichealth.jmir.org/2023/1/e46318",
url="http://www.ncbi.nlm.nih.gov/pubmed/37792452"
}


@Article{info:doi/10.2196/48998,
author="Goodman, S. Rachel
and Mittal, Lavanya
and Parker, Rawlings Eva",
title="Public Health Risks, Dermatological Manifestations, and Environmental Justice Associated With Vinyl Chloride Exposure: Narrative Review",
journal="JMIR Dermatol",
year="2023",
month="Sep",
day="7",
volume="6",
pages="e48998",
keywords="vinyl chloride",
keywords="cutaneous manifestations",
keywords="dermatology",
keywords="industrial accident",
keywords="climate advocacy",
keywords="public health",
keywords="environmental toxins",
keywords="environmental health",
keywords="acute",
keywords="chronic",
keywords="utilization",
keywords="malignancy",
keywords="community",
keywords="socioeconomic",
keywords="hazardous chemicals",
keywords="toxicology",
abstract="Background: Environmental vinyl chloride (VC) exposure may result in serious acute and chronic dermatological conditions. Because existing literature largely focuses on exposures in occupational settings, a gap persists in our understanding of the medical consequences of large-scale chemical spills. Objective: This study aims to examine the potential dermatological manifestations of VC exposure in the context of industrial spills and other environmental disasters and to highlight the public health and justice implications of such releases. Methods: In this narrative review, relevant evidence-based, peer-reviewed scientific sources, gray literature, and media reports were identified via searches of search PubMed and Google using predetermined keyword search terms related to VC, VC spills and releases, train derailment, cutaneous disease, public health, and vulnerable and marginalized populations. Results: Contact dermatitis and frostbite may arise acutely, highlighting the importance of swift decontamination. Long-term manifestations from chronic VC exposure due to persistence in environmental reservoirs include Raynaud disease, sclerodermatous skin changes, acro-osteolysis, and cutaneous malignancies. The clinical severity of cutaneous manifestations is influenced by individual susceptibility as well as duration, intensity, and route of exposure. Additionally, chemical releases of VC more frequently impact Communities of Color and those of lower socioeconomic status, resulting in greater rates of exposure-related disease. Conclusions: With environmental release events of hazardous chemicals becoming increasingly common and because the skin has increased contact with environmental toxins relative to other organs, an urgent need exists for a greater understanding of the overall short- and long-term health impacts of large-scale, toxic exposures, underscoring the need for ongoing clinical vigilance. Dermatologists and public health officials should also aim to better understand the ways in which the disproportionate impacts of hazardous chemical exposures on lower-income and minority populations may exacerbate existing health disparities. Herein, we describe the health implications of toxic releases with particular consideration paid to marginalized and vulnerable populations. In addition to legal and regulatory frameworks, we advocate for improved public health measures, to not only mitigate the risk of environmental catastrophes in the future, but also ensure timely and effective responses to them. ",
doi="10.2196/48998",
url="https://derma.jmir.org/2023/1/e48998",
url="http://www.ncbi.nlm.nih.gov/pubmed/37676716"
}


@Article{info:doi/10.2196/44950,
author="Kreslake, M. Jennifer
and Aarvig, Kathleen
and Muller-Tabanera, Hope
and Vallone, M. Donna
and Hair, C. Elizabeth",
title="Checkpoint Travel Numbers as a Proxy Variable in Population-Based Studies During the COVID-19 Pandemic: Validation Study",
journal="JMIR Public Health Surveill",
year="2023",
month="Aug",
day="29",
volume="9",
pages="e44950",
keywords="research methods",
keywords="public health",
keywords="data quality",
keywords="psychosocial factors",
keywords="history",
keywords="COVID-19",
keywords="social",
keywords="behavioral",
keywords="validation",
keywords="social distancing",
keywords="tracking survey",
keywords="survey",
keywords="pandemic",
abstract="Background: The COVID-19 pandemic had wide-ranging systemic impacts, with implications for social and behavioral factors in human health. The pandemic may introduce history bias in population-level research studies of other health topics during the COVID-19 period. Objective: We sought to identify and validate an accessible, flexible measure to serve as a covariate in research spanning the COVID-19 pandemic period. Methods: Transportation Security Administration checkpoint travel numbers were used to calculate a weekly sum of daily passengers and validated against two measures with strong face validity: (1) a self-reported item on social distancing practices drawn from a continuous tracking survey among a national sample of youths and young adults (15-24 years) in the United States (N=45,080, approximately 280 unique respondents each week); and (2) Google's Community Mobility Reports, which calculate daily values at the national level to represent rates of change in visits and length of stays to public spaces. For the self-reported survey data, an aggregated week-level variable was calculated as the proportion of respondents who did not practice social distancing that week (January 1, 2019, to May 31, 2022). For the community mobility data, a weekly estimate of change was calculated using daily values compared to a 5-week prepandemic baseline period (January 3, 2020, to February 6, 2020). Spearman rank correlation coefficients were calculated for each comparison. Results: Checkpoint travel data ranged from 668,719 travelers in the week of April 8, 2020, to nearly 15.5 million travelers in the week of May 18, 2022. The weekly proportion of survey respondents who did not practice social distancing ranged from 18.1\% (n=42; week of April 15, 2020) to 70.9\% (n=213; week of May 25, 2022). The measures were strongly correlated from January 2019 to May 2022 ($\rho$=0.90, P<.001) and March 2020 to May 2022 ($\rho$=0.87, P<.001). Strong correlations were observed when analyses were restricted to age groups (15-17 years: $\rho$=0.90; P<.001; 18-20 years: $\rho$=0.87; P<.001; 21-24 years: $\rho$=0.88; P<.001), racial or ethnic minorities ($\rho$=0.86, P<.001), and respondents with lower socioeconomic status ($\rho$=0.88, P<.001). There were also strong correlations between the weekly change from the baseline period for checkpoint travel data and community mobility data for transit stations ($\rho$=0.92, P<.001) and retail and recreation ($\rho$=0.89, P<.001), and moderate significant correlations for grocery and pharmacy ($\rho$=0.68, P<.001) and parks ($\rho$=0.62, P<.001). A strong negative correlation was observed for places of residence ($\rho$=?0.78, P<.001), and a weak but significant positive correlation was found for workplaces ($\rho$=0.24, P<.001). Conclusions: The Transportation Security Administration's travel checkpoint data provide a publicly available flexible time-varying metric to control for history bias introduced by the pandemic in research studies spanning the COVID-19 period in the United States. ",
doi="10.2196/44950",
url="https://publichealth.jmir.org/2023/1/e44950",
url="http://www.ncbi.nlm.nih.gov/pubmed/37191643"
}


@Article{info:doi/10.2196/44657,
author="Keck, W. James
and Lindner, Jess
and Liversedge, Matthew
and Mijatovic, Blazan
and Olsson, Cullen
and Strike, William
and Noble, Anni
and Adatorwovor, Reuben
and Lacy, Parker
and Smith, Ted
and Berry, M. Scott",
title="Wastewater Surveillance for SARS-CoV-2 at Long-Term Care Facilities: Mixed Methods Evaluation",
journal="JMIR Public Health Surveill",
year="2023",
month="Aug",
day="29",
volume="9",
pages="e44657",
keywords="wastewater surveillance",
keywords="wastewater-based epidemiology",
keywords="evaluation",
keywords="long-term care facility",
keywords="COVID-19",
keywords="SARS-CoV-2",
abstract="Background: Wastewater surveillance provided early indication of COVID-19 in US municipalities. Residents of long-term care facilities (LTCFs) experienced disproportionate morbidity and mortality early in the COVID-19 pandemic. We implemented LTCF building-level wastewater surveillance for SARS-CoV-2 at 6 facilities in Kentucky to provide early warning of SARS-CoV-2 in populations considered vulnerable. Objective: This study aims to evaluate the performance of wastewater surveillance for SARS-CoV-2 at LTCFs in Kentucky. Methods: We conducted a mixed methods evaluation of wastewater surveillance following Centers for Disease Control and Prevention (CDC) guidelines for evaluating public health surveillance systems. Evaluation steps in the CDC guidelines were engaging stakeholders, describing the surveillance system, focusing the evaluation design, gathering credible evidence, and generating conclusions and recommendations. We purposively recruited stakeholders for semistructured interviews and undertook thematic content analysis of interview data. We integrated wastewater, clinical testing, and process data to characterize or calculate 7 surveillance system performance attributes (simplicity, flexibility, data quality, sensitivity and positive predictive value [PPV], timeliness, representativeness, and stability). Results: We conducted 8 stakeholder interviews. The surveillance system collected wastewater samples (N=811) 2 to 4 times weekly at 6 LTCFs in Kentucky from March 2021 to February 2022. Synthesis of credible evidence indicated variable surveillance performance. Regarding simplicity, surveillance implementation required moderate human resource and technical capacity. Regarding flexibility, the system efficiently adjusted surveillance frequency and demonstrated the ability to detect additional pathogens of interest. Regarding data quality, software identified errors in wastewater sample metadata entry (110/3120, 3.53\% of fields), technicians identified polymerase chain reaction data issues (140/7734, 1.81\% of reactions), and staff entered all data corrections into a log. Regarding sensitivity and PPV, using routine LTCF SARS-CoV-2 clinical testing results as the gold standard, a wastewater SARS-CoV-2 signal of >0 RNA copies/mL was 30.6\% (95\% CI 24.4\%-36.8\%) sensitive and 79.7\% (95\% CI 76.4\%-82.9\%) specific for a positive clinical test at the LTCF. The PPV of the wastewater signal was 34.8\% (95\% CI 27.9\%-41.7\%) at >0 RNA copies/mL and increased to 75\% (95\% CI 60\%-90\%) at >250 copies/mL. Regarding timeliness, stakeholders received surveillance data 24 to 72 hours after sample collection, with delayed reporting because of the lack of weekend laboratory staff. Regarding representativeness, stakeholders identified challenges delineating the population contributing to LTCF wastewater because of visitors, unknown staff toileting habits, and the use of adult briefs by some residents preventing their waste from entering the sewer system. Regarding stability, the reoccurring cost to conduct 1 day of wastewater surveillance at 1 facility was approximately US \$144.50, which included transportation, labor, and materials expenses. Conclusions: The LTCF wastewater surveillance system demonstrated mixed performance per CDC criteria. Stakeholders found surveillance feasible and expressed optimism regarding its potential while also recognizing challenges in interpreting and acting on surveillance data. ",
doi="10.2196/44657",
url="https://publichealth.jmir.org/2023/1/e44657"
}


@Article{info:doi/10.2196/44204,
author="Deckert, Andreas
and Anders, Simon
and Morales, Ivonne
and De Allegri, Manuela
and Nguyen, Thi Hoa
and Souares, Aur{\'e}lia
and McMahon, Shannon
and Meurer, Matthias
and Burk, Robin
and Lou, Dan
and Brugnara, Lucia
and Sand, Matthias
and Koeppel, Lisa
and Maier-Hein, Lena
and Ross, Tobias
and Adler, J. Tim
and Brenner, Stephan
and Dyer, Christopher
and Herbst, Konrad
and Ovchinnikova, Svetlana
and Marx, Michael
and Schnitzler, Paul
and Knop, Michael
and B{\"a}rnighausen, Till
and Denkinger, M. Claudia",
title="Comparison of Four Active SARS-CoV-2 Surveillance Strategies in Representative Population Sample Points: Two-Factor Factorial Randomized Controlled Trial",
journal="JMIR Public Health Surveill",
year="2023",
month="Aug",
day="17",
volume="9",
pages="e44204",
keywords="COVID-19",
keywords="SARS-CoV-2",
keywords="randomized controlled trial",
keywords="multiarm",
keywords="cluster sampling",
keywords="surveillance",
keywords="effectiveness",
keywords="pandemic",
abstract="Background: The COVID-19 pandemic is characterized by rapid increases in infection burden owing to the emergence of new variants with higher transmissibility and immune escape. To date, monitoring the COVID-19 pandemic has mainly relied on passive surveillance, yielding biased epidemiological measures owing to the disproportionate number of undetected asymptomatic cases. Active surveillance could provide accurate estimates of the true prevalence to forecast the evolution of the pandemic, enabling evidence-based decision-making. Objective: This study compared 4 different approaches of active SARS-CoV-2 surveillance focusing on feasibility and epidemiological outcomes. Methods: A 2-factor factorial randomized controlled trial was conducted in 2020 in a German district with 700,000 inhabitants. The epidemiological outcome comprised SARS-CoV-2 prevalence and its precision. The 4 study arms combined 2 factors: individuals versus households and direct testing versus testing conditioned on symptom prescreening. Individuals aged ?7 years were eligible. Altogether, 27,908 addresses from 51 municipalities were randomly allocated to the arms and 15 consecutive recruitment weekdays. Data collection and logistics were highly digitized, and a website in 5 languages enabled low-barrier registration and tracking of results. Gargle sample collection kits were sent by post. Participants collected a gargle sample at home and mailed it to the laboratory. Samples were analyzed with reverse transcription loop-mediated isothermal amplification (RT-LAMP); positive and weak results were confirmed with real-time reverse transcription--polymerase chain reaction (RT-PCR). Results: Recruitment was conducted between November 18 and December 11, 2020. The response rates in the 4 arms varied between 34.31\% (2340/6821) and 41.17\% (2043/4962). The prescreening classified 16.61\% (1207/7266) of the patients as COVID-19 symptomatic. Altogether, 4232 persons without prescreening and 7623 participating in the prescreening provided 5351 gargle samples, of which 5319 (99.4\%) could be analyzed. This yielded 17 confirmed SARS-CoV-2 infections and a combined prevalence of 0.36\% (95\% CI 0.14\%-0.59\%) in the arms without prescreening and 0.05\% (95\% CI 0.00\%-0.108\%) in the arms with prescreening (initial contacts only). Specifically, we found a prevalence of 0.31\% (95\% CI 0.06\%-0.58\%) for individuals and 0.35\% (95\% CI 0.09\%-0.61\%) for households, and lower estimates with prescreening (0.07\%, 95\% CI 0.0\%-0.15\% for individuals and 0.02\%, 95\% CI 0.0\%-0.06\% for households). Asymptomatic infections occurred in 27\% (3/11) of the positive cases with symptom data. The 2 arms without prescreening performed the best regarding effectiveness and accuracy. Conclusions: This study showed that postal mailing of gargle sample kits and returning home-based self-collected liquid gargle samples followed by high-sensitivity RT-LAMP analysis is a feasible way to conduct active SARS-CoV-2 population surveillance without burdening routine diagnostic testing. Efforts to improve participation rates and integration into the public health system may increase the potential to monitor the course of the pandemic. Trial Registration: Deutsches Register Klinischer Studien (DRKS) DRKS00023271; https://tinyurl.com/3xenz68a International Registered Report Identifier (IRRID): RR2-10.1186/s13063-021-05619-5 ",
doi="10.2196/44204",
url="https://publichealth.jmir.org/2023/1/e44204",
url="http://www.ncbi.nlm.nih.gov/pubmed/37235704"
}


@Article{info:doi/10.2196/42143,
author="Hori, Daisuke
and Takahashi, Tsukasa
and Ozaki, Akihiko
and Tabuchi, Takahiro",
title="The Impact of Priority Settings at the Start of COVID-19 Mass Vaccination on Subsequent Vaccine Uptake in Japan: One-Year Prospective Cohort Study",
journal="JMIR Public Health Surveill",
year="2023",
month="Jul",
day="10",
volume="9",
pages="e42143",
keywords="cohort studies",
keywords="SARS-CoV-2",
keywords="COVID-19",
keywords="Japan",
keywords="vaccination",
keywords="vaccination hesitancy",
keywords="vaccines",
abstract="Background: Distributing COVID-19 vaccines to the public was an important task for the governments of each country. Because of various limitations, priority settings for vaccination were determined at the time of mass vaccination. However, trends between vaccine intention and uptake, as well as reasons for getting vaccinated or not getting vaccinated, among these groups were understudied, undermining verification of the legitimacy of priority selection. Objective: This study aims to illustrate a trend from prior COVID-19 vaccine intention, when the vaccine was not available, to the actual uptake within 1 year when all residents had access to the vaccine, to illustrate a change of reason for getting vaccinated or not getting vaccinated and to examine whether priority settings predicted subsequent vaccination uptake. Methods: Prospective cohort, web-based, self-administered surveys were conducted in Japan at 3 time points: February 2021, September to October 2021, and February 2022. In total, 13,555 participants (age: mean 53.1, SD 15.9 years) provided valid responses, with a 52.1\% follow-up rate. On the basis of the information obtained in February 2021, we identified 3 types of priority groups: health care workers (n=831), people aged ?65 years (n=4048), and those aged 18 to 64 years with underlying medical conditions (n=1659). The remaining patients were treated as nonpriority (n=7017). Modified Poisson regression analysis with a robust error estimated the risk ratio for COVID-19 vaccine uptake after adjusting for socioeconomic background, health-seeking behavior, attitude toward vaccines, and COVID-19 infection history. Results: In February 2021, a total of 5182 out of 13,555 (38.23\%) respondents expressed their intention to get vaccinated. In February 2022, a total of 1570 out of 13,555 (11.6\%) respondents completed the third dose and 10,589 (78.1\%) respondents completed the second dose. Prior vaccine intention and subsequent vaccine coverage rates were higher in the priority groups. Protection of themselves and their families from potential infection was the most frequent reason for getting vaccinated, whereas concern about side effects was the most frequent reason for hesitation across the groups. Risk ratios for received, reserved, or intended for vaccination in February 2022 were 1.05 (95\% CI 1.03-1.07) for the health care worker group, 1.02 (95\% CI 1.005-1.03) for the older adult group, and 1.01 (95\% CI 0.999-1.03) for the preexisting conditions group compared with the nonpriority group. Prior vaccine intention and confidence in vaccines were strong predictors of vaccine uptake. Conclusions: The priority settings at the start of the COVID-19 vaccination program had a significant impact on vaccine coverage after 1 year. The priority group for vaccination achieved higher vaccination coverage in February 2022. There was room for improvement among the nonpriority group. The findings of this study are essential for policy makers in Japan and other countries to develop effective vaccination strategies for future pandemics. ",
doi="10.2196/42143",
url="https://publichealth.jmir.org/2023/1/e42143",
url="http://www.ncbi.nlm.nih.gov/pubmed/37235691"
}


@Article{info:doi/10.2196/34598,
author="Mabuka, Thabo
and Naidoo, Natalie
and Ncube, Nesisa
and Yiga, Thabo
and Ross, Michael
and Kurehwa, Kuzivakwashe
and Nare Nyathi, Mothabisi
and Silaji, Andrea
and Ndemera, Tinashe
and Lemeke, Tlaleng
and Taiwo, Ridwan
and Macharia, Willie
and Sithole, Mthokozisi",
title="The Impact of SARS-CoV-2 Lineages (Variants) and COVID-19 Vaccination on the COVID-19 Epidemic in South Africa: Regression Study",
journal="JMIRx Med",
year="2023",
month="Jul",
day="3",
volume="4",
pages="e34598",
keywords="COVID-19",
keywords="SARS-CoV-2",
keywords="vaccines",
keywords="variants",
keywords="lineages",
keywords="South Africa",
keywords="epidemiology",
keywords="statistics",
abstract="Background: Emerging SARS-CoV-2 variants have been attributed to the occurrence of secondary, tertiary, quaternary, and quinary COVID-19 epidemic waves threatening vaccine efforts owing to their immune invasiveness. Since the importation of SARS-CoV-2 in South Africa, with the first reported COVID-19 case on March 5, 2020, South Africa has observed 5 consecutive COVID-19 epidemic waves. The evolution of SARS-CoV-2 has played a major role in the resurgence of COVID-19 epidemic waves in South Africa and across the globe. Objective: We aimed to conduct descriptive and inferential statistical analysis on South African COVID-19 epidemiological data to investigate the impact of SARS-CoV-2 lineages and COVID-19 vaccinations in South African COVID-19 epidemiology. Methods: The general methodology involved the collation and stratification, covariance, regression analysis, normalization, and comparative inferential statistical analysis through null hypothesis testing (paired 2-tailed t tests) of South African COVID-19 epidemiological data. Results: The mean daily positive COVID-19 tests in South Africa's first, second, third, fourth, and fifth COVID-19 epidemic wave periods were 11.5\% (SD 8.58\%), 11.5\% (SD 8.45\%), 13.3\% (SD 9.72\%), 13.1\% (SD 9.91\%), and 14.3\% (SD 8.49\%), respectively. The COVID-19 transmission rate in the first and second COVID-19 epidemic waves in South Africa was similar, while the COVID-19 transmission rate was higher in the third, fourth, and fifth COVID-19 epidemic waves than in the aforementioned waves. Most COVID-19 hospitalized cases in South Africa were in the general ward (60\%-79.1\%). Patients with COVID-19 on oxygen were the second-largest admission status (11.2\%-16.8\%), followed by patients with COVID-19 in the intensive care unit (8.07\%-16.7\%). Most patients hospitalized owing to COVID-19 in South Africa's first, second, third, and fourth COVID-19 epidemic waves were aged between 40 and 49 years (16.8\%-20.4\%) and 50 and 59 years (19.8\%-25.3\%). Patients admitted to the hospital owing to COVID-19 in the age groups of 0 to 19 years were relatively low (1.98\%-4.59\%). In general, COVID-19 hospital admissions in South Africa for the age groups between 0 and 29 years increased after each consecutive COVID-19 epidemic wave, while for age groups between 30 and 79 years, hospital admissions decreased. Most COVID-19 hospitalization deaths in South Africa in the first, second, third, fourth, and fifth COVID-19 epidemic waves were in the ages of 50 to 59 years (15.8\%-24.8\%), 60 to 69 years (15.9\%-29.5\%), and 70 to 79 years (16.6\%-20.7\%). Conclusions: The relaxation of COVID-19 nonpharmaceutical intervention health policies in South Africa and the evolution of SARS-CoV-2 were associated with increased COVID-19 transmission and severity in the South African population. COVID-19 vaccination in South Africa was strongly associated with a decrease in COVID-19 hospitalization and severity in South Africa. ",
doi="10.2196/34598",
url="https://med.jmirx.org/2023/1/e34598",
url="http://www.ncbi.nlm.nih.gov/pubmed/37463043"
}


@Article{info:doi/10.2196/42958,
author="Huang, Yiman
and Zhang, Ling
and Fu, Jiaqi
and Wu, Yijin
and Wang, Hao
and Xiao, Weijun
and Xin, You
and Dai, Zhenwei
and Si, Mingyu
and Chen, Xu
and Jia, Mengmeng
and Leng, Zhiwei
and Cui, Dan
and Su, Xiaoyou",
title="COVID-19 Vaccine Hesitancy Among Patients Recovered From COVID-19 Infection in Wuhan, China: Cross-Sectional Questionnaire Study",
journal="JMIR Public Health Surveill",
year="2023",
month="Jul",
day="3",
volume="9",
pages="e42958",
keywords="COVID-19",
keywords="COVID-19 survivors",
keywords="vaccine hesitancy",
keywords="complacency",
keywords="confidence",
keywords="convenience",
keywords="cross-sectional questionnaire",
keywords="health education",
keywords="health promotion",
keywords="public health",
abstract="Background: Although patients recovered from COVID-19 already have immunity gained from natural infection, they are still at risk of reinfection due to the emergence of new variants of COVID-19 and the diminishing of naturally acquired immunity over time. Vaccination is associated with efficacious protection against COVID-19 infection and could boost infection-acquired immunity; however, various COVID-19 survivors have not been vaccinated due to vaccine hesitancy. Objective: The aim of this study was to investigate COVID-19 vaccine hesitancy and related factors among COVID-19 survivors. Methods: A cross-sectional questionnaire survey was conducted among patients who recovered from COVID-19 infection in Wuhan, China, between June 10 and July 25, 2021. The questionnaire included sociodemographic information, items on COVID-19 infection, the COVID-19 vaccine hesitancy scale based on the 3Cs (complacency, convenience, and confidence) model, trust in vaccine manufacturers and health facilities, and reasons for the decision to accept COVID-19 vaccination. Multivariate logistic regression analysis was used to assess the factors influencing COVID-19 vaccine hesitancy. Results: Among the 1422 participants, 538 (37.8\%) were not vaccinated against COVID-19. The COVID-19--recovered patients who self-reported having a current unhealthy status expressed more hesitancy about the COVID-19 vaccine than those who perceived themselves to be healthy (odds ratio [OR] 0.45, 95\% CI 0.28-0.71). Compared to the asymptomatic patients, patients with mild symptoms were more likely to receive a COVID-19 vaccine (OR 1.67, 95\% CI 1.02-2.82). Regarding the 3Cs model, high complacency (P=.005) and low convenience (P=.004) were significant negative factors for COVID-19 vaccination. Trust in vaccine manufacturers and health facilities was a significant positive factor for COVID-19 vaccination (OR 1.14, 95\% CI 1.09-1.19). ``Self-needs'' was the main reason for patients to receive the COVID-19 vaccine, whereas ``already have antibodies and do not need vaccination'' was the main reason for patients to not receive the COVID-19 vaccine. Conclusions: Among the three major factors of vaccine hesitancy, complacency proved to be the most notable among COVID-19--recovered patients. Therefore, educational campaigns can focus on raising the awareness of risk of infection and the benefits of vaccination to reduce complacency toward vaccination among this population. In particular, for individuals who have recovered from COVID-19, improving factors related to convenience such as transportation, the environment of vaccination, and providing door-to-door service was also deemed necessary to facilitate their vaccination. In addition, addressing the concerns about vaccination of COVID-19--recovered patients could foster trust and promote their uptake of vaccination. ",
doi="10.2196/42958",
url="https://publichealth.jmir.org/2023/1/e42958",
url="http://www.ncbi.nlm.nih.gov/pubmed/37247615"
}


@Article{info:doi/10.2196/45600,
author="Ar{\'e}valo-Baeza, Marta
and Viuda-Serrano, Alejandro
and Juan-Llamas, Carmen
and Sotoca-Orgaz, Pablo
and As{\'i}n-Izquierdo, Iv{\'a}n",
title="Impact of a Serious Game (\#RedPing{\"u}iNO) to Reduce Facial Self-Touches and Prevent Exposure to Pathogens Transmitted via Hands: Quasi-Experimental Intervention",
journal="JMIR Serious Games",
year="2023",
month="Jun",
day="30",
volume="11",
pages="e45600",
keywords="self-touching",
keywords="face",
keywords="serious game",
keywords="health",
keywords="pathogen transmission",
keywords="hazard scenarios",
keywords="body language",
abstract="Background: After the COVID-19 pandemic, society has become more aware of the importance of some basic hygienic habits to avoid exposure to pathogens transmitted via hands. Given that a high frequency of touching mucous membranes can lead to a high risk of infection, it is essential to establish strategies to reduce this behavior as a preventive measure against contagion. This risk can be extrapolated to a multitude of health scenarios and transmission of many infectious diseases. \#RedPing{\"u}iNO was designed as an intervention to prevent the transmission of SARS-CoV-2 and other pathogens through the reduction of facial self-touches by thoughtfully engaging participants in a serious game. Objective: Facial self-touches should be understood as behaviors of limited control and awareness, used to regulate situations of cognitive and emotional demands, or as part of nonverbal communication. The objective of this study was to ensure that participants become aware of and reduce these behaviors through a game of self-perception. Methods: The quasi-experimental intervention was applied to 103 healthy university students selected by convenience sampling and put into practice for 2 weeks, with 1 control group (n=24, 23.3\%) and 2 experimental groups (experimental group with no additional social reinforcement interventions: n=36, 35\%; experimental group with additional social reinforcement interventions: n=43, 41.7\%). The objective was to improve knowledge and perception and reduce facial self-touches to prevent exposure to pathogens transmitted via hands not only in health multihazard scenarios but also in ordinary circumstances. The ad hoc instrument used to analyze the experience consisted of 43 items and was valid and reliable for the purpose of this study. The items were divided into 5 blocks extracted from the theoretical framework: sociological issues (1-5); hygiene habits (6-13); risk awareness (14-19); strategies for not touching the face (20-26); and questions after the intervention (27-42), designed as a postintervention tool assessing the game experience. Validation of the content was achieved through assessment by 12 expert referees. External validation was performed using a test-retest procedure, and reliability was verified using the Spearman correlation. Results: The results of the ad hoc questionnaire, which were analyzed using the Wilcoxon signed-rank test and McNemar index to identify significant differences between test and retest for a 95\% CI, showed that facial self-touches were reduced (item 20, P<.001; item 26, P=.04), and awareness of this spontaneous behavior and its triggers increased (item 15; P=.007). The results were reinforced by qualitative findings from the daily logs. Conclusions: The intervention exhibited a greater effect from sharing the game, with interactions between people; however, in both cases, it was helpful in reducing facial self-touches. In summary, this game is suitable for reducing facial self-touches, and owing to its free availability and design, it can be adapted to various contexts. ",
doi="10.2196/45600",
url="https://games.jmir.org/2023/1/e45600",
url="http://www.ncbi.nlm.nih.gov/pubmed/37389910"
}


@Article{info:doi/10.2196/40441,
author="Bonner, Carissa
and Batcup, Carys
and Cvejic, Erin
and Ayre, Julie
and Pickles, Kristen
and Copp, Tessa
and Cornell, Samuel
and Nickel, Brooke
and Dhahir, Mustafa
and McCaffery, Kirsten",
title="Addressing Behavioral Barriers to COVID-19 Testing With Health Literacy--Sensitive eHealth Interventions: Results From 2 National Surveys and 2 Randomized Experiments",
journal="JMIR Public Health Surveill",
year="2023",
month="Jun",
day="29",
volume="9",
pages="e40441",
keywords="behavior change",
keywords="health literacy",
keywords="COVID-19",
keywords="testing",
keywords="infectious disease",
keywords="public health",
abstract="Background: Polymerase chain reaction (PCR) testing for COVID-19 was crucial in Australia's prevention strategy in the first 2 years of the pandemic, including required testing for symptoms, contact with cases, travel, and certain professions. However, several months into the pandemic, half of Australians were still not getting tested for respiratory symptoms, and little was known about the drivers of and barriers to COVID-19 PCR testing as a novel behavior at that time. Objective: We aimed to identify and address COVID-19 testing barriers, and test the effectiveness of multiple eHealth interventions on knowledge for people with varying health literacy levels. Methods: The intervention was developed in 4 phases. Phase 1 was a national survey conducted in June 2020 (n=1369), in which testing barriers were coded using the capability-opportunity-motivation-behavior framework. Phase 2 was a national survey conducted in November 2020 (n=2034) to estimate the prevalence of testing barriers and health literacy disparities. Phase 3 was a randomized experiment testing health literacy--sensitive written information for a wide range of barriers between February and March 2021 (n=1314), in which participants chose their top 3 barriers to testing to view a tailored intervention. Phase 4 was a randomized experiment testing 2 audio-visual interventions addressing common testing barriers for people with lower health literacy in November 2021, targeting young adults as a key group endorsing misinformation (n=1527). Results: In phase 1, barriers were identified in all 3 categories: capability (eg, understanding which symptoms to test for), opportunity (eg, not being able to access a PCR test), and motivation (eg, not believing the symptoms are those of COVID-19). Phase 2 identified knowledge gaps for people with lower versus higher health literacy. Phase 3 found no differences between the intervention (health literacy--sensitive text for top 3 barriers) and control groups. Phase 4 showed that a fact-based animation or a TikTok-style video presenting the same facts in a humorous style increased knowledge about COVID-19 testing compared with government information. However, no differences were found for COVID-19 testing intentions. Conclusions: This study identified a wide range of barriers to a novel testing behavior, PCR testing for COVID-19. These barriers were prevalent even in a health system where COVID-19 testing was free and widely available. We showed that key capability barriers, such as knowledge gaps, can be improved with simple videos targeting people with lower health literacy. Additional behavior change strategies are required to address motivational issues to support testing uptake. Future research will explore health literacy strategies in the current context of self-administered rapid antigen tests. The findings may inform planning for future COVID-19 variant outbreaks and new public health emergencies where novel testing behaviors are required. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12621000876897, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=382318?; Australian New Zealand Clinical Trials Registry ACTRN12620001355965, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380916\&isReview=true ",
doi="10.2196/40441",
url="https://publichealth.jmir.org/2023/1/e40441",
url="http://www.ncbi.nlm.nih.gov/pubmed/37172319"
}


@Article{info:doi/10.2196/42678,
author="Amicosante, Vincenza Anna Maria
and Rosso, Annalisa
and Bernardini, Fabio
and Guglielmi, Elisa
and Eugeni, Erica
and Da Re, Filippo
and Baglio, Giovanni",
title="COVID-19 Contact Tracing Strategies During the First Wave of the Pandemic: Systematic Review of Published Studies",
journal="JMIR Public Health Surveill",
year="2023",
month="Jun",
day="23",
volume="9",
pages="e42678",
keywords="COVID-19",
keywords="SARS-CoV-2",
keywords="contact tracing",
keywords="public health",
keywords="infectious disease",
keywords="disease control",
keywords="community engagement",
keywords="digital tool",
abstract="Background: Contact tracing (CT) represented one of the core activities for the prevention and control of COVID-19 in the early phase of the pandemic. Several guidance documents were developed by international public health agencies and national authorities on the organization of COVID-19 CT activities. While most research on CT focused on the use digital tools or relied on modelling techniques to estimate the efficacy of interventions, poor evidence is available on the real-world implementation of CT strategies and on the organizational models adopted during the initial phase of the emergency to set up CT activities. Objective: We aimed to provide a comprehensive picture of the organizational aspects of CT activities during the first wave of the pandemic through the systematic identification and description of CT strategies used in different settings during the period from March to June 2020. Methods: A systematic review of published studies describing organizational models of COVID-19 CT strategies developed in real-world settings was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. PubMed, Embase, and Cochrane Library were searched. Studies not providing a description of the organizational aspects of CT strategies and studies reporting or modelling theoretical strategies or focusing on the description of digital technologies' properties were excluded. Quality of reporting was assessed by using the Template for Intervention Description and Replication Checklist for Population Health and Policy. We developed a narrative synthesis, using a conceptual framework to map the extracted studies broken down by target population. Results: We retrieved a total of 1638 studies, of which 17 were included in the narrative synthesis; 7 studies targeted the general population and 10 studies described CT activities carried out in specific population subgroups. Our review identified some common elements across studies used to develop CT activities, including decentralization of CT activities, involvement of trained nonpublic health resources (eg, university students or civil servants), use of informatics tools for CT management, interagency collaboration, and community engagement. CT strategies implemented in the workplace envisaged a strong collaboration with occupational health services. Outreach activities were shown to increase CT efficiency in susceptible groups, such as people experiencing homelessness. Data on the effectiveness of CT strategies are scarce, with only few studies reporting on key performance indicators. Conclusions: Despite the lack of systematically collected data on CT effectiveness, our findings can provide some indication for the future planning and development of CT strategies for infectious disease control, mainly in terms of coordination mechanisms and the use of human and technical resources needed for the rapid development of CT activities. Further research on the organizational models of CT strategies during the COVID-19 pandemic would be required to contribute to a more robust evidence-making process. ",
doi="10.2196/42678",
url="https://publichealth.jmir.org/2023/1/e42678",
url="http://www.ncbi.nlm.nih.gov/pubmed/37351939"
}


@Article{info:doi/10.2196/43672,
author="Montiel Ishino, Alejandro Francisco
and Villalobos, Kevin
and Williams, Faustine",
title="COVID-19 Vaccination Among US-Born and Non--US-Born Residents of the United States From a Nationally Distributed Survey: Cross-sectional Study",
journal="JMIR Form Res",
year="2023",
month="Jun",
day="20",
volume="7",
pages="e43672",
keywords="COVID-19",
keywords="vaccination",
keywords="nativity",
keywords="health disparity",
keywords="survey",
keywords="sociodemographics",
keywords="socioeconomics",
keywords="pandemic",
keywords="vaccine",
keywords="US",
keywords="USA",
keywords="United States",
keywords="birth",
keywords="country",
abstract="Background: Extended literature has demonstrated that COVID-19 vaccination is crucial for the health of all individuals, regardless of age. Research on vaccination status in the United States (US) among US-born and non--US-born residents is limited. Objective: The objective of our study was to examine COVID-19 vaccination during the pandemic among US-born and non--US-born people, while accounting for sociodemographic and socioeconomic factors gathered through a nationally distributed survey. Methods: A descriptive analysis was conducted on a comprehensive 116-item survey distributed between May 2021 and January 2022 across the US by self-reported COVID-19 vaccination and US/non-US birth status. For participants that responded that they were not vaccinated, we asked if they were ``not at all likely,'' ``slightly to moderately likely,'' or ``very to extremely likely'' to be vaccinated. Race and ethnicity were categorized as White, Black or African American, Asian, American Indian or Alaskan Native, Hawaiian or Pacific Islander, African, Middle Eastern, and multiracial or multiethnic. Additional sociodemographic and socioeconomic variables included gender, sexual orientation, age group, annual household income, educational attainment, and employment status. Results: The majority of the sample, regardless of whether they were US-born or non--US-born, reported being vaccinated (3639/5404, 67.34\%). The US-born participants with the highest proportion of COVID-19 vaccination self-identified as White (1431/2753, 51.98\%), while the highest proportion of vaccination among non--US-born participants was found among participants who self-identified as Hispanic/Latino (310/886, 34.99\%). Comparing US-born and non--US-born participants showed that among those who were not vaccinated, the highest self-reported sociodemographic characteristics by proportion were similar between the groups, and included identifying as a woman, being straight or heterosexual, being aged 18 to 35 years, having an annual household income <\$25,000, and being unemployed or taking part in nontraditional work. Among the 32.66\% (1765/5404) of participants that reported not being vaccinated, 45.16\% (797/1765) stated that they were not at all likely to seek vaccination. Examining US/non--US birth status and the likelihood to be vaccinated for COVID-19 among nonvaccinated participants revealed that the highest proportions of both US-born and non--US-born participants reported being not at all likely to seek vaccination. Non--US-born participants, however, were almost proportionally distributed in their likelihood to seek vaccination; they reported to be ``very to extremely likely'' to vaccinate (112/356, 31.46\%); compared to 19.45\% (274/1409) of US-born individuals reporting the same. Conclusions: Our study highlights the need to further explore factors that can increase the likelihood of seeking vaccination among underrepresented and hard-to-reach populations, with a particular focus on tailoring interventions for US-born individuals. For instance, non--US-born individuals were most likely to vaccinate when reporting COVID-19 nonvaccination than US-born individuals. These findings will aid in identifying points of intervention for vaccine hesitancy and promoting vaccine adoption during current and future pandemics. ",
doi="10.2196/43672",
url="https://formative.jmir.org/2023/1/e43672",
url="http://www.ncbi.nlm.nih.gov/pubmed/37097810"
}


@Article{info:doi/10.2196/43344,
author="Arguni, Eggi
and Chamida, Murni Fatia
and Indrawanti, Ratni
and Rusmawatiningtyas, Desy
and Dewi, Puspa Yunika
and Laksanawati, Safitri Ida",
title="The Kinetics of Anti--SARS-CoV-2 Antibodies in Pediatric Patients and the Characterization of Post--COVID-19 Condition at 6 Months After Infection: Protocol for a Longitudinal Observational Study",
journal="JMIR Res Protoc",
year="2023",
month="Jun",
day="6",
volume="12",
pages="e43344",
keywords="kinetics",
keywords="anti--SARS-CoV-2 antibodies",
keywords="post--COVID-19 condition",
keywords="long COVID",
keywords="pediatric patient",
keywords="antibodies",
keywords="COVID-19",
abstract="Background: Data regarding the kinetics of anti--SARS-CoV-2 antibodies and information about post--COVID-19 condition (colloquially known as ``long COVID'') in children are scarce, especially in low-income countries. Even though cases of COVID-19 in children are less prevalent than adults, post--COVID-19 condition cases in children are high and have a burden that may impact their growth and development. There are other features of antibody kinetics in connection with SARS-CoV-2 infection that are yet unknown as of this writing, especially in children following infection. Furthermore, the long-term results, risk factors, and underlying pathophysiology are still uncertain. To better understand post--COVID-19 condition in children, it is necessary to further investigate the impact of clinically significant factors such multisystem inflammatory syndrome and disease severity among hospitalized survivors through their SARS-CoV-2 antibody response. Objective: We aim to analyze anti--receptor-binding domain SARS-CoV-2 immunoglobulin G antibodies over time and characterize the signs and symptoms of post--COVID-19 condition in pediatric patients at the time of diagnosis and at 2 weeks and 1, 3, and 6 months following infection. Methods: This is a longitudinal observational study in Indonesia. Pediatric patients diagnosed with COVID-19 by positive molecular assay using nasopharyngeal swab will be tested for anti--SARS-CoV-2 antibodies using the Roche Elecsys Anti-SARS-CoV-2 S assay at the time of diagnosis and at 2 weeks and 1, 3, and 6 months following infection. Antibody titer data will be reported as means and SDs. The respondents' signs and symptoms will be observed up to 6 months after the onset of infection, including the vaccination event, reinfection, rehospitalization, and mortality. The clinical features will be reported as frequencies and percentages. Results: Participant enrollment began in February 2022. As of September 30, 2022, a total of 58 patients were enrolled. After data collection, results are expected to be analyzed in August 2023. Conclusions: This study will allow us to know the kinetics of anti--receptor-binding domain SARS-CoV-2 immunoglobulin G antibodies and data regarding post--COVID-19 condition up to 6 months following infection in the Indonesian pediatric population. Furthermore, this study has the potential to serve as a foundation for government decisions about vaccination programs and prevention measures. International Registered Report Identifier (IRRID): DERR1-10.2196/43344 ",
doi="10.2196/43344",
url="https://www.researchprotocols.org/2023/1/e43344",
url="http://www.ncbi.nlm.nih.gov/pubmed/37246961"
}


@Article{info:doi/10.2196/47079,
author="M{\'a}rquez, Gallego Nuria
and Jamal, Armaan
and Johnston, Rowena
and Richter, India E.
and Gorbach, M. Pamina
and Vannorsdall, D. Tracy
and Rubin, H. Leah
and Jennings, Cheryl
and Landay, L. Alan
and Peluso, J. Michael
and Antar, R. Annukka A.",
title="Characterizing Symptoms and Identifying Biomarkers of Long COVID in People With and Without HIV: Protocol for a Remotely Conducted Prospective Observational Cohort Study",
journal="JMIR Res Protoc",
year="2023",
month="May",
day="31",
volume="12",
pages="e47079",
keywords="HIV",
keywords="SARS-CoV-2",
keywords="COVID-19",
keywords="long COVID",
keywords="post--acute COVID-19 syndrome",
keywords="postacute sequelae of SARS-CoV-2 infection",
keywords="prospective observational cohort study",
keywords="remote study",
keywords="remote participation",
abstract="Background: Living with HIV is a risk factor for severe acute COVID-19, but it is unknown whether it is a risk factor for long COVID. Objective: This study aims to characterize symptoms, sequelae, and cognition formally and prospectively 12 months following SARS-CoV-2 infection in people living with HIV compared with people without HIV. People with no history of SARS-CoV-2 infection, both with and without HIV, are enrolled as controls. The study also aims to identify blood-based biomarkers or patterns of immune dysregulation associated with long COVID. Methods: This prospective observational cohort study enrolled participants into 1 of the following 4 study arms: people living with HIV who had SARS-CoV-2 infection for the first time <4 weeks before enrollment (HIV+COVID+ arm), people without HIV who had SARS-CoV-2 infection for the first time within 4 weeks of enrollment (HIV?COVID+ arm), people living with HIV who believed they never had SARS-CoV-2 infection (HIV+COVID? arm), and people without HIV who believed they never had SARS-CoV-2 infection (HIV?COVID? arm). At enrollment, participants in the COVID+ arms recalled their symptoms, mental health status, and quality of life in the month before having SARS-CoV-2 infection via a comprehensive survey administered by telephone or on the web. All participants completed the same comprehensive survey 1, 2, 4, 6, and 12 months after post--acute COVID-19 symptom onset or diagnosis, if asymptomatic, (COVID+ arms) or after enrollment (COVID? arms) on the web or by telephone. In total, 11 cognitive assessments were administered by telephone at 1 and 4 months after symptom onset (COVID+ arms) or after enrollment (COVID? arms). A mobile phlebotomist met the participants at a location of their choice for height and weight measurements, orthostatic vital signs, and a blood draw. Participants in the COVID+ arms donated blood 1 and 4 months after COVID-19, and participants in the COVID? arms donated blood once or none. Blood was then shipped overnight to the receiving study laboratory, processed, and stored. Results: This project was funded in early 2021, and recruitment began in June 2021. Data analyses will be completed by summer 2023. As of February 2023, a total of 387 participants were enrolled in this study, with 345 participants having completed enrollment or baseline surveys together with at least one other completed study event. The 345 participants includes 76 (22\%) HIV+COVID+, 121 (35.1\%) HIV?COVID+, 78 (22.6\%) HIV+COVID?, and 70 (20.3\%) HIV?COVID? participants. Conclusions: This study will provide longitudinal data to characterize COVID-19 recovery over 12 months in people living with and without HIV. Additionally, this study will determine whether biomarkers or patterns of immune dsyregulation associate with decreased cognitive function or symptoms of long COVID. International Registered Report Identifier (IRRID): DERR1-10.2196/47079 ",
doi="10.2196/47079",
url="https://www.researchprotocols.org/2023/1/e47079",
url="http://www.ncbi.nlm.nih.gov/pubmed/37104709"
}


@Article{info:doi/10.2196/43308,
author="Niesen, Sydney
and Ramon, Daniel
and Spencer-Hwang, Rhonda
and Sinclair, Ryan",
title="The Relationship Between Face Mask Use and Face-Touching Frequency in Public Areas: Naturalistic Study",
journal="Interact J Med Res",
year="2023",
month="May",
day="29",
volume="12",
pages="e43308",
keywords="COVID-19",
keywords="mask wearing",
keywords="face-touching",
keywords="self-inoculation",
keywords="public health",
keywords="digital surveillance",
keywords="webcam video",
keywords="prevention",
keywords="health risk",
keywords="health",
keywords="risk",
keywords="mask",
keywords="surveillance",
keywords="transmission",
keywords="behavior",
abstract="Background: Throughout the COVID-19 pandemic in the United States, a major public health goal has been reducing the spread of the virus, with particular emphasis on reducing transmission from person to person. Frequent face touching can transmit viral particles from one infected person and subsequently infect others in a public area. This raises an important concern about the use of face masks and their relationship with face-touching behaviors. One concern discussed during the pandemic is that wearing a mask, and different types of masks, could increase face touching because there is a need to remove the mask to smoke, drink, eat, etc. To date, there have been few studies that have assessed this relationship between mask wearing and the frequency of face touching relative to face-touching behaviors. Objective: This study aimed to compare the frequency of face touching in people wearing a mask versus not wearing a mask in high--foot traffic urban outdoor areas. The purpose of this study was to assess if mask wearing was associated with increased face touching. Methods: Public webcam videos from 4 different cities in New York, New Jersey, Louisiana, and Florida were used to collect data. Face touches were recorded as pedestrians passed under the webcam. Adult pedestrians wearing masks were compared to those not wearing masks. Quantitative measures of frequency, duration, site of touch, and oral activities were recorded. Linear regression analysis was used to assess the association between mask use and face touching. Results: Of the 490 observed subjects, 241 (49.2\%) were wearing a mask properly and 249 (50.8\%) were not. In the unmasked group, 33.7\% (84/249) were wearing it improperly, covering the mouth only. Face touching occurred in 11.4\% (56/490) of the masked group and 17.6\% (88/490) in the unmasked group. Of those who touched their face, 61.1\% (88/144) of people were not wearing a mask. The most common site of face touching was the perioral region in both groups. Both the masked and unmasked group had a frequency of face touching for 0.03 touches/s. Oral activities such as eating or smoking increased face touching in the unmasked group. Conclusions: Contrary to expectations, non--mask-wearing subjects touched their face more frequently than those who were wearing a mask. This finding is substantial because wearing a face mask had a negative association with face touching. When wearing a mask, individuals are less likely to be spreading and ingesting viral particles. Therefore, wearing a mask is more effective in preventing the spread of viral particles. ",
doi="10.2196/43308",
url="https://www.i-jmr.org/2023/1/e43308",
url="http://www.ncbi.nlm.nih.gov/pubmed/37094229"
}


@Article{info:doi/10.2196/41365,
author="Addis Gesese, Abreha
and Duer Thot, Tut",
title="Face Mask Use and Associated Factors Among Students: Mixed Methods Study",
journal="Interact J Med Res",
year="2023",
month="May",
day="22",
volume="12",
pages="e41365",
keywords="face mask use",
keywords="associated factors",
keywords="COVID-19",
keywords="Gambella",
keywords="students",
keywords="Ethiopia",
abstract="Background: COVID-19 has gravely affected the world, including students, due to the high level of contracting infections. Objective: This study assessed the magnitude of mask use and associated factors among students. Methods: A cross-sectional study using mixed methods was conducted among students at Gambella Teachers' Education and Health Science College, Gambella Region, Southwest Ethiopia, from March 5 to March 30, 2021. The stratified random sampling technique was used. Proportional allocation of samples was used to randomly select case teams, and a simple random sampling technique was used to recruit the students. The data were collected by trained and experienced enumerators. Data were entered into EpiData (version 3.1; EpiData Association) and exported to SPSS (version 22; IBM Corp) for analysis. Logistic regression was executed. The adjusted odds ratio (AOR) with the 95\% CI was used to determine the association and strength with the outcome variable. The qualitative data were transcribed, translated, coded, and analyzed using thematic analysis. Then, the themes were used to triangulate the quantitative study. Results: The study included a total of 379 participants and yielded a response rate of 95.5\% (379/397). The majority of study participants were older than 25 years, with the mean age being 26.34 (SD 5.8) years. This study found that the magnitude of mask use among students was 87\% (330/379). The odds of mask use were higher among students who were female (AOR 3.32, 95\% CI 1.191-9.248), younger (AOR 2.55, 95\% CI 1.155-5.627), agreed that not all persons with COVID-19 develop severe disease (AOR 3.38, 95\% CI 1.36-8.41), agreed that there is currently no effective cure (AOR 6.28, 95\% CI 1.36-28.99), performed proper washing with soap and water (AOR 0.027, 95\% CI 0.004-0.182), had started to stay home (AOR 0.168, 95\% CI 0.054-0.52), agreed that COVID-19 is fatal (AOR 0.236, 95\% CI 0.084-0.666), agreed that a flu vaccine is sufficient for COVID-19 prevention (AOR 3.874, 95\% CI 1.540-9.749), and disinfected equipment and working areas at least once a day (AOR 0.222, 95\% CI 0.086-0.575). Conclusions: This study found that the magnitude of mask use among students was relatively moderate in Ethiopia. Sex, age, agreeing that not all persons with COVID-19 develop severe disease, agreeing that there is currently no effective cure, performing proper washing with soap and water, starting to stay home, agreeing that COVID-19 is fatal, and agreeing that the flu vaccine is sufficient to prevent COVID-19 were independently associated with mask use among students. Therefore, colleges should aggressively encourage students to wear masks and monitor the implementation of COVID-19 prevention regulations along with the accessibility of masks. ",
doi="10.2196/41365",
url="https://www.i-jmr.org/2023/1/e41365",
url="http://www.ncbi.nlm.nih.gov/pubmed/37130014"
}


@Article{info:doi/10.2196/44051,
author="Kawuki, Joseph
and Chan, Shing-fong Paul
and Fang, Yuan
and Chen, Siyu
and Mo, H. Phoenix K.
and Wang, Zixin",
title="Knowledge and Practice of Personal Protective Measures Against COVID-19 in Africa: Systematic Review",
journal="JMIR Public Health Surveill",
year="2023",
month="May",
day="16",
volume="9",
pages="e44051",
keywords="personal protective measures",
keywords="mask use",
keywords="social distancing",
keywords="hand hygiene",
keywords="COVID-19",
keywords="Africa",
keywords="nonpharmaceutical interventions",
abstract="Background: With COVID-19 being a newly evolving disease, its response measures largely depend on the practice of and compliance with personal protective measures (PPMs). Objective: This systematic review aimed to examine the knowledge and practice of COVID-19 PPMs in African countries as documented in the published literature. Methods: A systematic search was conducted on the Scopus, PubMed, and Web of Science databases using appropriate keywords and predefined eligibility criteria for the selection of relevant studies. Only population-based original research studies (including qualitative, quantitative, and mixed methods studies) conducted in Africa and published in the English language were included. The screening process and data extraction were performed according to a preregistered protocol in PROSPERO (CRD42022355101) and followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The quality of the included studies was assessed using the Mixed Methods Appraisal Tool. Thematic analysis was used to systematically summarize the studies into 4 predefined domains: knowledge and perception of PPMs, mask use, social and physical distancing, and handwashing and hand hygiene, including their respective levels and associated factors. Results: A total of 58 studies across 12 African countries were included, published between 2019 and 2022. African communities, including various population groups, had varying levels of knowledge and practice of COVID-19 PPMs, with the lack of personal protective equipment (mainly face masks) and side effects (among health care workers) being the major reasons for poor compliance. Lower rates of handwashing and hand hygiene were particularly noted in several African countries, especially among low-income urban and slum dwellers, with the main barrier being the lack of safe and clean water. Various cognitive (knowledge and perception), sociodemographic, and economic factors were associated with the practice of COVID-19 PPMs. Moreover, there were evident research inequalities at the regional level, with East Africa contributing 36\% (21/58) of the studies, West Africa contributing 21\% (12/58), North Africa contributing 17\% (10/58), Southern Africa contributing 7\% (4/58), and no single-country study from Central Africa. Nonetheless, the overall quality of the included studies was generally good as they satisfied most of the quality assessment criteria. Conclusions: There is a need to enhance local capacity to produce and supply personal protective equipment. Consideration of various cognitive, demographic, and socioeconomic differences, with extra focus on the most vulnerable, is crucial for inclusive and more effective strategies against the pandemic. Moreover, more focus and involvement in community behavioral research are needed to fully understand and address the dynamics of the current pandemic in Africa. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42022355101; https://www.crd.york.ac.uk/prospero/display\_record.php?ID=CRD42022355101 ",
doi="10.2196/44051",
url="https://publichealth.jmir.org/2023/1/e44051",
url="http://www.ncbi.nlm.nih.gov/pubmed/37058578"
}


@Article{info:doi/10.2196/42548,
author="Li, Rui
and Shen, Mingwang
and Liu, Hanting
and Bai, Lu
and Zhang, Lei",
title="Do Infrared Thermometers Hold Promise for an Effective Early Warning System for Emerging Respiratory Infectious Diseases?",
journal="JMIR Form Res",
year="2023",
month="May",
day="3",
volume="7",
pages="e42548",
keywords="respiratory infectious diseases",
keywords="early warning",
keywords="infrared thermometer",
keywords="theoretical framework",
keywords="economic burden",
keywords="outbreak prevention",
keywords="warning system",
keywords="community health",
keywords="infectious disease",
keywords="smartphone device",
keywords="digital health surveillance",
abstract="Background: Major respiratory infectious diseases, such as influenza, SARS-CoV, and SARS-CoV-2, have caused historic global pandemics with severe disease and economic burdens. Early warning and timely intervention are key to suppress such outbreaks. Objective: We propose a theoretical framework for a community-based early warning (EWS) system that will proactively detect temperature abnormalities in the community based on a collective network of infrared thermometer--enabled smartphone devices. Methods: We developed a framework for a community-based EWS and demonstrated its operation with a schematic flowchart. We emphasize the potential feasibility of the EWS and potential obstacles. Results: Overall, the framework uses advanced artificial intelligence (AI) technology on cloud computing platforms to identify the probability of an outbreak in a timely manner. It hinges on the detection of geospatial temperature abnormalities in the community based on mass data collection, cloud-based computing and analysis, decision-making, and feedback. The EWS may be feasible for implementation considering its public acceptance, technical practicality, and value for money. However, it is important that the proposed framework work in parallel or in combination with other early warning mechanisms due to a relatively long initial model training process. Conclusions: The framework, if implemented, may provide an important tool for important decisions for early prevention and control of respiratory diseases for health stakeholders. ",
doi="10.2196/42548",
url="https://formative.jmir.org/2023/1/e42548",
url="http://www.ncbi.nlm.nih.gov/pubmed/37133929"
}


@Article{info:doi/10.2196/39451,
author="Sfaelos, Konstantinos
and Kontodimas, Stathis
and Charisiadi, Theodora
and Chantzara, Nagia
and Pesiridis, George
and Tampouratzi, Eleftheria",
title="Patient Engagement With the Myderma Platform for Psoriasis During the COVID-19 Pandemic",
journal="JMIR Dermatol",
year="2023",
month="Apr",
day="19",
volume="6",
pages="e39451",
keywords="psoriasis",
keywords="social media",
keywords="online health-related information",
keywords="COVID-19",
keywords="disease awareness",
keywords="disease awareness website",
keywords="digital campaigns",
keywords="patient activation",
keywords="patient engagement",
keywords="COVID-19 pandemic",
doi="10.2196/39451",
url="https://derma.jmir.org/2023/1/e39451",
url="http://www.ncbi.nlm.nih.gov/pubmed/37124952"
}


@Article{info:doi/10.2196/41394,
author="Ishizuka-Inoue, Mami
and Shimoura, Kanako
and Nagai-Tanima, Momoko
and Aoyama, Tomoki",
title="The Relationship Between Health Literacy, Knowledge, Fear, and COVID-19 Prevention Behavior in Different Age Groups: Cross-sectional Web-Based Study",
journal="JMIR Form Res",
year="2023",
month="Apr",
day="17",
volume="7",
pages="e41394",
keywords="infodemic",
keywords="COVID-19",
keywords="health literacy",
keywords="fear of COVID-19",
keywords="cross-sectional study",
keywords="behavior",
keywords="age group",
keywords="misinformation",
keywords="influence",
keywords="prevention",
keywords="disease",
abstract="Background: COVID-19 prevention behaviors have become part of our lives, and they have been reported to be associated with health literacy, knowledge, and fear. However, the COVID-19 pandemic may be characterized by different situations in each age group. Since the severity of the infection and the means of accessing information differ by age group, the relationship between health literacy, knowledge, and fear may differ. Thus, factors that promote preventive behavior may differ by age group. Clarifying the factors related to prevention behaviors by age may help us consider age-appropriate promotion. Objective: This study aims to examine the association between COVID-19 prevention behaviors and health literacy, COVID-19 knowledge, and fear of COVID-19 by age group. Methods: A cross-sectional study was conducted among 512 participants aged 20-69 years, recruited from a web-based sample from November 1 to November 5, 2021. A web-based self-administered questionnaire was used to obtain the participants' characteristics, COVID-19 prevention behaviors, health literacy, COVID-19 knowledge, and fear of COVID-19. The Kruskal-Wallis rank sum test was used to compare the scores of each item for each age group. The relationships among COVID-19 prevention behaviors, health literacy, COVID-19 knowledge, and fear of COVID-19 were analyzed using the Spearman rank correlation analysis. Additionally, multiple regression analysis was conducted with COVID-19 prevention behaviors as dependent variables; health literacy, COVID-19 knowledge, and fear of COVID-19 as independent variables; and sex and age as adjustment variables. Results: For all participants, correlation and multiple regression analyses revealed that prevention behaviors were significantly related to health literacy, COVID-19 knowledge, and fear of COVID-19 (P<.001). Additionally, correlation analysis revealed that fear of COVID-19 was significantly negatively correlated with COVID-19 knowledge (P<.001). There was also a significant positive correlation between health literacy and COVID-19 knowledge (P<.001). Furthermore, analysis by age revealed that the factors associated with prevention behaviors differed by age group. In the age groups 20-29, 30-39, and 40-49 years, multiple factors, including health literacy, influenced COVID-19 prevention behaviors, whereas in the age groups 50-59 and 60-69 years, only fear of COVID-19 had an impact. Conclusions: The results of this study revealed that the factors associated with prevention behaviors differ by age. Age-specific approaches should be considered to prevent infection. ",
doi="10.2196/41394",
url="https://formative.jmir.org/2023/1/e41394",
url="http://www.ncbi.nlm.nih.gov/pubmed/37011226"
}


@Article{info:doi/10.2196/43061,
author="Kunkel, Amber
and Veytsel, Gabriella
and Bonaparte, Sarah
and Meek, Haillie
and Ma, Xiaoyue
and Davis, J. Amy
and Bonwitt, Jesse
and Wallace, M. Ryan",
title="Defining County-Level Terrestrial Rabies Freedom Using the US National Rabies Surveillance System: Surveillance Data Analysis",
journal="JMIR Public Health Surveill",
year="2023",
month="Apr",
day="7",
volume="9",
pages="e43061",
keywords="rabies",
keywords="surveillance",
keywords="zoonoses",
keywords="zoonosis",
keywords="model",
keywords="disease spread",
keywords="infection spread",
keywords="animal",
keywords="predict",
keywords="public health",
abstract="Background: Rabies is a deadly zoonotic disease with nearly 100\% fatality rate. In the United States, rabies virus persists in wildlife reservoirs, with occasional spillover into humans and domestic animals. The distribution of reservoir hosts in US counties plays an important role in public health decision-making, including the recommendation of lifesaving postexposure prophylaxis upon suspected rabies exposures. Furthermore, in surveillance data, it is difficult to discern whether counties have no cases reported because rabies was not present or because counties have an unreported rabies presence. These epizootics are monitored by the National Rabies Surveillance System (NRSS), to which approximately 130 state public health, agriculture, and academic laboratories report animal rabies testing statistics. Historically, the NRSS classifies US counties as free from terrestrial rabies if, over the previous 5 years, they and any adjacent counties did not report any rabies cases and they tested ?15 reservoir animals or 30 domestic animals. Objective: This study aimed to describe and evaluate the historical NRSS rabies-free county definition, review possibilities for improving this definition, and develop a model to achieve more precise estimates of the probability of terrestrial rabies freedom and the number of reported county-level terrestrial rabies cases. Methods: Data submitted to the NRSS by state and territorial public health departments and the US Department of Agriculture Wildlife Services were analyzed to evaluate the historical rabies-free definition. A zero-inflated negative binomial model created county-level predictions of the probability of rabies freedom and the expected number of rabies cases reported. Data analyzed were from all animals submitted for laboratory diagnosis of rabies in the United States from 1995 to 2020 in skunk and raccoon reservoir territories, excluding bats and bat variants. Results: We analyzed data from 14,642 and 30,120 county-years in the raccoon and skunk reservoir territories, respectively. Only 0.85\% (9/1065) raccoon county-years and 0.79\% (27/3411) skunk county-years that met the historical rabies-free criteria reported a case in the following year (99.2\% negative predictive value for each), of which 2 were attributed to unreported bat variants. County-level model predictions displayed excellent discrimination for detecting zero cases and good estimates of reported cases in the following year. Counties classified as rabies free rarely (36/4476, 0.8\%) detected cases in the following year. Conclusions: This study concludes that the historical rabies freedom definition is a reasonable approach for identifying counties that are truly free from terrestrial raccoon and skunk rabies virus transmission. Gradations of risk can be measured using the rabies prediction model presented in this study. However, even counties with a high probability of rabies freedom should maintain rabies testing capacity, as there are numerous examples of translocations of rabies-infected animals that can cause major changes in the epidemiology of rabies. ",
doi="10.2196/43061",
url="https://publichealth.jmir.org/2023/1/e43061",
url="http://www.ncbi.nlm.nih.gov/pubmed/37027194"
}


@Article{info:doi/10.2196/43836,
author="Marques-Cruz, Manuel
and Nogueira-Leite, Diogo
and Alves, Miguel Jo{\~a}o
and Fernandes, Francisco
and Fernandes, Miguel Jos{\'e}
and Almeida, {\^A}ngelo Miguel
and Cunha Correia, Patr{\'i}cia
and Perestrelo, Paula
and Cruz-Correia, Ricardo
and Pita Barros, Pedro",
title="COVID-19 Contact Tracing as an Indicator for Evaluating a Pandemic Situation: Simulation Study",
journal="JMIR Public Health Surveill",
year="2023",
month="Apr",
day="6",
volume="9",
pages="e43836",
keywords="COVID-19",
keywords="public health",
keywords="public health surveillance",
keywords="quarantine",
keywords="infection transmission",
keywords="epidemiological models",
abstract="Background: Contact tracing is a fundamental intervention in public health. When systematically applied, it enables the breaking of chains of transmission, which is important for controlling COVID-19 transmission. In theoretically perfect contact tracing, all new cases should occur among quarantined individuals, and an epidemic should vanish. However, the availability of resources influences the capacity to perform contact tracing. Therefore, it is necessary to estimate its effectiveness threshold. We propose that this effectiveness threshold may be indirectly estimated using the ratio of COVID-19 cases arising from quarantined high-risk contacts, where higher ratios indicate better control and, under a threshold, contact tracing may fail and other restrictions become necessary. Objective: This study assessed the ratio of COVID-19 cases in high-risk contacts quarantined through contact tracing and its potential use as an ancillary pandemic control indicator. Methods: We built a 6-compartment epidemiological model to emulate COVID-19 infection flow according to publicly available data from Portuguese authorities. Our model extended the usual susceptible-exposed-infected-recovered model by adding a compartment Q with individuals in mandated quarantine who could develop infection or return to the susceptible pool and a compartment P with individuals protected from infection because of vaccination. To model infection dynamics, data on SARS-CoV-2 infection risk (IR), time until infection, and vaccine efficacy were collected. Estimation was needed for vaccine data to reflect the timing of inoculation and booster efficacy. In total, 2 simulations were built: one adjusting for the presence and absence of variants or vaccination and another maximizing IR in quarantined individuals. Both simulations were based on a set of 100 unique parameterizations. The daily ratio of infected cases arising from high-risk contacts (q estimate) was calculated. A theoretical effectiveness threshold of contact tracing was defined for 14-day average q estimates based on the classification of COVID-19 daily cases according to the pandemic phases and was compared with the timing of population lockdowns in Portugal. A sensitivity analysis was performed to understand the relationship between different parameter values and the threshold obtained. Results: An inverse relationship was found between the q estimate and daily cases in both simulations (correlations >0.70). The theoretical effectiveness thresholds for both simulations attained an alert phase positive predictive value of >70\% and could have anticipated the need for additional measures in at least 4 days for the second and fourth lockdowns. Sensitivity analysis showed that only the IR and booster dose efficacy at inoculation significantly affected the q estimates. Conclusions: We demonstrated the impact of applying an effectiveness threshold for contact tracing on decision-making. Although only theoretical thresholds could be provided, their relationship with the number of confirmed cases and the prediction of pandemic phases shows the role as an indirect indicator of the efficacy of contact tracing. ",
doi="10.2196/43836",
url="https://publichealth.jmir.org/2023/1/e43836",
url="http://www.ncbi.nlm.nih.gov/pubmed/36877958"
}


@Article{info:doi/10.2196/40587,
author="Asim, Saba
and Wang, Kailu
and Nichini, Elena
and Yip, Fu Faustina
and Zhu, Liling
and Fung, Eddy Hin Chung
and Zeng, Yan
and Fang, Zhilan
and Cheung, Wai-Ling Annie
and Wong, Lai-yi Eliza
and Dong, Dong
and Yeoh, Eng-Kiong",
title="COVID-19 Vaccination Preferences Among Non-Chinese Migrants in Hong Kong: Discrete Choice Experiment",
journal="JMIR Public Health Surveill",
year="2023",
month="Mar",
day="27",
volume="9",
pages="e40587",
keywords="COVID-19 vaccination",
keywords="migrants",
keywords="discrete choice experiment",
keywords="ethnic minorities",
keywords="vaccine attributes",
keywords="Hong Kong",
keywords="COVID-19",
abstract="Background: Studies have shown increasing COVID-19 vaccination hesitancy among migrant populations in certain settings compared to the general population. Hong Kong has a growing migrant population with diverse ethnic backgrounds. Apart from individual-level factors, little is known about the migrants' preference related to COVID-19 vaccines. Objective: This study aims to investigate which COVID-19 vaccine--related attributes combined with individual factors may lead to vaccine acceptance or refusal among the migrant population in Hong Kong. Methods: An online discrete choice experiment (DCE) was conducted among adults, including Chinese people, non-Chinese Asian migrants (South, Southeast and Northeast Asians), and non-Asian migrants (Europeans, Americans, and Africans) in Hong Kong from February 26 to April 26, 2021. The participants were recruited using quota sampling and sent a link to a web survey. The vaccination attributes included in 8 choice sets in each of the 4 blocks were vaccine brand, safety and efficacy, vaccine uptake by people around, professionals' recommendation, vaccination venue, and quarantine exemption for vaccinated travelers. A nested logistic model (NLM) and a latent-class logit (LCL) model were used for statistical analysis. Results: A total of 208 (response rate 62.1\%) migrant participants were included. Among the migrants, those with longer local residential years (n=31, 27.7\%, for ?10 years, n=7, 20.6\%, for 7-9 years, n=2, 6.7\%, for 4-6 years, and n=3, 9.7\%, for ?3 years; P=.03), lower education level (n=28, 28.3\%, vs n=15, 13.9\%, P=.01), and lower income (n=33, 25.2\%, vs n=10, 13.2\%, P=.04) were more likely to refuse COVID-19 vaccination irrespective of vaccination attributes. The BioNTech vaccine compared with Sinovac (adjusted odds ratio  [AOR]=1.75, 95\% CI 1.14-2.68), vaccine with 90\% (AOR=1.44, 95\% CI 1.09-1.91) and 70\% efficacy (AOR=1.21, 95\% CI 1.03-1.44) compared with 50\% efficacy, vaccine with fewer serious adverse events (1/100,000 compared with 1/10,000; AOR=1.12, 95\% CI 1.00-1.24), and quarantine exemption for cross-border travelers (AOR=1.14, 95\% CI 1.01-1.30) were the vaccine attributes that could increase the likelihood of vaccination among migrants. For individual-level factors, full-time homemakers (AOR=0.44, 95\% CI 0.29-0.66), those with chronic conditions (AOR=0.61, 95\% CI 0.41-0.91) and more children, and those who frequently received vaccine-related information from the workplace (AOR=0.42, 95\% CI 0.31-0.57) were found to be reluctant to accept the vaccine. Those with a higher income (AOR=1.79, 95\% CI 1.26-2.52), those knowing anyone infected with COVID-19 (AOR=1.73, 95\% CI 1.25-2.38), those having greater perceived susceptibility of COVID-19 infection (AOR=3.42, 95\% CI 2.52-4.64), those who received the influenza vaccine (AOR=2.15, 95\% CI 1.45-3.19), and those who frequently received information from social media (AOR=1.52, 95\% CI 1.12-2.05) were more likely to accept the vaccine. Conclusions: This study implies that migrants have COVID-19 vaccination preference heterogeneity and that more targeted and tailored approaches are needed to promote vaccine acceptance for different subgroups of the migrant population in Hong Kong. Vaccination promotion strategies are needed for low-education and low-income migrant groups, migrants with chronic diseases, the working migrant population, homemakers, and parents. ",
doi="10.2196/40587",
url="https://publichealth.jmir.org/2023/1/e40587",
url="http://www.ncbi.nlm.nih.gov/pubmed/36848242"
}


@Article{info:doi/10.2196/37527,
author="Liu, W. Jenny J.
and Lum, Andrea P.
and Foxcroft, Laura
and Lim, Rod
and Richardson, Don J.",
title="Faculty-Wide Peer-Support Program During the COVID-19 Pandemic: Design and Preliminary Results",
journal="JMIR Form Res",
year="2023",
month="Mar",
day="2",
volume="7",
pages="e37527",
keywords="physician",
keywords="doctor",
keywords="medical professional",
keywords="health care professional",
keywords="peer support",
keywords="burnout",
keywords="mental distress",
keywords="stress",
keywords="work",
keywords="job",
keywords="peer leadership",
keywords="mental health",
keywords="occupational health",
keywords="COVID-19",
abstract="Background: Physicians experience higher rates of burnout relative to the general population. Concerns of confidentiality, stigma, and professional identities as health care providers act as barriers to seeking and receiving appropriate support. In the context of the COVID-19 pandemic, factors that contribute to burnout and barriers to seeking support have been amplified, elevating the overall risks of mental distress and burnout for physicians. Objective: This paper aimed to describe the rapid development and implementation of a peer support program within a health care organization located in London, Ontario, Canada. Methods: A peer support program leveraging existing infrastructures within the health care organization was developed and launched in April 2020. The ``Peers for Peers'' program drew from the work of Shapiro and Galowitz in identifying key components within hospital settings that contributed to burnout. The program design was derived from a combination of the peer support frameworks from the Airline Pilot Assistance Program and the Canadian Patient Safety Institute. Results: Data gathered over 2 waves of peer leadership training and program evaluations highlighted a diversity of topics covered through the peer support program. Further, enrollment continued to increase in size and scope over the 2 waves of program deployments into 2023. Conclusions: Findings suggest that the peer support program is acceptable to physicians and can be easily and feasibly implemented within a health care organization. The structured program development and implementation can be adopted by other organizations in support of emerging needs and challenges. ",
doi="10.2196/37527",
url="https://formative.jmir.org/2023/1/e37527",
url="http://www.ncbi.nlm.nih.gov/pubmed/36862464"
}


@Article{info:doi/10.2196/44244,
author="Moragas Moreno, Ana
and Fern{\'a}ndez-Garc{\'i}a, Silvia
and Llor, Carl
and Ouchi, Dan
and Garc{\'i}a-Sangen{\'i}s, Ana
and Monteagudo, M{\`o}nica
and Monf{\`a}, Ramon
and Giner-Soriano, Maria",
title="Diagnostic and Therapeutic Management of Urinary Tract Infections in Catalonia, Spain: Protocol for an Observational Cohort Study",
journal="JMIR Res Protoc",
year="2023",
month="Feb",
day="22",
volume="12",
pages="e44244",
keywords="urinary tract infection",
keywords="primary health care",
keywords="anti-bacterial agents",
keywords="diagnosis",
keywords="drug resistance",
keywords="electronic health records",
abstract="Background: Antibiotic resistance is an individual and public health problem; multidrug-resistant infections could cause an estimated 10 million deaths worldwide by 2050. Unnecessary use of antimicrobials is the most important cause of resistance generation in the community, and an estimated 80\% of antimicrobials are prescribed in primary health care, frequently for urinary tract infections (UTIs). Objective: This paper presents the protocol for the first phase of the Urinary Tract Infections in Catalonia (Infeccions del tracte urinari a Catalunya) project. We aim to examine the epidemiology of the different types of UTIs in Catalonia (an autonomous community in Spain) and their diagnostic and therapeutic management by health professionals. Furthermore, we aim to evaluate the correlation between types and total consumption of antibiotics for recurrent UTIs in 2 cohorts of women with the presence and severity of infectious complications of urological origin, especially pyelonephritis and sepsis, and 2 potentially serious infections: pneumonia and COVID-19. Methods: The study is a population-based observational cohort study including adults with a diagnosis of UTI registered in the Information System for the Development of Research in Primary Care (in Catalan: Sistema d'informaci{\'o} per al desenvolupament de la investigaci{\'o} en atenci{\'o} prim{\`a}ria), the Minimum Basic Data Sets of Hospital Discharges and Emergency Departments (in Catalan: Conjunt m{\'i}nim b{\`a}sic de dades a l'hospitalitzaci{\'o} d'aguts i d'atenci{\'o} urgent), and data from the Hospital Dispensing Medicines Register (in Catalan: Medicaci{\'o} hospital{\`a}ria de dispensaci{\'o} ambulat{\`o}ria) of Catalonia from the period between 2012 and 2021. We will evaluate the variables obtained from the databases to analyze the proportion of different types of UTIs, the percentage of adequate antibiotic treatments prescribed or received for recurrent UTIs according to the national guidelines, and the proportion of UTIs with complications. Results: We expect to describe the epidemiology of UTIs in Catalonia from 2012 to 2021, as well as describe the diagnostic and therapeutic management of UTIs by health professionals. Conclusions: We expect to find a high percentage of UTI cases with inadequate management according to the national guidelines, considering that on many occasions UTIs are treated with second- or third-line antibiotic therapies with a preference for the longest regimens. Furthermore, the use of antibiotic suppressive therapies, or prophylaxis, in recurrent UTIs will likely be highly variable. Moreover, we aim to determine whether women with recurrent UTIs treated with antibiotic suppressive therapies have a higher incidence and severity of potentially serious future infections, with special attention to acute pyelonephritis, urosepsis, COVID-19, and pneumonia, compared to women who receive antibiotic treatment after they present with a UTI. This is an observational study of data from administrative databases that will not allow causality analysis. The limitations of the study will be handled according to the appropriate statistical methods. Trial Registration: European Union Electronic Register of Post-Authorisation Studies EUPAS49724; https://www.encepp.eu/encepp/viewResource.htm?id=49725 International Registered Report Identifier (IRRID): DERR1-10.2196/44244 ",
doi="10.2196/44244",
url="https://www.researchprotocols.org/2023/1/e44244",
url="http://www.ncbi.nlm.nih.gov/pubmed/36811950"
}


@Article{info:doi/10.2196/39994,
author="Yang, Liuqing
and Ji, Lili
and Wang, Qiang
and Yang, Guoping
and Xiu, Shixin
and Cui, Tingting
and Shi, Naiyang
and Zhu, Lin
and Xu, Xuepeng
and Jin, Hui
and Zhen, Shiqi",
title="Understanding Drivers of Vaccine Hesitancy During the COVID-19 Pandemic Among Older Adults in Jiangsu Province, China: Cross-sectional Survey",
journal="JMIR Form Res",
year="2023",
month="Feb",
day="7",
volume="7",
pages="e39994",
keywords="vaccine hesitancy",
keywords="older adults",
keywords="socioeconomic status",
keywords="vaccination history",
keywords="COVID-19",
keywords="3Cs model",
keywords="confidence, complacency, and convenience",
abstract="Background: Older adults are particularly at risk from infectious diseases, including serve complications, hospitalization, and death. Objective: This study aimed to explore the drivers of vaccine hesitancy among older adults based on the ``3Cs'' (confidence, complacency, and convenience) framework, where socioeconomic status and vaccination history played the role of moderators. Methods: A cross-sectional questionnaire survey was conducted in Jiangsu Province, China, between June 1 and July 20, 2021. Older adults (aged ?60 years) were recruited using a stratified sampling method. Vaccine hesitancy was influenced by the 3Cs in the model. Socioeconomic status and vaccination history processed through the item parceling method were used to moderate associations between the 3Cs and hesitancy. Hierarchical regression analyses and structural equation modeling were used to test the validity of the new framework. We performed 5000 trials of bootstrapping to calculate the 95\% CI of the pathway's coefficients. Results: A total of 1341 older adults participated. The mean age was 71.3 (SD 5.4) years, and 44.7\% (599/1341) of participants were men. Confidence (b=0.967; 95\% CI 0.759-1.201; P=.002), convenience (b=0.458; 95\% CI 0.333-0.590; P=.002), and less complacency (b=0.301; 95\% CI 0.187-0.408; P=.002) were positively associated with less vaccine hesitancy. Socioeconomic status weakened the positive effect of low complacency (b=--0.065; P=.03) on low vaccine hesitancy. COVID-19 vaccination history negatively moderated the positive association between confidence (b=--0.071; P=.02) and lower vaccine hesitancy. Conclusions: Our study identified that confidence was the more influential dimension in reducing vaccine hesitancy among older adults. COVID-19 vaccination history, as well as confidence, had a positive association with less vaccine hesitancy and could weaken the role of confidence in vaccine hesitancy. Socioeconomic status had a substitution relationship with less complacency, which suggested a competitive positive association between them on less vaccine hesitancy. ",
doi="10.2196/39994",
url="https://formative.jmir.org/2023/1/e39994",
url="http://www.ncbi.nlm.nih.gov/pubmed/36693149"
}


@Article{info:doi/10.2196/43055,
author="Tran, Xuan Bach
and Do, Linh Anh
and Boyer, Laurent
and Auquier, Pascal
and Le, Thi Huong
and Le Vu, Ngoc Minh
and Dang, Thi Trang Huyen
and Cao, Minh Khuy
and Le, Thi Linh Dieu
and Cu, Ngoc Lam Tung
and Ly, Viet Bang
and Nguyen, Thi Duong Anh
and Nguyen, Duc Manh
and Latkin, A. Carl
and Ho, M. Roger C.
and Ho, H. Cyrus S.
and Zhang, B. Melvyn W.",
title="Preference and Willingness to Pay for the Regular COVID-19 Booster Shot in the Vietnamese Population: Theory-Driven Discrete Choice Experiment",
journal="JMIR Public Health Surveill",
year="2023",
month="Jan",
day="31",
volume="9",
pages="e43055",
keywords="COVID-19",
keywords="epidemic",
keywords="vaccine",
keywords="booster",
keywords="willingness to take",
keywords="willingness to pay",
keywords="Vietnam",
keywords="policy",
keywords="feasibility",
keywords="acceptability",
keywords="infection",
keywords="vaccination",
keywords="social media",
keywords="intervention",
abstract="Background: The COVID-19 booster vaccination rate has declined despite the wide availability of vaccines. As COVID-19 is becoming endemic and charges for regular booster vaccination are being introduced, measuring public acceptance and the willingness to pay for regular COVID-19 boosters is ever more crucial. Objective: This study aims to (1) investigate public acceptance for regular COVID-19 boosters, (2) assess the willingness to pay for a COVID-19 booster shot, and (3) identify factors associated with vaccine hesitancy. Our results will provide crucial insights into and implications for policy response as well as the development of a feasible and effective vaccination campaign during Vietnam's waning vaccine immunity period. Methods: A cross-sectional study was conducted among 871 Vietnamese online participants from April to August 2022. An online questionnaire based on the discrete choice experiment (DCE) design was developed, distributed using the snowball sampling method, and subsequently conjointly analyzed on the Qualtrics platform. A history of COVID-19 infection and vaccination, health status, willingness to vaccinate, willingness to pay, and other factors were examined. Results: Among the participants, 761 (87.4\%) had received or were waiting for a COVID-19 booster shot. However, the willingness to pay was low at US \$8.02, and most participants indicated an unwillingness to pay (n=225, 25.8\%) or a willingness to pay for only half of the vaccine costs (n=222, 25.4\%). Although information insufficiency and a wariness toward vaccines were factors most associated with the unwillingness to pay, long-term side effects, immunity duration, and mortality rate were the attributes the participants were most concerned with during the vaccine decision-making period. Participants who had children less than 18 years old in their homes infected with COVID-19 had a lower willingness to pay (odds ratio [OR] 0.54, 95\% CI 0.39-0.74). Respondents who had children under 12 years old in their family who received at least 1 vaccine dose had a higher willingness to pay (OR 2.03, 95\% CI 1.12-3.66). The burden of medical expenses (OR 0.33, 95\% CI 0.25-0.45) and fear of the vaccine (OR 0.93, 95\% CI 0.86-1.00) were negative factors associated with the level of willingness to pay. Conclusions: A significant inconsistency between high acceptance and a low willingness to pay underscores the role of vaccine information and public trust. In addition to raising awareness about the most concerning characteristics of the COVID-19 booster, social media and social listening should be used in collaboration with health professionals to establish a 2-way information exchange. Work incentives and suitable mandates should continue to encourage workforce participation. Most importantly, all interventions should be conducted with informational transparency to strengthen trust between the public and authorities. ",
doi="10.2196/43055",
url="https://publichealth.jmir.org/2023/1/e43055",
url="http://www.ncbi.nlm.nih.gov/pubmed/36599156"
}


@Article{info:doi/10.2196/35784,
author="Hong, Chong Hye
and Lee, Hyeonkyeong
and Lee, Jeong Suk
and Park, Chang
and Lee, Mikyung",
title="The Determinants of Adherence to Public Health and Social Measures Against COVID-19 Among the General Population in South Korea: National Survey Study",
journal="JMIR Public Health Surveill",
year="2023",
month="Jan",
day="17",
volume="9",
pages="e35784",
keywords="COVID-19",
keywords="preventive measures",
keywords="health literacy",
keywords="trust",
keywords="national survey",
keywords="Tobit regression",
abstract="Background: The COVID-19 pandemic has created devastating health, social, economic, and political effects that will have long-lasting impacts. Public health efforts to reduce the spread of COVID-19 are the priority of national policies for responding to the pandemic globally. Public health and social measures (PHSMs) have been shown to be effective when used alone or in combination with other measures, reducing the risk of spreading COVID-19. However, there is insufficient evidence on the status of compliance with PHSMs in the general population for the prevention of COVID-19 in public areas, including Korea. Objective: The aim of this study was to assess levels of compliance with the recommended PHSMs against SARS-CoV-2 infection and their predictors among the general population by using national data. Methods: This study was a secondary data analysis of the National Survey of Infectious Disease Preventive Behaviors in Community, which was conducted by the Korea Centers for Disease Control and Prevention Agency (KDCA) between October 12 and October 30, 2020. The primary study was cross-sectional, using stratified sampling via an adjusted proportional allocation method to select representative samples and ensure the stability of samples. The data were collected through phone interviews conducted by trained enumerators using a structured questionnaire. PHSM adherence was measured using a 10-item comprehensive infectious disease prevention behavior (CIDPB) scale, and each sociocognitive factor, including perceived susceptibility to SARS-CoV-2 infection, perceived severity of SARS-CoV-2 infection, perceived confidence in performing preventive behaviors related to COVID-19, information comprehension ability, and trust in information from the KDCA, was measured. A total of 4003 participants were included in the final analysis. Tobit regression and a decision tree analysis were performed to identify the predictors of preventive measures and the target groups for intervention. Results: We discovered that women scored 1.34 points higher on the CIDPB scale than men (P<.001). Compared to the group aged 19 to 29 years, those aged 50 to 59 years and those older than 60 years scored 1.89 and 2.48 points higher on the CIDPB scale (P<.001), respectively. The perceived severity of infection, confidence in preventive behaviors, information comprehension ability, and trust in information from the KDCA were significant positive determinants of CIDPBs (P<.001). The perceived susceptibility to infection showed a significant negative relationship with CIDPBs (P<.001). Conclusions: Female sex, older age, lower income, and sociocognitive factors were found to be significant determinants of adhering to PHSMs. The findings suggest the need for tailored interventions for target groups; specifically, the age group that was the most active at work indicated the highest potential to spread infection. Adequate public health education and health communication for promoting adherence to PHSMs should be emphasized, and behavior change strategies for those with low perceived confidence in performing PHSMs should be prioritized. ",
doi="10.2196/35784",
url="https://publichealth.jmir.org/2023/1/e35784",
url="http://www.ncbi.nlm.nih.gov/pubmed/36446132"
}


@Article{info:doi/10.2196/42616,
author="Binka, Mawuena
and Adu, Asumadu Prince
and Jeong, Dahn
and Vadlamudi, Khatri Nirma
and Vel{\'a}squez Garc{\'i}a, Alexander H{\'e}ctor
and Mahmood, Bushra
and Buller-Taylor, Terri
and Otterstatter, Michael
and Janjua, Zafar Naveed",
title="The Impact of Mask Mandates on Face Mask Use During the COVID-19 Pandemic: Longitudinal Survey Study",
journal="JMIR Public Health Surveill",
year="2023",
month="Jan",
day="11",
volume="9",
pages="e42616",
keywords="face mask",
keywords="face covering",
keywords="COVID-19",
keywords="SARS-CoV-2",
keywords="outbreak",
keywords="public health",
keywords="health policy",
keywords="trend analysis",
keywords="logistic regression",
abstract="Background: Face mask use has been associated with declines in COVID-19 incidence rates worldwide. A handful of studies have examined the factors associated with face mask use in North America during the COVID-19 pandemic; however, much less is known about the patterns of face mask use and the impact of mask mandates during this time. This information could have important policy implications, now and in the event of future pandemics. Objective: To address existing knowledge gaps, we assessed face mask usage patterns among British Columbia COVID-19 Population Mixing Patterns (BC-Mix) survey respondents and evaluated the impact of the provincial mask mandate on these usage patterns. Methods: Between September 2020 and July 2022, adult British Columbia residents completed the web-based BC-Mix survey, answering questions on the circumstances surrounding face mask use or lack thereof, movement patterns, and COVID-19--related beliefs. Trends in face mask use over time were assessed, and associated factors were evaluated using multivariable logistic regression. A stratified analysis was done to examine effect modification by the provincial mask mandate. Results: Of the 44,301 respondents, 81.9\% reported wearing face masks during the 23-month period. In-store and public transit mask mandates supported monthly face mask usage rates of approximately 80\%, which was further bolstered up to 92\% with the introduction of the provincial mask mandate. Face mask users mostly visited retail locations (51.8\%) and travelled alone by car (49.6\%), whereas nonusers mostly traveled by car with others (35.2\%) to their destinations---most commonly parks (45.7\%). Nonusers of face masks were much more likely to be male than female, especially in retail locations and restaurants, bars, and caf{\'e}s. In a multivariable logistic regression model adjusted for possible confounders, factors associated with face mask use included age, ethnicity, health region, mode of travel, destination, and time period. The odds of face mask use were 3.68 times greater when the provincial mask mandate was in effect than when it was not (adjusted odds ratio [aOR] 3.68, 95\% CI 3.33-4.05). The impact of the mask mandate was greatest in restaurants, bars, or caf{\'e}s (mandate: aOR 7.35, 95\% CI 4.23-12.78 vs no mandate: aOR 2.81, 95\% CI 1.50-5.26) and in retail locations (mandate: aOR 19.94, 95\% CI 14.86-26.77 vs no mandate: aOR 7.71, 95\% CI 5.68-10.46). Conclusions: Study findings provide added insight into the dynamics of face mask use during the COVID-19 pandemic. Mask mandates supported increased and sustained high face mask usage rates during the first 2 years of the pandemic, having the greatest impact in indoor public locations with limited opportunity for physical distancing targeted by these mandates. These findings highlight the utility of mask mandates in supporting high face mask usage rates during the COVID-19 pandemic. ",
doi="10.2196/42616",
url="https://publichealth.jmir.org/2023/1/e42616",
url="http://www.ncbi.nlm.nih.gov/pubmed/36446134"
}


@Article{info:doi/10.2196/36538,
author="Tong, Chengzhuo
and Shi, Wenzhong
and Zhang, Anshu
and Shi, Zhicheng",
title="A Spatiotemporal Solution to Control COVID-19 Transmission at the Community Scale for Returning to Normalcy: COVID-19 Symptom Onset Risk Spatiotemporal Analysis",
journal="JMIR Public Health Surveill",
year="2023",
month="Jan",
day="6",
volume="9",
pages="e36538",
keywords="return to normalcy",
keywords="precise prevention and control",
keywords="risk prediction",
keywords="COVID-19 symptom onset",
keywords="symptom",
keywords="COVID-19",
abstract="Background: Following the recent COVID-19 pandemic, returning to normalcy has become the primary goal of global cities. The key for returning to normalcy is to avoid affecting social and economic activities while supporting precise epidemic control. Estimation models for the spatiotemporal spread of the epidemic at the refined scale of cities that support precise epidemic control are limited. For most of 2021, Hong Kong has remained at the top of the ``global normalcy index'' because of its effective responses. The urban-community-scale spatiotemporal onset risk prediction model of COVID-19 symptom has been used to assist in the precise epidemic control of Hong Kong. Objective: Based on the spatiotemporal prediction models of COVID-19 symptom onset risk, the aim of this study was to develop a spatiotemporal solution to assist in precise prevention and control for returning to normalcy. Methods: Over the years 2020 and 2021, a spatiotemporal solution was proposed and applied to support the epidemic control in Hong Kong. An enhanced urban-community-scale geographic model was proposed to predict the risk of COVID-19 symptom onset by quantifying the impact of the transmission of SARS-CoV-2 variants, vaccination, and the imported case risk. The generated prediction results could be then applied to establish the onset risk predictions over the following days, the identification of high--onset-risk communities, the effectiveness analysis of response measures implemented, and the effectiveness simulation of upcoming response measures. The applications could be integrated into a web-based platform to assist the antiepidemic work. Results: Daily predicted onset risk in 291 tertiary planning units (TPUs) of Hong Kong from January 18, 2020, to April 22, 2021, was obtained from the enhanced prediction model. The prediction accuracy in the following 7 days was over 80\%. The prediction results were used to effectively assist the epidemic control of Hong Kong in the following application examples: identified communities within high--onset-risk always only accounted for 2\%-25\% in multiple epidemiological scenarios; effective COVID-19 response measures, such as prohibiting public gatherings of more than 4 people were found to reduce the onset risk by 16\%-46\%; through the effect simulation of the new compulsory testing measure, the onset risk was found to be reduced by more than 80\% in 42 (14.43\%) TPUs and by more than 60\% in 96 (32.99\%) TPUs. Conclusions: In summary, this solution can support sustainable and targeted pandemic responses for returning to normalcy. Faced with the situation that may coexist with SARS-CoV-2, this study can not only assist global cities in responding to the future epidemics effectively but also help to restore social and economic activities and people's normal lives. ",
doi="10.2196/36538",
url="https://publichealth.jmir.org/2023/1/e36538",
url="http://www.ncbi.nlm.nih.gov/pubmed/36508488"
}


@Article{info:doi/10.2196/38196,
author="Qasmieh, A. Saba
and Robertson, M. McKaylee
and Rane, S. Madhura
and Shen, Yanhan
and Zimba, Rebecca
and Picchio, A. Camila
and Parcesepe, M. Angela
and Chang, Mindy
and Kulkarni, G. Sarah
and Grov, Christian
and Nash, Denis",
title="The Importance of Incorporating At-Home Testing Into SARS-CoV-2 Point Prevalence Estimates: Findings From a US National Cohort, February 2022",
journal="JMIR Public Health Surveill",
year="2022",
month="Dec",
day="27",
volume="8",
number="12",
pages="e38196",
keywords="COVID-19 prevalence",
keywords="at-home rapid SARS-CoV-2 tests",
keywords="population-based surveys",
keywords="COVID-19",
keywords="surveillance",
keywords="public health",
keywords="rapid test",
keywords="Omicron variant",
keywords="point prevalence",
abstract="Background: Passive, case-based surveillance underestimates the true extent of active infections in the population due to undiagnosed and untested cases, the exclusion of probable cases diagnosed point-of-care rapid antigen tests, and the exclusive use of at-home rapid tests which are not reported as part of case-based surveillance. The extent in which COVID-19 surveillance may be underestimating the burden of infection is likely due to time-varying factors such as decreased test-seeking behaviors and increased access to and availability of at-home testing. Objective: The objective of this study is to estimate the prevalence of SARS-CoV-2 based on different definitions of a case to ascertain the extent to which cases of SARS-CoV-2 may be underestimated by case-based surveillance. Methods: A survey on COVID-19 exposure, infection, and testing was administered to calculate point prevalence of SARS-CoV-2 among a diverse sample of cohort adults from February 8, 2022, to February 22, 2022. Three-point prevalence estimates were calculated among the cohort, as follows: (1) proportion positives based on polymerase chain reaction (PCR) and rapid antigen tests; (2) proportion positives based on testing exclusively with rapid at-home tests; and (3) proportion of probable undiagnosed cases. Test positivity and prevalence differences across booster status were also examined. Results: Among a cohort of 4328, there were a total of 644 (14.9\%) cases. The point prevalence estimate based on PCR or rapid antigen tests was 5.5\% (95\% CI 4.8\%-6.2\%), 3.7\% (95\% CI 3.1\%-4.2\%) based on at-home rapid tests, and 5.7\% (95\% CI 5.0\%-6.4\%) based on the case definition of a probable case. The total point prevalence across all definitions was 14.9\% (95\% CI 13.8\%-16.0\%). The percent positivity among PCR or rapid tests was 50.2\%. No statistically significant differences were observed in prevalence between participants with a COVID-19 booster compared to fully vaccinated and nonboosted participants except among exclusive at-home rapid testers. Conclusions: Our findings suggest a substantial number of cases were missed by case-based surveillance systems during the Omicron B.1.1.529 surge, when at-home testing was common. Point prevalence surveys may be a rapid tool to be used to understand SARS-CoV-2 prevalence and would be especially important during case surges to measure the scope and spread of active infections in the population. ",
doi="10.2196/38196",
url="https://publichealth.jmir.org/2022/12/e38196",
url="http://www.ncbi.nlm.nih.gov/pubmed/36240020"
}


@Article{info:doi/10.2196/40042,
author="Yan, Xiangyu
and Fang, Yian
and Li, Yongjie
and Jia, Zhongwei
and Zhang, Bo",
title="Risks, Epidemics, and Prevention Measures of Infectious Diseases in Major Sports Events: Scoping Review",
journal="JMIR Public Health Surveill",
year="2022",
month="Dec",
day="2",
volume="8",
number="12",
pages="e40042",
keywords="major sports event",
keywords="epidemic",
keywords="risk factor",
keywords="prevention",
keywords="surveillance",
keywords="scoping review",
abstract="Background: Major sports events are the focus of the world. However, the gathering of crowds during these events creates huge risks of infectious diseases transmission, posing a significant public health threat. Objective: The aim of this study was to systematically review the epidemiological characteristics and prevention measures of infectious diseases at major sports events. Methods: The procedure of this scoping review followed Arksey and O'Malley's five-step methodological framework. Electronic databases, including PubMed, Web of Science, Scopus, and Embase, were searched systematically. The general information (ie, publication year, study type) of each study, sports events' features (ie, date and host location), infectious diseases' epidemiological characteristics (ie, epidemics, risk factors), prevention measures, and surveillance paradigm were extracted, categorized, and summarized. Results: A total of 24,460 articles were retrieved from the databases and 358 studies were included in the final data synthesis based on selection criteria. A rapid growth of studies was found over recent years. The number of studies investigating epidemics and risk factors for sports events increased from 16/254 (6.3\%) before 2000 to 201/254 (79.1\%) after 2010. Studies focusing on prevention measures of infectious diseases accounted for 85.0\% (238/280) of the articles published after 2010. A variety of infectious diseases have been reported, including respiratory tract infection, gastrointestinal infection, vector-borne infection, blood-borne infection, and water-contact infection. Among them, respiratory tract infections were the most concerning diseases (250/358, 69.8\%). Besides some routine prevention measures targeted at risk factors of different diseases, strengthening surveillance was highlighted in the literature. The surveillance system appeared to have gone through three stages of development, including manual archiving, network-based systems, and automated intelligent platforms. Conclusions: This critical summary and collation of previous empirical evidence is meaningful to provide references for holding major sports events. It is essential to improve the surveillance techniques for timely detection of the emergence of epidemics and to improve risk perception in future practice. ",
doi="10.2196/40042",
url="https://publichealth.jmir.org/2022/12/e40042",
url="http://www.ncbi.nlm.nih.gov/pubmed/36459401"
}


@Article{info:doi/10.2196/40175,
author="Kwan, Ho Tsz
and Wong, Sze Ngai
and Chan, Pok Chin
and Yeoh, Kiong Eng
and Wong, Yeung-shan Samuel
and Lee, Shan Shui",
title="Mass Screening of SARS-CoV-2 With Rapid Antigen Tests in a Receding Omicron Wave: Population-Based Survey for Epidemiologic Evaluation",
journal="JMIR Public Health Surveill",
year="2022",
month="Nov",
day="9",
volume="8",
number="11",
pages="e40175",
keywords="COVID-19",
keywords="SARS-CoV-2 antigen testing",
keywords="COVID-19 vaccine",
keywords="mass screening",
keywords="antigen test",
keywords="epidemiology",
keywords="Omicron",
keywords="Hong Kong",
keywords="public health",
keywords="outbreak",
keywords="epidemic",
keywords="screening",
keywords="transmission",
keywords="online",
keywords="vaccination",
keywords="vaccines",
keywords="surveillance",
abstract="Background: The COVID-19 Omicron BA.2 epidemic wave in Hong Kong peaked in the first quarter of 2022. Following the implementation of stringent public health measures, the daily number of reported cases fell from over 50,000 to below 2000. Although outbreaks steadily receded, the government rolled out a 3-day ``voluntary universal rapid testing'' campaign to invite all citizens to self-perform a rapid antigen test (RAT) daily to identify undetected prevalent infections. Objective: This study aimed to evaluate the uptake and results of RAT mass screening to estimate the population's residual epidemic burden and assess the risk of further transmission. Methods: A cross-sectional study comprising an open web-based population-based survey was conducted a week after the RAT campaign. Participants were asked to report their COVID-19 vaccination and infection history and the RAT performance and test result during the period. They were also invited to report their coliving individuals' test performance and results. Reasons for nonuptake were enquired. Testing and positive rates were age-adjusted. Determinants of undergoing RAT were identified using univariable and multivariable logistic regression models. Results: In total, particulars from 21,769 individuals were reported by 8338 participants. The overall age-adjusted testing rate was 74.94\% (95\% CI 73.71\%-76.18\%), with over 80\% of participants in the age groups between 45-84 years having self-performed RAT during the campaign period. After age-adjustment, 1.03\% (95\% CI 0.86\%-1.21\%) of participants tested positive. The positive rates in the age groups between 20-29 years and >84 years exceeded 2\%. Taking into account the positive rate and 5819 reported cases during the period, the cases identified in the campaign might account for 7.65\% (95\% CI 6.47\%-9.14\%) of all infections. Testers were more likely to be female, older, not previously diagnosed with COVID-19, and have received COVID-19 vaccination. Adjusting for the number of household members, those living with a child aged <12 years and whose household members were also tested were more likely to have self-performed an RAT. Main reasons for not performing an RAT included the absence of symptoms (598/1108, 53.97\%), disbelief of the appropriateness of the campaign as an antiepidemic measure (355/1108, 32.04\%), and a recent COVID-19 diagnosis (332/1108, 29.96\%). Conclusions: The residual population burden remained substantial in spite of the clear evidence of a receding epidemic wave. Despite caution in generalization to the Hong Kong population, the high participation rate in mass screening indicated that the voluntary RAT was well accepted, making it a feasible option for implementation as a complementary means of public health surveillance. ",
doi="10.2196/40175",
url="https://publichealth.jmir.org/2022/11/e40175",
url="http://www.ncbi.nlm.nih.gov/pubmed/36240027"
}


@Article{info:doi/10.2196/38898,
author="Kshirsagar, Meghana
and Nasir, Md
and Mukherjee, Sumit
and Becker, Nicholas
and Dodhia, Rahul
and Weeks, B. William
and Ferres, Lavista Juan
and Richardson, Barbra",
title="The Risk of Hospitalization and Mortality After Breakthrough SARS-CoV-2 Infection by Vaccine Type: Observational Study of Medical Claims Data",
journal="JMIR Public Health Surveill",
year="2022",
month="Nov",
day="8",
volume="8",
number="11",
pages="e38898",
keywords="breakthroughs",
keywords="vaccines",
keywords="Pfizer",
keywords="Moderna",
keywords="Janssen",
keywords="SARS-CoV-2",
keywords="COVID-19",
keywords="coronavirus",
keywords="infectious disease",
keywords="viral infection",
keywords="vaccination",
keywords="breakthrough infection",
keywords="public health",
keywords="health policy",
keywords="decision making",
keywords="booster vaccine",
keywords="mortality",
keywords="hospitalization",
keywords="healthcare system",
abstract="Background: Several risk factors have been identified for severe COVID-19 disease by the scientific community. In this paper, we focus on understanding the risks for severe COVID-19 infections after vaccination (ie, in breakthrough SARS-CoV-2 infections). Studying these risks by vaccine type, age, sex, comorbidities, and any prior SARS-CoV-2 infection is important to policy makers planning further vaccination efforts. Objective: We performed a comparative study of the risks of hospitalization (n=1140) and mortality (n=159) in a SARS-CoV-2 positive cohort of 19,815 patients who were all fully vaccinated with the Pfizer, Moderna, or Janssen vaccines. Methods: We performed Cox regression analysis to calculate the risk factors for developing a severe breakthrough SARS-CoV-2 infection in the study cohort by controlling for vaccine type, age, sex, comorbidities, and a prior SARS-CoV-2 infection. Results: We found lower hazard ratios for those receiving the Moderna vaccine (P<.001) and Pfizer vaccine (P<.001), with the lowest hazard rates being for Moderna, as compared to those who received the Janssen vaccine, independent of age, sex, comorbidities, vaccine type, and prior SARS-CoV-2 infection. Further, individuals who had a SARS-CoV-2 infection prior to vaccination had some increased protection over and above the protection already provided by the vaccines, from hospitalization (P=.001) and death (P=.04), independent of age, sex, comorbidities, and vaccine type. We found that the top statistically significant risk factors for severe breakthrough SARS-CoV-2 infections were age of >50, male gender, moderate and severe renal failure, severe liver disease, leukemia, chronic lung disease, coagulopathy, and alcohol abuse. Conclusions: Among individuals who were fully vaccinated, the risk of severe breakthrough SARS-CoV-2 infection was lower for recipients of the Moderna or Pfizer vaccines and higher for recipients of the Janssen vaccine. These results from our analysis at a population level will be helpful to public health policy makers. Our result on the influence of a previous SARS-CoV-2 infection necessitates further research into the impact of multiple exposures on the risk of developing severe COVID-19. ",
doi="10.2196/38898",
url="https://publichealth.jmir.org/2022/11/e38898",
url="http://www.ncbi.nlm.nih.gov/pubmed/36265135"
}


@Article{info:doi/10.2196/36412,
author="Chantziara, Sofia
and Brigden L C, Amberly
and Mccallum, H. Claire
and Craddock, J. Ian",
title="Using Digital Tools for Contact Tracing to Improve COVID-19 Safety in Schools: Qualitative Study Exploring Views and Experiences Among School Staff",
journal="JMIR Form Res",
year="2022",
month="Nov",
day="1",
volume="6",
number="11",
pages="e36412",
keywords="schools",
keywords="contact tracing",
keywords="COVID-19 mitigation",
keywords="COVID-19",
keywords="pandemic",
keywords="disease prevention",
keywords="health technology",
keywords="COVID-19 management",
keywords="technology support",
keywords="digital tool",
keywords="mobile health",
keywords="mobile technology",
abstract="Background: Throughout the pandemic, governments worldwide have issued guidelines to manage the spread and impact of COVID-19 in schools, including measures around social distancing and contact tracing. Whether schools required support to implement these guidelines has not yet been explored in depth. Despite the development of a range of technologies to tackle COVID-19, such as contact-tracing apps and electronic vaccine certificates, research on their usefulness in school settings has been limited. Objective: The aim of the study was to explore the needs of school staff in managing COVID-19 and their experiences and perspectives on technological support in relation to contact tracing. School staff are the ones likely to make key implementation decisions regarding new technologies, and they are also the ones responsible for using the new tools daily. Including both management staff and class teachers in the development of school-based technologies can lead to their successful adoption by schools. Methods: Semistructured interviews were conducted with UK school staff, including primary and secondary school teachers and school managers. Thematic analysis, facilitated by NVivo, was used to analyze the data. Two of the authors independently coded 5 (28\%) of the interviews and reached a consensus on a coding framework. Results: Via purposive sampling, we recruited 18 participants from 5 schools. Findings showed that primary schools did not perform contact tracing, while in secondary schools, digital seating plans were used to identify close contacts in the classroom and manual investigations were also conducted identify social contacts. Participants reported that despite their efforts, high-risk interactions between students were not adequately monitored. There was a need to improve accuracy when identifying close contacts in common areas where students congregate. Proximity tracking, use of access cards, and closed-circuit television (CCTV) emerged as potential solutions, but there were concerns surrounding false alerts, burden, and security. Conclusions: School staff have found it difficult to monitor and implement social distancing and contact-tracing provisions. There are opportunities for mobile digital technologies and CCTV to support school staff in keeping their students and colleagues safe; however, these must place minimal demands on staff and prioritize security measures. Study findings can help researchers and practitioners who work in different contexts and settings understand what particular challenges are faced by school staff, and inform further research on the design and application of digital solutions for contact tracing. ",
doi="10.2196/36412",
url="https://formative.jmir.org/2022/11/e36412",
url="http://www.ncbi.nlm.nih.gov/pubmed/36191172"
}


@Article{info:doi/10.2196/40233,
author="Liu, MingXin
and Zhou, SiYu
and Jin, Qun
and Nishimura, Shoji
and Ogihara, Atsushi",
title="Effectiveness, Policy, and User Acceptance of COVID-19 Contact-Tracing Apps in the Post--COVID-19 Pandemic Era: Experience and Comparative Study",
journal="JMIR Public Health Surveill",
year="2022",
month="Oct",
day="27",
volume="8",
number="10",
pages="e40233",
keywords="COVID-19",
keywords="contact-tracing app",
keywords="digital contact tracing",
keywords="mobile phone",
abstract="Background: In the post--COVID-19 pandemic era, many countries have launched apps to trace contacts of COVID-19 infections. Each contact-tracing app (CTA) faces a variety of issues owing to different national policies or technologies for tracing contacts. Objective: In this study, we aimed to investigate all the CTAs used to trace contacts in various countries worldwide, including the technology used by each CTA, the availability of knowledge about the CTA from official websites, the interoperability of CTAs in various countries, and the infection detection rates and policies of the specific country that launched the CTA, and to summarize the current problems of the apps based on the information collected. Methods: We investigated CTAs launched in all countries through Google, Google Scholar, and PubMed. We experimented with all apps that could be installed and compiled information about apps that could not be installed or used by consulting official websites and previous literature. We compared the information collected by us on CTAs with relevant previous literature to understand and analyze the data. Results: After screening 166 COVID-19 apps developed in 197 countries worldwide, we selected 98 (59\%) apps from 95 (48.2\%) countries, of which 63 (66.3\%) apps were usable. The methods of contact tracing are divided into 3 main categories: Bluetooth, geolocation, and QR codes. At the technical level, CTAs face 3 major problems. First, the distance and time for Bluetooth- and geolocation-based CTAs to record contact are generally set to 2 meters and 15 minutes; however, this distance should be lengthened, and the time should be shortened for more infectious variants. Second, Bluetooth- or geolocation-based CTAs also face the problem of lack of accuracy. For example, individuals in 2 adjacent vehicles during traffic jams may be at a distance of ?2 meters to make the CTA trace contact, but the 2 users may actually be separated by car doors, which could prevent transmission and infection. In addition, we investigated infection detection rates in 33 countries, 16 (48.5\%) of which had significantly low infection detection rates, wherein CTAs could have lacked effectiveness in reducing virus propagation. Regarding policy, CTAs in most countries can only be used in their own countries and lack interoperability among other countries. In addition, 7 countries have already discontinued CTAs, but we believe that it was too early to discontinue them. Regarding user acceptance, 28.6\% (28/98) of CTAs had no official source of information that could reduce user acceptance. Conclusions: We surveyed all CTAs worldwide, identified their technological policy and acceptance issues, and provided solutions for each of the issues we identified. This study aimed to provide useful guidance and suggestions for updating the existing CTAs and the subsequent development of new CTAs. ",
doi="10.2196/40233",
url="https://publichealth.jmir.org/2022/10/e40233",
url="http://www.ncbi.nlm.nih.gov/pubmed/36190741"
}


@Article{info:doi/10.2196/37693,
author="Jandee, Kasemsak
and Thanapop, Chamnong",
title="Food Delivery Drivers' Health Literacy Regarding COVID-19 Prevention and Protective Behaviors During the COVID-19 Pandemic: Cross-sectional Survey in Southern Thailand",
journal="JMIR Hum Factors",
year="2022",
month="Oct",
day="13",
volume="9",
number="4",
pages="e37693",
keywords="health literacy",
keywords="health information",
keywords="preventive behavior",
keywords="COVID-19",
keywords="food delivery",
keywords="delivery drivers",
abstract="Background: In 2019, COVID-19 spread worldwide, causing a pandemic that has posed unprecedented challenges and pressure for health systems and economies. Food delivery services have become an important medium for consumer food purchases to limit human-to-human contact. Thus, delivery drivers are at high risk of exposure to COVID-19 infection at work. To the best of our knowledge, no studies have analyzed the dimensions of health literacy (HL) regarding COVID-19 prevention in this population. Objective: This study aims to explore the HL status toward COVID-19 prevention and its associated factors among food delivery drivers in southern Thailand. Methods: Following a cross-sectional survey from July to August 2021, Thai food delivery drivers in the upper-south and lower-south regions of southern Thailand were recruited to participate during the compulsory COVID-19 lockdown. An online structured questionnaire was administered verbally and recorded by the interviewer. Univariate and multivariate linear regressions were used to explore independently associated factors. Results: Of 401 drivers, 291 (72.6\%) were men. The median age was 31 years (range 19-64 years). The median number of months working as a driver was 12 months, and the median number of working hours was 9 hours per day. The median number of daily food orders was 20, while the median daily income was Thai baht (THB) 600 (US \$15.90). Social media (Facebook and Line) was a common source of health information. The most common information required was about the COVID-19 vaccine, medications, and treatment. Most drivers (285/401, 71.1\%) had excellent HL levels regarding COVID-19 prevention. Only the practical application of information was statistically correlated with behavior (r=0.38, P<.001). Drivers in the lower south of Thailand were more likely to have excellent HL than other drivers ($\beta$=7.03, P<.001). Those who frequently accessed information through YouTube ($\beta$=--2.17, P=.01) and relatives ($\beta$=--4.19, P<.001) were less likely to have excellent HL levels. Conclusions: Understanding HL among food delivery drivers would be useful for planning effective interventions that target this population. Conventional health education through social media alone may not be effective at educating people about COVID-19 prevention. Information literacy skills could determine individuals' HL and drivers' behaviors. ",
doi="10.2196/37693",
url="https://humanfactors.jmir.org/2022/4/e37693",
url="http://www.ncbi.nlm.nih.gov/pubmed/36227652"
}


@Article{info:doi/10.2196/31579,
author="Muthuka, John
and Kiptoo, Michael
and Oluoch, Kelly
and Nzioki, Mativo Japheth
and Nyamai, Musangi Everlyn",
title="Association of Pregnancy With Coronavirus Cytokine Storm: Systematic Review and Meta-analysis",
journal="JMIR Pediatr Parent",
year="2022",
month="Oct",
day="4",
volume="5",
number="4",
pages="e31579",
keywords="COVID-19",
keywords="pandemic",
keywords="pregnancy",
keywords="maternal health",
keywords="cytokine",
keywords="cytokine storm",
keywords="immune response",
keywords="infectious disease",
keywords="coronavirus",
keywords="respiratory",
keywords="virus",
keywords="pregnant",
abstract="Background: COVID-19 was first identified in Wuhan, China, in December 2019, spreading to the rest of the globe, becoming a pandemic. Some studies have shown an association between pregnancy status and severe COVID-19 with a cytokine storm, whereas others have shown contrasting results. Objective: The aim of this study was to examine the relationship between pregnancy status and the clinical COVID-19 severity characterized by the cytokine storm through a systematic review and meta-analysis. Methods: We searched the Google Scholar, PubMed, Scopus, Web of Science, and Embase databases to identify clinical studies suitable for inclusion in this meta-analysis. Studies reporting pregnancy status and comparing the COVID-19 severity cytokine storm outcome were included. COVID-19 severity characterized by a cytokine storm was described using parameters such as intensive care unit admission, invasive mechanical ventilation, mechanical ventilation, hospital admission, pro- and anti-inflammatory cytokine levels, consolidation on chest computed tomography scan, pulmonary infiltration, extreme fevers as characteristic of a cytokine storm, syndromic severity, higher neutrophil count indicative of a cytokine storm, and severe COVID-19 presentation. Results: A total of 17 articles including data for 840,332 women with COVID-19 were included. This meta-analysis revealed a correlation between positive pregnancy status and severe COVID-19 with a cytokine storm (random-effects model odds ratio [OR] 2.47, 95\% CI 1.63-3.73; P<.001), with a cumulative incidence of 6432 (14.1\%) and 24,352 (3.1\%) among pregnant and nonpregnant women with COVID-19, respectively. The fixed-effects model also showed a correlation between pregnancy status and severe COVID-19 with a cytokine storm (OR 7.41, 95\% CI 7.02-7.83; P<.001). Considerable heterogeneity was found among all pooled studies (I{\texttwosuperior}=98\%, P<.001). Furthermore, the updated analysis showed substantially low heterogeneity (I{\texttwosuperior}=29 \%, P=.19), and the funnel plot revealed no publication bias. The subanalysis between single-center and multicenter studies demonstrated similar heterogeneity (I2=72\% and 98\%, respectively). Sensitivity analysis on each subgroup revealed that pregnancy was significantly related to severe COVID-19 with a cytokine storm from single-center studies (fixed-effects model OR 3.97, 95\% CI 2.26-6.95; P<.001) with very low heterogeneity (I{\texttwosuperior}=2\%, P=.42). Conclusions: Being pregnant is clearly associated with experiencing a severe course of COVID-19 characterized by a cytokine storm. The COVID-19 pandemic should serve as an impetus for further research on pregnant women diagnosed with COVID-19 to map out the salient risk factors associated with its severity. Trial Registration: PROSPERO CRD42021242011; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=242011. ",
doi="10.2196/31579",
url="https://pediatrics.jmir.org/2022/4/e31579",
url="http://www.ncbi.nlm.nih.gov/pubmed/35319475"
}


@Article{info:doi/10.2196/29927,
author="Iglesias, Natalia
and Juarez, M. Jose
and Campos, Manuel",
title="Business Process Model and Notation and openEHR Task Planning for Clinical Pathway Standards in Infections: Critical Analysis",
journal="J Med Internet Res",
year="2022",
month="Sep",
day="15",
volume="24",
number="9",
pages="e29927",
keywords="openEHR task planning",
keywords="business process model and notation",
keywords="BPMN",
keywords="clinical pathways",
keywords="catheter-related bloodstream infection",
keywords="CR-BSI",
keywords="clinical guidelines",
abstract="Background: Clinical pathways (CPs) are usually expressed by means of workflow formalisms, providing health care personnel with an easy-to-understand, high-level conceptual model of medical steps in specific patient conditions, thereby improving overall health care process quality in clinical practice. From a standardized perspective, the business process model and notation (BPMN), a widely spread general-purpose process formalism, has been used for conceptual modeling in clinical domains, mainly because of its easy-to-use graphical notation, facilitating the common understanding and communication of the parties involved in health care. However, BPMN is not particularly oriented toward the peculiarities of complex clinical processes such as infection diagnosis and treatment, in which time plays a critical role, which is why much of the BPMN clinical-oriented research has revolved around how to extend the standard to address these special needs. The shift from an agnostic, general-purpose BPMN notation to a natively clinical-oriented notation such as openEHR Task Planning (TP) could constitute a major step toward clinical process improvement, enhancing the representation of CPs for infection treatment and other complex scenarios. Objective: Our work aimed to analyze the suitability of a clinical-oriented formalism (TP) to successfully represent typical process patterns in infection treatment, identifying domain-specific improvements to the standard that could help enhance its modeling capabilities, thereby promoting the widespread adoption of CPs to improve medical practice and overall health care quality. Methods: Our methodology consisted of 4 major steps: identification of key features of infection CPs through literature review, clinical guideline analysis, and BPMN extensions; analysis of the presence of key features in TP; modeling of relevant process patterns of catheter-related bloodstream infection as a case study; and analysis and proposal of extensions in view of the results. Results: We were able to easily represent the same logic applied in the extended BPMN-based process models in our case study using out-of-the-box standard TP primitives. However, we identified possible improvements to the current version of TP to allow for simpler conceptual models of infection CPs and possibly of other complex clinical scenarios. Conclusions: Our study showed that the clinical-oriented TP specification is able to successfully represent the most complex catheter-related bloodstream infection process patterns depicted in our case study and identified possible extensions that can help increase its adequacy for modeling infection CPs and possibly other complex clinical conditions. ",
doi="10.2196/29927",
url="https://www.jmir.org/2022/9/e29927",
url="http://www.ncbi.nlm.nih.gov/pubmed/36107480"
}


@Article{info:doi/10.2196/34675,
author="Rodriguez-Blazquez, Carmen
and Romay-Barja, Maria
and Falcon, Maria
and Ayala, Alba
and Forjaz, Jo{\~a}o Maria",
title="Psychometric Properties of the COVID-19 Pandemic Fatigue Scale: Cross-sectional Online Survey Study",
journal="JMIR Public Health Surveill",
year="2022",
month="Sep",
day="8",
volume="8",
number="9",
pages="e34675",
keywords="COVID-19",
keywords="pandemic fatigue",
keywords="psychometric properties",
keywords="Rasch analysis",
keywords="validation",
keywords="online survey",
keywords="pandemic",
keywords="fatigue",
keywords="mental health",
keywords="information seeking",
keywords="health information",
abstract="Background: Pandemic fatigue is defined as feelings of demotivation to follow preventive measures against COVID-19, together with decreased trust in government and frequency of information-seeking behaviors. Objective: This study aims to analyze the psychometric properties of the COVID-19--specific pandemic fatigue scale according to classical test theory (CTT) and Rasch model approaches in the general Spanish population. Methods: This was a cross-sectional study in a representative sample of 1018 adults who completed an online survey in November 2020 in the framework of the COVID-19 Snapshot Monitoring (COSMO)-Spain project. The assessments included the 6-item COVID-19 Pandemic Fatigue Scale (CPFS) and other COVID-19--related variables: COVID-19 infection, adherence to preventive behaviors, information-seeking behavior, self-efficacy, worry, and cognitive and affective risk perception. Data quality, acceptability, reliability, and validity were analyzed according to CTT, and the fit to the Rasch model, unidimensionality, appropriateness of the response scale, item local independency, reliability (person-separation index [PSI]), and item-person distribution were also calculated. Results: The mean CPFS score was 17.06 (SD 5.04, range 6-30), with higher scores for women, younger participants, participants who never seek information on COVID-19, those who think they would contract a mild disease in case of infection, those with higher level of worry about coronavirus/COVID-19, and those who felt depressed or felt the coronavirus/COVID-19 is spreading slowly (all P<.01). The Cronbach alpha for the CPFS was 0.74. In the confirmatory factor analysis, one factor was identified (root mean square error of approximation [RMSEA]=.02; comparative fit index [CFI]=.99; $\chi$25=8.06, P=.15). The CPFS showed good fit to the Rasch model ($\chi$ 224=42.025, P=.01, PSI=.642), unidimensionality (binomial 95\% CI --.005 to .045), and item local independency. Conclusions: Our results suggest that the CPFS has moderate reliability and internal consistency and it is composed of a single dimension. It is a useful tool to ascertain the level of pandemic fatigue in the general population, which may help to guide the communication and information strategies to face the COVID-19 pandemic. ",
doi="10.2196/34675",
url="https://publichealth.jmir.org/2022/9/e34675",
url="http://www.ncbi.nlm.nih.gov/pubmed/35785547"
}


@Article{info:doi/10.2196/34757,
author="Palmer, Tanner
and Benson, Scott L.
and Porucznik, Christina
and Gren, H. Lisa",
title="Impact of COVID-19 Social Distancing Mandates on Gastrointestinal Pathogen Positivity: Secondary Data Analysis",
journal="JMIR Public Health Surveill",
year="2022",
month="Aug",
day="24",
volume="8",
number="8",
pages="e34757",
keywords="social distancing",
keywords="gastrointestinal",
keywords="COVID-19",
keywords="gastroenteritis",
keywords="surveillance",
keywords="epidemiology",
keywords="pathogen transmission",
keywords="respiratory pathogen",
keywords="public health",
keywords="pathogen outbreak",
keywords="outbreak",
keywords="surveillance tool",
keywords="diagnostic database",
abstract="Background: Acute gastrointestinal (GI) illnesses are of the most common problems evaluated by physicians and some of the most preventable. There is evidence of GI pathogen transmission when people are in close contact. The COVID-19 pandemic led to the sudden implementation of widespread social distancing measures in the United States. There is strong evidence that social distancing measures impact the spread of SARS-CoV-2, and a growing body of research indicates that these measures also decrease the transmission of other respiratory pathogens. Objective: This study aims to investigate the impact of COVID-19 social distancing mandates on the GI pathogen positivity rates. Methods: Deidentified GI Panel polymerase chain reaction test results from a routinely collected diagnostic database from January 1, 2019, through August 31, 2020, were analyzed for the GI pathogen positivity percentage. An interrupted time series analysis was performed, using social distancing mandate issue dates as the intervention date. The following 3 target organisms were chosen for the final analysis to represent different primary transmission routes: adenovirus F40 and 41, norovirus GI and GII, and Escherichia coli O157. Results: In total, 84,223 test results from 9 states were included in the final data set. With the exception of E coli O157 in Kansas, Michigan, and Nebraska, we observed an immediate decrease in positivity percentage during the week of social distancing mandates for all other targets and states. Norovirus GI and GII showed the most notable drop in positivity, whereas E coli O157 appeared to be least impacted by social distancing mandates. Although we acknowledge the analysis has a multiple testing problem, the majority of our significant results showed significance even below the .01 level. Conclusions: This study aimed to investigate the impact of social distancing mandates for COVID-19 on GI pathogen positivity, and we discovered that social distancing measures in fact decreased GI pathogen positivity initially. The use of similar measures may prove useful in GI pathogen outbreaks. The use of a unique diagnostic database in this study exhibits the potential for its use as a public health surveillance tool. ",
doi="10.2196/34757",
url="https://publichealth.jmir.org/2022/8/e34757",
url="http://www.ncbi.nlm.nih.gov/pubmed/35507923"
}


@Article{info:doi/10.2196/37668,
author="Meza-Torres, Bernardo
and Delanerolle, Gayathri
and Okusi, Cecilia
and Mayor, Nikhil
and Anand, Sneha
and Macartney, Jack
and Gatenby, Piers
and Glampson, Ben
and Chapman, Martin
and Curcin, Vasa
and Mayer, Erik
and Joy, Mark
and Greenhalgh, Trisha
and Delaney, Brendan
and de Lusignan, Simon",
title="Differences in Clinical Presentation With Long COVID After Community and Hospital Infection and Associations With All-Cause Mortality: English Sentinel Network Database Study",
journal="JMIR Public Health Surveill",
year="2022",
month="Aug",
day="16",
volume="8",
number="8",
pages="e37668",
keywords="medical record systems",
keywords="computerized",
keywords="Systematized Nomenclature of Medicine",
keywords="post--acute COVID-19 syndrome",
keywords="phenotype",
keywords="COVID-19",
keywords="post--COVID-19 syndrome",
keywords="long COVID",
keywords="ethnicity",
keywords="social class",
keywords="general practitioners",
keywords="data accuracy",
keywords="data extracts",
keywords="biomedical ontologies",
keywords="SARS-CoV-2",
keywords="hospitalization",
abstract="Background: Most studies of long COVID (symptoms of COVID-19 infection beyond 4 weeks) have focused on people hospitalized in their initial illness. Long COVID is thought to be underrecorded in UK primary care electronic records. Objective: We sought to determine which symptoms people present to primary care after COVID-19 infection and whether presentation differs in people who were not hospitalized, as well as post--long COVID mortality rates. Methods: We used routine data from the nationally representative primary care sentinel cohort of the Oxford--Royal College of General Practitioners Research and Surveillance Centre (N=7,396,702), applying a predefined long COVID phenotype and grouped by whether the index infection occurred in hospital or in the community. We included COVID-19 infection cases from March 1, 2020, to April 1, 2021. We conducted a before-and-after analysis of long COVID symptoms prespecified by the Office of National Statistics, comparing symptoms presented between 1 and 6 months after the index infection matched with the same months 1 year previously. We conducted logistic regression analysis, quoting odds ratios (ORs) with 95\% CIs. Results: In total, 5.63\% (416,505/7,396,702) and 1.83\% (7623/416,505) of the patients had received a coded diagnosis of COVID-19 infection and diagnosis of, or referral for, long COVID, respectively. People with diagnosis or referral of long COVID had higher odds of presenting the prespecified symptoms after versus before COVID-19 infection (OR 2.66, 95\% CI 2.46-2.88, for those with index community infection and OR 2.42, 95\% CI 2.03-2.89, for those hospitalized). After an index community infection, patients were more likely to present with nonspecific symptoms (OR 3.44, 95\% CI 3.00-3.95; P<.001) compared with after a hospital admission (OR 2.09, 95\% CI 1.56-2.80; P<.001). Mental health sequelae were more strongly associated with index hospital infections (OR 2.21, 95\% CI 1.64-2.96) than with index community infections (OR 1.36, 95\% CI 1.21-1.53; P<.001). People presenting to primary care after hospital infection were more likely to be men (OR 1.43, 95\% CI 1.25-1.64; P<.001), more socioeconomically deprived (OR 1.42, 95\% CI 1.24-1.63; P<.001), and with higher multimorbidity scores (OR 1.41, 95\% CI 1.26-1.57; P<.001) than those presenting after an index community infection. All-cause mortality in people with long COVID was associated with increasing age, male sex (OR 3.32, 95\% CI 1.34-9.24; P=.01), and higher multimorbidity score (OR 2.11, 95\% CI 1.34-3.29; P<.001). Vaccination was associated with reduced odds of mortality (OR 0.10, 95\% CI 0.03-0.35; P<.001). Conclusions: The low percentage of people recorded as having long COVID after COVID-19 infection reflects either low prevalence or underrecording. The characteristics and comorbidities of those presenting with long COVID after a community infection are different from those hospitalized. This study provides insights into the presentation of long COVID in primary care and implications for workload. ",
doi="10.2196/37668",
url="https://publichealth.jmir.org/2022/8/e37668",
url="http://www.ncbi.nlm.nih.gov/pubmed/35605170"
}


@Article{info:doi/10.2196/35840,
author="Luo, Wei
and Liu, Zhaoyin
and Zhou, Yuxuan
and Zhao, Yumin
and Li, Elita Yunyue
and Masrur, Arif
and Yu, Manzhu",
title="Investigating Linkages Between Spatiotemporal Patterns of the COVID-19 Delta Variant and Public Health Interventions in Southeast Asia: Prospective Space-Time Scan Statistical Analysis Method",
journal="JMIR Public Health Surveill",
year="2022",
month="Aug",
day="9",
volume="8",
number="8",
pages="e35840",
keywords="COVID-19",
keywords="Delta variant",
keywords="space-time scan",
keywords="intervention",
keywords="Southeast Asia",
abstract="Background: The COVID-19 Delta variant has presented an unprecedented challenge to countries in Southeast Asia (SEA). Its transmission has shown spatial heterogeneity in SEA after countries have adopted different public health interventions during the process. Hence, it is crucial for public health authorities to discover potential linkages between epidemic progression and corresponding interventions such that collective and coordinated control measurements can be designed to increase their effectiveness at reducing transmission in SEA. Objective: The purpose of this study is to explore potential linkages between the spatiotemporal progression of the COVID-19 Delta variant and nonpharmaceutical intervention (NPI) measures in SEA. We detected the space-time clusters of outbreaks of COVID-19 and analyzed how the NPI measures relate to the propagation of COVID-19. Methods: We collected district-level daily new cases of COVID-19 from June 1 to October 31, 2021, and district-level population data in SEA. We adopted prospective space-time scan statistics to identify the space-time clusters. Using cumulative prospective space-time scan statistics, we further identified variations of relative risk (RR) across each district at a half-month interval and their potential public health intervention linkages. Results: We found 7 high-risk clusters (clusters 1-7) of COVID-19 transmission in Malaysia, the Philippines, Thailand, Vietnam, and Indonesia between June and August, 2021, with an RR of 5.45 (P<.001), 3.50 (P<.001), 2.30 (P<.001), 1.36 (P<.001), 5.62 (P<.001), 2.38 (P<.001), 3.45 (P<.001), respectively. There were 34 provinces in Indonesia that have successfully mitigated the risk of COVID-19, with a decreasing range between --0.05 and --1.46 due to the assistance of continuous restrictions. However, 58.6\% of districts in Malaysia, Singapore, Thailand, and the Philippines saw an increase in the infection risk, which is aligned with their loosened restrictions. Continuous strict interventions were effective in mitigating COVID-19, while relaxing restrictions may exacerbate the propagation risk of this epidemic. Conclusions: The analyses of space-time clusters and RRs of districts benefit public health authorities with continuous surveillance of COVID-19 dynamics using real-time data. International coordination with more synchronized interventions amidst all SEA countries may play a key role in mitigating the progression of COVID-19. ",
doi="10.2196/35840",
url="https://publichealth.jmir.org/2022/8/e35840",
url="http://www.ncbi.nlm.nih.gov/pubmed/35861674"
}


@Article{info:doi/10.2196/37891,
author="Folkvord, Frans
and Peschke, Lutz
and A?ca, G{\"u}m{\"u}? Yasemin
and van Houten, Karlijn
and Stazi, Giacomo
and Lupi{\'a}{\~n}ez-Villanueva, Francisco",
title="Preferences in the Willingness to Download a COVID-19 Contact Tracing App in the Netherlands and Turkey: Experimental Study",
journal="JMIR Form Res",
year="2022",
month="Jul",
day="28",
volume="6",
number="7",
pages="e37891",
keywords="COVID-19 tracing app",
keywords="willingness to download",
keywords="discrete choice task",
keywords="pandemic",
keywords="mitigation strategies",
keywords="COVID-19",
keywords="health application",
keywords="mobile health",
keywords="gaming",
keywords="tracing application",
keywords="digital health",
keywords="data protection",
abstract="Background: Despite the worldwide growth in using COVID-19 contact tracing apps (CTAs) and the potential benefits for citizens, governments, health care professionals, businesses, and other organizations, only a few studies have examined the factors affecting the levels of willingness to download a CTA. Objective: This study aimed to investigate individuals' preferences in the willingness to download a health app. Methods: We conducted an experimental study in 2 countries, the Netherlands (N=62) and Turkey (N=83), using 4 different vignettes (ie, data protection, manufacturer, reward, and gaming models) with different attributes. Participants were randomly assigned to 1 of the conditions within the vignettes. Results: The results showed that data protection and gaming elements are factors that influence the willingness to download a COVID-19 CTA. More specifically, we see that data protection is an important factor explaining the willingness to download the app in Turkey, whereas including gaming elements significantly affects the willingness to download the app in the Netherlands. Conclusions: COVID-19 CTAs are highly promising to reduce the spread of the virus and make it easier to open up society faster, especially because they can be used quickly and share information rapidly. COVID-19 CTA developers must ensure that their apps satisfactorily and sufficiently address ethical considerations, even in times of crisis. Furthermore, integrating gaming elements in the CTA could enhance the willingness to download the CTA. ",
doi="10.2196/37891",
url="https://formative.jmir.org/2022/7/e37891",
url="http://www.ncbi.nlm.nih.gov/pubmed/35867840"
}


@Article{info:doi/10.2196/37929,
author="Burns, Joy
and Rivers, Patrick
and LeClair, B. Lindsay
and Jovel, S. Krystal
and Rai, P. Ramona
and Lowe, A. Ashley
and Edwards, J. Laura
and Khan, M. Sana
and Mathenge, Clare
and Ferraris, Maria
and Kuntz, L. Jennifer
and Lamberte, Mayo Julie
and Hegmann, T. Kurt
and Odean, J. Marilyn
and McLeland-Wieser, Hilary
and Beitel, Shawn
and Odame-Bamfo, Leah
and Schaefer Solle, Natasha
and Mak, Josephine
and Phillips, L. Andrew
and Sokol, E. Brian
and Hollister, James
and Ochoa, S. Jezahel
and Grant, Lauren
and Thiese, S. Matthew
and Jacoby, B. Keya
and Lutrick, Karen
and Pubillones, A. Felipe
and Yoo, M. Young
and Rentz Hunt, Danielle
and Ellingson, Katherine
and Berry, C. Mark
and Gerald, K. Joe
and Lopez, Joanna
and Gerald, B. Lynn
and Wesley, G. Meredith
and Krupp, Karl
and Herring, K. Meghan
and Madhivanan, Purnima
and Caban-Martinez, J. Alberto
and Tyner, L. Harmony
and Meece, K. Jennifer
and Yoon, K. Sarang
and Fowlkes, L. Ashley
and Naleway, L. Allison
and Gwynn, Lisa
and Burgess, L. Jefferey
and Thompson, G. Mark
and Olsho, EW Lauren
and Gaglani, Manjusha",
title="Pediatric Research Observing Trends and Exposures in COVID-19 Timelines (PROTECT): Protocol for a Multisite Longitudinal Cohort Study",
journal="JMIR Res Protoc",
year="2022",
month="Jul",
day="28",
volume="11",
number="7",
pages="e37929",
keywords="COVID-19",
keywords="SARS-CoV-2",
keywords="vaccine effectiveness",
keywords="vaccine",
keywords="efficacy",
keywords="effectiveness",
keywords="cohort study",
keywords="pediatric",
keywords="child",
keywords="inoculation",
keywords="vaccination",
keywords="public health",
keywords="children",
keywords="health care professional",
keywords="health care",
keywords="caregiver",
keywords="health data",
keywords="online survey",
keywords="incidence",
abstract="Background: Assessing the real-world effectiveness of COVID-19 vaccines and understanding the incidence and severity of SARS-CoV-2 illness in children are essential to inform policy and guide health care professionals in advising parents and caregivers of children who test positive for SARS-CoV-2. Objective: This report describes the objectives and methods for conducting the Pediatric Research Observing Trends and Exposures in COVID-19 Timelines (PROTECT) study. PROTECT is a longitudinal prospective pediatric cohort study designed to estimate SARS-CoV-2 incidence and COVID-19 vaccine effectiveness (VE) against infection among children aged 6 months to 17 years, as well as differences in SARS-CoV-2 infection and vaccine response between children and adolescents. Methods: The PROTECT multisite network was initiated in July 2021, which aims to enroll approximately 2305 children across four US locations and collect data over a 2-year surveillance period. The enrollment target was based on prospective power calculations and accounts for expected attrition and nonresponse. Study sites recruit parents and legal guardians of age-eligible children participating in the existing Arizona Healthcare, Emergency Response, and Other Essential Workers Surveillance (HEROES)-Research on the Epidemiology of SARS-CoV-2 in Essential Response Personnel (RECOVER) network as well as from surrounding communities. Child demographics, medical history, COVID-19 exposure, vaccination history, and parents/legal guardians' knowledge and attitudes about COVID-19 are collected at baseline and throughout the study. Mid-turbinate nasal specimens are self-collected or collected by parents/legal guardians weekly, regardless of symptoms, for SARS-CoV-2 and influenza testing via reverse transcription-polymerase chain reaction (RT-PCR) assay, and the presence of COVID-like illness (CLI) is reported. Children who test positive for SARS-CoV-2 or influenza, or report CLI are monitored weekly by online surveys to report exposure and medical utilization until no longer ill. Children, with permission of their parents/legal guardians, may elect to contribute blood at enrollment, following SARS-CoV-2 infection, following COVID-19 vaccination, and at the end of the study period. PROTECT uses electronic medical record (EMR) linkages where available, and verifies COVID-19 and influenza vaccinations through EMR or state vaccine registries. Results: Data collection began in July 2021 and is expected to continue through the spring of 2023. As of April 13, 2022, 2371 children are enrolled in PROTECT. Enrollment is ongoing at all study sites. Conclusions: As COVID-19 vaccine products are authorized for use in pediatric populations, PROTECT study data will provide real-world estimates of VE in preventing infection. In addition, this prospective cohort provides a unique opportunity to further understand SARS-CoV-2 incidence, clinical course, and key knowledge gaps that may inform public health. International Registered Report Identifier (IRRID): RR1-10.2196/37929 ",
doi="10.2196/37929",
url="https://www.researchprotocols.org/2022/7/e37929",
url="http://www.ncbi.nlm.nih.gov/pubmed/35635842"
}


@Article{info:doi/10.2196/37454,
author="Hanson, L. Bridget
and Finley, Kari
and Otto, Jay
and Ward, J. Nicholas",
title="Role of Trusted Sources and Behavioral Beliefs in Promoting Mitigation Behaviors During the COVID-19 Pandemic: Survey Study",
journal="JMIR Hum Factors",
year="2022",
month="Jul",
day="13",
volume="9",
number="3",
pages="e37454",
keywords="behavioral beliefs",
keywords="health literacy",
keywords="vaccination",
keywords="trusted sources",
keywords="social media",
keywords="vaccine hesitancy",
keywords="health information",
keywords="masking",
keywords="healthcare",
keywords="public health",
keywords="health beliefs",
abstract="Background: During the ongoing COVID-19 pandemic and in preparation for future public health crises, it is important to understand the relationship between individuals' health beliefs, including their trust in various sources of health information, and their engagement in mitigation behaviors. Objective: We sought to identify relationships between trust in various sources of health information and the behavioral beliefs related to vaccination and mask wearing as well as to understand how behavioral beliefs related to vaccination differ by willingness to be vaccinated. Methods: We conducted an online survey of 1034 adults in the United States and assessed their trust in federal, local, and media sources of health information; their beliefs about vaccination; and their masking intention and vaccination willingness. Results: Using regression, masking intention was predicted by trust in the World Health Organization (P<.05) and participants' state public health offices (P<.05), while vaccine willingness was predicted by trust in participants' own health care providers (P<.05) and pharmaceutical companies (P<.001). Compared to individuals with low willingness to be vaccinated, individuals with high willingness indicated greater endorsement of beliefs that vaccines would support a return to normalcy, are safe, and are a social responsibility (P<.001 for all). Conclusions: Results can be used to inform ongoing public health messaging campaigns to manage the COVID-19 pandemic and increase readiness for the next pandemic. Additionally, results support the need to bolster the public's trust in health care agencies as well as to enhance trust and respect in health care providers to increase people's adoption of mitigation behaviors. ",
doi="10.2196/37454",
url="https://humanfactors.jmir.org/2022/3/e37454",
url="http://www.ncbi.nlm.nih.gov/pubmed/35830238"
}


@Article{info:doi/10.2196/37961,
author="Abdel Azim, Sara
and Vecerek, Natalia
and Ortega-Loayza, G. Alex
and Bauer, Andrea
and Adler, L. Brandon",
title="From the Cochrane Library: Interventions for Preventing Occupational Irritant Hand Dermatitis",
journal="JMIR Dermatol",
year="2022",
month="Jul",
day="6",
volume="5",
number="3",
pages="e37961",
keywords="occupational irritant hand dermatitis",
keywords="barrier creams",
keywords="moisturizers",
keywords="skin protection education",
keywords="protective gloves",
keywords="prevention",
keywords="COVID-19",
keywords="Cochrane",
keywords="meta-analysis",
keywords="irritant",
keywords="dermatitis",
keywords="hand",
keywords="skin",
keywords="dermatology",
keywords="occupational",
keywords="skin disease",
keywords="protection",
doi="10.2196/37961",
url="https://derma.jmir.org/2022/3/e37961",
url="http://www.ncbi.nlm.nih.gov/pubmed/37632884"
}


@Article{info:doi/10.2196/33995,
author="Yao, Yan
and Chai, Ruiyu
and Yang, Jianzhou
and Zhang, Xiangjun
and Huang, Xiaojie
and Yu, Maohe
and Fu, Geng-feng
and Lan, Guanghua
and Qiao, Ying
and Zhou, Qidi
and Li, Shuyue
and Xu, Junjie",
title="Reasons for COVID-19 Vaccine Hesitancy Among Chinese People Living With HIV/AIDS: Structural Equation Modeling Analysis",
journal="JMIR Public Health Surveill",
year="2022",
month="Jun",
day="30",
volume="8",
number="6",
pages="e33995",
keywords="COVID-19 vaccine",
keywords="vaccine hesitancy",
keywords="PLWHA",
keywords="structural equation modeling",
abstract="Background: Many countries and organizations recommended people living with HIV/AIDS (PLWHA) receive the COVID-19 vaccine. However, vaccine hesitancy still exists and becomes a barrier for promoting COVID-19 vaccination among PLWHA. Objective: This study aims to investigate factors that contributed to COVID-19 vaccine hesitancy among PLWHA. Methods: The study used a multicenter cross-sectional design and an online survey mode. We recruited PLWHA aged 18-65 years from 5 metropolitan cities in China between January 2021 and February 2021. Participants completed an online survey through Golden Data, a widely used encrypted web-based survey platform. Multiple linear regression models were used to assess the background characteristics in relation to COVID-19 vaccine hesitancy, and structural equation modeling was performed to assess the relationships among perceived benefits, perceived risks, self-efficacy, subjective norms, and COVID-19 vaccine hesitancy. Results: Among 1735 participants, 41.61\% (722/1735) reported COVID-19 vaccine hesitancy. Older age, no other vaccinations in the past 3 years, and having chronic disease history were positively associated with COVID-19 vaccine hesitancy. Structural equation modeling revealed a direct relationship of perceived benefits, perceived risks, and subjective norms with self-efficacy and vaccine hesitancy and an indirect relationship of perceived benefits, perceived risks, and subjective norms with vaccine hesitancy. Moreover, self-efficacy toward COVID-19 vaccination was low. PLWHA had concerns of HIV disclosure during COVID-19 vaccination. Family member support could have an impact on COVID-19 vaccination decision-making. Conclusions: COVID-19 vaccine hesitancy was high among PLWHA in China. To reduce COVID-19 vaccine hesitancy, programs and strategies should be adopted to eliminate the concerns for COVID-19 vaccination, disseminate accurate information on the safety and efficacy of the COVID-19 vaccine, encourage family member support for COVID-19 vaccination, and improve PLWHA's trust of medical professionals. ",
doi="10.2196/33995",
url="https://publichealth.jmir.org/2022/6/e33995",
url="http://www.ncbi.nlm.nih.gov/pubmed/35486810"
}


@Article{info:doi/10.2196/33429,
author="Li, Yiping
and Wang, Qinjian
and Liang, Shu
and Feng, Chuanteng
and Yang, Hong
and Yu, Hang
and Yuan, Dan
and Yang, Shujuan",
title="Effect of Switching Antiretroviral Treatment Regimen in Patients With Drug-Resistant HIV-1 Infection: Retrospective Observational Cohort Study",
journal="JMIR Public Health Surveill",
year="2022",
month="Jun",
day="24",
volume="8",
number="6",
pages="e33429",
keywords="HIV",
keywords="antiretroviral therapy",
keywords="drug resistance",
keywords="protease inhibitors",
keywords="parametric g-formula",
abstract="Background: Evidence on the efficacy of antiretroviral therapy (ART) regimen switches on the mortality of patients with HIV drug resistance (HIVDR) is limited. Objective: We aim to provide policy guidance for ART regimen selection and evaluate the effectiveness of ART regime switches for people living with HIV and HIV-1 drug resistance. Methods: This retrospective observational cohort study included 179 people living with HIV and HIV-1 drug resistance from 2011 to 2020. The time that participants switched treatment regimens either to protease inhibitor (PI)--based ART regimens (PIs) or nonnucleoside reverse transcriptase inhibitor (NNRTI)--based ART regimens (NNRTIs) was taken as an observation starting point and followed up every 12 months. The parametric g-formula was used to estimate the 5-year risk of mortality under the situations of (1) natural course, (2) immediate switch to NNRTIs, (3) immediate switch to PIs, and (4) if CD4(+) T cells<200 switched to PIs. Results: The follow-up time of the 179 patients ranged from 30 to 119 months. The median follow-up time was 90 months. During a follow-up of 15,606 person-months, 27 individuals died in the cohort. The estimated 5-year risk of mortality under natural course, immediate switch to NNRTIs, immediate switch to PIs, and if CD4(+), and switch to PIs if T cells<200 were 11.62\% (95\% CI 7.82-17.11), 31.88\% (95\% CI 20.79-44.94), 2.87\% (95\% CI 0.32-7.07), and 5.30\% (95\% CI 2.07-10.21), respectively. The risk ratios (RRs) of immediate switch to NNRTIs, immediate switch to PIs, and switch to PIs if CD4(+) T cells<200, compared with natural course mortality rate, were 2.74 (95\% CI 2.01-3.47), 0.25 (95\% CI: 0.04-0.54), and 0.46 (95\% CI 0.22-0.71), respectively. The risk differences were 20.26\% (95\% CI 10.96-28.61), --8.76\% (95\% CI --13.34 to --5.09) and --6.32\% (95\% CI --9.75 to --3.11), respectively. Conclusions: Our study found that a PI-based ART regimen was beneficial for reducing mortality in people living with HIV and HIV-1 drug resistance. More effort should be given to find HIV-1 drug resistance earlier to ensure a timely adjustment to PI-based ART, thereby maximizing the benefit of early switch treatment for people living with HIV and HIV-1 drug resistance. ",
doi="10.2196/33429",
url="https://publichealth.jmir.org/2022/6/e33429",
url="http://www.ncbi.nlm.nih.gov/pubmed/35749212"
}


@Article{info:doi/10.2196/35343,
author="Zhao, Xixi
and Li, Meijia
and Haihambo, Naem
and Jin, Jianhua
and Zeng, Yimeng
and Qiu, Jinyi
and Guo, Mingrou
and Zhu, Yuyao
and Li, Zhirui
and Liu, Jiaxin
and Teng, Jiayi
and Li, Sixiao
and Zhao, Ya-nan
and Cao, Yanxiang
and Wang, Xuemei
and Li, Yaqiong
and Gao, Michel
and Feng, Xiaoyang
and Han, Chuanliang",
title="Changes in Temporal Properties of Notifiable Infectious Disease Epidemics in China During the COVID-19 Pandemic: Population-Based Surveillance Study",
journal="JMIR Public Health Surveill",
year="2022",
month="Jun",
day="23",
volume="8",
number="6",
pages="e35343",
keywords="class B infectious disease",
keywords="COVID-19",
keywords="event-related trough",
keywords="infection selectivity",
keywords="oscillation",
keywords="public health interventions",
keywords="pandemic",
keywords="surveillance",
keywords="health policy",
keywords="epidemiology",
keywords="prevention policy",
keywords="public health",
keywords="risk prevention",
abstract="Background: COVID-19 was first reported in 2019, and the Chinese government immediately carried out stringent and effective control measures in response to the epidemic. Objective: Nonpharmaceutical interventions (NPIs) may have impacted incidences of other infectious diseases as well. Potential explanations underlying this reduction, however, are not clear. Hence, in this study, we aim to study the influence of the COVID-19 prevention policies on other infectious diseases (mainly class B infectious diseases) in China. Methods: Time series data sets between 2017 and 2021 for 23 notifiable infectious diseases were extracted from public data sets from the National Health Commission of the People's Republic of China. Several indices (peak and trough amplitudes, infection selectivity, preferred time to outbreak, oscillatory strength) of each infectious disease were calculated before and after the COVID-19 outbreak. Results: We found that the prevention and control policies for COVID-19 had a strong, significant reduction effect on outbreaks of other infectious diseases. A clear event-related trough (ERT) was observed after the outbreak of COVID-19 under the strict control policies, and its decreasing amplitude is related to the infection selectivity and preferred outbreak time of the disease before COVID-19. We also calculated the oscillatory strength before and after the COVID-19 outbreak and found that it was significantly stronger before the COVID-19 outbreak and does not correlate with the trough amplitude. Conclusions: Our results directly demonstrate that prevention policies for COVID-19 have immediate additional benefits for controlling most class B infectious diseases, and several factors (infection selectivity, preferred outbreak time) may have contributed to the reduction in outbreaks. This study may guide the implementation of nonpharmaceutical interventions to control a wider range of infectious diseases. ",
doi="10.2196/35343",
url="https://publichealth.jmir.org/2022/6/e35343",
url="http://www.ncbi.nlm.nih.gov/pubmed/35649394"
}


@Article{info:doi/10.2196/37004,
author="Dang, Ting
and Han, Jing
and Xia, Tong
and Spathis, Dimitris
and Bondareva, Erika
and Siegele-Brown, Chlo{\"e}
and Chauhan, Jagmohan
and Grammenos, Andreas
and Hasthanasombat, Apinan
and Floto, Andres R.
and Cicuta, Pietro
and Mascolo, Cecilia",
title="Exploring Longitudinal Cough, Breath, and Voice Data for COVID-19 Progression Prediction via Sequential Deep Learning: Model Development and Validation",
journal="J Med Internet Res",
year="2022",
month="Jun",
day="21",
volume="24",
number="6",
pages="e37004",
keywords="COVID-19",
keywords="audio",
keywords="COVID-19 progression",
keywords="deep learning",
keywords="mobile health",
keywords="longitudinal study",
abstract="Background: Recent work has shown the potential of using audio data (eg, cough, breathing, and voice) in the screening for COVID-19. However, these approaches only focus on one-off detection and detect the infection, given the current audio sample, but do not monitor disease progression in COVID-19. Limited exploration has been put forward to continuously monitor COVID-19 progression, especially recovery, through longitudinal audio data. Tracking disease progression characteristics and patterns of recovery could bring insights and lead to more timely treatment or treatment adjustment, as well as better resource management in health care systems. Objective: The primary objective of this study is to explore the potential of longitudinal audio samples over time for COVID-19 progression prediction and, especially, recovery trend prediction using sequential deep learning techniques. Methods: Crowdsourced respiratory audio data, including breathing, cough, and voice samples, from 212 individuals over 5-385 days were analyzed, alongside their self-reported COVID-19 test results. We developed and validated a deep learning--enabled tracking tool using gated recurrent units (GRUs) to detect COVID-19 progression by exploring the audio dynamics of the individuals' historical audio biomarkers. The investigation comprised 2 parts: (1) COVID-19 detection in terms of positive and negative (healthy) tests using sequential audio signals, which was primarily assessed in terms of the area under the receiver operating characteristic curve (AUROC), sensitivity, and specificity, with 95\% CIs, and (2) longitudinal disease progression prediction over time in terms of probability of positive tests, which was evaluated using the correlation between the predicted probability trajectory and self-reported labels. Results: We first explored the benefits of capturing longitudinal dynamics of audio biomarkers for COVID-19 detection. The strong performance, yielding an AUROC of 0.79, a sensitivity of 0.75, and a specificity of 0.71 supported the effectiveness of the approach compared to methods that do not leverage longitudinal dynamics. We further examined the predicted disease progression trajectory, which displayed high consistency with longitudinal test results with a correlation of 0.75 in the test cohort and 0.86 in a subset of the test cohort with 12 (57.1\%) of 21 COVID-19--positive participants who reported disease recovery. Our findings suggest that monitoring COVID-19 evolution via longitudinal audio data has potential in the tracking of individuals' disease progression and recovery. Conclusions: An audio-based COVID-19 progression monitoring system was developed using deep learning techniques, with strong performance showing high consistency between the predicted trajectory and the test results over time, especially for recovery trend predictions. This has good potential in the postpeak and postpandemic era that can help guide medical treatment and optimize hospital resource allocations. The changes in longitudinal audio samples, referred to as audio dynamics, are associated with COVID-19 progression; thus, modeling the audio dynamics can potentially capture the underlying disease progression process and further aid COVID-19 progression prediction. This framework provides a flexible, affordable, and timely tool for COVID-19 tracking, and more importantly, it also provides a proof of concept of how telemonitoring could be applicable to respiratory diseases monitoring, in general. ",
doi="10.2196/37004",
url="https://www.jmir.org/2022/6/e37004",
url="http://www.ncbi.nlm.nih.gov/pubmed/35653606"
}


@Article{info:doi/10.2196/36882,
author="Vilendrer, Stacie
and Lough, E. Mary
and Garvert, W. Donn
and Lambert, H. Monique
and Lu, Hsijing Jonathan
and Patel, Birju
and Shah, H. Nigam
and Williams, Y. Michelle
and Kling, R. Samantha M.",
title="Nursing Workflow Change in a COVID-19 Inpatient Unit Following the Deployment of Inpatient Telehealth: Observational Study Using a Real-Time Locating System",
journal="J Med Internet Res",
year="2022",
month="Jun",
day="17",
volume="24",
number="6",
pages="e36882",
keywords="telemedicine",
keywords="telehealth",
keywords="informatics",
keywords="real-time locating system",
keywords="COVID-19",
keywords="pandemic",
keywords="nursing",
keywords="patient safety",
keywords="PPE",
keywords="virtual care",
keywords="nurses",
keywords="patient outcomes",
keywords="pathogen exposure",
keywords="health risk",
keywords="health care staff",
keywords="health care professional",
abstract="Background: The COVID-19 pandemic prompted widespread implementation of telehealth, including in the inpatient setting, with the goals to reduce potential pathogen exposure events and personal protective equipment (PPE) utilization. Nursing workflow adaptations in these novel environments are of particular interest given the association between nursing time at the bedside and patient safety. Understanding the frequency and duration of nurse-patient encounters following the introduction of a novel telehealth platform in the context of COVID-19 may therefore provide insight into downstream impacts on patient safety, pathogen exposure, and PPE utilization. Objective: The aim of this study was to evaluate changes in nursing workflow relative to prepandemic levels using a real-time locating system (RTLS) following the deployment of inpatient telehealth on a COVID-19 unit. Methods: In March 2020, telehealth was installed in patient rooms in a COVID-19 unit and on movable carts in 3 comparison units. The existing RTLS captured nurse movement during 1 pre- and 5 postpandemic stages (January-December 2020). Change in direct nurse-patient encounters, time spent in patient rooms per encounter, and total time spent with patients per shift relative to baseline were calculated. Generalized linear models assessed difference-in-differences in outcomes between COVID-19 and comparison units. Telehealth adoption was captured and reported at the unit level. Results: Change in frequency of encounters and time spent per encounter from baseline differed between the COVID-19 and comparison units at all stages of the pandemic (all P<.001). Frequency of encounters decreased (difference-in-differences range --6.6 to --14.1 encounters) and duration of encounters increased (difference-in-differences range 1.8 to 6.2 minutes) from baseline to a greater extent in the COVID-19 units relative to the comparison units. At most stages of the pandemic, the change in total time nurses spent in patient rooms per patient per shift from baseline did not differ between the COVID-19 and comparison units (all P>.17). The primary COVID-19 unit quickly adopted telehealth technology during the observation period, initiating 15,088 encounters that averaged 6.6 minutes (SD 13.6) each. Conclusions: RTLS movement data suggest that total nursing time at the bedside remained unchanged following the deployment of inpatient telehealth in a COVID-19 unit. Compared to other units with shared mobile telehealth units, the frequency of nurse-patient in-person encounters decreased and the duration lengthened on a COVID-19 unit with in-room telehealth availability, indicating ``batched'' redistribution of work to maintain total time at bedside relative to prepandemic periods. The simultaneous adoption of telehealth suggests that virtual care was a complement to, rather than a replacement for, in-person care. However, study limitations preclude our ability to draw a causal link between nursing workflow change and telehealth adoption. Thus, further evaluation is needed to determine potential downstream implications on disease transmission, PPE utilization, and patient safety. ",
doi="10.2196/36882",
url="https://www.jmir.org/2022/6/e36882",
url="http://www.ncbi.nlm.nih.gov/pubmed/35635840"
}


@Article{info:doi/10.2196/37327,
author="Johnson, K. Randi
and Marker, M. Katie
and Mayer, David
and Shortt, Jonathan
and Kao, David
and Barnes, C. Kathleen
and Lowery, T. Jan
and Gignoux, R. Christopher",
title="COVID-19 Surveillance in the Biobank at the Colorado Center for Personalized Medicine: Observational Study",
journal="JMIR Public Health Surveill",
year="2022",
month="Jun",
day="13",
volume="8",
number="6",
pages="e37327",
keywords="COVID-19",
keywords="surveillance",
keywords="pandemic",
keywords="biobank",
keywords="EHR",
keywords="public health",
keywords="integrated data",
keywords="population health",
keywords="health monitoring",
keywords="electronic health record",
keywords="eHealth",
keywords="health record",
keywords="emergency response",
keywords="vaccination status",
keywords="vaccination",
keywords="testing",
keywords="symptom",
keywords="disease impact",
abstract="Background: Characterizing the experience and impact of the COVID-19 pandemic among various populations remains challenging due to the limitations inherent in common data sources, such as electronic health records (EHRs) or cross-sectional surveys. Objective: This study aims to describe testing behaviors, symptoms, impact, vaccination status, and case ascertainment during the COVID-19 pandemic using integrated data sources. Methods: In summer 2020 and 2021, we surveyed participants enrolled in the Biobank at the Colorado Center for Personalized Medicine (CCPM; N=180,599) about their experience with COVID-19. The prevalence of testing, symptoms, and impacts of COVID-19 on employment, family life, and physical and mental health were calculated overall and by demographic categories. Survey respondents who reported receiving a positive COVID-19 test result were considered a ``confirmed case'' of COVID-19. Using EHRs, we compared COVID-19 case ascertainment and characteristics in EHRs versus the survey. Positive cases were identified in EHRs using the International Statistical Classification of Diseases, 10th revision (ICD-10) diagnosis codes, health care encounter types, and encounter primary diagnoses. Results: Of the 25,063 (13.9\%) survey respondents, 10,661 (42.5\%) had been tested for COVID-19, and of those, 1366 (12.8\%) tested positive. Nearly half of those tested had symptoms or had been exposed to someone who was infected. Young adults (18-29 years) and Hispanics were more likely to have positive tests compared to older adults and persons of other racial/ethnic groups. Mental health (n=13,688, 54.6\%) and family life (n=12,233, 48.8\%) were most negatively affected by the pandemic and more so among younger groups and women; negative impacts on employment were more commonly reported among Black respondents. Of the 10,249 individuals who responded to vaccination questions from version 2 of the survey (summer 2021), 9770 (95.3\%) had received the vaccine. After integration with EHR data up to the time of the survey completion, 1006 (4\%) of the survey respondents had a discordant COVID-19 case status between EHRs and the survey. Using all longitudinal EHR and survey data, we identified 11,472 (6.4\%) COVID-19-positive cases among Biobank participants. In comparison to COVID-19 cases identified through the survey, EHR-identified cases were younger and more likely to be Hispanic. Conclusions: We found that the COVID-19 pandemic has had far-reaching and varying effects among our Biobank participants. Integrated data assets, such as the Biobank at the CCPM, are key resources for population health monitoring in response to public health emergencies, such as the COVID-19 pandemic. ",
doi="10.2196/37327",
url="https://publichealth.jmir.org/2022/6/e37327",
url="http://www.ncbi.nlm.nih.gov/pubmed/35486493"
}


@Article{info:doi/10.2196/33484,
author="Yu, Hanzhi
and Du, Runming
and Wang, Minmin
and Yu, Fengyun
and Yang, Juntao
and Jiao, Lirui
and Wang, Zhuoran
and Liu, Haitao
and Wu, Peixin
and B{\"a}rnighausen, Till
and Xue, Lan
and Wang, Chen
and McMahon, Shannon
and Geldsetzer, Pascal
and Chen, Simiao",
title="Attitudes Toward the Global Allocation of Chinese COVID-19 Vaccines: Cross-sectional Online Survey of Adults Living in China",
journal="JMIR Public Health Surveill",
year="2022",
month="Jun",
day="7",
volume="8",
number="6",
pages="e33484",
keywords="COVID-19 vaccines",
keywords="China",
keywords="global allocation",
keywords="public attitudes",
keywords="cross-sectional",
keywords="survey",
keywords="vaccines",
keywords="COVID-19",
keywords="pandemic",
keywords="public health",
keywords="health policy",
keywords="epidemiology",
abstract="Background: COVID-19 vaccines are in short supply worldwide. China was among the first countries to pledge supplies of the COVID-19 vaccine as a global public product, and to date, the country has provided more than 600 million vaccines to more than 200 countries and regions with low COVID-19 vaccination rates. Understanding the public's attitude in China toward the global distribution of COVID-19 vaccines could inform global and national decisions, policies, and debates. Objective: The aim of this study was to determine the attitudes of adults living in China regarding the global allocation of COVID-19 vaccines developed in China and how these attitudes vary across provinces and by sociodemographic characteristics. Methods: We conducted a cross-sectional online survey among adults registered with the survey company KuRunData. The survey asked participants 31 questions about their attitudes regarding the global allocation of COVID-19 vaccines developed in China. We disaggregated responses by province and sociodemographic characteristics. All analyses used survey sampling weights. Results: A total of 10,000 participants completed the questionnaire. Participants generally favored providing COVID-19 vaccines to foreign countries before fulfilling domestic needs (75.6\%, 95\% CI 74.6\%-76.5\%). Women (3778/4921, 76.8\%; odds ratio 1.18, 95\% CI 1.07-1.32; P=.002) and those living in rural areas (3123/4065, 76.8\%; odds ratio 1.13, 95\% CI 1.01-1.27; P=.03) were especially likely to hold this opinion. Most respondents preferred providing financial support through international platforms rather than directly offering support to individual countries (72.1\%, 95\% CI 71\%-73.1\%), while for vaccine products they preferred direct provision to relevant countries instead of via a delivery platform such as COVAX (77.3\%, 95\% CI 76.3\%-78.2\%). Conclusions: Among our survey sample, we found that adults are generally supportive of the international distribution of COVID-19 vaccines, which may encourage policy makers to support and implement the distribution of COVID-19 vaccines developed in China worldwide. Conducting similar surveys in other countries could help align policy makers' actions on COVID-19 vaccine distribution with the preferences of their constituencies. ",
doi="10.2196/33484",
url="https://publichealth.jmir.org/2022/6/e33484",
url="http://www.ncbi.nlm.nih.gov/pubmed/35483084"
}


@Article{info:doi/10.2196/31955,
author="Froese, Henri
and A Prempeh, G. Angel",
title="Mask Use to Curtail Influenza in a Post--COVID-19 World: Modeling Study",
journal="JMIRx Med",
year="2022",
month="May",
day="27",
volume="3",
number="2",
pages="e31955",
keywords="mask",
keywords="protection",
keywords="COVID-19",
keywords="influenza",
keywords="transmission",
keywords="intervention",
keywords="infectious disease",
keywords="respiratory",
keywords="simulation",
keywords="model",
keywords="prevalence",
keywords="efficacy",
abstract="Background: Face mask mandates have been instrumental in the reduction of transmission of airborne COVID-19. Thus, the question arises whether comparatively mild measures should be kept in place after the pandemic to reduce other airborne diseases such as influenza. Objective: In this study, we aim to simulate the quantitative impact of face masks on the rate of influenza illnesses in the United States. Methods: Using the Centers for Disease Control and Prevention data from 2010 to 2019, we used a series of differential equations to simulate past influenza seasons, assuming that people wore face masks. This was achieved by introducing a variable to account for the efficacy and prevalence of masks and then analyzing its impact on influenza transmission rate in a susceptible-exposed-infected-recovered model fit to the actual past seasons. We then compared influenza rates in this hypothetical scenario with the actual rates over the seasons. Results: Our results show that several combinations of mask efficacy and prevalence can substantially reduce the burden of seasonal influenza. Across all the years modeled, a mask prevalence of 0.2 (20\%) and assumed moderate inward and outward mask efficacy of 0.45 (45\%) reduced influenza infections by >90\%. Conclusions: A minority of individuals wearing masks substantially reduced the number of influenza infections across seasons. Considering the efficacy rates of masks and the relatively insignificant monetary cost, we highlight that it may be a viable alternative or complement to influenza vaccinations. ",
doi="10.2196/31955",
url="https://med.jmirx.org/2022/2/e31955",
url="http://www.ncbi.nlm.nih.gov/pubmed/35666696"
}


@Article{info:doi/10.2196/32278,
author="Xu, Yue
and Wu, Qingqing
and Xu, Shuiyang
and Zhao, Yusui
and Zhang, Xuehai",
title="Factors Associated With Protective Mask-Wearing Behavior to Avoid COVID-19 Infection in China: Internet-Based Cross-sectional Study",
journal="JMIR Public Health Surveill",
year="2022",
month="May",
day="26",
volume="8",
number="5",
pages="e32278",
keywords="COVID-19",
keywords="internet-based",
keywords="disease prevention",
keywords="mask",
keywords="knowledge",
keywords="behavior",
abstract="Background: The novel coronavirus disease COVID-19 is likely to spread from person to person in close-contact settings. The Chinese Center for Disease Control and Prevention released a handbook on COVID-19, which introduced health information to the public, specifically related to wearing masks correctly and adopting preventive measures to avoid COVID-19 infection. Objective: The aim of this study was to assess the level of mask knowledge, behavior related to mask usage, and major information channels used for obtaining mask- and COVID-19--related information in China. Methods: An internet-based survey was conducted primarily using DingXiang Doctor WeChat public accounts. The data about mask knowledge and behavior were collected and analyzed. In addition to descriptive statistics, logistic regression was used to analyze significant risk factors contributing to protective mask behavior. Results: Data were collected from a total of 10,304 respondents to the survey. More than half of the respondents were under 30 years old and nearly three-quarters were women. Over 80\% of participants had a bachelor's degree or higher, and the largest proportion of respondents (n=4204, 40.80\%) were employed as business/service workers. Over half of the study participants were married (n=5302, 51.46\%). The findings revealed that 67.49\% (6954/10,304) of the participants practiced protective mask behavior; 97.93\% (10,091/10,304) believed that wearing masks is an effective protective measure against COVID-19; 96.85\% (9979/10,304) chose a mask that has two or more layers of washable, breathable fabric; and 70.57\% (7272/10,304) wore the masks correctly. Gender, age, occupation, and education level had significant effects on behavior, whereas marital status and the infection status of family members were not significantly related to mask-wearing behavior. In addition, WeChat public accounts (9227/10,304, 89.55\%) were the most prominent source of obtaining health information for Chinese netizens after the outbreak of COVID-19. Conclusions: This study elucidated that Chinese netizens' protective mask behavior is far lower than their mask-related knowledge. Improved information channels and adequate information on wearing masks are necessary to improve the public's protective mask behavior, particularly among men, the elderly, and people with less education. ",
doi="10.2196/32278",
url="https://publichealth.jmir.org/2022/5/e32278",
url="http://www.ncbi.nlm.nih.gov/pubmed/35486491"
}


@Article{info:doi/10.2196/35311,
author="Liu, Cong
and Lee, Junghwan
and Ta, Casey
and Soroush, Ali
and Rogers, R. James
and Kim, Hyun Jae
and Natarajan, Karthik
and Zucker, Jason
and Perl, Yehoshua
and Weng, Chunhua",
title="Risk Factors Associated With SARS-CoV-2 Breakthrough Infections in Fully mRNA-Vaccinated Individuals: Retrospective Analysis",
journal="JMIR Public Health Surveill",
year="2022",
month="May",
day="24",
volume="8",
number="5",
pages="e35311",
keywords="COVID-19",
keywords="medical informatics",
keywords="real-word evidence",
keywords="vaccination",
keywords="electronic health records",
abstract="Background: COVID-19 messenger RNA (mRNA) vaccines have demonstrated efficacy and effectiveness in preventing symptomatic COVID-19, while being relatively safe in trial studies. However, vaccine breakthrough infections have been reported. Objective: This study aims to identify risk factors associated with COVID-19 breakthrough infections among fully mRNA-vaccinated individuals. Methods: We conducted a series of observational retrospective analyses using the electronic health records (EHRs) of the Columbia University Irving Medical Center/New York Presbyterian (CUIMC/NYP) up to September 21, 2021. New York City (NYC) adult residences with at least 1 polymerase chain reaction (PCR) record were included in this analysis. Poisson regression was performed to assess the association between the breakthrough infection rate in vaccinated individuals and multiple risk factors---including vaccine brand, demographics, and underlying conditions---while adjusting for calendar month, prior number of visits, and observational days in the EHR. Results: The overall estimated breakthrough infection rate was 0.16 (95\% CI 0.14-0.18). Individuals who were vaccinated with Pfizer/BNT162b2 (incidence rate ratio [IRR] against Moderna/mRNA-1273=1.66, 95\% CI 1.17-2.35) were male (IRR against female=1.47, 95\% CI 1.11-1.94) and had compromised immune systems (IRR=1.48, 95\% CI 1.09-2.00) were at the highest risk for breakthrough infections. Among all underlying conditions, those with primary immunodeficiency, a history of organ transplant, an active tumor, use of immunosuppressant medications, or Alzheimer disease were at the highest risk. Conclusions: Although we found both mRNA vaccines were effective, Moderna/mRNA-1273 had a lower incidence rate of breakthrough infections. Immunocompromised and male individuals were among the highest risk groups experiencing breakthrough infections. Given the rapidly changing nature of the SARS-CoV-2 pandemic, continued monitoring and a generalizable analysis pipeline are warranted to inform quick updates on vaccine effectiveness in real time. ",
doi="10.2196/35311",
url="https://publichealth.jmir.org/2022/5/e35311",
url="http://www.ncbi.nlm.nih.gov/pubmed/35486806"
}


@Article{info:doi/10.2196/33380,
author="Teng, Rachel
and Ding, Yichen
and See, Choong Kay",
title="Use of Robots in Critical Care: Systematic Review",
journal="J Med Internet Res",
year="2022",
month="May",
day="16",
volume="24",
number="5",
pages="e33380",
keywords="COVID-19",
keywords="intensive care",
keywords="high dependency",
keywords="telepresence",
keywords="intubation",
abstract="Background: The recent focus on the critical setting, especially with the COVID-19 pandemic, has highlighted the need for minimizing contact-based care and increasing robotic use. Robotics is a rising field in the context of health care, and we sought to evaluate the use of robots in critical care settings. Objective: Although robotic presence is prevalent in the surgical setting, its role in critical care has not been well established. We aimed to examine the uses and limitations of robots for patients who are critically ill. Methods: This systematic review was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. MEDLINE, Embase, IEEE Xplore, and ACM Library were searched from their inception to December 23, 2021. Included studies involved patients requiring critical care, both in intensive care units or high-dependency units, or settings that required critical care procedures (eg, intubation and cardiopulmonary resuscitation). Randomized trials and observational studies were included. Results: A total of 33 studies were included. The greatest application of robots in the intensive care unit was in the field of telepresence, whereby robots proved advantageous in providing a reduced response time, earlier intervention, and lower mortality rates. Challenges of telepresence included regulatory and financial barriers. In therapy and stroke rehabilitation, robots achieved superior clinical outcomes safely. Robotic use in patient evaluation and assessment was mainly through ultrasound evaluation, obtaining satisfactory to superior results with the added benefits of remote assessment, time savings, and increased efficiency. Robots in drug dispensing and delivery increased efficiency and generated cost savings. All the robots had technological limitations and hidden costs. Conclusions: Overall, our results show that robotic use in critical care settings is a beneficial, effective, and well-received intervention that delivers significant benefits to patients, staff, and hospitals. Looking ahead, it is necessary to form strong ethical and legislative frameworks and overcome various regulatory and financial barriers. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42021234162; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=234162 ",
doi="10.2196/33380",
url="https://www.jmir.org/2022/5/e33380",
url="http://www.ncbi.nlm.nih.gov/pubmed/35576567"
}


@Article{info:doi/10.2196/32859,
author="Constant, Aymery
and Conserve, Donaldson
and Gallopel-Morvan, Karine
and Raude, Jocelyn",
title="Cognitive Factors Associated With Public Acceptance of COVID-19 Nonpharmaceutical Prevention Measures: Cross-sectional Study",
journal="JMIRx Med",
year="2022",
month="May",
day="13",
volume="3",
number="2",
pages="e32859",
keywords="Extended Parallel Process Model",
keywords="COVID-19",
keywords="lockdown",
keywords="public acceptance",
keywords="nonpharmaceutical measures",
keywords="Likert scale",
keywords="France",
abstract="Background: During the COVID-19 crisis, protests against restrictions emerged and rule violations increased, provoking peaks in new positive cases, forcing authorities in France to impose fines to slow down the spread of the disease. Due to these challenges, subsequent implementations of preventive measures in response to COVID-19 recurrences or other pandemics could present difficulties for decision makers. A better understanding of the factors underlying the public acceptance of COVID-19 nonpharmaceutical preventive measures may therefore contribute greatly to the design of more effective public communication during future pandemics. Objective: The aim of this study was to evaluate the acceptance of COVID-19 nonpharmaceutical prevention measures in France. The specific objectives were (1) to examine the public's acceptance of COVID-19 nonpharmaceutical prevention measures and (2) to assess the association of the public's acceptance of these prevention measures and their perception of COVID-19. Methods: Data were collected from 2004 individuals through an online survey conducted 6-8 weeks after the first lockdown in France. For objective 1, participants were asked the extent to which they supported 8 COVID-19 nonpharmaceutical preventive measures using a 4-point Likert scale. For objective 2, COVID-19--related perceptions were assessed using a 5-point Likert scale from an adapted version of Witte's Extended Parallel Process Model. Sociodemographic and environmental variables were also collected. The public's acceptance factors were estimated using an unweighted least squares factorial analysis, and their associations with perceptions of COVID-19, expressed as rate ratios (RR) and 95\% CIs, were estimated using generalized linear Poisson regression models. Statistical analyses were performed using the SPSS statistical package. Results: The acceptance rate reached 86.1\% for individual protective measures, such as making masks mandatory in public open spaces, and 70.0\% for collective restrictions, such as isolating the most vulnerable people (1604/2004, 80\%) or forbidding public gatherings (n=1590, 79.3\%). The least popular restrictions were closing all schools/universities and nonessential commerce such as bars and restaurants (n=1146, 57.2\%). Acceptance of collective restrictions was positively associated with their perceived efficacy (RR 1.02, 95\% CI 1.01-1.03), fear of COVID-19 (RR 1.04, 95\% CI 1.03-1.05), and perceived severity of COVID-19 (RR 1.04, 95\% CI 1.03-1.06), and negatively with age >60 years (RR 0.89, 95\% CI 0.81-0.98). Acceptance of individual protective measures was associated with their perceived efficacy (RR 1.03, 95\% CI 1.03-1.04), fear of COVID-19 (RR 1.02, 1.01-1.03), and perceived severity of COVID-19 (RR 1.03, 1.01-1.05). Conclusions: Acceptance rates of COVID-19 nonpharmaceutical measures were rather high, but varied according to their perceived social cost, and were more related to collective than personal protection. Nonpharmaceutical measures that minimize social costs while controlling the spread of the disease are more likely to be accepted during pandemics. ",
doi="10.2196/32859",
url="https://med.jmirx.org/2022/2/e32859",
url="http://www.ncbi.nlm.nih.gov/pubmed/35648730"
}


@Article{info:doi/10.2196/34480,
author="Calo, A. William
and Francis, Erica
and Kong, Lan
and Hogentogler, Ruth
and Heilbrunn, Emily
and Fisher, Abbey
and Hood, Nancy
and Kraschnewski, Jennifer",
title="Implementing Infection Control and Quality of Life Best Practices in Nursing Homes With Project ECHO: Protocol for a Patient-Centered Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2022",
month="May",
day="13",
volume="11",
number="5",
pages="e34480",
keywords="infection control",
keywords="COVID-19",
keywords="nursing home",
keywords="telementoring",
keywords="Project ECHO",
keywords="case-based learning",
keywords="patient-centered outcome",
keywords="RE-AIM",
keywords="randomized controlled trial",
keywords="implementation",
keywords="quality of life",
keywords="best practice",
keywords="guideline",
keywords="comparison",
keywords="effectiveness",
keywords="intervention",
abstract="Background: Nursing homes in the United States were devastated by COVID-19, with 710,000 cases and 138,000 deaths nationally through October 2021. Although facilities are required to have infection control staff, only 3\% of designated infection preventionists have taken a basic infection control course prior to the COVID-19 pandemic. Most research has focused on infection control in the acute care setting. However, little is known about the implementation of infection control practices and effective interventions in nursing homes. This study utilizes Project ECHO (Extension for Community Health Outcomes), an evidence-based telementoring model, to connect Penn State University subject matter experts with nursing home staff and administrators to proactively support evidence-based infection control guideline implementation. Objective: Our study seeks to answer the research question of how evidence-based infection control guidelines can be implemented effectively in nursing homes, including comparing the effectiveness of two ECHO-delivered training interventions on key patient-centered outcomes such as reducing the number of residents with a COVID-19 diagnosis. Methods: A stratified cluster randomized design was utilized. Using a 1:1 ratio, we randomly assigned 136 nursing homes to ECHO or ECHO Plus arms. Randomization was stratified by geographic location, baseline COVID-19 infection rate, and facility capacity. The study had two phases. In phase one, completed in July 2021, nursing homes in both study arms received a 16-week infectious disease and quality improvement training intervention via real-time, interactive videoconferencing and the ECHO learning model. Phase one sessions were up to 90 minutes in duration. In phase two, completed in November 2021, the ECHO group was offered optional 60-minute office hours for 9 weeks and the ECHO Plus group received 9 weeks of 60-minute sessions on emerging topics and an additional 8-session refresher series on infection control. Results: A total of 290 nursing home facilities were assessed for eligibility, with 136 nursing homes recruited and randomly assigned to ECHO or ECHO Plus. Guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework, we will simultaneously evaluate the study's effectiveness and implementation outcomes at baseline (intervention start date), and at 4, 6, 12, and 18 months. The primary outcome is the COVID-19 infection rate in nursing homes. Secondary outcomes include COVID-19 hospitalizations and deaths, flu-like illness, and quality of life. Surveys and interviews with participants will also provide data as to the adoption, implementation, and maintenance of best practices taught throughout ECHO sessions. Conclusions: A multipronged approach to improving infection control and emergency preparedness in nursing homes is important, given the toll that the COVID-19 pandemic has taken on residents and staff. The ECHO model has significant strengths when compared to traditional training, as it allows for remote learning delivered by a multidisciplinary team of experts, and utilizes case discussions that match the context and capacity of nursing homes. Trial Registration: ClinicalTrials.gov NCT04499391; https://clinicaltrials.gov/ct2/show/NCT04499391 ",
doi="10.2196/34480",
url="https://www.researchprotocols.org/2022/5/e34480",
url="http://www.ncbi.nlm.nih.gov/pubmed/35476823"
}


@Article{info:doi/10.2196/36208,
author="Mignault, Alexandre
and Tchouaket Nguemeleu, {\'E}ric
and Robins, Stephanie
and Maillet, {\'E}ric
and Matetsa, Edwige
and Dupuis, St{\'e}phane",
title="Automated Intraoperative Short Messaging Service Updates: Quality Improvement Initiative to Relieve Caregivers' Worries",
journal="JMIR Perioper Med",
year="2022",
month="May",
day="6",
volume="5",
number="1",
pages="e36208",
keywords="COVID-19",
keywords="surgery",
keywords="intraoperative",
keywords="OR nurse",
keywords="communication",
keywords="technology",
keywords="short messaging service",
keywords="SMS",
keywords="text message",
keywords="caregiver",
keywords="anxiety",
keywords="perioperative",
keywords="surgical",
keywords="surgical procedure",
keywords="mHealth",
keywords="mental health",
keywords="digital health",
keywords="digital health care",
abstract="Background: Undergoing a surgical procedure is anxiety provoking for patients and their caregivers. During the intraoperative period, caregivers seek out informational updates from health care professionals, a situation complicated by COVID-19 health measures that require caregivers to wait outside the hospital. Short messaging service (SMS)-based communication that allows caregivers to follow their loved ones through surgery has shown promise in relieving anxiety and improving satisfaction with overall care. This form of communication is also well accepted by health care professionals and may be effective at relieving staff burden. Objective: Here, we describe a quality improvement initiative of a standardized and integrated intraoperative SMS-based system to improve communication between surgical teams and caregivers. The main goal was to improve satisfaction with care, while the secondary goal was to reduce caregiver anxiety. Methods: The initiative followed the framework of the Model for Improvement. A large tertiary care hospital offered the SMS to caregivers who were waiting for loved ones undergoing surgery. SMS messages were integrated into the clinical information system software and sent at key points during the surgical journey to phone numbers provided by caregivers. A satisfaction survey was sent to caregivers 1 business day after surgery. Data were collected between February 16 and July 14, 2021. Results: Of the 8129 surgeries scheduled, caregivers waiting for 6149 (75.6\%) surgeries agreed to receive SMS messages. A total of 34,129 messages were sent. The satisfaction survey was completed by 2088 (34\%) of the 6149 caregivers. Satisfaction with messages was high, with the majority of respondents reporting that the messages received were adequate (1476/2085, 70.8\%), clear (1545/2077, 74.4\%), informative (1488/2078, 71.6\%), and met their needs (1234/2077, 59.4\%). The overall satisfaction score was high (4.5 out of 5), and caregivers reported that receiving text messages resulted in a reduction in anxiety (score=8.2 out of 10). Technical errors were reported by 69 (3.3\%) caregivers. Suggestions for improvements included having messages sent more often; providing greater patient details, including the patient's health status; and the service being offered in other languages. Conclusions: This digital health initiative provided SMS messages that were systematically sent to caregivers waiting for their loved ones undergoing surgery, just as COVID-19 restrictions began preventing waiting onsite. The messages were used across 15 surgical specialties and have since been implemented hospital-wide. Digital health care innovations have the capacity to improve family-centered communication; what patients and their families find useful and appreciate will ultimately determine their success. ",
doi="10.2196/36208",
url="https://periop.jmir.org/2022/1/e36208",
url="http://www.ncbi.nlm.nih.gov/pubmed/35436760"
}


@Article{info:doi/10.2196/33394,
author="Huo, Shutong
and Wang, Kai
and Liu, Zongchao
and Yang, Yuao
and Hee, Yi Jia
and He, Qiwei
and Takesue, Rie
and Tang, Kun",
title="Influence of Maternal Exposure to Mass Media on Growth Stunting Among Children Under Five: Mediation Analysis Through the Water, Sanitation, and Hygiene Program",
journal="JMIR Public Health Surveill",
year="2022",
month="Apr",
day="6",
volume="8",
number="4",
pages="e33394",
keywords="water, sanitation and hygiene",
keywords="mass media",
keywords="malnutrition",
keywords="Democratic Republic of Congo",
keywords="DRC",
keywords="mediation analysis",
keywords="children",
keywords="pediatric",
keywords="stunting",
keywords="television",
keywords="internet",
keywords="sanitation",
keywords="hygiene",
abstract="Background: The issue of malnutrition in the Democratic Republic of Congo is severe. Meanwhile, the Water, Sanitation, and Hygiene program has been demonstrated to be effective in reducing the rates of growth stunting among children. Objective: We aimed to explore the association between maternal exposure to mass media and stunting in children through water, sanitation, and hygiene behaviors. Methods: Mediation analysis was conducted using data from the 2018 Multiple Indicators Cluster Surveys. Results: Mothers' exposures to television and the internet in the Democratic Republic of Congo significantly decreases the risk of stunting in children by 5\% and 10\%, respectively, mediated by household water, sanitation, and hygiene facilities and practices. Conclusions: These findings could inform interventions and policies to reduce the rate of stunting rate children by promoting water, sanitation, and hygiene through mass media, especially through the internet and television. ",
doi="10.2196/33394",
url="https://publichealth.jmir.org/2022/4/e33394",
url="http://www.ncbi.nlm.nih.gov/pubmed/35384848"
}


@Article{info:doi/10.2196/31732,
author="Deiner, S. Michael
and Seitzman, D. Gerami
and Kaur, Gurbani
and McLeod, D. Stephen
and Chodosh, James
and Lietman, M. Thomas
and Porco, C. Travis",
title="Sustained Reductions in Online Search Interest for Communicable Eye and Other Conditions During the COVID-19 Pandemic: Infodemiology Study",
journal="JMIR Infodemiology",
year="2022",
month="Mar",
day="16",
volume="2",
number="1",
pages="e31732",
keywords="COVID-19",
keywords="pandemic",
keywords="communicable disease",
keywords="social distancing",
keywords="infodemiology",
keywords="Google Trends",
keywords="influenza",
keywords="conjunctivitis",
keywords="ocular symptoms",
keywords="seasonality",
keywords="trend",
keywords="online health information",
keywords="information-seeking",
abstract="Background: In a prior study at the start of the pandemic, we reported reduced numbers of Google searches for the term ``conjunctivitis'' in the United States in March and April 2020 compared with prior years. As one explanation, we conjectured that reduced information-seeking may have resulted from social distancing reducing contagious conjunctivitis cases. Here, after 1 year of continued implementation of social distancing, we asked if there have been persistent reductions in searches for ``conjunctivitis,'' and similarly for other communicable disease terms, compared to control terms. Objective: The aim of this study was to determine if reduction in searches in the United States for terms related to conjunctivitis and other common communicable diseases occurred in the spring-winter season of the COVID-19 pandemic, and to compare this outcome to searches for terms representing noncommunicable conditions, COVID-19, and to seasonality. Methods: Weekly relative search frequency volume data from Google Trends for 68 search terms in English for the United States were obtained for the weeks of March 2011 through February 2021. Terms were classified a priori as 16 terms related to COVID-19, 29 terms representing communicable conditions, and 23 terms representing control noncommunicable conditions. To reduce bias, all analyses were performed while masked to term names, classifications, and locations. To test for the significance of changes during the pandemic, we detrended and compared postpandemic values to those expected based on prepandemic trends, per season, computing one- and two-sided P values. We then compared these P values between term groups using Wilcoxon rank-sum and Fisher exact tests to assess if non-COVID-19 terms representing communicable diseases were more likely to show significant reductions in searches in 2020-2021 than terms not representing such diseases. We also assessed any relationship between a term's seasonality and a reduced search trend for the term in 2020-2021 seasons. P values were subjected to false discovery rate correction prior to reporting. Data were then unmasked. Results: Terms representing conjunctivitis and other communicable conditions showed a sustained reduced search trend in the first 4 seasons of the 2020-2021 COVID-19 pandemic compared to prior years. In comparison, the search for noncommunicable condition terms was significantly less reduced (Wilcoxon and Fisher exact tests, P<.001; summer, autumn, winter). A significant correlation was also found between reduced search for a term in 2020-2021 and seasonality of that term (Theil-Sen, P<.001; summer, autumn, winter). Searches for COVID-19--related conditions were significantly elevated compared to those in prior years, and searches for influenza-related terms were significantly lower than those for prior years in winter 2020-2021 (P<.001). Conclusions: We demonstrate the low-cost and unbiased use of online search data to study how a wide range of conditions may be affected by large-scale interventions or events such as social distancing during the COVID-19 pandemic. Our findings support emerging clinical evidence implicating social distancing and the COVID-19 pandemic in the reduction of communicable disease and on ocular conditions. ",
doi="10.2196/31732",
url="https://infodemiology.jmir.org/2022/1/e31732",
url="http://www.ncbi.nlm.nih.gov/pubmed/35320981"
}


@Article{info:doi/10.2196/33531,
author="Keizer, Julia
and Bente, E. Britt
and Al Naiemi, Nashwan
and Van Gemert-Pijnen, JEWC Lisette
and Beerlage-De Jong, Nienke",
title="Improving the Development and Implementation of Audit and Feedback Systems to Support Health Care Workers in Limiting Antimicrobial Resistance in the Hospital: Scoping Review",
journal="J Med Internet Res",
year="2022",
month="Mar",
day="11",
volume="24",
number="3",
pages="e33531",
keywords="scoping review",
keywords="audit and feedback",
keywords="eHealth",
keywords="development",
keywords="implementation",
keywords="antimicrobial resistance",
keywords="antibiotic stewardship",
keywords="infection control",
abstract="Background: For eHealth technologies in general and audit and feedback (AF) systems specifically, integrating interdisciplinary theoretical underpinnings is essential, as it increases the likelihood of achieving desired outcomes by ensuring a fit among eHealth technology, stakeholders, and their context. In addition, reporting on the development and implementation process of AF systems, including substantiations of choices, enables the identification of best practices and accumulation of knowledge across studies but is often not elaborated on in publications. Objective: This scoping review aims to provide insights into the development and implementation strategies for AF systems for a real-world problem that threatens modern health care---antimicrobial resistance---and provide an interdisciplinary conceptual framework that can serve as a checklist and guidance for making informed choices in the development and implementation of future AF systems. Methods: A scoping review was conducted by querying PubMed, Scopus, Web of Science, IEEE Xplore Digital Library, and Embase (?2010) for studies describing either the development or implementation process, or both, of an AF system for antimicrobial resistance or infections in hospitals. Studies reporting only on effectiveness or impact were excluded. A total of 3 independent reviewers performed the study selection, and 2 reviewers constructed the conceptual framework through the axial and selective coding of often-used theories, models, and frameworks (TMFs) from the literature on AF and eHealth development and implementation. Subsequently, the conceptual framework was used for the systematic extraction and interpretation of the studies' descriptions of AF systems and their development and implementation. Results: The search resulted in 2125 studies that were screened for eligibility, of which 12 (0.56\%); 2012-2020) were included. These studies described the development and implementation processes heterogeneously in terms of study aims, study targets, target groups, methods, and theoretical underpinnings. Few studies have explicitly explained how choices for the development and implementation of AF systems were substantiated by the TMFs. The conceptual framework provided insights into what is reported on the development and implementation process and revealed underreported AF system constructs (eg, AF system design; engagement with the AF system; and comparison, goal setting, and action planning) and development and implementation (eg, champions) constructs. Conclusions: This scoping review showed the current heterogeneous reporting of AF systems and their development and implementation processes and exemplified how interdisciplinary TMFs can (and should) be balanced in a conceptual framework to capture relevant AF systems and development and implementation constructs. Thereby, it provides a concrete checklist and overall guidance that supports the professionalization and harmonization of AF system development and implementation. For the development and implementation of future AF systems and other eHealth technologies, researchers and health care workers should be supported in selecting and integrating TMFs into their development and implementation process and encouraged to explicitly report on theoretical underpinnings and the substantiation of choices. ",
doi="10.2196/33531",
url="https://www.jmir.org/2022/3/e33531",
url="http://www.ncbi.nlm.nih.gov/pubmed/35275082"
}


@Article{info:doi/10.2196/25532,
author="Morel, Benoit
and Bouleux, Guillaume
and Viallon, Alain
and Maignan, Maxime
and Provoost, Luc
and Bernadac, Jean-Christophe
and Devidal, Sarah
and Pillet, Sylvie
and Cantais, Aymeric
and Mory, Olivier",
title="Evaluating the Increased Burden of Cardiorespiratory Illness Visits to Adult Emergency Departments During Flu and Bronchiolitis Outbreaks in the Pediatric Population: Retrospective Multicentric Time Series Analysis",
journal="JMIR Public Health Surveill",
year="2022",
month="Mar",
day="10",
volume="8",
number="3",
pages="e25532",
keywords="respiratory infections",
keywords="emergency departments",
keywords="flu outbreak",
keywords="bronchiolitis outbreak",
keywords="cardiorespiratory illness",
keywords="time series analysis",
keywords="influenza",
keywords="bronchiolitis",
keywords="outbreak",
keywords="pediatrics",
abstract="Background: Cardiorespiratory decompensation (CRD) visits have a profound effect on adult emergency departments (EDs). Respiratory pathogens like respiratory syncytial virus (RSV) and influenza virus are common reasons for increased activity in pediatric EDs and are associated with CRD in the adult population. Given the seasonal aspects of such challenging pathology, it would be advantageous to predict their variations. Objective: The goal of this study was to evaluate the increased burden of CRD in adult EDs during flu and bronchiolitis outbreaks in the pediatric population. Methods: An ecological study was conducted, based on admissions to the adult ED of the Centre Hospitalier Universitaire (CHU) of Grenoble and Saint Etienne from June 29, 2015 to March 22, 2020. The outbreak periods for bronchiolitis and flu in the pediatric population were defined with a decision-making support tool, PREDAFLU, used in the pediatric ED. A Kruskal-Wallis variance analysis and a Spearman monotone dependency were performed in order to study the relationship between the number of adult ED admissions for the International Classification of Diseases (ICD)-10 codes related to cardiorespiratory diagnoses and the presence of an epidemic outbreak as defined with PREDAFLU. Results: The increase in visits to the adult ED for CRD and the bronchiolitis and flu outbreaks had a similar distribution pattern (CHU Saint Etienne: $\chi$23=102.7, P<.001; CHU Grenoble: $\chi$23=126.67, P<.001) and were quite dependent in both hospital settings (CHU Saint Etienne: Spearman $\rho$=0.64; CHU Grenoble: Spearman $\rho$=0.71). The increase in ED occupancy for these pathologies was also significantly related to the pediatric respiratory infection outbreaks. These 2 criteria gave an idea of the increased workload in the ED due to CRD during the bronchiolitis and flu outbreaks in the pediatric population. Conclusions: This study established that CRD visits and bed occupancy for adult EDs were significantly increased during bronchiolitis and pediatric influenza outbreaks. Therefore, a prediction tool for these outbreaks such as PREDAFLU can be used to provide early warnings of increased activity in adult EDs for CRD visits. ",
doi="10.2196/25532",
url="https://publichealth.jmir.org/2022/3/e25532",
url="http://www.ncbi.nlm.nih.gov/pubmed/35266876"
}


@Article{info:doi/10.2196/34098,
author="Marx, Gernot
and Greiner, Wolfgang
and Juhra, Christian
and Elkenkamp, Svenja
and Gensorowsky, Daniel
and Lemmen, Sebastian
and Englbrecht, Jan
and Dohmen, Sandra
and Gottschalk, Antje
and Haverkamp, Miriam
and Hempen, Annette
and Fl{\"u}gel-Bleienheuft, Christian
and Bause, Daniela
and Schulze-Steinen, Henna
and Rademacher, Susanne
and Kistermann, Jennifer
and Hoch, Stefan
and Beckmann, Hans-Juergen
and Lanckohr, Christian
and Lowitsch, Volker
and Peine, Arne
and Juzek-Kuepper, Fabian
and Benstoem, Carina
and Sperling, Kathrin
and Deisz, Robert",
title="An Innovative Telemedical Network to Improve Infectious Disease Management in Critically Ill Patients and Outpatients (TELnet@NRW): Stepped-Wedge Cluster Randomized Controlled Trial",
journal="J Med Internet Res",
year="2022",
month="Mar",
day="2",
volume="24",
number="3",
pages="e34098",
keywords="telemedicine",
keywords="infectious disease medicine",
keywords="sepsis",
keywords="evidence-based medicine",
keywords="eHealth",
abstract="Background: Evidence-based infectious disease and intensive care management is more relevant than ever. Medical expertise in the two disciplines is often geographically limited to university institutions. In addition, the interconnection between inpatient and outpatient care is often insufficient (eg, no shared electronic health record and no digital transfer of patient findings). Objective: This study aims to establish and evaluate a telemedical inpatient-outpatient network based on expert teleconsultations to increase treatment quality in intensive care medicine and infectious diseases. Methods: We performed a multicenter, stepped-wedge cluster randomized trial (February 2017 to January 2020) to establish a telemedicine inpatient-outpatient network among university hospitals, hospitals, and outpatient physicians in North Rhine-Westphalia, Germany. Patients aged ?18 years in the intensive care unit or consulting with a physician in the outpatient setting were eligible. We provided expert knowledge from intensivists and infectious disease specialists through advanced training courses and expert teleconsultations with 24/7/365 availability on demand respectively once per week to enhance treatment quality. The primary outcome was adherence to the 10 Choosing Wisely recommendations for infectious disease management. Guideline adherence was analyzed using binary logistic regression models. Results: Overall, 159,424 patients (10,585 inpatients and 148,839 outpatients) from 17 hospitals and 103 outpatient physicians were included. There was a significant increase in guideline adherence in the management of Staphylococcus aureus infections (odds ratio [OR] 4.00, 95\% CI 1.83-9.20; P<.001) and in sepsis management in critically ill patients (OR 6.82, 95\% CI 1.27-56.61; P=.04). There was a statistically nonsignificant decrease in sepsis-related mortality from 29\% (19/66) in the control group to 23.8\% (50/210) in the intervention group. Furthermore, the extension of treatment with prophylactic antibiotics after surgery was significantly less likely (OR 9.37, 95\% CI 1.52-111.47; P=.04). Patients treated by outpatient physicians, who were regularly participating in expert teleconsultations, were also more likely to be treated according to guideline recommendations regarding antibiotic therapy for uncomplicated upper respiratory tract infections (OR 1.34, 95\% CI 1.16-1.56; P<.001) and asymptomatic bacteriuria (OR 9.31, 95\% CI 3.79-25.94; P<.001). For the other recommendations, we found no significant effects, or we had too few observations to generate models. The key limitations of our study include selection effects due to the applied on-site triage of patients as well as the limited possibilities to control for secular effects. Conclusions: Telemedicine facilitates a direct round-the-clock interaction over broad distances between intensivists or infectious disease experts and physicians who care for patients in hospitals without ready access to these experts. Expert teleconsultations increase guideline adherence and treatment quality in infectious disease and intensive care management, creating added value for critically ill patients. Trial Registration: ClinicalTrials.gov NCT03137589; https://clinicaltrials.gov/ct2/show/NCT03137589 ",
doi="10.2196/34098",
url="https://www.jmir.org/2022/3/e34098",
url="http://www.ncbi.nlm.nih.gov/pubmed/35103604"
}


@Article{info:doi/10.2196/28268,
author="Geyer, E. Rachel
and Kotnik, Henry Jack
and Lyon, Victoria
and Brandstetter, Elisabeth
and Zigman Suchsland, Monica
and Han, D. Peter
and Graham, Chelsey
and Ilcisin, Misja
and Kim, E. Ashley
and Chu, Y. Helen
and Nickerson, A. Deborah
and Starita, M. Lea
and Bedford, Trevor
and Lutz, Barry
and Thompson, J. Matthew",
title="Diagnostic Accuracy of an At-Home, Rapid Self-test for Influenza: Prospective Comparative Accuracy Study",
journal="JMIR Public Health Surveill",
year="2022",
month="Feb",
day="22",
volume="8",
number="2",
pages="e28268",
keywords="influenza",
keywords="rapid testing",
keywords="acute respiratory illness",
keywords="self-collection",
keywords="self-testing",
keywords="mHealth",
keywords="mobile health",
keywords="home collection",
keywords="home testing",
keywords="mobile phone",
abstract="Background: Rapid diagnostic tests (RDTs) for influenza used by individuals at home could potentially expand access to testing and reduce the impact of influenza on health systems. Improving access to testing could lead to earlier diagnosis following symptom onset, allowing more rapid interventions for those who test positive, including behavioral changes to minimize spread. However, the accuracy of RDTs for influenza has not been determined in self-testing populations. Objective: This study aims to assess the accuracy of an influenza RDT conducted at home by lay users with acute respiratory illness compared with that of a self-collected sample by the same individual mailed to a laboratory for reference testing. Methods: We conducted a comparative accuracy study of an at-home influenza RDT (Ellume) in a convenience sample of individuals experiencing acute respiratory illness symptoms. Participants were enrolled in February and March 2020 from the Greater Seattle region in Washington, United States. Participants were mailed the influenza RDT and reference sample collection materials, which they completed and returned for quantitative reverse-transcription polymerase chain reaction influenza testing in a central laboratory. We explored the impact of age, influenza type, duration, and severity of symptoms on RDT accuracy and on cycle threshold for influenza virus and ribonuclease P, a marker of human DNA. Results: A total of 605 participants completed all study steps and were included in our analysis, of whom 87 (14.4\%) tested positive for influenza by quantitative reverse-transcription polymerase chain reaction (70/87, 80\% for influenza A and 17/87, 20\% for influenza B). The overall sensitivity and specificity of the RDT compared with the reference test were 61\% (95\% CI 50\%-71\%) and 95\% (95\% CI 93\%-97\%), respectively. Among individuals with symptom onset ?72 hours, sensitivity was 63\% (95\% CI 48\%-76\%) and specificity was 94\% (95\% CI 91\%-97\%), whereas, for those with duration >72 hours, sensitivity and specificity were 58\% (95\% CI 41\%-74\%) and 96\% (95\% CI 93\%-98\%), respectively. Viral load on reference swabs was negatively correlated with symptom onset, and quantities of the endogenous marker gene ribonuclease P did not differ among reference standard positive and negative groups, age groups, or influenza subtypes. The RDT did not have higher sensitivity or specificity among those who reported more severe illnesses. Conclusions: The sensitivity and specificity of the self-test were comparable with those of influenza RDTs used in clinical settings. False-negative self-test results were more common when the test was used after 72 hours of symptom onset but were not related to inadequate swab collection or severity of illness. Therefore, the deployment of home tests may provide a valuable tool to support the management of influenza and other respiratory infections. ",
doi="10.2196/28268",
url="https://publichealth.jmir.org/2022/2/e28268",
url="http://www.ncbi.nlm.nih.gov/pubmed/35191852"
}


@Article{info:doi/10.2196/30063,
author="Fitzsimon, Jonathan
and Gervais, Oliver
and Lanos, Chelsea",
title="COVID-19 Assessment and Testing in Rural Communities During the Pandemic: Cross-sectional Analysis",
journal="JMIR Public Health Surveill",
year="2022",
month="Feb",
day="8",
volume="8",
number="2",
pages="e30063",
keywords="healthcare",
keywords="virtual care",
keywords="access",
keywords="COVID-19",
keywords="pandemic",
keywords="assessment",
keywords="testing",
keywords="community paramed",
keywords="digital health",
keywords="online health",
keywords="physician",
keywords="virtual health",
abstract="Background: The COVID-19 pandemic exacerbated the need for urgent improvements in access to health care for rural, remote, and underserviced communities. The Renfrew County Virtual Triage and Assessment Centre (VTAC) was designed to provide access to COVID-19 testing and assessment with a family physician. The goal was to protect emergency departments and 911 paramedics while ensuring that nobody was left at home, suffering in silence. Residents were encouraged to call their own family physician for any urgent health needs. If they did not have a family physician or could not access their usual primary care provider, then they could call VTAC. This study reports on the output of a service model offering access to assessment and COVID-19 testing through a blend of virtual and in-person care options by a multidisciplinary team. Objective: The purpose of this study was to assess the ability of VTAC to provide access to COVID-19 assessment and testing across rural, remote, and underserviced communities. Methods: We conducted a cross-sectional analysis of the data derived from the cases handled by VTAC between March 27, 2020 (launch day), and September 30, 2020. Results: Residents from all 19 census subdivisions and municipalities of Renfrew County accessed VTAC. A total of 10,086 family physician assessments were completed (average 64 per day). Of these, 8535 (84.6\%) assessments were to unique patient users. Thirty physicians provided care. Using digital equipment setup in the patients' home, 31 patients were monitored remotely. VTAC community paramedics completed 14,378 COVID-19 tests and 3875 home visits. Conclusions: Renfrew County's experience suggests that there is tremendous synergy between family physicians and community paramedics in providing access to COVID-19 assessment and COVID-19 testing. The blended model of virtual and in-person care is well suited to provide improved access to other aspects of health care post pandemic, particularly for patients without a family physician. ",
doi="10.2196/30063",
url="https://publichealth.jmir.org/2022/2/e30063",
url="http://www.ncbi.nlm.nih.gov/pubmed/35022158"
}


@Article{info:doi/10.2196/32384,
author="Hadian, Kimia
and Fernie, Geoff
and Roshan Fekr, Atena",
title="A New Performance Metric to Estimate the Risk of Exposure to Infection in a Health Care Setting: Descriptive Study",
journal="JMIR Form Res",
year="2022",
month="Feb",
day="2",
volume="6",
number="2",
pages="e32384",
keywords="hand hygiene",
keywords="health care-acquired",
keywords="infection control",
keywords="compliance",
keywords="electronic monitoring",
keywords="exposure",
keywords="risk",
keywords="hygiene",
keywords="monitoring",
keywords="surveillance",
keywords="performance",
keywords="metric",
keywords="method",
keywords="estimate",
keywords="predict",
keywords="development",
abstract="Background: Despite several measures to monitor and improve hand hygiene (HH) in health care settings, health care-acquired infections (HAIs) remain prevalent. The measures used to calculate HH performance are not able to fully benefit from the high-resolution data collected using electronic monitoring systems. Objective: This study proposes a novel parameter for quantifying the HAI exposure risk of individual patients by considering temporal and spatial features of health care workers' HH adherence. Methods: Patient exposure risk is calculated as a function of the number of consecutive missed HH opportunities, the number of unique rooms visited by the health care professional, and the time duration that the health care professional spends inside and outside the patient's room without performing HH. The patient exposure risk is compared to the entrance compliance rate (ECR) defined as the ratio of the number of HH actions performed at a room entrance to the total number of entrances into the room. The compliance rate is conventionally used to measure HH performance. The ECR and the patient exposure risk are analyzed using the data collected from an inpatient nursing unit for 12 weeks. Results: The analysis of data collected from 59 nurses and more than 25,600 records at a musculoskeletal rehabilitation unit at the Toronto Rehabilitation Institute, KITE, showed that there is no strong linear relation between the ECR and patient exposure risk (r=0.7, P<.001). Since the ECR is calculated based on the number of missed HH actions upon room entrance, this parameter is already included in the patient exposure risk. Therefore, there might be scenarios that these 2 parameters are correlated; however, in several cases, the ECR contrasted with the reported patient exposure risk. Generally, the patients in rooms with a significantly high ECR can be potentially exposed to a considerable risk of infection. By contrast, small ECRs do not necessarily result in a high patient exposure risk. The results clearly explained the important role of the factors incorporated in patient exposure risk for quantifying the risk of infection for the patients. Conclusions: Patient exposure risk might provide a more reliable estimation of the risk of developing HAIs compared to ECR by considering both the temporal and spatial aspects of HH records. ",
doi="10.2196/32384",
url="https://formative.jmir.org/2022/2/e32384",
url="http://www.ncbi.nlm.nih.gov/pubmed/35107424"
}


@Article{info:doi/10.2196/29539,
author="Frisch, Stacey
and Jones, Sarah
and Willis, James
and Sinert, Richard",
title="COVID-19 Infection and Symptoms Among Emergency Medicine Residents and Fellows in an Urban Academic Hospital Setting: Cross-sectional Questionnaire Study",
journal="JMIRx Med",
year="2022",
month="Jan",
day="27",
volume="3",
number="1",
pages="e29539",
keywords="COVID-19",
keywords="emergency medicine",
keywords="housestaff wellness",
keywords="medical education",
keywords="training",
keywords="frontline health care workers",
keywords="frontline",
keywords="personal protective equipment",
keywords="pandemic",
keywords="infectious disease",
keywords="emergency",
abstract="Background: COVID-19, an illness caused by the novel coronavirus SARS-CoV-2, affected many aspects of health care worldwide in 2020. From March to May 2020, New York City experienced a large surge of cases. Objective: The aim of this study is to characterize the prevalence of illness and symptoms experienced by residents and fellows in 2 New York City hospitals during the period of March to May 2020. Methods: An institutional review board--exempt survey was distributed to emergency medicine housestaff in May 2020, and submissions were accepted through August 2020. Results: Out of 104 residents and fellows, 64 responded to our survey (a 61.5\% response rate). Out of 64 responders, 27 (42\%) tested positive for SARS-CoV-2 antibodies. Most residents experienced symptoms that are consistent with COVID-19; however, few received polymerase chain reaction testing. Out of 27 housestaff with SARS-CoV-2 antibodies, 18 (67\%) experienced fever and chills, compared with 8 out of 34 housestaff (24\%) without SARS-CoV-2 antibodies. Of the 27 housestaff with SARS-CoV-2 antibodies, 19 (70\%) experienced loss of taste and smell, compared with 2 out of 34 housestaff (6\%) without SARS-CoV-2 antibodies. Both fever and chills and loss of taste and smell were significantly more commonly experienced by antibody-positive compared to antibody-negative housestaff (P=.002 and <.001, respectively). All 13 housestaff who reported no symptoms during the study period tested negative for SARS-CoV-2 antibodies. Conclusions: Our study demonstrated that in our hospitals, the rate of COVID-19 illness among emergency department housestaff was much higher than previously reported. Further studies are needed to characterize illness among medical staff in emergency departments across the nation. The high infection rate among emergency medicine trainees stresses the importance of supplying adequate personal protective equipment for health care professionals. ",
doi="10.2196/29539",
url="https://med.jmirx.org/2022/1/e29539",
url="http://www.ncbi.nlm.nih.gov/pubmed/35263391"
}


@Article{info:doi/10.2196/28036,
author="Yu, Jia-Ruei
and Chen, Chun-Hsien
and Huang, Tsung-Wei
and Lu, Jang-Jih
and Chung, Chia-Ru
and Lin, Ting-Wei
and Wu, Min-Hsien
and Tseng, Yi-Ju
and Wang, Hsin-Yao",
title="Energy Efficiency of Inference Algorithms for Clinical Laboratory Data Sets: Green Artificial Intelligence Study",
journal="J Med Internet Res",
year="2022",
month="Jan",
day="25",
volume="24",
number="1",
pages="e28036",
keywords="medical informatics",
keywords="machine learning",
keywords="algorithms",
keywords="energy consumption",
keywords="artificial intelligence",
keywords="energy efficient",
keywords="medical domain",
keywords="medical data sets",
keywords="informatics",
abstract="Background: The use of artificial intelligence (AI) in the medical domain has attracted considerable research interest. Inference applications in the medical domain require energy-efficient AI models. In contrast to other types of data in visual AI, data from medical laboratories usually comprise features with strong signals. Numerous energy optimization techniques have been developed to relieve the burden on the hardware required to deploy a complex learning model. However, the energy efficiency levels of different AI models used for medical applications have not been studied. Objective: The aim of this study was to explore and compare the energy efficiency levels of commonly used machine learning algorithms---logistic regression (LR), k-nearest neighbor, support vector machine, random forest (RF), and extreme gradient boosting (XGB) algorithms, as well as four different variants of neural network (NN) algorithms---when applied to clinical laboratory datasets. Methods: We applied the aforementioned algorithms to two distinct clinical laboratory data sets: a mass spectrometry data set regarding Staphylococcus aureus for predicting methicillin resistance (3338 cases; 268 features) and a urinalysis data set for predicting Trichomonas vaginalis infection (839,164 cases; 9 features). We compared the performance of the nine inference algorithms in terms of accuracy, area under the receiver operating characteristic curve (AUROC), time consumption, and power consumption. The time and power consumption levels were determined using performance counter data from Intel Power Gadget 3.5. Results: The experimental results indicated that the RF and XGB algorithms achieved the two highest AUROC values for both data sets (84.7\% and 83.9\%, respectively, for the mass spectrometry data set; 91.1\% and 91.4\%, respectively, for the urinalysis data set). The XGB and LR algorithms exhibited the shortest inference time for both data sets (0.47 milliseconds for both in the mass spectrometry data set; 0.39 and 0.47 milliseconds, respectively, for the urinalysis data set). Compared with the RF algorithm, the XGB and LR algorithms exhibited a 45\% and 53\%-60\% reduction in inference time for the mass spectrometry and urinalysis data sets, respectively. In terms of energy efficiency, the XGB algorithm exhibited the lowest power consumption for the mass spectrometry data set (9.42 Watts) and the LR algorithm exhibited the lowest power consumption for the urinalysis data set (9.98 Watts). Compared with a five-hidden-layer NN, the XGB and LR algorithms achieved 16\%-24\% and 9\%-13\% lower power consumption levels for the mass spectrometry and urinalysis data sets, respectively. In all experiments, the XGB algorithm exhibited the best performance in terms of accuracy, run time, and energy efficiency. Conclusions: The XGB algorithm achieved balanced performance levels in terms of AUROC, run time, and energy efficiency for the two clinical laboratory data sets. Considering the energy constraints in real-world scenarios, the XGB algorithm is ideal for medical AI applications. ",
doi="10.2196/28036",
url="https://www.jmir.org/2022/1/e28036",
url="http://www.ncbi.nlm.nih.gov/pubmed/35076405"
}


@Article{info:doi/10.2196/32329,
author="Lee, Minjung
and You, Myoungsoon",
title="Direct and Indirect Associations of Media Use With COVID-19 Vaccine Hesitancy in South Korea: Cross-sectional Web-Based Survey",
journal="J Med Internet Res",
year="2022",
month="Jan",
day="6",
volume="24",
number="1",
pages="e32329",
keywords="COVID-19",
keywords="coronavirus",
keywords="vaccination",
keywords="vaccine hesitancy",
keywords="media use",
keywords="social media",
keywords="public health",
keywords="pandemic",
keywords="epidemiology",
keywords="online information",
keywords="health information",
abstract="Background: The battle against the 2019 novel coronavirus (COVID-19) has not concluded. Despite the availability of vaccines, the high prevalence of vaccine hesitancy represents a significant challenge to public health, and raising vaccine acceptance among the public is critical. Although media has become an increasingly popular source of COVID-19 vaccine-related information, the question of whether and how media use is related to the public's vaccine hesitancy warrants exploration. Objective: This study aimed to (1) examine the level of COVID-19 vaccine hesitancy, (2) identify factors associated with COVID-19 vaccine hesitancy, and (3) explore the direct and indirect relationship between media use and vaccine hesitancy through psychological factors. Methods: A month before COVID-19 vaccination was initiated in South Korea, we conducted a cross-sectional web-based survey over 6 days (January 20-25, 2021). This study included 1016 participants, and a logit model for regression analyzed associations between sociodemographic factors, health-related factors, psychological factors, and media use toward one's COVID-19 vaccine hesitancy. Additionally, we conducted a path analysis to examine the indirect effects of media use on vaccine hesitancy by using psychological factors (ie, perceived risk of COVID-19 infection, perceived benefits, and perceived barriers of COVID-19 vaccination). Results: Among the participants (N=1016), 53.3\% (541/1016) hesitated to take the COVID-19 vaccine, while 46.7\% (475/1016) agreed to accept the vaccine. Of the sociodemographic factors, female gender (odds ratio [OR] 1.967, 95\% CI 1.36-2.86; P<.001), age in 50s (OR 0.47, 95\% CI 0.23-0.96; P=.004), and age over 60s (OR 0.49, 95\% CI 0.24-0.99; P=.04) were significant individual predictors of COVID-19 vaccine hesitancy. Perceived susceptibility of infection (OR 0.69, 95\% CI 0.52-0.91; P=.01) and perceived benefits of vaccination (OR 0.69, 95\% CI 0.52-0.91; P=.01) were associated with lower vaccine hesitancy. Perceived barriers of vaccination (OR 1.63, 95\% CI 1.29-2.07; P<.001) and lower trust in government (OR 0.72, 95\% CI 0.53-0.98; P=.04) were related to vaccine hesitancy. The use of offline and online media as sources for the perceived benefits of vaccination was associated with vaccine hesitancy, resulting in lower vaccine hesitancy. Moreover, perceived susceptibility of the disease and perceived barriers of vaccination mediated the association between social media use and vaccine hesitancy. Conclusions: Our findings revealed a considerable level of COVID-19 vaccine hesitancy in South Korea. Gender-based and generation-based public health policies and communication are recommended. Efforts to lower the perceived risk of vaccine side effects and heighten perceived benefits of the vaccine are required. Although the use of media has a positive and negative effect on the population's vaccine hesitancy, efforts should be made to disseminate reliable and timely information on media while confronting misinformation or disinformation for successive implementation of vaccine programs during pandemics. ",
doi="10.2196/32329",
url="https://www.jmir.org/2022/1/e32329",
url="http://www.ncbi.nlm.nih.gov/pubmed/34870605"
}


@Article{info:doi/10.2196/30006,
author="Alves-Cabratosa, Lia
and Comas-Cuf{\'i}, Marc
and Blanch, Jordi
and Mart{\'i}-Lluch, Ruth
and Ponjoan, Anna
and Castro-Guardiola, Antoni
and Hurtado-Ganoza, Abelardo
and P{\'e}rez-Ja{\'e}n, Ana
and Rexach-Fuma{\~n}a, Maria
and Faixedas-Brunsoms, Delfi
and Gispert-Ametller, Angels Maria
and Guell-Cargol, Anna
and Rodriguez-Batista, Maria
and Santaularia-Font, Ferran
and Orriols, Ramon
and Bonnin-Vilaplana, Marc
and Calder{\'o}n L{\'o}pez, Carlos Juan
and Sabater-Talaverano, Gladis
and Queralt Moles, Xavier Francesc
and Rodriguez-Requejo, Sara
and Avellana-Revuelta, Esteve
and Ball{\'o}, Elisabet
and Fages-Masmiquel, Ester
and Sirvent, Josep-Maria
and Lorencio, Carol
and Morales-Pedrosa, Miquel Josep
and Ortiz-Ballujera, Patricia
and Ramos, Rafel",
title="Individuals With SARS-CoV-2 Infection During the First and Second Waves in Catalonia, Spain: Retrospective Observational Study Using Daily Updated Data",
journal="JMIR Public Health Surveill",
year="2022",
month="Jan",
day="6",
volume="8",
number="1",
pages="e30006",
keywords="epidemiology",
keywords="SARS-CoV-2",
keywords="COVID-19",
keywords="timeline",
keywords="comparison",
keywords="pandemic",
keywords="waves",
keywords="population characteristics",
abstract="Background: A description of individuals with SARS-CoV-2 infection comparing the first and second waves could help adapt health services to manage this highly transmissible infection. Objective: We aimed to describe the epidemiology of individuals with suspected SARS-CoV-2 infection, and the characteristics of patients with a positive test comparing the first and second waves in Catalonia, Spain. Methods: This study had 2 stages. First, we analyzed daily updated data on SARS-CoV-2 infection in individuals from Girona (Catalonia). Second, we compared 2 retrospective cohorts of patients with a positive reverse-transcription polymerase chain reaction or rapid antigen test for SARS-CoV-2. The severity of patients with a positive test was defined by their admission to hospital, admission to intermediate respiratory care, admission to the intensive care unit, or death. The first wave was from March 1, 2020, to June 24, 2020, and the second wave was from June 25, 2020, to December 8, 2020. Results: The numbers of tests and cases were lower in the first wave than in the second wave (26,096 tests and 3140 cases in the first wave versus 140,332 tests and 11,800 cases in the second wave), but the percentage of positive results was higher in the first wave than in the second wave (12.0\% versus 8.4\%). Among individuals with a positive diagnostic test, 818 needed hospitalization in the first wave and 680 in the second; however, the percentage of hospitalized individuals was higher in the first wave than in the second wave (26.1\% versus 5.8\%). The group that was not admitted to hospital included older people and those with a higher percentage of comorbidities in the first wave, whereas the characteristics of the groups admitted to hospital were more alike. Conclusions: Screening systems for SARS-CoV-2 infection were scarce during the first wave, but were more adequate during the second wave, reflecting the usefulness of surveillance systems to detect a high number of asymptomatic infected individuals and their contacts, to help control this pandemic. The characteristics of individuals with SARS-CoV-2 infection in the first and second waves differed substantially; individuals in the first wave were older and had a worse health condition. ",
doi="10.2196/30006",
url="https://publichealth.jmir.org/2022/1/e30006",
url="http://www.ncbi.nlm.nih.gov/pubmed/34797774"
}


@Article{info:doi/10.2196/33989,
author="Agarwal, Arnav
and Basmaji, John
and Fernando, M. Shannon
and Ge, Zhou Fang
and Xiao, Yingqi
and Faisal, Haseeb
and Honarmand, Kimia
and Hylands, Mathieu
and Lau, I. Vincent
and Lewis, Kimberley
and Couban, Rachel
and Lamontagne, Fran{\c{c}}ois
and Adhikari, KJ Neill",
title="Administration of Parenteral Vitamin C in Patients With Severe Infection: Protocol for a Systematic Review and Meta-analysis",
journal="JMIR Res Protoc",
year="2022",
month="Jan",
day="6",
volume="11",
number="1",
pages="e33989",
keywords="vitamin C",
keywords="ascorbic acid",
keywords="severe infection",
keywords="sepsis",
keywords="COVID-19",
keywords="SARS-CoV-2",
keywords="infection",
keywords="parenteral",
keywords="vitamin",
keywords="infectious disease",
keywords="protocol",
keywords="review",
keywords="meta-analysis",
keywords="treatment",
keywords="inflammation",
keywords="oxidation",
keywords="effectiveness",
keywords="safety",
keywords="critical care",
abstract="Background: Severe infections are characterized by inflammation and oxidative damage. Ascorbic acid (vitamin C) administration may attenuate oxidative damage and, in turn, reduce vascular endothelial injury in pulmonary and systemic vasculature. Objective: We aim to describe a protocol for a living systematic review that will evaluate the effectiveness and safety of parenteral vitamin C administration in adults with severe infections, including those with COVID-19. Methods: We searched Ovid MEDLINE, Embase, CINAHL, the Centers for Disease Control and Prevention COVID-19 database, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov from inception to March 30, 2021, for randomized controlled trials evaluating parenteral vitamin C versus no parenteral vitamin C in hospitalized adults with severe infection. Eligible studies will include at least 1 arm involving any dose of parenteral vitamin C alone or in combination with other cointerventions and at least 1 arm not involving parenteral vitamin C. The primary outcomes of interest will include in-hospital, 30-day, and 90-day mortality. Title and abstract screening, full-text screening, data extraction, and risk of bias evaluation via a modified Risk of Bias 2.0 tool will be conducted independently and in pairs. We will perform random effects modeling for meta-analyses, in which study weights will be generated by using the inverse variance method. We will assess certainty in effect estimates by using the Grading of Recommendations Assessment, Development and Evaluation methodology. Meta-analyses will be updated iteratively as new trial evidence becomes available. Results: Among the 1386 citations identified as of March 30, 2021, a total of 17 eligible randomized controlled trials have been identified as of September 2021. We are in the process of updating the search strategy and associated data analyses. Conclusions: The results will be of importance to critical care physicians and hospitalists who manage severe infection and COVID-19 in daily practice, and they may directly inform international clinical guidance. Although our systematic review will incorporate the most recent trial evidence, ongoing trials may change our confidence in the estimates of effects, thereby necessitating iterative updates in the form of a living review. Trial Registration: PROSPERO CRD42020209187; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=209187 International Registered Report Identifier (IRRID): RR1-10.2196/33989 ",
doi="10.2196/33989",
url="https://www.researchprotocols.org/2022/1/e33989",
url="http://www.ncbi.nlm.nih.gov/pubmed/34910661"
}


@Article{info:doi/10.2196/29872,
author="Tsai, Richard
and Hervey, John
and Hoffman, Kathleen
and Wood, Jessica
and Johnson, Jennifer
and Deighton, Dana
and Clermont, Donald
and Loew, Brian
and Goldberg, L. Stuart",
title="COVID-19 Vaccine Hesitancy and Acceptance Among Individuals With Cancer, Autoimmune Diseases, or Other Serious Comorbid Conditions: Cross-sectional, Internet-Based Survey",
journal="JMIR Public Health Surveill",
year="2022",
month="Jan",
day="5",
volume="8",
number="1",
pages="e29872",
keywords="COVID-19",
keywords="vaccine",
keywords="hesitancy",
keywords="cancer",
keywords="autoimmune diseases",
keywords="vaccination",
keywords="comorbidities",
keywords="SARS-CoV-2",
keywords="survey",
keywords="cross-sectional",
keywords="incidence",
keywords="safety",
keywords="vulnerable",
keywords="perception",
keywords="attitude",
abstract="Background: Individuals with comorbid conditions have been disproportionately affected by COVID-19. Since regulatory trials of COVID-19 vaccines excluded those with immunocompromising conditions, few patients with cancer and autoimmune diseases were enrolled. With limited vaccine safety data available, vulnerable populations may have conflicted vaccine attitudes. Objective: We assessed the prevalence and independent predictors of COVID-19 vaccine hesitancy and acceptance among individuals with serious comorbidities and assessed self-reported side effects among those who had been vaccinated. Methods: We conducted a cross-sectional, 55-item, online survey, fielded January 15, 2021 through February 22, 2021, among a random sample of members of Inspire, an online health community of over 2.2 million individuals with comorbid conditions. Multivariable regression analysis was utilized to determine factors independently associated with vaccine hesitancy and acceptance. Results: Of the 996,500 members of the Inspire health community invited to participate, responses were received from 21,943 individuals (2.2\%). Respondents resided in 123 countries (United States: 16,277/21,943, 74.2\%), had a median age range of 56-65 years, were highly educated (college or postgraduate degree: 10,198/17,298, 58.9\%), and had diverse political leanings. All respondents self-reported at least one comorbidity: cancer, 27.3\% (5459/19,980); autoimmune diseases, 23.2\% (4946/21,294); chronic lung diseases: 35.4\% (7544/21,294). COVID-19 vaccine hesitancy was identified in 18.6\% (3960/21,294), with 10.3\% (2190/21,294) declaring that they would not, 3.5\% (742/21,294) stating that they probably would not, and 4.8\% (1028/21,294) not sure whether they would agree to be vaccinated. Hesitancy was expressed by the following patients: cancer, 13.4\% (731/5459); autoimmune diseases, 19.4\% (962/4947); chronic lung diseases: 17.8\% (1344/7544). Positive predictors of vaccine acceptance included routine influenza vaccination (odds ratio [OR] 1.53), trust in responsible vaccine development (OR 14.04), residing in the United States (OR 1.31), and never smoked (OR 1.06). Hesitancy increased with a history of prior COVID-19 (OR 0.86), conservative political leaning (OR 0.93), younger age (OR 0.83), and lower education level (OR 0.90). One-quarter (5501/21,294, 25.8\%) had received at least one COVID-19 vaccine injection, and 6.5\% (1390/21,294) completed a 2-dose series. Following the first injection, 69.0\% (3796/5501) self-reported local reactions, and 40.0\% (2200/5501) self-reported systemic reactions, which increased following the second injection to 77.0\% (1070/1390) and 67.0\% (931/1390), respectively. Conclusions: In this survey of individuals with serious comorbid conditions, significant vaccine hesitancy remained. Assumptions that the most vulnerable would automatically accept COVID-19 vaccination are erroneous and thus call for health care team members to initiate discussions focusing on the impact of the vaccine on an individual's underlying condition. Early self-reported side effect experiences among those who had already been vaccinated, as expressed by our population, should be reassuring and might be utilized to alleviate vaccine fears. Health care--related social media forums that rapidly disseminate accurate information about the COVID-19 vaccine may play an important role. ",
doi="10.2196/29872",
url="https://publichealth.jmir.org/2022/1/e29872",
url="http://www.ncbi.nlm.nih.gov/pubmed/34709184"
}


@Article{info:doi/10.2196/32846,
author="Zimba, Rebecca
and Romo, L. Matthew
and Kulkarni, G. Sarah
and Berry, Amanda
and You, William
and Mirzayi, Chloe
and Westmoreland, A. Drew
and Parcesepe, M. Angela
and Waldron, Levi
and Rane, S. Madhura
and Kochhar, Shivani
and Robertson, M. McKaylee
and Maroko, R. Andrew
and Grov, Christian
and Nash, Denis",
title="Patterns of SARS-CoV-2 Testing Preferences in a National Cohort in the United States: Latent Class Analysis of a Discrete Choice Experiment",
journal="JMIR Public Health Surveill",
year="2021",
month="Dec",
day="30",
volume="7",
number="12",
pages="e32846",
keywords="SARS-CoV-2",
keywords="testing",
keywords="discrete choice experiment",
keywords="latent class analysis",
keywords="COVID-19",
keywords="pattern",
keywords="trend",
keywords="preference",
keywords="cohort",
keywords="United States",
keywords="discrete choice",
keywords="diagnostic",
keywords="transmission",
keywords="vaccine",
keywords="uptake",
keywords="public health",
abstract="Background: Inadequate screening and diagnostic testing in the United States throughout the first several months of the COVID-19 pandemic led to undetected cases transmitting disease in the community and an underestimation of cases. Though testing supply has increased, maintaining testing uptake remains a public health priority in the efforts to control community transmission considering the availability of vaccinations and threats from variants. Objective: This study aimed to identify patterns of preferences for SARS-CoV-2 screening and diagnostic testing prior to widespread vaccine availability and uptake. Methods: We conducted a discrete choice experiment (DCE) among participants in the national, prospective CHASING COVID (Communities, Households, and SARS-CoV-2 Epidemiology) Cohort Study from July 30 to September 8, 2020. The DCE elicited preferences for SARS-CoV-2 test type, specimen type, testing venue, and result turnaround time. We used latent class multinomial logit to identify distinct patterns of preferences related to testing as measured by attribute-level part-worth utilities and conducted a simulation based on the utility estimates to predict testing uptake if additional testing scenarios were offered. Results: Of the 5098 invited cohort participants, 4793 (94.0\%) completed the DCE. Five distinct patterns of SARS-CoV-2 testing emerged. Noninvasive home testers (n=920, 19.2\% of participants) were most influenced by specimen type and favored less invasive specimen collection methods, with saliva being most preferred; this group was the least likely to opt out of testing. Fast-track testers (n=1235, 25.8\%) were most influenced by result turnaround time and favored immediate and same-day turnaround time. Among dual testers (n=889, 18.5\%), test type was the most important attribute, and preference was given to both antibody and viral tests. Noninvasive dual testers (n=1578, 32.9\%) were most strongly influenced by specimen type and test type, preferring saliva and cheek swab specimens and both antibody and viral tests. Among hesitant home testers (n=171, 3.6\%), the venue was the most important attribute; notably, this group was the most likely to opt out of testing. In addition to variability in preferences for testing features, heterogeneity was observed in the distribution of certain demographic characteristics (age, race/ethnicity, education, and employment), history of SARS-CoV-2 testing, COVID-19 diagnosis, and concern about the pandemic. Simulation models predicted that testing uptake would increase from 81.6\% (with a status quo scenario of polymerase chain reaction by nasal swab in a provider's office and a turnaround time of several days) to 98.1\% by offering additional scenarios using less invasive specimens, both viral and antibody tests from a single specimen, faster turnaround time, and at-home testing. Conclusions: We identified substantial differences in preferences for SARS-CoV-2 testing and found that offering additional testing options would likely increase testing uptake in line with public health goals. Additional studies may be warranted to understand if preferences for testing have changed since the availability and widespread uptake of vaccines. ",
doi="10.2196/32846",
url="https://publichealth.jmir.org/2021/12/e32846",
url="http://www.ncbi.nlm.nih.gov/pubmed/34793320"
}


@Article{info:doi/10.2196/27266,
author="Mehmood, Amjad
and Khalid Khan, Fawad
and Chaudhry, Ambreen
and Hussain, Zakir
and Laghari, Ali Mumtaz
and Shah, Ijaz
and Baig, Iqbal Zeeshan
and Baig, Amir Mirza
and Khader, Yousef
and Ikram, Aamer",
title="Risk Factors Associated with a Dengue Fever Outbreak in Islamabad, Pakistan: Case-Control Study",
journal="JMIR Public Health Surveill",
year="2021",
month="Dec",
day="30",
volume="7",
number="12",
pages="e27266",
keywords="dengue fever",
keywords="DENV-2",
keywords="outbreak investigation",
keywords="Islamabad",
keywords="Pakistan",
keywords="outbreak",
keywords="epidemiology",
keywords="disease surveillance",
keywords="surveillance",
keywords="vector",
abstract="Background: On October 23, 2016, 79 dengue fever cases were reported from the Union Council Tarlai to Federal Disease Surveillance and Response Unit Islamabad. A team was established to investigate the suspected dengue outbreak. Objective: The aim of this study was to determine the extent of the outbreak and identify the possible risk factors. Methods: Active case finding was performed through a house-to-house survey. A case was defined as an acute onset of fever ?38{\textcelcius} in a resident of Tarlai from October 2 to November 11, 2016, with a positive dengue virus (nonstructural protein, NS-1) test and any of the two of following signs and symptoms: retroorbital/ocular pain, headache, rash, myalgia, arthralgia, and hemorrhagic manifestations. A structured questionnaire was used to collect data. Age- and sex-matched controls (1:1) were identified from residents in the same area as cases. Blood samples were taken and sent to the National Institute of Health for genotype identification. Results: During the active case search, 145 cases of dengue fever were identified by surveying 928 houses from October 23 to November 11, 2016. The attack rate (AR) was 17.0/10,000. The mean age was 34.4 (SD 14.4) years. More than half of the cases were male (80/145, 55.2\%). Among all cases, 29\% belonged to the 25-34 years age group and the highest AR was found in the 35-44 years age group (35.6/10,000), followed by the 55-64 years age group (35.5/10,000). All five blood samples tested positive for NS-1 (genotype DENV-2). The most frequent presenting signs/symptoms were fever and headache (both 100\%). Stagnant water around houses (odds ratio [OR] 4.86, 95\% CI 2.94-8.01; P<.001), presence of flower pots in the home (OR 2.73, 95\% CI 1.67-4.45; P<.001), and open water containers (OR 2.24, 95\% CI 1.36-3.60; P<.001) showed higher odds among cases. Conversely, use of bed nets (OR 0.44, 95\% CI 0.25-0.77; P=.003), insecticidal spray (OR 0.33, 95\% CI 0.22-0.55; P<.001), door screens (OR 0.27, 95\% CI 0.15-0.46; P<.001), mosquito coil/mat (OR 0.26, 95\% CI 0.16-0.44; P<.001), and cleanliness of the house (OR 0.12, 95\% CI 0.05-0.26; P<.001) showed significant protective effects. Conclusions: Stagnant water acting as breeding grounds for vectors was identified as the probable cause of spread of the dengue outbreak. Establishment of surveillance and an early reporting system along with use of protective measures against the vector are strongly recommended. ",
doi="10.2196/27266",
url="https://publichealth.jmir.org/2021/12/e27266",
url="http://www.ncbi.nlm.nih.gov/pubmed/34967753"
}


@Article{info:doi/10.2196/30424,
author="Benham, L. Jamie
and Atabati, Omid
and Oxoby, J. Robert
and Mourali, Mehdi
and Shaffer, Blake
and Sheikh, Hasan
and Boucher, Jean-Christophe
and Constantinescu, Cora
and Parsons Leigh, Jeanna
and Ivers, M. Noah
and Ratzan, C. Scott
and Fullerton, M. Madison
and Tang, Theresa
and Manns, J. Braden
and Marshall, A. Deborah
and Hu, Jia
and Lang, Raynell",
title="COVID-19 Vaccine--Related Attitudes and Beliefs in Canada: National Cross-sectional Survey and Cluster Analysis",
journal="JMIR Public Health Surveill",
year="2021",
month="Dec",
day="23",
volume="7",
number="12",
pages="e30424",
keywords="coronavirus",
keywords="COVID-19",
keywords="public health",
keywords="marketing",
keywords="behavior",
keywords="risk reduction",
keywords="attitudes",
keywords="compliance",
keywords="vaccine",
keywords="hesitancy",
keywords="risk",
keywords="belief",
keywords="communication",
keywords="cross-sectional",
keywords="Canada",
keywords="gender",
keywords="education",
keywords="income",
keywords="race",
keywords="ethnicity",
abstract="Background: There are concerns that vaccine hesitancy may impede COVID-19 vaccine rollout and prevent the achievement of herd immunity. Vaccine hesitancy is a delay in acceptance or refusal of vaccines despite their availability. Objective: We aimed to identify which people are more and less likely to take a COVID-19 vaccine and factors associated with vaccine hesitancy to inform public health messaging. Methods: A Canadian cross-sectional survey was conducted in Canada in October and November 2020, prior to the regulatory approval of the COVID-19 vaccines. Vaccine hesitancy was measured by respondents answering the question ``what would you do if a COVID-19 vaccine were available to you?'' Negative binomial regression was used to identify the factors associated with vaccine hesitancy. Cluster analysis was performed to identify distinct clusters based on intention to take a COVID-19 vaccine, beliefs about COVID-19 and COVID-19 vaccines, and adherence to nonpharmaceutical interventions. Results: Of 4498 participants, 2876 (63.9\%) reported COVID-19 vaccine hesitancy. Vaccine hesitancy was significantly associated with (1) younger age (18-39 years), (2) lower education, and (3) non-Liberal political leaning. Participants that reported vaccine hesitancy were less likely to believe that a COVID-19 vaccine would end the pandemic or that the benefits of a COVID-19 vaccine outweighed the risks. Individuals with vaccine hesitancy had higher prevalence of being concerned about vaccine side effects, lower prevalence of being influenced by peers or health care professionals, and lower prevalence of trust in government institutions. Conclusions: These findings can be used to inform targeted public health messaging to combat vaccine hesitancy as COVID-19 vaccine administration continues. Messaging related to preventing COVID among friends and family, highlighting the benefits, emphasizing safety and efficacy of COVID-19 vaccination, and ensuring that health care workers are knowledgeable and supported in their vaccination counselling may be effective for vaccine-hesitant populations. ",
doi="10.2196/30424",
url="https://publichealth.jmir.org/2021/12/e30424",
url="http://www.ncbi.nlm.nih.gov/pubmed/34779784"
}


@Article{info:doi/10.2196/27521,
author="Mbiine, Ronald
and Nakanwagi, Cephas
and Lekuya, Monka Herve
and Aine, Joan
and Hakim, Kawesi
and Nabunya, Lilian
and Tomusange, Henry",
title="An Early Warning Mobile Health Screening and Risk Scoring App for Preventing In-Hospital Transmission of COVID-19 by Health Care Workers: Development and Feasibility Study",
journal="JMIR Form Res",
year="2021",
month="Dec",
day="17",
volume="5",
number="12",
pages="e27521",
keywords="mHealth",
keywords="risk score for Covid-19",
keywords="Africa",
keywords="mobile health",
keywords="digital health",
keywords="pandemic",
keywords="COVID-19",
keywords="COVID",
keywords="screening tool",
keywords="healthcare workers",
keywords="transmission",
keywords="warning system",
abstract="Background: Hospitals have been identified as very high-risk places for COVID-19 transmission between health care workers and patients who do not have COVID-19. Health care workers are the most at-risk population to contract and transmit the infection, especially to already vulnerable patients who do not have COVID-19. In low-income countries, routine testing is not feasible due to the high cost of testing; therefore, presenting the risk of uncontrolled transmission within non--COVID-19 treatment wards. This challenge necessitated the development of an affordable intermediary screening tool that would enable early identification of potentially infected health care workers and for early real time DNA--polymerase chain reaction testing prioritization. This would limit the contact time of potentially infected health care workers with the patients but also enable efficient use of the limited testing kits. Objective: The aims of this study are to describe an early warning in-hospital mobile risk analysis app for screening COVID-19 and to determine the feasibility and user-friendliness of the app among health care workers. Methods: The primary result of this research project was the development of a mobile-based daily early warning system for in-hospital transmission of COVID-19. Overall, the Early Warning System for In-Hospital Transmission of COVID-19 (EWAS) mobile app was found to be feasible, with over 69\% of the health care workers having logged more than 67\% of the required times. Over 93\% of the participants reported that the tool was easy to use. Results: The primary result of this research project was the development of a mobile-based daily early warning system for in-hospital transmission of COVID-19. Overall, the Early Warning System for In-Hospital Transmission of COVID-19 (EWAS) mobile app was found to be feasible, with 69\% of the health care workers (69/100) having logged more than 67\% of the required times. Of the 100 participants, 93 reported that the tool was easy to use. Conclusions: The EWAS mobile app is a feasible and user-friendly daily risk scoring tool for preventing in-hospital transmission of COVID-19. Although it was not designed to be a diagnostic tool but rather a screening tool, there is a need to evaluate its sensitivity in predicting persons likely to have contracted COVID-19. ",
doi="10.2196/27521",
url="https://formative.jmir.org/2021/12/e27521",
url="http://www.ncbi.nlm.nih.gov/pubmed/34793321"
}


@Article{info:doi/10.2196/34286,
author="Divi, Nomita
and Smolinski, Mark",
title="EpiHacks, a Process for Technologists and Health Experts to Cocreate Optimal Solutions for Disease Prevention and Control: User-Centered Design Approach",
journal="J Med Internet Res",
year="2021",
month="Dec",
day="15",
volume="23",
number="12",
pages="e34286",
keywords="epidemiology",
keywords="public health",
keywords="diagnostic",
keywords="tool",
keywords="disease surveillance",
keywords="technology solution",
keywords="innovative approaches to disease surveillance",
keywords="One Health",
keywords="surveillance",
keywords="hack",
keywords="innovation",
keywords="expert",
keywords="solution",
keywords="prevention",
keywords="control",
abstract="Background: Technology-based innovations that are created collaboratively by local technology specialists and health experts can optimize the addressing of priority needs for disease prevention and control. An EpiHack is a distinct, collaborative approach to developing solutions that combines the science of epidemiology with the format of a hackathon. Since 2013, a total of 12 EpiHacks have collectively brought together over 500 technology and health professionals from 29 countries. Objective: We aimed to define the EpiHack process and summarize the impacts of the technology-based innovations that have been created through this approach. Methods: The key components and timeline of an EpiHack were described in detail. The focus areas, outputs, and impacts of the twelve EpiHacks that were conducted between 2013 and 2021 were summarized. Results: EpiHack solutions have served to improve surveillance for influenza, dengue, and mass gatherings, as well as laboratory sample tracking and One Health surveillance, in rural and urban communities. Several EpiHack tools were scaled during the COVID-19 pandemic to support local governments in conducting active surveillance. All tools were designed to be open source to allow for easy replication and adaptation by other governments or parties. Conclusions: EpiHacks provide an efficient, flexible, and replicable new approach to generating relevant and timely innovations that are locally developed and owned, are scalable, and are sustainable. ",
doi="10.2196/34286",
url="https://www.jmir.org/2021/12/e34286",
url="http://www.ncbi.nlm.nih.gov/pubmed/34807832"
}


@Article{info:doi/10.2196/33739,
author="Gurley, Stephen
and Bennett, Brady
and Sullivan, Sean Patrick
and Kiley, Maryellen
and Linde, Jamie
and Szczerbacki, David
and Guest, Jodie",
title="COVID-19 Vaccine Perceptions, Intentions, and Uptake Among Young Adults in the United States: Prospective College-Based Cohort Study",
journal="JMIR Public Health Surveill",
year="2021",
month="Dec",
day="15",
volume="7",
number="12",
pages="e33739",
keywords="COVID-19",
keywords="vaccine",
keywords="hesitancy",
keywords="college",
keywords="higher education",
keywords="race",
keywords="perception",
keywords="intention",
keywords="uptake",
keywords="prospective",
keywords="cohort",
keywords="demographic",
keywords="minority",
keywords="young adult",
abstract="Background: Uptake of the COVID-19 vaccine among US young adults, particularly those that belong to racial and ethnic minorities, remains low compared to their older peers. Understanding vaccine perceptions and their influence on vaccination uptake among this population remains crucial to achieving population herd immunity. Objective: We sought to study perceptions of COVID-19 vaccines as well as intended and actual vaccine uptake among one population of college students, faculty, and staff. Methods: As part of a larger study aimed at investigating the dynamics of COVID-19 transmission, serology, and perception on a college campus, participants were asked about their views on the COVID-19 vaccine in February 2021. Vaccination status was assessed by self-report in April 2021. Logistic regression was used to calculate prevalence ratios with marginal standardization. Results: We found that non-White participants were 25\% less likely to report COVID-19 vaccination compared to White participants. Among those who were unvaccinated, Black and other non-White participants were significantly more likely to indicate they were unwilling to receive a COVID-19 vaccine compared to White participants. The most common reason for unwillingness to receive the vaccine was belief that the vaccine approval process was rushed. Conclusions: There are racial differences in perceptions of the COVID-19 vaccine among young adults, and these differences might differentially impact vaccine uptake among young racial and ethnic minorities. Efforts to increase vaccine uptake among college populations might require campaigns specifically tailored to these minority groups. ",
doi="10.2196/33739",
url="https://publichealth.jmir.org/2021/12/e33739",
url="http://www.ncbi.nlm.nih.gov/pubmed/34847054"
}


@Article{info:doi/10.2196/32203,
author="Akhtar, Hashaam
and Khalid, Sundas
and Rahman, ur Fazal
and Umar, Muhammad
and Ali, Sabahat
and Afridi, Maham
and Hassan, Faheem
and Saleh Khader, Yousef
and Akhtar, Nasim
and Khan, Mujeeb Muhammad
and Ikram, Aamer",
title="Presenting Characteristics, Comorbidities, and Outcomes Among Patients With COVID-19 Hospitalized in Pakistan: Retrospective Observational Study",
journal="JMIR Public Health Surveill",
year="2021",
month="Dec",
day="14",
volume="7",
number="12",
pages="e32203",
keywords="COVID-19",
keywords="indicators",
keywords="symptoms",
keywords="risk factors",
keywords="comorbidities",
keywords="severity",
keywords="Pakistan",
abstract="Background: COVID-19 became a pandemic rapidly after its emergence in December 2019. It belongs to the coronavirus family of viruses, which have struck a few times before in history. Data based on previous research regarding etiology and epidemiology of other viruses from this family helped played a vital role in formulating prevention and precaution strategies during the initial stages of this pandemic. Data related to COVID-19 in Pakistan were not initially documented on a large scale. In addition, due to a weak health care system and low economic conditions, Pakistan's population, in general, already suffers from many comorbidities, which can severely affect the outcome of patients infected with COVID-19. Objective: COVID-19 infections are coupled with a manifestation of various notable outcomes that can be documented and characterized clinically. The aim of this study was to examine these clinical manifestations, which can serve as indicators for early detection as well as severity prognosis for COVID-19 infections, especially in high-risk groups. Methods: A retrospective observational study involving abstraction of demographic features, presenting symptoms, and adverse clinical outcomes for 1812 patients with COVID-19 was conducted. Patients were admitted to the four major hospitals in the Rawalpindi-Islamabad region of Pakistan, and the study was conducted from February to August 2020. Multivariate regression analysis was carried out to identify significant indicators of COVID-19 severity, intensive care unit (ICU) admission, ventilator aid, and mortality. The study not only relates COVID-19 infection with comorbidities, but also examines other related factors, such as age and gender. Results: This study identified fever (1592/1812, 87.9\%), cough (1433/1812, 79.1\%), and shortness of breath (998/1812, 55.1\%) at the time of hospital admission as the most prevalent symptoms for patients with COVID-19. These symptoms were common but not conclusive of the outcome of infection. Out of 1812 patients, 24.4\% (n=443) required ICU admission and 21.5\% (n=390) required ventilator aid at some point of disease progression during their stay at the hospital; 25.9\% (n=469) of the patients died. Further analysis revealed the relationship of the presented symptoms and comorbidities with the progression of disease severity in these patients. Older adult patients with comorbidities, such as hypertension, diabetes, chronic kidney disease, and asthma, were significantly affected in higher proportions, resulting in requirement of ICU admission and ventilator aid in some cases and, in many cases, even mortality. Conclusions: Older adult patients with comorbidities, such as hypertension, diabetes, asthma, chronic obstructive pulmonary disorder, and chronic kidney disease, are at increased risk of developing severe COVID-19 infections, with an increased likelihood of adverse clinical outcomes. ",
doi="10.2196/32203",
url="https://publichealth.jmir.org/2021/12/e32203",
url="http://www.ncbi.nlm.nih.gov/pubmed/34710053"
}


@Article{info:doi/10.2196/29234,
author="Strong, E. Laura
and Middendorf, Irene
and Turner, Michelle
and Edwards V, K. David
and Sama, Varun
and Mou, Joshua
and Adams, Colleen K.",
title="Usability of an At-Home Anterior Nares SARS-CoV-2 RT-PCR Sample Collection Kit: Human Factors Feasibility Study",
journal="JMIR Hum Factors",
year="2021",
month="Dec",
day="14",
volume="8",
number="4",
pages="e29234",
keywords="COVID-19 testing",
keywords="at-home collection kit",
keywords="SARS-CoV-2",
keywords="feasibility studies",
keywords="self-collection",
keywords="usability study",
keywords="COVID-19",
abstract="Background: Readily available testing for SARS-CoV-2 is necessary to mitigate COVID-19 disease outbreaks. At-home collection kits, in which samples are self-collected without requiring a laboratory or clinic visit and sent to an external laboratory for testing, can provide convenient testing to those with barriers to access. They can prevent unnecessary exposure between patient and clinical staff, increase access for patients with disabilities or remote workers, and decrease burdens on health care resources, such as provider time and personal protective equipment. Exact Sciences developed an at-home collection kit for samples to be tested to detect SARS-CoV-2 that includes an Instructions for Use (IFU) document, which guides people without prior experience on collecting a nasal swab sample. Demonstrating successful sample collection and usability is critical to ensure that these samples meet the same high-quality sample collection standards as samples collected in clinics. Objective: The aim of this study was to determine the usability of a SARS-CoV-2 at-home nasal swab sample collection kit. Methods: A human factors usability study was conducted with 30 subjects without prior medical, laboratory, or health care training and without COVID-19 sample self-collection experience. Subjects were observed while they followed the IFU for the at-home sample collection portion of the SARS-CoV-2 test in a setting that simulated a home environment. IFU usability was further evaluated by requiring the subjects to complete a survey, answer comprehension questions, provide written feedback, and respond to questions from the observer about problems during use. Results: All 30 subjects successfully completed the sample collection process, and all 30 samples were determined by reverse transcription--polymerase chain reaction (RT-PCR) testing to meet quality standards for SARS-CoV-2 testing. The subjects' written feedback and comments revealed several recommendations to improve the IFU. Conclusions: The study demonstrated the overall usability of an at-home SARS-CoV-2 collection kit. Various feedback mechanisms provided opportunities to improve the wording and graphics for some critical tasks, including placing the label correctly on the tube. A modified IFU was prepared based on study outcomes. ",
doi="10.2196/29234",
url="https://humanfactors.jmir.org/2021/4/e29234",
url="http://www.ncbi.nlm.nih.gov/pubmed/34609947"
}


@Article{info:doi/10.2196/33746,
author="Badran, Samir
and Chen, Ming
and Coia, E. John",
title="Multiplex Droplet Digital Polymerase Chain Reaction Assay for Rapid Molecular Detection of Pathogens in Patients With Sepsis: Protocol for an Assay Development Study",
journal="JMIR Res Protoc",
year="2021",
month="Dec",
day="13",
volume="10",
number="12",
pages="e33746",
keywords="sepsis",
keywords="ddPCR",
keywords="clinical microbiology",
keywords="molecular diagnostics",
keywords="infectious diseases",
abstract="Background: Blood cultures are the cornerstone of diagnosis for detecting the presence of bacteria or fungi in the blood, with an average detection time of 48 hours and failure to detect a pathogen occurring in approximately 50\% of patients with sepsis. Rapid diagnosis would facilitate earlier treatment and/or an earlier switch to narrow-spectrum antibiotics. Objective: The aim of this study is to develop and implement a multiplex droplet digital polymerase chain reaction (ddPCR) assay as a routine diagnostic tool in the detection and identification of pathogens from whole blood and/or blood culture after 3 hours of incubation. Methods: The study consists of three phases: (1) design of primer-probe pairs for accurate and reliable quantification of the most common sepsis-causing microorganisms using a multiplex reaction, (2) determination of the analytical sensitivity and specificity of the multiplex ddPCR assay, and (3) a clinical study in patients with sepsis using the assay. The QX200 Droplet Digital PCR System will be used for the detection of the following species-specific genes in blood from patients with sepsis: coa (staphylocoagulase) in Staphylococcus aureus, cpsA (capsular polysaccharide) in Streptococcus pneumoniae, uidA (beta-D-glucuronidase) in Escherichia coli, oprL (peptidoglycan-associated lipoprotein) in Pseudomonas aeruginosa, and the highly conserved regions of the 16S rRNA gene for Gram-positive and Gram-negative bacteria. All data will be analyzed using QuantaSoft Analysis Pro Software. Results: In phase 1, to determine the optimal annealing temperature for the designed primer-probe pairs, results from a gradient temperature experiment will be collected and the limit of detection (LOD) of the assay will be determined. In phase 2, results for the analytical sensitivity and specificity of the assay will be obtained after an optimization of the extraction and purification method in spiked blood. In phase 3, clinical sensitivity and specificity as compared to the standard blood culture technique will be determined using 301 clinical samples. Conclusions: Successful design of primer-probe pairs in the first phase and subsequent optimization and determination of the LOD will allow progression to phase 3 to compare the novel method with existing blood culture methods. International Registered Report Identifier (IRRID): PRR1-10.2196/33746 ",
doi="10.2196/33746",
url="https://www.researchprotocols.org/2021/12/e33746",
url="http://www.ncbi.nlm.nih.gov/pubmed/34898460"
}


@Article{info:doi/10.2196/33677,
author="Hazenberg, L. Hanna M. J.
and Dubbink, Henk Jan
and Sesay, Issa
and Versteege, Tom
and Bangura, Hassan
and Hoevenaars, K. Louise
and Falama, M. Abdul
and Koudijs, M. Heleen
and Roemers, Rosa
and Bache, B. Emmanuel
and Kelling, F. Emil
and Schaumburg, Frieder
and Spijkervet, L. Fred K.
and Grobusch, P. Martin",
title="Complicated Odontogenic Infections at 2 District Hospitals in Tonkolili District, Sierra Leone: Protocol for a Prospective Observational Cohort Study (DELAY)",
journal="JMIR Res Protoc",
year="2021",
month="Dec",
day="13",
volume="10",
number="12",
pages="e33677",
keywords="complicated odontogenic infection",
keywords="dental abscess",
keywords="deep neck space infection",
keywords="Ludwig angina",
keywords="necrotizing fasciitis",
keywords="prospective observational cohort study",
abstract="Background: Deficits in global oral health care are paramount, and complications of odontogenic infections constitute a considerable global health problem, particularly in low-income countries. A high mortality rate has been observed for patients who have been admitted with complicated odontogenic infections to our facilities in Tonkolili District, Sierra Leone, although exact data have not been published yet. Data regarding who in this region is at risk and why are lacking. Objective: The Dental Abscess Study (DELAY) aims to prospectively investigate morbidity and mortality from complicated dental abscesses and to analyze patients' characteristics and microbial findings to examine predisposing factors for poor outcomes. In particular, the incidence and the clinical and microbial characteristics of complicated odontogenic infections, as well as the sociodemographic data and comorbidities of affected patients, will be studied to develop improved management algorithms based on circumstance-specific factors. Methods: Patients who present with complicated dental infections requiring hospital admission in Masanga Hospital or Lion Heart Medical Centre will be consecutively selected for possible inclusion in the study (starting on September 4, 2021) over a study period of 1 year, and individual routine follow-ups will be conducted at least 3 months after discharge. The results of standardized questionnaires will be obtained, and clinical measurements as well as medical photos will be taken. Standard laboratory tests (eg, full blood count and HIV status tests) will be performed, and pus specimens will be examined. Local treatment guidelines will be adhered to, and data on medical and surgical treatment as well as data on outcomes will be collected. The study results will be reported according to the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) criteria. Routine follow-ups will take place at 1 and 3 months postdischarge. Results: The DELAY protocol was endorsed by the Masanga Medical Research Unit's Scientific Review Committee on June 16, 2021, and ethical approval was granted on July 5, 2021, by the Sierra Leone National Ethics Committee. The funding of the budgeted study costs was approved by Dental Health International Netherlands in August 2021. The projected start date of data collection was September 4, 2021, and the study period will most likely last for 1 year. As such, data collection is expected to be complete in November 2022. Conclusions: The aim of our prospective observational cohort study is to gain more knowledge about complicated odontogenic infections in Tonkolili District, Sierra Leone, to further improve treatment strategies. International Registered Report Identifier (IRRID): DERR1-10.2196/33677 ",
doi="10.2196/33677",
url="https://www.researchprotocols.org/2021/12/e33677",
url="http://www.ncbi.nlm.nih.gov/pubmed/34898462"
}


@Article{info:doi/10.2196/28307,
author="Hu, Alvin",
title="Conjugation of Silver Nanoparticles With De Novo--Engineered Cationic Antimicrobial Peptides: Exploratory Proposal",
journal="JMIR Res Protoc",
year="2021",
month="Dec",
day="8",
volume="10",
number="12",
pages="e28307",
keywords="antimicrobial peptides",
keywords="silver nanoparticles",
keywords="ESKAPE pathogens",
keywords="research proposal",
abstract="Background: Cationic antimicrobial peptides have broad antimicrobial activity and provide a novel way of targeting multidrug-resistant bacteria in the era of increasing antimicrobial resistance. Current developments show positive prospects for antimicrobial peptides and silver nanoparticles (AgNPs) individually. Objective: The primary objective is to propose another method for enhancing antimicrobial activity by conjugating AgNPs with cationic antimicrobial peptides, with a subsequent preliminary assessment of the minimum inhibitory concentration of multidrug-resistant bacteria. The secondary objective is to evaluate the safety of the conjugated compound and assess its viability for in vivo use. Methods: The proposal involves 3 stages. First, WLBU2C, a modified version of the antimicrobial peptide WLBU2 with an added cysteine group, needs to be synthesized using a standard Fmoc procedure. It can then be stably conjugated with AgNPs ideally through photochemical means. Second, the WLBU2C-AgNP conjugate should be tested for antimicrobial activity according to the Clinical \& Laboratory Standards Institute manual on standard minimum inhibitory concentration testing. Third, the cytotoxicity of the conjugate should be tested using cell lysis assays if the above stages are completed. Results: I-TASSER (iterative threading assembly refinement) simulation revealed that the modified peptide WLBU2C has a secondary structure similar to that of the original WLBU2 peptide. No other results have been obtained at this time. Conclusions: The addition of AgNPs to already developed de novo--engineered antimicrobial peptides provides an opportunity for the development of potent antimicrobials. Future prospects include emergency last-line therapy and treatment for current difficult-to-eradicate bacterial colonization, such as in cystic fibrosis, implantable medical devices, cancer, and immunotherapy. As I do not anticipate funding at this time, I hope this proposal provides inspiration to other researchers. International Registered Report Identifier (IRRID): PRR1-10.2196/28307 ",
doi="10.2196/28307",
url="https://www.researchprotocols.org/2021/12/e28307",
url="http://www.ncbi.nlm.nih.gov/pubmed/34780345"
}


@Article{info:doi/10.2196/33296,
author="Izadi, Neda
and Etemad, Koorosh
and Mehrabi, Yadollah
and Eshrati, Babak
and Hashemi Nazari, Saeed Seyed",
title="The Standardization of Hospital-Acquired Infection Rates Using Prediction Models in Iran: Observational Study of National Nosocomial Infection Registry Data",
journal="JMIR Public Health Surveill",
year="2021",
month="Dec",
day="7",
volume="7",
number="12",
pages="e33296",
keywords="hospital-acquired infections",
keywords="standardized infection ratio",
keywords="prediction model",
keywords="Iran",
abstract="Background: Many factors contribute to the spreading of hospital-acquired infections (HAIs). Objective: This study aimed to standardize the HAI rate using prediction models in Iran based on the National Healthcare Safety Network (NHSN) method. Methods: In this study, the Iranian nosocomial infections surveillance system (INIS) was used to gather data on patients with HAIs (126,314 infections). In addition, the hospital statistics and information system (AVAB) was used to collect data on hospital characteristics. First, well-performing hospitals, including 357 hospitals from all over the country, were selected. Data were randomly split into training (70\%) and testing (30\%) sets. Finally, the standardized infection ratio (SIR) and the corrected SIR were calculated for the HAIs. Results: The mean age of the 100,110 patients with an HAI was 40.02 (SD 23.56) years. The corrected SIRs based on the observed and predicted infections for respiratory tract infections (RTIs), urinary tract infections (UTIs), surgical site infections (SSIs), and bloodstream infections (BSIs) were 0.03 (95\% CI 0-0.09), 1.02 (95\% CI 0.95-1.09), 0.93 (95\% CI 0.85-1.007), and 0.91 (95\% CI 0.54-1.28), respectively. Moreover, the corrected SIRs for RTIs in the infectious disease, burn, obstetrics and gynecology, and internal medicine wards; UTIs in the burn, infectious disease, internal medicine, and intensive care unit wards; SSIs in the burn and infectious disease wards; and BSIs in most wards were >1, indicating that more HAIs were observed than expected. Conclusions: The results of this study can help to promote preventive measures based on scientific evidence. They can also lead to the continuous improvement of the monitoring system by collecting and systematically analyzing data on HAIs and encourage the hospitals to better control their infection rates by establishing a benchmarking system. ",
doi="10.2196/33296",
url="https://publichealth.jmir.org/2021/12/e33296",
url="http://www.ncbi.nlm.nih.gov/pubmed/34879002"
}


@Article{info:doi/10.2196/33455,
author="Goldin, Shoshanna
and Kong, Joyce So Yeon
and Tokar, Anna
and Utunen, Heini
and Ndiaye, Ngouille
and Bahl, Jhilmil
and Appuhamy, Ranil
and Moen, Ann",
title="Learning From a Massive Open Online COVID-19 Vaccination Training Experience: Survey Study",
journal="JMIR Public Health Surveill",
year="2021",
month="Dec",
day="3",
volume="7",
number="12",
pages="e33455",
keywords="COVID-19",
keywords="vaccination",
keywords="training",
keywords="massive open online course",
keywords="pandemic",
keywords="vaccine",
keywords="education",
keywords="online education",
keywords="preparation",
keywords="evaluation",
keywords="user experience",
keywords="challenge",
keywords="impact",
keywords="knowledge",
keywords="interest",
abstract="Background: To prepare key stakeholders for the global COVID-19 vaccination rollout, the World Health Organization and partners developed online vaccination training packages. The online course was launched in December 2020 on the OpenWHO learning platform. This paper presents the findings of an evaluation of this course. Objective: The aim of this evaluation was to provide insights into user experiences and challenges, measure the impact of the course in terms of knowledge gained, and anticipate potential interest in future online vaccination courses. Methods: The primary source of data was the anonymized information on course participants, enrollment, completion, and scores from the OpenWHO platform's statistical data and metric reporting system. Data from the OpenWHO platform were analyzed from the opening of the courses in mid-December 2020 to mid-April 2021. In addition, a learner feedback survey was sent by email to all course participants to complete within a 3-week period (March 19 to April 9, 2021). The survey was designed to determine the perceived strengths and weaknesses of the training packages and to understand barriers to access. Results: During the study period, 53,593 learners enrolled in the course. Of them, 30,034 (56.0\%) completed the course, which is substantially higher than the industry benchmark of 5\%-10\% for a massive open online course (MOOC). Overall, learners averaged 76.5\% on the prequiz compared to 85\% on the postquiz, resulting in an increase in average score of 9\%. A total of 2019 learners from the course participated in the survey. Nearly 98\% (n=1647 fully agree, n=308 somewhat agree; N=1986 survey respondents excluding missing values) of respondents fully or somewhat agreed that they had more confidence in their ability to support COVID-19 vaccination following completion of this course. Conclusions: The online vaccine training was well received by the target audience, with a measurable impact on knowledge gained. The key benefits of online training were the convenience, self-paced nature, access to downloadable material, and ability to replay material, as well as an increased ability to concentrate. Online training was identified as a timely, cost-effective way of delivering essential training to a large number of people to prepare for the COVID-19 vaccination rollout. ",
doi="10.2196/33455",
url="https://publichealth.jmir.org/2021/12/e33455",
url="http://www.ncbi.nlm.nih.gov/pubmed/34794116"
}


@Article{info:doi/10.2196/33433,
author="Oganesyan, Ani
and Sivesind, Torunn
and Dellavalle, Robert",
title="From the Cochrane Library: Interventions for Impetigo",
journal="JMIR Dermatol",
year="2021",
month="Dec",
day="3",
volume="4",
number="2",
pages="e33433",
keywords="impetigo",
keywords="pustular lesions",
keywords="Staphylococcus aureus",
keywords="Streptococcus pyogenes",
keywords="dermatology",
keywords="skin infection",
doi="10.2196/33433",
url="https://derma.jmir.org/2021/2/e33433"
}


@Article{info:doi/10.2196/30648,
author="Donnat, Claire
and Bunbury, Freddy
and Kreindler, Jack
and Liu, David
and Filippidis, T. Filippos
and Esko, Tonu
and El-Osta, Austen
and Harris, Matthew",
title="Predicting COVID-19 Transmission to Inform the Management of Mass Events: Model-Based Approach",
journal="JMIR Public Health Surveill",
year="2021",
month="Dec",
day="1",
volume="7",
number="12",
pages="e30648",
keywords="COVID-19",
keywords="transmission dynamics",
keywords="live event management",
keywords="Monte Carlo simulation",
abstract="Background: Modelling COVID-19 transmission at live events and public gatherings is essential to controlling the probability of subsequent outbreaks and communicating to participants their personalized risk. Yet, despite the fast-growing body of literature on COVID-19 transmission dynamics, current risk models either neglect contextual information including vaccination rates or disease prevalence or do not attempt to quantitatively model transmission. Objective: This paper attempted to bridge this gap by providing informative risk metrics for live public events, along with a measure of their uncertainty. Methods: Building upon existing models, our approach ties together 3 main components: (1) reliable modelling of the number of infectious cases at the time of the event, (2) evaluation of the efficiency of pre-event screening, and (3) modelling of the event's transmission dynamics and their uncertainty using Monte Carlo simulations. Results: We illustrated the application of our pipeline for a concert at the Royal Albert Hall and highlighted the risk's dependency on factors such as prevalence, mask wearing, and event duration. We demonstrate how this event held on 3 different dates (August 20, 2020; January 20, 2021; and March 20, 2021) would likely lead to transmission events that are similar to community transmission rates (0.06 vs 0.07, 2.38 vs 2.39, and 0.67 vs 0.60, respectively). However, differences between event and background transmissions substantially widened in the upper tails of the distribution of the number of infections (as denoted by their respective 99th quantiles: 1 vs 1, 19 vs 8, and 6 vs 3, respectively, for our 3 dates), further demonstrating that sole reliance on vaccination and antigen testing to gain entry would likely significantly underestimate the tail risk of the event. Conclusions: Despite the unknowns surrounding COVID-19 transmission, our estimation pipeline opens the discussion on contextualized risk assessment by combining the best tools at hand to assess the order of magnitude of the risk. Our model can be applied to any future event and is presented in a user-friendly RShiny interface. Finally, we discussed our model's limitations as well as avenues for model evaluation and improvement. ",
doi="10.2196/30648",
url="https://publichealth.jmir.org/2021/12/e30648",
url="http://www.ncbi.nlm.nih.gov/pubmed/34583317"
}


@Article{info:doi/10.2196/33365,
author="Alam, Mahbub-Ul
and Ferdous, Sharika
and Ercumen, Ayse
and Lin, Audrie
and Kamal, Abul
and Luies, Khan Sharmin
and Sharior, Fazle
and Khan, Rizwana
and Rahman, Ziaur Md
and Parvez, Masud Sarker
and Amin, Nuhu
and Tadesse, Tilahun Birkneh
and Moushomi, Akter Niharu
and Hasan, Rezaul
and Taneja, Neelam
and Islam, Aminul Mohammad
and Rahman, Mahbubur",
title="Effective Treatment Strategies for the Removal of Antibiotic-Resistant Bacteria, Antibiotic-Resistance Genes, and Antibiotic Residues in the Effluent From Wastewater Treatment Plants Receiving Municipal, Hospital, and Domestic Wastewater: Protocol for a Systematic Review",
journal="JMIR Res Protoc",
year="2021",
month="Nov",
day="26",
volume="10",
number="11",
pages="e33365",
keywords="antimicrobial resistance",
keywords="antimicrobial-resistant bacteria",
keywords="antibiotic-resistant bacteria",
keywords="antimicrobial-resistance genes",
keywords="antibiotic-resistance genes",
keywords="antibiotics",
keywords="antibiotic residues",
keywords="wastewater treatment plant",
keywords="effluent",
keywords="systematic review",
abstract="Background: The widespread and unrestricted use of antibiotics has led to the emergence and spread of antibiotic-resistant bacteria (ARB), antibiotic-resistance genes (ARGs), and antibiotic residues in the environment. Conventional wastewater treatment plants (WWTPs) are not designed for effective and adequate removal of ARB, ARGs, and antibiotic residues, and therefore, they play an important role in the dissemination of antimicrobial resistance (AMR) in the natural environment. Objective: We will conduct a systematic review to determine the most effective treatment strategies for the removal of ARB, ARGs, and antibiotic residues from the treated effluent disposed into the environment from WWTPs that receive municipal, hospital, and domestic discharge. Methods: We will search the MEDLINE, EMBASE, Web of Science, World Health Organization Global Index Medicus, and ProQuest Environmental Science Collection databases for full-text peer-reviewed journal articles published between January 2001 and December 2020. We will select only articles published in the English language. We will include studies that measured (1) the presence, concentration, and removal rate of ARB/ARGs going from WWTP influent to effluent, (2) the presence, concentration, and types of antibiotics in the effluent, and (3) the possible selection of ARB in the effluent after undergoing treatment processes in WWTPs. At least two independent reviewers will extract data and perform risk of bias assessment. An acceptable or narrative synthesis method will be followed to synthesize the data and present descriptive characteristics of the included studies in a tabular form. The study has been approved by the Ethics Review Board at the International Centre for Diarrhoeal Disease Research, Bangladesh (protocol number: PR-20113). Results: This protocol outlines our proposed methodology for conducting a systematic review. Our results will provide an update to the existing literature by searching additional databases. Conclusions: Findings from our systematic review will inform the planning of proper treatment methods that can effectively reduce the levels of ARB, ARGs, and residual antibiotics in effluent, thus lowering the risk of the environmental spread of AMR and its further transmission to humans and animals. International Registered Report Identifier (IRRID): PRR1-10.2196/33365 ",
doi="10.2196/33365",
url="https://www.researchprotocols.org/2021/11/e33365",
url="http://www.ncbi.nlm.nih.gov/pubmed/34842550"
}


@Article{info:doi/10.2196/33003,
author="Suppan, Melanie
and Stuby, Loric
and Harbarth, Stephan
and Fehlmann, A. Christophe
and Achab, Sophia
and Abbas, Mohamed
and Suppan, Laurent",
title="Nationwide Deployment of a Serious Game Designed to Improve COVID-19 Infection Prevention Practices in Switzerland: Prospective Web-Based Study",
journal="JMIR Serious Games",
year="2021",
month="Nov",
day="25",
volume="9",
number="4",
pages="e33003",
keywords="COVID-19",
keywords="serious game",
keywords="infection prevention",
keywords="SARS-CoV-2",
keywords="prospective",
keywords="web-based",
keywords="deployment",
keywords="prevention",
keywords="gaming",
keywords="public health",
keywords="dissemination",
keywords="health information",
keywords="behavior",
keywords="survey",
abstract="Background: Lassitude and a rather high degree of mistrust toward the authorities can make regular or overly constraining COVID-19 infection prevention and control campaigns inefficient and even counterproductive. Serious games provide an original, engaging, and potentially effective way of disseminating COVID-19 infection prevention and control guidelines. Escape COVID-19 is a serious game for teaching COVID-19 infection prevention and control practices that has previously been validated in a population of nursing home personnel. Objective: We aimed to identify factors learned from playing the serious game Escape COVID-19 that facilitate or impede intentions of changing infection prevention and control behavior in a large and heterogeneous Swiss population. Methods: This fully automated, prospective web-based study, compliant with the Checklist for Reporting Results of Internet E-Surveys (CHERRIES), was conducted in all 3 main language regions of Switzerland. After creating an account on the platform, participants were asked to complete a short demographic questionnaire before accessing the serious game. The only incentive given to the potential participants was a course completion certificate, which participants obtained after completing the postgame questionnaire. The primary outcome was the proportion of participants who reported that they were willing to change their infection prevention and control behavior. Secondary outcomes were the infection prevention and control areas affected by this willingness and the presumed evolution in the use of specific personal protective equipment items. The elements associated with intention to change infection prevention and control behavior, or lack thereof, were also assessed. Other secondary outcomes were the subjective perceptions regarding length, difficulty, meaningfulness, and usefulness of the serious game; impression of engagement and boredom while playing the serious game; and willingness to recommend its use to friends or colleagues. Results: From March 9 to June 9, 2021, a total of 3227 accounts were created on the platform, and 1104 participants (34.2\%) completed the postgame questionnaire. Of the 1104 respondents, 509 respondents (46.1\%) answered that they intended to change their infection prevention and control behavior after playing the game. Among the respondents who answered that they did not intend to change their behavior, 86.1\% (512/595) answered that they already apply these guidelines. Participants who followed the German version were less likely to intend to change their infection prevention and control behavior (odds ratio [OR] 0.48, 95\% CI 0.24-0.96; P=.04) and found the game less engaging (P<.001). Conversely, participants aged 53 years or older had stronger intentions of changing infection prevention and control behavior (OR 2.07, 95\% CI 1.44-2.97; P<.001). Conclusions: Escape COVID-19 is a useful tool to enhance correct infection prevention and control measures on a national scale, even after 2 COVID-19 pandemic waves; however, the serious game's impact was affected by language, age category, and previous educational training, and the game should be adapted to enhance its impact on specific populations. ",
doi="10.2196/33003",
url="https://games.jmir.org/2021/4/e33003",
url="http://www.ncbi.nlm.nih.gov/pubmed/34635472"
}


@Article{info:doi/10.2196/27880,
author="Wang, Chaofan
and Jiang, Weiwei
and Yang, Kangning
and Yu, Difeng
and Newn, Joshua
and Sarsenbayeva, Zhanna
and Goncalves, Jorge
and Kostakos, Vassilis",
title="Electronic Monitoring Systems for Hand Hygiene: Systematic Review of Technology",
journal="J Med Internet Res",
year="2021",
month="Nov",
day="24",
volume="23",
number="11",
pages="e27880",
keywords="hand hygiene",
keywords="hand hygiene compliance",
keywords="hand hygiene quality",
keywords="electronic monitoring systems",
keywords="systematic review",
keywords="mobile phone",
abstract="Background: Hand hygiene is one of the most effective ways of preventing health care--associated infections and reducing their transmission. Owing to recent advances in sensing technologies, electronic hand hygiene monitoring systems have been integrated into the daily routines of health care workers to measure their hand hygiene compliance and quality. Objective: This review aims to summarize the latest technologies adopted in electronic hand hygiene monitoring systems and discuss the capabilities and limitations of these systems. Methods: A systematic search of PubMed, ACM Digital Library, and IEEE Xplore Digital Library was performed following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Studies were initially screened and assessed independently by the 2 authors, and disagreements between them were further summarized and resolved by discussion with the senior author. Results: In total, 1035 publications were retrieved by the search queries; of the 1035 papers, 89 (8.60\%) fulfilled the eligibility criteria and were retained for review. In summary, 73 studies used electronic monitoring systems to monitor hand hygiene compliance, including application-assisted direct observation (5/73, 7\%), camera-assisted observation (10/73, 14\%), sensor-assisted observation (29/73, 40\%), and real-time locating system (32/73, 44\%). A total of 21 studies evaluated hand hygiene quality, consisting of compliance with the World Health Organization 6-step hand hygiene techniques (14/21, 67\%) and surface coverage or illumination reduction of fluorescent substances (7/21, 33\%). Conclusions: Electronic hand hygiene monitoring systems face issues of accuracy, data integration, privacy and confidentiality, usability, associated costs, and infrastructure improvements. Moreover, this review found that standardized measurement tools to evaluate system performance are lacking; thus, future research is needed to establish standardized metrics to measure system performance differences among electronic hand hygiene monitoring systems. Furthermore, with sensing technologies and algorithms continually advancing, more research is needed on their implementation to improve system performance and address other hand hygiene--related issues. ",
doi="10.2196/27880",
url="https://www.jmir.org/2021/11/e27880",
url="http://www.ncbi.nlm.nih.gov/pubmed/34821565"
}


@Article{info:doi/10.2196/33576,
author="Leal-Neto, Onicio
and Egger, Thomas
and Schlegel, Matthias
and Flury, Domenica
and Sumer, Johannes
and Albrich, Werner
and Babouee Flury, Baharak
and Kuster, Stefan
and Vernazza, Pietro
and Kahlert, Christian
and Kohler, Philipp",
title="Digital SARS-CoV-2 Detection Among Hospital Employees: Participatory Surveillance Study",
journal="JMIR Public Health Surveill",
year="2021",
month="Nov",
day="22",
volume="7",
number="11",
pages="e33576",
keywords="digital epidemiology",
keywords="SARS-CoV-2",
keywords="COVID-19",
keywords="health care workers",
abstract="Background: The implementation of novel techniques as a complement to traditional disease surveillance systems represents an additional opportunity for rapid analysis. Objective: The objective of this work is to describe a web-based participatory surveillance strategy among health care workers (HCWs) in two Swiss hospitals during the first wave of COVID-19. Methods: A prospective cohort of HCWs was recruited in March 2020 at the Cantonal Hospital of St. Gallen and the Eastern Switzerland Children's Hospital. For data analysis, we used a combination of the following techniques: locally estimated scatterplot smoothing (LOESS) regression, Spearman correlation, anomaly detection, and random forest. Results: From March 23 to August 23, 2020, a total of 127,684 SMS text messages were sent, generating 90,414 valid reports among 1004 participants, achieving a weekly average of 4.5 (SD 1.9) reports per user. The symptom showing the strongest correlation with a positive polymerase chain reaction test result was loss of taste. Symptoms like red eyes or a runny nose were negatively associated with a positive test. The area under the receiver operating characteristic curve showed favorable performance of the classification tree, with an accuracy of 88\% for the training data and 89\% for the test data. Nevertheless, while the prediction matrix showed good specificity (80.0\%), sensitivity was low (10.6\%). Conclusions: Loss of taste was the symptom that was most aligned with COVID-19 activity at the population level. At the individual level---using machine learning--based random forest classification---reporting loss of taste and limb/muscle pain as well as the absence of runny nose and red eyes were the best predictors of COVID-19. ",
doi="10.2196/33576",
url="https://publichealth.jmir.org/2021/11/e33576",
url="http://www.ncbi.nlm.nih.gov/pubmed/34727046"
}


@Article{info:doi/10.2196/32591,
author="Valera, Pamela
and Carmona, David
and Malarkey, Sarah
and Sinangil, Noah
and Owens, Madelyn
and Lefebre, Asia",
title="Exploring Online Health Reviews to Monitor COVID-19 Public Health Responses in Alabama State Department of Corrections: Case Example",
journal="JMIR Form Res",
year="2021",
month="Nov",
day="10",
volume="5",
number="11",
pages="e32591",
keywords="Alabama",
keywords="correctional facilities",
keywords="COVID-19",
keywords="online health reviews",
keywords="review",
keywords="monitoring",
keywords="public health",
keywords="policy",
keywords="response",
keywords="prison",
keywords="United States",
keywords="case study",
keywords="formative",
keywords="feasibility",
keywords="acceptability",
keywords="survey",
abstract="Background: COVID-19, caused by SARS-CoV-2, has devastated incarcerated people throughout the United States. Objective: The purpose of this study was to test the feasibility and acceptability of a COVID-19 Health Review for Correctional Facilities. Methods: The COVID-19 Health Review survey for the Department of Corrections was developed in Qualtrics to assess the following: (1) COVID-19 testing, (2) providing personal protective equipment, (3) vaccination procedures, (4) quarantine procedures, (5) COVID-19 mortality rates for inmates, (6) COVID-19 mortality rates for correctional officers and prison staff, (7) COVID-19 infection rates for inmates, (8) COVID-19 infection rates for correctional officers and prison staff, and (9) uptake of COVID-19 vaccines. The estimated time to review the Alabama State Department of Corrections COVID-19 responses on their website and complete the survey items was 45 minutes to 1 hour. Results: Of the 21 participants who completed the COVID-19 Health Review for Correctional Facilities survey, 48\% (n=10) identified as female, 43\% (n=9) identified as male, and 10\% (n=2) identified as transgender. For race, 29\% (n=6) self-identified as Black or African American, 24\% (n=5) Asian, 24\% (n=5) White, 5\% (n=1) Pacific Islander or Native Hawaiian, and 19\% (n=4) Other. In addition, 5 respondents self-identified as returning citizens. For COVID-19 review questions, the majority concluded that information on personal protective equipment was ``poor'' and ``very poor,'' information on COVID-19 testing was ``fair'' and above, information on COVID-19 death/infection rates between inmates and staff was ``good'' and ``very good,'' and information on vaccinations was ``good'' and ``very good.'' There was a significant difference observed (P=.03) between nonreturning citizens and returning citizens regarding the health grade review with respect to available information on COVID-19 infection rates. Conclusions: COVID-19 health reviews may provide an opportunity for the public to review the COVID-19 responses in correctional settings. ",
doi="10.2196/32591",
url="https://formative.jmir.org/2021/11/e32591",
url="http://www.ncbi.nlm.nih.gov/pubmed/34609313"
}


@Article{info:doi/10.2196/29319,
author="Monnig, A. Mollie
and Treloar Padovano, Hayley
and Sokolovsky, W. Alexander
and DeCost, Grace
and Aston, R. Elizabeth
and Haass-Koffler, L. Carolina
and Szapary, Claire
and Moyo, Patience
and Avila, C. Jaqueline
and Tidey, W. Jennifer
and Monti, M. Peter
and Ahluwalia, S. Jasjit",
title="Association of Substance Use With Behavioral Adherence to Centers for Disease Control and Prevention Guidelines for COVID-19 Mitigation: Cross-sectional Web-Based Survey",
journal="JMIR Public Health Surveill",
year="2021",
month="Nov",
day="9",
volume="7",
number="11",
pages="e29319",
keywords="SARS-CoV-2",
keywords="novel coronavirus",
keywords="COVID-19",
keywords="alcohol use",
keywords="alcohol drinking",
keywords="opioid use",
keywords="stimulant use",
keywords="nicotine",
keywords="smoking",
keywords="survey",
keywords="substance abuse",
keywords="addiction",
keywords="mental health",
keywords="pandemic",
abstract="Background: Substance use is a risk factor for COVID-19 infection and adverse outcomes. However, reasons for elevated risk for COVID-19 in substance users are not well understood. Objective: The aim of this study was to evaluate whether alcohol or other drug use is associated with adherence to Centers for Disease Control and Prevention (CDC) guidelines for COVID-19 mitigation. Preregistered analyses tested the hypothesis that greater use of alcohol and other drugs would be associated with lower CDC guideline adherence. A secondary objective was to determine whether substance use was associated with the likelihood of COVID-19 testing or outcome. Methods: A cross-sectional web-based survey was administered to a convenience sample recruited through Amazon's Mechanical Turk platform from June 18 to July 19, 2020. Individuals aged 18 years or older and residing in Connecticut, Massachusetts, New Jersey, New York, or Rhode Island were eligible to participate. The exposure of interest was past 7-day use of alcohol, cigarettes, electronic cigarettes, cannabis, stimulants, and nonmedical opioids. The primary outcome was CDC guideline adherence measured using a scale developed from behaviors advised to reduce the spread of COVID-19. Secondary outcomes were likelihood of COVID-19 testing and a positive COVID-19 test result. All analyses accounted for the sociodemographic characteristics. Results: The sample consisted of 1084 individuals (mean age 40.9 [SD 13.4] years): 529 (48.8\%) men, 543 (50.1\%) women, 12 (1.1\%) other gender identity, 742 (68.5\%) White individuals, 267 (24.6\%) Black individuals, and 276 (25.5\%) Hispanic individuals. Daily opioid users reported lower CDC guideline adherence than nondaily users (B=--0.24, 95\% CI --0.44 to --0.05) and nonusers (B=--0.57, 95\% CI --0.76 to --0.38). Daily alcohol drinkers reported lower adherence than nondaily drinkers (B=--0.16, 95\% CI --0.30 to --0.02). Nondaily alcohol drinkers reported higher adherence than nondrinkers (B=0.10, 95\% CI 0.02-0.17). Daily opioid use was related to greater odds of COVID-19 testing, and daily stimulant use was related to greater odds of a positive COVID-19 test. Conclusions: In a regionally-specific, racially, and ethnically diverse convenience sample, adults who engaged in daily alcohol or opioid use reported lower CDC guideline adherence for COVID-19 mitigation. Any opioid use was associated with greater odds of COVID-19 testing, and daily stimulant use was associated with greater odds of COVID-19 infection. Cigarettes, electronic cigarettes, cannabis, or stimulant use were not statistically associated with CDC guideline adherence, after accounting for sociodemographic covariates and other substance use variables. Findings support further investigation into whether COVID-19 testing and vaccination should be expanded among individuals with substance-related risk factors. ",
doi="10.2196/29319",
url="https://publichealth.jmir.org/2021/11/e29319",
url="http://www.ncbi.nlm.nih.gov/pubmed/34591780"
}


@Article{info:doi/10.2196/33022,
author="Bhalla, Sameer
and Sharma, Brihat
and Smith, Dale
and Boley, Randy
and McCluskey, Connor
and Ilyas, Yousaf
and Afshar, Majid
and Balk, Robert
and Karnik, Niranjan
and Keshavarzian, Ali",
title="Investigating Unhealthy Alcohol Use As an Independent Risk Factor for Increased COVID-19 Disease Severity: Observational Cross-sectional Study",
journal="JMIR Public Health Surveill",
year="2021",
month="Nov",
day="5",
volume="7",
number="11",
pages="e33022",
keywords="unhealthy alcohol use",
keywords="COVID-19",
keywords="SARS-CoV-2",
keywords="acute respiratory distress syndrome",
keywords="substance misuse",
keywords="mechanical ventilation",
keywords="substance use",
abstract="Background: Unhealthy alcohol use (UAU) is known to disrupt pulmonary immune mechanisms and increase the risk of acute respiratory distress syndrome in patients with pneumonia; however, little is known about the effects of UAU on outcomes in patients with COVID-19 pneumonia. To our knowledge, this is the first observational cross-sectional study that aims to understand the effect of UAU on the severity of COVID-19. Objective: We aim to determine if UAU is associated with more severe clinical presentation and worse health outcomes related to COVID-19 and if socioeconomic status, smoking, age, BMI, race/ethnicity, and pattern of alcohol use modify the risk. Methods: In this observational cross-sectional study that took place between January 1, 2020, and December 31, 2020, we ran a digital machine learning classifier on the electronic health record of patients who tested positive for SARS-CoV-2 via nasopharyngeal swab or had two COVID-19 International Classification of Disease, 10th Revision (ICD-10) codes to identify patients with UAU. After controlling for age, sex, ethnicity, BMI, smoking status, insurance status, and presence of ICD-10 codes for cancer, cardiovascular disease, and diabetes, we then performed a multivariable regression to examine the relationship between UAU and COVID-19 severity as measured by hospital care level (ie, emergency department admission, emergency department admission with ventilator, or death). We used a predefined cutoff with optimal sensitivity and specificity on the digital classifier to compare disease severity in patients with and without UAU. Models were adjusted for age, sex, race/ethnicity, BMI, smoking status, and insurance status. Results: Each incremental increase in the predicted probability from the digital alcohol classifier was associated with a greater odds risk for more severe COVID-19 disease (odds ratio 1.15, 95\% CI 1.10-1.20). We found that patients in the unhealthy alcohol group had a greater odds risk to develop more severe disease (odds ratio 1.89, 95\% CI 1.17-3.06), suggesting that UAU was associated with an 89\% increase in the odds of being in a higher severity category. Conclusions: In patients infected with SARS-CoV-2, UAU is an independent risk factor associated with greater disease severity and/or death. ",
doi="10.2196/33022",
url="https://publichealth.jmir.org/2021/11/e33022",
url="http://www.ncbi.nlm.nih.gov/pubmed/34665758"
}


@Article{info:doi/10.2196/29049,
author="Ennab, Farah
and ElSaban, Mariam
and Khalaf, Eman
and Tabatabaei, Hanieh
and Khamis, Hassan Amar
and Devi, Radha Bindu
and Hanif, Kashif
and Elhassan, Hiba
and Saravanan, Ketharanathan
and Cremonesini, David
and Popatia, Rizwana
and Malik, Zainab
and Ho, B. Samuel
and Abusamra, Rania",
title="Clinical Characteristics of Children With COVID-19 in the United Arab Emirates: Cross-sectional Multicenter Study",
journal="JMIR Pediatr Parent",
year="2021",
month="Nov",
day="5",
volume="4",
number="4",
pages="e29049",
keywords="pediatrics",
keywords="children",
keywords="COVID-19",
keywords="SARS-CoV-2",
keywords="United Arab Emirates",
keywords="viral shedding",
keywords="pandemic",
keywords="treatment",
keywords="outcomes",
keywords="clinical",
keywords="public heath",
abstract="Background: COVID-19 has infected over 123 million people globally. The first confirmed case in the United Arab Emirates (UAE)\thinspacewas reported on January 29, 2020. According to studies conducted in the early epicenters of the pandemic, COVID-19 has fared mildly in the pediatric population. To date, there is a lack of published data about COVID-19 infection among children in the Arabian region. Objective: This study aims to investigate the clinical characteristics, laboratory findings, treatment, and outcomes of children with COVID-19. Methods: This cross-sectional, multicenter study included children with confirmed COVID-19 infection admitted to 3 large hospitals in Dubai, UAE, between March 1 and June 15, 2020. Serial COVID-19 polymerase chain reaction (PCR) testing data were collected, and patients' demographics, premorbid clinical characteristics, and inpatient hospital courses were examined. Results: In all, 111 children were included in our study and represented 22 nationalities. Of these, 59 (53.2\%) were boys. The mean age of the participants was 7 (SD 5.3) years. About 15.3\% of children were younger than 1 year. Only 4 (3.6\%) of them had pre-existing asthma, all of whom had uneventful courses. At presentation, of the 111 children, 43 (38.7\%) were asymptomatic, 68 (61.2\%) had mild or moderate symptoms, and none (0\%) had severe illness requiring intensive care. Fever (23/111, 20.7\%), cough (22/111, 19.8\%), and rhinorrhea (17/111, 15.3\%) were the most common presenting symptoms, and most reported symptoms resolved by day 5 of hospitalization. Most patients had no abnormality on chest x-ray. The most common laboratory abnormalities on admission included variations in neutrophil count (22/111, 24.7\%), aspartate transaminase (18/111, 22.5\%), alkaline phosphatase (29/111, 36.7\%), and lactate dehydrogenase (31/111, 42.5\%). Children were infrequently prescribed targeted medications, with only 4 (3.6\%) receiving antibiotics. None of the 52 patients tested for viral coinfections were positive. COVID-19 PCR testing turned negative at a median of 10 days (IQR: 6-14) after the first positive test. Overall, there was no significant difference of time to negative PCR results between symptomatic and asymptomatic children. Conclusions: This study of COVID-19 presentations and characteristics presents a first look into the burden of COVID-19 infection in the pediatric population in the UAE. We conclude that a large percentage of children experienced no symptoms and that severe COVID-19 disease is uncommon in the UAE. Various laboratory abnormalities were observed despite clinical stability. Ongoing surveillance, contact tracing, and public health measures will be important to contain future outbreaks. ",
doi="10.2196/29049",
url="https://pediatrics.jmir.org/2021/4/e29049",
url="http://www.ncbi.nlm.nih.gov/pubmed/34643535"
}


@Article{info:doi/10.2196/29789,
author="Liew, Ming Tau
and Lee, Sin Cia",
title="Examining the Utility of Social Media in COVID-19 Vaccination:  Unsupervised Learning of 672,133 Twitter Posts",
journal="JMIR Public Health Surveill",
year="2021",
month="Nov",
day="3",
volume="7",
number="11",
pages="e29789",
keywords="social media",
keywords="COVID-19",
keywords="vaccine hesitancy",
keywords="natural language processing",
keywords="machine learning",
keywords="infodemiology",
abstract="Background: Although COVID-19 vaccines have recently become available, efforts in global mass vaccination can be hampered by the widespread issue of vaccine hesitancy. Objective: The aim of this study was to use social media data to capture close-to-real-time public perspectives and sentiments regarding COVID-19 vaccines, with the intention to understand the key issues that have captured public attention, as well as the barriers and facilitators to successful COVID-19 vaccination. Methods: Twitter was searched for tweets related to ``COVID-19'' and ``vaccine'' over an 11-week period after November 18, 2020, following a press release regarding the first effective vaccine. An unsupervised machine learning approach (ie, structural topic modeling) was used to identify topics from tweets, with each topic further grouped into themes using manually conducted thematic analysis as well as guided by the theoretical framework of the COM-B (capability, opportunity, and motivation components of behavior) model.  Sentiment analysis of the tweets was also performed using the rule-based machine learning model VADER (Valence Aware Dictionary and Sentiment Reasoner). Results: Tweets related to COVID-19 vaccines were posted by individuals around the world (N=672,133).  Six overarching themes were identified: (1) emotional reactions related to COVID-19 vaccines (19.3\%), (2) public concerns related to COVID-19 vaccines (19.6\%), (3) discussions about news items related to COVID-19 vaccines (13.3\%), (4) public health communications about COVID-19 vaccines (10.3\%), (5) discussions about approaches to COVID-19 vaccination drives (17.1\%), and (6) discussions about the distribution of COVID-19 vaccines (20.3\%).  Tweets with negative sentiments largely fell within the themes of emotional reactions and public concerns related to COVID-19 vaccines.  Tweets related to facilitators of vaccination showed temporal variations over time, while tweets related to barriers remained largely constant throughout the study period. Conclusions: The findings from this study may facilitate the formulation of comprehensive strategies to improve COVID-19 vaccine uptake; they highlight the key processes that require attention in the planning of COVID-19 vaccination and provide feedback on evolving barriers and facilitators in ongoing vaccination drives to allow for further policy tweaks.  The findings also illustrate three key roles of social media in COVID-19 vaccination, as follows: surveillance and monitoring, a communication platform, and evaluation of government responses. ",
doi="10.2196/29789",
url="https://publichealth.jmir.org/2021/11/e29789",
url="http://www.ncbi.nlm.nih.gov/pubmed/34583316"
}


@Article{info:doi/10.2196/32345,
author="Xiao, Jin
and Meyerowitz, Cyril
and Ragusa, Patricia
and Funkhouser, Kimberly
and Lischka, R. Tamara
and Mendez Chagoya, Alberto Luis
and Al Jallad, Nisreen
and Wu, Tong Tong
and Fiscella, Kevin
and Ivie, Eden
and Strange, Michelle
and Collins, Jamie
and Kopycka-Kedzierawski, T. Dorota
and ",
title="Assessment of an Innovative Mobile Dentistry eHygiene Model Amid the COVID-19 Pandemic in the National Dental Practice--Based Research Network: Protocol for Design, Implementation, and Usability Testing",
journal="JMIR Res Protoc",
year="2021",
month="Oct",
day="26",
volume="10",
number="10",
pages="e32345",
keywords="teledentistry",
keywords="mDentistry",
keywords="oral diseases",
keywords="virtual visit",
keywords="intraoral camera",
keywords="pandemic response",
keywords="COVID-19",
keywords="mHealth",
abstract="Background: Amid COVID-19, and other possible future infectious disease pandemics, dentistry needs to consider modified dental examination regimens that render quality care, are cost effective, and ensure the safety of patients and dental health care personnel (DHCP). Traditional dental examinations, which number more than 300 million per year in the United States, rely on person-to-person tactile examinations, pose challenges to infection control, and consume large quantities of advanced-level personal protective equipment (PPE). Therefore, our long-term goal is to develop an innovative mobile dentistry (mDent) model that takes these issues into account. This model supplements the traditional dental practice with virtual visits, supported by mobile devices such as mobile telephones, tablets, and wireless infrastructure. The mDent model leverages the advantages of digital mobile health (mHealth) tools such as intraoral cameras to deliver virtual oral examinations, treatment planning, and interactive oral health management, on a broad population basis. Conversion of the traditional dental examinations to mDent virtual examinations builds upon (1) the reliability of teledentistry, which uses intraoral photos and live videos to make diagnostic decisions, and (2) rapid advancement in mHealth tool utilization. Objective: In this pilot project, we designed a 2-stage implementation study to assess 2 critical components of the mDent model: virtual hygiene examination (eHygiene) and patient self-taken intraoral photos (SELFIE). Our specific aims are to (1) assess the acceptance and barriers of mDent eHygiene among patients and DHCP, (2) assess the economic impact of mDent eHygiene, and (3) assess the patient's capability to generate intraoral photos using mHealth tools (exploratory aim, SELFIE). Methods: This study will access the rich resources of the National Dental Practice-Based Research Network to recruit 12 dentists, 12 hygienists, and 144 patients from 12 practices. For aims 1 and 2, we will use role-specific questionnaires to collect quantitative data on eHygiene acceptance and economic impact. The questionnaire components include participant characteristics, the System Usability Scale, a dentist-patient communication scale, practice operation cost, and patient opportunity cost. We will further conduct a series of iterative qualitative research activities using individual interviews to further elicit feedback and suggestion for changes to the mDent eHygiene model. For aim 3, we will use mixed methods (quantitative and qualitative) to assess the patient's capability of taking intraoral photos, by analyzing obtained photos and recorded videos. Results: The study is supported by the US National Institute of Dental and Craniofacial Research. This study received ``single'' institutional review board approval in August 2021. Data collection and analysis are expected to conclude by December 2021 and March 2022, respectively. Conclusions: The study results will inform the logistics of conducting virtual dental examinations and empowering patients with mHealth tools, providing better safety and preserving PPE amid the COVID-19 and possible future pandemics. International Registered Report Identifier (IRRID): PRR1-10.2196/32345 ",
doi="10.2196/32345",
url="https://www.researchprotocols.org/2021/10/e32345",
url="http://www.ncbi.nlm.nih.gov/pubmed/34597259"
}


@Article{info:doi/10.2196/31125,
author="Huang, Xiaojie
and Yu, Maohe
and Fu, Gengfeng
and Lan, Guanghua
and Li, Linghua
and Yang, Jianzhou
and Qiao, Ying
and Zhao, Jin
and Qian, Han-Zhu
and Zhang, Xiangjun
and Liu, Xinchao
and Jin, Xia
and Chen, Guohong
and Jiang, Hui
and Tang, Weiming
and Wang, Zixin
and Xu, Junjie",
title="Willingness to Receive COVID-19 Vaccination Among People Living With HIV and AIDS in China: Nationwide Cross-sectional Online Survey",
journal="JMIR Public Health Surveill",
year="2021",
month="Oct",
day="21",
volume="7",
number="10",
pages="e31125",
keywords="people living with HIV and AIDS",
keywords="COVID-19 vaccination",
keywords="willingness",
keywords="perceptions",
keywords="internet and social media influences",
keywords="interpersonal communication",
abstract="Background: HIV infection is a significant independent risk factor for both severe COVID-19 presentation at hospital admission and in-hospital mortality. Available information has suggested that people living with HIV and AIDS (PLWHA) could benefit from COVID-19 vaccination. However, there is a dearth of evidence on willingness to receive COVID-19 vaccination among PLWHA. Objective: The aim of this study was to investigate willingness to receive COVID-19 vaccination among a national sample of PLWHA in China. Methods: This cross-sectional online survey investigated factors associated with willingness to receive COVID-19 vaccination among PLWHA aged 18 to 65 years living in eight conveniently selected Chinese metropolitan cities between January and February 2021. Eight community-based organizations (CBOs) providing services to PLWHA facilitated the recruitment. Eligible PLWHA completed an online survey developed using a widely used encrypted web-based survey platform in China. We fitted a single logistic regression model to obtain adjusted odds ratios (aORs), which involved one of the independent variables of interest and all significant background variables. Path analysis was also used in the data analysis. Results: Out of 10,845 PLWHA approached by the CBOs, 2740 completed the survey, and 170 had received at least one dose of the COVID-19 vaccine. This analysis was performed among 2570 participants who had never received COVID-19 vaccination. Over half of the participants reported willingness to receive COVID-19 vaccination (1470/2570, 57.2\%). Perceptions related to COVID-19 vaccination were significantly associated with willingness to receive COVID-19 vaccination, including positive attitudes (aOR 1.11, 95\% CI 1.09-1.12; P<.001), negative attitudes (aOR 0.96, 95\% CI 0.94-0.97; P<.001), perceived support from significant others (perceived subjective norm; aOR 1.53, 95\% CI 1.46-1.61; P<.001), and perceived behavioral control (aOR 1.13, 95\% CI 1.11-1.14; P<.001). At the interpersonal level, receiving advice supportive of COVID-19 vaccination from doctors (aOR 1.99, 95\% CI 1.65-2.40; P<.001), CBO staff (aOR 1.89, 95\% CI 1.51-2.36; P<.001), friends and/or family members (aOR 3.22, 95\% CI 1.93-5.35; P<.001), and PLWHA peers (aOR 2.38, 95\% CI 1.85-3.08; P<.001) was associated with higher willingness to receive COVID-19 vaccination. The overall opinion supporting COVID-19 vaccination for PLWHA on the internet or social media was also positively associated with willingness to receive COVID-19 vaccination (aOR 1.59, 95\% CI 1.31-1.94; P<.001). Path analysis indicated that interpersonal-level variables were indirectly associated with willingness to receive COVID-19 vaccination through perceptions ($\beta$=.43, 95\% CI .37-.51; P<.001). Conclusions: As compared to PLWHA in other countries and the general population in most parts of the world, PLWHA in China reported a relatively low willingness to receive COVID-19 vaccination. The internet and social media as well as interpersonal communications may be major sources of influence on PLWHA's perceptions and willingness to receive COVID-19 vaccination. ",
doi="10.2196/31125",
url="https://publichealth.jmir.org/2021/10/e31125",
url="http://www.ncbi.nlm.nih.gov/pubmed/34543223"
}


@Article{info:doi/10.2196/32425,
author="Agley, Jon
and Xiao, Yunyu
and Thompson, E. Esi
and Chen, Xiwei
and Golzarri-Arroyo, Lilian",
title="Intervening on Trust in Science to Reduce Belief in COVID-19 Misinformation and Increase COVID-19 Preventive Behavioral Intentions: Randomized Controlled Trial",
journal="J Med Internet Res",
year="2021",
month="Oct",
day="14",
volume="23",
number="10",
pages="e32425",
keywords="infodemic",
keywords="misinformation",
keywords="trust in science",
keywords="COVID-19",
keywords="RCT",
keywords="randomized controlled trial",
abstract="Background: Trust in science meaningfully contributes to our understanding of people's belief in misinformation and their intentions to take actions to prevent COVID-19. However, no experimental research has sought to intervene on this variable to develop a scalable response to the COVID-19 infodemic. Objective: Our study examined whether brief exposure to an infographic about the scientific process might increase trust in science and thereby affect belief in misinformation and intention to take preventive actions for COVID-19. Methods: This two-arm, parallel-group, randomized controlled trial aimed to recruit a US representative sample of 1000 adults by age, race/ethnicity, and gender using the Prolific platform. Participants were randomly assigned to view either an intervention infographic about the scientific process or a control infographic. The intervention infographic was designed through a separate pilot study. Primary outcomes were trust in science, COVID-19 narrative belief profile, and COVID-19 preventive behavioral intentions. We also collected 12 covariates and incorporated them into all analyses. All outcomes were collected using web-based assessment. Results: From January 22, 2021 to January 24, 2021, 1017 participants completed the study. The intervention slightly improved trust in science (difference-in-difference 0.03, SE 0.01, t1000=2.16, P=.031). No direct intervention effect was observed on belief profile membership, but there was some evidence of an indirect intervention effect mediated by trust in science (adjusted odds ratio 1.06, SE 0.03, 95\% CI 1.00-1.12, z=2.01, P=.045) on membership in the ``scientific'' profile compared with the others. No direct nor indirect effects on preventive behaviors were observed. Conclusions: Briefly viewing an infographic about science appeared to cause a small aggregate increase in trust in science, which may have, in turn, reduced the believability of COVID-19 misinformation. The effect sizes were small but commensurate with our 60-second, highly scalable intervention approach. Researchers should study the potential for truthful messaging about how science works to serve as misinformation inoculation and test how best to do so. Trial Registration: NCT04557241; https://clinicaltrials.gov/ct2/show/NCT04557241 International Registered Report Identifier (IRRID): RR2-10.2196/24383 ",
doi="10.2196/32425",
url="https://www.jmir.org/2021/10/e32425",
url="http://www.ncbi.nlm.nih.gov/pubmed/34581678"
}


@Article{info:doi/10.2196/26840,
author="Lau, Joseph
and Yu, Yanqiu
and Xin, Meiqi
and She, Rui
and Luo, Sitong
and Li, Lijuan
and Wang, Suhua
and Ma, Le
and Tao, Fangbiao
and Zhang, Jianxin
and Zhao, Junfeng
and Hu, Dongsheng
and Li, Liping
and Zhang, Guohua
and Gu, Jing
and Lin, Danhua
and Wang, Hongmei
and Cai, Yong
and Wang, Zhaofen
and You, Hua
and Hu, Guoqing
and ",
title="Adoption of Preventive Measures During the Very Early Phase of the COVID-19 Outbreak in China: National Cross-sectional Survey Study",
journal="JMIR Public Health Surveill",
year="2021",
month="Oct",
day="7",
volume="7",
number="10",
pages="e26840",
keywords="COVID-19",
keywords="health behavior",
keywords="prevention",
keywords="control",
keywords="cognition",
keywords="face mask",
keywords="hand hygiene",
keywords="interpersonal contacts",
keywords="China",
keywords="protection",
keywords="public health",
keywords="behavior",
keywords="infectious disease",
keywords="cross-sectional",
keywords="survey",
abstract="Background: The outbreak of COVID-19 in China occurred around the Chinese New Year (January 25, 2020), and infections decreased continuously afterward. General adoption of preventive measures during the Chinese New Year period was crucial in driving the decline. It is imperative to investigate preventive behaviors among Chinese university students, who could have spread COVID-19 when travelling home during the Chinese New Year break. Objective: In this study, we investigated levels of COVID-19--related personal measures undertaken during the 7-day Chinese New Year holidays by university students in China, and associated COVID-19--related cognitive factors. Methods: A cross-sectional anonymous web-based survey was conducted during the period from February 1 to 10, 2020. Data from 23,863 students (from 26 universities, 16 cities, 13 provincial-level regions) about personal measures (frequent face-mask wearing, frequent handwashing, frequent home staying, and an indicator that combined the 3 behaviors) were analyzed (overall response rate 70\%). Multilevel multiple logistic regression analysis was performed. Results: Only 28.0\% of respondents (6684/23,863) had left home for >4 hours, and 49.3\% (11,757/23,863) had never left home during the 7-day Chinese New Year period; 79.7\% (19,026/23,863) always used face-masks in public areas. The frequency of handwashing with soap was relatively low (6424/23,863, 26.9\% for >5 times/day); 72.4\% (17,282/23,863) had frequently undertaken ?2 of these 3 measures. COVID-19--related cognitive factors (perceptions on modes of transmission, permanent bodily damage, efficacy of personal or governmental preventive measures, nonavailability of vaccines and treatments) were significantly associated with preventive measures. Associations with frequent face-mask wearing were stronger than those with frequent home staying. Conclusions: University students had strong behavioral responses during the very early phase of the COVID-19 outbreak. Levels of personal prevention, especially frequent home staying and face-mask wearing, were high. Health promotion may modify cognitive factors. Some structural factors (eg, social distancing policy) might explain why the frequency of home staying was higher than that of handwashing. Other populations might have behaved similarly; however, such data were not available to us. ",
doi="10.2196/26840",
url="https://publichealth.jmir.org/2021/10/e26840",
url="http://www.ncbi.nlm.nih.gov/pubmed/34479184"
}


@Article{info:doi/10.2196/32468,
author="Thomas Craig, Jean Kelly
and Rizvi, Rubina
and Willis, C. Van
and Kassler, J. William
and Jackson, Purcell Gretchen",
title="Effectiveness of Contact Tracing for Viral Disease Mitigation and Suppression: Evidence-Based Review",
journal="JMIR Public Health Surveill",
year="2021",
month="Oct",
day="6",
volume="7",
number="10",
pages="e32468",
keywords="contact tracing",
keywords="non-pharmaceutical interventions",
keywords="pandemic",
keywords="epidemic",
keywords="viral disease",
keywords="COVID-19",
keywords="isolation",
keywords="testing",
keywords="surveillance",
keywords="monitoring",
keywords="review",
keywords="intervention",
keywords="effectiveness",
keywords="mitigation",
keywords="transmission",
keywords="spread",
keywords="protection",
keywords="outcome",
abstract="Background: Contact tracing in association with quarantine and isolation is an important public health tool to control outbreaks of infectious diseases. This strategy has been widely implemented during the current COVID-19 pandemic. The effectiveness of this nonpharmaceutical intervention is largely dependent on social interactions within the population and its combination with other interventions. Given the high transmissibility of SARS-CoV-2, short serial intervals, and asymptomatic transmission patterns, the effectiveness of contact tracing for this novel viral agent is largely unknown. Objective: This study aims to identify and synthesize evidence regarding the effectiveness of contact tracing on infectious viral disease outcomes based on prior scientific literature. Methods: An evidence-based review was conducted to identify studies from the PubMed database, including preprint medRxiv server content, related to the effectiveness of contact tracing in viral outbreaks. The search dates were from database inception to July 24, 2020. Outcomes of interest included measures of incidence, transmission, hospitalization, and mortality. Results: Out of 159 unique records retrieved, 45 (28.3\%) records were reviewed at the full-text level, and 24 (15.1\%) records met all inclusion criteria. The studies included utilized mathematical modeling (n=14), observational (n=8), and systematic review (n=2) approaches. Only 2 studies considered digital contact tracing. Contact tracing was mostly evaluated in combination with other nonpharmaceutical interventions and/or pharmaceutical interventions. Although some degree of effectiveness in decreasing viral disease incidence, transmission, and resulting hospitalizations and mortality was observed, these results were highly dependent on epidemic severity (R0 value), number of contacts traced (including presymptomatic and asymptomatic cases), timeliness, duration, and compliance with combined interventions (eg, isolation, quarantine, and treatment). Contact tracing effectiveness was particularly limited by logistical challenges associated with increased outbreak size and speed of infection spread. Conclusions: Timely deployment of contact tracing strategically layered with other nonpharmaceutical interventions could be an effective public health tool for mitigating and suppressing infectious outbreaks by decreasing viral disease incidence, transmission, and resulting hospitalizations and mortality. ",
doi="10.2196/32468",
url="https://publichealth.jmir.org/2021/10/e32468",
url="http://www.ncbi.nlm.nih.gov/pubmed/34612841"
}


@Article{info:doi/10.2196/26104,
author="Miller, Sascha
and Ainsworth, Ben
and Weal, Mark
and Smith, Peter
and Little, Paul
and Yardley, Lucy
and Morrison, Leanne",
title="A Web-Based Intervention (Germ Defence) to Increase Handwashing During a Pandemic: Process Evaluations of a Randomized Controlled Trial and Public Dissemination",
journal="J Med Internet Res",
year="2021",
month="Oct",
day="5",
volume="23",
number="10",
pages="e26104",
keywords="behavior",
keywords="infection",
keywords="prevention",
keywords="respiratory tract infection",
keywords="internet",
keywords="evaluation studies",
keywords="pandemic",
keywords="COVID-19",
keywords="transmission",
keywords="virus",
keywords="influenza",
keywords="respiratory",
keywords="intervention",
keywords="digital intervention",
keywords="dissemination",
abstract="Background: Washing hands helps prevent transmission of seasonal and pandemic respiratory viruses. In a randomized controlled trial (RCT) during the swine flu outbreak, participants with access to a fully automated, digital intervention promoting handwashing reported washing their hands more often and experienced fewer respiratory tract infections than those without access to the intervention. Based on these findings, the intervention was adapted, renamed as ``Germ Defence,'' and a study was designed to assess the preliminary dissemination of the intervention to the general public to help prevent the spread of seasonal colds and flu. Objective: This study compares the process evaluations of the RCT and Germ Defence dissemination to examine (1) how web-based research enrollment procedures affected those who used the intervention, (2) intervention usage in the 2 contexts, and (3) whether increased intentions to wash hands are replicated once disseminated. Methods: The RCT ran between 2010 and 2012 recruiting participants offline from general practices, with restricted access to the intervention (N=9155). Germ Defence was disseminated as an open access website for use by the general public from 2016 to 2019 (N=624). The process evaluation plan was developed using Medical Research Council guidance and the framework for Analyzing and Measuring Usage and Engagement Data. Both interventions contained a goal-setting section where users self-reported current and intended handwashing behavior across 7 situations. Results: During web-based enrolment, 54.3\% (17,511/32,250) of the RCT participants dropped out of the study compared to 36.5\% (358/982) of Germ Defence users. Having reached the start of the intervention, 93.8\% (8586/9155) of RCT users completed the core section, whereas 65.1\% (406/624) of Germ Defence users reached the same point. Users across both studies selected to increase their handwashing in 5 out of 7 situations, including before eating snacks (RCT mean difference 1.040, 95\% CI 1.016-1.063; Germ Defence mean difference 0.949, 95\% CI 0.766-1.132) and after blowing their nose, sneezing, or coughing (RCT mean difference 0.995, 95\% CI 0.972-1.019; Germ Defence mean difference 0.842, 95\% CI 0.675-1.008). Conclusions: By comparing the preliminary dissemination of Germ Defence to the RCT, we were able to examine the potential effects of the research procedures on uptake and attrition such as the sizeable dropout during the RCT enrolment procedure that may have led to a more motivated sample. The Germ Defence study highlighted the points of attrition within the intervention. Despite sample bias in the trial context, the intervention replicated increases in intentions to handwash when used ``in the wild.'' This preliminary dissemination study informed the adaptation of the intervention for the COVID-19 health emergency, and it has now been disseminated globally. Trial Registration: ISRCTN Registry ISRCTN75058295; https://www.isrctn.com/ISRCTN75058295 ",
doi="10.2196/26104",
url="https://www.jmir.org/2021/10/e26104",
url="http://www.ncbi.nlm.nih.gov/pubmed/34519661"
}


@Article{info:doi/10.2196/28000,
author="Persson, Inger
and {\"O}stling, Andreas
and Arlbrandt, Martin
and S{\"o}derberg, Joakim
and Becedas, David",
title="A Machine Learning Sepsis Prediction Algorithm for Intended Intensive Care Unit Use (NAVOY Sepsis): Proof-of-Concept Study",
journal="JMIR Form Res",
year="2021",
month="Sep",
day="30",
volume="5",
number="9",
pages="e28000",
keywords="sepsis",
keywords="prediction",
keywords="early detection",
keywords="machine learning",
keywords="electronic health record",
keywords="EHR",
keywords="software as a medical device",
keywords="algorithm",
keywords="detection",
keywords="intensive care unit",
keywords="ICU",
keywords="proof of concept",
abstract="Background: Despite decades of research, sepsis remains a leading cause of mortality and morbidity in intensive care units worldwide. The key to effective management and patient outcome is early detection, for which no prospectively validated machine learning prediction algorithm is currently available for clinical use in Europe. Objective: We aimed to develop a high-performance machine learning sepsis prediction algorithm based on routinely collected intensive care unit data, designed to be implemented in European intensive care units. Methods: The machine learning algorithm was developed using convolutional neural networks, based on Massachusetts Institute of Technology Lab for Computational Physiology MIMIC-III clinical data from intensive care unit patients aged 18 years or older. The model uses 20 variables to produce hourly predictions of onset of sepsis, defined by international Sepsis-3 criteria. Predictive performance was externally validated using hold-out test data. Results: The algorithm---NAVOY Sepsis---uses 4 hours of input and can identify patients with high risk of developing sepsis, with high performance (area under the receiver operating characteristics curve 0.90; area under the precision-recall curve 0.62) for predictions up to 3 hours before sepsis onset. Conclusions: The prediction performance of NAVOY Sepsis was superior to that of existing sepsis early warning scoring systems and comparable with those of other prediction algorithms designed to predict sepsis onset. The algorithm has excellent predictive properties and uses variables that are routinely collected in intensive care units. ",
doi="10.2196/28000",
url="https://formative.jmir.org/2021/9/e28000",
url="http://www.ncbi.nlm.nih.gov/pubmed/34591016"
}


@Article{info:doi/10.2196/28005,
author="Qaisieh, Rami
and Al-Tamimi, Mohammad
and El-Hammuri, Naser
and Shalabi, Marwan
and Kilani, M. Muna
and Taha, Hana
and Al-Muhtaseb, Abdallah
and Alfarrajin, Ibrahim
and Abu Shaqra, Marwan
and Hamdan, Almothana",
title="Clinical, Laboratory, and Imaging Features of COVID-19 in a Cohort of Patients: Cross-Sectional Comparative Study",
journal="JMIR Public Health Surveill",
year="2021",
month="Sep",
day="21",
volume="7",
number="9",
pages="e28005",
keywords="COVID-19",
keywords="gender",
keywords="clinical",
keywords="laboratory",
keywords="imaging",
keywords="SARS-CoV2",
keywords="Jordan",
abstract="Background: The clinical, laboratory, and imaging features of COVID-19 disease are variable. Multiple factors can affect the disease progression and outcome. Objective: This study aimed to analyze the clinical, laboratory, and imaging features of COVID-19 in Jordan. Methods: Clinical, laboratory, and imaging data were collected for 557 confirmed COVID-19 patients admitted to Prince Hamzah Hospital (PHH), Jordan. Analysis was performed using appropriate statistical tests with SPSS version 24. Results: Of the 557 COVID-19 polymerase chain reaction (PCR)-positive cases admitted to PHH, the mean age was 34.4 years (SD 18.95 years; range 5 weeks to 87 years), 86.0\% (479/557) were male, 41\% (29/70) were blood group A+, and 57.1\% (93/163) were overweight or obese. Significant past medical history was documented in 25.9\% (144/557), significant surgical history in 12.6\% (70/557), current smoking in 14.9\% (83/557), and pregnancy in 0.5\% (3/557). The mean duration of hospitalization was 16.4 (SD 9.3; range 5 to 70) days; 52.6\% (293/557) were asymptomatic, and 12.9\% (72/557) had more than 5 symptoms, with generalized malaise and dry cough the most common symptoms. Only 2.5\% (14/557) had a respiratory rate over 25 breaths/minute, and 1.8\% (10/557) had an oxygen saturation below 85\%. Laboratory investigations showed a wide range of abnormalities, with lymphocytosis and elevated C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and D-dimer the most common abnormalities. Ground glass opacity was the most common imaging finding. Men had a significantly higher frequency of symptoms, incidence of smoking, reduced hemoglobin, increased monocyte \%, elevated creatinine levels, and intensive care unit admissions compared with women (P<.05). Hospitalization duration was associated with increased age, male gender, symptom score, history of smoking, elevated systolic blood pressure, elevated respiratory rate, and elevated monocyte \%, CRP, ESR, creatinine, and D-dimer (P<.05). Conclusions: Most COVID-19 cases admitted to PHH were asymptomatic. Variabilities in symptoms, signs, laboratory results, and imaging findings should be noted. Increased age, male gender, smoking history, and elevated inflammatory markers were significantly associated with longer duration of hospitalization. ",
doi="10.2196/28005",
url="https://publichealth.jmir.org/2021/9/e28005",
url="http://www.ncbi.nlm.nih.gov/pubmed/34081600"
}


@Article{info:doi/10.2196/27283,
author="Siedlikowski, Sophia
and No{\"e}l, Louis-Philippe
and Moynihan, Anne Stephanie
and Robin, Marc",
title="Chloe for COVID-19: Evolution of an Intelligent Conversational Agent to Address Infodemic Management Needs During the COVID-19 Pandemic",
journal="J Med Internet Res",
year="2021",
month="Sep",
day="21",
volume="23",
number="9",
pages="e27283",
keywords="chatbot",
keywords="COVID-19",
keywords="conversational agents",
keywords="public health",
keywords="artificial intelligence",
keywords="infodemic",
keywords="infodemiology",
keywords="misinformation",
keywords="digital health",
keywords="virtual care",
doi="10.2196/27283",
url="https://www.jmir.org/2021/9/e27283",
url="http://www.ncbi.nlm.nih.gov/pubmed/34375299"
}


@Article{info:doi/10.2196/30460,
author="Bachtiger, Patrik
and Adamson, Alexander
and Maclean, A. William
and Kelshiker, A. Mihir
and Quint, K. Jennifer
and Peters, S. Nicholas",
title="Determinants of Shielding Behavior During the COVID-19 Pandemic and Associations With Well-being Among National Health Service Patients: Longitudinal Observational Study",
journal="JMIR Public Health Surveill",
year="2021",
month="Sep",
day="20",
volume="7",
number="9",
pages="e30460",
keywords="COVID-19",
keywords="shielding",
keywords="well-being",
keywords="personal health record",
keywords="determinant",
keywords="behavior",
keywords="protection",
keywords="longitudinal",
keywords="observational",
keywords="health policy",
keywords="mental health",
keywords="epidemiology",
keywords="public health",
abstract="Background: The UK National Health Service (NHS) classified 2.2 million people as clinically extremely vulnerable (CEV) during the first wave of the 2020 COVID-19 pandemic, advising them to ``shield'' (to not leave home for any reason). Objective: The aim of this study was to measure the determinants of shielding behavior and associations with well-being in a large NHS patient population for informing future health policy. Methods: Patients contributing to an ongoing longitudinal participatory epidemiology study (Longitudinal Effects on Wellbeing of the COVID-19 Pandemic [LoC-19], n=42,924) received weekly email invitations to complete questionnaires (17-week shielding period starting April 9, 2020) within their NHS personal electronic health record. Question items focused on well-being. Participants were stratified into four groups by self-reported CEV status (qualifying condition) and adoption of shielding behavior (baselined at week 1 or 2). The distribution of CEV criteria was reported alongside situational variables and univariable and multivariable logistic regression. Longitudinal trends in physical and mental well-being were displayed graphically. Free-text responses reporting variables impacting well-being were semiquantified using natural language processing. In the lead up to a second national lockdown (October 23, 2020), a follow-up questionnaire evaluated subjective concern if further shielding was advised. Results: The study included 7240 participants. In the CEV group (n=2391), 1133 (47.3\%) assumed shielding behavior at baseline, compared with 633 (13.0\%) in the non-CEV group (n=4849). CEV participants who shielded were more likely to be Asian (odds ratio [OR] 2.02, 95\% CI 1.49-2.76), female (OR 1.24, 95\% CI 1.05-1.45), older (OR per year increase 1.01, 95\% CI 1.00-1.02), living in a home with an outdoor space (OR 1.34, 95\% CI 1.06-1.70) or three to four other inhabitants (three: OR 1.49, 95\% CI  1.15-1.94; four: OR 1.49, 95\% CI 1.10-2.01), or solid organ transplant recipients (OR 2.85, 95\% CI 2.18-3.77), or have severe chronic lung disease (OR 1.63, 95\% CI 1.30-2.04). Receipt of a government letter advising shielding was reported in 1115 (46.6\%) CEV participants and 180 (3.7\%) non-CEV participants, and was associated with adopting shielding behavior (OR 3.34, 95\% CI 2.82-3.95 and OR 2.88, 95\% CI 2.04-3.99, respectively). In CEV participants, shielding at baseline was associated with a lower rating of mental well-being and physical well-being. Similar results were found for non-CEV participants. Concern for well-being if future shielding was required was most prevalent among CEV participants who had originally shielded. Conclusions: Future health policy must balance the potential protection from COVID-19 against our findings that shielding negatively impacted well-being and was adopted in many in whom it was not indicated and variably in whom it was indicated. This therefore also requires clearer public health messaging and support for well-being if shielding is to be advised in future pandemic scenarios. ",
doi="10.2196/30460",
url="https://publichealth.jmir.org/2021/9/e30460",
url="http://www.ncbi.nlm.nih.gov/pubmed/34298499"
}


@Article{info:doi/10.2196/31930,
author="Barkia, Abdelaziz
and Laamrani, Hammou
and Belalia, Abdelmounaim
and Benmamoun, Abderrahman
and Khader, Yousef",
title="Morocco's National Response to the COVID-19 Pandemic: Public Health Challenges and Lessons Learned",
journal="JMIR Public Health Surveill",
year="2021",
month="Sep",
day="17",
volume="7",
number="9",
pages="e31930",
keywords="COVID-19",
keywords="public health",
keywords="challenges",
keywords="prevention",
keywords="control",
keywords="infectious disease",
doi="10.2196/31930",
url="https://publichealth.jmir.org/2021/9/e31930",
url="http://www.ncbi.nlm.nih.gov/pubmed/34388104"
}


@Article{info:doi/10.2196/31052,
author="Han, Lei
and Zhan, Yanru
and Li, Weizi
and Xu, Yuqing
and Xu, Yan
and Zhao, Jinzhe",
title="Associations Between the Perceived Severity of the COVID-19 Pandemic, Cyberchondria, Depression, Anxiety, Stress, and Lockdown Experience: Cross-sectional Survey Study",
journal="JMIR Public Health Surveill",
year="2021",
month="Sep",
day="16",
volume="7",
number="9",
pages="e31052",
keywords="COVID-19",
keywords="cyberchondria",
keywords="depression",
keywords="anxiety",
keywords="stress",
keywords="ABC theory of emotions",
keywords="lockdown experience",
keywords="perceived severity",
keywords="cross-sectional",
keywords="online health information",
abstract="Background: The outbreak of the COVID-19 pandemic has caused great panic among the public, with many people suffering from adverse stress reactions. To control the spread of the pandemic, governments in many countries have imposed lockdown policies. In this unique pandemic context, people can obtain information about pandemic dynamics on the internet. However, searching for health-related information on the internet frequently increases the possibility of individuals being troubled by the information that they find, and consequently, experiencing symptoms of cyberchondria. Objective: We aimed to examine the relationships between people's perceived severity of the COVID-19 pandemic and their depression, anxiety, and stress to explore the role of cyberchondria, which, in these relationship mechanisms, is closely related to using the internet. In addition, we also examined the moderating role of lockdown experiences. Methods: In February 2020, a total of 486 participants were recruited through a web-based platform from areas in China with a large number of infections. We used questionnaires to measure participants' perceived severity of the COVID-19 pandemic, to measure the severity of their cyberchondria, depression, anxiety, and stress symptoms, and to assess their lockdown experiences. Confirmatory factor analysis, exploratory factor analysis, common method bias, descriptive statistical analysis, and correlation analysis were performed, and moderated mediation models were examined. Results: There was a positive association between perceived severity of the COVID-19 pandemic and depression ($\beta$=0.36, t=8.51, P<.001), anxiety ($\beta$=0.41, t=9.84, P<.001), and stress ($\beta$=0.46, t=11.45, P<.001), which were mediated by cyberchondria ($\beta$=0.36, t=8.59, P<.001). The direct effects of perceived severity of the COVID-19 pandemic on anxiety ($\beta$=0.07, t=2.01, P=.045) and stress ($\beta$=0.09, t=2.75, P=.006) and the indirect effects of cyberchondria on depression ($\beta$=0.10, t=2.59, P=.009) and anxiety ($\beta$=0.10, t=2.50, P=.01) were moderated by lockdown experience. Conclusions: The higher the perceived severity of the COVID-19 pandemic, the more serious individuals' symptoms of depression, anxiety, and stress. In addition, the associations were partially mediated by cyberchondria. Individuals with higher perceived severity of the COVID-19 pandemic were more likely to develop cyberchondria, which aggravated individuals' depression, anxiety, and stress symptoms. Negative lockdown experiences exacerbated the COVID-19 pandemic's impact on mental health. ",
doi="10.2196/31052",
url="https://publichealth.jmir.org/2021/9/e31052",
url="http://www.ncbi.nlm.nih.gov/pubmed/34478402"
}


@Article{info:doi/10.2196/28759,
author="Roberts, J. Derek
and Nagpal, K. Sudhir
and Stelfox, T. Henry
and Brandys, Tim
and Corrales-Medina, Vicente
and Dubois, Luc
and McIsaac, I. Daniel",
title="Risk Factors for Surgical Site Infection After Lower Limb Revascularization Surgery in Adults With Peripheral Artery Disease: Protocol for a Systematic Review and Meta-analysis",
journal="JMIR Res Protoc",
year="2021",
month="Sep",
day="16",
volume="10",
number="9",
pages="e28759",
keywords="lower limb revascularization surgery",
keywords="peripheral artery disease",
keywords="risk factors",
keywords="surgical site infection",
keywords="systematic review",
abstract="Background: Surgical site infections (SSIs) are common, costly, and associated with increased morbidity and potential mortality after lower limb revascularization surgery (ie, arterial bypass, endarterectomy, and patch angioplasty). Identifying evidence-informed risk factors for SSI in patients undergoing these surgeries is therefore important. Objective: The aim of this study is to conduct a systematic review and meta-analysis of prognostic studies to identify, synthesize, and determine the certainty in the cumulative evidence associated with reported risk factors for early and delayed SSI after lower limb revascularization surgery in adults with peripheral artery disease. Methods: We will search MEDLINE, Embase, the seven databases in Evidence-Based Medicine Reviews, review articles identified during the search, and included article bibliographies. We will include studies of adults (aged ?18 years) with peripheral artery disease that report odds ratios, risk ratios, or hazard ratios adjusted for the presence of other risk factors or confounding variables and relating the potential risk factor of interest to the development of SSI after lower limb revascularization surgery. We will exclude studies that did not adjust for confounding, exclusively examined certain high-risk patient cohorts, or included >20\% of patients who underwent surgery for indications other than peripheral artery disease. The primary outcomes will be early (in-hospital or ?30 days) SSI and Szilagyi grade I (cellulitis involving the wound), grade II (infection involving subcutaneous tissue), and grade III (infection involving the vascular graft) SSI. Two investigators will independently extract data and evaluate the study risk of bias using the Quality in Prognosis Studies tool. Adjusted risk factor estimates with similar definitions will be pooled using DerSimonian and Laird random-effects models. Heterogeneity will be explored using stratified meta-analyses and meta-regression. Finally, we will use the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach to determine certainty in the estimates of association between reported risk factors and the development of SSI. Results: The protocol was registered in PROSPERO (International Prospective Register of Systematic Reviews). We will execute the peer-reviewed search strategy on June 30, 2021, and then complete the review of titles and abstracts and full-text articles by July 30, 2021, and September 15, 2021, respectively. We will complete the full-text study data extraction and risk of bias assessment by November 15, 2021. We anticipate that we will be able to submit the manuscript for peer review by January 30, 2022. Conclusions: This study will identify, synthesize, and determine the certainty in the cumulative evidence associated with risk factors for early and delayed SSI after lower limb revascularization surgery in patients with peripheral artery disease. The results will be used to inform practice, clinical practice statements and guidelines, and subsequent research. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42021242557; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=242557 International Registered Report Identifier (IRRID): PRR1-10.2196/28759 ",
doi="10.2196/28759",
url="https://www.researchprotocols.org/2021/9/e28759",
url="http://www.ncbi.nlm.nih.gov/pubmed/34161251"
}


@Article{info:doi/10.2196/28989,
author="Vancini, L. Rodrigo
and Camargo-Neto, Luiz
and Andrade, S. Marilia
and de Lira, A. Claudio
and dos Santos, G. Rafaela
and Nikolaidis, T. Pantelis
and Knechtle, Beat
and Piacezzi, HV Luiz
and Teixeira-Lopes, CB Maria
and Assayag-Batista, E. Ruth
and Pinto-Okuno, F. Meiry
and Vancini-Campanharo, R. C{\'a}ssia",
title="A Sociodemographic Profile of Mask Use During the COVID-19 Outbreak Among Young and Elderly Individuals in Brazil: Online Survey Study",
journal="JMIR Aging",
year="2021",
month="Sep",
day="14",
volume="4",
number="3",
pages="e28989",
keywords="aging",
keywords="older adults",
keywords="COVID-19",
keywords="pandemic",
keywords="sociodemographic profile",
keywords="face mask",
keywords="social media",
keywords="online media",
keywords="adolescents",
abstract="Background: Sociodemographic variables may impact decision making regarding safety measures. The use and selection of adequate face masks is a safety and health measure that could help minimize the spread of COVID-19 infection. Objective: This study aims to examine sociodemographic variables and factors relating to COVID-19 that could impact decision making or the choice to use or not use face masks in the prevention and care of a possible COVID-19 infection among a large sample of younger and older Brazilian people. Methods: An online survey composed of 14 closed-ended questions about sociodemographic variables and COVID-19 was used. A total of 2673 participants consisted of Brazilian people (aged ?18 years) from different states of Brazil and were grouped according to age (?59 years and ?60 years). To compare the variables of interest (associated with wearing a face mask or not), chi-square and likelihood ratio tests were used (with P<.05 being significant). Results: Most of the participants in both groups were women from the southeast region who had postgraduate degrees. Approximately 61\% (1452/2378) of individuals aged ?59 years and 67.8\% (200/295) of those aged ?60 years were not health professionals. In the group aged ?59 years, 83.4\% (1983/2378) did not show COVID-19 signs and symptoms, and 97.3\% (2314/2378) were not diagnosed with COVID-19. In the older adult group, 92.5\% (273/295) did not show signs and symptoms of COVID-19, and 98.3\% (290/295) were not diagnosed with the disease. The majority of the participants in both groups reported using face masks, and their decision to use face masks was influenced by the level of education and their occupation as a health professional. Conclusions: Younger and older adults have worn face masks during the COVID-19 outbreak. It is difficult to measure how much of a positive impact this attitude, habit, and behavior could have on the degree of infection and spread of the disease. However, it can be a positive indicator of adherence to the population's security and safety measures during the pandemic. ",
doi="10.2196/28989",
url="https://aging.jmir.org/2021/3/e28989",
url="http://www.ncbi.nlm.nih.gov/pubmed/34253508"
}


@Article{info:doi/10.2196/30854,
author="Hu, Tao
and Wang, Siqin
and Luo, Wei
and Zhang, Mengxi
and Huang, Xiao
and Yan, Yingwei
and Liu, Regina
and Ly, Kelly
and Kacker, Viraj
and She, Bing
and Li, Zhenlong",
title="Revealing Public Opinion Towards COVID-19 Vaccines With Twitter Data in the United States: Spatiotemporal Perspective",
journal="J Med Internet Res",
year="2021",
month="Sep",
day="10",
volume="23",
number="9",
pages="e30854",
keywords="Twitter",
keywords="public opinion",
keywords="COVID-19 vaccines",
keywords="sentiment analysis",
keywords="emotion analysis",
keywords="topic modeling",
keywords="COVID-19",
abstract="Background: The COVID-19 pandemic has imposed a large, initially uncontrollable, public health crisis both in the United States and across the world, with experts looking to vaccines as the ultimate mechanism of defense. The development and deployment of COVID-19 vaccines have been rapidly advancing via global efforts. Hence, it is crucial for governments, public health officials, and policy makers to understand public attitudes and opinions towards vaccines, such that effective interventions and educational campaigns can be designed to promote vaccine acceptance. Objective: The aim of this study was to investigate public opinion and perception on COVID-19 vaccines in the United States. We investigated the spatiotemporal trends of public sentiment and emotion towards COVID-19 vaccines and analyzed how such trends relate to popular topics found on Twitter. Methods: We collected over 300,000 geotagged tweets in the United States from March 1, 2020 to February 28, 2021. We examined the spatiotemporal patterns of public sentiment and emotion over time at both national and state scales and identified 3 phases along the pandemic timeline with sharp changes in public sentiment and emotion. Using sentiment analysis, emotion analysis (with cloud mapping of keywords), and topic modeling, we further identified 11 key events and major topics as the potential drivers to such changes. Results: An increasing trend in positive sentiment in conjunction with a decrease in negative sentiment were generally observed in most states, reflecting the rising confidence and anticipation of the public towards vaccines. The overall tendency of the 8 types of emotion implies that the public trusts and anticipates the vaccine. This is accompanied by a mixture of fear, sadness, and anger. Critical social or international events or announcements by political leaders and authorities may have potential impacts on public opinion towards vaccines. These factors help identify underlying themes and validate insights from the analysis. Conclusions: The analyses of near real-time social media big data benefit public health authorities by enabling them to monitor public attitudes and opinions towards vaccine-related information in a geo-aware manner, address the concerns of vaccine skeptics, and promote the confidence that individuals within a certain region or community have towards vaccines. ",
doi="10.2196/30854",
url="https://www.jmir.org/2021/9/e30854",
url="http://www.ncbi.nlm.nih.gov/pubmed/34346888"
}


@Article{info:doi/10.2196/24081,
author="Liu, Songxiang
and Xie, Mao
and Zhang, Zhicai
and Wu, Xinghuo
and Gao, Fei
and Lu, Lin
and Zhang, Jiayao
and Xie, Yi
and Yang, Fan
and Ye, Zhewei",
title="A 3D Hologram With Mixed Reality Techniques to Improve Understanding of Pulmonary Lesions Caused by COVID-19: Randomized Controlled Trial",
journal="J Med Internet Res",
year="2021",
month="Sep",
day="10",
volume="23",
number="9",
pages="e24081",
keywords="COVID-19",
keywords="mixed reality",
keywords="hologram",
keywords="pulmonary",
keywords="lesion",
keywords="diagnostic",
keywords="imaging",
abstract="Background: The COVID-19 outbreak has now become a pandemic and has had a serious adverse impact on global public health. The effect of COVID-19 on the lungs can be determined through 2D computed tomography (CT) imaging, which requires a high level of spatial imagination on the part of the medical provider. Objective: The purpose of this study is to determine whether viewing a 3D hologram with mixed reality techniques can improve medical professionals' understanding of the pulmonary lesions caused by COVID-19. Methods: The study involved 60 participants, including 20 radiologists, 20 surgeons, and 20 medical students. Each of the three groups was randomly divided into two groups, either the 2D CT group (n=30; mean age 29 years [range 19-38 years]; males=20) or the 3D holographic group (n=30; mean age 30 years [range 20=38 years]; males=20). The two groups completed the same task, which involved identifying lung lesions caused by COVID-19 for 6 cases using a 2D CT or 3D hologram. Finally, an independent radiology professor rated the participants' performance (out of 100). All participants in two groups completed a Likert scale questionnaire regarding the educational utility and efficiency of 3D holograms. The National Aeronautics and Space Administration Task Load Index (NASA-TLX) was completed by all participants. Results: The mean task score of the 3D hologram group (mean 91.98, SD 2.45) was significantly higher than that of the 2D CT group (mean 74.09, SD 7.59; P<.001). With the help of 3D holograms, surgeons and medical students achieved the same score as radiologists and made obvious progress in identifying pulmonary lesions caused by COVID-19. The Likert scale questionnaire results showed that the 3D hologram group had superior results compared to the 2D CT group (teaching: 2D CT group median 2, IQR 1-2 versus 3D group median 5, IQR 5-5; P<.001; understanding and communicating: 2D CT group median 1, IQR 1-1 versus 3D group median 5, IQR 5-5; P<.001; increasing interest: 2D CT group median 2, IQR 2-2 versus 3D group median 5, IQR 5-5; P<.001; lowering the learning curve: 2D CT group median 2, IQR 1-2 versus 3D group median 4, IQR 4-5; P<.001; spatial awareness: 2D CT group median 2, IQR 1-2 versus 3D group median 5, IQR 5-5; P<.001; learning: 2D CT group median 3, IQR 2-3 versus 3D group median 5, IQR 5-5; P<.001). The 3D group scored significantly lower than the 2D CT group for the ``mental,'' ``temporal,'' ``performance,'' and ``frustration'' subscales on the NASA-TLX. Conclusions: A 3D hologram with mixed reality techniques can be used to help medical professionals, especially medical students and newly hired doctors, better identify pulmonary lesions caused by COVID-19. It can be used in medical education to improve spatial awareness, increase interest, improve understandability, and lower the learning curve. Trial Registration: Chinese Clinical Trial Registry ChiCTR2100045845; http://www.chictr.org.cn/showprojen.aspx?proj=125761 ",
doi="10.2196/24081",
url="https://www.jmir.org/2021/9/e24081",
url="http://www.ncbi.nlm.nih.gov/pubmed/34061760"
}


@Article{info:doi/10.2196/24295,
author="Geva, A. Gil
and Ketko, Itay
and Nitecki, Maya
and Simon, Shoham
and Inbar, Barr
and Toledo, Itay
and Shapiro, Michael
and Vaturi, Barak
and Votta, Yoni
and Filler, Daniel
and Yosef, Roey
and Shpitzer, A. Sagi
and Hir, Nabil
and Peri Markovich, Michal
and Shapira, Shachar
and Fink, Noam
and Glasberg, Elon
and Furer, Ariel",
title="Data Empowerment of Decision-Makers in an Era of a Pandemic: Intersection of ``Classic'' and Artificial Intelligence in the Service of Medicine",
journal="J Med Internet Res",
year="2021",
month="Sep",
day="10",
volume="23",
number="9",
pages="e24295",
keywords="COVID-19",
keywords="medical informatics",
keywords="decision-making",
keywords="pandemic",
keywords="data",
keywords="policy",
keywords="validation",
keywords="accuracy",
keywords="data analysis",
abstract="Background: The COVID-19 outbreak required prompt action by health authorities around the world in response to a novel threat. With enormous amounts of information originating in sources with uncertain degree of validation and accuracy, it is essential to provide executive-level decision-makers with the most actionable, pertinent, and updated data analysis to enable them to adapt their strategy swiftly and competently. Objective: We report here the origination of a COVID-19 dedicated response in the Israel Defense Forces with the assembly of an operational Data Center for the Campaign against Coronavirus. Methods: Spearheaded by directors with clinical, operational, and data analytics orientation, a multidisciplinary team utilized existing and newly developed platforms to collect and analyze large amounts of information on an individual level in the context of SARS-CoV-2 contraction and infection. Results: Nearly 300,000 responses to daily questionnaires were recorded and were merged with other data sets to form a unified data lake. By using basic as well as advanced analytic tools ranging from simple aggregation and display of trends to data science application, we provided commanders and clinicians with access to trusted, accurate, and personalized information and tools that were designed to foster operational changes and mitigate the propagation of the pandemic. The developed tools aided in the in the identification of high-risk individuals for severe disease and resulted in a 30\% decline in their attendance to their units. Moreover, the queue for laboratory examination for COVID-19 was optimized using a predictive model and resulted in a high true-positive rate of 20\%, which is more than twice as high as the baseline rate (2.28\%, 95\% CI 1.63\%-3.19\%). Conclusions: In times of ambiguity and uncertainty, along with an unprecedented flux of information, health organizations may find multidisciplinary teams working to provide intelligence from diverse and rich data a key factor in providing executives relevant and actionable support for decision-making. ",
doi="10.2196/24295",
url="https://www.jmir.org/2021/9/e24295",
url="http://www.ncbi.nlm.nih.gov/pubmed/34313589"
}


@Article{info:doi/10.2196/30692,
author="Klingelh{\"o}fer, Doris
and Braun, Markus
and Br{\"u}ggmann, D{\"o}rthe
and Groneberg, A. David",
title="The Pandemic Year 2020: World Map of Coronavirus Research",
journal="J Med Internet Res",
year="2021",
month="Sep",
day="8",
volume="23",
number="9",
pages="e30692",
keywords="COVID-19",
keywords="SARS-CoV-2",
keywords="incidence, research funding",
keywords="socioeconomic factors",
keywords="bibliometrics",
keywords="bibliometric analysis",
keywords="global health",
keywords="public health",
keywords="health database",
keywords="online research",
keywords="research database",
abstract="Background: SARS-CoV-2 is one of the most threatening pandemics in human history. As of the date of this analysis, it had claimed about 2 million lives worldwide, and the number is rising sharply. Governments, societies, and scientists are equally challenged under this burden. Objective: This study aimed to map global coronavirus research in 2020 according to various influencing factors to highlight incentives or necessities for further research. Methods: The application of established and advanced bibliometric methods combined with the visualization technique of density-equalizing mapping provided a global picture of incentives and efforts on coronavirus research in 2020. Countries' funding patterns and their epidemiological and socioeconomic characteristics as well as their publication performance data were included. Results: Research output exploded in 2020 with momentum, including citation and networking parameters. China and the United States were the countries with the highest publication performance. Globally, however, publication output correlated significantly with COVID-19 cases. Research funding has also increased immensely. Conclusions: Nonetheless, the abrupt decline in publication efforts following previous coronavirus epidemics should demonstrate to global researchers that they should not lose interest even after containment, as the next epidemiological challenge is certain to come. Validated reporting worldwide and the inclusion of low-income countries are additionally important for a successful future research strategy. ",
doi="10.2196/30692",
url="https://www.jmir.org/2021/9/e30692",
url="http://www.ncbi.nlm.nih.gov/pubmed/34346891"
}


@Article{info:doi/10.2196/31409,
author="Lee, Hocheol
and Noh, Bi Eun
and Park, Jong Sung
and Nam, Kweun Hae
and Lee, Ho Tae
and Lee, Ram Ga
and Nam, Woo Eun",
title="COVID-19 Vaccine Perception in South Korea: Web Crawling Approach",
journal="JMIR Public Health Surveill",
year="2021",
month="Sep",
day="8",
volume="7",
number="9",
pages="e31409",
keywords="COVID-19 vaccine",
keywords="COVID-19",
keywords="instagram",
keywords="social media",
keywords="infodemiology",
keywords="sentiment analysis",
keywords="vaccine perception",
keywords="South Korea",
keywords="web crawling",
keywords="AstraZeneca",
keywords="Pfizer",
abstract="Background: The US Centers for Disease Control and Prevention and the World Health Organization emphasized vaccination against COVID-19 because physical distancing proved inadequate to mitigate death, illness, and massive economic loss. Objective: This study aimed to investigate Korean citizens' perceptions of vaccines by examining their views on COVID-19 vaccines, their positive and negative perceptions of each vaccine, and ways to enhance policies to increase vaccine acceptance. Methods: This cross-sectional study analyzed posts on NAVER and Instagram to examine Korean citizens' perception of COVID-19 vaccines. The keywords searched were ``vaccine,'' ``AstraZeneca,'' and ``Pfizer.'' In total 8100 posts in NAVER and 5291 posts in Instagram were sampled through web crawling. Morphology analysis was performed, overlapping or meaningless words were removed, sentiment analysis was implemented, and 3 public health professionals reviewed the results. Results: The findings revealed a negative perception of COVID-19 vaccines; of the words crawled, the proportion of negative words for AstraZeneca was 71.0\% (476/670) and for Pfizer was 56.3\% (498/885). Among words crawled with ``vaccine,'' ``good'' ranked first, with a frequency of 13.43\% (312/2323). Meanwhile, ``side effect'' ranked highest, with a frequency of 29.2\% (163/559) for ``AstraZeneca,'' but 0.6\% (4/673) for ``Pfizer.'' With ``vaccine,'' positive words were more frequently used, whereas with ``AstraZeneca'' and ``Pfizer'' negative words were prevalent. Conclusions: There is a negative perception of AstraZeneca and Pfizer vaccines in Korea, with 1 in 4 people refusing vaccination. To address this, accurate information needs to be shared about vaccines including AstraZeneca, and the experiences of those vaccinated. Furthermore, government communication about risk management is required to increase the AstraZeneca vaccination rate for herd immunity before the vaccine expires. ",
doi="10.2196/31409",
url="https://publichealth.jmir.org/2021/9/e31409",
url="http://www.ncbi.nlm.nih.gov/pubmed/34348890"
}


@Article{info:doi/10.2196/30406,
author="Bernardes-Souza, Breno
and J{\'u}nior, Costa Saulo Ricardo
and Santos, Ali Carolina
and Neto, Nascimento Raimundo Marques Do
and Bottega, Carvalho Fernando De
and Godoy, Carolina Daiana
and Freitas, Louren{\c{c}}oni Bruno
and Silva, Garcia Daniela Leite
and Brinker, Josef Titus
and Nascimento, Aranha Raiza
and Tupinamb{\'a}s, Una{\'i}
and Reis, Barbosa Alexandre
and Coura-Vital, Wendel",
title="Logistics Workers Are a Key Factor for SARS-CoV-2 Spread in Brazilian Small Towns: Case-Control Study",
journal="JMIR Public Health Surveill",
year="2021",
month="Sep",
day="1",
volume="7",
number="9",
pages="e30406",
keywords="COVID-19",
keywords="SARS-CoV-2",
keywords="logistics workers",
keywords="risk factors",
keywords="household infection",
abstract="Background: Data on how SARS-CoV-2 enters and spreads in a population are essential for guiding public policies. Objective: This study seeks to understand the transmission dynamics of SARS-CoV-2 in small Brazilian towns during the early phase of the epidemic and to identify core groups that can serve as the initial source of infection as well as factors associated with a higher risk of COVID-19. Methods: Two population-based seroprevalence studies, one household survey, and a case-control study were conducted in two small towns in southeastern Brazil between May and June 2020. In the population-based studies, 400 people were evaluated in each town; there were 40 homes in the household survey, and 95 cases and 393 controls in the case-control study. SARS-CoV-2 serology testing was performed on participants, and a questionnaire was applied. Prevalence, household secondary infection rate, and factors associated with infection were assessed. Odds ratios (ORs) were calculated by logistic regression. Logistics worker was defined as an individual with an occupation focused on the transportation of people or goods and whose job involves traveling outside the town of residence at least once a week. Results: Higher seroprevalence of SARS-CoV-2 was observed in the town with a greater proportion of logistics workers. The secondary household infection rate was 49.1\% (55/112), and it was observed that in most households (28/40, 70\%) the index case was a logistics worker. The case-control study revealed that being a logistics worker (OR 18.0, 95\% CI 8.4-38.7) or living with one (OR 6.9, 95\% CI 3.3-14.5) increases the risk of infection. In addition, having close contact with a confirmed case (OR 13.4, 95\% CI 6.6-27.3) and living with more than four people (OR 2.7, 95\% CI 1.1-7.1) were also risk factors. Conclusions: Our study shows a strong association between logistics workers and the risk of SARS-CoV-2 infection and highlights the key role of these workers in the viral spread in small towns. These findings indicate the need to focus on this population to determine COVID-19 prevention and control strategies, including vaccination and sentinel genomic surveillance. ",
doi="10.2196/30406",
url="https://publichealth.jmir.org/2021/9/e30406",
url="http://www.ncbi.nlm.nih.gov/pubmed/34388105"
}


@Article{info:doi/10.2196/24181,
author="Lap{\~a}o, Velez Lu{\'i}s
and Peyroteo, Mariana
and Maia, Melanie
and Seixas, Jorge
and Greg{\'o}rio, Jo{\~a}o
and Mira da Silva, Miguel
and Heleno, Bruno
and Correia, C{\'e}sar Jorge",
title="Implementation of Digital Monitoring Services During the COVID-19 Pandemic for Patients With Chronic Diseases: Design Science Approach",
journal="J Med Internet Res",
year="2021",
month="Aug",
day="26",
volume="23",
number="8",
pages="e24181",
keywords="primary healthcare",
keywords="information systems",
keywords="telemedicine",
keywords="implementation",
keywords="design science research",
keywords="COVID-19",
keywords="monitoring",
keywords="chronic disease",
keywords="elderly",
keywords="digital health",
abstract="Background: The COVID-19 pandemic is straining health systems and disrupting the delivery of health care services, in particular, for older adults and people with chronic conditions, who are particularly vulnerable to COVID-19 infection. Objective: The aim of this project was to support primary health care provision with a digital health platform that will allow primary care physicians and nurses to remotely manage the care of patients with chronic diseases or COVID-19 infections. Methods: For the rapid design and implementation of a digital platform to support primary health care services, we followed the Design Science implementation framework: (1) problem identification and motivation, (2) definition of the objectives aligned with goal-oriented care, (3) artefact design and development based on Scrum, (4) solution demonstration, (5) evaluation, and (6) communication. Results: The digital platform was developed for the specific objectives of the project and successfully piloted in 3 primary health care centers in the Lisbon Health Region. Health professionals (n=53) were able to remotely manage their first patients safely and thoroughly, with high degrees of satisfaction. Conclusions: Although still in the first steps of implementation, its positive uptake, by both health care providers and patients, is a promising result. There were several limitations including the low number of participating health care units. Further research is planned to deploy the platform to many more primary health care centers and evaluate the impact on patient's health related outcomes. ",
doi="10.2196/24181",
url="https://www.jmir.org/2021/8/e24181",
url="http://www.ncbi.nlm.nih.gov/pubmed/34313591"
}


@Article{info:doi/10.2196/28716,
author="Chum, Antony
and Nielsen, Andrew
and Bellows, Zachary
and Farrell, Eddie
and Durette, Pierre-Nicolas
and Banda, M. Juan
and Cupchik, Gerald",
title="Changes in Public Response Associated With Various COVID-19 Restrictions in Ontario, Canada: Observational Infoveillance Study Using Social Media Time Series Data",
journal="J Med Internet Res",
year="2021",
month="Aug",
day="25",
volume="23",
number="8",
pages="e28716",
keywords="COVID-19",
keywords="public opinion",
keywords="social media",
keywords="sentiment analysis",
keywords="public health restrictions",
keywords="infodemiology",
keywords="infoveillance",
keywords="coronavirus",
keywords="evaluation",
abstract="Background: News media coverage of antimask protests, COVID-19 conspiracies, and pandemic politicization has overemphasized extreme views but has done little to represent views of the general public. Investigating the public's response to various pandemic restrictions can provide a more balanced assessment of current views, allowing policy makers to craft better public health messages in anticipation of poor reactions to controversial restrictions. Objective: Using data from social media, this infoveillance study aims to understand the changes in public opinion associated with the implementation of COVID-19 restrictions (eg, business and school closures, regional lockdown differences, and additional public health restrictions, such as social distancing and masking). Methods: COVID-19--related tweets in Ontario (n=1,150,362) were collected based on keywords between March 12 and October 31, 2020. Sentiment scores were calculated using the VADER (Valence Aware Dictionary and Sentiment Reasoner) algorithm for each tweet to represent its negative to positive emotion. Public health restrictions were identified using government and news media websites. Dynamic regression models with autoregressive integrated moving average errors were used to examine the association between public health restrictions and changes in public opinion over time (ie, collective attention, aggregate positive sentiment, and level of disagreement), controlling for the effects of confounders (ie, daily COVID-19 case counts, holidays, and COVID-19--related official updates). Results: In addition to expected direct effects (eg, business closures led to decreased positive sentiment and increased disagreements), the impact of restrictions on public opinion was contextually driven. For example, the negative sentiment associated with business closures was reduced with higher COVID-19 case counts.  While school closures and other restrictions (eg, masking, social distancing, and travel restrictions) generated increased collective attention, they did not have an effect on aggregate sentiment or the level of disagreement (ie, sentiment polarization). Partial (ie, region-targeted) lockdowns were associated with better public response (ie, higher number of tweets with net positive sentiment and lower levels of disagreement) compared to province-wide lockdowns. Conclusions: Our study demonstrates the feasibility of a rapid and flexible method of evaluating the public response to pandemic restrictions using near real-time social media data. This information can help public health practitioners and policy makers anticipate public response to future pandemic restrictions and ensure adequate resources are dedicated to addressing increases in negative sentiment and levels of disagreement in the face of scientifically informed, but controversial, restrictions. ",
doi="10.2196/28716",
url="https://www.jmir.org/2021/8/e28716",
url="http://www.ncbi.nlm.nih.gov/pubmed/34227996"
}


@Article{info:doi/10.2196/30612,
author="Beaudoin, E. Christopher
and Hong, Traci",
title="Predictors of COVID-19 Preventive Perceptions and Behaviors Among Millennials: Two Cross-sectional Survey Studies",
journal="J Med Internet Res",
year="2021",
month="Aug",
day="12",
volume="23",
number="8",
pages="e30612",
keywords="COVID-19",
keywords="coronavirus",
keywords="pandemic",
keywords="preventive perceptions",
keywords="preventive behaviors",
keywords="health information seeking",
keywords="political party identification",
keywords="COVID-19 testing",
abstract="Background: COVID-19 preventive perceptions and behaviors, especially among US millennials, are an important means by which the pandemic can be slowed and negative health outcomes can be averted. Objective: This manuscript aims to advance knowledge on COVID-19 preventive perceptions and behaviors and their main predictors, including digital health information--seeking behavior (HISB), political party identification, and COVID-19 testing status. Methods: Two cross-sectional online surveys of US millennials were conducted from April 10 to 14, 2020 (N=274) (ie, Study 1), and from April 27 to May 7, 2020 (N=1037) (ie, Study 2). In the regression models, dependent variables included preventive behaviors (eg, wearing a face mask and social distancing) as well as four preventive perceptions: severity (ie, a person's conception of the seriousness of COVID-19), susceptibility (ie, a person's conception of the likelihood of being infected with COVID-19), self-efficacy (ie, a person's perception that he or she can wear a face mask and perform social distancing to prevent COVID-19 infection), and response efficacy (ie, a person's perception of whether wearing a face mask and social distancing can prevent COVID-19 infection). Key independent variables included digital HISB for self, digital HISB for another person, political party identification, and COVID-19 testing status. Results: Millennials reported lower levels of perceived susceptibility than the other three preventive perceptions (ie, severity, self-efficacy, and response efficacy), as well as fairly high levels of preventive behaviors. Unlike HISB for another person, digital HISB for self was positively associated with preventive perceptions and behaviors. In Study 1, respondents with higher levels of digital HISB for self had significantly higher perceptions of severity ($\beta$=.22, P<.001), self-efficacy ($\beta$=.15, P=.02), and response efficacy ($\beta$=.25, P<.001) as well as, at nearing significance, higher perceptions of susceptibility ($\beta$=.11, P=.07). In Study 2, respondents with higher levels of digital HISB for self had significantly higher perceptions of severity ($\beta$=.25, P<.001), susceptibility ($\beta$=.14, P<.001), and preventive behaviors ($\beta$=.24, P<.001). Preventive behaviors did not vary significantly according to political party identification, but preventive perceptions did. In Study 1, respondents who identified as being more Republican had significantly lower perceptions of self-efficacy ($\beta$=?.14, P=.02) and response efficacy ($\beta$=?.13, P=.03) and, at nearing significance, lower perceptions of severity ($\beta$=?.10, P=.08) and susceptibility ($\beta$=?.12, P=.06). In Study 2, respondents who identified as being more Republican had significantly lower perceptions of severity ($\beta$=?.08, P=.009). There were mixed effects of COVID-19 testing status on preventive perceptions, with respondents who had tested positive for COVID-19 having significantly higher perceptions of susceptibility in Study 1 ($\beta$=.17, P=.006) and significantly lower perceptions of severity in Study 2 ($\beta$=?.012, P<.001). Conclusions: As the largest and most digitally savvy generation, US millennials saw COVID-19 as a severe threat, but one that they were less susceptible to. For millennials, digital HISB for self, but not for another person, was critical to the development of preventive perceptions and behaviors. ",
doi="10.2196/30612",
url="https://www.jmir.org/2021/8/e30612",
url="http://www.ncbi.nlm.nih.gov/pubmed/34182460"
}


@Article{info:doi/10.2196/30251,
author="Liu, Siru
and Li, Jili
and Liu, Jialin",
title="Leveraging Transfer Learning to Analyze Opinions, Attitudes, and Behavioral Intentions Toward COVID-19 Vaccines: Social Media Content and Temporal Analysis",
journal="J Med Internet Res",
year="2021",
month="Aug",
day="10",
volume="23",
number="8",
pages="e30251",
keywords="vaccine",
keywords="COVID-19",
keywords="leveraging transfer learning",
keywords="pandemic",
keywords="infodemiology",
keywords="infoveillance",
keywords="public health",
keywords="social media",
keywords="content analysis",
keywords="machine learning",
keywords="online health",
abstract="Background: The COVID-19 vaccine is considered to be the most promising approach to alleviate the pandemic. However, in recent surveys, acceptance of the COVID-19 vaccine has been low. To design more effective outreach interventions, there is an urgent need to understand public perceptions of COVID-19 vaccines. Objective: Our objective was to analyze the potential of leveraging transfer learning to detect tweets containing opinions, attitudes, and behavioral intentions toward COVID-19 vaccines, and to explore temporal trends as well as automatically extract topics across a large number of tweets. Methods: We developed machine learning and transfer learning models to classify tweets, followed by temporal analysis and topic modeling on a dataset of COVID-19 vaccine--related tweets posted from November 1, 2020 to January 31, 2021. We used the F1 values as the primary outcome to compare the performance of machine learning and transfer learning models. The statistical values and P values from the Augmented Dickey-Fuller test were used to assess whether users' perceptions changed over time. The main topics in tweets were extracted by latent Dirichlet allocation analysis. Results: We collected 2,678,372 tweets related to COVID-19 vaccines from 841,978 unique users and annotated 5000 tweets. The F1 values of transfer learning models were 0.792 (95\% CI 0.789-0.795), 0.578 (95\% CI 0.572-0.584), and 0.614 (95\% CI 0.606-0.622) for these three tasks, which significantly outperformed the machine learning models (logistic regression, random forest, and support vector machine). The prevalence of tweets containing attitudes and behavioral intentions varied significantly over time. Specifically, tweets containing positive behavioral intentions increased significantly in December 2020. In addition, we selected tweets in the following categories: positive attitudes, negative attitudes, positive behavioral intentions, and negative behavioral intentions. We then identified 10 main topics and relevant terms for each category. Conclusions: Overall, we provided a method to automatically analyze the public understanding of COVID-19 vaccines from real-time data in social media, which can be used to tailor educational programs and other interventions to effectively promote the public acceptance of COVID-19 vaccines. ",
doi="10.2196/30251",
url="https://www.jmir.org/2021/8/e30251",
url="http://www.ncbi.nlm.nih.gov/pubmed/34254942"
}


@Article{info:doi/10.2196/29205,
author="Bauer, Cici
and Zhang, Kehe
and Lee, Miryoung
and Fisher-Hoch, Susan
and Guajardo, Esmeralda
and McCormick, Joseph
and de la Cerda, Isela
and Fernandez, E. Maria
and Reininger, Belinda",
title="Census Tract Patterns and Contextual Social Determinants of Health Associated With COVID-19 in a Hispanic Population From South Texas: A Spatiotemporal Perspective",
journal="JMIR Public Health Surveill",
year="2021",
month="Aug",
day="5",
volume="7",
number="8",
pages="e29205",
keywords="COVID-19",
keywords="spatial pattern",
keywords="social determinants of health",
keywords="Bayesian",
keywords="underserved population",
keywords="health inequity",
abstract="Background: Previous studies have shown that various social determinants of health (SDOH) may have contributed to the disparities in COVID-19 incidence and mortality among minorities and underserved populations at the county or zip code level. Objective: This analysis was carried out at a granular spatial resolution of census tracts to explore the spatial patterns and contextual SDOH associated with COVID-19 incidence from a Hispanic population mostly consisting of a Mexican American population living in Cameron County, Texas on the border of the United States and Mexico. We performed age-stratified analysis to identify different contributing SDOH and quantify their effects by age groups. Methods: We included all reported COVID-19--positive cases confirmed by reverse transcription--polymerase chain reaction testing between March 18 (first case reported) and December 16, 2020, in Cameron County, Texas. Confirmed COVID-19 cases were aggregated to weekly counts by census tracts. We adopted a Bayesian spatiotemporal negative binomial model to investigate the COVID-19 incidence rate in relation to census tract demographics and SDOH obtained from the American Community Survey. Moreover, we investigated the impact of local mitigation policy on COVID-19 by creating the binary variable ``shelter-in-place.'' The analysis was performed on all COVID-19--confirmed cases and age-stratified subgroups. Results: Our analysis revealed that the relative incidence risk (RR) of COVID-19 was higher among census tracts with a higher percentage of single-parent households (RR=1.016, 95\% posterior credible intervals [CIs] 1.005, 1.027) and a higher percentage of the population with limited English proficiency (RR=1.015, 95\% CI 1.003, 1.028). Lower RR was associated with lower income (RR=0.972, 95\% CI 0.953, 0.993) and the percentage of the population younger than 18 years (RR=0.976, 95\% CI 0.959, 0.993). The most significant association was related to the ``shelter-in-place'' variable, where the incidence risk of COVID-19 was reduced by over 50\%, comparing the time periods when the policy was present versus absent (RR=0.506, 95\% CI 0.454, 0.563). Moreover, age-stratified analyses identified different significant contributing factors and a varying magnitude of the ``shelter-in-place'' effect. Conclusions: In our study, SDOH including social environment and local emergency measures were identified in relation to COVID-19 incidence risk at the census tract level in a highly disadvantaged population with limited health care access and a high prevalence of chronic conditions. Results from our analysis provide key knowledge to design efficient testing strategies and assist local public health departments in COVID-19 control, mitigation, and implementation of vaccine strategies. ",
doi="10.2196/29205",
url="https://publichealth.jmir.org/2021/8/e29205",
url="http://www.ncbi.nlm.nih.gov/pubmed/34081608"
}


@Article{info:doi/10.2196/26111,
author="Su, Zhaohui
and McDonnell, Dean
and Cheshmehzangi, Ali
and Li, Xiaoshan
and Maestro, Daniel
and {\vS}egalo, Sabina
and Ahmad, Junaid
and Hao, Xiaoning",
title="With Great Hopes Come Great Expectations: Access and Adoption Issues Associated With COVID-19 Vaccines",
journal="JMIR Public Health Surveill",
year="2021",
month="Aug",
day="4",
volume="7",
number="8",
pages="e26111",
keywords="COVID-19",
keywords="coronavirus",
keywords="COVID-19 vaccine",
keywords="made in China",
keywords="vaccine efficacy",
keywords="vaccine safety",
keywords="vaccine",
keywords="China",
keywords="expectation",
keywords="safety",
keywords="efficacy",
keywords="infectious disease",
keywords="public health",
keywords="consequence",
keywords="standard",
doi="10.2196/26111",
url="https://publichealth.jmir.org/2021/8/e26111",
url="http://www.ncbi.nlm.nih.gov/pubmed/33560997"
}


@Article{info:doi/10.2196/25795,
author="Kimmie-Dhansay, Faheema
and Barrie, Robert
and Naidoo, Sudeshni
and Roberts, Sharon Tina",
title="Prevalence of Early Childhood Caries in South Africa: Protocol for a Systematic Review",
journal="JMIR Res Protoc",
year="2021",
month="Aug",
day="3",
volume="10",
number="8",
pages="e25795",
keywords="dmft",
keywords="prevalence",
keywords="dental caries",
keywords="South Africa",
keywords="early childhood caries",
abstract="Background: Young children are at the highest risk of developing dental caries as they have a lack of autonomy over their diet and oral hygiene practices. Dental caries develops over time due to demineralization of tooth substance (enamel), which results from acid production during sugar metabolism by bacteria. Early onset of dental caries often results in asymptomatic presentation, but if left untreated, it can result in severe pain, infection, and dentoalveolar abscesses. Early childhood caries (ECC) is defined as dental caries in children aged 6 years and younger and is a significant public health problem in South Africa. According to the Global Burden of Disease study, untreated dental caries of primary teeth affects 532 million children. Untreated dental caries has many detrimental effects which can affect the physical development and reduce the quality of life of affected children. Furthermore, long-term untreated dental caries can result in school absenteeism, low BMI, and poor educational outcomes. Objective: The purpose of this study was to determine the prevalence and severity of ECC in South Africa in children under the age of 6 years. Methods: All cross-sectional studies documenting the prevalence and severity of dental disease (decayed, missing, and filled teeth scores) will be included. Various databases will be searched for eligible studies. Only studies conducted on South African children aged 6 years and under will be included. There will be no restriction on the time or language of publication. The quality of all eligible studies will be analyzed by a risk of bias tool developed by the Joanna Briggs Institute. The results will be presented narratively, and if possible, a meta-analysis will be conducted. Results: The protocol is registered with PROSPERO. The literature search was initially conducted in November 2018 and was repeated in November 2020. Conclusions: The results of this study will be used to advise stakeholders of the prevalence and severity of dental disease in children under 6 years of age in South Africa. Trial Registration: PROSPERO CRD42018112161;    International Registered Report Identifier (IRRID): DERR1-10.2196/25795 ",
doi="10.2196/25795",
url="https://www.researchprotocols.org/2021/8/e25795",
url="http://www.ncbi.nlm.nih.gov/pubmed/34342587"
}


@Article{info:doi/10.2196/29195,
author="Xiong, Ziyu
and Li, Pin
and Lyu, Hanjia
and Luo, Jiebo",
title="Social Media Opinions on Working From Home in the United States During the COVID-19 Pandemic: Observational Study",
journal="JMIR Med Inform",
year="2021",
month="Jul",
day="30",
volume="9",
number="7",
pages="e29195",
keywords="characterization",
keywords="COVID-19",
keywords="social media",
keywords="topic modeling",
keywords="Twitter",
keywords="work from home",
abstract="Background: Since March 2020, companies nationwide have started work from home (WFH) owing to the rapid increase of confirmed COVID-19 cases in an attempt to help prevent the disease from spreading and to rescue the economy from the pandemic. Many organizations have conducted surveys to understand people's opinions toward WFH. However, the findings are limited owing to a small sample size and the dynamic topics over time. Objective: This study aims to understand public opinions regarding WFH in the United States during the COVID-19 pandemic. Methods: We conducted a large-scale social media study using Twitter data to portray different groups of individuals who have positive or negative opinions on WFH. We performed an ordinary least squares regression analysis to investigate the relationship between the sentiment about WFH and user characteristics including gender, age, ethnicity, median household income, and population density. To better understand the public opinion, we used latent Dirichlet allocation to extract topics and investigate how tweet contents are related to people's attitude. Results: On performing ordinary least squares regression analysis using a large-scale data set of publicly available Twitter posts (n=28,579) regarding WFH during April 10-22, 2020, we found that the sentiment on WFH varies across user characteristics. In particular, women tend to be more positive about WFH (P<.001). People in their 40s are more positive toward WFH than those in other age groups (P<.001). People from high-income areas are more likely to have positive opinions about WFH (P<.001). These nuanced differences are supported by a more fine-grained topic analysis. At a higher level, we found that the most negative sentiment about WFH roughly corresponds to the discussion on government policy. However, people express a more positive sentiment when discussing topics on ``remote work or study'' and ``encouragement.'' Furthermore, topic distributions vary across different user groups. Women pay more attention to family activities than men (P<.05). Older people talk more about work and express a more positive sentiment regarding WFH. Conclusions: This paper presents a large-scale social media--based study to understand the public opinion on WFH in the United States during the COVID-19 pandemic. We hope that this study can contribute to policymaking both at the national and institution or company levels to improve the overall population's experience with WFH. ",
doi="10.2196/29195",
url="https://medinform.jmir.org/2021/7/e29195",
url="http://www.ncbi.nlm.nih.gov/pubmed/34254941"
}


@Article{info:doi/10.2196/28255,
author="Lehlewa, Mahdi Asaad
and Khaleel, Abdulghafoor Hanan
and Lami, Faris
and Hasan, Falah Saif Aldeen
and Malick, Asmail Hasanain
and Mohammed, Hashim Razzaq
and Abdulmottaleb, Abdulazziz Qais",
title="Impact of Modifiable Risk Factors on the Occurrence of Cutaneous Leishmaniasis in Diyala, Iraq: Case-Control Study",
journal="JMIRx Med",
year="2021",
month="Jul",
day="30",
volume="2",
number="3",
pages="e28255",
keywords="cutaneous leishmaniasis",
keywords="outbreak",
keywords="Iraq",
keywords="risk factors",
keywords="risk",
keywords="disease",
keywords="infectious disease",
keywords="disease prevention",
keywords="prevention",
abstract="Background: In 2018, an outbreak of cutaneous leishmaniasis (CL) occurred in Diyala Province in Iraq. Several risk factors of CL were identified in a prior study; however, the impact of removing modifiable risk factors on the occurrence of the disease was not measured. Objective: The aim of this study is to measure the impact of removing modifiable risk factors of CL on the occurrence of the disease. Methods: We conducted a population-based unmatched case-control study in two conveniently selected districts in Diyala Province. All cases of CL were included. Controls were chosen preferentially according to the site where the cases occurred. A structured questionnaire was used to collect data. The unadjusted odds ratios (ORs) and 95\% confidence intervals for each risk factor were calculated using binary logistic regression. We also calculated the attributable fractions and 95\% confidence intervals of the modifiable risk factors. A P value <.05 was considered statistically significant. Results: Data from 844 persons (432 cases, 51.2\%) were analyzed. Cases were more likely than controls to report a history of previous displacement (OR 5.18, 95\% CI 3.84-6.98), electricity supply for less than 12 hours per day (OR 1.94, 95\% CI 1.47-2.55), living in a rural area (OR 1.91, 95\% CI 1.45-2.51), living in a clay house (OR 2.41, 95\% CI 1.59-3.66), having an unpainted indoor living space (OR 2.14, 95\% CI 1.51-3.02), having rodents inside the house (OR 5.15, 95\% CI 3.56-7.47), having chickens, sheep, or both (OR 3.44, 95\% CI 2.48-4.75), having a mixture of dogs and sheep or of dogs and chickens within a distance of less than 100 meters (OR 3.92, 95\% CI 2.59-5.94), fogging (OR 2.11, 95\% CI 1.40-3.19), bed net use (OR 1.72, 95\% CI 1.08-2.72), and sleeping outside or a mixture of inside and outside (OR 4.01, 95\% CI 1.32-12.19). The data show that the exposure of approximately 70\% to 80\% of cases was associated with displacement, the presence of rodents inside the house, the presence of animals within 100 meters of the house, the presence of animals (chickens/sheep/both or a mixture of dogs and sheep or of dogs and chickens), and sleeping outside. Approximately 40\%-50\% of the cases reported living in a clay house, living in a rural area, having an unpainted indoor space, having an electricity supply for less than 12 hours, and using a bed net. Conclusions: Prevention and control of CL requires a multifaceted approach that relies on changing environmental conditions, housing conditions, and human behavior. Fogging and bed net use were not effective because the underlying housing characteristics and human behavior provided a good culture for the disease. We recommend conducting a study to identify the species, reservoirs, and vectors of CL in Iraq; studying vector behaviors before applying environmental control measures; and educating the public on how and when to use bed nets as well as how to accompany their use with behavioral changes. ",
doi="10.2196/28255",
url="https://med.jmirx.org/2021/3/e28255",
url="http://www.ncbi.nlm.nih.gov/pubmed/37725543"
}


@Article{info:doi/10.2196/26371,
author="An, Yongdae
and Lee, Seungmyung
and Jung, Seungwoo
and Park, Howard
and Song, Yongsoo
and Ko, Taehoon",
title="Privacy-Oriented Technique for COVID-19 Contact Tracing (PROTECT) Using Homomorphic Encryption: Design and Development Study",
journal="J Med Internet Res",
year="2021",
month="Jul",
day="12",
volume="23",
number="7",
pages="e26371",
keywords="COVID-19",
keywords="homomorphic encryption",
keywords="privacy-preserving contact tracing",
keywords="PROTECT protocol",
keywords="GPS data",
keywords="mobile application",
keywords="web service",
abstract="Background: Various techniques are used to support contact tracing, which has been shown to be highly effective against the COVID-19 pandemic. To apply the technology, either quarantine authorities should provide the location history of patients with COVID-19, or all users should provide their own location history. This inevitably exposes either the patient's location history or the personal location history of other users. Thus, a privacy issue arises where the public good (via information release) comes in conflict with privacy exposure risks. Objective: The objective of this study is to develop an effective contact tracing system that does not expose the location information of the patient with COVID-19 to other users of the system, or the location information of the users to the quarantine authorities. Methods: We propose a new protocol called PRivacy Oriented Technique for Epidemic Contact Tracing (PROTECT) that securely shares location information of patients with users by using the Brakerski/Fan-Vercauteren homomorphic encryption scheme, along with a new, secure proximity computation method. Results: We developed a mobile app for the end-user and a web service for the quarantine authorities by applying the proposed method, and we verified their effectiveness. The proposed app and web service compute the existence of intersections between the encrypted location history of patients with COVID-19 released by the quarantine authorities and that of the user saved on the user's local device. We also found that this contact tracing smartphone app can identify whether the user has been in contact with such patients within a reasonable time. Conclusions: This newly developed method for contact tracing shares location information by using homomorphic encryption, without exposing the location information of patients with COVID-19 and other users. Homomorphic encryption is challenging to apply to practical issues despite its high security value. In this study, however, we have designed a system using the  Brakerski/Fan-Vercauteren scheme that is applicable to a reasonable size and developed it to an operable format. The developed app and web service can help contact tracing for not only the COVID-19 pandemic but also other epidemics. ",
doi="10.2196/26371",
url="https://www.jmir.org/2021/7/e26371",
url="http://www.ncbi.nlm.nih.gov/pubmed/33999829"
}


@Article{info:doi/10.2196/29986,
author="Lee, Y. Jewel
and Molani, Sevda
and Fang, Chen
and Jade, Kathleen
and O'Mahony, Shane D.
and Kornilov, A. Sergey
and Mico, T. Lindsay
and Hadlock, J. Jennifer",
title="Ambulatory Risk Models for the Long-Term Prevention of Sepsis: Retrospective Study",
journal="JMIR Med Inform",
year="2021",
month="Jul",
day="8",
volume="9",
number="7",
pages="e29986",
keywords="sepsis",
keywords="machine learning",
keywords="electronic health records",
keywords="risk prediction",
keywords="clinical decision making",
keywords="prevention",
keywords="risk factors",
abstract="Background: Sepsis is a life-threatening condition that can rapidly lead to organ damage and death. Existing risk scores predict outcomes for patients who have already become acutely ill. Objective: We aimed to develop a model for identifying patients at risk of getting sepsis within 2 years in order to support the reduction of sepsis morbidity and mortality. Methods: Machine learning was applied to 2,683,049 electronic health records (EHRs) with over 64 million encounters across five states to develop models for predicting a patient's risk of getting sepsis within 2 years. Features were selected to be easily obtainable from a patient's chart in real time during ambulatory encounters. Results: The models showed consistent prediction scores, with the highest area under the receiver operating characteristic curve of 0.82 and a positive likelihood ratio of 2.9 achieved with gradient boosting on all features combined. Predictive features included age, sex, ethnicity, average ambulatory heart rate, standard deviation of BMI, and the number of prior medical conditions and procedures. The findings identified both known and potential new risk factors for long-term sepsis. Model variations also illustrated trade-offs between incrementally higher accuracy, implementability, and interpretability. Conclusions: Accurate implementable models were developed to predict the 2-year risk of sepsis, using EHR data that is easy to obtain from ambulatory encounters. These results help advance the understanding of sepsis and provide a foundation for future trials of risk-informed preventive care. ",
doi="10.2196/29986",
url="https://medinform.jmir.org/2021/7/e29986",
url="http://www.ncbi.nlm.nih.gov/pubmed/34086596"
}


@Article{info:doi/10.2196/29942,
author="Chan, Calvin
and Sounderajah, Viknesh
and Daniels, Elisabeth
and Acharya, Amish
and Clarke, Jonathan
and Yalamanchili, Seema
and Normahani, Pasha
and Markar, Sheraz
and Ashrafian, Hutan
and Darzi, Ara",
title="The Reliability and Quality of YouTube Videos as a Source of Public Health Information Regarding COVID-19 Vaccination: Cross-sectional Study",
journal="JMIR Public Health Surveill",
year="2021",
month="Jul",
day="8",
volume="7",
number="7",
pages="e29942",
keywords="COVID-19",
keywords="infodemiology",
keywords="public health",
keywords="quality",
keywords="reliability",
keywords="social media",
keywords="vaccination",
keywords="vaccine",
keywords="video",
keywords="web-based health information",
keywords="YouTube",
abstract="Background: Recent emergency authorization and rollout of COVID-19 vaccines by regulatory bodies has generated global attention. As the most popular video-sharing platform globally, YouTube is a potent medium for the dissemination of key public health information. Understanding the nature of available content regarding COVID-19 vaccination on this widely used platform is of substantial public health interest. Objective: This study aimed to evaluate the reliability and quality of information on COVID-19 vaccination in YouTube videos. Methods: In this cross-sectional study, the phrases ``coronavirus vaccine'' and ``COVID-19 vaccine'' were searched on the UK version of YouTube on December 10, 2020. The 200 most viewed videos of each search were extracted and screened for relevance and English language. Video content and characteristics were extracted and independently rated against Health on the Net Foundation Code of Conduct and DISCERN quality criteria for consumer health information by 2 authors. Results: Forty-eight videos, with a combined total view count of 30,100,561, were included in the analysis. Topics addressed comprised the following: vaccine science (n=18, 58\%), vaccine trials (n=28, 58\%), side effects (n=23, 48\%), efficacy (n=17, 35\%), and manufacturing (n=8, 17\%). Ten (21\%) videos encouraged continued public health measures. Only 2 (4.2\%) videos made nonfactual claims. The content of 47 (98\%) videos was scored to have low (n=27, 56\%) or moderate (n=20, 42\%) adherence to Health on the Net Foundation Code of Conduct principles. Median overall DISCERN score per channel type ranged from 40.3 (IQR 34.8-47.0) to 64.3 (IQR 58.5-66.3). Educational channels produced by both medical and nonmedical professionals achieved significantly higher DISCERN scores than those of other categories. The highest median DISCERN scores were achieved by educational videos produced by medical professionals (64.3, IQR 58.5-66.3) and the lowest median scores by independent users (18, IQR 18-20). Conclusions: The overall quality and reliability of information on COVID-19 vaccines on YouTube remains poor. Videos produced by educational channels, especially by medical professionals, were higher in quality and reliability than those produced by other sources, including health-related organizations. Collaboration between health-related organizations and established medical and educational YouTube content producers provides an opportunity for the dissemination of high-quality information on COVID-19 vaccination. Such collaboration holds potential as a rapidly implementable public health intervention aiming to engage a wide audience and increase public vaccination awareness and knowledge. ",
doi="10.2196/29942",
url="https://publichealth.jmir.org/2021/7/e29942",
url="http://www.ncbi.nlm.nih.gov/pubmed/34081599"
}


@Article{info:doi/10.2196/28925,
author="Lutrick, Karen
and Ellingson, D. Katherine
and Baccam, Zoe
and Rivers, Patrick
and Beitel, Shawn
and Parker, Joel
and Hollister, James
and Sun, Xiaoxiao
and Gerald, K. Joe
and Komatsu, Kenneth
and Kim, Elizabeth
and LaFleur, Bonnie
and Grant, Lauren
and Yoo, M. Young
and Kumar, Archana
and Mayo Lamberte, Julie
and Cowling, J. Benjamin
and Cobey, Sarah
and Thornburg, J. Natalie
and Meece, K. Jennifer
and Kutty, Preeta
and Nikolich-Zugich, Janko
and Thompson, G. Mark
and Burgess, L. Jefferey",
title="COVID-19 Infection, Reinfection, and Vaccine Effectiveness in Arizona Frontline and Essential Workers: Protocol for a Longitudinal Cohort Study",
journal="JMIR Res Protoc",
year="2021",
month="Jun",
day="24",
volume="10",
number="6",
pages="e28925",
keywords="SARS-CoV-2",
keywords="COVID-19",
keywords="health care personnel",
keywords="first responders",
keywords="essential workers",
abstract="Background: COVID-19 has spread worldwide since late 2019, with an unprecedented case count and death toll globally. Health care personnel (HCP), first responders, and other essential and frontline workers (OEWs) are at increased risk of SARS-CoV-2 infection because of frequent close contact with others. Objective: The Arizona Healthcare, Emergency Response, and Other Essential Workers Study (AZ HEROES) aims to examine the epidemiology of SARS-CoV-2 infection and COVID-19 illness among adults with high occupational exposure risk. Study objectives include estimating the incidence of SARS-CoV-2 infection in essential workers by symptom presentation and demographic factors, determining independent effects of occupational and community exposures on incidence of SARS-CoV-2 infection, establishing molecular and immunologic characteristics of SARS-CoV-2 infection in essential workers, describing the duration and patterns of real-time reverse transcription--polymerase chain reaction (rRT-PCR) positivity, and examining postvaccine immunologic response. Methods: Eligible participants include Arizona residents aged 18 to 85 years who work at least 20 hours per week in an occupation involving regular direct contact (ie, within 3 feet) with others. Recruitment goals are stratified by demographic characteristics (50\% aged 40 years or older, 50\% women, and 50\% Hispanic or American Indian), by occupation (40\% HCP, 30\% first responders, and 30\% OEWs), and by prior SARS-CoV-2 infection (with up to 50\% seropositive at baseline). Information on sociodemographics, health and medical history, vaccination status, exposures to individuals with suspected or confirmed SARS-CoV-2 infection, use of personal protective equipment, and perceived risks are collected at enrollment and updated through quarterly surveys. Every week, participants complete active surveillance for COVID-like illness (CLI) and self-collect nasal swabs. Additional self-collected nasal swab and saliva specimens are collected in the event of CLI onset. Respiratory specimens are sent to Marshfield Laboratories and tested for SARS-CoV-2 by rRT-PCR assay. CLI symptoms and impact on work and productivity are followed through illness resolution. Serum specimens are collected every 3 months and additional sera are collected following incident rRT-PCR positivity and after each COVID-19 vaccine dose. Incidence of SARS-CoV-2 infections will be calculated by person-weeks at risk and compared by occupation and demographic characteristics as well as by seropositivity status and infection and vaccination history. Results: The AZ HEROES study was funded by the US Centers for Disease Control and Prevention. Enrollment began on July 27, 2020; as of May 1, 2021, a total of 3165 participants have been enrolled in the study. Enrollment is expected to continue through December 1, 2021, with data collection continuing through at least April 2022, contingent upon funding. Conclusions: AZ HEROES is unique in aiming to recruit a diverse sample of essential workers and to prospectively follow strata of SARS-CoV-2 seronegative and seropositive adults. Survey results combined with active surveillance data on exposure, CLI, weekly molecular diagnostic testing, and periodic serology will be used to estimate the incidence of symptomatic and asymptomatic SARS-CoV-2 infection, assess the intensity and durability of immune responses to natural infection and COVID-19 vaccination, and contribute to the evaluation of COVID-19 vaccine effectiveness. International Registered Report Identifier (IRRID): DERR1-10.2196/28925 ",
doi="10.2196/28925",
url="https://www.researchprotocols.org/2021/6/e28925/"
}


@Article{info:doi/10.2196/26655,
author="Massey, Daisy
and Huang, Chenxi
and Lu, Yuan
and Cohen, Alina
and Oren, Yahel
and Moed, Tali
and Matzner, Pini
and Mahajan, Shiwani
and Caraballo, C{\'e}sar
and Kumar, Navin
and Xue, Yuchen
and Ding, Qinglan
and Dreyer, Rachel
and Roy, Brita
and Krumholz, Harlan",
title="Engagement With COVID-19 Public Health Measures in the United States: A Cross-sectional Social Media Analysis from June to November 2020",
journal="J Med Internet Res",
year="2021",
month="Jun",
day="21",
volume="23",
number="6",
pages="e26655",
keywords="COVID-19",
keywords="public perception",
keywords="social media",
keywords="infodemiology",
keywords="infoveillance",
keywords="infodemic",
keywords="social media research",
keywords="social listening",
keywords="social media analysis",
keywords="natural language processing",
keywords="Reddit data",
keywords="Facebook data",
keywords="COVID-19 public health measures",
keywords="public health",
keywords="surveillance",
keywords="engagement",
keywords="United States",
keywords="cross-sectional",
keywords="Reddit",
keywords="Facebook",
keywords="behavior",
keywords="perception",
keywords="NLP",
abstract="Background: COVID-19 has continued to spread in the United States and globally. Closely monitoring public engagement and perceptions of COVID-19 and preventive measures using social media data could provide important information for understanding the progress of current interventions and planning future programs. Objective: The aim of this study is to measure the public's behaviors and perceptions regarding COVID-19 and its effects on daily life during 5 months of the pandemic. Methods: Natural language processing (NLP) algorithms were used to identify COVID-19--related and unrelated topics in over 300 million online data sources from June 15 to November 15, 2020. Posts in the sample were geotagged by NetBase, a third-party data provider, and sensitivity and positive predictive value were both calculated to validate the classification of posts. Each post may have included discussion of multiple topics. The prevalence of discussion regarding these topics was measured over this time period and compared to daily case rates in the United States. Results: The final sample size included 9,065,733 posts, 70\% of which were sourced from the United States. In October and November, discussion including mentions of COVID-19 and related health behaviors did not increase as it had from June to September, despite an increase in COVID-19 daily cases in the United States beginning in October. Additionally, discussion was more focused on daily life topics (n=6,210,255, 69\%), compared with COVID-19 in general (n=3,390,139, 37\%) and COVID-19 public health measures (n=1,836,200, 20\%). Conclusions: There was a decline in COVID-19--related social media discussion sourced mainly from the United States, even as COVID-19 cases in the United States increased to the highest rate since the beginning of the pandemic. Targeted public health messaging may be needed to ensure engagement in public health prevention measures as global vaccination efforts continue. ",
doi="10.2196/26655",
url="https://www.jmir.org/2021/6/e26655",
url="http://www.ncbi.nlm.nih.gov/pubmed/34086593"
}


@Article{info:doi/10.2196/26267,
author="Bashier, Haitham
and Ikram, Aamer
and Khan, Ali Mumtaz
and Baig, Mirza
and Al Gunaid, Magid
and Al Nsour, Mohannad
and Khader, Yousef",
title="The Anticipated Future of Public Health Services Post COVID-19: Viewpoint",
journal="JMIR Public Health Surveill",
year="2021",
month="Jun",
day="18",
volume="7",
number="6",
pages="e26267",
keywords="COVID-19",
keywords="public health",
keywords="health system",
keywords="health services",
doi="10.2196/26267",
url="https://publichealth.jmir.org/2021/6/e26267",
url="http://www.ncbi.nlm.nih.gov/pubmed/33592576"
}


@Article{info:doi/10.2196/28269,
author="Brakefield, S. Whitney
and Ammar, Nariman
and Olusanya, A. Olufunto
and Shaban-Nejad, Arash",
title="An Urban Population Health Observatory System to Support COVID-19 Pandemic Preparedness, Response, and Management: Design and Development Study",
journal="JMIR Public Health Surveill",
year="2021",
month="Jun",
day="16",
volume="7",
number="6",
pages="e28269",
keywords="causal inference",
keywords="COVID-19 surveillance",
keywords="COVID-19",
keywords="digital health",
keywords="health disparities",
keywords="knowledge integration",
keywords="SARS-CoV-2",
keywords="Social Determinants of Health",
keywords="surveillance",
keywords="urban health",
abstract="Background: COVID-19 is impacting people worldwide and is currently a leading cause of death in many countries. Underlying factors, including Social Determinants of Health (SDoH), could contribute to these statistics. Our prior work has explored associations between SDoH and several adverse health outcomes (eg, asthma and obesity). Our findings reinforce the emerging consensus that SDoH factors should be considered when implementing intelligent public health surveillance solutions to inform public health policies and interventions. Objective: This study sought to redefine the Healthy People 2030's SDoH taxonomy to accommodate the COVID-19 pandemic. Furthermore, we aim to provide a blueprint and implement a prototype for the Urban Population Health Observatory (UPHO), a web-based platform that integrates classified group-level SDoH indicators to individual- and aggregate-level population health data. Methods: The process of building the UPHO involves collecting and integrating data from several sources, classifying the collected data into drivers and outcomes, incorporating data science techniques for calculating measurable indicators from the raw variables, and studying the extent to which interventions are identified or developed to mitigate drivers that lead to the undesired outcomes. Results: We generated and classified the indicators of social determinants of health, which are linked to COVID-19. To display the functionalities of the UPHO platform, we presented a prototype design to demonstrate its features. We provided a use case scenario for 4 different users. Conclusions: UPHO serves as an apparatus for implementing effective interventions and can be adopted as a global platform for chronic and infectious diseases. The UPHO surveillance platform provides a novel approach and novel insights into immediate and long-term health policy responses to the COVID-19 pandemic and other future public health crises. The UPHO assists public health organizations and policymakers in their efforts in reducing health disparities, achieving health equity, and improving urban population health. ",
doi="10.2196/28269",
url="https://publichealth.jmir.org/2021/6/e28269",
url="http://www.ncbi.nlm.nih.gov/pubmed/34081605"
}


@Article{info:doi/10.2196/26452,
author="Safaeinili, Nadia
and Vilendrer, Stacie
and Williamson, Emma
and Zhao, Zicheng
and Brown-Johnson, Cati
and Asch, M. Steven
and Shieh, Lisa",
title="Inpatient Telemedicine Implementation as an Infection Control Response to COVID-19: Qualitative Process Evaluation Study",
journal="JMIR Form Res",
year="2021",
month="Jun",
day="16",
volume="5",
number="6",
pages="e26452",
keywords="telemedicine",
keywords="inpatient",
keywords="COVID-19",
keywords="qualitative",
keywords="RE-AIM",
keywords="infection control",
keywords="personal protective equipment",
keywords="implementation science",
keywords="quality improvement",
abstract="Background: The COVID-19 pandemic created new challenges to delivering safe and effective health care while minimizing virus exposure among staff and patients without COVID-19. Health systems worldwide have moved quickly to implement telemedicine in diverse settings to reduce infection, but little is understood about how best to connect patients who are acutely ill with nearby clinical team members, even in the next room. Objective: To inform these efforts, this paper aims to provide an early example of inpatient telemedicine implementation and its perceived acceptability and effectiveness. Methods: Using purposive sampling, this study conducted 15 semistructured interviews with nurses (5/15, 33\%), attending physicians (5/15, 33\%), and resident physicians (5/15, 33\%) on a single COVID-19 unit within Stanford Health Care to evaluate implementation outcomes and perceived effectiveness of inpatient telemedicine. Semistructured interview protocols and qualitative analysis were framed around the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework, and key themes were identified using a rapid analytic process and consensus approach. Results: All clinical team members reported wide reach of inpatient telemedicine, with some use for almost all patients with COVID-19. Inpatient telemedicine was perceived to be effective in reducing COVID-19 exposure and use of personal protective equipment (PPE) without significantly compromising quality of care. Physician workflows remained relatively stable, as most standard clinical activities were conducted via telemedicine following the initial intake examination, though resident physicians reported reduced educational opportunities given limited opportunities to conduct physical exams. Nurse workflows required significant adaptations to cover nonnursing duties, such as food delivery and facilitating technology connections for patients and physicians alike. Perceived patient impact included consistent care quality, with some considerations around privacy. Reported challenges included patient--clinical team communication and personal connection with the patient, perceptions of patient isolation, ongoing technical challenges, and certain aspects of the physical exam. Conclusions: Clinical team members reported inpatient telemedicine encounters to be acceptable and effective in reducing COVID-19 exposure and PPE use. Nurses adapted their workflows more than physicians in order to implement the new technology and bore a higher burden of in-person care and technical support. Recommendations for improved inpatient telemedicine use include information technology support and training, increased technical functionality, and remote access for the clinical team. ",
doi="10.2196/26452",
url="https://formative.jmir.org/2021/6/e26452",
url="http://www.ncbi.nlm.nih.gov/pubmed/34033576"
}


@Article{info:doi/10.2196/22999,
author="Tyrovolas, Stefanos
and Gin{\'e}-V{\'a}zquez, Iago
and Fern{\'a}ndez, Daniel
and Morena, Marianthi
and Koyanagi, Ai
and Janko, Mark
and Haro, Maria Josep
and Lin, Yang
and Lee, Paul
and Pan, William
and Panagiotakos, Demosthenes
and Molassiotis, Alex",
title="Estimating the COVID-19 Spread Through Real-time Population Mobility Patterns: Surveillance in Low- and Middle-Income Countries",
journal="J Med Internet Res",
year="2021",
month="Jun",
day="14",
volume="23",
number="6",
pages="e22999",
keywords="COVID-19",
keywords="transmission",
keywords="digital public health",
keywords="social distancing",
keywords="policy",
keywords="mobile data",
keywords="estimate",
keywords="real-time",
keywords="pattern",
keywords="surveillance",
keywords="low and middle-income countries",
keywords="emerging countries",
keywords="database",
abstract="Background: On January 21, 2020, the World Health Organization reported the first case of severe acute respiratory syndrome coronavirus 2, which rapidly evolved to the COVID-19 pandemic. Since then, the virus has also rapidly spread among Latin American, Caribbean, and African countries. Objective: The first aim of this study is to identify new emerging COVID-19 clusters over time and space (from January 21 to mid-May 2020) in Latin American, Caribbean, and African regions, using a prospective space--time scan measurement approach. The second aim is to assess the impact of real-time population mobility patterns between January 21 and May 18, 2020, under the implemented government interventions, measurements, and policy restrictions on COVID-19 spread among those regions and worldwide. Methods: We created a global COVID-19 database, of 218 countries and territories, merging the World Health Organization daily case reports with other measures such as population density and country income levels for January 21 to May 18, 2020. A score of government policy interventions was created for low, intermediate, high, and very high interventions. The population's mobility patterns at the country level wereobtained from Google community mobility reports. The prospective space--time scan statistic method was applied in five time periods between January and May 2020, and a regression mixed model analysis was used. Results: We found that COVID-19 emerging clusters within these five periods of time increased from 7 emerging clusters to 28 by mid-May 2020. We also detected various increasing and decreasing relative risk estimates of COVID-19 spread among Latin American, Caribbean, and African countries within the period of analysis. Globally, population mobility to parks and similar leisure areas during at least a minimum of implemented intermediate-level control policies (when compared to low-level control policies) was related to accelerated COVID-19 spread. Results were almost consistent when regional stratified analysis was applied. In addition, worldwide population mobility due to working during high implemented control policies and very high implemented control policies, when compared to low-level control policies, was related to positive COVID-19 spread. Conclusions: The prospective space--time scan is an approach that low-income and middle-income countries could use to detect emerging clusters in a timely manner and implement specific control policies and interventions to slow down COVID-19 transmission. In addition, real-time population mobility obtained from crowdsourced digital data could be useful for current and future targeted public health and mitigation policies at a global and regional level. ",
doi="10.2196/22999",
url="https://www.jmir.org/2021/6/e22999",
url="http://www.ncbi.nlm.nih.gov/pubmed/33950850"
}


@Article{info:doi/10.2196/29528,
author="Basch, H. Corey
and Mohlman, Jan
and Fera, Joseph
and Tang, Hao
and Pellicane, Alessia
and Basch, E. Charles",
title="Community Mitigation of COVID-19 and Portrayal of Testing on TikTok: Descriptive Study",
journal="JMIR Public Health Surveill",
year="2021",
month="Jun",
day="10",
volume="7",
number="6",
pages="e29528",
keywords="TikTok",
keywords="social media",
keywords="COVID-19",
keywords="testing",
keywords="disgust",
keywords="anxiety",
keywords="content analysis",
keywords="communication",
keywords="infodemiology",
keywords="infoveillance",
keywords="public health",
keywords="digital public health",
keywords="digital health",
keywords="community mitigation",
abstract="Background: COVID-19 testing remains an essential element of a comprehensive strategy for community mitigation. Social media is a popular source of information about health, including COVID-19 and testing information. One of the most popular communication channels used by adolescents and young adults who search for health information is TikTok---an emerging social media platform. Objective: The purpose of this study was to describe TikTok videos related to COVID-19 testing. Methods: The hashtag \#covidtesting was searched, and the first 100 videos were included in the study sample. At the time the sample was drawn, these 100 videos garnered more than 50\% of the views for all videos cataloged under the hashtag \#covidtesting. The content characteristics that were coded included mentions, displays, or suggestions of anxiety, COVID-19 symptoms, quarantine, types of tests, results of test, and disgust/unpleasantness. Additional data that were coded included the number and percentage of views, likes, and comments and the use of music, dance, and humor. Results: The 100 videos garnered more than 103 million views; 111,000 comments; and over 12.8 million likes. Even though only 44 videos mentioned or suggested disgust/unpleasantness and 44 mentioned or suggested anxiety, those that portrayed tests as disgusting/unpleasant garnered over 70\% of the total cumulative number of views (73,479,400/103,071,900, 71.29\%) and likes (9,354,691/12,872,505, 72.67\%), and those that mentioned or suggested anxiety attracted about 60\% of the total cumulative number of views (61,423,500/103,071,900, 59.59\%) and more than 8 million likes (8,339,598/12,872,505, 64.79\%). Independent one-tailed t tests ($\alpha$=.05) revealed that videos that mentioned or suggested that COVID-19 testing was disgusting/unpleasant were associated with receiving a higher number of views and likes. Conclusions: Our finding of an association between TikTok videos that mentioned or suggested that COVID-19 tests were disgusting/unpleasant and these videos' propensity to garner views and likes is of concern. There is a need for public health agencies to recognize and address connotations of COVID-19 testing on social media. ",
doi="10.2196/29528",
url="https://publichealth.jmir.org/2021/6/e29528",
url="http://www.ncbi.nlm.nih.gov/pubmed/34081591"
}


@Article{info:doi/10.2196/25674,
author="Dinas, C. Petros
and Domanovic, Dragoslav
and Koutedakis, Yiannis
and Hadjichristodoulou, Christos
and Stefanidis, Ioannis
and Papadopoulou, Kalliope
and Dimas, Konstantinos
and Perivoliotis, Konstantinos
and Tepetes, Konstantinos
and Flouris, D. Andreas",
title="The Presence of Fungal and Parasitic Infections in Substances of Human Origin and Their Transmission via Transfusions and Transplantations: Protocol for Two Systematic Reviews",
journal="JMIR Res Protoc",
year="2021",
month="Jun",
day="10",
volume="10",
number="6",
pages="e25674",
keywords="fungal and parasitic infections",
keywords="donor-derived substances",
keywords="transplantation",
keywords="transfusion",
abstract="Background: The European Union Directives stipulate mandatory tests for the presence of any infections in donors and donations of substances of human origin (SoHO). In some circumstances, other pathogens, including fungi and parasites, may also pose a threat to the microbial safety of SoHO. Objective: The aim of the two systematic reviews is to identify, collect, and evaluate scientific evidence for the presence of fungal and parasitic infections in donors and donations of SoHO, and their transmission via transfusion and transplantation. Methods: An algorithmic search, one each for fungal and parasitic disease, was applied to 6 scientific databases (PubMed, EMBASE, Web of Science, Scopus, Cochrane Library [trials], and CINAHL). Additionally, manual and algorithmic searches were employed in 15 gray literature databases and 22 scientific organization websites. The criteria for eligibility included peer-reviewed publications and peer-reviewed abstract publications from conference proceedings examining the prevalence, incidence, odds ratios, risk ratios, and risk differences for the presence of fungi and parasites in donors and SoHO donations, and their transmission to recipients. Only studies that scrutinized the donors and donations of human blood, blood components, tissues, cells, and organs were considered eligible. Data extraction from eligible publications will be performed independently by two reviewers. Data synthesis will include a qualitative description of the studies lacking evidence suitable for a meta-analysis and a random or fixed-effect meta-analysis model for quantitative data synthesis. Results: This is an ongoing study. The systematic reviews are funded by the European Centre for Disease Prevention and Control, and the results are expected to be presented by the end of 2021. Conclusions: The systematic reviews will provide the basis for developing a risk assessment for fungal and parasitic disease transmission via SoHO. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42020160090; https://www.crd.york.ac.uk/prospero/display\_record.php?ID=CRD42020160090 ; PROSPERO International Prospective Register of Systematic Reviews CRD42020160110; https://www.crd.york.ac.uk/prospero/display\_record.php?ID=CRD42020160110 International Registered Report Identifier (IRRID): DERR1-10.2196/25674 ",
doi="10.2196/25674",
url="https://www.researchprotocols.org/2021/6/e25674",
url="http://www.ncbi.nlm.nih.gov/pubmed/34110295"
}


@Article{info:doi/10.2196/24378,
author="Lambraki, Anna Irene
and Majowicz, Elizabeth Shannon
and Parmley, Jane Elizabeth
and Wernli, Didier
and L{\'e}ger, Ana{\"i}s
and Graells, Tiscar
and Cousins, Melanie
and Harbarth, Stephan
and Carson, Carolee
and Henriksson, Patrik
and Troell, Max
and J{\o}rgensen, S{\o}gaard Peter",
title="Building Social-Ecological System Resilience to Tackle Antimicrobial Resistance Across the One Health Spectrum: Protocol for a Mixed Methods Study",
journal="JMIR Res Protoc",
year="2021",
month="Jun",
day="10",
volume="10",
number="6",
pages="e24378",
keywords="antimicrobial resistance",
keywords="One Health",
keywords="resilience",
keywords="transdisciplinary",
keywords="participatory",
keywords="interventions",
keywords="systems dynamics",
keywords="social-ecological system",
abstract="Background: Antimicrobial resistance (AMR) is an escalating global crisis with serious health, social, and economic consequences. Building social-ecological system resilience to reduce AMR and mitigate its impacts is critical. Objective: The aim of this study is to compare and assess interventions that address AMR across the One Health spectrum and determine what actions will help to build social and ecological capacity and readiness to sustainably tackle AMR. Methods: We will apply social-ecological resilience theory to AMR in an explicit One Health context using mixed methods and identify interventions that address AMR and its key pressure antimicrobial use (AMU) identified in the scientific literature and in the gray literature using a web-based survey. Intervention impacts and the factors that challenge or contribute to the success of interventions will be determined, triangulated against expert opinions in participatory workshops and complemented using quantitative time series analyses. We will then identify indicators using regression modeling, which can predict national and regional AMU or AMR dynamics across animal and human health. Together, these analyses will help to quantify the causal loop diagrams (CLDs) of AMR in the European and Southeast Asian food system contexts that are developed by diverse stakeholders in participatory workshops. Then, using these CLDs, the long-term impacts of selected interventions on AMR will be explored under alternate future scenarios via simulation modeling and participatory workshops. A publicly available learning platform housing information about interventions on AMR from a One Health perspective will be developed to help decision makers identify promising interventions for application in their jurisdictions. Results: To date, 669 interventions have been identified in the scientific literature, 891 participants received a survey invitation, and 4 expert feedback and 4 model-building workshops have been conducted. Time series analysis, regression modeling of national and regional indicators of AMR dynamics, and scenario modeling activities are anticipated to be completed by spring 2022. Ethical approval has been obtained from the University of Waterloo's Office of Research Ethics (ethics numbers 40519 and 41781). Conclusions: This paper provides an example of how to study complex problems such as AMR, which require the integration of knowledge across sectors and disciplines to find sustainable solutions. We anticipate that our study will contribute to a better understanding of what actions to take and in what contexts to ensure long-term success in mitigating AMR and its impact and provide useful tools (eg, CLDs, simulation models, and public databases of compiled interventions) to guide management and policy decisions. International Registered Report Identifier (IRRID): DERR1-10.2196/24378 ",
doi="10.2196/24378",
url="https://www.researchprotocols.org/2021/6/e24378",
url="http://www.ncbi.nlm.nih.gov/pubmed/34110296"
}


@Article{info:doi/10.2196/26043,
author="Moore, C. Ryan
and Lee, Y. Angela
and Hancock, T. Jeffrey
and Halley, C. Meghan
and Linos, Eleni",
title="Age-Related Differences in Experiences With Social Distancing at the Onset of the COVID-19 Pandemic: A Computational and Content Analytic Investigation of Natural Language From a Social Media Survey",
journal="JMIR Hum Factors",
year="2021",
month="Jun",
day="9",
volume="8",
number="2",
pages="e26043",
keywords="COVID-19",
keywords="natural language processing",
keywords="public health messaging",
keywords="social distancing compliance",
keywords="age differences",
keywords="older adults",
keywords="younger adults",
keywords="age",
keywords="NLP",
keywords="public health",
keywords="elderly",
keywords="youth",
keywords="adult",
keywords="emotion",
keywords="compliance",
keywords="guideline",
abstract="Background: As COVID-19 poses different levels of threat to people of different ages, health communication regarding prevention measures such as social distancing and isolation may be strengthened by understanding the unique experiences of various age groups. Objective: The aim of this study was to examine how people of different ages (1) experienced the impact of the COVID-19 pandemic and (2) their respective rates and reasons for compliance or noncompliance with social distancing and isolation health guidance. Methods: We fielded a survey on social media early in the pandemic to examine the emotional impact of COVID-19 and individuals' rates and reasons for noncompliance with public health guidance, using computational and content analytic methods of linguistic analysis. Results: A total of 17,287 participants were surveyed. The majority (n=13,183, 76.3\%) were from the United States. Younger (18-31 years), middle-aged (32-44 years and 45-64 years), and older (?65 years) individuals significantly varied in how they described the impact of COVID-19 on their lives, including their emotional experience, self-focused attention, and topical concerns. Younger individuals were more emotionally negative and self-focused, while middle-aged people were other-focused and concerned with family. The oldest and most at-risk group was most concerned with health-related terms but were lower in anxiety (use of fewer anxiety-related terms) and higher in the use of emotionally positive terms than the other less at-risk age groups. While all groups discussed topics such as acquiring essential supplies, they differentially experienced the impact of school closures and limited social interactions. We also found relatively high rates of noncompliance with COVID-19 prevention measures, such as social distancing and self-isolation, with younger people being more likely to be noncompliant than older people (P<.001). Among the 43.1\% (n=7456) of respondents who did not fully comply with health orders, people differed substantially in the reasons they gave for noncompliance. The most common reason for noncompliance was not being able to afford to miss work (n=4273, 57.3\%). While work obligations proved challenging for participants across ages, younger people struggled more to find adequate space to self-isolate and manage their mental and physical health; middle-aged people had more concerns regarding childcare; and older people perceived themselves as being able to take sufficient precautions. Conclusions: Analysis of natural language can provide insight into rapidly developing public health challenges like the COVID-19 pandemic, uncovering individual differences in emotional experiences and health-related behaviors. In this case, our analyses revealed significant differences between different age groups in feelings about and responses to public health orders aimed to mitigate the spread of COVID-19. To improve public compliance with health orders as the pandemic continues, health communication strategies could be made more effective by being tailored to these age-related differences. ",
doi="10.2196/26043",
url="https://humanfactors.jmir.org/2021/2/e26043",
url="http://www.ncbi.nlm.nih.gov/pubmed/33914689"
}


@Article{info:doi/10.2196/27189,
author="Benoni, Roberto
and Panunzi, Silvia
and Campagna, Irene
and Moretti, Francesca
and Lo Cascio, Giuliana
and Spiteri, Gianluca
and Porru, Stefano
and Tardivo, Stefano",
title="The Effect of Test Timing on the Probability of Positive SARS-CoV-2 Swab Test Results: Mixed Model Approach",
journal="JMIR Public Health Surveill",
year="2021",
month="Jun",
day="3",
volume="7",
number="6",
pages="e27189",
keywords="close contact",
keywords="COVID-19",
keywords="health care workers",
keywords="health surveillance",
keywords="swab test timing",
abstract="Background: During the COVID-19 pandemic, swab tests proved to be effective in containing the infection and served as a means for early diagnosis and contact tracing. However, little evidence exists regarding the correct timing for the execution of the swab test, especially for asymptomatic individuals and health care workers. Objective: The objective of this study was to analyze changes in the positive findings over time in individual SARS-CoV-2 swab tests during a health surveillance program. Methods: The study was conducted with 2071 health care workers at the University Hospital of Verona, with a known date of close contact with a patient with COVID-19, between February 29 and April 17, 2020. The health care workers underwent a health surveillance program with repeated swab tests to track their virological status. A generalized additive mixed model was used to investigate how the probability of a positive test result changes over time since the last known date of close contact, in an overall sample of individuals who tested positive for COVID-19 and in a subset of individuals with an initial negative swab test finding before being proven positive, to assess different surveillance time intervals. Results: Among the 2071 health care workers in this study, 191 (9.2\%) tested positive for COVID-19, and 103 (54\%) were asymptomatic with no differences based on sex or age. Among 49 (25.7\%) cases, the initial swab test yielded negative findings after close contact with a patient with COVID-19. Sex, age, symptoms, and the time of sampling were not different between individuals with an initial negative swab test finding and those who initially tested positive after close contact. In the overall sample, the estimated probability of testing positive was 0.74 on day 1 after close contact, which increased to 0.77 between days 5 and 8. In the 3 different scenarios for scheduled repeated testing intervals (3, 5, and 7 days) in the subgroup of individuals with an initially negative swab test finding, the probability peaked on the sixth, ninth and tenth, and 13th and 14th days, respectively. Conclusions: Swab tests can initially yield false-negative outcomes. The probability of testing positive increases from day 1, peaking between days 5 and 8 after close contact with a patient with COVID-19. Early testing, especially in this final time window, is recommended together with a health surveillance program scheduled in close intervals. ",
doi="10.2196/27189",
url="https://publichealth.jmir.org/2021/6/e27189",
url="http://www.ncbi.nlm.nih.gov/pubmed/34003761"
}


@Article{info:doi/10.2196/26784,
author="Lee, Hyojung
and Kim, Yeahwon
and Kim, Eunsu
and ?Lee, Sunmi",
title="Risk Assessment of Importation and Local Transmission of COVID-19 in South Korea: Statistical Modeling Approach",
journal="JMIR Public Health Surveill",
year="2021",
month="Jun",
day="1",
volume="7",
number="6",
pages="e26784",
keywords="COVID-19",
keywords="transmission dynamics",
keywords="South Korea",
keywords="international travels",
keywords="imported and local transmission",
keywords="basic reproduction number",
keywords="effective reproduction number",
keywords="mitigation intervention strategies",
keywords="risk",
keywords="assessment",
keywords="transmission",
keywords="mitigation",
keywords="strategy",
keywords="travel",
keywords="mobility",
keywords="spread",
keywords="intervention",
keywords="diagnosis",
keywords="monitoring",
keywords="testing",
abstract="Background: Despite recent achievements in vaccines, antiviral drugs, and medical infrastructure, the emergence of COVID-19 has posed a serious threat to humans worldwide. Most countries are well connected on a global scale, making it nearly impossible to implement perfect and prompt mitigation strategies for infectious disease outbreaks. In particular, due to the explosive growth of international travel, the complex network of human mobility enabled the rapid spread of COVID-19 globally. Objective: South Korea was one of the earliest countries to be affected by COVID-19. In the absence of vaccines and treatments, South Korea has implemented and maintained stringent interventions, such as large-scale epidemiological investigations, rapid diagnosis, social distancing, and prompt clinical classification of severely ill patients with appropriate medical measures. In particular, South Korea has implemented effective airport screenings and quarantine measures. In this study, we aimed to assess the country-specific importation risk of COVID-19 and investigate its impact on the local transmission of COVID-19. Methods: The country-specific importation risk of COVID-19 in South Korea was assessed. We investigated the relationships between country-specific imported cases, passenger numbers, and the severity of country-specific COVID-19 prevalence from January to October 2020. We assessed the country-specific risk by incorporating country-specific information. A renewal mathematical model was employed, considering both imported and local cases of COVID-19 in South Korea. Furthermore, we estimated the basic and effective reproduction numbers. Results: The risk of importation from China was highest between January and February 2020, while that from North America (the United States and Canada) was high from April to October 2020. The R0 was estimated at 1.87 (95\% CI 1.47-2.34), using the rate of $\alpha$=0.07 for secondary transmission caused by imported cases. The Rt was estimated in South Korea and in both Seoul and Gyeonggi. Conclusions: A statistical model accounting for imported and locally transmitted cases was employed to estimate R0 and Rt. Our results indicated that the prompt implementation of airport screening measures (contact tracing with case isolation and quarantine) successfully reduced local transmission caused by imported cases despite passengers arriving from high-risk countries throughout the year. Moreover, various mitigation interventions, including social distancing and travel restrictions within South Korea, have been effectively implemented to reduce the spread of local cases in South Korea. ",
doi="10.2196/26784",
url="https://publichealth.jmir.org/2021/6/e26784",
url="http://www.ncbi.nlm.nih.gov/pubmed/33819165"
}


@Article{info:doi/10.2196/19544,
author="Bongolan, Pearl Vena
and Minoza, Antonio Jose Marie
and de Castro, Romulo
and Sevilleja, Emmanuel Jesus",
title="Age-Stratified Infection Probabilities Combined With a Quarantine-Modified Model for COVID-19 Needs Assessments: Model Development Study",
journal="J Med Internet Res",
year="2021",
month="May",
day="31",
volume="23",
number="5",
pages="e19544",
keywords="COVID-19",
keywords="epidemic modeling",
keywords="age stratification theory",
keywords="infection probability",
keywords="SEIR",
keywords="mathematical modelling",
abstract="Background: Classic compartmental models such as the susceptible-exposed-infectious-removed (SEIR) model all have the weakness of assuming a homogenous population, where everyone has an equal chance of getting infected and dying. Since it was identified in Hubei, China, in December 2019, COVID-19 has rapidly spread around the world and been declared a pandemic. Based on data from Hubei, infection and death distributions vary with age. To control the spread of the disease, various preventive and control measures such as community quarantine and social distancing have been widely used. Objective: Our aim is to develop a model where age is a factor, considering the study area's age stratification. Additionally, we want to account for the effects of quarantine on the SEIR model. Methods: We use the age-stratified COVID-19 infection and death distributions from Hubei, China (more than 44,672 infections as of February 11, 2020) as an estimate or proxy for a study area's infection and mortality probabilities for each age group. We then apply these probabilities to the actual age-stratified population of Quezon City, Philippines, to predict infectious individuals and deaths at peak. Testing with different countries shows the predicted number of infectious individuals skewing with the country's median age and age stratification, as expected. We added a Q parameter to the SEIR model to include the effects of quarantine (Q-SEIR). Results: The projections from the age-stratified probabilities give much lower predicted incidences of infection than the Q-SEIR model. As expected, quarantine tends to delay the peaks for both the exposed and infectious groups, and to ``flatten'' the curve or lower the predicted values for each compartment. These two estimates were used as a range to inform the local government's planning and response to the COVID-19 threat. Conclusions: Age stratification combined with a quarantine-modified model has good qualitative agreement with observations on infections and death rates. That younger populations will have lower death rates due to COVID-19 is a fair expectation for a disease where most fatalities are among older adults. ",
doi="10.2196/19544",
url="https://www.jmir.org/2021/5/e19544",
url="http://www.ncbi.nlm.nih.gov/pubmed/33900929"
}


@Article{info:doi/10.2196/24811,
author="Majam, Mohammed
and Msolomba, Vanessa
and Scott, Lesley
and Stevens, Wendy
and Marange, Fadzai
and Kahamba, Trish
and Venter, Francois
and Conserve, Fadael Donaldson",
title="Self-Sampling for SARS-CoV-2 Diagnostic Testing by Using Nasal and Saliva Specimens: Protocol for Usability and Clinical Evaluation",
journal="JMIR Res Protoc",
year="2021",
month="May",
day="28",
volume="10",
number="5",
pages="e24811",
keywords="SARS-CoV-2",
keywords="SARS-CoV-2SS",
keywords="testing",
keywords="COVID-19",
keywords="South Africa",
keywords="usabillity",
keywords="self-sampling",
keywords="diagnostic",
keywords="sensitivity",
keywords="specificity",
abstract="Background: SARS-CoV-2 is a novel coronavirus discovered in December 2019 and is currently the cause of the global COVID-19 pandemic. A critical aspect of fighting this pandemic is to obtain accurate and timely test results so that patients who have tested positive for COVID-19 can be identified and isolated to reduce the spread of the virus. Research has shown that saliva is a promising candidate for SARS-CoV-2 diagnostics because its collection is minimally invasive and can be reliably self-administered. However, little research has been conducted on saliva testing and SARS-CoV-2 self-sampling (SARS-CoV-2SS) in Sub-Saharan Africa. Objective: The primary objective of this study is to comparatively evaluate the clinical sensitivity and specificity of nasal and oral samples self-collected by individuals for SARS-CoV-2 testing against a reference method involving sample collection and testing by a health care professional. The secondary objectives of this study are to evaluate the usability of nasal self-sampling and saliva self-sampling as a sample collection method for SARS-CoV-2 diagnostic testing by using failure mode and error assessment. Methods: Participants will be recruited from the general population by using various methods, Participants will be screened progressively as they present at the clinical trial sites as well as in primary health care catchment areas in the inner city of Johannesburg, South Africa. In the event that recruitment numbers are low, we will use a mobile van to recruit participants from outlying areas of Johannesburg. We aim to enroll 250 participants into this study in approximately 6 weeks. Two sample types---a self-administered nasal swab and a self-administered saliva sample---will be collected from each participant, and a health care professional will collect a third sample by using a nasopharyngeal swab (ie, the standard reference method). Results: This protocol has been approved by the University of the Witwatersrand Human Research Ethics Committee on July 31, 2020 (Protocol number EzCov003). As of May 13, 2021, 120 participants have been enrolled into the study. Conclusions: SARS-CoV-2SS may offer many benefits to individuals, by allowing for initial self-identification of symptoms and collection of samples without involving third parties and potential risk of infection provided the sample can be safely processed via a collection system. The results of this study will provide preliminary data on the acceptability, feasibility, and usability of SARS-CoV-2SS among the general population for its future implementation. International Registered Report Identifier (IRRID): DERR1-10.2196/24811 ",
doi="10.2196/24811",
url="https://www.researchprotocols.org/2021/5/e24811",
url="http://www.ncbi.nlm.nih.gov/pubmed/33882023"
}


@Article{info:doi/10.2196/23461,
author="Ibrahim, Ahmed
and Zhang, Heng
and Clinch, Sarah
and Poliakoff, Ellen
and Parsia, Bijan
and Harper, Simon",
title="Digital Phenotypes for Understanding Individuals' Compliance With COVID-19 Policies and Personalized Nudges: Longitudinal Observational Study",
journal="JMIR Form Res",
year="2021",
month="May",
day="27",
volume="5",
number="5",
pages="e23461",
keywords="behavior",
keywords="compliance",
keywords="COVID-19",
keywords="digital phenotyping",
keywords="nudges",
keywords="personalization",
keywords="policy",
keywords="sensor",
keywords="smartphone",
abstract="Background: Governments promote behavioral policies such as social distancing and phased reopening to control the spread of COVID-19. Digital phenotyping helps promote the compliance with these policies through the personalized behavioral knowledge it produces. Objective: This study investigated the value of smartphone-derived digital phenotypes in (1) analyzing individuals' compliance with COVID-19 policies through behavioral responses and (2) suggesting ways to personalize communication through those policies. Methods: We conducted longitudinal experiments that started before the outbreak of COVID-19 and continued during the pandemic. A total of 16 participants were recruited before the pandemic, and a smartphone sensing app was installed for each of them. We then assessed individual compliance with COVID-19 policies and their impact on habitual behaviors. Results: Our results show a significant change in people's mobility (P<.001) as a result of COVID-19 regulations, from an average of 10 visited places every week to approximately 2 places a week. We also discussed our results within the context of nudges used by the National Health Service in the United Kingdom to promote COVID-19 regulations. Conclusions: Our findings show that digital phenotyping has substantial value in understanding people's behavior during a pandemic. Behavioral features extracted from digital phenotypes can facilitate the personalization of and compliance with behavioral policies. A rule-based messaging system can be implemented to deliver nudges on the basis of digital phenotyping. ",
doi="10.2196/23461",
url="https://formative.jmir.org/2021/5/e23461",
url="http://www.ncbi.nlm.nih.gov/pubmed/33999832"
}


@Article{info:doi/10.2196/26372,
author="Hou, Zhiyuan
and Song, Suhang
and Du, Fanxing
and Shi, Lu
and Zhang, Donglan
and Lin, Leesa
and Yu, Hongjie",
title="The Influence of the COVID-19 Epidemic on Prevention and Vaccination Behaviors Among Chinese Children and Adolescents: Cross-sectional Online Survey Study",
journal="JMIR Public Health Surveill",
year="2021",
month="May",
day="26",
volume="7",
number="5",
pages="e26372",
keywords="COVID-19",
keywords="prevention",
keywords="vaccination",
keywords="behavior",
keywords="children",
keywords="China",
abstract="Background: The COVID-19 epidemic and the related containment strategies may affect parental and pediatric health behaviors. Objective: The goal of this study was to assess the change in children's and adolescents' prevention and vaccination behaviors amid China's COVID-19 epidemic. Methods: We conducted a cross-sectional online survey in mid-March 2020 using proportional quota sampling in Wuhan (the epidemic epicenter) and Shanghai (a nonepicenter). Data were collected from 1655 parents with children aged 3 to 17 years. Children's and adolescents' prevention behaviors and regular vaccination behaviors before and during the epidemic were assessed. Descriptive analyses were used to investigate respondents' characteristics, public health prevention behaviors, unproven protection behaviors, and vaccination behaviors before and during the COVID-19 epidemic. Univariate analyses were performed to compare differences in outcome measures between cities and family characteristics, using chi-square tests or Fisher exact tests (if expected frequency was <5) and analyses of variance. Multivariate logistic regressions were used to identify the factors and disparities associated with prevention and vaccination behaviors. Results: Parent-reported prevention behaviors increased among children and adolescents during the COVID-19 epidemic compared with those before the epidemic. During the epidemic, 82.2\% (638/776) of children or adolescents always wore masks when going out compared with 31.5\% (521/1655) before the epidemic; in addition, 25.0\% (414/1655) and 79.8\% (1321/1655) had increased their frequency and duration of handwashing, respectively, although only 46.9\% (776/1655) went out during the epidemic. Meanwhile, 56.1\% (928/1655) of the families took unproven remedies against COVID-19. Parent-reported vaccination behaviors showed mixed results, with 74.8\% (468/626) delaying scheduled vaccinations and 80.9\% (1339/1655) planning to have their children get the influenza vaccination after the epidemic. Regarding socioeconomic status, children and adolescents from larger families and whose parents had lower education levels were less likely to improve prevention behaviors but more likely to take unproven remedies. Girls were less likely than boys to always wear a mask when going out and wash their hands. Conclusions: Prevention behaviors and attitudes toward influenza vaccination have improved during the COVID-19 epidemic. Public health prevention measures should be continuously promoted, particularly among girls, parents with lower education levels, and larger families. Meanwhile, misinformation about COVID-19 remains a serious challenge and needs to be addressed by public health stakeholders. ",
doi="10.2196/26372",
url="https://publichealth.jmir.org/2021/5/e26372",
url="http://www.ncbi.nlm.nih.gov/pubmed/33882450"
}


@Article{info:doi/10.2196/26630,
author="Du, Li
and Raposo, L{\'u}cia Vera
and Wang, Meng",
title="Authors' Reply to: And Justice for All? There Is More to the Interoperability of Contact Tracing Apps Than Legal Barriers. Comment on ``COVID-19 Contact Tracing Apps: A Technologic Tower of Babel and the Gap for International Pandemic Control''",
journal="JMIR Mhealth Uhealth",
year="2021",
month="May",
day="26",
volume="9",
number="5",
pages="e26630",
keywords="COVID-19",
keywords="contact tracing",
keywords="data protection",
keywords="privacy",
keywords="interoperability",
keywords="global health",
keywords="public health",
doi="10.2196/26630",
url="https://mhealth.jmir.org/2021/5/e26630",
url="http://www.ncbi.nlm.nih.gov/pubmed/33852409"
}


@Article{info:doi/10.2196/26218,
author="Crutzen, Rik",
title="And Justice for All? There Is More to the Interoperability of Contact Tracing Apps Than Legal Barriers. Comment on ``COVID-19 Contact Tracing Apps: A Technologic Tower of Babel and the Gap for International Pandemic Control''",
journal="JMIR Mhealth Uhealth",
year="2021",
month="May",
day="26",
volume="9",
number="5",
pages="e26218",
keywords="COVID-19",
keywords="contact tracing",
keywords="data protection",
keywords="privacy",
keywords="interoperability",
keywords="global health",
keywords="public health",
doi="10.2196/26218",
url="https://mhealth.jmir.org/2021/5/e26218",
url="http://www.ncbi.nlm.nih.gov/pubmed/33848974"
}


@Article{info:doi/10.2196/28845,
author="Halabi, Reem
and Smith, Geoffrey
and Sylwestrzak, Marc
and Clay, Brian
and Longhurst, A. Christopher
and Lander, Lina",
title="The Impact of Inpatient Telemedicine on Personal Protective Equipment Savings During the COVID-19 Pandemic: Cross-sectional Study",
journal="J Med Internet Res",
year="2021",
month="May",
day="19",
volume="23",
number="5",
pages="e28845",
keywords="inpatient telemedicine",
keywords="bedside iPad",
keywords="video visits",
keywords="personal protective equipment",
keywords="COVID-19",
keywords="virtual visits",
keywords="pandemic",
keywords="telehealth",
keywords="telemedicine",
keywords="digital health",
doi="10.2196/28845",
url="https://www.jmir.org/2021/5/e28845",
url="http://www.ncbi.nlm.nih.gov/pubmed/33945494"
}


@Article{info:doi/10.2196/27609,
author="Ali, Sabahat
and Khalid, Sundas
and Afridi, Maham
and Akhtar, Samar
and Khader, S. Yousef
and Akhtar, Hashaam",
title="Notes From the Field: The Combined Effects of Tocilizumab and Remdesivir in a Patient With Severe COVID-19 and Cytokine Release Syndrome",
journal="JMIR Public Health Surveill",
year="2021",
month="May",
day="19",
volume="7",
number="5",
pages="e27609",
keywords="COVID-19",
keywords="remdesivir",
keywords="treatment",
keywords="tocilizumab",
doi="10.2196/27609",
url="https://publichealth.jmir.org/2021/5/e27609",
url="http://www.ncbi.nlm.nih.gov/pubmed/34009133"
}


@Article{info:doi/10.2196/26073,
author="Harling, Guy
and G{\'o}mez-Oliv{\'e}, Xavier Francesc
and Tlouyamma, Joseph
and Mutevedzi, Tinofa
and Kabudula, Whiteson Chodziwadziwa
and Mahlako, Ruth
and Singh, Urisha
and Ohene-Kwofie, Daniel
and Buckland, Rose
and Ndagurwa, Pedzisai
and Gareta, Dickman
and Gunda, Resign
and Mngomezulu, Thobeka
and Nxumalo, Siyabonga
and Wong, B. Emily
and Kahn, Kathleen
and Siedner, J. Mark
and Maimela, Eric
and Tollman, Stephen
and Collinson, Mark
and Herbst, Kobus",
title="Protective Behaviors and Secondary Harms Resulting From Nonpharmaceutical Interventions During the COVID-19 Epidemic in South Africa: Multisite, Prospective Longitudinal Study",
journal="JMIR Public Health Surveill",
year="2021",
month="May",
day="13",
volume="7",
number="5",
pages="e26073",
keywords="behaviour change",
keywords="COVID-19",
keywords="economic well-being",
keywords="health care access",
keywords="health knowledge",
keywords="mental health",
keywords="South Africa",
keywords="surveillance",
keywords="nonpharmaceutical interventions",
abstract="Background: In March 2020, South Africa implemented strict nonpharmaceutical interventions (NPIs) to contain the spread of COVID-19. Over the subsequent 5 months, NPI policies were eased in stages according to a national strategy. COVID-19 spread throughout the country heterogeneously; the disease reached rural areas by July and case numbers peaked from July to August. A second COVID-19 wave began in late 2020. Data on the impact of NPI policies on social and economic well-being and access to health care are limited. Objective: We aimed to determine how rural residents in three South African provinces changed their behaviors during the first COVID-19 epidemic wave. Methods: The South African Population Research Infrastructure Network nodes in the Mpumalanga (Agincourt), KwaZulu-Natal, (Africa Health Research Institute) and Limpopo (Dikgale-Mamabolo-Mothiba) provinces conducted up to 14 rounds of longitudinal telephone surveys among randomly sampled households from rural and periurban surveillance populations every 2-3 weeks. Interviews included questions on the following topics: COVID-19--related knowledge and behaviors, the health and economic impacts of NPIs, and mental health. We analyzed how responses varied based on NPI stringency and household sociodemographics. Results: In total, 5120 households completed 23,095 interviews between April and December 2020. Respondents' self-reported satisfaction with their COVID-19--related knowledge and face mask use rapidly rose to 85\% and 95\%, respectively, by August. As selected NPIs were eased, the amount of travel increased, economic losses were reduced, and the prevalence of anxiety and depression symptoms fell. When the number of COVID-19 cases spiked at one node in July, the amount of travel dropped rapidly and the rate of missed daily medications doubled. Households where more adults received government-funded old-age pensions reported concerns about economic matters and medication access less often. Conclusions: South Africans complied with stringent, COVID-19--related NPIs despite the threat of substantial social, economic, and health repercussions. Government-supported social welfare programs appeared to buffer interruptions in income and health care access during local outbreaks. Epidemic control policies must be balanced against the broader well-being of people in resource-limited settings and designed with parallel support systems when such policies threaten peoples' income and access to basic services. ",
doi="10.2196/26073",
url="https://publichealth.jmir.org/2021/5/e26073",
url="http://www.ncbi.nlm.nih.gov/pubmed/33827046"
}


@Article{info:doi/10.2196/22973,
author="Rager, L. Theresa
and Koepfli, Cristian
and Khan, A. Wasif
and Ahmed, Sabeena
and Mahmud, Hayat Zahid
and Clayton, N. Katherine",
title="Usability of Rapid Cholera Detection Device (OmniVis) for Water Quality Workers in Bangladesh: Iterative Convergent Mixed Methods Study",
journal="J Med Internet Res",
year="2021",
month="May",
day="12",
volume="23",
number="5",
pages="e22973",
keywords="cholera",
keywords="environmental surveillance",
keywords="mHealth",
keywords="usability",
abstract="Background: Cholera poses a significant global health burden. In Bangladesh, cholera is endemic and causes more than 100,000 cases each year. Established environmental reservoirs leave millions at risk of infection through the consumption of contaminated water. The Global Task Force for Cholera Control has called for increased environmental surveillance to detect contaminated water sources prior to human infection in an effort to reduce cases and deaths. The OmniVis rapid cholera detection device uses loop-mediated isothermal amplification and particle diffusometry detection methods integrated into a handheld hardware device that attaches to an iPhone 6 to identify and map contaminated water sources. Objective: The aim of this study was to evaluate the usability of the OmniVis device with targeted end users to advance the iterative prototyping process and ultimately design a device that easily integrates into users' workflow. Methods: Water quality workers were trained to use the device and subsequently completed an independent device trial and usability questionnaire. Pretraining and posttraining knowledge assessments were administered to ensure training quality did not confound trial and questionnaire Results: Device trials identified common user errors and device malfunctions including incorrect test kit insertion and device powering issues. We did not observe meaningful differences in user errors or device malfunctions accumulated per participant across demographic groups. Over 25 trials, the mean time to complete a test was 47 minutes, a significant reduction compared with laboratory protocols, which take approximately 3 days. Overall, participants found the device easy to use and expressed confidence and comfort in using the device independently. Conclusions: These results are used to advance the iterative prototyping process of the OmniVis rapid cholera detection device so it can achieve user uptake, workflow integration, and scale to ultimately impact cholera control and elimination strategies. We hope this methodology will promote robust usability evaluations of rapid pathogen detection technologies in device development. ",
doi="10.2196/22973",
url="https://www.jmir.org/2021/5/e22973",
url="http://www.ncbi.nlm.nih.gov/pubmed/33978590"
}


@Article{info:doi/10.2196/27342,
author="Nakanishi, Miharu
and Shibasaki, Ryosuke
and Yamasaki, Syudo
and Miyazawa, Satoshi
and Usami, Satoshi
and Nishiura, Hiroshi
and Nishida, Atsushi",
title="On-site Dining in Tokyo During the COVID-19 Pandemic: Time Series Analysis Using Mobile Phone Location Data",
journal="JMIR Mhealth Uhealth",
year="2021",
month="May",
day="11",
volume="9",
number="5",
pages="e27342",
keywords="COVID-19",
keywords="mobility data",
keywords="on-site dining",
keywords="public health and social measures",
keywords="public health",
keywords="mobile phone",
keywords="mobility",
keywords="protection",
keywords="time series",
keywords="location",
keywords="infectious disease",
keywords="transmission",
abstract="Background: During the second wave of COVID-19 in August 2020, the Tokyo Metropolitan Government implemented public health and social measures to reduce on-site dining. Assessing the associations between human behavior, infection, and social measures is essential to understand achievable reductions in cases and identify the factors driving changes in social dynamics. Objective: The aim of this study was to investigate the association between nighttime population volumes, the COVID-19 epidemic, and the implementation of public health and social measures in Tokyo. Methods: We used mobile phone location data to estimate populations between 10 PM and midnight in seven Tokyo metropolitan areas. Mobile phone trajectories were used to distinguish and extract on-site dining from stay-at-work and stay-at-home behaviors. Numbers of new cases and symptom onsets were obtained. Weekly mobility and infection data from March 1 to November 14, 2020, were analyzed using a vector autoregression model. Results: An increase in the number of symptom onsets was observed 1 week after the nighttime population volume increased (coefficient=0.60, 95\% CI 0.28 to 0.92). The effective reproduction number significantly increased 3 weeks after the nighttime population volume increased (coefficient=1.30, 95\% CI 0.72 to 1.89). The nighttime population volume increased significantly following reports of decreasing numbers of confirmed cases (coefficient=--0.44, 95\% CI --0.73 to --0.15). Implementation of social measures to restaurants and bars was not significantly associated with nighttime population volume (coefficient=0.004, 95\% CI --0.07 to 0.08). Conclusions: The nighttime population started to increase after decreasing incidence of COVID-19 was announced. Considering time lags between infection and behavior changes, social measures should be planned in advance of the surge of an epidemic, sufficiently informed by mobility data. ",
doi="10.2196/27342",
url="https://mhealth.jmir.org/2021/5/e27342",
url="http://www.ncbi.nlm.nih.gov/pubmed/33886486"
}


@Article{info:doi/10.2196/27276,
author="Vighio, Anum
and Syed, Asif Muhammad
and Hussain, Ishfaque
and Zia, Masroor Syed
and Fatima, Munaza
and Masood, Naveed
and Chaudry, Ambreen
and Hussain, Zakir
and Iqbal Baig, Zeeshan Mirza
and Baig, Amir Mirza
and Ikram, Aamer
and S Khader, Yousef",
title="Risk Factors of Extensively Drug Resistant Typhoid Fever Among Children in Karachi: Case-Control Study",
journal="JMIR Public Health Surveill",
year="2021",
month="May",
day="11",
volume="7",
number="5",
pages="e27276",
keywords="case-control study",
keywords="drug resistance",
keywords="extensively drug resistant typhoid fever",
keywords="risk factors",
keywords="typhoid fever",
abstract="Background: Extensively drug resistant typhoid fever (XDR-TF) has been responsible for an ongoing outbreak in Pakistan, which began in November 2016. Objective: This study aimed to determine the risk factors associated with?XDR-TF. Methods: This age- and sex-matched case-control study was conducted during May-October 2018 in Karachi. All patients with XDR-TF were identified from the laboratory-based surveillance system data. Cases included patients aged <15 years living in Karachi with culture-positive Salmonella enterica serovar Typhi with resistance to chloramphenicol, ampicillin, trimethoprim/sulfamethoxazole, fluoroquinolones, and third-generation cephalosporins. Age- and sex-matched controls included children free from the symptoms of TF, aged under 15 years, and residing in Karachi. All controls were recruited from among those who attended outpatient clinics. Results: A total of 75 cases and 75 controls were included in this study. On univariate analysis, the odds of having XDR-TF were 13-fold higher among participants who used piped municipal water than among those who did not (odds ratio [OR] 12.6, 95\% CI 4.1-38.6). The use of bore water was significantly associated with XDR-TF (OR 5.1, 95\% CI 1.4-19.0). Cases were more likely to report eating French fries with sauce (OR 13.5, 95\% CI 3.9-47.0) and poppadum (OR 3.4, 95\% CI 1.7-6.7) from street vendors than controls. Boiling water at home was negatively associated with XDR-TF (OR 0.3, 95\% CI 0.2-0.7). On multivariate analysis, 2 factors were independently associated with XDR-TF. Using piped municipal water (OR 10.3, 95\% CI 3.4-30.4) and eating French fries with sauce from street vendors (OR 8.8, 95\% CI 2.1-36.2) were significantly associated with an increased odds of XDR-TF. Conclusions: Community water supply and street food eating habits were implicated in the spread of the superbug S typhi outbreak, which continues to grow in Karachi. Therefore, it is recommended to improve the community water supply to meet recommended standards and to develop a policy to improve the safety of street food. In addition, health authorities are required to conduct mass vaccination for TF among high-risk groups. ",
doi="10.2196/27276",
url="https://publichealth.jmir.org/2021/5/e27276",
url="http://www.ncbi.nlm.nih.gov/pubmed/33973861"
}


@Article{info:doi/10.2196/27412,
author="Abu El Sood, Hanaa
and Abu Kamer, Ali Shimaa
and Kamel, Reham
and Magdy, Hesham
and Osman, S. Fatma
and Fahim, Manal
and Mohsen, Amira
and AbdelFatah, Mohamad
and Hassany, Mohamed
and Afifi, Salma
and Eid, Alaa",
title="The Impact of Implementing the Egypt Pandemic Preparedness Plan for Acute Respiratory Infections in Combating the Early Stage of the COVID-19 Pandemic, February-July 2020: Viewpoint",
journal="JMIR Public Health Surveill",
year="2021",
month="May",
day="7",
volume="7",
number="5",
pages="e27412",
keywords="pandemic preparedness",
keywords="Egypt",
keywords="ARI",
keywords="epidemic mitigation",
keywords="COVID-19",
doi="10.2196/27412",
url="https://publichealth.jmir.org/2021/5/e27412",
url="http://www.ncbi.nlm.nih.gov/pubmed/33830932"
}


@Article{info:doi/10.2196/22789,
author="Wilcha, Robyn-Jenia",
title="Does Wearing a Face Mask During the COVID-19 Pandemic Increase the Incidence of Dermatological Conditions in Health Care Workers? Narrative Literature Review",
journal="JMIR Dermatol",
year="2021",
month="May",
day="6",
volume="4",
number="1",
pages="e22789",
keywords="COVID-19",
keywords="dermatology",
keywords="face masks",
keywords="health care worker",
keywords="incidence",
keywords="literature",
keywords="mask",
keywords="N95 mask",
keywords="review",
keywords="skin",
abstract="Background: COVID-19 is a health emergency. SARS-CoV-2 was discovered in Wuhan (Hubei Province, China) and has rapidly spread worldwide, leaving no country untouched. COVID-19 is a respiratory infection characterized by a pneumonia of unknown etiology. It is transmitted through respiratory droplets; for example: through breathing, talking, and coughing. Transmission of the virus is high. Health care workers play important roles in helping those affected by COVID-19; this could not be done without the use of personal protective equipment (PPE). PPE involves the use of goggles, masks, gloves, and gowns and is known to reduce COVID-19 transmission; however, multiple reports of skin disease and damage associated with occupational mask-wearing have emerged. Objective: The objective of this study is to review the literature for newly emerging dermatological conditions as a result of occupational mask-wearing during the COVID-19 pandemic. Methods: A narrative review of new reports of dermatological conditions associated with occupational mask-wearing was carried out in May 2020 by referencing keywords including: ``covid mask dermatology,'' ``covid dermatological damage,'' ``covid mask skin,'' ``covid N95 mask damage,'' and ``covid mask skin damage'' from PubMed, supplemented by searches on both Google Scholar and ResearchGate. A total of 287 articles were found, of which 40 were successfully included in this study, and an additional 7 were selected from the reference lists of these 40 articles. The findings were tabulated and analyzed under the following headings: dermatological diagnosis, causes, and management. Results: Qualitative analysis of the reviewed data was carried out. A number of dermatological conditions were found to increasingly occur owing to prolonged and frequent use of face masks. Pressure-related injuries were often the most serious complaint; recommendations to reduce this type of injury include the use of hydrocolloid dressings, plastic handles, education, and regular moisturization. Innovation in PPE as well as services, such as virtual clinics, need to be advanced to protect the welfare of health care staff. Conclusions: In these unprecedented times, PPE has been an effective barrier to the transmission of COVID-19 among health care workers. This has allowed health care workers to provide care to patients, with minimal risk. However, our findings suggest that despite the obvious benefits of using face masks to protect the respiratory system, there are also considerable health consequences to the skin. Future research studies are required to focus on improving face masks to ensure both the protection of the respiratory system as well as skin care, which, according to our study, has been overlooked. ",
doi="10.2196/22789",
url="https://derma.jmir.org/2021/1/e22789",
url="http://www.ncbi.nlm.nih.gov/pubmed/34028470"
}


@Article{info:doi/10.2196/25600,
author="Li, Shaojie
and Cui, Guanghui
and Kaminga, Chiwanda Atipatsa
and Cheng, Sixiang
and Xu, Huilan",
title="Associations Between Health Literacy, eHealth Literacy, and COVID-19--Related Health Behaviors Among Chinese College Students: Cross-sectional Online Study",
journal="J Med Internet Res",
year="2021",
month="May",
day="6",
volume="23",
number="5",
pages="e25600",
keywords="COVID-19",
keywords="health literacy",
keywords="eHealth literacy",
keywords="COVID-19--related health behavior questionnaire",
keywords="Chinese college students",
abstract="Background: During the COVID-19 pandemic, the internet has significantly spread information, providing people with knowledge and advice about health protection regarding COVID-19. While a previous study demonstrated that health and eHealth literacy are related to COVID-19 prevention behaviors, few studies have focused on the relationship between health literacy, eHealth literacy, and COVID-19--related health behaviors. The latter includes not only preventative behaviors but also conventional health behaviors. Objective: The objective of this study was to develop and verify a COVID-19--related health behavior questionnaire, explore its status and structure, and examine the associations between these behaviors and participants' health literacy and eHealth literacy. Methods: A snowball sampling method was adopted to recruit participants to complete anonymous cross-sectional questionnaire surveys online that assessed sociodemographic information, self-reported coronavirus knowledge, health literacy, eHealth literacy, and COVID-19--related health behaviors. Results: Of 1873 college students who were recruited, 781 (41.7\%) had adequate health literacy; the mean eHealth literacy score was 30.16 (SD 6.31). The COVID-19--related health behavior questionnaire presented a two-factor structure---COVID-19--specific precautionary behaviors and conventional health behaviors---with satisfactory fit indices and internal consistency (Cronbach $\alpha$=.79). The mean score of COVID-19--related health behaviors was 53.77 (SD 8.03), and scores differed significantly (P<.05) with respect to residence, college year, academic major, family economic level, self-reported health status, having a family member or friend infected with coronavirus, and health literacy level. Linear regression analysis showed that health literacy and eHealth literacy were positively associated with COVID-19--specific precautionary behaviors ($\beta$health literacy=.149, $\beta$eHealth literacy=.368; P<.001) and conventional health behaviors ($\beta$health literacy=.219, $\beta$eHealth literacy=.277; P<.001). Conclusions: The COVID-19--related health behavior questionnaire was a valid and reliable measure for assessing health behaviors during the pandemic. College students with higher health literacy and eHealth literacy can more actively adopt COVID-19--related health behaviors. Additionally, compared to health literacy, eHealth literacy is more closely related to COVID-19--related health behaviors. Public intervention measures based on health and eHealth literacy are required to promote COVID-19--related health behaviors during the pandemic, which may be helpful to reduce the risk of COVID-19 infection among college students. ",
doi="10.2196/25600",
url="https://www.jmir.org/2021/5/e25600",
url="http://www.ncbi.nlm.nih.gov/pubmed/33822734"
}


@Article{info:doi/10.2196/25207,
author="Griswold, Dylan
and Gempeler, Andr{\'e}s
and Rosseau, Gail
and Kaseje, Neema
and Johnson, D. Walter
and Kolias, Angelos
and Hutchinson, J. Peter
and Rubiano, M. Andres",
title="Chest Computed Tomography for the Diagnosis of COVID-19 in Emergency Trauma Surgery Patients Who Require Urgent Care During the Pandemic: Protocol for an Umbrella Review",
journal="JMIR Res Protoc",
year="2021",
month="May",
day="6",
volume="10",
number="5",
pages="e25207",
keywords="systematic review",
keywords="broad-evidence synthesis",
keywords="COVID-19",
keywords="global health",
keywords="trauma surgery",
keywords="evidence-based practice",
keywords="chest CT",
keywords="rapid testing",
keywords="testing",
keywords="diagnosis",
keywords="scan",
keywords="computed tomography",
keywords="review",
keywords="antigen",
keywords="immune system",
keywords="health care worker",
keywords="surgery",
keywords="emergency",
keywords="protocol",
abstract="Background: Many health care facilities in low- and middle-income countries are inadequately resourced. COVID-19 has the potential to decimate surgical health care services unless health systems take stringent measures to protect health care workers from viral exposure and ensure the continuity of specialized care for patients. Among these measures, the timely diagnosis of COVID-19 is paramount to ensure the use of protective measures and isolation of patients to prevent transmission to health care personnel caring for patients with an unknown COVID-19 status or contact during the pandemic. Besides molecular and antibody tests, chest computed tomography (CT) has been assessed as a potential tool to aid in the screening or diagnosis of COVID-19 and could be valuable in the emergency care setting. Objective: This paper presents the protocol for an umbrella review that aims to identify and summarize the available literature on the diagnostic accuracy of chest CT for COVID-19 in trauma surgery patients requiring urgent care. The objective is to inform future recommendations on emergency care for this category of patients. Methods: We will conduct several searches in the L{\textperiodcentered}OVE (Living Overview of Evidence) platform for COVID-19, a system that performs automated regular searches in PubMed, Embase, Cochrane Central Register of Controlled Trials, and over 30 other sources. The search results will be presented according to PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis). This review will preferentially consider systematic reviews of diagnostic test accuracy studies, as well as individual studies of such design, if not included in the systematic reviews, that assessed the sensitivity and specificity of chest CT in emergency trauma surgery patients. Critical appraisal of the included studies for risk of bias will be conducted. Data will be extracted using a standardized data extraction tool. Findings will be summarized narratively, and the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach will be used to grade the certainty of evidence. Results: Ethics approval is not required for this systematic review, as there will be no patient involvement. The search for this systematic review commenced in October 2020, and we expect to publish the findings in early 2021. The plan for dissemination is to publish the findings in a peer-reviewed journal and present our results at conferences that engage the most pertinent stakeholders. Conclusions: During the COVID-19 pandemic, protecting health care workers from infection is essential. Up-to-date information on the efficacy of diagnostic tests for detecting COVID-19 is essential. This review will serve an important role as a thorough summary to inform evidence-based recommendations on establishing effective policy and clinical guideline recommendations. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42020198267; https://www.crd.york.ac.uk/PROSPERO/display\_record.php?RecordID=198267 International Registered Report Identifier (IRRID): PRR1-10.2196/25207 ",
doi="10.2196/25207",
url="https://www.researchprotocols.org/2021/5/e25207",
url="http://www.ncbi.nlm.nih.gov/pubmed/33878019"
}


@Article{info:doi/10.2196/26932,
author="Denis, Fabrice
and Septans, Anne-Lise
and Le Goff, Florian
and Jeanneau, Stephan
and Lescure, Fran{\c{c}}ois-Xavier",
title="Analysis of COVID-19 Transmission Sources in France by Self-Assessment Before and After the Partial Lockdown: Observational Study",
journal="J Med Internet Res",
year="2021",
month="May",
day="4",
volume="23",
number="5",
pages="e26932",
keywords="COVID-19",
keywords="web application",
keywords="digital health",
keywords="analysis",
keywords="transmission",
keywords="France",
keywords="self-assessment",
keywords="lockdown",
keywords="observational",
keywords="survey",
keywords="impact",
keywords="public health",
abstract="Background: We developed a questionnaire on a web application for analyzing COVID-19 contamination circumstances in France during the second wave of the pandemic. Objective: This study aims to analyze the impact on contamination characteristics before and after the second partial lockdown in France to adapt public health restrictions to further prevent pandemic surges. Methods: Between December 15 and 24, 2020, after a national media campaign, users of the sourcecovid.fr web application were asked questions about their own or a close relative's COVID-19 contamination after August 15, 2020, in France. The data of the contamination's circumstances were assessed and compared before and after the second partial lockdown, which occurred on October 25, 2020, during the second wave of the pandemic and was ongoing on December 24, 2020. Results: As of December 24, 2020, 441,000 connections on the web application were observed. A total of 2218 questionnaires were assessable for analysis. About 61.8\% (n=1309) of the participants were sure of their contamination origin, and 38.2\% (n=809) thought they knew it. The median age of users was 43.0 (IQR 32-56) years, and 50.7\% (n=1073) were male. The median incubation time of the assessed cohort was 4.0 (IQR 3-5) days. Private areas (family's or friend's house) were the main source of contamination (1048/2090, 50.2\%), followed by work colleagues (579/2090, 27.7\%). The main time of day for the contamination was the evening (339/961, 35.3\%) before the lockdown and was reduced to 18.2\% (86/473) after the lockdown (P<.001). The person who transmitted the virus to the user before and after the lockdown was significantly different (P<.001): a friend (382/1317, 29\% vs 109/773, 14.1\%), a close relative (304/1317, 23.1\% vs 253/773, 32.7\%), or a work colleague (315/1317, 23.9\% vs 264/773, 34.2\%). The main location where the virus was transmitted to the users before and after the lockdown was significantly different too (P<.001): home (278/1305, 21.3\% vs 194/760, 25.5\%), work (293/1305, 22.5\% vs 225/760, 29.6\%), collective places (430/1305, 33\% vs 114/760, 15\%), and care centers (58/1305, 4.4\% vs 74/760, 9.7\%). Conclusions: Modalities of transmissions significantly changed before and after the second lockdown in France. The main sources of contamination remained the private areas and with work colleagues. Work became the main location of contamination after the lockdown, whereas contaminations in collective places were strongly reduced. Trial Registration: ClinicalTrials.gov NCT04670003; https://clinicaltrials.gov/ct2/show/NCT04670003 ",
doi="10.2196/26932",
url="https://www.jmir.org/2021/5/e26932",
url="http://www.ncbi.nlm.nih.gov/pubmed/33878018"
}


@Article{info:doi/10.2196/27341,
author="Adikari, Achini
and Nawaratne, Rashmika
and De Silva, Daswin
and Ranasinghe, Sajani
and Alahakoon, Oshadi
and Alahakoon, Damminda",
title="Emotions of COVID-19: Content Analysis of Self-Reported Information Using Artificial Intelligence",
journal="J Med Internet Res",
year="2021",
month="Apr",
day="30",
volume="23",
number="4",
pages="e27341",
keywords="COVID-19",
keywords="pandemic",
keywords="lockdown",
keywords="human emotions",
keywords="affective computing",
keywords="human-centric artificial intelligence",
keywords="artificial intelligence",
keywords="AI",
keywords="machine learning",
keywords="natural language processing",
keywords="language modeling",
keywords="infodemiology",
keywords="infoveillance",
abstract="Background: The COVID-19 pandemic has disrupted human societies around the world. This public health emergency was followed by a significant loss of human life; the ensuing social restrictions led to loss of employment, lack of interactions, and burgeoning psychological distress. As physical distancing regulations were introduced to manage outbreaks, individuals, groups, and communities engaged extensively on social media to express their thoughts and emotions. This internet-mediated communication of self-reported information encapsulates the emotional health and mental well-being of all individuals impacted by the pandemic. Objective: This research aims to investigate the human emotions related to the COVID-19 pandemic expressed on social media over time, using an artificial intelligence (AI) framework. Methods: Our study explores emotion classifications, intensities, transitions, and profiles, as well as alignment to key themes and topics, across the four stages of the pandemic: declaration of a global health crisis (ie, prepandemic), the first lockdown, easing of restrictions, and the second lockdown. This study employs an AI framework comprised of natural language processing, word embeddings, Markov models, and the growing self-organizing map algorithm, which are collectively used to investigate social media conversations. The investigation was carried out using 73,000 public Twitter conversations posted by users in Australia from January to September 2020. Results: The outcomes of this study enabled us to analyze and visualize different emotions and related concerns that were expressed and reflected on social media during the COVID-19 pandemic, which could be used to gain insights into citizens' mental health. First, the topic analysis showed the diverse as well as common concerns people had expressed during the four stages of the pandemic. It was noted that personal-level concerns expressed on social media had escalated to broader concerns over time. Second, the emotion intensity and emotion state transitions showed that fear and sadness emotions were more prominently expressed at first; however, emotions transitioned into anger and disgust over time. Negative emotions, except for sadness, were significantly higher (P<.05) in the second lockdown, showing increased frustration. Temporal emotion analysis was conducted by modeling the emotion state changes across the four stages of the pandemic, which demonstrated how different emotions emerged and shifted over time. Third, the concerns expressed by social media users were categorized into profiles, where differences could be seen between the first and second lockdown profiles. Conclusions: This study showed that the diverse emotions and concerns that were expressed and recorded on social media during the COVID-19 pandemic reflected the mental health of the general public. While this study established the use of social media to discover informed insights during a time when physical communication was impossible, the outcomes could also contribute toward postpandemic recovery and understanding psychological impact via emotion changes, and they could potentially inform health care decision making. This study exploited AI and social media to enhance our understanding of human behaviors in global emergencies, which could lead to improved planning and policy making for future crises. ",
doi="10.2196/27341",
url="https://www.jmir.org/2021/4/e27341",
url="http://www.ncbi.nlm.nih.gov/pubmed/33819167"
}


@Article{info:doi/10.2196/26940,
author="Yu, Fengyun
and Geldsetzer, Pascal
and Meierkord, Anne
and Yang, Juntao
and Chen, Qiushi
and Jiao, Lirui
and Abou-Arraj, E. Nadeem
and Pan, An
and Wang, Chen
and B{\"a}rnighausen, Till
and Chen, Simiao",
title="Knowledge About COVID-19 Among Adults in China: Cross-sectional Online Survey",
journal="J Med Internet Res",
year="2021",
month="Apr",
day="29",
volume="23",
number="4",
pages="e26940",
keywords="COVID-19",
keywords="knowledge",
keywords="perception",
keywords="risk",
keywords="public health",
keywords="China",
keywords="cross-sectional",
keywords="survey",
abstract="Background: A detailed understanding of the public's knowledge and perceptions of COVID-19 could inform governments' public health actions in response to the pandemic. Objective: The aim of this study was to determine the knowledge and perceptions of COVID-19 among adults in China and its variation among provinces and by sociodemographic characteristics. Methods: Between May 8 and June 8, 2020, we conducted a cross-sectional online survey among adults in China who were registered with the private survey company KuRunData. We set a target sample size of 10,000 adults, aiming to sample 300-360 adults from each province in China. Participants were asked 25 questions that tested their knowledge about COVID-19, including measures to prevent infection, common symptoms, and recommended care-seeking behavior. We disaggregated responses by age; sex; education; province; household income; rural--urban residency; and whether or not a participant had a family member, friend, or acquaintance who they know to have been infected with SARS-CoV-2. All analyses used survey sampling weights. Results: There were 5079 men and 4921 women who completed the questionnaire and were included in the analysis. Out of 25 knowledge questions, participants answered a mean and median of 21.4 (95\% CI 21.3-21.4) and 22 (IQR 20-23) questions correctly, respectively. A total of 83.4\% (95\% CI 82.7\%-84.1\%) of participants answered four-fifths or more of the questions correctly. For at least one of four ineffective prevention measures (using a hand dryer, regular nasal irrigation, gargling mouthwash, and taking antibiotics), 68.9\% (95\% CI 68.0\%-69.8\%) of participants answered that it was an effective method to prevent a SARS-CoV-2 infection. Although knowledge overall was similar across provinces, the percent of participants who answered the question on recommended care-seeking behavior correctly varied from 47.0\% (95\% CI 41.4\%-52.7\%) in Tibet to 87.5\% (95\% CI 84.1\%-91.0\%) in Beijing. Within provinces, participants who were male, were middle-aged, were residing in urban areas, and had higher household income tended to answer a higher proportion of the knowledge questions correctly. Conclusions: This online study of individuals across China suggests that the majority of the population has good knowledge of COVID-19. However, a substantial proportion still holds misconceptions or incorrect beliefs about prevention methods and recommended health care--seeking behaviors, especially in rural areas and some less wealthy provinces in Western China. This study can inform the development of tailored public health policies and promotion campaigns by identifying knowledge areas for which misconceptions are comparatively common and provinces that have relatively low knowledge. ",
doi="10.2196/26940",
url="https://www.jmir.org/2021/4/e26940",
url="http://www.ncbi.nlm.nih.gov/pubmed/33844637"
}


@Article{info:doi/10.2196/27433,
author="Fahim, Manal
and Ghonim, Sood Hanaa Abu El
and Roshdy, H. Wael
and Naguib, Amel
and Elguindy, Nancy
and AbdelFatah, Mohamad
and Hassany, Mohamed
and Mohsen, Amira
and Afifi, Salma
and Eid, Alaa",
title="Coinfection With SARS-CoV-2 and Influenza A(H1N1) in a Patient Seen at an Influenza-like Illness Surveillance Site in Egypt: Case Report",
journal="JMIR Public Health Surveill",
year="2021",
month="Apr",
day="28",
volume="7",
number="4",
pages="e27433",
keywords="influenza-like Illness",
keywords="pandemic",
keywords="SARS-CoV-2",
keywords="COVID-19",
keywords="influenza",
keywords="virus",
keywords="case study",
keywords="Egypt",
keywords="flu",
keywords="coinfection",
keywords="infectious disease",
keywords="surveillance",
keywords="outcome",
keywords="demographic",
abstract="Background: Sentinel surveillance of influenza-like illness (ILI) in Egypt started in 2000 at 8 sentinel sites geographically distributed all over the country. In response to the COVID-19 pandemic, SARS-CoV-2 was added to the panel of viral testing by polymerase chain reaction for the first 2 patients with ILI seen at one of the sentinel sites. We report the first SARS-CoV-2 and influenza A(H1N1) virus co-infection with mild symptoms detected through routine ILI surveillance in Egypt. Objective: This report aims to describe how the case was identified and the demographic and clinical characteristics and outcomes of the patient. Methods: The case was identified by Central Public Health Laboratory staff, who contacted the ILI sentinel surveillance officer at the Ministry of Health. The case patient was contacted through a telephone call. Detailed information about the patient's clinical picture, course of disease, and outcome was obtained. The contacts of the patient were investigated for acute respiratory symptoms, disease confirmation, and outcomes. Results: Among 510 specimens collected from patients with ILI symptoms from October 2019 to August 2020, 61 (12.0\%) were COVID-19--positive and 29 (5.7\%) tested positive for influenza, including 15 (51.7\%) A(H1N1), 11 (38.0\%) A(H3N2), and 3 (10.3\%) influenza B specimens. A 21-year-old woman was confirmed to have SARS-CoV-2 and influenza A(H1N1) virus coinfection. She had a high fever of 40.2 {\textdegree}C and mild respiratory symptoms that resolved within 2 days with symptomatic treatment. All five of her family contacts had mild respiratory symptoms 2-3 days after exposure to the confirmed case, and their symptoms resolved without treatment or investigation. Conclusions: This case highlights the possible occurrence of SARS-CoV-2/influenza A(H1N1) coinfection in younger and healthy people, who may resolve the infection rapidly. We emphasize the usefulness of the surveillance system for detection of viral causative agents of ILI and recommend broadening of the testing panel, especially if it can guide case management. ",
doi="10.2196/27433",
url="https://publichealth.jmir.org/2021/4/e27433",
url="http://www.ncbi.nlm.nih.gov/pubmed/33784634"
}


@Article{info:doi/10.2196/26628,
author="Yeung, YS Arnold
and Roewer-Despres, Francois
and Rosella, Laura
and Rudzicz, Frank",
title="Machine Learning--Based Prediction of Growth in Confirmed COVID-19 Infection Cases in 114 Countries Using Metrics of Nonpharmaceutical Interventions and Cultural Dimensions: Model Development and Validation",
journal="J Med Internet Res",
year="2021",
month="Apr",
day="23",
volume="23",
number="4",
pages="e26628",
keywords="COVID-19",
keywords="machine learning",
keywords="nonpharmaceutical interventions",
keywords="cultural dimensions",
keywords="random forest",
keywords="AdaBoost",
keywords="forecast",
keywords="informatics",
keywords="epidemiology",
keywords="artificial intelligence",
abstract="Background: National governments worldwide have implemented nonpharmaceutical interventions to control the COVID-19 pandemic and mitigate its effects. Objective: The aim of this study was to investigate the prediction of future daily national confirmed COVID-19 infection growth---the percentage change in total cumulative cases---across 14 days for 114 countries using nonpharmaceutical intervention metrics and cultural dimension metrics, which are indicative of specific national sociocultural norms. Methods: We combined the Oxford COVID-19 Government Response Tracker data set, Hofstede cultural dimensions, and daily reported COVID-19 infection case numbers to train and evaluate five non--time series machine learning models in predicting confirmed infection growth. We used three validation methods---in-distribution, out-of-distribution, and country-based cross-validation---for the evaluation, each of which was applicable to a different use case of the models. Results: Our results demonstrate high R2 values between the labels and predictions for the in-distribution method (0.959) and moderate R2 values for the out-of-distribution and country-based cross-validation methods (0.513 and 0.574, respectively) using random forest and adaptive boosting (AdaBoost) regression. Although these models may be used to predict confirmed infection growth, the differing accuracies obtained from the three tasks suggest a strong influence of the use case. Conclusions: This work provides new considerations in using machine learning techniques with nonpharmaceutical interventions and cultural dimensions as metrics to predict the national growth of confirmed COVID-19 infections. ",
doi="10.2196/26628",
url="https://www.jmir.org/2021/4/e26628",
url="http://www.ncbi.nlm.nih.gov/pubmed/33844636"
}


@Article{info:doi/10.2196/27832,
author="Han, J. Paul K.
and Scharnetzki, Elizabeth
and Scherer, M. Aaron
and Thorpe, Alistair
and Lary, Christine
and Waterston, B. Leo
and Fagerlin, Angela
and Dieckmann, F. Nathan",
title="Communicating Scientific Uncertainty About the COVID-19 Pandemic: Online Experimental Study of an Uncertainty-Normalizing Strategy",
journal="J Med Internet Res",
year="2021",
month="Apr",
day="22",
volume="23",
number="4",
pages="e27832",
keywords="uncertainty",
keywords="communication",
keywords="ambiguity",
keywords="vaccination",
keywords="COVID-19",
abstract="Background: Communicating scientific uncertainty about public health threats such as COVID-19 is an ethically desirable task endorsed by expert guidelines on crisis communication.  However, the communication of scientific uncertainty is challenging because of its potential to promote ambiguity aversion---a well-described syndrome of negative psychological responses consisting of heightened risk perceptions, emotional distress, and decision avoidance.  Communication strategies that can inform the public about scientific uncertainty while mitigating ambiguity aversion are a critical unmet need. Objective: This study aimed to evaluate whether an ``uncertainty-normalizing'' communication strategy---aimed at reinforcing the expected nature of scientific uncertainty about the COVID-19 pandemic---can reduce ambiguity aversion, and to compare its effectiveness to conventional public communication strategies aimed at promoting hope and prosocial values. Methods: In an online factorial experiment conducted from May to June 2020, a national sample of 1497 US adults read one of five versions of an informational message describing the nature, transmission, prevention, and treatment of COVID-19; the versions varied in level of expressed scientific uncertainty and supplemental focus (ie, uncertainty-normalizing, hope-promoting, and prosocial).  Participants then completed measures of cognitive, emotional, and behavioral manifestations of ambiguity aversion (ie, perceived likelihood of getting COVID-19, COVID-19 worry, and intentions for COVID-19 risk-reducing behaviors and vaccination).  Analyses assessed (1) the extent to which communicating uncertainty produced ambiguity-averse psychological responses; (2) the comparative effectiveness of uncertainty-normalizing, hope-promoting, and prosocial communication strategies in reducing ambiguity-averse responses; and (3) potential moderators of the effects of alternative uncertainty communication strategies. Results: The communication of scientific uncertainty about the COVID-19 pandemic increased perceived likelihood of getting COVID-19 and worry about COVID-19, consistent with ambiguity aversion.  However, it did not affect intentions for risk-reducing behaviors or vaccination.  The uncertainty-normalizing strategy reduced these aversive effects of communicating scientific uncertainty, resulting in levels of both perceived likelihood of getting COVID-19 and worry about COVID-19 that did not differ from the control message that did not communicate uncertainty.  In contrast, the hope-promoting and prosocial strategies did not decrease ambiguity-averse responses to scientific uncertainty.  Age and political affiliation, respectively, moderated the effects of uncertainty communication strategies on intentions for COVID-19 risk-reducing behaviors and worry about COVID-19. Conclusions: Communicating scientific uncertainty about the COVID-19 pandemic produces ambiguity-averse cognitive and emotional, but not behavioral, responses among the general public, and an uncertainty-normalizing communication strategy reduces these responses.  Normalizing uncertainty may be an effective strategy for mitigating ambiguity aversion in crisis communication efforts.  More research is needed to test uncertainty-normalizing communication strategies and to elucidate the factors that moderate their effectiveness. ",
doi="10.2196/27832",
url="https://www.jmir.org/2021/4/e27832",
url="http://www.ncbi.nlm.nih.gov/pubmed/33769947"
}


@Article{info:doi/10.2196/27069,
author="Tsai, Wen-Hsun
and Wu, Yi-Syuan
and Cheng, Chia-Shiang
and Kuo, Ming-Hao
and Chang, Yu-Tien
and Hu, Fu-Kang
and Sun, Chien-An
and Chang, Chi-Wen
and Chan, Ta-Chien
and Chen, Chao-Wen
and Lee, Chia-Cheng
and Chu, Chi-Ming",
title="A Technology Acceptance Model for Deploying Masks to Combat the COVID-19 Pandemic in Taiwan (My Health Bank): Web-Based Cross-sectional Survey Study",
journal="J Med Internet Res",
year="2021",
month="Apr",
day="21",
volume="23",
number="4",
pages="e27069",
keywords="personal health record",
keywords="electronic medical record",
keywords="my health bank",
keywords="technology acceptance model",
keywords="structural equation model",
keywords="electronic health record",
keywords="COVID-19",
keywords="protection",
keywords="survey",
keywords="model",
keywords="intention",
keywords="usage",
keywords="literacy",
keywords="privacy",
keywords="security",
abstract="Background: The successful completion of medical practices often relies on information collection and analysis. Government agencies and medical institutions have encouraged people to use medical information technology (MIT) to manage their conditions and promote personal health. In 2014, Taiwan established the first electronic personal health record (PHR) platform, My Health Bank (MHB), which allows people to access and manage their PHRs at any time. In the face of the COVID-19 pandemic in 2020, Taiwan has used MIT to effectively prevent the spread of COVID-19 and undertaken various prevention measures before the onset of the outbreak. Using MHB to purchase masks in an efficient and orderly way and thoroughly implementing personal protection efforts is highly important to contain disease spread. Objective: This study aims to understand people's intention to use the electronic PHR platform MHB and to investigate the factors affecting their intention to use this platform. Methods: From March 31 to April 9, 2014, in a promotion via email and Facebook, participants were asked to fill out a structured questionnaire after watching an introductory video about MHB on YouTube. The questionnaire included seven dimensions: perceived usefulness, perceived ease of use, health literacy, privacy and security, computer self-efficacy, attitude toward use, and behavioral intention to use. Each question was measured on a 5-point Likert scale ranging from ``strongly disagree'' (1 point) to ``strongly agree'' (5 points). Descriptive statistics and structural equation analysis were performed using SPSS 21 and AMOS 21 software. Results: A total of 350 valid questionnaire responses were collected (female: 219/350, 62.6\%; age: 21-30 years: 238/350, 68.0\%; university-level education: 228/350, 65.1\%; occupation as student: 195/350, 56.6\%; average monthly income <NT \$30,000 [<US \$1054.89]: 230/350, 65.7\%; residence in northern Taiwan: 236/350, 67.4\%; and health status perceived as ``good'': 171/350, 48.9\%). Five indicators, including chi-square test (X2310=2.63), goodness-of-fit index (0.85), adjusted goodness-of-fit index (0.81), comparative fit index (0.91), and root mean square error of approximation (0.07), were calculated. The results indicated a good fit. Further analysis indicated that the most important factor affecting respondents' behavioral intention to use MHB was their attitude toward use (0.78), followed by perceived ease of use (0.65), perceived usefulness (0.41), health literacy (0.10), and privacy and security (0.07). Conclusions: From the perspective of the populace, this study explored the factors affecting the use of MHB and constructed an interpretation model with a strong goodness of fit. The results of our analysis are consistent with the technology acceptance model. Through the diverse value-added services of MHB, Taiwan's experience in pandemic prevention with smart technology can facilitate future responses to unknown, emerging infectious diseases. ",
doi="10.2196/27069",
url="https://www.jmir.org/2021/4/e27069",
url="http://www.ncbi.nlm.nih.gov/pubmed/33819168"
}


@Article{info:doi/10.2196/20699,
author="Telles, Roberto Charles
and Roy, Archisman
and Ajmal, Rehan Mohammad
and Mustafa, Khalid Syed
and Ahmad, Ayaz Mohammad
and de la Serna, Moises Juan
and Frigo, Pires Elisandro
and Rosales, Hern{\'a}ndez Manuel",
title="The Impact of COVID-19 Management Policies Tailored to Airborne SARS-CoV-2 Transmission: Policy Analysis",
journal="JMIR Public Health Surveill",
year="2021",
month="Apr",
day="21",
volume="7",
number="4",
pages="e20699",
keywords="social distancing policies",
keywords="COVID-19",
keywords="airborne transmission",
keywords="convergence and stability properties",
abstract="Background: Daily new COVID-19 cases from January to April 2020 demonstrate varying patterns of SARS-CoV-2 transmission across different geographical regions. Constant infection rates were observed in some countries, whereas China and South Korea had a very low number of daily new cases. In fact, China and South Korea successfully and quickly flattened their COVID-19 curve. To understand why this was the case, this paper investigated possible aerosol-forming patterns in the atmosphere and their relationship to the policy measures adopted by select countries. Objective: The main research objective was to compare the outcomes of policies adopted by countries between January and April 2020. Policies included physical distancing measures that in some cases were associated with mask use and city disinfection. We investigated whether the type of social distancing framework adopted by some countries (ie, without mask use and city disinfection) led to the continual dissemination of SARS-CoV-2 (daily new cases) in the community during the study period. Methods: We examined the policies used as a preventive framework for virus community transmission in some countries and compared them to the policies adopted by China and South Korea. Countries that used a policy of social distancing by 1-2 m were divided into two groups. The first group consisted of countries that implemented social distancing (1-2 m) only, and the second comprised China and South Korea, which implemented distancing with additional transmission/isolation measures using masks and city disinfection. Global daily case maps from Johns Hopkins University were used to provide time-series data for the analysis. Results: The results showed that virus transmission was reduced due to policies affecting SARS-CoV-2 propagation over time. Remarkably, China and South Korea obtained substantially better results than other countries at the beginning of the epidemic due to their adoption of social distancing (1-2 m) with the additional use of masks and sanitization (city disinfection). These measures proved to be effective due to the atmosphere carrier potential of SARS-CoV-2 transmission. Conclusions: Our findings confirm that social distancing by 1-2 m with mask use and city disinfection yields positive outcomes. These strategies should be incorporated into prevention and control policies and be adopted both globally and by individuals as a method to fight the COVID-19 pandemic. ",
doi="10.2196/20699",
url="https://publichealth.jmir.org/2021/4/e20699",
url="http://www.ncbi.nlm.nih.gov/pubmed/33729168"
}


@Article{info:doi/10.2196/21269,
author="De Leo, Stefano",
title="Impact of COVID-19 Testing Strategies and Lockdowns on Disease Management Across Europe, South America, and the United States: Analysis Using Skew-Normal Distributions",
journal="JMIRx Med",
year="2021",
month="Apr",
day="21",
volume="2",
number="2",
pages="e21269",
keywords="COVID-19",
keywords="testing strategy",
keywords="skew-normal distributions",
keywords="lockdown",
keywords="forecast",
keywords="modeling",
keywords="outbreak",
keywords="infectious disease",
keywords="prediction",
abstract="Background: As COVID-19 infections worldwide exceed 6 million confirmed cases, the data reveal that the first wave of the outbreak is coming to an end in many European countries. There is variation in the testing strategies (eg, massive testing vs testing only those displaying symptoms) and the strictness of lockdowns imposed by countries around the world. For example, Brazil's mitigation measures lie between the strict lockdowns imposed by many European countries and the more liberal approach taken by Sweden. This can influence COVID-19 metrics (eg, total deaths, confirmed cases) in unexpected ways. Objective: This study aimed to evaluate the effectiveness of local authorities' strategies in managing the COVID-19 pandemic in Europe, South America, and the United States. Methods: The early stage of the COVID-19 outbreak in Brazil was compared to Europe using the weekly transmission rate. Using the European data as a basis for our analysis, we examined the spread of COVID-19 and modeled curves pertaining to daily confirmed cases and deaths per million using skew-normal probability density functions. For Sweden, the United Kingdom, and the United States, we forecasted the end of the pandemic, and for Brazil, we predicted the peak value for daily deaths per million. We also discussed additional factors that could play an important role in the fight against COVID-19, such as the fast response of local authorities, testing strategies, number of beds in the intensive care unit, and isolation strategies adopted. Results: The European data analysis demonstrated that the transmission rate of COVID-19 increased similarly for all countries in the initial stage of the pandemic but changed as the total confirmed cases per million in each country grew. This was caused by the variation in timely action by local authorities in adopting isolation measures and/or massive testing strategies. The behavior of daily confirmed cases for the United States and Brazil during the early stage of the outbreak was similar to that of Italy and Sweden, respectively. For daily deaths per million, transmission in the United States was similar to that of Switzerland, whereas for Brazil, it was greater than the counts for Portugal, Germany, and Austria (which had, in terms of total deaths per million, the best results in Europe) but lower than other European countries. Conclusions: The fitting skew parameters used to model the curves for daily confirmed cases per million and daily deaths per million allow for a more realistic prediction of the end of the pandemic and permit us to compare the mitigation measures adopted by local authorities by analyzing their respective skew-normal parameters. The massive testing strategy adopted in the early stage of the pandemic by German authorities made a positive difference compared to other countries like Italy where an effective testing strategy was adopted too late. This explains why, despite a strictly indiscriminate lockdown, Italy's mortality rate was one of the highest in the world. ",
doi="10.2196/21269",
url="https://xmed.jmir.org/2021/2/e21269",
url="http://www.ncbi.nlm.nih.gov/pubmed/34032814"
}


@Article{info:doi/10.2196/23488,
author="Resnicow, Ken
and Bacon, Elizabeth
and Yang, Penny
and Hawley, Sarah
and Van Horn, Lee M.
and An, Lawrence",
title="Novel Predictors of COVID-19 Protective Behaviors Among US Adults: Cross-sectional Survey",
journal="J Med Internet Res",
year="2021",
month="Apr",
day="20",
volume="23",
number="4",
pages="e23488",
keywords="COVID-19",
keywords="protective behavior",
keywords="psychological predictors",
keywords="reactance",
keywords="conspiracy beliefs",
keywords="public health",
keywords="health communication",
keywords="communication",
keywords="protection",
keywords="behavior",
keywords="psychology",
abstract="Background: A central component of the public health strategy to control the COVID-19 pandemic involves encouraging mask wearing and social distancing to protect individuals from acquiring and transmitting the virus. Objective: This study aims to understand the psychological factors that drive adoption or rejection of these protective behaviors, which can inform public health interventions to control the pandemic. Methods: We conducted an online survey of a representative sample of 1074 US adults and assessed three novel potential predictors of COVID-19 behaviors: trait reactance, COVID-19 conspiracy beliefs, and COVID-19 apocalypse beliefs. Key outcomes (dependent variables) included an index of COVID-19 protective behaviors, the number of trips taken from the home, and COVID-19 knowledge. Results: In bivariate analyses, all three predictors were significantly correlated in the hypothesized direction with the three COVID-19 outcomes. Specifically, each predictor was negatively (P<.01) correlated with the COVID-19 protective behaviors index and COVID-19 knowledge score, and positively correlated with trips taken from home per week (more of which was considered higher risk). COVID-19 protective behaviors and COVID-19 knowledge were significantly lower in the top median compared to the bottom median for all three predictors. In general, these findings remained significant after adjusting for all novel predictors plus age, gender, income, education, race, political party, and religiosity. Self-identified Republicans (vs other political affiliations) reported the highest values for each of the novel predictors. Conclusions: This study can inform the development of health communication interventions to encourage the adoption of COVID-19 protective behaviors. Interestingly, we found that higher scores of all three novel predictors were associated with lower COVID-19 knowledge, suggesting that lack of an accurate understanding of the virus may be driving some of these attitudes; although, it is also possible that these attributes may interfere with one's willingness or ability to seek and absorb accurate health information. These individuals may be particularly immune to accepting new information and yielding their beliefs. Health communication professionals may apply lessons learned from countering similar beliefs around climate change and vaccine hesitancy. Messages designed for individuals prone to reactance may be more effective if they minimize controlling language and emphasize the individual's independence in adopting these behavioral recommendations. Messaging for those who possess conspiracy beliefs should similarly not assume that providing evidence contrary to these beliefs will alone alter behavior. Other communication techniques such as rolling with resistance, a strategy used in motivational interviewing, may be helpful. Messaging for those with apocalyptic beliefs may require using religious leaders as the message source and using scripture that would support the adoption of COVID-19 protection behaviors. ",
doi="10.2196/23488",
url="https://www.jmir.org/2021/4/e23488",
url="http://www.ncbi.nlm.nih.gov/pubmed/33835930"
}


@Article{info:doi/10.2196/21468,
author="Ilyin, O. Sergey",
title="A Recursive Model of the Spread of COVID-19: Modelling Study",
journal="JMIR Public Health Surveill",
year="2021",
month="Apr",
day="19",
volume="7",
number="4",
pages="e21468",
keywords="epidemiology",
keywords="COVID-19",
keywords="model",
keywords="modelling",
keywords="prediction",
keywords="spread",
keywords="infection",
keywords="effective",
keywords="contagious",
keywords="transmission",
abstract="Background: The major medical and social challenge of the 21st century is COVID-19, caused by the novel coronavirus SARS-CoV-2. Critical issues include the rate at which the coronavirus spreads and the effect of quarantine measures and population vaccination on this rate. Knowledge of the laws of the spread of COVID-19 will enable assessment of the effectiveness and reasonableness of the quarantine measures used, as well as determination of the necessary level of vaccination needed to overcome this crisis. Objective: This study aims to establish the laws of the spread of COVID-19 and to use them to develop a mathematical model to predict changes in the number of active cases over time, possible human losses, and the rate of recovery of patients, to make informed decisions about the number of necessary beds in hospitals, the introduction and type of quarantine measures, and the required threshold of vaccination of the population. Methods: This study analyzed the onset of COVID-19 spread in countries such as China, Italy, Spain, the United States, the United Kingdom, Japan, France, and Germany based on publicly available statistical data. The change in the number of COVID-19 cases, deaths, and recovered persons over time was examined, considering the possible introduction of quarantine measures and isolation of infected people in these countries. Based on the data, the virus transmissibility and the average duration of the disease at different stages were evaluated, and a model based on the principle of recursion was developed. Its key features are the separation of active (nonisolated) infected persons into a distinct category and the prediction of their number based on the average duration of the disease in the inactive phase and the concentration of these persons in the population in the preceding days. Results: Specific values for SARS-CoV-2 transmissibility and COVID-19 duration were estimated for different countries. In China, the viral transmissibility was 3.12 before quarantine measures were implemented and 0.36 after these measures were lifted. For the other countries, the viral transmissibility was 2.28-2.76 initially, and it then decreased to 0.87-1.29 as a result of quarantine measures. Therefore, it can be expected that the spread of SARS-CoV-2 will be suppressed if 56\%-64\% of the total population becomes vaccinated or survives COVID-19. Conclusions: The quarantine measures adopted in most countries are too weak compared to those previously used in China. Therefore, it is not expected that the spread of COVID-19 will stop and the disease will cease to exist naturally or owing to quarantine measures. Active vaccination of the population is needed to prevent the spread of COVID-19. Furthermore, the required specific percentage of vaccinated individuals depends on the magnitude of viral transmissibility, which can be evaluated using the proposed model and statistical data for the country of interest. ",
doi="10.2196/21468",
url="https://publichealth.jmir.org/2021/4/e21468",
url="http://www.ncbi.nlm.nih.gov/pubmed/33871381"
}


@Article{info:doi/10.2196/26734,
author="Bachtiger, Patrik
and Adamson, Alexander
and Chow, Ji-Jian
and Sisodia, Rupa
and Quint, K. Jennifer
and Peters, S. Nicholas",
title="The Impact of the COVID-19 Pandemic on the Uptake of Influenza Vaccine: UK-Wide Observational Study",
journal="JMIR Public Health Surveill",
year="2021",
month="Apr",
day="14",
volume="7",
number="4",
pages="e26734",
keywords="COVID-19",
keywords="influenza",
keywords="vaccination",
keywords="COVID",
keywords="Pandemic",
keywords="National Health Service",
keywords="Health Service",
keywords="flu",
keywords="virus",
keywords="vaccine",
keywords="impact",
keywords="uptake",
keywords="observational",
keywords="United Kingdom",
keywords="public health",
keywords="intention",
keywords="electronic health record",
abstract="Background: In the face of the COVID-19 pandemic, the UK National Health Service (NHS) extended eligibility for influenza vaccination this season to approximately 32.4 million people (48.8\% of the population). Knowing the intended uptake of the vaccine will inform supply and public health messaging to maximize vaccination. Objective: The objective of this study was to measure the impact of the COVID-19 pandemic on the acceptance of influenza vaccination in the 2020-2021 season, specifically focusing on people who were previously eligible but routinely declined vaccination and newly eligible people. Methods: Intention to receive the influenza vaccine in 2020-2021 was asked of all registrants of the largest electronic personal health record in the NHS by a web-based questionnaire on July 31, 2020. Of those who were either newly or previously eligible but had not previously received an influenza vaccination, multivariable logistic regression and network diagrams were used to examine their reasons to undergo or decline vaccination. Results: Among 6641 respondents, 945 (14.2\%) were previously eligible but were not vaccinated; of these, 536 (56.7\%) intended to receive an influenza vaccination in 2020-2021, as did 466 (68.6\%) of the newly eligible respondents. Intention to receive the influenza vaccine was associated with increased age, index of multiple deprivation quintile, and considering oneself to be at high risk from COVID-19. Among those who were eligible but not intending to be vaccinated in 2020-2021, 164/543 (30.2\%) gave reasons based on misinformation. Of the previously unvaccinated health care workers, 47/96 (49\%) stated they would decline vaccination in 2020-2021. Conclusions: In this sample, COVID-19 has increased acceptance of influenza vaccination in previously eligible but unvaccinated people and has motivated substantial uptake in newly eligible people. This study is essential for informing resource planning and the need for effective messaging campaigns to address negative misconceptions, which is also necessary for COVID-19 vaccination programs. ",
doi="10.2196/26734",
url="https://publichealth.jmir.org/2021/4/e26734",
url="http://www.ncbi.nlm.nih.gov/pubmed/33651708"
}


@Article{info:doi/10.2196/27045,
author="Zeng, Chengbo
and Zhang, Jiajia
and Li, Zhenlong
and Sun, Xiaowen
and Olatosi, Bankole
and Weissman, Sharon
and Li, Xiaoming",
title="Spatial-Temporal Relationship Between Population Mobility and COVID-19 Outbreaks in South Carolina: Time Series Forecasting Analysis",
journal="J Med Internet Res",
year="2021",
month="Apr",
day="13",
volume="23",
number="4",
pages="e27045",
keywords="COVID-19",
keywords="mobility",
keywords="incidence",
keywords="South Carolina",
abstract="Background: Population mobility is closely associated with COVID-19 transmission, and it could be used as a proximal indicator to predict future outbreaks, which could inform proactive nonpharmaceutical interventions for disease control. South Carolina is one of the US states that reopened early, following which it experienced a sharp increase in COVID-19 cases. Objective: The aims of this study are to examine the spatial-temporal relationship between population mobility and COVID-19 outbreaks and use population mobility data to predict daily new cases at both the state and county level in South Carolina. Methods: This longitudinal study used disease surveillance data and Twitter-based population mobility data from March 6 to November 11, 2020, in South Carolina and its five counties with the largest number of cumulative confirmed COVID-19 cases. Population mobility was assessed based on the number of Twitter users with a travel distance greater than 0.5 miles. A Poisson count time series model was employed for COVID-19 forecasting. Results: Population mobility was positively associated with state-level daily COVID-19 incidence as well as incidence in the top five counties (ie, Charleston, Greenville, Horry, Spartanburg, and Richland). At the state level, the final model with a time window within the last 7 days had the smallest prediction error, and the prediction accuracy was as high as 98.7\%, 90.9\%, and 81.6\% for the next 3, 7, and 14 days, respectively. Among Charleston, Greenville, Horry, Spartanburg, and Richland counties, the best predictive models were established based on their observations in the last 9, 14, 28, 20, and 9 days, respectively. The 14-day prediction accuracy ranged from 60.3\%-74.5\%. Conclusions: Using Twitter-based population mobility data could provide acceptable predictions of COVID-19 daily new cases at both the state and county level in South Carolina. Population mobility measured via social media data could inform proactive measures and resource relocations to curb disease outbreaks and their negative influences. ",
doi="10.2196/27045",
url="https://www.jmir.org/2021/4/e27045",
url="http://www.ncbi.nlm.nih.gov/pubmed/33784239"
}


@Article{info:doi/10.2196/25762,
author="Dennis, S. Alexander
and Moravec, L. Patricia
and Kim, Antino
and Dennis, R. Alan",
title="Assessment of the Effectiveness of Identity-Based Public Health Announcements in Increasing the Likelihood of Complying With COVID-19 Guidelines: Randomized Controlled Cross-sectional Web-Based Study",
journal="JMIR Public Health Surveill",
year="2021",
month="Apr",
day="13",
volume="7",
number="4",
pages="e25762",
keywords="Amazon Mechanical Turk",
keywords="compliance",
keywords="COVID-19",
keywords="custom",
keywords="effectiveness",
keywords="guideline",
keywords="identity",
keywords="public health",
keywords="public health announcement",
keywords="public service announcement",
keywords="social media",
keywords="web-based health information",
abstract="Background: Public health campaigns aimed at curbing the spread of COVID-19 are important in reducing disease transmission, but traditional information-based campaigns have received unexpectedly extreme backlash. Objective: This study aimed to investigate whether customizing of public service announcements (PSAs) providing health guidelines to match individuals' identities increases their compliance. Methods: We conducted a within- and between-subjects, randomized controlled cross-sectional, web-based study in July 2020. Participants viewed two PSAs: one advocating wearing a mask in public settings and one advocating staying at home. The control PSA only provided information, and the treatment PSAs were designed to appeal to the identities held by individuals; that is, either a Christian identity or an economically motivated identity. Participants were asked about their identity and then provided a control PSA and treatment PSA matching their identity, in random order. The PSAs were of approximately 100 words. Results: We recruited 300 social media users from Amazon Mechanical Turk in accordance with usual protocols to ensure data quality. In total, 8 failed the data quality checks, and the remaining 292 were included in the analysis. In the identity-based PSA, the source of the PSA was changed, and a phrase of approximately 12 words relevant to the individual's identity was inserted. A PSA tailored for Christians, when matched with a Christian identity, increased the likelihood of compliance by 12 percentage points. A PSA that focused on economic values, when shown to individuals who identified as economically motivated, increased the likelihood of compliance by 6 points. Conclusions: Using social media to deliver COVID-19 public health announcements customized to individuals' identities is a promising measure to increase compliance with public health guidelines. Trial Registration: ISRCTN Registry 22331899; https://www.isrctn.com/ISRCTN22331899. ",
doi="10.2196/25762",
url="https://publichealth.jmir.org/2021/4/e25762",
url="http://www.ncbi.nlm.nih.gov/pubmed/33819910"
}


@Article{info:doi/10.2196/26330,
author="Taeymans, Jan
and Luijckx, Eefje
and Rogan, Slavko
and Haas, Karin
and Baur, Heiner",
title="Physical Activity, Nutritional Habits, and Sleeping Behavior in Students and Employees of a Swiss University During the COVID-19 Lockdown Period: Questionnaire Survey Study",
journal="JMIR Public Health Surveill",
year="2021",
month="Apr",
day="13",
volume="7",
number="4",
pages="e26330",
keywords="COVID-19",
keywords="healthy lifestyle",
keywords="pandemics",
keywords="public health",
keywords="universities",
abstract="Background: The new coronavirus SARS-CoV-2 led to the COVID-19 pandemic starting in January 2020. The Swiss Federal Council prescribed a lockdown of nonessential businesses. Students and employees of higher education institutions had to install home offices and participate in online lectures. Objective: The aim of this survey study was to evaluate lifestyle habits, such as physical activity (PA), sitting time, nutritional habits (expressed as median modified Mediterranean Diet Score [mMDS]),  alcohol consumption habits,  and sleeping behavior during a 2-month period of confinement and social distancing due to the COVID-19 pandemic. Survey participants were students and employees of a Swiss university of applied sciences. Methods: All students and employees from Bern University of Applied Sciences, Department of Health Professions (ie, nursing, nutrition and dietetics, midwifery, and physiotherapy divisions) were invited to complete an anonymous online survey during the COVID-19 confinement period. Information on the lifestyle dimensions of PA, sitting time, nutritional and alcohol consumption habits, and sleep behavior was gathered using adaptations of validated questionnaires. Frequency analyses and nonparametric statistical methods were used for data analysis. Significance was set at 5\% $\alpha$ level of error. Results: Prevalence of non-health-enhancing PA was 37.1\%, with participants of the division of physiotherapy showing the lowest prevalence. Prevalence of long sitting time (>8 hours/day) was 36.1\%. The median mMDS was 9, where the maximal score was 15, with participants of the division of nutrition and dietetics being more adherent to a Mediterranean diet as compared to the other groups. Prevalence of nonadherence to the Swiss alcohol consumption recommendations was 8.3\%. Prevalence of low sleeping quality was 44.7\%, while the median sleeping duration was 8 hours, which is considered healthy for adult populations. Conclusions: In the group analysis, differences in PA, sitting time, and mMDS were observed between different divisions of health professions as well as between Bachelor of Science students,  Master of Science students, and employees. Therefore, public health messages regarding healthy lifestyle habits during home confinement should be more group specific. The results of this study may provide support for the implementation of group-specific health promotion interventions at universities in pandemic conditions. Trial Registration: ClinicalTrials.gov NCT04502108; https://www.clinicaltrials.gov/ct2/show/NCT04502108 ",
doi="10.2196/26330",
url="https://publichealth.jmir.org/2021/4/e26330",
url="http://www.ncbi.nlm.nih.gov/pubmed/33630747"
}


@Article{info:doi/10.2196/24292,
author="Benneyan, James
and Gehrke, Christopher
and Ilies, Iulian
and Nehls, Nicole",
title="Community and Campus COVID-19 Risk Uncertainty Under University Reopening Scenarios: Model-Based Analysis",
journal="JMIR Public Health Surveill",
year="2021",
month="Apr",
day="7",
volume="7",
number="4",
pages="e24292",
keywords="COVID-19",
keywords="university reopening",
keywords="community impact",
keywords="epidemic model",
keywords="model",
keywords="community",
keywords="university",
keywords="safety",
keywords="strategy",
keywords="risk",
keywords="infectious disease",
abstract="Background: Significant uncertainty has existed about the safety of reopening college and university campuses before the COVID-19 pandemic is better controlled. Moreover, little is known about the effects that on-campus students may have on local higher-risk communities. Objective: We aimed to estimate the range of potential community and campus COVID-19 exposures, infections, and mortality under various university reopening plans and uncertainties. Methods: We developed campus-only, community-only, and campus {\texttimes} community epidemic differential equations and agent-based models, with inputs estimated via published and grey literature, expert opinion, and parameter search algorithms. Campus opening plans (spanning fully open, hybrid, and fully virtual approaches) were identified from websites and publications. Additional student and community exposures, infections, and mortality over 16-week semesters were estimated under each scenario, with 10\% trimmed medians, standard deviations, and probability intervals computed to omit extreme outliers. Sensitivity analyses were conducted to inform potential effective interventions. Results: Predicted 16-week campus and additional community exposures, infections, and mortality for the base case with no precautions (or negligible compliance) varied significantly from their medians (4- to 10-fold). Over 5\% of on-campus students were infected after a mean of 76 (SD 17) days, with the greatest increase (first inflection point) occurring on average on day 84 (SD 10.2 days) of the semester and with total additional community exposures, infections, and mortality ranging from 1-187, 13-820, and 1-21 per 10,000 residents, respectively. Reopening precautions reduced infections by 24\%-26\% and mortality by 36\%-50\% in both populations. Beyond campus and community reproductive numbers, sensitivity analysis indicated no dominant factors that interventions could primarily target to reduce the magnitude and variability in outcomes, suggesting the importance of comprehensive public health measures and surveillance. Conclusions: Community and campus COVID-19 exposures, infections, and mortality resulting from reopening campuses are highly unpredictable regardless of precautions. Public health implications include the need for effective surveillance and flexible campus operations. ",
doi="10.2196/24292",
url="https://publichealth.jmir.org/2021/4/e24292",
url="http://www.ncbi.nlm.nih.gov/pubmed/33667173"
}


@Article{info:doi/10.2196/22880,
author="Asgari Mehrabadi, Milad
and Dutt, Nikil
and Rahmani, M. Amir",
title="The Causality Inference of Public Interest in Restaurants and Bars on Daily COVID-19 Cases in the United States: Google Trends Analysis",
journal="JMIR Public Health Surveill",
year="2021",
month="Apr",
day="6",
volume="7",
number="4",
pages="e22880",
keywords="bars",
keywords="coronavirus",
keywords="COVID-19",
keywords="deep learning",
keywords="infodemiology",
keywords="infoveillance",
keywords="Google Trends",
keywords="LSTM",
keywords="machine learning",
keywords="restaurants",
abstract="Background: The COVID-19 pandemic has affected virtually every region in the world. At the time of this study, the number of daily new cases in the United States was greater than that in any other country, and the trend was increasing in most states. Google Trends provides data regarding public interest in various topics during different periods. Analyzing these trends using data mining methods may provide useful insights and observations regarding the COVID-19 outbreak. Objective: The objective of this study is to consider the predictive ability of different search terms not directly related to COVID-19 with regard to the increase of daily cases in the United States. In particular, we are concerned with searches related to dine-in restaurants and bars. Data were obtained from the Google Trends application programming interface and the COVID-19 Tracking Project. Methods: To test the causation of one time series on another, we used the Granger causality test. We considered the causation of two different search query trends related to dine-in restaurants and bars on daily positive cases in the US states and territories with the 10 highest and 10 lowest numbers of daily new cases of COVID-19. In addition, we used Pearson correlations to measure the linear relationships between different trends. Results: Our results showed that for states and territories with higher numbers of daily cases, the historical trends in search queries related to bars and restaurants, which mainly occurred after reopening, significantly affected the number of daily new cases on average. California, for example, showed the most searches for restaurants on June 7, 2020; this affected the number of new cases within two weeks after the peak, with a P value of .004 for the Granger causality test. Conclusions: Although a limited number of search queries were considered, Google search trends for restaurants and bars showed a significant effect on daily new cases in US states and territories with higher numbers of daily new cases. We showed that these influential search trends can be used to provide additional information for prediction tasks regarding new cases in each region. These predictions can help health care leaders manage and control the impact of the COVID-19 outbreak on society and prepare for its outcomes. ",
doi="10.2196/22880",
url="https://publichealth.jmir.org/2021/4/e22880",
url="http://www.ncbi.nlm.nih.gov/pubmed/33690143"
}


@Article{info:doi/10.2196/26216,
author="Peng, Li-Hsun
and Bai, Ming-Han",
title="How Gameful Experience Affects Public Knowledge, Attitudes, and Practices Regarding COVID-19 Among the Taiwanese Public: Cross-sectional Study",
journal="JMIR Serious Games",
year="2021",
month="Apr",
day="6",
volume="9",
number="2",
pages="e26216",
keywords="COVID-19",
keywords="knowledge",
keywords="attitude",
keywords="practice",
keywords="serious game",
keywords="gameful experience",
abstract="Background: In 2019, with the COVID-19 pandemic sweeping across the globe, public health systems worldwide faced severe challenges. Amid the pandemic, one simulation game, Plague Inc., has received substantial attention. This game has indirectly drawn greater public attention to public health issues by simulating pathogen transmission and disease symptoms. Objective: Against this backdrop, this research investigates whether the gameful experience of Plague Inc. has indirectly affected public knowledge, attitudes, and practices (KAP) regarding COVID-19. Methods: An online survey was conducted through social networking services in Taiwan from May 6-28, 2020. Results: A total of 486 subjects participated in this study, of which 276 (56.8\%) had played Plague Inc. This study had several findings. First, participants who had played Plague Inc. demonstrated higher levels of knowledge (P=.03, median 7, IQR 7-8) and attitudes (P=.007, median 8, IQR 7-8) than participants who had not played Plague Inc. (knowledge: median 7, IQR 6-8; attitude: median 7, IQR 6-8). Second, there was a significant correlation between creative thinking ($\rho$=.127, P=.04) and dominance ($\rho$=.122, P=.04) in attitude. Finally, there was a significant correlation between creative thinking ($\rho$=.126, P<.001) and dominance ($\rho$=.119, P=.049) in practice. Conclusions: Serious games highlighting the theme of pathogen transmission may enhance public knowledge and attitudes regarding COVID-19. Furthermore, the creative thinking and dominance involved in gameful experiences may act as critical factors in public attitudes and practices regarding COVID-19. These findings should be further verified through experimental research in the future. ",
doi="10.2196/26216",
url="https://games.jmir.org/2021/2/e26216",
url="http://www.ncbi.nlm.nih.gov/pubmed/33737262"
}


@Article{info:doi/10.2196/26780,
author="Al-Ramahi, Mohammad
and Elnoshokaty, Ahmed
and El-Gayar, Omar
and Nasralah, Tareq
and Wahbeh, Abdullah",
title="Public Discourse Against Masks in the COVID-19 Era: Infodemiology Study of Twitter Data",
journal="JMIR Public Health Surveill",
year="2021",
month="Apr",
day="5",
volume="7",
number="4",
pages="e26780",
keywords="pandemic",
keywords="coronavirus",
keywords="masks",
keywords="social medial, opinion analysis",
keywords="COVID-19",
abstract="Background: Despite scientific evidence supporting the importance of wearing masks to curtail the spread of COVID-19, wearing masks has stirred up a significant debate particularly on social media. Objective: This study aimed to investigate the topics associated with the public discourse against wearing masks in the United States. We also studied the relationship between the anti-mask discourse on social media and the number of new COVID-19 cases. Methods: We collected a total of 51,170 English tweets between January 1, 2020, and October 27, 2020, by searching for hashtags against wearing masks. We used machine learning techniques to analyze the data collected. We investigated the relationship between the volume of tweets against mask-wearing and the daily volume of new COVID-19 cases using a Pearson correlation analysis between the two-time series. Results: The results and analysis showed that social media could help identify important insights related to wearing masks. The results of topic mining identified 10 categories or themes of user concerns dominated by (1) constitutional rights and freedom of choice; (2) conspiracy theory, population control, and big pharma; and (3) fake news, fake numbers, and fake pandemic. Altogether, these three categories represent almost 65\% of the volume of tweets against wearing masks. The relationship between the volume of tweets against wearing masks and newly reported COVID-19 cases depicted a strong correlation wherein the rise in the volume of negative tweets led the rise in the number of new cases by 9 days. Conclusions: These findings demonstrated the potential of mining social media for understanding the public discourse about public health issues such as wearing masks during the COVID-19 pandemic. The results emphasized the relationship between the discourse on social media and the potential impact on real events such as changing the course of the pandemic. Policy makers are advised to proactively address public perception and work on shaping this perception through raising awareness, debunking negative sentiments, and prioritizing early policy intervention toward the most prevalent topics. ",
doi="10.2196/26780",
url="https://publichealth.jmir.org/2021/4/e26780",
url="http://www.ncbi.nlm.nih.gov/pubmed/33720841"
}


@Article{info:doi/10.2196/28314,
author="Bentvelsen, Gerard Robbert
and Veldkamp, Ellen Karin
and Chavannes, H. Niels",
title="A Smartphone App for Engaging Patients With Catheter-Associated Urinary Tract Infections: Protocol for an Interrupted Time-Series Analysis",
journal="JMIR Res Protoc",
year="2021",
month="Mar",
day="23",
volume="10",
number="3",
pages="e28314",
keywords="catheter-associated urinary tract infections",
keywords="infection control",
keywords="patient empowerment",
keywords="urinary catheter",
keywords="eHealth",
abstract="Background: Catheter-associated urinary tract infections (CAUTIs) are the main cause of health care--associated infections, and they increase the disease burden, antibiotic usage, and hospital stay. Inappropriate placement and unnecessarily prolonged usage of a catheter lead to an elevated and preventable risk of infection. The smartphone app Participatient has been developed to involve hospitalized patients in communication and decision-making related to catheter use and to control unnecessary (long-term) catheter use to prevent CAUTIs. Sustained behavioral changes for infection prevention can be promoted by empowering patients through Participatient. Objective: The primary aim of our multicenter prospective interrupted time-series analysis is to reduce inappropriate catheter usage by 15\%. We will evaluate the efficacy of Participatient in this quality improvement study in clinical wards. Our secondary endpoints are to reduce CAUTIs and to increase patient satisfaction, involvement, and trust with health care services. Methods: We will conduct a multicenter interrupted time-series analysis---a strong study design when randomization is not feasible---consisting of a pre- and postintervention point-prevalence survey distributed among participating wards to investigate the efficacy of Participatient in reducing the inappropriate usage of catheters. After customizing Participatient to the wards' requirements, it will be implemented with a catheter indication checklist among clinical wards in 4 large hospitals in the Netherlands. We will collect clinical data every 2 weeks for 6 months in the pre- and postintervention periods. Simultaneously, we will assess the impact of Participatient on patient satisfaction with health care services and providers and the patients' perceived involvement in health care through questionnaires, and the barriers and facilitators of eHealth implementation through interviews with health care workers. Results: To reduce the inappropriate use of approximately 40\% of catheters (currently in use) by 15\%, we aim to collect 9-12 data points from 70-100 patients per survey date per hospital. Thereafter, we will conduct an interrupted time-series analysis and present the difference between the unadjusted and adjusted rate ratios with a corresponding 95\% CI. Differences will be considered significant when P<.05. Conclusions: Our protocol may help reduce the inappropriate use of catheters and subsequent CAUTIs. By sharing reliable information and daily checklists with hospitalized patients via an app, we aim to provide them a tool to be involved in health care--related decision-making and to increase the quality of care. Trial Registration: Netherlands Trial Register NL7178; https://www.trialregister.nl/trial/7178 International Registered Report Identifier (IRRID): DERR1-10.2196/28314 ",
doi="10.2196/28314",
url="https://www.researchprotocols.org/2021/3/e28314",
url="http://www.ncbi.nlm.nih.gov/pubmed/33755026"
}


@Article{info:doi/10.2196/21606,
author="Tran, Phoebe
and Tran, Lam
and Tran, Liem",
title="The Influence of Social Distancing on COVID-19 Mortality in US Counties: Cross-sectional Study",
journal="JMIR Public Health Surveill",
year="2021",
month="Mar",
day="18",
volume="7",
number="3",
pages="e21606",
keywords="COVID-19",
keywords="marginal effects",
keywords="mortality",
keywords="negative binomial model",
keywords="social distancing",
abstract="Background: Previous studies on the impact of social distancing on COVID-19 mortality in the United States have predominantly examined this relationship at the national level and have not separated COVID-19 deaths in nursing homes from total COVID-19 deaths. This approach may obscure differences in social distancing behaviors by county in addition to the actual effectiveness of social distancing in preventing COVID-19 deaths. Objective: This study aimed to determine the influence of county-level social distancing behavior on COVID-19 mortality (deaths per 100,000 people) across US counties over the period of the implementation of stay-at-home orders in most US states (March-May 2020). Methods: Using social distancing data from tracked mobile phones in all US counties, we estimated the relationship between social distancing (average proportion of mobile phone usage outside of home between March and May 2020) and COVID-19 mortality (when the state in which the county is located reported its first confirmed case of COVID-19 and up to May 31, 2020) with a mixed-effects negative binomial model while distinguishing COVID-19 deaths in nursing homes from total COVID-19 deaths and accounting for social distancing-- and COVID-19--related factors (including the period between the report of the first confirmed case of COVID-19 and May 31, 2020; population density; social vulnerability; and hospital resource availability). Results from the mixed-effects negative binomial model were then used to generate marginal effects at the mean, which helped separate the influence of social distancing on COVID-19 deaths from other covariates while calculating COVID-19 deaths per 100,000 people. Results: We observed that a 1\% increase in average mobile phone usage outside of home between March and May 2020 led to a significant increase in COVID-19 mortality by a factor of 1.18 (P<.001), while every 1\% increase in the average proportion of mobile phone usage outside of home in February 2020 was found to significantly decrease COVID-19 mortality by a factor of 0.90 (P<.001). Conclusions: As stay-at-home orders have been lifted in many US states, continued adherence to other social distancing measures, such as avoiding large gatherings and maintaining physical distance in public, are key to preventing additional COVID-19 deaths in counties across the country. ",
doi="10.2196/21606",
url="https://publichealth.jmir.org/2021/3/e21606",
url="http://www.ncbi.nlm.nih.gov/pubmed/33497348"
}


@Article{info:doi/10.2196/23218,
author="Roberts, A. James
and David, E. Meredith",
title="Improving Predictions of COVID-19 Preventive Behavior: Development of a Sequential Mediation Model",
journal="J Med Internet Res",
year="2021",
month="Mar",
day="17",
volume="23",
number="3",
pages="e23218",
keywords="pandemic",
keywords="COVID-19",
keywords="preventive behavior",
keywords="self-efficacy",
keywords="prevention",
keywords="behavior",
keywords="modeling",
keywords="student",
keywords="communication",
abstract="Background: Since the beginning of the COVID-19 pandemic, social distancing, self-quarantining, wearing masks, and washing hands have become part of the new norm for many, but not all. It appears that such preventive measures are critical to ``flattening the curve'' of the spread of COVID-19. The public's adoption of such behaviors is an essential component in the battle against what has been referred to as the ``invisible enemy.'' Objective: The primary objective of this study was to develop a model for predicting COVID-19 preventive behaviors among US college students. The Health Belief Model has a long history of use and empirical support in predicting preventive health behaviors, but it is not without its purported shortcomings. This study identifies a more optimal and defensible combination of variables to explain preventive behaviors among college students. This segment of the US population is critical in helping slow the spread of COVID-19 because of the relative reluctance of college students to perform the needed behaviors given they do not feel susceptible to or fearful of COVID-19. Methods: For this study, 415 US college students were surveyed via Qualtrics and asked to answer questions regarding their fear of COVID-19, information receptivity (seeking relevant information), perceived knowledge of the disease, self-efficacy, and performance of preventive behaviors. The PROCESS macro (Model 6) was used to test our conceptual model, including predictions involving sequential mediation. Results: Sequential mediation results show that fear of COVID-19 leads individuals to seek out information regarding the disease, which increases their perceived knowledge and fosters self-efficacy; this is key to driving preventive behaviors. Conclusions: Self-imposed preventive measures can drastically impact the rate of infection among populations. Based on this study's newly created sequential mediation model, communication strategies for encouraging COVID-19 preventive behaviors are offered. It is clear that college students, and very possibly adults of all ages, must have a healthy fear of COVID-19 to set in motion a process where concerned individuals seek out COVID-19--related information, increasing their store of knowledge concerning the disease, their self-efficacy, and ultimately their likelihood of performing the needed preventive behaviors. ",
doi="10.2196/23218",
url="https://www.jmir.org/2021/3/e23218",
url="http://www.ncbi.nlm.nih.gov/pubmed/33651707"
}


@Article{info:doi/10.2196/24804,
author="Ostermann, Thomas
and Gampe, Julia
and R{\"o}er, Philipp Jan
and Radtke, Theda",
title="Antecedents of Individuals' Concerns Regarding Hospital Hygiene and Surgery Postponement During the COVID-19 Pandemic: Cross-sectional, Web-Based Survey Study",
journal="J Med Internet Res",
year="2021",
month="Mar",
day="11",
volume="23",
number="3",
pages="e24804",
keywords="COVID-19",
keywords="public health",
keywords="medical investigations",
keywords="surgery",
keywords="hospitalization, medical practices",
abstract="Background: The COVID-19 pandemic poses a major challenge to people's everyday lives. In the context of hospitalization, the pandemic is expected to have a strong influence on affective reactions and preventive behaviors. Research is needed to develop evidence-driven strategies for coping with the challenges of the pandemic. Therefore, this survey study investigates the effects that personality traits, risk-taking behaviors, and anxiety have on medical service--related affective reactions and anticipated behaviors during the COVID-19 pandemic. Objective: The aim of this study was to identify key factors that are associated with individuals' concerns about hygiene in hospitals and the postponement of surgeries. Methods: We conducted a cross-sectional, web-based survey of 929 residents in Germany (women: 792/929, 85.3\%; age: mean 35.2 years, SD 12.9 years). Hypotheses were tested by conducting a saturated path analysis. Results: We found that anxiety had a direct effect on people's concerns about safety ($\beta$=?.12, 95\% CI ?.20 to ?.05) and hygiene in hospitals ($\beta$=.16, 95\% CI .08 to .23). Risk-taking behaviors and personality traits were not associated with concerns about safety and hygiene in hospitals or anticipated behaviors. Conclusions: Our findings suggest that distinct interventions and information campaigns are not necessary for individuals with different personality traits or different levels of risk-taking behavior. However, we recommend that health care workers should carefully address anxiety when interacting with patients. ",
doi="10.2196/24804",
url="https://www.jmir.org/2021/3/e24804",
url="http://www.ncbi.nlm.nih.gov/pubmed/33617458"
}


@Article{info:doi/10.2196/23231,
author="Bowman, Leigh
and Kwok, On Kin
and Redd, Rozlyn
and Yi, Yuanyuan
and Ward, Helen
and Wei, In Wan
and Atchison, Christina
and Wong, Yeung-Shan Samuel",
title="Comparing Public Perceptions and Preventive Behaviors During the Early Phase of the COVID-19 Pandemic in Hong Kong and the United Kingdom: Cross-sectional Survey Study",
journal="J Med Internet Res",
year="2021",
month="Mar",
day="8",
volume="23",
number="3",
pages="e23231",
keywords="COVID-19",
keywords="novel coronavirus",
keywords="pandemic",
keywords="behavioural response",
keywords="risk perceptions",
keywords="anxiety",
keywords="comparative",
keywords="Hong Kong",
keywords="United Kingdom",
abstract="Background: Given the public health responses to previous respiratory disease pandemics, and in the absence of treatments and vaccines, the mitigation of the COVID-19 pandemic relies on population engagement in nonpharmaceutical interventions. This engagement is largely driven by risk perception, anxiety levels, and knowledge, as well as by historical exposure to disease outbreaks, government responses, and cultural factors. Objective: The aim of this study is to compare psychobehavioral responses in Hong Kong and the United Kingdom during the early phase of the COVID-19 pandemic. Methods: Comparable cross-sectional surveys were administered to adults in Hong Kong and the United Kingdom during the early phase of the epidemic in each setting. Explanatory variables included demographics, risk perception, knowledge of COVID-19, anxiety level, and preventive behaviors. Responses were weighted according to census data. Logistic regression models, including effect modification to quantify setting differences, were used to assess the association between the explanatory variables and the adoption of social distancing measures. Results: Data from 3431 complete responses (Hong Kong, 1663; United Kingdom, 1768) were analyzed. Perceived severity of symptoms differed by setting, with weighted percentages of 96.8\% for Hong Kong (1621/1663) and 19.9\% for the United Kingdom (366/1768). A large proportion of respondents were abnormally or borderline anxious (Hong Kong: 1077/1603, 60.0\%; United Kingdom: 812/1768, 46.5\%) and regarded direct contact with infected individuals as the transmission route of COVID-19 (Hong Kong: 94.0\%-98.5\%; United Kingdom: 69.2\%-93.5\%; all percentages weighted), with Hong Kong identifying additional routes. Hong Kong reported high levels of adoption of various social distancing measures (Hong Kong: 32.6\%-93.7\%; United Kingdom: 17.6\%-59.0\%) and mask-wearing (Hong Kong: 98.8\% (1647/1663); United Kingdom: 3.1\% (53/1768)). The impact of perceived severity of symptoms and perceived ease of transmission of COVID-19 on the adoption of social distancing measures varied by setting. In Hong Kong, these factors had no impact, whereas in the United Kingdom, those who perceived their symptom severity as ``high'' were more likely to adopt social distancing (adjusted odds ratios [aORs] 1.58-3.01), and those who perceived transmission as ``easy'' were prone to adopt both general social distancing (aOR 2.00, 95\% CI 1.57-2.55) and contact avoidance (aOR 1.80, 95\% CI 1.41-2.30). The impact of anxiety on adopting social distancing did not vary by setting. Conclusions: Our results suggest that health officials should ascertain baseline levels of risk perception and knowledge in populations, as well as prior sensitization to infectious disease outbreaks, during the development of mitigation strategies. Risk should be communicated through suitable media channels---and trust should be maintained---while early intervention remains the cornerstone of effective outbreak response. ",
doi="10.2196/23231",
url="https://www.jmir.org/2021/3/e23231",
url="http://www.ncbi.nlm.nih.gov/pubmed/33539309"
}


@Article{info:doi/10.2196/23720,
author="Hsing, C. Julianna
and Ma, Jasmin
and Barrero-Castillero, Alejandra
and Jani, G. Shilpa
and Pulendran, Palam Uma
and Lin, Bea-Jane
and Thomas-Uribe, Monika
and Wang, Jason C.",
title="Influence of Health Beliefs on Adherence to COVID-19 Preventative Practices: International, Social Media--Based Survey Study",
journal="J Med Internet Res",
year="2021",
month="Feb",
day="26",
volume="23",
number="2",
pages="e23720",
keywords="COVID-19 pandemic",
keywords="health belief model",
keywords="behavior change",
keywords="preventative health behaviors",
keywords="handwashing",
keywords="social distancing",
keywords="international",
keywords="online survey",
keywords="social media",
keywords="cross-sectional study",
abstract="Background: Health behavior is influenced by culture and social context. However, there are limited data evaluating the scope of these influences on COVID-19 response. Objective: This study aimed to compare handwashing and social distancing practices in different countries and evaluate practice predictors using the health belief model (HBM). Methods: From April 11 to May 1, 2020, we conducted an online, cross-sectional survey disseminated internationally via social media. Participants were adults aged 18 years or older from four different countries: the United States, Mexico, Hong Kong (China), and Taiwan. Primary outcomes were self-reported handwashing and social distancing practices during COVID-19. Predictors included constructs of the HBM: perceived susceptibility, perceived severity, perceived benefits, perceived barriers, self-efficacy, and cues to action. Associations of these constructs with behavioral outcomes were assessed by multivariable logistic regression. Results: We analyzed a total of 71,851 participants, with 3070 from the United States, 3946 from Mexico, 1201 from Hong Kong (China), and 63,634 from Taiwan. Of these countries, respondents from the United States adhered to the most social distancing practices ($\chi$23=2169.7, P<.001), while respondents from Taiwan performed the most handwashing ($\chi$23=309.8, P<.001). Multivariable logistic regression analyses indicated that self-efficacy was a positive predictor for handwashing (odds ratio [OR]United States 1.58, 95\% CI 1.21-2.07; ORMexico 1.5, 95\% CI 1.21-1.96; ORHong Kong 2.48, 95\% CI 1.80-3.44; ORTaiwan 2.30, 95\% CI 2.21-2.39) and social distancing practices (ORUnited States 1.77, 95\% CI 1.24-2.49; ORMexico 1.77, 95\% CI 1.40-2.25; ORHong Kong 3.25, 95\% CI 2.32-4.62; ORTaiwan 2.58, 95\% CI 2.47-2.68) in all countries. Handwashing was positively associated with perceived susceptibility in Mexico, Hong Kong, and Taiwan, while social distancing was positively associated with perceived severity in the United States, Mexico, and Taiwan. Conclusions: Social media recruitment strategies can be used to reach a large audience during a pandemic. Self-efficacy was the strongest predictor for handwashing and social distancing. Policies that address relevant health beliefs can facilitate adoption of necessary actions for preventing COVID-19. Our findings may be explained by the timing of government policies, the number of cases reported in each country, individual beliefs, and cultural context. ",
doi="10.2196/23720",
url="https://www.jmir.org/2021/2/e23720",
url="http://www.ncbi.nlm.nih.gov/pubmed/33571103"
}


@Article{info:doi/10.2196/22197,
author="Ainsworth, Ben
and Miller, Sascha
and Denison-Day, James
and Stuart, Beth
and Groot, Julia
and Rice, Cathy
and Bostock, Jennifer
and Hu, Xiao-Yang
and Morton, Katherine
and Towler, Lauren
and Moore, Michael
and Willcox, Merlin
and Chadborn, Tim
and Gold, Natalie
and Aml{\^o}t, Richard
and Little, Paul
and Yardley, Lucy",
title="Infection Control Behavior at Home During the COVID-19 Pandemic: Observational Study of a Web-Based Behavioral Intervention (Germ Defence)",
journal="J Med Internet Res",
year="2021",
month="Feb",
day="25",
volume="23",
number="2",
pages="e22197",
keywords="COVID-19",
keywords="novel coronavirus",
keywords="behavior change",
keywords="digital medicine",
keywords="infection control",
keywords="infectious disease",
keywords="protection",
keywords="digital health",
abstract="Background: To control the COVID-19 pandemic, people should adopt protective behaviors at home (self-isolation, social distancing, putting shopping and packages aside, wearing face coverings, cleaning and disinfecting, and handwashing). There is currently limited support to help individuals conduct these behaviors. Objective: This study aims to report current household infection control behaviors in the United Kingdom and examine how they might be improved. Methods: This was a pragmatic cross-sectional observational study of anonymous participant data from Germ Defence between May 6-24, 2020. Germ Defence is an open-access fully automated website providing behavioral advice for infection control within households. A total of 28,285 users sought advice from four website pathways based on household status (advice to protect themselves generally, to protect others if the user was showing symptoms, to protect themselves if household members were showing symptoms, and to protect a household member who is at high risk). Users reported current infection control behaviors within the home and intentions to change these behaviors. Results: Current behaviors varied across all infection control measures but were between sometimes (face covering: mean 1.61, SD 1.19; social distancing: mean 2.40, SD 1.22; isolating: mean 2.78, SD 1.29; putting packages and shopping aside: mean 2.75, SD 1.55) and quite often (cleaning and disinfecting: mean 3.17, SD 1.18), except for handwashing (very often: mean 4.00, SD 1.03). Behaviors were similar regardless of the website pathway used. After using Germ Defence, users recorded intentions to improve infection control behavior across all website pathways and for all behaviors (overall average infection control score mean difference 0.30, 95\% CI 0.29-0.31). Conclusions: Self-reported infection control behaviors other than handwashing are lower than is optimal for infection prevention, although handwashing is much higher. Advice using behavior change techniques in Germ Defence led to intentions to improve these behaviors. Promoting Germ Defence within national and local public health and primary care guidance could reduce COVID-19 transmission. ",
doi="10.2196/22197",
url="https://www.jmir.org/2021/2/e22197",
url="http://www.ncbi.nlm.nih.gov/pubmed/33566791"
}


@Article{info:doi/10.2196/24452,
author="Anyanwu, C. Emeka
and Ward, Parker R.
and Shah, Atman
and Arora, Vineet
and Umscheid, A. Craig",
title="A Mobile App to Facilitate Socially Distanced Hospital Communication During COVID-19: Implementation Experience",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Feb",
day="23",
volume="9",
number="2",
pages="e24452",
keywords="adoption",
keywords="communication",
keywords="COVID-19",
keywords="hospital",
keywords="inpatient",
keywords="mHealth",
keywords="mobile app",
keywords="telemedicine",
abstract="Background: COVID-19 has significantly altered health care delivery, requiring clinicians and hospitals to adapt to rapidly changing hospital policies and social distancing guidelines. At our large academic medical center, clinicians reported that existing information on distribution channels, including emails and hospital intranet posts, was inadequate to keep everyone abreast with these changes. To address these challenges, we adapted a mobile app developed in-house to communicate critical changes in hospital policies and enable direct telephonic communication between clinical team members and hospitalized patients, to support social distancing guidelines and remote rounding. Objective: This study aimed to describe the unique benefits and challenges of adapting an app developed in-house to facilitate communication and remote rounding during COVID-19. Methods: We adapted moblMD, a mobile app available on the iOS and Android platforms. In conjunction with our Hospital Incident Command System, resident advisory council, and health system innovation center, we identified critical, time-sensitive policies for app usage. A shared collaborative document was used to align app-based communication with more traditional communication channels. To minimize synchronization efforts, we particularly focused on high-yield policies, and the time of last review and the corresponding reviewer were noted for each protocol. To facilitate social distancing and remote patient rounding, the app was also populated with a searchable directory of numbers to patient bedside phones and hospital locations. We monitored anonymized user activity from February 1 to July 31, 2020. Results: On its first release, 1104 clinicians downloaded moblMD during the observation period, of which 46\% (n=508) of downloads occurred within 72 hours of initial release. COVID-19 policies in the app were reviewed most commonly during the first week (801 views). Users made sustained use of hospital phone dialing features, including weekly peaks of 2242 phone number dials, 1874 directory searches, and 277 patient room phone number searches through the last 2 weeks of the observation period. Furthermore, clinicians submitted 56 content- and phone number--related suggestions through moblMD. Conclusions: We rapidly developed and deployed a communication-focused mobile app early during COVID-19, which has demonstrated initial and sustained value among clinicians in communicating with in-patients and each other during social distancing. Our internal innovation benefited from our team's familiarity with institutional structures, short feedback loops, limited security and privacy implications, and a path toward sustainability provided by our innovation center. Challenges in content management were overcome through synchronization efforts and timestamping review. As COVID-19 continues to alter health care delivery, user activity metrics suggest that our solution will remain important in our efforts to continue providing safe and up-to-date clinical care. ",
doi="10.2196/24452",
url="https://mhealth.jmir.org/2021/2/e24452",
url="http://www.ncbi.nlm.nih.gov/pubmed/33513562"
}


@Article{info:doi/10.2196/24204,
author="Gu, Dayong
and He, Jianan
and Sun, Jie
and Shi, Xin
and Ye, Ying
and Zhang, Zishuai
and Wang, Xiangjun
and Su, Qun
and Yu, Wenjin
and Yuan, Xiaopeng
and Dong, Ruiling",
title="The Global Infectious Diseases Epidemic Information Monitoring System: Development and Usability Study of an Effective Tool for Travel Health Management in China",
journal="JMIR Public Health Surveill",
year="2021",
month="Feb",
day="16",
volume="7",
number="2",
pages="e24204",
keywords="infectious disease",
keywords="epidemic information",
keywords="travel health",
keywords="global",
keywords="surveillance",
abstract="Background: Obtaining comprehensive epidemic information for specific global infectious diseases is crucial to travel health. However, different infectious disease information websites may have different purposes, which may lead to misunderstanding by travelers and travel health staff when making accurate epidemic control and management decisions. Objective: The objective of this study was to develop a Global Infectious Diseases Epidemic Information Monitoring System (GIDEIMS) in order to provide comprehensive and timely global epidemic information. Methods: Distributed web crawler and cloud agent acceleration technologies were used to automatically collect epidemic information about more than 200 infectious diseases from 26 established epidemic websites and Baidu News. Natural language processing and in-depth learning technologies have been utilized to intelligently process epidemic information collected in 28 languages. Currently, the GIDEIMS presents world epidemic information using a geographical map, including date, disease name, reported cases in different countries, and the epidemic situation in China. In order to make a practical assessment of the GIDEIMS, we compared infectious disease data collected from the GIDEIMS and other websites on July 16, 2019. Results: Compared with the Global Incident Map and Outbreak News Today, the GIDEIMS provided more comprehensive information on human infectious diseases. The GIDEIMS is currently used in the Health Quarantine Department of Shenzhen Customs District (Shenzhen, China) and was recommended to the Health Quarantine Administrative Department of the General Administration of Customs (China) and travel health--related departments. Conclusions: The GIDEIMS is one of the most intelligent tools that contributes to safeguarding the health of travelers, controlling infectious disease epidemics, and effectively managing public health in China. ",
doi="10.2196/24204",
url="http://publichealth.jmir.org/2021/2/e24204/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33591286"
}


@Article{info:doi/10.2196/26392,
author="Basch, H. Corey
and Fera, Joseph
and Pierce, Isabela
and Basch, E. Charles",
title="Promoting Mask Use on TikTok: Descriptive, Cross-sectional Study",
journal="JMIR Public Health Surveill",
year="2021",
month="Feb",
day="12",
volume="7",
number="2",
pages="e26392",
keywords="TikTok",
keywords="COVID-19",
keywords="social media",
keywords="infodemiology",
keywords="infoveillance",
keywords="mask use",
keywords="prevention",
keywords="promotion",
keywords="communication",
keywords="public health",
keywords="cross-sectional",
keywords="content analysis",
keywords="transmission",
abstract="Background: Over the past decade, there has been an increasing secular trend in the number of studies on social media and health. Objective: The purpose of this cross-sectional study was to examine the content and characteristics of TikTok videos that are related to an important aspect of community mitigation---the use of masks as a method for interrupting the transmission of SARS-CoV-2. Methods: In total, 100 trending videos with the hashtag \#WearAMask (ie, a campaign on TikTok), along with 32 videos that were posted by the World Health Organization (WHO) and involved masks in any way (ie, all related WHO videos at the time of this study), were included in our sample. We collected the metadata of each post, and created content categories based on fact sheets that were provided by the WHO and the US Centers for Disease Control and Prevention. We used these fact sheets to code the characteristics of mask use. Results: Videos that were posted on TikTok and had the hashtag \#WearAMask garnered almost 500 million views, and videos that were posted by the WHO garnered almost 57 million views. Although the ratio of the number of trending \#WearAMask videos to the number of WHO videos was around 3:1, the \#WearAMask videos received almost 10 times as many cumulative views as the WHO videos. In total, 68\% (68/100) of the trending \#WearAMask videos involved humor and garnered over 355 million cumulative views. However, only 9\% (3/32) of the WHO videos involved humor. Furthermore, 27\% (27/100) of the trending \#WearAMask videos involved dance and garnered over 130 million cumulative views, whereas none of the WHO videos involved dance. Conclusions: This study is one of the first to describe how TikTok is being used to mitigate the community spread of COVID-19 by promoting mask use. Due to the platform's incredible reach, TikTok has great potential in conveying important public health messages to various segments of the population. ",
doi="10.2196/26392",
url="http://publichealth.jmir.org/2021/2/e26392/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33523823"
}


@Article{info:doi/10.2196/21734,
author="Ateudjieu, J{\'e}r{\^o}me
and Yakum, Martin Ndinakie
and Goura, Pascal Andr{\'e}
and Guenou, Etienne
and Beyala, Bita'a Landry
and Amada, Lapia
and Ngoche, Isabelle
and Kiadjieu, Forex Frank
and Nangue, Charlette
and Djosseu, Soukep Elvis Briand
and Kenfack, Bruno",
title="Tracking Demographic Movements and Immunization Status to Improve Children's Access to Immunization (TDM-IAI): Protocol for a Field-Based Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2021",
month="Feb",
day="8",
volume="10",
number="2",
pages="e21734",
keywords="immunization status",
keywords="coverage: completeness",
keywords="timeliness",
keywords="EPI vaccines",
keywords="children under five",
keywords="Foumban",
keywords="Cameroon",
keywords="vaccines",
keywords="infectious",
keywords="immunization",
abstract="Background: In Cameroon, the coverage, completeness, and timeliness of the Expanded Programme on Immunization (EPI) vaccines administration in children have remained heterogeneous and below the national and districts targets in several districts. In an effort to solve this problem, many interventions have been tested but none has shown significant improvement of the situation. Objective: This trial aims to test whether involving Community Volunteers to assess children vaccination status and demographic movements and using recorded data to plan catch-up immunization sessions can improve children vaccination timeliness, completeness and coverage. Methods: Communities of the Foumban Health district, West region of Cameroon will be selected and assigned to either intervention or control groups using a restricted randomization of 2. In the intervention group, one Community Volunteer per community will be trained to visit households and record EPI-targeted children in a register, record their demographic movements, and assess their immunization status monthly for a year. The information recorded will be snapped and sent to the competent health center immunization team through WhatsApp. These will be used to plan and implement monthly community catch up immunization sessions in collaboration with the community volunteer. In the control group, the routine immunization sessions will be conducted with health centers organizing either weekly vaccination sessions for communities situated not farther than 5 kilometers away from the health facility or monthly vaccination sessions in communities situated more than 5 kilometers away from the health center. Baseline, mid-term and end-line surveys will be conducted to assess and compare immunization coverage, timeliness, and completeness. Results: Funded in 2018, data collection started in 2018 and has been completed. Data analysis and reporting are ongoing. Conclusions: This trial is expecting to test an innovative approach to improving children's immunization timeliness, completeness and coverage of immunization by tracking EPI targeted population vaccination status and denominator at household level and building collaboration between the community and health facilities vaccination teams to organize monthly community-based response vaccination sessions. This intervention is expected to improve children sustainable access to EPI vaccination as it offers assessing and responding to their immunization needs at monthly basis using low cost local human resources. Trial Registration: Pan African Clinical Trials Registry ID PACTR201808527428720; tinyurl.com/u058qnse International Registered Report Identifier (IRRID): DERR1-10.2196/21734 ",
doi="10.2196/21734",
url="https://www.researchprotocols.org/2021/2/e21734",
url="http://www.ncbi.nlm.nih.gov/pubmed/33555269"
}


@Article{info:doi/10.2196/23400,
author="Xiu, Xiaolei
and Wang, Anran
and Qian, Qing
and Wu, Sizhu",
title="The US Public's Perception of the Threat of COVID-19 During the Rapid Spread of the COVID-19 Outbreak: Cross-Sectional Survey Study",
journal="J Med Internet Res",
year="2021",
month="Feb",
day="8",
volume="23",
number="2",
pages="e23400",
keywords="COVID-19",
keywords="perceived threat of disease",
keywords="environment",
keywords="behavior",
keywords="America",
abstract="Background: The rapid spread of the COVID-19 pandemic in the United States has made people uncertain about their perceptions of the threat of COVID-19 and COVID-19 response measures. To mount an effective response to this epidemic, it is necessary to understand the public's perceptions, behaviors, and attitudes. Objective: We aimed to test the hypothesis that people's perceptions of the threat of COVID-19 influence their attitudes and behaviors. Methods: This study used an open dataset of web-based questionnaires about COVID-19. The questionnaires were provided by Nexoid United Kingdom. We selected the results of a questionnaire on COVID-19--related behaviors, attitudes, and perceptions among the US public. The questionnaire was conducted from March 29 to April 20, 2020. A total of 24,547 people who lived in the United States took part in the survey. Results: In this study, the average self-assessed probability of contracting COVID-19 was 33.2\%, and 49.9\% (12,244/24,547) of the respondents thought that their chances of contracting COVID-19 were less than 30\%. The self-assessed probability of contracting COVID-19 among women was 1.35 times that of males. A 5\% increase in perceived infection risk was significantly associated with being 1.02 times (OR 1.02, 95\% CI 1.02-1.02; P<.001) more likely to report having close contact with >10 people, and being 1.01 times (OR 1.01, 95\% CI 1.01-1.01; P<.001) more likely to report that cohabitants disagreed with taking steps to reduce the risk of contracting COVID-19. However, there was no significant association between participants who lived with more than 5 cohabitants or less than 5 cohabitants (P=.85). Generally, participants who lived in states with 1001-10,000 COVID-19 cases, were aged 20-40 years, were obese, smoked, drank alcohol, never used drugs, and had no underlying medical conditions were more likely to be in close contact with >10 people. Most participants (21,017/24,547, 85.6\%) agreed with washing their hands and maintaining social distancing, but only 20.2\% (4958/24,547) of participants often wore masks. Additionally, male participants and participants aged <20 years typically disagreed with washing their hands, maintaining social distancing, and wearing masks. Conclusions: This survey is the first attempt to describe the determinants of the US public's perception of the threat of COVID-19 on a large scale. The self-assessed probability of contracting COVID-19 differed significantly based on the respondents' genders, states of residence, ages, body mass indices, smoking habits, alcohol consumption habits, drug use habits, underlying medical conditions, environments, and behaviors. These findings can be used as references by public health policy makers and health care workers who want to identify populations that need to be educated on COVID-19 prevention and health. ",
doi="10.2196/23400",
url="http://www.jmir.org/2021/2/e23400/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33481753"
}


@Article{info:doi/10.2196/24591,
author="Garnier, Romain
and Benetka, R. Jan
and Kraemer, John
and Bansal, Shweta",
title="Socioeconomic Disparities in Social Distancing During the COVID-19 Pandemic in the United States: Observational Study",
journal="J Med Internet Res",
year="2021",
month="Jan",
day="22",
volume="23",
number="1",
pages="e24591",
keywords="COVID-19",
keywords="SARS-CoV-2",
keywords="disease ecology",
keywords="nonpharmaceutical interventions",
keywords="mobility data",
keywords="economic",
keywords="disparity",
keywords="social distancing",
keywords="equity",
keywords="access",
keywords="socioeconomic",
keywords="infectious disease",
keywords="mobility",
abstract="Background: Eliminating disparities in the burden of COVID-19 requires equitable access to control measures across socio-economic groups. Limited research on socio-economic differences in mobility hampers our ability to understand whether inequalities in social distancing are occurring during the SARS-CoV-2 pandemic. Objective: We aimed to assess how mobility patterns have varied across the United States during the COVID-19 pandemic and to identify associations with socioeconomic factors of populations. Methods: We used anonymized mobility data from tens of millions of devices to measure the speed and depth of social distancing at the county level in the United States between February and May 2020, the period during which social distancing was widespread in this country. Using linear mixed models, we assessed the associations between social distancing and socioeconomic variables, including the proportion of people in the population below the poverty level, the proportion of Black people, the proportion of essential workers, and the population density. Results: We found that the speed, depth, and duration of social distancing in the United States are heterogeneous. We particularly show that social distancing is slower and less intense in counties with higher proportions of people below the poverty level and essential workers; in contrast, we show that social distancing is intensely adopted in counties with higher population densities and larger Black populations. Conclusions: Socioeconomic inequalities appear to be associated with the levels of adoption of social distancing, potentially resulting in wide-ranging differences in the impact of the COVID-19 pandemic in communities across the United States. These inequalities are likely to amplify existing health disparities and must be addressed to ensure the success of ongoing pandemic mitigation efforts. ",
doi="10.2196/24591",
url="http://www.jmir.org/2021/1/e24591/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33351774"
}


@Article{info:doi/10.2196/24495,
author="Yang, Xue
and Song, Bo
and Wu, Anise
and Mo, H. Phoenix K.
and Di, Jiangli
and Wang, Qian
and Lau, F. Joseph T.
and Wang, Linhong",
title="Social, Cognitive, and eHealth Mechanisms of COVID-19--Related Lockdown and Mandatory Quarantine That Potentially Affect the Mental Health of Pregnant Women in China: Cross-Sectional Survey Study",
journal="J Med Internet Res",
year="2021",
month="Jan",
day="22",
volume="23",
number="1",
pages="e24495",
keywords="eHealth",
keywords="lockdown",
keywords="quarantine",
keywords="depression",
keywords="anxiety",
keywords="pregnant women",
abstract="Background: Although lockdown and mandatory quarantine measures have played crucial roles in the sharp decrease of the number of newly confirmed/suspected COVID-19 cases, concerns have been raised over the threat that these measures pose to mental health, especially the mental health of vulnerable groups, including pregnant women. Few empirical studies have assessed whether and how these control measures may affect mental health, and no study has investigated the prevalence and impacts of the use of eHealth resources among pregnant women during the COVID-19 outbreak. Objective: This study investigated (1) the effects of lockdown and mandatory quarantine on mental health problems (ie, anxiety and depressive symptoms), (2) the potential mediation effects of perceived social support and maladaptive cognition, and (3) the moderation effects of eHealth-related factors (ie, using social media to obtain health information and using prenatal care services during the COVID-19 pandemic) on pregnant women in China. Methods: An online cross-sectional survey was conducted among 19,515 pregnant women from all 34 Chinese provincial-level administrative regions from February 25 to March 10, 2020. Results: Of the 19,515 participants, 12,209 (62.6\%) were subjected to lockdown in their areas of residence, 737 (3.8\%) were subjected to mandatory quarantine, 8712 (44.6\%) had probable mild to severe depression, 5696 (29.2\%) had probable mild to severe anxiety, and 1442 (7.4\%) had suicidal ideations. Only 640 (3.3\%) participants reported that they used online prenatal care services during the outbreak. Significant sociodemographic/maternal factors of anxiety/depressive symptoms included age, education, occupation, the area of residence, gestational duration, the number of children born, complication during pregnancy, the means of using prenatal care services, and social media use for obtaining health information. Multiple indicators multiple causes modeling ($\chi$214=495.21; P<.05; comparative fit index=.99; nonnormed fit index=.98; root mean square error of approximation=.04, 90\% CI 0.038-0.045) showed that quarantine was directly and indirectly strongly associated with poor mental health through decreased perceived social support and increased maladaptive cognition (B=.04; $\beta$=.02, 95\% CI 0.01-0.02; P=.001), while lockdown was indirectly associated with mental health through increased social support and maladaptive cognition among pregnant women (B=.03; $\beta$=.03, 95\% CI 0.02-0.03; P=.001). Multigroup analyses revealed that the use of social media for obtaining health information and the means of using prenatal care services were significant moderators of the model paths. Conclusions: Our findings provide epidemiological evidence for the importance of integrating mental health care and eHealth into the planning and implementation of control measure policies. The observed social and cognitive mechanisms and moderators in this study are modifiable, and they can inform the design of evidence-based mental health promotion among pregnant women. ",
doi="10.2196/24495",
url="http://www.jmir.org/2021/1/e24495/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33302251"
}


@Article{info:doi/10.2196/19349,
author="Niedfeldt, Jane Heidi
and Beckstead, Emmalene
and Chahalis, Emily
and Jensen, Mindy
and Reher, Britton
and Torres, Scott
and Rachmi, Novianti Cut
and Jusril, Hafizah
and Hall, Cougar
and West, H. Joshua
and Crookston, T. Benjamin",
title="Use of Technology to Access Health Information/Services and Subsequent Association With WASH (Water Access, Sanitation, and Hygiene) Knowledge and Behaviors Among Women With Children Under 2 Years of Age in Indonesia: Cross-sectional Study",
journal="JMIR Public Health Surveill",
year="2021",
month="Jan",
day="14",
volume="7",
number="1",
pages="e19349",
keywords="technology",
keywords="defecation",
keywords="handwashing",
keywords="WASH",
keywords="stunting",
abstract="Background: Water access, sanitation, and hygiene (WASH) remain a public health concern in Indonesia. Proper WASH practices can decrease risk of stunting, wasting, and disease in children under the age of 2. Objective: The purpose of our study is to examine if using technology to access health information and services among Indonesian women affects knowledge and behaviors regarding handwashing and defecation practices. Methods: Our study is an interview-based cross-sectional survey. Participants included 1734 mothers of children under 2 years of age. These women were randomly selected and interviewed as part of a 3-stage cluster sampling technique. Our study uses data regarding WASH knowledge which includes benefits of handwashing with soap, 5 critical times of handwashing, risks of open defecation, media of disease transmission, defecation locations, and risks of open defecation. Data regarding WASH behaviors were also included: handwashing with soap, type of latrine used at home, and where defecation took place. This investigation used adjusted and unadjusted logistic and linear regression models to determine differences in WASH outcomes between those who use technology to access health information and services and those who did not. Results: One result is that Indonesian women with children under 2 years of age who use technology to access health information and services are more likely to know the advantages of proper handwashing (odds ratio [OR] 2.603, 95\% CI 1.666-4.067) and know the 5 critical times of handwashing (OR 1.217, 95\% CI 0.969-1.528). Women who use technology to access health information are also more likely to know the risks of open defecation (OR 1.627, 95\% CI 1.170-2.264) and use a type of toilet (such as a gooseneck or squat toilet) that limits risk (OR 3.858, 95\% CI 2.628-5.665) compared to women who did not use technology to access health information. Conclusions: Using technology to access health information and services was associated with an increase in handwashing and defecation knowledge. In the future, promoting mothers of children under 2 years of age to access health information through technology might be used to increase handwashing and defecation knowledge as well as safe defecation practices. However, further research should be done to determine how technology may increase the frequency of recommended handwashing behaviors. ",
doi="10.2196/19349",
url="http://publichealth.jmir.org/2021/1/e19349/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33443485"
}


@Article{info:doi/10.2196/19958,
author="Chen, Rebecca
and Santo, Karla
and Wong, Grace
and Sohn, Woosung
and Spallek, Heiko
and Chow, Clara
and Irving, Michelle",
title="Mobile Apps for Dental Caries Prevention: Systematic Search and Quality Evaluation",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Jan",
day="13",
volume="9",
number="1",
pages="e19958",
keywords="dental caries",
keywords="oral hygiene",
keywords="self-management",
keywords="mobile applications",
abstract="Background: Dental caries is the most common multifactorial oral disease; it affects 60\% to 90\% of the global population. Dental caries is highly preventable through prevention behaviors aimed at improving oral hygiene, adequate fluoride usage, and dietary intake. Mobile apps have the potential to support patients with dental caries; however, little is known about the availability, target audience, quality, and features of these apps. Objective: This review aims to systematically examine dental caries prevention apps; to describe their content, availability, target audience, and features; and to assess their quality. Methods: We systematically identified and evaluated apps in a process paralleling a systematic review. This included a search strategy using search terms; an eligibility assessment using inclusion and exclusion criteria focused on accessibility and dental caries self-management behaviors, including oral hygiene, dietary intake, and fluoride usage; data extraction on app characteristics, including app store metrics; prevention behavior categorization; feature identification and description; a quality appraisal of all apps using the validated Mobile App Rating Scale (MARS) assessment tool; and data comparison and analysis. Results: Using our search strategy, we retrieved 562 apps from the Google Play Store and iTunes available in Australia. Of these, 7.1\% (40/562) of the apps fit our eligibility criteria, of which 55\% (22/40) targeted adults, 93\% (37/40) were free to download, and 65\% (26/40) were recently updated. Oral hygiene was the most common dental caries prevention behavior domain, addressed in 93\% (37/40) of the apps, while dietary intake was addressed in 45\% (18/40) of the apps and fluoride usage was addressed in 42\% (17/40) of the apps. Overall, 50\% (20/40) of the apps addressed only 1 behavior, and 38\% (15/40) of the apps addressed all 3 behaviors. The mean MARS score was 2.9 (SD 0.7; range 1.8-4.4), with 45\% (18/40) of the apps categorized as high quality, with a rating above 3.0 out of 5.0. We identified 21 distinctive features across all dental caries prevention behaviors; however, the top 5 most common features focused on oral hygiene. The highest-ranking app was the Brush DJ app, with an overall MARS score of 4.4 and with the highest number of features (n=13). We did not find any apps that adequately addressed dental caries prevention behaviors in very young children. Conclusions: Apps addressing dental caries prevention commonly focus on oral hygiene and target young adults; however, many are not of high quality. These apps use a range of features to support consumer engagement, and some of these features may be helpful for specific patient populations. However, it remains unclear how effective these apps are in improving dental caries outcomes, and further evaluation is required before they are widely recommended. ",
doi="10.2196/19958",
url="http://mhealth.jmir.org/2021/1/e19958/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33439141"
}


@Article{info:doi/10.2196/23699,
author="Kawakami, Norito
and Sasaki, Natsu
and Kuroda, Reiko
and Tsuno, Kanami
and Imamura, Kotaro",
title="The Effects of Downloading a Government-Issued COVID-19 Contact Tracing App on Psychological Distress During the Pandemic Among Employed Adults: Prospective Study",
journal="JMIR Ment Health",
year="2021",
month="Jan",
day="12",
volume="8",
number="1",
pages="e23699",
keywords="coronavirus disease",
keywords="digital contact tracing",
keywords="mental health",
keywords="working population",
keywords="longitudinal study",
keywords="COVID-19",
keywords="contact tracing",
keywords="surveillance",
keywords="tracking",
keywords="anxiety",
keywords="distress",
abstract="Background: Downloading a COVID-19 contact tracing app may be effective in reducing users' worry about COVID-19 and psychological distress. Objective: This 2.5-month prospective study aimed to investigate the association of downloading a COVID-19 contact tracing app, the COVID-19 Contact Confirming Application (COCOA), released by the Japanese government, with worry about COVID-19 and psychological distress in a sample of employed adults in Japan. Methods: A total of 996 full-time employed respondents to an online survey conducted May 22-26, 2020 (baseline), were invited to participate in a follow-up survey August 7-12, 2020 (follow-up). A high level of worrying about COVID-19 and high psychological distress were defined by baseline and follow-up scores on a single-item scale and the Kessler 6 (K6) scale, respectively. The app was released between the two surveys, on June 17. Participants were asked at follow-up if they downloaded the app. Results: A total of 902 (90.6\%) of 996 baseline participants responded to the follow-up survey. Among them, 184 (20.4\%) reported that they downloaded the app. Downloading of the contact tracing app was significantly negatively associated with psychological distress at follow-up after controlling for baseline variables, but not with worry about COVID-19. Conclusions: This study provides the first evidence that using a government-issued COVID-19 contact tracing app may be beneficial for the mental health of employed adults during the COVID-19 pandemic. ",
doi="10.2196/23699",
url="http://mental.jmir.org/2021/1/e23699/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33347424"
}


@Article{info:doi/10.2196/23232,
author="Rui, Raymond Jian
and Yang, Keqing
and Chen, Juan",
title="Information Sources, Risk Perception, and Efficacy Appraisal's Prediction of Engagement in Protective Behaviors Against COVID-19 in China: Repeated Cross-sectional Survey",
journal="JMIR Hum Factors",
year="2021",
month="Jan",
day="12",
volume="8",
number="1",
pages="e23232",
keywords="information source",
keywords="perceived severity",
keywords="perceived susceptibility",
keywords="response efficacy",
keywords="self-efficacy",
keywords="health information",
keywords="protective behavior",
keywords="COVID-19",
keywords="protection",
keywords="behavior",
keywords="risk",
keywords="perception",
keywords="prediction",
abstract="Background: As the COVID-19 pandemic has become a major public health threat worldwide, it is critical to understand what factors affect individual engagement in protective actions. Because of its authoritarian political system and state-owned media system, how Chinese individuals engaged in protective actions against COVID-19 might be different compared to other countries. Objective: The purpose of this study is to examine how the source of information about COVID-19, Chinese individuals' risk perception of COVID-19 (ie, perceived severity and perceived susceptibility), and their efficacy appraisal in controlling COVID-19 (ie, response efficacy and self-efficacy) affected their engagement in protective actions. Additionally, this study aims to investigate whether there is any difference in these relationships throughout the duration of this pandemic. Methods: A six-wave repeated cross-sectional survey (N=1942) was conducted in six major cities in China between February 7 and April 23, 2020. Participants' reliance on expert versus inexpert sources for information about COVID-19, their perceived severity of and susceptibility to COVID-19, their response efficacy and self-efficacy, and their engagement in protective actions (staying at home, wearing a face mask, and washing hands) were measured. Demographic variables (sex, age, income, education, and city of residence), knowledge of COVID-19, and self-rated health condition were controlled. Results: Reliance on expert sources did not become the major factor that motivated these actions until wave 3, and the negative effect of inexpert sources on these actions was limited to wave 2. Perceived severity encouraged some protective behaviors but its effect varied depending on the specific behavior. In addition, perceived severity exhibited a stronger effect on these behaviors compared to perceived susceptibility. The positive effect of response efficacy was only significant at waves 1 and 2, and limited to certain behaviors. Conclusions: Chinese individuals' engagement in protective behaviors might not entirely be their autonomous decision but a result of compliance with executive orders. After the early outbreak, expert sources started to facilitate protective behaviors, suggesting that it might take time to develop trust in these sources. The facilitating effect of perceived severity lasted throughout the duration of the pandemic, but that of response efficacy was limited to the early stage. ",
doi="10.2196/23232",
url="http://humanfactors.jmir.org/2021/1/e23232/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33338027"
}


@Article{info:doi/10.2196/24320,
author="van den Broek-Altenburg, M. Eline
and Atherly, J. Adam
and Diehl, A. Sean
and Gleason, M. Kelsey
and Hart, C. Victoria
and MacLean, D. Charles
and Barkhuff, A. Daniel
and Levine, A. Mark
and Carney, K. Jan",
title="Jobs, Housing, and Mask Wearing: Cross-Sectional Study of Risk Factors for COVID-19",
journal="JMIR Public Health Surveill",
year="2021",
month="Jan",
day="11",
volume="7",
number="1",
pages="e24320",
keywords="COVID-19",
keywords="risk of infection",
keywords="community exposure",
keywords="self-protecting behavior",
keywords="mask wearing",
keywords="infection fatality rate",
keywords="infection",
keywords="self-protecting",
keywords="mask",
keywords="fatality rate",
keywords="exposure",
keywords="virus",
keywords="SARS-CoV-2",
abstract="Background: Many studies have focused on the characteristics of symptomatic patients with COVID-19 and clinical risk factors. This study reports the prevalence of COVID-19 in an asymptomatic population of a hospital service area (HSA) and identifies factors that affect exposure to the virus. Objective: The aim of this study is to measure the prevalence of COVID-19 in an HSA, identify factors that may increase or decrease the risk of infection, and analyze factors that increase the number of daily contacts. Methods: This study surveyed 1694 patients between April 30 and May 13, 2020, about their work and living situations, income, behavior, sociodemographic characteristics, and prepandemic health characteristics. This data was linked to testing data for 454 of these patients, including polymerase chain reaction test results and two different serologic assays. Positivity rate was used to calculate approximate prevalence, hospitalization rate, and infection fatality rate (IFR). Survey data was used to analyze risk factors, including the number of contacts reported by study participants. The data was also used to identify factors increasing the number of daily contacts, such as mask wearing and living environment. Results: We found a positivity rate of 2.2\%, a hospitalization rate of 1.2\%, and an adjusted IFR of 0.55\%. A higher number of daily contacts with adults and older adults increases the probability of becoming infected. Occupation, living in an apartment versus a house, and wearing a face mask outside work increased the number of daily contacts. Conclusions: Studying prevalence in an asymptomatic population revealed estimates of unreported COVID-19 cases. Occupational, living situation, and behavioral data about COVID-19--protective behaviors such as wearing a mask may aid in the identification of nonclinical factors affecting the number of daily contacts, which may increase SARS-CoV-2 exposure. ",
doi="10.2196/24320",
url="http://publichealth.jmir.org/2021/1/e24320/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33315576"
}


@Article{info:doi/10.2196/25174,
author="Wang, Xiaofeng
and Ren, Rui
and Kattan, W. Michael
and Jehi, Lara
and Cheng, Zhenshun
and Fang, Kuangnan",
title="Public Health Interventions' Effect on Hospital Use in Patients With COVID-19: Comparative Study",
journal="JMIR Public Health Surveill",
year="2020",
month="Dec",
day="23",
volume="6",
number="4",
pages="e25174",
keywords="COVID-19",
keywords="public health",
keywords="intervention",
keywords="hospital",
keywords="use",
keywords="prediction",
keywords="comparative",
keywords="United States",
keywords="China",
keywords="implementation",
keywords="observational",
abstract="Background: Different states in the United States had different nonpharmaceutical public health interventions during the COVID-19 pandemic. The effects of those interventions on hospital use have not been systematically evaluated. The investigation could provide data-driven evidence to potentially improve the implementation of public health interventions in the future. Objective: We aim to study two representative areas in the United States and one area in China (New York State, Ohio State, and Hubei Province), and investigate the effects of their public health interventions by time periods according to key interventions. Methods: This observational study evaluated the numbers of infected, hospitalized, and death cases in New York and Ohio from March 16 through September 14, 2020, and Hubei from January 26 to March 31, 2020. We developed novel Bayesian generalized compartmental models. The clinical stages of COVID-19 were stratified in the models, and the effects of public health interventions were modeled through piecewise exponential functions. Time-dependent transmission rates and effective reproduction numbers were estimated. The associations of interventions and the numbers of required hospital and intensive care unit beds were studied. Results: The interventions of social distancing, home confinement, and wearing masks significantly decreased (in a Bayesian sense) the case incidence and reduced the demand for beds in all areas. Ohio's transmission rates declined before the state's ``stay at home'' order, which provided evidence that early intervention is important. Wearing masks was significantly associated with reducing the transmission rates after reopening, when comparing New York and Ohio. The centralized quarantine intervention in Hubei played a significant role in further preventing and controlling the disease in that area. The estimated rates that cured patients become susceptible in all areas were small (<0.0001), which indicates that they have little chance to get the infection again. Conclusions: The series of public health interventions in three areas were temporally associated with the burden of COVID-19--attributed hospital use. Social distancing and the use of face masks should continue to prevent the next peak of the pandemic. ",
doi="10.2196/25174",
url="http://publichealth.jmir.org/2020/4/e25174/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33315585"
}


@Article{info:doi/10.2196/24206,
author="Gupta, Bhawna
and Sharma, Vyom
and Kumar, Narinder
and Mahajan, Akanksha",
title="Anxiety and Sleep Disturbances Among Health Care Workers During the COVID-19 Pandemic in India: Cross-Sectional Online Survey",
journal="JMIR Public Health Surveill",
year="2020",
month="Dec",
day="22",
volume="6",
number="4",
pages="e24206",
keywords="occupational epidemiology",
keywords="anxiety",
keywords="GAD-7",
keywords="sleep quality",
keywords="health care worker",
keywords="pandemic",
keywords="COVID-19",
keywords="online survey",
keywords="sleep",
keywords="mental health, personal protective equipment",
abstract="Background: The COVID-19 pandemic caused by SARS-CoV-2 has become a serious concern among the global medical community and has resulted in an unprecedented psychological impact on health care workers, who were already working under stressful conditions. Objective: In this study, we aimed to evaluate and measure the effects of the COVID-19 pandemic on the anxiety levels and sleep quality among health care workers in India, as well as to determine how the unavailability of personal protective equipment affects their willingness to provide patient-related care. Methods: We conducted an online cross-sectional study using piloted, structured questionnaires with self-reported responses from 368 volunteer male and female health care workers in India. Study participants were identified through social networking platforms such as Facebook and WhatsApp. The survey evaluated the participants' degree of signs and symptoms of anxiety and sleep quality based on the 7-item Generalized Anxiety Disorder (GAD-7) scale and single-item Sleep Quality Scale, respectively. Information on the availability of personal protective equipment was collected based on responses to relevant survey questions. Results: The majority of health care workers (126/368, 34.2\%) were in the age group 45-60 years, and 52.2\% (192/368) were doctors. Severe anxiety (ie, GAD-7 score >10) was observed among 7.3\% (27/368) health care workers, whereas moderate, mild, and minimal anxiety was observed among 12.5\% (46/368), 29.3\% (108/368), and 50.8\% (187/368) health care workers, respectively. Moreover, 31.5\% (116/368) of the health care workers had poor-to-fair sleep quality (ie, scores <6). Univariate analysis showed female gender and inadequate availability of personal protective equipment was significantly associated with higher anxiety levels (P=.01 for both). Sleep disturbance was significantly associated with age <30 years (P=.04) and inadequate personal protective equipment (P<.001). Multivariable analysis showed that poorer quality of sleep was associated with higher anxiety levels (P<.001). Conclusions: The COVID-19 pandemic has potentially caused significant levels of anxiety and sleep disturbances among health care workers, particularly associated with the female gender, younger age group, and inadequate availability of personal protective equipment. These factors put health care workers at constant risk of contracting the infection themselves or transmitting it to their families. Early identification of at-risk health care workers and implementation of situation-tailored mitigation measures could help alleviate the risk of long-term, serious psychological sequelae as well as reduce current anxiety levels among health care workers. ",
doi="10.2196/24206",
url="https://publichealth.jmir.org/2020/4/e24206",
url="http://www.ncbi.nlm.nih.gov/pubmed/33284784"
}


@Article{info:doi/10.2196/24614,
author="Ebrahim, Senan
and Ashworth, Henry
and Noah, Cray
and Kadambi, Adesh
and Toumi, Asmae
and Chhatwal, Jagpreet",
title="Reduction of COVID-19 Incidence and Nonpharmacologic Interventions: Analysis Using a US County--Level Policy Data Set",
journal="J Med Internet Res",
year="2020",
month="Dec",
day="21",
volume="22",
number="12",
pages="e24614",
keywords="communicable diseases",
keywords="COVID-19",
keywords="data set",
keywords="pandemic",
keywords="policy",
keywords="public health",
keywords="data",
keywords="intervention",
keywords="effectiveness",
keywords="incidence",
keywords="time series",
abstract="Background: Worldwide, nonpharmacologic interventions (NPIs) have been the main tool used to mitigate the COVID-19 pandemic. This includes social distancing measures (closing businesses, closing schools, and quarantining symptomatic persons) and contacttracing (tracking and following exposed individuals). While preliminary research across the globe has shown these policies to be effective, there is currently a lack of information on the effectiveness of NPIs in the United States. Objective: The purpose of this study was to create a granular NPI data set at the county level and then analyze the relationship between NPI policies and changes in reported COVID-19 cases. Methods: Using a standardized crowdsourcing methodology, we collected time-series data on 7 key NPIs for 1320 US counties. Results: This open-source data set is the largest and most comprehensive collection of county NPI policy data and meets the need for higher-resolution COVID-19 policy data. Our analysis revealed a wide variation in county-level policies both within and among states (P<.001). We identified a correlation between workplace closures and lower growth rates of COVID-19 cases (P=.004). We found weak correlations between shelter-in-place enforcement and measures of Democratic local voter proportion (R=0.21) and elected leadership (R=0.22). Conclusions: This study is the first large-scale NPI analysis at the county level demonstrating a correlation between NPIs and decreased rates of COVID-19. Future work using this data set will explore the relationship between county-level policies and COVID-19 transmission to optimize real-time policy formulation. ",
doi="10.2196/24614",
url="http://www.jmir.org/2020/12/e24614/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33302253"
}


@Article{info:doi/10.2196/24775,
author="Wang, Yilin
and Wu, Peijing
and Liu, Xiaoqian
and Li, Sijia
and Zhu, Tingshao
and Zhao, Nan",
title="Subjective Well-Being of Chinese Sina Weibo Users in Residential Lockdown During the COVID-19 Pandemic: Machine Learning Analysis",
journal="J Med Internet Res",
year="2020",
month="Dec",
day="17",
volume="22",
number="12",
pages="e24775",
keywords="COVID-19",
keywords="residential lockdown",
keywords="subjective well-being",
keywords="online ecological recognition",
abstract="Background: During the COVID-19 pandemic, residential lockdowns were implemented in numerous cities in China to contain the rapid spread of the disease. Although these stringent regulations effectively slowed the spread of COVID-19, they may have posed challenges to the well-being of residents. Objective: This study aims to explore the effects of residential lockdown on the subjective well-being (SWB) of individuals in China during the COVID-19 pandemic. Methods: The sample consisted of 1790 Sina Weibo users who were residents of cities that imposed residential lockdowns, of which 1310 users (73.18\%) were female, and 3580 users who were residents of cities that were not locked down (gender-matched with the 1790 lockdown residents). In both the lockdown and nonlockdown groups, we calculated SWB indicators during the 2 weeks before and after the enforcement date of the residential lockdown using individuals' original posts on Sina Weibo. SWB was calculated via online ecological recognition, which is based on established machine learning predictive models. Results: The interactions of time (before the residential lockdown or after the residential lockdown) {\texttimes} area (lockdown or nonlockdown) in the integral analysis (N=5370) showed that after the residential lockdown, compared with the nonlockdown group, the lockdown group scored lower in some negative SWB indicators, including somatization (F1,5368=13.593, P<.001) and paranoid ideation (F1,5368=14.333, P<.001). The interactions of time (before the residential lockdown or after the residential lockdown) {\texttimes} area (developed or underdeveloped) in the comparison of residential lockdown areas with different levels of economic development (N=1790) indicated that the SWB of residents in underdeveloped areas showed no significant change after the residential lockdown (P>.05), while that of residents in developed areas changed. Conclusions: These findings increase our understanding of the psychological impact and cost of residential lockdown during an epidemic. The more negative changes in the SWB of residents in developed areas imply a greater need for psychological intervention under residential lockdown in such areas. ",
doi="10.2196/24775",
url="http://www.jmir.org/2020/12/e24775/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33290247"
}


@Article{info:doi/10.2196/25595,
author="Suppan, Laurent
and Abbas, Mohamed
and Catho, Gaud
and Stuby, Loric
and Regard, Simon
and Harbarth, Stephan
and Achab, Sophia
and Suppan, M{\'e}lanie",
title="Impact of a Serious Game on the Intention to Change Infection Prevention and Control Practices in Nursing Homes During the COVID-19 Pandemic: Protocol for a Web-Based Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2020",
month="Dec",
day="15",
volume="9",
number="12",
pages="e25595",
keywords="COVID-19",
keywords="transmission",
keywords="serious game",
keywords="infection prevention",
keywords="health care worker",
keywords="SARS-COV-2",
keywords="nursing home",
keywords="randomized controlled trial",
keywords="elderly",
keywords="older adult",
keywords="infection control",
keywords="infectious disease",
abstract="Background: Nursing home residents are at high risk of complications and death due to COVID-19. Lack of resources, both human and material, amplifies the likelihood of contamination in these facilities where a single employee can contaminate dozens of residents and colleagues. Improving the dissemination of and adhesion to infection prevention and control (IPC) guidelines is therefore essential. Serious games have been shown to be effective in developing knowledge and in increasing engagement, and could motivate nursing home employees to change their IPC practices. Objective: Our aim is to assess the impact of ``Escape COVID-19,'' a serious game designed to enhance knowledge and application of IPC procedures, on the intention of nursing home employees to change their IPC practices. Methods: We will carry out a web-based randomized controlled trial following the CONSORT-EHEALTH (Consolidated Standards of Reporting Trials of Electronic and Mobile Health Applications and Online Telehealth) guidelines and incorporating relevant elements of CHERRIES (Checklist for Reporting Results of Internet E-Surveys). Participants will be randomized to either the control or the serious game (intervention) group. First, both groups will be asked to answer a questionnaire designed to gather demographic data and assess baseline knowledge. The control group will then receive a quick reminder of the current national guidelines and links to IPC guidelines for health care professionals, while the other group will play the game. Both groups will then have to answer a second questionnaire designed to assess their willingness to change their IPC practices after having followed their respective material. After completing this questionnaire, they will be granted access to the material presented to the group they were not assigned to and receive a course completion certificate. The primary outcome will be the proportion of participants willing to change their IPC practices according to group. Secondary outcomes will include the analysis of specific questions detailing the exact changes considered by the participants. Factors associated with participant willingness or reluctance to change behavior will also be assessed. Attrition will also be assessed at each stage of the study. Results: The study protocol has been presented to our regional ethics committee (Req-2020-01262), which issued a declaration of no objection as such projects do not fall within the scope of the Swiss federal law on human research. Data collection began on November 5, 2020, and should be completed by December 4, 2020. Conclusions: This study should determine whether ``Escape COVID-19,'' a serious game designed to improve compliance with COVID-19 safe practices, modifies the intention to follow IPC guidelines among nursing home employees. International Registered Report Identifier (IRRID): DERR1-10.2196/25595 ",
doi="10.2196/25595",
url="http://www.researchprotocols.org/2020/12/e25595/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33296329"
}


@Article{info:doi/10.2196/21499,
author="Xu, Paiheng
and Dredze, Mark
and Broniatowski, A. David",
title="The Twitter Social Mobility Index: Measuring Social Distancing Practices With Geolocated Tweets",
journal="J Med Internet Res",
year="2020",
month="Dec",
day="3",
volume="22",
number="12",
pages="e21499",
keywords="COVID-19",
keywords="social distancing",
keywords="mobility",
keywords="Twitter",
keywords="social media",
keywords="surveillance",
keywords="tracking",
keywords="travel",
keywords="index",
abstract="Background: Social distancing is an important component of the response to the COVID-19 pandemic. Minimizing social interactions and travel reduces the rate at which the infection spreads and ``flattens the curve'' so that the medical system is better equipped to treat infected individuals. However, it remains unclear how the public will respond to these policies as the pandemic continues. Objective: The aim of this study is to present the Twitter Social Mobility Index, a measure of social distancing and travel derived from Twitter data. We used public geolocated Twitter data to measure how much users travel in a given week. Methods: We collected 469,669,925 tweets geotagged in the United States from January 1, 2019, to April 27, 2020. We analyzed the aggregated mobility variance of a total of 3,768,959 Twitter users at the city and state level from the start of the COVID-19 pandemic. Results: We found a large reduction (61.83\%) in travel in the United States after the implementation of social distancing policies. However, the variance by state was high, ranging from 38.54\% to 76.80\%. The eight states that had not issued statewide social distancing orders as of the start of April ranked poorly in terms of travel reduction: Arkansas (45), Iowa (37), Nebraska (35), North Dakota (22), South Carolina (38), South Dakota (46), Oklahoma (50), Utah (14), and Wyoming (53). We are presenting our findings on the internet and will continue to update our analysis during the pandemic. Conclusions: We observed larger travel reductions in states that were early adopters of social distancing policies and smaller changes in states without such policies. The results were also consistent with those based on other mobility data to a certain extent. Therefore, geolocated tweets are an effective way to track social distancing practices using a public resource, and this tracking may be useful as part of ongoing pandemic response planning. ",
doi="10.2196/21499",
url="https://www.jmir.org/2020/12/e21499",
url="http://www.ncbi.nlm.nih.gov/pubmed/33048823"
}


@Article{info:doi/10.2196/23194,
author="Du, Li
and Raposo, L{\'u}cia Vera
and Wang, Meng",
title="COVID-19 Contact Tracing Apps: A Technologic Tower of Babel and the Gap for International Pandemic Control",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Nov",
day="27",
volume="8",
number="11",
pages="e23194",
keywords="COVID-19",
keywords="contact tracing apps",
keywords="privacy",
keywords="public health",
keywords="global health",
doi="10.2196/23194",
url="http://mhealth.jmir.org/2020/11/e23194/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33156804"
}


@Article{info:doi/10.2196/21672,
author="Cui, Tingting
and Yang, Guoping
and Ji, Lili
and Zhu, Lin
and Zhen, Shiqi
and Shi, Naiyang
and Xu, Yan
and Jin, Hui",
title="Chinese Residents' Perceptions of COVID-19 During the Pandemic: Online Cross-sectional Survey Study",
journal="J Med Internet Res",
year="2020",
month="Nov",
day="25",
volume="22",
number="11",
pages="e21672",
keywords="COVID-19",
keywords="perception",
keywords="China",
keywords="cross-sectional survey",
keywords="health education",
keywords="time-varying reproduction number",
keywords="knowledge",
keywords="skill",
keywords="behavior",
keywords="work resumption",
keywords="study resumption",
abstract="Background: COVID-19 has posed a global threat due to substantial morbidity and mortality, and health education strategies need to be adjusted accordingly to prevent a possible epidemic rebound. Objective: This study aimed to evaluate the perceptions of COVID-19 among individuals coming to, returning to, or living in Jiangsu Province, China, and determine the impact of the pandemic on the perceptions of the public. Methods: In this study, an online questionnaire was distributed to participants between February 15 and April 21, 2020. The questionnaire comprised items on personal information (eg, sex, age, educational level, and occupation); protection knowledge, skills, and behaviors related to COVID-19; access to COVID-19--related information; and current information needs. Factors influencing the knowledge score, skill score, behavior score, and total score for COVID-19 were evaluated using univariate and multivariate analyses. The time-varying reproduction number (Rt) and its 95\% credible interval were calculated and compared with the daily participation number and protection scores. Results: In total, 52,066 participants were included in the study; their average knowledge score, skill score, behavior score, and total score were 25.58 (SD 4.22), 24.05 (SD 4.02), 31.51 (SD 2.84), and 90.02 (SD 8.87), respectively, and 65.91\% (34,315/52,066) had a total protection score above 90 points. For the knowledge and skill sections, correct rates of answers to questions on medical observation days, infectiousness of asymptomatic individuals, cough or sneeze treatment, and precautions were higher than 95\%, while those of questions on initial symptoms (32,286/52,066, 62.01\%), transmission routes (37,134/52,066, 71.32\%), selection of disinfection products (37,390/52,066, 71.81\%), and measures of home quarantine (40,037/52,066, 76.90\%) were relatively low. For the actual behavior section, 97.93\% (50,989/52,066) of participants could wear masks properly when going out. However, 19.76\% (10,290/52,066) could not disinfect their homes each week, and 18.42\% (9589/52,066) could not distinguish differences in initial symptoms between the common cold and COVID-19. The regression analyses showed that the knowledge score, skill score, behavior score, and total score were influenced by sex, age, educational level, occupation, and place of residence at different degrees (P<.001). The government, television shows, and news outlets were the main sources of protection knowledge, and the information released by the government and authoritative medical experts was considered the most reliable. The current information needs included the latest epidemic developments, disease treatment progress, and daily protection knowledge. The Rt in the Jiangsu Province and mainland China dropped below 1, while the global Rt remained at around 1. The maximal information coefficients ranged from 0.76 to 1.00, which indicated that the public's perceptions were significantly associated with the epidemic. Conclusions: A high proportion of the participants had sufficient COVID-19 protection knowledge and skills and were able to avoid risky behaviors. Thus, it is necessary to apply different health education measures tailored to work and study resumption for specific populations to improve their self-protection and, ultimately, to prevent a possible rebound of COVID-19. ",
doi="10.2196/21672",
url="http://www.jmir.org/2020/11/e21672/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33152684"
}


@Article{info:doi/10.2196/23019,
author="Al-Hasan, Abrar
and Khuntia, Jiban
and Yim, Dobin",
title="Threat, Coping, and Social Distance Adherence During COVID-19: Cross-Continental Comparison Using an Online Cross-Sectional Survey",
journal="J Med Internet Res",
year="2020",
month="Nov",
day="18",
volume="22",
number="11",
pages="e23019",
keywords="COVID-19",
keywords="adherence",
keywords="coping appraisal",
keywords="threat appraisal",
keywords="protection motivation theory",
keywords="social distancing",
keywords="information sources",
keywords="social media",
keywords="knowledge",
keywords="coping",
keywords="threat",
keywords="protection",
keywords="motivation",
keywords="cross-sectional",
keywords="survey",
abstract="Background: Social distancing is an effective preventative policy for COVID-19 that is enforced by governments worldwide. However, significant variations are observed in adherence to social distancing across individuals and countries. Due to the lack of treatment, rapid spread, and prevalence of COVID-19, panic and fear associated with the disease causes great stress. Subsequent effects will be a variation around the coping and mitigation strategies for different individuals following different paths to manage the situation. Objective: This study aims to explore how threat and coping appraisal processes work as mechanisms between information and citizens' adherence to COVID-19--related recommendations (ie, how the information sources and social media influence threat and coping appraisal processes with COVID-19 and how the threat and coping appraisal processes influence adherence to policy guidelines). In addition, this study aims to explore how citizens in three different countries (the United States, Kuwait, and South Korea), randomly sampled, are effectively using the mechanisms. Methods: Randomly sampled online survey data collected by a global firm in May 2020 from 162 citizens of the United States, 185 of Kuwait, and 71 of South Korea were analyzed, resulting in a total sample size of 418. A seemingly unrelated regression model, controlling for several counterfactuals, was used for analysis. The study's focal estimated effects were compared across the three countries using the weighted distance between the parameter estimates. Results: The seemingly unrelated regression model estimation results suggested that, overall, the intensity of information source use for the COVID-19 pandemic positively influenced the threat appraisal for the disease (P<.001). Furthermore, the intensity of social media use for the COVID-19 pandemic positively influenced the coping appraisal for the disease (P<.001). Higher COVID-19 threat appraisal had a positive effect on social distancing adherence (P<.001). Higher COVID-19 coping appraisal had a positive effect on social distancing adherence (P<.001). Higher intensity of COVID-19 knowledge positively influenced social distancing adherence (P<.001). There were country-level variations. Broadly, we found that the United States had better results than South Korea and Kuwait in leveraging the information to threat and coping appraisal to the adherence process, indicating that individuals in countries like the United States and South Korea may be more pragmatic to appraise the situation before making any decisions. Conclusions: This study's findings suggest that the mediation of threat and coping strategies are essential, in varying effects, to shape the information and social media strategies for adherence outcomes. Accordingly, coordinating public service announcements along with information source outlets such as mainstream media (eg, TV and newspaper) as well as social media (eg, Facebook and Twitter) to inform citizens and, at the same time, deliver balanced messages about the threat and coping appraisal is critical in implementing a staggered social distancing and sheltering strategy. ",
doi="10.2196/23019",
url="http://www.jmir.org/2020/11/e23019/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33119538"
}


@Article{info:doi/10.2196/20656,
author="Li, Mengyao
and Liu, Li
and Yang, Yilong
and Wang, Yang
and Yang, Xiaoshi
and Wu, Hui",
title="Psychological Impact of Health Risk Communication and Social Media on College Students During the COVID-19 Pandemic: Cross-Sectional Study",
journal="J Med Internet Res",
year="2020",
month="Nov",
day="18",
volume="22",
number="11",
pages="e20656",
keywords="COVID-19",
keywords="anxiety",
keywords="panic",
keywords="health risk",
keywords="communication",
keywords="social media",
abstract="Background: The outbreak of COVID-19 began in 2019 and is expected to impact the psychological health of college students. Few studies have investigated the associations among health risk communication, social media, and psychological symptoms during a major pandemic. Objective: The aim of this research was to assess the prevalence of psychological symptoms among college students and explore their associations with health risk communication and social media. Methods: A web-based survey was distributed through the Wenjuanxing platform among Chinese college students from March 3-15, 2020. In addition to demographics, information on health risk communication and social media was collected, and the Symptom Checklist 90 Phobia and Health Anxiety Inventory subscale was used to assess psychological symptoms among 1676 college students in China. Multivariable logistic regression was performed to examine these independent risk factors. Results: The prevalence of panic and health anxiety was 17.2\% (288/1676) and 24.3\% (408/1676), respectively. Regarding risk communication, understanding the risk of COVID-19 (odds ratio [OR] 0.480, 95\% CI 0.367-0.627) was a protective factor against panic. Knowledge of prognosis (OR 0.708, 95\% CI 0.551-0.910), preventive measures (OR 0.380, 95\% CI 0.195-0.742), and wearing face masks (OR 0.445, 95\% CI 0.230-0.862) were shown to be protective factors in predicting health anxiety. Perceived lethality (OR 1.860, 95\% CI 1.408-2.459), being affected by the global spread (OR 1.936, 95\% CI 1.405-2.669), and impact on social contacts (OR 1.420, 95\% CI 1.118-1.802) were identified as significant risk factors associated with health anxiety. In terms of social media, trust in mainstream media (OR 0.613, 95\% CI 0.461-0.816) was considered to be a protective factor against health anxiety. Conclusions: There was a high prevalence of psychological symptoms among college students. Health risk communication and social media use were important in predicting psychological symptoms, especially health anxiety. Scientific and evidence-based information should be reported by social media platforms. Web-based consultation and intervention measures should be the focus of future studies. ",
doi="10.2196/20656",
url="http://www.jmir.org/2020/11/e20656/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33108308"
}


@Article{info:doi/10.2196/22205,
author="Lee, Jae Jung
and Kang, Kyung-Ah
and Wang, Ping Man
and Zhao, Zhi Sheng
and Wong, Ha Janet Yuen
and O'Connor, Siobhan
and Yang, Ching Sook
and Shin, Sunhwa",
title="Associations Between COVID-19 Misinformation Exposure and Belief With COVID-19 Knowledge and Preventive Behaviors: Cross-Sectional Online Study",
journal="J Med Internet Res",
year="2020",
month="Nov",
day="13",
volume="22",
number="11",
pages="e22205",
keywords="COVID-19",
keywords="misinformation",
keywords="infodemic",
keywords="infodemiology",
keywords="anxiety",
keywords="depression",
keywords="PTSD",
keywords="knowledge",
keywords="preventive behaviors",
keywords="prevention",
keywords="behavior",
abstract="Background: Online misinformation proliferation during the COVID-19 pandemic has become a major public health concern. Objective: We aimed to assess the prevalence of COVID-19 misinformation exposure and beliefs, associated factors including psychological distress with misinformation exposure, and the associations between COVID-19 knowledge and number of preventive behaviors. Methods: A cross-sectional online survey was conducted with 1049 South Korean adults in April 2020. Respondents were asked about receiving COVID-19 misinformation using 12 items identified by the World Health Organization. Logistic regression was used to compute adjusted odds ratios (aORs) for the association of receiving misinformation with sociodemographic characteristics, source of information, COVID-19 misinformation belief, and psychological distress, as well as the associations of COVID-19 misinformation belief with COVID-19 knowledge and the number of COVID-19 preventive behaviors among those who received the misinformation. All data were weighted according to the Korea census data in 2018. Results: Overall, 67.78\% (n=711) of respondents reported exposure to at least one COVID-19 misinformation item. Misinformation exposure was associated with younger age, higher education levels, and lower income. Sources of information associated with misinformation exposure were social networking services (aOR 1.67, 95\% CI 1.20-2.32) and instant messaging (aOR 1.79, 1.27-2.51). Misinformation exposure was also associated with psychological distress including anxiety (aOR 1.80, 1.24-2.61), depressive (aOR 1.47, 1.09-2.00), and posttraumatic stress disorder symptoms (aOR 1.97, 1.42-2.73), as well as misinformation belief (aOR 7.33, 5.17-10.38). Misinformation belief was associated with poorer COVID-19 knowledge (high: aOR 0.62, 0.45-0.84) and fewer preventive behaviors (?7 behaviors: aOR 0.54, 0.39-0.74). Conclusions: COVID-19 misinformation exposure was associated with misinformation belief, while misinformation belief was associated with fewer preventive behaviors. Given the potential of misinformation to undermine global efforts in COVID-19 disease control, up-to-date public health strategies are required to counter the proliferation of misinformation. ",
doi="10.2196/22205",
url="http://www.jmir.org/2020/11/e22205/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33048825"
}


@Article{info:doi/10.2196/21372,
author="Xu, Hong
and Gan, Yong
and Zheng, Daikun
and Wu, Bo
and Zhu, Xian
and Xu, Chang
and Liu, Chenglu
and Tao, Zhou
and Hu, Yaoyue
and Chen, Min
and Li, Mingjing
and Lu, Zuxun
and Chen, Jack",
title="Relationship Between COVID-19 Infection and Risk Perception, Knowledge, Attitude, and Four Nonpharmaceutical Interventions During the Late Period of the COVID-19 Epidemic in China: Online Cross-Sectional Survey of 8158 Adults",
journal="J Med Internet Res",
year="2020",
month="Nov",
day="13",
volume="22",
number="11",
pages="e21372",
keywords="COVID-19",
keywords="nonpharmaceutical personal interventions",
keywords="NPI",
keywords="public health",
keywords="mask wearing",
keywords="intervention",
keywords="infection",
keywords="risk perception",
keywords="knowledge",
keywords="attitude",
keywords="online survey",
keywords="China",
abstract="Background: So far, there have been no published population studies on the relationship between a COVID-19 infection and public risk perception, information source, knowledge, attitude, and behaviors during the COVID-19 outbreak in China. Objective: This study aims to understand the relationships between COVID-19 infection; four personal nonpharmaceutical interventions (NPIs; handwashing, proper coughing habits, social distancing, and mask wearing); and public risk perception, knowledge, attitude, and other social demographic variables. Methods: An online survey of 8158 Chinese adults between February 22 and March 5, 2020, was conducted. Bivariate associations between categorical variables were examined using Fisher exact test. We also explored the determinants of four NPIs as well as their association with COVID-19 infection using logistic regression. Results: Of 8158 adults included, 57 (0.73\%) were infected with COVID-19. The overwhelming majority of respondents showed a positive attitude (n=8094, 99.2\%), positive risk perception (n=8146, 99.9\%), and high knowledge levels that were among the strongest predictors of the four adopted NPIs (handwashing: n=7895, 96.8\%; proper coughing: 5997/6444, 93.1\%; social distancing: n=7104/8158, 87.1\%; and mask wearing: 5011/5120, 97.9\%). There was an increased risk of COVID-19 infection for those who did not wash their hands (2.28\% vs 0.65\%; risk ratio [RR] 3.53, 95\% CI 1.53-8.15; P=.009), did not practice proper coughing (1.79\% vs 0.73\%; RR 2.44, 95\% CI 1.15-5.15; P=.03), did not practice social distancing (1.52\% vs 0.58\%; RR 2.63, 95\% CI 1.48-4.67; P=.002), and did not wear a mask (7.41\% vs 0.6\%; RR 12.38, 95\% CI 5.81-26.36; P<.001). For those who did practice all other three NPIs, wearing a mask was associated with a significantly reduced risk of infection compared to those who did not wear a mask (0.6\% vs 16.7\%; P=.04). Similarly, for those who did not practice all or part of the other three NPIs, wearing a mask was also associated with a significantly reduced risk of infection. In a penalized logistic regression model including all four NPIs, wearing a mask was the only significant predictor of COVID-19 infection among the four NPIs (odds ratio 7.20, 95\% CI 2.24-23.11; P<.001). Conclusions: We found high levels of risk perception, positive attitude, desirable knowledge, as well as a high level of adopting the four NPIs. The relevant knowledge, risk perception, and attitude were strong predictors of adapting the four NPIs. Mask wearing, among the four personal NPIs, was the most effective protective measure against COVID-19 infection, with added preventive effect among those who practiced all or part of the other three NPIs. ",
doi="10.2196/21372",
url="http://www.jmir.org/2020/11/e21372/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33108317"
}


@Article{info:doi/10.2196/22894,
author="Do, N. Binh
and Tran, V. Tien
and Phan, T. Dung
and Nguyen, C. Hoang
and Nguyen, P. Thao T.
and Nguyen, C. Huu
and Ha, H. Tung
and Dao, K. Hung
and Trinh, V. Manh
and Do, V. Thinh
and Nguyen, Q. Hung
and Vo, T. Tam
and Nguyen, T. Nhan P.
and Tran, Q. Cuong
and Tran, V. Khanh
and Duong, T. Trang
and Pham, X. Hai
and Nguyen, V. Lam
and Nguyen, T. Kien
and Chang, S. Peter W.
and Duong, Van Tuyen",
title="Health Literacy, eHealth Literacy, Adherence to Infection Prevention and Control Procedures, Lifestyle Changes, and Suspected COVID-19 Symptoms Among Health Care Workers During Lockdown: Online Survey",
journal="J Med Internet Res",
year="2020",
month="Nov",
day="12",
volume="22",
number="11",
pages="e22894",
keywords="COVID-19",
keywords="health literacy",
keywords="eHealth literacy",
keywords="health care workers",
keywords="personal protective equipment",
keywords="handwashing",
keywords="masks",
keywords="disposing",
keywords="lifestyle",
keywords="Vietnam",
keywords="eHealth",
keywords="adherence",
keywords="infection prevention",
keywords="control",
abstract="Background: The COVID-19 pandemic has imposed a heavy burden on health care systems and governments. Health literacy (HL) and eHealth literacy (as measured by the eHealth Literacy Scale [eHEALS]) are recognized as strategic public health elements but they have been underestimated during the pandemic. HL, eHEALS score, practices, lifestyles, and the health status of health care workers (HCWs) play crucial roles in containing the COVID-19 pandemic. Objective: The aim of this study is to evaluate the psychometric properties of the eHEALS and examine associations of HL and eHEALS scores with adherence to infection prevention and control (IPC) procedures, lifestyle changes, and suspected COVID-19 symptoms among HCWs during lockdown. Methods: We conducted an online survey of 5209 HCWs from 15 hospitals and health centers across Vietnam from April 6 to April 19, 2020. Participants answered questions related to sociodemographics, HL, eHEALS, adherence to IPC procedures, behavior changes in eating, smoking, drinking, and physical activity, and suspected COVID-19 symptoms. Principal component analysis, correlation analysis, and bivariate and multivariate linear and logistic regression models were used to validate the eHEALS and examine associations. Results: The eHEALS had a satisfactory construct validity with 8 items highly loaded on one component, with factor loadings ranked from 0.78 to 0.92 explaining 76.34\% of variance; satisfactory criterion validity as correlated with HL ($\rho$=0.42); satisfactory convergent validity with high item-scale correlations ($\rho$=0.80-0.84); and high internal consistency (Cronbach $\alpha$=.95). HL and eHEALS scores were significantly higher in men (unstandardized coefficient [B]=1.01, 95\% CI 0.57-1.45, P<.001; B=0.72, 95\% CI 0.43-1.00, P<.001), those with a better ability to pay for medication (B=1.65, 95\% CI 1.25-2.05, P<.001; B=0.60, 95\% CI 0.34-0.86, P<.001), doctors (B=1.29, 95\% CI 0.73-1.84, P<.001; B 0.56, 95\% CI 0.20-0.93, P=.003), and those with epidemic containment experience (B=1.96, 95\% CI 1.56-2.37, P<.001; B=0.64, 95\% CI 0.38-0.91, P<.001), as compared to their counterparts, respectively. HCWs with higher HL or eHEALS scores had better adherence to IPC procedures (B=0.13, 95\% CI 0.10-0.15, P<.001; B=0.22, 95\% CI 0.19-0.26, P<.001), had a higher likelihood of healthy eating (odds ratio [OR] 1.04, 95\% CI 1.01-1.06, P=.001; OR 1.04, 95\% CI 1.02-1.07, P=.002), were more physically active (OR 1.03, 95\% CI 1.02-1.03, P<.001; OR 1.04, 95\% CI 1.03-1.05, P<.001), and had a lower likelihood of suspected COVID-19 symptoms (OR 0.97, 95\% CI 0.96-0.98, P<.001; OR 0.96, 95\% CI 0.95-0.98, P<.001), respectively. Conclusions: The eHEALS is a valid and reliable survey tool. Gender, ability to pay for medication, profession, and epidemic containment experience were independent predictors of HL and eHEALS scores. HCWs with higher HL or eHEALS scores had better adherence to IPC procedures, healthier lifestyles, and a lower likelihood of suspected COVID-19 symptoms. Efforts to improve HCWs' HL and eHEALS scores can help to contain the COVID-19 pandemic and minimize its consequences. ",
doi="10.2196/22894",
url="https://www.jmir.org/2020/11/e22894",
url="http://www.ncbi.nlm.nih.gov/pubmed/33122164"
}


@Article{info:doi/10.2196/23853,
author="Cao, Zicheng
and Tang, Feng
and Chen, Cai
and Zhang, Chi
and Guo, Yichen
and Lin, Ruizhen
and Huang, Zhihong
and Teng, Yi
and Xie, Ting
and Xu, Yutian
and Song, Yanxin
and Wu, Feng
and Dong, Peipei
and Luo, Ganfeng
and Jiang, Yawen
and Zou, Huachun
and Chen, Yao-Qing
and Sun, Litao
and Shu, Yuelong
and Du, Xiangjun",
title="Impact of Systematic Factors on the Outbreak Outcomes of the Novel COVID-19 Disease in China: Factor Analysis Study",
journal="J Med Internet Res",
year="2020",
month="Nov",
day="11",
volume="22",
number="11",
pages="e23853",
keywords="COVID-19",
keywords="new cases",
keywords="growth rate",
keywords="multidimensional factors",
keywords="statistical machine learning",
abstract="Background: The novel COVID-19 disease has spread worldwide, resulting in a new pandemic. The Chinese government implemented strong intervention measures in the early stage of the epidemic, including strict travel bans and social distancing policies. Prioritizing the analysis of different contributing factors to outbreak outcomes is important for the precise prevention and control of infectious diseases. We proposed a novel framework for resolving this issue and applied it to data from China. Objective: This study aimed to systematically identify national-level and city-level contributing factors to the control of COVID-19 in China. Methods: Daily COVID-19 case data and related multidimensional data, including travel-related, medical, socioeconomic, environmental, and influenza-like illness factors, from 343 cities in China were collected. A correlation analysis and interpretable machine learning algorithm were used to evaluate the quantitative contribution of factors to new cases and COVID-19 growth rates during the epidemic period (ie, January 17 to February 29, 2020). Results: Many factors correlated with the spread of COVID-19 in China. Travel-related population movement was the main contributing factor for new cases and COVID-19 growth rates in China, and its contributions were as high as 77\% and 41\%, respectively. There was a clear lag effect for travel-related factors (previous vs current week: new cases, 45\% vs 32\%; COVID-19 growth rates, 21\% vs 20\%). Travel from non-Wuhan regions was the single factor with the most significant impact on COVID-19 growth rates (contribution: new cases, 12\%; COVID-19 growth rate, 26\%), and its contribution could not be ignored. City flow, a measure of outbreak control strength, contributed 16\% and 7\% to new cases and COVID-19 growth rates, respectively. Socioeconomic factors also played important roles in COVID-19 growth rates in China (contribution, 28\%). Other factors, including medical, environmental, and influenza-like illness factors, also contributed to new cases and COVID-19 growth rates in China. Based on our analysis of individual cities, compared to Beijing, population flow from Wuhan and internal flow within Wenzhou were driving factors for increasing the number of new cases in Wenzhou. For Chongqing, the main contributing factor for new cases was population flow from Hubei, beyond Wuhan. The high COVID-19 growth rates in Wenzhou were driven by population-related factors. Conclusions: Many factors contributed to the COVID-19 outbreak outcomes in China. The differential effects of various factors, including specific city-level factors, emphasize the importance of precise, targeted strategies for controlling the COVID-19 outbreak and future infectious disease outbreaks. ",
doi="10.2196/23853",
url="http://www.jmir.org/2020/11/e23853/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33098287"
}


@Article{info:doi/10.2196/23148,
author="Huang, Zhilian
and Guo, Huiling
and Lee, Yee-Mun
and Ho, Chin Eu
and Ang, Hou
and Chow, Angela",
title="Performance of Digital Contact Tracing Tools for COVID-19 Response in Singapore: Cross-Sectional Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Oct",
day="29",
volume="8",
number="10",
pages="e23148",
keywords="infectious disease",
keywords="real-time locating systems",
keywords="electronic medical records",
keywords="COVID-19",
keywords="contact tracing",
keywords="public health",
abstract="Background: Effective contact tracing is labor intensive and time sensitive during the COVID-19 pandemic, but also essential in the absence of effective treatment and vaccines. Singapore launched the first Bluetooth-based contact tracing app---TraceTogether---in March 2020 to augment Singapore's contact tracing capabilities. Objective: This study aims to compare the performance of the contact tracing app---TraceTogether---with that of a wearable tag-based real-time locating system (RTLS) and to validate them against the electronic medical records at the National Centre for Infectious Diseases (NCID), the national referral center for COVID-19 screening. Methods: All patients and physicians in the NCID screening center were issued RTLS tags (CADI Scientific) for contact tracing. In total, 18 physicians were deployed to the NCID screening center from May 10 to May 20, 2020. The physicians activated the TraceTogether app (version 1.6; GovTech) on their smartphones during shifts and urged their patients to use the app. We compared patient contacts identified by TraceTogether and those identified by RTLS tags within the NCID vicinity during physicians' 10-day posting. We also validated both digital contact tracing tools by verifying the physician-patient contacts with the electronic medical records of 156 patients who attended the NCID screening center over a 24-hour time frame within the study period. Results: RTLS tags had a high sensitivity of 95.3\% for detecting patient contacts identified either by the system or TraceTogether while TraceTogether had an overall sensitivity of 6.5\% and performed significantly better on Android phones than iPhones (Android: 9.7\%, iPhone: 2.7\%; P<.001). When validated against the electronic medical records, RTLS tags had a sensitivity of 96.9\% and specificity of 83.1\%, while TraceTogether only detected 2 patient contacts with physicians who did not attend to them. Conclusions: TraceTogether had a much lower sensitivity than RTLS tags for identifying patient contacts in a clinical setting. Although the tag-based RTLS performed well for contact tracing in a clinical setting, its implementation in the community would be more challenging than TraceTogether. Given the uncertainty of the adoption and capabilities of contact tracing apps, policy makers should be cautioned against overreliance on such apps for contact tracing. Nonetheless, leveraging technology to augment conventional manual contact tracing is a necessary move for returning some normalcy to life during the long haul of the COVID-19 pandemic. ",
doi="10.2196/23148",
url="http://mhealth.jmir.org/2020/10/e23148/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33006944"
}


@Article{info:doi/10.2196/22305,
author="Herbert, Jeremy
and Horsham, Caitlin
and Ford, Helen
and Wall, Alexander
and Hacker, Elke",
title="Deployment of a Smart Handwashing Station in a School Setting During the COVID-19 Pandemic: Field Study",
journal="JMIR Public Health Surveill",
year="2020",
month="Oct",
day="19",
volume="6",
number="4",
pages="e22305",
keywords="COVID-19",
keywords="hand hygiene",
keywords="health promotion",
keywords="public health",
keywords="preventive medicine",
keywords="digital health technology",
abstract="Background: Hand hygiene is one of the most effective ways to remove germs, prevent the spread of infectious pathogens, and avoid getting sick. Since the COVID-19 pandemic began, health authorities have been advocating good hand hygiene practices. Objective: The primary aim of this study is to field test a prototype smart handwashing station deployed in a school setting during the COVID-19 pandemic. Methods: We deployed a smart handwashing station and examined key technological considerations including connectivity, security, and data management systems, as well as the health and safety of users. Results: The smart handwashing station was deployed for 10 days in a school setting in Australia during the COVID-19 pandemic. The smart handwashing station's electrical components remained operational during field testing and underwent robust cleaning protocols each day. The handwashing station was used 1138 times during the field test and there was no COVID-19 transmission at the school during the testing. Conclusions: This study demonstrates that a personalized feedback approach using technology can successfully be implemented at a school and can provide a platform to improve hand hygiene among school-aged children. ",
doi="10.2196/22305",
url="http://publichealth.jmir.org/2020/4/e22305/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33006559"
}


@Article{info:doi/10.2196/19878,
author="Liu, Ping-Yen
and Tsai, Yi-Shan
and Chen, Po-Lin
and Tsai, Huey-Pin
and Hsu, Ling-Wei
and Wang, Chi-Shiang
and Lee, Nan-Yao
and Huang, Mu-Shiang
and Wu, Yun-Chiao
and Ko, Wen-Chien
and Yang, Yi-Ching
and Chiang, Jung-Hsien
and Shen, Meng-Ru",
title="Application of an Artificial Intelligence Trilogy to Accelerate Processing of Suspected Patients With SARS-CoV-2 at a Smart Quarantine Station: Observational Study",
journal="J Med Internet Res",
year="2020",
month="Oct",
day="14",
volume="22",
number="10",
pages="e19878",
keywords="SARS-CoV-2",
keywords="COVID-19",
keywords="artificial intelligence",
keywords="smart device assisted decision making",
keywords="quarantine station",
abstract="Background: As the COVID-19 epidemic increases in severity, the burden of quarantine stations outside emergency departments (EDs) at hospitals is increasing daily. To address the high screening workload at quarantine stations, all staff members with medical licenses are required to work shifts in these stations. Therefore, it is necessary to simplify the workflow and decision-making process for physicians and surgeons from all subspecialties. Objective: The aim of this paper is to demonstrate how the National Cheng Kung University Hospital artificial intelligence (AI) trilogy of diversion to a smart quarantine station, AI-assisted image interpretation, and a built-in clinical decision-making algorithm improves medical care and reduces quarantine processing times. Methods: This observational study on the emerging COVID-19 pandemic included 643 patients. An ``AI trilogy'' of diversion to a smart quarantine station, AI-assisted image interpretation, and a built-in clinical decision-making algorithm on a tablet computer was applied to shorten the quarantine survey process and reduce processing time during the COVID-19 pandemic. Results: The use of the AI trilogy facilitated the processing of suspected cases of COVID-19 with or without symptoms; also, travel, occupation, contact, and clustering histories were obtained with the tablet computer device. A separate AI-mode function that could quickly recognize pulmonary infiltrates on chest x-rays was merged into the smart clinical assisting system (SCAS), and this model was subsequently trained with COVID-19 pneumonia cases from the GitHub open source data set. The detection rates for posteroanterior and anteroposterior chest x-rays were 55/59 (93\%) and 5/11 (45\%), respectively. The SCAS algorithm was continuously adjusted based on updates to the Taiwan Centers for Disease Control public safety guidelines for faster clinical decision making. Our ex vivo study demonstrated the efficiency of disinfecting the tablet computer surface by wiping it twice with 75\% alcohol sanitizer. To further analyze the impact of the AI application in the quarantine station, we subdivided the station group into groups with or without AI. Compared with the conventional ED (n=281), the survey time at the quarantine station (n=1520) was significantly shortened; the median survey time at the ED was 153 minutes (95\% CI 108.5-205.0), vs 35 minutes at the quarantine station (95\% CI 24-56; P<.001). Furthermore, the use of the AI application in the quarantine station reduced the survey time in the quarantine station; the median survey time without AI was 101 minutes (95\% CI 40-153), vs 34 minutes (95\% CI 24-53) with AI in the quarantine station (P<.001). Conclusions: The AI trilogy improved our medical care workflow by shortening the quarantine survey process and reducing the processing time, which is especially important during an emerging infectious disease epidemic. ",
doi="10.2196/19878",
url="http://www.jmir.org/2020/10/e19878/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33001832"
}


@Article{info:doi/10.2196/19533,
author="Zhang, Haipeng
and Dimitrov, Dimitar
and Simpson, Lynn
and Plaks, Nina
and Singh, Balaji
and Penney, Stephen
and Charles, Jo
and Sheehan, Rosemary
and Flammini, Steven
and Murphy, Shawn
and Landman, Adam",
title="A Web-Based, Mobile-Responsive Application to Screen Health Care Workers for COVID-19 Symptoms: Rapid Design, Deployment, and Usage",
journal="JMIR Form Res",
year="2020",
month="Oct",
day="8",
volume="4",
number="10",
pages="e19533",
keywords="public health",
keywords="clinical informatics",
keywords="digital health",
keywords="coronavirus",
keywords="COVID-19",
keywords="SARS-CoV-2",
keywords="2019-nCov",
keywords="app",
keywords="eHealth",
abstract="Background: As of July 17, 2020, the COVID-19 pandemic has affected over 14 million people worldwide, with over 3.68 million cases in the United States. As the number of COVID-19 cases increased in Massachusetts, the Massachusetts Department of Public Health mandated that all health care workers be screened for symptoms daily prior to entering any hospital or health care facility. We rapidly created a digital COVID-19 symptom screening tool to enable this screening for a large, academic, integrated health care delivery system, Partners HealthCare, in Boston, Massachusetts. Objective: The aim of this study is to describe the design and development of the COVID Pass COVID-19 symptom screening application and report aggregate usage data from the first three months of its use across the organization. Methods: Using agile principles, we designed, tested, and implemented a solution over the span of one week using progressively customized development approaches as the requirements and use case become more solidified. We developed the minimum viable product (MVP) of a mobile-responsive, web-based, self-service application using research electronic data capture (REDCap). For employees without access to a computer or mobile device to use the self-service application, we established a manual process where in-person, socially distanced screeners asked employees entering the site if they have symptoms and then manually recorded the responses in an Office 365 Form. A custom .NET Framework application solution was developed as COVID Pass was scaled. We collected log data from the .NET application, REDCap, and Microsoft Office 365 from the first three months of enterprise deployment (March 30 to June 30, 2020). Aggregate descriptive statistics, including overall employee attestations by day and site, employee attestations by application method (COVID Pass automatic screening vs manual screening), employee attestations by time of day, and percentage of employees reporting COVID-19 symptoms, were obtained. Results: We rapidly created the MVP and gradually deployed it across the hospitals in our organization. By the end of the first week, the screening application was being used by over 25,000 employees each weekday. After three months, 2,169,406 attestations were recorded with COVID Pass. Over this period, 1865/160,159 employees (1.2\%) reported positive symptoms. 1,976,379 of the 2,169,406 attestations (91.1\%) were generated from the self-service screening application. The remainder were generated either from manual attestation processes (174,865/2,169,406, 8.1\%) or COVID Pass kiosks (25,133/2,169,406, 1.2\%). Hospital staff continued to work 24 hours per day, with staff attestations peaking around shift changes between 7 and 8 AM, 2 and 3 PM, 4 and 6 PM, and 11 PM and midnight. Conclusions: Using rapid, agile development, we quickly created and deployed a dedicated employee attestation application that gained widespread adoption and use within our health system. Further, we identified 1865 symptomatic employees who otherwise may have come to work, potentially putting others at risk. We share the story of our implementation, lessons learned, and source code (via GitHub) for other institutions who may want to implement similar solutions. ",
doi="10.2196/19533",
url="https://formative.jmir.org/2020/10/e19533",
url="http://www.ncbi.nlm.nih.gov/pubmed/32877348"
}


@Article{info:doi/10.2196/22117,
author="Hassani, Asma
and Khan, Gulfaraz",
title="Human-Animal Interaction and the Emergence of SARS-CoV-2",
journal="JMIR Public Health Surveill",
year="2020",
month="Oct",
day="7",
volume="6",
number="4",
pages="e22117",
keywords="zoonosis",
keywords="human-animal interface",
keywords="COVID-19",
keywords="SARS-CoV-1",
keywords="outbreak",
keywords="virus",
keywords="transmission",
keywords="pathogen",
keywords="emergence",
keywords="reservoir",
doi="10.2196/22117",
url="http://publichealth.jmir.org/2020/4/e22117/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33001837"
}


@Article{info:doi/10.2196/21211,
author="Giunti, Guido
and Goossens, Richard
and De Bont, Antoinette
and Visser, J. Jacob
and Mulder, Mark
and Schuit, E. Stephanie C.",
title="The Need for Sustainable Teleconsultation Systems in the Aftermath of the First COVID-19 Wave",
journal="J Med Internet Res",
year="2020",
month="Oct",
day="5",
volume="22",
number="10",
pages="e21211",
keywords="telemedicine",
keywords="COVID-19",
keywords="telehealth",
keywords="teleconsultation",
keywords="exposure",
keywords="software",
keywords="digital health",
keywords="organization",
doi="10.2196/21211",
url="http://www.jmir.org/2020/10/e21211/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32997642"
}


@Article{info:doi/10.2196/22457,
author="Pan, Yihang
and Fang, Yuan
and Xin, Meiqi
and Dong, Willa
and Zhou, Liemin
and Hou, Qinghua
and Li, Fanping
and Sun, Gang
and Zheng, Zilong
and Yuan, Jinqiu
and Wang, Zixin
and He, Yulong",
title="Self-Reported Compliance With Personal Preventive Measures Among Chinese Factory Workers at the Beginning of Work Resumption Following the COVID-19 Outbreak: Cross-Sectional Survey Study",
journal="J Med Internet Res",
year="2020",
month="Sep",
day="29",
volume="22",
number="9",
pages="e22457",
keywords="COVID-19",
keywords="work resumption, factory workers",
keywords="facemask wearing",
keywords="hand hygiene",
keywords="physical distancing",
keywords="prevention",
keywords="cross-sectional",
keywords="online",
keywords="survey",
keywords="compliance",
abstract="Background: Maintaining compliance with personal preventive measures is important to achieve a balance of COVID-19 pandemic control and work resumption. Objective: The aim of this study was to investigate self-reported compliance with four personal measures to prevent COVID-19 among a sample of factory workers in Shenzhen, China, at the beginning of work resumption in China following the COVID-19 outbreak. These preventive measures included consistent wearing of face masks in public spaces (the workplace and other public settings); sanitizing hands using soap, liquid soap, or alcohol-based hand sanitizer after returning from public spaces or touching public installations and equipment; avoiding social and meal gatherings; and avoiding crowded places. Methods: The participants were adult factory workers who had resumed work in Shenzhen, China. A stratified two-stage cluster sampling design was used. We randomly selected 14 factories that had resumed work. All full-time employees aged ?18 years who had resumed work in these factories were invited to complete a web-based survey. Out of 4158 workers who had resumed work in these factories, 3035 (73.0\%) completed the web-based survey from March 1 to 14, 2020. Multilevel logistic regression models were fitted. Results: Among the 3035 participants, 2938 (96.8\%) and 2996 (98.7\%) reported always wearing a face mask in the workplace and in other public settings, respectively, in the past month. However, frequencies of self-reported sanitizing hands (2152/3035, 70.9\%), avoiding social and meal gatherings (2225/3035, 73.3\%), and avoiding crowded places (1997/3035, 65.8\%) were relatively low. At the individual level, knowledge about COVID-19 (adjusted odds ratios [AORs] from 1.16, CI 1.10-1.24, to 1.29, CI 1.21-1.37), perceived risk (AORs from 0.58, CI 0.50-0.68, to 0.85, CI 0.72-0.99) and severity (AOR 1.05, CI 1.01-1.09, and AOR 1.07, CI 1.03-1.11) of COVID-19, perceived effectiveness of preventive measures by the individual (AORs from 1.05, CI 1.00-1.10, to 1.09, CI 1.04-1.13), organization (AOR 1.30, CI 1.20-1.41), and government (AORs from 1.14, CI 1.04-1.25, to 1.21, CI 1.02-1.42), perceived preparedness for a potential outbreak after work resumption (AORs from 1.10, CI 1.00-1.21, to 1.50, CI 1.36-1.64), and depressive symptoms (AORs from 0.93, CI 0.91-0.94, to 0.96, CI 0.92-0.99) were associated with self-reported compliance with at least one personal preventive measure. At the interpersonal level, exposure to COVID-19--specific information through official media channels (AOR 1.08, CI 1.04-1.11) and face-to-face communication (AOR 0.90, CI 0.83-0.98) were associated with self-reported sanitizing of hands. The number of preventive measures implemented in the workplace was positively associated with self-reported compliance with all four preventive measures (AORs from 1.30, CI 1.08-1.57, to 1.63, CI 1.45-1.84). Conclusions: Measures are needed to strengthen hand hygiene and physical distancing among factory workers to reduce transmission following work resumption. Future programs in workplaces should address these factors at multiple levels. ",
doi="10.2196/22457",
url="http://www.jmir.org/2020/9/e22457/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32924947"
}


@Article{info:doi/10.2196/19992,
author="Sun, Shaoxiong
and Folarin, A. Amos
and Ranjan, Yatharth
and Rashid, Zulqarnain
and Conde, Pauline
and Stewart, Callum
and Cummins, Nicholas
and Matcham, Faith
and Dalla Costa, Gloria
and Simblett, Sara
and Leocani, Letizia
and Lamers, Femke
and S{\o}rensen, Soelberg Per
and Buron, Mathias
and Zabalza, Ana
and Guerrero P{\'e}rez, Isabel Ana
and Penninx, WJH Brenda
and Siddi, Sara
and Haro, Maria Josep
and Myin-Germeys, Inez
and Rintala, Aki
and Wykes, Til
and Narayan, A. Vaibhav
and Comi, Giancarlo
and Hotopf, Matthew
and Dobson, JB Richard
and ",
title="Using Smartphones and Wearable Devices to Monitor Behavioral Changes During COVID-19",
journal="J Med Internet Res",
year="2020",
month="Sep",
day="25",
volume="22",
number="9",
pages="e19992",
keywords="mobile health",
keywords="COVID-19",
keywords="behavioral monitoring",
keywords="smartphones",
keywords="wearable devices",
keywords="mobility",
keywords="phone use",
abstract="Background: In the absence of a vaccine or effective treatment for COVID-19, countries have adopted nonpharmaceutical interventions (NPIs) such as social distancing and full lockdown. An objective and quantitative means of passively monitoring the impact and response of these interventions at a local level is needed. Objective: We aim to explore the utility of the recently developed open-source mobile health platform Remote Assessment of Disease and Relapse (RADAR)--base as a toolbox to rapidly test the effect and response to NPIs intended to limit the spread of COVID-19. Methods: We analyzed data extracted from smartphone and wearable devices, and managed by the RADAR-base from 1062 participants recruited in Italy, Spain, Denmark, the United Kingdom, and the Netherlands. We derived nine features on a daily basis including time spent at home, maximum distance travelled from home, the maximum number of Bluetooth-enabled nearby devices (as a proxy for physical distancing), step count, average heart rate, sleep duration, bedtime, phone unlock duration, and social app use duration. We performed Kruskal-Wallis tests followed by post hoc Dunn tests to assess differences in these features among baseline, prelockdown, and during lockdown periods. We also studied behavioral differences by age, gender, BMI, and educational background. Results: We were able to quantify expected changes in time spent at home, distance travelled, and the number of nearby Bluetooth-enabled devices between prelockdown and during lockdown periods (P<.001 for all five countries). We saw reduced sociality as measured through mobility features and increased virtual sociality through phone use. People were more active on their phones (P<.001 for Italy, Spain, and the United Kingdom), spending more time using social media apps (P<.001 for Italy, Spain, the United Kingdom, and the Netherlands), particularly around major news events. Furthermore, participants had a lower heart rate (P<.001 for Italy and Spain; P=.02 for Denmark), went to bed later (P<.001 for Italy, Spain, the United Kingdom, and the Netherlands), and slept more (P<.001 for Italy, Spain, and the United Kingdom). We also found that young people had longer homestay than older people during the lockdown and fewer daily steps. Although there was no significant difference between the high and low BMI groups in time spent at home, the low BMI group walked more. Conclusions: RADAR-base, a freely deployable data collection platform leveraging data from wearables and mobile technologies, can be used to rapidly quantify and provide a holistic view of behavioral changes in response to public health interventions as a result of infectious outbreaks such as COVID-19. RADAR-base may be a viable approach to implementing an early warning system for passively assessing the local compliance to interventions in epidemics and pandemics, and could help countries ease out of lockdown. ",
doi="10.2196/19992",
url="https://www.jmir.org/2020/9/e19992",
url="http://www.ncbi.nlm.nih.gov/pubmed/32877352"
}


@Article{info:doi/10.2196/20896,
author="Cresswell, Kathrin
and Sheikh, Aziz",
title="Can Disinfection Robots Reduce the Risk of Transmission of SARS-CoV-2 in Health Care and Educational Settings?",
journal="J Med Internet Res",
year="2020",
month="Sep",
day="15",
volume="22",
number="9",
pages="e20896",
keywords="robotics",
keywords="disinfection",
keywords="SARS-CoV-2",
keywords="COVID-19",
keywords="risk",
keywords="transmission",
keywords="virus",
doi="10.2196/20896",
url="http://www.jmir.org/2020/9/e20896/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32903196"
}


@Article{info:doi/10.2196/21490,
author="Singh, Parvati
and Cumberland, G. William
and Ugarte, Dominic
and Bruckner, Tim-Allen
and Young, D. Sean",
title="Association Between Generalized Anxiety Disorder Scores and Online Activity Among US Adults During the COVID-19 Pandemic: Cross-Sectional Analysis",
journal="J Med Internet Res",
year="2020",
month="Sep",
day="10",
volume="22",
number="9",
pages="e21490",
keywords="online activity",
keywords="COVID-19",
keywords="anxiety",
keywords="generalized anxiety disorder",
keywords="GAD",
keywords="scores",
keywords="stress",
keywords="internet",
keywords="survey",
keywords="cross-sectional",
abstract="Background: Evidence from past pandemics suggests that fear, uncertainty, and loss of control during large-scale public health crises may lead to increased pandemic-related information seeking, particularly among persons predisposed to high anxiety. In such groups, a greater consumption of information pertaining to the COVID-19 pandemic may increase anxiety. Objective: In this study, we examine the association between online activity and Generalized Anxiety Disorder 7 (GAD-7) scores in the United States. Methods: We recruited participants for an online survey through advertisements on various platforms such as Google, Facebook, and Reddit. A total of 406 adult US participants with moderate to severe (?10) GAD-7 scores met the inclusion criteria and completed the survey. Anxiety levels measured using the GAD-7 scale formed our primary outcome. Our key independent variables were average daily time spent online and average daily time spent online searching about COVID-19 within the past 14 days. We used as controls potential confounders of the relation between our key independent variables and GAD-7 scores, namely, sleep quality, the COVID-19 Fear Inventory scale, binge drinking, substance use, prescription drug abuse, and sociodemographic attributes. Results: Linear multivariate regression analyses showed that GAD-7 scores were higher among those who spent >4 hours online (per day) searching for information about COVID-19 (coefficient 1.29, P=.002), controlling for all other covariates. The total time spent online was not statistically associated with GAD-7 scores. Conclusions: Results from this study indicate that limiting pandemic-related online information seeking may aid anxiety management in our study population. ",
doi="10.2196/21490",
url="http://www.jmir.org/2020/9/e21490/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32841152"
}


@Article{info:doi/10.2196/21319,
author="Oliver, Nuria
and Barber, Xavier
and Roomp, Kirsten
and Roomp, Kristof",
title="Assessing the Impact of the COVID-19 Pandemic in Spain: Large-Scale, Online, Self-Reported Population Survey",
journal="J Med Internet Res",
year="2020",
month="Sep",
day="10",
volume="22",
number="9",
pages="e21319",
keywords="COVID-19",
keywords="SARS-CoV-2",
keywords="public health authorities",
keywords="large-scale online surveys",
keywords="infectious disease",
keywords="outbreak",
keywords="public engagement",
keywords="disease prevalence",
keywords="impact",
keywords="survey",
keywords="spain",
keywords="public health",
keywords="perception",
abstract="Background: Spain has been one of the countries most impacted by the COVID-19 pandemic. Since the first confirmed case was reported on January 31, 2020, there have been over 405,000 cases and 28,000 deaths in Spain. The economic and social impact is without precedent. Thus, it is important to quickly assess the situation and perception of the population. Large-scale online surveys have been shown to be an effective tool for this purpose. Objective: We aim to assess the situation and perception of the Spanish population in four key areas related to the COVID-19 pandemic: social contact behavior during confinement, personal economic impact, labor situation, and health status. Methods: We obtained a large sample using an online survey with 24 questions related to COVID-19 in the week of March 28-April 2, 2020, during the peak of the first wave of COVID-19 in Spain. The self-selection online survey method of nonprobability sampling was used to recruit 156,614 participants via social media posts that targeted the general adult population (age >18 years). Given such a large sample, the 95\% CI was {\textpm}0.843 for all reported proportions. Results: Regarding social behavior during confinement, participants mainly left their homes to satisfy basic needs. We found several statistically significant differences in social behavior across genders and age groups. The population's willingness to comply with the confinement measures is evident. From the survey answers, we identified a significant adverse economic impact of the pandemic on those working in small businesses and a negative correlation between economic damage and willingness to stay in confinement. The survey revealed that close contacts play an important role in the transmission of the disease, and 28\% of the participants lacked the necessary resources to properly isolate themselves. We also identified a significant lack of testing, with only 1\% of the population tested and 6\% of respondents unable to be tested despite their doctor's recommendation. We developed a generalized linear model to identify the variables that were correlated with a positive SARS-CoV-2 test result. Using this model, we estimated an average of 5\% for SARS-CoV-2 prevalence in the Spanish population during the time of the study. A seroprevalence study carried out later by the Spanish Ministry of Health reported a similar level of disease prevalence (5\%). Conclusions: Large-scale online population surveys, distributed via social media and online messaging platforms, can be an effective, cheap, and fast tool to assess the impact and prevalence of an infectious disease in the context of a pandemic, particularly when there is a scarcity of official data and limited testing capacity. ",
doi="10.2196/21319",
url="http://www.jmir.org/2020/9/e21319/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32870159"
}


@Article{info:doi/10.2196/17242,
author="Martin, S{\'e}bastien
and Maeder, Nirina Muriel
and Gon{\c{c}}alves, Rita Ana
and Pedrazzini, Baptiste
and Perdrix, Jean
and Rochat, Carine
and Senn, Nicolas
and Mueller, Yolanda",
title="An Online Influenza Surveillance System for Primary Care Workers in Switzerland: Observational Prospective Pilot Study",
journal="JMIR Public Health Surveill",
year="2020",
month="Sep",
day="10",
volume="6",
number="3",
pages="e17242",
keywords="influenza",
keywords="surveillance system",
keywords="primary care",
keywords="online",
keywords="nosocomial",
keywords="transmission",
abstract="Background: A better understanding of the influenza epidemiology among primary care workers could guide future recommendations to prevent transmission in primary care practices. Therefore, we designed a pilot study to assess the feasibility of using a work-based online influenza surveillance system among primary care workers. Such an approach is of particular relevance in the context of the coronavirus disease (COVID-19) pandemic, as its findings could apply to other infectious diseases with similar mechanisms of transmission. Objective: This study aims to determine the feasibility of using a work-based online influenza surveillance system for primary care workers in Switzerland. Methods: Physicians and staff of one walk-in clinic and two selected primary care practices were enrolled in this observational prospective pilot study during the 2017-2018 influenza season. They were invited to record symptoms of influenza-like illness in a weekly online survey sent by email and to self-collect a nasopharyngeal swab in case any symptoms were recorded. Samples were tested by real-time polymerase chain reaction for influenza A, influenza B, and a panel of respiratory pathogens. Results: Among 67 eligible staff members, 58\% (n=39) consented to the study and 53\% (n=36) provided data. From the time all participants were included, the weekly survey response rate stayed close to 100\% until the end of the study. Of 79 symptomatic episodes (mean 2.2 episodes per participant), 10 episodes in 7 participants fitted the definition of an influenza-like illness case (attack rate: 7/36, 19\%). One swab tested positive for influenza A H1N1 (attack rate: 3\%, 95\% CI 0\%-18\%). Swabbing was considered relatively easy. Conclusions: A work-based online influenza surveillance system is feasible for use among primary care workers. This promising methodology could be broadly used in future studies to improve the understanding of influenza epidemiology and other diseases such as COVID-19. This could prove to be highly useful in primary care settings and guide future recommendations to prevent transmission. A larger study will also help to assess asymptomatic infections. ",
doi="10.2196/17242",
url="http://publichealth.jmir.org/2020/3/e17242/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32909955"
}


@Article{info:doi/10.2196/21956,
author="Zens, Martin
and Brammertz, Arne
and Herpich, Juliane
and S{\"u}dkamp, Norbert
and Hinterseer, Martin",
title="App-Based Tracking of Self-Reported COVID-19 Symptoms: Analysis of Questionnaire Data",
journal="J Med Internet Res",
year="2020",
month="Sep",
day="9",
volume="22",
number="9",
pages="e21956",
keywords="COVID-19",
keywords="self-reporting",
keywords="symptom",
keywords="tracking",
keywords="app",
keywords="surveillance",
keywords="distribution",
keywords="digital tool",
keywords="screening",
abstract="Background: COVID-19 is an infectious disease characterized by various clinical presentations. Knowledge of possible symptoms and their distribution allows for the early identification of infected patients. Objective: To determine the distribution pattern of COVID-19 symptoms as well as possible unreported symptoms, we created an app-based self-reporting tool. Methods: The COVID-19 Symptom Tracker is an app-based daily self-reporting tool. Between April 8 and May 15, 2020, a total of 22,327 individuals installed this app on their mobile device. An initial questionnaire asked for demographic information (age, gender, postal code) and past medical history comprising relevant chronic diseases. The participants were reminded daily to report whether they were experiencing any symptoms and if they had been tested for SARS-CoV-2 infection. Participants who sought health care services were asked additional questions regarding diagnostics and treatment. Participation was open to all adults (?18 years). The study was completely anonymous. Results: In total, 11,829 (52.98\%) participants completed the symptom questionnaire at least once. Of these, 291 (2.46\%) participants stated that they had undergone an RT-PCR (reverse transcription-polymerase chain reaction) test for SARS-CoV-2; 65 (0.55\%) reported a positive test result and 226 (1.91\%) a negative one. The mean number of reported symptoms among untested participants was 0.81 (SD 1.85). Participants with a positive test result had, on average, 5.63 symptoms (SD 2.82). The most significant risk factors were diabetes (odds ratio [OR] 8.95, 95\% CI 3.30-22.37) and chronic heart disease (OR 2.85, 95\% CI 1.43-5.69). We identified chills, fever, loss of smell, nausea and vomiting, and shortness of breath as the top five strongest predictors for a COVID-19 infection. The odds ratio for loss of smell was 3.13 (95\% CI 1.76-5.58). Nausea and vomiting (OR 2.84, 95\% CI 1.61-5.00) had been reported as an uncommon symptom previously; however, our data suggest a significant predictive value. Conclusions: Self-reported symptom tracking helps to identify novel symptoms of COVID-19 and to estimate the predictive value of certain symptoms. This aids in the development of reliable screening tools. Clinical screening with a high pretest probability allows for the rapid identification of infections and the cost-effective use of testing resources. Based on our results, we suggest that loss of smell and taste be considered cardinal symptoms; we also stress that diabetes is a risk factor for a highly symptomatic course of COVID-19 infection. ",
doi="10.2196/21956",
url="http://www.jmir.org/2020/9/e21956/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32791493"
}


@Article{info:doi/10.2196/20786,
author="Ramaswamy, Ashwin
and Yu, Miko
and Drangsholt, Siri
and Ng, Eric
and Culligan, J. Patrick
and Schlegel, N. Peter
and Hu, C. Jim",
title="Patient Satisfaction With Telemedicine During the COVID-19 Pandemic: Retrospective Cohort Study",
journal="J Med Internet Res",
year="2020",
month="Sep",
day="9",
volume="22",
number="9",
pages="e20786",
keywords="telemedicine",
keywords="medicine",
keywords="pandemics",
keywords="patient satisfaction",
keywords="remote consultation",
keywords="disruptive technology",
keywords="medical informatics",
keywords="health care delivery",
keywords="practice patterns",
keywords="physicians",
keywords="health policy",
keywords="health services research",
keywords="health care reform",
keywords="COVID-19",
abstract="Background: New York City was the international epicenter of the COVID-19 pandemic. Health care providers responded by rapidly transitioning from in-person to video consultations. Telemedicine (ie, video visits) is a potentially disruptive innovation; however, little is known about patient satisfaction with this emerging alternative to the traditional clinical encounter. Objective: This study aimed to determine if patient satisfaction differs between video and in-person visits. Methods: In this retrospective observational cohort study, we analyzed 38,609 Press Ganey patient satisfaction survey outcomes from clinic encounters (620 video visits vs 37,989 in-person visits) at a single-institution, urban, quaternary academic medical center in New York City for patients aged 18 years, from April 1, 2019, to March 31, 2020. Time was categorized as pre--COVID-19 and COVID-19 (before vs after March 4, 2020). Wilcoxon-Mann-Whitney tests and multivariable linear regression were used for hypothesis testing and statistical modeling, respectively. Results: We experienced an 8729\% increase in video visit utilization during the COVID-19 pandemic compared to the same period last year. Video visit Press Ganey scores were significantly higher than in-person visits (94.9\% vs 92.5\%; P<.001). In adjusted analyses, video visits (parameter estimate [PE] 2.18; 95\% CI 1.20-3.16) and the COVID-19 period (PE 0.55; 95\% CI 0.04-1.06) were associated with higher patient satisfaction. Younger age (PE --2.05; 95\% CI --2.66 to --1.22), female gender (PE --0.73; 95\% CI --0.96 to --0.50), and new visit type (PE --0.75; 95\% CI --1.00 to --0.49) were associated with lower patient satisfaction. Conclusions: Patient satisfaction with video visits is high and is not a barrier toward a paradigm shift away from traditional in-person clinic visits. Future research comparing other clinic visit quality indicators is needed to guide and implement the widespread adoption of telemedicine. ",
doi="10.2196/20786",
url="http://www.jmir.org/2020/9/e20786/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32810841"
}


@Article{info:doi/10.2196/19913,
author="Ali, F. Khawla
and Whitebridge, Simon
and Jamal, H. Mohammad
and Alsafy, Mohammad
and Atkin, L. Stephen",
title="Perceptions, Knowledge, and Behaviors Related to COVID-19 Among Social Media Users: Cross-Sectional Study",
journal="J Med Internet Res",
year="2020",
month="Sep",
day="8",
volume="22",
number="9",
pages="e19913",
keywords="COVID-19",
keywords="social media",
keywords="public health",
keywords="perception",
keywords="knowledge",
keywords="health information",
keywords="health education",
keywords="virus",
abstract="Background: Social media is one of the most rapid and impactful ways of obtaining and delivering information in the modern era. Objective: The aim of this study was to rapidly obtain information on public perceptions, knowledge, and behaviors related to COVID-19 in order to identify deficiencies in key areas of public education. Methods: Using a cross-sectional study design, a survey web link was posted on the social media and messaging platforms Instagram, Twitter, and WhatsApp by the study investigators. Participants, aged ?18 years, filled out the survey on a voluntary basis. The main outcomes measured were knowledge of COVID-19 symptoms, protective measures against COVID-19, and source(s) of information about COVID-19. Subgroup analyses were conducted to determine the effects of age, gender, underlying illness, and working or studying in the health care industry on the perceived likelihood of acquiring COVID-19 and getting vaccinated. Results: A total of 5677 subjects completed the survey over the course of 1 week. ``Fever or chills'' (n=4973, 87.6\%) and ``shortness of breath'' (n=4695, 82.7\%) were identified as the main symptoms of COVID-19. Washing and sanitizing hands (n=4990, 87.9\%) and avoiding public places and crowds (n=4865, 85.7\%) were identified as the protective measures most frequently used against COVID-19. Social media was the most utilized source for information on the disease (n=4740, 83.5\%), followed by the World Health Organization (n=2844, 50.1\%). Subgroup analysis revealed that younger subjects (<35 years), males, and those working or studying in health care reported a higher perceived likelihood of acquiring COVID-19, whereas older subjects, females, and those working or studying in non--health care areas reported a lower perceived likelihood of acquiring COVID-19. Similar trends were observed for vaccination against COVID-19, with older subjects, females, and those working or studying in non--health care sectors reporting a lower likelihood of vaccinating against COVID-19. Conclusions: Our results are indicative of a relatively well-informed cohort implementing appropriate protective measures. However, key knowledge deficiencies exist with regards to vaccination against COVID-19, which future efforts should aim at correcting. ",
doi="10.2196/19913",
url="http://www.jmir.org/2020/9/e19913/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32841153"
}


@Article{info:doi/10.2196/19623,
author="Okereafor, Kenneth
and Ekong, Iniobong
and Okon Markson, Ini
and Enwere, Kingsley",
title="Fingerprint Biometric System Hygiene and the Risk of COVID-19 Transmission",
journal="JMIR Biomed Eng",
year="2020",
month="Sep",
day="8",
volume="5",
number="1",
pages="e19623",
keywords="biometric",
keywords="contact",
keywords="contaminate",
keywords="coronavirus",
keywords="COVID-19",
keywords="cybersecurity",
keywords="disease",
keywords="fingerprint",
keywords="hygienic",
keywords="infectious",
keywords="pathogen",
keywords="scanner",
keywords="surface",
keywords="verification",
doi="10.2196/19623",
url="http://biomedeng.jmir.org/2020/1/e19623/"
}


@Article{info:doi/10.2196/22321,
author="Nakamoto, Ichiro
and Wang, Sheng
and Guo, Yan
and Zhuang, Weiqing",
title="A QR Code--Based Contact Tracing Framework for Sustainable Containment of COVID-19: Evaluation of an Approach to Assist the Return to Normal Activity",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Sep",
day="7",
volume="8",
number="9",
pages="e22321",
keywords="COVID-19",
keywords="coronavirus",
keywords="symptom-based",
keywords="quick response",
keywords="eHealth",
keywords="digital health",
keywords="telesurveillance",
keywords="pandemic",
keywords="epidemic",
keywords="interoperability",
doi="10.2196/22321",
url="http://mhealth.jmir.org/2020/9/e22321/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32841151"
}


@Article{info:doi/10.2196/19578,
author="Friesen, John
and Pelz, F. Peter",
title="COVID-19 and Slums: A Pandemic Highlights Gaps in Knowledge About Urban Poverty",
journal="JMIR Public Health Surveill",
year="2020",
month="Sep",
day="4",
volume="6",
number="3",
pages="e19578",
keywords="slums",
keywords="informal settlements",
keywords="COVID-19, pandemic",
keywords="infectious disease",
keywords="living conditions",
keywords="lifestyle",
keywords="risk",
keywords="risk group",
keywords="health information",
doi="10.2196/19578",
url="http://publichealth.jmir.org/2020/3/e19578/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32877347"
}


@Article{info:doi/10.2196/20143,
author="Dhala, Atiya
and Sasangohar, Farzan
and Kash, Bita
and Ahmadi, Nima
and Masud, Faisal",
title="Rapid Implementation and Innovative Applications of a Virtual Intensive Care Unit During the COVID-19 Pandemic: Case Study",
journal="J Med Internet Res",
year="2020",
month="Sep",
day="3",
volume="22",
number="9",
pages="e20143",
keywords="intensive care units",
keywords="critical care",
keywords="pandemics",
keywords="SARS-CoV-2",
keywords="telemedicine",
keywords="infection control",
keywords="COVID-19",
abstract="Background: The COVID-19 pandemic has necessitated a rapid increase of space in highly infectious disease intensive care units (ICUs). At Houston Methodist Hospital (HMH), a virtual intensive care unit (vICU) was used amid the COVID-19 outbreak. Objective: The aim of this paper was to detail the novel adaptations and rapid expansion of the vICU that were applied to achieve patient-centric solutions while protecting staff and patients' families during the pandemic. Methods: The planned vICU implementation was redirected to meet the emerging needs of conversion of COVID-19 ICUs, including alterations to staged rollout timing, virtual and in-person staffing, and scope of application. With the majority of the hospital critical care physician workforce redirected to rapidly expanded COVID-19 ICUs, the non--COVID-19 ICUs were managed by cardiovascular surgeons, cardiologists, neurosurgeons, and acute care surgeons. HMH expanded the vICU program to fill the newly depleted critical care expertise in the non--COVID-19 units to provide urgent, emergent, and code blue support to all ICUs. Results: Virtual family visitation via the Consultant Bridge application, palliative care delivery, and specialist consultation for patients with COVID-19 exemplify the successful adaptation of the vICU implementation. Patients with COVID-19, who were isolated and separated from their families to prevent the spread of infection, were able to virtually see and hear their loved ones, which bolstered the mental and emotional status of those patients. Many families expressed gratitude for the ability to see and speak with their loved ones. The vICU also protected medical staff and specialists assigned to COVID-19 units, reducing exposure and conserving personal protective equipment. Conclusions: Telecritical care has been established as an advantageous mechanism for the delivery of critical care expertise during the expedited rollout of the vICU at Houston Methodist Hospital. Overall responses from patients, families, and physicians are in favor of continued vICU care; however, further research is required to examine the impact of innovative applications of telecritical care in the treatment of critically ill patients. ",
doi="10.2196/20143",
url="http://www.jmir.org/2020/9/e20143/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32795997"
}


@Article{info:doi/10.2196/21419,
author="Doogan, Caitlin
and Buntine, Wray
and Linger, Henry
and Brunt, Samantha",
title="Public Perceptions and Attitudes Toward COVID-19 Nonpharmaceutical Interventions Across Six Countries: A Topic Modeling Analysis of Twitter Data",
journal="J Med Internet Res",
year="2020",
month="Sep",
day="3",
volume="22",
number="9",
pages="e21419",
keywords="COVID-19",
keywords="SARS-CoV-2",
keywords="topic modeling",
keywords="nonpharmaceutical interventions",
keywords="social media",
keywords="public health",
keywords="machine learning",
keywords="social distancing",
keywords="lockdown",
keywords="face masks",
keywords="infodemiology",
abstract="Background: Nonpharmaceutical interventions (NPIs) (such as wearing masks and social distancing) have been implemented by governments around the world to slow the spread of COVID-19. To promote public adherence to these regimes, governments need to understand the public perceptions and attitudes toward NPI regimes and the factors that influence them. Twitter data offer a means to capture these insights. Objective: The objective of this study is to identify tweets about COVID-19 NPIs in six countries and compare the trends in public perceptions and attitudes toward NPIs across these countries. The aim is to identify factors that influenced public perceptions and attitudes about NPI regimes during the early phases of the COVID-19 pandemic. Methods: We analyzed 777,869 English language tweets about COVID-19 NPIs in six countries (Australia, Canada, New Zealand, Ireland, the United Kingdom, and the United States). The relationship between tweet frequencies and case numbers was assessed using a Pearson correlation analysis. Topic modeling was used to isolate tweets about NPIs. A comparative analysis of NPIs between countries was conducted. Results: The proportion of NPI-related topics, relative to all topics, varied between countries. The New Zealand data set displayed the greatest attention to NPIs, and the US data set showed the lowest. The relationship between tweet frequencies and case numbers was statistically significant only for Australia (r=0.837, P<.001) and New Zealand (r=0.747, P<.001). Topic modeling produced 131 topics related to one of 22 NPIs, grouped into seven NPI categories: Personal Protection (n=15), Social Distancing (n=9), Testing and Tracing (n=10), Gathering Restrictions (n=18), Lockdown (n=42), Travel Restrictions (n=14), and Workplace Closures (n=23). While less restrictive NPIs gained widespread support, more restrictive NPIs were perceived differently across countries. Four characteristics of these regimes were seen to influence public adherence to NPIs: timeliness of implementation, NPI campaign strategies, inconsistent information, and enforcement strategies. Conclusions: Twitter offers a means to obtain timely feedback about the public response to COVID-19 NPI regimes. Insights gained from this analysis can support government decision making, implementation, and communication strategies about NPI regimes, as well as encourage further discussion about the management of NPI programs for global health events, such as the COVID-19 pandemic. ",
doi="10.2196/21419",
url="https://www.jmir.org/2020/9/e21419",
url="http://www.ncbi.nlm.nih.gov/pubmed/32784190"
}


@Article{info:doi/10.2196/20572,
author="Walrave, Michel
and Waeterloos, Cato
and Ponnet, Koen",
title="Adoption of a Contact Tracing App for Containing COVID-19: A Health Belief Model Approach",
journal="JMIR Public Health Surveill",
year="2020",
month="Sep",
day="1",
volume="6",
number="3",
pages="e20572",
keywords="COVID-19",
keywords="SARS-CoV-2",
keywords="health belief model",
keywords="contact tracing",
keywords="proximity tracing",
keywords="privacy",
abstract="Background: To track and reduce the spread of COVID-19, apps have been developed to identify contact with individuals infected with SARS-CoV-2 and warn those who are at risk of having contracted the virus. However, the effectiveness of these apps depends highly on their uptake by the general population. Objective: The present study investigated factors influencing app use intention, based on the health belief model. In addition, associations with respondents' level of news consumption and their health condition were investigated. Methods: A survey was administered in Flanders, Belgium, to 1500 respondents, aged 18 to 64 years. Structural equation modeling was used to investigate relationships across the model's constructs. Results: In total, 48.70\% (n=730) of respondents indicated that they intend to use a COVID-19 tracing app. The most important predictor was the perceived benefits of the app, followed by self-efficacy and perceived barriers. Perceived severity and perceived susceptibility were not related to app uptake intention. Moreover, cues to action (ie, individuals' exposure to [digital] media content) were positively associated with app use intention. As the respondents' age increased, their perceived benefits and self-efficacy for app usage decreased. Conclusions: Initiatives to stimulate the uptake of contact tracing apps should enhance perceived benefits and self-efficacy. A perceived barrier for some potential users is privacy concerns. Therefore, when developing and launching an app, clarification on how individuals' privacy will be protected is needed. To sustain perceived benefits in the long run, supplementary options could be integrated to inform and assist users. ",
doi="10.2196/20572",
url="http://publichealth.jmir.org/2020/3/e20572/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32755882"
}


@Article{info:doi/10.2196/19857,
author="Altmann, Samuel
and Milsom, Luke
and Zillessen, Hannah
and Blasone, Raffaele
and Gerdon, Frederic
and Bach, Ruben
and Kreuter, Frauke
and Nosenzo, Daniele
and Toussaert, S{\'e}verine
and Abeler, Johannes",
title="Acceptability of App-Based Contact Tracing for COVID-19: Cross-Country Survey Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Aug",
day="28",
volume="8",
number="8",
pages="e19857",
keywords="COVID-19",
keywords="contact tracing",
keywords="proximity tracing",
keywords="app",
keywords="digital",
keywords="user acceptability",
keywords="mHealth",
keywords="epidemiology",
abstract="Background: The COVID-19 pandemic is the greatest public health crisis of the last 100 years. Countries have responded with various levels of lockdown to save lives and stop health systems from being overwhelmed. At the same time, lockdowns entail large socioeconomic costs. One exit strategy under consideration is a mobile phone app that traces the close contacts of those infected with COVID-19. Recent research has demonstrated the theoretical effectiveness of this solution in different disease settings. However, concerns have been raised about such apps because of the potential privacy implications. This could limit the acceptability of app-based contact tracing in the general population. As the effectiveness of this approach increases strongly with app uptake, it is crucial to understand public support for this intervention. Objective: The objective of this study is to investigate the user acceptability of a contact-tracing app in five countries hit by the pandemic. Methods: We conducted a largescale, multicountry study (N=5995) to measure public support for the digital contact tracing of COVID-19 infections. We ran anonymous online surveys in France, Germany, Italy, the United Kingdom, and the United States. We measured intentions to use a contact-tracing app across different installation regimes (voluntary installation vs automatic installation by mobile phone providers) and studied how these intentions vary across individuals and countries. Results: We found strong support for the app under both regimes, in all countries, across all subgroups of the population, and irrespective of regional-level COVID-19 mortality rates. We investigated the main factors that may hinder or facilitate uptake and found that concerns about cybersecurity and privacy, together with a lack of trust in the government, are the main barriers to adoption. Conclusions: Epidemiological evidence shows that app-based contact tracing can suppress the spread of COVID-19 if a high enough proportion of the population uses the app and that it can still reduce the number of infections if uptake is moderate. Our findings show that the willingness to install the app is very high. The available evidence suggests that app-based contact tracing may be a viable approach to control the diffusion of COVID-19. ",
doi="10.2196/19857",
url="http://mhealth.jmir.org/2020/8/e19857/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32759102"
}


@Article{info:doi/10.2196/21613,
author="Kaspar, Kai",
title="Motivations for Social Distancing and App Use as Complementary Measures to Combat the COVID-19 Pandemic: Quantitative Survey Study",
journal="J Med Internet Res",
year="2020",
month="Aug",
day="27",
volume="22",
number="8",
pages="e21613",
keywords="COVID-19",
keywords="protection motivation theory",
keywords="social distancing",
keywords="contact tracing app",
keywords="data donation app",
keywords="social trust",
keywords="data security",
abstract="Background: The current COVID-19 pandemic is showing negative effects on human health as well as on social and economic life. It is a critical and challenging task to revive public life while minimizing the risk of infection. Reducing interactions between people by social distancing is an effective and prevalent measure to reduce the risk of infection and spread of the virus within a community. Current developments in several countries show that this measure can be technologically accompanied by mobile apps; meanwhile, privacy concerns are being intensively discussed. Objective: The aim of this study was to examine central cognitive variables that may constitute people's motivations for social distancing, using an app, and providing health-related data requested by two apps that differ in their direct utility for the individual user. The results may increase our understanding of people's concerns and convictions, which can then be specifically addressed by public-oriented communication strategies and appropriate political decisions. Methods: This study refers to the protection motivation theory, which is adaptable to both health-related and technology-related motivations. The concept of social trust was added. The quantitative survey included answers from 406 German-speaking participants who provided assessments of data security issues, trust components, and the processes of threat and coping appraisal related to the prevention of SARS-CoV-2 infection by social distancing. With respect to apps, one central focus was on the difference between a contact tracing app and a data donation app. Results: Multiple regression analyses showed that the present model could explain 55\% of the interindividual variance in the participants' motivation for social distancing, 46\% for using a contact tracing app, 42\% for providing their own infection status to a contact tracing app, and 34\% for using a data donation app. Several cognitive components of threat and coping appraisal were related to motivation measurements. Trust in other people's social distancing behavior and general trust in official app providers also played important roles; however, the participants' age and gender did not. Motivations for using and accepting a contact tracing app were higher than those for using and accepting a data donation app. Conclusions: This study revealed some important cognitive factors that constitute people's motivation for social distancing and using apps to combat the COVID-19 pandemic. Concrete implications for future research, public-oriented communication strategies, and appropriate political decisions were identified and are discussed. ",
doi="10.2196/21613",
url="http://www.jmir.org/2020/8/e21613/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32759100"
}


@Article{info:doi/10.2196/20828,
author="Wilmink, Gerald
and Summer, Ilyssa
and Marsyla, David
and Sukhu, Subhashree
and Grote, Jeffrey
and Zobel, Gregory
and Fillit, Howard
and Movva, Satish",
title="Real-Time Digital Contact Tracing: Development of a System to Control COVID-19 Outbreaks in Nursing Homes and Long-Term Care Facilities",
journal="JMIR Public Health Surveill",
year="2020",
month="Aug",
day="25",
volume="6",
number="3",
pages="e20828",
keywords="COVID-19",
keywords="SARS-CoV-2",
keywords="contact tracing",
keywords="nursing homes",
keywords="long term care",
keywords="care homes",
keywords="digital contact tracing",
abstract="Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can spread rapidly in nursing homes and long-term care (LTC) facilities. Symptoms-based screening and manual contact tracing have limitations that render them ineffective for containing the viral spread in LTC facilities. Symptoms-based screening alone cannot identify asymptomatic people who are infected, and the viral spread is too fast in confined living quarters to be contained by slow manual contact tracing processes. Objective: We describe the development of a digital contact tracing system that LTC facilities can use to rapidly identify and contain asymptomatic and symptomatic SARS-CoV-2 infected contacts. A compartmental model was also developed to simulate disease transmission dynamics and to assess system performance versus conventional methods. Methods: We developed a compartmental model parameterized specifically to assess the coronavirus disease (COVID-19) transmission in LTC facilities. The model was used to quantify the impact of asymptomatic transmission and to assess the performance of several intervention groups to control outbreaks: no intervention, symptom mapping, polymerase chain reaction testing, and manual and digital contact tracing. Results: Our digital contact tracing system allows users to rapidly identify and then isolate close contacts, store and track infection data in a respiratory line listing tool, and identify contaminated rooms. Our simulation results indicate that the speed and efficiency of digital contact tracing contributed to superior control performance, yielding up to 52\% fewer cases than conventional methods. Conclusions: Digital contact tracing systems show promise as an effective tool to control COVID-19 outbreaks in LTC facilities. As facilities prepare to relax restrictions and reopen to outside visitors, such tools will allow them to do so in a surgical, cost-effective manner that controls outbreaks while safely giving residents back the life they once had before this pandemic hit. ",
doi="10.2196/20828",
url="http://publichealth.jmir.org/2020/3/e20828/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32745013"
}


@Article{info:doi/10.2196/20334,
author="Collado-Borrell, Roberto
and Escudero-Vilaplana, Vicente
and Villanueva-Bueno, Cristina
and Herranz-Alonso, Ana
and Sanjurjo-Saez, Maria",
title="Features and Functionalities of Smartphone Apps Related to COVID-19: Systematic Search in App Stores and Content Analysis",
journal="J Med Internet Res",
year="2020",
month="Aug",
day="25",
volume="22",
number="8",
pages="e20334",
keywords="COVID-19",
keywords="mobile apps",
keywords="contact tracing",
keywords="monitoring",
keywords="telemedicine",
keywords="smartphone",
abstract="Background: Knowledge of the quantity and quality of apps related to coronavirus disease (COVID-19) is lacking. In addition, no directory has been established listing all the apps developed to address the COVID-19 pandemic. Objective: The aim of this study was to identify smartphone apps designed to address the COVID-19 pandemic and to analyze their characteristics. Methods: We performed an observational, cross-sectional, descriptive study of all smartphone apps associated with COVID-19. Between April 27 and May 2, 2020, we searched the App Store (iOS) and Google Play Store (Android) for COVID-19 apps. The search terms used were coronavirus, COVID-19, and SARS-COV-2. The apps were downloaded and evaluated. The variables analyzed were name, platform, country, language, category, cost, update date, size, version, number of downloads, developer, and purpose. Purpose was further classified into the following categories: news, general information, self-diagnosis, contact tracing, notices to contacts, notification of close cases, awareness, helplines, monitoring of clinical parameters, recording of symptoms and treatment, and messaging with health care professionals. Results: We identified 114 apps on the investigated platforms. Of these, 62/114 (54.4\%) were on Android and 52/114 (45.6\%) were on iOS. Of the 114 apps, 37 (32.5\%) were developed in Europe, 32 (28.1\%) in Asia, and 30 (26.3\%) in North America. The most frequent languages were English (65/114, 57.0\%), Spanish (34/114, 29.8\%), and Chinese (14/114, 12.3\%). The most common categories were health and well-being/fitness apps (41/114, 41.2\%) and medicine apps (43/114, 37.7\%). Of the 114 apps, 113 (99.1\%) were free. The mean time between the date of the analysis and the date of the last update was 11.1 days (SD 11.0). Overall, 95 of the 114 apps (83.3\%) were intended for the general population, 99 apps (7.9\%) were intended for health professionals, and 3 apps (2.6\%) were intended for both. Regarding the type of developer, 64/114 apps (56.1\%) were developed by governments; 42/114 (64.1\%) were developed by national governments, and 23/114 (35.9\%) were developed by regional governments. The apps with the highest number of downloads (100,000+) were developed by governments (P=.13), except for the World Health Organization app (500,000+). The purposes of the apps available in Western languages (107/114, 93.9\%) were determined; the most common purposes were general information about COVID-19 (66, 64.0\%), COVID-19 news (53, 51.0\%), recording of symptoms (53, 51.0\%), and contact tracing (51, 47.7\%). More than one purpose was identified for 99/107 apps (92.5\%). Conclusions: This paper offers a comprehensive and unique review of all available COVID-19 apps. Governments have adopted these tools during the pandemic, and more than half of the apps were developed by government agencies. The most common purposes of the apps are providing information on the numbers of infected, recovered, and deceased patients, recording of symptoms, and contact tracing. ",
doi="10.2196/20334",
url="https://www.jmir.org/2020/8/e20334",
url="http://www.ncbi.nlm.nih.gov/pubmed/32614777"
}


@Article{info:doi/10.2196/21265,
author="Suppan, Laurent
and Abbas, Mohamed
and Stuby, Loric
and Cottet, Philippe
and Larribau, Robert
and Golay, Eric
and Iten, Anne
and Harbarth, Stephan
and Gartner, Birgit
and Suppan, M{\'e}lanie",
title="Effect of an E-Learning Module on Personal Protective Equipment Proficiency Among Prehospital Personnel: Web-Based Randomized Controlled Trial",
journal="J Med Internet Res",
year="2020",
month="Aug",
day="21",
volume="22",
number="8",
pages="e21265",
keywords="personal protective equipment",
keywords="COVID-19",
keywords="electronic learning",
keywords="prehospital",
keywords="randomized controlled trial",
keywords="protection",
keywords="equipment",
keywords="safety",
keywords="gamified",
keywords="online learning",
keywords="communication",
abstract="Background: To avoid misuse of personal protective equipment (PPE), ensure health care workers' safety, and avoid shortages, effective communication of up-to-date infection control guidelines is essential. As prehospital teams are particularly at risk of contamination given their challenging work environment, a specific gamified electronic learning (e-learning) module targeting this audience might provide significant advantages as it requires neither the presence of learners nor the repetitive use of equipment for demonstration. Objective: The aim of this study was to evaluate whether a gamified e-learning module could improve the rate of adequate PPE choice by prehospital personnel in the context of the coronavirus disease (COVID-19) pandemic. Methods: This was an individual-level randomized, controlled, quadruple-blind (investigators, participants, outcome assessors, and data analysts) closed web-based trial. All emergency prehospital personnel working in Geneva, Switzerland, were eligible for inclusion, and were invited to participate by email in April 2020. Participants were informed that the study aim was to assess their knowledge regarding PPE, and that they would be presented with both the guidelines and the e-learning module, though they were unaware that there were two different study paths. All participants first answered a preintervention quiz designed to establish their profile and baseline knowledge. The control group then accessed the guidelines before answering a second set of questions, and were then granted access to the e-learning module. The e-learning group was shown the e-learning module right after the guidelines and before answering the second set of questions. Results: Of the 291 randomized participants, 176 (60.5\%) completed the trial. There was no significant difference in baseline knowledge between groups. Though the baseline proportion of adequate PPE choice was high (75\%, IQR 50\%-75\%), participants' description of the donning sequence was in most cases incorrect. After either intervention, adequate choice of PPE increased significantly in both groups (P<.001). Though the median of the difference in the proportion of correct answers was slightly higher in the e-learning group (17\%, IQR 8\%-33\% versus 8\%, IQR 8\%-33\%), the difference was not statistically significant (P=.27). Confidence in the ability to use PPE was maintained in the e-learning group (P=.27) but significantly decreased in the control group (P=.04). Conclusions: Among prehospital personnel with an already relatively high knowledge of and experience with PPE use, both web-based study paths increased the rate of adequate choice of PPE. There was no major added value of the gamified e-learning module apart from preserving participants' confidence in their ability to correctly use PPE. ",
doi="10.2196/21265",
url="http://www.jmir.org/2020/8/e21265/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32747329"
}


@Article{info:doi/10.2196/19995,
author="Niu, Zhaomeng
and Wang, Tingting
and Hu, Pengwei
and Mei, Jing
and Tang, Zhihan",
title="Chinese Public's Engagement in Preventive and Intervening Health Behaviors During the Early Breakout of COVID-19: Cross-Sectional Study",
journal="J Med Internet Res",
year="2020",
month="Aug",
day="21",
volume="22",
number="8",
pages="e19995",
keywords="COVID-19",
keywords="China",
keywords="preventive health behaviors",
keywords="intervening health behaviors",
keywords="psychosocial",
keywords="health literacy",
keywords="behavior",
keywords="prevention",
keywords="cross-sectional",
abstract="Background: Since January 2020, the coronavirus disease (COVID-19) swept over China and then the world, causing a global public health crisis. People's adoption of preventive and intervening behaviors is critical in curbing the spread of the virus. Objective: The aim of this study is to evaluate Chinese people's adoption of health behaviors in responding to COVID-19 and to identify key determinants for their engagement. Methods: An anonymous online questionnaire was distributed in early February 2020 among Mainland Chinese (18 years or older) to examine their engagement in preventive behaviors (eg, frequent handwashing, wearing masks, staying at home) and intervening behaviors (eg, advising family to wash hands frequently), and to explore potential determinants for their adoption of these health behaviors. Results: Out of 2949 participants, 55.3\% (n=1629) reported frequent engagement in preventive health behaviors, and over 84\% (n=2493) performed at least one intervening health behavior. Greater engagement in preventive behaviors was found among participants who received higher education, were married, reported fewer barriers and greater benefits of engagement, reported greater self-efficacy and emotional support, had greater patient-centered communication before, had a greater media literacy level, and had greater new media and traditional media use for COVID-19 news. Greater engagement in intervening behaviors was observed among participants who were married, had lower income, reported greater benefits of health behaviors, had greater patient-centered communication before, had a lower media literacy level, and had a greater new media and traditional media use for COVID-19 news. Conclusions: Participants' engagement in coronavirus-related preventive and intervening behaviors was overall high, and the associations varied across demographic and psychosocial variables. Hence, customized health interventions that address the determinants for health behaviors are needed to improve people's adherence to coronavirus-related behavior guidelines. ",
doi="10.2196/19995",
url="http://www.jmir.org/2020/8/e19995/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32716897"
}


@Article{info:doi/10.2196/21257,
author="Chiu, Nan-Chang
and Chi, Hsin
and Tai, Yu-Lin
and Peng, Chun-Chih
and Tseng, Cheng-Yin
and Chen, Chung-Chu
and Tan, Fatt Boon
and Lin, Chien-Yu",
title="Impact of Wearing Masks, Hand Hygiene, and Social Distancing on Influenza, Enterovirus, and All-Cause Pneumonia During the Coronavirus Pandemic: Retrospective National Epidemiological Surveillance Study",
journal="J Med Internet Res",
year="2020",
month="Aug",
day="20",
volume="22",
number="8",
pages="e21257",
keywords="novel coronavirus",
keywords="COVID-19",
keywords="SARS-CoV-2",
keywords="pandemic",
keywords="influenza",
keywords="pneumonia",
keywords="hygiene",
keywords="social distancing",
keywords="prevention",
keywords="incidence",
keywords="surveillance",
abstract="Background: The coronavirus disease (COVID-19) pandemic is an important health crisis worldwide. Several strategies were implemented to combat COVID-19, including wearing masks, hand hygiene, and social distancing. The impact of these strategies on COVID-19 and other viral infections remains largely unclear. Objective: We aim to investigate the impact of implemented infectious control strategies on the incidences of influenza, enterovirus infection, and all-cause pneumonia during the COVID-19 pandemic. Methods: We utilized the electronic database of the Taiwan National Infectious Disease Statistics System and extracted incidences of COVID-19, influenza virus, enterovirus, and all-cause pneumonia. We compared the incidences of these diseases from week 45 of 2016 to week 21 of 2020 and performed linear regression analyses. Results: The first case of COVID-19 in Taiwan was reported in late January 2020 (week 4). Infectious control strategies have been promoted since late January. The influenza virus usually peaks in winter and decreases around week 14. However, a significant decrease in influenza was observed after week 6 of 2020. Regression analyses produced the following results: 2017, R2=0.037; 2018, R2=0.021; 2019, R2=0.046; and 2020, R2=0.599. A dramatic decrease in all-cause pneumonia was also reported (R2 values for 2017-2020 were 0.435, 0.098, 0.352, and 0.82, respectively). Enterovirus had increased by week 18 in 2017-2019, but this was not observed in 2020. Conclusions: Using this national epidemiological database, we found a significant decrease in cases of influenza, enterovirus, and all-cause pneumonia during the COVID-19 pandemic. Wearing masks, hand hygiene, and social distancing may contribute not only to the prevention of COVID-19 but also to the decline of other respiratory infectious diseases. Further studies are warranted to elucidate the causal relationship. ",
doi="10.2196/21257",
url="http://www.jmir.org/2020/8/e21257/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32750008"
}


@Article{info:doi/10.2196/21486,
author="Martin, Guy
and Koizia, Louis
and Kooner, Angad
and Cafferkey, John
and Ross, Clare
and Purkayastha, Sanjay
and Sivananthan, Arun
and Tanna, Anisha
and Pratt, Philip
and Kinross, James
and ",
title="Use of the HoloLens2 Mixed Reality Headset for Protecting Health Care Workers During the COVID-19 Pandemic: Prospective, Observational Evaluation",
journal="J Med Internet Res",
year="2020",
month="Aug",
day="14",
volume="22",
number="8",
pages="e21486",
keywords="COVID-19",
keywords="mixed reality",
keywords="telemedicine",
keywords="protection",
keywords="acceptability",
keywords="feasibility",
keywords="impact",
keywords="headset",
keywords="virtual reality",
keywords="augmented reality",
keywords="pilot",
abstract="Background: The coronavirus disease (COVID-19) pandemic has led to rapid acceleration in the deployment of new digital technologies to improve both accessibility to and quality of care, and to protect staff. Mixed-reality (MR) technology is the latest iteration of telemedicine innovation; it is a logical next step in the move toward the provision of digitally supported clinical care and medical education. This technology has the potential to revolutionize care both during and after the COVID-19 pandemic. Objective: This pilot project sought to deploy the HoloLens2 MR device to support the delivery of remote care in COVID-19 hospital environments. Methods: A prospective, observational, nested cohort evaluation of the HoloLens2 was undertaken across three distinct clinical clusters in a teaching hospital in the United Kingdom. Data pertaining to staff exposure to high-risk COVID-19 environments and personal protective equipment (PPE) use by clinical staff (N=28) were collected, and assessments of acceptability and feasibility were conducted. Results: The deployment of the HoloLens2 led to a 51.5\% reduction in time exposed to harm for staff looking after COVID-19 patients (3.32 vs 1.63 hours/day/staff member; P=.002), and an 83.1\% reduction in the amount of PPE used (178 vs 30 items/round/day; P=.02). This represents 222.98 hours of reduced staff exposure to COVID-19, and 3100 fewer PPE items used each week across the three clusters evaluated. The majority of staff using the device agreed it was easy to set up and comfortable to wear, improved the quality of care and decision making, and led to better teamwork and communication. In total, 89.3\% (25/28) of users felt that their clinical team was safer when using the HoloLens2. Conclusions: New technologies have a role in minimizing exposure to nosocomial infection, optimizing the use of PPE, and enhancing aspects of care. Deploying such technologies at pace requires context-specific information security, infection control, user experience, and workflow integration to be addressed at the outset and led by clinical end-users. The deployment of new telemedicine technology must be supported with objective evidence for its safety and effectiveness to ensure maximum impact. ",
doi="10.2196/21486",
url="http://www.jmir.org/2020/8/e21486/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32730222"
}


@Article{info:doi/10.2196/18912,
author="Woldaregay, Zebene Ashenafi
and Launonen, Kalervo Ilkka
and Albers, David
and Igual, Jorge
and {\AA}rsand, Eirik
and Hartvigsen, Gunnar",
title="A Novel Approach for Continuous Health Status Monitoring and Automatic Detection of Infection Incidences in People With Type 1 Diabetes Using Machine Learning Algorithms (Part 2): A Personalized Digital Infectious Disease Detection Mechanism",
journal="J Med Internet Res",
year="2020",
month="Aug",
day="12",
volume="22",
number="8",
pages="e18912",
keywords="type 1 diabetes",
keywords="self-recorded health data",
keywords="infection detection",
keywords="decision support techniques",
keywords="outbreak detection system",
keywords="syndromic surveillance",
abstract="Background: Semisupervised and unsupervised anomaly detection methods have been widely used in various applications to detect anomalous objects from a given data set. Specifically, these methods are popular in the medical domain because of their suitability for applications where there is a lack of a sufficient data set for the other classes. Infection incidence often brings prolonged hyperglycemia and frequent insulin injections in people with type 1 diabetes, which are significant anomalies. Despite these potentials, there have been very few studies that focused on detecting infection incidences in individuals with type 1 diabetes using a dedicated personalized health model. Objective: This study aims to develop a personalized health model that can automatically detect the incidence of infection in people with type 1 diabetes using blood glucose levels and insulin-to-carbohydrate ratio as input variables. The model is expected to detect deviations from the norm because of infection incidences considering elevated blood glucose levels coupled with unusual changes in the insulin-to-carbohydrate ratio. Methods: Three groups of one-class classifiers were trained on target data sets (regular days) and tested on a data set containing both the target and the nontarget (infection days). For comparison, two unsupervised models were also tested. The data set consists of high-precision self-recorded data collected from three real subjects with type 1 diabetes incorporating blood glucose, insulin, diet, and events of infection. The models were evaluated on two groups of data: raw and filtered data and compared based on their performance, computational time, and number of samples required. Results: The one-class classifiers achieved excellent performance. In comparison, the unsupervised models suffered from performance degradation mainly because of the atypical nature of the data. Among the one-class classifiers, the boundary and domain-based method produced a better description of the data. Regarding the computational time, nearest neighbor, support vector data description, and self-organizing map took considerable training time, which typically increased as the sample size increased, and only local outlier factor and connectivity-based outlier factor took considerable testing time. Conclusions: We demonstrated the applicability of one-class classifiers and unsupervised models for the detection of infection incidence in people with type 1 diabetes. In this patient group, detecting infection can provide an opportunity to devise tailored services and also to detect potential public health threats. The proposed approaches achieved excellent performance; in particular, the boundary and domain-based method performed better. Among the respective groups, particular models such as one-class support vector machine, K-nearest neighbor, and K-means achieved excellent performance in all the sample sizes and infection cases. Overall, we foresee that the results could encourage researchers to examine beyond the presented features into other additional features of the self-recorded data, for example, continuous glucose monitoring features and physical activity data, on a large scale. ",
doi="10.2196/18912",
url="https://www.jmir.org/2020/8/e18912",
url="http://www.ncbi.nlm.nih.gov/pubmed/32784179"
}


@Article{info:doi/10.2196/20634,
author="Al-Hasan, Abrar
and Yim, Dobin
and Khuntia, Jiban",
title="Citizens' Adherence to COVID-19 Mitigation Recommendations by the Government: A 3-Country Comparative Evaluation Using Web-Based Cross-Sectional Survey Data",
journal="J Med Internet Res",
year="2020",
month="Aug",
day="11",
volume="22",
number="8",
pages="e20634",
keywords="COVID-19",
keywords="adherence",
keywords="social distancing",
keywords="government perception",
keywords="information sources",
keywords="social media",
keywords="knowledge",
abstract="Background: Social distancing is an effective preventative policy for the coronavirus disease (COVID-19) that is enforced by governments worldwide. However, significant variations are observed in following the policy across individuals and countries. Arguably, differences in citizens' adherence actions will be influenced by their perceptions about government's plans and the information available to guide their behaviors---more so in the digital age in the realm of mass influence of social media on citizens. Insights into the underlying factors and dynamics involved with citizens' adherence process will inform the policy makers to follow appropriate communication and messaging approaches to influence citizens' willingness to adhere to the recommendations. Objective: The aim of this study is a comparative evaluation of citizens' adherence process to COVID-19--relevant recommendations by the government. The focus is on how three different countries' (United States, Kuwait, and South Korea) citizens, randomly sampled, respond to governments' pandemic guidance efforts. We draw insights into two categories of perceived government roles in managing the pandemic: (1) citizens' perceptions of government's role in responding to the pandemic and (2) citizens' perceptions of government's business reopening efforts. Undoubtedly, the internet and social media have burgeoned, with differing effects on shaping individuals' views and assessments of the COVID-19 situation; we argue and test for the effects of information sources, social media use, and knowledge on the adherence actions. Methods: We randomly sampled web-based survey data collected by a global firm in May 2020 from citizens of the United States, Kuwait, and South Korea. A nonlinear ordered probit regression, controlling for several counterfactuals, was used for analysis. The focal estimated effects of the study were compared across countries using the weighted distance between the parameter estimates. Results: The total sample size was 482 respondents, of which 207 (43\%) lived in the United States, 181 (38\%) lived in Kuwait, and 94 (20\%) lived in South Korea. The ordered probit estimation results suggest that overall, perception of government response efforts positively influenced self-adherence (P<.001) and others' adherence (P<.001) to social distancing and sheltering. Perception of government business reopening efforts positively influenced others' adherence (P<.001). A higher intensity of general health information source for COVID-19 had a positive effect on self-adherence (P=.003). A higher intensity of social media source use for COVID-19 positively influenced others' adherence (P=.002). A higher intensity of knowledge on COVID-19 positively influenced self-adherence (P=.008) and negatively influenced others' adherence (P<.001). There were country-level variations---broadly, the United States and Kuwait had better effects than South Korea. Conclusions: As the COVID-19 global pandemic continues to grow and governmental restrictions are ongoing, it is critical to understand people's frustration to reduce panic and promote social distancing to facilitate the control of the pandemic. This study finds that the government plays a central role in terms of adherence to restrictions. Governments need to enhance their efforts on publicizing information on the pandemic, as well as employ strategies for improved communication management to citizens through social media as well as mainstream information sources. ",
doi="10.2196/20634",
url="http://www.jmir.org/2020/8/e20634/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32716896"
}


@Article{info:doi/10.2196/20328,
author="Guo, Yan
and Cheng, Chao
and Zeng, Yu
and Li, Yiran
and Zhu, Mengting
and Yang, Weixiong
and Xu, He
and Li, Xiaohua
and Leng, Jinhang
and Monroe-Wise, Aliza
and Wu, Shaomin",
title="Mental Health Disorders and Associated Risk Factors in Quarantined Adults During the COVID-19 Outbreak in China: Cross-Sectional Study",
journal="J Med Internet Res",
year="2020",
month="Aug",
day="6",
volume="22",
number="8",
pages="e20328",
keywords="COVID-19",
keywords="anxiety or depressive symptoms",
keywords="quarantine",
keywords="risk and protective factors",
abstract="Background: People undergoing mass home- and community-based quarantine are vulnerable to mental health disorders during outbreaks of coronavirus disease (COVID-19), but few studies have evaluated the associated psychosocial factors. Objective: This study aimed to estimate the prevalence of anxiety and depressive symptoms and identify associated demographic and psychosocial factors in the general Chinese population during the COVID-19 pandemic quarantine period. Methods: Participants aged 18 years or above were recruited in a cross-sectional online survey using snowball sampling from February 26-29, 2020. The survey included questions on demographics, family relationships, chronic diseases, quarantine conditions, lifestyle, COVID-19 infection, and anxiety and depressive symptoms. Logistic regression analyses were conducted to identify factors associated with elevated anxiety or depressive symptoms. Results: Out of 2331 participants, 762 (32.7\%) experienced elevated anxiety or depressive symptoms. Nine risk factors associated with anxiety or depressive symptoms included younger age, reduced income, having cancer or other chronic diseases, having family members living with cancer, concerns related to COVID-19 infection for themselves or family members, living alone, having family conflicts, having <3 or >8 hours of sedentary time per day, and worsened sleep quality. Conclusions: The findings highlight an urgent need for psychological support for populations at high risk for elevated anxiety or depressive symptoms during the COVID-19 pandemic. ",
doi="10.2196/20328",
url="http://www.jmir.org/2020/8/e20328/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32716899"
}


@Article{info:doi/10.2196/15965,
author="Song, Wongeun
and Jung, Young Se
and Baek, Hyunyoung
and Choi, Won Chang
and Jung, Hwa Young
and Yoo, Sooyoung",
title="A Predictive Model Based on Machine Learning for the Early Detection of Late-Onset Neonatal Sepsis: Development and Observational Study",
journal="JMIR Med Inform",
year="2020",
month="Jul",
day="31",
volume="8",
number="7",
pages="e15965",
keywords="prediction",
keywords="late-onset neonatal sepsis",
keywords="machine learning",
abstract="Background: Neonatal sepsis is associated with most cases of mortalities and morbidities in the neonatal intensive care unit (NICU). Many studies have developed prediction models for the early diagnosis of bloodstream infections in newborns, but there are limitations to data collection and management because these models are based on high-resolution waveform data. Objective: The aim of this study was to examine the feasibility of a prediction model by using noninvasive vital sign data and machine learning technology. Methods: We used electronic medical record data in intensive care units published in the Medical Information Mart for Intensive Care III clinical database. The late-onset neonatal sepsis (LONS) prediction algorithm using our proposed forward feature selection technique was based on NICU inpatient data and was designed to detect clinical sepsis 48 hours before occurrence. The performance of this prediction model was evaluated using various feature selection algorithms and machine learning models. Results: The performance of the LONS prediction model was found to be comparable to that of the prediction models that use invasive data such as high-resolution vital sign data, blood gas estimations, blood cell counts, and pH levels. The area under the receiver operating characteristic curve of the 48-hour prediction model was 0.861 and that of the onset detection model was 0.868. The main features that could be vital candidate markers for clinical neonatal sepsis were blood pressure, oxygen saturation, and body temperature. Feature generation using kurtosis and skewness of the features showed the highest performance. Conclusions: The findings of our study confirmed that the LONS prediction model based on machine learning can be developed using vital sign data that are regularly measured in clinical settings. Future studies should conduct external validation by using different types of data sets and actual clinical verification of the developed model. ",
doi="10.2196/15965",
url="http://medinform.jmir.org/2020/7/e15965/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32735230"
}


@Article{info:doi/10.2196/20469,
author="He, Shuhan
and Ojo, Ayotomiwa
and Beckman, L. Adam
and Gondi, Suhas
and Ranney, Megan
and Betz, Marian
and Faust, S. Jeremy
and Choo, Esther
and Kass, Dara
and Raja, S. Ali",
title="The Story of \#GetMePPE and GetUsPPE.org to Mobilize Health Care Response to COVID-19 : Rapidly Deploying Digital Tools for Better Health Care",
journal="J Med Internet Res",
year="2020",
month="Jul",
day="20",
volume="22",
number="7",
pages="e20469",
keywords="digital health",
keywords="getusppe",
keywords="getmeppe",
keywords="COVID-19",
keywords="personal protective equipment",
keywords="protection",
keywords="Twitter",
keywords="pandemic",
keywords="health care worker",
doi="10.2196/20469",
url="https://www.jmir.org/2020/7/e20469",
url="http://www.ncbi.nlm.nih.gov/pubmed/32530813"
}


@Article{info:doi/10.2196/20586,
author="Lin, Chien-Hao
and Tseng, Wen-Pin
and Wu, Jhong-Lin
and Tay, Joyce
and Cheng, Ming-Tai
and Ong, Hooi-Nee
and Lin, Hao-Yang
and Chen, Yi-Ying
and Wu, Chih-Hsien
and Chen, Jiun-Wei
and Chen, Shey-Ying
and Chan, Chang-Chuan
and Huang, Chien-Hua
and Chen, Shyr-Chyr",
title="A Double Triage and Telemedicine Protocol to Optimize Infection Control in an Emergency Department in Taiwan During the COVID-19 Pandemic: Retrospective Feasibility Study",
journal="J Med Internet Res",
year="2020",
month="Jun",
day="23",
volume="22",
number="6",
pages="e20586",
keywords="COVID-19",
keywords="triage",
keywords="emergency department",
keywords="health care workers",
keywords="infection control",
keywords="telemedicine",
abstract="Background: Frontline health care workers, including physicians, are at high risk of contracting coronavirus disease (COVID-19) owing to their exposure to patients suspected of having COVID-19. Objective: The aim of this study was to evaluate the benefits and feasibility of a double triage and telemedicine protocol in improving infection control in the emergency department (ED). Methods: In this retrospective study, we recruited patients aged ?20 years referred to the ED of the National Taiwan University Hospital between March 1 and April 30, 2020. A double triage and telemedicine protocol was developed to triage suggested COVID-19 cases and minimize health workers' exposure to this disease. We categorized patients attending video interviews into a telemedicine group and patients experiencing face-to-face interviews into a conventional group. A questionnaire was used to assess how patients perceived the quality of the interviews and their communication with physicians as well as perceptions of stress, discrimination, and privacy. Each question was evaluated using a 5-point Likert scale. Physicians' total exposure time and total evaluation time were treated as primary outcomes, and the mean scores of the questions were treated as secondary outcomes. Results: The final sample included 198 patients, including 93 cases (47.0\%) in the telemedicine group and 105 cases (53.0\%) in the conventional group. The total exposure time in the telemedicine group was significantly shorter than that in the conventional group (4.7 minutes vs 8.9 minutes, P<.001), whereas the total evaluation time in the telemedicine group was significantly longer than that in the conventional group (12.2 minutes vs 8.9 minutes, P<.001). After controlling for potential confounders, the total exposure time in the telemedicine group was 4.6 minutes shorter than that in the conventional group (95\% CI ?5.7 to ?3.5, P<.001), whereas the total evaluation time in the telemedicine group was 2.8 minutes longer than that in the conventional group (95\% CI ?1.6 to ?4.0, P<.001). The mean scores of the patient questionnaire were high in both groups (4.5/5 to 4.7/5 points). Conclusions: The implementation of the double triage and telemedicine protocol in the ED during the COVID-19 pandemic has high potential to improve infection control. ",
doi="10.2196/20586",
url="http://www.jmir.org/2020/6/e20586/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32544072"
}


@Article{info:doi/10.2196/19947,
author="Parush, Avi
and Wacht, Oren
and Gomes, Ricardo
and Frenkel, Amit",
title="Human Factor Considerations in Using Personal Protective Equipment in the COVID-19 Pandemic Context: Binational Survey Study",
journal="J Med Internet Res",
year="2020",
month="Jun",
day="17",
volume="22",
number="6",
pages="e19947",
keywords="COVID-19",
keywords="personal protective equipment",
keywords="PPE",
keywords="human factors",
keywords="cognitive functioning",
keywords="multinational survey",
keywords="pandemic",
keywords="protection",
keywords="infectious disease",
keywords="infection",
keywords="survey",
abstract="Background: Full level 1 personal protective equipment (PPE) is used in various domains and contexts. Prior research has shown influences of such equipment on performance, comfort, and contamination levels. The coronavirus disease (COVID-19) pandemic forced a pervasive requirement of PPE, with little preparation, rushed deployment, inadequate time for training, and massive use by personnel who are inexperienced or not qualified in its effective use. Objective: This study aims to examine the key human factors (physical and ergonomic, perceptual and cognitive) that influence the use of level 1 PPE when attending to patients with suspected or confirmed COVID-19. Methods: The research approach consisted of a short survey disseminated to health care professionals in two countries, Israel and Portugal, with similar demographics and health care systems. The survey included 10 items with a 5-point Likert scale regarding the key human factors involved in level 1 PPE, as identified in prior research. Results: A total of 722 respondents from Israel and 301 respondents from Portugal were included in the analysis. All the respondents reported using level 1 PPE with patients with COVID-19 in the range of several hours daily to several hours weekly. The Cronbach $\alpha$ was .73 for Israel and .75 for Portugal. Responses showed high levels of difficulty, with medians of 4 for items related to discomfort (n=539/688, 78\% in Israel; n=328/377, 87\% in Portugal), hearing (n=236/370, 64\% in Portugal; n=321/642, 50\% in Israel), seeing (n=697/763, 89\% in Israel; n=317/376, 84\% in Portugal), and doffing (n=290/374, 77\% in Portugal; n=315/713, 44\% in Israel). A factor analysis showed a set of strongly related variables consisting of hearing, understanding speech, and understanding the situation. This suggests that degradation in communication was strongly associated with degradation in situational awareness. A subsequent mediation analysis showed a direct effect of PPE discomfort on situational awareness (P<.001); this was also influenced (mediated) by difficulties in communicating, namely in hearing and understanding speech. Conclusions: In 2020, the COVID-19 pandemic is paving the way for updating PPE design. The use of already deployed technology affords ample opportunities to improve, adapt, and overcome caveats. The findings here suggest that the use of level 1 PPE with patients with COVID-19 has perceptual and cognitive effects, in addition to physical and ergonomic influences. Efforts should be taken to mitigate the harmful effects of such influences, both regarding the performance of medical actions and the risk of contamination to health care workers. Such efforts involve the design of PPE; the introduction of technologies to enhance vision, hearing, and communicating during the use of PPE; and training staff in using the equipment and in effective communication and teamwork protocols. ",
doi="10.2196/19947",
url="http://www.jmir.org/2020/6/e19947/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32511099"
}


@Article{info:doi/10.2196/19782,
author="Li, Siyue
and Feng, Bo
and Liao, Wang
and Pan, Wenjing",
title="Internet Use, Risk Awareness, and Demographic Characteristics Associated With Engagement in Preventive Behaviors and Testing: Cross-Sectional Survey on COVID-19 in the United States",
journal="J Med Internet Res",
year="2020",
month="Jun",
day="16",
volume="22",
number="6",
pages="e19782",
keywords="COVID-19",
keywords="coronavirus",
keywords="preventive behaviors",
keywords="testing",
keywords="online health information",
keywords="risk awareness",
abstract="Background: During the coronavirus disease (COVID-19) pandemic, engagement in preventive behaviors and getting tested for the virus play a crucial role in protecting people from contracting the new coronavirus. Objective: This study aims to examine how internet use, risk awareness, and demographic characteristics are associated with engagement in preventative behaviors and testing during the COVID-19 pandemic in the United States. Methods: A cross-sectional survey was conducted on Amazon Mechanical Turk from April 10, 2020, to April 14, 2020. Participants' internet use (in terms of the extent of receiving information pertaining to COVID-19), risk awareness (whether any immediate family members, close friends or relatives, or people in local communities tested positive for COVID-19), demographics (sex, age, ethnicity, income, education level, marital status, and employment status), as well as their engagement in preventative behaviors and testing were assessed. Results: Our data included 979 valid responses from the United States. Participants who received more COVID-19--related health information online reported more frequent effort to engage in all types of preventive behaviors: wearing a facemask in public (odds ratio [OR] 1.55, 95\% CI 1.34-1.79, P<.001), washing hands (OR 1.58, 95\% CI 1.35-1.85, P<.001), covering nose and mouth when sneezing and coughing (OR 1.78, 95\% CI 1.52-2.10, P<.001), keeping social distance with others (OR 1.41, 95\% CI 1.21-1.65, P<.001), staying home (OR 1.40, 95\% CI 1.20-1.62, P<.001), avoiding using public transportation (OR 1.57, 95\% CI 1.32-1.88, P<.001), and cleaning frequently used surfaces (OR 1.55, 95\% CI 1.34-1.79, P<.001). Compared with participants who did not have positive cases in their social circles, those who had immediate family members (OR 1.48, 95\% CI 8.28-26.44, P<.001) or close friends and relatives (OR 2.52, 95\% CI 1.58-4.03, P<.001) who tested positive were more likely to get tested. Participants' sex, age, ethnicity, marital status, and employment status were also associated with preventive behaviors and testing. Conclusions: Our findings revealed that the extent of receiving COVID-19--related information online, risk awareness, and demographic characteristics including sex, ethnicity, age, marital status, and employment status are key factors associated with US residents' engagement in various preventive behaviors and testing for COVID-19. ",
doi="10.2196/19782",
url="http://www.jmir.org/2020/6/e19782/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32501801"
}


@Article{info:doi/10.2196/18186,
author="Chen, Weijia
and Lu, Zhijun
and You, Lijue
and Zhou, Lingling
and Xu, Jie
and Chen, Ken",
title="Artificial Intelligence--Based Multimodal Risk Assessment Model for Surgical Site Infection (AMRAMS): Development and Validation Study",
journal="JMIR Med Inform",
year="2020",
month="Jun",
day="15",
volume="8",
number="6",
pages="e18186",
keywords="surgical site infection",
keywords="machine learning",
keywords="deep learning",
keywords="natural language processing",
keywords="artificial intelligence",
keywords="risk assessment model",
keywords="routinely collected data",
keywords="electronic medical record",
keywords="neural network",
keywords="word embedding",
abstract="Background: Surgical site infection (SSI) is one of the most common types of health care--associated infections. It increases mortality, prolongs hospital length of stay, and raises health care costs. Many institutions developed risk assessment models for SSI to help surgeons preoperatively identify high-risk patients and guide clinical intervention. However, most of these models had low accuracies. Objective: We aimed to provide a solution in the form of an Artificial intelligence--based Multimodal Risk Assessment Model for Surgical site infection (AMRAMS) for inpatients undergoing operations, using routinely collected clinical data. We internally and externally validated the discriminations of the models, which combined various machine learning and natural language processing techniques, and compared them with the National Nosocomial Infections Surveillance (NNIS) risk index. Methods: We retrieved inpatient records between January 1, 2014, and June 30, 2019, from the electronic medical record (EMR) system of Rui Jin Hospital, Luwan Branch, Shanghai, China. We used data from before July 1, 2018, as the development set for internal validation and the remaining data as the test set for external validation. We included patient demographics, preoperative lab results, and free-text preoperative notes as our features. We used word-embedding techniques to encode text information, and we trained the LASSO (least absolute shrinkage and selection operator) model, random forest model, gradient boosting decision tree (GBDT) model, convolutional neural network (CNN) model, and self-attention network model using the combined data. Surgeons manually scored the NNIS risk index values. Results: For internal bootstrapping validation, CNN yielded the highest mean area under the receiver operating characteristic curve (AUROC) of 0.889 (95\% CI 0.886-0.892), and the paired-sample t test revealed statistically significant advantages as compared with other models (P<.001). The self-attention network yielded the second-highest mean AUROC of 0.882 (95\% CI 0.878-0.886), but the AUROC was only numerically higher than the AUROC of the third-best model, GBDT with text embeddings (mean AUROC 0.881, 95\% CI 0.878-0.884, P=.47). The AUROCs of LASSO, random forest, and GBDT models using text embeddings were statistically higher than the AUROCs of models not using text embeddings (P<.001). For external validation, the self-attention network yielded the highest AUROC of 0.879. CNN was the second-best model (AUROC 0.878), and GBDT with text embeddings was the third-best model (AUROC 0.872). The NNIS risk index scored by surgeons had an AUROC of 0.651. Conclusions: Our AMRAMS based on EMR data and deep learning methods---CNN and self-attention network---had significant advantages in terms of accuracy compared with other conventional machine learning methods and the NNIS risk index. Moreover, the semantic embeddings of preoperative notes improved the model performance further. Our models could replace the NNIS risk index to provide personalized guidance for the preoperative intervention of SSIs. Through this case, we offered an easy-to-implement solution for building multimodal RAMs for other similar scenarios. ",
doi="10.2196/18186",
url="http://medinform.jmir.org/2020/6/e18186/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32538798"
}


@Article{info:doi/10.2196/16195,
author="Al-Orainan, Nourah
and EL-Shabasy, Mohamed Adel
and Al-Shanqiti, Alamin Khawlah
and Al-Harbi, Awad Rawan
and Alnashri, Rajeh Hadeel
and Rezqallah, Ahmed Raghad
and Mirghani, Abdallah Alanoud",
title="Public Awareness of Sepsis Compared to Acute Myocardial Infarction and Stroke in Jeddah, Saudi Arabia: Questionnaire Study",
journal="Interact J Med Res",
year="2020",
month="Jun",
day="15",
volume="9",
number="2",
pages="e16195",
keywords="sepsis",
keywords="public awareness",
keywords="survey",
abstract="Background: Sepsis is a state of organ dysfunction caused by an impaired host response to infection. It is one of the leading causes of death globally. Sepsis, acute myocardial infarction (AMI), and stroke share the primary management requirement of rapid intervention. This could be achieved through early presentation to the hospital, which demands previous knowledge of the disease to ensure better outcomes. Objective: Our study aimed to assess the level of public awareness of sepsis compared with AMI and stroke. Methods: This was a cross-sectional survey study performed in June and July 2018, with 1354 participants from Jeddah, Saudi Arabia, aged ?18 years. Data entry was performed using Microsoft Excel and statistical analysis including chi-square tests and multilogistic regression was performed using SPSS software. Results: A total of 1354 participants were included. Only 56.72\% (768/1354) had heard of the term ``sepsis'' and 48.44\% (372/768) of these participants were able to correctly identify it. In addition, 88.33\% (1196/1354) had heard the term ``myocardial infarction'' and 64.63\% (773/1196) knew the correct definition of that condition. Stroke was recognized by 81.46\% (1103/1354) of participants and 59.20\% (653/1103) of these participants correctly identified the condition. The difference between those who had heard of these diseases and those who knew the correct definition significantly differed from the values for awareness of sepsis and its definition. Conclusions: We found that public awareness and knowledge of sepsis are poor amongst the population of Jeddah compared with the awareness and knowledge of AMI and stroke. This lack of knowledge may pose a serious obstruction to the prompt management needed to limit fatal outcomes. ",
doi="10.2196/16195",
url="http://www.i-jmr.org/2020/2/e16195/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32538794"
}


@Article{info:doi/10.2196/20173,
author="Suppan, M{\'e}lanie
and Gartner, Birgit
and Golay, Eric
and Stuby, Loric
and White, Marion
and Cottet, Philippe
and Abbas, Mohamed
and Iten, Anne
and Harbarth, Stephan
and Suppan, Laurent",
title="Teaching Adequate Prehospital Use of Personal Protective Equipment During the COVID-19 Pandemic: Development of a Gamified e-Learning Module",
journal="JMIR Serious Games",
year="2020",
month="Jun",
day="12",
volume="8",
number="2",
pages="e20173",
keywords="personal protective equipment",
keywords="electronic learning",
keywords="gamification",
keywords="prehospital",
keywords="COVID-19",
abstract="Background: The coronavirus disease (COVID-19) pandemic has led to increased use of personal protective equipment (PPE). Adequate use of this equipment is more critical than ever because the risk of shortages must be balanced against the need to effectively protect health care workers, including prehospital personnel. Specific training is therefore necessary; however, the need for social distancing has markedly disrupted the delivery of continuing education courses. Electronic learning (e-learning) may provide significant advantages because it requires neither the physical presence of learners nor the repetitive use of equipment for demonstration. Objective: Inclusion of game mechanics, or ``gamification,'' has been shown to increase knowledge and skill acquisition. The objective of this research was to develop a gamified e-learning module to interactively deliver concepts and information regarding the correct choice and handling of PPE. Methods: The SERES framework was used to define and describe the development process, including scientific and design foundations. After we defined the target audience and learning objectives by interviewing the stakeholders, we searched the scientific literature to establish relevant theoretical bases. The learning contents were validated by infection control and prehospital experts. Learning mechanics were then determined according to the learning objectives, and the content that could benefit from the inclusion of game mechanics was identified. Results: The literature search resulted in the selection and inclusion of 12 articles. In addition to gamification, pretesting, feedback, avoiding content skipping, and demonstrations using embedded videos were used as learning mechanics. Gamification was used to enhance the interactivity of the PPE donning and doffing sequences, which presented the greatest learning challenges. The module was developed with Articulate Storyline 3 to ensure that it would be compatible with a wide array of devices, as this software generates HTML5-compatible output that can be accessed on smartphones, tablets, and regular computers as long as a recent browser is available. Conclusions: A gamified e-learning module designed to promote better knowledge and understanding of PPE use among prehospital health care workers was created by following the SERES framework. The impact of this module should now be assessed by means of a randomized controlled trial. ",
doi="10.2196/20173",
url="http://games.jmir.org/2020/2/e20173/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32516115"
}


@Article{info:doi/10.2196/18788,
author="Akram, Hammad
and Andrews-Paul, Alison
and Washburn, Rachel",
title="Assessing Hand Hygiene and Low-Level Disinfection of Equipment Compliance in an Acute Care Setting: Mixed Methods Approach",
journal="JMIR Nursing",
year="2020",
month="Jun",
day="5",
volume="3",
number="1",
pages="e18788",
keywords="compliance",
keywords="hand hygiene",
keywords="low-level disinfection",
keywords="patient safety",
keywords="qualitative",
keywords="quality improvement",
keywords="infection prevention",
keywords="infection control",
keywords="nursing",
keywords="mixed-methods",
keywords="HAI",
keywords="health care-associated infections",
keywords="hand washing",
keywords="hand sanitizers",
abstract="Background: Hand hygiene and low-level disinfection of equipment behaviors among hospital staff are some of the leading cost-effective methods to reduce hospital-acquired infections (HAI) among patients. Objective: The aim of this study is to examine hand hygiene and low-level disinfection of equipment practices in a central Texas hospital and to explore pertaining gaps, perceptions, and challenges. Methods: Data were collected using a multipronged mixed methods approach that included the following: (1) observation of hand hygiene and low-level disinfection practices (12 and 8 units during morning and evening shifts, respectively); (2) observation of usability/placement of hand sanitizer dispensers; (3) semistructured interviews; and (4) a follow-up email survey. Results: In total, 222 (156 morning shift and 66 evening shift) staff members were observed. Of 526 hand hygiene and 33 low-level disinfection opportunities, compliance was observed 410 (78\%) and 17 (51\%) times, respectively. Overall, 6 units (50\%) had ?0.80 (favorable) hand hygiene compliance during the morning shift and 2 units (25\%) had ?0.80 hand hygiene compliance during the evening shift. Aggregated low-level disinfection compliance was 0.54 during the morning and 0.33 during the evening. Overall, the odds of noncompliant hand hygiene behavior were 1.4 times higher among staff who worked during night shifts compared to day shifts; however, this relationship was not statistically significant (95\% CI 0.86-2.18; P=.18). Noncompliant behavior was most likely among unit B staff during the evening; however, this relationship was not statistically significant (OR 5.3, 95\% CI 0.84-32.9; P=.07) All units, except one, had similar hand sanitizer dispenser usability characteristics. In the qualitative part of the study, the following challenges were identified: ``shortage of time while seeing patients,'' ``sometimes the staff forgets,'' ``concern about drying hands,'' ``behavior is difficult or requires reminders,'' and ``there may be issues with resources or access to supplies to perform these behaviors.'' Staff also stated that ``a process that is considered effective is the Stop the Line program,'' and that the ``behavior is easy and automatic.'' Conclusions: Hand hygiene and low-level disinfection compliance is dependent on several personal and nonpersonal factors. Issues such as time constraints, peer pressure, work culture, available resources, and understanding of guidelines could influence staff behavior. The information collected through this study can be used to re-examine similar or related issues at a larger scale. ",
doi="10.2196/18788",
url="https://nursing.jmir.org/2020/1/e18788",
url="http://www.ncbi.nlm.nih.gov/pubmed/34345785"
}


@Article{info:doi/10.2196/19927,
author="Garg, Suneela
and Basu, Saurav
and Rustagi, Ruchir
and Borle, Amod",
title="Primary Health Care Facility Preparedness for Outpatient Service Provision During the COVID-19 Pandemic in India: Cross-Sectional Study",
journal="JMIR Public Health Surveill",
year="2020",
month="Jun",
day="1",
volume="6",
number="2",
pages="e19927",
keywords="primary health care",
keywords="COVID-19",
keywords="pandemic",
keywords="health systems",
keywords="India",
abstract="Background: Primary health centers (PHCs) represent the first tier of the Indian health care system, providing a range of essential outpatient services to people living in the rural, suburban, and hard-to-reach areas. Diversion of health care resources for containing the coronavirus disease (COVID-19) pandemic has significantly undermined the accessibility and availability of essential health services. Under these circumstances, the preparedness of PHCs in providing safe patient-centered care and meeting the current health needs of the population while preventing further transmission of the severe acute respiratory syndrome coronavirus 2 infection is crucial. Objective: The aim of this study was to determine the primary health care facility preparedness toward the provision of safe outpatient services during the COVID-19 pandemic in India. Methods: We conducted a cross-sectional study among supervisors and managers of primary health care facilities attached to medical colleges and institutions in India. A list of 60 faculties involved in the management and supervision of PHCs affiliated with the community medicine departments of medical colleges and institutes across India was compiled from an accessible private organization member database. We collected the data through a rapid survey from April 24 to 30, 2020, using a Google Forms online digital questionnaire that evaluated preparedness parameters based on self-assessment by the participants. The preparedness domains assessed were infrastructure availability, health worker safety, and patient care. Results: A total of 51 faculties responded to the survey. Each medical college and institution had on average a total of 2.94 (SD 1.7) PHCs under its jurisdiction. Infrastructural and infection control deficits at the PHC were reported in terms of limited physical space and queuing capacity, lack of separate entry and exit gates (n=25, 49\%), inadequate ventilation (n=29, 57\%), and negligible airborne infection control measures (n=38, 75.5\%). N95 masks were available at 26 (50.9\%) sites. Infection prevention and control measures were also suboptimal with inadequate facilities for handwashing and hand hygiene reported in 23.5\% (n=12) and 27.4\% (n=14) of sites, respectively. The operation of outpatient services, particularly related to maternal and child health, was significantly disrupted (P<.001) during the COVID-19 pandemic. Conclusions: Existing PHC facilities in India providing outpatient services are constrained in their functioning during the COVID-19 pandemic due to weak infrastructure contributing to suboptimal patient safety and infection control measures. Furthermore, there is a need for effective planning, communication, and coordination between the centralized health policy makers and health managers working at primary health care facilities to ensure overall preparedness during public health emergencies. ",
doi="10.2196/19927",
url="http://publichealth.jmir.org/2020/2/e19927/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32452819"
}


@Article{info:doi/10.2196/19501,
author="Laestadius, Linnea
and Wang, Yang
and Ben Taleb, Ziyad
and Kalan, Ebrahimi Mohammad
and Cho, Young
and Manganello, Jennifer",
title="Online National Health Agency Mask Guidance for the Public in Light of COVID-19: Content Analysis",
journal="JMIR Public Health Surveill",
year="2020",
month="May",
day="26",
volume="6",
number="2",
pages="e19501",
keywords="public health policy",
keywords="infectious disease",
keywords="personal protective equipment",
keywords="public health",
keywords="COVID-19",
keywords="pandemic",
keywords="online health information",
keywords="content analysis",
abstract="Background: The rapid global spread of the coronavirus disease (COVID-19) has compelled national governments to issue guidance on the use of face masks for members of the general public. To date, no work has assessed how this guidance differs across governments. Objective: This study seeks to contribute to a rational and consistent global response to infectious disease by determining how guidelines differ across nations and regions. Methods: A content analysis of health agency mask guidelines on agency websites was performed in late March 2020 among 25 countries and regions with large numbers of COVID-19 cases. Countries and regions were assigned across the coding team by language proficiency, with Google Translate used as needed. When available, both the original and English language version of guidance were reviewed. Results: All examined countries and regions had some form of guidance online, although detail and clarity differed. Although 9 countries and regions recommended surgical, medical, or unspecified masks in public and poorly ventilated places, 16 recommended against people wearing masks in public. There were 2 countries that explicitly recommended against fabric masks. In addition, 12 failed to outline the minimum basic World Health Organization guidance for masks. Conclusions: Online guidelines for face mask use to prevent COVID-19 in the general public are currently inconsistent across nations and regions, and have been changing often. Efforts to create greater standardization and clarity should be explored in light of the status of COVID-19 as a global pandemic. ",
doi="10.2196/19501",
url="http://publichealth.jmir.org/2020/2/e19501/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32427103"
}


@Article{info:doi/10.2196/14973,
author="Moore, M. Courtney
and Wiehe, E. Sarah
and Lynch, O. Dustin
and Claxton, EM Gina
and Landman, P. Matthew
and Carroll, E. Aaron
and Musey, I. Paul",
title="Methicillin-Resistant Staphylococcus aureus Eradication and Decolonization in Children Study (Part 2): Patient- and Parent-Centered Outcomes of Decolonization",
journal="J Participat Med",
year="2020",
month="May",
day="20",
volume="12",
number="2",
pages="e14973",
keywords="patient-centered outcomes",
keywords="Staphylococcus aureus",
keywords="abscess",
keywords="decolonization",
keywords="human-centered design",
abstract="Background: Skin and soft tissue infections (SSTIs) due to community-acquired methicillin-resistant Staphylococcus aureus (MRSA) can lead to a number of significant known medical outcomes including hospitalization, surgical procedures such as incision and drainage (I\&D), and the need for decolonization procedures to remove the bacteria from the skin and nose and prevent recurrent infection. Little research has been done to understand patient and caregiver-centered outcomes associated with the successful treatment of MRSA infection. Objective: This study aimed to uncover MRSA decolonization outcomes that are important to patients and their parents in order to create a set of prototype measures for use in the MRSA Eradication and Decolonization in Children (MEDiC) study. Methods: A 4-hour, human-centered design (HCD) workshop was held with 5 adolescents (aged 10-18 years) who had experienced an I\&D procedure and 11 parents of children who had experienced an I\&D procedure. The workshop explored the patient and family experience with skin infection to uncover patient-centered outcomes of MRSA treatment. The research team analyzed the audio and artifacts created during the workshop and coded for thematic similarity. The final themes represent patient-centered outcome domains to be measured in the MEDiC comparative effectiveness trial. Results: The workshop identified 9 outcomes of importance to patients and their parents: fewer MRSA outbreaks, improved emotional health, improved self-perception, decreased social stigma, increased amount of free time, increased control over free time, fewer days of school or work missed, decreased physical pain and discomfort, and decreased financial burden. Conclusions: This study represents an innovative HCD approach to engaging patients and families with lived experience with MRSA SSTIs in the study design and trial development to determine meaningful patient-centered outcomes. We were able to identify 9 major recurrent themes. These themes were used to develop the primary and secondary outcome measures for MEDiC, a prospectively enrolling comparative effectiveness trial. Trial Registration: ClinicalTrials.gov NCT02127658; https://clinicaltrials.gov/ct2/show/NCT02127658 ",
doi="10.2196/14973",
url="http://jopm.jmir.org/2020/2/e14973/"
}


@Article{info:doi/10.2196/14974,
author="Moore, M. Courtney
and Wiehe, E. Sarah
and Lynch, O. Dustin
and Claxton, EM Gina
and Landman, P. Matthew
and Carroll, E. Aaron
and Musey, I. Paul",
title="Methicillin-Resistant Staphylococcus aureus Eradication and Decolonization in Children Study (Part 1): Development of a Decolonization Toolkit With Patient and Parent Advisors",
journal="J Participat Med",
year="2020",
month="May",
day="20",
volume="12",
number="2",
pages="e14974",
keywords="Staphylococcus aureus",
keywords="MRSA",
keywords="abscess",
keywords="decolonization",
keywords="human-centered design",
keywords="communication design",
abstract="Background: Community-acquired methicillin-resistant Staphylococcus aureus (MRSA) skin and soft tissue infections affect many healthy children. A significant number of these children are hospitalized and require surgical incision and drainage (I\&D). Once sent home, these children and families are asked to complete burdensome home decolonization and hygiene procedures in an effort to prevent the high rate of recurrent infections. Objective: This component of the Methicillin-resistant Staphylococcus aureus Eradication and Decolonization in Children (MEDiC) study aimed to develop a toolkit to assist MEDiC study participants in completing MRSA decolonization and hygiene procedures at home (the MEDiC kit). Methods: In all, 5 adolescents (aged 10-18 years) who had undergone an I\&D procedure for a skin infection and 11 parents of children who had undergone an I\&D procedure for a skin infection were engaged in a 4-hour group workshop using a human-centered design approach. The topics covered in this workshop and analyzed for this paper were (1) attitudes about MRSA decolonization procedures and (2) barriers to the implementation of MRSA decolonization and hygiene procedures. The team analyzed the audio and artifacts created during the workshop and synthesized their findings to inform the creation of the MEDiC kit. Results: The workshop activities uncovered barriers to successful completion of the decolonization and hygiene procedures: lack of step-by-step instruction, lack of proper tools in the home, concerns about adverse events, lack of control over some aspects of the hygiene procedures, and general difficulty coordinating all the procedures. Many of these could be addressed as part of the MEDiC kit. In addition, the workshop revealed that effective communication about decolonization would have to address concerns about the effects of bleach, provide detailed information, give reasons for the specific decolonization and hygiene protocol steps, and include step-by-step instructions (preferably through video). Conclusions: Through direct engagement with patients and families, we were able to better understand how to support families in implementing MRSA decolonization and hygiene protocols. In addition, we were able to better understand how to communicate about MRSA decolonization and hygiene protocols. With this knowledge, we created a robust toolkit that uses patient-driven language and visuals to help support patients and families through the implementation of these protocols. Trial Registration: ClinicalTrials.gov NCT02127658; https://clinicaltrials.gov/ct2/show/NCT02127658 ",
doi="10.2196/14974",
url="http://jopm.jmir.org/2020/2/e14974/"
}


@Article{info:doi/10.2196/18821,
author="Yamahata, Yoshihiro
and Shibata, Ayako",
title="Preparation for Quarantine on the Cruise Ship Diamond Princess in Japan due to COVID-19",
journal="JMIR Public Health Surveill",
year="2020",
month="May",
day="11",
volume="6",
number="2",
pages="e18821",
keywords="SARS-CoV-2",
keywords="COVID-19",
keywords="infectious control",
keywords="cruise ship quarantine",
keywords="pandemic",
keywords="outbreak",
keywords="surveillance",
keywords="preparation",
keywords="infectious disease",
keywords="public health",
keywords="quarantine",
abstract="Background: Japan implemented a large-scale quarantine on the Diamond Princess cruise ship in an attempt to control the spread of the novel coronavirus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in February 2020. Objective: We aim to describe the medical activities initiated and difficulties in implementing quarantine on a cruise ship. Methods: Reverse transcription--polymerase chain reaction (RT-PCR) tests for SARS-CoV-2 were performed for all 3711 people (2666 passengers and 1045 crew) on board. Results: Of those tested, 696 (18.8\%) tested positive for coronavirus disease (COVID-19), of which 410 (58.9\%) were asymptomatic. We also confirmed that 54\% of the asymptomatic patients with a positive RT-PCR result had lung opacities on chest computed tomography. There were many difficulties in implementing quarantine, such as creating a dividing traffic line between infectious and noninfectious passengers, finding hospitals and transportation providers willing to accept these patients, transporting individuals, language barriers, and supporting daily life. As of March 8, 2020, 31 patients (4.5\% of patients with positive RT-PCR results) were hospitalized and required ventilator support or intensive care, and 7 patients (1.0\% of patients with positive RT-PCR results) had died. Conclusions: There were several difficulties in implementing large-scale quarantine and obtaining medical support on the cruise ship. In the future, we need to prepare for patients' transfer and the admitting hospitals when disembarking the passengers. We recommend treating the crew the same way as the passengers to control the infection. We must also draw a plan for the future, to protect travelers and passengers from emerging infectious diseases on cruise ships. ",
doi="10.2196/18821",
url="http://publichealth.jmir.org/2020/2/e18821/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32365046"
}


@Article{info:doi/10.2196/19161,
author="Clements, M. John",
title="Knowledge and Behaviors Toward COVID-19 Among US Residents During the Early Days of the Pandemic: Cross-Sectional Online Questionnaire",
journal="JMIR Public Health Surveill",
year="2020",
month="May",
day="8",
volume="6",
number="2",
pages="e19161",
keywords="public health",
keywords="surveillance",
keywords="COVID-19",
keywords="knowledge",
keywords="behavior",
keywords="outbreak",
keywords="infectious disease",
keywords="health information",
abstract="Background: The early days of the coronavirus disease (COVID-19) pandemic in the United States brought uncertainty in the knowledge about COVID-19 and what to do about it. It is necessary to understand public knowledge and behaviors if we are to effectively address the pandemic. Objective: The aim of this study is to test the hypothesis that knowledge about COVID-19 influences participation in different behaviors including self-reports of purchasing more goods than usual, attending large gatherings, and using medical masks. Methods: This study was funded and approved by the Institutional Review Board on March 17, 2020. The cross-sectional online survey of 1034 US residents aged 18 years or older was conducted on March 17, 2020. Results: For every point increase in knowledge, the odds of participation in purchasing more goods (odds ratio [OR] 0.88, 95\% CI 0.81-0.95), attending large gatherings (OR 0.87, 95\% CI 0.81-0.93), and using medical masks (OR 0.56, 95\% CI 0.50-0.62) decreased by 12\%, 13\%, and 44\%, respectively. Gen X and millennial participants had 56\% and 76\% higher odds, respectively, of increased purchasing behavior compared to baby boomers. The results suggest that there is a politicization of response recommendations. Democrats had 30\% lower odds of attending large gatherings (OR 0.70, 95\% CI 0.50-0.97) and 48\% lower odds of using medical masks (OR 0.52, 95\% CI 0.34-0.78) compared to Republicans. Conclusions: This survey is one of the first attempts to study determinants of knowledge and behaviors in response to the COVID-19 pandemic in the United States. A national, coordinated effort toward a pandemic response may ensure better compliance with behavioral recommendations to address this public health emergency. ",
doi="10.2196/19161",
url="http://publichealth.jmir.org/2020/2/e19161/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32369759"
}


@Article{info:doi/10.2196/19145,
author="Basch, E. Charles
and Basch, H. Corey
and Hillyer, C. Grace
and Jaime, Christie",
title="The Role of YouTube and the Entertainment Industry in Saving Lives by Educating and Mobilizing the Public to Adopt Behaviors for Community Mitigation of COVID-19: Successive Sampling Design Study",
journal="JMIR Public Health Surveill",
year="2020",
month="Apr",
day="21",
volume="6",
number="2",
pages="e19145",
keywords="YouTube",
keywords="COVID-19",
keywords="social media",
keywords="pandemic",
keywords="outbreak",
keywords="infectious disease",
keywords="public health",
keywords="prevention",
abstract="Background: Effective community mitigation through voluntary behavior change is currently the best way to reduce mortality caused by coronavirus disease (COVID-19). This study builds on our prior study based on the scientific premise that YouTube is one of the most effective ways to communicate and mobilize the public in community mitigation to reduce exposure to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Objective: Because of the rapidly changing nature of YouTube in the context of the COVID-19 pandemic, we conducted a follow-up study to document how coverage of preventive behaviors for effective community mitigation has changed. Methods: A successive sampling design was used to compare coverage of behaviors to mitigate community transmission of COVID-19 in the 100 most widely viewed YouTube videos in January 2020 and March 2020. Results: Videos in the January and March samples were viewed >125 million times and >355 million times, respectively. Fewer than half of the videos in either sample covered any of the prevention behaviors recommended by the US Centers for Disease Control and Prevention, but many covered key prevention behaviors and were very widely viewed. There were no videos uploaded by entertainment television in the January sample, but this source comprised the majority of videos and garnered the majority of cumulative views in the March sample. Conclusions: This study demonstrates the incredible reach of YouTube and the potential value of partnership with the entertainment industry for communicating and mobilizing the public about community mitigation to reduce mortality from the COVID-19 viral pandemic. ",
doi="10.2196/19145",
url="http://publichealth.jmir.org/2020/2/e19145/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32297593"
}


@Article{info:doi/10.2196/15812,
author="Al-Abhar, Nabil
and Moghram, Saeed Ghuzlan
and Al-Gunaid, Abdulmalek Eshrak
and Al Serouri, Abdulwahed
and Khader, Yousef",
title="Occupational Exposure to Needle Stick Injuries and Hepatitis B Vaccination Coverage Among Clinical Laboratory Staff in Sana'a, Yemen: Cross-Sectional Study",
journal="JMIR Public Health Surveill",
year="2020",
month="Mar",
day="31",
volume="6",
number="1",
pages="e15812",
keywords="injury",
keywords="hepatitis B",
keywords="vaccination",
keywords="biosafety",
keywords="laboratory staff",
keywords="Yemen",
abstract="Background: Laboratory staff handling blood or biological samples are at risk for accidental injury or exposure to blood-borne pathogens. Hepatitis B virus (HBV) vaccinations for laboratory staff can minimize these risks. Objective: The aims of this study were to determine the prevalence of occupational exposure to needle stick injuries (NSIs) and assess HBV vaccination coverage among clinical laboratory staff in Sana'a, Yemen. Methods: A cross-sectional survey was conducted among clinical laboratory staff who were involved in handling and processing laboratory samples at the main public and private clinical laboratories in Sana'a. Data collection was done using a semistructured questionnaire. The questionnaire was divided into 3 parts. Part 1 included information on sociodemographic characteristics of participants. Part 2 included information on the availability of the personal protective equipment in the laboratories, such as lab coats and gloves. Part 3 included questions about the history of injury during work in the laboratory and the vaccination status for HBV. Results: A total of 219/362 (60\%) participants had been accidentally injured while working in the laboratory. Of those, 14.6\% (32/219) had been injured during the last 3 months preceding the data collection. Receiving the biosafety manual was significantly associated with lower risk of injury. Out of those who were injured, 54.8\% (120/219) had received first aid. About three-quarters of respondents reported that they had been vaccinated against HBV. The vaccination against HBV was significantly higher among laboratory staff who were working at private laboratories (P=.01), who had postgraduate degrees (P=.005), and who received the biosafety manual (P=.03). Conclusions: Occupational exposure to NSI is still a major problem among laboratory staff in public and private laboratories in Sana'a, Yemen. The high incidence of injuries among laboratory staff and the low rate of receiving first aid in laboratories combined with low vaccination coverage indicates that all laboratory staff are at risk of exposure to HBV. Therefore, strengthening supervision, legalizing HBV vaccinations for all laboratory staff, and optimizing laboratory practices regarding the management of sharps can minimize risks and prerequisites in Yemen. ",
doi="10.2196/15812",
url="http://publichealth.jmir.org/2020/1/e15812/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32229462"
}


@Article{info:doi/10.2196/17001,
author="Wang, Chaofan
and Sarsenbayeva, Zhanna
and Chen, Xiuge
and Dingler, Tilman
and Goncalves, Jorge
and Kostakos, Vassilis",
title="Accurate Measurement of Handwash Quality Using Sensor Armbands: Instrument Validation Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Mar",
day="26",
volume="8",
number="3",
pages="e17001",
keywords="hand hygiene",
keywords="wearable devices",
keywords="machine learning",
abstract="Background: Hand hygiene is a crucial and cost-effective method to prevent health care--associated infections, and in 2009, the World Health Organization (WHO) issued guidelines to encourage and standardize hand hygiene procedures. However, a common challenge in health care settings is low adherence, leading to low handwashing quality. Recent advances in machine learning and wearable sensing have made it possible to accurately measure handwashing quality for the purposes of training, feedback, or accreditation. Objective: We measured the accuracy of a sensor armband (Myo armband) in detecting the steps and duration of the WHO procedures for handwashing and handrubbing. Methods: We recruited 20 participants (10 females; mean age 26.5 years, SD 3.3). In a semistructured environment, we collected armband data (acceleration, gyroscope, orientation, and surface electromyography data) and video data from each participant during 15 handrub and 15 handwash sessions. We evaluated the detection accuracy for different armband placements, sensor configurations, user-dependent vs user-independent models, and the use of bootstrapping. Results: Using a single armband, the accuracy was 96\% (SD 0.01) for the user-dependent model and 82\% (SD 0.08) for the user-independent model. This increased when using two armbands to 97\% (SD 0.01) and 91\% (SD 0.04), respectively. Performance increased when the armband was placed on the forearm (user dependent: 97\%, SD 0.01; and user independent: 91\%, SD 0.04) and decreased when placed on the arm (user dependent: 96\%, SD 0.01; and user independent: 80\%, SD 0.06). In terms of bootstrapping, user-dependent models can achieve more than 80\% accuracy after six training sessions and 90\% with 16 sessions. Finally, we found that the combination of accelerometer and gyroscope minimizes power consumption and cost while maximizing performance. Conclusions: A sensor armband can be used to measure hand hygiene quality relatively accurately, in terms of both handwashing and handrubbing. The performance is acceptable using a single armband worn in the upper arm but can substantially improve by placing the armband on the forearm or by using two armbands. ",
doi="10.2196/17001",
url="http://mhealth.jmir.org/2020/3/e17001/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32213469"
}